PRIME May/June 2025 by IM-Aesthetics

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.

WELCOME TO THE MAY/JUNE ISSUE OF PRIME JOURNAL. IN THE 15 years I have been covering aesthetic medicine, the field has transformed from a niche focused on cosmetic touch-ups into a mainstream medical discipline embracing holistic anti-ageing and regenerative therapies. This evolution is evident everywhere in refined techniques, safer products, and a more inclusive patient base. As we look ahead, it’s inspiring to see a specialty once defined by simple ‘nip-and-tuck’ procedures now leading innovations that improve not just appearances but overall well-being.

The momentum of this progress comes to life at industry gatherings, and this issue places a spotlight on one in particular: FACE 2025. Taking place in London this June, FACE 2025 is the UK’s premier aesthetic medicine conference and a focal point for our community. In this issue, we preview how it will bring together experts to share insights on cutting-edge treatments. From breakthroughs in regenerative medicine to the newest anti-ageing techniques, FACE 2025 captures the current wave of innovation driving our specialty. The conference’s emphasis on scientific rigour and practical education mirrors the momentum propelling aesthetic medicine today.

Echoing the forward-looking spirit of FACE 2025, the rest of this issue explores key trends and players shaping the future of aesthetics. We profile Evolus, the industry’s first aesthetics-only ‘performance beauty’ brand. Its bold, millennial-focused approach to injectables prioritising accessibility, inclusivity, and brand experience exemplifies how our industry is adapting to a new generation of beauty consumers.

Affiliated partners:

International Journal of Aesthetic and Anti-Ageing Medicine

Informa Australia, Level 4/24 York St, Sydney, NSW, 2000, Australia ISSN 2159-8908 (print) ISSN 2159-8916 (online)

Editor Balraj Juttla balraj.juttla@informa.com

Art Director David ‘Spike’ McCormack

Digital Marketing Manager Slim Hakimi slim.hakimi@informa.com

Production & Ads Department balraj.juttla@informa.com

Please send your manuscripts and press releases to: balraj.juttla@informa.com All submitted

We also examine the surge in male aesthetics, as more men embrace treatments once considered taboo. This shift expands the conversation around beauty and prompts clinics to tailor services to a broader patient base.

Prejuvenation the proactive approach of treating younger patients early to delay ageing is another trend highlighting how patient expectations are shifting across generations. Finally, we examine emerging therapies poised to reshape the future of aesthetic medicine. From novel injectables and energy-based devices to regenerative medicine breakthroughs and even weight loss therapies, these innovations could redefine practice in the years to come.

Change in aesthetic medicine is accelerating, and I’m thrilled by the dynamic growth and innovation we’re witnessing.

Balraj Juttla

Editor, PRIME balraj.juttla@informa.com

www.fotona.com

Experience the Next Generation of Skin Rejuvenation

The HoneyComb® Lift protocol offers a novel approach to face and neck tightening, achieving optimal lifting effects while enhancing skin quality and appearance. This innovative treatment combines the Fotona SMOOTH® modality with the advanced T-Runner® scanner and proprietary HoneyComb® (HC6) optics for an exceptional, natural-looking anti-aging effect with minimal-to-no downtime.

May/June 2025

AESTHETIC FEATURES

7 Candela launches Vbeam Pro® Laser platform for vascular and dermatologic conditions

8 Powerful skincare partnership redefines aesthetic standards EVENT PREVIEW

10 FACE 2025: Highlighting the game-changers in regenerative and anti-ageing medicine

PRIME speaks to experts on the insights they will be sharing at the FACE Conference and Exhibition in London, UK, on June 26-27, 2025

COMPANY PROFILE

14 A new chapter for VYDENCE® Medical: 38 years of innovation in medical aesthetics

Combining powerful multi-platform systems with user-friendly innovation, VYDENCE® Medical is equipping practices worldwide with versatile, compact, and effective tools that deliver measurable results and profitability

18 The evolution of Evolus

This global player in aesthetics has been taking health, beauty, and wellness seriously since 1986

INDUSTRY INSIDER

24 Tariffs, layoffs, wars and uncertainty: Challenges for maintaining a thriving aesthetic business in a topsy-turvy market

Wendy Lewis gathers perspectives from global experts across dermatology, plastic surgery, business, and finance to uncover how aesthetic practices can weather today’s economic storms and emerge stronger

32 Shaping Modern Man:

The evolution of male aesthetic treatments

PRIME explores the latest trends in male aesthetics, as leading experts reveal what today’s male patients want and how clinics can meet their needs in 2025 and beyond

36 Prejuvenation: How Gen Z and Alpha are leading the way in early interventions

From AI-powered skin analysis to collagen-boosting neuromodulators, Diala Haykal, MD, examines the rise of prejuvenation and the responsibilities of physicians and brands in guiding this new generation of patients

40 Raising the standard in aesthetic competence

As filler use grows worldwide, the International Society for Aesthetic Competence (ISAC) is setting a new benchmark for global education, collaboration, and patient safety through the development of shared guidelines and competency frameworks

44 The SHÉ clinical aesthetics system:

A novel facial assessment and treatment approach

Explore a novel new approach to facial assessment and treatment that offers a multi-dimensional, personalised method for understanding and enhancing facial aesthetics

PRACTICE MANAGEMENT

50 Empowering new practitioners through connection and collaboration

Ashley Moores reflects on the vital role of support networks, mentorship, and community in helping new entrants navigate the dynamic world of aesthetics

PRIME PROMOTION

54 Minimally invasive skin rejuvenation using hyaluronic acid and amino acids

58 Broad-spectrum sunscreen for sensitive skin

62 Poly-D,L-lactic acid: a novel approach to reduce UV-induced skin pigmentation

66 Ensuring quality: The importance of lyophilisation for exosomal stability

EVENTS

70 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

CANDELA LAUNCHES VBEAM PRO® LASER PLATFORM FOR VASCULAR AND

DERMATOLOGIC CONDITIONS

NEW SYSTEM IS FDA-CLEARED FOR PAEDIATRIC USE AND OFFERS DUAL-WAVELENGTH CAPABILITIES

Candela Corporation, a global leader in energy-based medical aesthetics, announced the launch of the Vbeam Pro platform at the 2025 Annual Meeting of the American Society for Laser Medicine and Surgery (ASLMS), held in Orlando, FL. Representing the most significant advancement in Candela’s four-decades of clinical leadership in pulsed dye laser (PDL) technology, the Vbeam Pro device sets a new market standard for the treatment of vascular and dermatologic conditions.

The Vbeam Pro device is the only vascular laser FDA-cleared for use in pediatric patients and combines an advanced 595 nm pulsed dye laser with a 1064 nm Nd:YAG wavelength to

The Vbeam Pro device is the only vascular laser FDA-cleared for use in pediatric patients and combines an advanced 595 nm pulsed dye laser with a 1064 nm Nd:YAG wavelength to offer unmatched precision, accuracy, and treatment versatility.

offer unmatched precision, accuracy, and treatment versatility. The platform is designed to effectively treat a broad spectrum of skin conditions, including rosacea, port-wine stains, acne, leg veins, spider veins, scars, benign pigmented lesions, wrinkles, warts, stretch marks, and photoaging.

‘The Vbeam Pro system is a transformative evolution in pulsed dye laser technology,’ says Dr. Roy Geronemus, Clinical Professor in the Department of Dermatology at NYU Grossman School of Medicine and Medical Director of the Vascular Birthmarks Foundation. ‘The clinical results are remarkably consistent, and patients

are experiencing enhanced outcomes compared to earlier-generation systems,’ he adds.

With its dual wavelengths and 30% tighter energy delivery control, the Vbeam Pro laser offers a new level of efficacy and efficiency for clinicians treating patients across all Fitzpatrick skin types (I–VI).

The platform also features optimized dye life and an enhanced user interface, delivering a superior treatment experience for both practitioners and patients.

Backed by rigorous clinical research, the Vbeam Pro laser has demonstrated: 20% improved clearance of treated lesions¹

50% faster treatment times² 20% reduction in reported patient discomfort³

‘Reinforcing Candela’s commitment to scientific rigour, the Vbeam Pro system underwent extensive clinical evaluation at leading dermatology practices across the United States,’ says Konika Patel Schallen, MD, Senior Vice President of Clinical Operations and Medical Director at Candela. ‘We put the platform through stringent testing, using it in busy clinical environments on a wide variety of skin types and conditions. We are excited about the feedback from our dermatology users on enhancing patient outcomes and treatment efficiency.’ she concludes.

‘Building on Candela’s longstanding clinical leadership, the introduction of the Vbeam Pro system represents a major leap forward in the treatment of vascular and other skin conditions,’ said Geoffrey Crouse, Chief Executive Officer of Candela. ‘This milestone launch reflects our unwavering commitment to continuous innovation, rooted in proven science, consistent clinical outcomes, and trusted partnerships with both healthcare providers and patients.’

For more information, please visit: candelamedical.com

1 Compared to Vbeam Perfecta; Vbeam 595 nm output Accuracy and Precision data on file

2 Supported by early LCR participant treatment feedback

3 Data from LCR sites relative to Perfecta

4 Based on patient reports from LCR sites relative to prior Vbeam systems

POWERFUL SKINCARE PARTNERSHIP REDEFINES AESTHETIC STANDARDS

SKINCEUTICALS AND LASERAWAY JOIN CLINICAL SKINCARE FORCES

SkinCeuticals, recognized as the leading medical skincare brand in the U.S., has established a national partnership with LaserAway, a prominent provider of aesthetic dermatological services. This collaboration integrates scientifically-backed skincare with in-clinic treatments, aiming to enhance treatment outcomes and patient satisfaction.

As part of this partnership, SkinCeuticals’ C E Ferulic serum will be applied after treatments at LaserAway’s 174 locations throughout the United States. Patients will also have access to a selection of SkinCeuticals retail products and exclusive skincare bundles to support their treatment regimens and maintain results between visits.

Both SkinCeuticals and LaserAway emphasize high-performance skincare, medical integrity, and consumer trust. LaserAway specializes in noninvasive cosmetic procedures conducted by licensed healthcare professionals, including board-certified dermatologists, registered nurses, nurse practitioners, and physician assistants. SkinCeuticals, founded in 1997, has been dedicated to formulating dermatology-grade skincare solutions based on peer-reviewed research for over two decades.

'With LaserAway's commitment to providing top-tier aesthetic treatments and SkinCeuticals' dedication to clinically proven skincare, this union is a natural fit,' said Christian Bouchard, President of Medical Aesthetic Skincare, North America at L'Oreal USA. 'Together, we're redefining the way patients experience post-laser care, offering a science-backed approach to achieving optimal skin health.'

'The synergy between these two brands isn't just about convenience it's about transformation,' said Scott Heckmann, CEO at LaserAway. 'The two brands are redefining what it means to invest in skin health. This merger marks a new era in aesthetics, where clinical precision meets daily skincare, giving patients the best of both worlds.'

The partnership is grounded in the belief that clinical procedures and at-home skincare should work in conjunction for long-term improvements in skin quality,

texture, tone, and overall appearance. This philosophy resonates with contemporary beauty consumers, who are increasingly seeking a medically informed approach to skin health.

The collaboration also offers a distribution advantage, as LaserAway’s extensive network provides a clinical setting without competing skincare brands. SkinCeuticals can utilize this partnership to engage directly with aesthetic patients seeking high-quality post-procedure care.

Both brands cater to consumers who value performance-driven products and services, often seeking cosmetic treatments like laser rejuvenation, injectables, and skin tightening. This partnership positions them as a comprehensive resource for aesthetic services, blending in-office treatments with daily skin maintenance.

Patients are able to receive customized skincare plans that align with their LaserAway treatment protocols, including guidance on pre-treatment and post-treatment care using products designed to support healing and optimize treatment results. SkinCeuticals’ C E Ferulic, known for its antioxidant properties, complements laser and light-based treatments by improving skin firmness and reducing fine lines.

Patients interested in services can visit laseraway.com for treatment options and skinceuticals.com for information on participating locations. This partnership emerges at a time when more patients are inclined to merge medical aesthetic treatments with tailored professional skincare regimens.

This collaboration arrives at a pivotal time in the industry as more patients look to combine their medical aesthetic treatments with professional skincare routines tailored to their specific goals. It’s a holistic shift in how skincare is practiced—and sold in a clinical setting.

The synergy between these two brands isn’t just about convenience—it’s about transformation.

— Scott Heckmann, CEO of LaserAway

As both companies continue expanding, the partnership reflects a broader movement within aesthetics toward sciencebased care, cross-disciplinary partnerships, and outcomedriven solutions. The future of aesthetic skincare lies not just in lasers or serums alone—but in how the two can work together to deliver radiant, resilient, and healthy skin.

CLEARING AGED CELLS BOOSTS IMMUNITY

Immorta Bio Inc, a longevity-focused biotech company, has announced promising new results from preclinical experiments tied to its latest patent filing (#63/789,097), titled 'Augmentation of Natural Killer Cell Number and Activity by Senolytic Therapies.' The data show that reducing the number of senescent (aged) cells leads to a significant increase in both the quantity and activity of natural killer (NK) cells, a crucial component of the immune system known for combating cancer and viral infections.

The company's proprietary SenoVax™ immunotherapy, currently in development for lung cancer, previously demonstrated its ability to reduce senescent cells, enhance the effects of checkpoint inhibitors and chemotherapy, and stimulate stem cell regeneration. The new findings suggest SenoVax may also 'teach' NK cells to target tumour — an effect transferable to other organisms.

'Reducing senescent cell burden enhances NK cells, which may lower cancer and viral infection risks,' said Thomas Ichim, PhD, President and CSO of Immorta Bio. Their studies found that therapies like dasatinib plus quercetin, as well as SenoVax, significantly increased NK cell function in animal models.

Crucially, NK cells from treated animals, when transferred to untreated ones, led to tumour eradication. The findings support a dual role for SenoVax: as a standalone treatment and as an adjuvant that boosts response to existing therapies.

'SenoVax is a natural way of amplifying the body’s existing power to fight cancer,' said Dr. Boris Reznik, CEO and Chairman of Immorta Bio. 'By removing the ‘senescent shield,’ we expose the cancer, allowing the immune system to act more effectively.'

Immorta Bio continues to explore SenoVax's broad therapeutic potential.

FACE 2025 HIGHLIGHTING THE GAME-CHANGERS IN REGENERATIVE AND ANTI-AGEING MEDICINE

PRIME speaks to experts on the insights they will be sharing at the FACE Conference and Exhibition in London, UK on June 26-27, 2025

THE 2025 FACIAL AESTHETIC Conference and Exhibition (FACE) may be taking place in the UK, but this year’s focus on the science of regenerative and anti-ageing medicine is top of mind for aesthetic providers worldwide.

Held between June 26 and 27 in London, this year’s FACE is bringing together thought leaders, scientists and clinicians from around the world with expertise in regenerative and

anti-ageing treatments. PRIME highlights what some experts believe are the biggest gamechangers in aesthetic regenerative and longevity medicine.

‘The biggest trends within the medical aesthetic space right now are regenerative medicine/biostimulatory agents, personalised treatments, and maintaining a natural appearance. Technology is rapidly evolving, so the market will continue to be flooded by innovation, each claiming to be the newest and greatest laser/energy-based devices, botulinum

toxins, fillers, stem cells, and compounds like exosomes, polynucleotides, and countless others that claim to work on longevity and health span,’ says FACE speaker Vivian Bucay, MD, FAAD, of the Bucay Center for Dermatology and Aesthetics in San Antonio, Texas, USA.

Dermatologists, plastic surgeons, cosmetic physicians, nurse practitioners, and other aesthetic providers are being exposed to evolving technologies aimed at improving health, inside and out. To make that journey a little easier, we asked some who have devoted

themselves to longevity and regenerative medicine game-changers.

Harnessing Mitochondria as an indicator for skin health

Mark Birch-Machin, PhD, professor of molecular dermatology at Newcastle University, pioneered the use of mitochondria as a skin health biomarker in the mid-1990s and has been focused since on making use of the biomarker widely accessible with a non-invasive skin swab.

Today, the founder and Chief Scientific Officer of Skin Life Analytics and 2023 recipient of the prestigious Society of Cosmetic Scientists Lifetime Achievement Award, says his work focused on human skin’s response to the environment in the context of skin ageing and disease has come full circle. Now, it’s easy for aesthetic practices and patients alike to better understand the power they have over skin ageing and the delivery of personalised skin health strategies.

Skin Life Analytics, a Newcastle University spinoff, just launched the world’s first skin swab test measuring the health of the batteries of cells, namely mitochondria.

‘The single biggest game-changer for healthier skin and to help it thrive in 2025 is the dynamic monitoring of the powerhouse of mitochondria within our skin. This groundbreaking science, using mitochondria as a unique skin health biomarker, empowers everyone to test and track their skin’s inner molecular health and bioenergy, thereby making the invisible damage visible,’ says Professor Birch Marchin, who is lecturing during the FACE conference ‘Advances in Regenerative Aesthetics’ session on ‘Novel biomarkers of skin health and how they can be used to monitor skin interventions and treatments.’ He is also presenting a talk entitled ‘Skin swab mitochondrial DNA test’ during the ‘Science of Regeneration and Longevity’ session.

Environmental factors, including UV light exposure, pollution, and smoking; lifestyle factors, including sleep, diet, and exercise; as well as biological factors, such as age and genetics, are primary interacting factors responsible for skin appearance changes.

‘Understanding how these different factors affect our skin’s health and what can be done to prevent them can promote and prolong overall skin health and help to counter the skin ageing phenotype,’ according to a paper Professor Birch-Machin recently coauthored in PMFA Journal1. ‘Measuring mitochondrial damage in skin serves as a highly sensitive and reliable biomarker of skin health. Following exposure to different external and internal stressors, this

The biggest trends within the medical aesthetic space right now are regenerative medicine/biostimulatory agents, personalised treatments, and maintaining a natural appearance.

Vivian Bucay, MD

technology can lead to a more customised skin health approach to the individual, including smart targeting of skin interventions.’

The more people understand the skin ageing potential of these stressors, the more empowered they are to follow, implement, and track the success of healthy skin ageing strategies, he says.

The power of bio-rejuvenation

Professor Syed Haq, MBBS, BSc, PhD, DIC, MRCP(UK), consultant physician and founder of AM Aesthetic in London and Belfast, says, ‘In a nutshell, the most important change in aesthetic cosmetic medicine in recent years that will no doubt evolve over the next decade or more will be in the area of bio-rejuvenation. When we talk about bio-rejuvenation, those are elements, proteins, growth factors, hybrids— whatever they may be, that have an intrinsic impact on the health of the cell. That will transmit into the way a person looks and feels.’

Leading bio-rejuvenators in Europe and Asia

are called polynucleotides, which are short DNA fragments, according to Dr Haq, who presented at the conference during the ‘Science of Regeneration and Longevity’ sessions, with an overview on longevity.

‘[Bio-rejuvenators] are derived from a natural source--either from the spermatozoa (sperm) of farm trout or wild salmon. I launched both in the UK years ago, but now I’m a much bigger advocate of the trout version,’ Dr Haq says.

Dr Haq notes that in his experience, the sperm-based derivative of salmon resulted in more allergic issues.

‘Trout has a much more unblemished impact on patients, and it is so versatile. We use it for improving skin laxity, collagen, and elastin production. We use it in the face, the under-eye area a particularly delicate area of the face to treat. We use it to treat scars and for other skin conditions—acne, rosacea, redness. You can use it in the face, the neck, the backs of the hands, areas of stress and strife including around the tummy,’ he says.

VIVIAN BUCAY, MD, FAAD , Bucay Center for Dermatology and Aesthetics in San Antonio, Texas, USA

JEANINE B. DOWNIE, MD, FAAD, director of image Dermatology, in Montclair, NJ, USA

MARK BIRCH-MACHIN, P h D, professor of molecular dermatology at Newcastle University, UK

NICHOLA CONLON, P h D, molecular biologist and founder of Nuchido, Newcastle, UK

SYED HAQ, MBBS, BS c, P h D, DIC, MRCP(UK), consultant physician and founder of AM Aesthetic in London and Belfast, UK

GORDAN LAUC, P h D, professor, director of the National Centre of Scientific Excellence in Personalized Healthcare and Genos Glycoscience Research Laboratory, Zagreb, Croatia

Dr Haq uses the bio-rejuvenator as a standalone treatment or in conjunction with other types of aesthetic treatment.

‘I advocate for early preemptive use. You can prime the skin and what happens thereafter is if you were to conduct treatment with botulinum toxin, dermal filler, chemical peel or even surgery, the outcome will be noticeably better,’ he says.

The injectable comes in a 2 mL syringe, which when injected intradermally targets the fibroblasts directly.

‘The polynucleotide binds to cell surface receptors on the fibroblast, which [results] in various triggers that bring about some of the things that I just mentioned, including increased cellular migration. All of this is important for rejuvenating the skin,’ Dr Haq adds. ‘I use it in patients with young scars and even scars as old as three or four decades. And it still works well.’

Croma-Pharma’s Polyphil is a popular brand available in Europe, but these products are not available in the US.

Hand-held, portable laser niche

One of today’s biggest game-changers in antiageing medicine is the hand-held portable MultiFrax laser, according to Jeanine B. Downie, MD, FAAD, director of image Dermatology, in Montclair, NJ, USA.

A novel concept in the aesthetic laser space, MultiFrax (Powered by MRP, Park City, Utah, USA) simultaneously delivers 1550nm/1927nm non-ablative and thulium laser wavelengths, offering the capabilities of traditional lasers in a sleek, portable, and cordless design.

This compact technology has been available in Europe and Asia since 2020, according to Dr Downie.

MultiFrax treatment is good for all skin types and has less downtime than after treatment with traditional laser devices. According to Dr Downie, downtime with MultiFrax treatment is about four to five days as opposed to over a week with similar laser treatments because users can increase and decrease the spot size, as well as increase and decrease the density.

And there’s no sacrifice in power, Dr Downie adds. The power of the device is equivalent to non-ablative and thulium lasers, and the MultiFrax tip has two million pulses, which can treat 40 to 80 patients, depending on the size of the area that you are treating.

‘MultiFrax with novel SimulScan technology powers the only device on the market delivering two fractionated wavelengths simultaneously. Two wavelengths hitting the skin surface simultaneously allows for better heat penetration, generating unparalleled results for your patients,’ she says.

MultiFrax is the first portable SimulScan 1550 nm/1927 nm laser, according to company press materials.

Treatment with the technology’s 1550 nm non-ablative resurfacing laser corrects textural irregularities, from wrinkles to acne scars, while the 1927 nm thulium laser treats sun damage to dyschromia and melasma.

‘It is a game-changer because the 1550 nm and the 1927 nm work independently or simultaneously to address a wide range of skin texture and pigment concerns. And the fact that it is hand-held--about the size of a cell phone--is also a game-changer,’ notes Dr Downie, who is presenting on hormonal health, aesthetic treatment of the perioral area and lips, as well as skin of colour during the FACE conference.

NAD+ clinically proven to reverse biological age

Nichola Conlon, PhD, a molecular biologist specialising in the study of cellular ageing and founder of Nuchido, is presenting during the FACE meeting’s ‘Science of Regeneration and Longevity’ session on what she believes is today’s biggest breakthrough in anti-ageing: a specially formulated version of NAD+.

‘One of the most significant advancements in anti-ageing and regenerative medicine in 2025 is the focus on restoring nicotinamide adenine dinucleotide (NAD+) a vital coenzyme that declines with age, leading to reduced cellular function, skin ageing, and overall fatigue,’ according to Dr Conlon. ‘NAD+ is essential for DNA repair, energy production, and activating longevity-related proteins that regulate our cellular health.’

As a molecular biologist specialising in healthy ageing, Dr ConIon says she has been fortunate to be at the forefront of this research and as the founder of Nuchido, she has dedicated her career to translating cutting-edge longevity science into accessible, effective solutions at home.

‘Recognising the limitations of traditional

NAD+ supplements, Nuchido TIME+ is a scientifically formulated supplement developed not only to replenish NAD+ levels but also to enhance the body’s ability to produce it naturally,’ she adds.

A clinical study published last year in npj Aging2 demonstrated that after 28 days of supplementation, participants experienced a significant rise in NAD+ levels, a reduction in pro-inflammatory markers, and an average decrease in biological age by 1.26 years.

These findings highlight the crucial role of NAD+ in slowing the ageing process at a cellular level, Dr Conlon reasons.

‘For aesthetic practitioners, integrating Nuchido TIME+ into treatment plans offers a science-backed approach to skin rejuvenation and cellular repair. By supporting collagen production, reducing inflammation, and improving overall cellular function, it provides patients with a powerful inside-out solution for healthier, more youthful skin and supports their overall wellbeing,’ she says.

Glycans: ageing’s master regulators

‘Glycans, master regulators of ageing, immunity, and inflammation, are among the most precise biomarkers of biological age. Though studied for over 30 years, we are only beginning to unlock their full potential, with 2025 marking a pivotal moment in harnessing glycans for regenerative medicine and longevity science,’ says Gordan Lauc, PhD, professor, director of the National Centre of Scientific Excellence in Personalized Healthcare and Genos Glycoscience Research Laboratory, Zagreb, Croatia.

Glycans are generated by modifying proteins with chemical structures that integrate genetic, epigenetic, and environmental information. Hundreds of genes are involved in the complex pathway of glycan biosynthesis, and glycome composition is notably heritable.

Alternative glycosylation, which refers to the attachment of different glycans to the same glycosylation site on a protein, modulates protein function. As a result, it participates in the transition from health to disease, according to Dr Lauc.

Dr Lauc and his team have analysed more than 200,000 individuals and demonstrated that glycans have significant biomarker potential in the personalisation of

One of the most significant advancements in anti-ageing and regenerative medicine in 2025 is the focus on restoring nicotinamide adenine dinucleotide (NAD+) a vital coenzyme that declines with age, leading to reduced cellular function, skin ageing, and overall fatigue.

Nichola

Conlon,

PhD

pharmacological and lifestyle interventions to promote health and decrease the risk of disease development. The research led to him developing the GlycanAge test, which is used to gauge health, wellness, and longevity, as well as optimise therapy through menopause.

Dr Lauc is presenting ‘Glycans A Breakthrough in Personalised Health and Ageing Biomarkers’ at the FACE conference.

Harnessing what’s tried and true

After deliberating about the biggest gamechangers in regenerative and anti-ageing medicine, Dr Bucay says that one stands out: Sculptra (Galderma Laboratories, Zug, Switzerland), for its biostimulatory effects across all ages and ethnicities, ‘especially as we learn more and more about how it affects a variety of cell types in the skin,’ says Dr Bucay, who will present at the FACE conference on ‘Advances in Regenerative Aesthetics’.

Sculptra, which is also referred to as poly-Llactic acid (PLLA), affects more than just the fibroblasts (collagen and elastin-producing cells). PLLA also exerts positive effects on dermal macrophages, which promotes a shift from older to more youthful macrophages that stimulate collagen production. And dermal white adipocytes that promote wound healing and skin immunity create a more favourable, or youthful, environment for fibroblasts to do their work, according to Dr Bucay.

Exciting times for living better for longer

Longevity medicine is only beginning to find its footing.

Longevity specialists meeting at a research institute in California last year gathered with the goal of being recognised as a credible medical field, according to an article in the MIT Technology Review3 .

Participants talked about how modern medicine has for far too long focused on treating disease rather than preventing it and expressed their belief that it’s time to move from reactive healthcare to proactive healthcare.

By setting standards and guidelines for best practice in the field, this indeed could be the beginning of a revolution in medicine, the author writes.

'The emerging field of longevity medicine represents a rapidly evolving multidisciplinary healthcare domain. It is dedicated to

comprehending and extending the span of a healthy human life a concept known as "healthspan"– rather than simply extending life in general…,' researchers report in a recent review article in Frontiers in Aging4. 'The rapid advancements in this field, coupled with growing global interest in ageing, present an exciting, yet challenging, frontier in healthcare, necessitating a balanced approach that considers both individual wellbeing and broader societal implications.'

For more, visit: www.faceconference.com

Written by Lisette Hilton, contributing editor

References

1. Sotia Iosifidou and Prof. Mark Birch-Machin. The impact of 21st Century stressors and lifestyle factors on skin ageing. Edinburgh: PMFA Journal, Febraury 2025. Available at: www.thepmfajournal.com/features/features/ post/the-impact-of-21st-century-stressors-and-lifestyle-factors-on-skinageing

2. Henderson, J.D., Quigley, S.N.Z., Chachra, S.S. et al. The use of a systems approach to increase NAD+ in human participants. npj Aging 10, 7 (2024). https://doi.org/10.1038/s41514-023-00134-0

3. Hamzelou J. The quest to legitimise longevity medicine. MIT Technology Review. March 2024. Available from: https://www.technologyreview. com/2024/03/18/1089888/the-quest-to-legitimize-longevity-medicine/

4. Artinovi A, Mantovani M , Trpchevska N, et al. Climbing the longevity pyramid: overview of evidence-driven healthcare prevention strategies for human longevity. Frontiers in Aging 2024, 5: https://doi.org/10.3389/ fragi.2024.1495029

A NEW CHAPTER FOR VYDENCE® MEDICAL 38 YEARS OF INNOVATION IN MEDICAL AESTHETICS

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

VYDENCE® MEDICAL IS BASED IN SÃO CARLOS, BRAZIL, AND HAS expanded its presence globally to be present in over 30 countries. The recent acquisition of VYDENCE® Medical by the MedSystems Group marks a strategic milestone for the company. Their goal is to shape the future of innovation in medical-aesthetic technology.

According to Denis Régis, ‘I am honoured to step into the role of CEO at MedSystems Group during this transformative time in our history of more than 38 years. The acquisition of VYDENCE® by the MedSystems Group marks an important milestone in medical-aesthetic technology around the world.’

‘Backed by the strength of the MedSystems ecosystem, we are now poised to accelerate our innovation roadmap, expand our global footprint, and deliver even more value to our customers, partners, and teams,’ he says.

Currently, the company is active in six key markets: Latin America, Europe, the Middle East, Africa, Asia, and, most recently, North America. Under the new management team, they are considering their next opportunities in major markets.

The Brazilian heritage

VYDENCE® Medical is based in São Carlos, Brazil, and has expanded its presence globally. The company is currently present in over 30 markets, including headquarters in Brazil and the United States. This international expansion underscores VYDENCE®’s commitment to delivering advanced laser technologies across diverse markets.

VYDENCE® has earned its place as a leader in the development and manufacturing of high-performance medical devices in key markets. Their Etherea MX platform is sold in more than 30 countries worldwide to date.

Antônio Olivatto is the Executive Vice President Global at VYDENCE® Medical and is leading the next chapter in the company’s evolution with the MedSystems Group. ‘We pride ourselves on taking care of our partners and will find efficacy, versatility, and

ZYE ALX®

profitability to enhance their practices and achieve their bottom line. We aim to foster aesthetic excellence for all our clients and partners.’

Their handPICO® is the world’s first picosecond laser handpiece, merging platform versatility with revolutionary picosecond laser technology. Renowned globally as a leader in skin rejuvenation, handPICO® also excels in tattoo and pigmented lesion removal as well as pico toning, offering safe and effective treatments for all skin types, year-round. The new FDA-approved fractional micro-lens array will be introduced to enhance the treatment of melasma and resurfacing.

Backed by the strength of the MedSystems ecosystem, we are now poised to accelerate our innovation roadmap, expand our global footprint, and deliver even more value to our customers, partners, and teams.

– Denis Régis, CEO, MedSystems Group

With years of experience in aesthetic dermatology, Dr. Valéria Campos has seen firsthand how VYDENCE® technology transforms patient care. ‘As a medical professional, I’ve noticed a clear improvement in patient comfort and satisfaction. We achieve better results with less pain and reduced recovery time, which makes a significant difference in our clinical practice. I’ve been using this technology for a while now, and I can confidently say it stands out for its versatility and safety, offering real benefits to my patients. Without a doubt, this is a technology that’s here to stay. I highly recommend it to fellow physicians looking for innovation paired with consistent outcomes.’

Their core systems include:

■ ETHEREA-MX®

■ ZYE ALX®

■ ZYE YAG®

■ Siberian-FIT®

■ 8 handPieces + 4 fibers.

João Faria is VP Global Sales for VYDENCE® Medical.

‘With a robust presence in over 30 countries and a reputation for excellence in laser-based technologies for both aesthetic and therapeutic indications, VYDENCE® is now better positioned to double our revenue in the near term by combining commercial agility with cuttingedge innovation and local excellence. We have a footprint in key global markets, including Europe, the United States and Latin America, to ensure that every customer receives the gold standard in service and support.’

‘Our top priority is to increase VYDENCE®'s presence and strengthen our technical service infrastructure in each market. We remain deeply committed to continuous medical education, supporting physicians and clinics with world-class training and scientific programming that elevates outcomes. Backed by MedSystems’ ecosystem, we will continue to design new laser

technologies, setting the pace for what’s next in medicalaesthetic and therapeutic solutions.’

Dermatologist Ariel Haus in London has been working with Vydence and their team since 2024. ‘The company is well known in Brazil, which is a highly competitive aesthetic market. We specialise in laser technology in our London practice on Harley Street and have been able to get excellent results with these devices for acne, acne scars, melasma, PIH, rosacea, tightening, laxity, and sagging. The benefits of speed and efficiency in our busy international practice have been exceptional, and our doctors and nurses can treat our diverse patients who come from all over the world.’

DENIS RÉGIS, CEO, MedSystems Group

ETHEREA-MX®

handPICO®

ProDeep® DualMode®

VYDENCE® features a wide range of handpieces that can expand the versatility and effectiveness of their systems. These unique developments underscore their commitment to advancing laser technology and enhancing aesthetic treatments for their clients.

BAB

VYDENCE® Medical Milestones

Joel L. Cohen, MD, FAAD, FACMS, Director of AboutSkin Dermatology and Aesthetics in Denver, Colorado, was one of the first practices in the U.S. to use the handPICO noting that the handPICO integrates seamlessly with VYDENCE® Medical’s Zye and ETHEREA-MX laser platforms. ‘The handPICO’s ability to add onto these platforms makes it very easy to incorporate into a practice, with their wide range of handpieces offering efficiency, affordability, and, of course, efficacy. The VYDENCE® handpieces facilitate rapid transitions and start-ups (without prolonged calibration delays), including the most frequently used handpieces in our office, handPICO and ProDeep.’

‘The handPICO’s also has a new fractional pico technology called the microlens array 6mm which is a non-ablative fractional but at the same time generates a photoacoustic effect causing cavitation and intradermal vacuoles (laser-induced optical breakdown or LIOBs) beneficial because it doesn’t cause significant thermal or surface damage and is safe for all skin types. The

Figure 1 Before and after treatment for acne scars using the ETHEREA-MX®. Photos courtesy of Valéria Campos, MD

Figure 2 Before and after fractional skin resurfacing treatment using the ZYE ALX® and ZYE YAG®. Photos courtesy of Isabelle Wu, MD

JOÃO FARIA, VP Global Sales, VYDENCE® Medical

ZYE YAG®

handPICO allows me to address a broad spectrum of pigment issues, from low contrast lentigines to darker lesions. The ProDeep is great for scars, acne scars, areas of acne flares, as well as hidradenitis, plus now hair restoration settings,’ says Cohen.

Dermatologist Michael Gold, Founder of the Gold Skin Care Center in Nashville, Tennessee, has been using VYDENCE®’s handPICO technology in his practice. ‘We have found this system to be effective in treating scars and active acne. Our nurses offer this treatment to patients in a series of 4 to 6 treatments. The system is easy to delegate and affordable, plus it is compact to keep in a treatment room. Most importantly, patients seem to like their results.’

Dermatologist Stephen Eubanks in Port Orange, Colorado, uses both an EthereaMX and a ZYE. ‘I have the IPL-sq, ProDeep, DualMode, LongPulse and handPICO applicators. This is the best multi-platform device on the market today. The ProDeep, Nd:YAP (perovskite), 1340 nm non-ablative is unique in the U.S. When used alone, the ProDeep has been superb for treating both active acne and acne scarring. I use several applicators by layering them. I use the IPL-sq first, the collimated handPICO, followed by fractional pico, the ProDeep and DualMode to complete an amazing resurfacing procedure. He continues, ‘I particularly like to layer these applicators since I can treat each with

lower power, having a safer treatment but with overall better results. Finally, each of the VYDENCE® lasers stands up to or even exceeds most single lasers. Most practices are short of space and these devices are just the best.’

Innovations driving profitability

‘We pride ourselves on taking great care of our partners and will find efficacy, versatility, and profitability to enhance their practices and achieve their bottom line. We are committed to driving aesthetic excellence and profits for all our partners,’ says Régis.

‘Backed by the strength of the MedSystems ecosystem, we are poised to accelerate our innovation roadmap, expand our global footprint, and deliver even more value to our customers, partners, and teams. VYDENCE® is on the move to grow our global presence. We will continue to operate with our unique brand and dedicated leadership to fuel the technological breakthroughs and product excellence that have defined our legacy for over three decades.’

For more information, visit www.vydence.com / Instagram: Vydenceworld / Facebook: Vydence World

Figure 3 Before and after treatment for pigmented lesions using the ETHEREA-MX®. Photos courtesy of Maisa Pamponet, MD

Figure 4 Before and after treatment for vascular lesions using the ETHEREA-MX®. Photos courtesy of Charles Esteves, MD

ANTÔNIO OLIVATTO, Executive Vice President Global, VYDENCE® Medical

THE EVOLUTION OF EVOLUS

Performance Beauty leader Evolus is shaking up the aesthetics industry with a millennial-focused approach, international expansion, and groundbreaking innovations

EVOLUS IS ON A ROLL. THE FIRST-EVER aesthetics-only performance beauty company is changing the narrative on how injectables are seen and requested by the next generation of beauty consumers.

As of 2024, the company recorded the 5th year of revenue growth above 30%, making it one of the fastest-growing companies in the medical aesthetics sector1. David Moatazedi, the company’s President and CEO, credits this achievement to the company’s strategic focus on a key demographic: millennials.

The company estimates its total net revenues for 2025 to be between $345 million and $355 million1

The origin of Evolus centres around the concept of ‘evolve with us’. The go-to-market strategy of Evolus is

and has always been unapologetically millennial. Born between 1981 and 1996, millennials are now aged between 29 and 44. They represent the largest demographic seeking aesthetic treatments and are an industry growth driver2. By appealing to this younger audience, Evolus saw a significant opportunity to differentiate themselves.

Millennials, also known as Generation Y or Gen Y, are now the largest generation in the workforce and, therefore, a critical market segment for many industries, including aesthetics. This power demographic significantly altered the technology landscape by pioneering the widespread use of social media, online shopping, and mobile devices.

They are now altering the aesthetics sector. Unlike older generations, who may be more hesitant, younger

WENDY LEWIS is founder/ President of Wendy Lewis & Co Ltd, Global Aesthetics Consultancy since 1997, and author of 13 books.

individuals are increasingly embracing aesthetic treatments as a routine part of beauty and self-care rather than a medical procedure2. Research from the American Society of Plastic Surgeons3 reveals that millennials are twice as likely as their parents to undergo cosmetic procedures. This growing acceptance is influenced by evolving beauty standards, the rise of social media, and the visibility of enhancements among influencers and celebrities.

‘Our branding and marketing strategies are crafted to align with the vibrant energy and values of the younger generation, focusing on empowerment and inclusivity,’ said Tomoko Yamagishi-Dressler, Evolus Chief Marketing Officer (CMO).

Evolus is committed to reflecting today’s society. ‘We showcase a diverse range of models representing different ages, skin tone, and personal expression including tattoos, piercings, and unique styles. This helps us define beauty in a more inclusive way. In our campaigns, our models are not just posing they’re in motion, expressing themselves, and embracing their individuality,' she adds.

A Performance Beauty pioneer

Evolus is redefining the medical aesthetics landscape by merging the precision of science with the appeal of modern beauty branding.

Positioned as a Performance Beauty leader, the company has a strong commitment to safety, efficacy, and innovation with a fresh, engaging vibe that breaks away from the traditional pharmaceutical mold. Evolus takes a tech-forward, millennial-focused approach with a strong emphasis on authenticity to reshape how consumers interact with aesthetic treatments.

At the heart of the Evolus strategy is a dedication to inclusivity, accessibility, and empowerment. The brand’s commitment to a modern, consumer-friendly experience makes aesthetic treatments feel more like self-care than medical procedures, a shift largely driven by millennial and Gen Z preferences. By combining scientific credibility with a bold, playful brand identity, Evolus is poised at the intersection between beauty, wellness and medical aesthetics, evolving the future of the industry.

Our branding and marketing strategies are crafted to align with the vibrant energy and values of the younger generation, focusing on empowerment and inclusivity.

This difference resonates

According to Dr. Natasha Berridge, consultant oral, maxillofacial and aesthetic surgeon in London, 'Working with Evolus, a company that emphasizes both performance and beauty, has been a truly enriching experience. It’s so refreshing to see a company that values and strives to meet the millennial patients’ expectations for individuality and innovation,' Natasha concludes.

Expanding internationally

Evolus continues to expand geographically, with recent launches in Australia, Spain, and Ireland. Due to their rapid expansion, Evolus will open an international headquarters in Milan, Italy. According to the company, Milan is a perfect fit for Evolus as a Performance

DR. NATASHA BERRIDGE, Consultant Maxillofacial & Facial Plastic Surgeon, London, UK

TOMOKO YAMAGISHIDRESSLER, Evolus Chief Marketing Officer (CMO)

Beauty company, and the site will house operations, including marketing, medical education, training, digital and customer services.

'We are excited about these milestones as they support our goal of establishing a strong presence in key regions

These milestones strengthen our leadership in performance beauty and represent the next evolution in our longterm strategy to expand our portfolio and become a multi-product innovator.

and fueling growth,' said Umberto La Magna, Senior Vice President, Evolus International. 'We know that beauty is changing and that our healthcare professional customers are looking to evolve too. We are planning a range of educational programs and an easy-to-use online service platform to help healthcare professionals evolve their practices and deliver patient satisfaction.'

An evolving portfolio

Evolus is set to become one of a small group of companies with a portfolio of neurotoxins and injectable hyaluronic acid (HA) gels. Evolus recently secured U.S. FDA approval for Evolysse Form® and Evolysse Smooth® injectable hyaluronic acid (HA) gels, which are the first two products in the Evolysse® collection4. The company has also received approval for Estyme® injectable HA gels in the European Union, with a full launch expected in the second half of 20255

‘These milestones strengthen our leadership in performance beauty and represent the next evolution in our long-term strategy to expand our portfolio and become a multi-product innovator,’ concludes David Moatazedi, President and Chief Executive Officer of Evolus.

We can look forward to even more innovation and evolution from Evolus coming soon. Watch this space.

This company feature was funded by Evolus

References

1. Evolus. Evolus Reports Record Fourth Quarter and Full-Year 2024 Financial Results; Reaffirms 2025 Guidance. March 2025. Available at: https://investors.evolus.com/ press-releases-and-news/newsdetails/2025/Evolus-Reports-RecordFourth-Quarter-and-Full-Year-2024Financial-Results-Reaffirms-2025-Guidance/ default.aspx

2. McKinsey & Company. From Extreme to Mainstream: The Future of Aesthetics Injectables. McKinsey & Company, Dec. 2021

3. American Society of Plastic Surgeons (ASPS). Inaugural ASPS Insights and Trends Report: Cosmetic Surgery 2022. Available at:

https://www.plasticsurgery.org/ documents/News/Trends/2022/ trends-report-cosmetic-surgery-2022.pdf

4. Evolus. Evolus Announces FDA Approval of Evolysse™ Form and Evolysse™ Smooth Injectable Hyaluronic Acid Gels. February 2025. Available at: https://investors.evolus. com/press-releases-and-news/ news-details/2025/Evolus-Announces-FDAApproval-of-Evolysse-Form-and-EvolysseSmooth-Injectable-Hyaluronic-Acid-Gels/ default.aspx

5. Evolus. Scientific Investor Presentation. May 2024. Data on File.

DAVID MOATAZEDI , President and Chief Executive Officer, Evolus

UMBERTO LA MAGNA, Senior Vice President Evolus International

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

TARIFFS, LAYOFFS, WARS AND UNCERTAINTY: CHALLENGES FOR MAINTAINING A THRIVING AESTHETIC BUSINESS IN A TOPSY-TURVY MARKET

email: wl@wendylewisco.com

THE FIRST HALF OF 2025 FEELS A LOT like a roller coaster ride, and not in a good way. Just turning on your daily news can make your stomach do somersaults. It seems inevitable that some of what we are reading about today will ultimately lead to higher inflation. The only question is how much and for how long.

One thing we can surely agree on is that the fields of medical aesthetics, dermatology and plastic surgery have proven to be very resilient, despite wars, natural disasters, economic downturns, climate change, and anything else we may have to navigate. On a positive note, remember that it wasn’t so long ago that the aesthetic category survived the setbacks of COVID-19 and came out swinging.

We reached out to a wide range of practitioners, from dermatologists to plastic surgeons, facial plastic surgeons, industry veterans, private equity, bankers, and entrepreneurs, to get their take on how to thrive and come out on top.

Humberto C. Antunes

Partner, Gore Range Capital Southlake, TX

All approved dermal fillers are manufactured outside the U.S. The trade tariffs will eventually hit any imported product into the U.S., but there are many ways to minimise the impact on the supply chain. Local U.S. contract manufacturers, for example, will have a huge windfall.

The aesthetic market has proven to be resilient to crisis, and sometimes it may even benefit from it. Therefore, this is the moment to invest in marketing and advertising to grow an aesthetic business. It is important to understand that the

aesthetic market is becoming more medical, requiring evidence beyond testimonials. Wellness is taking a larger share of mind and pocket among consumers globally. The need for individuals to stay competitive is heightened during times of uncertainty, which compels them to enhance their competitive edge.

Gerry Muhle

Head of Global Product Strategy, Galderma Zug, Switzerland

Aesthetics is a category which is quite ‘trend sensitive’, and therefore we have to be able to rapidly detect, adapt and respond to these emerging trends and embrace them, even more so now with the ever-growing influence of social media on patients’ expectations. I believe Galderma’s performance in this volatile global market illustrates our ability to do just that. Through our strong relationships with the aesthetics medical community, we’ve kept our finger on the pulse of healthcare professional and patient needs, and our heritage in dermatology enables us to react quickly to these needs by providing the right education, training, and products. For example in Europe, we’re seeing strong uptake of our novel, fast-acting and sustainablydeveloped liquid neuromodulator, which is addressing key aesthetics trends identified in our NEXT by Galderma report following extensive research, including that patients expect fast-acting and longer-lasting results, as well as products that align with their environmentallyconscious lifestyle. By working with aesthetics experts, we were also quick to identify the emergence of a new group of patients who are seeking aesthetic solutions after weight loss from prescription medicines, then determined

their aesthetic needs and published international consensus guidelines on how best to manage them. Despite changing market conditions, I firmly believe that by remaining in lock-step with the community’s needs and responding to these in an agile way, we’ve set ourselves up for a bright future in aesthetics.

Alan Matarasso, MD, FACS

Plastic Surgeon New York, NY

Although it can be stressful to consider plastic surgery during difficult financial times, the timing in relation to work can be advantageous. The economic markets will fluctuate, but wherever we are in those cycles, plastic surgery results will endure longer. The results will be either permanent (like a rhinoplasty) or semi-permanent/ long-lasting (like facial or eyelid surgery). Providing quality patient care and delivering excellent outcomes and value are always a priority.

Benoit Chardon

Founder and CEO of BC Consulting Paris, France

Harvard Business Review’s research shows that in downturns, consumers don’t stop spending they consolidate their spending with brands they TRUST most. This means doubling down on patient education, creating digital content that builds authority, and engineering signature treatment plans that differentiate their practice from commoditised competitors. Don’t discount, but rather build more trust with high-authority content and reassuring messages that reinforce an emotional connection with your brand. It is vital to demonstrate empathy during downturns. As affordability is also critical during a recession, think about rewards to make your patients work for you to elevate trust around your brand, such as free service to reward online reviews and different platforms, for example.

Anil Shah, MD, FACS

do not last forever, we hope, so those patients who are hesitant now will be more than ready when their wallets are, too. Also, I believe practices that focus on productivity, such as bonuses, often have an easier time navigating recessions. Minimum high base salaries can make it difficult to be profitable for non-surgical practices in the midst of a recession storm.

Nikos Metaxotos, MD, PhD

Founder of SYMMETRIA®

Athens, Greece

Traditional plastic surgery offices and beauty clinics are evolving into collective social clubs due to several factors. First, there is a growing emphasis on community and shared experiences in beauty and wellness, where clients seek not just procedures but also a sense of belonging. These spaces often build a sense of community among clients who share similar goals, making them feel more comfortable discussing their aesthetic desires. Additionally, clinics are incorporating lifestyle and wellness services, such as skincare, nutrition, and holistic treatments, which creates a more comprehensive approach to beauty. By blending aesthetic services with social interaction, they appeal to clients looking for a supportive and engaging environment, transforming the perception of beauty treatments from clinical to communal. Even in an uncertain economy, aesthetic patients keep coming back.

Kim Campbell CEO of The Dermatology Authority & ClubDerm.com

New Jersey

– Kim Campbell, CEO of The Dermatology Authority & ClubDerm.com

Board-Certified Facial Plastic Surgeon Chicago, IL and New York, NY

You definitely do not want to be over-leveraged in a recession. The recession of 2007 to 2009 taught us that more than 25% of medical spas declared bankruptcy. My advice is to not buy any unnecessary capital equipment, such as lasers, as many of these purchases need to be paid off in six months in order for them to be profitable. Instead, offer a variety of services so patients have options between surgical and non-surgical treatments. Recessions

Staffing remains one of the most significant challenges in running a successful medical aesthetics practice. As demand for aesthetic services grows, practices face the hurdles of retaining and training skilled staff while effectively incentivising them. To combat these challenges, establishing standardised training materials is crucial. By creating a comprehensive training manual and a centralised library of training videos, practices can ensure consistency and minimise reliance on staff for training. In terms of recruitment, leveraging dedicated job boards or recruiters can streamline the search for qualified candidates, while a specific email address for hiring inquiries can help organise the process. Adding as much detail to the job postings as possible

and including links to photos and videos is a big plus. Additionally, incentivising employees can foster loyalty and motivation. If traditional incentives are not feasible, consider implementing quarterly bonuses to reward performance. By addressing these staffing challenges with targeted strategies, practices can cultivate a skilled and motivated team who are essential for thriving in the competitive medical aesthetics, despite the fear of a recession.

Michael H. Gold, MD

Board-Certified Dermatologist, Founder & Medical Director of Gold Skin Care Center Nashville, TN

some patients do not understand the difference in the level of care. The challenges of private practice may scare away young graduates. The entire nature of the practice of medicine in the U.S. and other markets has changed, and not necessarily for the better.

Jane Yoo, MD

Board-Certified Dermatologist and Mohs Surgeon New York, NY

The 2025 economy is shaping up to be a little challenging for the aesthetics community. While we have many new and exciting treatments and options for our patients to improve their well-being, we are also facing an unprecedented time in our global economy. It feels different from downturns we have experienced in the past. We hope, as with other economic downturns, this too shall pass so we can look forward to a resurgence of a prosperous economy that brings back an environment where we can thrive. In time, we will be able to take care of patients with the benefits of the exciting technological advances at our disposal. I am always an optimist, so I think downturns can end sooner rather than later. We will be able to look back on this period as we have with other market disruptions, and maintain our commitment to exceptional patient care very soon.

Judith Hellman, MD

Associate Clinical Professor of Dermatology, Mt Sinai Hospital; New York, NY

We

are in a strange and unfamiliar time economically, but high-ticket items like deep plane facelifts, deep neck surgery, rhinoplasties and regenerative facial surgery are still thriving, but only if they deliver on trust, innovation, artistry, and natural results in good taste that last.

–

Steven R. Cohen, MD, Plastic Surgeon and Founder of FACES+ Plastic Surgery, Skin and Laser Center

During economic downturns, the key to maintaining a thriving aesthetic practice lies in strategic pricing tiers that preserve accessibility without compromising quality or devaluing your expertise. I’ve found that practices excel by focusing on high-retention treatments with predictable, gradual results that encourage patients to continue investing in their appearance even when tightening their budgets elsewhere. Communication becomes even more critical during economic uncertainty— patients need to understand the true value proposition of each treatment and how it fits into their long-term aesthetic goals rather than seeking quick, cheap fixes that may ultimately disappoint. Counterintuitively, recessions can actually be opportunities to strengthen patient relationships through added-value services that require minimal additional cost, such as enhanced follow-up protocols or personalised skincare regimens that extend treatment benefits. Above all, maintaining a thriving practice demands unwavering commitment to measurable results—when patients see consistent improvement despite spending less overall on discretionary items, they view your services not as a luxury to be cut but as an essential investment in their professional image and personal confidence.

This is a challenging time for many physicians in private practice in light of the economy and uncertainty. In my dermatology practice, our greatest challenge is to find qualified and reliable staff who will stay for the long term, including doctors and supporting staff. Young candidates for receptionist and medical assistant roles often have minimal qualifications and high salary demands, and they are not always motivated to stay long term. It can be difficult to recruit physician associates, as many young doctors look for opportunities in hospitals or join a large practice rather than start on their own. Solo practice is becoming a thing of the past, considering the high costs of staffing, marketing, equipment, and insurance. PAs and NPs may function as MDs and

Steven R. Cohen, MD

Plastic Surgeon and Founder of FACES+ Plastic Surgery, Skin and Laser Center; San Diego, CA

As someone who has been involved in regenerative medicine and surgery for decades, I think we are on the precipice of a new way of treating patients. We are moving away from reductive techniques to one that is fundamentally regenerative. The future is not just about filling and lifting, but about rewinding the cellular clock and restoring and enhancing biological function. Through my lens, I see a new standard in facial fat grafting, such as ITR2 injectable tissue replacement and regeneration is no longer a fringe

concept but has become foundational. We are shifting away from mechanical corrections to long-term biological rejuvenation. We are in a strange and unfamiliar time economically, but high-ticket items like deep plane facelifts, deep neck surgery, rhinoplasties and regenerative facial surgery are still thriving, but only if they deliver on trust, innovation, artistry, and natural results in good taste that last.

Alexander Z. Rivkin, MD

Cosmetic Surgeon and Owner of RIVKIN Aesthetics

Los Angeles, CA

The aesthetic industry is going through somewhat of a slowdown, it seems, with a decrease in filler sales partly due to financial concerns in an uncertain economy and partly due to worries about ‘filler fatigue’ and filler side effects spread by social media influencers and media. It is times like these when we learn that the trust and respect of the local patient community can really pay off for a practice. I’m hearing about medical spa chains and budget ‘factory style’ places with low prices and packed schedules going bankrupt. Practices that have invested in top market talent and the best technology will survive. Practices that have invested in creating a luxurious, individualised experience for patients do well in times like this because they realise that the service they provide is well worth the price tag.

Jason Pozner, MD

Board-Certified Plastic Surgeon and Founder of Sanctuary Medical Aesthetic Center; Boca Raton, FL

Like it or not, those of us in the aesthetic surgery field are in the luxury goods business. You don’t need that facelift— you may want it, but no one needs one now (except maybe the mother of the bride). Given the current economic climate of uncertainty and wild market swings, this translates into some uncertainty in the luxury goods and aesthetic marketplace. I have always said you need to be in a good mood to buy luxury goods, cars, watches, purses, etc., and the market swings are not putting anyone in a good mood. I think the tariff issues will settle out, and the market and the economy will be strong in the near future.

Jean-Yves Coste

Windome Banking Partners SAS Paris & Frankfurt

Aesthetics is no longer a vanity play, which accounts for the proliferation of medical aesthetics clinics and medspas on the rise. The hyper-informed consumer is ready to start earlier than ever. There is an intensification of telemedicine, telediagnostics, and telesurgery, along with digital post-op monitoring. Personalisation of procedures favours combined therapies synergistically with proven skincare protocols and energy-based devices with physician-dispensed dermocosmetics, dermal fillers, or skinboosters that are a rising category of regenerative aesthetics based on exosomes, secretome and other bioengineering approaches.

The economic outlook, capital market sentiment,

– Alexander Z. Rivkin, MD, Cosmetic Surgeon and Owner of RIVKIN Aesthetics

consumer confidence, and discretionary spending are deteriorating due to uncertainties and the unpredictability of trade tariff policies instituted by the U.S., which reduce short and midterm visibility for investors. Rationalisation induced by DOGE could also negatively impact the speed of FDA approval of novel technologies. Market traction may resume as the pending geopolitical uncertainties and bilateral trade discussions reach these results.

Chytra V Anand, MD

Cosmetic Dermatologist & Founder of Kosmoderma Clinics & SkinQ DermoCosmetics; Bangalore, India

The global aesthetic space is undergoing a seismic shift patients are more informed, cautious with spending, and seeking long-term value over vanity.

Emotional connection, clinical credibility, and transparency now outweigh glamour. Meanwhile, employees especially younger clinicians—are demanding purpose, flexibility, and growth over traditional hierarchies. The economic headwinds are real, but they’re also refining the industry: pushing out the fluff and spotlighting substance. This is the era of consolidation, education, and patient-first innovation. As a doctor and entrepreneur, I believe survival and success now lie in building emotionally intelligent teams, investing in results-driven science, and treating every patient as a relationship, not a revenue stream.

Jean-Paul Meningaud, MD, PhD

Professor of Plastic Surgery

Paris, France

In an increasingly regulated environment, especially in France, maintaining excellence in aesthetic medicine requires not only clinical expertise but also robust ethical and administrative standards. Our main challenge lies in balancing innovation with compliance, particularly when introducing new treatments. To protect our practices, transparency with patients, ongoing staff education, and collaboration with professional societies are key. Above all, never lose sight of the human connection this is what keeps patients returning and builds trust across borders.

While there is a lot of concern about President Trump’s tariff war, it hasn’t slowed the demand for laser and light treatments, at least not yet. Aesthetic treatments are more resilient than people might think. These treatments have little to no downtime and an affordable price point.

– Aaron Burton, CEO of Sciton

Rami K. Batniji, MD, FACS

Board-Certified Facial Plastic Surgeon

Newport Beach and Beverly Hills, CA

Proactive strategies can help maintain patient volume and revenue even in uncertain times like a recession. I’ve found that bundling treatments helps and providing phased treatment plans allows patients to invest gradually without sacrificing quality. Practices need to focus on excellence, safety, and service—without relying on aggressive promotions that devalue your expertise. Educating the patients is always a priority, while providing high-retention services reinforces the long-term value of expert care.

Paul Herchman

CEO & Co-Founder of GetHairMD™

Southlake, TX

Aesthetics practices can thrive in tighter economic times by being patient-first. Consumer spending on aesthetic treatments remains surprisingly robust, with many patients continuing to prioritise self-care and appearanceenhancing services even during tighter financial periods. Building strong patient relationships through personalised care plans and consistent follow-up creates loyalty to withstand any uncertain economic fluctuations. Forwardthinking physicians are diversifying their service offerings and deepening their expertise in high-demand areas. Technology investments are great practice differentiators that help attract patients who prioritise quality results. Practices that position themselves as specialists rather than generalists are finding they can maintain premium pricing.

Aaron Burton

CEO of Sciton

Dallas/Fort Worth, Texas

SCITON IQ (our cloud-based data intelligence system on all Sciton platforms) shows that treatments per system, from January 1st through April 1st, 2025, are nearly identical to the same period in 2024. This data reflects a year-over-year comparison of the same systems. Treatment volume has increased significantly if we include new systems in the field. While there is a lot of concern about President Trump’s tariff war, it hasn’t slowed the demand for laser and light treatments, at least not yet. Aesthetic treatments are more resilient than people might think. These treatments have little to no downtime and an affordable price point. Most of us have played this game before, so I’ll stay optimistic. We are always planning for crazy things to happen, including a bigger slowdown. If a downturn does happen, this is when the aesthetic practices with the best people and best products thrive. We have gone through plenty of cycles to date, and the best ones don’t just survive; they thrive.

Mark Schwartz, MD, FACS Board-Certified Plastic Surgeon New York, NY

In the current climate, plastic surgery practices need to focus on enhancing value rather than trying to compete

on price, which is always a losing proposition. We find that an educational approach works best to create a sense of trust and clarity.

Patients may be more cautious about their spending in a volatile economy, so we focus on building trust by spending extra time, especially with new patients, so they can feel comfortable in our care. In a volatile economy, with the looming threats of tariffs and inflation and a 24/7 news cycle, we are taking extra care to use an even softer approach to build trust. It’s important to maintain unwavering clinical standards while strategically streamlining operations, never compromising on patient safety or results to manage costs. We view this challenging period as an opportunity to refine the patient journey by extending our commitment to exceptional care. Patient loyalty can withstand shortterm economic fluctuations.

Bill

quickly. Bundy Group expects this trajectory to continue, especially for aesthetic practices that reflect the business fundamentals of leading dermatology groups.

Mukta Sachdev, MD

Dermatologist and Founder of MS Skin Centre; Bangalore, India

Carpou CEO at Octane Aliso

Viejo, CA

Despite the current state of the global markets, we understand from our portfolio companies and industry partners that consumer behaviour for spending on medical aesthetics treatments seems to be consistent, which speaks to a resilient market. Medical aesthetics has shown resilience during economic fluctuations, with the market demonstrating less price sensitivity than other discretionary categories. Additionally, a strong emphasis on investments in early-stage companies has grown as investors seek the next new technology. Overall, we continue to see longevity and wellness coming into play as consumers are focused on living healthy and active lives as they consume products to improve their appearance. Octane remains bullish on the industry overall.

Clint

Bundy

Managing Director of Bundy Group Charlotte, NC

It’s important to maintain unwavering clinical standards while strategically streamlining operations, never compromising on patient safety or results to manage costs.

Having practised aesthetic dermatology in India for over three decades, I have witnessed the industry’s transformation from a niche service to a dynamic, mainstream segment. Today, while the opportunities are abundant, so are the challenges—particularly with the influx of poorly regulated providers and aggressive marketing that often overshadows clinical integrity. My advice to fellow practitioners is to stay rooted in ethical, evidence-based medicine. Prioritise patient safety over trends, invest in your team’s training, and don’t underestimate the power of patient education in fostering loyalty. In an era where devices and injectables are widely accessible, it’s the trust you build and the results you deliver that will protect and future-proof your practice. For investors looking at India, there’s immense potential—but sustainable growth will only come from aligning with clinics that value long-term patient outcomes over quick wins.

– Mark Schwartz, MD, FACS Board-Certified Plastic Surgeon

Amid market uncertainty, including trends toward deglobalisation, economic volatility, and concerns over stagflation (rising prices coupled with slowing growth), dermatology and aesthetic practice owners face a challenging operating environment. These macroeconomic headwinds raise questions about the potential impact on mergers and acquisitions within the sector. Historical trends suggest that dermatology and aesthetics remain highly attractive areas for continued investment and consolidation. The aesthetics sector, including medspas and cosmetic plastic surgery, has seen accelerated momentum over the past five years. Though earlier in its consolidation cycle, investor and buyer interest is rising

Lana

Kerr

CEO

of Lumisque Skincare/CO2LIFT Fort Lauderdale, FL

Maintaining a thriving aesthetic practice in this unpredictable market feels a bit like trying to surf during a storm. It may be challenging, but with the right approach, it can be very satisfying when you get there. The real challenge lies in adapting to rapid changes while ensuring patient trust at the forefront. Innovation is essential, and so is providing treatments that are reliable and meet the real needs of patients in this economy. Aesthetic patients may scale back temporarily due to the uncertainty of the economy, but most will not stop cold turkey. Find the balance between staying ahead of the curve with the latest technology that meets your patients’ goals and building long-lasting relationships so they feel confident in your care. When we get that right, it’s a winwin for everyone.

Join the ESTHETIC MULTISPECI LTY SOCIETY

A platform designed for ESTHETIC MEDICINE PROFESSION LS

The AMS, the world’s largest multispecialty aesthetic medicine society, provides a digital platform where members can network and access an extensive library of on-demand scientific and sponsored videos, helping them grow and advance in their careers.

members are already benefiting from the AMS features and enhancing their medical practice.

www. multispecialtysociety. com . 30,000+

AMS is the scientific supervisor of leading aesthetic medicine events

SHAPING MODERN MAN: THE EVOLUTION OF MALE AESTHETIC TREATMENTS

PRIME explores the latest trends in male aesthetics, as leading experts reveal what today’s male patients want and how clinics can meet their needs in 2025 and beyond

THE FIELD OF MALE AESTHETICS IS undergoing a significant transformation, reflecting broader societal shifts and technological advancements. Today, men are increasingly seeking treatments that enhance their physical appearance while maintaining a natural look. This phenomenon may be driven by multiple factors, including increased awareness of physical aesthetics, the influence of social media, the aspiration to remain competitive both personally and professionally and updated technologies that are being adapted to male preferences and trends in aesthetics.

Top treatments and technological advancements

Facial Plastic Surgeon Steven Dayan, MD, director of DeNova Research (Chicago, IL), reported that he sees male patients lean towards surgical procedures and other longlasting treatments as many prefer a one-and-done approach. ‘In my practice, the top treatment that men are getting is rhinoplasty, as well as sculpted jaws and chins.’ According to him, evidence suggests that men with strong jawlines, chins, cheeks and brows often enjoy increased confidence, which may positively influence career and other life goals. While some physicians may opt for implants to achieve this goal, Dr. Dayan incorporates more fillers today, thanks to updated technologies that make them easier to use with results that last longer.

opinion, not much has changed in terms of the numbers. ‘According to aestheticsurgery.org, the absolute number for men getting plastic surgery has increased, but the percentage has decreased,’ he clarified. ‘What is different is that we use different vehicles. With men the key is to not do too much; they want to look like themselves, but younger or more refreshed. For example, I have to be judicious when I perform facelifts for men and be very careful not to change their persona.’ Dr. Dayan also noted that as more men are using glucagon-like peptides (GLP-1s) for weight loss, physicians may see an increase in male patients looking to treat loose skin and muscle loss in the near future.

With men the key is to not do too much; they want to look like themselves, but younger or more refreshed. For example, I have to be judicious when I perform facelifts for men and be very careful not to change their persona.

Steven Dayan, MD

German Board Clinical Dermatologist Dr. Pegah Dehdari, global aesthetic expert and key opinion leader (KOL), sees men’s aesthetics trending towards selfcare at her practice, CosmeSurge in Dubai, United Arab Emirates (UAE). Based on her experience, popular treatments for men increasingly focus on enhancing skin quality to achieve a more naturally youthful appearance. ‘In general men are now more open to aesthetic procedures and see it as investing in themselves on a more regular basis rather than a one-shot treat. Once they trust, they are very open to injectables,’ she reported. ‘I have the impression that men are less impressed by social media compared to women. They instead follow their friend’s or partner’s advice or other doctor’s referrals and recommendations.’

With a shift in societal norms, male patients are more open to aesthetic treatments; however, in Dr. Dayan’s

Dr. Dehdari emphasised that aesthetic practices can appeal to modern male patients by offering discretion in their practice with a separate waiting area and a gradual approach to treatments, allowing time for the patient to adapt. Additionally, providers should have an active

STEVEN DAYAN, MD, facial plastic surgeon and director of DeNova Research, Chicago, IL, USA; PEGAH DEHDARI, MD, dermatologist, CosmeSurge, Dubai, UAE; TJ TSAY, MD , medical director/owner of Ageless M.D.,Orange County, CA, USA

A B

knowledge of how to assess the male face, including anatomy and ageing features, and focus on the overall emotional message rather than small distractions such as fine lines.

Trending in California aesthetics

TJ Tsay, MD, medical director/owner of Ageless M.D. in Orange County, California, reported that trending aesthetic treatments for men in 2025 focus on naturallooking enhancements and regenerative therapies. ‘The term “Brotox,” albeit the same neuromodulators that women use, seems to be a buzzword when marketing to men,’ he stated. ‘Most men prefer more subtle, strategic applications to maintain natural expressions while reducing wrinkles. Masculinising dermal fillers are in high demand to create a chiselled, well-defined jawline and cheekbones. Certain dermal fillers placed on the bone can mimic and enhance the bony structure of the face and create sharp angular features.’

Men’s aesthetic preferences emphasise natural, lowmaintenance, and effective treatments that enhance masculinity without looking artificial. Clinics that offer a mix of regenerative medicine, advanced skin care solutions, and nonsurgical sculpting procedures will attract a growing male clientele.

Dr. Tsay added that younger men are investing in preventative treatments such as skin boosters for hydration and skin quality, subtle Botox, and regenerative therapies to maintain youthful skin over time. ‘Men’s aesthetic preferences emphasise natural, low-maintenance, and effective treatments that enhance masculinity without looking artificial. Clinics that offer a mix of regenerative medicine, advanced skin care solutions, and nonsurgical sculpting procedures will attract a growing male clientele.’

With the boundaries of masculinity and femininity being blurred, Dr. Tsay pointed out that treatments should be very tailored to each individual man with consideration into how men identify themselves. Providers should ensure open communication during an initial consultation to ascertain the patient’s desired outcome. 'This means we can be more versatile in how we see and deliver male aesthetics results. There is not a more exciting time than now to offer male aesthetic treatments,' he added.

Advancements in penile enhancement

The field of nonsurgical penile augmentation has also seen significant advancements in recent years. 'In the past, there were not many nonsurgical options for patients, but with the rapid rise in dermal filler used in aesthetics, these products have crossed over and are being heavily used to increase girth and flaccid length in men,' Dr. Tsay reported. 'At Ageless MD, I have been performing nonsurgical girth enhancements since 2017 and utilise the entire gamut of products ranging from hyaluronic acid (HA), calcium hydroxyapatite, polymethylmethacrylate (PMMA), and even Renuva (an allograft adipose matrix that stimulates your body to grow its own fat). The most popular would be HA since it’s fairly easy to use and reversible. We have men from all walks of life, from the mid-20s to the late 60s, who desire to have this procedure done.'

'Other popular adjuvant treatments that complement dermal filler injections include botulinum injections in the scrotum and into the shaft of the penis to relax and give a fuller appearance of the scrotum and increase the flaccid length and size of the penis, respectively,' Dr. Tsay continued. 'Botox has been well documented to improve erectile dysfunction by relaxing the muscles of the vasculature, providing more blood flow to the penis. This is especially helpful for those who are not responding to prescription medications such as Viagra or Cialis. Injections of Botox targeting the Dartos muscle can also help certain men who have penile retraction, a condition that causes their penis to appear shorter than normal. Finally, regenerative treatments such as platelet-rich plasma (PRP) and exosomes are effective at helping patients who have erectile dysfunction.'

Conclusion

TJ Tsay, MD

The field of male aesthetic treatments is rapidly evolving with growing acceptance and demand for subtle, naturallooking enhancements. Providers who can adapt to these changes and offer innovative, minimally invasive solutions will be well-positioned to meet the diverse needs of their male clients. The future of men’s aesthetics looks promising, with advancements in technology and a broader understanding of the current, changing and trending male beauty standards paving the way for continued growth and acceptance.

Written by Cindy J. Papp, contributing editor

1 © Dr Dayan

Figure

Figure 1 (A) Before and (B) 4 weeks after calcium hydroxyapatite to cheeks jawline and chin.

PREJUVENATION HOW GEN Z AND ALPHA ARE LEADING THE WAY IN EARLY INTERVENTIONS

ABSTRACT

The concept of prejuvenation, the proactive prevention of visible ageing signs before their onset, has transformed the skincare landscape, particularly among Generation Z and Alpha. Unlike previous generations who sought treatments reactively, younger consumers are prioritising preventive skincare in their late teens and early twenties. This shift is driven by advancements in dermatology, social media influence, and an increased focus on wellness, reinforcing a holistic approach to skin health. Social platforms and digital innovations, including AI-powered skin analysis tools and personalised skincare subscriptions,

have democratised access to professional-grade skincare and medical treatments, making prejuvenation both mainstream and widely accepted. Non-invasive cosmetic procedures such as neuromodulators, dermal fillers, fractional lasers, and microneedling have gained popularity as early interventions to preserve collagen, prevent dynamic wrinkles, and maintain skin structure. However, the rapid adoption of prejuvenation raises ethical concerns, including the risk of over-treatment, unrealistic beauty standards, and the influence of non-medical experts on social media. Dermatologists and aesthetic physicians play a crucial role in guiding young patients toward evidence-based,

responsible skincare practices while ensuring that interventions are appropriate and necessary. The skincare industry also bears responsibility for innovating gentle yet effective formulations, fostering inclusivity, and prioritising sustainability to meet the expectations of younger consumers. Collaboration between healthcare professionals and skincare brands can help establish balanced prejuvenation practices that emphasise education, prevention, and long-term skin health. Ultimately, prejuvenation is not just about delaying ageing but about empowering individuals to embrace a lifetime of radiant, confident, and well-cared-for skin through informed decision-making and ethical skincare solutions.

THE CONCEPT OF PREJUVENATION, proactively addressing the visible signs of ageing before they appear, has revolutionised the way skincare is approached by younger generations. Generation Z and Alpha, influenced by advancements in dermatology, social media trends, and a broader cultural emphasis on wellness, are driving this shift1. Unlike previous generations, who often sought treatments reactively in their 30s and 40s, today’s youth are focusing on prevention during their 20s or even late teens. This paradigm shift reflects a deeper understanding of skin biology and environmental factors, paired with increased accessibility to skincare education and cosmetic treatments. Prejuvenation is more than just a trend; it represents a holistic and proactive approach to skin health, emphasising early intervention to delay or prevent the onset of wrinkles, fine lines, pigmentation and other signs of ageing2. As this movement continues to grow, it raises questions about its ethical implications, the role of healthcare professionals, and how the skincare industry can innovate responsibly to support this new wave of consumers3 .

The

rise of prejuvenation

Prejuvenation has emerged as a defining feature of modern skincare, particularly among younger demographics who have grown up in the digital age. Social media platforms such as Instagram, TikTok, and YouTube play a significant role in promoting preventive skincare. Influencers and dermatologists alike share their routines, product recommendations, and experiences with treatments like neuromodulators, lasers, and medical-grade skincare, making these practices more accessible and less stigmatised4. This increased visibility has encouraged many young people to adopt a proactive approach to skincare. They understand that ageing is a gradual process influenced by the combination of genetics, environmental factors, and lifestyle choices5. By addressing early signs of ageing, such as dynamic wrinkles and collagen depletion, before they become visible, the younger demographic aim to preserve their youthful skin for longer1,2. This philosophy is supported by research showing that early intervention can indeed delay the progression of ageing, particularly when combined with a consistent routine of sun protection and skincare maintenance6. The accessibility and affordability of treatments have also played a critical role in the rise of prejuvenation. Clinics now offer packages tailored for younger patients, focusing on minimal, non-invasive procedures with little to no downtime. Additionally, the availability of over-the-counter medical-grade skincare products has democratised prejuvenation, making it a standard rather than a luxury for many.

Cultural shifts driving prejuvenation

The popularity of prejuvenation is deeply rooted in broader cultural shifts that emphasise self-care, wellness, and prevention7. For younger generations, skincare is not

Influencers and dermatologists alike share their routines, product recommendations, and experiences with treatments like neuromodulators, lasers, and medical-grade skincare, making these practices more accessible and less stigmatised. This increased visibility has encouraged many young people to adopt a proactive approach to skincare.

just a means of improving appearance but a holistic practice that contributes to mental and emotional wellbeing. This approach aligns with the broader trend of preventive health, where individuals prioritise maintaining their health and vitality rather than addressing problems after they arise. For many young people, the practice of prejuvenation is also about control and empowerment. It allows them to take charge of their ageing process, challenging the notion that ageing is inevitable and irreversible8. By starting early, they aim to preserve their confidence and self-esteem, viewing skincare as an investment in their future.

Social media, while instrumental in promoting prejuvenation, also perpetuates unattainable beauty standards9. Youngsters are exposed to highly curated and filtered images that often blur the line between reality and fantasy, which feed unrealistic expectations. While this has driven interest in skincare, it has also created pressure to conform to unrealistic ideals, which can lead to overtreatment and dissatisfaction.

Skincare in the digital age: Accessibility and democratisation

One of the most significant factors fueling the prejuvenation movement is the democratisation of skincare. In our digital age, knowledge about skincare and access to treatments are no longer limited to a privileged few. The proliferation of technology-driven solutions has brought skincare into the hands of millions, making it easier for the younger generations to learn, experiment, and adopt preventive measures10. This shift has played a pivotal role in the widespread adoption of prejuvenation practices. Online platforms and mobile applications have revolutionised how individuals approach skincare. Tools like AI-powered skin analysis apps allow users to assess their skin health, receive personalised recommendations, and track progress over time, all from the comfort of their homes. Applications like these use advanced algorithms to evaluate concerns such as acne, wrinkles, pigmentation, and texture, offering tailored suggestions for products and routines11. By bridging the gap between professional-grade diagnostics and athome care, these apps make skincare education more accessible to a global audience. E-commerce platforms have further democratised skincare by offering a vast range of products, from medical-grade formulations to budgetfriendly alternatives. These platforms are often complemented by user reviews, tutorials, and expert endorsements, helping consumers make informed decisions. Additionally, many brands now offer virtual consultations, allowing individuals to connect with dermatologists or aestheticians without geographical

email: docteur.haykal@gmail.com

KEYWORDS

Prejuvenation, preventive skincare, non-invasive cosmetic procedures, social media influence, collagen preservation

DIALA HAYKAL, MD, cosmetic doctor and laser expert, Palaiseau, France

limitations. This virtual shift has been especially significant in reaching underrepresented communities, providing access to skincare knowledge and treatments that were previously unavailable in certain regions.

Social media has also played a vital role in democratising skincare. Platforms like TikTok, Instagram, and YouTube serve as educational hubs where dermatologists, influencers, and enthusiasts share their insights, routines, and product reviews4,12. These platforms have dismantled barriers to information, empowering young people to take charge of their skincare journeys. However, this democratisation comes with its challenges, such as the risk of misinformation or the promotion of products that may not be suitable for everyone. This underscores the need for careful guidance from credible professionals to ensure that the benefits of these tools are maximised while minimising potential harm.

The rise of subscription-based skincare services has further simplified access to professional-grade care. Companies offering customised skincare regimens, often based on online quizzes or consultations, have made prejuvenation more approachable. These services typically deliver products directly to consumers, combining convenience with a personalised touch. This model resonates particularly well with younger generations, who value both efficiency and tailored solutions and are simultaneously digital natives. This modern technology and innovation have played a central role in making skincare and, by extension, prejuvenation more accessible, inclusive, and appealing to a broader audience. It adds depth by connecting the movement to larger societal and technological trends, enhancing the relevance of the article in today’s context.

Cosmetic dermatological procedures in prejuvenation

Cosmetic procedures play a pivotal role in the prejuvenation movement, offering young individuals a range of options to prevent and address early signs of ageing. Non-invasive and minimally invasive treatments are particularly popular among this demographic due to their safety profile, minimal downtime, and subtle yet effective results8,13,14. Procedures such as neuromodulators are commonly used to soften dynamic wrinkles before they become deeply etched

The success of prejuvenation depends not only on the choices made by individuals, but also on the guidance provided by healthcare professionals and the innovation driven by the skincare industry.

into the skin. Similarly, dermal fillers are employed to maintain facial volume and structure, addressing concerns such as nasolabial folds or early signs of hollowing under the eyes. Skin resurfacing techniques, including fractional lasers and chemical peels, help to improve skin texture, tone, and overall radiance while stimulating collagen production. Emerging technologies like microneedling with radiofrequency and ultrasound-based skin tightening are also gaining traction, offering solutions for enhancing elasticity and firmness. These treatments, combined with medical-grade skincare, allow young individuals to take a proactive and personalised approach to maintaining their skin health13,14. The availability of customisable protocols tailored to each patient’s unique needs ensures that prejuvenation remains both effective and accessible, reinforcing its growing popularity among younger generations.

Ethical and social challenges

While prejuvenation offers many benefits, it also raises ethical concerns, particularly regarding its application among younger populations9. Young skin is naturally resilient and often does not require the same level of intervention as older skin. Over-treatment, driven by external pressures or misinformation, can have adverse effects, including thinning of the skin, loss of natural elasticity, and long-term dependency on procedures. The influence of social media further complicates the issue. The promotion of treatments by influencers who may lack medical expertise can lead to a distorted understanding of what is necessary or appropriate. Youngsters may feel compelled to pursue unnecessary procedures to achieve the perfect skin depicted online, which can result in financial strain, physical harm, or psychological distress. Healthcare providers have a critical role in addressing these challenges. Dermatologists and cosmetic physicians must guide their young patients toward balanced and evidence-based practices. This includes emphasising the importance of a solid skincare foundation, sun protection, hydration, and antioxidant use before considering advanced treatments. Practitioners should also prioritise patient education, helping younger individuals understand the science behind prejuvenation and setting realistic expectations for its outcomes.

The role of physicians and laboratories

The success of prejuvenation depends not only on the choices made by individuals, but also on the guidance provided by healthcare professionals and the innovation driven by the skincare industry3. Physicians are uniquely positioned to educate young patients about skin ageing and preventive care. By conducting thorough consultations and developing personalised skincare plans, they can ensure that treatments are tailored to the individual’s needs and concerns. Practitioners also have a responsibility to discourage unnecessary interventions. Over-treatment not only poses risks to the patient’s skin but also undermines the credibility of the prejuvenation movement. By promoting a balanced approach, physicians can help their patients achieve long-term benefits without compromising their skin’s health or integrity.

The skincare industry plays an equally important role in shaping the future of prejuvenation. Laboratories have the opportunity to develop innovative products and treatments

References

1. Haykal D, Nahai F, Cartier H. Prejuvenation: The Global New Anti-Aging Trend. Aesthetic Surg J Open Forum. 2023;5:ojad061. doi:10.1093/asjof/ojad061

2. Hogan SR, Zachary CB, Arndt KA. Prejuvenation: Definition of the Term and Evolution of the Concept. Dermatol Surg. 2021;47(6):871. doi:10.1097/ DSS.0000000000002929

3. Haykal D, Cartier H, Kroumpouzos G. Educational strategies to combat harmful cosmetic dermatology trends in Generations Alpha and Z. Clin Dermatol. 2024;42(4):415419. doi:10.1016/j.clindermatol.2024.05.004

4. Joshi M, Korrapati NH, Reji F, Hasan A, Kurudamannil RA. The Impact of Social Media on Skin Care: A Narrative Review. Lviv Clin Bull. 2022;1-2:85-96. doi:10.25040/

Key points

Younger generations are proactively embracing skincare in their teens and twenties to delay signs of ageing, influenced by social media, wellness culture, and increased access to dermatological knowledge

AI-powered skin analysis tools, personalised skincare subscriptions, and social media education have made professional-grade skincare and non-invasive treatments more accessible than ever before

Neuromodulators, fillers, microneedling, and fractional lasers are increasingly used by young patients to preserve collagen, prevent wrinkles, and maintain skin structure—often with minimal downtime

The rise of prejuvenation raises concerns about overtreatment and unrealistic beauty standards. Physicians and skincare brands must collaborate to promote responsible, evidencebased, and inclusive practices.

specifically designed for younger skin. This includes creating formulations that are gentle yet effective, as well as addressing the unique needs of diverse skin types and tones. Sustainability is another critical consideration, as younger consumers increasingly prioritise eco-friendly and ethical products3. Collaboration between healthcare providers and the skincare industry can further enhance the prejuvenation movement. Joint educational campaigns, supported by scientific evidence, can help demystify prejuvenation and empower young individuals to make informed decisions. Such efforts can also promote inclusivity, ensuring that the benefits of prejuvenation are accessible to a wide range of demographics.

Conclusion

Prejuvenation represents a generational shift in how we approach skincare and ageing. Today’s youth are leading the way, redefining beauty standards with a focus on prevention, empowerment, and self-care. By embracing early intervention and maintaining consistent routines, complemented by non-invasive procedures, they are setting a new precedent for skin health that prioritises longevity and confidence. These targeted interventions enhance collagen production, maintain facial volume, and improve skin texture, offering tailored solutions that align with individual needs and lifestyles. However, this movement also demands careful guidance and ethical considerations. Healthcare professionals must act as trusted advisors, steering their patients toward evidencebased practices and discouraging over-treatment. At the same time, the skincare industry must innovate responsibly, creating solutions that are effective, inclusive, and sustainable. As prejuvenation continues to evolve, it offers an opportunity to redefine ageing as a proactive and positive process. With the combined efforts of physicians, laboratories, and informed consumers, this movement has the potential to empower future generations to take charge of their skin health while fostering a culture of education, balance, and responsibility. Ultimately, prejuvenation is not just about delaying ageing, but also about embracing a lifetime of healthy, confident, and radiant skin.

Declaration of interest None

lkv2022.01-02.085

5. Guo J, Huang X, Dou L, et al. Aging and aging-related diseases: from molecular mechanisms to interventions and treatments. Signal Transduct Target Ther. 2022;7(1):1-40. doi:10.1038/s41392-022-01251-0

6. Bertossi D, Giampaoli G, Lucchese A, et al. The skin rejuvenation associated treatment—Fraxel laser, Microbotox, and low G prime hyaluronic acid: preliminary results. Lasers Med Sci. 2019;34(7):1449-1455. doi:10.1007/ s10103-019-02738-z

7. Minimally Invasive Facial Cosmetic Procedures for the Millennial Aesthetic Patient. JDDonline - Journal of Drugs in Dermatology. Accessed March 10, 2023. https://jddonline. com/articles/minimally-invasive-facial-cosmetic-

procedures-for-the-millennial-aesthetic-patientS1545961620P0100X/

8. Wong V. Resurface, Retone and Reboost: A Multi-Modality Approach for Prejuvenation of Millennial Patients. (549).

9. Haykal D, Cartier H, du Crest D, Day D. Aesthetic dermatology in the age of social media: Where is the limit between professionalism and ethics? A literature review. J Eur Acad Dermatol Venereol JEADV. 2023;37(6):e713-e714. doi:10.1111/jdv.18867

10. Ananthsai N, D N, Vivekanandhan N, Muthu Kumar H. A Study on the Influence of Social Media on the Purchase of Skin Care Products.; 2023.

11. The relevance and accuracy of an AI algorithm based

descriptor on 23 facial attributes in a diverse female US population. Accessed May 9, 2024. https://onlinelibrary. wiley.com/doi/epdf/10.1111/srt.13690

12. Alamer MA, Alrashed H, Abuageelah BM, et al. Impact of Social Media on Choosing Skin Care and Cosmetic Products Among Females in Saudi Arabia. Cureus. 15(12):e49922. doi:10.7759/cureus.49922

13. B K. Prejuvenation: What, Why, and How. LiVDerm. March 25, 2022. Accessed March 5, 2023. https://www.livderm. org/prejuvenation-what-why-and-how/ 14. Hilton L. Examining the prejuvenation trend. 2019;40. Accessed March 10, 2023. https://www.dermatologytimes. com/view/examining-prejuvenation-trend

RAISING THE STANDARD IN AESTHETIC COMPETENCE

ABSTRACT

The International Society for Aesthetic Competence (ISAC) is advancing global standards in aesthetic medicine by developing evidence-based protocols and educational frameworks to enhance patient safety and practitioner skill. As minimally invasive procedures like dermal fillers and neurotoxins grow in popularity, so do the associated risks especially among less experienced injectors. Through collaboration between 56 physicians across 30 countries, ISAC aims to reduce complications, support practitioner development, and promote consistent global competencies in aesthetic treatments.

KEYWORDS International Society for Aesthetic Competence (ISAC), Aesthetic medicine, Dermal fillers, Patient safety, Global collaboration, Medical education

MINIMALLY INVASIVE COSMETIC procedures have revolutionised the treatment paradigm for both facial and body rejuvenation. With these techniques, more invasive surgical procedures such as face-lifts, lip corrections and phenol peels can either be postponed or disregarded entirely.

Injection treatments with botulinum toxin and fillers form the largest part of minimally invasive treatments. Although there are many different classifications of fillers, for the purpose of adverse event descriptions they are mostly classified by their biodegradability into nonresorbable and resorbable fillers1. In 2020, the number of soft tissue filler (STF) treatments performed by plastic surgeons in the United States was estimated at 1.3 million, with a revenue of almost $1 billion2. The resorbable filler hyaluronic acid (HA) accounts for 95% of the fillers injected3. The increasing popularity of hyaluronic acid (HA) filler injections has unfortunately led to a rise in complications. These complications sometimes need immediate treatment

Aesthetic medical education could benefit from the implementation of core competencies and treatment guidelines, as would patients and the injection community as a whole4. However, the path to establishing and implementing such competencies and guidelines is long and difficult4. Considerable research is needed to provide a high level of evidence to design and incorporate levels of competency and to create a standardised educational path to becoming an expert aesthetic practitioner4. As the discipline of aesthetic medicine is constantly growing, the onus is on our community to establish guidelines to ensure the best education and highest competency of providers in order to produce the best outcomes with the highest level of patient safety4. In a large multicentre prospective cohort study by Alam et al., they estimate adverse event rates associated with major categories of aesthetic procedures, including laser and energy device procedures, as well as injectable fillers and neurotoxins5. In the hands of welltrained doctors, these procedures are safe, with aggregate adverse event rates of well under 1%5. Patients seeking such procedures can be reassured that, at least in their hands,

they face minimal risk5. Recognising this critical need for standardised treatment, the International Society for Aesthetic Competence (ISAC) World Board, comprising 56 physicians from 30 countries, is creating these protocols and algorithms to help young and less experienced doctors.

Fillers

Soft tissue fillers have become an integral part of nonsurgical cosmetic procedures over the past few decades. They are primarily used to restore facial volume, enhance facial contours, and reduce the appearance of wrinkles and fine lines. This popularity can be attributed to their minimally invasive nature, immediate results, and relatively low cost compared to surgical alternatives.

While dermal fillers are generally safe, complications can arise. Some potential issues include:

■ Bruising and swelling: Injection-related reaction that commonly subsides within a few days

■ Lumps and bumps: These can occur if the filler is not injected smoothly or if it migrates to another area

■ Infection: Though rare, infections at the injection site are possible.

■ Allergic reactions: Some individuals may have reactions to ingredients in the filler

■ Vascular occlusion:

A more serious risk, this happens when filler is accidentally injected into a blood vessel, potentially leading to skin necrosis or other complications such as vision loss.

To minimise risks, the practitioner should have a thorough understanding of facial anatomy and the properties of different fillers. In cases of adverse effects, immediate attention from a healthcare professional is necessary. For instance, hyaluronidase can be used to dissolve HA fillers in case of vascular occlusion.

global health challenges. This approach leverages the diverse strengths and perspectives of practitioners from different regions and cultures, fostering innovation and comprehensive solutions to health issues.

Benefits of global collaboration

Knowledge sharing and capacity building

One of the most significant advantages of global collaboration is the opportunity for knowledge exchange. Doctors around the world encounter different challenges and develop unique strategies to address them. By sharing these experiences, doctors can learn from one another, avoiding pitfalls and adapting successful strategies to their contexts. This exchange can occur through international conferences, online platforms, and collaborative research projects.

Addressing global health challenges

Many health issues, such as pandemics, non-communicable diseases, and environmental health hazards, transcend national borders. By working together, doctors can develop coordinated responses to these challenges. For example, during the COVID-19 pandemic, doctors worldwide shared clinical data, treatment protocols, and research findings, accelerating the development of treatments and vaccines.

Advancing medical research

Collaborative research undertaken by international teams can lead to breakthroughs that might not be possible in isolation. Diverse teams bring different perspectives and methodologies to medical research, enhancing creativity and innovation. Moreover, global collaborations allow for larger-scale studies that can provide more robust and generalisable results.

Global collaboration

In the increasingly interconnected world of the 21st century, the concept of doctors working together globally has gained significant traction. Global collaboration among doctors involves sharing knowledge, expertise, and resources to improve patient care, promote public health, and address

As the discipline of aesthetic medicine is constantly growing, the onus is on our community to establish guidelines to ensure the best education and highest competency of providers in order to produce the best outcomes with the highest level of patient safety.

Improved resource distribution

Disparities in resource availability can be addressed through global collaboration. Well-resourced nations and organisations can support those with fewer resources by providing access to medical supplies, technology, and expertise. This kind of support is crucial in times of crisis, such as natural disasters or outbreaks, where prompt response can save lives.

email: fischer@isac.expert

TANJA FISCHER, MD, HLCP, Skin and Laser Center, Potsdam and Berlin, Germany; TOM DECATES, MD, PHD, Aesthetic medicine and Assistant professor, ErasmusMC, Amsterdam, Netherlands; PATRICK TREACY, MBCHB, Cosmetic Physician, Ailesbury Clinics Ltd | Dublin, Irland

Challenges to overcome

Cultural and language barriers

Communication is an essential component of effective collaboration. Differences in language and cultural understanding of healthcare can pose significant challenges. It is crucial for teams of doctors to develop cultural competence and foster an environment of mutual respect and understanding.

Regulatory and ethical differences

Different countries have different healthcare regulations and ethical standards. Navigating these differences can be complex, requiring agreements that respect local regulations while maintaining international standards.

Digital divide

While technology enables global collaboration, disparities in access to technology can limit participation from some regions. Efforts to improve global digital infrastructure are needed to ensure inclusivity.

Logistical challenges

Coordinating efforts across time zones and geographies requires robust logistical planning. Establishing clear communication channels and relying on technology to

bridge gaps are essential strategies for effective collaboration.

Path forward

To harness the full potential of global collaboration among doctors, it is imperative to invest in infrastructure that supports communication and data sharing. International bodies such as the World Health Organization (WHO) can play a pivotal role in facilitating these partnerships. Furthermore, educational programmes that emphasise global health perspectives and intercultural competence can prepare future healthcare professionals to thrive in collaborative environments.

Working together globally presents a tremendous opportunity for doctors to improve health outcomes worldwide. By overcoming challenges through strategic investment and cultural competency training, practitioners can collectively advance the global health agenda, making significant strides in tackling both longstanding and emerging health challenges. This spirit of collaboration can foster a more equitable and effective global health system, ultimately enhancing the well-being of populations globally.

Acknowledgments ISAC (International Society for Aesthetic Competence) has the following members: Tanja Fischer, Chytra Anand, Pierre Andre, Ofir Artzi, Beatriz Beltran, Su Becker-Weimann, Hagai Betzer, Hugues Cartier, Olivier Claude, Iñigo de Felipe, Tom Decates, Romeu Fadul, Ronald Feiner, Greg Goodman, Lisa Grunebaum, Traore Ibrahima, Jonathan Kadouch, Saami Khalifian, Marina Landua, Wendy Lee, Steven Liew, Leonardo Marini, John Martin, Beatriz Molina, Rachna Murthy, James Neffendorf, Ha Nguyen Hong, Ahmed Nouh, Alexandra Ogilvie, Tapan Patel, Eric Petzold, Thomas Rappl, Wolfgang RedkaSwoboda, Hervé Raspaldo, Alexander Rivkin, Kelsey Roelofs, Jonathan Roos, Christopher Rowland Payne, Leonie Schelke, Todd Schlesinger, Robyn Siperstein, Philippe Snozzi, Nenad Stankovic, Ziah Taufig, Jesper Thulesen, Patrick Treacy, Jani van Loghem, Joan Vandeputte, Peter Velthuis, Ines Verner, Andre Viera Braz, Simone Vogel, Gillian Wang, Heidi Waldorf, Steven Weiner, Sandy Zhang-Nunes, Thomas Zimmerman. By overcoming challenges through strategic investment and cultural competency training, practitioners can collectively advance the global health agenda, making significant strides in tackling both longstanding and emerging health challenges.

References

1. Decates TS, Velthuis PJ, Schelke LW, Lardy N, Palou E, Schwartz S, Bachour Y, Niessen FB, Nijsten T, Alijotas-Reig J. Increased risk of late-onset, immune-mediated, adverse reactions related to dermal fillers in patients bearing HLA-B*08 and DRB1*03 haplotypes. Dermatol Ther. 2021 Jan;34(1):e14644.

2. American Society for Aesthetic Plastic Surgery, “Cosmetic Surgery National Data Bank Statistics 2020,” accessed March 03 2025 https://www.surgery.org/sites/ default/files/Aesthetic-Society_ Stats2020Book_FINAL.pdf.

4. Cotofana S, Gold MH, Biesman BS, Alfertshofer M. Should novice injectors treat every facial region in their first year of practice? J Cosmet Dermatol. 2024 Jun;23(6):2288-2289.

5. Alam M, Kakar R, Nodzenski M, et al. Multicenter prospective cohort study of the incidence of adverse events associated with cosmetic dermatologic procedures: lasers, energy devices, and injectable neurotoxins and fillers. JAMA Dermatol. 2015 Mar;151(3):271-7.

3. PlasticSurgery.org (2023) American society of plastic surgeons online resources. Accessed March 03 2025 https://www. plasticsurgery.org/documents/News/ Statistics/2023/plastic-surgery-statisticsreport-2023.pdf

SHE a, MD; YONG LIAO b, MD; YISHUANG NI a , MD; LIANGSEN ZHAO b, MD; aNingbo Yinzhou She Yuhong Aesthetic Medical Clinic, Ningbo, 315100, China; bDepartment of Medicine, Bloomage Biotechnology Corporation Limited, Beijing 100000, China

THE SHÉ CLINICAL AESTHETICS SYSTEM: A NOVEL FACIAL ASSESSMENT AND TREATMENT APPROACH

Explore a novel approach to facial assessment and treatment that offers a multi-dimensional, personalised method for understanding and enhancing facial aesthetics

ABSTRACT

The SHÉ Clinical Aesthetics System, developed by Dr. Yuhong She, represents an innovative approach to facial assessment and treatment that harmonises artistic principles with advanced medical techniques. Originating from Dr She’s aesthetic background and extensive clinical experience, the system emphasises the significance of individualised, multi-dimensional assessments

THE DEVELOPMENT OF THE SHÉ

Clinical Aesthetic System is closely tied to the personal background of its creator, Dr. Yuhong Shé. Hailing from an artistic family in Ningbo City, Zhejiang Province, Dr. Shé was immersed in an environment rich in aesthetic influences from an early age and received a comprehensive education in aesthetics. Throughout their professional career, Dr. Shé has maintained a sustained focus on medical aesthetics, integrating advanced techniques with the solid foundation of aesthetics cultivated through their personal experiences, all while prioritising the aesthetic needs of clients1 .

Drawing on a deep exploration and profound understanding of the intrinsic patterns of human morphology and aesthetic principles, Dr. Shé pioneered a multidimensional, multi-level, and multi-position concept of human morphology aesthetics, which serves as the core for this system. In clinical aesthetic practice, Dr. Shé provides individualised, comprehensive assessments and aesthetic designs for each patient, formulating personalised aesthetic treatment plans tailored to their unique morphological characteristics. These practical experiences have gradually converged to form the SHÉ Clinical Aesthetic System (Figures 1-6).

Origin of the SHÉ Clinical Aesthetic System

of facial morphology, psychology, and structure. By systematically integrating these components, the SHÉ Clinical Aesthetic System enables practitioners to construct tailored aesthetic treatment plans that respect each patient's unique features and enhance overall facial harmony. This article explores the conceptual foundations, methodologies, and clinical implications of the SHÉ system, aiming to establish a new paradigm in aesthetic medicine.

and constructing a foundational logic that closely links facial information with the clinical aesthetic system2. The system encompasses the following key aspects (Figure 2):

Morphology

Facial morphology is composed of the head and face contour and the five facial features. In clinical practice, a multi-dimensional approach from the overall structure and individual details to sub-unit specifics is crucial for understanding facial harmony3. Facial morphology and condition involve static, dynamic, ageing, gender, racial, and era-related variations. A thorough analysis of coordination across these dimensions allows for a precise understanding of facial features. Furthermore, facial morphology includes both commonalities and individuality, with respect for these differences forming the basis for shaping a unique, personalised appearance.

Psychology

KEYWORDS

Facial aesthetics, personalised treatment, SHÉ Clinical Aesthetic System, multi-dimensional assessment, dynamic contour aesthetics

The SHÉ Clinical Aesthetic System derives from the author’s many years of clinical practice and meticulous observation. Its core lies in accurately capturing key facial feature information from those seeking aesthetic enhancements

The psychological dimension includes three aspects: expression, physiognomy, and aesthetic sense. Expression encompasses emotional, physiological, and social expressions, closely linked to dynamic facial morphology and emotional expression, emphasising the importance of dynamic treatments in clinical practice. Physiognomy reveals the psychological expression of facial features through shape, character traits, and style, helping to create a precise, personalised style. The aesthetic sense dimension explores the underlying logic and patterns of facial beauty, based on aesthetic standards, the ‘average face,’ symmetry, and gender dimorphism.

YUHONG

Structure

Facial structure is composed of several layers, including the skeleton, ligaments, deep fat, muscles, superficial fat, skin, and mucosa. Each layer serves a specific purpose: the skeleton provides support, ligaments help stabilise and lift, deep fat offers cushioning, muscles control facial expressions, superficial fat contributes to tension, and the skin and mucosa form the outer protective layer.

From a morphological perspective, the skeleton is threedimensional, ligaments are tight and strong, deep fat appears plump, muscles are dynamic and flexible, superficial fat is soft, and both skin and mucosa should appear healthy. In terms of physiognomy, the skeleton represents ‘skeletal features,’ ligaments are linked to ‘youth,’ deep fat correlates with ‘soft tissue physiognomy,’ muscles convey ‘emotion,’ superficial fat also relates to ‘soft tissue physiognomy,’ skin signifies ‘skin features,’ and mucosa indicates overall health.

Clinically, understanding the complex interactions of these structural layers and making precise adjustments is essential for effective aesthetic treatments.

Causes

The core factors that determine and influence facial morphology are primarily genetic and environmental. A deep understanding of the interplay between endogenous genetic factors and exogenous environmental influences during facial formation and ageing processes aids in uncovering the underlying causes of a patient’s aesthetic morphology. This allows medical aesthetics professionals to offer targeted and specialised aesthetic assessment and treatment plans.

Components of the SHÉ Clinical Aesthetic System

Based on the underlying logic of the SHÉ Clinical Aesthetic System, which links facial information with the system’s core principles4, the system consists of the following components:

Figure 1 Conceptual framework of the SHÉ Clinical Aesthetic System, illustrating its multidimensional integration of aesthetics, structure, and clinical practice

3D Facial Static Contour Aesthetics

The main aesthetic goal is to achieve overall harmony in facial contours while applying a holistic assessment to ensure a cohesive and balanced facial structure. The key elements of the trade-off and curves to consider include symmetry, the golden ratio, the three-part division of the face, the five-eye standard, and variations in head and face types, all of which are essential for facial contour corrections5. The subunit principle supports detailed refinement and personalised adjustments to specific areas. Additionally, cranial morphology serves as the foundational support for facial contours, significantly influencing the overall shape of the face. The texture principle also plays a

The SHÉ Clinical Aesthetic System provides a comprehensive, multi-dimensional approach to facial aesthetics, ensuring personalised and precise treatments for each patient.

crucial role by guiding the selection of treatment materials, ensuring they match the properties and structure of surrounding tissues. Finally, the head-body proportion highlights the importance of coordinating the head and facial contours with the overall body to enhance overall aesthetic appeal.

4D Facial Dynamic Contour Aesthetics

The 4D facial dynamic contour aesthetics highlight the importance of expressive muscles and facial wrinkles in assessing dynamic features of the face. Dynamic subunits form the aesthetic foundation and serve as the basis for treatment approaches, relying on a careful evaluation of various dynamic morphological factors. Emotions such as joy, anger, sadness, surprise, and disgust are all reflected in the assessment of facial dynamics. Each expression type should align with specific evaluation criteria, following aesthetic principles that guide treatment planning6. Notably, a captivating smile is regarded as a key indicator of dynamic facial beauty.

5D Facial Ageing Contour Aesthetics

Ageing morphology can be understood through static and dynamic dimensions. Static signs of ageing include a narrower upper face, a wider lower face, sagging skin, wrinkles, indentations, blurred facial contours, and a loss of distinct gender features. On the other hand, dynamic ageing is expressed through actions such as eyelid lifting, squinting, drooping of the mouth corners, and slower movements.

The mechanisms of ageing involve several structural

layers. For instance, expanding and correcting the underlying skeleton can significantly improve facial contours. Ligament lifting can reduce sagging, while treatments targeting the muscle layer should focus on preventing atrophy in facial expression muscles and addressing the atrophy of masticatory muscles. Combining deep fat expansion with superficial fat filling can enhance facial shape. At the skin level, techniques for tightening and removing wrinkles can help address signs of skin ageing7.

To counteract the effects of gravity on facial tissue structures, appropriate treatment measures are essential to mitigate its negative impact.

6D Gender-Dependent Aesthetics

Female facial morphology typically exhibits delicate, graceful, and refined characteristics, while male faces are marked by broad, rugged, and angular features. In clinical injection guidance, females generally have more injection points with smaller amounts of product per point, whereas males have fewer injection points but use larger quantities at each point.

When comparing male and female skeletons, several structural differences stand out. Female skeletons tend to be smaller, while male skeletons are larger and more robust. Additionally, females generally have thinner muscles, whereas males typically possess thicker muscles. Women also have a higher volume of body fat compared to men, who tend to have less fat. The skin of females is

usually finer and softer, while male skin is often thicker and firmer.

In terms of specific facial features, women typically exhibit a more prominent forehead, while men have more pronounced brow ridges. The eye area in women is softer and rounder, whereas men’s eye contours are more angular. Women’s noses are generally more delicate and raised, while men’s noses tend to be larger and more robust. Lips in females are rounder and softer, while males have lips with sharper, more defined contours. Lastly, the chin is usually more centred in females, while it tends to be shifted toward the sides in males.

7D Race-Dependent Aesthetics

Racial morphological differences are apparent, with Western populations generally exhibiting more prominent skeletal features, while Eastern populations tend to show softer, more refined facial characteristics8. In terms of differences, Eastern populations often focus on skeletal structure adjustments to enhance facial contours, while Western populations emphasise fat redistribution to create softer, more elegant curves. Eastern populations have been more concerned with skin whitening, whereas Western populations have prioritised skin tightening.

8D Era-Dependent Aesthetics

Understanding the evolution of aesthetic preferences and facial morphological changes is an essential part of the 8D SHÉ Clinical Aesthetic System. Human aesthetic ideals

Figure 2 Key facial morphological landmarks and dynamic expressions analysed for personalised aesthetic assessment

have evolved over the past 40,000 years, from temple cultures and the Renaissance to modern society, with each period having distinct aesthetic characteristics. This evolution is clearly visible in the transition from ancient Greek sculptures, Renaissance paintings, to modern photography, which showcase changes in aesthetic ideals.

9D Physiognomy Aesthetics

The components of 9D physiognomy aesthetics include both appearance and psychology. Genetically, facial morphology has a deep and broad impact, affecting both the skin and skeletal layers. This includes aspects such as facial type, head-body proportion, skeleton and soft tissue structure, the curvature of lines, the proportions of facial features, wrinkles, and skin texture. Environmental factors include both social and natural environments. The former is influenced by factors like economics, politics, technology, and culture, manifesting in habitual movements, facial expressions, thoughts, and cognitive processes. Physiognomy is the study of how our facial features can reflect our personality9. It is based on the idea that there is a strong link between how our face looks and our psychological traits. This connection comes from the way our genes and environment interact, affecting the relationship between our bones and the skin. When we make expressions, the muscles in our face can change the structure of our skull over time. In practical terms, this knowledge helps with identifying and creating personalised styles for individuals.

Understanding the complex interactions of facial structural layers is essential for effective aesthetic treatments.

Clinical Application of the SHÉ Clinical Aesthetic System

Based on the composition of the SHÉ Clinical Aesthetic System and the general overview of the head and facial information, in combination with clinical practice scenarios, the aesthetic treatment pathway is as follows: Consultation— Assessment—Plan—Injection—Reassessment.

Consultation

The clinical consultation closely aligns with the patient’s needs and the aesthetic treatment pathway, covering the chief complaint, aesthetic demands, assessment, technique selection, plan design, procedure, and outcome assessment (Figure 3). The consultation environment should be comfortable and artistically enriched, equipped with diagnostic mirrors, cameras, and computer software tools. During the communication process, an effective rapport is established by analysing facial features and personality traits, which helps to deeply explore the aesthetic needs while considering the patient’s social and cultural background and aesthetic awareness.

From a medical perspective, it is crucial to understand the patient’s previous treatment history and their understanding of medical procedures. The diagnostic process includes: psychological diagnosis, which reveals the underlying psychological motives for aesthetic desires; aesthetic diagnosis, which evaluates the facial structure and aesthetic imbalances; and medical diagnosis, which assesses the feasibility and risks of the chosen techniques. Achieving a

Figure 3 Consultation workflow

Cause

Symptom State

Figure 5 'Fourfold Consensus' treatment planning framework (psychological,

consensus across psychological, aesthetic, medical, and consumer dimensions through thorough communication with the patient is key to the success of aesthetic practices. Finally, a brief introduction to the injection techniques used and the principles of post-treatment assessment is provided to ensure treatment efficacy and patient satisfaction.

Assessment

The core task of aesthetic assessment is to identify areas of morphological imbalance, determine the underlying causes, achieve multi-dimensional morphological harmony, and prioritise treatment. The assessment model follows a system with multi-level, multi-position, multi-dimensional, and multi-sequential structures. This analysis looks at different

parts of the face, including the skeleton, ligaments, fat, muscles, and skin. It evaluates the face from various angles, considering the whole face, specific areas, and individual parts. A comprehensive multi-dimensional assessment involves various factors such as 3D contour, 4D dynamics, 5D aspects of ageing, 6D gender considerations, 7D ethnicity, 8D historical context, and 9D psychological traits. The multisequential assessment is based on a four-dimensional hierarchical comparison (local, subunit, layer, and dimension) to determine the treatment order. This systematic assessment provides a solid foundation for the precise formulation of subsequent treatment plans (Figure 4).

Treatment Plan

The treatment plan is structured around the core framework of the ‘Fourfold Consensus,’ focusing on two key elements: facial assessment and technique selection, to create a multidimensional collaborative diagnostic and treatment plan (Figure 5). Achieving psychological consensus involves capturing people’s facial expressions and matching them with their unique psychological styles. This alignment helps connect treatment goals with emotional needs. Aesthetic consensus focuses on looking at facial features and understanding the factors that enhance appearance and personal style. Medical consensus requires assessing skin texture and following the principles of how the body adapts. This process helps choose the right techniques, predict outcomes, and evaluate risks.

Consumer consensus assesses the commercial value and pricing strategies, striking a balance between service value and market demands. The treatment plan is structured around six key elements, represented in a deep green circular diagram:

■ Points: precise injection locations

■ Layers: progression through anatomical layers

■ Volume: calculations for dosage

■ Technique: choice of needle and injection method

■ Material: ensuring compatibility of materials with tissue

■ Sequence: managing the timing of effects.

These elements create a closed-loop treatment pathway. In a 3D to 9D multi-dimensional framework, material selection follows tissue texture guidelines, while medical safety is grounded in evidence-based practices related to injection techniques, needle specifications, and material properties. Combining anatomical data with technical adaptability ensures a harmonious balance among aesthetic results, medical safety, and consumer expectations.

Injection

The analysis of aesthetic medical injection techniques is organised in a pyramid, moving from foundational to advanced levels. At the base, medical safety focuses on treatment planning and anatomical knowledge to ensure procedure safety.

The next level emphasises asepsis and effective pain management. Following that, injection techniques encompass the skills needed for filler injections, highlighting precise anatomical knowledge and dosages.

At the top, aesthetic sculpture includes design (linked to ‘aesthetic safety’), anatomical application (related to

Figure 4 Multidimensional assessment model for identifying morphological imbalances and prioritising treatments

‘aesthetic morphology’), injection techniques (associated with ‘overall morphology’), and psychological aspects (connected to 'overall style’). This structure illustrates the progression from ‘medical injection’ to ‘aesthetic injection,’ highlighting key aspects of each dimension (see Figure 6).

Reassessment

Reassessment encompasses multiple factors. Psychological assessment is based on the patient’s subjective satisfaction, graded as ‘very satisfied,’ ‘satisfied,’ or ‘dissatisfied,’ reflecting their acceptance of the treatment results.

Aesthetic assessment uses the ‘Aesthetic Improvement Scale,’ presented on a 0-10 scale (0 being ‘not beautiful’ and 10 being ‘perfect’), quantifying the efficacy from an aesthetic perspective. Medical assessment focuses on the effectiveness of the treatment plan and technical execution, assessing from both the selection and execution aspects, graded as ‘excellent,’ ‘good,’ ‘average,’ ‘poor,’ or ‘incorrect.’ Additionally, establishing trust aims to foster long-term, stable doctor-patient relationships, with specific measures including providing satisfactory results, developing longterm plans, and continuous follow-up to enhance patient trust and satisfaction.

Personalised Aesthetic Plan Approach

Personalised aesthetic assessment focuses on the head and face, covering (Figure 7): 3D profile (profile imbalance), 4D Dynamics (negative emotions), 5D Ageing (age differences), 6D Gender (gender differences), 7D Ethnicity (ethnic differences), 8D Era (era differences), and 9D psychological state (psychological imbalance). Each step involves the

skeleton, ligaments, muscles, fat, and skin. The principles for developing a personalised plan include determining the overall style, refining the profile, enhancing profile tightness, softening the profile, and creating a pleasant expression10. The methods involve selecting injection points, layers, materials, capacities, techniques, and sequence, covering the entire path from comprehensive assessment to medical treatment, ensuring the plan is both personalised and scientific.

Declaration of interest Yong Liao and Liangsen Zhao are employed by Bloomage Biotechnology Corporation.

References

1. Harrar H, Myers S, Ghanem AM. Art or Science? An Evidence-Based Approach to Human Facial Beauty a Quantitative Analysis Towards an Informed Clinical Aesthetic Practice. Aesthetic Plast Surg. 2018 Feb;42(1):137-146. doi: 10.1007/ s00266-017-1032-7. Epub 2018 Jan 8.

2. Nain FB. Facial Aesthetics: Concepts & Clinical Diagnosis. 2025 John Wiley & Sons Ltd.

3. Divaris M. Decoding Facial Dissymmetry: A

Comparative Morphological Study on Human Skulls and Facial Structures. Plast Reconstr Surg Glob Open. 2025 Feb 19;13(2):e6514. doi: 10.1097/GOX.0000000000006514. PMID: 39974771; PMCID: PMC11838159.

4. Meneghini F, Bondi P. Clinical facial analysis: elements, principles, and techniques. Second edition. Springer, 2012. 10.1007/978-3-642-27228-8.

5. Injectable Fillers: Facial Shaping and

Contouring. Jones DH, Swift A (ed). Wiley, 2019.

6. Li CW, Wang CC, Chou CY, Lin CS. Customized Precision Facial Assessment: An AI-assisted Analysis of Facial Microexpressions for Advanced Aesthetic Treatment. Plast Reconstr Surg Glob Open. 2020 Mar 11;8(3):e2688. doi: 10.1097/ GOX.0000000000002688.

7. Swift A, Liew S, Weinkle S, Garcia JK,

Silberberg MB. The Facial Aging Process From the “Inside Out”. Aesthet Surg J. 2021 Sep 14;41(10):1107-1119. doi: 10.1093/asj/sjaa339. PMID: 33325497; PMCID: PMC8438644.

8. Gao Y, Niddam J, Noel W, et al. Comparison of aesthetic facial criteria between Caucasian and East Asian female populations: An esthetic surgeon’s perspective[J]. Asian Journal of Surgery, 2016; 41( 1): 4-11 9. Dayan S, Bucker B, van der Meulen J, et al.

6 Hierarchical injection techniques pyramid emphasising safety, precision, and aesthetic sculpture principles

Key points

The SHÉ Clinical Aesthetic System is built on a multi-dimensional framework, analysing facial aesthetics from 3D to 9D, covering static, dynamic, ageing, gender, racial, era, and psychological aspects

The system emphasises individualised aesthetic design, taking into account each patient's unique facial morphology, expressions, and psychological traits

Facial assessment under this system is a detailed process, incorporating analysis of skeletal structure, fat distribution, muscle dynamics, and skin condition

The Evolution of Aesthetic Medicine: Exploring the Intersection of Social Psychology, Technology, and Aesthetic Medicine. Aesthet Surg J Open Forum. 2025 Mar 13;7:ojaf015. doi: 10.1093/asjof/ojaf015.

10. Shah-Desai S,

B et al. Elevating Aesthetics: Patient-Specific Treatment with Hyaluronic Acid Fillers to Improve Appearance and Psychosocial Wellbeing. EMJ. 2023;8[2]:10-18

Sezgin

Dhillon

Figure

Figure 7 Personalised aesthetic plan methodology.

EMPOWERING NEW PRACTITIONERS THROUGH CONNECTION AND COLLABORATION

Ashley Moores reflects on the vital role of support networks, mentorship, and community in helping new entrants navigate the dynamic world of aesthetics

WITH FACE CONFERENCE 2025 fast approaching, I wanted to take the opportunity to delve deeper into the themes I explored during my talk at last year’s FACE Conference in London, UK, which revolved around empowering inexperienced practitioners in the aesthetics industry. By drawing parallels from an unexpected source rugby I highlighted the importance of support networks, mentorship, and collaborative learning in navigating the challenges of any field, especially one as dynamic and demanding as aesthetics.

In life and in our professional journeys, the people we surround ourselves with hold immense power to shape our path. This sentiment formed the foundation of my talk at FACE. Distilling years of professional and personal experiences into a concise presentation was no small task, but the core message was clear: the right people profoundly influence our growth, confidence, and success.

The energy at FACE was electric as I stood before the audience. I introduced myself and gave the audience a glimpse into my world. I shared that I’m a mother of twin 16-year-old boys, a nurse, and an educator deeply invested in the aesthetics field. My background includes being a lead

In training environments, we have the opportunity to learn not just from the trainers but also from one another. By fostering a spirit of community over competition, we can build a stronger, more supportive industry.

clinic nurse in Riverview, New Brunswick, Canada, cofounding Bloom Academy of Medical Aesthetics, and hosting two podcasts: The Silver Edition and Bloom Unscripted

Rugby and aesthetics: finding the connection

Yes, you read that right rugby. As a newly dubbed ‘rugby mom,’ I used my recent experiences in the stands to draw an analogy that resonated deeply with the audience. My sons had just started playing this rough and unpredictable sport, and I, like many practitioners new to aesthetics, knew nothing about it.

At rugby games, I quickly discovered the importance of finding my people the parents who welcomed my enthusiasm and explained the sport’s nuances. They taught me the difference between a ruck, scrum, and lineout and cheered alongside me when I screamed at the top of my lungs.

This mirrors the journey of a new practitioner entering aesthetics. Like me in the stands, they may feel overwhelmed or out of place at first. But with the right support network, they can find a safe space to learn, grow, and thrive.

Building a support network

Support networks are more than just a safety net; they are the foundation for achieving personal and professional goals. During my talk, I asked the audience to reflect on their own support systems. Who are the people they can count on in this field? These might include family, friends, patients, or colleagues who grow and learn with them, sharing both triumphs and setbacks.

Support networks in aesthetics can be cultivated in various ways:

■ Social media: platforms like Instagram and LinkedIn connect practitioners with like-minded individuals

■ Community gatherings and training: these events are opportunities to meet peers and mentors

■ Collaborative learning environments: training sessions encourage open-mindedness and unity, allowing everyone to learn from one another.

Starting a career in aesthetics can be overwhelming, but a strong support system not only provides guidance but also amplifies success.

Collaboration over competition

email: a_c_m_z@hotmail.com

One of the key messages I wanted to leave the audience with was the value of collaboration. In training environments, we have the opportunity to learn not just from the trainers but also from one another. By fostering a spirit of community over competition, we can build a stronger, more supportive industry.

During training sessions or events, such as the FACE Conference, I encouraged practitioners to connect with at least one or two new people. True collaboration comes from shared learning and open communication, and it starts with simple, genuine connections. I even had the audience turn and introduce themselves to someone sitting next to them to make a new friend. This is how unexpected relationships form.

I met some incredible people at the FACE Conference. One connection that stood out was with Darcie Verstraten, a

ASHLEY MOORES, LPN, Coowner, Silver Clinic, New Brunswick, Canada

Invest in your education. Embrace mentorship. And most importantly, never stop learning.

nurse from Aesthetic Geelong in Australia, who travelled all the way to London. We first connected on social media and made a point to meet in person, and we continue to stay in touch to this day.

Mentorship: a game-changer

Mentorship is another cornerstone of empowerment for new practitioners. Whether it’s formal one-on-one training or informal guidance, mentors can help bridge the gap between inexperience and expertise.

During my talk, I honoured my former medical director, who played a pivotal role in shaping my early career. Her mentorship gave me the confidence to take risks and learn from failures, a lesson I carry with me to this day.

In today’s digital age, mentorship can also be found online. Platforms like Patreon offer access to specialised content and virtual guidance. This industry demands continuous investment in oneself, both in terms of education and personal growth.

The double-edged sword of social media

While social media can be a powerful tool for connection and education, it also has challenges especially for new practitioners. The constant comparison to others can create feelings of inadequacy. Practitioners may wonder why others seem to have more clients, attend more events, or achieve more success.

However, it’s important to remember that social media often showcases only the highlights. Behind every polished post lies a story of struggle, trial, and error. As I told the audience, follower count does not equate to skill. What matters is authenticity, dedication to learning, and perseverance.

To illustrate this, I reached out to some of my own connections and asked them, ‘If you could tell yourself one thing when you were first starting out, what would it be?’ Their responses were both insightful and inspiring:

■ ‘Don’t pay attention to what others are doing.’ – Nicole (@NINAaesthetics)

■ ‘Be true to who you are!’ – Nurse Mandy

■ ‘It’s okay to be scared; education will be your best friend.’

– Sara Cyr

■ ‘Brace yourself.’ – Alina Morales

■ ‘Stay humble, never stop learning, and connect with peer network support.’ – Denise (@TheTreatmentRoom)

■ ‘Just start already.’ – Julie Nesbitt

These words highlight the importance of perseverance, self-belief, and community in overcoming the challenges of starting out in aesthetics.

Reflecting on growth

As I look back on the 2024 FACE Conference and my presentation, I can’t help but reflect on how much my own professional journey has evolved. Aligning myself with the right people has been instrumental in achieving my goals, and I hope my talk inspired others to do the same.

For inexperienced practitioners, the road ahead may seem daunting, but it’s also filled with opportunities for growth and connection. By building strong support networks, seeking mentorship, and embracing collaboration, they can navigate this challenging yet rewarding field with confidence.

The right people—whether they’re colleagues, mentors, or friends—have the power to transform your career and life.

Just as the rugby parents in the stands helped me understand the sport and cheered alongside me, the aesthetics community can provide the support and encouragement needed to thrive.

Since the conference, my career has undergone a significant transformation. I became the co-owner of The Silver Clinic, while my previous roles as co-founder of Bloom Academy and host of Bloom Unscripted have dissolved. These changes have taught me the importance of adaptability and leaning on a strong network to navigate the evolving landscape of aesthetics.

So, find your people. Invest in your education. Embrace mentorship. And most importantly, never stop learning.

Declaration of interest None

MINIMALLY INVASIVE SKIN REJUVENATION USING HYALURONIC ACID AND AMINO ACIDS

Elena Fasola, MD, explores the results of a prospective open-label clinical trial evaluating the combined use of Sunekos 1200 and Sunekos Performa with a High-Performance Technique to treat signs of facial ageing

FACIAL SKIN AGEING IS a complex process influenced by intrinsic actors, such as genetic predisposition and hormonal changes, as well as extrinsic factors like ultraviolet (UV) radiation and environmental pollutants. Recent studies have shed light on the cellular and molecular mechanisms underlying skin ageing, highlighting the role of cellular senescence, extracellular matrix (ECM) degradation, and oxidative stress. The skin, particularly the facial region, undergoes significant changes with ageing, manifesting wrinkles, loss of elasticity and pigmentation alterations1 Cellular senescence refers to a

state of permanent cell cycle arrest, contributing to ageing and age-related diseases. In the skin, senescent cells accumulate due to intrinsic and extrinsic factors, leading to impaired tissue function and the secretion of pro-inflammatory cytokines; this accumulation disrupts skin homeostasis and accelerates ageing processes2

The ECM supports the skin's structure, while ageing degrades the ECM, causing wrinkles and sagging due to the increased activity of matrix metalloproteinases (MMPs) that break down collagen and elastin fibres. The dermis, composed of the papillary and reticular layers, relies on ECM fibres for structural integrity. Degradation leads to the separation between the dermis and epidermis, skin laxity and reduced stem cell renewal. Fibroblasts, which are the primary represented cells in the dermis, produce the ECM's collagen elastic fibres and glycosaminoglycans3. As we age, fibroblasts decrease in both number and function4. Young dermal fibroblasts produce glycosaminoglycans, hyaluronic acid (HA) and ECM fibres like elastin and collagen. With ageing, collagen fibres reduce in number and size, increasing the ratio of type III to type I collagen, while types IV and VII

collagen also decrease. Additionally, ageing skin shows fragmentation of collagen and elastin, leading to reduced elasticity and turgor. Even oxidative stress results from an imbalance between reactive oxygen species (ROS) and the skin's antioxidant defences. ROS can damage cellular components, including lipids, proteins, and DNA, leading to accelerated ageing. Factors such as UV exposure and pollution exacerbate oxidative stress, further contributing to skin ageing4

Hyaluronic acid is a key component of skin, but its properties differ depending on its molecular weight. Low molecular weight hyaluronic acid (LMWHA), up to 200 kDa, plays a crucial role in regulating homeostasis due to its main property to stimulate fibroblasts, thereby promoting the synthesis of dermal structural elements such as collagen, elastin, hyaluronic acid and blood vessels. It also exhibits immunomodulatory effects. Conversely, high molecular weight hyaluronic acid (HMWHA) within the range of 1000–1500 kDa functions as an antioxidant also due to its water retention capability, which hydrates the skin. It also acts as a reactive oxygen species (ROS)

scavenger, thus safeguarding fibroblasts and dermal structural components7

Furthermore, ageing is associated with an increase in hyaluronidase, which directly contributes to hyaluronic acid degradation8.

Aims of the study

We are evaluating the efficacy of multiple injections of an already well-studied and clinically tested product9-11 containing free low molecular weight hyaluronic acid (50–250 kDa), in combination with a single injection of free high molecular weight hyaluronic acid (1200 kDa). Both are supplemented with a specific, patented blend of six amino acids. (SuneKos® 1200 & SuneKos® Performa respectively) on the dermis of the face area affected by chrono ageing and photo-ageing. The study aims to demonstrate enhancement in skin appearance and quality of life through improvements to the skin's health, its tropism and the restructuring of the ECM.

The evaluation of skin quality and health improvement was conducted on a group of 20 female patients.

Material and methods

The open clinical pilot trial was conducted on 20 healthy female

ELENA FASOLA, MD , Microsurgeon, is General Secretary of the Italian Association of Aesthetic and Functional Gynecology (AIGEF), Italy

adult volunteers between 45 and 65 years of age whose informed consent had been obtained. At T1, the first treatment session, both products were injected, first 3 ml of SuneKos® 1200 (HMWHA) with 25–27 G cannula and immediately after 3.5 ml SuneKos® Performa (LMWHA) with intradermal multiple injections by 30–32 G needle, according with High Performance Technique (HPT) (Figure 1); at T2, 14 days after T1 only the multiple injections of SuneKos® Performa were repeated; at T3 (14 days from T2) another injection of 3.5 ml of LMWHA SuneKos® Performa was performed to complete the whole treatment according to the treatment protocol (Figure 2).

For the assessment, data were collected by iPhone Photo at T0 (baseline), T4 (3 months after the first injection) and T5 (6 months after the first injection). GAIS to investigate the appearance improvement at T3 (before the third injection), T4 (3 months after the first injection) and T5 (6 months after the first injection) by a 5-point Likert scale to evaluate the patient tolerability to the treatment at T1, T2, T3.

Inclusion Criteria

■ Number of patients: 20

■ Healthy patients

■ Age range: 46-65 years old

“Low molecular weight hyaluronic acid (LMWHA), up to 200kDa, plays a crucial role in regulating homeostasis due to its main property to stimulate fibroblasts, thereby promoting the synthesis of dermal structural elements such as collagen, elastin, hyaluronic acid and blood vessels."

■ Female patients

■ All races included

■ Signing the Informed Consent Form.

Exclusion criteria

■ Presumed or confirmed sensitivity towards one of the contents or ingredients of the product

■ Ongoing inflammatory or infection diseases affecting the treatment area

■ Ongoing anti-inflammatory therapy

■ Patients with auto-immune soft tissue diseases

■ Patients with systemic oncological diseases

■ Predisposition to keloid scars.

High-performance technique side effects

Treatment is generally well tolerated. The most common

side effects are redness immediately after SuneKos® Performa needle injection, slight swelling localised only at the needle injection sites, and a sensation of warmth diffused to the treated area. We recorded one case of small ecchymosis after needle injection in the zygomatic-malar area that resolved spontaneously within 3 days. No serious complications were recorded.

Figure 2 Treatment Protocol. In the first treatment session, both products were injected, first SuneKos® 1200 and immediately after SuneKos® Performa; after 14 days, only the multiple injection of SuneKos®Performa was repeated; after another 14 days, the whole treatment ended with a further injection of SuneKos® Performa.

Figure 1 High Performance Technique: Scheme of SuneKos®1200 (HMWHA) and SuneKos®Performa (LMWHA) Injection Technique

PROMOTION

Results

Figure 5 5-Point Likert Scale: Tolerability of the Treatment

In total, 89% of patients showed good results regarding their appearance; data were collected by iPhone Photo (Figure 3).

Results by Global Aesthetic Improvement Scale (GAIS)

The results on the treatment efficacy, evaluated by the patients through GAIS, obtained at T3 and recorded before the third injection, showed a marked

References

1. . Shin, S. H., Lee, Y. H., Rho, N. K., & Park, K. Y. (2023). Skin aging from mechanisms to interventions: focusing on dermal aging. *Frontiers in Physiology*, 14, 1195272

2. Chin, T., Lee, X. E., Ng, P. Y., Lee, Y., & Dreesen, O. (2023). The role of cellular senescence in skin aging and age-related skin pathologies. *Frontiers in Physiology*, 14, 1297637

3. Driskell RR, Lichtenberger BM, HosteE, Kretzschmar K, Simons

BD, CharalambousM. Distinct fibroblast lineages determine dermal architecture in skin development and repair. Nature. 2013; 504 (7479): 277–81

4. Miller GF, Kligman AM. The pathobiology of skin aging: New insights into an old dilemma. *The American Journal of Pathology* 2020; 190(7): 1356-1369

5. Lee H, Hong Y, Kim M. Structural and functional changes and possible molecular mechanisms in aged skin. Int J Mol Sci. 2021;22(22):12489.

6. Taihao Quan, Gary J Fisher.Role of Age-Associated Alterations of the Dermal Extracellular Matrix Microenvironment in Human Skin Aging. Gerontology. 2015 Feb 4;61(5):427–434. doi: 10.1159/000371708

7. Sun Hye Shin 1, Yoon Hwan Lee 1, NarkKyoung Rho 2, Kui Young Park 1,* Skin aging from mechanisms to interventions: focusing on dermal aging. Front Physiol. 2023 May 10;14:1195272. doi: 10.3389/fphys.2023.1195272

8. Ye J, Zhang H, Wu H, et al. Cytoprotective

improvement compared to the baseline condition, which further improved at 3 months from the first injection (T4) with only a minimal variation or slight decline observed at 6 months after the first injection (T5).

Results by 5-point Likert scale on tolerability

Since it is an injectable treatment, it is important to evaluate the degree of tolerability of the treatment at each injection interval (T1, T2, and T3). The data that emerged are more than encouraging (Figure 4) and indicate that it is very well tolerated and that the pain sensation is reduced further after each injection.

Conclusion

Advancements in understanding the cellular and molecular mechanisms of facial skin ageing have led to the development of various therapeutic strategies, and the trend is moving towards minimally invasive procedures because, thanks to them, you can achieve a good aesthetic result through improving skin health. This treatment aimed to remodel the extracellular matrix to restructure dermis support and achieve a long-lasting aesthetic goal. Further studies would be interesting to assess how much such an effective, minimally invasive and well-tolerated treatment impacts on quality of life and the patient's level of satisfaction with their aesthetic appearance.

Declaration of interest None

effect of hyaluronic acid and hydroxypropyl methylcellulose against DNA damage induced by thimerosal in Chang conjunctival cells. Graefes Arch Clin Exp Ophthalmol. 2012; 250 (10): 1459-1466.

9. B De Servi A Orlandini E Caviola, M Meloni. Amino acid and hyaluronic acid mixtures differentially regulate extra cellular matrix genes in cultured human fibroblasts. Biol Regul Homeost Agents. May-Jun 2018; 32(3): 517-527. PMID: 29921376

10. Tedesco L. A designer mixture of six amino acids promotes the extracellular matrix gene expression in cultured human fibroblasts. Bioscience, Biotechnology, and Biochemistry , 2022, Vol. 86, No. 9, 1255-1261

11. Fasola E, Kutera EA. Pilot Study evaluating the therapeutic effects of a new pre-mixed injectable product of low molecular weight (LMW) hyaluronic acid added to six amino acids (HY6AA + Formula) in facial skin aging. JDC, August 2022.

Figure 3 57 year old patient with extrinsic and intrinsic signs of ageing, (A) before (T0) and (B) after 3 months from first injection (T4). Results captured on iPhone

Figure 4 46 year old patient with extrinsic and intrinsic signs of ageing, (A) before (T0), (B) after 3 months (T4) and (C) and after 6 months (T5) from first injection. Results captured on iPhone

BROAD-SPECTRUM SUNSCREEN FOR SENSITIVE SKIN

Isabel Diaz and Arnoldo López Baca share the results of a new study evaluating the efficacy and tolerability of a broad-spectrum UV sunscreen in reducing facial redness and strengthening the skin barrier in Chinese women

SKIN IS THE BODY’S largest organ and serves as a critical barrier against environmental aggressors. The prolonged exposure to UV radiation is known to lead to photodamage, increased transepidermal water loss (TEWL), and visible skin redness, particularly in individuals with compromised barrier function. Due to these effects, the use of sunscreen and cosmetic products to help improve this natural protective barrier and maintain skin health has become common practice and recommended by dermatologists as part of a daily skincare regimen 1-4 .

While much of the research efforts in the field have focused on people of European descent, few studies have been conducted on Asian populations5. In the Chinese population, skin sensitivity is a prevalent concern, with nearly 50% of women reporting self-perceived sensitive skin, a figure that has recently risen significantly6. Chinese females with sensitive facial skin are also reported to have more visible erythema and a poorer skin barrier than those who do not have sensitive skin7. Finally, cultural preferences for even-toned, pale skin further

drive the demand for solutions combining effective sun protection with specific cosmetics8

This study evaluated the efficacy of facial zinc oxide-based sunscreen in reducing facial redness and improving skin hydration and barrier function in Chinese women with self-perceived sensitive skin and visible skin redness.

Methods

Participants

Thirty-three (33) females who signed an informed consent form were screened and enrolled in the study; all participants had selfperceived sensitive skin with visible facial redness (as assessed by a dermatologist).

Study design

The study was conducted at the Guangzhou Landproof Testing Technology Co. Ltd, Guangzhou, Guangdong, China, between December 2023 and January 2024. The study followed a monadic design in which all subjects applied sunscreen to their entire face daily in the morning for 28 days.

Test product

The test product was EltaMD UV Shield Defense (CP Skin

ISABEL DIAZ is Director of Dermal Clinical Research at ColgatePalmolive and has 20+ years of experience in the cosmetic testing industry; ARNOLDO LÓPEZ BACA is Senior Principal Scientist at Colgate-Palmolive. He holds a Master’s degree in biotechnology and has many years of R&D experience

Health Group, Inc, USA) a zinc oxide-based sunscreen containing octisalate, bisabolol and ginger root extract, squalane, and the antioxidants vitamin E and carnosine.

Efficacy assessments

The study incorporated clinical evaluations by a qualified dermatologist (skin redness, vibrancy, and moisturisation grading) and bioinstrumentation techniques. The specific area of the face used for evaluations is illustrated in Figure 1 , with site one (blue) representing the location where the skin hydration and TEWL measurements were made, site two (purple) where the spectrophotometer-assisted skin redness measurements were made, and site three (red circle) where skin redness was measured using the Visia-CR and Image Pro Plus analysis software (IPP) on facial images captured under Standard Two Light Mode and Red Area Mode.

Evaluations were conducted at baseline (D0; the day before test product application), one week after treatment initiation (D7), and four weeks after treatment initiation (D28). An additional time point, 10–15 minutes after the first application of the sunscreen

“In the Chinese population, skin sensitivity is a prevalent concern, with nearly 50% of women reporting self-perceived sensitive skin, a figure that has recently risen significantly.”

(D0), was also considered for skin redness assessments.

Ethics

The study protocol and informed consent were reviewed and approved by the Ethics Committee of Guangdong Daily Chemical Industry prior to the initiation of the study. The study adhered to the principles of the Declaration of Helsinki and Good Clinical Practice guidelines.

Statistics

Analyses of the differences between the baseline value (D0) and the values at D0’, D7, and D28 were performed by repeated measures using the ANOVA test or Wilcoxon signed ranks test. Analysis of the Figure 1 Evaluation sites

Table 1 Summary of clinical result vs. D0

subject questionnaire was performed using a binomial test. The software SPSS 21.0 was used for data analysis. A two-tailed test was used for statistical analysis, with significance defined as p≤0.05.

Results

The results are based on the thirty-two subjects who completed the study.

The study dermatologists observed a significant reduction in facial redness grade as early as D0’, with the improvement persisting throughout the study period. Significant increases in skin vibrancy and moisturisation grade were also noted at D7 and D28 compared to baseline, with cumulative benefits observed over the study period ( Table 1 ).

Bio-instrumental assessments confirmed these objective improvements in facial skin parameters ( Table 1 ). Indeed, a progressive, statistically significant reduction in TEWL was observed, suggesting an improvement in skin barrier integrity. These changes coincided with increases in skin moisturisation. In addition, compared to the baseline, a measurable, significant decrease in facial redness was seen at all time points, further demonstrating the product’s efficacy in mitigating erythema.

Visia-CR imaging provided visual confirmation of redness reduction over the course of the study ( Figure 2A-D ). The progressive improvements in facial appearance over the study duration are further

suggesting improvements in skin barrier strength. These positive outcomes are further complemented by the excellent skin tolerability reported for the product, with no adverse events reported throughout the

“Through a combination of clinical assessments and bio-instrumentation evaluations, this study unequivocally demonstrates that the sunscreen tested is effective in reducing facial redness, with the onset of effects occurring as soon as 10–15 minutes after the first application of the sunscreen.”

supported by quantification of skin redness from the images, which showed significant decreases in redness throughout the study when compared to baseline.

Discussion

Through a combination of clinical assessments and bio-instrumentation evaluations, this study unequivocally demonstrates that the sunscreen tested is effective in reducing facial redness, with the onset of effects occurring as soon as 10–15 minutes after the first application of the sunscreen. In addition, cumulative benefits of the test product were observed over the 28-day study period with regards to TEWL, moisturisation, and vibrancy,

study period, as assessed by the study dermatologist.

Unsurprisingly, these favourable results are echoed in participant self-evaluations, with >90% of participants reporting that the product

References

1. CUTIS Medical Laser Clinics. Skipping Sunscreen: What Happens to Your Skin Without UV Protection? 2024 [Available from: https://www.cutislaserclinics.com/blog/ skipping-sunscreen-what-happens-to-your-skin-withoutuv-protection/#:~:text=Weakens%20skin%20 barrier,-Also%20referred%20to&text=UV%20rays%20 put%20a%20strain,become%20weaker%20or%20less%20 cohesive

2. Cleveland Clinic | healthessentials. How To Tell if Your Skin Barrier Is Damaged and What To Do About It 2022 [Available from: https://health.clevelandclinic.org/ skin-barrier

3. Cleveland Clinic | healthessentials. Skin Care Tips, Tricks and Trends with Melissa Piliang, MD 2022 [Available from: https://my.clevelandclinic.org/podcasts/healthessentials/skin-care-tips-tricks-and-trends-with-melissapiliang

4. Cleveland Clinic | healthessentials. Korean Skin Care Routines: What You Need To Know 2023 [Available from: https://health.clevelandclinic.org/korean-skincare-routine

contributed to reducing skin redness and sebum-associated shine, and soothed red/ sensitive skin as of the first use. Moreover, by the end of the study period (D28), >95% of participants reported the product was gentle enough for daily use on their sensitive skin and improved skin hydration and vibrancy.

Conclusion

The study supports facial sunscreen as an effective and well-tolerated daily sunscreen for sensitive skin consumers, offering broad-spectrum UV protection while improving redness, hydration, and barrier function.

Find out more at: www/eltamd.com/

5. Pan Y, Ma X, Zhao J, Yan S, Liu Q, Zhao H. The Interaction of Age and Anatomical Region Influenced Skin Biophysical Characteristics of Chinese Women. Clin Cosmet Investig Dermatol. 2020;13:911-26

6. Xiao X, Qiao L, Ye R, Zuo F. Nationwide Survey and Identification of Potential Stress Factor in Sensitive Skin of Chinese Women. Clin Cosmet Investig Dermatol. 2020;13:867-74

7. Voegeli R, Gierschendorf J, Summers B, Rawlings AV. Facial skin mapping: from single point bio-instrumental evaluation to continuous visualisation of skin hydration, barrier function, skin surface pH, and sebum in different ethnic skin types. Int J Cosmet Sci. 2019;41(5):411-24

8. Bowers JM, Hamilton JG, Wu YP, Moyer A, Hay JL. Acculturation, Sun Tanning Behavior, and Tanning Attitudes Among Asian College Students in the Northeastern USA. Int J Behav Med. 2022;29(1):25-35

Figure 2 Representative photographic images with red area mode 5 ‘skin redness’ filter (A-B) and standard 2 light mode (C-D), prior to the initiation of the treatment (D0; panels A, C) and 28 days after treatment initiation (D28; panels B, D).

Join the ESTHETIC MULTISPECI LTY SOCIETY

The largest global community in Aesthetic Medicine

www. multispecialtysociety. com

. 30,000+ Members Worldwide

Connect with like-minded peers. . KOL s, Global Experts & Peers

Access exclusive knowledge from Key Opinion Leaders.

. 150+ CME Credits

Earn CME credits and meet professional requirements anytime, anywhere.

. 20% Discount on Conference Passes

Save on world-class events like AMWC, Vegas Cosmetic Surgery, and The Aesthetic Show.

. 3,600+ On-Demand Videos

Watch live demos, scientific presentations, and workshops on the latest techniques.

. Certificate of Membership

Receive an official certificate that acknowledges your affiliation with the Aesthetic Multispecialty Society.

Subscribe today for €392 (regularly €490/year)

PRIME Readers receive 20% off. Use promo code: PRIME20

POLY-D,L-LACTIC ACID: A NOVEL APPROACH TO REDUCE UV-INDUCED SKIN PIGMENTATION

Professor Kyung-Hee Byun examines the results of her study, revealing PDLLA's potential to not only enhance skin structure but also reduce pigmentation caused by UV exposure

radiation at 2-day intervals (day 15 - day 69)

UV radiation Saline injection PDLLA (JUVELOOK) injection

Sample harvest

What led you to choose this research topic?

Building on our findings of Poly-D,L-lactic acid (PDLLA), we initiated this study to investigate whether PDLLA fillers have additional biological effects beyond promoting collagen and elastin fibre regeneration.

Our research aimed to address the damaging effects of UV radiation on the skin, particularly how it causes pigmentation changes and damages the basement membrane (BM). The BM is integral to maintaining skin structure, and its destruction contributes to visible skin damage, including irregular pigmentation. While PDLLA fillers have been used extensively in aesthetic treatments for their regenerative properties, their effect on protecting the skin from UV-induced damage has not been fully explored. We wanted to

INJECTION METHOD

determine whether PDLLA fillers could reduce pigmentation by protecting the BM from UVinduced damage.

What impact does ultraviolet (UV) radiation have on our skin?

Ultraviolet exposure is a key factor in skin ageing, promoting increased melanin production,

breakdown of the BM, and inflammation, all of which contribute to hyperpigmentation and skin degradation. When UV radiation penetrates the epidermis and upper dermis, it increases skin inflammation, oxidative stress, and immune cell infiltration, leading to cell damage, ECM degradation, and BM disruption, which allows

Injection location and area: Dermis 2 x 2 cm2

Injection volume:

500 μl (100 μl/point, 4 cc dilution)

Injection syringe:

Johns Screw Needle (27G)

melanin to move into the dermis. This disruption can lead to more severe skin conditions, such as melasma.

What was the goal of this study?

The primary goal of our study was to investigate how PDLLA filler could mitigate the effects of ultraviolet B (UVB)-induced skin

PROF. KYUNG-HEE BYUN , Professor, School of Medicine Department of Anatomy & Cell Biology, Gachon University, Incheon, Korea.

Figure 1 Study schematic diagram

“PDLLA not only addresses pigmentation but also aids skin regeneration and repair, which is something that many traditional fillers do not do.”

2 Effect of PDLLA on pigmentation

pigmentation, a common consequence of sun exposure. We formulated the following hypothesis for the study of the effects of PDLLA on pigmentation:

■ PDLLA would increase macrophage type 2 (M2) polarisation and reduce the secretion of TNF-α in UV-irradiated skin

■ The decreased secretion of TNF-α would reduce NF-κB, NLRP3 inflammasome formation, MMPs and BM destruction

■ The injection of PDLLA into UV-irradiated skin could decrease melanin movement into the dermis via the damaged BM, thereby reducing skin hyperpigmentation.

Can you share the study design?

For the validation, we conducted experiments in two ways: in vitro and in vivo. We used a mouse model that was exposed to UVB radiation to simulate the environmental damage that humans experience from prolonged sun exposure. We divided the mouse model groups into four based on the duration of radiation exposure for the experiment. After exposing the skin to UVB, we treated it with PDLLA filler (10 mg/mL in a 500 μL) and inflammatory markers (CD86, CD163, TNF-α) along with NF-κB, NLRP3,

Figure

Figure 3 Mechanism of PDLLA effect on pigmentation

MMP2, and MMP9 expressions to observe its effects on pigmentation and skin structure. This experiment went on for 8 weeks.

What was the result of the study?

We encountered three remarkable results from the study, as follows:

PDLLA increases M2 polarisation and decreases macrophage type 1 (M1) polarisation, reducing pro-inflammatory cytokine (TNF-α) in UV-irradiated macrophages and mouse skin PDLLA down-regulates NF-κBmediated NLRP3 and MMP activation restoring BM (increased nidogen, collagen IV) in UVB-irradiated fibroblasts and mouse skin.

■ PDLLA reduces BM degradation and limits melanin migration reducing persistent and recurrent melasma, which was proven by the improvement in skin colour.

Can you explain more about the mechanism of how PDLLA is effective on pigmentation?

The mechanism by which PDLLA (Poly-D,L-lactic acid) reduces

pigmentation involves regulating inflammation and tissue repair. PDLLA decreases the production of TNF-α, an inflammatory cytokine, which in turn reduces the activation of M1. M1 is associated with proinflammatory responses, while M2 is linked to tissue repair and anti-inflammatory effects. By promoting the shift from M1 to M2 macrophages, PDLLA reduces inflammation and supports healing. The suppression of M1 also leads to the inhibition of NF-κB and NLRP3 inflammasomes, which further decreases the release of MMPs (matrix metalloproteinases). MMPs degrade the extracellular matrix and damage the BM, allowing melanin to migrate into the dermis, causing hyperpigmentation. The mechanism of PDLLA protects the BM, preventing melanin migration and reducing pigmentation.

When you first saw the results, what was your impression? Was there anything particularly surprising? The results were quite remarkable. As you can see from

the figure, PDLLA is very effective in reducing skin pigmentation. We found that PDLLA significantly reduced UVBinduced pigmentation, which is often a sign of skin damage. Moreover, PDLLA was shown to protect the integrity of the BM, a critical structure in the skin that supports its structure and function. This finding suggests that PDLLA not only addresses pigmentation but also aids skin regeneration and repair, which is something that many traditional fillers do not do.

The fact that PDLLA could reduce pigmentation and simultaneously protect the skin’s structural integrity confirmed its potential as more than just a volumising agent. It reinforced the idea that biostimulators like PDLLA have a unique role in dermatology—they’re not just about cosmetic enhancement but also about long-term skin health.

What was the key finding of PDLLA?

A key finding of this study is that PDLLA has the potential to reduce dermal pigmentation by BM. PDLLA shifts macrophage polarisation from the proinflammatory M1 phenotype to

the anti-inflammatory M2 phenotype, preventing melanin migration into the dermis as well as promoting tissue repair and collagen production.

UVB exposure damages the BM, leading to hyperpigmentation as melanin moves into the dermis. PDLLA reduces M1 polarisation and TNF-α, which is linked to changes in NF-κB activity and the NLRP3 inflammasome in UVB-irradiated skin. Additionally, PDLLA decreases BM destruction and lightens skin colour.

PDLLA helps reduce chronic inflammation, preventing excessive melanin production and supporting overall skin regeneration. It stimulates collagen synthesis, strengthens the BM, and improves skin elasticity, which is essential for long-term skin health. This study suggests that PDLLA not only counters UVB-induced pigmentation but also enhances skin structure through its anti-inflammatory effects and collagen remodelling. Compared to traditional whitening or laser treatments, PDLLA offers a more comprehensive approach, addressing both pigmentation and inflammation at a cellular level. What surprised us was how well

PDLLA worked without causing significant side effects. Traditional treatments like laser therapies often have higher risks of irritation, but PDLLA provides a gentle, effective solution with minimal complications, making it a promising treatment for photoaging.

What are the potential applications of this research in the field of dermatology, particularly in treating skin ageing or pigmentation disorders?

This research opens up several exciting possibilities in the field of

dermatology and aesthetics, particularly in treating UV-induced pigmentation disorders and skin ageing. PDLLA fillers could offer a new, non-invasive option for patients seeking to address skin discolouration, sunspots, or uneven pigmentation caused by UV exposure. Beyond pigmentation, the regenerative properties of PDLLA could be leveraged to improve overall skin texture and elasticity, making it a promising option for anti-ageing treatments. By stimulating collagen production and enhancing skin repair, PDLLA fillers could help restore youthful

skin appearance and prevent further signs of ageing. Moreover, because this treatment targets the underlying structural damage rather than just masking pigmentation, it offers a more holistic approach to skin rejuvenation. As research progresses, PDLLA-based therapies could become a cornerstone in treating both aesthetic concerns and skin health

Reference

conditions associated with sun damage.

Find out more at: juvelook.com/

1. Byun KA, Seo SB, Oh S, Jang JW, Son KH, Byun K. Poly-D,L-lactic Acid Filler

Skin

Figure 4 Before and After Juvelook treatment on pigmentation. The results are shown 1 month after the first session.

ENSURING QUALITY: THE IMPORTANCE OF LYOPHILISATION FOR EXOSOMAL STABILITY

Dae Hyun Ha explains how ExoCoBio/BENEV’s patented lyophilisation process is setting a new standard for exosome-based therapies by ensuring structural integrity, long-term stability, and preserved bioactivity

THE CONCEPT OF lyophilisation is often misunderstood, and although it is a wellestablished technique for preserving biological materials, some still think of it simply as ‘freezing’. This oversimplification ignores the decades of scientific evidence and the advanced technology required to lyophilise unstable proteins such as exosomes. A successful lyophilisation process is critical for maintaining exosome integrity, ensuring long-term stability, and preserving biological activity.

This paper aims to clarify and emphasise why advanced

lyophilisation technology is an exceptional preservation method rather than a risk to exosomes in ice or water.

What is lyophilisation

Lyophilisation, also known as freeze-drying, is a drying process in which the solvent, usually water, is removed from a sample through sublimation after the sample is frozen and placed under a vacuum. It is a standard process used for the long-term preservation of water-containing substances. Unlike the typical dehydrating heat evaporation, lyophilisation minimises thermal degradation, making it ideal for sensitive biologics. Due to the low processing temperature, lyophilised products retain their structural and functional integrity.

Lyophilisation has been widely used in the biopharmaceutical industry, such as vaccines, biologics, and injectable drugs, as it offers several advantages, including increased stability, extended shelf life, easier storage and transportation, and reduced risk of contamination. The best-known example is botulinum toxin. By removing water and preserving the toxin in a dry state, lyophilisation ensures that its biological activity remains intact. These benefits are also relevant for exosome-based products.

Implications for exosomes

Lyophilisation has been validated by scientists in publications and is growing popular in exosomebased treatments. At the same time, according to the previous data, the deep freezing of exosomes at -80°C or -20°C induces aggregation or degradation to make them much bigger over time.

ExoCoBio has been leading the exosomal lyophilisation process for 9 years with multi-million dollar investment and long-term experience to show that seven quality control tests were found to have no statistical changes before and after lyophilisation. This indicates that properly lyophilised exosomes, when reconstituted with an optimised

solution, can retain 100% of their exosomal markers and bioactivities (Table 1).

Lyophilisation has clear benefits for exosome-based therapeutics, yet its impact on vesicle integrity and biological function is an ongoing area of research. Exosomes are sensitive because of their delicate lipid bilayer and protein/miRNA/lipid contents, making them vulnerable to structural damage during the freeze-drying process. The challenge is ensuring that a specialised lyophilisation method can preserve exosome stability and functionality without risking their therapeutic potential. Several studies highlight lyophilisation as a superior method for the stability of exosomes. For example:

Table 1 QC tests indicating No Statistical Changes

DAE HYUN HA , Director, ExoCoBio Exosome Institute(EEI), ExoCoBio Inc., Seoul, Republic of Korea

■ Mesenchymal stem cell freeze-dried secretome: A GMP-compliant study demonstrating exosome preservation1

■ In the freeze-dried product, a non-aggregated population of EVs was detected by nanoparticle tracking analysis; Fourier transform infrared spectra showed the simultaneous presence of proteins and lipids, while differential scanning calorimetry demonstrated that the lyophilisation process successfully occurred2.

■ Freeze-dried pharmaceuticals containing exosomes for therapy: Research shows that lyophilised exosomes maintain activity for up to four weeks at room temperature using trehalose as a cryoprotectant3.

■ HansaBioMed’s study: Findings indicate that lyophilised exosomes offer easy reconstitution, stability for up to 36 months, and enhanced performance compared to liquid formulations4.

Proprietary

lyophilisation technology developed by ExoCoBio/BENEV

Specialised manufacturing technology in ExoCoBio/BENEV exosome products differs from others due to three factors:

■ Membrane integrity: Exosomes in ice or frozen water are under strong physical stress from ice crystal formation, which leads to structural damage or aggregation.

“Lyophilisation

represents a breakthrough in the stability, scalability, and practicality of exosome-based therapeutics.”

■ Ingredient stability: Exosomal ingredients of proteins, miRNAs, and lipids are very sensitive to degradation in ice or water. Only freeze-drying can protect them, in addition to specially formulated excipients.

■ Rehydration performance: Upon reconstitution, exosomes must retain their natural size, morphology, and biological activity to ensure clinical efficacy.

ExoCoBio’s patented method (US11337419B2) addresses these challenges through a precisely engineered cryoprotectant

Figure 2 Detection of Exosomal Markers CD63 and CD81 after Reconstitution. Source: ExoCoBio, Inc.

Figure 1 Exosomal Membrane Integrity after Reconstitution (Red scale bar: 50nm). Source: ExoCoBio, Inc.

CD63/ R1

PROMOTION

formulation optimised for exosome biology.

Multiple analytical techniques are used to assess exosome stability before and after freeze-drying to evaluate the effectiveness of ExoCoBio’s lyophilisation technology.

■ Integrity of the lipid bilayer: Nanoparticle tracking analysis (NTA) and transmission electron microscopy (TEM) show that lyophilised exosomes maintain their natural structure and size distribution after rehydration (Figure 1).

■ Expression of exosome markers: Flow cytometry confirms the presence of key exosome markers (CD63, CD81), demonstrating protein integrity (Figure 2). The red curve means the detection of CD markers from the reconstituted finished products.

■ Comparative functional analysis between fresh and lyophilised exosomes: Macrophage cell studies (RAW 264.7) indicate that lyophilised exosomes retain their anti-inflammatory properties, reducing cytokine expression to levels comparable to fresh

exosomes. Additionally, dermal fibroblast cells responded to the reconstituted exosomal treatment and demonstrated the same level of collagen synthesis as well as cellular proliferation. These findings demonstrate that ExoCoBio’s lyophilised exosomes maintain their structural and biological properties, making them suitable for commercial applications such as ASCE™ and ERC™ (BENEV, US) products.

Implications for the exosome industry

The ability to lyophilise exosomes without risking their bioactivity is a paradigm shift in exosome-based therapeutics. ExoCoBio’s patented technology enables:

■ Scalability and commercial viability: Our GMP-certified manufacturing facility allows for high-volume production, ensuring batch-to-batch consistency and quality in addition to the lower cost of logistics and convenient storage at clinics.

■ Expanded applications: Lyophilised exosomes can be

integrated into pharmaceutical, cosmetic, and regenerative medicine applications without stability concerns.

Despite the growing number of companies claiming to sell exosome-based products, few have the scientific and technological capabilities to manufacture them under large-scale GMP conditions, ensure long-term stability, and validate bioactivity. ExoCoBio is the only company that has a patented lyophilisation process specifically designed for the best grade exosomes.

Concerns that lyophilisation may ‘kill’ exosomes are due to the lack of proper lyophilisation and advanced technological methods. Products such as botulinum toxins, vaccines, and therapeutic antibodies present empirical data demonstrating the value of lyophilisation.

References

1. Bari, Elia et al. “Freeze-dried and GMP-compliant pharmaceuticals containing exosomes for acellular mesenchymal stromal cell immunomodulant therapy.” Nanomedicine (London, England) vol. 14,6 (2019): 753-765. doi:10.2217/nnm-2018-0240

Conclusion

The field of lyophilisation applications ranges from relatively simple preservable foods to complex biotech products. Lyophilisation represents a breakthrough in the stability, scalability, and practicality of exosome-based therapeutics. The patented lyophilisation technology developed by ExoCoBio/BENEV effectively preserves the structure and bioactivity of exosomes and other ingredients, ensuring the product quality of ASCE™ and ERC™ (BENEV, US). With proprietary GMP-certified manufacturing, scientifically validated methods, and regulatory-compliant production, ExoCoBio/BENEV keeps setting industry standards.

Visit: www.exocobio.com

2. Bari, Elia et al. “Pilot Production of Mesenchymal Stem/Stromal Freeze-Dried Secretome for Cell-Free Regenerative Nanomedicine: A Validated GMP-Compliant Process.” Cells vol. 7,11 190. 30 Oct. 2018, doi:10.3390/ cells7110190

3. Charoenviriyakul, Chonlada et al. “Preservation of exosomes at room temperature using lyophilisation.” International journal of pharmaceutics vol. 553,1-2 (2018): 1-7. doi:10.1016/j.ijpharm.2018.10.032

4. HansaBioMed. Lyophilized Exosome Standards. HansaBioMed Life Sciences Ltd, Tallinn. Available at: galenmolecular.com/wp-content/uploads/2023/03/ Exosome-Standards-2020.pdf