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the uk’s only free of charge medical aesthetics trade magazine

This Isn’t an Ordinary Retinol Product IT’s An Extraordinary New Concept in Retinol Technology from Jan Marini Skin Research

Through the

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xpo 2012 29th - 30th april 2012 | business design centre, islington, london

also inside this issue of cosmetic News Cosmetic Gynaecology | i-lipo laser lipo | Christmas Party Legalities

cosmetic news expo 2012: The UK’S Largest Aesthetics Meeting | 29th & 30th april 2012 | www.cosmeticnewsuk.com

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Welcome to the December issue of Cosmetic News. December is an exciting month for us here at Body Media as it sees the very first Aesthetic Awards taking place at Sopwell House. As this month’s issue went to print before the awards took place you will have to wait until next month to find out who has won! We will be creating an exclusive 24-page awards supplement with our January issue, including pictures from the night and details on all the winners. This will also be available electronically for our winners to share with their customers as well as featuring on MyFaceMyBody.com and the Cosmetic Surgery and Beauty Guides websites – giving our winners the maximum exposure to the consumer. The awards were a fantastic way to end what has been another eventful year in the aesthetics industry. The end of the year is always a time to reflect and look forward to the year ahead and Antonia Mariconda does just this as she predicts the biggest trends for 2012 (p19-20). Also this month Mike Murphy takes a look at the differences between FDA approval and CE marking for Laser and IPL (p22-24) and lawyer Norman Rea takes an amusing look at the legal implications of office Christmas parties (p48-49). I am also ending the year on a high after being asked to edit a Cosmetic Procedures supplement, on behalf of Raconteur, for The Times. The supplement came out on November 30 and was a fantastic opportunity to educate the consumer about our exciting an booming industry. On behalf of all of the team here at Cosmetic News I would like to take this opportunity to wish you a happy Christmas and a prosperous 2012.

the AwArds night for your industry


Awards 2011-12 in AssociAtion with p l At i n u m

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TWELVE Providing superior lifting capacity since 1999 For more information contact your territory manager, call 020 7976 3290 or visit www.q-medpractitioner.com/uk Q-Med (UK) Ltd, 6th Floor, 10 Dean Farrar Street, London SW1H 0DX

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04 EDITOR’S CHOICE Vicky Eldridge on the SkinCeuticals AOX+ Eye Gel

06 INDUSTRY NEWS We round up the latest industry news


We report on the BODY meeting, IMCAS India and the AQ Skin Solutions Seminar

12 COSMETIC NEWS EXPO 2012 Why you should book now for the Cosmetic News Expo 2012 and take advantage of our early bird offer

16 PEOPLE IN PROFILE We chat to the man behind MyFaceMyBody, Stephen Handisides about his plans to take the brand global

19 TRENDS Antonia Mariconda reflects on current aesthetic market and looks ahead to 2012

22-24 LASER AND IPL –FDA VERSUS CE Mike Murphy on how the CE Mark compares with FDA approval for medical/cosmetic lasers and IPL devices

29 CLINICAL STUDY We give an overview of a recent dermatological study measuring the efficacy of i-Lipo™ laser lipolysis treatments in reducing cellulite, thigh and abdomen circumferential measurement and collagen synthesis

3 3 I N N O VAT I O N S – CO S M E T I C GYNAECOLOGY David Leahy on the uses of laser in cosmetic gynaecology

38 Q&A We speak to Leslie Flethcer, the innovator behind the ArqueDerma™ Artistic Restoration Lift™

40 PRODUCT FOCUS We take a look at the Lumixyl skin brightening system


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Sk i n Ce u t i c a l s AOX + Eye G e l They say the eyes are the ‘window to the soul’ so it is no wonder that so many of us are concerned about keeping our eyes looking fresh and young. The delicate skin around the eyes is one of the first areas to show the telltale signs of ageing due to unique biological traits, which make it less resistant to UV radiation and other environmental insults that cause damageing reactive oxygen species (ROS) to bombard skin. As someone who smiles a lot I am prone to ‘laughter lines’ and have noticed more and more wrinkles appearing around my eye area as I have reached my 30s. Of course botulinum toxin injections help minimise this but what about the rest of the eye area? The thin skin around the eyes can’t tolerate harsh sun filters or high concentrations of actives. Therefore a daily antioxidant optimised for the anatomy of under-eye skin is needed to defend this delicate area from constant exposure to environmental aggressor. SkinCeuticals has recently launched a new product – AOX+ Eye Gel. The company has never before been able to get its antioxidant formula into a gel format, but now they have and I for one am very happy about it! Not only is the product very cooling and soothing, which is great for tired eyes, but it both protects against damage and corrects it. Following Duke-patented vitamin C technology, this breakthrough serum-ina-gel contains a precise and synergistic antioxidant combination of phloretin, L-ascorbic acid, and ferulic acid to help protect the eye area from oxidative stress, while targeted actives revive under-eye skin and reduce the appearance of puffiness. Instead of encapsulating the actives in solution, the open matrix delivery system is comprised of a gel network that suspends the actives in an acidic serum. It maintains the integrity of the solution until it makes contact with the skin. The serum releases from the open matrix in a controlled manner, leaving the empty gel network on top of skin to protect the barrier while driving actives to the target site. The serum is then released to the target site for maximum bioavailability. Clinical results using a Laser Doppler Perfusion Imageing showed that daily application of AOX+ Eye Gel significantly improved microcirculation reducing puffiness and under-eye bags. I have just started using the product and can’t wait to see the results.

We round up the latest product news

46 ABSTRACTS We round up the latest clinical studies

Meet the Cosmetic News team Charlotte Body Publisher 01268 754 897 charlotte@creativemedialtd.co.uk

Peter Johnson, Art Director 01268 754 897 peter.johnson@creativemedialtd.co.uk

Norman Rea takes a light hearted look at the pleasures and potential pitfalls of office Christmas parties

Vicky Eldridge Editor 01268 754 897 M: 07940 083 677 vicky@creativemedialtd.co.uk

Loraine Winter Designer 01268 754 897 loraine@creativemedialtd.co.uk


Emilia Cops Associate Publisher 01268 754 897 emilia@creativemedialtd.co.uk

Shauna Peters Production Assistant 01268 754 897 shauna.peters@creativemedialtd.co.uk


Dr Peter Prendergast on how the European College of Aesthetic Medicine is helping practitioners to up their skills in aesthetic medicine

5 2 D AT E S F O R T H E D I A RY Training course, conference and meeting dates

Hollie-Jane Dunwell Account Manager 01268 754 897 hollie.jane@creativemedialtd.co.uk DISCLAIMER The editor and the publishers do not necessarily agree with the views expressed by contributors and advertisers nor do they accept responsibility for any errors in the transmission of the subject matter in this publication. In all matters the editor’s decision is final.

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News - Industry News

Receive Cosmetic News electronically and help save the environment

Joining forces DestinationSkin and Renew Medica have announced a merger to create an industry leading chain of aesthetic beauty clinics in the UK, offering a broad range of advanced body and skin care treatments and products. The merged Company will have a total of 23 clinics with a nationwide presence and a turnover of £10m. Business integration will start immediately, with the merged Company being led by Ella Tracey, current CEO of DestinationSkin. Ella has considerable knowledge of the aesthetics industry having built the DestinationSkin brand over the last three years. As CEO, Ella will develop a management team capable of delivering significant growth for the group and establish the new company as a dominant player within the fragmented aesthetic beauty market.

L’Oreal USA acquire Clarisonic®

While many of us still love flicking through the pages of a magazine, nowadays more and more people are reading Cosmetic News electronically. and online. Not only does receiving the magazine this way help save the environment by cutting down on printing, but it is also a great way to make sure you have a chance to read our latest issue, even if you are on the go. If you would prefer to receive Cosmetic News this way then just email Lisa Blatch at lisa.blatch@creativemedialtd.co.uk or call 01268 754 897.

L’Oréal USA and Pacific Bioscience Laboratories, Inc. (PBL) has announced a signed merger agreement. PBL’s Clarisonic® is the market leader in the rapidly growing areas of sonic skincare devices, topicals and technology. “L’Oréal brings powerful marketing, distribution, and R&D synergy to the Clarisonic® agenda,” said David Giuliani, CEO and co-founder of PBL. “L’Oréal shares our vision for ingenuity and dedication to quality”. “This is a strategic acquisition for L’Oréal,” said Frédéric Rozé, President and CEO of L’Oréal USA. “Devices are rapidly emerging globally as an important new skin care category. Clarisonic® is successful and the fast growing premium brand in this segment. The merger, subject to the approval of PBL’s shareholders and other closing conditions, is expected to close in December, 2011.

Debbie Bannister joins Heather Irvine Aesthetics Academy Former Q-Med senior training manager Debbie Bannister has joined the team at the Heather Irvine Aesthetics Academy as a lead trainer. The Yorkshire-based training academy was founded by Heather earlier this year. Debbie’s appointment complements the dedicated team which includes a plastic surgeon, dentist and business consultant. Together Heather and Debbie have more than 20 years experience in the aesthetics industry. Heather has owned her own clinic in Yorkshire for 12 years. She is a qualified medical  aesthetics teacher and Independent Nurse Prescriber,

has previously worked as a consultant trainer for Q-Med and is currently an advisory board member and consultant trainer at Allergan. Debbie brings almost 10 years training experience to the academy and has worked throughout the country, including several years in central London and on Harley Street. The comprehensive course programme and content reflect the trainers’ experience and skills. Courses include foundation and advanced filler and  botulinum toxin, tear trough, lip masterclass, micro-cannula, Juvederm Voluma, dental block and business development.

New website promotes VShape

Cosmetic News Goes Classified

A new website has been launched to educate patients about the Accent VShape treatment. The site www.myvshape.com includes FAQ’s, testimonials from patients and doctors, before and after galleries and a ‘find a practitioner’ section. The VShape is a facial contouring treatment which allows you to provide a completely non-invasive and long lasting alternative to injectables and plastic surgery. Utilising the latest in ultrasound technology and combining the power of radio-frequency, the Accent VShape eliminates fat deposits found around the jowl and neck area and tightens sagging skin. Incorporating ABC Lasers’ patented In Motion technology, these brand new modules allow for safe, pain free and effective treatments with no risk of injury and minimal downtime.

Are you looking to recruit new staff, find new premises, sell equipment or promote training dates? Cosmetic News will be launching a new classified section in the magazine and online from January 2012, and these are just a few of the needs that can be met by taking out a classified advertisement. With rates starting from £200+VAT, classified advertising is a costeffective way to get your message across and have a consistent presence in Cosmetic News, making your return on investment more tangible. If you are interested in taking out a classified ad, or to find out more, contact Hollie Dunwell on 01268 754 897 or email hollie.jane@ creativemedialtd.co.uk




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xpo 201 2 29th - 30th april

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st an d 58

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Mini 360 Protocol for the face and neck Photos courtesy: James Chan, MD



AFT 570 SR

Photos courtesy: Fernando Stengel, MD


Pixel Laser

Photos courtesy: Amber Brown, MD

Multiple technologies can be combined during a single session or repeated frequently and spread out over 60 days. • When performed in a single treatment session, the Mini Laser360TM program consists of AFT for pigment and vascularity, ST for skin tightening, and Pixel for fractionated skin resurfacing. • The Traditional Laser360 treatment consists of 4-6 treatment sessions, layering multiple technologies (AFT, ST and Pixel), spaced about 10-15 days apart over a 60-day period.

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AFT 420 Acne

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Pixel Laser

Photos courtesy: Bhupendra Patel, MD


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News - Industry News

Consulting Room™ Golf Challenge 2012 Control the pain of cosmetic injections

INSTANTLY with a clinically proven topical anaesthetic

Following the success of its 2011 Golf Challenge, The Consulting Room™ has announced details of its 2012 tournament. The event will take place on May 19-20, 2012 at The Belfry hotel on the outskirts of Birmingham, and will encompass golf, fine dining and a chance to network with other industry professionals. Clinics and industry suppliers can enter in teams of two to compete for the Consulting Room Challenge Cup. But if you can’t find a partner, they will aim to find one for you on the day. The tournament will be split into a team stableford event The 2011 Consulting Room Challenge Cup winners, and single stableford event. Trophies will be awarded for the Jerry Loveday and David Patten from sk:n team of two with the best combined score; nearest the pin; longest drive; best male and best female golfer; alongside a ‘hacker’ for worst score on the day trophy. A range of overnight packages for both the golfer and non-golfer, including luxurious spa packages, have been organised. For more details visit www.consultingroomgolf.co.uk.

Sonia Norman joins Intraceuticals Sonia Norman has joined the team at Intraceuticals. Sonia has worked in the medical aesthetic arena for nine years, and is very excited about joining the company. She said “I see a real gap in the market for this results based treatment, as it delivers overall skin plumping and radiance, non-invasively.” Previously Sonia has been involved in running an aesthetic clinic, delivering marketing support and training to clinics, and has extensive sales experience in the laser, IPL and radiofrequency devices market.

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Report examines challenges and opportunities in skincare market Skincare brands are failing to engage with a significant proportion of today’s users, says a new report from Datamonitor. Issues with brand loyalty, too much choice and ineffective marketing all emerged as problem areas, even as the industry faces the potential for significant growth and huge profits in the next few years. Datamonitor’s report – “The Future of Skincare: Consumption trends and product preferences” – highlights key areas of opportunity and provides recommendations for brand owners who want to win favour with today’s consumers, but it also shows that opportunities are being missed. “The emotive nature of personal care products means that consumer are inherently brand loyal, with some 55% choosing to stick with a tried and tested brand rather than try out a new one,” explains Michaela Peck, report author and analyst at Datamonitor.  “In addition, our research shows that consumers are becoming fatigued by the amount of product choice.  This leads to an unfavourable situation in store, with customers ‘reverting to type’ and choosing to ignore product innovation.” Datamonitor’s research highlights the extent to which new skincare product launches are failing to allure today’s personal care consumers, with half of respondents admitting that they fail to notice new facial skincare (49%), body skincare (50%), and suncare (54%) products launched. The situation is not helped by marketers not understanding what claims consumers want to see. Datamonitor research shows that many are losing “the claim game”. Consumers are interested in products which speak about freshness, purity, and come recommended by medical professionals, but relatively few brands are actually tapping into this. “The need for skincare brands to better engage with consumers is evident,” continues Michaela. “Companies need to address the confusion and frustration that results from overextended product lines and ensure that customers understand the true value of the product.”   Companies that get it right will reap huge rewards, however.  Globally, per capita usage of facial skincare up to 2015 is forecast to increase across 19 out of 20 major markets. 

s e e u s at

CosEmetiC news www.CosmetiCnewsuk.Com

xpo 2012 29th - 30th april 2012 | business design Centre,

islington, london

sta nd 58

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on the scene

ON THE SCENE Out and about in the industry this month

BODY Conference, Royal Society of Medicine, London Face Ltd hosted the third annual BODY conference at the Royal Society of Medicine in London last month. The sister conference to FACE was launched to provide a meeting dedicated purely to body aesthetic treatments and advances. The first day’s agenda was split into ‘Non-Surgical’ and ‘Surgical’ with the morning’s presentations in the surgical session sparking debate over whether or not non plastic surgeons should be performing more invasive body contouring procedures.

The JMSR girls (from left to right) Yvonne Thompson (senior trainer), Naomi Capello (trainer) and Leigh Wilson (trainer)

The Non-Surgical progarmme included a panel discussion with Dr Bruce Freedman, Mr Chris Inglefield, Dr Chantal Sciuto, Dr Fernando Urdiales Galvez and Dr Nada Soueidan on ‘Non-Surgical Body Contouring – Where Are We Today?’ , as well as an insightful presentation by Dr Geoff Bond on ‘Lifestyle Changes for Health and Beauty: Darwinian Insights’. Professor Marco Gasparotti, who opened the conference last year, was back again this year to share his knowledge and experience in growing a business in this sector as part of ‘An Evening With’. Following a champagne and canape reception, guests were invited to spend the next few hours listening to Professor Gasparotti share his pearls of wisdom and ask questions as part of the interactive session. The informal evening event has become a highlight of the conference and took place at the end of the first day of the meeting. Professor Gasparotti runs a successful cosmetic clinic in Rome and had given an earlier presentation on buttock augmentation using autologous fat transfer. Sunday’s programme saw the ‘Non-Surgical’ agenda continue alongside sessions on ‘New Innovations’. Topics covered in this part of the programme included ‘A Novel Monotherapy Hyperimmune Caprine Sera in the Treatment of Pathological Fibrosis/Vasculopathy and Neurological Disease Implcations for Wound Healing’ by Professor Syed Haq, Lasers for the Use of Scar Revision’ by Dr Tapan Patel and ‘An Update on the Science and Applications in Stem Cell Therapy’ by Dr Ali Ghanem. The event was supported by a number of exhibitors including ABC Lasers, AesthetiCare, BTL Industries, Candela/Syneron, Carleton, Chromogenex, The Consulting Room™, Cynosure, DermaQuest, Galderma, Hamilton Fraser, JMSR, Lifestyle Aesthetics, PronoKal, RioBlush, Sigmacon, SilDerm, Sound Surgical, Tekno Surgical and Wigmore Medical.

Professor Marco Gasparotti with Dr Ravi Jain

A number of exhibitors hosted workshops at the event including Candela/Syneron who gave a very popular workshop on ‘The Gentlelaser challenge’, showing hair removal is of continued interest. The

challenge had owners and users of hair removal systems looking in detail at how they can improve the profitability of their business. As hair removal continues to grow as a treatment sector and with practitioners offering a more varied range of treatments, the emphasis is on efficacy across the range of skin and hair types and speed of delivery. The workshop also provided delegates with tools to analyse their business. Of the topics covered, improving profits and the dilemma posed by Groupon, were two of the topics debate. 10


IMCAS India The UK aesthetics industry was strongly represented at the IMCAS India 2011 congress in November. Dr Bob Khanna presents at IMCAS India The event took place at the Leela Kempinsli Hotel, ideally located in the gateway business district of Gurgaon, New Dehli. A number of UK practitioners including Dr Tapan Patel, Dr Raj Acquilla, Malti O’Mahony and Dr Bob Khanna travelled out to New Delhi for the event. Other familiar faces from the UK included Professor Nick Lowe who presented on ‘What’s new in cosmeceutics in the UK?’ Dr Khanna was also given the honor of being invited to be on the faculty for the two-day event and gave a lecture on ‘What’s new in masseteric and peribuccal toxin injection?’ as well as co-chairing a session on ‘Fillers, Toxins, Peelings, Cosmeceutics and Lipolytic Raffi Eghiayan (Face Ltd), Dr Bob Khanna, Malti O’Mahony, Dr Tapan Patel and Dr Raj Acquilla Treatments’ along with Dr Philippe Deprez and Dr Tamara Griffiths. A highlight of the event was the IMCAS India Industry Tribune, a session dedicated to the economic and financial evolutions of the aesthetic market, focusing of course on the Indian market. Representatives of major aesthetic medical companies, financial analysts and medical and economic journalists were invited to present the last updated information on the market and its potentialities.

AQ Skin Solutions Seminar, Melia White House Hotel, London SkinGeeks hosted an exclusive oneday seminar exploring stem cell and growth factor technology in cosmetics to mark the UK launch of AQ Skin Solutions in London last month. Dr Ahmed Al-Qahtani, an innovator Dr Al_Qahtani gives a live demonstration in growth factor technology and the inventor of the patent pending range of AQ products, flew in from the States to introduce the range and give a presentation on ‘Stem Cell and Growth Factor Technology in Cosmetics – The Future’. He also gave a live demonstration on the ‘Recovery Complex Procedure with Dermastamp’’. The meeting explored the relationship between growth factors and stem cells; the function and importance of growth factors in the body; he role of growth factor therapy in medicine and cosmetics; the safety of growth factors for topical application and the implications surrounding the use of human-sourced growth factors in cosmetics.



Awards 2011 in AssociAtion with cosmetic news

Cosmetic n ews E www.cosmeticnewsuk.com

xpo 2012 29th - 30th april 2012 | business design centre, islington, london

rd of fe r an d Ta ke ad va nt ag e of ou r ea rl y bi Ex p o 20 12 s w Ne ic et sm Co e th r fo w no b o ok Everyone likes a good discount, especially at this time of year, and that is why we at Cosmetic News have extended our early bird booking discount for the Cosmetic News Expo 2012 until the end of 2011. Since its launch in 2010, the Cosmetic News Expo has become one of the ‘must-visit’ events in the aesthetics calendar. Taking place once again at the Business Design Centre in Islington, the event will be held on Sunday April 29 and Monday April 30, 2012. The Cosmetic News Expo is the UK’s largest aesthetic conference and exhibition, bringing together more aesthetic practitioners under one roof than any other meeting. As well as this it offers aesthetic professionals the chance to gain CPD accredited education at the same time as networking and exchanging information with their peers and finding out about the latest technologies and products on the market. Entry to the exhibition and workshops, as always, is free but, due to demand, we will be introducing a small charge for the conference for 2012. The tickets will cost £45 per day for the 2012 conference or £80 for both days if you book in advance or £75 per day/£150 for both days if you pay on the day. A complimentary lunch



will be incorporated into the delegate package, with refreshments provided throughout the conference breaks. You will also receive a VIP invite to the Cosmetic News Expo after show party. Our early bird offer, which is only open until the end of this month (December 30, 2011), will entitle you to 10% off the price of an advance ticket – an offer that is well worth taking advantage of.

Train with the best to stay ahead of the rest The Cosmetic News conference is an excellent opportunity to gain CPD accredited education and see the very best UK and international speakers, discussing the latest topics and demonstrating the most up-to-date techniques in aesthetics, at the fraction of the cost of other industry events. This year we will be catering for both the beginner and the advanced practitioner with masterclasses aimed at these two distinct audiences.

Cosmetic News Exp o 2012 preliminar y conference pro gramme Sunday April 29

M o n d ay Ap ri l 3 0

9am-10am Coffee and Registration/Exhibition Viewing

9am-10am Coffee and Registration/Exhibition Viewing



11am-11.30am Coffee break

11am-11.30am Coffee break




1pm-3pm Lunch and exhibition viewing

1pm-3pm Lunch and exhibition viewing




5pm-6pm Exhibition Viewing


7pm Party

5pm-6pm Exhibition viewing

Key topics for 2012 include: • • • • •


Giving you the time you need to network, do business and learn Often when you attend conferences there is not enough time to look around the exhibition, without missing out on the educational programme, but at the Cosmetic News Expo, we give you plenty of breaks to allow you to not only enjoy some food and respite and networking with your peers, but also to make sure you have plenty of time to speak to our wide range of exhibitors. The Cosmetic News Expo brings together more aesthetics suppliers under one roof than any other event in the UK. Our exhibitors are made up of the key manufactures and suppliers in the industry, making the Cosmetic News Expo a must visit for those new to the industry who are trying

• • • • •


to source suppliers and busy practitioners who want to be able to see all their reps under one roof. And because our exhibitors are keen to attract practitioners to their stand, many often offer exclusive show deals. These are the type of deals that can give you great margins and that you wouldn’t necessarily get if you didn’t attend. In tough trading times these are the kind of deals that can really help your business to boom. With more than 40 exhibitors already signed up for 2012 and with Syneron/Candela on board as our Silver Sponsor this is one opportunity you can’t afford to miss.

Party time Sometimes the best contacts can be made and the best business can be done in a social setting and we at Cosmetic News realize the value of that so that is why we are also offering all delegates a complimentary VIP invite to the post show party, which is a fantastic opportunity network with speakers and

exhibitors and let your hair down after the show. As the Olympics are coming to London in 2012 we have decided to honor this momentous occasion by giving our after show party an Olympian theme. The party will take place at the Pitcher and Piano in Islington on the evening of Sunday April 29, following the first day of the Expo. This dynamic and exciting venue has a fantastic atmosphere and is just a stone’s throw away from the Business Design Centre and, as the last two years have shown, the after show party is one of the highlights of the event. Tickets for non-delegates and guests for the party will cost £10.

To book your place and to take advantage of our exclusive early bird discount visit www.cosmeticnewsuk.com or call 01268 754 897 before December 30 2011. cosmeticnewsuk.com


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People in Profile - Stephen Handisides

Not just a pretty face (o r bo dy)

As Stephen Handisides prepares to host the Aesthetic Awards this month we caught up with the young entrepreneur to find out about his latest brainchild – online skincare retailing – and how he plans to make MyFaceMyBody a global brand

Since Stephen Handsides launched MyFaceMyBody in 2009 the Kiwi-born entrepreneur has become one of the most recognised faces and personalities in the aesthetics industry. Steve has always had a passion for creative sales and marketing, and it is this that has enabled him to not only market his own brand but to be able to help others market theirs. After studying for a degree in Commerce, with a double major in marketing and management and an Arts degree in Spanish, Steve went on to work in a variety of sales and marketing roles. But it was when he arrived in London in 2005 that he had his first foray into the world of aesthetics, working with two different cosmetic injectable brands. During this time Steve met a lot of aesthetic practitioners and started to realise that, having come from the NHS, many practitioners were baffled by the concept of having to suddenly promote and market their services commercially to consumers. He had also long been interested in the power of video and film in communicating marketing messages and set up his own production company, Handi Productions. Recruiting young and forward thinking production staff to work with him, Steve won accounts for big names, such as Ernest Jones, and quickly realised the potential in offering video production services to aesthetic practitioners to use as marketing tools to the patients both in their waiting rooms and online. He says, “I saw a niche market in producing video content for doctors and plastic surgeons to help consumers overcome the fears they have about cosmetic procedures and to encourage them to pick up the telephone and book a consultation.” At the same time Steve, who was now regularly working as a model after winning the 2006 16


Specsavers Spectacle Wearer of the Year competition, recognised that, although consumer interest in cosmetic surgery and aesthetic procedures was beginning to boom, his insider knowledge highlighted what a lot of misinformation there was out there and how confused many consumers were. “I had many friends who had had problems with surgery because of not having the correct information”, he says. “I felt that there was a gap in the industry for a consumer focused site where they could come along and get accurate advice on treatment so they could make an informed decision about whether or not cosmetic surgery or nonsurgical treatments were right for them.” It was these three things that came together to form the MyFaceMyBody (MFMB) concept.

MyFaceMyBody Launched in February 2009, MFMB was originally set up as an online resource for consumers looking to have cosmetic procedures, but the brand has now evolved and grown to encompass beauty, fashion and lifestyle too. The website carries over 10,000 pages of independent treatment advice as well as 1,500 educational videos, news, blogs and a forum. The user-friendly website also has an online shop and of course MyFaceMyBody TV, the UK’s first television programme dedicated to cosmetic surgery, non-surgical procedures, dentistry and well-being which is now broadcast on InformationTV, Sky Channel 231 and Freesat 402 as well as on the site.

One of the original features of the site, which has remained one of its biggest USPs, is its video based physician locator. Patients can look for a specialist and then watch videos showcasing the practitioner, the facilities and the procedures they offer. This has proven to be a fantastic tool for patients, but also for the practitioners who want to increase their exposure and be seen as an expert. Steve explains, “We did some research how consumers behave online and what their fears are. Using video you can effectively create the whole experience of that clinic online in a very concise and easy to digest way. Role-playing the consultation process was also key because people had a lot of questions about that and were worried about what was involved.” One of the things that sets MFMB apart is the fact that it is not just an information resource for patients, but that it also offers an extensive marketing service to the practitioners signed up to its packages by helping them find creative ways to promote their services through social media, video, website design and television. Steve’s knowledge and expertise in internet marketing, social media and online video marketing have also seen him be invited to speak at various international conferences and to write for trade magazines, including Cosmetic News. “To date we have done more than 1,000 videos with 150 clients and by integrating video with the right content on their website has increased their online conversions on average from about 30% to 80%” he says. “Some of our clients were paying a lot for PPC advertising and they have been able to reduce their spend on that because their conversion rates are increasing.” The MFMB TV show has been one of the big success stories of the brand, allowing Steve to not only raise his own celebrity, but also to promote his team of carefully selected expert practitioners who are listed on the site, to the consumer. Steve

already had experience in presenting, so he was the natural choice to front the show. Each episode is designed to be entertaining as well as educational and informative. Viewers can watch Steve undertake challenges in order to bust some of the myths surrounding the industry, including the now infamous occasion where he jumped out of an aircraft with two breast implants strapped to his chest to prove how strong and durable they are. The programme and site also encourage viewers to conduct regular polls and surveys, bringing fresh statistics and trend information each month on hot topics. “During the last series we travelled round the country and talked to different experts as well as to consumers about how they defined beauty. Off the back of that I have now been approached to do a book, which is awesome”, Steve says.

Another brilliant idea The newest addition to the MFMB site, and Steve’s latest innovative idea, is the MFMB online shop, selling professional skincare directly to the consumer online. The shop includes videos explaining how to choose the right skincare brand as well as a dermatologist devised 30-second skin test, which then recommends the right products for consumers based on their individual skin needs and concerns. It also includes skincare tips and trends and enables consumers to search for products by type i.e moisturiser, night cream, eye cream; by skin condition or by brand name. It also has a section specifically

dedicated to male skincare needs, recommending the best products for men. “The skin test has 10 simple questions about your lifestyle and your skin”, explains Steve. “It takes a few seconds then it recommends the active ingredients that you should be looking for in skincare products. The products are all colour coded on the website so it will tell you if it has the ingredients you are looking for in it. That has been huge.” With its online shop proving a hit with consumers, Steve realised that he could utilise the same concept to help clinicians with selling their own skincare. He explains, “When we were talking to clinics about selling skincare online they didn’t want to have to stock all the products or have to go to the post office to send the products out so what we decided to do was join in with people like Wigmore and Med-fx and take away all the pain of selling skincare online. Of course they can still sell products in their clinic but this enables them to have their own online shop without any of the headaches.”The biggest challenge, and what has now made the shop such a unique concept, was devising something that, rather than directing patients away from the clinic’s own website, enabled them to buy their products from the clinic they trust even though the shop and its content are managed by MFMB. Steve and his team spent 18 months developing software specifically for this purpose. He explains, “Usually if you want to sell someone’s products on your website, when you go to check out it takes you to another website. You lose

about 50-60% of people at that point because they don’t have a relationship with the other site. What we decided to do was develop software so we could have a skincare shop that right through to check out did not take you away from the clinic’s website. We are on about 200 websites now and they only pay about a £1 a day to have the shop. What is also great about it is that, because the shop has updated skincare news written by our journalists, so they get fresh content on their site all the time. We give them some of our library treatment videos to have on their site.” Steve has also created badges for the clinics who have the shop saying ‘take our free skin test’ which has proved to be a fantastic tool in encouraging clients to buy skincare. “We have found that it is a much softer sell and patients are asking the clinics about the skin test which makes it easier to them talk about skincare.” It is this vision and passion for constantly evolving the MFMB brand that has made Steve’s business double year on year and with the UK side of the business now really taking off, he plans to take the brand global, launching into the US and Australia and New Zealand in 2012. The MFMB show will also be back again for a new series and Steve has some more innovative video marketing concepts up his sleeve. But before all that Steve has another important job to do and that is donning his tux to present the first Aesthetic Awards in association with Cosmetic News on December 1, and we can’t think of a better man for the job.

Rosmetics is pleased to obtain distribution of Magic Needle, blunt cannulae, within the UK. Magic Needles are probably the best known of all blunt cannulae and are available in a wide range of diameters and lengths, to suit most procedures. Rosmetics will be offering training for all medical practitioners at our training centres in London, Birmingham and Scotland.. For further information please contact: Tel: 0845 50 50 601 Email: info@rosmetics.co.uk www.magicneedles.co.uk

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e m b r a c e

l i f e


Through the looking glass As the year draws to a close, Antonia Mariconda reflects on the highs and lows of the aesthetic industry and looks ahead to 2012, forecasting the trends and predicting what will lead the way in the New Year


here is no such thing as a ‘quiet’ year in the busy, fast-paced world of aesthetic medicine. I always say that “for as long as there are mirrors in the world, there will always be a business in cosmetic

Antonia Mariconda, also known as The Cosmedic Coach, is recognised as a leading authority on health, beauty and cosmetic surgery in the UK. Quoted in publications such as Top Santé, and newspapers such

medicine”. 2011 has certainly not been a dull year. Many official industry reports predicted that it was set to be another year of growth, despite the recession, and they were right: The non-surgical sector has continued to expand, and growth in the non-surgical sector is expected to be even stronger once the economy recovers. Injectable toxins and fillers remain firm favourites in terms of nonsurgical treatments, In challenging economic times

as The Evening Standard, and Daily Mail, Antonia is also a national health and beauty journalist and the author of The

Essential Guide to Acne published in September 2009 (Forward Press), and most notably The Cosmetic Surgery Companion

– Look and Feel Beautiful (Apple Press) 2010. In her role as The Cosmedic Coach, Antonia advises clients around the world on where and where not to shop for cosmetic surgery, beauty and anti-ageing treatments. Her client list includes A-list celebrities, royals and VIPs.

Dr Mike Comins says, “it has not been uncommon this year to see several patients who are looking for cost effective alternatives to cosmetic surgery, I have treated many patients this year who had originally opted for a surgical face-lift but found they could not afford it, so they looked for the best alternative via cosmetic facial procedures”. Growth in the non-surgery sector is expected to be more pronounced than in invasive surgery sectors, such as facial surgery in 2012, as less invasive alternatives become increasingly available. In line with patient demand injectable toxins and fillers will continue to grow in 2012, botulinum toxin remains the most popular non-surgical treatment, and

I predict that in 2012 it will continue to be the number one facial aesthetic treatment as it is safe, effective and in the right hands, gives a very natural look. Facial rejuvenation has also seem major developments in radio-frequency, which really seems to have come of age via ePrime and eMatrix from Candela, which are set to lead the way in 2012 for non-surgical lower facial lifting and skin tightening. Dr David Eccleston, clinic lead at Medizen states “Radio-frequency procedures from ePrime and eMatrix eliminate the ‘guesswork’ from earlier technologies such as Thermage and Accent”. As competition from new rival manufacturers intensifies Thermage has stepped up its technology with the advent of the new CPT system, which has presented some interesting results. The system represents a leap forward in skin tightening and contouring technology. Superior results and greater patient comfort are being marketed as the core of the new system, which is leveraged via Comfort Pulse Technology™ and a vibrating hand piece for more comfortable treatments. Laser skin rejuvenation remains popular. Fastdeveloping laser and micro-current technology procedures currently only available via larger providers (as the development of these types of procedures requires a high level of investment) will become available more cheaply, and will be affordable to smaller clinics and other practitioners

“There is no such thing as a ‘quiet’ year in the busy, fast-paced world of aesthetic medicine...for as long as there are mirrors in the world, there will always be a business in cosmetic medicine”.” cosmeticnewsuk.com



OPPORTUNITIES • Demand for male cosmetic procedures is currently growing faster than that for women, and there will continue to be opportunities for expansion in this area of the market in 2012 • Awareness of cosmetic operations and procedures gone wrong may increase consumers’ knowledge of the industry, thus benefiting registered and reputed surgeons and cosmetic doctors – if you are not already registered think about getting yourself on a professional register. • The abolishment of Default Retirement Age (DRA) in April this year will allow both men and women to work well into their 60s, reinforcing the growing desire to look younger.

in 2012. 2011 was a year that saw the refinement and improvement of a lot of existing techniques and technologies elevating them into new and more ‘effective’ league. Vaser Liposuction saw real developments this year and was very much sought after, as were hair transplant procedures fuelled by the media coverage of celebrities such as Wayne Rooney and James Nesbitt. Dr Comins adds “It’s been very much a year of looking at treatments that have been around for a while and refining and improving them such as hair transplants using FUE, which gives these types of procedures a great leap forward”. Advancements in technology and medical science mean that new and improved products and procedures are being constantly developed, helping to boost demand and keep the market fresh, this will continue into 2012. All of this bodes well for the non-surgical market, which on the whole, will remain robust and continue to attract a growing number of consumers well into the future. Key Note forecasts that the cosmetic surgery and cosmetic procedures market will reach £1.1bn in 2015, after increasing by 53.9% from 2006. The industry is expected to continue to expand, albeit at a slower pace than in previous years as the market reaches maturity.

Out with the old and in with the new What will be in? What will be out? IN • Sublative skin rejuvenation and other fractional radio-frequency devices that can rejuvenate and tighten skin with less downtime than fractional ablative lasers • Watch this space: the ‘Uplift Network’, a select group of specialist eye surgeons who have come together to offer cosmetic eyelid surgery, cataract removal and laser eye correction through a network of optometrists and cosmetic clinics across the UK. • Botox® and fillers - the trend is for local anaesthetic to be added to the filler to make injection less painful. (There will be increasing competition from other toxins such as Azzalure® from Galderma and Bocouture® from Merz, chipping away at the market share of Allergan’s Botox®. New fillers and techniques will continue to emerge in 2012) • Stem Cell Technology • Hair transplants • Elure (topical skin lightening) • Laser procedures

OUT • Big overfilled lips and the ‘pillow face’ as patients rebel against the ‘unnatural look’ • Macrolane • Non-invasive ‘spot fat reduction’ treatments that don’t work (i.e. Strawberry lipo) • The ‘roving practitioner’ clients will want to be sure their money is being well spent and will seek out reputable clinic-based practitioners in preference to visiting a series of salons

Stem Cell Technology

I’m watching this space in 2012

Breast enlargement, treatment of wrinkles and facial rejuvenation now can be achieved with highly improved success rates. For some time we have been educated that precious stem cells exist in fat and that we remove these cells in procedures such as liposuction, We have learned what we can do with these valuable living cells and as a result we now harvest them instead of dumping them, and bank them for future use if necessary, The Private Clinic in London is one of the first UK clinics to offer the service of banking your own stem cells. The future has already begun and now with the development of stem cell technology - a patient’s own living cells can be used as filler where 20


“Advancements in technology and medical science mean that new and improved products and procedures are being constantly developed, helping to boost demand and keep the market fresh, this will continue into 2012” ever more fullness is needed. Simply speaking we now have the option to take the best part of own fat - living stem cells - and use them optimally. This opens new horizons in aesthetic medicine: For suitable candidates: breast enlargement with stem cells provides volume gain achieved not by plastic but by living tissue. Enlarged breasts with stem cells will feel and look perfectly natural. And what is true for the breast is also true for other parts of the body like bottom, hips, thighs, calves etc. Stem cells offer a 100% natural results - these will also last (according to medical experts) a lifetime, and I am looking forward to seeing how stem cell technology develops in 2012.

2012 Seminar


As the exclusive distributor of Jan Marini Skin Research products, JMSR Europe Ltd will be conducting free seminars on the dates opposite. Join us for an opportunity to find out about the portfolio. Learn how leveraging the Skin Care Management System, and other key JMSR accelerator products, can increase your business success. Additionally, we will cover a broad range of relevant marketing and business concepts intended to positively impact your top and bottom line. If you wish to talk to one of our trainers about potential attendance on an appropriate seminar for you, please call us on 020 8868 4411.

JMSR Europe Ltd. www.janmarini.co.uk info@jmsreurope.com

Seminar Dates Monday 6th February 2012 MANCHESTER Great John Street Hotel Tuesday 28th February 2012 DUBLIN The Burlington Hotel Tuesday 13th March 2012 LONDON Royal Society of Medicine

special feature: Laser/IPL

n o ev i l Mike Murphy on how the CE Mark compares with FDA approval for medical/cosmetic lasers and IPL devices There appears to be some confusion about FDA approval and how it compares with the CE Mark in the cosmetic/medical arena. Many people in Europe mistakenly believe that FDA approval is a ‘higher standard’ than the CE Mark. Certainly, many manufacturers (particularly American suppliers and their distributors) use this confusion to imply that their equipment is, somehow, superior to the European-based competition. Hopefully this article will help to shed some light on the subject.

Mike Murphy, B.Sc., M.Sc. (Bioengineering) Mike Murphy has been involved with lasers and IPL systems since 1986 when he worked with plastic surgeons in the Plastic and Reconstructive Surgery Unit, Canniesburn Hospital, Glasgow. He is a physicist and was involved in clinical research into the removal of vascular and pigmented lesions and tattoos using lasers and was also the laser safety officer in the hospital’s laser unit. He has published a number of clinical reports in peer-reviewed journals across the world in both clinical and theoretical aspects of laser/ IPL treatments in skin. In the last few years he has worked as an independent consultant in both lasers and IPLs around the world.



FDA Approval – What is it?

PMA submission

The FDA, or Food and Drug Administration, is a US government body which “regulates companies who manufacture, repackage, re-label and/or import medical devices which are sold into the US market, including lasers, IPLs, ultrasound and x-ray equipment”, according to their web site.

A PMA submission is the most stringent type of device marketing application required by the FDA. A device manufacturer/supplier must obtain approval of its PMA application before marketing the device into the US market. Devices which require PMAs are Class III products which are deemed to be of ‘high risk’ in that they may pose a significant risk of injury or illness, such as lasers or IPL units. The approval process for a PMA is much more rigorous than a 510(k) submission (see below) and must include clinical data to substantiate any claims made by the manufacturer. The evidence submitted to support a PMA must show that the device is not only safe to use, but also effective for its intended use(s). Hence, a PMA approval is an actual ‘approval’ which is based on clinical results.

Under the FDA’s classification system medical/aesthetic devices are divided into three regulatory (risk) classes - I, II and III. Devices are classified according to the level of control necessary to ensure the safety and the effectiveness of the device. Regulatory control increases from class I to class III and these define the regulatory requirements that must be satisfied before the device may be sold on the open US market. Under current regulations any electrical medical/ aesthetic device must be approved under either a Premarket Approval (PMA) submission or a Premarket Notification 510(k) (or, if it is a low risk device, it may be classed as ‘exempt’).

Device Type

FDA Regulatory Requirements

Class I

‘Low Risk’ - may only require a 510(k)

Class II

‘Medium Risk ‘ - may only require a 510(k)

Class III

‘High Risk’ - requires a PMA approval

Premarket Notification 510(k) submission A 510(k) submission is significantly different from a PMA in that it merely requires the manufacturer to show ‘substantial equivalence’ to a similar, existing device which is “legally in commercial distribution in the US market”. It does not mean that it has been FDA approved – it is essentially a paper exercise. Indeed, some devices achieve a 510(k) against another system which itself only has a 510(k). Such a submission does not require clinical evidence to substantiate its claims. However, some FDA reviewers may request evidence, if they feel it necessary.

In fact, when a manufacturer receives a 510(k) ‘approval’ letter from the FDA they are specifically instructed not to use the terms ‘safe’ or ‘effective’ in their marketing literature or web sites because the FDA do not endorse such claims based on this assessment. It is merely ‘substantially equivalent.’ Many US companies offer devices which have a number of clinical claims to broaden their market appeal. However, a 510(k) only requires that ONE of these claims is actually met. This is now commonplace within the US market, and, consequently, internationally. Hence, a device which claims to treat hair, blood vessels and pigmented skin marks may actually have only been tested on hair or blood vessels or brown skin marks, but not necessarily all three. Before a company is allowed to market a device in the US under a 510(k) they must receive a written ‘order’ from the FDA which states that the device has been ‘cleared’ for commercial distribution in the US – it does NOT mean that the device is ‘approved’ by the FDA. Merely that it is ‘substantially equivalent’ to an existing device. Finally, a 510(k) submission may only take 90 days to clear while a PMA submission could take six months or more plus the time for clinical trials (which themselves could take years.) This fact alone should raise some concerns about any device cleared under the 510(k) process. I recently spoke to a very well-known American investigator who does a lot of work for companies seeking FDA approval for their equipment. His words were that “they (the FDA) are all over the place.” When asked what he meant he replied that the process depended entirely on which FDA official reviewed the submission. Often, under a 510(k), one reviewer may just want to see the specification sheet, while another may ask for three or six months’ clinical results. However, he did admit that the FDA are “becoming more hardnosed now.” A conversation with an American medical laser industry consultant confirmed these comments. Recently, a report1 was published which investigated the ‘recall’ rate on medical devices by the FDA. The authors found that there had been 113 recalls in the period 2005 to 2009 based on high risk devices which could ‘cause serious health problems or death.’ Out of these 113 devices 71% had been cleared through the 510(k) process which indicates a serious, potential problem with this particular route. Interestingly, 19% of these devices had been processed via the PMA route which is, perhaps, more worrying, since this is supposed to be a much more rigorous process. (7% were devices which had been considered ‘exempt’ from FDA regulation – and yet were subsequently

found to be dangerous.). The authors concluded that a reform of the regulatory process should be undertaken to ensure future safety of medical devices. I would say that understatement is clearly evident here. Clearly, this shows that not all FDA ‘approvals’ are the same. While a PMA submission is more stringent than the 510(k) process, it is obvious that there is a significant efficacy and safety (or device risk) difference between the two procedures. In other words, ‘FDA approval’ in itself is meaningless without further explanation as to which type of ‘approval’. In summary, FDA approval basically relates to studies proving that claimed clinical results of any device are shown to be statistically significant (compared with the original state) and that any side effects of the clinical procedure(s) are “reasonable” and not life threatening.

CE Mark (Declaration of Conformity) The CE Mark is a legal requirement for virtually every product sold within the EU. Before any medical/aesthetic product can be placed on the European market they must meet the requirements of the relevant EU product Directives. These Directives are joint rules that have been put in place to simplify trade to and between the member countries of the European Union.  

The CE Mark has specific meanings including the following: 1.

It is a manufacturer’s declaration that their product complies with the required health and safetyregulationsunderArticle100A,European health, safety and environmental legislation, known as the Product Directives; 2. The product may be legally placed into the market of any EU country; 3. It shows users that the product meets the designated minimum safety standards and a minimum quality level 4. It allows for the withdrawal of non-conforming products by customs or enforcement authorities. As with the American FDA system such products are usually classified under the following scheme: The CE mark means that a manufacturer is satisfied that his product conforms with the

relevant Essential Requirements in the 93/42/ EEC Directives and that it is fit for its intended purpose. However, they do not need to submit clinical data to support their claims. It also means that the product can be freely marketed anywhere in the EU without further control. Unlike the FDA processes, the requirements of the CE Mark are clearly established in the Directives. These are quite precise and minimise the vagueness which appears to plague the FDA processes. That’s not to say that the CE regulatory process is perfect – there is something of a grey area in the definitions of whether a procedure is ‘medical’ or ‘cosmetic’.

The CE Medical Mark The CE Medical mark is a requirement for all medical devices used in ‘medical applications’ – this applies to most Class III products, but not necessarily to the other classes. Regulations dictate that extensive data from clinical trials are provided as part of any submission to support any claims. Any device used in hospitals and similar clinical settings must have the CE Medical mark to ensure no interference with other life-sustaining equipment, such as respirators. Many medical and aesthetic devices fall into the Class II category – these include lasers, IPL and RF systems, ultrasound and similar devices. Class II devices do not require clinical investigation data to be provided as part of the submission, but it is recommended that any clinical claims are supported by a “compilation of the relevant scientific literature.” For example, an IPL system which is sold for hair removal only is classed as a ‘cosmetic device’ and therefore does not require the CE Medical mark – the CE mark is sufficient. However, if the same unit is used to treat haemangiomas/port wine stains then it will be classed as a ‘medical’ unit and hence require the CE Medical mark, since these are judged to be vascular abnormalities. But, the treatment of ‘thread veins’ is regarded as an aesthetic procedure in many European countries and hence there is no need for the CE Medical mark.

Device Type

CE Regulatory Requirements

Class I

devices with low risk such as external patient support products

Class IIa / IIb or IPL devices

devices with medium risk such as laser

Class III

devices with high risk such as cardiovascular catheters

Interestingly, the CQC no longer requires registration (in England and Wales, as of October 2010) of IPL units used solely for hair removal, while they do require registration for devices used to treat blood vessels.. They do require registration for all



special feature: Laser/IPL

CE Medical Mark

Equipment must satisfy EU medical devices directive - clinical data evidence required only for Class III devices, but not necessarily for IPLs or lasers.

Legally required for all ‘Medical Devices’ sold within the EU – not valid in the US. Required for all hospital-based electrical equipment

CE Mark

Equipment must satisfy general EU safety Directives – no clinical evidence required

Legally required for virtually everything sold within the EU – not valid in the US

Premarket Approval (PMA)

Equipment must satisfy FDA requirements including data to support clinical claims

Required for distribution and use in the US – not required in the EU

Premarket Notification 510(k)

Equipment must be ‘substantially equivalent’ to an existing device on the US market

Required for distribution and use in the US – not required in the EU

medical/aesthetic lasers used in England and Wales regardless of their clinical applications (including hair.). However, light-emitting devices, such as IPLs or lasers, can be granted the CE Medical mark without clinical results being submitted during the application process. Hence these systems are not necessarily more reliable in terms of efficacy, contrary to widely believed misconceptions. In conclusion, what I am trying to say here is that neither CE nor FDA approval guarantees that medical/aesthetic equipment will deliver good clinical results. They are essentially safety tests with large variations in clinical efficacy. The main

“In conclusion, what I am trying to say here is that neither CE nor FDA approval guarantees that medical/aesthetic equipment will deliver good clinical results. They are essentially safety tests with large variations in clinical efficacy”

difference is that medical/aesthetic devices cannot be sold legally in Europe without the CE mark while there is no legal requirement for any FDA approval in the European markets. So, when a salesman tells you his equipment ‘has FDA approval’ be sure to ask him ‘is that a PMA or a 510(k) approval?’ Because, as we now know, PMA is a real approval with reference to actual clinical results while a 510(k) is not. And, be absolutely sure the equipment has the CE or CE Medical mark – it MUST appear on the body of the equipment – otherwise you could end up in serious trouble if something goes wrong.

Summary of Regulatory Approvals One final word of warning; many products are now manufactured in China at a fraction of the cost of EU-manufactured devices. I have learned, via a manufacturer who has factories in Europe, South America and China, that CE certification may be easily ‘bought’ in China without the proper requirements being met. A ‘real’ CE Mark should show the identification of the Notified Body – a company licensed to ensure compliance with the Directives. Since any importer into Europe bears responsibility for the safety of their imported products, they should satisfy themselves that their equipment truly does meet the various Directives required under the CE Mark. Otherwise they might get an unexpected knock on their door one night.

REFERENCES (1) Medical Device Recalls and the FDA Approval Process Archives of Internal Medicine, Vol. 171, No. 11, June 13, 2011 Note: The author has personal experience of 510(k) submissions to the FDA with medical lasers in the past. 24


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Clinical Study - i-Lipo™

BODY OF EVIDENCE We give an overview of a recent dermatological study measuring the efficacy of i-Lipo™ laser lipolysis treatments in reducing cellulite, thigh and abdomen circumferential measurement and collagen synthesis Introduction

Materials and Methods (Part 1 of Study)

It is the general consensus in the world of health and fitness that ‘spot reduction’ is not possible, suggesting that a person cannot localise weight loss through exercise and diet alone (2). This suggests that the removal of stubborn pockets of fat will sometimes require intervention other than exercise and a healthy diet. A study recently conducted by GREDECO, a Parisian dermatology centre, tested the efficacy of i-Lipo™ laser lipolysis, on a group of individuals suffering from ‘resistant’ areas of excess weight and cellulite. i-Lipo™ emits low levels of laser energy, which creates a chemical signal in the fat cells, breaking down the stored triglycerides into free fatty acids and glycerol and releasing them through channels in the cell membranes. The fatty acids and glycerol are then transported around the body to the tissues that will use them during metabolism to create energy. This process of fatty acid release is a natural response of the body when the body needs to used stored energy reserves, thus i-Lipo™ is not creating any unnatural reaction in the body nor does it affect or damage any surrounding structures such as skin, blood vessels and peripheral nerves. A period of exercise post treatment ensures the complete metabolism and thus elimination from the body of the freed fatty acids. The study was a prospective evaluation of 15 patients (12 women, three men) during a course of eight i-Lipo™ treatment sessions over four weeks. The included subjects were chosen as having a history of ‘resistant’ anatomical areas that had previously demonstrated nil improvement to regular gym exercise and diet control alone. Seven subjects had treatments on the thigh, eight subjects had abdominal treatments. Direct circumference measurements of treated anatomy and echography measurements of fat layer thickness were recorded. The second part of the study, histological and biological analysis was performed on human skin explants maintained in survival conditions, using light microscopy and assaying glycerol collagen synthesis levels after five i-Lipo™ simulated treatments (of 20 minutes in length) on the tissue versus control (untreated) tissue (3).

15 patients between the ages of 20 and 63 were included in the study, comprising of 12 women and three men. These subjects had expressly made the decision to improve their overall health through diet and fitness and wanted to lose one to two dress sizes in specific anatomical areas. Of these 15 subjects, seven had identified their thighs as their resistant anatomical areas and the remaining eight considered their abdomen as their target zone. Despite their efforts and regular physical exercise, the subjects identified these combined two anatomical areas as ‘resistant’ to weight loss through conventional methods. There are several medical instances which render to the use of i-Lipo™ unsuitable and thus subjects were excluded from the study on the basis of health contraindications. Contraindications include pregnancy, epilepsy, thyroid dysfunction, diabetes, cardiac arrhythmias, heart disease, hypertension, pacemakers, history of cancer, liver or kidney disease, photosensitivity of 650-660 nm light, and immuno- suppressed disorders. The 15 subjects included in the study were deemed physically appropriate by the examining dermatologists. The Tefal BodySignal2 digital weight scale was used to determine both the overall weight of the subjects (kg) and also the weight of their fat tissue (kg). The i-Lipo ™ device, emitting low-level laser energy, was the device used to administer cellulite reduction treatment. As previously noted, the system is composed of a command interface with a digital screen, three command buttons, light weight laser units that are attached to the body with Velcro straps, and lymphatic stimulators (1).

Analysis • Pre treatment In accordance with the protocol established by Chromogenex™ the subjects scheduled eight sessions of i-Lipo™ over eight weeks comprising two 20 minute sessions a week. Prior to the first session circumferential measurements were taken and echography precisely measured compressible and non-compressible fat layer thickness.



Clinical Study - i-Lipo™

Control Skin before treatment

• During treatment Immediately before and after each treatment a standing measurement was taken from each patient on their chosen anatomical resistant area. Photographs were taken in standardised conditions before each treatment to document progress. Subjects were invited to avoid fasting, heavy meals and fizzy drinks and also encouraged to engage in cardio vascular activity post treatment to encourage drainage of adipose fat from the cells of the resistant anatomical zones. • Post treatment A post treatment echography was completed within the 48 hours following the last session of treatment in order to measure compressible a non-compressible fat layer thickness. Photographs were taken in standardised conditions to document the changes undergone by each subject.

Materials and Methods (Part 2 of Study)

Fat cells of control skin

Skin fragments were cut into 3cm2 thick pieces and washed three times with antibiotic solution. These skin fragments were taken from eight donors undergoing unrelated plastic surgery and were treated by five sessions (lasting 20 minutes each) of i-Lipo™ treatment every two days and then were maintained in survival condition with humidified atmosphere of 95% air-5% CO2 and 37°C. A comparison was made with untreated skin (control skin). After 10 days of culture, one part of the skin was utilised for histological analysis. The remaining fragment was utilised for collagen synthesis (1).

Combined Results;

Fat Cells treated by iLipo 8 treatments

Skin Treated by iLipo 8 treatments

Circumferential measurements: • An average of 4.16cm was reduced from eight abdominal treatments • An average of 1.5cm was lost from eight thigh treatments • Echography (ultrasound fat thickness measurements): • An average of 5.1mm reduction in fat layer thickness without compression, 1.75mm reduction with compression • An average of 5.6mm reduction in fat layer thickness, 4.0mm with compression • Overall, for all subjects, an average thickness reduction in adipose tissue of 18% Reduction of fatty tissue (Kg): • An average of 4.8% reduction in mass of fatty tissue in the eight abdomen treatments • •

An average of 2.41% reduction in mass of fatty tissue in the eight thigh treatments One subject reduced fatty tissue mass by 7.84% during their eight treatments

Histological Analysis using Light Microscopy: • Visible thinning of the hypodermis (fat layer) • Reduction of average fat cell size • Reduction of fibrosis divisions between the fat lobules • Modification of fat cell membranes including flattening or elongation of the fat cell shape compared to the normal globular shape of filled capacity fat cells • No observed necrosis or destruction of adjacent structures (epidermis, microvasculature, dermal collagen) Biochemical Analysis: • Increase in measured Glycerol levels to 233.5μg/g fat in i-Lipo™ treatment tissue versus 177.16μg/g for control (untreated) areas (p=0.043) representing an increase of approximately 30% • Increase in measured collagen synthesis to 46.2μg/ mg tissue in i-Lipo™ treatment tissue versus 40.25μg/mg in control (untreated) tissue (p=0.001), representing an increase in collagen synthesis of approximately 15%. This collagen will act to restructure the dermis and hypodermis following shrinkage of the fatty tissue, improving the visible appearance of cellulite and potentially slowing or preventing relapse of the condition.

Conclusion The study has tested the efficiacy of i-Lipo™ on common areas of ‘resistant’ excess weight. The results demonstrate significant statistical reductions of abdominal and thigh cellulite and circumferential measurement. A good correlation was found between clinical and echographic measurements of cellulite. The double echographic measurements with and without compression permitted the dermatologists to identify the effects of i-Lipo™ on adipose tissue. For the second part of the study, an anti-cellulite effect was observed after treatment by i-Lipo™. A statistically significant increase in the amount of glycerol released by the adipose tissue was found, as well as modification in the appearance of fat cells. Moreover, a statistically significant stimulation of the dermal fibroblasts’ metabolism was noted after i-Lipo™ treatment with an increase of collagen synthesis which acts to restructure the dermis and hypodermis following the shrinking of fatty tissue and also acts to prevent cellulite relapse (1). The results and conclusions of this study suggest that i-Lipo™ laser lipolysis can offer a safe alternative to invasive fat removal such as liposuction in individuals struggling to combat targeted weight loss from healthy diet and exercise alone. The fact that post treatment physical activity helps to promote fat cell drainage suggests that i-Lipo™ treatment is effective and suitable in conjunction with exercise and therefore a suitable option and alternative to liposuction.

References: 1. Benchiou, L, MD and Boisnic, S, MD (2011) Clinical Evaluation of an Anti-Cellulite Device (iLipo™) GREDECO; PARIS 2. Nickol, C, RD, MEd (2001) Spot Fat Reduction, (online), available http://www.netwellness.uc.edu/question.cfm/21417.htm, accessed 4/11/11 3. www.chromogenex.com 30



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Innovations - Cosmetic Gynaecology

W h a t

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David Leahy on the uses of laser in cosmetic gynaecology

Though the recession, in some cases, has reduced the overall demand for cosmetic surgery procedures, one sub-category appears to be entering a huge growth phase – cosmetic gynaecology.

David Leahy David is the MD of ABMEtech UK Ltd. and a pharmacologist by training, having specialised in skin. 10 years ago David took on the distribution of Fotona aesthetic and medical laser systems, a role he still manages today. As well as laser distribution into the

At the annual Congress on Female and Male Cosmetic Genital Surgery, held this year in September, at the Venetian Hotel in Las Vegas, more than 150 doctors and surgeons, most of them OB-GYNs, converged to discuss the expanding and highly profitable field of cosmetic-gynaecological elective surgeries for women seeking to ‘rejuvenate’ and/or ‘beautify’ their vaginas. Attendance at this and the competing Aesthetic Vaginal Surgery conferences has been increasing by over 25% each year since 2005. One doctor that came to our trade stand explained that his services are in such demand; he has opened two further operating rooms so he can move quickly from one surgery to the next.

UK market, David is also the Director of the New Opportunities Research Division (NORG) for Fotona Europe,. In this role David spends a considerable amount of time researching new laser applications and novel uses of aesthetic and medical laser systems.

Vaginal rejuvenation, laser vaginal rejuvenation, the ‘mummy makeover’, ‘designer vaginas’, reduction labioplasty and vaginal tightening are among the growing number of terms used to describe surgeries focused on female genital enhancement. With the rapid expansion in the demand for vaginal cosmetic surgery both women and surgeons are becoming more conscious of the non-medical genital effects of childbirth, weight fluctuations, tissue laxity and anatomic idiosyncrasies, which can be very successfully addressed by a variety of surgical procedures. Together with the increasing interest in cosmetic gynaecology the growing numbers of surgeons that consider themselves leaders and pioneers in

this type of surgery have launched the International Society of Cosmetogynaecology. Surgeons practicing aesthetic vaginal techniques carry out a range of procedures, summarised further in this article, and as with any new procedures that stimulate public interest the media has given some procedures great, if not slightly concerning names. One such term invented Dr Red Alinsod, one of the early adopters of cosmetic gynaecology and the organiser of the Aesthetic Vaginal Surgery Conference is recognised for inventing the procedure in which the labia-minora are completely amputated to create a ‘smooth’ genital appearance known in the field as ‘the Barbie’. Alinsod began his gynaecology career by winning a prestigious fellowship in gyn-oncology at Yale in 1990, but he now spends the majority of his surgical time making female genitalia ‘look pretty’ for the wealthy patients that descend on his Southern

“Mummy makeover, ‘designer vaginas’ and vaginal tightening are among the growing number of terms used to describe surgeries focused on female genital enhancement” cosmeticnewsuk.com


Innovations - Cosmetic Gynaecology

California practice from all over the world. He is also a great advocate in his field, preaching its very lucrative gospel to fellow surgeons tired of toiling in the time-intensive and high-liability fields of traditional obstetrics and gynaecology.

greater role in the surgical treatment of urinary incontinence. One of the most commonly sought after procedures culturally, is the hymenoplasty, sometimes referred to as ‘revirgination’ and is typically performed at the request of previously sexually active females that are about to get married for the first time.

The increased interest in cosmetic-gyn has been explained by the development of the cultural acceptance of these type of procedures brought about primarily by the effect of porn on aesthetic trends. The related rise in popularity of the ‘Brazilian’ and ‘Hollywood’ wax, which leaves the genital area bare and thus enabling closer scrutiny has played a big part in the drive to achieving aesthetic vaginal perfection. In the opinion of many surgeons attending the conference, the breakthrough moment for the Ob-Gyn field is movement of high profile surgeons such as Beverly Hills based Dr David Matlock (who appeared on realityTV plastic-surgery show Dr 90210) becoming full time, cosmetic-gyn specialists.

Prior to undertaking any cosmetic vaginal surgery, a thorough gynaecologic evaluation is performed to screen for any pre-existing gynaecological, urogynaecological or urological conditions, which could affect the timing of the procedure or influence the surgical strategy. Failure to carry out these pre-screens may result in considerable patient dissatisfaction with the cosmetic procedure or heighten aggravation of the medical condition. In some instances for semi-invasive procedures both therapeutic and cosmetic surgeries can be performed under the same anesthesia.

Cosmetic gynaecology background

Consideration must also be given prior to any of these cosmetic gynaecological procedures to females of child bearing potential. Understanding the potential effects of future vaginal childbirth on the

Female genital enhancement is considered by many to be the fastest growing area of cosmetic surgery. Although cosmetic vaginal surgery or vaginal rejuvination are the generally accepted terms, external or vulvar structures are also commonly treated as part of, or separately to tightening procedures. Other structures treated include the mons pubis, the labia majora and the labia minora including the clitoral hood or prepuce. The perineum, which forms the muscular bridge of connecting tissue between the anus and the vagina, the lower third of the posterior vaginal wall are also the areas typically operated on for vaginal tightening procedures. The anterior vaginal wall plays a reduced role in vaginal tightening, but a far

Before and after labioplasty. Courtesy Dr Ivan Fistonic

desired cosmetic procedure and that a caesarean delivery by patient request may not always be available. Invasive cosmetic vaginal surgeries, such as the anterior and posterior lift for tightening are routingly performed with general anaesthesia, epidural anaesthesia, spinal anaesthesia or intravenous sedation with local infiltration and pudendal block. As technology and surgery has developed however there has been a noticeable move towards local anaesthesia where appropriate especially for less invasive procedures such as laser tightening. In fact laser tightening with the Fotona smooth mode does not require any form of anaesthetia with the patients just describing a warm sensation.

Before and after labioplasty, ‘The Barbie’ . Courtesy Dr R. M. Ray

Before and after labioplasty. Courtesy Dr S Gershenbaum

Areas for cosmetic gynaecological intervention Mons Pubis Individually or in combination, mons pubis laser lipolysis, liposuction or mons pubis lifting will act to alter the appearance of this area. Mons pubis contouring is typically performed in the supine position and is often combined with general abdominal liposuction. The clinical endpoint of mons pubis contouring is a uniform thickness of the fat contours between the landmarks, cephalad and caudad to the pubic bone without skeletonizing the latter. Mons pubis liposuction or contouring is also integral to conventional abdominoplasty when the lower incision edge is thicker than the upper edge. Traditionally known as a mons pubis lift, this procedure is an effective semi-invasive cosmetic option for women with a high 34


degree of laxity in the mons pubis region and noticeable sagging of the labia majora, as viewed when the patient is in the standing position. The mons pubis lift is achieved by the precise alignment of the central tension vectors at the time of abdominoplasty. The pubic lift integrates well with mons pubis liposuction or the alternative contouring procedures and yields a more complete and balanced cosmetic solution for the abdominal wall. The Clitoral Region Clitoral cosmetic alterations are primarily focused on the excision of loose and redundant folds of skin from the prepuce. When planning this type of surgery in combination with a mons pubis lift, the lift is done as the first stage because it frequently produces a tightening of the prepuce in the vertical axis

I n t e r n a t i o n a l

I n t e r n a t i o n a l

M a s t e r

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C o u r s e

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o n

o n

A g i n g

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S k i n


COURSE DIRECTOR Benjamin ASCHER, Plastic Surgeon, France COURSE COORDINATORS David GOLDBERG, Dermatologist, USA Bernard MOLE, Plastic Surgeon, France Bernard ROSSI, Dermatologist, France







COURSE SCIENTIFIC SECRETARIES Olivier GERBAULT, Plastic Surgeon, France Anne LE PILLOUER PROST, Dermatologist, France Serge MORDON, PHD - Research, France


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Innovations - Cosmetic Gynaecology

when the mons pubis is placed on cephalad traction. Inferior to the prepuce, the trifurcation of the posterolateral portion or the prepuce, the frenulum and the labium minus must be addressed when prepuce alterations and reduction of the labia minora are requested by the patient. The Labia Minora Reduction labioplasty (removal or the ‘trimming’ of part of the labia) is the most common treatment for patients unhappy with elongated, asymmetric or hyperpigmented labial tissue. When carrying out an examination of the labia minora, it is necessary to spread them laterally onto the labia majora to determine the degrees of hypertrophy, hyperpigmentation and asymmetry which may be present. When a combination reduction labialplasty and vaginal tightening procedure is performed, the vaginal tightening is performed initially because it involves the resection of the fourchette with subsequent remodelling in a more anterior position. The Labia Majora Three main procedures are available for the cosmetic alteration of the labia majora: 1. Augmentation by autologous fat transfer 2. Skin tightening by resection of loose skin 3. Sclerotherapy or laser vein removal It is common for the labia majora to lose volume with both age and weight loss giving a deflated appearance with laxity and wrinkling of the overlying skin. In the majority of patients, these changes can be effectively addressed with autologous fat transfer. Very similar to fat grafting in facial applications, a sufficient volume of fat is harvested from a suitable site, prepared according to the fat harvesting systems protocol and then re-injected into the subcutaneous fat layer. Deeper injections are avoided as they may affect the structures of the vestibule. When a larger degree of skin laxity or obvious sagging is present, an ellipsoidal, full thickness skin resection along vertical axis of the labia majora is carried out. This can be done alone or in conjunction with autologous fat transfer that will provide a very effective cosmetic solution. Varicose veins of the vulvar region respond very well to laser occlusion (transdermal 1064nm) or to sclerotherapy in much the same manner as those of the legs. Often these varicosities are the source of pelvic pain and a full gynaecological review should be carried out in this case to rule out other etiologies prior to treatment. The veins are usually marked out in the standing position and lasered or injected in the supine position. This technique is the same for any laser vein or sclerotherapy treatment of the leg varicosities working from the proximal to the distal veins. Pelvic compression garments are worn for the first seven days following this type of treatment. Vaginal Tightening More commonly known as vaginal rejuvenation, procedures for reducing vaginal laxity originate from a class of gynaecological procedures known as vaginoplasties or colporrhapies, initially developed for the treatment of prolapse of the bladder (cystocele) and of the posterior vaginal wall (rectocele). Mild to moderate degrees of vaginal laxity are now routinely corrected successfully by targeting the lower third of the posterior vaginal wall and the perineal body. In these procedures part of the wall is removed surgically and the sides then sutured back together to reduce the internal dimension. The future The biggest breakthrough in recent years in the use of erbium laser in the non-ablative mode to internally tighten the vagina. One such laser made by Fotona uses erbium smooth mode to give tightening without the need to any anaesthesia. Data shows up to a 32% contraction with just one treatment. With the new technologies making the cosmetic gynaecological procedures easier to carry out for the physician and with only minimal downtime to the patient the use of lasers to name but one modality is certain to continue to drive this area forward.



“The biggest breakthrough in recent years in the use of erbium laser in the non-ablative mode to internally tighten the vagina”

w w w. c o s m e t i c - i n s u r a n c e . c o m / c o s m e t i c n e w s

Q&A - Leslie Fletcher


Following its recent UK launch, we speak to the innovator behind the ArqueDerma™ Artistic Restoration Lift™, Leslie Fletcher

The ArqueDerma™ Artistic Restoration Lift™ was officially hatching. I really have to thank the physicians in the classes I was teaching who pulled me to one side and said ‘this is not cross hatching, launched into the UK last month. The patent-pending this is huge, you don’t know what you have right here, we have never technique originates from the United States where there are seen anything like this, this is going to change the way we inject, you currently more than 200 licensed practitioners. Developed by really need to look at patenting it’. I heard that several times from very well respect physicians, which made me think ‘maybe this is more aesthetic nurse Leslie Fletcher, who has been injecting for 10 than I think it is’. It was seeing it through other people’s eyes that years and is one of the top trainers for several pharmaceutical pushed me to file a method patent for it and then to develop an entire companies in the US, ArqueDerma™ is a methodology for curriculum devoted to it. delivering dermal fillers that is designed to provide natural, CN: What makes the ArqueDerma™ technique so more dramatic results. Using precepts found in physics and different? LF: It is an approach to treating the entire face, not just the nasolabial architectural engineering, the ArqueDerma™ technique folds, you can use the same technique and the same principles to treat utilises 40% less filler to achieve unprecedented, longer the whole face and neck. It is about lifting and ‘redirecting’, it is not lasting results (up to six months longer than conventional just about filling lines in the face. It is about looking at the structure and the design. It is not even a volumising technique, which is another methods of dermal filling). Cosmetic News: How did you develop the ArqueDerma™ Artistic Restoration Lift™ technique? Leslie Fletcher: I have been in facial aesthetics for about 10 years, working with plastic surgeons and as aesthetic injection trainer. At the point that I developed this I had been injecting for about six years and was dissatisfied with the methods that we were using for filling the nasolabial folds. I have pretty deep nasolabial folds myself and I wasn’t happy with the results I was getting in my own face, I felt that I was all one contour and I had lost a bit of who I was. One day I was driving down the freeway on the way home from an office in Santa Monica and there was some road construction on the 405. They had propped up this wall with perpendicular beams which were strategically placed every foot or so. As I kept driving it occurred to me that everything that needs very good structural support has this perpendicular component and I thought to myself ‘I bet this would work in the face’. So I used myself as my first test subject and I was really surprised that it worked. I had finished with my nasolabial folds and I had only used two or three tenths of the syringe when in the past I had been using a full syringe per side. I thought maybe that was just a fluke so I started treating friends and family in this way and then started on my clients and I couldn’t believe the results I was getting.

CN: When did you realise that you had developed something unique? LF: As a teacher and educator I started incorporating the technique into my classes. Part of my discovery was really not knowing how different this was to anything we had been doing before. We had been using cross-hatching techniques before but it really wasn’t cross38


thing that sets it apart and puts it in its own category. With volumising it takes a lot of product to create volume, this technique does not. It is really re-organising and shifting their own volume. What this technique does is utilise the patients own tissue to do the volumising by putting back to or over to where it would be most aesthetically pleasing for them. That is why it doesn’t take a lot of product it is just using the product as a vehicle for getting it there. You are really just taking what they have and moving it back to where it used to be or where it should be.

CN: How has the technique evolved? LF: It has really been an evolving process. I was not doing a lot of the ‘arching’ at first I was just going perpendicular to the fold. Just like that wall on the freeway I was putting a ‘beam’ in. The arching of the needle is what really brings this to a new category. That is what the intellectual property is but it is very hard to explain that on paper. That is what sets ArqueDerma™ apart from any other ‘vectoring’ techniques out there in terms of longevity and lift because you are able to detach and lift the tissue at the same time with minimal amount of trauma. There is just nothing like it as far as lifting goes with such a minimal amount of product and also the way the tissue changes too, the neocollagenisis, which I haven’t seen with any other technique out there in the same way.

CN: Is the technique difficult to master? LF: The technique is so different that even my trainers have taken the course from me four or five times before they feel like they are ready to do it. It is so completely different from anything else that is out there they feel like they don’t have a handle on it until they have spent that many hours with me watching me lecture and watching

me inject. It can really take people a long time to get comfortable with it and that is the thing I have a hard time with, is getting people prepared for that because nobody can imagine that there can be anything as different as this. They may have been injecting for many years and gone to every conference and read every book, so they can’t imagine that there could be anything so counterintuitive and different as this technique is. It is really difficult to get people to understand that ahead of time I just have to get them there and then once they attend a course, I have never had anyone tell me they have seen anything like this. They always say, ‘Wow, this is so different’ . I have had people who have been injectors for 15 years who have found it really difficult because they are not used to all the different changes they have to make in the way they are injecting. Once people have mastered it though their numbers have grown exponentially within weeks of taking the class. It is really such a different concept and it gets injectors excited and inspired because now they are seeing the face in a different light and focus on making each patient look their best.

CN: What kind of results can you achieve with the technique? LF: It is a more natural result and I think the reason for that is that it is putting back what was there years ago. Patients bring in a photograph and say ‘this is a picture of me 10 years ago, can you do that?’ Yes they have lost volume but most often it has just shifted or moved around and needs to be re-organised back to where it was and that is why the results are so natural because it is a face they have seen before it is not a new face. A lot of people here in the US are still doing the straight nasolabial folds, so just filling that crease from the nose to the corner of the mouth, and that is an unnatural look. If you look at children even they have a natural break in their face there. If you try and fill that or put volume into that depression in order to get rid of the fold, you are not going to have that natural contour to the face and people look more like a beach ball. The second alternative is to do the cheeks, but in order to get rid of the nasolabial folds by treating the cheeks you have to put in a lot of volume, which gives them cheeks they may not have had before, so that’s another different face. Even though it may look better it is still different from what they had 10 years ago. If you watch TV now you can see all these stars with these massive cheeks and again it looks a bit artificial and everybody looks the same. Yes their nasolabial folds have gone but they have big cheeks. Most of my patients just want to look like themselves but better and I think that is unachievable if you are going to put that kind of volume into the cheeks. It is trying to figure out a way to give the patient what they want without using vast amounts of product.

CN: Can you use this technique with any filler product? LF: Yes you can use any filler product however I try to encourage physicians to use a hyaluronic acid because the depth is a little more superficial than

“The arching of the needle is what really brings this to a new category and sets ArqueDerma™ apart” some of the conventional methods. I feel like products like Radiesse® should be injected more deeply and do not give the same type of lift with this technique so I would try and get them to stick with HA’s for this.

CN: How can practitioners in the UK now learn the technique? LF: Our official media launch in the UK was just last month. I have one trainer (Christine Blackburn, founder of Angle Face Medical, Lancashire), who is one of only five licensed ArqueDerma™ Trainers worldwide and who understands the technique implicitly which is really important. Christine actually sought me out in the States because she had the same disappointment in the techniques she was using. We share the same vision. We corresponded via email for two years before she came out here and she is now really excited to be able to take this message to the UK. We want to do everything we can for any licensees that sign up in the UK so we will be doing everything we can to promote them in terms of marketing through social media and our own website which has a practitioner locator.

Product Focus

L ooking on the bright side We take a look at the Lumixyl™ Topical Skin Brightening System, from SilDerm

Skin brightening products are used extensively with patients for a wide range of conditions. The use of skin brightening products is usually for aesthetic reasons, yet these products have historically only been available on prescription or restricted by the relevant governmental authorities due to concerns over the side effects of these acid-based treatments.



In-Vitro Data

Like hydroquinone, Lumixyl™ inhibits the production of tyrosinase, which is a precursor in the production of melanin, however, unlike hydroquinone, it does not kill the skin cells (melanocytes) that produce pigment in the skin. The active ingredient in Lumixyl™ is Decapeptide-12, which has been found to be an effective inhibitor of tyrosinase. The mode of action and safety profiles were published in the Journal of Investigative Dermatology in 2009 (J Invest Dermatol. 2009 Sep;129(9):2242-9). The study found that Decapeptide-12 inhibits the over production of melanin by 40%.

In-Vivo Testing

The results of a small pilot study were published in the Journal of Drugs in Dermatology in 2009 (J Drugs Dermatol.2009 Aug;8(8):732-5). The study was a split faced, double blind, randomised and placebo controlled evaluation of a unique Oligopeptide for the treatment of recalcitrant melasma. Method: Both Decapeptide-12 and the placebo were applied to the same patient. The patient



Results: The treatment was well tolerated by all the patients with no signs of skin sensitivity or irritation. All five patient showed a significant improvement in their melasma and overall facial aesthetics compared to the placebo. In addition, patient satisfaction was highly rated. Conclusion: Lumixyl™ and its active ingredient Decapeptide-12, have proven to have a strong inhibitory effect on the production of melanin. This method of treating hyperpigmentation provides an efficacious way to stop the over production of melanin and hence minimise hyperpigmentation. In studies carried out to date there are no toxicity issues, long term use of this peptide should allow patients to treat their hyperpigmentation on an on-going basis.

Decapeptide-12 inhibits human tyrosinase better than hydroquinonebits L-Tyrosinase (substrate)

L-Dopa (substrate)

70 60

70 HQ



% Tyrosinase Inhibition

% Tyrosinase Inhibition

Lumixyl™, now distributed in the UK by SilDerm, offers clinically proven effective technology that has a unique mode of action. This makes it safe for long term as well as short-term usage. Lumixyl™ can be used to treat a range of skin conditions such as age or liver spots (solar lentigos), melasma and post-inflammatory hyperpigmentation, which are all caused by the over production of melanin in the skin. The Lumixyl™ Topical Brightening System works best for people of all skin types who have mild to moderate epidermal hyperpigmentation. It is also ideal on its own for anyone looking for a skin health regime that will help prevent photodamage for brighter and healthier skin function. It can be used to treat deeper dermal melasma when coupled with laser resurfacing or aggressive physician medicated chemical peeling procedures. In these cases it can be used as a preparatory conditioning system to begin addressing the epidermal hyperpigmentation areas to prepare the skin for better results from the procedure, as well as being used post-procedure to enhance results and maintain brighter, healthier skin. The Lumixyl™ crème woks to regulate the over production of melanin but cannot degrade or clear melanin that has already been deposited throughout the layers of the epidermis. Instead, hyperpigmented layers of skin are removed by the Lumixyl™ GlycoPeel 20 Rapid Exfoliating Lotion, which serves to exfoliate the stratum corneum and accelerate turnover in the epidermis. The GlycoPeel 20 is used as a ‘leaveon’ product, even though it contains 20% glycolic acid because it is buffered to a pH of 3.0+. This prevents chemical burns from occurring (when used appropriately) and allows for enhanced tolerability of the product while maintaining its exfoliating efficacy.

used the treatment over a period of 16 weeks. Five patients were Fitzpatrick skin type IV, who had failed outcomes using other treatments for melasma. Changes in the melasma were measure using photography and peer-reviewed evaluation. In addition patient satisfaction was measured over the duration of the trial.

40 30 20 10 0


50 40 30 20 10








Concentration [uM]

Concentration [uM]

1st step in melanin synthetic pathway

2nd step in melanin synthetic pathway

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Product News Elure in the UK

UK first from SmartMed

Elure skin lightening is now available in the UK following its successful launch in the US and Asia. The product launched to the UK press and practitioners on November 15 at the Covent Garden Hotel. Elure is indicated for the treatment of uneven pigmentation, general skin lightening, PIH and melasma. Training is provided on the range of three products, to help stockists understand the action and physiology of pigmentation.   “Demand for safe and effective skin lightening products has never been greater”, said Michaela Barker, UK general manager at Syneron/Candela. “We have had an amazing response from people waiting to purchase this new topical product. We believe there is a gap in the market for a product that breaks up the melanin in pigmentation to even and lighten the complexion. For Syneron/ Candela the topical products arena is a new area, however this products fits well into the drive to effectively offer patients a solution based on science results and trust. What is interesting is the number of physicians hearing about the product abroad and contacting us in the UK to obtain it.”

The first monopolar/bipolar RF microneedling device has been launched into the UK.

Laser Physics Introduces Surgical Instruments Laser Physics has introduced a new range of surgical instruments for use during laser procedures. When performing surgical procedures using lasers there is a risk of stray reflections caused by reflective surfaces. These unwanted, accidental stray reflections can pose a risk to theatre staff and patient. Laser Protection Advisors agree that shiny, reflective surfaces should ideally be removed or covered up when performing laser procedures. Laser Physics’ range of stainless steel surgical instruments are designed specifically for use during laser procedures. All sufaces are non-reflective for safe use with lasers and are autoclavable. Instruments available include Eye Shields, Retractors, Castroviejo, Forceps and Lid Clamps.



Supplied exclusively through SmartMed, the INTRAcel has received acclaim as a revolutionary skin rejuvenation system; leading the market for aesthetic devices. Effective for a wide range of cosmetic indications, including tightening of the neck and jowls, plus dramatic improvement of acne scarring, this device offers the ultimate skin rejuvenation solution from a single system with little or no down time. “The actual volume effect (of the treatment) showed increased production of procollagen and elastin”, said Dr Un-Cheol. Yeo, MD, S&U Dermatologic Clinic, Seoul, Korea. “The treatment can be undertaken with no side effect and short downtime. Fractional deep dermal heating system on a selected target area is expected to provide a good and positive efficacy for skin tightening, wrinkle reduction, scars and pore treatment”. Launch events are being held in London throughout December. Places are limited so to make sure you don’t miss out contact Donna Ofsofke on 0845 689 0090 or email info@intraceluk.com.

New eTwo launches at the EADV in Lisbon As the eMatrix fractional RF system for sublative rejuvenation grows in popularity across the globe, offering a practical solution to wrinkles and acne scars with less downtime, Syneron/Candela has gone a step further and added the Sublime hand piece into the platform.   “Sublime gives the ability to create a greater tightening effect on lax skin, it can be used on its own or alongside the sublative treatment,” stated James Bartholomeusz, VP of product development at Syneron/Candela. “This is a product that is safe to use on all skin types and delivers results beyond what we were anticipating” Sublime is a combined NIR and radio-frequency combination, the eMatrix can be upgraded to take the new hand piece.” 

NASA RESEARCHED SUPPLEMENTS AVAILABLE IN UK AmeriSciences AS10, the first ever super-league multivitamin and nutritional formula developed from joint research with NASA and the Johnson Space Centre, is now available in the UK.  Key figures from the field of nutrition, including the Institute for Optimum Nutrition and The Nutrition Society, attended a roundtable at the Royal Society of Medicine last month to discuss how the AmeriSciences AS10 range of products will pave the way for the next generation of breakthrough technology in nutritional supplementation.  AmeriSciences AS10 is a powerful antioxidant and anti-ageing liquid beverage, comprising a unique formulation of only 100% fruit and vegetable-derived ingredients, including the new ‘superfruits’ acai, cupuaçu and acerola sustainably sourced from the Brazilian rainforest. AmeriSciences AS10 is also part of a wider range of nutritional supplements including AS10 Life multivitamin; derived from the same joint research with NASA and the JSC for achieving optimum nutrition. Bernice Berry, associate director of training and personnel development for The Harley Medical Group, the major distributor of AmeriSciences AS10 in the UK, said, “Before patients have cosmetic surgery they need to be in peak physical condition – as with any surgical procedure – and the AmeriSciences AS10 products will be invaluable in supporting our patients’ pre-operative preparation and post-operative recovery. For our nonsurgical patients optimum nutrition is paramount as this is reflected in their outward appearance; glowing skin, strong hair and nails and an energy boost are just some of the benefits seen by our patients following use of these products. Many are particularly excited about the anti-ageing properties of range, which compliments our non-surgical treatment options.”

Move over laser, here comes the space age!

The first monopolar and bipolar fractional RF mirco-needling technology for skin and scar rejuvenation; bringing new life to your skin

“This is the future of non-surgical skin tightening. The results are truly stunning� Dr John Curran



V t is a a nd it t u IM D s 2 C a A & t S ! D3

Skin tightening and resurfacing without the downtime associated with ablative lasers. INTRAcel delivers RF energy deep to the dermis bypassing the epidermis using fractionalised insultated microneedling at variable therapeutic depths

Product News JMSR introduces new concept in retinol technology JMSR has launched two new retinol products: Age Intervention Retinol PLUS and Age Intervention Retinol PLUS MD, a product available only through doctors and nurse prescribers. The products synergistically combine the most aggressive levels of stabilised all-trans-retinol with advanced topical agents to maximise efficacy, while simultaneously decreasing or even eliminating acclimation/irritation concerns. Age Intervention Retinol PLUS has been specially formulated to utilise the maximum amount of all-trans-retinol PLUS anti-ageing and collagen boosting peptides, antioxidants, hydrators and skin soothing ingredients. The products are being released on January 4, 2012.

FDA Approves Belotero Balance®

Rosmetics launches Modelis in the UK

The US Food and Drug Administration (FDA) has approved Merz Aesthetics’ dermal filler Belotero Balance® for the correction of moderate-to-severe facial wrinkles and folds.

Rosmetics is pleased to announce the UK launch of Anteis’ deep volumising filler for cheek filling and sculpting.

Belotero Balance® is the newest addition to the Merz Aesthetics™ expanding portfolio of intelligently designed products and the second Merz Aesthetics FDA approval in 2011. The FDA approval of Belotero Balance® is based on the results from a randomised, double-blind, active-controlled, multicenter study of 118 patients. In a split face design, patients received bilateral treatment with Belotero Balance® filler and an approved bovine collagen filler for the correction of their moderate-to-severe nasolabial folds. Patients were evaluated using a five-point Wrinkle Severity Scale (WSRS), ranging in severity from least (0) to most (4). Belotero Balance® dermal filler demonstrated greater reduction in the mean change of the WSRS at all-time points and maintained more than one point WSRS reduction at week 24 (compared to 0.5 for the control). No serious adverse events were reported in this study for either treatment. Commonly occurring, short-term injection site reactions, including swelling, bruising and injection site nodules, were mild to moderate in severity.



Modelis’ Hybrid Plastic Matrix pushes polydensification to the extreme, allowing dense parts and less dense parts to be combined in one cohesive monophasic gel. This makes the product not only highly volumising and long lasting, but also malleable and easy to inject. There is also no migration with the product and bio-implatation is very safe.

Serious About Skin launches new range of Dermalux™ LED Light Therapy systems Serious About Skin has just launched a new range of Dermalux™ LED Light Therapy systems. Offering a range of wavelengths that are clinically proven to achieve results in their standard systems, they also manufacture bespoke versions that are tailored to meet individual wavelength requirements, which may be specific to certain specialist skin conditions. Standalone treatments can be used for anti-ageing, acne, rejuvenation and healing, however the system can also be used in combination with other treatments such as microdermabrasion, peels, injectables and laser. The company also claims that the estimated return on investment of the system is around three months, making it a highly profitable product. Serious About Skin also offers onsite training, bespoke protocols, client launch events, marketing and on-going support.

Jan Marini Skin Research (JMSR) is a leading manufacturer of clinically validated skin care and aesthetic products for the professional marketplace. JMSR is known for creating breakthrough product solutions and dramatic technological advancements. Over the years, the company has established a portfolio of proprietary formulas that reflect its ongoing commitment to be the preeminent developer of skin care products that produce measurable clinical results. JMSR Europe Ltd is the exclusive distributor for the JMSR range in the UK. We are looking for exceptional, career focussed candidates with a passion for skin care to join our successful, highly regarded team.

Training Account Managers (South East England and North of England territories) Reporting to the Senior Training and Account Manager, core responsibilities include the training, support and sales of customers in their designated geographical area. This diverse and challenging role will primarily take place at customer accounts in the defined territory area. It is envisaged that the job may require occasional overnight stays with some limited European travel from time to time. Successful candidates will be highly motivated, organised, confident, self-directed professionals with strong communication skills and a drive to succeed. Experience within the cosmeceutical or medical market or perhaps within a clinic environment will be required. The company will provide successful applicants with an attractive salary package, additional bonus structure and company car. Applicants should send CV with additional covering letter to: personnel@jmsreurope.com Mr T Clarke, Personnel JMSR Europe Ltd, Dermadist House, 9 Kildare Close, Eastcote, Middlesex, HA4 9LG Tel: 020 8868 4411 Fax: 020 8868 4466

JMSR Europe Ltd. www.janmarini.co.uk info@jmsreurope.com





We summarise some of the most recent studies you may have missed

Title: Investigating the Efficacy of Vibration Anaesthesia to Reduce Pain From Cosmetic Botulinum Toxin Injections Authors: Sharma P, Czyz CN, Wulc AE Published: Aesthetic Surgery Journal, November 2011, 31: 966-971 Background: Many analgesic modalities have been employed with limited success to alleviate the pain associated with botulinum toxin type A (BTX-A) injections. Vibration is an effective method of reducing pain during facial cosmetic injections, but it has not been previously studied in the context of clinical cosmetic procedures. Objectives: The authors evaluated the safety and efficacy of vibration-assisted anesthesia for reducing pain associated with BTX-A injections. Methods: 50 patients received BTX-A injections for cosmetic rhytid reduction. Injections were given in a split-face design that was randomly assigned. A vibration stimulus was coadministered with BTX-A injections on one side, while the other side of each patient’s face received BTX-A injections alone. Patients completed a questionnaire immediately post-treatment and were contacted for follow-up three to four weeks later. Results: Patients reported less injection pain on the vibration-treated half of the face as compared to the control side (an average of 1.3 vs 2.4 on a five-point scale; P = .000). Overall, 86% of patients preferred to receive vibration with their next BTX-A treatment. Five of 50 patients experienced transient side effects perceived to be associated with vibration, including tingling teeth, increased bruising, and headaches. Of the patients who did not request vibration with subsequent BTX-A injections, none cited decreased BTX-A efficacy as the reason for their preference. Conclusions: Vibration is a safe and effective means of reducing patient discomfort during BTX-A injections for cosmetic rhytid reduction and may have applications in other cosmetic procedures.

Synergistic Effects of Cryolipolysis and Shock Waves for Non-invasive Body Contouring Authors: Ferraro GA, De Francesco F, Cataldo C, Rossano F, Nicoletti G andD’Andrea F Published: Aesthetic Plast Surg., 2011 Nov 1 Title:

Background: Excess body fat, localised adiposity,

and cellulite represent important social problems. To date, techniques using radio-frequencies, cavitation and non-cavitation ultrasound, and carbon dioxide have been studied as treatments for non-invasive body contouring. Ice-Shock Lipolysis is a new non-invasive procedure for reducing subcutaneous fat volume and fibrous cellulite in areas that normally would be treated by liposuction. It uses a combination of acoustic waves and cryolipolysis. Shock waves, used normally in the treatment of renal calculi and musculoskeletal disorders, are focused



on the collagen structure of cellulite-afflicted skin. When used on the skin and underlying fat, they cause a remodeling of the collagen fibers, improving the orange-peel appearance typical of the condition. Cryolipolysis, on the other hand, is a non-invasive method used for the localised destruction of subcutaneous adipocytes, with no effects on lipid or liver marker levels in the bloodstream. The combination of the two procedures causes the programmed death and slow resorption of destroyed adipocytes. Methods: In this study, 50 patients with localised fat and cellulite were treated with a selective protocol for the simultaneous use of two transducers: a Freezing Probe for localised fatty tissue and a Shock Probe for fibrous cellulite. Results: The procedure significantly reduced the circumference in the treated areas, significantly diminishing fat thickness. The mean reduction in fat thickness after treatments was 3.02 cm. Circumference was reduced by a mean of 4.45 cm. Weight was unchanged during the treatment, and no adverse effects were observed. Histologic and immunohistochemical analysis confirmed a gradual reduction of fat tissue by programmed cell death. Moreover, the reduction in fat thickness was accompanied by a significant improvement in microcirculation, and thus, the cellulite. The safety of the method also has been highlighted because it is accompanied by no significant increase in serum liver enzymes or serum lipids. Conclusion: The findings show that the action of Ice-Shock Lipolysis is a safe, effective, and well-tolerated non-invasive procedure for body contouring. In particular, the authors believe that this could be an ideal alternative to liposuction for patients who require only small or moderate amounts of adipose tissue and cellulite removal or are not suitable candidates for surgical approaches to body contouring. Title: Plastic Surgery Marketing in a Generation of ‘Tweeting’ Authors: Wong W, Gupta S Published: Aesthetic Surgery Journal, November 2011, 31: 972-976 Background: Social media describes interactive communication through Web-based technologies. It has become an everyday part of modern life, yet there is a lack of research regarding its impact on plastic surgery practice. Objectives: The authors evaluate and compare the prevalence of classic marketing methods and social media in plastic surgery. Methods: The Websites of aesthetic surgeons from seven US cities were compared and evaluated for the existence of Facebook, Twitter, or MySpace links and promotions. To find the sites, the authors conducted a Google search for the phrase ‘plastic surgery’ with

the name of each city to be studied. The trends of social networking memberships were also studied in each of these cities. Results: In comparison to aesthetic surgeons practicing in other cities, those in Miami, Florida, favored social media the most, with 50% promoting a Facebook page and 46% promoting Twitter. Fifty-six percent of New York City aesthetic surgeons promoted their featured articles in magazines and newspapers, whereas 54% of Beverly Hills aesthetic surgeons promoted their television appearances. An increase in the number of new Facebook memberships among cosmetic providers in the seven cities began in October 2008 and reached a peak in October, November, and December 2009, with subsequent stabilisation. The increase in the number of new Twitter memberships began in July 2008 and remained at a steady rate of approximately 15 new memberships every three months. Conclusions: Social media may seem like a new and unique communication tool, but it is important to preserve professionalism and apply traditional Website-building ethics and principles to these sites. Title: Laser and IPL Therapy for the Treatment of Hypertrophic Scars: a Systematic Review Authors: Vrijman C, van Drooge AM, Limpens J, Bos JD, van der Veen JPW, Spuls PI, Wolkerstorfer A Published: British Journal of Dermatology, Volume 165, Issue 5, pages 934–942, November 2011

Several lasers and light sources have been evaluated in the past and have been shown to improve hypertrophic scars. To assess current evidence of efficacy of all laser and IPL therapies used in the treatment of hypertrophic scars, we performed a systematic review searching electronic databases MEDLINE, EMBASE and CENTRAL. The quality of the controlled clinical trials was evaluated according to the Cochrane Collaboration’s tool for assessing risk of bias. 13 articles involving seven different lasers met the inclusion criteria. Most evidence was found for the pulsed dye laser (PDL) 585nm (eight studies), followed by the PDL 595nm (two studies), whereas limited evidence (one trial per laser) was available for the fractional nonablative laser 1,540nm, CO2 laser 10,600nm, low-level laser therapy, Nd:YAG laser 532nm and Erbium:YAG laser 2,940nm. Treatment recommendations should be formulated with caution as current evidence is insufficient for comparing the efficacy of different laser therapies. The PDL 585nm showed a low efficacy for the treatment of hypertrophic scars. With moderate efficacy, the PDL 595nm is promising, although more research is necessary. Little evidence was found for the efficacy of other lasers. Future research, with a low risk of bias, well-defined scar characteristics, validated outcome measures, standardised measurement methods, follow-up periods of at least six months and well-defined laser settings, is needed.

Business Focus

Party poopers As plans for our various Christmas or New Year parties are approaching the final planning stage, award winning lawyer Norman Rea, consultant with Sydney Mitchell LLP Solicitors, takes a light-hearted look at the pleasures and potential pitfalls of an office ‘do’ and provides a gentle but sobering warning in an effort to prevent things getting out of hand Bah Humbug? No, not a bit of it. Anyone who knows me will confirm that I am at the front of the queue where good food, wine and company is on offer. However, having survived many years of office Christmas parties I feel that I am well qualified to offer you what I hope is a helpful guide to acceptable behaviour and point out a few potential ‘hotspots’. Have you ever woken up the morning after the works party and wondered who and where you are? Ever returned to work in the New Year and walked past a line of staff who are staring grimly at their computer screens and refusing to respond to your cheery “Happy New Year”?

If so, then this article for you … As an employer organising any type of social function you have to remember that you could potentially be held liable for the actions of your staff. An article playfully lobbed across a room at the Christmas lunch could leave you liable for damages and/or personal injury. This is obviously bad news.



Remember to invite everyone Those members of staff on maternity or sick leave can easily be forgotten when it comes to parties and Christmas bonuses and failure to include them could lead to accusations of discrimination – yes it has happened!

Catering – Have you considered all comers? i.e. remember vegetarians and coeliacs and also remember to provide soft drinks for tee-totallers, under age members of staff and those whose religion forbids alcohol.

Party ‘Policy’ It would be wise to display this on your intranet or staff noticeboards so that acceptable levels of behaviour are clearly understood from the outset.

Photocopiers Always best to keep them in a locked room or isolate the power – avoids temptation – enough said!

Transport facilities If your budget permits, consider providing alternative transport facilities for your staff. Whether you bus ‘em in and bus ‘em out is a matter for you but it could prevent accidents, potential claims and consequent absenteeism. As function organiser you will be busy and you may not always spot the person who (despite several glasses of wine) does not want to leave their Ford Focus in the NCP overnight.

“When alcohol has loosened your brain/ tongue what you consider to be a reasoned and constructive criticism may come back to haunt you. ” empty bottle of fizz. Parental wrath should not be underestimated!!

DO be wise before the event.

Some Don’t’s for Staff

DON’T skive off. Employer’s are not stupid. There is an amazingly high incidence of absences in the

DON’T drive the next day – you may have been bussed home at 3am that morning but that doesn’t mean you are safe to drive a few hours later that same day.

week before the Christmas/New Year shut down (shopping) or on the morning of the works party (hair appointment). A threat of a disciplinary warning in such cases concentrates the mind.

DON’T discuss work issues. When alcohol has loosened your brain/tongue what you consider to be a reasoned and constructive criticism of your immediate boss, the organisation as a whole and/ or your work colleagues may come back to haunt you. 12 Barcardi Breezers, three Jack Daniels and a bottle of red is no excuse for telling your boss what you really think.

DON’T spend hours online at the office.

If you wouldn’t raise it at a normal work’s meeting;

Under age drinking

don’t do it at the office party.

Clearly stipulate this will not be tolerated in your party policy and, as above, provide soft drinks. There is nothing worse than leaving a venue, quietly congratulating yourself on a successful, trouble free evening, only to spot the 17 year old ‘junior’ whispering sweet nothings to the water cooler in the corner of the foyer whilst clutching an

DON’T be too tactile – you may have long fancied Gemma from reception or Wayne from accounts but that last slow dance or ‘innocent’ mistletoe kiss can easily slip over into allegations of ‘groping’ and a subsequent harassment claim depending on the recipient’s interpretation of your actions.

Lynton Lasers 1/4 Landscape DEC:Layout 1



DO take note of your firm’s internet policy. Get off e-bay looking for that perfect ‘little black number’/fancy bow tie and get on with your work! Most important of all – don’t let this article dishearten you. Most functions are a huge success and a great opportunity to socialise and celebrate with colleagues. I am now going to search for my novelty Christmas tie and flashing reindeer antlers in readiness for my own Christmas party. I must also find time to practice my air guitar – it was a dance floor triumph last year … I think … I would like to take this opportunity of wishing you all a safe and happy Christmas and a claims free New Year.

Page 1


THE ROLE * The successful candidate will be selling to the health and beauty sectors e.g. tattoo removal, hair removal and skin clinics etc. * You will be liaising with clients at various levels from cosmetic doctors, clinic owners, clinic technicians and assistants, demonstrating the equipment and winning new customers * This role will also involve attending exhibitions, training workshops, and seminars. * Due to the nature of the role, you will be responsible for growing and maintaining sales from existing accounts as well as generating new accounts supported by the lead generation team as well as your own market knowledge.

THE CANDIDATE * The successful applicant will have a proven track record in sales ideally of capital equipment. * Experience of the aesthetic industry preferred by not essential. * Must be able to self-generate leads as well as develop accounts. * Naturally you will be well presented, confident and articulate.

If you tick these boxes then please apply now attaching your CV to: Andrew Magee, Sales and Marketing Manager - amagee@lynton.co.uk Lynton Lasers Ltd Lynton House, Manor Lane, Holmes Chapel, Cheshire, CW4 8AF


In Training

I n

t ra i n i n g

Dr Peter Prendergast on how the European College of Aesthetic Medicine is helping practitioners to up their skills in aesthetic medicine

In the leafy hills of Bologna, Italy’s beautiful northern University city, is situated a small private hospital called Villalba. Every four months, senior faculty from the European College of Aesthetic Medicine gather to deliver live demonstrations and hands-on training in ultrasoundassisted liposculpture to doctors from around the globe. After three days of lectures, discussions, demonstrations, and hands-on training, all participants sit an examination that must be passed in order to obtain the highly coveted ECAM VASER certification, a mark of having reached a certain proficiency and standard in the art of VASER lipoplasty. The European College of Aesthetic Medicine has become a leading institute in training for doctors of all specialties interested in developing or improving their practice in aesthetic medicine. From basic techniques such as botulinum toxins and fillers, to advanced body and facial sculpting, and minimally invasive breast augmentation and thread lifting, the College offers comprehensive training at sites in Europe, the Middle East, and Asia. The growth in aesthetic medicine in recent years is reflected in the quickly growing and eclectic ECAM membership, with members from over 20 countries in disciplines such as aesthetic

medicine, general practice, plastic surgery, dermatology, general surgery, and general medicine. One of the tenets of ECAM that is realised through the teaching philosophy and methods. The teaching method incorporates didactic lectures that emphasise safety, anatomy, artistic approach, and cutting edge techniques. This is followed by extensive live techniques and hands-on training. One of the most important parts of the ECAM experience is post-course mentorship. You’ve seen one and done one—but can you confidently do it again and again on your own back at your own clinic?

“The European College of Aesthetic Medicine has become a leading institute in training for doctors of all specialties interested in developing or improving their practice in aesthetic medicine. ” 50


Having your mentors close at hand whenever you need them makes it a whole lot easier, and instills confidence as you incorporate your new skills. Courses at the European College of Aesthetic Medicine fill fast, with the last VASER course in Bologna being no exception. Doctors from the UK, Ireland, Kuwait, USA, Thailand, and Malaysia learned new techniques in body contouring, including applications for circumferential thigh contouring, calves, neck and face, abdomen, arms, fat transfer, and more. The senior faculty included the father of VASER himself, Prof. Alberto di Giuseppe, and ECAM’s current President, Dr Peter Prendergast. Di Giuseppe pioneered VASER lipoplasty, superficial skin redraping, female breast reduction using VASER, and authored several books on the techniques, including Liposuction. Principles and Practice, Body Contouring. Art, Science, and Clinical Practice, and Cosmetic Surgery, published by Springer. Dr Prendergast pioneered VASER in Ireland, performs high-definition liposculpture and fat grafting, and has trained doctors all over the world in aesthetic medical techniques. His new book, Aesthetic Medicine. Art and Techniques, has just been released by Springer. ECAM’s next Master Course in VASER Lipoplasty will be held in Bologna, Italy, from February 16-18, and Master Course in Suture (Thread) Lifting Techniques in Dublin on January 13-14. Registration and membership is available on www. ecamedicine.com

EC European College AM of Aesthetic Medicine LEADERS THAT CREATE LEADERS


FEEDBACK FROM OUR DELEGATES “Continue as you do it. It’s perfect!” “Excellent academic, very good organisation, excellent hands-on practice”

October's Master course was fully attended with doctors from different specialties from UK, USA, Thailand, Malaysia, and the Middle East learning incredible body contouring techniques from the experts.

3 Days HANDS-ON Master Course in VASER Lipoplasty Bologna, Italy:

16 to 18 Feb 2012

2 Days HANDS-ON Master Course in Suture (thread) lifting techniques Dublin, Ireland:

Here's your chance to learn from the leaders in body contouring and add a whole new dimension to your aesthetic practice. Following this intensive, HANDS-ON course, you will: * Understand all assisted liposuction technologies and the unique benefits of VASER, the newest ultrasound-assisted technique for body contouring * Understand VASER physics and safety * Know how to start an office-based practice in lipoplasty * Be proficient in performing the tumescent technique for anaesthesia * Understand patient selection, marking, preparation, and aftercare * Be able to contour face, neck, abdomen, flanks, thighs, knees, calves, arms, and male breasts * Understand risks and potential complications associated with ultrasoundassisted lipoplasty and how to avoid and treat them * Be able to introduce the VASER technique to your practice immediately * Receive ongoing advice and support from ECAM faculty * Have an understanding of advanced techniques using VASER, including circumferential thigh contouring, skin redraping, treatment of hyperhidrosis, and fat harvesting

13 to 14 Jan 2012 A C

We offer the most comprehensive and exciting course available in thread lifting techniques. As a practitioner offering a range of effective thread lift techniques, you will stand out and be sought after by patients seeking minimally invasive face and neck lifting. During this hands-on Master course, you will learn: • Non-barbed suture suspension lifts • Barbed suture lifts • Coned suture lifts with temporal anchorage • Anatomy, patient selection, detailed technique, complications and complementary techniques for panfacial rejuvenation

BECOME A MEMBER TODAY Why should you become a member of the AT ECAM today? a Core and advanced hands-on training modules WWW.ECAMEDICINE.COM a Direct training from leading international authorities FOR ONLY €100 All specialties welcome. Our members include general practitioners, plastic surgeons, dermatologists, ophthalmologists, gynaecologists, ENT and maxillofacial surgeons, anti-aging physicians, and cosmetic doctors.

a Worldwide courses a Staying up to date with developments in aesthetic medicine including European CEN standards a Unique post-course mentorship from senior faculty a Certification and examinations leading to Fellowship a Members enjoy course discounts, certificates, and exclusive access to news portals

Skin { Subcutaneous fat STF

DTF Temporalis ms.

B Periosteum

D Skull




Under local anaesthesia, scarless lifting of • temporal/upper face • brow • midface • jowls • neck


At the European College of Aesthetic Medicine, we teach techniques in a way that allows you to confidently perform them as soon as you return to your practice. * Clear instruction in theory, safety, and technique * Step-by-step supervised hands-on training * Ongoing mentorship and guidance from senior ECAM faculty following the course

ECAM Fellowship programme: Module 1: Botulinum toxins and fillers: Essentials

Module 8: Sclerotherapy and laser vascular therapies

Module 2: Chemical and mechanical skin resurfacing

Module 9: Laser skin resurfacing

Module 3: Lasers and light in aesthetic medicine

Module 10: Anti-aging and regenerative medicine

Module 4: Body contouring: techniques and technologies

Module 11: Master course in ultrasound-assisted (VASER) lipoplasty

Module 5: Botulinum toxins, fillers, and stimulators: advanced

Module 12: Master course in suture (thread) lifting techniques

Module 6: Mesotherapy: principles and practice

Module 13: Non-surgical breast augmentation

Module 7: Cosmeceuticals and clinical nutrition in aesthetic medicine

Module 14: Autologous fat transfer Module 15: Hair transplantation

For more details on training modules and membership, visit www.ecamedicine.com. T: +353 1 2542188. E: info@ecamedicine.com

Dates for the Diary



bioptica Laser Safety Consultants Bioptica: Laser Core of Knowledge course given at YOUR clinic on a date that suits YOU. Visit www.bioptica.co.uk for more information or call 07766 591 085.


9 Micro Cannula, West Yorkshire, www.heatherirvineaestheticsacademy.co.uk 13 Juvederm Voluma, West Yorkshire, www.heatherirvineaestheticsacademy.co.uk 13 Obagi Workshop, Manchester, www.healthxchange.com 16 Obagi Workshop, London, www. healthxchange.com 16 Sally Durant Training and Consultancy, Advanced Skin Science, Birmingham, 01527 919 880 16 SkinCeuticals One Day Sales Training, London, www.SkinBrands.co.uk 16-17 SkinCeuticals Training, Cheshire, www.SkinBrands.co.uk


1 The Aesthetic Awards in Association with Cosmetic News, Sopwell House, St Albans, www.cosmeticnewsuk.com 1-2 SkinCeuticals Training, Cheshire, www.SkinBrands.co.uk 2 Genuine Dermaroller™ Medical Device Training, The Glass House Clinic, London SW, www.genuinedermaroller.co.uk 3 Dermis Deep Advanced Botox Course, Central London, www.dermisdeep.com 3 Dermis Deep Superficial and Medium Chemical Peels, Manchester, www.dermisdeep.com 3 Cosmetic Courses Foundation Botulinum Toxin and Dermal Fillers, www.cosmeticcourses.co.uk 3 Cosmetology Botox Vistabel Foundation, Glasgow, www.cosmetologyuk.com 4 Cosmetology Dermal Fillers Foundation, Glasgow, www.cosmetologyuk.com 5 Medik8 Training, Cheshire, www.SkinBrands.co.uk

1 Medik8 Roller Training, London, www.SkinBrands.co.uk 2 Premed Taster Course, Guildford, www.theclinicalexchange.com 2-3 SkinMedica Training, London, www.SkinBrands.co.uk 13 Sally Durant Training and Consultancy, The Art of Skin Peeling, London, 01527 919 880 6 Dr Bob Khanna Training Institute, Botulinum Toxin - Beginners, www.drbobkhanna.com 6 Foundation Botulinum Toxin, West Yorkshire, www.heatherirvineaestheticsacademy.co.uk 6-7 SkinCeuticals Training, Cheshire, www.SkinBrands.co.uk 7 Dr Bob Khanna Training Institute, Botulinum Toxin - Advanced, www.drbobkhanna.com 8 Dr Bob Khanna Training Institute, Dermal Fillers – Beginners, www.drbobkhanna.com 15 Dr Bob Khanna Training Institute, Refreshers Course, www.drbobkhanna.com 15 Dr Bob Khanna Training Institute, Heart Lips™, www.drbobkhanna.com 16 Dr Bob Khanna Training Institute, The Team

5 Dr Bob Khanna Training Institute, Botulinum Toxin Beginners, www.drbobkhanna.com 6 Dr Bob Khanna Training Institute, Botulinum Toxin Advanced, www.drbobkhanna.com 6 SkinMedica Training, Cheshire, www.SkinBrands.co.uk 6-7 Medik8 Training, London, www.SkinBrands.co.uk 6 Genuine Dermaroller™ Medical Device Training, The Clinic, Brighouse, Yorkshire www.genuinedermaroller.co.uk 7 Genuine Dermaroller™ Medical Device Training, The Ashleigh Clinic, Leicester, www.genuinedermaroller.co.uk 7 Dr Bob Khanna Training Institute, Dermal Fillers – Beginners, www.drbobkhanna.com 7 Lip Master Class, West Yorkshire, www.heatherirvineaestheticsacademy.co.uk 7 Wigmore Medical Training, GloMinerals Workshop, London, training@wigmoremedical.com 9 Wigmore Medical Training, CPR and Anaphylaxis, London, training@wigmoremedical.com 9 Microsclerotherapy, Guildford, www.theclinicalexchange.com 10 Meeting of the Society of Cosmetic Physicians and Surgeons (SCPS), London, www.scps-uk.org

10 Dermis Deep Botox Course, Central London, www.dermisdeep.com 10 Dermis Deep Dermal Filler Course, Central London, www.dermisdeep.com 10 Wigmore Medical Training, Microsclerotherapy and Facial Telangiectasia, London, training@ wigmoremedical.com 12 Genuine Dermaroller™ Medical Device Training, The Glass House Clinic, London SW, www.genuinedermaroller.co.uk 12 Obagi Workshop, London, www.healthxchange.com 13-14 SkinCeuticals Training, London, www.SkinBrands.co.uk 14 Wigmore Medical Training, Introduction to Skincare and Chemical Peels, London, training@wigmoremedical.com 14 Foundation level Botulinum Toxin and Dermal Filler Training Course, Glasgow, www.inspiredcosmetictraining.com 15 Wigmore Medical Training, Introduction to Boutlinum Toxin Type A, London, training@wigmoremedical.com 16 Wigmore Medical Training, Introduction to Dermal Fillers, London, training@wigmoremedical.com

17 Sally Durant Training and Consultancy, Investigative Consultation ad Advanced Skin Assessment, Birmingham, 01527 919 880 18 Dr Bob Khanna Training Institute, Botulinum Toxin - Beginners, www.drbobkhanna.com 18 Dental Block, West Yorkshire, www.heatherirvineaestheticsacademy.co.uk 19 Dr Bob Khanna Training Institute, Botulinum Toxin - Advanced, www.drbobkhanna.com 20 Dr Bob Khanna Training Institute, Dermal Fillers – Beginners, www.drbobkhanna.com 20 Business Development, West Yorkshire, www. heatherirvineaestheticsacademy.co.uk

21 Cosemtic Courses Foundation Botulinum Toxin and Dermal Fillers, www.cosmeticcourses.co.uk 21-22 SkinCeuticals Training, London, www.SkinBrands.co.uk 23 Foundation Dermal Filler, West Yorkshire, www.heatherirvineaestheticsacademy.co.uk 23-24 Medik8 Training, Cheshire, www.SkinBrands. co.uk 24-25 SkinCeuticals Training, London, www.SkinBrands.co.uk 26-29 IMCAS 2012, Paris, France, www.imcas.com/en/ 30 Sally Durant Training and Consultancy, Laser Hair Removal – Core Knowledge for the Aesthetic Therapist, London, 01527 919 880

Program, www.drbobkhanna.com 16-18 Microsclerotherapy for Thread Veins of the Leg, www.theclinicalexchange.com 20-21 Medik8 Training, Cheshire, www.SkinBrands.co.uk 22 Obagi Workshop, London, www.healthxchange.com 23 Dr Bob Khanna Training Institute, Oral Facial Course, www.drbobkhanna.com 23-24 Medik8 Training, London, www.SkinBrands.co.uk 24 Dr Bob Khanna Training Institute, Dermal Fillers – Advanced, www.drbobkhanna.com 25 Cosemtic Courses Foundation Botulinum Toxin and Dermal Fillers, www.cosmeticcourses.co.uk 27 Obagi Blue Peel Workshop, London, www.healthxchange.com 27 SkinMedica Training, Cheshire, www.SkinBrands.co.uk 28 4th annual meeting of the RSM Interventional Cosmetics Group, www.rsm.ac.uk

CosmetiC n ews E the uk’s only free of charge aesthetiCs exhibition



We round up upcoming events, training courses and meetings


xpo 2012 29th - 30th april 2012 | business design Centre, islington, london

full logo

MARCH 5-6 SkinCeuticals Training, Cheshire, www.SkinBrands.co.uk 12 Dr Bob Khanna Training Institute, Botulinum Toxin Beginners, www.drbobkhanna.com 12-13 Medik8 Training, Cheshire, www.SkinBrands.co.uk 13 Dr Bob Khanna Training Institute, Botulinum Toxin Advanced, www.drbobkhanna.com 14 Dr Bob Khanna Training Institute, Dermal Fillers – Beginners, www.drbobkhanna.com 15 Dr Bob Khanna Training Institute, Gel Peel, www.drbobkhanna.com 27-28 SkinCeuticals Training, London, www.SkinBrands.co.uk

• If you have any dates you would like to add to our Dates for the Diary section please email vicky@creativemedialtd.co.uk •

the uk’s largest aesthetics Meeting

train with the Best to overtake the rest!

• • • • • •

Over 35 exhibitOrs have already signed up again fOr the third cOnsecutive year catch up with all yOur suppliers under One rOOf gain cpd accredited educatiOn netwOrk with Other aesthetic practitiOners take advantage Of great shOw deals see new prOducts first

CosmetiC n ews E the uk’s only free of charge aesthetiCs exhibition


xpo 2012 29th - 30th april 2012 | business design Centre, islington, london


for 2012

conference programme

due to the demand there will be a small charge of £45 for the 2012 conference.

the conference is an excellent opportunity for delegates to see the very best uk and international speakers,discussing the latest topics and demonstrating the most up-to-date techniques. a complimentary lunch will be incorporated into the delegate package, with refreshments provided throughout the conference breaks. early Bird discount - receive 10% off on your conference ticket, book before the 31st december 2011 (you will also receive a complimentary vip party invite,which will include an evening of free food and alcohol)

r e g i s t e r o n l i n e f o r yo u r f r e e o f c h a r g e e x h i B i t i o n t i c k e t w w w . c o s m e t i c n e w s u k . c o m






ABC Laser Contact: Guy Gouldsmit T: 08451 707 788 E: info@a-b-c-uk.com W: www.abclasers.co.uk

Candela UK Ltd Contact: Michaela Barker T: +44 08455210698 E: alex@alexsilver.co.uk W: www.candelalaser.co.uk

Aesthetic Academy + Training Contact: Chantalle Coombes T: 0845 519 4823 W: www.aestheticstraining.co.uk E: training@aestheticacademy.co.uk

Chromogenex Service: Laser System Manufacturer Contact: Lauren Roberts T 01554 755444 E: lroberts@chromogenex.com W: www.chromogenex.com

Allergan Contact: Customer Service T: 01628 494444 W: www.juvedermultra.co.uk

Beehive Medical Solutions Contact: Kevin Rendell T: 020 8550 9108 E: enquiries@beehive-solutions.co.uk W: http: //www.beehive-solutions.co.uk/ catalog

Cosmetic Courses Contact: Morag Hague T: 0845 230 4110 E: info@cosmeticcourses.co.uk W: www.cosmeticcourses.co.uk



Betheny Workwear Service: Uniforms Contact: Siju Jacob T: 01516 776 777 W: www.betheny.co.uk E: enquiries@betheny.co.uk

Bioptica Contact: Roy Henderson T: 07766 591 085 E: roy@biotica.co.uk W: www.bioptica.co.uk Blue Horizons Marketing T: 01242 236600 E: info@bluehorizonsmarketing.co.uk W: www.bluehorizonsmarketing.co.uk Services: Websites, patient literature, referral literature, brand image, advertising, e-marketing and more. Boston Medical Group LTD Contact: Iveta Vinklerova T: 0207 727 1110 E: info@boston-medical-group.co.uk W: www.boston-medical-group.co.uk




Cutera (Europe) Contact: Stephen Ritchie T: 07969993296 E: sritchie@cutera.com W: www.cutera.com



MACOM Compression Garments Contact: MACOM Customer Services T: 020 7386 0011 E: info@macom-medical.com W: www.macom-medical.com

Morning Star Surgical S.A. (Pty) Ltd Contact: Brian Nielsen T: +27 (82) 667 2506 E: brian@morningstar-medical.com W: www.morningstarsurgical.co.za

Galderma Contact: Azzallure Sales Team T: 01923 208950 E: info.uk@galderma.com W: www.galderma.co.uk


Polaris Lasers Contact: Neil Calder T: 01234841536 E: njc@polaris-laser.com W: www.polaris-laser.com

Rosactive Phytoceutical U.K. Contact: Mr. Naci Gulsan T: 020 85090907 E: hunalp@hunalp.co.uk W: www.rosactive.co.uk www.hunalp.co.uk Sanofi Aventis Contact: Customer Service T: 01483 554 809 W: www.sanofi-aventis.co.uk

Specialist Make-Up Services Ltd Contact: Mike Lawrence T: 0845 2302021 E: enquiries@permanent-makeup.com W: www.permanent-makeup.com Services: Permanent Make-Up



My Cells/Scandinavian UST Ltd Contact: John Tucker T: +35361 312979 E: info@mycells.ie W: www.my-cells.net Pronokal Service: Medically supervised weight loss programme E: info@pronokal.co.uk T: 0845 604 8834 W: www.pronokal.co.uk

RECOVA COMPRESSION GARMENTS Contact: Eva Sanchez-Smith E: eva.sanchez@recovapostsurgery.com W: www.recovapostsurgery.com T: 0207 000 1044

Skin Geeks Ltd Contact: Trishna Shah T: +44 (0)1865 338046 E: trishna@skingeeks.co.uk W: www.skingeeks.co.uk

Medical Aesthetic Group Contact: David Gower T: 02380 676733 E: info@magroup.co.uk W: www.magroup.co.uk Merz Aesthetics Contact: Merz Aesthetics Customer Services T: 0333 200 4140 E: info@merzaesthetics.co.uk

Qutis Contact: Marea Brennan Thorns T: 01844 213007 E: info@qutisclinics.co.uk W: www.qutisclinics.co

Skin brands Contact: Tracey Beesley T: +44 (0) 2089978541 E: tracey@skinbrands.co.uk W: www.skinbrands.co.uk

Med-fx Contact: Faye Price T: 01376 532800E: sales@medfx.co.uk W: www.medfx.co.uk

Euromedical Systems Ltd. Contact: Phillip Richardson T: 0845 130 4949 W: www.euromedicalsystems.co.uk E: info@euromedicalsystems.co.uk

Harley Aesthetics Contact: Dr Mark Harrison T: 02074872772 E: enquiries@harleyaesthetics.com W: www.harleyaesthetics.com Services: Training

Lifestyle Aesthetics Contact: Sue Wales T: 0845 0701 782 E: info@lifestyleaestheics.com W: www.lifestyleaesthetics.com

Mayfair Medical Contact: Mike Filapiuak T: +44 02076296269 E: mike@ericson-laboratoire.co.uk W: www.ericson-laboratoire.com

E-Clinic Contact: Mark Lainchbury T: 01274 530 505 E: info@e-clinic.uk.com W: www.e-clinic.uk.com

Hamilton Fraser Contact: Wai Chan T: 0845 3106 300 E: cosmetic@hamiltonfraser.co.uk W: www.hamiltonfraser.co.uk


Mapperley Park Training www.mapperleypark.co.uk/training Email: training@mapperleypark.co.uk Tel: 01159 690 111

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Surface Imageing Solutions Contact: Nick Miedzianowski-Sinclair Service: Skin Analysis systems & services Telephone : +447774802409 E: nms@surfaceimageing.co.uk W: www.surfaceimageing.co.uk Vaser Lipo/ Sound Surgical Technologies LLC Contacts: Simon Davies T: +44 (0) 7971 686114 E: SDavies@soundsurgical.com W: www.vaser.com Wealden Projects Contact: Kevin Dewhurst E: kevin@wealden projects.com W: www.wealdenprojects.com T: 01892 611552 M: 07969 697593 Wellness Trading Contacts: Adam Birtwistle T: 01746 718123 E: contact@wellnesstrading.co.uk W: www.wellnesstrading.co.uk Zanco Models Contacts: Mr Ricky Zanco T: 08453076191 E: info@zancomodels.co.uk W: www.zancomodels.co.uk

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www.belotero.com Merz Pharma UK Ltd 260 Centennial Park, Elstree Hill South Elstree, Hertfordshire, WD6 3SR Tel: +44 (0) 333 200 4140



onfidence is... Her happiness. Your expertise. Our experience. Vistabel® is licensed for the treatment of moderate to severe glabellar lines Delivers lasting patient satisfaction, time after time1,2 Trusted with over 1 million cosmetic procedures across Europe3* The world’s first and most studied botulinum toxin4†

Satisfaction that shows

Vistabel® (botulinum toxin type A) Abbreviated Prescribing Information Presentation: Botulinum toxin type A (from clostridium botulinum), 50 Allergan Units/vial. Indications: Temporary improvement in the appearance of moderate to severe vertical lines between the eyebrows seen at frown, in adults <65 years, when the severity of these lines has an important psychological impact for the patient. Dosage and Administration: See Summary of Product Characteristics for full information. Do not inject into blood vessels. Doses of botulinum toxin are not interchangeable between products. Not recommended for patients <18 or >65 years. Use for one patient treatment only during a single session. Reconstitute vial with 1.25ml of 0.9% preservative free sodium chloride for injection (4U/0.1ml). The recommended injection volume per muscle site is 0.1ml (4U). Five injection sites: 2 in each corrugator muscle and 1 in the procerus muscle: total dose 20U. Contra-indications: Known hypersensitivity to any constituent. Myasthenia gravis, Eaton Lambert syndrome. Infection at proposed injection sites. Pregnancy or lactation. Warnings/Precautions: Use for one patient treatment only during a single session. Relevant anatomy and changes due to prior surgical procedures must be understood prior to administration. Product contains less than 1mmol sodium (23mg) per dose. Do not exceed recommended dosages and frequency of administration. Epinephrine (adrenaline) or any other anti-anaphylactic measures should be available. Very rare reports of adverse reactions possibly related to spread of toxin distant from site of injection. Therapeutic doses may cause exaggerated muscle weakness. Caution in patients with history of dysphagia and aspiration. Patients or caregivers should seek immediate medical care if swallowing, speech or respiratory disorders arise. Too frequent or excessive dosing can result in risk of antibody formation, which may lead to treatment failure. Caution in the presence of inflammation at the proposed injection site(s) or when excessive muscle weakness or atrophy is present. Caution when used in patients with amyotrophic lateral sclerosis or with peripheral neuromuscular disorders. Effects of administering different botulinum toxin stereotypes simultaneously, or within several months of each other, is unknown and may cause exacerbation of excessive neuromuscular weakness. Interactions: Theoretically, effect may be potentiated by aminoglycoside antibiotics or other drugs that interfere with neuromuscular transmission. Adverse Effects: See Summary of Product Characteristics for full information on side effects. Based on controlled clinical trial data, the proportion of patients that would be expected to experience an adverse reaction after treatment is 23.5% (placebo: 19.2%). These adverse reactions may be related to treatment, injection technique or both. In general, reactions occur within the first few days following injection and are transient and of mild to moderate severity. Pain/burning/stinging, oedema and/or bruising may be associated with the injection. Frequency By Indication: Defined as follows: Very Common (≥1/10), Common (≥1/100, <1/10), Uncommon (≥1/1,000, <1/100), Rare (≥1/10,000, <1/1,000), Very Rare (<1/10,000). Infections and infestations. Uncommon: Infection.

Psychiatric disorders. Uncommon: Anxiety. Nervous system disorders. Common: Headache. Uncommon: Paresthesia, dizziness. Eye disorders. Common: Eyelid ptosis. Uncommon: Blepharitis, eye pain, visual disturbance. Gastrointestinal disorders. Uncommon: Nausea, oral dryness. Skin and subcutaneous tissue disorders. Common: Erythema, Uncommon: Skin tightness, oedema (face, eyelid, periorbital), photosensitivity reaction, pruritus, dry skin. Musculoskeletal and connective tissue disorders. Common: Localised muscle weakness, Uncommon: Muscle twitching. General disorders and administration site conditions. Common: Face pain, Uncommon: Flu syndrome, asthenia, fever. The following have been reported rarely for glabellar lines and other indications: rash, urticaria, pruritus, erythema multiforme, psoriasiform eruption, anaphylactic reaction (angiodema, bronchospasm), alopecia, madarosis, tinnitus and hypoacousia. Adverse reactions possibly related to spread of toxin distant from injection site have been reported very rarely (muscle weakness, dysphagia, or aspiration pneumonia which can be fatal). Price: £85.00 per vial. Marketing Authorization Number: PL 05179/0010 Marketing Authorization Holder: Allergan Pharmaceuticals (Ireland) Ltd., Westport, Co. Mayo, Ireland. Legal Category: POM. Date of preparation: December 2008.

Adverse events should be reported. Reporting forms and information can be found at www.yellowcard.gov.uk Adverse events should also be reported to Allergan Ltd. UK_Medinfo@allergan.com or 01628 494026 References: 1. Stotland MA et al. Plast Reconstr Surg, 2007;120:1386-1393. 2. Carruthers A et al. Journal of Clinical Research, 2004;7:1-20. 3. Allergan Data on File (DoF) VIS/003/DEC 2010. 4. Allergan Data on File (DoF) VIS/005/MAR 2011. *Given in 5 key EU countries since VISTABEL® launch. Data taken from UK, France, Spain, Italy and Germany. Global figures. Launched in 1989 in the U.S. Search strategy conducted using; Medline, Embase, Embal, Biosis, SciSearc, Pascal, HCAPlus, IPA. Search applied to Allergan, Ipsen & Merz botulinum toxin type A presentations (cosmetic indication).

Date of search: February 2011.

UK/0101/2011 Date of Preparation: March 2011

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