Cosmetic News Feb 2012-b

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

Tatts Off Laser tattoo removal special

Implant Controversy The PIP scandal Conference Calling

Cosmetic n ews E xpo 2012

29th - 30th april 2012

business design centre, islington, london

also inside this issue of cosmetic News S O C I A L M E D I A | B u y i n g a n d selli n g p r ac t ices | t h e V B eam

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

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2012

Cosmetic news t h e

Azzalure® Abbreviated Prescribing Information Presentation: Botulinum toxin type A (Clostridium botulinum toxin A haemagglutinin complex) 10 Speywood units/0.05ml of reconstituted solution (powder for solution for injection).

Indications: Temporary improvement in appearance of moderate to severe glabellar lines seen at frown, in adult patients under 65 years, when severity of these lines has an important psychological impact on the patient. Dosage & Administration: Botulinum toxin units are different depending on the medicinal products. Speywood units are specific to this preparation and are not interchangeable with other botulinum toxins. Reconstitute prior to injection. Intramuscular injections should be performed at right angles to the skin using a sterile 29-30 gauge needle.

Recommended dose is 50 Speywood units (0.25 ml of reconstituted solution) divided equally into 5 injection sites,: 2 injections into each corrugator muscle and one into the procerus muscle near the nasofrontal angle. (See summary of product characteristics for full technique). Treatment interval should not be more frequent than every three months. Not recommended for use in individuals under 18 years of age. Contraindications: In individuals with hypersensitivity to botulinum toxin A or to any of the excipients. In the presence of infection at the proposed injection sites, myasthenia gravis, Eaton Lambert Syndrome or Amyotrophic lateral sclerosis. Special warnings and precautions for use: Use with caution in patients with a risk of, or clinical evidence of, marked defective neuro-muscular transmission, in the presence of inflammation at the proposed injection site(s) or when the targeted muscle shows excessive weakness or atrophy. Patients treated with therapeutic doses may experience exaggerated muscle weakness. Not recommended in patients with history of dysphagia, aspiration or with prolonged bleeding time. Seek immediate medical care if swallowing, speech or respiratory difficulties arise. Facial asymmetry, ptosis, excessive dermatochalasis, scarring and any alterations to facial anatomy, as a result of previous surgical interventions should be taken into consideration prior to injection.

Injections at more frequent intervals/higher doses can increase the risk of antibody formation. Avoid administering different botulinum neurotoxins during the course of treatment with Azzalure. To be used for one single patient treatment only during a single session. Interactions: Concomitant treatment with aminoglycosides or other agents interfering with neuromuscular transmission (e.g. curare-like agents) may potentiate effect of botulinum toxin. Pregnancy & Lactation: Not to be used during pregnancy or lactation. Side Effects: Most frequently occurring related reactions are headache and injection site reactions.

Generally treatment/injection technique related reactions occur within first week following injection and are transient and of mild to moderate severity and reversible. Very Common (≥ 1/10): Headache, Injection site reactions (e.g. erythema, oedema, irritation, rash, pruritus, paraesthesia, pain, discomfort, stinging and bruising). Common (≥ 1/100 to < 1/10): Facial paresis (predominantly describes brow paresis), Asthenopia, Ptosis, Eyelid oedema, Lacrimation increase, Dry eye, Muscle twitching (twitching of muscles around the eyes). Uncommon (≥ 1/1,000 to <1/100): Dizziness, Visual disturbances, Vision blurred, Diplopia, Pruritus, Rash, Hypersensitivity. Rare (≥ 1/10,000 to < 1/1,000): Eye movement disorder, Urticaria. Adverse effects resulting from distribution of the effects of the toxin to sites remote from the site of injection have been very rarely reported with botulinum toxin (excessive muscle weakness, dysphagia, aspiration pneumonia with fatal outcome in some cases).

Packaging Quantities & Cost: UK 1 Vial Pack (1 x 125u) £64.00 (RRP), 2 Vial Pack (2 x 125u) £128.00 (RRP) IRE 2 Vial Pack (2 x 125u) €187.05 (RRP). Marketing Authorisation Number: PL 06958/0031 (UK), PA 1609/001/001(IRE). Legal Category: POM. Full Prescribing Information is Available From: Galderma (UK) Limited, Meridien House, 69-71 Clarendon Road, Watford, Herts.

WD17 1DS, UK. Tel: +44 (0) 1923 208950 Fax: +44 (0) 1923 208998. Date of Revision: January 2011.

Adverse events should be reported.

Reporting forms and information can be found at www.yellowcard.gov.uk. Adverse events should also be reported to Galderma (UK) Ltd.

Azzalure® is indicated for the temporary improvement in the appearance of moderate to severe glabellar lines seen at frown, in adult patients under 65 years, when the severity of these lines has an important psychological impact on the patient.

The passage of time

The secret to reveal beauty

Azzalure® is a Botulinum Toxin Type A for aesthetic use.

• Fast onset of action (median time to onset 2-3 days)1 • Long duration of action (up to 5 months)1 • High level of patient satisfaction (93% after 6 months, following one treatment session)2

References 1. Azzalure® Summary of Product Characteristics.

2. Ascher B et al. J Am Acad Dermatol 2004; 51: 223-33.

Azzalure® is a registered trademark of Galderma.

Date of preparation: February 2011 AZZ/510/0211

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an aesthetic choice

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Welcome to the February issue of Cosmetic News.

While statistics on the cosmetic surgery industry are readily available, stats on the non-surgical side of medical aesthetics are few and far between. As such, for the past two years, to coincide with the Cosmetic News Expo, we have carried out a survey on aesthetic trends with our readers, the results of which have received impressive amounts of coverage in the national press.

This year we are planning to do the same and with the event just three months away we are asking you to take some time out to fill in our online survey at www.cosmeticnewsuk.com. We would really appreciate your involvement in helping us to create some exciting data about the trends and latest developments in our industry – your feedback is invaluable. On to this month’s issue…

The cosmetic surgery industry has been in the headlines recently with the PIP implant scandal hitting the national press. The negative implications of this story on the industry are plentiful and, as such, it has stirred up a lot of controversial debates. As part of a special report (p18-22) we examine the issues surrounding the scandal and ask key opinion leaders their views.

As part of this month’s special feature (p28-30) we will also be examining laser tattoo removal and looking at the best lasers to treat different pigments and colours.

I hope you enjoy reading this month’s issue and don’t forget to register for your tickets to the Cosmetic News Expo at www.cosmeticnewsuk.com.

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Cosmetic news

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February

SilDerm™

04 EDITOR’S CHOICE

Stretch marks are something that many women are

SilDerm™ Stretch Mark Repair Cream and Prevention Oil.

plagued with and they can be notoriously difficult to prevent and treat.

0 6 I ND U ST R Y N E W S

Stretch marks occur as a result of excessive tension

We round up the latest industry news

put on the skin creating redness and indentation.

1 0 R E G U L AT I O N U P DAT E

The biggest causes of stretch marks are sudden/ rapid weight gain or pregnancy. The risk of getting

Mike Regan gives us an update on the new European Aesthetic Surgery Services Standard

stretch marks is higher if you have fair skin, like me; if you are a teenager or young mother; have had stretch marks during puberty or if they run in

12 ON THE SCENE

your family. However, while stretch marks are never

Out and about in the industry this month

100% preventable, there are steps that can be taken to decrease the risk of suffering, such as maintaining

14 COSMETIC NEWS EXPO 2012

a healthy weight, gaining weight steadily during

We announce the speakers for the Cosmetic News Conference 2012

18 SPECIAL REPORT

c h o i c e

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pregnancy and looking after the skin by keeping it hydrated and moisturised.

As the PIP implant controversy dominated the headlines at the start of 2012 we gauge the industry’s views and opinions

Prevention and treatment for stretch marks has been hit and miss, however, one

24 PEOPLE IN PROFILE

tocopherol, a natural vitamin E and strong antioxidant that helps prevent tissue

method that has been clinically proven to help prevent stretch marks is SilDerm™ Stretch Mark Prevention Oil. The product contains gotu kola, an extract from the centella asiatica plant that stimulates fibroblast cells to produce collagen and

We speak to the multi-talented Dr Bob Khanna

damage. All the ingredients in the product have been screened for use in pregnancy

2 8 L AS E R TATT O O R E M O V A L

becoming pregnant and are worried about stretch marks.

so it is ideal for any of your clients who are pregnant or are thinking about

We take a look at laser tattoo removal and examine some of the best lasers to treat different pigments and colours

For clients that have existing stretch marks, there is SilDerm™ Stretch Mark

3 2 T R E AT M E NT S P O T L I G H T

length and redness of stretch marks and improve the indentation by up to 70%.

Repair Cream which contains ingredients that have been proven to reduce the

We find out about the new EndyMed PRO radio-frequency system from AesthetiCare

Unlike other topical treatments SilDerm™ Repair Cream actually works to help

34 Q&A

with topical use twice daily for a month darutoside can significantly decrease the

We speak to Dr Roberto Viel about ActiStem

severity of stretch marks by up to 34%.

36 PRODUCT FOCUS

It also contains registril, which works by stimulating collagen repair. Clinical

treat the visible signs of stretch marks. The product contains darutoside, which is well known for its wound healing properties. Clinical studies have shown that

We ask practitioners if the V Beam is making a comeback

studies have shown that with topical use, twice daily for two months, registril can

38 PRODUCT NEWS

by up to 72%.

We round up the latest product news

improve a stretch mark’s colour while also decreasing the appearance of its depth All the ingredients in SilDerm™ Stretch Mark Repair Cream have been screened for safety during pregnancy and breast-feeding and the product is currently

4 0 A B ST R A C TS

undergoing further clinical trials at Manchester University.

We round up the latest clinical studies

4 3 B E ST P R A C T I C E

Antonia Mariconda takes us inside the mind of the cosmetic consumer

4 7 B U S I N E SS F O C U S

Meet the Cosmetic News team

Richard Crawford-Small from RCS Consulting provides a 10-step guide to social media

Charlotte Body Publisher 01268 754 897 charlotte@creativemedialtd.co.uk

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

5 0 F I NAN C E

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

Lawrence Grant give their top tips to consider when buying or selling a practice

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

54 DIRECTORY Our guide to the manufacturers, suppliers and business services featured in this month’s issue

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.

Your partner in injectable facial aesthetics

Belotero® now approved by the FDA • One of only 3 HA fillers approved by the FDA currently promoted in the US • Optimal integration1 for superior evenness2 • Minimal local inflammation3 for sustained patient satisfaction4

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Call Merz Aesthetics Customer Services now to find out more or place your orders: Tel: +44(0) 333 200 4140 Fax: +44(0) 208 236 3526 Email: customerservices@merz.com 1 Histological examination of human skin (eyelid dermis layer). Courtesy Dr. J. Reinmüller, Wiesbaden, Germany 2 Prager W, Steinkraus V. A prospective, rater-blind, randomized comparison of the effectiveness and tolerability of Belotero Basic versus Restylane for correction of nasolabial folds. Eur J Dermatol 2010;20 (6):748-52.

3 Taufig A, et al. A new strategy to detect intradermal reactions after injection of resorbable dermal fillers. J Ästhetische Chirurgie 2009; 2: 29-36 4 Reinmüller J et al. Poster presented at the 21 World Congress of Dermatology, Buenos Aires, Argentina, Sept 30 – Oct 5, 2007. Thereafter published as a supplement to Dermatology News: Kammerer S. Dermatology News 2007; 11: 2-3.

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

News - Industry News

ISAPS releases study results The International Society of Aesthetic Plastic Surgery (ISAPS) has released the results of the second International Study of Aesthetic/Cosmetic Surgery Procedures.

The 2011 study reveals a new hierarchy of countries with the most surgical and nonsurgical aesthetic/cosmetic procedures performed by board certified (or equivalent) plastic surgeons in 2010. The United States continues its dominance in the field, with Brazil having the second highest number of plastic surgeons. Britain ranked 16th, perhaps surprisingly behind China, Japan, India, Mexico, Italy, South Korea, France, Colombia, Germany, Turkey, Spain, Russia and Canada.

Lipoplasty remains the most performed procedure, representing 23% of total surgical procedures, followed by breast augmentation at 16%, blepharoplasty at 11.5%, rhinoplasty at 10.4%and abdominoplasty at 7.2%. The popularity of surgical procedures varied by country with the United States, Brazil, China, India, Japan, Mexico and Italy the dominant countries for these top five surgical procedures. Advances in non-surgical procedures, coupled with the desirability of less expensive treatments, correlated with the number of these procedures performed by plastic surgeons with the five leading procedures being: botulinum toxin type A (Botox® and Dysport® ), hyaluronic acid, autologous fat, laser hair removal and IPL laser treatment.

A new feature of the 2011 study includes average surgeons’ fees charged per procedure.

The analysis weighted the averages based on the number of procedures performed in each country and the country’s average reported fee. Face-lifts remain the most expensive of the 10 procedures reported.

The ISAPS survey also reports several important statistics with regard to the total number of board certified (or national equivalent) plastic surgeons practicing globally (estimated to be 33,000). The total number of surgical procedures is projected to have increased to 9,462,391 and the number of non-surgical procedures is estimated at 9,095,434 bringing the combined worldwide total of surgical and non-surgical procedures performed by board certified plastic surgeons to 18,557,825, up from the 2009 total of 17,295,557. These figures do not take into account surgical and non-surgical procedures performed by medical professionals and others who are not plastic surgeons.

“Calculating surgical and non-surgical procedures by properly trained plastic surgeons around the world was a challenging process,” said Dr Sampaio Goes of Brazil, an ISAPS past president and chairman of the ISAPS Communications Committee responsible for oversight of the survey. “We chose a respected survey company with extensive experience in plastic surgery. The results are credible and scientifically significant. Comparison with the previous year’s figures show modest trends that we will continue to watch with the planned 2012 survey.”

The survey was compiled, tabulated and analysed by Industry Insights, Inc and the full results can be seen by visiting www.isaps.org.

Seminar is a Smart Idea The Consulting Room™ is hosting a special event in conjunction with Candela Syneron and Merz Aesthetics.

The SMART Ideas seminar will take place on Saturday February 18 at the Cavendish Conference Centre, London and is entitled ‘Practical Business Strategies and Product Ideas to Increase Your Profits in 2012’.

The event provides an opportunity for practitioners to explore the very latest product innovations, alongside reviewing core business principles related to running an aesthetic clinic.

Practical total facial contouring injectable demonstrations will be held alongside the launch of three new concepts: eLase™ pain free diode laser for hair removal; eTwo™ complete facial rejuvenation system and Elure™ advanced topical skin lightening.

New ideas related to business development and web marketing will also be explored in order to help practitioners maximise profitability during 2012. There will also be a chance to have a free web evaluation with a professional web designer. For more information and to register visit www.smartseminar.co.uk

Carly Oreschnick joins SkinBrands Carly Oreschnick has now joined SkinBrands as regional sales manager for the South East and Home Counties.

She will be responsible for areas including Hertfordshire, Kent, Essex, Buckinghamshire, Leicestershire, Norfolk, Northamptonshire, Cambridgeshire, Bedfordshire and Suffolk. SkinBrands is the UK distributor of SkinMedica, Medik8, Susan Posnick mineral based make-up, RevitaLash™ and HydraFacial™.

Karen Betts joins forces with The Katie Piper Foundation Leading permanent cosmetics practitioner Karen Betts has announced a new collaboration with The Katie Piper Foundation, which will see her become their official and exclusive permanent cosmetics consultant for 2012.

Katie Piper and her Foundation are well known in the UK for their charitable work, which aims to make life easier for people living with burns and scars.

Katie’s ambition is to help others in their quest to feel confident again in spite of their scars, and strives to recommend and provide a network of the best treatments and beauticians available for fellow sufferers. Karen Betts is one of the 6

cosmeticnewsuk.com

first in this growing network for the Foundation and has personally worked with Katie as she recovered from an acid attack in 2008. Over a 12-month process she recreated Katie’s lips, brows and eye definition. Karen said, “When I first met Katie I was bowled over by her drive and determination to help other survivors have the same opportunities that she has had. The Katie Piper Foundation is a fantastic charity. I hope this collaboration will be a success and that we can help as many people as possible and continue the relationship well beyond 2012.”

Katie added, “I’m so pleased that Karen has offered her expertise to help other survivors feel more confident about themselves. She has a great passion and determination to help change people’s lives and I’m delighted that she’s able to help the Foundation.”

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Before

Before

After

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

After

Before

AFT 570 SR

Photos courtesy: Fernando Stengel, MD

After

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.

Pixel ST

Before

AFT

After

Before

AFT 420 Acne

Photos courtesy: Elizabeth VanderVeer, MD

Before

After

After

Pixel Laser

Photos courtesy: Bhupendra Patel, MD

Before

ContaCt us on: tel: 0845 1707788, info@a-b-c-uk.com, www.abclasers.co.uk

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News - Industry News

Solta sponsors ‘love handles’ survey To mark the launch of its new nonsurgical permanent fat reduction procedure, Liposonix Gen II, Solta Medical sponsored a survey entitled, ‘The State of Love Handles in America’ to quantify the extent of the desire to lose fat in the waist area.

The nationwide survey of more than 1,000 women revealed that for 62% of women the part of their body they are most uncomfortable with is their tummy/love handles. A surprising 45% said they would give up sex for one year just to lose an inch, 66% would give up chocolate and 75% would give up clothes shopping.

The survey findings support a growing demand for fat reduction treatments. In fact, more than a half million fat reduction procedures were performed in the US in 2011and it is estimated that the non-invasive fat reduction market will grow by 42% annually through 2016 – nine times faster than its surgical counterparts.

Charity Golf Day raises money for Cancer Research Body Media is supporting a charity golf day in aid of Cancer Research and is inviting teams from the aesthetics industry to take part.

The Leslie Walker Trophy event will take place at Stock Brook Manor in Essex on March 12 2012.

18 holes will be played in the tournament. Entry costs £300 for a team of four and includes a bacon roll and an after golf meal. The price also includes a donation and automatic entry into a raffle draw.

To enter contact Thurloe Walker on 07913 993 089 or David Hodgson on 07809 395 587.

Karen Evans Joins Sterex Karen Evans has joined the Sterex team as principle trainer at their training academy in Birmingham.

Karen has had 17 years experience within the beauty industry as a therapist, salon manager, business owner, trainer and lecturer in further education.

Karen was first introduced to Sterex in 2008 having entered one of her students in Sterex Student of the Year and winning the coveted title of Sterex Student/Lecturer of the Year, a success she repeated with another student in 2011. This year she will take an active part in the organisation and judging of this competition.

Karen has won two Outstanding Awards for her contribution to teaching and has been part of the General Working Team for HABIA and a consultant for City and Guilds. She said, “I am delighted and proud to be part of the Sterex training team – which has such a strong portfolio and reputation.”

Elaine Stoddart, director of education added, “We are delighted to welcome Karen to Sterex. With her excellent skills set and experience she will make our team even stronger.”

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LPG introduces training workshops LPG Endermologie is expanding its UK education support with the introduction of workshops to help practitioners better understand how offering non-aggressive treatments can help them drive revenue.

The workshops, which offer practical experience with LPG Endermologie’s equipment, are open to both prospective customers considering adding these non-aggressive treatments to their menu of services and to existing LPG customers to ensure they can get more from their investment.

Diane Snelson, LPG area manager, said, “These workshops focus on developing core product knowledge and specialist training, so that attendees have the knowledge and skills to get the most from their machines and in turn deliver results for their customers.”

Linda Pritchard from Diamonds Laser clinic in Withernsea added, “We are proud to be part of the LPG family. The training provided by LPG’s head trainer, Marjory Sautreuil was invaluable. It has helped us to improve upon the great results we have already achieved with our clients and shown us how to do more with Endermologie equipment.”

Further workshops are planned throughout the UK during 2012. To find out more please contact LPG Customer Services on 0800 085 0533 or e-mail info@lpgendermologie.co.uk

Surgeons put forward regulation proposal The British Association of Aesthetic Plastic Surgeons has proposed a straightforward, six-point plan to instil tighter controls in the aesthetic sector, following news of an enquiry by MPs to examine lax regulations which have allowed a ‘cowboy’ market to flourish in the UK. According to consultant plastic surgeon and BAAPS President Fazel Fatah, “Despite the unfortunate scandal which has brought this issue onto the agenda, it is an absolute joy for us at the BAAPS to hear that this year, the Government will be examining the lax regulations in our sector..”

The plan consists of six main points: • • •

•

•

•

Ban all advertising of cosmetic surgery. As medical procedures, they should not be publicised – the same as prescription medicines Re-establish an implant register for all all types if silicone implants, not just the breast Re-classify dermal fillers as medicines. At the moment injectables just require a CE mark (the same as with a teddy bear or washing machine), which has allowed over a hundred to be marketed in the UK, when there are less than a dozen in the US as they require FDA clearance Compulsory registration of practitioners in aesthetic medicine and lasers. Currently, there is only a voluntary database for clinics, rather than the actual practitioners. Registration should be mandatory and management by an independent entity such as the Care Quality Commission Mandatory (BAAPS-style) Safety Audit. BAAPS surgeons are audited on an annual basis as a membership requirement. This should be established for all practitioners in the UK and a part of their revalidation to continue practicing Revalidation and mystery shopping in CE marking

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Alma Lasers revolutionary SopranoXL BLUE • Pain-Free laser hairXLi removal Alma Lasers revolutionary Soprano for permanent reduction and topical dermal hair heating standou • Extremely effective Hair-Free results XLi a Lasers revolutionary SopranoXLi for permanent hair reduction and topical dermal heating standout in the industry.

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Regulation update

Open for discussion Mike Regan chair to the Aesthetic Surgery Services Committee (CH/403) of the British Standards Institution gives up an update on the new European Aesthetic Surgery Services Standard now that the draft is available for public comment

The purpose of the consultation process for EN 16372 is to develop a European best practice standard for surgeons, doctors and nurses in private healthcare facilities offering aesthetic procedures to change physical appearance.

The standard aims to define the requirements for the quality for the aesthetic surgery service offered in order to ensure patient safety and other factors which influence the overall quality of service included such as staff behaviour and facility design.

This European standard is designed to help clinics who adopt it to: • Improve their services by enhancing patient safety and avoid the risk of complications • Avoid patient criticism about poor service • Ensure patients are clearly communicated to and each procedure is clearly explained including the risks • Have the right facilities for the procedures offered • Keep and maintain patient records • Selection process of products and suppliers • Effective and timely post-procedure check-up process

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The public consultation will run until April 22, 2012 and once the process is finalised, EN 16372 will be applicable to any organisation working with the aesthetic surgery industry. The final version of the standard is expected to be published in the first half of 2013.

To review and comment on the draft standard, use the process: http://drafts.bsigroup.com/ Search on either: ‘aesthetics surgery services’ or the draft standard number: prEN 16372 This will take you through to a ‘draft details’ option.

You will then be asked to register with the site.

After that you can make comments on a clause by clause basis.

Mike Regan has been actively involved in the national and international standardisation sector since 2001. This experience ideally positions him to advise and manage the BSI CH/403 Committee from a process point of view - how Standards are developed, voted on and implemented. His specific technical area of interest and expertise is laser safety. With a background in physics and engineering, he has since 2005 actively represented the UK on the Aesthetic/Medical Working Group (WG4) of the International Electrotechnical Commission TC76 Laser Safety Committee. He works full time as a Laser Protection Adviser, primarily in the aesthetics sector, carrying out specialised risk assessments of clinics and salons, delivering Core of Knowledge Training and liaising with laser and IPL product manufacturers. Mike is a chartered engineer with the IET (Institution of Engineering and Technology)and also holds the position of chair to the Association of Laser Safety Professionals.

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4. Allergan Data on File (DoF) Marketing overview, 2011. Instructions and directions for use of JUvéDeRm® vOLUmA® with Lidocaine are available on request. Lidocaine does not affect the intrinsic performances of JuvéDERM® vOLuMA® and its safety profile, therefore, JuvéDERM® vOLuMA® data is representative of JuvéDERM® vOLuMA® with Lidocaine3

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The public consultation process for the European standard for Aesthetics Surgery Services, EN 16372, is open for a four-month period. The British Standards Institution (BSI) is leading the consultation process in the UK and interested parties from the aesthetics surgery industry can register their comments online at http://drafts.bsigroup.com from January 16.

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on the scene

ON THE SCENE Out and about in the industry this month

Mole and Sun Advice Roadshow 2012 launch, London

Marketing Your Facial Aesthetic Business for Profit Masterclass, Glasgow

La Roche-Posay and the British Association of Dermatologists invited members of the press to the Royal Society of Medicine to mark the launch of the Mole and Sun Advice Roadshow 2012 as part of the BAD’s annual Sun Awareness Campaign.

After enjoying breakfast and a free mole check with one of the consultant dermatologists on hand, the press were greeted by Denis Donohoe, MD of La Roche-Posay, who gave an overview of the objectives of the roadshow and presented results of a survey of sun awareness and skin cancer attitudes in the UK. Worryingly, while 83% of the survey sample knew about the risks of skin cancer less than a third had ever checked their skin for signs of cancer. The survey also revealed that 92%

Marketing your facial aesthetic business with a focus on botulinum toxins and dermal fillers was the theme of the recent masterclass held at La Belle Forme Clinic, Glasgow. The masterclass, organised by Inspired Cosmetic Training, provided opportunity for dentists, nurses, doctors and clinic staff from throughout Scotland to hear and learn from experts, gain practical advice and to network with others working in the same area.

Speakers included Julian Popple, marketing manager for Q-Med/Galderma, who also helped support the event. Julian’s informative talk was focused on understanding your customers, how to keep ahead of the competition, tips for building customer loyalty and how to keep new patients coming through your door. Simon Bennison, digital marketing manager at Alienation Digital, then gave a whistle stop tour of websites, web marketing, using social media and how to dominate Google! Delegates were also asked to put their own websites up for examination and were given tips and recommendations from Simon on how to improve them. The event was rounded off by Yvette Newman, senior training manager, and Gail Stewart, product specialist, from Q-Med, who provided demonstrations on the latest treatments and techniques and opportunity for the delegates to ask questions and discuss in small groups.

Tamuir Shoaib, consultant plastic surgeon and chair of the event said, “The masterclass was a resounding success and will be one of a series of events Inspired Cosmetic Training will be holding this year focusing on marketing, business and finance”.

of those asked said they had experienced sunburn, and many had been burnt multiple times. Dr Stephen Jones, president of the British Association of Dermatologists then took to the podium to present on the rise of skin cancer in the UK and the importance of early detection. He said, “The receptiveness of the public to our messages Dr Stephen Jones, President of the demonstrated to me how British Association of Dermatologists, extremely worthwhile with Managing Director of La RochePosay, Denis Donohoe and useful a roadshow of this kind can be. Whilst protecting your skin from being sun damaged in the first place is of course the best way to reduce your skin cancer risk, regrettably many people will still have got sunburnt at some point in their lives. Therefore, educating the public on how to check their skin is a priority– so that people know what to look out for if the prevention message comes too late.”

MP Sian James then spoke about her role as chair of the Melanoma Taskforce and her campaign to raise awareness of the dangers of sunbeds. She said, “We still see far too many cases of UV exposure with damaging long term health effects.

The message that we have to get out to young people in particular is that it’s cool to stay safe in the sun.”

The Mole and Sun Advice Roadshow is the biggest, public, event-based skin cancer awareness tour in the UK. Thousands of people across the country will receive mole and sun-care advice from expert dermatologists and nurses, in addition to free sunscreen samples, at the eight major national events. The roadshow will start on May 9 at the Windsor Horse Show and end in August at the Edinburgh Fringe Festival. Denis Donohoe, said, “La Roche-Posay is delighted to be supporting the BAD again with their Mole and Sun Advice Roadshow. We are dedicated to increasing the awareness and understanding of melanoma, including early detection and prevention. Our objective is to help raise awareness of the need for protection and decrease the risks associated with exposure.”

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cosmeticnewsuk.com

Avlon Couches joins forces with TOWIE star Amy Childs Fans of The Only Way is Essex will have seen its ditzy beauty therapist star Amy Childs talking about how great it would be to have a treatment couch with ‘boob holes’ in it to make lying down during treatments more comfortable for her and all her clients who have had boob jobs. After watching the programme Debbie Pearson, manager Debbie and Claire from Avalon of Avalon Couches, got in touch with Amy Couches with Amy Childs and told her that Avalon could design beds for this very purpose and the result was the new ‘Volupturest’ treatment bed, or ‘boob hole bed’, as it has been coined.

Amy, who is now the star of her own Channel 5 reality show Its All About Amy, has recently opened her own salon in Brentwood and the bed has been a talking point, allowing Amy’s more ‘well endowed’ customers to relax and The new Volupturest enjoy their treatments in comfort.

Debbie said, “When I heard Amy mention how painful it is for ladies with large breasts to lie on their front, straight away I thought ‘we can do that’. We’ve designed a bed with a removable section for the breasts to rest and be supported which makes all the difference.”

Debbie was featured on the second episode of the show with her manager Claire and the prototype model of the couch, which comes in a wide range of colours and has additional support cushions such as neck and head cushions and bolsters to match.

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CHaNGES fOr 2 CONfErENCE PrOGraMME Cosmetic News Expo 2012

Cosmetic n ews C osmetiC n ews E www.cosmeticnewsuk.com

the uk’s only free of charge aesthetiCs exhibition

www.CosmetiCnewsuk.Com

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

platinUM sponsor

gold sponsors

silver sponsor

due to demand there will be a small ch for the 2012 conference.

Advance bookings will be charged at £45 per day or £80 f days. On the day bookings will be charged at £75 per day for both days. The conference is an excellent opportunity delegates to see the very best UK and international speake discussing the latest topics and demonstrating the most up date techniques. A complimentary lunch will be incorporat the delegate package, with refreshments provided through conference breaks.

Topics covered at this year’s conference will include: • TrEaTING MENOPauSal ClIENTS • bEGINNErS aNd adVaNCEd laSEr full logo WOrkSHOPS • ClINICal PHOTOGraPHY WOrkSHOP • INJECTION TECHNIQuES • TrEaTING blaCk aNd aSIaN SkIN • TrEaTING MalE ClIENTS • POST PrEGNaNCY TrEaTMENTS • bEGINNErS aNd adVaNCEd INJECTOrS MaSTErClaSSES

E l E G aT E S d O N ’ T M I S S O u T : P u r C H a S E YO u r CO N f E r E N C E T I C k E T N O W We update you on thedspeakers and topics shaping the Cosmetic News Conference 2012

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Providing accredited education at a price everyone can afford..

The Cosmetic News Conference 2012 promises to be an educational, motivational and inspirational meeting, bringing together the best UK and international speakers, discussing the latest topics and demonstrating the most up-to-date techniques. And with new and exciting speakers being confirmed every day, there has never been a better time to book.

Running alongside the Cosmetic News Expo at the Business Design Centre, Islington, on April 29-30, 2012, the Cosmetic News Conference offers aesthetic professionals the chance to gain CPD accredited education, at the same time as networking and exchanging information with their peers, at a fraction of the cost of other industry events.

Continued professional growth and updating of skills is key to the development of any specialty, especially in one so dynamic and ever changing as aesthetic medicine, but in tough economic times keeping up with essential ongoing education can take a back seat. That is why, at Cosmetic News, our ethos has always been to provide the highest standard of education at a price that every aesthetic practitioner can afford, no matter what their budget. Entry to the Cosmetic News Conference has always been free however, due to demand, we will be introducing a small charge for the conference for 2012. The tickets will cost £45 per day or £80 for both days, if you book in advance, or £75 per day or £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.

The Cosmetic News Conference has been designed to help you to not only expand your business but also to develop your skills to keep you one step ahead of the competition – whether you are an experienced practitioner or just starting out. Since its launch in 2012, the Cosmetic News Expo has become one of the ‘must-visit’ events in the aesthetics calendar. The UK’s largest aesthetic conference and exhibition, the Cosmetic News Conference brings you a full and varied programme covering the most up-to-date techniques and topics in aesthetics. This year we will be catering for both the beginner and the advanced practitioner with masterclasses aimed at these two distinct audiences.

Key topics for 2012: • • • • • • • • • • 14

TREATING MENOPAUSAL CLIENTS ADVANCED LASER WORKSHOP BEGINNERS LASER WORKSHOP CLINICAL PHOTOGRAPHY WORKSHOP INJECTION TECHNIQUES TREATING BLACK AND ASIAN SKIN 3D VOLUME REPLACEMENT MASTERCLASS SKIN CANCER AND MOLE DETECTION ADVANCED INJECTORS MASTERCLASS BEGINNERS INJECTORS MASTERCLASS cosmeticnewsuk.com

2012 Speaker line-up The Cosmetic News Conference 2012 promises to be better than ever with our speaker line-up already including some of the biggest names in the industry.

Speakers confirmed so far include:

• • • • • • • • • • • • • • • • •

Dr Nicholas Panay Dr Tracy Mountford Dr Bob Khanna Monica Berrange Mr Paul Banwell Miss Jonquille Chantrey Dr Raj Acquilla Dr Peter Forrester Mr Dalvi Humzah Dr Russell Emerson Leslie Fletcher Dr Gertrude Huss Dr Toni Phillips Dr Stephen Hennessey Dr Stephen Jones Dr Kate Goldie Dr Tapan Patel

Networking is Key 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, while 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 manufacturers and suppliers in the industry, making the Cosmetic News Expo a must visit for those who are new to the industry and are trying to source suppliers, as well as busy practitioners who want to be able to see all their product representatives and business partners under one roof. With more than 70 exhibitors already signed up for 2012 and with Q-Med as our

Platinum Sponsor alongside Gold Sponsors, Skinceuticals/La-Roche Posay, and Silver

As the last two years have shown, the after show party is one of the highlights of the

Sponsors, Candela Syneron, this is one opportunity you can’t afford to miss. Entry to

event and is a fantastic chance to network with speakers and exhibitors and let your

the exhibition as always, is free, but, as mentioned previously, we will be introducing a

hair down after the show. This year’s party will have an Olympic theme to mark the 2012

small charge for the conference for 2012. The tickets will cost £45 per day or £80 for both

Olympics coming to London. Delegates are welcome to bring guests but tickets for

days, if you book in advance, or £75 per day or £150 for both days if you pay on the day.

non-delegates will cost £10.

Tickets will include lunch and refreshments as well as a VIP invite to the Cosmetic News

To book your place at the Cosmetic News Conference and Expo 2012 visit www.cosmeticnewsuk.com today or or call our booking hotline on 01268 754 897.

Expo after show party, at the Pitcher and Piano in Islington on the evening of Sunday April 29.

Sunday April 29

Monday April 30

9am-10am Coffee and Registration/Exhibition Viewing

9am-10am Coffee and Registration/Exhibition Viewing

10am-11am TREATING MENOPAUSAL CLIENTS Many female clients visiting cosmetic practitioners are in the age group that are either pre, post or going through menopause. But while these clients often seek medical support to help them through the hormonal and physical changes to their bodies, more and more are seeking the help of aesthetic practitioners as the side effects of the menopause can drastically effect their skin and looks. Leading menopause expert and chairman of the British Menopause Society, Dr Nicholas Panay, will join Dr Tracy Mountford, winner of the 2011 Speaker of the Year Award, to examine these issues as well as the treatment options for these patients.

10am-11am TREATING BLACK AND ASIAN SKIN Treating different skin types is one of the biggest challenges faced by aesthetic practitioners. With so many products and treatments out there not being suitable for certain skin types this can be a minefield. As part of this session we will look at challenging skin types and the procedures and products that can be used to treat them. Speakers will include Dr Tapan Patel.

11am-11.30am Coffee Break 11.30am-1pm ADVANCED LASER WORKSHOP Lasers are one of the staple treatments of any clinic, but how can you take your laser practice beyond the basic treatments and offer more advanced applications? From novel uses of lasers such as cosmetic gynaecology, fungal toe nails and snoring to innovative new indications and tried and tested advanced applications, including laser lipo and fractional resurfacing, this session is designed for the experience laser practitioner who wants to step up to the next level.

11.30am-1pm BEGINNERS LASER WORKSHOP From hair removal to facial rejuvenation, lasers are a core part of many successful aesthetic practices. But how do you set up a successful laser business and, in tough economic times, how do you make the right investment? Designed for the novice laser practitioner, this session will examine the most profitable starter procedures for your clinic as well as providing you with key core of knowledge skills. Speakers will include Dr Phil Dobson and Martyn Roe. 1pm-3pm Lunch and Exhibition Viewing 3pm-4pm CLINICAL PHOTOGRAPHY WORKSHOP Before and after photographs are an invaluable tool when it comes to presenting the results of your work to clients or for PR, but badly taken, inconsistent photographs let many practitioners down. From taking basic, consistent before and after shots to utilising 3D and 4D imageing tools, this workshop will focus on all aspects of creating good clinical photography.. Speakers will include Mr Dalvi Humzah, Dr Bob Khanna and Nick Medzianowski-Sinclair.

4pm-5pm INJECTION TECHNIQUES As cosmetic injectables have evolved so have the techniques used to administer them. Hear from leading experts, including Leslie Fletcher, the pioneer of the Arque Derma technique, Dr Bob Khanna and Dr Peter Forrester, about their injection techniques and learn about the tools, such as injection systems and cannulas, that are revolutionising the way dermal fillers are injected in facial aesthetics.

11am-11.30am Coffee Break 11.30am-1.30pm A MINI-MASTERCLASS IN 3D facial volume replacement, enhancement and beautification with reference to anatomy, technique and risk management with dr Raj Acquilla and miss Jonquille Chantrey 1.30pm-3pm Lunch 3pm-4pm SKIN CANCER, MOLE DETECTION AND SUN AWARENESS Skin cancer incidence continues to rise in the UK with more than 100,000 people being newly diagnosed every year. Most cases are curable, if detected early, but if diagnosis is delayed and the cancer spreads then the chances of surviving are greatly reduced.

Aesthetic practitioners are at the front line when it comes to seeing patients with ageing and sun damaged skin, so sun advice, mole checking and skin cancer are issues no aesthetic clinic can afford to ignore. Join leading skin cancer expert Mr Paul Banwell, the British Association of Dermatologists and La Roche-Posay for this exclusive workshop.

4pm-5pm ADVANCED INJECTORS MASTERCLASS This session, aimed at the advanced injector, will look at the cosmetic injectable treatments and techniques that go beyond filling lines and wrinkles and enable total facial sculpting to be achieved. From botulinum toxin in the lower third, to creating natural looking lips and ground breaking new techniques.

Speakers will include Monica Berrange, Dr Kate Goldie, Dr Gertrude Huss and Dr Russell Emerson.

4pm-5pm BEGINNERS INJECTORS MASTERCLASS Botulinum toxin and dermal fillers are the gold standard in non-surgical facial rejuvenation and are the bread and butter treatments for many clinics. Learn from some of the industry’s best injectors about how they have developed a successful practice based around cosmetic injectables and get hands on experience of the treatments that will bring clients through your door.

5pm-6pm Exhibition Viewing

5pm-6pm Exhibition Viewing 7pm After Show Party - The Pitcher and Piano, Islington cosmeticnewsuk.com

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

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

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WHY VISIT THE COSMETIC NEWS EXPO 2012?

• MOrE EXHIbITOrS than any other UK aesthetics show • 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

CHaNGES fOr 2012 CONfErENCE PrOGraMME due to demand there will be a small charge for the 2012 conference.

Advance bookings will be charged at £45 per day or £80 for both days. On the day bookings will be charged at £75 per day/£150 for both days. 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.

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Topics covered at this year’s conference will include: • TrEaTING MENOPauSal ClIENTS • bEGINNErS aNd adVaNCEd laSEr full logo WOrkSHOPS • ClINICal PHOTOGraPHY WOrkSHOP • INJECTION TECHNIQuES • TrEaTING blaCk aNd aSIaN SkIN • TrEaTING MalE ClIENTS • POST PrEGNaNCY TrEaTMENTS • bEGINNErS aNd adVaNCEd INJECTOrS MaSTErClaSSES

2012 SPEakEr lINE-uP

the cosmetic news conference 2012 promises to be better than ever with our speaker line-up already including some of the biggest names in the industry. speakers confirmed so far include:

• Dr Nicholas Panay • Dr Tracy Mountford • Dr Bob Khanna • Monica Berrange • Mr Paul Banwell • Miss Jonquille Chantrey • Dr Raj Acquilla • Dr Peter Forrester • Mr Dalvi Humzah • Dr Russell Emerson • Leslie Fletcher • Dr Gertrude Huss • Dr Toni Phillips • Dr Stephen Hennessey • Dr Stephen Jones • Dr Kate Goldie • Dr Tapan Patel

r YO N E C a N a f f O r d. . . W W W. C O S M E T I C N E W S u k . C O M

Special Report PIP Scandal

T he P I P d eb at e

With the PIP controversy dominating the headlines we gauge the industry’s opinion on the fallout from the scandal In recent weeks the cosmetic surgery and aesthetics industry has been hitting the headlines for all the wrong reasons as the PIP scandal has unfolded in the national media. While the story is nothing new for the industry, having been reported on ever since the MHRA issued a Medical Device Alert to breast implant surgeons and healthcare professionals back in April 2010, the heightened media coverage at the beginning of this year has caused wide spread panic about the safety of cosmetic surgery that has extended to discussions about non-surgical cosmetic injectables and the regulation of the industry as a whole.

The situation is that, over the last 10 years, the French

company Poly Implant Prosthesis (PIP) or if they have M-Implants

manufacturer Poly Implant Prostheses (PIP) and the Dutch

manufactured by ROFIL Medro in the Netherlands. Even without

company Rofil Medical used inferior, industrial grade, silicone

any clinical signs of rupture, these implants should be removed

(suitable for use in mattresses) in the breast implants they

or exchanged immediately to avoid further health risks. In a

produced. The direct result of this was that PIP reportedly made

recently conducted study, a connection between PIP breast

a £10 cost saving on the manufacture of each implant by using

implants and possible cancers was not detected; however, other

industrial silicone and its founder Jean–Claude Mas now faces

medical complications may result from a ruptured implant.

criminal charges.

Women with breast implants not manufactured by these two companies are not affected and should feel safe.”

The rupture rate of these implants appears to be higher than other implants, and, as they contain industrial grade silicone,

The president of the British Association of Aesthetic Plastic

which is not subject to the same stringent quality requirements

Surgeon, Fazel Fatah, has also publicly argued that all the PIP

as medical grade silicone, it is not known what the adverse

implants should be removed as the quality of the silicone “is

effects of rupture may be. Mechanical tests have even shown

not fit to be implanted into humans”. It is the unknown risks

the PIP implants are more likely to rupture in a manner so severe

associated with the implants that are of most concern. Surgeon

it is effectively a disintegration of the implant shell. Furthermore,

Miles Berry from Simply Better Breasts says, “The question is does

an audit of 453 patients by two British Surgeons, Mr Jan Stanek

non-medical grade silicone (PIP) cause cancer? Does it cause

and Mr Miles Berry, concluded that PIP implants exhibited a

abnormalities in mothers who have had this operation? Does it

failure rate of between 16% and 34%, compared with a failure

cause connective tissue diseases? Using medical grade silicone,

rate of 0.9% among the newer implants they are using. This

we know the answer is NO to all three of these questions.

has now caused wide spread debate about whether or not all

But, using industrial non-medical grade silicone (such as PIP

women with these implants should have them removed and

implants), have been indicated as causing 20 cases of cancer

who should bare the brunt of this cost.

amongst an estimated 30,000 ladies”.

It is estimated that 40,000 women in the UK have had PIP

However there is another question over the safety of actually

implants, however the Government’s position is that women

taking the implants out and putting thousands of women

with PIP breast implants do not need to have them removed,

through an operation, and under a general anaesthetic, which

unless they have symptoms such as pain and tenderness,

may not be necessary. Every operation in itself carries risks

and that there is no link to cancer and no clear evidence of

and some are taking a more cautious view when it comes to

an increased risk of harm compared to other brands of breast

removing PIP implants. Consultant surgeon Mr Dalvi Humzah

implants. However other countries, including France, where the

comments, ““At the moment we have got a difference of

controversy started, as well as Germany and the Czech Republic,

opinion across the channel with the French and German’s

are recommending that all PIP implants be removed.

recommending removal and the UK saying it is not necessary unless there is a problem. In terms of rupture rates, I don’t think

18

cosmeticnewsuk.com

This is a position supported by the International Society of

we have got accurate figures that are industry accepted. What

Aesthetic Plastic Surgery (ISAPS), which issued this statement:

we do know is that it is no genotoxic and it is not poisonous. I do

“The International Society of Aesthetic Plastic Surgery (ISAPS)

feel sorry for the women who have had these implants but our

strongly supports the French recommendation that breast

reaction has got to be measured. I understand there are certain

implant patients should check with their doctor or hospital to

groups that say you should have them removed, and for some

determine if their implants were manufactured by the French

people’s anxiety they should have them removed, however you

have got to balance the risk of taking the implant out

the dangers of the PIP product from the start. The right

meeting of the Expert Group so we can discuss these

with leaving it in. I would suggest that patients with the

thing for the Government to do is to act decisively and

points in more detail.”

implants get checked with a scan at least yearly.”

ensure all women are treated swiftly and with sensitivity.

A cross-party group of MPs forming a moral judgement

Consultant plastic surgeon and BAAPS president Fazel

on whether women should opt for plastic surgery on the

Fatah added, “We are delighted to jointly provide clear

Whether they are safe or not is one thing, however

grounds of vanity or aesthetics is a moral crusade and

surgical guidance that removes any ambiguity about

the media storm caused by the whole affair has had a

just kicking the can down the road”.

the right course of action, not just for women who

The psychological impact significant psychological impact on the women affected.

have PIP breast implants, but to all those who become

A survey by Clinical Partners (www.clinical-partners.

Issuing guidance

co.uk), a private clinic of over 60 leading psychiatrists,

In response to the situation, the professional bodies

surgeons. Our message also reinforces the importance

psychologists and psychotherapists, revealed that well

representing surgeons joined together to release clear

of commitment to duty of care for anyone providing

over half of women had missed work due to stress over

new guidance on PIP breast implants for patients and

private health services to the public. The BAAPS remains

having PIPs, nearly eight out of 10 feel their self-esteem

doctors. The new guidance provides patients with

steadfast in our recommendation for precautionary

and self-worth has been affected, two thirds are feeling

practical advice on what to expect and their rights,

removal of these defective implants.”

severely depressed and anxious and 80% feel they will

indicates to GPs where to refer different groups of patient

need the help of a therapist or counsellor. Nearly all

and advises surgeons on treatment. The guidance goes

The blame game

(92%) are suffering from insomnia, with many needing

beyond current Government advice aimed at patients

With so many different view points flying around, one of

medication. Respondents – of which there were over 120

with symptoms to give additional practical advice for the

the biggest questions is who should be held responsible?

in less than 24 hours – confessed to being ‘in tears all the

majority of patients who do not. Key points include:

Of course the manufacturer of the product was most at

involved in their care and treatment - including GPs and

fault but, as the company was closed down by the French

time’ and ‘a complete mess’, visiting their GPs for anxiety All patients should be able to have an assessment

Government, and has no money to pay for corrective

even self-harming. Many reported being unable to be

by a surgeon regardless of whether they have

surgery for the women that want it, who is left to pick up

intimate with their partners, feeling unable to look after

symptoms.

the pieces?

medication and sleeping pills, and in one instance

their children, wanting (or having to) quit their jobs and

•

•

hating their own bodies.

If a patient requests removal – they should expect to get this, regardless of the presence of any

The health secretary, Andrew Lansley, has said that the

symptoms. If a patient wants time to make up

NHS will continue with its ‘duty of care ‘and replace any

Richard Sherry, a counselling and clinical psychologist

their minds this should be respected – surgery to

PIP implants that were put in on the NHS. However, the

at Clinical Partners, who devised the survey said,

remove implants must not be a time-limited “take

majority of the implants were used privately.

“Following a growing number of enquiries from women

it or leave it” offer.

seeking support for the emotional issues they were

Scans should only be used as a tool to assist

Some people believe it is down to the surgeons and

facing following the PIP scare, I felt it was important to

•

patients make a decision and only take place

clinics who opted to use these ‘inferior’ implants however

understand the greater impact this situation was creating

after the patient has had a consultation with a

others argue that because the implants were approved

for them and their families. Having a specialist interest in

surgeon. Scanning alone is not a reliable enough

by the MHRA they were using them in good faith and

the psychology of cosmetic surgery, I knew that breasts

tool for detecting failure rates in breast implants.

therefore the Government, through the NHS, should be

in themselves can be complicated embodiments of

This reaffirms the surgical association’s view that

held responsible.

femininity, sexuality and maternal identity. So when

all clinics have an ethical and moral duty of care to

things go wrong, as they have – rather catastrophically

offer these patients treatment without charge.

For many the fault lies with the MHRA. Mr Kirwan says,

Advice to GPs on where to refer patients with

“The responsibility for this fiasco lies with the MHRA,

even depression, so it’s essential to see the whole picture:

different symptoms to ensure they get the most

who in performing it’s regulatory duties, allowed these

beyond just the practical dimension to its psychological

appropriate treatment.

products to be used for a number of years. If the MHRA

in this instance –it can trigger deep levels of anxiety and

•

ramifications. The comments we received really highlight

shuts up shop on this matter it should be shut down and

the severe levels of distress being felt by those affected.

The document, Poly Implant Prostheses (PIP) Breast

the responsibility handed to the FDA. The responsibility

It is important to foster communities of support, and it

Implants: Joint surgical Statement on Clinical Guidance for Patients, GPs and Surgeons has been jointly endorsed by the Association of Breast Surgery, British Association of Plastic, Reconstructive and Aesthetic Surgeons, British Association of Aesthetic Plastic Surgeons, Federation of Surgical Speciality Associations and the Royal College of Surgeons.

most certainly doesn’t lie with private surgeons and

behoves health professionals to address the emotional repercussions of this situation as urgently as the physical.”

Given these kind of statistics does the industry and the Government not have a moral and ethical obligation to act? Professor Laurence Kirwan thinks so. He says,

clinics who in good faith purchased government regulated breast implants from the French manufacturer Poly Implant Prostheses (PIP).”

David Gower MD of Medical Aesthetic Group said, “Surely the situation is more straightforward than reported in the newspapers? PIP were granted a CE mark class 3 for

“The Government is shamefully misleading women who have suffered and been traumatised from the

Tim Goodacre, head of professional standards at

a medical device. The MHRA accept the CE mark without

‘recall’ of PIP breast implants. Government newspaper

the British Association of Plastic, Reconstructive and

further testing under the EU Treaty BUT they do have the

advertisements running at the weekend offer women a

Aesthetic Surgeons (BAPRAS) commented, “It has been

option to ‘call in’ any marked product for testing if they

replacement operation – but only if the initial operation

a distressing time for all the women caught up in the PIP

have any concerns or receive indications of problems

was done on the NHS. This leaves just 5% of women

breast implant issue. We hope that this comprehensive

from physicians or others.

with an immediate solution to the problem. The other

guidance, for both patients and healthcare professionals,

thousands of women, taxpayers and voters, are now

will ensure we can conclude this effectively and with

“There is considerable evidence that a number of

being humiliated as they are pitted against private

compassion. We must now look at how cosmetic

surgeons had advised the MHRA as long ago as 2005

surgeons and clinics.

products and interventions are regulated in the UK more

that they were experiencing higher than usual adverse

broadly so that we can avoid a repeat of this scenario.

events with PIP implants. At least one private group has

“The fact the NHS was offering PIP implants to women

BAPRAS continues to be driven by patient safety and

reported that they stopped using PIP in 2006. Under

shows how wrong the Government got it’s analysis of

professional standards and we look forward to the next

these circumstances it is inconceivable that the MHRA

cosmeticnewsuk.com

19

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Special Report PIP Scandal

did not ‘call in’ PIP implants and advise the private sector and NHS.

“It seems apparent that PIP Implants were widely used in the

“In the meantime why is no one asking about PIP Product Liability

NHS, in many private hospitals whose operating surgeons

Insurance? Surely the company (PIP) would carry significant cover

includes BAAPS members, by private plastic surgeons and

and the premium would have been paid for the period during

larger clinic groups, with the full approval from the MHRA. The

which the company was trading. It seems to me that Clinics should

Government approved PIP implants as safe devices for use in the

be claiming on this cover through the administrator of PIP. The

UK therefore, while it has already made promises with regards to

insurers in turn would claim against the CEO if found guilty. Any

NHS patients, in light of their responsibility for regulating these

clinics that may have used PIP implants after PIP was closed must be

implants, it’s good to hear that they intend to work with the

considered culpable and therefore make restitution from their own

private sector to ensure that patients’ needs are met. There are

resources which in turn may be supported by insurance. In view of

physical, psychological and emotional factors to consider and all

what we know I would think that a claim against the MHRA may be

will need to be addressed.”

difficult to defend also as they clearly had serious information which they chose not to act upon.”

LEGAL ACTION So could cosmetic surgery clinics and practitioners actually find

The cosmetic surgery chains have come under fire for trying to

themselves facing law suits over the fiasco? Lawyer Neille Ryan, a

‘save costs’ by using cheap implants, however saving costs surely

partner at Furley Page, believes that they could be held responsible

makes good business sense, and they were using a product that

legally. He says, “Private companies who refuse to replace French-

they believed had been determined safe by the MHRA. However

made PIP breast implants can be sued for breach of contract.

concerns were raised about the safety of the implants years ago so

While the UK Government has confirmed that the NHS will replace

are those who made a commercial decision to continue using them

French-made PIP implants for those whose original breast surgery

in order to save money, despite this knowledge, really at fault?

was carried out on the NHS, the vast majority will have come from private providers.

Nuffield, Spire and BMI have ‘stepped up to the plate’ and agreed to replace the PIP implants they used. However both Transform

“Some have already offered to replace implants without charge but

(4,000 PIP patients) and the Harley Medical Group (almost 14,000

many have not and women may wonder what they are entitled

PIP patients) have allegedly refused, with the chairman of Harley

to. The most obvious claim against a private provider would be for

Medical Group saying the cost of doing so would ‘put them out of

breach of contract for the supply of goods and services. Section 14

business’.

of the Sale of Goods Act 1979 implies a term into the contract that the implants will be of satisfactory quality. Clearly the terms have

The Independent Healthcare Advisory Services (IHAS) has also

been breached and, therefore, damages will follow for the cost of

come under fire as some of the clinics using the implants were on

removing and replacing the implants plus for any injury caused

its register and has been accused of not monitoring the situation

either by the implants themselves or the surgery.

or having significant data on the implants and their rupture rates.

But Sally Taber, director of the IHAS said, “Members of IHAS are

“Claims should be brought within three years of the date when the

as much a victim of this fraud as the NHS and the patients. We all

victim knew or ought to have known their implants were defective

trusted the standards regulator, the MHRA, and the Department

so in most cases that will presumably be three years from about

of Health. If there is any moral or ethical obligation outstanding

now. This is a specialist field and anyone seeking more information

it lies with the Government’s regulatory agency, the MHRA. But

should ensure that they approach a solicitor with genuine

the overriding issue here is that it is in everyone’s interest to work

expertise in personal injury claims.”

together to ensure that patients are treated with compassion. The IHAS welcomes the intention for CQC to carry out unannounced

Call for tighter regulations

inspections of independent providers. All our members comply

The whole debacle has reignited debates about regulation of the

with the CQC guidance framework and are registered by the CQC.”

industry and led to a resurgence of calls for the UK Breast Implant Registry, which was closed by The Department of Health in 2006, to

Of course while the industry plays the blame gain the real victims

be reinstated.

of all of this are the women who have had the implants. Ashley Yeo, lead medical devices analyst, at PRIME commented, “Not all women

Mr Humzah says. “At the moment, there is no way of knowing

who had PIP breast implants for cosmetic reasons will be able to

for sure how many women have been given PIP implants. If the

afford a second implant, even if the explant procedure is paid for.

registry was reinstated, we could easily access this information

This would leave thousands of women with little choice other than

to ensure patients affected are treated and made aware of such

to live with their existing implants – and the fear (well founded or

complications. Many problems associated with implants surface

not) of possible sinister effects should a rupture occur. So, while

after several years. With no comprehensive record-keeping

we await the forthcoming UK review, it must be asserted that the

mechanism, necessary long-term information is unavailable.

question of who pays for explants is, for many women, not at all the

Ideally, we need a new registry that protects women’s privacy, yet

end of the story.”

enables the research we need to make sound, informed safety decisions. Just as importantly, it means women can be alerted

TV GP, Dr Hilary Jones adds, “Patient wellbeing is paramount and

quickly to any health threats that develop.

that remains inviolable and indisputable whether someone has had treatments on the NHS or privately. Following Andrew Lansley’s

“I think the Government is being economical with the truth

statement on PIP implants it’s important for everyone to remember

about why it disbanded the register. It was a very good register

that all medical professionals used the Government regulated PIP

and I don’t think it was because women didn’t want their data

implants in good faith. Hundreds of nurses and surgeons in private

put on. In the 10 years I was using it none of my patients ever

clinics are distressed at the implication that they used a cheap

said ‘don’t put my information on’. If I remember rightly it was

implant and the idea that they are at fault for using what was a

purely to do with funding. So I think it needs to be re-started

Government-approved product.

forthwith – there should not be any discussion about it. If it is cosmeticnewsuk.com

21

Special Report PIP Scandal

an issue of funding then I think the industry should step by to the

•

plate and do it – the breast implant manufacturers could fund it

How decisions were taken, and who was involved in this process;

themselves.”

•

What action was taken to safeguard and advise patients;

Surgeon Dai Davies adds, “There should be an obligatory register of

•

Whether action was sufficiently prompt and appropriate

all implants that are inserted, run centrally where all complications are recorded, as in the case of hip replacements. There should be

Lord Howe said, “I want to quickly establish the facts of what

proper control and regulation of the cosmetic surgery industry, for

happened so we can, as far as possible, prevent anything like this

instance many lasers have been de-regulated by unappropriate

from happening again. Women with PiP implants are, quite rightly,

medical or non-medical people”.

very concerned. We need to give them answers and set out lessons

Although it revolved around breast implants in particular, the PIP

for the future.”

incident has had a profound effect on opinions surrounding all aspects of cosmetic surgery, including cosmetic injectables and other

The second review will be led by Sir Bruce Keogh and will look at

non-surgical treatments and prompted the Health Secretary, Andrew

whether the cosmetic surgery industry needs to be more effectively

Lansley, to announce a series of steps to respond to these concerns.

regulated. This review will take around a year to complete given the complexities of the issues. He will aim to give a report to the Health

The first step will be a review led by professor Sir Bruce Keogh, the

Secretary by March 2013. In particular, it will look at:

NHS Medical Director, and will look at the arrangements for ensuring the safety of people seeking cosmetic interventions such as breast

•

implants and dermal fillers. Sir Bruce Keogh will look at how the cosmetic sector can improve the quality and safety of care through

interventions is appropriate; •

better governance based on better quality data collection and improved professional development; whether cosmetic products

How best to assure patients and consumers that the people who carry out procedures have the skills to do so;

•

and interventions are appropriately regulated; and if not how

How to ensure that the organisations which deliver such procedures have the clinical governance systems to assure the

regulation of the sector in the UK and in Europe can be improved. It was also acknowledged that lessons needed to be learned from how

Whether the regulation of the products used in cosmetic

care and welfare of people who use their services; •

the regulation of medical devices operates at a European level.

How to ensure that people considering such interventions are given the information, advice and time for reflection to make an informed choice;

In addition, the Care Quality Commission will conduct a swift review

•

of private clinics that offer cosmetic surgery. They will look at whether

organisations to offer redress in the event of harm, and if so

they meet essential levels of safety and quality and at the information and support they provide to their patients. Where a provider

Whether there should be a statutory requirement for such how this could be funded;

•

What improvements are needed in systems for reporting

does not meet these requirements, the CQC has a wide range of

patient outcomes, including adverse events, for central analysis

enforcement powers that it can use to protect the safety of patients.

and surveillance.

Mr Lansley said, “My concern throughout this situation has been for the safety and wellbeing of all women with PiP implants. We have

The review will consider issues of governance, data quality, record

set out how the NHS will help patients affected, and we expect the

keeping and surveillance, as well as ensuring that sufficient

private sector to do the same. We must now go further and this

information is provided to secure patients’ informed consent. It will

is why I have set out a number of actions to ensure we learn the

include consideration of the feasibility of an outcomes-based register

lessons, and look at how we can tighten up regulation of the wider

of commonly implanted devices. The interventions to be considered

cosmetic industry so that this doesn’t happen again.”

for the purpose of this review could potentially include:

HOT OFF THE PRESS

•

As Cosmetic News was about to go to press the Department of Health issued this press release setting out the scope of PiP implant

other surgery intended to change the appearance of the body; •

and cosmetic surgery reviews...

Injection with any product, whether medicinal or otherwise; and

• January 24, 2012: The Department of Health has today published the terms of

The surgical insertion of a medical device or prosthesis, or

Any other form of intervention at the discretion of the review team.

•

Where the intervention is not clinically indicated to safeguard

reference for two reviews established following the recent concerns

or improve the physical health of the recipient including

about PIP implants. The first review, led by Lord Howe, the Minister

interim recommendations if appropriate including interim

for Quality, will establish what happened in the UK when the MHRA

recommendations if appropriate.

and Department of Health learnt about the situation with PiP implants in France. Lord Howe will submit a report to the Health

Sir Bruce Keogh, said, “I am working with experts from the plastic

Secretary by the end of March this year and will look at:

surgery field to look at what we can do to make sure people who choose to have cosmetic surgery and other cosmetic procedures are

•

What information about PiP implants was available from

safe. I will be looking at all aspects of regulation – at the regulation of

routine adverse reporting systems;

implants and fillers, at whether the people who carry out cosmetic

What external concerns about PiP implants were brought to

interventions have the right skills, at whether the clinics look after the

the attention of the MHRA or the wider Department of Health,

care and welfare of their patients. This would include treatments such

and when;

as cosmetic surgery, Botox® injections and dermal fillers and other

How these concerns and any related information were

cosmetic treatments where there is a potential risk to health.

handled;

“There is already considerable support for a comprehensive register

•

What advice was sought and from whom;

of significant surgical devices – from breast implants to heart valves

•

What information was shared between MHRA and its

to replacement joints. We will be looking critically at the value and

counterparts in other countries in the EU and elsewhere;

feasibility of such a register and at how best to put this into action.”

•

•

22

cosmeticnewsuk.com

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people in profile

A man of many talents We speak to Dr Bob Khanna about his passion for facial aesthetics, how he has become one of the leading trainers and lecturers in his field and his many other talents When he was a little boy Dr Bob Khanna was always getting told off for talking too much but, in his adult life, his ability to be able to get up on the podium and speak, not only with confidence but with a stage presence that very few clinicians possess, has seen him speak at an international level around the globe and become known as one of the most engaging lecturers in aesthetics.

realized why it didn’t work for my father, it was all to do with technique, it wasn’t just about one size fits all – there was a lot more to it – it was about understanding anatomy, dosages and techniques. I think my skills as a cosmetic dentist were invaluable in understanding that. I already had the background skills in anatomy, physiology, biochemistry and, of course, as a dentist, your manual dexterity has to be honed because you are doing intricate work in a very confined environment so you learn very quickly to become very good with your hands. All those things put together put me in good stead.”

It has also seen the popularity of his training courses soar with thousands of surgeons, dentists, nurses and doctors flocking to the Dr Bob Khanna Training Institute to learn from the master, perhaps hoping a little bit of his magic will rub off on them. But while Dr Bob certainly has the gift of the gab, he isn’t just good at talking the talk, he has the skills to back it up and is widely regarded as one of the best advanced injectors to come out of the UK – another reason he is in such high demand to lecture around the world.

But it wasn’t just his skills as a dentist that helped Dr Bob to rapidly become a good injector, it was his eye for all things artistic too. Like many successful aesthetic practitioners, he is somewhat of an artist and he thinks this has played an important part in his success. He comments, “It sounds obvious but, if you are going to get involved in aesthetics, then you need to have an aesthetic eye.

That is of paramount importance. You have got to understand what makes something aesthetic and what makes something unaesthetic. I was always very fond of art at school – artistry and sculpting were my thing and I think if I hadn’t done what I do now I probably would have been one of these out of work painter/sculptors you often see on the roadside in cities!”

> Something to smile about

> In training

With such a strong reputation in the field of aesthetics it is sometimes easy to forget that Dr Bob is first and foremost a cosmetic dentist and a good one at that. In 2003 he was awarded with a Fellowship from the ‘International Academy of Dental Facial Aesthetics’ in New York, an accolade shared by some of the world’s most eminent dental surgeons and in 2009 he was named UK Private Dentist of the Year. His passion for dentistry remains today and he still carries out a full spectrum of treatments from surgical implantology and bone regeneration procedures to full mouth rehabilitation. He says, “A lot of people ask me why I am still doing dentistry but I have spent years developing that skill so why would I just throw that away. The synergy between cosmetic dentistry and facial aesthetics is a marriage made in heaven so it would be foolish for me to give that up.”

As Dr Bob’s skills in facial aesthetics evolved, he got approached to start training other practitioners in the art of injecting and it was this that spurred him to pioneer the concept of hands on training courses for other medical and dental professionals. “My first ever training course was in 1999 and I still remember it to this day”, he says. “There were five doctors huddled around my laptop in my little Ascot clinic. It had no real structure and I will be totally honest I had no idea how to even use Powerpoint let alone put a presentation together. It was probably the most childish looking presentation you have ever seen with all different fonts and colours and that sea blue background that was one of the default settings which I thought was really cool.”

But in true Dr Bob style it didn’t take long for him to hone in his skills as a teacher and he know gives some of the most impressive presentations you will see. In 2008 his courses won the accolade of Training Course of the Year at the Aesthetic Medicine awards and his style and methods of training are now used as a benchmark for other courses and for the indemnity providers.

To date Dr Bob has trained more than 12,000 practitioners in non-surgical facial rejuvenation procedures and has pioneered many of the techniques that he teaches including advanced botulinum toxin treatments for for brow lifting and the lower face and his ‘Heart Lips™’ concept. He has also helped develop the art of ‘Total Facial Sculpting’. The training facilities at his flagship Reading clinic are bespoke and state of the art to say the least, with an impressive audio-visual set up and a 100-seater auditorium linked by HD to his surgeries. But it is not just about the trimmings, it is Dr Bob’s clear and unwavering passion for teaching that makes him so inspirational to his students. He says, “My passion for facial aesthetics has never dwindled. I am just as passionate as I was when I started out and I am still as eager when I stand up and teach today.”

In fact it was his work as a dentist that led Dr Bob to first discover Botox® and become one of the first dental surgeons in the world to venture into facial aesthetics. He explains, “My journey with aesthetics really began in 1997.

As a cosmetic and reconstructive dentist, I was involved in implant dentistry and that took me to a number of places around the world for post-graduate training, one of them being Canada, where I was fortunate enough to meet the Carruthers. That was my first real introduction into the world of Botox®.

Until then I didn’t really know anything about it and I was fascinated with the whole concept. I came back to the UK and realised that very few people were involved at that stage and so I started to do some research.”

But although Dr Bob is now renowned for his skills as an injector, he is the first to admit that it was hit and miss in the early days. He jokes, “I do feel sorry for my first few patients but at the end of the day that is what family and friends are for! My first patient was my late father, followed by my mother. There was no real strategy behind what I was doing and I have to shamefully say that it was very much trial and error.

“It worked very well on my mother but didn’t work at all on my father so I had about a 50% success rate”, he laughs. It wasn’t until later on that I

24

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One of the things that makes Dr Bob so passionate about teaching is sharing knowledge. He says, ““I love teaching. I think one of the greatest gifts you can give is to share your knowledge with others. Many people have said

to me ‘you are mad-you have developed so many techniques and then you share them, - why don’t you just keep them to yourself?’ but that is just not who I am. If you have a technique or concept that can treat people with far less complications and deliver optimum results why would you not share that with your fellow colleagues? I think that would be wrong and quite unethical.”

Ironically being a leading trainer has not only enabled him to share his expertise with others but has also made him a better injector himself.

He explains, “Teaching has given me the opportunity to critique absolutely everything that I do. If you are there on the podium teaching other professionals techniques and concepts you have got an ethical responsibility to be absolutely sure that your material is robust. By default it means that you become more self critical and advanced in your thinking and this has encouraged me to become an even better clinician so I am very thankful for that.”

> Going global This unique style of teaching coupled with impressive clinical results has resulted in Dr Bob being invited to lecture at major conferences on the world stage. In fact he is one of the only practitioners to have lectured at the highest level in both aesthetic medicine and cosmetic dentistry in every continent. His training courses have now been rolled out across the United States and Europe and soon Australia. He has become heavily involved in IMCAS,and as part of the regular faculty, lecturing at its conferences around the world (Europe,India and Far east) and playing a key role as one of the clinical course directors.

He is now also just about to embark on a Nordic Roadshow, which will see him training international trainers his techniques in Stockholm, Copenhagen and Oslo. His work as a Key Opinion Leader (KOL) for Galderma and Q-Med and has also seen him travelling the globe to present and demonstrate his techniques and in recent years he has been giving prestigious teaching appointments – in 2009 he was appointed as Lead Clinical lecturer in facial aesthetics at the Royal College of Surgeons (London) and in 2010 became the author and clinical director of the facial aesthetics module of the Aesthetics MSc at Kings College London (KCL) and is currently in the process of creating a full MSc in Facial Aesthetics for the college.

>Don’t judge a book by its cover Standing up in front of thousands of your peers and speaking is not something everyone would enjoy doing but Dr Bob certainly doesn’t suffer from stage fright, in fact he is quite the showman. He exudes such confidence that he has become one of the biggest personalities in the industry and, love him or hate him, there is something fascinating about the man. He says, “I am like a caged animal I can’t wait to get on stage to present, it is like: ‘give me that microphone!’ I was always known as a chatterbox and I can remember my mother and my teachers saying to me ‘Bobby you talk too much’. I suppose in some ways I am now putting my talking to good use at least!” But despite his public persona, Dr Bob is actually very unassuming and down to earth and it is this humility that keeps him grounded despite his phenomenal success. He doesn’t take himself too seriously and he does not

have the kind of professional arrogance that those who don’t know him may assume he does. He says, “It is unfortunate but it is human nature to be very dismissive of other individuals and in the aesthetic medicine industry there is a lot of ego bashing.

I always say, if you have heard me lecture and seen my material and you don’t like what you see then that is absolutely fine, I have no problem with that, but I do think it is wrong to judge somebody when you haven’t given them the time of day. My personality is never ever going to please everyone because I am not afraid to be ‘out there’ and innovative. But I like to think that I add enthusiasm to what I do and I really don’t take myself too seriously. I am very able to poke fun at myself believe me! I think life is too short and sometimes people can be a little too serious about things. I am simple, plain old Bob, there are no airs or graces with me. I am what I am and I am always reminded of my humble beginnings in aesthetics. I feel very blessed with the success I have had but my true wealth is my family. I have got three lovely sons and a beautiful supportive wife and I would give everything up for them alone.”

> Giving back With a training academy, an international lecturing schedule and two busy facial aesthetics and dental practices to run (not to mention a young family), it is surprising that Dr Bob finds time for anything else, but another thing he is incredibly passionate about is the association he founded in 2007 – the International Academy of Advanced Facial Aesthetics (IAAFA), of which he is president.

While one of the motivations for launching IAAFA was to bring practitioners from all aspects of aesthetics together, the other key motivation was to give something back and there has always been a strong alliance with supporting charity through the organisation. A highlight of the annual IAAFA meeting is its charity ball, which over the years has raised thousands of pounds for the Make a Wish Foundation, a charity that is very close to Dr Bob’s heart. He says, “I always admire people who do great things for no monetary gain. It is all very well being very successful and being wealthy but if you can at least dedicate part of your time to good charitable causes then, without sounding trite, it puts you at a higher spiritual level. There is no question that when you give something to someone that gives you a lot of pleasure and if you are able to use your notoriety to create an organisation that has a charitable aim, then that is a dream come true. I felt the need to do something with this concept in mind and I am so proud of what we have achieved with IAAFA.” And just when you thought that he couldn’t surprise you any more, the ever-talented Dr Khanna goes and reveals another string to his bow. “Have I told you about my hobby?”, he asks, before offering up the information that he is also a singer/songwriter and has co-produced, written and been the lead vocalist on a dance music album. On hearing this, I was a little dubious, but, as Dr Bob is constantly proving, you should never make an assumption about him until you have seen what he can do and as he pressed play and the music blared out of his top of the range sound system, I had to smile, because, like everything he does, he was not just talking it up, it really was that good.

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stand 37

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Special Feature

Tat s o f f We examine the use of lasers in tattoo removal

Tattooing has been performed for centuries as a form of ‘body art’, however, in recent years the popularity of tattoos in mainstream culture has increased significantly and hence the demand for tattoo removal has also been on the rise.

Tattooing has never been more popular in the UK, with a fifth of British adults reportedly now sporting one. However, according to statistics, more than half of people who have a tattoo later regret it, which means that, if you are not already doing so, offering tattoo removal services could be a boost to your laser business.

The history of the tattoo There are many why reasons people tattoo their bodies and the symbolism and significance of them varies greatly from culture to culture. Across history tattoos have symbolised rites of passage, marks of status and rank, symbols of religious and spiritual devotion, decorations for bravery, marks of fertility, pledges of love, and as the marks of outcasts, slaves and convicts (Source Wikipedia). They have also been used as a way of self-

“Until the advent of laser, getting rid of tattoos was incredibly challenging ” 28

cosmeticnewsuk.com

expression or for sentimental reasons and as a symbol of belonging to a certain group or subculture. Ironically, while there is this perception of tattoos as being something slightly distasteful or ‘freakish’ among some social groups, the origins of tattooing lie in ancient tribal cultures and religion where the practice of tattooing was seen as a way of branding and belonging and in some cultures as a way of warning off evil spirits.

In European culture however the tattoo was more often associated with criminals, thugs, bikers and deviants.

Today tattoos have become more and more a part of mainstream culture, particularly with their prevalence among celebrities such as David Beckham, Rihanna and Cheryl Cole, and with TV shows, such as Miami Ink and LA Ink, ranking high on the ratings, however, despite this fact there are still negative connotations associated with tattoos as being something that is slightly seedy, rebellious and ‘underground’ and, as such, many people who have them seek to have them removed.

What are tattoos?

A tattoo is created by inserting indelible ink or pigment into the dermal layer of the skin to create a ‘permanent’ marking. The American Academy of Dermatology has classified tattoos as belonging to one of five different types: • • • • •

Tattoo removal While tattoos are considered permanent, it is possible to remove them, however, until the advent of laser, getting rid of tattoos was incredibly challenging and in many cases, extreme including dermabrasion, salabrasion (scrubbing the skin with salt), cryosurgery, excision and skin grafting. The first evidence of tattoo removal attempts was found in Egyptian mummies, dated to have lived 4,000 years BC. Ancient Greek writings describe tattoo removal with salt abrasion or with a paste containing cloves of white garlic mixed with Alexandrian cantharidin (Adatto MA, Halachmi S, Lapidoth M. Tattoo removal.

Curr Probl Dermatol. 2011;42:97-110. Epub 2011 Aug 16.)

The removal of tattoos using lasers has been carried out for approximately 20 years, and has become more widespread since the mid1990s. Tattoo removal using Q-switched lasers is well established in the medical literature and has revolutionised the removal of unwanted tattoos particularly because it carries a lower risk of scarring than some other methods of tattoo removal. In addition to their selective absorption by the pigment, the extremely short pulse duration of Q-switched lasers has made them the gold standard for tattoo removal.

Three types of lasers are most commonly used for tattoo removal: Q-switched ruby laser (694 nm), Q-switched Nd:YAG laser (532 nm, 1064 nm), and Q-switched alexandrite laser (755 nm). The Q-switched ruby and alexandrite lasers are useful for removing black, blue and green pigments. The Q-switched 532 nm Nd:YAG laser can be used to remove red pigments and the 1064 nm Nd:YAG laser is used for removal of black and blue pigments (Kuperman-Beade M, Levine VJ, Ashinoff R. Laser removal of tattoos. Am J Clin Dermatol.

2001;2(1):21-5.).

Q-switched lasers deliver their energy in a very particular way (very short pulse-durations which ‘crack’ the tattoo pigment particles) that

Amateur Professional Cosmetic (permanent make-up) Medicinal and; Traumatic (i.e caused by an accident or injury)

“Tattoo removal using Q-switched lasers is well established in the medical literature and has revolutionised the removal of unwanted tattoos” is effectively absorbed by tattoo pigment but not very well by the surrounding skin. The tattoo pigment particles heat up and break down into smaller particles; these minute particles are targeted by the body’s own immune system and removed. Because the energy is selectively absorbed by the tattoo pigment, surrounding tissues are not heated up to such a high temperature and there is no lasting damage to the skin. (Source: Mapperley Park).

Lasers that are not Q-switched will not be effective on tattoos and Intense Pulsed Lights (IPLs) will also be ineffective, delivering energy that is not effectively absorbed by tattoo pigment and which may damage surrounding skin (Source: The Consulting Room™).

The most common types of tattoos you will see patients seeking removal of in a laser clinic will most likely be amateur/professional ones where the person has either had a design or symbol (or in many cases the name of an ex lover) tattooed on their body in their youth that they no longer want to have or be associated with.

With the cross over that aesthetics has with permanent make-up you may also find clients who have had permanent make-up applied that they want to have removed, however this is far less common.

As the prevalence of tattooing has grown it has become somewhat of a art and as such technologies and pigments have developed so that much more elaborate designs can be

created – but with this comes more challenges when it comes to removing them.

Amateur tattoos are far easier to treat than professional ones because they are usually done with black pigments and are less elaborate. Large, professional multicolored tattoos can be a challenge to remove because the inks are injected deep into the lower layer of the skin or dermis, where they become surrounded by a network of collagen fibres, making removal without damaging the rest of the tissues in the skin quite difficult (Source: The Consulting Room™). Patients should be prepared to undergo a significant number of treatment sessions in order to obtain the desired result.

Black pigments are the most easy to remove with a laser, although some coloured inks also respond well. The most difficult pigment colours to target with a laser are light blues and greens. Modern, pastel, white or ultravivid pigments can also be challenging and may respond by turning brown or black. These residues then may, or may not respond to further treatment.

Semi-permanent or micro pigmentation pigments may be particularly difficult as they are often blends of ‘earth’ toned pigments, often containing iron-oxide compounds, which commonly turn black on exposure to laser light. It is essential that careful test patching is carried out on

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Special Feature

difficult colours is the only way to check response and it may take multiple visits to find out whether a particular pigment will respond. Tattoo removal with Q-switched lasers can be very painful so the patient needs to be aware of this. The use of a local anaesthetic injection or topical anaesthesia cream is advisable prior to treatment to minimise discomfort.

The most common adverse effects following laser tattoo treatment with the Q-switched ruby laser include textural change, scarring, and pigmentary alteration.

As with many laser treatments hyper and hypo-pigmentation are a risk. Transient hypopigmentation and textural changes have been reported in up to 50 and 12%, respectively, of patients treated with the Q-switched alexandrite laser. Hyperpigmentation and textural changes are infrequent adverse effects of the Q-switched Nd:YAG laser and the incidence of hypopigmentary changes is much lower than with the ruby laser. (KupermanBeade M, Levine VJ, Ashinoff R. Laser removal of tattoos. Am J Clin Dermatol. 2001;2(1):21-5.)

anymicro-pigmentation inks to ensure that the pigment will respond without making matters worse.

Since many wavelengths are needed to treat multicolored tattoos, not one laser system can be used alone to remove all the available inks and combination of inks. The Mapperly Park Clinic recommends using the Q-switched ruby laser for straight forward blue, green or black tattoos, however advises that reds, oranges and yellows are best treated with a Q-Switched ND:Yag laser.

According to The Consulting Room™, the most common laser combination is the Ruby (694nm) and Nd:YAG (532nm and 1064nm), which together deliver three wavelengths, greatly increasing the chance that there is an effective wavelength available for each pigment.

Managing expectations When it comes to laser tattoo removal, managing expectations is essential because the treatment does not work in all cases as some pigments do not respond well. Skin type also plays a factor in determining whether or not a patient is suitable for treatment with a laser to remove a tattoo. Test patching potentially

Hyperpigmentation is a particular risk for patients with dark skin. The condition usually resolves on its own, although skin products are available to help even out disrupted skin tones.

Hypopigmentation causes patches of pale skin colouring or loss of natural skin colour. As the laser treatment can also target the natural skin pigment colour or melanin in the skin as well as the colour of the tattoo inks, this can leave the treated area with a somewhat ‘bleached’ look following treatment. This will usually recover to some extent but it can take months and even years to do so. In some cases, the skin where the tattoo was treated may never match exactly with the surrounding area. This risk is increased with darker skin colours and the number of treatment sessions required to successfully remove the tattoo pigments.

Extra caution should be taken when treating people with darker skin types for laser tattoo removal. Removing a black tattoo from dark skin can leave in its place a light patch with the same shape. Recently tanned skin should also not be treated. Active melanocytes (the cells which produce melanin) are readily targeted by Q-switched lasers and the damage done is likely to lead to long-term hypopigmentation (Source: The Consulting Room™).

[REFERENCES] • •

• • •

•

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Kent KM, Graber EM. Laser tattoo removal: a review. Dermatol Surg. 2012 Jan;38(1):1-13.

Kossida T, Rigopoulos D, Katsambas A, Anderson RR. Optimal tattoo removal in a single laser session based on the method of repeated exposures. J Am Acad Dermatol. 2012 Feb;66(2):271-7. Epub 2011 Oct 27.

Adatto MA, Halachmi S, Lapidoth M. Tattoo removal. Curr Probl Dermatol. 2011;42:97110. Epub 2011 Aug 16.

Koljonen V, Kluger N. Specifically requesting surgical tattoo removal: are deep personal motivations involved? J Eur Acad Dermatol Venereol. 2011 Jun 17.

Harper J, Losch AE, Otto SG, Zirwas M, Delaney KO, Wakelin JK 3rd. New insight into the pathophysiology of tattoo reactions following laser tattoo removal. Plast Reconstr Surg. 2010 Dec;126(6):313e-314e.

Weiss ET, Geronemus RG. Combining fractional resurfacing and Q-switched ruby laser for

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• •

•

• •

tattoo removal. Dermatol Surg. 2011 Jan;37(1):97-9.

Kluger N. [Tattoo removal at the start of the 20th century]. Ann Dermatol Venereol. 2010 Aug-Sep;137(8-9):582-4.

Jow T, Brown A, Goldberg DJ. Patient compliance as a major determinant of laser tattoo removal success rates: a 10-year retrospective study. J Cosmet Laser Ther. 2010 Aug;12(4):166-9.

Latreille J, Levy JL, Guinot C. Decorative tattoos and reasons for their removal: a prospective study in 151 adults living in South of France. J Eur Acad Dermatol Venereol. 2011 Feb;25(2):181-7.

Choudhary S, Elsaie ML, Leiva A, Nouri K. Lasers for tattoo removal: a review. Lasers Med Sci. 2010 Sep;25(5):619-27.

Kilmer SL. Laser treatment of tattoos. Dermatol Clin. 1997 Jul;15(3):409-17.

treatment spotlight

Deep

i m pa c t We find out about the new EndyMedPRO™ 3DEEP® from AesthetiCare

As we age the collagen fibres in our skin break down and become less structured and elastic and our repair and replacement of them becomes less efficient. External factors such as UV exposure and lifestyle can make this worse. The result is wrinkles and changes in the deeper tissue that lead to lax or sagging skin. In body areas, changes in and around fat cells in the hypodermis, where the supporting collagen fibres and circulatory system become impaired, lead to them becoming less compact and structured causing a raised and dimpled appearance, known as cellulite.

Radio-frequency can be an ideal non-surgical treatment

warmed to a temperature that feels like a relaxing hot bath

for sagging or lax skin as it can potentially deliver

or shower.

energy to heat the dermal and hypodermal tissue and stimulate collagen production. However, the problem

An individual procedure for an area such as the face will

with some radio-frequency technologies is limited

take approximately 30 to 40 minutes. Lifting of the skin

efficacy and predictability of results, requiring either too

can often be seen at the end of a procedure but a course

much uncontrolled energy, which can also be painful, or

of treatments consisting of six sessions, one to two weeks

conversely not delivering enough deep energy.

apart, is normally recommended to achieve an optimum effect.

AesthetiCare® has recently launched a new radiofrequency skin tightening device for the treatment

The visible tightening and lifting at the end of the course

of lax or sagging skin, wrinkles and cellulite – the

of treatments will often go on improving as the collagen

EndyMedPRO™ 3DEEP®. Rapidly becoming established as

matures and tightens. The EndyMedPRO™ 3DEEP results

the must-have skin tightening and contouring treatment

are due to natural changes in the skin and as such are

with a large celebrity clientele, EndyMedPRO™ enables

on-going and long lasting. These can be enhanced with

patients to experience pain-free treatments and see

good evidence based skincare, UV protection and periodic

significant and predictable clinical results.

EndyMedPRO™ 3DEEP® top up treatments.

The EndyMedPRO™ utilises 3DEEP® technology which

Internationally renowned plastic surgeon, Mr Chris

delivers multiple sources of radio-frequency by phase-

Inglefield of the London Bridge Plastic Surgery

controlled skin electrodes, driving energy comfortably and

and Aesthetics Clinic, London, has been using the

safely, deep in to the skin’s dermis and hypodermis.

EndyMedPRO™ 3DEEP® in his clinic for the past year. He says, “In under a year we have treated over 200 patients and

The 3DEEP® controlled and focused energy creates a

they are delighted with the results of the 3DEEP® treatment.

uniform and deep heat that causes the collagen to contract

I recommend this safe and effective treatment for skin

and this starts to tighten and lift the skin. This immediate

tightening.”

effect is followed by the regeneration of new collagen and skin tissue, which remodels and naturally tightens over

Dr Julia T Hunter MD, dermatologist of Skin Fitness Plus,

time providing a natural firming, tightening and lifting of

Beverly Hills, USA uses EndyMedPRO™ 3DEEP® in her clinics

the skin on the face, jowl, neck and décolleté as well as

around the world. She says “I have to say that EndyMed’s

contouring body areas such as the arms, tummy, flanks,

3DEEP® is the best total body tightening technology I

thighs and bottom and helping improve the appearance of

have seen so far. 3DEEP® is both user and patient friendly.

areas of cellulite.

Patients, male and female, are beating down my doors worldwide for us to treat them, and that only happens if

During the EndyMedPRO™ procedure a hand-piece,

a technology delivers what it promises with correct value

designed specifically for the target treatment area, will

as well.”

be constantly moved around across the skin and a gel

32

cosmeticnewsuk.com

will be used to enhance the motion and treatment. The

Liliane Mouyal, MD, Specialist Medical Laser, Paris, France,

practitioner’s expertise and the advanced EndyMedPRO™

says, “I am enthusiastic to work with this new device,

controls will make the procedure comfortable and optimise

EndyMedPRO™. My patients are satisfied with the effective

safety. The treatment is not painful as the skin is just

improvements and this treatment is easy and not painful!!”

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q&A

Q&A We speak to Dr Roberto Viel about his facial rejuvenation techniques and the innovative new procedure he is championing at his Harley Street practice, which utilises stem cells from sheep placentas and dermal rollering – ActiStem®

Cosmetic News: What are the newest procedures you are offering in your practice at the moment?

Roberto Viel: ActiStem® and PRP (Vampire Therapy) for all over rejuvenation. For more extreme cases there is also the MAC’s lift. A subtle face-lift with fat transfer, this is a great procedure as it avoids the wind tunnel look and gives natural results putting volume back into the face.

The facial rejuvenation methods I offer (ActiStem® and PRP) use new techniques to help rejuvenate the skin and regenerate the facial tissue, resulting in a smoother, more youthful-looking appearance.

As we age, our faces begin to show the effects of gravity, sun exposure and years of facial muscle movement, such as smiling, chewing and squinting.

The underlying tissues that keep our skin looking youthful and plumped up begin to break down, often leaving laugh lines, smile lines, crow’s feet or facial creases over the areas where this muscle movement occurs.

Both ActiStem® and PRP work by activating the natural stem cells that exist in the facial tissue and stimulate your own skin cells to produce collagen and elastin, therefore rejuvenating the skin.

This improves the appearance of the skin’s texture. It will help to fill out deep facial wrinkles, creases and furrows and will improve the appearance of ‘sunken’ cheeks, skin depressions and some types of scars.

For patients wanting more rejuvenation on their face, this treatment works extremely well along side lipo-fixing, which is fat injections to the face. The facial rejuvenation treatment is recommended twice

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a year to keep up maintenance and can be carried out in conjunction with the fat harvest procedure.

CN: What is ActiStem®?

RV: ActiStem® is a natural, cosmetic solution which contains protein extract derived from sheep’s placenta which activates stem cells and other cells of the dermis to regenerate new skin and is applied topically to the face, neck and back of hands through the use of a dermal roller.

It has a unique combination of cytokines, small peptides and growth factor peptides (such as EGF, FGF, HGF, PDGF) so it activates and awakens dormant stem cells and fibroblasts inherent to the skin of the face and neck.

Stem cells are the body’s repair mechanism. They do this through their ability to divide into new cells and hence replenish old cells. This helps to maintain the normal turnover of cells in the blood, skin, organs and tissues. Fibroblasts provide the structural framework for tissues and are not only responsible for the production of the collagen and elastin found in the extracellular matrix but are also important in wound healing.

CN: What does the treatment involve?

RV: The procedure takes a total of 30-40 minutes and is a virtually pain free facial that regenerates damaged and ageing skin.

First of all I prep the skin with a dermal micro roller to open up the facial pores. Then, it’s time for the protein formula to be applied, which, with the open pores, can now be absorbed deep into the skin. This is repeated three times in the 30

“ActiStem® is a natural, cosmetic solution which contains protein extract derived from sheep’s placenta which activates stem cells and other cells of the dermis to regenerate new skin” minute treatment to ensure maximum absorption and ultimately results.

CN: What kind of results can be achieved?

RV: Unlike ‘blockers’ and ‘fillers’, ActiStem® dermal treatment is an ‘activator’. After it is introduced into the mesoderm layer of the skin, the stem cells are activated to revitalise the skin cells. The skin will increase its collagen and elastin content over two to three weeks following the treatment. At the same time, both men and women will notice within just a few days a lifting and tightening of their skin, while also seeing an improvement in skin tone, radiance or glow and a visible reduction in fine wrinkles. For optimum results, ActiStem® is recommended every four to five months.

CN: And finally?

RV: ActiStem® represents a tremendous advancement in facial rejuvenation and with regular treatments can dramatically reduce the need for other more invasive facial rejuvenation procedures.

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Product Focus

C omeback ki d Leading practitioners share their clinical experience with the V Beam Perfecta from Candela Syneron

The V Beam Perfecta 595nm pulsed dye laser has been around for years but practitioners are becoming more and more enthusiastic about the results it can achieve. We asked them whether the product is in the midst of a comeback or if this is just a revival of a classic.

The pulsed dye laser has been around since the 1970s and was the first laser Candela made to treat lesions such as port wine stains. Some systems in service are almost 20 years old and are still in use. Many dermatologists will state it is the most used laser in their practice and this almost iconic laser has now developed something of a following amongst today’s aesthetic practitioners for a number of skin applications. Michaela Barker Candela Syneron’s UK country manager comments, “When we talked to a user group about the V Beam we were surprised at the passion and commitment felt by the doctors and practitioners using it, so we thought we should investigate in more detail. Sometimes we are in search of the fastest and latest new treatment but we miss the consistently dependable treatments that will and do offer a safe return on investment.”

Mrs Cath Gorst at Alderhey Childrens Hospital Laser Unit uses the V Beam so regularly she states she would ‘lock herself in the room with it’ if they tried to take it away. A view shared by professor John Harper at GOSH who has been treating babies and children with the Candela pulsed dye lasers for 17 years. He says he cannot imagine working in a unit that did not have the V Beam as a tool for removing any type of vascular lesion because “it is safe and consistently effective and we have always had great service from Candela.”

Dr Neil Walker, consultant dermatologist at the Lister hospital, switches his V Beam on every day and uses it through every list on all manner of vascular malformations large and small. “It is just the laser I will go to - to try if there is any red tone in the skin “, he says.

So in the NHS and private hospitals the V Beam is well known but what about in the smaller cosmetic clinics?

Dr Tapan Patel is a specialist in treating acne and rosacea. He says, “I am seeing much more of a result with V Beam than when I used an IPL earlier on in my practice, the results are predictable and I see a result with all patients. Downtime is kept to a minimum with the non-bruising mode. Patients like the results – my practice would not run without it. The training was excellent and I have a full understanding of its clinical applications and its limitations.”

Dr Robin Stones mirrors those feelings and says it is the easiest laser to predict results for. He says, “I will always choose this laser over IPL if given the opportunity. I have been operating a Candela V Beam Perfecta for six years now and before that had to rely on my IPL for most vascular work. I find the V Beam to be a very versatile laser for a wide range of vascular conditions, vascular blemishes and vascular birth marks and also for lentigines. It is very effective for removing bruising following injectable procedures such as dermal fillers and is helpful in treating inflammatory acne. Together with the Candela Gentle YAG laser it enables me to offer a comprehensive vascular laser service to my patients. It has proven to be a highly effective laser and the choice of purpurogenic and non-purpurogenic treatment parameters means I can offer treatments with no downtime in many cases.

The hand-piece is highly ergonomic and light and a wide range of spot sizes allows easy treatment of difficult facial contours. Treatments are always well tolerated and I have never seen burns from this laser. Results are excellent. Of all the lasers I operate, the V Beam is the one I would not wish to be without.”

Jo Martin at Mapperley Park Clinic recently added a V Beam as a replacement to a much loved older system and now she ‘does not know how she survived without it’. She says the protective cryogen spray is ‘amazing’ and she treats patients prior to other more invasive treatments to encourage healing, she treats active acne, pigment and all types of rosacea. Now that IPL and light are used commonly in so many beauty clinics and spas, maybe it is time for a more effective laser to make something of a comeback. It is not new but it does exactly what it promises and that is worth its weight in gold.

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“l find the V Beam to be a very versatile laser for a wide range of vascular conditions, vascular blemishes and vascular birth marks and also for lentigines. It is very effective for removing bruising following injectable procedures such as dermal fillers and is helpful in treating inflammatory acne” Dr Robin Stones

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Product News MAG introduces Stylage® HydroMAX Treatment

Medik8 creates new Growth Factor Serum Medik8 has created a new Growth Factor Serum. The fragrance free, light-weight non greasy serum will help smooth out lines and wrinkles to refine skin texture. With its easy to use dropper bottle, this serum is designed to be applied directly to the affected areas. Medik8 Growth Factor Serum (£80) includes a next generation active complex for maximum effectiveness in increasing skin tone, known as ShOligopeptide-1, which promotes

Medical Aesthetic Group has introduced a new treatment for skin hydration to the UK. Developed by

cell renewal and skin regeneration.

Laboratories VIVACY®, Stylage® HydroMAX is the first mesotherapy treatment to cross link hyaluronic

This essential active ingredient

acid filler with sorbitol. Sorbitol is a potent antioxidant naturally found in fruits and vegetables, which

helps inhibit and prevent cellular

reduces the negative effects of free radicals and optimises the longevity of the treatment. It restores

breakdown therefore minimising

proper levels of skin hydration and improves elasticity and firmness to produce a perfectly natural

the appearance of wrinkles. It has been proven to increase

smoothing effect on lines and wrinkles.

the number of epidermal cells and the production of

Due to its long-lasting anti-oxidative hydration, skin that has been compromised by age, stress, poor diet,

collagen, elastin and hyaluronic acid to smooth out the

smoking, sun exposure, frost, wind and hormonal imbalances can now drink in the benefits of this painless

skin. Whilst adding a revitalising glow, the serum helps the

procedure and appear healthy and glowing again. During a treatment, Stylage® HydroMAX is delivered into the

natural wound healing process the skin is prone to suffer

skin via series of multiple, micro fine injections otherwise known as mesotherapy or skin needling. Hyaluronic

with age. The youth activating complex with triple-filtered

gel creates an intense smoothing, hydrating and plumping effect and antioxidant sorbitol immediately reduces

EGF regulates cell production that slows in efficiency with

the negative effects of free radical damage. Also any risk of bruising and swelling is greatly decreased and the

age. By applying the Growth Factor Serum on a regular

sorbitol protects the product from degrading creating a longer lasting effect.

basis, it stimulates the growth of fibroblast cells, which are

For best results a course of four treatments in one-week intervals is recommended.

responsible for collagen and elastin formation.

Solta develops LIPOSONIX GEN II

Awards for Skinceuticals

Solta Medical has announced the arrival of its new generation Liposonix technology

SkinCeuticals has won beauty awards from

in the UK. Using advanced high-intensity focused ultrasound (HIFU) technology,

two prestigious publications. AOX+ Eye Gel

Liposonix Gen II is a non-surgical permanent fat reduction procedure that has been

received Best Eye Cream in the Red Best of

clinically shown to slim down the waistline by one dress size without surgery or

Beauty 2012 awards, while Emollience was

downtime.

awarded the Industry Insider award for Best

Dr Rita Rakus who currently provides the treatment exclusively says, “Finally we have an

Moisturiser for Dry Skin in the handbag.com

effective and convenient, non-invasive fat removal system that is much more comfortable

Beauty Awards 2011.

than previous treatments. We are at last able to treat many new body areas in addition to

SkinCeuticals AOX+ Eye Gel is a breakthrough

the traditional stomach muffin top. Sometimes diet and exercise just aren’t enough to drop

serum-in-a-gel that contains a precise and

that last inch, the Liposonix custom contouring treatment is a terrific option for patients to

synergistic antioxidant combination of Phloretin,

achieve the shape they want without the expense, discomfort and recovery time of invasive

L-ascorbic acid and ferulic acid to help protect

procedures, such as liposuction.”

the delicate eye area form oxidative stress, while

Unlike other non-invasive fat reduction treatments, Liposonix Gen II permanently destroys

targeted actives revive under-eye skin and reduce

the fat cells found beneath the skin without harming the skin with just one treatment in a

the appearance of puffiness. A state-of-the-art-

procedure that takes about one hour. The body naturally processes and removes the fat tissue

gelifier enables the proven antioxidant trio to

over a period of eight to 12 weeks, leaving behind the desired slimmer, more contoured

be formulated in solution at an acidic pH within

waistline. Clinical studies have demonstrated an average waist circumference reduction of

an open matrix delivery system for maximum

approximately 2.6 cm (1 inch) after a single Liposonix Gen II treatment.

penetration and efficacy.

“The addition of Liposonix Gen II to our brand portfolio allows us to expand into the fast-

SkinCeuticals Emollience is formulated with an

growing, non-invasive fat reduction market and to offer a new and exciting approach to

exclusive selection of seven natural extracts

custom body contouring,” said Stephen J Fanning, chairman of the board, president and CEO

and lipids. This rich and restorative moisturiser is perfect for use on dry or

of Solta. “We now have one of the strongest portfolios in the aesthetic space, with non-invasive,

sensitive skin. Enriched with three nutrient-rich Brazilian sea algae and oils

cutting-edge technologies in large and growing market segments – body contouring, skin

of grape seed, rose hip and macadamia seed, Emollience deeply nourishes

tightening, skin resurfacing and rejuvenation, as well as acne treatment.”

the skin and helps to restore and maintain moisture throughout the day.

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Introducing Apothederm™ Stretch Mark Cream Clinical studies have shown the effectiveness of a new topical cream in treating stretch marks. Apothederm™ Stretch Mark Cream (£68) reinforces the skin’s

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fundamental support structures and helps to visibly repair existing stretch marks. A fast absorbing lotion formulated with patented SmartPeptide™ technology, it helps build collagen while reducing the appearance of both red and silver stretch marks and smoothing skin texture.

In a clinical study of 30 subjects conducted by a leading dermatologist, 70% of participants had visible improvement in stretch marks in 14 days and over 90% saw overall improvement after 12 weeks of continued use. The study included new and old stretch marks as well as red and silver stretch marks.

Apothederm™ Stretch Mark Cream optimally blends four natural emollients: shea butter, cocoa butter, olive oil and highly moisturising meadow foam seed oil for a silky, fast-absorbing formulation. Adding power-packed action are patented heptapeptide-7, resveratrol, licorice

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extract, brightening amino acids, algae extract, sodium hyaluronate and other advanced ingredients that work to fade the appearance of stretch marks and nourish the skin.

Cosmeceuticals re-launches Vitage® Advanced Antioxidant Skincare™

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Cosmeceuticals has re-launched the Vitage® Advanced Antioxidant Skincare™ line. The latest range includes a line of 12 retail products and four

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professional treatments and is the culmination of over 13 years of clinical experience that utilises potent antioxidants to deliver gentle but visible anti- ageing and skin rejuvenation benefits.

A brand conceived and developed in the United Kingdom, Vitage® Advanced Antioxidant Skincare™ was originally formulated in 2004 by renowned cosmetic doctor, Dr Patrick Bowler.

Key ingredients have been upgraded, products have been reformulated and new products have been added to address the skincare needs of the modern consumer, replacing some of the original line up.

Vitage® Advanced Antioxidant Skincare™ uses potent antioxidants in all of its formulations to deliver simple solutions for many skin conditions making it an ideal multi-tasking unisex range for all skin types and ages.

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The newly formulated Vitage® Advanced Antioxidant Skincare™ products have been packaged* in the first of its kind recyclable Ecosolution™ bottles using AirFree®

Cynosure acquires worldwide exclusive rights to distribute PinPointe™ FootLaser™ Cynosure UK has acquired the PinPointe™ FootLaser™ from NuvoLase, Inc, the world’s first FDA cleared lightbased device for the treatment of onychomycosis (toenail fungus). The condition affects one in every 100 people in the UK and an estimated 10% of the population worldwide. PinPointe™ is also cleared for marketing

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in Australia, Canada and the European Union.

PinPointe™ FootLaser™ uses laser light to kill the fungus that lives in and under the nail without causing damage to the nail or the surrounding skin. The treatment typically takes 20 minutes with no downtime. In a 12-month multi-site retrospective study conducted on more than 250 consecutive patients, 71.4% experienced continuous improvement in clear nail area after a single treatment. By contrast, oral drugs and topical medications are estimated to be between 30-50% effective in treating the condition, with potential for significant side effects.

Hamish Dow, founder of the Dow Clinic in Newcastle says, “The PinPointe™ laser offers my patients a sophisticated, effective and technologically advanced treatment to kill the fungus that lives under toenails. With its unique delivery pulsing energy characteristic, this laser is a safe and comfortable side effect free treatment option- something my patients are grateful for when the alternative is a course of powerful tablets prescribed by their GP that must be taken daily, often for many months.”

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Abstracts

We summarise some of the most recent studies you may have missed Title: An in vivo histopathological comparison of single and double pulsed modes of a fractionated CO2 laser Authors: Georgette Oni, Daniel Robbins, Steven Bailey, Spencer A Brown, Jeffrey M Kenkel Published: Lasers in Surgery and Medicine, Volume 44, Issue 1, pages 4–10, January 2012 Introduction: Studies examining the histopathological changes that occur in human skin following fractional laser treatment have been performed mainly in animals or abdominal tissue prior to abdominoplasty. This study looks at the effect of double pulse fractional CO2 laser compared to single pulse treatments to assess differences in tissue injury in the face and abdomen.

Methods: Twelve healthy subjects randomised into two groups, had two 1 cm2 areas (infraumbilical and forehead) treated with the fractional CO2 laser (Deep Fx, Lumenis). Settings used were 15 mJ double pulse and 30 mJ single pulse, 300 Hz, 10% density and compared to the historic control of 15 patients treated at 15 mJ single pulse [Bailey et al. (2011), Lasers Surg Med 43: 99–107].

Treated sites were biopsied and analysed with H&E and TUNEL staining to measure width and depth of the microthermal zones (MTZ) of ablation.

Results: When comparing 15 mJ double pulse to single pulse there were significant differences both in depth (abdominal skin, P = 0.002 and facial skin, P = 0.001) and width (facial skin, P = 0.0002) of MTZ. When comparing double pulsing at 15 mJ with single pulsing at 30 mJ there were significant differences between MTZ depths in the abdomen (P < 0.01) but not in either the MTZ depth (P = 0.69) or the width in the face (P = 0.502).

Discussion: This study demonstrates the differences between histopathological laser injury patterns in the face compared to the abdomen when single pulsing is used. It also demonstrates that double pulsing at 15 mJ is statistically similar to single pulsing at 30 mJ in the face. We think this could have ramifications for clinical practice where by double pulsing at lower energies may result in better clinical outcomes than increasing energies or using multiple passes at single pulse. Clinical studies need to be performed to investigate this further.

Title: A three-dimensional construct of the ageing eyebrow: the illusion of volume loss Authors: Konstantinos I. Papageorgiou, Ronald Mancini, Helene Chokron Garneau, Shu-Hong Chang, Imran Jarullazada, Adam King, Erin Forster-Perlini, Catherine Hwang, Raymond Douglas, Robert A Goldberg Published: Aesthetic Surgery Journal January 2012 32: 46-57 Background: The eyebrows and eyebrow fat pads, key structures in upper facial aesthetics, are particularly vulnerable to age-related changes.

Objectives: In this study, the authors compare the impact of ageing on the eyebrows and eyebrow fat pad volume in men and women through three-dimensional (3D) volumetric analysis.

Methods: Electronic medical records of patients seen at the Jules Stein Eye Institute in the Division of

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Orbital and Ophthalmic Plastic Surgery between 2005 and 2010 were reviewed. Patients were included if they had undergone investigative imageing of the orbit for unilateral pathology. Computed tomography (CT) scans of patients with Graves disease diagnosis, extensive orbital trauma and/or previous eyebrow surgery were excluded. A total of 52 CT scans (24 men and 28 women) were retained for analysis. A 3D reconstruction software was used to analyse the scans and calculate volumes of the retroorbicularis oculi fat (ROOF), galeal fat (ROOF and subcutaneous fat)and soft tissue muscles.

Results: Galeal and brow fat volumes showed a significant positive trend toward enlargement in women (P values of .01 and .05, respectively). Although men showed a tendency toward fat enlargement with age, this was not statistically significant. Soft tissue–muscle volume decreased significantly in ageing women (9.32 mm3/y) (P = .02). Data indicated that soft tissue volume in men tended to increase with age (3.92 mm3/y) but not significantly (P = .36).

Neither total volume nor brow thickness appeared to change significantly in women (P = .56, P = .73). In men, total volume and brow thickness showed weak evidence of increasing with age (P = .12, P = .22). Linear regressions of Hertel measurements with and without sex interaction showed no statistically significant trend between the amount of proptosis and the galeal or brow fat.

Conclusions: Although overall eyebrow volume does not change with age, the relative contribution of fat and soft tissue to the total volume does seem to change. This pattern also differs between males and females. As women age, the fat volume increases and the soft tissue volume decreases. In men, the shift from soft tissue volume to fat volume is less pronounced. Although many clinicians have been drawn to the concept of fat volume deflation as a key element of facial ageing, this study does not support this perspective in the eyebrow fat pad. An increasingly refined understanding of the dynamics of facial ageing is mandatory for clinical diagnosis and will likely provide the framework from which to develop more innovative treatment options.

Title: Comparative study of therapeutic effects of 20% azelaic acid and hydroquinone 4% cream in the treatment of melasma Authors: Susan Farshi Published: Journal of Cosmetic Dermatology, Volume 10, Issue 4, pages 282–287, December 2011 Background: Melasma is an irregular brown or grayish-brown symmetric facial hypermelanosis, often affecting women, especially those living in areas with intense ultraviolet radiation.

Objective: Comparison of therapeutic effects of 20% azelaic acid and 4% hydroquinone cream in the treatment of melasma.

Methods: Twenty-nine women with melasma were recruited. Fifteen patients were treated with 4% hydroquinone cream and 14 patients were treated with azelaic acid cream for two months. The cream was applied twice daily. A broad-spectrum sunscreen was used concomitantly by both groups.

The Melasma Area Severity Index (MASI) scores were determined prior to treatment and at each follow-up.

Results: The mean MASI score before treatment was 7.2 ± 3.2 in the hydroquinone group and 7.6 ± 3.5 in the azelaic acid group, with no significant difference between them (t-test, CI 95% = −2.9 to 2.2).

One month after treatment, the mean MASI score reached 6.7 ± 3.4 with hydroquinone and 6.3 ± 3.4 with azelaic acid with no significant difference between them (t-test, CI 95% = −2.2 to 3). After two months’ treatment, the MASI score was 6.2 ± 3.6 with hydroquinone and 3.8 ± 2.8 with azelaic acid, a significant statistical difference (t-test, CI 95% = 0.03– 4.9).

Conclusions: In conclusion, this study suggests that 20% azelaic acid cream applied twice daily may be more effective than hydroquinone 4% in reducing mild melasma. However, because this was an open trial, it is suggested that further studies involving large groups of patients be conducted to achieve a more conclusive result.

Title: Combination of microneedling and glycolic acid peels for the treatment of acne scars in dark skin Authors: Jaishree Sharad Published: Journal of Cosmetic Dermatology, Volume 10, Issue 4, pages 317–323, December 2011 Introduction: Acne scars can cause emotional and psychosocial disturbance to the patient. Various modalities have been used for the treatment of acne scars like punch excision, subcision, peels, microdermabrasion, unfractionated and fractioned lasers. The latest in the treatment armamentarium is microneedling. Acne scars commonly coexist with postinflammatory hyperpigmentation. A combination of microneedling and glycolic acid (GA) peels was found to give excellent results in the treatment of such scars. The aim was to study the efficacy of a combination of microneedling with glycolic peel for the treatment of acne scars in pigmented skin.

Method: Thirty patients in the age group of 2040 years with atrophic box type or rolling scars with postinflammatory hyperpigmentation were chosen for the study. Two groups were made. The first group comprised of 30 patients in whom only microneedling was performed once in six weeks for five sessions. In the second group of 30 patients, a combination of microneedling and 35% GA peels was carried out. Patients were evaluated using the Echelle d’Evaluation clinique des Cicatrices d’acné classification.

Results: Based on the objective scoring and its statistical analysis, there was significant improvement in superficial and moderately deep scars (grade I-III). There was also improvement in skin texture, reduction in postacne pigmentation in the second group.

Conclusion: Microneedling is a simple, inexpensive procedure with no downtime. It is safe in skin types III–IV. The combined sequential treatment with GA peel caused a significant improvement in the acne scars without increasing morbidity.

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BEST PRACTICE - Cosmetic Consumers

The Truth Laid Bare

Antonia Mariconda aka ‘The Cosmedic Coach’ takes us inside the mind of the cosmetic consumer

Antonia Mariconda, also known as The Cosmedic Coach, is recognised

As recently as 10 years ago cosmetic surgery and medicine was seen as the domain of the weird and famous; characters such as Michael Jackson and Jocelyn Wildenstein, aka ‘the Bride of Wildenstein’, encompassed what ‘messing around’ with your looks could result in.

as a leading authority on health, beauty and cosmetic surgery in the UK. Quoted in publications such as

Top Santé, and newspapers such as The Evening Standard, and Daily

Mail, Antonia is also a national health and beauty journalist and

Back then, most people considered cosmetic surgery and cosmetic procedures such as Botox® or fillers as highly suspect – after all, who would pay someone thousands of pounds to put them under anaesthetic (always potentially dangerous), cut into their skin, or inject a toxin to change their looks, perhaps irreversibly?

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

Well, as it turns out, a lot of us. A recent survey found that almost half of Britons would consider cosmetic procedures. The cosmetic surgery market has experienced sharp growth, in terms of both volume and value, over the past five years. The number of surgical and non-surgical procedures has more than doubled, with the market now worth more than £900m, a figure which looks set to top £1bn in the next year or so. This hugely lucrative industry is the ultimate sign that cosmetic surgery and medicine has gone main stream.

A-list celebrities, royals and VIPs.

To further fuel the demand the gradual de-stigmatisation of the nip and tuck and has not only led to a huge increase

in surgery and cosmetic procedures, but has resulted in far more openness from those who undergo image enhancement.

The first step in removing the negative image of cosmetic procedures was getting people to actually admit to having had them. Over the last decade more celebrities began coming clean about having had ‘work’ done, such as Botox® or a face-lift and suddenly it started becoming accepted and respected to have cosmetic work, whereas in the past celebrities, as well as everyday folk, would pretend their appearance was down to good genes, exercise and diet. Subsequently this new wave of ‘honesty’ burst the floodgates open and has continued to be propelled by the huge popularity of television programmes featuring surgical makeovers over the last few years.

I believe that honesty and truth is the best policy in this industry. When the media consults with me for advice or information on cosmetic procedures they will nine times out of 10 ask me what ‘work’ I have had done and I am always open and honest – I do indeed practice what I preach. The media is refreshingly fascinated by my willingness to discuss how fabulous my experience was with Vaser liposuction but how I condemn it being touted as a ‘lunchtime’ procedure, how I hugely advocate the use of Botox® for anti-ageing, but in moderation, and performed by the right professional and how I continuously preach to people about ditching the razor and switching to laser (it’s more cost effective and time efficient in the long run). cosmeticnewsuk.com

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Best Practice - Cosmetic Consumers

The truth, even if sometimes uncomfortable or hard to stomach, will always work. The media will find it hard to fuel or promote stories of an exploitative and badly regulated industry if we contradict them by being open and honest.

The consumer will have realistic expectations if a clinic or an aesthetic practitioner is honest about what can or cannot be achieved. Miracles cannot be performed but improvements can and will happen with cosmetic procedures; that’s the truth in a nutshell, (so tell your clients please).

Ten years ago information on cosmetic procedures was not as freely or openly available as it is now, the internet had limited and somewhat fragmented information, it was confusing for the consumer to find honest, factual, information or advice and therefore it was very difficult for consumers to really understand what they were entering into if they wanted to make improvements or changes to their image.

In the past, unregulated marketing campaigns by large commercial cosmetic companies, coupled with exaggerated claims, or scaremongering stories in the press made it hard to sort fact from fiction. However, thankfully, owing mostly to the campaigning efforts of several industry watchdogs and associations, such as the BAAPS and the BACD, the last two years have seen a dramatic shape up in the way the industry markets itself. Yes it has to an extent become more aggressive and competitive with its marketing strategies (especially on the internet), but to some extent, it has also evolved to be more informative and educational in its multitude of subjects and specialities: if a patient is now

“There are approximately 42 million Google search terms on the word Botox® itself” questioning what Botox® is and whether they should have it; there are approximately 42 million Google search terms on the word Botox® itself. There are pictures diagrams, videos and endless content to read on just one subject alone. The downside? Occasional sensory overload.

Owing to pressure for regulatory changes the industry is also much more guarded and controlled in what it can say or cannot say and do. The tightening of regulations, which seems set to continue and intensify together with the much needed demand for responsible information has given birth to a new generation of consumer. The informed consumer.

Now for those who are not aware the truth is this: I am not a doctor, but I have spent 10 good years passionately dedicated to this industry. I have worked with surgeons, doctors, researchers and the best collection of industry experts from around the world; I have had several cosmetic surgery operations and procedures carried out on myself. I am to most degrees the depiction of a very real and ordinary person just like your consumer, (a thirty something time pushed spouse, professional and a busy parent, seeking a little self improvement), the only difference is I have built a career on writing 44

cosmeticnewsuk.com

The informed Consumer The informed consumer will have a plan, which will cover all the crucial factors in trusting you with their face and body.

An informed consumer will have carefully drafted a list of potential clinics or professionals. If you are on that list it is because people have referred a positive experience of you.

Word of mouth works it is free advertising and the best investment in winning new clients to your practice. There is no such thing as a ‘time waster’, treat every new consultation as a potential free advertisement for how brilliant your service is.

Informed consumers screen potential clinics, or professionals with ‘telephone screening checklists’. Every phone call answered in your practice or premises is of vital importance. Small details matter, the tone of a voice and the co-operation offered in one simple phone call could make the difference to that person becoming your new client, think about it. The difference that just one helpful phone conversation could make in enabling that person to walk through your door.

Expect to be asked what makes you or your clinic a ‘specialist’ at what you do. Expect the informed consumer to understand the difference, as they will confidently ask about your experience, qualifications and training.

Expect the informed consumer to get the best out of their consultations, with a tick list of questions to ask. So satisfy their questions with honest, friendly and illustrated examples of previous work to exemplify your skills and experience.

This new generation of consumer is empowered with positive messages about the way they look and feel, in the past this industry has dedicated itself to exploiting those physical insecurities, however the informed consumer understands the concept of ‘realistic expectations’and will expect you to work to produce the best results you can, whilst being truthful of the expected outcome.

Price and presentation is important – a golden rule that the informed consumer has learnt. You may have presented your service well, but is it priced fairly? Equally consider the opposite you may have priced your service well but have your presented it the best you can to your client?

and advising and researching all aspects of surgery and cosmetic procedures. My latest book The Cosmetic Surgery Companion - Look and Feel Beautiful (Apple Press) is a complete cosmetic beauty guide and includes topics such as how to shop for a surgeon and clinic and how to recover post-procedure. Power is knowledge and I have made it my mission and my professional crusade to empower and inform consumers.

So make way for a new consumer coming your way, the very consumer that I am helping to shape with my philosophy of ‘power is knowledge’ and above all else the truth should be paramount.

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Social Media

The social scene Richard Crawford-Small from RCS Consulting provides a 10-step guide to social media

Conversations around social networking generally go

but if you want 2012 to be the year you finally get

Take your time, as your answers to these questions

something like this:

your head around social networking, you have to start

will inform you and make sure that your efforts are

Practitioner: “I heard social media is important, do I need

somewhere…

consistent. Once you know what your goals are, you will

to get with this?”

be able to measure the effectiveness of your efforts and

RCS: “It really depends on what you want to achieve.”

Getting Started

Practitioner: “I mean it’s the future, isn’t it?”

Before you launch headlong into this, take a step back

RCS: “It has become a major communications channel

and think. Have you really identified why you need your

Activity Two – Choose your tools

and is very useful for increasing brand awareness.”

to use social media?

OK, so you know what the objective is, now we need to

Practitioner: “Times are tough and need my business to

Like my conversation at the beginning of the article, the

choose the network and medium. I would start with the

grow.”

real need here was to grow the business, which means

one of the following:

RCS: “That is your real need right there, social media is a

using social media as a means to ENGAGE and CONNECT

Blogging – Blogs are great if you have a lot to say, but

tool that can help.”

with YOUR PATIENTS.

it can be time consuming and difficult to write original

Practitioner: “Great, how do I build a network really

A social networking objective would fit into one of the

content. Don’t overcomplicate matters and add the Blog

quickly? Will it take long?”

following categories and ideally move through them

page to your website. www.blogger.com is a good simple

in order:

one to use, if you want something a little more advanced www.wordpress.com is your weapon of choice. Both

This is a great conversation to have because, as part of a coordinated approach to customer communications, social media should play a factor in your 2012 marketing plan. However, the reality is that, for the majority of small businesses in the medical aesthetics sector, social media

ensure you choose the right tools for the job.

1. Initiate interaction 2. Develop relationships 3. Foster loyalty 4. Develop advocacy

integrated nicely with websites.

Twitter - Amazing how much you can squeeze into 140 characters, great for quick comments to connections and simplicity itself to set up. Can be quite fun too!!

tools are something that are seen as important but that people often put off and say “I’ll get around to it”. But why

Conveniently, these also fit very nicely into the Acquire

is social media so important and how do you use it?

– Retain – Return lifecycle of an aesthetic patient.

It’s now 2012 and Facebook launched in 2004 – eight

You Initiate interaction in the acquisition phase

this is where your patients live – let’s just look at the

years is an aeon ago in technological terms – so there is

through outbound marketing. Once the patient is in

numbers for a minute;

now a large amount of information on the web about the

the clinic, you develop the relationship and encourage

myriad of reasons why a business should engage in social

retention through loyalty and finally encourage them

•

Estimated 1BN users by Jan 2012

networking. A quick Google search will provide you with

to be a long term returning patient, advocate and

•

The UK is the 3rd biggest Facebook audience after

hours of bedtime reading, however, the purpose of this

eventual evangelist.

Facebook – You’ve heard of it because it is huge – massive even! The sheer scale of Facebook is astonishing,

the US and Indonesia •

article is to show you the ‘How’ and help to cut down on

1 million new UK users sign up to the site each

Activity One - Thorough Planning and Goals

•

Women between 35-54 fastest growing segment

I have done the work and provided 10 simple activities

It is important to think through and know what your

•

50% of UK users logging in every day

that will get you up and running, or a ‘0-60 Plan’. As

goals are. Are you trying to acquire patients? Are you

they say, there are many, many ways to skin a cat and

looking to communicate with existing patients? Are

LinkedIN - Awesome tool for building business

my prescribed activities are by no means the only way,

you looking to raise your profile within the industry?

credibility and a great online CV.

the time needed to translate the ‘Why?’ to the ‘How’.

month

cosmeticnewsuk.com

47

Social Media Go to their homepages, set up your accounts. Twitter is a very straightforward process, Choose one or two networks and base on this criteria

Facebook is a little more complicated as you need to set up on Facebook pages, not a Facebook Page. Confusing, but the helpful chaps at

Are you currently using it ‘socially’?

Are you familiar with the technology?

Activity Three - Your window to the World: the biography and image

•

Before we can start inviting people to connect, you need to let them know who you are.

•

It is much quicker to build a network if you already have one!

It is far less time consuming if you know the shortcuts and etiquette

Can anyone close help you?

•

If you don’t know what #ff means, ask someone you know who is active on

I love the fact that social networking etiquette allows us to blur the boundaries between

the network (or tweet @rcsconsulting)

work and life – we are human, so allow yourself to have some fun. Be professional and consider what you want your patients to see about you; even Alan Sugar is funny on Twitter. Remember that people buy from people, just ask Mr Branson.

If you are stuck, go with Twitter, Facebook, Blogger. Simple and effective.

Activity Four - Build your network

a collective “hmmm”. Maybe, or just think about your

too carried away with followers and friend numbers,

Look at some of your colleagues’ bios and get some

identified goals and objectives, as what you write

what you should track are the ones you influence

decent images of yourself (RCS Consulting practice

is linked directly to your audience. Be yourself and

and can work with to grow the business and spread

what you preach). Then begin building your network.

comment on your interests, if you hate motor racing,

the word.

Things should have been pretty simple so far and

don’t try to be an authority on it.

Good tool to use is www.klout.com, which uses

you’ll have spent five or six hours depending on

If you haven’t gathered by now I am a fan of Twitter

complicated algorithms to tell you how important

your skill level. You now know what you want to

– it makes connecting and engageing with your new

you are and will tell you if you are on the right track.

achieve, you have your accounts, a nice photo of

network very easy indeed! Like all things in life, you

you looking professional and imperious and now

get what you give, so be generous with your time

are ready to start building your network. Invite

and network.

Activity Nine – Measure your success with patients Be consistent with your efforts and don’t overdo the

people you know and trust first, then open up to the wolves. Start safely and invite family and friends

Here are some tactics I have used to grow and

‘me’. It is very easy to unwittingly alienate people on

onto Facebook and ask for honest feedback people

connect with my network;

Twitter.

who you trust and implement it. Personally I prefer

•

Thank people for following you

Twitter; I find it much more fun than Facebook

•

ReTweet interesting updates

Just think of yourself hiring a nice consultant, me

as it is a constant stream of noise and wonderful

•

Engage in activity and discussions

perhaps. We link up on Twitter and I bombard you

conversation, so I have linked Twitter to my

•

Use #ff every Friday to recommend your

with Tweets of me enjoying a debonair lifestyle and

favourite “Tweep” to your followers.

not working. Suddenly, you will become keenly

Facebook page (more on that later).

focused on the fee and not the quality of my work.

Your patients would react in the same way. A nice way of thinking about it is the concept of a cocktail party; if you meet Mr or Mrs Big I Am, how do you react?

If you feel uncomfortable talking about it in an intimate gathering, don’t Tweet it.

A big benefit of using a number of tools or channels

Activity Seven – Invite the thought leaders

Activity Ten - Have fun, enjoy exploring the Twitterverse and Facebook pages

is that you can often do it without having to

The other stupendous thing with social networking

Social media is the MEDIUM, Facebook and Twitter

duplicate your efforts. You don’t need to post on

is the amount of expert opinion there is to be found

are the TOOLS, the mechanism for you to use

Twitter and then Facebook and then LinkedIN

and you are your patients’ expert. Align yourself with

to ENGAGE with your patients. It is still a patient at

for example. By putting #IN on a Twitter post will

the industry leaders and people you admire and you

the end of the day and you still need to have an

automatically update it on your LinkedIN status. But

never know you might get airtime with them.

objective and a plan to acquire them.

serious Networking Ninja.

Also now choose and invite your top 20% patients

However, before you start think about how much



with a personal invite and message. These are crucial

time you have to dedicate to this. You need to be

That being said, let me save you hours of strife –

in establishing your credibility with your patients and

disciplined and commit at least two to five hours per

recent changes made to Facebook now mean that

moving them towards loyalty and evangelism.

week to be consistent with your efforts and not be a

Activity Five – Link them up

you knew that didn’t you, as you are becoming a

you can’t add your blog feed into Facebook pages.

flash in the pan.

This is clearly not helpful as you will need to copy and paste into Facebook and I have voiced my

Also and quite boringly if you are employed or are

displeasure to Mr Zuckerberg. However Twitter links

a contractor check that organisations policy on the

with Facebook very easily and vice versa, just look

use of social networking. Some are quite restrictive

for Twitter in Facebook Apps.

and it would be a shame to have to shut down after a few days.

Activity Six - Start being social

48

Yep, no hiding anymore – you now actually have to

Activity Eight – Track your results

Finally feedback is a gift, let me know what you think

start writing original comedy, or insightful business

Tracking your efforts is quite straightforward and

of this article @rcsconsulting!! (providing expert

musings that will have the world rubbing its chin in

again, links to your goals and objectives. Don’t get

tweetments).

cosmeticnewsuk.com

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On September 6, 2011, the indomitable Chris Evans (DJ, TV presenter and multi-millionaire) stated on his BBC2 Radio show that his wife had had electrolysis treatment. He jovially expressed the words ‘Tish’ (his wife’s name) and ‘Tash’ in the same sentence which she may, or may not be mortified about, but the fact is, that even Chris Evans (not one normally associated with being ‘au fait’ with the ‘beautification’ of women) demonstrates proof, by his knowledgeable and relaxed demeanor regarding his wife’s treatment, that electrolysis is a well known, acceptable and popular treatment with today’s sophisticated women.

Electrolysis is a brilliant stand alone, modern, affordable treatment and with improvements in technology has developed into a more comfortable and gentle treatment, even more effective and increasingly popular today. Not only does it remain to this day the only permanent method of hair removal but it also complements laser and IPL treatments and together they make the perfect combination offering speed of treatment with the added benefit of permanency.

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FINANCE

Sales

t a lk

Alan Rajah from Lawrence Grant gives his top tips to consider when buying or selling a practice

There are various reasons why someone decides to sell their practice - the most common being retirement or ill health.

system should be sophisticated enough to maintain patient records and diagnostic results that avoid the need for storage requirements. The ability to access the patient information remotely is an important criteria in determining the price that is paid for a medical practice.

Other factors that could lead to a clinic being bought are when the clinician decides to expand or upgrade his or her practice by broadening their client base; wants to increase the geographical coverage of their practice or increase the scope of services offered to clients including accessing specialised knowledge or technology.

Quality of service

Surgery performance Every single private practitioner should be looking to enhance the value of their business. This involves building a brand name that will be saleable in the future. The most common mistake made by most practitioners is to use their personal name as the trading name or company name rather than using a generic name that could be adopted by a new buyer.

There is also a moral issue when it comes to selling a medical practice.

You will need to ensure that the new buyer will be able to deliver the same or even superior quality of service that you are currently providing for your patients. Almost all disposal of medical practices is linked to ensuring that there will be a similar level of fees for the next two years â&#x20AC;&#x201C; the last thing any selling practitioner would want is to deal with patient complaints or falling numbers of patients in subsequent years that could impact on the final price that has been negotiated.

A key consideration for any purchaser is to ensure that they have good title to any assets that form part of the purchase price and the appropriate due diligence work should be undertaken that will include reviewing maintenance contracts and hire purchase/leasing commitments.

Additional resource If relevant, a review of the latest Care Quality Commission report should be undertaken that would highlight any short comings in the practice.

A review of claims made by patients against the practice will provide an indication of any pending legal issues as well as the risk profile of the practice.

Accountancy services

It is also important to have a good accounting system in place to ensure that you are able to produce management accounts on a timely basis and ensure that the appropriate controls and checks are stringent to ensure that all procedures are invoiced on time.

Finally you should always engage a professional medical accountant at an early stage to ensure that the appropriate due diligence questions are raised to ensure that the costs of the process â&#x20AC;&#x201C; both opportunity and out of pocket costs are kept to the minimum.

Financial analysis

For further information on buying, selling and valuing practices, please contact Alan Rajah at alan@lawrencegrant.co.uk or visit http://www.lawrencegrant.co.uk/specialist-services/doctors.htm

Any purchaser should undertake further analysis of the turnover of the practice that they are looking to acquire by breaking it down by insurers and self-paying patients. There should also be further analysis of turnover by repeat patients. This will give an indication of the dependency of the practice on different streams of income.

A detailed review of source of referrers should also be undertaken to establish if the same relationships could be maintained by the new buyer and the steps that will need to be taken to continue to maintain the income levels.

There are a number of patient management software systems on the market and consideration will need to be taken regarding the quality of the management software when a bid is made for the practice. The software 50

One of the important factors in purchasing a medical practice is the quality of the staff that you are taking on and the training that they have undergone to enable them to continue to maintain a high standard of care and service. You need to ensure that staff records are kept up to date and every staff member has been issued with an employment contract and a handbook. Health and safety aspects of the business will need to be taken into account as well.

cosmeticnewsuk.com

Alan Rajah joined Lawrence Grant in 1994 and became partner in 2001. Alan is involved in all areas of general practice and specialises in valuations of business, due diligence and mergers and acquisitions.

Alanâ&#x20AC;&#x2122;s client portfolio includes local and overseas companies and individuals and has specialist knowledge of clients in the medical profession and has accumulated a wealth of experience in dealing with the specialist tax and compliance issues facing doctors, consultants and other medical professions. His main focus is assisting individuals and corporate organisations in minimising their tax bills and providing strategic analysis and business development techniques in increasing revenue streams. He also deals with resolving partnership and shareholder disputes as well as providing advice to clients and solicitors in dealing with matrimonial disputes. Alan is a member of the International Tax Practice Group and Real Estate Practice Group of Geneva Group International.

He also deals with both corporate and personal tax planning for UK and international clients and specialises in implementing onshore and offshore tax structures for clients by the utilisation of offshore trust and companies.

Dates for the Diary

February

diary

1 Medik8 Roller Training, London, www.SkinBrands.co.uk 2 Laser core of knowledge, Birmingham, www.lasersafe.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 4 Innomed Training Advanced Botulinum Toxin, South Coast, www.innomedtraining.co.uk 5 Innomed Training Advanced Dermal Fillers and Lip Masterclass, South Coast, www.innomedtraining.co.uk 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 8 Genuine Dermaroller Training, Dermal Clinic, Edinburgh, www.genuinedermaroller.co.uk 8 Mapperley Park Core of Knowledge, London, www.mapperleypark.co.uk

15 Dr Bob Khanna Training Institute, Refreshers Course, www.drbobkhanna.com 15 Dr Bob Khanna Training Institute, Heart Lips™, www.drbobkhanna.com 13 Genuine Dermaroller Training, The Glass House Clinic, Clapham, London, www.genuinedermaroller.co.uk 16 Module 11. Master Course in Ultrasound-Assisted (VASER) Lipoplasty, Villa Alba Hospital, Bologna, Italy, www.ecamedicine.com 16 Dr Bob Khanna Training Institute, The Team Program, www.drbobkhanna.com 16-18 Microsclerotherapy for Thread Veins of the Leg, www.theclinicalexchange.com 18 Innomed Training Hands-on Botulinum Toxin for beginners, Birmingham, www.innomedtraining.co.uk 18 Innomed Training Hands-on Peels and Medical Skincare for beginners, London, www.innomedtraining.co.uk 19 Innomed Training Hands-on Dermal Fillers for Beginners, Birmingham, www.innomedtraining.co.uk 19 Innomed Training Hands-on Mesotherapy for local fat and cellulite for beginners, London, www.innomedtraining.co.uk 20 Genuine Dermaroller Training, The Clinik, Brighouse, Yorkshire, www.genuinedermaroller.co.uk 20-21 Medik8 Training, Cheshire, www.SkinBrands.co.uk 22 Obagi Workshop, London, www.healthxchange.com

We round up upcoming events, training courses and meetings

22 Genuine Dermaroller Training, Cosmedical Skin and Laser Clinic, Dublin, Ireland, www.genuinedermaroller.co.uk 22 Genuine Dermaroller Training, Horrington Clinic, Wells, Somerset, www.genuinedermaroller.co.uk 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 Innomend Training Basic Botulinum Toxin for Beginners, Newcastle-upon,Tyne, www.innomedtraining.co.uk 26 Innomend Training Basic Dermal Fillers for Beginners, Newcastle-upon,Tyne, www.innomedtraining.co.uk 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 28 Innomed Training Hands-on Botulinum Toxin for beginners, Newcastle, www.innomedtraining.co.uk 29 Innomed Training Hands-on Dermal Fillers for Beginners, Newcastle, www.innomedtraining.co.uk

March

April

May

5 Mapperley Park Core of Knowledge, Nottingham, www.mapperleypark.co.uk 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 17 British Association of Cosmetic Doctors Spring Conference, Royal Society of Medicine, London, www.cosmeticdoctors.co.uk 17 Foundation Level Botulinum Toxins and Fillers, Glasgow, www.inspiredcosmetictraining.com 22 Laser core of knowledge, London, www.lasersafe.co.uk 26 Enhancing Skincare Knowledge with Sally Durrant, London, enquries@sallydurant.com 27-28 SkinCeuticals Training, London, www.SkinBrands.co.uk 29-31 10th Anti-Ageing Medicine World Congress, Aesthetic Dermatology and Surgery Preventive and Anti-Ageing Medicine, Medical Spa, Monte Carlo, www.euromedicom.com 31 Innomed Training Basic Botulinum Toxin for Beginners, London, www.innomedtraining.co.uk

1 Innomed Training Hands-on Dermal Fillers for Beginners, London, www.innomedtraining.co.uk 16-17 SkinCeuticals Training, Cheshire, www.SkinBrands.co.uk 16-19 BTEC Award – Laser and Light Based Hair Removal and Photorejuvenation, Nottingham, www.mapperleypark.co.uk 18 Dr Bob Khanna Training Institute, Botulinum Toxin - Beginners, www.drbobkhanna.com 18 Intermediate/Advanced Level Botulinum Toxins and Fillers, Glasgow, www.inspiredcosmetictraining.com 19 Dr Bob Khanna Training Institute, Botulinum Toxin - Advanced, www.drbobkhanna.com 20 Dr Bob Khanna Training Institute, Dermal Fillers – Beginners, www.drbobkhanna.com 23-24 Medik8 Training, Cheshire, www.SkinBrands.co.uk 24 Enhancing Skincare Knowledge with Sally Durrant, London, enquries@sallydurant.com 24-25 SkinCeuticals Training, London, www.SkinBrands.co.uk 26 Medik8 roller, London, www.SkinBrands.co.uk 28 Innomed Training Comprehensive Chemical Peels and Medical Skincare, London, www.innomedtraining.co.uk 29 Innomed Training Mesotherapy for Cellulite, Fat and Skin Rejuvenation, London, www.innomedtraining.co.uk 29-30 Cosmetic News Expo 2012, Business Design Centre, Islington, www.cosmeticnewsuk.com 30 SkinMedica Training, Cheshire, www.SkinBrands.co.uk

7 Foundation Level Botulinum Toxins and Fillers, Aberdeen, www.inspiredcosmetictraining.com 9 Mapperley Park Core of Knowledge, London, www.mapperleypark.co.uk 9 Dr Bob Khanna Training Institute, Botulinum Toxin - Beginners, www.drbobkhanna.com 10 Dr Bob Khanna Training Institute, Botulinum Toxin - Advanced, www.drbobkhanna.com 11 Dr Bob Khanna Training Institute, Dermal Fillers – Beginners, www.drbobkhanna.com 14-15 SkinCeuticals Training, Cheshire, www.SkinBrands.co.uk 21-22 Medik8 Training, Cheshire, www.SkinBrands.co.uk 22-23 SkinCeuticals Training, London, www.SkinBrands.co.uk 24-25 Medik8 Training, London, www.SkinBrands.co.uk 24-26 Microsclerotherapy for Thread Veins of the Leg, Guildford, www.theclinicalexchange.com 30 Foundation Level Botulinum Toxins and Fillers, Glasgow, www. inspiredcosmetictraining.com

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onfidence is Reliable1,2 Rewarding3 Performance4,5 BOTOX® is licensed for the treatment of moderate to severe glabellar lines Delivers long-lasting patient satisfaction, time after time2,3 Has been used for over 20 years in over 26 million treatment sessions worldwide6 Is the world’s first and most studied botulinum toxin*7

stand 27 BOTOX® (botulinum toxin type A) Abbreviated Prescribing Information Presentation: Botulinum toxin type A (from clostridium botulinum), 50 or 100 or 200 Allergan Units/vial. Indications: Temporary improvement in the appearance of moderate to severe vertical lines between the eyebrows seen at frown (glabellar lines), 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. Contraindications: Known hypersensitivity to any constituent. Infection at proposed injection site(s). Warnings/Precautions: Relevant anatomy and changes due to prior surgical procedures must be understood prior to administration. Do not exceed recommended dosages and frequency of administration. Adrenaline and other anti-anaphylactic measures should be available. Reports of side effects related to spread of toxin distant from injection site, sometimes resulting in death. Therapeutic doses may cause exaggerated muscle weakness.

Caution in patients with underlying neurological disorder and history of dysphagia and aspiration.

Patients should seek medical help if swallowing, speech or respiratory disorders arise. Clinical fluctuations may occur during repeated use. Too frequent or excessive dosing can lead to antibody formation and treatment resistance. The previously sedentary patient should resume activities gradually. Caution in the presence of inflammation at injection site(s) or when excessive weakness/ atrophy is present in target muscle. Caution when used for treatment of patients with peripheral motor neuropathic disease. Use with extreme caution and close supervision in patients with defective neuromuscular transmission (myasthenia gravis, Eaton Lambert Syndrome). Contains human serum albumin. Procedure related injury could occur. Interactions No interaction studies have been performed. No interactions of clinical significance have been reported. Theoretically, the effect may be potentiated by aminoglycoside antibiotics or other drugs that interfere with neuromuscular transmission. 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. Pregnancy: BOTOX® should not be used during preganancy unless clearly necessary.

Lactation: use during lactation cannot be recommended. 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%). In general, reactions occur within the first few days following injection and are transient. 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 to <1/10); Uncommon (>1/1,000 to <1/100); Rare (>1/10,000 to <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 other adverse events have been reported since the drug has been marketed: dysarthria; abdominal pain; vision blurred; pyrexia; focal facial paralysis; hypoaesthesia; malaise; myalgia; pruritus; hyperhidrosis; diarrhoea; anorexia; hypoacusis; tinnitus; radiculopathy; syncope; myasthenia gravis; erythema multiforme; dermatitis psoriasiform; vomiting and brachial plexopathy; rash; psoriasiform eruption; anaphylactic reaction (angiodema, bronchospasm); alopecia and madarosis.

Adverse reactions possibly related to spread of toxin distant from injection site have been reported very rarely (exaggerated muscle weakness, dysphagia, or aspiration pneumonia which can be fatal). NHS Price: 50 Units: £77.50, 100 Units: £138.20, 200 Units £276.40. Marketing Authorization Number: PL 00426/0074 Marketing Authorization Holder: Allergan Pharmaceuticals (Ireland) Ltd., Westport, Co. Mayo, Ireland. Legal Category: POM. Date of preparation: November 2011.

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. De Almeida A et al. Dermatologic Surgery 2007;33:S37–43. 2. Carruthers A et al. J Clin Res, 2004;7:1–20. 3. Stotland MA et al. Plast Reconstr Surg, 2007;120:1386–1393.

4. Beer KR et al. J Drugs Dermatol, 2011;10(1) :39–44. 5. Lowe et al. Am Acad Dermatol, 2006;55:975-980. 6. Allergan data on file. BOTGL/001/SEP 2011 7. Allergan Data on File VIS/006/JUL2011. *Allergan botulinum toxin type A. Global figures. Launched in 1989 in the US. UK/1010/2011 Date of Preparation November 2011