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i n d u s try

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

And the winners are…

Glossy 24-page Aesthetic Awards supplement inside this issue

The lure of perfect skin The elure Advanced Skin Lightening System

into 2012

Review of the year

A Meeting of Minds

Cosmetic n ews E

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also inside this issue of cosmetic News fillers study | nutrition and skin health | dr alfredo hoyos | clear + brilliant

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

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Cosmetic news t h e

e d s

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Welcome to the first issue of Cosmetic News for 2012. I hope you all had a good Christmas and are looking forward to the year ahead. We ended 2011 on a high with our first annual Aesthetic Awards evening at Sopwell House. The night was a huge success and we have created a special 24page supplement along with this month’s issue to mark the event which I hope you enjoy. Also in this issue… January is a key month for promoting weight loss treatments with losing weight being top of the new year’s resolutions list for many people, but how does what we eat affect our skin? We take a look at the Pronokal Method for weight loss and skin rejuvenation through nutrition (p30-31). We also examine the latest low-downtime laser treatment Clear + Brilliant (p32) and speak to leading Columbian surgeon and Hi-Def VASER pioneer Dr Alfredo Hoyos (p22-23). I hope you enjoy this issue and look forward to bringing you more in 2012. Happy New Year!

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e d s

c h o i c e

I N N O -T D S M e s o t h e r a p y

04 EDITOR’S CHOICE Vicky Eldridge on the INNO-TDS Mesotherapy treatment

06 INDUSTRY NEWS We round up the latest industry news

  10 NEWS SPECIAL REPORT We report on the Treatments You Can Trust Governance Group meeting

12 COSMETIC NEWS EXPO 2012 How the Cosmetic News Conference will help you stay ahead of the competition in 2012

14 ON THE SCENE Out and about in the industry this month

16 REVIEW OF THE YEAR We ask some of the industry’s key players what their highs and lows of 2011 were and what they are looking forward to for the year ahead

22 PEOPLE IN PROFILE We speak to the pioneer of Hi-Definition body sculpting, Dr Alfredo Hoyos


Aref Alsoufi discusses a retrospective analysis of 108 cases of patients receiving a hyaluronic acid filler for long-lasting volume restoration on the face


We look at the link between the PronoKal Method ® and skincare

3 2 T R E AT M E N T S P OT L I G H T

We find out about the latest treatment from Solta Medical, Clear + Brilliant


We find out about the elure™ Advanced Skin Lightening System


It is the beginning of the New Year – a time for making resolutions and thinking about change and one thing that will no doubt be on many of your clients’ minds is getting rid of that post Christmas bulge. January is one of the best times of the year for promoting weight loss treatments in your clinic. After the over-indulgence of the festive period many people are looking to slim down and trim up fast. While there are many different treatments for fat reduction and body contouring, one that gets less press than its machine-based rivals, but has been proven to be very effective, is mesotherapy. One company that has long recognised the benefits of mesotherapy is Medical Aesthetic Group. The company distributes two mesotherapy ranges, INNO-TDS and Simildiet, both of which have solutions designed for weight loss and contouring, which gently enhance the results of a weight loss and exercise programme. INNO-TDS is a line of products based on high concentrations of active ingredients that have been formulated according to efficacy guidelines and are highly effective and safe for the skin. These active ingredients are aimed at globally preventing ageing as well as the treatment of aesthetic imperfections such as weight loss and cellulite reduction. The treatment is not suitable for obese clients but is ideal for those who want to get rid of localised areas of excess fat. Multi-dose treatments are required with the best results being seen after two months with 12-14 days between treatment. The solution used for fat reduction is INNO-TDS Dermocosmetic SolutionsDraining PPC, a phosphatidylcholin-enriched soy lecithin fraction that is used to minimise or eliminate localised or generalised hydrolipodystrophy. It increases the fluidity and permeability of adipocyte membranes, helping remove their lipidic component. This is due to its great emulsifying power when converting the solid fat in the adipocyte into an easier-to-metabolise fluid water-fat or oily water solution that is passed as bile. In other words it chemically dissolves fat! This is available in a 50ml vial or in individual 5ml vials and is administered via multi-site injections. It can be used to treat the stomach, thighs and love handles and is very effective for the jaw line and chin area, particularly in men, making it the perfect treatment for tackling that post Christmas bulge.

We round up the latest product news

38 ABSTRACTS We round up the latest clinical studies


Award winning lawyer Norman Rea Consultant with Sydney Mitchell LLP continues his series of articles on hot employment topics for us by shining a torch into the commonly misunderstood world of balloting and industrial action

4 4 D AT E S F O R T H E D I A RY Training course, conference and meeting dates

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

Meet the Cosmetic News team Charlotte Body Publisher 01268 754 897

Peter Johnson, Art Director 01268 754 897

Vicky Eldridge Editor 01268 754 897 M: 07940 083 677

Loraine Winter Designer 01268 754 897

Emilia Cops Associate Publisher 01268 754 897

Shauna Peters Production Assistant 01268 754 897

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

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

News - Industry News

BACN holds Managing Complications workshop Control the pain of cosmetic injections

INSTANTLY with a clinically proven topical anaesthetic

The British Association of Cosmetic Nurses (BACN) has announced a day-long workshop on Managing Complications in Aesthetics. The meeting will take place on Tuesday January 24 at the Ark Conference Centre in Basingstoke.  Issues to be covered include swelling and inflammation following treatment with hyaluronic acid; dealing with allergies; ptosis, granuloma and necrosis; risk management and responsible prescribing. Speakers will include Dr Tracy Mountford, Fiona Peniston-Bird, Lorna Bowes, Marie Dolan, Chris Worth and Eddie Hooker. The event is not exclusive to BACN members and is open to all aesthetic nurses, doctors and dentists. The cost is £60 for BACN members or £80 for non-members.  For more information visit  

IMCAS conducts first worldwide survey on filler complications

The IMCAS Scientific Committee has created a survey to collect evidence-based medicine data on the incidence of fillers complications. Participation is fully anonymous and open to any practitionner dealing with fillers in their practice. The objective of the survey is to measure the incidence and prevalence of complications arising from filler injections (i.e. vascular events, severe infections, granuloma and any others). This data has not been collected before in any reliable worldwide way, and, because of the increasing popularity of filler procedures, the IMCAS committee felt it was important to gather information that practitioners could use when counselling their patients. The survey is designed to take less than 10 minutes and participants will be granted free access for two months to the extensive IMCAS Premium Media Access, featuring more than recent 150 videotaped demonstrations. The results will be presented during session 30 (Filler Complications 2) at the IMCAS annual meeting at the Palais des Congres, Paris, on January 28, 2012, and published inside the IMCAS abstract booklet. The deadline for participating is January 9. Visit to take part.

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Insights by TRIA Home Laser reveal new trend amongst women The well-groomed woman, once viewed as a throwback to the 1950s, is seeing a huge revival thanks to the likes of Kate, Duchess of Cambridge, Pippa Middleton and TV shows such as ‘Mad Men’ – according to home laser hair removal brand TRIA. Nearly 70% of women in the UK say they remove body hair because they like to feel groomed, and one in four say they have become more vigilant about hair removal over the last three years, which indicates a new focus on good grooming practice. “We are seeing a huge revival of a ‘groomed look’ amongst women in the UK,” said Dr Honey LangcasterJames, independent psychologist. “Research demonstrates that nearly half of women do it because it boosts their confidence (45%). This is driven by a number of different factors. When they’re feeling well groomed, women feel more superior than their less groomed counterparts. They feel ready to tackle anything life throws at them – both in their professional and personal lives.” Not surprisingly, singletons are most likely to focus on hair removal as a way of boosting confidence with over half (55%) citing this as a reason. As women get older, however, they are less in need of a confidence booster. Two thirds (61%) of 18 – 24 year olds cite boosting confidence as a key reason for hair removal which then drops significantly to a third (33%) amongst the 55+ age group. “As women get older, there are a multitude of reasons why they focus less on grooming”, added Dr Langcaster-James. “It’s likely they rely less on outer confidence – as they have more inner confidence. In addition, they are less likely to be able to spend time on themselves as they have more going on.”

double Aesthetic AwArds 2011/12 • winner •

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Before and after ONE i-Pixel treatment




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



AFT 570 SR

Photos courtesy: Fernando Stengel, MD


Pixel Laser

Photos courtesy: Amber Brown, MD

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

Pixel ST





AFT 420 Acne

Photos courtesy: Elizabeth VanderVeer, MD




Pixel Laser

Photos courtesy: Bhupendra Patel, MD


ContaCt us on: tel: 0845 1707788,,




s e e u s at

CosmetiC news E www.CosmetiCnewsuk.Com


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

stand 58

News - Industry News

New website for Carleton Medical Carleton Medical has launched a new website The company supplies a wide range of surgical and aesthetic laser devices to both the National Health Service and private healthcare sector. The new site has a section dedicated purely to the company’s aesthetic systems including AIridex and Asclepion Lasers and Ultrashape.

Dental regulator issues guidance on remote prescribing The UK’s dental regulator, the General Dental Council (GDC), has issued new guidance for registrants on non-surgical cosmetic procedures such as the prescription or administration of Botox or injectable cosmetic medicinal products. The GDC says that remote prescribing shall not be used in the provision of these procedures. It said: “Remote prescribing in dentistry is acceptable in some instances but should only be used in exceptional circumstances. It should not be used in relation to non-surgical cosmetic procedures.” The guidance has been issued in response to concerns that registrants may use remote prescribing inappropriately and to achieve consistency with the approach of other healthcare regulators in this area. More information can be found on the GDC’s website

LPG Endermologie awards its second UK Centre of Excellence

Ulthera appoints Greg Waller as Chief Financial Officer

The first UK clinic to install the Cellu M6 Integral machine by LPG has now achieved LPG Centre of Excellence status, signifying its commitment to training and customer service. Penina’s Clinic, in London, is only the second UK clinic to be awarded this distinction from LPG. To qualify, they must offer consistently high standards of treatment and all therapists must be trained at the LPG Academy in France. “I’m delighted to have been recognised as a centre of excellence”, said clinic owner Penina Katsch. “We have already achieved excellent results for our clients with our Cellu M6 Integral machine. The visual results have been outstanding and the effectiveness of the treatments has exceeded my expectations, and those of the client. It has certainly proved to be a worthwhile investment.” Penina’s Clinic has been offering beauty treatments for 24 years. It installed LPG’s latest generation Cellu M6 Integral machine last year, to ensure it could offer its clients the very latest natural, non-aggressive slimming and anti-ageing treatments. LPG Export Area Manager Renata Indacochea said, “Penina and her staff are passionate about the brand and are real LPG ambassadors. We’ve awarded this clinic our prestigious plaque of excellence in recognition of their consistently great work in administering high quality treatments which have achieved amazing results for their clients.”

Ulthera has named Greg Waller as its Chief Financial Officer (CFO). Greg’s three-and-a-half decades of experience showcases a solid track record of strategic financial growth for both privately held and publically traded companies. He said, “Although a young company, the technology achievements, market penetration and clinical respect that Ulthera has garnered in such a short period of time is not only impressive and significant; it is an auspicious indicator of what’s to come. I am honored to be part of such a promising company where medical innovation is highly encouraged, and consistency, safety and efficacy are at the heart of operating principals.” Matthew Likens, president and CEO of Ulthera added, “Greg’s resultsoriented skill set will play a vital role in further enhancing our sound corporate infrastructure as more and more cosmetic physicians in the US and internationally adopt our device to help meet the ever-growing consumer demand for safe and effective non-invasive procedures. I am confident that Greg will provide steadfast leadership to ensure a strong financial future for our growing company, especially as we tap the potential of our platform technology.”

Chris Worth raises money for prostate cancer research The aesthetics industry normally dedicates its time to removing hair but Intraderm managing director Chris Worth has been doing the opposite in a bid to raise money for prostate cancer research. Chris raised almost £300 for the charity by joining the thousands of men growing moustaches as part of ‘Movember’. It is not too late to donate to the cause. Simply visit 8

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3/2/11 6:

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

3/2/11 6:25:39 PM stand 58 3/2/11 6:25:39 PM PBSP28021101

Outstanding patient awareness and demand. Soprano XLi ad Russia.indd 1

3/2/11 6:25:39 PM

ww w . visit: and see how your patients can locate you and see treatments Live on tV


M oving fo r wa rd We report on the second meeting of the Treatments You Can Trust Governance Group

Political and consumer voices tasked with overseeing the management of met for the second time recently to discuss how the scheme is progressing. The Governance Group meeting was chaired by IHAS director Sally Taber and was attended by TV GP Dr Hilary Jones; Edwina Rawson, AvMA; Andy Randall, Sk:n Clinics; Jacqueline Cuming, The Harley Medical Group; Jeni Hough, Ramsay Health Care; Dr Rab Mittal, Spire Healthcare; Dr Toni Phillips, Renew Medica; Dawn Attewell, Royal College of Nursing and British Association of Cosmetic Nurses; Dr Patrick Bowler, British Association of Cosmetic Doctors; and Dr Brian Franks, Bupa. The Governance Group was formed in March 2011 to establish the independence of the Register and ensure that it has a clear focus on patient safety. It will also monitor any possible patient complaints about a provider on the Register.

European Standards One of the hot topics under discussion was the CEN/TC 403 European Standards. A public consultation will run from December 22, 2011 to May 22, 2012 with the Standard likely to be introduced in 2013, depending on the outcome of the consultation. Sally confirmed that currently registered nurses and dentists are not included in the Standard and that an action plan is being implemented with the British Association of Cosmetic Nurses in order to address the issue of recognised qualifications. A meeting has also been requested with the General Dental Council.

The Register of Registers An announcement was made during the meeting that the Council for Healthcare Regulatory Excellence was due to become the Professional Standards Authority, providing that the Health and Social Bill achieves its passage through the House of Lords. Sally confirmed that www. is being considered for entry as one of the Registers that could obtain the voluntary assurance accreditation.

Quality Assurance for Training The group discussed the importance of Quality Assuring Training courses for injectables and agreed to launch a registration scheme for training courses. This would include: • • • •

A desktop review of the training material Validation of the professional registration of the trainer (registered with GMC, GDC or NMC) Checking of attendance lists to ensure that only qualified professionals are accepted for training Random sampling of the training delivery of one of the training days to be notified to the organisation within 24 hours of CHKS attendance

Beauty therapists The Minister Anne Milton, Parliamentary Under-Secretary of State for Health is continuing in her support for the scheme and has requested that the issue surrounding beauty therapists administering treatments be addressed with the relevant trade associations. Sally confirmed that this will be taken forward with the Hair and Beauty Industry Association (HABIA) but also addressed separately with BABTAC who are supporting CTIA (Cosmetic Treatments Industry Association) set up to train beauty therapists to do cosmetic injectables. A quote confirming Anne Milton’s support had been submitted to HABIA and accepted by them.


Groupon Groupon was another item on the agenda, following the increased representation of cosmetic injectable ‘offers’ on Groupon and other group buying sites, including Wowcher. TYCT has written a letter to Lord Smith, chairman of the Advertising Standards Authority. A letter of complaint had also been sent to the chief executive of Wowcher Ltd for the blatant advertisement of ‘Botox®’ in the Metro newspaper. The issue was further highlighted in Which? which ran a news alert online. This was followed by a news announcement in The Times and Daily Mail.

Coverage Highlights Raising consumer awareness of the scheme has been high on the Governance Group’s agenda and www. has received significant coverage since its last meeting in June 2011. There have been 27 media features equating to over £140,000 of editorial value and a reach of over 730 million people. As part of its continued campaign to drive regional coverage with the support of Local MPs, November saw the Harley Medical Group in Reading featured on ITV Meridian with a supporting interview from Rob Wilson MP urging local constituents to use the Register. The clip can be viewed at meridian-west/fancy-somebotox83336/



A dermatology company

like no other.

double Aesthetic AwArds 2011/12 winner best product innovation Gold - Pix’L Micro Canula (Q-Med) best newcomer Gold - Emervel (Galderma)

Innovative medical solutions that meet the needs of dermatology patients and physicians: • P remier investor in dermatology research • S tate-of-the-art global research and development

Galderma (UK) Limited, Meridien House, 69-71 Clarendon Road, Watford, Herts, WD17 1DS. Tel: +44 (0)1923 208950 Fax: +44 (0)1923 208998. Copyright © 2011 Galderma (UK) Ltd. Date of preparation: March 2011


• F ocus on therapeutic, corrective and aesthetic innovations

Cosmetic News Expo 2012

CosEmetic news C o n f e r e n c e

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

C alling

How the Cosmetic News Conference will help you stay ahead of the competition in 2012

... st re e th of d ea ah ay st to st be e th h it Train w Continued professional growth and ongoing education is key to the development of any specialty, especially in one so dynamic and ever changing as aesthetic medicine. That is why 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. 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. Since its launch in 2010, 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 the very best UK and international speakers, discussing the latest topics and demonstrating the most up-to-date techniques in aesthetics, at a fraction of the cost of other industry events. This year we will be catering for both the beginner and the advanced practitioner with masterclasses aimed at these two distinct audiences.

Key topics for 2012 include:


Giving you the time you need to network, do business and learn Often when you attend conferences there is not enough time to look around

you great margins and that you wouldn’t necessarily get if you didn’t attend. In

the exhibition, without missing out on the educational programme, but at the

tough trading times these are the kind of deals that can really help your business

Cosmetic News Expo, we give you plenty of breaks to allow you to not only enjoy

to boom. With more than 60 exhibitors already signed up for 2012 and with

some food and respite and networking with your peers, but also to make sure you

Qmed on board as our Platinum sponsor alongside Gold sponsors Skinceuticals/

have plenty of time to speak to our wide range of exhibitors.

La-Roche Posay and Silver sponsors Syneron/Candela, this is one opportunity you

The Cosmetic News Expo brings together more aesthetics suppliers under one

can’t afford to miss.

roof than any other event in the UK. Our exhibitors are made up of the key

Entry to the exhibition as always, is free, but, due to demand, we will be

manufactures and suppliers in the industry, making the Cosmetic News Expo a

introducing a small charge for the conference for 2012. The tickets will cost £45

must visit for those who are new to the industry and are trying to source suppliers,

per day or £80 for both days, if you book in advance, or £75 per day/£150 for both

as well as busy practitioners who want to be able to see all their reps under one

days if you pay on the day. A complimentary lunch will be incorporated into the

roof. And because our exhibitors are keen to attract practitioners to their stand,

delegate package, with refreshments provided throughout the conference breaks.

many often offer exclusive show deals. These are the type of deals that can give

You will also receive a VIP invite to the Cosmetic News Expo after show party,


which will have an Olympic theme to mark the 2012 Olympics coming to London.

we offer all conference delegates a complimentary VIP invite to the post show

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

party, so you can network with speakers and exhibitors and let your hair down

the event. It will take place at the Pitcher and Piano in Islington on the evening

after the show.

of Sunday April 29, following the first day of the Expo. This dynamic and exciting venue has a fantastic atmosphere and is just a stone’s throw away from the

Tickets for non-delegates and guests for the party will cost £10.

Business Design Centre. Sometimes the best contacts can be made and the best business can be done in a social setting and we at Cosmetic News realise the value of that which is why

Sunday April 29

To book your place at the Cosmetic News Conference 2012 visit or call 01268 754 897.

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 too as the side effects of the menopause can drastically affect their skin and looks. This session will 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.

11am-11.30am Coffee Break

11.30am-1pm TREATING MALE CLIENTS The beauty industry has always been dominated by women, however the male grooming market has seen a phenomenal growth in the last two decades with more and more men heading through the doors of aesthetic clinics to improve their appearance. In this session we will look at the most popular treatments for men, from moob reduction to hair removal and cosmetic injectables, as well as examining how to attract male clients to your clinic and tap into this rapidly growing sector of the market.

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 experienced laser practitioner who wants to step up to the next level.

11am-11.30am Coffee Break

1pm-3pm Lunch 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. 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 imaging tools, this workshop will focus on all aspects of creating good clinical photography. 4pm-5pm INJECTION TECHNIQUES As cosmetic injectables have evolved so have the techniques used to administer them. Hear from leading experts 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. 5pm-6pm Exhibition Viewing

3pm-4pm POST-PREGNANCY TREATMENTS Having children is a wonderful thing, but, for many women, the joyful experience of becoming a mum can be blighted by the effect that pregnancy has on their body. Even those who follow a healthy diet and fitness regime to get back in to shape after having children can be left with melasma, stretch marks, saggy breasts and excess fat that will just not shift, no matter what they do. So it’s no wonder that more and more women are turning to cosmetic surgeons and doctors to give them a helping hand. This session will take a look at the growing trend for ‘mummy makeovers’ and examine the best post-pregnancy treatments. 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, this is a session that no experienced injector can afford to miss. 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.

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


on the scene

ON THE SCENE Out and about in the industry this month

Clear + Brilliant Launch, London Members of the press gathered at the plush St Martin’s Lane hotel in London for the launch of Solta Medical’s new treatment, Clear + Brilliant. The new laser-based system is designed not only to target but also to prevent the early signs of ageing with little to no downtime. Leading TV psychologist Dr Linda Papadopoulos gave a short presentation on psycho-dermatology talking about the link between the mind and the skin. Dr Tracy Mountford, who has been using the device in her clinic in Buckinghamshire, spoke about her experience with the device. See this month’s Treatment Spotlight p32.

Sergio Blumenblat (Solta Medical), Dr Tracy Mountford and Stephen Handisides (MyFaceMyBody)

Jean Beard and Dr Tracy Mountford (Cosmetic Skin Clinic) with Cosmetic News editor Vicky Eldridge

SCPS meeting, London

SCPS president Dr Ravi Jain, Dr Alfredo Hoyos, Asti Alexandria and Dalvi Humzah

Leading Columbian plastic surgeon Alfredo Hoyos was the headline speaker at The Society of Cosmetic Physicians and Surgeons meeting at the Holiday Inn Bloomsbury, London, last month. Dr Hoyos who is internationally renowned for pioneering the VASER High Definition and 4D Sculpt techniques flew in for a week of lectures. Other speakers on the programme included Dr Phil Dobson, Mr Brian Leatherbarrow, Dr Peter Crouch, Peter Bootes and Mr Dalvi Humzah. For our interview with Dr Hoyos see this month’s People in Profile (p22-23)

TRIA launch, London Leading at-home laser hair removal device, TRIA, was re-launched to the UK market at the end of 2011. The FDA-approved device utilises the same laser technology used by physicians Dr Penelope Tympanidis, Honey worldwide for achieving permanent, hair-free Langcaster-James Nathalidevice Eleni The TRIA Laser hairand removal results and has long been a leader in the at-home device market. With a newly designed handpiece and improved safety features, the device offers clinically proven results for hair reduction in the comfort of the patient’s own home. The TRIA System is suitable for those with light to medium skin tones and dark hair. Each unit comes with a skin chart so patients can check the suitability of their skin tone prior to using. It also has been designed with three contact sensors to safeguard against misuse. 14

FacialAestheticsMasterclass with Koenraad De Boulle, Oxford

World-renowned non-surgical expert, Dr Koenraad De Boulle, presented a facial aesthetics masterclass on behalf of Cosmetic Courses at St Anne’s College, Oxford at the end of 2011. The event was held to enhance and continue the ongoing support that Cosmetic Courses offer their delegates after completing their courses. The morning session involved an interesting interactive lecture covering facial aesthetics, discussions of product selection, managing potential complications and a question and answer session. With Dr De Boulle’s outstanding knowledge on a huge variety of nonsurgical aesthetic treatments, he was able to provide expert advice for all those who attended. The afternoon consisted of interactive assessments of selected patients and demonstrations of treatments from basic to advanced. These were projected onto a screen at the front so that everyone was able to observe Dr De Boulle’s techniques. This also gave the whole audience the opportunity to ask questions whilst the treatments were being performed. Dr De Boulle’s injecting technique was particularly fascinating; it was very quick, efficient and effectively pain free. Asked about how Dr De Boulle’s injecting technique felt, one model answered “I honestly couldn’t feel a thing!”. Another replied “amazing”. The day was a great success and thoroughly enjoyed by the delegates and models alike who had the chance to be treated by one of the greatest injectors in the industry.

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Review of the Year

Looking forward We find out what some of the industry’s key players are looking forward to in the year ahead and what were their highs and lows of 2011

Mr Adrian Richards, Cosmetic Courses

David Beesley, SkinBrands “It has been a fantastic year for SkinBrands! Looking back, as always, a few highs and lows, but thankfully mostly high notes! After 10 years in the aesthetic market, we really do feel good about the support we have received, the friends we have made and the business success we have had as our brands perform well. Two brands in particular are growing beyond our expectations. In 2011, we have tried, as we do every New Year, to up our game! In doing so, we have invested in our business significantly. We have opened two bespoke training suites one in London and one in Manchester, where we have trained over 700 clients. Images of the training suites can be viewed on our website. We have four primary websites that are regularly updated. The SkinBrands site in particular is now full of useful information, images, videos, downloads etc. Our brands resource (ftp) section holds over a thousand files all for immediate download, providing all the information that you need. The big hit of the year for us though (as 76% of our customers are using it), is our stockist web shop. Here, our customers can place orders 24/7. Their orders seamlessly shoot out the printer in the warehouse and are immediately packed. The Cosmetic News Expo was a great success too, helped by our new trade show booth where all our brands were highlighted together for the first time.

So, what about 2012? We are expanding and taking on more staff, but we all see the negatives in the media – should we be cautious? We think not. For us, it’s all about more training and education and selling great efficacious products that work and change people’s lives as they again, become happy in the skin they are in.”


“2011 has been the biggest year for Cosmetic Courses since it was founded 10 years ago. We have gone from strength to strength under the new management of Rachael Langford and her young, dynamic team with a record number of nurses, dentists and doctors being trained in medical aesthetics. Many of our delegates are going on to develop extremely successful nonsurgical practices. During 2011 we ran our first Dermaroller course and developed our unique, very successful one to one teaching programme. We recruited several popular new trainers and our regular Cosmetic Course Podcast (providing weekly updates on what is happening in the UK Cosmetics industry) has proved to be a hit on iTunes as our subscribers just keep increasing! Our first Masterclass, held in Oxford in November, was a definite highlight of the year for us. Dr Koenraad De Boulle – one of the world’s best lecturers in facial aesthetic treatments – hosted an update on what is new in the industry, including the latest cannula techniques. We were excited to have a specialist of Dr de Boulle’s expertise aligned with Cosmetic Courses.

Our aims in 2012? To continue to provide the best nonsurgical training to medical professionals in the UK. The training industry is more competitive than ever but Cosmetic Courses are leaders in digital marketing (SEO, PPC and social media plus using Youtube, podcasts and other exciting marketing sources). Reflecting this, our range of courses is extending to include business and marketing training, as requested by our delegates. 2011 has been a great year for Cosmetic Courses thanks to the quality of and input from our trainers, the hard work of Rachael’s team of Admin staff and, most importantly, our delegates and loyal model base.  We are looking forward to an equally successful and positive 2012.”

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 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

an aesthetic choice

Review of the Year

Ben Sharples, Advantech Surgical Ltd. “2011 started on a high for us as we took over distribution of the MicroAire Power Assisted Lipoplasty (PAL) and the MicroAire Endoscopic Carpal Tunnel Release (ECTR) systems as a part of Advantech Surgical becoming MicroAire’s sole UK distributor for aesthetics and orthopaedic specialties. These new products sit nicely beside our existing ranges such as the Endotine resorbable soft tissue fixation system for facial aesthetics and reconstruction and the NewGel+ line of silicone gel products for scar management. Despite the economic challenges faced by everyone at the moment, we have managed to grow significantly over the past 12 months and we are looking to continue this growth into 2012 with the addition of some great products to our range including the LipoFilter 3000, a great adipose tissue harvesting system that can be used in-line with the PAL system to allow easy tissue harvesting for re-injection in lipomodelling, and the Motiva Matrix range of next generation breast implants. The Moriva range are set to introduce the first real changes to breast implant technology in the past 20 years and so we are very excited about their prospects in 2012. Undoubtedly the lowest moment of 2011 was taking the call advising the sudden and tragic loss of Matt Clegg of Cloverleaf Medical who was a dear friend and colleague.”

Michaela Barker, Syneron/Candela “This year has been a challenge as we changed the whole structure of the company and tried to refocus on the service we give our customers, with our training, technical support and our clinical support, which we believe will put us in a position of strength going forward into 2012. We will continue to develop new products and investigate new treatments and we are very excited as we begin to launch into new areas of the market, with our new branding and our belief that Science = Results = Trust. In 2012 we will invest in even more PR and internet marketing. I believe that, with the right people and good support backing up some great products, we can grow our market segment. We have enjoyed a whole series of highs and lows this year, but the trend has been high. We have had success at the meetings and conferences we have sponsored and we will continue to support these in 2012. Syneron/Candela has developed Globally as a strong force in the aesthetic arena, after merging over two years ago. We have the largest spend on R&D than any other laser company and this results in our being able to produce some fantastic new treatments such as the CORE the eTwo and the ePrime devices.  In 2011 ePrime has been very successful here in the UK as we led the way in Europe, with doctors now travelling here to learn about the treatment. This is the first energy-based device to give, not only an answer to loss of Laxity, but also to give volume and increase elastin in the skin. Delivering RF energy directly down to the reticular dermis is a first and the ability to control this and replicate it has been a very positive advantage embraced by our doctors. The CORE CO2 brought the ability to treat lower and upper layers of the

skin at the same time with its fusion mode again giving maximum efficacy. Its speed and ease of use and its versatility mean this is already on most of many doctors shopping lists. Candela’s V Beam Perfecta has also now been embraced into the aesthetic field in the UK for treating facial redness and acne along with pigmentation. It was previously known as the Gold standard for port wine stains and is present in most laser units in the NHS. However its abilities go far beyond treating malformations as many of the Dermatologists and Vascular surgeons are finding  I cannot deny that the biggest segment of the market is still hair removal and again we have been fortunate that our Gentlelasers already enjoy a stronghold position with serious providers of the service. Our best selling laser worldwide was relaunched this year and the Gentlelase Pro was introduced, which is faster, easier to use and has a wider choice of pulse duration and cooling methods. Some of the UK’s biggest chains have now moved over to using the Candela Gentlelasers after trialing them against other systems and finding that patient satisfaction with the systems is greater.  Having now settled on the complex patent issues with Palomar the company no longer has  those threats and we have no royalties to pay on hair removal as part of the agreement reached. This has meant that globally we are able to strive forward with the hair removal market to further dominate the market.

So what else is new for 2012? Well you will have to wait and see, but if I were to give a sneak preview – we will continue to develop faster and more effective treatments, we will launch a new alternative hair removal system with a virtually painless super fast mode. Our existing treatments will continue to grow and develop. The new venture with the new elure range of topical products promises to take us into a new arena so exciting times.”

Cosmetic News Publisher Charlotte Body “The market is still in a growth phase, despite the recession with an estimated 1.4 million cosmetic injectable procedures carried out in 2011 and Mintel reporting a £617m growth in the market in the last three years. However, where other markets have already made changes I believe ours are to come in 2012. This year we have already been hit with marketing budget cuts as an industry and I think 2012 will see suppliers being even more cautious of over-spending. Cosmetic News has enjoyed a year of growth and with the launch of the Aesthetic Awards in December 2011, we witnessed the biggest response from an industry that I have personally ever seen when organising these types of events, with over 5,000 votes. The night was a great success and we were happy to bring joy to so many people in these tough economic times by recognising outstanding work and commitment to the aesthetics industry. The 2011 Cosmetic News Expo was our proudest achievement to date, having the largest number of visitors to an aesthetics meeting in the UK and the fantastic feedback from our visitors and exhibitors made the blood sweat and tears worth it! Our editor Vicky Eldridge editing the recent Cosmetic Procedures supplement in The Times newspaper was another high and it was refreshing to see some positive journalism in the consumer press. On a personal note, being nominated by my team for Business Woman of the Year and getting shortlisted for the title, made 2011 another memorable year. May I take this opportunity to wish all our readers and clients a prosperous 2012!”


t h e

U K ’ s

l a r G E S T




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


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

platinUM sponsor

gold sponsors

silver sponsor

d 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

e s t h e t i c s

M e e t i n g

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-todate techniques. A complimentary lunch will be incorporated into the delegate package, with refreshments provided throughout the 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

f E r E N C E T I C k E T N O W aT W W W. C O S M E T I C N E W S u k . C O M

People in Profile - Dr Alfredo Hoyos



We speak to leading Colombian surgeon and pioneer of Hi-Definition body sculpting, Alfredo Hoyos, about how he has combined his two passions – cosmetic surgery and art


hen Alfredo Hoyos was at school he dreamt about becoming an artist but, much like famous Italian Renaissance painter and sculptor, Michelangelo, his father did not want his son to make a living out of the arts and encouraged him instead to train as a doctor. What his father did not realise was that his son would go on to become one of the most talented ‘artists’ in his field by pioneering the art of aesthetic body sculpting, creating living works of art in his patients.

Dr Hoyos has always been ahead of his time. A child prodigy, he started medical school at the tender age of 15 and now, still only in his thirties, is one of the youngest and most exciting plastic surgeons in the world. But while his passion for cosmetic surgery is now very clear to see, his love affair with medicine was a slow burner. He remembers, “For the first three years of med school I didn’t like anything! All my class mates were saying ‘I like general surgery’ or ‘I like obstetrics’ and I was thinking ‘I don’t like anything – what am I going to do?’ It was really tough for a while. You only see plastic surgery when you are in your fourth or fifth year and the plastic surgery rotation was only two weeks in the whole of med school, but as soon as I did it I thought ‘this is my field’.” Dr Hoyos studied at El Rosario University in Bogotá, Colombia and specialised in plastic, aesthetic, maxillofacial and hand surgery. He then went on to develop his craft by studying as a visiting fellow in New York University(NYU)inaestheticsurgery,inMountSinaiHospital(NewYork) in maxillofacial surgery and Manhattan Eye and Ear Institute in facial aesthetic surgery. Today he is member of the Colombian Society of Plastic Surgery (SCCP) and the International Confederation of Plastic Reconstructive and Aesthetic Surgery (IPRAS), has authored numerous articles and scientific papers in several publications worldwide, and lectures around the globe. But it is his inventive and pioneering side that has earned him notoriety. With more than 10 patents to his name, Dr Hoyos has developed, not only innovative instruments to refine surgical techniques, but also the techniques themselves, quite an achievement in a field like plastic surgery where established techniques have held firm for decades. “I suppose I am an inventor in that sense”, he says, “My OR is more like a laboratory for new devices!” 22

• The art of body sculpting Dr Hoyos has truly made body contouring an art, developing first the Hi-Definition Liposculpture (HDL) technique more than 10 years ago and subsequently the technique he is now most known for: VASER Assisted Hi-Definition liposculpture (VAHDL). A talented painter and sculptor, Dr Hoyos uses a combination of cutting edge technology, advanced surgical techniques, artistic flair and his combined surgeon’s and artist’s understanding of human anatomy to develop and realise the true potential of surgical body sculpting and create what he describes as “the ultimate manifestation of surgery into art”. He says, “Being an artist definitely helps me in being a plastic surgeon but actually I think I have become more adept as an artist as well through my work (as a surgeon). It is about looking at the medical things from the outside with an artist’s eye – that was one of my life changers in this business. The first thing I teach my students is to learn to observe the human form differently. It has to become an obsession for art. As they become more fascinated by the beauty of the human body, the procedure becomes more of an art than a science. The key to doing VAHDL is an understanding of the anatomy as an artistic manifestation of surgery.” It is ironic that Dr Hoyos has created his art out of liposuction, traditionally one of the least ‘creative’ areas of cosmetic surgery. He says, “In the real sense liposuction is very uncreative and boring – it is just sucking fat out of people. I remember during my residency other doctors saying ‘I hate doing liposuction - it is messy and repetitive but it puts food on the table’. I thought to myself ‘why should it be this way? Why should it be something we hate to do?’ That is when I started designing this procedure (HDL).” Although Hi-Definition has now become synonymous with VASER, Dr Hoyos originally developed his sculpting techniques using traditional liposuction. He says, “When I started doing this specific method of Hi-Def it was with suction assisted only. But this is very hard to do in terms of every day work. I started to get tendonitis in both arms and I started panicking because I was getting sick and had to limit myself to only doing a certain amount of surgeries a week. As a surgeon this is taking away your living, so I realised I needed to look for a technology that makes

“Being an artist definitely helps me in being a plastic surgeon but actually I think I have become more adept as an artist as well through my work” doing it easier, otherwise I wouldn’t be able to work. I started to do some research and that’s when I came across VASER.” VAHDL is a refinement of the traditional lipoplasty in which the superficial muscular anatomy is molded into the patient’s silhouette leaving a highly athletic figure. Less amounts of fat are extracted, as this is an exacting technique, allowing for a safer procedure, and achieving results that are not possible with traditional lipoplasty. It is also about molding and enhancing other structures, such as the gluteal area in females or the pectorals in males. The VASER is used as a key part of the procedure; it is an enabling tool utilising ultrasonic technology in resonance to facilitate the fat extraction, reduce pain and speed up the recovery time, showing results in less time.

process can damage some of the fat cells so what we have done is refine the technique of how to select these fat cells to create the perfect fat to be transplanted.” It is not just in body contouring that Dr Hoyos is a pioneer. In breast surgery he pioneered the Secondary Implant Mastopexy by Capsulorraphy, and the Inverted Double – Pocket Breast Augmentation and, in facial surgery, the Closed Otoplasty by Needle CON (ear reduction surgery), olecranon graft full rhinoplasty (full dorsum and tip graft), and the Inverted Alar Resection for nose tip surgery. But body contouring is his true passion. “I started out as a general plastic surgeon so I started doing everything but it is like natural selection, once you become good at something you start getting more patients for that”, he says, “Later when you look backwards the only thing you are doing is that. I do perform other procedures but I like to focus on sculpting and body contouring.”

• Spreading the word

And with the emergence of VASER 4D Sculpt™, the technique has developed even further by using each individual’s unique anatomical landmarks to prevent muscular definition deformity and integrate dynamic definition. Dr Hoyos says, “When I developed Hi-Def I could apply everything in a single patient but the thing is it was not the solution for everybody. When you do definition, essentially you align the sculpture but when you do a sculpture, the sculpture does not move. People are the opposite – they have to move – and they have to look natural and nice whether they are moving or not moving. 4D

An international surgical trainer in all aspects of aesthetic surgery, Dr Hoyos enjoys travelling the world and sharing his pioneering techniques with fellow surgeons and doctors. From his clinic in Bogata he set up The Dynamx International Center for Artistic Body Sculpting (IC:ABS) running courses in basic, intermediate (full body applications) and advanced lipoplasty (Hi-Definition) applications for VASER assisted procedures. From here he has trained some of the best VASER practitioners in the world including Dr Ravi Jain of Riverbanks Clinic who, after reaching excellence in all three of Dr Hoyos’ VASER training courses, was selected to become the first doctor in the world to join the Dynamx International Faculty and operate a satellite training facility from his award-winning Bedfordshire Clinic. Dr Jain offers Basic and Advanced VASER courses, while the Hi-Def course is still offered exclusively by Dr Hoyos at the Bogotá clinic, as well as in his travels to Europe, Asia, and all around South America. Dr Hoyos says, “For me it is important that the people who learn this procedure have all the resources and the proper training. The training is performed by a team of expert surgeons and myself through the VASER Institute. It is a dynamic view of the marriage of new techniques and new technologies.”

Sculpt™ is dynamic definition – it is more designed. The difference with 4D is that every patient is a different entity – every different body type, every different stage in life, requires something different. This takes every variable into account and can also account for the effects of future weight loss and age on the body during surgery.”

It is this marriage of technology and techniques that has gained Dr Hoyos a client list that includes famous actors, models, celebrities, exNFL football players, top athletes and even royalty. Even so, he remains modest about his achievements,” I am simply helping to bring out the beauty within people.”

Dr Hoyos has also developed the EVE Lipectomy (Enhanced VASER and Extraction) technique and VASER Assisted Hi-Definition Miniabdominoplasty as well as refinements in fat transfer including GAL (Gluteal Autologous Lipograft) and PLM (Pectoral Lipograft in Men). He says, “You see skinny people who want to be more defined but they also need volume, so I designed procedures for instance for the pecs in men and breast fat grafting for women. Fat grafting has been around for a long time, but it is becoming fashionable again, which, for me, is perfect timing. The VASER itself helps us take out the fat but at the same time the emulsification

It is in saying things like this that make the comparison between Michelangelo and Dr Hoyos not so far fetched. Michelangelo was famed for being able to visualise the finished sculpture merely by looking at a block of stone in front of him and, as a talented artist and sculptor himself, Dr Hoyos has transferred this same skill into surgery by being able to visualise the ‘perfect’ body lying beneath the canvas of each individual patient. Michaelangelo once said. ‘A man paints with his brains and not with his hands’ and it is with this same sentiment that Alfredo Hoyos has made a name for himself as a sculptor of the living human form.

These techniques enable practitioners to surgically sculpt the body to physical perfection to create rippling abs and six packs in men and slim, hourglass figures with taut abs in women. This allows people to realistically achieve physical standards once thought unattainable and has widened the scope of body sculpting procedures to younger, slimmer patients and most notably, men.


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

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Clinical Study - Dermal Fillers

Plump up the volume Aref Alsoufi discusses a retrospective analysis of 108 cases of patients receiving a hyaluronic acid filler for long-lasting volume restoration on the face Aesthetic demands for volume restoration of the face and body have increased for a number of reasons. Surface deformities can be congenital (e.g. cleft lip) or caused by endogenous defects (e.g. pectus excavatum), or owing to ageing or results of facial reconstructive surgery. There is a loss of connective and subcutaneous tissue during the normal ageing process. With ageing changes to the face appear; the skin loses some of its elasticity and becomes thinner, dry and more wrinkled. Over the last few years, the focus in the field of aesthetic medicine has gradually shifted to minimally‑invasive procedures, often because more and more patients are refusing to take prolonged absences from work. For the correction of surface deformities, botulinum toxin A, chemical peels, laser therapies, fat implantation and soft tissue fillers can be used. Minimally‑invasive volume restoration of the face through long-lasting resorbable fillers is now more attractive and important for the patient. In the course of the ageing process, the treatments that are necessary for each specific individual can be applied without creating an irrevocable outcome for the patient, which may happen when invasive surgical procedures are used. It is necessary for the treating physician to master all new minimally invasive techniques in order to provide patients with optimal advice tailored to their specific needs. The ideal filler materials should be well tolerated by the body and comprise ingredients that are not toxic or antigenic. The injection of the filler should be simple and safe; patients should experience minimal side‑effects and minimal downtime. In response to patients’ demands for safe and effective filler materials for the correction of wrinkles and volume restoration, a range of products have been developed. Aref Alsoufi, MD, Plastic Surgeon, Frankfurt, Germany

Soft tissue fillers are typically classified according to their longevity of effect: temporary, long‑lasting, semi-permanent and permanent. A variety of soft tissue fillers for facial volume augmentation are available worldwide. Fillers such as collagen and hyaluronic acid (HA) are biodegradable and are therefore temporary. The use of permanent fillers such as polyacrylates has become increasingly controversial, owing to the appearance of granulomas as a side-effect of treatment. The use of HA is now the gold standard. However, in applications and clinical evaluations, the author found that the approximate effective duration with first and second generation HAs was only three to four months, even considering with the range ‘new’ HAs that have been developed in the past few years.

Hyaluronic acid HA is a high molecular weight glycosaminogly, composed of disaccharide repeats of N-acetylglucosamine and glucuronic acid. Owing to its viscoelastic properties, it is a component of soft connective tissues, including skin, synovial fluid and vitreous humour. HA is extremely hygroscopic, meaning that it binds water in skin, influencing skin volume and compressibility. Previously, HA was commonly extracted from rooster comb or human umbilical cord, but is now manufactured in large quantities by a process of bacterial fermentation.

Cross-linked hyaluronic acid The half-life of HA in tissue ranges from 0.5 days to a few days. HA must be modified to prolong its half-life time in

vivo. HA can be modified through cross-linking reagent of polymer chains to hydrogel compounds. HA gel is able to hold large volumes of water. The cross‑linking of HA results in prolongation of residence time in tissue by up to 18 months; the cross-linking procedure does not reduce its biocompatibility. Cross-linked HA (Varioderm) comprises HA produced by biofermatentation. The use of Varioderm ensures the absence of immunologically active proteins and biologically active animal components (e.g. viruses). A skin test is not required prior to injection. The highly concentrated and cross-linked HA (Varioderm Subdermal), which has a


Clinical Study - Dermal Fillers

significantly higher viscosity compared with the initial HA solution,

perform the injection at the supra-periosteal plane. The injection

is subsequently made into particles and stabilised to facilitate

pressure was acceptable and acute reactions such as swelling,

the filling of the syringes without the need of any dilution. This is

reddening and pain were either minimal, or did not occur. A

described as a Monophasic Particle Technology (MPT).

pronounced volume effect and good adaptation to the tissue were observed, so that even very pronounced folds could be augmented.

When injected properly, this HA has proven to be effective for a

No complications were noticed either in the short-term or during

significantly longer period of time (12–18 months after a single

check-ups after three, six, nine and 12 months, with treatment

injection). The only disadvantage was a slightly increased tendency

effects lasting between 12 and 18 months. (Figures 2 and 3).

for swelling during the initial phase. There were no subsequent complications. In the author’s view, this substance represents an interesting development in the field of fillers.



Injection technique Varioderm Subdermal was injected in 80% of the patients using 18 and 20 gauge cannulae, and a 26 gauge needle in 20% of patients. The injection technique began with horizontal injections from the edge of the malar bone forward towards the nose and strictly inferior to the orbital rim. It is important to avoid any large boluses; to make the injection easier, the skin must be stretched in the opposite direction to the point of injection (Figure 1).

Figure 2: Injection with Varioderm® Subdermal 6ml in the cheekbones/nasolabial folds. (A) before treatment and (B) 12 months after treatment A


Figure 1: Injection technique Injected Sites Region

Number of patients (%)

Cheeks and malar enhancement

43 (39.8%)

Nasal bridge and tip

22 (20.4%)

Malar and nasolabial fold

41 (37.9%)

Tear trough and chin

2 (1.90%)

Figure 3: Injection with Varioderm® Subdermal 2ml in the nasolabial folds and marionette lines and 2 ml malar areas. (A) before treatment and (B) 14 months after treatment

Clinical trials


The latest development of HA-based Varioderm products is a

The objective of the study was to assess effectiveness and longevity of

highly cross-linked HA (cross-linking grade more than 80%), which

Varioderm Subdermal. For cross-linked HA, the polymer chains must be

has no suspension at all and still has the best injectability profile.

linked to each other with a cross-linking agent to form a network. It is

Varioderm Subdermal, a newly developed HA‑based soft tissue filler

this linking that makes the HA resistant to mechanical and enzymatic

from Adoderm, was studied between 2007 and 2010. A total of 108

degradation, and thereby able to remain in the body for months after

patients were treated for a range of indications.

injection (up to 18 months).

The product comprises 27mg/ml of cross-linked Varioderm Subdermal, which has the highest concentration of dermal filler

In the author’s view, the duration of effective treatment has been

currently available worldwide.

disappointing with previous HA fillers for subcutaneous indications, and the material was somewhat difficult to inject and tended to slip.

Injected sites

Newer products, especially Varioderm Subdermal, showed significant

Varioderm Subdermal was injected in subcutaneous soft tissue

advantages in this domain. The use of Varioderm Subdermal is safe;

using a 26 gauge needle and blunt cannula (18 or 20 gauge). Careful

however, some immediate side-effects such as swelling, redness or pain

injection using the fanning and tunnelling technique is necessary to

can appear, but these usually only last for two to seven days. Significant

prevent any irregularities or palpable mass.

side-effects such as necrosis, allergic reactions and infections have not

Subcutaneous injections of Varioderm Subdermal were mostly used

been observed in the author’s patients.

for the treatment of deep nasolabial and marionette folds, cheeks, cheek bones and chin augmentation (Table 1). It is also possible to



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You are what you eat We look at the link between the PronoKal Method ® and skincare

One of the most visible symptoms of ageing is skin atrophy. Over the years, the skin changes its appearance, its secretions, pigmentation and hydration. This follows the collapse of the amount and activity of fibroblasts and decreased collagen, elastin, proteoglycans, decreased vascularisation, decreased sweat and sebaceous secretions as well as skin dryness and lethargy.

The PronoKal Method ® The PronoKal Method ® is a personalised weight loss and slimming treatment based on a strict programme that controls the intake of proteins, vitamins and minerals by the patient, while reducing the ingestion of lipids and carbohydrates. It is conducted under medical supervision and complemented by a multidisciplinary team of professionals (registered dietitians, psychological adviser and personal trainer). The method is divided into three stages: active, re-education and maintenance. These three stages are designed to enable the patient to reach the desired weight and maintain it long term thanks to having acquired new knowledge, healthier eating habits and the introduction of physical exercise into the daily routine. In the first (or Active) stage, after a thorough health check and medical history, the doctor (who has been trained specially to prescribe the method) decides if the patient can engage in the

The skin becomes thinner, with a loss of elasticity, worsening of

treatment. With the patient´s commitment, both agree in targeting

wrinkles, tissue atrophy, telangiectasia and pigmentation anarchy.

80% of the weight reduction during this stage. To achieve it, the

In short, it loses its firmness and becomes more lax, thin and with a

patient follows a diet composed of some vegetables and hydrolyzed

less healthy appearance. Skin ageing is a major concern of patients

protein products, combined with the correct supplementation of

attending medical aesthetic clinics.

vitamins and minerals. Each of these protein products contains 15

At the origin of this process, other than the obvious genetic factors,

grams of high biological value proteins. Over time the hydrolyzed

are sun exposure, smoking, alcohol consumption, lack of cosmetic

protein products get gradually replaced with regular protein rich

care and inadequate nutrition. Correct nutrition is vital for the

foods. The intake of carbohydrates and fats are restricted in order to

maintenance of skin regeneration and this is where the PronoKal

induce a state of ketosis in the patient. This process, which is closely

Method ® slots in and presents itself as a useful tool for practitioners

monitored by the prescribing physician, means that most of the

of aesthetic medicine in anti-ageing treatments.

required energy is sourced from the stored body fat. The result is a reduction in body fat.

Collagen and elastin, the proteins of youth

On completion of the Active stage (Stage 1), the patient then enters the Re-education stage (Stage 2). This second stage is characterised


Collagen and elastin are some of the proteins present in our body,

by the progressive introduction of different food groups in the

which are responsible for providing strength and elasticity to our

diet, allowing for the further 20% of the target weight loss to be

skin. Over the years, the body gradually loses its ability to synthesize

achieved. The rate of weight reduction during this second stage

them. An unbalanced diet causes the body to turn to the proteins

is slower than in the first stage, which is essential to enable for

present in it, including collagen and elastin, to obtain the necessary

physiological adjustments and re-stabilisation. Throughout this

nutrients. This results in the loss of these proteins, accelerating skin

stage, the dietitians will advise the patient and help in the adoption

atrophy and consequently, the visible symptoms of ageing. In this

of a healthier lifestyle.

situation, the PronoKal Method ®, which is based on a protein diet,

Once the target weight is reached, the prescribing doctor moves

helps improve skin regeneration.

the patient to the Maintenance stage (Stage 3). This third and final

“With the PronoKal Method ® the patient quickly perceives changes in body composition, with a loss of fat, a percentage increase in muscle mass, and figure remodeling as a result of ketosis, correct nutrition, and increased activity level. Patients will also see an improvement in smoothness of skin as well as hydration and elasticity”

the reduction of comorbidities associated with obesity, such as diabetes. In the emotional sphere, the patient feels better, healthier, better looking and gains self-confidence. All the above means that, in addition to the usual anti-ageing treatments, the PronoKal Method ® is a valid tool for medical aestheticians to deal with the problems of ageing, skin flaccidity and weight loss. In short, this is a method based on scientific knowledge; it is rigorous, safe and effective for the patient, in which different disciplines work closely together. More than 2000 doctors are currently prescribing the PronoKal Method ® with one goal: improvement in the patient´s wellbeing.

In summary

stage lasts two years, during which the patient will follow a

Over time the skin loses its firmness and elasticity, as a result

completely normal and balanced diet under the dietitians´

of the collapse of the amount and activity of fibroblasts,

supervision (free of charge), with the aim on maintaining the

decreased collagen, elastin, proteoglycans, decreased

achieved healthy weight.

vascularization, decreased sweat and sebaceous secretions,

The work of doctors and dietitians is complemented with

skin dryness and lethargy. The factors influencing that process,

the participation of the personal trainer and psychological

other than genetic, are exposure to the sun, smoking, alcohol

coach. The role of the personal trainer is to advise the patient

consumption, lack of cosmetic care and inadequate nutrition.

on appropriate exercises for each stage of treatment (many

During weight loss the body often turns to skin proteins for

of which can be done at home). The aim is to speed-up the

nutrients. The PronoKal Method ® is a personalised weight

metabolic rate, accelerating the weight loss and improving

loss treatment based on strict control of high biological value

muscle tone. The psychological coach helps the patient to

protein products ingested by the patient, which actually helps

find the intellectual and emotional tools that reinforce the

improve skin regeneration. This method is carried out by a

commitment to following the path towards acquiring a healthy

multidisciplinary team of professionals at the center of which is

weight and improved quality of life.

the doctor. It is divided into three stages: active, re-education and maintenance.

Multiple benefits for patients With the PronoKal Method ® the patient quickly perceives changes in body composition, with a loss of fat, a percentage increase in muscle mass, and figure remodeling as a result of ketosis, correct nutrition, and increased activity level. Patients will also see an improvement in smoothness of skin as well as hydration and elasticity. Thanks to the proper intake of high biological value proteins, the body no longer resorts to the collagen and elastin to obtain the necessary nutrients.

“The work of doctors and dietitians is complemented with the participation of the personal trainer and psychological coach”

The improvement in the physical condition is clear, including

Seminar Dates and Training for YOUR Diary in 2012 Every Monday – Skincare and Peel Training, London and Oxford.

The science behind beautiful skin

Monday 16th February – Breakfast Nurses Monthly Networking Meeting, London.

Distributors for

Friday 24th February – 2012 Image Skincare Global Launch Party, London. Monday 28th May – SKIN Conference, London. Friday 15th June – Round Table Discussion, Stem Cells and Growth Factors, London.

For more enquiries please contact Skin Geeks Ltd: Tel: +44 (0)1865 338046 Email:


Treatment Spotlight - Clear + Brilliant

A clear winner

We find out about the latest treatment from Solta Medical, Clear + Brilliant

In November Solta Medical launched its new laser treatment Clear + Brilliant, a less invasive alternative to fractional lasers designed to attract younger patients looking to take control of their ageing process. In-depth research with patients and their skincare providers revealed an unmet need in the skincare regime that lies between over the counter or spa treatments and more aggressive laser offerings such as Fraxel. Clear + Brilliant is a new laser based system that not only targets, but also prevents early signs of ageing with little to no downtime. The laser energy creates millions of microscopic treatment zones in the skin, replacing damaged skin with healthy, younger looking tissue resulting in a smoother, radiant and clearer complexion. Upon consultation and skin assessment, it is generally recommended that a maximum of six treatments at two-week intervals is carried out for optimal results. The treatment is CE marked and FDA approved and suitable for all skin types and recommended for both men and women. Because it works on the more superficial layers of the skin, the treatment is indicated for preventing the early signs of ageing and improving the look and feel of the skin. This makes it ideal for patients who do not need or want more aggressive treatments. It also works well as a maintenance treatment in between or following more aggressive procedures, including surgery, prolonging an overall rejuvenated look at an affordable price. Patients can expect to see fresher, smoother looking skin with improved texture and tone and a natural radiance and glow.

25-45 year old age category, and are excited to be the first clinic to launch this in the UK. It is a simple 20-minute procedure, which is ideally performed every two weeks for approximately four to six treatments. The effect gradually becomes more and more impressive with the skin looking increasingly more radiant and refreshed as time goes on. I consider it to particularly satisfy an ever-increasing demand for preventative anti ageing treatment amongst the younger age category.

Being pioneered in the UK by Dr Tracy Mountford at the Cosmetic Skin Clinic, Clear + Brilliant features a patented delivery system that refreshes the skin from the inside out. The treatment effectively targets early signs of skin ageing with results that naturally improve tone, texture and radiance, helping the skin to look younger for a longer period of time. Dr Mountford explains, “We have been lucky to be involved in trialling Clear + Brilliant since March 2011, predominantly on the

“My patients have had so many positive compliments since having their Clear + Brilliant treatments. From the second treatment they were all noticing a real difference in their skin: a more even skin tone, with added vibrancy. They have commented on how their foundation goes on much easier and they need much less coverage than before. This is a welcome new innovation for those in the 25 plus category that take their age prevention seriously”. 

Before Clear and Brilliant


“In-depth research with patients and their skincare providers revealed an unmet need in the skincare regime that lies between over the counter or spa treatments and more aggressive laser offerings such as Fraxel”

1 Month Post 6 Treatments

Before Clear and Brilliant

Photographs courtesy of Solta Medical Aesthetic Center

1 Week Post 6 Treatments

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Product Focus

H itting the mark We find out about the elure™ Advanced Skin Lightening System

It has become common knowledge that a complexion marked with hyperpigmentation can be every bit as ageing as lines and wrinkles. It is the brightness, uniformity of tone and overall glow that can affect how old we look. Young skin reflects light more evenly, meaning an uneven, patchy complexion, combined with the naturally occurring dulling of the skin as we age, results in skin that will not reflect light as well and will lack radiance. Hyperpigmentation and age spots are caused when the melanocytes in our skin are over stimulated most commonly by the sun or hormones, causing melanin to accumulate on the skin creating sun spots, freckles, liver spots and brown marks. Brown patches can also be caused by a trauma to the skin like a burn, or even from picking a spot. Known for its cutting edge laser treatments, Syneron/Candela has now branched into the topical skincare market with a product range that targets pigmentation to brighten and refresh the skin – elure™. Launched in the UK in November 2011, elure™ is indicated for the treatment of uneven pigmentation, general skin lightening, PIH and melasma.

elure’s range of three products for home use addresses concerns gently, safely, yet effectively in seven to 10 days.  Acting only on the skin’s surface elure™ does not interrupt the natural mechanism of melanin production unlike other skin lighteners.  The active, Melanozyme™, breaks down melanin on the skin’s surface, allowing the natural melanin production deeper down to continue. The new elure™ Advanced Skin Whitening product range is the first scientifically proven enzymatic skin lightening treatment to harness the unique scientific discovery


of a naturally occurring bio-active substance called Melanozyme™. Melanozyme™ acts to immediately target and disintegrate the melanin to diminish dark coloured pigment in the skin safely. Victoria Battersby, manager at the Urban Retreat Medi-Spa at Harrods comments,, “I am delighted to share my excitement for the arrival of elure™ into the Urban Retreat Medi-Spa at Harrods. It is wonderful to finally embrace an advanced skin lightening product that, unlike many others on the market, does not contain hydroquinone yet delivers fantastic results on both pigmentation and the general improvement of skin tone. Our doctors and clients are delighted that we can now offer a frequently requested resolution to pigmentation with no downtime.” Wendy Lewis, Knife Coach and author of 11 books comments, “elure™ has taken the American market by storm and dermatologists and plastic surgeons have taken notice. This is a brilliant new skin lightening technology that we have not seen before. Other products turn off the pigment generating mechanism and over time, there is a lightening effect. But with elure™, there can be significant improvement in tone and pigment, without redness or irritation. Skin looks brighter and clearer, and it is safe for all skin types which is a big benefit.” Unlike many other whitening products on the market, the elure™ product range does not contain Hydroquinone, which has been reported to cause potentially serious side effects such as severe skin irritation.  In addition, while other skin whitening products only halt the production of melanin, elure™ acts in a unique way by targeting and disintegrating the melanin resulting in a much faster lightening effect.

The active ingredients in elure™ do not require a prescription, but as a cosmeceutical range, elure™ is only available from approved medi-spas, aesthetic clinics, dermatologists and cosmetic surgery clinics. The elure™ Product Range elure™ includes a complete range of products formulated to quickly and safely lighten the skin. Suitable for even the most sensitive skin: elure™ Advanced Skin Lightening Lotion (day), £105 A rebalancing skin moisturiser with Melanonzyme™ to brighten, soften, soothe and replenish skin appearance. Appropriate for day and night use. elure™ Advanced Skin Lightening Night Cream, £110 Moisture rich, recovery hydration complex, with Melanozyme™ for a brighter and softer skin tone. Works through the night. elure™ Advanced Facial Wash, £39 elure’s Advanced Skin Lightening products work best when used in combination with elure’s Advanced Facial Wash as it ensures that the skin is at the correct pH level. It lathers into a rich and creamy foam that removes dirt and dead skin debris, transforming dull looking skin into soft, smooth and radiant skin. elure™ Advanced Skin Lightening Set, £250   Includes one of each of the above. Clinical Trials The elure™ product range has been clinically researched and found to provide much faster improvement when compared to other products on the market. It is also concluded that elure™ is safe even at concentrations far higher than the dose you would typically use. Clinical studies showed the following when used twice a day for 28 days: ·         82% of the subjects demonstrated a significant decrease in their Melanin* ·         91% of the subjects showed an overall improvement in fairness and skin tone* * Skin whitening clinical study conducted in Asia by Dermscan, France.

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Product News

LMX4 avaialble in 30g tube AesthetiCare® is now offering its LMX4 topical anaesthetic cream in a new and bigger 30g tube. Previously only available in 5g tubes, the new size now brings greater convenience and flexibility at the same great price that practitioners have come to expect for the LMX4 Cream 5x5g pack, meaning that users of the new 30g tube will gain 20% extra cream for free. The advanced liposomal LMX4 Cream helps facilitate the penetration of the lidocaine into the epidermis and dermis of the skin improving the onset of skin numbness, which is approved to be clinically significant after 30 minutes application. The formulation also means that it is well tolerated on the skin. Clinical studies have shown LMX4 Cream to cause minimal levels of erythema and significantly less blanching than other topical anaesthetics.

Carleton Medical launches new laser from Asclepion Carleton Medical has launched a new hair removal laser from Asclepion into the UK market – the MeDiorStar NeXT. The 810 diode laser can be used to treat all skin types and has a 14x10 spot-size. The high power laser also operates at12hz, making the treatment incredibly fast. The portable system comes on a mobile rack and includes a choice of different handpieces that are specialised on different applications. The MeDioStar NeXT handpieces are fitted with a system that cools the area to be treated immediately before emitting the pulse, guaranteeing greater comfort and safety for the patient during treatment. A monitoring system inside the laser device regulates the cooling level, always keeping the skin temperature low and ensuring painless and extremely delicate treatment of all skin types. It also has a homogeneous spot for a safe and precise treatment and a built in 8.4” full color TFT Touch Screen Display that features an improved software with parameters suggestions, a picture and video library and treatment information. 

Cell Fusion C now available through Med-fx Cell Fusion C products will now be available exclusively through Med-fx. Med-fx has teamed up with Mayfair Medical to widen the availability of the products in the UK market. Cell Fusion C is one of the leading cosmeceutcial ranges in Asia. Cell Fusion C products incorporate nanotechnology to help restore skin barrier function of skin disorders. The products are designed to enhance the results of medical procedures and restore skin elasticity and collagen production. They use patented technologies and clinically proven active ingredients at the highest level available without prescription. Cell Fusion C offers hypoallergenic and non-comedogenic products that enhance skin barrier functions and provide effective antioxidant protection against photoageing and free radical damage.

SilDerm launches Lumixyl™ Revitaleyes Brightening Eye Cream SilDerm has introduced a new product to the Lumixyl™ range Revitaleyes Brightening Eye Cream. Revitaleyes is the first eye product to be formulated with Decapeptide-12, an alternative to hydroquinone, developed by Stanford researchers. It is designed to reduce the appearance of swelling and shadowing around the eyes and decrease the look of dark under-eye circles caused by excessive melanin and iron deposits. It also hydrates with hyaluronic acid, promoting smoother texture and reducing the appearance of finelines and wrinkles.


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We summarise some of the most recent studies you may have missed Title: Can Platelet-Rich Plasma Be Used for Skin Rejuvenation? Evaluation of Effects of Platelet-rich Plasma on Human Dermal Fibroblast Authors: Kim DH, Je YJ, Kim CD, Lee YH, Seo YJ, Lee JH, Lee Y Published: Ann Dermatol. 2011 Nov;23(4):424-31. Epub 2011 Nov 3 BACKGROUND: Autologous platelet-rich plasma has attracted attention in various medical fields recently, including orthopaedic, plastic, and dental surgeries and dermatology for its wound healing ability. Further, it has been used clinically in mesotherapy for skin rejuvenation. OBJECTIVE: In this study, the effects of activated platelet-rich plasma (aPRP) and activated platelet-poor plasma (aPPP) have been investigated on the remodelling of the extracellular matrix, a process that requires activation of dermal fibroblasts, which is essential for rejuvenation of aged skin. METHODS: Platelet-rich plasma (PRP) and platelet-poor plasma (PPP) were prepared using a double-spin method and then activated with thrombin and calcium chloride. The proliferative effects of aPRP and aPPP were measured by [(3)H]thymidine incorporation assay, and their effects on matrix protein synthesis were assessed by quantifying levels of procollagen type I carboxy-terminal peptide (PIP) by enzyme-linked immunosorbent assay (ELISA). The production of collagen and matrix metalloproteinases (MMP) was studied by Western blotting and reverse transcriptase-polymerase chain reaction. RESULTS: Platelet numbers in PRP increased to 9.4-fold over baseline values. aPRP and aPPP both stimulated cell proliferation, with peak proliferation occurring in cells grown in 5% aPRP. Levels of PIP were highest in cells grown in the presence of 5% aPRP. Additionally, aPRP and aPPP increased the expression of type I collagen, MMP-1 protein, and mRNA in human dermal fibroblasts. CONCLUSION: aPRP and aPPP promote tissue remodelling in aged skin and may be used as adjuvant treatment to lasers for skin rejuvenation in cosmetic dermatology. Title: The Unwritten Price of Cosmetic Tourism: An Observational Study and Cost Analysis Authors: Miyagi K, Auberson D, Patel AJ, Malata CM Published: Journal of Plastic, Reconstructive


and Aesthetic Surgery, Volume 65, Issue 1, Pages 22-28, January 2012 Introduction and aims: Cosmetic tourism, driven by the promise of inexpensive operations abroad, is increasingly popular despite warnings from professional bodies regarding associated risks. Increasing numbers of individuals have presented to our department requesting NHS treatment of complications from such surgery. We set out to characterise these patients and evaluate costs incurred through their assessment and management. Material and methods: An observational study was conducted from 2007 to 2009 on patients presenting to a tertiary referral Plastic Surgery practice with complications of cosmetic tourism surgery. Demographic characteristics, as well as those related to the operation, were recorded. Hospital patient flow pathways were constructed, cost analysis performed using Patient Level Costing, and expenditure and profitability calculated. Key results: 19 patients presented within the study period. Most operations were performed in Europe or Asia, and were primarily breast augmentation procedures (n=13). The principal complications were wound infection or dehiscence, and poor cosmetic results. Eleven patients received NHS treatment, at a cost of £120,841. The mean cost for all patients’ management was £6360 (range: £114–£57,968), rising to £10,878 for those accepted for treatment. For 8 of the 9 patients (89%) for whom full patient level costing was available, the hospital incurred a financial loss. Conclusion: The costs to the NHS of manageing complications of cosmetic tourism are substantial, and underestimated by central funding agencies. Title: Minimal-Scar Handlift: A New Surgical Approach Authors: Markus Handle, Luiz M. BonfattiRibeiro,Bárbara H. Barcaro-Machado, Ivo Pitanguy Published: Aesthetic Surgery Journal November 2011 vol. 31 no. 8 953-9 Background: Removal of excess skin from the ageing hand can cause scarring in one of the body’s most visible areas. A minimalscar approach to tightening this skin, in conjunction with the rejuvenating effects of minimally-invasive procedures, is therefore needed. Objectives: The authors describe a new technique for limiting scar size and visibility by

locating the incision in a unique position on the ulnar side of the dorsum of the hand. Methods: 11 patients were treated with the authors’ method. Both hands were treated for each patient, but these procedures occurred separately, at an interval of two to four months. The surgical approach included skin flap advancement and rotation, and the procedure took place under local anaesthesia and sedation. The resultant scar was S-shaped. Changes in post-operative stress ratio were visualised. Results: Patients reported being highly satisfied with this procedure with regard to scar size, quality, and location. No major complications were observed. All minor complications were treated conservatively. Patients with Fitzpatrick skin types I-III profited from less scar visibility in their outcomes. All patients experienced quick recovery with minimal downtime, independent of skin type. Conclusions: The minimalscar handlift technique is an effective surgical approach to rejuvenating the hand and can be implemented concurrently with minimallyinvasive techniques for volume restoration. The complication rate is low, and patient/surgeon satisfaction with outcomes is high. Title: Cosmetic Surgery in Inpatients with Eating Disorders: Attitudes and Experience Authors: Coughlin JW, Schreyer CC, Sarwer DB, Heinberg LJ, Redgrave GW, Guarda AS Published: Body Image. 2011 Nov 25 Abstract: Body image disturbance is frequent among individuals undergoing cosmetic surgery and core to the pathology of eating disorders (ED); however, there is little research examining cosmetic surgery in ED. This study examined body image related measures, ED behaviors, and depression as predictors of attitudes toward cosmetic surgery in 129 women with ED. Patients who had undergone surgery (n=16, 12%) were compared to those who had not. Having a purging diagnosis, linking success to appearance, and making physical appearance comparisons were predictive of more favorable cosmetic surgery attitudes. All of those who had undergone surgery had purging diagnoses and, on average, were older, had higher BMIs, and were more likely to make physical appearance comparisons and know someone who had undergone surgery. In ED, acceptance and pursuit of cosmetic surgery appears to be related to social group influences more than weight and shape disturbance, media influences, or mood.

Business Focus ™ ™

WINTER OF DISCONTENT? Award winning lawyer Norman Rea, a consultant with Sydney Mitchell LLP, continues his series of articles on hot employment topics by shining a torch into the commonly misunderstood world of balloting and industrial action and provides some useful tips on how to lessen the likely impact on your business caused by industrial action

Well, the Public Sector dispute came and went and, by all accounts, its effect was not as bad as some had feared. But what will happen as we continue into the New Year? Will we and our businesses suffer inconvenience and disruption due to ‘copycat’ strikes by rail or postal workers? Will the trades unions draw together and arrange a concerted national strike? The ‘Winter of Discontent’ was a title used by journalists over 30 years ago as the description applied to a period of widespread strikes at that time. Many years later what is surprising is the fact that, in these days of over regulation, there is still no statutory definition of ‘industrial action’ in this country. Importantly – there is no so called ‘right to strike’!

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Strike Action

This is a work stoppage caused by the mass refusal of employees to perform work, usually to promote employee grievances and, sometimes, to put pressure on governments to change policies. It is one of the most powerful weapons available to workers and unions taken after proper ballot.

A strike has been defined as:


Cessation of work by a body of employed persons acting in combination or a concerted refusal, or a refusal under a common understanding of any number of employed persons to continue to work for an employer in consequence of a dispute.

Industrial Action

This may take many forms, including a work to rule, go slow, or an overtime ban. The ultimate of course is a complete cessation of work – strike. The question of what is and is not ‘industrial action’ in any particular set of circumstances is a question of fact for an Employment Tribunal.

Breach of Contract

A cessation or refusal of work is a breach of the Contract of Employment for which the worker can be dismissed. Workers are only protected from dismissal if they took industrial action after a properly held ballot was conducted by their union. Any dismissals for such ‘official action’ is considered automatically unfair. There are technically complicated legal rules for determining the proper conduct of the ballot and the calling of ‘official industrial action’. Recent cases however have relaxed the fine technicality of balloting provisions to an extent.


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Business Focus

Union Position Organising a strike or other industrial action will usually involve the commission of one or more of the so called ‘industrial torts’: • Inducing a person to break a contract. • Interfering with trade or business or a contract by unlawful means (or inducement of such interference). • Intimidation – this involves threatening to induce a breach of contract or to interfere with a contract.

Statutory Immunities Where there is a breach, there is usually a remedy. However in circumstances where the action is organised by a union ‘in furtherance of a trade dispute’ and the union has complied with the balloting provisions including giving due notice to the employer, then (and only then) are they and their striking members given special protection from legal liability. It is important to emphasise that anyone organising a strike or industrial action, which is not officially union backed, will be liable to dismissal and legal proceedings by the employer or others such as their customers and suppliers who suffer loss by such action.

Compensation When the statutory immunities do not apply then the employer, and others who have suffered loss by the action, may take civil proceedings. It will be necessary to prove that the unlawful, unprotected act has been done or threatened and that the person seeking redress is party to a contract, which will be (or has been) broken or interfered with by the unlawful act.

Injunctions Where there is no immunity, the most important remedy for an employer in the context of industrial action is an application for

an injunction to be granted by the court. An interim injunction will restrain the unlawful acts or continuing industrial action pending a full trial of the action. In practice, interim injunctions are effective in trade dispute cases since they often determine the outcome of the case at an early stage.

What precautionary steps can you take to lessen business disruption? As a business owner you may be faced with some ‘ knock on ‘ effects of industrial action and it is important to have a contingency plan in place to ensure as much business continuity as possible. Unions have to give due notice of when a strike is to take place so you will have time to perhaps arrange for key workers to work from home if that is feasible for your business. What happens if staff are willing to work but can’t get there - say, due to a transport or school strike and they have travelling or childcare problems? Well much depends on their contract – you may be able to get them to agree that they take it as a paid holiday day out of their annual entitlement or perhaps agree to still pay them at your discretion.

Action for Damages If you suffer economic loss due, say ,to the non-delivery of a vital piece of equipment caused by industrial action then, if the strike was ‘unlawful’ i.e. not properly organised by a Union, you may have an action for damages against the workers or individual concerned who organised the unofficial action. This could include applying for an injunction to stop the action from occurring or continuing.

NORMAN REA Norman Rea is an award winning employment lawyer and experienced tribunal advocate and has written many articles for the legal and national press. Norman advised West Midlands Fire Service in the national dispute and also advised TGWU Strike Committee in the Rover Lode Lane dispute over 20 years ago. He successfully represented a Black Country Company in one of the longest running trade disputes, which had been organised by the GMB. He is a Consultant within the Employment Team and is based at Sydney Mitchell’s Shirley Office. He is also a member of the Employment Lawyers Association and a long serving committee member of Birmingham Law Society’s Education and Training committee. 42

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Dates for the Diary



7 Botulinum Toxins and Fillers: Essentials, Dublin, 9 Micro Cannula, West Yorkshire, 13 Juvederm Voluma, West Yorkshire, 13 Obagi Workshop, Manchester, 13 Master Course in Suture (Thread) Lifting Techniques, Dublin, 16 Module 11. Master Course in Ultrasound-Assisted (VASER) Lipoplasty, Villa Alba Hospital, Bologna, Italy, 16 Obagi Workshop, London, 16 Sally Durant Training and Consultancy, Advanced Skin Science, Birmingham, 01527 919 880 16 SkinCeuticals One Day Sales Training, London, 16 Innomed Training Hands-on Sculptra for

beginners – day 1 (day 2 is on February 27, South Coast, 16 Genuine Dermaroller Training, The Glass House Clinic, London, 16-17 SkinCeuticals Training, Cheshire, 17 Sally Durant Training and Consultancy, Investigative Consultation ad Advanced Skin Assessment, Birmingham, 01527 919 880 18 Dr Bob Khanna Training Institute, Botulinum Toxin - Beginners, 18 Dental Block, West Yorkshire, 19 Dr Bob Khanna Training Institute, Botulinum Toxin - Advanced, 20 Dr Bob Khanna Training Institute, Dermal Fillers – Beginners, 20 Business Development, West Yorkshire, 21 Cosmetic Courses Foundation Botulinum Toxin and Dermal Fillers, 21-22 SkinCeuticals Training, London, 23 Genuine Dermaroller Training, The Clinik,

Brighouse, Yorkshire, 23 Foundation Dermal Filler, West Yorkshire, 23 Physiology of Ageing and Skin Regeneration Treatments Day 1 (Day 2 takes place on February 13), 23-24 Medik8 Training, Cheshire, 24-25 SkinCeuticals Training, London, 25 Genuine Dermaroller Training, Drayton, Portsmouth, 26 Laser core of knowledge, London, 26-29 IMCAS 2012, Paris, France, 28 Innomed Training Hands-on Botulinum Toxin for beginners, Manchester, 29 Innomed Training Hands-on Dermal Fillers for Beginners, Manchester, www.innomedtraining. 30 Sally Durant Training and Consultancy, Laser Hair Removal – Core Knowledge for the Aesthetic Therapist, London, 01527 919 880

1 Medik8 Roller Training, London, 2 Laser core of knowledge, Birmingham, 2 Premed Taster Course, Guildford, 2-3 SkinMedica Training, London, 13 Sally Durant Training and Consultancy, The Art of Skin Peeling, London, 01527 919 880 4 Innomed Training Advanced Botulinum Toxin, South Coast, 5 Innomed Training Advanced Dermal Fillers and Lip Masterclass, South Coast,  6 Dr Bob Khanna Training Institute, Botulinum Toxin - Beginners, 6 Foundation Botulinum Toxin, West Yorkshire, 6-7 SkinCeuticals Training, Cheshire, 7 Dr Bob Khanna Training Institute, Botulinum Toxin - Advanced, 8 Dr Bob Khanna Training Institute, Dermal Fillers – Beginners, 8 Genuine Dermaroller Training, Dermal Clinic, Edinburgh, 8 Mapperley Park Core of Knowledge, London, 15 Dr Bob Khanna Training Institute, Refreshers Course,

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

and Laser Clinic, Dublin, Ireland, 22 Genuine Dermaroller Training, Horrington Clinic, Wells, Somerset, 23 Dr Bob Khanna Training Institute, Oral Facial Course, 23-24 Medik8 Training, London, 24 Dr Bob Khanna Training Institute, Dermal Fillers – Advanced, 25 Innomend Training Basic Botulinum Toxin for Beginners, Newcastle-upon,Tyne, 26 Innomend Training Basic Dermal Fillers for Beginners, Newcastle-upon,Tyne, 25 Cosmetic Courses Foundation Botulinum Toxin and Dermal Fillers, 27 Obagi Blue Peel Workshop, London, 27 SkinMedica Training, Cheshire, 28 4th annual meeting of the RSM Interventional Cosmetics Group, 28 Innomed Training Hands-on Botulinum Toxin for beginners, Newcastle, 29 Innomed Training Hands-on Dermal Fillers for Beginners, Newcastle,

5 Mapperley Park Core of Knowledge, Nottingham, 5-6 SkinCeuticals Training, Cheshire, 12 Dr Bob Khanna Training Institute, Botulinum

Toxin - Beginners, 12-13 Medik8 Training, Cheshire, 13 Dr Bob Khanna Training Institute, Botulinum

Toxin - Advanced, 14 Dr Bob Khanna Training Institute, Dermal Fillers – Beginners, 15 Dr Bob Khanna Training Institute, Gel Peel,

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BOCOUTURE® vs Vistabel®: Equal Potency1 1:1 Clinical Conversion Ratio2

Unit doses recommended for BOCOUTURE are not interchangeable with those for other preparations of botulinum toxin1 1 BOCOUTURE SmPC, June 2010 2 Sattler, G. et al. Dermatol Surg 2010; 36: 2146–2154

Bocouture® 50 Abbreviated Prescribing Information Please refer to the Summary of Product Characteristics (SmPC). Presentation 50 LD50 units of Botulinum toxin type A (150 kD), free from complexing proteins as a powder for solution for injection. Indications Temporary improvement in the appearance of moderate to severe vertical lines between the eyebrows seen at frown (glabellar frown lines) in adults under 65 years of age when the severity of these lines has an important psychological impact for the patient. Dosage and administration Unit doses recommended for Bocouture are not interchangeable with those for other preparations of Botulinum toxin. Reconstitute with 0.9% sodium chloride. Intramuscular injection (50 units/1.25 ml). Standard dosing is 20 units; 0.1 ml (4 units): 2 injections in each corrugator muscle and 1x procerus muscle. May be increased to up to 30 units. Not recommended for use in patients over 65 years or under 18 years. Injections near the levator palpebrae superioris and into the cranial portion of the orbicularis oculi should be avoided. Contraindications Hypersensitivity to Botulinum neurotoxin type A or to any of the excipients. Generalised disorders of muscle activity (e.g. myasthenia gravis, Lambert-Eaton syndrome). Presence of infection or inflammation at the proposed injection site. Special warnings and precautions Should not be injected into a blood vessel. Not recommended for patients with a history of dysphagia and aspiration. Adrenaline and other medical aids for treating anaphylaxis should be available. Caution in patients receiving anticoagulant therapy or taking other substances in anticoagulant doses. Caution in patients suffering from amyotrophic lateral sclerosis or other diseases which result in peripheral neuromuscular dysfunction. Too frequent or too high dosing of Botulinum toxin type A may increase the risk of antibodies forming. Should not be used during pregnancy unless clearly necessary. Interactions Concomitant use with aminoglycosides or spectinomycin requires special care. Peripheral muscle relaxants should be used with caution. 4-aminoquinolines may reduce the effect. Undesirable effects Usually observed within the first week after treatment. Localised muscle weakness, blepharoptosis, localised pain, tenderness, itching, swelling and/or haematoma can occur in conjunction with the injection. Temporary vasovagal reactions associated with pre-injection anxiety, such as syncope, circulatory problems, nausea or tinnitus, may occur. Frequency defined as follows: very common (≥ 1/10); common (≥ 1/100, < 1/10); uncommon (≥ 1/1000, < 1/100); rare

(≥ 1/10,000, < 1/1000); very rare (< 1/10,000). Infections and infestations; Uncommon: bronchitis, nasopharyngitis, influenza infection. Psychiatric disorders; Uncommon: depression, insomnia. Nervous system disorders; Common: headache; Uncommon: facial paresis (brow ptosis), vasovagal syncope, paraesthesia, dizziness. Eye disorders; Uncommon: eyelid oedema, eyelid ptosis, blurred vision, eye disorder, blepharitis, eye pain. Ear and Labyrinth disorders; Uncommon: tinnitus. Gastrointestinal disorders; Uncommon: nausea, dry mouth. Skin and subcutaneous tissue disorders; Uncommon: pruritus, skin nodule, photosensitivity, dry skin. Musculoskeletal and connective tissue disorders; Common: muscle disorders (elevation of eyebrow), sensation of heaviness; Uncommon: muscle twitching, muscle cramps. General disorders and administration site conditions; Uncommon: injection site reactions (bruising, pruritis), tenderness, Influenza like illness, fatigue (tiredness). General; In rare cases, localised allergic reactions; such as swelling, oedema, erythema, pruritus or rash, have been reported after treating vertical lines between the eyebrows (glabellar frown lines) and other indications. Overdose May result in pronounced neuromuscular paralysis distant from the injection site. Symptoms are not immediately apparent post-injection. Bocouture® may only be used by physicians with suitable qualifications and proven experience in the application of Botulinum toxin. Legal Category POM. Basic NHS Price 50 U/vial £72.00. Product Licence Number PL 29978/0002. Marketing Authorisation Holder Merz Pharmaceuticals GmbH, Eckenheimer Landstraße 100, 60318 Frankfurt/Main, Germany. Date of revision of text JAN 2011. Full prescribing information and further information is available from Merz Pharma UK Ltd., 260 Centennial Park, Elstree Hill South, Elstree, Hertfordshire WD6 3SR. Tel: +44 (0) 333 200 4143 Adverse events should be reported. Reporting forms and information can be found at Adverse events should also be reported to Merz Pharma UK Ltd at the address above or by email to or on +44 (0) 333 200 4143.


Date of preparation November 2011

BOCOUTURE® is a registered trademark of Merz Pharma GmbH & Co, KGaA. Vistabel® is a registered trademark of Allergan Inc.


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

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 Adverse events should also be reported to Allergan Ltd. 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

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