Cosmetic News UK August 2012

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

remote prescribing special news report

needle work

on point

Skin Needling Special

mesotherapy for cellulite

also inside this issue of cosmetic News Va s e r

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a e s t e h t i c awa r d s 2 0 1 2 d at e s a n n o u n c e d ! 1 st d e c e m b e r 2 0 1 2 : t h e g r a n d c o n n a u g h t r o o m s , l o n d o n

Cosmetic news t h e

Date of Preparation: February 2012 RES/004/0212

NEW RESTYLANE FOR LIPS. IRRESISTIBLE SOFTNESS.

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Welcome to the August issue of Cosmetic News.

The aesthetics industry has been suffering a lot of bad press in the national media this year following the PIP crisis, so when the BBC did an undercover expose on remote prescribing of botulinum toxin last month, the industry prepared itself for yet another backlash. The issue of remote prescribing of has long been a controversial one and the debate on the ethics and legalities surrounding it have been ongoing, however, now the GMC has finally made its position clear on the subject, will this be the end of the matter? Read our special news report on pages 10-11 to find out what key opinion leaders think. Also in this issue...

We will be taking a closer look at skin needling treatments. Skin needling has been one of the fastest growing and most popular skin rejuvenation treatments in recent years. With little downtime and impressive results, its place as a stand alone and combination treatment has been fully established. As part of this month’s special feature (p16-30) we will be looking at the development of skin needling products and techniques. And don’t forget to keep an eye out on www. cosmeticnewsuk.com where we will be announcing the shortlists for the Aesthetic Awards 2012 on August 15. After that voting will be opened and will be live until October 15. Check out page 14 for all the Awards latest.

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Cosmetic news August

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04 EDITOR’S CHOICE Vicky Eldridge on the LoveLite Ice Lipoglaze treatment

06 INDUSTRY NEWS We round up the latest industry news

10 NEWS SPECIAL REPORT We report on the recent controversy surrounding remote prescribing of botulinum toxin

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

14 AESTHETIC AWARDS 2012 The latest on the most glamorous event of the year

SKIN NEEDLING SPECIAL 16-18 NEEDLE WORK From rollers to stamps, we examine the growing trend for skin needling

21-24 CLINICAL STUDY We summarise the results of a study of percutaneous collagen induction therapy in the correction of post-burn scars

29-30 TECHNIQUES Kamila Kingston on why skin needling techniques matter

3 2 T R E AT M E N T S P OT L I G H T We find out about the latest non-invasive body contouring treatment from Sound Surgical – Vaser Shape (MedContour)

35 MESOTHERAPY Malti O’Mahony on mesotherapy for cellulite

38 CASE STUDY How iS Clinical is transforming problem skin

42 PRODUCT FOCUS The original ‘pain-free’ hair removal laser – Soprano XLi

44 PRODUCT NEWS

Lipoglaze There are two things that are instantly guaranteed to get consumers interested in and talking about a treatment. One is celebrity endorsement and the other is anything that promises a quick, painless and simple solution to getting rid of fat. Not being immune to the power of these pulls myself, my ears instantly pricked up when I was offered the chance to try out the latest Hollywood craze in fat busting – Lipoglaze.

Brought to the UK by LoveLite Ice, Lipoglaze is a non-invasive, low downtime, non-surgical treatment to target and diminish resistant areas of fat.

The procedure is simple and involves a non-invasive vacuum suction, which cools localised fat cells reducing them to re-shape the body’s contours. Following the treatment, the body’s metabolism naturally digests the frozen fat cells, which results in loss of weight. One session can be performed in a lunch hour and can, on average, destroy up to 26% of fat in a single treatment area, effective and fast with no scarring and no pain.

Described as ‘the future of fat removal’, Lipoglaze is based on an FDA approved treatment using cryo-therapy. Studies show it is not only more advanced than liposuction; it is also more affordable. The treatment also claims to have less health side effects than radiofrequency and ultrasound.

I tried the treatment out at Debra Robson’s clinic in Harley Street. Debra and business partner Donnamarie McBride are the owners of LoveLite and are continually searching for new and innovative products to fulfill consumer’s needs.

My treatment was carried out by Donna, an experienced therapist, and was, in the most part, a very comfortable experience and one I would definitely repeat if it yields the results it promises. I laid back on the treatment couch and the vacuum device was attached to my stomach and sucked the fat up inside. I then felt a warming sensation as the fat was heated and then a slight stinging/tingling sensation as it is cooled to -5 degrees centigrade. The only other thing I really felt during treatment was the slightly bizarre sensation of your fat being sucked inside a tube, but again this is not unbearable or even that uncomfortable at all. After the treatment my stomach was ice cold and slightly red and swollen but this dissipated very quickly and I had no other side effects. It has only been three weeks since my treatment and I have alredy begun to notice a result in the treated area. It can take up to two months to see the final result so watch this space!

We round up the latest product news

46 ABSTRACTS We round up the latest clinical studies

48 BUSINESS FOCUS

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

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

We find out what a typical day has in store for Mr Chris Inglefield

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

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

5 2 D AT E S F O R T H E D I A RY

Susie Macklin Account Manager 01268 754 897 susie.macklin@creativemedialtd.co.uk

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

Antonia Mariconda on Twitter

5 0 A W O R K I N G D AY I N T H E L I F E O F…

Training course, conference and meeting dates

Carly Mcfarlane Sales and Events Assistant 01268 754 897 carly.mcfarlane@creativemedialtd.co.uk DISCLAIMER The editor and the publishers do not necessarily agree with the views expressed by contributors and advertisers nor do they accept responsibility for any errors in the transmission of the subject matter in this publication. In all matters the editor’s decision is final.

≤ 25°C

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. List 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 FEB 2012. 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 yellowcard.mhra.gov.uk. Adverse events should also be reported to Merz Pharma UK Ltd at the address above or by email to medical.information@merz.com or on +44 (0) 333 200 4143.

1084/BOC/JUN/2012/JH

Date of preparation June 2012

Bocouture® is a registered trademark of Merz Pharma GmbH & Co, KGaA.

e n t e r / n o m i n at e n o w ! c o s m e t i c n e w s u k . c o m n o m i n at i o n s c l o s e 1 st a u g u s t

GMC bans remote prescribing of toxins Doctors are to be banned from prescribing botulinum toxin by phone, email, video-link or fax under new guidance from the General Medical Council (GMC) issued last month.

The change means that doctors must have face-to-face consultations with patients before prescribing botulinum toxin to ensure they fully understand the patient’s medical history and reasons for wanting the treatment. Under current GMC guidance doctors must adequately assess the patient’s condition before prescribing remotely and they must be confident they can justify the prescription. Where doctors cannot satisfy these conditions, they must not prescribe remotely. The new guidance, which came into force on July 23, updates and strengthens these rules. See our special report on page 10-11 for the full story.

Book your place now for the Aesthetics Conference Online booking for the Aesthetics Conference 2013 is now open and with a new look conference programme, booking early is a must.

Running alongside the Cosmetic News Expo at the Business Design Centre in Islington on February 16-17 2013, the Aesthetics Conference is a chance to gain value for money CPD accredited education and learn about the latest trends in medical aesthetics.

Now in its fourth year, the Cosmetic News Expo has traditionally been held in April or May but has been moved to the earlier dates to make it the first key educational event in the UK aesthetic medicine calendar, so you will not want to miss out.

To book your tickets simply visit www.cosmeticnewsuk.com today.

IIP award for Hamilton Fraser Hamilton Fraser has been awarded the Investors in People Standard for staff development and training.

Originally created to help businesses recover after the recession of the 1980s, the national quality Standard is equally as relevant today. Awarded to well-run organisations which demonstrate good management practice with a high emphasis on best practice people management and development, the Standard encourages growth, profitability and efficiency.

Eddie Hooker, Chief Executive Officer, at Hamilton Fraser Insurance which employs more than 120 people, said, “I am happy and excited that our company now has proof that we are an inclusive and enjoyable company to work for. The Investors in People Award is recognition of the hard work and determination of the business.”

Research shows that organisations of any type and size that adopt a comprehensive approach to people development perform better than those without, indicated by higher gross profits per employee, higher profit margins and higher productivity. Companies that have achieved the Investors in People Standard also have higher levels of trust, co-operation and commitment than their competitors. John Telfer, managing director of Inspiring Business Performance Ltd (IBP), the IIP Centre for London and the South of England said, “This award is a celebration of both management and staff learning from each other and collaborating together to create an efficient and enjoyable working environment.

I look forward to hearing about further success and award recognition from Hamilton Fraser in the future.”

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Baroness Morris of Bolton announced as new chair of TYCT Governance Group Baroness Morris of Bolton has agreed to take the Chair of the 16 strong Governance Group for the Department of Health backed Register TreatmentsYouCanTrust following the sad death of Baroness Ritchie of Brompton in April.

Baroness Morris was an Opposition Spokesperson for Health in 2004 to 2006 and 2009 to 2010 and also Shadow Minister for Women in 2005 to 2010. She is very keen that patients are able to receive safe cosmetic treatments from appropriate providers and also that they are protected from the escalating number of unqualified providers. Baroness Morris echoes the Parliamentary UnderSecretary of State for Health, Anne Milton, in backing the work www.

TreatmentsYoucanTrust.org.uk to ensure safe practice for injectable cosmetic procedures and exclusion of unregulated beauty therapists.

Baroness Morris said, “Whilst the beauty industry provides an important service, with well-trained therapists in beauty treatments, it is important to ensure patients are made aware are that they are not appropriately qualified to administer cosmetic injectables, and only Registered providers may display the www.TreatmentsYouCanTrust. org.uk quality mark. I am very pleased to assume the Chair of the Governance Group and to lead the nationwide campaign in the interests of safeguarding patient safety.”

Sally Taber, responsible for the management of the Standards and Training Principles, and speaking for the members of the Governance Group added, “We look forward to working with Baroness Morris joining us as Chair to lead forward our patient safety agenda. She brings with her years of experience as Shadow Health Minister and Shadow Minister for Women. We are confident that Baroness Morris will lead the scheme from strength to strength.”

The Governance Group has responsibility for monitoring and developing the www.TreatmentsYouCanTrust.org.uk scheme, a key industry-supported Standard focussed on patient safety. Governance Group Members are drawn from medical, nursing and dental professional bodies, consumer advocates, patient representative bodies, the Government and industry commercial interests.

New Sales and Marketing Manager for Medical Aesthetic Group Medical Aesthetic Group is pleased to announce that Katrina Ellison has joined the sales team.

Katrina previously worked for Sanofi Aventis for eight years where she was the National Sales Manager for the medical aesthetic business managing Sculptra and Succeev. Katrina brings a wealth of knowledge and experience to her role as UK Sales and Marketing Manager for Medical Aesthetic Group.

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BCAM announces details of autumn conference The British College of Aesthetic Medicine has announced the details of its autumn conference.

The event will take place on September 15-16 at The Celtic Manor Resort Newport, South Wales and is open to both members and non-members. An informal dinner will be held on the evening of Friday September 14 to mark the start of the event. Saturday’s programme will include a main conference and series of workshops with a dinner following the close of the event. Sunday will then see the BCAM Open Golf Championship at the famous 2010 golf course. All golf players are welcome to join. The cost for this is £230 to include 18 holes, shared golf buggy, refreshments and trophies.

For more information and bookings email registrations@BCAM.ac.uk or call 0845 450 2875.

Cosmetic Procedures Get Personal, as Treatments Move to the Home Treatments at home are becoming more and more popular, as beauty-conscious people opt for quick and cost effective non-surgical cosmetic procedures, according to a new report by healthcare experts GlobalData.

The new report, Aesthetic Lasers and Energy Devices – Global Pipeline Analysis, Competitive Landscape and Market Forecasts to 2018, claims that rising obesity rates will expand the market for liposuction and contouring treatments and leading cosmetic medical treatments are expected to become increasingly common.

Home use devices are becoming incredibly popular due to their cost effectiveness and ease of use. Applications range from hair

Surgeons ‘seek to protect title’

removal to skin rejuvenation, peri-orbital wrinkle treatment and acne treatment. Repeated usage is required to achieve desired results, and

Leading doctors are calling on the government to legally protect the title “surgeon”.

A Royal College of Surgeons (RCS) poll of 2,000 people found 95% expect someone using the title “surgeon” to be medically qualified.

There are no restrictions on who can use the title - but the RCS wants only those with a medical degree and surgical training to be able to do so. But others who use the title defended their right to do so. It takes around 16 years of training and experience for surgeons to reach consultant level.

Those who the RCS feels should not use the title include podiatric surgeons, who do not complete medical degrees but are trained in the surgical and non-surgical treatment of the foot. Another group the RCS feels should not use the title surgeon are “aesthetic surgeons”, who may not have a medical degree or have undertaken specialist training.

The British Association of Aesthetic Plastic Surgeons (BAAPS), whose members are fully qualified, backed the RCS. BAAPS president Mr Fazel Fatah said, “The public has been misled and cheated for too long by practitioners falsely claiming to be surgeons, without having the training and qualifications required. The issue is at the very centre of patient protection and the public deserve the peace of mind that doctors who carry out surgery are qualified and trained for that purpose.”

this helps in keeping the market buoyant.

Aesthetic lasers are preferred for body contouring and skin exfoliation in the case of many busy individuals, due to speed, price and convenience. Similarly, fractional non-ablative lasers are expected to dominate the skin resurfacing device market, due to reduced recovery times. These treatments all share a focus on accessibility within a modern busy lifestyle.

A sharp increase in obesity rates in emerging economies such as China and India is also expected to drive the growth of bodycontouring devices in the future. China’s obese population had topped 100 million by 2009, and around 38% of the total Chinese population is currently overweight. Similarly in India, 20% of the total population and 40% of the urban population are overweight.

Increase in obese population can lead to increase in bariatric surgeries, in turn boosting demand for body-contouring procedures.

These numbers therefore imply a significant potential for future growth in the global body-contouring devices market. Laser-

CACI celebrates 20 years of success

assisted liposuction procedures are set to drive the future market for minimally invasive body-contouring devices, providing impressive fat reduction for the rapidly expanding obese market. at $1.4 billion in 2011, and is forecast to grow at a Compound Annual

launching in the UK in 1992, CACI International has experienced constant growth and is

Growth Rate (CAGR) of 12% to reach $3 billion by 2018. Home use

now available in over 6,000 locations and over 40 countries.

devices are the fastest growing segment in the global aesthetic

The UK manufacturing company recently opened new distribution channels in Poland,

lasers and energy devices market. The market was valued at $700m

South America, Turkey, Morocco, and Saudi Arabia.

in 2011 and is forecast to reach $1.6 billion by 2018 at a CAGR of 13%.

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Date of Preparation: January 2012 UK/0023/2012

The global market for aesthetic lasers and energy devices was valued

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News SPECIAL - REMOTE PRESCRIBING

THE end

of the affair?

As the GMC finally makes its position on remote prescribing clear, we take a look at the latest controversy to rock the aesthetics industry

T

he aesthetics industry has been suffering a lot of bad press in the national media this year so when the BBC did an undercover exposé on remote prescribing last month, the industry prepared itself for yet another backlash.

The issue of remote prescribing of botulinum toxin has long been a controversial one and the debate on the ethics and legalities surrounding it have been ongoing, even after the Nursing and Midwifery Council issued a very clear position statement and advice to its members on the subject in April 2011. They stated that nurses engaging in treating patients with botulinum toxins following a remote consultation will be going against the NMC standards and thus risk

their registration (which could be withdrawn following a disciplinary hearing) if they operate via that business model.

But while this should have made the situation cut and dry for nurses, the lack of clarity from the GMC on the topic meant that the practice of remote prescribing has continued, despite vehement opposition to it by certain sectors of the industry. However as of July 23 the GMC has finally made its position on the matter clear and has issued new rules to its members, stating that the practice of remotely prescribing prescription only botulinum toxin products, such as the brands Botox®, Vistabel®, Azzalure®, Dysport®, Xeomin® and Bocouture® will no longer be permitted and doctors must see a patient face-to-face before issuing a prescription for the drug; (although they may still delegate the administration of it to someone under their supervision, such as a nurse). This means that the ongoing loop-hole of writing prescriptions for Botox® following a telephone call, fax, email or voice over internet connection (i.e., Skype etc.) will mean that a doctor is practising outside of the GMC rules and could face disciplinary charges in the form of a fitness to practise hearing.

The guidance, which will be issued to every doctor in the UK, states: ‘You must undertake a physical examination of patients before prescribing non-surgical cosmetic medicinal products such as Botox®, Dysport® or Vistabel® or other injectable cosmetic medicines. You must not therefore prescribe these medicines by telephone, fax, video-link, or online.’

Niall Dickson, Chief Executive of the GMC said, “We recognise that patients can benefit from communicating with their doctor by email, phone, or video-link or fax and that is fine as long as it is done safely, but

Here is what some of the industry’s key figures have to say on the matter:

“The aim of the British College Of Aesthetic Medicine is to advance the effective, safe and ethical practice of aesthetic medicine and we therefore welcome the new General Medical Council (GMC) guidelines on remote prescribing. As per our Articles of Association ALL BCAM members are expected to understand and have a working knowledge of the Code of Practice as set out by GMC and must adhere to it in daily practice.” Dr Samantha Gammell, president of The British College Of Aesthetic Medicine

Medicines Management published on 9th October 2007. We welcome the fact that the practice has been highlighted and we look forward to clarity from the General Medical Council (GMC).” British Association of Cosmetic Nurses (BACN)

“The BACN has been concerned for some time that some doctors offer reassurance to nurses that remote prescribing is accepted practice and meets NMC standards, this is not the case, as in NMC New Advice for Botox – Nurses and Midwives, published on 1st April 2011 and the NMC Standards for

any nurse administering a drug to a patient, without a valid prescription, is breaking NMC guidance in any walk of medicine. Imaging the consequences of doing that on a ward drug round! I would also argue that any doctor, dentist or nurse found to be encouraging another health care professional to act

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cosmeticnewsuk.com

“Plain and simple, it is against GMC guidance to raise a prescription for any drug using a fictitious patient name or in the name of a family member for use by someone else. If found doing so, any doctor, dentist or independent nurse prescriber could be referred to the GMC/GDC/NMC. Likewise,

in contravention of their own professional guidelines should be asked to account for their actions by their own regulator. If an antibiotic or analgesic cannot be prescribed remotely in a fictitious name or be administered with out a prescription, why do some doctors, dentists and nurses think that the potent Botulism neurotoxins are different? Remote prescribing was introduced to save lives in remote communities, not to treat wrinkles.” Mr Nigel Mercer, former BAAPS President “Hamilton Fraser has always made its position clear in respect of remote consultations and the prescription of medicines in the absence of the patient. All malpractice insurance policies offered to our clients are conditional on the practitioner following the professional guidelines laid down by their governing bodies, in this case the GMC, GDC and NMC. Hamilton Fraser will only indemnify the practitioner if they are acting under the direction of an authorised prescribing practitioner, such as a doctor, dentist or nurse prescriber, and the patient

our new guidance makes clear that doctors must now not prescribe medicines such as Botox® remotely. These are not trivial interventions and there are good reasons why products such as Botox® are prescription only. We are clear that doctors should assess any patient in person before issuing a prescription of this kind. So while remote prescribing may be the right answer in many situations, this is not one of them.”

The NMC also issued a renewed statement. It said: “ Following the announcement by the GMC that doctors are to be banned from prescribing Botox® remotely, we are reminding employers and managers of our guidance on remote prescribing and injectable cosmetic products. We have received several enquiries from nurses and midwives who prescribe and administer medicines, asking whether these changes impact on them. Employers should be aware that this change has implications for those administrating cosmetic injectable products prescribed by doctors. The GMC’s new specific guidance, says that a physical examination is necessary before prescribing non-surgical cosmetic medicinal products. We published a position statement on this issue last year in consultation with the Royal College of Nursing. This builds on our standards for medicines management making it clear that remote prescriptions or directions to administer should only be used in exceptional circumstances and not as a routine means to administer injectable cosmetic medicinal products. Remote prescribing by nurse independent prescribers is addressed comprehensively in the Standards of proficiency for nurse and midwife prescribers (NMC, 2006)” The story broke on the BBC London Evening News on July 9, which highlighted an investigation into the practice of remote prescribing services following concerns that were raised to the broadcaster.

The BBC sent a researcher undercover to investigate operations by infiltrating training sessions with one of the UK’s largest purchasers of botulinum toxin products, Dr Mark Harrison, who runs Harley Aesthetics, a company, which provides training courses and remote prescription services for registered nurses up and down the UK.

has had a face-to-face consultation with that prescribing practitioner. We welcome the recent clarification from the GMC on this issue.” Hamilton Fraser Cosmetic Insurance “Allergan supports initiatives that help establish and maintain best practice standards within medical aesthetics as this ultimately benefits patients. As practice in the industry evolves, we will also evolve to support appropriately trained and qualified medical aesthetics practitioners to continue to deliver excellent services to their patients.” Dan Stewart, Business Unit Director, Allergan UK “As a support and education group for nurses practicing aesthetic medicine in the north of England. We have taken a proactive approach to practicing within the law and guidelines by encouraging our members to undertake the Independent Nurse Prescribing programme. In order to maintain public safety and fulfil their obligation to meet NMC guidelines. Remote

While Dr Harrison is by no means the only doctor practising remote prescribing in the aesthetics arena, the damming documentary shocked many people in the industry who saw it as an unethical encouragement of nurses to operate outside of the guidance of their professional body. Commenting to the BBC, Dr Harrison said he had performed more than 50,000 remote consultations since 2005, with no adverse affects on patient health. He told them that the use of prescriptions in one person’s name for the treatment of others was “common, almost universal practice throughout the aesthetics industry” and concluded; “I can confirm that I take my professional and moral obligations to both the patients who have treatments and the nurses who use the service extremely seriously.”

Writing on www.consultingroom.com, he added, “The claim that the practices of Harley Aesthetics are ‘potentially endangering the life of the patient’ is contemptible. The report resorts to ridiculous sensational language merely for effect as these claims are neither present in the published literature or in the specific treatments of Harley Aesthetics. Of course there is no story to report if it is merely concerned with some grey areas of both medical law and guidelines from professional bodies, hence having to resort to sensational journalism. With remote consultations being common and increasingly routine in the NHS it will be interesting to see how remote consultations are considered safe and ethical in the NHS but not so in aesthetic medicine. The Harley Aesthetic nurses will be hoping that I will be able to adapt the current practises of Harley Aesthetics to accommodate the new GMC guidelines. For many of the nurses it is their whole livelihood for the rest an invaluable additional family income. If for a moment you suppose that all the remote consultation services were to close down with the subsequent loss of many hundreds of experienced and well trained nurses- it would be easy to suppose that the various unregulated practitioners may fill the gap.”

A copy of the new guidance can be read on the GMC’s website www.gmc-uk.org/guidance/ethical_guidance/13594.asp

prescribing to nurses is the tip of the iceberg; we have had a number of concerns for some time relating to the issue of training and remote prescribing. We refer to situations in the North West which we are sure are not isolated cases, where sadly a few medical doctors and dentists have proactively recruited and trained nonmedical professionals eg. Beauty therapists in the administration of Botulinum toxin and providing remote prescribing for these groups.” Yvonne Senior, co-founder of the Private Independent Aesthetic Practices Association (PIAPA)

Vallance-Owen, chairman of IHAS Cosmetic Surgery/Treatments Working Group

“As champions of best practice in the cosmetic injectable industry, and acting in the best interests of patients, www.

“The Patients Association welcomes all guidance that strengthens rights and helps inform choice. Face to face appointments give patients the most appropriate opportunity to question clinicians directly about their care. Doctors must encourage a partnership approach, ensuring that patients are equal partners in their care and the decisions made about it.”

Katherine Murphy, chief executive of the Patients

TreatmentsYouCanTrust.org.uk applaud the move by the GMC to dovetail their remote prescribing guidance with the other professional regulators in the UK, leaving remote prescribing behind and marking a promising future for further stamping out bad practice in the industry.” Dr Andrew

“The cosmetic injectable industry has for many years recognised remote prescribing as unsafe and totally inappropriate. The review of prescribing guidance by the GMC marks an important step in further stamping out bad practice in the industry and ensuring patient safety.” Sally Taber, director of the IHAS, responsible for the management of www.

TreatmentsYouCanTrust.org.uk

Association

on the scene

ON THE SCENE Out and about in the industry this month

Love Lite Ice Lipoglaze launch, The Sanctum Soho Hotel, London The glamorous roof terrace of the Sanctum Soho Hotel in London was the setting for the star-studded launch of Lipoglaze. Stars of The Only Way is Essex and other tabloid celebs joined the LoveLite team, including Debra Robson, Donnamarie McBride and Andy Pallister, and members of the press at the party. The paparazzi crowded outside the hotel to snap pictures of the famous guests as well as a very convincing George Michael lookalike and tribute act.

Lipoglaze is a non-invasive, low down time, non-surgical treatment to target and diminish resistant areas of fat. The procedure is simple and involves a non-invasive vacuum suction, which cools localised fat cells reducing them to re-shape the body’s contours. Following the treatment, the body’s metabolism naturally digests the frozen fat cells, which results in loss of weight. One session can be performed in a lunch hour and can, on average, destroy up to 26% of fat in a single treatment area, effective and fast with no scarring and no pain. (See this month’s Editor’s Choice).

Competition Winner Announced

Journal of Aesthetic Nursing launch, London

Industry get togethers usually revolve around conferences and meetings, so it made a refreshing change to have one that

The aesthetic nursing community came together to mark the launch of the Journal of Aesthetic Nursing at a one-day meeting at the America Square Conference Centre in London. The journal was first published in June and focuses specifically on the issues affecting aesthetic nurse practitioners as well as providing peer reviewed clinical editorial on treatments and techniques.

Chaired by Lorna Bowes, the meeting kicked off with an introduction by JAN editor Natasha Devan before a keynote speech by Professor Ian Peate on The Road to Regulation – What is the Future of Aesthetic Nursing? In his lecture he looked back at the history of regulation in the nursing sector and highlighted the main issues and challenges for nurses working in the aesthetic specialty. The morning programme then continued with presentations on Preparing and Anaesthetising the Skin by Dr Riyaz Baba and Sclerotherapy by Emma Davies. Helena Collier then gave a lecture on How, Why and When to

The afternoon programme saw lectures on Skin Tghtening by Trudy Friedman, Imaging Technologies by Nick Miedzianowski Sinclair, Buddying and Mentorship by Marea Brennan Thorns and lessons from the NHS by Sharron Brown. One of the highlights of the event was the afternoon debate on Should Nurses be Required to Complete a Mandatory Accredited Programme of Study? where the recent issues surrounding remote prescribing figured heavily. Panel members including Helena Collier, Sally Taber, Frances Turner Traill and Yasmin Khan fielded questions from

was purely about having fun. Organised by Dr Ravi Jain, the Riverbanks Waterskiing Day, was a chance for friends and colleagues from the aesthetics industry to let their hair down and enjoy a bit of time out from work. A keen waterskier, Dr Jain hosted the event at his local club, Denham Waterski Club. The rain held off for most of the day and while some sat down by the lake enjoying a BBQ and a few drinks, others took to the water to have a go at waterskiing themselves.

prescribe Hyaluronidase while Dr Toni Phillips spoke about Lower Facial Anatomy and Product Placement. The last session before lunch was a panel discussion on How Safe are Fillers and Implants? With Sharon Bennett, Helena Collier, Trudy Friedman and Dr Barbara Kubrika.

the audience on this controversial issue.

A small exhibiton was held along side the meeting supported by Aesthetic Source, Allergan, Church Pharmacy, Lifestyle Aesthetics, Medex Medical Training, Medical Aesthetic Group, Merz Aesthetics, Sinclair IS Pharma and Syneron Candela.

At this year’s FACE conference, Nordson Micromedics ran a competition for one lucky delegate to win an Artiste Injection System. The winner was Emma Tonry-Webb of Sapphire Aesthetics in Herefordshire (pictured with Mandy Cameron of Nordson Micromedics). Emma says, “I am really excited to win this prize as the best I have ever done is a box of chocolates in a raffle! I am looking forward to giving my patients the benefit of improved filler treatments with Artiste”

Riverbanks Waterskiing Day

Your partner in injectable facial aesthetics

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

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

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

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

cosmeticnewsuk.com

13

A night to remember This month we will be announcing the shortlists for the Aesthetic Awards 2012. Here is everything you need to know about the night and what happens next…

silver sponsorship by

Over the past few weeks the entries have been flooding in for the Aesthetic Awards 2012 and on August 15 we will be announcing who is in line to win one of the coveted prizes. Once again we have been astounded with the response from the industry, with thousands of nominations and entries coming in for the 30 awards categories.

With so many high caliber entries to sort through, picking the final shortlisted nominees will be a tough but rewarding task. Once the shortlists have been announced on www.cosmeticnewsuk.com voting will open. Mystery shoppers will also be sent out in the relevant categories. A judging panel is also being selected to help choose the winners in some of the categories.

The 2012 Aesthetic Awards promises to be a high glamour affair. Taking place at The Grand Connaught Rooms in Covent Garden on December 1, the event, which is sponsored

by Syneron Candela, will have a Moulin Rouge theme. The Grand Connaught Rooms is one of

the most elegant and beautiful venues in central London and is a fitting venue for an evening that is designed to celebrate the successes of this exciting, dynamic and thriving industry.

The Aesthetic Awards brings together the cream of the aesthetics industry crop to acknowledge the success stories of the past year and reward those who are excelling. 30 awards categories have been designed to recognise those who have gone above and beyond in their dedication and service to the industry from the clinics and practitioners who are leading the way to the manufacturers and suppliers who have developed and brought to market the most innovative and inspiring products and treatments.

The categories for the 2012 Aesthetic Awards are…

Awards for Manufacturers and Suppliers • • • • • • • • • • • • •

Best Product Innovation Best Newcomer (Product or Treatment) Cosmeceutical of the Year Injectable Product of the Year Treatment of the Year (Face) Treatment of the Year (Body) Best Selling Retail Product Equipment Brand of the Year Best Weight Loss/Diet Programme Sales Representative of the Year Best Customer Service by a Manufacturer/Supplier Best Advertising Campaign by a Manufacturer/Supplier Distributor of the Year

Awards for Clinics/Practitioners • • • • • • • • • • • • • • •

Rising Star Best New Clinic Best Clinic Chain Best Clinic (four rooms or more) Best Clinic (three rooms or less) Best Cosmetic Dental Clinic Best Mobile Practitioner Aesthetic Nurse Practitioner of the Year Aesthetic Practitioner of the Year (Sponsored by ) Cosmetic Dentist of the Year Best Clinic Customer Service Best Clinic Website Speaker of the Year Clinic Receptionist of the Year Association of the Year

Last year’s event was a sell-out and tickets are already going fast for this year so early booking is highly recommended to avoid disappointment. Not only are the awards a fantastic chance to revel in the achievements of you and your peers but with our high glamour Moulin Rouge theme you will be treated to a night of decadence, showgirls and top quality entertainment – what better way to end the year! Tables are priced at £1,600 plus VAT and single tickets are £165 plus VAT.

Special Awards • •

14

The Baroness Ritchie Award for Services to the Industry (Sponsored by Lifetime Achievement Award

cosmeticnewsuk.com

)

For more information or to book your table at this prestigious event, please call Carly on 01268 754 897.

MEDICAL AEsthEtICs:

itâ&#x20AC;&#x2122;s A Question

of QuAlity

At Allergan, we passionately believe in quality.

Our 35 years of commitment to science and innovation in medical aesthetics means that practitioners and their patients can make decisions with confidence.

We are launching a landmark public awareness and education campaign to help start a conversation between practitioners and patients about why quality matters.

Ask your AllergAn representAtive for more informAtion.

March 2012 UK/0326/2012

35 years of quality, science and innovation

Skin Needling Special

Pins and needles We examine the best products for skin needling

Skin needling has been one of the fastest growing and most popular skin rejuvenation treatments in recent years. With little downtime and impressive results, its place as a stand alone and combination treatment has been fully established.

In the last few decades there has been a dramatic rise in the use of treatments for rejuvenating ageing skin. Traditionally the most effective way of achieving noticeable results was by more aggressive methods, which carried significant downtime for the patient, however in recent years a number of less- or noninvasive treatments have emerged. One such treatment, which is growing in popularity, is medical skin needling.

The concept of using surgical needles in minimally invasive skin rejuvenation started to develop as a recognised technique during the mid 1990s. Now known as medical skin needling, Collagen Induction Therapy (CIT) and micro-needling, it is aimed at stimulating the body’s own collagen production to reduce the appearance of fine lines and wrinkles, stretch marks, skin laxity and scarring and, more recently, to stimulate hair growth.

This is achieved by introducing a series of fine, sharp needles into the skin following the administration of a topical local anaesthetic, in the case of medical grade devices, to reduce

M edical

skin

discomfort. The needles are usually attached to a sterile roller, which is moved over the surface of the skin to create many microscopic channels or columns at various depths of penetration, however using a stamp like device has also become popular. In the case of medical rollers this is within the papillary dermal layer of the skin where collagen and elastin fibres are located. Cosmetic rollers however reach a much shallower level in the epidermis where they aid absorption of topical ingredients. These minute punctures close over almost immediately as the skin heals.

This ‘damage’ to the dermis encourages the body to produce more new collagen and elastin, which generates new skin cells to literally repair itself, thus the skin becomes thicker, plumper and more youthful. Although primarily used on the face, this procedure can be carried out anywhere on the body, such as on stretch marks on the thighs and abdomen, and generally on all skin types. (Reference: Lorna Jackson, Cosmetic News July/ August 2009)

needling

d e v i c e s

There are a number of different devices now available to the UK marketplace aimed at medical skin needling. These vary in needle length, from approximately 0.02mm, designed for personal, cosmetic use at home, often in conjunction with a skincare regime, as the minute skin punctures assist the absorption of any active ingredients, to up to 3mm, designed for professional, medical use, which will achieve a more significant result on skin regeneration to induce new collagen formation.

G enuine D ermaroller ™ ( A estheti C are )

16

The Genuine Dermaroller™ device (distributed in the UK by AesthetiCare) has become a gold standard in skin needling. It was the first such device to be given a European CE mark classification - the medical rollers are approved as Class IIa single use devices.

Each device is equipped with 192 needles mounted on a 20mm wide roller, which has eight needles in each horizontal row, and comes in both medical and cosmetic use models.

and cannot reach the dermis where collagen formation occurs, thus are aimed at assisting the infiltration of active ingredients within skincare products for the home user.

The Medical models MF8, MS4 and CIT8 are for use by trained professionals only. The CIT8 has a needle length of 1.0mm and the MF8 has 1.5mm, which depending upon the applied pressure can penetrate the skin from 0.1-1.3mm deep, with a needle diameter of up to 0.12mm. Both of these models are designed to reach deep enough into the dermis to induce new collagen formation, whilst minimising down time. For smaller areas of the face, such as above the upper lip the MS4 -1.5mm is available. This device has 96 needles mounted on a 10mm wide roller with four needles per row.

The Cosmetic, C8 model has needles of 0.2mm in length, with a penetration diameter of 0.07mm. As these needle tips can barely be seen with the naked eye, they only penetrate into the epidermis

The latest additions to the Dermaroller™ family are the Dermaroller™ MC925 for the treatment of thicker dermal areas and fibrotic and thick scars and the Genuine Dermaroller Dermastamp.

cosmeticnewsuk.com

The Dermaroller™ MC925 features advanced medically-engineered 2.5mm micro-medical skinneedles in an enhanced roller design to ensure optimum penetration, stimulation and patient comfort. It enables practitioners to enhance their treatment of thicker dermal areas, e.g. for acne scarring on the back or treatment of the abdomen and buttocks, particularly with respect to skin laxity and stretch mark improvements and fibrotic and thick scars, e.g. burns.

The Dermastamp™ is a sterile single use medical device created to repeatedly puncture deep scarring and lines with maximum precision and minimum pressure. Using high quality 2mm micro-

medical skin-needles in a 5mm diameter circular arrangement, the Dermaroller™ Dermastamp™ is perfect for skin regeneration and scar repair for these previously difficult to treat areas.

The multiple medical-needle-columns stimulate the regeneration of skin cells, blood vessels and collagen and also helps release tissue tethering the scar and lines. The Dermaroller™ Dermastamp™ is available individually or in a combination sterile pack with the Genuine Dermaroller™ MF8 1.5mm for the treatment of larger areas of skin that also features deeper scars and lines. The Genuine Dermaroller™ Dermastamp™ is available to all trained

Genuine Dermaroller™ practitioners and authorised Dermaroller™ clinics.

Cosmetic surgeon Mr Chris Inglefied says, “Genuine Dermaroller is a significant part of the treatment for acne scarring, postsurgery scarring and scars following injuries including burns. At LBPS we combine Dermaroller™ treatments with skin peels and SkinCeuticals Blemish & Age serum. For skin rejuvenation and anti-ageing we combine Dermaroller™ with Growth Factor Serum and home use of SkinCeuticals Phloretin CF gel. Our signature facial treatment – Inglefield Facial, incorporates Dermaroller™ with JetMeso, Omnilux and Collagen mask for a luxurious anti-ageing treatment. Our Hair Restoration program utilizes in clinic Dermaroller™ treatments and home treatment with the Home Dermaroller™.”

I N N O - roller ( M edical A esthetic G roup ) One of the ways microneedling is now being used is in the treatment of hair loss. Under the direction of Dr Fernando Bouffard, Innosearch has used its knowledge and pharmaceutical experience to offer a fully integrated range of products based on the biology of the skin which work synergistically to produce genuine and visible results. The range includes effective topical, transdermal and oral solutions for a number of anti ageing problems including hair loss for and thinning hair for both men and women.

INNO-ROLLER® is a line of solutions designed to be used with a dermaroller as an apparatus for transdermal delivery and the stimulation of cell renewal. The solutions have a unique combination of active ingredients which act specifically on the condition being treated including, hair loss, cellulite, anti ageing, scars and stretch marks. INNO-ROLLER Hair Revival contains active ingredients to stimulate micro circulation in the hair follicle and inhibit 5-alpha-reductase, an enzyme responsible for hair loss.

INNO-TDS® is a trans dermal release mesotherapy system that includes products formulated according to efficacy guidelines based on high concentrations of active ingredients that are highly effective yet safe for the skin.

The range offers weight, cellulite, hair loss and anti-ageing solutions and includes INNO-TDS Hair Loss Control, which contains copper peptides to improve the hair micro-circulation and inhibit the production of dihidrotestosterone (DHT) responsible for hair loss. INNO-TDS Hair Loss Control increases hair thickness and supplies sufficient nutritive supplementation direct to the hair follicle. The application of the active ingredients to the base of the follicle combined with the stimulation from the mesotherapy, micro-needling technique, produces healthier hair and extends the anagen or growth phase of the hair cycle. For optimum results one treatment per week for eight weeks.

R oll - C I T ™ ( E N V I R O N ) The Roll-CIT™ from Environ® is the creation of Dr Des Fernandes, a South African Plastic Surgeon.

Dr Fernandes conceived his original needling device over a decade ago; a small needle stamp to induce collagen formation and used it as a regular treatment in his surgical practice. He delivered his first clinical paper on skin needling of the upper lips to the International Society of Aesthetic Plastic Surgery (ISAPS) congress in 1996.

Since then he has gone on to develop a range of needling products. The Roll-CIT™ is available in a Cosmetic model, which has a penetration depth of between 0.02-0.2mm, and in a Medical model with a needle length of 1mm, as well as a Surgical model with a 3mm needle length for more aggressive, professional treatments.

Using both micro-needling technique and Environ’s topical vitamin skincare, the brand’s signature treatment is Collagen Stimulation Therapy ™, which they claim significantly enhances results compared with needling alone. It is indicated for wrinkles, acne scarring, slack skin, stretch marks and burn scars and can also be used to help tighten skin after liposuction. It has also been shown to significantly lighten pigmentation marks.

cosmeticnewsuk.com

17

Skin Needling Special

before

The latest addition to the range is the the Environ® Cosmetic Body Roll-CIT™, a unique rolling barrel device with integrated (0.2mm) needles which protrude just sufficiently to create micro-channels in the ‘dead’ skin surface layer. Rolling the skin means the ingredients in subsequently applied Environ skin care products can penetrate the active layers of the skin about 10,000 times more effectively, for better and faster results. The home-use tool features a patent pending component designed so that one can painlessly, easily and quickly roll large curved surfaces on the torso, arms and legs.

after

R ed + M R S F ine T itanium D erma R oller

M T S - R oller ™ ( M edical A esthetic G roup )

The Red + MRS Fine Titanium Derma Rollers were introduced to the UK market by Inspira Med earlier this year and include both in-clinic and at-home use devices ranging in sizes from 0.20mm-0.30mm for home use and 0.50mm-3.00mm for professional use. All rollers are delivered in individual sealed sterile envelopes and plastic cases.

Microneedle Therapy System or MTS-Roller™ consists of six different models, two for personal use (CR2 – 0.2mm and CR3 – 0.3mm needle lengths), one for clinical use by trained aestheticians (CR5 – 0.5mm) and three for medical use by trained nurses, doctors, surgeons etc. (CR10 – 1.0mm, CR15 – 1.5mm and CR20 – 2.0mm).

The MTS-Rollers™ are equipped with 200 needles mounted along a 21.5mm wide roller with eight needles per horizontal row; this is the highest number of needles of any medical skin-needling roller on the market, according to the manufacturer. They create miniscule holes of 0.07mm diameter with a penetration depth of between 0.13mm and 2.5mm.

Clinical Resolution Lab (CRL) has also developed a range of clinically proven peptide based solutions and support products to enhance MTS treatments These include: Vital W (Wrinkle) for natural Collagen Inducing Therapy against acute and/or chronic ageing; Vital PS (Pigment Stabilization) to inhibit the synthesis of melanin, limits its migration at the skin surface and provide effective skin lightening; Vital HR (Hair Restoration) for Alopecia, to stimulate the Anagenic Growth phase and suppress the Catagenic Rest and Telogenic Loss phases; Vital CL (Cellulite) for regulating pre-adipocyte diff erentiation and stimulating lipolysis; Vital SM (Stretch Marks) to restore the skin’s dermal matrix molecules prematurely destroyed by the trauma of the skin being forcibly extended; MTS Peptide Aqua Gel Mask, a hydrating gel mask for soothing the skin after treatments; MTS Numb Master Topical Anesthetic Crème and MTS Sterilizing Solution for sterilizing the MTS Roller at home.

M edik 8 ® T itanium R oller and D ermastamp The Medik8 Titanium Dermaroller is designed to treat wrinkles, scars, acne scars, hyperpigmentation, cellulite and stretch marks, the device can be used on its own or in conjunction with products from the Medik8 range. The dermaroller’s accurate and minimally intrusive penetration allows not only a much higher absorption of Medik8 serums and creams but has also been proven to stimulate collagen production, dramatically improving the condition of the skin.

Most dermatological facial rollers are made from stainless steel, which can blunt easily with daily use. The Medik8 Titanium Dermaroller needles are engineered in Sweden from pure titanium giving a finer and more durable edge, preventing excess irritation caused by ordinary steel needles.

In addition each individual Medik8 Titanium Dermaroller microneedle is gold plated to maintain sterility. This technology produces extremely accurate and pinpoint punctures in the skin, with the aim of improving the treatment result. The gold coating also prevents oxidation and pitting of the surface even with long-term use. No other dermaroller is made with

18

cosmeticnewsuk.com

titanium needles, so only the Medik8 Titanium Dermaroller can be re-used intensively for three to six months. Medik8® also recently launched the Titanium Dermastamp to compliment its existing dermal rolling therapy.

A convenient and multi purpose device the Titanium Dermastamp uses precision-engineered titanium needles to penetrate the epidermis of the skin and provide penetration pathways to enhance the absorption and consequently, the power of the topically applied skincare product.

The extreme precision capabilities of the Titanium Dermastamp provide tremendous accuracy meaning it can be used on all areas of the face and body including around the delicate eye and peri-oral area and those usually difficult to treat with the Dermaroller. As with the traditional Medik8® Dermaroller therapy, Dermastamp is suitable for all skin types and comes with minimal risk and contraindications. Medik8® Titanium Dermastamp is available in three models: Medik8® Titanium Dermastamp Personal 0.2mm & 0.3mm; Medik8® Titanium Dermastamp Clinical Models 0.3mm & 0.5mm and Medik8® Titanium Dermastamp Medical Models 0.5mm, 1.0mm & 1.5mm.

GENUINE GERMAN MEDICAL ENGINEERING DO NOT ACCEPT SUBSTITUTES

• Stretch Marks

• Sun damaged & ageing skin

Genuine Dermaroller ™ Therapy ™ only available from trained practitioners and authorised Genuine Dermaroller ™ clinics.

MEDIZINISCH-NADEL-TECHNIK™

TH

IC

• Facial and décolleté lines & wrinkles AU

• Acne Scars

ISED CL OR I TH

IC N

Make sure it’s a Genuine Dermaroller ™ with its German medical engineering, quality and safety assurance that is used to improve:

AU

Genuine efficacy, quality & safety assurance

OR

ISE D CL

IN

For more information call:

0800 0195 322

It’s a Genuine Dermaroller™ if it’s manufactured by Dermaroller GmbH, Germany and you see the Dermaroller trademark logo

www.genuinedermaroller.co.uk Advanced evidence-based dermatological medical-devices, pharmaceuticals & medigrade skincare

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Skin Needling Special/Clinical Study

tissue

We summarise the results of a study of percutaneous collagen induction therapy in the correction of post-burn scars by Dr Igor Safonov from the Centre for Treatment and Correction of Scars in the Ukraine

AB S T R AC T Post-burn scars are usually treated with laser, dermabrasion or deep chemical peels. All these are ablative methods, however, which means that they partially remove the epidermis.

Microneedle or Collagen Induction Therapy (CIT) offers a non-ablative and thus less traumatic alternative for the treatment of post-burn scars.

This article discusses the abilities of this therapy for the improvement of hypertrophic and inactive keloid post-burn scars and gives typical treatment results. Due to its numerous advantages over ablative methods, CIT has the potential to develop from an alternative to a standard method of post-burn scar correction.

I NTRO DU C T ION Scars are permanent companions of humans. They may differ in appearance, depending on a number of factors like depth and mechanism of trauma or inflammation, adequacy of treatment, localisation etc. However, all scars leave marks not only on the body, but in the soul as well. Almost all patients would like either to get rid of their scars, or at least improve their appearance. The causes for scarring are manifold including home accidents, cuts, emergencies, surgery and skin inflammatory diseases.

Post-burn scars hold a unique position in this list. Burn scars in the vast majority are either hypertrophic scars or keloids.

Presently, there are few methods capable of any substantial improvement in the appearance of burn scars. Most of these methods employ epidermal removal and disruption of dermis continuity, and consequently bear the threat of new scarring. Moreover, such procedures are often followed by hyper- or hypopigmentation.

At present, the least traumatic method to treat varying types of burn scars is Microneedling, also known as Collagen Induction Therapy (CIT). With this method, both the epidermis and dermis continuity remain intact, which makes this method clearly less traumatic.

TYPES OF POST-BURN SCARS Hypertrophic and keloid post-burn scars most often cause serious physical as well as aesthetic problems.

Therefore, many dermatologists and plastic surgeons focus on the treatment and improvement of these scar types. Hypertrophic scars (Fig. 1) rise above the adjacent skin, but unlike keloids they do not surpass the bounds of the damaged area. Collagen fibres making up the scar tissue are oriented parallel to the skin surface. Such scars usually mature in 12-18 months. Self improvement is possible in some cases, though never complete.

Keloid scars or keloids (Fig.2) significantly surpass the primary trauma area. They are a massive growth of the

Fig. 1. Hypertrophic scar on a calf

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connective tissue on locations of burns, traumas, post inflammatory processes and surgery. Unlike all other types of scars, keloid scars cannot be defined as “young” or “old”. Instead they are defined as “active” or “inactive”, irrespective of the scar age. Active keloid scars grow, cause pain, itching, numbness, and emotional distress.

They look tense and red, often with a cyanosis tint.

Inactive keloid scars do not grow, their colour is pinkish or resembles the normal skin tone, and the distress caused is thus much smaller.

The scar substrate of keloids is made up of hypertrophic fibroblasts and randomly located immature collagen fibres forming a fingerprint-like pattern.

Fig.2. Active keloid scars on a body

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BURN WO UND PHYSIOPAT H OLOG Y As early as 24 hours after a heat injury, a great number of inflammatory mediators appear on the trauma site. Post-burn scar formation is mainly controlled FGF (fibroblast growth factors), which induce granulation tissue formation in vivo, and TGF-β (transforming growth factors).

Depending on the presence or absence of other growth factors, TGF-β stimulate or inhibit the growth of many different cell types [1]. TGF-β are located in the alpha granules of platelets and can be synthesized by many cells in vitro. They have a powerful chemotaxis and attract mobile cells, including macrophages [2-4]. Moreover, TGF-β1 and TGF-β2 have been shown in recent years to induce collagen synthesis, and TGF-β3 to facilitate wound healing with a normal collagen lattice, i.e. without scarring [5, 6]. Embryonal tissue - which heals without scarring – is characterised by low levels of

TGF-β1 and TGF-β2, and a high level of TGF-β3.

Put simply, hypertrophic or keloid scars form as follows. Shortly after a heat injury, TGF and FGF appear in the wound besides other inflammatory mediators. They cause migration of fibroblasts from other regions to the injury site, and proliferation of those already there. Since the injury is severe, fibroblasts have to work with higher intensity, which gradually leads to hypertrophy. Hypertrophic fibroblasts synthesize large quantities of collagen, much more than can be lysed by collagenase. Thus the dynamic equilibrium “collagen synthesis = collagen degradation” is shifted towards synthesis, which eventually results in hypertrophic and keloid scarring. The entire chain will look as follows: trauma = TGF and FGF = fibroblast migration = fibroblast proliferation = fibroblast hypertrophy = immature collagen fiber synthesis = hypertrophic / keloid scar.

COL L AGE N INDUC TION TH E R APY (C I T ) Collagen induction therapy (CIT) was carried out using the Dermaroller® (Dermaroller Fig. 3) with a needle length of 1.5 mm, 2.0 mm, and 2.5 mm respectively (depending on scar type, scar mass and scar location). In the facial area, the 1.5 mm roller was used, 2.0 mm in the calf area, and 2.5 mm on a thigh and lower arm.

A needle length of 1.5 - 2.5 mm is necessary to destroy the old Fig.3. Dermaroller® (Dermaroller)

PAT I E N T GRO UP S E L E C T I O N Any currently existing invasive or minimally invasive correction technique is recommended only to be applied to hypertrophic scars and inactive keloids.

Active keloids, however, should not be treated since there would be a high probability that they start to grow even more. The reasons for this are as follows: The epidermis over an active keloid scar is usually thinner, whereas the reticular layer of the dermis is enlarged, and the papillary layer is smoothed.

Even a small trauma may cause damage to the entity of epidermis and dermis, especially also such procedures as peeling, laser or mechanical resurfacing. In response to the trauma, hypertrophic fibroblasts will forcibly “patch” the defect and this will require even more fibroblasts. This will result in even more fibroblast proliferation, increase in collagen synthesis and further scar enlargement.

T R E ATM E N T R E S ULTS Some months after CIT, a clear improvement in all scar tissue characteristica is visible. Existing erythema are significantly reduced by Dermaroller therapy. That this reduction is indeed caused by the CIT and is no effect of self-regeneration can be seen from the fact that erythema is reduced only in those areas where the Dermaroller was used (Fig. 4,5). After a facial treatment, for example, erythema is reduced where the Dermaroller was used, but not on the (untreated) upper eyelids. Here, erythema persists even seven months post-op. The reason for this reduction presumably is the destruction of excess capillaries.

scar tissue located in the dermis at a depth of 1.0 mm to 2.0 mm.

In conducting a CIT, it is expedient to use either local application anaesthesia or general anaesthesia, if required. Local infiltration anaesthesia should not be used, since it will cause local edema that will prevent the needle penetration into the reticular dermis to the required depth. Moreover, this type of anaesthesia may distort the visual pattern of the operative field.

In all cases, we used local application anaesthesia with Sol. Lidocaine 10% (spray) under occlusion. About 20-30 min. after applying the anaesthetic, the Dermaroller procedure was carried out according to a standard protocol. After the procedure, a thin layer of antibiotic cream or ointment was applied on the surface treated to prevent infection. No pre-operative preparation was carried out. Some authors suggest the application of vitamins C and A, or their derivatives, during at least one month before the procedure [7].

However, vitamin C is not accumulated in tissues, but is constantly consumed, oxidised and excreted from the body. Its elevated concentration in the area of a hypertrophic or keloid scar can promote even more intensive growth. Preferably, vitamin C should be used in the post-operative period, when the synthesis of new collagen starts. It is needed as a hydroxylation participant namely in this period [8].

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Fig.4. Post-burn hypertrophic facial scars before (left) and 7 months after the procedure

Fig. 5. The same case (fragments)

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Skin Needling Special/Clinical Study

In another case one can see a hyperemic area at the edge of a scar (Fig. 6, left “before”). This is usually the area of active scar growth. However, this scar differs from the keloid shown in Fig. 2 as the skin tone in the center of the scar hardly differs from normal skin. This keloid is inactive and is in the status of regression. Such scars may be exposed to micro-needle therapy with a reasonable risk.

In this case, CIT was performed with a 2.5 mm Dermaroller. Results were visible 5 months postprocedure: the old scar tissue is destroyed mechanically.

Fig.6 Post-burn keloid scar on a thigh before and 5 months after one CIT procedure

factors. Interestingly, gene expression for TGF-β3 stayed up-regulated longer than the initial healing phase, in contrast to TGF-β1 and TGF-β2. This finding indicates that healing after a CIT takes place without scarring [9, 10].

Another example is the treatment of hyperpigmentated scars. The case shown here is a three year old hypertrophic hyperpigmented post-burn scar on the posterior surface of the left calf (Fig. 7). The scar relief was very inhomogeneous: normotropic tissue areas interchanged with hypertrophic areas, normal pigmentation with hyper- and hypopigmented areas.

A single CIT was carried out with a 2.0 mm Dermaroller®.

Some months after treatment the skin relief is smoothed, the scar surface became practically level with the adjacent skin. Also the colour much more resembles the normal skin tone. One may suggest that Dermaroller microneedles injured the melanocytes in which the melanin content was unusually high. The old, already synthesized melanin slowly dissolved, and new melanin was synthesized in normal amounts. Since melanin biodegradation is a long process, the result of the procedure was visible only after 8 months.

Fig.7 Old hypertrophic hyperpigmented post-burn scar on the posterior surface of the left calf before (left) and 8 months after a single CIT procedure Chaotically organised immature collagen is transformed into regular mature collagen fibres forming a normal parallel pattern. The scar becomes much flatter and scar mobility is clearly increased.

The formation of a regular collagen lattice after microneedling is supported by other authors’ clinical findings. Moreover, animal studies show that microneedling stimulates the expression of genes coding for collagen I and various growth

CO N C LU S I O N In conclusion it can be said that microneedle-therapy with the Dermaroller® is not just an alternative method, but presently is evolving into a main method for the treatment and correction of post-burn hypertrophic and inactive keloid scars. And though the mechanisms of microneedle action are not fully understood yet, the advantages of the method are obvious: • No pre-operative care needed • No need for general anaesthesia [References] 1. Lynch, S.E., R.B. Colvin, and H.N. Antoniades. 1989. Growth Factors in Wound Healing. Single and Synergistic Effects on Partial Thickness Porcine Skin Wounds. J. Clin. Invest. The American Society for Clinical Investigation, Inc. Volume 84:640-646.

2. Sporn, M.B., A.B. Roberts, L.M. Wakefield, and R.K. Assoian. 1986. Transforming growth factor beta: biological function and chemical structure. Science 233:532-534.

3. Wahl, S.M., D.A. Hunt, L.M. Wakefield, N. McCartney-Francis, L.M. Wahl, A.B. Roberts, and M.B.Sporn.

1987. Transforming growth factor beta 3 induces monocyte chemotaxis and growth factor production.

Proc. Natl. Acad. Sci. USA. 84:5788-5792.

4. Assoian, R.K., and M.B. Sporn. 1986. Type beta transforming growth factor in human platelets: release during platelet degranulation and action on vascular smooth muscle cells. J. Cell Biol. 102:1217- 1223.

5. Bandyopadhyay B., J. Fan, S. Guan, Y. Li, M. Chen, D.T. Woodley, and W.Li. 2006. A “traffic control” role for TGFbeta3: Orchestrating dermal and epidermal cell motility during wound healing. J Cell Biol.

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• No post-operative period • Short rehabilitation period, thus low professional and social downtime • Minimal pain after the procedure • Post-op redness and swelling subsides within 24-48 hrs • Minimal risk of post-op hyper- or hypopigmentation • Procedure can be repeated until a satisfactory result is achieved (treatment interval of at least six to eight weeks is recommended) • High efficiency at low cost

172(7):1093-1105. DOI: 10.1083/jcb.200507111 6. Bhogal R.K., C.M. Stoica, T.L. McGaha, and C.A. Bona. 2005. Molecular aspects of regulation of collagen gene expression in fibrosis. J Clin Immun. 25(6):592-603. DOI: 10.1007/s10875-005-7827-3 7. Aust M.C., K. Reimers, and P.M. Vogt. 2009. Medical needling: improving the appearance of hyperthrophic burn-scars. GMS Verbrennungsmedizin 3:Doc03.

8. http://www.vitamins-supplements.org/vitamin-C.php: Vitamin C functions, uses, and health benefits.

9. Aust M.C., K. Reimers, A. Gohritz, S. Jahn, F. Stahl, C. Repenning, T. Scheper, M.A. Altintas, N. Schwaiger, J, Redeker, and P.M. Vogt. 2010. Percutaneous collagen induction. Scarless skin rejuvenation: fact or fiction? Clin Exp Dermatol 35:437-439 doi:10.1111/j.1365-2230.2010.03779.x 10. Aust M.C., A. Gohritz, J. Redeker, K. Knobloch, M. A. Altintas, C. Herold, N. Schwaiger, and P.M. Vogt.

2010. Die perkutane Kollageninduktion durch “Medical Needling”. Plastische Chirurgie 2/2010:91-97.

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Skin Needling Special/needling skills

Skill seeking Kamila Kingston on why skin needling techniques matter

It is extraordinarily rare to find a course taught by someone experienced at needling the skin to induct collagen or for transdermal absorption. It is commonly accepted that skin needling is taught by someone with no experience or background in needling or knowledge of needles in general. This is the age of the professional trainer and experience using the products is no longer a prerequisite of providing training.

Kamila Kingston co- founded the first cosmetic acupuncture clinic in Australasia that was widely featured in the media for its innovative natural techniques. Kamila now resides in the UK and is a director of White Lotus Anti Aging- www. whitelotusantiaging.co.uk and www.whitelotus.com.au

There are so many techniques that can be taught that not only improve the treatment and results, but have higher patient compliance and allow bespoke treatments. By gaining a true understanding of how skin needling works and can be applied in actual practice clinicians have the ability to tailor the treatments to suit their clients rather than adopting the one size fits all approach commonly promoted in the industry.

As well as allowing bespoke treatments good technique has other compelling advantages. It is quite simple to teach painless skin needling; this is without the use of anaesthetics if you have the experience to know how to. In a recent survey 93% of students that attended the White Lotus training reported it not to be painful. This seems incredible considering it was the first time that they had received and practised these techniques on each other. An experienced therapist can truly use needles painlessly this in fact should be the first step in accessing the skill of the clinician.

It may help to compare these practises to those of a surgeon. There is no way that a student surgeon would not practice diligently how best to use a scalpel before commencing surgery and continue to improve their skills once qualified and experienced. It would be unheard of for the student to teach or even practise surgery without learning good methodology and proving they were competent. They would also no doubt learn different techniques to perform certain procedures and be willing to update their skills even when they were proficient. They would also use the best materials and equipment and ensure they were sterile. It is baffling why this does not

â&#x20AC;&#x153;As well as allowing bespoke treatments good technique has other advantagesâ&#x20AC;? occur with the practice of skin needling.

Learning tested techniques allows the therapist to deliver the highest quality treatment as well as thoroughly understand the process. The practise of needling heavily and slowly with larger needle sizes (whether with a stamp or a roller) creates unnecessary trauma, bleeding and recovery time. Ultimately this practise gives skin needling a bad name with poor patient compliance. If anyone doubts this Google a patient forum that provides feedback on these more damaging skin needling techniques. It is instantly clear that they are found to be painful and unnecessarily traumatic. Even the purists amongst us will recognise that no matter how good the results you can demonstrate in scientific trials you will not achieve results if patients will not come for treatments. In addition the results often arenâ&#x20AC;&#x2122;t comparable to what can be achieved when skilful techniques are adopted with high quality, sterile devices, natural products and the smallest needle size appropriate to the condition.

When discussing this topic it is interesting to note the results of several scientific studies into the length of micro needles required to achieve results. A 2006 study demonstrated that collagen induction only takes place to

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Skin Needling Special/needling skills

“Skin needling is being touted as ‘the next best thing’ surely we can raise the standard and offer a superior, safe service?” around a depth of 0.5-0.6mm (1). This was despite the use of a 1.5mm roller. Even taking into account the fact that the micro needles do not penetrate to their full depth this clearly suggests the needles are unnecessarily long and therefore unnecessarily damaging underlying structures. This clearly begs the question why some still advocate the unnecessarily high trauma of these longer needles for all conditions and skin types.

This collagen induction is principally performed by the fibroblasts which have become something of a holy grail of the cosmetic industry in the last 20 years. There is also however speculation that keratinocytes located much closer to the surface may play a much larger role than previously considered through improved communication with the fibroblasts. Given this and the evidence above it does not make a lot of sense to use excessively long needles that just cause higher levels of trauma without higher results to justify it.

In addition to its ability to increase collagen induction the other principal benefit of skin needling is its ability to increase transdermal absorption. Interesting a 2009 study showed that the 0.5mm roller is actually more effective for increasing transdermal absorption than the 1.5mm roller (2). This sounds counter intuitive but reflects the fact that the 0.5mm roller deposits substances at the most advantageous depth for absorption.

In practise the skin certainly responds better when using this less invasive approach, it also responds best to the least amount of physical damage to achieve the desired result. The philosophy that we always teach is to use the 0.5mm on the face wherever possible. Scientific trials have clearly shown that collagen induction takes place with a 0.5mm roller. If this is truly the case surely in many cases larger needles are overkill and may be working against the results one would like to achieve.

Only being taught to use 1.5mm rollers creates a one size fits all approach to skin needling limiting a clinicians ability to provide the best possible treatment in each individual case. As all in the

cosmetic industry know all patients’ skin is not the same and neither are their expectations. Good scientific practice fosters experimentation and trying different approaches, something that is entirely lacking in the way many practise skin needling.

It is of course necessary to use quality devices otherwise they will damage the skin. Surgical stainless steel remains the gold standard for needles and other surgical devices. The quality of the needles, how sharp they are, the gauge and sterility are of paramount importance to achieve the desired results. Inferior rollers literally catch on the skin, damaging the skin and causing pain. They also crumple from the pressure of rolling, further damaging the skin and causing little visible scratches.

The belief that topical vitamin A needs to be applied is another unnecessary practise that creates further side effects. Two major studies with skin needling have demonstrated very successful collagen induction without the use of any products (1,3). That is not to say that some products cannot enhance skin needling.

It simply explains that other products are accessories to the actual skin needling and are not essential as many marketing campaigns may suggest.

Dry, red, photosensitive skin is common after skin needling, why risk using a product which will virtually guarantee that this occurs in an exaggerated form? A lack of knowledge of products that are suitable and compatible with skin needling, coupled with the trainers’ need to cross sell a skin care range, is leading therapists to soak their clients skin with products that may potentially do more harm than good.

Why is it acceptable to perform exactly the same treatment on everyone? By applying skin needling into a system with sound protocols, it allows a broader application of treatments to arise.

Bespoke treatments should be the norm with skin needling as with all other cosmetic treatments.

Completely organic and natural treatments that improve health and beauty simultaneously are easy to deliver with skin needling if you are taught how to apply them. By using natural products without preservatives, parabens, petrochemicals, sls, synthetic vitamins, minerals and stem cells; you can achieve the best results and ultimately the highest patient compliance.

There is undoubtedly a skill to needling the skin and many approaches that can enhance these results. It is my hope that therapists will learn how to needle proficiently and efficiently.

The current practise of applying as much topical anaesthetic as possible in the hope that it will hide the pain created from poor technique, limited experience and heavy handed methods produces a very disappointing treatment. Skin needling is being touted as ‘the next best thing’ surely we can raise the standard and offer a superior, safe service?

[REFERENCES] 1-Schwartz et al, 2006, internet paper. Abstract reflections about COLLAGEN-INDUCTION-THERAPY (CIT) A Hypothesis for the Mechanism of Action of Collagen Induction Therapy (CIT) using Micro-Needles; 1st edition February 2006. 2nd revision January 2007 Horst Liebl 2. Badram, M. M., Kuntsche, J. & Fahr, A. (2009). Skin penetration enhancement by a micro needle device (Dermaroller®) in vitro: Dependency on needle size and applied formulation. European journal of pharmaceutical sciences. 3 6, 511–523.

3. Majid, I.(2009). Micro needling Therapy in Atrophic Facial Scars: An Objective Assessment. J Cutan Aesthet Surg. Jan–Jun 2(1), 26–30.

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Treatment Spotlight/ VASER Shape

S h a p i n g up

We take a look at the non-surgical alternative to liposuction, VASER Shape

Body contouring has become one of the biggest growth areas in aesthetics and one company that has been leading the way in this field is Sound Surgical with its revolutionary ultrasound assisted liposuction device, VASER. The VASER technique differs from traditional Ultrasound – Assisted Lipoplasty (UAL) procedures as it uses a patented probe, which delivers ultrasound energy from all sides, as well as from the tip, allowing the practitioner to sculpt more precisely. This means there is less risk of damaging the surrounding structures such as blood vessels or nerves, as with traditional UAL. The treatment can be done in a minor surgery environment however, despite offering a less invasive option to some other forms of surgical liposuction, VASER s still a minor op with downtime.

So it is no surprise that Sound Surgical has also now developed a ‘non-surgical’ system to meet the demand of the ‘no pain’, ‘no downtime’ clients as well as to enhance the results of other body contouring procedures by aiding lymphatic drainage.

VASER Shape is a non-invasive ultrasound and massage system that received FDA clearance in May 2010. This innovative computerised technology uses a combination of ultrasound diathermy (the application of high-frequency sound waves for local heat therapy) and zonal lymphatic massage to treat the fatty tissue layer and reduce the appearance of cellulite.

The VASER Shape treatment uses advanced ultrasound technology to warm the selected area and treat the underlying tissue to smooth, firm and shape the body by temporarily reducing in the appearance of cellulite and increasing local blood circulation and lymphatic drainage. VASER Shape can be used as a standalone treatment, and is also a perfect complement to body contouring/liposuction procedures to reduce postoperative pain and swelling.

It can be used to treat the abdomen, love handles, back, arms, hips, buttocks, thighs and knees.

The Procedure The average VASER Shape session time is about 30 BEFORE

AFTER

minutes per body area utilising both an ultrasound and massage handpiece. Treatments are usually scheduled a week apart, with a lymphatic drainage session scheduled between each combined ultrasound and massage session. Patients typically undergo a regimen of 4 to 5 total treatments, although physicians report that many patients see improvement after the first session. The treatment is comfortable and no pre-treatment preparation or anaesthetic is required. Patients report feeling a gentle warming of the skin accompanied by a feeling similar to a deep tissue massage. Following the procedure, patients can resume normal activity without pain or downtime. The skin may appear slightly pink and feel warm after the procedure due to the increased local blood circulation in the area. This should resolve itself within a few hours after the treatment.

The two handpieces of the VASER Shape System work in tandem to treat the target area and promote drainage through the lymphatic system. · Ultrasound Diathermy – Through the application of high-frequency sound waves for local heat therapy, the ultrasound energy affects fatty tissue in a non-invasive manner by warming the treatment area and producing a “micromassage” to the fat cells, encouraging excess fat to escape from the cell membranes and ultimately temporarily reducing the appearance of cellulite. · Zonal Massage – The zonal massage handpiece on the system then works with the lymphatic system to drain away excess toxins and fats for removal from the body and increase local blood circulation. The zonal massage handpiece can also help to open the lymph nodes pre- and post-treatment.

Clinical Benefits: · Smooth and shape the body by temporarily reducing the appearance of cellulite · Improve local blood circulation · Reduce pain and swelling postoperatively BEFORE

AFTER

Before and after treatment with Sound Surgical’s ultrasound assisted liposuction device, VASER.

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Marie N DiLauro, MD said, “ I am thrilled with my VASER Shape purchase. My patients are seeing consistent, predictable results with a pleasant treatment experience. The system was installed in mid-July, and by the end of August I had already made $65,000 from VASER Shape treatments.”

Paul Vanek, MD commented, “Patients see results right away and their clothes fit better. By week five they have significant, photographable and measurable improvement. Patients love that there’s no downtime and that they can get it done during a lunch break.”

Jeffry Schafer, MD added, “ The demand for non-surgical body shaping has grown tremendously over the past few years. VASER Shape is effective for men and women who wish to improve specific problem areas but do not want or need liposuction.

I have been in practice since 1978 and have been performing liposuction for the past 16 years. VASER Shape is the first non-surgical body shaping device that I have determined to be effective enough to introduce to my patients.”

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Mesotherapy/CELLULITE TREATMENT

On point Malti O’Mahony on treating cellulite with mesotherapy

Cellulite is known to appear as a result of the effects of excess oestrogen in females. It is estimated that approximately 98% of women suffer in some degree. Women develop cellulite after reaching puberty. Anyone may suffer from cellulite regardless of age, culture or ethnic background. Cellulite is not weight related.

‘Peau d’orange’ or orange peel is the reason many women seek treatment. There is a great demand for non-invasive treatments such as laser, ultrasound, cavitation, endermology, lymphatic drainage, pressotherapy or carboxytherapy.

Causes of cellulite Hormonal factors • Metabolic changes • Physiology • Connective issue • Genetic factors • Insulin • Catecholamines adrenaline • Noradineline • Thyroid hormone • Prolactin Genetic factors • Angiotensin converting enzymes (ACE) • Polymorphism • Hypoxia-inducible factor Predisposing factors • Sex • Ethnic background Lifestyle • Stress

changes starting with extra cellular matrix and connective tissue which is ineffective microcirculatory function.

In the extra cellular matrix, there is a change in the fibroblasts with decrease function and production of collagen, elastin and glycosaminoglycan’s (GAGs). That dysfunction increases the acidosis, resulting in overload of free radical reducing speed of microcirculatory flow, reduction in blood flow - this leads to a slowing and reduction in the flow of the capillaries and venules.

Changes in permeability of the capillaries, a loss of fibres and increase in free water in the extra cellular matrix, all of these cause lipoedema.

The treatment for cellulite should correct changes in extra cellular matrix; only then reduction of cellulite can be achieved.

Extra cellular matrix or interstitial matrix is a link between the extra cellular spaces. It supports scaffold for cell movement. The three dimensional complex is made up of protein, carbohydrates, salts, fixed cells, migrating cells and fibres which support the tissues and organs which is called interstitial matrix. It is important composition of extra cellular matrix (ECM).

the microcirculatory system, detoxification and drainage of venous and lymphatic systems slows, causing cellular and lipoedema. GAGS and ECM are responsible for the flow of microcirculation.

Viscosity in the ECM is supported by good concentration of GAGs allowing for the proper movement of molecules.

Mesotherapy Mesotherapy is therapeutic discipline that cannot be ignored. Today, it is widely used in several countries and in various specialities. It is also became subject of international congresses.

Mesotherapy techniques should be considered as contemporary therapeutic measure in the clinician’s practice.

Mesotherapy is defined as intradermal or superficial or subcutaneous, multiple injections of low doses of medications to treat local or regional pathologies. Mesotherapy techniques allow drug administration in low quantities at the site of dysfunction areas. The therapeutic effects depend on the choice of medication administration, depth, composition of drug cocktail and the site to be injected.

Mesotherapy works well in both younger and older females. Younger females achieve faster results than from middle age onwards.

Dr Michel Pistor (1958) states that mesotherapy is an allopathic, light, parental, polyvalent and regionalised therapy: •

Extra cellular matrix composition: All of these factors contribute to changes in skin.

Most women suffer dimpling and nodulary effect in the pelvic region, lower limbs and abdomen which is subcutaneous fat within fibrous connective tissue.

• • • •

•

Cellulite is a result of biochemical and metabolic

Without good concentration of GAGs and ECM in

Structural fibrous protein (fibroblasts) Adhesive proteins (glycoproteins) Proteoglycans Glycosaminoglycan’s (GAGS)

•

•

Allopathic therapy: medications are included in the official pharmacopeia Light therapy: lower doses are used in comparison with doses used in traditional medicine Parental therapy: intradermal or subcutaneous injections with active drugs are administered, using procaine as a vehicle Polyvalent therapy: multiple diseases in cosmeticnewsuk.com

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Mesotherapy/CELLULITE TREATMENT

“Mesotherapy for cellulite treatment requires one weekly session for three to four months...a minimum of eight to 10 treatments are required”

•

various specialities have effective benefits Regionalised therapy: the treatment is delivered close to the site of the disease

Following is a chronological list of theories explaining the mechanism of action of mesotherapy: 1. Micro-circulatory theory (Dr Bicheron) 2. Mesodermic theory (Dr Dalloz-Bourguignon) 3. Theory of integumentary stimulation therapy (Dr Dalloz-Bourguignon) 4. Energetic theory (Dr Ballesteros) 5. Systematised spot theory (Dr Mrejen) 6. Third circulation (Dr Multedo, Dr Grau-Llobet) > Benefits of using Mesotherapy are: 1.

2.

3.

4.

Speed of injections Precision - delivery of medication per injection Consistency - achievement of same depth of penetration on each injection site Comfort - more comfortable for the patient and practitioner

The pharmacologically active agents used to act on the adipose tissue and on the connective tissue to improve microcirculation.

The active drugs acting on adipose tissue are methylxanthines, such as caffeine, theophylline and aminophylline, which have a lypolytic action and inhibit phosphodiesterase.

Also-beta-andrenergic agonists methylxanthins stimulate lipolysis thus reducing the size of adipocytes through increase of Cyclic Intracellular AMP (cyclic-adenosine-monophosphate) and

inhibition of phosphodiesterase. Coenzyme A and the amino acid L-carnitine facilitate the effects of mehylxanthines by stimulating mobilization and destruction of free fatty acids, by improving their active transport through the mitochondrial membrane. To achieve methylxanthine activity in subcutaneous fat over the beta-1, 2 and 3 adrenergic receptors, it is important to block the alpha 2 receptors (antilipolytic receptor) using Yohimbine.

Mesotherapy is often described as a ‘’magical treatment’’ for localised adipocytes that are sometimes called “liposculpture”. However, the two treatments have entirely different actions on adipose tissue. Drugs used in mesotherapy to reduce adiposities have a lipolytic action, while liposculpture has a lipoclassic action (reduction in number of fat cells).

The drugs acting on connective tissue i.e. silicium salts have a structural element that regulates and normalises cellular metabolism and cellular division.

> Mesotherapy action depends on: 1. Reducing lipoedemas - use of benzopirone plus procaine 2. Restoring efficient microcirculation – use of flavonoids, which are beneficial for vasculo-protective effects i.e. vitamin C is essential for neutralising effect on free radicals generated by newly oxygenated tissue 3. Lipolysis - use of theophylline, caffeine, L-carnitine and yohimbine plus procaine 4. Restructuring and protecting connective tissue – silicium stimulates the regeneration of connective tissue Mesotherapy for cellulite treatment requires one weekly session for three to four months.

To see the results a minimum of eight to 10 treatments are required. Patient can continue the treatments until desired effect is achieved.

This technique works on extra cellular matrix, the microcirculation (arterial and venous capillary) and lymphatic system and finally, targets fatty tissue.

Remember, mesotherapy is a medical technique: 1.

2.

The other drugs act on the microcirculation include the vegetable extracts of Ivy and Indian chestnut which is rich in saponins (soap like foams when shaken in water), hydrophilic – water solutions such as gingko biloba and rutin which contains bioflavonoids. They reduce capillary’s hyperpermeability and increase venous tone by stimulating proline hydrolysis by inhibiting prostaglandin. They also reduce platelet aggregation, inhibiting the formation of microthrombi. The effective improvement in perfusion of microcirculation through its effect on erythrocyte deformation, platelet aggregation and fibrinogen plasma concentration.

3.

4.

Performing mesotherapy requires medical knowledge and practice An accurate assessment is essential on consultation The effective treatment is not linked to the amount of drugs but effectiveness of the drugs chosen for its pharmacokinetic and dynamic actions This also requires precise pharmacological criteria

Mesotherapy is one of many treatment modalities that we should master in order to be accomplished cosmetic/aesthetic practitioners.

[References] • • • • • • • •

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Fodor P.B. & Coll: Endermologie LPG, does it work? Aesthetic Surgery Journal, USA, 1997, 21:68 Bjorntorp P.: The fat cells, a clinical view. Recent advances in Obesity II, 1978 Bjorntorp P., Sjostrom L.: Number and sizes of adipous tissue fat cells in relation to metabolism in human obesity. Rev. Metabolism, 1972 Casley-Smith J.: Fine structure properties and permeabilities of the lymphaic endothelium. New trends in basic Lymphology – Exper. Suppl. 14, Bale Birkauser edit., 1981, 19 – 40 Binaglia, Marconi, Pitzurra: The diffusion of inradermally administred procaine. Giornale di Mesoterapia, 1981, I Salus Ed Parenti I.J., Serres P.: La Cellulite, Cahiers de Medicine Esthetique, 1986, Solal Ed Ravily G.: Atlas Clinique de Mesotherapie, Publications Medicales Internationales Ed, 1988 Pistor M.: Expose sommaire des proprieties nouvelles de la procaine locale en

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Case Study

i S t h at t h e case We find out how the iS Clinical® range is delivering dramatic physiological improvements to the skin iS Clinical® is dedicated to producing innovative, highly effective, clinically-validated skincare products that deliver dramatic physiological improvements to the skin.

Originally from the US, this scientifically advanced luxury skincare line is available globally and bridges the gap between science and beauty. Appealing to the sophisticated consumer that researches and is well educated about skin concerns and treatment options, this range is ‘clinician friendly’ as it is easy to incorporate into a practice and introduce to an existing client skincare regime.

The iS range is manufactured using only the highest pharmaceutical grade ingredients and is extremely successful in treating medical skincare conditions such as acne, rosacea and hyperpigmentation as well as exceptional results in the aesthetic beauty market.

Selling points of the iS range:

• Results: Exceptional result driven product range.

• Quality: Pharmaceutical grade ingredients.

Case-studies Hyperpigmentation iS Clinical products for hyperpigmentation are formulated with pharmacy-grade botanical ingredients that work synergistically and safely with skin cells to gradually lighten and even the appearance of pigmentation. The Hyperpigmentation Regime includes products

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• • • • •

Back up: Full product training is provided and all clinical review paper and patient testimonials supplied to stockists.

Concise: Small product range.

Customer satisfaction: High yield, profit generating repeat business.

Exclusivity: iS Clinical is not available in department stores. Only sold in high-end medi-spa’s and dermatologists.

Luxury: High quality packaging and point of sale display.

Celebrity following: iS Clinical® is established and used by a host of high profile celebrities in the US including: Beyonce, Charlize Theron, Courteney Cox, Demi Moore, Gwyneth Paltrow, Halle Berry, Jada Pinkett Smith, Lindsay Lohan, Mary J. Blige, Melanie Griffith, Nicole Scherzinger, Oprah Winfrey, Rachel Bilson, Renee Zellweger, Ryan Seacrest, Sheryl Crow, Will Smith and Zac Efron.

The strength of this range really does lie in the vast amount of research and clinical studies conducted to support the development and formulation for the range. Not only are the ingredients supported by studies, but the finished formulations also undergo clinical studies.

that address overproduction of melanin, encourage exfoliation, and provide sun protection. Broad-spectrum UV sun protection is of paramount importance to treat this condition and prevent its reoccurrence

Acne Formulated to synergistically and safely clear the skin, the iS Clinical Acne regime includes

BEFORE

AFTER

•

products that encourage exfoliation while addressing inflammation and infection.

Rosacea Developed to soothe and calm the symptoms of rosacea, the Rosacea regime includes products that provide antioxidant protection, reduce inflammation and irritation, and improve the appearance of the skin.

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ADVERTORIAL - Clarisonic

Riding the wave of success How Clarisonic’s latest innovation, the Opal Sonic Infusion® is offering the next wave in sonic skincare to the professional arena

T

he at home devices market has been booming over the past few years and one of the leading innovators in this field is Clarisonic. Led by the primary inventor of Sonicare®, Clarisonic’s sonic skin cleansing devices have become increasingly popular due to their effectiveness at clearing pores and removing dirt six times more efficiently than manual cleansing.

The brand has also extended this success into the professional arena with the Clarisonic Pro and its latest revolution, the Opal Sonic Infusion®. Building on the benefits of the sonic skin cleansing systems, Opal extends Clarisonic products from sonic cleansing to sonic infusion. According to Robb Akridge PhD, Clarisonic’s Vice President of Clinical Affairs, “Opal’s soothing, gentle sonic vibrations infuse your serum into the upper layers of the epidermis where it begins to work immediately.

In clinical studies most women reported seeing an immediate reduction in fine lines and wrinkles and firmer, brighter, more hydrated skin in just one minute. The results typically last for hours and benefits improve over time.”

A palm-sized sonic infusion device, the Opal is specially designed to help build skin’s resilience over time and prevent future damage around the eyes. By gently tapping the skin around the eye at 125 sonic movements per second, the Opal dispenses the eye serum more effectively than using your finger alone.

Dr Toni Phillips, Clinical Consultant at Destination Skin, has been using the product for seven months.

She comments, “The great thing about the Opal is that it is meant to imitate the tapping of the fingers when you are putting serum around the eyes. The way that I sell it to my clients is that it will allow better infusion of whatever eye serum they are using.

“What we are also seeing is that when you use the tapping motion around the eye you do get a change in the fluid dynamics in the area so instant hydration and brighter looking eyes. Because you can see a result instantly it is quite a nice marketing tool and will help translate into sales because they have tried the product. Clients spend quite a lot of money on these eye serums and if they use them with the Opal they will get an enhanced result.”

As well as being a highly desirable retail item, the Opal can also be used in clinic. Dr Phillips explains, “We get a lot of patients who are concerned about the appearance of the eye area and it is an area I really love to treat. I use a lot of botulinum toxin, but toxin can only go so far, you have also got to address the quality of the skin and also volume in the tear trough area and the hydration of the skin.

In clinic you can use the Opal before botulinum toxin treatments to infuse the area with an antioxidant. It will give a better infusion of whatever eye product you are using and enhance the results of other treatments you are doing in clinic.

I recommend to my clients that they wait at least a week after having toxin treatment before using the Opal, ideally after two weeks when they have their review, and with the dermal filler just 24 hours.”

Application is quick, gentle and involves three easy steps: simply charge Opal, dispense an eye serum onto the applicator tip, and infuse your skin by moving the device in a circular motion around the bone of the eye. Proven immediate and long-lasting results include a decrease in the appearance of fine lines and wrinkles as well as invigorated, soothed and firmed skin.

Dr Phillips has been using the product at home herself and this helps her when selling the concept to patients. She says, “I have had my Opal since Christmas and I use it just about every night. It is really good the morning after a big night out when your eyes are a bit puffy. I gave one to my 72-year-old mother for her birthday and she has got a fantastic result – particularly on one eye – she swears her eye area looks firmer and the skin is tighter and that is after using it for four weeks.”

Opal has been developed to be used with the Clarisonic Anti-Aging Sea Serum or the patient’s preferred eye serum. The Clarisonic Anti-Aging Sea Serum has been scientifically developed by Robb Akridge, PhD, and Greg Peterson, PhD and is optimized for the dynamics of sonic infusion. The antioxidant-rich formula provides a multi-layered approach to promote healthy, vibrant skin.

Key ingredient include: • Kigelia Africana Fruit Extract: firms, plumps and soothes

Key statistics/benefits: • 88% of people noticed a reduction in the appearance of fine lines and wrinkles* • 95% reported firmer, tighter skin* • Refreshes, energizes and brightens the appearance of your skin • Increases skin’s hydration • Reduces appearance of puffiness • More effective than manual product application

• Glycosaminoglycans: firm, brighten and moisturize • Canadian Willow Herb and Oat Kernel Extract: soothe • Gentle for daily use. Paraben free.

Dr Phillips says, “You can use it with any eye product however because the tip is silicone it doesn’t glide by itself over the skin so you need to use a product that acts like a lubricant so in my experience using a gel is generally better than using a cream. The Opal comes with the marine algae serum, which is really great, as it is very soothing and it makes your eyes look fresher and brighter. So I would recommend using that as well as their own eye product afterwards.”

Designed to be used twice a day, the Opal Sonic Infusion System delivers optimum results if applied after Clarisonic cleansing. The Opal Sonic Infusion System provides 21 days of use from a full charge, features one sonic infuser, two applicator tips, Clarisonic Opal Anti-Aging Sea Serum and universal charger.

Stockist Enquiries: aterrington@clarisonic.com General Enquiries: uksales@clarisonic.com

LoveLite Ice have developed Lipoglaze a new found celebrity secret for both Men and Women delivering fast results!

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Product Focus

N o pain ,

clinics ’ gain We find out why Soprano is the treatment of choice for many aesthetic clinics offering laser hair removal

Hair removal is big business and, alongside cosmetic injectables, is the bread and butter treatment for most aesthetic clinics. When it comes to laser and light based hair removal treatments today it is all about providing less painful or even ‘pain free’ hair removal in a shorter amount of sessions with longer lasting and more permanent results for a wide range of hair types and skin colours.

One treatment that ticks all these boxes and has become the laser of choice for many leading aesthetics clinics is the Soprano® XLi from ABC Lasers.

One of the original pioneers of virtually pain free laser hair removal, the Soprano® XLi has raised the bar across the industry. Recent Google statistics show that over a third of Google searches for laser hair removal are for Soprano® showing that this treatment with its 810nm diode laser and exclusive In-Motion™ technology has captured the hearts of both the public and medical professionals.

For leading clinic chain Court House Clinics, Soprano laser hair removal, is one of their most popular and signature treatments. CEO Paul Wilkinson says, “When I joined Court House Clinics three years ago it was apparent that the clinics with Soprano had the highest repeat business and were attracting most new business. At first glance the high capital cost seemed prohibitive but as Soprano uses no consumables, the annual running costs worked out much cheaper than lower priced machines and patient satisfaction was very high. We now have Sopranos in eight of our clinics and our laser hair removal business has increased by 250%. A fantastic return on investment that has completely changed our fortunes as well as enhancing our reputation as a clinic group that offers the highest quality treatments.”

Dr Bob Khanna Founder of the DrBK Clinic agrees.

He says, “When looking to develop my new aesthetic dental and cosmetic clinic – ‘Dr BK’ in Reading – I

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wanted to introduce an aesthetic treatment that would have high patient demand and provide excellent results. We opted for the Soprano XLi laser and the painless hair removal has proven to be a great success with our clients. Treatments are fast, comfortable and results are great – I speak from personal experience! The level of support and service you get from ABC Lasers is fantastic. Any problems we have had have been very minimal but if we have ever had anything that needs adressing the team is happy to go out of their way to make sure there is minimal disruption to your clinic and patients which is invalueable.”

Top cosmetic surgeon, Mr Chris Inglefield adds, “Soprano XLi has been a quantum leap in my clinic for offering our patients pain free hair removal.”

Low fluence makes the Soprano XLi standout in the industry. Instead of simply blasting unwanted hair, SHR technology heats the hair follicles gradually—without discomfort. In fact, this approach, combined with cooling from the Sapphire tip, makes it so comfortable that neither gels nor analgesics are required. The Soprano® XLi works by safely and gently heating the dermis to a temperature that damages the hair follicle, prevents re-growth, yet does not injure the surrounding skin.

“Soprano® is one of the most popular systems for laser hair removal. It’s In-Motion technique has been proven to be a faster treatment and less painful than traditional diode lasers, and is effective for maintaining hair reduction for a long period of time”, commented US Dermatologist and laser luminary Dr Michael Gold. Soprano XLi works on all skin types, including tanned skin, and all hair pigmentation, so the practitioner can provide safe, effective and painfree SHR hair removal for anyone, anytime--without restrictions at any time of the year which is a plus for profitability.

The system is also incredibly versatile, allowing you to treat darker skin types, including tanned skin, widening the scope of laser hair removal in your practice. The Soprano XLi Blue laser was the first laser hair removal system to receive FDA clearance for the treatment of all skin types. This breakthrough modification in the Soprano XLi SHR technology has uniquely and exclusively opened the door for clinics to offer laser hair removal all year round even to those clients who are sun tanned (although fake tans are still prohibited). The FDA approval was a result of very extensive clinical research and publication of several peer reviewed studies which provide an overwhelming evidence as to the long term efficacy (six month and 18 month post a six sessions course), presenting an impressive safety record of 0% adverse skin respond of any kind.

Soprano® XLi also has a super fast coverage rate, with a huge 12x10 mm spot and up to 10 Hz repetition rate. Plus, with no consumables, it is easy to operate and very cost-effective. What’s more, the Soprano® XLi can also provide skin tightening with the near infrared NIR module. Uniform energy distribution with a huge 18cm2 spot produces deep dermal heating – without damage to the epidermis.

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Product News Lumixyl Revitaleyes Is Clinically Proven To Lighten Dark Under-Eye Circles

FDA-cleared Body Contouring Device Arrives in the UK

The SilDerm Group has just launched Lumixyl Revitaleyes Brightening Eye Cream, the first and only eye cream that uses the latest Decapeptide-12 technology to roll back the years by rejuvenating the eyes. It has been shown to be especially effective in lightening the dark circles around the eyes, a particularly common problem in Asian women due to the darker pigmentation of the skin.

Lumixyl Revitaleyes uses the skin brightening Decapeptide-12 technology, which inhibits over production of melanin, which is the natural dark pigment in the skin. Overproduction of melanin causes sun and liver spots on the hands and face and dark rings under the eyes.

Decapeptide-12 technology was developed recently at Stanford University in the USA and has been shown in clinical trials and published in respected dermatology journals, to effectively reduce the overproduction of melanin. It does this without causing problems such as permanent skin bleaching, thinning of the skin, irritation or redness associated with other products.

As well as combating hyperpigmentation, Lumixyl Revitaleyes contains the other proven ingredients that tackle the iron deposits, inflammation, dry lines and wrinkles, which make it the most comprehensive, professional-strength treatment for combating dark under-eye circles. The result is a, brighter, smoother and firmer skin around the eyes that gives a more even skin tone as well as a younger and more youthful appearance.

A groundbreaking new FDA-cleared medical device that won ‘Best Non-Surgical Body Contouring’ at the annual Aesthetic Awards in the US has launched in the UK. The MedContour treatment is a painless procedure that uses ultrasound and cavitation technology to break down fat cells in specifically targeted problem areas without invasive techniques, damage or scarring to the skin. By concentrating the ultrasound directly and only on fat cells, skilled clinicians are able to use a vacuum pump to suck in tissue and maintain its position on the unique ultrasound handpiece head, optimising the focus of the variable ultrasound frequencies to smooth and dramatically improve the body’s contours.

According to Dr Ravi Jain of Riverbanks, one of the first clinics to offer the treatment in the UK, “MedContour can be performed almost anywhere on the body and further aids the body’s lymphatic drainage system by helping the body excrete the fat cells, and after the recommended series of 4-6 treatments the results are long-lasting. In contrast to surgical liposuction there is no recovery time, so clients can resume their normal activities immediately following the effective, gentle and completely safe treatment.”

SkinCeuticals Unveils Impressive Clinical Results For Blemish + Age Defense® In 2011 SkinCeuticals launched the Blemish + Age product range to fight skin imperfections and signs of ageing. The application of the potent formula of the Blemish + Age Defense® serum, which contains a 1st-to-market acid combination of 1.5% salicylic acid, 3.5% glycolic acid, 2% dioic acid and 0.3% capryloyl salicylic acid, resulted in substantial improvements for blemished and aged skin, comparable to the results achieved from prescription drugs.

In 2012, following trials of Blemish + Age Defense® and the leading prescription drug for acne, BenzaClin® by a renowned boardcertified dermatologist, SkinCeuticals can confirm that there is no significant difference between the performance of SkinCeuticals Blemish + Age Defense® and BenzaClin® (a prescription drug containing 1% clindamycin and 5% benzoyl peroxide).

In a separate study, trials of Blemish + Age Defense® and the vitamin A, retinoic acid drug, Tretinoin (0.025% prescription drug) were undertaken to examine the efficacy of each on skin tone, blotchiness, roughness, dullness, fine lines, clogged pores and total lesions. The outcome resulted in Blemish + Age Defense® being statistically better performing than Tretinoin in improving skin tone, blotchiness and reducing total lesions. It performed equally effective as Tretinoin in improving all other signs of ageing and acne. At no point during the 8 week trial did Tretinoin statistically outperform Blemish + Age Defense®.

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Leave Scars Behind with SkinMedica® Scar Recovery Gel SkinMedica® has launched Scar Recovery Gel, a topical scar product containing Centelline™ that is clinically proven to minimise the appearance of scaring.

In a clinical study of 60 subjects who received small incisions from various plastic surgery procedures, 80% of those using Scar Recovery Gel demonstrated the best possible scar resolution (to Grade 1) in as little as six months compared to 13% of those receiving no treatment. In another study of 30 patients who received large incisions, 80% of those using of Scar Recovery Gel along with an adhesive tape demonstrated scar resolution to Grade 1 as compared to only 20% of those using adhesive tape alone.

LIPO-LIGHT OFFERS BREAKTHROUGH IN PAINLESS NON-SURGICAL BODY CONTOURING A new slimming and toning system, which uses LED light therapy for non-invasive body contouring, has been launched in the UK. Lipo-Light is a safe, non-surgical and painless alternative to liposuction, which can be used for targeted sculpting of those areas of the body which are notoriously difficult to tone; such as the stomach and waist, thighs and buttocks, or arms. The Lipo-Light slimming and toning machine uses eight pads, containing LED lights; six of which are placed directly on the area the client wishes to reshape, while the other two pads are placed on the lymph glands.

It works by stimulating the fat burning process or lypolysis. When the body requires energy, adipose cells are instructed to break down stored fat, which causes free fatty acids to be released into the blood stream and circulate through the body. The heat and light emitted from the LED light pads also stimulate this process, triggering this same physiological change in the body. Glycerol, fatty acids and water are released from fat cells in the area where six of the pads are placed.

The pads on the lymph glands stimulate the lymphatic drainage process, helping to release this matter through natural means.

Representing and Supporting Nurses

BACN 3rd Annual Conference and Exhibition ‘Beyond Fillers and Toxins’ 6th October 2012 – 08.30am to 5pm at The IET Savoy Place, 2 Savoy Place, London, WC2R 0BL A day of expert knowledge, with evidence based clinical presentations, practical advice and new approaches in treatments such as Carboxy Therapy, Skin Needling and Topical skin pharmaceuticals, Radio Frequency and much more. Including presentations from international and homegrown speakers who are leaders in the field of aesthetics and the skin.

The BACN hope that those attending will be inspired and motivated, charged with fresh ideas and armed with useful information and understanding to put into practice.

Cost is only £110 for BACN members. Non BACN £150.

Open to nurses, doctors and dentists.

Price includes lunch, refreshments and post-conference reception and canapes Registration is via the website www.cosmeticnurses.org; or email to admin@cosmeticnurses.org or phone 01749 836 328.

The BACN committee and regional leaders look forward to seeing you all there.

Forthcoming Diary Dates Legal Workshop. Friday 2nd November 2012. Arc Conference Centre, Basingstoke.

Barrister Katie Hill will present on Legal issues including Informed Consent, Record Keeping and Expert Witness.

2 day Business Workshop and Practical Demonstration Day. Sun 10th and Mon 11th February 2013.

Details to follow on website soon.

Florence Barrett-Hill 4th-7th May 2013 Advanced skin analysis and treatments. Back due to popular demand, this will be Florence’s final appearance in the UK. Details to follow on website soon.

The BACN offers • • • • • •

Regional meetings across the UK Mandatory Basic Life Support training Informative Website with Blog/Forum Discounts on Insurance Sharing Expertise and Advice Education

• • • • •

Workshops Recruitment section on website Discounted services Offering Support Members only Facebook page

We off support er non-pre for scr registe ibing red nurses

www.cosmeticnurses.org | email: admin@cosmeticnurses.org | tel: 01749 836 328

abstracts

Abstracts

We summarise some of the most recent studies you may have missed Title: Reconstituted Injectable Hyaluronic Acid: Expanded Applications in Facial Aesthetics and Additional Thoughts on the Mechanism of Action in Cosmetic Medicine Authors: Fagien, Steven MD; Cassuto, Daniel MD Published: Plastic & Reconstructive Surgery: July 2012 Volume 130 - Issue 1 - p 208–217 Background: As we currently have a better understanding of the components of facial ageing, injectable filling agents have a larger role in nonsurgical facial rejuvenation. Many products are now available worldwide as options for treating the spectrum of indications that include particular agents used for the treatment of various facial rhytides and in larger quantities for regional or panfacial volumization. The latter indication has been most popularly treated with a host of agents classified as hyaluronans or injectable hyaluronic acid gels. The former had been traditionally and more successfully treated with injectable collagen or dermal matrix agents. Attempts to confuse these generalized approaches have often led to unsatisfactory results. With the precipitous disappearance of the availability of most injectable collagen substances, other methods of treating finer facial rhytides have been explored.

Methods: Of the many options available for the treatment of facial fine lines, the authors describe a novel technique of formulating reduced concentrations of existing hyaluronic acid gels by variable dilution/reconstitution.

Results: Over 350 of the authors’ collective patients have been treated with this approach. The results have been highly satisfactory, with greater persistence, and have challenged traditional concepts of mechanism of action and biodegradation and suggest alternative options in formulations of currently available products.

Conclusions: Reconstituted injectable hyaluronic acid is a highly effective and viable alternative for the aesthetic treatment of facial fine lines and other components of ageing.

Observations, treatment guidelines, and a rationale for this novel use and concepts to explain these finding are contained in this article.

Title:

Indocyanine green-augmented diode laser therapy of telangiectatic leg veins: A randomized controlled proof-ofconcept trial Authors: Annette Klein, Wolfgang Bäumler, Michael Koller, Gal Shafirstein, Elisabeth A. Kohl, Michael Landthaler, Philipp Babilas Published: Lasers in Surgery and Medicine. Volume 44, Issue 5, pages 369–376, July 2012 Background: Telangiectatic leg veins, which affect about 40–50% of adults, represent a frequent cosmetic rather than a medical problem. Besides sclerotherapy, various laser devices are common treatment options. However, complete clearance rates can only be achieved in a small number of patients.

Objective: In this proof-of-concept study, the safety and efficacy of indocyanine green (ICG)-augmented diode laser therapy (808 nm) was evaluated for the treatment of telangiectatic leg veins.

Methods: ICG (2 mg/kg body weight) was intravenously administered in 15 female patients (skin type II to III) with telangiectatic leg veins (measuring between 0.25 and 3 mm in diameter). Immediately after ICG injection, diode laser pulses with different radiant exposures (50–110 J/cm2) were applied as one single treatment. Safety and efficacy were assessed 1 and 3 months after treatment by a blinded investigator and 46

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the patient. Treatments with the pulsed dye laser (PDL) and the diode laser without ICG served as reference therapies.

Results: The safety of ICG application and diode laser treatment was excellent in all patients with no persisting side effects. Vessel clearance was dose-dependent. Diode laser treatment at radiant exposures between 100 and 110 J/cm2 resulted in good vessel clearance, which even improved to excellent after the application of double pulses. Diode laser therapy without ICG and PDL treatment induced poor to moderate clearance of telangiectatic leg veins.

Conclusion: ICG-augmented diode laser therapy has proved to be a safe and effective treatment option for telangiectatic leg veins.

Title:

Formulation optimization, skin irritation, and efficacy characterization of a novel skin-lightening agent Authors: Piyush Jain, Sujatha Sonti, John Garruto, Rahul Mehta, Ajay K. Banga Published: Journal of Cosmetic Dermatology. Volume 11, Issue 2, pages 101–110, June 2012 Background: Skin-lightening preparations are used by people all over the world for a diverse range of dermatologic indications. The gold standard treatment for skin lightening is with hydroquinone but has been controversial because of the presence of several side effects. Therefore, there has been a constant search for developing new treatment alternatives.

Furthermore, the new amendments and bans on animal testing by ECVAM have made the three-dimensional models like EpiDerm™ and MelanoDerm™ increasingly popular.

Objectives: This work aims at the formulation development for a new skin-lightening agent, SMA-012, followed by testing for skin irritation and efficacy.

Methods: Formulation parameters such as concentration of SMA-012, amount of ethanol, effect of permeation enhancers and pH were first optimized using Franz cell experiments. Tape stripping and underlying skin assays were performed to analyze the amounts of SMA-012 in different layers of skin. The irritation potential and efficacy of the screened formulation were evaluated using Epiderm™ and Melanoderm™ models.

Results: Skin permeation experiments suggested that concentrations of 0.1% SMA-012, 35% ethanol, and pH of 8.5 to be the best formulation characteristics. This particular formulation was found to be nonirritant for short-term exposure, when tested in Epiderm™ model and also significantly effective in decreasing the amount of melanin in pigmented skin equivalent models.

Conclusion: SMA-012 shows a good promise as a skinlightening agent for cosmetic and therapeutic applications.

Additionally, our study demonstrates the application of skin equivalent models as alternatives to animal testing in studying the regulation of skin pigmentation.

Title: Clinical Efficacy and Safety of Focused-Image Ultrasonography: A 2-Year Experience Authors: Gordon H. Sasaki, Ana Tevez Published: Aesthetic Surgery Journal July 2012 vol. 32 no. 5 601-612 Background: Focused-image ultrasonography produces controlled waves that image dermal and subdermal structures in real time, with precise thermal coagulation points in a linear pattern, for eventual nonsurgical lifting.

Objectives: The authors evaluate the effectiveness of single and dual planes of ultrasound treatment by varying the

directions of treatment lines, depths, and cumulative joule energies and compare the safety and efficacy of treatment with these variations.

Methods: In this prospective, 2-part study, patients were treated by single- or dual-treatment depth with differing directions of treatment lines while the number of treatment lines and amount of energy delivered to brows or marionette lines remained constant (Study 1) or with lower or higher joule energy to opposing areas while the dual depths and number of vectored lines remained constant (Study 2). Lifting was measured using the matched-orientation function of specific mirroring software. Clinical outcomes were assessed with global aesthetic improvement scales.

Results: Vertical vectoring of 15 treatment lines in both tissue depths produced significant lifting over the 15 horizontally-placed treatment lines in the opposing brows and marionette lines. Sites with more treatment lines and higher joule energy at dual depths resulted in significantly greater lifting (Study 2). Side effects were minimal.

Conclusions: Focused-imaged ultrasound therapy to facial tissues is safe and effective when performed as described.

Title: The Use of Adipose Tissue–Derived Stem Cells within a Dermal Substitute Improves Skin Regeneration by Increasing Neoangiogenesis and Collagen Synthesis Authors: Meruane, Manuel A. M.D., M.Sc.; Rojas, Mariana; Marcelain, Katherine Ph.D Published: Plastic & Reconstructive Surgery. July 2012 Volume 130 - Issue 1 - p 53–63 Background: Surgical treatment of injuries with loss of skin tissue has improved significantly with the advent of regenerative medicine and tissue bioengineering, and the use of stem cells and dermal substitutes. The success of tissue regeneration depends on optimal local vascularization and the successful integration of the artificial skin. The present study combines the use of autologous adipose-derived stem cells with a commercially available dermal substitute (Integra) for skin regeneration.

Methods: Adipose-derived stem cells were isolated from the inguinal region of eight Sprague-Dawley adult rats, seeded onto a piece of dermal substitute for 48 hours, and then implanted into the same rat, followed by comparison of the evolution with a contralateral implant without adiposederived stem cells. After 1, 2, and 3 weeks of regeneration in vivo, implants were removed for histologic evaluation.

Results: Adipose-derived stem cells adhere properly to the dermal matrix, and autologous tissue integration in the rat was good. The histologic evaluation showed that adipose-derived stem cells significantly increased microvascular density (7.7 ± 0.6 percent versus 5.3. ± 0.5 percent, as assessed by immunohistochemical staining of factor VIII) and the synthesis of collagen type I (24 ± 3 percent versus 16 ± 2 percent, as assessed by Sirius red staining). Although there was greater epithelialization on the side treated with adipose-derived stem cells (2530 ± 939 μm versus 1911 ± 763 μm), as assessed by anticytokeratin immunohistochemistry staining 34βE12, this difference was not statistically significant.

Conclusions: The authors’ data suggest that the seeding of adipose-derived stem cells onto a dermal substitute improves skin regeneration and tissue integration by increasing vascularity and collagen synthesis. Further studies are necessary to achieve complete epithelialization with the use of adiposederived stem cells.

Autumn Conference 2012 Main conference takes place on:

Saturday 15th September 2012 9am - 5pm followed by a gala dinner

Venue: Celtic Manor Resort, Newport, Wales Main conference speakers include Dr Russell Emerson, Professor Alex Anstey, Dr Raj Acquilla and more...

7 x workshops by Healthxchange Pharmacy, Wigmore Medical Ltd, Merz Aesthetics and more...

Drinks reception & gala dinner on the Saturday evening

£390 (conference fee , Saturday dinner & accommodation) £250 (conference fee & Saturday dinner) £190 (conference fee only)

£30

per person per workshop

(an extra £20 charge applies to all prices for non members of BCAM, BACN, BACD & CODE-AFA)

Register now for the conference and the golf championship: www.regonline.com/bcamautumnmeeting2012

BCAM Open Golf Championship at the famous 2010 golf course Sunday 16th September The programmes for this is as follows: £230 (includes 18 holes, shared golf buggy, lunch & trophies) + 11:00 - Bacon rolls – Spike Bar + 12:00 – 12:10 - Briefing meeting + 12:10 – 12:30 - Warm up + 12:30 - Tee off

+ Hole 9 & Hole 10 - Lunch at Halfway House (approx 3pm) + Holes 11 – 18 + Shower & change + 18:40 - Spike Bar for presentations

Alternative activities for those who aren’t keen golfers are: + Forest Jump (High Ropes), Adventure Golf and various Spa treatments

To register your interest and to find out more contact: registrations@bcam.ac.uk or call 0845 450 2875

Business Focus/Social Media

Tweets for my Tweet Antonia Mariconda on the pros of Twitter Up until about four years ago, I was happily plodding away at my career, silently behind the social scenes.

For more than a decade I had relentlessly worked away at carving my own niche in this busy, fast paced world of aesthetics and cosmetic surgery. One day a rather ‘switched on’ PR and media guru (now a very close friend of mine) suggested I come out more on the ‘social media scene’, by this he meant, Twitter, Facebook and YouTube. Initially the idea seemed a bit daunting, after all I was quite comfortable behind the anonymity of my laptop screen, but I relented and eventually gave in and set up a Twitter account and tweeted happily away. It was a very slow and bewildering climb to reach my first 100 hundred followers, but after that first breakthrough the double digits soon turned to triple digits and my love affair with Twitter has grown stronger and stronger....

Antonia Mariconda, also known as The Cosmedic Coach, is recognised as a leading authority on health, beauty and cosmetic surgery in the UK. Quoted in publications such as Top Santé, and newspapers such as The Evening Standard, and Daily Mail, Antonia is also a national health and beauty journalist and the author of The Essential Guide to Acne published in September 2009 (Forward Press), and most notably The Cosmetic Surgery Companion – Look and Feel Beautiful (Apple Press) 2010. In her role as The Cosmedic Coach, Antonia advises clients around the world on where and where not to shop for cosmetic surgery, beauty and anti-ageing treatments. Her client list includes A-list celebrities, royals and VIPs.

N

early 20,000 followers strong I would like to share with you the five keys to Twitter success.

In today’s world of social media being part of the ‘scene’ is almost a necessary evil. Now whilst some of my peers and colleagues favour Facebook and YouTube, I just have a personal preference for Twitter. It has been an invaluable tool in helping to establish my identity, personality and expertise. It allows me to release short timely messages and engage with my followers in a way I find much more interesting and fun, but, hey, that’s just my personal choice, maybe in a year or two you’ll find me writing a similar article about Facebook.

If you are looking to develop your Twitter readership, the first thing to do is develop a focus, rather than just an existence.

What is your focus going to be?

What is your goal in using Twitter?

If it’s just to complain about your life, or keep inside jokes going with your friends, you may not need to read further. But, if you are an expert or a business in the field of aesthetics, or cosmetic surgery, you’re going to want to follow the next five steps to grow a readership on Twitter.

1. Follow Your Dreams Follow three new people per day who are influential in your field. There are plenty of influential professionals and profiles worth following, and learning from! For example, if you are wanting to engage with the press and media in your field @journorequest. One of the best things about Twitter is that you can get inside your mentor, or hero’s, head.

If you don’t have many names in mind, a quick Google search for “[authors] to follow on Twitter” returns a long list of suggestions. But, remember that quality is greater than quantity when it comes to following. It is recommended to follow less people than you have followers.

Be picky, don’t follow just anyone – look at their

“Whilst some of my peers and colleagues favour Facebook and YouTube, I just have a personal preference for Twitter. It has been an invaluable tool in helping to establish my identity, personality and expertise.”

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followers. They may appear to be an expert, but do the experts follow them? Some investigative work will leave you with a strong list of followers who pertain to your focus.

2. Win Their Hearts Having difficulty getting a conversation going? It is going to take outreach on your part to break the ice.

First, search for Twitter # tags relevant to your industry or focus.

When you see valuable content, take a look at the user’s profile and followers. If you hope to start a conversation, Google the person’s name and dig deeper. Read articles about them, peruse their website or blog, and take note of things about them that you can bring up. If a fellow expert recently spoke at a conference tweet them and say “I really enjoyed your talk at last weeks conference”...interaction means reaction.

Get involved in #FF (Friday Follows). This is how you can give something back to your influencers. Let your followers know they’re a great resource and that everyone should follow them. Following is the highest form of Twitter flattery.

Remember Twitter manners! Reply to all of your direct messages and re-tweets! In the beginning this will be pretty easy, but as you grow your readership, you’ll want to narrow it down to the most relevant ones. And always, always, always say ‘thank you’. Give shout outs of praise to your influencers!

3. Be Realistic We can’t all become influential Twitter users overnight, but we can learn from the best – what are the most influential users tweeting? How often do they tweet? Notice their focus, their point of view, their brand. How do they stick to it? How can they make a recent movie they watched relate back to their niche?

Growing readership is a process, just like it is for any publication. There are 100 million global active Twitter users and 460,000 people sign up for Twitter accounts each day, making it near impossible to simply stand out simply based on your content. So, find your niche and stick to it! If you are an expert at beauty what exactly is it that makes you an expert, focus on your subject and tweet it constantly.

4. Trend Follower or Trend Setter?

Join in on Twitter trends, but only if it pertains to your focus. Think of yourself as a ‘brand’. If you find an article that would help out your readership, or you’ve discovered a new type of fruit, tweet about it! Start to become a leader rather than just a follower. If you’ve successfully found your focus and niche, think highly of yourself.

Be an industry expert and publish the information your readership wants to hear about.

5. Be Yourself Finally, don’t be self-conscious. No one is watching your every move. The beautiful thing about social media is the ability to show off your personality. So, create # tags that are unique to you, and throw in a bit of personal flair. Show your audience your personality!

When you develop your focus, it never hurts to go back in time and review what you’ve done. Twitter can be your own personal

“If a fellow expert recently spoke at a conference tweet them and say “I really enjoyed your talk at last weeks conference”... interaction means reaction.” journal as well. Go back in time and view your progress.

Upon developing a readership, you have the opportunity to move into the realm of ‘influencers’. So, get creative.

One word of warning never engage in a Twitter conflict of words, I learnt the harsh way this year that reaction to negative tweets is a no-no if you care about your profile protect it and simply stay away for contentious or argumentative Twitter users, everybody is entitled to an opinion just don’t be emotionally drawn into cyber conflicts, trust me you have better things to do with your energy, and most negative comments simply fade away if ignored.

What made my personality grow?

As a health and beauty author and coach, I carved a ‘Twitter’ niche for myself and I have become quite well known for my somewhat entertaining ‘body fact’ trivia on Twitter, people just love reading fascinating unknown facts about the human body.

My Twitter profile states that as ‘The Cosmedic Coach’ I am on a ‘mission to bring as much beauty into the world as possible’, by this I mean the beauty of discovering who we really are as human beings and how amazing we are inside out. I tweet facts, statistics, information and trivia – I have carved my personality out by doing this. I have often been stopped by strangers at social events who say “you’re that cosmedic coach woman who tweets body stuff right?” its amusing to say the least, especially when they add “oh I loved your tweets about how many times a day the average human passes gas” People engage with my ‘tweets’ daily from Australia to America, to Japan I have some fantastic amazing followers who always send their praise and appreciation for learning something new, as a result people have faith and confidence in my information, whether it is factual or just fun, and I am asked by hundreds of people a week for information tips and advice for all things pertaining to beauty, I answer them ALL. As a reward now to all my followers I have created an ebook that gives all the information that I am asked for daily in one medium, this book is downloadable free from Autumn 2012 http://www. thecosmediccoach.com/freegift.htm reward your followers and keep them constantly interested, grow your profile by establishing your personality, one of my most retweeted quotes is “beauty will take your far in life but personality will take you all the way”.

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A Day in the life

T he knife and t i m e s

Antonia Mariconda finds out what a typical day in the life of surgeon Chris Inglefield is like Christopher Inglefield BSc,MBBS,FRCS(Plast) is renowned in the field of Plastic Surgery, not only for his expertise but also for offering the most up to date and innovative treatments and procedures available. Chris is noted for his extremely warm attitude and caring team, whilst maintaining an extremely high level of understanding and professionalism that means he is in demand worldwide. He specializes in a wide range of procedures, both surgical and non-surgical, and has pioneered a number of procedures in the UK. Antonia Mariconda talks to Christopher about a typical day in his working life.

“The alarm clock will go off at 6am and a typical day starts at 7am on days when I have surgery lists; but on my clinic days I start my day at 9am. My morning kicks off with a decaff coffee; I always have a good breakfast – eggs, bacon and sausage. I do put some time in at the gym but not enough really I confess, that is the hazard of a busy life in this industry.

I work an average of 50 hours per week, my days are long and intense, but I love my work so even a long working day is not a chore particularly if it has been a rewarding day. I travel around London on my scooter.

On a surgical day I will typically review operations scheduled in and discuss goals, surgery, risks, aftercare with each patient. I like to spend the time reassuring my patients, most patients are nervous about surgery and anaesthesia and just five to 10 minutes spent with a patient can make a huge difference for their reassurance.

I love helping people and the art and science of plastic surgery was the perfect career choice for me. In the realm of plastic surgery there is no substitute for experience. Being able to discuss all options including non-surgical options is vital in the current practice. Too many surgeons only offer costly surgical procedures which may not be the right option for a patient. I am proud every day that our patients receive the best care possible! Some of my best moments of satisfaction

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have been performing successful major cancer reconstruction operations on patients who were told that nothing more could be done for them.

I love listening to music in theatre whilst I am operating; I listen to a variety depending on what surgery I am doing. Beethoven, Enya, Katherine Jenkins, Bob Marley, Queen, or Susan Boyle.

After a busy morning of surgery in theatre, I rarely sit down and break for lunch; it’s more a question of grab-something-on-the-go that’s why breakfast is so important to get right to set the day off well.

Roast chicken salad is my favourite –with a bottle of sparkling water or decaff coffee. Most afternoons will be consulting new patients as well as seeing post-surgery patients for review. I am always very happy and proud

place the interest of their patients first. I draw inspiration from Sir Ian Jackson – hard work and excellence in patient care – everything else is secondary.

I’d like to see some improvements in our industry such as: less marketing hype and more evidenced based practice. More focus on improving patient care and not on protecting groups’ market share and getting all professionals working in cosmetic surgery to work together for the benefit of patients. I’d also like to see tighter regulation on what a cosmetic surgeon is? Thus WHO can perform cosmetic surgery?

Since the PIP Implants fiasco, there have been lots of calls for banning Cosmetic Surgery Advertising, I find this illogical – The ASA Advertising Standards Authority mandate exists to ensure that ads are true, ethical and do not make light of the seriousness of surgery. If we want improvement – then as professionals we should give the ASA the guidance to exercise their mandate.

This move is supported by groups who are trying to protect their own business and has nothing to do with patient safety. I’d like to see the implementation of a National Breast Implant Register, and I would like to emphasise sun protection – skin cancer is the biggest killer in young adults.

When my day is over I scoot home, I love spending time

“Unwinding with a glass of a Rioja is a lovely way to reflect on my day which normally consists of me asking myself, “Have I done my best for my patients?” to see our patients one year or five years post-op, catch up with their lives, family, work etc, and see how their surgery has improved their quality of life. We hold weekly management meetings in the practice and monthly team meetings. I also attend many national and international meetings lecturing. Just in last the two months I have been to Rio, Vancouver, New York, Paris and Frankfurt presenting on different topics. I’d like to dispel the myth that plastic surgeons are superficial money grabbing professionals who prey on people’s vulnerabilities and insecurities. Most good plastic surgeons are very caring, professional doctors who

with the kids, reading, catching up on the days’ events.

And if time allows catch a quick session at the gym.

Unwinding with a glass of a Rioja Campo Viejo is a lovely way to reflect on my day which normally consists of me asking myself, “Have I done my best for my patients?”

Missed the Viora workshop at FACE Conference and Exhibition 2012? If so donâ&#x20AC;&#x2122;t worry; contact us today to arrange a demonstration and share the success.

august

4 Botulinum toxin and dermal fillers Foundation Course, Birmingham, www.aesthetox.co.uk 4 Refresher/Intermediate Toxins and Fillers, London, www.wigmoremedical.com/events 6 Core of knowledge, Dublin, www.advancebeautytraining.com 6-7 SkinCeuticals Training, Cheshire, www.SkinBrands.co.uk 6-8 Laser/IPL hair removal course, Dublin, www.advancebeautytraining.com 7 Sculptra, London, www.wigmoremedical.com/events 8 Dr Bob Khanna Training Institute, Botulinum Toxin - Beginners, www.drbobkhanna.com 8 Genuine Dermaroller™ Medical Device Training, Yorkshire, www.genuinedermaroller.co.uk 9 Dr Bob Khanna Training Institute, Botulinum Toxin - Advanced, www.drbobkhanna.com 10 Dr Bob Khanna Training Institute, Dermal Fillers – Beginners, www.drbobkhanna.com 13-14 Medik8 Training, Cheshire, www.SkinBrands.co.uk 19 White Lotus Anti Aging Holistic Skin Needling, www.whitelotusantiaging.co.uk 18 Botulinum toxin and dermal fillers Advanced Course, Birmingham, www.aesthetox.co.uk 20 Core of knowledge, London, www.advancebeautytraining.com 20-22 Laser hair removal course, London, www.advancebeautytraining.com 21-22 SkinCeuticals Training, London, www.SkinBrands.co.uk 22 Genuine Dermaroller™ Medical Device Training, London, www.genuinedermaroller.co.uk 23 Laser/IPL Core of Knowledge, Glasgow, www.lasersafe.co.uk 23-24 Medik8 Training, London, www.SkinBrands.co.uk 27 Genuine Dermaroller™ Medical Device Training, Yorkshire, www.genuinedermaroller.co.uk

october

Friday August 31-Saturday September 1 IAAFA annual meeting, Royal Society of Medicine, www.iaafa.net 1-2 SkinCeuticals Training, Cheshire, www.SkinBrands.co.uk 4 Obagi Ireland Workshop, Dublin, www.healthxchange.com 4-6 BDTA Dental Showcase 2012, ExCel, London, www.dentalshowcase.com 8-9 Medik8 Training, Cheshire, www.SkinBrands.co.uk 11 Dr Bob Khanna Training Institute, Dermal Fillers – Advanced, www.drbobkhanna.com 12 Dr Bob Khanna Training Institute, Oral Facial Course, www.drbobkhanna.com

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september

Dates for the Diary

diary

Saturday September 1 IAAFA Charity Ball in aid of the Make a Wish Foundation, Portman Radisson Hotel, London 1 Botulinum toxin and dermal fillers Foundation Course – Birmingham, www.aesthetox.co.uk 3 Obagi Workshop, London, www.healthxchange.com 3 Advanced laser training course, London, www.advancebeautytraining.com 4 Sigmacon Aesthetic Workshop – Building a Successful Aesthetic Practice (Half Day event 1.30pm-5.30pm), London, 01923 266339 or clive@cliveswan.com 5 Obagi Workshop, Manchester, www.healthxchange.com 8 Innomed Training Chemical Peeling Systems: Comprehensive Course for New Users, Central London, www.innomedtraining.co.uk 9 Innomed Training Mesotherapy for Fat, Cellulite and Skin Rejuvenation: New Users, Central London, www.innomedtraining.co.uk 10 Obagi Workshop, Glasgow, www.healthxchange.com 10 Genuine Dermaroller™ Medical Device Training, London, www.genuinedermaroller.co.uk 10 Core of knowledge, Belfast, www.advancebeautytraining.com 10-12 Laser/IPL hair removal course, Belfast, www.advancebeautytraining.com 15 Botulinum toxin and dermal fillers Foundation Course – London, www.aesthetox.co.uk 15-16 British College of Aesthetic Medicine Autumn Meeting, The Celtic Manor Resort, Newport, South Wales, registrations@BCAM.ac.uk 16 Chemical Peel Course – London, www.aesthetox.co.uk 16 White Lotus Anti Aging Holistic Skin Needling, www.whitelotusantiaging.co.uk 17 Dr Bob Khanna Training Institute, Botulinum Toxin Beginners Course, www.drbobkhanna.com 17-18 SkinCeuticals Training, Cheshire,

13 Chemical Peel Course, Birmingham, www.aesthetox.co.uk 15 Dr Bob Khanna Training Institute, Botulinum Toxin Beginners Course, www.drbobkhanna.com 15 Blue Peel Workshop, London, www.healthxchange.com 15-17 Laser hair removal training, Dublin, www.advancebeautytraining.com 16 Dr Bob Khanna Training Institute, Botulinum Toxin Advanced Course, www.drbobkhanna.com 17 Dr Bob Khanna Training Institute, Dermal Filler Beginners Course, www.drbobkhanna.com

We round up upcoming events, training courses and meetings

www.SkinBrands.co.uk 18 Dr Bob Khanna Training Institute, Botulinum Toxin Advanced Course, www.drbobkhanna.com 19 Dr Bob Khanna Training Institute, Dermal Filler Beginners Course, www.drbobkhanna.com 20 Obagi Ireland Workshop, Belfast, www.healthxchange.com 23 BIAE One Day Skin Seminar Benign and Malignant Skin Lesions and Inflammatory Skin Disorders, Victory Services Club, London, www.electrolysis.co.uk 24 Genuine Dermaroller™ Medical Device Training, Yorkshire, www.genuinedermaroller.co.uk 24-25 Medik8 Training, Cheshire, www.SkinBrands.co.uk 25 Advanced laser training, Dublin, www.advancebeautytraining.com 25-26 SkinCeuticals Training, London, www.SkinBrands.co.uk 26 SkinMedica Training, Cheshire, www.SkinBrands.co.uk 27 Medik8 Roller, London, www.SkinBrands.co.uk 27 Laser/IPL Core of Knowledge, London, www.lasersafe.co.uk 27-29 Microsclerotherapy for Thread Veins of the Leg, Guildford, www.theclinicalexchange.com 28 SkinMedica Training, London, www.SkinBrands.co.uk 29 Botulinum toxin and dermal fillers Foundation Course – Birmingham, www.aesthetox.co.uk 29 Innomed Training Botulinum Toxin in Facial Aesthetics: New Users (incl. all major brands), Birmingham, www.innomedtraining.co.uk 30 Innomed Training Dermal Fillers in Facial Aesthetics: New Users to Hyaluronic Acid Fillers, Birmingham, www.innomedtraining.co.uk

15-16 British College of Aesthetic Medicine Autumn Meeting, The Celtic Manor Resort, Newport, South Wales, registrations@BCAM.ac.uk

19 Obagi Workshop, London, www.healthxchange.com 22 Core of knowledge, London, www.advancebeautytraining.com 22-24 Laser hair removal course, London, www.advancebeautytraining.com 27 Botulinum toxin and dermal fillers Foundation Course, Birmingham, www.aesthetox.co.uk 28 White Lotus Anti Aging Holistic Skin Needling, www.whitelotusantiaging.co.uk 30-31 SkinCeuticals Training, London, www.SkinBrands.co.uk

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

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

BOTOX® (botulinum toxin type A) Abbreviated Prescribing Information Presentation: Botulinum toxin type A (from clostridium botulinum), 50 or 100 or 200 Allergan Units/vial. Indications: Temporary improvement in the appearance of moderate to severe vertical lines between the eyebrows seen at frown (glabellar lines), in adults <65 years, when the severity of these lines has an important psychological impact for the patient. Dosage and Administration: See Summary of Product Characteristics for full information. Do not inject into blood vessels. Doses of botulinum toxin are not interchangeable between products. Not recommended for patients <18 or >65 years. Use for one patient treatment only during a single session. Reconstitute vial with 1.25ml of 0.9% preservative free sodium chloride for injection (4U/0.1ml). The recommended injection volume per muscle site is 0.1ml (4U). Five injection sites: 2 in each corrugator muscle and 1 in the procerus muscle: total dose 20U. Contraindications: Known hypersensitivity to any constituent. Infection at proposed injection site(s). Warnings/Precautions: Relevant anatomy and changes due to prior surgical procedures must be understood prior to administration. Do not exceed recommended dosages and frequency of administration. Adrenaline and other anti-anaphylactic measures should be available. Reports of side effects related to spread of toxin distant from injection site, sometimes resulting in death. Therapeutic doses may cause exaggerated muscle weakness.

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

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

Lactation: use during lactation cannot be recommended. Adverse Effects: See Summary of Product Characteristics for full information on side effects. Based on controlled clinical trial data, the proportion of patients that would be expected to experience an adverse reaction after treatment is 23.5% (placebo: 19.2%). In general, reactions occur within the first few days following injection and are transient. Pain/burning/stinging, oedema and/or bruising may be associated with the

injection. Frequency By Indication: Defined as follows: Very Common (> 1/10); Common (>1/100 to <1/10); Uncommon (>1/1,000 to <1/100); Rare (>1/10,000 to <1/1,000); Very Rare (<1/10,000). Infections and infestations. Uncommon: Infection. Psychiatric disorders. Uncommon: Anxiety. Nervous system disorders. Common: Headache. Uncommon: Paresthesia, dizziness. Eye disorders. Common: Eyelid ptosis. Uncommon: Blepharitis, eye pain, visual disturbance.

Gastrointestinal disorders. Uncommon: Nausea, oral dryness. Skin and subcutaneous tissue disorders. Common: Erythema, Uncommon: Skin tightness, oedema (face, eyelid, periorbital), photosensitivity reaction, pruritus, dry skin. Musculoskeletal and connective tissue disorders.

Common: Localised muscle weakness, Uncommon: Muscle twitching. General disorders and administration site conditions. Common: Face pain, Uncommon: Flu syndrome, asthenia, fever.

The following other adverse events have been reported since the drug has been marketed: dysarthria; abdominal pain; vision blurred; pyrexia; focal facial paralysis; hypoaesthesia; malaise; myalgia; pruritus; hyperhidrosis; diarrhoea; anorexia; hypoacusis; tinnitus; radiculopathy; syncope; myasthenia gravis; erythema multiforme; dermatitis psoriasiform; vomiting and brachial plexopathy; rash; psoriasiform eruption; anaphylactic reaction (angiodema, bronchospasm); alopecia and madarosis.

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

Adverse events should be reported. Reporting forms and information can be found at www.yellowcard.gov.uk Adverse events should also be reported to Allergan Ltd. UK_Medinfo@allergan.com or 01628 494026.

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

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