Looking for Effective Sun Protection?

VOLUME 1/ISSUE 6 - MAY 2014

Looking for effective sun protection?

ASK US! Huge Sales Event Epionce Ultra Shield Lotion SPF 50 • Blocks up to 98% of UV rays • Light, quick-absorbing sheer formula blends without leaving white residue • Very water resistant • Reduces signs of ageing and minimises the risk of skin cancer www.epionce.co.uk

Combination Data protection SPF Debate Lip anatomy - treatments Dr Natalie Blakely Dr Tiina Orasmae- Leading aesthetic and Mandy Luckman Meder and Deborah CPD Article practitioners explore the legal Forsythe on the Sharon King discusses the anatomy and discuss combination and ethical issues benefits and physiology of the lower face for treatment of treatments for body with storing patient limitations of using the lips. CPD accredited article contouring data sunscreen Vbeam The Most Advanced Pulsed Dye Laser Technology

Science. Results. Trust.

Vbeam Perfecta is the gold standard and the world’s best selling pulsed-dye laser.

• Broad variety of indications and outstanding performance • Safe, easy-to-use tool for the treatment of vascular, pigmented and certain non-pigmented lesions • 8-micropulse technology that allows the physician to treat with or without purpura, increasing treatment efficacy or reducing patient down time when required • Patented Integrated Dynamic Cooling Device™ saves time, is operator independent, scales with fluence and provides consistent protection of the epidermis • Ergonomic contoured design reduces wrist strain and increases operator comfort

www.syneron-candela.co.uk | [email protected] | Tel. 0845 5210698

* This ad is not intended for use in the U.S. market. ©2012. All rights reserved. Syneron, the Syneron logo are trademarks of Syneron Medical. Candela and Vbeam are trademarks of the Candela Corporation. PB78001EN Contents • May 2014

INSIDER 06 News The latest product and industry news 14 On the Scene Out and about in the industry this month 17 News Special: Anti-Aging Medicine World Congress We report on the AMWC in Monaco, including the Allergan Medical Institute symposium 18 News Special: American Academy of Dermatology Meeting Dr Nick Lowe and Wendy Lewis share their thoughts on the 72nd annual AAD meeting in Denver CLINICAL PRACTICE CLINICAL PRACTICE Lip augmentation Page 26 20 Special Feature: Combination Treatments A look at the best treatment combinations for body contouring 26 CPD Clinical Article Sharon King discusses the anatomy of the lower face for lip augmentation 32 Treatment Focus Dr Tiina Orasmae-Meder and Deborah Forsythe debate the benefits and limitations of using SPF sunscreen 38 Clinical Focus Leading practitioners discuss the best methods for treating pigmentation problems using skincare 44 Techniques Dr Carolyn Berry shares her experiences in treating caesarean scars IN PRACTICE and stretch marks Data protection Page 50 46 Spotlight On We learn more about Eternogen, the new collagen dermal filler portfolio coming to the UK Clinical contributors 48 Aesthetics Awards Special Focus The latest news from the upcoming Aesthetics Awards 2014 Dr Nick Lowe is president of the BCDG, professor of dermatology and a consultant dermatologist IN PRACTICE with over 30 years of experience who practises in London and California

50 Data Protection Wendy Lewis has authored 11 books on anti-ageing Dr Natalie Blakely and Mandy Luckman on storing patient data legally and cosmetic surgery, and regularly lectures interna- and ethically tionally. She is the president of Wendy Lewis & Co Ltd and founder/editor in chief of Beautyinthebag.com

52 Treatment Portfolio Sharon King is a director and clinical nurse special- Wendy Lewis explains why body shaping procedures will benefit your clinic ist at the Cosmedic Skin Clinic, board member of the British Association of Cosmetic Nurses and member 56 Marketing of the Aesthetic Complications Expert Group

John Castro on how using videos effectively can attract potential patients Dr Tiina Orasmae-Meder is a dermatologist and the founder of Meder Beauty Science, based in Swit- 60 HR zerland, who also works at Iris Brand Vigilance John Sellers discusses the importance of nurturing your workforce to guide cosmetic safety 62 In Profile Deborah Forsythe is a medical aesthetic specialist and member of the Allergan faculty responsible for We speak to Mr Chris Inglefield about challenging the perception of aesthetic validating practitioners on injection techniques. She procedures specialises in non-surgical dermal facial rejuvenation 64 The Last Word Dr Carolyn Berry is the founder and medical director of the Firvale Clinic, and also practises as a Dr Darren McKeown promotes collaboration between surgeons and aesthetic research fellow and general practitioner professionals

Subscribe to Aesthetics NEXT MONTH Subscribe to Aesthetics, the UK’s only free-of-charge journal • IN FOCUS: Lower body • CPD – Identifying suspicious lesions for medical aesthetic professionals. • Special focus: cellulite treatments Visit aestheticsjournal.com or call 01268 754 897 • Treating rosacea Best Cosmeceutical Skincare Range UK 2013

“The winner of this category showed they were clearly loved by consumers who really trusted the ingredients and effectiveness in getting real results”

Before After 16 weeks use of NeoStrata Skin Active 4 product regimen; an advanced, comprehensive antiaging regimen, to target all the visible signs of aging with state-of-the-art technologies Farris PA, Edison BL, Brouda I et al.: A High-Potency Multimechanism Skincare Regimen Provides Significant Antiaging Effects: Results From a Double-Blind, Vehicle-Controlled Clinical Trial. Journal of Drugs in Dermatology 11(12) 1447-1454, 2013 www.neostrata.co.uk

Meeting the needs of your business, delivering high satisfaction to your patients Call us on 01234 313130 [email protected] www.aestheticsource.com Editor’s letter

I am delighted to be taking over as Editor of This issue, our focus revolves around ‘The Sun’. For our special Aesthetics journal. Having been intricately feature, we spoke to practitioners about which treatments they use involved in medical aesthetics since it first in combination to produce the best bespoke solution for patients became a professional discipline, I have brought seeking body contouring. Dr Carolyn Berry shares her advice on the this experience to my work with the Aesthetics treatment of scars such as stretch marks and caesarean scars, which Amanda Cameron Conference and Exhibition (ACE) and as part of are a particular concern to patients during the summer months. We also Editor the journal Editorial Advisory Board. I now look feature a fascinating debate regarding the use of SPF, with Deborah forward to leading the expanding editorial team and working closely Forsythe supporting the use of sunscreen profusely, whilst Dr Tiina Best Cosmeceutical Skincare Range UK 2013 with our valued contributors and our Advisory Board, which this month Orasmae-Meder argues that it can be unnecessary in certain climates welcomes two new members; Dr Raj Acquilla and Mr Dalvi Humzah. and seasons. Aesthetic nurse Sharon King has provided our CPD article As the journal continues to move forward as the leading publication for for this month, which details the anatomy of the lip and perioral area in medical aesthetic professionals, we are honoured that two more highly relation to lip augmentation procedures. Our business development respected and experienced members of the profession have chosen articles this month include a guide from Wendy Lewis in building a body “The winner of this category showed to join this select group. The knowledge, expertise and advice of both, shaping clinic and key advice from Dr Natalie Blakely and lawyer Mandy along with our other board members, will be invaluable in continuing our Luckman regarding data protection. Our goal for the journal is to support they were clearly loved by consumers work to create a safer and better industry for patients. In April, we were both established products and innovation through medical education. pleased to be able to attend the Anti-Aging Medicine World Congress We aim to provide impartial, credible and evidence based information to in Monaco, where new products and treatments were showcased support good clinical decisions. This also involves you, and we will work who really trusted the ingredients and alongside insightful and educational lectures and presentations from hard to ensure that the journal continues to be a forum for expressing international experts. Our report from this congress is featured on p. 17, quality opinions and mature debate in order to continue to raise the effectiveness in getting real results” along with thoughts from Dr Nick Lowe and Wendy Lewis regarding standards in our industry. If you are interested in contributing to a future the American Academy of Dermatology meeting in Denver, which took edition of Aesthetics journal, or would like to share your thoughts and place in March. comments on this issue, contact us on [email protected]

Dr Sarah Tonks is an aesthetic doctor and previous Editorial advisory board maxillofacial surgery trainee with dual qualifications in both medicine and dentistry, who fell in love with the results We are honoured that a number of leading figures from the possible through minimally invasive methods. Now based medical aesthetic community have joined Aesthetics journal’s at Beyond Medispa in Harvey Nichols, she practises cosmetic editorial advisory board to help steer the direction of educational, injectables and hormonal based therapies. clinical and business content

Dr Mike Comins is president and Fellow of the British Dr Raj Acquilla is a cosmetic dermatologist with over 11 years College of Aesthetic Medicine. He is part of the cosmetic experience in facial aesthetic medicine. UK ambassador, global interventions working group, and is on the faculty for the KOL and masterclass trainer in the cosmetic use of botulinum toxin European College of Aesthetic Medicine. Dr Comins is also and dermal fillers, in 2012 he was named Speaker of the Year at an accredited trainer for advanced Vaser liposuction, having the UK Aesthetic Awards. He is actively involved in scientific audit, performed over 3000 Vaser liposuction treatments. research and development of pioneering products and techniques.

Sharon Bennett is chair of the British Association of Mr Dalvi Humzah is a consultant plastic, reconstructive and Cosmetic Nurses (BACN) and also the UK lead on the BSI aesthetic surgeon and medical director at the Plastic and Derma- committee for aesthetic non-surgical medical standard. Sharon tological Surgery. He previously practised as a consultant plastic has been developing her practice in aesthetics for 25 years and surgeon in the NHS for 15 years, and is currently a member of the has recently taken up a board position with the UK Academy of British Association of Plastic, Reconstructive and Aesthetic Sur- Aesthetic Practitioners (UKAAP). geons (BAPRAS). Mr Humzah lectures nationally and internationally.

Before After Dr Nick Lowe is president of the BCDG and a consultant Mr Adrian Richards is a plastic and cosmetic surgeon with dermatologist with over 30 years of experience who practises 12 years of specialism in plastic surgery at both NHS and private 16 weeks use of NeoStrata Skin Active 4 product regimen; in London and California. Dr Lowe is Clinical Professor of clinics. He is a member of the British Association of Plastic and Dermatology at the UCLA School of Medicine in Los Angeles, Reconstructive Surgeons (BAPRAS) and the British Association of as well as director of a clinical research company specialising in Aesthetic Plastic Surgeons (BAAPS). He has won numerous awards an advanced, comprehensive antiaging regimen, skin ageing. and has written a best-selling textbook. to target all the visible signs of aging with state-of-the-art technologies PUBLISHED BY FOLLOW US Farris PA, Edison BL, Brouda I et al.: A High-Potency Multimechanism Skincare Regimen Provides Significant Antiaging Effects: EDITORIAL ADVERTISING @aestheticsgroup Chris Edmonds • Managing Director Hollie Dunwell • Sales Manager Results From a Double-Blind, Vehicle-Controlled Clinical Trial. Journal of Drugs in Dermatology 11(12) 1447-1454, 2013 T: 01268 754 897 | M: 07867 974 121 T: 01268 754 897 | M: 07557 359 257 Aesthetics Journal [email protected] [email protected] Aesthetics Suzy Allinson • Associate Publisher Craig Christie • Administration and Production T: 0207 148 1292 | M: 07500 007 013 T: 01268 754 897 | [email protected] ARTICLE PDFs AND REPRO www.neostrata.co.uk [email protected] MARKETING Material may not be reproduced in any form without the Amanda Cameron • Editor Laura Weir • Marketing Manager publisher’s written permission. For PDF file support please T: 0207 148 1292 M: 07810 758 401 T. 01268 754 897 contact Craig Christie; [email protected] [email protected] [email protected] Sarah Dawood • Journalist Claire Simpson • Events Manager © Copyright 2013 Aesthetics. All rights reserved. Aesthetics T: 0207 148 1292 | M: 07788 712 615 T: 01268 754 897 | [email protected] Journal is published by Synaptiq Ltd, which is registered [email protected] DESIGN as a limited company in England; No 3766240 Betsan Jones • Journalist Peter Johnson • Senior Designer Meeting the needs of your business, delivering high satisfaction to your patients T: 0207 148 1292 | M: 07741 312 463 T: 01268 754 897 | [email protected] [email protected] Chiara Mariani • Designer Call us on 01234 313130 [email protected] www.aestheticsource.com DISCLAIMER: The editor and the publishers do not necessarily agree with the views T: 01268 754 897 | [email protected] 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. Insider News @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com

Editorial board Talk Aesthetics Mr Dalvi Humzah and Dr Raj What you’re talking about this month Acquilla join the Aesthetics #AMWC Chytra V Anand / @drchytra Editorial Board At #AMWC2014 the world anti ageing congress @#monaco. My talk on Mr Dalvi Humzah and Dr Raj Acquilla are this month #radiofrequency for #skin tightening... — welcomed as official members of the Aesthetics editorial at Forum Grimaldi. advisory board. Mr Humzah is a consultant plastic, #Stats reconstructive and aesthetic surgeon based at the Plastic Dermatological Surgery. A former NHS Consultant Aesthetic Source / @AestheticSource How much do u spend on #skincare? Plastic Surgeon, Mr Humzah currently maintains a plastic Women in their Sixties now splash out £235 surgery private practice and is a key opinion leader for a year! Dr Raj Acquilla several aesthetic companies. Dr Acquilla is a cosmetic dermatologist with over 11 #Bestpractice years experience in facial aesthetic medicine. He is UK Sharonbennettskin / @sharonbennettuk ambassador, global key opinion leader and masterclass @JAestheticNurse @aestheticsgroup @ trainer in the cosmetic use of botulinum toxin and dermal Consulting_Room @CosmedicCoach fillers. Of the appointment Dr Acquilla said, “I am delighted Who tells their patients which toxin they’re to be joining the Aesthetics editorial advisory board at administering? Always. such an exciting time for the journal. Leading Aesthetics forward in its new clinical direction, my role will be to advise Mr Dalvi Humzah #Nutrition and support the publication in order to ensure that we Dr Nick Lowe / @DrNickLoweSkin are delivering content of the highest quality and medical authority to our readers. If you’re getting fewer than 20 grams of fat a day, your body may not absorb enough Aesthetics and its board members are at the forefront of developments within the vitamin A, which can lead to premature medical aesthetics industry, and I look forward to being a part of this journey.” ageing.

#BJNawards Industry Emma Davies / @daviesemma5 @BJNursing @Nurse_A_Baker Sinclair IS Pharma acquires @BACNurses fantastic night at BJN awards. Congrats Adrian, well deserved global rights to Ellansé winner Aesthetic nurse of the year. Sinclair IS Pharma #SPF announced that the Dermalogica UK / @DermalogicaUK1 company has entered Increases in #pollution levels can cause skin ageing. Use an #SPF with #antioxidants to into agreements combat both UV and free radical damage. to acquire the #dermalogica global rights to Ellansé, a combined #Research dermal filler and Debi@cosmeticsupport / collagen stimulator @cosmeticsupport product range. The If the NHS does not provide cosmetic international speciality surgery, where will reliable scientific pharmaceutical evidence come from company acquires the global rights to Ellansé through the acquisition of AQTIS Medical BV. The addition of the Ellansé brand will complement Perfectha, #Treatment Sinclair’s range of hyaluronic acid fillers, acquired in January 2014. Dr Sarah Shah / @DrSarahShah Chris Spooner, Sinclair CEO, commented, “Facial aesthetics is one of the #BeautyFact The non-surgical neck rejuvenation is a great alternative to surgery. fastest growth segments in dermatology and creating a global presence is Regain your youthful neck with #Botox and a key strategic objective for Sinclair. We expect Ellansé’s innovative product dermal fillers. range and emerging market bias, in combination with our existing aesthetics business, to add materially to Sinclair’s overall growth rate and market To share your thoughts follow us on presence in this exciting field.” This financial year, over one third of Sinclair’s Twitter @aestheticsgroup, or email us at revenues are expected to come from aesthetics. The impact of recent [email protected] acquisitions including Ellansé means that this is expected to rise to around 50% in the year ending 30 June 2015.

6 Aesthetics | May 2014 Insider @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com News

Acne New website launched to provide post-acne support

A new acne scar resource website has was started to support people, connecting American Academy of Dermatology and a been launched for people suffering with them with a community for advice and help.” contributor to ascarfreeme.ca. “The first step acne scarring. ascarfreeme.ca aims to help The website offers free online resources, from in treating acne scars is to understand the people manage the emotional and physical articles on the latest treatments to blog posts skin condition, and through ascarfreeme.ca, impacts of the aftermath of acne. “Beyond on improving self-esteem. “Millions of people visitors can quickly get information on how the physical effects, acne scars can impact suffer from acne scars every day, often feeling these scars occur, what to expect at your first self-esteem and self-confidence,” said a com- socially isolated and without hope,” said acne scar consultation and access to many munity manager for the site. “‘A Scar Free Me’ dermatologist Dr. Ruth Tedaldi, member of the other resources,” she said.

Research supplements,” said Jonathan Orchard, Clinical trial indicates director of Abundance & Health, distributors of vitamin C makes skin 33% the product. “However, up to 85% of the firmer vitamin C contained in tablets and powders A four-week placebo-controlled clinical trial conducted by Aspen is destroyed in the Clinical Research has demonstrated that liposomal vitamin C gel digestive system. Altrient C vitamin C is encased in a tiny bubble Altrient C significantly improved skin elasticity.The trial included of protective fatty acids. This safeguards the vitamin through the 60 participants with non-firm ageing skin aged between 31 and 65+. harsh digestive system and the body’s absorption barriers, into 50% took three sachets of Altrient C a day for four weeks and 50% the bloodstream, where it is transported through the body.” Danny took a placebo. Skin elasticity and firmness were measured at three McCamlie, lead clinical scientist and principal investigator at Aspen points throughout the trial. Clinical, said, “With an increase of 15.1% and 32.7% in skin firmness, Results presented that participants using Altrient C showed following two and four weeks respectively, Altrient C achieved results improvement in skin firmness and elasticity compared to participants that, in our experience, some topically applied creams fail to achieve taking the placebo. Those who took Altrient C showed an increase following eight weeks of use.” in skin firmness of 32.7% after four weeks. Following the four weeks, “Formation of free oxygen radicals is widely accepted as a pivotal 100% of participants who consumed Altrient C also reported an mechanism leading to skin ageing, and the production of free radicals overall improvement in their skin, 50% of which noted greater increases with ageing,” said Dr Sanjay Rajpara, dermatologist and hydration, 43% thought they looked younger and 33% thought their cosmetic skin doctor. “Vitamin C is an important part of the body’s anti- skin appeared more nourished. “This research has demonstrated a oxidative defence mechanism. This product has a potential to become clear link between the skin ageing process and vitamin C via dietary one of the first line products for anti-ageing.”

Awards Sponsors announced for the Aesthetics Awards 2014

The first sponsors for the Aesthetics delighted to sponsor the Aesthetics Awards 2014 categories have been Awards 2014. We will be thrilled to present announced. 3D Aesthetics will present the 3D-lipomed Award for Best New Clinic the 3D-lipomed Award for Best New to the deserving winner.” Of The Janeé Clinic, UK and Ireland; Dermalux will Parsons Award for Sales Representative present the award for Best Clinic South of the Year, chairman of Healthxchange England; Church Pharmacy will present Pharmacy Dr John Curran said, “Sales the award for Best Clinic North England; and marketing people are the backbone Institute Hyalual will present the award of any good business; great staff make for Aesthetic Nurse Practitioner of the great businesses work. Janeé was an Year; Aesthetic Source will present the exceptional example of a colleague prestigious Lifetime Achievement award who gave her all. Each one of you need whilst Healthxchange Pharmacy will recognition and we at the Healthxchange present The Janeé Parsons Award for would like to honour the very best Sales Representative of the Year. amongst you. Good Luck!” Details of how Roydon Cowley, managing director of to enter the Awards are found on pages 3D Aesthetics said, “3D-Aesthetics are 48 and 49 of the journal.

Aesthetics | May 2014 7 Insider News @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com

White paper Industry National Special Procedures Winner announced for BJN Register proposed in Wales Aesthetic Nurse of the Year

The Welsh government has put forward a proposal for a Oxfordshire aesthetic nurse Adrian Baker has won Aesthetic mandatory register for practitioners offering cosmetic piercing, Nurse of the Year at the British Journal of Nursing Awards tattooing, semi-permanent skin colouring, acupuncture and 2014. The awards ceremony, which took place on March 21 in electrolysis. The National Special Procedures Register would require London, was set up to celebrate the contribution of individual practitioners and businesses in Wales to meet specified standards nurses to the development of the profession as a whole. Nurses to obtain registration, and then practice to specific standards to from across the country were in attendance. maintain this registration. Mr Baker, who qualified as a nurse six years ago, became an Part of the requirements to achieve this would include a standardised independent nurse in 2011 and immediately started training to pre-and post-consultation with patients and the maintenance of become an aesthetic nurse specialist. He then trained for an records. Pre- and post-consultation at a minimum would include independent nurse prescribing qualification and now works whether the person receiving treatment had any medical problems as an aesthetic nurse at the MBNS and Qutis Skin clinics in that would put them at greater risk resulting from treatment, how the Oxfordshire. “I was incredibly honoured to have been nominated treatment would be carried out, including potential complications, and in the first place,” said Mr Baker. “To have won the award was how to look after any wounds in order to prevent infection occurring. simply breath taking. The best part about this award is that it is Other points in the proposal include all practitioners and businesses demonstrating a recognition of aesthetic nursing as a profession, being required to register in order to practice, practitioners and whilst celebrating excellence within all nursing specialisms.” businesses being required to pay a fee to register and the inclusion of a specified ‘fit and proper’ person test for all practitioners and Industry businesses. There would also be cleanliness standards based on infection control advice and industry best practice. A practitioner or Aesthetics journal team business could also be removed from the register for a specified period of time and would be unable to practice in that time period for welcomes new contributors offences such as failing to meet cleanliness standards or not following pre-and post-consultation requirements. The Aesthetics journal is proud to welcome new members to A Welsh Government spokesperson said, “Over the last decade, its contributing editorial team. Ruth Donnelly started her writing cosmetic procedures such as body piercing and tattooing have career on Brand New You, a consumer magazine focused on become increasingly popular. However, there are known health risks cosmetic enhancement. connected to these procedures if they are carried out in an unhygienic In 2009 she moved to The Cosmetic Surgery and Aesthetics fashion. It is therefore important that practitioners have safe working Magazine (later to become The Cosmetic Surgery Guide), before practices, and that good infection control practices are followed at all becoming editor in early 2010. More recently, she has been times, so that customers are protected. Some people taking up these contributing as a health writer for a number of publications. Also procedures are often more vulnerable than others, which is why we’re joining the team are Suzi Lewis-Barned and David Jacobs. Suzi proposing to make it compulsory for consultation with customers is a freelance writer, editor, researcher and healthcare journalist which would include, for example, a requirement to check whether with more than 20 years experience. Producing commissioned the person has any health problems that may put them at greater content across all print and digital media, Suzi’s expertise is risk as a result of the procedure.” The proposal, released on April 2, also in demand for the fourth year running as a judge at the was published in a White Paper entitled, ‘Listening to you: Your health 2014 Communiqué Awards for Writing Excellence. David is the matters. Consultation on proposals for a Public Health Bill’. The Welsh senior copywriter and a partner at Lewis-Barned & Associates. Government is currently inviting responses to the proposal, which A published author and report writer and editor, he also trains should be submitted by June 24. others to improve their writing skills.

Not all HA dermal ﬁ llers are created equal.

Intelligent manufacturing technology creates a variable density gel1 resulting in... Injectable Product Optimal tissue integration2 Superior cosmetic results4 of the Year 2013 Greater dermal compatibility3 High patient satisfaction5

Contact Merz Aesthetics NOW and ask for Belotero.

1. BEL-DOF3-001_01. 2. Tran C et al. in vivo bio-integration of three Hyaluronic Acid fi llers in human skin: a histological study. +44 (0) 333 200 4140 Dermatology DOI:10.1159/000354384. 3. Taufi g A.Z. et al., J Ästhet Chir 2009 2:29 – 36. 4. Prager W et al. A Prospective, Tel: Split-Face, Randomized, Comparative Study of safety and 12-Month Longevity of Three Formulations of Hyaluronic Acid [email protected] Dermal Filler for Treatment of Nasolabial Folds. Dermatol Surg 2012, 38: 1143 – 1150. 5. Buntrock H, Reuther T, Prager Email: W, Kerscher M. Effi cacy, safety, and patient satisfaction of a monophasic cohesive polydensifi ed matrix versus a biphasic nonanimal8 stabilized hyaluronic acid fi ller after single injection in nasolabial folds. Dermatol Surg. 2013; 39(7):1097-105.Aesthetics | Maywww.belotero.uk.com 2014 BEL093/0314/FS Date of preparation: March 2014

MZ011 Banner AD Not ALL HA are Equal 75x215.indd 1 14/04/2014 15:43 Insider @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com News

Training Vital Statistics Dr Raj Acquilla launches online There are over 4000 training academy aesthetic nurses in Dr Raj Acquilla is set to launch his new the UK online facial injectables training academy, British Association of Cosmetic Nurses the RA Academy, in May 2014. The website 4000+ will comprise a series of video masterclasses demonstrating various facial injectable techniques, from common procedures such as frown lines to more advanced strategies, Over 10% of women including some of Dr Acquilla’s signature techniques. surveyed said stretch marks The RA Academy has been set up as both a training tool and a reference for practitioners to call upon during their day-to-day practice. As well as the were their biggest skin dislike online masterclasses, members will be offered the opportunity to attend an Syneron-Candela, Censuswide survey annual live symposium. Dr Acquilla said, “Through continuing to learn and constantly updating our knowledge and technical application we can deliver safe, consistent and exceptional results that will delight our patients and help non-surgical to grow our practices.” cosmetic procedures Conference were carried out in the US ACE 2015 is announced The American Society for Aesthetic Plastic Surgery (ASAPS) in 2013 The Aesthetics Conference and Exhibition 2015 will take place on Saturday 7 and Sunday 8 March 2015 at the Business Design Centre, London. This follows the success of ACE 2014, where packed lectures, More than ﬁ ve billion dollars was clinical demonstrations and business workshops provided helpful guidance spent on non-surgical procedures in the to practitioners in best practice, new innovations and business development. US in 2013 Post-event feedback further confirmed the popularity of the conference The American Society for Aesthetic Plastic Surgery (ASAPS) as a vital learning tool for practitioners. One delegate said, “The event had wonderful lectures aimed at the right level, and a great environment to learn from colleagues.” Another delegate praised the exhibition, saying it was a One in 20 patients “great opportunity to meet some truly interesting suppliers who were very helpful.” Based on the feedback, work has already begun on an even larger who undergo non- educational programme, featuring more masterclasses and expert clinic surgical treatments demonstrations. With over 90% of delegates from this year’s event interested in attending again, and key suppliers already requesting exhibition stand self-administer Transform Cosmetic Surgery Group, space, ACE is set to be the major conference for aesthetic professionals in Botox Survey 2015. Registration will open later this year.

Injectables Over 14% of people surveyed do not want anyone to know they have had line TSK Laboratories launch new and wrinkle smoothing treatments syringe for botulinum toxin Transform Cosmetic Surgery Group, UK Wrinkle Smoothing Survey

injections 40% of men have TSK Laboratory Europe BV has launched the 3dose syringe, the noticeable hair loss by company’s new instrument for use in botulinum toxin injections. The age 35 The Belgravia Centre product was launched at the AMWC 2014 meeting, Monaco, and is expected to be commercially available in May 2014. The 3dose syringe has an adjustable clicker system, which provides a Non-surgical facial rejuvenation precise dose injection of 0.025ml, 0.04ml or 0.05ml. TSK claim that this procedures are the fastest growing precision means that there is no risk of over- or under-injection, allowing segment in cosmetics, up almost 6% practitioners to administer small doses accurately and consistently. Each annually syringe comes packed with two 33G 13mm needles, which are 22% thinner Iovera Beauty, London Beauty Survey than a standard 30G needle and aim to reduce discomfort for patients.

Aesthetics | May 2014 9 Insider News @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com

Events diary Injectables

20th September 2014 Galderma launches new syringes British College of Aesthetic Medicine - Galderma has launched two new syringe delivery BCAM Conference 2014, London systems for their Restylane range. Launched at the www.bcam.ac.uk Anti-Ageing Medicine World Congress in April, the Restylane Filler Syringe and Restylane SkinBoosters 25th - 26th September 2014 Syringe have been designed with the aim of offering The British Association of Aesthetic Plastic greater precision, comfort and control as well as Surgeons - BAAPS Meeting 2014, London incorporating new safety measures. The new Restylane Filler Syringe has been www.baaps.meetings.org.uk designed in consultation with practitioners and has a new grip and thumb rest to provide rd 3 October 2014 greater comfort. Safety measures include a British Association of Cosmetic Nurses - new tamper-proof seal and a Luer lock. The BACN Meeting 2014, London Restylane SkinBoosters Syringe uses the www.cosmeticnurses.org SmartClick system to provide built-in dosage control, dispensing ~10 μL microdroplets. 6th December 2014 The idea is to allow practitioners to focus The Aesthetics Awards 2014, London on technique, rather than the amount being injected. The feature can also be turned off if www.aestheticsawards.com required. The Restylane SkinBoosters Syringe also incorporates the same safety precautions as the Restylane Filler Syringe. Both syringes Radiofrequency are compatible with thin walled needles and Syneron’s Sublative pix’L flexible microcannulas. technology gains CE Hair removal Soprano ICE introduces diode mark clearance for laser alexandrite technology stretch marks and The Soprano ICE hair removal system acne scars has now expanded its usage to offer removal for fine hair that aims to be Syneron Medical Ltd has announced that its pain-free, using a diode laser based Sublative technology has received a CE mark, on an alexandrite wavelength. clearing it for the treatment of stretch marks and The system, created by ABC Lasers, acne scarring. Promoted as an anti-ageing treatment, incorporates a wavelength of 755nm, Sublative uses fractionated bi-polar radiofrequency to provide better energy absorption to generate deep dermal heating and elicit a wound- by the melanin chromophore. Soprano healing response, with the aim of tightening and ICE cools the skin with an encircled rejuvenating the skin. sapphire tip, preventing surface With stretch marks affecting an estimated 95% of burns while maintaining heat within women and up to 85% of adolescents suffering from the dermis. This high fluency delivery acne, the company expects that the new treatment system aims to provide a comfortable protocols, which will be available on all of the Sublative and fast treatment with improved compatible systems, will expand the appeal of the results for light-coloured and thin hair. technology to a wider market. Soprano ICE now also has a lighter “We have received very positive physician and and improved ergonomic design, patient feedback on the Sublative technology meaning it can be used to treat since its introduction in 2009,” said Amit Meridor, smaller and difficult-to-target areas CEO of Syneron. “This patented fractional bi-polar such as the eyebrows, nose and ears. combined with contact cooling, radiofrequency technology delivers excellent This provides a more comfortable treatment coverage, comfort and low outcomes with little to no downtime and is a safe and treatment experience for the maintenance of the solid-state laser more effective treatment alternative for all skin tones.” practitioner, as well as the patient. provides a solution for a wide range The typical Sublative protocol consists of three to five The manufacturers claim that the new, of hair types and colours using one treatments, spaced four to six weeks apart. more powerful energy absorption platform.

10 Aesthetics | May 2014 Insider @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com News

Fat reduction Skin tightening Zeltiq launches new Study demonstrates single CoolSmooth head treatment tightening effect with

Zeltiq Aesthetics Inc has ThermiAesthetics device launched its CoolSmooth applicator for non- Temperature controlled invasive fat reduction radiofrequency system ThermiRF on the outer thighs. The has demonstrated effective skin latest addition to the tightening in a single treatment, CoolSculpting range of according to a study published in the applicators, CoolSmooth is Journal of Drugs in Dermatology. The to be used in conjunction 18-person study, which was carried with the CoolFit applicator, out by board-certified dermatologist designed to treat the Dr Douglas Key, showed statistically inner thigh, now allowing significant results in reducing skin practitioners to treat laxity on the face and neck after just the entire thigh area. one treatment. “The introduction of the Patients reported no pain during or after imaging allows medical professionals CoolSmooth applicator the ThermiTight procedure, and any to see and direct heat at all three layers provides a new solution redness or swelling subsided within a of the skin, achieving optimal skin to individuals who struggle to reduce fat in the thigh few hours. No pigmentary alterations or tightening results in a single treatment.” area, a difficult-to-treat part of the body,” said Mark scarring occurred during the trial. As a safety measure, the ThermiRF Foley, president and chief executive officer of Zeltiq. “This is the future of skin tightening,” device contains an auto shut off feature “Through our newest applicator, we are excited by said Dr. Key. “Previous radiofrequency that is triggered when temperatures rise the opportunity to expand our current offerings to devices have required multiple above predetermined levels. A number physicians and, ultimately, the individuals who may treatments and offered unpredictable of further studies are planned and benefit from our unique technology. Results achieved results. ThermiRF delivers underway to demonstrate the use of with CoolSmooth add to the growing body of evidence radiofrequency heat energy in ThermiRF for conditions such as axillary demonstrating the safety, efficacy and long-lasting conjunction with Thermal Image hyperhidrosis, cellulite, snoring and post- results of the CoolSculpting procedure.” Monitoring. This advanced infrared child-bearing vaginal laxity.

Botulinum toxin Johnson & Johnson to terminate neurotoxin programme

Pharma giant Johnson & Johnson surgery business. The termination of the breast surgery market, both in augmentation has revealed that it will discontinue PurTox programme will lead to a small number and reconstruction, and we are committed to developments of PurTox, a neurotoxin of job losses in the US. “We are winding down maintaining our leadership,” he said. widely referred to as a potential rival for the neurotoxin program in a responsible “Focusing on our core breast surgery Allergan’s Botox. manner,” said Tom Sanford, vice president business will allow us to expand successful Johnson & Johnson acquired PurTox in 2009, of communications at Johnson & Johnson. programs, as well as increase our investments following the acquisition of breast implant “Regrettably, this involves the elimination of to develop additional new products to meet maker, Mentor. The company has now a small number of positions in the United the needs of patients and the surgeons who expressed a desire to focus on its core breast States. Mentor has long been a leader in the care for them.”

beautifully matured

The unique CaHA collagen stimulating dermal filler 10 years’ experience with almost 5 million syringes sold FDA Approved

no wonder you Best Customer Service Winners in 2011, 2012, & 2013 Tel: +44(0) 333 200 4140 Fax: +44(0) 208 236 3526 RAD092/0314/FS Date of Preparation: March 2014 Email: [email protected] Aesthetics | May 2014 11 Insider News @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com

Radiofrequency News in Brief

PelleFirm receives FDA Murad reveal new Essential-C Sun Balm This month Murad will launch its portable sun stick, clearance for tissue heating and Essential-C Balm Broad Spectrum SPF 35 PA+++. The balm provides protection against UVA and cellulite reduction UVB rays and incorporates the use of the branded MuraSol Antioxidant Defence: a blend of antioxidants The new PelleFirm RF designed to penetrate the skin to create a protective body treatment system barrier of encapsulated free radical neutralisers. has received FDA 510(K) clearance for Dr Carl Thornfeldt to present Epionce tissue heating and for workshop temporary reduction Dr Carl Thornfeldt, CEO and founder of Episciences in the appearance of Inc., will present a workshop at this year’s FACE cellulite. Its distributor conference. He will explain the science behind the Ellman International, Epionce line, offer practical demonstrations and Inc. has also received launch the Epionce MelanoLyte Pigment Perfecting FDA clearance to market the system. The PelleFirm is CE marked for Serum to the European market. “I am pleased to have body skin tightening and cellulite reduction. The system is a non-invasive the opportunity to share some pearls from my years radiofrequency treatment for the body, which aims to produce firmer skin of clinical practice and research with the attendees,” and impermanent reduction in the appearance of cellulite. PelleFirm has two said Dr Thornfeldt. The workshop will take place on large diameter handpieces, which elevate tissue temperature up to 45°C, June 21. and mechanical massage heads to treat areas with cellulite, and particularly focuses on problem zones such as the abdomen, arms, thighs and buttocks. Aneva Nutraceuticals introduce new anti- “We have been working with physicians around the world to develop ageing skin drink PelleFirm and are excited to bring this innovative RF body treatment system Aneva Nutraceuticals have launched new skin to market,” said Ellman International CEO and president Frank D’Amelio. “It health drink Aneva Derma. The product’s formula addresses the need for an effective, non-invasive body solution. With two includes bio absorbable collagen and hyaluronic different sized handpieces, PelleFirm can address almost every area of acids, promoting collagen synthesis and skin the body.” Dermatologist Josephine Hernandez said, “Many of my patients health. Dr Diane Keith, based in Harley Street request treatment for sagging skin in their arms, hands, abdomen, thighs said, “Aneva Derma differs from other collagen and gluteal area. The results with the PelleFirm system are outstanding and drinks by addressing crosslinking problems with superior to any of the many body contouring or skin tightening devices we antioxidants. It also provides exceptional collagen have used in our practice. I have seen PelleFirm results in as little as a few and hydration skin support due to the high level of treatments. We are very satisfied users.” hyaluronic acid and hydrolysed collagen peptides.”

Cambridge Biotech Ltd launch Research Uma Jeunesse Ultra Cambridge Medical Aesthetics/Cambridge Biotech C-Tetra found to be effective Ltd have announced the launch of Uma Jeunesse Ultra, the latest addition to the Uma Jeunesse against photo-ageing range of dermal fillers. Uma Jeunesse dermal fillers are monophasic, hyaluronic acid (HA)- An independent study carried out by researchers at Prefectural based and cross-linked with butanediol diglycidyl Hiroshima University, Japan, has established that Tetrahexadecyl ether (BDDE). Uma Jeunesse Ultra also contains Ascorbate, otherwise known as C-Tetra, is more effective at preventing lidocaine, which aims to make the procedure photo-ageing than standard vitamin C. C-Tetra, a vitamin C derivative more comfortable for patients without the need for used in the Medik8 cosmeceutical range, was also found to increase topical anaesthesia. collagen synthesis. It was found that by administering 10-50 microM of Tetrahexadecyl Medik8 launch new skin ageing kit Ascorbate to human fibroblasts and then irradiating them with UVA, the Medik8 has launched a new Skin Ageing Essential cells were protected from UV damage. The tests used several markers to Kit, aimed at women and men aged 40+. The kit evaluate the performance of C-Tetra, including the successful repression is suitable for normal to dry skin and contains of MMPs and the repression of p53 gene expression, a hallmark of UV- both Vitamin C and Vitamin A skin serums and induced damage. moisturisers for day and night. The edited collection Pharmacologist and Medik8 founder Elliot Isaacs, said, “We are extremely treats skin ageing concerns including lines and satisfied with the conclusions of this respected Japanese scientific group wrinkles, dull complexion, uneven skin tone and whose findings corroborate and in fact exceed our own research data into sun damage. the activity of Tetrahexadecyl Ascorbate.”

12 Aesthetics | May 2014 The Award Winning Laser

SHR is the first innovation in laser hair removal in the past 10 years. “It doesn’t matter if your skin is dark, light, or tanned. We can remove your hair with no pain.” – MARTIN BRAUN, M.D.

Contact us on Tel: 0845 1707788 [email protected] | www.abclasers.co.uk Insider On the Scene @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com

Enerjet The Future of Harley Street, demonstration, London

London A live debate on the future of the famous medical destination Harley Street took place on March 27, at the Royal Society of Medicine. The event was host to over 200 attendees, including Harley Street doctors and surgeons, practice managers, property owners and advisors, patients and health journalists, and was opened by Keith Pollard, managing director of harleystreet.com. The debate, chaired by medical journalist and former ITV News medical correspondent Dr Tapan Patel played host to an intimate Sue Saville, allowed attendees to vote on presentation on Enerjet on Monday March 24 at 102 a number of issues. The results of the votes included that 75% believe there is Harley Street, speaking to an audience of doctors additional potential in the Harley Street brand that is yet to be exploited, whilst and aesthetic practitioners, including Apprentice 50% believe that Harley Street is the place to go for the best doctors, dentists winner Dr Leah Totton. A dermal remodelling system and healthcare professionals. Other issues discussed included the lack of that pneumatically introduces a jet of Hyaluronic Acid representation of the UK and Harley Street at international medical tourism events, (HA), Enerjet works to remodel skin, repair scars and and lack of central marketing support promoting UK clinics to those overseas who lift facial tissue. Described as a non-surgical facelift wish to visit the UK for aesthetic treatment. Pollard said, “As a result of Thursday’s using HA, Enerjet is a skin remodelling treatment in events, we already have a number of people interested in joining a steering which strong, controlled volumetric injury induces committee, who will look at forming a formal Harley Street Partnership, to maximise collagen regeneration. As the first practitioner to the Harley Street brand both in this country and overseas.” introduce this treatment to the UK, Dr Patel shared Attendee Darren Rowe, managing director at Harley Street Cancer Concierge, said, his experience of the system before performing live “I was keen to attend this event as I felt it was important to support what I consider demonstrations. This saw Dr Patel administer powerful to be a very worthwhile initiative. We’ve known for some time that Harley Street pneumatic injections into the model’s skin in order to as a brand isn’t keeping up with other parts of the world and the data presented create intentional wounds, triggering a natural healing at the meeting highlighted this,” he said. “The fragmented nature of Harley Street process that generates production of new collagen, can make it quite difficult for patients, and with no cohesive marketing plan, our skin thickening and tightening. voice on the international stage is drowned out. I was encouraged that the survey indicated a desire to do something collectively. I hope we can maintain momentum and start to work towards a common goal of increasing patient volumes and ARTAS Workshop, providing an outstanding level of customer service to go with the outstanding level Manchester of patient care.”

Europe’s only live Sculptra Open Day, London robotic hair transplant surgery workshop took A Sculptra open day was held at The place at the Farjo Hair Cadogan Clinic in London on March Institute on Friday 28 27, to demonstrate the effectiveness and Saturday 29 March. of the CanuSculpt technique to Each day included guests. As part of the open day, a morning seminar consultant oculoplastic and aesthetic followed by a live specialist, Dr Maryam Zamani, demonstration of new completed a full facial analysis on a technology, the ARTAS model and treated half her face with Robotic System. Sculptra using the cannula technique. The system uses a robotic arm to identify follicles for Dr Maryam illustrated how this procedure leaves minimal or no marks, makes harvest and extract the donor hairs and surrounding the procedure more comfortable for the patient and decreases the risk of tissue. Performing up to 1,000 follicular extractions bruising. per hour, the ARTAS Robotic System uses advanced Sculptra aesthetic account manager Claire Williams said, “This type of exclusive imaging technology to locate the densest areas of open event with a small group of clients is a very effective way to demonstrate donor hair before harvesting an evenly distributed the benefits of Sculptra using the cannula technique. It was a great success selection of donor grafts. with a high level of interest from all the guests.”

14 Aesthetics | May 2014 TheTheThe Award AwardAward Winning WinningWinning Laser LaserLaser

SHRSHR is is the the first first innovation innovation in in laser laser hair hair SHR is the first innovation in laser hair removalremoval in in the the past past 10 10 years. years. removal in the past 10 years. “It“It doesn’t doesn’t matter matter if if your your skin skin is is dark, dark, “It doesn’t matter if your skin is dark, light,light, or or tanned. tanned. We We can can remove remove your your light, or tanned. We can remove your hairhair with with no no pain.” pain.” – –MARTIN MARTIN BRAUN, BRAUN, M.D. M.D. hair with no pain.” – MARTIN BRAUN, M.D.

VISIBLEVISIBLE &&

PHYSICALPHYSICAL SKINSKIN

REJUVENATIONREJUVENATION

PHYSICALPHYSICALSKINSKIN

THEPHYSICALTHE SCIENCE SCIENCE OF OF

RETRIDERMRETRIDERM™™ THE THE

VISIBLEVISIBLE&& POWERVISIBLEPOWER OF OF VITAMIN VITAMIN A A

Unique, Unique, protein-driven™, protein-driven™, retinol retinol formulation formulation Clinically Clinically significant significant skin skin rejuvenation rejuvenation* * - - Reduces Reduces wrinkles wrinkles - - Tightens Tightens & &ﬁ rmsﬁ rms - - Improves Improves luminosity luminosity

Retriderm™Retriderm™ Vitamin Vitamin A ASkin Skin Rejuvenation Rejuvenation - - Retriderm™ Retriderm™ 0.5% 0.5% Retinol Retinol Serum Serum Start-up;Start-up; clinically clinically signifi signifi cant cant skin skin enhancementenhancement within within 8 8weeks weeks* * - - Retriderm™ Retriderm™ 1.0% 1.0% Retinol Retinol Serum Serum Power-step-up;Power-step-up; clinically clinically signifi signifi cant cant visiblevisible and and physical physical improvement improvement ofof aged aged and and photodamaged photodamaged skin skin* *

ASKASK US US ABOUT ABOUT

CPDCPD CERTIFIED CERTIFIED TRAINING TRAINING WORKSHOPS WORKSHOPS The The Skin; Skin; anatomy anatomy & physiology,& physiology, functions functions & mechanisms,& mechanisms, ageingageing & problem& problem conditions conditions WORKSHOPSWORKSHOPS EVERY EVERY Evidence Evidence based based skincare skincare ingredients ingredients and and products products MONTHMONTH ACROSS ACROSS THE THE UK UK Client Client consultations consultations and and evidence evidence based based regimes regimes

FORFOR FURTHER FURTHER DETAILS, DETAILS, SCIENTIFIC SCIENTIFIC & CLINICAL& CLINICAL INFORMATION INFORMATION PLEASE PLEASE CONTACT CONTACT AESTHETICARE AESTHETICARE® ® 08000800 0195 0195 322 322 retriderm.aestheticare.co.ukretriderm.aestheticare.co.uk [email protected]@aestheticare.co.uk @aestheticareuk@aestheticareuk facebook.com/aestheticareukfacebook.com/aestheticareuk

RetridermRetriderm trade trade Ad.indd Ad.indd 1 1 11/04/201411/04/2014 16:59 16:59 Insider @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com News Special

12th Anti-Aging Medicine World Congress On the 3 -5 April the annual AMWC meeting was held in Monaco. We look back on the event and report on the Allergan Medical Institute eye symposium

With delegates Editor Amanda Cameron reports on the Allergan symposium: “An eye for attending from over detail: a progressive approach to periorbital revitalisation” 120 countries, the 12th The Allergan Medical Institute symposium at AMWC, designed to both educate Anti-Aging Medicine and entertain, comprised a full day programme with a mixture of talks, live World Congress was demonstrations and debates, focused on the periorbital region. A panel of experts an opportunity for were in attendance to cover the topics of relevant anatomy, patient assessment, international peers and colleagues to learn from new clinical data and recommended injection technique. experts in their field and see the vast number of new Dr Koenraad De Boulle, chairing the day with Dr Lakhdar Belhaouari, introduced products available. This year, the emphasis was on the symposium with insightful photography, demonstrating the role that the looking forward, with the congress’s overall concept periorbital region has in conveying emotions and communicating feelings. This labelled, ‘Be ready for the future’. Dr Chytra V Anand, presentation highlighted the complexity of the area and thus its treatment. a cosmetic dermatologist based in India, presented The first formal session of the day saw plastic surgeon Mauricio De Maio several sessions during the three days. She said of emphasising the importance of patient assessment. Thorough consultation and the event, “As faculty, what I love is that not only do I assessment, he reminded us, allows the practitioner to make an informed decision get to share my knowledge but I am also able to learn as to the most appropriate treatment, or combination, for each patient. He advised from other masters, which is very important in order to that the strategy for periorbital treatment should be dependent on the analysis of a stay updated.” number of key anatomical issues including: skin excess; muscle laxity; cheek ptosis; The importance of expert collaboration to enhance skin laxity; volume loss and excess fat. learning was also highlighted by Dr Ravi Jain, who said, “I was privileged to be part of the Galderma symposium on achieving patient satisfaction, using optimised injection strategies with Dr Philip Levy and Dr Colette Carmansch from Switzerland.” Dr Anand also emphasised the independent nature of the presentations as a key draw for practitioners looking for information on best practice, new products and clinical excellence; she said,, “I enjoy lecturing at this event as the organisers are keen on keeping Dr De Maio then spoke in detail on patient perception and expectation, stating the lectures devoid of commercialisation, and ask that patients will not be satisfied with just filling lines, as often the impact of these speakers to be open with their disclosures.” With outcomes are too minor in terms of what observers (partners, friends) will notice. more than 250 companies exhibiting over four His discussion also included an explanation of the stark differences between how floors, there was plenty of opportunity for delegates a patient perceives their own face, and how a practitioner views the patient’s face. to speak to suppliers and distributors and find out Patients, he explained, tend to view their face in units (small areas) whereas more about exciting products and treatments being the practitioner will consider the face in its entirety and get the ‘full picture’. His showcased. “I spent my time mainly looking at a recommendation was for practitioners to discuss the patient’s face with them in few new machines as I am currently expanding my facial thirds, either horizontally or vertically, as it is easier to take sections and look clinics”, said Dr Johanna Ward “I spoke with several at minor details of the patient without the distraction of the full face. leading dermatologists in France who use the Tri Professor Hee-Jin Kim continued with an informative session on anatomy, Wings LED system and they highly recommended focusing particularly on the need to study the anatomy of the nerves and vessels, it for the kind of dermatology work that I do.” highlighting the delicate nature of the skin around the eye and its anatomical Delegates at the congress were provided with a complexity. In his presentation on treating the tear trough, Dr Hervé Raspaldo comprehensive educational programme and a vast concurred with this, emphasising that in his opinion, the tear trough is an area for range of exhibitors, reflecting the congress’ focus on experienced injectors only, and that it took him 20 years before he felt confident preparing practitioners to meet with and embrace the enough to inject in that region. Delegates were then shown the new app from the challenges of the ever-changing world of anti-ageing Allergan Medical Institute, which allows practitioners to analyse exactly where they medicine. “It’s a good opportunity to understand are injecting whilst performing a procedure. This technology further underlined what is currently trending in the rest of Europe the importance of a firm and detailed grasp of anatomy when performing and liaise with our European colleagues,” said aesthetic treatments, a recurrent theme of the symposium, along with the role chair of the British Association of Cosmetic Nurses that technology can play in assisting practitioners to achieve increasingly precise Sharon Bennett. “I was particularly interested in the and aesthetically pleasing results. The symposium provided a wealth of learning workshops on periorbital and perioral areas as this for attendees, and not only demonstrated advanced injection techniques in the is so relevant to the type of patients I see in my clinic periorbital area but also provided delegates with expert and useful advice that on a day-to-day basis, and who are always wanting could be easily applied elsewhere in medical aesthetic practice. to know what’s new.”

Aesthetics | May 2014 17 Insider News @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com

resonance and can achieve a steady state deep tissue temperature of 48-50°C, providing collagen tightening, and refining body contour. For cryolipolysis, the Zeltiq system was considered at present the most reliable and fully tested system. Fat necrosis has been described with other systems. The key to success for all body contouring treatments is to be realistic in patient selection and evaluation. For example, it may be necessary to suggest weight loss before treatment, and patients with significant excess skin should be referred for abdominoplasty if they desire. Cynosure’s new Nd:YAG vascular laser presented an alternative American Academy treatment for facial redness. Unlike pulsed dye lasers, it did not result in several days of bruising, and patchy, irregular improvement. of Dermatology There were interesting presentations on combination scar treatments, showing how needle-driven RF systems such as Intracel or fractional CO2 lasers Annual Meeting deliver microscopic channels into hypertrophic or keloid scars, reducing vascular supply and scar Dr Nick Lowe, Aesthetics editorial advisory board density. Megapotent cortisone creams can then be applied, which penetrate deeper into the scar tissue, member, professor of dermatology and president of reducing scar thickness. Patients can also apply British Cosmetic Dermatology Group, discusses the Haelan tape overnight to the scars. Any scar erythema highlights of the recent AAD meeting can then be reduced with vascular lasers. Several treatment sessions may be required depending on Dr Nick Lowe is president of the With more than 350 sessions scar size and density. Recent topical treatments were BCDG, professor of dermatology and and attracting over 16,000 also discussed for rosacea; in addition to Galderma’s a consultant dermatologist with over 30 years of experience who practises delegates and exhibitors, recent Mirvaso (Brimonidine gel) for facial redness, in London and California the 72nd Annual Meeting of which has been available in the USA for several the American Academy of months, there was an interesting new treatment of Dermatology, which was held in Denver Colorado between March 21 and 25, is the rosacea papules and pustules with Ivermectin (a largest and most prestigious dermatology conference in the world. drug used to treat headlice) delivered as a gel. The This was the 30th consecutive AAD meeting I have attended. This year, I was invited mechanism of action is not known but may involve a by the Academy to be guest presenter at two sessions on injectables and facial reduction in dermadex population in rosacea lesions. rejuvenation. One of the most exciting products discussed at the The protocol I described and demonstrated was the use of different volumising meeting was a new biologic drug developed for adult fillers and neurotoxins for synergistic improvement of the facial lines and ageing. atopic eczema. Patients treated with Dupilumab, an This is achieved by using hyaluronic fillers such as Voluma or SubQ as lifting and antibody drug targeting the cytokine interleukin 4, filling injections, administered to the zygomatic area and mid-face. saw disease activity decline significantly. About 85% To correct volume loss caused by age, weight loss or post-acne scarring, Sculptra of patients treated with Dupilumab had at least 50% can be administered to the mid face following these hyaluronic filler injections. improvement in Eczema Activity and Severity Index Combining Sculptra with hyaluronic fillers creates the optimum lifting and filling (EASI-50) after 12 weeks, compared with 35% of the effect, and one that improves over time and with subsequent Sculptra treatments. placebo-treated patients. We have several active Some patients also benefit from injection of botulinum toxin to the depressor biologic drugs for psoriasis but Dupilumab is a first to angulae oris, the jawline and platysma, with small doses of neurotoxins. During be active in atopic eczema. the live demonstrations, a simultaneous cadaver dissection showed the relevant AAD also named its contact allergens of the year, anatomy, and key areas to avoid or be cautious with, such as the periocular nasal which are causing frequent contact dermatitis. This and lower facial areas, because of their vascularity. year one was benzophenone-3, the sunscreen Serious complications of injecting filler into the blood vessels and causing blindness ingredient better known as Oxybenzone. The other or skin necrosis when treating these areas with fillers were discussed at length. The key allergen discussed was methylisothiazolinone (MI), consensus view of the dermatologists was that injections into these areas should a widely used preservative in shampoos; particularly be classed as high risk interventional procedures and should only be administered when used every day, it can be a significant by specialist physicians with additional training. If signs of ischemia appear, such contributor to facial and neck dermatitis. Attending as pain or blanching, we can immediately inject Hyalase to dissolve the filler, apply and listening to the presentations reminded me of nitroglycerin paste to the affected area and consider other treatments to increase the vital role dermatologists and skin specialists hold vascularity, such as oral niacinamide. Any visual disturbances should be treated as as ‘dermatology detective’; identifying causative an ophthalmologic emergency. factors in skin diseases and being the specialist for There were interesting sessions on body contouring. Systems such as Venus all diseases and treatments of skin, hair and nails, as Freeze, Venus Legacy and ThermiRF administer radiofrequency plus magnetic well as having the optimum knowledge for aesthetic

18 Aesthetics | May 2014 treatments. This was an excellent conference from which delegates learned much new information and I brought back to the UK many ideas to refine our dermatology and aesthetic practices at the Cranley Clinic.

Wendy Lewis discusses the role of professional skin care at the American Academy of Dermatology Conference

According to the IMCAS Tribune, the global market for cosmeceuticals (referred to by the French as cosmeceutiques or cosmetique active) is valued at $1.05 billion for 2014 and is projected to grow to $1.38 billion by 2018 (imcas.org). This THE LEADING LIGHT IN represents an average annual growth rate of +7.4%. Unsurprisingly, LED PHOTOTHERAPY the principal zones, in descending order, were the US, Asia, Latin America, and Europe. Nowhere was this trend more apparent than at the 72nd annual American Academy of Dermatology Conference where, although the anti-ageing category captured the lion’s share of attention, acne, scars, stretchmarks, sensitive skin, sun protection, and pigmentation solutions all had a strong presence. Elizabeth Arden entered the physician channel with the Elizabeth Arden Rx collection featuring Triple Protection Factor Broad Spectrum Sunscreen SPF 50+, based on a combination of of three protective and restorative ingredients - DNA Enzyme Complex, Antioxidant Complex and broad-spectrum SPF 50+ sun protection in a moisturising base. Another new launch into the physician distributed skincare arena was GMC Medical, from G.M.Collin, a 25-year-old Montreal based spa brand. This comprehensive line of a dozen products addresses acne, skin ageing, sun damage, and pre- and post-medical aesthetic procedures. L’Oreal put forth new entries from some of its active cosmetics brands, while SkinCeuticals captured attention by featuring an impressive total of 13 scientific publications, and the debut of Resveratrol B E Antioxidant Night Concentrate. La Roche Posay showcased the new Anthelios 60 BEST NEW PRODUCT OR TREATMENT Ultra Light Lotion Spray with Cell-OX Shield, which boasts new micro shield technology to protect skin during intense UV conditions and in water. Also launched at the meeting was NeoStrata’s new Skin Active • Skin Rejuvenation Triple Firming Neck Cream, which targets the neck and décolleté • Acne (all grades) areas with Swiss Apple Stem Cell Extract and an array of proprietary • Pigmentation ingredients. Exuviance Age Reverse HydraFirm, a luxurious cream that targets the visible signs of ageing and replenishes optimal • Psoriasis hydration levels, was on display boasting a triple firming complex • Rosacea of patented Bionic, NeoGlucosamine and Matrixyl Peptides to • Accelerated Healing plump and fill skin. The Canadian giant Valeant Pharmaceuticals International presented its new Neotensil daily under eye reshaping procedure, available through Obagi Medical and sold in clinics. “The Tri-Wave is without a doubt Finally, pigmentation problems always take centre stage at the AAD the most useful machine I have and this year was no different. ZO Skin Health, Inc., from Dr. Zein ever bought and would Obagi, introduced two new GSR Systems, comprehensive home recommend it to anyone running care kits designed for normal to dry and normal to oily skin types, as an Aesthetic clinic.” well as two new specialised pigmentation treatment programs, ZO Dr Simon Ravichandran Multi-Therapy Hydroquinone System and ZO Non-Hydroquinone Cosmetic Doctor and Medical Director of Clinetix, Glasgow Hyperpigmentation System.

Aesthetic Technology Limited Wendy Lewis has authored 11 books on Park View House, Worrall Street antiageing and cosmetic surgery, and regularly Congleton, Cheshire CW12 1DT lectures internationally. She is the president of t: 0845 689 1789 | e: [email protected] Wendy Lewis & Co Ltd and founder/editor in w: www.dermaluxled.com chief of Beautyinthebag.com Clinical Practice Special Feature @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com

particular area (such as ‘muffin top’, inner thighs, or upper arms) then cryolipolysis works well. For all over body contouring we Suzi Lewis-Barned speaks to medical practitioners tend to use a combination of all treatments regarding the fat loss and skin tightening over several sessions and cellulite is often treated by a combination of radiofrequency treatments they use in combination at their clinics and dermology.” He adds, “For patients who are most interested in total weight loss, we would combine weekly treatments with a whole diet, exercise and wellbeing programme (3D-lipolite) using meal replacement supplements and biometric monitoring.” These treatments are normally offered over a course of eight sessions, starting with cavitation, which normally Body contouring for the gives quick results, and combined with radiofrequency during weekly sessions. There may also be one or two treatments summer -choosing the with cryolipolysis on specific areas and most courses are completed with dermology. winning combination Dr King has noticed good early results using cavitation, including improved body measurements, with the results of Body contouring is an increasingly popular People visit cosmetic clinics for treatments cryolipolysis tending to show after about market among a wide group of male and that target a range of problems: loose skin eight weeks. female patients seeking treatment for that needs tightening or firming; ‘stubborn’ a variety of conditions, including those areas of fat including around the abdomen; Zander says her clinic often combines resistant to exercise and diet regimens. ‘bingo wings’; fat thighs and/or buttocks. treatments for cellulite, such as Lipotripsy Although as Esther Fieldgrass, founder and And, according to Jill Zander, a key patient acoustic wave followed by Ballancer CEO at EF Medispa explains, treatments group is younger women looking for anti- treatment for lymphatic drainage. Lipotripsy typically appeal to women aged 25 to cellulite treatment. works as cellulite calcified deposits form 65, the male market is also now reported around fat cells, which prevent fat being to be growing; gynaecomastia treatment What treatments are combined? released; the acoustic wave shatters the fat increased by 24% and male liposuction was According to Dr Grant Hamlet, founder and cells so the fat can escape. As an alternative, up 28% last year, according to the British director at You by Design cosmetic surgery, her clinic might use the FDA approved, Association of Aesthetic Plastic Surgeons’ combination therapies are showing “true non-invasive, Cynosure SmoothShapes (BAAPS) annual audit for 2013. promise” although different combinations system, which combines laser (915nm) and Partly driven by the visible success of need to be used depending on the nature light (650nm) energy with a vacuum and treatment, Dr Andrew Weber, medical of the problem. Esther Fieldgrass of EF mechanical massage rollers, which allow director at Bodyvie Clinics, feels the Medispa explains, “We put specific treatments the expressed fat and fluids to be filtered popularity of this market is likely to be due together because they will enhance the out of the body via the lymphatic system. to the pressure many women feel after texture of the skin as well as the performance Additionally, Zander uses BTL’s Vanquish, browsing the content of popular magazines. of the treatment. As an example, after Vaser “People see pictures of other women and LipoSelection we will use manual lymphatic they feel they must have that look – there’s drainage to help with the healing process of a sense that it’s easily achievable for them the body by using the massage to stimulate too. Of course, some of the time, it isn’t,” he any particular fatty areas that we want to get says. Jill Zander, owner of the Jill Zander rid of. If there is a deep pocket of fat we may Skin Rejuvenation Clinic, has also noticed use carboxytherapy (carbon dioxide therapy) considerable growth in the market, as to pump blood and oxygen into that area to 3D-Lipo - Before and after three sessions of well as the increasing availability of new remove any fatty deposits.” RF combined with vacuum roller devices to serve this demand. She explains, Dr Martyn King, co-owner at the Cosmedic “Demand is increasing tremendously and Skin Clinic and medical director of the will continue to grow – we are investing 3D-lipolite program, uses the 3D-lipo more than ever in new devices and, machine, a multi-platform device, to combine without doubt, everyone who offers fat loss a range of treatments that will vary according treatments should also offer skin tightening, to the client’s expectations, gender and either through a different device or in areas of concern. He explains, “For slimmer 3D-Lipo - Before and after one session of cryolipolysis combination devices.” clients who are just concerned about a

20 Aesthetics | May 2014 n

a F

Skin Tightening lipomed

A Powerful Three Dimensional Alternative to Liposuction

No other system offers this advanced combination of technologies designed to target fat removal, cellulite and skin tightening without the need to exercise

Cellulite This NEW advanced device is dedicated exclusively to the clinical market

Why choose 3D-lipomed?

Cavitation • A complete approach to the problem Cavitation is a natural phenomenon based on low frequency • Prescriptive ultrasound. The Ultrasound produces a strong wave of pressure to fat cell membranes. A fat cell membrane cannot withstand this • Multi-functional pressure and therefore disintegrates into a liquid state. The result is • Inch loss natural, permanent fat loss. • Cellulite Duo Cryolipolysis (New) Using the unique combination of electro and cryo therapy 20-40% • Face and Body skin tightening of the fat cells in the treated area die in a natural way and dissolve over the course of several months. • Highly profitable Two areas can now be treated simultaneously. • No exercise required Radio Frequency Skin Tightening • National PR support campaign Focus Fractional RF is the 3rd generation of RF technology. It utilises three or more pole/electrodes to deliver the RF energy under • Clinician use only the skin. This energy is controlled and limited to the treatment area. Key advantages of this technology are high treatment efficacy, Complete start up and support no pain as less energy is required, shorter treatment services and package available from under variable depths of penetration.

£400 per month 3D Dermology RF (New) The new 3D-lipomed incorporates 3D Dermology RF with the stand alone benefits of automated vacuum skin rolling and radio frequency.

“I am so pleased to be given the opportunity to have the first medical version of the award winning 3D Lipo machine in my new clinic. This multi-platform technology offers a powerful non-surgical alternative to lipo suction with the addition of skin tightening and cellulite reduction modalities. I’m so proud to be able to offer my Before After clients the very latest result driven technology.”

Dr Leah Totton - Winner of The Apprentice 2013

For further information or a demonstration www.3d-lipo.com call: 01788 550 440 www.3d-skintech.com Clinical Practice Special Feature @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com

BTL Vanquish - Before treatment BTL Vanquish - After treatment the other is less intensive, which has implications for the clinic and staff.”

Treatment protocols For Esther Fieldgrass, the key is to see how a patient is responding to treatment and to adjust the protocol accordingly to achieve the optimal result. As she explains, BTL Vanquish “Body contouring is an art and practice is which she says is particularly effective for For his patients, Dr Grant Hamlet uses VASER required to see where [practitioners] are treatment of the abdomen. “Vanquish seems lipo, in conjunction with VelaShape, which going to get the best results.” Dr Hamlet to be a forerunner in the field,” she says. “The combines bi-polar radiofrequency (RF) and stresses the importance of careful patient technology is very new and powerful, and infrared light energy with a vacuum and consultation and monitoring to this effect. you have to be careful when monitoring the mechanical massage. VASER lipo targets “We treat what needs to be treated,” he temperature the patient’s skin reaches, which unwanted fat using ultrasonic technology says. This approach is also adopted at must not exceed 42°C.” whilst preserving important tissues such as Dr Weber’s clinic, as he explains, “Some Dr Ravi Jain, medical director and founder of nerves, blood vessels and collagen and helps people respond better than others to Riverbanks Clinic, says that for about three with particularly stubborn areas that will not specific treatments; it’s a question of finding years his clinic has used Med Contour. He shift through diet or exercise and can improve a treatment, or combination of treatments, explains, “This system combines ultrasound, overall shape. that are effective on that particular person. lymphatic drainage and massage in one As a rule of thumb you can assume a system. We’ve had very good results: fat What are the benefits of combining treatment is going to work in 95% of reduction on the tummy and waistline, and treatments? patients but the other 5% are not going to cellulite improvement on the thighs. We offer Many practitioners are confident in the use respond very well – so then it’s a question this treatment once a week for six treatments. of combination therapy to achieve optimum of having something as an alternative.” Alongside Accent radiofrequency, Dr results; Dr King says, “I would certainly Jill Zander suggests six to 10 Lipotripsy Weber uses the Endermolab endymology recommend a combination approach to treatments followed by Ballancer, then system, mesotherapy and injectable achieve the best results,” and Dr Hamlet mixing in SmoothShapes but, as she lipolysis, Aqualyx, in his clinic. “Endymology explains, “For example, VelaShape may explains, it’s never a case of ‘one size fits is a system of vacuum and rollers used for improve cellulite from a little to a lot, but all’. “What we try to do is to individualise treating cellulite,” he says. “It also provides adding other technologies and techniques, and personalise packages,” she says. lymphatic drainage, which will speed up or even a surgical procedure, is definitely “We also offer packages at different price absorption of fat. The Aqualyx, the injectable going to improve your final result. We points – this is a great way to encourage that dissolves fat, also helps to speed up are finding that combination treatments clients to commit to completing a full course the absorption of fat, produce more skin also increase the longevity of results.” of treatment.” Dr King’s experience has tightening and tones the skin, and can also The reported overall success rates of led him to believe that radiofrequency be used as a standalone. Mesotherapy can combination treatments tend to be higher treatment is best for skin tightening, be used for creating volume.” with women because they effectively especially of the lower abdomen post- Dr Tracy Mountford, founder and medical reduce their peripheral fat, whereas men pregnancy. He explains that cavitation director of the Cosmetic Skin Clinic deploys are more likely to have problems with works best for larger areas of fatty CoolSculpting in combination with Thermage visceral fat, which cannot be treated, tissue, and reaches greater depths than CPT radiofrequency skin tightening. She even with combined therapies. As Dr King radiofrequency while cryolipolysis can stresses that before adopting any new explains, “One size does not fit all; clients destroy 25-30% of fat cells, although the treatments she waits to check how they are different and treatment areas cannot all results do not appear quickly. This is why have been performing in the market and also be treated with the same technology,” an his treatment protocol often begins with waits until they have been FDA approved approach endorsed by other practitioners cavitation, for which the results are more or as meeting safety and efficacy measures; who confirmed the need to ‘mix and match’. less instantaneous. “It’s great to have ‘new’, but as I have always Esther Fieldgrass adds that ensuring maintained, ‘new’ does not always mean patient comfort whilst achieving the best What are the difficulties and better,” she says. possible end result is key when conducting limitations of combination therapies? combination treatments; “We want Dr King suggests that whilst most patients something that creates the best effects with are suitable for combination treatments, little down time,” she says. the normal exceptions apply, including: The practical considerations are also those with unrealistic expectations (for important as Dr Claire Oliver, medical example liposuction-style results), people director at Air Aesthetics Clinic, explains; in poor health, pregnant women and “The Exilis treatment can be used to target those breastfeeding, patients fitted with a areas of fat that another applicator may pacemaker and those with uncontrolled

Med Contour not be able to fit,” she says. “Furthermore, diabetes and taking immunosuppressants. one treatment is resource intensive whilst Dr Oliver adds that she will not offer

22 Aesthetics | May 2014 My

3½ Month Program lite program A New Three Dimensional Approach to Clinical Weight Loss and Body Contouring

1 2 3 + lite+ A New Three Dimensional Approach to Medical Weight Loss and Body Contouring 3D-lipo Treatments 3D-lipolite Diet & Nutrition 3D-lipolite Exercise Plan We can’t say that the 3D-lipolite program has changed her life. But Sharon can.

Following the birth of my baby I tried many diets desperate to get back my pre-pregnancy figure and weight which didn’t work. Unlike these other quick fix weight loss programs this one has educated me to eat correctly and I am convinced that I will maintain the results achieved as I have adapted to the change of lifestyle and new healthier eating habits.

I have gone from a size 14 to a size 8 in four months and feel better in myself with restored confidence.

Thank you to all at 3D-lipolite.

“I’ve been so impressed by the results of my own clinical trials that I would recommend this program to anybody” - Dr Martyn King (Finalist Aesthetic Practitioner of The Year 2013/14)

3½ Month Clinical Trial Results. Sharon Morrow, 37 Years of Age from Rugby

Weight Loss: 9.6 kilos (1.51 stone) Waist Measurement loss: 20cm For full details of our Hip Measurement loss: 16.5cm Chest Measurement loss: 8cm clinical trials contact us Exclusive territories available. www.3d-lipolite.com Do not miss out on this unique business opportunity. www.3d-lipo.com Call 01788 550 440 www.3d-skintech.com

2869 3D LipoLite - Sharon.indd 1 27/2/14 14:07:01 Clinical Practice Special Feature @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com

treatment to people who are more than on patient satisfaction to help two stone above their ideal body weight. improve the services you offer. Although there may be a number of “Each practice, no matter what risks associated with using treatments technology they have, needs to in combination, Dr Ravi Jain advises that audit their results and be able to the main consideration is to check for communicate satisfaction levels sensation; “A lot of these treatments can to their patients,” he says. cause temporary altered sensation to the “If satisfaction levels are skin so we need to know a patient has low, use a different type of normal sensation in the skin before we do technology to change that, we any treatment, let alone mix treatments,” need to be above 80%. You have to think to stand the test of time, so try to do your he says. “If they can’t feel pain, you may be about the patient’s point of view before the research.” He explains that trialling products doing them harm; if there is bruising from clinic’s; if you get that right your business and gathering feedback from other users treatment you don’t want to do another will be taken care of quite nicely.” Dr Claire is a good way to test the effectiveness of treatment until that has settled. CoolTech Oliver agrees that understanding your devices before making an investment. Dr is a very effective treatment, but if you try patients’ needs is the key to success, as Jain adds that it’s important to keep up-to- to repeat it too soon before the full effects well as being aware of financial investments date with technological advancements; “If a of the first treatment have taken effect that you are making. “Understand and clinic’s technology is over four or five years you could end up with over-correction. It’s identify what your clients require and old, the chances are they need to improve important to make sure you do not over- choose your system from there,” she says. it,” he says. treat people.” “Be mindful that investment in technologies In terms of what technology to opt for, requires a commitment to marketing to practitioners have differing opinions. “I Advice for ensure the targeted payback of the system feel the combination of radiofrequency CoolTech practitioners is achieved.” and ultrasound will be the future of body wishing Dr Weber also agrees that practitioners contouring,” says Jill Zander. However, to invest should be conscious of the investments Dr Ravi Jain believes everyone should in body they make in devices. “Investing in devices be looking into cryo technology. “A good contouring is a big financial commitment; with lasers cryo system means no treatment should devices you’re looking at close to £100,000 with be required more than once every three Dr Ravi Jain some. Endymology is still running at about months or once every two months,” he highlights the £30,000 and radiofrequency is around explains. “We’ve found it to be a one-off importance of £50,000. You need to get the most out of it treatment in most of our patients.” auditing results and make certain that the device is going He also finds benefits in designing your treatment package specifically for each patient. “When we have sold courses Device selection of three treatments, patients have had treatment in different areas, as there was With no shortage of choice within the body contouring device market, our contributors were invited to highlight the main factors they had considered no need to repeat in the same area,” Dr when selecting devices for their clinics. Jain explains. “So now, depending on how big the patient is, we adjust our package Esther Fieldgrass’s decision factors included: published research results; the offers. If they have two fistfuls of fat, we existence of good back-up support for any equipment procured; high quality are confident that they will only need one continuous training for the clinic’s therapists; and actual clinical results from an in-clinic two-month trial period. treatment. If they have a whole tummy [of fat] they may need two hours, which is two Dr Martyn King took patient conversion rates into account when it became sessions.” He also explains that you should apparent that a combination approach was far more popular with his patients. design your treatment packages to achieve Dr Tracy Mountford spoke to colleagues in the profession that she felt she could optimum efficiency; “Don’t combine one trust, as well as checking the device was FDA approved. weekly treatment with another weekly Dr Grant Hamlet considered whether or not a device would complement the other treatment as the patient will be with you treatments already offered in his practice and whether any future modifications forever; instead, combine a weekly, perhaps were planned that would help his patients, (e.g. a larger handpiece for the with a one-off treatment.” It is clear that VelaShape III that can be used to treat cellulite). there are multiple different combinations of treatments available on the market that Dr Claire Oliver highlighted the significance of ‘no downtime’, as well as the need to select a proven technology that was safe, effective, approved and that could be appear effective and choosing the right profitably deployed. combination requires careful analysis against a range of selection criteria determined by Dr Andrew Weber placed greater reliance on the objective feedback from your clinic’s particular priorities. Ultimately, colleagues and the results of clinical studies than on the pitch of device sales staff. success will be about choosing the right He also took account of the nature of the treatment and whether it was likely to be pleasant and well tolerated by his patients. combination for your patient group that provides them with the optimum results.

24 Aesthetics | May 2014 REJUVENATE

FIRMER

TIGHTER

LIFTED

YOUNGER LOOKING SKIN TIGHTER

THETIGHTER UNIQUE MULTI SOURCE PHASE

CONTROL RADIOFREQUENCY SYSTEM

A NEW WAVE IN CLINICAL PERFORMANCE FIRMER FIRMER 3DEEP® Skin Tightening, Firming, Lifting & Contouring Face (including peri-orbital & oral areas), jawline, jowls, neck, décolleté, body: arms, knees, tummy, bottom, thighs, flanks 3DEEP® Fractional Skin Resurfacing & Skin Tightening Face, neck, décolleté NEW 3DEEP® Intensif™ RF Microneedle Skin Remodelling & Sculpting* Face, neck, décolleté, body

After nearly 3 years experience with EndyMed™ 3DEEP® skin tightening and fractional resurfacing we are delighted with the results of our treatments for facial skin tightening and body skin tightening and cellulite. Our patients love their treatment sessions and always look forward to the next! MR CHRIS INGLEFIELD London Bridge Plastic Surgery & Aesthetic Clinic EMONS D T C R Having seen the results from our patients, the I A N T ™ I I EndyMed consistently outperforms all other non-surgical, O THE NEW L N C MAKE SURE

skin tightening systems on the market. S

DR D MAINI Zenith Cosmetic Clinics DESKTOP I YOU CONSIDER PLATFORM ENDYMED™!

C O S N T T U CONTACT US A C

FOR FURTHER DETAILS, SCIENTIFIC & CLINICAL INFORMATION PLEASE CONTACT AESTHETICARE® 0800 0195 322 endymed.aestheticare.co.uk [email protected] @aestheticareuk facebook.com/aestheticareuk

Endymed trade Ad.indd 1 11/04/2014 17:00 Clinical Practice one CPD Clinical Article point @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com

Lip Augmentation: an art and a science Sharon King discusses the anatomy and physiology of the lower face in relation to lips

INTRODUCTION ‘B’ line and Sushner’s tissue nasion-chin line ‘S2’. (Figures 2-6) Naidu, Lips are viewed by many as the most beautiful feature of the face. while studying the consistency of the five reference lines, found that Aesthetically, they provide a focal point of beauty and, functionally, they the S2 line, the E line and the B line had the smallest variation and are part of the apparatus of speech in addition to providing a visual therefore provided the best reference lines in judging the horizontal display of varied human emotions. Patients often have a clear idea of position of the lips in profile.4 what look they want before seeking treatment of the lips with dermal Rickett’s line (Figure 2) shows the relationship of the lips in relation fillers, although this may not always be ideal. Patients who want to look to the nose and chin. Although the upper lip should protrude slightly like a favourite celebrity or those asking to look significantly younger more than the lower lip in the vertical plane (1-3mm), for aesthetics pose a challenge to any practitioner as the shape of the lip alters with there should be a 4mm space and 2mm space between the maximum age and lip volume naturally decreases. Critical changes in the perioral protuberance of the upper and lower lips respectively. Burstone’s B area can include vertical rhytids, increased prominence of nasolabial line (Figure 5) joins the soft tissue sub nasally and the skin pogonion folds (the crease that runs from nose to the corner of the mouth), ptosis (with the mid point of the chin as its lower point of reference). of the oral commissures (sagging of lines from the corners of the mouth), Sushner’s line (Figure 4) is drawn from the soft tissue nasion (the thinning of the lips, and flattening of the upper lip with less definition of bridge of the nose) to the soft tissue pogonion. Holdaway’s line (Figure the Cupid’s bow.1 Rejuvenation of the lips is a commonly requested and 6) is a line drawn from the soft tissue pogonion to the upper lip.5 frequently performed procedure with numerous strategies available to Figure 2 Rickett’s E line Figure 3 Steiner’s S line Figure 4 Sushner’s S2 line practitioners. Common approaches include adding volume to the body of the lips or accentuating the vermillion border (lipline) usually through the injection of dermal fillers or enhancement of the lip line using semi- permanent makeup. Volume is added to create a more protruding and pouty lip, based on the fundamental belief that volume loss is a significant part of the ageing process. Figure 5 Burstone’s Figure 6 Holdaway’s ASSESSMENT AND MEASUREMENT B line H line Figure 1 Before proceeding with lip enhancement there are a few basic rules that should be considered. The Ancient Greeks are accredited with applying the ‘Golden Ratio’, with canons dictating that the lower lip should be 1.614 times as thick as the upper lip and (Figure 1) Copyright that the upper lip should protrude 2mm Cosmedic Skin Clinic 2014 The height of the upper face, mid face and lower face should be further than the lower lip. We should observe approximately equal to maintain symmetry. The lower face can be these rules when looking at aesthetic enhancement to maintain a split into thirds, with the upper third being the sub nasal point to the natural look and balance for the face.2 mouth (ideally 1.1cm) and the lower two thirds, the mouth to the chin. • In general the distance between both oral commissures should On projection the upper lip should project 1-2 mm forward from the be equal to the distance between both mid pupil points if the four lower lip.2 points were linked to form a square5 (Figure 1) Some common errors that tend to lead to poor aesthetic results • In Caucasians the proportion of the upper lip in relation to the include: lower lip should be 1 to 1.618mm (other ethnicities may have 1. Treating the vermillion border only, particularly in older patients dimensions approaching 1 to 1). 2. Placing too much product in the centre of the lips • The height/volume of the upper lip should be between 0.65-0.85 3. Failing to achieve balance by over injecting the upper lip versus the that of the lower lip. Although men have relatively thinner upper lower lip or vice versa lips than women, the ratio in both genders is similar. 4. Placing product throughout the lips without paying attention to • A well-shaped cupid’s bow with full philtral columns is the ideal.3 defining features creating shapeless lips 5. Injecting too much dermal filler in general Several other methods have been used for evaluating lip position and 6. Not retaining balance with the surrounding structures in the perioral its influence on facial profile. Among the most popularly referenced area or the face in general.2 For example over projection of the lips, are Rickett’s ‘E’ line, Steiner’s ‘S’ line, Holdaway’s ‘H’ line, Burstone’s giving the all too familiar ‘trout pout’

26 Aesthetics | May 2014 ProtocolsNEW

Stay safe in the sun: Stay on Obagi! Created in the sunshine state of California, Obagi, the No.1 medical skincare range for aging and pigmentation, was designed to use all year long for radiant, glowing skin

Unlock the secrets of Obagi’s summer protocols www.obagi.uk.com/summer

Contact us: +44 (0)1481 736837 www.healthxchange.com Clinical Practice CPD Clinical Article @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com

PHYSIOLOGY A good understanding of the Before performing a lip augmentation using dermal fillers, it is essential to understand the anatomy. An unqualified or anatomy of the lip and lower inexperienced injector is more likely to inject into the wrong tissue plane resulting in an unsatisfactory treatment or cause face, and the application of complications by injecting dermal filler into muscle or a the fundamental rules of measurement, will also enable the practitioner to achieve a result that is aesthetically pleasing with less risk of the errors around 1.5cm inferior to the oral commissure. The facial artery then carries on to the nasolabial groove as the angular artery forming branches to the alar and anastomosing with the dorsal nasal artery.

NERVE SUPPLY (Figure 7) © 2008 Encyclopedia Britannica, Inc. Motor nerve supply is provided via the seventh cranial nerve neurovascular vessel. A good understanding of the anatomy of (Facial Nerve), whilst sensory function of the perioral region is the lip and lower face, and the application of the fundamental provided via the maxillary and mandibular branches of the fifth rules of measurement, will also enable the practitioner to achieve cranial nerve (Trigeminal Nerve). The infraorbital nerve is a terminal a result that is aesthetically pleasing with less risk of the errors branch of the maxillary nerve and exits via the infraorbital foramen, referred to above, thus providing a safer outcome and more which is situated below the infraorbital rim. This usually lies in the effective treatment. If we were to dissect the tissue of the human mid-pupilliary line and it runs beneath the levator labii superiosis lip, we would find that from superficial to deep, the layers of the and superficial to the levator anguli oris to supply the lateral nasal upper and lower lips include the epidermis, subcutaneous tissue, sidewall, alar, columella, mid cheek and upper lip. The lower lip orbicularis oris muscle fibres and mucosa. In cross section, the and the chin receive their sensory supply from branches of the inferior and superior labial arteries run their course between mandibular nerve. A further branch of the mandibular nerve, the orbicularis oris muscle fibres and the mucosa. Minor salivary alveolar nerve travels through the body of the mandible and glands are present within the lip itself but are absent from the exits via the mental foramen, this is located below the apex of vermillion border. the second premolar with a variance of 6-10mm laterally. The nerve is located in the mucosa as it exits the foramen and can BLOOD SUPPLY often be visible in the mucosa. Having taken in to consideration Blood is supplied to both lips from the external carotid artery, the nervous and venous supply to the lips and lower face, next which ascends from the facial artery in the neck over the middle of we give consideration to the muscles of the lower face. A better the mandible. The facial artery runs deep in the platysma, risorius understanding of the function of each of the various muscle groups and zygomaticus major and minor muscles and superficial to the and their intersection points in relation to the lips will give a more buccinator and levator anguli oris where it branches into the inferior aesthetically pleasing result from the treatment. and superior labial arteries. The superior labial artery is located around 1cm above the oral commissure and the inferior labial artery MUSCLES Precise movement of the lips is essential for respiration, ingestion, (Figure 8) Copyright medicalartwork.co.uk phonation and facial expression. Thus, there are numerous muscles working together to produce the appropriate function. In order to describe the muscles acting on the lip, they have been divided below into three groups - Group I are muscles acting on the angle of the mouth at the modiolus, Group II attaching above the lip (elevators) and Group III acting on the lower lip (depressors).

Muscle Group I The modiolus is the area at each commissure, which serves as an attachment for several of the muscles of the lower and upper lip. Within this group are the orbicularis oris, buccinator, levator anguli oris, depressor anguli oris, zygomaticus major and risorius muscles. Orbicularis oris is a sphincter muscle, which causes the lips to purse and presses them against the teeth when contracted. Further muscle fibres of other muscles insert superficially in to orbicularis

28 Aesthetics | May 2014 oris. In cross section orbicularis oris is seen as a long vertical segment that curls out at the superior and inferior margins. Motor movement is provided by the buccal and marginal mandibular nerves. In the upper lip the fibres of orbicularis oris are few, sparing the central region, this gives rise to the philtral column, which is devoid of dermal attachment, and thus this gives rise to a concave depression or cupids bow. Buccinator arises from the posterior alveolar process of the maxilla (Pterygomandibular raphe), a ligamentous band of the buccopharyngeal fascia and the body of the mandible it inserts into the modiolus. Its function is to press the cheek and lips against the teeth. Motor movement is supplied via the buccal branches of the facial nerve. The parotid duct joins the buccinator at the edge of the masseter muscle. Levator anguli oris arises from the canine fossa of the maxilla beneath the infraorbital foreman and descends vertically and inserts in the modiolus with the function of elevating the oral commissure. The buccal and zygomatic branches of the facial nerve innervate this muscle and the facial artery and infraorbital nerve travel superficially on the surface of the muscle. Depressor anguli oris (DAO) lies on the mandible below the canine and first premolar and inserts in to the modiolus. The marginal mandibular branch of the facial nerve supplies the DOA and enters the muscle deep. The DAO’s function is to depress the oral commissure, this brings the smile line down, a feature often associated with negative perceptions. Risorius arises in the fascia over the parotid gland and passes horizontally forward superficial to the platysma and inserts into the skin at the angle of the mouth, drawing the commissure laterally to help produce a pleasing smile. The buccal branch of the facial nerve enters the muscle deep. This muscle helps to produce the smile that is unique to human emotions. Zygomaticus Major originates in the cheek area of the zygomatic arch just anterior to the zygomaticotemporal suture line, passing over the buccintor and inserting into the modiolus. Superiorly its fibres are deep and inferior and run superficially to the facial vessels and facial nerve. The zygomatic and buccal branches of the facial nerve supply zygomatic major and upon contraction, the corners of the mouth are lifted obliquely upwards and laterally, lifting in the corners of the mouth, resulting in a smile.

Muscle Group II A further group of muscles insert in to the upper lip. These are levator labii superioris, levator labii superioris alaeque nasi STYLAGE® Lidocaine is the only patented range of cross-linked (Otto’s muscle) and zygomaticus minor. hyaluronic acid (IPN-Like technology) dermal fillers which incorporates Levator labii superioris is a quadrilateral muscle arising from both an anaesthetic (lidocaine) and an antioxidant (mannitol) for the inferior orbital rim under orbicularis oculi and attached to safe, comfortable and effective aesthetic treatments. It can be used the maxilla above the infraorbital foramen. Muscle fibres insert for filling and smoothing of wrinkles, natural lip correction, volume into the dermis of the upper lip skin and into the orbicularis oris restoration, hydration, chin remodelling, tear trough correction, neck, décolleté and hand rejuvenation. STYLAGE® is perfectly suited for use muscle. The buccal branch of the facial nerve innervates this with a cannula. Launched in 2008, STYLAGE® by Laboratoires Vivacy muscle and its action is to elevate the upper lip. (France) is now one of the world’s fastest growing dermal fillers. Levator labii superioris alaeque nasi, this muscle has the longest name of any muscle in the human body. It is sometimes For further information about: referred to as ‘Otto’s muscle’ after an anatomist who argued that its anatomical name was too long. It is not to be confused with levator labii superioris; this completely separate muscle arises Contact Medical Aesthetic Group from the frontal process of the maxilla. Its interior fibres insert on 02380 676733 on to the lateral alar cartilage and the dermis of the upper lip or visit www.magroup.co.uk and orbicularis oris. Again nerve innervation is provided by the

MAGROUP STYLAGE HPV 95x265mm Aesthetic Journal April 2014 Issue Clinical Practice CPD Clinical Article @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com

buccal branch of the facial nerve and, upon contraction, levator occur and may be immediate or delayed in onset. Complications labii superioris alaeque nasi dilates the nostril and elevates the might include injection site reactions, infection, sensitivity and upper lip into a snarl. allergy, bruising and trauma from poor injection technique. After Zygomaticus Minor originates from the zygoma, seated below a thorough consultation and medical history the practitioner orbicularis oculi and laterally to the zygomaticomaxilliary suture. should consider herpes prophylaxis if indicated before treating Fibres pass downward and inferiorly insert into orbicularis oris. with dermal fillers (Aciclovir 200mg 5 times a day for 5 days).9 Innervation is supplied by the buccal branch of the facial nerve There is no evidence-based data to support the belief that fillers and blood supply via the labial branch of the facial artery. Upon play a triggering role in recurrent herpes infection and thus there contraction, zygomaticus minor elevates and pulls the commissure is no rationale in using an antiherpes prophylaxis regimen with laterally, contributing to the smile but also the formation of the every patient. However, patients who have had an history of nasolabial fold. developing cold sores after a filler injection may benefit from it.10 Filler injections should not be performed if there is an adjacent Muscle Group III site of infection e.g. intraoral, mucosal or dental infection or herpes Depressor Labii inferioris originates from the anterolateral labialis for lip injections. Stopping anti inflammatory drugs and mandible and medial to the insertion of the depressor anguli oris refraining from alcohol for two to three days prior to injection can and lying deeper than the depressor anguli oris. Its fibres pass in help to minimise the risk of bruising. Practitioners should discuss a fan like distribution into the lower lip dermis and orbicularis oris with the patient the treatment fully including expected results muscle, depressing the lower lip and pulling it slightly laterally. and potential complications. Any pre-existing asymmetry or skin Mentalis, a paired central muscle of the lower lip, arises from conditions should be highlighted and of course good pre- and the anterior midline of the mandible and inserts into the dermis. It post-treatment photographs are essential. pulls down on the margin of inferior orbicularis oris and everts the Products which are placed too superficially may result in central portion of the lower lip. In conjunction with orbicularis oris nodules or the presence of a bluish tinge known as the Tyndall contraction, the mentalis muscle allows the lips to ‘pout’. Externally, phenomenon. This can also be a result of hemosiderin caused by mentalis contraction causes wrinkling of the chin skin (a dimpled intradermal bleeding.11 Nodules formed of hyaluronic acid (HA) in chin), as used in expressions of doubt or displeasure. the lip can sometimes be punctured and their contents expressed. Platysma is a broad thin sheet of paired muscle made up of (Figures 9 and 10) Consider injections at the lip angles to offer fibrous bands arising from the fascia covering the upper part extra support and injection of the philtral column if needed for of the pectoral and deltoid muscles, passing upwards over the optimum aesthetic results. clavicle, the fibres proceed upwards and insert into the inferior border of the anterior mandible. The fibres cross superiorly just CONCLUSION before reaching the edge of the mandible border and attach to When treating the lips and perioral region it is important to create the bone of the lower jaw and also have insertions into the skin and maintain an overall plan. Understanding the anatomy of the region as well as taking into consideration the age, gender and ethnicity of the patient will ultimately give a more favourable and aesthetically pleasing result. Assessment using well-defined scales is helpful and taking into account additional factors such as volume and movement will create a more natural appearance.

Sharon King RN, NIP is a director and clinical nurse specialist at Cosmedic Skin Clinic, board member of The British Association of Cosmetic Nurses, member (Figure 9) Removal of (Figure 10) Removal of of the Aesthetic Complications Expert Group and granulomatous material lower lip granulomatous material lower lip unknown HA. Copyright Cosmedic unknown HA. Copyright Cosmedic Aesthetic Nurse Practitioner of the Year (Aesthetics Skin Clinic 2014 Skin Clinic 2014 Awards 2013-14). She has worked as a clinical trainer for some of the leading suppliers to the aesthetics industry during her 10 and subcutaneous tissue of the lower face. Many of the fibres of years in aesthetic practice. platysma blend with muscle fibres of neighbouring muscles around the angle of the mouth and lower face. The cranial branch of the REFERENCES facial nerve provides innervation and predominant blood supply 1. Chisholm BB, ‘Facial implants: Facial augmentation and volume restoration.’ Oral & Maxillofacial Surgery Clinics of North America, 17(1), (2005), pp.77-84. via the submental branch of the facial artery.6,7,8 2. Goodman,G Duckless, ‘Lips: How to Rejuvenate the Older Lip Naturally and Appropriately’ Cosmetic Dermatology, Vol 25 No 6 (June 2012) 3. Swift A, Remington K, ‘BeautiPHIcation: a global approach to facial beauty.’ Clinical Plastic Surgery., 38 TREATMENT TECHNIQUE AND MINIMISING RISK (2011), pp. 347-377 Starting with the vermillion border, and working from lateral to 4. Naidu D, ‘Comparisons of the Consistency and Sensitivity of Five Reference Lines of the Horizontal Position of the Upper and Lower Lip to Lateral Facial Harmony’ The Orthodontic Cyber medial, slowly inject the filler (retrograde technique) and aspirate, Journal, (2010) http://orthocj.com/2010/11/comparisons-of-the-consistency-and-sensitivity-of- or draw back, prior to injection to minimise the risk of intra-vascular five-reference-lines-of-the-horizontal-position-of-the-upper-and-lower-lip-to-lateral-facial-harmony/ 5. Hoefflin SM, The beautiful face: The First Mathematical Definition, Classification and Creation of True injection. Volume can be created by injecting into the wet/dry Facial Beauty (California, Steven M. Hoefflin, M.D, 2002) border at mid-depth. Complications or unwanted side effects can 6. Nelson DW, Gingrass RP, ‘Anatomy of the mandibular branches of the facial nerve.’ Plastic Reconstructive Surgery, 64(4), (1979), pp.479-82 occur with the injection of any dermal filler no less so than when 7. Gray H, Grays Anatomy The Classical Collector’s Edition, (Crown Publishing, 1977) injecting the lips, hence the importance of seeking training in 8. Pinar Y A, Bilge, O,Govsa F, ‘Anatomic study of the blood supply of perioral region.’, Clin Anat., 18(5), (Jul 2005), pp.330-9 this specific technique from an experienced trainer. The first step 9. British National Formulary (BMJ Group London, 2013) to avoiding complications is to ensure an appropriate product 10. Duffy DM, ‘Complications of fillers: Overview’ Dermatol Surg, 31 (2005), pp. 1626-33 11. Bergeret-Galley C, Latouche X, Illouz YG, ‘The value of a new filler material in corrective and cosmetic for the indication is used. Adverse events, however, can still surgery: DermaLive and DermaDeep’, Aesthetic Plast Surg, 25 (2001), pp. 249-55

30 Aesthetics | May 2014 Not all HA dermal ﬁ llers are created equal.

Intelligent manufacturing technology creates a variable density gel1 resulting in... Optimal tissue integration2 Greater dermal compatibility3 Superior cosmetic results4 High patient satisfaction5

Contact Merz Aesthetics NOW and ask for Belotero.

Tel: +44 (0) 333 200 4140 Email: [email protected]

OPTIMAL www.belotero.uk.com TISSUE INTEGRATION

Injectable Product of the Year 2013

1. BEL-DOF3-001_01. 2. Tran C et al. in vivo bio-integration of three Hyaluronic Acid fi llers in human skin: a histological study. Dermatology DOI:10.1159/000354384. 3. Taufi g A.Z. et al., J Ästhet Chir 2009 2:29 – 36. 4. Prager W et al. A Prospective, Split-Face, Randomized, Comparative Study of safety and 12-Month Longevity of Three Formulations of Hyaluronic Acid Dermal Filler for Treatment of Nasolabial Folds. Dermatol Surg 2012, 38: 1143 – 1150. 5. Buntrock H, Reuther T, Prager W, Kerscher M. Effi cacy, safety, and patient satisfaction of a monophasic cohesive polydensifi ed matrix versus a biphasic nonanimal stabilized hyaluronic acid fi ller after single injection in nasolabial folds. Dermatol Surg. 2013; 39(7):1097-105. BEL092/0314/FS Date of preparation: March 2014

MZ010 A4 AD NOT ALL HA ARE EQUAL.indd 1 14/04/2014 15:51 Clinical Practice Treatment Focus @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com

up to 20% due to reflection of the rays, and snow will do the same but with up to an 80% increase in exposure. Within UVR, UVA and UVB are not present in similar quantities - they are split as 95% UVA and just 5% UVB. However the different wavelengths are responsible for different concerns, concisely described by the European Commission, document IP/06/571 04/05/20064 as, “UVB radiation is the cause for ‘sun-burn’. UVA radiation causes premature skin ageing, interferes with the human immune system, and is an important contributor to the skincancer risk.” UVR affects skin both acutely and in the The SPF debate: benefits longer term. Immediate effects are sunburn, immunosuppression and DNA damage. As reported by Green et al5 sunburn is due and limitations to UVB radiation, and is an inflammatory response known as apoptosis, which It’s vital to use SPF profusely, says aesthetic breaks down damaged keratinocytes in specialist Deborah Forsythe a sort of cell-suicide whereby severely damaged cells are killed in an attempt to prevent them becoming cancerous. Deborah Forsythe is a (SPF) is a concept that was first described by Sunburn is also associated with an medical aesthetic specialist chemist Franz Greiter in 1962. Coincidentally, increased risk of melanoma, particularly and member of the Allergan 6 faculty responsible for Greiter is also one of four people variously before the age of 20. validating practitioners on credited with bringing to market the first Long-term UVR effects are caused by injection techniques. She specialises in non- sun protection products in the 1930s and both UVA and UVB damage. Fisher GJ surgical dermal facial rejuvenation. 40s. Recent changes to both the Food and et al7 reported that UVA reaches the There is a dark side to the sun. The US Drug Administration (FDA) SPF rules and the dermis and is absorbed by fibroblasts government has officially identified European Cosmetic Regulation 1223/2009 and stimulates matrix metalloproteinases ultraviolet radiation (UVR) both from the have underlined the need for ‘broad (MMPs), causing a reduction in collagens sun and from tanning machines as a known spectrum SPF’3. I, III and VII, a reduction in fibrillin and an cause of cancer in humans.1 UVR produces To understand the SPF debate, we need to increase in elastotic material It is these DNA changes that may lead to mutations be clear about the difference between SPF changes that lead to the visible signs of in genes involved in the development and ‘broad spectrum SPF’, and for this we ageing – skin laxity, facial volume loss, fine of skin cancer.1 The US Environmental need to understand what we are using them lines and wrinkles. Chronic sun exposure Protection agency (EPA) estimates that the for. Ultraviolet Radiation (UVR) is produced by is associated with an increase in risk of sun causes 90% of all non-melanoma skin the sun and measured by wavelength, from squamous cell carcinoma (SCC)6 as UVA cancers2 and other research links it to 65% 100 to 400. (Fig 1) and UVB radiation creates free radicals of all melanomas.2 Therefore, along with Even when the weather is cloudy, over 80% (unstable oxygen molecules that have lost other sun safety strategies, sunscreens that of UV rays penetrate the cloud layer, and one of their two electrons) which damage absorb or block UVR serve an important other factors can increase UV exposure. For cell function and can alter RNA and DNA. protective function. Sun Protection Factor example, sand will increase UV exposure by Basal cell carcinoma (BCC) is the most common skin cancer, and is also due to Figure 1 long-term sun exposure. SPFs are mostly combinations of physical and chemical Wavelength From To Notes ingredients; zinc and titanium oxides are the Not filtered by glass most frequently used physical screens, and UVA 100 290 Penetrates dermis work by scattering the light and blocking it Intensity consistent all day, all year from the skin; avobenzone, benzophenones, dibenzoylmethanes, ecamsule, octocrylene, Unable to penetrate glass octyl methoxycinnamate, PABA, Affects epidermis, causes sunburn UVB 290 320 Most intense in summer - 70% of phenylbenzimidazole sulfonic acid and annual exposure salicylates are among the more common Vitamin D synthesis chemical sunscreens, and they work purely by absorbing UV light.8 Absorbed by ozone layer UVC 320 400 The EU document IP/06/571 goes on to No effect on skin state, “However, the so-called SPF only

32 Aesthetics | May 2014 PROTECT & PREVENT

ESSENTIAL ANTI AGEING

PROTECTION

& PREVENTION

THEPROTECTION REVOLUTION

Medigrade skincare management of the complete ANTI AGEINGspectrum of daily skin ageing challenges with

New & Unique HELIOCARE® 360º

PROTECTS - Unique combination of clinically researched ESSENTIALorganic, inorganic and biological filters protect against the complete spectrum of daily environmental challenges - UVB, UVA, IR-A and visible light PREVENTS - Powerful prevention of ROS/ free radical damage with Fernblock® FC, a natural patented clinically proven skin anti-oxidant fortified with ferulic and caffeic acid REPAIRS - Helps prevent the effects of skin-cell DNA damage with evidenced based DNA repair enzymes CARES - Silky, smooth, moisturising, every-day use skin loving formulations

ASK US ABOUT

CPD CERTIFIED TRAINING WORKSHOPS The Skin; anatomy & physiology, functions & mechanisms, ageing & problem conditions WORKSHOPS EVERY Evidence based skincare ingredients and products MONTH ACROSS THE UK Client consultations and evidence based regimes

FOR FURTHER DETAILS, SCIENTIFIC & CLINICAL INFORMATION PLEASE CONTACT AESTHETICARE® 0800 0195 322 heliocare.aestheticare.co.uk [email protected] @aestheticareuk facebook.com/aestheticareuk

Heliocare 360 trade Ad.indd 2 11/04/2014 17:14 Clinical Practice Treatment Focus @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com

Cancer Council immediate pain of ‘sun-burn’ through to Australia are clear: cosmetic and health implications of long “Apply sunscreen term exposure. liberally – at least a Protection against photo damage is critical. teaspoon for each Many procedures carried out by aesthetic limb, front and back practioners increase the risk of damage of the body and associated with exposure to UV radiation. half a teaspoon for For maximum protection against the the face, neck and damage of UVA and UVB a broad spectrum ears. Most people SPF is essential.10 However the manner don’t apply enough of application of the SPF is vital to ensure sunscreen resulting not only protection against ever present in only 50-80% of the UV damage, but continued support for the protection stated on epidermal and dermal structures to prevent the product.”9 premature ageing. SPF15 provides REFERENCES greater than 93% 1. World Health Organisation (WHO), Environmental Health Criteria protection against (EHC) 160: Ultraviolet radiation, United Nations Environment Programme, World Health Organization, International Commission UVB. Protection on Non-Ionizing Radiation Protection (Geneva: WHO, 1994) 2. United States Environmental Protection Agency, Sunscreen: This led to changes in EU legislation 30+. Therefore the difference between a the Burning Facts (EPA, 2006) < http://www.epa.gov/sunwise/doc/ including the need for a UVA logo or seal to SPF 15 and a SPF 30 sunscreen may not sunscreen.pdf> 3. Regulation (EC) No 1223/2009 of the European Parliament and of inform consumers that a given product has have a noticeable difference in actual use the Council of 30 November 2009 on cosmetic products’, Official ‘broad spectrum SPF’ (i.e. includes protection as the effectiveness of a sunscreen has Journal of the European Union (2009) against UVA), a ban on the terms ‘sun-block’ more to do with how much of it is applied, 4. Council Directive of 27 July 1976 on the approximation of the and ‘total protection’, and improved labelling how often it is applied, whether the person laws of the Member States relating to cosmetic products, (European Commission, 2010) In the US, SPF is measured when product water. EU Commissioner Markos Kyprianou, 5. Green A, Williams G Logan V, Strutton G, ‘Reduced melanoma after regular sunscreen use: randomized trial follow up’, J Clin Oncol, is applied to the skin at a uniform thickness responsible for health and consumer 29(3) (2011), pp. 257–63. of 2mg/cm2. If it takes 10 minutes to burn protection says, “Consumers must be made 6. Bowes L., ‘Understanding the dermal effects of heightened exposure to the sun’, Journal of Aesthetic Nursing, 1(1) (2011), pp. without a sunscreen and 100 minutes to fully aware that no sunscreen product can 25-31. burn with a sunscreen, then the SPF of that provide 100% protection against hazardous 7. Fisher G.J., Datta S.C., Talwar H.S. et al, ‘Molecular basis of sun induced premature skin aging and retinoid antagonism’, Nature, 379 sunscreen is 10 (100/10). 2mg/cm2 equates UV-radiation. There are serious health risks, (6563) (1996), pp. 335–9. to approximately 30ml to cover the body, such as skin cancer, linked to insufficient 8. Skin Cancer Foundation < http://www.skincancer.org> 9. Cancer Council of Australia and approximately 1.2g to adequately protection from the sun. EU citizens need to 10. National Institute for Health and Care Excellence, Skin cancer cover the face. In Europe, The European be fully informed about what sunscreens will prevention: information, resources and environmental changes (PH32) (NICE, 2011) Commission guidelines recommend a higher and will not do for them.”4 level of 35g to cover the body, equivalent There is a vast body of evidence of the FURTHER READING Armstrong B.K., Kricker A., ‘How much melanoma is caused by sun to six teaspoons of cream. Guidelines from damage that UVR can cause, from the exposure?’, Melanoma Res, 3(6) (1993), pp. 395-401.

The deficit of UV stimulation is virtually such as the activator protein 1 (AP-1) and nuclear factor kappa- as dangerous as its surplus, argues Dr Tiina light-chain-enhancer of activated B cells, NF-kB are known effects Orasmae-Meder that UV radiation has on human skin. It is without doubt that ultraviolet rays, especially UVB-type, cause degradation of the Dr Tiina Orasmae-Meder is Generally speaking, skin’s main structures. However, lack of consideration of the UV a dermatologist and founder the advice given spectrum as a factor affecting human organisms is unfavorable. of Meder Beauty Science, One of the basic vitamins, liposoluble vitamin D, is synthesised based in Switzerland, and also by cosmetic works at Iris Brand Vigilance dermatologists to only if activated by skin exposure to UV radiation. Therefore the to guide cosmetic safety patients regarding absence of such stimulation may result in vitamin D deficiency, sunscreen is to and the development of hypovitaminosis. Insolation deficiency insist that it should be worn during all seasons, anywhere and in individuals who for various reasons have only limited sun by everyone, suggesting to their patients, “There is no safe exposure (for example prisoners, Arctic dwellers and people tan.” Indeed, the damaging effect of ultraviolet (UV) has been with disabilities that make it hard or impossible to spend time researched thoroughly. It’s been confirmed many times that the outdoors) is known to enhance the development of osteoarticular skin damage caused by UV radiation is a major risk factor for all disorders (such as decrease in bone tissue density, pain types of skin cancer, including melanoma and basalioma1. syndrome, undesired changes in ligament elasticity, stiffness and Degradation of dermal amorphous substance, increased activity dystrophic degeneration of joints) and characteristic changes of of free radicals resulting in enhanced lipid peroxidation, activated skin2. Furthermore, vitamin D deficiency is linked to a higher risk of metalloproteinase and direct activation of transcription factors, certain types of cancer, cardiovascular pathologies, and decrease

34 Aesthetics | May 2014 A New Dimension in Non-Surgical Technology

A revolution in the non-surgical aesthetic skincare market...

Rotational Diamond Peel Microdermabrasion Utilising the latest technology available you can work in conjunction is set to create a revolution in the with topical skincare to ensure that hydration and comfort are not non-surgical Aesthetic skincare market. Following the success of compromised whilst delivering excellent peeling results. the award winning 3D-lipo which combines technologies for the Radio Frequency effective treatment of fat, cellulite and skin-tightening we are set Tri-polar Radio Frequency is the most advanced technology to launch a phenomenal new multi-functional device for the face. available for skin-tightening ensuring excellent results without the Here are just some of the reasons why 3D-skintech will become discomfort associated with mono or bi – polar devices. the brand of choice in 2013 Mesotherapy • Complete treatment portfolio for anti-ageing, Non-invasive mesotherapy ensures that the active ingredients are pigmentation and acne delivered where they are needed most without the need for needles. • 4 technologies ensure a prescriptive & total LED approach to your clients needs Full canopy LED ensures both rapid treatment time and excellent • Used in conjunction with medical peel and results are achieved. Available wavelengths Red (640nm - 700nm), cosmeceutical skin care line Blue (425nm - 470nm), Yellow (590nm) and Green (520 - 564nm) ensures effective treatment for anti-ageing, pigmentation, acne and • Unsurpassed results ensures maximum detoxification. client loyalty 3D-skintech peels and clinical skincare • Highly profitable with a multitude A compact range of medical grade peels and cosmeceutical skincare of services to offer products complete the Skintech’s unique offering and enables you • Provides you with a competitive to both use as a “stand-alone” service or combine with equipment protocols. edge in your area

• Free product starter pack ‘To compliment our core injectable business the 3D-skintech has added an array of new result driven facial services to our clinic’s menu as well as the combination services • Affordable finance packages for our more curative patients. We recognized that this device offered the stand alone available quality of each technology in a unique machine that will ensure that we both deliver the results but equally can make money from the start due its affordability. As a clinician too many times in the past we have invested huge sums of money in a single concept that has proven difficult to profit from. In my opinion this type of system represents the IT’S ALL YOU WILL EVER NEED… future in our industry.’ Dr Martyn King – GP and Clinical director Cosmedic Skin Clinic

For more information or a demonstration www.3d-skintech.com Please call 01788 550 440 www.3d-lipo.com

2659 3D Lipo Skintech.indd 1 29/1/14 14:51:08 Clinical Practice Treatment Focus @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com in immunity system function.3 In Saint Petersburg, Oslo, From an aesthetic point of view, both insufficient and excess exposure to UV radiation causes rather similar skin changes. Stockholm and some other cities Excess UV is a risk factor for skin tumours and accumulative pigmentation disorders (hyperpigmentation, mostly of chloasma or the level of UV radiation is so melasma type). However, if we look at the potential acceleration of ageing as a process of structural proteins’ degradation, then the low that it can be disregarded. deficit of UV stimulation is virtually as dangerous as its surplus. The UV index 1 is considered To establish a safe time frame for insolation, it is crucial to remember that there are different levels of UV radiation. The a negligibly low level of UV intensity of its impact depends on several factors: the number of rays penetrating the atmosphere, their angle to the Earth, and the radiation and in the course of the presence or absence of barriers (dust in the air, clouds, high levels northern winter the UV index of ozone). may equal 0 for significantly long In Saint Petersburg, Oslo, Stockholm and some other cities the level of UV radiation is so low that it can be disregarded. The UV periods of time. index 1 is considered a negligibly low level of UV radiation and in the course of the northern winter the UV index may equal 0 for Of course, a lot depends on the laboratory data that researchers significantly long periods of time. At this time, I would advise that rely on, specifically the level of 25-hydroxycholecalciferol (25(HO) using sunscreen is not necessary because there is no damaging D) that is considered borderline. Today most researchers agree impact to protect the skin from. that the level of 25(HO)D < 30 nMol/L corresponds to a vitamin A noticeable damaging effect (i.e. with visible results on D deficiency risk, and level 30 to 49 nMol/L signifies insufficient unprotected skin after 20 minutes exposure to the sun) is intake. Level 50 nMol/L and higher allows us to call the intake caused by sun radiation with UV index 5 or higher. In England sufficient4. the season of intense UV (around UV index 7) lasts for no more The nutrition available to an average person does not cover the than two weeks, usually at the end of June. The UV index in need for vitamin D due to low amounts of it in staple foods and England virtually never goes higher than 8, a level that borders high caloric value of the food that contains calcifierol5. According between “high risk” and “very high risk”. In England, the average to research data, people living between the 37th and 50th UV index from the end of October until the beginning of April parallels (most European countries and a large part of North rarely exceeds 3. The intensity and characteristics of the vitamin America) do not receive the amount of insolation necessary for D synthesis varies and is individual. For some people, several independent vitamin D synthesis in winter time5, and for those who minutes of exposure to the sun is sufficient to activate the live north of the 50th parallel (Scandinavian countries and most of synthesis completely, whilst others need more time. According Russia) the level of UV radiation is not high enough for complete to a large survey held in the USA in 2001-2006, around 8% of synthesis all year round6. the population are in the vitamin D deficiency risk group, and I absolutely concur with the consensus that it is completely another 24% face the risk of insufficient intake. Together these necessary to use sunscreens when open body parts are exposed two groups make up almost a third of the country’s population3. to the sun with UV index higher than 5. It is important to remember Various research shows that some vitamin D deficiency, at least that even with the low UV index its impact can be doubled in the half-related to insufficient insolation, is diagnosed in over a billion mountains or by the sea due to the light reflecting from snow people over the world3. or water. But for city dwellers, in the days when UV index is not higher than 4 and especially when the solar activity is minimal and UV index equals 1–2 or less, I believe there is no objective need to protect the skin from the sun. Moreover, excessive use of sunscreen may lead to the development of vitamin D deficiency and related problems, like the acceleration of the natural skin ageing process, early wrinkles and loss of skin tone. The guidelines for using skin protection against the sun are too general and based on an assumption that ultraviolet radiation in any form has a solely damaging effect.

REFERENCES 1. Marija Buljan et al, ‘The Role of UV Radiation in the Development of Basal Cell Carcinoma’, Coll antropol., 32 (2008) , Suppl. 2, pp. 167-170. 2. M. Nathaniel Mead, ‘Benefits of Sublight: A Bright Spot for Human Health’,Environ Health Perspect., 116(4) (2008) , pp. 160-167. 3. Holick MF, ‘Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease’, American Journal Clinical Nutrition, 80(6 Suppl) (2004), pp. 1678S-88S 4. Wolpowitz D1, Gilchrest BA, ‘The vitamin D questions: how much do you need and how should you get it?’, Journal of the American Academy of Dermatology, 54(2) (2006), pp. 301-17 5. Ross AC, Taylor CL, Yaktine AL, Del Valle HB, Dietary Reference Intakes for Calcium and Vitamin D, (Washington (DC): National Academies Press, 2011) 6. Harinarayan CV, Joshi SR, ‘Vitamin D status in India — Its implications and Remedial Measures’, Journal of the Association of Physicians of India, 57 (2009), pp. 40–48

36 Aesthetics | May 2014 For medium to deep depressions including naso-labial Folds.1

WITH LIDOCAINE

A highly versatile, injectable gel using VYCROSS™ technology.1

reference: 1. Juvéderm VOLIFT with Lidocaine DFU, 2013. Allergan, Marlow International, 1st Floor, The Parkway Marlow, Buckinghamshire SL7 1YL, UK | May 2013 UK/0658/2013

13874 Juvederm VOLIFT Trade Ad May 2013.indd 1 11/06/2013 15:20 Clinical Practice Clinical Focus @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com

Pigmentation: a topical issue Ruth Donnelly speaks to leading aesthetic practitioners regarding their recommendations for treating pigmentation problems using skincare

The treatment of pigmentation is a rapidly says Beverly-Hills based dermatologist better result than in someone with a fairer emerging market in aesthetics. “Dark Dr Harold Lancer. “So the protocol in my complexion but who is from a Moroccan or patches, irregular skin tone, sun spots on clinic is that everyone is evaluated by Italian ancestry.” Founder of Pharmaclinix the hands, face, chest, neck and red faces me then at the end of that consultation Advanced Cosmeceuticals and chemist, are some of the most ageing conditions a treatment plan is created to include Shashi Gossain agrees that pigmentation is on the skin,” says esteemed consultant lightening, exfoliating and epidermal a complex issue. “Types of skins and types dermatologist Dr Nick Lowe. Many and dermal rebuilding agents; topical of melasma are very different,” she says. practitioners treat the condition with laser medical treatments are used for at least “Some people have very light patches, and and light-based treatments, using skincare a two to four week period before any some patches are very deep due to long as a complementary resource. However, instrumentation is considered.” exposure to sun damage, so you have with a recent influx of cosmeceutical Dr Mervyn Patterson agrees that skin to be careful and specific on what and products designed specifically for the needs to be fully prepped before the how you treat. You absolutely cannot use purpose, some experts in the field assert commencement of any treatment, be lasers to treat hyperpigmentation on skin that topical treatment should be every it laser, IPL or topical. “It’s important to types III to V, because of the risk of post- practitioner’s front line when it comes to control all aspects of the pigmentation inflammatory hyperpigmentation, which is a pigmentation. process whilst at the same time controlling lot more common in the darker skin tones.” inflammation, without disrupting the A 2012 study conducted by Dr Lowe external skin barrier,” he says. “Tackling Hydroquinone – the gold standard? showed that a combination cream pigmentation without first repairing the Hydroquinone has been deemed to programme can be as effective as skin barrier and dampening chronic be the gold standard for the treatment treating pigmentation with Intense Pulsed inflammation would be like repainting the of pigmentation for over 50 years2. Light. An independent double blind walls of a building without first fixing the However, it has been reported that 80% study was carried out on 24 randomly roof.” of patients can develop a resistance selected subjects with mild to moderate to hydroquinone if used for more than pigmentation, who received either the Key patient groups a few months3, and the ingredient has cream treatment (12 subjects) or IPL (12 Although commonly thought of as an also been shown to cause ochronosis, subjects). Results showed that when age- or ethnicity-related issue, people of a skin condition presenting as severe, measured with the complexion analysis all ethnic groups, ages and both genders irreversible darkening and coarsening of computer, 10 of 12 subjects (83%) of experience pigmentation problems. the skin, in darker Fitzpatrick skin types.4 those treated using the cream treatment However, the way you treat the problem Although hydroquinone can still be found programme showed improvement, will differ depending on many factors, in most of the major prescription-only as did those treated with IPL (10 of 12 foremost of which, according to Dr Lancer, skincare lines, some doctors prefer not subjects/83%).1 “This study clearly shows is the patient’s ancestry. “Pigmentation to use the ingredient, for reasons of both that a daily combination of the right creams concerns are the most difficult arena in safety and efficacy. “I reject hydroquinone can be highly effective for redness and cosmetic dermatology,” he says. “Because or hydroquinone/retinoid combinations pigmentation,” says Dr Lowe. the lighter the ancestry – not just the because of the irritation rates and risk of With the number of ways to treat clinical presentation of the patient, but profound rebound of pigmentation once pigmentation evidently on the rise, the geographical origin of their great- the bleaching agents are withdrawn,” Dr approaches vary. However, most leading grandparents and grandparents – the Mervyn Patterson explains. Dr Lowe takes practitioners agree that skin preparation chances are, the better result from a different approach, combining agents is key. “People with colouration need to treatment. So if you have a pigmentary to achieve optimal results. “It’s key when be medically blended as best they can problem in a person from a Swedish treating pigmentation to use a combination before they go on to further treatment,” origin then chances are you will get a of numerous safe lightening agents to work

38 Aesthetics | May 2014 3. Farhi D et al, J Drugs Dermatol 2013; 12: E88-E93 12: 2013; Dermatol JDrugs al, Det Farhi 3. 2. 1153–1161 2012;38: Surg Dermatol al, Bet Rzany 1. References (*Results taken from a mean value across all treatments performed in study) in performed treatments all across value amean from taken (*Results s17-s26 (1)(Supp): 11 2012; Dermatol. JDrugs al, et Cartier efficacy and and patientcomfort withefficacy Emervel Proven studiesdemonstrate -Clinical great of patients would like to have again Emervel - Satisfaction Patient High Technology Balance Distinctive Technology -Optimal remained improvedremained at month baseline 6vs. of -92.1% participants Lasting Long longevity concentration of 20mg/ml for and safety cross-linkingand levels afixed around HA TM offers a calibrationvariety offers of For more information visit visit information more For [email protected] Email: 208950 Switchboard: 01923 Galderma WD17 1DS Watford, Hertfordshire Road, Clarendon 69-71 House, Ltd, Meridien (UK) Galderma Across the range, 92%*Across range, the

1,2,3 1

www.galderma-alliance.co.uk

EME/021/1013 Date of prep: October 2013 Clinical Practice Clinical Focus @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com

Active Ingredients on different aspects of melanin production. problem with treating pigmentation with Lorna Bowes lists some of the key This is a preferable approach to only using skincare is patient compliance, especially ingredients that she would recommend prescription hydroquinone products.” Other regarding sun protection,” he says. “The when choosing a skincare line to treat practitioners claim that the ingredient can secret of success is through compliance pigmentation be used safely if clinicians are cautious: in the use of lightening products, and Fruit and lactic acids – exfoliate to Dr Lancer says, “We use hydroquinone year-round sunscreen use is absolutely reduce superficial hyperpigmentation treatment under tremendous clinical essential. The skin must always be Vitamin C – reduces melanin observation; we don’t use prescription protected with a day cream containing production level hydroquinone, our chemists make it anti-oxidants and broad-spectrum UVB and Neoglucosamine – reduces tyrosinase to our specification. Depending on how it’s UVA protection. Without this, any benefits and exfoliates manufactured and what it’s blended with, from creams or IPL will be undone as sun Tertahydrocurcumin (THC) – inhibits it works differently; discolouration from exposure is one of the primary causes of tyrosinase production; antioxidant hydroquinone can occur only if it’s used in a pigmentation and contributes to redness. properties misguided fashion.” The shift away from the “Patient education about this is very Oligopeptide 34 – reduces tyrosinase use of hydroquinone has led cosmeceutical important. There is a myth that patients and melanin production; anti- companies to conduct significant research need not apply their skin lightening creams inflammatory properties into what other ingredients can be used if they are on a sunny holiday. This is Kojic acid – chelates copper and to treat pigmentation problems. Lorna absolute nonsense. In fact this is when they inhibits tyrosinase production (although Bowes, aesthetic nurse and director of need it most.” many manufacturers have chosen to AestheticSource.com, UK distributor of withdraw products containing kojic NeoStrata, says, “There are multiple plant Dr Stefanie Williams agrees; “Whether a acid due to concerns of dermatitis and extracts known to resurface, reducing prescription or non-prescription option toxicity) superficial hyperpigmentation, and inhibit is chosen, the patient must use a broad- tyrosinase, which is a key enzyme in the spectrum sun protection with SPF 45 or 50, production of melanin.” every single day, whether sunny or not,” she says. “However, it’s not only sun protection, Topical versus light-based treatments but also sun avoidance that is crucial. One Although proven to effectively treat day of excess sun can undo months of pigmentation, lasers and light sources do treatments.” The clinician’s job is therefore have their limitations. “There are many to ensure that patients understand the things that will not respond [to light- importance of sticking to the prescribed based treatment], even in the most ideal treatment programme. circumstance,” Dr Lancer explains. “There are certain hormonal situations such as Another key factor in patient education oestrogen imbalance that can cause a high is managing expectations. Although the risk rate or non-response rate to lasers and overall results from a skincare regime can light sources.” be extremely effective, it will take longer for Dr Marc Ronert, president and medical those results to appear than with a course director of Image Skincare, claims that the of laser treatments, and patients need to new Iluma line from Image yields similar be aware of that. “It’s important to tell the results to laser treatment. He adds that, patient that any improvements are gradual,” “The active ingredients in the Iluma line Dr Williams explains. “The best result can have also been clinically proven to block take as long as six months.” melanin production, which is not possible However, topical skincare for the correction with a laser.” These ingredients include of pigmentation can be combined with in- Belides (bellis perennis (daisy flower)) and clinic treatments, such as chemical peels, Indian Kudzu Pueraria tuberosa leaf cell for maximum effect. Dr Lowe claims that the extract, claimed by the company to limit combination of skincare with Dermasweep melanogenesis. can prove particularly effective. Many clinicians clearly agree that it is “Dermasweep uses a vacuum action to lift possible to receive effective results the skin as the particle-free dermabrasion from the use of skincare products alone; brushes sweep away dead skin cells,” he however, patient education is key to explains. “This disturbs the skin barrier yielding those results. just enough to enable the infusion of an antioxidant skin lightening complex. There Educating your patients to increase was a good presentation on brush-delivered positive outcomes systems at the recent American Academy of Dr Nick Lowe explains that the efficacy of Dermatology conference. This system can a skincare range depends on the user’s also be used with laser or intense pulsed Patients before and after treatment with cream1 commitment to the regime. “The biggest light treatments to improve results.”

40 Aesthetics | May 2014 ELEGANT • FULFILLED • MY TIME

Bocouture® 50 Abbreviated Prescribing Information Please refer to the Summary of Product rash, have been reported after treating vertical lines between the eyebrows (glabellar frown lines)

Characteristics (SmPC). Presentation 50 LD50 units of Botulinum toxin type A (150 kD), free from and other indications. Overdose May result in pronounced neuromuscular paralysis distant from complexing proteins as a powder for solution for injection. Indications Temporary improvement the injection site. Symptoms are not immediately apparent post-injection Bocouture® may only in the appearance of moderate to severe vertical lines between the eyebrows seen at frown (gla- be used by physicians with suitable qualifications and proven experience in the application of bellar frown lines) in adults under 65 years of age when the severity of these lines has an important Botulinum toxin Legal Category: POM. List Price 50 U/vial £72.00 Product Licence Number: psychological impact for the patient. Dosage and administration Unit doses recommended for PL 29978/0002 Marketing Authorisation Holder: Merz Pharmaceuticals GmbH, Eckenheimer Bocouture are not interchangeable with those for other preparations of Botulinum toxin. Recon- Landstraße 100, 60318 Frankfurt/Main, Germany. Date of revision of text: November 2013. stitute with 0.9% sodium chloride. Intramuscular injection (50 units/1.25 ml). Standard dosing is Full prescribing information and further information is available from Merz Pharma UK Ltd., 260 20 units; 0.1 ml (4 units): 2 injections in each corrugator muscle and 1x procerus muscle. May Centennial Park, Elstree Hill South, Elstree, Hertfordshire WD6 3SR.Tel: +44 (0) 333 200 4143 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 orbicu- Adverse events should be reported. Reporting forms and information can be found at laris oculi should be avoided. Contraindications Hypersensitivity to Botulinum neurotoxin type www.mhra.gov.uk/yellowcard. Adverse events should also be reported to Merz Pharma UK Ltd A or to any of the excipients. Generalised disorders of muscle activity (e.g. myasthenia gravis, at the address above or by email to [email protected] or on +44 (0) 333 200 4143. 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 recommend- 1. Bocouture 50U Summary of Product Characteristics. Bocouture SPC 2012 September Available ed for patients with a history of dysphagia and aspiration. Adrenaline and other medical aids for from: URL: http://www.medicines.org.uk/emc/medicine/23251. 2. Prager, W et al. Onset, longevi- treating anaphylaxis should be available. Caution in patients receiving anticoagulant therapy or ty, and patient satisfaction with incobotulinumtoxinA for the treatment of glabellar frown lines: a taking other substances in anticoagulant doses. Caution in patients suffering from amyotrophic single-arm prospective clinical study. Clin. Interventions in Aging 2013; 8: 449-456. 3. Sattler, G et lateral sclerosis or other diseases which result in peripheral neuromuscular dysfunction. Too fre- al. Noninferiority of IncobotulinumtoxinA, free from complexing proteins, compared with another quent or too high dosing of Botulinum toxin type A may increase the risk of antibodies forming. botulinum toxin type A in the treatment of glabelllar frown lines. Dermatol Surg 2010; 36: 2146-2154. Should not be used during pregnancy unless clearly necessary. Interactions Concomitant use 4. Prager W, et al. Botulinum toxin type A treatment to the upper face: retrospective analysis of daily with aminoglycosides or spectinomycin requires special care. Peripheral muscle relaxants should practice. Clin. Cosmetic Invest Dermatol 2012; 4: 53-58. 5. Data on File: BOC-DOF-11-001_01 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 Bocouture® is a registered trademark of Merz Pharma GmbH & Co, KGaA. pain, tenderness, itching, swelling and/or haematoma can occur in conjunction with the injection. 1139/BOC/NOV/2013/LD Date of preparation: March 2014 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 disor- der, 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).Gen - eral; In rare cases, localised allergic reactions; such as swelling, oedema, erythema, pruritus or Clinical Practice Clinical Focus @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com

The ones to watch Super Light Skin Tone Perfector by Dr Nick Lowe Dr Lowe’s most powerful skin lightening cream yet, the cream contains an increased number of skin lightening active ingredients, from three to nine. Octadecenedioic acid and liquorice root extract limit melanin production in the skin cells that produce pigment, niacinamide and azalaic derivative lightens skin, whilst ferulic acid provides natural antioxidant protection against Super Light Skin Tone Perfector by Dr Nick Lowe pigmentation. Preliminary studies showed that 71% of subjects showed a visible reduction in the appearance of pigmentation spots, 77% of subjects reported a more even skin tone and 82% Iluma by Image Skincare of subjects reported a more radiant complexion after just four weeks of use. “The key is to use products with proven active ingredients, such as niacinamide, liquorice extract and anti-oxidants,” says Dr Lowe.

Iluma by Image Skincare “What really makes Iluma unique is the use of a revolutionary new delivery system called Vectorize Technology,” says Dr Ronert. The company claims that the Vectorize delivery system creates non-ionic vesicles that penetrate the deeper layers of the skin, releasing active ingredients for a prolonged time. With active ingredients including green tea extract, Dipeptide-16, Vitamin C and Coenzyme Q10, the Iluma range aims not only to correct pigmentation problems but to prevent their recurrence.

Epionce MelanoLyte Pigment Perfecting Serum and Melanolyte Tx “An independent clinical study showed that Epionce MelanoLyte Pigment Brightening Lotion and Pigment Perfecting Serum are as effective as hydroquinone/retinoid combinations without the irritation5,” says Dr Patterson. “Epionce Pigment products contain a wide blend of proven botanical

Epionce MelanoLyte Pigment ingredients that are effective at controlling all the steps in the pigmentation process and at Perfecting Serum and Melanolyte Tx reducing inflammation.” Active ingredients include turmeric, paper mulberry, bamboo and apple, and the promotional pack claims that, if used together, the two products address all the steps leading to irregular pigmentation.

Medik8 White Balance Click A brightening serum containing kojic acid, niacinamide, alpha-arbutin and linoleic acid, Medik8 White Balance Click claims to combat seven signs of hyperpigmentation, including sun damage, age spots, dark spots, melasma, uneven skin tone and blotchiness. “We use the Medik8 White Balance Click in our clinic because it contains a good concentration of a number of effective Medik8 White Balance Click over-the-counter anti-pigmentation ingredients,” says Dr Williams.

NeoStrata Enlighten NeoStrata Enlighten is a three-product regimen containing NeoGlucosamine, THC, Vitamin C, Oligopeptide 34 and selected plant extracts. “In a study presented at the European Academy of Dermatology meeting in 2012, NeoStrata Enlighten demonstrated efficacy when used alone to lighten hyperpigmented areas, as well as providing all over brightening of skin tone,” says Lorna Bowes. “A group of 30 ethnically diverse women used the Enlighten three product regimen for 16 weeks; clinical grading, chronometer measurement, photography and self-assessment were used to establish efficacy and 93% of patients showed clinical improvement within four weeks.” NeoStrata Enlighten

REFERENCES 1. Hassan, H. Lowe, NJ. Barlow, R. Harris, D., ‘Four The future is bright methods of evaluation of facial erythema and pigment treated with intense pulsed light or cream’, Journal of Cosmetic and Laser Therapy 14 (2012), pp. 200-206 With technology and products improving all the time experts agree that treatment for 2. Halder R. M. and Richards G.M., ‘Topical Agents pigmentation can only get more effective in years to come. “The topical chemistry of Used in the Management of Hyperpigmentation’, Skin Therapy Letter, 9(6) (2004) technology is always improving.” As consumers become ever more aware of the ageing 3. Hill, Rosalind, ‘Zein Obagi: ZO Skin Health’, PRIME Journal, (2012) disposal to treat a diverse range of patients, and it seems that skincare could play a pivotal 4. Phillips, James, ‘Ochronosis in Black South Africans Who Used Skin Lighteners’, American Journal of role, as both a post-procedure regimen and a stand-alone treatment. Dermatopathology, 8(1) (1986) Disclaimer: Please refer to the European Commission directive 1223/2009 Scientific Committee on 5. Epionce, Melano Corrective System vs. Obagi® Nu Derm Consumer Safety for opinions on certain ingredients for Hyperpigmentation (Episciences, Inc.: www.epionce. com, 2011)

42 Aesthetics | May 2014 chromogenex TM

The world’s rst Super Fast Pulse 585nm laser for inammatory skin conditions

Introducing the world’s rst Super Fast Pulse 585nm laser, Safe, fast and e ective a major advancement in the treatment of inammatory treatment for: skin conditions such as psoriasis, rosacea, eczema and acne as well as rejuvenation of the skin and other • Psoriasis dermatological conditions. • Rosacea The Regenlite™ Transform is a new concept of • Eczema therapeutic laser and the only laser proven to stimulate • Acne the skin’s immune system by triggering an increase in Rejuvenation Transforming Growth Factor Beta (TGFβ) and engineered • to deliver consistent results using patented pulse pro le innovation. Enquire now visit www.regenlite.com

For further enquiries call 0800 037 8003 or email [email protected]

UK: +44 (0)1554 755444 • USA: 1-855-438-4547 • South Africa: +27(0)11 079 4242 Australia: 1800 827 817 • Brazil: +55 (11) 4702 4451 • Hong Kong (852) 3965-3175 Made in the UK

Chromogenex @chromogenex chromogenex ™ Leaders in Laser Technology Clinical Practice Techniques @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com

understand this, and it almost seems trivial to even consider such unimportant issues as overhang and stretch marks – they are often considered our battle scars to be worn with pride. For me, treatment for the caesarian section overhang happened by accident. I had acquired a CoolSculpting machine and one of my patients requested I treat her caesarian section overhang. There was sufficient mobility of the fat to treat with CoolSculpting and the results were very encouraging. Unfortunately, many women do not realise that there is such an effective, non-invasive treatment for this fat bulge, and still believe the only treatment is invasive liposuction. Scar However, if clinicians increasingly focus their attention on treating both striae distensae and the caesarean overhang, our patients will as a consequence feel that they don’t have to just “put up “ with the Treatment sequelae of pregnancy. Dr Carolyn Berry shares her experiences in treating caesarean scars and stretch marks

There has been an interesting evolution of ‘body awareness’ in aesthetic practice. In the past, we have been primarily concerned with rejuvenating the face, but certainly in my practice, there has evolved an increasing emphasis on improving body concerns. This is particularly noticeable at this time of year, as our patients prepare for their summer holidays. Interest in body image increases year on Dr Berry uses CoolSculpting to treat caesarian section overhang year and I anticipate it will continue to do so. As practitioners, we need to be appropriately skilled in order to address our patients’ concerns Striae distensae and provide them with the best possible results. Whilst we are seeing Unlike the overhang, there is thankfully some helpful information a growing male population in our practices, the majority is still made on stretch marks. Striae distensae (stretch marks) are an extremely up of women. A large proportion of these women have children common, therapeutically challenging form of dermal scarring.1 and very few women go through pregnancy without any sequelae. Aetiology remains somewhat of a mystery with various possible Stretch marks are a very common problem, particularly on the lower causes cited including hormones, physical stretch and structural abdomen. The caesarean section scar itself is rarely a significant worry alterations to the integument. Genetics would also appear to be an because it now lies very low, however the ‘overhang’ affects virtually important factor in determining susceptibility of connective tissue.2 100% of women post caesarian section, even the very thin. This is Various treatments have been trialled over the years. However, due to the reflection of the abdominal fat of the rectus muscles of the few high-level randomised controlled trials evaluating treatments anterior abdominal wall. for striae distensae exist. The histology of stretch marks is that of a scar and the development likened to that of wound healing.3 In Caesarean section overhang the early stages there are inflammatory changes with recent striae Most women aspire to wearing a bikini post childbirth. It is a marker of distensae showing superficial perivascular lymphocytic infiltrate body attractiveness because it is unforgiving and shows every bulge around the venules.4 In the later stages there is thinning of the and imperfection, and even those without abdominal stretch marks epidermis due to flattening of the rete ridges and loss of collagen struggle with the ‘fatty pouch’ or overhang following caesarian section. and elastin.5 Because of this I am increasingly asked to provide correction. Many Many therapies have been tried over the years, including topical of these women are not existing patients, and are not already having agents, and these have had limited success. Vitamin E creams aesthetic treatments. However, successful treatment of this area often may have some effect on prevention of stretch marks6 and leads to further interest in other aesthetic procedures. Tretinoin was found to have better results in striae rubra but even As a doctor I have been pre-occupied with the caesarean overhang this was limited.7 As our patients’ expectations have evolved for many years, having first noted it when I worked in general practice. they now expect significant change and good results, and are What fascinated me was that it did not just occur with heavier women, increasingly unhappy with minor improvements, which means we but also with very slim women with a flat abdomen. Even these women as practitioners are under pressure to deliver. experienced a little bulge, tending to sit just above the bikini bottoms. Unfortunately there is very little in medical literature about this Treatment phenomenon, and it appears thus far to have been largely ignored With the knowledge that we are dealing with scar tissue, it is by doctors. The overriding consensus would appear to be: baby reasonable that we treat striae distensae in a similar manner to a well, mother well, scar clean and healed, job well done. One can fully scar. Scar tissue needs to be damaged and stimulated to initiate

44 Aesthetics | May 2014 Clinical Practice @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com Techniques

reconstructive surgery showed a substantially beneficial effect of PRP for several indications, including better wound healing rate, an increased survival rate of fat grafts and an enhancement of bone graft regeneration.14 Platelets contain a number of bioactive factors that contribute to the process of wound healing, such as platelet derived growth factor and transforming growth factor.15

Technique As previously mentioned, I apply my scar treatment to stretch marks and caesarian section scars. If the patient has loose skin, which they often have as the abdominal skin has lost elasticity due to the striae distensae, I will start them on a course of radiofrequency with weekly treatments. Not only will this tighten the skin but it also causes visible improvement in the striae distensae without further treatment. Usually after three treatments, the patient has CO2 I had already observed that PRP fractional resurfacing and immediately afterwards, I inject their PRP has really revolutionised my under the treated skin, paying particular attention to the worst striae distensaes and to the caesarian scar. I mainly use a mesotherapy treatment of scar tissue in general, technique, or inject the length of the striae distensae. The settings and therefore predicted similarly for the CO2 laser will depend on assessment of the patient’s skin and apparent depth and severity of the lesions. The first treatment positive results when treating is usually milder to allow me to assess what they will tolerate and striae distensae. how long their healing time is. When healed, the patient will return to their radiofrequency for a further three treatments after which repair mechanisms and so the more invasive treatments will I will repeat the process. I only treat skin types I to IV with this yield better results. Having researched the literature and various method as studies have shown treatment of IV to VI can cause treatment modalities it became apparent to me that lasers presently side effects, including hyperpigmentation.16 In darker skins I use appear to give the best results.8 Various lasers improve the radiofrequency and skin needling with PRP injections. appearance of striae distensae: the pulse dye improves immature striae rubra,9 and the Nd:Yag laser gave satisfactory results in Dr Carolyn Berry was brought up and trained in Belfast. treatment of striae distensae in a study of 20 patients.10 Practicing as both a research fellow and GP, she founded the Firvale Clinic in 2008. Her aim is to bring excellence The most encouraging results to date have been with fractional but in Aesthetics medicine, through treatments and research unfortunately the studies with fractional laser available are few and of new techniques. Firvale Clinic is now one of the limited. A 2007 Brazilian clinical study showed that Fraxel improved most technically advanced clinics in the UK, offering a wide range of texture and appearance of mature, white striae distensae in skin treatments to its patients. type I to IV. The study demonstrated an early new indication for 11 stretch mark treatment with Fraxel. This certainly looks promising REFERENCES and from reviewing the literature, it would seem that fractional is the 1. Al-Himdani et al. Striae distensae: a comprehensive review and evidence based evaluation of prophylaxis and treatment. British Journal of Dermatology, 170, (2014), pp. 527-547. laser currently giving the best results in treating striae distensae. 2. Burrows NP, Lowell CR, ‘Disorders of Connective Tissue’. Textbook of Dermatology However mention should also be made of radiofrequency. Of (Blackwell Science, 2004), pp. 46-47. 3. Atwal GS, Manku LK, Griffiths CM et al. ‘Striae gravidarum in primiparae’,Br J Dermatology, note is a study evaluating the effectiveness of a radiofrequency 155 (2006), pp. 965-9. device in combination with a pulsed dye laser, in which 89% of the 4. Arem AJ, Kischer CW. ‘Analysis of Striae’, Plast Reconstr Surg,65 (1980), pp. 22-9. 5. Pierard GE, Nizet Jl, Adant JP et al. ‘Tensile properties of relaxed excised skin exhibiting stria patients showed good to very good overall improvement. This is of distensae’, J. Med Engl Technol, 23 (1999), pp. 69-72. particular interest because the study population was Asian and only 6. Wierrani F, Kozak W, Schramm L N et al. ‘Attempt of preventative treatment of strie gravidarum using preventative massage ointment administration’, Wiener klinische one developed hyperpigmentation, which then improved in three Wochenschrift, 104 (1992), pp. 42-4. months.12 7. Kangs, Kim KJ, Griffith CE et al. ‘Topical tretinoin (retinoic acid) improves early stretch marks’, Arch Dermatol, 132 (1996), pp. 519-26. So where does this leave treatment of striae distensae? I for one 8. Elsaie ML, Baumann LS, Elsaaiee LT. ‘Striae distensae (stretch marks) and different want more efficiency and whilst the studies show improvement, modalities of therapy: an update’, Dermatol Surg Vol 35 (2009), pp. 563-573. 9. Karsai S, Roos S, Hammes S, et al. ‘Pulsed dye laser: what’s new in non-vascular lesions’, we want reproducible and excellent results. How therefore JEAD, 21(2007), pp. 877-90. can I improve upon the results of fractional laser, and maximise 10. Goldman A, Rossato F, Pratti C. ‘Stretch marks: treatment using the 1,064 nm Nd:YAG laser’, Dermatol Surg, 34(2008), pp. 1-7. stimulation of the repair mechanisms? 11. Macedo OR, Macedo O, Bussade M et al. ‘Fractional photothermolysis for the treatment of The answer would appear to be with platelet rich plasma. I had striae distensae’, JAAD, 56 (2007), p. 204. 12. Ho D, Moskowitz K, Sum R, Dee J, Rudolph A,Burch C, Pebley W and Orser C. ‘Wound already observed that PRP has really revolutionised my treatment Healing Properties of Reconstituted Freeze-Dried Platelets’, Wound Repair and of scar tissue in general, and therefore predicted similarly positive Regeneration, 13 (2005), pp. 1067-1927. 13. Suh DH, Chang KY, Son HC et al. ‘Radiofrequency and 585 nm pulsed dye laser treatment results when treating striae distensae. General studies encouraged of striae distensae: a report of 37 Asian patients’, Dermatol Surg 33 (2007), pp. 29-34. this thought and good results have been achieved by adding PRP 14. Suh DH, Lee SJ, Lee JH, Kim HJ, Shin MK, Sang KY. J. Cosmet Laser Ther, 14 (2012), pp. 272-6. 15. Sommeling CE, Heyeman A, Hoeksematt, Verbelen J, Stillaert FP, Monstrey S, J. Plast treatment to fractional radiofrequency. Objective assessment in Reconstr Aesthetic Surg, 66 (2013), pp. 301-11 one study showed 71.9% of participants reported “good” or “very 16. Nouri K, Romagosa R, Chartier T, Bowes L and Spencer JM. ‘Comparison of the 585nm Pulse Dye Laser and the Short Pulsed CO2 Laser in the Treatment of Striae Distensae in 13 good” overall improvement. A review study of PRP in plastic and Skin Types 4 and 6’, Dermatologic Surgery 25(1999), pp. 368-370.

Aesthetics | May 2014 45 Clinical Practice Spotlight On @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com

Rapid Polymerising Collagen: Tissue in a Syringe Collagen could be returning to the UK aesthetics market with the development of a new collagen dermal filler portfolio. But what benefits does collagen have to offer the modern practitioner?

Collagen was the original dermal filler; it rapidly became so Figure 1 synonymous with volumising that it is still often used as a popular Histology of RPC vs HA one month post-injection term for all fillers, particularly in the lips.Introduced in the 1980s, it was skin-friendly, safe, soft and natural. However, there was a small risk of allergic reaction to bovine collagen, so patients required a skin test, and the product lasted as little as two to four months post-injection. The emergence of safe, long-lasting and reversible hyaluronic acid fillers decreased the demand for collagen. A durable, cross-linked, porcine collagen product, Evolence, was launched in 2004 but was withdrawn again in 2009 for business reasons. However, whilst HA fillers are now incredibly sophisticated, some doctors are still nostalgic Rapid Polymerising Collagen Hyaluronic Acid remains as a for the unique properties of porcine collagen, particularly for fine, resembles host tissue’s cellular and distinct blue bolus delicate skin indications. vascular structure At IMCAS, at the beginning of 2014, EternoGen attracted a great Bridge Plastic Surgery, has recently been conducting human trials deal of interest as the company unveiled a new collagen portfolio using the new collagen portfolio. He says, “The RPC collagen is a comprising Rapid Polymerising Collagen (RPC) and Gold Nanoparticle clear liquid which injects very smoothly through a 30 or 32G needle, Collagen (CG Nanomatrix). Charles Weatherstone, EternoGen’s having the lowest extrusion force for fillers. It is associated with mild marketing director, announced that, “Both have been formulated with to moderate discomfort on injection. We are in the middle of a human unique integral shielding protection from collagenase degradation to safety study and all is proceeding well. “RPC is unique in replacing the offer long-lasting, natural-looking treatment results.” skin’s lost collagen,” he says. “Therefore it is suitable for rebuilding the “They are also designed to provide high biocompatibility, facilitating skin, where lines or wrinkles are a concern, or for example, for treating natural integration with the skin at a cellular level, which minimises acne scars and post-surgical scars.” He continues that RPC’s unique the risk of inflammatory reactions and post-treatment problems,” says ability to integrate with human skin is its key strength compared to Weatherstone. “A lidocaine combination has also been developed other fillers. “RPC collagen can be used in a mesotherapy treatment to ease discomfort on injection of RPC.” Given the sheer number of or as a volumising produce because of the in-situ polymerisation,” he hyaluronic acid fillers, we might question why the aesthetics market says. “This remains stable with no risk of product migration.” needs a new collagen filler. Weatherstone explains, “Skin is 80% Some doctors remain wary because of previous cases of patients collagen, and collagen is lost with age. Injected hyaluronic acids hold experiencing reactions; However, Mr Inglefield says, “There will always the skin up well, but they stay as a bolus, and don’t integrate with the be concerns about the use of porcine collagen despite numerous skin. On the other hand, RPC is a liquid that trickles through the dermis. safety studies and hundreds of thousands of patients who have After a few minutes, it polymerises to form a mesh of tissue that won’t benefited from porcine products. migrate or change shape.” “The producers of EternoGen are being scientific and ethical in the “In our studies, just two weeks after injection, blood vessels started development of the product to ensure that they launch a highly to grow into the injected collagen,” he says. “After 53 days, you developed and researched product,” he says. “Collagen started the could look at the injection site under a microscope and the collagen revolution in non-surgical aesthetic medicine; HAs have provided a was completely integrated into the dermis. It all became one tissue, very beneficial tool in restoring lost volume, but collagen is the gold which is why we call it ‘tissue in a syringe’. It also improves skin standard in providing true rejuvenation of the skin. smoothness and radiance.” EternoGen has conducted investigations “I firmly believe there is a clear need for a skin friendly collagen- into conjugating collagen with gold nanoparticles to provide additional based filler to provide safe, natural-looking results and the skin benefits and enhanced duration. The research, carried out at health benefits that both consumers and physicians seek today,” University of Missouri, demonstrates that Gold Nanoparticle Collagen says Mr Inglefield. “RPC is particularly suited for delicate and (CG Nanomatrix) has the potential to further increase resistance to challenging treatments in the peri-orbital and peri-oral areas where degradation with treatment results lasting for up to two years. The the risk of lumps and product migration needs to be minimised.” addition of gold nanoparticles also provides antioxidant benefits. “This Whilst hyaluronic acid fillers produce long-lasting, safe results, recent has the potential to reduce possible inflammatory reactions, such as developments of RPC, enabling it to integrate completely into the swelling,” Weatherstone says. “The product will also not need a skin dermis, and the potential of Gold Nanoparticle Collagen to last for up test before use, and it will be long-lasting and easy to use.” to two years, mean that there could soon be an increased demand Christopher Inglefield, plastic surgeon and medical director of London for collagen in the aesthetics market.

46 Aesthetics | May 2014 LightSheer ® DESIRE ™ The starting point to your success

1LASER HAIR REMOVAL SYSTEM 2 ADVANCED TECHNOLOGIES 3 HANDPIECES

Benefit from a rapid return on investment

Increase your patient satisfaction

Grow your business

Lumenis (UK) Ltd 418 Centennial Park, Elstree Borehamwood, Hertfordshire WD6 3TN Telephone: 020 8736 4110 e-mail: [email protected]

AESTHETIC.LUMENIS.COM PB-1003147 Rev A PB-1003147 Awards Special Focus @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com

The Aesthetics Awards bring together the very best in medical aesthetics and leaders in the industry to celebrate the achievements of the past year. For 2014, twenty-one prestigious awards categories have been designed to recognise the finalists and winners for their services to the profession and industry. Awards are presented to those who have worked hard to represent the highest standards and have truly excelled in the field of aesthetic medicine, from clinics and individual practitioners to manufacturers and suppliers. Following the success of last year’s awards, the 2014 event will be bigger and more glamorous than ever. To be held on Saturday 6th December at the luxurious Park Plaza Hotel in Westminster, the evening will play host to 500 guests, new award categories and exciting entertainment. Aesthetics is delighted to announce Changing Faces as the official charity of the awards once again. Entries will be open from 12th May until the end of June, whereby a shortlist of finalists will be selected based on the key category criteria. Finalists will be announced in September and online voting and judging will commence until the end of October. The award winners, and those who have been highly commended and commended in their categories, will be announced at the awards presentation evening in December and winners will be invited on to the stage to receive their award in front of an audience of their peers, colleagues and friends. The categories for The Aesthetics Awards 2014 are as follows:

The Pinnell Award for Product Treatment of the Year Best Customer Service by a Innovation This award will be given to the Manufacturer/Supplier This award recognises the most innovative and manufacturer or supplier with the best This award acknowledges the manufacturer dynamic products on the market. To be eligible medical aesthetic treatment as voted or supplier that voters believe has offered the for nomination, products must have been for by Aesthetics journal readers. The best service in terms of practitioner support, launched into the UK market in the 12 months winner should show how this treatment is customer training and client relations. before the 2014 Awards entries opened. a valuable addition to the UK market for Entrants should demonstrate how their product patients and practitioners. Distributor of the Year provides a new and original treatment, leading This award acknowledges the vital role to a better patient experience. Equipment Supplier of the Year played by UK distributors who bring new, Taking into account customer service, international products and treatments to the Cosmeceutical Range/Product of support for practitioners and product range, UK market. The winner will be voted for on the Year this award will be presented to the the basis of their customer service, product This award will go to the best cosmeceutical company voted as the best equipment range and services to the industry. range or product. This can be any professional supplier in the UK. use product range but must be retailed in UK Training Initiative medical aesthetics clinics. The winner should The Janeé Parsons Award for Sales of the Year demonstrate support from practitioners and Representative of the Year, supported This award will be strong safety and efficacy evidence. by Healthxchange Pharmacy presented to the This award, given training provider or Injectable Product of the Year in memory of individual trainer This award will go to the manufacturer or Obagi territory who is considered to have advanced UK distributor of the injectable product manager Janeé the education of aesthetic medical deemed to be the best available in the Parsons, will be presented to the UK professionals most effectively during 2014 UK. Entrants will be required to explain industry sales representative who is through their course. Judges will take the potential and realistic outcomes of deemed to have provided the best service into consideration the dynamic method of treatment along with good evidence of to his or her company, customers and delivery, attendee reviews and outcomes safety and efficacy. ultimately patients. for participants.

48 Aesthetics | May 2014 Awards @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com Special Focus

Best Clinic Awards efforts of an aesthetic nurse who has provided How will winners be For 2014, Best Clinic Awards will be awarded exceptional care and treatment to their selected? regionally. Clinics will be judged on their patients. The winner will be judged based on customer service, commitment to patient care evidence provided by the entrant about him or Our judging panel will select a list of and safety and demonstration of continuous herself, along with patient testimonials. finalists for each category, which will be clinical excellence. Clinics can nominate announced in September. A process of voting will take place to select the themselves in the following regions – Aesthetic Medical Practitioner of winners. Aesthetics journal readers the Year will be able to vote online to select the Best Clinic Scotland This award goes to the cosmetic doctor, winner in the following categories: dermatologist or surgeon who has excelled The Church Pharmacy Award for • Cosmeceutical Range/ Product of the in his or her field this year. The winner will Best Clinic North England Year be judged based on evidence provided by • Injectable Product of the Year the entrant about him or herself, along with • Treatment of the Year patient testimonials. • Equipment Supplier of the Year • The Janeé Parsons Award for Sales The Dermalux Award for Best Clinic Clinic Reception Team of the Year Representative of the Year, supported South England by Healthxchange Pharmacy This award will go to a front of house team • Best Customer Service by a that has provided outstanding customer Manufacturer/Supplier service, along with strong practitioner support • Distributor of the Year for the benefit of both the clinic and patients. • Association/Industry Body of the Year Best Clinic London An expert judging panel selected by Association/Industry Body of the Year Aesthetics will vote for the winners in the Best Clinic Wales This award will be presented to the following categories: Best Clinic Ireland association who is deemed by voters to have • The Pinnell Award for Product achieved the most, both for their members Innovation • Training Initiative of the Year The 3D-lipomed Award for Best and aesthetic medicine as an industry and • The 3D-lipomed Award for Best New New Clinic, UK and Ireland profession in 2014. Clinic, UK and Ireland This award will recognise • Best Clinic Scotland the recently launched The Aesthetic Source Award • The Church Pharmacy Award for Best clinics in the UK. Entrants for Lifetime Achievement Clinic North England • The Dermalux Award for Best Clinic will need to show how they have provided an This award South England excellent standard of care to patients along recognises the • Best Clinic London with details of initiatives used to grow their achievements • Best Clinic Wales business during 2014. The clinic must have of an individual who • Best Clinic Ireland been established within the 12 months prior to has had a long career • The Institute Hyalual Award for Aesthetic Nurse Practitioner of the Year nominations opening. within aesthetic • Aesthetic Medical Practitioner of the medicine and honours Year The Institute Hyalual Award for their significant • Clinic Reception Team of the Year Aesthetic Nurse Practitioner of contribution to the The winner of the Aesthetic Source the Year industry. Previous Award for Lifetime Achievement will be This award will winners include Mr selected by Aesthetics Journal and will recognise the Chris Inglefield and be announced on the night. achievements and Dr Patrick Bowler.

How to enter

All entries must be made via the Aesthetics Awards website, disregarded. All entries must be accompanied by the supporting www.aestheticsawards.com. You can enter in as many categories evidence requested in the entry form. This information will be as you wish but you may only enter yourself, a company used to create the list of finalists and by the judges when voting you work for, or an employee who works for your company. on a winner. Nominations made on behalf of a third party will not be accepted. You should only enter once. Multiple entry forms for the The list of finalists will be announced in the September issue of same clinic, company, individual, treatment or product will be Aesthetics Journal, after which the voting process will begin.

Voting

Readers of Aesthetics journal will be able to vote for their favorite finalist in each of the appropriate categories from September. Each reader can vote for one finalist in each category. Multiple votes from the same email address, name and IP address will be discounted from the final result.

Aesthetics | May 2014 49 In Practice Data Protection @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com

Data Protection: what every practitioner needs to know Dr Natalie Blakely and specialist lawyer Mandy Luckman answer key questions about the ethical and legal issues involved in storing patient data

Protecting your patient’s details isn’t just example, records should only be transported and back it up on several servers: this is crucial for your business but also for your when absolutely necessary and if so, they are called redundancy and means that, should reputation. If you record, handle and store stored in locked cases. a server fail, your data is unaffected. medical information, then you are liable It is worth checking with your cloud under the Data Protection Act 1998 to What must we do to ensure patient data provider that their server is based within protect that information. The Act states you protection when transporting medical the EU. Right now the EU provides strong should only collect the information you need, records? protection for personal data. If data keep it secure, ensure it is up-to-date, only Security measures will include physical, belonging to EU businesses or citizens hold as much as you need and for as long organisational and technological measures, is stored outside the EU, the transfer of as you need it and allow the patient to see such as use of secure portable equipment that data needs to be secure with data it on request. With data protection breaches and ensuring administrative and strategic protection requirements at the other end, at for unauthorised disclosure and for lost and processes are in place to guarantee that least as strong as those in the EU. stolen paperwork higher in healthcare than the documentation is secure at all times. in other sectors, collecting good quality The movement and location of records What happens to patient records if you data and storing it securely demonstrates should be controlled so that a record terminate the contract with a digital good practice and could help to protect you can be easily retrieved at any time, any provider? against litigation. outstanding issues can be dealt with, EU data law states that cloud providers and there is an auditable trail of record must allow a person or business to move Is it legal to transport paper medical records transactions. data from one cloud provider to another. around? It’s also worth checking that, should you Clinical records must be kept confidential Is it legal to store patient photos on phones request it, your data will be returned to you at all times, including during transfer and/or a personal cloud? in a usable format, such as a PDF. between sites. It is legal to transport medical The Data Protection Act 1998 controls how records if necessary but stringent security data is used by organisations, businesses and Where should patient photos be stored? measures must be put in place to avoid public authorities (part 1 (1) (e) Data Protection Appropriate technical and organisational security breaches. There are many reported Act 1998) 1. A key principle of the Act stipulates measures should be taken against examples of data protection breaches that information must be kept safe and secure. accidental loss. Therefore it is advisable occurring. One such case involved a lawyer There is a stronger legal protection for more to store confidential data in a safe secure who was transporting patient records by sensitive information such as information environment or electronically where hand to a court hearing. Unfortunately she related to health. It is therefore not advisable appropriate security protections are in was involved in a RTA and the records were to store confidential data on mobile phones place. The Data Protection Act advises dispersed around the site of the accident. which can easily be lost or stolen, or on a that you should have security that is Clearly, although the circumstances are personal cloud which disseminates to other appropriate to the nature of the information very unfortunate, this had the potential of devices around the house. in question and the harm that might result allowing very sensitive patient information to from its improper use, or from its accidental be accessed by unauthorised persons. This What security features should you look for loss or destruction.2 Since photographs resulted in stringent measures being put in in a digital system? pertaining to medical treatment may be place to avoid the scenario recurring. For Cloud-based storage systems encrypt data particularly sensitive there will be a greater

50 Aesthetics | May 2014 In Practice @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com Data Protection

requirement for security. The movement and location of records should be Guidance given by the Information controlled so that a record can be easily retrieved at any Commissioner’s Office states that physical and technological security is likely to be time, any outstanding issues can be dealt with, and there essential as well as management and is an auditable trail of record transactions. organisational security measures3. Physical security includes considering the quality advisable to seek appropriate advice from such breaches. Fines have been imposed of doors and locks, and whether premises a specialist IT company. The Information in the past for incidents such as transfer are protected by alarms, security lighting Commissioner’s Office advised that data of personal data using unencrypted or CCTV. It also includes how you control retention and review schedules should be memory sticks and loss of electronic access to premises, supervise visitors, in place for categories of personal data to devices containing personal data.14 The dispose of paper waste, and keep portable help practitioners comply with this principle. draft proposal introduces a requirement for equipment secure. Technological security After a set period of time the data should be supervisory authorities to impose prescribed involves use of secure servers, firewalls and reviewed, and destroyed when it no longer fines of up to €1 million (£0.9 million) or 2% encryption. needs to be retained.10 When paper records of a company’s annual global turnover in are no longer required, their placement in the event of a violation of the Regulation How long must we keep patient medical a designated secondary storage area may (Article 79), regardless of the harm caused. records for? be a more economical and efficient form More serious breaches are likely to involve The Data Protection Act stipulates that of storage. There are several accredited deliberate misuse of data leading to records should only be retained for as documentary storage facilities, which are substantial damage or substantial distress.15 long as necessary.4 There is no definition able to securely store NHS, medical and of ‘necessary’ in the Act; however, the pharmaceutical records. Dr Natalie Blakely is medical director of the Light Touch Department of Health states that the Clinic in Surrey and founder maximum period of retention of NHS Who do the records belong to? of the Consentz patient records should be thirty years.5 The Legally, although the patient owns the record app. While developing NHS code of practice states that records information contained within the medical Consentz she became fascinated by the legal issues surrounding consent and how should be retained for at least eight years records, the healthcare provider owns the practitioners can improve their consenting for adults and 25 years for children.6 GP paperwork that contains this information. processes, helping to protect both themselves records must be kept for ten years after a The records should therefore be retained and their patients. patient dies or leaves the country.7 This also by the treating clinician, though patients is a partner applies to private records in accordance have a legal right to access their medical Mandy Luckman in the Medical Law & Patients with the Private and Voluntary Health Care records under the Data Protection Act Rights team at Irwin Mitchell (England) Regulations 2001.8 1998.11 This means that any individual is in Birmingham. Mandy leads The Medical Defence Union advises that, able to obtain a copy of their own medical a team that acts exclusively for claimants in clinical negligence cases and is if possible, records should be kept for records upon request, subject to paying regularly contacted by the media to quote on beyond the prescribed periods, as claims do reasonable copying charges up to a cost developments and regulation within the field sometimes arise after these timescales, and of £50.12 of cosmetic surgery. it may prove difficult to successfully defend a REFERENCES claim without the records.9 What does the new EU directive on 1. Data Protection Act 1998, Schedule 1 2. Data Protection Act 1998, Schedule 1, Part II, Principle 7(9) Ideally, all records should be reviewed practitioners and clinics? before they are destroyed, and it is sensible Under current law, the Information 3. Information Commissioner’s Office 4. Data Protection Act, Schedule 1, Part I, Principle 5 has been an adverse incident or complaint. maximum penalty of up to £500,000 for 5. Records Management: NHS Code of Practice, Part One (2006) and Part Two (2009) < https://www.gov.uk/government/ Disposal should be carried out in such a the most serious breaches of the Data publications/records-management-nhs-code-of-practice> way that protects patient confidentiality, Protection Act.13 Moreover the Information 6. Records Management: NHS Code of Practice, Part One (2006) and Part Two (2009) < https://www.gov.uk/government/ for example, by shredding paper records. Commissioning Officer can decide to apply publications/records-management-nhs-code-of-practice> Computer-held records may be difficult to fines or not at their own discretion based 7. Records Management: NHS Code of Practice, Part One (2006) and Part Two (2009) < https://www.gov.uk/government/ delete entirely from a hard drive and it is on the severity of the consequences of publications/records-management-nhs-code-of-practice> 8. The Private and Voluntary Health Care (England) Regulations 2001, Schedule 3, Part 1 < http://www.legislation.gov.uk/ uksi/2001/3968/contents/made> Other key changes in the new EU directive include: 9. MDU 10. Information Commissioner’s Office • Higher standard of consent (Articles 4(8) and 7) 11. The Data Protection Act, Part II, Section 7 12. The Data Protection (Subject Access) (Fees and Miscellaneous • New and strengthened rights for data subjects (Articles 12, 17 and 18) Provisions) Regulations 2000, Regulation 6 < http://www. • Breach notification within 24 hours (Article 31) legislation.gov.uk/uksi/2000/191/made> • Data protection impact assessments prior to risky processing operations (Article 33) 13. The Data Protection Act, Sections 55A and 55B • Obligation to appoint a data protection officer (Articles 35-37) 14. Information Commissioner’s Office • Imposition of large fines for failure to comply (Article 79) 15. The Data Protection Act, Sections 55A and 55B

Aesthetics | May 2014 51 In Practice Treatment Portfolio @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com

the major segments of cosmetic surgery for the body. For example, to address the mid-section, surgeons may now offer a standard abdominoplasty, modified or mini abdominoplasty, abdominal etching, liposuction, fat grafting or a combination procedure. This may also be combined with a lower body lift, thigh lift, buttock lift and/or fat grafting, as well as an upper body lift consisting of breast augmentation, mastopexy or reduction mammoplasty or gynaecomastia, brachioplasty, liposuction and so on. According to the American Society for Aesthetic Plastic Surgery (ASAPS), 2013 marked a record upward trend in both labiaplasty and buttock augmentation surgeries. Labiaplasty procedures increased by 44% over the course of the year, and buttock augmentation procedures rose by 58%.2 The rise in vaginal Building a body rejuvenation is often credited to the explosion of pornography online, while the increasing interest in buttock sculpting procedures has been at least partially driven by an overwhelming desire to have a shaping clinic firm, smooth, round bottom like many celebrities. Cosmetic Surgery of the Body Wendy Lewis explains why now is the perfect • Abdominoplasty time to consider expanding your offering from • Body lift the face to the body • Brachioplasty • Breast enhancement The emerging market segments of body shaping and skin tightening have • Breast lift or reduction shown unprecedented growth in recent years. Body shaping and skin tightening • Buttock enhancement devices have demonstrated aggressive expansion and have shown explosive • Buttock lift growth: the British Association of Aesthetic Plastic Surgeons (BAAPS) audit for • Calf implants 2013 showed a 41% rise in liposuction procedures, a 16% rise in abdominoplasty • Fat grafting procedures and a 24% increase in male gynaecomastia body contouring • Gynaecomastia procedures.1 The emergence of energy-based systems and innovative • Laser lipolysis technologies has paved the way for more companies to enter the sector, offering • Liposuction more options for practitioners as well as consumers. The time has never been • Pectoral implants better to consider adding body-shaping procedures to your clinic offering. • Thigh lift Body shaping encompasses a wide range of procedures that target weight • Vaginal rejuvenation reduction, as well as toning, firming and cellulite reduction. Skin-tightening procedures address wrinkles and skin laxity on the face and body. For the quickest and most dramatic results, more invasive body-shaping surgery If you are not a trained surgeon, but are seeing may be the preferred option. However, there has been a sea change in the patients who are candidates for surgery and who mindset and goals of consumers since 2008, resulting in flat levels of growth in the have the means to have it done, consider recruiting surgical category. Because consumers tend to associate surgical procedures with a BAAPS plastic surgeon to your clinic a few days longer recovery times, possible risks, higher costs, an anaesthetic, a hospital stay per month to expand your service offering. This and visible scars, they are very open to investigating alternative options. Although way you may be able to keep those patients in your non-surgical or minimally invasive treatments may not be the right fit for obese clinic rather than risk losing them to another clinic patients or patients with excessive skin laxity, a large percentage of consumers are that is not likely to refer them back to you for non- willing to accept a lesser result from a lesser procedure. surgical treatments. Today, there are effective forms of cosmetic enhancement procedures to target every part of the body, which may require some improvement. NON-SURGICAL BODY CONTOURING More clinics in the UK are expanding their treatment SURGICAL PROCEDURES menu as new and effective options for fat reduction, Whether their ultimate goal is to look great in clothes, fit into a smaller size or look cellulite treatment, skin tightening, hair removal and good naked, patients have a lot of options to consider. The fact remains that there décolletage and hand rejuvenation evolve. The are some body issues that cannot be significantly altered through diet and exercise emerging range of laser and light treatments and alone. The category of surgery for the body has greatly expanded to include non-surgical services can now effectively address numerous variations in ways to address excess fat, skin sagging and contouring every conceivable aesthetic concern. Advanced defects. There is a global trend of more and newer procedures making up each of technologies enable many wavelengths and energies

52 Aesthetics | May 2014 Introducing the NEW

One Treatment

NEW FDA Clearance

Ultimate Body Platform

More Power

Innovative Design

www.syneron-candela.co.uk | [email protected] Tel. 0845 5210698 This is not intended for the U.S. market. ©2013. All rights reserved. Syneron and the Syneron logo are trademarks of Syneron Medical Ltd. and may be registered in certain jurisdictions. Candela is a registered trademark of the Candela Corporation. UltraSculpt and UltraShape are registered trademarks of UltraShape. PB82801EN In Practice Treatment Portfolio @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com

to expand laser therapies to would be the Body Shaping – the three basic categories chest or décolleté and the hands. If you and most popular treatment areas are currently doing full face IPL or skin tightening, try using the same treatment 1. Skin tightening – tummy, arms, thighs, knees for other areas where patients may have discolouration, crepey skin texture and 2. Fat reduction – tummy, hips, thighs, knees, back, arms, chest (men) other signs of sun damage and ageing 3. Cellulite reduction – thighs, buttocks, knees skin. Patients are not only conscious of the skin quality of their face; they are also to be used on all skin types and skin this service. Cellulite patients come in all interested in improving brown spots colours. shapes and sizes; even thin women can on their chest, arms and legs, and are Skin tightening can be accomplished have lumps and dimples, which tend to interested in laser hair removal literally with a variety of energies including get worse with age. There is some overlap from their hairline to their toes. If you are an radiofrequency, ultrasound, heat-based when it comes to the body contouring expert peeler, consider launching a body energy or a combination of wavelengths. and cellulite reduction categories, peel programme, with peeling solutions, Fat reduction is used to target localised fat which is why it is important not only to microdermabrasion, dermal infusion deposits without injections, anaesthetic or research and trial several systems, but systems and body products for home use. visiting the hospital. The energies used to also to have more than one method to Hand rejuvenation using dermal fillers fight fat range from heat (radiofrequency) to offer patients. Each patient represents as well as neurotoxins, fat grafting and a cold, ultrasound and lasers. Actual fat loss a unique set of circumstances, which series of glycolic or TCA peels, as well in centimetres varies from person to person makes the task of consulting with patients as energy-based treatments, is a popular and the downside is that results may not be even more important. Some systems may category, which offers patients a whole immediate and usually multiple treatment simultaneously sculpt specific areas of the new reason to come back to your clinic sessions are needed. Ideal candidates are body and target cellulite, or it might take regularly. If you deal with reputable at a good weight with only small bulges. a combination of different approaches to manufacturers or distributors that stand Each system comes with its own limitations deliver good results. behind their products, you should enquire based on the energy used and the With regards to cellulite, it is critical to be about having the clinic staff retrained to configuration of handpieces. For example, honest with patients. Every woman has expand the uses of the systems you now some systems use handpieces that are too heard about the miracle cures and most own. Alternatively, consider trading up. If large for small body areas like upper arms, have a healthy degree of scepticism you have limited space, look into additional under the chin and knees. It is important about new treatments. Let patients know handpieces, or upgrading your current to know before you buy exactly what the up front what they can expect and how system(s) for newer models that work system will treat when you are purchasing many treatments they really need, and better, faster and do more. it, not just what is planned for the future. build a maintenance programme into In the near future, many practitioners Most non-invasive systems just reduce the treatments from the beginning. Offer focusing predominantly on facial injectables fat cells and are not intended for serious advice on diet, exercise, lifestyle, and have and skin-rejuvenation treatments will need skin tightening, so you may need more them come back for additional treatment to incorporate other services into their than one device to treat a wider range of sessions as necessary. treatment portfolio to remain competitive patients. Cellulite is like everything else you treat: it and ensure clinic growth; looking into Consider which areas patients are most is chronic, it often gets worse with age, and opportunities to do so will help expand interested in treating, and what fees they it requires a multifactorial approach to keep your clinic, increase patient retention and may be willing to pay, based on your it under control. encourage new patients to choose you location and the demographics of your over your competitors. current clientele. It is not wise to bring on OFF-FACE APPLICATIONS FOR ENERGY- Wendy Lewis is president of a new device with the sole purpose of BASED SYSTEMS Wendy Lewis & Co Ltd, Global attracting a brand new segment of patients, If you find that patients are asking about Aesthetics Consultancy, the unless you have a huge marketing budget: services that you do not yet offer, and that author of 11 books on anti- you should have enough existing patients you are referring them to colleagues and/ ageing and cosmetic surgery, and founder/editor in chief of in your clinic to target first, and then build or competitors, it is time to take a look at Beautyinthebag.com. She is an international up additional clientele over time. how best to step it up. presenter and lecturer and has written Cellulite reduction has proven very A good place to start is to analyse what over 500 articles for medical journals and difficult historically, with past treatments you already have in your clinic that may consumer publications. focusing on surface remedies; however, currently be underutilised. For example, if new therapies are changing the way you are the proud owner of a multi-platform REFERENCES practitioners approach cellulite. It has been device that targets brown spots, hair, sun 1. The British Association of Aesthetic Plastic Surgeons, Britain sucks (2014) which accounts for a vast number of ability to do off-face treatments without 2. Plastic Surgery Practice, ASAPS: Below-the-belt procedures on the rise (2014)

54 Aesthetics | May 2014

In Practice Marketing @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com

than any TV network. This age group may not be your exact target demographic for treatments, however these statistics prove how easy it is to reach people directly through the use of video.

It is this growth that has changed how consumers want to receive information, John Castro, owner of Websites for especially marketing messages. Consumers today are increasingly savvy, Cosmetics, explains how the power and the use of video provides a dynamic, of video can be harnessed to increase interactive experience for website visitors. footfall to your clinic This medium enables you to introduce your company more effectively and highlight promotions, as well as provide treatment Getting in front of the descriptions. Below are the two most common reasons camera: using video to clients give for avoiding the use of videos, along with some advice to help you when increase enquiries creating and posting your videos online.

“I don’t know how to record good videos” The way we absorb information is still medical aesthetic clinic based in Glasgow, This is the most common objection, not fully understood, despite extensive and one of our clients. Clinetix host a as everyone naturally wants to look research into the field. However, it does highly effective video on the homepage professional. However, today video can seem fairly certain that humans absorb of their website, introducing their clinic. be recorded using a smart phone as long information much better with a visual aid, Our tracking shows that aside from the as it supports recording in HD. There are which is why video as a medium is a highly treatments tab, the video is the second some limitations to this, but the truth is that powerful tool, and one which you should most clicked-on item on their home page. many smart phones record video that is of employ in your marketing strategy. This proves that when easily accessible, a good enough quality to get a message videos entice browsers, which in turn will out there. If you are, however, thinking Why video? increase the rate of conversion of website of investing in some equipment, a good Video allows you to really engage and visitors into enquiries. Video also helps to quality HD camera will not cost more than interact with users, and deliver your gain the trust of potential clients before £200. message easily, quickly and clearly. The they’ve even picked up the phone, as it medical aesthetic industry is very much conveys personality. With the amount of “Video is too expensive” driven by gaining trust from potential information online today, being personal Video does not need to cost thousands clients and the immediacy of video will has never been so important. of pounds. However, if video is to become help you gain that trust quicker. We have a focal part of your marketing strategy, all heard the saying, ‘people buy people’, The growth in accessing video online has then I would suggest investing a couple so put yourself in front of the camera, increased in recent years and continues to of hundred pounds in purchasing your HD deliver your message and watch your do so. Today, 100 hours of video content camera, lighting and lapel microphone. enquiries increase. An example of good is uploaded to YouTube per minute and Spending a portion of your marketing video utilisation comes from Clinetix, a the site reaches more 25 to 35-year-olds money on producing videos should not be considered a burden but an investment. Even if you buy a higher-end camera, Two key tips for recording video: some lights and a high-end microphone, 1. Audio the total cost should not exceed £1,000. Make sure you use an external microphone. Audio is key to any video recording and Video has become so effective that testing shows that bad audio will result in people changing their mind and clicking onto once you have invested that money and something else. A £20 lapel microphone is sufficient. started shooting and sharing videos, I am convinced that you will see an increase 2. Lighting in enquiries. You could even make videos Lighting can lift a video from looking amateur to looking like professional media footage. on treatment aftercare and hand them out Natural sunlight is great but if you can, purchase some professional ‘soft box studio to patients, which will inevitably increase lights’ as they will make a big difference to the look and feel of your recording. Studio client loyalty as it demonstrates to your lighting is not expensive either. For less than £60 you should be able to pick up two soft customers that their wellbeing is important box studio lights online. to you, and not just when they are in your treatment room.

56 Aesthetics | May 2014 2862 Med-fx Ad March 2014_Med-fx Sales Ad 30/01/2014 08:43 Page 1

There is one supplier that does it all....

1000’s Consumablesof Peels, & Accessories Anti-Ageing & Cosmetics Pharmacy Service Free 28 day Fillers & Credit Toxins Next-day Terms Delivery † *

From specialist aesthetic products to general consumable items, Med-fx offers massive choice and outstanding value-for-money. Add to this free next-day delivery,* a full pharmacy service, 28 day credit terms† plus our special promotions and you can see that Med-fx really does have it all. The one-stop aesthetics shop 0800 783 06 05 Med-fx Limited, Unit 3, Perry Way, Witham, Essex CM8 3SX medfx.co.uk Tel: 01376 532832 Fax: 01376 532801 Email: [email protected] *Excludes Saturday deliveries. All prices are subject to VAT. †Credit terms subject to status.

Are you paying too much for your gloves? Not if you buy from Med-fx! Classic UnoDent Classic UnoDent Nitrile Aloecare Vinyl Gloves Ultratouch Powder-free From only From only Gloves Gloves From only Nitrile Pink, Powder-free Latex with soothing, £5.99 From only £4.80 moisturising Aloe Vera £2.65 Gloves Box 100 Box 100 Powder-free £4.99 Box 100 Box 100 Powder-free In Practice Marketing @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com

Creating the right kind of videos The type of video you record will depend on what message or end goal you are trying to achieve. Below are four types of videos you should record and their purpose:

1. THE INTRODUCTORY VIDEO 3. THE TREATMENT VIDEO instantly personalises the user’s viewing This video is for your website home page. It This type of video is perfect for describing experience. is an introduction to either you or your clinic, and explaining your treatments. When and probably both. Ideally this should be consumers want to undergo a medical 4. THE PERSONAL EVERYDAY led by the clinic manager, clinical director aesthetic treatment they will have several VIDEO or owner. It is vital in any small business to questions; this video can answer those In my opinion this video is the most effective be personal and inviting. Use this video to questions and help to alleviate some of video strategy if used properly, and over introduce who you are and your specialist their concerns. A short, informative video time. One of my 10 Online Marketing treatments. It should be no longer than two about the treatments you offer could be Commandments is ‘Be Personal, Not minutes, ideally about 90 seconds. the difference between a patient booking Promotional’ and today this is more important a consultation with you or your competitor than ever. Due to the amount of generic 2. THE CLIENT-IN-THE-CLINIC – and this kind of video does not always information thrown at people everyday, your VIDEO have to be produced by you. Most large patient is now looking for a personal touch Nothing builds trust more than aesthetic brands today can supply access in their purchasing experience. A personal, recommendations. It is the lifeblood of to their library of videos, meaning that everyday video is spontaneous. It could many businesses today, but many do not you can easily share this ready-made be about a new treatment that you plan think outside the box and rely on clients material on your own digital platform, aiding on introducing, or it may be that you are at recommending within their own social circle. potential patients’ understanding of what an event and want to post a video of your By producing a video with your patients in a particular treatment involves. However, experience. This should not be professional your clinic discussing their experience, you filming a treatment video yourself at your or structured, just you in front of your camera will build trust with potential new clients. clinic can be much more effective as it sharing yourself.

Where to share Sharing your videos is crucial. It is vital that people actually click the play button, and in our experience, there are three places where video creates an effective impact: YouTube, Facebook and your own website.

YOUTUBE On average, our written Facebook posts reach around 100 This is where you should host your people each time according to page analytics. However, when videos. Upload them here first and we post videos the number of people the post reaches exceeds then embed and share the YouTube around 500 each time. video on other platforms. This is important firstly because of Google’s recent implemented change in how they rank YOUR WEBSITE websites. This change has resulted in a dramatic increase in the It is a must to put your videos on your website. Make sure you appearance of videos on the first page of Google. Search Engine create a section on your website just for your video content. We Optimisation is complex and just uploading a video to YouTube recently did this with a client of ours, Dr Anil Budh-Raja. It has does not mean you will be page one of Google, but every little been very effective and now users can access a selection of helps. Secondly, hosting your videos on YouTube as a primary videos directly on his website, including videos about the doctor base is important because if you upload video directly to your and his most popular treatments. website it could create speed problems when loading, as video As well as having a ‘Videos’ section, uploading videos in a blog is files are usually fairly large. You certainly do not want someone also very effective. If you write a blog, complement it with a video clicking off your website because they are waiting for it to load. about what you have written. We now know that having a visual YouTube is a great platform for hosting purposes and embedding aid to any piece of writing engages users better, and that patient a YouTube video on your website is much more effective than engagement is crucial to boosting enquiry conversion rates. The uploading it directly. personal nature of video encourages users to spend more time on your website, which in turn will increase interest in your clinic, FACEBOOK services or company. Facebook is the most effective social media John Castro is the founder and director platform to share video. It’s a space where videos of Websites For Cosmetics, the only web are shared and watched daily as the user can agency that solely and exclusively works easily watch without having to leave the site. We have found that with the medical aesthetic and cosmetic sharing video on Facebook business pages is extremely effective. surgery industry.

58 Aesthetics | May 2014 TRANSFORM YOUR PATIENTS. RESHAPE YOUR PRACTICE.

BEFORE 8 WEEKS AFTER 9 WEEKS AFTER FIRST COOLSCULPTING® SECOND COOLSCULPTING® TREATMENT TREATMENT (No weight change)

Give your patients the transformation they’re after with CoolSculpting.® The only non-invasive fat reduction procedure to use exclusively licensed Cryolipolysis technology to safely target and eliminate fat. CoolSculpting provides the perfect combination of safety, efficacy, and convenience:

• SELECTIVELY TARGETS FAT without harm to surrounding tissue • COMFORTABLE PROCEDURE producing measurable results • PHYSICIAN IS FREE TO LEAVE THE ROOM once the treatment is initiated

Learn how CoolSculpting can transform your patients and reshape your practice at coolsculpting.com/for-physicians or contact your local Zeltiq Representative today.

[B&A] Procedure by Edward Becker, MD In the U.S. and Taiwan, non-invasive fat reduction is cleared only for the flank (love handle) and abdomen. The CoolSculpting procedure for non-invasive fat layer reduction is available worldwide. CoolSculpting, the CoolSculpting logo and the Snowflake design are registered trademarks of ZELTIQ Aesthetics, Inc. © 2013. All rights reserved. IC1293-A In Practice HR @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com

John Sellers explains how to acquire in employment or gaps between jobs. It may show a lack of loyalty, or an inability to hit targets, though this may not be the and keep hold of staff who will prove employee’s fault every time, so there is a balance to be struck. an asset to your businesses Skills can be taught and knowledge can be instilled in someone who has the right attitude to fit into your organisation. A CV doesn’t tell you about an individual’s personality, emotional intelligence or social skills. Would you rather hire someone with the right experience but the wrong attitude, or someone with not quite enough experience but the right attitude? Conducting a thorough interview is one of the best ways to get a deeper sense of a person’s character and mindset. Think about your interview questions carefully. It’s also important to remember that an interview is a two-way process. The best candidates will be interviewing you, too, as they will get their pick of employers. Nurturing your When you find a great candidate, don’t hang around, as the best work force candidates will be quickly snapped up. Induction and retention: lay solid foundations and The medical aesthetics industry is extremely competitive. Most stay in touch clinics are using similar technology and offering the same A good induction process will help your new employee feel treatments, so how can your business stand out? comfortable, and will reassure them that they have made the right Though your clinic may have a similar offering to your decision joining your company. Employees are happier in their competitors, the service you provide can differ significantly. jobs when they fully understand what is expected of them. Set out Making your customers feel respected, cared for, and safe in your the company values and goals, and individual expectations and hands does not stem from the reputation of the principal medical targets, but don’t ignore the basics, as these also help to form professional alone, it is acquired from the contact your customer solid foundations. Tell your employee who they report to, how has with every single member of staff involved in their treatment they book holiday, and even where they can eat their lunch. journey. Your people make your business. Make staffing policies clear. An ‘unwritten rule’ should be formalised in writing if it is a regulation that you all tend to Advertising to attract the best industry follow. For example, if you want employees to give you a professionals month’s notice before booking holiday, include it in induction Making a hiring mistake can be very costly, when you take into documents, don’t just tell them when the instance arises. account the potential damage to your reputation, loss of revenue, Consider training opportunities for all employees, even if they and training costs. Hiring the right employees is fundamental are very experienced, as this will show that you are willing to to the continued success of your company. People are an invest in every staff member, and help them with training that investment, not a cost. Define your specifications carefully. List can complement and develop their role. Be fair; don’t make the requirements of the job and the personal qualities of the employees work every weekend or too many late evenings. Make ideal candidate. Define what skills and attributes are necessary sure you tell them when they are doing well in their role. You to the role, and be realistic: don’t look for something that does will be amazed at how well they’ll respond to praise. If you are not exist. You should think about the company as a whole, for in any doubt about how satisfied your employees are, organise example, think about the personality that would gel successfully regular catch-ups so they can give you their feedback. Create with your existing staff members, and one which your customers opportunities for progression and development. If your company would appreciate. Write a clear and honest job advert. Include can accommodate internal promotion, create a structure where the expectations of the role, the responsibilities, the salary and this is possible. Otherwise, think about ways that employees can benefits, the hours worked, and make each detail as accurate as increase their responsibilities or benefits. If your company is doing possible. If the details are too vague or are subject to change, this well financially, share the success in the form of a bonus scheme. might deter serious jobseekers, or might cause you to waste time If funds are tight, an extra day of holiday for loyal employees will interviewing candidates who simply cannot meet your needs. remind them that their hard work is valued. Advertise only via appropriate channels. Make sure you pick a Take some time out together as a company. You don’t have to relevant job board for your vacancy. If job boards don’t work for book an expensive away-day, sometimes just treating your team you, then industry-specific recruitment companies will utilise all to some cakes and having a chat during your tea break can raise of the appropriate advertising avenues for you, and proactively a smile after a difficult working week. headhunt ideal candidates. Don’t forget that referrals are also often a good method to find candidates. Ask people you trust in John Sellers is the managing director and owner of the sector to recommend staff to you. ARC Aesthetic Professionals, a recruitment consultancy specialising in the aesthetic medicine and cosmetic CVs and interviews: identify the right candidates surgery sector. Since 2008, John and his team have helped numerous organisations within the industry grow Don’t judge someone purely on their CV, but do filter out their businesses by hiring the most talented aesthetic the weakest applications. Beware CVs that have short stints professionals in the UK.

60 Aesthetics | May 2014 A complete range designed to match your needs - perfectly.

Perfectha® is the latest generation of hyaluronic acid fillers with E-Brid technology. This allows for: - optimal lift - long-lasting - hydrating effect - easy injection

The range includes: Perfectha® FineLines - for fine lines and superfical wrinkles Perfectha® Derm - for moderate corrections to the face Perfectha® Deep - for deep wrinkles and furrows Perfectha® SubSkin - for large losses of volume Perfectha® Complement - for retouching after procedures

Sinclair IS Pharma 1st Floor Whitfield Court, 30-32 Whitfield Street London W1T 2RQ. United Kingdom www.sinclairispharma.com Date of preparation: April 2014 UK/SIPPER/14/0003 In Practice In Profile @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com

“Seeing happy patients is why I do what I do” Mr Christopher Inglefield, esteemed surgeon and medical director of the London Bridge Plastic Surgery and Aesthetic Clinic, explains his route into plastic surgery and challenges common cosmetic misconceptions

After completing his medical degree in 1985, it was postgraduate training that ignited Mr Inglefield’s love for plastic surgery. “I loved the challenge and the variety in fixing problems for patients that nobody else could fix,” he explains. His career journey began in Canada, where he studied a BSc (Hons) in Biochemistry and Microbiology in Waterloo, Ontario, before moving back to his birthplace, Trinidad, The West Indies, to pursue medicine. He went on to work in general surgery, orthopaedics and intensive care anaesthetics, before moving to the UK in 1988 to undertake surgical postgraduate training. What’s been the biggest lesson of your Mr Inglefield attained his Fellowship of the Royal College of Surgeons (FRCS) in 1990, career? and was then awarded the FRCS Plastic Surgery in 1998. He went on to work as a To be humble, no matter how good or paediatric reconstructive plastic surgeon and as a consultant plastic surgeon in the NHS experienced you think you are, and to focus on until 2006, when he decided to devote his time to setting up his own private practice providing the highest standard of care I possibly at London Bridge Hospital. “I was splitting my time between the NHS and private work; can for my patients. I realised my service to my patients and my own quality of life would be better if they What advice would you offer others? could have me around 24/7 for follow-up care and personal contact,” he explains. In Always put your patients first and do what’s 2010, he moved his practice to Wimpole Street, where it is currently based. best for them. Additionally, challenge the Throughout his extensive career, he says that he’s seen much change in the accepted; always ask why procedures are done private medical industry. “There’s been a big increase in ensuring the private sector a certain way, and look into the evidence and provides a very high standard of medical care, and a huge increase in the standard science behind what you do. Finally, embrace technological change to offer your patients the of products and treatments available to patients, for example, implants.” He says that best solutions. this improvement in technology has lead to the growth of non-surgical treatments, which has opened the doors of cosmetic medicine to a much wider segment of the What’s the best advice you’ve received? population. “Only 5% of the population would have surgery, whereas 80% would have Aim to be well trained and to have enough non-surgical treatment,” he says. “Where cosmetic treatment used to be restricted experience to deal with the difficult problems – to celebrities, now practitioners treat everyone from teachers to bus drivers to chief don’t settle for the easy job, but at the same time don’t stretch yourself beyond reality. executives. Whoever the patient is, from cleaners to lords and ladies, they all get treated the same in my clinic.” What is currently your favourite treatment? Whilst the patient demographic has widened, he explains that criticism of those who Endymed 3-Deep radiofrequency (RF) skin have cosmetic treatment still exists. “We live in a very judgemental society,” he says. “It is tightening. It’s state-of-the-art technology in non- a quality of life issue, not a necessity, to reconstruct a skier’s anterior cruciate ligament so surgical rejuvenation and when patients finish a that they can ski again next season. They are not judged, but the person who has a large course, they want to come back for another. It’s a multi-phased RF device, which provides more nose and wants to improve it to increase their self-esteem, is stigmatised and considered effective heating of the collagen than bi-polar RF. to be superficial. In reality, what is the difference? Any procedure done for the right reasons in the right patient, which improves their quality of life, is a good thing.” What gives you the greatest satisfaction in He also challenges the controversy behind certain cosmetic procedures, such as vaginal your career? reshaping, which is carried out at his own clinic. “Labial surgery is sometimes criticised Seeing my patients happy. Watching them come back after a treatment or surgery smiling and and associated with female genital mutilation (FGM), which has received a lot of attention confident is why I exist. recently,” he explains. “This comparison is absurd and belittles FGM. I see several patients suffering from the condition every year, and it is assault of the worst possible kind. The What is the future for aesthetics? majority of patients come to me requesting reduction because of physical symptoms due Cellular therapy, using stem cells, fat cells and to an enlarged labia; aesthetic improvement is a secondary benefit.” fibroblasts, is advancing fast and will be used for For the industry to move forward and simultaneously raise standards, he advises that everything from skin rejuvenation to rebuilding cartilage and noses. The use of ultrasound for an overall non-judgemental and supportive attitude is key. “I will listen to a patient, treating fat will become more commonplace, understand who they are and why they have a desire to change something and help but I feel radiofrequency devices will still be the them understand what is possible and whether it is good for them or not,” he says. number one choice. “Seeing happy patients is why I do what I do.”

62 Aesthetics | May 2014 Light New.pdf 1 04/04/2014 09:11

SEE US AT

2014

• Utilises UV re ectance photography to view areas of pigment density below the skins

C surface

M • Portable UV imaging solution Y

CM • Customisable branded cover MY eliminating external light CY

CMY

K 23 Year Old Male - High Sun Damage

Sunburn and tanning are the short term visible results of over exposure to UV rays. Long term exposure can cause prematurely aged skin, wrinkles, loss of skin elasticity, dark patches and pre-cancerous skin changes, such eects occur overtime and are not always visible to the naked eye.

The Schuco UV Light enables clinical professionals and patients to view UV damage to their skin and can also be used to identify; Acne, bacteria, vitiligo, hyperpigmentation and skin ageing.

The Schuco UV Light is now available to hire!

www.schuco.co.uk [email protected] 01923 234 600 In Practice The Last Word @aestheticsgroup Aesthetics Journal Aesthetics aestheticsjournal.com

classic example encountered every day in the non-surgical clinic is the patient with heavy upper eyelids who presents requesting treatment to improve them. The non-surgical solution is to carry out botulinum toxin treatment using a pattern of injections designed to elevate the eyebrows. Whilst this does solve the problem of the heavy upper lids, it does so at the expense of creating a whole new problem of over-elevated eyebrows that inadvertently age the face and create an unnatural appearance. The proper solution in this situation is usually to recommend an upper blepharoplasty to remove the excess skin followed by a course of botulinum toxin treatment and filler The last word injections to improve the remaining rhytids. By combining the two, it is possible to create Collaboration between surgeons and aesthetic an optimal cosmetic result. doctors would provide patients with the best Whilst it is true that some patients simply treatment solutions, argues Dr Darren McKeown do not want surgery, that is an informed decision that they need to make themselves after having a thorough consultation and The last two decades have seen significant in the procedure day-in, day-out carrying out explanation of the options available. It is not a growth in cosmetic practice both in the UK thousands of procedures per year. decision that should be dictated based upon and worldwide. This explosion in cosmetic Indeed, this sort of cavalier attitude towards the availability of local skills and services. interventions has been largely characterised non-surgical procedures fails to realise the Last year I teamed up with a surgical by newer, less invasive surgical procedures significant benefits that can be achieved or colleague to offer joint consultations in my and the emergence of a whole new field of the degree of skill required to achieve them. non-surgical practice. The objective of the non-surgical procedures. Whilst it may be easy for anyone to pick up a collaboration was to offer our patients a As the cosmetic interventions market has syringe and inject, doing it in such a way as to more comprehensive assessment that truly grown, more and more practitioners from a make a face look genuinely more attractive is put their needs at the heart of the process. wide range of backgrounds have fought for a far from easy and requires a great degree of Patients are assessed from both a surgical slice of the pie, territories have been marked skill, knowledge and experience. and non-surgical perspective and the options out and fierce competition has emerged I believe that this attitude extends both ways, are discussed in detail until we arrive at the between rival factions. There has developed and there are non-surgical practitioners most appropriate treatment package for each a ferocious battle between surgical and non- attempting increasingly complex surgical individual. By combining the skills of surgical surgical practitioners, with the former claiming procedures, which, in some cases, may and non-surgical practitioners, a synergy their surgical results are more durable and be beyond their level of competence. In is achieved where the result of combining longer lasting whilst the latter camp argues this situation, patients might be offered the skill sets achieves better results than either that their procedures have less down time surgical procedure the doctor can do, rather practitioner acting independently. The overall and less risk. than the one that might be best for them. result is happier patients, with optimised There are a few surgical practitioners who will But is the competition and rivalry between outcomes and rapid growth in practice. In make the argument that they are qualified to surgical and non-surgical practitioners recent years, multi-disciplinary teamwork has offer both surgical and non-surgical solutions justified? The cosmetic market is already dominated the management of most areas of and therefore they alone are best placed a substantial size and growing every year; medicine, although until now this has largely to fully assess patients’ needs and offer there is plenty of opportunity for good evaded cosmetic practice. Perhaps now is the most appropriate treatment. But in my practitioners to grow a large and successful the time to re-think this position. Rather than opinion this argument does not really cut it. practice, without fear of competition from viewing other specialists as a threat, we As with all things in medicine, and indeed life other specialists. At the heart of our practice should look to each other as allies and work in general, the more experienced you are should always be finding the right procedure, together for the benefit of everyone, not least at one particular procedure, the better your for the right patient, with delivery by the right for all our patients. outcomes will be. A general plastic surgeon practitioner. This is good medical practice Dr Darren McKeown who does 10 rhinoplasty operations per year across the board, and should equally be specialises in facial aesthetics is highly unlikely to achieve the same level applied to cosmetic practice. What is required and is medical director of the of results as a rhinoplasty specialist who is closer collaboration between surgical and Dr Darren McKeown Aesthetic does 10 rhinoplasty operations per week. non-surgical practitioners, with the focus on Medicine Institute clinic chain, based in Glasgow and on Harley Likewise, a plastic surgeon who does the the needs of each individual patient. Street. He previously trained as a plastic occasional injection of Botox will not achieve There are many clear overlaps between surgeon and is a member of the Royal College the same results as a doctor who specialises surgical and non-surgical practice. One of Surgeons.

64 Aesthetics | May 2014 INTRODUCING LASER

TREATMENTS INTO YOUR CLINIC Advance provides full support to all clinics in training, registration and business development. We will enable your business to maximise its success and set an image above the rest. Advance support offers assistance in:

Setting up

Marketing and Advertising your business • Brochures • Poster/Flyers/Advertisement’s • Search engine optimisation • Marketing action plan • Business Management

Tracking your business • Growth management • Reassessing your goals • Mystery shopping reports • Customer service and treatment testing • Retail training –Staff targets, efficiency and K.P.I.’s

Protocols • Introducing Laser and Cosmetic treatments • All Training required for Aesthetic procedures

For more information or to book contact Advance on [email protected] UK: 0845 261 3714 / +44 (0) 7885 215025 IRE: +353 (0) 860640595 For less than £25 per month, you can list your company details here. For more Directory information contact Aesthetics • 01268 754 897 [email protected]

a Merz Aesthetics SMARTER TOOLS FOR Chromogenex Contact: Lauren Roberts Healthxchange Pharmacy +44 0333 200 4140 ABC Laser +44 01554 755444 Contact: Steve Joyce [email protected] Contact: Guy Gouldsmit [email protected] +44 01481 736837 +44 08451 707 788 www.chromogenex.com +44 01481 736677 [email protected] Service: Laser System [email protected] Mesoestetic UK SMARTER WORKING www.abclasers.co.uk Manufacturer www.healthxchange.com Contact: Adam Birtwistle www.obagi.uk.com +44 01746 718123

d [email protected] l www.mesoestetic.co.uk Services: Cosmeceutical Skincare Aesthetic Source DermaLUX Treatment Solutions, Cosmelan, Contact: Sharon Morris Contact: Louise Taylor Laser Physics Antiagaing, Depigmentation, +44 01234 313 130 +44 0845 689 1789 +44 01829773155 Anti Acne, Dermamelan [email protected] [email protected] [email protected] Services: NeoStrata and Exuviance www.dermaluxled.com www.laserphysics.co.uk p Service: Manufacturer of LED Phototherapy Systems PolarisMedical Lasers Microdermabrasion ContactFrom: Neil Calder e MATTIOLI ENGINEERING Lawrence Grant +44 01234841536 Aesthetox Academy As featured on Contact: Alan Rajah [email protected] Contact: Lisa Tyrer Eden Aesthetics +44 0208 861 7575 www.polaris-laser.com +44 0870 0801746 Contact: Anna Perry [email protected] [email protected] +44 01245 227 752 www.lawrencegrant.co.uk/ s www.aesthetox.co.uk [email protected] specialist-services/doctors.htm Service: Training www.edenaesthetics.com SkinBrands Contactneedle: freeTracey Beesley Mesotherapy +44for the 0289 delivery of983 active 739 [email protected].

www.skinbrands.co.ukTel: 01234 841536 Allergan TECHNICAL SUPPORT Intense Pulse Light (I2PL) & Laser Systems www.polarismedicallasers.co.uk delivering the promise +44 0808 2381500 Beautylight Technical Services Ltd Contact: Jane Myerson Lifestyle Aesthetics Contact: Jane Myerson Contact: Ashaki Vidale Ellipse-IntenseT: 0208 741 1111 Pulse Light www.juvedermultra.co.uk T: 0208 741 1111 Contact: Sue Wales T: 0208 741 1111 E: [email protected] (I2PL) &Laser Systems E: [email protected] E: [email protected] W: www.ellipseipl.co.uk +44 0845 0701 782 W: www.venusconceptuk.co.uk W: www.technicalsupport.ellipseipl.co.uk/ Contact: Jane Myerson Services: UK distributor of IPL & Laser Services: UK distributor of Venus [email protected] Services: Onsite service & repairs of systems, IPL & Laser training courses Freeze and Swan Radio Frequency (RF) aesthetic systems. UK agent for Ellipse +44 0208 741 1111 and technical support & Magnetic Pulse (MP)2 systems www.lifestyleaesthetics.com Silhouette Soft IPL & Venus Radio Frequency systems [email protected] Contact: Denise Daddario www.ellipseipl.co.uk +442089730518 Services: IPL & Laser systems, AZTEC Services www.juvin-essence.com Contact: Anthony Zacharek IPL & Laser training courses +44 07747 865600 and technical support [email protected] Lumenis UK Ltd www.aztecservices.uk.com Contact: Nigel Matthews or Service: Exclusive UK distributor Mark Stevens for Viora product range 020 8736 4110 Skin Geeks Ltd TECHNICAL SUPPORT Intense Pulse Light (I2PL) & Laser Systems [email protected] the promise +44 01865 338046 Beautylight Technical Services Ltd Contact: Jane Myerson www.lumenis.comContact: Jane Myerson [email protected] EllipseContact: Ashaki Technical Vidale Support T: 0208 741 1111 T: 0208 741 1111 www.skingeeks.co.uk b T: 0208 741 1111 E: [email protected] Beautylight Technical E: [email protected] E: [email protected] W: www.ellipseipl.co.uk W: www.venusconceptuk.co.uk ServicesW: www.technicalsupport.ellipseipl.co.uk/ Ltd Services: UK distributor of IPL & Laser Services: UK distributor of Venus Services: Onsite service & repairs of Contact: Ashaki Vidale systems, IPL & Laser training courses Freeze and Swan Radio Frequency (RF) aesthetic systems. UK agent for Ellipse and technical support & Magnetic Pulse (MP)2 systems Bioptica Laser Aesthetics +44IPL & Venus0208 Radio 741 Frequency 1111 systems Contact: Mike Regan [email protected] +44 07917 573466 technicalsupport.ellipseipl.co.uk Sound Surgical (UK) LTD [email protected] Services: Onsite service&repairs Lynton Contact: Raj Jain www.bla-online.co.uk of aesthetic systems. Ellipse IPL& 01477 536975 +44 7971 686114 Services: Core of Knowledge Venus Radio Frequency systems [email protected] [email protected] Training and Laser Protection www.lynton.co.uk www.SoundSurgical.co.uk Adviser (LPA) Services m t Energist Medical Group ThermaVein Contact: Eddie Campbell-Adams Catherine Fuente Boston Medical Group Ltd +44 01792 798 768 MACOM 0161 826 3404 Contact: Iveta Vinklerova [email protected] Contact: James Haldane [email protected] +44 0207 727 1110 www.energistgroup.com +44 02073510488 www.thermavein.com [email protected] [email protected] www.boston-medical-group.co.uk g www.macom-medical.com v Restylane® stands for innovation as the original non-animal HA dermal ﬁ ller. With over 20 million treatments worldwide, we are now TECHNICAL SUPPORT Intense Pulse Light (I2PL) & Laser Systems delivering the promise Beautylight Technical Services Ltd Contact: Jane Myerson injecting even more innovation: new delivery systems for Restylane Contact: Jane Myerson c Contact: Ashaki Vidale T: 0208 741 1111 VenusT: 0208 741 1111Freeze Galderma Aesthetic & T: 0208 741 1111 E: [email protected] E: [email protected] and Restylane Skinboosters™ that are designed to give you improved E: [email protected] Contact: Jane Myerson W: www.ellipseipl.co.uk Corrective Division W: www.venusconceptuk.co.uk Candela UK Ltd W: www.technicalsupport.ellipseipl.co.uk/ Med-fx Services: UK distributor of IPL & Laser +44Services: 0208UK distributor 741 of Venus1111 comfort, control and precision. +44 01923 208950 Services: Onsite service & repairs of systems, IPL & Laser training courses Freeze and Swan Radio Frequency (RF) Contact: Michaela Barker aesthetic systems. UK agent for Ellipse 2 : Faye Price and technical support [email protected]& Magnetic Pulse (MP) systems [email protected] IPL &Contact Venus Radio Frequency systems +44 0845 521 0698 www.galderma-alliance.co.uk +44 01376 532800 www.venusconceptuk.co.uk To ﬁ nd out how smarter tools can help in your daily practice contact [email protected] [email protected] Services: Venus Freeze and Swan www.syneron-candela.co.uk www.medfx.co.uk Radio Frequency (RF) & Magnetic your local Galderma representative today. h Pulse (MP)2 systems

z Carleton Medical Ltd Contact: Nick Fitrzyk Hamilton Fraser Medical Aesthetic Group Zanco Models +44 01633 838 081 Contact: Wai Chan Contact: David Gower Contact: Ricky Zanco [email protected] +44 0845 3106 300 +44 02380 676733 +44 08453076191 www.carletonmedical.co.uk [email protected] [email protected] [email protected] Services: Asclepion Lasers www.hamiltonfraser.co.uk www.magroup.co.uk www.zancomodels.co.uk

RES/013/0414 Date of Preparation April 2014 66 Aesthetics | May 2014 SMARTER TOOLS FOR SMARTER WORKING

Restylane® stands for innovation as the original non-animal HA dermal ﬁ ller. With over 20 million treatments worldwide, we are now injecting even more innovation: new delivery systems for Restylane and Restylane Skinboosters™ that are designed to give you improved comfort, control and precision. To ﬁ nd out how smarter tools can help in your daily practice contact your local Galderma representative today.

RES/013/0414 Date of Preparation April 2014 14495 UK BOTOX CFL Trade Ad 2014.indd 1 07/02/2014 15:30