VOLUME 1/ISSUE 4 - MARCH 2014
Just for you
Don’t miss the UK’s biggest event dedicated to the practice of facial and body aesthetics Register free for ACE 2014, London 8th & 9th March www.ace2014.co.uk
Focus on Platelet Rich Nose reshaping The external skin Injectables Plasma Dr Sotirios Rejuvenation using Dr Sarah Tonks Foutsizoglou shares barrier – CPD needles: new investigates PRP his techniques for Dr Mervyn Patterson on the key role of approaches, new methods for your non-surgical nose the epidermis. CPD accredited article products, new science practice augmentation COME AND SEE US AT STAND 1 Size Matters Introducing Gentle Pro Hair Removal Large Spot Delivery System
SPOT SIZES NOW AVAILABLE (actual size)
1.5mm, 3mm, 3×10mm
6mm, 8mm, 10mm
12mm, 15mm, 18mm
NEW The Gold Standard Gentle Hair Removal 20mm, 22mm, 24mm Laser just got better • Treat an average male back in 21 minutes • Select 755 or 1064nm wavelengths • No compromise on fluence • No unhappy patients
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 Contents • March 2014
INSIDER
06 The Word Mr Paul Harris on the government response to the Keogh Report 06 News The latest product and industry news CLINICAL PRACTICE 11 On the Scene The skin barrier Page 24 Out and about in the industry this month 14 News Special: IMCAS We report on the International Master Course on Aging Skin in Paris CLINICAL PRACTICE 19 Special Focus: PRP Dr Sarah Tonks explores the uses of platelet rich plasma in aesthetics 24 CPD Clinical Article IN PRACTICE Dr Mervyn Patterson discusses the importance of the external skin HR Considerations Page 54 barrier 28 Techniques Miss Jonquille Chantrey explains the 8-point lift technique for facial Clinical contributors rejuvenation Dr Sarah Tonks is an aesthetic doctor and previous maxillofacial surgery trainee with dual qualifications 32 Clinical Focus in both medicine and dentistry. She practises cos- Dr Beatriz Molina on treating lips using Emervel metic injectables and hormonal based therapies. 34 Techniques Dr Mervyn Patterson is a co-owner of Woodford Medical and has worked in aesthetic medicine Dr Askari Townshend on delivering Sculptra using needles over the past fifteen years. He specialises in the 37 Spotlight On latest injectable anti-ageing treatments. We discuss SkinCeuticals’ new Advanced Pigment Corrector Miss Jonquille Chantrey is a surgeon specialising in 38 Clinical Study aesthetic medical procedures, with a practice in Chesh- ire. She has been published in peer-reviewed journals An investigation into the use of the 1440nm Wavelength with and presents at plastic surgery conferences worldwide. Sidelaze800 delivery Dr Beatriz Molina practised general medicine for 42 Spotlight On 12 years, before opening her first practice. She now practises as a cosmetic doctor, alongside teaching Dr Iryna Stewart explains the mechanisms of the Hyalual Daily DeLux techniques in botulinum toxin and dermal fillers. spray Dr Askari Townshend is an international 44 Treatment Focus Sculptra trainer as well as lead UK Sculptra trainer and medical consultant for Sinclair Pharma. His Dr Sotirios Foutsizoglou discusses non-surgical nose reshaping interests include injectables, lasers and peels. Abstracts 50 Dr Iryna Stewart is managing director of Rederm The latest clinical studies and founder of IS clinics. After 15 years in the NHS, she has dedicated the last five to aesthetic medicine, 52 Aesthetics Conference and Exhibition Special Focus specialising in skin rejuvenation and restoration. The latest news from ACE 2014 Dr Sotirios Foutsizoglou is founder and medical director of SFMedica. He has written for numerous IN PRACTICE UK publications and presented at national and international conferences and expert meetings. 54 Managing staff absence Lawyer Vanessa Di Cuffa on setting rules for employee holiday and sick leave Subscribe to Aesthetics 56 Boosting online presence Subscribe to Aesthetics, the UK’s only free-of-charge John Castro outlines simple digital strategies to improve sales journal for medical aesthetic professionals. Visit aestheticsjournal.com or call 01268 754 897 58 Cash Flow Business consultant Kurt Won explains how to maximise your cash flow 60 Call Handling Gilly Dickons discusses the importance of making a good first impression 62 In Profile The Aesthetics Conference We speak to Dr Terry Loong, Best New Clinic winner at the Aesthetics and Exhibition 2014 Awards 2013 is nearly here! 64 The Last Word Aesthetics’ Editorial Advisory Board’s views on the Government response to the Keogh Report Book now at ace2014.co.uk or call 01268 754 897 NEXT MONTH • IN FOCUS: Dermatology • CPD: Cosmeceuticals • Acne scarring • How to read a clinical study Come and see us at stand 48
The Science of Great Skin
NeoStrata: Scientifically advanced, clinically proven dermatologist developed skincare to target specific patient needs.
NeoStrata professionals: Leading medical aesthetic clinics. Practitioners requiring effective skincare. Building successful business solutions.
Aesthetic Source: Multi award winning UK distributor. World renowned potent skincare ranges for professional aesthetic clinics.
We deliver: Comprehensive training and support. Focussed marketing and PR campaign. Skincare you and your clients will love:
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
Just before we went to press, the government medics, and indicate on their pack inserts who should administer finally published its response to the Keogh report. their products. They regard injectables as medical treatments, are The industry response was mixed, ranging from dismayed to see their products in the hands of unqualified injectors outrage to cautious optimism. We were disappointed, and support stronger legislation. If the GMC, GDC and NMC issue although far from surprised, to see Keogh’s key strict guidance about selling on, about who is an appropriate person Leah Hardy recommendation of a compulsory register for to use prescribed toxins, and about the importance of practitioners Editor aesthetic practitioners being rejected outright and only working within their competencies, with firm sanctions against lasers and lights seemingly slipping off the UK regulatory agenda. But those who breach the rules, then the industry could improve ethics what should happen next regarding injectables, which are the focus and standards. The Committee of Advertising Practice with the of this issue of Aesthetics journal? The government response was Advertising Standards Authority has independently created codes to frustratingly vague about plans to change the law. As Keogh himself meet Keogh’s recommendations and is moving to deal with websites has pointed out, it was impossible to classify fillers as prescription-only and advertising campaigns that breach them, even unwittingly. medicines due to EU legislation. However, we believe the government Health Education England is also working on training and standards. should be introducing legislation to make fillers prescription-only We at Aesthetics strongly support moves within the industry to devices. Unfortunately, even this would not regulate every type of filler improve training and education, hence our introduction of CPD until 2018. The EU Medical Devices Directive will reclassify all fillers as accredited content and the strong educational focus of the Aesthetics medical devices, but manufacturers will then have a three-year grace Conference and Exhibition 2014. While we still need legislation in the period to apply for CE marking. Controlling who administers fillers is industry, for which continued lobbying is vital, regulatory bodies can also complicated; the MHRA states that all medicines may potentially devise their own codes of conduct supported by the industry itself. We be administered by non-medics under the direction of a prescriber. have seen unprecedented cooperation between ethical aesthetics However, the prescription model makes the prescriber responsible practitioners for European standards and UK training standards. This for the patient, which is where prescribers and regulatory bodies have must continue and develop if we are to create a safer industry for the opportunity to self-regulate. The major filler companies voluntarily patients. To see more about the government response to Keogh, CE mark their products as medical devices, do not sell direct to non- visit our website www.aestheticsjournal.com. Editorial advisory board
We are honoured that a number of leading figures from the medical aesthetic community have joined Aesthetics journal’s advisory board to help steer the direction of educational, clinical and business content
Dr Mike Comins is president and Fellow of the British College Amanda Cameron is a sales and marketing professional, of Aesthetic Medicine. He is part of the cosmetic interventions and was one of the first nurse injector trainers in the UK for working group, and is on the faculty for the European College of dermal fillers. With over 20 years experience in the industry Aesthetic Medicine. Dr Comins is also an accredited trainer for in both the UK and Europe, Amanda has extensive knowledge advanced Vaser liposuction, having performed over 3000 Vaser of medical aesthetics and business development. liposuction treatments.
Mr Adrian Richards is a plastic and cosmetic surgeon with Dr Sarah Tonks is an aesthetic doctor and previous 12 years of specialism in plastic surgery at both NHS and private maxillofacial surgery trainee with dual qualifications in both clinics. He is a member of the British Association of Plastic and medicine and dentistry, who fell in love with the results Reconstructive Surgeons (BAPRAS) and the British Association possible through minimally invasive methods. Now based of Aesthetic Plastic Surgeons (BAAPS). He has won numerous at Beyond Medispa in Harvey Nichols, she practises cosmetic awards and has written a best-selling textbook. injectables and hormonal based therapies.
Sharon Bennett is currently vice chair of the British Dr Nick Lowe is president of the BCDG and a consultant Association of Cosmetic Nurses (BACN) and also the UK lead on dermatologist with over 30 years of experience who practises the BSI committee for aesthetic non-surgical medical standard. in London and California. Dr Lowe is Clinical Professor of Sharon has been developing her practice in aesthetics for 25 Dermatology at the UCLA School of Medicine in Los Angeles, years and has recently taken up a board position with the UK as well as director of a clinical research company specialising Academy of Aesthetic Practitioners (UKAAP). in skin ageing.
PUBLISHED BY FOLLOW US EDITORIAL ADVERTISING @aestheticsgroup Chris Edmonds • Managing Director Hollie Dunwell • Sales Manager 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: 01268 754 897 | M: 07500 007 013 T: 01268 754 897 | [email protected] ARTICLE PDFs AND REPRO [email protected] MARKETING Material may not be reproduced in any form without the Leah Hardy • Editor Jenna Earl • Marketing Manager publisher’s written permission. For PDF file support please T: 01268 754 897 | M: 07880 812 582 T: 01268 754 897 | M: 07710 947 842 contact Craig Christie; [email protected] [email protected] [email protected] Sarah Dawood • Journalist Claire Simpson • Events Manager © Copyright 2013 Aesthetics. All rights reserved. Aesthetics T: 01268 754 897 | 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 T: 01268 754 897 | M: 07741 312 463 T: 01268 754 897 | [email protected] [email protected] Chiara Mariani • Designer 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 aestheticsjournal.com
The Word Legal RCN indemnity scheme no This month the Government’s response to the Keogh review has left many stakeholders shocked by the lack of longer covers aesthetic practice implementation of the majority of its recommendations. Without decisive action from our regulatory authorities, it Changes to the Royal College of Nursing is more important than ever that surgeons and clinicians (RCN) indemnity scheme means that share knowledge and expertise in order to benefit aesthetic nurses will no longer be patients, and that we work together to eradicate the covered. At present the RCN indemnity ‘cowboy’ practitioners, who prey on vulnerable people. scheme is a contractual arrangement A key component of Keogh’s recommendations was the providing members with cover for clinical call to publish outcome data across all providers. The negligence claims. Government appears to have ignored this proposal, Commencing July 1, 2014, all employed missing a vital opportunity to establish greater clarity in RCN members will be excluded from the cosmetic sector and, as a consequence, increasing the scheme’s coverage in a bid to stop the risks to patients. It is now crucial that we collectively employers moving the burden of risk onto address the data vacuum to ensure that treatments on the RCN. offer are evidence-based, and that all centres produce Most self-employed members will still be covered by the scheme, apart freely-available safety results. from those working in the field of aesthetic medicine. Christopher Cox, We know of the risks, as well as the benefits, of aesthetic director of legal service at the RCN, claimed that the RCN has spent in treatment and as professionals we invariably agree that excess of £1,500,000 on aesthetic claims since 2004. “In the light of the these treatments are not appropriate for every would-be claims history involving aesthetic practitioners, the RCN will in future no patient. However, in a culture where ‘enhanced’ beauty longer be able to provide indemnity cover for our members practising in is increasingly popular (the BAAPS 2013 annual audit this area,” he said. “This will affect both self-employed members and those showed record numbers of patients going under the working under a contract of employment. Members practising in aesthetics knife), our shared goal must be to educate the public remain protected by the full range of other legal advice and support about the dangers of an unregulated sector, where services available to RCN members, including workplace difficulties, NMC cheap, unproven and often unsafe aesthetic treatment is referrals, personal injury accidents and so on. “ sold ‘off the shelf,’ like toothpaste or nail varnish. BAAPS The BACN responded, stating, “Those 78% of members (BACN) who are has long been calling for an injection of common sense to also RCN members will have been shocked to hear the news that the remodel the sector, and our collective efforts must ensure RCN, from July, will exclude aesthetic nursing from their insurance cover. that patient care always comes before profit. Whilst we have no expectation that the RCN will change its stance, we will be asking for further information on why and how they reached this Mr Paul Harris momentous decision, which we feel sends out a very negative message Consultant plastic surgeon and council member of without the necessary detail to qualify it.” the British Association of Aesthetic Plastic Surgeons Training Talk Aesthetics Mesotherapy society #Keogh Tchauhanconsultancy / @tchauhan01 launches in UK @aestheticsgroup this is a wasted opportunity patient safety clearly not important for gov The Society of Mesotherapy of the United Kingdom (SOMUK) has been #advertising launched to promote the use of Mesotherapy in the UK. The society ReVamp / @ReVampClinics provides access to the latest Mesotherapy tools and information for all @aestheticsgroup great piece on POM and disciplines including: Facial rejuvenation, Lipolysis, Fat Reduction, Cellulite, advertising... first rule of Botox club...you can’t MesoSculpting, Mesolift, Mesobotox, Alopecia and Pain Management. say Botox #Simple Mesotherapy remains relatively unknown to many aesthetic practitioners in #ACE the UK, though a popular aesthetic treatment in France, South America, and Dr Johanna Ward / @DrJohannaWard Europe. The SOMUK is the exclusive member of the International Society of I am presenting a masterclass at @ Mesotherapy (SIM) and works closely with the French Society of Mesotherapy. aestheticsgroup conference on 8 March for SOMUK courses are CPD accredited within the UK. anyone interested in the science & art of @ President Dr Philippe Hamida-Pisal said, “The SOMUK teaches the art, CoolSculptingUK #ACE science, techniques and procedures of Mesotherapy to licensed practitioners, regardless of their specialty. We provide education and hands-on training If you would like to be featured in within the UK and across the globe.” New member Dr Mohamed Bocus said, next month’s letter section, email us at “I am a GP in the UK and traditionally we are sceptics about the benefits of [email protected], or follow us at Twitter @aestheticsgroup and include alternative medicine. However, with growing interests from patients we need #talkaesthetics in your comments. to learn more about what is available.”
6 Aesthetics | March 2014 Insider aestheticsjournal.com News
Technology News in Brief
Dutch company launch new Medical Aesthetic Group appoints new members cloud-based patient app Medical Aesthetic Group (MAG) has appointed Simon Bell as special product consultant for Makmel was inspired to create hyaluronic acid dermal filler Stylage. His role will the the CRM application because include consolidating and increasing sales in the of his desire for a simple and UK, and supporting doctors and clinics that offer the all-encompassing tool for patient treatment. “HA fillers are perfect tools for the job, but management. Stylage has the added benefit of shortened recovery “At the time, we were looking for an time and increased duration of results, which makes application covering the full clinical it a unique and attractive proposition for doctors,” workflow, that was user friendly Bell said. Laurinder Young has been appointed as and also affordable for smaller sales coordinator across all MAG brands, and Pauline Clinicminds has launched a cloud- clinics,” said Makmel. Hume will be running training and sales support for based app for patient relationship Tested over the course of a year topical products including Inno Aesthetics, Mene and management. The Dutch by medical aesthetics practitioners, Moy and Simildiet. software development company the cloud-based app has so far has launched the Clinicminds received favourable reviews. Since Venus Concept launch Venus Viva application, which has so far the software stores patient details, Venus Concept have launched new facial treatment been taken up by two UK clinics, including personal information as scanner VenusViva, which uses nano fractional to addresses the full clinical well as treatment information, it smart scan technology to even skin texture, tighten workflow: from appointments to is also possible to use the app in skin, smooth deep lines and wrinkles and reduce invoicing and client analytics. order to compile patient analytics. appearance of scars. It includes two hand pieces, the The cloud-based nature of the This function allows practitioners Firm FX fractional radio frequency handpiece, and the app means that all patient data is to gather data useful for marketing Firm (MP)2 magnetic pulse hand piece. It has a short stored in a secure and accessible campaigns that target specific downtime of only three to four days, and does not point. Data can be accessed by kinds of patients, in specific require topical anaesthesia. the practitioner from any location, postcodes. and from any device with internet One Dutch client said, “The Dr Harold Lancer publishes rejuvenation book access. The app was created by a Clinicminds app allowed us to Renowned Beverly Hills dermatologist Dr Harold team of software developers and organize our day-to-day work much Lancer has written a book detailing his 3-step method medical aesthetic physician Toby more efficiently allowing us more on rejuvenating skin at home to maintain youthful Makmel. A clinic owner himself, quality time with our patients.” skin and reverse the ageing process. Younger: The Breakthrough Anti-Aging Method for Radiant Skin Accreditation details Dr Lancer’s regimen, which involves skin care products and lifestyle choices such as diet, exercise, PaPPS Accreditation and stress management, to stimulate the skin’s own healing power. His book is due to be released on launched to improve psycho- March 27.
emotional support Chromogenex launches i-Lipo Touch The Wright Initiative is launching a new Pre and Chromogenex has post Procedure Support Accreditation body. The launched new low level Wright initiative, which works with practitioners to laser diode device i-Lipo ensure patients are prepared, mentally and physically, Touch for non-invasive fat for their treatments, has established the PaPPS reduction. The system uses Accreditation due to the rise in demand for psycho- photobiomodulation to stimulate emotional support in conjunction with surgical and the body’s natural response to non-surgical treatments. The PaPPS Accreditation fat-burning, targeting areas of follows the PaPPS Initiative, which was shortlisted for Industry Body of the excess fat. The lasers trigger a chemical signal in Year at the Aesthetics Awards in December. the fat cells, which breaks down stored triglycerides The requirements to become PaPPS accredited include holding one or into free fatty acids and glycerol to then be released more of the following registrations: NMC, GMC/Specialist register, BACN, through channels in the cell membranes. It can be BAAPS or BAPRAS. Founder Mr Norman Wright said,”The benefits of performed on all skin types and body areas with being PaPPS Accredited for clinicians involves dedicated PaPPS training unwanted fat, and the manufacturers claim it can and access to the PaPPS support line six days a week.” remove four to five inches off the waistline after a The PaPPS Accreditation will go live on Tuesday 2 April 2014. course of treatments.
Aesthetics | March 2014 7 Insider News aestheticsjournal.com
Laser New Duetto MT hair removal device uses Mixed Technology to treat dark skin and fine hair
A new innovation in laser too gentle for the low melanin benefits such as increased This characteristic is particularly technology addresses the content in the hairs. safety when treating tanned important when treating issue of Fitzpatrick skin type MT or Mixed Technology, skin and reduced discomfort v’s previously sun-exposed skin IV with thin hairs, such as found within the Duetto MT Nd:YAG alone. The high power or skin types higher than those on the face. Long pulsed from Lynton Lasers, allows a and the large spot sizes allow Fitzpatrick Skin Type 4. In these Nd:YAG (1064 nm) laser and practitioner to simultaneously fast treatment at deep skin cases, the suggested protocol Alexandrite (755 nm) laser is deliver a mixture of both Alex layers, at fluences sufficient to combines a small amount of a versatile combination used (755 nm) and Nd:YAG (1064 nm) completely damage the hair Alexandrite energy (always less for gold standard hair removal in varying proportions. Dr Sam follicles in all body areas. The than 12 J/cm2) with a low dose results. These wavelengths Hills, the Clinical and Training Duetto MT is the only laser in of Nd:YAG laser energy (always are optimal for hair removal in Manager at Lynton says, “Mixing the world with this technological less than 25 J/cm2). Using this low and high Fitzpatrick skin the efficacy of the Alex with the innovation, offering increased mixed modality results in more types respectively. However, safety of the YAG in this format clinical efficacy. The Duetto effective, safer and less painful the 755nm wavelength may means these hairs can now can also emit the two treatments when compared to be too aggressive for some of be successfully treated. Mixed wavelengths independently, treatments performed with the these skins and the 1064nm just Technology also has other simultaneously or sequentially. Nd:YAG 1064 nm laser alone.”
Industry Appointment Cosmeceuticals and Dr Red Alinsod joins SkinBrands announce ThermiAesthetics business merge advisory board
and along with new training ThermiAesthetics, creator of the ThermiRF temperature programmes for businesses. controlled radiofrequency system, has announced the David Beesley, managing appointment of Dr. Red Alinsod, MD, FACOG, FACS as director at SkinBrands, said, Chairman of its Women’s Health Advisory Clinical Board. Companies Cosmeceuticals “With the merger, we now have Ltd. and SkinBrands have over a dozen brands to create He will help develop strategies and devices to treat specific announced they will be the benefits of a one-stop shop gynecological conditions. merging to provide the service. Practitioners will be “We are privileged to have a world renowned urogynecologist, professional market with a able to cherry-pick the best with an outstanding clinical experience in treating women range of skincare brands and products to meet the needs for vaginal laxity, as chairman of our Women’s Healthcare treatments. The new company, of their patients, and it will Advisory Board,” said Paul Herchman, Chief Executive Officer of which will be known as provide a more harmonious ThermiAesthetics. “ SkinBrands @ Cosmeceuticals and easily workable business Dr. Alinsod founded “CAVS” (Congress for Aesthetic will have eight full-time business relationship between us and Vulvovaginal Surgery) in 2005 and is considered one of the development managers our customers.” pioneers of this evolving field.
Practitioners & their patients feel the difference... “The favourable safety profile has lead to high patient satisfaction and subsequent recommendations from one patient to another, increasing our practice1” n Not® palpable2 No ® Tyndall Effect1 Comfortable® on injection2
1. Kuhne, U et al. Five-year retrospective review of safety, injected volumes, and longevity of the hyaluronic acid Belotero Basic for facial treatments in 317 patients. J Drugs Dermatol. 2012 Sep; 11(9):1032-5 2. Data on File: BEL-DOF2_001 Belotero Juvederm Study MRZ 90028_4007
Injectable Product ® of the Year 2013 Tel: +44(0) 333 200 4140 Fax: +44(0) 208 236 3526
BEL065/0813/LD Date of Preparation: December 2013 Email: [email protected] Insider aestheticsjournal.com News
Topical Vital Statistics Study shows Galderma’s From the age of 20 Mirvaso gel safe and effective we lose 1% of collagen Galderma Laboratories, LP, has announced the publication of the every year long-term efficacy and safety results of a one-year, open-label, non- Murad UK comparative study of Mirvaso (brimonidine) Topical Gel, 0.33% in patients with moderate to severe facial erythema (redness) of rosacea. Mirvaso was approved by the U.S. Food and Drug Administration in Last year saw a August 2013 as the first and only topical treatment indicated for the persistent facial erythema of rosacea in adults 18 years of age or older. rise in liposuction The results of this study, in which 276 subjects applied Mirvaso for at 41% procedures least one year, demonstrate that Mirvaso is safe and effective when used once daily for up to 12 months. The study results were published in the British Association of Aesthetic Plastic Surgeons January issue of Journal of Drugs in Dermatology. “The positive results of this long-term study provide additional evidence This year of the efficacy and safety of Mirvaso for patients with the persistent facial conference redness of rosacea,” said Humberto Antunes, president and CEO at 4,500 IMCAS in Paris participants travelling from Galderma Laboratories. “Since we launched Mirvaso commercially in the attended the 80 United States in September 2013, we have seen widespread adoption by dermatologists, underscoring the important need for an effective topical International Master Course on Aging Skin prescription treatment for this most common symptom of rosacea.” Mirvaso is a topical gel which works by constricting the dilated facial blood vessels to reduce the redness of rosacea. Mirvaso should be The average person loses applied in a pea-sized amount, once daily to each of the five regions of the face: the forehead, chin, nose and each cheek. The study indicates 50 to 100 hairs per day Mirvaso works quickly to reduce the redness of rosacea from day one of treatment and lasts up to 12 hours before the redness returns. American Academy of Dermatology Consistent results were observed throughout the 12 month study. In addition, no evidence of tachyphylaxis (a sudden decrease in response after drug administration compared to prior usage) was reported. With An estimated of South Korean women regard to safety, no new major safety findings were observed in this have undergone study as compared to the vehicle-controlled pivotal studies. The most plastic surgery common adverse events (≥4% of subjects) were flushing (10%), erythema 20% to alter their faces (8%), worsening of rosacea (5%), nasopharyngitis (5%), skin burning International Society of Aesthetic Plastic Surgeons sensation (4%), increased intraocular pressure (4%) and headache (4%). Subjects were allowed to use other rosacea therapies (oral and topical) in addition to Mirvaso. Mirvaso is due to launch in the UK in April. It will be a prescription-only medicine. reduction in hair growth can be expected with ACE each treatment of laser hair removal 1532 aesthetic practitioners American Academy of Dermatology have registered for ACE 2014 would use
At time of printing, 1532 aesthetic 19% their partner’s Face practitioners have registered for the of men Cream Aesthetics Conference and Exhibition 2014, more than twice as many Smart Beauty Guide attending CN EXPO last year. 18% of registrants are clinic managers and directors, 17% are dentists, 15% are dy Conto Bo urin roceduces aesthetic nurses and 15% are cosmetic g p 24% for gyna doctors. Also registered are GPs, surgeons, dermatologists, aestheticians, ecomastia rose in 2013 laser therapists and other aesthetic professionals. Join practitioners from across the country at ACE 2014 on Saturday 8 and Sunday 9 March at the British Association of Aesthetic Plastic Surgeons Business Design Centre in London. www.ace2014.co.uk
Aesthetics | March 2014 9 Insider News aestheticsjournal.com
Events diary Research
8th - 9th March 2014 EternoGen unveils the Aesthetics Conference and Exhibition - potential of advanced collagen ACE 2014, London www.ace2014.co.uk replenishment portfolio 3rd - 5th April 2014 At the IMCAS conference in Paris, EternoGen LLC presented its latest Anti-Ageing Medicine World Congress - research on its Advanced Collagen Replenishment therapy portfolio for AMWC 2014, Monaco cosmetic use in regenerative dermatology. EternoGen has developed a new www.euromedicom.com/amwc-2014 type of collagen dermal filler which it claims has overcome issues with previous collagen formulations, such as allergic reactions and short duration of effect. 20th September 2014 The innovative EternoGen portfolio comprises Rapid Polymerizing Collagen British College of Aesthetic Medicine (RPC) and Gold Nanoparticle Collagen (CG Nanomatrix). BCAM Conference 2014, RIBA, The products have been formulated with integral shielding protection from 66 Portland Place, London collagenase degradation. Additionally, they are designed to provide high www.bcam.ac.uk biocompatibility facilitating natural integration with the skin at a cellular level. EternoGen says the research presented at IMCAS, “Demonstrates the ability th th 25 - 26 September 2014 of EternoGen advanced collagen replenishment to overcome the limitations of The British Association of Aesthetic Plastic earlier generations of collagen.” Surgeons - BAAPS Meeting 2014, London EternoGen plans to launch its Rapid Polymerizing Collagen (RPC) portfolio www.baaps.meetings.org.uk in late 2014. Christopher Inglefield, leading UK plastic surgeon, said, “The absence of collagen from the physician’s armamentarium has been felt rd 3 October 2014 keenly in recent years. RPC is particularly suited for delicate and challenging British Association of Cosmetic Nurses - treatments in the peri-orbital and peri-oral areas where the risk for lumps and BACN Meeting 2014, London product migration needs to be minimized. A clinical study in the naso-labial www.cosmeticnurses.org folds using RPC is underway and the experience to date is very encouraging.”
Surgical Training BAAPS reveal increase in ACE 2014 additions
operations on men With ACE fast approaching we are delighted to welcome the following exhibitors: Medira, Silhouette Soft, 3D Medic, Statistics from the British Association of Aesthetic Plastic Surgeons (BAAPS) Sedation Solutions, ThermaVein, 5 Squirrels, BioCorrex, have revealed that the number of cosmetic operations in 2013 increased Pay4Later, Society of Mesotherapy UK, Hydropeptide and by 17% since 2012. Figures show that men account for one in 10 aesthetic Lamprobe. Also, joining Dr Tapan Patel and Dr Raj Acquilla at our plastic surgery procedures. Body contouring procedures showed the Free Exhibition Clinical Programme will be Dr Maria Gonzalez, biggest increase amongst men, with an increase of 28% for liposuction, Dr Sach Mohan, Dr Leah Totton, Dr Sarah Tonks, Dr Sotirios and gynaecomastia surgery up by 24%. Former BAAPS president Mr Fazel Foutsizoglou, Mr Adrian Richards, Dr John Ashworth, Mr Simon Fatah said, “Men are becoming more body-image conscious due to men’s Ravichandran, Dr Martyn King, Dr Gabriela Mercik, Dr Britta magazines and the media. Gynaecomastia can occur for no pathological Knoll, Dr Johanna Ward and Lorna Bowes. For details of our full reason, and is a feature in a young person that can affect their confidence.” programme and to book your visit go to www.ace2014.co.uk.
When it comes to evidence you’re safe with Radiesse…
FDA approved1 most studied safety profile2 safe & versatile1
1. Sadick N, et al A Multicentre, 47 month Study of Safety & Efficacy of Calcium Hydroxylapatite for Soft-Tissue Augmentation of Nasolabial Folds and Other Areas of the Face. Dermatol Surg 2007; 33 (Supp 2): s112-s127. 2. DoF-1-001_01 no wonder you
Best Customer Service Winners in 2011, 2012, & 2013 Tel: +44(0) 333 200 4140 Fax: +44(0) 208 236 3526 Email: [email protected] RAD071/0813/LD Date of Preparation: December 2013 Insider aestheticsjournal.com On the scene
Venus Freeze Business Development seminar, London
The Venus Freeze Business Clinical and practice The seminar included short Business seminar. Tracey Development seminar took enhancement manager Tracey demonstrations using the Mancuso provided excellent place on February 10 at the Mancuso led the seminar Venus Concept machines, as resources, and up-to-date Millennium Hotel Knights- alongside guest speaker and well as Mancuso and Olsen examples to reinforce tips bridge, with the aim of helping international clinical specialist, talking on ensuring financial and concepts on the Venus attendees promote their Anna Olsen. The seminar was success. Venus Freeze delivers Freeze. The seminar definitely businesses and increase sales attended by clinic, salon and treatments for the face and met my expectations and from utilising the Venus Freeze. spa owners. body using magnetic pulses the general feedback from and radio frequency, including our clients it was extremely cellulite improvement, body practical and insightful, with contouring, skin tightening and clinical key points. wrinkle reduction, as well as “I was especially delighted the patented ‘Venus Freeze with the comments on the new Facial’. Venus Viva and Venus Legacy Michael Dodd, managing from those who attended. My director of Venus Concept UK, team and I look forward to said, “I was extremely pleased hosting the next Venus event,” with the turn out for the Venus he said. 3d-lipolite launch, London
Regency Aesthetics Launch, London The launch of the 3d-lipolite program took place on Jan 27 at the Royal Society of Medicine. The programme – a combination of diet, The launch of new non- treatments and medical exercise, motivation and support along with non-surgical treatment surgical cosmetic clinic skincare. It also offers machine – was discussed in length by a panel consisting of Roydon Cowley, Regency Aesthetics took treatments, including Ultrapulse Josh Yardley and Dr Martyn King and Sharon King. Dr Martyn King place on January 23 on Upper CO2 laser skin resurfacing, M22 and Sharon King were responsible for developing the weight Wimpole Street. The event saw IPL and Nd:YAG laser platforms loss and body-contouring programme. “We have developed 50 clinicians, industry leaders for treating acne, pigmentation, this programme exactly how we would want it in our clinic,” and celebrities attend, and rosacea, vascular lesions and said Dr Martyn King. “With this approach, patients get the same included a champagne and veins, and the Fractora platform service wherever they go, with the same level of professionalism. canapés reception, tour of the for skin resurfacing, tightening Everyone is individual, but as long as this is the core principal clinic, and free skin consultation and non-surgical fat reduction. then all patients will have a successful programme.” The stages and analysis. The new clinic, Additionally, their treatment of the programme include a detox phase, which lasts for two run by medical director and package includes their own weeks, and an active phase, which lasts as long as is required for facial aesthetics practitioner bespoke No-Knife Facelift, the patient. The final stage is a maintenance phase, in which the Dr Rikin Parekh, contains two and the TiteFX fat reduction patient remains on a controlled diet. The programme administers large treatment rooms and a treatment for the body. sessions of cryolipolysis and fat cavitation, as well as sessions of smaller consultation room, and Alongside Dr Parekh, the team radiofrequency and vacuum rolling where required. offers treatments including contains four specialist medical Dr Johanna Ward, one of the doctors who attended the launch in anti-wrinkle injectables, dermal professionals. Treatment order to find out more about the programme, said “I like the idea fillers, and skin rejuvenation protocol includes consultation, of combining clinician-led guidance with technology. I think it’s treatments such as skin peels, specialist photography and exciting that this can be rolled out at a national level with exacting micro-needling, PRP Therapy, computerised skin analysis for results. We’re thinking of taking it on at our clinic.” mesotherapy hydration every patient.
Aesthetics | March 2014 11 Insider On the scene aestheticsjournal.com
I-Lipo Ultra launch, Inverness
The launch of laser lipolysis system I-Lipo Ultra from targets excess fat without damaging fat cells using Chromogenex at the SHRINKme clinic marked the low-level laser. “I-Lipo Ultra is supported at the clinic first I-Lipo system available to patients in Scotland. by gentle lymphatic stimulation using the Reviber The event took place at the Thistle Hotel in Inverness plate, which accelerates fat out of the body,” Urquhart on January 16, where UK and European Chromogenex said. “Using this programme, the client can complete product specialist Jo Briggs demonstrated how the the whole treatment in the clinic, without the need to treatment works. Clinic owner Iona Urquhart said, “We go home and exercise.” The I-Lipo course includes have been seeing consistently good results, with many eight 30-45 minute treatments, taken twice a week at of my clients losing in excess of 10 inches before the regular intervals. “Watching people shrink substantially eight sessions are finished.” I-Lipo can treat calves, in a few short weeks and seeing their self-esteem and knees, thighs, buttocks, stomach, arms and chin, and confidence grow is hugely rewarding,” Urquhart said. Inaugural Meeting of the Allergan Medical Institute, Amsterdam Advanced Technical
Training: Excellence in Aesthetic Care By Dr Mervyn Patterson
On January 24-26, Allergan invited leading aesthetic doctors from all over Europe to share and discuss advanced aesthetic injection techniques. The meeting is part of a major new initiative by Allergan to help improve the delivery of injectables to patients by providing advanced technical training and encouraging a consensus in best practice techniques. The meeting was lead by an international faculty of experts who shared their extensive experience using botulinum toxin and hyaluronic acid fillers. Multiple small group sessions with high quality video technology allowed for a clear, precise demonstration of injection techniques, and the informal atmosphere facilitated a high level of discussion. “There is a clear need for improvement in the delivery of injectable treatments and Allergan are really raising hand. Dr Raspaldo, and indeed all of the faculty members, reinforced standards by getting together all the leading doctors to improve quality the need for strict adherence to a sterile technique whilst injecting. of training,” said Dr David Eccleston, a cosmetic physician from the UK. The use of hyaluronic acid fillers in the forehead and temple region “This training, by way of detailed cadaveric dissection, reinforces the is currently of considerable interest and much discussion was given importance of understanding anatomy to ensure safe treatments.” in the meeting to the placement of filler under the eyebrow to give Midface augmentation techniques were demonstrated to show an support and lift. Dr Mauricio de Maio, a plastic surgeon from Brazil, indirect improvement in the infraorbital area, a good choice for less skillfully managed the treatment of complex and difficult cases. With experienced clinicians looking to improve this popular area. Chin clear treatment goals set out, his staged treatments displayed the augmentation was an additional focus, with treatments designed to lifting potential of correctly placed facial filler. Importantly, he gave project the chin forward and improve the jaw line. Delegates also expert advice on how to prioritise treatment steps to gain maximal received advice on how to use fillers in the chin and mental crease improvement within the patient’s budget.The new training format area to support the lower lip. Dr Gregor Wahl, a dermatologist of the Allergan Medical Institute proved to be a success amongst from Germany was tasked with leading the presentation on the delegates. Dr Tapan Patel, a specialist in facial aesthetics based in management of the infraorbital area. “Treating the tear trough with the UK, said, “Yet again Allergan raises the standard of training above hyaluronic acid fillers can be at times challenging,” he said. “The and beyond what we have had before.” Mr Kambiz Golchin, a plastic meeting allowed a discussion of the possibilities and limitations.” surgeon from Ireland, added, “I have great respect for the emphasis Dr Raina Zarb Adami, a plastic surgeon specialising in non-surgical placed by Allergan on training and increasing the safety profile of treatments from London, commented on a demonstration by Dr Boris procedures.” Dr John Quinn, a specialist in aesthetic medicine from the Sommer, a consultant dermatologist from Germany. “I was impressed UK said, “The conference really reinforced the concept of overall facial with the technique demonstrated by Dr Sommer for volumisation of volumisation for rejuvenation, and thus treating the patient holistically.” the lip. This is a different approach with small boluses of filler being A spokesperson for Allergan explained that one of the company’s placed in the body of the lip to give volume and support, something main objectives is to improve patient outcomes by teaching others I will definitely be introducing into my daily practice.” Revitalisation to be better injectors. He said, “The Allergan Medical Institute was techniques for the hand were discussed in a separate session developed to promote excellence in practice and this conference is led by Dr Hervé Raspaldo, an aesthetic surgeon from France. He just one of the steps on the road to achieving our objective.” demonstrated the use of a cannula for delivery of a very even layer of Dr Mervyn Patterson has no financial disclosures in the area of filler just under the skin to significantly improve the look of the ageing dermal fillers.
12 Aesthetics | March 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 ACE aestheticsjournal.com Special Focus
The Aesthetics Conference and Exhibition 2014
After months of preparation, the 1532 registrants Aesthetics Conference and Exhibition 2014 is set to be the largest medical 100 exhibitors aesthetics event in the UK this year. Comprising a huge programme of exhibitors, workshops, masterclasses and lectures, ACE provides visitors with the unique opportunity to get up-to-date 57 speakers on the latest product, service and technique innovations and hear from world- renowned experts on the topics most relevant to the medical aesthetic industry today.
59 CPD points Dr Mike Comins, head of the ACE steering committee, said, “I look forward to the wide selection of CPD accredited education available at the conference. to choose from The masterclasses, lectures, live demonstrations and workshops are vital learning tools for practitioners, 40 lectures and which will allow them to progress in their careers and expand their skills masterclasses and knowledge base.”
ACE programme coordinator 26 clinical Amanda Cameron said, “We have tried to put together an educational demonstrations and interesting programme so that the audience will not only be entertained but they will leave 13 business equipped with new skills to enhance their businesses. The mix of clinical, business and practical sessions is unique and this will create an event that is not workshops to miss.” “ACE is a huge compendium of learning and development,” said BACN vice- chair Sharon Bennett. “I’m really looking forward to the expert clinics with 2 days demonstrations and intelligent, innovative presentations from an impressive line up of experts.
1 event “ACE has understood and captured the essence of a rapidly evolving specialty and set a new level for Book Now aesthetic excellence and learning,” Over 1532 have already registered she said. for their place at ACE 2014. To book your FREE place today call Cosmetic dermatologist Dr Raj 01268 754 897 or visit Acquilla, who is demonstrating at the conference, said, “This will be www.ace2014.co.uk my third year presenting at ACE, which is a great opportunity for aesthetic practitioners of all levels to come together to learn and share the latest knowledge and techniques in our exciting and rapidly advancing specialty. This year I will be sharing injection strategies from my teaching experience around the world.”
Aesthetics | March 2014 53 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.
COME AND SEE US AT STAND 17
Contact us on Tel: 0845 1707788 [email protected] | www.abclasers.co.uk THE SCIENCE OF RETRIDERM™
THE POWER
OF VITAMIN A
OF VITAMIN A
FIGHT THE VISIBLE SIGNS OF THE POWER
THEAGEING AND SUN DAMAGE WITH
CLINICALLY PROVEN RETRIDERM™
DERM
DERM Unique medigrade Retinol formula
™
Clinically significant™ skin improvement OF RETRI OFafter 4 weeks daily Retriderm™ use*
Two strength Retriderm™ Vitamin A Skin THE SCIENCE THERegeneration step-up programme; straight forward to start and easy to continue
Ask us about…
CPD CERTIFIED TRAINING WORKSHOPS The Skin; anatomy, physiology, ageing & problem conditions Evidence based skincare ingredients and products COME AND SEE FOR FURTHER DETAILS Client consultations and evidence based regime US AT STAND 56 SCIENTIFIC & CLINICAL INFORMATION 0800 0195 322 [email protected] WORKSHOPS EVERY MONTH ACROSS THE UK RETRIDERM.AESTHETICARE.CO.UK @aestheticareuk facebook.com/aestheticareuk ©2013 AesthetiCare® a division of Ferndale Pharmaceuticals Ltd © AesthetiCare® 2014 6468.1/02.14 * Clinical study data available on request
6468•Retriderm Aesthetic Journal Ads Feb 14.indd 1 12/02/2014 17:25 Clinical Practice aestheticsjournal.com Special Focus
Dr Sarah Tonks discusses what you need to know when selecting a PRP method for your practice Investigating Platelet Rich Plasma
The use of Platelet Rich Plasma (PRP) in aesthetics the ideal concentration of PRP is at the moment unclear, most PRP systems is relatively recent but has gained considerable produce a substance containing concentrations of growth factors that are three- publicity due to its adoption by celebrities such as five times that in normal plasma. A count of 1,000,000/μL or 338% more than the Kim Kardashian and Bar Refaeli, who were both normal total blood platelet count has been proposed as being the ideal4. Studies depicted with their faces smeared with whole have shown that PRP with a low platelet concentration does not work and too blood rather than PRP, resulting in a dramatic effect. high concentrations have an inhibitory effect on cell growth. The concentration of However, PRP has been used clinically in humans PRP for bone regeneration was found to be best around 1,000,000/ μL.5 since the 1970s in opthalmic surgery, orthopaedics A separate study found that higher leukocyte content increases inflammation and and sports medicine. reduces tissue regeneration so it is important to exclude as many of these cells as possible from the PRP.6 Platelet Poor Plasma (PPP) is blood plasma with a very Much of the interest around PRP has come from low number of platelets, usually <10,000. This can be found in the top fraction of the idea that this is an autologous substance and the centrifuged blood. PPP is still a useful fraction of blood: it has been shown therefore considered to be ‘safer’ than traditional that both PRP and PPP, when activated with calcium and thrombin, can induce dermal fillers and botulinum toxins. WhatClinic. proliferation of dermal fibroblasts.7 com reported an increase in enquiries regarding the procedure of 807% over the previous year in The Growth Factors 2013. Although PRP is now offered by many clinics PRP contains high concentrations of growth factors and more than 800 different and there are numerous systems on the market, proteins and it appears that the growth factors work together synergistically.8 some uncertainty remains over its efficacy and Growth factor secretion begins 10 minutes after clotting with more than 95% proposed mode of action. Some have expressed of pre-synthesised growth factors secreted within an hour, however platelets doubts as to whether this truly represents evidence- continue to synthesise growth factors for at least seven days.9 Ideally the PRP based medicine due to the lack of robust clinical must be used on the application site 10 minutes after activation to harness the trials and outcomes. Indeed a recent Cochrane growth factors. After the death of the platelet, the macrophage takes over wound review in 2012 stated that at the moment there was healing by secreting some of the same growth factors.4 insufficient evidence to support the use of PRP.1 However, at a microscopic level in a study of PRP PRGF and TGF- ß1 treated fibroblasts, the PRP treated groups showed more proliferation and differentiation of fibroblasts IMPORTANT COMPONENTS OF PRP into myofibroblasts which are essential for wound • Three isomers of platelet derived growth factors PDGF PDGF-α α, PDGF- α β and PDGF- β β healing and increased contraction of the wound • Vascular endothelial growth factor VEGF during healing time.2 PRP stimulates endothelial • Two of the transforming growth factors TGF- β1, TGF- β2 cells near their application site and favours the • Epithelial growth factor EGF proliferation and formation of new capilliaries.3 Doctors report a high satisfaction and return rate from patients. The major effects of PRP are derived from PRGF and TGF- β1, which are concentrated in the alpha granule of the platelet and released during platelet What is PRP? activation. Both PRGF and TGF- β1 stimulate cell proliferation and differentiation Generation of PRP involves centrifugation of resulting in tissue formation.10 autologous blood to separate the plasma and buffy coat portion of the blood, which contains high levels Could it be dangerous? of platelets. Most people have a baseline blood Although no undesirable effects have been reported, hypotheses exist as to platelet count of 200,000 (+/- 75,000) and although the over expression of growth factors and their receptors related to tumour formation and dysplastic tissue. However it is thought that the circumstances leading to neoplasm growth require more continuous doses of growth factors over time than those in PRP, which degrade in seven-ten days.11 Nonetheless, the use of PRP should be avoided in patients with pre-cancerous lesions, in areas of epithelial dysplasia and those with a history of exposure to carcinogens.12
Types of kits Several commercially available methods to obtain PRP are currently used in the clinical setting and there are many kits, centrifuges and vials available. The Before After centrifugation process should be sterile and suited to platelet separation without © Regen Lab Aesthetics | March 2014 19 Clinical Practice Special Focus aestheticsjournal.com
lysing or damaging the platelets. Not all systems have been created to produce sufficiently viable platelet and this has led to criticism regarding the efficacy of PRP. When anti-coagulated blood is centrifuged, three layers form due to the differing densities of the blood components; the bottom layer consists of red blood cells, the middle of platelets and white blood cells, and the top plasma layer.3 It is important to reduce platelet fragmentation during centrifugation. Integrity of the membrane can be preserved by the use of acid citrate dextrose Before After type A anticoagulant and low gravity forces during centrifugation.4 Dr Daniel © Angel system Sister, anti-ageing and hormone specialist at BeautyWorksWest and pioneer of Dracula therapy, speaks on considerations when applying PRP. “The type reported were related to the source and quantity of of harvesting kit, centrifugation methods and time play a crucial role,” he says. the thrombin used.13 The addition of calcium is now “Plasma is autologous, so most new systems now come without the gel-like considered to be a safer option.2 separation, because plasma is not totally hermetical and filaments of the gel get mixed with the plasma. All systems must be closed.” “There is also the cost per How is it used? ml of active plasma to consider,” he says. “The new systems harvest 20cc in one The indications for PRP are numerous. There kit and are more efficient, have better ration of growth factors and are cheaper is evidence for its use to diminish dark circles than previous systems.” In the UK the most widely available kits available include around the eyes, hair growth and cutaneous Angel, Regen, Tropocells, BTI Technologies, Dracula and Selphyl. regeneration.14,15 PRP is most often performed as a The Angel system is unique amongst the described systems in that the superficial treatment. It can be used intradermally outcome is customisable. The haematocrit level can be adjusted to the desired with a 30g needle, in a linear thread, cross-hatching percentage (usually 2-7% in aesthetics), which will determine the amount of white or using the fan technique. It can be used like blood cells in the PRP. In order to activate the platelets the most commercially mesotherapy, in a micro injection or micro papular used method is to add thrombin or calcium to the PRP, although it can be used technique with a 32g needle. Additionally, it is being without activation as in vitro the platelets are activated by contact with collagen. used supraperiosteally to assist with slowing of Addition of calcium replenishes that which was bound by the acid citrate bone remodelling and ageing, although at present dextrose type A anticoagulant. Previously, bovine thrombin was used as an there is no strong evidence base for this.16 activator which was associated with the risk of life threatening coagulopathies via PRP is being used in combination with fat to improve immunologic problems and factor V deficiencies; however the adverse reactions the survival of grafted fat with good results.17
DRACULA SKIN ANGEL REGEN SELPHYL TROPOCELLS BTI REJUVENATION Amount of 50ml 8ml 18-36ml 10ml or 30 ml 54ml 20ml blood taken
Butterfly set for 10ml blood Needle and syringe. Method of Butterfly needle draw. Needle and syringe Butterfly cannula with Needle and Has a specific kit with Closed system taking blood and vacutainer could be used for 30ml vacutainer vials syringe ACDA anticoagulant blood draw
Sterile blood No tubes. Uses dedicated Yes Yes Yes Yes, endotoxin free Yes tubes? sterile hospital quality set
Size of tubes N/A 8ml 10ml 15ml or 50ml 9ml 20ml
10ml blood draw = 6-2ml Amount of PRP 6-10mls 4-5ml 9-18 ml depending on platelet conc 24ml dependent on Minimum 6ml obtained needed. 30ml blood draw = heamocrit 18-6ml conc platelets
4-8 x baseline platelet 1-2x volume blood Concentration of 3.44 x initial concentration when 1.8-2.5-fold +2.2 (yield 74.1%) 3-5 x above baseline (depends on fraction PRP: normal blood concentration diluted with PPP being used)
Centrifuge time 17mins 5mins 6mins 10mins 8mins 8mins
First cycle: 3800 First cycle: 3700rpm 1500 RCF (or g) Centrifuge speed 3200 rpm rpm Second cycle 580g 1800 Second cycle: 2700rpm Only one cycle (optional): 1800 rpm
Spinning angle N/A 45° 90⁰ 90° preferred or 45° n/a under patent 30° of centrifuge
None - self activating Calcium Activation Calcium gluconate when injected with Calcium Chloride None, activation in situ Calcium chloride gluconate substance (optional) small lumen needle optional
3 treatments, 4-6 3 treatments every 4 3 treatments 3 treatments every 4-6 3 treatments at 3-4 weeks Number of weeks apart and then weeks apart and then every 6 weeks weeks and then every apart for 3 months, top up Twice a year treatments every 6-18 months every 6 months 6–18 months every 6-12 months
LED cellular Cycloaliphatic polymer Method of Mechanical with Manually using a plasma photospectometry Thixotropic gel inert gel, 100% Mechanical filter separating PRP sodium citrate transfer device and fractionation biocompatible
20 Aesthetics | March 2014 n
o
i
t
c
u
d
e
R
t a F lipomed
Skin Tightening
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
COME AND SEE This NEW advanced device is dedicated US AT STAND 79 Cellulite 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% of • Face and Body skin tightening 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 the • Clinician use only skin. This energy is controlled and limited to the treatment area. Key advantages of this technology are high treatment efficacy, no pain Complete start up and support as less energy is required, shorter treatment services and variable package available from under 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 clients the very latest Before After 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 Focus aestheticsjournal.com
Conclusions REFERENCES Standardisation of PRP preparations is urgently needed to best compare 1. Martinez-Zapata M, Marti-Carvajal A, Sola I, et al., ‘Autologous systems. General opinion is that the majority of clinical studies do not have platelet-rich plasma for treating chronic wounds’ (Review), Cochrane the statistical power to give conclusive results. Human trials do not take Libr (2012), (p. 10). 2. Kushida S, Kakudo N, Suzuki K, Kusumoto K., ‘Effects of platelet- into account whether the platelets have been effectively concentrated, rich plasma on proliferation and myofibroblastic differentiation in whether the PPP is discarded or not, whether early activation occurred or human dermal fibroblasts’, Ann Plast Surg., 71(2) (2013), pp. 219–24. whether there were purification problems. Regarding skin rejuvenation, 3. Eppley BL, Pietrzak WS, Blanton M., ‘Platelet-rich plasma: a review larger scale studies and randomised controlled trials which would of biology and applications in plastic surgery’, Plast Reconstr Surg., decisively say which methods are most effective have not yet been 118(6) (2006), 147e–159e. performed. However, clinical experience suggests that in general, PRP, for 4. Marx R., ‘Platelet-rich plasma: evidence to support its use’, J Oral skin rejuvenation and other aesthetic indications such as hair loss, can be Maxillofac Surg., 62 (2004), pp. 489-96,
Dr Rita Rakus, aesthetic doctor, Dr Rita Rakus Clinic - Dr Sarah Tonks is an aesthetic Angel PRP system doctor and previous maxillofacial The Angel Lift is a highly effective treatment; it is a two-step procedure surgery trainee with dual qualifications in both medicine and that combines PRP with a fractional laser system. Targeting the signs of dentistry, who fell in love with the ageing inside and out, The Angel Lift reduces fine lines, wrinkles and results possible through minimally blemishes on the skin surface as well as addressing the structure of the invasive methods. Now based layers beneath to produce visible natural results. With medical grade at Beyond Medispa in Harvey credentials, the Angel PRP machine offers optimum performance, Nichols, she practises cosmetic injectables and ensuring it delivers the best possible results.” hormonal based therapies.
22 Aesthetics | March 2014 COME AND SEE US AT STAND 79
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 Clinical Practice one point CPD Clinical Article aestheticsjournal.com The External Skin Barrier Dr Mervyn Patterson discusses the structure, physiological function and mechanisms for repair of the external skin barrier
The external skin barrier, the outermost layer of the skin, is comprised of flattened cells separated by thin layers of lipids.The integrity of this barrier is critical to the health of the underlying skin. All skincare professionals who wish to deliver optimal skin health to their clients need to be aware of the importance of the external skin barrier and how to maximise barrier repair mechanisms.
KEY COMPONENTS OF THE EXTERNAL SKIN BARRIER The permeability barrier resides in the stratum corneum and consists of two components; the structural, cellular part and the lipid layer that lies between these cells. A simple analogy is that of slates on a roof kept together and apart by a thin layer of glue, or in this case, lipid. The slates are made of proteinaceous corneocytes filled with keratin. The glue between the slates is made of multiple layers and is predominantly made of three lipids: cholesterol, ceramides and free fatty acids. A point of note is that half of the free fatty acid component must be linoleic acid, an essential acid that cannot be synthesised by the body and must be ingested as an omega-6 fatty acid. When the three key lipids exist in a specific equimolar relationship the barrier is at its optimum. Further research(1, 2) has demonstrated that repair of the barrier is induced by several different, specific ratios of these lipids with very different degrees of repair resulting with each of the ratios. Topical applications of skincare with the 3:1:1 ratio with either cholesterol or ceramide dominating was shown to be the most effective reparative ratio. These lipids have a hydrophilic end that binds water and a hydrophobic end where they join to other lipids. They exist in a weight ratio of 50% ceramide, 30% cholesterol and 20% free fatty acids. This is the equivalent to an equimolar ratio of 1:1:1 in young healthy skin. To date 11 different ceramides have been described in human skin. The production of these Figure 1: The Epidermis complex molecules is limited by one single enzyme, serine protein transferase. Other enzymes are catabolic and contribute to the anti-inflammatory and hydration effects of ceramides. Sensitive skin and those with eczema are characterised by a marked decrease in ceramide levels and the catabolic enzymes are present in concentrations five times higher than in normal skin.(2, 3) Cholesterol is essential for skin barrier function and is synthesised by the enzyme HMG CoA- reductase. Very low cholesterol diets or prolonged high dose lipid-lowering drugs may damage the skin barrier and underscores the importance of taking a good patient history when trying to unravel the cause of a skin complaint. About 20-35% (by weight) of the stratum corneum is composed of water lying between the lipid layers attached to the hydrophilic ends of the three key lipids. The skin’s natural moisturising factor is a complex material that is a highly efficient humectant. The balance of moisturising factor, the three key lipids and water affect pliability and Figure 2: 28 day life of an flexibility of the skin. The three lipids are reduced in dry skin and aged skin.(3) Moisturisation results epidermal cell in increased water holding capacity or hydration. It does not necessarily improve the barrier because excessive moisturisation actually reduces barrier function. This factor explains why lipid- soluble corticosteroids applied to treat diseased skin penetrate the skin by up to fifteen times 14 1 more if the skin is excessively hydrated. This disruption of the stratum corneum and its barrier is Days due to hydration changes throughout the day or with bathing cycles. The epidermis must be in a continuous state of metabolic and differentiation activity to obtain homeostasis.(4) The skin barrier in addition to including corneocytes and their lipid layers also has two other 2 groups of molecules residing in the epidermis. Preformed biological response modifiers include 14 cytokines, growth factors and minerals and anti-inflammatory molecules that specifically bind to Days pro-inflammatory factors to reduce, prevent or reverse the magnification of the seven inflammatory cascades. The purpose of the preformed biological response modifiers is that when injury occurs barrier repair is immediately activated, as is acute inflammation, to rapidly kill microbes, neutralise 3 toxins, irritants and allergens and prevent their penetration.
1 Stratum corneum or External Skin Barrier. THE SKIN’S RESPONSE TO BARRIER DISRUPTION During the first 30 minutes following insult, preformed packets of biological response modifiers 2 Epithelial cells migrate to the including cytokines such as tissue necrosis factor, interleukin-1, growth factors, histamine and surface, change shape, flatten, nuclear receptors are released along with barrier lipids from lamellar bodies, which are ready loose their nucelus and turn into prepared storage vesicles of lipids inside the cells. During the next 30 minutes synthesis of the stratum corneum cholesterol and free fatty acids are markedly increased to facilitate repair, then ceramide 3 Cells divide and produce the synthesis increases during the next hour. Between two and six hours after injury DNA synthesis stratum corneum and production of fresh lamellar bodies leads to further secretion of the three key lipids into the extracellular space(5). The repair process after injury is dynamic. Basal cells at the base of
24 Aesthetics | March 2014 Clinical Practice aestheticsjournal.com CPD Clinical Article
the epithelium divide and the new cells migrate to the surface to be eventually shed. This maturation of the keratinocyte takes 28 days, but slows to 35-40 days as we age. In addition to lipid synthesis disruption of the skin barrier by injury leads to reparative epidermal proliferation as evidenced by increased DNA synthesis of basal cell keratinocytes.
ABNORMALITIES OF EPIDERMAL CELLS ARE SEEN IN MANY DISEASE STATES The epidermal cell turnover is markedly increased in many chronic skin diseases, up to three times more in dermatitis and nine times greater in psoriasis. Scaly diseases like ichthyosis vulgaris are due to abnormalities in the keratinocyte maturation process, which are due to abnormal desquamation and have an additional abnormal barrier function.(1, 6) Compromised barrier function is seen in a significant proportion of humans as determined by measuring transepidermal water loss. Upwards of 30% of females complain of sensitive skin with some estimates of sensitivity rising to over 60% in diseases such as rosacea. This is often due to deficiency of total lipid content contributed to by their skincare regimens. Up to 30% of children in the western world are atopic, a condition characterised by a compromised external skin barrier function. Here the greatest reduction is in ceramide levels but with a reduction in all three key lipids as well as reduced levels of urea, filaggrin and small protein-rich proteins. This genetic abnormality is linked to asthma, hay fever and food allergies with gastrointestinal symptoms.(2, 7)
SEVERAL ENVIRONMENTAL INSULTS COMPROMISE THE EXTERNAL SKIN BARRIER • UVA, UVB and X radiation • Excessive use of humectants • Humidity and temperature extremes • Prolonged use of cold creams • Microdermabrasion and chemical peels • Certain skincare ingredients • Excessive hydration, especially hot water • Physical and emotional stress
During the summer our skin is exposed to the sun for a longer period resulting in increased UV disruption.(8) Humidity and temperature changes are known to compromise barrier function. In the winter, after two to four days in freezing or below freezing conditions, the low ambient humidity results in dehydrated skin, scaling, itching or burning with water or moisture application and higher sensitivity to the elements.(8, 4) Prolonged visits to polar regions where the protective troposphere is deficient allows for significant increased exposure to UV damage. Microdermabrasion treatments and chemical peels may make the skin more vulnerable to sun damage, particularly if exposure occurs before the external skin barrier has had time to repair. Sunscreen with a high sun protection factor must be regularly applied, especially during times of increased sebum Figure 3: External skin barrier production because the sunscreen breaks down with sun exposure and is diluted as it mixes with the acids in the skin barrier. Repeated or excessive hydration, particularly having hot baths, usually disrupts the skin barrier. Despite moisturisers being regularly used by women, the incidence of facial dermatitis has been steadily increasing over the past few decades. One contributing factor is over hydration of the skin with excessive water and humectants, which Lipids that make up the external skin actually decrease the protective function of the skin barrier by separating the spaces between The external skin barrier is barrier are in a ratio of 1:1:1 the lipid layers. The converse to this is prolonged use of cold creams as cleansers. These composed of the top 12 to 15 skin products are devoid of water and dehydrate the skin to less than 10%, which causes abnormal cells and the lipids that lie between corneocyte desquamation, producing visible skin scaling, decreased skin pliability and stratum them. These keratinocytes and lipids provide protection to the corneum fracturing.(4, 7) Harsh ingredients in skincare products, especially soaps and cleansers underlying layers. damage the stratum corneum by various methods. Sodium lauryl sulphate is still commonly found in skincare products and actually destroys the lipid layers and corneocytes.(9, 10) Other chemicals known to cause damage to the skin barrier include propylene glycol, retinoic Figure 4: Electron acid, formaldehyde, urushiol, quaternium 15 and certain hydroxy-acids, including lactic acid. microscope image of the Whilst intermittent exposure to these products causes acute inflammation, prolonged use stratum corneum and leads to activation of chronic inflammation which in turn produces upregulation of matrix transitional layer metalloproteinase enzymes. These go on to reabsorb and remodel collagen and elastin fibres to produce micro scarring and wrinkling.(8, 11) A reduced quantity of the three key lipids in our diet also contributes to a compromise in the quality of barrier function. Inadequate consumption of 2 anti-inflammatories and antioxidants impinge on the skin’s ability to mount a protective acute 1 inflammatory response. Also chronic use of lipid lowering agents, fish oil and Niacin, as well as anti-inflammatories such as ibuprofen and aspirin, contribute to abnormal stratum corneum 3 and epidermal function. Radiation therapy carries a high risk of inducing itchy, difficult to treat dermatitis due to barrier disruption, inhibition of lipid synthesis, slow epidermal proliferation and reduced sebum production. Lipid variations resulting in barrier function abnormalities occur in peri- and post-menopausal women due to the fall in oestrogen and relative rise of testosterone which are known to compromise the permeability barrier. The production of all three key lipids and particularly cholesterol is reduced in this group. Medication that depletes water such as 1 Stratum Corneum diuretics and those that reduce sebum production, including isotretinoin, retinoids, niacin and 2 Stratum Corneum cells separated by a thin layer of lipids tetracyclines, all have an impact on barrier repair. 3 Transitional Layer Epithelial cells make a transition into the REPAIRING THE BARRIER, RESTORING THE DEFENSIVE SHIELD flat, hardened stratum corneum cells In young adults, after injury to the stratum corneum barrier, a rapid recovery phase occurs during
Aesthetics | March 2014 25 Clinical Practice CPD Clinical Article aestheticsjournal.com
the first 12 hours which produces 50-60% recovery, with full recovery taking up to improvement in tactile roughness, clarity and three days. In older people this may take up to a week or longer. Reaccumulating reduction in fine lines and wrinkles after 12 weeks of skin lipids becomes the most critical factor in restoring barrier function. As use.(13) stated before, normal skin contains an equimolar ratio of cholesterol, ceramide Many of the very light moisturising products are and free fatty acids of which 50% is the essential acid, linoleic acid. Work by actually very destructive to the external skin barrier Dr Carl Thornfeldt and other researchers(11, 12) has shown that barrier recovery is because they are deficient in the total amount of markedly accelerated by changing the proportion of the key lipids to a 3:1:1 ratio lipid needed and often negatively affect the normal with ceramide or cholesterol dominance. In one study this ratio produced a 75% skin lipid ratio, thus damaging barrier integrity. barrier recovery within four hours compared to only 35% with the equimolar ratio 1:1:1. Work has shown that formulas containing just ceramide or cholesterol or SUMMARY fatty acids have either no significant barrier repair properties or adversely affect • An intact skin barrier is the first line of defence barrier function. Certain non-physiological lipids such as petrolatum, glycerin, against harmful environmental insults lanolin, bees wax, and squalene provide some barrier repair. 100% petrolatum • The integrity of the stratum corneum regulates is known to markedly improve barrier function by 43% in 45 minutes. The DNA synthesis of the epidermis other non-physiological lipids work by different mechanisms and also improve • Many skin diseases and ageing are characterised barrier function, but at different time points and to various degrees. Thornfeldt by external skin barrier abnormalities and others developed skincare technology that combined the best ratio of • A disrupted external skin barrier is a primary driver the three key barrier repair lipids with low therapeutic concentrations of these for unwanted chronic inflammation non-physiological lipids. The EpiB complex, which forms a key component of the • After exfoliating procedures, the barrier must be platform technology within Epionce skincare, has been shown to produce an rapidly regenerated, otherwise the benefits of the 89.6% repair of the skin barrier with complete normalisation after two hours.(6) procedure are reduced For extrinsic ageing the ideal repair ratio of the physiological lipids is a 3:1:1 ratio • Rapid closure of the external skin barrier post- with cholesterol as dominant combined with petrolatum and glycerin between procedure is achieved with appropriately 3-15% concentrations of each. When used regularly, barrier-repairing moisturisers formulated combinations of physiological and non- not only help to produce and maintain remission of many inflammatory skin physiological lipids diseases but they also help reverse and prevent the activation of extrinsic • Practitioners now have available barrier-repair ageing. An independent, split face, double blind, prospective controlled clinical moisturisers proven in clinical studies to treat the study using this barrier repair formulation showed a highly statistically significant signs of ageing skin
Figure 5: Healthy lipid ratio is Figure 6: Lipid layer made of three lipids, key to a healthy barrier ceramide, cholesterol and free fatty acids
fatty acid (Stearic Acid) Lipids that make up the external skin Ageing, skin disease and poor skin repairbarrier are in a ratio of 1:1:1 ceramides lead to a deterioration of the skin barrier and Lipids that make up the the normal ratio of healthy lipids changes. cholesterol external skin barrier are Epionce is formulated to restore a healthy in a ratio of 1:1:1 Lipids that make up the external skin lipid ratio and external skin barrier. barrier are in a ratio of 1:1:1 Lipids that makeAs a co-owner up of Woodford the externalMedical, skin REFERENCES Dr Mervyn Patterson is a highly experienced aesthetic doctor providing 1) A.W. Johnson, ‘Cosmeceuticals: function and the skin barrier’, in Cosmeceuticalsbarrier 2nd are in a ratio of 1:1:1 ed, ed. by Z.D. Draelos (Philadelphia: Saunders-Elsevier, 2009), pp. 7-14. a wide range of non-surgical treatments. 2) G. Dell’Acqua, ‘Sensitive Skin and Skin Barrier’, Cosmetics & Toiletries, 123:12 (2008), Financial disclosures: 71-75. Medical director at Eden Aesthetics. 3) J.A. Bouwstra, G. Pilgram and M. Ponec, ‘Structure of the Skin Barrier’, in Skin Barrier, Distributors of Epionce / Agera skincare, ed. by Peter M. Elias and Kenneth R. Feingold (New York: Taylor Francis, 2006), 65-96. and Colorescience mineral makeup. 4) J.Q. DelRosso, ‘Moisturizers: Function and Clinical Applications’, in Cosmeceuticals 2nd ed, ed. by Z.D. Draelos, (Philadelphia: Saunders/Elsevier, 2009), pp. 97-103. Dermagenesis microdermabrasion and Dermafrac 5) Kenneth R Feingold, ‘The role of epidermal lipids in cutaneous permeability barrier microneedling @drmervpatterson homeostasis’, Journal of Lipid Research (2007), 48: 2531–2546. 6) Medical Barrier Cream Superior in Cutaneous Healing (2014)
26 Aesthetics | March 2014 fatty acid (Stearic Acid) Dare to go naked
Award winning Obagi; COME AND SEE clinically proven for healthier, US AT STAND 66 beautiful looking skin.
Obagi transforms skin whatever your age or skin type and is Winner of Best Cosmeceutical Range 2013, recognised for the fourth year in a row by the UK’s aesthetic medical profession. www.healthxchange.com
HCP_obagi_A4.indd 1 17/12/2013 17:02 Clinical Practice Techniques aestheticsjournal.com
in eight areas of the face to achieve an overall lifting effect, with the ethos being to treat minimally and precisely, looking beyond individual zones of concern to the definitive causes of the signs of ageing, which is often fat and bone resorption in predictable parts of the face. The technique utilises the Juvéderm Vycross collection of non-permanent HA dermal fillers. These hyaluronic acid dermal fillers each work in specific ways to volumise and give structure to the face: Juvéderm Voluma is injected deeply, lifting and restoring volume; Juvéderm Volbella has a water-like consistency and is suitable for the delicate peri-orbital area, as well as the area around the lip; Juvéderm Volift works to treat medium- deep depressions. My personal preference with my patients 8-point lift: achieving is to use both needle and cannula for a full-face treatment. The aim of the 8-point lift is to support the infra-orbital areas, lift the mid-face, nasolabial fold, the liquid face lift oral commissure and help to improve the jawline. It also helps to give more contour Miss Jonquille Chantrey on the benefits of Allergan’s and appropriate fullness through the malar, new 8-point lift technique in achieving a comprehensive, parotid and buccal areas. whole-face approach to facial rejuvenation In terms of patient selection, the 8-point approach has a lot of versatility. It is a technique appropriate for the young Miss Jonquille to treat the changes in the facial fat patient, perhaps in his or her 30s, who Chantrey is a highly- compartments. In doing so, there have might do a lot of physical training or who experienced surgeon been many techniques whereby large has had large weight fluctuations due to and well-respected boluses of products have been placed dieting, and has experienced significant figure in cosmetic in the anterior malar and zygomatic fat loss shifts to their superficial fat medicine and areas. This can create inappropriate compartments. Other indications may be minimally invasive cosmetic surgery. projection and volume, resulting in an post-pregnancy facial changes or illness. She regularly presents at plastic surgery unnatural-looking result, both in repose This technique addresses the variations conferences throughout the world and animation, when patients speak and that can give the face a tired appearance, and has published scientific articles in smile. Other side effects of large bolus despite a relatively young age of patient. peer-reviewed journals, including The techniques may also include the formation The technique is also appropriate for Lancet. Miss Chantrey has her own of biofilms. patients 10 to 20 years older. These practice in Cheshire. For some time, many practitioners have patients will notice further signs of facial As an industry, we are continuing to move been considering and utilising techniques ageing and descent within the face, away from ‘chasing the wrinkle’ and more in which we can use minimal amount of accompanied by a development of the towards treatments and techniques that product – with specific placements in pre-jowl sulcus and an early loss of the incorporate a whole-face approach, with certain areas – in order to achieve the mandibular line. increasing prominence given to flexible maximum amount of lift for the patient with I have successfully used the 8-point lift and well-considered strategies. a more natural outcome. This has now technique to treat patients in their 70s been stratified into eight points: the key and 80s, who have advanced volumetric Facial volume loss contributes significantly lifting areas of the face. changes and descent, with excellent to facial ageing, typically occurring in The 8-point lift was results showing a pleasing lift. the malar region, temples, infra-orbital originally devised by This approach is effective for both male and mandibular areas, resulting in dark Dr Mauricio De Maio, and female patients. Needless to say, shadows that give the face a tired and a plastic surgeon from the proportions of a male face are very drawn appearance. Over the past five Brazil, and I was one of different to the proportions of a female years we have primarily treated the mid- the first physicians in the face. As long as that is respected then the face, both supporting the peri-orbital UK to be trained by him on this signature 8-point lift is absolutely appropriate for region and lifting the perioral region, technique. Small adjustments are made both genders.
28 Aesthetics | March 2014 COME AND SEE My US AT STAND 79
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 Clinical Practice Techniques aestheticsjournal.com
The positions of the 8-point lift are as follows:
• The first pointis the junction between the cheek and the temple. It is a very specific point and treated with a deep placement of Juvederm Voluma onto the zygomatic bone, usually 0.1-0.2mL. This can help to lift the zygomatic area and restore it’s youthful curve, whilst also correcting the lid-cheek junction. • Point number two is a beautification point, positioned over the anterior aspect of the 1 3 zygomatic bone. Here I would use a further 0.1-0.2mL. This also helps to support the 2 outer aspect of the infra-orbital region and lift the mid face. 8 4 • Point number three is a point in the anterior malar area, within the cheek. The deep 7 malar fat is injected in this position, so that it acts as an anchor point to fix the face superiorly. Placement of 0.3mL of Juvederm Voluma or Volift in this position helps to 5 support the tear trough, correct the palpebral-malar groove and can lift the nasolabial 6 fold. • For point number four, I would switch to a lighter product such as Volift in order to minimise any external vascular compression and inject a small amount of this into the canine fossa. Between 0.2-0.3mL may be sufficient to lift the rest of the nasolabial fold. THE NO-GO AREAS • Point number fiveis the oral commissure. Here, I would also use 0.1mL Volift intra- dermally, which helps to give the oral commissure a more supported horizontal position. • Point number six is the pre-jowl sulcus. This is the area that female patients in particular can experience early mandibular recession and is also important for patients who exhibit retrognathia. Treating this point delivers more support to the chin, and gives better definition. This is a point where I use a cannula to simultaneously support the pre- jowl sulcus, marionette line and deeper element of the oral commisure. My product of choice is commonly Voluma and 0.5mL can produce excellent contouring. • Point number seven varies between a male and a female. In a male, this is the definition of the mandibular angle, resulting in a square appearance to the jaw. In a woman, it may be desirable to give gentle mandibular definition, but certainly not overly project it, as this can masculinise a female face. The position where I tend to put point number seven is higher than the mandibular angle, usually approximately 2cm above, which gives a nice lift to the posterior aspect of the face. The important point to note about this point is that it needs to be very superficial in its placement. If injected deep in this area then risks could include a parotid cyst or facial nerve injury. Juvederm Voluma Images © Dr Mauricio De Maio or Volift can be used in this area; product volume varies from 0.05mL to 0.3mL for
before after enhanced definition. • Finally, I like to think of point number eight as a superficial zone.This tends to run from the pre-auricular area, across the parotid and then into the sub-malar and buccal areas. By treating this zone, not only can volume deficit and hollowing be treated appropriately, but a subtle lift of the buccal or jowl fat can be achieved. I always use a cannula here, gently in the subdermal plane, above the parotid fascia. This helps to minimise the risk of facial nerve, facial artery and parotid duct damage. Quantities used for this zone may be approximately 0.3mL to 0.6mL. In patients that have significant solar before after elastosis or weakness to the skin I would use Volift not Voluma. This area then requires massage immediately post-treatment.
In points one to five I use a needle to administer the treatment, but it is important to note that you can also achieve additional improvements by using cannulas in these points, by revisiting points two and three. I return to these areas and treat them superficially with vectoring. I generally use a Patient images © Miss Jonquille Chantrey many vectoring techniques in my cannula work and so I incorporate this into the 8-point lift.
I don’t use all eight points in every patient. In many patients, for must understand that if small initial quantities are used, then instance if they’re young or they have very good preservation of they may require several appointments to achieve the desired their facial fat compartments, then I may only treat point one and result. In the initial one-hour assessment, I consult the patient point two. Similarly, I may only use points one, two and three in to understand what they’re trying to achieve and also discuss a patient whose face has a tired expression. With other patients in detail the causes of the changes in their face. We then agree who might be financially limited we can use points one, two and a strategy as to how quickly or slowly they want to progress. eight to give a lifting effect. This technique is about precise and One of the advantages of this method is that the result is specific positioning and placing of the product, focusing on the buildable, depending upon the expectations of the patient. cause of the descent, rather than just treating the effects of it. In my experience, this approach results in a very high patient Communication is an essential part of the 8-Point Lift. Patients satisfaction rate and predictable, beautiful outcomes.
30 Aesthetics | March 2014 Advertorial aestheticsjournal.com Boston Medical Group (BMG) Ltd Revanesse and Redexis HA dermal fillers: the practitioners’ choice Boston Medical Group (BMG) Ltd. presents Prollenium Medical Technologies, Canada and explains why more clinicians are opting for their products
Established in 2007 with the goal of providing filling, sterilisation, testing and packaging. Their on-site R&D department means exceptional aesthetic products within the UK and they are constantly researching new advances in aesthetics to improve their Ireland, Boston Medical Group (BMG) distributes range and stay ahead of their competitors. With integrity and trust at the heart of mainly to aesthetic practices. BMG prides itself on what they do, Prollenium’s in-house nature lends transparency to the brand and only selecting the most effective product ranges, distributors can see exactly where the products come from – a welcome idea research-based with proven results and keeping following recent events in the industry such as the PIP scandal. This traceability up-to-date with advances in the aesthetic world is one of the reasons many practitioners have opted to use the range. Malti with their top quality training programmes. BMG’s O’Mahony, medical director at popular London clinic Harley Street Treatments extensive product range includes Revanesse Ltd., said, “The products are an ideal choice for me due to the safety and easy and Redexis dermal fillers, and Dermal Roller traceability to the manufacturer in Canada.” SR - all manufactured by Prollenium Medical The Revanesse range is becoming increasingly popular with medical Technologies. In addition to this, they also offer practitioners across the UK and Ireland, receiving high acclaim due to its variety SR Serum for skin rejuvenation and cellulite, HL and quality. Dentist Dr. I. Mian at Chinbrook Medical Ltd., said, “Revanesse serum for hair loss, Viscoderm hyaluronic acid, seems to tick all the boxes. The portfolio range can be used for different depths Phiderma cosmeceuticals and CNC equipment. The and indications and you do not need to overcorrect. While the filler slowly Revanesse range is composed of six hyaluronic degrades over time, it does not result in complete loss of volume, and tends acid (HA) dermal fillers, all of which suit a different to maintain its integrity whilst it degrades.” Others have noticed the numerous purpose whether it be for treating deep lines and benefits in comparison to other dermal fillers on the market. “I have incorporated wrinkles, achieving fuller lips, volumetric filling or Revanesse into my every day practice as it offers advantages in ease of injection, improving hydration. The great thing about HA- volume enhancement and smoothness of results,” said nurse practitioner Elena based fillers such as Revanesse is that they are Korshunova. “I have also found it to be very good for use in the lips, as it is soft, biodegradable and non-animal based, therefore does not cause more severe or prolonged swelling than other HA products safe for all skin types. and once it is settled, the results look very natural, rather than the persistent ‘rubberiness’ seen with other longer-lasting HA fillers. Patient satisfaction is high.” Malti O’Mahony agrees that the product range has produced high patient satisfaction and little swelling. “The product is extremely well-tolerated by my patients,” she said. “I am especially pleased with Revanesse Kiss due to its ease of application, minimal swelling and longevity. The Revanesse range is extremely well-tolerated and is now the most popular choice amongst my patients.” Dr. Khan, medical director at the London-based Beauty Spot Ltd., added, “I have recently been introduced to the Revanesse range, and I am very happy with the results. I will continue to use this product range.” Both Revanesse and Redexis incorporate a Recent additions to BMG’s growing product range include the Lidocaine range, unique formula and patented Thixofix cross-linking Revanesse Contour for facial volumising and chemical peels – the perfect technology, which maximises the effectiveness of solution for medical practitioners who want to purchase their products from the cross-linked HA chains in the gel and makes one reputable and well-tested source. Prollenium may be a relatively small the product safe and long-lasting. As a result, a company compared to well-known industry brands, but with a strong research homogenous highly viscous gel with smaller, uniform and development department that is always at the cutting edge of aesthetic particles is created, allowing it to be easily injected advances, they are fast establishing themselves as a name to trust. through a fine gauge needle without causing Want to learn more about any of the products from the Prollenium range? degradation to the modified HA particles - setting it BMG offers free product training in their purpose-built premises in London’s apart from other HA-based fillers. Bayswater area. Visit the Boston Medical Group at stand 5 at this year’s The manufacturer of the Revanesse range, Aesthetics Conference and Exhibition (ACE) 2014 and see Revanesse Ultra, Prollenium Medical Technologies based in Ontario, Revanesse Ultra Lidocaine and Revanesse Contour in use at their ‘Facial is the first and only manufacturer of dermal fillers Volumising and Shaping’ workshop on Sunday March 9 at 2pm. in Canada. The company undertake the whole Boston Medical Group Ltd - Tel: +44 (0) 207 727 1110 formulation process in-house including syringe- [email protected] - www.boston-medical-group.co.uk
Aesthetics | March 2014 31 Clinical Practice Clinical Focus aestheticsjournal.com
noticeable amount of volume loss Why Emervel Lips? in mid-face, presenting heavy jowls and deep naso-labials creating Dr Beatriz Molina shares deep mouth commissure lines, but only wants a lip treatment with one her technique when using Needle treatment using Emervel Lips: syringe of product. In these cases I Emervel to treat the lip and will limit my treatment to just the lip and upper lip lines. The versatility perioral area of Emervel Lips means that you can Lip treatments are a particular favourite of mine. provide an impactful treatment with Treatments of this area can have a big impact, noticeable improvement. However, and make a substantial difference to patient self- I would always recommend a full confidence. My choice of product when treating Cannula treatment using Emervel Lips: treatment to the mid-face first, the lip and peri-oral area is Emervel Lips hyaluronic making the overall result much acid (HA) dermal filler. The Emervel Range offers more balanced. an optimal balance between cross-linking and gel Another challenge is uneven lips 1 First 2 small calibration, creating four degrees of cross-linking injections of and uneven smile. Always ensure (resistance to deformation) and three degrees of lidocaine 2%. you take a range of patient photos calibration (lifting capacity). This optimal balance at rest, smile and profile. Uneven therefore provides (1) the broadest spectrum of 2 Second do your smiles will normally require a distinctive soft textures and (2) the optimal match access point with combination of botulinum toxin to the tissue type at each injection site. In a recent a 23G needle. (BontA) and filler. I prefer to treat FRESH study, 85.7–100% of patients injected with with BontA first two to four weeks products from the Emervel range for lips, upper prior to balance the smile before 3 Third I would lip lines, nasolabial folds and marionette lines, normally use a defining with Emervel Lips filler. said they would like to be injected with the same 25G 2” cannula (you may also use product again. Scores ranged from 85.7% for a 27G) and do a In summary, the key to a successful Emervel Lips to 100% for Emervel Classic (upper fanning retrograde technique which treatment is: lip lines). The versatility of Emervel Lips allows allows me to treat upper and lower • The initial assessment practitioners to treat vermillion border, body of the perioral lines as vermillion border and • A technique that suits you commisures of the mouth from one lip and upper lip lines with only one syringe. access point. You may even want to • Keeping facial features in treat nasolabial folds and marionette if balance and in keeping with age TECHNIQUES: indicated from the same access point. • Making small tweaks and When treating the lip I divide treatments, improvements to create a huge depending on which areas my patient and I have difference agreed to treat. I look specifically at the following Assessing the face as a whole is the most effective approach and will always factors: amount of volume loss or enhancement for deliver best results. You have one opportunity; if a patient is not impressed on lip, symmetry and treating only vermillion border their first visit, it is likely that the initial assessment and consultation of needs and/or also perioral area. All of this will influence was incorrect. treatment technique (layering, crosshatching, linear threading) depth of injections, and tools (sharp Dr Beatriz Molina is a member of the British College needle or blunt needle (cannula). For quick lip of Aesthetic Medicine (BCAM). She practised general volumising treatments, or just for lip definition, I use medicine in Somerset for 12 years, before opening needles. The needle is versatile, and creates great her first practice, the Medikas MediSpa Clinic. She definition within the vermillion border and volumes now practises full time as a cosmetic doctor whilst the body of the lip well. Emervel Lips has 0.3ml also teaching beginners and advanced techniques in lidocaine and injects easily through a 30G needle botulinum toxin and dermal fillers. so comfort for the patient is optimised. However, if I am treating the peri-oral area as a whole I prefer FURTHER READING: using a 25G cannula, as I feel it is less traumatic for 1) Cartier, H., et al., ‘Perioral rejuvenation with a range of customized hyaluronic acid fillers: patients and can treat a wider expanse. I believe efficacy and safety over six months with a specific focus on the lips’, J Drugs Dermatol, that when treating the lips it is essential to take 11(2012) (1 Suppl), 17-26 the whole perioral area into account and to assess 2) Kestemont, P., et al., ‘Sustained efficacy and high patient satisfaction after cheek patients’ balance and asymmetry, not only face-on, enhancement with a new hyaluronic acid dermal filler’, J Drugs Dermatol, 11(2012)(1 Suppl), 9-16 but also from in profile. Normally I begin with two 3) Rzany, B., et al., ‘Correction of tear troughs and periorbital lines with a range of small injections of lidocaine in the chosen access customized hyaluronic acid fillers’, J Drugs Dermatol, 11(2012) (1 Suppl), 27-34 point, which will vary depending on the area of 4) Segura, S. et al., ‘A complete range of hyaluronic acid filler with distinctive physical treatment. I then use the 23G needle to puncture properties specifically designed for optimal tissue adaptations’ J Drugs Dermatol, 11 (2012) the skin to allow easy penetration of my 25G (1 Suppl), 5-8 cannula. It can be challenging when a patient has a
32 Aesthetics | March 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
2
www.galderma-alliance.co.uk
US AT STAND 58 COME ANDSEE
EME/021/1013 Date of prep: October 2013 Clinical Practice Techniques aestheticsjournal.com
Dr Askari Townshend explains the technique of using needles to deliver Sculptra Using Sculptra with needles 1
In last month’s issue, the benefits of using cannulae stay still to avoid traumatising surrounding by means of a new technique were discussed. structures. Immediate post-injection In this article, I explain the advantages and massage is also essential to ensure mechanisms of the needle technique to deliver good spread of the product and an even Sculptra. aesthetic result.
PREPARATION TREATMENT AREAS Sculptra is a powder that must be carefully Sculptra should not be used in boney reconstituted with water (I use 7mls) at least 24 hours areas with little fatty covering e.g. before use though I strongly recommend no less forehead and nose. The lip vermillion, top 2 than three days. Injection of clumps of product risks lip and modiolus (just under 1cm inferio- nodule formation and blockage of your needle. 2mls lateral from the oral commissure) should of 2% lidocaine is added just before treatment, which also be avoided. As with fillers, always provides patient comfort during the treatment (some start with the most superior area and work practitioners also like to apply topical anaesthetic your way inferiorly as the volumisation up beforehand). Ensure that you have a sterile field high will change the requirements of the for your equipment including a plastic reservoir for areas lower down. chlorhexidine. Use it to clean the face thoroughly before you start and before every injection. TEMPLE Often, only two depot injections are EQUIPMENT AND TECHNIQUE required of up to 1.5mls each. These Cannulae are useful for fanning under large areas should be near perpendicular to the skin of skin minimising the number of needle punctures and pass through both layers of fascia to 3 and reducing the chance of bruising. However, for the periosteum. those of you not familiar with cannulae, needles are Know your anatomy and avoid the cheaper, easier to use and still achieve great results. superficial temporal artery and its 1. Before Many use brown 26G x 0.5inch Terumo needles branches as well as any visible superficial 2. After first session (Microlance seem to block more often) but you should veins. 3. After month 7 from first also consider the orange 25G x 1.5inch size (of either injection brand). This much longer needle allows fanning ZYGOMATIC ARCH (similar to a cannula) in the sub-dermal plane. This can be treated in two ways – over the top of the arch with the 1.5inch needle Most use a 1ml luer lock syringe but I prefer to use a via a deep retrograde injection (as you might do with a heavy filler), or by a series 2.5/3ml slip lock syringe. If you are pushing so hard of deep injections just underneath it. A total of 2mls can be used here, which that the needle comes away, take this as a warning provides volume from deep within, helping lift the skin of the lower face. that if you feel resistance to your injection, then stop. Never inject against great resistance. Excellent MID-CHEEK aspiration technique is important for all aesthetic facial My personal feeling is that the area most commonly needing volumisation is over injections, regardless of the treatment, but is essential the infra-orbital foramen. Be respectful of the neurovascular bundle that exits with Sculptra as the volumes injected in depots are here though it is deep and has a fibrous covering. I use one finger to push up larger. Ensure that the needle tip is not moved during fat from lower down to create a buffer and ensure that my needle doesn’t reach aspiration and that it maintains the same position the periosteum. If you are anxious about damaging the bundle, aim a little lateral. when injecting. Attention to detail in this will also be I place boli of up to 1.5mls from medial to lateral without removing my needle important if your needle becomes blocked. When completely. Only change the direction of your needle once you have withdrawn pulling the plunger to and fro, the needle tip should almost all of it.
34 Aesthetics | March 2014 aestheticsjournal.com
ALAR TRIANGLE Are you easily LED? This single 45° injection, 5mm from the nasal alar pointing medially, is sensitive but very straightforward. Pull the nose anterially as you enter to move the angular artery out of the way and deposit up to 1ml.
PAROTID AND BUCCAL AREAS If hollow, filling this area can make the masseter less prominent and improve the jawline and jowls. Beware those with masseter Best New hypertrophy and/or round faces: this is where the longer 1.5inch Product or Treatment 2013-2014 needle is ideal. Stay above the parotid fascia and don’t stray towards the superficial temporal artery. Fan the area and consider using gentle aterograde injection. Hydrodissection is the idea; I’m THE LEADING LIGHT IN uncertain how much of a difference this makes but in my opinion LED PHOTOTHERAPY it won’t do any harm. You can easily use 2mls here.
MARIONETTE AND CHIN Over 100 Clinics across the UK now have our Systems. Using Marionette areas are treated with a vertical injection from the a range of clinically proven underside of the chin keeping deep and parallel with the ramus wavelengths Dermalux™ of the mandible. Like the mid-cheek, place more than one bolus, LED Phototherapy is a only moving the angle of injection once you have withdrawn non-invasive and the needle almost fully. The mental crease can be treated with a affordable treatment deep retrograde injection. delivering exceptional results for a wide range of skin SKIN TEXTURE IMPROVEMENT conditions including: As long as you keep to the rules set out above, you can fan almost any area of skin that needs improvement such as thin, • Skin Rejuvenation crepey, sun-damaged skin or acne scarring. Ensure that you do • Acne (all grades) not leave any boli here; leave a thin lake of Sculptra across the • Pigmentation • Psoriasis whole area and massage well. COME AND SEE US AT STAND 22 • Rosacea • Accelerated Healing AFTER CARE Although you will have massaged after every injection, perform a thorough massage at the end of the treatment. One big Before & After Dermalux™ LED difference with Sculptra treatment is that the patient must massage the treated areas at home. The European consensus is Rosacea Psoriasis Acne for five minutes twice a day for one week. There are benefits to facial massage and so I ask my clients to massage until they see me next, usually six weeks later. You cannot massage too much, but you can certainly do it too little.
In summary, needles can be used to deliver Sculptra to various treatment areas allowing for a diverse alternative to cannulae. BEFORE BEFORE BEFORE Whilst cannulae reduce the number of needle punctures and chance of bruising, needles are cheaper, quicker and easier to use with different lengths and styles available to target different problem areas.
Dr Askari Townshend qualified as a AFTER AFTER AFTER doctor in 2002 and was awarded MRCS 8 Dermalux treatments 8 Dermalux treatments 9 Dermalux treatments in 2006. Already with several years of in 3 weeks in 2 weeks in 3 weeks injectable experience, Dr Askari opened his own clinic in 2008. Having been approached by sk:n in 2010, he sold the Aesthetic Technology Limited Park View House, Worrall Street clinic and held the position of Director Congleton, Cheshire CW12 1DT of Medical Services there until 2013. His interests include t: 0845 689 1789 | e: [email protected] injectables, lasers, and peels. Dr Askari is an international w: www.dermaluxled.com Sculptra trainer as well as lead UK Sculptra trainer for Before and after images courtesy of; Rosacea – Blushers Clinic, Coventry; Sinclair Pharma. In addition, he is the UK medical Psoriasis – Miss Zahida Butt, The Cosmetic Clinic, Kings Lynn; Acne – Dr Steve McGurk – Ilkley consultant providing support for Sculptra practitioners. ADVANCED PROFESSIONAL SKINCARE
For more information on SkinCeuticals contact our dedicated team on 0870 850 4338. www.skinceuticals.co.uk
14832 Skin Ceuticals A4 advert.indd 1 19/02/2014 11:36 am Clinical Practice aestheticsjournal.com Spotlight On
stimulating tyrosinase in the melanocytes at the basal layer. Ellagic acid has been shown to be as effective as 4% hydroquinone at reducing the appearance of dark spots and hyperpigmentation. It also contains hydroxyphenoxy propionic acid, a non-toxic derivative of hydroquinone, to reduce melanin transfer to skin cells in all the layers of the skin. Hydroxyphenoxy propionic acid has been shown to be as effective as 2% kojic acid at reducing discolouration. The Pigmentation formula also includes 0.3% salicylic acid to enhance exfoliation of dark spots at the skin surface and enhance penetration of the active is the new ingredients. wrinkle As they age, these women We discuss SkinCeuticals’ newest are now seeing unwanted addition to its skincare line, pigmentation appear and are Advanced Pigment Corrector increasingly seeking out treatment
Today, over half of women aged between 35 and 59 cite from aesthetic doctors and discolouration and uneven skin tone as a more significant dermatologists for the problem skin concern than loss of firmness. Dermatologist Dr Patricia Ogilvie has gone so far as to say that “Pigmentation is the RESULTS new wrinkle.” While pigment problems can occur for hormonal In a 12-week, multi-ethnic clinical trial, Advanced Pigment Corrector reasons, due to post-inflammatory hyper-pigmentation, and was found to improve hyperpigmentation by an average of 15%, because of environmental inflammation, UV exposure is dark spots by nearly 20%, and radiance by 20%. the primary cause. Many women experienced excessive Jim Krol says, “No patients failed to respond and there was up to UV exposure in a time before high SPF creams were a 90% improvement in some cases. Indeed, the results matched widely available, or indeed, before there was any popular those of the gold standard treatment of 4% hydroquinone plus understanding of the long-term risks of tanning. As they age, 0.025% tretinoin, with the treatment performing better on skin these women are now seeing unwanted pigmentation appear tone clarity, radiance and evenness.” Cosmetic doctor Dr Tapan and are increasingly seeking out treatment from aesthetic Patel says, “Tretinoin, though invaluable doctors and dermatologists for the problem. Advanced to dermatologists, can be too irritating for Pigment Corrector is now offered as a new topical treatment. some patients, and we do not recommend it for daytime use. Advanced Pigment THE SCIENCE OF SKIN TONE Corrector can be used day and night. Jim Krol, SkinCeuticals head of Hydroquinone may also be problematic. It Scientific Affairs, explains that the can cause irritation, plus it can bleach skin concept behind Advanced Pigment to a lighter colour than the natural skin tone, Corrector was to take a cocktail which is impossible with the ingredients in approach to address pigmentation in all Advanced Pigment Corrector.” Krol adds, “We saw no side effects layers of the skin. “No other treatment in our studies. No subject discontinued the study because of does this,” he says. This meant it had redness or peeling and we had 95% compliance in the study.” The to interrupt melanin stimulation of the treatment can safely be combined with other skincare products melanocytes, block production of and medical treatments, such as laser and IPL. Study participants melanin, and prevent transfer to keratinocytes, plus it would used Advanced Pigment Corrector alone, with only Skinceuticals help exfoliate existing dark marks from the skin surface. And Gentle Cleanser and SkinCeuticals Physical UV Defense SPF30, the aim was to achieve this with a topical cream that was which offered visible results, but these may be boosted further by pleasant to use, would fit into a simple skincare routine and adding an anti-oxidant serum before applying Advanced Pigment would be non-irritating. corrector by day, and, for severe discolouration, adding retinol Research presented at the World Congress of Dermatology 0.3% at night. As with all treatments for pigmentation, a broad- in Seoul, Korea, found that photoaged fibroblasts produce spectrum sunscreen is essential to achieve and maintain results. melanogenic growth factors that promote excess pigment Krol says, “We launched Advanced Pigment Corrector in the US production, leading to both new and recurring pigmentation. in September where it was very successful. It has addressed a By strengthening fibroblasts, the expression of these growth huge unmet need for an effective product that is easy to use. The factors are downregulated, making skin more resistant to new big trend in aesthetic dermatology is to offer home care with pigmentation. in-office treatments. We believe this can help build patient loyalty Skinceuticals’ Advanced Pigment Corrector contains 5% and compliance. When patients see the results and are invested in yeast extract, which strengthens the dermal fibroblasts to them, they are more likely to stick with their treatment programme enhance skin resistance to newly forming pigment, and and to try new treatments. When they see results, they want to contains ellagic acid to inhibit the production of melanin, achieve more.”
Aesthetics | March 2014 37 Clinical Practice Clinical Study aestheticsjournal.com
Clinical Experience using Before After the 1440nm Wavelength with SideLaze800 Delivery System for Facial Contouring
Gordon H. Sasaki, MD, FACS Professor, Loma Linda Medical University Center Clinical Protocol Private Practice: Pasadena, California USA Patients with isolated accumulation of fat to the lower third of the face and neck and mild to moderate tissue laxity were selected for Introduction laser lipolysis and tissue tightening1-3 with the 1440nm wavelength, The purpose of this white paper is to report the early experience utilising the SideLaze800 delivery system. The procedure was with the 1440nm wavelength in combination with the SideLaze800 recommended in patients without strong and apparent vertical delivery system, including a side-firing fibre for facial contouring, platysmal bands. Patient exclusion criteria included pregnancy, primarily to the lower third of the mid-face and neck. uncontrolled diabetes mellitus, collagen disorders, significant cardiovascular diseases, bleeding disorders, smokers, and those The recent implementation of the 1440nm Neodymium YAG having previous surgical procedures to the current treatment wavelength laser (Cynosure, Inc., Westford, MA), provides tissue sites within a year. All subjects were consented for their office rejuvenation in areas such as the face.1-3 The longer 1440nm procedures under local anaesthesia treatments. Subjective wavelength provides increased and localised photothermal and aesthetic assessments included the Global Aesthetic Improvement photomechanical (microbubbling) effects on fatty tissue and Scale and a patient satisfaction questionnaire at the third and collagen fibres (water), achieving 20 times more absorption in sixth month follow-up period. After pre-operative, standardised adipose tissue than the 1064nm/1320nm—and 40 times more digital photography, treatment sites were marked into one 5x5cm absorption than 924nm/980nm wavelengths.4 square, lateral to each marionette line, and into three 5x5cm squares across the entire neck. Subjects received oral pre- Laser Delivery System medication and skin preparation with povidineiodine (Betadine) The SideLaze800 delivery system allows for use of a 1440nm washes. Tumescent solution, consisting of 500mg lidocaine, 1mg wavelength through a fibre protruding 2mm from the tip of a 2mm epinephrine, and 20ml 8.4% sodium bicarbonate per litre of normal microcannula, delivering energy in a bidirectional manner. In this saline, was infiltrated into the deep and superficial subcutaneous report, the 1440nm wavelength was selected for laser lipolysis and fat layers. Lasing began about 20 minutes later to allow for shallow heating of collagen fibres (water) within the dermis and diffusion of tumescent infiltrate and maximum vasoconstriction septae. An accelerometer (SmartSense), a motion-sensing device, through two incisions, ‹1cm postlobular and ‹1cm submental. Laser was attached to the laser handpiece. This prevents excessive energy was delivered within the deep subcutaneous fat in each thermal deposition by regulating uniform energy delivery to the square. Then, liposuction with a 1.2mm cannula to the lower third treated tissues. To control tissue heating, two additional systems of the face or with a 3.2mm flat cannula to the neck removed the were employed alongside SmartSense to monitor and regulate liquefied fat and tissue debris under a vacuum pressure of 450- realtime temperatures during bilayered treatments. First, the 500mm Hg. Thirdly, shallow subdermal treatment distributed laser energy in each square, achieving the targeted skin temperature Before After of between 40-42°C. Temporary quarter inch penrose drains were inserted into each post-lobule incision site and removed within 24 hours. Compression garments with sponge inserts were applied for 7-10 days, after which a series of weekly external ultrasound treatments were administered to reduce irregularities and swelling.
Results Between September 2010 and May 2011, 12 consecutive patients ThermaGuide system recorded subdermal temperature changes (two men, ten women; 41-74 years old, mean age 53.3) were with a temperature sensor located at the tip of the cannula. It was indicated for laser lipolysis and improvement in fat contour set to an alarm temperature of 47°C, which reflected a superficial and tissue tightening at jowl and neck regions.1-3. The mean skin temperature of between 40-42°C, optimal for collagen pretreatment weight was 78.8 kg (range 46.6-103.6 kg) with a denaturation. It also later delayed tissue tightening.1-3 When the mean body mass index of 29.5 (range 20.5-36.9). At the third and local temperature reading exceeded the limit, the laser system sixth-month evaluation period, there was no significant change in would stop, resuming again when the temperature decreased the baseline weights and body mass indices. An average of 200ml below 47°C, or when the laser fibre was moved to cooler of tumescent solution (range 125-280) was infiltrated into the deep temperature areas. Second, an infrared thermal camera (FLIR and superficial subcutaneous layers within the lower third of the ThermCAM E45, Niceville, Florida) was used to obtain continuous face and the entire neck. This total volume was equal to about 30- skin temperatures between 40-42°C and ensure a uniform, real- 50ml within each 5x5cm square. Within the deep subcutaneous time delivery of heat via a depiction of a confluent orange-red fat in each square, the delivered energy ranged from 6-10 watts at colouration within each treatment site.
38 Aesthetics | March 2014 chromogenex TM
COME AND SEE US AT STAND 35
The world’s rst Super Fast Pulse 585nm laser for in ammatory skin conditions
Introducing the world’s rst Super Fast Pulse 585nm laser, Safe, fast and e ective a major advancement in the treatment of in ammatory 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 Clinical Study aestheticsjournal.com
25 Hz, averaging 695 joules per 5x5cm square (range 500-1044 joules per 5x5 Conclusion cm square). The endpoints of treatment were determined when: (1) the average The incorporation of the 1440nm wavelength number of joules was between 500-700 per square, (2) the ThermaGuide delivered through a side-firing fibre, SideLaze800, temperature consistently measured around 47°C whereas skin temperatures achieved effective laser lipolysis and tissue measured between 38-42°C, and (3) there was increased ease of passing tightening through coagulation for facial contouring the firing laser fibre through the tissues. Depending on preoperative findings, in 12 patients who presented fat accumulation in liposuction removed between 50-125ml aspirate, of which about 55% per volume the lower third of the face and neck. Most of these consisted of fat. Shallow subdermal heating distributed an average of 285 joules patients exhibited moderate degrees of tissue laxity per 5x5cm square (range 250-400 joules per 5x5cm square) at 1-5mm below the and sagging. Photographic analyses and positive dermis. The total average joules (deep and superficial) delivered per patient was responses from Global Aesthetic Improvement Scale roughly 5565 joules, which translated to about 1030 joules per 5x5 cm square. indicated that the 1440nm wavelength achieved high Because elevated skin temperatures returned to baseline levels within two to thermal absorption within fat and collagen (water), five minutes after termination of shallow lasing, the skin was re-challenged with which led to laser-assisted lipolysis and collagen additional lasing to temperatures between 38-42°C for possible increased tissue denaturation, and progressive tissue tightening* by tightening through tissue coagulation1-3, based on clinical findings. The quarter three to six months. The combination of the 1440 nm inch penrose drains were removed within 24 hours to facilitate drainage of wavelength, SideLaze800 side-firing fibre, and the residual fluids. The surgical time averaged about one hour (range 45-75 minutes), thermal-control systems provided a safer and more with postoperative recovery less than an hour. Compression garments were worn effective means for facial contouring. Further studies for another 10 days to prevent any incidence of seroma formation. are needed to validate these initial findings.
Outcomes And Side Effects REFERENCES Patients were very satisfied with their results, especially regarding the definition 1. Gordon H. Sasaki and Ana Tevez, ‘Laser-Assisted Liposuction of their mandibular-neck outlines with reduction of the pre-jowls and submental for Facial and Body Contouring and Tissue Tightening: a 2 fullness. The incidence of bruising and swelling was low and resolved completely Year Experience with 75 Consecutive Patients’, Seminars in within two weeks. No patients developed hematomas, sensory or motor nerve Cutaneous Medicine and Surgery, 28(4) (2009), 226-235. injuries, striations, blisters or dyschromias after dual layers of treatment. Three 2. Gordon H. Sasaki, ‘Quantification of Human Abdominal patients developed small fibrous nodules within the subcutaneous fat in the Skin Tightening and After Component Treatments with neck, which resolved within six weeks with post-operative ultrasound treatments. 1064nm/1320nm Laser-Assisted Lipolysis: Clinical Implications’, Post-operative discomfort was mild to moderate, with patients using analgesic Aesthetic Surgery Journal/The American Society for Aesthetic products such as extra-strength acetaminophen or lowest doses of hydrocodone/ Plastic Surgery, 30(2) (2010), 239-245. 3. Gordon H. Sasaki, ‘The Significance of Shallow Thermal acetaminophen. Most patients were able to resume their levels of pre-surgical Effects from 1064/1320nm Laser on Collagenous Fibrous activities within two weeks. There were no unanticipated significant adverse Septae and Reticular Dermis: Implications for Remodeling events. Patients experienced about an 80% improvement by three months, and Skin Tightening’ (unpublished White Paper, Loma Linda with progressive tissue tightening* and contouring thereafter until six months. Medical University Center Private Practice, 2009) Patients were asked to evaluate their overall satisfaction at three and six months 4. Francis A. Duck, Physical Properties of Tissue (San Diego: after treatment on a five-point scale (0, worse; 1, no change; 2, mild; 3, moderate; Academic Press, 1990), pp. 320 -328. 4, excellent). The mean score at three months was 2.5 with improvements in 5. Gordon H. Sasaki, Ana Tevez and Marcella Gonzales, fat reduction and tissue laxity. The mean score at six months increased to 3.5 ‘Histological Changes after 1440nm, 1320nm and 1064nm with continued progressive definition through tissue tightening. Ultrasound Wavelength Exposures in the Deep and Superficial Layers imaging and measurements from one patient taken pre and three months of Human Abdominal Tissue: Acute and Delayed Findings’ post SideLaze800 treatment, represented intensity change of the dermis with (unpublished White Paper, Loma Linda Medical University enhanced collagen depositions from 1.40mm pre to 1.81mm three months post- Center Private Practice, 2010) treatment. This represents an increase in skin thickness of 29%. All patients said 6. J. I. Youn, ‘Ablation Efficiency Measurements for Laser- they would recommend the procedure to others. Assisted Lipolysis Using Optical Coherence Tomography’ (unpublished White Paper, Lutronic Corporation, 2009) Discussion Using the side-firing 1440nm wavelength produces selective fat destruction and Gordon H. Sasaki, MD, FACS collagen denaturation in septal and dermal structures for eventual tightening Professor, Loma Linda Medical University Center through coagulation.5 A Monte Carlo simulation study6 with three different Private Practice: Pasadena, California USA wavelengths (1064nm, 1320nm, and 1440nm) demonstrated that the 1440nm Ana Tevez, Surgical RN wavelength produced the highest fat and dermal tissue ablation efficiency, with Pasadena, CA. USA minimal localisation of heat over depth. A recent study5 on the acute and delayed Connie Ha, LVN histological changes after 1440nm, 1320nm and 1064nm wavelength exposures in Pasadena, CA. USA the deep and superficial layers in human abdominal tissue, confirmed the Monte Erica Lopez Ulloa, CST Carlo simulation observations. The present clinical experience demonstrated Pasadena, CA. USA persistence of clinical benefits at six months in all patients by objective and Chelsea Knutson, CST subjective analyses. Adverse events were limited to transient swelling and Pasadena, CA. USA bruising, the severity of which was mild and completely resolved by two to Margaret Gaston, three weeks. Treatment burns were not observed because the internal and skin Computer Analyst temperatures were monitored in real time. Pasadena, CA. USA
40 Aesthetics | March 2014 THE UNIQUE MULTI SOURCE PHASE CONTROL RADIOFREQUENCY SYSTEM A NEW WAVE IN CLINICAL PERFORMANCE FIRMER
TIGHTER
LIFTED
LIFTED
YOUNGER LOOKING SKIN TIGHTER TIGHTER THE NEW
EndyMedPRO™ the complete upgradable DESKTOP
multi-applicator platform PLATFORM
3DEEP® Skin Tightening, Firming, Lifting & Contouring FIRMER FIRMERFace (including peri-orbital & oral areas), jawline, jowls, neck, décolleté, body: arms, knees, tummy, bottom, thighs, flanks 3DEEP® Fractional Skin Resurfacing & Skin Tightening EMONS Face, neck, décolleté D TR IC A N T ® I I NEW 3DEEP Intensif™ RF Microneedle Skin Remodelling O L
* N of Deep Lines, Stretchmarks, Scarring C MAKE SURE MAKE SURE
S
N Face, neck, décolleté, body
I YOU CONSIDER YOU CONSIDER ENDYMED™! ENDYMED
After nearly 3 years experience with EndyMed™ 3DEEP® skin tightening C and fractional resurfacing we are delighted with the results of our O S COME AND SEE N T T U treatments for facial skin tightening and body skin tightening and US AT STAND 56 A C cellulite. Our patients love their treatment sessions and always look forward to the next! MR CHRIS INGLEFIELD London Bridge Plastic Surgery & Aesthetic Clinic
Having seen the results from our patients, the FOR FURTHER DETAILS SCIENTIFIC & CLINICAL INFORMATION EndyMed™ consistently outperforms all other non-surgical, skin tightening systems on the market. 0800 0195 322 DR D MAINI Zenith Cosmetic Clinics [email protected] ENDYMED.AESTHETICARE.CO.UK @aestheticareuk facebook.com/aestheticareuk
© AesthetiCare® 2014 6468.2/02.14 *Intensif RF Microneedle handpiece only available with the EndyMedPRO platform.
6468 EndyMed Advert Jan 14.indd 1 12/02/2014 16:58 Clinical Practice Spotlight On aestheticsjournal.com
of the spray included 20 patients aged 26-52 years.1 After a redermalisation procedure, Daily DeLux Hyalual Daily Hyalual spray was used at the final stage to reduce intensity of pain, severity of oedema and erythema. A control group of 20 patients aged 28-52 years did not receive post-treatment. Results showed that 30 DeLux minutes after procedure and spray application, the Dr Iryna Stewart explains the mechanisms decrease in intensity of hyperaemia was 31%, intensity and benefits of the new anti-ageing and post- of oedema reduced by 45% and severity of pain, due to potentiation of anaesthetic cream, decreased procedural restorative care spray by 46%. Three days after application, there was no pain or swelling recorded. Results of the control Most cosmetic procedures are associated
with primary damage to the epidermis and Patient A sometimes dermis, and this damage to the Patient in the control group before integrity of the skin causes an inflammatory the procedure (T0) and after 30 minutes response. Procedures in aesthetic redermalisation medicine most commonly associated with before after (T30)
epidermis damage include chemical peels, Patient B Patients were microdermabrasion, laser resurfacing, sprayed with Daily electrosurgical and laser excisions, DeLux before the procedure (T0) and cryotherapy, electrical and laser hair removal after 30 minutes redermalisation and injection techniques (redermalisation, before after (T30) mesotherapy and biorevitalisation). Hyalual Daily DeLux spray aids skin restoration group showed that there was a slower decline in the post-procedure by forming a membrane severity of symptoms, and pain persisted after 30 on the skin surface. The spray contains a minutes and after the procedure. The average score combination of 0.014% hyaluronic acid (HA), 0.071% succinic acid (SA) and water, of hyperaemia 30 minutes after procedure was 1.1, and has no conservatives or preservatives. Both active ingredients are already oedema was 0.9 and pain was 0.9, compared to 0.5, contained in body tissue and do not cause allergies or complications. 0.5 and 0.7 with use of the spray. On average, 80% of The HA in Hyalual retains epidermal moisture by forming a microfilm on the skin treated patients reported low pain level, whilst only surface, keeping moisture within the epithelium. This aids restoration after traumatic 55% of untreated patients reported low pain. Figures procedures, where transepidermal moisture loss occurs. The resulting hydration of A and B compare pre- and post-treatment photos the HA film increases the antioxidant and metabolic effects of SA. SA neutralises free of patients in the control group (A) with patients radicals, which are formed during skin traumatisation and attack cells. SA also has who used Daily Delux (B). Hyalual Daily DeLux is a an anti-bacterial and anti-inflammatory effect, providing cell mitochondria with more product only available for aesthetic specialists and energy to fight bacteria. This optimises cell metabolism and improves cell recovery. their patients. It reduces patient recovery time and Any anti-ageing or moisturising face cream will have no effect as soon as water pain, by decreasing severity of inflammation and evaporates from the skin. The use of Hyalual Daily DeLux spray builds a membrane contributing to potentiation of anaesthetic creams. on the dermis, which prevents water from evaporating and enables the effect of This helps to restore the surface of the lipid mantle, face creams to be prolonged by extending their absorption time into the skin. It accelerate healing and increase patient comfort, can therefore be recommended to patients for daily rejuvenation. Other benefits which enhances their clinic experience and improves of Hyalual include no contraindications, no staining on clothes and no effect on efficiency and quality of treatment. make up. Additionally the spray applicator provides a touch-free alternative for your patients; the spray dries after one to three minutes and there is no need to REFERENCES wipe, minimising the risk of infection. The product can be used post-procedure 1. E.A. Bardova, ‘Justification of applying the Daily DeLux with any major treatment, such as laser procedures, dermal and chemical peels, spray after invasive cosmetic procedures’ (unpublished Dermaroller, microneedling and botulinum toxin injections. Spray for three seconds clinical trial, National Academy for Postgraduate Education, continuously one minute after treatment, then repeat one to three times, each time Department of Dermatovenerology, Ukraine, 2013), p. 5. after the evaporation of the water fraction and the formation of the HA microfilm. The patient should then be advised to use the spray twice daily for up to a week Dr Iryna Stewart is after the procedure, in the morning and evening. The hydrophilic ingredients managing director of Rederm shorten recovery period and reduce appearance of erythema and oedema. It and founder of IS clinics. can also be used on patients post-acne and with burns. The spray can be used After graduating in 1998, she pre-procedure as a replacement for cling film when using Emla numbing cream or worked for 15 years in NHS, Lidocaine. Ten minutes after application of the anaesthetic cream, spray Hyalual for and has spent the last five three seconds continuously in a parallel plane to provide uniform deposition and years dedicated to aesthetic absorption. Spray again after three minutes to improve the effect: the SA attracts medicine. She specialises in skin rejuvenation Emla into the layer of the epidermis. A clinical trial investigating the effectiveness and restoration.
42 Aesthetics | March 2014 COME AND SEE US AT STAND 6 Clinical Practice Techniques aestheticsjournal.com
A growing area in aesthetics is reshaping the nose without surgery. Dr Sotirios Foutsizoglou discusses Non-Surgical Nose Reshaping
Despite the fact that rhinoplasty is the most common facial operation in aesthetic augmentation of the dorsum, definition of the tip plastic surgery - among both men and women, and overall the third most and correction of minor defects such as retracted common - it is one of the most technically difficult surgical procedures and is columella, slight asymmetry, saddle nose or quite often associated with complications and poor aesthetic results. Over the pollybeak deformity. Fillers offer a safe alternative last few years non-surgical nose reshaping using dermal fillers seems to be to both primary and revision rhinoplasty when gaining popularity due to its safety profile, almost instant results and high patient there is a small area to be filled out. Although satisfaction for well selected individuals. great results can be achieved with dermal filllers, they are not comparable with those obtained by Patients seeking surgical or non-surgical nose reshaping often have dimensional surgical rhinoplasties, and this is an important issue abnormalities such as the following. to discuss with the prospective patient. In addition, • Excessive or inadequate nasal length the patient should be made aware of the fact that • Excessive or inadequate nasal tip projection repeat injections are likely to be necessary to • Excessive or inadequate radix projection maintain the result. • Congenital or acquired deformities (e.g. “saddle nose” or previous over reduction of the bony dorsum, the so-called “ski slope” appearance). Nasal Aesthetics The nose is the most prominent facial feature, Y The excessive dimensions need a surgical rhinoplasty whereas patients with particularly, on a profile view. A three dimensional EST LAN R E inadequate nasal dimensions or minor deficits in the nasal skeleton would assessment (caudal, profile, frontal view) of the N T R IO potentially be very good candidates for dermal fillers. The use of silicone and nasal osteo-cartilaginous skeleton is of paramount L E
L A I
other permanent graft materials in the nose is generally not advocated. These importance. Optimal results can only be achieved T
M M
E
tend to be unreliable and the rate of extrusion and other complications is too following a thorough evaluation of all the factors that 0
N 2
T
high to make such grafts a viable and safe option. are associated with the nasal appearance. E
20S
D
I
W
O W D R My experience with non-absorbable fillers such as Aquamid or Artecoll is limited For instance, missing frontal teeth causing inversion L and therefore I cannot advise for or against these. Fat grafting by the Coleman of the lips and accentuation of the smoker’s lines method can give good and predictable results when used to disguise visible or a retracted chin will keep distracting from facial irregularities of the underlying cartilage and bone and enlarge the nasal tip with balance even after a well corrected nasal dorsal virtually no complications or serious side effects. However autologous fat transfer asymmetry. Heritage – Over 16 year’s will inevitably prolong the procedure and make it more costly for the patient. experience in aesthetic Injectable hyaluronic acid or CaHA fillers are by far the most commonly used Other facial features affecting nasal treatments filler materials worldwide for non surgical nose reshaping. They are suitable for appearance ▪ Nasal skin Advantages and disadvantages of dermal fillers in nasal augmentation. You can achieve a better definition in a thin Superior Lifting – Firmness 1 ADVANTAGES skinned nose but a thick skin is more forgiving to that gives shape and definition potential mistakes (e.g. poor injection technique, • Ideal for those who do • Minimally invasive overcorrection), lumps and bumps formed following Lasting Effect – Clinical studies not want surgery for • Less expensive whatever reason or may injection of a filler, etc. demonstrate duration up have contraindications to • Safer ▪ Subnasale to 36 months with just two general anaesthesia • Less complications The point at which the nasal septum merges, in the maintenance treatments 2,3 • Can be used in both • Potential for reversibility midsagittal plane, with the upper lip. congenital and acquired • Minimal downtime ▪ Chin projection nasal defects When viewed in profile, an underprojected chin may • Quick treatment • Satisfactory cosmetic magnify the perceived size of the nose. • Almost instant results enhancement ▪ Contour of lips and philtrum • Only topical anaesthesia Full lips and a well defined philtrum improve the References: 1 – Edsman K et al. Dermatol Surg 2012;38:1170-1179. • Can be used in conjunction 2 – Narins RS et al. Dermatol Surg 2008;34(Suppl 1)S2-8. required 3 – Narins RS et al. Dermatol Surg 2011;37(5):644-650. with rhinoplasty surgery nasolabial angle. ▪ Malar contour DISADVANTAGES Enhancement of the malar/mid-face volume makes the nose appear smaller.
• Non permanent • Cannot correct nasal Galderma (UK) Ltd, Meridien House, 69-71 Clarendon Road, functional problems • Limited range of application Below are some measurements that can help the Watford, Hertfordshire WD17 1DS • Skin necrosis or thinning • Cannot be used when nasal inexperienced injector familiarize themselves with
reduction is required the “ideal” nasal dimensions. Galderma Switchboard: 01923 208950 Email: [email protected] RES/031/1113a For more information visit www.galderma-alliance.co.uk Date of prep: Feb 2014 44 Aesthetics | March 2014
Restylane Heritage Cosmetic News Ad 11-13 Feb 2014 v1.indd 1 12/02/2014 17:52 Restylane Heritage CosmeticNews Ad11-13Feb2014 v1.indd1
MIL 20 LIO 3 –NarinsRSetal.Dermatol Surg 2011;37(5):644-650. 2 –NarinsRSetal.Dermatol Surg 2008;34(Suppl1)S2-8. References: 1–Edsman Ketal.Dermatol Surg 2012;38:1170-1179. maintenance treatments to 36monthswithjust two demonstrate duration up Lasting Effect –Clinicalstudies that gives shapeanddefinition Superior Lifting–Firmness treatments experience inaesthetic Heritage –Over 16year’s
E 20 N ID R E W S D T
L
Y
R L
A O
N
W
E
S
T
T
R
N
E E A M T 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 2,3 1 www.galderma-alliance.co.uk
US AT STAND 58 COME ANDSEE
12/02/2014 17:52
RES/031/1113a Date of prep: Feb 2014 Clinical Practice Techniques aestheticsjournal.com
Nasal Anatomy Frontal View The supporting skeleton of the nose is composed of • Symmetry bone and hyaline cartilage (Fig. 1). The bony part of • Tip Defining Points the nose consists of nasal bones, frontal processes • Alar width of maxillae and nasal part of the frontal bone and - Equals Intercanthal distance its nasal spine. The cartilaginous part consists - Half of Interpupillary distance of five main cartilages: two lateral cartilages, two - 70% of Nasal length greater alar (or lower lateral) cartilages and a septal • Nasal length cartilage. The bony part is covered with periosteum, - 1/3 of the face which is continous with the perichondrium over the cartilaginous part. Please note that the angular Profile View branch (A) of the facial artery (F) runs along the • Dorsal Humps nasolabial fold, branching off the superior labial • Nasal Length artery (SL). The alar branch is a terminal branch of • Naso-Frontal Angle (NFA) the angular artery, which is the main feeding blood • Naso-Facial Angle (NFcA) vessel for the nasal ala. The superior labial artery • Nasolabial Angle (NLA) and the dorsal branch (D) of the supratrochlear artery (ST) communicate with the alar branch around Caudal View the nasal tip (Fig. 2). Fig. 3 shows the course of • Equilateral Triangle the angular artery and vein across the side of the • Columella:Lobule = 2:1 nose as they approach the medial canthus. Bearing • Ala (A):Lobule (L) = 1:1 this image in mind can help practitioners to avoid • Columellar Show = 2 - 4mm injecting into these important blood vessels.
TERMINOLOGY Glabella is the smooth, slightly depressed area on the frontal bone between the superciliary arches. Nasion is the intersection of the frontonasal and internasal sutures. Nasal Root or Radix is a point on the midline nasal dorsum at the level of the supratarsal folds. If a supratarsal fold is not present, then the root of the nose can be reliably measured in the midline 6mm above the inner canthus. Tip is the midline point found at the level of the Fig. 1 Fig. 2 Fig. 3 dome-projecting points of the lower lateral Injection technique cartilages. For correcting humps, augmenting the bridge or defining the dorsum of the nose I prefer using either connecting the glabella to the supratip, and by using a linear threading technique Radiesse or HA filler such as Juvederm Ultra 4. I deposit threads of about 0.1-0.2ml per injection until the desired dorsal definition VOLUMA can also be used when greater volumes and augmentation has been achieved. Please note that by increasing the are required such as in cases of westernisation of height of the dorsum, the nasofacial angle will decrease. This will lead to an a depressed bridge in an Asian nose (Fig 4). By apparent decrease in nasal tip projection. This is why I tend, almost always, to using a 27G x 0.5inch sterile hypodermic needle refine the tip with every nose reshaping procedure. My favourite form of topical (0.4x13mm) I usually start near the nasion where I anaesthesia for a non-surgical nose reshaping is application of cold packs deposit, on average, anything between 0.2-0.5ml around the injection site which, in addition to instant pain relief, will also produce over the bridge of the nose depending on the vasoconstriction minimising any swelling or bleeding. In the case of dorsal degree of the augmentation I want to achieve. I hump(s) I would apply the same technique as above with the only difference use the same size needle to inject both the nasal being that I would inject only anteriorly and posteriorly to the hump(s) trying to dorsum and tip. Moving caudally, in a straight line even out the height of the dorsum when looked at from the side.
Before After Before After
Fig. 4 Non-surgical nose augmentation Nasal dorsal augmentation with Radiesse Fig. 5 Linear threading over nasal dorsum
46 Aesthetics | March 2014
Clinical Practice Techniques aestheticsjournal.com
Dermal fillers can also help in the case of a significant nasal asymmetry such as deviated septum or nasal bone deformity. Fig 6 shows the example of a 42-year-old lady whom I treated quite recently. The patient has had two surgical rhinoplasties following an assault 10 years ago. She was left with a deviated septum, a C-shaped nasal dorsum and a bulbous tip. I injected 0.7ml of Juvederm Grade 4 across the dorsum as described above and 0.3ml in order to redefine the tip. That has resulted in the illusion of a straighter and better defined dorsum and slightly more projected tip. Fig. 6 Before and right After correction of nasal asymmetry and tip projection
Sculpturing the nasal tip The nasal tip, on lateral view, influences the refinement, inclination, length, and width of the nose. Changing the nasal tip contour will change both the apparent nasal length and dorsal height.
INDICATIONS FOR NASAL TIP REFINEMENT METHOD Fig. 8 The needle is inserted through the infratip lobule Nasal tip volume reduction Surgical Interdomal distance reduction Surgical Summary Non-surgical nose reshaping has increasingly Cranial rotation Surgical become a very popular alternative to the traditional Increasing tip projection Non-surgical / Surgical surgical rhinoplasty due to its safety, quick results Decreasing tip projection Surgical and high patient satisfaction when used for the appropriate indications. A thorough three Sound knowledge of the blood supply to the tip will allow practitioners to inject dimensional examination of the nose and application safely in this area. The superior labial artery supplies the nostril sill and the base of nasal aesthetics can guide you to a very of the columella. The columellar artery of the superior labial artery, which is a satisfactory outcome. Remember that documented substantial branch, ascends in the columella just superficial to the medial crura evaluation of all parameters that contribute to the (Fig. 7). My experience in redefining the tip lies mainly with hyaluronic acid fillers appearance of the nose such as the thickness of and therefore I cannot recommend or reject any alternative non-HA filler. the nasal skin must also be made. No matter how Dermal filler injections in the tip can be used instead of well defined the underlying osteo-carilaginous nasal • a spreader graft to restore the vault shape support skeleton may be, you may not be able to achieve between the upper lateral cartilage and the septum optimal definition of the dorsum or projection of the • a columellar graft in order to reinforce the medial crus tip in the thick skinned nose. In a future article I will and increase the nasal tip projection share my experience in using intradermal 10mg/1ml • a tip graft for tip projection and to correct the steroid injections for the thick nasal skin. Finally, proportion between the nostril and the nasal tip you can always complement a non-surgical nose thus avoiding any potential risks and complications enhancement by injecting a few units of BTX-A (i.e. associated with nasal tip surgery and general 2 units per side) in the alaeque nasi for the bunny anaesthesia. Fig. 7 lines, in the nasalis and levator alae nasi for the flaring of nostrils, and in the depressor septi nasi for Nasal tip technique the plunging tip. I insert my needle through the columella and caudal aspect of the septal REFERENCES cartilage approximately 3-5mm below the tip defining points near the infratip Foutsizoglou S and Leontsinis T. Augmentation break in a superoanterior direction. Bearing in mind the columellar arteries Rhinoplasty: A Unique technique using autograft rib I inject boluses of 0.2-0.3ml between and over the domes as far as the shavings enveloped in bovine pericardium for a more suspensory ligament of the tip. The dome is formed by the junction between natural and predictable result. Body Language Journal. the middle and lateral crura of the greater alar cartilage - some rhinoplasty Issue 46; p. 60-62. 2011 surgeons also call it lower later cartilage. Ideally the projected tip of the nose Brown DL. Borschel GH. Michigan Manual of Plastic should have a triangular appearance with its superior apex lying approximately Surgery. Lippincott Williams & Wilkins, 2004. 2 mm above the dorsum and this is what we try to recreate by injecting fillers in the dome area. This is a relatively safe area Dr Sotirios Foutsizoglou to inject as there are no end arteries other than is the founder and medical anastomoses as shown in figure 7. Finally I apply director of SFMedica. He has a lightweight aluminium external nasal splint for written for numerous UK 24 hours which molds to any shape of nose and publications and presented can be trimmed easily to adjust size, but remains at national and international rigid once applied (Fig. 9). The splint provides conferences and expert protection for the nose against trauma as well meetings. He is also the senior as preventing excessive soft tissue swelling lecturer in Facial Anatomy and trainer in non- Fig. 9 Nasal splint which may precipitate filler migration altering the surgical procedures with KT Medical Aesthetics desired shape and size. Training Group.
48 Aesthetics | March 2014 COME AND SEE US AT STAND 61 ®
LightSheer ® LightSheer™ ® Fig. 6 Before and right After correction of nasal DESIRELightSheer™ asymmetry and tip projection DESIREThe starting point to your™ success DESIREThe starting point to your success The1 LASERstarting HAIR pointREMOVAL to SYSTEM your success2 ADVANCED TECHNOLOGIES 3 HANDPIECES
1LASER HAIR REMOVAL SYSTEM 2 ADVANCED TECHNOLOGIES 3 HANDPIECES 1LASER HAIR REMOVAL SYSTEM 2 ADVANCED TECHNOLOGIES 3 HANDPIECES
Benefit from a rapid return on investment
IncreaseBenefit from your a patientrapid return satisfaction on investment Benefit from a rapid return on investment IncreaseGrow your your business patient satisfaction Increase your patient satisfaction Grow your business Grow your business
Lumenis (UK) Ltd 418 Centennial Park, Elstree Borehamwood, Hertfordshire WD6 3TN Telephone: 020 8736 4110 e-mail:Lumenis [email protected] (UK) Ltd 418 Centennial Park, Elstree LumenisBorehamwood, (UK) Ltd Hertfordshire WD6 3TN 418Telephone: Centennial 020 Park,8736 Elstree4110 Borehamwood,e-mail: [email protected] Hertfordshire WD6 3TN Telephone: 020 8736 4110 e-mail: [email protected] AESTHETIC.LUMENIS.COM
AESTHETIC.LUMENIS.COM PB-1003147 Rev A PB-1003147 AESTHETIC.LUMENIS.COM PB-1003147 Rev A PB-1003147 PB-1003147 Rev A PB-1003147 In Practice Abstracts aestheticsjournal.com
A summary of the latest clinical studies
Title: Impact of vulvovaginal atrophy on sexual health and Published: Pathogens and Disease. 2014 Jan quality of life at postmenopause. Keywords: Biofilm, soft tissue fillers, bacteria Authors: Nappi RE, Palacios S. Abstract: Injection of soft tissue fillers plays an important Published: Climacteric, 2014 Feb role in facial reconstruction and aesthetic treatments such as Keywords: Vulvovaginal, postmenopausal women, VVA cosmetic surgery for lip augmentation and wrinkle smoothening. Abstract: Vulvovaginal atrophy (VVA) or atrophic vaginitis is a Adverse events are an increasing problem and recently it has medical challenge because it is under-reported by women, under- been suggested that bacteria are the cause of a vast fraction of recognized by health-care providers and, therefore, under-treated. these. A novel mouse model was developed and hyaluronic acid More or less 50% of postmenopausal women experience vaginal gel, calcium hydroxylapatite microspheres and polyacrylamide discomfort attributable to VVA. Very recent surveys suggest health- hydrogel were evaluated for their potential for sustaining bacterial care providers should be proactive in order to help their patients infections and their possible treatments. The authors were able to to disclose the symptoms related to VVA and to seek adequate culture Pseudomonas aeruginosa, Staphylococcus epidermidis and treatment when vaginal discomfort is clinically relevant. Women Probionibacterium acnes in all three gels. When contaminated gels are poorly aware that VVA is a chronic condition with a significant were left for 7 days in a mouse model, the authors found sustainment impact on sexual health and quality of life and that effective and safe of bacterial infection with the permanent gel, less with the semi- treatments may be available. Indeed, female sexual dysfunction and permanent gel and no growth within the temporary gel. Evaluation genitourinary conditions are more prevalent in women with VVA. of treatment strategies showed that once the bacteria had settled That being so, it is very important to include VVA in the menopause (into biofilms) within the gels, even successive treatments with agenda, by encouraging an open conversation on the topic of high concentrations of relevant antibiotics were not effective. The intimacy and performing a gynaecological pelvic examination, if data substantiates bacteria as a cause of adverse reactions reported indicated. According to very recent guidelines for the appropriate when using tissue fillers, and the sustainability of these infections management of VVA in clinical practice, it is essential to overcome appears to depend on longevity of the gel. Most importantly, the the vaginal ‘taboo’ in order to optimize elderly women’s health care. infections are resistant to antibiotics once established but can be prevented using prophylactic antibiotics. Title: Recent trend in the choice of fillers and injection techniques in Asia: a questionnaire study based on expert opinion. Authors: Lee SK, Kim HS. Published: The Journal of Drugs in Dermatology, 2014 Jan Keywords: Filler injection, Asia, questionnaire Abstract: A panel of dermatologists, who are recognized as filler experts and key speakers in Korea were asked to fill out an in-depth questionnaire on fillers in 2012. The results of the 2012 questionnaire are presented and compared with the questionnaire FacialFacialMuscle injectioninjection Training M manianikins manKiKin’sin results of the exact same group of doctors in 2011. Those who OurOur extremely extremely realistic realistic injection injection manikin’smanikin are are an an participated in the questionnaire study practiced fillers for an average essentialessential aidaid for any clinic,clinic,college college or training coursecourse of 10.6 years with an average of 32.8 filler cases per week. Common indications for filler injection were midface augmentation and nose • Practice/ Demonstrate needle techniques augmentation. Indications that most drastically increased between • Perfect for reassuring delegates & customers • Use on refresher courses • Use along side live models 2011 and 2012 were midface and forehead augmentation. For the • Hand painted and very realistic in look and feel nasolabial folds, the most preferred choice of filler product, needle, • Uses include: anti-injectables - Dermal fillers- Electrolysis, injection technique and injection depth was Radiesse, 27G short laser and many more needle, layering technique and the upper subcutaneous fat layer. For filler rhinoplasty, the preferred choices were Radiesse, 27G short needle,linear threading technique and the mid-deep fatty layer. For dark circles, the favoured choices were Esthelis Basic, 30G short needle, vertical technique and the SOOF (suborbicularis oculi fat) COME AND SEE layer. For forehead augmentation, the most favoured choices were US AT STAND 25 Juvederm Voluma, 23G cannula, linear threading technique and fanning and the supraperiosteal layer.
Title: Bacterial biofilm formation and treatment in soft tissue fillers Authors: Alhede M, Er O, Eickhardt S, Kragh K, Alhede facialMUSCLEfacial injection injection TRAINING manikin’s manikinMANIKINS M, Christensen LD, Poulsen SS, Givskov M, Christensen LH, Høiby N, Tvede M, Bjarnsholt T. tel: +44 (0) 845 307 61 91 | Fax: +44 (0) 845 307 61 92 email: [email protected] | Web: www.zancomodels.co.uk
50 ACE Special Focus aestheticsjournal.com
Question Time is now free to all Aesthetics Conference Sponsored by and Exhibition attendees. lite Another reason to register FREE for ACE 2014
Over 1532 medical aesthetic practitioners have What is Question Time? already registered to attend ACE 2014, taking place Following a drinks networking reception, delegates will have the opportunity to at the Business Design Centre on March 8-9. observe and participate with a panel of industry figures, and discuss important topics affecting the medical aesthetic profession. Professional press will also Now, in addition to an exhibition of over 100 attend this important event. premium aesthetic suppliers and access to a huge programme of complimentary business workshops, Want to ask a question? clinical demonstrations and masterclasses, Audience members can submit their questions online now; so If you would like attendees will receive FREE entry to the evening to know what the implications of the Keogh report will be, how the CEN standard Question Time. Our thanks to Question Time will affect you, or you have another important question you would like to ask the sponsors 3D-lipo and their 3D-lipolite programme panel, submit your question today. for making this possible. Visit www.ace2014.co.uk
The Question Time Panel
Peter Sissons - Chair Dr Andrew Vallance-Owen Formerly a news presenter for ITN Dr Andrew Vallance-Owen is the and BBC News, Mr Sissons was a former medical director of Bupa broadcast journalist for 45 years and a member of Sir Bruce Keogh’s before retiring from the BBC in 2009. Cosmetic Interventions Review team.
Dr Leah Totton Dr Mike Comins After completing her Bachelor of Dr Comins is president and fellow Medicine and Bachelor of Surgery, of the British College of Aesthetic Dr Totton went on to win the 9th Medicine and head of the ACE series of The Apprentice in July 2013. steering committee.
Dr Tracy Mountford Sharon Bennett Dr Mountford is the founder and medical Sharon is currently vice chair of the director of The Cosmetic Skin Clinic with British Association of Cosmetic Nurses clinics in both Buckinghamshire and (BACN) and also the UK lead on the London Harley Street. BSI/CEN Committee.
Mr Dalvi Humzah Dr Martyn King Mr Humzah was a consultant plastic Dr Martyn King is the owner and surgeon in the NHS for 15 years and director of Cosmedic Skin Clinic has maintained a plastic surgery private and medical director of Cosmedic practice for over 10 years. Pharmacy.
Book Now The Aesthetics Conference and Exhibition 2014 is just weeks away but you can still register for your FREE place today. Call 01268 754 897 or visit the website www.ace2014.co.uk
52 Aesthetics | March 2014 In Practice HR aestheticsjournal.com
Other parts of the handbook will not be contractual and will consist of employment policies, which may be subject to change in order to comply with legal updates and general business changes. Although it is never easy to predict the range of issues you, as a business owner, will face, it is almost a certainty that if you employ people, you will be required to deal with absence and questions about holiday entitlement and allowances.
Since there are a range of laws in the UK which provide protection and rights for various sections of society in relation to different types of absences (pregnancy related absence, sickness Managing absence, holidays etc) it is crucial that you have a process in place which enables your business to maintain consistency in the management of absence and also offers the opportunity to establish the reasons for absence in each staff absence individual case. Employers can request ‘fit notes’ from an employee’s doctor if they have been Employment law specialist Vanessa Di Cuffa continually off sick for seven days or more. On the occasion where a fit note states an employee explains the importance of setting out rules for may actually be fit for work, employers may need holiday and sick leave entitlement for employees to discuss wider occupational health issues with the employee. Changes to working hours Managing employees and staff is arguably one of the hardest aspects of or level of responsibility held by an employee running a business. And if you are a small business owner, you are unlikely could be amended to encourage an employee to have a dedicated resource to deal with employee issues. Certain rules are to return to work. These changes should be essential in any business because they ensure compliance with the various laws discussed with the employee in detail to ensure that we are all bound by, as well as providing clarity and certainty for managers a suitable solution can be made. In the event that and employees on how to deal with routine scenarios that might occur. By an employee is unable to return to work or do always following the same set of rules that have been clearly outlined to staff, their job or any other job on account of illness, a you provide consistency of approach, which will help to safeguard your business capability process may need to be implemented. against being sued. If an employee is unable to do the job they are employed to do and/or there are no alternatives, The policies that are most vital are in relation to discipline and grievance an employer may have to manage the employee processes. The ACAS Code of Practice provides basic practical guidelines for out of the business through a capability process. employers and employees to ensure policies on disciplinary and grievance in Legal advice should be taken in respect of how the workplace are outlined effectively. Acting promptly and consistently with all this could be done. employees at the time of any issue is vital in maintaining relationships within the business. Employers must be seen to carry out necessary investigations on any Pinpointing the reason for absence is critical issues that arise in order to establish the facts and make informed actions. It is in determining the process that may follow. important to note that failing to comply with the Code does not, in itself, make For example, you need to ask if the absence a person or organisation liable to proceedings. However, employment tribunals is related to sickness, a child being sick, an do take the Code into consideration when assessing cases. Despite this, both emergency, bereavement, or is it not attributable parties should always seek to resolve disciplinary and grievance issues within to anything and therefore unauthorised? The law the workplace by encouraging an open communication culture and following the affords different levels of protection depending appropriate policies and guidance from an expert. on what the reason for absence is. Managing the absence correctly is important to reduce the As your business grows, your bank of policies will most likely expand. Regular risk to the business if an individual challenges policies I might recommend include: health and safety, company car use, the process and threatens to sue. The rights expenses, study leave, flexible working, maternity, paternity and adoption leave, afforded to individuals who are deemed disabled, stress at work, equal opportunities, bullying and harassment and whistle blowing, in the legal sense of the word, are complex: the but this is by no means an exhaustive list. management of a disabled employee requires proper consideration and an element of flexibility Some businesses choose to place these rules or at least a summary of them in on the part of an employer, in order to assist and a staff handbook, parts of which may be deemed to be contractual. Detail in the help the employee to feel at ease to work. handbook may expand on the rights set out in employment contracts. When an employee books a holiday, a clear set
54 Aesthetics | March 2014 In Practice aestheticsjournal.com HR
of rules outlining the process from their employer means that the nature of what you do and the type of people you employ. difficult conversations can sometimes be averted because the Look on the ACAS website for guidance but generally it is matters are set out in a policy. Your business may have peak always best to consult a lawyer or HR professional. periods and you would be entitled to set out in a policy whether Remember the more policies you have, the more you have to there are periods or days that holiday cannot be taken. It may keep up-to-date. Having a policy does not rule out the ability to specify whether there is a limit on the time you take and a limit exercise discretion and make exceptions but in the key areas, on the number of people who can be off at one time. such as absence and holiday, it is always sensible for you and your staff to have clear rules and to follow them. This will Holiday entitlement and working bank and public holidays reduce the risk of allegations against owners and managers of always creates confusion and emotion. If your business works discrimination based on sensitive and difficult issues. Sound, bank holidays, this must be clear in the contract and policy. professional advice can establish quickly what will and what If you want to shut your entire business down for a specific won’t be appropriate for your business, and experience and period each year, for example, at Christmas or during a exposure to the issues you may face will ensure that you get particularly quiet period, then set it out in a policy. According the appropriate policies to suit your business. to Gov.uk, holiday entitlement for those who work a five-day week is 28 days paid annual leave. However, self-employed Vanessa Di Cuffa Is an employment workers, which are common amongst the small business partner specialising in employment law community, aren’t entitled to annual leave at all. Whether and HR at the Birmingham office of law employees are full-time or part-time, and whether they have firm Shakespeares. Vanessa advises on irregular or flexible working hours will determine the level all aspects of employment law and HR of leave eligible to individuals, but it is important to ensure across sectors including medical, ranging all employees on the same contracts are offered the same from small SMEs to large corporate holiday entitlement in order to avoid employee unrest in the organisations. She is commercially focused, providing you workplace. with real solutions.
It really is not advisable to have the full range of ‘A-Z’ of REFERENCES possible policies. You simply need what is relevant to your 1) http://www.acas.org.uk/\ business and the complexity of the policy will be dependent on 2) https://www.gov.uk/holiday-entitlement-rights
ADVANCED PAIN FREE IPL WITH RF MANUFACTURED IN ISRAEL
Adare Aesthetics Ltd 26 Fitzwilliam Square South Dublin 2 Ireland COME AND SEE US AT STAND 44 M: +353 (0) 85 711 7166 T: +353 (0) 1 676 9810 Mobile UK: +44 07492 070522 E: [email protected] W: www.adareaesthetics.com £18,900 + VAT Contact us today for more details!
In Practice Digital Strategy aestheticsjournal.com 5 Ways to boost your online presence
John Castro explains how employing simple online strategies can grow your business
The world has changed. The way consumers spend money, access information, build trust; the way they do just about everything has changed. Why? The digital economy. The emergence and huge growth of social networks and mobile devices has allowed us to access anything, anywhere, anytime we want it and all with our smart phones. Recent research even suggests that 2014 is the year we will see 50% of internet search originating from mobile devices. It is clear there is a wealth of information available, with new technologies and social networks launching every day. However, using these platforms can be a confusing arena, especially for someone for whom this is a new experience. Here, I’ve outlined five simple strategies to improve your online presence and thus boost your sales.
1. FIND TIME regular. However, don’t forget the importance of being personal and You may already feel as though there aren’t enough hours in the day relevant. You should make sure you also post in response to current to accomplish all that you need to, but if you’re not willing to dedicate affairs and reply to others’ comments. some time each week then you will struggle to boost your online presence. Consistency is key. Set up a schedule and stick to it; two to 4. UPDATE YOUR WEBSITE three hours a week will be sufficient. Putting this time aside regularly to If you had your website designed over three years ago, it is more help increase enquires and appointments for your clinic is truly a must than likely already dated and not mobile responsive. The goal of for an effective digital strategy. most websites is to get visitors to the content they seek as quickly as possible. A simple, intuitive design is the best way to accomplish 2. CONTENT IS KING, BUT CONTEXT IS GOD that and fewer page elements are key to this. Keep focus on the Frequent content additions to your website such as blogging ultimate outcome, whether it’s a phone call, email enquiry, or sale. and news letters are certainly the easiest way to engage visitors Work with a web designer to clean up your site and make sure they and send out new information regularly. However, be sure to be know and understand your intended client base. It is your design selective and relevant.. Your content should be something of interest and user interface that will help your home page generate more to your readers and potential patients, the last thing they will want is enquires for you. just more junk email. Quick tip: Replication is the easiest way to get results fast. This Quick tip: Write about more than one new treatment including ones does not mean copy, it means finding out what design techniques you don’t even provide. This may seem counter-intuitive but will others use to generate enquires and utilising these. Doing your gain trust and ensures your readers that you genuinely care for their research and using a web agency that understands this is key. wellbeing and that you are not only concerned with sales. 5. GOOGLE, GET INVOLVED 3. SOCIAL MEDIA I strongly encourage you to make use of Google’s free marketing You may feel that you have heard this before but that’s because it tools, such as Google Local and Google Plus (their social network). is of paramount importance to the success of your online presence Set yourself up a Google Plus profile and a Google Plus Business and thus potential sales. However, social media can be daunting. Page and work it like you do other social networks. The more you Here are some tips to get you started are active with Google products and platforms, the more Google Be consistent. If you are going to build attention on social media will value your website as an authority and therefore the higher you make sure you are regularly distributing content. But remember are likely to rank in a search. quality information and content, no rubbish or you may find that These five simple tips will help you to boost your online presence. your audience dwindles. If you are consistent, patient and get on board with this ever- Be patient. Social media is a marathon not a sprint. Your goal is growing digital economy then you will soon see the returns in both to build an audience by providing quality content and information new enquiries and a loyal and engaged customer base. that captures attention so that when you post your services and start to sell to them, they trust you and are more likely to book an USEFUL WEBSITES appointment. http://www.google.co.uk/business/placesforbusiness Be personable. Do not be afraid to be you when posting and sharing; do not follow the crowd. People buy people and you are John Castro is the founder not going to attract everyone. Your ideal clients are those who you and director of Websites For genuinely engage with. It is those who become patients forever, Cosmetics, the only web agency and it those who recommend you to others, thus expanding your that solely and exclusively works customer base. with the medical aesthetic and Be organised. You should plan your social media activity in advance cosmetic surgery industry. each week. This will save you time and help you to keep your posts
56 Aesthetics | March 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 † *
COME AND SEE US AT STAND 80
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 Finance aestheticsjournal.com Maximising your cash flow READY • AUTHENTIC • MY BUSINESS
Kurt Won explains the importance of close control and understanding your business’ finances
The Common Myth: “If I’m a great practitioner, my payments, or going into unauthorised overdraft limits. For example, one of my business is guaranteed to be a success,” clients discovered that a particular month-end was going to end in a large deficit, Being a fantastic practitioner certainly helps to so we focused their team on generating new sales and collecting outstanding attract new patients and retain existing ones. payments from their clients, which saved my client hundreds of pounds in bank However, it does not guarantee the financial and overdraft charges. sustainability of your business. The future of your 2) Manage your accounts receivable and accounts payable business depends on your ability as the business In your aesthetics business, there should not be a great deal of accounts owner to manage cash flow, and essentially receivable (patients who owe you money) but patients may be paying for increase revenue and reduce expenses. Many treatments in instalments. Make a conscious effort to keep track of these clearly people shy away from taking responsibility for their and to chase your patients for those remaining payments. finances: they stick their head in the sand and wait Accounts payable is the money you owe to suppliers. If your supplier has kindly for their accountant to tell them the state of their given you terms on your invoice, e.g. ‘30 days to pay’, ensure you schedule finances at month-end or quarter-end. Having a the date of the payment into your cash flow projection report so that you pay bookkeeper and an accountant on your team is of it on time. Paying on time will help build trust and a good credit score with course vital, but it is even more important for you to your supplier, which will help if you need to negotiate for extended payment be comfortable looking at the numbers. Numbers terms. Successfully extending payment terms to 60 or 90 days will benefit your don’t lie and having a clear idea of the timing of business considerably. Failing to make payments on time could mean payment cash coming in and going out will help you make terms or credit lines being revoked: avoid this at all costs. better business decisions. 3) Get into the habit of putting money away I’ve set out some simple but effective ways to help It’s important to strategically re-invest money into the business. Have sub- you take better control of your cash flow: accounts where you can divert a percentage of your money coming in every 1) Ask your bookkeeper or accountant to prepare week or month. Your bank can easily create a long-term savings account if a weekly cash flow projection, which will use the you are thinking of investing in new equipment, premises or even staff. It’s also following formula: advisable to create sub-accounts for tax and payroll. Speak to your accountant Step 1: Note down your bank balance at the start of about how much you can and should be putting away every week or month to Bocouture® 50 Abbreviated Prescribing Information Please refer to the Summary of Product result in pronounced neuromuscular paralysis distant from the injection site. Symptoms are not the week (W) meet your future obligations. Your ultimate target as a good business owner ® Characteristics (SmPC). Presentation 50 LD50 units of Botulinum toxin type A (150 kD), free from immediately apparent post-injection. Bocouture may only be used by physicians with suitable complexing proteins as a powder for solution for injection. Indications Temporary improvement in qualifications and proven experience in the application of Botulinum toxin. Legal Category: Step 2: Calculate how much money is due to come should be to get the business to a position which operates on 70-75% of the the appearance of moderate to severe vertical lines between the eyebrows seen at frown (glabellar POM. List Price 50 U/vial £72.00 Product Licence Number: PL 29978/0002 Marketing Authorisation into your business that week (X) money that comes into its bank account, so the remaining 25-30% goes into a frown lines) in adults under 65 years of age when the severity of these lines has an important Holder: Merz Pharmaceuticals GmbH, Eckenheimer Landstraße 100, 60318 Frankfurt/Main, Germany. psychological impact for the patient. Dosage and administration Unit doses recommended Date of revision of text: FEB 2012. Full prescribing information and further information is available Step 3: Work out what expenses (including payroll) contingency or long-term investment account. Don’t worry if you can’t put 25% of for Bocouture are not interchangeable with those for other preparations of Botulinum toxin. from Merz Pharma UK Ltd., 260 Centennial Park, Elstree Hill South, Elstree, Hertfordshire WD6 3SR. Reconstitute with 0.9% sodium chloride. Intramuscular injection (50 units/1.25 ml). Standard dosing Tel: +44 (0) 333 200 4143 are due to be paid out of the account (Y) your money away straight away. is 20 units; 0.1 ml (4 units): 2 injections in each corrugator muscle and 1x procerus muscle. May Step 4: Calculate your projected bank balance using 4) Prepare and review monthly management reports be increased to up to 30 units. Not recommended for use in patients over 65 years or under 18 Adverse events should be reported. Reporting forms and information can be found years. Injections near the levator palpebrae superioris and into the cranial portion of the orbicularis at www.mhra.gov.uk/yellowcard Adverse events should also be reported to Merz Pharma UK Ltd this formula: At a minimum, ask your accountant or bookkeeper to prepare detailed, monthly oculi should be avoided. Contraindications Hypersensitivity to Botulinum neurotoxin type A or to at the address above or by email to [email protected] or on +44 (0) 333 200 4143. any of the excipients. Generalised disorders of muscle activity (e.g. myasthenia gravis, Lambert- Beginning week bank balance + Projected revenues profit and loss statements for you to review with them or with a business advisor. Eaton syndrome). Presence of infection or inflammation at the proposed injection site. Special warnings and precautions Should not be injected into a blood vessel. Not recommended for 1. Frevert J. Content in BoNT in Vistabel, Azzalure and Bocouture. Drugs in R&D 2010-10(2), 67-73 – Projected Expenses = End of Week Cash Balance Don’t be afraid to ask them to explain what the numbers in your financial patients with a history of dysphagia and aspiration. Adrenaline and other medical aids for treating 2. Prager, W et al. Onset, longevity, and patient satisfaction with incobotulinumtoxinA for the W + X – Y = Z statements and management reports mean. It helps to see each month’s anaphylaxis should be available. Caution in patients receiving anticoagulant therapy or taking other treatment of glabellar frown lines: a single-arm prospective clinical study. Clin. Interventions substances in anticoagulant doses. Caution in patients suffering from amyotrophic lateral sclerosis in Aging 2013; 8: 449-456. Being aware of your projected end of week revenues and expenses in one spreadsheet, so that you can spot trends or or other diseases which result in peripheral neuromuscular dysfunction. Too frequent or too high 3. Sattler, G et al. Noninferiority of IncobotulinumtoxinA, free from complexing proteins, compared dosing of Botulinum toxin type A may increase the risk of antibodies forming. Should not be used with another botulinum toxin type A in the treatment of glabelllar frown lines. Dermatol Surg 2010; balance will help you to make decisions quicker. anomalies in how your money is being made and spent. The more frequently you during pregnancy unless clearly necessary. Interactions Concomitant use with aminoglycosides 36: 2146-2154. For example, deciding how many products or review your numbers, the quicker you can make decisions and adjustments in or spectinomycin requires special care. Peripheral muscle relaxants should be used with caution. 4. Prager W, et al. Botulinum toxin type A treatment to the upper face: retrospective analysis of daily 4-aminoquinolines may reduce the effect. Undesirable effects Usually observed within the first week practice. Clin. Cosmetic Invest Dermatol 2012; 4: 53-58. consumables you can order from your supplier. If the your business and the more empowered you will feel as a business owner. after treatment. Localised muscle weakness, blepharoptosis, localised pain, tenderness, itching, 5. Data on File: BOC-DOF-11-001_01 swelling and/or haematoma can occur in conjunction with the injection. Temporary vasovagal Bocouture® is a registered trademark of Merz Pharma GmbH & Co, KGaA. end of week balance was projected to be negative, reactions associated with pre-injection anxiety, such as syncope, circulatory problems, nausea is the CEO and co-founder of SalesPartners 1134/BOC/NOV/2013/LD Date of preparation: November 2013 you have advanced warning of how many more Kurt Won or tinnitus, may occur. Frequency defined as follows: very common (≥ 1/10); common (≥ 1/100, < UK (www.salespartnersuk.com), a multi-award 1/10); uncommon (≥ 1/1000, < 1/100); rare (≥ 1/10,000, < 1/1000); very rare (< 1/10,000). Infections products or treatments you or your staff need to and infestations; Uncommon: bronchitis, nasopharyngitis, influenza infection. Psychiatric disorders; winning business consultancy that has helped over Uncommon: depression, insomnia Nervous system disorders; Common: headache. Uncommon: facial sell to cover the deficit. If you have a contingency paresis (brow ptosis),vasovagal syncope, paraesthesia, dizziness. Eye disorders; Uncommon: eyelid 850 business owners and entrepreneurs in the past four oedema, eyelid ptosis, blurred vision, eye disorder, blepharitis, eye pain. Ear and Labyrinth disorders; fund, you will be aware of when to transfer money years to make and keep more money by driving sales, Uncommon: tinnitus. Gastrointestinal disorders; Uncommon: nausea, dry mouth. Skin and into your current account. The worst position to be subcutaneous tissue disorders; Uncommon: pruritus, skin nodule, photosensitivity, dry skin. increasing profitability and building championship Musculoskeletal and connective tissue disorders; Common: muscle disorders (elevation of in is being caught unaware of a potential negative business teams. He has spoken at various aesthetic and eyebrow), sensation of heaviness; Uncommon: muscle twitching, muscle cramps. General disorders and administration site conditions Uncommon: injection site reactions (bruising, pruritis), balance and being charged for returned direct debit beauty conferences. tenderness, Influenza like illness, fatigue (tiredness). General; In rare cases, localised allergic reactions; such as swelling, oedema, erythema, pruritus or rash, have been reported after treating vertical lines between the eyebrows (glabellar frown lines) and other indications. Overdose May 58 Aesthetics | March 2014 READY • AUTHENTIC • MY BUSINESS
Bocouture® 50 Abbreviated Prescribing Information Please refer to the Summary of Product result in pronounced neuromuscular paralysis distant from the injection site. Symptoms are not ® Characteristics (SmPC). Presentation 50 LD50 units of Botulinum toxin type A (150 kD), free from immediately apparent post-injection. Bocouture may only be used by physicians with suitable complexing proteins as a powder for solution for injection. Indications Temporary improvement in qualifications and proven experience in the application of Botulinum toxin. Legal Category: the appearance of moderate to severe vertical lines between the eyebrows seen at frown (glabellar POM. List Price 50 U/vial £72.00 Product Licence Number: PL 29978/0002 Marketing Authorisation frown lines) in adults under 65 years of age when the severity of these lines has an important Holder: Merz Pharmaceuticals GmbH, Eckenheimer Landstraße 100, 60318 Frankfurt/Main, Germany. psychological impact for the patient. Dosage and administration Unit doses recommended Date of revision of text: FEB 2012. Full prescribing information and further information is available for Bocouture are not interchangeable with those for other preparations of Botulinum toxin. from Merz Pharma UK Ltd., 260 Centennial Park, Elstree Hill South, Elstree, Hertfordshire WD6 3SR. Reconstitute with 0.9% sodium chloride. Intramuscular injection (50 units/1.25 ml). Standard dosing Tel: +44 (0) 333 200 4143 is 20 units; 0.1 ml (4 units): 2 injections in each corrugator muscle and 1x procerus muscle. May be increased to up to 30 units. Not recommended for use in patients over 65 years or under 18 Adverse events should be reported. Reporting forms and information can be found years. Injections near the levator palpebrae superioris and into the cranial portion of the orbicularis at www.mhra.gov.uk/yellowcard Adverse events should also be reported to Merz Pharma UK Ltd oculi should be avoided. Contraindications Hypersensitivity to Botulinum neurotoxin type A or to at the address above or by email to [email protected] or on +44 (0) 333 200 4143. any of the excipients. Generalised disorders of muscle activity (e.g. myasthenia gravis, Lambert- Eaton syndrome). Presence of infection or inflammation at the proposed injection site. Special warnings and precautions Should not be injected into a blood vessel. Not recommended for 1. Frevert J. Content in BoNT in Vistabel, Azzalure and Bocouture. Drugs in R&D 2010-10(2), 67-73 patients with a history of dysphagia and aspiration. Adrenaline and other medical aids for treating 2. Prager, W et al. Onset, longevity, and patient satisfaction with incobotulinumtoxinA for the anaphylaxis should be available. Caution in patients receiving anticoagulant therapy or taking other treatment of glabellar frown lines: a single-arm prospective clinical study. Clin. Interventions substances in anticoagulant doses. Caution in patients suffering from amyotrophic lateral sclerosis in Aging 2013; 8: 449-456. or other diseases which result in peripheral neuromuscular dysfunction. Too frequent or too high 3. Sattler, G et al. Noninferiority of IncobotulinumtoxinA, free from complexing proteins, compared dosing of Botulinum toxin type A may increase the risk of antibodies forming. Should not be used with another botulinum toxin type A in the treatment of glabelllar frown lines. Dermatol Surg 2010; during pregnancy unless clearly necessary. Interactions Concomitant use with aminoglycosides 36: 2146-2154. or spectinomycin requires special care. Peripheral muscle relaxants should be used with caution. 4. Prager W, et al. Botulinum toxin type A treatment to the upper face: retrospective analysis of daily 4-aminoquinolines may reduce the effect. Undesirable effects Usually observed within the first week practice. Clin. Cosmetic Invest Dermatol 2012; 4: 53-58. after treatment. Localised muscle weakness, blepharoptosis, localised pain, tenderness, itching, 5. Data on File: BOC-DOF-11-001_01 swelling and/or haematoma can occur in conjunction with the injection. Temporary vasovagal Bocouture® is a registered trademark of Merz Pharma GmbH & Co, KGaA. reactions associated with pre-injection anxiety, such as syncope, circulatory problems, nausea 1134/BOC/NOV/2013/LD Date of preparation: November 2013 or tinnitus, may occur. Frequency defined as follows: very common (≥ 1/10); common (≥ 1/100, < 1/10); uncommon (≥ 1/1000, < 1/100); rare (≥ 1/10,000, < 1/1000); very rare (< 1/10,000). Infections and infestations; Uncommon: bronchitis, nasopharyngitis, influenza infection. Psychiatric disorders; Uncommon: depression, insomnia Nervous system disorders; Common: headache. Uncommon: facial paresis (brow ptosis),vasovagal syncope, paraesthesia, dizziness. Eye disorders; Uncommon: eyelid oedema, eyelid ptosis, blurred vision, eye disorder, blepharitis, eye pain. Ear and Labyrinth disorders; Uncommon: tinnitus. Gastrointestinal disorders; Uncommon: nausea, dry mouth. Skin and subcutaneous tissue disorders; Uncommon: pruritus, skin nodule, photosensitivity, dry skin. Musculoskeletal and connective tissue disorders; Common: muscle disorders (elevation of eyebrow), sensation of heaviness; Uncommon: muscle twitching, muscle cramps. General disorders and administration site conditions Uncommon: injection site reactions (bruising, pruritis), tenderness, Influenza like illness, fatigue (tiredness). General; In rare cases, localised allergic reactions; such as swelling, oedema, erythema, pruritus or rash, have been reported after treating vertical lines between the eyebrows (glabellar frown lines) and other indications. Overdose May In Practice Patient Experience aestheticsjournal.com
Gilly Dickons explains the importance of call-handling in increasing patient retention in your clinic Is your practice making an exceptional first impression?
In the highly competitive sector of aesthetics it is very important · Knowledge about you that you regularly review the quality of your customer service, Your employees must be able to credential you and let prospective especially your call handling. ideally you should take this clients know why you are the person that they should choose to action every three months. The aesthetic client is making an administer their treatment. emotional and important decision in terms of having treatment, as well as deciding where to go to receive it, and this requires · Knowledge about the procedures you offer both a professional and personal initial response. If you have a A general understanding of the treatments that you offer is receptionist, whether part time or full time, it is essential that they essential. Whilst you will give clients the technical information, your are thoroughly trained. After all, they are responsible for creating staff must be confident in discussing the various treatments you the first impression that your patient will receive of your practice. provide at a conversational level. Equally, if you are an independent practitioner who handles your own calls, the following will still apply. With great initial call handling · Ability to ask the client questions your practice will grow, enabling you to garner the right support. Asking questions enables the patient to open up, and when they do your staff need to sound interested and engaged. Questions I am convinced that hospitality is the one of the most important should be gently probing and focused towards the reason for the aspects of your business, and suggest that you set time aside to call. For example, ‘Have you been considering this treatment for a take a look at the various skills your front of house staff require, in while?’ This leads to the next point… order to ensure you are optimising any new opportunities. If you do not employ staff, these are skills you either need yourself, or · Ability to listen should look to acquire via outsourcing to a specialist service. The Listening is the key skill in building relationships. To use as a guide, consensus of opinion is that the current industry gold standard here are ten commandments of active listening: of converting a new enquiry to appointment is 60%. With great 1) Stop talking: you cannot listen if you are talking. training and focus on the following areas this could be 75-85%, 2) Concentrate: always be prepared to listen before the need which could make a big impact on your revenue. arises; stay focused. 3) Acknowledge and empathise: prove that you are listening and Any front line member of staff will benefit from call handling interested by using encouraging noises and showing empathy training; after all, they are in a sale’s role, albeit a soft one. The where appropriate. person who answers your phone requires exceptional customer 4) Be objective: keep an open mind and do not make hasty service skills, in the same way that you need to be a skilled judgements of your clients. Everyone is different and everyone’s treatment provider. As a starting point for a review of this aspect reaction to a given situation is different. Never assume and always of your business, whether for staff or to critique yourself, I would treat each client as if they are your most important one. recommend that you consider the following tips as a brief guide to 5) Ask questions so that you can listen to answers: questions the essential skills your staff require: demand answers and help to build understanding and relationships. · Tone of voice 6) Reflect, confirm, clarify, summarise: it is important to do this as Your staff must sound warm, inviting and interested. There is we cannot see the person we are talking to. We need to check our nothing worse than rushing your caller, sounding distracted or understanding to maintain control of the call, for example, “So you having an abrupt manner. would like to book xyz – is that correct?” 7) Be patient: allow the patient his or her say and do not interrupt · Calls need to be picked up within a few rings them. Simply wait until they finish what they are saying. Listen to Not left to go to answer machine. When a first time caller gets understand, rather than to reply. through to an answer machine they may be very reluctant to leave 8) Take notes: get the key points of the conversation down so that a message. A caller who has waited for more than 10 rings may you can refer back to them. become agitated and may question the service you are providing. 9) Listen between the lines: listen for feelings and ideas behind the words. Often it is the way something is said, not what is said, that is · Knowledge about the clinic important. A thorough understanding of the clinic and what makes it special is 10) Stop talking: this is the first and the last commandment, as all essential. the others depend on this action.
60 Aesthetics | March 2014 In Practice aestheticsjournal.com Patient Experience
Gilly Dickons explains the importance of call-handling · Understanding key motivators/indicators making an initial enquiry or are simply shopping around. Ideally in increasing patient retention in your clinic Clients always have a reason or a ‘trigger’ for their call. For you will have implemented the above and there will only be 15- example, an event such as a wedding or a holiday. It’s important to 25% of enquiries who don’t book. Ensure that you have gathered understand this as it helps to build a strong relationship right from adequate information to enable you to send patients your next the outset. newsletter and other relevant material as some of them will book at a later date. · Overcoming objections You may have identified at this stage that some of these points refer There will always be objections, most frequently regarding the cost to natural skills and abilities, such as tone of voice and warmth, whilst of a treatment. Equip your staff to handle these effectively right others require training from you, such as product knowledge, for from the start. Objections provide another highly effective way to example. If you are not in a position to employ staff you can look to build the relationship, so see them as positive. Objections may employ a remote enquiry management and appointment booking include price, appointment times, recovery time, how ‘painful’ the service to take care of your phones for you. As you seek to grow treatment is perceived to be, lack of support from their partner etc. your practice, don’t overlook this area or take it for granted; the time and investment you make in your call handling will make a huge · Need versus want impact on your success. These essential front line skills will not only Patients often ask for one thing, even though they may require impact your conversion of new enquiries into consultations, but will something completely different. Asking questions and listening also enhance your existing patient’s experience, contributing to carefully will highlight any inconsistency. For example, a new caller increased patient retention, which in turn will increase your revenue. often wants a ‘quick fix’ treatment, but what they really need is Gilly Dickons is the founder of Aesthetic the very best solution for the issue they are concerned about. It Response, a unique, expert enquiry is important to identify the need using gentle questions, and by management service to the UK’s aesthetic building a relationship on the phone. and cosmetic sector. AR’s team of patient advisors manage calls and diaries on behalf · Effective data capture of a variety of practices, using exceptional The minimum on any call needs to be a name and number, as well customer service skills to convert valuable as where the patient heard about you. Some patients are only enquiries into consultations.
PROVIDING EXCELLENCE IN ADVANCED SKINCARE TRAINING But don’t take our word for it...
“The best training I have ever had! In depth and advanced, just “Sally has provided the clinical what is required for serious skin health professionals.. Nationally Accredited Aesthetics industry with a high Theresa Fleetwood, Owner, Andresa Aesthetics standard qualification that all skin Level 4 Qualifications in care practitioners should complete Clinical Skin procedures “Sally Durant and her team “The courses I have attended ... her Level 4 Certificate in Clinical have been invaluable in the with Sally have been fantastic. Aesthetics has educated me to Advanced CPD on going training of our I would highly recommend perform treatments in my clinic staff ... We are a high end anyone wishing to advance and advise my clients at the highest Short Courses in medispa, our clients value their skills and knowledge in and most knowledgeable standard Skin Health and the advice and treatments the skin care/aesthetic industry possible. The audio videos online Cosmetic dermatology we give and training of such to go on Sally’s courses. Nurses are easy and great to use, allowing a high standard is therefore especially who have not you freedom to learn at your own of the utmost importance to studied the skin in detail would pace, a brilliant way of delivering a Online Audio Visual enable us to do this.” find this very useful.” qualification for all learning styles.” and Bespoke Practical Julia Gateley, Naked Health, Ruth Breedon, Regional Sarah Fearn, FE Lecturer and Clinic Workshops Wimbledon Manager, sk:n Owner, Clarity Advance
“What Sally Durant doesn’t know about skin really isn’t worth knowing. Her wealth of knowledge, her Corporate Staff enthusiasm for skin health, and her refreshing ability to communicate effectively with her students in Development a relaxed, informal style make her courses very enjoyable and informative. Una Brennan, Celebrity Skin Care Specialist and Owner of Superfacialist Skin Care
COME AND SEE US AT OUR STAND 5b Don’t get left behind... Tel: O1527 919880 Email: [email protected] www.sallydurant.com In Practice In Profile aestheticsjournal.com Owning your own clinic is very different to renting a room
Dr Terry Loong, owner of The Skin Energy Clinic and winner of Best New Clinic at the Aesthetics Awards 2013, explains her route into the industry and provides insight on setting up your own practice
After qualifying in 2002, working as an anatomy demonstrator, and undergoing surgical training for four years, Dr Terry was inspired by her late mother to change direction in 2007. “She suffered from terrible acne, psoriasis, eczema, good practitioner, you have to develop as an ethical varicose veins and stretch marks,” says Dr Terry of her mother. “She inspired business person, and learn about finances, human me to help as many women as I could.” Dr Loong began aesthetic training resources, sales, team building, marketing, patient taking courses in botulinum toxin and fillers, then started out by treating patients retention, practitioner motivation and administration. at a friend’s beauty salon in Kent, whilst working as an associate to a clinic in The big learning curve was working with a range Knightsbridge. “I was an ex-surgeon, so the eye-hand coordination and artistry of personalities in my team, whilst serving patients,” of aesthetics came naturally to me,” she says. In 2010, she started her own she says. Dr Terry attended multiple workshops business, at first just renting a room on Harley Street a few days a week. “I on business, marketing and public speaking, and was reluctant to open my own clinic, as I saw many doctors who owned clinics even hired her fiancée, a business consultant, working constantly with no work-life balance, which scared me,” she says. as her business coach. She worked with online She expanded her skill-base by studying nutrition, hormonal rebalancing and marketing and video coaches, and when she found functional medicine in the US in 2011, focussing on preventative and holistic her premises, commissioned an interior designer to anti-ageing. Now with more experience and confidence, in 2012 she invested in create a stylish interior. However, the set up wasn’t her first practice, The Skin Energy Clinic, based on South Molton Street. “Owning a seamless process. “If I was to do it again, I would your own clinic is very different to renting a room,” she says. “As well as being a spend less money on decorating the clinic and more on PR and marketing to promote the business,” she admits. Now, to keep in touch with patients, she ADVICE ON SETTING UP YOUR OWN CLINIC sends out weekly newsletters. “They’re inspirational, ■ If you can, go into ■ Do be realistic educational and remind patients that you’re there for partnership I was overly optimistic about having them,” she says. “I don’t like pushing treatments. The You’ll find it easier to pay the 100% capacity in my clinic at the lack of consumer education in this industry concerns overheads and will have a better start – optimism will help you move me, so I want to put information in the public work-life balance, rather than going forward, but being unrealistic domain.” The Skin Energy Clinic offers injectables, it alone and hiring a manager, who can be stressful. If you halve the PRP, chemical peels, microneedling, mesotherapy will require a high salary. expected capacity figure in your and hormonal rebalancing. “PRP is my favourite business plan, you’ll exceed it, aesthetic treatment, because of the preventative ■ Don’t get too emotionally which is much better than trying to anti-ageing qualities,” she says. “It’s not just for attached catch up. now, but for the future.” For her own future, Dr Running your own clinic is not easy; Terry is partnering with a pharmacy. “This will make you will have good and bad days. ■ Do retain your personality dispensing a lot easier for my patients,” she says. Remember that it’s just business, My aesthetic mentor advised me to She also wants to create a training school, and focus don’t take things personally and build my clinic the way I want and on her educational Dr Terry TV YouTube channel. don’t make enemies. not to change who I am. You will At the root of her plans is the aim of creating happy attract your own type of patients, patients and practitioners. “My biggest goal is to ■ Do present yourself publicly and there are enough patients create a clinical environment where patients love Being a social butterfly by for every practitioner. My patients coming to see us and feel looked after, but which networking and using social tell me I’m like a friend; they feel also promotes a positive work-life balance, so that media will help your business comfortable telling me things, practitioners enjoy coming to work.” she says. “I’m grow - there’s nothing better than and I am honest with them when getting married at the end of this year and want to word-of-mouth marketing. Take I don’t know the answer. Doctors start a family, so that’s really important to me.” But opportunities to talk: I spoke at The are trained not to show weakness, crucially, she wants her patients to feel confident. Anti-Ageing and Beauty Show last but patients love to know you still “The irony of aesthetics is that, if everybody was year. It’s about meeting new clients, have skin breakouts, you’re worried confident in their appearance, the industry would retaining them, exceeding their about your wrinkles and that you’re not make any money,” she says. “I want to take a expectations and getting referrals. human. different approach: I want my patients to feel they want, rather than need, aesthetic treatment.”
62 Aesthetics | March 2014 TRANSFORM YOUR PATIENTS. RESHAPE YOUR PRACTICE.
COME AND SEE US AT STAND 71 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 The Last Word aestheticsjournal.com
With the long-awaited government response to the Keogh report published this month, we asked members of our editorial board to share their reactions Government response to the Keogh report on cosmetic interventions
Mr Adrian Richards high standard of practice across the board. Each Plastic and cosmetic surgeon practitioner must practice according to their abilities “The government response to Keogh lacked firmness regarding regulations but with knowledge of all the available treatment and who can do what. As an industry I think we were hoping that dermal fillers options. At the moment we are all separate, would be made prescription-only medicines. What the response said was that practicing alone and often with no professional individuals need to be trained before administering fillers – however it didn’t give support. It’s time to take aesthetic medicine into the details on what kind of training, or who would be able to administer them. This medical professional arena and make it a serious was disappointing. In the UK there are many different competing bodies within specialty with our own governing body.” this industry that naturally have different interests, so it’s understandable that it’s difficult for the government to get consensus. Hopefully this response can be Amanda Cameron marked as progress, in terms of assessing regulation and in the execution of an Sales and marketing professional implant registry, but it seems that real change will take a long time.” “Whilst the government has gone some way to protect consumers, I feel they have missed a great Dr Nick Lowe opportunity to fully regulate the industry. They Consultant dermatologist and president of the BCDG appear to be encouraging double standards with “I hope the details of the response today will be influential as far as this is the qualified providers being held to account, whilst feasible. I am currently involved in proposing ideas to Health Education England unqualified individuals are still free to practice with (HEE), the body which has been chosen by the government to work with no accountability. I read the report several times stakeholders to approve training for practitioners. I believe that an appropriate in the hope of finding some concrete actions but body such as the British Association of Dermatologists working with the HEE and they are sadly lacking. I am disappointed but not with royal colleges would be ideally placed to organise training programmes surprised, as reports on our industry have been for practitioners. Today’s response was very much an overview of what’s been produced before with recommendations developed discussed previously. Now it’s down to individual bodies to put this into effect. It’s only to be ignored. It appears this one is no a move in the right direction, but I would have liked it to have regulatory teeth.” exception and patient safety does not feature on the government’s list of priorities.” Sharon Bennett Vice chair of the BACN Dr Mike Comins “I welcome any review leading to tighter regulation in the aesthetic industry. President and fellow of BCAM Following the government report there may be concern that it does not go far “I was disappointed by the fact that there wasn’t enough to regulate an industry in need. Loopholes are in need of tightening any immediate action on making dermal fillers surrounding cosmetic injectables. The HEE will require support and guidance from a prescription-only device. I think that this was a us all at this time and I am confident that their committee, made up of industry experts missed opportunity and would have changed the including the BACN, will produce a framework of education and training with defined whole industry. I welcome most of the other points minimum standards to ensure patient safety is met. Support from the professional raised, particularly the need for standardisation and bodies will make a real difference to the practitioners who work in this area.” training in non-surgical aesthetics. I know that BCAM are working with Heath Education England regarding Dr Sarah Tonks this. Whilst I support the idea that surgeons need Aesthetic doctor to be on the specialist register to perform cosmetic “The recommendations specifically around non-surgical providers are shockingly surgery, I do feel that minor surgical procedures lax – what on earth is an appropriately trained person? Unless there are such as fat reduction treatments and hair transplants, prescriptive guidelines set out around who can inject what and where then which are performed under local anaesthetic and I don’t see how this can be in the patient’s best interests. I disagree with the which fall under the definition of aesthetic medicine, statement that we do not need our own register, because registration and need to be addressed. There’s still some confusion training as a unified body for all non-surgical providers doctors, dentists and around this area and I’m hoping BCAM can work nurses is essential to ensure that we are all moving together, maintaining a with the GMC to resolve this.”
64 Since 1994 we’ve been providing exceptional products with unrivalled after-sales support in the areas of Laser, IPL and aesthetic technology. Innovative design and manufacturing, combined with a commitment to our customers, has led to our reputation as the UK’s premier supplier of aesthetic technology to salons, private clinics and the NHS.
Work with the best call Lynton today on 01477 536 977 or visit lynton.co.uk
Hair Removal Vascular Lesions Body Shaping Tattoo Removal Pigmentation Anti Ageing Resurfacing Acne Treatment Onychomycosis 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 h
Med-fx Carlton Group Beauty & Spa Contact: Faye Price ABC Laser +44 01903 761100 Hamilton Fraser +44 01376 532800 Contact: Guy Gouldsmit [email protected] Contact: Wai Chan [email protected] +44 08451 707 788 www.thecarltongroup.co.uk +44 0845 3106 300 www.medfx.co.uk [email protected] [email protected] www.abclasers.co.uk www.hamiltonfraser.co.uk
Chromogenex Medical Aesthetic Group Contact: Lauren Roberts Contact: David Gower Aesthetic Source +44 01554 755444 Healthxchange Pharmacy +44 02380 676733 Contact: Sharon Morris [email protected] Contact: Steve Joyce [email protected] +44 01234 313 130 www.chromogenex.com +44 01481 736837 www.magroup.co.uk [email protected] Service: Laser System +44 01481 736677 Services: NeoStrata and Exuviance Manufacturer [email protected] www.healthxchange.com www.obagi.uk.com Merz Aesthetics +44 0333 200 4140 d [email protected]
Aesthetox Academy Contact: Lisa Tyrer DermaLUX Contact: Louise Taylor Mesoestetic UK +44 0870 0801746 Highgate Private Hospital +44 0845 689 1789 Contact: Adam Birtwistle [email protected] Contact: Highgate Cosmetic Clinic [email protected] +44 01746 718123 www.aesthetox.co.uk +44 020 8347 3871 www.dermaluxled.com [email protected] Service: Training [email protected] Service: Manufacturer of LED www.mesoestetic.co.uk www.highgatehospital.co.uk Phototherapy Systems Services: Cosmeceutical Skincare Treatment Solutions, Cosmelan, l Antiagaing, Depigmentation, Allergan Anti Acne, Dermamelan +44 0808 2381500 e p www.juvedermultra.co.uk Laser Physics Eden Aesthetics +44 01829773155 Contact: Anna Perry [email protected] PolarisMedical Lasers +44 01245 227 752 Microdermabrasion www.laserphysics.co.uk ContactFrom: Neil Calder [email protected] MATTIOLI ENGINEERING +44 01234841536 www.edenaesthetics.com As featured on AZTEC Services [email protected] Contact: Anthony Zacharek www.polaris-laser.com +44 07747 865600 s [email protected] Lawrence Grant TECHNICAL SUPPORT Intense Pulse Light (I2PL) & Laser Systems www.aztecservices.uk.com delivering the promise Contact: Alan Rajah Service: Exclusive UK distributorBeautylight Technical Services Ltd Contact: Jane Myerson SkinBrands Ellipse-Intense Pulse LightContact: Jane Myerson +44 0208 861 7575 needle free Contact: Ashaki Vidale T: 0208 741 1111 Contact: Tracey Beesley for Viora product range T: 0208 741 1111 Mesotherapy T: 0208 741 1111 E:(I2PL)[email protected] &Laser Systems [email protected] for the delivery of active E: [email protected] E: [email protected] +44 substances.0289 983 739 W: www.ellipseipl.co.uk Contact: Jane Myerson W: www.venusconceptuk.co.uk www.lawrencegrant.co.uk/ W: www.technicalsupport.ellipseipl.co.uk/ [email protected] Services: UK distributor of IPL & Laser Services: UK distributor of Venus Services: Onsite service & repairs of specialist-services/doctors.htm systems,+44 IPL0208 & Laser 741 training 1111 courses Freeze and Swan Radio Frequency (RF) aesthetic systems. UK agent for Ellipse www.skinbrands.co.ukTel: 01234 841536 and technical support & Magnetic Pulse (MP)2 systems www.polarismedicallasers.co.uk b IPL & Venus Radio Frequency systems [email protected] www.ellipseipl.co.uk Services: IPL & Laser systems, Bioptica Laser Aesthetics IPL & Laser training courses Contact: Mike Regan and technical support +44 07917 573466 Lifestyle Aesthetics Skin Geeks Ltd [email protected] Contact: Sue Wales +44 01865 338046 www.bla-online.co.uk +44 0845 0701 782 [email protected] Services: Core of Knowledge [email protected] www.skingeeks.co.uk TECHNICAL SUPPORT Intense Pulse Light (I2PL) & Laser Systems Training and Laser Protection www.lifestyleaesthetics.comdelivering the promise Beautylight Technical Services Ltd Contact: Jane Myerson Adviser (LPA) Services Ellipse Technical Support Contact: Jane Myerson Contact: Ashaki Vidale T: 0208 741 1111 T: 0208 741 1111 T: 0208Beautylight 741 1111 Technical E: [email protected] E: [email protected] E: [email protected] W: www.ellipseipl.co.uk Services Ltd W: www.venusconceptuk.co.uk W: www.technicalsupport.ellipseipl.co.uk/ Ashaki Vidale Services: UK distributor of IPL & Laser Services: UK distributor of Venus Services:Contact:Onsite service & repairs of Sound Surgical (UK) LTD 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 IPL & Venus Radio Frequency systems Contact: Raj Jain [email protected] Lumenis UK Ltd Boston Medical Group Ltd +44 7971 686114 technicalsupport.ellipseipl.co.uk Contact: Nigel Matthews or Contact: Iveta Vinklerova [email protected] Services: Onsite service&repairs Mark Stevens +44 0207 727 1110 www.SoundSurgical.co.uk of aesthetic systems. Ellipse IPL& 020 8736 4110 [email protected] Venus Radio Frequency systems [email protected] v www.boston-medical-group.co.uk www.lumenis.com
TECHNICAL SUPPORT Intense Pulse Light (I2PL) & Laser Systems delivering the promise Beautylight Technical Services Ltd Contact: Jane Myerson Contact: Jane Myerson Contact: Ashaki Vidale T: 0208 741 1111 c VenusT: 0208 741 1111Freeze T: 0208 741 1111 E: [email protected] E: [email protected] E: [email protected] Contact: Jane Myerson Energist Medical Group W: www.ellipseipl.co.uk W: www.venusconceptuk.co.uk W: www.technicalsupport.ellipseipl.co.uk/ Contact: Eddie Campbell-Adams Services: UK distributor of IPL & Laser +44Services: 0208UK distributor 741 of Venus1111 Candela UK Ltd Services: Onsite service & repairs of systems, IPL & Laser training courses Freeze and Swan Radio Frequency (RF) aestheticLynton systems. UK agent for Ellipse and technical support [email protected]& Magnetic Pulse (MP)2 systems Contact: Michaela Barker +44 01792 798 768 IPL & Venus Radio Frequency systems +44 0845 521 0698 [email protected] 01477 536975 www.venusconceptuk.co.uk [email protected] www.energistgroup.com [email protected] Services: Venus Freeze and Swan www.syneron-candela.co.uk www.lynton.co.uk Radio Frequency (RF) & Magnetic g Pulse (MP)2 systems m z Carleton Medical Ltd Contact: Nick Fitrzyk Galderma Aesthetic & MACOM Zanco Models +44 01633 838 081 Corrective Division Contact: James Haldane Contact: Ricky Zanco [email protected] +44 01923 808950 +44 02073510488 +44 08453076191 www.carletonmedical.co.uk [email protected] [email protected] [email protected] Services: Asclepion Lasers www.galderma-alliance.co.uk www.macom-medical.com www.zancomodels.co.uk COME AND SEE US AT STAND 59 14495 UK BOTOX CFL Trade Ad 2014.indd 1 07/02/2014 15:30