www.aestheticmed.co.uk
FEBRUARY 2019
ISSUE 49
M EDICI N E
FEBRUARY 2019
C CLASS
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aestheticmed.co.uk
Contents FEBRUARY
06
NEWS AND ANALYSIS
BUSINESS
6 NEWS The latest news
36 WEBSITES Adam Hampson on how to design and build a website for the best chances of conversion
12 TALKING TO We chat to BCAM president Paul Charlson
EDITORIAL Vicky Eldridge E: vicky@aestheticmed.co.uk T: +44 (0) 207 351 0536
ADVERTISING Jack Diamond
14 AM LIVE 2019 Find out what will be happening at Aesthetic Medicine Live in March
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40 PHOTOGRAPHY Dr Sophie Shotter and Clint Singh tell us how to get good before and afters in aesthetics 45 EMPLOYMENT Victoria Vilas discusses giving constructive feedback 50 BUSINESS CONNECTIONS Richard Crawford-Small on why being connected is important for your business growth
E: jack@aestheticmed.co.uk T: +44 (0) 207 349 4792
CLASSIFIED Nur Suleyman E: nur@aestheticmed.co.uk T: +44 (0) 207 349 4796
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MARKETING Chloe Skilton
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E: chloe@aestheticmed.co.uk T: +44 (0) 207 351 0536
PUBLISHER Mark Moloney E: mark@aestheticmed.co.uk T: +44 (0) 207 351 0536
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DESIGN AND PRODUCTION ICD imagecreativedesign.co.uk
PRINTING Walstead United Kingdom walstead-uk.com
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SUBSCRIBE Annual print subscription UK: £44.50 or DD £39.50; Europe: £59.50; outside Europe: £67.30. To receive your copy of Aesthetic Medicine every month call 01371 851875 or see escosubs.co.uk/aestheticmedicine The publisher accepts no responsibility for any advertiser whose advertisement is published in Aesthetic Medicine. Anyone dealing with advertisers must make their own enquiries. M 2 Media Unit 1.17 The Plaza 535 Kings Road London SW10 0SZ
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Aesthetic Medicine • February 2019
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CONTENTS
IN THIS ISSUE...
aestheticmed.co.uk
71
66
SKIN
INJECTABLES
52 DOSSIER We take a look at some of the best vitamin C products on the market
62 JAWLINES Dr Yasmin Shakarchy on facial slimming and the three-point masseter reduction technique
60 SKINCARE SPY We ask industry professionals what their go-to products are
66 INTERVIEW We speak to Professor Syed Haq about trends in the aesthetic market and the future of injectables
71 CASE STUDY Frances Turner Traill describes how she helped a patient who was “uncomfortable in her own skin”
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THREADS
DEVICES
74 THREAD LIFTING Dr Sotirios Foutsizoglou shares his experience with threads
78 EDITOR’S CHOICE Vicky Eldridge tries the CryoLed facial 80 TREATMENT SPOTLIGHT SkinPen Precision
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52
Welcome
to the February issue of Aesthetic Medicine We may all start the year feeling motivated with big plans for our lives and our businesses but as January draws to a close and we are in the midst of the cold winter months, our good intentions can start to wane. That’s why Aesthetic Medicine, taking place next month (March 23-24) at Olympia London, is a well-timed opportunity to reinvigorate your business for the year ahead. With a full and well-rounded CPD-accredited educational programme encompassing both business and clinical programmes and bringing together the many faculties of aesthetic medicine from surgery and hair restoration to regenerative medicine, skin and non-surgical rejuvenation, Aesthetic Medicine Live helps give you the competitive edge in an increasingly growing market. We are also excited to be launching the Aesthetic Medicine Video Awards, recognising excellence in video-based marketing and education. Our show preview on pages 16-32 tells you everything you need to know about this year’s meeting so make sure you check it out and book your tickets now so you don’t miss out. aestheticmed.co.uk/booktickets Vicky Eldridge - Editor
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N E W S A N D A N A LY S I S
INDUSTRY NEWS
www.aestheticmed.co.uk
IQ Resources releases first of its kind Level 7 eLearning platform for injectables IQ Resources, a sister company to UKAS-accredited certification body IQ Verify, has launched a new eLearning package for level 7 injectables. The new course – Botulinum Toxin and Dermal Filler Level 7 eLearning – is aimed at supporting the delivery of the IQ Level 7 certificate in Injectables for Aesthetic Medicine, to support all other forms of injectables training (regulated or unregulated) and to support the further learning and upskilling of existing practitioners who are looking to maintain knowledge without attendance at a formal training event. Laurence Clarke, qualification development and sector lead for aesthetic medicine, said, “We have pulled upon our experience within this sector and have worked with key technology providers to produce high calibre eLearning materials meeting the requirements of Level 7. “The key benefit of these materials is that they allow for the flexible delivery of the current injectables knowledge. Regulated and unregulated training schools alike can use these materials to ensure that their delegates have a solid grasp of injectables knowledge and understanding,
prior to attendance at a more hands-on clinical training event. Individual practitioners can use these materials to develop and maintain their essential treatment knowledge, assured by the fact that these materials will always remain up-to-date.” Modules include; History, Ethics and Law, Cosmetic Psychology, Dermal Filler Use, Ageing and photoageing, among others.
Functional anatomy of the deep facial fat compartments investigated in study A study investigating the functional anatomy of the deep facial fat compartments to provide information on the effects of injected material in relation to age and gender differences, has been published in the journal Plastic Reconstructive Surgery. Forty fresh frozen cephalic specimens of 17 male and 23 female Caucasian body donors were investigated. Computed tomographic and magnetic resonance imaging procedures were carried out using coloured contrast-enhanced materials with rheologic properties similar to commercially available soft-tissue fillers, and anatomical dissections
were performed to guide conclusions. No statistically significant influences of age or gender were detected in the investigated sample. Increased amounts of injected contrast agent did not correlate with inferior displacement of the material in any of the investigated compartments. The authors concluded that increasing volume in the deep midfacial fat compartments did not cause inferior displacement of the injected material. This underscores the role of deep soft-tissue filler injections (i.e., in contact with the bone) in providing support for overlying structures and resulting in anterior projection.
Ban on plastic-stemmed cotton buds The UK Government is proposing a ban on plastic-stemmed cotton buds, straws and drinks stirrers after it launched a consultation, which closed in December 2018, to make the selling or distribution of the plastic items illegal. Eliminating single-use plastic items is high on the Government’s agenda as part of its 25-year Environment
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Plan. Plastic-stemmed cotton buds are in the top 10 most common marine litter items to get washed up on the world’s beaches, and most use plastic-based adhesives to secure the cotton tips. While the buds are a common consumable for clinics and salons, they “cause multiple environmental harms particularly when they are discarded incorrectly, including harm to marine animals and visual pollution,” said the Department for Environment, Food & Rural Affairs’s impact assessment. “Even if disposed of correctly, plastic-stemmed cotton buds may end up in incineration, generating high carbon emissions. Intervention is required in order to shift the cotton bud market to plastic-free alternatives that already exist and decompose much quicker.”
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N E W S A N D A N A LY S I S
www.aestheticmed.co.uk
INDUSTRY NEWS
Rates of skin cancer far higher than thought Data from a newly established UK skin cancer database, the largest of its kind in the world, has revealed that there are more than 45,000 cutaneous squamous cell carcinomas (cSCC) every year in England, 350% more than previous estimates suggested. Developed by experts at Queen Mary University of London and Public Health England, and funded by the British Association of Dermatologists, the new database fills in gaps in the recording of skin cancer, ensuring that accurate UK numbers are available for the three most common types of skin cancer: melanoma, basal cell carcinoma (BCC), and cSCC. The study, published in the journal JAMA Dermatology, found that a higher risk of cSCC was associated with being older, male, white, and of lower socioeconomic deprivation. The three-year survival was 65% among men and 68% among women. The researchers also found that between 2013 and 2015 there were 1,566 patients diagnosed with metastatic SCC for the first time – the cancer having spread to other parts of the body.
Nina Goad of the British Association of Dermatologists, said, “This database is an important national milestone in the treatment of skin cancer, the UK’s most common cancer. Previously, researchers and policy makers have been working on a puzzle without all the pieces. Now they know how many cases are being treated every year, better decisions can be made about treatment, prevention, and screening. This is a real step forward.”
Self-care trend causes nighttime skincare sales to soar The “self-care” trend has impacted the prestige nighttime skincare category, causing sales to grow 7% in the period from October 2017 to September 2018. According to analyst The NPD Group, “me-time” has seen consumers adopting a more targeted approach to their nighttime beauty rituals. As a result, anti-ageing night skincare has increased 9% in this time period, driving 74% of growth in night-only skincare, the report found. Sales of night eye products, including masks and creams, also increased 14%, while facial gels rose 12% and facial oils 4%. “Beauty brands are delivering their technical expertise with innovative products to work on the skin overnight,” said June Jensen, NPD UK’s beauty director.
Cannabinoid medications could play an important role in managing a severe genetic skin condition, research shows Pharmaceutical grade cannabinoid-based medications (CBMs) could improve the treatment of epidermolysis bullosa (EB), a severe and debilitating genetic skin disease, according to research. The study, carried out by doctors in the Netherlands, highlighted the lack of effective pain relief options for people with EB, a condition in which even minor knocks and friction can cause the skin to blister or ulcer. Three adult EB patients with chronic, severe pain were treated with CBM oil as part of the study, the findings of which were published in the British Journal of Dermatology. All three participants reported a significant reduction in pain levels experienced while undergoing CBM oil treatment relative to their previous drug regime. An additional benefit was reduction in itching. Mr Nicholas Schräder of the University Medical Center Groningen and the study’s lead author said, “The cases reported in this study indicate that there is a possibility that patients with EB may be able to respond to treatment with a CBM oil, and call for in-depth controlled scientific
studies to understand the true effect and impact this type of treatment may have on patients with EB, especially with regard to pain and itching.” Home Secretary Sajid Javid announced in July 2018 that specialist doctors in the UK will be able to legally prescribe cannabis-based medicinal products, however, few have been approved by the Medicines and Healthcare products Regulatory Agency (MHRA).
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N E W S A N D A N A LY S I S
INDUSTRY NEWS
NEWS IN BRIEF POTENTIAL NEW ECZEMA TREATMENT SHOWS PROMISE
A new cream being developed by scientists could greatly improve the treatment of eczema symptoms, according to new research published in the British Journal of Dermatology. The research, conducted by dermatologists in Korea, has shown that a non-steroid containing cream, called PAC14028, can be as effective in treating eczema symptoms as current creams on the market but with fewer side-effects.
ALLERGAN SUSPENDS SALES OF TEXTURED IMPLANTS IN EUROPE
Allergan has suspended sales of textured breast implants and tissue expanders and is withdrawing any remaining supply in European markets. The withdrawal decision follows a compulsory recall request from Agence Nationale de Sécurité du Médicament (ANSM), the French regulatory authority. The suspension of sales stems from the expiration of the company’s CE Mark for these products.
NEW PHARMACY FOR PRIVATE PRESCRIBERS LAUNCHES
www.aestheticmed.co.uk
First degree for aesthetic therapists has launched The first undergraduate-level degree in aesthetics for beauty therapists has been launched. From January 2019, Level 3 therapists can now gain a BSc in Clinical Cosmetology with Fusion Aesthetic Academy, a training provider directed by microneedling expert and aesthetics trainer Andrew Hansford and accredited by the University of Bolton. The three-year degree includes 22 modules, mapped to the original HEE Framework, that can be taken at the student’s own pace. The course accreditors will also take into account prior knowledge and experience, meaning, for example, that some very experienced therapists may be eligible to do the final-year modules only. The aesthetic therapist pathway comprises units including mesotherapy, IPL, electrotherapy, pathogens, and anatomy and physiology; while the medical pathway covers toxin and filler, advanced peels and ultrasound, among other modules. Only doctors, dentists, nurses and pharmacists are qualified for this route. Unlike many other courses, there are no online modules. The courses were developed in association with Helen Gordon, manager of the Wynyard Aesthetics Academy, and are externally moderated. Degree certificates are awarded from the University of Bolton, which officially recognises the course. Hansford said, “Too many courses make false promises and I felt it was unfair that there was no university-accredited pathway for beauty therapists above Level 4. I want therapists to be able to say, ‘I’ve proven I’m the best I can be and I can stand side by side with medics with a recognised degree’.”
A pharmacy that is dedicated to private prescribers has launched into the aesthetics sector. Galenic Laboratories, trading as Roseway Labs, supplies licensed, unlicensed and compounded medications, as well as vitamins, minerals, supplements and diagnostic testing kits. Unlicensed medicines include things like natural desiccated thyroid drugs, that are approved in other countries but haven’t been licensed by the NHS.
HARLEY ACADEMY FIRST TRAINER TO BE RECOGNISED BY IQ VERIFY
Harley Academy has become the first training company to achieve certification to become a recognised IQ Verify learning provider in the sector. This means the company has evidenced that it meets the core requirements to operate a training facility to meet both international standards and modality specific aesthetic training requirements as identified by the CPSA, demonstrating their ability to provide a high calibre and safe aesthetic training.
TRANSFORM GROUP CREATES PATIENT CHARTER
Cosmetic surgery clinic group Transform has launched a ‘Patient Charter’, to outline how it aims to deliver against its commitment to “provide patients with the highest quality care before, during and after their procedure” and to be “accountable for delivery of that care.” In the charter the group, which operates clinic chains Transform and The Hospital Group, details its clinical and internal governance and patient engagement measures across its cosmetic interventions and weight loss business.
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JCCP agrees memorandum of understanding with key organisations The Joint Council for Cosmetic Practitioners (JCCP) has signed Memorandums of Understanding (MoU) with key organisations in the aesthetics, dental and medical sectors as it moves forward with its plans to tighten up standards of practice in the industry. MoUs have been signed with the Nursing and Midwifery Council (NMC), General Dental Council (GDC), the General Pharmaceutical Council (GPhC) and the Royal Pharmaceutical Society (RPS). The purpose is to set out a framework between the various organisations and the JCCP and to allow the JCCP to share any concerns it has about registrants with these bodies, as well as to work collaboratively with them in the interests of public protection. This will include opening effective channels of communication and sharing information to promote patient safety and high quality services for those receiving non-surgical aesthetic treatments; to align (where appropriate and necessary) the processes and procedures adopted by the organisations with regard to matters of ‘fitness to practice’ for professionals involved in the provision of non-surgical aesthetic treatments for the purpose of public protection; and ensuring openness and transparency between the organisations as to when cooperation is and is not considered necessary or appropriate.
Aesthetic Medicine • February 2019
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N E W S A N D A N A LY S I S
INDUSTRY NEWS
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NEWS IN BRIEF FEMINIST GROUP PRAISED FOR ITS CAMPAIGN AGAINST LOVE ISLAND ADS
Feminist group Level Up has been named in The Drum’s New Year’s Honours List for its campaign to get Love Island to stop showing cosmetic surgery and diet pill ads during its commercial breaks, after its own research found that 40% of women who watched the popular show felt more self-conscious about their bodies afterwards. Level Up issued a rallying cry to supporters to contact ITV about it and thousands did. The movement eventually prompted the channel’s chief executive Carolyn McCall to launch an internal review into whether ads for cosmetic surgery were appropriately aired next to the summer smash hit.
LISA SNOWDON ANNOUNCED AS STRAWBERRY LIFT’S AMBASSADOR
British TV presenter and fashion model Lisa Snowdon is the newest ambassador for Laser Lipo’s Strawberry Lift. Committed to staying well away from surgical procedures, Snowdon said, “I couldn’t believe when I heard there was non-invasive treatment that works to both define the jawline and contour the cheekbones with absolutely no surgery, needles or pain involved. I am honestly blown away by the results of my first treatment.”
AESTHETIC SOCIETY UNVEILS 2019 PLASTIC SURGERY PREDICTIONS
The American Society for Aesthetic Plastic Surgery has released its 2019 predictions detailing what plastic surgery trends are expected in the coming year, including specific trends for surgical and non-invasive options, and a topline forecast for the next decade, such as less emphasis on celebrity emulation and more emphasis on a tailored, individual look.
BIONIC EXPERIMENTS COULD LEAD TO SOLUTION FOR FACIAL PARALYSIS
An implantable neuroprosthetic device may provide a new approach to restoring more natural facial movement in patients with one-sided facial paralysis (hemifacial palsy), suggests a study in the January issue of Plastic and Reconstructive Surgery. Initial experiments in animals show promising results with a “bionic face” approach to facial reanimation, using electrical signals from the uninjured side of the face to trigger muscle movement on the paralysed side.
Early gut bacterial colonisation may help prevent eczema, research shows Strains of a bacterium commonly found in skin infections may help to protect against eczema, according to new research in the British Journal of Dermatology. Scientists from Sweden have discovered the strains (genetic variants) of staphylococcus aureus (S. aureus), often seen as an exasperator of eczema, may actually help protect against it with early gut exposure. In a group of 64 infants, swabs and faecal samples were taken to measure microbe colonisation in the gut and in the nasal passage. 12 infants developed atopic eczema and 52 did not. Nina Goad of the British Association of Dermatologists explained, “Up until now, S. aureus has been seen as the villain of the eczema story, as this bacterium tends to be found in infected eczema patches and is thought to aggravate the disease. This study shows that actually, it has a positive effect too, as early gut exposure to S. aureus can actually help prevent eczema developing. Research like this is incredibly helpful in providing a clearer picture of these factors, as we still do not fully understand this common, sometimes debilitating disease.” Dr Forough Nowrouzian from the University of Gothenburg in Sweden and lead author of the study said: “The two groups of children used in the two studies were sampled five to seven years apart and from different geographical areas: the first in the city of Gothenburg and the second in a rural part of southwestern Sweden. The almost identical findings for the two cohorts lend credibility to the hypothesis that early mucosal colonisation by certain types of S. aureus beneficially affects stimulation of the infant’s immune system in a manner that reduces the risk of eczema development.”
Women stop removing body hair as part of “Januhairy” movement A campaign to remove the stigma around female body hair was held last month. #Januhairy, was founded by drama student Laura Jackson from Exeter University and encourages women to grow out their natural body hair and raise money for charity. “Society seems to be behaving as if the natural hair we grow on our bodies is unattractive and distasteful. We are so used to removing our body hair that we are becoming unfamiliar with our authentic selves,” said Jackson. “Januhairy is an experiment for women to come together, encourage one another and be sponsored to grow out our body hair for the month of January.” Jackson came up with the idea after growing out her hair for a drama performance last year. “Though I felt liberated and more confident in myself, some people around me didn’t understand why I didn’t shave/didn’t agree with it. I realised that there is still so much more for us to do to be able to accept one another fully and truly,” she added.
NEWS IN PICTURES Black Skin Directory hosted an immersive learning event to showcase cosmeceutical options and professional treatments suited for skin of colour. The event was held at the Adonia Clinic with a Q&A session led by Dr Ejikeme, the clinic’s director, and moderated by Dija Ayodele, founder of BSD. Ayodele said, “We’re grateful to Dr Ejikeme in opening up her clinic and sharing her in-depth knowledge to the BSD audience. The evening was insightful and it was great for our guests to witness a live chemical peel demonstration.
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A vision for change We chat to president of the British College of Aesthetic Medicine Paul Charlson, about its plans for the year ahead
T
he professionalisation of aesthetic medicine is essential for the development of the industry and its long-term survival. Organisations such as the British College of Aesthetic Medicine (BCAM) have long championed the need to improve patient safety, and part of that vision is supporting the development of its members through raising standards and driving education. This is particularly important with new practitioners coming into the industry. Paul Charlson, the association’s president says, “A number of young medical and dental professionals are choosing aesthetics as a career without training in another field. BCAM has recognised this and has developed the BCAM Academy which provides a curriculum, mentorship and training partners, culminating in an entrance examination into associate membership. This allows those who would not be eligible to become associates under the current rules to join BCAM. It also provides the public with assurance that the person concerned has demonstrated competence.” Another way BCAM is tightening up its standards is by adding in an examination process and demonstration of suitable experience for full membership. Charlson explains, “This will again assure the general public that members are properly trained and are advanced in their field. It is hoped that full membership will become a specialist qualification recognised by the GMC and GDC. BCAM is also looking to work with a Royal College to become a faculty in the near future.” The issue of regulation was high on the agenda in 2018 and looks set to continue to be a topic of debate in 2019. BCAM has been involved with the Joint Council for Cosmetic Practitioners (JCCP) since its inception and Charlson says it will continue to do so. “BCAM will continue to be permanent
members of the JCCP council and, as such, will work closely with them on matters of regulation. It is our goal to ensure both practitioners and training organisations work to correct standards but also to ensure that registration is not too complex. We are also meeting with Government to push for regulation to have as much force as possible.” But Charlson also believes that being a member of an organisation such as BCAM offers more than just supporting the move towards higher standards of education and tighter regulation. He says, “From a commercial point of view in a crowded market, consumers are becoming increasingly discerning. Good quality patients who will come regularly are more likely to seek out well qualified practitioners. As BCAM raises its profile and indeed demonstrates the quality of its members, it can rightly claim that its members will provide premium service and results. BCAM is actively involved in regulation and this will slowly (as it is voluntary) begin to exclude those professionals who are performing the occasional treatment and hopefully completely exclude non-professionals from injecting anyone. BCAM also hosts an excellent annual members conference which is scientific and evidence-based, moving away from anecdote. Membership confers support when members get into difficulty and a community of like-minded professionals.” So what are BCAM’s other plans for the future? “The vision is to become a true Royal College. Membership will be a mark of quality,” Charlson says. “It will in time provide its own training schemes, recruitment possibilities and advice via its website and in time, an electronic journal. While this is some way off, we are moving rapidly towards these goals. If people are considering becoming a member, there could not be a better time to join us.” Visit bcam.ac.uk for more information. AM
It is hoped that full membership will become a specialist qualification recognised by the GMC and GDC
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Get connected with a visit to Aesthetic Medicine Live at Olympia London this March 23-24 and reinvigorate your business for 2019
W
e may all start the new year feeling motivated with big plans for our businesses, but that can quickly wane as daily life takes over. At Aesthetic Medicine, we believe that one of the keys to running a successful business is making the right connections. As aesthetic clinic owners or practitioners that means partnering with the right suppliers, products and treatments; networking and sharing your experiences with your peers; and learning from global key opinion leaders and other successful business owners. Taking place at the end of the first quarter of 2019 – March 23-24 – Aesthetic Medicine Live is the ideal opportunity to reinvigorate your business for the year ahead. So why not come and meet with like-minded people and restoke the fires of your enthusiasm by finding out about the latest product launches and trends on the market that could add commercial value to your clinic, gaining valuable CPD-accredited education and connecting with world-class speakers and business leaders? Over the next few pages we share some of the highlights of our 2019 event…
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• DISCOVER the latest treatment trends and products by walking around our bustling exhibition featuring market-leading brands. • LEARN by attending our CPD-accredited education programme including the UK’s first ever two-day conference on aesthetic regenerative medicine. • WATCH live demonstrations of treatments from our exhibitors and hear from KOLs about exciting product developments for free on the Live Stage. • CONNECT with your peers and network in the delegate lounge or in the cafes within the exhibition. • BUY products and devices and take advantage of exclusive offers only available to visitors to the show. • INVIGORATE your passion for your business at our two-day CPD-accredited business workshop programme with new features for 2019.
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BOOST YOUR BUSINESS SKILLS
Our Business Workshop programme gives you access to successful clinic owners and leading business consultants to inspire you to grow and develop your clinic.
NEW FOR 2019
UK’S FIRST TWO-DAY CONFERENCE ON AESTHETIC REGENERATIVE MEDICINE
New for 2019, our conference will feature a two-day programme on aesthetic regenerative medicine, in collboration with the MSC in Aesthetic Medicine at Queen Mary’s University London’, and chaired by leading regenerative medicine expert, Mr Ali Ghanem.
LEARN ABOUT HAIR RESTORATION
Aesthetic Medicine Live will once again be hosting the British Association of Hair Restoration Surgery’s (BAHRS) annualconference, where you can learn about the growing trend for hair restoration.
WATCH FREE DEMONSTRATIONS
Our Live Stage provides visitors to the exhibition with free education on the show floor, featuring demonstrations of the latest treatments and techniques from our exhibitors.
GET CPD-ACCREDITED EDUCATION
Aesthetic Medicine Live’s two-day CPD-accredited clinical conference features global key opinion leaders and cutting-edge topics.
EXPERIENCE THE LATEST TREATMENTS FOR YOURSELF
At Aesthetic Medicine Live, many of our exhibitors offer you the chance to try out their treatments for yourself on their stands. If you are thinking of investing in a new brand, there’s no better way to see if it’s right for your clinic and your patients than experiencing it for yourself.
FIND OUT ABOUT THE LATEST SURGICAL INNOVATIONS
For the third year running, Aesthetic Medicine Live will host the UK Assocation of Aesthetic Plastic Surgeons (UKAAPS) annual conference with a one-day programme dedicated to cosmetic surgery practice and featuring an international faculty.
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DON’T FORGET TO DOWNLOAD THE SHOW APP
To get the most out of the show, why not download our app to search the exhibitors, products and offers? Stay up-to-date with the wide range of seminars and other features of the show. Don’t forget to turn on notifications for instant updates. Download the show app at aestheticmed.co.uk/showapp
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Video nation Aesthetic Medicine is excited to announce the launch of the Aesthetic Medicine Video Awards
V
ideo is one of the most powerful ways to communicate and engage with your audience, and its popularity as a marketing medium is continuing to grow. In recognition of this, at this year’s Aesthetic Medicine Live, we will be acknowledging those who have created the most informative, engaging and well-produced videos to positively promote our sector at our first Aesthetic Medicine Video Awards. Whether you are a clinic, individual practitioner, training provider or brand you are eligible to enter. The event will take place as part of the Aesthetic Medicine Live after-party at Pergola on the Roof at Olympia London on Saturday March 23. *please note the event is not black tie and the awards will be presented as a short part of the evening’s entertainment. The winning videos will be screened on the night. To enter all you need to do is send a we-transfer or dropbox link to your video to entries@aestheticmed.co.uk including your full name and video credits, category you are entering and a short description of who your video is aimed at and what you were aiming to achieve with it. Or you can visit aestheticmed.co.uk and enter online. Entries opened on Wednesday January 16 and will close on Friday February 15. You can enter any video created and distributed in 2018. Categories: est social media video (b2c or b2b) – open to clinics, •B practitioners and brands. Videos must be no longer than 1 minute and have been created for social media
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est training or educational video (b2b) – open to clinics, •B practitioners and brands. Videos must be no longer than five minutes and be for the purposes of training and education for aesthetic practitioners •B est b2c video – open to clinics, practitioners and brands. Videos must be no longer than three minutes and have been created for the purposes of marketing, for use on a website or to be played in a clinic reception Aesthetic Medicine editor Vicky Eldridge commented, “Video has become such an important part of any marketing strategy. So much of our communication either directly to patients or within the profession is now done digitally. Video gives people a chance to really see who you and your business are and let your personality shine through. At Aesthetic Medicine, a large part of our focus is on the business side of aesthetics as well as the clinical, and by launching these awards, which we will be looking to expand in 2020, we want to acknowledge those who are representing the best of our industry in their digital marketing.”
OUR JUDGING PANEL
Our judging panel is made up of both respected aesthetic practitioners and clinic owners as well as business coaches and marketing experts. They include: Dr Harry Singh, Sue Thomson, Jean Johnston, Dr Ali Ghanem, Dr Johanna Ward, Dr Monah Mansoori, Jon Mowat, Dr Roshan Vara, Alan Adams, Richard Crawford-Small and Pam Underdown. AM
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The world’s first ‘Pain-Free’ TRUE Alexandrite & Nd:YAG Laser The Motus AY is the worlds first and only ‘Pain-Free’ laser hair removal platform to deliver the two gold-standard lasers for treating ALL skin types - TRUE Alexandrite & Nd:YAG.
Now Supported in the UK by Lynton
Call Lynton on 01477 536 977 Visit lynton.co.uk/motus PB DPS.indd 2 with Stand.indd 2 698 Lynton Laser
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On show We round up some of the products and technologies on show at Aesthetic Medicine Live 2019 on March 23–24 at Olympia London BIOACTIVE AESTHETICS BioActive Aesthetics will be offering a show discount of £300 for the SkinPen Precision, a mechanical micro-needling device, which includes a full day of training for two delegates, patient safety treatment packs and marketing support.
ADVANCED ESTHETICS SOLUTIONS New from AES is the dual laser treatment, Shelase, for the resurfacing and tightening of the mucosa. The mixed-laser technology performs a treatment of the vaginal tissue by creating the production of new collagen to regain elasticity. They will also showcase the Thunder device offering a solution for hair removal, dermatological vascular lesions and skin rejuvenation treatments.
BTL BTL will bring the Emsella system to the show, a treatment that combats SUIs in women. The company will also launch new applications for intimate health and sexual wellbeing alongside the SUI systems already available on the Emsella system.
AQ SKIN SOLUTIONS AQ Skin Solutions will be bringing its cosmeceutical line, including products such as the Eye Rejuvinating System, formulated to stimulate collagen production for increased skin firmness.
CELLUMA - BIOPHOTAS BioPhotas will be bringing the Celluma Pro. The light therapy tool has three pre-programmed settings for acne, anti-ageing and dermal wound healing and pain. The flexible component conforms closely to the treatment areas, optimising light therapy efficacy.
AZTEC SERVICES Aztec Services will be showcasing the Tixel by Novoxel, a thermal fractional skinrejuvenation system. The compact, ergonomic design ensures that the system is comfortable to use. The Thermo-Mechanical Technology is less painful than lasers offers quicker down time.
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CHURCH PHARMACY - PCA SKIN PCA Skin will be introducing its latest launch, the C & E Advanced with hexylresorcinol and silymarin, formulated to diminish dark spots, soothe irritated skin and reduce signs of ageing using ingredients such as L-ascorbic acid and tocopherol.
THE CONSULTING ROOM The Consulting Room will bring the HydraFacial machine, a non-ablative facial-rejuvenation system that uses vortex cleansing, HydroPeel exfoliation, vortex extraction and vortex fusion.
CYNOSURE Cynosure will be showcasing its newest launches including the PicoSure, a picosecond aesthetic laser. Ultra-short pulse bursts of energy are delivered to the skin in trillionths of a second, ideal for tattoo removal, skin revitilasation and the removal of pigmented lesions.
ENDOSPHERES UK/ FENIX GROUP Machines brand Endospheres UK will be showcasing its Eva Facial new device as well as the AkSensorALL, a single device for face and body treatments with two hand pieces.
LEVURA Levura will be launching a medical-grade LED photodynamic therapy device, offering blue, red, yellow and infra-red light through a multi-focus head. The Levura LED light therapy improves fine lines and wrinkles, rejuvenates skin and reduces pigmentation.
COSMEDITECH Cosmeditech will be showcasing the Primelase Hair Removal device, offering a combination of solid state laser and diode laser for quicker and safer hair-removal treatments.
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INMODE InMode will be showcasing the Optimas system, providing light, laser and radiofrequency devices for skincare and hair removal in one work station.
PERFACTION TECHNOLOGIES PerfAction will be bringing the JVR powered Enerjet 2.0. The combined effect of controlled micro-trauma and healing compounds promotes collagen generation, creating thicker dermal tissue and correcting skin imperfections for long-lasting, healthy aesthetic improvement.
PROTOCOL Protocol, will be bringing its skincare range, including the Collagen Cordial, a clinical-grade collagen drink that contains vitamins B6, C & E, zinc, biotin, copper and bioactive collagen peptides for improved skin health and wound healing.
JETT MEDICAL Jett Medical will be bringing its Jett Plasma Pen as well as the VinDoc Lab, a new training and product range launched by Dr Vincent Wong, and the VinDoc PRP. Dr Vincent Wong will be offering free booster shot training to everyone who signs up for the IV Vitamin Course at the show.
LYNTON Lynton will be showcasing the Onda device. A non-surgical body-shaping device using Coolwaves that bypass the uppermost layers of skin tissue, delivering heat directly to the subcutaneous fat cells.
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ROSMETICS Rosmetics will be offering over ÂŁ100 off the VI Peel Collection Box at the show as well as showcasing the Carbomed Carboxytherapy machine that can be used for a range of conditions including body contouring and anti-ageing, stretch marks, and scars and dark circles.
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SKINGEN SkinGen will be bringing its flagship product range, SkinGenuity. Focused and targeted growth factors in the product range aid a range of conditions such as skin ageing, redness, hair loss and acne.
SKINBRANDS Skinbrands will be showcasing the new Triple Turmeric Complex collection from Priori. Containing the brand’s triple turmeric complex, the clean skincare line uses three kinds of turmeric root extracts as well as green tea, grape seed and licorice.
LASER LIPO Laser Lipo will exhibit Strawberry Lift, an aesthetic device that combines class-three lasers with silent ultrasound to lift the face and neck.
TRULY CONTENT Truly Content is an online marketing service, covering a broad range of essential marketing components, including online marketing packages, social media management, online ad campaigns and website design.
VENUS CONCEPT Venus Concept will be showcasing a range of its devices including the Venus Versa a multi-platform device offering IPL photo rejuvenation, IPL hair removal, radiofrequency skin tightening and nonablative skin resurfacing.
SKYNCARE Skyncare will be showcasing the HIFU MediLift, a non-invasive skin-tightening treatment, Biocare-lite, an advanced IPL, SHR and SSR device, and Biocareone, an all-in-one aesthetic platform.
AESTHETIC MEDICINE LIVE takes place at Olympia London on March 23–24. Attendance to the exhbition is free if you register in advance online at aesthetic medicine.co.uk/register
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Knowledge is power Find out what’s in store for our 2019 CPD-accredited education programme
N
ow in its fifth year, our two-day, two-agenda CPDaccredited conference, chaired by David Hicks, has grown from strength to strength. Featuring leading speakers from around the globe, its interactive format inspires discussion and audience participation. This year we will be hosting three individual conference streams, the first on Saturday March 23 on Agenda 1 will be on current injection techniques while Agenda 2 will feature day one of the Aesthetic Regenerative Medicine programme, new for 2019 and a UK first. On Sunday March 24 Agenda 1 will focus on the Skin while Agenda 2 will see the regenerative medicine programme continue for its second day.
DON’T’ MISS
SATURDAY MARCH 23 - CURRENT INJECTION TECHNIQUES A ONE-DAY CLINICAL CONFERENCE Injectables are key treatments in aesthetic clinics, but what are the latest techniques and innovations in this area of aesthetics? As part of this one-day conference, learn from some of the UK’s leading injectors about how they achieve their results and watch live demonstrations. Speakers include: Dr Anna Hemming , Dr Beatriz Molina, Dr Steven Harris and Dr Ash Labib
DON’T’ MISS
THE UK’S FIRST TWO-DAY CPD-ACCREDITED AESTHETIC REGENERATIVE MEDICINE CONFERNECE Aesthetic Medicine Live is proud to be hosting the UK”s first two-day conference dedicated solely to Aesthetic Regenerative Medicine, one of the future growth sectors of our industry.
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Chaired by Mr Ali Ghanem and organised in conjunction with Queen Mary’s University, this programme will educate you on the growing trend for a 360-degree approach to aesthetics, which utilises medical skills to not only address the outward signs of ageing but also those internal issues that exasperate aesthetic concerns. From bioidentical hormones to stem cells and more, examine the latest procedures and science that can expand your services and take your practice to the next level.
DON’T’ MISS
SUNDAY MARCH 24 SKIN: THE LATEST TRENDS The skin is the largest organ in the body and imporving its appearance is a huge part of what aesthetic medicine is about. Today’s one-day conference on skin will cover all areas of rejuvenation, from anatomy and assessment to the latest treatments and techniques using devices and products. Speakers include: Dr Uliana Gout, Anna Baker, Prof Mukta Sachdev AM Conference delegate passes cost £139+VAT for 1 day and £195+VAT for 2 days. Price includes entry to the Business workshops. Book before january 25 and take advantage of our Early Bird Offer 1 Day - £118 + VAT or 2 Days - £166 + VAT. To register visit aestheticmed.co.uk/live * Please note that entry to sessions on Saturday’s conference programme on Current Injection Techniques is limited to medically trained practitioners only and you will be asked to provide proof of your membership to a professional regulatory body such as the GMC, NMC or GDC. Aesthetic Medicine reserves the right to refuse entry to anyone not meeting that criteria.
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CLINICAL CONFERENCE SATURDAY MARCH 23
SUNDAY MARCH 24
8:30 - 9:30
COFFEE AND REGISTRATION
8:30 - 9:30
COFFEE AND REGISTRATION
9:30 – 12:45
CURRENT INJECTION TECHNIQUES A ONE-DAY CLINICAL CONFERENCE
9:30 – 12:30
SKIN: MEETING THE CHALLENGES MORNING SESSION Topics covered will include: the science and absorption of clay minerals, healthy skin from within, using plasma to improve skin quality and choosing and using a peel.
MORNING SESSION Topics covered will include: advertising and promoting injections, using toxins and fillers to rejuvenate selected areas , correcting ear lobes, the non-surgical lip lift, nasal corrections using HA and the latest techniques in non-surgical rhinoplasty (including live demo) Speakers include: Mr Ash Labib, Rosemary Drewitt-Staples, Cheryl Barton, Dr Katherine Taylor Barnes, Dr Steve Harris, Dr Kanliarda 12:45 – 14:45 LUNCH AND EXHIBITION VIEWING 14:45– 17:30
CURRENT INJECTION TECHNIQUES A ONE-DAY CLINICAL CONFERENCE
Speakers include: Dr Uliana Gout, Dr Shirin Lakhani, Ben Fuchs, Victoria Hiscock, Dr Ahmed Haq and Anna Baker
12:30 - 14:30
LUNCH AND EXHIBITION VIEWING
14:30 – 16:30
SKIN: MEETING THE CHALLENGES AFTERNOON SESSION Topics covered will include: fractionated CO2 for quality skin, using RF to improve skin quality, laser skin rejuvenation, skin of colour and The AML Dermatology Group panel discussion.
AFTERNOON SESSION Topics covered will include: using HA’s in body contouring and vaginal rejuvenation. The majority of the afternoon session will be dedicated to injection techniques for the face with live demos. Speakers include: Dr Aamer Khan, Dr Shazhadi Harper, Dr Beatriz Molina, Dr Shirin Lakhani, Prof Mukta Sachdev and Dr Anna Hemming
Speakers include: Dr Uliana Gout, Dr David Jack, Dr Bonan, Prof Mukta Sachdev, Dr Anna Hemming, Anna Baker, Dr Beatriz Molina, Victoria Hiscox, Dr Ana Prasad
AESTHETIC REGENERATIVE MEDICINE CONFERENCE in collaboration with M.Sc Aesthetic Medicine QMUL SATURDAY MARCH 23 8:30 - 9:30 9:30 – 12:45
SUNDAY MARCH 24
COFFEE AND REGISTRATION
8:30 - 9:30
COFFEE AND REGISTRATION
EVIDENCED BASED MEDICINE
9:30 – 12:30
TISSUE SPECIFIC STEM CELLS FOR SKIN, FOLLICLES AND BEYOND A workshop on micrografting
Topics covered will include: carboxytherapy, Ozone Therapy, bio identical hormones Speakers include: Mr Ali Ghanem, Dr Aamer Khan, Dr Daniel Sister, Dr Irfan Mian, Dr Martin Kinsella
FAT DERIVED STEM CELLS Fat microtransfer Speaker: Mr Ali Ghanem
SYNTHETIC REGENERATIVE MEDICINE Topics covered will include: Placenta derived stem cells, recombitant stem cells, harnessing growth factors Speakers include: Dr Ivor Lim, Dr Shirin Lakhani, Dr Anna Hemming, Dr Ahmed al-Qatani 12:45 – 14:45 LUNCH AND EXHIBITION VIEWING 14:45– 17:30
12:30 - 14:30
LUNCH AND EXHIBITION VIEWING
14:30 – 14.50 TECHNOLOGY IN REGENERATIVE MEDICINE
BLOOD DERIVED FACTORS Topics covered will include: PRP, PRF, combination therapies, combining PRP and PRF as a filler Speakers include: Dr Alex Kharki, Dr Daniel Sister, Dr Aamer Khan
Conference delegate passes cost £139+VAT for 1 day and £195+VAT for 2 days. Price includes entry to the Business workshops. To register visit aestheticmed.co.uk/live
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Business bootcamp The Aesthetic Medicine Live business workshops have a new format for 2019 with more interaction and take home tips to help you boost your business Get your business in shape for 2019 by attending this year’s Aesthetic Medicine Live Business Bootcamp! We are passionate about helping aesthetic practices grow and flourish and that’s why our business workshop programme has become one of the strongest parts of our educational programme. And, in 2019 we are shaking things up with a new format that makes the sessions more interactive than ever before. From audience participation and panel discussions to take away tips and role plays, this two-day programme chaired by Richard Crawford-Small will excite and invigorate your passion for your business. So come on, flex your business muscles and sign up today!
Saturday March 23 – Chair Richard Crawford-Small
Sunday March 24 – Chair Richard Crawford-Small
11am-1.30pm SESSION 1 GET MOTIVATED FOR SUCCESS IN 2019
11am-1.30pm SESSION 3 STANDING OUT FROM THE CROWD – HOW TO DIFFERENTIATE YOURSELF AND YOUR BUSINES S IN A COMPETITIVE MARKET
At the end of the first business quarter how do you keep yourself and your team motivated to drive your business to success? This session will examine different skills and techniques to reinvigorate you and your business for 2019. When you are operating at your best, your business will flourish too. 11am-11.45am Workshop 1: Fred Brandt Memorial Lecture “Physician Heal Thyself” Dr Sadequr Rahman 11.45am-12.30pm Workshop 2: What Entrepreneurs Do? Panel session with Dr Monah Mansoori, Dr Simon Zokaie, Dr Dev Patel, Helen Taylor and Nikki Zanna 12.30pm-1.15pm Workshop 3: My Three Key Takeaways: Tips from Top Business Coaches on Building and Growing Your Business Richard Crawford-Small, Mark Masters, Alan Adams and Dr Harry Singh, 1.15pm-2pm Workshop 4: Strategies to Motivate You and Your Team for Success 2pm-4.30pm SESSION 2 SALES COACHING BOOTCAMP Many medical practitioners find it hard to sell but working in the private sector means being able to sell yourself and your services is an important aspect of running a booming business. This session will include role plays, live interactive Q&As and coaching advice from the experts. 2pm-2.45pm Workshop 5: How to Sell: Getting into the Sales Mindset Jean Johnston
Aesthetics is a rapidly growing industry and with that comes both huge opportunity and competition so how do you stand out from the crowd and make your clinic shine? This session will focus on everything from creating engaging content such as video and social media marketing to developing your USPs and brand identity. 11am-11.45am Workshop 1: Developing your USP – What’s your Special Sauce? Richard and Amy Crawford-Small 11.45am-12.30pm Workshop 2: How to Write a Press Release and Get the Right Media Coverage Rebecca Barnes, Lynne Thomas, Sophie Attwood 12.30pm-1.15pm Workshop 3 : How to stand out from the crowd with your brand and online profile Dr Abdul-Karim Nassimizadeh, Adam Hamson, Dr Roshan Vara, Russell 1.15pm-2pm Workshop 4 Role Play and Improv to Improve Customer Service Customer service is one of the most important ways you can make your clinic stand out from the crowd but how do you keep your cool and maintain those standards when dealing with difficult or challenging clients? in this role play session trained actors will play the role of a different variety of patients and volunteers will be coached on 2pm-4.30pm SESSION 4 THE BEST LAID PLANS: PLANNING FOR SUCCESS
2.45pm-3.45pm Workshop 6: How I Boosted Sales in My Business Panel
How do you create a business plan, plan your business growth strategies or plan your marketing budgets and campaigns? Proper planning can make you more time efficient and help boost your business and drive growth.
3.45pm-4.30pm Workshop 7 KEYNOTE SPEAKER: Standout Selling: Top Tips from a World Leading Sales Coach Andy Preston
2pm-2.45pm Workshop 5: Time is of the Essence – How to More Effectively Plan and Manage Your Time to increase Productivity and the Bottom Line Dr Harry Singh
4.30pm-5.30pm Workshop 8: Mr and Mrs – The Secret of our Success presented by Martyn Roe Dr Beatriz Molina and Stephen Barlett, Dr Shirin Lakhani and Jay Shah, Debbie Thomas and Richard Weare, Dr Aamer Khan and Lesley Reynolds-Khan, Richard and Amy CrawfordSmall and Drs Simon and Emma Ravichandran
2.45pm-3.30pm Workshop 6: Money Talks: Creating Budgets and Financial Plans 3.30pm-4.15pm Workshop 7: Creating a Social Media and Video Marketing Plan Jon Mowat, Dr Zoya Diwan and Dr Sanjay Trikwan
Business workshops can be booked individually for £10 each or for those who want to attend multiple sessions as well as the clinical edication, buy a full delegate pass and access all the CPD-accredited education on offer.
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MINUTE LASER BODY SCULPTING
23-24 March 2019 Olympia London
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Live Stage Our Live Stage programme offers you a chance to see free live demonstrations and listen to talks from KOLs on some of the treatments and brands on display at the show Saturday March 23
Sunday March 24
11.00
Using new microwave technology to selectively target fat cells Dr Aamer Khan (Lynton Lasers)
11.30
Microneedling scar tissue (using Bellus Medicals SkinPen Precision) Dr Andy Williams (Bio-Active Aesthetics)
Celuma Dr Aamer Khan
11.30
Wigmore Medical
12.00
Specific depth tissue tightening with 3rd generation HIFU Dr Beatriz Molina (Church Pharmacy)
12.30
Fusion GT
13.00
Castle House Medical
13.30
Are all plasma devices the same? Dr Vincent Wong (Jett Medical)
14.00
A modern approach to using HIFU technology for nonsurgical face lifts and body reshaping Dr Alex Karkhi (Enoura Aesthetics)
12.00
Lumenis Kevin Williams
12.30
Combination treatments for total skin rejuvenation Dr Ivona Igerc (Venus Concept)
13.00
PRP Labs
13.30
Advanced Esthetics Solutions
14.00
Submental fat and the facts behind the treatments for this area Mr Brent Tanner (Strawberry Lift)
14.30
Alumier Labs Victoria Hiscock
14.30
Smart Group
15.00
Syneron Candela
15.00
How to protect your business Naomi Di Scala (Hamilton Fraser)
16.00
Aesthetic Source
15.30
Amitis New World
16:30
Skingen
16.00
Bio ID
DON’T MISS
DON’T MISS
SATURDAY MARCH 23 • 11.00AM Using new microwave technology to selectively target fat cells (Lynton Lasers)
SUNDAY MARCH 24 • 12.00PM Specific depth tissue tightening with 3rd generation HIFU (Church Pharmacy)
Dr Aamer Khan
Dr Beatriz Molina
SATURDAY MARCH 23 • 11.30AM Microneedling scar tissue (using Bellus Medical’s SkinPen Precision) Dr Andy Williams
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11.00
SUNDAY MARCH 24 • 13.30PM Are all plasma devices the same? (Jett Medical) Dr Vincent Wong
SATURDAY MARCH 23 • 14.00PM Submental fat and the facts behind the treatments for this area (Strawberry Lift)
SUNDAY MARCH 24 • 13.30PM A modern approach to using HIFU technology for non-surgical face lifts and body reshaping (Enoura Aesthetics)
Mr Brent Tanner
Dr Alex Karkhi
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1 Fractional CO2 laser for vaginal tightening
SEE US ON STAND F16
23-24 March 2019 Olympia London
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23-24 March 2019 Olympia London
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UKAAPS Surgeons’ Day Aesthetic Medicine Live will be welcoming surgeons from around the globe to the fourth annual UKAAPS conference Leading plastic surgeons from around the world will be coming to London for the fourth annual UKAAPS conference in association with Aesthetic Medicine Live 2019. The one-day agenda is free to access for UKAAPS members and AM Live delgates with full delgates passes. The programme will include presentations on a wide range of both facial and body techniques for surgery from practical applications for regenerative medicine; Facetite, Bodytite radiofrequency; the role of injection therapy; update on toxins and the “one stitch hitch”; non-surgical rejuvenation of the neck; ellevate neck lift procedure; presto facelift; mini-facelift and autologous fat revolumisation and ancillary facial plastic surgery procedures to closed rhinoplasty; innovative minimally invasive Earfold Implant System for correction of bilateral prominent ears; the effects of ‘cold’ thermally produced plasma on wound healing and biofilm; breast pocket and implant selection; breast reduction, mastopexy, mastopexy augment complications; skin reducing surgery in gynaecomastia treatment; a message on the dangers of fat graft to buttocks and an update on the Brazilian Butt Lift and rhinophyma.
Speakers include: Mr Ali Ghanem, Mr Taimur Shoaib, Mr Dalvi Humzah, Mr Greg Mueller, Mr Fuan Chan, Pro James Frame, Mr Pericles Foroglou, Mr Shailesh Vadodaria, Mr Shadi Ali, Mr Rudo Madada-Nyakauru, Mr Charles Malata, Mr Riccadro Frati, Mr Tariq Ahmad, Ros Hannen, Paul Baguley, Neil Wolfenden and Peter Cranstone.
Hair today Aesthetic Medicine Live is proud to be partnering with the British Assocation of Hair Restoration Surgery to host its annual conference 2018 saw Aesthetic Medicine Live’s first collaboration with the British Assocation of Hair Restoration Surgery (BAHRS) and this year they are back with a two day conference at the show. Covering the latest advancements and trends in this exciting and developing field, topics on day one will include: hair surgery and simulation – multi-modality options and pitfalls; integrating adjuvant therapies into a
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hair loss practice; managing hair loss in afro-textured hair; what is the role of SPM and prosthetic hair fibres in hair loss?; optimising your practice and avoiding problems; the psychology of hair loss; complications in hair transplant surgery and hair restoration – non-surgical injectable options. Day two will see topics covering injectable options for hair loss, stem cell and growth factor therapy for hair loss, platelet rich injections for hair loss and the best of the non-injectable non-pharmacological hair loss therapies. Speakers will include Patrick Mwamba, Iain Sallis, Mr Ali Ghanem, Ingrid Wilson, Sharon Wong, Stephanie Sey, Emma Furlong, Nilofer Farjo, Dr Ash Dutta, Dawn Forshaw, Debbie Clifford, Paul Beguley and Mr Max Malik. BAHRS Delegate 1 day £125 + VAT BAHRS Delegate 2 days £175 + VAT AM
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Building conversion Digital marketing specialist Adam Hampson divulges how to design and build a website for the best chances of conversion
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our website could become invaluable to your business when it’s designed and built with the best usability and engaging content. The steady growth and evolution of medical aesthetics has led to a boom in those seeking treatments and those seeking to provide them, creating a highly competitive marketplace. In order to compete, you need to stand out from your competitors, both local and further afield, and ensure that you are communicating everything necessary with your brand. Combine the need for brand communication, competition, and boosted conversion rates and at this crossroads you will find web design. I’m going to lead you through the three key components and the elements your website needs to conquer 2019.
channels, print media, and email marketing, which helps instil a certain reputation. A lot can be absorbed from the design of a logo and the colour scheme chosen for your website, so cater these aspects to your target market to ensure that you receive conversions from users who are likely to become loyal and repeat clients. Create brand unity and brand communication to best instil trust in your traffic and encourage them to enquire about your treatments and services.
When you design your website, you need to design for your traffic’s journey. Don’t confuse the user with rabbit warrens of pages
USABILITY: DOES IT WORK?
Designing In order to gain new conversions from your website visitors, they need to trust you. Often someone’s first interaction with your clinic is through your website, and even word-ofmouth and social recommendations are followed up with a website visit to learn more about you. This is why it’s vitally important that your website not only works, but works well, because a website with poor usability will detract exponentially from traffic trust levels. When you design your website, you need to design for your traffic’s journey. Don’t confuse the user with rabbit warrens of pages and a confusing array of clickable links and buttons. Consider for yourself what you feel would make you distrust a website – long loading times, broken pages and misplaced elements that just don’t feel right – and then design and build to combat them. Keep your website simple and easy to navigate with a design that makes sense. If there is potential for a user to get lost on your site, then you’re going to put them off from enquiring about your services.
Images and photography When designing and building your website, you need to populate it with the different aspects that makes your clinic unique. This kind of image content can come directly from you and your team. Premises photos, treatment demonstrations, before and afters, and team photos are all effective examples of photography that help humanise your aesthetics clinic. Seeing these kinds of images on your website will tell your site visitors who you are, what you look like, and that they can place their trust in you. Some of the best social media interaction comes from these kinds of organic images and content, so using the products of a photoshoot on your website will help demonstrate to your visitors that you are proud to share your clinic with them. Not only this, but unique images (i.e. non-stock images that come directly from you) are valued better by search engines and could improve your SEO. >
Mobile compatibility In this age of smartphones and tablets, you need a website that is mobile compatible. With search engines like Google actually penalising websites that don’t have this kind of compatibility, it’s never been more important to your website’s visibility and value that it works and looks great on a mobile screen. Your website should have separate designs for mobile and desktop to ensure that you’re not stretching images, compressing text, or completely cutting off some important aspects like contact forms. More web browsing and Google searching is done on these portable devices than on desktops and laptops, so if you don’t have a functioning mobile site for your clinic then you could be missing out on some curious new clients.
CONTENT: WHO ARE YOU?
Branding A well-designed logo, memorable tag line, and branding colours all help to unify your website with the rest of your marketing materials. Achieving brand unity across your website will help users to recognise your social media
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forms or contact forms are boxes placed on website pages that ask for contact details and a message, allowing your website visitors to send a question to you, arrange a callback, or share their interest. Placing these contact forms on your website will help to encourage real-time enquiries, and attentive responses will help to boost your conversion rate. They can’t convert if they can’t contact you, so these will be invaluable to your site! Mailing list sign-ups If you use email marketing and would like to consensually receive your traffic’s email addresses, including a mailing list sign-up on your website is important. This encourages further communication with your clinic and allows your team to keep in touch with the latest offers, treatments, and promotions to encourage repeated conversions. Mailing list sign-ups can also function as a litmus test for how engaging your content is, allowing you to make appropriate changes to drive more interest. A mailing list sign-up gets your foot in the door of a fresh conversion, but your email content will really seal the deal. Written content Written content directly communicates the treatments and services you provide, who you are as a team, and who you are as a brand. Your tone, level of information, and approachability will all be conveyed in the words and sentences you choose to represent your clinic, which is why it needs some time and attention. If your written content doesn’t flow well, has incorrect punctuation and spelling mistakes, and doesn’t provide enough information to your website visitors then you could be really hindering your conversion rates. Effective written communication is persuasive, approachable, and easily digestible, ensuring you’re garnering the interest and trust of your visitors rather than alienating them with too much jarring and intimidating medical jargon. Search engines are now valuing the readability and human appeal of written content over keywords, so it’s very important your written content is written for reading first, SEO second.
Social media links Sometimes a conversion comes after a little more research into your clinic, for example after someone has interacted with your social media. Clients that are converting are generally more clued up about the products they are receiving and who is performing their treatment, so they may interact with your social media too before booking with you. In any case, links to your different social media platforms on your website encourage further contact with your brand. They may visit your website once or twice and decide to follow your Facebook or Instagram pages, whose new content they will see when they scroll down their newsfeed. This kind of routine brand communication can help to build their trust in your clinic, which can lead to a conversion. Inviting your website users to engage with your brand across different platforms helps to build your users’ trust in your clinic and provides a consistent reminder of your services, treatments, and reasons to convert. A website that is filled with engaging content, is easy to use, and encouraging of future communication with your clinic can form the basis of many conversions and digital marketing campaigns to come. Reaching the perfect balance of information, imagery, and functionality might seem difficult, but when all are combined you could see an improvement in your conversion rates. Merge your web design with attentive search engine optimisation, and you will become a formidable competitor in your local area and even beyond. AM
Inviting your website users to engage with your brand across different platforms helps to build your users’ trust
CONTACT: WHERE CAN I CONVERT?
Contact and enquiry forms All of these design elements work in tandem to drive your website visitors to get in contact with you and your team and convert to a treatment. This means that, after all of this shepherding and trust instigating, you need to give your visitors appropriate opportunities to convert. Enquiry
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Adam Hampson is the founder and managing director of Cosmetic Digital in Nottingham, a digital marketing agency that specialises in healthcare, aesthetics, medical, and dentistry marketing. Established for over 13 years, Cosmetic Digital has become one of the UK’s leading digital marketing agencies for these lucrative sectors. Cosmetic Digital’s in-house team continues to provide timeless yet contemporary websites and digital marketing solutions for clients in both the UK and overseas, and for businesses large and small.
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rowing g t s e t s a f the unity. m m o C ’ s Be part of r trepreneu n E c i t e h t Aes discover d n a , t r o p alth of sup e w a s s e c ourses, c Ac s s e n i s u ge of b our full ran orum. and f resources y visit: l p p a o t d rmation an o f n i e r o m For rs.com u e n e r p e r theticent www.aes
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CALL FOR ARTICLES Are you interested in becoming a contributor to Aesthetic Medicine magazine? Do you have any articles you would like to write or any thoughts, treatment tips or techniques you would like to share? Then we want to hear from you. Whether it’s writing about running an aesthetics business or sharing your case studies and clinical expertise, then get in touch and let us know your ideas by emailing
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Say Cheese Dr Sophie Shotter and Clint Singh on how to get good before and afters in aesthetics DR SOPHIE SHOTTER
“From the first moment I started working in aesthetics I understood the importance of good before and after photographs. Not least because my insurance policy contains an explicit clause that they will only cover me for treatments if I take before and after pictures. As I spent more and more time in aesthetics I also wanted to produce good photographs to demonstrate my results – both for sharing with prospective patients and for marketing. Spending time looking at industry colleagues’ social media, I found the vast majority of the time I was picking apart the
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photographs – pictures were taken from different angles, with different lighting conditions. I didn’t feel most of these photos showed a true result. When I first set up Illuminate Skin Clinic, I was determined to get the photography right. I tried everywhere to find some good guidance on clinical photography, but for once Google was coming up empty. I did my best to get it right, and one of my first investments was a good Digital SLR camera complete with an extra flash and flash diffuser. I hung charcoal grey blinds in the treatment rooms, as a plastic surgeon colleague had told me this provided the
After
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expert to help me get my set up just right. I now produce studio quality photography, with entirely reproducable photographs regardless of how bright it is outside.”
CLINT SINGH
“Getting consistent before and after images is much harder than people realise. It’s not as simple as buying a camera, then pointing and shooting . When I first looked at the sort of photographs Sophie wanted to achieve, it was clear an iPad was not the right choice of equipment. The pictures she was producing were not standardised, often blurry and out of focus, and showed colour differences from one picture to the next. This is because cameras set in ‘auto’ modes, like iPads and iPhones, will make changes according to the varying light conditions. These adjustments are the main reasons for making images blurry and for the colour variation. Not everyone has huge budgets for getting photography right, although personally I feel the investment in producing great before and after images pays off quickly in engaging patients. There are six simple tips you can use to get this right: Use a camera that allows you to make manual adjustments. This doesn’t have to be a very expensive camera – you’re not a professional photographer. But a decent DSLR is crucial for your kit. Invest in some basic training on how to use your camera. If you understand how the camera works you will be able
From the first moment I started working in aesthetics I understood the importance of good before and after photographs
best background for showing shadows and therefore demonstrating results. Yet I still found that my photographs looked inconsistent, and this was clearly demonstrated by the difference in the tone of the charcoal background in before and after images. I dabbled with everything I could think of but could not get it right. I ended up reverting back to an iPad based system – if the DSLR wasn’t providing me with the image quality I needed, then why bother with the hassle? Setting up in business I, like many of you, tried to be a jack of all trades. Trying to do the social media and the bookkeeping, as well as performing treatments. My journey in business has taught me that while I can do these things, I can’t do them as well as an expert. The key to my business growth has been outsourcing. I’m an expert clinician, and I now work with experts in other fields who help me get these things right. It was the same with photography – it took an
Before
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Not everyone has huge budgets for getting photography right, although personally I feel the investment in producing great before and after images pays off quickly
Before and after using the old set up
to change some simple settings that allow you to take better photographs. Ideally have a room for photography with no natural lighting. This removes any variability in the final pictures. If this isn’t an option then just try to take the photos in the same spot and with the same camera, with lighting as close to that in the original photo as possible. Have a black background. This is easier to do than you realise. You could buy a black roller blind to mount on the wall, or a black sheet to hang over a door. This background is best for showcasing your results, and is not distracting. Try to use a hairband and a black shoulder drape for your photos – this removes distracting features in your patients’ hair and clothing. To make it easier to get the angles of your photographs the same, mount some gaze spots on the wall around the room. You can ask the patient to look at these and it will help to keep their chin position and their eye direction the same between pictures.
DR SOPHIE SHOTTER
Having spoken with Clint I decided to go a step further, and set up a dedicated photography suite. When developing our new clinic premises, I asked the designer to create a room with no natural light. I opted for the PhotoPro Studio set up – I have a DSLR camera, light tent and a tripod. It has made things so much easier for me – I don’t need to worry about remembering to charge the flash batteries, as the set up does it all for me. With the confidence that the photographs now genuinely show my fantastic results, I’ve been able to implement so many more ideas within my business. I have a patient co-ordinator who regularly
looks through the before and after photos as she uploads them onto our CRM system. If she thinks one is particularly great, she immediately asks the patients for permission to use it. We create patient stories for our website. We all know the impact some of our treatments have on our patients. Where someone is willing to share their journey with us, it’s the most powerful way of conveying the message. It’s far better to get someone else to sing your praises than for you to tell the world how great you are. It’s so refreshing to be able to use our own great quality before and after images on social media that haven’t been used on 50 other clinic’s pages. Having our own images also allows us to create bespoke consultation tools. We have used a professional designer to compile some of our own before and after images into a lovely folder in clinic. This is within easy reach if I want to show a patient what we can achieve. I feel this is much more powerful than using generic images. Sharing patients’ own results with them is also important. We all get those patients sometimes who come back two weeks after treatment, feeling like they can’t see any difference. When we are doing subtle treatments, our patients quickly forget what they used to look like. I now have the confidence to show them the before and after images without worrying that they are going to pick them apart like I do! Showing them their great result definitely improves patient satisfaction. I think it’s really worthwhile thinking about your own set-up and getting it right for you. A picture tells a thousand words, as they say. It’s worth some investment to get your message out there more powerfully. AM
Clint Singh is a professional photographer and photography mentor. He runs ‘off the grid’ photography workshops and training courses in locations including Iceland, Greenland and the Sahara, as well as in the UK. He also acts as a photography mentor to many clients who have attended his courses, providing on-going guidance and tuition as they continue to develop their photographic skills. While working with a client who owned a dental practice and required an ‘in-house’ photographic facility, Clint realised the broader need for products of this nature. In consultation with aesthetics and other medical clinic owners, he developed and launched Clinical PhotoPro.
Dr Sophie Shotter has worked full-time in aesthetics for five years, setting up her own clinic in Kings Hill, Kent and working for the Cosmetic Skin Clinic two to three days per week. Her passion is for achieving natural balanced results through injectables and high quality treatments. She is a trainer for Aesthetic Source and key opinion leader for Venus Concept. She is also personally mentored by Dr Mauricio de Maio through the Allergan Mentorship programme, with a view to joining its faculty.
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Aesthetic Awards Supplement January 2019
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23-24 March 2019 Olympia London
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Constructive feedback Victoria Vilas on how to deliver constructive feedback to staff
A
s a clinic manager, you may on occasion find yourself in a situation where you feel disappointed by the lack of effort from a member of staff, but your team member hasn’t done anything serious enough to warrant a warning. You feel like giving your team member a telling off, but you don’t want them to feel as if they have been singled out or made an example of, and you don’t want your criticism to hurt their feelings, as you know a dejected team member won’t do much to help team morale or performance. It is possible to deliver criticism as constructive feedback, but it may take a bit of practice to perfect the kind of tactful language that will be effective and motivational, and be seen as fair and valuable. After all, when you feel annoyed or let down by a staff member, the first words that come to mind are probably not the most diplomatic. We would all love to be managers of a flawless team who complete each of their daily tasks demonstrating their best effort, skill and positive attitude, but in reality, none of us can be perfect or at our best every day of the year. There will be times when you must address areas that need improvement, and deliver feedback to your team members that is not entirely positive. You will have to prepare staff assessments for performance reviews and one-to-ones, or perhaps hold an
impromptu meeting when a problem arises that needs to be dealt with promptly. The problem may take several forms. It may be that a team member hasn’t followed procedure correctly or has behaved in an inappropriate manner in front of patients. Perhaps your employee hasn’t hit their targets, or has received some less-than-perfect feedback from patients. Whatever the scenario, there are a few steps you can follow each time to make your feedback process consistent and fair. Make it timely. If a team member could just do with a bit of a boost to improve their work overall, perhaps the feedback can wait until your scheduled monthly one-to-one. If they have made an error that needs addressing sooner, ask them to join you for an informal but private chat as soon as you can. Chances are, your employee will be aware of the issue and may be expecting you to call them aside anyway. Don’t criticise in public. It isn’t fair to make an example of a team member by chastising them in front of their colleagues. Some employees who are not so selfassured may feel crushed by such a scene, or belittled, which is unlikely to inspire them. Communicate with tactful and diplomatic language. Use objective phrasing and keep your conversation free of ‘blame’. Refer to the situation not the individual. Try saying >
It is possible to deliver criticism as constructive feedback, but it may take a bit of practice to perfect the kind of tactful language that will be effective and motivational
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“when greeting patients over the phone, I would like all team members to state their name, please,” instead of “you never remember to say who you are when you answer the phone”. Don’t say, “you never do this right” or “you always do this”, as it sounds as if you have typecast your employee and you will always look at them in a negative light. If it appears as if you have no belief in your staff members, they are unlikely to respect you as a manager. Be sincere and be specific. Don’t give false praise or skirt around an issue. Be honest, in a tactful way, and identify the exact issue, using examples if necessary. For example, rather than saying “you need to improve your communication”, say “we need to talk about communication, specifically about how all team members should speak to patients enquiring over the phone”. Don’t balance negative feedback with generic praise that means nothing to the individual. For example, rather than saying “other than that, everything is fine”, try saying “though we’ve had to discuss this issue about communication over the phone, I would also like to commend you for the positive feedback you’ve received from the patients you’ve treated this week”. Listen, and ask for feedback in return. An appraisal or one-to-one should not be a one-sided meeting where a manager does all the talking. Remember to listen to your team member, too. Try asking them what they think of the situation, and their own opinion of their performance. Criticism may be easier to deliver if an employee is already aware of what they have done wrong and can identify
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the issue before you have to. Also, ask if there is anything that you or the team could do to help them solve the issue. Offering assistance will help an employee know that they have a supportive manager. Don’t just offer negatives, give praise too. You may have called your team member aside to point out something they have done wrong, but try and balance that by thanking them for what they have done right. No one wants to feel as if they have been a hindrance, so don’t focus solely on negatives. Be aware of your tone and body language. You may have mastered the art of using tactful language when you have criticism to deliver, but have you thought about whether your displeasure shows in your body language or your tone of voice? If your words suggest you are being impartial and open-minded, but your body language and tone suggest you are angry, then you may appear to be passive-aggressive and your chat may not have the desired effect. Make eye contact, sit back in a relaxed position with uncrossed arms, and speak slowly in a calm tone. Remember that the ideal outcome of a one-to-one is for an employee to leave feeling motivated and positive, regardless of whether the feedback they received is glowing praise or constructive criticism. Keep that in mind every time you have feedback to give to a team member, and take the time to consider and plan your approach. The better you manage feedback, the more respect you are likely to garner from your team. AM
Victoria Vilas is marketing and operations manager at ARC, an aesthetics recruitment consultancy. The ARC team helps organisations in the industry grow their businesses by hiring the most talented aesthetic professionals.
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Authentic communication Richard Crawford-Small on resonance marketing and how being authentic in your messages can help you build better relationships with clients
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f your clients trust you to solve their problems, you’ll never have to sell anything”. I don’t know if I coined this phrase, or someone else did. It doesn’t actually matter as I’m claiming it anyway. It’s a cool phrase, and one that has shaped the whole ethos and philosophy of not just my business, but the business of everyone I am working with. In 2019 there are three very simple truths: People do NOT want to be sold to People only buy from those they TRUST People will NOT just hand over money In truth this has always been the case, but the real trick is how do you promote a product or service without coming across as a sleazy sales person?
The answer is pretty simple, you need to embrace the philosophy of “resonance marketing”. Resonance marketing is where your personal beliefs and your business values align perfectly with the beliefs and values of your ideal client. When you create some marketing content that does this, it “resonates” with them and as if by magic you attract a new client. It sounds simple and it would be, if it wasn’t for one thing: Your message needs to be genuine, honest and not actually sell anything. Now, for mere mortals this is a challenge, but for aesthetic entrepreneurs it’s just what we do. The key to getting resonance in your marketing is to follow a structure that allows your ideal client to follow the breadcrumbs to your door. >
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BUSINESS
BUSINESS CONNECTIONS
You need to create conversations, build meaningful relationships and convert those relationships to sales. The biggest mistake you can make is to try to “close the sale” before you’ve built any kind of relationship. If you do this you’ll create a dissonant environment and it’s at this point that both you and your client will feel uncomfortable. At the end of the day we are all human, and being over-eager in building relationships is never a good thing, so just relax, If you get this right, you’ll enjoy a life without ever feeling like you are selling to anyone. I always follow a simple structure to make sure that any campaign is resonant, but there are three key issues that will prevent you from achieving it.
1. YOU DON’T KNOW WHO YOUR IDEAL CLIENTS ARE
I have found it a rare thing indeed that anyone puts any real thought into who they are actually trying to target. We are in the business of solving problems, not selling and without the fundamental understanding of who you want to serve, what problems they have and how important those problems are you cannot hope to achieve resonance. This is called defining your customer avatar, and it is crucial to the success of your business. An easy way to do this is to think of an actual client, someone you really wouldn’t mind treating or working with every day. You might have more than one (I actually have four different avatars), and I have created products and services for each one. Now, this neatly leads on to the second thing that will kill your resonance.
2. YOU DON’T KNOW WHAT PROBLEM THEY HAVE
If your clients trust you to solve their problems, you’ll never have to sell anything
We create our products and solutions based on data and insight gained from each of our avatars on what the key issues they faced were and the problems they have. How do we achieve this I hear you cry? Really simply, I ask them. No clever marketing, no underhand strategies, just ask really simple question. “If I could wave a magic wand, and get rid of a problem in your business, what would i have to do?” Then listen to the answer. I mean really listen to the answer, not superficial pretend listening but dig in, actually care about the answer, be interested in what they are saying. The language used will give you some real insight into the tone of your messaging, after all you’re trying to connect with them so why not use the same language as they do? Which leads me on to the final, and most important thing that will prevent your marketing from resonating
3. YOU’RE NOT BEING AUTHENTIC
Authenticity is a word that is becoming increasingly used in the marketing world, and simply for me it means just being yourself. People know when someone is being disingenuous, and it sticks out a mile. Authenticity means allowing your personality to shine through in your marketing, and connect your beliefs with your ideal client. For example, veganism
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is very much on trend in the aesthetics world. If you are claiming that you’re vegan friendly, but you are doing it to be on trend and couldn’t actually care less about veganism, you will not be able to sustain that messaging and will appear totally inauthentic to that audience. However, dissonance isn’t a bad thing. We cannot be all things to all people, yet many try to do exactly that when they advertise or market their business. Being all things to all people means you are being nothing to no one, and it’s this lack of bravery that will hamper your business growth. So find out who your customers really are, find out what problems they have and create solutions for them. The final benefit of resonance is that you will attract partnerships, and this is a fantastic opportunity that many miss. The concept of “connected aesthetics” as pioneered by us, is still very new, however, it has the potential to radically transform a business. Essentially, once you have identified your ideal client, it’s relatively easy to then identify other businesses that serve them. It doesn’t need to be the obvious contenders either, one of my clients partnered with the local Audi dealership and ran an event. If they sell to your avatar, they are connected. So think out of the box, be creative, be authentic, be bold, be brave, don’t be boring. Be yourselves! AM
Richard Crawford-Small has more than 14 years’ experience in helping to grow aesthetic businesses. His unique approach to consultancy, and helping you put your clients first has led to the creation of the award-winning iConsult system. Crawford-Small is the author of the best-selling book, Changing Faces, and the creator of Aesthetic Entrepreneurs (aestheticentreprenuers.com), the fastest growing aesthetic business community online.
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VITAMIN C
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VITAMIN C
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C
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In this month’s dossier we take a look at vitamin C based products
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n 2018 vitamin C was highlighted as being among the “hottest beauty ingredients” of the year. On social media the Pinterest 100, an insight report based on users’ top pins, showed that “saves” of images tagged with “vitamin C” were up by 3,379. In the aesthetics industry we have long known the power of this superhero antioxidant, but, as skincare technology has progressed, so too has the use of this potent but unstable ingredient in products which harness its benefits in new and exciting ways. Here we round up some of the best vitamin C products on the market.
Victoria Hiscock, product and education specialist at AlumierMD explains, “L-ascorbic acid (LAA) is the only bioavailable form of vitamin C that’s been proven to stimulate collagen production and improve collagen quality in the skin. However, it needs to be delivered into the skin at 15% in a base formula with a pH of 3.5 or less. “What makes EverActive C&E so unique is that it delivers fresh and active 15% LAA into the skin along with a peptide for further upregulation of fibroblast activity at a pH of 2.12.5, all while adhering to our commitment to safe chemistry. Nothing short of a scientific achievement.”
DCL (MEDICAL AESTHETIC GROUP)
ALUMIERMD EVERACTIVE C&E (ALUMIER LABS)
One of the star skincare launches of 2018 was AlumierMD’s new EverActive C&E. The potent antioxidant serum was four years in research and development before coming to market. It contains 15% vitamin C and utilises a unique delivery system that ensures the complex is always optimally active. Each bottle of EverActive C&E incorporates two chambers – the first containing the active serum and the second containing the vitamin C crystals, which are released into the serum by snapping the air-tight seal. Each pack contains three individual bottles to be opened one at a time to further enhance the efficacy of the vitamin C against oxidisation. This avoids the long-term challenge with the use of vitamin C which is notoriously unstable and oxidises easily, making it turn brown and and become no longer beneficial to the skin. The product’s key ingredients include L-ascorbic acid USP, the only bioavailable form of vitamin C for the skin and a powerful antioxidant that protects cells from free radical damage caused by the sun and pollution. Vitamin C is also essential for collagen synthesis, which helps reduce the appearance of fine lines and wrinkles and brightens and evens out skin tone. It also includes tocopherol acetate USP, an effective form of vitamin E that is highly moisturising and fat soluble. It helps to protect cell membranes and acts as an antioxidant, which strengthens the effect of the vitamin C. Finally, the tripeptide peptide matrixyl synthe’6 stimulates the synthesis of six major constituents of the skin, including collagen, elastin, hyaluronic acid, fibronectin and laminin.
Vitamin C is a key ingredient in DCL’s age prevention ranage of daily treatments. Infused with a triple vitamin C complex and silanol technology, along with other protective and revitalising powerhouses, the products are designed to rejuvenate skin, safeguard it from future damage and fight the first signs of ageing. Products include C-Scape Enzymatic Gel Cleanser; C-Scape High Potency Night Booster 30; C-Scape High Potency Serum 25 and C-Scape High Potency Eye Treatment. There is also a C Scape High Potency Body Lotion. The C-Scape High Potency Night Booster contains a 30% concentration of L-ascorbic acid, plus a groundbreaking vitamin C that are gently released into skin both immediately and over time for maximum efficacy and absorption. Advanced technology strengthens skin’s other structural components to improve elasticity and help fend off lines and wrinkles. Intense hydrators deeply moisturise, as antioxidants valiantly safeguard from environmental assailants. Meanwhile, focused brighteners even out skin tone creating a healthier, more radiant and beautifully uniform complexion.
DERMAQUEST C INFUSION COLLECTION (DERMAPURE)
DermaQuest’s C Infusion collection includes three hero products: C Infusion Cleanser, C Infusion Eye Cream and C Infusion Serum. Overflowing with antioxidants, the foaming C Infusion Cleanser purifies and preserves while slowing the effects of harmful free radicals. It leaves the skin feeling refreshed, energised and primed for homecare or professional treatments. >
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VITAMIN C
C Infusion Eye Cream is specifically developed with orange plant stem cells and Hyaluronic Acid Filling > Spheres™ to deeply hydrate and improve skin’s lustre. The revitalising effects of Eyeliss™ and Matrixyl™ reduce dark circles and increase circulation to the delicate skin under the eye. C Infusion Serum uses a lipid soluble vitamin C: extraactive BV-OSC and Orange Plant Stem Cells, known to gently tone and tighten, while protecting skin from harmful free radicals that cause fine lines and wrinkles. A good investment for all skin types at every stage, C Infusion energises skin as discoloration and future signs of ageing recede through the power of nourishing antioxidants.
EPIONCE INTENSE DEFENCE SERUM (EDEN AESTHETICS)
Epionce Intense Defense Serum contains vitamins A, B, C, D and E at optimum concentrations in a form as they exist in the skin. The powerful antioxidants and anti-inflammatories in this highly advanced anti-ageing serum stimulate skin rejuvenation, helping the skin to function properly. It reverses fine lines, wrinkles, roughness and uneven skin tone while improving firmness, elasticity and texture. In only one week, fine lines and wrinkles were visibly improved – 94% better than leading anti-ageing physician-strength serums. The serum provides the functionality of high therapeutic concentrations, without the pro inflammatory and barrier destroying properties typically associated with vitamin-derived serums.
EXUVIANCE AF 20% VITAMIN C20 SERUM CAPSULES (AESTHETIC SOURCE) Exuviance’s potent new capsules, launched in 2018, contain 20% maximum strength vitamin C to visibly transform the skin, brightening the appearance of dark spots and leaving the skin feeling silky smooth to the touch. They contain L-ascorbic acid to help reverse the effects of skin damage caused by over exposure to the sun, while providing protection against further environmental damage including pollution. It also stimulates collagen production, promoting
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tighter and firmer skin and revealing a bright and luminous complexion. Combined with AminoFilTM, these capsules deliver plumper and firmer skin by helping to volumise and reduce the appearance of deep wrinkles. With these potent ingredients, each capsule leaves the skin looking and feeling both youthful and glowing. Pamela Marshall, owner of Mortar & Milk clinic says, “These capsules are truly the best vitamin C product I’ve ever tried, both in treatment and at home. With 20% L-ascorbic acid and 1% AminofilTM, Exuviance has created a masterful combination of effectiveness, without any irritation. They are great for the face, neck and décolleté, but also on the back of the hands to help reduce pigmentation and premature ageing.”
IMAGE SKINCARE VITAL C (IMAGE)
Vital C Hydrating Anti-Ageing Serum is an Image bestseller. It works effectively on all skin types to soften the appearance of wrinkles, support collagen, and protect skin against oxidative damage. It acts as a wake-up call on the skin to fight the visible signs of stress and fatigue that commonly appear in ageing skin. As well as brightening and tightening the skin, it binds moisture and protects against the effects of environmental damage. It is also clinically proven to support collagen synthesis. Vital C Hydrating Eye Recovery Gel is a cooling gel formula that soothes the delicate eye area and improves the signs of ageing with ultra-hydrating hyaluronic acid, wrinkle-altering peptides and nourishing antioxidants. Featuring a proprietary Collagen Recovery Complex, it helps to firm skin, improve elasticity and diminish dark circles and puffiness.
IS CLINICAL ADVANCE+ LINE (HARPAR GRACE)
The iS Clinical Advance+ line features cutting-edge vitamin C technology along with copper tripeptide growth factor (in select products). The technology employed in the Advance+ formulas has been developed to increase stability and to offer time-released, continuous and steady delivery of L-ascorbic acid to the cell, providing a more efficient and effective form of vitamin C. This powerhouse ingredient provides improved collagen production, exceptional an-tioxidant and UV-photo protection, as well as safe, natural lightening of the skin. Until now, the addition of copper-containing substances to vitamin C products has been quite problematic because copper oxidizes the L-ascorbic acid. The addition of another moiety to its chemical structure allows Advance+ L-ascorbic acid to become much more stable and facilitates easier formulation. This is particularly important when combined with substances that might react with it. This exact issue was investigated by using copper ions as a pro-oxidant and adding it to the Advance+ L-ascorbic acid. At the experiment’s conclusion, the amount
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of copper and the amount of Advance+ L-ascorbic acid remained unchanged. Hero products include Pro-Heal Serum Advance + which combines vitamin C with a superior form of olive leaf extract, and pure vitamins E and A. This powerful formulation significantly increases antioxidant protection and offers enhanced healing properties. A clinically-proven formula, it is excellent for treating rosacea, cystic acne, insect bites and some forms of dermatitis.
MEDIK8 (SKINBRANDS)
The Medik8 brand includes a wide variety of vitamin C based products. Medik8 Super C30 Ultra-Brightening Serum is its most powerful, containing ultra-stable 30% ethylated ascorbic acid (vitamin C) plus skin-nourishing vitamin E. It fights environmental and sun-induced damage to prevent premature ageing, while boosting collagen levels to smooth and brighten the complexion. Skin is noticeably supple with fine lines and wrinkles visibly diminished and skin texture refined. The highstrength serum is fortified with brightening turmeric root to leave the complexion glowing and revitalised, as well as botanical oils such as grapefruit and geranium for their antiageing benefits and added natural antioxidant protection. The lightweight, dry-touch serum sinks in rapidly, leaving skin supple and protected from free radical damage. Medik8 Daily Radiance Vitamin C is a hydrating cream with a light, cashmere texture that delivers powerful antioxidant protection alongside a non-greasy broad spectrum SPF 30. Using a 100% stable and lipid soluble form of vitamin C, tetrahexyldecyl ascorbate, the formula is able to boost radiance from deep within. C-Tetra is Medik8’s super-light daily vitamin C serum. Antioxidant power is provided through vitamin C and E. Using a lipid-soluble form of vitamin C called tetrahexyldecyl ascorbate, the formula penetrates deep into skin to provide powerful antioxidant protection with minimal irritation. The range also includes C-Tetra Eye and Pure C15™ using vitamin E and glutathione: two powerful ingredients that work as a rechargeable antioxidant network.
MENE AND MOY (MEDICAL AESTHETIC GROUP)
The Mene and Moy System of active cosmetics includes a number of products incoporating vitamin C at different concentrations. Facial Lotion C contains 20% vitamin C in an absorbable form, associated with 6% glycolic acid, green tea, vitamins E and A and grapeseed extract with a pH of 3.8. The product stimulates collagen and elastin formation at the same time as protecting and repairing the skin from
sun and pollution damage. It also serves as an excellent make-up base and is well-tolerated by all skin types. Eye Contour C 5 is a weaker formulation of the vitamin C 20 lotion for day use around the sensitive eye area. It contains a vitamin C derivative at 5%, grapeseed extract, vitamins E and A, phytic acid, glycolic acid 4% and shea butter. Stand By Cream C contains vitamin C (5%), phytic acid (4%), vitamins A and E, grapeseed extract which soothes the skin and encourages maximal collagen production following therapeutic peeling and when the skin is irritated by retinoic acid or hydroquinone. The addition of shea butter, bisabolol and chamomile extract makes this cream soothing and intensely moisturising.. Facial Masque C 10 is a transparent peel-off mask containing 10% vitamin C derivative and antioxidant vitamins E, A, phytic acid, bisabolol and zinc. For sensitive skins, post-peeling, intense hydration and soothing. Finally C Silk Touch Infusion is a triple antioxidant protection with vitamins C, E and A to increase collagen synthesis, moisturise from within and aid in the reduction of fine lines.
MESOESTETIC (WELLNESS TRADING)
Mesoestetic sells a number of vitamin C based products including the newly launched in 2018 AOX Ferulic and the Energy C Range. AOX Ferulic is a cutting-edge antioxidant concentrate that protects cells and also has a powerful anti-ageing effect, as it immediately inhibits the oxidative cascade produced by external aggressions in a long-lasting way. The formulation has the optimum balance between efficacy and stability thanks to the synergistic combination of its active ingredients, which helps to prevent skin ageing and make the skin brighter. It contains a high concentration of ascorbic acid (15%) as well as ferulic acid (0.5%), a powerful antioxidant that protects the fibroblasts against radiation and provides protection from the inflammation produced by the sun. Lastly, the protech-cell complex (1.5%), which contains vitamin E and a latest-generation synthetic active ingredient, strengthens the antioxidant action of the product, provides specific protection against IR-A and HEV radiation, protects the epidermal lipids and provides immediate and long-lasting protection. >
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VITAMIN C
The Energy C Range is formulated with a high concentration of vitamin C, making it the ideal treatment for skin that has become fragile due to excessive sun exposure, smoking, poor nutrition, or stress. Energy C also includes a home maintenance line and a professional treatment.
MZ SKIN BRIGHTEN & PERFECT
The MZ Skin Brighten & Perfect 10% Vitamin C Corrective Serum is the latest addition to Dr Maryam Zamani’s celebrated skincare portfolio. Encompassing the brand’s signature combination of luxurious textures and results-driven ingredients, this high performance serum is formulated with clinicallyproven brighteners to target existing dark spots and inhibit the production of future pigmentation. The serum works instantly to reveal a brighter, smoother and more even skin tone. During the clinical trial, 39.7% of individuals saw a reduction in the appearance of brown spots and pigmentation after continuous onemonth use. The peptide-rich formula and 10% concentration of vitamin C fades existing pigmentation to luminate skin, while azelaic acid controls the pigmentation cycle by inhibiting future dark spots from forming and sodium hyaluronate provides long lasting hydration.
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NeoGlucosamine™ gently exfoliates skin, targeting dark spots and surface cells to fade existing skin discolourations; peptides inhibit tyrosinase and melanin production for a brighter complexion and licorice extract, vitamin C, seven alpine extracts and antioxidant leaf extract leave skin brighter and more luminous. Pigment Lightening Gel is a high strength gel that signifigantly reduces skin pigmentation and targets discolourations such as dark spots, age spots and hyperpigmentation. This formulation combines active brighteners to reduce the appearance of existing pigmentation and discourages new dark spots from forming. Kojic acid stops the production of melanin to improve the appearance of age spots, sun spots, and spots related to melasma; Butyl Resorcinol improves the appearance of existing pigmentation to brighten skin and vitamin C helps create younger, firmer skin fading signs of sun damage and post-acne marks.
NEOSTRATA ENLIGHTEN (AESTHETIC SOURCE)
NeoStrata Enlighten tackles a dull complexion, melasma, pigmentation and photo damage with a clinically tested range of advanced formulations. Featuring a combination of effective ingredients such as SabiWhite (an alpine plant extract), NeoGlucosamine™, retinol and stabilised vitamin C teamed with an optical diffuser, NeoStrata offers the most advanced brightening products on the market today. Products in the range that utilise vitamin C include Illuminating Serum and Pigment Lightening Gel. Illuminating Serum is a powerful serum designed to illuminate and brighten skin that is affected by hyperpigmentation caused by ageing, hormonal fluctuations and UV exposure. It contains 12 active brighteners that target six pigment control systems to break up and reduce the appearance of existing pigmentation and discourage new dark spots from forming.
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OBAGI (HEALTHXCHANGE)
Obagi Medical has launched some new additions to its existing Professional-C™ Portfolio: Professional-C™ Peptide Complex and Professional-C™ Suncare SPF 30. Dr Mayoni Gooneratne, medical director at The Clinic by Dr Mayoni, comments, “Vitamin C is an incredibly versatile ingredient within skincare and it is the stability and potency of the Obagi Vitamin C products which makes them stand out from others available on the market. It is useful for both skin concerns and the prevention of skin issues, helping to fade pigmentation, boost sun protection and stimulate collagen production. “The Obagi Professional-C™ serums are a much loved product within my own clinic and throughout the skincare industry as a whole. Given the high levels of oxidative stress in a city’s polluted atmosphere, a combined SPF and vitamin C product is a basic essential in any skincare system. The recent additions are also lightweight, glide on easily and sit well under make-up. These products are all incredibly effective and high quality which is one of the many reasons why I really like the range.” >
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VITAMIN C
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Professional-C™ Peptide Complex helps to reduce the appearance of ageing skin while promoting a healthylooking, youthful glow. It contains the key ingredients kinetin and zeatin, synthetic forms of plant growth factors, which can assist in improving firmness and tone as well as reducing fine lines and wrinkles. Professional-C™ Peptide Complex also contains the highly effective SNAP-8 (acetyl octapeptide), which helps to reduce the appearance of wrinkles. Professional-C™Suncare SPF 30 helps to defend against skin-damaging UVA and UVB rays. Professional-C™ Suncare SPF 30 is formulated with 10% L-ascorbic acid to help address the appearance of ageing skin. Vitamin C also defends against the free radicals associated with sun damage. The sunscreen has a luxurious feel upon application, as well as being non-comedogenic.
PCA SKIN (CHURCH PHARMACY)
PCA Skin C&E Advanced strengthens, smoothes and protects skin while dramatically reducing the appearance of discoloration. This advanced, anhydrous corrective antioxidant contains therapeutic levels of hexylresorcinol (1%), a powerful skin-brightening, age-fighting antiglycation agent that brightens and promotes an even skin tone while reducing future discoloration; silymarin (1%), a potent antioxidant derived from milk thistle that has skin-calming and brightening benefits and helps fight free radical damage; and maximum vitamin concentrations: 20% L-ascorbic acid, an antioxidant and matrix metalloproteinase inhibitor (MMPi) that minimises the appearance of fine lines and wrinkles while promoting an even skin tone, and 5% tocopherol (vitamin E). The product provides superior antioxidant protection, reducing photodamage caused by harmful UVA/UVB rays, and helps prevent free radical damage.
SKINCEUTICALS (L’OREAL)
With more than 30 years of research, SkinCeuticals vitamin C antioxidants have been shown to deliver enhanced absorption and proven efficacy with high concentrations of pure L-ascorbic acid. In addition they contain precise ingredient combinations proven to perform synergistically. Hero products include C E Ferulic, a daytime triple antioxidant that delivers advanced environmental protection and improves the appearance of fine lines, wrinkles and loss of firmness. It features a synergistic antioxidant combination of 15% pure vitamin C (L-ascorbic acid), 1% vitamin E (alpha tocopherol), and 0.5% ferulic acid to enhance protection against environmental damage. Phloretin CF is a patented triple antioxidant serum containing 2% Phloretin, 10% pure vitamin C, and 0.5% Ferulic Acid. These ingredients treat sources of damage at every level in the skin. Phoretin CF Gel is the same antioxidant combination as Phloretin CF but in a concentrated antioxidant gel for easy application. AOX Eye Gel is a refreshing gel that is suitable for all skin types. It helps protect the fragile skin around the eye and reduce puffiness and the appearance of under eye bags to give a more vibrant look. AOX Eye Gel actives include 5% L-ascorbic acid, 0.5% ferulic acid, 1% phloretin, ruscus aculeatus and caffeine. Serum 10 is a lightweight fast absorbing serum
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suitable for sensitive skin types. Perfect as an introductory serum for first time vitamin C users, this fast absorbing serum combines Ferulic Acid with 10% pure vitamin C to enhance antioxidant performance to suppress radiationinduced oxidative reactions and promote natural skin repair.
TEOXANE RHA X VCIP SERUM (TEOXANE UK)
Teoxane Cosmeceuticals RHA x VCIP SERUM brings together the brand’s patented RHA resilient hyaluronic acid technology and VCIP, an advanced form of vitamin C acknowledged by dermatologists for its anti-ageing properties including antioxidant activity, brightening effect and skin collagen stimulation. Together with pyruvic acid, this exceptional combination of RHA x VCIP ensure visible results on skin firmness, evenness and radiance. It contains patented NovHyal (N-Acétyl Glucosamine-6-Phosphate), Dermo-Restructuring Complex, optimised vitamin C and pyruvic acid. After 28 days of application, the skin improves its firmness, cutaneous hydration barrier is reinforced and the complexion is fresher and visibly more radiant.
VITAGE VITAMIN C TIGHTENING SERUM (SKINBRANDS)
Previously named Vitage Vitamin C Radiance Serum, Vitamin C Tightening Serum has been re-packaged and re-formulated to rapidly target visible signs of ageing. Enriched with high levels of stabilised vitamin C, this serum brightens dull, uneven skin tone. It stimulates collagen production, firming the skin and minimising lines and wrinkles. The powerful antioxidant benefits of vitamin C defend the skin against the prematurely ageing damage of environmental aggressors and free radicals. Hyaluronic acid deeply hydrates, replenishing lost moisture levels and tackling dehydration, thus smoothing out any dehydration lines. Argantensyl™ proteins provide both instant and long-term lifting and tightening benefits to restore a youthful appearance. AM
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SKINCARE SPY
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Skincare Spy We take a peek inside the bathroom cabinets of industry professionals to see if they are practising what they preach and what their cosmeceutical staples are Dr Mayoni Gooneratne, Surgeon, The Clinic by Dr Mayoni, Honor Oak Park, London Dr Mayoni Gooneratne (MBBS, BSc, MRCS) is a London-based general surgeon with more than 18 years of medical and surgical experience. She has been a member of the Royal College of Surgeons since 2002. Dr. Mayoni has undertaken extensive training with Cosmetic Courses at Aurora Clinics. Her surgical and research-based training are evident in her approach, and her insistence upon using only effective treatments.
“I always start off with Obagi Gentle Cleanser as I’ve got quite dry skin – it’s effective enough to take off my make-up but doesn’t strip my skin or leave it feeling tight. Next I go for the NeoStrata Tri Therapy Lifting Serum and Skin Active Triple Firming Neck Cream – I have seen such amazing changes to the evenness of my pigmentation, skin plumpness and lifting – I can really see it working! After that has absorbed, I like to apply a bit of Neostrata Matrix Support and let it soak in while I’m pottering about in the morning, followed by Neostrata Dermal Replenishment, which also doubles up as my night moisturiser. Finally, on goes my Obagi warm tint SPF.”
Dr Fiona McCarthy, Consultant Oncologist & Aesthetic Doctor, Cosmetech, Chelsea
“I start every day with Jan Marini Bioglycolic face cleanser – it really leaves skin feeling incredibly fresh and glowing. I always use SkinCeuticals CE Ferulic – the synergistic combination of antioxidants gives an incredible brightening effect. Then I layer over CeraVe moisturiser as I love the richness, followed by the Heliocare SPF 50 . The oil-free gel formulation works really well as a make-up base and gives consistent protection throughout the day. Twice a week, I also do a 0.3% SkinCeuticals retinol treatment at night to keep my collagen plumped up.”
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Dr Fiona McCarthy is an aesthetic doctor with almost two decades of medical experience. She has been a member of the Royal College of Physicians since 2007. During her time in the NHS she specialised in oncology, climbing to the top of her field as a consultant medical oncologist, specialising in dermatological cancers. She continues to work as a consultant oncologist in the NHS part time. She was awarded a PhD by the University of London in 2017 for her work on the links between inflammation and cancer. Dr Fiona’s passion and expertise in dermatology formed the perfect pathway for her to switch careers and pursue her passion for aesthetics, following the birth of her two children. AM
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Jaw-inspiring Dr Yasmin Shakarchy on facial slimming and the three-point masseter reduction technique
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n the famous words of Aladdin, it is definitely “a whole new world”, and within this world non-surgical jawline slimming is quickly proving to be a popular treatment modality. The current trend, especially among females, moves away from a ‘square face’, which is often a secondary cause masseter hypertrophy.1 Due to their position laterally to the mandibular ramus, and involvement in mastication, enlargement results in significant changes to the overall aesthetics of a patient’s lower face. 2 Cases are found to be either bilateral or unilateral. It is most common between the ages of 20 to 40 and it is not gender specific. Although rarer, noticeable unilateral hypertrophy is a challenging aesthetic feature to manage. Physiological habits causing masseter hypertrophy include bruxism (teeth grinding), variations in dietary habits (such as chewing dried meat, fibrous vegetables or betel nut), gum chewing and overcompensation for poor dentition.3 While a majority of these causes can be asymptomatic, bruxism in particular can result in temporomandibular joint pain, intermittent headaches, dental attrition, maxillary and mandibular bone resorption, and accelerated ageing. The foundation blocks for aesthetic management include the understanding that while a well-defined jawline is considered youthful and a sign of beauty, a square jaw shape, out of proportion with other facial features, is noticeable by patients.
attractive.4 But while opinions exist and vary over time, there are also some vital genetic components to consider. Korean women, in particular, have a wider mandible on average compared to Caucasians. Coupling these anatomical variations with populous opinions has resulted in ‘Asian plastic surgery’ becoming increasingly sought after internationally, for surgical and non-surgical work.5,6
TREATMENT OPTIONS
There is a plethora of treatment options for altering facial shape, ranging for non-surgical to surgical modalities. Surgical management includes genioplasty, jaw bone remodelling and facial remodelling variations. While these interventions have proven successful they carry significant risks including condyle fractures, nerve injuries, haematoma risks, infection, trismus and long rehabilitation or recovery periods. As a result, non-surgical options have gained greater prominence. The most notable of these is the use of Botulinum endotoxin type A (Botox).8 Botox treatment is a minimally invasive and technically straightforward treatment of the masseter muscle. Injections directly placed into the masseter muscle were first introduced by Smyth, Moore and Wood in 1994.9,10 The resultant muscular changes include relaxation and reduction of volume of the masseter. End results highlighted facial recontouring and slimming. In addition to cosmetic enhancement, Botox administration improves facial tension, headaches and neck stiffness, with varying success dependant on cause and patient. These features are not well studied with anecdotal evidence available currently. Furthermore, studies have shown repeated administration of Botox into the masseter muscle reduces overall volume, in addition to inducing bony changes in the mandibular angle.8,11,12 For significantly noticeable differences it is recommended to have a second Botox administration at approximately four to six months.8
Genetic and demographic factors have strong correlations with masseter hypertrophy and jawline aesthetics
EPIDEMIOLOGY AND VARIATION
Genetic and demographic factors have strong correlations with masseter hypertrophy and jawline aesthetics. This statement is highlighted by the fact that jawline slimming treatments are the fastest growing trend in East Asian communities. Ethnic factors include the perception of beauty and its relation to lower face cosmesis. Studies have analysed variations in beauty standards between ethnicities.4-7 A soft, oval facial shape is currently considered more feminine and desirable within East Asian populations. In contrast triangular or trapezoidal variations were most unpopular. Even within Caucasian populations, an oval or inverted triangular facial shape was deemed most
ANATOMICAL CONSIDERATIONS
The masseter, being one of the muscles of mastication, is a thick, quadrangular muscle consisting of both a >
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There are however advocates for both four or five point injection techniques. Injections Quantity per injection site varies from five to 15 units depending on initial examination, patient desires and masseteric volume. This provides a maximum dose of 45 units per side. Following injection, we advise compression for several minutes of sites, before finally cleaning the markings. Follow up Usual follow up is four to six weeks following injection, for accurate examination of masseteric volume. Early follow up can result in excess administration as muscular atrophy can take time. Repeated injections are advised between four to six monthly periods.
POTENTIAL COMPLICATIONS AND LIMITATIONS
superficial and deep component. The superficial component arises from the anterior two-thirds of the lower border of the zygomatic arch and the zygomatic process of the maxilla. The deep component arises from the posterior third of the lower medial surface of the zygomatic arch. Important surrounding structures include the superficial mimetic muscles of the face overlying the masseter, with further important motor nerves lying both superiorly and inferiorly to the masseter. Posteriorly lies the parotid gland, while the facial artery and vein cross at the antero-inferior corner of the masseter.
TECHNIQUE
Following written informed consent and pre-treatment frontal face photography, preparation of Botox is performed.
With appropriate anatomical knowledge, Botox treatment of the masseter can be both a safe and effective procedure. But it is imperative for practitioners to be able to take steps to avoid, recognise and properly treat complications. An aptly designed management protocol is important.13 Typical non-muscular complications include bruising, haematomas, dizziness and headaches. With regards to vascular damage resulting in bruising, there should be immediate compression of the site following damage. Haematomas resolve spontaneously within seven days. Dizziness and headaches, although rare, are managed conservatively with rest and typically subside within several days. There is the potential for product to diffuse into the Buccinator muscles and our advice would be to keep injections at least 10mm from the anterior border of the masseter muscle. Similarly, injections should be inferior to the sigmoid notch of the mandible (consider this
Preparation Botox is supplied in a freeze-dried powder of one hundred units. This is reconstituted with 5 ml of bacteriostatic saline giving a concentration of two units per 0.1 ml. We typically utilise 1ml syringe with an inch long 30 gauge needle for patient comfort. Careful skin preparation is performed to maintain asepsis. Skin marking Firstly, and most importantly, a straight line is drawn from the angle of the lip to the ear tragus indicating the superior extent of potential injection sites. During periods of teeth clenching, the medial and lateral borders of the masseter are palpated and marked, with the aim to accentuate masseteric contouring. During this period, masseteric volume is assessed. P yramidal markings are then drawn. The superior tip is at the level of maximum masseteric bulge. The remaining two points are inferior to the initial marking, but level with each other. There is usually approximately 10 mm of distance between the markings. This creates a triangular target of injecting.
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Before
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approximately at the level of the concha of the auricle) to avoid diffusion into the pterygoid muscles. There can be some smile asymmetry if injections are too high, as well as minor changes to facial expression.1,14 With regards to masseter reduction, there are rare occasions of skin sagging if the muscle shrinks quicker than the skin contracts, as well as sunken cheeks secondary to atrophy to the superior portion of the masseter. These appearances typically improve over the proceeding six weeks, but patients must be advised thoroughly prior to treatment. To our knowledge there have been no permanent complications secondary to treatment.15,16
CONCLUSION
Non-surgical pyramidal masseter reduction using Botox is generally an extremely effective procedure in trained hands. Having an adequate understanding of patient facial features, demographic variations, anatomical considerations and complication avoidance are the foundation blocks for all treatment. This is no different. If all factors are considered and accounted for, results from treatment are usually excellent. AM REFERENCES 1. K aya B, Apaydin N, Loukas M, Tubbs RS. The topographic anatomy of the masseteric nerve: A cadaveric study with an emphasis on the effective zone of botulinum toxin A injections in masseter. Journal of plastic, reconstructive & aesthetic surgery, J Plast Reconstr Aesthet Surg. 2014 Dec;67(12):1663-8. 2. N etter FH. (2010). Atlas of human anatomy. 5th ed. Philadelphia, PA: Saunders/Elsevier. 3. Almukhtar RM, Fabi SG. The Masseter Muscle and Its Role in Facial Contouring, Aging, and Quality of Life: A Literature Review. Plast Reconstr Surg. 2019 Jan;143(1):39e-48e. 4. Gao Y, Niddam J, Noel W, Hersant B, Meningaud JP. Comparison of aesthetic facial criteria between Caucasian and East Asian female populations: An esthetic surgeon’s perspective. Asian J Surg. 2018 Jan;41(1):4-11. 5. Chen T, Khadka A, Hsu Y, et al. How to achieve a balanced and delicate lower third of the face in Orientals by mandibular contouring. J Plast Reconstr Aesthet Surg. 2013;66:47e56.
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6. Johnston C, Hunt O, Burden D, Stevenson M, Hepper P. The influence of mandibular prominence on facial attractiveness. Eur J Orthod. 2005;27:129e133 7. K uroda S, Sugahara T, Takabatake S, Taketa H, Ando R, Takano, Yamamoto T. Influence of anteroposterior mandibular positions on facial attractiveness in Japanese adults. Am J Orthod Dentofacial Orthop. 2009;135:73e78. 8. L ee WJ, Kim SJ, Lee KJ, Yu HS, Baik HS. Repeated injections of botulinum toxin into the masseter muscle induce bony changes in human adults: A longitudinal study. Korean J Orthod. 2017 Jul; 47(4): 222–228. 9. Smyth AG. Botulinum toxin treatment of bilateral masseteric hypertrophy. Br J Oral Maxillofac Surg 1994; 32: 29-33. 10. M oore AP, Wood GD. The medical management of masseteric hypertrophy with botulinum toxin type A. Br J Oral Maxillofac Surg 1994; 32: 26-8. 11. Z hou R, Pan B, Wang C, Wang D. Mandibular Rim Trilogy with Botulinum Toxin Injection: Reduction, Projection, and Lift. Facial Plast Surg. 2017 Feb;33(1):102-108.
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12. Chang CS, Lin S, Wallace CG, Hsiao YC, Lin CM, Kang GC, Chen ZC, Chen PK, Lo LJ, Chen YR, Chen JP. Masseter Muscle Volume Changes Evaluated by 3-Dimensional Computed Tomography After Repeated Botulinum Toxin A Injections in Patients With Square Facial Morphology. Ann Plast Surg. 2019 Jan;82(1S Suppl 1):S29-S32. 13. Peng HLP, Peng JH. Complications of botulinum toxin injection for masseter hypertrophy: Incidence rate from 2036 treatments and summary of causes and preventions. J Cosmet Dermatol. 2018 Feb;17(1):33-38. 14. Liew S, Dart A. Nonsurgical reshaping of the lower face. Aesthet Surg J 2008; 28: 251–7. 15. Kim HJ, Yum KW, Lee SS, Heo MS, Seo K. Effects of botulinum toxin type A on bilateral masseteric hypertrophy evaluated with computed tomographic measurement. Dermatol Surg 2003; 29: 484–9.
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16. Wu WT. Botox facial slimming/facial sculpting: the role of botulinum toxin-A in the treatment of hypertrophic masseteric muscle and parotid enlargement to narrow the lower facial width. Facial Plast Surg Clin North Am 2010; 18: 133-40.
All Before and After images courtesy of Dr Don Yoo
Dr Yasmin Shakarchy completed her dental training at the University of Birmingham. Her combination of re-creating celebrity smiles, and local school changes with Jamie Oliver’s Sugar Smart campaign have formed the cornerstones of her career. She became a member of the Faculty of Dental Surgery (MFDS Ed), and simultaneously received a PG certificate in Aesthetic and Restorative dentistry, helping her to primarily focus on smile makeovers and cosmetic treatments. She recently won an award as Best Young Dentist of the Year across the Midlands.
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The future of injectables Aesthetic Medicine speaks to Professor Syed Haq about trends in the aesthetic market and the future of injectables Aesthetic Medicine: Do you think that the aesthetic market is growing and if so, where is the growth in the market coming from? Professor Syed Haq: The aesthetic market is clearly growing and it continues to grow in spite of the global crash in 2008 and with Brexit. I can only see that continuing over the next five to 10 years and one of the main reasons is because the population is ageing and people want to look younger. AM: What do you think have been the biggest trends in aesthetics in the last year? SH: In dermal fillers the biggest trend has been a more targeted approach to profiling patients. It used to be all about volumisation and wrinkle chasing, now it’s about profiling the jawline and chin augmentation. So you’re not just looking at the patient front on with an anterior
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posterior approach, you are also looking laterally, side on and that is actually achieving better results with greater symmetry and balance. With profiling we have a better understanding of the face and how we can use our products to achieve a natural look. Through an expansive portfolio, we are able to do a lot more. A prime example would be the Restylane range. It gives you every single aspect you need to treat the standard problems that patients come to see you with on a daily basis and even more, because of the NASHA and OBT technology. Within those individual ranges, you have greater versatility and greater viscoelastic properties. They allow you to treat the chin, jawline, and nose and to volumise and project. With the full Restylane portfolio you can treat your patient in a way that truly transforms their look and gives them a much more youthful, natural appearance.
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AM: What have been the major product innovations in terms of dermal fillers within the last year? SH: In terms of dermal fillers, there have been some new trends with the advent of products that use mesodermal therapy. But one of the problems with these products, which are increasing in popularity, is that they don’t last. Patients are paying less for these treatments but they are having to be used more frequently. I’m glad to see that Restylane Lyft has obtained FDA approval recently, because it is without a doubt the standalone product for the highest G prime noted in any dermal filler out there. Now that means you get greater profiling for your patient, and that’s the big trend. Under eye treatment is also a big trend right now but it’s being done poorly and superficially. It needs to be done deeply, and there’s only a couple of products that I would advocate using, one of which is Restylane Refyne. I wouldn’t recommend many other products for use in that area because you have to be highly specific in what you use. AM: What are the major differences between dermal fillers and what should practitioners consider when selecting which products to use? SH: They should be asking themselves if this new product is safe and if the clinical data is strong enough and presented over a sufficiently prolonged period of time where you can clearly see its efficacy. And far and above all other dermal fillers your standalone products would be the Restylane range and the Juvéderm range, these are above and beyond anything else out there. These brands have clinical data based on large patient numbers over a prolonged period of time.
doesn’t back up what they say. HA is often used by clinicians that don’t have the experience to use them, so we are using corrective treatments much more often than we have in the past. Those patients that have damage to their underlying tissue have to deal with unnecessary complications. We need greater restriction on those using high HA products. These products shouldn’t be used by those who don’t have the credentials to use them. AM: Are there any products/innovations on the horizon that are likely to come onto the market in the next few years? SH: I think the use of peptides will improve technology, as will antioxidants, but it’s too early at the moment because they haven’t been tried and tested. However, I think these will be introduced and make a significant difference. In particular lidocaine mixed with dermal fillers, which really helps provide administration of the product. There is potential use of different delivery systems of HA filler. For example, the use of microcapsules which contain HA and various antioxidants that can be administered locally with a principle of longer lasting effect because you can even concentrate HA and vary it to be more versatile in the approach and reduce the amount of BBDE that you are using. At the moment it’s hypothetical but these delivery systems are being used with transdermal medicines so I don’t see why they can’t be used with HA.
In dermal fillers the biggest trend has been a more targeted approach to profiling patients
AM: Does the flexibility of fillers play an important role and, if so, why? SH: Flexibility is defined by the viscoelastic property of the filler as well as the G prime, its lifting capacity in other words, the concentration of HA, level of cross linking and what the cross linker is. With a high cross link level, you are more likely to have issues with allergic reactions and if you have too high an HA content you may have problems with swelling. Elastic properties and G prime define where you place your product. If you are using filler in the tear trough, you want to use a product that has a lower HA concentration, so softer, and also is not overly cross linked – it has to be highly viscoelastic, so you are not so worried about a high G prime. If you’re looking at the chin you want a higher G prime with less viscoelasticity, a higher HA concentration and maybe more cross linkage, so a firmer product. The flexibility of product dictates how and where you use it in this way.
AM: When considering switching products what should practitioners think about? SH: If a practitioner has a patient in front of them and they are thinking they are going to use X rather than Y they first have to think about why they are switching products and what the clinical indication is. When switching, price is the last thing you should be thinking about. You need to think about what you are trying to address, if you’re primarily looking at volumising or line chasing, anti-wrinkle treatment or if you’re looking more at profiling because there are fillers that fall into those sub divisions and categories. It should be an informed choice based on clinical data, outcome, longevity and efficacy. All of those should be questioned and thought about before you consider changing. You shouldn’t be considering products based on offers and other commercial factors. We have a responsibility when making changes to what we are using, and it has to be for the right reasons. >
AM: What would you like to see next for dermal fillers? SH: I’d like to see more comparative studies on different dermal fillers. Far too many studies are linked to a specific product without a direct comparator. This would provide better information for how best to use the products. We are seeing HA products that talk a lot about viscoelasticity and really these are unfounded claims, because the data
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used greatly and will continue to expand, however, you have to be very careful with the kind of cannula you are using and consider the length, gauge, and flexibility. Many people start off thinking they cannot puncture a vessel when using a cannula, but this is not true. Particularly when you are injecting around the tear trough area. There is less pain and swelling with cannulas but there is a reduction in precision, there is also an issue with force and understanding depth can often be quite difficult unless you are well experienced. If you are too forceful in the way in which you are manipulating the cannula you can cause damage to the blood vessels. The important thing is, if you have a cannula with gauge 27, you still have a possibility of puncturing a vessel. With a 25 gauge less so, but it is still possible if you are not careful. Larger cannulas are very useful when augmenting the jaw and chin as well as body contouring. So, in general, cannulas are extremely helpful but there is still a skill set required. AM: What do you think of the increased regulation of the market? Do you think that this will continue and would you like to see more changes? If so, what changes would you like to see? SH: I would like to see a lot of changes and more regulation, in terms of who can use dermal fillers and who can prescribe and use Hylase. There is a huge problem with remote prescribing and that needs to be stamped out. Another problem is where people are travelling abroad to purchase brands of dermal filler and then coming back to the UK and using it here, despite there being no label for them here. This leaves the patient without any cover because they do not have the correct lot number or reference to use in the UK. This loophole must be closed with immediate effect. We also need to set a higher level of attainment in general in the UK. Far too many products are coming on to the market without adequate clinical data. These companies should be registered with the ABPI but most of them are marketing companies that have some sort of distribution license and the distributer should scrutinise the links to make sure they reach appropriate standards. There’s an ex lorry driver who was injecting 2-4 ml of filler in lips. When questioned he said that he could inject better than a nurse or any qualified practitioner because he had seen more YouTube videos on injecting. I want “Botox parties” banned, as they are completely nonsensical, in a house they do not have adequate facilities to deal with patients who have suffered complications from the procedure. Tighter rules around who does and doesn’t do these treatments are needed urgently. AM
I’d like to see more comparative studies on different dermal fillers
AM: Which clinical trial results are most important – onset of action, duration of effect, tolerability, adverse events – and are there any major differences in the data between different products? SH: For toxins the most important aspects are longevity of action, onset of action, and reproducibility. For example, Galderma’s toxin product Azzalure has a wealth of data behind it, including speed of onset and the efficacy of repeat treatments. In terms of dermal fillers, these have a different interface but once again longevity is extremely important as is predictability. You are also looking at things like reduced pain and swelling. Some products require a review and ‘top up’ and this is because they experience a drop in volume of 10-15%. You want to be working with a portfolio that provides you with a range of possibilities, especially if you have the skillset to carry out more complex work.
AM: Have you seen any trends in how products are delivered and do you think that the growth in cannula use will continue? SH: Cannula use is and has been a very important trend, probably over and above what was predicted. It is being
Professor Syed Haq is a consultant physician and founder of The London Preventative Medicine Centre. He was formerly the CMO/CMS of Daval International, a biopharmaceutical company that is developing a platform for the treatment of autoimmune, neurodegenerative, Alzheimer’s disease, Myasthenia Gravis, Multiple Sclerosis and inflammatory diseases using a patented polyclonal antibody/peptide composite. He has overseen two MHRA registered phase II double blind clinical trials conducted in the UK, one in secondary progressive multiple sclerosis and the other in established late-stage diffuse systemic sclerosis. He has worked and trained at some of the foremost institutions – Guy’s Hospital, Hammersmith and Royal Brompton Hospitals, Imperial College, Massachusetts General Hospital, Harvard Medical School and Tufts University, New England Medical Center Hospitals.
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HAS SHE GOT
A SECRET?
r e h n i It’s w o l g l a r natu
96% of patients showed aesthetic improvement one month after treatment with Restylane® Skinboosters™ Vital1* *Results shown for investigator-reported Global Aesthetic Improvement Scale (GAIS) at one month after the second treatment session. Patients received Restylane Skinboosters Vital over two treatment sessions scheduled four weeks apart. 2 mL of product was administered at the first treatment session and 1 mL at the second session. In addition, a single maintenance treatment (1 mL of product) was given at six months (n=27).
www.restylane.co.uk/AM
Reference: 1. Kerscher M et al. Restylane Skinboosters for improved facial skin quality using two treatment sessions. Poster presented at IMCAS, 26 – 29 January 2017, Paris, France.
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CASE STUDY
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Restored to confidence Aesthetic nurse Frances Turner Traill, describes how she helped a patient who was “uncomfortable in her own skin”
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s an aesthetic nurse, I have been treating patients for the past 12 years in Scotland where I have two clinics – one in Northern Scotland, in Inverness and one in the Central Belt just outside Glasgow. In the case I am presenting in this article I was assisted by Carol Dunn, also an aesthetic nurse working at FTT Skin Clinics, who has 13 years’ experience. Jean, a 69-year-old lady who had not had any aesthetic injectable treatments before, visited my clinic. Her main concern was her ageing face, which was making her look tired and unhappy, to the point that she felt “uncomfortable in her own skin”. She had always had an outgoing personality and was usually very sociable, but more recently had started to withdraw socially as she no longer felt visible or as relevant as she did before. It was evident she was suffering from low self-esteem. She was in good physical health with no underlying health issues. During the consultation photographs were taken and these, along with a mirror, were used to discuss Jean’s face and enable her to see the areas that had changed due to the ageing process. We were then able to formulate a plan of care together. As the face ages, there are a combination of factors that need to be considered in order to formulate a plan that will achieve balance and harmony while maintaining a natural look, something that is particularly important in the mature patient. It is therefore extremely important to manage
expectations well in this patient group, and for the journey ahead. In this case study, treatment was delivered in stages and over a period of several months. With whole face rejuvenation, cost has to be taken into consideration as can be expensive, therefore patients need to be adequately counselled using tools to help them understand these ageing related facial changes, such as Galderma’s Harmony tool and Allergan MD codes, and explanation given on how much dermal filler is required to make changes that have been agreed. Treatment for this mature patient would involve injecting into the supraperiosteal plane to mimic the underlying bony structure that had receded through the ageing process, and revolumisation with product placement into the deep subcutaneous and superficial fat pads to reinstate a degree of balance and harmony to the facial contours. Treatment began with the upper face, progressing downwards to create lifting vectors at each stage. Our final stage was with intra dermal placement of hyaluronic acid fillers to treat fine lines in particular. A systematic patient assessment was carried out incorporating the patient’s medical history, social history, allergies and medications currently taken. Given Jean’s age, lack of aesthetic experience, and risks versus benefits we decided for the lowest risk option of non-permanent HA using the Perfectha range of dermal fillers. I estimated that Jean would require 20mls of HA over three sessions >
A combination of factors need to be considered in order to formulate a plan that will achieve balance and harmony in order to maintain a natural look
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to build in review times, allow for hydrophilic response from HA, complication management if occurred and to reduce noticeability factor in our full face rejuvenation journey.
FACIAL ASSESSMENT
Full facial assessment was carried out which indicated severe volume loss in all facial areas with moderate skin laxity. It was also noted that there was partial dentition which added to the sunken look of her face. So the patient was also advised to seek dental advice which resulted in a full set of dentures for the upper and lower jaws by the end of her nine-month treatment journey. We considered the Golden Ratio and the five pillars of beauty as assessment tools to guide us in our treatment plan, together with other measurements such as Ricketts line. Our assessment was that Jean presented as a lovely lady with strong features that were more masculine. Our task and goal was to not only rejuvenate but also to feminise her features and in particular her nose, by increasing the angle and reducing the width; addressing her chin by reducing the pogonion width and lengthening overall. We also needed to treat her cheeks by giving more volume, improving ogee curve, thus creating a more feminine, slimming effect; her forehead and temples by reducing hollowness and softening of a masculine heavy horizontal brow, to create a rounder softer forehead with more height at the tail of the brow. Finally, we wanted to
Before
TREATMENT PLAN IN MORE DEPTH
Upper face During our general assessment we noted dynamic rhytids on forehead and in glabella region which were untreated in this case study. We treated hollowing of the temple region with 1ml of Perfectha Subskin in each, deep to bone with needle and 1ml Perfectha Derm subdermal using a 25g cannula. Her upper eyelid ptosis and downward tilt of lateral canthus were treated with Perfectha Complement subdermally using a 25g cannula into her forehead with improved static rytides. We feminised her nose using Perfectha Deep 1ml, which in my experience is the longest lasting, predictable HA filler for nose augmentation, resulting in a softer curve feminisation of her upper third only using hyaluronic acid dermal fillers. Mid face We noted under eye hollowing combined with a lack of volume and support in malar area, which we treated with a combination of Perfectha Complement 1ml to each tear trough area using a 25g cannula to the mid-line first, lateral, then completing our tear trough treatment medially. Her naso-jugal groove, contributing to a tired appearance, as well as lower cheek hollowing extending to pre-auricular region, which were treated with dermal fillers – firstly with Perfectha Subskin 2mls deep to bone to give support and lift to tissue as it has the greatest G prime of HA fillers. We overlaid this with a 25g cannula subdermally of Perfectha Derm to contour and feminise the mid face.
After
amend her jaw to raise her gonial angle of mandible from a more masculine 90 degrees to an elevated female tilt of closer to 120 degrees. A combination of needle and cannula was used throughout, respectful of the facial anatomy, at desired plane of injection and following our intended planned outcome. At the outset we agreed a staged treatment plan, building in integrated review appointments to monitor progress and agree the need for each stage of care, as well as obtaining medical photography to record progress. We carried out our treatment plan over three sessions.
Lower face Our assessment noted jawline sagging, pre-jowl sulcus, upward tilt of chin, chin recession, lack of dental support which we addressed using dermal fillers - Perfectha Subskin again – chosen for its G prime to give structure and volume where lacking to the angle of mandible, pre-jowl sulcus, chin, this was overlaid with Perfectha Derm and Deep using a 25g cannula. We completed her transformation with a lip augmentation over two sessions, firstly introducing volume to the lip body with Perfectha Derm then enhancing her vermillion border, philtrum and more superficially with Perfectha Complement using a 25g cannula. AM
Frances Turner Traill RGN, RMN, MA(Hons), NIP, BSc (Derm) PG Cert (Medical Aesthetics) is an independent nurse prescriber and owns two Medical Aesthetic Clinics in Scotland. She is now an Honorary BACN Board member after serving six years on the board and continues to represent BACN with the Scottish Government. She is a career injector with 12 years’ full time medical aesthetic and dermatology experience.
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YOUR PERFECT MATCH PERFECTHA® a tailor made range of Hyaluronic Acid dermal fillers. Designed for wrinkle improvement, face contouring and volume restoration.* Natural-looking results and long lasting effect.1 Made in FRANCE. For more information on the PERFECTHA® range please visit: www.perfectha.com Or email: perfecthauk@sinclairpharma.com to contact your local account manager. Sinclair Pharma. 1st Floor Whitfield Court, 30-32 Whitfield Street, London W1T 2RQ.
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THREADS
THREAD LIFTING
aestheticmed.co.uk
Picking up the thread Dr Sotirios Foutsizoglou shares his experience with thread lifting
S
kin regeneration and lifting using threads is becoming increasing popular. Threads can be broadly categorised as mesothreads or collagen stimulating threads and suspension or lifting threads used to mechanically lift the skin. There is a vast array of different brands, products, materials and configurations to choose from. In this article I will focus on PDO threads and in particular the RegenAlift PDO threads that I have been using almost exclusively over last few years due to their excellent safety profile, long lasting results, and a great range of sizes and configurations satisfying the needs of my cautiously selected threadlift patients. At this point I need to emphasise that a thread lift is not synonymous with a surgical face lift whereby excess skin is removed, the remaining undermined skin is redraped, and ptotic and atrophic deeper facial tissues are manipulated and tightened. No procedure is more closely associated with plastic surgery in the eyes of the public than facelifting, and perhaps rightfully so. When performed with appropriate attention to detail in a properly selected patient the procedure provides consistently satisfactory results, creating a natural, unoperated appearance and leaving the patient looking like a crisper version of himself or herself. The
facelift confers another benefit that is more difficult to define. Ageing results in jowls and a rectangular lower face. A facelift lifts the jowls back into the face, augmenting the upper face and narrowing the lower face, producing the “inverted cone of youth.” This change in overall facial shape from rectangular to heart shaped is a benefit that no other treatment modality can provide. When not properly performed, the procedure can be catastrophic, resulting in visible scars, distorted ears and hairlines, unnatural creases, and a disharmonious, obviously operated look. Threadlifting, on the other hand, being much less invasive negating the telltale signs of the surgical lift can produce natural looking results in patients showing mild skin laxity and jowling. It can also address, less effectively though than a surgical facelift, the age-related ptosis of the malar tissues, deepening of the nasolabial folds and labiomental creases, downturn of the oral and loss of neck definition. Threadlifting is not recommended for patients with heavy sagging facial tissues, significant volume loss or severely photodamaged atrophic skin. For these patients a more holistic approach combining a wide range of surgical procedures and non-surgical treatments and would be required.
“Threadlifting is not recommended for patients with heavy sagging facial tissues, significant volume loss or severely photodamaged atrophic skin”
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THREADS
THREAD LIFTING
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PDO THREADS
Prior to the advent of PDO threads other more permanent materials had been used for collagen stimulation (e.g. Gold) and anti-ptosis (e.g. Polypropylene) with variable success. Over the last five years there has been a considerable shift towards the use of biodegradable polymers for the manufacturing of threads such as poly-l-lactic acid and polydioxanone (PDO) designed as either standalone monofilaments for intradermal placement (collagen stimulating threads) or configured with various anchoring systems such as barbs or cogs for subcutaneous placement providing an instant mechanical lift. Polydioxanone (PDO, PDS) or poly-p-dioxanone is a colourless, crystalline, biodegradable synthetic polymer whose biodegradation takes place by slow hydrolysis that can last up to eight months. PDO is not a new product. It has been used in surgery for over twenty years as suturing material with excellent characteristics including tensile strength, tissue reaction, and resistance to infection. Polydioxanone (PDO) stimulates fibroblasts to natural neocollagenesis. The scientific basis of the PDO induced collagen stimulation relies on the normal healing process of the human tissue and the principle of mechanotransduction which I have both described in great detail in previous articles. Insertion of polydioxanone threads generates neocollagenesis in the skin by mild fibrosis (Type III collagen). The new bands of collagen strengthen the connective tissues of the skin and work like anti-ptosis mechanism. Face lifting threads create traction to mechanically lift sagging tissue to a more youthful and desirable position – it has been described as a non-surgical face lift, that can restore the contours of a youthful face without the risk and complications of conventional surgery. The RegenAlift suspension threads come in different sizes and their main configuration consists of evenly distributed small sturdy cogs attached onto the core thread. They are inserted under the skin and above the SMAS layer via a thin cannula to grab and lift the tissue that has descended as a result of ageing. The superficial musculoaponeurotic system (SMAS), the third layer of the face, is the most heterogeneous. It is fibrous, muscular, or fatty, depending on the location in the face. The muscles of facial expression are part of the SMAS layer (e.g., frontalis, orbicularis oculi, zygomaticus major and minor, and platysma). In the temporal region, this layer is not muscular but is fascial in quality and is represented by the superficial temporal fascia (or temporoparietal fascia). What is important for the medical practitioner to remember is that in the midface the main trunk of the facial nerve and all its branches are under the SMAS layer and the paratidomasseteric fascia, a thin transparent fascia representing the 4th layer of the face. Therefore placement of the lifting threads above the SMAS and the use of cannulas instead of sharp needles can almost eliminate the risk of nerve damage or vascular puncture and subsequent haematoma formation (which is the most common complication seen in the surgical facelift).
BEFORE
AFTER
THE TWO CATEGORIES OF REGENALIFT PDO THREADS Skin Regeneration
Lifting
tightness - texture colour - firmness
Correcting ptosis of loose sagging tissue
Intradermal via needle
Transdermal - SMAS layer via cannula
Threads are straight or coiled
Threads are thicker with cogs
Mono filament - straight - regular skin regeneration Double Spirals - coiled booster skin regeneration
The cogs anchor to the tissue to create a mechanical lift
Optimum results - after six weeks. Duration - 12 to 18 months
Instant results Lasts around 12- 18 months.
TECHNIQUE
Stimulating threads I like using an intradermal mesh pattern with the monos and the double spirals for an overall skin revitalisation or to create a fibrotic scaffold reinforcing, strengthening and tightening the skin for a later thread lift using the suspension threads in a two stage process. The Double Spirals is a design where there are two strands of PDO threads coiled outside and around the > needle to increase the amount of thread that can be implanted into a small localised areas in the skin, maximising the contact with the skin. This acts as a super booster to proliferate the collagen and kick-start the skin regeneration process. This is an ideal way to create all over skin regeneration or to even out folds and wrinkles in small precise areas, in particular: Marionette Nasolabial Smoker’s lines
Glabella Forehead tightening Crow’s feet
Eye bags Neck Submental
Different patterns for the suspension threads
Vector Linear Technique Sewing Technique Reinforcing Net Technique L Technique Fan technique V Technique Sandwich Technique W Technique I also use the RegenAlift monos and double spirals into localised fatty tissue for lipolysis and intramuscularly to induce muscle relaxation. >
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THREADS
THREAD LIFTING
Suspension threads The first step is to choose the right candidates for a thread lift. Mildly ptotic facial tissues and men and women who have started “looking tired” are ideal candidates for a thread lift. A thorough consultation with the potential threadlift patient explaining all the pros and cons of the treatment is of paramount of importance with regards to any post procedure misunderstanding and complaints. My motto is “anything that is said before is an explanation; anything that is said after is an excuse”. Patients with very high expectations are excluded as this non-surgical treatment is unlikely to yield the drastic results they may have in their mind. The second step is to decide on the direction of the vector(s) to lift, the type and size of threads, the pattern, and how many threads to use. Depending on the practitioner’s preference, problematic areas of the face, desires of the patient, and type of the suspension thread to be used (cannula vs twin needles) a variety of patterns can be used The third step is to mark, prep and anaesthetise the skin – in this order. I use lignospan special that contains 2% lignocaine and adrenaline for my predetermined entry points if I am using straight cannulas as a means of placement of the cog threads; and exit points if I am using the twin needle.
Figure 1-3: Inramuscular placement of double spirals into the corrugators for muscle relaxation, intradermal cross hatching for neocollagenesis, and insertion of PDO monofilaments into subcutaneous fat tissue (double chin) for lipolysis respectively”
The design of the anchoring system is paramount when choosing lifting threads. PDO threads have high tensile strength so they are ideally suited to be used as lifting threads. Despite the fact that all PDO threads come from South Korea, not all threads perform the same and this could be down to a variety of reason: Type of anchoring system – RegenAlift uses cogs Size of cogs Where and How they are placed Number and distribution of the cogs Manufacturing method
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aestheticmed.co.uk
For lifting threads to work well, the cogs need to be placed closed together. In addition, cogs need to be short and placed all around the thread (3D) – this evenly distributes the horizontal and vertical stress levels, giving stability to the lift, while lifting everything in its path. Finally, for medicolegal and insurance purposes CE marking and /or FDA approval must be sought. The goal in every thread treatment is to restore the highly desired V shaped face whilst giving the skin a more youthful look and texture. Most of the time I tend to combine stimulating threads inside the skin with suspension threads as in this way I double the benefits of my treatment: instant mechanical lift and increased neocollagenesis. Occasionally I may use ancillary procedures concomitantly with my threadlifts such as facial volumisation with fat grafting. Fat grafting will restore upper and mid face concavities, a hallmark of facial ageing secondary to volume loss and shift. In addition, its adipose derived stem cells and growth factors will improve the quality of the facial soft tissues and prolong the thread lift results by reducing the inflammatory phase and enhancing the remodelling phase of the healing process. Figure 4. Most commonly used patterns for upper, midface and lower face and neck thread lift using cog RegenAlift threads with cannulas. There are no exit points. The end of the thread is 1-1.5cm lateral to the nasolabial and marionette’s lines. Never go beyond the aforementioned anatomical landmarks as a) the branches of the facial nerve and the facial artery become superficial, and b) the SMAS layer is densely adherent to the skin and subcutaneous tissue (SMAS type II).
Quite recently I have also started using the RegenAlift twin needle suspension threads. Twin needles are recommended for more advanced practitioners with better familiarization with the facial anatomy as the sharp needles at the two ends of the cog thread can damage vessels and nerves if the right plane of insertion is not maintained throughout. These threads will also require accurate marking of two exit points too; one of each of its two needles. The technique used with this type of threads will be the focus in one of my future articles.
FUTURE DEVELOPMENTS
Koreans have been using threads for a massive range of skin problems ranging from acne scarring to pigment disorders. New areas that I am looking into with regards to the effectiveness, safety and longevity of the treatment include the use of mesothreads into eye fat bags taking
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THREADS
aestheticmed.co.uk
THREAD LIFTING
RegenAlift Twin Needle suspension threads with two 110mm silicone coated straight stainless steel needles in opposite directions and a bidirectional cog configuration diverging from a cog free mid-space of 20mm (or 30mm for the longer RegenAlift Twin Needles) on either side for insertion into the subcutaneous areolar fat tissue above the superficial musculoaponeurotic system of the face and neck providing better and stronger support. Technique and patterns of use vary depending on the practitioner’s experience. Twin Needles can also be used in a surgical facelift fixing their cog free portion of the PDO core thread onto the unyielding temporalis fascia”
advantage of their lipolytic properties as described above, and skin scarring secondary to either trauma or acne. The results have been encouraging. As soon as I have gathered enough supporting evidence I will get my results published. In summary PDO threads can produce: Instant lift – achieved mechanically Cell renewal – creates biostimulation and collagenesis Improved blood flow to the skin Lipolysis – contracting and reducing fat cells Muscle relaxation- when inserted intramuscularly
CONCLUSION
Threadlifting is an exciting and indispensable anti-ageing tool that every practitioner in the field of Aesthetic Medicine should possess in their armamentarium. A thread lift is a type of procedure wherein temporary sutures (threads) are used to produce a subtle but visible lift in the skin. Polydioxanone (PDO) has stood the test of time as a synthetic absorbable surgical suture with excellent properties such as minimal tissue reaction, superior tensile strength, and absorption by simple hydrolysis. The inherent flexibility of its polymer allows the polydioxanone suture to be fabricated into a monofilament fibre of various sizes which can then be intertwined to produce multi filaments or configured with small outward projections in the form of barbs, cogs, or cones that can act as an anchoring system when placed under the skin. The favorable profile of the polymeric material PDO in conjunction with the multitude of arrangements threads
made of PDO can be manufactured in (e.g. stimulating vs suspension threads) as well as the diversity of applications of PDO threads ranging from lifting the aeging face and tightening soft tissues to lipolysis to neocollagenesis to muscle relaxation make PDO thread lifts my favourite nonsurgical treatment. Training, sound anatomical knowledge, and getting experience with basic PDO threadlifting techniques are highly recommended before exploring the benefits of more advanced techniques (e.g. using the temporalis fascia as fixation point) and products (e.g Twin Needles). “ AM
Before and right after pictures of a midface and lower face threadlift using RegenAlift cog suspension threads with cannulas. Note the softening of her nasolabial and marionette lines. I cover all my threadlift patients with prophylactic antibiotics (i.e. Azythromycin 500mg x 3) starting the first dose 2 hours prior to the procedure and then 1 more dose the following day, followed by one last dose the day after.
Dr Sotirios Foutsizoglou developed a particular interest in anatomy during his time working in plastic and reconstructive surgery in the NHS. He became heavily involved in teaching anatomy and physiology to medical students and junior doctors and has worked as an anatomy demonstrator for Imperial College. He is currently completing his last year of training in plastic and reconstructive surgery at Evangelismos General Hospital of Athens. Since 2012, in his role as the lead trainer of KT Medical Aesthetics Group, he has been training practitioners in facial anatomy and advanced non-surgical treatments and procedures. He has written and lectured on facial anatomy and complications associated with injectables both nationally and internationally.
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DEVICES
EDITOR’S CHOICE
aestheticmed.co.uk
Filorga CryoLED Facial Vicky Eldridge tries out the Filorga CryoLED Facial at Joanne Fuller Beauty in Kent
I
t’s no secret that I love a facial, especially one that involves gadgets as well. These pages are often filled with me waxing lyrical about the latest one I’ve tried and this month is no different. For my latest treatment trial, I went to visit Joanne Fuller Beauty in Hamstreet, Kent, the village I grew up in, to try out Filorga’s CryoLED facial with the salon’s owner, Jo Fuller. Designed to give an instant lifting and tightening effect as well as rehydrating the skin and minimising the appearance of fine lines and wrinkles, the CryoLED protocol combines a number of treatment modalities for optimum results. Jo has also added in her own touches and, as I lie back and relax on her very comfy heated couch, I am treated to a neck and shoulder massage and a full skin cleanse before the treatment with the device begins. The facial starts with a light peel to remove the top layer of dead skin cells, exfoliate and help the products used during the treatment to penetrate deeper into the skin. Jo then mixes up the Filorga serums. There’s a choice of four serums containing concentrated doses that can be combined to create a tailored, high-performance response to the specific skincare diagnosis including serums for hydration, wrinkles and firmness. Their superfine texture makes it possible to layer them one on top of the other if you wish to, in order to achieve a combined effect. She applies the serum to the area she is treating as she goes. Then, using controlled thermal shocks via the patented CryoLED device, the skin’s temperature is rapidly cooled and reduced to well below freezing (-18°) in a matter of minutes using the ‘Cryo-probe’. This leads to a tightening of the microcirculation blood stream and then dilation of the blood vessels and capillaries, which helps to flush toxins and impurities away from the skin, increase oxygen and nutrient supply to the skin’s surface and improve its overall appearance. As well as this the treatment can help with psoriasis, eczema, rosacea and acne, due to the vasoconstriction. Jo says, “You do see results straight away which is the lovely thing about this treatment. The skin definitely looks a lot brighter, tighter and firmer and any redness or
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pigmentation is a lot more subtle. That’s what I love about it, that and the fact it’s a treatment you can have once a month, once every six weeks or as a one off. Obviously if you have it regularly then you will see more benefits. A lot of people think that -18° is going to feel really cold but usually afterwards they say ‘that was really relaxing.’ It’s especially nice around the eyes.” Jo is right. I don’t find the treatment uncomfortable at all, in fact I could happily have nodded off to sleep during it. I loved the cooling sensation on my skin and, as I turned 40 last month, I’ve definitely noticed increased signs of ageing around my eyes, so the cool, soothing and de-puffing element in the eye area was great for me. As well as treating the face the treatment also targets the décolletage and neck at the same time, another key concern for me as I get older. The next stage is an amazing hydrating Hyaluronic Youth Mask which my skin just drinks. Then Jo uses the device to perform 15 minutes of light therapy, using a combination of red and blue light. To finish the Skin Perfusion, medi-grade skincare is applied including a day cream, eye cream and SPF. As is the way these days, I have to pose for a social media picture afterwards with no make-up on, but I don’t mind as I look a lot more fresh faced than I did when I walked in with my face on. I really enjoyed the treatment and it was great to visit this lovely little salon which is a hidden gem. AM
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DEVICES
TREATMENT SPOTLIGHT
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Precision engineering We find out about the SkinPen Precision treatment
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echanical microneedling is the process of using tiny needles to create thousands of “micro” channels in the skin, to stimulate the wound healing response mechanism and collagen remodelling process. Though it’s been safely used by medical professionals for a wide variety of skin conditions since the 1990s, mechanical microneedling has suffered from little oversight in the industry and was in urgent need of redesign for the correct classification and for patient safety against crosscontamination. In March 2018, after three years of proactive work with the FDA designed to clean up the microneedling arena, Bellus Medical (Dallas, Texas), earned the first and, so far, only FDA clearance of a microneedling pen with its flagship product, SkinPen Precision. The clearance established a new microneedling classification and category, making SkinPen the only legally marketed Class 2 microneedling pen in the USA and setting a new standard. The following three contamination path shields for mechanical needling for patient safety have been addressed: First is the cartridge – 100% double lined sealed providing ‘ingress protection” (the measurement of fluids that can enter an electrical component). Second is the pen – 100% ultrasonically sealed, necessary because it’s virtually impossible to clean the inside of a pen. Third is a protective sheath covering for handling, to protect the pen from blood contamination by the operator.
IMPROVEMENTS PATIENTS CAN EXPECT TO SEE
Collagen Induction Therapy (CIT) triggers the wound healing response – sensory nerve endings are stimulated, cell membranes damaged, and mast cells stimulated that all lead to the release of neurotransmitters, a complex signalling process made up of growth factors and cytokines. This instigates the proliferation of platelet, fibroblast, epithelial and endothelial cells and the natural healing response, leading to the repair and regeneration of new healthy tissue. This wound healing response will not only encourage epidermal repair, but also dermal regeneration, to induce
the endogenous production of cutaneous collagen and fortification of the epidermal tissue as well as increased integrity and density of the dermal matrix. Patients will receive between three to six procedures one month apart, dependent on the treatment protocol, age and condition of the skin. Regular top up treatments would be recommended once every three months to maintain maximum effects. Studies prove that microneedling thickens the dermis and epidermis. As proliferation and remodelling take place so does the support of the dermal-epidermal junction. The results are gradual and not reversible. Dermal thickness increases 0.5mm after five months, with a 400% increase in thickness of the dermal thickness after six months of remodelling. The levels of regeneration and remodelling will be linked to genetics, lifestyle, age and health. It is important for the practitioner to assist this process with good lifestyle advice and post-treatment support products that will assist healing and regeneration and long-term effects. Sally Wagstaff from the Xodos Clinic in Sutton Coldfield says, “I decided I wanted to take on needling at the clinic as I wasn’t providing a treatment that adequately treated acne scarring and stretch marks. I did quite a lot of research into pens (I knew I didn’t want a roller), and it became very apparent that SkinPen was [the best] option due to its safety. We started using it…and wow! While we have been really pleased with the scar reduction, we just can’t get over the quality of its anti-ageing results, it’s quite unbelievable. I recommend it to a far larger proportion of my clients than I was expecting to be able to and they all love it. It’s going to be a huge part of our business in 2019.” AM
Before and after treatment with SkinPen Precision
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