Aesthetic Medicine February 2020 by Aesthetic Medicine

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February 2020 | aestheticmed.co.uk

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CONTENTS

IN THIS ISSUE...

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Contents FEBRUARY

4 EDITORIAL BOARD Meet our editorial advisory board 8 NEWS The latest news from the industry

EDITORIAL Vicky Eldridge, Editor

16 NEWS ANALYSIS Hamilton Fraser shares its industry survey results

E: vicky@aestheticmed.co.uk T: +44 (0) 7931 924 322

Georgia Seago, Deputy Editor E: georgia@aestheticmed.co.uk T: +44 (0) 20 3728 9063

20 AESTHETIC MEDICINE LIVE 2020 All the information you need for our 2020 event 40 CLINIC PROFILE Georgia Seago discovers newly-opened BeautiPhi 46 OUTSOURCING Gilly Dickons explains how outsourcing could save you time and money

ADVERTISING Jack Diamond E: jack@aestheticmed.co.uk T: +44 (0) 207 349 4792

MARKETING Chloe Monina E: chloe@aestheticmed.co.uk T: +44 (0)207 349 4799

PUBLISHER Mark Moloney E: mark@aestheticmed.co.uk T: + 44(0) 207 349 4790

DESIGN AND PRODUCTION ICD imagecreativedesign.co.uk

PRINTING Pensord Press pensord.co.uk SUBSCRIBE

Annual subscription UK: Print £44, DD £39.50, Digital £10. Europe: £59; outside Europe: £67.50. 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. Professional Beauty Group 25 Allington House High Street Wimbledon Village SW19 5DX

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CONTENTS

IN THIS ISSUE...

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48 LIP THREADING The new dermal filler? 54 SOCIAL MEDIA Jemma Edwards compares the advantages of Facebook vs. Instagram 58 CLINICAL CONTRIBUTOR Dr Ahmed El Houssieny considers the ethical aspects of facial beautification in younger females

62 REFERRALS Dr Haroun Gajraj discusses when to refer leg spider veins to a vascular specialist 66 BUSINESS Dr Harry Singh shares his tips for turbo-charging your business’ patient base 68 PRODUCT NEWS The latest product launches

70 LAUNCH FOCUS Cutera’s take on the muscle stimulation trend 72 PRODUCT FOCUS The new ProLean weight loss supplement from ZENii 76 TREATMENT NEWS The latest treatment launches and reviews

80 TALKING TO Vicky Eldridge speaks to Jay Shah from Elite Aesthetics about his innovative clinic chat bot 82 CLINICAL EXPERIENCE Dr Xavier Goodarzian shares his experience with collagen stimulators 86 INTIMATE PEELS We examine the results that can be achieved with intimate peels

88 LASER AND IPL Kathryn Conway sheds some light on choosing a laser or IPL device 92 REGULATION Tracey Jones and Sophie Singh-Jaggatia discuss whether or not you should be registering with the CQC 96 EMPLOYMENT Victoria Vilas gives her tips on employing practitioners who work at other clinics

Welcome to the February issue of Aesthetic Medicine 70

This month while researching an article I was writing on diet pills and supplements I was shocked to discover that only 8% of people ever actually achieve the resolutions they set themselves at the beginning of the new year and that most people give up by mid-January. While this applies more to personal goals, such as weight loss, stopping drinking and starting at the gym, many of us also set professional and work-related goals and resolutions too. But these can also fall by the wayside. With so much to think about and do on a daily basis, it can be hard to know what to focus on and prioritise first when it comes to your business goals. So why not come along to Aesthetic Medicine Live this month (February 29-March 1). Our Business Workshops will be kicking off with a session on this very topic and we have a fantastic speaker line-up for 2020 ready to share their expertise across every area that aesthetics encompasses. Turn to pages 20-37 to find out what you can see and learn. I look forward to seeing you there. Vicky Eldridge – Editor

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CO N T R I B U TO R S

EDITORIAL ADVISORY BOARD

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Meet the experts The Aesthetic Medicine editorial board includes some of the leading names in aesthetics. Their clinical expertise and diverse range of specialties will help ensure the magazine meets the needs of its reader’s.

DR NICK LOWE

DR ULIANA GOUT

DR SOPHIE SHOTTER

Dr Nick Lowe is a consultant dermatologist at Cranley Clinic, London and clinical professor of Dermatology at UCLA School of Medicine, Los Angeles. He is a Fellow of the Royal College of Physicians, American Academy of Dermatology and American Society of Laser Medicine and Surgery. He has authored more than 450 clinical and research publications, 15 scientific and five educational books.

Dr Uliana Gout is the founder of London Aesthetic Medicine Clinic & LAM Academy. She sits on the Board of the British College of Aesthetic Medicine (BCAM) and acts as a BCAM Appraiser for the GMC. She also sits on the Board of the International Peeling Society. She has co-authored numerous medical textbooks.

Dr Sophie Shotter is the founder and medical director of Illuminate Skin Clinic in Kent. In 2019, she was invited to join the Allergan faculty board, having been mentored by Dr Mauricio de Maio. She is also on the board of the International Association for the Prevention of Complications in Aesthetic Medicine (IAPCAM). In 2017, she won Businesswoman of the Year at the Kent Women in Business awards.

DR STEVEN HARRIS

DR SHIRIN LAKHANI

DR RAJ THETHI

Dr Steven Harris has been practising aesthetic medicine at his clinic in North London since 2004 and has gained an international reputation for producing natural looking results. His original approach and techniques include Facial Reshaping with Myomodulation and the Nonsurgical Lip Lift (NLL). Dr Harris is also a trainer and educator. His regular educational posts can be viewed on Instagram: @drharrisclinic

Dr Shirin Lakhani has an extensive background in medicine, having worked both in general practice and in a hospital environment. She is also a trained anaesthetist. In 2013 she founded Elite Aesthetics in Kent. She also practices from the renowned Cranley Clinic in London. She has a specialist expertise in intimate health and appears regularly on television and in the press as well as speaking at medical conferences worldwide.

Dr Raj Thethi graduated from Leeds University Medical School in 2013, having completed an additional BSc (Hons) 1st Class Degree in Anatomy. On completion of his surgical training in the Yorkshire Deanery he qualified as a Member of the Royal College of Surgeons (Edinburgh). He has completed a Level 7 accredited course in Aesthetic Medicine. He is an aesthetic trainer and has been published in several aesthetic industry journals.

MR ALI GHANEM

DIJA AYODELE

EMMA DAVIES

Mr Ali Ghanem is a consultant aesthetic plastic surgeon and clinical senior lecturer in plastic, reconstructive and aesthetic surgery at Barts and the London School of Medicine & Dentistry, as well as visiting professor and head of department of Aesthetic Medicine at the College of Medicine and Dentistry, Ulster University. He is qualified in Medical Law and Ethics, Surgical Science and Developmental and Stem Cell Biology.

Dija Ayodele is an aesthetician and founder of the award-winning educational platform Black Skin Directory (BSD). With more than 10 years’ experience, her Kensington-based clinic is a go-to destination for patients of colour seeking skin rejuvenation treatments and advice for their skincare needs. She speaks regularly at both industry and consumer events and in 2019 launched a pioneering sunscreen campaign for black skin.

Emma Davies has specialised in aesthetic medicine since 1998. She was a committee member on the RCN Aesthetic Nurses Forum from 2000-2010; founder member and secretary of the British Association of Sclerotherapists (2003-2010) and founder member and past chair of the British Association of Cosmetic Nurses (20102014). She is currently clinical director of Save Face and vice chair of The Aesthetic Complications Expert Group.

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INDUSTRY NEWS

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ASA warns industry to stop illegally advertising botulinum toxin Aesthetics and beauty businesses are being warned to stop illegally promoting botulinum toxin injections on social media. The Advertising Standards Authority (ASA), working with the Committees of Advertising Practice (CAP), alongside the Medicines and Healthcare products Regulatory Agency (MHRA), has issued an Enforcement Notice to the aesthetics and beauty industries on the rules around advertising botox. It is illegal to advertise prescriptiononly medicines such as botulinum toxin to the public. This applies even if the drug is administered by a registered medical professional. The CAP has already sent the warning to more than 130,000 beauty service providers. Coming into force from

January 31, the ASA will use “monitoring technology” to find problematic ads, flagging them to Facebook and Instagram for removal. The watchdog will be cracking down on paid-for ads, non-paid-for posts and influencer marketing, as well as promotional advertising such as “botox parties” or treatments as a competition prize. Non-compliant sellers will be referred to the MHRA, which has investigatory and enforcement powers. The CAP will also be rolling out a targeted ad campaign across Facebook. This is the furthest-reaching enforcement notice ever issued by the CAP. Director Shahriar Coupal said, “This is an example of how CAP is exploring new, proactive ways of ensuring ads stick to the rules and rising to the challenges presented by the online environment.”

Dalvi Humzah Aesthetic Training to provide Level 7 award in facial anatomy Dalvi Humzah Aesthetic Training has announced that its Facial Anatomy course will now be offered as a Level 7 award. The course has been developed with an OFQUAL-recognised awarding organisation. The company has also announced new developments including its first 3D and VR learning environments that will be rolled out in 2020. Mr Dalvi Humzah, consultant plastic surgeon and lead tutor said, “This Level 7 award will provide a standard for medical practitioners in aesthetics. We have also appointed new faculty tutors who will be helping in the further development of this course which will make it a novel, exciting and educational course.”

New indications and technology to drive global injectables market growth The global facial injectables market is forecast to grow at a compound annual growth rate (CAGR) of 10.8% by 2025. ResearchAndMarkets.com cited the anticipated launch of new products in the coming years as one of the key factors predicted to drive the growth. An increase in beauty consciousness and growing awareness of injectables and what they can treat will also contribute to the market’s development. Innovation in technology, techniques and procedures will fuel the market, with suppliers set to focus more on evidence-based clinical trials to support R&D, especially given the rumoured imminent launch into key global markets of a new breed of toxins from Asia, renowned for fast technological progress. North America accounted for the largest share of the global facial injectables market in 2018, followed by Europe (Germany, France, the UK and Italy). The markets in Brazil, China, Russia and India are expected to grow at a rapid pace due to a high adoption rate of cosmetic procedures and the growing number of aesthetic clinics opening in these countries.

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INDUSTRY NEWS

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Interest in cosmetic surgery revisions on the rise, says RealSelf report RealSelf has revealed the fastest-growing cosmetic treatments of 2019 and industry predictions for 2020 in its new 2019 Aesthetics Trend Report. The 2019 Aesthetics Trend Report is based on traffic from consumers in the United States who researched cosmetic treatments on RealSelf.com between January 1, 2019, and October 31, 2019. One of the most notable trends from this year’s report is the prevalence of treatments meant to correct or revise previous cosmetic surgeries. Hyaluronidase, an injectable enzyme that breaks down hyaluronic acid–based fillers, ranked third on the list of fastest-growing treatments, with 50% growth compared to 2018. On the surgical side, a total of four revision treatments made the list, including liposuction revision, with 183% growth; tummy tuck revision, with 100% growth; breast implant removal, with 91% interest increase; and silicone

injection removal, with 89% growth. Morpheus8, Jeuveau, and BodyFX were the most-researched new treatments that launched in 2019. It was also a breakout year for BTL’s Emsculpt. The muscle toning treatment saw a 450% year-overyear interest increase in 2019, making it the fastest-growing cosmetic treatment on RealSelf. The trend for muscle-toning treatments was predicted to grow throughout 2020. Other predictions included longer-lasting and more versatile injectable fillers coming to market as well as 2020 being coined as the “year of the tweakment”.

Cosmetic laser market to reach $5.41bn (£4.15bn) by 2026 Increase in awareness, developments in the field and a surge in obesity across the globe will drive the growth of the global cosmetic laser market, according to a recent report by Allied Market Research. In its Cosmetic Laser Market document the analyst claimed the industry garnered $1.81bn (£1.39bn) in 2018 and estimated it would generate $5.4bn (£4.15bn) by 2026, growing at a compound annual growth rate of (CAGR) of 14.5%. The non-ablative lasers segment accounted for nearly three-fifths of the total global market share in 2018 and was predicted to retain its lead position during the forecast period. Based on region, North America held the largest share in 2018, accounting for more than two-fifths of the global market, and will lead during the forecast period. Asia-Pacific is estimated to witness the largest growth rate, registering a CAGR of 16.2% from 2019 to 2026.

Cosmetic applications to drive PRP market growth The global platelet-rich plasma market is predicted to be worth over £414 million by 2026, says a report by by Transparency Market Research. Reflected in a CAGR of 12% from 2018 to 2026, PRP’s growth will be influenced in part by the popularity of the technique in cosmetic applications for skin rejuvenation and hair restoration. PRP’s role in accelerating wound healing presents wide applications across healthcare, including for orthopaedic surgical procedures, sports injuries and chronic wounds. Innovations in PRP technology are also likely to boost market growth, such as changes in production protocol, output level and more companies investing in research and development to create new applications and devices. New approaches to combined treatments are also being studied, such as blending PRP with ultrasound for accelerated healing of certain medical conditions. Because of the speed at which PRP modifies facial aesthetics – owing to its accelerated wound-healing capabilities – the cosmetic surgery segment is predicted

to expand at the highest CAGR during the forecast period. North America accounted for the biggest share of the market in 2017 at 40%. This is due to an increase in demand for cosmetic procedures as well as a high prevalence of orthopaedic diseases and approvals of various PRP systems by the FDA. However, high cost of devices to practitioners and the treatments itself to patients, along with the possibility of treatment failure, are hampering market growth.

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INDUSTRY NEWS

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Aesthetic physicians should recognise the course of the ascending mental artery in chin augmentation, says study Every aesthetic physician should recognise the course of the ascending mental artery and use the appropriate techniques to avoid vascular injury during chin augmentation using filler injections, according to a paper published in Plastic Reconstructive Surgery. The authors measured the topographic anatomy of the artery at the chin injection area in 31 cadaveric faces using a threedimensional camera. The midline of the inferior margin of the mandibular protuberance was marked with a pin. A variation in size between the two opposite ascending mental arteries was

noticed. The depth of the artery from the skin surface and distance from the midline were measured using a threedimensional camera. There were 19 dominant ascending mental arteries on the right and 12 on the left. The dominant ascending mental arteries enter the chin paracentrally, approximately 6mm (mean ± SD, 5.64 ± 4.34 mm) from the midline, within the muscular plane, and at a depth of 4.15 ± 1.95 mm from the skin. Furthermore, the artery formed an anastomosis with the sublingual artery, within the floor of the mouth.

Contact dermatitis could be prevented, say scientists Contact dermatitis could be prevented from developing on the skin, according to researchers at Columbia University’s Irving Medical Center. Contact dermatitis occurs when the immune system’s T cells recognise a chemical as foreign, however, the team found that a chemical reaction with larger proteins needs to take place in order to be picked up by the T cells. They believe that CD1a – a molecule found on Langerhans cells, residing on the basal and suprabasal layers of the epidermis – could be the catalyst for making foreign chemicals visible to T cells. According to the research, several common chemicals known to trigger allergic contact dermatitis were unable to bind to CD1a molecules. “The study paves the way for follow ups to confirm the mechanism in allergic patients and design inhibitors of the response,” said assistant Professor Annemieke De Jong. “From previous studies, we know the identity of several lipids that can bind to CD1a but won’t activate T cells.”

Association launches to raise awareness of the dangers of surgical plume A new association has launched with the aim of raising awareness of the potential dangers of surgical smoke or diathermy plumes generated by electrosurgical, laser or ultrasonic devices. The UK Council for Surgical Plumes aims to educate both patients and practitioners of the importance of implementing measures to protect them from vapours, smoke, and particulate debris produced during laser and IPL procedures to vaporise, coagulate, and cut tissue. The association has been founded by physicist and bioengineer Mike Murphy and Dr Zambia Kader, who say the evidence linking surgical smoke and harm to the human body should not be ignored. Headaches, eye watering, coughing, sore throats, odours absorbed in the hair, nausea, drowsiness, dizziness, sneezing and rhinitis were all highlighted as side-effects in a 2016 study of nurses and doctors performing electrosurgery by Özcan İlçe et al. The UKCSP is recommending that practitioners performing such treatments have extractor fans with proper filters and ventilate their treatment rooms as well as ensuring both they and their patients wear masks.

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INDUSTRY NEWS

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NEWS IN BRIEF SINCLAIR PHARMA TO RUN TRAINING IN IRELAND WITH PATRICIA MOLLOY

Sinclair Pharma is to launch a new training partnership in Ireland with aesthetic practitioner Patricia Molloy, founder of DermaClinic in Dublin. Molloy will join Sinclair as a trainer from Merz Aesthetics, and will run a comprehensive training programme for Perfectha hyaluronic acid gel filler, as well as the Ellansé range of biostimulating dermal fillers. The new programme is aimed at experienced doctors, dentists and selected nurse practitioners.

CALL FOR PAPERS FOR BCAM 2020 CONFERENCE

The British College of Aesthetic Medicine (BCAM) has opened submissions for papers for its 2020 conference, to be held on Saturday, September 19. This year’s conference will be themed “The leading edge of aesthetic medicine”. Those wishing to share their passion, knowledge and expertise in aesthetics by speaking at the conference are asked to fill out a form, which is available from BCAM, with the chosen topic. The deadline for submissions is Sunday, February 29. Visit bcam.ac.uk

CYNOSURE ISSUES STATEMENT TO CUSTOMERS OVER COMPANY’S SALE

CynoSure’s global president has assured its clinic accounts that the company’s recent sale will increase customer support. Erik Anderson released a statement about the aesthetic devices company’s future following news of the completion of its sale from medical technology company Hologic. CynoSure was acquired by an affiliate of investment funds manager Clayton, Dubilier & Rice for $205 million (approx. £157m). Hologic purchased CynoSure for $1.7 billion ($1.3bn) in 2017.

PAPER EXAMINES TRENDS IN FACE-LIFTING IN BALD MEN

A paper published in Plastic Reconstructive Surgery has shown that a face-lifting technique for bald men, involving a peculiar and innovative way of handling the skin excess, has proven to be reliably effective in obtaining virtually invisible scars. A 10-year observational study was carried out on 68 bald male face-lift patients. All patients underwent deep plane lifting with a specific method for handling skin excess.

More than half of UK women do not know what early or premature menopause is A survey conducted by Health & Aesthetics has revealed that 34.3% of women do not know the difference between premature and early menopause, while 25.4% confessed they were not aware of what either is. The average age that women go through ‘the change’ in the UK is 51 but, according to research, one in 100 women reach menopause prematurely before the age of 40. Early menopause, which can occur between the ages of 40 and 45, affects around 5% of women. Dr Rekha Tailor, founder and medical director of Health & Aesthetics, said, “Experiencing menopausal symptoms at a younger age than expected can put a strain on romantic relationships and disrupt everyday activities. But there are ways to manage the symptoms and cope with any distressing feelings.” The main difference between early and premature menopause is the age at which they happen. However, both conditions are caused by similar issues, such as autoimmune diseases, genetic abnormalities, family history and smoking. The symptoms of both conditions are similar to those associated with menopause in general, including hot flushes, loss of libido, vaginal dryness and mood swings. But going through menopause at an earlier age can also trigger complex emotions, which may include embarrassment or feelings of loss.

Almirall and Iktos announce AI research collaboration Global pharmaceutical company Almirall has announced a collaboration with Iktos, a company specialised in artificial intelligence. The partnership will see Iktos’s generative modelling AI technology used to design novel optimised compounds, to speed up the identification of promising drug candidates. This tackles one of the key challenges in drug design: rapid and iterative identification of molecules which simultaneously validate multiple bioactive attributes and drug-like criteria for clinical testing. “Artificial Intelligence will provide Almirall a unique opportunity to combine our proficiency with the preciseness and agility to truly make a difference in patients’ lives”, said Dr Bhushan Hardas, executive vice president of R&D and chief scientific officer at Almirall.

NEWS IN PICTURES Stylage and Desirial manufacturer Vivacy has expanded its laboratory in Archamps, on the border of France and Switzerland, to 5,000m2. The facility is responsible for the company’s product development, distribution and production. The expansion of the lab will allow the company to double its production capacity from three million to six million syringes a year, as well as providing more office space and a new VIP Floor dedicated to doctor training, with panoramic views of Lake Geneva on the top floor of the building.

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NEWS IN BRIEF BAS INVITES POSTER PRESENTATIONS FOR CONFERENCE

The British Association of Sclerotherapists (BAS) is inviting poster submissions for its 2020 Sclerotherapy Conference taking place on May 19 in Windsor. Entrants have until April 30 to submit the final posters which will be displayed alongside the oral presentations and sponsors’ exhibition at the annual conference. The poster topic can be research-based or demonstrate experience and information from individuals or teams. Posters will be peer-reviewed and judged on relevance, clarity, originality, case presentation methodology and visual impact.

SK:N GROUP MEDICAL DIRECTOR WINS GLOBAL EXCELLENCE AWARD

Dr Firas Al-Niaimi, group medical director for sk:n has won the LUXLife Global Excellence Award and title of Consultant Dermatologist of the Year 2019 – London. He said, “It’s extremely rewarding to be recognised by the LUXLife panel for my medical experience within the dermatology industry and contributions to research over the years. I am also very thankful for the opportunities that sk:n has provided me to grow, which have helped me to achieve this.”

3D-LIPO EXTENDS BUSINESS INITIATIVE TO SCOTLAND

Following the launch of its Business Development initiative in May 2019, 3D-lipo has announced the expansion of this program into Scotland for 2020. Mandy McCulloch is the latest member to join the team of business development managers and will be working throughout Scotland. McCulloch has more than 20 years’ experience within the retail industry for beauty brands. She said, “From my experience, my main lesson has been that you should always imagine walking in your customers shoes. If you put your customers first, everything else tends to fall into place.”

ALLERGAN MARKS BEGINNING OF BOTOX 30TH ANNIVERSARY

The close of 2019 saw global pharmaceutical company Allergan begin celebrations to mark the 30th anniversary of Botox by ringing the opening bell at the New York Stock Exchange. Over the last three decades more than 100 million vials of Botox and Botox Cosmetic have been manufactured. With two additional US FDA approvals being given in 2019, Botox now has 14 approved therapeutic and aesthetic indications combined. “This incredible milestone underscores our constant focus on innovation and motivates us to further build on our 30 years of research and development efforts,” said Mitchell F Brin, senior VP of global grug development and chief scientific officer for Botox and Neurotoxins.

The Sun’s Fabulous brand launches campaign to crackdown on unregulated cosmetic fillers The Sun’s Fabulous brand has launched a campaign called Had Our Fill aimed at cracking down on unregulated cosmetic fillers. It is calling for fillers to be made illegal for under 18s, a crackdown on social media sites allowing fillers to be irresponsibly advertised, and a Government-backed central register. Duncan Stephenson from the Royal Society for Public Health said, “Dermal fillers are a crisis waiting to happen, which is why we’re backing Fabulous’s campaign. Around two in three young people know someone in their social circle who has had fillers. “The law of the land has struggled to keep pace with this relatively recent phenomenon. Anyone can set themselves up to give these procedures and there is absolutely no requirement for knowledge, training or previous experience.” Rachel Shields, assistant editor of Fabulous said, “Fabulous is standing up for the women falling victim to Britain’s shockingly unregulated injectables industry. The fact that someone with no medical training can inject potentially lethal substances into another person’s face is a scandal.” The campaign is also backed by the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS), the British Association of Aesthetic Plastic Surgeons (BAAPS), and Save Face.

2020 beauty trends highlighted in Future 100 list Science-backed skincare, menopause beauty and a growing demand for hyperpersonalisation have been highlighted as just some of the trends set to shape the beauty market in 2020. The Future 100 annual report from Wunderman Thompson Intelligence looks ahead to the defining trends in consumer behaviour and innovation. While the report encompasses the entire beauty industry, some key trends may impact the aesthetics sector. Skincare featured heavily on the list, with the report claiming that people are turning more and more to experts in scientific fields to deliver technical, precise products. It also suggested that a growing demand for hyper-personalisation is driving innovation in product dosage and application and that beauty would be getting “biological” with more brands turning their attention to the skin’s microbiome, the bacterial barrier that protects the skin. Menopause beauty was also flagged as a growing trend, with the industry catching on to demand from menopausal women, who the report described as a “powerful group of consumers”.

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NEWS SPECIAL REPORT

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Inside track We highlight the most valuable insights from Hamilton Fraser’s 2019 aesthetic industry survey

amilton Fraser Cosmetic Insurance has published the results of its 2019 annual industry survey. Over 450 aesthetic practitioners answered questions designed to better understand their motivations, needs, wants, challenges and requirements in the sector. As the first commercial insurance provider to offer medical malpractice insurance within the cosmetic industry since 1996, Hamilton Fraser’s unique understanding of the aesthetics market allows the insurance provider to help ensure patient and practitioner safety and professionalism, supporting best practice in aesthetics. “This is a fantastic response to our annual survey, with 461 practitioners completing it at the end of 2019, representing an increase of 51% on the previous year”, commented Mark Copsey, associate director for the healthcare division at Hamilton Fraser. “We will use this valuable data to enhance our products and proposition as well as providing our customers with important information about training course partners, business planning and further knowledge of the wider cosmetic community”.

MOTIVATIONS FOR ENTERING AESTHETICS

Survey results showed that aesthetic practitioners had a number of reasons for entering the sector. The top results showed: 1. 62% entered the field due to their interest in non-surgical cosmetic treatments

2. 61% listed a key motivation for entering aesthetics was as a “new challenge” 3. 49% suggested that both job satisfaction and flexible working hours also contributed as motivating factors for entering the market. > Aesthetic Medicine • February 2020

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N E W S A N D A N A LY S I S

NEWS SPECIAL REPORT

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ASSOCIATIONS AND AESTHETICS BODIES

There are a number of cosmetic associations and independent aesthetic bodies providing support and guidance to practitioners and helping to improve patient safety throughout the industry. Of those surveyed, 58% of aesthetic practitioners reported that they were not a member of listed associations, including BACN, BCAM, PIAPA, BABS, BAAPS, UKAAPS, BAAD, BACDP or BACD. In addition, when asked if they were a member of any independent aesthetic bodies, 46% of practitioners reported being a member of the ACE group 45% were not a member of any of the listed bodies, including AAIC, CSA, JCCP, and Save Face.

CHALLENGES IN AESTHETICS

Practitioners were asked about what they felt was the greatest challenge within the aesthetics industry. 1. 60% of practitioners (as answered by 350 respondents) commented that their greatest challenge was increased competition within the aesthetics industry. This could be as a result of a growth in non-invasive cosmetic procedures and clinics offering treatments 2. 54% believed marketing was their greatest challenge 3. 41% suggested that keeping up with the latest products and technology was also a significant challenge. AM

Results also showed that 75% of practitioners reported that aesthetics was not their only source of income, while 74% reported practising on a part-time basis (equating to up to 20 hours per week).

WHERE PRACTITIONERS PRACTISE

Of those practitioners surveyed, 34% reported practising from their own clinic premises and 28% reported working from a clinic within their home.

TREATMENTS PROVIDED

The most common treatment types provided were: 1. Botulinum toxin – 90% 2. Dermal fillers – 88% 3. Skin treatments – 51%

TRAINING AND DEVELOPMENT

When asked which Continuing Professional Development (CPD) methods practitioners had undertaken in the last 24 months, survey results showed that: 76% had completed active learning in the form of a training event 74% had undertaken reading (including textbooks, journals and papers) 51% had attended conferences 47% had taken part in peer group discussions 37% had undertaken an academic course. Read the full survey results from Hamilton Fraser Cosmetic Insurance: hamiltonfraser.co.uk/knowledge/hamilton-fraser-cosmetic-insurances-annual-survey Find out more about recent industry regulatory changes and guidelines: hamiltonfraser.co.uk/knowledge/annual-aesthetics-roundup-2019-highlights

Aesthetic Medicine • February 2020

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Contact us for more information or to book a demonstration today. Aesthetic Technology Limited | T: 0845 689 1789 | E: info@dermaluxled.com | W: dermaluxled.com

AM LIVE 2020

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Look before you leap Why a visit to Aesthetic Medicine Live is a must for any aesthetic business looking to expand its products and services in 2020

020 is a leap year, so why not make the most of the extra day with a visit to Aesthetic Medicine Live to get fresh ideas on new products and treatments, to help your clinic stay at the cutting edge. Taking place on February 29 â&#x20AC;&#x201C; March 1 at Olympia London, Aesthetic Medicine Live is the first major UK aesthetics conference and exhibition of the year, giving you a chance to see leading brands all under one roof. If you are a busy clinic owner then finding time to meet with reps and look at new products and technologies you may want to introduce can be challenging. A visit to the Aesthetic Medicine Live exhibition will give you a chance to meet face-toface with market-leading manufacturers and suppliers. From injectables and threads to skincare, body-shaping devices and lasers, our exhibitors will be showcasing their latest innovations, with many giving free demonstrations on the Live Stage so you can expand your knowledge and see treatments in action.

Aesthetic Medicine â&#x20AC;˘ February 2020

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Attending the exhibition will also give you a chance to take advantage of exclusive show offers and deals, which are only available to visitors at the show. Check out pages 26-32 for the latest launches and see page 24 for our Live Stage line-up. EXHIBITOR FOCUS: TECHNOLOGY AND INNOVATION Buying capital equipment is one of the biggest investments your clinic will make so being able to see, feel and touch devices, as well as watch demonstrations and hear from KOLs who use them, is an invaluable part of this decisionmaking process. The Aesthetic Medicine Live exhibition brings you access to key players in the devices and technologies market. Whether you are looking to upgrade existing equipment or want to introduce new services such as body-shaping,

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AM LIVE 2020

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More and more aesthetic clinics are also tattoo removal or skin rejuvenation, we TREND WATCH: realising the benefits of an inside-out have it all covered. From laser and IPL INTIMATE REJUVENATION approach, expanding their services to HIFU, LED, micro-needling and Visit our Platinum Sponsor to offer patients more insight into radiofrequency, you will be able Mesoestetic on stand H6 and find what is going on intrinsically, not to find what you need on the out more about the new Dermamelan just extrinsically. Visit BioID on exhibition floor. treatment for depigmenting the genitalstand G26 to find out more about Our device manufacturers perianal area, inner thighs and groins. You can bioidentical hormones and see and suppliers include: 3D-lipo also find Desirial on the Vivacy stand (C6), a brands like Fagron (stand H22), Sky (stand E14), ABC Lasers (stand range of cross-linked injectable gels to help Medic (stand D35) and Roseway D14), ACUMAG (stand B1), improve and maintain women’s intimate Labs (stand K14) who offer bespoke Advanced Esthetics Solutions health and wellbeing. Many of our medicine services. AQ Skin Solutions (stand G14), Aztec Services technology brands also (stand B22) will also be showcasing its (stand D26), Baldan Group (stand have intimate rejuvenation transdermal topical product to enhance C16), Belle/INDIBA (stand F22), devices. testosterone production. Best Brothers (stand J22), BioActive And don’t forget about the benefits Aesthetics/SkinPen UK (stand J6), Biotec of PRP treatments when it comes to Italia (stand D18), BTL (stand B14), Candela regenerative medicine. See Medira (stand (stand H14), Celluma (stand G2), Cocoon Medical UK G32), PRP Lab (stand K18) and Rosmetics (D22), Consulting Room (stand A14), Cryoslim (stand B24), (stand F6) to capitalise on this trend. Cutera (J18), Cynosure (stand C14), Dermalux (stand G6), Enoura Aesthetics (stand A9), Erchonia Lasers (stand H16), BOOK WORM BUSINESS SERVICES Fusion GT (stand F20), Healthxchange Aesthetic Medicine While the clinical aspects of running (stand H28), InBody UK (stand Live is the place to stock a practice are key, successful clinic B18), Inmode (stand D10), Jett up on quality educational TREND WATCH: owners also embrace the business Medical, Juvaplus (stand books. Visit Wisepress MUSCLE SCULPTING side too. Insurance is one of the D24), Lumenis (stand J14), (stand B23) and Muscle sculpting devices, most important things you need Lynton (stand F10), Med Archimedia which mimic the effects of when starting an aesthetic business. Aesthetics (stand E6), (stand A15). exercise, are one of the latest Visit Cosmetic Insure (stand A23), Natura Studios (stand innovations in device-based Enhance Insurance (stand B30) and J28), Opatra (stand C30), technology. Visit BTL (stand Hamilton Fraser (stand H24). Perfecte’Me (stand B6), B14 ), Cutera (stand J18 ) and Pure Swiss Aesthetics Taking before and after photographs is also an Cynosure (stand C14) to (stand A30), Thermavein important factor, not just for insurance reasons but also find out more. (stand C22), Unique Skin as a tool for marketing and demonstrating your results to (E24), Venus Concept (stand perspective patients. Visit Observ on stand E35 and Clinical B8) and; WOW Facial (stand J10). PhotoPro on stand F36. We also have clinic management systems such as Pabau HEALTH AND WELLBEING : FROM HORMONES TO (stand G35) and finance companies including Integra Asset WEIGHT LOSS Finance (stand A10) exhibiting at the show. Wellness has been a key trend in recent years that has filtered into the aesthetics industry, and nutrition and Book in advance for free at aestheticmed.co.uk/ weight loss are a key part of that. ZENii (stand G20) has booktickets, or buy a ticket for £20 on the door recently launched a new weight loss supplement (see page on the day. 72), while the National Medical Weight Loss Programme (stand A22) offers solutions for weight management. PLATINUM SPONSOR New to AM Live, The Pure Package (stand C24) offers preprepared healthy meal delivery programmes and is looking to partner with clinics.

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VISIT US ON STAND H6

pharmaceutical excellence in depigmentation OLYMPIA LONDON 29 FEB-1 MAR 2020

10 MILLION TREATMENTS WORLDWIDE 35 years of innovation

experience the results..... now intimate joins the depigmenting solutions family. 10/01/2020 13:00

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Suitable for all skin types Our instagram is overflowing with the exceptional results that our customers are achieving everyday with these products. Adhering to our philosophy of continual R&D combined with the very highest quality active principles ensures our clients the results they desire. Dermamelan is for medical professionals to use in clinic.

cosmelan is the aesthetic sister to dermamelan. Together they form the answers to pigmentation for all aesthetic clinics.

All our product packaging is recyclable all the packaging we use is either biodegradable, recyclable or being reused to prevent waste PB DPS.indd 2

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the NEW depigmenting solution by mesoesteticÂŽ

NEW from the world leader in depigmentation treatments now you can correct pigmentation imperfections and improve the quality, turgor and appearance of the intimate area in a single clinical session. This is the latest innovation in pigmentation treatment brought to you by mesoesteticÂŽ through over 35 years of research and development. Developed in collaboration with specialised gynaecologists for use in clinic by Doctors.

For more information visit us at www.mesoestetic.co.uk tel: 01625 529540 email: contact@mesoestetic.co.uk

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On the Live Stage Our Live Stage offers you a chance to take part in free education across the two days at Aesthetic Medicine Live. Open to all visitors, this is where exhibitors showcase and demonstrate their treatments, products and services Saturday, February 29

Sunday, March 1

10.30

11.00 11.30 12.00 12.30 13.00 13.30 14.00

Belle/Indiba Bulletproof Before and Afters: Protect Your Reputation Clint Singh (Clinical PhotoPro) CO2 101: How to Enhance Your Business with CO2 Technology Dr Aamer Khan (Lynton Lasers) Vivacy The Future of Muscle-stimulation Devices Dr Victoria Manning (Cutera) Light Therapy: Past, Present and Future Dr Aamer Khan (Celluma) Enhancing Outcomes for Rosacea Through Combination Treatments Dr Sunny Dhesi (Venus Concept) BioActive Aesthetics Dr Benji Dhillon

11.30 12.00 12.30

Bio ID

13.00

TBC

13.30

Pure Swiss Aesthetics

14.00

Candela

14.30

Cynosure

14.30

Peels vs. Energy-based Devices for Pigmentation Dr Loredana Nigro (Mesoestetic)

15.00

Hydrafacial

15.00

Fusion GT

15.30

Combining Radiofrequency and Ultrasound for the Treatment of Face and Body Concerns Gemma Halliday (BTL)

15.30

Fagron

16.00

PRP Lab

16.00

16.30

A New Method for Treating Small Scars and Surface Defects Dr Olivier Amar (Sterimedix)

16.30

Vascular IPL and Laser Treatments Dr Miguel Montero (Lumenis) Generating a Safe and Effecive HIFU Protocol Dr Elena Ferrari (Biotec Italia)

DON’T MISS

SATURDAY FEBRUARY 29 • 11:00AM • BULLETPROOF BEFORE AND AFTERS – PROTECT YOUR REPUTATION WITH CLINT SINGH (CLINICAL PHOTOGRAPHY)

SUNDAY MARCH 1 • 10:30AM CELLULAR ANTI-AGEING EFFECTS WITH NON-THERMAL LASER WITH ROBERT SULLIVAN (ERCHONIA LASERS)

What is your reputation worth to you? Capturing your patients photographically is the only true testament of your work, but there is a problem in the industry. There is a lack of standardisation with photography resulting in inconsistent quality and inaccurate client documentation. Clint Singh is a professional photographer who runs workshops in the Arctic. With sub-zero temperatures, extreme environments and the constant threat of polar bears, making the right decisions is critical. He has taken this knowledge and applied it to the aesthetics industry to create products which solve problems and help maintain exact standards. In this talk Clint will discuss the core concepts of how to achieve bulletproof before and after images to protect your reputation and boost your marketing.

11.00

Cellular Anti-ageing Effects with Non-thermal Laser Robert Sullivan (Erchonia Laers) The Benefits of Mixed Modality in Aesthetics Sarah McNulty (Advanced Esthetics Solutions) Fractional Radiofrequency to Brighten, Tighten and Volumise Skin Dr Dev Patel (Inmode) Dermalux Lucy Cade

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Is beauty no longer only skin deep? Robert Sullivan is clinical director of Midleton Foot and Laser Clinic, Midleton, Co. Cork. His presentation is based on a number of recent publications examining the role of mtDNA in the ageing process. The hypothesis he will present is based on a recent paper published in Scientific Reports and Open Access publications on the mitochondrial basis of ageing, the role of adiponectin and the mechanisms of stomach stem cells in ageing. He has linked this in to knowledge and recent studies carried out himself into the use of low level laser therapy and the effects that this is known to have on cellular mtDNA.

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ARCHIMEDIA | STAND A15

MEDIOSTAR | BEST BROTHERS | STAND J22

Archimedia brings its new range of Facial Injection anatomy models to AM Live, offering the look and feel of human tissue with a firm but pliant silicone overlay and bone-like, hard-acrylic base layer. The models are available as male, female or as a half-intact, halfsubcutaneous structure.

Best Brothers will showcase its German-made hair removal diode laser MeDioStar, which comes with dual handpieces and can complete a full body treatment in less than 30 minutes. The laser can also be used for skintightening, skin-whitening, acne treatments, skin rejuvenation and vascular treatments.

On show

Take a look at some of the products and devices you can see at Aesthetic Medicine Live 2020

CLINICAL PHOTOPRO | STAND F36

Clinical PhotoPro will be showcasing its Anywhere Studio at this year’s event. The collection includes the portable LightTowers and DSLR camera, which come preconfigured with no cables and no installation.

SILKANN CANNULA | ROSMETICS | STAND F6

Rosmetics is pleased to announce that it will be the UK distributor of Silkann cannulae and the revolutionary GTI cannula (Amar), both manufactured in the UK by Sterimedix (see page 32). GTI cannulae are available in both 25g to cover both facial/superficial body scars and 18g for denser scars on the body.

S1500 MESO PEN GUN | ROSMETICS | STAND F6

Rosmetics is now the sole distributor of the new S1500 meso pen gun in the UK. Manufactured in Turkey to CE Class IIa specifications, the S1500 meso pen gun is fully adjustable for frequency, pressure and depth. It is capable of 1,500 strokes per minute in pen mode and 700 strokes per minute in gun mode. Depth is adjustable between 0.5mm and 10 mm, with 0.1mm precision.

VERJU AND ZERONA | ERCHONIA | STAND H16

Laser brand Erchonia will bring a range of lasers to this year’s show, including the Verju/Zerona Experience, a non-invasive, non-temporary contouring device which preserves endocrinal function of adipocytes, and EVRL, a handheld non-thermal laser for acne and chronic neck and shoulder pain.

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LIPOFIRM | ADVANCED ESTHETICS SOLUTIONS | STAND G14

Advanced Esthetics Solutions will be showcasing its range of platforms for face and body, with demonstrations taking place across the weekend. Devices include the Lipofirm PRO, Lipofirm MED, Divine PRO and geneO. The company will also be launching the Lipofirm MED+ in 2020 with four technologies in one platform.

PLATINUM SP O N SO R

DEMAMELAN INTIMATE | MESOESTETIC | STAND H6

Pharmaceutical company mesoestetic are our platinum sponsors. The company specialises in aesthetic and cosmeceutic medicine, and has developed dermamelan intimate, a non-invasive depigmenting method for the genital-perianal area, inner thighs and groins, which is safe and effective for all phototypes.

SKINPEN | BIOACTIVEAESTHETICS | STAND J6

BioActiveAesthetics, UK distributors of SkinPen Precision, will be offering a 10% show discount for the SkinPen. SkinPen is an award-winning mechanical micro-needling device. It’s FDA-cleared, CE Class 1, ISO Certified for Quality & Assurance and BSI Kitemark certified – the only UK device to hold all these certifications at the same time. The show price includes: SkinPen Device, SkinPen Wireless Charging Unit, six free SkinPen Safety Cartridge Treatment Kits, one full-day micro-needling training and new customer marketing pack, in both soft and hard copies.

CELLUMA DELUX | BIOPHOTAS | STAND G2 Celluma introduces the Celluma Delux, a flexible, full-coverage light therapy panel with all the benefits of the award winning Celluma Pro in a whole-body design. The portable, space-saving, full-body LED device hangs on the back of a door when not in use, but still offers all the advantages of a light therapy bed. Incorporating blue, red and near-infrared wavelengths, the Celluma Delux is FDA-cleared for skin and pain conditions and has a medical CE-Mark for skin, pain and wound healing.

TRUSCULPT FLEX | CUTERA | STAND J18

New and exclusive from Cutera is truSculpt Flex, an FDA-approved muscle sculpting platform featuring proprietary Multi-Direction Stimulation (MDS) technology – unique only to this device. It can also treat up to eight areas simultaneously. It is FDA-cleared for the improvement of abdominal tone, strengthening of the abdominal muscles, and development of a firmer abdomen. It is also cleared for the strengthening, toning, and firming of buttocks and thighs.

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NUERA TIGHT | LUMENIS | STAND J14

JUVAPLUS | STAND D24

Juvaplus will be showcasing its injection devices made in Switzerland, including Juvapen, designed for precise botulinum toxin injections and Lipopen, which stabilises injection pressure and extrusion rate in the injection of autologous substances.

Lumenis will bring its range of leading aesthetic devices, including NuEra Tight, Splendorx, PiQo4, M22 and AcuPulse. NuEra Tight is a radiofrequency skin tightening machine that uses one resistive bipolar handpiece and two monopolar handpieces as well as Automatic Power and Impedance Control (APIC), which reads the live skin temperature and impedance to automatically regulate the system’s power and maintain the target temperature on an entire treatment area. .

DESIRIAL | VIVACY | STAND C6

Desirial is a range of innovative monophasic, cross-linked injectable gels that contain hyaluronic acid and the antioxidant mannitol, to help improve and maintain women’s intimate health and well-being.

LYNTON LASERS | STAND F10

Professional laser and equipment manufacturer Lynton Lasers will bring a range of machines to this year’s show, including the Lumina, Motus AY, Onda and Smatxide. Onda is set to revolutionise the treatment of cellulite, with results that are impressive and long-lasting. The system claims to treat cellulite faster and more effectively than any other non-surgical option on the market.

WOW FACIALS | STAND J10 Wow Facials will be bringing its new Wow Fusion Serum to Aesthetic Medicine Live 2020, designed for use with the Wow Fusion Device. As well as this, the brand will be showcasing a new post-treatment mask for stage five of its facial and new medical, CE-certificated LED light technology.

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TIME FOR YOUR PRACTICE TO FLEX ITS MUSCLES. Untitled-17 1

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Make your practice stand out with truSculpt®ﬂex, a muscle building device that offers personalised treatments based on patient fitness level, shape and goals. Only truSculpt flex with Multi-Directional Stimulation (MDS) provides three unique treatment options, covering up to 8 areas simultaneously to optimise results and practice revenue.

Personalised and Selective

3 treatment modes

Treat 8 areas simultaneously

Learn how truSculpt flex can strengthen your practice at cutera.com/truSculptflex

#whycutera Cutera UK. Head Office 42 Kingston Space Ltd, Molly Millars Lane, Wokingham RG412PQ 01462 419 937 | info.uk@cutera.com | cutera.co.uk

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Designed and manufactured in the San Francisco Bay Area, USA, our world-leading portfolio of laser & energybased aesthetic devices provide professionals with the innovation, quality, and performance required to provide unrivalled clinical results for their patients.

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CLEVER CLINIC | HEALTHXCHANGE | STAND H28

Clever Clinic was developed as a complete, forwardthinking solution to practice management, with a focus on helping practitioners ensure they comply with regulatory requirements. Free to Healthxchange customers and downloadable from the iOS App Store, the platform is custom-built to each user’s requirements with the three principles of patient management at its core – consultation, patient consent and regulatory compliance.

STYLAGE | VIVACY | STAND C6

Available with or without Lidocaine, Stylage is a range of innovative monophasic cross-linked injectable dermal fillers from Vivacy. The products contain hyaluronic acid and antioxidants (mannitol or sorbitol). They are made with Laboratoires Vivacy’s advanced patented IPN-Like Technology.

SOPRANO TITANIUM | ABC LASERS | STAND D14

The Soprano Titanium combines four proprietary technologies, offering improvements in the treatment experience for patients, as well as enhanced productivity for practitioners. The Quattro™ applicator (the device includes dual connectors, enabling sequential use of two separate applicators if desired) features a large 4cm² spot size that promises to shorten treatment time by 40%.

3D-HYDRO2 FACIAL | 3D-LIPO | STAND E14

3D-HydrO2 Facial is a multi-technology facial device designed to target universal facial concerns including hydration, oxygenation, antiageing, brightening, skin tightening and congestion by utilising seven different technologies, which can be used in varying combinations. These include Hydro Peel, Deep Cleanse, Oxygenation, Skin Lifting, Skin Tightening, Hydration and Cryo.

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ENDO- TEST | AQ SKIN SOLUTIONS | STAND B22

AQ Skin Solutions Endo-Test is a transdermal supplement without transferability of active ingredients. It uses peptide specific signaling technology to help boost the body’s natural production of free testosterone by activating the proteins involved in testosterone production. The active ingredients then stimulate the hypothallus in the brain and pituitary gland to enhance natural hormones to encourage testosterone production.

ACCUTITE AND FACETITE | INMODE | STAND D10

InMode will be displaying its award-winning devices including AccuTite and FaceTite. AccuTite is the smallest of the BodyTite family of handpieces. The same size as a dermal filler cannula, it uses bi-polar radiofrequency to contract the subcutaneous fat and tighten the skin in smaller areas such as in the peri-orbital area and nasolabial folds. FaceTite is a bigger handpiece and goes deeper into the skin, and can be used on the face or body.

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The Premier Hair Removal Option The excel HR combines the two gold-standard wavelengths for laser hair removal - the 755nm Alexandrite and Cutera’s pioneered 1064 nm Nd:YAG - for quick, safe, effective treatments on ALL skin types. • Superior sapphire contact cooling, maximising comfort • Proprietary truPulse technology with Index Matching • Incudes the signature ‘celebrity lunchtime’ Laser Genesis facial

VISIT US ON STAND J18

Features: OLYMPIA LONDON 29 FEB-1 MAR 2020

excel HR Results Hair

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Vascular

Before

After 1 treatment Photos courtesy of Cutera CRC

Before

After 2 treatments Photos courtesy of Cutera CRC

#LaserGenesis Cutera UK. Head Office 42 Kingston Space Ltd, Molly Millars Lane, Wokingham RG412PQ 01462 419 937 | info.uk@cutera.com | cutera.co.uk

@cutera_UK 875 Cutera Excel with Stand.indd 1

excel HR also includes Cutera’s signature facial skin rejuvenation procedure, Laser Genesis. This unique, nodowntime ‘celebrity’ treatment delivers gentle micro-pulses of laser light and is designed to help polish and perfect a wide range of skin rejuvenation concerns, acting as the perfect additional revenue stream for your business.

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STIMSURE | CYNOSURE | STAND C14

KELO-COTE | ALLIANCE PHARMACEUTICALS | STAND A27

Alliance Pharmaceuticals will be showcasing KELOCOTE®, its patented range of products including a gel, a spray and UV gel for the treatment and prevention of keloid and hypertrophic scars. KELO-COTE®’s advanced formula has been clinically proven to help flatten, smooth and reduce the redness associated with scarring.

DERMALUX | AESTHETIC TECHNOLOGY | STAND G6

Aesthetic Technology, the manufacturer of Dermalux, will be showcasing its awardwinning portfolio including the Dermalux Flex and Tri-Wave. Tri-Wave is a free-standing LED system with an ergonomic, lightweight design that enables three clinically proven wavelengths to be delivered as single or multi-wavelength treatments for powerful and lasting standalone results. Flex is a fully portable entry-level device which delivers the same wavelengths as the Tri-Wave.

StimSure is a non-invasive electromagnetic muscle building and toning treatment designed for use on the abdomen, buttocks and thighs that stimulates the motor neuron cells of the body’s muscles, delivering up to 24,000 muscle contractions in just 20 to 30 minutes and causing the muscle to contract as it would during movement or exercise.

VBEAM PRIMA | CANDELA | STAND H14

Among the devices on display on the Candela stand will be the Vbeam Prima. The device treats vascular lesions, hemangiomas, angiomas and spider angiomas, leg veins, inflammatory acne, benign pigmented lesions, striae (stretch marks), warts, facial veins, port wine stains, rosacea, poikiloderma, scars and wrinkles.

GTI CANNULA | STERIMEDIX | STAND A19

UK manufacturer Sterimedix’s products include the GTI Cannula (Grooved Tipped Injection Cannula), created in collaboration with Dr Olivier Amar for the treatment of scars and surface defects. Clinical trials have shown it successfully disrupts scar tissue strands, without the traumatic effects of a blade under the skin. After breaking up the scar tissue, filler is injected into the space that has been created to support and smooth the skin surface.

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BTL EMSELLA | BTL | STAND B14

BTL will bring its range of devices to the show including the Emsella system, a breakthrough treatment that combats SUIs in women via focused electromagnetic energy. A single BTL Emsella session brings thousands of supramaximal pelvic floor muscle contractions, which are extremely important in muscle re-education of incontinent patients. This stimulation leads to regained control over pelvic floor muscles and bladder. With 95% patient satisfaction, patients remain fully clothed throughout the treatment.

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A world of education Education is at the heart of Aesthetic Medicine Live and this year’s show offers more programmes and access to CPD-accredited knowledge than ever before*

ow in its sixth year, Aesthetic Medicine Live prides itself on offering world-class CPD-accredited education. Our conference programmes span the whole spectrum of practice, from clinical topics like injectables, skin and body treatments to the ins and outs of running a business, as well as specialist subjects such as plastic surgery, hair loss and regenerative medicine. Featuring leading speakers from around the globe, its interactive format inspires discussion and audience participation. This year we will be hosting five individual conference streams – the Clinical Conference, Aesthetic Regenerative Medicine Conference, BAHRS Conference and Business Workshop programme, which all run over two day, as well as the one-day UKAAPS Conference. Here’s a taster of what to expect. *See our Show Guide in this month’s issue for full programmes

CLINICAL CONFERENCE

One of the things that makes aesthetics such an exciting sector to work in is the diverse range of patients that our treatments, techniques and procedures can help. This year’s Clinical Conference will follow the theme of diversity, examining the different types of patients seeking aesthetic enhancement and how we can help them.

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Day one is our medical-only day with a focus on injectable treatments. This is only open to those with a registration to a professional statutory body, such as the General Medical Council (GMC), the Nursing Midwifery Council (NMC), the General Dental Council (GDC) and the General Pharmaceutical Council (GPhC) or an overseas equivalent. Day two will focus on treatments for the skin and body and wider applications of aesthetics and is open to all those working within the sector.

AESTHETIC REGENERATIVE MEDICINE CONFERENCE

After a successful first collaboration in 2019, Aesthetic Medicine Live is delighted to once again be hosting the Aesthetic Regenerative Medicine Conference in collaboration with Mr Ali Ghanem, the MSc in Aesthetic Medicine at Queen Mary University London, the London School of Medicine & Dentistry and the department of Aesthetic Medicine at the College of Medicine and Dentistry, Ulster University. Featuring a global faculty of speakers, the two day CPD-accredited conference is a chance to learn about this exciting and developing area of medical aesthetics and to tap into the growing trend for a 360-degree approach to anti-ageing and regeneration from the inside out. Day one will focus purely on aesthetic regenerative medicine while day two will include an advanced injectables masterclass and body contouring.

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SATURDAY, FEBRUARY 29 | 9.30AM-11AM FULL FACIAL REJUVENATION FOR OUR CORE MARKET: THE AGEING FEMALE Women aged 35-55 are the core market of most aesthetic clinics, but how do we evolve our treatments and enhance outcomes with the latest techniques? Join a host of leading speakers including Dr Nick Lowe, Dr Steve Harris, Dr Sophie Shotter, Dr Anna Hemming and Dr Arturo Almeida for our opening session focused on rejuvenation of the ageing female face.

DON’T MISS

SATURDAY, FEBRUARY 29 | 11AM-12PM CONSIDERATIONS WHEN TREATING THE MALE FACE The main focus of this session will be creating a natural look and avoiding overfilling to address volume loss in the male face without feminising features. Speakers include: Dr Lee Walker, Dr Raul Cetto and Mr Ash Labib.

DON’T MISS

SATURDAY, FEBRUARY 29 | 3PM-4.30PM THE DIVERSITY OF HUMAN ANATOMY When it comes to avoiding complications, indepth knowledge of anatomy is key. We explore how VR is bringing the world of clinical anatomy into the future and how a one-size-fits all approach does not work. Join Mr Dalvi Humzah, Anna Baker and Dr Hervé Raspaldo.

DON’T MISS

SATURDAY, FEBRUARY 29 | 4.30PM-5.30PM MANAGING COMPLICATIONS PANEL Managing complications is one of the most important skill sets an aesthetic practitioner can have. In this session a panel of speakers including Dr Martyn King, Dr Lee Walker, Dr Raul Cetto, Cheryl Barton and Dr Steve Harris, will discuss a diverse range of complications and how to manage them.

DON’T MISS

SUNDAY, MARCH 1 | 12PM-1.15PM TREATING MENOPAUSAL PATIENTS The menopause has an effect on many factors, from skin to hormones and intimate regeneration. We look at the role aesthetic clinics have to play. Dr Shirin Lakhani, Dr Lori Nigro, Dr Martin Kinsella , Dr Ahmed Al-Qahtani and Dr Sophie Shotter will explore this topic.

DON’T MISS

SUNDAY, MARCH 1 | 3.30PM-4.30PM MENTAL HEALTH MATTERS How do we recognise mental health disorders or underlying problems that may be a contraindication to treatment, and how do we help our patients for whom mental health is an issue? Join our panel including Lou Sommereux, Dee Hadley and Nofie Johnson to discuss this issue. >

DON’T MISS

CONFERENCE DELEGATE PASSES COST £185 INC VAT FOR ONE DAY AND £275 INC VAT FOR TWO DAYS. INCLUDES LUNCH AND ACCESS TO ALL FIVE AGENDAS. aestheticmed.co.uk/conferences

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AM LIVE 2020 PREVIEW

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Business workshops SATURDAY FEBRUARY 29: MINDSET, MONEY AND MOTIVATION | CHAIR: RICHARD CRAWFORD-SMALL

SUNDAY MARCH 1: COMMUNICATION AND MARKETING | CHAIR: RICHARD CRAWFORD-SMALL

11.00-11.40 | WORKSHOP 1 Why Goal Setting Doesn’t Work with Richard Crawford-Small 11.40-12.20 | WORKSHOP 2 Introducing the Game Changer! Metaphysical and Mindset Work Within Your Aesthetic Business with Tracey Dennison 12.20-13.00 | WORKSHOP 3 The Sales Warmup, The Sale and The After-Sale with Alan Adams 13.00-13.40 | WORKSHOP 4 Starting a New Decade in Aesthetics: Why 2020 Could Make or Break Your Aesthetic Practice with Pam Underdown 13.40-14.20 | WORKSHOP 5 Creating a Lifestyle Business with Phil Elder and Dr Cristina Perea 14.20-15.00 | WORKSHOP 6 Workshop 6: How to Build a Multi-Million Pound Aesthetics Business in 12 Months with Antonia Mariconda 15.00-15.40 | WORKSHOP 7 Don’t Undersell Yourself – Developing Pricing Structures for Your Practice with Robin Wait 15.40-16.20 | WORKSHOP 8 Bulletproof Before and Afters – Protect Your Reputation with Clint Singh 16.20-17.00 | WORKSHOP 9 How Registration with the Healthcare Regulator can Improve your Business with Tracey Jones

11.00-11.40 | WORKSHOP 1 The Most Profitable Business Model in the World Richard Crawford-Small

BUSINESS WORKSHOPS COST £10 PER SESSION OR ARE FREE TO CONFERENCE DELEGATES aestheticmed.co.uk/businessworkshops

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11.40-12.20 | WORKSHOP 2 How To Double Your Customers & Profits In 30 Days Using Facebook and Instagram with Kris Trinity 12.20-12.50 | WORKSHOP 3 How to Increase Enquiries to Your Clinic Using Google Ads with Laura Moxham 12.50-13.30 | WORKSHOP 4 Digital and Web Marketing Strategies: From SEO and Websites to Content and Blog Writing with Alex Bugg 13.30-14.00 | WORKSHOP 5 8 Ways to Automate Your Aesthetics Practice in 2020 with Rick O’Neal 14.00-14.40 | WORKSHOP 6 7 Reasons Why You Do Not Have Enough Aesthetic Patients with Harry Singh 14.40-15.10 | WORKSHOP 7 The Risks of Running Your Practice from a Phone with Gilly Dickons 15.10-15.50 | WORKSHOP 8 Increase Engagement and Enquiries Utilising the Latest Technology and Chat Bots with Ron Myers and Stevie Potter 15.50-16.30 | WORKSHOP 9 How to Get a Fully Booked Aesthetic Clinic Without Spending a Penny on Advertising with Danny Bermant

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AM LIVE 2020 PREVIEW

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BAHRS CONFERENCE

The British Association of Hair Restoration Surgery (BAHRS) brings its annual conference back to Aesthetic Medicine Live for the third year. Running over two days, this is a fantastic opportunity for professionals already practising hair maintenance and hair restoration procedures to increase their knowledge of products and techniques, as well as for those who are new to or interested in the subject to gain insight into what the best treatment options to get started with are. SATURDAY, FEBRUARY 29 | 9.30AM-10.50AM GROWTH FACTORS FOR GENETIC HAIR LOSS The non-surgical agenda for the BAHRS meeting will open with this topical exploration of one of the latest trends: growth factors. Topics will include: PRP – Debunking the Terminology and Choosing a Device; PRP for Genetic Hair Loss – My Experience as a Dermatologist; Topical Growth Factors for Hair Loss; and Exosomes – Is This the Future of Growth-Factor Delivery?

DON’T MISS

SATURDAY, FEBRUARY 29 | 2.30PM-3.50PM UNDERSTANDING FEMALE HAIR This session will explore topics including: Botulinum Toxin for Post-menopausal Scalp Hyperhidrosis; Why Does Hair Curl and How do Heat and Chemicals Work?; Hair Masks, Oils and Other Revitalisers – Hype or Not?; and Investigating and Managing Female Pattern Hair Loss Non-surgically.

DON’T MISS

SUNDAY, MARCH 1 | 11.50AM-1PM WHAT’S NEW? Find out about the latest trends in this Q&A panel session with topics including genetic testing, topical growth factors and micrografting.

UKAAPS SURGEONS’ DAY

The UK Association of Aesthetic Plastic Surgeons (UKAAPS) one-day agenda on Saturday, February 29, organised by Professor Jim Frame and Mr Shailesh Vadodaria. SATURDAY, FEBRUARY 29 | 10AM-11AM OPENING SESSION Topics in this session will include: How I Use Toxins, Fillers and Fat Graft in Facial Rejuvenation with Mr Shank Shankar; How I Do Correction of Prominent Ears Using Suture Technique Under Local Anaesthetics with Mr Tariq Ahmed; Management Protocol for Complications of Dermal Fillers and Toxins with Mr Dalvi Humzah; Chin Aesthetics with Liposuction, Dermal Fillers, Fat Graft or Chin Implants with Mr James McDiarmid; and Responsibilities in Blepharoplasty Surgery with Mr Jonathan Britto.

DON’T MISS

SATURDAY, FEBRUARY 29 | 4PM-5PM CLOSING SESSION To close the UKAAPS day Mr Brent Tanner will be sharing seven pearls of wisdom in his talk, Things I Recommend Doing in Aesthetic Plastic Surgery, an extract of his 40year career, while Mr Shank Shankar will explore the novel application of WhatsApp groups in a new era of aesthetic plastic surgery. The final topic will be an evidence based update on ALCL and breast implants with Mr Patrick Tansley.

DON’T MISS

THE UKAAPS SURGEONS’ DAY IS FREE TO ATTEND FOR UKAAPS MEMBERS AND AM CONFERENCE DELEGATES

THE BAHRS CONFERENCE IS FREE TO ATTEND FOR BAHRS MEMBERS AND AML CONFERENCE DELEGATES

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Aesthetic Medicine • February 2020

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Advertorial

Lipofirm - the gold standard non-invasive platform for inch loss, cellulite reduction, body sculpting, skin tightening and facial rejuvenation

Before

After

Lipofirm uniquely combines two technologies TriLipo Radiofrequency (RF) and TriLipo Dynamic Muscle Activation (DMA). Working simultaneously using a single applicator, they create a synergistic effect that delivers noninvasive fat removal and lymphatic drainage, as well as skin tightening. TriLipo – triple action fat reduction The triple action of TriLipo technology consists of RF deep volumetric heating combined with internal muscle contraction and external mechanical force, which together yield maximum fat removal and lymphatic drainage as well as skin tightening. The TriLipo triple action effect is visible from the first treatment, and long-term body shaping is achieved in a minimal number of treatments. The RF energy generates heat through tissue resistance in both the dermal and subcutaneous layers. Selective and focused electro-heating of the skin stimulates and increases fat metabolism in the subcutaneous fat layer and collagen remodelling in the dermal layer. In the subcutaneous fat layer, the thermal effect accelerates the natural fat metabolism process and the release of liquid fat from the cells into the extra-cellular matrix (figure one).

Drainage of the released liquid fat is accelerated by simultaneously applying internal and external pressure on the fat layer. Internally, TriLipo Dynamic Muscle Activation (DMA) pulses stimulate the muscle layer causing the muscle to contract. This contraction elevates the muscle and pushes the fat cells up towards the surface.

VoluDerm, is a minimally invasive solution that uses between 36 and 100 needles with radiofrequency energy to penetrate the deep dermis layer. This energy creates micro wounds which trigger the body’s natural healing response mechanism, inducing neocollagenesis to create healthy skin tissue. (figure four).

Simultaneously, the mechanical pressure of the applicator presses the skin from above. The combined internal and external pressure increases the removal of the liquid fat via accelerated lymphatic drainage (figure two). The simultaneous effect of the RF and the forced drainage results in the homogenous heating, and in accelerated blood and lymph circulation that optimises tissue oxygenation and detoxification.

TriFractional, is an advanced and effective fractional skin resurfacing technology using radiofrequency micro-pins to safely ablate and renew the epidermis layer of the skin (figure four).

Figure 4

Why choose Lipofirm technology? Figure 2: external and internal pressure yielding optimal drainage

In the dermal layer, focused RF energy heats the collagen fibres causing them to contract, resulting in immediate skin tightening and smoothening. In addition, fibroblasts’ metabolism is accelerated leading to collagen regeneration and long-term skin tightening and firming (figure three).

Figure 3: collagen remodelling in the dermal layer leads to smoother skin surface

Figure 1: liquid fat released from fat cells

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■ Focused fat reduction ■ Cellulite improvement ■ Long-term circumferential decrease ■ Skin tightening and firming ■ Facial contouring ■ Skin resurfacing ■ Scar reduction ■ Dermal volumising ■ Wrinkle reduction ■ Lifting, toning and firming of muscles ■ Detoxification and improved drainage ■ Enhanced blood circulation and oxygenation ■ 30-minute treatment sessions ■ Fast return on investment ■ No need for cardiovascular exercise.

Lipofirm is distributed in the UK and Ireland by: After After Advanced Esthetics Solutions LTD | advancedestheticssolutions.co.uk

After

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A Platform for Every Practitioner

DMA

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TriFractional

VoluDerm

Inspired by Professionals Loved by Celebrities Don’t Take Our Word For It... Before

After

Before

After

“I bought the Lipofirm following a demo by the company. I was impressed by the user friendly nature of the machine. It is both easy to use and cost effective due to the shorter operating time required to achieve the desired results. Lipofirm has allowed me better use of my time and it has been well received by my clients. Overall Lipofirm has been an asset to my clinic’’

DR K MISRA MBBS LRCP, LRCF, MRCGP

“After years of deliberating due to ﬁnancial implications, I can honestly say it is the best thing we have done for the business. We are getting some phenomenal results.” Before

After

Before

After

Sarah Wilkinson Equilibrium Aesthetics

As seen in the media:

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For further information call or email sales@advancedesthetics.co.uk @aesolutionsuk www.advancedestheticssolutions.co.uk

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COV E R STO RY

CLINIC PROFILE

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Perfect Harmony Georgia Seago discovers a Lancashire clinic blending aesthetics, beauty and spa to treat clients from head to toe under one roof

he evolution of non-surgical procedures in recent years means that it’s rare to come across an area of the UK that isn’t occupied by at least one thriving aesthetics business. It was this anomaly that inspired the owner of BeautiPhi MediSpa to open in Colne, Lancashire, where manager Ammarah Tahir says that, apart from an award-winning hotel spa nearby, there isn’t anywhere offering doctor-led aesthetic services in a premium environment. “We wanted to do something where all the services patients could want are grouped together,” she says. “And in terms of aesthetics, there’s quite a few people [offering treatments] in salons locally but it’s not exactly the safest way to be doing it.” On the other end of the spectrum, BeautiPhi’s aesthetic clinic is headed up by consultant facial surgeon Dr Chris Sweet and specialist orthodontist Dr Zia Ud-Din, with an aesthetic nurse and capacity for an additional orthodontist. This part of the business operates under the name Smyli Orthodontics and Facial Aesthetics, while skin, laser and body-sculpting treatments are performed by expert therapists in the Skin Lumino clinic, all under the same roof. “We’re split over two floors in a large Victorian building. Our builders had to do a lot of work to restore damage to the beautiful original architecture, but they got it to the point where everything was a clean slate and restored to its former grandeur,” says Tahir. The sleek white interiors with polished marble floors and grey accents throughout provide an appropriate and luxurious environment for both the clinical and beauty

services on offer. “We want to operate across the whole spectrum of aesthetic treatments, with a real focus on crossreferrals,” explains Tahir. “If someone comes in for a dental treatment their orthodontist might notice some scarring around the mouth and be able to refer them to have it looked at and treated, for example, and we can let patients know that we offer popular treatments like laser hair removal.”

START WITH SKIN

Tahir explains that BeautiPhi opened in stages, with Skin Lumino launching initially, followed by orthodontics at Smyli. Aesthetic treatments were up and running as of the start of 2020. “Already, the most popular skin treatment has been HydraFacial, and we’ve had a lot of interest in laser hair removal too,” she says. Skin Lumino has a 3D Trilogy Ice laser,

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COV E R STO RY

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along with the HydraFacial MD machine, Crystal Clear Comcit Elite microneedling, microdermabrasion and cryo-oxygen facial system as well as the 3D-Lipomed, which performs cavitation, HIFU, radiofrequency and fat; and 3D-Skinmed. A range of advanced non-surgical treatments are on offer at Smyli, such as PRP for hair restoration and skin rejuvenation, injectables, including Profhilo, and nonsurgical blepharoplasty using plasma. BeautiPhi’s full treatment menu marries together under the Greek concept of phi, also known as “the golden ratio”, where the clinic gets its name. “Everything is about balance and creating a natural, harmonious look that works for each patient using all these specialities that complement each other,” says Tahir, adding, “There have been one or two people who decided not to go ahead with treatment with us because the predicted results would have been too subtle for them.”

WARM WELCOME

This commitment to delivering the best, most natural looking-results to suit every patient is also reflected in the clinic’s customer service and client journey. “The way staff deal with customers is so important. We take care of their every single need and just be as friendly, open and welcoming as possible,” says Tahir. “We’ve tried to think about all the little touches that make a huge difference to the client experience, which is why we have our comfortable lounge room for them to relax and take some time before or after their treatment with a menu of hot drinks or mocktails.” Other examples include the TVs with streaming apps fitted

CLINIC PROFILE

in each treatment room to help patients relax – particularly suited to fat-freezing treatments, which require patients to lie on the couch for up to an hour, Tahir points out. While BeautiPhi currently operates across the ground and first floors of the building, the basement space is currently under construction, with a phase two launch, set for a late 2020 opening. “It’s been part of the plan from the start to have a Moroccan-themed spa with hammam in the basement,” says Tahir. This third element of the business will be called Zagora Hammam & Spa and will also feature a Himalayan salt sauna. Massages and body scrubs will be carried out in the spacious facial treatments room. Blending aesthetics and spa is an interesting approach, and one that Tahir is confident will prove popular with clients. “There’s a glass door at the back of the ground floor leading down to the basement where the spa will be, which we’ve had frosted and printed with the Zagora logo. Existing clients are already asking when it will be open because they’d be keen to try it out, and people have also been asking if we offer massage yet,” says Tahir. The team anticipates drawing new business to the spa facilities as well as bookings from aesthetic or beauty clients. While it’s still early days, it looks likely that BeautiPhi will make a strong mark on the aesthetics market in the north of England. AM

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STEP INTO YOUR FUTUREâ&#x20AC;¦

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It’s the only chance you get to meet colleagues, clinics and people you may have trained with Dr Marco La Malfa, Aesthetic Doctor

There’s so many people who can help you grow your business Amandeeo Grewal, Clinical Director

Network and exchange expertise while seeing what’s new Dr Simi Adedeji, GP and Aesthetic Doctor

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EVOLVE WITH US AT THE FIRST INDUSTRY EVENT OF THE NEW DECADE NEW LAUNCHES Brands showcase their latest products and treatment launches CPD-ACCREDITED CONFERENCE Featuring sessions from leading clinicians from across the globe CPD-ACCREDITED BUSINESS WORKSHOPS Expert advice on running a successful aesthetic practice LIVE DEMONSTRATIONS Showcasing the newest treatments, techniques and equipment on the market BAHRS CONFERENCE Discover current practice and what’s new in hair restoration surgery UKAPPS SURGEONS’ DAY The UK Association of Plastic Surgeons hosts its annual conference

Entrance policy: The show is open to doctors, dentists, nurses, medical professionals and qualified aesthetic practitioners. Strictly no persons under the age of 18 will be admitted.

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BUSINESS

OUTSOURCING

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Time is money Gilly Dickons asks, is outsourcing the key to more time and money?

ime is money, but how can you make more of both? Outsourcing is a concept that many business owners in the aesthetics sector are not particularly comfortable with. After all, why would you pay someone to do something that you can do better yourself for less, or even nothing? But there are good reasons you should reconsider your view on outsourcing, and there are bound to be tasks in your business that you can consider letting go of.

A SENSIBLE SOLUTION

“Take a step back from all of the tasks that you are juggling and consider what help would make the most impact for you”

When we set out to start our own business we normally base it on our key skill – in your case, treating patients with various aesthetic treatments. For me, it was about using my knowledge and experience to service aesthetic practices. We often don’t consider the tasks that come with growth: accounts, recruitment, marketing, stock control, staff management, cyber security, information management, even the cleaning the list is endless! While you continue to undertake many

of these tasks yourself, you are not in the treatment room doing what you do best – generating income. Outsourcing can be a sensible solution as your task list grows, as we have found here for ourselves at Aesthetic Response. We work with an HR company, have an HR platform, an accountant and book-keeper, a GDPR consultant, third party cyber security, a CRM development team, a cleaning company, and recruitment specialists, all supporting our business with their expertise, which in turn frees up our team to focus on what we are good at and what more we want to achieve.

TAKE A STEP BACK

I would recommend that you take a step back from all of the tasks that you are juggling and consider what help would make the most impact for you. Remember, you are looking to maximise on your clinical time to ensure that you are making the most of your skills. Here are some areas of support that you could consider:

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BUSINESS

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Customer Relationship Management software (CRM) – Having a great system in place will enable you to run the business smoothly day-to-day. Your diary, consultation notes, stock levels, invoices, appointment reminders and confirmations are just some of the tasks a good system will facilitate, keeping you organised and efficient. Platforms are generally subscription-based with monthly fees. Accounting – A good book-keeper or a company accountant can take a headache away for you. It’s no good leaving a year’s worth of accounts until January 29 unless you can handle the stress. A good accounting firm will have systems that integrate so that you can have full access and visibility on all aspects of your practice finances. Your accountant or book-keeper can also run your payroll on a monthly basis if you have a growing team. Fees will be directly related to the extent you use their services. HR – Human resources is a huge minefield for a business. From employing your first member of staff you need to be on the right track. Companies like Wirehouse, who we use here at AR, are there to give you advice and guidance as and when needed. They can also create your staff handbook. Good HR support is critical when we are seeing a huge rise in mental health conditions that need to be supported in the workplace. Having great HR advice and support in place can save you a lot of time and money in the longer term. Service contracts are often 12-36 months in length with a monthly fee. We also use the online platform Bright HR as it provides all of the practical tools we need on a day to day basis from time management and managing staff personal information, to storing notes from personnel meetings and many other tasks. This platform also offers support to our employees in the form of online tools, advice and even one-to-one counselling sessions – invaluable in our aim to provide good mental health and wellbeing support where needed. Fees are charged per employee and can prove to be highly cost effective. Marketing support – This includes social media, PR and design work, an area we frequently try to manage ourselves which often falls by the wayside. You can contract someone to run your social media campaigns, to write your blogs and websites and help with your PR, or you can simply subscribe to a scheduling platform such as HootSuite or MeetEdgar and run your own campaigns. Third party support is usually charged by the hour per month, so you need to monitor the results to ensure you are getting a good return for your investment. Recruitment – Using an agency can be beneficial if you are recruiting on a regular basis or if you struggle to retain staff. Recruitment can absorb a lot of time and a good agency can help to address challenges. Fees can be related to each position offered or a percentage of the salary – you should interview several companies to get the right fit. Business consultancy and coaching – Using a business coach or a consultant can help you to plan and grow your business effectively. There are one-to-one

OUTSOURCING

sessions, online platforms and business workshops to tap into. The fees will directly relate to the help and support you choose to access. Call handling and staff support – Our area of expertise at AR. If you are building your practice from your mobile phone and are missing valuable calls, or are calling people back at the end of a long day, consider handing your calls over to a third party. If you have a busy clinic and your staff are tied up with patients on reception, are on other calls or are off sick you need back up – your phones are a priority! You can use a generic message-taking service or look into a dedicated service like ours, where you have the choice to respond yourself or have the call contained. A service offering treatment knowledge and diarybooking skills can closely align to how your own practice works, although it seems hard to imagine a third party booking your appointments, this support is available. Our clients say they use us because we handle their calls and book their appointments in the same way they do with their knowledge, using their systems. The fees will relate to the volume of calls and how you want them to be managed. It may well be that you are already outsourcing with great results, however, if you are not, my hope is that you will have gained insight into the support and help that is available to you as you look to free up valuable time to grow your business. These services can enable you and your team to focus on what you do best in the treatment room. AM

Gilly Dickons is the managing director of Aesthetic Response. Over the past nine years, the company has provided an award-winning call handling and diary booking service to aesthetic practices across the UK and Ireland. Aesthetic Response’s management of more than 150,000 calls a year has given her valuable insight into the constantly evolving sector.

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F E AT U R E

LIP THREAD LIFTS

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Aesthetic Medicine â&#x20AC;¢ February 2020

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F E AT U R E

LIP THREAD LIFTS

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Fill or thread? Using threads to give lips a subtle tweak could be the next big lip augmentation trend. Georgia Seago finds out

ith aesthetic procedure trend predictions for 2020 indicating a backlash against the large, obviously filled lips that have come to define the market in recent years, could lip thread lifts present a far more naturallooking method of lip augmentation? “I have only used monofilament PDO threads in a crosshatch fashion for the perioral lines”, says Dr Sotirios Foutsizoglou, founder of SFMedica. “Prominent perioral lines are quite difficult to be effectively treated because of the thinness of the skin, the very small amount of adipose tissue and the mobility of the lips. Botulinum toxin and low G’ HA fillers, either alone or in combination, are the most commonly used treatment modalities to soften those lines, but both are associated with potential problems. Too many units of Botox will paralyse the orbicularis oris, the sphincter of the mouth, too much filler will create a prominent subnasale”, he explains. “Using threads for the perioral lines is based on the principle of mechanotransduction, whereby a mechanical stimulus such as the insertion of a thread into the dermis will stimulate the fibroblasts to produce more collagen, elastin and ground substance that could potentially ameliorate the texture of the perioral skin, reverse age-related elastosis, tighten the skin through neocollagenesis, and increase the thickness of the dermal layer”, he said. As well as the perioral lines, threads can be used to lift the upper lip to create the illusion of more natural fullness. “People are always intrigued by a new application of an existing product”, says Jonquille Chantrey, who runs a practice in Cheshire. “But I think the idea of lip threads also started to become more popular when Kylie Jenner had her lip filler reversed. Public opinion on filler has started to change, and some may think threads can give more lift with a natural look.” >

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F E AT U R E

LIP THREAD LIFTS

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SECOND THOUGHTS

Dr Victoria Manning, co-founder of River Aesthetics, with clinics in London, Dorset and Hampshire, says the clinic group previously used monofilament PDO threads to treat the perioral lines but stopped offering the procedure over a year ago owing to unsatisfactory results. “We stopped using them because you just don’t get very good results from trying to regenerate the skin with a little tiny thread”, she says. “You don’t have much control, it’s far better with a needle, or cannula.” Foutsizoglou says that the number of “minor yet troublesome” complications he has experienced from using threads in the lip area outweighs any potential of good results. “Threads are probably my least favourite treatment modality for lip enhancement and perioral rejuvenation”, he says, listing a few key reasons: “Lips have a rich blood supply, so using a sharp needle to insert thin monofilament threads into the dermis will inadvertently go through fine small vessels of the sub-epidermal and dermal plexuses, precipitating bleeding and leading to bruising. “The cutaneous part of the lip is extremely thin – only

comparable with the periorbital skin, creating a mesh-like pattern to increase fibrous bridging and neocollagenesis can result in a temporary protrusion of the upper cutaneous lip”, he explains, adding: “Due to the mobility of the lips I have had patients complain of being able to palpate and see the end of the thread like a whisker. Thread migration can also occur due to the mobility of the lips.”

SPECIAL CONSIDERATIONS

Facial animation and mobility of the lips is a key consideration where lip augmentation is concerned, and Chantrey says this is one of the main reasons she doesn’t offer the procedure herself. “I’ve done a lot of work with facial animation. I want a natural result for my patients when they’re speaking and animating, and sometimes threads don’t quite give as natural a result. It can give a nice lift but you need an option with a lot more versatility when you understand all of the structures around the lip from an animation perspective”, she says. “I’ve seen tethering – so uneven areas – asymmetry, puckering, and in one case, it had created almost scar tissue around the vermillion border.” Foutsizoglou also expresses concern around the pain inserting threads into or around the lip can cause patients: “The lips are rich in sensory nerves, so any treatment in that area can be particularly painful, necessitating either a topical or a local anaesthesia”, he says. “Topical anaesthetics cause vasodilation precipitating bruising and potential haematoma formation, whereas any local anaesthesia injected including infraorbital and mental blocks can temporarily distort the anatomy of lips making asymmetries more likely.” Every doctor we spoke to is of the opinion that threads are far better suited to other areas of the face, >

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LIP THREAD LIFTS

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having experienced minimal completely satisfactory results. “Threads are great for the face but they’re very difficult to reverse”, says Manning. “I’ve also tried them in the arms and stomach and I think there are better treatments for those areas too.” The difficulty of removing threads from the lip area is also a red flag for Chantrey, who says she personally prefers to only carry out non-surgical procedures that are reversible. “Threads are better used in areas of the face that aren’t as mobile or dependent on natural animation”, she advises, adding “Anything in regards to the lips has always got to be about understanding the muscles and the anatomy, what’s going on with the teeth, maxilla and mandible. If threads are something you’re really keen on you can always become much more proficient in other areas.”

DIFFERENT APPROACH

If patients desire a subtle augmentation to the natural lip shape rather than increased volume, or a soft lift to the upper lip, Manning advises using a HA filler. “It’s about being skilled as an injector. If someone wants a subtle lift of the cupid’s bow or vermillion border, you can still do that with filler but by using a softer product. Choose your product accordingly and use a small amount”, she says. As ever, it’s vital to assess the patient’s full face and consider how their desired results will look in relation to their other features. “Lip filler has become so trend-led that you see so many people with overfilled and badly filled lips”, says Manning. “If someone asks for lips like a particular celebrity, don’t just do it. They don’t know what that’s going to look like on their face, they’re not an aesthetician. You’ve got to assess their face and decide if those lips would suit them – everything has to be in proportion.” AM

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Facebook

Jemma Edwards examines the differences between Facebook and Instagram in promoting your business

ince Mark Zuckerberg launched Facebook across several US universities in 2004, the rise of the world’s largest social media platform has been stratospheric. After Facebook, more and more social media platforms have been introduced, not all as successfully, each one looking to add something unique to the marketplace. Instagram launched several years later in 2010, but within two years it had been bought by Facebook. Both of these social media platforms have many millions of users (Facebook 2.2billion and Instagram 800 million) and are often used by people and businesses in the aesthetics industry almost interchangeably. Clearly they are two different platforms that fulfill a different function – otherwise why would Facebook have paid $1 billion for it? These two platforms have similarities and differences, so building your business with Instagram or with Facebook might pan out differently depending on what you are posting and what you are looking to achieve. Facebook has been around much longer than Instagram and therefore has a larger user database than Instagram. Also, as a general rule, Facebook is considered to be more popular among older people while Instagram is more popular among the younger generation. But, other than that, how different are they and when should you use each

“Building your business with Instagram or with Facebook might pan out differently depending on what you are posting and what you are looking to achieve”

platform? Let’s start by looking at the features of each from both a business and personal use perspective.

FACEBOOK

You can create a very detailed personal or business biography to display plenty of information about you and your business directly on your page You can curate and schedule content using text, images and video There are many ways to engage with posts (like, comment, share, etc.) You can place or share links Facebook has sub-sections such as Groups and Communities You can set up date-based events, provide plenty of information about it, invite people and send reminders You can stream live video directly onto your page.

Facebook’s goal is to continually grow the number of users, and it encourages this by using its algorithm to promote content it believes to be more likely to create higher engagement levels with the people that are likely to be viewing it. The intention is for users to receive content that has been selected for them as opposed to seeing everything that is posted by all of their friends. Despite this selective newsfeed feature, there is still a lot of “noise” on Facebook not made any quieter by the multimedia aspect.

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Facebook is very good when looking to: dvertise your business A Promote an event or specific content Share content you’ve created Share content created by others Connect across different demographics Use different forms of media.

INSTAGRAM

Instagram’s main purpose is to capture specific moments. As most people capture moments/ pictures on their phone, it is geared up to be used mainly from your smartphone as opposed to a desktop. Here’s how Instagram operates: It’s smartphone based No text – it’s images only (photos/videos) You can’t manage or schedule content, everything is original content to be uploaded immediately You’re not able to research other businesses on Instagram or understand too much about what a business does You don’t have the same options to engage with Instagram posts like you can with Facebook There are higher engagement levels than Facebook (less cluttered) Hashtags are more of a feature on Instagram There’s less of a call to action with Instagram – it’s more about capturing what’s happening right now, hence the “insta” in the name.

SO HOW DOES THIS TRANSLATE INTO STRENGTHS?

For Instagram, the focus is very much on the visual and sharing moments. Initially, videos were restricted to 15 seconds long but now this has been increased to one minute. From a business perspective, Instagram is useful to help build up loyal customers for your brand and this happens by regular posting about personal things that occur on a daily basis in the lives of the account holder. Celebrities, for example, use Instagram to create a sense of intimacy with their followers, giving them a small window into their “real” world or at least the parts that they want people to know about. This is why the engagement levels are high – it’s clean, uncomplicated and uncluttered and there’s no expectation upon the viewer when accessing content.

ENGAGEMENT LEVELS

Because of its simpler approach, research reveals that, despite having a much smaller audience, Instagram engagement levels are much higher (almost 10 times) than Facebook. What’s more, the engagement for each post is growing rapidly, at a rate of almost four times over the last couple of years. So, although more people access Facebook than Instagram, when people do interact with Instagram they are more likely to actively engage.

CUSTOMER ADVERTISING

Both Instagram and Facebook have simple-to-use advertising features. They both offer the ability to specify audiences and track campaign performance by seeing how many people have been reached or actually clicked on the ad. However, Instagram doesn’t contain the feature for links in posts, which will prevent people from being able to buy your services, whereas you can put links into Facebook ads that can take the viewer away from Facebook. Both platforms can be useful for your business, but under what circumstance should you use Facebook, and when should you use Instagram?

WHEN TO USE FACEBOOK AND WHEN TO USE INSTAGRAM

A big mistake that companies make is treating Instagram like Facebook. Content that works on Facebook doesn’t always translate well to Instagram. I would recommend testing your content on both Facebook and Instagram to see which platform returns the best performance. >

FACEBOOK’S RANGE OF OPTIONS

Facebook has a greater range of options by contrast. There are more than just images – you can have stories, shops, videos, photos, events, groups and ads, pretty much every media format going. There’s also plenty of information available about the business or account holder, giving the viewer almost, if not as much, information as could be found on the company website. You can set up as many of these features as you like for your business but you then also have to keep track of what’s happening in each of the streams.

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“Facebook remains the best for visibility with older age groups”

You have to post regularly as you can’t share other posts because all your content has to be original. It takes a long time to build an audience that cares about your business, but if you can, then you have a massive competitive advantage. You can start by using Instagram influencers or even people in your local area with a large number of followers to spread the word about your treatments or business by offering them a free service. One strategy that might work well for you is to post business content like news, offers, new procedures and advice on your Facebook business page and use your Instagram account for posting more personal content; for example, what you use on your skin and treatments you have, what products you take on holiday, etc. The best ways to use Instagram for the engagement are: Use it as your portfolio to showcase your work   Use it for more personal content  Find influencers or local people to recommend you.

“Consider who you are looking to engage; are you trying to get sales?”

There are benefits to both. As mentioned earlier, Facebook is very good for advertising and promoting your business, events or groups; connecting with others and interacting with your target audience. Being able to create, schedule, manage both your own content and that produced by others also gives you more opportunities to engage when you use Facebook. However, Instagram is generally better for: Engaging with customers Spreading awareness Showcasing new products/services Comparison shopping and influencer marketing.

Furthermore, Instagram is a powerhouse for the under 30 demographic, especially teenagers. Facebook, on the other hand, remains the best for visibility with older age groups, even more so if you’re using paid advertisements. It’s also worth noting Facebook makes it easier to funnel users to a third-party site like your website. As Instagram prohibits link sharing in posts and comments this makes it tricky to get sales. Any outside links appear in your bio only and the extra steps required to visit your site make it harder to generate traffic and get leads from Instagram unless the viewer messages you. Because Instagram is very visual, it’s better for influencer marketing and free exposure. Users on Instagram more often sign in actively looking for product recommendations, as opposed to Facebook where they actively ignore them.

It really depends on who your ideal client is and what it is that you are looking to achieve as to where you should be concentrating more of your efforts. AM

WHAT ABOUT STARTING OUT ON SOCIAL MEDIA?

To be honest, from a business perspective, it’s pretty tough to do well using Instagram, especially when starting out. Jemma Edwards is owner of deliveringdemand.com, helping aesthetics professionals and cosmetic surgeons get more patients and grow their practice.

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Beautification in younger females Ahead of his talk at Aesthetic Medicine Live, Dr Ahmed El Houssieny considers the ethical aspects of facial beautification in younger females

ody confidence is recognised as a challenge among many young females (aged below 25), particularly given the impact of social media, where a perceived ideal of physical perfection is often portrayed. Constant attention on the ideal of perfection can negatively impact emotional and mental wellbeing1 and drive younger females to seek cosmetic treatment.2 As young people become increasingly aware that their natural look can be enhanced with non-surgical treatments, there is an increase in this age group attending facial aesthetic clinic appointments. It is our responsibility as aesthetic practitioners to ensure an ethical approach to the treatment of this population. A UK-based survey involving more than

1,600 young women reported that up to 47% of girls aged 1121 felt that the way they look affects their body confidence. Findings noted that girls can feel embarrassed and ashamed of how they look and that fear of their bodies being criticised may hold them back from doing everyday things.3 It has been suggested that these social pressures can, in some cases, lead to psychological consequences such as body dysmorphic disorder2, a psychiatric condition characterised by an excessive preoccupation with a perceived flaw in appearance, involving high levels of focus on appearance and seeking reassurance from others.4 National Institute for Clinical Excellence (NICE) guidance recommends screening for body dysmorphic disorder in aesthetic clinics, particularly where there appears to be excessive concern about a minor defect.5

“Beautification is defined as ‘the process of improving the appearance of someone or something’”

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WHAT IS BEAUTIFICATION?

Beautification is defined as “the process of improving the appearance of someone or something”. In facial aesthetics this is referred to as enhancing natural beauty in order to maintain natural facial ratios and proportions. The aim of aesthetic treatment is to help patients feel more attractive and as satisfied with their appearance as possible, by creating and maintaining a harmonious, balanced, and natural look.6 When treating younger females it is important to enhance natural facial features in order to obtain a natural look that enhances patient confidence, rather than treating fine lines and wrinkles, which is often the goal when managing more mature individuals. Tailored treatment is typically designed with individual needs and circumstances in mind, including ethnic and cultural considerations, including skin type, facial shape and aesthetic ideals.6

OPTIMISING THE BEAUTIFICATION CONSULTATION

A comprehensive consultation is an essential first step in beautification treatment (Box 1). This involves building a rapport with the patient by having a detailed discussion about treatment goals, with the overall aim of combining what the patient wants with what they need. Box 1. Key consultation considerations •T ake a full medical history, including a psychological/ emotional assessment •H ighlight that the aim is to provide non-permanent, natural-looking results •R ule out unnecessary treatment •A llow the patient time to go away and think about treatment •A im to enhance natural beauty and create a look that maintains natural ratio and proportions •D iscuss potential short and long-term complications •C larify that dermal fillers are not a permanent option, and may need to be repeated •D epending on age, consider parental permission •D iscuss costs of treatment Table 1. Key ethical considerations and solutions

The consultation should be tailored according to individual needs, gaining insights into why the patient believes they require treatment and the desired or expected results. Unrealistic expectations are common in younger patients and this must be addressed upfront to avoid disappointment later. These aspects and other ethical considerations, along with related solutions are presented in Table 1. A full-face assessment should always be conducted. It is often the case that a patient will have a specific treatment area in mind, e.g. plumper lips, however, treating one part of the face may contribute to an imbalance in another facial region. Thus, to ensure a natural and balanced look, it is important that a holistic approach be taken, meaning that rather than treating one part of the face in isolation, you should consider elements of the upper, middle and lower face that may also benefit from beautification. A treatment plan should be developed in close consultation with the patient. This will present everything that could be done to enhance natural beauty and achieve their goals. It is important not to phrase any elements of treatment as imperfections, but rather as enhancements of natural beauty. After the initial consultation, the patient is provided with a summary of the treatment plan and advised to go away and consider this before initiating treatment. This increases confidence that the patient is making an informed treatment choice and is an important step in ensuring longterm patient satisfaction. It is important that each patient understands the treatment process and the potential risks and benefits of treatment including side effects, the duration of treatment effect and need for retreatment. Complications should be discussed, and the patient informed of the common complications and side effects, such as redness, bruising and swelling. Patients can be reassured that these will >

Consideration

Solution

Always keep the best interest of the patient in mind

Conduct a full consultation to ensure selection of the most appropriate treatment to achieve desired goals

Aim for natural results

Take a balanced, full-face approach

Ensure the patient is happy before initiating treatment

Provide the patient with a treatment plan after the consultation and advise them to go away and review this before attending a treatment appointment

Make sure patients have the information they want or need, including clear accurate information about side effects, complications and other risks

Provide this information in written format at the initial consultation, as part of the treatment plan

Ensure the patient has consented to treatment

Completion of a consent form

Use the most suitable products

In younger patients use HA dermal fillers (reversible)

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“Use of small quantities of dermal fillers is the most common treatment for beautification in the younger female population”

be minimised with safe technique. The risk of other complications, such as infection, must also be discussed.7 Once treatment is initiated it is advisable to utilise a staged approach, conducting treatments over multiple sessions, with follow-up appointments to ensure satisfaction and check on possible side effects. In addition, sharing before and after photos during each session can demonstrate treatment success, check patient satisfaction and build confidence.

WHAT ARE THE OPTIONS WHEN TREATING YOUNGER FEMALES?

a psychological or emotional assessment, and a detailed discussion to check patient expectations, provides details of the injection procedure and potential complications. Along with a treatment plan, this is an important first step prior to initiation of treatment. AM REFERENCES 1. Walker CE et al. 2019. Effects of social media use on desire for cosmetic surgery among young women. Curr Psychol. 2019. https://doi.org/10.1007/ s12144-019-00282-1

Use of small quantities of dermal fillers is the most common treatment for beautification in the younger female population. This acts as a scaffold, helping keep skin elastic and hydrated. Dermal fillers consist of chains of hyaluronic acid and are typically soft and gel-like7, offering temporary results lasting approximately six to 12 months or longer until the body gradually and naturally absorbs the particles. Experts in the area have devised tools for guiding the use of injectable treatments in facial beautification. Allergan’s MD Codes provide a simple and straightforward method, detailing a series of precise sites created to guide injections on the face. ‘Beautiphication’ is an injection facial procedure involving the medical application of the Golden Ratio, also known as Phi, with the aim of offering desirable facial proportions and harmony.8

2. Rajanala S et al. Selfies-Living in the era of filtered photographs. JAMA Facial Plast Surg. 2018;20:443-444.

CONCLUSIONS

8. Swift A and Remington K. BeautiPHIcation: A global approach to facial beauty. Clin Plastic Surg 2011;38:347-377.

An ethical approach to facial beautification in younger females involves building a relationship with the patient to gain an understanding of their reasons for seeking treatment, and conducting an emotional assessment to rule out any psychological challenges. A consultation involving

3. Girls attitude survey, 2016. Available at: https://www.girlguiding.org.uk/ globalassets/docs-and-resources/research-and-campaigns/girls-attitudessurvey-2016.pdf (Last accessed 02 Jan 2020). 4. N uffield Council on Bioethics. Cosmetic procedures: ethical issues. 2017. Available at: https://nuffieldbioethics.org/publications/cosmeticprocedures (Last accessed 02 Jan 2020). 5. National Institute for Health and Care Excellence (2005) Obsessivecompulsive disorder and body dysmorphic disorder: treatment. Clinical guideline 31. Available at: https://www.nice.org.uk/guidance/cg31 (Last accessed 02 Jan 2020) 6. Carruthers JD et al. Advances in Facial Rejuvenation: Botulinum Toxin Type A, Hyaluronic Acid Dermal Fillers, and Combination Therapies–-Consensus Recommendations. Plast Reconstr Surg 2008;121:5S-30S. 7. L apa T and Mandavia R. Understanding HA dermal fillers. Aesthetics Journal. 14 Jul 2017.

9. Critchley R. Beautifying the young face. Aesthetics Journal. 23 Aug 2017. 10. Farolch-Prats L and Nome-Chamorro C. Facial Contouring by Using Dermal Fillers and Botulinum Toxin A: A Practical Approach. Aesth Plast Surg (2019) 43:793-802.

Dr Ahmed El Houssieny runs the Doctor A Clinics in Hale and Stockton Heath. He is an honorary lecturer at Chester university and an education provider on cosmetic procedures, involved in training future practitioners. He is a member of the British Association of Beauty Therapy and Cosmetology and the British Society of Aesthetics. He is also working on a masters in aesthetic medicine.

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When to refer Dr Haroun Gajraj discusses when to refer leg spider veins to a vascular specialist

elangiectasia are called spider veins and thread veins by the public: small, superficial veins in the dermis of the skin, found in clusters on the legs. Reticular veins are usually referred to as blue veins and they are situated slightly deeper at the junction of the dermis and subcutis. Nearly half the adult population has blue leg veins and telangiectasia and requests for treatment are rising quickly as the public becomes aware that treatment by microsclerotherapy is safe, effective and available privately (Figure 1). In most cases, people are concerned by the appearance of their thread veins and blue veins, but telangiectasias and reticular veins may cause symptoms such as ache, itch, throbbing and cramps. Leg telangiectasias and reticular veins can be a sign of superficial venous reflux which may benefit from investigation by duplex ultrasound and treatment in order to mitigate the risks of venous complications such as superficial venous thrombosis, venous eczema and venous ulceration. For Figure 1: Idiopathic popliteal fossa leg telangiectasias suitable for microsclerotherapy

this reason, it is important that patients with telangiectasia and reticular veins are assessed appropriately prior to microsclerotherapy (Figure 2).

Figure 2: Schematic of connections of telangiectasia and reticular veins, showing that these may be secondary to venous reflux

Microsclerotherapy is safe and effective. It is widely practiced around the world. For selected patients, in an appropriate clinical setting, with sufficient training and with regular practice, microsclerotherapy can be undertaken by doctors and nurses from a wide range of specialties and backgrounds. Selecting people for microsclerotherapy and identifying those who might benefit from a referral for a specialist vascular opinion are clinical management decisions based on a history, examination and Continuous Wave Doppler screening test (Fig 3).

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about symptoms of vascular disease, such as intermittent claudication, which may be a contraindication to compression. Patients should be given privacy to undress and the legs should be examined in good light, with the patient standing and the legs exposed from the groin to the feet. The patient should stand for at least two to three minutes to allow varicose veins (if present) to fill. There is a risk of syncope during the examination, so I ask the patient to lean against the treatment couch. Signs of underlying venous disease should be sought. You must be able to see the entire leg, not just the veins that concern the patient. Check and record the following details: History of ache, throbbing and swelling History of claudication or cardiovascular disease Past history of vein treatments and thromboembolism Skin colour, warmth and texture Any abnormal scars or pigmentation/marks Types of vein that are visible Feel for varicosities Identify and discuss with the patient those veins that concern him or her most and consider your treatment plan.

DOPPLER ASSESSMENT

Figure 3: CWD for detecting saphenofemoral reflux

INCLUSION CRITERIA

Healthy patients without significant comorbidity Absence of varicose veins Leg telangiectasia and reticular veins only Healthy skin with no pigmentation or signs of chronic venous insufficiency (including severe ankle telangiectasias and reticular veins corona phlebectasia) No major swelling No contraindications

Reflux (abnormal reverse flow) may be confirmed by Continuous Wave Doppler (CWD) or Colour Duplex Imaging (CDI). CWD is a screening test that I recommend as a minimum to check for superficial venous reflux. CDI is the gold standard diagnostic test for venous disease. CDI may be indicated by the clinical history or examination or by a positive CWD test. I recommend that those who undertake microsclerotherapy establish a referral pathway for CDI and to a vascular specialist for a second opinion when indicated.

“Nearly half the adult population has blue leg veins and telangiectasia and requests for treatment are rising”

NOTES BMI >30 is a major risk factor in line with NICE guidelines nice.org.uk/guidance/ng89/ resources/department-of-health-vte-riskassessment-tool-pdf-4787149213 My recommendation is that those who plan air travel > eight hours or a journey of any type >12 hours are at increased risk of DVT. This is in line with NICE guidance cks.nice.org.uk/dvt-prevention-fortravellers#!scenario There is a four-fold increase in risk for air-travel over eight hours and the risk increases markedly for journeys in excess of 12 hours.

REFERRAL FOR COLOUR DUPLEX IMAGING

It is generally appropriate to request CDI for any of the following type of patient: Has symptoms suggestive of venous disease such as ache, throbbing and swelling; worse with standing, relieved by elevation Has CWD evidence venous insufficiency (at saphenofemoral or saphenopopliteal junctions or in a palpable vein) >

INITIAL EXAMINATION

A thorough general medical history should be taken and, in addition, symptoms of venous disease such as ache, throbbing and swelling should be sought. Graduated compression hosiery is frequently prescribed after sclerotherapy and therefore patients should be asked

Figure 4: Corona phlebectasia and skin changes indicating need for CDI

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Has palpable veins larger than 5mm in diameter Has corona phlebectasia or skin changes (Fig 4). CDI examinations are not routinely performed on patients who present simply for spider veins and small reticular veins. If there are concerns about the patient’s arterial circulation, examine the patient supine on the couch, palpate foot pulses and perform an arterial Doppler examination (Fig 5). Consider referring patients with arterial disease and offer life-style advice (smoking cessation for example).

before administering treatment. Veins that appear or worsen during pregnancy may spontaneously resolve.

RELATIVE CONTRAINDICATIONS

The following in my opinion are relative contraindications and, in such cases, sclerotherapy should only be undertaken after a risk assessment by very experienced practitioners and after careful consultation with the patient: lderly and sedentary patients (older than 80 years E of age) Obesity 1 Patients with arterial insufficiency (who may not tolerate compression hosiery and who may have delayed healing if they develop skin necrosis) Patients with associated varicose veins or skin changes associated with venous disease; or patients with a positive CWD screening test Diabetes (increased prevalence of arterial disease, neuropathy and poor wound healing) Patients on anticoagulants Recent or upcoming long-haul flights2 Patients with unrealistic expectations (consider body-dysmorphia).

Figure 5: Assessment of arterial circulation by Doppler Pressure Indices

ABSOLUTE CONTRAINDICATIONS

In my opinion, the following are absolute contraindications to the treatment of telangiectasia and venulectasia for cosmetic reasons: Pregnancy and breast-feeding mothers* Generalised systemic disease such as cardiac, renal, hepatic, pulmonary and collagen diseases and malignancies Severe rheumatoid arthritis or osteoarthritis or indeed any disease which significantly interferes with the patient’s mobility and which may render the patient susceptible to deep vein thrombosis History of deep vein thrombosis Acute febrile illness Allergy to sclerosing agents or any other constituent of the solution Severe atopy such as bronchial asthma, severe skin eczematous conditions Severe Lymphoedema Thrombophilia clotting disorders Immunodeficiency or use of immuno-suppressants such as steroids Recurrent cellulitis. *Pregnancy has a variable effect upon lower extremity varicose veins and telangiectasias. In general, with repeated pregnancies, telangiectasias and varicose veins appear earlier and are more severe. This process peaks at the third pregnancy. It is wise to wait at least six months postpartum

Provided patients are carefully selected, microsclerotherapy is the most effective treatment for leg telangiectasias. Healthcare professionals who provide this treatment must be clear when it is appropriate to decline treatment and when to consider referral to a venous or vascular specialist. I strongly recommend that those who undertake microsclerotherapy establish referral pathways for Colour Duplex Imaging and for a second opinion both before treatment and in the event of an unexpected complication such as matting, ulceration, or resistance to sclerotherapy.

SUMMARY: REASONS FOR REFERRAL

eferral for Colour Duplex Imaging as listed above R Symptoms or signs of arterial disease Failure of microsclerotherapy to improve telangiectasia (might there be superficial venous reflux?) Severe neotelangiectasias (sometimes called “matting”) after microsclerotherapy (might there be superficial venous reflux?) Complications such as skin ulceration (for help in their management) AM

FURTHER READING • ‘ Sclerotherapy: Treatment of Varicose and Telangiectatic Leg Veins’. Mitchel P Goldman and Robert A Weiss. 6th Edition © 2017 Elsvier Inc • ‘ Somjen GM. Anatomy of the Superficial Venous System’. Dermatol Surg 1995; 21: 35-45 • B ritish Association of Sclerotherapists https://www.bassclerotherapy.com/articles/

Dr Haroun Gajraj is a phlebologist based in Dorset. He is the medical director of the VeinCare Centre, Responsible Officer for the GMC, specialist adviser for NICE and sits on the board of the British Association of Sclerotherapists. The VeinCare Centre is regulated by the Care Quality Commission and is a Designated Body with the GMC. In 2019, The VeinCare Centre won business awards for “Customer Care” and “Online Engagement”.

Aesthetic Medicine • February 2020

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Become a Certified Partner of

The National Medical Weight Loss Programme Agenda

Daily Injection

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Module 1 The epidemiology and physiology of obesity a) How we define and assess obesity b) Epidemiology c) Obesity and weight-related diseases

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Module 3 Weight Loss Interventions a) Diet and nutrition b) VLCDs (very low-calorie diets) c) Physical activity d) Bariatric surgery

BOOK Module 4 Pharmacotherapy NOW! a) b) c) d) e)

Phentermine Limited spaces Orlistat Mysimba Saxenda (daily injection) Ozempic (weekly injection “off-label” prescribing)

Module 5 Setting up a private weight management clinic a) Decommissioning of services in the NHS b) Clinic requirements c) The patient pathway d) Electronic consultation form step by step

Business Support a) CQC registration assistance (where needed) b) Insurance c) Pharmacy d) Pathology services e) Drop box f) Closed Facebook group g) Website clinic locator h) Personal electronic consultation form i) Marketing material

About us The gradual erosion of NHS weight management services means that people living with obesity, have fewer options for treatment than ever before. The National Medical Weight Loss Programme (NMWLP) was founded in 2018 with a vision to offer every person living with obesity access to treatments. We hope to achieve this by helping registered healthcare professionals, set up their own private medical weight management services.

Who can join? The NMWLP was developed exclusively to support and train registered healthcare professionals belonging to the following Bodies GMC, NMC or GPhC (i.e. doctors, nurses or pharmacists).

Our training

ing from our official Pharmacy Partner - PriMed Aesthetic Pharmacy.

Clinical support

• Clinic locator on www.nmwlp.co.uk • Personalised electronic consultation form

unique to your clinic to send to your patients.

• Access to extensive shared dropbox files -

NICE guidelines, useful tools and documents.

• Access to our closed Facebook group for

continued support, advice and supervision.

Marketing support

• Access to pre-made branded marketing material which can be customised for your clinic.

• Templates for eblasts and social media etc. • Advice on of how to run a successful event to introduce this service into your practice.

All Partners will receive accredited face-to-face training written and delivered by an Expert Advisor to the National Institute for Clinical Excellence (NICE) on Obesity - Dr Matt Capehorn.

Next training dates

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BUSINESS

PATIENT ATTRACTION

aestheticmed.co.uk

Five ways to increase your clinic’s patient base in 2020 Dr Harry Singh shares his tips for turbo-charging your clinic’s patient base

hile the run up to Christmas is a busy time for clinics, the beginning of the year can often be a bit slow, so it’s a good time to start looking for new customers, says Dr Harry Singh, founder of facial aesthetics training company The Botulinum Toxin Club. Here he shares his five tops tips for attracting new patients.

1. ORGANISE AN OPEN DAY/EVENING

Organise an open day or evening for your business to generate interest around your brand. These types of event are a great way to invite people to your clinic and show them what you do. You can provide refreshments, put on some talks, give demonstrations of treatments and give away samples or goodie bags. Be careful of time-limited offers around injectable treatments, but offer some form of incentive for potential clients to make an initial booking for other treatments you provide.

2. GET INVOLVED WITH LOCAL PRESS AND RADIO

People often get caught up in the desire to make it into national publications, but while being featured in a big name magazine or newspaper may help build your profile, don’t forget local media – they directly target people who live and work in your area. While some patients will travel to see a good practitioner who they trust, the majority of people will want to find someone local. Contact your local press and radio channels and consider placing an advert or putting yourself forward to comment on relevant stories.

3. WORK OUT WHO YOUR TARGET MARKET IS

Spend some time really working out who your target market is. What kind of patients do you already have and enjoy working with? What kind of patients do you want to attract? Who does your offering currently appeal most to? Targeting your efforts more specifically at those you actually want to get through your clinic doors will help to save a lot of effort and money. It can help you to clarify your marketing messages and will mean you will be getting yourself in front of relevant people, especially if you are doing digital advertising.

4. GET ONLINE

Online is where most people will first find you. So use any quieter periods in clinic to get online and make sure your website and social channels are up to date, informative, efficient and reaching as many people as possible. Be consistent with the branding and names of the social media handles. Use a mixture of promotional and educational posts. Find out what social media channels your target market uses and become an expert on that specific channel.

5. WRITE GUEST POSTS

Offer to write an article for a magazine or blog that’s in a related field to you. Not only will this demonstrate your expertise and your clinic’s unique selling points, but it’ll also work as free marketing. You can showcase these posts to your patients via your newsletters, website and social media. AM

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PRODUCTS

PRODUCT NEWS

aestheticmed.co.uk

SMARTMED ANNOUNCES INTRODUCTION OF ULTRACEL Q+

MURAD EXTENDS RETINOL YOUTH RENEWAL COLLECTION

Murad has extended its preventative and corrective range, Retinol Youth Renewal, following the popularity of the existing Retinol Youth Renewal Serum. The two new products are Eye Serum, which contains cotton wool grass extract and marine kelp complex, and a hydrating Night Cream, which includes niacinamide and picolinamide. All products use retinol tri-active technology to minimise lines, even skin tone and boost radiance.

MEDIK8 CREATES LIP BALM

Cosmeceutical brand Medik8 has created its first lip balm. Named Mutiny, the product is squalene-based and has been formulated to replenish lost lipids and support the natural healing of chapped lips. Unlike many other lip balms, it does not rely on occlusives such as petrolatum, which can form a fake barrier. Instead, Mutiny is a gel-like balm intensified with plant-sourced sea buckthorn oil, which infuses the top layers of the lip skin with omega oils.

SmartMed (Healthxchange Group) has announced the arrival of the ULTRAcel Q+ device in the UK. Designed for tightening and lifting, the device uses high-intensity focused ultrasound (HIFU) to stimulate new collagen growth and tighten the SMAS layer, which traditionally could only be targeted with surgery. The device allows 300 shots to be fired in less than three minutes and includes cartridges for both small and larger treatment areas. While some patients may see some immediate effect, full results are usually visible after two to six months.

PURESKIN LAUNCHES VEGA QS

Pure Skin has launched the Vega QS Q-switched Nd:YAG system for the treatment of pigmented and vascular lesions, skin rejuvenation including acne treatments, and tattoo removal. The device incorporates both 1064nm and 532nm wavelengths and has a demineralised water-cooling system. It also includes three interchangeable tips and does not have an orthostatic arm which the company claims allows improved operator visibility.

CLINICAL STUDY ON EMEPELLE PUBLISHED IN LEADING JOURNAL

A study has been published in the Journal of Drugs in Dermatology outlining the effectiveness of menopausal skincare line Emepelle. Featuring MEP Technology, the range targets the root cause of accelerated collagen loss and skin ageing due to the decline in oestrogen levels. US Dermatologist, Joel Cohen led the 20- week open label research investigation study. Participants used Empelle Serum and Night Cream daily. Outcomes were assessed at week eight, 12 and 20 by clinical as well as subject-graded improvement. Results showed that 100% of participants experienced aesthetic improvements per investigator-assessed Global Aesthetic Improvement Scale (GAIS) at week 14 and 93% saw two grades or more improvement in the 0-4 Facial Hydration Scale at week 20. Wrinkles, texture, and colour were also improved at week 20 in 93%.

Aesthetic Medicine â&#x20AC;˘ February 2020

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L AU N C H FO C U S

TRUSCULPT FLEX

aestheticmed.co.uk

Setting the tone We find out about the newly launched truSculpt flex from Cutera

uscle sculpting has become the latest trend within the aesthetic devices sector with big name brands such as BTL (Emsculpt), Cynsoure (StimSure) and now Cutera (truSculpt flex) launching products aimed at improving muscle tone and definition. Research by the Global Wellness Institute showed the market for fitness, mind and body services was $595bn (£497bn) in 2017 with an increase of 14.5% in bodyshaping procedures year over year, according to Medical Insight. Furthermore the International Health, Racquet & Sportsclub Association estimated that 60 million people are paying members at gyms and health clubs hoping for a more fit and toned body. It makes sense then that technology follows where demand arises. Cutera announced the UK launch of its muscle sculpting platform truSculpt flex on January 1, 2020. The company was already gaining momentum in the bodyshaping market with its truSculpt iD device for fat reduction, and described the launch of truSculpt flex as “another significant step forward in shaping the future of aesthetics.” The device is FDA-cleared for the improvement of abdominal tone, strengthening of the abdominal muscles, and development of a firmer abdomen. It is also cleared for the strengthening, toning, and firming of buttocks and thighs. Its key selling points, the brand says, are its use of proprietary Multi-Direction Stimulation (MDS) technology, which delivers three distinct treatment modes by replicating intensified crunch, squat

“Our practice was very pleased with how the technology performed and delivered, real, personalised muscle toning results for patients”

and twisting actions, and the fact it can treat up to eight areas simultaneously, the largest in the body sculpting industry, says the brand. The modes include: Prep Mode – creates a Dr Michael Somenek twisting motion to warm up, stretch the muscles and slowly build a tolerance to muscle contractions Tone Mode – contracts the muscles, holds it to the point of exhaustion, and then relaxes it to increase strength and enhance endurance Sculpt Mode – fast, deep, sequential contractions of the muscles for building muscle mass. Treatments can be personalised to meet patients’ fitness levels, shape, and goals allowing practitioners to target multiple, specific small and large muscle groups with no downtime. Dr Michael Somenek, a plastic surgeon based in Washington DC, USA, and a lead investigator for the truSculpt flex clinical studies, stated, “During the clinical study for truSculpt flex, our practice was very pleased with how the technology performed and delivered, real, personalised muscle toning results for patients. This technology opens up the possibilities for any aesthetics provider looking to offer best-in-class muscle toning services.” AM

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The new S1500 Meso Pen Gun exclusively from Rosmetics Aesthetics Limited

S ON VISIT U F6 D STAN

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1500 stroke/min in Pen Mode 700 stroke/min Gun Mode 17:37 020 2 / 1 0 / 14 - 10 mm adjustable depth 0.5 Depth adjustment with 0.1 mm precision High penetration speed Adjustable frequency, pressure and depth parameters 10 different recordable protocol memories Special Needle Kit containing 50 needles (27Gx13mm or 30Gx13mm) CE Class IIa certified gun and special needle kit

Rosmetics Aesthetics Limited Telephone: (+44) 0345 5050601 Email: info@rosmetics.co.uk Website: www.rosmetics.co.uk VI Aesthetics - Regen Labs - Regenera - Hyacorp - Hyabell - Carboxy - Silkann

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P RO D U CT FO C U S

ZENII PROLEAN

aestheticmed.co.uk

Lean machine We find out about the newly launched ZENii ProLean

ne of the things that always tops new year’s resolutions lists is weight loss. But, now we are moving into February, many people have long fallen off the post-Christmas crash diet. In fact, according to a study conducted by the University of Scranton in Pennsylvania, US, only 8% of people ever succeed in achieving their new year’s resolutions, with research conducted by Strava, the social network for athletes, showing that the majority fall off the wagon as early as January 12. In a desperate bid to shift pounds many people are tempted by the lure of a quick-fix and go online to buy unproven and unregulated diet pills and weight loss supplements to help them. In 2017, the Medicines and Healthcare products Regulatory Agency (MHRA) released a report that said one third of people trying to lose weight have tried potentially dangerous slimming pills bought online. As medical professionals offering weight loss and body contouring services, the likelihood is that your clients may make up some of these numbers. However, if your patients are looking for a helping hand with their weight loss journey, nutrition brand ZENii London now has a safe and efficacious solution in the form of its newly launched ProLean supplement, which has been specifically formulated for weight loss, portion control and slimming support. This is the brand’s first foray into the weight loss market and ZENii founder Dr Johanna Ward says it’s a great accompaniment to in-clinic body shaping treatments. She says, “The launch of ProLean takes ZENii firmly into the weight loss market. For aesthetic clinicians ProLean is a safe and natural supplement that will complement any weight loss, body

“We see ProLean as a total game changer and a very helpful clinically-evidenced tool for those who overeat. With a third of modern western society overweight or obese, ProLean has incredible health-improving potential.”

contouring or fatfreezing treatment. Body contouring results will always look more dramatic and satisfactory when coupled with natural weight loss.” Manufactured in the UK, ProLean contains Dr Johanna Ward natural glucomannan (konjac root) in a 3000mg daily dose. Glucomannan is a dietary fibre clinically evidenced to support weight loss. Glucomannan is the only food ingredient with an European Food Safety Authority (EFSA)-approved health claim for weight loss. Glucomannan absorbs water like a sponge and expands in the stomach before a meal to promote a feeling of fullness or satiety. ProLean works by reducing portion size with each meal, causing overall calorie reduction. ProLean also contains zinc which contributes to normal carbohydrate metabolism and the normal metabolism of fatty acids. It is vegan friendly and contains no milk, nuts, gluten or soy and is GMO free. Dr Ward adds, “ProLean doesn’t interfere with the body’s endocrine, thermal or immune systems. Instead, it simply gives mechanistic portion control in a safe and effective way. We see ProLean as a very helpful clinically-evidenced tool for those who overeat. With a third of modern western society overweight or obese, ProLean has incredible health improving potential.” AM

Aesthetic Medicine • February 2020

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SAY SAY YES YES TO TO INTIMATE INTIMATE WELLNESS WELLNESS

A Breakthrough A Breakthrough in Intimate Health in Intimate Health REMAIN FULLY REMAIN FULLY CLOTHED CLOTHED

IMPROVEMENT IN OVERALL IMPROVEMENT IN OVERALL INTIMATE SATISFACTION* INTIMATE SATISFACTION*

WALK-IN WALK-OUT WALK-IN WALK-OUT PROCEDURE PROCEDURE

*Data on file. ©2020 BTL Group of Companies. All rights reserved. BTL®, EMSELLA® and HIFEM® are registered trademarks in the United States of America, the European Union *Data on file. and/or other countries. The products, the methods of manufacture or the use may be subject to one or more U.S. or foreign patents or pending applications. 099-79EMSADAJ1ENGB100 ©2020 BTL Group of Companies. All rights reserved. BTL®, EMSELLA® and HIFEM® are registered trademarks in the United States of America, the European Union Trademarks EMSCULPT®, EMSELLA®, EMTONE™, EMBODY®, and HIFEM® are parts of EM™ Family of products. BTL_Emsella_AD_Aesthetics-Journal_A4_ENGB100 and/or other countries. The products, the methods of manufacture or the use may be subject to one or more U.S. or foreign patents or pending applications. 099-79EMSADAJ1ENGB100 Trademarks EMSCULPT®, EMSELLA®, EMTONE™, EMBODY®, and HIFEM® are parts of EM™ Family of products. BTL_Emsella_AD_Aesthetics-Journal_A4_ENGB100

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C O M M E R C I A L F E AT U R E

ZO GROWTH FACTOR SERUM Growth factors are one of the best active ingredients for skin rejuvenation and offer exceptional results with less irritation than other gold standard ingredients

sk any skin expert for the ingredient they swear by and you will hear at least two of the following: sunscreen, retinol, antioxidants, hyaluronic acid, peptides. These are the ultimate wrinklefighters and radiance warriors that any skincare lover keeps in their stash. But there’s a new complexion mandate that has quietly entered the fold: growth factors.

What are growth factors? Growth factors are groups of proteins that occur naturally in our bodies. They’re produced by all types of cells and are responsible for the regulation of vital cellular functions, such as survival, proliferation, migration and differentiation. Simply put, growth factors can command your cells to replicate, repair and rejuvenate.

and smoothness, 92% reported overall improvement in all signs of ageing and 78% said their skin felt tighter and firmer.

How do they benefit the skin?

Using growth factors

When it comes to fighting skin ageing, growth factors are the true all-rounders. By our late 20s the natural production of growth factors in the skin starts to decline which lays the groundwork for wrinkles, sagging and skin thinning. Adding them topically through your skincare will stimulate the production of fibrous proteins such as collagen and elastin to improve skin thickness and texture. Boosting collagen production also enhances the skin’s natural ability to heal and hydrate.

While growth factors are one of the best active ingredients for skin rejuvenation, they can’t replace the basics—sun protection, exfoliants and antioxidants. Think of them as the icing on the cake that can bolster existing skincare regimes and slow down the ageing process with much less irritation than other gold-standard ingredients such as retinol.

Do they really work? In our most recent study, 92% of participants who used ZO Growth Factor Serum noticed significant improvement in fine lines and crow’s feet after following the simple routine of cleansing, applying Growth Factor Serum and wearing SPF every day for 12 weeks. Furthermore, clinicians observed 31% improvement of skin thickness after just four weeks of using Growth Factor Serum in the morning and evening and PM and the number continued to increase throughout the completion of the study. Overall, 95% of participants reported visible improvement in their skin texture

ZO Growth Factor Serum ZO Growth Factor Serum features a combination of both plant and enzymatically derived growth factors. By applying topically, growth factors strengthen the skin’s extra cellular matrix, stimulate collagen and trigger the skin’s natural ability to heal—making growth factors an invaluable component of antiageing skincare. Growth Factor Serum, featuring ZPRO is clinically proven to help: • Improve skin density • Improve skin firmness and elasticity • Reduce the appearance of lines

Skin density Growth Factor Serum helps improve skin density. Our study saw 31% improvement

in dermal thickness at the four week interval compared to baseline. Assessment was conducted using the DermaScan C Ultrasound instrument—a compact high-resolution ultrasound scanner that analysed for dermal thickness and density.

Fine lines and wrinkles 92% of participants experienced improvement in fine lines and wrinkles at the 12week interval compared to baseline. Participants noticed significant improvements in fine lines and crow’s feet after just two weeks, and these improvements continued through the completion of the study. Assessment was conducted via expert grading analysis. Images captured and analysed with an Antera 3D camera to determine improvements in fine lines and wrinkles.

Firmness and elasticity An average of 80% of participants showed improvement in the appearance of elasticity. While an average of 81% of participants showed improvement in the appearance of skin firmness. Improvement in firmness ans elasticity determined by instrumental evaluation via a Cutometer.

Overall Improvement 93% of participants experienced improvement in all attributes at the 12week interval.

WIGMOREMEDICAL.COM

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OLYMPIA LONDON 29 FEB-1 MAR 2020

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T R E AT M E N T S

TREATMENT NEWS

aestheticmed.co.uk

New: InMode Accutite

he latest non-surgical face-lift option to hit the UK market straight from the US is InMode’s AccuTite. Billed as the smallest radiofrequency assisted lipolysis device on the market, AccuTite is designed to accurately and precisely treat smaller areas of the face and body such as the eyelids, jowls, midface, knees and hands. The device claims to offer patients a total facial refresh with little to no downtime and less discomfort than other skin-tightening treatments. It works by triggering energyassisted lipolysis for targeted fat destruction while progressively tightening skin tissue without manipulating tissues, as with excisional face-lifts.

Before

After

Instead, AccuTite encourages the body to naturally tighten its superficial tissue for increased skin smoothness, more structural definition, a sharper jawline and tighter skin on the neck. Clients typically have just one treatment, taking around 40 minutes to an hour. InMode says results are immediately visible, though final results peak at around six months and can last for up to five years.

Before

After

London-based Dr Tatiana Lapa recently introduced AccuTite to her clinic, Dr Tatiana Aesthetic Dermatology. She said: “We introduced AccuTite to meet the growing demand for a minimally-invasive, effective and safe treatment to achieve fat reduction and skin tightening with minimal downtime. The treatment is performed under local anaesthetic and can be used in conjunction with FaceTite and BodyTite to treat larger areas of fat and excess skin around the face and body for a more comprehensive treatment.” AM

The treatment involves local anaesthesia but leaves no surgical scars, with side effects usually limited to small amounts of swelling and bruising, according to InMode. Some results will be visible immediately following treatment, with most patients noticing approximately 30 to 40% of the results once any post-treatment swelling has gone down after four to six weeks. The treated area then continues to improve, with final results peaking around six months post-treatment.

Aesthetic Medicine • February 2020

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T R E AT M E N T S

REVIEW

aestheticmed.co.uk

Tried and tested Amanda Pauley tries a Bespoke Oxyjet Skin Rejuvenation treatment

ell-known for its high-tech oxygen system, Oxyjet revitalises dull complexions using pulsed oxygen pressure to deliver active ingredients deep into the skin. It is a skin treatment rather than a facial, with the protocol tailored to each client’s skincare needs and featuring a range of advanced elements on top, such as microdermabrasion, lymph drainage and LED light therapy. I had my treatment with therapist Alice Spice at the Aurora Wellbeing Spa at Park Plaza County Hall in Waterloo, London. After double cleansing my skin, Spice applied an enzyme peel to resurface my skin, which was left on for five minutes, during which she performed a hand and arm massage. Then, the treatment was ramped up a gear with a threestep oxygen approach. First came Oxycool – a pulsed oxygen pressure injection which shoots a purifying concentrate serum into the skin to tighten cells and calm redness, which I was suffering from on my chin due to congestion. It was cold on the skin but by no means uncomfortable. This was followed by Oxytone – a poly-rotational device head that

works to tone the facial muscles using a lifting action, all the while pulsing oxygen into the skin to deliver actives further into the epidermis. The last element was Oxyspray – an oxygen fluid which was sprayed onto the skin in a sweeping motion. It contains moisturising and antiinflammatory active ingredients to further refresh the skin, after which a Cooling Mask was applied to further enhance the results. Spice also added an LED element to my treatment to further tackle my congestion. She used the Bio2Light LED Light Therapy Hood for 10 minutes, using a mixture of blue light to minimise the inflammation and red light to boost collagen production. The treatment finished with application of an eye oil and moisturiser. My skin looked and felt incredible afterwards. I had such a healthy glow, the congestion on my chin had minimised and everything looked tighter thanks to the lifting action in treatment. Although oxygen facials have been around for a while, none are as advanced as Oxyjet. The brand’s different ways of using oxygen to smartly deliver actives deeper into the skin is a great point of difference to have on your treatment menu, and because the protocol is tailored every time, the experience feels really personalised. AM

Aesthetic Medicine • February 2020

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C O M M E R C I A L F E AT U R E

Verju Experience

Non-invasive, Non-temporary fat loss......with a difference...... it includes cellular anti-ageing, and a plethora of other health benefits to your patients! As clinicians, we are always looking for the best products for our clients, and we search for the best clinical experience and best clinical outcomes. Erchonia is a research and development organisation dedicated to non-thermal laser technology which is the foundation for our reputation as world leaders in our respective field. When we brought our first devices to the US market, the FDA had to design a new assessment formula for low level laser technology. All non-thermal low level lasers have to follow our lead in this process. We are the next evolution in Nonthermal Laser Technology. Research tells us, as we age, our cells lose the ability to function as they should…...fact! The viable numbers of mitochondrial DNA decrease…...fact! This is primarily due to the fact that we see elevations in our inflammatory biomarkers and we suffer from inflammation. Specificity and methylation on the D-loop undergoes modification and nodulation. We age and we begin to decline. Botox and fillers can help with the psychological aspects of ageing. Thermal lasers can resurface the skin and improve collagen synthesis, and excessive freezing/heating of fat and liposuction can destroy or remove fat cells. All of these are interventions into a system, that in essence is self-maintaining. These mechanical interventions rely on an element of microtrauma to effect a change through chemical processes that are natural to the body.

“

94% of all our patients achieved the result they were looking for with the Erchonia fat loss laser

“

Erchonia pride ourselves in the fact that we can create all this change without any of this trauma. We work on the principal that our bodies have all they need to maintain them, all we need is a way to stimulate natural chemical processes; to increase the viable number of mitochondrial DNA, regulate inflammatory biomarkers, and balance methylation. Erchonia’s non-thermal lasers do exactly that!

Dr Miguel Montero-Garcia, Discover Laser, UK

Welcome to an age where we can support the renovation of the skin by the revitalisation, rejuvenation, restoration, and replenishment of the body as a whole. We hold 17 of the 20 US FDA clearances in non thermal laser. We hold 6 FDA clearances on fat loss/cellulite. To find out more and to discuss how you can integrate our lasers into your clinical practice visit us as stand H16. Why not come to our clinical presentation and listen to how our lasers can change your practice and increase you revenue potential. Erchonia Lasers, Beauty is no longer skin deep.

“

BEFORE

The Verju Laser is one of the most innovative products in the aesthetic industry. The fact of a completely pain free treatment with amazing results for the patients is convincing in any aspect.

“

Dr.med. Janine Pantzek, Hamburg

AFTER

female patient treated for body contouring to the mid-section and thighs for subcutaneous fat and the appearance of cellulite which has been significantly reduced with the Verju Laser system.

T +44 (0)1491 821135 E info@erchoniaeurope.com @ErchoniaLasersLimited @ErchoniaL  verju.com

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BEAUTY IS NO LONGER SKIN DEEP – CELLULAR ANTI-AGEING EFFECTS WITH NON-THERMAL LASER

Robert Sullivan Robert Robert Sullivan Sullivan BSc(Hons) MSc Surg(Edin) BSc(Hons) BSc(Hons) MSc MSc Surg(Edin) Surg(Edin) PgDipMAcu MInstChP MCoP PgDipMAcu PgDipMAcuMInstChP MInstChP MCoP MCoP MASugPC FIChPA, Clinical MASugPC MASugPCFIChPA, FIChPA,Clinical Clinical Consultant Erchonia Lasers Ltd Consultant Consultant Erchonia Erchonia Lasers Lasers Ltd Ltd and Clinical &&Surgical Director and and Clinical Clinical &Surgical Surgical Director Director MFCGp (Ireland) MFCGp MFCGp (Ireland) (Ireland)

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I NTERVI EW

TALKING TO...

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Time for a chat Vicky Eldridge speaks to Jay Shah from Elite Aesthetics about how developing a bespoke chat bot has doubled enquiries on its website

our clinic’s website is often the first point of number, the treatment they were interested in and a good call for potential patients, so making sure it’s time to call. And it worked. The clinic saw its enquiries informative and functional is key. But, even double and it also saved his team time. if you have a fantastic website that ticks all He says, “My staff were spending a lot of time trying to the right boxes in terms of its usability, look get in touch with people who had enquired through the and content, you may still find that your volume of traffic website. This has completely streamlined my business doesn’t translate into bookings. because we’ve got those leads coming in, we know when to Chat bots are increasingly being used to help encourage call them and we know that they are serious, so we are not enquiries and generate bookings but they can often be wasting time. It’s just turned the efficiency up by a cumbersome and sometimes even put potential factor of 10.” clients off. Because the bot is running 24 hours a Having worked in Silicon Valley and with a day, it also enables the clinic to capture degree and masters in computer science, enquiries more efficiently outside Jay Shah, who runs the Elite Aesthetics of opening hours. It then emails the Clinic in Greenhithe, Kent, with wife conversation trail instantly to the and aesthetic doctor Shirin Lakhani, team and Shah has set it up to write decided to have a go at creating his own out to a Google sheet too in order to chat bot to better fit the clinic’s needs. capture the data. He called it Response Robot. The bot has been so successful for Martin MacKenzie, Xavier G He explains, “I noticed that we might the clinic that Shah has now partnered Medi-spa have something in the region of 10,000 with the Consulting Room to roll it out to people coming to the website over the other clinics. So far it has been taken up by course of a month but only a very small The Cranley Clinic, London and the Xavier G percentage of those would actually enquire. Clinic, Southampton. “When you walk into an aesthetic clinic you Martin MacKenzie, client services director at Xavier are normally greeted by someone from front of house G Medi-Spa Clinic, said, “I thought that our website already who asks how you are and gives help and guidance, but our delivered a good number of enquiries but I have been totally websites don’t do that. amazed at how many more we now receive thanks to the “So I built this bot to say hello to people and ask Response Robot – we have doubled our website enquiries. some basic questions. The way it’s been done its very I can say that without any doubt, this is the best investment conversational. It’s really easy and user friendly. I call it our we have made in our 15 years in business.” front of house concierge and we have named her ‘Monique’, after our actual front of house team member and have used Ron Myers from The Consulting Room will be speaking her picture to make it more personal.” about chat bots and how they can help you get more The second priority was to look at what the clinic actually enquiries as part of the Business Workshop agenda needed from the bot so, rather than bombarding browsers at Aesthetic Medicine Live on Sunday March 1 at with treatment information and lots of questions, Shah 3.10pm-3.50pm. The Consulting Room is also offering kept it simple and got the bot to ascertain a name, phone its subscribers a 30-day free trial of Response Robot. AM

“This is the best investment we have made in our 15 years in business.”

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Change is good Dr Xavier Goodarzian tells us how EllansĂŠ surpassed Sculptra as his non-HA filler of choice

switched from using Sculptra to EllansĂŠ dermal fillers in my practice in 2017. Patients and other practitioners alike often ask me why I made the change, and the answer is simple. Treatments evolve over time, so when a new option makes more sense, why not evolve with it? I was introduced to Sculptra in 2006, with very basic initial training. The rep from the distributor, which at the time was Sanofi Aventis, simply told me how to inject it and I tried it on my first patient there and then. Thinking back, I must have been crazy to do that, but that was a different time. Over the years I performed many treatments and, as the general knowledge about Sculptra grew, my injection

technique changed and improved thanks to continuous training with other doctors. The knowledge we have now about facial ageing, skeletal volume loss and changes in the various facial fat pads did not exist back in 2006, so we were essentially just treating the skin. It was only years later, and primarily thanks to Dr Danny Vleggaar and his seminars and advanced training sessions, that we started to understand the difference between skin ageing and volume loss from the fat and bony compartments.1-2 I then became an approved Sculptra trainer and a member of the Sanofi Aventis training advisory board. Over the years up to 2017, I treated and trained many

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CLINICAL

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INJECTABLES

Patients treated with Sculptra. Top pictures: Mid face volume loss; nasolabial folds, frontal and lateral cheeks. Bottom pictures: Mid and lower face volume loss; frontal cheeks and lower cheek hollows

hundreds of patients and practitioners all over the UK and in Europe. I was asked multiple times and by various distributors who were looking at taking on Ellansé or distributing it, to try it. I had previously always refused to do so because I was very happy with the results I was achieving with Sculptra, and I was also naturally cautious about this “new kid on the block” collagen stimulator – essentially a rival for Sculptra.

MY EXPERIENCE WITH SCULPTRA

Sculptra had been used since 2000 and, although initially there had been many cases of nodule formation and granulomas, its safety profile had improved greatly over the years as we had started to understand how to prepare the product, how to mix it, how long to soak it for and how to inject it.4-5 For those who are not familiar with Sculptra, let me give you an insight into how technically challenging it can be. It is made of Poly-L-lactic acid (PLLA), which comes in vials in powder form. When a patient has been booked (and hopefully paid a deposit) the product has to be mixed with sterile water (there have been many arguments over the years about exactly how much water) and must stand to soak for at least three days (the initial guidance was two hours, hence so many issues).3 So, the product being injected is a suspension of powder in water. The treatment

is performed using lots of needle injections all over the face in specific areas at various depths – a technique that is always challenging to teach to novice injectors. If that wasn’t hard enough, you had to work very quickly for the powder not to settle in your syringe, shaking the vial and syringe constantly. Plus, the suspension form meant that the needle would get blocked all the time, causing a lot of delays and frustrations for novice injectors and delegates on courses. When cannulae became more fashionable, Dr Linda Eve, another Sculptra trainer at the time, developed a technique of injecting the product with a cannula, which was more patient friendly. From a patient’s point of view, Sculptra is a course of treatment (one or two vials per session and up to three sessions over a period of time). After each session the patient has to massage their face at least twice daily for up to two weeks to ensure the PLLA particles spread evenly, as the water is being reabsorbed over that period. Once the water is reabsorbed there is no visible result until the collagen stimulation (which happens over six to 12 weeks) gradually shows its results. The results last around two years, after which annual topups can maintain the result. The collagen formed by Sculptra is essentially type III collagen6, which can sometimes feel quite stiff and lumpy. It can also make further treatments harder as the patient’s skin becomes thicker and tougher to inject. >

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CLINICAL

INJECTABLES

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Male face treated with Ellansé: Mid face volume loss; jawline ccontouring, frontal lateral cheeks and chin

MAKING THE SWITCH

I started seriously looking at the evidence regarding Ellansé in 2016/ 2017. At this point the product had been around for a good number of years and a lot of evidence about its safety and efficacy was published. Hearing trainers talk about Ellansé at a Sinclair Pharma seminar in Barcelona made me really want to try the product. I booked myself onto a training course in London and the rest is basically history. Nowadays, for those who wish to opt for a non-HA filler, Ellansé is my preferred choice when it comes to collagen stimulation and facial volumisation. The collagen created by Ellansé is type I collagen7, which gives a much softer and more naturally youthful look. The results are amazing and last anywhere between one to seven years depending on the type of product used. Ellansé is essentially a filler/collagen stimulator based on Carboxy Methyl Cellulose (CMC) as the carrier gel and Poly-Caprolactone (PCL), which are the collagen-inducing particles made of this medical-grade polymer 8-10. Ellansé S lasts a year, M – the type I use – lasts two years, L lasts five years and E lasts seven years. The injection technique is effortless, quick and very patient friendly. It is much more comfortable compared

with Sculptra as the majority of treatments are done using a cannula. More than two syringes can be used per treatment, so the entire face can be treated in one session, and there isn’t any massage required from the patient at home. The results are immediate but actually improve greatly over three to four months. The change from Sculptra to Ellansé took place almost overnight in my practice. Once I ran out of my last vial of Sculptra I never ordered any more and swapped instantly to Ellansé. We communicated our decision to all our Sculptra patients and only one questioned my reasoning. We organised an Ellansé event with a few live demonstrations in the clinic, which were very successful. My Ellansé use has continually grown over time and I absolutely love the results. Personally, I would never go back to using Sculptra.

“Nowadays Ellansé is my preferred choice when it comes to collagen stimulation and facial volumisation”

MY EXPERIENCE WITH ELLANSE

Ellansé is still quite technique-sensitive so I would strongly recommend practitioners attend training courses before you start using the product in your practice. Being a HA user does not qualify you to use Ellansé, and you must also be able to use cannulae with ease before you attempt an Ellansé course. Please learn facial contouring

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CLINICAL

INJECTABLES

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Female face treated with Ellansé: Temples; mid face; lower face contouring, frontal cheeks, lower cheeks and jawline

techniques and the use of cannulae properly with a HA filler first before you move on to Ellansé. I have often seen delegates on advanced filler courses (both HA and Ellansé) whose technical abilities are not sufficient to provide them with adequate training, but unfortunately this is never stated on a certificate of attendance. Attendance does not in any shape or form guarantee competence. I would also strongly recommend that even experienced Sculptra users attend an Ellansé training course if you are thinking about this option. Ellansé can also be used safely in the backs of the hands for hand rejuvenation, and most recently it has been used for neck and décolletage rejuvenation. Sculptra was initially used extensively to treat HIV-induced lipoatrophy before it became a trend in the aesthetic industry, and is still being offered in some NHS Trusts for this treatment. I have also treated patients for this indication and the results are impressive. It is worth noting that Ellansé is not FDA approved, whereas Sculptra is FDA-approved for facial aesthetics.3 I would love to treat half a volunteer’s face with Ellansé and the other half with Sculptra to compare the results to the longevity of it over time. Any takers? AM

REFERENCES 1. Changes in the facial skeleton with aging: implications and clinical applications in facial rejuvenation. Aesthetic plastic surg. 2012 Aug; 36(4): 753-760 2. The clinical importance of the fat compartments in midfacial aging. Wan D, et al. Plast Reconstr surg glod open. 2013. 3. Consensus recommendations on the use of injectable Poly-L-Lactic Acid for facial and nonfacial volumisation. Journal of Drugs and Dermatology 13(4):s44-51. April 2014 by Danny Vleggaar and Rebecca Fitzgerald 4. Tips for preventing nodules and papules with Sculptra. MDedge Dermatology 1 May 2009 5. A facial filler needs a dose of patience. The New York Times. Skin deep. Catherine Saint Louis 23 Sept 2009 6. The biological basis for Sculptra-induced augmentation. Dissertation by Philipp Stein. Aug 2014 7. Nicolau P, Marijnissen-Hofste J. Neocollagenesis after injection of polycaprolactone based dermal filler in a rabbit. Eur.J.Aesth Medicine and Dermatology. 2013;3;19-26 8. Ellanse whitepaper W113.05 9. Christen Mo Ellanse safety report 2016 10. M oers-Carpi MM, Sherwood S. Polycaprolactone for the correction of nasolabial folds: a 24-month prospective randomised controlled clinical trial. Dermatol Surg. 2013;39 (3 Pt 1);457-63

Dr Xavier Goodarzian MD(Hons) MRCGP DipClinDerm PGCCosMed MBCAM is the medical director and co-owner of the national award-winning Xavier G. Clinic in Southampton. He is a leader in the field of aesthetic medicine and is a trainer and lecturer at major conferences throughout the UK and abroad. He is a member of the British College of Aesthetic Medicine and the Royal College of General Practitioners.

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TREND

INTIMATE PEELS

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Intimate appeal We find out about the latest trend in sexual rejuvenation – intimate peels

n recent years sexual rejuvenation has become a more widely practiced area of aesthetic medicine with men and women opening up more freely about issues with sexual dysfunction and concerns about the aesthetic appearance of their genitals. Device-based laser and radiofrequency treatments have dominated this arena with other options including PRP and injectables, such as Vivacy’s Desirial, but recently a new trend has emerged – intimate peels. Until now there has not been widespread use of peels for intimate regeneration as most peels are not indicated for the female genital area and practitioners were understandably anxious about off-label usage of such treatments in such an intimate and sensitive place. However, now two new peel systems have been launched that are specifically designed to rejuvenate the vaginal area – Mesoestetic’s Dermamelan Intimate and Trimedica’s Pink Intimate.

DERMAMELAN INTIMATE

“Genital hyperpigmentation can adversely affect self-esteem and quality of life, with an impact on personal and sexual relationships”

Dermamelan Intimate is a non-invasive depigmenting method for the genital-perianal area, inner thighs and groins, which is safe and effective for all phototypes. Developed in collaboration with a medical team specialised

in gynaecology-aesthetics, the treatment removes and prevents the recurrence of hyperpigmentation, helping, mainly women, to feel more confident with the appearance of their genitals and improve their sexual health. Dr Lori Nigro, from Riverbanks Clinic, who is a KOL for the brand, comments, “Although genital hyperpigmentation does not involve any impact on the functional wellbeing of the patient, it is a growing reason for consultation as it can adversely affect self-esteem and quality of life, with an impact on personal and sexual relationships. “Genital pigmentation increase is an event of multifactorial origin that is closely related to ageing and other factors, mainly affecting women, in the different times of their lives. Hormonal changes, sun exposure, mechanical friction of the inner thighs, hair removal or personal predisposition to excessive skin pigmentation are causes related to the skin pigmentation change in this area. “In addition, the fact that melanocyte activity is greater in this area than in the rest of the body is also responsible for the high prevalence of the colour change.”

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TREND

INTIMATE PEELS

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The results of the method are supported by a multicentre prospective clinical study demonstrating that Dermamelan Intimate is an effective, painless, easy-to-follow option to treat genital hyperpigmentation.

PINK INTIMATE

The high therapeutic response level of Dermamelan Intimate is due to its dual action of corrective, regulating efficacy. It stimulates the skin renewal process, forcing flaking and removing melanin deposits and reducing the amount of melanin formed, thus decreasing the intensity of the spot. It also reduces the transfer of melanin to the upper skin layers and the function of tyrosinase, as it contains copper (Cu2+) chelating active ingredients, and controls the overstimulation of tyrosinase inside the melanosome, reducing oxidative stress and thus decreasing melanin synthesis. To achieve the target result, a two-stage protocol is required: one intensive depigmentation session in clinic and one home protocol for the care of recurrences.

The Pink Intimate System, distributed exclusively by aesthetics product and equipment company Trimedica, aims to restore a more youthful, healthy appearance to the vaginal and sensitive-area tissues, as well as tighten, lift and whiten skin. The non-invasive solution includes nourishing and soothing ingredients such as vitamin B12, bisabolol, ionic acid, rucinol and glycyrrhiza glabra root extract. It can be used on many intimate areas including the mons venus (the mound of flesh above the pubic area); the labia majora (the outer folds of skin that are situated on the vaginal opening); the perianal region (the area around the anus); and the inguinal region (the area of the crotch). The skin-sensitive peel can also be used to whiten other areas of the body, including the underarms, elbows, knees, glutes and areola. The treatment can be performed as a simple clinic-based procedure taking no more than 20 minutes on average, and patient case studies have shown immediate and lasting results, many with just a single treatment. Dr Kannan Athreya, aesthetic doctor at Essex Private Doctors, commented, “Until now, no peel has been engineered to be used safely in the labial area for intimate rejuvenation. “Pink Intimate is a fabulous product. All practitioners are looking for a treatment that is safe, easy to use, welltolerated, and that has good reproducible results. This ticks all of those boxes. “I have been offering intimate rejuvenation treatments for some years now and have been very happy with the laser treatments I offer but I was absolutely startled by the results of the Pink Intimate. To get that sort of result after a single treatment is nothing short of astonishing. “It is extremely well-tolerated, safe and affordable for the patient, providing results that rival, and in some cases surpass, outcomes that were only previously achievable by energy-based devices costing tens of thousands of pounds. “It is not going to help with labial shrinking but for lightening, tightening and treatment of laxity I would now use this as a first port of call.” AM

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F E AT U R E

LASER AND IPL

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FINGER ON THE PULSE Laser technology is moving at the speed of light. Kathryn Conway consults the experts on where to start when investing in a laser or IPL device to ensure you make the right choice for your business and patients

ver since the development of the first ruby, Nd:YAG and CO2 lasers in the 1960s, the therapeutic applications of laser and IPL technology have expanded exponentially. In a rapidly developing market where indications for laser and IPL are continually being tweaked, as new techniques and mixed modalities are brought to the fore, the subject can feel wholly confusing for anyone who simply wants to buy the best device for their business. But, says Jon Exley, managing director of Lynton Lasers, an informed purchasing decision is impossible without “a sound knowledge of anatomy, basic understanding of laser physics, and clarity on the needs and demands of your client base”. So, let’s pause for a moment and consider the fundamentals of laser and IPL.

CORE KNOWLEDGE

Laser light is monochromatic, meaning that the light a laser emits is composed of a single wavelength. The wavelength generated is determined by the medium through which the

light passes – either gas (as seen in CO2 lasers), a crystal (as with solid state laser such as alexandrite, erbium, KTP, Nd:YAG and ruby), dye (as seen in pulsed-dye lasers) or a semiconductor (as with diode). It is the chromophores – the target molecules in the skin, namely melanin, haemoglobin and water – that determine the absorption of the wavelength, with each chromophore absorbing different wavelengths according to its “absorption coefficient”. Put simply, by using a laser’s wavelength, energy and pulse duration, a chromophore may be selectively targeted to achieve various treatment outcomes. So, if you want to achieve hair removal, for example, you select lasers with wavelengths that target melanin; if you want to heat and destroy blood vessels, you opt for lasers with wavelengths that target haemoglobin. When it comes to IPL (intense pulsed light) systems, these high-intensity flash lamps are polychromatic, discharging a broad range of wavelengths simultaneously. This broad-spectrum pulsed light is passed through cut-on filters in the handpiece of a device to change the

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IPL

Intense pulsed light has found a real niche as a tool for photorejuvenation of late, with Jade Shelden, clinical trainer UK and Ireland for Venus Concept, noting that this is “because of its epidermal absorption. It is extremely effective at removing facial pigmentation lesions as well as vascular lesions.” Campbell-Adams agrees, adding, “The reason we have nine different filters on our M22 systems is because we want to get to different depths with different filters. So, if we’re targeting something superficial, like a vascular lesion, we’ll use a lower number filter such as a 515 nanometre (nm). But, because we know that superficial lesion might be being fed by a deeper vessel, we’ll also want to start moving up to the 560nm, 590nm and 640nm filters to get deeper. This way, we achieve a better overall effect and long-term results, because if you only treat the superficial lesion and it is being fed by a deeper vessel it will repopulate and return.” Debbie Thomas, who runs her eponymous laser and skincare practice in London, uses the vascular filter on the Lumenis M22 device and says, “What has been proven over the past few years is that you get a much better reduction in vascular activity if there’s a double pulse. The first pulse that hits the vein almost provides a slight shock and creates a chemical reaction in the blood that has just been heated, then the second pulse cauterises it much more effectively. This really allows us to treat very small veins and any flushing of the face.” The Lumina Platform system from Lynton is also effective in treating superficial red veins and pigment, as Exley explains, “The Lumina incorporates reflective coatings within the handpiece to generate extremely short pulses. It’s the combination of the short pulse, high energy

Advanced Esthetics Solutions

range of the wavelengths and enable the targeting of the relevant chromophore. Because of the broad spectrum of light delivered, IPL opens up the potential for multiple treatments from one device. But, cautions Eddie CampbellAdams, UK country manager at Lumenis, “what you can do with an IPL depends on a number of factors, be that power, the filtering, the way the pulse is delivered and flexibility to adjust that to get the best effect.” So, bearing in mind that not all IPL devices are created equal, what indications can IPL treat effectively?

and correct wavelength range that results in excellent treatment outcomes”. But, as Exley explains, the Lumina platform system also incorporates laser technology as there are limitations for IPL alone. IPL’s application as a tool for hair removal has been superseded somewhat by solid-state and semi-conductor lasers thanks to their speed, comfort and ability to treat a broader range of skin types. Plus, “you can only do millisecond pulses with an IPL, not shorter, making it wholly unsuitable for tattoo removal, for instance,” notes Exley.

Lynton Lasers

“The picosecond laser delivers energy so fast that it creates acoustic waves that shatter the ink particles into tiny pieces”

VASCULAR LASERS

By taking aim at haemoglobin, lasers are also effective at heating and destroying blood vessels, with pulsed-dye lasers and KTP the key workhorses here. (As an interesting aside, if you’ve ever heard mention of frequency doubling and wondered what it was, here’s a quick lesson from Exley: “With a KTP laser you’ve actually got a normal Nd:YAG at 1,064nm that is fired through another crystal called potassium titanyl phosphate (KTP) and this halves the wavelength to 532nm. In physics, we call it frequency doubling; you are doubling the frequency of the light, but when you double the frequency you halve the wavelength”). KTP lasers can produce efficacious results in superficial telangiectasias and cherry angiomas, particularly in nontanned Fitzpatrick skin types I-III, but, says CampbellAdams, “the shorter wavelengths are more aggressive on the surface of the skin.” Pulsed-dye, meanwhile, with its slightly longer wavelength (anywhere between 585nm and 595nm), was once considered the gold-standard for vascular lesions. However, its use was plagued by the development of unsightly purpura (bruising) following treatment, a complication that has largely been overcome with the use of longer pulses. Today, pulsed-dye is used to treat and lighten the colour of port wine stains, spider naevi and some haemangiomas, and has been used to reduce the red flushing of >

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rosacea, but post-inflammatory hyperpigmentation and hypopigmentation is a possible complication. “The cost of the dye kits, which can be expensive and have a shelf-life, should also be taken into consideration,” concludes Campbell-Adams.

aestheticmed.co.uk

nanosecond pulses with extremely high peak power,” says Joanne Leahy, head of training at 3D-lipo. And because any solid-state laser can have a Q-switch inside, technicians have a broad range of wavelengths at their disposal. This makes them particularly effective at targeting individual brown spots (such as sun, age and café au lait spots) across a range of skin types. The advent of picosecond lasers, meanwhile, which fire 1,000 times faster than the Q-switched nanosecond pulse, has seen a new dawn for tattoo removal. “The picosecond laser delivers energy so fast that it creates acoustic waves that shatter the ink particles into tiny pieces, which are then removed by the body’s lymphatic draining system,” says Shelden. Interestingly, melasma is another possible indication for Q-switched lasers, with Thomas having found success treating the condition by using the M22’s Q-switched laser in combination with specific peels designed to suppress pigmentation production. “Melasma is triggered by VEGF, which is the vascular endothelial growth factors, and more of these growth factors are produced when the skin is inflamed. So, if you use a laser that is very hot and is very stimulating, you’re actually going to be triggering more VEGF, which in turn triggers the production of melanocytes,” she says. “A very low-dose Q-switch won’t put a lot of heat in the skin, so you can chip away at the pigment without creating a lot of bulk heating.” Of course, we shouldn’t forget that melanin is also a pigment and it is the melanin pigment in the hair shaft that is the target in all lasers used for hair removal, one of the most requested laser treatments for clinics up and down the country. Ruby, Alexandrite, diode and Nd:YAG can all be used for hair removal; however, it is the mixing of Alexandrite and Nd:YAG that appears to be marching ahead when it comes to delivering an efficacious treatment on a broad range of skin types. “Alexandrite 755nm is highly absorbed by the chromophore melanin, which makes it the gold standard for hair removal. However, Alexandrite is only safe to use on untanned skin types I-III, making it unsuitable for darker Fitzpatricks,” says Sarah McNulty, national educator at Advanced Esthetics Solutions (AES). “Nd:YAG 1,064nm is the most versatile laser wavelength due to the fact it can safely treat hair removal on all skin types (I-VI). It has the capability to reach deeper layers of tissue than other types of laser, and because Nd:YAG is attracted to

“Fractional nonablative erbium glass lasers such as the ResurFX at 1,565nm are a great tool for rejuvenation”

CONTRAINDICATIONS “Lasers absorb light into the skin, which then converts into heat, which has the potential to create burns, blisters, swelling, excessive erythema, and hyper and hypopigmentation,” warns Shelden. “Manufacturers’ protocols and guidelines must be followed to avoid risks and complications. Contraindications will vary but the most common are diseases stimulated by light such as epilepsy and lupus, photosensitive medications, autoimmune conditions, diseases stimulated by heat, and metal within the treatment area. Pregnancy, pacemakers and sun-tanned skin should also be taken into consideration.” Further guidance on photosensitising drugs and laser standards can be downloaded from the British Medical Lasers Association’s website: bmla.co.uk

Q-switched and picosecond lasers are typically the first that spring to mind when targeting pigment. A Q-switch essentially “allows for the production of six to 10

3D-lipo

PIGMENT-TARGETING LASERS

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haemoglobin it works on the papilla, the section of the bulb responsible for growth.” AES has combined these two wavelengths in its Duetto MT Evo device, delivering both wavelengths simultaneously to target both chromophores at the same time. “This improves the treatment outcome and increases treatment safety and flexibility in each skin and hair type,” adds McNulty. Meanwhile, while Cutera’s Excel HR doesn’t fire two wavelengths at the same time, it combines the two goldstandard wavelengths for laser hair removal – 755nm Alexandrite and 1064 nm Nd:YAG – for quick, safe, effective treatments on all skin types. Driving further growth in lasers for hair removal has been the advent of so called “pain free” treatments. Initially launched with diode lasers, this technology has been enhanced in lasers such as Deka Motus AY from Lynton, which delivers Alexandrite and Nd:YAG without pain.

LASER SKIN RESURFACING

C02 and erbium lasers, which target water to generate heat, can be both ablative and non-ablative (wavelengths below 2,000nm), and both can be fractionated. “Fractional just means splitting the beam into tiny pinpoints,” says Exley, and because only fractions of tissue are ablated with areas in between left untouched, downtime is greatly reduced. “Fractional non-ablative erbium glass lasers such as the ResurFX at 1,565nm are a great tool for rejuvenation without the downtime of an ablative laser

as they coagulate tiny columns of tissue, speeding up the turnover of the epidermis. This is also effective for scars, stretchmarks and epidermal pigmentation,” notes Campbell-Adams. Speaking in relation to 3D-lipo’s fractional CO2 laser, found on the 3D Vjuve machine, Leahy says, “this technology works by making small holes of ablation, creating thin, spaced columns of thermal damage that penetrate deep into the dermal tissue.” She adds, “The columns stimulate the production of healthy skin, helping to speed up the healing process and deliver improvements in the appearance of the skin.” Fractional lasers are obviously great for collagen remodelling, skin tightening and encouraging cellular

Advanced Esthetics Solutions

Lynton Lasers

aestheticmed.co.uk

turnover of the epidermis, but uses of C02 and erbium go far beyond what can be covered here, which is why training is key. A Level 4 Core of Knowledge laser course is a good place to start to get up to speed on the relevant standards and regulations and the safe use of lasers and IPL, and you should take all the training and support offered to you by the manufacturers of the devices you purchase. However, be sure to look beyond the marketing material to ensure the specifications of a device are going to meet the needs of your business and patients. Finally, reminds Thomas, “No amount of training is going to give you that hands-on, day-to-day experience working on people’s skin. You need to draw on a well of knowledge to ensure you are making the best treatment decisions for the client.” AM

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R E G U L AT I O N

CQC

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To register or not to register? Ahead of their workshop at Aesthetic Medicine Live, Tracey Jones and Sophie Singh-Jaggatia, directors of Inspire to Outstand, discuss whether or not you should be registering with the CQC

he discussion related to aesthetic medicine and regulation has been awarded substantial focus in recent months, with more literature being published exploring the subject. Medical practitioners are contending the necessity for more rigorous governance, specifically over non-medical practitioners.

When we hear the word ‘regulation’ we often think of red tape, but in the context of healthcare would we be content without it? Interestingly, those working in the remit of aesthetic medicine are one of the only groups of medical professionals who still appear to believe that they have the choice whether to register or not. In no other field of medicine is this the case.

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R E G U L AT I O N

CQC

aestheticmed.co.uk

Many of the concerns raised by MPs related to aesthetic medicine have included the lack of formal, recognised training for administering procedures such as dermal fillers and botulinum toxin and the types of products used. So, one should ask, is this where the regulation should ultimately start? Should those administering the education be held accountable for leading the way in regulation? There has been a recent increase in aesthetic academies applying for healthcare registration, which will require their governance and practice to be examined by an external agency. Recently Dr Julia Sevi from Aesthetic Health published a piece about how to approach the registration process having gained an outstanding rating from the CQC. This article led the reader through some of the key areas where the regulator will expect firm governance and evidence. So why is it that many practitioners are still avoiding the landscape of regulation and burying their head in the sand?

A QUESTION OF CHOICE

During our time as regulation consultants we have spoken with many clinicians and clinic owners to promote our services and have been met with a wide range of responses. We would like to explore what is it that embodies registration with the healthcare regulator and what puts it at the top of some practitioner lists, while others to avoid and run? Dr Cormac Convery stated that regulation has become an instrument to solve a problem of a community seen to be, or which perceives itself to be, at risk. With the continual increase in media coverage of poor practice, this is indeed an industry at risk if regulation is not embraced. Reasons for avoidance can be vast and are often linked to the cost and the lack of understanding about regulation surrounding some aesthetic treatments. It is without doubt that the process of registration is costly, both in terms of money and effort. However, it is imperative that those who plan to lead the way in the world of aesthetics focus not on the costs but on the gains. The recognition of being awarded registration with the healthcare regulator should be celebrated and shouted from the highest platform. Still websites are adorned with marketing detail which often does not include the one thing that the public will recognise – a CQC approval. At the last CCR Expo meeting in London, Professor David Sines, chair of the board of trustees for the JCCP, gave a presentation where he discussed the need for further >

“When we hear the word ‘regulation’ we often think of red tape, but in the context of healthcare would we be content without it?”

Regulation is simply a way to make sure that healthcare professionals are safe to practice and deliver safe care to the patients they treat. The ongoing appraisal system and checks ensure that those offering the services are of good character, have the relevant training and experience and most importantly have the correct skills to carry out the procedure. This not only assures the public but also provides the registered manager with a guarantee that the health practitioner remains safe to practice.

IN THE GREY AREA

There is a wide diversity of education provision within the field of aesthetic medicine, with academies offering courses over varying time periods, ranging from hours to days. It is not only the time scales for learning that vary but the qualifications of the trainers, which are not always transparent. Practitioners make assumptions that there are standards in place about safety, efficacy, and integrity, however, this is not always the case. Having worked in the area of higher education for many years, it is of concern to see the volume of training available within the industry with little or no external monitoring.

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R E G U L AT I O N

CQC

aestheticmed.co.uk

is no national framework for the auditing of mistakes or reactions in aesthetic medicine which would not only lend to offer some learning but would be another safety mechanism to protect the public. In a Westminster debate back in early 2019, MP Alberto Costa was quoted as saying that, “A voluntary and independent register does not go far enough.” He continued, “I would like to ask the Government to at least consider setting up a cohesive and compressive plan to properly regulate the non-surgical cosmetics industry.” Any aesthetic business owner making their plan for the New Year should include preparing for changes to regulation and examine what they need to do to get their business governance ready. This is not something that can be done at a later date – it can be detrimental to the service you provide if you are found to be performing regulated activities when not registered with the healthcare regulator. There have been cases where clinic managers have been prosecuted by the regulators and reported to the governing body. Many risk their professional registration by continuing to offer regulated procedures knowing that they are flaunting the rules. We are mindful that registering with the healthcare regulator is a complicated and lengthy process but, when completed in small stages, the feeling of being overwhelmed with policies and processes can be avoided. Start to consider what would be your expectation if you were still working for the NHS. The healthcare regulator aligns much of the inspection process around what follows within a hospital inspection. Consider your mandatory training – this continues to be a requirement and demonstrates clear governance and process that align to safe practice. Above all, question what being registered will offer your patients. This is not only about a process or tick-box exercise, but an opportunity to learn and improve. AM

“Any aesthetic business owner making their plan for the New Year should include preparing for changes to regulation”

regulation of all those offering cosmetic procedures and services. This is not an appeal that is new to this industry and one which has been requested many times, specifically in the field of non-healthcare practitioners. Why is it that all areas of healthcare provision are covered by such regulation, yet a procedure one enters voluntarily for often a cosmetic purpose is not deemed to require such scrutiny? When we launched Inspire to Outstand we had a dearth of experience within healthcare regulation, predominantly within acute services. When exploring not only the world of aesthetics but that of counselling, psychotherapy, physiotherapy and more, it became clear that much is happening without any external monitoring or governance. Rooms are being rented to an array of practitioners selling their wares without any form of monitoring or process. This lack of governance questions how practitioners assure themselves that practice is safe and responsive. The increase in claims for financial recompense has increased the demand for many of these services provided from rooms let within aesthetic clinics. This was one of the areas that caused us some alarm in relation to who is accountable for the service provision from such rooms. When a clinic is registered with the healthcare regulator a manager or owner must become the registered manager. This role is one which comes with both responsibility and accountability. The person must provide evidence that they are a “fit and proper person”, one who can account for the service provision being provided within the regulated environment. When this is explained it can cause some to become sceptical about the process and sometimes reconsider if registration is right for their service. It is without doubt that the arena of healthcare regulation is under a process of immense change. There is a strong need for wider benchmarking and sharing of information. There

REFERENCES 1. Department of Health. Review of the Regulation of Cosmetic Interventions. Available from: https://www.gov.uk/government/uploads/system/ uploads/attachment_data/file/192028/Review_of_the_Regulation_of_ Cosmetic_Interventions.pdf [Accessed 12/12/15]. 2. Scottish Cosmetic Interventions Expert Group Report July 2015. Options for regulation. Available from: http://www.gov.scot/ Publications/2015/07/2616/8 [accessed 3/12/15]. 3. Arie S. Cosmetic industry regulation is only skin deep. BMJ2017;358:j3047. doi:10.1136/bmj.j3047 pmid:28652383.Google Scholar 4. Westminister Hall, Non-surgical Cosmetic Procedures: Regulation, February 12 2019.<https://hansard. parliament.uk/Commons/2019-02-12/ debates/C5F01389-9B2F-4867-BFF8-0B85376CFBFD/Non-SurgicalCos meticProceduresRegulation>

Tracey Jones and Sophie Singh-Jaggatia are directors of Inspire to Outstand, a team from Cheshire who support businesses moving forward with Care Quality Commission registration and inspection. Between them they have more than 35 years’ experience in healthcare and regulation. Their backgrounds include both angles of the regulatory process. One as a senior manager supporting NHS trusts through CQC preparation, the other in the contrasting role, as the CQC inspector awarding the rating. Since launching in 2019 they have predominantly worked with businesses from the world of aesthetics.

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VISIT US ON STAND J6

OLYMPIA LONDON 29 FEB -1 MAR 2020

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BUSINESS

EMPLOYMENT

aestheticmed.co.uk

Happy as the day is long Victoria Vilas explores the link between employee happiness and productivity

f you are an employer and rely on your team to keep your aesthetic medicine business running smoothly and profitably, you should never underestimate the importance of employee engagement and happiness. Your clinic business needs to operate efficiently and provide a high standard of treatment and patient service. Low morale among employees is likely to lead to a lack of motivation and disengagement, and subsequently, poorer performance. Happy employees are likely to have more enthusiasm, energy and focus, and the motivation to do their very best. Negativity in a team can spread and cause low morale, but happiness can be equally infectious. Happy employees help create a positive atmosphere in the workplace, they may be able to help lift the spirits of a dejected colleague and are likely to be better team players. A positive attitude can help employees work towards clinic targets with confidence, and care more about achieving goals. Happy employees are also likely to be healthier. Stress and anxiety are a major cause of employee absence in the UK, so if you have a happy, motivated team, you may find that fewer days of sick leave are taken each year. In summary, happy employees are productive, loyal workers. So, how do you defeat negativity in your clinic team and turn it into positivity? Mark Price, former Minister of Trade and employee engagement expert, suggests, “There are six core fundamentals that businesses can address to ensure that their employees enjoy coming to work. These are: reward and recognition, information (giving staff enough

of it and sharing it openly), empowerment, wellbeing, and instilling pride and job satisfaction.” Low morale, a lack of motivation, or negative feelings should be addressed as soon as possible to avoid any minor issue growing into a more serious problem. Communication is key. If you notice that one or more of your team seem unhappy, speak to them, ask them for feedback, and take the time to listen and consider their points. Review what you are offering your team in terms of support and reward on a regular basis to ensure that you are doing what you can to make your employees feel valued. Rewarding your team does not have to take the form of a monetary bonus. While it may be true that most employees would welcome financial rewards such as a salary increase or bonus, this is not the only way to make your staff feel appreciated. Even if you cannot hand out a bonus every time a team member impresses you, you can still recognise their achievement by giving thanks. Respect for your employees and recognition of their dedication will help your team feel positive, secure in the knowledge that they have an employer who is grateful for their efforts. AM

“Happy employees help create a positive atmosphere in the workplace”

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REFERENCES Mark Price, ‘Happy employees make a productive workforce’, The Telegraph, January 4, 2019. telegraph. co.uk/business/2019/01/04/happy-employees-makeproductive-workforce/>

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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