Aesthetic Medicine January 2020

INSPIRING BEST PRACTICE IN MEDICAL AESTHETICS

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January 2020

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U S E F U L I N F O R M AT I O N

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Contents JANUARY

10

EDITORIAL Vicky Eldridge, Editor

6 EDITORIAL BOARD Meet our new editorial advisory board

20 OUT AND ABOUT Out and about in the industry this month

10 NEWS The latest news from the industry

23 AESTHETIC MEDICINE LIVE 2020 Get a first look at what will be happening

18 NEWS SPECIAL Training and prescribing for non-medics

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

18

Georgia Seago, Deputy Editor

40 COVER STORY Georgia Seago has an exclusive chat with Dr Tijion Esho

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E: georgia@aestheticmed.co.uk T: +44 (0) 20 3728 9063

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

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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

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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.

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CONTENTS

IN THIS ISSUE...

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44 VIRTUAL REALITY VR as a tool for training 48 DIGITAL STRATEGY Alex Bugg on why you should make 2020 the year of the digital “retox” 52 PATIENT JOURNEY Julie Scott shares her insights into the patient journey

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54 BUSINESS STRATEGY Reece Tomlinson’s strategies for taking your business to the next level

64 PRODUCT NEWS The latest product launches

58 CLINICAL CONTRIBUTORS Dr Olivier Amar and Mr Shaheel Chummun on restoring contour defects with a cannula

70 TREATMENT SPOTLIGHT The Elipse intragastric balloon

68 PRODUCT FOCUS We discover the Skinade MD range

72 TREATMENT REVIEW Fusion GT’s Biodermogeni treatment

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86

74 TALKING TO...

Vicky Eldridge speaks to plastic surgeon David Gateley about his round the word clipper race

84 DIGITAL MARKETING Laura Moxham gives her tips for getting the most out of Google Ads

76 HAIR LOSS Benedetto Cusumano explores the role of complementary medicine in hair loss

86 CASE STUDY Dr Raina Rodrigues shares her experience of managing scars

81 CLINICAL STUDY We look at a recently published paper by Mr Alex Kardis on his “quilting” technique for gynecomastia

88 EMPLOYMENT Victoria Vilas on employing practitioners who works at other clinics

Welcome to the January issue of Aesthetic Medicine Happy New Year and welcome to the first edition of Aesthetic Medicine for a new decade. New Year is often a time of reflection, where we look back at the previous 12 months and make plans for the future.

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We are starting 2020 with a slightly new look and feel to the magazine. We have collaborated with the amazing Dr Tijion Esho on an incredible photoshoot for this month’s cover with an exclusive four-page interview on pages 40-43 about his new clinic and plans for the future; we have a new editorial board who will be contributing to the content of the magazine over the coming months; and we have shaken things up a bit in terms of our content with a new editorial structure, removing our sections on skin, injectables, business and devices, and adding in new regular features that we hope will give our readers more varied and valuable content.

As you make plans for 2020, don’t forget to sign up to Aesthetic Medicine Live.

As the first big industry meeting of the year we have more education that ever before. This is a perfect opportunity to invigorate and motivate yourself and stay ahead of the curve. See our show preview on pages 23-36 to find out what will be going on.

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.

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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, Queen Mary University of London. He is also qualified in Medical Law and Ethics (Glasgow University), Surgical Science (Distinction – University of London) and Developmental and Stem Cell Biology (PhD - University College London).

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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EX H IB IT I O N • C O N F E R E NCE • DEM ONS TR ATI ONS • WOR K SHOPS

“Seeing treatments being offered that I actually hadn’t considered that I will be introducing into my practice” Kris Trinity Aesthetic Clients On Demand

How do you keep up to date in our fast-paced industry?

"Meeting colleagues, networking and exchanging experiences while seeing what is new” Dr Simi Adedeji GP and Aesthetic Doctor

"You can’t replace talking to people face to face, seeing things in your hand and looking at demos" Dr Marco La Malfa Aesthetic Doctor EF Medispa

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THE FUTURE OF THE AESTHETICS INDUSTRY AWAITS YOU Bookings now open for the Aesthetic Medicine Live 2020 education programmes

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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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#AMLondon @AestheticMLive /aestheticmedicinelive aestheticmed_live Aesthetic Medicine

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

INDUSTRY NEWS

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Dangerous new “devil lips” fi ller treatment trends on Instagram A bizarre new lip filler trend, thought to have originated in Russia, is causing concern among industry experts who have labelled it as “unnatural” and “dangerous”.

The procedure, which has been trending on Instagram, is known as “devil lips” or “octopus lips” and creates waves around the lip border. Although some women use make-up to create the look, others are now turning to dermal fillers, it has been reported.

Aesthetic Medicine editorial board members Dr Steven Harris and Dr Sophie Shotter gave their views on the trend.

Dr Harris commented, “The ‘wavy pouts’ or ‘devil lips’ have been receiving much attention in the media, especially on Instagram, with mixed reviews. It represents a very poor understanding of natural anatomy along with a gross lack of artistic acumen and everything that is wrong with our industry, including the complete lack of regulation.

“These practices involving a distortion of the vermillion border are not only unsightly and offensive, but involve significant risk. This is especially true in the upper lip where the course of the superior labial artery is unpredictable, raising the risk of a vascular occlusion. Furthermore, the filler is very resistant to break down on the hard side of

the border, so a degree of disfigurement can be very long lasting, even with attempts to dissolve the filler.”

Dr Sophie Shotter added, “The vermillion border of the lip cannot be augmented in the way suggested in recent devil lip photos. Not only does it look bizarre, but I would suggest that anyone wanting to learn this technique might want to book onto a photoshop course rather than onto an injectable training workshop. The way this has trended shows a fascination with the bizarre, but I’m very pleased to say this hasn’t translated into requests in clinic.”

60% of young women say social media has made them paranoid about ageing A survey by Flawless.org has shown that almost half (45%) of 13-24year olds believe they are already showing signs of ageing, with 60% saying social media had made them more paranoid about getting old.

Sagging skin was the number one concern, with 25% of participants citing this as a worry. Changes to their breasts and wrinkles both received 22% of the vote, while hair loss was the top fear for 15%. Only 16% had no concerns at all. As a result, 48% said they would consider having surgery, with 33% saying their main motivations would be to stop signs of ageing and live up to society’s beauty standards (33%).

Surgeons unite over breast implant safety and associated cancer links Three leading surgical organisations have issued a joint statement calling for international collaboration and information gathering to help garner a better understanding of Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL).

The statement was signed by British Association of Plastic Reconstructive Surgeons (BAPRAS) president-elect Mr Mark Henley, Association of Breast Surgery (ABS) president Ms Julie Doughty and British Association of Aesthetic Plastic Surgeons (BAAPS) president-elect Ms Mary O’Brien. It said: “BIA-ALCL continues to be a rare disease in the UK [but] we are monitoring both UK and international events closely with the MHRA. It is essential to obtain as much information as possible about each case to help understand this disease.

“The UK plastic and breast surgery associations are closely involved in a growing international collaboration by the healthcare community to collect the information needed to find out more about breast implants and inform our patients.”

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INDUSTRY NEWS

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Survey reveals celebrities who most influence interest in surgery A list of the celebrities who are most influential when it comes to the British public’s plastic surgery interests has been revealed by cosmetic surgery advice website Flawless.org.

Composed almost entirely of reality TV personalities, the list is topped by Keeping up with the Kardashians star Kylie Jenner. Jenner receives an average of 7,460 searches per month relating to her cosmetic treatments.

Fifth on the list is Jenner’s father, former Olympic medallist and recent I’m A Celebrity, Get Me Out of Here contestant Caitlyn Jenner. UK searches about Jenner’s gender reassignment surgery average at 2,000 monthly, though this figure peaked by 376% within the first 24 hours of this year’s I’m A Celebrity airing.

Former Love Island contestant Megan Barton-Hanson is second on the list, with 6,490 searches per month,

followed by Kim Kardashian with 5,080, and Love Island’s Molly May Hague with 2,670. Other Love Island contestants Maura Higgins and Anna Vakili also made the list, as did reality personalities Khloé Kardashian, Katie Price and Charlotte Crosby. The average monthly searches were recorded from January to October 2019.

A survey into people’s motivations for considering undergoing plastic surgery procedures found that one in 10 female respondents said it was due to “celebrities who had work done before”. 40% said celebrities and influencers are a big source of surges in cosmetic surgery.

Male skincare market will hit $10bn (£7.45bn) this year Analyst Future Market Insights (FMI) has revealed that the market for men’s skincare products will hit $10 billion (£7.45bn) by the end of 2019, with double digit growth forecasted through to 2029.

While shaving cream was understandably up there, accounting for 30% of spend, moisturisers, facial scrubs, sunscreens, cleansers and face washes were also among those generating the most sales. The demand for serums was also on the rise.

The report claimed the market was “moving beyond traditional male marketing tactics” and that high-quality ingredients will be a priority for manufacturers of men’s skincare products in the future.

Pricing also continues to be a decisive factor in shaping consumer choices in the male skincare market and mid-range products were predicted to see high sales, especially in Asian countries, with premium products, on the other hand, gaining momentum in Europe and North America.

Dangers of cosmetic surgery tourism highlighted during inquest into death of British BBL patient The dangers of cosmetic surgery tourism were highlighted during the inquest into the death of British woman Leah Cambridge, who died after complications during a Brazilian butt lift (BBL) procedure in Turkey in 2018.

The inquest heard that Cambridge was likely to have been dangerously uninformed about the risks of the surgery. It was reported that she suffered three heart attacks while under anaesthesia and ultimately died from a pulmonary embolism after fat entered her circulatory system and blocked the pulmonary artery to the lungs.

Speaking at the inquest, though not directly involved in the case, consultant plastic and reconstructive surgeon Simon Withey said: “One of the things which anyone undertaking surgery in this area is aware of is the

enthusiasm of the patients, which is almost a frenzy of excitement.

“It’s important that they spend time talking about their wishes with the surgeon, and seeing whether they are going to be met, and then talking about the risks of the surgery.”

Cambridge’s mother travelled to Turkey with her daughter for the procedure. She told the inquest she believed Cambridge was pressured into reading and signing documents and forms about the surgery in a rush, potentially missing crucial safety warnings.

Aesthetic Medicine isn’t aware of details around any consultation that may have taken place before Cambridge’s arrival at Izmir Private Can Hospital, where the surgery happened.

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INDUSTRY NEWS

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Tackling ageing could be Britain’s next major industry Proper research funding could propel Britain to the forefront of a lucrative industry in combatting the effects of ageing.

Professor Richard Faragher, the University of Brighton’s Professor of Biogerontology, told a House of Lords’ Science and Technology Committee that the country’s scientists have the expertise and potential to reverse or slow ageing and, in doing so, build a “formidable” industry.

Members of the House of Lords were meeting to question academic experts about the fundamental processes of ageing. The committee will use the information to help its inquiry into how science and technology can enable healthier living in old age.

Professor Faragher said one of the culprits of ageing were senescent cells, (cells that go rogue and start secreting

chemicals that damage the body).

Older bodies are less effective in getting rid of them. He added that if senescent cells were eliminated then the result could be dramatic: “In experimental animals where it has proved possible to delete these cells, the animals showed enormous increase in their health.

I did some back-of-the-envelope calculations for what this would mean (for) a human and effectively it would be rather like taking somebody of 80, putting something in their drinking water for a few weeks and watching them jog like a person of 30.

“If Government leads, funds basic research properly, and establishes the full translation pipeline that our clinical and pharmaceutical colleagues (are proposing), then this country could build up a formidable industrial base in this area.”

Harley Street Skin launches franchise model London-based Harley Street Skin Clinic has announced the launch of a franchise operation.

Franchisees gain access to the business’s referral process around the country and the opportunity to offer advanced treatments that have so far only been available in London.

The flagship clinic’s core team will monitor, train and support sister clinics, providing guidance in site selection, tailored training plans, financial viability checks, business planning advice, management and operational soft ware programmes.

Franchisees will also receive full brand support from the Harley Street Skin website and social media sites.

Harley Street Skin Clinic was co-founded in 2006 by husband and wife duo cosmetic doctor Dr Aamer Khan and skincare expert Lesley Reynolds. The clinic offers a wide range of surgical and minimally-invasive treatments.

JCCP issues statement on procedures that fall outside of its five treatment modalities The Joint Council for Cosmetic Practitioners (JCCP) has issued a statement to affirm its position on adjunctive therapies and orphan treatments, such as PRP and threads, which sit outside of its five recognised modalities for which there are guidelines and standards.

The statement read, “The JCCP accepts that our registrants may elect to perform adjunctive and/or orphan therapies. Adjunctive therapies relates to any non-surgical aesthetic procedure that a registrant performs in addition to those registered modalities that are formally recognised by the JCCP. It is important to understand that these treatments are not currently recognised by the JCCP or CPSA as ‘registered modalities’ and as such the council has not set or adopted benchmark standards of proficiency for these treatments and is unable to endorse evidence of practitioner competence to perform them safely or effectively.

“While we do not ask registrants to refrain from offering adjunctive/orphan treatments, we do of course expect that all registered members apply their professional standards and ethical responsibility to uphold client or patient safety and public protection at all times, irrespective of the status of the procedure.”

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INDUSTRY NEWS

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NEWS IN BRIEF TASKER INSURANCE GROUP ACQUIRES ENHANCE INSURANCE

Leading medical aesthetic insurance provider Enhance has been acquired by Tasker Insurance Brokers. The Enhance team, which is headed up by managing director Martin Swann and led by client account manager Sharon Allen, will now form part of the specialist retail broking division within Tasker, although it will continue to trade under the Enhance Brand and is remaining in its current office.

MERZ RESTRUCTURES TO FORM MERZ AESTHETICS

Global pharma company Merz has announced restructure plans to form three independently operating businesses including one dedicated to medical aesthetics. The reorganisation will see the company form three separate businesses; aesthetics, therapeutics and consumer care.

Merz Aesthetics will then be the largest dedicated medical aesthetics business globally, according to the company. The new structure will start operating from January 1, 2020, with the Merz Aesthetics global management team based in Raleigh, North Carolina.

BOTOX GETS FDA APPROVAL FOR CHILDREN WITH LIMB SPASTICITY

Allergan has received FDA approval for Botox to treat paediatric patients with lower limb spasticity. OnabotulinumtoxinA has been approved for paediatric patients of two to 17 years of age, though it has not been approved to treat spasticity of muscles caused by cerebral palsy. Botox received FDA approval for upper limb spasticity in paediatric patients earlier in 2019. This marks the 11th approved therapeutic indication for Botox. It is based on a phase 3 study of more than 300 paediatric patients.

HAIR TRANSPLANTS MOST SEARCHED-FOR SURGERY IN THE UK

Hair transplants are the most searched-for cosmetic surgery in the UK. The research by Flawless.org found an average of 27,100 monthly Google searches for hair transplantation in the UK. Liposuction and breast reduction are the second and third most searched for, with 27,000 and 22,200 average monthly searches respectively. Otoplasty or ear correction was the least searched-for at only 1,600 average monthly searches.

Mesotherapy safety and complication management outlined in paper Larger systematic studies are needed in order to adequately evaluate the safety profile of mesotherapy, and in order to determine standardised therapy parameters, so as to minimise the risk of potential adverse reactions, according to a paper published in the latest issue of The Journal of Cosmetic Dermatology.

Mesotherapy involves the injection of active substances into the dermis and subcutaneous tissue in order to treat several local medical and cosmetic conditions. Despite being considered a relatively safe method, a series of adverse reactions can occur due to its wide application and lack of standardisation processes.

The aim of the paper was to summarise all the mesotherapy-related complications published so far, and to provide an insight into their management.

Articles derived from databases PubMed, EMBASE and SCOPUS, and published between 1992 and 2018, were analysed for this review. The study was conducted according to the PRISMA guidelines.

“The literature contained a number of case series and isolated case reports describing various side effects of different severities”, the authors wrote. “The therapeutic management of these complications is – in most cases –individualised.”

New method of determining psoriasis severity announced The International Psoriasis Council (IPC) has developed a new, more simple method of classifying psoriasis severity to aid physicians in determining the right course of treatment.

The method turns previous methods on their heads by making diagnosis a treatment-first approach that calls for classifying patients as candidates either for topical therapy or systemic therapy. To qualify for systemic therapy, patients must have psoriasis lesions on 10% or more of their body surface and/or on sensitive areas of the body such as the hands, feet, face, genitals or scalp, where topical therapy failed to control symptoms.

“This new approach to classifying psoriasis severity furthers IPC’s work to help improve the health of psoriasis patients around the world,” said Peter van de Kerkhof, MD, PhD, chief medical officer of IPC.

NEWS IN PICTURES Surgeons, researchers and industry experts educated delegates on ergonomic implants at the 5th V World Symposium in Lake Garda, Italy. Delegates learned through a cadaver workshop about the latest techniques and tools that maximise women’s health and lead the evolution of aesthetic and reconstructive breast surgery. Practitioners also learned about Motiva breast implants – considered the 6th generation of breast implants due to how evolved the technology is and its unique surface, designed with women’s health as a priority.

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INDUSTRY NEWS

NEWS IN BRIEF GPS WORKING IN DUBAI NOW ALLOWED TO PRACTICE AESTHETICS The Dubai Healthcare City Authority, the regulator of Dubai Healthcare City (DHCC), has announced that general practitioners working in the country will be allowed to practice minor cosmetic procedures. This means that, for the first time, GPs will be able to obtain a license to carry out non-invasive cosmetic procedures including dermal fillers, body contouring and skin treatments, such as peels. Previously, only plastic surgeons and dermatologists could perform such treatments.

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Survey shows 23% of Brits use expired products on their skin A new survey carried out by contract packing company We-Pack has shown that almost a quarter of Brits (23%) are using beauty products on their face that are out of date. In addition, 17% said they won’t stop applying products until they appear “off” and one in six admitted that they weren’t even aware of the expiry dates.

The report found that just under a fifth of Brits even ignore or simply don’t check the shelf-life dates on products. Using expired products can not only cause breakouts and bacterial infections on the skin but is also dangerous as the effectiveness of items containing SPF or antioxidants can diminish over time.

Cosmetic companies are required to include lifespan dates on products under EU Cosmetic Regulation. Products with a shelf-life of longer than 30 months must include a “period after opening” item on the packaging, while cosmetics with a lifespan of less than 30 months must include a “best before the end of” date.

RSM ANNOUNCES NEW HORIZONS IN RHINOPLASTY EVENT World leading experts will showcase their work and update delegates about the changing philosophy, techniques and technology of the art of rhinoplasty this month at the Royal Society of Medicine. The New Horizons in Rhinoplasty meeting will take place on Wednesday, January 15. The rising movement of “Preservation Rhinoplasty” will be introduced as well as the benefits of piezo surgery in reducing bone and making osteotomies.

COSMETIC COURSES TO RUN SINCLAIR PHARMA TRAINING IN 2020 Sinclair Pharma has joined forces with aesthetic training provider Cosmetic Courses to offer introductory courses in Silhouette Soft. From 2020, Cosmetic Courses will run the training sessions for experienced aesthetic doctors, dentists and selected nurse practitioners that are new to thread lift procedures. The courses will be led by experienced trainers Mel Recchiaa and Dr Fiona Durban, and will take place at Cosmetic Courses’ CQC-registered training facility in Buckinghamshire. The first courses dates are scheduled for February 2 and 23, 2020.

4T MEDICAL ANNOUNCES IT HAS GONE CARBON NEUTRAL 4T Medical has announced that it has become a carbon neutral organisation. This has been achieved primarily by offsetting its current emissions. It has partnered with Carbon Footprint Ltd to plant trees in local schools.

For every one tree planted in the UK, one tonne of CO2 is offset through a Verified Carbon Standard (VCS) project in the Brazilian Amazon. As a next step in its long-term commitment to sustainability, 4T Medical has set itself the goal of becoming carbon negative by 2021.

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Plastic surgery trainees face significant barriers to having children The majority of both men and women said they had intentionally postponed having children owing to the demands of their career, found a survey published in the November 2019 issue of Plastic and Reconstructive Surgery.

A total 76.5% of female and 67.4% of male trainee cosmetic surgeons said their residency had caused them to put off having children in an anonymous survey sent to all current plastic surgery residents and fellows in the US. While both men and women agreed there is a negative stigma attached to being pregnant during residency, women were unsurprisingly significantly more likely to report it, at 70.4% versus 51.1% likelihood for men.

Of the 59% of respondents who were married, female trainees married to a non-physician were significantly more likely to delay starting a family until after training, at 64.7% compared to men married to a non-physician (21.1%).

The mean maternity leave taken by female respondents who reported at least one pregnancy was 5.5 weeks, ranging from one to 12. Nearly half took less than six weeks and 62.3% reported dissatisfaction with the amount of leave they took.

Non-child bearing parental leave averaged at 1.2 weeks, ranging from zero to four weeks. 47% of trainees reported that their residency had a formal parental leave policy.

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SHAPE PHYSIQUES STRENGTHEN YOUR BUSINESS

StimSureÂŽ Introducing the new electromagnetic muscle toning and building technology from CynoSure

1.0 Tesla per applicator 24,000 contractions during a 20 minute treatment session 4 pre-programmed treatments for the abdomen, buttocks and thigh areas Non-invasive and safe applicator Suitable for most patients To build your body contouring portfolio visit cynosure.co.uk/stimsure or call 01628 522252

T&C: StimSure is a non-invasive body contouring system, CE cleared for muscular atrophy, with recommended application to strengthen and tighten the abdominal, gluteal and thigh muscles.

StimSure is an electrically operated medical device generating an electromagnetic field and is able to contract/stimulate the muscles. Individual results may vary and are not guaranteed. Treatments are not intended for weight-loss or for people who are obese. There are no reports of side effects. The adverse effects may include, but are not limited to: muscular pain, temporary muscle spasm, temporary joint or tendon pain, local erythema or skin redness, premature menstruation and/or lower abdominal cramps. StimSure is only available in selected countries within EMEA and APAC regions, not available in the USA. Models for illustrative purposes only and not an actual consumer of the product.

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

NEWS SPECIAL REPORT

aestheticmed.co.uk

In motion Vicky Eldridge reports on the BACN’s recent move to urge healthcare professionals not to train or prescribe for non-medics, and asks what the way forward is for our industry as we enter a new decade

T

he issue surrounding the provision of injectables by non-medics is, for many, at the heart of the debate around safety and the need for more stringent regulation within the aesthetics sector.

In the age of the selfie and the reality TV celeb, injectable treatments have become more mainstream and are now often lumped in the same category as having a spray tan or getting a set of eyelash extensions done. Despite more and more headlines alerting the public to “botched”

18

procedures, particularly where lip fillers are concerned, 2019 saw a continual influx of newly-trained injectors treating the public with little or no qualifications or medical acumen to do so.

The beauty sector has come under fire the most, particularly on clinical aesthetics forums, with beauty therapists providing botulinum toxin and dermal filler treatments in salons without the oversight of a medic in increasing numbers. Worse still are the stories of reality TV

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

NEWS SPECIAL REPORT

aestheticmed.co.uk

celebrities being trained. There is no denying the public is at risk and that those providing treatments without medical qualifications, competencies or recourse are ill-equipped to deal with serious complications.

Many medical practitioners claim they have seen a huge increase in the number of complications they are having to manage as a result, and the trend has also sparked a price war with fillers in particular being sold by the ml at cheaper and cheaper costs. There are also the stories of syringes being shared between friends and BOGOF offers, which many believe is endangering price-driven consumers even more as they become blind to the risks involved if these procedures are not done safely and in an appropriate environment.

While bad practice is not only limited to those outside of the medical profession, as professionals who answer to regulatory bodies, doctors, nurses, dentists and pharmacists do have an important role to play in this by maintaining their own standards and ethics. It’s time for the industry to start looking more closely within itself at those who are not only prescribing for, but also training non-medics.

Some organisations are now taking the lead on this. The General Pharmaceutical Council (GPhC) just issued new prescribing guidelines stopping pharmacy prescribers prescribing for non-medics and, at its annual conference in November 2019, the British Association of Cosmetic Nurses (BACN), proposed a motion that regulated healthcare professionals should not train or prescribe for beauty therapists or other non-healthcare professionals in injectables.

The motion highlighted the rising number of complications associated with invasive aesthetic treatments administered by beauty therapists and non-healthcare professionals, such as non-surgical rhinoplasty, jaw and facial sculpting, lip filler and fat-dissolving injections, and aimed to put public safety firmly at the forefront. It said: “…the public [is] exposed to an inability to be cared for medically by this group and those training them are not accountable. The public are often subject to poorly administered treatments, [a] lack of post-treatment care, ghosting, blocking and intimidation should they complain; and the medical profession are increasingly required to pick up these cases and help, often out of goodwill and a duty of care towards the public.”

the patient’s best interest and be able to demonstrate our own competency for all we do, and also the competency of those we delegate to.”

Delegation was a key issue. According to the NMC, it is defined as “the transfer to a competent individual of the authority to perform a specific task in a specified situation.”

The BACN believes this is key and does not believe delegating to non-medics meets this criteria. Chair Sharon Bennett said, “The NMC have set out expectations of people on their register and that the delegation of tasks will be in the other person’s scope of practice of competence, and they fully understand what is being asked of them.

“They must also ensure that they (whoever they delegate to) are adequately supervised and supported so they can provide safe and compassionate care, and that they meet the required standard.

“While the basic task of injecting a botulinum toxin or a dermal filler at its most elementary level can be taught relatively easily over time, a wider knowledge of the whole human body and clinical acumen is required.

“The training of anyone without a medical degree and who cannot ever prescribe, such as a beauty therapist or lay person, must surely conflict with the NMC Code where maintaining patient safety is a priority. I believe this pans across the whole of the medical fraternity including the GMC and GDC. Someone with no essential medical qualification has no clinical knowledge, judgement or diagnostic skills and acumen, no duty of care and no requirement to demonstrate competency. They are not required to evidence, have no governance in place, cannot consult or consent fully as their clinical knowledge is absent, cannot prescribe nor manage complications, are not working with a cross speciality, multi -disciplinary team and are not answerable or accountable for their actions.”

For the future this may mean that members who are found to be providing training or prescriptions for nonmedics could face losing their membership.

As we enter a new decade it’s time to clean house. As an industry we need to come together and stand up not just against those who are putting the public at risk by offering treatments without any recourse, but also against those who are enabling this and continuing to ignore the guidelines of their medical regulatory bodies by training and prescribing for non-medics. AM

“It’s time for the industry to start looking more closely within itself at those who are not only prescribing for, but also training non-medics”

REMOTE PRESCRIBING AND DELEGATION

It’s been five years since the remote prescribing debate came to a head with the medical regulatory bodies being forced to make their positions very clear, that remote prescribing was not appropriate for cosmetic treatments, following the airing of an undercover BBC London investigation which saw a high profile doctor lose his right to practice. Yet it still goes on, alongside prescribing for, and delegating treatment to, non-medics, which many believe is done for nothing other than financial gain and is not in the best interests of the patient.

As part of the motion, the BACN vowed to tackle this issue and reminded members of their code of conduct as nurses, stating: “Let us not forget the principles of the NMC Code [of Conduct] which require us to act at all times within

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OUT AND ABOUT

aestheticmed.co.uk

DIARY DATES CUTERA CUCF WORKSHOP

FEBRUARY 17 Park Plaza Westminster, London First UK version of the laser and aesthetic technology manufacturer’s laser training workshop, featuring talks, live product demos and panel discussions. bookwhen.com/cuteratraining

MIAMI COSMETIC SURGERY

FEBRUARY 20-22 Miami Beach Convention Center, Miami, Florida, USA Multispecialty forum for medics providing content on the science, practice and techniques of aesthetic surgery and medicine. miamicosmeticsurgery.info

AESTHETIC MEDICINE LIVE

FEB 29-MARCH 01 Olympia London Annual conference and trade show bringing the aesthetic industry under one roof, with top exhibitors and world-class medical speaker programme. aestheticmed.co.uk

Out and about All the happenings in the industry this month

CynoSure Aesthetic Exchange Educational Symposium The King’s Fund, Cavendish Square, London Laser and aesthetic devices manufacturer CynoSure held its third event in partnership with iS Clinical, focussing on how cosmeceutical skincare and laser rejuvenation technologies work synergistically for enhanced patient outcomes. The event also gave delegates advice on building a robust commercial strategy for their clinics.

Across the two days, expert speakers including Dr Diane Quibell, Dr Charlene Dehaven and Miss Sherina Balaratnam discussed pigmentation, scarring and vascular issues, through to laser hair and tattoo removal and body contouring. There were also demos of the combined use of iS Clinical’s topicals and CynoSure’s laser technologies.

AESTHETIC MEDICINE VIDEO AWARDS

FEBRUARY 29 Venue TBC The second edition of AM’s video marketing awards, with five categories to recognise the brands, clinics and practitioners who created the best videos to positively promote our sector in 2019. aestheticmed.co.uk

BSD SKIN OF COLOUR WORKSHOP

MARCH 12 Harley Academy, London First CPD workshop from Black Skin Directory delivered by an expert faculty and covering physiology, treatment selection and managing complications for skin of colour. blackskindirectory.com

ACE

MARCH 13 Business Design Centre, London Aesthetic conference and exhibition with stands and educational sessions. aestheticsconference.com

EMEPELLE MENOPAUSE MASTERCLASS THE ALLBRIGHT MAYFAIR, LONDON Menopause skincare brand Emepelle held a masterclass for attendees to learn the true impact of the change on women’s skin. The panel, which included brand ambassador and celebrity facialist Teresa Tarmey, dermatologist Dr Emma Wedgeworth and menopause expert Dr Joanne Hobson, discussed the hormonal changes caused by menopause and how women should change their skincare accordingly.

Key findings were: that women can experience up to 51 different symptoms with the menopause and, during the first five years of the change, 30% of collagen is lost in the skin. All attendees were gifted Emepelle’s Serum and Night Cream, which helps invigorate the natural function of skin affected by menopause.

AMWC

APRIL 2-4 Grimaldi Forum, Monaco 18th annual edition of the congress, featuring interactive educational and networking opportunities. euromedicom.com

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OUT AND ABOUT

aestheticmed.co.uk

Biotechnologies workshop event DMC Aesthetic, Knightsbridge, London Aesthetics treatment distributor Biotechnologies held a workshop event for nine medically trained delegates including plastic surgeons, doctors, dentists and aesthetic nurses.

Throughout the day, delegates watched presentations, experienced live demos of treatments and completed handson training in treatments including Aptos Visage Excellence thread lift , Jalupro HMW skin booster, Genefill Contour dermal fillers and Microfat and Nanofat Graft. Before lunch Dr Deniz Kanliada presented on his virtual reality app for the promotion of safe injecting.

The other plastic surgeons that presented during the full-day course were Dr Mario Goisis and Dr Sachi Sivananathan.

Dr Rita Rakus Festive Open Evening Dr Rita Rakus, Knightsbridge, London Patients, press and friends were invited to Dr Rakus’s clinic for a preChristmas event. Guests discovered treatments including ULTRAcel, and BTL EMsculpt, and watched demonstrations of HydraFacial and Dermalux.

There were talks by Dr Marco Nicoloso and Dr Wassim Taktouk, who spoke about the benefits of injectables, while Dr Galyna Selezneva discussed the non-surgical body treatments available at the clinic. There was also the opportunity to do some Christmas shopping, with jewellery, accessories and bespoke pet collars to buy. Dr Rakus revealed a new shade in her lipstick line with Code8, Monte Carlo. Guests were able to blend their own shade at the mixing station on the night.

3D-LIPO CELEBRITY PAMPER DAY HUTTON HALL, BRENTWOOD Machines brand 3D-lipo recently held an exclusive treatment day in Essex to carry out a range of face and body treatments on VIP guests using the newly launched 3D-Ultimate Pro, which focuses on non-surgical fat loss, and the 3D-HydrO2 facial. Celebrities in attendance included former Love Island contestant Nathan Massey, TOWIE’s Amy Childs, The Circle contestant Beth Dunlavey, celebrity hairstylist James Johnson, CBB 2018 contestant Benjamin Jardine, X-Factor 2014 finalist Jordi Whitworth, and TOWIE’s Harry Lee, among many other well-known faces.

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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.

AM LIVE 2020 PREVIEW

GOLD SPONSOR

Aesthetic Medicine Live is back at Olympia London in 2020. Turn the page to find out what will be going on. #AMLive @AestheticMLive /aestheticmedicinelive aestheticmed_live Aesthetic Medicine • January 2020

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AM LIVE 2020 PREVIEW

www.aestheticmed.co.uk

The live event Aesthetic Medicine Live 2020 is the first major industry meeting of the new year, so why not enter the next decade inspired and invigorated with knoweldge, ideas and new treatments and products for your clinic

2

020 will see the start of a new decade and, as we move in to the future, Aesthetic Medicine Live is here to help your clinic stay at the cutting edge with more education, exhibitors and launches than ever.

Taking place at Olympia London on 29 February-1 March, Aesthetic Medicine Live is the first major UK meeting of the year. Encompassing a two-day, two-agenda CPD-accredited clinical conference, a two-day business workshop programme, Live Stage and an ever-growing exhibition displaying marketleading brands, Aesthetic Medicine Live is a must-attend event for aesthetic practitioners and business owners.

MEET WITH KEY UK MANUFACTURERS AND SUPPLIERS A visit to the Aesthetic Medicine Live exhibition will give you a chance to meet face-to-face with market-leading manufacturers and suppliers. From injectable products 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.

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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. Confirmed exhibitors include ABC Lasers, ACUMAG, Advanced Esthetics Solutions, Alliance Pharma, AQ Skin Solutions, Archidemia, Baldan Group, Belle, BestBrothers, BioActiveAesthetics / SkinPen UK, BioID, BTL, Candela, Celluma, Clinic Photopro, Cocoon Medical UK, Cosmetic Insure, Cutera, Cynosure, Dermalux, Enoura Aesthetics, Erchonia Lasers, Fusion GT, Hydrafacial UK, InBody UK, Inmode, Lumenis, Lynton Lasers, Med Aesthetics, mesoestetic (Platinum Sponsor), Natura Studios, Observ, Opatra, Pabau, Perfecte’Me, PRP Lab, REVIV, Sky Medic, Sterimedix, Venus Concept, VIVACY; and Wisepress.

Book in advance for free at aestheticmed.co.uk/booktickets or £20 on the door on the day.

PLATINUM SPONSOR

aestheticmed.co.uk/live 13/12/2019 15:14

AM LIVE 2020 PREVIEW

aestheticmed.co.uk

BUILD YOUR BUSINESS SKILLS

Our Business Workshop programme gives you access to successful clinic owners and leading business consultants to inspire you to grow and develop your clinic. Topics will include Money, Motivation and Mindset on day one and Communication and Marketing on day two covering everything from planning to implementation.

TAKE PART IN THE 2020 VIDEO AWARDS

Following last year’s success, the Aesthetic Medicine Video Awards are back for 2020, recognising those who have excelled in using the medium of video for training, education, marketing and social media.

ACCESS SPECIALIST EDUCATION

Aesthetic Medicine Live will once again be hosting the UK Association of Aesthetic Plastic Surgeons (UKAAPS) surgeons’ day as well as the British Association of Hair Restoration Surgery (BAHRS) conference. We will also once again be running the Aesthetic Regenerative Medicine Conference in collaboration with Mr Ali Ghanem and Queen Mary University London.

GET CPD-ACCREDITED EDUCATION

Aesthetic Medicine Live’s CPD-accredited Clinical Conference features a comprehensive two-day programme covering the latest trends in clinical practice.

WATCH FREE DEMONSTRATIONS

Watch free demonstrations and hear about the latest innovations and launches from our exhibitors and their key opinion leaders on the Live Stage, located on the show floor and accessible to all visitors without booking.

DON’T FORGET TO DOWNLOAD THE SHOW APP

CHAT TO EXHIBITORS

Meet face-to-face with market-leading manufacturers and suppliers. By registering for Aesthetic Medicine Live in advance you can save £20 on the on-the-day entry fee.

To get the most out of the show download our app to search exhibitors, products and offers. Stay up to date with the wide range of seminars and other features of the show. Don’t forget to turn on notifications for instant updates. Download the show app at aestheticmed.co.uk/showapp

FOLLOW US: #AMLondon @AestheticMLive

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/aestheticmedicinelive

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AM LIVE 2020 PREVIEW

aestheticmed.co.uk

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

Belle

10.30

Erchonia Lasers

11.00

Clinical Photography

11.00

AES

11.30

Lynton Lasers

11.30

Inmode

12.00

Vivacy

12.00

Mesoestetic

12.30

Marion Gluck Clinic

12.30

Bio ID

13.00

Celluma

13.00

Candela

13.30

Venus Concept

13.30

Pure Swiss Aesthetics

14.00

BioActive Aesthetics

14.00

AlumierMD

14.30

Cynosure

14.30

3D-Lipo

15.00

Hydrafacial

15.00

Fusion GT

15.30

BTL

15.30

Dermalux

16.00

PRP Lab

16.00

Lumenis

16.30

Sterimedix

16.30

Biotec Italia

DON’T MISS SATURDAY FEBRUARY 29 • 11:00AM • BULLETPROOF BEFORE AND AFTERS – PROTECT YOUR REPUTATION WITH CLINT SINGH (CLINICAL PHOTOGRAPHY) 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.

DON’T MISS SUNDAY MARCH 1 • 10:30AM CELLULAR ANTI-AGEING EFFECTS WITH NON-THERMAL LASER WITH ROBERT SULLIVAN (ERCHONIA LASERS) 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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aestheticmed.co.uk/live 13/12/2019 15:26

A Solution for Every Skin

Resurface - Wrinkles/Lines

Rebright - Vascular Outbreak

Remodel - Facial Skin Tightening

Courtesy of Laser Skin Solutions

Every face is unique – precisely why any facial skin treatment should be too.

3JUVEÂŽ is an entirely customisable treatment which uses 3 market-leading skin rejuvenation technologies in one stand-alone platform.

A skin solution for every client.

Call 01477 536 977 or visit lynton.co.uk/3JUVE

Intensive Pigment Corrector

Help your patients.

Reduce their pigmented marks.

Reclaim their natural beauty.

67%

melanin pigment reduction in pigmented lesions.1

90%

noticed moderate to significant improvements after 16 weeks.2

1.Mansouri et al (2015)British Journal of Dermatology 173 (1) 209 –217

2.Farshi et al (2018) Journal of Dermatological Treatment, 29 (2) 182–189

Meeting the needs of your business, delivering high satisfaction to your patients Call us on 01234 313130 info@aestheticsource.com www.aestheticsource.com

AM LIVE 2020 PREVIEW

aestheticmed.co.uk

ARCHIMEDIA

MEDIOSTAR

Archimedia brings the new range of Facial Injection anatomy models to AM Live London, 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 bring the 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 skin-tightening, 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

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.

CUTERA EXCEL HR

Cutera will be launching the excel HR, combining a high-power 755nm alexandrite laser and Cutera’s long-pulse 1064nm Nd:YAG laser for safe highvolume hair removal on all skin types. It can also solve epidermal pigmented lesions.

ERCHONIA

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 nonthermal laser for acne and chronic neck and shoulder pain.

FOLLOW US: #AMLondon @AestheticMLive

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/aestheticmedicinelive

aestheticmed_live

Aesthetic Medicine • January 2020

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AM LIVE 2020 PREVIEW

aestheticmed.co.uk

LUMENIS Lumenis will bring a range of their leading aesthetic devices, including NuEra Tight, a radiofrequency skin tightening machine, Splendorx, for customisable hair removal, and PiQo4, a machine to treat pigment colours, as well as the M22 and AcuPulse machines.

JUVAPLUS

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

STYLAGE AND DESIRIAL

Vivacy will showcase a range of monophasic cross-linked injectable dermal fillers and gels, called Stylage and Desiral respectively, as well as Bi-Soft Injection Technology, a newly designed syringe offering better precision, comfort and control for physicians.

LYNTON LASERS

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

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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aestheticmed.co.uk/live 13/12/2019 15:28

Why should you have... in your business?

Because any face, in any picture, is your potential client.

It’s suitable for ALL skin types...

It’s that simple!

Find out about the unique facial treatment that gives instant results and improves long term skin health.

Tel: 01788 572 007 or email: infouk@hydrafacial.com www.hydrateyourbusiness.co.uk HF Advert AM Live (Free Ad).indd 1

13/12/2019 11:14:35

AM LIVE 2020 PREVIEW

aestheticmed.co.uk

QUANTA SYSTEMS Advanced Esthetics Solutions will be showcasing its Quanta System Laser platforms including the Thunder MT, Shelase and Qplus C. Shelase is the world’s first mixed laser technology platform for female wellbeing, combining the gold standards of the CO2 10600nm and GaAs 1540nm wavelengths in a sequential or simultaneous fractional emission.

DERMAMELAN INTIMATE

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

CELLUMA DELUX SKINPEN

BioActiveAesthetics, UK distributors of SkinPen Precision, will be offering a 10% show discount for the SkinPen. SkinPen is an awardwinning 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 microneedling training and new customer marketing packin both soft and hard copies.

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

New and exclusive from Cutera is truSculpt Flex, an FDA-approved muscle sculpting platform featuring proprietary MultiDirection 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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aestheticmed.co.uk/live 13/12/2019 15:29

THE SMALL DEVICE THAT PACKS A

BIG PUNCH! The WOW fusion device, a tailored skin care solution that can improve the overall condition of the skin.

Using our very own high quality ingredients and additional anti-ageing formulas we are able to treat a wide range of indications including: NN Fine lines and wrinkles NN Rosacea NN Open pores NN Oily skin NN Hyperpigmentation NN Dehydrated skin NN Dull skin The ultimate skin rejuvenation treatment that will WOW your clients time and time again.

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ic Medicine

AM LIVE 2020 PREVIEW

aestheticmed.co.uk

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*

N

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 two-day Clinical Conference, the two-day Aesthetic Regenerative Medicine Conference, the twoday BAHRS conference, the two-day Business Workshop programme and the one-day UKAAPS conference. Here’s a taster of what will be going on. *See our Education insert 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. Topics will include: Full Facial Rejuvenation for our Core Market: The Ageing Female; Considerations when Treating the Male Face; The Ethics of Treating Younger Patients with Injectables; Treating Transgender Patients.

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. Topics will include: Treating Patients With Skin Conditions; Treating Menopausal Patients; How Can We Help Clients With Weight Issues? and Mental Health Matters.

Our speaker faculty for 2020 includes: Dr Nick Lowe, Dr Steven Harris, Dr Sophie Shotter, Dr Anna Hemming and Dr Artuto Almeida, Dr Lee Walker, Dr Raul Cetto, Sharon Bennett, Dr Ahmed El Houssieny, Dr Vincent Wong, Mr Dalvi Humzah, Anna Baker, Dr Hervé Raspaldo, Dr Martyn King, Cheryl Barton, Rachel Goddard, Dr Raj Thethi, Dija Ayodele, Dr Ifeoma Ejikeme, Dr Shirin Lakhani, Dr Lori Nigro, Dr Martin Kinsella, Dr Ash Dutta, Dr Alexandra Davidson, Ginny Thomas, Lou Sommereux, Dee Hadley and Nofie Johnson.

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AM LIVE 2020 PREVIEW

aestheticmed.co.uk

SATURDAY FEBRUARY 29 | 9.30AM-11.00AM 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 Steven 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 | 3PM-4.30PM THE DIVERSITY OF HUMAN ANATOMY When it comes to avoiding complications, in depth 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

SUNDAY MARCH 1 | 12PM-1.15PM TREATING MENOPAUSAL PATIENTS The menopause has an effect on many factors from skin to hormones to intimate regeneration.

We look at the role aesthetic clinics have to play. Dr Shirin Lakhani, Dr Lori Nigro, Dr Martin Kinsella 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

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 and Queen Mary University London (QMUL). 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.

BUSINESS WORKSHOPS

Learn strategies to grow and enhance your business with our two-day business programme, chaired by Richard Crawford-Small from Aesthetic Entrepreneurs.

Saturday’s agenda will focus on Mindset, Money and Motivation, with topics including: Goal Setting; Metaphysical and Mindset Work Within Your Aesthetic Business; The Sales Warmup, The Sale and the After-Sale; Starting a New Decade in Aesthetics: Why 2020 Could Make or Break Your Aesthetic Practice; How to Build a Multi-Million Pound Aesthetics Business in 12 Months; Don’t Undersell Yourself – Developing Pricing Structures for Your Practice and How to Get a Fully Booked Aesthetic Clinic Without Spending a Penny on Advertising.

Sunday’s agenda will cover topics relating to Communication and Marketing with sessions including: Creating Your Perfect Patient Avatar; How to Double Your Customers & Profits in 30 Days Using Facebook and Instagram; How to Increase Enquiries to Your Clinic Using Google Ads; Digital and Web Marketing Strategies: From SEO and Websites to Content and Blog Writing; 8 Ways to Automate Your Aesthetics Practice in 2020; The Risks of Running Your Practice off a Phone; Increase Engagement >

FOLLOW US: #AMLondon @AestheticMLive

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AM LIVE 2020 PREVIEW

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and Enquiries Utilising the Latest Technology and Chat Bots; How Registration with the Healthcare Regulator can Improve your Business and Bulletproof Before and Afters – Protect Your Reputation.

Speakers include: Tracey Dennison, Alan Adams, Pam Underdown, Phil Elder, Dr Cristina Perea, Antonia Mariconda, Robin Waite, Danny Bermant, Laura Moxham, Kris Trinity, Alex Bugg, Rick O’Neal, Gilly Dickons, Ron Myers, Stevie Potter, Tracey Jones and Clint Singh.

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

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.

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, will welcome speakers including: Mr Tariq Ahmed, Mr Rizwan, Alvi, Dr Santosh Bhatia, Sailesh Mehta, Mr Muhammad Riaz, Mr Navid Jalali, Pam Underdown and Mr Jonathan Britto.

Topics covered will include controversies in prominent ear correction; ear fold correction of prominent ears; tips for safety when using local anaesthetic for aesthetic plastic surgery procedures; increasing trends in labioplasty LA vs GA; minimising risks in face-lift surgery; careful consent process in managing aesthetic breast augmentation in view of ALCL and breast implant linked chronic illnesses; and non-surgical face-lift with judicious use of absorbable dermal fillers and botulinum toxins.

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 AM CONFERENCE DELEGATES

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AESTHETIC TECHNOLOGY

Transform your aesthetic business with LED Phototherapy LED Phototherapy is now recognised as an essential skincare modality for aesthetic practice, due to its versatility and role in the maintenance of good skin health.

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ell-evidenced for its regenerative benefits without trauma or downtime, the noninvasive nature of LED Phototherapy makes it particularly effective in targeting problematic and inflammatory skin conditions.

The treatment involves exposing the skin to low levels of beneficial light energy from the visible and infrared part of the light spectrum. Specific wavelengths activate key cell receptors and trigger a transfer of light energy to cellular energy, which stimulate or regulate biological processes for therapeutic effect. The mechanism is a natural response similar to that of plant photo-synthesis through a process known as photobiomodulation.

Choosing a good quality device offers the opportunity to introduce LED Phototherapy as a standalone service, as an express treatment menu and as an adjunctive treatment to enhance results and accelerate healing. However, not all LED devices are created equal. The key to successful treatment is the correct choice of wavelength, coupled with sufficient photon intensity to maximise the light/chromophore interaction.

Dermalux LED systems combine blue 415nm, red 633nm and near infrared 830nm, which are the most clinically-evidenced wavelengths delivered via proprietary LED technology with proven results driven protocols.

With Dermalux you will simply deliver better results.

The 415nm light is absorbed by p.acnes bacteria and triggers a natural photochemical reaction, releasing singlet oxygen, which has a powerful antibacterial action to help eliminate spots, while being gentle on the skin.

The 633nm light is absorbed in the mitochondria and supercharges cells triggering a cascade of regenerative and healing effects and the 830nm light is absorbed in the cell membrane, kick starting the wound healing process, calming redness and irritation and helping to reduce pigmentation.

Commercially, Dermalux is one of the most profitable treatments available to a clinic. LED Phototherapy creates the basis for all client treatment programs, offering new revenue and upselling opportunities. In short, Dermalux is a safe, simple and results-driven treatment with an exceptional return on investment.

Dermalux is a world-leading and trusted British brand for professional LED Phototherapy. Our systems have been uniquely designed to offer the most innovative and technically advanced LED Phototherapy treatment available. This coupled with our specialist knowledge, independent industry expertise, on-site training and on-going customer support has enabled us to become a market leader in LED Phototherapy.

We offer an award-winning portfolio of LED systems to meet every requirement. The Dermalux MD range, which include the new Flex MD are Medically CE marked for acne, psoriasis, wound healing and musculoskeletal pain.

For more information on any of our systems or to arrange a no obligation demonstration, please contact Dermalux on 0845 689 1789 or info@dermaluxled.com.

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Aesthetic Medicine • January 2020

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12/12/2019 17:04

EDUCATION NOT TO BE MISSED! TWO-DAY CLINICAL CONFERENCE*

BUSINESS WORKSHOPS

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*Please note the Saturday conference sessions are open only to those who are members of a professionally registered statutory body such as the GMC, GDC, NMC, GPhC or overseas equivalent.

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COV E R STO RY

CLINIC PROFILE

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LEVEL UP Dr Tijion Esho takes Georgia Seago through his journey from foldout treatment couch to the clinic of his dreams

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ooking at the glossy black exterior of Dr Tijion Esho’s clinic in London’s affluent and leafy Wimbledon Village, his signature engraved in gold on the doorstep and the storefront’s big windows showing off a sleek, highly stylised interior, it’s clear this is the work of someone who wants to make an impact.

But Dr Esho’s newest clinic – his third outpost currently – isn’t an expense he takes lightly. “This clinic is the biggest spend I’ve had and I did question it, but I know why I’m doing it and why it makes sense,” he says. “The Wimbledon clinic is actually a full circle moment for me.” Five years in the making, Esho says he was watching the tennis at Wimbledon years ago when the idea was first sparked. “I thought it was a lovely area with such a nice atmosphere; lots of high-end businesses around and well-to-do people. I thought, ‘we could do a clinic here’”.

It wasn’t until years later when Esho and his partner ended up moving to the family-friendly area after falling pregnant with their first child that the dream started to take shape. “Walking in the Village one day, I noticed an empty shop with a card in the window and suddenly thought it would be perfect for a clinic,”

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CLINIC PROFILE

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skin analysis with 3D mapping, followed by monthly treatments and skin health follow-ups.

Developing and executing the concept will be a key focus at the Wimbledon clinic, where Esho will ultimately employ a head aesthetic therapist, an additional therapist, two doctors as well occasionally treating patients there himself, and a front of house manager.

BEST OF THE BEST

he says. “So I made the calls and spoke to my dad who is an accountant. We did the maths and decided that I could do it, but then it became a question of how it was going to fit in to the business overall.”

NEW IN TOWN

Having successfully turned his name – not to mention his skill as a cosmetic doctor – into a brand, Esho believes he has somewhat of a responsibility to the industry to innovate and impress. “At the stage we’re at now, I’ve matured as a brand and people are looking to me to see what I do, so when it came to designing the clinic, I had to do it in way that would wow people,” he says. “I had to make sure that all the details were perfect. For example, I wanted all the machines to be black. I don’t want the classic white, clean look because everybody else has it.”

Rather than a typical doctor’s office, Esho says he wanted the clinic to be “almost like a bespoke boutique”, so he looked carefully at making sure every element was as premium as possible, “from the building materials and fabrics to the refreshments for clients, like the option of Champagne for those having non-invasive facials, or a choice of coffees so patients can have their favourite.”

This level of customer service was inspired by Esho’s quarterly clinics at Nova Clinic in Dubai, where he says the service had a real impact on him when he first started practicing there in 2018. “The big thing out there is service; you can’t get away with just giving good results now, the consumer demand is stronger than that so you have to give them an experience now too,” he says.

Taking this to the next level, patients at the Wimbledon clinic are given a buzzer to let them know when their appointment is ready after they check in, allowing them to make a day of their visit and explore the local area instead of sitting in the waiting room. “We’re also piloting a >

Harley Street has a name but it isn’t where you need to be anymore if you’ve got a brand

At the time, Esho was practicing from his Harley Street clinic, but the thought of opening a site in a completely different area made him question his future in London’s most famous medical postcode. “For the rent I was paying on Harley Street I could have two clinics in places like Wimbledon Village. Harley Street has a name but it isn’t where you need to be anymore if you’ve got a brand,” he says. “And anyway, aesthetics is a service-led industry so people will go where the service is good.”

A second West London clinic in a yet-to-be-revealed location is also underway. “For the price of one clinic on Harley Street I can have two with more rooms and be able to scale in terms of therapy treatments, particularly with the Esho Skin Lab, which is growing. It’s a no-brainer,” he says. Esho Skin Lab is a subscription-based skin treatment service whereby patients pay a monthly fee for 12 months and get access to treatments including Byonik laser, microneedling and peels at a reduced cost. Designed as long-term treatment plan, patients first receive a detailed

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You have to be choosy about who you associate your name with… with maturity you gain the confidence to say no

WhatsApp concierge service for Skin Lab patients, which means we’re easily contactable throughout their subscription for aftercare advice or whatever else they need to know. It’s adding those extra layers of service,” he says.

HUMBLE BEGINNINGS

These are all decisions Esho probably never thought would one day take up his time. He started his journey in aesthetics working in the NHS in plastic surgery and began taking on patients in his boss’s private, non-surgical clinic after developing a stronger interest in this realm. He started his own practice in 2013 on a foldout bed in a small space in spa, followed by opening his first proper clinic in Newcastle

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while still on rotation as a GP in order to gain his Certificate of Completion of Training – something his dad said he had to do if he wanted to pursue aesthetics.

At this time Esho was also leasing a small room on Harley Street, but when it all got too much to juggle on his own, he brought in GP colleague and friend Matthew McCloskey, trained him and handed over most of his Newcastle patients.

McCloskey now heads up the Newcastle clinic, which has since expanded to three rooms, one of which is used for training. “At that stage I got a permanent room on Harley Street, but between us we still couldn’t treat any more patients because we just didn’t have the hands. I also hadn’t matured as an injector yet – eventually you learn to take a more holistic approach to injecting and understand the way people age and how different modalities can help – but I was becoming more interested in skin and things like laser and microneedling,” says Esho.

He realised that in order to scale and free up some of his and McCloskey’s time, he needed to invest in modality treatments and bring in therapists to train: “They’d be able to provide treatments that we didn’t need to be there doing.

It made financial sense,” he says. But as someone relatively new even to injecting, let alone the myriad products, devices and technologies available for advanced skin treatments, Esho had another challenge on his hands.

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CLINIC PROFILE

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BACK TO SCHOOL

“I had to really become a student of aesthetics. I started paying attention to what treatments people ahead of me were interested in and what machines they were investing in, then doing lots of my own research,” says Esho. “I thought, ‘these people have time on me and I can’t get that back, but I can maximise my time now by being awake reading research while they’re sleeping, still going until 9pm while they finish work at six’. That mentally really helped me to mature both clinically and in my business mind set.”

Esho readily admits that there were ways in which he had to mature as a both a practitioner and business owner in order to make a success of himself. For example, he learned that resisting the “lip guy” title the media tried to bestow upon him could actually do more harm than good.

“As I started to understand Instagram algorithms, I’d notice that I’d post a before-and-after image of a non-surgical rhinoplasty that I thought was amazing and it would get maybe 50 likes, but then I’d post a picture of lips that I thought were OK, and it would get 200,” he says.

“It wasn’t making sense to me but I decided to give my followers what they wanted to see. In a way it was good that I let myself be categorised into that niche, because if you’re general, even if you’re good at many things, it’s harder to make an impact than when you’re known for one specific thing.” Although he started to be known as the lip doctor in the press and on social media, “when people came into clinic, they realised I could offer them so much more”, he says.

SCREEN TIME

This self-awareness has helped Esho establish himself as a regular on primetime TV and a go-to aesthetic expert commentator in the consumer press. His first appearance was in 2013 on BBC Newcastle to perform a hand lift after producers found him on

social media. This eventually led to guest appearances on Channel 4’s Bodyshockers and a regular slot on E4 programme Body Fixers, advising and performing corrective procedures on members of the public.

Most recently, guest appearances on ITV’s This Morning have led to Esho appearing at least once monthly as the programme’s resident cosmetic doctor on all aesthetic medicine or surgery segments, having even injected live on TV. However, Esho is discerning about what he puts his name to, having learned the hard way when he was starting out. “You have to be choosy about who you associate your name with,” he says. “Some people think you have to say yes to every opportunity at the beginning, but I soon realised I needed to think about each opportunity properly and how it will affect me in the long term.

With maturity you gain the confidence to say no.”

A new 10-part documentary-style TV series is on the way, though the network is still under wraps, which Esho says will follow himself, his staff and the clinics, “focused on treating patients day to day and the Esho Initiative charity side”, whereby Esho performs free corrective treatments in collaboration with Church Pharmacy and Cosmetronic.

On top of this, Esho is also working on releasing a bespoke designer scrubs line under the name ESHO X CLOTHSURGEON, along with an online service that will launch in 2020 and allow fellow medics to design their own scrubs with the fabric, cut and pattern of their choosing.

There’s also an impending cosmeceutical lip product line, “because lips is always an afterthought with skincare brands”, says Esho. His range will allow his patients and consumers alike to address concerns like pigmentation and dryness specific to the lips with various products that can be mixed and layered.

He has worked hard to build this empire, and it’s only in its infancy. While the shiny surface of the Esho brand could give the impression of being run by a big team propping up the doctor’s name, the reality is that this is a very personal passion project for Esho. He’s the first to acknowledge that the late nights and lessons to learn are far from over, but, as he puts it, “Anything that’s hard work is worth it in the end.” AM

When it came to designing the clinic, I had to do it in way that would wow people

All clinic images: Holly Wren

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TRAINING

VIRTUAL REALITY

aestheticmed.co.uk

IN REALITY Just how useful is virtual reality in aesthetics, and how far does its potential reach?

We get the lowdown from two of the practitioners leading the way

WHY USE VR FOR AESTHETICS TRAINING?

“If you go to a conference you often end up sitting next to someone who is texting, blocking your view or just generally being distracting,” says Mr Dalvi Humzah, consultant plastic, reconstructive and aesthetic surgeon and founder of Dalvi Humzar Aesthetic Training (DHAT). “With VR you’re completely in that scenario, everyone gets the same view and we can deliver it in any venue. Delegates don’t have

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to come to my clinical room; they can sit at home and still get the learning.” DHAT created a VR training platform for launch in March of last year, which was put on hold for further development and is due to re-launch in 2020.

For ophthalmic plastic reconstructive surgeon Dr Sabrina Shah-Desai, the training modules in her OFAA Virtual Reality App are particularly suited to international practitioners: “I really want this for the global practitioners because I get

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TRAINING

VIRTUAL REALITY

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adds Shah-Desai. “Then they have something they can go back to as a reference to refresh their memory.”

Cost is also a factor; the OFAA App costs £250 for lifetime access. Compared to the investment in real life training, virtual reality options are often very affordable, even with the cost of a VR headset taken into account.

HOW DOES IT WORK?

Most VR training programmes can be accessed via VR headsets at a range of price points, from the under-£10 Google Cardboard to the Occulus device, which can cost up to £500 for the latest model and allows for sound reproduction. With Humzah’s training, the new version of which is currently still in development, delegates will have around 18 different modules to choose from – a whole face procedure split into different areas – that they can spend five to 10 minutes on and move on.

In a recent masterclass trial session in Italy involving 30 delegates, “they got transported into a virtual reality clinic situation where they could have a look around and see me there, presenting what we were planning to teach.

Then they could see different screens, so there was one where I was actually doing a procedure from a point of view scenario, which we filmed with a camera mounted on my chest,” explains Humzah. “When they were looking at it, it was as though they were doing it, but I was narrating exactly what I was doing and they were able to understand without any disturbances.”

WHAT CAN BE TAUGHT?

a lot of messages from abroad but they can’t all come to the cadaver labs here in the UK. This way, they’re with me seeing what I’m dissecting, hearing me all the time.” The online modules also allow unlimited playback – something that obviously isn’t possible in real life situations. “They can play back again and again. I see this as a really good tool for if they’ve attended a lab in their own country, or they’ve had industry training or attended a conference on the subject,”

Delegates using Shah-Desai’s app have access to content covering holistic facial assessment, advanced filler injection techniques, detailed cadaver anatomy and the use of hyaluronidase to manage complications. “I think that’s where this works so well, because it covers so many things,” she says, “Not all people who are injecting are surgeons, so they don’t know how to dissect and can get confused by needles and sometimes they just want to see it very clearly again and again with an explanation. There are also modules in clinic with me where I’m assessing male and female patients using different portfolios, trying to explain my philosophy.”

The DHAT VR training only includes injectables for the time being, but with the option for delegates to take part in in-depth anatomy sessions simultaneously. “Obviously >

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TRAINING

VIRTUAL REALITY

we have a lot of anatomy that we tie into it, so they don’t just see the injectable but the anatomy too,” he explains.

“There are two screens which they can switch on and off to run simultaneously or just turn one off while they watch the other one. It gives them the option to see how the anatomy relates to the injection.”

WHAT ABOUT COMPLICATIONS MANAGEMENT?

One area in which VR may be particularly helpful is complications management, as practitioners are able to see and experience a case right in front of them, the steps narrated by their expert trainer. “The reason I wanted to show management of a VO is that every time I’ve helped practitioners with complications they’ve been in such a state that they’ve forgotten what they’ve previously learned in their training,” says Shah-Desai. “With this mobile-based app, you can also use it as a normal video in 2D, so in theory that video can be played then and there; me mixing up the hyaluronidase and talking you through it.”

This is a big advantage of having refresher training in your pocket, and could well stop practitioners from panicking and not acting quickly enough to successfully and safely manage a complication. However, Humzah believes that the next step beyond VR could be even more beneficial in this crucial area of training. “Augmented reality is in its infancy for this kind of application, but potentially if a practitioner had a complication in front of them, they could be streaming that video feed directly to me and I could be marking things out on the ‘patient’, taking the practitioner through exactly what to do as they’re doing it with me on hand to monitor how it’s progressing,” he says.

Shah-Desai agrees that while the technology isn’t yet accessible or affordable, “VR is one thing but augmented reality is the next stage. It’s like you’re actually in the space, experiencing it differently for simulated learning,

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even practising on models and experiencing where to put the syringe and feeling the sensations of feedback,” she explains. “You could even experience things like going into a lymph node and seeing what it actually looks and feels like.”

WHAT’S NEXT?

Humzah predicts that within the next six months technology will be available in aesthetics training that allows delegates to move around in the VR environment, but is keen to ensure its use within DHAT is controlled. “We’ve just taken a very careful look at how useful it would be in aesthetics because it can change between being a good educational tool to just being a toy if you’re not careful,” he says, “Plus, the technology moves so fast that it quickly supersedes itself, which is why we were initially delayed with the DHAT VR platform.”

While nothing could ever replace the importance of real life, hands-on training in medicine, the capabilities and potential evolution of VR is promising. “I think this is a very useful tool for introducing a concept to somebody, or for them to see what a procedure is like before they embark on hands-on training,” says Humzah, “But it’s very easy to get carried away with it and make everything virtual reality. You’ve got to understand that our brains aren’t really designed to be in that kind of environment for more than about 20 minutes. After that, you can’t process the information and it just becomes a video show that you’re watching.”

“We’ve tried it with an hour-long dissection, but when people were in the virtual reality room for that long, they were almost losing interest. I think the current generation aren’t used to virtual reality, there’s a generational gap. Ten years from now though, people will just be used to sticking on a VR headset and going straight in.” AM

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Become a Certified Partner of

The National Medical Weight Loss Programme Agenda

Daily Injection

Weekly Injection

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

Module 2 The fat cell, metabolism & appetite regulation a) Biochemistry of the fat cell b) Gut hormones & the regulation of appetite

Module 3 Weight Loss Interventions

a) Diet and nutrition b) VLCDs (very low-calorie diets) c) Physical activity d) Bariatric surgery

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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.

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

Business Support

Our training is the only UK course that waivers the need to have experience working in the field of obesity or diabetes for insurance purposes.

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.

Training always takes place on a Sunday at our clinic in Doncaster.

Guaranteed insurance All Partners are guaranteed cover through Cosmetic Insure, and will also enjoy 10% off the price of their total premium. Partners can also spread the cost of payments over ten months.

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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 guidance.

Who can join?

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

a) CQC registration assistance 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

ums, all Partners will receive preferential pricing from our official Pharmacy Partner - PriMed Aesthetic Pharmacy.

01302 965432

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.

Next training date

• Sunday 26th January 2020 in Doncaster

Special Offer save £600 + VAT now only

£900 + vat book online at www.nmwlp.co.uk 3-month payment plan available on request

NB: This advert is intended for healthcare professionals only

www.nmwlp.co.uk

BUSINESS

DIGITAL STRATEGIES

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l a t i g Di retox

Alex Bugg, head of content at Web Marketing Clinic, breaks down three key digital focus areas for clinic owners to get their business in order for the New Year

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BUSINESS

DIGITAL STRATEGIES

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hinking about doing a digital detox in 2020? Don’t!

Certainly not in your professional life, anyway.

Now is the perfect time for a digital “retox” to get everything in line ahead of the new year, so you can prepare for another year of business knowing your clinic’s digital marketing is working for you.

There are three key areas you should focus on to tidy up and get ahead.

WEBSITE AUDIT

Why: Your website is the number one source of clinic information available, so it needs to represent you well and be up to date.

When was the last time you read your website? We’re not talking about browsing, checking a price or a procedure, or even showing it off to a friend. We’re talking about the last time you read each page with a fine-tooth comb, checking for errors.

Consumers scan read websites rather than digest every word, looking for the pieces of information they need, but factual errors or missing details can cause your clinic problems.

If you list prices on your site, it’s vital that you regularly check them. Incorrectly priced treatments online create a bad customer experience and could lose you that lead entirely, especially if you don’t count the old listed price as a goodwill gesture.

If you’ve not updated your website in a year or two, you may have dropped and introduced new treatments, taken on additional staff or opened new locations. Writing new pages can be daunting, but make it more manageable by first writing down every new page title you think you need to add with three key points of information you want the page to get across.

When it comes to the finer details of treatments or important information, think about what information you’d deliver at consultation. By breaking it down like this, you’re likely to write the best and most thorough copy that converts more site visitors to patients.

A note on consistency Check every existing page – are there at least 400 words on each? Does each page feel consistent, as if written by the same person?

While it may seem easier to take the copy provided by your treatment or product supplier and paste it to your website, this not only makes your site sound like it’s been written by 10 different people (because it then would be), but it can be counter-productive to your search ranking.

Duplicate copy, with no added value, tells Google that your page is not useful because that exact same copy is already out there, and so the site is filtered out of search results.

Is there a clear call to action on each page – is it easy for the user to transition from taking in this information to booking a consultation? Even a simple link to the contact form at the bottom of each treatment page is better than tucking it away in the menu.

Does your website make it easy for prospective patients to contact you? Are there multiple channels (email, phone, contact form, live chat, etc.) directed from more than one page?

ANALYTICS

Why: Google Analytics gives you the metrics you need to measure the performance of your website. By making use of analytics, you can compare performance before and after any edits you make, offers you add, or even social media posts you share.

Ensure you have Google Analytics installed. It’s a free tool that gives you deep insights into the visitors to your website. You can see where your web traffic is coming from, which pages are being visited, and how many visits convert to enquiries. Use this information to see which of your marketing efforts is driving the most traffic and bookings, which pages are performing best and where best to invest your time and money.

Take notice of your bounce rate; this is where people are leaving your site after visiting just one page. You could get masses of web traffic, but a high bounce rate suggests something is wrong with the page that people are visiting then leaving. It could be a visual issue – the page might not have a clear navigation around the site (inserting internal links to other pages on your site can improve this), or the call to action might be weak. A single, clear instruction such as “book a consultation” or “download our skincare guide” works much better than having three or four messages scattered across the page.

GOOGLE MY BUSINESS

Why: Google has provided you with a totally free and simple way to increase your clinic visibility. It’s easy to optimise to increase your local presence.

Google My Business (GMB) is great. It allows people to connect with your business, find you on Google Maps, leave reviews, and ask questions and more. This local listing is powerful, and an integral piece of your search engine optimisation (SEO) efforts.

Don’t just set it up and leave it though; if you utilise the functionalities such as reviews, Q&As, photos and posts, you’re feeding Google more information about your operation. This effort, or optimisation, is rewarded with better search visibility. >

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BUSINESS

DIGITAL STRATEGIES

This acts as your local listing and mini-homepage when somebody searches for an aesthetic clinic or treatment near them, but doesn’t click on any of the results (known as zero-click searching).

It also provides some basic insights into your business, like how many people see your listing via search and Google Maps, which search terms were used to bring up your GMB listing, and the ratio of direct views (from people who searched your business by name) to discovery views (people who were searching for a specific product or service).

CONTENT (AKA YOUR BLOG)

Why: Digital marketing 101 says that a blog for your website is great for your SEO, social media and more. But without a plan, you’re wasting valuable time by thinking on your feet.

Content marketing is so important in an internet age because it delivers value and education to patients; produces great original content for social media; and signals to search engines that your website is valuable.

If you find this kind of thing difficult to do yourself, your patients and staff can be very useful. Think about the treatments and conditions you or your team are asked about most, and then write about them. It’s that simple.

For example, if you’re constantly asked about acne, rosacea, pigmentation and scarring, there are at least four “introduction to…” blogs right there, before you’ve got into posts about specific treatment protocols.

If you haven’t got the time to write – 500 words should be the minimum for your articles – then commission an

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industry expert to do this for you, and edit it yourself for the right voice and consistency with the rest of your website.

Most of our medical aesthetics clients opt for at least two blogs per month, but to get started you can even commit to just one per month.

Planning your titles and subheadings is key. Start with an attentiongrabbing headline and write short paragraphs, breaking these up with subheadings that indicate the flow of the text. The vast amount of content online means that attention spans are getting shorter, so people aren’t reading every word you write.

Internal links to other pages and posts on your website are a great way of improving the reader’s experience. You can direct them to relevant treatment or condition pages in your text, for example. It’s a good idea to set these links to open in a new window so that readers can easily get back to your post and carry on reading.

Include keywords in the URL, headline, first sentence, meta-description, image alt-text (Google can’t “see” pictures, so we have to describe them), and in most, but not all, of your subheadings.

End with a call to action – what do you want readers to do now they’ve finished reading? Fill in a form? Purchase a product? Book a consultation? Be clear.

Where can this content be shared?

Social media posts Convert it into a short video summary Post on Google My Business Send in an email newsletter Share treatment or condition guides with patients before consultation/after treatment as part of your service Use in-depth, original case studies as press releases New Year digital retox checklist: Review website content Connect Google Analytics to your website Set up Google My Business Fill your GMB with photos, videos, Q&As and encourage reviews Plan a content calendar by sketching 12 ideas for posts Write or commission a blog post Share blog across social media and email and post to GMB. AM

Alex Bugg works for Web Marketing Clinic, a family-run digital agency, which specialises in medical aesthetics. They build websites and deliver award-winning marketing campaigns for doctors, nurses, dentists, distributors and aesthetic brands. Contact her on alex@webmarketingclinic.co.uk or follow her on Instagram: @webmarketingclinic

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CUCF LONDON . 17 TH FEBRUARY 2020 . WESTMINSTER

W I T H M O D E R AT O R D R TA PA N PAT E L , P H I C L I N I C

L E A R N . C O N N E C T. G R O W

CUTERA University Clinical Forum is coming to London! The UK’s first CUCF workshop will consist of a range of talks and open panel discussions with some of the worlds leading aesthetic experts, leading onto live product demonstrations. The agenda will focus on all the latest clinical trends & developments in aesthetic technology, together with expert marketing & business advice. CUCF London is an event for any aesthetic practitioner/business owner with an interest in aesthetic technology and the clinical outcomes achievable.

London Marriott Hotel County Hall Westminster Bridge Road, London, SE1 7PB 020 7928 5200

Monday, 17 th February 2020 10:00 - 18:00 Book today at: bookwhen.com/cuteratraining

Speakers at CUCF London

@cutera_UK

Dr. Victoria Manning River Aesthetics London

Dr. Sach Mohan Revere Clinics London

Dr. Asif Hussein MD sk:n Westminster London

Wendy Lewis Aesthetic Marketing Expert New York, USA

Nicola Russell Skin Geek Falkirk

Kevin Williams Wynyard Aesthetics Ltd Cardiff

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

C U STO M E R S E RVI C E

PATIENT JOURNEY

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On a journey Independent nurse prescriber Julie Scott discusses the patient journey

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have a confession to make: I have never had any training in customer service. I have had 14 years’ experience working in the NHS treating patients for plastic and reconstructive surgery, I run my own clinic in Essex and see multiple patients a day, and I have been in the aesthetics industry for more than 25 years. But, like most who come from an aesthetic or medical background, I acquired interpersonal skills through interacting with patients over the years. These skills are important, but what I find the need to emphasise to fellow practitioners is that customer care is a whole different ballgame.

When I look back at the years of building my business Facial Aesthetics, I can confidently say the #1 contributing factor to my success has been my approach to customer care towards my patients. Not my training, not my prices, not even what my clinic looks like. I learned customer service from experience, and recognised the crucial role it plays in building my business. This is because when you build rapport with your clients and earn their trust, this results in the three Rs: Revenue, Retention and Reviews.

So whether you’re an established and successful practice, or you’re just getting off the ground and are looking for guidelines, it’s always a great time to review your team’s customer service skills at every touchpoint along the patient journey.

The patient journey doesn’t end when they walk out your door first hurdle! You have seven seconds to make an impression with your website landing page before that potential client clicks the back button to go to the next Google result. To engage this would-be patient, it’s important to give them what they are looking for first. I believe customer care starts online by making sure your contact information is easy to find, and trying to pre-empt possible questions by posting the answers in easy to find pages on your website. Also, something very important but often forgotten:

1. THE PATIENT JOURNEY STARTS ONLINE

Nowadays, we all know that patients have all the information in the world at their fingertips, and they use this information wisely. Before even picking up the phone to call your clinic, they will have found your website and used it to make a decision whether to contact you or not. Don’t fall at the

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C U STO M E R S E RVI C E

PATIENT JOURNEY

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make sure your online and social presence matches your in-clinic atmosphere. Don’t overuse stock images – feature yourself and your staff. You are the heart and probably the face of your business, after all. Live up to the expectations you portray online.

2. THEN THEY PICK UP THE PHONE

Aesthetics is an industry most patients feel nervous about making first contact with. It often takes years for them to do their online research and talk themselves into it before they pick up the phone. So once they do, if it’s your phone that rings, congratulations! They have chosen to invest time in you, so make sure that whether you, a member of your team, or an answerphone pick up, your patient feels instantly welcomed and helped. If they can’t speak to you right away, make sure they have clear expectations of when they will hear from you.

And of course, don’t make promises you can’t keep. Under promising and over delivering is the key to success, after all.

3. CROSSING YOUR THRESHOLD

Finally, the patient has reached your door. When you welcome them through, it can be so tempting to take the easy route into making money. By this, I mean up-selling, hard selling, or treating red-flag patients even when you know you shouldn’t.

It’s so easy to do in this industry: pointing out problem areas, knowing you have the solution. And while using that approach may result in making money out of that patient once, it’s far less likely to keep the patient coming back or referring their friends, which is ultimately what will generate the most revenue. My approach is to offer a complimentary consultation formatted as a relaxed discussion followed by a cooling- off period. It may seem counterintuitive to offer your time for free , but trust

that it’s an investment in your patients, and therefore your business. It’s important to guide and advise your patients, educating and addressing concerns without planting seeds or asking leading questions. My takeaways are to have a professional but positive outlook, educate your patients while presenting yourself on the same level as them, and create a safe, friendly, and welcoming clinic environment.

4. FOLLOWING UP

Of course, the patient journey doesn’t end when they walk out your door. You want them to come back, don’t you? Once they leave, giving them a quick call or email the next day is a great opportunity for after care. “How was everything, do you have any questions? Let’s book you in for a follow up appointment.” Keep your patients in the loop without spamming them, and remember details about them when they come back. Asking patients about the little details of their life that they mentioned last time when they come back to see you will go a long way. Build that rapport and trust with them, and they will turn into a loyal client that stays with you and your business for years!

The main thing to remember here is that the core of your business is your patient. Look after them. Of course it’s important that you are a safe and skilled practitioner. Of course a proper marketing strategy will work wonders to bring patients to your door. Of course having awards and advertisements make you look more impressive. But patients expect all of this. What is most important is how you make your patient feel, because this alone will be the deciding factor on whether they spend their hard-earned money on your business or not. I’ll leave you with one of my favourite quotes, which has formed the basis of how I treat all my patients and run my business: “They will forget what you said, they will forget what you did, but they will never forget how you made them feel.” AM

Julie Scott has more than 25 years’ experience in the fields of plastic surgery and skin rejuvenation.

She is a member of the BACN and RGN having qualified as a plastic surgery nurse and nurse prescriber.

Since 2003, Scott has been the clinical director of Facial Aesthetics, providing wide ranging therapeutic techniques for skin aging and dermatological skin conditions for clients across Essex.

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BUSINESS

BUSINESS DEVELOPMENT

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Growing your clinic – the basics Reece Tomlinson shares his strategies for taking your business to the next level

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n order to take a clinic to the next level there are a number of key points that the clinic owner or manager must thoroughly understand. From my own experience running and advising businesses in the aesthetic medical space, I have developed eight key points that should be carefully considered.

1. FOCUS ON KEY PERFORMANCE INDICATORS

Many companies refer to the critical qualitative or quantitative performance-based information that is being measured by the company as key performance indicators, which are defined as both financial and non-financial information needed to explain a company’s progress towards its stated goals and strategy.

Every clinic has a number of key performance indicators that could be routinely measured to gauge individual, team and overall clinic performance.

Although there is not a set of rules regarding how often a clinic should calculate KPI data, I would suggest monthly or bi-weekly KPI reports are ideal.

Similar to checking the gauges in your car to determine how fast you are going and how much longer you can go before you need to fill up with petrol; KPIs are crucial to determining whether or not are you on track to perform as

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a clinic and if your employees meeting, exceeding or falling short of expectations. The more regular and consistent the KPI reports; the quicker the clinic can alter individual and company performance to ensure objectives are being met.

When the clinic can stay on top of the critical items that will make its daily operations successful, operational risk reduces and ability to achieve its objectives improves.

2. CASHFLOW IS EVERYTHING

Whether the clinic is new, growing or simply wanting to make more money, cash flow cannot afford to be ignored. In order to fuel growth and otherwise achieve the goals of the clinic, it is imperative that cash flow remains strong during both the busy and non-busy months of the year.

I strongly suggest that the clinic highly analyse and monitor indicating factors of positive and negative cash flow such as bookings, sales and costs.

In business they say that cash is king and this is true for the aesthetic clinic. An incredibly simple equation that every clinic can utilise is this; aim to bring in more cash than you spend every week. If the clinic can repeat this during most weeks throughout the year, there is a high likelihood the clinic can begin to accumulate cash, which can be used to both take the clinic to the next level and reward its ownership.

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BUSINESS DEVELOPMENT

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KEY PERFORMANCE INDICATOR

EMPLOYEES WHO MAY BE MEASURED AGAINST KPI

Sales growth

Anyone impacting sales / entire company

Profit

Depends on the clinic, however certainly managers should be measured against the degree to which the clinic can generate profits

Cash generated from operations

Manager

Customer retention rate

Anyone impacting sales / entire company

Add-on sales as a percentage of sales

Customer service, reception, practitioners

Customer complaints

Practitioners, customer services

Average number of patient treatments annually

Anyone impacting sales / entire company / customer service

Percentage of capacity

Entire company

Quality related complaints

Practitioners

Number of new customers

Anyone impacting sales / customer service / entire company

Number of calls made per day

Customer service

In summary, every clinic owner should be monitoring cash flow on a regular and detailed basis so they can plan operations, staffing, promotions and spending accordingly.

3. BUILD THE RIGHT TEAM

Understand that it takes a highly functioning team to build a solid and sustainable business.

In order to do this, it is important to ensure that the clinic’s employees are the right people for the respective role, have the right attitude and are motivated to succeed.

The focus for the clinic should be to build and maintain a team that is highly situated around the culture of the clinic, is comprised of team members that are committed to the overall success of the clinic and are motivated (via compensation) to do so.

The team has the ability to either make or break the clinic, so should be chosen wisely.

4. ESTABLISH REPEATABLE OPERATING PROCEDURES

5. MANAGE CAPACITY

Aesthetic clinics operate in a highly variable environment with considerable demand fluctuations based on seasonality and other factors. It is therefore highly important that capacity, which can be defined as the output capability of the clinic, is managed effectively.

Capacity and cash flow are directly correlated because poor capacity management costs the clinic money in the form of staff that are not directly producing revenues, spaces that are not being used and money tied up in the form of inventory that is not being utilised. When capacity is not managed properly it can decrease available cash flow and negatively impact the profitability of the clinic as the company starts to spend more money than it is making.

Although a topic in its own right, it is paramount that the clinic recognise that improved capacity planning and management can directly equate to better cash flow and increased profitability, which is critical if the clinic wants to take itself to the next level.

Every clinic has a number of key performance indicators that should be routinely measured

Within any clinic, it should be the aim of management and the clinic owner(s) to establish repeatable operating procedures.

What this means is that the clinic should develop clear operating protocols that deliver repeatable and predictable results.

Such procedures can include how the clinic’s team deals with a new customers, booking procedures, customer service, complaints, complications and follow ups.

Consider how the airline industry utilises procedures to ensure that it can operate numerous complex functions simultaneously without issue. The adherence to procedures is the primary reason airlines can maintain control and keep passengers safe in what is an otherwise very complex business to operate with serious potential risks.

By establishing operating procedures that are situated around delivering predictable results, the clinic can then better predict the result of any interaction or function,.

This also allows the clinic owner(s) the ability to focus on growing the clinic rather then dealing with issues.

6. BE DISTINGUISHABLE

In today’s aesthetic market there are more and more clinics competing for a piece of the pie. Although the market is growing at a very healthy rate, it is important to determine ways in which the clinic can be memorable and distinguished from the competition.

It is not enough to simply open a clinic and hope it will grow. It is imperative that the clinic has a distinguishable look, feel and service offering that will both separate it from the competition but also create a verifiable distinguished impression for its customers.

Valentino and Christian Louboutin are great examples of fashion designers that have a distinguishable feature, which both separates it from the competition and becomes a signature that the brand is otherwise recognised for.

In some cases, becoming distinguished can not only lead to increased brand recognition, it can also lead to the ability to increase pricing and profit margins.

In respect to the aesthetic clinic, this can be the general atmosphere of the clinic, its ethos, additional services >

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the clinic offers to provide added value, the way in which it delivers its services and so on.

7. ADD VALUE

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It is important to determine ways in which the clinic can be memorable and distinguished from the competition

The value that a customer receives from each visit and interaction with clinic is paramount to the overall success of the business.

As it relates to the aesthetic clinic, value can be defined as the amount of satisfaction or benefit that the customer receives from the price they pay for the service or treatments they receive and the quality of interactions with the clinic itself.

If a customer believes that the clinic has provided more than they expected or catered to something that other clinics may not be addressing; the customer will likely

determine that they have received added value for their patronage.

Therefore, clinics should focus on adding value to their customers. To do so, clinics must understand the needs, wants and desires of their target market. No clinic can be everything to every customer, so it therefore becomes necessary to focus on adding value to the target market the clinic intends to focus upon.

8. USE PROMOTIONS TO CONTROL DEMAND

As previously mentioned, capacity management is paramount to the success of the clinic.

Too much capacity will equate to lower profitability as the clinic will invariably be spending more money to achieve a less than optimised financial result. Conversely, too little capacity and the clinic may not be able to deliver the value that it wants to deliver for its customers, which results in negative customer experiences and a detraction from the clinic’s strategy.

In order to reduce the potential for capacity to negatively impact the clinic, it is imperative that the clinic use promotions and marketing to effectively manage periods of weak demand or decreased bookings. By offering promotions during such times, the clinic can increase demand and therefore reduce idle capacity, which would otherwise negatively impact cash flow and profitability.

In summary, by focusing on the key points contained in this article, the clinic can increase its ability to grow, make more money and achieve its objectives. AM

Reece Tomlinson is a founding partner of RWT Growth, a fast-growing management consulting firm. They help businesses optimise their financial positions and advise on strategy, corporate finance, mergers and acquisitions, leadership, operations and information technology, across a number of industries.

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Europe’s

LEADING

manufacturer of aesthetic cannulas

Aesthetic injections need a cannula that is reliable, consistent and cost effective: perfect in every way.

Standard cannula walls

Ultra thin cannula walls

Sterimedix ultra thin cannula walls increase the inner diameter of the cannula and reduces injection forces

Sterimedix port hole shape matches the cannula diameter to optimise control and filler flow rate.

CLINICAL

CANNULAS

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Special delivery Dr Olivier Amar and Mr Shaheel Chummun on restoring contour defects with the Sterimedix GTI cannula (Amar) ABSTRACT

Tethered scars can often be unsightly and there is a growing desire of patients to improve the appearance of such scars.

The GTI cannula (Amar) has been specifically designed to divide the deforming forces in the tethered scars and help improve their appearance. An excellent patient satisfaction and operator ease of use was noted following the introduction of the cannula.

INTRODUCTION

Scarring, irrespective of the cause, can have a negative impact on the psychological wellbeing of patients, leading to an increased level of anxiety and self-consciousness (Tebble, Thomas et al. 2004). There is no doubt that the increased popularity of social media has made people more self-conscious about their appearance, and as a consequence, demand a simple and effective procedure to improve the quality of their scars and enhance their appearance. It is estimated that acne scars affect about 90% of adolescents worldwide.

Scarring is a normal physiological process of the body’s response to injury to the skin integument.

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Any injury to the deeper reticular layer of the dermis will lead to the formation of a scar. This can be a hypertrophic scar, a keloid scar or an atrophic scar (Gu, Li et al. 2018).

In keloid and hypertrophic scars, there is an abnormal accumulation of extra-cellular matrix, mainly in the form of collagen. On the other hand, an atrophic scar can be sunken, pigmented or hypopigmented, and is often seen in patients with facial acne. It is the loss of collagen, elastin and dermal fat that leads to the downward pull of the epidermis, producing the sunken appearnace typically seen in acne scars (Yug, Lane et al. 2006).

TREATMENT MODALITIES

While a variety of treatments have been described for the management of scars, it is primordial for the operator to carefully evaluate the cause of the scarring and subsequently formulate the most appropriate treatment plan. It is also crucial for the operator to manage the patient’s expectations so that the latter can understand what can be achieved. It is not unusual for a combination of treatment modalities to be used to manage the various components of a scar; resurfacing techniques, in the form

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CLINICAL

CANNULAS

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of chemical peels, lasers and dermabrasion, can be used to improve the contour of a scar, fat grafting and fillers can be used to replenish any loss of volume, and surgery used for revision and excision of scars (O’Daniel 2011; Cho, Park et al.

2006; Tanzi and Alster 2004; Gu, Li et al. 2018; Newberry, Thomas et al. 2018).

Fillers The use of fillers in restoring volume in the face has seen an exponential rise in the last decade and has been well documented.

More recently, fillers are being used more frequently, in combination with other treatment modalities, to replenish any volume loss seen in facial scars. It has been suggested that the ideal filler would recreate a subcutaneous scaffold, while stimulate the local tissue for neo-collagenesis (Beer 2007). There is some evidence that supports the use of poly-L-lactic acid and hyaluronic acid in the management of acne facial scars (Forbat, Ali et al. 2017).

to improve the quality of facial scars (Tenna, Cogliandro et al. 2017, Gu, Li et al. 2018). Under the right conditions, fat grafting can produce a stable, long term outcome, reducing the risks of fat graft resorption (Coleman 2006).

Subcision The tethering of the dermis by fibrous bands and the loss of the underlying connective tissue usually result in the depression seen in superficial scars (Barikbin, Akbari et al. 2017). Division of these fibrous bands forms the basis of subcision, and this can be achieved using sharp needles such as NoKor needles, cataract blades and wires. However, the safety and efficiency of subcision by using these needles have been questioned, as an increased incidence of injuries to the operator and to neurovascular bundles have been reported (Barikbin, Akbari et al. 2017). This has subsequently led to the development of blunt cannulas for subcision, that have been reported to be safer and more efficient (Barikbin, Akbari et al. 2017, Gheisari, Iranmanesh et al. 2018).

Scarring, irrespective of the cause, can have a negative impact on the psychological wellbeing of patients, leading to increased anxiety and self-consciousness

Fat grafting The success of autologous fat grafting in improving contour deformities and restoring volume loss while improving the quality of scars is well documented (Negenborn, Groen et al. 2016; Pallua, Baroncini et al. 2014). The use of nanofat with fat graft, and nanofat graft combined with platlet-rich plasma and fractional carbon dioxide laser has been shown

NEEDLES VS. CANNULAS

As the techniques for facial rejuvenation have involved over the years, there has been a shift towards the use of cannulas for delivery of the filler material to the desired anatomical location. The use of needles has been associated with increased pain, bruising, haematoma, and infiltration of vessels, resulting in catastrophic life-changing events, >

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CLINICAL

CANNULAS

including blindness (Hexsel, Soirefmann et al. 2012; Tansatit, Apinuntrum et al. 2017). On the other hand, the use of blunttipped cannulas is associated with fewer complications (Fulton, Caperton et al. 2012).

Moreover, cannulas have been shown to be superior at delivering the filler material most accurately at the desired anatomical area, with less spilling into the neighbouring tissues (Pavicic, Frank et al. 2017, van Loghem, Humzah et al.

2017). Nonetheless, one has to be cognisant of the fact that intra-vascular embolisation can occur with both needles and cannulas (Tansatit, Apinuntrum et al. 2017, van Loghem, Humzah et al. 2017). Intra-vascular embolisation can still happen (van Loghem, Humzah et al. 2017), even when a needle is applied perpendicular to the periosteum, a technique that was previously thought to be safe.

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This would often not be accurate as the area targeted would often fill with blood while the changeover of instruments is being carried out.

THE STERIMEDIX GTI CANNULA (AMAR)

The Sterimedix GTI cannula (Amar) is a new cannula that has been designed for the treatment of facial scars and contour defects on the face and body. It was felt that there was a gap in the operator’s repertoire required for the safe delivery of a filler agent or fat to restore contour defects, while performing subcision and to divide any adherent bands that may cause the tethering seen in scars.

To restore the contour defects seen in scars, the tethering bands are subcised, using either a sharp needle or blade, followed by infiltration of the desired volume to restore the contour. The GTI cannula (Amar) is specifically designed to do both, obviating the need for small blades and needles and additional cannula. The blunt cannula has a unique grooved tip that allows it to pass easily through the fibrous adherent bands, undertaking the subcision process as it passes through (Figure 1). With a conventional non-grooved cannula, considerable force is often required to pass the cannula through the scar tissue, which can potential cause more trauma to the surrounding structures or damage the cannula itself.

Figure 2. With the tethering bands divided, the deforming forces on the skin surface are removed.

Figure 3. The contour deformity can be corrected with filler/fat as the cannula is withdrawn.

Figure 1. The grooved tip allows easy glide of the cannula through the scar tissue, while performing a subcision.

As the GTI cannula (Amar) divides the restricting bands, the tension from the overlying skin is released (Figure 2), allowing the operator to accurately deliver the filler agent or fat at the desired location (Figure 3). This would be difficult with a non-grooved cannula, as the operator would need to remove the small blade used for the subcision and then introduce a cannula for the delivery of the filler agent.

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The GTI cannula (Amar) also has a black arrow at the base of the needle, which is in line with the side opening of the cannula. This allows the operator to orientate the cannula and accurately place the filler material at the desired location in a much more controlled fashion.

The first Sterimedix GTI cannula (Amar) was the 25g 40mm cannula that comes with a 23g pre-hole sharp needle (GTI 1). It is designed to fit like any other cannula on any filler syringe and can also be used with Luer lock syringes for fat transfer.

Its fine bore makes it very useful for facial scars and small superficial scars on the body. Following the ease of use and satisfaction from both operators and patients with the 25g cannula, a second cannula, the GTI 2, with similar design as the GTI 1 but with a longer and wider bore (18g 80mm) (Figure 4) and a 19g pre-hole sharp needle, was designed to address denser scars on the body. This proved to be equally successful in operator and patient satisfaction.

Figure 4. The wider calibre and longer GTI 2 cannula® (Amar),18g 80mm, designed for thicker scars on the body

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CLINICAL

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CASE STUDY 1 A 49 year-old patient with a depressed scar to the forehead (Figure 5) was managed with the GTI 1 cannula (Amar) where subcision was performed to release the underlying deforming bands and the contour deformity was restored with non-permanent filler. The final result, immediately after the procedure, shows restoration of the contour and no bruising or haematoma (Figure 6).

CANNULAS

CASE STUDY 2 This patient presented with a tethered scar on her lower abdomen (Figure 7). The pre-hole needle was used to create the guide hole through the thick caesarean section scar, through which the wide bore GTI 2 cannula (Amar) 18g 80mm was inserted to divide the tethering bands (Figure 8. Nonpermanent filler was used to improve the contour of the area (Figure 9).

Figure 7. Patient presenting with tethered lower abdominal scar Figure 8. The pre-hole needle used to puncture the thick scar to provide the guide hole. The GTI 2 cannulaÂŽ (Amar), 18g 80mm, is inserted into in the guide hole in the thick scar before the tethering bands of the scar in the suprapubic area are subcised with the cannula.

Figure 5. Depressed scar to right forehead

Figure 6. Contour deformity to right forehead restored using the GTI 1 cannula (25g 40mm), with minimal bruising

Figure 9. The tethered area in the middle of the scar has been released and the contour improved with non-permanent filler

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CLINICAL

CANNULAS

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CONCLUSION

The GTI cannula (Amar) has been specifically designed to allow the operator to safely divide any fibrous tethering and deforming structures and allow for a safe and accurate restoration of volume, in a bid to enhance the contour of any scar. Our initial experience has shown the cannulas to have a high patient and operator satisfaction. AM REFERENCES Barikbin, B., Z. Akbari, M. Yousefi and Y. Dowlati (2017). “Blunt Blade Subcision: An Evolution in the Treatment of Atrophic Acne Scars.” Dermatol Surg 43 Suppl 1: S57-S63.

Beer, K. (2007). “A single-center, open-label study on the use of injectable poly-L-lactic acid for the treatment of moderate to severe scarring from acne or varicella.” Dermatol Surg 33 Suppl 2: S159-167 Cho, S. B., C. O. Park, W. G. Chung, K. H. Lee, J. B. Lee and K. Y. Chung (2006).

“Histometric and histochemical analysis of the effect of trichloroacetic acid concentration in the chemical reconstruction of skin scars method.” Dermatol Surg 32(10): 1231-1236; discussion 1236.

Coleman, S. R. (2006). “Structural fat grafting: more than a permanent filler.”

Plast Reconstr Surg 118(3 Suppl): 108S-120S. Forbat, E., F. R. Ali and F. Al-Niaimi (2017). “The role of fillers in the management of acne scars.” Clin Exp Dermatol.

Fulton, J., C. Caperton, S. Weinkle and L. Dewandre (2012). “Filler injections with the blunt-tip microcannula.” J Drugs Dermatol 11(9): 1098-1103.

Gheisari, M., B. Iranmanesh and B. Saghi (2018). “Blunt cannula subcision is more effective than Nokor needle subcision for acne scars treatment.” J Cosmet Dermatol.

CASE STUDY 3 This patient presented with a tethered dense scar of her back (Figure 10). The wider bore GTI 2 cannula (Amar) was used to release the tethered scar and nonpermanent filler was used to improve the contour of the scar (Figure 11).

Gu, Z., Y. Li and H. Li (2018). “Use of Condensed Nanofat Combined With Fat Grafts to Treat Atrophic Scars.” JAMA Facial Plast Surg 20(2): 128-135.

Hexsel, D., M. Soirefmann, M. D. Porto, C. Siega, J. Schilling-Souza and C. Brum (2012). “Double-blind, randomized, controlled clinical trial to compare safety and efficacy of a metallic cannula with that of a standard needle for soft tissue augmentation of the nasolabial folds.” Dermatol Surg 38(2): 207-214.

Negenborn, V. L., J. W. Groen, J. M. Smit, F. B. Niessen and M. G. Mullender (2016). “The Use of Autologous Fat Grafting for Treatment of Scar Tissue and Scar-Related Conditions: A Systematic Review.” Plast Surg Nurs 36(3): 131-143.

Newberry, C. I., J. R. Thomas and E. W. Cerrati (2018). “Facial Scar Improvement Procedures.” Facial Plast Surg 34(5): 448-457.

O’Daniel, T. G. (2011). “Multimodal management of atrophic acne scarring in the aging face.” Aesthetic Plast Surg 35(6): 1143-1150 Pallua, N., A. Baroncini, Z. Alharbi and J. P. Stromps (2014). “Improvement of facial scar appearance and microcirculation by autologous lipofilling.” J Plast Reconstr Aesthet Surg 67(8): 1033-1037.

Figure 10. Depressed scar on the back, released with the wider bore GTI 2 Cannula (18g 80mm) and volume restoration with non-permanent filler

Pavicic, T., K. Frank, K. Erlbacher, R. Neuner, S. Targosinski, T. Schenck, R. H. Gotkin and S. Cotofana (2017). “Precision in Dermal Filling: A Comparison Between Needle and Cannula When Using Soft Tissue Fillers.” J Drugs Dermatol 16(9): 866-872 Tansatit, T., P. Apinuntrum and T. Phetudom (2017). “A Dark Side of the Cannula Injections: How Arterial Wall Perforations and Emboli Occur.” Aesthetic Plast Surg 41(1): 221-227 Tanzi, E. L. and T. S. Alster (2004). “Comparison of a 1450-nm diode laser and a 1320-nm Nd:YAG laser in the treatment of atrophic facial scars: a prospective clinical and histologic study.” Dermatol Surg 30(2 Pt 1): 152-157 Tebble, N. J., D. W. Thomas and P. Price (2004). “Anxiety and self-consciousness in patients with minor facial lacerations.” J Adv Nurs 47(4): 417-426.

Tenna, S., A. Cogliandro, M. Barone, V. Panasiti, M. Tirindelli, C. Nobile and P. Persichetti (2017). “Comparative Study Using Autologous Fat Grafts Plus Platelet-Rich Plasma With or Without Fractional CO2 Laser Resurfacing in Treatment of Acne Scars: Analysis of Outcomes and Satisfaction With FACE-Q.” Aesthetic Plast Surg 41(3): 661-666. van Loghem, J. A. J., D. Humzah and M. Kerscher (2017). “Cannula Versus Sharp Needle for Placement of Soft Tissue Fillers: An Observational Cadaver Study.”

Aesthet Surg J 38(1): 73-88

Figure 11. Contour deformity improved following subcision and volume restoration

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Yug, A., J. E. Lane, M. S. Howard and D. E. Kent (2006). “Histologic study of depressed acne scars treated with serial high-concentration (95%) trichloroacetic acid.” Dermatol Surg 32(8): 985-990; discussion 990.

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PRODUCTS

PRODUCT NEWS

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INDIBA DEEP CARE LAUNCHES NATIONWIDE

INDIBA Deep care is a clinically proven, non-surgical, noninvasive and pain-free device offering treatments such as skin tightening, cellulite reduction and scar improvement.

It can also help reduce recovery time following aesthetic and surgical procedures and can be used to address skin conditions such as psoriasis and rosacea. Results can be seen after just one session, the company says.

PINK INTIMATE VAGINAL REJUVENATION SKIN TREATMENT LAUNCHES IN UK

The Pink Intimate System, distributed by Trimedica, aims to restore a more youthful, healthy appearance to the vaginal and sensitive-area tissues, as well as tighten, lift and whiten skin with ingredients such as vitamin B12, bisabolol, ionic acid, rucinol and glycyrrhiza glabra root extract.

It can be used on external imitate areas including the labia majora and the perianal region around the anus. It can also be used to whiten other areas of the body such as underarms, elbows, knees, glutes and areola.

AESTHETIC SOURCE TO SUPPLY LIGHTSTIM® LED DEVICES AND BEDS

Aesthetic Source will be supplying professional and athome hand-held LED devices and LED Beds thanks to new partnership with FDA-cleared US brand LightStim.

LightStim’s proprietary Multi-Wave technology simultaneously emits multiple wavelengths of light that stimulate collagen and elastin production to reduce wrinkles.

CYNOSURE ADDS STIMSURE TO BODY CONTOURING PORTFOLIO StimSure is a non-invasive electromagnetic muscle building and toning treatment designed for use on the abdomen, buttocks and thighs.

StimSure uses 1.0 Tesla per applicator, providing an electromagnetic field 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.

StimSure is only available in selected countries within the EMEA and Australasia regions. It is not available in the US.

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PRIORI INTRODUCES NEW PRODUCTS

Skincare brand PRIORI has expanded its Genetic Protection Factor (GPF) line with DNA Intense Recovery Creme and DNA Eye Recovery Creme.

Both products feature proprietary GPF protection, which blocks 43% of harmful HEV blue light emitted from everyday electronics and protects from damage caused by pollution and environmental factors.

The brand has also launched PRIORI Smart Peel Pads delivering a multi-layer of AHA resurfacing to remove only the outermost layer of dead skin cells for fresher and healthier skin.

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PRODUCTS

PRODUCT NEWS

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NIMUE SKIN TECHNOLOGY LAUNCHES MICRONEEDLING

Nimue has launched microneedling treatments. The cylindrical roller device is studded with 192 sterile, fine, stainless steel needles. The device has needle lengths of 1mm and a diameter of 0.2mm, with the top of the needle tapered to a point of 0.07mm. This shape is specifically designed to make the treatment less painful for the clients while not reducing the collagen induction process. The treatment can be combined with Nimue’s TDS and Super Fluids.

THERADOME LAUNCHES EVO LH40 HAIR RESTORATION DEVICE

Theradome has introduced the EVO LH40 Laser Helmet device. It contains 40 cool lasers, which flood coherent light across the scalp, penetrating at an optimum depth of 3-5mm in order to stimulate the base of the hair follicles and promote hair regrowth.

Theradome EVO LH40 is a cordless and portable device that patients can use in their own homes. It features a one-touch button function, accompanied by a user-friendly guided voice command function and has a USB charging port that allows the battery to be charged and can be used hands-free.

REVILO INTRODUCES NON-NEEDLE NANO MESO DEVICE

The Skin Refiner Nano treatment hydrates and stimulates collagen to reduce lines, wrinkles, redness and pigmentation and to balance the skin and refine pores. It also claims to increase the absorption of products into the skin from around 30% up to 70%.

The treatment uses disposable silicone tips rather than needles and therefore has no downtime.

5 SQUIRRELS INTRODUCES GLYCOALA

ELÉNZIA LAUNCHES AT THE DR RITA RAKUS CLINIC

Dr Rita Rakus has added elénzia’s Endor Technologies range to her London clinic.

The brand utilises nano gold technology to stimulate the natural production of hyaluronic acid, collagen and elastin.

Products include the Celltense serum, which boosts and accelerates the efficacy of radiofrequency for anti-ageing and cellulite reduction and the Hyalgen™ serum to enhance the effects of radiofrequency facial skin tightening treatments. Both are clinically proven to increase the effects by 18%. The brand also offers a skincare line for home use.

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5 Squirrels and Alamed technologies have introduced GlycoAla, a photodynamic gel that claims to maximise the benefits of using phototherapy devices by addressing issues such as poor patient tolerance, pain, long incubation times and high levels of downtime.

The product includes hyaluronic acid and utilises an advanced glycosphere nanoparticle delivery system which enables enhanced penetration into the skin to help improve tone, reduce sun damage and ageing, minimise pore size, promote hydration and improve the effects of moisture retention.

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introducing

the neXT generation of HydraFacial™ MD Elite™

THE hydrafacial ELITE™ IS our LATEST SYSTEM WITH unique ADVANCEMENTS TO ENSURE YOUR SUCCESS. With an enhanced user interface, LED light therapy, mechanical lymphatic drainage and a Perk delivery switch as standard...

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for more information on the hydrafacial elite: Tel: 01788 572 007 email: infouk@hydrafacial.com HydraFacial UK is now a direct business and part of the global HydraFacial Company bringing you the same high level of customer service, combined with the benefits of greater brand visibility, more investment and the increased support that comes from being part of world wide business.

P RO D U CT FO C U S

SKINADE MD

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Heal from within Nutraceutical brand Skinade has developed a product specifically for aesthetic practitioners to retail to patients for improved post-surgery recovery

D

rawing on the properties of its original formula, Skinade has launched a programme of products to help improve clients’ skin health recovery after surgical aesthetic procedures.

Skinade MD comprises liquid and powder sachets, capsules and a sublingual spray. The protocol covers a 45-day period and is designed for patients to start before their procedure. The four-step protocol comes with a tick box planner to help patients track their programme, indicating when and how often to take each product.

The programme is suitable for patients undergoing a wide range of surgical procedures, from face-lifts and breast enhancements to hair restoration; offering practitioners a wide scope for extra retail revenue.

The brand says the programme helps with bruising, scarring, swelling, inflammation and bleeding, through the use of ingredients including: collagen peptides to trigger fibroblast cells to produce collagen and hyaluronic acid, vitamin B complex to support nutrient delivery through optimising capillary dilation, flaxseed oil to lower inflammation, nettle leaf 2% silica powder extract for the formation of connective tissue after surgery; and arnica montana to target bruising and swelling.

The other ingredients are: vitamin C, methylsulfononylmethane (msm), L-lysine, N-acetyl-l-cysteine, calcareous marine algae, papain, magnesium citrate, staphysagria, cardus marianus, thlosinaminum, L-glutamine, bromelain, zinc gluconate, vitamin A-retinol acetate, natural mixed carotenoids, copper bisglycinate, sodium selenite, citrus bioflavonoids, quercetin dehydrate, hypericum perforatum, calendula officinallis, graphites; and vitamin K1.

Consultant plastic surgeon Mr Dalvi Humzah says, ‘’Skinade MD comes as a direct result of a postprocedure protocol conversation I had with the brand a few years

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back. The Skinade MD Pre+Post Care Programme will be offered to my patients as a key part of my procedure protocols. It will enhance my patients’ experience for better results and reduced downtime.”

• Step 1 is designed to trigger a targeted wound-healing response ahead of surgery so that the body is already providing the key materials to promote quicker healing • Step 2 removes omega and B-vitamin-containing compounds to prevent excess bleeding and bruising closer to surgery, and begins to support and prepare the body with actives to reduce scarring and scar thickening and inflammation • Step 3 continues to support the mechanisms from step 2 and steps up vitamin A intake to help with normal cell proliferation • Step 4 re-introduces omegas 3 and 6 and the vitamin B complex to re-establish normal skin function, resupplying the peptide load in the dermis. AM

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W EI G H T LOS S

TREATMENT SPOTLIGHT

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Inflate to deflate We speak to weight loss surgeon Mr Simon Monkhouse about the Elipse intragastric balloon

I

n 2018 the chief executive of Public Health England, Duncan Selbie, announced that, “Britain needs to go on a diet.” With almost two-thirds of adults in the UK classified as overweight or obese – the highest levels in Western Europe – and obesity costing the NHS £6 billion a year due to an increase in serious diseases like diabetes, cardiovascular disease and certain types of cancer, it’s no wonder that weight loss will be one of the main things topping New Year’s resolution lists this January.

It’s also no surprise that demand for non-invasive procedures which assist in shedding the pounds is on the rise too.

The Elipse Balloon from Allurion is one such device. Billed as “the first and only procedure-less intragastric balloon for safe and rapid weight loss”, the treatment was first launched in Europe in 2017 and has now been used by over 20,000 patients globally.

The balloon was masterminded by Allurion founders Dr Sammy Levy and Dr Shantanu Gaur, both Harvard Medical School graduates. The thin polymer film balloon is encased in a capsule the size of a pill and is swallowed with water and then

inflatedonceinsitu.Itrequiresnoanaesthetic,sedation,surgery or endoscopy.

Weight loss surgeon Mr Simon Monkhouse was one of the first in the UK to start offering the procedure in May 2018.

He says, “It’s like a little pill which contains the deflated balloon. You swallow it down with a glass of water.

It has a very fine little tube attached to it so, when it goes down into your stomach, you’ve got this little tube hanging out through your mouth. We do an X-ray to make sure it’s in the stomach and then attach it to a 550ml bag of pressurised sterile water.

The balloon starts to inflate and we take another X-ray to make sure it’s all looking good and then we pull the tube off.

“It only takes 20 minutes to do, in fact we did one today in 16 minutes. You literally just walk in, sit down on a chair, swallow the balloon, have a couple of X-rays and then walk out again, so you can drive yourself to the clinic and carry on with your normal day.

The insertion procedure is painless and very straightforward and the balloon deflates itself. There is a little release valve on it that is held together by a stitch that is heated up by

It’s a bit like having a personal trainer and not going to the gym. You’ve got to put the effort in

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W EI G H T LOS S

aestheticmed.co.uk

your body temperature and is designed to dissolve after four months so when that stitch dissolves the release valve opens, the water spills into your stomach harmlessly and you then pass the casing out through your normal digestive tract.”

The balloon offers a lower-risk option for those who don’t want to have or are unsuitable for bariatric surgery.

It’s particularly good for those with a BMI between 27 and 35 but has demonstrated a good safety and efficacy profile with patients with a higher BMI who manage to lose 30 pounds. They also have the option to have a second or third balloon if they want to continue in their weight journey. Mr Monkhouse explains, “You have to have a BMI of 35 in order to have weight loss surgery, so you’ve got this whole range of patients between overweight and morbidly obese where there isn’t really much you can do to help people other than suggest diets and exercise. That’s where the balloon fits really nicely.”

One of the other benefits is that the balloon gives patients a “honeymoon from hunger” as it not only makes them feel full after a smaller portion but slows the digestion of the food itself.

Mr Monkhouse says, “The idea is that you feel full after a small portion and also it delays food leaving your stomach, so you feel fuller for longer. You don’t tend to feel hungry which makes it very different to a diet. On a diet you are constantly hungry and that’s one of the main reasons for failure, whereas with this you are not consumed by hunger so you can focus on the behavioural change.”

Another advantage is that the balloon reduces many of the risks associated with other procedures. Mr Monkhouse says, “In my mind, the Elipse Balloon replaces the other balloons we’ve been using for years, which needed to be placed and removed endoscopically and under general anaesthetic. The whole process of putting it in and taking it out is quite risky in terms of perforations of the stomach or anaesthetic problems, etc., so this balloon just eliminates that risk, but it is not risk free. They did a study of 10,000 Elipse balloon placements and 98% of patients had no trouble at all. The 2% who had trouble experienced after-effects like not being able to cope with the balloon, ongoing nausea and vomiting, the balloon deflating early, bowel obstruction and pancreatitis, but the percentage complications for each of these things were of the order of 0.03%, so very, very low.”

If a patient does have any problems, the balloon can be taken out endoscopically in the same way as other balloons, which is

TREATMENT SPOTLIGHT

why Monkhouse stresses that anyone offering the procedure should have the skills to manage any complications, even though they are rare.

He says, “I strongly believe that if you do something like this you have got to be able to manage the complications.

In the initial consultation you need to have somebody who is knowledgeable about the risks and how to manage them.”

Clinical trials have shown that the balloon typically results in 10% to 15% total body weight loss, with an average loss of 15kg (2.3st) but Mr Monkhouse stresses that success depends on patients following the programme, not just having the balloon in isolation.

He says, “I have personally done about 130 now and the success is like a bell-shaped curve. You’ve got some people who are absolute stand out successes, they lose five stone and it really transforms their lives and then you’ve got other people at the other end of the spectrum who don’t lose very much at all and see it as less of a success and that is down to them not engaging in the programme. The balloon is only part of the deal.

“The deal is an education and training programme for the four months. So you have five consultations with our dietician, Lucy Jones, an app and some Bluetooth smart scales, so there’s a lot of interactivity. The idea is that it’s all done at your convenience in your home, so all the dietician appointments are done via facetime or skype. If you really engage with the programme then you should be able to make long term changes, but if you have the balloon and drink a bottle of wine a night and eat chocolate and ice cream you are not going to lose the weight.

“We’ve got very clear evidence that those who commit to it do well. It’s a bit like having a personal trainer and not going to the gym. You’ve got to put the effort in. The key message is that it’s not a magic pill, it’s a tool to help you, but if you don’t help yourself it won’t work.” AM

Mr Simon Monkhouse is a consultant weight loss surgeon in Surrey offering a full range of weight loss procedures, both surgical and non-surgical. He has placed over 130 Elipse balloons and long term aftercare with a multidisciplinary team at the core of his practice. simonmonkhouse.com

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T R E AT M E N T S

REVIEW

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Tried and tested Georgia Seago tries Fusion GT Biodermogenesi

B

iodermogenesi has been garnering attention for its impressive results on stretch marks since it launched in the UK at the start of 2019. The non-invasive skin-rejuvenation device combines electromagnetic field, electro-stimulation and vacuum technologies and claims to regenerate the skin by reorganising its structure.

Specifically, Biodermogenesi works to increase type III collagen and elastin as well as cell mitosis, while it also boosts skin’s hydration and normalises its pH, causing a reduction in inflammation. It can treat skin laxity, cellulite, stretch marks, scars and burns; and can also be used for vaginal rejuvenation and atrophy.

I visited the Fusion GT clinic in London to have the cellulite on my buttocks and the backs of my thighs treated by executive manager Tiziana Giovanelli. After explaining how the treatment works and taking pictures of the area, Giovanelli began by applying a hyaluronic and amino acid serum. First, she did a gentle microdermabrasion treatment over the area – an abrasive pad attached to the vacuum hand piece – to remove dead skin cells and prepare the surface for optimum absorption of the electro-stimulation to follow.

Before beginning the second part of the treatment Giovanelli asked me to hold the Bio-Feed-Back hand piece. This allows the practitioner to keep track of the skin tissue temperature during treatment. Giovanelli applied body oil to the skin to facilitate smooth movement of the electro-stimulation hand piece. She passed it over the area in a pattern specific to the cellulite protocol, explaining that there are particular movements to best target different indications.

I was completely relaxed and comfortable throughout the treatment. A firm, massage-like pressure was the only sensation I felt. This, coupled with no downtime, no side effects, according to Fusion GT, and no limitation to sun

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exposure post-treatment, makes it a very appealing option for patients. Dr Alex Baker of Bader Medical was the first doctor in the UK to use the device in clinic. He comments: “No other treatment currently available is able to ensure that stretch marks disappear completely and return to the normal skin appearance.

“With the Biodermogenesi method we can straighten rough skin, and by improving melanocytes in the treated area we help stretch marks gain colour, even late term marks, which no other treatment can do.”

Six to nine treatments are recommended for most patients to achieve optimum results, generally costing around £2,200 per course.

Biopsies have shown an increase in collagen and elastin fibres and greater cell reproduction, while clinical studies are available that show stability of results after more than five years. AM

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BREAKTHROUGH INNOVATION to target accelerated collagen loss and skin ageing caused by menopause.

Clinical studies show that low oestrogen levels result in up to 30% loss of skin’s collagen in the first 5 years of menopause1.

Emepelle® featuring breakthrough MEP Technology® is clinically proven to address the root cause of accelerated skin ageing caused by menopause.2,3

FEMALE, AGE 60

“93% of study participants responded that the combination of Emepelle Serum and Night Cream regimen helped improve wrinkles, texture, and colour.”

Joel L. Cohen, MD, clinical study on Emepelle published in the Journal of Drugs in Dermatology.

BASELINE

WEEK 8

Photos courtesy of Joel L. Cohen, MD.

Find out how you can empower your clients to confidently and effectively manage the ageing process of their skin with Emepelle®.

REFERENCES 1. Archer DF. Postmenopausal skin and oestrogen. Gynecol Endocrinol. 2012;28(suppl 2): 2-6. doi:10.3109/09513590.2012.705392. 2. Draelos ZD. A double-blind randomized pilot study evaluating the safety and efficacy of topical MEP in the facial appearance Improvement of oestrogen deficient females. J Drugs Dermatol. 2018;17(11):1032-1035. 3. Joel L. Cohen MD: Evaluation of Efficacy of a Skin Care Regimen Containing Methyl Estradiolpropanoate (MEP) for Treating Estrogen Deficient Skin J Drugs Dermatol. 2019;18(12):1226-1230. .

aestheticare.co.uk/emepelle 0800 0195 322 info@aestheticare.co.uk

I NTERVI EW

TALKING TO...

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All at sea Vicky Eldridge speaks to plastic surgeon David Gateley about his recent adventure taking part in the Unicef UK Round the World Clipper Race

P

irates, porpoises and plastic surgeons are not words you would usually associate with one another, but the recent adventures of surgeon Mr David Gateley have led me to write about them all in the same story nonetheless.

There are two things I most admire in people – a spirit of adventure and dedicating their time to help others. Both of these things often come together when people set out to overcome personal challenges in order to raise funds for charity, which is just what Mr Gateley has done.

At the time I spoke to him, he’d just returned from almost eight weeks away from home, taking part in the first leg of the epic round the world clipper sailing race in aid of UNICEF UK and his own chosen charity, Child Action Nepal (CAN).

Mr Gateley is a trustee of CAN and regularly visits Kathmandu, where he also provides teaching and surgery at a specialist hospital. What appealed to him with CAN was working with a hospital where he knew the patients would be supported after he left. He says, “Plastic surgery is a specialty that I think translates very well to developing countries because you don’t need much ‘kit’. It works at many levels, which is why I love it.

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“My first venture into work abroad was in Sierra Leone and I realised that, although it was great to fly in and help the kids and the adults with their burns and their traumatic injuries, the problem was that there was very little good aftercare once you left. If you do surgery on someone and they don’t get the right rehab you can make them worse,” he says. That was why Nepal appealed to me, because I go into a local cleft and burns plastic surgery unit that has residents and consultants. I am able to go in and help them, assist their trainees to do the surgery, and then come out again knowing that the patients would be well looked after.”

SETTING SAIL

A keen sailor, Mr Gateley was inspired by the idea of taking on an endurance race if it meant he could also raise funds for charity. And the Clipper Race is an endurance test like no

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I NTERVI EW

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other. Created by Sir Robin Knox-Johnston, the first person to sail solo non-stop around the world, the 40,000 nautical mile race is now in its 12th edition.

“I’m a bit of a dreamer”, Mr Gateley says. “I’d known about the Clipper Race for a few years. I guess everyone dreams about doing things like that and then, as is often the case, things moved into position so that it actually becomes doable. I left the NHS about four years ago, so I am now in private practice full-time, which means I have much more control over my diary and my life.”

So, in September 2019, Mr Gateley, who is the founder of DRG Plastic Surgery in Harley Street and nakedhealth MEDISPA in Wimbledon, swapped his surgical instruments and operating theatre for ropes, sails and the open ocean as he boarded the 70-foot racing yacht and made the 7,250mile passage from St Katherine Docks in London to Punta del Este, Uruguay.

He joined Team Guy, a crew of 60 people aged between 18 and 74, for the voyage known as the Atlantic Trade Winds Leg, sailing first to Portugal and then via the Canaries towards the equator, through the dreaded Doldrums, and on to South America.

Each of the 11 identical racing yachts that takes part has a fully-qualified skipper, but the crew is made up of ordinary, every-day people, some of whom had only ever sailed as part of the training programme required to take part.

Mr Gateley says, “I’ve never done what’s called ‘off shore’ sailing, I’ve done lots of coastal sailing, but with the remit that you will pull into port that night, moor up the boat and get to the nearest pub.

“Even the training weeks involved getting on a boat in Gosport and going out into the channel. You might stay overnight on the boat once or twice but on the whole you went back to port that night. Nothing really prepares you for the actual race conditions. You have no choice, whatever the weather, if you can’t scoot round it, you will go through it. You can’t turn round to the skipper and say ‘actually I feel sick, can you drop me off ?’. You’re on a journey and you can’t get off. Although I appreciated that was exactly what was going to happen, there were some people whose mouths began to drop when they realised they were in a situation that was dangerous,” he says.

“We hit some very bad weather in the Bay of Biscay – gail force conditions. When there’s wind the boat is always over on its side so you are literally climbing up inside the boat

TALKING TO...

and, because it’s so heeled over, everything has to be done more slowly with absolute concentration. In the first weeks we had fractured ribs and a scolded forearm from hot water in the galley. We had to be really careful.

“By the time we got to Portugal four people said, ‘I can’t do this’ and got off for a variety of reasons, so there’s a slow attrition of people getting off the boat, not just through injury but through fear, and that’s a very mental thing.”

While weather was one of the unpredictable fear factors of the trip, Mr Gateley said he only really ever felt afraid for his life when they were stalked by pirates. He says, “We were watched by them for two nights off the coast of Africa. They’d come out at dusk in a big boat and drop rigid inflatables and come up close to us about two boat lengths away with a torch to see how many crew were on board, so that was a bit frightening.”

But the trip was also life-changing and Mr Gateley had many memorable experiences. He says, “I absolutely loved it. It’s just extraordinary. You are sleeping at night in a bunk with about 10cm between you and the ocean on the other side of the hull and you can hear the water whooshing past.

“We had a wonderful crossing across the Atlantic and got to see an extraordinary amount of aquatic life. We saw different types of whales, porpoises, flying fish, migratory birds and some albatross. It was just amazing. At the equator about five of us jumped off the boat when it was stationary because there was no wind and swam in water 5km deep.

“It is life changing because you have a lot of time to reflect.

You are on a watch system so you are either in bed, eating or on watch. There’s a lot of time to think about stuff.”

So would he like to do another challenge? “At the moment my wife Julia has the upper hand so I can’t claim to do anything”, he jokes. “My eldest son is doing the Marathon des Sables race through the Sahara, so we will focus on that next year and I will just be a support person. I’d like to do something else but I can’t think what yet. I’m still thinking about and reveling in what I did.“ AM There’s still time to donate to Mr Gateley’s fund.

Simply visit justgiving.com/davidgateley

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H A I R R E S T O R AT I O N

COMPLEMENTARY THERAPY

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A complementary alternative Benedetto Cusumano discusses using complementary medicine in the treatment of hair loss

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t TrichoCentre, we are always looking for new and innovative ideas to treat hair loss conditions.

Given the psychological impact of hair loss, many patients turn to less conventional treatments, when mainstream hair restoration treatments fail.

According to statistics provided by the National Centre for Complementary and Integrative Health, more than 30% of adults and 12% of children use treatments established outside of what is considered “conventional medicine”.

Hair loss can be caused by many different factors including genetics, hormones, medication or diet, and the use of complementary medicines can provide added benefits as vitamins and minerals play a vital role in hair health. Beyond oral treatments, wellbeing practices such as acupuncture and massage can help reduce stress, another key contributor to hair loss.

However, few complementary treatments are backed by controlled trials nor regulated by the Food and Drug Administration – a US marker of safety and efficacy respected the world over. In this article, we will explore the effectiveness of the use of natural products and wellness practices as a way of treating hair loss.

and zinc, taken four times daily. The result was a significant increase in hair count over a 50-week study.

Lysine is an amino acid found in meat and dairy products and is thought to play a vital role in how the body absorbs iron. A supplement of L-lysine, in combination with iron, vitamins B and C and selenium (an essential mineral and micronutrient necessary to human health), resulted in a 39% reduction in hair loss after six months, in addition to a recorded increase in serum ferritin levels (the amount of ferritin in the blood) in women who had not seen positive results using an iron supplement alone.

Methionine is a further amino acid vital for keratin, and studies have suggested that L-methionine could play a key role in slowing down the start of greying hairs. However, to date, there have been no human studies that indicate that L-methionine is beneficial in the treatment of hair loss.

NATURAL PRODUCTS

Natural products include vitamins, minerals, herbs and flowers, all of which can be found in any health store, marked as dietary supplements.

Amino acids Amino acids are one of the few natural alternatives that have been studied in clinical trials for use in the treatment of hair loss – specifically, cystine and lysine, is an amino acid that occurs in keratin and other proteins.

Cystine is derived from cysteine through oxidisation, providing strength and rigidity between keratin strands.

Oral L-cystine has been studied, in combination with retinol (otherwise known as vitamin A) in the treatment of diffuse alopecia, with recorded increases in both hair density and growth rate.

Oral L-cystine has also been studied in combination with histidine (an α-amino acid that is used in the biosynthesis of proteins), copper

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those studied, however, further studies are needed to confirm the preliminary results of the effectiveness of pumpkin seed oil on hair loss.

Rosemary oil Rosemary is a fragrant herb, with potent antioxidant and anti-inflammatory agents. When tested using a topical lotion, applied daily, the use of rosemary oil demonstrated a meaningful increase in hair count over six months. The results of the study are worthy of further analysis and research.

Caffeine Caffeine is an organic compound that functions as a phosphodiesterase inhibitor (a drug that blocks one or more of the five subtypes of the enzyme phosphodiesterase).

Studies have shown that caffeine counteracts the inhibitory effects of the hormone testosterone on hair growth. Research has focused on the use of caffeine as a topical treatment.

Using a caffeine-based shampoo daily demonstrated less hair shed through brushing and reduced the overall amount of hair loss.

Caffeine lotions have revealed similar results, and topic caffeine treatments show real potential as a treatment for hair loss, however, more studies are needed to confirm this.

Vitamin B (biotin) Biotin deficiency has been reported in 38% of healthy women suffering from some form of hair loss, and although biotin supplements are said to be beneficial in treatment, there have been no studies to evaluate the effects of biotin in the treatment of alopecia.

Current clinical evaluation suggests that biotin should only be recommended as a treatment for hair loss in instances where biotin deficiency is a secondary cause.

Complementary medicine offers options to reduce hair loss with fewer side effects than conventional methods

Curcumin Curcumin is the active ingredient in turmeric and has been used for centuries as an anti-inflammatory. An excellent general tonic, it is also good for the circulation of blood in the body. After six months of studies, no significant improvement in total hair count was reported through the use of a topical extract of curcumin (curcuma aeruginosa). However, it was shown to increase the epidermal absorption of Minoxidil (MXD), a topical treatment for promoting hair growth in people with androgenic alopecia, when used in combination, potentially acting as an improved delivery agent.

Onion juice Onions are naturally high in dietary sulfur. In an evaluation of 62 patients, 87% treated with onion juice demonstrated full hair regrowth at eight weeks, with the most common reported side effect being the disagreeable odour.

Pumpkin seed oil High in zinc and a good source of vitamin B, iron and protein, pumpkin is known to prevent the conversion of testosterone to active dihydrotestosterone, which is a hormone linked to hair loss.

Pumpkin seed oil taken orally, once a day over 24 weeks showed an improvement in hair count for

Vitamin D Vitamin D receptors are intercellular receptors expressed in hair follicles, which are needed for healthy hair growth. Studies have shown that the knockout of these receptors in mice resulted in almost total hair loss at eight months.

Multiple studies have investigated the effectiveness of vitamin D supplements, taken orally, in the treatment of alopecia, but failed to support its benefit. However, in instances where alopecia was associated with reduced vitamin D receptors, complete clinical remission was reported after using a topical lotion daily for three months. Furthermore, those using a topical cream twice daily for 12 weeks had more than 50% regrowth in 65% of patients. From these preliminary studies, there is a potential therapeutic benefit for the use of topical vitamin D, with minor side effects.

Zinc A deficiency in the mineral zinc can impede growth, delay puberty, cause diarrhoea and alopecia and decrease a personâ&#x20AC;&#x2122;s immunity levels. Using zinc to tackle alopecia has been studied as both a topical solution and oral supplement. Positive results were seen in 67% of patients taking an oral dose of zinc daily, with one study demonstrating complete resolution in a child suffering diffuse alopecia. Results from the use of a topical solution were not as remarkable, with only a moderate improvement in hair growth. It is concluded that zinc supplementation may prove to be an effective treatment, but more studies are required. >

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A study involving electro-acupuncture, which uses a low electrical current, showed improved hair growth, with 89% showing complete regrowth and the remaining 11% showing a marked improvement. Additional studies are necessary to interpret the role of acupuncture in the treatment of hair loss, but the initial results look promising.

MIND AND BODY

Wellbeing practices focus on the connection between the mind and body and utilise different techniques to promote positive thought and reduce stress. These practices include aromatherapy, massage, acupuncture, hypnotherapy and more.

Wellbeing practices, such as acupuncture and massage, can help reduce stress, another key contributor to hair loss

Aromatherapy and massage Aromatherapy uses a variety of essential oils, which have been derived from natural sources and have proven benefits in the treatment of various disorders. Cedarwood, lavender, thyme and rosemary have been used anecdotally for over 100 years in the treatment of hair loss. To use essential oils during massage, they need to be mixed with a carrier oil, such as jojoba, grapeseed or coconut oil. Massage in itself is also known to promote improved blood circulation and reduce stress and anxiety.

A study showed that massaging essential oils into the scalp of a patient suffering from hair loss demonstrated a significant improvement in hair growth in 44% patients, compared to 15% of patients who were massaged with carrier oil alone. Further substantiation in the use of aromatherapy and massage for treating hair loss is lacking, but additional studies are warranted.

Acupuncture Acupuncture involves inserting fine needles into the epidermis at specific points in the body for therapeutic purposes, and has demonstrated a benefit for easing pain. It is also suggested that acupuncture can increase circulation and stimulate hair follicles.

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Hypnotherapy Hypnotherapy induces a trance-like state of consciousness, opening the patient to suggestion from the therapist, dealing directly with the subconscious mind.

Hypnotherapy techniques have been explored in the treatment of hair loss, with conflicting results from no response to positive outcomes.

One study showed an improvement in anxiety after several sessions, but no improvement in hair loss.

However, another demonstrated a significant improvement in 57% of its patients. Levels of anxiety and depression were highlighted as being improved in all instances. Therefore it is inconclusive if there is any benefit from using hypnotherapy as a treatment for hair loss.

Conclusion Hair loss is a disorder that effects most men and women at some point in their lives and can have significant damaging psychological effects, such as low self-esteem and depression.

Currently, the only FDA-approved treatment options for hair loss are topical MXD, oral finasteride and low-level light therapy. More invasive treatment options include platelet rich plasma (PRP) injections or hair transplantation.

Complementary medicine offers options to reduce hair loss with fewer side effects than conventional methods.

However, while some have evidence to back up their claims, others have little evidence at all, and it is inherently difficult to test their effectiveness, as they are often used in conjunction with conventional treatments, or in combination with each other.

There is an increasing demand to look at more holistic ways to treat multiple disorders, including hair loss.

Therefore, it is our view that trichologists should be familiar with the potential alternatives and stay up to date with evidence-based results.

Furthermore, if considering some of the treatments mentioned within this article, it is imperative to ensure that a complete medical and allergen history is determined, as this may preclude the use of some of these treatments.

We conclude that the use of complementary medicine is something that should be further trialled and tested, with more robust and quantitative measurements, to offer more options to patients suffering the devastating effects of hair loss. AM

Benedetto Cusumano is a consultant trichologist and founder of the TrichoCentre in Peterborough. He set up the clinic in 2015 because he wanted to do more to help people suffering from hair loss and scalp conditions. He qualified at the prestigious Institute of Trichologists in London and was awarded the John Firmage Certificate of Distinction, in recognition for this work in this field. He is a registered member of The Institute of Trichologists, the International Association of Trichologists, an affiliate member of the British Association of Hair Restoration Surgery (BAHRS), and was shortlisted for the Outstanding Trichologist Newcomer Award at the Hair Science Awards in 2018.

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C LI N I C A L ST U DY

SURGICAL STITCHING

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The quilting technique We summarise a recently published paper by Mr Alex Karidis on his gynaecomastia stitching technique known as “quilting”

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ollowing on from winning the Hackett Memorial Prize awarded by the British Association of Aesthetic Plastic Surgeons, Mr Alex Karidis and his trainee surgeon Log Murugesan, have now published a paper outlining the quilting technique for stitching in gynaecomastia surgery.

The paper entitled ‘External Quilting: New Technique to Avoid Haematoma in Gynaecomastia Surgery’ was published in Aesthetic Plastic Surgery, the official publication of the International Society of Aesthetic Plastic Surgery, and is dedicated to advancing the art of aesthetic plastic surgery.

The innovative stitching technique was developed by Mr Karidis to reduce the risk of a haematoma developing after male breast reduction. This is a relatively common complication and, in some cases, might result in delayed healing and even may require a return to the operating theatre.

Operating on 149 gynaecomastia patients between 2018 and 2019, Mr Karidis used external quilting structures to obliterate any of the space that is left when fat and glandular tissue is removed from the chest wall.

In a recent interview, Mr Karidis explained what makes his male breast reduction stitching technique stand out from the competition: “My quilting technique for male breast reduction was extrapolated from a facelift technique. The idea was to quilt the skin down. When you’re removing tissue from underneath the skin, you’re effectively leaving an empty space between the skin and muscle and, immediately after surgery, you can be left with broken blood vessels that leak into the empty space, filling and causing a haematoma. >

With the quilting technique, I’m stitching the skin to the muscle to close off that empty space

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“In the male breast reduction this isn’t desirable, as you obviously want a flat chest, so with the quilting technique I’m stitching the skin to the muscle to close off that empty space. It also helps guide the skin where you want it to heal, nudging into place and not leaving anything to chance.”

In the study that has been published, Mr Karidis was able to conclude that his stitching technique was useful in minimising haematoma, yielding good results for the patient.

ABSTRACT Background Haematoma after gynaecomastia surgery is the most common early complication. It may necessitate a return to the theatre and cause increased infection risk, poor wound or delayed healing, and abnormal scar. Strategies to avoid haematoma range from perioperative blood pressure control to the use of tranexamic acid and compressive dressings.

Objective To demonstrate a new technique that would avoid haematoma or limit its expansion should it occur, after gynaecomastia surgery.

Before

Before

Before

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After

After

After

Methods One hundred and forty-nine patients had surgery for gynaecomastia between 2018 and 2019 by the senior author. External quilting sutures are used to obliterate any dead space following liposuction and piecemeal excision to address fatty, stromal, and glandular components. No drains are used. Patients receive cooling therapy before discharge, and they reattend clinic the following day for suture removal.

Results Two patients had haematomas which were managed conservatively and healed well. Fine suture tracks, which were observed in another two patients, became unnoticeable at three months. Overall, the complication rate in the cohort was 2.7% (haematoma 1.3%, temporary suture track 1.3%).

Conclusions The method is useful in minimising haematoma. It limits expansion of haematoma should it occur. Suture track is the other transient complication. This new technique in gynaecomastia correction is simple, yields good results, and gives the surgeon another option to deal with haematoma. AM

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D I G I TA L M A R K E T I N G

GOOGLE ADS

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is the magic number Laura Moxham shares three things you can do with your Google Ads today to get more patients “I think we’re paying Google more than we need to for our advertising.

I’m just not convinced it’s working for my clinic.”

This is what clinic owners are telling me right now. If you’re feeling like this, you’re not alone. Having audited hundreds of Google Ads accounts, they typically aren’t set up for success.

The challenge is that Google Ads is one of the most complicated platforms in the marketing space. With countless tools, settings, channels, ad formats, reports, bidding methods and ways to spend money. As the saying goes: “a little knowledge can be very dangerous”. It can also be very costly financially and detrimental to the growth of your clinic. However, on the flip side, when it’s done right, the rewards can be great. Having your clinic appear at the top of Google when people are searching for treatments in the local area is a robust and reliable way to get more patient enquiries.

We’ve reviewed hundreds of Google Ads accounts and so I’m going to share the top three reasons accounts are underperforming. My hope is that you’ll check and adjust

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yours today to generate more sales and enquiries with less money. I’m a glass half-full type person, so I see these as ‘opportunity levers’. Corny, but true.

1. SET UP ACCURATE CONVERSION TRACKING

One of the critical elements of a successful Google Ads account is setting up accurate conversion tracking.

In simple terms, conversion tracking is monitoring whatever physical action you want someone to take on your website to show that they’re a possible enquiry for your clinic. This tracking is key to success with Google Ads, and really any marketing you’re doing.

Much like sport, unless you know the ‘score’ for your campaigns, how do you know if you’re winning or losing?

Without conversion tracking, it’s impossible to tell. The tracking will tell you how many leads and enquiries you’re getting and at what cost.

A study found that only 29% of Google Ads accounts

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GOOGLE ADS

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track conversions accurately, leaving 71% of accounts who don’t have their conversion tracking set up correctly or even at all.

For many clinics, a conversion will be when someone: calls from the website fills out a free consultation or contact us form fills out a booking form engages in live chat With accounts, we typically see two scenarios. Either tracking is not set up so you will have no clue as to what is working in the account and what’s not. Or conversion tracking is set up incorrectly. What’s happened here is the tracking tags might be placed on the homepage, meaning every single time someone clicks on your ad, a conversion is recorded. But that’s not a conversion at all, it’s just a visit.

This gives you a false sense that the campaigns are more effective than they are.

But it’s not the clinic’s fault. Most small clinics don’t have time to know this stuff. Why would they However, sadly, this is fundamental, so we need to try to get this nailed first.

2. AVOID BROAD KEYWORD MATCH TYPES

As we discussed in one of my previous articles, it is an important step to select the right keywords to bid on so you won’t waste money on the wrong ones. For example ”lip fillers Leeds” instead of “cost of lip fillers”.

But there’s more. The next stage is selecting the right “match type” of these keywords to use. Painful, I know, but but please bear with me!

There are four categories of match types that every Google advertiser should be familiar with: broad match, phrase match, exact match and broad match modifier.

The problem is that many accounts we review aren’t using the right ones. They are using “broad match”. Big red flag here. This is typically a no-no. It leaves Google deciding who to show your ads to. Be more in control. Don’t let Google decide your business for you. It often generates wasted ad spend and sends irrelevant people to your site.

Best practice is to use “exact match” and “broad match modifier” keywords. This way you have much more control.

>>

“Exact match” means exactly as it says on the tin – your ad will only show when someone types in that exact keyword string. ‘Broad match modified’ means that the keywords you bid on can be typed into Google search in any particular order and your ad is eligible to show. Don’t worry about phrase for the moment.

This allows you to find new ways that people type things in but still remain more in control.

P.S. Another quick one on keywords. Don’t have too many keywords in each ad group, but spread them across ad groups using specific ad copy for that keyword. So when a keyword is typed in, they see an ad that is closely matched to that keyword and are therefore more likely to click and visit your site.

3. MORE OF WHAT’S WORKING

If there is one cardinal sin of Google Ads, it’s letting your account just “be.” Don’t leave it untouched after setup and let the cards fall where they may. This is a fool-proof way to ensure that your account is wasting money and holding back your lead flow.

Daily, weekly, and monthly changes should be made in the account to ensure it’s working efficiently and getting you good leads. It’s a game of data. The data allows you to make the right changes in the account so you can get more of what’s working and less of what’s not.

Take for example keywords. You can look at the spend of each keyword to look at which one is generating you ‘conversions’ and which aren’t. Then chop back on the ones that aren’t working well for you.

There are numerous changes you can make in your account with this strategy in mind – time of day, day of week, locations, gender, age; the list goes on. Let the data tell you the story of what you need to change.

I could share so much more on the areas to improve your returns from Google Ads but I’d be here all day! The options are prett y much endless. Until next time.

A free 20-minute strategy session with Laura Moxham, managing director of YBA PPC, is available for all Aesthetic Medicine (in italics) readers. Simply email team@ybappc. co.uk quoting “Aesthetic Magazine Jan 20”. AM

Laura Moxham is an expert in internet marketing for Google Ads and PPC. She is the managing director of boutique agency YBA PPC, which is recognised as being in the top 3% of agencies within Europe and has been shortlisted in the ‘Best for Growing Businesses Online’ category in the Google Premier Partner awards, due to its high-calibre results from Google Ads.

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C AS E ST U DY

SCAR MANAGEMENT

A scar is born

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By the time patients come in to see us, they generally would have tried various methods of improving the scars themselves

Dr Raina Rodrigues discusses scar management

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’m a mother to a beautiful 11-month old sleep thief, who made her entrance into the world via a planned C-section. I had full confidence in my excellent obstetrician, however, I do understand that the final quality of my scar would depend on my care as much as her wonderful surgical expertise. My roles as an aesthetic doctor and plastic surgery trainee have placed me at a great advantage, in that I could practise scar prevention rather than treatment.

This meant I had a tube of KELO-COTE ready and waiting for me at home.

Any time someone undergoes an operation or sustains a skin wound (I should know, I’ve just completed a PhD in burns, wound healing and scarring) I generously dish out my advice on wound management and scar prevention.

The three pillars of this advice are sunscreen, massage, moisturise. When

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exposed to the sun, healing skin and scars pigment differently to normal skin. A generous application of sunscreen (to the whole area, not only to the scar) will prevent the scar being more noticeable due to it being lighter or darker than surrounding skin. Massage helps to flatten a scar and shortens the time it takes for it to mature and take on its final appearance.

This should be regular and frequent, I advise massaging a scar at least three times a day. A silicone gel such as KELOCOTE traps the moisture on the healing scar, keeping it just where we want it.

Various pre-clinical and clinical studies have shown that this hydration reduces redness and decreases collagen, helping to convert the healing tissue into a flat and pale scar, which is what we want.

I am the medical director of Aesthetic Virtue, a small chain of medical cosmetic

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clinics in London and Malta, offering scar treatments among others (mainly facial rejuvenation procedures). We perform about 20 scar treatments every month. By the time patients come in to see us, they generally would have tried various methods of improving the scars themselves.

Depending on the type of scar, we offer various treatments. The most common procedure we carry out is steroid injections for keloid scars, which are raised pigmented scars that often itch and grow beyond the margins of the originally injured skin. For such scars we recommend a course of a few injections at six-week intervals with the use of occlusive hydrating silicone gels such as KELO-COTE and sunscreen (in exposed areas) to be applied twice daily by the patient at home. Very often patients present to us early on following an injury or surgery.

Scars take 12-18 months to reach their final “destination”, and there is no indication for steroid injections until this time has elapsed. We always advise clients to follow the massage, moisturise, sunscreen mantra. This same advice applies to hypertrophic scars. These are scars that are red and raised, but do not grow out of the margins of the original wound. Such scars are often an “enthusiastic” part of the normal wound healing process. Only rarely do these scars persist as such, and only very rarely is steroid injection indicated.

Being a KELO-COTE user myself, it really requires no extra effort to incorporate this into daily routine, even as a sleep-deprived, near-zombie parent. It doesn’t rub off onto or stain clothes when dry and its application takes all of 10 seconds. I’ve found that it’s easiest to apply just after a shower and before bed, but different routines would suit different people.

While a c-section scar is usually neatly hidden from public view both on the beach and under clothes, having seen the negative effect unsightly scars can have on some of my patients, I was keen to do whatever was in my ability to achieve the best scar possible. So far, I am pleased to report that the evidence of my baby’s entry into the world is shaping up into a relatively inconspicuous flat, thin, neat line. To be fair, I also did have an amazing obstetrician!

Alas, scarless surgery and skin healing doesn’t exist, except in unborn babies (a lot of research into this is currently going on), so until something revolutionary comes along we need to continue using the tools available to us in our armamentarium. As always, prevention is key. AM

Dr Raina Rodrigues (Zarb Adami) MD MRCS MSc MBA(Aesthetic Surgery) is a surgeon with more than 10 years’ experience in facial aesthetic medicine, having performed more than 15,000 procedures. She qualified as a medical doctor from Malta before securing plastic surgery experience in Sydney, Australia and in the UK. She is the medical director of Aesthetic Virtue, a chain of clinics offering medical cosmetic treatments in London’s Harley Street and in Malta. She founded The Academy of Aesthetic Excellence, which has successfully trained many practitioners in cosmetic procedures.

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13/12/2019 09:57 13/12/2019 16:21

BUSINESS

EMPLOYMENT

aestheticmed.co.uk

Conflicts of interest Victoria Vilas answers the question, “should I employ an aesthetic practitioner who also works at another clinic?”

T

he best aesthetic clinicians will be in demand from patients, and from clinic owners looking to employ them. When you are looking for a new practitioner for your clinic, it is likely that some aesthetic clinicians you meet will also practise at another clinic or may be looking for more hours of work in aesthetics than you can offer. Should you avoid employing such clinicians due to conflicts of interest? Should you disregard a practitioner because your patients could be tempted to see them at another practice? Will someone take advantage of your training, then use their skills to the benefit of another business?

When hiring, it is wise to be aware of potential risks and make decisions to protect your business, but if you are too stringent with your recruitment policies you could rule out talented, trustworthy practitioners who would relish the opportunity to help, not harm, your clinic.

Consider making a concise list of the clinics you would consider to be in direct competition with your own, or identify a geographical region covering your main patient catchment area. Advise your practitioner that you are happy for them to take other work in the same industry, as long as they choose a clinic or area you have not specified. Try to reasonable though, as it may be fair to focus on a local area but not a whole city or county.

Don’t get too attached to one candidate. If a medical professional is looking to further their career in aesthetic

medicine, they may not agree to work solely for one clinic, especially if you cannot offer them the hours they are looking for. If the terms of employment you offer are perfectly reasonable, it may be better to continue your search for a more accommodating practitioner rather than agreeing to an arrangement you are uncomfortable with.

When you do employ a practitioner, offer a contract that includes a clause on intellectual property and confidentiality, to identify and protect your patient database as confidential information owned by your business. If you invest in costly training courses that greatly benefit a practitioner’s development, you could include a contract clause so your practitioner must return some or all of their training costs if they choose to leave your clinic after only a brief period.

As an employer, you cannot foresee all eventualities, you can only attempt to make rational hiring decisions. It is sensible to be aware of what could go wrong with the appointment of a new employee, but don’t focus solely on the negatives. There is no need to be suspicious of every clinician, as most will be ethical, trustworthy and loyal.

Consider what you can offer a practitioner, not just what they can offer your clinic. To garner respect and loyalty and keep a skilled aesthetic clinician as a long-term employee, you’ll need to a maintain a positive working environment and be a supportive and fair employer, too. AM

Consider making a concise list of the clinics you would consider to be in direct competition with your own

>> 88

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.

Aesthetic Medicine • January 2020

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13/12/2019 16:18

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