Aesthetic Medicine - July/August 2019 by Aesthetic Medicine

INSPIRING BEST PRACTICE IN MEDICAL AESTHETICS

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FRAME OF MIND MENTAL HEALTH IN AESTHETICS

July/August 2019 | aestheticmed.co.uk

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#jawlineenvy July/August 2019

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Demand a higher standard.

July/August 2019 | aestheticmed.co.uk

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The secret to a sharper, chiselled jawline with Restylane Lyft™ with Aesthetic Practitioner and A&E Consultant Dr Paul Baines

“ I use Restylane Lyft™

for 95% of my work on the lower face ” DR PAUL BAINES

Have you seen a rise in the number of people looking for work on their jaw? Definitely. I’ve been working in facial aesthetics for more than ten years and we used to find that people were looking to fill wrinkles, but in the last two years the demand for facial contouring and sculpting has really grown. There are two features on the face that people notice first – the eyes and the mouth. I recommend treating the chin or jaw as they frame the lower third of the face, but the treatment is much subtler and less noticeable than treating the lips or around the eyes. The posterior aspect of the mandible, the cheek and the chin are very effective anchor points to lift the face and provide structural support.

Do you have a product that you recommend for sculpting the chin and jaw? I use Restylane Lyft™ for 95% of my work on the lower face. I really like Galderma’s patented Non-Animal Stabilised HA (NASHA™) technology as it provides maximum lift and precision. I like the sharpness of the high G prime.

A patient treated with Restylane Lyft™

Occasionally I’ll use Restylane Defyne™ from Galderma’s Optimal Balance Technology (OBT™) range as the smaller particle size gives me flexibility, particularly when treating women. Restylane has the broadest range of dermal fillers, so I can tailor the treatment to each patient and it’s important to me to have a dermal filler I can trust.

What are your tips for sculpting the lower face? •

Assess the upper two thirds of the face first, as the temples, preauricular region and cheeks may need to be treated first

•

Make sure you are aware of the key safety points, especially the positioning of the facial artery and the parotid gland

•

Treat progressively – the angle of the mandible, then the chin and finally the peri-jowl area

•

Use a product with a high lifting capacity, predictable results and robust clinical data

How long do you find each treatment lasts? The results can last up to 12 to 15 months depending on the patient and the treatment provided, but I often ask people to come back at three months and six to nine months for assessment.

About Dr Paul Baines Dr Paul Baines divides his time between running The Crescent Clinic and working as an Accident and Emergency Consultant at Musgrove Park Hospital in Taunton. He is a member of the Royal College of Surgeons and has an extensive knowledge of facial anatomy. Dr Baines has worked alongside world-renowned plastic surgeons and is a member of the Galderma Faculty.

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

aestheticmed.co.uk

Contents JULY/AUGUST

EDITORIAL Vicky Eldridge

NEWS AND ANALYSIS

BUSINESS

10 NEWS The latest news from the industry

16 PRICING Richard Crawford-Small on selling filler by the ml

24 DIGITAL MARKETING Adam Hampson provides a beginner’s guide to DIY digital marketing

E: vicky@aestheticmed.co.uk T: +44 (0) 207 351 0536

ADVERTISING Jack Diamond

29 EMPLOYMENT Victoria Vilas advises on how to spot a star among job applicants

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

32 MARKETING Shaz Memon shares what every practitioner needs to know about marketing minimally invasive facial aesthetics

CLASSIFIED Nur Suleyman E: nur@aestheticmed.co.uk T: +44 (0) 207 349 4796

MARKETING Chloe Skilton

21 CYBER SECURITY Clive Taylor on the importance of strong password security

E: chloe@aestheticmed.co.uk T: +44 (0) 207 351 0536

PUBLISHER Mark Moloney E: mark@aestheticmed.co.uk T: +44 (0) 207 351 0536

DESIGN AND PRODUCTION ICD www.icd.gb.com

PRINTING Walstead United Kingdom walstead-uk.com SUBSCRIBE Annual subscription UK: Print £44, DD £39.50, Digital £10. Europe: £59.50; outside Europe: £67.30. To receive your copy of Aesthetic Medicine every month call 01371 851875 or see escosubs.co.uk/aestheticmedicine The publisher accepts no responsibility for any advertiser whose advertisement is published in Aesthetic Medicine. Anyone dealing with advertisers must make their own enquiries. M 2 Media Unit 1.17 The Plaza 535 Kings Road London SW10 0SZ

Aesthetic Medicine • July/August 2019

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CONTENTS

IN THIS ISSUE...

aestheticmed.co.uk

MENTAL HEALTH SPECIAL 37 MENTAL HEALTH SPECIAL Introduction 38 ASSESSMENT Nofie Johnston on why mental health assessment matters in aesthetics 40 TALKING TO We chat to Dr Jonquille Chantrey about her new series of ‘Mind, Body and Soul’ forums

SKIN

INJECTABLES

HAIR LOSS

DEVICES

47 SUNSCREEN SPECIAL An in-depth look at sunscreens

60 LIPS Dr Krystyna Wilczynski on the art of natural lip fillers

76 HAIR LOSS AND AESTHETICS Dr Sharon Wong on the relationship between the aesthetics and hair loss sectors

86 NEW TREATMENTS Profound at the Dr Tatiana Aesthetic Dermatology Clinic

78 PRODUCT FOCUS The Kerastem device for male and female pattern hair loss

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

48 ENVIRONMENT Reef-safe SPFs 50 DOSSIER Tinted SPFs for summer 58 SKIN NEWS The latest skin product launches

42 PRE AND POST PROCEDURE SUPPORT Plastic surgeon Mr Alex Karidis on the PaPPS Initiative (Pre and Post Procedure Support Program)

68 TREATMENT SPOTLIGHT Dr Stefanie Williams shares her Haute Couture Meso Therapy protocol 66 CASE STUDY Practitioners discuss their results with Skin Tech’s RRS range

SURGICAL 70 EARS Dr Sotirios Foutsizoglou on auricular reconstruction

44 ETHICS Dr Raj Arora shares her five main ethical principles of aesthetic treatments to safeguard vulnerable patients

OUT AND ABOUT

80 HAIR LOSS TREATMENTS Dr Ash Dutta on how Regenera combats hair loss 82 BLOOD TESTS Benedetto Cusumano discusses how blood tests contribute to understanding the underlying causes of hair loss

Welcome to the July/August edition

of Aesthetic Medicine

Hair loss is becoming an ever-increasing part of the aesthetics vocabulary, and rightly so. There is a lot of synergy between the two industries, not only in the treatments available to address concerns but also in the reasons many patients seek treatment. As such, Aesthetic Medicine is proud to be a media partner of Get Ahead of Hair Loss. The event will be held on September 22 at the Royal Society of Medicine and was launched by Dr Sharon Wong, alongside consultant dermatologists and hair experts, to educate and inform the consumer. There will be two concurrent programmes at this year’s event: one for consumers and one for hair professionals. There will also be a dedicated sessions on Afro hair and men’s hair. Visit getaheadofhairloss.com to find out more. We are also featuring a number of articles this month on the hair loss topic (see pages 76-82) and I am proud to be joining the speaker faculty at The Business of Hair event organised by the British Association of Hair Restoration Surgery (BAHRS) also taking place this autumn on September 28 at the Crown Plaza Solihull. I hope to see you there. Vicky Eldridge - Editor Aesthetic Medicine • July/August 2019

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

INDUSTRY NEWS

aestheticmed.co.uk

Report by the Royal Society for Public Health (RSPH) calls for a ban on cosmetic injectables for under 18s The Royal Society for Public Health (RSPH) is demanding that the Government make nonsurgical cosmetic treatments, such as botulinum toxin and dermal fillers, illegal for those under 18, a move it says is supported by the majority (87%) of the public. The calls were made in a recent report examining the health risks associated with tattoos, piercings and other treatments that compromise the skin barrier. The public health organisation raised concerns that TV programmes, such as Love Island, were making such treatments more popular with teenagers and warned that cosmetic procedures can cause infections, sepsis, scarring and even blindness, particularly if conducted by untrained or rogue practitioners. Shirley Cramer, head of the RSPH, has branded the current rules surrounding injectables as “unfit for purpose”,

adding, “the regulation of providers of these services is markedly different across the UK”. Spokesperson Duncan Stephenson commented, “A desire to resort to quick fixes among the selfie generation has led to a massive increase in demand for nonsurgical cosmetic procedures, especially lip fillers. There is huge pressure on young people to conform to the unrealistic and unattainable ideals they see on Instagram and TV shows like Love Island, but there are no age restrictions on non-surgical procedures. It means any 15-year-old schoolgirl could just walk into a shop and get their lips injected.” The Irish Government is also considering an age restriction on cosmetic procedures, with Minister for Health Simon Harris calling for a ban on treatments for anyone under 18.

Study analyses benefit of digital image speckle correlation in optimising botulinum toxin treatment The benefits of using digital image speckle correlation to determine optimal botulinum toxin type A injection sites has been demonstrated in a study published in the June issue of Plastic Reconstructive Surgery. As part of the prospective, randomised, crossover trial, 10 female patients were randomised to either injections based on digital image speckle correlation analysis or to physician assessment based on the 2004 facial aesthetics consensus recommendations. All patients received 20U of botulinum toxin type A in the glabellar region and were crossed over and reinjected after six months. On average, the digital image speckle correlation analysis provided 4.8 injection sites, whereas the practitioner chose five injection sites. Patients receiving digital image–directed injections had higher rates of satisfaction on the Facial Line Outcomes instrument (p = 0.0003) and a larger degree of paralysis (p = 0.003). Furthermore, muscle function returned to normal later in patients injected with digital image speckle correlation (17.9 weeks versus 20 weeks; p = 0.03).

34% of eczema self-management apps contain information which is inconsistent with international guidelines, says study A study, published in the British Journal of Dermatology has claimed that 34% of eczema smartphone applications contain information which is inconsistent with international guidelines, particularly regarding treatments and the progression of the condition. The study reviewed 98 eczema self-management smartphone apps, aimed at patients and carers. Of the apps 67 were in English, 22 in Chinese and nine in Spanish. Of the apps assessed, 84% provided educational information, 39% tracking functions and 13% both. In addition to the 34% of apps providing information which is inconsistent with international guidelines, only 15% provided information supported by international guidelines on pharmacological therapies and 16% on nonpharmacological therapies. None of the included apps

complied with all criteria for educational information, tracking functions or health information principles. 11% failed to mention mainstay therapies such as the use of emollients and moisturisers.

Aesthetic Medicine • July/August 2019

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

INDUSTRY NEWS

aestheticmed.co.uk

Glasgow is leading the way in reducing medicine’s gender gap Glasgow is leading the way in closing medicine’s gender gap, thanks to a new initiative jointly launched in June by the Royal College of Physicians and Surgeons of Glasgow and the University of Glasgow. Despite the fact that over half the UK’s medical graduates are women, a significant gender gap remains in senior medical leadership roles. Currently only around 25% of medical directors and 36% of NHS chief executives are female, while women only represent approximately 40% of lecturers, 30% of senior lecturers, and only 15% of professors in UK medical schools. The Developing Female Medical and Academic Leaders Scholarship Programme is designed to help to nurture female leadership in the medical field. Professor Jackie Taylor, president of the Royal College of Physicians and Surgeons of Glasgow said, “I’m proud that our college is taking action to help close medicine’s gender gap and assist women to reach their full potential as leaders. This isn’t just the right thing to do for women, equality

benefits everyone in our health service. Research has shown that greater gender diversity can improve financial and organisational performance and decision making and increase productivity.“ Professor Anna Dominiczak, vice principal and head of college, College of Medical, Veterinary & Life Sciences at the University of Glasgow added, “Gender equality is an issue of great importance to the college. 50% of our medical graduates are women, and yet they are underrepresented in leadership roles within our health service, to the detriment of the public and profession alike. We look forward to welcoming applicants to this very important and exciting initiative.”

All party-parliamentary group (APPG) established to represent aesthetics industry in Government An all party-parliamentary group (APPG) has been set up to represent the aesthetics industry in Government. The group’s formation was announced at a Westminster Hall debate on May 14. It will be chaired by Carolyn Harris, Deputy Leader of Welsh Labour and Judith Cummins, Shadow Minister for International Trade. It was established to show that MPs recognise the challenges facing the aesthetics sector and will recommend on policy decision to Government going forward. During the debate, MPs called for a minimum age law of 18 to stop young people having cosmetic procedures, echoing the Department for Health and Social Care’s recent consumer safety campaign.

Cotton buds among items to be banned in UK as Government brings in new controls on plastic in 2020 Cotton buds, along with straws and drink stirrers are among items to be banned from April 2020 under Government plans to reduce the damage of single-use plastics on the environment. The ban was confirmed by environmental secretary Michael Gove on May 22 after an open consultation, which demonstrated overwhelming public support for the move. Cotton buds are a common consumable for clinics and salons, however they are also in the top 10 most common marine litter items that get washed up on the world’s beaches. It is also estimated that, even though non plastic alternatives are available, 95% of straws are still plastic. Under the ban, shops and supermarkets will no longer be allowed to sell the plastic items, while bars and restaurants

cannot display straws or stirrers or hand them out. The only exemption will be for those with medical needs or disabilities. This means that restaurants, bars and other businesses will be able to provide plastic straws on request for disabled customers. Registered pharmacies will also be allowed to sell them over the counter or online. In a statement Gove said, “Urgent and decisive action is needed to tackle plastic pollution and protect our environment. These items are often used for just a few minutes but take hundreds of years to break down, ending up in our seas and oceans and harming precious marine life. I am taking action to turn the tide on plastic pollution, and ensure we leave our environment in a better state for future generations.”

Aesthetic Medicine • July/August 2019

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

INDUSTRY NEWS

aestheticmed.co.uk

Politician criticises beauty industry for appearance-related discrimination A conservative politician has criticised the beauty industry for promoting an “obsession with perfection” that leads to discrimination against people with disfigurements. Commenting on data collected by Changing Faces, a charity which supports people with a mark, scar or condition that alters their appearance, Minister for Equalities Baroness Williams of Trafford said the beauty industry promoted a distorted perception of beauty that fuels social media abuse. During a discussion with the Telegraph, Baroness Williams said: “There’s an obsession in the beauty industry with perfection and many girls have got such a distorted perception of what beauty and perfection looks like.” The Changing Faces report, My Visible Difference, surveyed 1,000 people with a “visible difference” and found that almost a quarter said they felt self-conscious or

embarrassed going out in public. 58% said they had experienced hostile behaviour from strangers as a result of their difference, and 29% said they felt depressed or anxious because of it. Changing Faces is calling for employers, schools, police forces and other agencies to raise awareness of appearance-related discrimination, with improved reporting procedures for victims. The charity’s Pledge To Be Seen campaign is asking brands to sign up and commit to better representation of people with a visible difference. Philanthropist and burns victim Katie Piper (pictured above) is supporting the campaign.

“Burnout” recognised as a medical condition by the World Health Organization The World Health Organization (WHO) has added “burnout” to its International Classification of Diseases (ICD), with the condition being globally recognised as a disease from 2020. This is the first time burnout has been recognised in WHO’s handbook for medical conditions. The development comes a year after global health experts recommended burnout be added to the catalogue. WHO defines burnout as “a syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed. It is characterised by three dimensions including feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and reduced professional efficacy”. The WHO definition clarifies that: “Burnout refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life”. The decision was made during the World Health Assembly in Geneva.

Platelet-Rich Fibrin (PRF) may lead to better outcomes with fat grafting, according to experimental study Platelet-Rich Fibrin (PRF) might enhance the outcomes of fat grafting for plastic surgery procedures, an experimental study in the June issue of Plastic and Reconstructive Surgery has reported. The research by Shaoheng Xiong, MD, and colleagues of Fourth Military Medical University in Xi’an, Shaanxi, China, provides preliminary evidence that PRF might lead to more favourable characteristics of transplanted fat cells, compared to the “first-generation” platelet concentrate Platelet-Rich Plasma (PRP). A key advantage of PRF may be the prolonged release time of growth factors and immune-active cytokines, in contrast to the rapid release by PRP. Platelet-Rich Fibrin is also easier to produce, which may avoid some of the variations in PRP preparations and effectiveness reported in previous studies. The authors plan further studies to “explore the detailed molecular mechanisms of PRP/PRF in fat grafting” and emphasise that high-quality randomised clinical trials will be needed to define and compare the benefits of these platelet concentrates for patients undergoing plastic and reconstructive surgery procedures.

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

INDUSTRY NEWS

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NEWS IN BRIEF NMC REPORTS A RISE IN NURSES ENTERING ITS REGISTER

A report published by the Nursing and Midwifery Council (NMC) has shown a rise in the number of nurses and midwives that have joined the register in the last year. There were 698,237 people on the register on March 31, 2019, an increase of 7,959 (1.2%) from the previous year. There was also a 126% increase in the number of nurses and midwifes from outside of the EU registering for the first time, totalling 6,157.

CCR ORGANISER EASYFAIRS BUYS AESTHETICS MEDIA

Easyfairs, the organiser of CCR, has acquired the Aesthetics Media portfolio, which includes the Aesthetics Conference & Exhibition (ACE), the Aesthetics Journal print and digital platform and the Aesthetics Awards. The combined exhibitions, awards and publication will be managed by Easyfairs UK & Global, with the entire Aesthetics Media team joining Easyfairs as part of the acquisition.

CONSUMERS TUNING IN TO EFFECT OF NUTRITION ON THE SKIN

Skincare users are becoming more aware of the impact of nutrition on skin quality, according to a survey by skincare supplement brand Lycored. Of over 500 regular skincare users from the UK, US, France, China, Japan and Korea, 98% said they agree that good nutrition is necessary to achieve a healthy glow. Sleep came out top when asked which factors contributed to glowing skin, with 66% of the respondents choosing this option, followed by 65% who said a healthy diet was most important. Only 39% chose topical skincare products as most likely to give skin a healthy glow.

IMAGE SKINCARE APPOINTS NEW SALES DIRECTOR

Image Skincare UK has appointed Graham Clarke as its new sales director. Clarke brings more than 20 years of beauty and wellness experience to the brand, having worked with Space NK, AVEDA and Sothys. As part of his new role, Clarke will be leading the company’s growth strategies. He said, “Being a part of Image Skincare is a privilege and a chance to explore new opportunities for the market here in the UK. With a strong team and leadership, we’ll be designing a new strategy to further establish and empower our presence in the professional skincare market.”

New data from ASAPS shows rise in demand for non-surgical options in US The popularity of non-surgical aesthetic procedures has continued to see a significant rise, according to new data from the American Society for Aesthetic Plastic Surgery (The Aesthetic Society). The study highlighted botulinum toxin, hyaluronic acid fillers, non-surgical fat reduction, photo rejuvenation and chemical peels as the top five procedures in 2018. A total of 1,801,033 botulinum toxin procedures were performed by respondents, a rise of 16% from 2017 and 36% since 2013. The report claimed that 810,240 HA filler procedures were carried out. A rise of 12% from 2017 and 54% since 2013. Non-surgical fat reduction was down 4% on 2017, despite being the third most popular procedure, however, it was still up by 135% overall since 2013. In addition, 135,624 photo rejuvenation (IPL) procedures were performed (up 20%) and 129,596 chemical peels were carried out (up 9%). Dr Charles Thorne president-elect of ASAPS said, “Patients are becoming increasingly sophisticated. There used to be a myth, propagated by the press, that non-invasive procedures were a substitute for surgical procedures. Most patients now understand that non-invasive techniques address certain issues and certain aspects of the ageing process and surgical procedures address others.”

MATA launches Level 7 diploma in injectables The Medical Aesthetic Training Academy (MATA) has introduced a Level 7 Postgraduate Diploma in Facial Aesthetics. The qualification, which is regulated by Ofqual, incorporates the OTHM Level 7 Certificate/ Diploma in Clinical Aesthetic Injectable Therapies. The course includes foundation, advanced, and mentorships days and covers theory learning such as anatomy, physiology and patient assessment as well as injectable therapies for the management of hyperhidrosis. Delegates will be continually assessed with direct observational practice, virtual learning environment quizzes, critical essays, short answer questions and a clinical log book. They must also complete 20 observed and delivered botulinum toxin treatments and 20 observed and delivered dermal filler treatments. The new qualification is mapped to the new JCCP/ CPSA guidelines.

NEWS IN PICTURES Black Skin Directory hosted an event on Beating Acne Successfully in collaboration with the Health & Aesthetic Clinic. Given the clinic’s south London location, the team is very experienced in treating acne on Fitzpatrick V and VI skin. The educational evening was designed to discuss the management and prevention of acne on darker skin tones. Presenters included clinical director Dr Bhavjit Kaur, Dr Vimple Bhalani, Shannon McCarthy and Dija Ayodele, founder of Black Skin Directory.

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The 1ml myth Richard Crawford-Small discusses selling fillers ‘by the ml’ and how it devalues the skills of aesthetic practitioners

f there is ever a question that is guaranteed to annoy me it’s this, “Hi babes… how much is it for 1ml?” I’ve been working in the aesthetics marketplace for about 15 years and have worked with many different technologies and products, helping people commercialise and make money from products. I started out with Zyderm/Zyplast collagen, then Hydra-Fill, then Softline, then Botox/Vistabel, then Juvederm, then Natrelle Breast Implants, then LapBand, then RegenPRP, then ZO – the list goes on. In that time my background in software enabled me to bring iConsult, the first paperless client management system to the sector, and last year I launched the first ever digital currency for the aesthetic market. I have also created the Aesthetic Entrepreneurs community to help businesses achieve their goals and support them in areas such as revenue generation and client communication, engagement and trust. I’ve built an app to connect and link product manufacturers, practitioners and clients together and reward best practice. I’ve written a best-selling book Changing Faces, that has helped thousands of people around the world launch and grow their own aesthetic businesses. Finally, through the Entrepreneurs Club, I’m mentoring a group of driven, focussed and hungry business owners to grow and develop not only their businesses, but also as entrepreneurs. As part of my consultancy business, I’ve worked with businesses ranging from small, independent start-ups to large chains. I’ve also been involved in deals concerning anything from one box of filler through to £3m worth of breast implants. I like pioneering things and I love being an entrepreneur. I’ve been involved in start-ups and new businesses pretty much my entire career and I love the energy of launches, new ventures, new products, and working with new businesses. Why am I telling you all of this? Because I value myself. I value my insight, my skills and my talent. I’m proud of the results I get. I’m also extremely proud of the results my clients get. I can assure you, they don’t sell fillers by the ml.

As an industry, we have enabled clients to feel it’s acceptable to ring up and say, “how much is 1ml?” When did that become a thing?

IN COMPETITION

It’s natural to feel threatened by competition and feel like you have got to discount because someone is offering something cheaper, but the race on price is a race to the bottom. There’s always someone cheaper, however, you don’t have to fight on price. In my career I never have, nor never will compete with anyone on price, and neither should you. If price is really all your clients are focussed on, then they are really not for you. It’s all about outcome and, let’s be honest, that’s really what they should be buying on. My business, like yours, is outcome-related and it really annoys me that as an industry, we have enabled clients to feel it’s acceptable to ring up and say, “How much is 1ml?” When did that become a thing? As you now know I’ve been working with fillers since collagen, and it was never a thing. When did we allow the market to cheapen and give clients permission to dictate this element of the process? It’s time to demonstrate leadership, educate the consumer and claim back our business. Hopefully it’s not too late. If you want to clearly differentiate yourself, don’t charge per ml.

VALUING YOURSELF

If someone rings you up and asks how much it is for 1ml, thereason they’re doing it is because they have no other >

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But it’s this desperation that leads people to price filler by the ml, or commoditise their products and services. What is it that makes you stand out from everybody else? We’re in a market that’s growing rapidly, and if you are reading this, you most likely have the skills and talent to perform your work well, and that should make you feel comfortable, however, confidence and credibility comes from establishing and understanding what your unique selling points (USPs) are. As an industry, we solve problems, we generate trust and we build relationships. This is your first USP, but other USPs can be as simple as having a red door or having a big smiley face the first time someone walks in your door. It depends on what attributes you have that enable you to be successful. Don’t be afraid of your clients, just be direct and trust that they are on the same wavelength as you. Your clients’ desire to pay a certain price does not and should not set your pricing. You must know your value. To become a mere service provider is to totally devalue everything you have learned to this point. The studying, the late nights, the investment, the failures, the successes, the nights in while your mates went out, the waking up in the middle of the night in a cold sweat wondering what you have done, the stress, the elation, the advice given and taken, the mentoring, the time you did that amazing thing that you are really proud of. All of these things are worth much more than, “Hi babes… how much is it for 1ml?” So create an authority statement and write down what you have done. List out all of the experiences that got you where you are now. You probably have amazing skills, that you probably haven’t even realised, such as empathy, compassion and listening. Don’t take these for granted. Value them and make this worthwhile. Then that annoying question might go away. AM

If you want to clearly differentiate yourself, don’t charge per ml point of reference at all. They’re doing this because the only way that they know how to navigate and select is through price. It’s a case of, “My mate had her lips at £100, so that’s what I want too.” For me, pricing is all about credibility and fear. You might be worried that because you’re just at the start of the journey that you have no credibility. Nothing could be further from the truth. You might have a lack of experience in certain areas, but you have credibility. The way to get over this is to percieve yourself as strong, not weak. In my intro, I outlined my credibility, my authority, my value. You must learn to value yourself and your own skills before others can. If you don’t value yourselves, then your clients aren’t going to value you either. This will also impact how you communicate to the market, how you carry yourself and how you interact with your clients. To allow your treatments to be judged on the product you use makes no sense at all. Often this is down to a lack of planning or thought around who your target client is, what problem they have, and how you can solve it. A lack of a plan will make you feel overwhelmed and exposed. Because you have no plan, no real clear cut structure, no idea of your own value, you leave yourself open to being completely and utterly overwhelmed. It’s this paralysis, that sense of overwhelm, that sense of “I haven’t got a clue what I’m doing”, that creates a feeling of panic. Because you’ve invested heavily in your training, you’ve invested in aesthetics as your future. Maybe you left a job to do this and this leads to desperation to make it work.

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Richard Crawford-Small has more than 14 years’ experience in helping to grow aesthetic businesses. His unique approach to consultancy, and helping you put your clients first has led to the creation of the award-winning iConsult system. Crawford-Small is the author of the best-selling book, Changing Faces, and the creator of Aesthetic Entrepreneurs (aestheticentreprenuers.com), the fastest growing aesthetic business community online.

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CYBER SECURITY

Password protected Clive Taylor on protecting your business by prioritising password security

ith so much publicity given to serious data breaches and the devastating effect a hacked password can have for individuals and businesses, the most recent report from the National Cyber Security Centre (NCSC) makes for worrying reading. According to the report, 70% of people believe they will fall victim to a cybercrime within the next two years, while 23.3 million hacked accounts of victims worldwide used 123456 as the password, which is unlikely to take a sophisticated hacking app long to crack. This disregard for strong password protection shows there is still a lack of understanding about the nature of modern hacking attacks, as the advice of security experts continues to fall on deaf ears. Rather than manually testing a series of simple combinations in the hope of guessing your password, criminals are now using much more sophisticated methods to breach accounts, and it’s crucial that you stay one step ahead of the threat.

NCSC REPORT FINDINGS

Taking the lead on cyber security issues within the UK, the NCSC uses its own research and findings to deliver practical guidance to businesses of all sizes.

Responding quickly to security incidents and protecting companies from serious harm, the organisation draws on industry and academic expertise to improve security measures and safeguard public and private sector networks. The report delivered by the NCSC is based on data compiled from telephone interviews and shows that 37% of respondents agreed that losing money or personal details over the internet has become unavoidable. Ironically, the same report reveals a serious lack of concern when it comes to password security, with many individuals setting weak or predictable combinations that make it easy for hackers. With freely available programs designed to run automatically and try millions of combinations, simply setting your password to ‘Pa55word’ will no longer suffice.

CREATING A STRONG PASSWORD

When it comes to protecting your data, information or money, the only way to make a long-term difference is by changing your attitude towards password security. Although it may sound straightforward, the first step is to stay away from obvious passwords that you’ve trusted in the past. This includes sequential numbers or letters, birthdays, and especially the word ‘password’. >

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Not only will these be cracked in seconds, but hackers will recognise you probably use it for other accounts and target all your other password-protected assets. Instead, it’s important to make passwords longer, aiming for at least 15 characters where possible, using a combination of upper-case and lower-case letters, while throwing in numbers and symbols for good measure. Alternatively, a word combo which uses a combination of random but memorable words, making it impossible for hackers to guess, can be extremely effective. An example of a word combo could be ‘FootballDogYellowRibbon’ – the more ridiculous, the better. Another option is to use one of the many free password generator tools available from leading cyber-security organisations, which work locally on your computer with no risk of your choices being compromised.

SOPHISTICATED METHODS

Although changing your attitude towards password security is an important first step, that won’t necessarily help you spot an incoming threat or identify the points of attack. The most common method used by hackers remains brute force which, despite its name, can be technically effective for those looking to breach an already weak security system. Brute-force attacks will often use a password dictionary, that contains millions of words and numbers that can be tried in combinations to discover the correct password. This can take minutes, hours, days or even years – the program has enough patience. Once a hacker has set the program running, passwords will be tried systematically, delivering a successful hack if the dictionary contains the correct password. Therefore, it is critical that steps are taken to create a complex password that contains more than one word.

This link then leads to a fake website that has been carefully designed to look like a legitimate banking website, often duping unsuspecting users into entering their access details and password. A message will then inform the individual that the account cannot be accessed and they should retry in 10 minutes – just enough time for the criminals to empty your account. This same approach is used regularly by cybercriminals targeting businesses, law firms, banks and anyone with valuable data or money moving through their accounts.

Brute-force attacks will often use a password dictionary, that contains millions of words and numbers that can be tried in combinations

INTERNAL THREATS

While outside hacking attacks can be difficult to prevent, there are other routes into secure networks and accounts, which typically involve the actions of individuals granting access. Some cybercriminals will try to trick, intimidate or pressure an individual into giving them what they want, otherwise known as phishing, when attacks are personalised to target a specific organisation. Typically, the phishing email explains that a receiving bank account’s details have changed or there is something wrong with an account, prompting the recipient to click a link to resolve the issue.

SECURING THE FUTURE OF YOUR BUSINESS

Password protection is not a new security feature, but research shows that individuals and businesses are still not treating it seriously enough. Although it may be tempting to create a relatively straightforward password that is memorable and quick to type, hackers now have the power to test millions of combinations and breach your account within minutes. Although opting to use a selection of upper-case and lower-case characters isn’t always efficient, doing so can help secure your account from would-be hackers. Remember, cyberattacks are becoming more sophisticated over time, so it is important to regularly update your password and other security measures, ensuring you stay one step ahead of criminals. If you’re unsure about the next steps, contact an experienced managed service provider and begin securing the future of your business. AM

Clive Taylor leads on Cyber security for managed IT services specialist Quiss Technology and is responsible for all aspects of system, network and device security. With more than 15 years’ experience in the sector, he also manages the firm’s partnerships with leading ethical hackers and security specialists to develop practical cyber-crime solutions, regardless of the sector in which clients operate. A regular commentator on the industry, technology and future practices, Taylor is respected for his ability to make difficult topics sound simple.

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Do it yourself Digital marketing specialist Adam Hampson provides a beginner’s guide to DIY digital marketing

igital marketing is a vast landscape of specialties and tasks, but there is plenty you can do in-house to increase your online visibility and brand representation. For small-to-medium sized clinics, working with a budget-friendly agency is essential, and the tasks you can take on yourselves will inevitably be the most cost-effective. In this DIY digital marketing guide, I’m going to detail which steps you can do in-house with your team to boost the new client bookings for your aesthetic clinic.

SET OUT YOUR STRATEGY AND GOALS

It will come as no surprise to hear that social media is an actively and aggressively growing digital marketing platform. The main trick to social media marketing is working out where your target demographic is spending their time, and then spend your time there too. A Facebook Business Page (FBP) is always useful for a business, as you can link it your website and vice versa. FBP reviews also show up on your Google My Business (GMB) profile once you link the two, which we’ll discuss further later on. The majority of aesthetics clinics’ social media traffic is spread across Facebook and Instagram, so these are two key platforms you should be optimising.

Set out your goals and how you think you should get there before starting your digital marketing journey

A proper content and digital marketing strategy goes a long way. Set out your goals and how you think you should get there before starting your digital marketing journey. Decipher what you’re missing, what you can do inhouse, and what might need a little extra time or research or even outsourcing. The approach to digitally marketing popular treatments such as dermal fillers is vastly different from promoting an event or launching a new machine online, so decide exactly what you want to push for the next month, three months, six months, a year. This will help inform your content strategy and how you’re going to execute your plans over time.

OPTIMISING AND INCREASING YOUR SOCIAL MEDIA PRESENCE

FACEBOOK BUSINESS PAGE

Creating a FBP is really simple, and Facebook itself will walk you through this. Optimising and populating it, though, is crucial to the trust your page inspires in potential new clients and followers. Updating your contact information, opening hours, price ranges, services, and geographical location shown in a Google-style map allows visitors to your page to find out vital information. Without this information to inspire trust in your business, you risk not looking ‘legitimate’ and therefore alienating potential clients and followers. A FBP

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is far more than just posting content; it needs to be fully optimised with your username, business details, and even an ‘Our Story’ segment to gain the trust of potential new clients. Creating a content strategy to stretch across all of your social media channels is important for unity and also showcasing the treatments and products you’re seeking to promote.

INSTAGRAM BUSINESS PAGE

Connecting your FBP to your Instagram page results in an Instagram Business Page. This is why it’s important to fill out all of the vital location and contact details on your FBP, because the information will directly translate to clickable buttons on your Instagram Business Page. This encourages higher click-throughs and conversions, because a potential client can immediately request a consultation or get in touch with your reception team. Creating synergy between the two accounts will also help to create client trust, as social media users will see that neither platform has been neglected and that your clinic is actively inviting clients.

SOCIAL MEDIA CONTENT

Once you’ve optimised your social media platforms, it’s wwwwnow time to start posting on them. One of the downfalls of in-house social media marketing for many clinics is that they simply don’t have the time to formulate a proper content strategy. Consider the top three or four treatments you want to promote, add a product promotion as well if appropriate, and post about them frequently. Visuals such as before and after images are particularly compelling, as your Instagram grid or Facebook posts can become comparable to a portfolio. Potential clients will see the kind of results

you’ve produced for others and that you have been trusted by their peers, increasing the chances of them booking with you. This kind of imagery performs exceptionally well on Instagram and only marginally less successfully on Facebook, but they are extremely valuable to new client conversions. One of the major benefits of posting before and after images on your FBP is that you can also include a live link to your website in the caption, encouraging immediate click-throughs from potential clients. You can even monitor how successfully these posts perform when you visit your analytics and take note of the link clicks. Articles and blog posts, especially those from your website, also encourage click-throughs and engage with your followers on your FBP, but please note that Instagram does not currently support direct links in captions.

GOOGLE MY BUSINESS PAGE

Setting up and optimising your GMB profile is an easy task to perform in-house that will help boost your local SEO and potentially drive new client enquiries. Your (GMB) can be set up through Google. If you don’t have one yet, you >

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WEBSITE CONTENT

On-page optimisation and the written content on your website positively influence your SEO efforts when done correctly. Writing and rewriting your own content is an easy task to do in-house, or to entrust to a member of your team, especially if your website has an easy-to-use content management system. This may be through regular blog posts or your own treatment pages.

WEBSITE PAGES

Your written website content can be optimised through on-page SEO. This is one of the easier SEO tasks, as others such as increasing your domain authority and link building can be complex and are best trusted to an agency. Writing (and rewriting) your website content to contain the keyword relevant to each page and your location will help search engines to positively identify the correlation between your web pages and searches your traffic are performing. This means those searching for ‘dermal fillers’ or ‘laser hair removal’ will receive relevant search engine results from clinics close to them. Incorporating ‘laser hair removal in Nottingham’, for example, into your written content will help people searching for that treatment in that location find your website. Optimising on-page content will help draw your potential clients to you, but it’s always advisable to do this in tandem with other SEO tasks to truly make an impact.

BLOGGING

should definitely add it to your digital marketing shopping list as it is incredibly useful. A fully optimised GMB page includes premises photography, business category, map location, address, opening hours, contact number, and website link. The main ranking factors for whether your GMB profile shows up first for relevant keywords, such as ‘aesthetics clinics near me’, is if it is optimised with all of the valuable content detailed above. A GMB page also allows your current clients to leave Google reviews, which have been shown to more compelling than those on a FBP. That being said, linking your FBP to your GMB ensures your Facebook reviews average will also show up, and your Instagram profile can also be featured. This kind of cross-linking provides your searchers with plenty of opportunities to interact with you and can positively influence whether they click-through to your site. It doesn’t necessarily boost your SEO, but it can greatly impact search behaviour.

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Blogging is an easy in-house task you can perform that will positively boost your digital marketing efforts through appeasing Google’s algorithm. Fresh content is valued highly by search engines, almost above all else, so updating your blog once or twice monthly with a new blog post could drastically improve your SEO. Writing a blog post on relevant subjects and answering key questions such as ‘are dermal fillers safe?’ increase the likelihood of your website and blog posts getting noticed. The way your potential clients are searching for answers is literally through questions, so by offering a question and answer in a blog post you drastically increase the likelihood of you being noticed in search engine results. Blog posts are also extremely valuable on your FBP, because posting them not only informs your followers of your expertise and continued investment in content for them, but it also encourages click-throughs to your website and potential appointment bookings. Across SEO and social, DIY digital marketing blog posts are extremely useful content. DIY digital marketing is as simple as discussed, and there are plenty of tasks that you can perform for your own clinic. For those who simply don’t have the time or want to gain more from their digital marketing, finding a budget-friendly agency who knows your industry is a step in the right direction. DIY digital marketing can be done in-house, but you may need more than social media and blog posts to truly leave your mark in the aesthetics industry. AM

Adam Hampson is the founder and managing director of Cosmetic Digital in Nottingham, a digital marketing agency that specialises in healthcare, aesthetics, medical, and dentistry marketing. Established for more than 13 years, Cosmetic Digital has become one of the UK’s leading digital marketing agencies for these lucrative sectors. Cosmetic Digital’s in-house team continues to provide timeless yet contemporary websites and digital marketing solutions for clients in both the UK and overseas, and for businesses large and small.

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Star gazing Victoria Vilas on how to identify the stars among job applicants

job applicant’s CV may provide you with an overview of their work experience, training and skills, but the facts and figures laid out in that document won’t give you much of an insight into whether that person has the right attitude, work ethic, or personality to fit with your role and your clinic team. When answering interview questions, an interviewee could give generic answers, providing you with standard responses that they think employers want to hear. Though the answers may sound acceptable, they won’t reveal much of an interviewee’s true personality or outlook. To try and better understand your job applicants, look beyond their CV and their rehearsed answers, and look at their actions and their behaviour.

COMMUNICATION

First of all, when you contacted your applicant to invite them to interview, did they respond promptly? Did your applicant sound positive and polite when replying to you? If an applicant has a good work ethic and has a strong desire to get the job at your clinic, they should demonstrate this by making the effort to communicate professionally and show some eagerness. Their communication will give you your first insight into how your applicant may act as an employee. A new employee who understands the importance of professional communication and is excited about their new role is more likely to strive to become a valuable employee than someone who appears disengaged or a bit too casual. When you held your interview, was your applicant easy to talk to? Though some interviewees can be understandably

nervous, do watch out for warning signs that someone may not be the team player you are looking for. Interviewees who talk in an open and straightforward manner, and those who try and highlight the positive aspects of their work history, are more likely to bring a good energy to your clinic team than those who are negative about past roles or seem defensive when asked to explain their answers further. Do take note if your interviewee is not forthcoming or gives superficial answers. This is not to suggest that you should have a suspicion that every applicant has something to hide, but someone who doesn’t probably won’t be cagey during an interview. Did your interviewee do a good job of balancing talking and listening? Though it’s good to meet a job applicant with enthusiasm and plenty to say about their passion for the aesthetic medicine industry, it’s also a good sign if an interviewee listens carefully to the questions you ask and comments you make. New clinic employees will need to listen to managers or colleagues to learn and follow clinic processes correctly.

EFFORT

Did your applicant make the effort to write a covering letter or note of some sort? You can’t expect every applicant to be a talented writer, but writing a covering note, even if it is very brief, shows that a job seeker has made more of an effort than just submitting their CV, and that they perhaps care more about their application. How much research and preparation did your interviewee do prior to interview? You may not have asked your >

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Though some interviewees can be understandably nervous, do watch out for warning signs that someone may not be the team player

candidate to prepare anything in particular, but they should certainly have made an effort to understand your clinic business before attending an interview. Every clinic website is easily accessible to job applicants and will usually provide a good deal of useful information, such as your treatment menu, your USPs, and perhaps the company history and profiles of the clinic team. Candidates for interview should be reading this information for their own benefit, to get an idea of whether your clinic is a good fit for their needs and wants before they take their application further, not just so they can prove that they know something about your business if questioned at interview.

PROFESSIONALISM

Did your applicant present themselves professionally at interview? For example, did they arrive at interview looking smart and well groomed? Regardless of whether your vacancy is for a patient-facing role or a back-office administrative position, a good job applicant should demonstrate something of their intent and their work ethic by making an effort to look presentable and professional when they first meet their prospective employer. Someone who turns up to an interview looking scruffy may also turn up at work looking unkempt. Did your applicant use professional language throughout their communication with you? Even if you both got on well during the interview, an interview is a formal meeting, not a chat with friends. It’s a good sign if an applicant is personable and shows some warmth and spirit, but they

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should stick to language and topics suitable for a workplace discussion with an employer. Candidates should also make the effort to be polite. It isn’t hard to show a bit of courtesy and simply say “please” or “thank you” when appropriate. If you are interviewing a candidate for a patient-facing role where customer service skills are key, they should demonstrate that they are courteous at interview.

PERSONALITY

You may be making a judgement on whether an applicant will be a good fit your clinic role, not your group of friends, but do ask yourself this: did you like them? You need to consider whether a new employee will work well with your other team members, and please your patients. If you thought your interviewee was a pleasant person with positive personality traits, your team and your patients are likely to think the same. If you find someone to be quite cold and distant, do consider what effect this may have on teamwork and customer service. You can’t expect to collect a thorough profile of any person through a couple of interviews alone, but you can look for traits that will give you an outline of their personality, and have a better idea of whether they will be a positive addition to the team. Is your candidate honest, open-minded, eager to learn, adaptable, sociable, positive thinking, energetic, kind and understanding, confident but modest, and a good communicator? If so, you may have found a valuable new employee. AM

Victoria Vilas is marketing and operations manager at ARC, an aesthetics recruitment consultancy. The ARC team helps organisations in the industry grow their businesses by hiring the most talented aesthetic professionals.

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Picture this

Shaz Memon, creative director of Digimax and Digimax Dental, discusses what every practitioner needs to know about marketing minimally invasive facial aesthetics and how to use Instagram ethically

he concept of a ‘better version of yourself’ has become a buzzword in modern aesthetic practice. Gone are the days of extreme makeovers and, increasingly, less is more. Facial aesthetics is now valued for its minimally invasive treatments rather than the big-ticket surgical procedures of yesteryear. In an industry once plagued by a media spotlight that took a dim view of any dramatic results, clinical excellence and the safe delivery of bespoke patient care now take priority over the consequences of extreme surgery. Together with these assurances, medical professionalism, open communication and the careful handling of patient expectations encapsulate the ideal of best practice. From minimally invasive injectables to fillers and threadlift treatments, the evolution within the facial aesthetics market has been rapid, thanks largely to the innovation of pharmaceutical companies, the honing of skills in treatment applications, and a need by the industry to meet the growing demands of patients inspired by what they see online – evidence-based ‘lite’ procedures that deliver results. In tandem with this evolution came the digital revolution, offering practitioners a new way to market their clinical expertise, as well as a chance to turn the tide on the seemingly incessant wave of bad press. Essentially, aestheticians needed to promote their values and share their results online in order to engage with an audience hungry for new treatments and optimum results, but without the extreme approach they had previously learnt about in headlines.

INSTAGRAM

Roll on to 2019 and the marketing of any aesthetic practitioner needs to go beyond an online profile, a treatment menu and a blog or two. Social media platforms offer countless opportunities for on-going ‘conversations’ with patients – old and new – as well as the promotion of a brand. While a Facebook page and Google searches are often the initial starting point for a patient seeking treatments and practitioners, Instagram, the photo-sharing platform, is perfectly placed to educate patients and, in particular, showcase case studies evidencing your work. With one billion people using Instagram every month, it is very much the go-to space for those looking for fast and easy engagement. Potential patients scrolling through their Instagram feed want to know about you, the treatments you offer and the results you are achieving. They want to see results in high quality before and after images shared by both you and your patients and, as Instagram tends to attract a much younger audience than Facebook, engaging on this platform will widen your audience to include this

demographic for whom celebrity lifestyles might matter – and for whom first impressions and great aesthetics count. Make sure you opt for a business account so you have access to detailed analytical data. If you already have a personal Instagram account, then do check your privacy settings. Use your practice name as your Instagram username. Try to append your location to the name, for example @AcmeAestheticsActon. Adding your location will mean that if you like a picture on an account belonging to a local business or influencer, or any potential patient, they are more likely to check your profile as the location would feel familiar. It encourages local engagement, which is where you are most likely to elicit new patients. If your favoured username is taken, avoid using numbers. Although often the simplest way to create a unique username, it can impact on your credibility as a business – and may even suggest the account is not genuine. Don’t forget to fill out your biography. You need to flesh out the details in your bio so that people know what your account is about. Keep it brief, but do link to your practice website. You can also direct traffic by mentioning the link, i.e. ‘We have a gallery of makeovers to share with you. Check them out. See link in bio.’ Inspire with imagery and storytelling. Digital storytelling is a skill that creates a personal narrative to share with your target audience. When it comes to creating posts for Instagram, it is as important to focus on the visual, as it is the script. Instagram is all about images and a facial aesthetic clinic is, of course, very much a visual business. Also, think about how the clinic is being portrayed – a luxury setting should be reflected in the tone of voice and quality of photos, for example. Engaging digital storytelling has tremendous potential for motivating patients to enquire further, take an action, and proceed in scheduling their treatments.

SAFETY FIRST

The importance of safe treatment is, of course, a key driver when it comes to patient communication, with the regulatory expectations placed upon clinicians to advertise and market with integrity at the heart of an aesthetic business. Make staff members’ aesthetic qualifications a key component in the marketing messages you share. >

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BUSINESS

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DIGITAL MARKETING

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BUSINESS

DIGITAL MARKETING

At a Cosmetic Treatments and Lifestyle Therapies Roundtable organised by the JCCP and the Care Quality Commission (CQC) in February that was attended by various regulators and interested parties, it was agreed that there is a very real need to work closely with the Advertising Standards Authority to identify ‘potentially misleading or inaccurate advertising claims relating to the provision of cosmetic or lifestyle treatments and interventions’. In the same month, MP Alberto Costa tabled a parliamentary debate on the regulation of non-surgical procedures, calling for stricter regulation in the beauty industry, which covered treatments such as dermal fillers and Botox injections. Parliamentary Under Secretary of State for Mental Health, Inequalities and Suicide Prevention, Jackie DoylePrice, responded at the time by acknowledging: “It is important to ensure that the public understand the risks

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associated with the procedures, and we need to do our best to improve standards throughout the industry”. As pressure mounts on the government to make changes to the current regulatory status, aesthetic practitioners promoting their business on social media platforms should use this lack of clarity as a springboard for educating patients. Indeed, arguably any marketing of facial aesthetics should include three key principles: skills, safety and setting. As well as sharing your work and discussing what various non-invasive treatments can and cannot achieve, consider walking your online audience through a patient journey, highlighting the safety elements of seeking treatments from people like you – a medical practitioner – in a clinical setting. Do be sure to promote positively. Talk about the assurances your medical background offers rather than focus on the lack of skills and knowledge of non-medics. MP Jackie Doyle-Price observed that the government “clearly needs to make much more rapid and substantial progress if we are to protect consumers properly”. In the meantime, it is left to medically trained practitioners to ensure potential patients know that their clinic is a safe place for their noninvasive treatments and effective risk-free results – and social media is most probably the best place to do so. AM

Shaz Memon is the creative director of Digimax and Digimax Dental. He is a business leader, designer and award-winning digital and dental marketing expert. He has worked with leading names such as: Barclays, BBC, FHM, HP, House of Fraser, James Caan, Lennox Lewis, McDonald’s, and UBS. His work has won numerous awards, and today he is a regulator contributor to leading magazines and UK publications, including The Telegraph and The Guardian.

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M E N TA L H E A LT H S P E C I A L

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MENTAL HEALTH

Frame of mind Mental health has been at the forefront of the national consciousness in 2019, with more open and frank discussions about its impact and importance. The aesthetics industry plays a crucial role, often dealing with patients who have low self-esteem or are emotionally vulnerable, as well the rarer cases of those suffering from Body Dysmorphic Disorder (BDD). Over the next few pages we explore the role of mental health awareness in aesthetics.

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MENTAL HEALTH

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Keep it in mind

Nofie Johnston discusses why mental health matters in aesthetics

he medical aesthetics specialism is gaining new ground in publicising the safety and protective measures in place for patients.1 It is routine practice for consultations to be documented, structured and detailed, with sufficient time allocated to ensure a medical history is taken, there has been a clinical assessment, the patient has been consented and that any questions have been answered. The role of a mental health assessment is rarely included in the training syllabuses of aesthetic foundation and advanced training courses. This is despite the fact that the General Medical Council (GMC) guidelines stress the importance of the role of the psychological assessment, and most aesthetics clinicians do recognise the need for mental health skills in clinical practice. It’s an apt time for professionals to be considering which frameworks for mental health assessment work well in aesthetic practice and which mental health diagnoses

are most prevalent in aesthetic practice. A broad range of symptoms can be determined from a mental health assessment. Such symptoms can be attributed to common mental health disorders, such as anxiety and depression, and also severe and enduring mental health conditions. Established aesthetic professionals appear to be familiar with screening tools for Body Dysmorphic Disorder (BDD) and often have pathways for such a patient group, particularly for surgical patients.3 In this article, I would like to share with you: Which mental health conditions are likely to be present in your patient group How patients can benefit from your awareness and management of these conditions The risks of not being aware of a patient’s mental health needs.

It’s an apt time for professionals to be considering which frameworks for mental health assessment work well in aesthetic practice

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MENTAL HEALTH

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DEPRESSION AND ANXIETY

In 2014, 19.7% of people in the UK aged 16 and above showed symptoms of anxiety or depression. This percentage was higher among females (22.5%) than males (16.8%).4 Evidence suggests a clear link between depression and lowself esteem.5 For many patients, the decision to have a nonsurgical treatment is a solution to boost self-confidence. However, symptoms of depression can impact on a personâ&#x20AC;&#x2122;s ability to understand, reason and appreciate and express a choice.6 By screening for the absence of active symptoms of depression, aesthetic clinicians would be able to evidence a robust consent for treatment. Anxiety may form part of a greater underlying picture of mental health disorders (such as Generalised Anxiety Disorder) or it can be situational and normal as a result of stress. Due to this common presentation, aesthetic clinicians are likely to already have well-developed skills in managing anxious patients.7 Clinicians may wish to reflect on ways to share essential aftercare information in a manner that does not trigger further stress. Further consideration may also need to be given as regards appropriate channels for the patient to access aftercare services, how the clinic will respond and the method of review offered to the anxious patient.

POST-TRAUMATIC STRESS DISORDER (PTSD)

About 7-8% of the population will have PTSD at some point in their life.8 The disorder is likely to occur after a traumatic event such as an accident, physical assault, disaster or to witness death or injury. Symptoms of PTSD are very distressing and can include extreme physical symptoms, flashbacks where it feels like the trauma is happening again, nightmares and feeling emotionally numb. Although a trigger to this disorder is usually related to the sights, sounds and smells of the original trauma, a person will be hypersensitive to stress and touch (including facial touch), even in situations completely unlike the original trauma. For this reason alone, it is good practice to screen for this diagnosis and/or the progress of the treatment of PTSD so that the patient and clinician can be pre-warned of a relapse of the condition due to the potential stress caused by an aesthetic treatment.

PERSONALITY DISORDER

There is much stigma regarding this diagnosis, and it is ventured that in the UK there could be as many as one in 20 of the population experiencing an undiagnosed personality disorder.9 UK psychiatrists understand there to be 10 different type of personality disorder,10 making it a complex disorder to diagnose. A person with a personality disorder is likely to have difficulty with relationships, their management of emotions and controlling their behaviours. People with personality disorders may also experience decompensation when stressed or having difficulty adapting. Aesthetic procedures, their expected complications and a disappointment in treatment outcomes may all trigger decompensation and therefore patients with a personality disorder diagnosis (under the care of a mental health team) must be made aware of this risk to their psychological health.

BODY DYSMORPHIC DISORDER (BDD)

BDD often occurs in people with other mental health disorders, such as major depression and anxiety.11 Other factors that might influence the development of the disorder is experience of traumatic events or emotional conflict during childhood. Patients with BDD are at risk of seeking a cosmetic treatment for a perceived flaw and are unlikely to be satisfied that the outcome improves their psychological preoccupation of the issue. While there is some evidence to support consideration of treatment in mild to moderate cases,12 it is broadly recognised that clinicians are at risk of retaliation by a patient who thinks that the intervention has worsened their appearance.

IN CONCLUSION

This article seeks to expand on awareness regarding some of the mental health disorders likely to present in cosmetic medicine. Diagnosing and managing such conditions in aesthetic practice is complex and requires more than a paper-based approach. It is good practice for clinicians to consider the appearance and behaviours of the person presenting alongside the information elicited via their medical history and any appropriate screens. Such processes, alongside any additional mental health training, are reasonable steps for professionals to take in order that a more holistic approach to patient safety is taken. Clinicians are advised to consider: Have I assessed mental health needs? Is there a risk the patient cannot consent to treatment and/or is inappropriate for treatment? Are there drug interactions from psychotropic medication? Has the patient been made aware of the psychological risks of treatment and/or likelihood of dissatisfaction? Is a mental health referral required for further assessment or case management support? What support is required for pre-care and post-care information to be retained and understood.What plans for support during treatment are required? AM

REFERENCES 1. nhs.uk/conditions/cosmetic-procedures/before-you-have-a-cosmeticprocedure/ 2. gmc-uk.org/-/media/documents/Guidance_for_doctors_who_offer_ cosmetic_interventions_210316.pdf_65254111.pdf 3. ncbi.nlm.nih.gov/pmc/articles/PMC5986110/ 4. digital.nhs.uk/data-and-information/publications/statistical/adultpsychiatric-morbidity-survey/adult-psychiatric-morbidity-survey-surveyof-mental-health-and-wellbeing-england-2014 5. Manna G, Falgares G, Ingoglia S, Como MR, De Santis S. The Relationship between Self-Esteem, Depression and Anxiety: Comparing Vulnerability and Scar Model in the Italian Context. Mediterranean Journal of Clinical Psychology MJCP VOL 4 N.3 (2016) 6. bmcmedethics.biomedcentral.com/articles/10.1186/1472-6939-14-54 7. bmj.com/content/325/7357/207 8. M ental health statistics for England: prevalence, services and funding. Number 6988, 25 April 2018. 9. mentalhealth.org.uk/a-to-z/p/personality-disorders 10. medical.cfoapublications.co.uk/12581 11. a daa.org/understanding-anxiety/related-illnesses/other-relatedconditions/body-dysmorphic-disorder-bdd 12. n cbi.nlm.nih.gov/pmc/articles/PMC5986110/#bb0210

Nofie Johnston is a registered mental health nurse. She has practiced in cosmetic medicine since 2014 and is the director/lead clinician at Juno Aesthetics. Nofie has an interest in identifying and managing mental health conditions within aesthetic practice and is keen for other aesthetic health professionals to embrace this holistic approach.

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M E N TA L H E A LT H S P E C I A L

TALKING TO

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Inside out Dr Jonquille Chantrey has pioneered a series of forums promoting positive body image and self-esteem. She tells Fiona Vlemmiks why

omewhat uniquely, the underpinning philosophy of Manchester-based ØNE Aesthetic Studiø, is centred not only on physical enhancement but also the holistic improvement of mental and spiritual wellbeing. In addition to aesthetic medicine, an expert team of 12, led by Dr Jonquille Chantrey, offers nutrition, health, psychology, hypnotherapy, yoga and meditation, plus spiritual and personal development services. To coincide with the recent Mental Health Week 2019, Dr Chantrey was further inspired to create a series of Mind, Body and Soul forums. This launch reflects a growth in body dissatisfaction in a society where our appearance is constantly scrutinised. In a recent Mental Health Foundation with YouGov online survey, just over one third of adults said they had felt anxious or depressed because of their body image. The study, conducted in March this year, highlighted that one in

five adults felt images used in advertising had caused them to worry about their body image. The same proportion also believed that images on social media caused them to worry about their body image. “We’re living in a pretty difficult world where society can be full of judgement,” says Dr Chantrey. “Body image and selfesteem can directly influence each other and our wider feelings, thoughts, and behaviours. For some patients that are unhappy with aspects of their body, it can be difficult to accept and feel positive about their whole self. The reverse is also true: if selfesteem is lacking it can be hard to notice the good things and give our bodies the respect it deserves. “The forums are about empowerment and sending the message that it’s ok to want to improve yourself, be it physically, mentally or health wise.” Dr Chantrey, who is a Global Key Opinion Leader for Allergan, regularly advises the international media in print,

Body image and self-esteem can directly influence each other and our wider feelings, thoughts, and behaviours

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radio and TV. She explains how she recently rebranded her clinic to include a more holistic element, prior to launching the forums. “I’ve done a lot of research on the motivations of people coming in for aesthetic treatments and, often, there is an underlying reason which they may need support with, so I think it’s important to understand that and be open about it. “Aesthetics is wonderful, it’s what I’m known for. However, Iast year I began to get frustrated with others defining me as somebody who just works on the outside of a person, when actually a lot of the work that I’ve always done with my patients is on the inside from an emotional and mindset perspective. This may not necessarily always be in a formal way, but as part of my overall journey with them.” The Alderley Edge clinic was hence rebranded as ØNE Aesthetic Studiø, a 2,500 sq ft haven comprising six treatment rooms, private waiting areas and a new, multi-purpose studio for yoga, meditation and workshop sessions. Additionally, the studio serves as a facility to host training seminars for visiting UK and International medical professionals. Though there is some cross over between the aesthetics clinic and holistic services, Dr Chantrey is keen to outline that this is not where her motivation comes from. “Some of my aesthetics patients just want to look good and that’s fine. But generally patients really like the new space and they’ve been extremely supportive of my concept. “A few years ago, we were one of the first clinics in the UK to bring a psychologist into the clinic. Last year, I did my yoga teacher training and expanded the clinic because I simply found that I could not refrain from speaking my inner truth any longer about a subject I am passionate about.” Dr Chantrey’s interest in the mind goes back to medical school. “In my first degree, Bachelor of Medical Sciences, my research major was in psychiatry. “I was torn between psychiatry and surgery but when I was offered both opportunities

TALKING TO

after graduating, I went for surgery. However, psychiatry remains a big passion of mine. “Throughout my life, I have been in the selfimprovement space. I have always been one of those people with a self-help book on the go – to the amusement of my friends.” Sponsored by SkinCeuticals, the first two-hour Mind, Body and Spirit forum was attended by local press and celebrities including ex-Coronation Street star Catherine Tyldesley, Hollyoaks actresses Sarah Jayne Dunn and Nicole Barber Lane, TV presenter Natalie Anderson and actress Sophie Austin. The event commenced with a Mirror Soul Connection exercise from meditation expert Ashleigh Guthrie, followed by a 90-minute Q & A with a team of experts and a sound healing session. Accompanying Guthrie, the expert panel included Calum Tierney, director of Terence Paul Salons group; Penelope Silver, ØNE’s in-house, multi-award-winning reiki master, advanced EFT practitioner and wellbeing coach; Mark Bohannon, acclaimed Manchester personal trainer and Lorraine McCulloch, celebrity stylist and TV fashion expert. “The energy was incredible,” explains Dr Chantrey. “Seeing how passionate people were about these body image topics blew me away. “What was also really amazing was that a lot of people in the room felt safe enough to share their mental health stories. For example, one actress explained how she’d suffered from depression. A contributing factor was that she found her appearance played a major part in the kind of roles she was offered. “This encouraged other people to share their experiences, which I wasn’t necessarily expecting. It felt like a really safe space where people could open up and realise they were not alone in their feelings. Also the body positivity movement was a shared passion of the attendees.” Following the success of the inaugural session, the forums will subsequently be held at the ØNE Aesthetic Studiø on the last Wednesday of every month. Dr Chantrey intends that the forums will become part of her ØNE Beauty Project, focusing on mental health, body image and self esteem. AM

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M E N TA L H E A LT H S P E C I A L

PATIENT SUPPORT

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In support Plastic surgeon Mr Alex Karidis discusses the PaPPS Initiative (Pre and Post Procedure Support Program) and mental health in his practice Aesthetic Medicine: Do you think its increasingly important to offer mental health support within the aesthetics setting? Mr Alex Karidis: I think it is essential that we offer psychological support for our patients because I truly feel that every single patient walking through the door of a cosmetic surgery clinic has some psychological issues that will be affecting their daily life or relationships. Nobody is flippant enough to walk into a cosmetic surgery clinic and want surgery ‘just because’. There’s always something that is strongly affecting them and that’s why they are willing to go through the potential pain and risk. So this is where something like the PaPPS Initiative really helps as my staff can offer the appropriate support both before and after the surgery. I always tell my patients that cosmetic surgery is a journey and it’s a journey that begins well before they come to us. Trying to inform themselves and navigate through the ins and outs of something they don’t

inherently understand is stressful enough; they are out of their comfort zone and they also have the underlying issue that they want addressed affecting them. From our point of view, it’s not justsimply matter of saying ‘Do you want this operation?’ We have to address any psychological issues, too. How the emotional aspect impacts the patient varies from individual to individual. Some people will show it and some won’t. The problem is that if everything goes smoothly then everyone is happy. However, sometimes things don’t go exactly according to plan and that’s where the emotional impact can be huge. We need to be there to understand and address it and offer the appropriate support.

I think it is essential that we offer psychological support for our patients

AM: Did you know much about the The Wright Initiative and PaPPS before signing up to the training? AK: Norman Wright [founder of The Wright Initiative and PaPPs] is reasonably well known in our industry as he’s been preaching about the need for support for cosmetic surgery

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patients. If you are going to be offering a complete service to patients, you have to address this emotional aspect. It could be an issue they have lived with for decades and, eventually, it comes to the crunch and they think I can’t live with it any longer and I want to do something about it. The emotional aspect will have a profound impact on how the patient feels about the final outcome – how they think about their results. Because for some cosmetic surgery patients, it doesn’t matter how successful the surgery is, they will find faults. But if patients are happy and in a good frame of mind, they will be happy with the results. AM: Have you noticed social media having an impact on patient’s motivations for surgery or their emotional outlook? AK: I know there’s a growing trend of blaming selfies for making people feel dissatisfied with their looks, but I don’t think you can blame everything on social media. I think it is human nature to have insecurities. We all work through them at a different pace and yes, some things can exacerbate them, but they don’t create them. AM: Is managing a patient’s expectations key to a successful outcome? AK: Meeting patient’s expectations is the hardest part of my job, far harder than the surgical side. You can have a fantastic results and yet it might not meet the patient’s expectations. We have to discover what patients truly want and sometimes that can be a moving goalpost. And it can change from day to day; it is not set in stone as some people might think and that’s because of the emotional aspect of what’s happening. That’s why we support the emotional side of it. AM: Would you say your job is part psychologist as well as surgeon? AK: I often say that cosmetic surgery is psychiatry with a knife. We are trying to address an emotional issue through

PATIENT SUPPORT

the scalpel and, thankfully, by and large it’s successful. It’s not possible to totally differentiate the emotional and physical and say it’s all in the mind. If someone has a very large nose, no amount of counselling is going to make this person believe that his or her nose is small. And if it’s prominent and stands out then it can be addressed through surgery, but, at same time, you need the emotional support to take this patient through the whole journey. AM: Why is it important to continue supporting a patient after their surgery? AK: PaPPS is not just about preparing them for surgery, there’s also two post-procedure session sessions – it’s the complete support package and looks at all elements. After the operation is just as important as beforehand. Healing can take many months and the patient goes through many stages – a rollercoaster of emotions. Initially, they may be thinking ‘Why did I do this?’, and then they go through a period a week later where they start to say ‘I understand why I did it and I can see the light at the end of the of tunnel’. We need to identify the patients most in need of support and that’s why all Karidis staff get trained. AM: Do you think plastic surgery training covers this aspect? AK: This aspect was never addressed and there’s still a lot of deficiencies in the training. When you’re training to be a surgeon, the most important thing is learning the surgical skills and that takes many years to understand and master and you are focused solely on that aspect – your patients are usually asleep in the theatre and you aren’t engaging with them on a personal level. But when you complete training and you start seeing patients, that’s a completely different skill set to learn and you should be trained accordingly. We aren’t trained psychologists and sometimes patients need to be referred for help or support. I’m not saying every patient needs help from something like the PaPPS Initiative, but they all need support. AM

Mr Alex Karidis is one of the UK’s best known and respected cosmetic surgeons with more than 20 years’ experience in his field. Mr Karidis is renowned for his invisible scarring techniques, including his pioneering Karidis Quilting Technique that reduces post-surgical complications caused by haematomas and excessive swelling. This won The Hackett Memorial Prize at the annual scientific meeting of the British Association of Aesthetic Plastic Surgeons in 2018.

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ETHICS

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A matter of ethics Dr Raj Arora from The FaceBible shares her five main ethical principles of aesthetic treatments to safeguard vulnerable patients

he demand for aesthetic procedures has soared in recent years as our culture has become increasingly concerned about appearance and cosmetic perfection. As a result, there’s a growing trend for practitioners to offer treatments that aren’t ethical – either from the patient’s point of view or the clinician’s. Here are my five main principles by which aesthetic treatments should be carried out. 1. Respect for patient autonomy – every client is different, and their individual wishes should be respected. FaceBible doesn’t force anything on anyone – we simply allow the client to make the most informed decision possible, based on the risks, benefits and realistic achievable outcomes.

The clinician should never act against the patient’s best interests, especially for their own personal gain

2. Beneficence – clinicians should act in the best interests of the client, whatever those may be. Careful consideration should be given to patients who suffer from low self-esteem, have unrealistic expectations, or have body dysmorphia – a psychological disorder where one becomes obsessed with a non-existent or very minimal defect.

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3. Non-maleficence – the clinician should never act against the patient’s best interests, especially for their own personal gain (for example, when expectations are unrealistic or where the risks outweigh the benefits). Equally, the clinician should always ensure they have three things: a safe environment to operate in, emergency equipment, and advanced life-support training. 4. Justice – clinicians should provide a fair treatment accessible by all in the independent sector. Some procedures – dermatology or laser hair removal, for example – may be available through the NHS if deemed appropriate for an underlying condition.

5. Adolescent patients – extra care should be taken to ensure young patients have a cooling-off period (a period inbetween the initial consultation and the actual procedure) and full mental health assessment prior to treatments. It’s also important to consider that students are often unable to afford top treatments/ practices, pushing them to choose cheaper choices that are more likely to result in a ‘botch job’. AM

Dr Raj Arora is a UK-based GP with more than 10 years’ medical experience. Having worked in a number of fields ranging from surgery to dermatology and general medicine, Dr Arora founded The FaceBible based near London’s Heathrow Airport and now focusses on aesthetics and skincare and the ethics behind them.

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MEDICINE MEDICINE

Aesthetic Medicine • March 2019

MEDICINE

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DOSSIER

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SPFS

Stars of the screen The summer is well and truly upon us and while wearing SPF is key all year round, it is particularly important that clients protect their skin while on holiday or when spending more time directly in the sun. In this special report, we take a look at SPFs, from those protecting the environment as well as our skin to the tinted products offering clients a bridge between make-up and sunscreen. Aesthetic Medicine â&#x20AC;˘ July/August 2019

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REEF-SAFE SPFS

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Under the sea Environmentally conscious clients are seeking out sunscreen formulas that do more than just protect the skin, but safeguard the marine environment too

ublic consciousness has recently been shifting to a greater awareness, not only of the scale of marine pollution, particularly concerning plastic, but also to the plethora of challenges the world faces in terms of ocean health and the impact global warming, over fishing and pollution are having on the ocean’s ecosystem. June 8 was World Oceans Day and, as well as a recent ban on plastic straws and cotton buds, sunscreen is the latest everyday item to come under the scrutiny of environmentalists for its damaging effects on the planet. Some traditional sunscreen filters have been detected in coastal waters either directly as a consequence of washing off swimmers or indirectly from wastewater treatment plant effluents. And new research now attributes a substantial amount of coral reef damage, including bleaching, to these chemicals, sparking quick responses to try to stop the harm before it’s too late.1 Ingredients including oxybenzone and octinoxate have long been used in sunscreen formulas to filter the sun’s rays away from the skin, keeping it protected, however,

these have been found to be the most damaging filters to the coral reefs.1 In fact, in May 2018 the Hawaiian government passed a bill banning the sale of sunscreens containing oxybenzone and octinoxate in the state, after a study found it severely damaged its marine environment. Florida’s Key West followed suit in February this year. The ban will come into force in January 2021. Coral reefs may be the most diverse ecosystem on the planet, and through the habitat they give to fish and other marine life, indirectly provide food for millions of humans. While scientists agree that more thorough research needs to be conducted to determine the relationship between sunscreen and reef damage, environmentally aware consumers are starting to turn their backs on traditional suncare products in favour of reef-safe alternatives, at least when intending to apply them beachside. Environmentally-focused brands such as AlumierMD, Medik8 and ZeNNi have been the frontrunners in developing chemical free, green and ocean-friendly products in the aesthetics arena offering reef-safe formulas for your environmentally conscious clients.

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ZENII

Dr Johanna Ward’s ZENii SPF was formulated to be reef safe and free from nanoparticles so that it can’t penetrate into the blood/circulation and cause low grade inflammation. The organic antioxidant SPF 50 is ideal for daily use and is packed with beneficial ingredients like aloe vera and vitamin B5. It uses organic filters and has a light tint that means it goes on the skin seamlessly with no obvious white residue and sits beautifully and elegantly under make-up. Suitable for normal to dry skin, it is especially good for skin in need of extra hydration or for sensitive skin that needs to be protected from UV radiation.

MEDIK8

ALUMIERMD

AlumierMD was founded with clean chemistry at its heart. The brand does not use chemical filters due to concerns about toxic-loading and these chemicals penetrating through the skin into the bloodstream. AlumierMD uses physical sunscreens (zinc oxide and titanium dioxide), which sit on the skin surface and largely reflect and scatter UVA I, UVA II and UVB rays but are not absorbed by the body. Toxins being absorbed by our bodies can disrupt our hormonal balance and have a long-term negative impact on our health. They can also have a negative impact on ocean health. Removing these toxic ingredients not only makes products safer for clients but for the coral reefs too. Alumier Labs UK Limited has also been offsetting its carbon footprint. The company has purchased 120 tonnes of carbon offsets in its bid to be carbon neutral by 2020.

Medik8 has had green philosophies at its core since its inception. The UK-manufactured brand had always been packaging and carbon footprint conscious and actively promotes ocean safe products too. To protect the coral reefs and general aquatic health, the brand actively avoids the sunscreen filters which are associated with damage to the coral reefs and instead chooses to use reef-safe sunscreen filters. The brand only ever uses non-nano physical sunscreen filters. Nano-sized zinc oxide and titanium dioxide are defined as smaller in diameter than 100nm and are often used in sunscreens because they are easier to formulate with. However, nanoparticles have been linked with safety concerns, and nano-sized zinc oxide has even been linked with disruption to coral reefs. 2 Its Physical Sunscreen uses mineral filters titanium dioxide and zinc oxide. In its chemical sunscreens, the brand only uses a select few next-generation filters which they claim are much safer than traditionally used chemical filters such as Uvinul A Plus, Tinosorb S and Uvinul T150. They are all exceptionally stable in the sun, safe for the skin and offer high level protection from UV rays. None of these chemical sunscreen filters have been linked to damage to the coral reefs. AM REFERENCES 1 C. A. Downs et al, Toxicopathological Effects of the Sunscreen UV Filter, Oxybenzone (Benzophenone-3), on Coral Planulae and Cultured Primary Cells and Its Environmental Contamination in Hawaii and the U.S. Virgin Islands, Archives of Environmental Contamination and Toxicology, 2016, 70(2), pp 265-288 2. Corinaldesi et al, Impact of inorganic UV filters contained in sunscreen products on tropical stony corals (Acropora spp.)., Sci Total Environ, 2018, 637-638, pp 1279-1285

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TINTED SPF DOSSIER

Tint of colour Tinted SPFs offer a bridge between make-up and sunscreen, making them a fantastic way to get clients to comply with application while evening out skin tone and giving a dewy glow at the same time ALUMIERMD (ALUMIER LABS)

AlumierMDâ&#x20AC;&#x2122;s wide range of chemical-free sunscreens has a number of tinted options. The Moisture Matte Broad Spectrum Sunscreen SPF 40 collection provides powerful broad-spectrum protection against harmful UVA and UVB rays using a combination of zinc oxide and titanium dioxide, both physical filters. The formula lightly moisturises to smooth and hydrate, while absorbing excess oil to create a matte finish. Antioxidants like caffeine, silybin and knotgrass extract protect skin from UV and free radical

damage. Cutting edge, colour-encapsulated technology blends on the skin, creating a sheer tint and healthy glow. The product is available in Ivory, Sand and Amber tints and can be used in place of daily foundation. Sheer Hydration Broad Spectrum Sunscreen SPF 40 is a silky and sheer physical only sunscreen. The formula also uses a combination of zinc oxide and titanium dioxide to protect against UVA and UVB rays, while moisturising with vitamin E. The product is also packed with freeradical quenching antioxidants including a stable vitamin C, resveratrol, grape seed extract and glutathione, to protect skin from UV damage. It is available in both untinted and a versatile tint that blends beautifully on the skin creating a sheer radiance.

EPIONCE (EDEN AESTHETICS)

Daily Shield Lotion Tinted SPF 50 is ideal for clients who want the protection of a sunscreen with a sheer, natural make-up-like coverage. The formulation combines botanical ingredients rich in antioxidant and anti-inflammatory properties, plus broad-spectrum UV protection. >

Aesthetic Medicine â&#x20AC;˘ July/August 2019

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TINTED SPF DOSSIER

This protects against damaging inflammation and premature skin ageing and protects the skin from pollution and cancer-causing UV rays. The cosmetically elegant product evens out skin tone while imparting a natural-looking healthy glow. Perfect for all skin types – even sensitive skin – the very water resistant formula provides sheer protection in just the right amount of colour to let skin look bare, Epionce Daily Shield Lotion SPF 50 is ideal for daily use. The one shade blends flawlessly making it ideal for most skin types and tones. It can be worn alone or under make-up to provide optimum protection from UV exposure.

HELIOCARE 360O (AESTHETICARE)

Heliocare 360˚ includes a number of tinted options in its range. Its Colour Gel Oil-Free Gel provides natural, matte coverage to even out skin tone, creating a smoother and more perfected complexion. It can be worn alone or underneath foundation. It uses a blend of natural and mineral UV filters, antioxidants and Biomimetic Melanin. This lightweight colour-enriched fluid hides imperfection, shields the skin’s surface from damage and defends from within with its powerful Fernblock FC.

tinted moisturiser provides an even skin tone and healthy glow. The product contains a next generation blend of antioxidants to decrease damaging effects of the sun and environmental exposures. The oil-free sheer tint can be used as a moisturiser and make-up in one and has a water resistant formula. DNA Protection Complex fights physical signs of ageing while protecting against free radical damage while BV-OSC accelerates collagen synthesis up to 50% better than traditional vitamin C, according to the brand.

IS CLINICAL (HARPAR GRACE)

Combining the latest in anti-ageing technology with sun protection, iS Clinical’s Eclipse SPF 50+ provides all-physical broad-spectrum UVA/ UVB protection. The product is water resistant, has an ultrasheer finish and is fast absorbing and weightless. It is available in translucent or PerfecTint® Beige. It contains transparent titanium dioxide ()5.20%), derived from titanium, which makes it nonirritating, non-allergenic and noncomedogenic. Micronised zinc oxide (1.10%) provides safe, physical broad-spectrum protection by creating a physical barrier to reflect and absorb UV radiation. Tocopherol (vitamin E 1.0%) acts as a moisturiser and potent lipophilic antioxidant. It inhibits DNA damage, thymine dimer formation, inflammation and oxidative damage as well as protecting against UV-induced photo-damage.

MESOESTETIC (WELLNESS TRADING)

This combination means the skin will not only have the maximum protection against UVA, UVB, visible light and infrared-A, but also the free radicals caused by other environmental challenges. The Heliocare 360° Colour Cushion Compact SPF50+ combines UV protection and light, dewy coverage in one product. The non-comedogenic formula contains sheer make-up pigments to minimise the appearance of imperfections, making it the perfect alternative to foundation on minimal make-up days.

IMAGE SKINCARE

Image Skincare’s Prevention+ daily matte moisturiser SPF 30 is an oil-free, broad-spectrum UVA/UVB sunscreen that delivers high sun protection. This daily

Mesoestetic’s Ultimate W+ whitening BB cream is a multi-action cream that moisturises, unifies and brightens the tone of the skin instantly and naturally. It attenuates dark spots and blemishes, in addition to preventing and combating the appearance of wrinkles and expression lines. It provides maximum, even and constant photoprotection against UVA and UVB rays. Ultimate W+ BB cream is available in two shades - light and medium.>

Aesthetic Medicine • July/August 2019

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SEE US ON STAND C8

NORTH MANCHESTER CENTRAL 29-30 JUNE 2019

SEE US ON STAND C8

Pigmentation Prevention with

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EverActive C&E® 15% L-Ascorbic Acid – the most bioavailable form of Vitamin C – is an antioxidant which strengthens and brightens skin.

Eventone Brightening Serum

Bright & Clear Solution

Intellibright Complex

Emblica™ has antioxidant and skin brightening properties, improving skin tone and reducing the appearance of hyperpigmentation.

Lime Pearl™ is naturally rich in AHA, gently exfoliating skin for a brighter and more even toned complexion.

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TINTED SPF DOSSIER

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OBAGI (HEALTHXCHANGE)

Mesoestetic’s mesoprotech range also offers tinted options. All the products in the range incorporate mesoprotech complex, a wide-spectrum sun protection complex that combines physical, biological and/or chemical filters for maximum efficacy against UVB, UVA, HEV and IR radiation. The sunscreens are also formulated with ‘collagen pro-47’, a plant extract that increases the presence of type 47 heat shock proteins (HSP), which protect collagen networks in the skin and enhance the synthesis of new type I collagen fibres. HSPs act on the collagen formation process, increasing both quality and quantity to help prevent photo-ageing and promote skin elasticity and tone. It’s mineral matt anti-ageing fluid is a very high factor sunscreen (SPF 50+) specially formulated for combination, oily and sensitive skins. The formula includes mineral filters and mattifying particles that eliminate excess shine and leave the skin with a velvety matt finish. It has an innovative non-greasy fluid texture that turns into a powdery emulsion on the skin.

NEOSTRATA (AESTHETIC SOURCE)

NeoStrata’S Sheer Daily Protection SPF 50, is a lightweight, transparent, high protection formula that offers broad spectrum UVA/UVB protection. It has a virtually invisible universal tint and ultrasheer mattifying texture that is ideal for all skin types, including sensitive skin. The weightless fluid makes make-up free days easy with no white or oily residue, while the lactobionic acid maintains a healthy skin matrix, slowing collagen breakdown as well as improving firmness, smoothing skin, and reducing the appearance of fine lines and wrinkles. The multi-antioxidant blend includes vitamin E to fortify the skins natural defence against free radicals, helping to neutralise environmental damage. A highly purified and concentrated form of green tea extract (EGCG) reduces cell breakdown and protects cellular DNA for healthy skin. The easily blendable formulation absorbs quickly, so it is ideal for layering with light skincare such as serums.

Sun Shield Tint Broad Spectrum SPF 50 is part of the popular Obagi Sun Shield range. Available in two shades, warm and cool, the tint works with the natural undertones of the skin to enhance the complexion while providing protection, and is suitable for Fitzpatrick skin types I-V. Although most sunscreens primarily protect against UV rays, Obagi Sun Shield Tint Broad Spectrum SPF 50 has been specifically formulated to provide protection against UVA, UVB and infrared red wave lengths, which penetrate the skin deepest. Both zinc oxide and titanium dioxide provide infrared red defence and help to buffer the skin from heat derived oxidation and support the skin’s resilience against IR radiation.

PRIORI (SKINBRANDS)

Tetra fx251 Broad Spectrum SPF 45 from PRIORI offers four levels of protection that adapt, in realtime, to provide what the skin needs, when it’s needed. This multilayer formula is enriched with broad spectrum mineral sunscreen, proprietary Infrared and HEV Protection Complex, antioxidants and DNA repair enzymes to shield the skin from harmful environmental elements, such as free radicals and pollutants and the damaging effects of sun radiation and (HEV) high energy, visible blue light from everyday electronics. It is available in choice of finishes: Universal Shade and Color Guide that melts to your complexion. All PRIORI Tetra products feature Genetic Protection Factor (GPF).

SKINCEUTICALS (L’OREAL)

SkinCeuticals has three tinted sunscreens, all tailored to meet specific skin needs. Mineral Radiance UV Defense SPF 50, is a lightweight, ultrasheer tinted formula which is best suited to Fitzpatrick skin types I-V, making it ideal for daily use to prevent visible signs of ageing and photo-damage. It is combined with translucent colour spheres to provide a tinted sunscreen. The spheres evenly disperse within the fluid to provide a sheer surface coating. They repel oil to minimise sebum appearance and enhance natural skin tone and radiance thanks to the light coverage provided. Mineral Radiance UV Defense SPF 50 is water resistant and can be worn under make-up. It offers an optimal formulation in mineral sunscreens delivering 100% mineral broad spectrum protection against damaging UVA and UVB rays, with micro fine titanium dioxide. >

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UPLIFTING. ONE SERUM. TRIPLE SOLUTIONS.

Tri-Therapy Lifting Serum Aminofil® Amplified. A proprietary Triple Anti-ageing Complex helps to volumise and sculpt skin, filling the look of deep wrinkles and improving the appearance of skin laxity.

VOLUMISES Slack Skin with Aminofil® 79% improvement in wrinkles RENEWS Tone with Gluconolactone 90% skin brightness and improved clarity SMOOTHES Skin with LMW Hyaluronic Acid 97% reduced appearance of fine lines Volumises Slacked Skin

Week 0

Smoothes Skin

Week 0

Renews Tone

Week 0

*% of subjects with clinical improvement at week 12. Week 12

Week 12

Data on file, NeoStrata Co., Inc.

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

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TINTED SPF DOSSIER

Mineral Matte UV Defense SPF 30 is a lightweight tinted formulation for combination and oily skin types and provides broad spectrum UV protection. Mineral Matte UV Defense SPF 30 has a weightless mousse texture which makes application easier and ensures an even distribution. It dries to a powder finish over which make-up can be applied if desired. It contains a mattifying complex of active ingredients including titanium dioxide and aerated silica which are combined with translucent colour spheres to unify skin tone and provide light coverage. The aerated silica has long lasting oil absorbing properties to ensure a matte finish and it also contributes to the silky feel of the formulation. High protection sunscreens can be challenging for patients with oily or combination skin because they can create a sheen on the skin and clog pores. Sun exposure and heat exacerbates the situation further by increasing surface oil and shine. Mineral Matte UV Defense SPF 30 is very absorbing and has been tested in high humidity. It maintains the matte appearance of the skin making it suitable for patients prone to acne and breakouts. Finally, Mineral Eye UV Defense SPF 30 is a tinted mineral based sunscreen especially formulated for daily use on the delicate and sensitive skin area around the eye. It provides high protection without migration or irritation of the eyes while enhancing and nourishing the entire eye area. Mineral Eye UV Defense SPF 30 also contains titanium dioxide and translucent colour spheres. The colour spheres even skin tone around the eyes not only to create a smooth canvas for optimal eye make-up application but also refreshes the under the eye area by concealing bothersome dark circles so reducing the appearance of fatigue.

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TANCREAM (AESTHETIC SOURCE)

A premium face and body sun protection and skincare lotion, Tancream is ideal for people who have had skin treatments for acne and cosmetic procedures, such as microdermabrasion, facials, HIFU and other aesthetic treatments where patients are advised to stay out of the sun and not to wear make-up. Designed to be worn daily for sun protection, this odourless formulation also provides an instant “bronze” which develops as a gradual self-tan with the benefits of an advanced anti-ageing treatment. It uses the latest sunscreen technology, natural phospholipids and vegetable-derived cationic emulsifier, which among many attributes also conditions the skin and gives a feel-soft effect. The product prevents sunburn, helps slow down skin ageing and gives a golden natural looking tan which builds gradually over a few days and, because of the special formulation base, it does not smell or streak.

ZO SKIN HEALTH (WIGMORE)

ZO Skin Health’s Sunscreen + Primer SPF 30 and Daily Sheer SPF are nongreasy, quick drying sunscreens with a universal tint and a silky matte finish help reduce the appearance of skin imperfections. The products can be used alone or worn under make-up for a more even, long-lasting application. Offering broad-spectrum protection against UVA, UVB rays, they are oxybenzone free and engineered with ZO’s exclusive 12-hour, time-release ZOX12® complex, to help shield the skin from harmful infrared (IR-A) rays.Natural melanin also shields the skin from the ageing effects of high-energy visible (HEV) light. AM

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dermamelan

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S K I N / D E R M AT O L O G Y

SKIN NEWS

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AestheticSource launch new SkinTech Peel2Glow formula

Skinade unveils new ranges Skinade has announced the introduction of two new ranges – the Skinade|MD® Pre+Post Care Programme and Targeted Solutions. Skinade|MD® is designed to be integrated into clinical protocols to help patients prepare and recover from surgical or invasive aesthetic procedures, improving results and reducing down time, increasing patient satisfaction and retention. The four-step protocol covers a 45-day period, pre and post procedure. The programme integrates liquid and powder sachets, capsules and a sublingual spray enabling the active ingredients to be consumed with optimal efficacy to improve results and mitigate procedure impact. Targeted Solutions are designed to target specific concerns and are exclusive to the skincare professional. Skinade® Targeted Solutions is a professional-grade range of products that provides result-driven solutions to specific concerns. The first three products in the range are Cellulite, Clear and Vitamin Boost A&D, which all work from the inside out.

New product from 5 Squirrels to benefit Orangutan Foundation 5 Squirrels has introduced LIFT, a clinically effective neck and décolletage firming cream, to its Your Signature Skincare Range. This is the seventh product in the range to be launched without the inclusion of palm oil or palm derivatives to keep the brand’s commitment to be completely palm free by 2021. The new LIFT product is formulated with powerful active ingredients to firm and smooth the neck and décolletage. 5 Squirrels has also joined forces with the Orangutan Foundation to save valuable habitat for this endangered species. Every product purchased will save one acre of the orangutan’s precious habitat for one year. To mark this collaboration LIFT was launched on World Rainforest Day (June 22, 2019).

AestheticSource has announced the introduction of the latest Peel2Glow formula, the second in a collection of skin solutions to be launched in the UK. The brand will be releasing seven different peels over the next few years. The first one was for radiance and glow and the new product is designed to target pigmentation, and to control and reduce redness and pigment stimulation. The product provides practitioners with a safe and easy-to-use professional skin radiance peel that can be incorporated into an existing treatment portfolio as well as retailed in clinic for regular home use or for a pre-event glow. Presented in a single-dose format and designed to deliver the correct measure of solution, this two-step treatment is easy to apply and suitable for all skin types and ages. Aesthetic nurse Anna Baker said, “The new Peel2Glow formula has clinically effective ingredients to specifically target pigmentation and uneven skin tone. The innovative and proven blend of tranexamic acid, vitamin C and azaleic complex brightens and evens pigmented skins, while the acetyl hexapeptide38 provides a firming effect and feel to the skin. This 10% AHA formula just got better, and is much more than glycolic and mandolin acid blended peel.”

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CALL FOR ARTICLES Are you interested in becoming a contributor to Aesthetic Medicine magazine? Do you have any articles you would like to write or any thoughts, treatment tips or techniques you would like to share? Then we want to hear from you. Whether itâ&#x20AC;&#x2122;s writing about running an aesthetics business or sharing your case studies and clinical expertise, then get in touch and let us know your ideas by emailing info@aestheticmed.co.uk or calling 0207 351 0536

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I N J E C TA B L E S

LIPS

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It’s only natural Dr Krystyna Wilczynski on the art of natural lip fillers

here is no doubt about it, the rise of popular culture, social media and influencers has had a significant effect on the demand for cosmetic and aesthetic procedures. The rise in facial enhancements has most definitely been due to the popularity of social media apps such as Snapchat and Instagram, which allow photos to be edited and filtered. The quest for the ‘perfect face’ can been seen as a direct result of this desire to enhance appearance. By adapting their photos, people see how their looks can potentially be improved or altered; and seeing what they could potentially look like, encourages people to favour this modified appearance in preference to their natural look. Previously, patients would use celebrities as comparisons or benchmarks. Nowadays, more often than not, clients will show photos of their younger self or edited versions of themselves. One of the most popular treatments has been lip enhancement. Celebrity lip enhancement has received

vast amounts of attention (Kylie Jenner being the most prominent), and their tales have fueled the market in the non-surgical aesthetic world. It has become more socially and publicly acceptable to undertake ‘tweakments’ , so for this reason I would like to focus this article on the art of the natural lip. Hydrated, fuller and more voluminous lips have, for many years, been considered a pillar of youth and beauty. Our lips are one of the first places to show signs of ageing. With time, lips become dehydrated, lose volume and definition and appear more wrinkly. This is especially prevalent among smokers and those frequently exposed to damaging UV rays. Lines appear more obvious due to increased muscular activity of lips around a cigarette. The gradual loss of collagen, which is a naturally hydrating and plumping protein structure, makes lips appear thinner. The introduction of lip injectables to combat this has developed vastly over the past 20 years and is considered extremely effective at tackling this problem.

Previously, patients would use celebrities as comparisons or benchmarks. Nowadays, clients will show photos of their younger self or edited versions of themselves

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I N J E C TA B L E S

LIPS

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TYPES OF LIP ENHANCEMENT

There are several types of dermal fillers that can be used. The most common product used today contains hyaluronic acid which is a substance naturally found in the body. This helps provide physical volume when injected to the structure, and also absorbs water to the site. The tissue appears hydrated and naturally plumped. Other lip injectables include collagen and fat injections, but these have been phased out due to the greater risk of side effects and lack of predictable results. The first generation of fillers available were collagen based and not FDA approved. The product was extremely expensive and was considered the preserve of the rich and famous. Nowadays, dermal fillers are much safer and more affordable to the general public. The current trend for lip augmentation is to produce a more natural yet effective result. Patients want to be enhanced, so that they feel more confident in themselves, rather than changed. Undetectable beauty is desired, as opposed to the ‘duck mouth’ look, the ‘trout pout’ or having had ‘something done’.

patients are happy with the injector. The consultation also is a time when you can discuss your goals. These may include: Enhancing overall fullness in the upper, lower or both lips Reducing wrinkling around the lips due to a loss of lip volume over time Slightly altering the shape of the lips, such as increasing the volume at the top or bow of the lips Unnatural, overfilled and lumpy lips can result due to poor technique, inappropriate product and inaccurate placement. If filler is injected into an artery, it can occlude (block) the artery and therefore lead to tissue necrosis (tissue death).. This is a highly serious complication and must be treated as a medical emergency. To ensure a natural result, use a small, direct needle suitable for intricate detailing and a cannula for the main body filler. A cannula is a wide bored needle that vastly reduces the trauma to the lip tissue, therefore resulting in less post-operative bruising and swelling. The first place to inject would be the area where the skin under the nose meets the top of the lip. This approach is frequently used for filling and shaping the upper lip. Linear threads (filler drawn in lines) are injected along the vermillion boarder to define and contour the lip shape. This is also a particularly useful technique when trying to combat smokers lines. Another area where injections are commonly placed is where the wet, inner portion of the lip meets the dry, outer portion. It is important that the injector does not over fill >

Undetectable beauty is desired, as opposed to the ‘duck mouth’ look

SKILLED PRACTITIONERS

The success of lip augmentation is highly dependent on the skill of the injector, and will stem from appropriate high-end training and experience. Bespoke treatment plans, tailored to the individual during a consultation appointment, are recommended in order to ensure

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I N J E C TA B L E S

LIPS

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the ‘wet’ portion of the lip as this will result in the ‘duck mouth’ ‘trout pout’ appearance. The amount of filler used will also determine how natural the result. If an injector overfills the lips to the point where they unbalance the facial harmony, it will appear more obvious that the client has had work done. It is also important to consider the age of the patient who wants the treatment. How young is too young? The influence of Facebook, Instagram and Twitter most definitely increases the appeal of cosmetic treatments to the younger generations. There is a growing concern that younger individuals are embarking on anti-wrinkle, facial filler and lip augmentation treatments too early. While these treatments are semipermanent, they are still medical, and patients must be aware there are possible detrimental consequences if not undertaken correctly. There is no definitive answer to the above. Patients who suffer with grinding issues, excessive sweating and migraines would be entitled to muscle relaxant treatment in the form of botulinum toxin injections at an earlier age. This would be acting in the best interests of the patient, to combat their issues and enhance their medial health.

Aesthetic treatment can be both preventative and corrective. The right time to start preventative treatment needs to be tailored to the individual. The time to start enhancing lips or cheeks with facial filler injections varies and the clinical decision is the responsibility of the injector. Every patient is unique, and some may warrant injections for corrective facial sculpting (or surgical options) at a younger age, while others are advised to wait until they have progressed further in their physical and psychological maturity. As a general rule of thumb, the legal age of consent for medical or dental procedures is 18 years old. Facial filler should not be undertaken until the individual has reached their mid-20s. Exceptions to this might apply if there is a serious facial asymmetry, cleft treatment or a deformity which can be helped with dermal filler. In conclusion, the use of lip fillers should not be considered a fad, or undertaken lightly. A reputable practitioner will examine, advise and carry out the procedure safely and to the benefit of the patient. Patients should do their own research beforehand, even though this is a non-surgical procedure. For a pleasing result, lip augmentation must be done for the right reasons. AM

Dr Krystyna Wilczynski is passionate about aesthetics. She is a qualified cosmetic dental surgeon and facial aesthetician. Since graduating from the University of Leeds in dentistry in 2010, she has undertaken a vast amount of post-graduate training in both dental and facial aesthetic procedures, including several advanced training programmes in both New York and London’s Harley Street.

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CASE STUDY

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A stimulating topic We take a look at the results practitioners are getting with the RRS range of biorevitalisers

he RRS range consists of 14 tailored injectable formulations designed to repair, refill and stimulate the skin, providing hydrobalance combined with biorevitalising benefits. It allows aesthetic practitioners to offer patients unsurpassed biorevitalisation treatments that are highly effective and safe to use for the face and body.

DR MAYONI GOONERATNE “RRS consists of non-cross-linked hyaluronic acid which supports and stimulates the extra-cellular matrix. In addition, some ranges also include silicium to stimulate the local production of collagen. Alongside these two main substrates, there are up to 72 added

RRS contains non-cross-linked hyaluronic acid combined with 20 to 72 active ingredients solubilised in a solution to treat a number of conditions conditions, including skin laxity, pigmentation, alopecia, and the appearance of cellulite and stretch marks, as well as boosting collagen, elastin and skin hydration. Easy to use as an injectable and compatible with multiple delivery systems, RRS offers stable, durable

amino acids, nucleotides and polyphenols among others that then provide a biorevitalisation cocktail. “Skin Tech is a company that prides itself in offering both laboratory and clinically tested products. There are robust medical studies that are available to refer to that demonstrate both efficacy and safety making the range an absolutely obvious choice. There are very few mesotherapy ranges available to the aesthetic practitioner, and those that do exist do not have the level of studies and testing that RRS has to support it. “Another main attraction of this mesotherapy range is its versatility. It can be added to many of the treatments that practitioners may already have in their clinic – microneedling, for example – which adds significant value, both therapeutically and commercially.”

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CASE STUDY

and rapid treatment results. RRS is an extremely versatile product range and can be tailored to the patient’s needs, skin condition and lifestyle. The RRS range can also be used in multiple modalities, depending on the qualification and profession of the practitioner, with consistent and predictable results.

COMBINATION TREATMENTS

Showcasing the versatility and diversity of RRS with multiple delivery systems and device modalities, four leading industry practitioners share their successful case-studies and how you can tailor and optimise RRS treatment outcome by utilising the benefits of true combination therapy. Modality 1 RRS XL Hair Meso gun Duration of treatment: 30 mins once per week for 12 weeks. Treatment summary: Reduce treatment time and stimulate dermal activity with Meso gun application – the multiple needle penetrations in this treatment protocol stimulate hair growth, combined with injection delivery of the RRS XL Hair formulation. Practitioner view: Dr Sophie Shotter, Illuminate Skin Clinic, says, “Using a meso gun for this application makes the treatment much more comfortable for the patient and also much quicker. It is also my go-to for treating any larger areas of the face or body. RRS is like my little apothecary. I love being able to blend and mix different vials to achieve utterly bespoke results for my patients, but I also know that picking just one vial off the shelf will do an incredible job, too. The safety profile, extensive testing and fantastic results mean it is my go-to for skin biorevitalisation.” Modality 2 Plasma Poration RRS XL Hair ® Therapy Duration of treatment: 30 mins per session per week for six to 12 weeks as necessary. Treatment summary: Utilises the cellular regeneration technology of Plasma Poration, which provides effective results and enables delivery of the product into the scalp without any needle discomfort. Practitioner view: Frances Turner Traill, FTT Skin Clinics says, ”We are in the early stages of trialling plasma and RRS therapy for hair loss and we are already experiencing great results. A 26-year-old female client who first presented with a solitary area of alopecia showed remarkable results after only two treatments. She had six treatments in total and her full hair growth is restored. A male patient who is in the early stages of treatment for male pattern baldness has had two treatments to date and is showing signs of new hair growth, which is promising. Any type of hair loss can cause great distress in a patient, so it’s fantastic to find an innovative treatment that is showing promising results.” Modality 3 Plasma Shower RRS Face & Eye Therapy Duration of treatment: 30 mins per session per week for six weeks. Treatment summary: Plasma Shower technology allows a transdermal delivery of a tailored selection of RRS serums directly into the dermis

and enables the delivery of the product into the skin without any discomfort. Treatment of the delicate periorbital area is also possible. Practitioner view: Dr Beatriz Molina, Medikas, says, “The combination of Plasma Shower and RRS serums has transformed the way we treat skin. We can achieve extraordinary results with no pain, downtime or side effects via an aesthetic treatment that is very relaxing and has a great patient satisfaction rate. I have used Skin Tech products for several years, including the RRS range, as I trust the products and the results; they are EU approved, have a great safety profile and, most importantly, they work! The ingredients have been thoughtfully put together to achieve optimal results. The fact that Lorna [McDonnell Bowes] and the team at AestheticSource have chosen the range to be a part of its portfolio is perfect for me. AestheticSource is such a great distributor/company and is a pleasure to work with.” Modality 4 Tixel RRS ® Meso Neck treatment Duration of treatment: 60 mins per session per month for three months with a follow-up. Treatment summary: An advanced fractional thermo-mechanical treatment, Tixel thermal energy creates micron-sized pores in an effect that is similar to that of fractional Co2 lasers. It enables effective dermal delivery of the RRS serums through the skin, offering an innovative transdermal delivery of product that reduces pigmentation, increases collagen production, and relaxes muscles. Practitioner view: Mrs Sabrina Shah-Desai, Perfect Eyes, says, “We have achieved amazing results by combining Tixel with the RRS serum portfolio. With the flexibility for three modalities and the range of RRS serums, I can tailor the treatment intensity and increase/reduce the application and formulation protocol for a truly bespoke programme. This versatility enables me to treat the face, décolletage and delicate periorbital area effectively.” AM

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TREATMENT SPOTLIGHT

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By design We find out about Dr Stefanie Williams’ new Haute Couture Mesotherapy treatment protocol launched in June 2019

hen it comes to skincare, consumers increasingly demand a tailored, bespoke approach. Facial mapping with face masks is a well- known method for targeting multiple facial concerns with different ingredients in order to treat the whole face effectively. Mesotherapy, however, is often one cocktail that is usually administered to the whole face. Always at the forefront of the latest trends and technologies, dermatologist Dr Stefanie Williams and the team at Eudelo, London have pioneered a new treatment that addresses complexion concerns with tailored mesotherapy solutions and expertly crafted formulations that can be adapted to different areas of the face. The results – a beautifully balanced and evenly-toned face, that is nourished from deep within the skin, generating glowing results that can last for up to three months. Most patients have different skincare needs across various parts of their face. One person may need to address under-eye hydration, T-zone refining, firming of the jawline and a wish for clarity to be brought back to the tone of the

When it comes to skincare, consumers increasingly demand a tailored, bespoke approach

cheeks, for example. To treat these myriad concerns effectively requires different mesotherapy solutions for each area. For the first time, this is now possible thanks to the new Eudelo Haute Couture Meso protocol. Three to six sessions at two-week intervals are recommend for the best results. But, a beautifully balanced, evenly-toned face that is nourished from deep within the skin can be expected – an effect that can last for up to three months.

TREATMENT DETAILS Treatment duration: one hour for numbing, one hour for treatment Treatment course: three to six sessions in two-week intervals are recommended for best results Outcome: results typically last for six month or more, but a maintenance top-up very two to three months is recommended Downtime: The tiny post-treatment ‘bumps’ can remain visible for a couple of days after each treatment. As with all treatments administered with a needle, bruising is a possibility. AM

Dr Stefanie Williams is the founder and medical director of Eudelo. She is a fully qualified, GMCregistered medical doctor, a specialist dermatologist and a key opinion leader in the industry. Eudelo, her dermatologist-led, multi award-winning private skin clinic in London, not only treats the entire spectrum of skin diseases and troubled skin, but also practices aesthetic dermatology.

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A PARTNERSHIP YOU CAN COUNT ON CELEBRATING OUR 10TH ANNIVERSARY IN AESTHETIC TREATMENTS As your trusted partner in aesthetics, Azzalure is a truly global toxin approved in 72 countries with 40 million glabellar line treatments in Europe and the United States alone.1,2 Here’s to another decade of natural-looking results and high patient satisfaction.3

Azzalure Prescribing Information (UK & IRE) Presentation: Botulinum toxin type A (Clostridium botulinum toxin A haemagglutinin complex) 125 Speywood units of reconstituted solution (powder for solution for injection) Indications: Temporary improvement in appearance of moderate to severe: • Glabellar lines seen at maximum frown, and/or • lateral canthal lines (crow’s feet lines) seen at maximum smile in adult patients under 65 years, when severity of these lines has an important psychological impact on the patient. Dosage & Administration: Azzalure should only be administered by physicians with appropriate qualifications and expertise in this treatment and having the required equipment. Botulinum toxin units are different depending on the medicinal products. Speywood units are specific to this preparation and are not interchangeable with other botulinum toxins. Reconstitute prior to injection. Intramuscular injections should be performed using a sterile suitable gauge needle. Glabellar lines: recommended dose is 50 Speywood units divided equally into 5 injection sites, 10 Speywood units to be administered intramuscularly, at right angles to the skin; 2 injections into each corrugator muscle and one into the procerus muscle near the nasofrontal angle. Lateral canthal lines: recommended dose per side is 30 Speywood units divided into 3 injection sites; 10 Speywood units to be administered intramuscularly into each injection point, injected lateral (20 - 30° angle) to the skin and very superficial. All injection points should be at the external part of the orbicularis oculi muscle and sufficiently far from the orbital rim (approximately 1 - 2 cm); (See summary of product characteristics for full technique). Treatment interval should not be more frequent than every three months. The efficacy and safety of repeat injections of Azzalure has been evaluated in Glabellar lines up to 24 months and up to 8 repeat treatment cycles and for Lateral Canthal lines up to 12 months and up to 5 repeat treatment cycles. Not recommended for use in individuals under 18 years of age. Contraindications: In individuals with hypersensitivity to botulinum toxin A or to any of the excipients. In the presence of infection at the proposed injection sites, myasthenia gravis, Eaton Lambert Syndrome or amyotrophic lateral sclerosis. Special warnings and precautions for use: Care should be taken to ensure that Azzalure is not injected into a blood vessel. Use with caution in patients with a risk of, or clinical evidence of, marked defective neuro-muscular transmission, in the presence of inflammation at the proposed injection site(s) or when the targeted muscle shows excessive weakness or atrophy. Patients treated with therapeutic doses may experience exaggerated muscle weakness. Not recommended in patients with history of dysphagia, aspiration or with prolonged bleeding time. Seek immediate medical care if swallowing, speech or respiratory difficulties arise. Facial asymmetry, ptosis, excessive dermatochalasis, scarring and any alterations to facial anatomy, as a result of previous surgical interventions should be taken into consideration prior to injection. Injections at more frequent intervals/higher doses can increase the risk of antibody formation. Avoid administering different botulinum neurotoxins during the course of treatment with Azzalure. To be used for one single patient treatment only during a single session. There is a potential risk of localised muscle weakness or visual disturbances linked with the use of this medicinal product which may temporarily impair the ability to drive or operate machinery. Interactions: Concomitant treatment with aminoglycosides or

other agents interfering with neuromuscular transmission (e.g. curare-like agents) may potentiate effect of botulinum toxin. Pregnancy, Lactation & Fertility: Not to be used during pregnancy or lactation. There are no clinical data from the use of Azzalure on fertility. There is no evidence of direct effect of Azzalure on fertility in animal studies. Side Effects: Most frequently occurring related reactions are headache and injection site reactions for glabellar lines and; headache, injection site reactions and eyelid oedema for lateral canthal lines. Generally treatment/injection technique related reactions occur within first week following injection and are transient. Undesirable effects may be related to the active substance, the injection procedure, or a combination of both. For glabellar lines: Very Common (≥ 1/10): Headache, Injection site reactions (e.g. erythema, oedema, irritation, rash, pruritus, paraesthesia, pain, discomfort, stinging and haematoma). Common (≥ 1/100 to < 1/10): Temporary facial paresis (due to temporary paresis of facial muscles proximal to injection sites, predominantly describes brow paresis), Asthenopia, Eyelid ptosis, Eyelid oedema, Lacrimation increase, Dry eye, Muscle twitching (twitching of muscles around the eyes). Uncommon (≥ 1/1,000 to <1/100): Dizziness, Visual impairment, Vision blurred, Diplopia, Pruritus, Rash, Hypersensitivity, Eye movement disorder. Rare (≥ 1/10,000 to < 1/1,000): Urticaria. For lateral canthal lines: Common (≥ 1/100 to < 1/10): Headache, Temporary facial paresis (due to temporary paresis of facial muscles proximal to injection sites), Eyelid ptosis, Eyelid oedema and Injection site disorders (e.g. haematoma, pruritus and oedema). Uncommon (≥ 1/1,000 to <1/100): Dry eye. Adverse reactions resulting from distribution of the effects of the toxin to sites remote from the site of injection have been very rarely reported with botulinum toxin (excessive muscle weakness, dysphagia, aspiration pneumonia with fatal outcome in some cases). Prescribers should consult the summary of product characteristics in relation to other side effects. Packaging Quantities & Cost: UK 1 Vial Pack (1 x 125u) £64.00 (RRP), 2 Vial Pack (2 x 125u) £128.00 (RRP), IRE 1 Vial Pack (1 x 125u) €93.50, 2 Vial Pack (2 x 125u) €187.05 (RRP) Marketing Authorisation Number: PL 06958/0031 (UK), PA 1613/001/001 (IRE) Legal Category: POM Further Information is Available From: Galderma (UK) Limited, Meridien House, 69-71 Clarendon Road, Watford, Herts. WD17 1DS, UK. Tel: +44 (0) 1923 208950 Fax: +44 (0) 1923 208998 Date of Revision: September 2018 Adverse events should be reported. For the UK, Reporting forms and information can be found at www.mhra.gov.uk/yellowcard. For Ireland, Suspected adverse events can be reported via HPRA Pharmacovigilance, Earlsfort Terrace, IRL - Dublin 2; Tel: +353 1 6764971; Fax: +353 1 6762517. Website: www.hpra.ie; E-mail: medsafety@hpra.ie. Adverse events should also be reported to Galderma (UK) Ltd. References: 1. Azzalure SPC 2018. 2. Data on File MA-39613. 3. Molina B et al. J Eur Acad Dermatol Venereol 2015;29(7):1382–8. Date of Preparation: April 2019 Job code: AZZ19-03-0018a

SURGICAL

EARS

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Ear, ear

Dr Sotirios Foutsizoglou provides an introduction to auricular reconstruction

he ear is morphologically unique. The skin of the lateral surface is densely adherent to the perichondrium and is devoid of subcutaneous tissue. The fascial layer between the skin and perichondrium contains a subdermal plexus of vessels. The medial surface of the ear has loosely attached skin containing subcutaneous fat. As a result, skin is relatively more abundant on the medial surface compared with the lateral surface of the ear and has greater mobility. Medial auricular skin provides an excellent donor site for grafts and flaps. The skeletal component of the ear consists of elastic cartilage. The unique property of this cartilage, that it is flexible and yet able to maintain a complex topographic contour, distinguishes it from the more rigid cartilage of the nasal septum or rib. Consequently, reconstruction of the ear with rib or septal cartilage results in loss of flexibility of the reconstructed auricle. The cartilaginous framework is composed of several distinct three-dimensional components. Medially, these components are the conchal, antihelical, antitragal, helical, and lobular complexes. These units are critical in planning the reconstruction of defects involving cartilage replacement.

BLOOD SUPPLY

The arterial supply to the auricle is derived from branches of the superficial temporal artery and the postauricular

artery. Both vessels arise from the external carotid artery. The medial surface of the ear is supplied by the postauricular artery. The lateral surface is supplied by both the postauricular and superficial temporal arteries, creating two arterial networks. The triangular foss-scapha network is supplied by the helical branch of the superficial temporal artery. The conchal network is supplied by the postauricular artery, which provides septal perforators to the conchal floor. Flap planning and design should give due consideration to these arterial networks. Venous drainage is through the postauricular vein, which drains into the external jugular system. There is supplemental venous drainage from the superficial temporal and retromandibular veins. Lymphatic drainage of the auricle is primarily to the preauricular, infra-auricular, and mastoid lymph nodes.

INNERVATION

The auricle is innervated by contributions from both cranial and spinal nerves. They include the great auricular nerve (C2, C3), the auriculotemporal nerve (V3), the lesser occipital nerve (C2, C3), and a branch of the vagus nerve (X, Arnoldâ&#x20AC;&#x2122;s nerve). The great auricular nerve divides into anterior and posterior branches. The anterior branch supplies the lower half of the lateral aspect of the auricle, while the posterior branch supplies a similar area on the medial surface of the auricle. The auriculotemporal nerve supplies the superolateral surface of the auricle. The lesser occipital

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SURGICAL

EARS

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nerve supplies the superior aspect of the ear on the medial side. The concha is supplied by Arnold’s nerve.

EMBRYOLOGY

The auricle arises embryologically from the first and second branchial arches. During the sixth week in utero, the external ear begins to develop around the dorsal end of the first branchial cleft. The ear arises from six buds of mesenchyme in the first and second branchial arches, known as the ‘six hillocks of His’. The anterior hillock gives rise to the tragus, the root of the helix, and the superior helix; the posterior hillock becomes the antihelix, tragus, and lobule. The first branchial groove forms the external auditory meatus and concha. The lobule is the last component of the external ear to form.

EAR ARCHITECTURE

descriptions of auricular orientation suggested that the long axis of the ear was roughly parallel to the dorsum of the nose, but it is now widely recognised that the ear is rotated 10° anterior to that plane. The superior level of the ear matches the level of the lateral eyebrow. To account for individual variations in topographic features, positioning, and symmetry, the contralateral ear is used as a template in planning reconstruction, rather than strict adherence to textbook-defined norms. The most important principle of auricular reconstruction is that size, location, and orientation of the reconstructed ear be similar to the normal ear. The dominant features that make an ear recognisable are the helix, tragus, antitragus, and conchal bowl.

Analysis of the dimensions and proportions of the external ear is important for planning reconstructive procedures

Analysis of the dimensions and proportions of the external ear is important for planning reconstructive procedures. The vertical height of the ear roughly matches the distance between the lateral orbital rim and the root of the helix, at the level of the eyebrow. Ear width is approximately 55% of its length, and the helical rim protrudes between 1cm and 2.5cm from the skull. The angle of protrusion from the skull typically ranges from 25° to 30°. The vertical axis of the ear is inclined posteriorly at an angle of approximately 15° to 20°. The original anatomical

GENERAL PRINCIPLES OF SMALL EAR DEFECTS

Auricular defects may be divided into defects of cutaneous coverage, with or without intact cartilage, and defects that are full thickness. Small cutaneous defects of the helical rim may be reconstructed with primary wound closure and occasionally require small excisions of cartilage to avoid distortion. Defects of the densely adherent lateral auricular skin can rarely be closed primarily, whereas those of the more pliable medial surface can often be repaired primarily. The pliability of medial auricular skin permits the harvest of relatively large postauricular skin grafts with primary closure of the donor site. Lateral cutaneous defects that have intact cartilage are best treated with >

Superior (posterior) crus of antihelix Triangular fossa

Inferior (anterior) crus of antihelix

Helix Scapha

Crus helix

Tragus

Incisura

Antihelix, stem

}

Cymba Cavum Concha

Antitragus

Figure 1: Topographic landmarks of the auricle

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EARS

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Figure 2. Earlobe repair

skin grafts, provided there is intact perichondrium over the exposed cartilage. The contralateral postauricular skin is an excellent donor site for a full-thickness skin graft used to resurface the lateral ear. Preauricular skin may also be used with minimal donor site morbidity. In cases in which the perichondrium is absent, resulting in an avascular surface, cartilage may be removed if it is not critical to auricular shape. Windows created through the cartilage provide surface contact between the graft and the vascularised subcutaneous tissue of the medial aspect of the auricle. The cartilage of the concha, fossa triangularis, and scapha are amenable to partial removal without loss of the structural integrity of the ear. The cartilaginous windows provide access to the perichondrium of the medial aspect of the ear, which in turn provides sufficient vascularity for successful skin grafting. Surgical approaches for the reconstruction of defects of the skin and underlying cartilage include converting the defect into a full-thickness, wedge-shaped excision, followed by primary wound closure, and employing a composite graft or flap that incorporates structural support. The size and location of the defect dictate which alternative is most appropriate. Defects less than 1.5cm of the helix or antihelix are best repaired by conversion to a wedge-shaped excision. The wound is then repaired primarily and results in a minimally visible scar. Whereas this approach does reduce vertical height of the ear, the difference with the contralateral ear is usually not conspicuous. When a wedge-shaped excision of the auricle is performed, excessive wound closure tension is avoided by removing a portion of the concha to accommodate advancement of the two borders of the ear defect. If this is not performed, cupping and distortion of the ear will

occur. Medium-sized helical defects, from 1.5cm-2cm, can be managed by composite grafting from the contralateral ear. Typically, a composite graft half the size of the defect is transplanted from the opposite ear, thereby creating two ears of equal size. The cartilage edges of the graft and the recipient site are securely approximated with a row of interrupted sutures. Graft immobilisation is essential for proper healing and can be accomplished by use of bolster sutures to secure a splint over the ear. De-epithelialisation of the medial aspect of the composite graft and its implantation into a subcutaneous recipient site have been described. The graft if released from the soft tissue attachment in a second surgical stage, an approach that is designed to increase graft survival. Transfer of a composite graft from the contralateral ear exposes both ears to some risk of infection and deformity, so its use must be carefully considered in view of this risk.

SURGICAL RECONSTRUCTION OF THE EARLOBE

Reconstruction of defects of the inferior third of the auricle is generally less difficult than repair of defects elsewhere on the ear because of the relative pliability and laxity of auricular and periauricular skin in this region. Up to 50% of the earlobe may be removed by a wedge-shaped excision followed by primary wound closure, yielding only minimal deformity. Total earlobe reconstruction is performed by employing a composite flap containing conchal cartilage in a two-staged procedure. First, a segment of cartilage, the shape of the earlobe obtained from the contralateral concha, is embedded in a subcutaneous pocket below the auricle in a location corresponding to the desired position of the earlobe. Six weeks later, the cartilage and overlying skin are elevated as a composite flap, based superiorly on the auricle. The medial surface of the composite flap is skin grafted and the donor site of the composite flap is closed primarily by advancing the adjacent skin. This technique provides an excellent skin colour match between the flap and the ear, results in minimal local distortion of tissues, produces a naturally shaped and contoured earlobe, and allows precise earlobe positioning. Earlobe repair is a simple procedure that can be performed in-office. Many patients want to repair the tear or slit caused by years of wearing heavy or dangling earrings or have their enlarged earlobes reduced in size. Many techniques have been described by various surgeons. One simple technique for for dilated ear lobules after gauge ear piercing is shown in figure 2. Another technique is double opposing perpendicular linear repair. This procedure can be performed using local anaesthetic and with 5-0 nylon sutures. The procedure is initiated by scoring a circle >

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within the circular rim of the defect. The scored circle is then undermined to fat. A linear closure is then placed on the anterior aspect of the circular lobular defect, followed by a linear closure on the posterior aspect oriented 90° to that on the anterior surface. A single linear reapproximation of tissue anteriorly and posteriorly in the same direction would distort the lobule and also result in a dogear deformity. Performing a posterior closure perpendicular to the anterior closure corrects the medial and lateral dog-ear deformity resulting from the anterior approximation. Two perpendicularly opposed linear closures pull the ear lobule together in a way such that it is rounded, free of notching, appears natural, and is aesthetically pleasing with minimal scarring.

The importance of earlobe aesthetics can be appreciated following facelift surgery

NON-SURGICAL REJUVENATION OF THE EARLOBE

The lobule is the last component of the external ear to form. It is a fibroadipose structure devoid of cartilage with a length of 1.5-2cm constituting 25-30% of the long axis of the ear. Age-related earlobe changes include volume loss, elongation, a more concave surface, wrinkly skin, and pigment changes similar to the rest of the facial skin. The importance of earlobe aesthetics can be appreciated following facelift surgery whereby ‘pixie ear’ deformities can be one of the most prominent stigmata of a surgical facelift. Earlobe deflation, concave appearance and rhytids can be easily addressed with HA fillers or collagen stimulating agents using a sandwich technique. I like using a more viscous product to inject deep into the main body of the earlobe to covert the developing age-related concavity into a slight convexity and a less viscous product intradermally using a multipuncture technique in order to fill the superficial rhytids and induce collagen and elastin stimulation.

SUMMARY

When auricular reconstruction is approached systematically, successful results may be achieved. The morphological uniqueness of the auricle, consisting of medial and lateral cutaneous cover over a thin, flexible, and highly convoluted cartilage, causes auricular reconstruction to be a challenge. Constituent components of the defect must be carefully analysed and a plan conceived for the reconstruction of each component. Depending on the size, depth, and anatomical location of the defect, different repair techniques are employed. These range from primary wound closure to skin grafting, or the use of local flaps and autogenous rib framework grafts. The ultimate goal is a functioning appendage that closely approximates the position, size, and contour of its normal contralateral counterpart. AM

>> 74

Dr Sotirios Foutsizoglou developed a particular interest in anatomy during his time working in plastic and reconstructive surgery in the NHS. He became heavily involved in teaching anatomy and physiology to medical students and junior doctors and has worked as an anatomy demonstrator for Imperial College. He is currently completing his last year of training in plastic and reconstructive surgery at Evangelismos General Hospital of Athens. Since 2012, in his role as the lead trainer of KT Medical Aesthetics Group, he has been training practitioners in facial anatomy and advanced non-surgical treatments and procedures. He has written and lectured on facial anatomy and complications associated with injectables both nationally and internationally.

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HAIR

HAIR LOSS

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Get ahead of hair loss Dr Sharon Wong on how aesthetic practitioners can embrace hair loss services in their practice

dermatologist isn’t the most obvious person to seek help from when it comes to a hair problem, but in fact medical trichology (the study of the science of hair) is indeed a branch of dermatology and most definitely falls in the remit of a dermatologist. Some dermatologists, like myself, will choose to develop a particular expertise in this area. Once I secured my consultant dermatologist post on the NHS I developed a hair loss service alongside my general dermatology clinics, accepting GP referrals for patients with all forms of hair loss. It is a niche area of dermatology but as hair loss is so common, the demand for such a service was high and very quickly a fortnightly clinic became a weekly clinic in order to accommodate the surge in referrals. Soon after setting up the NHS hair loss service, I also offered the same in the private sector and was consulting patients weekly with all forms of hair loss.

HOW I GOT INTO HAIR

So as a consultant dermatologist how did I get into hair? Whilst still a training dermatologist I was studying for exit exams and

CAUSES OF HAIR LOSS Genetic – male pattern balding and female pattern hair loss are by far the commonest causes of hair loss. Causes of hair shedding (telogen effluvium) – medications, emotional stress, nutritional deficiencies, recent ill health, dramatic weight loss, hormone shifts (stopping or being on the wrong contraceptives, post pregnancy, menopause). Alopecia areata – an autoimmune form of hair loss meaning that the patient’s own immune system attacks the hair follicles leading to hair loss. Scarring forms of hair loss – these are a rarer group of conditions in which inflammation damages a critical part of the upper hair follicle where the stem cells are located and eventually replaces the hair follicle with scar tissue, resulting in permanent hair loss. Traction - hair loss that results from prolonged and repetitive pulling forces applied to the hair through styling and grooming practices.

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HAIR

HAIR LOSS

aestheticmed.co.uk

came to the chapter on hair disorders. I remember thinking how interesting and multi-faceted hair is – there is the very detailed and complex science of hair follicle biology which essentially operates as a mini-organ, repetitively degenerating and regenerating throughout our lives. In contrast you cannot escape the highly aesthetic nature of the product of the hair follicle – the hair fibre itself. However, hair is much more than a beauty asset, it is intimately linked with a person’s identity, their confidence and self-expression. As a clinician I regularly see the damaging effects hair loss has on people – it never is ‘just hair’ to these patients. Hair research is an exciting and rapidly expanding field – with hair cloning, cell-based therapies and the gut microbiome being just a few examples of the therapeutic areas to watch out for in the near future. Once I had decided to subspecialise in hair disorders I arranged regular visits to dermatologists who already had an established expertise in the area in order to gain more clinical experience. Thanks to Professor Andrew Messenger in Sheffield and Dr Paul Farrant in Brighton who are both highly eminent hair dermatologists, I consolidated my decision to specialise in medical trichology. It was my interest in hair loss and the many questions I get asked by patients that led me to launch Get Ahead of Hair Loss, a one-day event on September 22 for consumers and professionals to learn more about all things hair loss. From men’s hair loss to the future of treatments and solutions to the psychology of hair loss and the effect it has on your confidence and self-esteem, we have some amazing speakers talking about the subject. I urge anyone interested in the subject – as well as clients who are looking for answers – to come along and network with like-minded people and discover that hair loss is something we can all discuss. There are a multitude of specialists and professionals who have very specific roles in managing the patient with hair loss and it is fantastic to have that diversity – from hair scientists to trichologists, dermatologists to hairdressers, psychologists to scalp tattooists, wig makers to transplant surgeons. However, the hair industry is not well regulated. The term ‘hair specialist’ is not a protected title and for the public it can be very difficult to be sure they are getting advice and treatment from an adequately experienced and skilled individual. It is a matter of establishing good working relations, finding professionals who operate with the same work ethic – knowing your own strengths and limitations and to know when to refer onwards and to whom. I believe working together with hair professionals and attending joint events and societies is key to the future of both industries – Get Ahead of Hair Loss, British Hair and Nail Society (BHNS), International Trichology Congress (ITC) and British Association of Hair Restorative Surgeons (BAHRS)

WHAT ARE THE IMPORTANT ISSUES SURROUNDING HAIR LOSS AND THINNING?

There is a lot of confusing and misleading information accessible to the public on hair loss/thinning and treatments. There needs to be tighter regulations on the marketing of hair products in what can be realistically achieved – there is a huge difference between a cosmetic product designed to improve the appearance of what you have, versus a treatment that has been scientifically proven to actually improve hair growth/density. Better public awareness on where they should go/who to see to get help for their hair problem. The hair supplement industry is huge and yet the amount of scientific data to support routine supplementation for hair loss/thinning is severely lacking. As supplements are regulated by the Food Standard Agency they do not have specific regulations on the claims made by the company – again hugely unethical and misleading. AM

Hair research is an exciting and rapidly expanding field

Get Ahead of Hair Loss is a one-day event at 1 Wimpole Street on September 22, 2019, aimed at offering information and inspiration to those suffering from hair loss and thinning, as well as hair experts looking to increase their expertise. Find out more at www.getaheadofhairloss.com or on Instagram: @getaheadofhairloss.

Dr Sharon Wong is a consultant dermatologist with clinics around London. She is a member of the British Association of Dermatologists (BAD), the Royal College of Physicians (RCP) and the British Hair and Nail Society (BHNS). She is also the founder of Get Ahead of Hair Loss, a one-day event aimed at offering information and inspiration to those suffering from hair loss and thinning, as well as hair experts looking to increase their expertise.

Aesthetic Medicine • July/August 2019

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H AI R LOS S

PRODUCT FOCUS

aestheticmed.co.uk

Kerastem We learn how Kerastem tackles male and female pattern hair loss

erastem is a device designed to treat the early stage of male and female pattern hair loss (Norwood scale I-III in men and I-II in women). It can restore the hair cycle by stimulating the niche of hair follicles with autologous fat enriched with adipose derived regenerative cells, also known as stromal vascular fraction (SVF). Adipocyte lineage cells support the stem cell niche and help drive the complex hair growth cycle. Adipose-derived regenerative cells are a heterogeneous group of non-cultured cells that can be reliably extracted from adipose by using automated systems, and these cells work largely via paracrine mechanisms to support adipocyte viability. During the hair follicle growth (anagen phase) cycle, the hair follicle delves deep into the rich dermal macroenvironment as it matures, where it is surrounded by large lipid-filled adipocytes. These intradermal adipocytes regenerate with faster kinetics than other adipose tissue depots. Such growth mirrors the hair cycle, suggesting an interplay between hair follicle cells and adipocytes. It has already been established that the adipocyte is an integral part of the normal hair cycle, and it is hypothesised that telogen (resting phase) may be due to an absence of adipose tissue. Hair loss and decreased adipocytes have been described to occur simultaneously. Therefore, the transplantation of adipose tissue, or autologous fat transfer (AFT), into the subcutaneous layer of fat in the scalp would stimulate the hair follicles in the scalp, and subsequently help overcome the problems of hair loss. During treatment, approximately 250mls of fat is harvested from the patient. 50ml of the harvested fat is processed through a 50mls Puregraft bag to provide 5mls of optimised fat.

The remaining 200mls of harvested fat is processed through the Kerastem system, providing 5mls of adipose-derived regenerative cells (ADRC). The 5mls of optimised fat is injected subcutaneously, followed by 5mls of ADRCs intradermally. Mr Olivier Amar, a London plastic surgeon and UK ambassador for Kerastem in the south of England, said: “Kerastem hair therapy is a regenerative medicine-based approach to hair growth. Early hair loss represents a significant unmet medical need and the Kerastem therapy is a one-time treatment that utilises adipose (fat) derived regenerative cells delivered to the affected area of the scalp. It is mostly effective in patients in the early stages of hair loss. The safety, efficiency and tolerability of the Kerastem hair therapy has been demonstrated in high quality scientific studies. “We firmly believe that this is an innovative, scientifically proven treatment in the management of early hair loss, and will be a powerful treatment modality in the armamentarium for the treatment of hair loss. We were very pleased to present the Kerastem hair therapy at The British Association of Hair Restoration Surgery’s (BAHRS) annual meeting in March, particularly as it generated a lot of interest from the distinguished members of the audience”. AM

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We firmly believe that this is an innovative, scientifically proven treatment… and will be a powerful treatment modality in the armamentarium for the treatment of hair loss

Aesthetic Medicine • July/August 2019

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REGENERA

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HAIR

HAIR LOSS TREATMENTS

aestheticmed.co.uk

All is not lost Dr Ash Dutta on how Regenera combats hair loss

oday, aesthetic medicine brings newer and more effective ways to both regenerate the skin and rejuvenate it. Thanks to aesthetic innovations, new and more effective ways of combating skin ageing, as well as hair loss and other aesthetic and health problems, can be more readily sought. The current trend is the use of ´biotechnologies´ and ´stem cells´ that are present in the body and which can trigger a massive regenerative process.

WHAT IS REGENERA?

Regenera (autologous stromal stem cells) is a specially designed system that uses autologous cell transplantation by utilising the cells which are present in the patient’s own body. This treatment triggers a regeneration and tissue renewal processes. Various fields of medicine already use this procedure – such as aesthetic dermatology, trichology, plastic surgery, orthopaedics, oral and maxillofacial surgery, etc. Effectively, the treatment takes place only once; when the patient is both the donor and recipient of these miraculous stem cells and with all follow up maintenance treatments being repeated once every two to three years. Regenera has been used for skin rejuvenation and wound or scar management for some time, but we now have CE clearance for the treatment of hair loss. It is quite exciting to see how this treatment works for hair loss in burns and scarred areas.

WHICH AREAS CAN BE TREATED?

Regenera stem cell treatment is a ´minimally invasive technique´ and is suitable for any facial area or scalp area,

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HAIR

HAIR LOSS TREATMENTS

aestheticmed.co.uk

as well as other body parts, according to the physician’s recommendation. The Regenera device prepares the cell solution and then, after dilution with saline, it is applied back to the skin through a mesotherapy technique (using a thin needle).

EFFECT OF REGENERA ACTIVA TREATMENT

The first results of Regenera treatment occur after a single treatment, with patients being able to observe the first visible changes within three to six months. The recovery period is minimal, with the main results becoming apparent around six to 12 months after treatment. Regenera is a safe and effective technique for both fighting alopecia and rejuvenating the skin, thanks to its unique methodology which does not employ any additives or chemical activators. In the case of a typical treatment, the material used is exclusively obtained from within the patient’s body. The process aims to improve the condition and quality of the skin, nourish hair follicles to give a positive visual result for the increased hair density and provides growth stimulation of new hair follicles.

alopecia). Here, the doctor collects the graft tissue. The process is virtually painless, and rapid healing is ensured due to its small size. The patented Regenera system treats the tissue samples taken and produces a beneficial stromal cell-rich solution abundant with growth factors. The physician then immediately applies this solution to the patient in the treated area described. The simplicity and effectiveness of this procedure will not limit the patient from their everyday activities.

ANDROGENIC ALOPECIA

Regenera is a treatment for androgenic alopecia, which is the most common cause of hair loss and occurs in 70% of men and 40% of women throughout their different stages of life. According to the studies, the main reason for androgenic alopecia is the male hormone (dihydrotestosterone), which occurs in both men and women. Androgens play a crucial role in the development of men from birth to adolescence, when they are responsible for the regulation of the sebaceous glands, sweat glands, libido, beard growth and hair growth. On the other hand, the development of alopecia is related to the sensitivity of hair follicles to the androgen levels. This hormone causes the hair to be weaker and thinner which is the first symptom of baldness, while at the same time its effect can also greatly reduce the life cycle of the hair, which causes both slower growth and diminutive hair follicles. AM

Regenera is a safe and effective technique for both fighting alopecia and rejuvenating the skin

HOW IS THE REGENERA TREATMENT PERFORMED?

Regenera is performed under local anaesthesia which involves taking 3mm pieces of tissue from the hair region of the nape (the area which is least prone to androgenic

Dr Ashish Dutta has spent the past 20 years in the aesthetics sector and runs the Aesthetic Beauty Centre in Newcastle. He is Fellow of the American Academy of Cosmetic Surgery and has held the position of secretary at the European Society of Aesthetic Surgery (ESAS), the British Association of Body Sculpting (BABS) and the International Division of American Board of Cosmetic Surgery (ID-ABCS). He is also vice president of the World Academy of Cosmetic Surgery (WAOCS).

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HAIR

TRICHOLOGY

aestheticmed.co.uk

Root analysis Consultant trichologist Benedetto Cusumano discusses the importance of blood tests in understanding the underlying causes of hair loss

osing hair is normal – each person can lose between 50 and 100 hairs a day without even noticing. And, while hair loss isn’t usually anything to be worried about, it can be a sign of an underlying medical condition or caused by a temporary ailment, such as iron deficiency or stress. Understanding the underlying causes of hair loss in women is not as straightforward to diagnose as it is in men. In a high percentage of men, hair pattern baldness is often hereditary. However, hair loss in women can be trigged by a vast range of conditions or circumstances, and a qualified trichologist and a doctor are not always looking for the same things; general health and hair health are two very different things. To help with any diagnosis one of the first things that can be useful in some cases is a blood test, as a proper diagnosis usually begins with a process of elimination. For some patients, these tests will come back

with results within normal, expected ranges, but they are also crucial in ruling out the possibility of certain disorders and conditions, which can attribute to or cause hair loss or loss of hair volume. A typical test will look at things such as basic blood counts, thyroid and iron (or ferritin as it is also known). For women with dietary restrictions, we would also look at blood sugars, zinc and vitamin D levels, which can all have a direct impact on the health of your hair. There is no standard template for bloodwork – it is our job to listen carefully to each and every patient individually to understand their lifestyle, nutrition, family history and health. This, together with the blood test results and an examination of the patient’s scalp, will enable us to offer advice and/or treat the underlying cause. Hair loss can be devastating. For many women, their hair is an important part of their identity and who they are. AM

A proper diagnosis usually begins with a process of elimination

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Benedetto Cusumano is a consultant trichologist and founder of TrichologistsUK and the TrichoCentre. 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 Institute of Trichologists in London and was awarded the John Firmage Certificate of Distinction in recognition of 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 O M M E R C I A L F E AT U R E

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Jett Plasma Pen Jett Medical Plasma Pen will be exhibiting at the Aesthetic Medicine North show in Manchester NOT ALL PLASMA PENS ARE THE SAME

If you feel it is time to understand the difference and the technology behind them come and visit the Jett medical stand at the show or you could attend Dr Vincent Wong’s live speaker slot on Sunday to find out more about the versatility of the Jett Pen and all the different treatment combinations you can offer. As aesthetic practitioners we are challenged to offer our clients amazing result with little to no down time. Jett Medical Plasma Pen offers you just that. Plasma is a growing market in the UK but due to the long down time and varying results of many of the devices on the market some clients can be put off the treatment. Jett Plasma is setting the standards within plasma treatments and training within over 60 countries around the world. Jett Plasma Pen is the only direct current device on the market. Compared to the AC (alternating Current) devices, this advanced DC (Direct Current) technology offers greater stability and precision every time. Due to Jett Medical’s patented technology it is the only Plasma Pen that can offer constant dot size and depth that is just not achievable with an AC device. Jett also comes with five treatment heads offering a wide range of treatments from the famous plasma spark, electrical meso therapy and skin tightening and firming making it the most diverse plasma pen on the market. The silver head treatments are totally pain free.

SO WHY CHOOSE JETT MEDICAL’S ADVANCED DIRECT CURRENT TECHNOLOGY?

With AC devices the – and + ions in the air are in both directions in irregular motion which releases a plasma shower that is split by the magnetic force causing each dot varying in both size and depth whereas Jett Plasma’s Direct Current flow is controlled in one direction offering a stability and precision that cannot be achieved with AC technology. The Jett Plasma Medical is a controlled-powered medical device used for a variety of skin treatments and helps with the removal of scars, moles and stretch marks as well as skin tightening and lifting and much more.

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Aesthetic Medicine • July/August 2019

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DEVICES

TREATMENT FOCUS

aestheticmed.co.uk

Profound device Dr Tatiana Lapa provides her thoughts on Candela’s Profound device

t the Dr Tatiana Aesthetic Dermatology Clinic, were among the first in England to use Profound, an award-winning regenerative treatment designed to tighten loose skin, lift sagging skin, remodel scars, smooth cellulite and reduce excess fat. Named ‘New Treatment of the Year’ at the MyFaceMyBody Awards USA in 2018, Profound is the first and only injectable radiofrequency treatment to be FDAapproved for the face, neck and body. The Profound system is a minimally-invasive treatment that delivers radiofrequency (RF) thermal pulses to the reticular dermis, creating thermal injury zones in a fractional manner without damage to the dermal-epidermal junction, epidermis or subcutis. The device uses temperature sensors within its needles to reliably heat the tissue to 67 degrees for four seconds. Studies have shown that this specific temperature and duration results in significant increases in reticular dermal volume, cellularity, hyaluronic acid and elastin content within 10 weeks of treatment. Profound offers an effective alternative to surgery for skin laxity and cellulite, which carries significant risks, including prolonged wound healing, scarring and poor aesthetic outcome. Other non-surgical options, including laser therapies and other radio-frequency systems, have shown modest improvements and variable patient satisfaction rates. In contrast, evidence from randomised controlled trials have demonstrated that the Profound system results in a significant reduction in the skin laxity of the face and neck relative to a surgical facelift. Results also display a 100% response rate for rhytides, and a 93% success rate for the treatment of cellulite. (See images). The treatment involves applying local anaesthetic cream, cleaning of the treatment area and local infiltration of topical anaesthetic and adrenaline. Profound has two modes: Dermal is used for skin tightening and scar remodelling, while SubQ is used to treat cellulite and excess fat. Treatments take approximately 90 minutes in total with minimal adverse events such as transient erythema, ecchymoses and oedema resolving within five days. AM

The device uses temperature sensors within its needles to reliably heat the tissue to 67 degrees for four seconds

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Dr Tatiana Lapa qualified as a doctor at St George’s Medical School. While attaining her membership to the Royal College of General Practitioners, she became interested in non-surgical aesthetics and was awarded a First-Class Masters Degree in Aesthetic Medicine at Queen Mary University. She established the Dr Tatiana Clinic in 2014. Dr Tatiana’s research interests are focused around the safety and effectiveness of cosmetic treatments and she has been published widely in the national press and scientific journals.

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info.uk@candelamedical.com

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OUT AND ABOUT

aestheticmed.co.uk

CynoSure UK and iS Clinical launch, Bulgari Hotel, London The UK division of Hologic’s CynoSure has announced a collaboration in the UK with leading cosmeceutical brand iS Clinical. During an educational event in London, the two brands highlighted the benefits of a combined treatment approach that incorporated superior patient outcomes and a robust commercial strategy for clinics. Speakers, including Dr Tapan Patel and Miss Sherina Balaratnam, presented the theory behind the approach of cosmeceuticals and laser science, and discussed the rising consumer demand for in-clinic innovation. A series of clinical case studies that illustrated the potential results from a combined approach of laser resurfacing treatments using the ICON laser alongside an iS Clinical cosmeceutical skincare regime was also presented. This is the first time an aesthetic device company and a cosmeceutical brand have worked together to demonstrate the benefits of a combined treatment approach.

Out and about Out and about in the industry this month

FACE CONFERENCE, QEII CONFERENCE CENTRE, LONDON Informa and EuroMediCom hosted the 17th annual FACE Conference and Exhibition in London. The event brings delegates and a faculty of 130 national and international speakers from around the globe to London to discuss the latest advances in aesthetics over two days. This year’s educational programme saw eight agendas covering injectables, skin, equipment, threads, business, hair and aesthetic gynaecology as well as workshop agendas and an advanced injectables masterclass. FACE 2020 will take place in London on June 5-6.

AlumierMD Irish Excellence in Aesthetics Conference, Dublin AlumierMD hosted a one-day conference in Ireland to discuss strategies for delivering excellence in aesthetics through multiple modality treatments, safe practice, topical skincare and effective business practice.Speakers included Dr Eithne Brenner, Anna Gunning, Dr Lee Walker, Pam Underdown and brand spokesperson, Victoria Hiscock. Samantha Summerfield, marketing and events manager UK & Ireland at AlumierMD, said, “For AlumierMD, education and patient safety is at the core of our business and it was important to us to pre-sent speakers that were able to offer delegates valuable advice that would be easy to implement into their current business practices. We are thrilled that we were able to of-fer the Irish market a such a valuable conference.”

Aesthetic Medicine • July/August 2019

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