Aesthetic Medicine March 2020

INSPIRING BEST PRACTICE IN MEDICAL AESTHETICS

ON THE JAW JAWLINES CAFFEINE FIX COFFEE AND FAT REDUCTION BOTTOM LINE BBL ALTERNATIVES March 2020 | aestheticmed.co.uk

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March 2020

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

10 MILLION TREATMENTS WORLDWIDE 35 years of innovation

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Suitable for all skin types Our instagram is overflowing with the exceptional results that our customers are achieving everyday with these products.

Adhering to our philosophy of continual R&D combined with the very highest quality active principles ensures our clients the results they desire.

Dermamelan is for medical professionals to use in clinic.

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the NEW depigmenting solution by mesoesteticÂŽ

NEW from the world leader in depigmentation treatments now you can correct pigmentation imperfections and improve the quality, turgor and appearance of the intimate area in a single clinical session.

This is the latest innovation in pigmentation treatment brought to you by mesoesteticÂŽ through over 35 years of research and development.

Developed in collaboration with specialised gynaecologists for use in clinic by Doctors.

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

TRUSCULPT FLEX

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Crunch time How Cutera’s new muscle sculpting device, truSculpt®flex can replicate 54,000 crunches in just 45 minutes

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The modes include: Prep Mode – creates a twisting motion to warm up, stretch the muscles and slowly build a tolerance to muscle contractions Tone Mode – contracts the muscles, holds it to the point of exhaustion, and then relaxes it to increase strength and enhance endurance Sculpt Mode – fast, deep, sequential contractions of the muscles for building muscle mass. truControl™ targets selective muscles and allows the

operator to customise current delivery (intensity and direction) with less energy for safe and consistent results. The handpiece design and use of truGel mean enhanced comfort and efficacy for patients and increased revenue for clinics.

During treatment, muscle fibers undergo trauma or microscopic tears, and then cells attempt to repair the damage, which results in increasing muscle size and strength, similar to strength training. This repair process, known as hypertrophy, begins after each treatment and involves releasing hormones, such as testosterone, to activate cell recovery, form new blood capillaries, repair muscle fibers, and manage the gain in muscle mass.

Patients will feel a gentle contraction sensation at the start of treatment. As the intensity slowly increases, the muscle contraction intensifies but remains comfortable.

Because truSculpt® flex is non-invasive, it requires no recovery time and patients are able to immediately return to normal activities after the treatment.

Treatments can be personalised to meet patients’ fitness levels, shape, and goals allowing practitioners to target multiple, specific small and large muscle groups with no downtime with between four and six treatments required, depending on fitness. Results may be visible after the second session with maximum results visible eight to 12 weeks after the last session. AM

Before

Before

esearch shows that, on average, a healthy, fit adult has the ability to perform a maximum of 100 crunches before reaching a point of complete exhaustion, but new technology is turning this on its head.

Launched into the UK market in January 2020, the truSculpt flex® from Cutera has the ability to bypass the brain and send unique waveforms to the skeletal muscle, which can then challenge muscles at an intensity and duration that is beyond the level that can be achieved during regular exercise.

A recently published white paper showed that the device was capable of replicating the equivalent of 54,000 crunches. A typical abdominal workout may include up to 10 minutes of various movements to contract, hold and relax the abdominal muscles; however, truSculpt flex® allows for selective targeting of motor neurons to contract specific skeletal muscles without the assistance of surrounding muscle groups, for 45 minutes.

WHAT IS TRUSCULPT FLEX®

The truSculpt® flex is a personalised muscle sculpting and building device that is FDA-cleared to strengthen, firm and tone the abdomen, buttocks, and thighs.

Its proprietary Multi-Direction Stimulation (MDS) technology delivers three distinct treatment modes by replicating intensified crunch, squat and twisting actions.

It has up to 16 handpieces, allowing you to treat up to eight areas simultaneously in just 45 minutes, the largest in the body sculpting industry.

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

TRUSCULPT FLEX

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For further information please contact Cutera on 01462 419937 or email info.uk@cutera.com

Before

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After 8 weeks

After 12 weeks

Front

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CONTENTS

IN THIS ISSUE...

aestheticmed.co.uk

Contents MARCH

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EDITORIAL Vicky Eldridge, Editor E: vicky@aestheticmed.co.uk T: +44 (0) 7931 924 322

Georgia Seago, Deputy Editor

8 EDITORIAL BOARD Meet our editorial advisory board

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

10 NEWS The latest news from the industry

26 CLINIC PROFILE We chat to Clare De Groot, coowner of RÖ Skin

18 NEWS SPECIAL REPORT Georgia Seago reports on the Scottish Government’s proposal to regulate nonmedics

30 BUTTOCK ENHANCEMENT Exploring the controversy surrounding the Brazilian butt lift

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

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

MARKETING Jennifer Shutter E: jennifer@aestheticmed.co.uk T: +44(0)203 841 7361

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

DESIGN AND PRODUCTION ICD imagecreativedesign.co.uk

PRINTING Pensord Press pensord.co.uk SUBSCRIBE Annual subscription UK: Print £44, DD £39.50, Digital £10.

Europe: £59; outside Europe: £67.50.

To receive your copy of Aesthetic Medicine every month call 01371 851875 or see escosubs.co.uk/aestheticmedicine The publisher accepts no responsibility for any advertiser whose advertisement is published in Aesthetic Medicine. Anyone dealing with advertisers must make their own enquiries.

Professional Beauty Group 25 Allington House High Street Wimbledon Village SW19 5DX

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CONTENTS

IN THIS ISSUE...

aestheticmed.co.uk

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34 DIGITAL MARKETING Jemma Edwards shares nine tips to get Google reviews to grow your business

44 HYDROGEN THERAPY Dr Elisabeth Dancey explores the skin-healing powers of hydrogen therapy

52 STUDY ANALYSIS Georgios Tzenichristos from LipoTherapeia asks if caffeine can help with weight loss

38 CONSULTATIONS Balsam Alabassi discusses the consultation process and how each interaction is an opportunity to improve patient outcomes

48 BUSINESS CASE STUDY Laura Moxham shares how improved Google Ads helped the Covent Garden Aesthetics Clinic fill its diary

58 JAWLINES Dr Zunaid Alli maps out his preferred approach to chin and jawline augmentation

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60 PRODUCT NEWS The latest product launches 64 TREATMENT NEWS We find out about the latest treatment from Dr Stefanie Williams, Eudelo Cell Hiit 70 TREATMENT REVIEW Treatments we’ve tried this month

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74 STANDING OUT ONLINE Alex Bugg asks, how do you stand out in an increasingly competitive landscape?

77 OPINION Dr Harry Singh on differentiating yourself from the unregulated competition 80 ONLINE REVIEWS Jordan Baker reveals five tips for getting five-star online reviews

Welcome to the March issue of Aesthetic Medicine 38

I love my daily cup, or I should more accurately say “cups”, of coffee so when I read that drinking coffee might help you lose weight that sounded like a win-win. Of course, as with all headlines, there’s more to it than that so we asked cellulite and fat loss specialist Georgios Tzenichristos to look at the data and give his views, see pages 52-54.

Other practitioners sharing their thoughts on hot topics in this month’s issue include Dr Harry Singh who discusses how to stand out against un-regulated non-medical practitioners (p77-78) and Balsam Alabassi who gives an in-depth insight into the consultation process and how it’s an opportunity to improve patient outcomes (p38-43).

As well as this we speak to Scottish clinics about their reaction to proposals by the Government in Scotland that would see a licensing scheme introduced for non-medics performing injectables (p18-19).

I hope you enjoy reading the views and opinions we are sharing this month and, as always, we welcome yours too – vicky@aestheticmed.co.uk Vicky Eldridge – Editor

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CO N T R I B U TO R S

EDITORIAL ADVISORY BOARD

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

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DR NICK LOWE

DR ULIANA GOUT

DR SOPHIE SHOTTER

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

Dr Uliana Gout is the founder of London Aesthetic Medicine Clinic & LAM Academy.

She sits on the Board of the British College of Aesthetic Medicine (BCAM) and has recently been elected president. She also acts as a BCAM Appraiser for the GMC. She sits on the Board of the International Peeling Society. She has co-authored numerous medical textbooks.

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

DR STEVEN HARRIS

DR SHIRIN LAKHANI

DR RAJ THETHI

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

His regular educational posts can be viewed on Instagram: @drharrisclinic

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

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

MR ALI GHANEM

DIJA AYODELE

EMMA DAVIES

Mr Ali Ghanem is a consultant aesthetic plastic surgeon and clinical senior lecturer in plastic, reconstructive and aesthetic surgery at Barts and the London School of Medicine & Dentistry, as well as visiting professor and head of department of Aesthetic Medicine at the College of Medicine and Dentistry, Ulster University.

He is qualified in Medical Law and Ethics, Surgical Science and Developmental and Stem Cell Biology.

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

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

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

INDUSTRY NEWS

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Sk:n buys Courthouse Clinics and becomes UK’s largest clinic group Sk:n has become the largest clinic group in the UK after purchasing The Adonia Medical Group, parent company of Courthouse Clinics.

The deal has taken Sk:n to 90 clinics worldwide, cementing its credentials as the largest independent aesthetic clinic network in the UK. Courthouse Clinics offers a range of anti-ageing aesthetic and wellbeing treatments and the chain has 11 locations in the UK including Courthouse Medispas; Birmingham, Brentwood, Esher, Haywards Heath, Hereford, London, Maidenhead, Sheffield, Southampton, Watford and Wilmslow.

Darren Grassby, chief executive at Sk:n, said, “This is another great addition to our portfolio, which will allow us to reach into new clinic locations while adding greater diversity to our group. Our aim is to grow and develop while continuing to offer the same levels of service and support to all our clients and staff.

“2020 will be a very exciting year for the group. We have great confidence in the future of the industry, and we look

forward to giving our clients an enhanced experience in and out of clinic.”

Paul Wilkinson, from The Adonia Medical Group, added, “The acquisition is a fantastic opportunity to join forces with the largest independent aesthetics clinic network in the UK... and I look forward to working with the senior team to continue to develop our businesses.”

Government releases Paterson Inquiry Report A report from the independent inquiry that was set up following the conviction of surgeon Ian Paterson has been published.

Paterson was convicted and sentenced to 20 years in prison after being found guilty of wounding with intent.

The report offers recommendations for the future, including a suggestion that there should be a single repository of the whole practice of consultant surgeons across England, setting out their practising privileges and other critical consultant performance data.

Other recommendations include the need to give patients time to consider surgery before consenting to treatment; clinicians being suspended whenever they are being investigated; patients receiving standard letters with their GPs copied in; and for the Care Quality Commission to check that all hospitals are getting doctors to discuss cases as part of multi-disciplinary team meetings.

Over a quarter of people with a facial disfigurement have been a victim of hate crime Over a quarter (28%) of people with a disfigurement have experienced a hate crime, yet the majority did not go on to report it, according to new research by charity Changing Faces.

Conducted by Savanta ComRes, the survey of more than 1,000 people with a visible difference, such as a mark or scar, showed that, while most abuse happens in public, more than 40% of people with a visible difference have had negative experiences online and one in 10 say they are repeatedly harassed on social media.

Almost half (45%) of those who have experienced negative behaviours say they have lost confidence, over a third (35%) say they now feel anxious when they go out and over a quarter (27%) say it has had a negative impact on their mental health.

It is now releasing a hard-hitting film as part of its new Hate Crime campaign – #VisibleHate. The campaign is supported by the Home Office and social media platforms such as Twitter, Instagram and Facebook.

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INDUSTRY NEWS

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Patients at risk due to lack of digital diligence around aesthetic treatments Only one in five women recognises “red flags” of unethical marketing when it comes to aesthetic treatments, according to new research commissioned by EV (etrevous. com) and conducted by independent surveyor OnePoll.

The survey of 500 women interested in cosmetic treatments reveals new insights into their purchasing habits.

While half of women across all age groups use online searches to vet potential clinics, women aged 18-49 are nearly twice as likely to rely on review sites in order to gauge aesthetic practitioners’ reputation and skills before undergoing treatment. Despite carrying out due diligence online, 29% of women aged 18-49 indicated they would not be put off by bad reviews, compared with just 18% of over 50s, indicating that younger patients may overestimate their digital savviness in assessing potentially harmful practitioners.

The data also showed that media attention on non-surgical treatment continues to influence decision-making and awareness, with seven out of 10 women saying they’d abandon pursuing aesthetic treatment as a result of the media attention generated by horror stories of “botched jobs”.

Despite the increased awareness, only one in five women recognise discount incentives – a hallmark of unethical marketing practice – as potential red flags, leading experts to say more work is necessary to convey the recognition of ethical marketing and help patients avoid “cowboy” practitioners.

2020 aesthetic treatment trend predictions revealed Jaw sculpting, “baby botox” and male combination surgeries are the top predictions for aesthetic trends in 2020, according to a report by The Private Clinic of Harley Street.

The trends and innovations survey saw 54% of respondents list non-surgical alternatives to traditionally surgical procedures as most likely to grow in popularity; specifically, non-surgical rhinoplasty and jaw and temple sculpting using dermal fillers.

When it came to surgical procedures, almost one in four respondents felt that “natural” body shaping methods such as autologous fat transfer or auto-augmentation would be a key trend.

The report also highlights “baby botox” (microinjections of a neurotoxin) to achieve more subtle results as a key trend.

In terms of current popularity, varicose vein treatments were a topthree procedure in every geographical region in the UK, and the third most popular overall.

Dr Uliana Gout named as new president of the British College of Aesthetic Medicine (BCAM) The British College of Aesthetic Medicine (BCAM) has named Dr Uliana Gout as its newly-elected president.

Aesthetic Medicine editorial board member Dr Gout is a long-standing member of BCAM and most recently served as director of PR and marketing.

She is a renowned clinician and educator in aesthetic medicine and also acts in director and committee roles for global congresses and industry associations.

Dr Gout has co-authored numerous medical textbooks and publications in the field. She commented, “It’s a great honour to have been elected president of BCAM. I am very proud of

BCAM’s 20-year heritage and its base of 400 members.

“I look forward to working closely with the board and the members in the coming months to crystallise our vision and growth strategy for the future of BCAM, and am grateful to all for their continued support. I am excited to build BCAM as a leading voice for the industry.”

BCAM’s immediate past president Dr Paul Charlson added, “I am delighted to see that BCAM will be going forward under Dr Gout’s leadership and her compelling vision for the future. I know our members and the team look forward to working with her.”

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INDUSTRY NEWS

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Improving workplace conditions is key to the future of surgery, says RCSEd president Michael Griffin A host of prominent medical professionals from across the globe are set to gather in Scotland’s capital to discuss improving the workplace for healthcare professionals.

The Royal College of Surgeons of Edinburgh’s (RCSEd) Triennial Conference will take place in Edinburgh on 4-5 June, with a focus on improving conditions for those involved in surgery and dentistry, to in turn protect patient safety.

Keynote speakers include chief medical officer for Scotland Dr Catherine Calderwood, Dame Clare Marx, chairman of the GMC and former president of the Royal College of Surgeons of England, and professor Carrie McEwen, chair of the Academy of Medical Royal Colleges and former president of the Royal College of Ophthalmologists.

Talks will focus on the challenges impacting the workforce in medical environments, as well as mental health and wellbeing, and the crucial issue of supporting trainees.

Professor Michael Griffin OBE, president of the Royal College of Surgeons of Edinburgh (pictured), said, “I believe improving workplace conditions is key to the future of surgery, and by creating a more inclusive working environment, we will entice and encourage more young people into this extremely rewarding specialty. The focus of the conference will really drive that message home.

“If we can successfully improve the workplace, it’s not only healthcare professionals who will benefit, but patients as well, which is always our ultimate goal.”

Sterex completes delivery of world’s first Level 5 qualification in Advanced Blemish Removal Sterex has completed delivery of the world’s first Level 5 qualification in Advanced Blemish Removal.

The first successful delegate was Janet Turner, an experienced practitioner in electrolysis and a Sterex trainer who, along with Sterex education manager Christine Hughes, co-wrote the Sterex/VTCT course.

Turner said, “It has taken almost two years to bring together all the learning resources and in-depth research needed to meet the exacting standards required by VTCT (ITEC). It has been a privilege to be part of such a focused team of developers associated with such a prestigious national qualification.”

Allergan opens €160m addition to Irish Botox plant Botox manufacturer Allergan officially opened its new facility on its Westport, Ireland campus on 28 January.

The new addition to the Co. Mayo-based manufacturing and microbiology campus is known as B2. The new facility was officially opened by Ireland’s minister for community and rural affairs Michael Ring, himself a Westport native.

The €160 million biologics plant will create 63 jobs in the local area and allow Allergan to further invest in and expand its ability to meet growing demand for its flagship products, especially for Botox, for which the pharmaceutical giant recently celebrated shipping its 100 millionth vial.

Paul Coffey, vice president of global manufacturing and site lead at Allergan Westport, commented, “With the addition of a new microbiology and cell-based laboratory, the team here in Westport are looking forward to contributing to product innovations that will make a difference to patients’ lives all over the world and maintain our position at the forefront of the global biopharma industry.”

Wayne Swanton, Allergan’s executive vice president, added, “We are very proud to say that we developed this world-class brand, with a world-class team, right here in

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Westport. These are 1,300 people who make a difference in the lives of our patients everyday.”

Allergan’s Westport campus opened in 1977 with 25 employees, and has since grown to employ more than 1,300 people in the town, and more than 2,000 in Ireland. This milestone coincides with the 30th anniversary of Botox’s first FDA approval.

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INDUSTRY NEWS

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NEWS IN BRIEF BTL MANAGING DIRECTOR LEE BOULDERSTONE STEPS DOWN

Lee Boulderstone has announced that he is to step down from his role as managing director at BTL Aesthetics after eight years with the company. Boulderstone, who introduced the company to the UK in 2012, said, “It has been a huge honour to lead the team at BTL Aesthetics and work alongside some of the most talented medical professionals in the UK. My decision to step down has been a difficult one to make but I really do look forward to seeing the company go from strength to strength in the coming years.”

ACE GROUP HOSTS COMPLICATIONS CONFERENCE THIS MONTH

The Aesthetic Complications Expert group has announced the programme for its inaugural conference, which will take place on Wednesday March 11 at the Birmingham Repertory theatre.

Delegates will be provided with an ACE Group conference bag which is ideal to be used as an emergency kit bag for their own clinics. ACE Group chair Dr Martyn King said, “Complications are daunting no matter how experienced the practitioner. The ACE Group conference will focus on how to avoid, recognise and manage complications with the most evidence-based approach.” For more details visit acegroup.online/2020-conference/

LYNTON LAUNCHES NEW COURSES

Lynton Lasers has launched a suite of new and updated courses. A new Level 3 course, Certificate in Principles of Cosmetic Practice, has been developed in conjunction with the Medical and Aesthetics Training Academy (MATA). At Level 4, Lynton has launched the Certificate in Laser and Light Therapies in Hair Removal and Skin Rejuvenation. The course is provided by VTCT and will act as a pre-requisite for Lynton’s advanced Level 5 courses, including the new Certificate in Tattoo Removal.

NMWLP COURSE SCOPE ACCREDITED

The National Medical Weight Loss Programme has had its course SCOPE accredited by the World Obesity Federation. SCOPE stands for Strategic Centre for Obesity Professional Education and is the only internationally-recognised certification in obesity management.

Study finds picosecond more effective than Q-switched laser at eyebrow tattoo removal A study of brown and black ink eyebrow-tattoo removal using laser in four patients presented several advantages to using picosecond over Q-switched laser for effective removal.

Each patient – with skin types III-IV and one of whom had eyebrow tattooing using the microblading method – underwent a mixed number of treatments with a dual-wavelength picosecond Nd:YAG laser at 1,064nm with a 3mm spot size and fluence of 4–4.6 J/cm2. A perfluorodecalin-infused patch was also used.

Three of the four patients had one treatment each – one was treated with a 532nm wavelength with a 4mm spot size and fluence of 0.5J/cm2 – while the remaining patient had three treatments spaced six to eight weeks apart.

Immediately post-treatment, only mild and transient localised erythema and edema was observed, with some epidermal crusting for three to five days. No adverse effects to the patients’ eyebrow hair growth were reported.

Patients 1 and 2 had 75% clearance, patient 3 had 90% clearance and 100% clearance was observed in patient 4. The authors concluded that the method used provides several advantages when treating eyebrow tattoos, namely that it requires less treatments and lower fluences. When used with the perfluorodecalin-infused patch, treatment resulted in excellent outcomes with no significant side effects.

Brits express little concern over fad surgery trends becoming dated Only one in 10 Brits is concerned that they may regret cosmetic surgery in the future despite rapidly changing fashion trends, research suggests.

Findings from a recent survey by Cynosure for its non-invasive body-sculpting device SculpSure showed that, while respondents in the 25 to 34 age bracket reported little worry about future regrets, those aged over 65 expressed the most concern.

Fears over surgery looking unnatural appeared to be the biggest barrier, with 30% citing fear of surgery going wrong as the primary deterrent. Worries about becoming addicted to cosmetic procedures would put off 9% of those surveyed while a further 8% reported being worried about the pain involved. Just 3% of respondents were concerned about the recovery time following surgery.

NEWS IN PICTURES The Grade II-listed Royal College of Surgeons (RCS) headquarters has celebrated a major land-mark in its redevelopment, with a topping out ceremony in Lincoln’s Inn Fields, London.Professor Derek Alderson, president of the RCS, was joined by Sir James Wates, chairman of Wates Group, whose construction arm is carrying out the heritage project. The £75 million redevelopment will provide a modern learning facility that will play an integral role in training the next generation of surgical practitioners.

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NEWS SPECIAL REPORT

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Indecent proposal?

Georgia Seago reports on the Scottish Government’s proposal to regulate non-medics

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n January, the Scottish Government announced a proposal that could see non-medics have to carry a licence in order to perform injectables such as fillers and botulinum toxin.

Public health minister Joe FitzPatrick said Scotland would be the first in the UK to introduce the licensing scheme. A consultation, which can be accessed online, has been initiated for the public to share their views until the end of April.

“We are committed to patient safety and want to ensure that all those who carry out non-surgical procedures, such as dermal fillers or lip enhancements, are competent and that the treatments take place in safe and hygienic premises,” said FitzPatrick.

“We plan to introduce regulations later this year and invite members of the public and interested parties to give their views as part of the consultation on our proposals.”

The licences would be akin to those required in tattoo parlours, where a licence will show that the practitioner has been adequately trained and has both the experience and skills to perform the treatment.

Clinics run by medical professionals who provide nonsurgical cosmetic procedures have been regulated by Healthcare Improvement Scotland (HIS) since 2016.

However, there is no regulation around who can practise injectables in locations such as aesthetic clinics, beauty salons, pharmacies and hairdressers. In addition to a rise in the number of traditional beauty salons offering injectable treatments, the proposed legislation was also launched in reaction to the increasing number of pharmacists entering the field of aesthetic medicine.

THE PROPOSAL

In the plans, non-healthcare practitioners providing treatments that pierce or penetrate the skin, including injectables, skin needling and possibly light and energybased devices like laser, would be regulated by a licence under Part 1 of the Civic Government (Scotland) Act 1982.

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The scheme is being modelled somewhat on the regulatory requirements that tattoo parlours and piercing shops are required to adhere to, whereby local authority Environmental Health officers (EHOs) visit the premises and assess them against the specified conditions before a licence is granted.

When it comes to what these conditions would be, the proposal consultation paper reads: “Conditions could include that services are provided in a clean and safe environment, individuals would be 18 years of age or older, cooling off periods would be offered and sharps etc. would be disposed of appropriately.”

It also says, “We intend to make it a requirement that an applicant’s knowledge, skill, training and experience is taken into account when determining whether they are a fit and proper person to hold a licence.” Further details are likely to be discussed and decided upon after the consultation process when responses have been reviewed.

Environmental health officers would be required to refuse a licence if they didn’t deem the applicant as a “fit and proper person”. It would be a requirement that an applicant’s “knowledge, skill, training and experience” would be taken into account. Whether or not the Government would specify certain qualifications or course certificates from recognised education providers is yet to be determined.

To address the legislative gap where pharmacists are concerned, the Government is also proposing amending the definition of “independent clinic” so that it covers pharmacy professionals. This would mean that non-surgical cosmetic procedures provided by pharmacy professionals would be

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NEWS SPECIAL REPORT

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(regulated by HIS) could provide non-surgical procedures, or else hold overall responsibility if the procedure was performed on their behalf. These recommendations are addressed in the current consultation paper, with the Government stating: “…there is currently a lack of evidence of harm from all activities and therefore we do not want to cause undue financial difficulties for reputable small businesses, if this can be avoided by the introduction of other appropriate regulation. We consider that a blanket ban on non-medical professionals carrying out non-surgical cosmetic procedures could be difficult to enforce and might drive unregulated providers underground.”

Dr Sam Robson, medical director at Temple Clinic in Aberdeen, believes the proposed legislation undermines aesthetics as a medical profession. She says, “This is an attempt by the Government to obfuscate the issue – nonmedics should just not be injecting. They do not have the experience or the knowledge to recognise or manage a complication and they do not have insurance. Aside from anything else this trivialises the whole procedure.”

Collier agrees: “The Government refuses to acknowledge that the practice of medical aesthetics is a specialist field of medicine. If lay people can be licensed by Government to perform these treatments, then how can the procedures be of a medical nature?” The consultation paper describes its proposed scheme as “a way forward that ensures the visibility of all services and licensing backed with rigorous implementation guides to ensure best practice in all circumstances.” However, Collier argues that “there is only one acceptable approach – only registered healthcare professionals with an appropriate healthcare degree should be practicing within the field of aesthetic medicine.” regulated by HIS in the same way as aesthetic businesses run by medical professionals.

NOT FAR ENOUGH?

Despite the Government’s intention to bring some level of regulation to an area that is essentially a free market, the proposals haven’t been met with much positivity from some Scottish clinicians who don’t think the proposed legislation is the right approach. “I am completely against the Scottish Government’s proposal to introduce a licensing scheme – this will effectively legitimise non-medical people performing medical procedures,” says Helena Collier, cofounder and clinical director of Skintalks Medical Aesthetics in Musselburgh, East Lothian. She adds, “Some may argue that a licensing system – similar to that of tattooists – is better than no regulation, but the Government implying that injecting a dermal filler is similar to getting a piercing clearly shows it has been misguided with regard to the level of knowledge, skill and expertise required to deliver medical aesthetic care.”

Following the 2013 Keogh Report, the Scottish Cosmetic Interventions Expert Group (SCIEG) was established to examine the provision of cosmetic surgery and interventions in Scotland and analyse the report’s recommendations for implementation. The group recommended that regulation should be extended so that only healthcare professionals

NOT FAR ENOUGH?

With Scottish healthcare professionals subject to demanding and robust regulation and inspection from HIS, it’s easy to see how some feel non-medics would be given an easy ride in comparison under the proposed licencing scheme. “The Government thinks it is acceptable to create a two-tier system whereby non-medics and lay people can simply have their premises inspected for hygienic purposes.

I find this thought process very offensive,” says Collier.

Ultimately, the question is whether the proposed legislation is going to improve the standards and patient outcomes of aesthetic procedures in Scotland. While nonmedics are allowed to continue injecting, despite having to be accepted for a licence, it seems many clinicians at the top of their profession think it, at best, unlikely that public safety will improve and, at worst, that the situation may become even more dangerous. “Many people are guided by price and social media marketing when they choose their practitioner. Young people are especially vulnerable to things like ‘winning’ a procedure by ‘liking and sharing a post’ on Instagram. The quality of products these people are injecting is often questionable and the price is usually too good to be true, often at the expense of safety,” says Dr Robson. “Non-medics injecting affects the safe practice of the whole aesthetics business and puts patients unnecessarily at risk.” AM

Read and respond to the consultation paper: consult.gov.scot/healthcare-quality-and-improvement/regulation-of-independent-healthcare/

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OUT AND ABOUT

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DIARY DATES ACE GROUP CONFERENCE MARCH 11 Birmingham Repertory Theatre Inaugural Conference of the Aesthetic Complications Expert Group. acegroup.online

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

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

BRITISH ASSOCIATION OF SCLEROTHERAPISTS CONFERENCE MAY 19 Eton College Rowing Club, Windsor Annual conference for sclerotherapy practitioners with education on varicose veins, reticular veins and telangiectases. bassclerotherapy.com

FACE CONFERENCE JUNE 5-6 QEII Centre, London Medical aesthetic conference dedicated to non-surgical aesthetics with academic programme and global speakers. faceconference.com

AM NORTH JUNE 13-14 Manchester Central, Manchester Northern edition of the leading aesthetics trade show and educational event for surgical and non-surgical practitioners. aestheticmed.co.uk

VEGAS COSMETIC SURGERY JUNE 10-13 Bellagio, Las Vegas, US Multispecialty forum addressing the science, practice and techniques of aesthetic surgery and medicine. vegascosmeticsurgery.info

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Out and about All the happenings in the industry this month

Dr Martin Nimmo and The Practice Beauty Clinic launches Surrey

Distributor Advanced Esthetics Solutions (AES) supported two of its major clinic accounts with launch events in late January. Dr Martin Nimmo hosted a star-studded party (pictured top) to celebrate the opening of his new Surrey clinic. Nimmo, who also runs a clinic in London, demoed AES’s Duetto MT, Divine Pro and geneO devices.

Meanwhile, The Practice Beauty Clinic (pictured bottom) in Sunbury-on-Thames held a red-carpet launch event, where Dr Saba Khan and the team showed off the facilities and the geneO, Duetto MT and Lipofirm Pro devices.

ALLERGAN B2 FACILITY OPENING WESTPORT, IRELAND Aesthetic Medicine deputy editor Georgia Seago was invited to the official opening of the new phase of Allergan’s Westport manufacturing and research facility, called B2. She joined international media and Allergan executives from the UK and US for event. There were talks from Paul Coffey, vice president of global manufacturing and site lead at Allergan Westport, and Wayne Swanton, Allergan’s executive vice president.

Michael Ring, Ireland’s minister for community and rural affairs, also gave a speech about how Allergan’s presence has benefitted the local area since the campus opened in 1977. A tour of the new €160 million biologics plant was given after a the ribbon-cutting ceremony by Ring, followed by lunch and presentations on the science of Botox

by Mitchell Brin from the global clinical development team; and Allergan’s anti-counterfeiting operation by lawyer Jose Leite Da Costa. An open Q&A rounded off the event.

The Private Clinic trends breakfast Asia House, London

The Private Clinic of Harley Street, with clinics all over the UK, organised a breakfast panel event for press to hear about the upcoming aesthetic trends for 2020. Hosted by journalist Oliva Falcon, the panel included aesthetic doctor Dr Tracy Mountford and consultant plastic surgeon Mr Adrian Richards, both of whom practise with The Private Clinic; and managing director Valentina Petrone. The panel talked through the key findings of its 2020 Trends and Innovations Report, including the current most popular treatments in different regions of the country; the celebrities that now top the “most requested” list in consultation; and the procedures they predict patients will be most interested in this year.

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OUT AND ABOUT

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Codage Paris La Maison Codage trip Paris, France Aesthetic Medicine deputy editor Georgia Seago hopped on the Eurostar over to Paris for the day to check the French skincare brand Codage’s flagship boutique. After a tour of the boutique she enjoyed a tailored facial featuring a gentle peel, masks and deep facial massage.

A bespoke serum was then mixed to address the skin’s specific needs at the My Codage mixing station. The exclusive service is available to customers after a skin analysis and can be customised by texture, active ingredients and concentration.

Codage co-founder Julien Azencott shared brand updates and future plans over lunch.

Indiba Deep Care launch BEYOND MEDISPA, HARVEY NICHOLS, LONDON Celebrities including Gail Porter, Imogen Thomas and Nadia Essex attended the launch of the Indiba Deep Care device into Harvey Nichols’ Beyond MediSpa. The day included Deep Care treatments, consultations with a nutritionist and facial scans with Prosecco, cleansing juices and healthy treats on hand. Indiba Deep Care performs non-surgical contouring treatments on the buttocks, arms, stomach, cheeks jaw and other areas of the face and body.

ULTRACEL Q+ LAUNCH THE HARLEY ACADEMY, LONDON Healthxchange held an exclusive launch event for new SmartMed device UltracelQ+. The evening event included welcome drinks, an introduction to the device and its technology, live demos and treatment trials and a Q&A session. The HIFU device for face and body uses new linear technology to stimulate collagen growth and tighten the SMAS layer. It fires 300 shots in less than three minutes and includes cartridges for both small and large treatment areas. Most patients see results after two to six months.

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CLINIC PROFILE

RÖ SKIN

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Skin deep The co-owners of RÖ Skin take Georgia Seago inside their Scandi-inspired clinic

C

lare De Groot and Claire Mason opened RÖ Skin in Stamford, Lincolnshire two years ago with one thing in mind – an obsession with skin. Friends since teenagers, the pair were only 23 years old when they opened the first branch of RÖ Skin as a beauty salon inside the Holiday Inn in Peterborough.

The salon is still going strong, offering beauty services alongside the expert facials RÖ Skin is really known for.

But it’s the Stamford clinic that the duo is particularly proud of, having decided to open a second site that focussed on advanced skin treatments after developing a passion for skin science. “We started off at the Peterborough salon mainly doing CACI non-surgical face-lifts, but we soon realised that there’s so much more that you can do with the skin,” says De Groot. “We always wanted clients to upgrade their treatments, to start looking after their skin as soon as possible, so we began to delve more into skin and started going on lots of courses at the same time as building up our staff. When we opened in Stamford, that was the real game-changer.”

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ORGANIC GROWTH

The pair spent time building on their respective Level 3 Beauty Therapy qualifications training in various product brands, devices and treatments in order to be able to really change their clients’ skin. “It’s always fascinated both of us, we’ve always been so intrigued by the skin, how clever it is, and what you can do to it. We’re really big on telling clients that you don’t have to try and mask a problem with injectables, you can actually fix your skin,” says De Groot.

“With patience and encouragement you can really repair damage and encourage cell renewal, and that’s what we try and get our clients to understand; that it’s not a quick fix, but you can change your skin.” The RÖ Skin sites are just a 20-minute drive apart and share a beautiful, modern Scandi-inspired interior – something De Groot says isn’t just important to the business’s branding, but also for creating the best experience for clients.

“We spent a lot of money on the Stamford clinic; we had an architect design it with lots of light woods, spherical shapes and neutral colours,” says De Groot. “We went to so

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many different skin clinics, ones that had had really good reputations, but they were all very clinical. You get a good treatment and good results, but why can’t you have a clinical treatment in a beautiful, tranquil environment?”

The peaceful vibes created by the clinic’s interior flow through to its treatments, with massage even incoporated into RÖ Skin’s clinical facials where possible, to make clients feel comfortable and relaxed. The clinic’s Fundamental Facials include mesotherapy, needling, radiofrequency and vitamin A-based Environ treatments, some of which incorporate sculpting and lifting manual massage.

The Popular RÖ Super Facial is a bespoke 85-minute treatment incorporating a series of tools tailored by the skin therapist to the client’s exact needs. “We use all the tools we have at our disposal to treat the skin and we mix it up to adapt the treatment each time. Even if a client is having a Super Facial every month, every month it’ll be different,” says De Groot. “This approach keeps them excited and invested in their skin health – they begin to understand that it’s an ongoing commitment.”

TREATMENT TOOLKIT

Environ has been the core product brand at RÖ from the beginning, and De Groot says they’ve remained loyal simply because it works. “We believe in it; the skin recognises vitamin A, and we get the results for our clients,” she says.

“We explain to them that the only way to change your skin is to use medical-grade, active ingredients.” The clinic also uses DMK Skincare Enzyme Therapy, a treatment that detoxifies and oxygenates the skin.

In terms of devices, RÖ does a lot of laser work with Cutera’s XEO CoolGlide, providing laser hair removal and the removal of vascular veins, skin tags and cherry angiomas. We wanted to take on laser to step up our offering and treat the skin on a more advanced level, so we did a lot of research,” explains De Groot. “There are a few clinics in Australia and America that we really respect, and they use Cutera.

You get what you pay for – the results are unbelievable, what you can do with it to change the skin.”

Cutera’s Laser Genesis treatment has done a lot to build the laser manufacturer’s reputation, and it’s working >

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Top image: the RÖ Skin team, with Mason pictured second left and De Groot far right

very well for RÖ too. “We’ve had great results with rosacea, but it’s also a really good all-rounder because it’s so good for every single skin type to promote cell renewal and skin rejuvenation,” says De Groot. “We use it as an add-on in our higher grade, bespoke facials. It’s so stimulating that the skin looks amazing afterwards; it gives instant results.” The Laser Limelight photo-rejuvenation treatment is also popular at the clinic; able to treat pigmentation, mild to moderate acne and other indications in one to three sessions.

RÖ will soon introduce Aqua Gold Fine Touch therapy, a needling treatment that uses microdosing with a bespoke cocktail of active ingredients to rejuvenate the skin.

Dermaquest peels are also on the way to allow therapists to treat melasma. “Laser Limelight is brilliant for pigmentation caused by the sun but it doesn’t treat melasma, whereas these peels at the right grade can,” says De Groot. She and Mason are perfect examples of skilled, talented advanced therapists from a beauty background who achieve brilliant results for their clients and sustain a healthy business without injecting.

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STARTING WITH SKIN

While De Groot believes dermal filler, for example, has its place in the industry, it’s not what RÖ Skin is about. “We always tell clients that if they’ve decided they want to have filler, always, always go to a medical practitioner,” she says, “Because if something went wrong, therapists like us don’t have the right tools or expertise to be able to fix it.

“It’s also perfectly normal to have a few lines and wrinkles.

You can correct a wrinkle or volume loss but if the skin looks really dull or you have textural problems, the face is going to look like it’s in need of care,” she adds.

De Groot, Mason and the staff that make up the RÖ team, pride themselves on offering clients more than great skin.

“We don’t ever want them to think that we’re just trying to sell to them. We tell them to call us if they ever want any advice, not just on their skin but their general health; nutrition, hormones… we always try to be there for them and help them understand what’s going on underneath their skin,” says De Groot. AM

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F E AT U R E

BBL

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The bottom line

Is the controversy surrounding the Brazilian butt lift warranted, and what are the alternatives? Georgia Seago explores the issue

W

e’re all aware of the impact social media and celebrities have on aesthetic treatment trends.

While most complications encountered from both surgical and nonsurgical procedures can be fixed in the right pair of hands, incidences of death are, thankfully, far rarer in the UK. One surgery trend though, has resulted in a distinctly high number of fatalities compared to other procedures. The Brazilian butt lift, commonly referred to as BBL, has been popularised by the reality TV stars and Instagram standards that have a strong influence on the mostly 18-35-year-olds requesting the procedure.

The most high-profile case in the UK is that of 29-year-old Leah Cambridge, who passed away from a BBL operation in Turkey in 2018. Cambridge died after fat entered her circulatory system and blocked the pulmonary artery to the lungs. The case led to the British Association of Aesthetic Plastic Surgeons’ (BAAPS) decision to advise its 350-plus members to stop performing the surgery while it undertakes a formal safety review. Could the BBL backlash be the creation of inflated media attention, or is it a worryingly dangerous procedure that should be banned?

AESTHETIC IDEAL

“BBL surgery is said to have been initially described

by Brazilian surgeon Ivo Pitanguy in the early 1960s. The procedure started becoming more popular with changes in perception of the ideal female look from the early 1980s, when a curvier body with narrower waist and fuller breasts gained increasing popularity,” explains Mr Sultan Hassan, lead surgeon at the Elite Surgical group of clinics and partnership hospitals. “The cartoon character Jessica Rabbit from the 1988 movie Who Framed Roger Rabbit highlighted the curvier figure and is often recalled during consultations by patients today.”

BBL is one of the procedures Elite Surgical offers, but the clinic group has suspended the surgery while awaiting guidance from the British Association of Plastic, Reconstructive and Aesthetics Surgeons (BAPRAS), another surgical association looking into its safety.

Kim Kardashian and Nicki Minaj are the go-to contemporary reference points, with the kind of hyperreal, hyper-feminine bodies that form the social media ideal. But what Instagram pictures hide are the serious complications, revisions and high death rate from the procedure, thought to be at around one in 3,000. The American Society of Plastic The American Society for Aesthetic Plastic Surgery (ASAPS) reported 25 deaths from BBL among its members between 2011 and 2016, while one Florida clinic alone had eight deaths between 2013 and 2018.

“It is difficult to give an exact figure but there have probably been around 50 deaths in the US and Mexico

alone,” says Dr Hassan, “But many more in Central and South America where the procedure is very popular.” So far two British women are known to have died from complications.

Mr Christopher Inglefield, consultant plastic, reconstructive and aesthetic surgeon at London Bridge Plastic Surgery and Aesthetic Clinic, has performed approximately 400 BBL surgeries. He believes the media focus on the negatives related to the procedure isn’t entirely warranted, but that it does help patient safety. “It is overstated but very necessary, as patients need to be fully informed about the risks. However, the most important risk factor is the doctor or surgeon doing the procedure,” he says.

DANGER ZONE

BBL has a high risk of complications owing to the complex anatomy of the buttocks area, with a lot of large muscles and blood vessels. The possibility of injecting fat into a vessel that can then travel through the body and can cause blockages is high. For this reason, Mr Inglefield reiterates the importance of the surgeon performing each step of the three-stage procedure correctly and safely. “The first step is the harvesting of the fat through liposuction, followed by collection and preparation of the fat before injection. Then, fat is injected into the buttocks,” he explains. “There are guidelines issued by the International Multispecialty Group to ensure the safety of BBL in each stage.”

As with any procedure, proper and specialist surgical technique is vital for a safe and desirable patient outcome, especially in an area of the body that carries as much risk as the buttocks. “Deaths from BBL have always been known among surgeons practising this surgery, but this has generally been regarded as surgical technique-related complications associated with performing large volume transfers and poor technique,” says Mr Hassan. “The key is where the fat is injected. A deep injection into or under the gluteal muscle is where the potential for fat injection into major veins is likely to occur. The key is to keep injections of fat in the superficial plane and to not go deep. Using a blunt cannula also helps.”

RIGHT AND WRONG

If performed by a specialist surgeon in an appropriate clinic setting on a properly consented patient, the probability of serious complications from BBL would of course be reduced.

But even so, for some, the risk isn’t one worth taking. Mr Adrian Richards, consultant plastic surgeon at The Private Clinic, which runs consultation clinics in London, Northampton and Buckinghamshire and operates in London, has never performed BBL surgery and questions not just the safety of the procedure, but also its ethics. “Is putting fat into the buttocks really the right thing for us to be doing? It’s purely aesthetic, it’s making people look unnatural; people don’t look like that naturally,” he says. “It makes you wonder how we’ve got here when we’re even contemplating performing a dangerous surgery that makes people look weird.” >

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F E AT U R E

BBL

Mr Richards believes BBL is a passing trend, and one that carries potentially irreversible consequences. He also has concerns over the high number of the procedures that are carried out abroad, with patients travelling to places like Turkey and Colombia for far cheaper surgery, often in unscrupulous settings. “I think people aren’t being properly consented. In the UK, we’re very keen on informed consent and there’s a two-week cooling-off period before any procedure,” he says. “Whereas patients travelling abroad for the surgery may have seen someone non-medical like a coordinator in the UK but then they may have the operation on the same day they arrive abroad.”

There’s also the issue of resolving complications and providing aftercare once a patient returns home, with the NHS often having to provide urgent care. “Problems from having surgeries abroad often need to be resolved on the NHS at the taxpayer’s expense. Also, you’re not supposed to fly immediately after an operation, so anyone flying abroad and coming back, it’s dangerous,” says Mr Richards. “There are so many risks involved.”

As a BAAPS member surgeon, Mr Richards adds that the association “is always talking about the inadvisability of having surgery abroad where it can’t be followed up”.

Mr Hassan is in agreement that the risks of complications from any procedure are significantly increased by patients travelling overseas for operations: “These issues are significantly due to a lack of aftercare and the uncertainty around qualifications and training of surgeons abroad. The cost difference between BBL surgery in the UK compared to abroad, where it is much cheaper, has a major role to play,” he says.

For these reasons, there are concerns that advice to UK surgeons to stop performing BBL surgery could cause more British patients to turn to surgery tourism. “This decision is not in the best interests of any patient seeking a safe procedure,” says Mr Inglefield. “It will certainly increase the risk that patients will have BBL by poorly trained doctors in unregulated facilities abroad. We must keep this into perspective. Our goal is always to improve standards for patients who seek our care.”

OTHER OPTIONS

The guidance for UK surgeons to stop performing BBL surgery is unlikely to change “unless a new technique, scientific evidence or data emerges,” predicts Mr Richards.

However, there are both surgical and non-surgical alternatives, which, while they won’t give the same results as a BBL, could present a suitable alternative for some

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patients. Surgically speaking, gluteal silicone implants are an alternative but also carry a high rate of complications – up to 30%, according to Mr Inglefield. The risk is too high for Mr Richards to consider implants for his patients, and Mr Hassan says: “Implants involve more surgery, risks of displacement and infection and the need for replacement.”

Advances in non-surgical body-contouring technology mean that aesthetic doctors now have several viable options to offer patients presenting with a desire to shape or lift their buttocks. “Because the risk of BBL is so high, those wanting the results from this type of procedure are resorting to having it non-surgically,” says Dr Tracy Mountford, founder and medical director of The Cosmetic Skin Clinic, with clinics in London and Buckinghamshire.

“BTL Emsculpt is our go-to treatment for lifting and firming the buttocks; each treatment is bespoke to the size and shape of each individual in what we can achieve.” Depending on the patient and their desired outcome, the clinic often incorporates CoolSculpting into the treatment plan to create a more “hourglass” shape, narrowing the waist and flanks, and, if appropriate, reducing the fat pad at the top of the leg, just below the buttock, which makes it look shapelier.

A combination treatment approach is also favoured at EF Medispa, where head of clinics division Violeta Negrea says, “For a non-surgical butt lift, we have a combination of technologies to choose from, such as ultrasound, radiofrequency, acoustic wave therapy, compression therapy, multisculpt therapy and MesoLift. This allows us to address concerns related to muscle tone, lack of elasticity and cellulite, which are all associated with the appearance of a beautiful buttocks.”

Specifically designed as a non-surgical alternative to BBL, Indiba Deep Care, distributed in the UK by Belle, can achieve firming, tightening and lifting of the buttocks after one session, says Irina Lewis, a practitioner at Best Laser Room, based at Royal Garden Hotel Kensington. “It works in two ways; first by a transfer of electricity which stimulates cells and promotes oxygenation and lymphatic drainage to smooth cellulite, then the tissue is heated by electrical resistance which stimulates fibroblasts to lay down collagen, tightening and lifting the bum,” she explains. AM

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

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

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BUSINESS

GOOGLE REVIEWS

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The power of Google Reviews Jemma Edwards shares nine tips to use Google reviews to grow your business

E

ven though Google has been around since 1998, Google reviews have only been a feature since 2012. Although other review sites (Facebook, Yelp, TripAdvisor and FourSquare) have been around as long, it’s Google that has captured the market and seen the biggest growth in review usage.

WHAT IS A GOOGLE REVIEW?

A Google review is a feature that exists within Google My Business and Google Maps that allow customers to publicly post a review on Google.

People can review your business and the services/ products you provide. The reviews help to level the playing field with the bigger companies where marketing hype and expensive campaigns aren’t able to dominate over genuine good customer service provided by smaller operations.

Anyone who has a Google account can leave a review, so when people search for your business or the services your practice provides they see the reviews in the search results.

WHY ARE REVIEWS IMPORTANT?

Online reviews are a reference point for people when they are considering buying a product or service. They are trusted because they are written from another customer’s experience as opposed to what the business says about itself.

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0% of people first check online reviews before 9 they make a purchase 8% of people trust online reviews as much as a 8 personal recommendation p to 31% of people are more likely to do business U with a company that has positive reviews. And this is true about businesses that are both local and global Getting people to visit your site is hard enough, let alone buy or book an appointment.

The advantage about having positive Google reviews is that often people will arrive at your site intending to book an appointment because they have already been convinced by the reviews.

So you don’t have to work as hard to convert leads into customers because the reviews have done it for you already.

2% of people will only do business with brands that 7 have positive reviews Clearly, positive reviews improve sales, however, sometimes even negative reviews are helpful as they present a chance for the business to turn the review into a positive one if the customer is contacted and the situation turned around.

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BUSINESS

GOOGLE REVIEWS

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eviews give you a clear understanding about what R your customers expect from your business Online reviews are your customer’s opportunity to give you feedback on your service.

By reading negative reviews on Google, you can quickly see what areas you need to improve upon and which areas you should be praising.

Reviews create loyalty to your business Someone who takes the time to leave a positive review will have been impressed with what they have experienced and it’s likely that they will buy or visit again.

Online reviews boost your SEO The more people talking about your business online in a positive way, the more attention search engines are going to give it.

These reviews tell the search engines that your business operates in a transparent and open way, so Google gets to “trust” you more, pushing you up the page rankings.

If Google thinks that the local, single practice provides a better experience than a corporate giant, that local practice can end up higher in the local search rankings. The same works the other way, of course.

GETTING PEOPLE TO WRITE REVIEWS People will rarely write a review of their own accord, so how can you encourage them?

Firstly, make sure your business is listed and verified on Google. Just type

in “register for Google My Business” on Google and follow the process.

Once you’re listed on Google My Business, we need to understand what a customer should do to leave a Google review: 1. They need to be logged into their Google account. For Gmail customers, this is pretty easy 2 . They then search for your business on Google 3 . From the results page, there will be a knowledge panel on the right hand side of the search results 4. In the knowledge panel is the option to write a review.

But rather than the customer having to go through all this, why not send them a link so they can go straight to writing the review?

Here’s how: 1. Sign into Google My Business 2. If you have multiple locations, open the location of the site you’d like to manage 3. In the menu on the left, click “Home” 4. In the “Get More Reviews: card, copy the short URL to share with customers.

And on a mobile: 1. On your phone, open the Google My Business app 2. Tap “Customers – Reviews” 3. In the top right tap “Share” 4. I f your short name is not created you will be prompted to create one 5 . T hen copy the short URL to share with customers. >

“Online reviews are a reference point for people when they are considering buying a product or service”

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4. Include a link to your reviews on your website and email Or wherever you communicate with your customers. Make it as easy as possible.

5. Provide options to leave reviews on the platform of their choice If someone is a regular Facebook user then leaving a review on Facebook might be easier for them. Once they’ve left the review on Facebook ask them if they would post the same review on Google.

6. Thank them for leaving the review Thanking customers for their review on the platform they have written it on, be it positive or negative, always works.

You might not like what someone has written but you should always acknowledge and respect that they have taken time to give you feedback.

Thanking them in anticipation of the review helps as well.

So when you’re asking them you can say, “Thank you for agreeing to leave a review – your views are really important to me”.

This increases the chances that the customer will follow through and leave the review. Also by thanking people publicly, it shows that you genuinely value the reviews and gives people confidence that you will take note of what they write as well.

After you’ve sent them a link, how do you motivate someone to leave that review? You might be so keen to get reviews that you think, “Surely I can just buy some?”

Well yes, you can. But be warned that buying fake reviews can result in having your business blacklisted on Google or worse, facing legal action.

The best businesses earn their positive reviews the right way.

NINE TIPS FOR SUCCESS

1. Run an email campaign asking for people to leave their comments Review software companies will automate the process so that a request for a review goes out to the customer immediately after you’ve interacted with them.

2. Ask them for a “favour” If you want to get the best response possible from clients, think about the psychology of how you ask them. For example, by asking for a “favour” you’re showing trust in them and it doesn’t have the same impact as straight out asking them to judge your business. If they’ve had a good experience, they’re more likely to agree to “help you out”.

3. Give them a reason to leave the review According to a 1978 Harvard study, people are 33% more likely to comply with your request if you use the word “because”. So by saying up front something like, “Because we care about what you think of our business” or “Because we would love to hear your thoughts”, people can understand why their involvement is important to you.

7. Make sure your staff knows how important reviews are Reminding staff to ask for reviews keeps them accountable for how they interact with your customers. They also need to thank the customer – again, it increases the chances of them leaving the review and improves the likelihood of it being a positive one.

Obviously disgruntled employees are hard to motivate to get customers to leave reviews. Engaged employees that are in line with the mission and values of your business should have no problems with this.

8. Use a customer survey You might find some customers aren’t too clear on how to write a review so you end up with “Good service”, which doesn’t mean much. Ticking a box to give a score is a lot less onerous for your customer. And you can advertise the results on your social media platforms.

9. Storytelling It might sound a little odd but asking for people to “leave a review and tell the story of your experience” helps others connect with the review. Stories generate a connection and are great social proof. The reader gets a feel for what it’s like to deal with your business. It’s also genuine and unique, and it gets people writing about their favourite subject – themselves! When it comes to aesthetic treatments especially, giving a sense of the professional and welcoming environment customers can expect is key. Hopefully you find these tips useful. In my next article I’ll be writing about how to handle negative reviews. AM

Jemma Edwards is the owner of deliveringdemand.com, helping aesthetics professionals and cosmetic surgeons get more patients and grow their practice.

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CLINICAL

CONSULTATION

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Consultation connection

Balsam Alabassi discusses the consultation process and how each interaction is an opportunity to improve patient outcomes

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A

consultation is a structured interaction between the practitioner and the patient. There are various consultation models, each of which has value.

1. The Biomedical Model (1800) – A traditional model that is still practiced in hospital settings today where disease state and diagnosis is central to the consultation. All diseases have physical or biological causes. It takes little into account of how the patient feels or thinks. This model is only focused on the physical examination, diagnosis and laboratory results to formulate a treatment.

2. Berne’s Transactional Analysis (1960) – A model which describes the dynamics of the patient and the prescriber existing in “ego states” where there is a “parent-adultchild” ego state. The ideal setting is achieved when both prescriber and the patient are in the adult ego state.

However, it can sometimes prevent autonomy.

3.

The Health Belief Model (1975) – Originated from an American group of psychologists and takes into account the patient’s thoughts and approach to their illness. It focuses on the patient’s ideas, concerns and expectations.

10.

The Three Function Model (2000) – Gathering data, developing rapport and patient motivation and education.

11. BARD (2002) – Focuses on the behaviour, aims, room and dialogue.

One common theme that is apparent with all consultation models is that they involve taking the patient’s history.

Although they differ in their style, where some are focused on the symptom and the disease while others are directed towards the actual patient, some of the models share common themes, with most modern consultation models striving to achieve a shared agenda.

The Health Belief Model, Pendleton’s Consultation Model and McWhinney’s Disease-Illness model all consider the patient’s ideas, concerns and expectations, whereas Hellman’s Folk Model focuses on the patient’s perspective, putting the patient and their journey at the heart of the consultation with empathy.

On the other hand, Neighbour’s Inner Consultation and Calgary Cambridge consultation guide both adopt a systematic five-step process to the consultation.

Ideas

Exploring thoughts that the patient may have.

Neighbour’s Inner Consultation (1987)

Calgary-Cambridge Consultation Guide (1998)

Concerns

Examining worries that may be present.

Connecting

Initiating session

Expectations

Determining what the patient hopes to be done.

Summarising

Gathering information

Fig 1: A self-adapted demonstration of the patient’s ideas, concerns and expectations2

Handing over

Facilitating the Patient’s involvement

4. Category Interventional Analysis (1976) – Prescriptive, informative, confronting, cathartic, catalytic and supportive. This is a journey where the prescriber can influence the patient during the consultation.

Safety-netting

Explanation and planning

Housekeeping

Closing the session

Helman’s ‘Folk’ Model (1981) – Also known as the 5. anthropological model. This model suggests that the patient visits the prescriber looking for answers to six main questions: What happened?; Why has it happened?; Why to me?; Why now?; What would happen if I do nothing?; What should I do about it?

6. Pendleton’s Consultation Model (1984) – Analyses the reasons for seeing the prescriber where an action plan is taken with shared understanding that involves the patient.

It considers the patient’s ideas, concerns and expectations.

7. McWhinney’s Disease-Illness Model (1986) – This model describes the disease as the case of the sickness whereas the illness is a unique experience of the sickness. It takes into account the patient’s ideas, concerns and expectations.

8.

Neighbour’s Inner Consultation (1987) – Composed of five structured elements: connecting, summarising, handing over, safety-netting and housekeeping.

Calgary Cambridge Model (1998) – Mostly used in 9. the UK, it involves initiating a consultation, gathering information, building relationships, explanation and planning; and closing the session. This is built with two pillars in mind and these are relationship and structure.

Fig 2: A self-adapted illustration of the Neighbour’s inner consultation and Calgary- Cambridge consultation guide3

In practice, these consultation techniques may comprise of a combination of consultation styles depending on the patient and the situation. It is vital to establish a strong relationship with the patient where both verbal and nonverbal methods of communication are utilised in order to reach a shared agenda and a shared outcome, as only 7% of the total communication is made of the word itself, leaving 55% for non-verbal and 38% for sound.1 Effective verbal communication should be tailored to the patient and the situation, involving the patient throughout the process, keeping the language simple and refraining from complex words or assumptions so that they understand the context of the information given.

Non-verbal methods of communication can also be achieved using the principle of SURETY, which stands for: Sit at an angle; Uncross legs and arms; Relax; Eye contact; Touch; Your intuition.4 This principle supersedes that of the SOLER model introduced by Egan in 1975 (Sit squarely; Open posture; Lean towards the other; Eye contact; Relax.)4 as it incorporates the use of touch and the importance of individual intuition is emphasised. This may establish a stronger relationship where empathy is applied, anchoring the consultation and therefore how the practitioner positions themselves is vital.4 >

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Using touch can strengthen the relationship between > the practitioner and the patient. This will influence the patient’s experience.5 Picking up body language is also important in demonstrating empathy and care while addressing concerns during the consultation.6 Not every consultation follows a treatment outcome and in some cases, no treatment is the most appropriate course of action. Therefore, a holistic approach is vital.7 Reflect on treatment practice. Peer review and learning outcomes.

Record keep.

Accutate, clear, legible, unambiguous, relevant, contemporaneous, dated, timed and signed. Untampered and secure.

Drug history

Assessment

History of presenting complaint

Family history

Prescription

Past medical history

Social history

Other treatment

Fig 3: Self-adapted Traditional Medical Model as a fundamental pillar to initially gather the patient’s history using the above. 2

Review. When, how, where and who.

Negotiate a treatment plan. Take into account compliance, adherance, concordance and persistence.

Choice of product.

Appropriate, safe, effective and acceptable. Cost.

Strategy. Diagnosis: is referral needed?

Expectations from the patient.

Consider the patient as a whole looking at all factors.

Is the treatment necessary? What are the reasons for the consultation? Build a relationship and rapport.

Identify the impact of the problem. Decide the treatment plan with the patient. Record and follow up.

CLIENT AND CONSULTATION

Patient selection is vital. Prior to the consultation, build a relationship and rapport, which can begin with a simple

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Presenting complaint

introduction. Exploring how the patient is feeling can add value to rule out reasons not to treat.

A detailed patient history is paramount including history of depression and body dysmorphia, capacity and age evaluation.

Identify the impact of the problem before deciding on the treatment to determine the strategy. Explore the patient’s ideas, concerns and expectations to achieve a shared agenda and outcome.

Communication should be conducted clearly and respectfully, offering an opportunity for the patient to ask questions, listening and being ready to answer any questions to manage realistic expectations to establish a shared agenda with a shared outcome.

Once the initial assessment is complete, mutually decide on the treatment plan ensuring that the patient is aware of the risks, including adverse drug reactions such as anaphylaxis, but reassure them that there are measures to rescue and remedy. In addition, the costs and the time frame of the treatment are vital to allow the patient to reflect. Offer patients a cooling-off period to consider and consolidate the information without hard selling tactics in order to decide.

The patient should always be the nucleus of every consultation, where a patient-centred approach places the patient at the heart of care, involving them in all steps of the decision-making process while respecting their own unique values and preferences in order to provide a complete care solution.8 It is important to educate the patient verbally and visually, supplemented by content handouts. Therefore, treatments are tailored with consideration of goals and aims, taking into account psychological needs.

When patients are listened to, where their ideas, concerns and expectations are explored, it is possible to empower them with the knowledge while demonstrating alternative treatments which they may not have thought as an appropriate option.9 For example, in younger patients the focus may be prevention, whereas in older patients their expectations may be unrealistic. Hence, establishing a shared agenda with a shared outcome is paramount.

This is essential when formulating a personalised treatment plan. Additional written information regarding the procedure, recovery period and side effects should be part of the shared agenda.10

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“It is the ethical and legal responsibility of the practitioner to ensure that realistic expectations are relayed to the patient”

It is important to check the patients understanding, allowing them to process the information prior to going ahead. Patients are less likely to be dissatisfied with treatment outcome if they have been involved and communicated with throughout – their expectations are more likely to be realistic.

It is the ethical and legal responsibility of the practitioner to ensure that realistic expectations are relayed to the patient in order to establish congruence through a two-way exchange of information, leading to loyalty and retention.11

THE IMPORTANCE OF INFORMED CONSENT

Consent is defined as granting permission or agreeing to proceed. It does not include the understating of action behind the permission.12 Consent is based on partial information and it is therefore difficult to determine if the patient has truly understood. There may not be enough time allocated before treatment, which restricts the patient’s awareness of risk or alternatives impacting on the decision-making process. In addition, aftercare is not included in the consultation process.12 The GMC guidelines require a patient’s ability to comprehend and consolidate information with ability to communicate prior to informed consent. The four principles of medical ethics focus on autonomy at the heart of informed consent and the patient’s right to determine the treatment based on information.

The Montgomery v Lanarkshire case of March 2015 is an example demonstrating the legal importance of informed consent.13 Therefore, the crucial difference between consent and informed consent is the knowledge that determines the decision-making process.

Informed consent is achieved when the practitioner has made every reasonable effort during an indepth consultation that the patient comprehends the reason for the proposed treatment, the benefit to harm of the treatment, adverse reactions associated with the treatment and options and alternatives to the treatment, including the no treatment option.14 Money is not exchanged before consent, with clear terms and conditions laid out. Capacity and age are applied before proceeding. When communication between a patient and the practitioner is completed, the patient with full capacity can then authorise and agree to proceed.

Time to consider the information regarding the risks and potential outcomes before deciding to proceed is vital and the patient should not rushed into making decisions; and given all information needed to aid selection of the most suitable treatment option. Once the patient is fully informed, consent is achieved in writing and accompanied with photographic evidence of the pre and post-procedure.

It is therefore vital to ensure shared decision making by establishing a relationship and communication between the patient and the practitioner with the aim of safety, transparency, integrity and trust where the values and opinions are core part of the consultation.15 Cooling-off periods can build a stronger relationship as they increase the patient-practitioner relationship, build trust as patients are not pressurised or forced to take up treatment, promote a sense of realism in the expected outcome of the treatment and ensure informed consent.

If a patient is acting on impulse, has unrealistic expectations, or does not have the essential comprehension of downtime involved in post-treatment, then a longer timeframe may be needed. >

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Those who rush into a treatment may expect dramatic results leading to disappointments with regards to treatment outcomes.

It is therefore clear to see that The Keogh Review was a positive way forward for a number of issues, including cooling-off periods, to give reassurance to those who are committed to working ethically and promoting best practice.

As with all consultations, robust record keeping is vital to ensure continuity of care, there are various formats that can follow a consultation, one of which is SOAP which consists of: 16 Subjective information given by the patient. bjective information that includes the patient’s O history. Physical examination if applicable. Results and investigations performed. Any relevant information including, that of third party where applicable.

A ssessment of the problem, differential diagnosis, rationale for giving medication.

Plan of action agreed with patient including the name of the medication, appliance (where applicable), and the dose as well as quantity.

Accurate, timely and detailed record keeping is vital. All consultations must be documented and a record is kept with agreed follow-up visits.7 Treatments may not work if the patient does not follow the post-treatment advice, therefore in order for patients to adhere they need to be convinced of the treatment outcome. There are different types of relationships that influence the patient’s attitude to their treatment.

Some patients still prefer their decision to be made for them in a practitioner led setting. However, more patients welcome the concept of shared decision making as they feel that they have ownership of their therapy.

Factors that can influence adherence : Internal – mindset, forgetfulness, misunderstanding,

anxiety, mood changes.

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Compliance – the extent to which the patient’s behaviour matches the recommendation of the practitoner in a form of telling approach.

Adherence- the extent to which the patient’s behaviour matches agreed recommendation from the practitioner.

Treatment

Concordance – which is relatively new and mostly used in the UK, is based on an agreement between the patient and the practitioner in order to work together in cohesion to reach a favourable outcome for use of medication with a shared decision making.

Persistence – time from starting the treatment to complete stop.

A self-adapted illustration of the differences between the four definitions relating to medicine use. 17

E xternal – convenience of the treatment, downtime,

outcome, social factors and cost.17 Reasons which may account for non-adherence: Unintentional – where the patient is willing but barriers exist, such as mobility, memory, dexterity and lack of support from others.

Intentional – unconvinced that the treatment will work, has undesirable effects and outcome.17 Adherence can be demonstrated though the NecessityConcerns Framework to outline the risk verses benefits of the treatment.17 The framework states that if the patient has high beliefs in the necessity of the treatment then, high level of adherence is achieved. However, if the patient has high concerns regarding the side effects, long-term effects,

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disruption and dependence of the treatment will result in low adherence.17 The need for concordance is vital as it can have a direct effect on treatment outcome and therefore a balanced approach during consultation is vital.

REFERENCES

CONCLUSION

3. G P-training.net (2016). Calgary Cambridge guide to the medical interview - communication process. gp-training.net/training/ communication_skills/calgary/guide.htm [accessed 11 Feb 2020].

Approach to patient care and treatment is influenced by the four principles of ethics: 18 Beneficence – Duty to do good. Actions can be taken to help prevent or remove harms or to simply improve the situation of others. It is the duty of this practitioner to do good, and therefore balancing the treatment benefits against the risks as well as costs to this patient are vital, while avoiding causation of harm. The practitioner must act for the welfare of the patient.

Non-maleficence – “Do no harm”. Refrain from providing ineffective service and treatments or acting in malice towards the patient. All treatments may carry a degree of harm, however the practitioner must assess the benefit to harm prior to commencing the treatment.

Respect for persons/autonomy – Acknowledge the person’s right. Respect the patient’s views with regards to their treatment, allowing the opportunity for them to establish informed choice.

Justice – Treat all patients equitably. Distribute benefits, burdens and costs fairly. Therefore, taking into consideration all aspects of treatment options and cost-effectiveness as well as the risks and benefits to the patient.

These four principles shape our moral understanding and aid in decision making, however each case needs to be assessed on an individual level taking into account the potential outcomes.

These four principles are dynamic tool which influences a reflective approach to patient care and earning outcomes.

The I.C.E principle is a vital tool in clinical setting that focuses on the patient and their needs, since their perception may negatively impact on their psychological as well as social state. It is therefore crucial that their situation is not trivialised.

Involving the patient in the decision-making process by providing evidence-based information may promote adherence as patients are more likely to be convinced if they have reasons to believe. In addition, it consolidates the partnership between the practitioner and the patient.

Consultations are as individual as the patient and therefore should be specifically tailored to their needs, taking into account physical and mental aspects as well language and personality traits without compromising details of their medical history and ensuring active listening and understanding throughout the process.

As with all consultations, one size does not fit all and no two consultations are ever the same.17 AM

>>

1. Belludi, N. (2008). Albert Mehrabian’s 7-38-55 Rule of Personal Communication. [online] rightattitudes.com/2008/10/04/7-38-55rule-personal-communication/ [Accessed 12 Feb. 2020].

2. M ehay, R. (no date) Revisiting models of the consultation how to read this chapter. Online at apo.scot.nhs.uk/wp-content/uploads/2015/09/ Consultation-models.pdf, [accessed: 08 Feb 2020].

4. Stickley, T. (2011) ‘From SOLER to SURETY for effective non-verbal communication’, Nurse Education in Practice, 11(6), pp. 395–398. doi: 10.1016/j.nepr.2011.03.021.

5. Cocksedge, S., George, B., Renwick, S. and Chew-Graham, C. (2013).

Touch in primary care consultations: qualitative investigation of doctors’ and patients’ perceptions. British Journal of General Practice, 63(609), pp.283-290.

6. Silverman, J. and Kinnersley, P. (2010). Doctors’non-verbal behaviour in consultations: look at the patient before you look at the computer. br j gen pract, 60(571), pp.76-78.

7. National Prescribing Centre (1999) Prescribing Nurse Bulletin Signposts for prescribing nurses – general principles of good prescribing npc.nhs. uk/non_medical/resources/nurse_bulletin_vol1no1.pdf 8. Sundaram, H., Signorini, M., Liew, S., Trindade de Almeida, A., Wu, Y., Vieira Braz, A., Fagien, S., Goodman, G., Monheit, G. and Raspaldo, H. (2016). Global Aesthetics Consensus. Plastic and Reconstructive Surgery, 137(3), pp.518e-529e.

9. Nahai, F. (2011). Embracing Patient-Centred Professionalism. Aesthetic Surgery Journal, 31(7), pp.834-836.

10. U bbink, D., Santema, T. and Lapid, O. (2015). Shared Decision-Making in Cosmetic Medicine and Aesthetic Surgery. Aesthetic Surgery Journal, 36(1), pp.NP14-NP19.

11. Brom, L., Hopmans, W., Pasman, H., Timmermans, D., Widdershoven, G. and Onwuteaka-Philipsen, B. (2014). Congruence between patients’ preferred and perceived participation in medical decision-making: a review of the literature. BMC Medical Informatics and Decision Making, 14(1).

12. Hall, D., Prochazka, A. and Fink, A. (2012). Informed consent for clinical treatment. Canadian Medical Association Journal, 184(5), pp.533-540.

13. Chan, S., Tulloch, E., Cooper, E., Smith, A., Wojcik, W. and Norman, J. (2017).

Montgomery and informed consent: where are we now? BMJ, p.j2224.

14. Bjmp.org. (2019). The right to consent: Is it absolute? | British Journal of Medical Practitioners. [online] Available at: https://www.bjmp.org/ content/right-consent-it-absolute [accessed 08 Feb. 2020].

15. B ae, J. (2017). Shared decision making: relevant concepts and facilitating strategies. Epidemiology and Health, 39, p.e2017048.

16. Physiciansoapnotes.com, 2016 17. Horne, R. (2001). How can we improve medicines adherence in europe?

1st ed. [ebook] epha.org/IMG/pdf/Rob_Horne_EP_handouts.pdf ,[accessed 09 Feb. 2020].

18. Page K. (2012). The four principles: can they be measured and do they predict ethical decision making?. BMC medical ethics, 13, 10. doi:10.1186/1472-6939-13-10 19. Derksen, F., Bensing, J. and Lagro-Janssen, A. (2013) ‘Effectiveness of empathy in general practice: A systematic review’, British Journal of General Practice, 63(606), pp. 76–84. doi: 10.3399/bjgp13x660814.

20. Gibbs, G. (1988). Learning by day: A guide to teaching and learning methods. Further Education Unit. Oxford: Oxford Polytechnic.

21. G mc-uk.org. (2018). [online] Available at: gmc-uk.org/-/media/ documents/Guidance_for_doctors_who_offer_cosmetic_ interventions_210316.pdf_65254111.pdf [accessed 11 Feb. 2020].

22. Issuu. (2019). HEE Cosmetic Publication - Part two. [online] Available at: issuu.com/healtheducationengland/docs/hee_cosmetic_publication_ part_two_u [accessed 08 Feb. 2020].

23. NICE. (2018). New competency framework for all prescribers. [online] Available at: nice.org.uk/news/article/new-competency-frameworkfor-all-prescribers [accessed 08 Feb. 2020].

24. U rdiales-Gálvez, F., Delgado, N. E., Figueiredo, V., Lajo-Plaza, J. V., Mira, M., Ortíz-Martí, F., … Rebenaque, C. V. (2017). Preventing the Complications Associated with the Use of Dermal Fillers in Facial Aesthetic Procedures: An Expert Group Consensus Report. Aesthetic plastic surgery, 41(3), 667–677. doi:10.1007/s00266-017-0798-y

Balsam Alabassi is an independent prescriber and aesthetic practitioner and founder of DermRefine Skin Clinic: dermrefine.com

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SOMETHING IN THE WATER Dr Elisabeth Dancey explores the skin-healing powers of hydrogen therapy

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ince time immemorial humans have sought solutions to ageing and hydrogen-rich water has long been used for its antioxidant-boosting powers. Seminal research published in 2007 turned focus onto the therapeutic properties of hydrogen to improve skin function and quality, and much more. This research also showed that there is no such thing as overdosage, and that hydrogen has shown to be effective in over 150 disease models.1

VITAL SOURCE

Hydrogen is a neutral, colourless gas that occurs naturally as H2; two hydrogen atoms linked by a single bond. With an atomic weight of 1.00794, it is the lightest element of all. It is found dissolved in water, especially fast-moving streams, springs and fountains, as well as a component of the air that we breathe. 2 Being such a small molecule, hydrogen can penetrate all biomembranes – including cell membranes, the blood-brain barrier and placenta – to reach the cells’ organelles such as mitochondria and nucleus. There is no need for a carrier or ion-channel mechanism.3 Once in the cells, hydrogen exerts its antioxidant effect. Hydrogen may act directly, indirectly or by modifying and up-regulating gene expression.

Research into this aspect remains in its infancy. We present here a number of possible mechanisms.

Our main source of internal hydrogen is the gut. We produce 10 litres of molecular hydrogen per day from the activity of gut flora on fibre-rich foods. Hydrogen gas readily passes through the intestinal membrane. A healthy gut flora (or microbiome) will produce optimum amounts of hydrogen (and presumably less methane).

Water as a source of hydrogen depends on the water that you drink. If you are lucky to live near high-hydrogen content waters such as spa waters in Nordenau, Germany, Tlacote, Mexico or Hita Tenryousi in Japan, then you will be obtaining a good hydrogen level. Hydrogen molecular gas exists in these waters due to the alkali earth metals or from bacteria and algae in the water that produces molecular hydrogen gas. Globally, tap water contains approx. 0.000,0002 ppm – insufficient as a therapeutic concentration.

HYDROGEN THERAPY

and catalase, although the mechanism is still unclear.8 Interestingly, this pathway is only activated in the presence of injury, which is doubly beneficial.9 As an adjunct, hydrogen has bacteriostatic qualities which have been used to improve dental hygiene.10 Most skin disorders that we see in aesthetic practice are due to age, disease or damage, including damage to the immune system and the skin microbiome. It seems a sweeping statement, but antioxidant, anti-ageing treatments and restoration of the skin immunity and microbiome will help improve any skin disease presenting to us in clinic. Just as vitamin C, vitamin A, polyphenols and other antioxidants made their way into our armamentarium, so should hydrogen.

To date, the most promising study on skin disorders relates to psoriasis, with beneficial results from any source of hydrogen intake, be it through inhalation, consumption at 5-7 ppm (dissolved in water) or IV; that amounted to near clearance at the end of the trial. 11

HARNESSING HYDROGEN

As with many finds, I somewhat stumbled on the whole concept of hydrogen. I was investigating another skin cleansing device for my clinic, but it didn’t seem to achieve much so I started researching into novel antioxidants, upregulation of the immune system and ideas to minimise the toxic effect of our everyday lives. I came across many scientific papers on the beneficial effects of hydrogen gas and noticed that they tended to originate in >

POSTIVE RESPONSE

In terms of direct anti-oxidant capability, hydrogen effects hydroxyl radicals, reducing oxidative stress and improving redox homeostasis. Hydrogen doesn’t reduce all reactive oxygen species. It is a weak antioxidant and reduces hydroxyl radicals quite slowly. Hydrogen application appears to have beneficial effects that are prolonged and distanced in time from administration. In one study on rheumatoid arthritis the protective effects are observed for up to four weeks after the dose of hydrogen.4 Moreover, there is evidence that tissues respond positively to injury long after administration of hydrogen as a therapeutic intervention, suggesting that the hydrogen has changed or altered the response to injury or trauma in a positive, beneficial way.5-6 It has been suggested that hydrogen acts by modulating signal transduction, protein phosphorylation and gene expression, providing the anti-inflammatory, anti-allergy and anti-apoptotic protective effects.7 Hydrogen also appears to act on the NrF2 pathway, regulating levels of glutathione, superoxide dismutase

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CLINICAL

HYDROGEN THERAPY

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The benefits of the treatment are: 1. Hydration 2. Exfoliation/gentle peeling 3. Normalisation of skin microflora (antibacterial action) 4. Antioxidant infusion to the skin 5. Up-regulation of anti-ageing capacity of the skin cells Indications for the treatment are: 1. Acne and spot-prone skin 2. Pigmentation 3. Rosacea 4. Skin ageing 5. Open pores 6. Poor skin complexion 7. Thick, oily skin

The H2 Aquasure machine

Japan and the Pacific rim. At the same time, I discovered the Aquasure device and got in contact with the developers in Korea. We now have one device in our clinic which is achieving great results. My patients are always looking for new treatments and especially those that are not invasive.

I believe that the ability to up-regulate the detoxification process must be the future of aesthetic and regenerative medicine.

The H2 Aquasure device is a small, portable skincare device that is designed for use by NVQ Level 3 beauty therapists and above. It is a combination treatment that takes about 45 minutes to perform. A galvanic current runs throughout the treatment and ensures that absorption of all products is increased by a factor of five. The USP of this device is the fact that hydrogen gas is generated and dissolved in water by a platinum catalyst.

The treatment takes place as a series of passes of a suction-infusion head that delivers solution to and aspirates waste from the skin. The first passage contains hydrogen-rich water. Subsequent passages contain alpha and beta-hydroxy acids as a gentle exfoliant and pore cleanser. The final passage infuses the skin with vitamin C and other botanical ingredients. A mask of choice (usually hyaluronic acid) is finally applied to the skin and smoothed with a galvanic probe.

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The treatment can be used in addition to nearly all other aesthetic procedures, such as laser, dermal fillers, toxin, peels, radio frequency, threads and microneedling. The treatment should be performed before or at least four weeks after medical aesthetic procedures, in general.

To obtain the best results three treatments one week apart are recommended, with maintenance every four to twelve weeks depending on the skin and the needs of the patient. Caution should be exercised in thin, fragile skin, facial telangectasia and skin being treated with highdose retinol.

Contraindications include pregnancy, pacemakers and other implanted devices and allergy to any of the component solutions. AM REFERENCES 1. Ichihara, M., et al., Beneficial biological effects and the underlying mechanisms of molecular hydrogen – comprehensive review of 321 original articles. Med Gas Res, 2015. 5: p. 12.

2. Pubchem.ncbi.nlm.nih.gov/compound/Hydrogen 3. Qian, L., J. Shen, and X. Sun, Methods of Hydrogen Application.

Hydrogen Molecular Biology and Medicine. 2015: Springer Netherlands.

4. Ishibashi, T., et al., Therapeutic efficacy of infused molecular hydrogen in saline on rheumatoid arthritis: A randomized, double-blind, placebocontrolled pilot study. Int Immunopharmacol, 2014. 21(2): p. 468-473.

5. Zhang, J.Y., et al., Protective role of hydrogen-rich water on aspirininduced gastric mucosal damage in rats. World J Gastroenterol, 2014.

20(6): p. 1614-22.

6. Gu, H., et al., Pretreatment with hydrogen-rich saline reduces the damage caused by glycerol-induced rhabdomyolysis and acute kidney injury in rats. J Surg Res, 2014. 188(1): p. 243-9.

7. Ohta, S., Molecular hydrogen as a preventive and therapeutic medical gas: initiation, development and potential of hydrogen medicine.

Pharmacol Ther, 2014.

8. Ichihara, M., et al., Beneficial biological effects and the underlying mechanisms of molecular hydrogen - comprehensive review of 321 original articles. Med Gas Res, 2015. 5: p. 12.

9. Hara, F., et al., Molecular Hydrogen Alleviates Cellular Senescence in Endothelial Cells. Circ J, 2016.

10. I nt J Oral Biol. 2013 Jun;38(2):81-85. Korean. Original Article.

Antibacterial Activity of Hydrogen-rich Water Against Oral Bacteria.

Lee SH, Baek DH 11. ncbi.nlm.nih.gov/pubmed/25936373

Dr Elisabeth Dancey is clinic lead at Bijoux Medi-spa in London. She has nearly 30 years’ experience in cosmetic medicine and has provided safe treatments with natural-looking results to thousands of patients. Dr Dancey was instrumental in establishing mesotherapy in the UK in the early 1990s and was one of the country’s first injecting doctors.

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BUSINESS

CASE STUDY

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FULL diary Laura Moxham shares how improved Google Ads helped the Covent Garden Aesthetics Clinic fill its diary

G

oogle has built a very complex yet super-powerful, online advertising platform – Google Ads. Google Ads can be incredibly useful when it comes to helping you build your clinic and filling the diary with new patients.

With more and more people searching on their mobile and relying on Google, it’s the perfect place for clinics to attract new patients. You can control when and where you place your advert at the top of Google to get in front of the right potential patients at the right time. However, in the wrong hands Google Ads can be a scary money-pit. As the

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saying goes, a little knowledge can be very dangerous. This is especially true in a competitive market such as health and wellbeing.

So, I thought it would be useful to talk through a case study to show you the experience first hand. It’s a client of ours, Covent Garden Aesthetics Clinic, who uses Google Ads to attract new patients to their clinic day in, day out. But their experience hasn’t been plain sailing.

When Covent Garden Aesthetics Clinic, which has two London-based clinics, contacted us, their story sounded very familiar.

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BUSINESS

CASE STUDY

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Effective Google Ads campaigns need some really simple ingredients: Clear objectives for the campaign. This seems obvious, but it is often overlooked.

Accurate “conversion tracking”. This is a fancy word for the gauge to show you what’s working and what’s not in your campaigns. Without it you’re sailing blind and potentially heading for a big sea storm.

Clear structure for success – the right keywords, striking ad copy and a good landing page to send the visitors on your site to.

The last bit of magic fairy dust is the account changes and “optimisations” that need to be done. This is to get you more of what’s working, and cut out what’s not. This is often where we see magic happen, and Covent Garden Aesthetics was no exception.

A full performance report of the existing campaigns was produced. Here we looked at all of the above points, and more. We looked under the bonnet at their campaigns and identified a whole lot of issues; things that, sadly, Richard and the team would not be aware of.

After talking this through, we agreed there was a lot of work to be done. We set to work, making a real difference to their clinic.

THE SOLUTION

Success with Google Ads comes down to having the right foundations: accurate conversion tracking. This wasn’t in place. Don’t get me wrong, the basics were there but not the key bits, so it was holding back Covent Garden Aesthetics’ campaigns. It wasn’t showing what was making the phone ring and what wasn’t.

The keywords that they were bidding on weren’t wrong, but they weren’t focusing on location-based searches.

For example, adding in the treatment plus the location in the search often shows that that person is looking for a company in the local area to buy from – it’s got what we call “‘in buyer intent”. >

THE CHALLENGE

“In the wrong hands Google Ads can be a scary money-pit”

Covent Garden Aesthetics had been working with a Google Ads agency to manage their ads, and had together developed a great campaign bringing in a stream of leads and enquiries. They had done the hard bit. But as the relationship developed, the results didn’t.

As it’s a live-bidding auction, Google Ads needs regular attention to manage it. There are many moving parts in there that need changing and Google is often updating its advertising platform, meaning you must adapt with it.

Their advertising spend had increased. But results hadn’t.

Over time the agency’s results and focus was faltering: “It was a real struggle. We’re not PPC experts but we just weren’t getting the results we had planned for. It was time for a review to see why. We spoke with YBA who offered to provide me a full account audit of our Google Ads. The findings were stark – a real eye-opener,” commented Richard Bridson, managing director of Covent Garden Aesthetics.

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BUSINESS

CASE STUDY

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In the aesthetics market it is really important to appreciate gender behavioral differences, because these determine the way that different people engage with, and respond to, promotional messages. Targeting therefore needed to be adjusted and messages to match.

Knowing this was fundamental to our work because we recognised that our campaign landing pages and all our creative content had to be oriented differently towards potential male and potential female clients. And this doesn’t just help reach the target audience, but also delivers brilliant results when it comes to Google’s rank and relevancy.

It’s important to ensure that we know exactly what local competitors are doing, so a detailed comparison of other local clinics helps us to differentiate our messaging while developing a robust and well-informed keyword strategy. For Covent Garden Aesthetics for example, we told “bargain shoppers” about cheap teeth whitening, pricing offers and promotions. As the clinics already focus on price leadership among their competitors, we were able to deliver a strategy which reflected their unique selling proposition.

We set to work on all these things and much more. The other element with Google is that it’s just a tool. Anyone can learn about Google Ads, but doing it well is the tricky part. From an agency perspective it’s especially effective when the relationship with the client is open and honest and reactive. With weekly email updates and monthly calls we worked together to manage performance, review and

reflect on the campaign and to refine it as required; a great way to build trust and collaboratively solve problems.

“We’d already had one bad experience. We were really pleased when YBA offered regular ongoing support. They really listen to us; we work together to continually refine the campaigns and we’re developing a great relationship”, commented Bridson.

This strategy works really well, and we continually watch competitor activity to strengthen our clients’ brand image through display products in advance of important seasonal events such as Black Friday, Christmas and New Year.

“As it’s a livebidding auction, Google Ads needs regular attention to manage it”

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THE RESULTS

The results of our work continue to build.

In January 2020 we delivered a record response to our new year’s resolutions campaign, which talked about fitness, beauty and the cosmetics industry.

Covent Garden Aesthetics enjoyed the biggest number of leads ever for the clinic in December 2019 with the lowest cost per lead; and had their best day of business ever in the first week of 2020.

Overall we have reduced cost per lead by 28% while increasing conversion rates by 70% and volume of leads by 71% – a great result compared to just a 23% cost increase. AM

A free 20-minute session with Laura Moxham is available to Aesthetic Medicine readers. Email team@ybappc.co.uk quoting “AM March 2020”.

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

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S T U D Y A N A LY S I S

CAFFEINE AND WEIGHT LOSS

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Coffee time Georgios Tzenichristos from LipoTherapeia explores thermogenesis and asks if caffeine can really help with weight loss?

S

ocial media has been awash recently with talk about “bulletproof” coffee, where people put slabs of butter into their morning beverage in a bid to lose weight. This is just one of the latest in a long line of coffee-related weight loss fads, however, how much truth is there in the link between caffeine and its ability to aid fat loss?

In 2019, a study carried out at the University of Nottingham found that coffee can help people lose weight by activating thermogenesis1, the process of burning fat in one of two special types of fat tissue called “borwn fat” and “beige fat”.

As a nutritionist who specialises in fat and cellulite reduction, Georgios Tzenichristos, founder of LipoTherapeia at The Private Clinic, has followed the subject of thermogenesis for the last 20 years with interest. Here he gives his views on the subject and puts the findings into context.

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WHITE FAT

White fat tissue is the vanilla variety of fat tissue, the stuff we all love to hate, the one that makes us, well, fat. White fat’s main purpose is to store fat in our bodies for use on a rainy day. It also produces loads of hormones and other chemicals called cytokines, which are implicated in heart disease and diabetes.

So reducing white fat, or at least reducing some of the cytokines it produces, is a big deal, not just for aesthetics but for health reasons as well.

BROWN FAT

In contrast, brown fat is a type of fat tissue whose sole purpose is to burn fat for heat creation, i.e. to keep us warm.

Brown fat thermogenesis works amazingly well in mice, which have plenty of brown fat to keep them warm. And they can always readily convert plenty of their white fat into beige fat too, given the right circumstances (think of

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S T U D Y A N A LY S I S

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extreme cold or scientists feeding them stimulants, like hot chilli powder or natural supplements at 100x the normal dose). Mice love thermogenesis and do well at burning fat for heat.

Brown fat sounds like such an amazing idea. Creating lots of brown fat on humans has been the holy grail of weight loss for more than two decades.

Imagine if we could find a way to develop brown fat tissue in our body and then we can eat anything we want and just burn it to heat our body.

In this way we could kill two birds with one stone; stay slim and reduce our energy bills (although for those who live in places like Dubai, Texas or Africa, airconditioning bills would skyrocket).

One small detail: unlike mice, adult humans have very little brown fat.

Babies have somewhat more brown fat to help them keep warm, but in just a few months they replace it with white fat and they start keeping warm via shivering thermogenesis, i.e. they create heat, like adults, by muscle contractions (shivering).

But despite this very small setback, there is still hope. Enter beige fat.

CAFFEINE AND WEIGHT LOSS

“If caffeine could make people lose weight, via thermogenesis or any other method, we would already know and everyone would be on it”

BEIGE FAT

Something like a cross breed of white and brown fat, beige fat tissue always starts its life as white fat and then, with the right stimulation it becomes burning fat for heat, like brown fat tissue does.

There is a small detail here too: beige fat never commits to becoming brown fat. As soon as the stimulation ends, it reverts from what scientists call the “beige adipose tissue phenotype” back to the good old white adipose tissue phenotype. In plain English this means that it becomes white fat tissue again, which continues storing fat with wild abandon.

THERMOGENESIS IN HUMANS

These two facts – that we have very little brown fat on us and that beige fat is very fickle and therefore not worth

Brown fat cell

converting to – are the reasons why many people have never heard about thermogenesis before.

It’s a pain to start and to maintain and then it just switches off and leaves you cold.

THERMOGENESIS WITH CAFFEINE

Caffeine is yet another hardcore compound, similar to ephedrine and capsaicin. We can’t have a lot of it to make a real difference in our weight without developing side effects.

Also, if caffeine, consumed by billions of people around the world, could make people lose weight, via thermogenesis or any other method, we would already know and everyone would be on it. Some studies found a minor benefit, but it is just that, minor.

However, the study, published in Scientific Reports by researchers at the University of Nottingham, found that >

Beige fat cell

White fat cell

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S T U D Y A N A LY S I S

CAFFEINE AND WEIGHT LOSS LOSS

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“Creating lots of brown fat on humans has been the holy grail of weight loss for more than two decades”

caffeine does indeed stimulate thermogenesis in humans and that it also stimulates the conversion of white fat cells into beige, in both mice and humans.

The researchers used new methodology to prove that temperature on the little fat we have on our neck indeed rises by about half a degree Celsius (~33.8ºC to ~34.3ºC on the spot tested) after one cup of instant coffee containing 65mg of caffeine - a moderate dose indeed.

So perhaps a higher dose, such as the 400mg of caffeine contained in two energy drinks or in four cups of espresso, would have better results, right? What about 10 cups of coffee, for even faster weight loss? Or 20 for extreme weight loss?

The problem is that overdosing on caffeine is not a benign thing. It can induce palpitations, cause anxiety attacks, high blood pressure, high heart rate, diarrhoea and leave the adrenals exhausted after continued use. And when you stop overdosing on it, it will just stop working. That beige fat tissue does not stay beige forever.

On the other hand, with low doses don’t expect much fat burning to occur, otherwise all these moderate coffee consumers (one to four cups a day) would already be slim – or at least slimmer than their non-coffee drinking peers.

And there is no evidence of any significant difference in that respect.

WHAT DOES THE FUTURE HOLD FOR WEIGHT LOSS WITH THERMOGENESIS?

The researchers want to find if specific nutrients, perhaps more benign than caffeine and capsaicin, can help switch on

thermogenesis. With their new experimental design (first in-vitro tests on cells and then in-vivo tests on humans), they could screen a few hundred promising compounds, perhaps the ones that already stimulate thermogenesis on mice.

In this way, they can perhaps find the top 10 most thermogenic compounds, create a combined pill and make us all lean, mean, overheated machines and help solve the obesity and diabetes crisis.

It is indeed a noble cause and even if it doesn’t bear fruit, it will contribute to our knowledge of thermogenesis, human adipose tissue, diabetes and obesity. But I am not that optimistic about amazing results any time soon.

The problem is that the known thermogenic compounds must be used at 10x, 100x, or even 1000x, times their natural concentration in foods, if they are to make any discernible difference in terms of thermogenesis. At these doses there are plenty of side effects of all kinds, plus we are talking about consuming 10-20 capsules a day. It works on mice fed by force that aren’t able to complain, but it is a totally different thing in humans.

Let’s face is, thermogenesis as it stands today is not very practical, not very effective and not very pleasant either.

Let’s hope the University of Nottingham team can change this one day. AM REFERENCES 1. Velickovic, K., Wayne, D., Leija, H.A.L. et al. Caffeine exposure induces browning features in adipose tissue in vitro and in vivo. Sci Rep 9, 9104 (2019). https://doi.org/10.1038/s41598-019-45540-1

Georgios Tzenichristos is the director of LipoTherapeia London as well as a nutritionist, aesthetic therapist and cosmetic formulator, who has specialised exclusively in skin tightening and cellulite for the last 20 years.

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CLINICAL

JAWLINES

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PERFECT proportions Dr Zunaid Alli maps out his preferred approach to chin and jawline augmentation using the Vivacy Stylage portfolio of dermal fillers

C

hin and jawline augmentation with dermal filler has gained popularity in the last few years, with an increasing number of celebrities undergoing injectable procedures to complement or enhance their facial profiles. Social media posts linked to these procedures have added to the popularity of chin and jawline enhancement.

Hyaluronic acid-based dermal filler with the correct rheology (viscoelastic) properties allow advanced practitioners to achieve this goal. Despite HA fillers being semi-permanent, it is accepted as an excellent alternative to surgical intervention at a much-reduced cost.

Within the last year, I have welcomed a small number of transgender patients into consultation to discuss the various treatment options available for jawline treatment by either creating the widely desired tapered lower face or V-shaped look (feminisation), or by enhancing the chin and jawline to create a more squared-off appearance (masculinisation).

In order to understand the treatment approach a little deeper, we should consider the “five Ps”: practitioner, patient, planning, product, and procedure.

should be taken in respect to the inferior alveolar nerve and branches, dentition and gingiva, superficial fat pads, submandibular and parotid salivary glands as well as the facial artery and veins.

PRACTITIONER

PLANNING

Chin and jawline augmentation is an advanced-level set of procedures which need to be performed by an experienced injector who has gained knowledge and skill in the correct procedures as well as mastery in using both needle and cannula.

Most advanced practitioners will have developed their own unique combinations of filler placement; I almost always use both needle and cannula when treating chin and jawline.

Knowledge of facial anatomy and danger zones are of paramount importance. Around the chin and jawline, care

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PATIENT

The approach should always centre on the needs of the patient and what is achievable for the practitioner. I often discourage the use of social media posts as a therapeutic endpoint and prefer to focus the patient’s attention on what can be achieved with their own facial structures and anatomical arrangement.

While most patients are suitable for chin and jawline augmentation, additional factors to consider when examining, which I often encounter are perhaps a male patient requesting enhancing of his mandibular angle, or a female patient requiring enhancement to allow for a more tapered or V-shaped face. The cultural background of the patient will add a further layer to the assessment: for example, oriental-Asian women may opt for a more anteriorly projected and elongated chin which can alter the profile to achieve a more tapered or V-shaped face with no augmentation to the mandibular angle.

I find the rule of thirds to be an excellent planning tool which allows for assessment of the upper third of the face, which may benefit from filler into the temporal region (+/- lateral brow) using Stylage M (cannula technique) or Stylage XL (direct periosteal injection). The middle third of the face utilises the rigid zygomatic arch to allow for restoration of volume to the cheeks – both anterior and lateral – which serves to lift or anchor the soft tissues,

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JAWLINES

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structures of the lower cheek and perioral area of the lower face.

In order to maintain the anatomical differences between male and female faces, it should be considered that in females the ratio of lateral to anterior cheek is 2:1, whereas in males it is 1:1; so as to replace midface volume and assist in improvement of the jowls, reducing the depth of the nasolabial folds and supporting the tear trough area.

The planning phase of treatment may often involve a multiple treatment session strategy where other treatments may be used beforehand, such as lipodissolving of the submental fat pad, or the insertion of PDO threads for collagen stimulation, or injection of toxin into the masseters – generally done prior to the placement of the dermal filler.

I often ask about weight loss, as this has an important bearing in the planning phase. Should a patient gain weight after treatment it may give a more rounded appearance to the chin and jawline, thereby giving an untoward outcome.

PRODUCT

The concentration of HA, rheology and most importantly, G-prime are the three crucial factors in considering filler choice for the chin and jawline. Stylage XL is one of the two volumisers in the Stylage volumiser portfolio and both are indicated for facial volume restoration, with Stylage XXL having a further indication for facial volume creation. Both Stylage XL and XXL exhibit Vivacy’s IPN-Like technology, which significantly adds to the longevity of the product. The addition of the antioxidant mannitol to both products serve to prevent early inflammatory breakdown of the product after injection and adds to the overall longevity after injection.

Stylage XL has a high G-prime with 26mg/g of HA (IPNLike technology). The product injects exceptionally well

>>

with the new Bi-soft syringe through needle and cannula, and has high malleability, especially when injected around the pogonion (direct periosteal injection method). Stylage XL is also my preferred choice for placement of filler into the prejowl sulcus (cannula method) and provides good volume restoration in the angle of the mandible.

Stylage XXL has the highest G-prime in the entire range, and although it contains 21mg/g of HA (IPN-Like technology) it is the most viscous and elastic of the two volumisers. I often use Stylage XXL for chin and jawline augmentation in patients where volume creation is required and projection of the mental protuberance and angle of the mandible is desired.

The rheology of the chosen product is very important, as if a filler with less viscoelastic property is chosen, it will lead to premature breakdown of the product, loss of projection and volume and will integrate into the tissues to provide a rounder appearance as opposed to a defined one. The longevity of the volumisers in the Stylage range provide for around 12-18 months duration, at which point further augmentation may be required to maintain the results.

PROCEDURE

Topical or local anaesthesia is always used to ensure optimum comfort for the patient and to prevent pain on injection. The Bi-soft syringe allows enough room within the length of the syringe to comfortably aspirate, thereby adding to the safety for the patient and injector. The plunger ergonomically enhances the surface area so less force is required to extrude this viscous product out. The ease of injection is not affected by the use of a cannula. This allows for a smoother, more refined injection and optimises product placement. AM

Dr Zunaid Alli is an aesthetic medicine practitioner. His medical background is in emergency medicine and trauma, general medicine and medical oncology. He is a key opinion leader for Vivacy UK and has trained locally and in Europe for the Stylage portfolio. He is also lead medical trainer for Glow Aesthetic Training and trains practitioners in injectables, aesthetic skincare and chemical skin resurfacing.

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PRODUCTS

PRODUCT NEWS

aestheticmed.co.uk

SKINGENUITY

The latest range from SkinGenuity, Hair Restoration, uses nanoencapsulated growth factors, such as complex protein noggin to improve the coverage and thickness of hair. Nine other growth factors induce the anagen phase in resting hair follicles and stimulate the cells that cause normal hair follicle and overall hair growth. The protocol first consists of in-clinic treatment, with microneedling in combination with Hair Restoration Serum or Empress Mico-Fusions Applicator with Empress Restorative Solution. This is then followed by use of the SkinGenuity Homecare Kit, which is a two-step process consisting of the Empress Mico-Fusions Applicator with Hair Restorative Solution, and then the use of a brush that delivers botanical and essential oils to enhance the effect of needling.

ELENZIA

Firming and Body Shaping Cream is new from Endor Technologies’ Elenzia. It is billed as having a threein-one effect, promoting the development of muscle and lowering the expression of the genes involved in the accumulation of fat, smoothing and firming the skin with an intense moisturising effect.

Using nano-gold technology, which combines fragments of hyaluronic acid with particles of gold, the cream is designed for aftercare to further improve the effects of fat-reducing and bodycontouring treatments such as fat freezing, fatdissolving injections, electro-muscle stimulation, ultrasound and radiofrequency.

PEEL2GLOW

Aesthetic Source has introduced two new Peel2glow treatments: Beauty & Boost Peel2glow, featuring a formula containing four anti-ageing peptides to help protect skin and smooth fine lines and wrinkles, and Sleep & Repair Peel2glow, which has a radiance-enhancing formula to target signs of ageing overnight and protect skin from free radicals caused

by UV radiation and pollution.

Both treatments come as a two-part system. Step one is a peel containing lactobionic and glycolic acid among other ingredients, and step two combines concentrated doses of ingredients to smooth, firm, plump and recondition the skin, tackling photo damage and pigmentation.

SKINCEUTICALS

Glycolic Renewal Cleanser, the latest launch from SkinCeuticals, is a soft, foaming gel to gently exfoliate skin and remove oil, dirt, debris and make-up.

The formula includes 11.75% glycolic acid at a pH of 3.5 (delivering a free acid value of 8%), 1% phytic acid derived from legumes and seeds, aloe barbadensis leaf extract and glycerine, and is formulated to enhance clarity and brightness, leaving skin looking smooth and feeling comfortable.

For patients on a skin brightening treatment plan, Glycolic Renewal Cleanser can be used in conjunction with Glycolic 10 Renew Overnight for best results.

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4T MEDICAL

4T Medical has recently launched Cebelia Comfort Cream, a new anti-pollutant cream that nourishes, soothes and protects sensitive skin against environmental stresses such as pollution, cigarette smoke, harsh climatic conditions and temperature variations.

Key ingredients include physcomitrella patens moss to create a protective barrier against external aggressors; a range of natural oils including coconut, olive and sweet almond that deliver lipids to the skin; glycerine, a powerful humectant that adds deep-penetrating hydration; and allantoin and beeswax, to calm redness and skin discomfort.

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

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

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

What are growth factors?

Growth factors are groups of proteins that occur naturally in our bodies.

They’re produced by all types of cells and are responsible for the regulation of vital cellular functions, such as survival, proliferation, migration and differentiation.

Simply put, growth factors can command your cells to replicate, repair and rejuvenate.

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

How do they benefit the skin?

Using growth factors

When it comes to fighting skin ageing, growth factors are the true all-rounders.

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

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

Do they really work?

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

Overall, 95% of participants reported visible improvement in their skin texture

ZO Growth Factor Serum ZO Growth Factor Serum features a combination of both plant and enzymatically derived growth factors.

By applying topically, growth factors strengthen the skin’s extra cellular matrix, stimulate collagen and trigger the skin’s natural ability to heal—making growth factors an invaluable component of antiageing skincare.

Growth Factor Serum, featuring ZPRO is clinically proven to help: • Improve skin density • Improve skin firmness and elasticity • Reduce the appearance of lines

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

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

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

Firmness and elasticity An average of 80% of participants showed improvement in the appearance of elasticity. While an average of 81% of participants showed improvement in the appearance of skin firmness.

Improvement in firmness ans elasticity determined by instrumental evaluation via a Cutometer.

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

WIGMOREMEDICAL.COM

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T R E AT M E N T S

TREATMENT NEWS

aestheticmed.co.uk

Hiitting new heights We find out about the latest treatment from Dr Stefanie Williams, Eudelo Cell Hiit™, advanced high altitude training for cells

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igh altitude training is something you’d usually associate with adventurous mountaineers scaling snowy peaks, not something that takes place inside the comfort of a London-based dermatology clinic, until now.

Ever on the cutting-edge, European Dermatology London (Eudelo) has introduced a new treatment which gives cells a truly unique work-out to combat ageing and improve wellbeing.

Eudelo Cell Hiit™ combines German IHHT (intermittent hypoxia-hyperoxia treatment) technology to regenerate the cells’ mitochondria and provide sub-cellular anti-ageing benefits in combination with brainwave entertainment.

IHHT can help to improve cell function and boost cellular fitness by regenerating mitochondria. It can also optimise stress resistance, increasing protection against oxidative stress (antiageing from the inside out) and strengthen the immune system, improving HRV (heart rate variability), which helps the body cope better with stress.

The high-tech system takes the physiological experience of altitude training (hypoxic training) that has been used with great success by athletes for a long time one step further.

During the relaxing 45-minute session, the breathing air is cycled between lower and higher oxygen concentrations in a controlled manner, giving cells a workout that is equivalent to climbing up and down a mountain five times.

HOW DOES THIS HELP WITH TARGETING AGEING?

An imbalance of free radical generation and anti-oxidant supply causes oxidative stress, which is one of the main causes of ageing. The visible consequences of cellular ageing include loss of skin elasticity, wrinkle formation and irregular pigmentation During IHHT the body adapts to the alternating oxygen-poor and oxygen-rich air levels through increased production of red blood cells, generation of new capillaries, among other things. As a result, more oxygen can be transported through the body including to the skin and ™ ultimately into the cells.

During each session the patient’s heart rate and oxygen blood levels are continuously monitored. The Eudelo Cell Hiit™ initiates a multitude of health promoting mechanisms that help the cells’ mitochondria to regenerate, increasing cellular vitality, which accelerates cell regeneration, resulting in healthy skin, more energy and less stress. AM

Eudelo Cell Hiit combines German IHHT technology to regenerate the cells’ mitochondria

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13/02/2020 16:42

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

INMODE

Full facial rejuvenation Dr Dev Patel, medical director of Perfect Skin Solutions, shares his formula for combating the ageing effects of the sun using InMode’s Morpheus8 and Lumecca

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hile sunlight is an abundant source of vitamin D, and a crucial ingredient for overall health, the UV radiation that comes along with it isn’t a matter to be taken lightly – and not just in relation to skin cancer. Although ageing is a natural process that affects the entire body, from bone density and muscle atrophy to neurological decline, sun damage remains one of the most overlooked signs of ageing with newcomers to my clinic.

What many people remain unaware of is the accelerating impacts UV damage can have on ageing. UV radiation from the sun causes damage to skin cells, including their DNA. Excessive exposure can lead to signs of premature ageing, such as pigmentation, wrinkles, thinning of skin, and, in the most severe cases, skin cancer.

Internally, UV radiation also speeds up collagen breakdown leading to skin laxity, which, combined with age-related loss of fat and bone, results in the loss of youthful projection. Patients will present various concerns such as droopy eyelids, jowls, and a sagging jawline or neck. Thanks to the cutting-edge radiofrequency technology of InMode’s Morpheus8 and Lumecca IPL, the fantasy of being able to globally treat every key component of ageing with one simple treatment protocol, from the skin’s surface down to the deeper zones, is now a reality.

LUMECCA IPL Lumecca delivers intense pulsed light (IPL) like I’ve never encountered before and, along with Morpheus8 fractional radiofrequency treatment, is a breakthrough, thanks to InMode’s pioneering technology. In particular, it is highly effective against vascular and pigmented lesions, such as wrinkles and pigmentation as a result of ageing by UV damage from sun exposure. It promises complete photo-rejuvenation in one to two treatments, compared to four to six treatments with standard IPLs. After just one treatment to the hands, my first patient exclaimed it had “taken 20 years off”. The results are indeed phenomenal.

MORPHEUS8 FRACTIONAL RF Morpheus8 is also one of the most impressive radiofrequency technologies I’ve seen in years. It’s a microneedling device that specifically targets not only the dermis for collagen production, resulting in tightness, but also deeper subdermal tissue, for remodelling and contouring. Large bursts of energy are delivered at a depth of 4,000 microns uniformly without any form of thermal damage to the skin. This kickstarts a natural anti-ageing process, where the dermal cells renew and rearrange, leading to smoothing of wrinkles as the skin tightens, as well as the disappearance of hyperpigmentation scars when

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damaged skin cells are replaced with healthy ones. The lift, tightening and volume I can deliver to a patient’s face or any treatment area is astounding, especially when you consider that it’s a simple office procedure with negligible downtime.

A POWERFUL COMBINATION Lumecca and Morpheus8 complement each other as an extraordinary powerhouse protocol that can reverse skin laxity, drooping and discolouration due to decades of sun damage, and even restore volume, which peaks six months to one year after the final treatment. By combining these two treatments in just Untitled-17 1 a few visits to my clinic, I can deliver holistic and safe skin damage correction simply but very effectively, to give the skin a healthier and more youthful appearance.”

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By combining these two treatments in just a few visits to my clinic, I can deliver holistic and safe skin damage correction simply but very effectively

10/01/2020 12:59

Don’t miss Dr Dev Patel’s talk at Aesthetic Medicine Live on Sunday 1st March at 11:30am ‘Fractional radiofrequency to brighten, tighten and volumise skin’ Before

24 Hours

3 Weeks

For further information or to find a local clinic, contact InMode: T: 0208 9652594 E: info@inmodemd.co.uk W: inmodemd.co.uk Dr Dev Patel is available at Perfect Skin Solutions A: 121 Winter Rd, Southsea, Portsmouth PO4 8DS E: info@perfectskinsolutions.co.uk T: 023 9275 4777 Consultants available in Harley Street, London.

Aesthetic Medicine • March 2020

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T R E AT M E N T S

REVIEW

aestheticmed.co.uk

Tried and tested Georgia Seago finds out if Aqua Gold Fine Touch is worth the hype

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icrodosing is being tipped as a big trend in aesthetics for 2020. The injection technique sees multiple small quantities of toxin, dermal filler or skin boosters injected superficially to only target the skin rather than the structures underneath. One of the first branded treatments to be associated with the trend is Aqua Gold Fine Touch, a small handheld vial topped with 20 super-fine screw thread microchannel needles. The needles are coated in 24-carat gold and are used to deliver a bespoke serum cocktail into the skin, mixed by the practitioner at each appointment depending on the client’s skin needs.

Stamping the device across the face creates thousands of micro-infusion sites, allowing the serum to get to work on indications including skin texture, pore size, redness, oiliness, acne scarring and skin tone, subject to the product used.

I had my treatment with Dr Nina Bal at her clinic, Facial Sculpting, in London’s Chelsea. After talking though any concerns I had with my skin, Dr Nina decided to use her goto cocktail of neurotoxin to shrink pores, skinboosters for hydration, hyaluronic acid dermal filler for firmness; and

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mesotherapy vitamins C and E for glow.

Lying back on the reclined treatment couch, I felt next to nothing as Dr Nina quickly but firmly stamped the device over my face, massaging in any excess serum when she finished.

My skin looked instantly fresher and plumper, which is to be expected immediately after a needling treatment, but as the days and weeks went on up to about four weeks, I could still see a clear difference in the radiance and clarity of my skin and felt confident enough to forgo make-up for much of that period. I also noticed a significant reduction in my nasolabial lines; and the pores in the oiler areas of my face that usually produce blackheads or spots were definitely clearer and smaller.

I can see how the treatment would be very popular with high disposable-income patients before a period of special events, and it’s fantastic as an all-round skin health treatment without any downtime.

Although a perfect example of what micro-dosing can achieve, Aqua Gold wouldn’t replace traditional injectables or skin boosters for patients who regularly have these treatments; and with prices starting at £350, it’s more likely to be an occasional add-on for clients that already spend.

A word of warning for practitioners interested in offering Aqua Gold Fine Touch – the brand’s official UK distributor and training provider Venn Healthcare has made Aesthetic Medicine aware of copycat devices sold over the internet from marketplace sites. These appear to be whitelabel imitations and do not, according to Venn Healthcare, have 24-carat gold needles or spiral threads, and are possibly not sterile. All enquires should be made via Venn Healthcare directly. AM

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BUSINESS

STANDING OUT ONLINE

aestheticmed.co.uk

One of a kind

With more and more aesthetic practitioners joining the industry, how do you stand out in an increasingly competitive landscape? Alex Bugg shares the areas to focus on online

R

eally standing out from the crowd as a clinic or practitioner may seem near impossible. The “superstar” injectors worldwide with thousands of followers appear to have it right. But with limited time and value, how do you build a name for yourself or your clinic to stand out, and is it worth it?

WHY SHOULD PATIENTS CHOOSE YOU?

Creating an online presence for your clinic gives you validation. In 2020, most people would say they “Googled” you if they weren’t recommended via word of mouth. People don’t make a decision to buy – or book – the first time they see or hear of you. Usually, it takes between seven to 11 touchpoints for this to happen.

Your online presence plays a massive part if you wish to grow beyond a single injector set-up. If you want to build a business with a proper location and staff, you must understand that people will look you up online, and will find

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it very strange or off-putting if they cannot find much on you or your business. Creating content gives potential patients reasons to visit you instead of your competitor clinic or practitioner. The purpose is to show who you are, what you do and why people should trust you with their care. The key platforms to host content on are your website, Google My Business profile and your social media platform(s).

Quick wins for effective content: Your own imagery (photography of your team, products, treatments and location) will always perform better than stock images Video Written content such as blogs or articles in local press Case studies Testimonials

GET BEHIND THE CAMERA

Video adds a face and a voice to your brand. New patients taking the leap into their first medical aesthetics treatment will search and consume your content to put them at ease before – or after – booking. A study conducted by Wordstream in 2018 found that using video on a landing page increased conversion by 86%. In the context of aesthetics, traffic directed to a specific treatment, condition or product page is more likely to result in an enquiry.

Producing video that introduces your clinic and staff and even walks through the environment will create a great first impression. It also allows you to reflect your brand and philosophy. Specific video on the consultation and process

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BUSINESS

STANDING OUT ONLINE

aestheticmed.co.uk

of your key treatments with key information also deliver great value to patients.

While video can help you stand out, hours of studioquality film takes a lot of time and money. Realistically, marketing budgets are limited. We recommend producing your key introductions and treatments using a videographer, and then taking to social media to fill out your video portfolio with more information. The camera on your smartphone is more than suitable for the job; a tripod and ring light will give an even more professional look for pieces you share on Facebook, Instagram, IGTV, Twitter and even Youtube.

YOUR WEBSITE STILL MATTERS

Most new patients will check out your website to get a feel for your business. You want to create a great first impression with a website that is easy to navigate and easy to make contact on. When a new patient holds no relationship with you, and is simply comparing clinics, your website may make the difference. Don’t let leads end up elsewhere – get these issues covered: ad on mobile – Does your website look great on a B smartphone? Or are images clashing and buttons hard to press, etc.? It’s vital that your website is mobile responsive Technical issues – If your website is slow or if you aren’t receiving messages from it, speak to your web developer Outdated content – Have you neglected the copy on your website for years? It needs regularly updating with news, treatments, correct contact information and new advances in your business Thin content – Have you only got 200 words on dermal fillers on your website? No separation of treatment areas? Rectify this by writing or commissioning more content and separating it logically Poor before and after images – Are you using the best examples of your work in the highest image quality possible? Are you providing context to the cases? Visually

and from a user-experience perspective, it is better to use no more than three to five exceptional before and afters, rather than flooding pages with “OK” examples.

FIX UP ON SOCIAL

A few quick points on social media, and how it can keep your professional, stand-out brand glowing: now your audience inside out, and show them what they K want to see. Patients want to see themselves reflected in your marketing Don’t just copy, paste and post content across multiple channels. It looks lazy, especially if posted at the same time Keep your messaging and image consistent. This doesn’t mean you need to painstakingly curate your Instagram feed as if it were an art gallery; just make sure everything you go out with has the same branding across it Reply to all comments, even if it’s just a quick “thank you”, as someone has clearly stopped, looked at your image, and taken the time to give their thoughts. Social media is meant to be social; you aren’t a lecturer and you’re using it wrong if you are treating it this way.

MAKE CLIENTS FEEL LIKE THEY KNOW YOU

“I feel like I’ve met you before” is a phrase I have heard patients use about some of our clients who spend time building their professional brand and reap the rewards of a busy clinic. Creating a friendly and welcoming atmosphere around your business for the benefit of your patients is surely what you are doing this for.

Ensure that the atmosphere of your online presence is reflected in clinic. Don’t use any false advertising in your branding; the last thing you want is for patients to arrive expecting one thing but getting another. This also flows into culture; having a great culture within your team, delivering a personal experience and following up with each patient will create a lasting impression. Patients will ultimately remember you by how you made them feel, not just the results you gave. AM

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

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OPINION

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REGULATION

Competitive edge Dr Harry Singh considers the practical steps clinicians can take to differentiate themselves from the unregulated competition

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adly, it is not uncommon to read a horror story in the media about cosmetic procedures that have gone wrong. Take, for example, 18-year-old Lauren Winstanley from Wigan, who reportedly visited a beauty therapist for lip fillers in late 2019

and ended up in hospital for a week to have a subsequent infection treated.

However, I’m fully aware of clinical complications and poor patient service from our medical colleagues too. A medical degree does not excuse poor technique, poor education >

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OPINION

REGULATION

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and poor patient service. These are three pillars which are essential for correct, best practice.

As healthcare professionals, we work in a profession that is carefully regulated and it’s hard to imagine that another arena concerned with health is not. While it would be wrong to say there is no regulation of non-surgical facial aesthetics, it is not where it needs to be.

The Joint Council for Cosmetic Practitioners’ (JCCP) Competency Framework does make it very difficult for non-clinicians to meet the JCCPs’ requirements, but it is not impossible. You can, as a non-healthcare professional, currently enrol on the provisional register based on your qualifications, training, and experience.

The JCCP has however restricted entry to its register for non-medics who inject or insert dermal fillers, only allowing qualified healthcare clinicians entry with regards to these “higher risk” procedures. For now, non-clinicians can perform facial aesthetic treatments that do not require a prescription (so botulinum toxin would be excluded), although work continues to be undertaken to fill these gaps.

When I ask my patients if they have heard of the JCCP, so far no one has answered in the affirmative. These voluntary regulatory bodies have not worked as well as we all thought, and public awareness needs to improve – much of the public either don’t know about them or don’t care.

ENGAGING THE PUBLIC

Perhaps this lack of public engagement with the importance of industry regulation is due to little awareness of the potential risks associated with aesthetic treatments, and I personally think it would be ideal if medical professionals helped to change this situation. This is also one way we can stand out from the cheap deals being offered locally by unregulated providers; and explain to potential patients that it’s not just about price, but the value you offer.

Patient safety underpins every aspect of our role as medical professionals, and it is our responsibility as clinicians to ensure that our patients are better informed about the risks associated with non-surgical aesthetic treatments; and to provide the assurance required to enable them to make an informed choice as part of the initial consultation process.

As we all know, a big problem with non-medically trained professionals providing aesthetic treatments is complication management. The British College of Aesthetic Medicine (BCAM) recently found that 77% of its members are treating other practitioners’ dermal filler complications.

This really highlights the number of active practitioners who are unable to deal with their own complications and are instead having to refer them to a medicallytrained professional, someone whose education includes understanding the anatomical structures allied to the face, and is adept in administering pain-free injections.

That being said, I believe there is definitely a role for non-medics in the aesthetics industry. Experience in the

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industry is invaluable, and I employ a skin therapist with a beauty background who is amazing with patients and very business savvy.

Both medics and non-medics can work together to achieve the optimum result for the patient, utilising the skills they are qualified for. In general, I would like to see medics focusing on injectables and non-medics on laser treatments and skin treatments.

SETTING YOURSELF APART

For those interested in advancing their skillset, aesthetics is a really rewarding area to work in, both professionally and financially. With appropriate postgraduate education we can ensure our patients stay safe in the pursuit of treatments like peels, fillers and laser.

At Botulinum Toxin Club (BTC), the aesthetics training school I set up, for example, we will only train appropriately educated medical and dental professionals. The company offers a comprehensive syllabus that ensures delegates can set up their own practice, gain employment in a cosmetic clinic, or simply offer aesthetic treatments to their existing patients with confidence.

Public relation services are an excellent investment if you want to actually make patients and consumers aware of who to visit for safe treatment. Good PR can showcase the positives of what medics can offer in a clean, safe and sterile environment, as well as professional treatments and procedures.

Aside from training, consider these other points to differentiate from the unregulated competition: 1. Price isn’t everything – Everyone loves a good bargain, and you may worry that you will be under-cut by lower prices, but your price should reflect the extensive experience and professionalism you can bring to the procedure. If a clinic is offering much lower prices than anywhere else on the market, that should raise red flags.

2. Show off your referrals – Show off examples of your work and give referrals as evidence to back up past procedures you’ve done. Encourage customers to look at these, as well as read your reviews.

3. Give a cooling off period – Show your professionalism in understanding the weight that aesthetic procedures carry by giving time to decide if the patient wants to move forwards. Make sure they don’t feel pressured into going ahead with the treatment.

4. Post-treatment access – A trustworthy and responsible clinic should always offer after-treatment access. Check in with your patients to ensure they have recovered well and are happy with the service you provided. This is all part of the customer service process of a respectable clinic. Remember to make sure customers know this is offered before they undertake the procedure. AM

Dr Harry Singh is an award-winning medical professional and owner of the Botulinum Toxin Club. With years of experience in the profession, Harry runs a workshop where healthcare professionals can learn how to treat the three areas most requested by patients, as well as a host of other information, with ongoing support once clients have completed the course.

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

ONLINE REVIEWS

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Under REVIEW Jordan Baker, CEO of Sanity Marketing, reveals five tips for getting five-star online reviews

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nline reviews really matter for today’s consumer.

Reports show that 98% of people read reviews for local businesses, with 93% saying that online reviews influence their decisions. In addition, 94% say an online review had convinced them to avoid a business and that 3.3 is the minimum star rating of a business consumers would engage with.

Here’s how to give yourself the best chance of getting five-star ratings.

1. Have a clear way for customers to voice their complaints to your business – You don’t want customers using online review sites a means to complain. Ask for feedback from your customers using feedback cards and emails with a simple “how did we do?” Most importantly, have a culture where you and your staff regularly “check in” with your customers.

Show you care. The majority of the time, just having someone listen to their thoughts and concerns will be enough to turn a disgruntled complainer into a local brand ambassador.

2. Action feedback – If people are regularly complaining about the same things, do something about it. Not all complaints require action but if the same complaint comes up again and again don’t create a rod for your own back – fix it.

3. Ask your customers for a review – Don’t be afraid to ask customers to review your business. 68% of consumers will leave a review if asked.

4. Reward your best (and happiest) customers for their review – Encourage reviews from your biggest fans

by offering them a discount or a freebie. This group of people are poised to sing your praises; just make sure it doesn’t come across as a bribe and don’t offer discounts or incentives on injectable treatments.

5. Encourage re-reviews – You were having an off day and now you have a one-star review? Sometimes things fall down.

Reach out to the reviewers and put it right. You just might be able to change their negative review into a positive one.

Don’t be tempted to go over to the dark side in the spirit of reaping the benefits of online reviews. Here are three things not to do: Don’t respond to negative reviews defensively – Instead, respond in a professional and empathetic manner.

89% of consumers read businesses’ responses to reviews. A good way to handle a review (no matter how ridiculous) is to simply say, “Sorry to hear that, that doesn’t sound right at all. Please email me/call me and I’d love the chance to set things right for you.”

To behave defensively only reflects poorly on you and your business.

Don’t post or buy fake reviews – They stick out like a sore thumb and you’ll come across as untrustworthy.

Consumers will question how genuine your real positive reviews are.

Don’t bribe, blackmail or coerce positive reviews – This is not good practice or ethical at all and, if exposed, will damage your reputation. AM

Jordan Baker is CEO of Sanity Marketing, a growth agency for growing business with a keen focus on boosting sales through marketing. The agency has worked with the likes of Britney Spears, Strictly Come Dancing, the Crowne Plaza hotel chain and the House of Commons, as well as over 120 small businesses.

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