Aesthetic Medicine Magazine May Issue by Aesthetic Medicine

INSPIRING BEST PRACTICE IN MEDICAL AESTHETICS

A BETTER PILL TO SWALLOW COLLAGEN SUPPLEMENTS

ON THE RADIO RF FOR SKIN TIGHTENING

NECK ON THE LINE TREATMENTS FOR THE NECK AND DÃ&#x2030;COLLETAGE

May 2019

May 2019| aestheticmed.co.uk

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

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Contents MAY

BUSINESS

08 NEWS The latest news from the industry

28 PERSONAL DEVELOPMENT Dr Harry Singh shares 10 personal development traits for entrepreneurs

14 NEWS SPECIAL REPORT We report on the recently aired Jeremy Kyle show on fillers

EDITORIAL Vicky Eldridge

16 AESTHETIC MEDICINE LIVE All the news from the show and awards

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

ADVERTISING Jack Diamond

26 AESTHETIC MEDICINE NORTH PREVIEW New dates, new features

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

CLASSIFIED Nur Suleyman

NEWS AND ANALYSIS

32 BUSINESS COACHING Richard Crawford-Small on why “shy kids don’t get sweets” 37 EMPLOYMENT Victoria Vilas gives her tips on writing job adverts 40 ASK THE EXPERT Our experts answer your questions 42 NEW CLINICS We visit the newly opened Kat & Co Aesthetics Birmingham and Define Clinic Beaconsfield

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

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

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

DESIGN AND PRODUCTION ICD www.icd.gb.com

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

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CONTENTS

IN THIS ISSUE...

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SKIN

DOSSIER

INJECTABLES

DEVICES

OUT AND ABOUT

48 SUPPLEMENTS Collagen supplements for skin health

59 NECK SPECIAL Practitioners share their treatments of choice for the neck

72 LIPS Lip anatomy refresher

80 RADIOFREQUENCY Dr Rekha Tailor on Accent Prime

88 OUT AND ABOUT Out and about in the i

50 EDITOR’S CHOICE SkinTech Peel2Glow 52 PRODUCT FOCUS How Derma-Seal has made its way from the UK Special Forces to aesthetics 54 SKINCARE SPY Kate Kerr tells us what her skincare staples are

76 INJECTABLES NEWS Big news from the world of injectables

82 Q&A We chat to Dr Charlie Attariani 84 NEW LAUNCHES The Morpheus8 from Inmode 86 DEVICES NEWS The latest device-based launches

56 SKIN NEWS The latest skin product launches

Welcome

to the May issue of Aesthetic Medicine

There are many reasons why I don’t watch The Jeremy Kyle Show.Firstly, it’s on during the day when I’m at work. Secondly, and more significantly, I find it difficult to stomach the behaviour of the people on the show and, if I’m honest, Kyle himself. However, I did watch The Kyle Files which recently aired on ITV. It centred on the dermal fillers market in the UK and, I must say, its changed my opinion on Jeremy Kyle. While what was contained in the documentary was no shock to those of us who work in the sector and are continually exasperated by the lack of regulation around fillers in particular, what it did do is highlight this to the public in a surprisingly powerful way. Save Face’s Ashton Collins brought some common sense to proceedings and Kyle, who openly admits to having procedures, proved to be just the right host. If you haven’t watched it, take a look on catch up. For me it encapsulates all that is wrong with the fillers market – patients with body dysmorphia being treated by unethical practitioners; non-medics ignoring laws around POMs and importing foreign fillers to inject on the cheap; the training of non-medics in fillers; young girls being sold to on social media and lack of accountability when things do go wrong. Read our news special report on it on page 14-15. Vicky Eldridge - Editor

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INDUSTRY NEWS

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JCCP introduces Fast Track Assessment (FTA) for PSRB-registered practitioners with competency The Joint Council for Cosmetic Practitioners (JCCP) has introduced a new process – Fast Track Assessment (FTA) – for practitioners who are already registered with a professional statutory regulatory body (PSRB) and wish to demonstrate that they have an equivalent level of knowledge, skill and competence. Practitioners interested in this will be required to register with a JCCP-approved FTA centre (run by an approved JCCP education and training provider) and attend a session that outlines the assessment process and outcome standards. Practitioners must provide information to support their existing FTA application, such as certificates, clinical placements and testimonials. As well as this, they will be given guidance on the format of the assessment and the required level of understanding they will be expected to have. They will then complete a test under timed examination conditions and a test of competence through an appropriate clinical assessment. They must pass both the knowledge and competency test. Professor David Sines, chair of the JCCP, commented, “This acknowledges that whilst practitioners may have

differing routes of learning, they potentially have achieved and can demonstrate the same level of knowledge, skills and competence in order to protect their patients and the public.” The JCCP board of trustees has approved this new assessment process and is currently seeking consultative feedback from practitioners and other stakeholders over the next six weeks with the intention of implementing an agreed FTA centre process by the end of June 2019. The JCCP aspires to have a FTA centre in each region of the UK.

Allergan reaches historic milestone with production of 100 million Botox® vials Allergan has announced it has reached a significant milestone in the history of Botox® by manufacturing the 100 millionth vial of the brand. The global manufacturing site in Westport, Ireland, remains the sole location to produce and distribute the 100 million vials of Botox® worldwide. The air in the filling rooms is changed 200 times in an hour to maintain the quality of the product and every vial is 100% visually inspected. Mitchell Brin, SVP global drug development and chief scientific officer at Allergan said, “After 30 years of studying this drug we have a large safety database and based upon our understanding of the mechanism of action and the safety profile, we are now moving into other disorders that I would say that two decades ago I would not have anticipated going into.”

Comprehensive guide to upper lip aesthetic rejuvenation published in journal A comprehensive guide to upper lip aesthetic rejuvenation has been published in the Journal of Cosmetic Dermatology. The authors present a comprehensive assessment of the techniques and indications in the treatment of the long upper lip. Setting aside the maxillofacial malformations, the review is focussed on senescence as the most frequent etiology. A graphical reminder of the anatomical entities and of the upper lip proportions allows optimal preoperative planning. All current treatment options, from fillers to surgical excision and dermabrasion, are reviewed and summarised in order to provide an overview of each technique’s expected results and contraindications.

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INDUSTRY NEWS

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Black Skin Directory to make people of colour part of suncare conversation Black Skin Directory (BSD) is launching a sun protection awareness campaign to shine a light on melanoma in the black population. BSD has partnered with consumer suncare brand Ultrasun on the campaign, which will feature people of colour in a video advert created to speak directly to a black audience. The campaign aims to respond to the absence of black skin in UK suncare adverts and a lack of sun protection messaging that speaks to people of colour, especially as the melanoma mortality rate is 1.5 times higher among the black population, according to research. “Clinical evidence shows that the darker skin demographic is less likely to develop skin cancer, but yet has a higher mortality rate than Caucasians”, commented Dija Ayodele, founder of Black Skin Directory. “This is not a fact that

many people are aware of and is due to various reasons, ranging from a lack of engagement with skin health messaging around sun protection, to health professionals and research focussing more on the white population where skin cancer rates are higher; and suncare brands being slow to adequately market to darker skin tones. All these factors combined have contributed to the dichotomy in skin cancer and its survival rates in the black population.” The campaign will run during Sun Awareness Week (May 6-12) and will also include a billboard and a popup e-shop on the BSD site featuring a selection of suncare products chosen by Ayodele as suitable for darker skin tones. BSD will also work with The British Skin Foundation to expose myths and misconceptions, such as that black skin doesn’t burn in the sun.

Police crackdown on selling of counterfeit AQUAGOLD® Fine Touch Police have started a criminal investigation into the selling ® of counterfeit, AQUAGOLD Fine Touch™. Authorities seized the products from a booth at convention in Korea as evidence and interrogated sales representatives. The ® company was displaying AQUAGOLD trademarks, videos and counterfeit products during the show. Counterfeit products are often made of non-medical grade materials and in the facilities that do not follow quality assurance requirements. Some of the main safety concerns are that they include cheap industrial plastic of unknown origin and non-surgical grade steel and glass and that they have no 24-carat gold plating and no micro channels (instead

they have been found to have straight needles with large holes on the plastic cover. There are also concerns over irregular and random thickness and length of needles and no proper sterilisation processes, with dust and hair found in counterfeit devices. ® A spokesperson for AQUAGOLD said, “Using such products poses a safety risk to patients and interferes with any improvement or advance in the technology and innovation.”

Intradermal BoNT-A injection may represent a promising new treatment for oily skin A review of published data has concluded that intradermal injection of botulinum toxin may be a promising new treatment for oily skin. The article, which feature in the April issue of the Journal of Cosmetic Dermatology, aimed to review the efficacy and possible treatment mechanisms of BoNT-A on oily skin by conducting a retrospective review of the published data. Most studies have suggested that the intradermal injection of BoNT-A decreased sebum production and pore size. Furthermore, this treatment attained high patient satisfaction without significant side effects. BoNT-A effectively decreased

sebum production and excretion, which was in keeping with previous studies, possibly via its blockade of cholinergic signaling and its neuromodulatory effects. The authors concluded that intradermal BoNT-A injection may represent a promising new treatment for oily skin and other relevant dermatological problems, such as enlarged pores, acne, and seborrheic dermatitis. Further study is still needed to determine the specific mechanisms of BoNT-A, and the optimal injection techniques and doses for oily skin and other relevant cosmetic concerns.

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INDUSTRY NEWS

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The Private Clinic Group acquires The Cosmetic Skin Clinic from Dr Tracy Mountford The Private Clinic Group has acquired The Cosmetic Skin Clinic to create a leading high-end invasive and non-invasive cosmetic treatment provider. The combined group will have revenue of £30 million, with a 20% EBITDA margin in 2019. The Private Clinic operates out of 12 clinics nationwide, six of which have been opened since its acquisition by BlueGem in 2008. The Cosmetic Skin Clinic specialises in cutting-edge non-surgical treatments carried out in a stateof-the-art clinic in Buckinghamshire and a second clinic in central London. Valentina Petrone, CEO of The Private Clinic, said, “The Private Clinic is always looking for innovative treatments and we believe we have found a partner of excellence for those patients opting for non-surgical alternatives.” Dr Tracy Mountford, founder of The Cosmetic Skin Clinic, added, “I have taken this exciting step forward with The Private Clinic, the vision being to raise the bar of cosmetic medicine still further. This acquisition means that patients will be able to receive the highest quality, innovative nonsurgical treatments for which The Cosmetic Skin Clinic is known, as well as having full access to the outstanding cosmetic surgical portfolio that The Private Clinic offers with its world-renowned surgeons. Both companies have more than 30 years high-end experience in the cosmetic sector.”

BAD launches Sun Awareness campaign this month The British Association of Dermatologists (BAD) will once again draw attention to skin cancer with its Sun Awareness initiative. The annual campaign, which includes this month’s Sun Awareness Week, is overseen by BAD’s Skin Cancer Prevention Committee, a body of leading medical professionals with expertise in skin cancer, vitamin D and public health messaging. The campaign is two-pronged and combines prevention and detection advice. The first aim is to encourage people to regularly self-examine for

skin cancer. The second is to teach people about the dangers of sunburn and excessive tanning, and to discourage people from using sunbeds in light of the associated risks of skin cancer. In addition to public education about the dangers of sunbed use, the BAD has also been involved in campaigning for legislation to regulate the sunbed industry and is continuing to push towards further and improved regulation. This year’s Sun Awareness Week will be held from May 6-12.

RealSelf highlights popularity of vaginal rejuvenation A survey conducted by RealSelf ranked diVa vaginal therapy, a laser used to address changes in vaginal health, as the top non-surgical treatment with a ranking of 100%. The topranked surgical procedure was breast implant removal with a 99% rating. Other top-rated non-surgical treatments and products included Restylane Lyft (99%), HydraFacial (98%), lip augmentation (98%) and laser hair removal (98%). To be included in the list, brands must have received 20 or more ‘worth it’ or ‘not worth it’ review ratings between January 1 and December 31, 2018. The survey was conducted online within the US by research firm The Harris Poll among 2,021 adults aged 18 and older.

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INDUSTRY NEWS

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NEWS IN BRIEF ALLERGAN INTRODUCES JUVÉDERM VOLUX TO VYCROSS RANGE

Allergan has launched Juvéderm VOLUX, a hyaluronic acid injectable gel that uses the existing VYCROSS patented technology. The product is designed to be used to sculpt the chin and jaw area, giving facial definition that can last for up to 24 months, the company claims. In a clinical trial, 95% of patients (85) reported that they were satisfied with the results three months post-treatment. At 18 months, 62% of patients (79) still felt results were positive.

Q MEDICAL NAMED AS NEW UK DISTRIBUTOR FOR B-LITE

Q Medical has become the exclusive UK distributor for B-Lite breast implants. B-Lite is a lightweight silicone gel breast implant that contains high-purity hollow borosilicate microscopic spheres that aim to reduce the implant’s mass, while maintaining its volume. The implants are also said to be 30% lighter than regular silicone implants, which lessens the stress on the connective tissue in the breast and helps to preserve its shape and appearance.

VIDA AESTHETICS TO DISTRIBUTE MANTIS NON-INVASIVE DEVICES

Vida Aesthetics is to be the exclusive UK distributor for Italian aesthetic device manufacturer Mantis. Mantis offers a range of non-invasive devices, including laser hair removal and body shaping devices. Eddy Emilio, director of Vida Aesthetics said, “The machines are technologically leadingedge and deliver outstanding results and exceptional after-sales support benefits. We see the Mantis range increasing the performance standard for these types of machines and, with the online support function, being an indispensable asset to a clinic or spa.”

FDA ISSUES WARNING LETTER TO BREAST IMPLANT MANUFACTURERS

The US Food and Drug Administration (FDA) has issued letters of warning to two breast implant manufacturers – Mentor Worldwide regarding its MemoryShape implants and Sientra regarding its Silicone Gel Breast Implants. The letters raised concerns regarding deficiencies in the post-approval studies for both companies, including poor follow-up rates with patients.

Safety and effectiveness of hyaluronic acid lip fillers assessed The Journal of Cosmetic Dermatology has published a systematic review of clinical studies examining the efectiveness and safety of hyaluronic acid fillers used to enhance overall lip fullness. The literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Twentytwo studies were included in the qualitative synthesis, nine of them with level of evidence (LOE) 1b (randomised controlled trials), one with LOE 2b (individual cohort study), and 12 with LOE 4 (case series, poor-quality cohort, and casecontrol studies). The total number of subjects included in all studies was 3,965. The results showed that the assessment methods (especially for efficacy) varied greatly from one study to another. Observed responses to the treatment in studies using different lip fullness scales varied between 71% and 93.2%. The most common adverse events were local reactions at the injection sites (swelling, contusion, bruising, pain, redness, and itching). The authors concluded that HA fillers are effective and safe to use. The majority of included subjects were satisfied with the result and their looks.

BCAM becomes a registered charity The British College of Aesthetic Medicine (BCAM) was recently awarded registered charitable status in England and Wales by the Charity Commission under the Charities Acts. BCAM was founded to advance the effective, safe and ethical practise of aesthetic medicine. It aims to achieve its objectives by promoting and encouraging the study and research of aesthetic medicine, the setting of standards, the prevention, diagnosis and treatment of diseases, disorders and conditions associated with the practise of aesthetic medicine, and the education of public and patients. It also facilities communication between patients and practitioners and the exchange of clinical expertise. Dr Paul Charlson, president of BCAM, said, “The awarding of charitable status to BCAM by the Charity Commission is another step on the journey to becoming the leading organisation for the setting of standards and delivery of safe, effective and appropriate aesthetic treatments to the public by qualified and trained doctors”.

NEWS IN PICTURES ZO Skin Health has announced a three-year partnership with West Ham United women’s team. In the first sponsorship deal of its kind, from April 2019, ZO Skin Health is giving West Ham United’s women’s team the knowledge and expertise to care for their skin. In addition, ZO Skin Health will become the official sponsors of West Ham United women’s Player of the Month award. Jack Sullivan, managing director of West Ham United women’s team, said, “It is a pleasure to welcome ZO Skin Health to West Ham United as the newest partner of our women’s team.”

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NEWS SPECIAL REPORT

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Dangerous dermal filler practices exposed on The Kyle Files TV personality Jeremy Kyle investigates the UK injectables market in explosive ITV documentary

he dangerous and unregulated landscape of the UK dermal fillers market has been exposed in an ITV programme presented by Jeremy Kyle. The 20-minute documentary as part of The Kyle Files series investigated the provision of dermal filler treatments in the, UK focussing on not only the worrying trend for excessive treatments but also the unsafe practices that are going on. Kyle, who admits to having cosmetic injectables himself, started the show by interviewing a mother and daughter, Georgina Clarke and Kayla Morris, who have forked out a staggering £60,000 to look like Barbie and glamour model Katie Price respectively. Morris admitted to having had sex with a sugar daddy when she was just 18 to pay for a boob job. Both had had extensive non-surgical cosmetic work, including lip fillers. Kyle said, “If my 18-year-old daughter was sleeping with a 50-year-old man in return for money to have her boobs done or her lips, I wouldn’t think of myself as a very good parent.” Dr Paul Charlson, president of the British College of Aesthetic Medicine, said, “As medical practitioners, we have an ethical duty to provide a range of treatment options. One of those options would be to have no treatment. There will be occasions when patients are not suitable for aesthetic interventions and those patients should be strongly advised to not have them. This may include young patients, those with body dysmorphia, those who have

clearly not understood what aesthetic intervention entails or the results of such an intervention, and those who are medically unsuitable. Therefore, a thorough psychological and medical assessment of the patient by a competent practitioner is essential.” The programme then went on to look at the worrying trend for lip fillers among young girls and, in particular, unscrupulous advertising of cheap deals on social media saying that 62% of girls under 25 who sought out treatment found a cut price deal online. The show quoted Save Face data which showed that of the 934 complications complaints received almost half (48%) were aged 18-25, and that 83% of reported complications were caused by non-medics. Two thirds of those treatments were fillers and 72% of those were lip injections. A young Scottish woman who was “nearly killed” after getting an infection from lip fillers performed by a nonmedic was then interviewed. Kyle was joined by Save Face’s Ashton Collins to investigate the use of injectables in a high street salon where not only were POMs being offered without a medical practitioner present, but foreign filler products were also being used. The salon, Beauty Box by Maggie in Essex, claimed to have a team of qualified medical professionals on its website, but the undercover team showed the receptionist getting a patient to fill out forms and providing her with a communal numbing crea. Botulinum toxin

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treatments were also offered without a consultation and with no medical practitioner present. The show also featured training company Cosmetic Couture, which trains beauty therapists in cosmetic injectables. Founder Maxine Hopley defended her right to do so to Kyle and claimed that Cosmetic Couture championed higher standards of training and education for non-medics in the sector. Ashton Collins, director of Save Face, said, “We were approached by The Kyle Files team in July 2018 for an initial research discussion, as they were keen to explore the landscape of the industry and and understand what key challenges consumers faced when trying to identify a safe practitioner. From there, we began informing them of the practitioners that were generating a lot of patient complaints and leaving patients to fend for themselves to seek corrective treatment. We had a lot of patients come forward about Beauty Box by Maggie, and I thought this would be a good example to use to highlight all of the prevalent issues that are associated with non-medics, namely: POMs being offered without prescriber consultations Illegal importation of products from abroad (Poland in this case) False information about the credentials of the practitioners. At the time, Maggie was promoting herself as a nurse and she was advertising that she had a doctor

NEWS SPECIAL REPORT

working at the clinic. However, when questioned, she couldn’t remember the doctor’s full name. “We then presented the evidence we had to the producers of The Kyle Files, who were able to get legal sign off for the undercover filming. As the footage shows, there is no attention paid to the patient consultation, all paperwork is completed by the patient in the waiting room while they apply their own numbing cream. As soon as the patient goes into the treatment room there is no discussion, they are just placed straight on to the couch ready for treatment. We felt it really illustrated how these practitioners trivialise the treatments and why patient see them as having little or no risk. All of the patients who complained to us about Maggie found her on social media, which is also another huge issue at the moment. “Off the back of the filming, the producers wanted to get an insight into how non-healthcare practitioners were able to train and what the courses entailed, so we informed them of Cosmetic Couture, which is the most well-known, and probably the largest, training provider of non-medics.” Antonia Mariconda, founder of the Safety in Beauty Campaign, commented, “Safety in Beauty continues to work at Government level to influence change in a positive way, and we are working with a variety of organisations and representatives to push for a safer pathway for the consumer. The Jeremy Kyle programme highlights what we as an industry are all too familiar with now. Awareness is fantastic but now we need regulation and law.” AM

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AM LIVE 2019

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Best in show

SPONSORED BY:

The UK’s only major conference and exhibition for the North of England – Aesthetic Medicine North – is back with new summer dates of June 29 and 30 at Manchester Central. Here’s some of the things that will be going on over the two days to help you plan your visit.

esthetic Medicine North, the UK’s only dedicated conference and exhibition for aesthetic practitioners in the North of England, returns to Manchester Central this year with new earlier dates of June 29-30, 2019. Building on the success of its third year running alongside Professional Beauty North, the new dates have been chosen to create a standalone event aimed specifically at doctors, nurses, dentists, dermatologists and surgeons working in the Midlands, North and Scotland. Featuring leading industry brands, AM North will showcase some of the newest treatments and techniques taking the market by storm. It is a fantastic opportunity for visitors to experience and compare the most cutting edge equipment and techniques at the same time as gaining valuable CPDaccredited education.

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• DISCOVER the latest treatment trends and products by walking round our bustling exhibition featuring market-leading brands. • LEARN by attending our CPD-accredited education programme including clinician-only conference on Saturday, and business workshops • WATCH live demonstrations of treatments from our exhibitors and hear from KOLs about exciting product developments for free on the Live Stage • CONNECT with your peers and network in the delegate lounge or in the coffee shops within the exhibition. • BUY products and devices and take advantage of exclusive show offers only available to visitors to the show.

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AM N O RTH 2019

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NEW FOR 2019

BUILD YOUR BUSINESS SKILLS

Our Business Workshop programme gives you access to successful clinic owners and leading business consultants to inspire you to grow and develop your clinic. Topics will include the entrepreneur mindset; how to differentiate yourself and your business in a competitive market; sales and marketing strategies for success and a social media bootcamp.

NEW DATES FOR 2019

After three years running alongisde Professional Beauty North, Aesthetic Medicine North is now a standalone show with new dates – June 29-30 – making it the perfect mid-year update to what’s going on in the market outside of London.

NEW FLEXIBLE EDUCATION PASSES

For the first time in 2019 you will be able to book individual 50-minute conference sessions for just £12.50 +VAT each. The programme’s headline topics will be Innovative Injection Techniques on Day 1 and Skin: Meeting the Challenges and Body on Day 2. NEW FO

2019

GET CPD-ACCREDITED EDUCATION

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

WATCH FREE DEMONSTRATIONS

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

CHAT TO EXHIBITORS

DON’T FORGET TO DOWNLOAD THE SHOW APP

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

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

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Aesthetic Medicine • May 2019

17/04/2019 14:19

BUSINESS

PERSONAL DEVELOPMENT

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Building the machine Dr Harry Singh shares 10 traits found in successful entrepreneurs, and explains how you can adopt them

Aesthetic Medicine â&#x20AC;¢ May 2019

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BUSINESS

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rom my many years of experience in this industry, and due to meeting so many professionals via my training company, I know, firsthand, what traits and habits are seen consistently among those who have made a success within aesthetics. The biggest mistake made in this industry is to concentrate on business strategies and tactics, without first addressing YOU! How can the same two people attend the same training and, a year later, one has made a real success of it and the other has done absolutely nothing? It all starts with you: your personal habits, your personal traits, your daily rituals, your mindset and your attitude. That’s why I’ve titled this article ‘Building the machine’. Let’s talk about the 10 traits I’ve found in successful entrepreneurs that have helped them Build Their Machine.

PERSONAL DEVELOPMENT

stop wasting time and money, stop getting stressed about it. Aesthetics is not for you!

2. HAVE PASSION FOR THE PROCESS/JOURNEY

I’m sure you have all heard that you need to be passionate about aesthetics, or in fact, any business you go into, to make it work. I agree with this but it’s only 50% correct. As well as being passionate about your speciality, you also need to be passionate about running a business. This is where a lot of people go wrong. They love treating patients and transforming their lives, but are useless at running a business. You are running a business, not a charity or a hobby. It’s essential you are passionate about being a business owner. In Michael Gerber’s book, The E-Myth Revisited, he says that the single biggest mistake technicians (people excellent at their core skill) make is to become business 1. DO YOU REALLY, REALLY, REALLY WANT IT? owners (entrepreneurs) because they think this I see so many medical professionals keen and is a natural progression. Just because you eager to get into this industry. They attend my are gifted at producing results (which is training, where they are given an action plan essential), it does not follow that you and are offered free, unlimited support. We all know the would make a great business owner. When I follow up with these delegates, Are you willing to give up family time, 80% haven’t completed the action plan dangers of burning holiday time, evenings and social time to or used the free support. When I ask out and the high stress run your business (which includes tasks them why this is, they come up with levels associated with an such as ordering stock, answering emails, myriad excuses, such as not having orangising payroll, dealing with suppliers, enough time, saying that the pharmacy unhealthy lifestyle networking, sorting out insurance, etc.)? took a while to get back them or that they You will be doing all this on your own when still haven’t decided which indemnity your first start, so you need to have a passion company to use –the list goes on and on. for the process of owning and running a business. One of my many mentors said to me, you either have ‘stories’ or ‘success’ you either have 3. BUILD THE MACHINE – GET THE RIGHT FUEL ‘results’ or ‘reasons’. If you really As many of you know, I’ve recently been on a fitness and want it, you would make the time, detox regime. I’ve stopped drinking alcohol, stopped you would be proactive in your area, consuming processed sugars, reduced my carbohydrate you would follow up with the pharmacy, intake and exercise at least six hours every week. I can’t tell you would stop procrastinating about you how much of a difference it’s made in my energy levels, your indemnity. You would just do it. memory and self-confidence. And I don’t mind admitting, That’s only if you really want it! that as a result of fueling myself correctly, I am making more If you feel you don’t have enough money than ever before. Make sure you are getting the right time or are procrastinating, it shows fuel and looking after yourself before you look after others. that you don’t really want it because We all the know the dangers of burning out and the high you are not making it a priority. stress levels associated with an unhealthy lifestyle. My advice would be, stop now,

4. REMEMBER TOMORROW

This mantra has helped me considerably in my business and personal life. Just consider the actions or the nonactions you are taking today and how this will make you feel tomorrow. Health – eating that chocolate cake today. How will you feel tomorrow when you step on the scales? Business – not writing that blog or phoning a potential new lead. How will you feel tomorrow when you look at your bank balance? Personal – losing your temper and shouting at your kids or partner. How will you feel tomorrow when you see them the next morning? Always remember tomorrow.

5. STAY IN THE GAME

Let’s imagine when you were at school. Despite having a dozen children in front of you, you waited patiently for your turn knowing that, eventually, you would be served. >

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PERSONAL DEVELOPMENT

You didn’t say, ‘ok, let’s leave the queue and come back in 10 minutes’ (only to find that the queue has got longer). But this is what people do in business. They don’t stay in the game long enough to get the rewards; they chop and change. One month they’re offering injectables, the next it’s skin, and the month after that it’s a new gadget. You can only win the game if you are still in the game.

www.aestheticmed.co.uk

If you are undertaking a consultation for a new enquiry, give this 100% of your attention and focus

6. CHANNEL SOMETHING

We are all concerned with what everyone else is doing. Don’t get me wrong, I understand that this is a competitive and saturated market. Instead of doing a BMW (Bitching, Moaning, Whining) about it, use this to your advantage. I want to crush the competition, so I’ll go that extra mile. Channel any anger you feel about a situation into making yourself more valuable to your marketplace.

7. DO ONE MORE

Be exceptional. Offer more than what is expected of you. You can do this in all aspects of your life. See one more patient Send one more email Do one more rep in the gym Do one more hour of business work Spend one more hour with your partner/kids.

8. BE WHERE YOUR FEET ARE - BE PRESENT

I find this difficult to do. We have so many distractions – things on our mind, emails to answer, phone calls to make – that our mind starts to wander. You need to focus and concentrate where your feet are. If you are undertaking a consultation for a new enquiry, give this 100% of your attention and focus. Do not let the mind wander. Let the patient know that they are the only person in the world you are concerned about. If you are meeting a supplier, give them 100% of your attention and focus. Do not be disturbed or take your mobile

with you to the meeting. In Nigel Risner’s book, The Impact Code, he advises: when you are in the room, be in the room.

9. CHIP AWAY – COMMITMENT AND CONSISTENCY

Let’s say you have a tree in your garden you want to chop down. So, every day you wake up and the first thing you do with your axe is chop at the tree five times. Then the next morning you do exactly the same: wake up, chop at the tree five times with the axe. If you repeat this every day, eventually, the tree will fall down. It’s because you were committed (every day you chopped the tree five times, you did not miss a day) and you were consistent (you didn’t chop another tree or use a baseball bat, you stuck with the same axe at the same tree). Business is like chopping the tree: Know what you want – the tree to fall down Get the right tools – axe Committment – stay focussed with the task in hand Consistency – do the task every day and stick with it until it is complete.

10. HAVE A STARTER RITUAL – IGNITION SWITCH

When you are in work mode, be in work mode. We all suffer from delaying things, procrastinating and doing the minor things first that will have little impact on the success of our business. I have a starter ritual similar to that used by sprinters when they start a race. They have set rituals that they rarely deviate from, and you can clearly see that they are in the zone. I have a necklace that I touch and this tells me and my brain that I am work mode. Nothing will disturb me or get in my way until I finish the task at hand. Over time, every time you touch your necklace you will automatically get into work mode and be in the zone. AM

Dr Harry Singh has been carrying out facial aesthetics since 2002 and has performed more than 3,000 cases. He is not only a skilful facial aesthetician but also a keen marketer, which he feels is vital to attract and retain patients requesting facial aesthetic services. He has published numerous articles on the clinical and non-clinical aspects of facial aesthetics and has spoken at dental and facial aesthetics conferences on these topics. He was shortlisted at the Private Dentistry Awards in 2012 and 2013 in the Best Facial Aesthetic Clinic category and was a finalist in 2012 at MyFaceMyBody Awards for the Best Aesthetics Clinic. To find out how to turbo boost your facial aesthetics business into profitability, buy Dr Singh’s book Let Go Of The Hand Brake at letgoofthehandbrake.com. Visit botulinumtoxinclub.co.uk to download his free Conversion Assessment Template.

Aesthetic Medicine • May 2019

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Aesthetic Medicine â&#x20AC;¢ May 2019

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BUSINESS

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Shy kids don’t get sweets Richard Crawford-Small shares some insights from Aesthetic Medicine Live and tells us why we shouldn’t be shy about putting ourselves out there and connecting with people on a personal level on social media to promote our business

chaired the business workshops at Aesthetic Medicine London. It was a great event (well done Vicky and team), and on the Sunday, I had my own session on USPs – I hope you saw it. It was totally epic, with a really great crowd in attendance. We had a full house - standing room only! A few planets aligned at Aesthetic Medicine Live, and one standout moment for me was the presentation from Lorna McDonnell Bowes. She shared a story that put a lump in my throat, the size of which has not been seen since I watched E.T. as an eight-year-old. It was one of the most engaging talks I have ever heard; and she talked candidly about her journey and how her recent health issues forced her to take a step back. She shared some intimate moments, and it was real and authentic. Authenticity, is a word that is thrown about in marketing a lot now, and was the theme for our workshops. After sitting in the audience for Lorna’s presentation, I wanted to carry on the theme, so I totally rewrote my talk to look at how we connect emotionally with our target market. To truly resonate with our clients, we must stand for something and we must be more than just business people or practitioners. We must identify what we stand for, what inspires us and what makes us authentic. You then need to share that with the world, and this is where the biggest challenge lies. >

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My talks are always interactive, and one thing I really like to do is to get my audience to engage by taking a selfie with the person next to them and posting it on a social media channel. Every time I do this, the outcome is the same: Only about 30% of the audience actually take the selfie Only about 1% of them actually post it I’ve been working with a coach and have different mentors for different things, and they have ALL said the same thing: “shy kids don’t get sweets”. In the past two years there has been a seismic shift in the way that social media works, with the creation of the influencer, and a real understanding of the power of creating online communities and tribes. People don’t like to be sold to; they will only buy from those they trust and they won’t just hand over money to you. The rules of marketing are changing, and building relationships through social media is key to your success. To effectively build relationships, you need to know three things: 1. WHO your target audience is 2. What PROBLEMS they have 3. HOW you can solve these problems. Once you have defined this, you can communicate with your audience and connect on an emotional level, just by simply telling them how you can solve their problems. To do this effectively, you MUST overcome the fear of putting yourself out there as the face of your business. If you do, you will massively grow your business. This itself comes with challenges, and the biggest one is fear. I routinely ask my clients to do a Facebook Live, and when I first mention this, the general look I get is one of abject terror. I’ve actually had clients actually quit on me at this point. Sharing personal experiences is difficult and is completely outside

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the comfort zone of most people. But doing so is authentic, and this is what people engage with. I’ve shared both my successes and my failures. My first Facebook Live was appalling, but I’ve now done nearly 50 Facebook Lives – some are good, some are still awful. . However, by understanding my target audience, learning what challenges they have, helping to solve those challenges, and putting myself out there to communicate and add value, my business has grown. I love getting the aesthetic entrepreneurs to do this and then watching as their business begins to grow. They get new and better clients and more profit just from being themselves. The bad news is that there are no restrictions, so anyone can set up a Facebook or Instagram profile and start talking about how they solve their clients problems and doing live videos. Anyone. The good news is that because it’s challenging and difficult, not everyone will, and judging by the numbers who do the selfies in my talks, it’s going to be less than 10% of your competition. Yet, even if they all do it, does it matter? If you share your own story and your philosophy on how you work, how can they compete or copy you? So, from here, I want you to do three things: 1. Think about who you serve and what their major problems are 2. Think about how you can solve those problems 3. Communication this to your audience and share a bit of your own story Putting yourself out there is difficult, but too many of you are hiding behind your businesses and your brand when you should take responsibility for your success of your business. This is your life and your future, so take control of it and stand proud. Do this, and you’ll not only get more sweets, you’ll also get the keys to your own sweet shop. AM

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

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FaceTite PR.pdf

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FACETITE IS A MINIMALLY-INVASIVE FACE AND NECK CONTOURING DEVICE THAT'S BEEN APPROVED BY THE US FDA FOR ITS SAFETY AND EFFICACY PROFILE

CMY

Morpheus 8 and FaceTite — the golden facial combination

SEE US ON STAND A14

NORTH MANCHESTER CENTRAL 29-30 JUNE 2019

Dr Ali Ghanem talks about the latest innovations being used in his Harley Street practice to treat facial skin laxity Ageing affects all facial tissue: bone resorption, fat loss, muscle changes and skin thinning — all contributing to the signs that show the passing years on our faces. However, it’s the laxity of the skin that leads to folds and wrinkles, which has the most dramatic effect. To address facial ageing, the aesthetic medical practitioner must attempt to reverse the signs of ageing from the surface to the foundation. Technological advances and a better understanding of human tissue characteristics mean there are many options to treat volume loss, pigmentation changes and skin laxity in its earliest forms, before they lead to fine lines and wrinkles. However, for moderate to severe forms of skin laxity, surgery was for a long time the only method available with all the caveats of long scars, downtime and associated risks. In this modern productive society, many people are unable to afford the downtime and risks associated with surgery. They wish for a refreshed look that can boost their confidence

laxity, in patients who don’t wish to undergo surgical interventions, this is a safe, effective and exciting treatment that offers significant improvement of skin laxity and impressive aesthetic results. The combination of Morpheus 8 and Facetite addresses skin laxity through differential tissue and three-dimensional remodelling that’s the next

best thing to a formal facelift. What I SEE US ON like about it most, is the built-in inteSTAND A14 grated safeguards of real time measurements of skin and fat temperature and audible feedback leading to automatic power cut-off if the tissue receives too much energy during the treatment. This greatly ensures NORTH patient safety. MANCHESTER CENTRAL 29-30 JUNE 2019

NEW LAUNCH:

Accutite 0.7mm Bi-polar RF tightening and contouring for the periorbital and brow area.

BEFORE AND AFTER TREATMENT

without the telltale signs of surgery or the relatively long recovery time before seeing results. Alternatives to address skin laxity range from camouflaging it by filling under the lax tissue to suspending the tissue or shrinking it. However, here comes the wonder of the radiofrequency technology in its treatment of both superficial layers of the skin (Morpheus 8) and deep tissue (FaceTite). Morpheus 8 is a radiofrequency augmented microneedling device that can deliver its energy at a depth

of 4,000 microns with an extremely uniform effect w ith little to no thermal damage to the skin surface. The combination of its long needles and silicone insulated shafts makes it a safe device to use in all skin types and shades, with little risk of post inflammatory hyperpigmentation (PIH), which is common with other resurfacing methods. FaceTite is a minimally-invasive face and neck contouring device that’s been approved by the US FDA for its safety and efficacy profile. For early to moderate skin and neck

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info@inmodemd.co.uk

For further information - T: 020 8965 2594 E: neil.wolfenden@inmodemd.com W: Inmodemd.co.uk

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BUSINESS

EMPLOYMENT

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Write for the job Victoria Vilas discusses how to write an appealing job advert

hen a key role at your clinic becomes vacant, one of your priorities will be to advertise the job online to attract talented aesthetic professionals. While you’ll want to get a job advert posted as soon as possible so the hiring process doesn’t become too lengthy, it’s wise to take the time to consider whether your advert draft is likely to catch the eye of the best applicants.

be clear to you, but unfamiliar to your potential applicants. Long, intricate sentences may appear to be eloquent, but to some applicants they may seem convoluted and impenetrable, and take too long for a reader to unpick and absorb. If you have a list of duties to include, it is usually better to use a concise bulleted list than to stretch each into an elaborate sentence, for example.

1. MAKE YOUR ADVERT EASY TO READ

Omitting key information can frustrate applicants. Your interviewees may need to demonstrate that they have researched your business, but if you leave out details that are important for an applicant, this may delay their application, or lead to them not submitting one at all. Provide key information such as the exact location, salary range, and minimum requirements. Adding this information can also help you avoid getting an influx of applications from job seekers who do not fit your requirements. If you choose not to list a salary range, you may put some applicants off. The salary may genuinely be ‘negotiable’ or ‘dependent on experience’, but giving an idea of the range you can consider will help increase applications. If a job seeker only finds out at interview that the salary you can offer is below what they can afford to accept, then you will have wasted both their time and yours. >

Don’t make your job advert too long or too dense. Some jobs may have a longer list of duties than others, but try to be concise, and edit your advert draft to highlight the most important elements. Between 200 and 300 words should be sufficient for many clinic vacancies, although some senior roles may require a little more detail, so may need up to 400 words. An advert that is too long may cause a reader to become disengaged before reaching the end, especially if they are skipping through a number of similar adverts. A job specification for a new employee should be detailed and try to cover every major and minor duty within their remit; a job advert should be concise and punchy, and focus solely on the core responsibilities of the job. Write your advert in plain English. In other words, be clear, concise, and avoid complex vocabulary and jargon that may

2. DON’T OMIT KEY INFORMATION

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3. BE CLEAR ABOUT REQUIREMENTS

Be clear with minimum requirements, but don’t put people off by demanding too much in your list of ‘essentials’. Think about what you can be flexible on, and make sure you separate requirements into what is essential and what is desirable. In an ideal world you may want your new aesthetician to have used the same brand of laser you use in your clinic, but perhaps you would be also be happy to offer training to an experienced therapist who has already performed very similar treatments using a different piece of equipment. List the minimum you require in terms of skills, training and work experience, but also try to add a brief description of the type of person who would best fit the role and the team. State exactly who you need and use a job title that is clear. For example, someone under the title of ‘aesthetic practitioner’ could be a doctor, a nurse, or a therapist, so advertising using the title ‘aesthetic nurse’ may attract more relevant applicants. Using an intelligible job title will also tell an applicant if they are likely to be reading about a fitting vacancy before they have read the body of the advert.

4. DON’T BE MISLEADING

Don’t use misleading information to amplify your role into something it is not. If your upper salary range would only be awarded to a practitioner so experienced you’re not sure they even exist, then you are essentially using false information to market your vacancy. If you want an aesthetician to spend most of their time performing laser hair removal, it is misleading to list the range of advanced

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skin treatments at your clinic and not state that you need a specialist in laser hair removal only. Applicants who feel they have been misled may drop out at a crucial moment in the hiring process, so providing misleading information could be to your detriment.

5. HIGHLIGHT YOUR USPS AND STAND OUT FROM THE CROWD

Instead of just stating what you want in your new employee, tell potential applicants what you can offer them, and not solely in terms of their remit and salary. Highlight your USPs and use some concise statements to say why a talented job seeker should choose to join your clinic instead of a competitor. Tell your applicants what you provide as an employer that makes your employees feel happy and motivated. Give applicants an idea of the environment they will work in, your company culture and ethics, and what you see as your speciality. For example, is your clinic large and modern with a multidisciplinary team of aestheticians, nurses, doctors and surgeons, or is it petite and bijou with a small but perfectly formed team of expert dermatologists? Don’t spend days agonising over your advert draft, but do consider how it reads from an applicant’s point of view before you post it online. If you were the applicant, would you apply for the job if you had to base your decision on the advert alone? Make your advert clear and concise, make your clinic sound welcoming, and make yourself sound like a fair and straightforward employer, and you should see applications from talented aesthetic professionals appearing in your inbox. AM

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

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SEE US ON STAND A6

NORTH MANCHESTER CENTRAL 29-30 JUNE 2019

SEE US ON STAND A6

NORTH MANCHESTER CENTRAL 29-30 JUNE 2019

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BUSINESS

ASK THE EXPERTS

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Ask the Experts What is the difference between an employee, a worker and someone who is self-employed, and how do I categorise staff?

here have been several cases over the past two years of self-employed individuals claiming they were in fact employees and should be entitled to rights such as holiday pay or the minimum wage. Often it has been ruled that the individual should be classed as a ‘worker’ rather than an ‘employee’. Still a victory for the claimant, but what is the difference? There are many self-employed individuals in the aesthetics industry, whether they provide specialist services or rent a room. If they were found to be workers, they would be entitled to up to 28 paid holiday days a year.

WHAT’S THE DIFFERENCE?

An employee has a contract of employment, whereas a worker must “undertake to do or perform personally any work or services for another party to the contract whose status is not that of a client or customer”. It sounds complicated, but basically, the person has to do the work themselves and the client isn’t seen as their customer. In general terms, for someone to be an employee, the following three criteria apply: They provide services personally, rather than being able to send a substitute to carry out the work in their place The employer must provide them with work and they are obliged to do that in return for an agreed wage on terms

laid down by the employer The employer must exercise a sufficient degree of control over the manner in which the individual carries out the work.

WHAT IS A WORKER?

If the criteria above aren’t met, the individual is going to be a worker or self-employed. Individuals are not employees if they are free to accept or reject work. Workers are entitled to rights, including minimum wage, holiday pay, protection against discrimination and the right not to be treated less favourably if they work part-time. However, a worker cannot claim unfair dismissal or redundancy payment.

SELF-EMPLOYMENT

Self-employed people have virtually no employment rights. They are running their own business so choose their hours, services and fees. There is not a single list of criteria which identify someone as self-employed, but if they have to do the work themselves, wear a uniform and work fixed hours, even if there aren’t any paying customers, this is not consistent with being self-employed. Another relevant factor the courts look at is mutuality of obligation – this means the individual can be offered work and there are no sanctions if they don’t want to do it. AM

David Wright is a consultant in all aspects of employment practice and law. He is the main employment law consultant for Habia and provides a personalised support service to UK salons.

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TECHNOLOGY CLIENT BASE PROFIT OPPORTUNITIES

Trilogy

advanced laser hair removal

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SEE US ON STAND A6

NORTH MANCHESTER CENTRAL 29-30 JUNE 2019

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02/04/2019 12:50

09/04/2019 12:13

BUSINESS

NEW CLINICS

aestheticmed.co.uk

Women on top We find out about the new female run Kat & Co Aesthetics super-clinic in Birmingham

team of superhero women are redefining beauty in Birmingham, with the launch of the awardwinning Kat & Co Aesthetics super-clinic. Headed by renowned consultant plastic surgeon Mrs Chien C Kat, the new, bespoke clinic, which is housed in a stunning four-storey property in Edgbaston, is led by a team of highly qualified and talented women – all leading experts in their fields. A specialist gynaecologist, aesthetic doctor and aesthetic nurse all support Mrs Kat, providing clients with an authoritative medical powerhouse. “Most of our aesthetic clients are female and many feel comfortable with having a consultation with a woman because they feel we understand their needs. My philosophy, which is shared by the team, is that we don’t just provide surgical treatment because not everyone needs it,” says Mrs Kat. “People have different needs in different phases of their lives. By providing the full spectrum of therapies and treatments, from non-surgical to surgical, we can

cater to younger patients who want to keep on top of their maintenance, as well as more mature patients who need more of a nip and tuck. “Our holistic approach means we can provide what is best for the patient, from basic skincare to complex surgical procedures. Our patients love to come to a place where they can see a team of dedicated professionals who are committed to being the best in their field working cohesively. “The new clinic is amazing. We used to have to fight for rooms but we now have a spacious waiting lounge, five dedicated consulting rooms, a laser room, a wound dressing room, a comfortable recovery room near the operating theatre and a brand new intravenous nutrient therapy bay. The feedback from the patients has been so positive and gratifying.” Mrs Kat is well known in the Midlands for her three signature procedures; the ‘two-stitch mini facelift’, the award-winning ‘lock and glue tummy tuck’ and the ‘Brazilian butt lift’. Aesthetic doctor Ana Mansouri, a former GP, has also joined the team. She offers a range of aesthetic procedures,

Most of our aesthetic clients are female and many feel comfortable with having a consultation with a woman because they feel we understand their needs

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BUSINESS

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NEW CLINICS

including skincare, fillers and anti-wrinkle injections. She is the clinic’s guru for non-surgical body contouring such as fat reduction with cryolypolysis or skin tightening using radiofrequency and ultrasound. Dr Mansouri also has a specialist interest in dietetics and provides nutritional and weight management advice. She is bringing two exciting new services to the clinic: weight loss with Saxenda® injections and intravenous nutrient therapy. “As a doctor, my overriding concern is patient safety and acting in the best interest of the patient, which is why I wanted to join Kat & Co Aesthetics,” says Dr Mansouri. “I feel passionately that, as a practitioner, it is my job to help a person look well rested and refreshed, whether that is through nutrition, weight and lifestyle advice or by providing guidance on non-surgical body contouring treatments. “Intravenous nutrient therapy is the most effective way of feeding essential nutrients into the body whether it is for general wellbeing, skin brightening, weight control, muscle building or post-surgical recovery. It is extremely popular in Sweden, where I grew up, and I am sure it will be just as popular here.” Aesthetic nurse specialist Natasha Rankin has worked with Mrs Kat for more than 10 years. She undertakes a wide range of non-surgical procedures, but her specialist skill is skin rejuvenation using chemical peels (Obagi Blue Peel®) and micro-needling with Platelet Rich Plasma. With the help of the skin therapists, she assesses and treats underarm sweating with the award-winning Miradry® microwave device. She is also the go-to person >

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for sclerotherapy injections to improve the appearance of thread veins. “We’re a growing team and it feels like family,” comments Rankin. “What appeals to me most about working in the clinic is the empathetic approach we adopt. We’re not here to push treatments on to people if we don’t believe they will work or are not appropriate. As a nurse, I want to help people and I’m focused on providing services that will make them feel better.“ “The evolution in aesthetic treatments has opened up the field to lots of people and we see people from all walks of life. It’s a real joy to someone people feel more confident now that there is less stigma around having these kinds of therapies. It’s also humbling to be part of their journeys. I went into nursing to help people and that’s what I do and see on a daily basis.” The clinic now has the services of leading consultant gynaecologist Miss Poonam Pradhan. She provides general obstetrics and gynaecology consultations and is the clinic’s expert in nonsurgical vaginal rejuvenation using ThermiVa® - a revolutionary non-invasive radiofrequency technology that helps women who suffer from vaginal laxity after childbirth or as a result of general ageing. It is also great non-surgical option for plumping and tightening the external genitalia. “As I look after obstetrics and gynaecology at the clinic, we are able to give patients a one-stop clinic for the vast majority of gynaecological conditions,” says Miss Pradham. “It’s a good complement to the aesthetic services here and it means women can come here to discuss any issue, from

urinary problems to menopause and period pains to postbirth complications.” “I’ve known CC Kat for many years and being part of the team means we can offer a full range of surgical and non-surgical treatment for feminine health, a first in the Midlands. I am particularly excited that we may soon be introducing the Emsella, a non-surgical treatment for urinary incontinence using magnetic resonance technology.” Behind the superwomen are of course the supportive men. Dr Haw-Shi Kat is the clinic’s laser specialist. He works his magic on patient’s skin with the SmartXide DOT CO2 Laser and the Vbeam Pulsed Dye Laser. Dr Camilio Diaz, consultant dermatologist, is one of the few hair transplant surgeons in the UK who has trained in the USA with some of the top hair surgeons in the world. He offers follicular unit transplants and follicular unit extraction at the clinic. Together with Dr Kat, they offer a One-Stop Mole Clinic where moles can be assessed and removed through shaving, excision or laser ablation. The two skin therapists, Kelly Umbers and Catherine Padgett, complete the clinical lined-up. They complement the team with expertise in skincare, microneedling, microdermabrasion (HydraFacial MD®), specialist facials, laser hair removal and lymphatic drainage, an essential post-operative therapy. Kat & Co Aesthetics has been listed in Tatler’s Beauty & Cosmetic Surgery Guide - the cosmetic surgery power list - for its body contouring surgery in 2013, 2017, 2018 and 2019. >

Our holistic approach means we can provide what is best for the patient, from basic skincare to complex surgical procedures

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It’s only Natural Define Clinic is breaking beauty tradition by offering aesthetics and cosmetic dentistry under one roof. We speak to Dr Benji Dhillon, Dr Mark Hughes and Dr Slaine McGrath to find out their plans for the suburban space WORDS: Rebecca Barnes

his March, three internationally renowned practitioners came together to launch an innovative one-stop-shop for facial aesthetics and cosmetic dentistry. Aside from the concept, what makes this clinic interesting is its address. Dr Benji Dhillon, Dr Mark Hughes and Dr Slaine McGrath – all from Harley Street institutions – have rejected a central London location for prime commuter belt territory. With a large number of their clients travelling into the capital from the home counties to see them, it made perfect sense to bring their expertise to South Buckinghamshire. Focused on finding the right building in the best part of town that offered sufficient size and scale to be able to deliver their state-of-the-art vision, they struck lucky when the 17th century, Grade II-listed Wendover House. “We wanted to bring what people deem as excellence in central London to the suburbs, and make it accessible to everyone,” says Dr Dhillon. “We recognise that people don’t always have the time to travel into London, so the idea was to bring something to the locals that’s within easy reach.” With children at the same school, Beaconsfield residents Dr Dillon and Dr Hughes met at a kid’s party. As they bonded over balloons and cake, they realised they had a lot in common in terms of what they strive to achieve for their patients. While talking, it became obvious to them that it can be very time-consuming for patients to have to go to more

than one place for services, so the idea of offering multidisciplinary aesthetics under one roof was born. By merging the worlds of cosmetic dentistry and aesthetic medicine, the patient would receive the most comprehensive advice and optimum treatment options and plan, following a unique joint assessment that uses photographs and video to assess the face and smile from all angles. “A youthful, vibrant smile is more than just about having great teeth,” says Dr Hughes. “The face is dynamic and I have learned to assess the whole face, both in static poses and full, spontaneous movements. “This has opened my eyes as to how aesthetic and minor surgical procedures can complement and enhance my smile design work, and it has become apparent that for the very best results, both have to be considered, ideally before carrying out any treatment. “I began referring patients to Benji and him to me, and we quickly realised that a fully integrated assessment and consultation approach was the best way forward.” In contrast to the increasing number of images seen online and on TV where an exaggerated look is preferred, the clinic is focused on providing considerably more understated results. “One of our guiding principles is natural beauty,” confirms Dr Slaine McGrath. “Overdone looks – veneers that are too big and too white, lips that are too big or faces that don’t

We wanted to bring what people deem as excellence in central London to the suburbs, and make it accessible to everyone

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move – is not what we are about; in fact we are aiming to be the complete opposite. “We can enhance the way someone looks without anybody knowing,” she continues. “If people come to us looking for an overdone look, we are more than happy to steer them in a different direction.” Having spent time with McGrath and Hughes, Dr Dhillon has learned to appreciate the finer details of facial aesthetics, particularly when assessing the mid and lower face, and she is also a strong advocate of naturallooking outcomes. “I am happiest when my patients come back to me for a follow up, and state that everyone around them kept on saying how good they looked but couldn’t work out why,” he says. Having spent a number of years working within the aesthetics industry both from a manufacturer and a clinical side, Dr Dhillon has learned what to look for when choosing products. “The most important thing to me is whether there is robust evidence to support their safety and efficacy, and the second and just as important, is choosing a partner to support you in delivering the best outcomes with the product for your patients, as well as being interested in helping you conduct clinical research with their product,” he says. As a result he is currently working with Teoxane, Allergan, Lumenis, Envy, and miraDry (a Sientra company). The clinic also has an exceptional photographic system from

Canfield, and are only the second medical facility in the UK to have this. Treatments on offer include injectables, Dual Sculpting with CoolSculpting, laser resurfacing for scarring and skin rejuvenation, IPL for skin pigmentation, microneedling, LED phototherapy, combination treatments with laser and mesotherapy, and SilkPeel facials. Dr Hughes’ current relationships also ensure he is providing cutting edge treatments and technology for his patients’ benefit: close partnerships have been formed with Align Technology which provides Invisalign, and the KaVo Kerr Group, which makes some of the finest dental equipment and dental materials in the world. The team strongly believes that prevention and early intervention are key to long-term health and youthfulness. Any adverse growth of the face and/or mal positioning of teeth can often be averted with early treatment in childhood. “About one in ten kids would benefit from early orthodontics and growth intervention between the ages of seven and nine,” says Dr Hughes. “We are inviting parents to come and have their children assessed by our orthodontic team at this age. “We also have a strong belief in creating natural yet beautiful results, in both areas of expertise. And this is intimately linked with a belief in health first, and where possible, the least invasive treatment options that will still achieve excellent results.” AM

I am happiest when my patients come back to me for a follow up, and state that everyone around them kept on saying how good they looked but couldn’t work out why

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SKIN NUTRITION

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Bounce back Collagen supplements are increasing in popularity. We find out what’s new and showcase some of the best on the market

he global collagen market is expected to be worth $6.7 billion (approximatley £5.1bn) by 2026. In an exclusive Insider survey published in the March issue of Aesthetic Medicine’s sister publication Professional Beauty, collagen came out top in the list of supplements that the magazine’s readers retail most to clients. With ongoing scientific studies informing brands’ research and development processes, collagen supplements are continually evolving to meet the anti-ageing concerns of clients. As the category grows, brands are finding new ways to make collagen products easier for clients to consume. “The growing demand for collagen products is fuelling innovation that is helping consumers to apply and ingest collagen in an ever-wider variety of formats”, says James Greenwell, founder of collagen products brand Proto-col.

Coverage of collagen supplements in the beauty media is also boosting sales, as more client groups become keen to explore what collagen could do for them. “Collagen used to be associated with older women, but product launches are increasingly engaging with younger audiences of both men and women,” Greenwell adds. “It is also being recognised as playing a role in active lives where joint mobility is as important as skin health.” While the most common and evidence-based forms of collagen are derived from animal sources, such as bovine and marine types, Greenwell predicts that the growing vegan movement means we’re likely to see more brands launching products that use plant-based collagen, while new formats like soft chews and cordials are also hitting the market. Here’s our round up of some of the most innovative collagen supplements to introduce to clients.

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SKIN NUTRITION

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ADVANCED NUTRITION PROGRAMME

The Skin Collagen Plus duo includes ANP’s Skin Collagen Support and Skin Vit C supplements. Skin Collagen Support combines plant-based antioxidants such as hesperidin, rutin and grapeseed extract with vitamins A, C and D to contribute towards building healthy collagen. When taken in conjunction with Skin Vit C – which also contains bioflavonoids – the brand says skin will appear firmer and plumper, with smoother fine lines and wrinkles. Trade: £19 for 120 capsules 020 8450 2020 (IIAA) iiaa.eu

MURAD

Developed from Dr Howard Murad’s theory of cellular water science, Youth Builder Dietary Supplement is formulated to meet the needs of older skin, billed as able to reduce the appearance of fine lines by 34%. Vitamin C contributes to the normal formation of collagen, while zinc, selenium and copper help protect skin from oxidative stress. Trade: £27.08 for 120 tablets 0844 472 7050 murad.co.uk

SKINADE

The product contains 7,000mg of high-grade hydrolysed marine collagen peptides sourced from freshwater fish – meaning low sodium and avoiding mercury contamination – are in each bottle of Skinade. Also included in the skincare drink are vitamins B and C, and amino acid l-lysine, MSM (an organic sulphur that helps form collagen and keratin) and omegas 3 and 6, sourced from organic flax seed oil. RRP: £105 for a 30-day supply 0845 130 0205 skinade.com

PROTO-COL

The collagen products brand will soon launch its Collagen Cordial, a concentrated liquid with a blood orange flavour that is fortified with vitamins C, B6 and E, along with biotin and zinc. Its bioactive collagen peptides are derived from a highly controlled production process of collagen, optimised to stimulate cell types involved with collagen biosynthesis. The Cordial delivers 5,000mg per 15ml serving, and can be offered to clients in salon as part of a treatment or for sampling. Trade: £41.97 for 500ml 0333 000 7788 proto-col.com

THALGO

French marine skincare brand Thalgo’s Collagène 5000 supplement is formulated to tackle premature ageing by addressing inflammation in the skin. It contains peptides concentrated in hydroxyproline to encourage synthesis of collagen and elastin fibres, helping to restore the dermal structure. Other ingredients are free-radical neutralisers vitamin C and selenium. One dose should be consumed daily, either pure or diluted in water. Trade: £21.50 for 10 doses 020 7512 0872 thalgo.co.uk

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DEVICES

EDITOR’S CHOICE

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SkinTech Peel2Glow Vicky Eldridge tries out SkinTech’s new Peel2Glow

eels are among my favourite treatments. When my skin looks fresh and glowing, I feel better. However, like many women my age with busy lives, my skin is also a window to how stressed I am at any given moment. I’ve written about my adult acne many a time on these pages and while its largely under control and is nowhere near as bad as it used to be, as soon as I am a bit run down and working too hard, my face breaks out in spots. We recently held our two-day conference and exhibition, Aesthetic Medicine Live, in London, and both the run up to the show and the show itself are super busy. Tight magazine deadlines, lack of sleep and sporadic eating patterns mean my normal healthy eating and exercise regimes go out of the window and, as a result, my skin never looks its best during this time. AestheticSource distributes some of my favourite skin products on the market. Knowing that my acne is more troublesome around show time, the company always provides me with some rescue remedies to help me deal with it. As well as an industrial-sized bottle of Clinisept, which I can’t live without, and my favourite Exuviance purifying clay mask, which is super cooling and soothing on spotty skin, this year AestheticSource gave me something new to try – SkinTech’s Peel2Glow system. Developed to restore the skin’s natural glow and smooth the appearance of unwanted fine lines and wrinkles, the new Skintech Peel2Glow has been developed for professional use and as part of a homecare regime to deliver radiant, bright and healthy skin, safely and effortlessly. Peel2Glow is the first in a collection of seven new skin solutions to be launched in the UK. Presented in a single dose format and designed to deliver the correct measure of solution, the two- step treatment is easy to apply and suitable for all skin types and ages. I used the small, but perfectly formed, home-use kit. The first step, the peel, exfoliates the superficial layer of the skin, removing the dead skin cells and impurities and aids penetration of actives from the Glow solution applied in step two. The Glow formulation moisturises and protects the skin against external aggressors and pollutants and enhances skin texture, tone and radiance. The kit is really easy to use. The products come in little vials; you simply break the seal and fix the dropper onto the top, then apply the solution. You leave the peel part on for

Left to right from top: Cleansing the skin with Clinisept; before (front and side profile); the Peel2Glow travel-sized home kit; applying the peel; wait 2-3 minutes; washing the peel off; applying the Glow solution; immediately after; after two days

two to three minutes, wash it off, and then apply the Glow serum. My face felt really soft afterwards and incredibly clean. A couple of days after using the treatment, my spots had diminished and my skin was looking brighter. This is a pocket-sized peel that is ideal for people on the go. AM

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Battlefield to beauty We find out how Derma-Seal has made its way from the UK Special Forces to aesthetics

any advances in technology and medicine have come from lessons learned on the battlefield. It is a statistical fact that infection and disease are the most dangerous enemies to the soldier on the ground. The award-winning product Derma-Seal had its beginnings in the UK Special Forces. When Hadrian Garner, now a director at Derma-Seal, was a patrol medic, he realised infection was an issue for his unit, particularly when out in the field. Soldiers were often stationed at observation posts for weeks at time, so any cuts or skin abrasions risked infection. Necessity is the mother of invention. Having a nurse for a mother, Garner was aware of a medical barrier cream used in the NHS on bedsores. As it helped to stop the foreign bodies that cause infection, Garner found this cream to be effective on cuts and abrasions, too.. After leaving the military, Garner worked as a police officer in Birmingham and enjoyed extreme sports in his spare time. He soon realised that first aid kits were lacking a barrier product to protect open cuts and abrasions. “After a few personal experiences, I decided to pursue developing my own barrier product,” says Garner. “When I was a police offer, a prisoner who had hepatitis B purposely spat at a cut he caused on my face as I struggled to arrest him. Then a plumber I knew contracted Weil’s disease when he exposed a new tattoo to a high risk environment while cleaning a drain. Within six months, I found a leading UK manufacturer of cosmetic and medical products to work with me to produce a water-resistant spray barrier product.”

Once launched, it soon became a firm favourite in the niche world of extreme sports, used by triathlon competitors and UK Special Forces’ medics in their first aid kits. Even Robson Green’s team took it to the jungle on one of his fishing Mr Dalvi Humzah adventures with the BBC.” The idea for Derma-Seal followed a chance meeting between Garner and Dalvi Humzah, a consultant plastic, reconstructive and aesthetic surgeon. Mr Humzah, one of the UK’s leading trainers and practitioners in aesthetic procedures, was concerned about the risk of infection, post treatment, that could happen once the patient left the clean environment of the clinic. Infection had several hours to occur before the puncture wound became impermeable. Clients, even after advice to the contrary, were often still applying make-up immediately after Botox and fillers. The potential infection from make-up, exposing the face to air pollution, and the unintentional touching of injection points was almost impossible to negate. To help prevent post-treatment infection, Mr Humzah used his years of experience to help Garner develop the new formula. Derma-Seal does not react with make-up and forms a protective, yet almost invisible shield, against infection. Many of the best ideas seem simple in hindsight. DermaSeal is being adopted as best practice across the industry. Demand for the transparent protective barrier spray is now worldwide, with orders recently placed in Poland, America and South Korea. AM

Derma-Seal does not react with cosmetic make-up and forms a protective, yet almost invisible, shield against infection

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MEDICINE

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SKINCARE SPY

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Skincare Spy Facialist Kate Kerr shares her skincare secrets

hen it comes to skincare, there are three main aspects to a healthy regime that I recommend to my clients and that guide my regime at home…

Preparation – this means prepping the skin for serums through cleansing and exfoliating to stimulate cell turnover

ZO Skin Health Offects Exfoliating Cleanser Exfoliating is the key to better skin as it helps remove dead cell build-up and encourage cell turnover. In our 30s, we start to see a loss of skin tone as our skin’s support starts to weaken and our glands become less effective at flushing out toxins. The result can be puffiness, particularly around the eyes, and an overall dullness to the skin. Cell turnover also slows at this age, causing skin to absorb light rather than reflect it, making the skin look dull. As we age, it’s more important than ever to ensure you’re exfoliating away dead skin cells. Use ZO Skin Health Offects Exfoliating Cleanser as a great way to deep cleanse, exfoliate and neutralise free radicals.

ZO Skin Health Offects Exfoliating Polish

Prevention and protection – this is where your antioxidant rich serums come in, helping to fight pollution and damaging oxidisation Targeted solutions – depending on your skin type or concern, a personalised regime of products to address your individual skincare needs. These will likely change with age. These are my selection of hero products.

ZO Skin Health Ossential Daily Power Defense Using a moisturiser sends a signal from our skin’s surface down to its water reservoirs telling it that there is plenty of moisture and to halt production. This makes the skin sluggish and lacking in moisture, so we reach for more moisturiser, thus exacerbating the problem.Instead we need to use an antioxidant serum every day to neutralise free radicals to prevent the breakdown of collagen and premature ageing. I recommend applying ZO Skin Health Ossential Daily Power Defense in the morning to help counteract oxidation, repair damage and protect the skin against future damage. The Daily Power Defense uses DNA repair enzymes to enhance your skin’s recovery capabilities. These special enzymes attach directly to your own DNA molecules and repair oxidative damage caused by UV exposure.

This exfoliator contains round magnesium crystals which work to gently exfoliate the face and neck and (more lightly) the eyelids and lips too. Not only will manual exfoliation of this kind remove the build-up of dead skin cells and leave skin more receptive to product penetration, it will also ensure the skin’s barrier is intact. This in turn helps to keep out toxins and prevent the irritation and inflammation that leads to premature ageing. For me, a Sunday night is the perfect time for this step, as exfoliation helps to leave the skin reflecting light better, giving you a more radiant complexion for the week ahead.

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SKINCARE SPY

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AlumierMD Clear Shield SPF42 Blue light, or HEV (hight energy visible) light, is emitted from our screens (phones, laptops, etc.) as well as the sun. HEV light is just as damaging, if not more so, than UVA and UVB but the studies are ongoing. Blue light infringes on the transportation of minerals in and out of the cells, causing irregular cell function and leading to DNA damage and premature ageing. I apply AlumierMD Clear Shield Broad Spectrum Sunscreen SPF 42 as it is a lightweight non-comedogenic sunscreen that provides powerful broad-spectrum protection against these harmful rays. It includes zinc oxide and titanium dioxide, both physical filters.

For almost two decades, expert facialist Kate Kerr has specialised in skin therapy and skin rejuvenation, creating bespoke treatments targeting skin-ageing as well as skin health. She is the director of Kate Kerr London, located in agua London at Sea Containers, and founded SkinHQ, an online destination to empower people with the knowledge to address their individual skin concerns.

Radara Eye Because the skin around the eyes is thinner and more delicate than the rest of the face, it’s one of the first to show wrinkles and crepiness. Using a hyaluronic acid formulation in patches such as the Radara, each morning, will offer the hydration that the skin needs without upsetting the it’s natural moisturising processes. With an optimised molecular weight hyaluronic acid serum and 3,000 microneedles to create channels to deliver the serum into deeper layers of the skin, this product hydrates effectively. AM

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

SKIN NEWS

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Image Skincare focusses on ‘power masking’

Éminence Organic Skin care adds new product collection to its range

Masks are a key focus for Image Skincare this month. Its Purifying Probiotic Masque features a blend of yoghurt-based probiotics and antioxidant superfruits, as well as vitamins and minerals to target dullness and green clay and charcoal to purify pores. Also new from the brand is the Firming Transformation Mask, which has a shimmering blue formula and is designed to fight skin stressors. Meanwhile, both the Anti-aging and the Hydrating Hydrogel Sheet Masks have been reformulated.

New from Éminence Organic Skin Care is the Lilikoi Mineral Defense Collection, which has been specially created to naturally combat environmental stressors, including pollution, blue light and the sun. The antioxidant-rich formulas help strengthen and protect the skin barrier function, while the lightweight all-mineral sun protection safeguards against the full spectrum of light without the use of hormone-disrupting chemicals. The products in the collection have been designed to be layered, providing the ultimate shield, but they can be used individually to help protect the skin. All ingredients are freshly sourced to create a product that contains potent healing and beautifying properties, also allowing for the majority of the range and professional protocols to be vegan.

ANP launches Skin Aesthetic skin689 launches Hand and Finger Rejuvenation Creme Post-Procedure Pack The Advanced Nutrition Programme™ has launched a new Skin Aesthetic Post-Procedure Pack. The pack is scientifically formulated for those that have undergone aesthetic treatments such as skin needling, microdermabrasion, chemical peels, skin resurfacing treatments, laser and injectables. Packaged in 28 convenient tear off pods, the pack provides a full month’s supply of 19 key ingredients. including vitamins A, C and D, Omegas 3 and 6, rosehips, turmeric root, bilberry extract, hesperidin, lutein, grapeseed and green tea extracts, lycopene, rutin, beta carotene, choline bitartrate, citrus bioflavonoids, Co Q10 and pine bark. The kit helps to calm and soothe skin that may be irritated and sensitive post aesthetic treatment, to maintain skin health and support the skin’s natural immunity against external stressors.

skin689 has added a new product to its portfolio designed to address the signs of ageing on the hands. Hand and Finger Rejuvenation Creme includes CHacoll, skin689’s proprietary patented active ingredient designed to restore elasticity and tonicity. Encapsulated ornithine helps to preserve the naturally cushioning fatty tissue, while carnosine helps to reduce the glycosylation of collagen. Study results show that L-carnosine can actually reverse the signs of ageing in cells. A combination of various vitamin C derivatives with a natural cress extract helps not only to balance skin pigmentation and reduce age spots, but also to reduce the colour depth of age spots. Other active ingredients neutralise key factors of environmental, premature skin ageing such as IR and HEV (blue light) radiation and the particle load of the skin, which can cause premature thinning of the skin. Included in a non-greasy and nonsticky formula, these mechanisms allow the skin of the hands to be strengthened and to appear more homogeneous. AM

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DOSSIER

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NECK AND DÉCOLLETAGE

Neck on the line While the face is the focus of most aesthetic rejuvenation treatments, the delicate skin on the neck and décolletage is equally prone to premature ageing. From sagging and the so-called ‘turkey neck’ to lines, creases and age spots, there are many indications that can be addressed in these areas. Over the next few pages, we take a look at treatments for the neck and décolletage

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DOSSI ER S PECIAL

NECK AND DÉCOLLETAGE

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NECK AND DÉCOLLETAGE

By the nape of the neck Aesthetic practitioners share their treatments of choice for the neck and décolletage ALICE JENKINS, MEDICAL DIRECTOR AT HARLEY INJECTABLES

The major factors that cause skin damage are ageing, sun exposure, lack of moisture, diet, lifestyle, and gravity. And because the skin of the décolletage is thin and delicate, it’s one of the first areas of the body to show signs of damage. Décolletage damage accelerates with ageing. As we age, the collagen and elastin in the middle layers of skin begin to break down. These proteins act as a support system pushing out from underneath to keep the skin firm.

HYALURONIC ACID

When collagen and elastin start to break down, the skin begins to sag inward, resulting in small creases that eventually become wrinkles. Hyaluronic acid (HA) helps increase skin firmness and elasticity, tighten and lift skin, improve skin tone and texture, rehydrate skin and restore radiance. Using non cross-linked hyaluronic acid injections, such as Juvéderm Volite, will help hydrate the skin and smooth texture. Volite is an innovative injectable treatment designed to improve skin quality for up to nine months. This is not a dermal filler, it’s a skin conditioning HA gel. Volite is injected into the middle layers of the dermis across many sites to nourish it from the inside out. The product is hydrophilic which means it acts as a sponge under the skin attracting water and therefore helping the skin maintain moisture and suppleness. I also use Profhilo, a skin laxity treatment that uses patented technologies engineered for ‘skin remodelling’ – a revolutionary concept of ‘curling’ wrinkles rather than ‘filling’ them. It effectively stimulates the production of both natural collagen and elastin to renew the skin from within. Thanks to the unique characteristics of Profhilo, skin condition can be visibly improved after just two sessions, with a one-month interval, and only five injection points on each side of the face. Profhilo can be used on a number of areas, including the the neck and décolletage, and is suitable for practically anyone – men and women, from 30 years old and with no upper age limit.

BOTULINUM TOXIN

A non-surgical cosmetic procedure for women concerned about their neck and décolletage is known as the Nefertiti lift.

This procedure involves injecting botulinum into the vertical strips of muscles (platysmal bands). As women age the platysma muscle plays a direct role in the appearance of the neck as it becomes more prominent and therefore more evident. The procedure helps to relax and soften the area, which stops the neck from looking scraggy both vertically and along the horizontal ‘bracelet’ lines. The treatments that we offer for platysmal bands are virtually painless and only take around 15 minutes, with the resulting effects of this treatment usually lasting from between three and five months. >

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NECK AND DÉCOLLETAGE

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FRACTIONAL LASER TREATMENTS

Patients who already have sun damage and pigmentation on the décolletage may want to consider getting a fractional laser treatment to help with the texture of the skin and appearance of pigmentation. Fractional laser has bridged the gap between the ablative and non-ablative laser techniques used to treat sun-damaged and ageing skin. While ablative laser treatments work mainly on the epidermis (surface skin cells) and non-ablative treatments work solely on dermal collagen (mid-layer of skin), fractional laser treatment works at both the epidermal and dermal layers of the skin.

HIFU

High-intensity focused ultrasound (HIFU) is a non-invasive therapeutic technique that uses non-ionising ultrasonic waves to heat tissue. It uses precise micro-focused ultrasound with visualisation (MFU-V) energy to target the deep structural layers of the skin without disrupting the skin’s surface, which means minimal downtime for the client. After treatment, the body’s tissue repair process stimulates the production of new collagen and elastin, creating a gradual lifting effect. HIFU is a good alternative for patients wishing to avoid surgery. A good candidate has mild to moderate skin laxity where the skin begins to look less firm and tight. HIFU results in a gradual lift leaving the patient looking refreshed and younger.

THERMAGE

Thermage is well known as a premium, non-invasive skin tightening and lifting procedure. Thermage tightens skin, lifts saggy features while smoothening wrinkles with minimal downtime and increased comfort. Thermage is an approved technology that uses heat from radiofrequency to tighten and lift skin by stimulating collagen. The RF energy heats the tissue and stimulates the production of new collagen and elastin. The process provides an alternative to invasive face-lifts and other skin tightening surgeries. This is great news for people looking for a needle-free, completely non-surgical way to lift droopiness and erase wrinkles.

SUN DAMAGE PREVENTION

THE BEST DÉCOLLETAGE SKINCARE TIPS

We all know how important cleansing and exfoliating is for our faces but it’s equally helpful for the neck and décolletage. It’s important to remove all the dirt and oils that build up on the skin of the décolletage over the course of the day. Before bed, use a gentle cleansing product to lightly exfoliate, clear pores, and repair. We recommend ZO Skin Health’s gentle exfoliating cleanser and exfoliating polish.

DR IMOGEN BEXFIELD, WHITE SWAN AESTHETICS

Neck and décolletage rejuvenation is often neglected and can be a tricky area for practitioners to treat non-surgically. I believe putting together a detailed and well considered multi-treatment approach depending on the key concerns is the most successful course of action. The most common complaints are “turkey neck”, double chin/loss of jawline, prominent neck rings around the neck and “crepey” skin. When treating all neck complaints, I first ensure that the best possible skincare regime is in place. The correct dose of retinol is essential in order to improve the skin quality and if there are age/dark spots then I recommend combining this with hydroquinone to treat the pigmentation. I always strongly suggest a daily non-comedogenicF factor 50 sunscreen to go alongside this. I have also found the ZO growth serum can be a wonderful addition for both the neck and face.

“TURKEY NECK”

Client assessment is crucial here. It is important to recognise when a surgical approach is really the best option. Moderate to severe skin laxity does not respond significantly to a non-surgical approach and can often lead to unmet client expectations. However, with mild to moderate “turkey necks” I use a combination of Profhilo and Ultherapy to remodel and tighten the skin and then will consider a PDO thread lift. I sometimes even use a light dermal filler like Aliaxin SR to finish off the results.

For a double chin and excess fatty jowls I use Aqualyx which is a deoxycholic acid which dissolves localised pockets of fat

Sun exposure hastens the ageing process. The UV rays from the sun cause collagen and elastin to break down more quickly than they would on their own. This results in skin that looks older than it really is. At the same time, UV rays can damage skin cells, which makes it harder for them to repair themselves and to create newer, healthier cells. Sunscreen should be applied to the décolletage before leaving the house in the morning and then every two hours thereafter. To block 97% of the sun’s harmful rays, choose a sunscreen with an SPF of at least 30 and make sure it protects against UVA and UVB. One of my favourite

sunscreens is Heliocare SPF 50, which is an oil free gel that is great for the face, neck and décolletage.

DOUBLE CHIN/ LOSS OF JAWLINE

For a double chin and excess fatty jowls I use Aqualyx which is a deoxycholic acid which dissolves localised pockets >

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NECK AND DÉCOLLETAGE

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of fat. It is similar to Kybella (available in the USA only). This requires two to four treatments but can work wonderfully well. You do need to be careful not to treat patients with significantly reduced skin elasticity as you may create a “turkey neck” once the fat has been removed. Then you could consider improving the jawline and disguising the jowls with some dermal filler. I usually use Voluma as it’s thick and long-lasting.

NECK RINGS

I usually use a needle technique directly into the neck rings using a Belotero Balance or Aliaxin SR. Knowing your neck anatomy and being mindful of the depth of your injections is key here.

CREPEY SKIN

Profhilo is a perfect solution for early crepey neck tissue and can also be used on the décolletage too. However, often 4ml (two syringes) are needed so it can end up being an expensive treatment option for patients.

DRS VICTORIA MANNING AND CHARLOTTE WOODWARD, RIVER AESTHETICS

River Aesthetics have extended their use of Ellansé to treat the neck and décolletage. According to Sinclair Pharma trainer Dr Victoria Manning, they have achieved “amazing results” with Silhouette Soft for necks, but for many patients requiring treatment to the lower part of the neck and décolletage, which are more sun damaged, Ellansé makes the perfect stand-alone or adjunctive treatment option. Ellansé is an exciting innovation belonging to a new generation of collagen stimulators which provides immediate and sustained correction by volumisation through biostimulation, which initiates long-lasting effects of different durations from one to four years. At River Aesthetics it is used for 70% of patients due to its compatibility with Silhouette Soft and other thread treatments, and its natural rejuvenating effects. Because of its biostimulating properties, Ellansé is indicated for

lasting correction of wrinkles and volume loss, to address the signs of ageing and now sun damaged skin. Dr Charlotte Woodward, who is an Ellansé trainer for Sinclair Pharma, advised “It’s all the bits our patients have missed over the year; they put sun cream on their faces and miss the neck, décolletage and hands. We now address all these hard to treat areas with Ellansé.” Ellansé can be used over the whole face, neck, décolletage and hands for both volumisation and reshaping, by injecting the product deep in the subcutaneous or pre-periosteal plane. Only small amounts are needed to achieve correction compared with HA-based dermal fillers, due to the product’s high G Prime. (Stocks et al, 2011 Ellansé is comprised of two parts; firstly, carboxymethyl cellulose (CMC), this is the component which provides the immediate volume; and secondly polycaprolactone (PCL) which provides the sustained effect as a result of collagen stimulation. In composition, PCL is present as microspheres and represents 30% of the total volume. PCL is a polymer, made up of a chain of a repeated single unit sequence; the longer the chain length, the longer duration of effect, namely one to four years. Ellansé use is best suited to practitioners experienced in using both needles and cannulae, to obtain both optimum results and reduce the risk of complications. It is mandatory to have a comprehensive understanding of ageing and anatomy to make a suitable assessment of the patient, which helps identify the areas to be augmented, to avoid danger zones, and to plan an overall treatment strategy. (Cotofana et al, 2016; Solish, 2016; Wilson et al, 2016; Woodward, 2016). PCL is completely bioresorbable with the cleavage of its ester linkages reducing the size of the polymer over time. (Pitt et al, 1981; Pitt, 1990: Woodward et al, 1985; Chen et al, 2000). The final degradation process leads to the elimination of the bi-products, CO2 and H2O from the body. Any soft tissue filler can cause long-term side effects, permanent side effects, or both, however, most side effects associated with dermal fillers occur shortly after injection and most resolve within less than two weeks. From a review following the launch of Ellansé in the UK in December 2015, there were 155 cases reported for 323,726 syringes sold, which gives an adverse event rate of 0.048% or one adverse event per 2,089 syringes. The adverse rate for lumps/nodules was 0.016%, while the adverse rate for oedema/swelling was 0.017% and inflammation/infection 0.002% (Christen, 2016). A review of the adverse events by the Sinclair Pharma vigilance team suggested that most cases of nodules and lumps were associated with injector error rather than the product (Christen, 2016). AM

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NECK AND DÉCOLLETAGE

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Byonik neck We examine the use of the Byonik laser for neck rejuvenation Byonik® Pulse Triggered Laser is one of the latest non-invasive device-based treatments to hit the market. The BYONIK® method stimulates cell processes and introduces special high volume hyaluronic acid gels with antioxidants deeply into the skin. The treatment offers specific dedicated protocols for the neck and décolletage area. During the treatment collagen type 1 is largely improved. Collagen being the most abundant protein in our bodies, especially type 1 collagen. These collagen improvements are so striking because this protein is what helps give our skin strength and elasticity, along with replacing dead skin cells and improving the contouring and colour of the skin. This also in turn allows the elastin fibres to move more freely. The elasticity of the skin improves and the skin receives intensive moisture and increased volume. In most cases the effects can be seen following the first treatment and significant results achieved over a course.

The BYONIK® Pulse Triggered Laser and the Biological effects of laser light: accelerates transformation of fibrocytes (inactive cells) into fibroblasts (active cells) → stimulates the body to produce increased amounts of natural hyaluronic acid, collagen and elastin anti-inflammatory effect stimulates microcirculation stimulates the structural function of the connective tissue by acting upon the fibroblasts regenerates and generates blood vessels reduces skin blemishes alleviates broken capillaries (couperose) / telangiectasias rejuvenates the skin The cooperation of the wavelengths 658 nm and 808 nm enhances the structure of all skin functions and immediate anti-ageing effects are visible with optimum skin regeneration to preserve youthfulness. Studies have shown that the protein (collagen type 1) and elastin plays a major role in the skin’s tension. The elastic fibre and the skin cells are surrounded by a water layer in the matrix. Over time, fats, amino acids, calcium and salts accumulate. The elastic fibre is thus restricted in its freedom of movement and the tensioning force of the skin is reduced. The energy of the Byonik® laser during the treatment causes a “bio-lifting” due to the release of the elastic fibres. This allows the patented Byonik® Hyaluronic gels to move in and improve cell cohesion and collagen synthesis which contributes to an improved and sufficiently moisturised and firmer skin. The gels act as a collagen booster that improves the skins elasticity and compounds the cell structure enabling the skin to better retain its tension and volume. The neck and décolletage is typically a difficult area to achieve results and can be very unforgiving. The Byonik® delivers a great non-surgical answer with no pain and no down time to a more youthful neck and chest. Kerry Lewis from The Skin to Love Clinic, St Albans said, “Byonik® has been an extremely popular option for our patients since we included it into our portfolio in Autumn 2018. Not only have we seen good results on the faces of our patients but the treatment has been extremely beneficial for the neck and chest; areas which are often overlooked in the patients home care. In particular, those with ageing, sun damaged skin on their necks are seeing positive changes after just a few sessions.” AM

Before

After 8 treatments

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NECK AND DÉCOLLETAGE

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Save your neck We round up some of the best topical products for the neck and décolletage FILLERINA NECK & CLEAVAGE

Launched in 2018, the Fillerina Neck & Cleavage home skincare solution is designed to create intensely hydrated, plump and radiant skin in the neck and décolletage areas. The Swiss-made, dermo-cosmetic product benefits from the most recent molecular and transdermic innovations and employs eight types of low molecular weight hyaluronic acid and three different size molecules of collagen. The topical treatment propels large quantities of hyaluronic acid deep into the layers of the dermis, giving a filler effect without injections. It softens fine lines, boosts volume in the neck and décolleté, and targets deep wrinkles and sagging skin. Designed to work over 14-days, the kit contains 14 doses of 2ml Fillerina Gel Filler, 14 doses of 2ml of Nourishing Film and two precision applicators. Each night, the client applies 1ml of gel on the neck, followed by 1ml of gel on the cleavage. After 10 minutes, the area is patted dry with the palm of the hands and the Nourishing Film is then smoothed on to finish. Fillerina Neck & Cleavage is available in two strengths, Grade 4 and Grade 5. It can be used as a standalone treatment or to enhance and maintain the results of clinical Fillerina treatments in the neck and cleavage areas.

help enhance collagen synthesis and improve the cellular metabolism. Among other ingredients, sweet almond seed extract helps to enhance the complexion and suppleness of the skin while providing anti-inflammatory benefits, and calcium pantothenate enables the metabolism of carbohydrates, proteins and lipids, increasing cellular integrity and efficiency in the skin. Willow bark extract is a fantastic source of salicylic acid deeply cleansing the pores and removing debris within hair follicles with no inflammatory effect. With continued use, the neck and décolleté will appear more defined, radiant and youthful-looking. Improvement in wrinkling and crepiness

Before

After 12 weeks

Improvement in sagging, deep wrinkling and crepiness

Before

After 12 weeks

Improvement in skintexture, sagging and wrinkling

IS CLINICAL NECK PERFECT COMPLEX

This hero product targets a crepey neck, jawline and cleavage, rendering the areas more lifted, tightened and sculpted. It works by gently exfoliating the skin to diminish the appearance of fine lines and wrinkles, while dramatically improving skin tone and texture. Key to the product’s success is the proprietary blend of targeted botanicals and powerful antioxidants. Mixed fruit and sugar acids work to enhance desquamation, increase cellular turnover, smooth skin and decrease wrinkles while enabling deeper penetration of ingredients. Hydrolyzed quinoa helps repair damage and forms a protective barrier on the skin, preventing environmental aggressors from creating further damage, while small peptides in hydrolyzed rice protein

Before

After 12 weeks

NEOSTRATA TRIPLE FIRMING NECK CREAM

As we age, we produce less collagen and pigmentation becomes more mottled, resulting in loose, lined and uneven skin. Though the neck and cleavage area are among the first to reveal ageing, NeoStrata Skin Active Triple Firming Neck Cream tackles the issue with a powerful blend of

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unique, clinically proven ingredients. Suitable for dry, normal and oily skin, the cream will build volume and dramatically improve the look and feel of sagging, pigmented skin in the neck and cleavage. Using patented NeoCitrate and NeoGlucosamine, the cream promotes the production of hyaluronic acid and collagen to even skin tone, plump and firm and generally improve skin health and quality. The Pro-Amino Acid increases pro-collagen to help diminish wrinkles and Swiss apple stem cell extract helps protect the longevity of skin’s essential cells, helping older cells behave like those found in younger skin. The Skin Active Triple Firming Neck Cream significantly improves neck texture, décolletage texture, and décolletage pigmentation at eight, 12, and 16 weeks based on dermatologist grading and is applied twice daily to the neck and décolletage areas.

DermCom crocus bulb extract and CoAXEL, a combination of coenzyme A, L-carnitine and caffeine, the product enhances the regeneration of the collagen and elastin network to provide additional firmness and visibly reduce wrinkles. PhytoCellTec, an argan stem cell extract, is also employed for its wealth of antioxidants along with vitamins A and E, while apricot kernel oil, linoleic acid and hyaluron help store hydration and moisture, providing natural cushioning to the skin. To complement the cream, the Firm Skin Décolleté Mask sheet mask also contains the innovative active ingredient complex CoAXEL and DermCom. Perfect for special occasions, the mask acts after just ten minutes, giving an immediate rejuvenating effect for fewer wrinkles and visibly firmer skin. Additional active ingredients in the mask include snow algae, valued in medicine and cosmetics because it activates the longevity gene, klotho in aged skin cells. Glucoside lysine proline copper complex also stimulates ageing fibroblasts while moisturising betaines ensures that even sensitive skin is protected. AM

Improvement to neck laxity, crepiness and firmness

Before

After 12 weeks

SKIN689 FIRM SKIN DECOLLETÉ AND NECK AND SKIN689 FIRM SKIN DECOLLETÉ MASK

The sparse hypodermic fatty tissue in the décolleté area allows only a thin collagen network layer, reducing skin’s natural ability to bounce back. This is where the skin689Firm Skin Decolleté and Neck Creme can help. Containing patented

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I N J E C TA B L E S

LIPS

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Anatomy recap In our anatomy recap, we take a look at the most important anatomical considerations to take into account when treating the lips

ip augmentation is becoming more and more popular, but with this increase in popularity has come an increase in the number of complications being seen as anatomically the lips can be a dangerous and tricky area to treat. The lips are extremely vascular and contain the orbicularis oris and superior and inferior labial vessels and nerves, so putting a needle and product into them can, at least, cause bruising and bleeding and, at worst, cause necrosis, extreme swelling and infection. The lips are pliable, mobile, muscular folds that encircle the opening of the oral cavity. They are covered externally by skin and internally by mucous membrane. A sagittal cut through the lip can reveal the layers of soft tissue that form this relatively simple anatomical structure. That is, from superficial to deep, skin, superficial fat compartment, orbicularis oris muscle, deep fat compartment and mucosa.1 Vermilion: The red part of the lips. It is covered with a specialised stratified squamous epithelium, which is in continuity with the oral mucosa of the gingivolabial groove. Confusingly, the vermilion itself is also often referred to as the lips. Vermilion border: The demarcation line that separates the vermilion lip from the surrounding skin. It is also called the vermilion-cutaneous junction (V-C junction). Cupid’s bow: The upper central vermilion border at the base of the philtral columns. In a frontal view, this border resembles an archer’s bow, which curves medially and superiorly from the commissures to the paramedian peaks located at the bases

Cupid’s bow Vermilion border

Oral commissures

Philtrum Vermilion border

Oral commissures

Fig. 1. Anatomical landmarks of the lip

of the pillars of the philtrum (crista philtrae) with an inferior convexity lying between those peaks.2 Oral commissure: The landmark where the lateral aspects of the vermilion of the upper and lower lips join.3 Modiolus: A fibromuscular condensation where the extrinsic and intrinsic muscles of the mouth meet. The modiolus lies about 10-12mm superolateral to the corner of the mouth and is shaped in the form of a hub of a cart wheel. It is contributed to by the orbicularis oris, buccinator, levator anguli oris, depressor anguli oris, zygomaticus major, risorius, platysma and levator labii superioris. The modiolus is very important for the stability and strength of the oral aperture and movement of the mouth.

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I N J E C TA B L E S

LIPS

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MUSCLES

The orbicularis oris muscle, the lip muscle, is a broad elliptical muscle around the mouth. When the orbicularis oris is tonically contracted, the mouth is closed, whereas active (phasic) contraction causes the mouth orifice to become narrower as when kissing or whistling. Its lateral fibres join the modiolus, a chiasma of facial muscles held together by fibrous tissue, located lateral and slightly superior to each angle of the mouth. Orbicularis oris consists of two distinct parts, the pars marginalis and pars peripheralis, which differ in location and function.5 Anatomical studies have shown that pars peripheralis fibres decussate at midline and insert into the contralateral philtral ridge, whereas pars marginalis fibres form a continuous band from modiolus to modiolus. The pars marginalis is developed to a unique extent in human lips and is closely associated with speech. In each quadrant, the pars marginalis consists of a single (occasionally) double band of narrow-diameter muscle fibres lodged within the vermilion zone of the lip. At their medial end, the marginal fibres meet and interlace with their contralateral fellows and then attach to the dermis of the vermilion zone a few millimetres beyond the median plane. At their lateral ends, the fibres converge and attach to the deepest part of the modiolar base along a horizontal strip level with the buccal angle.6 The pars peripheralis is located in the cutaneous lip. It is the thinner and more peripheral portion of the muscle.7 Pars peripheralis fibres are reinforced directly by the buccinator, levator anguli oris, and the superficial part of zygomaticus major in the upper lip, and from buccinators and depressor anguli oris in the lower lip. Its most peripheral fibres are connected with the maxillary bone and nasal septum, above and with the mandible below. It has a dilatory function. The contraction of this portion of the muscle is responsible for accentuation of vertical fine perioral wrinkles or ‘smoker’s lines’. Orbicularis oris is supplied mainly by the superior and inferior labial branches of the facial artery, the mental and infraorbital branches of the maxillary artery, and the transverse facial branch of the superior temporal artery. Its nerve supply comes from the buccal and mandibular branches of the facial nerve.

Fig. 2. Facial arteries

exposed nerve, may produce pain during eating. Loss of all the teeth also results in a decrease in the vertical facial dimension and mandibular prognathism.8 Superior and inferior labial arteries arise from the facial artery. They are located 1mm posterior to the mucocutaneous border or white roll – the transition between the mucosa and skin of the lip. The labial arteries lie deep to the orbicularis oris muscle and anastomose with each other to form an arterial ring. The pulse of these arteries can be palpated by grasping the upper or lower lip lightly between the first two digits. AM

NERVES

Upper lip – the superior labial nerve The superior labial nerve runs from the infraorbital nerve, one of the major cutaneous branches of the maxillary nerve (CN V2), the intermediate division of the trigeminal nerve. Lower lip – mental nerve The mental nerve runs from the inferior alveolar nerve, a major branch of the mandibular nerve (CN V3), which arises in the mandibular canal and emerges from the mental foramen normally located inferiorly to the second premolar tooth in the mandible. Those practitioners who use mental blocks for injections into the lower lip should be aware of the anatomical changes associated with loss of mandibular teeth. Following complete loss or removal of mandibular teeth, the alveoli begin to fill in with bone and the alveolar process begins to resorb. Gradually the mental foramen lies near the superior border of the body of the mandible. In extreme cases, the mental foramina disappear, exposing the mental nerves to injury. Pressure from a dental prosthesis, resting on an

REFERENCES 1. Dr Sotirios Foutsizoglou, Lip Service, Aesthetic Medicine, February 2017, pp56-59 2. Hennekam, R.C., Cormier-Daire, V., Hall, J., Méhes, K., Patton, M., Stevenson, R. 2009. Elements of morphology: standard terminology for the nose and philtrum. Am J Med Genet Part A 149A: 61-76 3. Carey, J.C., Cohen, M.M. Jr., Curry, C., Devriendt, K., Holmes, L., Verloes, A. 2009. Elements of morphology: standard terminology for the lips, mouth, and oral region. Am J Med Genet Part A 149A: 77-92 4. Moore KL and Dalley AF. Clinically Oriented Anatomy. 4th Edition. Lippincott Williams & Wilkins, 1999 5. Azib N, et al. Anatomy and Lip Enhancement. Paris: E2e Medical Publishing/Master Collection 4, 2011 6. Standring Susan. Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 41st Edition. Elsevier, 2016 7. Trévidic P., Sykes J., and Criollo-Lamilla G. Anatomy of the Lower Face and Botulinum Toxin Injections. Plastic and Reconstructive Surgery Journal. Vol 136:55. November 2015 8. Moore KL and Dalley AF. Clinically Oriented Anatomy. 4th Edition. Lippincott Williams & Wilkins, 1999 9. Brown DL and Borschel GH. Michigan Manual of Plastic Surgery. Lippincott Williams & Wilkins, 2004

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The secret to full facial rejuvenation Dr Kuldeep Minocha, Aesthetic Practitioner

“ My go-to product would always be Restylane Lyft™ ” DR KULDEEP MINOCHA

Do you have any tips for practitioners looking to treat the whole face? Each time you see a patient, look at them with fresh eyes. Take the time to look at how the light is hitting the face and where the shadows are.

Which dermal fillers do you prefer? I only ever use the Restylane® range. I’ve used Restylane® in over 30,000 treatments over twelve years. My reputation depends on using products I know and trust. There are eight fillers in the range and each one varies slightly in consistency, particle size and lift capacity. I like having a broad artistic palette to choose from and it means I can tailor the treatment for each patient.

What do you look for when assessing the face? • Skin quality – assess skin hydration, sun damage, fine lines and wrinkles • Facial shape and balance – is there too much weight in the lower third and can we recreate the heart-shaped or oval-shaped face? • Proportions and contours – look at the frontal view, the profile view and the three-quarter view and assess the relationships between each subunit of the face • Facial symmetry – are the features balanced and how do they change when animated? • Emotion – does the face look sad, angry or tired and which areas are contributing to these emotions?

A patient treated with Restylane Lyft™, Restylane Refyne™, Restylane Volyme™ and Restylane Defyne™

BEFORE RES19-03-0144 DoP: March 2019

AFTER

What products do you use for different parts of the face? If I’m looking to fill a large area I use Restylane Volyme™, say for the temple or the sub-malar area. If I’m injecting more superficially I’d go for Restylane Refyne™ which has a smaller particle size and integrates nicely into the skin. Where I want definition and projection on the cheeks, nose, jaw or chin, I use Restylane Lyft™. If I’m reconstructing or restoring the lips I’ll use Restylane™, but if I’m looking to volumise, beautify and enhance the lip I’d use Restylane Kysse™ which is softer and integrates well.

If you could only choose one product what would you choose? That’s easy. My go-to product would always be Restylane Lyft™. The high G-prime, precision and lift means you can get a impressive result with only one or two syringes. It’s really effective for countering the reabsorption of the bone and the descent of the fat pads that happens to all of us as we age. Not everyone can afford multiple syringes and I find more and more people want the biggest bang for their buck. With Restylane Lyft™ you get that.

About Dr Minocha Dr Kuldeep Minocha qualified as a GP in 1996. After working for the NHS as GP principal in Essex for a number of years, he commenced training and practice in facial aesthetics in 2006. Dr Minocha founded Minocha Health, his aesthetic practice, the same year, before concluding his NHS commitments in 2011 to take up a full-time career in aesthetics. Dr Minocha is a global brand ambassador and key opinion leader for Galderma.

BREAKTHROUGH INNOVATION to target accelerated collagen loss and skin ageing caused by menopause. Menopause causes accelerated collagen loss and significantly ages the skin. Clinical studies show that low oestrogen levels lead up to 30% loss of skin’s collagen in the first 5 years of menopause1. Emepelle® featuring MEP Technology® is a new class of cosmeceutical which safely and effectively rejuvenates, restores and rebalances skin affected by menopause. Clinically proven to significantly improve2,3:

• DRYNESS • DULLNESS • LAXITY • LINES AND WRINKLES FEMALE, AGE 60

Emepelle® clinical study lead investigator, Joel Cohen, MD, Board Certified Dermatologist USA, commented:

“At only 8 weeks over 90% of participants said that the products alleviated some or all of the skin issues associated with menopause3.” BEFORE

WEEK 8

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

aestheticare.co.uk/emepelle 0800 0195 322 info@aestheticare.co.uk REFERENCES 1. Archer DF. Postmenopausal skin and oestrogen. Gynecol Endocrinol. 2012;28(suppl 2): 2-6. doi:10.3109/09513590.2012.705392. 2. Draelos ZD. A double-blind randomized pilot study evaluating the safety and efficacy of topical MEP in the facial appearance Improvement of oestrogen deficient females. J Drugs Dermatol. 2018;17(11):1032-1035. 3. Data on file.

I N J E C TA B L E S

INJECTABLES NEWS

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High patient satisfaction with Azzalure® (AbobotulinumtoxinA) demonstrated Studies presented at the Anti-Aging Medicine World Congress show patient satisfaction remains high four months after treatment of the glabellar complex and does not diminish with repeat treatments of the area THE ANGEL STUDY

The ANGEL study was a multi-centre, prospective, noninterventional observational study carried out in France, Germany, Spain and the United Kingdom. 2 Treatment dose and injection practice were in line with the Summary of Product Characteristics and Azzalure was generally well-tolerated.1,2 In the study (n=533), 94.7% of patients in 66 centres across four countries were satisfied or very satisfied with the aesthetic outcome of Azzalure at three weeks, and 89.6% were satisfied or very satisfied at four months. 2 93.4% considered that the results of the treatment met or surpassed their expectations at week three, and 88.7% had a similar reaction four months after treatment. 2 Nearly all subjects reported that they would like to receive the treatment again (97.2% and 92.9% at week three and month four, respectively) and would recommend it to their friends and family (96.2% and 93.4% at week three and month four, respectively). 2

injection.3 Patients who took part in the study in 13 sites across six countries rated aesthetic outcome (99.3%) and natural looks (100.0%) particularly highly.3 99.3% would recommend to friends and family and 98.5% would be happy to receive the same treatment again.3 Treatment dose and injection practice were in line with the Azzalure Summary of Product Characteristics and the maximum recommended treatment interval was six months.1,3 “These studies demonstrate the high levels of satisfaction patients feel when treated with Azzalure,” said Patricia Ramos, brand manager, medical solutions, aesthetic and corrective products, and prescription divisions, Galderma UK & Ireland. “It is very important for clinics to have a product that they can trust. These patient satisfaction studies add to the wealth of clinical data that we have demonstrating Azzalure’s efficacy.” The results seen in the APPEAL and ANGEL studies were consistent with the overall satisfaction levels reported by Rzany et al. in a retrospective study of up to five injection cycles of AbobotulinumtoxinA (n = 945).4 Rzany et al. reported consistently high levels of treatment satisfaction across injection cycles for both subjects (96–99%) and physicians (88–94%).4 AM

93.4% considered that the results of the treatment metor surpassed their expectations at week three

THE APPEAL STUDY

The APPEAL study was an international, noninterventional, prospective, longitudinal study conducted in 13 centers across six countries (Australia, the Czech Republic, Kazakhstan, Lebanon, the Russian Federation, and the Ukraine) with marketing authorisation for AbobotulinumtoxinA.3 The APPEAL study (n=135) indicated that 97% of the patients were satisfied or very satisfied three weeks after their first Azzalure glabellar line treatment cycle and that this figure increased to 99.3% by the third

REFERENCES 1. Azzalure® Summary of Product Characteristics. Updated September 2018. 2. Molina B et al. J Eur Acad Dermatol Venereol 2015;29:1382-1388. 3. Gubanova E et al. Aesthetic Plast Surg 2018;42:1672-1680. 4. Rzany B, Ascher B, Monheit G (2010) J Eur Acad Dermatol Venereol JEADV 24(Suppl1):1–14.

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INJECTABLES NEWS

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Merz Launches Belotero Revive Dermal Filler ®

The new hyaluronic acid (HA) filler works beneath the skin to improve skin hydration, reduce redness and roughness, and minimise the appearance of fine lines

erz has announced the launch of Belotero® Revive, a dermal filler product containing a unique combination of hyaluronic acid (HA) and glycerol, designed to improve hydration, elasticity and firmness of the skin, and address the appearance of fine lines.1,2 Belotero® Revive builds upon the success of the wellestablished Belotero® range, which includes a wider selection of fillers that can correct imbalances and loss of facial volume, lift, define contours, and fill lines and wrinkles. The newest addition to the range, Belotero® Revive was designed to meet the unique needs of today’s aesthetic patients. Modern consumers are especially focused on skin quality and on minimising early signs of ageing, and they value skincare and aesthetic solutions that deliver natural-looking results – the so-called ‘nofilter’ look. “We continue to see a growing interest in effective, high quality injectable treatments from a new generation of aesthetic patients, due in part to the influence of social media and other digital channels,” states professor of dermatology at the University of Hamburg Dr. Martina Kerscher who is lead author of the BELOVE study. “Strong scientific research forms the basis for this new dermal injectable and our study results show that treatment with this beauty booster is an effective way to provide direct skin hydration and increase skin smoothness, giving our patients beautiful, natural-looking results.” 3,4 The new Belotero® Revive campaign encourages consumers to “Show off the best version of yourself, without a filter!” The campaign hints playfully at the influence of the digital sphere on real-life moments and is designed to highlight the growing acceptance of aesthetic medicine in different age groups, while encouraging female consumers to make choices that bring out their own individual and natural beauty. “Customer research and market trends make it clear that a new generation of patients is increasingly open to aesthetic

medicine and actively looking for options to treat the first visible signs of ageing,” comments Philip Burchard, CEO of Merz. “At Merz, we have a strong focus on researching and developing innovative and effective solutions that can be used to address both specific patient needs and new market trends in medical aesthetics. With Belotero® Revive, we are proud to be able to provide aesthetic physicians with a new dermal injectable that can be used for both early intervention and beautification, to help meet the unique needs of individual patients.”

STUDY RESULTS

Belotero Revive is injected during a course treatments and works as a beauty booster to deliver a youthful radiance. It works beneath the skin to provide hydration but can also be used to reduce the appearance of fine lines, or as a preventative and early aesthetic intervention treatment to slow the progression of facial changes over time.4 Belotero® Revive was clinically assessed in a study involving 24 patients. The product was injected into the lower cheek area of the face and results were recorded over 36-week period.4 The study showed that Belotero® Revive improves skin elasticity, has an excellent safety profile, and a generally lower lever of pain at the injection site. Up to 36 weeks, patients experienced improved skin hydration and reduced skin redness. 100% of patients showed improved aesthetic results at week 12. M ore than 80% of patients were satisfied with the treatment at week 24. 9 0% of patients would recommend Belotero® Revive to friends. AM REFERENCES 1 . HA in rejuvenation: Bukhari et al., Int J Biol Macromolecules, 2018; 120:16821695. 2. Glycerol and hydration: Korponyai C et al., Acta Derm Venerol, 2017; 97:182-187. 3. Belotero® Revive Instruction for use Version 3.0, 2018

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Take your business to the next level. Youâ&#x20AC;&#x2122;ve done the training. Youâ&#x20AC;&#x2122;ve started your business. What next? ABC has been designed with aesthetic entrepreneurs in mind. Packed full of expert guidance, the conference provides an invaluable opportunity for practitioners and clinic managers to learn and network with some of the most influential names in the aesthetics business.

organised by

26th September 2019 The Royal College of Physicians, London Tickets on sale now at aestheticsbusinessconference.co.uk Untitled-9 1

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TREATMENT SPOTLIGHT

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RF and ready Dr Rekha Tailor on the Accent Prime

ccent Prime by Alma Lasers combines two key technologies – non-focused ultrasound and fractional unipolar radiofrequency – to deliver non-invasive lipolysis and circumference reduction, and a reduction in skin laxity. The fusion of these technologies ensures patients receive a longer-lasting result in fewer treatment sessions. Accent Prime has pioneered a unique way of applying radiofrequency with its Accentuate applicator. This is a larger paddle to cover a vast surface area with controlled heat, maintaining a constant temperature. Avoiding hot spots and keeping patients comfortable throughout the treatment leads to better results, and patients are able to immediately return to their daily routine.

HOW TO PICK THE RIGHT DEVICE FOR YOUR CLINIC

The aesthetics industry is inundated with manufacturers making vast claims about the efficacy and safety of their devices and the technologies they employ. The European CE mark only goes so far; it offers proof of safety and technical performance, but not a guarantee that the treatment delivers effective results. FDA approval is key when looking for a reputable treatment. It is a more transparent, trustworthy system, showing effectiveness as well as safety, therefore allowing a clinic and its patients to make much more informed decisions.

the treatment, 85.7% of patients stated that they were either greatly satisfied or satisfied with the treatment results, and skin biopsies showed an increase in collagen in the dermis. None of the participants experienced an adverse event during or after the procedure. In July 2016, Alma Lasers produced a report on its selective non-invasive lipolysis and circumference reduction for body contouring. During this study, patients underwent between two to seven treatments at one to two week intervals. The subjects reported minimal discomfort during the procedure and significant circumferential reductions were observed despite major differences in age and BMI, with no adverse events or safety concerns. Accent Prime is the only ultrasound treatment to be approved by the FDA for the face and body and the only machine to target 60cm2 in one handpiece.

FDA approval is key when looking for a reputable treatment

THE LOW-DOWN ON ACCENT PRIME

Accent Prime offers two main treatments: ultrasound and radiofrequency. The RF applicator produces thermal stimulation, which creates an immediate and temporary change in the helical structure of the collagen. Accent Prime uses the latest development of RF which involves the emission of electromagnetic radiation rather than a current, which is referred to as unipolar, and so no grounding pad is necessary. Ultrasound combines non-focussed technology delivered using an extra-large plate to increase the speed of body contouring. The device produces complex vibrational waves, both flexural-asymmetrical and longitudinal.

ACCENT PRIME TRIALS

On January 13, 2017, a study was published by the Journal of Cosmetic Dermatology that set out to evaluate the efficacy and safety of Accent Prime radiofrequency treatment for facial tightening. At the time, there were very few studies completed with unipolar handpieces. The trial studied participants who were an average age of 49.7-years old, with mild to moderate age-related facial laxity. After

WHY WE CHOSE ACCENT PRIME

Alma Lasers has consistently set the standard for high quality, safe, effective and results-driven treatments. After experiencing disappointing results with a previous contouring system, we wanted to ensure that our next machine would obtain results which patients have come to expect from us. When faced with the clear clinical evidence of successful treatments using Accent Prime we were definitely intrigued. With the growing segment of the population interested in reducing age-related skin laxity and an increasing number of patients wanting to contour their body, we required a high quality, results-driven machine, but with little downtime. The use of needles was something we were keen to avoid, too, as this would prove more invasive and would increase the downtime and discomfort for patients. Treatment with Accent Prime is gentle enough to allow patients to return to work the same day, but it also delivers extremely exciting results, tailored to each patient’s specific needs. With its impeccable track record and FDA approval, and considering the reputation of Alma Lasers as a whole, we felt that Accent Prime was the clear choice for treating body contouring and facial tightening. AM

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TREATMENT SPOTLIGHT

Dr Rekha Tailor is the founder and medical director of Health & Aesthetics clinic in Elstead, Surrey. Dr Tailor has been a medical practitioner for more than 29 years, with more than 14 yearsâ&#x20AC;&#x2122; experience in the aesthetics industry. She is a full member of the British College of Aesthetic Medicine and the Royal College of General Practitioners. Dr Tailor is also affiliated to various medical organisations including: the General Medical Council, the British Medical Association and the British Menopause Society.

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DEVICES

Q&A

aestheticmed.co.uk

Q&A Vicky Eldridge chats to Dr Charlie Attariani from Ego Dental Clinic about becoming one of the first clinics in the UK to install the new Soprano Titanium Aesthetic Medicine: Tell us a bit about your background and how you came into the aesthetics side of the industry? Dr Charlie Attariani: My wife and I always wanted to have our own practice. We took over a beauty salon which had eight treatment rooms. We had to apply for change of use as the usage is different for dental and medical purposes, but we decided to keep four of the beauty rooms and add the dental surgeries into it. I found that to be a very good combination. People who are interested in looking after themselves and are having facials, waxing and laser hair removal are often also looking to enhance other areas too, so aesthetic dentistry fits in quite nicely.

AM: When you started looking at what equipment you were going to invest in, what were your thought processes and how did you decide which brands you were going to use? CA: Technology was the most important thing for me. People are busy, they don’t have time to spend on themselves. So when it comes to our dental work we try to do everything here. We don’t send anything to the lab; we scan everything here and can make crowns the same day. We can also show patients how their smile will look afterwards using the latest technology. This philosophy worked well for me in dentistry so I carried that over into the beauty and aesthetic side of the business. Soprano was one of the lasers that people actually came in and asked for. People didn’t come in asking for hair removal, we got people asking for Soprano. So, I started looking into it. As a dentist, I come from a scientific background; I like to do my own research and not rely on what manufacturers tell me. I spent six months speaking to different laser companies and doing research before I decided that Soprano met our criteria.. AM: What is it specifically about the Soprano Titanium that makes it a good fit for your business? CA: The new Titanium is absolutely great, it’s just so fast. It’s the latest technology and it has good research behind it, and it suited my business. People are busy here and they want to save time. The Soprano Titanium helps us with that.

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We were one of the first clinics in the UK to get the machine. Normally to be the first in something in medicine is not the best, because you don’t want to be the guinea pig. However, Soprano was already a brand with a good reputation and research behind it, so I didn’t have any doubt about being one of the first to get the new system. AM: Other than the speed, what else does the new system offer? CA: It combines different lasers together – it has Alex, diode and Yag all in one. And it’s easier for my technicians to deal with as well. My therapists used to get very tired using some of the older laser machines as they were often quite heavy. I do laser hair removal and tattoo removal, and I found the older systems too clumsy to hold over my shoulder. In every aspect the Titanium is very favourable, it’s very easy to use.

Q&A

AM: What are your plans for the future of the business? CA: Quality not quantity is a very important motto for us. We want to add more treatments, particularly for the body, but we don’t want to bring in things for the sake of it. At the moment, we’re extremely strong in the head and neck area, but body treatments is something we’re looking into. Just as with lasers, there’s so many different system out there, so it’s very difficult. You need to look at the research and know what type of research to pay attention to, that’s the key thing for me. There are many companies that have paid for research so the results are not going to be unfavourable. You must know where to look, and do your research before making any decisions. AM

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DEVICES

NEW LAUNCHES

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The shape of things to come We find out about InMode’s new launch – the Morpheus8 – a cutting-edge subdermal, microneedling, radiofrequency device

nMode, a leading supplier of innovative, energy-based, minimally and non-invasive aesthetic solutions, has introduced a cutting-edge device to its expanding product portfolio. Morpheus8 is a unique, subdermal, adipose remodelling, radiofrequency (RF) device, which fractionally remodels and contours the face and body. The device delivers immediate results for patients, as well as more uniform, symmetrical, long-lasting and consistent outcomes by treating the subcutaneous fatty layers as well as the superficial layers of the skin. Morpheus8’s standout innovation comes from the use of fractionated RF energy into subdermal tissue. Typically, similar bipolar RF technologies on the market work exclusively in the superficial layers of the skin and patients may opt for surgery to reach the sub-dermal tissue for moderate and severe cases of laxity and wrinkles. However, Morpheus8 safely bypasses the epidermis, delivering bipolar RF energy to the subdermal and deeper subcutaneous layers; providing more effective and longer-lasting results. Dr Ash Dutta comments, “I have been using Morpheus8 for the face and body and my patients are delighted with the results. One of the main advantages is that it can be combined with other surgical or non-surgical treatments treatments such as fillers. It is gaining popularity with those patients who would like minimal downtime and subtle results.” With programmable penetration, depth and energy delivery, Morpheus8 is the ideal device for the treatment of fine lines and wrinkles, acne scars and general skin tone. Twenty-four silicone-coated pins penetrate into the subdermal tissue, tightening fat and contracting connective

tissue. Fractionated RF energy is scientifically proven to reduce wrinkles whilst rebuilding collagen and fat. It is minimally invasive with minimal patient downtime.

One of the main advantages is that it can be combined with other surgical or nonsurgical treatments

QUESTIONS ON SAFETY

While Morpheus8 can deliver its energy at a depth of 200, 300 and 400 microns with an extremely uniform effect, there is little to no thermal damage to the skin’s surface. It’s bipolar technology is arguable safer than monopolar, due to the way the energy passes between the poles. Furthermore, the combination of its long needles and silicone-insulated shafts make it a safe device that can be used on all skin types with very little risk of post-inflammatory hyperpigmentation (PIH), which is common with other resurfacing methods. “The device provides real-time measurements of skin and fat temperature and audible feedback, as well automatic power cut-off, if the tissue receives too much energy during the treatment. This ensures patient safety,” says Dr Ali Ghanem. Morpheus8 can be used on all areas that can benefit from subdermal renewal; the most commonly treated areas include the lower face and neck. The combination of Morpheus8 and FaceTite (a minimally-invasive face and neck contouring device that has been approved by the US FDA for its safety and efficacy profile), addresses skin laxity through differential tissue and three-dimensional remodelling and is the next best thing to a formal facelift. AM

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DEVICES NEWS

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Theradome launches new laser phototherapy course Theradome has launched an online laser phototherapy diploma course, one of the first of its kind in the UK. The launch comes in response to a gap in the market for academic training covering laser phototherapy for medical and aesthetics practitioners. The Theradome Online Diploma Course in Laser Phototherapy will cover the the history of lasers; how and why they work to assist hair growth; the benefits of laser phototherapy

technologies; the causes of hair loss; and other hair loss treatments and devices on the market and the pros and cons of each. Sally-Ann Tarver of Theradome GB, a trichologist with more than 20 years’ experience, said, “We are excited to be offering this course to hair loss and aesthetics industry professionals. It will be paramount in educating individuals on the scientific benefits of laser phototherapy treatment.”

UK clinic first to install new Vbeam device in Europe Dermatologist Dr Firas Al-Niaimi has become the first in the UK and Europe to install the new Candela Vbeam system in his clinic, following its recent CE mark approval. Long considered a ‘gold standard’ for Pulsed Dye Lasers (PDL), the Vbeam has a 20-year history and is used in nearly 700 university hospitals worldwide. The new Vbeam Prima builds on that legacy by offering advanced features to help physicians and patients achieve better results and an improved treatment experience. Dr Al-Niaimi said, “The Perfecta energy was sufficient, but increased energy in Vbeam Prima, coupled with a larger maximum spot-size (15mm compared to 12mm) means faster treatments. The need to calibrate the device only on first use with a wavelength means that patients

do not experience any delays once treatments have started. “The ability to choose contact cooling enables me to deliver an effective, comfortable treatment of surface pigment and in the same treatment session I can now combine 595nm Pulsed Dye Laser with 1064nm Nd:YAG, allowing me to treat both superficial vessels and deeper vessels effectively.”

Harpar Grace secure exclusive global distribution rights to the Déesse brand Harpar Grace has secured the exclusive global distribution rights to the Déesse brand. The Déesse Pro has been reengineered to a reduced price point to £1,200 + VAT and stand at £120 + VAT. Alana Marie Chalmers commented, “The Déesse brand has led the way in LED mask technology arena and despite numerous other versions, we pride ourselves in the continual development of the Déesse PRO’s capability to provide the most dynamic and price- competitive offering we can. “Déeese is the only LED mask brand that has global brand awareness and the acclaimed non-endorsed PR and we continue to focus on retaining this position and growth in the coming years. With the price point at £1,200 and the treatment guidelines at £1/min we are confident clinics will see a very quick return on their investment and with as little as 2 x £25 treatments per day for 12 days the device pays for itself. “The Déesse Pro continues to lead as the dynamic option for clinics as it doesn’t require a couch or a practitioner to remain with the client and can offer versatility, is portable and easily moved and utilized throughout the clinic due to the small and compact design. In addition the approachable pricepoint and diverse ranges of use – provide the opportunity to maximise revenue income.” AM

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OUT AND ABOUT

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Beauty Decoded Live, London Allergan hosted its first Beauty Decoded Live event in London. The series of events, which takes place in 15 countries around the world over 10 months, aims to build consumer confidence and increase knowledge when considering a medical aesthetic treatment. The events will demystify the consultation process, tackling concerns around unnatural-looking results and long-term safety in an experiential environment, and will provide a forum for consumers to have their questions answered. The London launch also coincided with Allergan’s latest campaign launch – JUVÉDERM IT – and featured Dr Mauricio de Maio, Dr Jonquille Chantrey and Dr Tapan Patel. Described as an “immersive experience for attendees” the event included one-to-one consultations with highly qualified and trained health care practitioners, live injection demonstrations and an interactive JUVÉDERM facial filler area.

Out and about Out and about in the industry this month

ALICE HART-DAVIS LAUNCHES TWEAKMENTS GUIDE IN LONDON The elegant first-floor drawing room at The Clock, a private members’ strength-training club in Marylebone, was the unusual setting for the launch of journalist Alice Hart-Davis’s new book, The Tweakments Guide: Fresher Face. One hundred people gathered to celebrate the launch, including leading aesthetic doctors, nurses, surgeons and dermatologists, along with journalists, publicists and influencers who follow this speciality. The book, the first of its kind to offer a comprehensive independent guide to the fast-growing field of aesthetic procedures, is subtitled: ‘Everything you’ve ever wanted to know about non-surgical treatments, by the woman who has tried them all’. The event included demonstrations of thetweakmentsguide.com, the accompanying website, which has interactive tools to help visitors discover which tweakments might help their concerns, and a practitioner finder that lists the best and most reliable aesthetic providers around the country.

Recognition for Amy Northen-Hills at Aesthetic Dentistry Awards, London Amy Northen-Hills, a dental therapist and member of the British Association of Cosmetic Dental Professionals, has won an award for Best Full-Face Treatment and Best Skin Rejuvenation at the Aesthetic Dentistry Awards. She was also shortlisted in four other categories, including Best Aesthetic Practice. Northen-Hills joined the military at 16 and spent six years as a dental nurse in the Royal Navy before moving into maxillofacial surgery. In 2015, after six years working in a private practice, she opened her own dental practice in Hull. She teaches at the Whitehills Training Academy, which offers CPD-accredited training courses to medical and dental professionals. In 2018, she won Dental Therapist of the Year at the Dental Awards and was shortlisted for Best Total Facial Sculpting at Dr Bob Khanna’s IAAFA awards. This year, Northen-Hills is nominated for Dental Therapist of the Year and Practice of the Year at the upcoming Dental Awards on May 17.

Aesthetic Medicine • May 2019

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