Aesthetic Medicine - October 2019

INSPIRING BEST PRACTICE IN MEDICAL AESTHETICS

TECH NECK TREATMENTS FOR THE NECK NO SMOKING THE EFFECTS OF SMOKING ON SKIN PERFECT PROPORTIONS WHAT MAKES A FACE BEAUTIFUL? October 2019 | aestheticmed.co.uk

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

Prescribing information can be found overleaf

October 2019

October 2019 | aestheticmed.co.uk

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References: 1. Azzalure SPC 2018. 2. Data on File MA-39613.

3. Molina B et al. J Eur Acad Dermatol Venereol 2015;29(7):1382–8.

Date of Preparation: May 2019 Job code: AZZ19-05-0053

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Azzalure Prescribing Information (UK & IRE) Presentation: Botulinum toxin type A (Clostridium botulinum toxin A haemagglutinin complex) 125 Speywood units of reconstituted solution (powder for solution for injection)

Interactions: Concomitant treatment with aminoglycosides or other agents interfering with neuromuscular transmission (e.g. curare-like agents) may potentiate effect of botulinum toxin.

Indications: Temporary improvement in appearance of moderate to severe:

Pregnancy, Lactation & Fertility: Not to be used during pregnancy or lactation. There are no clinical data from the use of Azzalure on fertility. There is no evidence of direct effect of Azzalure on fertility in animal studies

• Glabellar lines seen at maximum frown, and/or

• lateral canthal lines (crow’s feet lines) seen at maximum smile in adult patients under 65 years, when severity of these lines has an important psychological impact on the patient.

Dosage & Administration: Azzalure should only be administered by physicians with appropriate qualifications and expertise in this treatment and having the required equipment. Botulinum toxin units are different depending on the medicinal products.

Speywood units are specific to this preparation and are not interchangeable with other botulinum toxins. Reconstitute prior to injection. Intramuscular injections should be performed using a sterile suitable gauge needle.

Glabellar lines: recommended dose is 50 Speywood units divided equally into 5 injection sites, 10 Speywood units to be administered intramuscularly, at right angles to the skin; 2 injections into each corrugator muscle and one into the procerus muscle near the nasofrontal angle.

Lateral canthal lines: recommended dose per side is 30 Speywood units divided into 3 injection sites; 10 Speywood units to be administered intramuscularly into each injection point, injected lateral (20 - 30° angle) to the skin and very superficial. All injection points should be at the external part of the orbicularis oculi muscle and sufficiently far from the orbital rim (approximately 1 - 2 cm); (See summary of product characteristics for full technique).

Side Effects: Most frequently occurring related reactions are headache and injection site reactions for glabellar lines and; headache, injection site reactions and eyelid oedema for lateral canthal lines. Generally treatment/injection technique related reactions occur within first week following injection and are transient. Undesirable effects may be related to the active substance, the injection procedure, or a combination of both.

For glabellar lines: Very Common (≥ 1/10): Headache, Injection site reactions (e.g. erythema, oedema, irritation, rash, pruritus, paraesthesia, pain, discomfort, stinging and haematoma).

Common (≥ 1/100 to < 1/10): Temporary facial paresis (due to temporary paresis of facial muscles proximal to injection sites, predominantly describes brow paresis), Asthenopia, Eyelid ptosis, Eyelid oedema, Lacrimation increase, Dry eye, Muscle twitching (twitching of muscles around the eyes). Uncommon (≥ 1/1,000 to <1/100): Dizziness, Visual impairment, Vision blurred, Diplopia, Pruritus, Rash, Hypersensitivity, Eye movement disorder. Rare (≥ 1/10,000 to < 1/1,000): Urticaria.

For lateral canthal lines: Common (≥ 1/100 to < 1/10): Headache, Temporary facial paresis (due to temporary paresis of facial muscles proximal to injection sites), Eyelid ptosis, Eyelid oedema and Injection site disorders (e.g. haematoma, pruritus and oedema). Uncommon (≥ 1/1,000 to <1/100): Dry eye.

Treatment interval should not be more frequent than every three months. The efficacy and safety of repeat injections of Azzalure has been evaluated in Glabellar lines up to 24 months and up to 8 repeat treatment cycles and for Lateral Canthal lines up to 12 months and up to 5 repeat treatment cycles. Not recommended for use in individuals under 18 years of age.

Adverse reactions resulting from distribution of the effects of the toxin to sites remote from the site of injection have been very rarely reported with botulinum toxin (excessive muscle weakness, dysphagia, aspiration pneumonia with fatal outcome in some cases). Prescribers should consult the summary of product characteristics in relation to other side effects.

Contraindications: In individuals with hypersensitivity to botulinum toxin A or to any of the excipients. In the presence of infection at the proposed injection sites, myasthenia gravis, Eaton Lambert Syndrome or amyotrophic lateral sclerosis.

Packaging Quantities & Cost: UK 1 Vial Pack (1 x 125u) £64.00 (RRP), 2 Vial Pack (2 x 125u) £128.00 (RRP), IRE 1 Vial Pack (1 x 125u) €93.50, 2 Vial Pack (2 x 125u) €187.05 (RRP)

Special warnings and precautions for use: Care should be taken to ensure that Azzalure is not injected into a blood vessel. Use with caution in patients with a risk of, or clinical evidence of, marked defective neuro-muscular transmission, in the presence of inflammation at the proposed injection site(s) or when the targeted muscle shows excessive weakness or atrophy. Patients treated with therapeutic doses may experience exaggerated muscle weakness.

Not recommended in patients with history of dysphagia, aspiration or with prolonged bleeding time. Seek immediate medical care if swallowing, speech or respiratory difficulties arise.

Facial asymmetry, ptosis, excessive dermatochalasis, scarring and any alterations to facial anatomy, as a result of previous surgical interventions should be taken into consideration prior to injection.

Injections at more frequent intervals/higher doses can increase the risk of antibody formation. Avoid administering different botulinum neurotoxins during the course of treatment with Azzalure.

To be used for one single patient treatment only during a single session. There is a potential risk of localised muscle weakness or visual disturbances linked with the use of this medicinal product which may temporarily impair the ability to drive or operate machinery.

Marketing Authorisation Number: PL 06958/0031 (UK), PA 1613/001/001 (IRE) Legal Category: POM Further Information is Available From: Galderma (UK) Limited, Meridien House, 69-71 Clarendon Road, Watford, Herts. WD17 1DS, UK. Tel: +44 (0) 1923 208950 Fax: +44 (0) 1923 208998 Date of Revision: September 2018

Adverse events should be reported.

For the UK, Reporting forms and information can be found at www.mhra.gov.uk/yellowcard.

For Ireland, Suspected adverse events can be reported via HPRA Pharmacovigilance, Earlsfort Terrace, IRL - Dublin 2; Tel: +353 1 6764971; Fax: +353 1 6762517.

Website: www.hpra.ie; E-mail: medsafety@hpra.ie.

Adverse events should also be reported to Galderma (UK) Ltd.

AZZALURE® IS A TRADEMARK BELONGING TO NESTLE SKIN HEALTH S.A.

Date of Preparation: May 2019 Job code: AZZ19-05-0053

lynton.co.uk/3JUVE

A Skin Solution for Every Client

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Dr Nicole Chiang Consultant Dermatologist MBChB(Hons), MRCP(UK)(Derm), PGCert Aesthetic 38 City Road East, Manchester, M15 4QN 0161 236 6500 | lumiereclinic.co.uk

As a Consultant Dermatologist, what is it that initially inspired you to move into the aesthetics industry and open the LUMIERE Clinic?

Are you happy with the clinical results you have gained with your Lynton equipment?

As a Dermatologist, I acquired experience

importantly, so are our patients. We have

in cosmetic dermatology during my

treated a large volume of Rosacea patients

training in the UK, USA and Australia.

using the Rebright IPL application, and even

My experiences from different practices

after one treatment, there is significant

around the world provided me with an

clearance. We also see a large volume of

insight into how the broad range of

patients who suffer from acne scarring, so the

cosmetic dermatology treatments can

Resurface fractional laser works perfectly in

dramatically improve a patientâ&#x20AC;&#x2122;s quality of

helping improving the texture and appearance

life. I enjoy combining both my aesthetic

of their skin. From using other IPL and laser

and specialist dermatology knowledge

devices in the past, I can say that the Lynton

to ensure that patients achieve the best

IPL is much stronger, helping us see better

possible results, and this gives me an

and faster treatment results.

Courtesy of Lumiere Clinic - Lifting & Tightening (3JUVE)

The 3JUVE treatment concept works by using varying proportions of the 3 technologies, dependent on the needs of the client; is this something you do?

What advice would you give to someone considering investing in a piece of aesthetic equipment?

We like to treat every patient on an individual

accreditations is very important. I personally

basis, so the 3JUVE is sometimes used to just

chose Lynton because I know their

treat their particular concern. For a patient

technology is medically-certified and I have

who is looking for an overall anti-ageing

seen the awards they have won in recent

or skin rejuvenation result, we may tailor a

years for the quality of their equipment and

3JUVE treatment based on what they require

the level of their customer service. I also

most. The 3JUVE actually really complements

wanted to work with a UK-based company

some of the other treatments we offer as a

and manufacturer that could offer me a

skin clinic, allowing me to focus on delivering

high-level of technical service and quick

injectable and medical treatments, and then

response times. This gives me the peace

passing a patient onto to one of my laser

of mind that if I was to occur any problems,

practitioner to finish with a 3JUVE regime.

it could be solved quickly and avoid me

We are delighted with the results we have achieved with the 3JUVE, but more

Courtesy of Lumiere Clinic - Rosacia (3JUVE)

immense sense of job satisfaction.

Why did you decide to introduce the Lynton 3JUVE into your skin clinic?

As a new clinic, we needed to make an investment into one piece of equipment that would then offer us multiple treatment options, so the 3 in 1 option worked well. We have such a wide range of different skin conditions coming into the clinic, so it was important that we had a device that was versatile and that could treat our most in-demand skin rejuvenation treatments.

For me, picking a company that is well established and that has strong

cancelling any patients.

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

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

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

aestheticmed.co.uk

Contents OCTOBER

10

NEWS AND ANALYSIS

BUSINESS

10 NEWS The latest news from the industry

28 TALKING TO Fiona Vlemmiks chats to Cheshire-based practitioner, Dr Ahmed El Houssieny

20 NEWS SPECIAL REPORT Should you be paying VAT?

EDITORIAL Vicky Eldridge

20

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

ADVERTISING Jack Diamond

34 COMPETITOR ANALYSIS Gilly Dickons advises how to deal with growing competition in the sector 38 ASK THE EXPERT Aesthetic Medicine’s social media editor Chris Halpin answers your questions

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

40 LEGAL David Wright explains the legal procedures you need to follow when an employee resigns

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

MARKETING Chloe Skilton

31 EMPLOYMENT Victoria Vilas on how to promote team members

28 31

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 imagecreativedesign.co.uk

PRINTING Walstead United Kingdom walstead-uk.com

38

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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.

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

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Aesthetic Medicine • October 2019

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CONTENTS

IN THIS ISSUE...

aestheticmed.co.uk

76

86

92

TRENDS DOSSIER

SKIN

INJECTABLES

DEVICES

OUT AND ABOUT

44 TECH NECK Rebecca Barnes explores the growing issue of ‘tech neck’

57 SMOKING We explore the effects cigarette smoke has on skin ageing

70 COVER STORY Balsam Alabassi explores what makes a face beautiful

48 KOREAN BEAUTY Dr Sabrina Shah-Desai shares insights from her recent trip to Seoul

60 PRODUCT FOCUS How Medik8 is putting the environment first

76 MENTORING Claire Berry on mentoring in aesthetics

82 IN-CLINIC TREATMENTS Sara Cheeney introduces the InMode Optimas platform to her clinic

90 HUMANITARIAN WORK Dr Shailesh Vadodaria on his latest trip to Ghana with the Help Smile Trust

62 COMBINATION TREATMENTS Dr Preema Vig shares her Ultimate Fusion Facial concept

HEALTH

85 STUDY ANALYSIS Georgios Tzenichristos discusses a recent study on why women are more prone to cellulite

92 TRAINING SPOTLIGHT How surgeons are enhancing their skills though sculpting

88 TREATMENT SPOTLIGHT The ONDA system from DEKA

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

51 CONSUMER DRIVEN TRENDS Sharon Bennett shares her thoughts on consumer trends 54 BEARD TRANSPLANTS Dr Ashish Dutta on facial hair transplants

65 EDITOR’S CHOICE Vicky Eldridge tries out the Harley service

78 MENOPAUSE Dealing with vaginal dryness as a result of the menopause

68 SKIN NEWS The latest skin product launches

57

Welcome to the October edition

of Aesthetic Medicine I am often asked how I find enough content to fill a whole magazine every month, and the answer is simple. The aesthetics industry is an exciting, dynamic and evolving sector and, as such, there is always more than enough to write about.

From new launches of products and treatments and new trends, to changes in technology and strategies for running a new business, we are certainly not an industry that rests on its laurels or suffers from stagnation.

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This month we have dedicated our dossier to some of the latest trends. From the influence of the innovative Korean beauty market and consumer-driven trends, to the rise of treatments for ‘tech neck’ and beard transplants, our 11-page report looks at just some of the trends you can tap into in your clinic (pp. 43-55).

As well as this, I try out a new tech platform designed to empower practitioners to sell skincare and encourage compliance and retention with retail products (pp. 65-66).

Add to this all the latest industry and product news and Aesthetic Medicine will keep you abreast of what’s happening in the market.

Vicky Eldridge – Editor Aesthetic Medicine • October 2019

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

INDUSTRY NEWS

aestheticmed.co.uk

Hyaluronic acid dermal filler market predicted to be worth $6.04bn (£4.84bn) by 2025 The global hyaluronic acid dermal filler market size is expected to reach $6.04bn (£4.84bn) by 2025, according to a new report by Grand View Research.

The market is expected to register a compound annual growth rate (CAGR) of 8.31% over the forecast period. This growth can be attributed to the rising importance of quality of life and overall health. Moreover, technological innovations in the industry are likely to boost the market further.

According to the International Society of Aesthetic Plastic Surgery (ISAPS), in 2016 hyaluronic acid-based dermal filler procedures were the second-most preferred injectable across the globe.

The report suggests that the increasing influence of social media advertisements promoting flawless younger-looking skin is expected to drive the segment further.

Geographically, North America held the largest market share in 2017 on account of the higher number of minimally invasive cosmetic surgeries performed in the region.

However, Asia Pacific is expected to witness the highest CAGR due to growing awareness about applications of minimally invasive techniques in emerging economies,

such as China, and increasing disposable income levels.

Key players in the market mentioned in the report include Allergan, Galderma, Merz Pharma GmbH & Co. KGaA, Genzyme Corporation, Medicis Aesthetics Holdings and Anika Therapeutics.

The 100-page research report can be viewed at grandviewresearch.com/industry-analysis/hyaluronic-acidbased-dermal-fillers-market

US plastic surgeon claims women are increasingly seeking treatment to combat “resting bitch face” A derogatory term to describe women whose faces look “bitchy” has been driving demand for aesthetic treatments, a US-based plastic surgeon has claimed.

Dr David Shafer, director of the Shafer Plastic Surgery & Laser Center in Midtown New York, claims more and more women are seeking treatment to address ‘resting bitch face’ or ‘RBF’. Although the term entered the cultural lexicon about six years ago, requests for the procedure “more than doubled” over the past year, Shafer told The Sun newspaper.

He puts the trend down to a public shift in focus from the upper to lower face, “popularised by the Kardashians”, as well as taking selfies, which he says “accentuates the RBF”.

Allergan unveils new MD Codes protocols with leading plastic surgeon and KOL Mr Mauricio de Maio Two new MD Codes were launched by plastic surgeon Mr Mauricio de Maio last month at the first immersive digital tutorial held by the Allergan Medical Institute (AMI).

Advanced Allergan practitioners from around the world were invited to learn the latest injection techniques for effective mid and lower face treatments using the Juvéderm product range.

Mr de Maio highlighted the importance of continued learning during the webinar before introducing best practice for patient assessment and the new MD Codes – the 7-POINT SHAPE for women and 9-POINT SHAPE for men. The 7-POINT SHAPE for women involves seven points, which include Ck1, Ck4, Jw1, C1 and C2, and Jw4 and Jw5. The 9-POINT SHAPE for men involves injection of Ck1, Ck4, Jw1, Jw2, C1, C2, Jw4, Jw5 and C5 points.

He then demonstrated the 7-POINT SHAPE injection techniques using Juvéderm Volux and Juvéderm Voluma. He

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said, “I will leave you with one thought: remember that you must not stand still; you must continue to reflect and evolve as injectors, and if we do this together we can truly change our industry for the better.

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

aestheticmed.co.uk

INDUSTRY NEWS

Plastic surgeon tackles record-breaking round-theworld yacht race for charity Plastic surgeon Mr David Gateley has undertaken an epic round the world sailing race for charity.

He will spend at least 33 days at sea on a 70-foot ocean racing yacht in the Clipper Round the World Yacht Race in aid of two children’s charities: Unicef UK and Child Action Nepal (CAN), which supports an orphanage in Nepal. Mr Gateley is a trustee of CAN and regularly visits Kathmandu, where he also provides teaching and surgery at a specialist hospital.

Mr Gateley set sail from St Katharine Docks in London on September 1, joining Team Guy, a crew of 60 people aged between 18 and 74, to take part in the first leg of the race – a 7,250-mile passage from the UK to Uruguay.

The surgeon, who founded his private surgical practice DRG Plastic Surgery after working in the NHS for more than 30 years, said his skills in the operating theatre will come in useful during the adventure, “As surgeons, we operate on someone in our head first,” he said. “We go through each

step of the surgery we are going to perform and think about all the possible problems we may encounter on our journey. I feel that sailing is like that too – you have to meticulously plan each step. Hopefully, my methodical, scrupulous approach will be of benefit to the crew. This is the culmination of more than two years’ planning, intensive training and preparation.

“Sailing in the race is a dream for me but, unfortunately many children worldwide don’t have access to basic medical and surgical care, let alone the chance to fulfil their dreams.

Both of the charities I’m supporting work tirelessly to support disadvantaged children and I hope that I can raise much-needed donations to help fund their vital work.”

To support him visit: justgiving.com/davidgateley

Almost three-quarters of mums struggle to refine their stomach postpartum, says SculpSure survey More than 70% of women found the stomach the most difficult area to shape up after pregnancy, a survey conducted by body contouring specialists SculpSure has shown.

The brand asked more than 1,000 women which areas of their body they found most difficult to get back into shape after pregnancy. Most women who had given birth cited the stomach as the biggest problem area, followed by thighs and flanks, each attracting 8% of the votes. Results also highlighted that the chin was the least difficult to shape up, receiving only 1% of the votes. Only 5% expressed that they didn’t find it difficult to shape up any area.

Study evaluates economic impact of plastic reconstructive surgical efforts in the developing world Trips to perform reconstructive surgery procedures in developing countries are cost-effective in terms of reducing the impact of disability on the lives of patients, according to a report in Plastic and Reconstructive Surgery.

Researchers analysed the economic impact of surgical trips performed by ReSurge International. The organisation, which aims to provide reconstructive surgical care and build surgical capacity in developing countries, made 22 trips from 2014 to 2017 to eight countries in Asia, Africa, and South America. The average cost per trip was around $25,000 (£20,069.13).

During the trips, surgeons performed reconstructive surgery procedures on 756 patients, 60% of whom were children aged nine or younger. Cleft lip/palate repair was the most common procedure, followed by burn contracture release, eyelid (ptosis) surgery, and removal of soft tissue masses.

The researchers analysed the cost-effectiveness of these procedures, focusing on the cost to prevent one lost year of healthy life, or ‘disability-adjusted life year’ (DALY). In terms

of reducing disability, the benefits of surgery were greatest for patients with cancer-related conditions, followed by cleft lip/palate and hand conditions.

Based on World Health Organization criteria, 21 of the 22 trips were classified as cost-effective or very costeffective. The exception was an ‘educator’ trip taken mainly to teach local surgeons, where only two actual procedures were performed.

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

INDUSTRY NEWS

aestheticmed.co.uk

Dysport becomes first toxin to be granted licence update for administration by healthcare professionals in the UK The Medicines and Healthcare Products Regulatory Agency (MHRA) has granted a licence update for Dysport in the treatment of focal spasticity. The update to the Summary of Product Characteristics (SmPC) means that any appropriately trained and qualified healthcare professionals, which now includes physiotherapists, will be able to administer the product to patients for the treatment of focal spasticity within its licensed indications.

Dr Stephen Ashford, consultant physiotherapist at Northwick Park Hospital, London, said, “We are delighted by this news and it means the role of the physiotherapist in administration of botulinum toxin for spasticity management is recognised.”

Physiotherapists and other healthcare professionals are required to complete extensive training and educational programmes that are tightly regulated to ensure they have met the expected standards of qualification to administer BoNT-A injections as part of patient treatment and care. Practice is governed by professional organisations and should comply with national guidelines such as the Royal College of Physicians for adult spasticity.

Dr Marie-Helene Marion, chair of the British Neurotoxin Network, said, “Botulinum toxin type A therapies have been a standard of care for a range of therapeutic areas including spasticity for many years. We wholeheartedly support this expansion to the range of specially trained healthcare professionals who are able to administer these vital medicines.”

Trend for CBD skincare products predicted to rise The global CBD skincare market is expected to reach $1.7bn (£1.36bn) by 2025, expanding at a compound annual growth rate (CAGR) of 32.9% over the forecast period, according to a new report by Grand View Research.

The healing properties of CBD ingredients are expected to encourage manufacturers to develop products infused with these ingredients, thereby driving the market in the coming years.

North America led the market, accounting for a share of more than 40.0% in 2018, owing to high demand and legalisation of cannabis in the US and Canada. Hemp-based products generated a revenue of $147m (£117.78m) in 2018.

CBD is said to help the skin’s natural healing process, lowering the life span of breakouts and eczema flare-ups. It also showcases potential antioxidant properties that can help in counteracting signs of ageing, the report claims.

CBD-based skincare oils led the market and accounted for a share of 40.9% in 2018. This product type is said to be beneficial for skin conditions due to its anti-inflammatory properties.

Breast reduction is safe for young women and teens with excessively large breasts, says study A study published in Plastic and Reconstructive Surgery has concluded that breast reduction surgery is a safe and effective procedure for adolescents and young women with pain and other concerns related to excessively large breasts.

Adolescent reduction mammaplasty remains controversial because of concerns of postoperative breast growth, complications, and the effect on wellbeing.

In the authors’ sample of 512 participants undergoing reduction mammaplasty, the most common complications included hypertrophic scarring (20%) and altered sensation of the nipple (8.4%) or breast (7.8%).

The authors concluded that although complications following reduction mammaplasty were common, the vast majority were minor. Patients had significant postoperative improvements in their physical and psychosocial wellbeing regardless of whether they experienced a complication.

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

INDUSTRY NEWS

aestheticmed.co.uk

NEWS IN BRIEF ONE IN EIGHT CLUELESS ABOUT HOW TO REDUCE DOUBLE CHINS

One in eight Britons wouldn’t know how to get rid of stubborn excess fat around the chin area, research shows. In a survey by body sculpting specialist SculpSure, 12.1% of the British public said they would not know how to reduce the appearance of submental fullness – commonly known as a ‘double chin’. Almost half (46.6%) said they would try to refine a double chin through diet and exercise. However, this area is notoriously resistant to such methods.

DERMATOLOGY DEVICES MARKET WORTH $25.7BN (£20.59BN) BY 2025

The global dermatology devices market size is expected to reach a value of $25.7bn (£20.59bn) by 2025 at a 13.5% CAGR during the forecast period, according to a new report by Grand View Research.

Dermatology devices are expected to grow at a faster rate due to rising concerns among people regarding aesthetics. This has led to growing awareness about various types of procedures used for treating hair- and skin-related disorders.

Since women are larger consumers of skin and haircare treatments, they are considered as key revenue generators for the market.

FDA CLEARANCE FOR FACIAL LINES AND WRINKLES FOR SOFWAVE

Sofwave Medical has received 510(k) clearance from the US Food and Drug Administration (FDA) for its Sofwave system. The Sofwave device is indicated for use as a non-invasive aesthetic treatment to improve facial lines and wrinkles. The 510(k) clearance was supported by a blinded study. According to investigators’ evaluations, 86% of subjects demonstrated improvement in wrinkle appearance of at least one Elastosis Score, while the blinded reviewers identified correctly the pre- and post-treatment photographs for 78% of the treated subjects.

ACOUSTIC SHOCKWAVES COULD BE USED TO TREAT FIBROTIC SCARS

Soliton has announced that it is planning a proof of concept clinical trial for the use of its RAP technology for the treatment of keloid and hypertrophic scars. The Company’s first FDA-cleared commercial product will use rapid pulses of acoustic shockwaves as an accessory to lasers for the removal of unwanted tattoos.

One in five patients at Skin Renew clinics are male, says Superdrug A year after becoming the first retailer to bring an aesthetic service to the high street at the Strand, London, the company has revealed some insights into the uptake and popularity of its Skin Renew Service.

Almost one in five (18%) of all patients treated in the past year have been male, with an average age of 45-49 years old. Whereas women fall into the slightly older age bracket, with an average age of 50-54 years old.

Superdrug has also announced the expansion of its Skin Renew Service into its second London store in Hammersmith.

Caris Newson, head of health and wellbeing services at Superdrug, said, “Since the launch of our Skin Renew Service in 2018 we have seen high levels of customer satisfaction, therefore we’re delighted to be expanding to our third location in Hammersmith. We’re listening to what people are telling us; they would like the reassurance that if they choose to have aesthetic treatments, then it will be administered by qualified nurse practitioners in a safe, private consultation room.

“Our minimum age for this service is currently 25 years old and over. We ensure that when supported by a full clinical consultation, our customers are able to make informed decisions about engaging in aesthetic treatments.”

77% of dermatologists agree sunbeds should be banned in the UK A recent survey undertaken by the British Skin Foundation has shown that 77% of dermatologists think sunbeds should be banned in the UK. The survey also revealed that 94% think unregulated tanning salons are contributing to skin cancer cases in the UK and that there should be stricter enforcement of age restrictions on sunbeds. A further 91% agreed that tanning salons contribute significantly to the rates of skin cancer and that the age at which people are legally allowed to use them should be increased from 18 to 21.

British Skin Foundation spokesperson, Lisa Bickerstaffe, said, “The dermatologists’ opinions appear to support research stating that the potential to get skin cancer, including melanoma, is increased in those who have also used sunbeds.”

NEWS IN PICTURES Award winning clinic group HC MedSpa has introduced Soprano Titanium (ABC Lasers) at its four London clinic sites. Founded in 1993, HC MedSpa is a chain of luxury clinics that provides an extensive portfolio of advanced medical aesthetic treatments in conjunction with premium beauty services. “At HC MedSpa, we’ve merged the worlds of aesthetics and beauty [and are] excited to be able to offer our clients the best possible service, technology and results,” said Saad Aslam, CEO of HC MedSpa.

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NEWS IN BRIEF EXCEED RECEIVES FDA CLEARANCE FOR WRINKLES AND ACNE SCARRING German company MT.DERM has announced that its Exceed microneedling device has been FDA-cleared for the treatment of both acne scars and facial wrinkles. Marketing authorization for acne scarring was supported by an extensive clinical study which demonstrated a statistically significant improvement in facial acne scarring, with 85% of subjects exhibiting a visible improvement in their facial acne scars at the end of the study.

MARION GLUCK LAUNCHES NEW WOMEN’S HEALTH COURSE The Marion Gluck Training Academy has launched its first accredited online course.

Foundation in Women’s Health has been developed specifically to the needs of practitioners looking for essential knowledge in the basics of current hormone management for women. It serves as both a standalone course for all practitioners and a preliminary course for prescribing practitioners who wish to continue training onto Level 1 and 2 to develop competence and confidence in diagnosing and treating patients.

www.aestheticmed.co.uk

University introduces new programme with Dr Tracey Bell and ICE Postgraduate Dental Institute & Hospital The University of Salford has partnered with the ICE Postgraduate Dental Institute & Hospital to introduce a new PGCert in Non-Surgical Facial Aesthetics.

The programme is led by dental and clinical practitioner Tracey Bell, who runs Tracey Bell Dental and Aesthetic Medical Clinic, and is aimed at doctors, nurses, and dentists who are looking to obtain a qualification at Level 7 in botulinum toxin and dermal fillers.

The course is structured as a PGCert and focuses on developing student’s clinical skills and fosters an approach to lifelong learning. Students have access to mentors provided by ICE to support their education and training while building an ePortfolio of clinical cases.

Bell said, “I am delighted that the University of Salford has recognised the need for a university programme and, I believe, by providing an overview of those facial cosmetic procedures, it will lead the way in an educational structure that will become a necessary framework for practitioners like myself to achieve.”

DR RAUL CETTO WORKS WITH WEST HAM UNITED WOMEN’S TEAM Dr Raul Cetto will offer insights into skin health and care to the West Ham United women’s team, in collaboration with ZO Skin Health. The appointment of Dr Cetto comes follows ZO Skin Health becoming West Ham United women’s team official team sponsor from April 2019 and the company’s decision to take a proactive approach to help maintain player’s skin health. Dr Cetto will be focusing on common skin issues due to players being exposed to UV radiation and pollution during outdoor training sessions and matches.

CLEARCOURSE ACQUIRES CLINIC SOFTWARE COMPANY E-CLINIC ClearCourse has announced the acquisition of patient and clinic management software provider e-clinic. The deal is ClearCourse’s 13th since its foundation in October 2018. e-clinic helps its clients streamline operations through workload automation and workflow management. ClearCourse will work closely with e-clinic’s senior team, providing operational expertise and financial resources to bolster and support the company’s ambitious growth strategy and continued platform development.

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Facethetics Training launches nationally accredited course in cosmetic injectables Facethetics Training has launched a Level 6 educational course for cosmetic injectables. Devised by Yvonne Senior and Alison Stananought, the programme was created with quality education and public safety in mind.

The Level 6 programme, which is accredited by Gatehouse, is one of only a handful of Ofqual-regulated courses in Britain.

Senior, who is the lead educator at Facethetics Training, said, “I’ve been working within the aesthetics industry for almost two decades and, in this time, have seen non-surgical aesthetics explode into what is now a very successful but potentially dangerous market. As poor practice and underqualified injectors with questionable backgrounds continue to carry out procedures, we must create a better standard from day one.

“We’ve created something really indepth and unique, with our students benefiting from e-learning, real-life injecting, supervision and assessment and post-course support. By staging the path to Level 7 with the introduction of the first ever Level 6, we’ve been able to break down the learning process into a more cost and time efficient one.”

The course is delivered in the heart of the North West in the company’s south Liverpool-based training facility and is one of only a few chosen educators for major aesthetic product corporation Merz Aesthetics.

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Should you be paying VAT? Following a recent VAT tribunal involving an aesthetic clinic, we re-examine the issue of VAT in aesthetics

T

he aesthetics industry hit the national headlines again this summer, this time over the issue of VAT on procedures. With headlines reading, “Botox is not a medical procedure so VAT will have to be added” a wave of panic and confusion swept across the sector. Tax experts have been warning aesthetic clinics that HMRC is cracking down on VAT on procedures deemed to be ‘purely cosmetic’ for a number of years now, but the recent tribunal brought the issue firmly back into the spotlight.

The case in question involved a VAT tribunal in June, 2019, against the Skin Rich clinic in Richmond, London.

The question posed was whether botulinum toxin and other injectable treatments were exempt from VAT. The tribunal ruled that, in this case, the primary purpose of the treatments was not “protecting, restoring or maintaining health and thus not medical care”. They were therefore not exempt from VAT. Veronica Donnelly, a tax expert at Campbell Dallas, explains, “The headlines don’t actually give the true story. It’s not as bad as it looks but, that being said, assessments like these have the potential to put people out of business and so there is an understandable panic across the industry. The test for medical exemption in relation to VAT remains the same; the supply must be made by a person on a medical register, or someone supervised by that person, and the treatment must be one of medical care. The appropriate records must be kept to evidence these treatments and their medical purpose, and it is on this evidence that HMRC will rely.”

The court agreed that just because a treatment has a cosmetic benefit, this does not preclude it from also having the principal purpose of protecting, maintaining or restoring health and therefore being VAT exempt. However, it went on to say that, in this case, “we do not find that this principal purpose has been established”.

This was because, it said, some of the treatments performed at the clinic were not diagnosed by a medical professional and for those that were, it was not satisfied that the evidence produced was sufficient to prove a medical purpose for the treatments.

“This case turned on its own facts largely in that the evidence they produced wasn’t sufficient to convince the tribunal”, Donnelly says.

be VAT registered. If your total turnover is under £85,000 you are not required to be registered for VAT and HMRC can’t assess you. However, as Donnelly explains, “If there is a mixture of medical and cosmetic treatments in your business, the £85,000 only applies to the cosmetic element.

So you could have £1 million turnover but not be required to be registered because the cosmetic treatments within that million are not over the £85,000 threshold. As a starting point, HMRC will always look at your total turnover so if you are near or above £85,000 you should have your records up to scratch. It will look at total turnover and then say ‘now prove to us that the taxable element of it is under £85,000’.

However, until it establishes that there is a requirement to register for VAT, it should not start by reviewing your sales and purchase records. Your proof lies in your consultation notes and diagnostic records and HMRC should start there.”

‘Purely cosmetic’ or ‘for a medical purpose’ VAT law allows for the exemption from charging VAT for a service if there is a medical purpose to that service AND where such a service is delivered by a healthcare professional. This includes doctors, dentists and nurses. Where the purpose is ‘purely cosmetic’ then VAT would be chargeable at the standard prevailing rate, which is currently 20%.

Importantly, VAT is a European Tax and HMRC in the UK does not have the final say in how VAT law should be interpreted. HMRC’s focus on the patient perspective was successfully challenged in a landmark ruling by the Court of Justice of the European Union.

Dr John Curran, a founder member of the British College of Aesthetic Medicine (BCAM), has been working on providing clarity on this issue on behalf of BCAM members for the past 11 years. In speaking to us, he stresses that BCAM cannot lawfully give tax advice and advised those with genuine concerns to seek independent professional opinion and guidance. He says, “Even if the practitioner’s business is registered for VAT, each patient/treatment should be assessed on a case-by-case basis (as being exempt or nonexempt using the ‘purely cosmetic’ criteria).

“The European Court of Justice (ECJ) has interpreted ‘medical’ for the purposes of this law to include psychological and psychosocial reasons as well as preventative healthcare. The ECJ considered, in determining purpose, that it was the clinician who decided if the interaction with the patient had a medical purpose or was ‘purely cosmetic’.”

As aesthetics by nature has a cosmetic element to it the line has often been blurred as to the medical nature of certain treatments, despite most of the procedures >

The appropriate records must be kept to evidence these treatments and their purpose

VAT: WHAT IS THE LAW AS IT CURRENTLY STANDS?

Over the threshold The current UK threshold for VAT registration is £85,000. If your taxable turnover is more than £85,000 you will need to

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not just what I’m doing, it’s also why I’m doing it. Practitioners must not view this as a tax planning scam and start shoehorning everything they do under the ‘medical purpose’ banner to avoid paying VAT. It’s about seriously considering the purpose of the treatment they’re doing, what they are doing and then writing it down. If anybody tells me they are 100% medical and therefore completely exempt, they will get some degree of initial cynicism from me, never mind HMRC. It might be true but they are going to have to prove it”.

being provided by doctors, nurses and dentists. For example, performing laser hair removal on a bikini line because the client doesn’t want to shave or wax is different from removing facial hair caused by hirsutism or polycystic ovaries, or where someone has a psychological problem because of excessive hair growth.

Dr Curran says, “In [our interactions] with HMRC we were able to establish that a wide range of cosmetic dermatology treatments may have a medical element to the purpose, including the more common procedures such as botulinum toxin injections, IPL and the use of dermal fillers. However, HMRC has stated that it would need to see some evidence of a medical element to a treatment. Such evidence would be in the form of good medical records, including consent and setting out a medical purpose. This purpose may be one where a cosmetic procedure is undertaken to help with a patient’s underlying anxiety regarding a specific feature.

“It is my strongly held opinion, having read ‘Good Medical Practice’ (GMC), that it is unethical for a doctor to treat a patient for purely cosmetic reasons without giving regard to protecting the health of the patient.

To do so would be to put the health of the patient at risk without any health gain, something I believe our professional body would view negatively.

“Every time a doctor takes on a doctor/patient relationship they are practising medicine. Therefore, in all the things you do, you have to behave like a doctor. You must write notes. You must consent. You must have a duty of care. You must maintain patient confidentiality. You must take responsibility if it goes wrong. You must tell the patient about their options. You must have a purpose for doing something, write down why you are doing it and be able to explain that to a group of your peers. If you have no medical reason for doing something, you should tot up your £85,000 and charge your patient the VAT. You need to honest about it and say ‘there is no medical reason for me to do this’.”

But Donnelly stresses that just because the person performing the treatment is medically qualified, this is not enough proof that the treatment is for a medical purpose in tax law. She says, “It’s not just the case that if you are a doctor, you are always providing medical care. That may be the case in medicine, but it’s not the case in tax. Under medical ethics there are certain things doctors can and can’t do but in tax case law being on a medical register does not stop you from doing something that is not for a medical purpose. The test is not whether it’s medical treatment being performed by a medical person, it’s whether it’s for a medical purpose. So it’s

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A note on item 4 Another factor that came into play during the recent tribunal was the issue of state-regulated clinics or hospitals (CQC-registered clinics or HIS-registered clinics in Scotland).

Donnelly says, “Up until now the test has been articles 1 and 2 of the VAT Act where we talked about the provision of medical care by a professional. What this case did was start to address the question of item 4, which talks about provision of care by a state-regulated clinic or hospital, and that is particularly interesting. The case specifically said that had this type of registration been in place HMRC would have accepted the treatments as being the provision of care. You’ve still got to demonstrate the medical care, but it’s a softer test and again it comes down to the quality of the records.”

Evidence and good record keeping Both Donnelly and Dr Curran agree that providing evidence not only of your training and expertise but also of your consultation process, diagnosis and reasons for doing each treatment on a case-by-case basis is absolutely key. If HMRC does investigate you it will all be about the evidence and your records could be your saving grace or downfall.

Dr Curran says, “I know of six clinics or individuals currently dealing with an approach by HMRC regarding medical VAT. As they approach tribunal stage it is likely an expert will be appointed to review notes to determine if there is a medical basis for treatment. This is where the case will stand or fall apart. I cannot state too strongly the importance of good medical record taking and, in particular, thinking hard about the purpose and highlighting the medical/psychological benefit of treatment.

“The consultation process [should be] at the standard of any other medical consultation, carefully establishing why the patient is seeking treatment, the psychological impact of the presenting concerns and associated physical symptoms, and stating a therapeutic purpose for intervention. Such an approach will benefit patient and clinician alike.”

Donnelly adds, “The sector needs to stop burying its head in the sand and start addressing its record keeping. You have got to be able to demonstrate your medical qualifications and the fact you’re providing medical care. Your records need to show this and need to be detailed enough to stand up to scrutiny. Our advice continues to be for businesses to look very carefully at their record keeping and evidence of medical purpose. There are no shortcuts. Where you can clearly evidence a medical purpose the treatment is exempt from VAT. If not, it’s cosmetic and subject to VAT if you are VAT registered.” AM You can read the tribunal ruling by visiting financeandtax.decisions.tribunals.gov.uk/ judgmentfiles/j11271/TC07310.pdf

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VAT for rookies David Redfern, tax preparation expert and managing director of DSR Tax Claims, shares his guide to VAT for beginners

V

AT is seen as one of the most confusing taxes for both small businesses and consumers in general.

While it is a familiar part of daily life, due to its regular appearance on till receipts and invoices, consumers are often unaware of why it is being charged. Meanwhile, a governmental review for the Office of Tax Simplicity showed that many small businesses find VAT a barrier to growth.

VAT, or Value Added Tax, is a business tax charged on certain goods and services. VAT-registered businesses are obliged to charge VAT on their business sales of goods and services, as well as when hiring or loaning goods, selling business assets and when making commission payments.

These are known as “taxable supplies” and a business which is registered for VAT is required to charge the relevant rate of VAT on these. However, you cannot charge VAT on your goods and services if you aren’t registered for VAT with HMRC. While most taxable supplies are to be expected, there are a few which may come as a surprise – for example, VAT is still chargeable on goods which aren’t sold for cash but are bartered or partexchanged instead. Items which are sold to employees are also classed as a taxable supply and must be subject to VAT if your business is registered for VAT. Businesses which are registered for VAT must charge VAT on their taxable goods and services and are obliged to send a VAT return to HMRC on a quarterly basis.

Most taxable goods and services are taxed at the standard rate of VAT, which is currently 20%. The standard rate has remained at 20% since April 2011, although historically it used to change each April. Certain goods and services, such as child car seats and domestic fuel, are chargeable at a reduced rate of 5% while certain goods

and services are classed as zero-rated. Goods and services which are classed as zero-rated must still be reported on in your VAT return but you must charge a zero rate of VAT on them. Examples of zero-rated goods are children’s clothing and shoes as well as motorcycle helmets. Goods exported to non-EU countries are also zero-rated. In addition, there are certain goods and services which are exempt from VAT, such as medical and care services, education and vocational services as well as burial and cremation services. These don’t need to be reported on for VAT purposes although you should still record them in your general business records.

Goods and services provided to charities can benefit from a reduced rate of VAT. Businesses are required to register for VAT if they have a VAT-taxable turnover of £85,000 or more. A business calculates its VAT-taxable turnover as the total value of all the goods and services it sells which are not VAT exempt. Unlike other taxes, this is a rolling 12-month threshold, not a fixed period such as a tax year or accounting period. This means that if you believe your turnover is close to the threshold, you need to keep a close eye on it and register for VAT when it exceeds the £85,000 threshold. You can register for VAT voluntarily even if your business is below the threshold if you believe it will be advantageous to your business but you won’t be required to do so. Once registered you must charge VAT on your non-exempt goods and services. Once registered, a business will be required to submit a VAT return to HMRC every three months, reporting on their total sales and purchases, how much VAT the business owes and how much it can reclaim on business purchases.

Businesses must submit a return even when there is no VAT to pay or reclaim. A Final VAT return will be due if you cancel your VAT registration. AM

VAT is seen as one of the most confusing taxes for both small businesses and consumers in general

David Redfern is the managing director of DSR Tax Claims Ltd, which specialises in identifying potential allowable expenses for tax rebates for clients. He can be contacted on 0115 795 0232. Further information can be found at www.dsrtaxclaims.co.uk

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TALKING TO

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Rising star From full-time anaesthetist to one of Cheshire’s leading aesthetic experts, Dr Ahmed El Houssieny shares his rapid success story with Fiona Vlemmiks

D

r Ahmed El Houssieny hasn’t looked back since turning his expertise to aesthetics just six years ago. An honorary lecturer at the University of Chester and an educator on cosmetic procedures to future practitioners, his advanced injectables services are also much in demand at several renowned clinics in the North West.

In August 2018, he launched his own clinic, Dr A Aesthetics, operating in Cheshire, home of the rich and renowned.

“I was inspired by a colleague who had gone into aesthetics when I was working as anaesthetist,” he explains. “After visiting his clinic, I knew it was for me and began training in the field. I’m always hungry for knowledge and spent time training extensively. Becoming a trainer myself has been a dream come true for me.”

Still working as an anaesthetist, Dr El Houssieny’s whirlwind aesthetics schedule involves three days working at the acclaimed Greater Manchester aesthetics chain

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Skin Viva and a day in clinic at SkinGenius in Stockton Heath working alongside founder Martine Jarman. The rest of his time dedicated to Dr A Aesthetics. “It’s wonderful to work alongside such accomplished aesthetic practitioners,” he says. “The collaboration with Martine has worked really well, she’s a true professional, and leader in the field, who has shared a wealth of industry experience and knowledge.”

Dr El Houssieny’s precision and bespoke approach to treatment has ensured he’s a favourite with local celebrities and other clients who travel from as far as Switzerland for their appointments. “I have a presence on social media but it’s word of mouth that’s been the most important for me,” he admits. “I see a lot of local people but my clients travel from all over. I have people come from Scotland, London – I even have clients fly in from Switzerland. If people really trust you they won’t want anyone else. Sometimes there’s a bit of a waiting list, but now I have my own clinic I can better accommodate people’s schedules.”

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CLIENT CARE

The client demographic at Dr A Aesthetics is largely derived from women aged 40 to 60. “I do have some younger clients who usually want what is trending on Instagram and often arrive with a photo on their phone showing what they’d like to achieve,” says Dr El Houssieny. “They favour lip and jawline enhancement. The male clients tend to be very specific in what they want and ask for fast results. However, my main client demographic, females aged 40 and over, are usually more receptive to what I feel they’d benefit from.

With them, there’s often an emotional component. Instead of saying ‘that wrinkle bothers me’, they explain ‘I look sad, I look tired, what can you do?’”

In addition to anti-wrinkle injections, Dr A Aesthetics offers clients a full range of services, including dermal fillers, lip enhancement, non-surgical rhinoplasty, microneedling, Profhilo, skin peels and skincare. “My approach is holistic,” says Dr El Houssieny. “When I started out in aesthetics, there was a focus on tackling a problem area but now, for me, it’s more about facial harmonisation.

I don’t want people to say to my clients ‘where have you been’? I want them to say ‘you’re looking well’. This means that I have to go deeper than just looking at a particular line or wrinkle to achieve harmony.

“Whatever their concerns, when I assess clients, after a very in-depth consultation in which we discuss objectives, expectations and medical and aesthetic history, I look at the whole face and my treatment plan may involve an integrated approach including peels, skincare, injectables and fillers.

However, I am not in favour of dramatic transformations. I like to take things slowly, softening and improving gradually over periods of time.”

Dr El Houssieny believes that his background as a medical doctor and aesthetic trainer ensures that he is completely comfortable in saying no to clients. “The first rule of being a doctor is ‘do no harm’ and I think being a doctor has made

me even more risk adverse. About 40% of patients leave my clinic having being advised not to have treatment. I am comfortable telling my patients no – or perhaps telling them that’s enough for now, we should wait a while.”

FOCUS ON SKIN

Skincare is a passion for Dr El Houssieny, who spent a week training with Dr Zein Obagi in California. He now uses the ZO Skin Health peels and skincare line in the ELZ clinic. “I was fortunate enough to spend a week with Dr Obagi in Beverley Hills and it was a life-changing experience for me. I gained so much information and experience in just a week. Many clients don’t take care of their skin properly and just want a quick fix. There is so much you can do underneath the skin with injectables and fillers but to get truly great results, you need to address the skin itself, too.”

Dr El Houssieny is a strong advocate of Allergan’s Juvéderm line, including Volite for skin hydration and the new Volux for sculpting the lower face.

“The quality of the fillers I use is very important and I am really proud to be using the Juvéderm range because it allows me such great, natural-looking results. It has minimal side effects and maximum patient satisfaction – what more could I ask for?”

He also advocates the AQUAGOLD fine touch, a goldplated microinjection system that can propel a bespoke cocktail of skin enhancing ingredients deep into the skin to improve tone and acne-related problems.“When I launched my own clinic, I not only wanted something closer to home where I could be flexible with patients, another aim was to offer a one-stop-shop where clients could come for all their aesthetics needs. I’m not far from that now, but there’s a little way to go so that’s the plan for the future.

Dr El Houssieny has carved a niche in a highly competitive market and hopes to continue to build his knowledge and profile as an expert in the field, both nationally and internationally. He says: “To be able to teach in this sector, I have to be able to practice at the highest standard and I am continually learning and seeking out new knowledge and treatments to ensure I am at the top of my game.” AM

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BUSINESS

EMPLOYMENT

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On the up

Victoria Vilas discusses how to promote team members

P

romoting one of your clinic employees can be a rewarding experience, as you get to see one of your valued team members progress and achieve the recognition and responsibility they deserve. It can also be challenging, as you have to make an important business decision that is crucial to the success of your team, and one that may disappoint others who may have been hoping for a promotion themselves.

To ensure that you are making the right decision for both your business and your team, set criteria you can use to decide who should be promoted, and follow the same checklist every time you consider someone for promotion. This way your decision is fair to all team members, and will be based on objective assessments of performance, attitude, and ability.

remit would be first. It may be that a management role is soon to become vacant and you are thinking of an internal promotion, or it may be that you are creating a new position in response to business needs. Either way, you should have a detailed job specification prepared so you can measure your candidates against the needs of the role.

Once you have a job specification for your senior position, you will be able to see what skills, experience, and attributes a person will need to excel in the role, which will help you shortlist only employees who match those requirements. A job specification will help you narrow down the field of candidates, but you will also need to consider whether an employee deserves a promotion, and whether they really want the role you have in mind for them.

You shouldn’t feel obliged to promote an employee simply because they are older than other team members, have been with the team for longer, or because the employee feels it is their right to be next in line, and they threaten to leave if they don’t get a more senior role. You also shouldn’t promote someone based on personality alone, as although someone >

Set criteria you can use to decide who should be promoted, and follow the same checklist every time you consider someone for promotion

SELECT CRITERIA FOR PROMOTION

Perhaps you are considering promoting one of your team to a management role, or one where they will be training, mentoring or supervising others. Before you try and choose an employee to promote, work out what their

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likeable may be good at communicating with the team, it doesn’t necessarily mean they will be good at other management tasks.

It is appropriate to consider someone for promotion if they have the right attitude and attributes to manage, supervise or train others, and they are keen to move into management. Remember that some employees may have the qualities needed to be superb managers, but they may not want a management job, so don’t make assumptions before you have consulted with your staff members.

You should also select team members who are keen on progressing for the right reasons. Some may want a promotion simply because they want a higher salary, not because they have enthusiasm for the new role.

When looking at your candidates for promotion, you should look at their progress since they have been at your clinic, and consider their achievements. Has your candidate excelled at their given tasks and gradually taken on more responsibility?

Have they approached their new challenges with focus, enthusiasm and gratitude? Do they have a strong work ethic, motivation, and a positive attitude? Are they consistent, reliable, and a team player? Are they clearly capable of more?

Your shortlisted candidates should all meet the requirements of a more senior role, and have the right attributes, attitude and achievements to make them worthy of the promotion.

CONSULT WITH YOUR CANDIDATES

Once you know which of your employees may be worthy of a promotion, arrange to speak to them to discuss the opportunity. Explain your reasoning and the details of the new role you would like them to take on. Hopefully, they will be excited by the news, but allow them to take some time to absorb the information before they commit.

If you are making a choice between a couple of candidates,

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then consult with both to inform them of the process, and allow them to consider the proposal and give you feedback before you make a final decision.

CONSULT WITH YOUR TEAM

When you promote a staff member, don’t leave it to your employee to announce it to the team. As the clinic owner or manager who has made the decision, it is wise to make the announcement to the team yourself, along with an explanation of what change is being made to the team structure, why you made your decision, and how you came to your conclusion.

If your team know the criteria you adhere to when selecting staff members for promotion, it will help them understand why someone has been chosen, and hopefully feel less resentment for not being chosen themselves. If you demonstrate that you are being objective, other team members will see that your choice is based on valid reasons, not favouritism. It will also demonstrate how they could be considered for promotion in future, too.

It will be easier for a new manager or supervisor to be accepted by the team if you can generate buy-in from other team members, so think about getting your staff members together for a team meeting after your announcement.

Promoting a team member isn’t about separating colleagues or creating a culture of ‘them-and-us’, so it is wise to stress that despite a change in remit, you still expect your new manager and the other team members to work closely together.

Allow your newly promoted employee to settle into their new role, giving them time to understand their new duties.

Remember to give them support when needed, and arrange additional training if it would be useful. A promotion may be a reward for an employee, but it is also a move that should help your business develop and grow, so take the time to nurture your valuable team member. 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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BUSINESS

COMPETITION

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AHEAD OF THE

competition Gilly Dickons on how to deal with growing competition in the sector

O

ver the past decade there has been a huge surge in demand for aesthetic treatments across the UK, with clinics springing up on every high street. Thousands of medically trained professionals are now offering aesthetic treatments and, with more and more aestheticians and beauty therapists entering the market place too, the competition is growing rapidly year on year.

Whether you are running a well-established clinic or are in the process of setting up a new practice, you can’t afford to sit back and assume that you won’t be affected by the growing competition in this sector. It is essential to protect the valuable business you have by retaining clients, while at the same time working hard to attract new ones in this challenging market place.

Whether you are a new practitioner looking to hit the ground running in the industry, or a long-established clinic with an extensive client base, you will know how important, and challenging, it is to stay ahead of the curve, keeping up with new trends and developments, as well anything else that comes your way to impact your business.

One key to keeping up with this ever-growing sector is to ensure that you have based your business on a very strong foundation built on research and knowledge. With this in mind, there is a wide range of things that you can do and work on to ensure that your clinic stays ahead of the competition.

Laying these foundations involves being knowledgeable about your existing clients, potential new customers, and what your competitors are up to.

One key to keeping up with this evergrowing sector is to ensure that you have based your business on a very strong foundation

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The research that I will go on to suggest is something that you can do for yourself, or, if you are struggling to find the time yourself, you could delegate to an employee, friend or relative as the steps are fairly simple to carry out.

The important thing here is that you acquire the information needed to help influence your business decisions.

IDENTIFY YOUR TARGET MARKET

Are you clear about who your target market is? You need to consider who you want to attract to your practice by taking into account their age, gender, treatment preferences and spending habits. I would suggest that you undertake some research into different age groups, their communication styles and buying habits. For example, how do Millennials differ from Baby Boomers? Have you heard of Generation X (those born between 1965 and 1976)? You will benefit from having a basic understanding of the changing generations, what influences their choices and how their buying habits differ.

You can find lots of information online through a quick search.

Within this kind of research you should also consider your treatment portfolio. Which treatments do you currently offer, or what are you planning to offer? What is currently trending in the media and amongst your existing clients? What are your strongest competitors offering and promoting? What industry research is available? Look at your target market and link the treatment trends with them. What treatments are Millennials undertaking?

What procedures are the most popular with Generation X? You need to consider where your practice is located: are you in an affluent area? Based in a town centre? On a high street with a shop front?

In a home clinic in the suburbs? Differing locations will require slightly different marketing messages to attract potential clients.

SO WHAT WILL DIFFERENTIATE YOU FROM YOUR COMPETITION?

In today’s busy marketplace you have to have something to give you the edge. So what is there about you and your practice that makes you stand out from your competitors?

Here at AR we talk a lot about USPs (Unique Selling Propositions), this is because they are so important to your business and we truly believe in them. A business’s USPs are features or characteristics that set the business apart from the competition, in other words – what do you have that your competitors don’t? >

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won any awards for your treatments? Do you use awardwinning products? Work with award-winning brands?

Have people commented on the types of treatments and products on offer in your clinic? Remember that clients will come to the clinic with a specific treatment in mind – it’s up to you to showcase your work.

ASSESS AND PLAN YOUR PORTFOLIO

Identifying your USPs can take a lot of thought and consideration. With this in mind a good place to start would be to try to identify your competitors’ USPs by looking at their websites and promotional materials – we will cover more on this later in the article.

For your own USPs, you can think about breaking them down into three Ps: Practitioner, Practice, and Procedures: Practitioner: The identity of the person administering aesthetic treatments is important to clients. They want to know who is treating them, and about their relevant experience in order to establish trust. As the practitioner, you should think about identifying at least four key USPs for yourself.

These could be based on fact or feedback. An example of a fact would be to state how many years’ experience you have, or what qualifications you hold. Feedback, on the other hand, comes from any testimonials and reviews where clients have commented on you as a practitioner.

Keeping procedures in mind, it’s important for you to consider your most valuable asset – your time. If you want to stay ahead of the curve, you will need to make sure you are making the most return possible for the time spent treating patients. If you assess the average appointment time for each treatment you offer you should be able to allocate the cost of the treatment and products. This will allow you to see which has the best hourly return, and you will be able to prioritise certain treatments over others (this will be dependent on other factors, such as popularity).

Careful analysis of your time in clinic carrying out treatments will allow you to make decisions that you may not have previously considered.

For example, if you find that your time is limited but demand is high,

Practice: The place where clients receive their treatments is crucial to potential customers. Think about where you are based: what are the best things about the premises and the area?

Think about the building in which your clinic is situated. For example, if you practice from a beautiful listed building, you should promote it! Again try to look for four key USPs using facts and feedback. Has anyone commented on the environment or the atmosphere in clinic? Use any good feedback to your advantage.

Procedures: Finally, the treatments you offer can also be used as your USPs. What makes the treatments you offer better than others? Think again about fact and feedback: have you

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increase your prices! Similarly, if you have ample time you might want to consider lowering your prices so that they are more competitive and may attract a higher number of clients. Again, you need to find what works best for you.

If you find that you have a lot of people not attending booked appointments (a high DNA rate), I would suggest introducing deposits or holding fees for bookings to ensure your valuable time is not wasted. Further to this, if you do indeed find that demand is outstripping your clinic time you could consider charging a non-refundable consultation fee.

Reviewing your time on a regular basis will allow you to make these decisions and will aid the success of your clinic in the long run.

KNOW YOUR COMPETITION

I have already touched on the benefits of identifying your competitors USPs and the goal here should be to cast a wide net and get a comprehensive view of the competitive landscape. Most of the information you will need is online, so spend a little time searching clinics and practitioners within a 30-minute radius. It would be useful for you to log your competitors’ information on a spreadsheet so that you can refer back to it and track changes. Consider who would be a direct competitor (primary competition), and who offers similar products, but in a different price range (secondary competition).

Once you have done this you will be able to look at your competitors in more detail. Look at their website: how clear are their messages? Are their USPs obvious on their website?

Consider how easy their site is to navigate: will potential clients be able to contact them easily? You should also look for any social media links, or calls to action. Is the phone number or email address more dominant? Ask yourself, if you were a firsttime customer, would you get in touch with them based purely on the website experience?

This kind of information will be very useful if you are in the process of setting up a new clinic. However, if you haven’t already done so, it will also be good for you to do this research to support your business at whatever stage you are at. To ensure you are able to gather as much information as possible, make sure you sign up to their newsletter and follow them on social media. How do they engage with their clients on social media? Are they friendly, very casual or more professional? Look at how frequently they post and whether you need to step up your social media activity or draw it back if it’s not working.

To take it a step further and get a real insight into their customer experience, mystery shop them. Call them up as though you were a first-time enquirer and see how they

handle your enquiry. Try emailing an enquiry and look at the response you receive (if they send one at all!). Is it welcoming and warm? If you were a potential client, would it encourage you to book? If the response is impressive, relate it back to your own – is there anything you could emulate?

Another thing to look for with your competition is their pricing. If you are a new practitioner planning to start-up, you may be unsure where to start with your clinic fees.

Looking at the competition in your area should give you a fairly accurate indication of what people are willing to pay for treatments. If you are an established clinic, this information may encourage you to alter your pricing. Be careful, however, not to compromise on your fees as you must maintain profitable margins in order to keep your business running.

As a final way of gaining valuable insight into your competition, take the time to search for any testimonials and reviews about their services. What are clients saying about them? Are there any articles that promote their treatments? Look at their online presence as a whole, whether it’s published by them or not. This will give you as clear a picture as possible about their business.

It would be useful for you to log your competitors’ information on a spreadsheet so that you can refer back to it and track changes

KNOW YOUR CLIENTS

In order to treat your clients, you should know them inside out. Put yourself in your clients’ shoes and think about what you believe they really want. Do you think your clients simply want their fine lines and wrinkles treated? In reality it’s likely that they are looking for more than that. When people are “shopping around” for a clinic, there will be many things on their wish list, such as experience, treatment outcomes, quality, discretion, convenience, reliability, friendliness, cleanliness, customer service, and feeling valued and pampered. The price of the treatment will not be the only or most important reason as to why clients come to you for their treatments. You need to understand what motivates your clients’ buying decisions.

You also have a reliable source of information right at your fingertips – your existing clients! These people are your best source of information. You should take time to ask them why they come to your clinic and what makes them come back to you for treatments. Once you understand what it is they like about you, you can use it to promote your treatments to new clients.

The key to success in this ever-fluctuating industry is to make sure you have carried out your research for every aspect of your practice. You need to lay strong foundations so that you can adapt as this vibrant sector grows and the steps identified here can help you to stay ahead of the competition. AM

Gilly Dickons is the managing director of Aesthetic Response, which provides an award-winning, expert enquiry handling and diary management service to UK aesthetic practices. Dickons’s 30-year career in the aesthetic arena has provided experience in multiple roles, including client facing, marketing, and clinic management. AR’s management of more than 150,000 calls a year on behalf of aesthetic practices across the UK and Ireland enables Dickons to share a unique and valuable insight into the constantly evolving aesthetics sector and the challenges business owners face in this increasingly competitive marketplace.

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BUSINESS

ASK THE EXPERTS

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Ask the Experts Why is social media not working for my business?

U

nderstanding what does and doesn’t work on any social media platform can, at times, seem like a dark art. That’s because behind the scenes of every social media website there’s a complex algorithm working to determine a post’s quality.

Using a number of factors, that algorithm decides whether your post is good enough to take prime spot in a timeline.

It’s no surprise that the exact science of what these algorithms are looking for has never been revealed – otherwise we’d all have perfect posts every time. But, thankfully, there’s now plenty of practical evidence to suggest which techniques work well. Here are a few of them to help your business get ahead.

GET THE RIGHT KIND OF ENGAGEMENT

Facebook looks for “meaningful content” to push to the news feed. Simply put, this is content that is likely to generate the “right” kind of engagement from people.

This means avoiding “engagement baiting” tactics. Telling people to “like/share if you agree…” might seem like an easy way to get a fast engagement boost, but Facebook’s algorithm is smart to phrases like this and they’re read as spam and are marked down.

Instead, aim to create content that will spark comment or conversation. If you’re posting photos of a treatment, ask a relevant question in the text of the post. If the image alongside it is good, you’ll get engagement from people “liking” the image and commenting on it. Facebook will see

you’ve sparked commentary and will want to push that post to more people to encourage further engagement.

VIDEO REMAINS THE LEADER

Despite algorithms being regularly updated, video content continually performs better than all other types. Video is the perfect opportunity to allow your audience to build a relationship with you before they’ve even come in to your practice. It also ticks the “meaningful content” box as it’s most likely to encourage people to comment and interact.

LEARN TO LOVE NEW FEATURES

Other than video, when social media platforms update their algorithms there’s usually a shift to focus on newest features. Given the time put in to developing these features, it’s no surprise that social platforms reward those who use them.

Instagram’s IGTV is a prime example. Earlier this year, the platform introduced a feature that allows you to post a oneminute preview of an IGTV video to your grid. These videos regularly draw in up to four times the views of a normal video posted to the grid.

Similarly, there’s evidence that Facebook Stories are performing well for those who use them. While they’re nowhere near as popular as Instagram Stories, Facebook continues to push them strongly – implying they’re not going away anytime soon. Adopting them now, when the market is less crowded, could be an easy win for your business. AM

Chris Halpin is social media editor for Aesthetic Medicine and Professional Beauty Group. He is experienced in digital marketing marketing and specialises in pay-per-click, SEO and social media management.

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BUSINESS

LEGAL

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Leaving time If an employee resigns impetuously after a disagreement or incident, should you let them change their mind? David Wright explains the legal procedures you need to follow

M

ost business owners will experience a situation where they, or a manager, fall out with a member of staff, which leads to the employee resigning on the spot. They might walk out, and may not put their resignation in writing. So, what happens if they turn up for work the next day saying they’ve changed their mind or acting like nothing happened?

Generally, an employee who resigns cannot withdraw their resignation just because it was given in the heat of the moment. The decision as to whether to accept the change of mind is almost entirely the employer’s, but you should always look at the circumstances that led to the resignation, and the words that were used, before making a final decision.

If the employee didn’t give a written resignation, that’s a big issue if your contract says that notice has to be given in writing. If you don’t want the employee to leave, you might be happy to forget the incident. However, if the employee isn’t a model worker, or you simply can’t ignore the argument and what was said, then you face a more complicated situation.

It leaves the door open for the employee to argue that they had not meant to resign, that you overreacted, and to make a claim at an employment tribunal.

PREVIOUS CASES

The question of whether an employee did or did not resign has been considered in a number of cases. Previous decisions from employment tribunals have indicated that sometimes there are special circumstances and the employee hasn’t resigned.

The general advice is for the employer to consider: The context in which the resignation was given – cases where a tribunal decided the resignation didn’t stand included when the employee had been pressured or provoked by a manager.

The words used – “stuff your job, I quit” is very different from “I have to decide if I want to work here anymore”.

If there are special circumstances, the employer should wait a few days before acting on the resignation, giving the employee a window of opportunity to change their mind.

In the past, I have suggested writing to the employee to say you will accept their resignation and notice period but are allowing them time to reconsider. Allow a few days, but indicate that if you haven’t received any contact by a set date, you will process their resignation.

That will go a long way to protecting you from any tribunal claims. What is a reasonable period of time will depend, to a degree, on the details of the case, but a day or two is usually sufficient. You have then been seen to have allowed a cooling-off period and the employee cannot argue their resignation was in the heat of the moment.

The employee may well turn up for work the next day, tail between their legs, and it’s agreed they haven’t resigned. But if an employee walked off the job and left clients high and dry or shouted in front of them, you will reasonably be able to discipline them and in some cases dismiss them. Of course, you need to follow your disciplinary procedure to the letter. 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 for UK salons.

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

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DOSSIER

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TRENDS

On trend Aesthetic medicine is an industry that is constantly evolving. In this 11-page special we examine some of the latest trends on the market from influences from the innovative Korean beauty sector, to consumer driven trends and the rise of treatments for “tech neck” and beard transplants

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TRENDS DOSSIER

TECH NECK

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Tech Neck Do your clients feel that technology has contributed to their neck ageing issues?

If so, they’re not alone. Rebecca Barnes investigates the rise of ‘tech neck’

I

t’s been a beauty buzzword for a while now, but there’s no doubt about it, ‘tech neck’ is a first-world problem that more people can relate to. But what exactly is it?

Tech neck is defined as jowls, creases, lines and sagging skin that form on the neck due to looking down at a device or screen for extended periods of time.

While the digital era in which we live in has undoubtedly transformed our lives, for our fragile neck skin it’s perhaps not such good news. The length of time our heads are spent in a bent over position on a daily basis is not only contributing towards postural issues, it is also accelerating the impact of gravity on the skin and loss of elasticity.

And with four out of five UK adults now owning a smartphone, and usage most excessive in the 16-24 age group (source: Deloitte), a new generation of younger clients may soon be queuing up for solutions to tech neck.

NEGLECTED NECKS

Technology aside, our necks don’t tend to get as much love as our faces; often the application of skincare products stops at the chin, with anything further south neglected until signs of ageing appear.

“Many people focus their attention on their face when trying to combat ageing, however it’s actually our thin-skinned necks that tend to slacken first,” agrees facial aesthetic sculptress Dr Krystyna Wilczynski. “I have noticed a greater amount of interest in neck treatments – mainly lifting/tightening or reduction of lines – in females aged 40 and older.”

As well as suggesting that clients look at the way they use their phone, Dr Krystyna recommends topical skin

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boosters, combined with a neck lift using anti-wrinkle injections, injectable skin boosters and dermal fillers.

“Using hyaluronic acid fillers of different thickness can reduce fine lines and wrinkles and improve the skin’s quality, as well as lift any sagging skin if correctly placed around the neck and jawline,” she says.

“Teoxane’s ultra deep injectable products are fantastic here – the combination of Teosyal RHA 1 and Redensity 1 to rejuvenate the skin and fill superficial lines should be followed

by Teoxane RHA Serum to prolong the treatment results.”

Aesthetic nurse specialist Julie Brackenbury believes the phenomenon is down to the rise of social media, as more people are becoming aware of the ageing process than ever before, as well as the desire to keep in ‘aesthetic shape’.

“Women will often comment that they saw their neck in a window reflection, car mirror, or in a selfie or photo – ‘documenting’ our lives in a more public manner is playing its part,” says Brackenbury.

Brackenbury treated one female client for tech neck lines and sagging before an important party. Having already tried threads, they then moved on to Ellansé. After the treatment the client reported that she had noticed a difference and that it was working well.

Ellansé is a novel dermal filler consisting of a unique and patented composition – 70% Carboxymethyl Cellulose (CMC) based gel carrier and 30% PolyCaproLactone (PCL) microspheres.

Working differently from other fillers, it not only corrects wrinkles and folds but also stimulates collagen production to treat the underlying causes of facial ageing. The effects

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are gradual and longer-lasting, giving a natural, youthful appearance.

Suzi Noble, senior nurse practitioner at Karidis Clinic in London, believes fillers are an effective option – to a point.

“Juvéderm Volite, a hydrating hyaluronic filler injected in tiny droplets, will help improve the first signs of crepiness or ‘necklace’ lines caused by the constant bending of the neck,” she says.

For those with a slightly weaker chin or jawline, Noble recommends Juvéderm Volux along the jawline and in the chin to give lift, support and definition.

“However, if there is more laxity in the area, I would suggest using Ultherapy to stimulate the body’s production of collagen and tighten and lift the skin over a period of three to six months.”

Another fan of Ultherapy is Dr Joanna Christou of The Cosmetic Skin Clinic, who believes in a two-pronged approach: “Ultherapy is used for structural tightening and works by utilising an ultrasound scan to visualise and target specific zones to stimulate the natural collagen production.

“The ideal candidate would be someone who has sagging skin, jowls, and crepiness. When used in combination with an injectable treatment such as Profhilo, optimum results can be obtained with very high levels of patient satisfaction.”

Dr David Jack, who runs a clinic on Harley Street, is another is another advocate of this multi-modal approach, combining Profhilo with the new Morpheus8 by InMode.

Morpheus8 works at multiple depths in the skin and subcutaneous fat – it can resurface and tighten tissue at both the level of the dermis and submucosal adipose tissue. This also allows for reduction and tightening of the submental fat pad so it can be used as a treatment for the ‘turkey neck’ issue that Dr Jack sees in clinic in patients in their 50s and later.

TECK NECK

“My patients are delighted with the results, especially as it can be combined with other surgical or non-surgical treatments such as fillers,” he says. “It is also gaining popularity with patients who want minimal downtime and subtle results.

“I often combine Morpheus8 with Profhilo to give additional dermal fibroblast activation and to further boost levels of collagen and elastin. Usually treatments would be spaced in the following manner: Morpheus8 two to three monthly sessions; Profhilo, two sessions two weeks after the first and second Morpheus8 session.”

Profhilo is increasingly becoming the treatment of choice for neck lines. “Lines in the neck used to be a concern for ageing patients over time,” says cosmetic doctor Dr Esho. “Now, we use more and more technology and the position we continuously hold our necks in can bring about the early onset of ‘tech neck’.

Dr Esho recommends two sessions of Profhilo – one at day zero and the second at day 30; at both sessions the Profhilo is injected into specific points in the neck known as the BAP points. These are points that, in combination with Profhilo, deliver the maximum results.

Finally, Rachel Huskinson, beauty therapist and director of SKIN Lounge, takes a more holistic approach, combining practical advice with a treatment protocol: “By changing the way you interact with technology, you can save yourself from experiencing any discomfort,” says Huskinson.

“Monitoring how much you are using your phone or laptop and exercising or doing regular neck exercises when you are working can help to reduce stress and tension.

“To treat the physical appearance of lines and wrinkles across the neck, we use ClearLift treatment by Harmony XL Pro. Depending on the severity of the lines and age of the individual, at SKIN Lounge we also offer the combination of Venus Plus, HIFU and ClearLift.” >

While the digital era in which we live in has undoubtedly transformed our lives, for our fragile neck skin it’s perhaps not such good news

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TECK NECK

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TOPICAL SOLUTIONS

Following their aesthetic treatment/s of choice, clients can prolong results with a targeted at-home regimen and products containing ingredients designed to firm, plump, tighten and smooth the fragile neck skin.

“Any repetitive movement can lead to wrinkles and a loss of elasticity in the skin,” says Tracey Wilmot, education director for Murad. Wilmot recommends facial exercises to help strengthen the muscles in the neck, to be aware of looking down too much, holding a phone at eye level, and treating the area with ingredients like peptides that help boost collagen, elastin and firmness – as well as always using an SPF. Murad Rejuvenating Lift for Neck and Décolleté firms, smoothes and reduces the appearance of wrinkles on the neck and décolleté area and is clinically proven to increase skin firmness by 42% after just one application.

IS Clinical NeckPerfect Complex works on the neck, jawline and décolleté to lift, tighten and define. Containing fruit acids

and while willow bark extract (a natural source of salicylic acid), the formulation also exfoliates to diminish the signs of fine lines and wrinkles while improving skin tone and texture.

Clinical studies found that after just two weeks, 76% of subjects reported an improvement in skin elasticity, 80% an improvement in skin sagging and 77% an improvement in skin firmness.

NeoStrata Skin Active Triple Firming Neck Cream issues a powerful blend of unique, clinically proven ingredients that will build volume and dramatically improve the look and feel of sagging, pigmented skin in the neck and

Before

Before

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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 to help 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.

SkinCeuticals H.A. Intensifier contains a high concentration of hyaluronic acid (HA), proxlane and purple rice extract to support the skin’s HA levels and deliver surface hydration. Suitable for all skin types showing volume loss, reduced elasticity, fine lines and wrinkles, H.A. Intensifier is ideal for use at home posttreatment and helps maintain good skin quality.

Swisscode Bionic Stem Cell Radiant Elixir combines high levels of antioxidants, vitamins, amino acids and minerals. Stem cell ingredients include extracts of tiger grass to rejuvenate the skin’s structure, restore firmness, elasticity and moisture. There are a number of proven results after 40 days including an inhibition of collagen breakdown by 98%.

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.

After 12 weeks

After 16 weeks

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

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TECH NECK

of 2ml 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.

The sparse hypodermic fatty tissue in the décolleté allows only a thin collagen network layer, reducing skin’s natural ability to bounce back. This is where the skin689 Firm Skin Decolleté and Neck Creme can help. Containing patented 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 10 minutes, giving an immediate rejuvenating effect for fewer wrinkles and visibly firmer skin. Active ingredients in the mask include snow algae, which activates the longevity gene klotho in aged skin cells. Glucoside lysine proline copper complex also stimulates ageing fibroblasts while moisturising betaines ensure that even sensitive skin is protected. AM

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KOREAN BEAUTY

Korean beauty trends South Korea is always at the forefront when it comes to innovative beauty trends.

Following a recent trip to Seoul, Dr Sabrina Shah-Desai reports on the latest trends taking the country by storm

1. NO FILTER SKIN

Korean women are the most demanding beauty consumers and the goal of the entire K-beauty routine is to achieve luminous, fresh, glowing skin which is seen as a sign of youth. They use essences, ampoules and a vast range of masks including sheet, wash off and sleep-in masks, daily. Korean women use antiageing products much earlier than their Western counterparts and examine their skin weekly to ensure any issues are addressed immediately. They invest in weekly facials and have skin resurfacing with lasers. They prefer healthy skin first with little or no make-up, unlike the thick base and trend for contouring that Western women tend to favour. Their commitment also extends to their diet with many women eating fermented foods that help to decrease gut inflammation, which can be skin ageing.

HYDRATION – Gels, lotions or moisturises and masks

PROTECTION – Sunscreen

Common ingredients I spotted used in skincare products were arbutin, niacinamide, synthetic snake venom, EFF, placenta and snail mucin.

2. THE MULTISTEP KOREAN SKINCARE ROUTINE

The Korean skincare regime includes 10 different steps. If that seems too much, it’s good to know that it actually can be broken down into four stages: PREPARATION – Oil cleanser, a waterbased cleanser and toner used daily, plus an exfoliator used twice a week

REGENERATION – Essences followed by, or replaced with, serums and boosters

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3. EYELID GLUE

Double eyelid surgery is one of the most popular surgeries in the Far East. Nearly half of Asians are born with no upper eyelid crease (single eyelid), which can cause lashes to drop in the visual access (lash ptosis). As an eyelid surgeon myself, I was intrigued by the trend for double eyelid glue, which Koreans use as a quick party fix to to achieve a more wideawake look. Sometimes used by people with an epicanthic fold eyelid, common among Asian people, the levator muscle people, the levator muscle that helps to lift the eyelid attaches

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KOREAN BEAUTY

much lower resulting in a less prominent eyelid crease. Users of this glue or tape sometimes also use a small tool to push the lid back a little, creating the appearance of a double or noticeably creased eyelid. I spent time updating myself on the latest Asian suture blepharoplasty and scarless medical epicanthoplasty techniques that the Korean plastic surgeons use to create the bespoke Asian lids, as I often get requests from Asian men and women for double eyelid surgery that still respects their ethnicity.

4. CHERRY LIPS

The Korean word for this cherry is similar to the English word (체리 cheli) and, in terms of dermal filler treatments, refers to the shape and natural looking volume the injection techniques create, rather than an overall plumping of the lips (like the Western trend for Angelina Jolie-style pillow pouts). Practitioners focus filler just on the middle areas and don’t inject into the corners.

As Koreans are driven by a desire to appear young, the cherry shape gives a fuller and more youthful appearance and is usually achieved using a filler with a thinner consistency. The trend is comparable to the Western desire for the Cupid’s bow look, which accentuates the V area in the centre with microdroplets of filler.

5. SKIN BOTOX

Some Korean dermatologists are now targeting different parts of the face using Skin Botox, which is essentially designed to give “instant glass-like skin” without the need for multistep routines. Instead of targeting wrinkles by injectwing into the muscle, some K-beauty dermatologists are instead focusing Botox on the outer layer to lift the skin and target pores, creating an overall smoothing effect. This is an off-label use that Allergan cannot comment on and is one that has not been approved by the FDA in the US. AM

1. I t was great to see that Korean men tend to care for their skin much more than Western men. It was also interesting to see the ease with which young men in Korea are having plastic surgery 2. Koreans use a vast range of face masks and sheet masks.

They even use masks to make their feet softer 3. Eyelid glue and tape is used as a quick party fix 4. The average Korean skincare regime has 10 steps.

Dr Sabrina Shah-Desai, MS, FRCS, is an aesthetic ophthalmic plastic reconstructive surgeon and the director of the Perfect Eyes clinic and the Oculo-Facial Aesthetic Academy (OFAA) where she trains other practitioners in techniques as well as anatomy for injectables using cadavers.

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LEADING

manufacturer of aesthetic cannulas

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

Standard cannula walls

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

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

TRENDS DOSSIER

CONSUMER

aestheticmed.co.uk

Consumer trends With so many trends being driven by consumers, Sharon Bennett shares her insight and the treatments she offers in her practice 1. INJECTAGRAM? THE NEXT GEN TWEAKMENTS

There are three types of patients now: i) Tweakment curious teens (from 18+) who are unafraid and informed by social media and friends – they talk and compare.

They are contour and Instagram filter pros, wanting to erase perceived flaws for the ‘perfect selfie’. ii) The older generation who are now more knowledgeable than 20 years ago and who want combination treatments to help them become a better version of themselves without looking ‘done’. iii) Millennials who want continuous subtle, small changes throughout the year. Having done research, they are fussy and well-informed.

2. NO SUBSTITUTE

Despite some reports and suggested alternatives, botulinum toxin sales are definitely not down.

No creams, machine, radiofrequency or laser will match the results. Fact. The issue is with the person delivering it and managing expectations.

Dosing is vital; small tweaks in certain areas and concentrating on the minutiae of a face and muscle movement can give exceptional results.

3. SKIN BOOSTING

Skin health is the buzzword of the moment as clients realise that filling alone does not equate to youth. I use Restylane Skinboosters in my practice for this. I also incorporate super diluted botulinum >

THE TINKERBELL TIP Nose tip lifting tweaks and ironing out bumps in the nose are all the rage, finished off with filler on the outer cheek bone to project and act as a highlight and contour

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CONSUMER

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HOW MEN AGE COMPARED TO WOMEN 25% stronger skin due to more collagen Higher levels of sebum, so skin is less prone to dryness and wrinkles Men shave, which is exfoliating and invigorating, plus whiskers support skin.

toxin into superficial skin stamping to reduce pores, giving skin a smoother appearance as part of a facial. It gives the subtle lifted look of refined skin without the deep activity of affecting any muscle action.

Ellansé is a collagen stimulator that I also love as it lasts longer than HA fillers. It works brilliantly on the hands and neck as well as the face as it fills and volumises. It’s a slow burner but worth the investment as it triggers new collagen growth over time, so you get continual improvement over several months.

4. SCREEN-TIME SKIN

Ongoing skin stress is a major and modern culprit in ageing.

Aside from extrinsic factors such as smoking, UV, pollution and alcohol, etc., there are concerns that raised levels of cortisone, lack of sleep, High Energy Visible (HEV) Light and Infrared light (IRL) accelerates skin ageing and increases dehydration. One clinician in the US claims he can tell which hand a person holds their phone with as their skin is more damaged on that side!

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5. THE MENOPAUSE: FIGHTING BACK

Menopause hits like a car crash, but finally it is being discussed and women are no longer accepting the aesthetic changes. This loss of elasticity and volume coupled with dull, dry skin and the face shape changing from an upside down pyramid to a pyramid leaves many women feeling invisible.

Bioidentical HRT is starting to be more widespread and can make tangible changes to every aspect of the body and skin as it addresses oestrogen and progesterone levels and fine tunes hormones. I also recommend Skinade collagen boosting drinks to help skin and hair, and monthly HydraFacials and peels to encourage neocollagenesis and deal with pigmentation. If fillers are required, I redrape and fill where there is loss – Restylane is excellent for this.

Skincare is also emerging that targets the oestrogen receptors in our skin, triggering their reactivation and combining with other skin food such as retinols, antioxidants and peptides make perceptible changes at a dermal level over time. AM

Sharon Bennett RGN, NIP, is a director of Harrogate Aesthetics and current chair of the British Association of Cosmetic Nurses (BACN). She has worked in medical aesthetics for more than 25 years and is a national trainer in cosmetic injectables as well as a mentor for the aesthetic medicine course at Northumbria University. She has a special interest in the ageing face, facial lifting and skin restoration using dermal fillers. She leads the UK editing task force committee on the British Standards Institute/European Standards Committee Draft standard for Non-Surgical Aesthetic Medicine and has helped write and publish the BACN/Royal College of Nursing aesthetic nursing competencies.

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

C A S E S T U DY

The secret to beautiful lips with Restylane Kysse™ with aesthetic nurse practitioner, Sharon Bennett Gemma Johnson, 31, came to see me because she was looking for a natural looking enhancement to her lips.

She had well-proportioned lips and a well defined cupid’s bow, but felt that her lip disappeared when she smiled.

During the consultation I noticed that her philtral columns were slightly flat and there was also asymmetry between the left and right side of the lip which would be corrected during the treatment.

I explained how I would minimize the discomfort with a lidocaine gel, which would allow me to observe the lip movement (smiling and pouting) through the procedure and ensure the product is evenly placed. Bruising is always possible with treatment but slow injections, careful placement and avoiding vigorous massage post treatment, along with cool packs can minimize the potential.

“

Restylane Kysse™ is a beautiful product, it’s so soft and integrates well.”

SHARON BENNETT Lumps are usually caused by poor injection technique and/or selecting the wrong product. Using too much product in one area can cause the product to collect, protrude and look unsightly.

BEFORE

The perpendicular lip lift This is a technique I have been using more and more as it uses a small amount of filler and gives a beautiful eversion of the lip. It can also be incorporated with other techniques.

I injected from the vermillion border travelling along the red lip towards the wet dry border in a superficial plane, injecting retrograde supportive struts. This gives an eversion of the lip without the weight of injecting larger volumes, which can sometimes give a heaviness and thickness to the lip tissue. The additional benefit is that, if placed correctly, the product will track along the natural vermillion.

Injection sites – 0.02ml–0.05ml of Restylane Kysse™

Modern day fillers are tailored with different properties for each indication. Lips are the most mobile part of our face, and require a low-medium elasticity and cohesivity to allow for that natural movement, which is why I opt for Restylane Kysse™.

Top tips •

A thorough lip consultation is a must. Make sure you point out any idiosyncrasies and take high quality before and after photos

•

Spend time looking at the natural shape of the lips and how they fit with the rest of the face

•

Consider the cupid’s bow, the shape of the lips, compare the top and bottom lip, look inside the lip and see if there are any abnormalities

•

Don’t just look at the front of the face with an anterior posterior approach. Look at an oblique view and measure angles to create balance

•

Look at the face in animation, smiling, pouting, at rest

•

Galderma’s Harmony Programme has a series of questions to make sure that the consultation is as thorough as possible and unrealistic expectations are flagged

•

Make sure you know the anatomy of the lip

•

The superior and inferior labial arteries usually run below 4.5mm and are different in the upper and lower lip. When using a needle the safest plane will be no deeper than 4mm

AFTER

I injected approximately 0.02-0.05ml of Restylane Kysse™ at approximately 0.5cm intervals. This changes from patient to patient, the size of the lip and what you want to achieve.

I did not place the product in the corners of Gemma’s lips and started the injections 1 cm from the corner of the upper lip.

If a patient requires a fuller lip then I use Restylane™ in combination with this technique and cross hatching using linear threads and/or small bolus injections.

Sharon Bennett RGN, NIP, PG Dip Cosmetic Intervention

is a founder and current chair of the British Association of Cosmetic Nurses (BACN).

She is director of the award-winning clinic, Harrogate Aesthetics and a member of the Galderma Faculty.

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FACIAL HAIR TRANSPLANTATION

aestheticmed.co.uk

It’ll put hair on your chin Dr Ashish Dutta discusses facial hair transplantation and rejuvenation

T

he ability of a man to grow a beard or a moustache is sometimes seen as a sign of both maturity and masculinity. The growth of the ‘hipster’ movement in California in the early 1980s led to the impression of a man who facially sat somewhere between relaxed carefree individual and Albert Einstein.

Either way, this trend has certainly been popular for many men, with facial hair making a marked return to many male demographics across all career paths and social groupings.

Beards are most definitely ‘in’ and so is the need to acquire a little cosmetic help in cultivating enviable facial growth.

With an ever increasing variety of non-invasive options available, let us take a look at the possibilities available for beard transplantation.

ADVANTAGES OF FULLER FACIAL HAIR

The advantages of sporting a beard are numerous. Clients who have had facial trauma or injuries such as burns or scarring can benefit greatly from the comfortable camouflage a beard can provide to conceal potential scarring or surgical realignment.

However, this procedure is wholly dependent on the ability of the body’s hair follicles to be strong and healthy enough to be grafted and transplanted to the facial area requiring growth. This can be adversely affected by scar tissue preventing the overlay of the follicle into a suitable location on the face, causing a patchy appearance. In such cases, a beard transplant is the only permanent solution to this problem.

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BEARD AND MOUSTACHE TRANSPLANTATION METHODS

The two main surgical options for beard and moustache transplant are Strip Follicular Transplantation (FUT) and Follicular Unit Extraction (FUE). Donor hair, including healthy hair follicles from the patient, is taken from an area at the back of the scalp and transplanted into the region of required growth. Sometimes, however, especially in cases of patients suffering from pattern baldness, there must be a trade-off on which area of new growth is considered a priority – the face or scalp – as frequently there is not enough fresh follicles to supply both areas.

STRIP FUT

In this procedure, the cosmetic professional removes a thin strip of hair follicles from the donor area at the back of the patient’s head. The follicles are then separated and replanted in areas of need, using guidance from high powered microscopes. Hair is taken from the most follicle-rich areas of growth and can be best matched in existing areas of facial growth, if the existing beard-line is dense enough.

A good match of follicle rich transplanted hair can be matched to existing growth, but there is always a risk of a slight linear scar following the track of transplantation onto the chin. This can be minimised by the development of new growth and the ability of the cosmetic professional to match the line of the transplanted skin and follicles, so they blend into the overall profile once healed. As with any

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FACIAL HAIR TRANSPLANTATION

treatment, discussing the pros and cons of this procedure is important to the post-operative visual appearance and decisions should not be taken lightly.

for psychological behaviours or Obsessive-Compulsive Disorder is recommended prior to any discussions relating to surgical procedures.

FUE

Other dermatological conditions Inflammation of the skin, blotching or localised infections can cause body hair to stop growing and fall out. It is therefore recommended that patients be referred to a qualified dermatologist before any consideration should be given to beard or moustache transplantation

Individual hair follicle grafts are taken from the donor area, usually at the back and sides of the scalp, and then carefully transplanted into the recipient area of the face. This procedure has the advantage of avoiding the risk of linear scarring. If larger areas of transplantation are required, then this procedure can involve a time-consuming amount of grafts (sometimes numbering into the thousands in extreme cases) to give the desired result.

ALTERNATIVE FACTORS

Non-surgical options such as micropigmentation can help to create the illusion of dense beard growth. Pigment is injected into the dermal layer to create the image of stubble and replicate the roughly shaven look. This can be injected into various areas across the chin and in different densities to give a ´total stubble´ look for a more rugged appearance.

There are also scalp stimulants available, such as Minoxidil, which can encourage hair growth on the scalp but are not designed for facial use.

AFTER EFFECTS

UNSUITABLE CASES FOR TREATMENT

Alopecia sufferers Alopecia can be recognised as hair loss in small to medium circular patches. The loss of hair in the beard area is limited to men and is thought to be a failure of the autoimmune system that effects the growth of hair follicles. These follicles are detected and attacked as a foreign invader by the body’s systems.

Alopecia is believed to be brought on by stressful situations, but the whole disorder is not clearly understood and is currently subject to a number of medical research papers. Suffers are not advised to proceed with beard or moustache transplants because any growth could be curtailed prematurely by the condition. However, it may be possible to pre-treat the target area of the face via a course of an anti-inflammatory medicine containing corticosteroids, which are thought to suppress the immune system, giving time for the hair follicles to take root and grow back.

Possible side effects of these transplant procedures can include redness, initial pain and swelling, and post-operative scarring. However, these are all short-term responses by the body to such procedures and there are no long-term or health issues attached. Finding an experienced cosmetic professional is essential in helping the patient achieve the best and safest results.

Hair follicle are very delicate both physically and chemically. To stand the best chance of transplantation survival in the new area of growth, they should be operated upon by an aesthetic professional who understands the complexities of such a procedure. As with each and every aesthetic treatment, thorough research should be undertaken for the selection of a registered cosmetic surgeon alongside a realistic idea about the final results. AM

Trichotillomania This condition refers to an individual who suffers from a compulsion to pull out their hair on impulse, from any growth areas of the face or other areas of the body.

This can be a response to a stressful situation either emotionally or physically and can sometimes be done subconsciously. For this reason, professional counselling

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

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

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SMOKING

No smoke without lines We look at the effect cigarettes have on the skin and what you can do to help your clients whose faces are paying the price of their habit

A

fter sun damage, smoking is by far one of the biggest causes of premature skin ageing and, as such, addressing smoking-related side effects is a big part of any busy aesthetic clinicâ&#x20AC;&#x2122;s repertoire.

Although the percentage of people who smoke is on the decline, those who do smoke may find themselves ageing more prematurely than those who donâ&#x20AC;&#x2122;t.

According to recent figures from the National Office of Statistics (Adult smoking habits in the UK: 2018), 14.7% of people aged 18 years and above smoked cigarettes in 2018, which equates to around 7.2 million people in the population

and represents a statistically significant decline of more than five percentage points since 2011 (based on estimates from the Annual Population Survey). In the UK, 16.5% of men smoked compared with 13.0% of women. Those aged 25 to 34 years had the highest proportion of current smokers (19.2%).

Smoking is becoming more and more of an unsociable habit and this, coupled with the fact that the cost of cigarettes is increasing all the time, means that it is no surprise that the same report claimed 58.4% of people aged 16 years and above who currently smoked said they wanted to quit and 61.3% of those who had ever smoked said they had quit. >

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SMOKING

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LIFTING THE VALE OF SMOKE

Smoking can take up to 10 years off a person’s life and add up to 10 years to their looks. Of course, the effects of smoking are far wider reaching and damaging on more than just looks. However, for our industry, it is the effects on the face and skin that practitioners are regularly faced with in clinical practice, especially as giving up smoking can be the catalyst for people to seek aesthetic treatments and spend the cash they are saving from kicking the habit on making themselves look and feel better.

The effects of smoking in terms of ageing are significant. The free radicals present in cigarette smoke damage the skin’s collagen and reduce its elasticity as well as dull its appearance.

The classic signs of a smoker are lines and wrinkles on the face, particularly around the upper and lower lips from the action of pursing the lips to suck on the cigarette, as well as around the corner of the eyes from squinting to avoid smoke getting into the eyes.

The effects on the skin from smoking occur as a result of the chemicals and toxins in cigarettes that cause a prolonged state of oxygen and nutrient depravation, robbing the skin of its vitality and elasticity. When a person inhales cigarette smoke they inhale carbon monoxide. Blood absorbs this highly toxic gas 200 times faster than oxygen so the carbon monoxide effectively displaces oxygen and starves the skin of oxygen. Without oxygen, cells cannot function properly and are severely impaired. Add to this the vasoconstrictive effect of nicotine and it’s no wonder that the skin of smokers becomes wrinkly and saggy much faster than that of non-smokers.

“The list [of what smoking does to the skin] is long and exhaustive, but the most obvious is collagen and elastin degradation which leads to premature ageing”, says Pamela Marshall, aesthetician & co-founder of Mortar & Milk. “Deep perioral lines around the mouth can happen from puckering too much, crow’s feet occur from squinting our eyes, and overall structure degradation is the result of the thousands of chemicals inhaled when smoking tobacco. Many smokers have a pale, grey look to their skin, and are far more likely to suffer from blackheads. Research has also shown that smokers also have a greater tendency toward age spots than non-smokers.”

When someone gives up smoking, restoring the skin’s health and vitality should be the first port of call.

Replenishing vitamins, minerals and nutrients to restore luminosity, skin health and glow is key. A results-driven at home skincare regime will boost results of in-clinic treatments, and a course of peels or facials such as the WOW Facial or HydraFacial will help replenish, rehydrate and restore.

Injectables are another effective tool in addressing the signs of smoking.

Smokers are more prone to lines around the mouth and eyes, but crow’s feet can be treated with botulinum toxin and marionette lines can be addressed with fillers or skinboosters. Mesotherapy can also be effective for restoring hydration, addressing fine lines and wrinkles, and improving skin texture and the sallow smoker’s complexion. Another benefit is that it can deliver a cocktail of collagen-stimulating amino acids, antioxidants, vitamins and minerals lacking in the skin of a smoker, thereby improving cellular health and promoting revitalisation.

It’s important to inform clients who haven’t given up that smoking can deplete hyaluronic acid levels. Their body will degrade the HA more quickly, thus shortening how long the results of the treatment last.

“Smokers tend to suffer from increased skin laxity as well as collagen and elastin damage, particularly ‘smoker’s lines’ around the mouth that come from pursing lips during smoking”, comments aesthetic doctor, Dr Preema Vig. “In addition, skin laxity is experienced throughout the body with patients requesting treatments like EndyMed and Venus Legacy to combat this. I have found that a course of Profhilo also enhances and improves skin quality, tone and texture.”

Oculoplastic surgeon and founder of Perfect Eyes, Dr Sabrina Shah-Desai, says, “Due to the lack of sebaceous glands, the skin around the eye is thin and dehydrated and smokers tend to suffer from an earlier onset of deeper lines and wrinkles in the eye area. This is a result of the damage to skin from smoking as well as squinting to keep smoke out of the eyes. I utilise a combination of energy-based treatments such as Tixel and radiofrequency, specialist eye peels and hyaluronic dermal filler treatments to address of effects of smoking.”

Smoking also uses up the body’s supply of vitamin C, which is essential for skin health and collagen preservation. Vitamin C cannot be manufactured by the body so levels deplete quickly in smokers if they are not continuously replaced. A bespoke daily skincare regime that includes antioxidants and other regenerative ingredients will help up regulate the skin and kick start the recovery process.

Marshall says, “I will often recommend a face treatment using vitamin C for it’s ability to reduce pigmentation and inflammation and build collagen, followed by polyhydroxy acids to help hydrate the skin. If someone has stopped smoking, we often recommend microneedling to reform the skin in the areas where structure degradation is most prominent.” AM

The free radicals present in cigarette smoke damage the skin’s collagen and reduce its elasticity

TREATMENTS FOR SMOKERS

Aesthetic practitioners have a wide armamentarium of treatments at their disposal for smokers, and the close of the year may be a perfect time to start thinking about marketing them as many people vow to quit in January.

Of course, the most powerful and effective thing any smoker can do for their health and their skin is to quit.

If they continue to smoke then there is only so much aesthetic treatments can do.

Marshall comments, “I’m pretty honest with clients and will always try to manage their expectations. I can treat their skin, but as long as they’re smoking, our results are limited in scope.”

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Aesthetic Medicine • October 2019

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

PRODUCT FOCUS

aestheticmed.co.uk

Environmentally conscious We learn how Medik8 is putting the environment first in a bid to become the “world’s most sustainable professional skincare brand”

L

ast month, Medik8 announced that every product manufactured by the brand is now 100% veganfriendly and uses 100% Post-Consumer Recycled (PCR) plastic. This is in line with the company’s wider campaign surrounding its professional refresh (launching this month), which positions Medik8 as “the world’s most sustainable professional brand.”

These commitments towards ensuring a more environmentally friendly product and minimising the brand’s carbon footprint are just a few of the many initiatives within Medik8’s sustainability crusade, making the above statement more than fitting. Here’s an outline of the company’s initiatives.

100% RECYCLABLE PROFESSIONAL PRODUCT

Medik8 is striving to ensure all its professional products are 100% recyclable - caps, pumps, bottles, everything.

100% POST-CONSUMER RECYCLED PLASTIC

Since September 2019, every professional Medik8 product in a plastic bottle has been made from 100% PostConsumer Recycled (PCR) material. This means not only are they recyclable, but they are also made of 100% recycled material. Medik8 uses plastic derived from former drinks bottles that would otherwise have gone to landfill, taking centuries to degrade. This PCR material is primarily sourced from the UK to minimise the company’s carbon footprint.

100% VEGAN

Every single product manufactured by Medik8 (both in the retail and professional ranges) is 100% vegan-friendly.

ZERO PALM OIL

Since 2017, Medik8 products have not contained palm oil.

11% LESS WASTE

All Medik8’s new recycled PCR bottles allow for more formula to flow because of the new PET (Polyethylene Terephthalate) material being used, which means creams and lotion slide out more easily, helping to eliminate waste – 11% in fact.

OCEAN PLASTIC ENDEAVOUR

Medik8’s next long-term commitment will be to move all its professional product to ocean plastic-derived materials – plastic waste sourced from our oceans, rivers and seas.

PRE-LOVED GLASS

Medik8 currently uses amber bottles to prevent UV penetration and degradation of its formulas inside.

These bottles are made from 40% recycled glass and are naturally recyclable. Although 40% is the accepted industry maximum, Medik8 is looking to improve this.

It is working with local manufacturers to find a way to incorporate even more recycled glass without compromising on performance.

INGREDIENT FOCUS

Since 2009, Medik8 has always been known as “the green chemistry brand”, making products using an energy efficient process, from sourcing of ingredients to the initial research and final manufacturing. It is currently reviewing its ingredient deck and carrying out ingredient audits to be 100% certain of every ingredient’s origin and impact on the environment.

Medik8 is striving towards all its professional products used in pro treatments being 100% recyclable

MEDIK8 HATE WASTE

Alongside all these individual endeavours, Medik8 is constantly reviewing how it can make improvements. In 2018, the company removed three tonnes of plastic from packaging and replaced it with small Forest Stewardship Council (FSC)-certified inserts. All Medik8’s product cartons, collateral materials, leaflets, posters, bags, boxes, ribbons and alike are printed on FSC-certified recycled and recyclable materials with soya inks top reserve the environment. AM

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

COMBINATION TREATMENTS

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The perfect blend We speak to Dr Preema Vig about her Ultimate Fusion Facial, a bespoke combination of treatments to rejuvenate the skin at all levels 62

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COMBINATION TREATMENTS

aestheticmed.co.uk

I

I have chosen the most effective, clinic-led treatments and combined them to create Fusion Facials, which enable us to offer the benefits of ‘aesthetic layering’ to deliver a total skin rejuvenation

n a world where human and digital are merging, everyday life is on fast forward and even though the increased use of smartphones disrupts skin ageing, no-one has the time to wait for skin treatments to deliver results.

With this in mind, Dr Preema Vig and her team have developed the Ultimate Fusion Facial, a bespoke combination of the most effective non-surgical, medical grade aesthetic treatments.

These treatments are layered together to simultaneously lift, tighten, tone and brighten the skin. Starting with a detailed skin analysis, the team at the Dr Preema Vig clinic identify the exact aesthetic programme to supercharge and rejuvenate all the skin layers quickly but effectively – with no downtime.

Dr Vig explains, “Patients are now expecting more from their skin treatments. Not only do they desire tighter skin that appears glowing and hydrated, but they also want a reduction in fine lines and wrinkles, blemishes, large pores, sun damage and pigmentation. One noninvasive, standalone treatment is not able to target all these concerns.

“Utilising my years of experience, I have chosen the most effective, clinic-led treatments and combined them to create Fusion Facials, which enable us to offer the benefits of ‘aesthetic layering’ to deliver a total skin rejuvenation by treating skin concerns within the layers of the skin.”

and targets dry, dehydrated and prematurely ageing skin. The cooling, calming, pressurised oxygen increases the absorption of carefully selected products for individual skin concerns.

Combining three different molecular weights of hyaluronic acid, the Intraceutricals Oxygen Facial system infuses hyaluronic acid and the anti-ageing and youth restoring properties of vitamins A, C and E with aloe vera and green tea to layer the skin with hydration, lock in moisture and fight against fatigue, free-radicals and pollutants.

Results leave skin instantly plumped and clarified and glowing with health and vitality. Skin will continue to improve in the following days.

3. RESURFACING FACIAL: IS CLINICAL FIRE & ICE

The Fire & Ice Facial by iS Clinical is a, luxurious, intensive clinical treatment designed to rapidly and safely resurface the skin. By combining two professional treatment masques, each containing potent, clinical strength formulations, skin is left exfoliated and purified. The Intensive Resurfacing Masque, for example, includes sugar cane extract, lactic acid, citric acid, malic acid, retinol, vitamin B3 and potent antioxidants such as green tea extract, while the Rejuvenating Masque cools and soothes and intensely hydrates with hyaluronic acid.

4. LASER: LASER GENESIS

Collagen is stimulated by Nd:YAG 1064 laser creating a thermal response in the dermis that stimulates new collagen. The treatment is great for plumping fine lines and wrinkles, promoting vibrant and healthy-looking skin.

By gently heating the upper dermis well below the skin’s surface, Laser Genesis improves the appearance of wrinkles through collagen stimulation and naturally promotes a healthy look. Laser Genesis also reduces redness, improves pore size and the texture of the skin. This technology has no downtime and it’s safe for all skin types.

5. RADIOFREQUENCY: VENUS LEGACY 1. SKIN HEALTH FOR LIFE: HYDRAFACIAL

HydraFacial is a unique, deep-cleansing, medical-grade facial. The Skin Health for Life treatment is gentle and powerful, using pure water and natural skin-boosting ingredients to remove dead skin and debris, while adding skin nutrition directly to where it is needed.

The hydradermabrasion procedure cleanses, exfoliates, extracts, hydrates and provides antioxidant protection simultaneously. This results in clearer, more beautiful skin with no discomfort or downtime and is extremely gentle, making it suitable for all skin types. Results are instantly visible, with improved skin tone and texture. Plus the more hydrafacials you have, the better your skin will become.

2. OXYGEN FACIAL: INTRACEUTICALS

Regarded as the ultimate celebrity red-carpet treatment, the Intraceuticals Oxygen Facial uses a Topical Hyperbaric Oxygen System that helps increase the skin’s moisture levels

Radiofrequency uses heat to deeply penetrate the surface of the skin increasing collagen synthesis in the dermis, which in turn helps to reduce fine lines and wrinkles, leaving you with smoother, younger-looking skin.

It also stimulates lipolysis in the fat cells of the subcutaneous layer providing an instant lift and defining facial contours. This treatment is also safe for all skin types and tones.

6. RADIOFREQUENCY: ENDYMED 3DEEP

One of the most in-demand treatments in the industry, EndyMed’s facial skin tightening for the face and neck delivers exceptional immediate results.

EndyMed’s 3DEEP RF facial tightening handpieces are specifically designed for the treatment of wrinkles, and for the tightening and lifting of sagging skin. The treatment is painless, with no downtime, making it ideal for the delicate, sensitive and hard-to-treat areas, such as around the eyes and mouth. AM

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

EDITOR’S CHOICE

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aestheticmed.co.uk

Harley Vicky Eldridge tries out Harley, a brand new tech platform that enables and empowers practitioners to sell skincare

H

aving edited magazines in the aesthetic industry for more than 15 years, I know more than most how many amazing results-driven medical-grade skincare ranges there are out there. However, I also appreciate that retailing products in clinic and getting patients to comply is a challenge many practitioners face.

While some clinics thrive with their in-house retailing, others find sales of products are low and inconsistent and that even once they make the sale, keeping those customers making repeat purchases can be difficult.

Many clinics will be familiar with this scenario: you spend time personalising a skincare regimen for a customer, only to sell the products once and then lose them to online retailers such as Libertys or Amazon.

Other barriers include customers who want to repurchase products that were previously recommended by a practitioner in clinic, but are unable to do so without having to go back to the clinic. Or, customers who want some

time to think about purchasing the product regimen before committing but are not able to do so in today’s in-clinic setting, so leave without making a purchase.

All of this means that some practitioners are understandably put off by the inventory risk they have to undertake when purchasing and holding stock of skincare products. Yet, as we all know, product sales can increase profitability and encourage repeat business when sold effectively.

So what’s my point? This month I tried a new technology platform that aims to address all of these issues, enabling the practitioner to sell directly to the patient and drive repeat sales anytime, anywhere without any inventory risk at all. It’s aptly named Harley and, as well as the aforementioned, allows a practitioner to create a premium, personalised service for each patient.

There’s a number of ways it works. Either a doctor, nurse or therapist can deliver a skin consultation in clinic or they can do it online. Having moved down to the Kent coast, I opt to do mine online via video with Dr Sophie Shotter, one of the early adopters of the Harley system. We chat in depth about my skin and Dr Shotter puts together a regime for me based on my concerns which she enters directly into the online platform while I’m still online. I then receive a text and an email and am able to see Dr Shotter’s recommendations.

The patient can decide to buy these products from the clinic or they can have the products shipped directly to their doorstep by Harley.

For those wanting to ‘think about it’, they can purchase later on-thego via a link sent directly to their phone that contains details of their personalised regimen. >

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

EDITOR’S CHOICE

aestheticmed.co.uk

PRACTITIONER VIEW

Dr Sophie Shotter “Harley helps us to keep skincare patients within our business, and it’s working well.

We used to struggle with people running out without realising they were low on product and then ordering in a hurry from Amazon. For patients it’s not ideal as we don’t know the product supply chain, but for a business it is disastrous as we lose the repeat revenue.

Through a simple three-click-system, Harley nudges all of our skincare patients when they’re running low and reminds them to repurchase. Such a simple solution to a real business problem!”

I check out online and a few hours later there is a knock at my door and I’m presented with a canvas bag with the words “My skincare is powered by knowledge not hype” printed on it. Inside is a personalised, eco-friendly box and a handwritten note from Dr Shotter introducing me to my regime. I’m thoroughly impressed.

All products, across multiple brands and including prescription products, arrive in one delivery, providing the patient with a truly seamless one-stop-shop solution.

Inside my box is Neostrata Foaming Glycolic Wash, full-sized and travel versions of skinbetter science’s Alto Defense Serum, Even Tone Correcting Serum and AlphaRet Overnight Cream. I also have a NeoStrata Sheer Physical Protection SPF 50.

The link I’ve been sent enables me to access my personalised skincare regimen with application instructions anytime of the day.

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Harley also helps practitioners keep patients on their regimens by prompting them to repurchase products promptly before they run out. They deal with all the logistics and ship directly, on behalf of the practitioner or clinic. I feel supported but not pushed or pressured, and having everything made so easy and delivered to my door is great.

The other advantage for clinics is that every Harley touchpoint with the patient is a marketing tool for the practitioner. Harley actively reminds patients of the practitioner every time there is contact via its messages or marketing material included in the box of products. The practitioner is also able to customise treatment and/or product promotions within the box based on patient data and consent.

By using the Harley platform, practitioners do not need to invest in additional overheads or logistics (e.g. paying for stock, packaging, delivery, after-sales services or their own online webshops, which can cost tens of thousands of pounds).

Instead, they can join the platform and let Harley increase their revenue without any investment of time or money; all while looking after their patient’s skin. AM

Aesthetic Medicine • October 2019

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

SKIN NEWS

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New Discoloration Defense Serum from SkinCeuticals SkinCeuticals has announced the arrival of Discoloration Defense Serum, a new multi-phase treatment that is clinically proven to deliver a brighter, more even skin tone in just 14 days.

The serum is formulated to address pigmentation triggered by inflammatory processes in the skin, such as melasma and acne scarring.

Containing 1.8% tranexamic acid, 5% niacinamide and 5% HEPES, this optimised formula of anti-discolouration ingredients works in synergy to reduce uneven skin tone and the appearance of discolouration in as little as two weeks. Hero ingredient tranexamic acid minimises the reoccurrence of discolouration and stubborn brown patches, thus breaking the cycle of discolouration with continued use.

In a 12-week study, twice-daily application of Discoloration Defense Serum demonstrated a statistically significant reduction in the appearance of postinflammatory discolouration and uneven skin tone, including a 41% average reduction in the appearance of melasma.

Novel pigment treatment relaunches as Cyspera Cysteamine has relaunched in the UK as Cyspera. The new brand strategy comes after in-depth research by scientists, as well as market analysis and talking with clients. Results of this investigation showed that the name Cyspera would have greater resonance with clients and consumers, and would better represent the brand as an effective treatment for pigmentation using Cysteamine.

The name Cyspera was created from a combination of the two words “cysteamine” and “sperare”, with the latter meaning: belief, patience and confidence.

The topical pigment corrector, distributed in the UK by AestheticSource, addresses the appearance of discolouration and dark spots provding functional and emotional benefits for the user. Naturally present in human skin cells, cysteamine reduces melanin in the skin.

Research on the product shows an impressive 47% melanin pigment reduction in pigmented lesions after eight weeks of use and a 67% reduction after 16 weeks.

In fact, 90% of users noticed moderate to significant improvements overall.

The product is non-cytotoxic, non-carcinogenic and is free from hydroquinone, retinoic acid and corticosteroids.

Proto-col Clinical launches new vegan supplement Proto-col has added to its clinical range of high-grade ingestibles and results-led products with the launch of its vegan No.15 Red Superfruits.

Using powerful red superfruits, including blueberry, cranberry, grape and added vitamin C, the formula blends 15 natural ingredients rich in polyphenols and antioxidant compounds that help to slow down the ageing process by combating free radical activity.

Further reinforcing its dedication to achieving healthy skin from the inside out, this formula protects from skin damage, inflammatory skin conditions such as eczema and early signs of ageing.

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Minerva Research Labs launches Gold Collagen Vegan Minerva Research Labs has launched Gold Collagen Vegan. This is the brand’s first plantbased liquid food supplement, specifically formulated to provide support for those on a vegan and vegetarian diet. Gold Collagen Vegan is packed with 28 active nutrients chosen to support collagen formation, promote the health of skin, hair and nails and protect from oxidative stress. AM

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I N J E C TA B L E S

FACIAL BEAUTY

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That’s what makes you beautiful Balsam Alabassi explores what makes a face beautiful and our perceptions of beauty

A

lthough we often hear the saying that “beauty is in the eye of the beholder” or “beauty is only skin deep”, both implicate that attractiveness is a learned behaver which is directly related to cultural influences of what is ideally beautiful rather than a standard formula to what makes us beautiful.

This is consistent with every race, age and gender.1 Historically and evolutionary, facial symmetrically has always influenced what is defined as beautiful. There is a distinct equilibrium of attractiveness that is apparent which reflects harmony and symmetry. 2 An attractive face has a direct relationship with an absolute proportion of one to 1.618.3 All creatures are created with an innate inbuilt program that is genetically encrypted to define this proportion. However, both external and internal environmental factors may influence the level of proportion.4 In all races, the shape of the face impacts on beauty, where an oval face is a measure of attractiveness as well as a measure of youth. 2 Evidence suggests that the standards of facial attractiveness are similar across genders and cultures.4 Every ethnic group has its aesthetic advantages and disadvantages, but on the whole, the most beautiful and attractive people of all races have similarities in terms of face shape, and harmonious features with balance, and symmetry. 2

Liew et al. (2015) 2 found faces lose attractiveness as they display more distinct ethnic features. Caucasians have larger, deeply set eyes, greater anterior projection of the brow, nose, maxilla, and chin, with narrower faces and greater vertical height. Those of Asian and oriental origin on the other hand, have a wider face with shorter vertical height, flat or concave medial maxilla, as well as the lack of brow, nasal, and chin projection. They also exhibit a greater infraorbital volume, fuller lips, and better skin quality that serves to combat environmental influences thereby delaying the formation of lines and wrinkles. However, most exhibit skin and pigmentation changes including lentigines and seborrheic keratosis.

FACIAL SYMMETRY

Research of facial symmetry reveals that overall symmetrical facial attractiveness influences secondary sexual characteristics, particularly the perception of someone’s health, their suitability as a potential partner, and their genetic quality and developmental stability.2 An article by Little (2011)1 showed that face preferences affect a diverse range of critical and social outcomes, which even impacts social status as well as career selection. Establishing trust from healthy looking individuals is more probable than those who appear less healthy.

Rhodes et al. (2001)4 examined whether facial averageness and symmetry are attractive in non-Western cultures and found that faces that moved away from an average shape resulted in decreased attractiveness due to loss of symmetrical proportion.

Therefore, preferences for facial averageness and symmetry is not restricted to Western cultures.

Gender variations with females of slim or oval faces and high cheekbones are viewed as more attractive whereas, males with a square jawline and oval face are seen as most attractive. It seems that feminine characteristics and faces of low dominance are more aesthetically pleasing. Studies have shown that increasing masculinity of the face led to an increased perception of visual attraction and dominance >

Historically and evolutionary, facial symmetrically has always influenced of what is defined to be beautiful

THE QUALITIES OF A YOUTHFUL FACE

A youthful face exhibits a V shape. This V is distorted and diminished with time leading to its inversion. The loss of skeletal architecture and the formation of lines and wrinkles sees the proportion of the upper, middle and lower face decline. As a result, nasolabial folds may appear more protruded, eye sockets become hollow, and a loss of volume from the midface and cheeks due to the displacement of fat pads occurs. This in turn leads to pre-jowl depression, skin laxity and a saggy jaw thus creating a broader-looking face (the inverted V shape). 2

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I N J E C TA B L E S

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FACIAL BEAUTY

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I N J E C TA B L E S

FACIAL BEAUTY

aestheticmed.co.uk

but declined perception of personable attributes such as cooperativeness and empathy, In addition, the size of the male and female forehead, position of the eyebrow and definition of the jawline has a role to play in the perception of attractiveness and the impression of ageing.5

GENDER AND PROPORTIONS

Data by Czarnecki et al. (1993)6 also found that males and females differ in proportions. In males, a straighter profile was preferred compared to a slightly convex profile for females.

A proportionally lateral arched eyebrow in females provides a more youthful and attractive wide-awake look in comparison to straight eyebrows. Treatments that selectively elevate the lateral brow (an eyebrow lift with botulinum toxin, for example) have rejuvenating effects in the upper third female face compared to straight eyebrows which are seen to be more attractive in males.5 This is evident in aesthetic medicine where eyebrow lifts are popular treatments for female patients. Males, on the other hand, appear more attractive with straight eyebrows.

A study by Matros et al. (2009) 7 found that unlike other areas of the body where there is descent of soft tissues, there is paradoxical elevation of eyebrows with ageing.

Therefore, surgical elevation of the mid and medial brow provides results that are neither youthful nor aesthetically pleasing.

I personally view eyebrows as sisters, not twins. However, the quest to achieve symmetry is an expectation regardless of whether this is realistic or not, and it is therefore our role to manage those expectations. Of course, in trying to correct asymmetry, the Mephisto brow, an adverse effect of botulinum toxin treatment, can occur and can negatively impact attractiveness and confidence.

When it comes to lip proportion, shape and volume, trends have fluctuated throughout various eras, even as far back as the ancient Egyptians in 1400 BC. In the 1980s and 1990s, thin lips were considered a sign of beauty, whereas today, fuller, more luscious lips have become the beauty ideal.5

The shape of the young face is generally perceived to be more attractive for many reasons which resonates with values of skin deep.

THE ART OF BEAUTIFICATION

Beautification has been present throughout history. The quest for the elixir of youth was seen with the ancient Egyptians, who applied animal oils, salt, sour milk and alabaster in a bid to improve the clarity and tone of their skin.8 Skin radiance, light refraction and reflection globally influences the visual perception of beauty.

With ageing, as well as the extrinsic factors, skin becomes less hydrated. There is an integral loss of the extracellular matrix, which leads to slackening of the skin, reduced elasticity and the eventual formation of lines and wrinkles.

As well as light reflection and refraction, a wrinkle-free face emits translucency and transparency infused with the luminosity. It demonstrates signs of youth, vitality and fertility and influences our perception of beauty, where the skin of a child is portrayed as a non-speckled canvas that depicts health and happiness. As life commences its journey, this canvas is gradually ravaged by time. So textural changes are accompanied by an uneven skin tone, altering our perception of attractiveness and youth.

The skin of the Asian and Oriental population has an intrinsic sun protection in the form of melanin, which helps to delay the signs of photoageing and thereby aids skin to age at a slower rate. 2 Wrinkles and textural changes may give the impression that time has lapsed. This in turn leads to the perfect that most of life’s journey has been covered, impacting on health, fertility, vitality and confidence.

Skin radiance, light refraction and reflection globally influences the visual perception of beauty

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CLOSING THOUGHTS

It is apparent that many factors play a role in attractiveness that are anchored by an absolute proportion and governed by culture and gender, as well as skin condition. It’s also influenced by hormones, cheek alignment and position, the size of the lips, chin, nose and jawline. Social media, as >

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Results and patient experience may vary. Patients shown in the B&A pictures are within +/- 5 lbs of their original weight unless specified. As with any medical procedure, ask your doctor if the Emsculpt procedure is right for you.

Emsculpt® is intended for improvement of abdominal tone, strengthening of the abdominal muscles, development of firmer abdomen. Strengthening, toning, firming of buttocks, thighs, and calves. Improvement of muscle tone and firmness, for strengthening muscles in arms. ©2019 BTL Group of Companies. All rights reserved. BTL® and EMSCULPT® are registered trademarks in the United States of America, the European Union, and other countries. The products, the methods of manufacture or the use may be subject to one or more U.S. or foreign patents or pending applications. Trademarks EMSCULPT®, EMSELLA®, EMTONE™, EMBODY®, and HIFEM® are parts of EM™ Family of products.

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Results and patient experience may vary. Patients shown in the B&A pictures are within +/- 5 lbs of their original weight unless specified. As with any medical procedure, ask your doctor if the Emsculpt procedure is right for you.

Emsculpt® is intended for improvement of abdominal tone, strengthening of the abdominal muscles, development of firmer abdomen. Strengthening, toning, firming of buttocks, thighs, and calves. Improvement of muscle tone and firmness, for strengthening muscles in arms. ©2019 BTL Group of Companies. All rights reserved. BTL® and EMSCULPT® are registered trademarks in the United States of America, the European Union, and other countries. The products, the methods of manufacture or the use may be subject to one or more U.S. or foreign patents or pending applications. Trademarks EMSCULPT®, EMSELLA®, EMTONE™, EMBODY®, and HIFEM® are parts of EM™ Family of products.

EMSCULPT is the only procedure to help both women and men build muscle and burn fat without needles and anesthesia.

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I N J E C TA B L E S

FACIAL BEAUTY

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Studies have revealed that the position and the alignment of teeth, buccal corridors and gingiva play an essential role in aesthetics and attractiveness thorough the power of a smile.5 In nature, we may lean towards a butterfly and shy away from a moth, yet, essentially, they are similar creatures, formed with perfection and anchored in symmetry, perfectly demonstrating the drivers that influence our perceptions of beauty.

Defining beauty is not a streamlined process. While the value of attractiveness may be embedded in our genetic makeup, a symbiotic relationship exists between the innate perception of how we define beauty and the eternal attributes that determine the overall level of attractiveness.

Having imperfection can be beautiful, as it’s the quirky that makes us individual and gives each of us our signature USP. Love the beauty within and love the skin that we are in. AM

well as the era in which we live, strongly influences trends and has a powerful role to play in our perception of beauty.1 Beauty has somewhat standardised the perception of the individual from a personal and psychological perspective of how we are viewed and the shadow that we cast. The patient may desire aesthetic treatments to anchor their worth with an immersed evolutionary drive. While I advocate the right for every man and woman to look and feel beautiful by providing a complete care solution, patient assessment and selection are vital to detect the intricacy that lies between anatomical parameters and the ageing skin as well as their overall wellbeing.

It is also important to important to note that there are differences between self-confidence and self-value that drives the need for treatment. Therefore, differentiating between those who are seeking value and those that are adding value when identifying patient goals is crucial.

The features of Nefertiti, the Egyptian queen and wife of Akhenaten, an Egyptian Pharaoh of the country’s 8th dynasty, whose name translates as ‘a beautiful woman has come’, provides a clear demonstration that beauty has stood the test of time.9 I sometimes wonder if she has set an unrealistic expectation for us today. Her facial symmetry is calculated with protracted precision and her beauty is indeed a symbol of perfection. However, adding dimension is key to attractiveness regardless of how transient it may be. Facial expressions play a vital role in captivating the audience and therefore it is of no surprise that faces accompanied with smiles coupled with personality attributes are perceived to be more attractive than those of neutral disposition.1

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REFERENCES 1. Little, A., Jones, B. and DeBruine, L. (2011). Facial attractiveness: evolutionary based research. Philosophical Transactions of the Royal Society B: Biological Sciences, 366(1571), pp.1638-1659.

2. Liew, S., Wu, W., Chan, H., Ho, W., Kim, H., Goodman, G., Peng, P. and Rogers, J. (2015). Consensus on Changing Trends, Attitudes, and Concepts of Asian Beauty. Aesthetic Plastic Surgery, 40(2), pp.193-201.

3. Y, J. (2019). Facial beauty--establishing a universal standard. - PubMed NCBI. [online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih. gov/pubmed/15085778 [Accessed 28 Jul. 2019].

4. Rhodes, G., Yoshikawa, S., Clark, A., Lee, K., McKay, R. and Akamatsu, S. (2001). Attractiveness of Facial Averageness and Symmetry in NonWestern Cultures: In Search of Biologically Based Standards of Beauty.

Perception, 30(5), pp.611-625.

5. Shimogaki, Sheriann K., “Position of the lips and facial profile: preferences of orthodontists versus lay people” (2007). Scholar Archive. 829. http://digitalcommons.ohsu.edu/etd/829 6. Czarnecki, S., Nanda, R. and Currier, G. (1993). Perceptions of a balanced facial profile. American Journal of Orthodontics and Dentofacial Orthopedics, 104(2), pp.180-187.

7. Matros, E., Garcia, J. and Yaremchuk, M. (2009). Changes in Eyebrow Position and Shape with Aging. Plastic and Reconstructive Surgery, 124(4), pp.1296-1301.

8. H ealio.com. (2019). From the beginning: The history and applications of Botox. [online] Available at: htttps://www.healio.com/ophthalmology/ oculoplastics/news/print/ocular-surgery-news/%7B42a86db1-1bcc41e2-9336-6d61d0530a49%7D/from-the-beginning-the-history-andapplications-of-botox [Accessed 12 Jul. 2019].

9. Mark, J. J. (2014, April 14). Nefertiti. Ancient History Encyclopedia.

Retrieved from https://www.ancient.eu/Nefertiti/ 10. Wade, T. (2010). The Relationships between Symmetry and Attractiveness and Mating Relevant Decisions and Behaviour: A Review.

Symmetry, 2(2), pp.1081-1098.

11. Yalçınkaya, E., Cingi, C., Söken, H., Ulusoy, S. and Muluk, N. (2014).

Aesthetic analysis of the ideal eyebrow shape and position. European Archives of Oto-Rhino-Laryngology, 273(2), pp.305-310.

Balsam Alabassi is an independent prescriber and an aesthetic practitioner with a university degree in both pharmacology and pharmacy

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I N J E C TA B L E S

MENTORING

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Under guidance

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Claire Berry discusses the role of mentoring in aesthetics

ave you started a career in facial aesthetics and feel like you are a little fish in an ever growing lake, let alone pond? It’s not surprising you may feel like that, as non-invasive medical aesthetics is fast becoming a huge market globally, with statistics showing that the market was worth $7bn in 2014 increasing to close to $8,500bn in 2016. If these figures continue in this current trend then it is estimated it will be worth $14bn by 2021.

It seems everyone is wanting a slice of the pie with medical professionals increasing their skill set by undertaking training in medical aesthetics. Quite often these courses are undertaken in a matter of days and then the clinician is able to undertake procedures in their own clinics. It is sometimes not until the clinician is starting in this industry that they realise how lonely it can be. Moving from a medical environment where all professionals help each other reach a desired outcome, to a cut throat

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business environment where it can often seem ‘dog eat dog’. With so many practitioners popping up the market is also becoming saturated and in the current climate, where there is very little regulation, even beauty industry workers are carrying out these treatments.

It can often feel like a rush once qualified to get the patients in and get the experience so you can compete with others for business in your local area. Without a ‘hustle like’ business mind you may feel like your business is doomed before you begin. There is now more competition in prices, treatments, products and pharmacies than ever. It would be quite rare for a medical professional to be dual trained in that and marketing to affectively run a business. Why do we assume we have the necessary skills to do so, in an environment where these skills are needed more than ever before?

On another front, why do we also feel like we are competing with other professionals when we should be

You would never be expected to do a short course and then be let free to treat patients with potentially harmful procedures in nursing, dentistry and medicine

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MENTORING

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working together to ensure all patients are treated safely and in the right and ethical way?

You would never be expected to do a short course and then be let free to treat patients with potentially harmful procedures in nursing, dentistry and medicine. There would be an element of mentoring beforehand, a period of time for you to shadow an experienced colleague who can give you valuable tips and insights, to give you confidence in your skills and knowledge and watch over procedures so you are confident in your practical ability. How is this not common place in aesthetics? It is something the industry is calling out for. This is an environment that can easily see professionals work together in a medical capacity (for example in an NHS setting) and then compete with each other ferociously for business in a side line career within aesthetics. It is easy to forget aesthetics is also medical and we should be coming together ethically.

We are seeing increasing numbers of complications and reports of inappropriate treatment and aftercare. Let us not let the medical and dental professions come into disrepute for the sake of medical aesthetics. Amongst calls for more regulations surrounding this field of medical treatment, as that is what it should be more recognised as, we should also be having at least some period of shadowing and mentoring with experienced professionals for two reasons: 1. Patient protection first and foremost and 2. Business mentoring to best approach a career in this saturated industry.

HOW IT WORKS

I will only let professionals shadow me or agree to mentor them at their clinic if they are medically trained and have

>>

attended and passed qualified courses in medical/facial aesthetics. What needs to be established is that this is not training, but instead a ‘hand holding’ procedure to build the practitioners confidence in procedures in which they have only carried out in a training environment or feel they need more confidence in. It is to put into practice the techniques they have been taught in a situation where someone can positively critique their practice to make them an even better practitioner. I make a point of ensuring my delegates learn from my experience, be that something I have done well or something that I have adapted due to what I have found didn’t work well from experience doing it. Knowing that someone is to hand if the worst was to happen makes it a smoother transition into the confidence needed for lone practice.

My mentoring sessions actually go into a lot more detail than this, talking about complications and delving into the interesting world of marketing. I work alongside a marketer for my own business and my delegates get contact with her as part of signing up to my mentoring sessions. After the 1:1 session I am also on hand to guide them through their first lone treatments and beyond. Knowing you are not alone in this industry will help control any anxieties that arise and allow your confidence to grow, but also ensure you are treating all your patients with their safety in the forefront of your mind. AM REFERENCES Statista, The statistics portal Global non-invasive medical aesthetic treatment systems market in 2014, 2016, and 2021 (in million U.S. dollars) https://www.statista.com/statistics/982813/non-invasive-medical-treatmentsystems-market-size/ Accessed 15th April 2019

Claire Berry is the owner of Claire Louise Aesthetics. She carries out her work from dental clinics in Doncaster. She has been performing medical aesthetics alongside her dental career for five years and also mentors other clinicians so they can gain confidence and experience in their own practice.

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H E A LT H

MENOPAUSE AWARENESS

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Intimate chat Genitourinary disorders are a distressing but often less discussed part of the menopause. Fiona Vlemmiks outlines how you can help patients

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hanks to the media, public awareness of issues relating to menopause has risen in recent years, yet many women are still too embarrassed to discuss some of the symptoms – especially those that relate to the genital area.

According to NICE, about 80% of women in the UK experience the effects of the menopause and one in four have severe symptoms, including anxiety and depression, which can lead to them being diagnosed with mental health problems.

The Genitourinary Syndrome of Menopause (GSM), which is a fairly new term, refers to changes in the vagina, vulva and bladder, brought about by the decrease in oestrogen during and after menopause. Signs and symptoms may include vaginal dryness, burning and discharge, decreased vaginal lubrication during sexual activity, and a shortening and tightening of the vaginal canal. This can be coupled with genital itching, recurrent urinary infections and an increased urgency to urinate. According to the International Society for Sexual Medicine (ISSM), GSM affects around half of menopausal and postmenopausal women.

Dr Rekha Tailor is the founder and medical director of Health & Aesthetics in Elstead, Surrey. She treats many menopausal women. “The vaginal skin has receptors for oestrogen. Oestrogen increases secretions and therefore after the menopause these secretions decrease leading to dryness”, she says.

“Gynecologists call this vaginal atrophy. In addition to the other complications, atrophy also causes fragility of the skin and this can cause bleeding.

“Any bleeding after the menopause is always taken seriously as there could be underlying cervical or uterine cancer. However, the commonest cause of bleeding in the menopause, in more than 80% of women, is vaginal atrophy.

“The front of the vagina is very close to the base of the bladder and weakness of the vaginal skin causes extreme irritability of the bladder, which is sometimes called urethral syndrome. With this, women complain of increased urinary frequency, urgency and having to wake up at night.”

In addition to the discomfort caused by GSM, which can in itself cause women to struggle with day-to-day activities, the issue can have a massive emotional impact, leading to loss of confidence and even anxiety and depression.

Furthermore, in 2016, a British Menopause Society (BMS) survey revealed that half of the women surveyed admitted

that the menopause had put a strain on their sex life.

Doctor Nadia Yousri is a obstetrician and gynaecologist who specialises in fertility, sexual wellness, non-surgical gynaecology and regenerative medicine. She says:“GSM symptoms can be some of the worst symptoms of the menopause because of the implications on sexual relationships and on quality of life. Women experience a loss of confidence and don’t feel feminine anymore and it can lead to marital problems.”

Although the media is now focused on publicising women’s health issues, Dr Shirin Lakhani, founder of Elite Aesthetics in Kent, believes there’s more to be done.

Dr Lakhani has much expertise in the area of intimate rejuvenation and is a strong advocate of women’s health and comprehensive menopausal care.

“Until recently people wouldn’t talk the menopause and some women are still too embarrassed to talk about it,” she says.

“Luckily we’ve had some high profile celebrities come out and speak about the menopause, which is making women more aware of the options available to them.

“Other countries are well ahead of the UK when it comes to menopause management.

“I have had women tell me that they’ve spoken to their GP about the menopause and they’ve just told them to ‘get on with it’.

“However, when it comes to GSM, there are a range of treatments available. It’s just that people don’t know about them and that’s why educating people has been a huge part of my press strategy recently.

“When I hear what people go through, I get quite cross because they are not getting the care they need. There is plenty that can be done and treatment can be tailored to the individual.”

According to NICE, about 80% of women in the UK experience the effects of the menopause

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TREATMENT LOW DOWN

Lubricants and vaginal oestrogen For less severe symptoms lubricants and vaginal moisturiser in gel or liquid form can temporarily, but immediately, ease discomfort or pain during sex or even outside of sexual activity.

However, this type of treatment doesn’t restore the vaginal physiology and many women find the lubricants messy or a turn-off during intimate activity.

Prescription vaginal oestrogen in the form of cream or a pessary is also an effective but temporary solution, as problems will return once product use has ceased. >

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H E A LT H

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MENOPAUSE AWARENESS

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H E A LT H

MENOPAUSE AWARENESS

Side effects can also include irritation and damage to latex condoms and diaphragms.

“For it to be effective, this treatment would need to be maintained indefinitely with vaginal application about twice weekly,” says Dr Tailor. “Some women are reluctant to use this, especially those with a history of breast cancer, although concerns are generally not well founded as studies have shown that vaginal oestrogens can be used safely in a large proportion of these women.”

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of patients suffering from vaginal atrophy,” she says, “It’s a good treatment because it stimulates the skin’s glands and provides natural lubricant.”

The O-Shot works by taking a small amount of blood from the patient, placing it in a centrifuge to separate and concentrate the PRP, before injecting it into specific areas in the clitoris, labia and vagina.

The PRP then stimulates the omnipotent stem cells (cells that are capable of developing into any type of tissue), leading to an increase in the speed of cell growth and tissue regeneration. This can improve lubrication, sensitivity, and is an effective treatment for stress incontinence and increases other symptoms of GSM.

Laser and high frequency Vaginal rejuvenation via laser offers a non-surgical, quick and safe solution Oestrogen for various common feminine issues, such as stress urinary incontinence secretions and therefore Fillers (SUI), vaginal laxity, vaginal dryness after the menopause and recurring infections, caused Hyaluronic acid (HA) is naturally present by menopause and other hormone in the vaginal mucosa and injecting it these secretions decrease into the vestibular and vaginal mucous deficiency. leading to dryness Dr Rekha Tailor has been offering membrane can provide a solution for problems related to dryness of the vulva FemiLift treatments from Alma Lasers (ABC Lasers) to patients for more than and vagina, especially for women who want four years at her clinic and has received to avoid oestrogen or other hormonal products. great feedback from patients, many of whom Vivacy’s DESIRIAL product is the only injectable HA that has been CE marked for gynaecological indications.Dr describe the treatment as “life-changing”.

FemiLift uses a CO2 laser to heat the tissue in the vaginal Yousri has been using Vivacy’s DESIRIAL on patients for two years with huge success. She says: “With menopause, walls. “Laser treatments improve the tissue quality by many women experience shrinkage of the vaginal tissues, stimulating collagen production. This increase in collagen resulting in loss of the volume of the outer labia and rejuvenates and tightens vaginal tissue, which in turn the cushion-like protection this offers. Injecting HA can improves vaginal dryness”, Dr Tailor explains.

The treatment takes between 10 and 15 minutes and hydrate and soothe irritated areas and the tone and doesn’t require any downtime. tension of the connective tissues are also restored. It can “FemiLift is a great long-term solution for vaginal dryness, help women suffering from volume loss of the vulvar labia as well as many other problems women might experience such majora as it strengthens the protective role of the labia as a weak pelvic floor, painful sex and urinary incontinence,” majora and improves the aesthetic appearance of the she says. vulvo-vaginal area.

“DESIRIAL contains mannitol, which is hygroscopic and an antioxidant, so it slows down the breakage of the HA and PRP rejuventation prolongs the duration of action. Results are immediate and Another non-hormone treatment for menopause symptoms can last for up to a year. such as vaginal dryness is PRP, which uses the body’s own “The treatment is changing women’s lives, meaning platelet rich plasma (PRP) to rejuvenate and stimulate they no longer suffer in silence which is why I am a strong the vagina, just like it does on the face. Dr Lakini uses the advocate,” adds Dr Yousri. AM O Shot PRP treatment. “I find this works in the majority

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IN-CLINIC TREATMENTS

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Eternal Optimas Sara Cheeney shares why she has taken on the Optimas platform from InMode in her clinic

I

n July, the Pure Perfection Clinic in Rossett added the Optimas platform from InMode to its offering with founder and nurse practitioner Sara Cheeney describing it as the “final piece in the jigsaw”.

Complementing other services offered by the awardwinning company, based between Wrexham and Chester, the Optimas provides a series of non-invasive techniques to combat ageing skin, wrinkles, pigmentation disorders and jowling.

“There are other skin-tightening products and technology on the market, but nothing like this,” says Cheeney. “It’s a revolutionary, results-driven and safe machine which is not being used anywhere else in this area, so we are thrilled to be able to unveil it to current and prospective customers.

“Importantly, it’s non-invasive and feels like a hot-stones facial, though there are also fractional treatments to take away scarring and improve the skin further given that it’s penetrating deeper.

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“For peace of mind, we always look at the science and clinical trials behind a product or treatment to ensure that they give proven results. We’re a medical clinic with the patient’s health and wellbeing at the forefront of everything we do.”

She adds, “I’m really excited about this and believe the Optimas is the missing part of the jigsaw; it’s a great addition to the range of technology we already have here.

There’s a lot we can do with it and there has been interest already from the public.”

Cheeney, who has grown the successful business despite battling cancer, also recently won the title of Aesthetic Nurse of the Year at the Safety in Beauty Awards and says the victory has made her even more determined to rid the industry of unregulated and unscrupulous practitioners.

“To come back from cancer to launch the business and win a prestigious award is a big deal for me - it’s huge!”, she says. “Three years ago, I was having chemotherapy and recovering from surgery, and now here I am feeling fit and healthy and leading a successful clinic.

“I’ve been in the industry for 12 years and worked so hard to do things the right way, while there are people out there who are not properly qualified, so patients are always coming to me after botched treatments and scary experiences.

“We don’t do anything that hasn’t had clinical trials and got a safety profile behind it, we work tirelessly in this region to improve standards and will continue to do so.”

Pure Perfection Clinic has also been revamped and refurbished and Cheeney has taken on three new staff, including another aesthetician.

“We are growing, enquiries are rising, and the business is in a good place,” she says.

“There are plans to expand further – including a training academy – but for now we are going to continue to grow organically.” AM

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STUDY ANALYSIS

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Why don’t men get cellulite?

Georgios Tzenichristos from LipoTherapeia discusses a recent study that analysed why women are more prone to the dreaded orange peel than men

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question I am constantly asked at the clinic is “Why do men not get cellulite?” and my answer has always been that women develop cellulite because they have weaker connective tissue and larger fat cells, due to the effect of female hormones.

Men, on the other hand, have much stronger connective tissue and much less subcutaneous fat, so they normally do not develop cellulite.

A study published in Plastic Reconstructive Surgery 1 earlier this year has shown that this is indeed the reason why women have cellulite and men don’t, explaining the exact mechanisms at play in men and women’s skin.

The study on 20 men and 20 women aged 36-92 years’old, has demonstrated that women have 34% less collagen fibres and 57% larger fat lobules in the deep layer of their skin in relation to men. The combination of larger fat lobules pushing the skin upwards combined with fewer collagen anchors offering little resistance to the upward pressure of fat, gives the appearance of cellulite.

This study also showed that the ‘cellulite is trapped toxins’ theory is yet another internet myth. Men are actually less careful with their diet, alcohol and smoking. So if anyone was going to have lots of cellulite due to a high consumption of toxins, it would be men, not women. And don’t tell me that that chocolate before one’s period is a ‘toxin’, because it isn’t.

This also shows why lymphatic massages, mechanical massages with a machine and body wraps do not ‘work’ or only work very temporarily: because they just focus on a temporary reduction of water retention and they do not address the fat accumulation/lack of collagen issue. These are the proverbial ‘elephants in the room’ when it comes to cellulite, according to this and previous studies.

The study also revealed why cellulite develops more with age. In the study, both older men and women were found to have a thinner dermis (middle skin layer). Combine this with the gradual accumulation of superficial fat into the fat lobules we mentioned earlier, and you have an increasing occurrence of cellulite with age. >

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DEVICES

STUDY ANALYSIS

The scientists also found that the higher a woman’s body mass index (BMI), the bigger the superficial fat lobules are. And there is even more: men have their superficial fat arranged in many smaller lobules with a lot more collagen anchors around them, which makes the upward protrusion of fat very difficult.

Plus it makes skin tighter in men. Women, on the other hand, have larger fat lobules with less collagen anchors around them to keep them in place and a weaker dermis. The combination means more cellulite and diminished skin tightness.

Moreover, the researchers have found that mens’ collagen anchors are also 65% stronger, further keeping skin tight and controlling the growth of fat cells, by means of compression action. Make the collagen weaker and you have more uninhibited fat growth and therefore more cellulite. Keep collagen stronger and in a way you suffocate the growth of superficial fat cells and you have less cellulite.

Plus the fat tissue under the skin (under the cellulite layer) is 49% larger in women than men, further undermining skin tightness and increasing excessive plumpness.

The authors of the study succinctly summarise these findings as follows: “Our results demonstrated that these structural factors lead to a significantly reduced biomechanical stability in females compared to males.”

The researchers add that ”Cellulite can be understood as imbalance between containment and extrusion forces at the subdermal junction... Therapeutic options targeting cellulite should aim to strengthen the subdermal interface”.

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And how does one improve this “biomechanical stability” to get rid of the dreaded cellulite?

Obviously you have to reduce the size of the fat lobules and increase skin collagen, which practically means more everyday movement, more exercise, less calorie intake and more collagen-boosting foods, such as vegetables, berries, herbs and lean protein. Avoiding hormonal contraception can also prevent further deterioration of connective tissue and enlargement of fat lobules.

I have written an extensive list of more than 60 tips on how to get rid of cellulite naturally – it can be found atlipotherapeia.com/how-to-get-rid-of-cellulite. Treatment -wise, the only treatment that boosts both collagen in the deep skin layers and releases fat from fat cells is highpower, deep-acting radio frequency, ideally combined with high power ultrasound, which is what we have been offering at the clinic for almost a decade now, and this study actually confirms our approach. AM REFERENCES 1. R udolph, Christina B.A.; Hladik, Casey B.A.; Hamade, Hassan; Frank, Konstantin M.D.; Kaminer, Michael S. M.D.; Hexsel, Doris M.D.; Gotkin, Robert H. M.D.; Sadick, Neil S. M.D.; Green, Jeremy B. M.D.; Cotofana, Sebastian M.D., Ph.D. Structural Gender-Dimorphism and the Biomechanics of the Gluteal Subcutaneous Tissue – Implications for the Pathophysiology of Cellulite. Plastic and Reconstructive Surgery: April 2019 - Volume 143 - Issue 4 - p 1077-1086

Georgios Tzenichristos is the director of LipoTherapeia, London as well as a nutritionist, aesthetic therapist and cosmetic formulator, who has specialised exclusively in skin tightening and cellulite for the last 19 years.

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ONDA level We find out why Lynton is hailing the ONDA device from DEKA as the “next generation in body shaping”

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his year sees Lynton celebrate 25 years developing advanced aesthetic technologies and so it is fitting that its focus is currently on the new ONDA device from DEKA. “Onda” is Italian for “wave” and is an apt name for the Italian-made system, which harnesses smart microwave technology for body contouring applications to reduce, remodel and regenerate by targeting localised fat pockets, skin laxity and cellulite at the same time.

The game changer with ONDA, Lynton says, is its Coolwaves technology.

Microwaves are absorbed by molecules in the target tissue, which causes them to oscillate and heat up, all while keeping your client’s skin cool and comfortable. The ONDA handpieces generate microwaves at 2.45GHz, a frequency that is preferentially absorbed by adipose cells.

By passing straight through the top layers without depositing excessive heat (about 20% of the thermal effect from the microwaves), the majority of the Coolwaves energy affects the deeper layers of fat, which is heated far more rapidly that the skin (about 80% of the thermal effect).

REMODELS: Cellulite Coolwaves effectively target the connective tissue between the adipose lobules in the more advanced stages of cellulite. Diminishing the “orange peel” effect.

The Coolwaves technology works by fighting the fat that pushes skin out by heating and melting hardened connective septa, allowing the skin to inject new elastin into them renewing the fibrous bands that pull skin in. By killing fat, ONDA effectively removes the ‘push’ element of cellulite. By loosening connective septa, it removes the ‘pull’.

REDUCES: Localised fat deposits The handpiece enables Coolwaves to penetrate deeply, dissolving subcutaneous

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adipose cell membranes. The lysate is subsequently eliminated by stimulation of physiological metabolic processes (macrophage lipolysis). The integrated cooling system ensures that the skin remains cool for maximum patient comfort.

REGENERATES: Skin tightening The microwaves induce immediate shrinkage of collagen fibres in the dermis and boosts the production of new collagen. This tightens and smooths the tissue. Dr Aamer Khan, co-founder of The Harley Street Skin Clinic, said, “Since we starting using the ONDA, we have treated more than 200 patients, each requiring about five treatments on average. We have carried out about 1,000 treatments, which has meant there is a lot of data to look at. Patients are happy with the outcomes. We have a lot of celebrity patients due to them not wanting long periods of downtime with busy schedules; they are very happy with the treatment.

“I like all three functions that the ONDA offers, particularly the fact that it is an effective cellulite reduction treatment. There is no other technology that does the same nonsurgically. We offer treatment to men and women and are seeing good results with both. Clearly women have cellulite more prevalently than men, however with the ageing process of men there is estrogenisation and we are seeing skin similar to cellulite, so men are benefiting from this treatment also. Patient safety is a priority and with the ONDA, we can be rest assured that it is one of the safest treatments we can offer our patients, especially with regards to tissue damage, to burns and adverse outcomes”. AM

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OUT AND ABOUT

CHARITABLE WORK

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The power of a smile 2019 marks 20 years since Mr Shailesh Vadodaria started doing humanitarian work in the developing world. Vicky Eldridge speaks to him about his most recent trip to Ghana and The Help Smile Trust

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t’s been 20 years since plastic surgeon Mr Shailesh Vadodaria first started providing plastic reconstructive surgery to people in the developing world. Mr Vadodaria, who has just returned from his latest visit to Ghana in West Africa, wanted to give something back having grown up himself in a rural area of India.

“My childhood was in a very small village in India”, he says. ”There was very limited resources in terms of electricity and water. My dad was a farmer and I had no clue that I was going to become a doctor. My father passed away when he was 42 from gallbladder cancer and that inspired me to do medicine. I thought that I would become an onco surgeon but, when I was studying medicine, I felt that cancer surgery was very destructive and mutilating so I decided that I’d become a reconstructive surgeon so that when something is removed because of trauma, cancer or infection, I could do the reconstruction.

“The seed was always in my heart that I could give something back. Sometimes the modern lifestyle is so much focused on ourselves and I have found that to truly be happy in life is to share what you have selflessly. It’s a good quality in a surgeon’s life to give back rather than all the time running behind your own ambitions.”

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Between 1999 and 2007 Mr Vadodaria embarked on this work alone, funding himself to travel to countries in need and providing his time and expertise where required, but in 2008 he formalised things and officially set up a charity on the advice of some friends. It was then that the Help Smile Trust was born.

Today, under the umbrella of the charity, Mr Vadodaria travels to countries such as India, Bangladesh, Ghana and Madagascar to perform a wide range of reconstructive procedures.

The recent Ghana initiative was organised in partnership with Motec, a UK-based charity working in Ghana, which is led by retired Ghanaian British orthopaedic surgeon, Mr Paul Ofori-Atta. Joining Mr Vadodaria on the 10-day trip were plastic surgeon Mr Stefano Cotrufo and breast surgeon Mr Sanjay Baldota from the UK as well as Dr Santosh Bhatia, a plastic surgeon from Mumbai.

During the course of these visits Mr Vadodaria and the team will treat anything from post burn contractures to congenital facial and hand deformities and open wounds following road traffic accidents and they carried out 36 operations this time including skin grafts of ulcers, snake bites, releasing of severe contracture of the axillary and

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reconstruction of congenital hairy naevus. They also do a lot of treatments for cleft lip and palate in children, something Mr Vadodaria is particularly passionate about. It is estimated that 250,000 babies are born worldwide with cleft lip and palate deformities and 230,000 of these occur in the developing or underdeveloped world.

Mr Vadodaria says, “I was trained in India and cleft lip and palate was one of the common pathologies we used to deal with so my mind and hand are very familiar with how to recognise, treat and look after those children. When I go there and I see those children and I can do something for them I feel I have a purpose in my life.”

Another issue particularly present in Ghana is keloid scarring. “Keloid scars can be painful, itchy and cause social compromise in young patients”, Mr Vadodaria says. “There is no long term solution to this so far. Removal and steroid injection was performed as recurrence is almost inevitable.

This is a big issue in the population in Africa and Asia.”

Mr Vadodaria also feels that doing this work over the last 20 years has had a positive impact on his family, with his eldest son now also taking up the mantle. He says, “I feel that it is very good for families and children to be a part of it. While my boys were young and growing they never understood where daddy was going for a couple of weeks

CHARITABLE WORK

every year but they noticed that he was always happy when he came back. It creates a good consciousness among a young family. And without the support and approval of my wife Bela, I would not have been able to go to the developing world so often in the last 20 years. She has always been a silent but very profound supporter.”

Now in his 60s Mr Vadodaria hopes the legacy of the charity will continue after he is no longer able to travel so much. With ongoing fundraising efforts (the charity takes part in the British 10K in London every year) and with a documentary charting Mr Vadodaria’s work in this field in the pipeline, he hopes that other surgeons and practitioners will see the benefit of doing this kind of work. He says, “When you do an operation or share your skills, knowledge and time without expecting anything in return, it is a very unique satisfaction. If we can make people aware that there is an opportunity for them to help then the consciousness will be expanded and with or without my presence this good work will continue. That’s my hope for the future.”

Part of this dream will also be helping to train local surgeons and provide them with the equipment they need to carry on the work on a regular basis. “If we can train local surgeons to be confident enough to continue doing this work independently then it would be a very good thing. We want to empower them to do it by themselves rather than waiting for an overseas team to come.” AM

If you would like to give your time and expertise or would like to donate to the charity visit www.helpsmiletrust.co.uk

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OUT AND ABOUT

INTERVIEW

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THE ART OF

ANATOMY Vicky Eldridge chats to sculptor Andrew Sinclair about how he is giving surgeons a different perspective on anatomy through art

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he recreation of the human form is more than just the replication of what the eye sees: It is the point at which art and science meet to truly understand the wonder of the human anatomy in all its complexity.”

If you visit The Sculpture School’s website these will be the first words you read. And this couldn’t be more true of any other area of medicine than aesthetics. I’ve often heard it said that aesthetics and art have a lot in common and that to be a good aesthetic doctor, nurse or plastic reconstructive surgeon you need to have the same sort of eye for detail and attention to detail that an artist has. So I was excited to chat to the school’s co-founder, Andrew Sinclair, about how aesthetic professionals are coming to him to hone their anatomy skills in a unique and creative way.

Sinclair is widely heralded as one of this country’s leading exponents of figurative sculpture, with his work featuring in collections all across the globe.

Having developed his own acclaimed technique of working – The Sinclair Method –he set up The Sculpture School alongside Diane Coates in 2010 from a desire to

bring their passion alive for a new generation of sculptors and share this methodology.

He says, “The school felt like a natural progression and enabled me to give something back. What the teaching did was force me to understand what process I was using that other people didn’t. I think we have come up with something unique. I definitely don’t teach classical art, which is what is associated with realism. I teach what I call contemporary realism, which is a modern approach to the way that body is worked. This allows me to teach people to measure the human body, which is difficult because there are no edges or right angles, and then they apply that to their sculpture in a way that they can make it move. Part of it has now become educating surgeons, including plastic reconstructive surgeons, on how to look at the human body in a different way.”

While there may be synergies between art and cosmetic surgery, the artists way of looking at anatomy is very different to the medical way and this, Sinclair says, is what helps his students to get a different perspective.

“There’s a big difference between sculptural anatomy and medical anatomy, but I fundamentally believe that the two are mutually compatible and complimentary to each other.

They work beautifully together”, he says. “A surgeon can open up a knee and know where to find the cruciate ligament.

In my world, you have to make a cruciate ligament. There’s

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OUT AND ABOUT

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a big difference between the two, because they have to understand its place in the body and be able to create that symmetry and that beauty by a knowledge that you create around that anatomy.”

In my time in the aesthetics industry I’ve met many successful cosmetic surgeons and doctors who have told me they also have a passion for art. Some have even claimed to have originally wanted to be artists bit to have followed a career in medicine instead with aesthetics then becoming the prefect medium for them to use both talents. This is something Sinclair has experienced too.

“I think creativity is much more integrated into who we are as a species because we’ve been doing it for the last 35,000 years. It’s in our DNA” he says. “I think it’s really important, and it’s a message I’m really keen on getting across because we’re not taking it seriously enough. We’re not focusing on creativity because we believe that it’s not important.

But I believe that it’s more important than anything else because it gives perspective, and that perspective gives us the ability to see other things that are considered more important in a different way altogether.

“We’re teaching the rules of how something is put together because it creates pattern. It’s something that I call design criteria, and once you understand that you focus on the design than rather than trying to copy. I believe that copying kills creativity. What you want to do is understand and get into the soul of the creature or person that you are working with. And that, on a practical level, resolves entirely around designs. So, rather than looking at a hand or thinking “I’m going to draw a hand”, you’re looking at the design of the hand and there is a significant difference.”

INTERVIEW

The school is situated in purpose-built studio space in the heart of the beautiful county of Devon in the South West of England and many delegates tell Sinclair they feel like attending is like going on a retreat in a sanctuary of calm respite.

“Because we’re down here in Devon, we found that twoday courses that we used to run in Buckinghamshire don’t work because it’s too far to come. So, we run a four day course from Tuesday to Friday and that enables me to teach the basics of every different kind of sculpture.

“There’s a therapeutic aspect to it, people see it as a kind of retreat and they feel cleansed by the end of it. I never saw that coming. What is lovely is watching the cream of the cream, the intellectuals and the high-brow students, play like children, and they do. They’re giggling and they’re comparing what they’re doing to each other. When you are under that kind of pressure, which they are when they are studying for medicine, having a break like that and learning in a way that is hands on is incredibly powerful.

“I was teaching at UCL at the beginning of this year, looking at all the muscles of the forearm with the top reconstructive surgeons, and we had two brilliant days mainly because the reconstructive surgeons were having a whale of a time. The consultants thought it was really good fun. It’s a powerful thing.” AM

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OUT AND ABOUT

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Out and about Out and about in the industry this month

Pigmentation un-covered symposium, Euston Square, London Last month saw AestheticSource host its first Pigmentation Un-covered Symposium at the Royal College of General Practitioners, Euston Square, London.

The one-day symposium welcomed more than 130 attendees from the aesthetic industry and brought together leading international industry speakers, who shared their expertise on the diagnosis, treatment and maintenance of pigmentation and skin health.

The day concluded with a presentation of a cheque for £2,750 to Born to be Beautiful – a charity that teaches beauty therapy training and skills to those suffering from abject poverty and helps them with further education, work and setting up their own business.

Lorna McDonnell Bowes, founder and director of AestheticSource, said, “We have been overwhelmed with the positive feedback from holding our 2019 AestheticSource symposium – Pigmentation Un-covered. Pigmentation as a category is continuously evolving, and the event enabled us to showcase and share the knowledge and experience of our colleagues on this important topic, as well as the synergies within our portfolio for the treatment and maintenance of this skin condition.”

Dr Mayoni Gooneratne said, “What an absolute honour it was to be part of something so special. Yet again AestheticSource has hit it out of the park. I loved every minute and was educated to boot. Every time I wonder why I left surgery, events like yesterday remind me what I’m doing! The scientific-led learning, the fun and the incredible support from the team is why.”

The evening finished with a drinks reception combining summer cocktails on the rooftop balcony and a summer evening BBQ enabling delegates to relax and network.

BTC Training graduation event, London Dr Harry Singh invited past delegates and graduates of BTC Training to an event in London to celebrate their achievements.

Guests enjoyed drinks and canapés as well as an opportunity to network with the BTC team and fellow delegates and graduates. Attendees also learnt about the ups and downs of launching a facial aesthetic clinic and maintaining a profitable business model, before being given a goody bag crammed full of vouchers and offers from BTC Training and its partners.

Dr Singh said, “We value and appreciate the support that we receive from practitioners looking to pursue a career in facial aesthetics, who put their time, dedication and trust in the team at BTC Training to provide the levels of clinical, theoretical and business education required for success.

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BCAM, Church House Conference Centre, London The British College of Aesthetic Medicine (BCAM) held its annual conference last month at the Church House Conference Centre, Westminster, London.

This year’s event featured two agendas focussed on evidence-based medicine and business strategies. Speakers included Mr Dalvi Humzah, Dr Tapan Patel, Dr Kate Goldie, Dr Patrick Treacy, Dr Sabrina Shah-Desai, Dr Lucy Glancey, Dr Leah Totton, Dr Beatriz Molina, Dr Sandeep Cliff, Dr Tahera Bhojani Lynch, Dr Rupert Critchley and Dr Zunaid Alli.

BCAM conference director Dr Ruth Harker said, “A key element of this year’s BCAM conference is the introduction of a new, higher qualification, our membership examination or MBCAM, which will see BCAM members recognised fully for the pioneers they are.

“I would like to thank all the speakers, demonstrators, delegates, exhibitors, sponsors and staff without whom the event would not have become the flagship meeting of our profession.”

The 2020 event will take place on Saturday, September 19 at Church House Westminster.

Out and about Out and about in the industry this month

3D-HYDRO2 FACIAL LAUNCH, RUGBY, WARWICKSHIRE 3D-lipo held an exclusive VIP launch event for it’s new device, the 3D-HydrO2 Facial, at its head office and training centre in Rugby.

With more than 30 clinics in attendance, the day included the highly anticipated unveiling of the machine by founder and managing director Roy Cowley. Joanne Leahy, head of training at 3D-lipo, went on to showcase the technologies and treatments that can be offered using this seven-in-one platform.

National sales manager at 3D-lipo, Scott Julian, said, “The 3D-HydrO2 Facial is yet another game changer and is an important addition to 3D-lipo’s product portfolio, allowing therapists to customise facial treatments to individual clients’ concerns, conditions and skin types.”

BABTAC Conference and awards September saw beauty industry stalwarts and insurance providers BABTAC open the doors to it’s first ever conference, providing a day of education for members and non-members wanting to get the inside track on the latest developments in the industry.

Topics included new skincare ingredients, treating clients with cancer and how to build a social media following.

This year’s award winners included Jennifer Glen (pictured) who won both Beauty Therapist 2019 and the prestigious Gold Award that recognises members that go above and beyond what is expected of them. Glen is also part of the Zen Lifestyle team, which won the Large Salon 2019 award (also pictured).

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