Aesthetic Medicine April 2020

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CONTENTS

IN THIS ISSUE...

aestheticmed.co.uk

Contents APRIL

9

EDITORIAL Georgia Seago, Deputy Editor

6 EDITORIAL BOARD Meet our editorial advisory board

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

8 NEWS The latest news from the industry

20 AML SHOW REVIEW A look back at AML 2020, one of our most successful shows to date

14 NEWS SPECIAL Dr Vincent Wong’s upcoming masterclass roadshow project

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

Vicky Eldridge, Consultant Editor

28 EMPLOYMENT Victoria Vilas on handling employee lateness

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

ADVERTISING Jack Diamond

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

MARKETING Jennifer Shutter

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

PUBLISHER Mark Moloney

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

DESIGN AND PRODUCTION ICD

imagecreativedesign.co.uk

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

Europe: £59; outside Europe: £67.50.

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

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

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CONTENTS

IN THIS ISSUE...

aestheticmed.co.uk

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30 ENVIRONMENTAL PROTECTION Why EPF will become as commonplace as SPF

42 RUNNER’S FACE Dr Harry Singh discusses the role exercise plays in facial ageing and acne

33 LED Dr Mayoni Gooneratne presents new findings on LED’s in clinical facials

46 NON-SURGICAL RHINOPLASTY The importance of patient selection and managing expectations,

by Dr Yusra Al-Mukhtar

38 CLINIC PROFILE AM editorial board member Dija Ayodele opens her first clinic

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48 GOOGLE REVIEWS Everything you need to know about dealing with negative reviews on Google

56 BECOMING A KOL Antonia Mariconda shares advice on how to become a brand ambassador in aesthetics

70 TREATMENT REVIEW Vicky Eldridge’s journey with Mesoestetic’s Dermamelan peel

52 PRODUCT NEWS The latest product launches

60 WEBSITES Why your clinic’s website should still be a priority in the age of social media

72 HORMONE THERAPY Dr Sophie Shotter discusses the link between hormones and skin

54 PRODUCT FOCUS New antiseptic skin sprays from Thoclor Labs

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66 TREATMENT NEWS Profhilo releases body treatment protocols and a London clinic develops a lunchtime combination laser treatment

77 EYE REJUVENATION Looking at the surgical and non-surgical options for ageing eyes with Mr Daniel Ezra

Welcome to the April issue of Aesthetic Medicine 46

Some of you may be surprised to see a new name and face. After becoming deputy editor late last year, I’m so excited to now be taking the lead on the magazine going forward. Rest assured, I have the best mentor in Vicky Eldridge, who I’m sure a lot of you know and love after her 16 years as founding editor of the AM brand. Vicky remains as consultant editor to continue curating our ever-evolving conference programmes, and to offer me her guidance and unrivalled knowledge of the industry as I work on developing our content to be bigger and better.

The world is heading into unchartered territory and we’re all too aware of the uncertain and challenging times that lie ahead for the businesses in our sector. Those of you preparing to return to the NHS to help tackle the pandemic – we salute you.

We’re here to help all our readers ride the wave in any way we can – be it advice on how to keep things ticking over, tools to ensure you stay healthy mentally, or innovative ways to adapt your business model for the time being. Let us know what you want to read: georgia@aestheticmed.co.uk Georgia – Deputy Editor

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CO N T R I B U TO R S

EDITORIAL ADVISORY BOARD

aestheticmed.co.uk

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

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DR NICK LOWE

DR ULIANA GOUT

DR SOPHIE SHOTTER

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

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

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

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

DR STEVEN HARRIS

DR SHIRIN LAKHANI

DR RAJ THETHI

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

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

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

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

MR ALI GHANEM

DIJA AYODELE

EMMA DAVIES

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

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

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

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

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

INDUSTRY NEWS

aestheticmed.co.uk

Aesthetic nurse assembles practitioners to assist NHS amid COVID-19 pandemic As Aesthetic Medicine went to print, the UK was joining the rest of the world in rushing to deal with the COVID-19 global pandemic and aesthetic professionals were implementing ways to try to safeguard both patients and their businesses, while also lending their medical skills and assistance to the NHS. Sharon King, co-owner of Cosmedic Cosmetic & Aesthetic Medicine in Tamworth, Staffordshire, called for fellow medics to group together and offer their services to the NHS, should they be required, to help deal with the outbreak.

As a registered nurse and independent prescriber having formally worked in the NHS, King was asking any colleagues working privately who have the skills to assist or help NHS staff to join a register of names to be passed on to the relevant authorities.

In a post on her personal Facebook page, she said: “Our medical teams will be stretched beyond belief or capacity over the next few weeks or months. This will have

a detrimental effect on our businesses and healthcare generally, but in these trying times I ask that anyone who can assist or can help our colleagues working in the NHS offers their services, no matter how big or small.”

Anyone willing to help should email info@cosmedictraining.co.uk with their name, designation, contact details including phone number and registration number.

Less Brits had plastic surgery in 2019 The number of surgical cosmetic procedures recorded in the UK in 2019 was down 7.5% from the previous year, according to the annual British Association of Aesthetic Plastic Surgeons (BAAPS) audit.

A total of 27,000 procedures were performed by members, with breast augmentation and reduction remaining the most popular, despite both having seen a fall in numbers.

One procedure which bucked the trend and saw a growth in popularity was lower body lifts, which was up 22%.

The report was compiled by former BAAPS president Rajiv Grover. He commented, “While the overall number of procedures has dropped, the work we’ve been doing to educate about the life-changing implications of cosmetic surgery and the need to reflect carefully before taking this route is working. We’re seeing greater emphasis from surgeons on psychological assessment, as mental health awareness has taken centre stage both politically and in the news agenda.”

Beauty industry association warns therapists not to inject dermal fillers The British Association of Beauty Therapy and Cosmetology (BABTAC) is urging its members not to administer injectables.

The association is also asking therapists to make clients aware of the potential consequences of being injected by someone who doesn’t have quick access to a fully-stocked emergency kit bag that contains items including an EpiPen, adrenaline, hyaluronidase and chlorphenamine injection – items only available to medical professionals.

Lesley Blair, chair of BABTAC, said, “Both as an insurer and as an industry body on a mission to raise standards in the beauty sector, BABTAC does not condone these fast-track courses that are increasingly being taken by influencers in order to administer injectables.

“Medical training is essential to safely carry out these procedures. If you can’t prescribe an antidote if necessary, you shouldn’t be administering injectables. Anything less than that puts customers at serious risk.”

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

aestheticmed.co.uk

INDUSTRY NEWS

New points-based immigration system could negatively impact aesthetic clinics Government plans to introduce a points-based immigration system from January 2021 will make it harder for aesthetic therapists to enter the UK, and could have a negative impact on beauty and aesthetic businesses, warns the National Hair and Beauty Federation (NHBF).

The plans categorise the work of beauty and aesthetic therapists as “low-skilled”, owing to the often relatively low wages earned by professionals in these fields.

This means that potential clinic staff wanting to live and work in the UK from January next year may struggle to earn the 70 “points” needed to qualify for a visa.

The mandatory criteria for earning points include having a job offer with a “sponsoring” company (20 points) and at an appropriate skill level (20) as well as the ability to speak English at the required level (10).

After these criteria have been met, there are others that allow applicants to top up points.

Hilary Hall, NHBF chief executive said, “Salons [and clinics] looking to fill vacancies from overseas should make those appointments before 31 December 2020, as the new criteria will make it much harder to recruit foreign workers, whether they are EU or non-EU citizens.”

Golden skin tone linked to exercise and healthy diet A study by researchers at the School of Psychology and Neuroscience at the University of St Andrews found a strong link between a healthy lifestyle and a “healthylooking, golden skin colour”.

While previous studies showed connections between a good diet and improvements in skin colour, the most recent research focused on other aspects of a healthy lifestyle and how this impacts positively on skin colour.

It is known that eating a healthy diet including lots of fruit and vegetables increases skin yellowness due to the accumulation of coloured plant pigments in the skin and that exercise boosts the body’s antioxidant systems. This study took previous findings further by assessing whether a change in overall health affected skin appearance.

Lead scientist for the study Professor David Perrett said: “We worked with 134 students measuring fitness from heart rate while walking and running on a treadmill. We assessed body fat levels with an impedance meter much like that available on many bathroom weighing scales.

“We measured skin colour with a device that records how a rainbow of colours is reflected from the skin. We found that both high fitness and low body fat were associated with a higher skin yellowness.

“For 21 observers we found the change in colour with increased fitness was visible and was judged as looking healthier on 90% of trials.

“We were surprised to find that the skin colour changes accompanying change in health occurred quite quickly and within eight weeks.”

PHI buys first Cutera TruSculpt Flex in London Dr Tapan Patel’s Harley Street clinic, PHI, has been announced as Cutera’s first London-based provider of new muscle-stimulation and bodycontouring device, TruSculpt Flex.

Already housing a wide-reaching portfolio of aesthetic technology for almost all aesthetic treatments, PHI has now decided to introduce Cutera’s take on MDS (Multi-Directional Stimulation) technology to the clinic, a technology shown to increase muscle mass by an average of 30%, according to the manufacturer.

Dr Patel, clinical director at PHI Clinic, said of the clinic’s latest purchase: “At PHI we only use the highest quality devices that ensure our patients undertake treatment that is both safe and that will deliver the best possible results achievable.

“We like that with the TruSculpt Flex, we [can] tailor the treatment dependent on the individual’s fitness levels, and that we are able to target specific muscles directly, instead of just treating a large area.”

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INDUSTRY NEWS

aestheticmed.co.uk

Royal College of Surgeons welcomes pension taxation reforms for doctors in 2020 Budget Professor Mike Griffin, president of the Royal College of Surgeons of Edinburgh, gave a statement welcoming the pension taxation reforms laid out in Chancellor Rishi Sunak’s first Budget, released in March.

“We are glad that the Government has listened to the medical professions and raised the threshold income to £200,000. This will remove most doctors from the effect of the taper, meaning that the majority will now no longer be in the erroneous position where they are effectively paying to go to work, cutting their hours, or turning down important additional work.

“As medical and surgical professionals, we take pride in providing the best care for our patients and so are relieved that this anomaly has been addressed. However, we still have concerns over how suited the annual allowance is to defined benefit schemes such as the NHS. “Many doctors have incomes far below the new threshold income, so will face tax bills if they are exceeding the standard annual allowance of £40,000.

“This could happen if their pensionable pay rises as a result of assuming a leadership role or being recognised for clinical excellence. Moreover, as there is no change to the lifetime allowance, many doctors may still take early retirement.”

The Budget also included a plastic packaging tax, coming into force April 2022. Manufacturers and importers whose products have less than 30% recyclable material will be charged £200 per tonne. Sunak claimed the move would increase the use of recycled plastic in packaging by 40%, “equal to carbon savings of nearly 200,000 tonnes”.

In terms of tax and business rates, the National Insurance contributions tax threshold will rise from £8,632 to £9,500, saving employees more than £100 a year.

Meanwhile, those aged 25 and over will get the National Living Wage (NLW) of £8.72 an hour, a rise of 6.2%, with younger workers also getting more. This is paid by employers.

Business rates will be abolished for smaller companies in retail, leisure and hospitality, but this will only apply to premises with a rateable value of up to £51,000.

Any company eligible for small business rates relief will be allowed a £3,000 cash grant – a £2bn injection for 700,000 small businesses.

The economy is predicted to grow by 1.1% this year, but this does not take into account the impact of the coronavirus.

This would be the slowest economic growth since 2009.

The economic growth forecast is 1.8% in 2021–2022, 1.5% in 2022–2023, and 1.3% in 2023–2024.

Several measures were outlined to help tackle the impact of Covid-19 virus on small businesses up and down the country. Sunak said all of those advised to self-isolate, even if they don’t have symptoms, are to receive statutory sick pay if eligible.

Smaller businesses with fewer than 250 employees can reclaim the cost of sick pay for 14 days of isolation.

Those not eligible for sick pay, such as the self-employed, will be able to claim Employment and Support Allowance (ESA) from day one of “illness” instead of day eight.

Study analyses effectiveness of collagenesis stimulation by PLLA and PLGA threads A study published in the Journal of Cosmetic Dermatology has been the first to collate data on collagen stimulation by the poly-L-lactic acid (PLLA) and glycolide polymer (PLGA within absorbable suspension sutures used for tissue repositioning.

The single-center, open-label, prospective study enrolled 25 healthy volunteers treated with threads for midface tissue descent. Punch biopsies were evaluated and nasolabial fold severity was assessed by both subjects and investigators using the Nasolabial Fold Wrinkle Assessment Score (NLF-WAS).

Collagen deposition was apparent at day 90 and increased significantly compared with baseline at days 180 and 270 and between days 90 and 180. NLF-WAS was significantly improved at all post-treatment time points.

The authors concluded that their ability to provide mechanistic support and stimulate neocollagenesis in

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areas immediately adjacent to the path of the PLLA/PLGA monofilament and cones, made these threads a valuable tool for patients seeking facial rejuvenation.

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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 AESTHETIC SOURCE TO DISTRIBUTE OXYGENETIX Aesthetic Source has added US skincare and foundation brand Oxygenetix to its portfolio of clinical skincare brands. Oxygenetix is known for its patented ceravitae complex, antimicrobial properties and ability to function without blocking the flow of oxygen to the skin, making the products ideal for use post-procedure and on compromised skins. The Oxygenetix range consists of Oxygenating Foundation, which also comes in an Acne Control formula and Oxygenating Hydro-Matrix moisturiser. The foundation is available in 13 shades.

SINCLAI R CELEBRATES ELLANSÉ Sinclair Pharma recently celebrated a treble milestone with bio-stimulating dermal filler Ellansé. The one-millionth syringe was despatched while the company was celebrating the 10th anniversay of the product, and Sinclair announced a new manufacturing facility housed within the University of Utrecht in The Netherlands. The new site will allow for an increase in production capacity in anticipation of launching Ellansé into China.

ABC LASERS EXPANDS TEAM Distributor ABC Lasers has expanded its national sales team with the promotion of Adam Bashier as national sales director. The appointment is part of the business’s ongoing investment in the Alma Lasers portfolio and will assist in the continued development of new and existing business opportunities. Bashier will oversee the expansion of the sales team and look for growth in other areas.

CLINICS OFFER FREE LASER Two Lynton Lasers clinic accounts, Amy Jayne Aesthetics and The Beauty Editor, are taking part in a campaign that involves removing surgical tattoos for breast cancer survivors free of charge. Radiotherapy patients are tattooed with pin-point black or blue dots to enable the accurate targeting of the treatment.

Number of women studying for science degrees is on the rise The number of women choosing to study science and technology related degrees is growing year by year in the UK, with subjects allied to medicine at the forefront.

Figures from higher education and data analysis experts HESA have shown a 3.1% increase in women enrolling in science subjects from 2017/2018 to 2018/2019.

According to theknowledgeacademy.com, which studied figures from HESA, most women chose to study subjects linked to medicine. There were 560,530 undergraduate enrolments in 2017/2018. This number has spiked by 0.9% in the following years, taking the number of women studying subjects allied to medicine including anatomy and physiology, pharmacology, pharmacy, nutrition, ophthalmics, audiology, nursing and medical technology to 229,895.

Computer sciences had seen the highest spike in undergraduate female students, while the degree least sought after by women was veterinary science.

The UK is just below the EU average for the number of women in science and tech. Figures from Eurostat have shown that out of the total percentage of people in science and tech in the EU, 41% of them are women. In the UK, there are 40.7% women in the industry.

New pre-clinical link found between gut microbiome and brain function Scientists at the University of Glasgow have described new molecules which form a direct link between the gut microbiome and the brain, leading to inhibition of brain cell function.

Dr Dónal Wall, from the University’s Institute of Infection, Immunity and Inflammation, said, “The novel techniques we used in this study allowed us to demonstrate a molecular exchange between the gut microbiome and the brain, which could be of biological importance in many diseases.

“The microbiome compounds we found, which ‘mimic’ and localise with carnitine after travelling to the brain in the mice we studied, also affected its function, making it an extremely important finding for ongoing research in this area.”

This is the first mechanistic description of a microbial molecule inhibiting the function of the central nervous system’s mitochondria.

NEWS IN PICTURES

Miss Balaratnam (centre) with iS Clinical founders Alec Call (far left) and Bryan Johns (far right)

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Aesthetic doctor Miss Sherina Balaratnam was made the official global ambassador for cosmeceutical skincare brand iS Clinical. Alana Marie Chalmers, director of iS Clinical UK distributor Harpar Grace, said, “The experience, credibility and results Miss Balaratnam has built up on iS Clinical within her practice over the past five years make her the perfect fit for this highly coveted role, and she will be nothing but an inspiration to practitioners around the world as part of her global tours.”

Add pic caption (horizontal): Miss Balaratnam (centre) with iS Clinical founders Alec Call (far left) and Bryan Johns (far right)

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N EWS

TRAINING

aestheticmed.co.uk

Hit the road Dr Vincent Wong is taking his facial harmony concept on the road, and Aesthetic Medicine will help recognise the most skilled and talented injectors

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esthetic Medicine is partnering with Dr Vincent Wong to recognise the learning journeys of delegates of his recently-announced Essential Harmony masterclass roadshow.

Described by Dr Wong as a “360-degree, CPDaccredited learning journey on achieving facial harmonisation using a combination of techniques targeting all layers of the face”, AM will follow the roadshow around the country and eventually award the delegate who showcases the best transformative work with a special award.

The events will start in London and visit Brighton, Manchester, Birmingham, Newcastle, Edinburgh, Glasgow, Belfast, Dublin and Cardiff. One winner and one highly commended delegate will be chosen from each region.

Sponsored by Fillmed Laboratories, AQ Skin Solutions and Amedica, the one-day agenda will include facial balancing and harmony, shaping with neurotoxin,

eliminating shadows with dermal fillers, profiloplasty with dermal fillers and fat-dissolving injections, treating the midface and eyebrows with facial threads and skin rejuvenation with growth factor-induced therapy.

The concept of facial harmony and attractiveness will be examined in-depth, with Dr Wong teaching a breakdown of a 3D approach to lifting and repositioning, and discussing the differences between looking fresh and looking young.

The anatomy section will cover proportions and vectors, emotional attributes, and static vs. animated faces.

Limited spaces are available for two delegates in each location. Delegates must be intermediate to advanced-level practitioners registered with the GMC, GDC or NMC. Delegates will be automatically shortlisted to be awarded for their work, with Dr Wong choosing winners based on techniques demonstrated, facial harmony achieved and patient feedback.

The winning case study transformations will be featured in an issue of Aesthetic Medicine.

The roadshow dates and locations are: London – May 30 Brighton – June 6 Manchester – June 13 Birmingham – June 14 Newcastle – June 25 Edinburgh – June 27 Glasgow – June 28 Belfast – July 3 Dublin – July 5 Cardiff – July 10 Spaces cost £1,500. Full details and to book: thefacialharmony.com. Dates may have to be changed depending on the situation with Coronavirus in the UK AM

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OUT AND ABOUT

Dates correct at time of going to print but may be subject to change/postponement due to Coronavirus.

DIARY DATES FITZ FAHEY ACADEMY DIGITAL SMILE DESIGN CLASS

APRIL 24 The Swan, Streatley, Berkshire Workshop by cosmetic dentist Dr Elaine Halley on digital smile design techniques, organised by dental faculty the Fitz Fahey Academy. facebook.com/fitzfaheyacademy

AMWC ASIA

MAY 1-3 Taipei International Convention Center Meeting dedicated to aesthetic medicine and dermatology with focus on minimally-invasive rejuvenation and experts from Asia and around the world. euromedicom.com

SMART IDEAS 2020

MAY 2 Sopwell House, St Albans, Hertfordshire All-day, CPD-certified business seminar for aesthetic clinic owners run by The Consulting Room Group, featuring three parallel agendas. smartseminar.co.uk

BMLA CONFERENCE 2020

MAY 5-7 Royal College of Surgeons, Edinburgh Annual conference of the British Medical Laser Association for medics, surgeons, nurses, technicians and aestheticians in the field of laser and light-based devices. bmla.co.uk

BRITISH ASSOCIATION OF SCLEROTHERAPISTS CONFERENCE

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

FACE CONFERENCE

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

AM NORTH

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

VEGAS COSMETIC SURGERY

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

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aestheticmed.co.uk

Out and about All the happenings in the industry this month

HA Derma Aliaxin masterclass and North England education event Milan and Manchester

IBSA Derma UK and Ireland distributor HA Derma held two educational events recently. The first was the company’s first educational event in the North of England, held at the Radisson Blu in Manchester.

Organised to facilitate practitioners based outside of London, the event was a platform to launch Aliaxin SV dermal filler, IBSA’s new global marketing campaign, and tools and assests to support practitioners with Profhilo body protocols. Speakers at the event included Dr Fab Equizi, Dr Beatriz Molina, Anna Baker and Frank Ward and Rachel Dallison-Foster from HA Derma.

A few days later the HA Derma team headed to Milan with specially selected practitioners for two days of Aliaxin “MYVolution” training. The masterclass included theory presentations on the rheology, science and technical features of IBSA Derma portfolio, along with live demonstrations.

IS CLINICAL “MEET THE FOUNDERS” EVENT THE RITZ, LONDON AM deputy editor Georgia was invited to an intimate breakfast at The Ritz with iS Clinical founders Bryan Johns and Alec Call. The pair shared the history of the brand and how it developed along the way and explained the concept, ingredients and technology behind the cosmeceutical skincare products. Johns and Call also spoke about the brand’s work with the National Breast Cancer Coalition in the US. Guests were among the first in the world to take home a sample of the brand’s upcoming product launch – under wraps until the June launch date.

Oxyjet Oscars treatments Hotel Bel-Air, Los Angeles

The UK distributor and training branch of Oxyjet partnered with celebrity facialist Adeela Crown to treat some famous faces in preparation for the 92nd Academy Awards. Treatments with the oxygen-based skin-rejuvenation device in Crown’s skin suite were by invitation-only.

Celebrities she treated included Sir Kenneth Branagh, Annette Bening and Daisy Ridley. Oxyjet Go uses a pressure-pulsed method to deliver microencapsulated oxygen and active ingredient serums into the dermis, energising cells and plumping the skin.

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OUT AND ABOUT

aestheticmed.co.uk

DR RUSSO PRODUCT LAUNCH URBAN RETREAT AT THE WHITE HOUSE, LONDON Dr Luca Russo held an intimate press gathering over breakfast snacks to introduce the latest additions to his suncare product range – Once a Day Sun Protection Face Gel Bronzer SPF30 and After Sun. Both products have a brush-on mechanism that delivers the exact dose of product (2mg) with each click to cover a cm2 area of the face; the amount required to achieve the level of protection advertised on the product.

The new launches join existing SPF30 and 50 brush-on sun protection. At the event, Dr Russo talked through the products’ technology and ingredients, spoke about common sun protection myths and gave his guidance on how best to protect the skin.

Thames Skin Clinic launch TWICKENHAM Current and prospective clients were invited to celebrate the opening of Dr Anna Hemming’s new clinic in Twickenham.

Dr Hemming organised a half day of presentations and demonstrations around treating skin conditions safely and medically. Demos included plasma shower for transepidermal product absorption, ThermaVein for facial thread vein treatment, ZO Stimulator peel and Profhilo.

Dr Hemming also held an open discussion about toxin injections and introduced the Thames Face Uplift dermal filler treatments. The clinic also offers HIFU, LED, HydraFacial, microneedling and mesotherapy, among other treatments.

Social media and influencer workshop The Clinic by Dr Mayoni, Crystal Palace, London

Aesthetic doctor Dr Mayoni Gooneratne held a full-day workshop for fellow clinic owners to share tips and advice on making social media manageable and working with influencers to boost business. In collaboration with influencer Bethie Hungerford, Dr Mayoni ran the section of the workshop on how to curate a successful clinical social media feed; while Hungerford gave her insight on how aesthetic businesses can work effectively with social media influencers while staying true to brand values and using your voice in the right way. The event was designed to give delegates actionable ideas and advice, with a follow-up video from Hungerford post-workshop talking through how to set up a social media account.

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EXHIBITIONS

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“ThermaVein find Aesthetic Medicine Live to be one of the best shows in the UK. The size of the show makes it very engaging and the environment is great.”

“If we had to describe the show in one word it would be ‘unique’, as there’s no other place like “These are people who in the North” come withthis a shopping list and

John Fisher, managing director, ThermaVein

Sandy Green, Thecompanies National Weight actively engage with Loss for Programme and make purchases their aesthetic businesses. There are a lot of other events that ask us to spend our money with them but it’s important that we get a measurable return on investment, and we do from this show.”

Ron Myers, director of operations, Hydrafacial and Perk UK

Show and “It’s a very important meeting because it’s the first one of the year, but we didn’t expect it to be this busy. The fact that the UKAAPS conference runs alongside the show is also very important for us as we work closely with the surgical side of the market.”

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,978 aesthetic and medical professionals attended this year’s Aesthetic Medicine Live (AML) at Olympia London over the weekend. The first major event of the year on the aesthetic industry calendar, AML 2020 saw a steady stream of doctors, dentists, nurses, surgeons and aesthetic therapists through the doors for two days of education, networking and discovery in a relaxed, intimate environment. Visitor numbers were up 5% on last year, with many exhibitors commenting that both days of the show accommodated high-quality, engaged visitors and many up-and-coming faces in the industry.

The two-day clinical and regenerative conference agendas hosted packed-out audiences who heard from

Neil Wolfenden, managing director, Inmode Aesthetics UK

“It’s been one of our best shows; we’ve met lots of doctors who are up and coming in the industry.”

Sham Morjaria, managing director, Med Aesthetics

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“AML has been absolutely fantastic for us this weekend. It’s been great fun meeting all our new and old customers. And as a result of all the social media buzz and the presence that we’ve gained from AML, we’ve also sold equipment to people who aren’t even here.”

Tim Taylor, country manager, Cutera

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AML 2020 saw a record number of visitors engaging, interacting, buying and learning over the two-day event

names such as Dr Nick Lowe, Dr Vincent Wong, Dr Lee Walker, Dr Shirin Lakhani, Cheryl Barton and Dr Arturo Almeida. The business workshops stage featured a sold-out session by Antonia Mariconda on building a multi millionpound aesthetics business in 12 months, while the UKAAPS and BAHRS conferences ran successfully with high numbers over the two days.

Several exhibitors commented that AML 2020 had been one of the best aesthetics shows they’d attended: AM HEADLINE SPONSOR

“It’s been very good. We’ve seen a lot of people this weekend who are taking their first step into aesthetics, which is really encouraging.”

Ben Savigar-Jones, country manager, Cynosure UK and Ireland

EXHIBITIONS

“The show has been absolutely amazing.

We’ve sold three devices on the stand; it’s been one of the best shows we’ve done.”

Anisah Vidale, business manager, Venus Concept UK

“We are delighted to have taken part in AML. It was great to have our international KOL Dr Herve Raspaldo giving a live talk and a live demo during the conference.”

Camille Nadal, country director, Vivacy

PLATINUM SPONSOR

“The show has been fantastic for us – it’s the first show of the year and it’s certainly delivered – the quality of the visitor has been excellent and we’ve done superbly well. It’s almost been one of our best shows ever.”

Roy Cowley, managing director, 3D-aesthetics

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CONFERENCES

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Inspiring learning With five different streams and a faculty comprising global key opinion leaders and thought-shapers, the Aesthetic Medicine Live conferences brought education to life

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ducation has always been at the heart of Aesthetic Medicine Live and, now in its sixth year, our educational programmes have become stronger and more diverse than ever. With five seperate streams taking place across the two days, delegates had a wealth of sessions to choose from to arm them with the latest knowledge of clinical and business practices. What has always set the AML conference agendas apart is the interactivity and innovative topics delivered by our world-class speakers.

CONFERENCE HIGHLIGHTS

Our two-day clinical conference, encompassing two agendas including Aesthetic Regenerative Medicine in collaboration with the MSc in Aesthetics at QMUL and the College of Medicine and Dentistry Birmingham M.Sc Facial Aesthetics (chaired by Mr Ali Ghanem), was busier than ever.

The theme of this year’s clinical conference was the diversity of patients with our opening session on Full Facial Rejuvenation For Our Core Market: The Ageing Female Face drawing a huge first-morning crowd.

Other standout sessions on day one were Considerations When Treating the Male Face with Dr Lee Walker and Dr Raul Cetto; and The Diversity of Human Anatomy with Mr Dalvi Humzah and Anna Baker and with a live demonstration by Dr Hervé Raspaldo. As always, the complications session, led by Aesthetic Complications Expert Group chair Dr Martyn King, saw some lively and unmissable discussion.

On the Regenerative Medicine programme our injectables

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masterclass with Dr Nestor Demosthenous and Dr Tristan Mehta kicked Sunday off with a buzz, while the clinical agenda focussed on patients with skin conditions, hormonal concerns, weight issues and mental health problems.

SPECIALIST SECTORS

Both plastic surgery and hair restoration are key specialist sectors of the aesthetics market, so we were honoured to host both the British Association of Hair Restoration Surgery conference, organised by BAHRS’s CEO Danny Large and president Dr Greg Williams, and the UK Association of Aesthetic Plastic Surgeons conference organised by UKAAPS president elect Mr Shailesh Vadodaria. Both conferences had world-class programmes and discussions not found anywhere else in the UK.

THE BUSINESS BUZZ

Our Business Workshops, chaired by Richard CrawfordSmall, have become the place to be for sharing and connecting with other clinic owners, with some sessions even selling out. Our speakers comprise leading coaches from within and outside of the sector as well as successful clinic owners sharing their experience from the front line.

Stand out sessions with our delegates included: Developing Pricing Structures for Your Practice with Robin Waite; Metaphysical and Mindset Work Within Your Aesthetic Business with Tracey Dennison and How to Build a Multi-Million Pound Aesthetics Business in 12 Months with Antonia Mariconda. AM

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ON STAGE

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AM VIDEO MARKETING AWARDS

aestheticmed.co.uk

Stars of the show Find out who took home the prizes at the Aesthetic Medicine Video Awards 2020

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here is no other marketing tool as powerful as video. Whether shared on social media, featured on a clinic’s website, played on a screen in a waiting room or used as part of an advertising campaign, video is one of the most powerful ways to communicate and engage with your audience.

That’s why the Aesthetic Medicine Video Awards were launched – to recongise those who have created the most informative, engaging and well-produced videos that positively promote our sector.

The informal event, sponsored by Web Marketing Clinic, took place on Saturday, February 29, at the Hilton London Olympia.

There were five categories for both clinics and brands covering social media, promotional and educational videos. Here’s a rundown of who won and who came highly commended. AM

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BEST B2C VIDEO BY A BRAND WINNER: Soprano Titanium HIGHLY COMMENDED: Candela BEST B2C VIDEO BY A CLINIC OR PRACTITIONER WINNER : Dr Claire Oliver, Air Aesthetics, Safety in Beauty HIGHLY COMMENDED: Freyja Medical and Skin Radiance Clinic BEST SOCIAL MEDIA VIDEO BY A BRAND WINNER: IBSA Derma HIGHLY COMMENDED: Filmed Laboratories with Dr Vincent Wong BEST SOCIAL MEDIA VIDEO BY CLINIC OR PRACTITIONER WINNER: Air Aesthetics HIGHLY COMMENDED: Vindoc Aesthetics BEST TRAINING OR EDUCATIONAL VIDEO WINNER: Dr Harry Singh, BTC HIGHLY COMMENDED: Skin Philosophy

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BUSINESS

EMPLOYMENT

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Better late than never How should you manage an employee who is consistently late, asks Victoria Vilas

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o keep an aesthetics clinic running like clockwork, good timekeeping from your team is essential.

If a practitioner arrives late, the entire day’s schedule may have to be reorganised, causing delays for patients and extra work for bookings administrators. If any member of your team arrives late on a regular basis, their colleagues may resent having to put in the extra effort to cover someone who isn’t making the same contribution to the team.

While you shouldn’t let an employee get away with lateness when it has a significant effect on your clinic operations, it won’t make your employees feel appreciated if they are given a stern warning for arriving one minute late due to issues beyond their control.

Do promote the importance of punctuality and address lateness when it causes an issue, but don’t risk losing employee engagement and trust by imposing harsh penalties for minor misdemeanours.

DRAFT A POLICY AND FOLLOW IT

There will be genuine, unavoidable reasons for an employee being late, on occasion. Traffic disruptions, issues with

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IDENTIFY ISSUES AND DEAL WITH THEM

What are the reasons for your employee’s lateness? Poor organisation? Lack of motivation? If an employee is late on a regular basis, ask them what they think the issue is, and what could be done to solve it. Agree on an action plan and warn of the potential consequences if nothing changes.

Don’t just hand out penalties; speak to your employee and see if you can help. Can you offer advice on time management?

Could you make a minor change to an employee’s working hours to help avoid busy traffic? Though you’re there to manage a clinic business, not an employee’s personal life, some advice and encouragement can often be more motivating than a stern warning.

“Agree on an action plan and warn of the potential consequences if nothing changes”

Occasional lateness isn’t usually an issue so serious it warrants serious disciplinary proceedings, but it’s useful to think of what to do if an employee starts to disrupt your rota on a regular basis. For example, it is perhaps fairest to begin by warning employees verbally of any breach of policy, before they are given a written warning or are called in for a meeting. Don’t be too harsh on the first occasion, but don’t let it go unmentioned if it has caused a problem. Explain your attendance policy to all team members and let them know what penalties there will be for poor timekeeping.

BE FIRM BUT FAIR

childcare, home emergencies and other issues can sometimes arise without warning. Traffic disruption isn’t a reasonable excuse to use daily, however, as this suggests that your employee is simply poor at planning their travel and transport. Consider options for when an employee has a plausible reason for missing a short period of their shift. Could they make up the time rather than having pay deducted, for example?

BE CONSISTENT AND COMMUNICATE YOUR POLICIES

Whatever policy you decide to put in place, remember to follow it and to be consistent. You can’t let your most highperforming aesthetician get away with poor timekeeping but chide one of their colleagues for the same behaviour.

Promote the benefits of punctuality and explain the impact poor timekeeping has on both your business and the team.

Make sure your team understand your clinic policy, so there are no surprises when you call an employee for a meeting to discuss their attendance. 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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06/03/2020 14:21

TRENDS

ENVIRONMENTAL PROTECTION

aestheticmed.co.uk

The EP factor

We explore the move towards environmental protection and explain how Byonik is getting on board with the trend

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020 has seen a huge shift in consciousness and a strong focus on the damage humans are causing to the planet and to ourselves as a result of environmental pollution and destruction. As a result, there is a trend within the beauty and aesthetics sectors that has been gaining momentum – environmental protection and how we can safeguard our skin from the impacts pollution and other outside factors.

In an article predicting the most influential 2020 beauty trends, Harper’s Bazaar ranked anti-pollution skincare among its top choices, claiming that Environmental Protection Factors (EPF) will become as commonplace as sun protection.

Air pollution is a huge environmental health risk. In fact, latest figures show that 91% of the world’s population live in places where air quality exceeds the World Health Organisation’s guideline limits. Our skin is our main barrier to the outside world. As the largest organ in our body it takes the brunt of this exposure to pollution along with our lungs breathing in toxic air.

The latest skin protection research is starting to point to air pollution as one of the major causes of premature ageing of

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the skin, particularly in terms of sensitivity, pigment changes, dehydration and wrinkles.

It is estimated that around seven million toxins accumulate on a person’s skin every day, restricting cell regeneration, causing inflammation, cellular stress, disease and accelerated ageing. This is significantly sped up for those people living within cities and heavily polluted areas.1 This puts pollution right up there after sun exposure as one of the main extrinsic contributors to premature ageing and skin disease. So, what can we do?

PROTECTING YOUR CLIENTS’ SKIN FROM POLLUTION

By using some of the world’s most advanced technology, combined with a pulse triggered laser, Hyaluron and powerful anti-oxidants the patented anti-ageing cellular rejuvenation treatment from Byonik is offering a no downtime solution for patients wanting to repair, heal and protect their skin. The Byonik has the added benefits of boosting the skins’ immunity and integrity to pathogens, which is particularly encouraging within our current climate.

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TRENDS

ENVIRONMENTAL PROTECTION

aestheticmed.co.uk

Loved by celebrities including Denise Van Outen, Sophie Habo and Ashley Roberts, Byonik is a non-thermal laser that works within the healing and repair spectrum, while respecting the body’s own rhythm.

The unrivalled technology and the ingredients work synergistically, pushing the HA deep into the cellular matrix and the antioxidants into the cells. This method preserves the skin barrier and strengthens the skin while maximising skin rejuvenation and water retention at a cellular level.

Byonik is able to neutralise and dilute particulars deep within the skin at a cellular/connective tissue level. This includes microbes, irritants, allergens and environmental pollutants including house hold dust, pollen, spores, soot, metal particles, cigarette smoke, car exhaust fumes, construction activities, refuse incinerators, power plants, factories, woodburning/forest fires and blue light.

The Byonik range of products are specifically developed to tackle the effects of pollution on the skin by:

Creating an envelope to the skin with pollution-repelling molecules

Neutralising harmful particles Rebalancing the microbiome and PH Supporting and promoting optimal skin health and barrier function

Protecting against UVA/UVB and blue light exposure

Bonding and neutralising toxic agents to assist in the detoxification of the skin.

The Concur range is a luxurious anti-pollution and antiageing facial skincare range that protects, prevents, firms, regenerates and nourishes. Its patented formula of highquality detoxifying and anti-ageing substances protects

from the daily impact of damaging environmental factors neutralising the harmful and ageing free radicals, while regenerating the skin deep down.

The brand has also just introduced a new HA Ecto Gel, containing Ectoin, an anti-pollution ingredient.

Ectoin is a natural and resistant microorganism from the group of extremolytes which form bacteria in order to protect themselves in extreme conditions.

It preserves the integrity of the cells and is anti-inflammatory and anti-irritant. It also hinders collagen degradation and cellular denaturation. It has a global and multi-level anti-pollution efficacy capable of inhibiting and reducing cell damage to the skin and skin cells.

Providing cell protection, powerful antiinflammatory and membrane stabilising benefits, the product gives a critical boost to moisture penetration in all layers of the skin, repairing, strengthening and restoring its barrier function when used as part of the Byonik Ecto Repair Treatment.

With more and more clients becoming environmentally aware and conscious about the effect pollution is having not only on our planet but on their own health too, offering treatments which can be a first line of defence against this can set your clinic apart and tap into a trend that only looks set to grow. AM

“Those living in heavily polluted environments are more likely to suffer with skin conditions such as psoriasis, atopic dermatitis, acne and uneven pigmentation.”

REFERENCES 1. L .F. Eichenfield, A.J. Hendricks, V.Y. Shi. The impact of airborne pollution on atopic dermatitis: a literature review. First published: 03 December 2019 https://doi.org/10.1111/bjd.1878 2. harpersbazaar.com/uk/beauty/beauty-shows-trends/ a30279675/2020-beauty-trends/

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CLINICAL

LED

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LIGHT WORK New explorations into LED’s skin-rejuvenating abilities demonstrate its rightful place in treatment plans, says Dr Mayoni Gooneratne

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EDs (Light emitting diodes) are semiconductors that convert electrical current into narrow spectrum light. These diodes have been around since the 1960s, and now their presence is ubiquitous all down to the manufacture of a blue light LED in 1993 by Nichia Chemical of Japan 1. This allowed the blend with red, green and yellow lights to create white light. The subsequent evolution and relatively cheap cost of LED lights, has surged interest in their clinical application for a variety of medical and cosmetic uses.

Understanding the mechanism of action of LED light is slightly more complex, however. In the same way that plants use chlorophyll to convert sunlight into plant tissue, LEDs can trigger natural intracellular photo-biochemical

reactions. To have any effect on a living biological system, LED-emitted photons must be absorbed by a molecular chromophore or photoacceptor. Light, at appropriate doses and wavelengths, is absorbed by chromophores such as porphyrins, flavins, and other light-absorbing entities within the mitochondria and cell membranes of cells2.

The action of a chromophore can then modulate the respiratory pathway, and there are many theories about how this actually occurs. The photodissociation theory2 is possibly one of the most widely accepted, though the respiratory chain is complex and beyond the remit of this article. However, the latter stages are under the control of cytochrome c oxidase. This enzyme is the main chromophore for red and near infrared (NIR) light. Activation of the >

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CLINICAL

LED

aestheticmed.co.uk

respiratory pathway produces free radicals, which are essential to the feedback and regulation of all respiratory pathways. Carbon monoxide (CO) and nitrous oxide (NO) are two such free radicals, and in the ambient state they allow cross talk and feedback between mitochondria and various protein gene transcription pathways.

THE PHOTODISSOCIATION THEORY

“In the same way that plants use chlorophyll to convert sunlight into plant tissue, LEDs can trigger natural intracellular photo-biochemical reactions”

The photodissociation theory implies that NO and CO “clog up” the cytochrome c oxidase. By applying LED therapy, this then dissociates NO or CO off this enzyme to allow oxygen to bind instead and continue cell respiration. So, when a cell like a fibroblast is exposed to LED, there is a resultant increase in ATP production, which modulates free radicals, reduces apoptosis (programmed cell death) and increases blood flow and angiogenesis as well as up regulating transcription factors. These pathways lead to increased cell proliferation and migration, modulation in levels of cytokines (interleukins, tumour necrosis factor) and inflammatory mediators and it also

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increases anti-apoptotic proteins. So how does this actually manifest? Well, when LED is applied to skin with various aesthetic conditions, we are able to lift and tighten lax skin and reduce fine lines and wrinkles3,4.

Depending on the target chromophore, different wavelengths of light can be used. Three wavelengths of light that have demonstrated several therapeutic applications are blue (415nm), red (633nm), and near-infrared (830nm).

INCORPORATING IN CLINIC

There are several interesting studies that have been released recently looking at LED light and its role in augmenting clinic treatments. One split-face study, where Lightstim LED was used following micro-needling, demonstrated a subjective improvement in the appearance of the skin, and patients also observed less swelling, erythema and pain on the LED-treated side. Visia skin analyses also demonstrated objective improvements in pigmentation, bacterial load and pore size. The study also included a surgical arm of those who had undergone a SMASfacelift who reported similar improvements.

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CLINICAL

LED

aestheticmed.co.uk

A further study was designed to evaluate the tolerability and compatibility of various Exuviance alpha hydroxyl acid peels, Lightstim and three days’ home-use of Exuviance skincare. This used self-assessment questionnaires to determine how patients felt their skin was post-treatment. 94% rated their results as excellent (75%) or very good (12.5%). 100% felt that there was a significant improvement in their skin condition, and 93.8% of participants found the LED light relaxing 5 .

We offer an abbreviated treatment as an adjunct to all skin-based rejuvenation treatments at The Clinic by Dr Mayoni. So, anything that involves skin resurfacing (non-laser) will be followed by an abbreviated session of LED light. This is provided by handheld devices such as Lightstim or the panel treatment Dermalux. This will not include any thermal energy based skin treatments we offer, as the combined heat levels may be too high.

We also use the full protocol as a stand-alone treatment for rejuvenation and in the treatment of rosacea, acne, pigmentation and inflammatory conditions such as eczema and psoriasis. You can really add value to all your treatments with LED, with minimal outlay and improved downtime while allowing the patient a little bit of relaxation time during treatment.

Looking specifically at treating acne, propionibacterium acnes is a gram+ve bacteria involved in the pathogenesis of acne vulgaris. Traditionally blue light has been used to reduced bacterial load by strongly activating endogenous porphyrins. This then results in free radical production, which then damages the p. acnes cell wall and treatment of acne. Recent evidence shows that a combination of blue and red light6,7 benefits non-inflammatory and inflammatory lesions with minimal to no side effects. Improved results were seen in these patients where a superficial removal of the stratum corneum was performed to allow better penetration of LED6. This finding is applied in practice with our patients who suffer with mild to moderate acne.

We will resurface with a dermal infusion device or a peel immediately prior to delivering phototherapy.

AT-HOME OPTIONS

Many homecare devices are not able to provide the right wavelengths or frequencies in order to deliver results.

Generally, these will require more frequent application than an in-clinic treatment – usually six-eight times a week.

They come in the form of face masks or wands, although the wands do tend to be more practical. A mains-powered device will provide a more consistent level of energy in every treatment compared to a battery powered one. Not

>>

all devices are made the same, so you do have to be careful about what claims are made. Always ask for evidence of how the devices work in the form of clinical studies. Of course, FDA approval, which Lightstim carries, helps to ensure you are offering a medical standard of treatment.

With proper use, my patients have reported some immediate results including plumping, increased local blood circulation and calming of redness. They also report it to be a soothing and calming treatment. Of course, the longerterm resolution of fine lines and wrinkles will take slightly longer. Results of radiance and tightening are reported after two to four treatments and the full results are seen at six to eight weeks following the protocol. AM REFERENCES 1. Calderhead RG. The photobiological basics behind light-emitting diode (LED) phototherapy. Laser Ther. 2007;16:97–108.

2. Hamblin MR, Demidova TN: Mechanisms for Low-Light Therapy, in Hamblin MR, Waynant R, Anders J (eds): Proceedings of the SPIE, 6140:1-12, 2006 3. Kim JW. Clinical trial of nonthermal 633nm Omnilux LED array for renewal of photoaging: clinical surface profilometric results. J Korean Soc Laser Med Surg. 2005;9:69–76.

4. Nestor M, Andriessen A, Berman B, et al. J Cosmet Laser Ther. 2017.

Photobiomodulation with non-thermal lasers: mechanisms of action and therapeutic uses in dermatology and aesthetic medicine; pp. 1–9. Feb 17 5. McDonnell Bowes. Combining Light and professional skincare.

Consulting Rooms Vol 3:1 Jan-Mar 2020 6. Papageorgiou P, Katsambas A, Chu A. Phototherapy with blue (415nm) and red (660nm) light in the treatment of acne vulgaris. Br J Dermatol.

2000;142:973–978.

7. Lee SY, You CE, Park MY. Blue and red light combination LED phototherapy for acne vulgaris in patients with skin phototype IV. Lasers Surg Med. 2007;39:180–188.

Dr Mayoni Gooneratne (MBBS, BSc, MRCS) is a London-based general surgeon with over 18 years of medical and surgical experience. As a graduate of St George’s Hospital Medical School, she has been a member of the Royal College of Surgeons since 2002. Dr Mayoni has also undertaken extensive training with Cosmetic Courses at Aurora Clinics. Alongside her team of carefully chosen and highly trained individuals, she offers clients the best in results-driven treatments and customer service.

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20/03/2020 14:31

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CLINIC PROFILE

WESTROOM AESTHETICS

aestheticmed.co.uk

Open to all Aesthetic Medicine editorial board member Dija Ayodele talks to Georgia Seago as she prepares to open the doors to her first clinic

I

t was only a matter of time before Dija Ayodele opened her own clinic. The expert aesthetician of 12 years and pioneer for women of colour in the skincare space has gained a massive following over the two years since she launched the Black Skin Directory, a platform for women of colour to find vetted practitioners who understand the nuances of treating their skin effectively and safely.

Ayodele was into skin long before BSD’s launch, though.

She achieved her Beauty Therapy Level 2 and 3 NVQ at the London College of Beauty Therapy in 2008 and went on to train with aesthetic practitioner Sally Durant, making every effort to get to know big names in aesthetics such as nurse prescriber Anna Baker. Over the past three years, Ayodele was working from a rented room in a clinic space in Kensington, London, having built up a cult following among women of colour who trusted her with their skin concerns.

The launch of Black Skin Directory (BSD) in February 2018 soon brought an influx of mentions and requests for expert commentary in the consumer beauty media, and it wasn’t long before Ayodele needed a place to call her own.

“Being able to also offer as many days as my clients required was challenging because where I was before wasn’t my space. There were three to four rooms for rental at any time, but they were always booked up, so I couldn’t actually

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satisfy the demand of my clients. I could only ever offer one day in the week, which made it difficult to realise the full potential,” she says.

HEADING WEST

The official launch of Westroom Aesthetics in Maida Vale, London was scheduled for April as Aesthetic Medicine went to print, but Ayodele said she needed to open the doors early for her existing clients. 99% of her clients are women of colour, although this isn’t necessarily something Ayodele set out to achieve. “The market as we see it at the moment doesn’t satisfy,” she says. “Women of colour don’t feel like they are spoken to or don’t feel like they can walk into any clinic and have their needs satisfied – perhaps the therapist who is seeing them doesn’t have experience in black skin or understand the concerns they have.”

“I have a lot of people who come in and say it’s great to have a women of colour therapist because they know I’ll understand their concerns around hyperpigmentation or things like keloid scarring. I hear from my clientele that there is a need for a specialised service to satisfy that nuance.” A big focus for Ayodele, in both her work with BSD and for Westroom Aesthetics, is representation. Simply showing women of colour through imagery and messaging

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CLINIC PROFILE

aestheticmed.co.uk

that clinics can and want to cater to them, is one of her key messages for fellow aesthetic practitioners. “Say a client is walking past a regular clinic on the high street. If there’s no imagery which shows different skin tones or says, ‘we treat all skin colours and tones”, then people of colour will generally assume that it’s not for them.”

She recognises that the misconception happens in the reverse too, with some assuming Westroom Aesthetics only treats black skin.

“Westroom treats everyone but we especially provide a space where women of colour know that every product we’ve selected or every treatment that we do has been tailored towards their skin,” she says. “We’ve selected brands that have clinical trials in skin of colour across the Fitzpatrick scale and use imagery that reflects that. So, while anybody is welcomed – I’m trained in all skin – this is especially for black women; they don’t need to feel dubious as everything has been created in their image, though I do also have Asian and white clients.”

PERSONAL SPACE

Ayodele wanted to create a vibrant and inviting space for clients, so she set about sourcing interesting furniture pieces, fun design elements and warm, comforting colours to fill the space, taking Instagram followers on the journey with her and asking for their input on the clinic’s décor. “It’s me casa, su casa,” she says. “I want you to feel comfortable in my space. I wanted it to be chic, a luxurious but comfortable

WESTROOM AESTHETICS

environment that wasn’t intimidating.” Along with wanting to make the most of the building’s abundant natural light, Ayodele started following bathroom design accounts on Instagram and looking for flooring for the clinic’s WC since summer 2019. She says she wanted an “Instagrammable” bathroom so clients could take fun pictures, adding to the free and safe environment she set out to create.

A lot of love has been put into the one-treatment room space, with a reception area “that’s like a living room”, though Ayodele has bigger plans for Westroom Aesthetics going forward. “I decided to go for a smaller space that would give me room for growth. I only plan to be at this space for eighteen months to two years; even with all the work I have done on it, I feel that if I’m there in two years I haven’t progressed, that’s why I went for a smaller space as it would push me to not be there for too long,” she says. For now though, there are just four options on the treatment menu: an in-person or virtual skin health consultation, The Reset Treatment and Time Plan Programme. The latter includes six to 12 hours’ treatment time and autoenrolment into Skin+, in-clinic education evenings with wellness and nutrition experts. Modalities on offer include peels, microneedling, nanocurrent, LED light therapy, mesotherapy and microdermabrasion.

However, she says many clients will pay for one of the in-depth consultations, purchase some recommended products (Westroom stocks Aesthetic Source brands including NeoStrata, SkinBetter Science, Exuviance and >

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CLINIC PROFILE

WESTROOM AESTHETICS

Cyspera, among other separate brands) and report back that their skin health has improved massively. She notes that she’s also aware of budget restraints for a lot of clients, so gives them the most personalised and actionable skincare and lifestyle advice she can within the consultation timeframe; some of which won’t involve any cost. “Cost to the client is something I have to bear in mind. For example, someone came in recently and by the time they had paid for a consultation and bought some products, they’ve already spent just under £600.”

Interestingly, Westroom doesn’t post client images on social media. “We have a policy not to share photos of our clients on Instagram. I got fed up of before-and-after images on social; people are only going to upload pictures taken in a glowing light or might edit them, and I think it can be misleading,” she says. “I also have celebrity clients and want them to know that we are discreet. Every so often, if the results are spectacular and the client is happy, I may put an image on our grid, but I will obscure everything – you might just see a cheek to show the difference in skin quality, for example.”

UP TO THE CHALLENGE

Ayodele is refreshingly open and honest about the challenges she faces as a business owner in the early stages of owning her first clinic. She’s also a mother of two young children who lives outside of London, so works hard to keep a healthy balance in her life while also looking after those around her. “I think with something like this there are always challenges, financial and time. Some of the finance we thought we had secured to open the space didn’t

40

aestheticmed.co.uk

materialise at the last minute, so we had to sit down and look at our priorities and peel away the excess that wasn’t absolutely essential,” she explains. “Our branding still hasn’t been sorted, for example, and while it’s great to have nice branding it’s not essential to opening the front door, so things like that had to be pushed back so we could get all the products in, because you need that to carry on a business.”

Managing and controlling some of the elements involved in starting a business also proved tricky. “There’s so much to do when you open a clinic; I didn’t realise it but the admin time pressure – HMRC, accountants, going through the books all the time – can really keep you up at night. Because the investment didn’t work out we needed to make sure that every penny we got paid we could access it again straight away so we could reinvest it back into the business,” she says. “We had to choose our banking based on how quickly that money would get back into the business account, and that pressure is quite a lot. It’s the pressures other people put on you as well with their expectations – how they envision things to be for you, giving unsolicited advice, and how you deal with that extra stress. You feel like you don’t want to let anyone down.”

Despite these pressures, Ayodele will no doubt rise to the challenge and continue to solidify her status as a thought leader in the industry. With Westroom Aesthetics at least, she can rest assured that she’s rising above and beyond expectations; “I wanted women of colour to know that everything here, from products to devices and treatments, has all been designed with them in mind. It shouldn’t even have to be a question.” AM

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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 C A S E S T U DY

Restylane Lyps is back by popular demand!

Restylane Lyps is back by popular demand!

TM

TM

As Restylane LypsTM makes a comeback, aesthetic nurse practitioner TM As Restylane Lyps makes comeback, aesthetic Sharon Bennett reveals her atips on how to create anurse fuller practitioner natural-looking Sharon Bennett reveals her tips on how to create a fuller natural-looking lip for millennials. lip for millennials.

Chloe came to me as she wanted her lips volumised to bring more herwanted face, but that the Chloe camebalance to me astoshe herwas lipsfearful volumised to results would be far too obvious.

She wanted a natural bring more balance to her face, but was fearful that the but visible change. results would be far too obvious. She wanted a natural but visible change.

On examination her lips posed a number of

considerations. tubercleof bulged and On examinationThe her left lips superior posed a number dropped marginally lower than the right.

Lateral this considerations. The left superior tubercle bulged to and there wasmarginally a lack of evident red the lip show dropped lower than right.compared Lateral to to this the right and animation her upper lip thinned there wasside a lack ofon evident red lip show compared to significantly. the right side and on animation her upper lip thinned significantly.

As Chloe is young and wanted to see a good projection

TM andChloe uplift,isRestylane Lyps was product.

As young and wanted tomy seego-to a good projection It gives volume and definition and perfect for TM and uplift, Restylane Lyps was myisgo-to product. the younger andand millennial ageand group who want It gives volume definition is perfect for augmentation and uplift alongside a beautiful, smooth the younger and millennial age group who want hydrated appearance. augmentation and uplift alongside a beautiful, smooth hydrated appearance.

“ “

Restylane LypsTM gives my patients the Restylane LypsTM hydrated gives my volume patientsand the most lovely smooth, most lovely smooth, hydrated and lift they want and gives me thevolume reassurance lift they want and gives me the reassurance that a gold standard product with long that gold standard product with long termaresearch and data brings.” term research SHARON BENNETT and data brings.”

SHARON BENNETT

I often choose a product from the Galderma NASHATM range, as a Restylane LypsTM , for my younger I often such choose product from the Galderma NASHATM patients, who that evident look. The range, such aslike Restylane LypsTMand , forfull mylip younger uniqueness oflike Restylane LypsTMand is the its patients, who that evident fullbenefit lip look.ofThe natural entanglement of HA, giving a greater lift, whilst TM uniqueness of Restylane Lyps is the benefit of its minimising the crosslinks (BDDE) between the chains. natural entanglement of HA, giving a greater lift, whilst Combined with this is it’s (BDDE) isovolemic degradation, minimising the crosslinks between the chains. enabling the volume beisovolemic maintained throughout the Combined with this isto it’s degradation, degradation stabilising throughout bridge disappears, enabling the phase. volumeWhen to be amaintained the water takes its place.

The less concentrated the NASHATM degradation phase. When a stabilising bridge disappears, gel becomes, more water moleculethe is able to TM water takes itsthe place.

The less each concentrated NASHA bind.

The result that volume can be maintained. gel becomes, theismore water each molecule is able to bind. result is that volume be maintained.

I usedThe a 30 gauge needle and can delivered the treatment using a subcutaneous, linear retrograde threading I used a 30 gauge needle and delivered the treatment technique starting at approximately 1cmthreading medially using a subcutaneous, linear retrograde from the oral commissure on the upper and 1-2mm technique starting at approximately 1cmlip medially inferiorly from the border.

Delivering more product from the oral commissure on the upper lip and 1-2mm centrally to lift the I then repeated this 1-2mm down to inferiorly from border.

Delivering more lower product increase the red show. centrally to lift I then repeated this 1-2mm lower down to increase the red For the lower lip show.

I carried out the same technique finishing with a small 0.1mlout bolus to give shape.

For the lower lip I carried the centrally same technique TM In total I used of Restylane Lyps withto 0.6ml finishing with a1ml small 0.1ml bolus centrally give to shape. upper and 0.4ml to lower lip.

TM In total I used 1ml of Restylane Lyps with 0.6ml to

BEFORE

AFTER

BEFORE

AFTER

BEFORE

AFTER

BEFORE

AFTER

Sharon’s top tips Sharon’s top tips •

•

• •

• • • •

Always keep the needle on a subcutaneous (superficial) with low delivered Always keep plane, the needle on avolumes subcutaneous slowly, and observe the low skin volumes and circulation at (superficial) plane, with delivered all times. slowly, and observe the skin and circulation at all times. read, which affirms my choice A valuable to inject subcutaneously, is Cotofana S, et al.

A valuable read, which affirms my choice Distribution Pattern of theisSuperior to inject subcutaneously, Cotofanaand S, et al.

Inferior Labial Arteries: Impact for Safe Distribution Pattern of the Superior andUpper and Lower Lip Augmentation Procedures.

Inferior Labial Arteries: Impact for Safe Upper PlastLower Reconstr Surg. 2017;139(5):1075-1082. and Lip Augmentation Procedures.

Plast ReconstrisSurg.

2017;139(5):1075-1082.

The philtrum a vascular high risk area and mostly an unnecessary treatment The philtrum is a vascular high riskzone. area and

mostly an unnecessary treatment zone.

Avoid the tenting injection method – injection entry points are vascular high risk areas – it’s Avoid the tenting injection method – injection likely that too large volumes HAareas will be entry points are vascular highofrisk – it’s injected giving rise likely thattoo toodeeply, large volumes of to HApotential will be occlusion. injected too deeply, giving rise to potential occlusion.

Restylane LypsTM is now available at MedFx. Restylane LypsTM is now available at MedFx.

Sharon Bennett RGN, NIP, PG Dip Bennett CosmeticRGN, Intervention Sharon NIP, is a founder and current chair of the PG Dip Cosmetic Intervention

British Association of Cosmetic (BACN). is a founder and current chair ofNurses the She is director of the award-winning clinic, Harrogate British Association of Cosmetic Nurses (BACN).

Aesthetics andof a member of the Galderma Faculty.

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

upper and 0.4ml to lower lip.

RES20-01-0019 | Date of preparation: March 2020 RES20-01-0019 | Date of preparation: March 2020

Aesthetic Medicine • April 2020

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19/03/2020 16:45

TRENDS

FACIAL AGEING

aestheticmed.co.uk

Fighting Fit Dr Harry Singh discusses the role exercise plays in facial ageing and why there’s a new term in town – “gym face”

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TRENDS

aestheticmed.co.uk

FACIAL AGEING

W

e all know that unhealthy lifestyles, stress, sunbathing, and even spending too much time in front blue-light emitting devices can accelerate and cause premature ageing, but many people are unaware that some otherwise healthy habits, such as working out at the gym or going running, could also be taking their toll and making them age before their time.

Exercise has untold benefits in terms of combating stress, keeping off weight, building and toning muscle and improving overall health, however, there are a few downsides that have meant I am seeing more and more health and fitness conscious patients (both men and women) coming to me who feel like their faces don’t match the hard work they are putting into their bodies.

There has been a recent shift towards wellness and fitness in recent years, driven largely (in my view) by Instagram and by programmes such as Love Island, where muscular, toned bodies are being shown off.

While a lot of these images are not “real” – or, in the case of Instagram, have been heavily edited or filtered (we should always be mindful about the psychological impact on our patients) – any move towards better health and encouraging greater fitness is a positive thing in my book. However, there is a flipside to this new trend that we as aesthetic practitioners can help with and it’s being called “gym face” or “runner’s face”.

The very reason people work out in the first place is not just for their health but also to look and feel good about themselves, but if their gym routine and healthy lifestyle is not translating to their face, it can be disheartening. This is where facial aesthetics can play a rewarding role.

Runner’s face Friends star Courtney Cox once famously said that when you get older you have to “choose your battles”, either your face or your body, and there is an element of truth in that.

As we age, we may be keen to lose our middle-aged spread and have to work harder to keep our bodies fit, lean and in shape, however, as we know, losing fat in our faces can make us look gaunt and older, especially at a time where we are already losing the structure, support and plumpness of youth. Of course this is all a part of the ageing process but exercise and weight loss can exasperate the effects of this and make someone look old before their time.

By far the biggest culprit for fitness-related premature ageing is continuous high-impact training, which can lead to loss of volume and sagging of the skin as well as increased oxidative stress and increased production of free radicals, which in turn causes breakdown of collagen and elastin.

This is now often referred to as “runner’s face”.

This is added to by the fact that most people exercise outside, which means increased sun exposure and if they are not vigilantly applying SPF, more sun damage. For facial volume loss dermal fillers are the most effective way of repairing the scaffolding and adding volume back in where fat has been lost.

People who exercise a lot both, both male and female, are good candidates for this. >

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TRENDS

FACIAL AGEING

Many of these patients want to look fit, well and healthy, not “done”, so natural results are key. They may not want the same aesthetic outcome as someone who comes in for cheek enhancement or volumising fillers otherwise, particularly for male patients. Reiterating the importance of protecting the skin and wearing an SPF year round, come rain or shine, when they are working out outside, can help prevent further damage.

aestheticmed.co.uk

“By far the biggest culprit for fitness-related premature ageing is continuous highimpact training”

FEELING THE STRAIN

Weight-lifting has also increased in popularity and this has its own effects on facial ageing. We have all seen men lifting heavy weights at the gym pulling funny faces. As a form of exercise, weight lifting is physically challenging and the facial expressions people pull while doing it can cause more pronounced wrinkles. Wrinkles come in many shapes and sizes and can be both “static” and “dynamic” in nature.

It’s the “dynamic” ones caused by our facial movements such as smile lines, laughter lines, smoker’s lines and frown lines that I see more in those who exercise regularly. In particular, excessively straining during gym sessions can make the brow more furrowed. Botulinum toxin is the most effective treatment for these type of lines.

NO SWEAT

Sweating is another side-effect of exercising that may cause people to suffer from symptoms that aesthetic practices can help address. Breaking a sweat during workouts is a good thing but it can also lead to acne on both the face and body. Sweat flushes out impurities from the body but hot, sweaty skin – and the towels people use to mop their brow – can become a breeding ground for bacteria. Add to this the fact that sweat glands can become blocked, and you have the perfect recipe for acne. On top of this, some patients may be embarrassed in the gym if they sweat excessively and may benefit from botulinum toxin treatment for hyperhidrosis.

>> 44

THE RISE OF “BROTOX”

One thing I have noticed is that the fitness trend has definitely resulted in an increase in the number of men seeking treatment.

When I first started out in 2002 only around 2% of my clients were male. Now it’s closer to 20% and I’ve seen most of that rise in the last five years. It’s much more acceptable now for men to have tweakments and I think the social media sites like Instgram and the popularity of selfies has played a huge part.

The number of men getting Botox injections has rocketed, leading media outlets to coin the term “Brotox”.

Men have a different anatomical structure to women.

So, while many women want to accentuate the arch of their brow and have a completely wrinkle-free, smooth forehead, for my male patients it’s usually not the same (although this is obviously personal preference).

When treating men we usually focus on maintaining masculinity while softening deep brow furrows or frown lines and crow’s feet, which can make them look more angry and tired. Men have straighter brows so you need to know how much product to use and where to put it to get the desired result.

There are many documented benefits of regular exercise and facial aesthetics has an important part to play in helping this group of fit, health-conscious patients bring their face and body in alignment. AM

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

Aesthetic Medicine • April 2020

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20/03/2020 12:32

SHAPE PHYSIQUES STRENGTHEN YOUR BUSINESS

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

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

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

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

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03/12/2019 17:56

CLINICAL

NON-SURGICAL RHINOPLASTY

aestheticmed.co.uk

Smooth and subtle

Dr Yusra Al-Mukhtar breaks down the elements of non-surgical rhinoplasty, emphasising patient selection and limitations

T

he non surgical rhinoplasty is suitable for both male and female patients, and is an alternative to surgical rhinoplasty to correct minor deformities such as dorsal hump deformities, saddle nose, and poorly projected or downward drooping tips. It can be a suitable treatment for those patients who do not wish to go under the knife, and for those with low radix, where elevating the nasofrontal angle and nasolabial angle will result in an aesthetically pleasing curvature.

LIMITATIONS AND RISKS

“The vasculature of the nose in particular deems it a high risk area to inject”

Over-projection of the radix is undesirable and can be counterproductive, resulting in a more disproportionate and enlarged appearance, and so those patients who present with a high radix are not suitable for this procedure. Those patients with significant lateral cartilage deformities may also be best suited to a surgical procedure, as significant deviations requiring product placement lateral

46

to the nose would put the patient at high risk of causing an occlusion and potential embolism of filler into the angular artery, and subsequently central retinal artery.

The ideal patient will understand that the procedure will result in improvement largely in profile, straightening the appearance of a hump, elevating a downward droop, and should be engaged with the fact that they may need repeat treatments every one to two years depending on the filler product used. Patients’ expectations must be managed and those that have particularly large noses, very deep dorsal humps, a high radix, difficulty breathing or thick tissue type at the nasal tip may be best treated surgically and should be counselled accordingly.

Patients who have had previous surgical rhinoplasty pose greater risk of arterial complications due to the altered anatomy, and these cases must be approached with care and only performed by experienced advanced injectors. Further to this, I believe it is appropriate and unethical to treat patients that have body dysmorphia.

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CLINICAL

NON-SURGICAL RHINOPLASTY

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a high G-prime and cross-linked to provide longevity. The dermal filler of choice should have a high safety profile and a low risk profile. In my experience, a product that contains local anaesthetic makes treatment more tolerable in these otherwise sensitive areas.

PREPARATION AND PROTOCOL

An aseptic technique should be used, cleansing the nose with 20% chlorhexidine or Clinisept+ to disinfect the area.

I believe practitioners should always aspirate to check if the needle is in a blood vessel prior to injecting as a safety measure, and also to ensure that injections are deep to the bone or supraperichondrium (cartilage). I also advise injecting slowly and in small increments, always keeping an eye on the skin to check for any blanching which would indicate a vascular occlusion. Any signs of an occlusion must be treated promptly by dissolving the filler with hyaluronidase. It is important that patients are advised that if they experience any changes in skin colour, note ulceration or blistering of the skin, or experience white spots, which could indicate an impending necrosis, they must return for urgent treatment. AM

Those that have unrealistic expectations may be difficult to manage pre and post-operatively, and treatment in such cases may be best avoided.

Patients must be appropriately counselled about the risks involved with the procedure. The vasculature of the nose in particular deems it a high risk area to inject, as the angular artery that sits on the lateral aspect of the nose communicates directly with the retinal artery. There are approximately 150 reported cases of blindness to date, and of those 33% arise from injections to the nose. The experienced injector must always remain conscious of this fact, communicate this with the patient, and employ safe injecting techniques to reduce the risk of an occlusion.

PRODUCT SELECTION

The non-surgical rhinoplasty involves changing the skeletal structure of the nose. As such, I opt for a hyaluronic acid dermal filler for safety and ease of reversal, with approximately 25mg/ml of hyaluronic acid giving it volumising capacity with

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REFERENCES 1. ME Tardy, S Dayan, D Hecht, ‘Preoperative rhinoplasty’, Otlaryngol Clin North Am, (2002), pp.1-27.

2. Non-surgical minimally invasive rhinoplasty: tips and tricks from the perspective of a dermatologist Ali Sahan1 , Funda Tamer2 Acta Dermatovenerologica 2017;26:101-103 3. J Cutan Aesthet Surg. 2010 Jan-Apr; 3(1): 16–19. Fillers: Contraindications, Side Effects and Precautions Philippe Lafaille and Anthony Benedetto 4. Mohammed H.Abduljabbar, Mohammad A.Basendwh, Journal of Dermatology & Dermatologic Surgery, July 2016, Complications of hyaluronic acid fillers and their managements 5. Swift, A, Remington K, Clinics in Plastic Surgery, July 2011, Volume 38, BeautiPHIcation™: A Global Approach to Facial Beauty 6. Stephen S. Park, Clin Exp Otorhinolaryngol. 2011 Jun; 4(2): 55–66.

Fundamental Principles in Aesthetic Rhinoplasty

Dr Yusra Al-Mukhtar BDS (Hons) BSc (Hons) MFDS RCS Ed Mjdf RCS Eng is medical director of Dr Yusra Clinic in London and Liverpool. She is a dental surgeon and a medical aesthetic clinician with several years’ experience in head and neck surgery and skin cancer surgery.

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BUSINESS

GOOGLE REVIEWS

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Get a handle on it Jemma Edwards on how to handle negative reviews on Google

I

n last month’s issue of AM, I wrote about how valuable it can be to have customers leave Google reviews about your business and gave nine tips to help you get customers to write a review.

Of course, we’d all love to get lots of positive reviews, but sometimes we get negative ones and this can be a problem. Although the idea of this may make you nervous, you shouldn’t let the possibility of getting a negative review be the reason you don’t at least try and get reviews from your customers. If you get enough reviews, chances are you will get some negative ones, but it is worth knowing that 30% of people actually believe something is wrong if every single review about a business is positive. So how should you deal with a negative review?

DEALING WITH NEGATIVE REVIEWS

First of all, take a look and see who left the negative review.

If you know them, contact them directly and respond to their concerns. You can ask them to amend the review or even take it down, but you do need to deal with their concern.

The thing is, everyone understands that no business is perfect and that there are times when things go wrong.

Being open and responsive when dealing with a negative review can actually be more valuable to a customer than a string of positive reviews.

It’s always best to respond to each review anyway but

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replying to a negative review in an appropriate way also gives the customer a more balanced view of the situation.

HOW TO DEAL WITH FAKE GOOGLE REVIEWS

Sadly, there are some negative reviews that are fake and you won’t be able to rectify these. More often than not, these will come from competitors who are looking to hurt your reputation. If this happens, you will need a strategy to deal with it. This isn’t a guaranteed solution, however, it has been shown to work in the past.

Here’s what to do: 1. Find the review on Google Do this by searching for your business in Google and clicking on the total number of reviews.

2. Flag the review To “flag” the review, you need to hover your cursor over the post and click it once the flag shows up.

When you flag the review, you should also respond.

Calmly state that it is fake and refute any false claims.

It’s important not to let any emotion such as anger or frustration come across.

While this probably won’t get the review removed, it will show other customers that they should not trust it.

If you have reason to believe the reviewer has written

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BUSINESS

GOOGLE REVIEWS

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fake reviews for other businesses, there’s a better chance to get the post removed.

3. Choose your reason for flagging the review You’ll be presented with some options once you’ve flagged the post so go for the option that states it is a conflict of interest and complete the form. Then take a screenshot of the form with the date you completed it. . Go to the Spam & Policy forum of Google My 4 Business Check to see that the review has been removed and if it hasn’t then you should go to the Spam & Policy section of the Google My Business community.

The problem with flagging reviews as fake is it’s very hard to prove it is fake. It’s for this reason that so many fake reviews don’t get removed.

As mentioned, it’s not a guarantee but it’s at least something you can try because it feels really unfair when you know that someone has made something up just to make you look bad.

QUESTION TIME

I’ve included some common questions about Google reviews and what you can and can’t do in some scenarios.

Can people provide a Google review without having a Google account?

This has been stopped now. It used to be that you could but Google now realises it’s important to be able to trace the person who left the review.

“Half the battle with the online world is getting people to visit your site. The other half is getting them to buy or book once they are on the site”

5. State your case Write a post in the forum putting forward your case, stating that the review did not come from a proper customer and you know a competitor wrote it.

You submit a forum post by clicking the “plus” sign in the bottom righthand corner. Make sure you include a screenshot that shows you flagging the review as a conflict of interest.

It’s important to go into as much detail as you can here. The more descriptive you can be, the more you can back up your case, the better the chances of you actually being able to get the post removed

by Google.

The next stage is to wait and see if your case gets escalated. It shouldn’t take longer than a couple of days to recieve a response.

Can reviews be left anonymously?

No, although that used to be possible.

Today, Google can identify the account with the reviewer and will automatically attach it to them. This safeguards the integrity of the review system.

How can I see the reviews about my business?

You can either search for your business on Google and click on the reviews against it, or just log into Google My Business and see them from your dashboard.

Do Google reviews get taken down after a period of time?

The reviews will always remain against your business unless the person that wrote it deletes it. >

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BUSINESS

GOOGLE REVIEWS

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Can customers be paid for reviews?

Again, this is a no. Google and most other review sites state in their terms of service that paying for reviews is not allowed. This was a big problem with Amazon reviews, for example, and a lot of review businesses were making good money through paid reviews.

Can I get a fake review deleted?

Sometimes, although rarely. Fake reviews are difficult to prove so they aren’t often deleted. If you are unlucky enough to have one then you need to respond to the review, flag it up and report it.

Can I only ask the customers I know are happy to leave a review?

This is called “Review gating” and, as of 2018, Google prohibited it. Every customer should have the same opportunity to write a review.

This shouldn’t be seen as a negative because most of the time all that an unhappy customer wants is a resolution to their problem.

Can I offer incentives for Google reviews?

Google’s policy on this is pretty simple – don’t offer or accept money in exchange for reviews.

So even though this could mean that you should be OK as long as you don’t give them money, Google has acted against companies that have offered giveaways and gifts in exchange for reviews.

Can employees review my business?

No, you cannot ask employees to review your business. This is classed as conflict of interest due to potential bias even though they might be able to provide some helpful insight.

Can I ask customers to leave a review?

Yes, although you can’t do what Google calls “soliciting reviews from customers in bulk”. Basically, you can’t email your whole database in one go asking them to leave you a review. There has to be relevance for getting in touch.

For example, you could email a patient straight after they have had a treatment and you can set this up to happen automatically.

Or you can put up a request on your Facebook page. This isn’t a bulk solicitation because although all of your followers could see this request, you haven’t directly contacted everyone.

What if someone leaves an abusive review?

You need to flag it. If the review contains offensive language or gestures or any obscenities or profanities, Google will take it down.

The positives of having Google reviews far outweigh the negatives. We live in a world where online reviews are a way of life and a reference point when people are considering buying a product or service.

90% of people first check online reviews before they make a purchase 8 8% of people trust online reviews as much as a personal recommendation Up to 31% of people are more likely to do business with a company that has positive reviews. And this is true about businesses that are both local and global.

Half the battle with the online world is getting people to visit your site. The other half is getting them to buy or book once they are on the site.

So, the advantage of positive Google reviews is that often people will arrive at your site already with the intention of booking with you. AM

“30% of people actually believe something is wrong if every single review about a business is positive”

Is it possible to stop customers from writing negative reviews?

Other than giving them no cause to write a bad review, no.

Google makes it clear that it is forbidden to “selectively solicit positive reviews from customers”.

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

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A healing touch Give a better class of aftercare to encourage more patients

Include Oxygenetix in your clinic 1. Pre-procedure Going through any procedure can be worrying. You can help relieve patient concerns by letting them know Oxygenetix can conceal signs of skin redness and bruising. Your patients will be able to walk out of a treatment happily covered and protected by Oxygenetix.

2. Post-procedure Apply Oxygenating Hydro-Matrix to kill bacteria, soothe burning sensations post CO2 laser resurfacing, and replenish moisture loss following treatment.

Then apply Oxygenating Foundation to conceal damaged skin and aid the production of collagen and elastin. It creates an 85% breathable barrier, acting as a second skin to keep moisture in and bacteria out.

3. Everyday care Help patients recover faster and continue with their lives as they heal. Daily use will help to soothe their skin and promote healing. This is often the most important part for the patient. And with the best aftercare, you’ll deliver an even greater service that people will want to recommend.

Distributed by Meeting the needs of your business, delivering high satisfaction to your patients THE CLINICSOFTWARE.COM AWARD FOR AESTHETIC PRODUCT DISTRIBUTOR OF THE YEAR

Call us on 01234 313130 | info@aestheticsource.com www.aestheticsource.com

PRODUCTS

PRODUCT NEWS

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5 SQUIRRELS

The latest launch from the white label clinical skincare brand is Clear Maximum Strength Degreasing Cleanser, aimed at helping transform congested, oily skin with 10% glycolic, 3% salicylic and 2% lactic acid. Glycolic dissolves bonds of thickened dead skin cells on the surface of the skin, revealing newer, hydrated and healthy skin while reducing pore size and fine lines. Salicylic’s anti-inflammatory properties work as a keratolytic by exfoliating deep within the follicle and preventing pores from clogging; while lactic acid helps lighten dark spots and improve cell turnover.

Double Defense Kits are put together to tackle signs of ageing induced by ozone pollution and daily UV damage. Included respectively in the three kits is tripleantioxidant formula C E Ferulic and lightweight, broad-spectrum sunscreen Ultra Facial Defence SPF 50+; triple-antioxidant Phloretin CF to diminish the look of dullness and discolouration and moisturising sunscreen Brightening UV Defense SPF 30; AOX Eye Gel, designed for the thinner, more sensitive skin around the eyes and Mineral Eye UV Defense SPF 30, a non-migrating tinted mousse formulated with mineral filters.

Skinbetter Science has expanded its portfolio with the AlphaRet Professional Peel System, containing a prepeel solution, a triple-acid peel gel and an AlphaRet peel solution. Available in two strengths – 30 for patients with mildly photo-damaged skin and early signs of ageing and blemishes and 50 for those with moderate photodamage, fine lines and wrinkles – the lactic, glycolic and salicylic acid blend formula has shown viable results in clinical testing.

Also launched is the broad spectrum SPF 50 Advanced Mineral Protection, a 100% mineral-active sun protection product, delivered in a toneadapting compact containing zinc oxide and titanium oxide.

Ideal for patients post-treatment or with sensitive skin, the product offers UVA and UVB protection and 80 minutes of water resistance.

ZO SKIN HEALTH

MEDIK8

SKINCEUTICALS

The latest anti-ageing launch from Dr Zein Obagi’s skincare line is Firming Serum, designed to combat skin sagging and improve laxity for a more defined facial contour. Enriched with plant extracts, the serum supports the skin’s natural renewal process and fibroblast activity and defends the skin against free radical damage. Included in the formula is sodium DNA, which works alongside the skin’s matrix formation process to support fibroblast activity, and the brand’s ZCore complex, which consists of bio-mimetic tetrapeptide and sweet yellow clover.

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SKINBETTER SCIENCE

Illuminating Eye Balm is a brightening and hydrating eye balm to help minimise dark cirCles, puffiness and signs of tiredness in the eye area.

Illuminating mineral pigments and optical diffusers reflect light to soften the appearance of dark circles, while cucumber extract provides a cooling, refreshing and revitalising feel. Red algae extract is also included, for its fast action against puffiness and ability to regulate osmotic pressure in the under-eye area.

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PRODUCTS

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

PRODUCT NEWS Call 01477 536 977 lynton.co.uk/3JUVE

“When we had a demonstration of the LUMINA® it ticked all the boxes.”

MESOESTHETIC

Formulated with biomimetic peptides, Mesoesthetic’s Mesohyal Redenx and Mesohyal Argibenone offer intradermal facial treatments that reverse skin cell ageing with high efficacy and specificity. Argibenone is an antioxidant solution that combines biomimetic hexapeptide, idebenone and hyaluronic acid, which aims to reduce dynamic expression lines and photo induced damage by acting on the formation process of expression lines and key cell pathways that are altered during the ageing process.

Redenx is designed for peri and postmenopausal women to treat gravitational wrinkles while enhancing skin density and firmness, improving the densification of biological mechanisms impaired by the reduction of oestrogen. Included are tripeptide and a tetrapeptide to activate the synthesis of proteins of the extracellular matrix.

BYONIK

Hyaluronic Acid Gel 5. Ecto, the latest launch from Byonik, is a fast-acting, active-ingredient hyaluronic acid gel that is free of colourants, oil and silicone.

It contains three high-quality vegan hyaluronic acids with different molecular weights for penetration within all layers of the skin, as well as polygucuronic acid to boost the natural formation of hydration in the skin; and ectoin, promoting a multifunctional skin protection and repair response.

The gel is said to offer antipollution efficacy capable of inhibiting and reducing skin cell damage. It works by enhancing intermolecular interactions between water molecules and ensuring they are structurally arranged; preventing penetration of toxins, allergens, particulate matter, heavy metals and other toxic substances.

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Dr Hodgson and Dr Gallard

The highly skilled team at Principled Aesthetics are NHS trained and have experience working in General Practice and Dermatology.

Why did you choose Lynton as your aesthetic technology supplier?

“Lynton are a world-class company that supply lasers to our local NHS, so it was the obvious decision to purchase from Lynton. This decision was also backed up by the training and the impeccable service Lynton provide.”

“We have had excellent clinical results, especially with rosacea, pigmentation, birth marks, red veins and tattoo removal.”

principledaesthetics Principled Aesthetics

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www.principledaesthetics.co.uk

20/03/2020 12:41

P RO D U CT FO C U S

THOCLOR LABS

aestheticmed.co.uk

Spray

it safe

A new antiseptic treatment product line to help clinicians keep patients’ skin healthy post-treatment

H

ealthxchange Pharmacy has recently started distributing the latest range from Biotechnology skincare company Thoclor Labs, the third generation of its GF Skin Series, a new antiseptic treatment line including the GF1 Aftercare and GF2 Skin Rejuvenation.

Both products contain anti-pathogenic hypochlorous acid, a natural molecule formed by the human body as part of our immune response as a means of killing a range of disease-forming germs such as bacteria, viruses and fungi. They also both contain anti-inflammatory properties which stimulate healing, have not been tested on animals, contain no preservatives, and are suitable for all skin types.

GF1 Aftercare, an in-clinic aftercare treatment that supports the skin’s healing process, is designed for clinics providing treatments that compromise the stratum corneum, including microneedling, dermaplaning, peels, fillers, lasers and permanent make-up.

The product claims to offer a strong non-cyotoxic antiseptic action against all pathogens without damaging the microbiome; offers a rapid reduction of inflammation; gives 60 to 70% faster healing; reduces the risk of scarring; and creates a much lower likelihood of post-inflammatory hyperpigmentation (PIH) in darker skins.

GF1 also prevents complications such as infection, pain, redness, pigmentation and scarring; reduces downtime; and increases eligibility for skin manipulation on darker skin types (IV-VI), tackling skin treatment complications such as infection, discolouration, koebnerization and prolonged erythema.

“Most cosmetic medical procedures carry a risk of infection and often prolonged inflammation. Thoclor has the dual quality of effectively eradicating pathogens on the skin, protecting against post-procedure infection and has powerful anti-inflammatory effects; quickly reducing redness,” says Dr John Curran, medical director of Aesthetic Skin Clinic, who has trialled the products in clinic.

GF2 Skin Rejuvenation, to be used as an additional treatment to GF1, can be taken home and added to the patient’s regular skincare routine, designed specifically to combat “inflammageing”, also known as subclinical inflammation.

Inflammegeing causes changes in the cosmetic appearance of the skin’s structure and is caused by environmental factors like exposure to UV, pollution, toxins in skin products, and poor lifestyle habits such as smoking.

It affects both the dermis and epidermis.

GF2 switches off the genes associated with inflammation ageing; boosts results from existing skincare routines; causes the formation of skin cells such as collagen, elastin and melanin to normalise; and leaves smoother, more tolerant skin.

Other benefits include a reduction in DNA-repair protein, meaning no DNA faults when new cells are made; a reduction of redness of the skin; and, due to its anti-bacterial and anti-inflammatory effect, the product has been found to be beneficial in the treatment of acne, rosacea and cold sores and relieving sunburn.

Thoclor GF1 Aftercare or GF2 Skin Rejuvenation are available to clinics in the UK exclusively through Healthxchange Pharmacy via the e-pharmacy. AM

“The product claims to offer a strong non-cyotoxic antiseptic action against all pathogens without damaging the microbiome”

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06/03/2020 16:33:00

OPINION

BRAND AMBASSADORS

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A leading voice Safety in Beauty founder Antonia Mariconda on how to become a key opinion leader for an aesthetics brand

A

esthetics is a globally booming market with leading brands harnessing the power of combined marketing efforts to push their products and services to the forefront, from online advertising, social media, video and blog posts to the use of ambassadors or key opinion leaders (KOLs).

With a rising demand for brand ambassadors in the aesthetics industry in recent years, I set about researching and carefully studying what makes a successful KOL. Over a period of two years, I visited scores of industry conferences, both in the UK and worldwide; I sat and listened to endless presentations, seminars, speeches, and symposiums; I noted, read, studied, interviewed and had in-depth conversations with over a dozen leading global industry brand ambassadors and KOLs. What I discovered was that becoming a brand

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ambassador wasn’t as easy as many professionals believed it to be, but that when processed and disseminated into an effective formula, my research could simplify the process for those really considering becoming the face and voice of a brand. From this I created a workshop called How to be a Brand Ambassador.

“KOLs have significant persuasive power”

WHAT IS A KOL?

A KOL, or brand ambassador, also known as an “influencer”, is defined as someone who not only has considerable sway over others in their purchasing decisions but is also able to draw attention to and create awareness about the products and services they are fronting. In other words, KOLs have significant persuasive power.

The idea of using KOLs to increase brand awareness and to strengthen the customer/product relationship to fuel consumption and sales is not a new concept. Pharmaceutical companies have often used physicians and academics as their KOLs to provide advocacy to their medicines.

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OPINION

BRAND AMBASSADORS

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Today, KOLs do not necessarily have to be academics or people who talk at conferences. They could be bloggers, professionals or “gurus” in their selected field, or just a normal everyday social media user whose voice and expertise are being shared and recognised on the internet. In other words, they are the brand ambassadors for the online community.

Many of them actively engage with the target audience via social media channels by posting text, images or videos and have a high degree of public trust and credibility.

Asides from the cosmetic interventions industry, there has also been a rise is celebrities, socialites and popular Twitter and Instagram personalities representing brands. This is mainly because many of them have a large number of followers in their online communities; their level of influence is sometimes greater than the mass media. Consumers are likely to trust their feedback much more than those promoted via traditional channels.

It is no surprise then that many brands today are leveraging the use of KOLs and incorporating them into their marketing strategies. Not only are they effective in delivering marketing messages to their audience but they also make them feel more genuine, enabling potential customers to filter through all the clutter and make a quick decision on their purchases.

truth, without worrying how others might perceive you. I have a very no-nonsense, no frills, approach to “telling it like it is” when it comes to the aesthetics, beauty and cosmetic surgery industries. I have never been shy to broach tricky subjects and I like provoking thought in people and looking at a subject from a different point of view.

However uncomfortable my approach was deemed by some when I made my first debut in the industry, it soon became noticed. Social media was in its infancy then, but the platform allowed me the opportunity to just be myself. This grew me an audience of more than 46,000 followers and won me the attention of brands and products, ready to embrace a new authentic wave of influencers, comfortable in their own skin and voice.

Ultimately, the message is: know yourself and just be you.

“If you have a passion for a product, treatment or service and are already raving about it, chances are you’ll get spotted”

BECOMING A KOL

With a little work and effort, you can also become a successful brand ambassador. Our industry is saturated with many revered academics and experts, but it takes a magic formula of knowledge, passion, personality and engagement to become a successful influencer, and ultimately that is what a KOL is.

Can you speak confidently?

When a brand in looking for a new KOL, a key requisite is a person who can speak confidently. If you lack engagement with your audience, your message is pretty much going to fall on deaf ears.

Some of the best speakers I have listened to have a very unique style. They focus less on data, power point slides and complex terminology and instead refine the craft of story telling.

I am always fascinated by the wonderful array of TED talks on YouTube. Here you will find the world’s most prolific storytellers teaching us the true magic of engagement. You’ll notice the key to their formula is mostly defined by their passion, connection with the audience and confidence.

A good ambassador should be proactive at initiating conversation with others in promoting a brand’s product, >

Trust and credibility It is important for brands to hire the right expert in their field who can build trust and credibility, which in turn can help drive awareness (and ultimately sales).

If the KOL is connected and passionate with the brand, it will resonate in what they do and have a greater impact.

When they are actively looking for a new KOL, many brands conduct a search of their own brand on social media and scout people already talking passionately about it. You don’t have to be a big star or an influencer with a huge social media following, but if you have a passion for a product, treatment or service and are already raving about it, chances are you’ll get spotted. So don’t be afraid to tell the world what you love and why. It might just land you your first contract as a brand ambassador.

Are you authentic?

Being authentic means knowing who you are at the deepest level and being that person without pretense or phoniness.

Authenticity is the foundation of relevance because if you don’t understand who you are and where you’re coming from, you can’t possibly lead or influence others.

Being authentic is a unique selling point in becoming a KOL. When put into practice, authenticity allows you to “be real” and “in the moment”, to effortlessly practice the fine art of listening, and to have the courage to speak the

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OPINION

BRAND AMBASSADORS

on a stage, at an exhibition or trade show or on social media.

Communication is key.

As an ambassador your purpose is to build a connection between the products or services you are going to talk about and your audience. No matter how great the product is, or how amazing your credentials are, if your presentation is not delivered properly to the audience, then it’s pretty much useless. This is probably the biggest reason a KOL is dropped by a brand.

If you are considering becoming a KOL you need to truly ask yourself: are you comfortable in engaging healthy discussions and dealing with difficult people? Are you passionate about what you do and can you speak authentically?

Are you a leader?

The main purpose of a brand ambassador is to embody the values, character and overall image of the brand.

They also have the ability to inspire people to own, try, use or buy a product. A great brand ambassador will be passionate, motivated and appear natural, while emphasising the benefits of what they are promoting in a persuading manner.

A leading KOL gives people a “good image” and perception of a brand. This is why companies scout the industry for the right person to represent them.

SOME OTHER TIPS TO GET YOURSELF SPOTTED BY A BRAND Be tech-friendly KOLs should stay updated with the latest trends. Today, people are very much inclined towards social media so ambassadors should be competent in using social media tools when campaigning for a brand, as well as keeping

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their own profile fresh and relevant. Recruiting brands tend to avoid hiring ambassadors that do not have an active and engaged presence on social media.

Keep it professional If you are going to do social media make your profile and content appealing and attractive and keep content relevant and consistent across all of your platforms. Don’t forget to be authentic and, above all, please always stay professional.

Build relationships with brands Actively engage with the big brands in your niche, comment and like their posts, even share them whenever you can on your own profiles.

Network at industry events, and build relationships by being visible, not only online but in the real world too.

Brands are drawn towards professionals who are good relationship builders.

Be a team player Brand ambassadors need to be a part of the team. The sales and popularity of a product or brand is never down to one person, it is always a team effort. A good KOL will know this and be willing to work as an integral part of that and to work harmoniously with others.

Selecting the right brand ambassador or KOL is an essential part of a brand’s marketing strategy. By being hired, your role is to maximise this wonderful opportunity and help grow and build a brand.

In return, you can enjoy the wonderful privileged position of growing your own brand and profile too. In the process you will travel, meet lots of new people and do what you love best. What better way to live than to be paid for doing the job you love. AM

Antonia Mariconda has been working within the aesthetics and beauty industry for more than 20 years, writing, consulting, speaking and coaching, and has undertaken several successful brand ambassador collaborations herself. She is the founder of The Safety in Beauty Campaign and Diamond Awards, focused on raising awareness of safety in the cosmetic surgery and aesthetics industry for the consumer.

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BUSINESS

WEBSITES

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Shape up your site Social media and digital marketing efforts mean nothing without a strong website, says Alex Bugg

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website isn’t as fun to maintain as your social media, but keeping it looking great could be the difference between a full diary and a sparse one.

Your clinic’s website is your 24-hour shop front.

It’s a space where you can inform and educate visitors, bring together testimonials and set yourself apart from your competition (see my article in last month’s Aesthetic Medicine).

A great website is effortless to browse on a desktop, mobile or tablet device. It also looks professional and delivers everything that a potential patient is looking for; be it your treatments, prices, conditions you treat, names of practitioners, contact details, or something as simple as

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how to get to you. If your website is the first impression a potential new patient gets of your business, you want to do everything you can to ensure it’s a positive one. Conversely, a bad experience on a website may reflect on the clinic; your competition might have a slick website that takes more bookings than yours because yours feels dated.

You should be using your clinic website to curate your content, educate, sell products, take bookings and any other interaction. It is also somewhere to push traffic from all other marketing efforts, e.g. social media, PR, email marketing, events, paid advertising, print media and influencer marketing. These marketing efforts are joined up by your website, which reflects your brand.

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BUSINESS

WEBSITES

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you use for paid advertising – the first impression counts and you don’t want to lose visitors instantly. Checking your website analytics for the time on page and bounce rate will let you know if something is wrong, though not what is wrong.

While navigating around your website, make sure you include enough calls to action (CTAs). People like to be told what to do, so when reading about a treatment or a new event you’re holding, make it clear and simple what you want browsers to do next i.e. book in for the treatment or come along to the event. When using a CTA and directing to a contact page, it is best practice to have multiple ways of getting in touch with your clinic: phone, email, contact form, live chat, WhatsApp and so on. People will use the contact method they are most comfortable with, so presenting them with a choice means they are more likely to make that initial contact, rather than forcing people to use a phone and losing business.

Get your privacy policy, cookie policy and T&Cs all in check – if your website doesn’t inform visitors that you are using cookies, such as tracking cookies or advertising retargeting cookies, you are breaking the law. Including all the key legal business information in links at the bottom of your website takes seconds.

REMEMBER THE READER

MAINTAINING YOUR BRAND

Google is the number one resource for getting organic traffic (free search traffic) to your website. Search engine optimisation (SEO) is the practice of improving search rankings to increase traffic and hence, leads. Making sure your site ranks on Google is great, but ensure content is written first and foremost for your patients, not to spam search engines. Google’s algorithms are getting smarter at reading your site, so you don’t need to force “dermal fillers Coventry”, for example, into all of your pages.

Understanding what your searcher’s questions and queries are, and solving their problems, is a better bet for SEO. Writing in a professional, confident tone that addresses the queries browsers might have is key. Patients are being educated on treatment as fact, so making sure >

“Your clinic’s website is your 24-hour shop front”

Your brand is the impression that other people have of you; not your logo and colour scheme. A great brand makes patients stay loyal to a clinic or practitioner, which keeps regular bookings coming in. Conversely, an inconsistent brand between your website, social media and physical space may appear unprofessional.

People will want to see themselves reflected in the imagery on your website. If you must use stock imagery, use a mix of ages, ethnicities and genders. Have strong imagery on your website that makes your clinic look professional and inviting. It’s also a good idea to include pictures of yourself and your team, so people feel like they know you before they even step into clinic.

WELCOME HOME

Your homepage needs to make an instant impression, to quash scepticism and show people they’re in the right place for what they need – they’ve clicked a useful link.

Social proof, such as reviews, accreditations and media, is reassuring. The same can be said for any landing pages

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your writing is easy to read and delivers the information they seek is really important. I always recommend Grammarly, a writing tool that allows you to check the spelling, grammar and tone of a piece of text.

WEBSITE RED FLAGS

No website is a “bad” website, but here are some things to keep in mind that might turn visitors away:

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If your website was last updated however many years ago you had it built, this could be causing problems. A neglected website that ignores things like design, mobile-responsiveness and brand puts itself at risk of harming your business.

But the main reason you should regularly update is for security. Your security needs to be updated regularly to keep information secure. Websites can get hacked or spammed, meaning it could be blacklisted for Google rankings. Web browsers now alert visitors to potential harmful websites, and this break in trust can harm your business, for both new and existing patients. Other reasons to update: You may lose enquiries if your website doesn’t appear to offer a treatment which you now do, but haven’t put a treatment page up for; You may get asked about staff members that no longer work there; You may have moved premises or changed contact details or social media accounts; Keeping an eye on your website means you are unlikely to lapse on domain names and plugins; A blog last updated two years ago might still get read, but it is best practice to keep fresh content going up to get noticed and deliver more traffic to your website.

Take some time to check your website on multiple browsers and devices – and make sure you review your website regularly. Don’t have the time? Designate the task to a member of staff, or get your marketing agency to conduct this for you. You want to make the best first impression for potential patients, so don’t allow your website to let you down. AM

“At least 52% of web traffic is visited using a mobile device”

Looks disorganised – If a website is hard to navigate or looks like it was thrown up in a rush; B ad on mobile – At least 52% of web traffic is visited using a mobile device (smartphone or tablet). A website that doesn’t condense neatly into a mobile screen will suffer with a high bounce rate (the amount of people visiting and navigating away); Carelessness – Such as typos, images that don’t compress properly, no navigation, broken links, no contact form;

M ultiple treatments on one page – Having seen some websites that have three lines of text about each treatment on one page titled “treatments”, I can tell you that you are losing business by not providing enough education on each individual procedure you provide. Dermal fillers and toxin can be used in so many applications, so it makes sense to detail each of these, especially for visitors that are fairly new to aesthetics;

Thin content – While search engine optimisation isn’t an exact science – rather a continuous improvement – writing treatment pages that are rich in content (500+ words) and media will both benefit your patients and your SEO.

>>

KEEP UP TO DATE

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

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

BTL EMTONE

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Sometimes 1+1 does not equal 2 Simultaneous energy delivery - a proven solution for cellulite

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MTONE is an all-new device for the global aesthetics market to treat all five causes of cellulite – something that has not been achieved before. EMTONE from BTL combines radio frequency and targeted pressure energy; two proven and effective technologies that are able to treat all cellulite conditions whilst not limited by BMI or skin type.

THE CONDITION

Cellulite is the name for the dimpled, lumpy appearance of skin that mainly develops in the hips, thighs or buttocks. In females there is a very superficial layer of fat just under the skin, as this fat increases it bulges out, giving the lumpy appearance. As our skin thins with age the resistance to the underlying fat bulging is reduced. In addition, the fibrous strands in the dermal layers become more fibrous and twisted, pulling down to increase the dimpling effect in the skin. As fat accumulates in the interlobal space there is an increase in pressure and a decrease in the ability of the lymphatic systems to drain away lymph fluid, adding to the swelling in the area. This congestion decreases healthy blood circulation in the affected area and good circulation is a prerequisite for neocollagenesis.

The basic anatomical causes of cellulite are: 1. Enlarged fat chambers in hypodermis apply pressure outwards between interlobular spaces 2.

Collagen fibers remain rigid pulling inwards against outward pressure (creating a dimple) 3. Loss of skin elasticity decreases resistance to internal outward pressure 4. Metabolic waste accumulation in the interstitial spaces 5. Poor blood flow.

METHOD OF ACTION

EMTONE is a safe and effective alternative to invasive procedures currently available such as liposuction and subcision. EMTONE treatment modalities are proven over many years through multiple peer-reviewed clinical studies for different applications, such as skin tightening on the face and body contouring. EMTONE now combines both

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radiofrequency and targeted pressure energy to directly treat the anatomical causes of cellulite. The radiofrequency works by heating these fat cells to a comfortable 40-43 degrees, at which temperature they are shown to reduce in volume.

The simultaneous effect of mechanical and thermal energy with EMTONE results in the disruption of old damaged collagen fibres, followed by the synthesis of new healthy collagen and elastin fibres. This leads to a thickening of the dermis and, relaxation of the septae in the hypodermis and an increase in elasticity. Additionally, the treatment gives a deep massage, increasing blood flow, lymphatic flow and lymphatic drainage

THE TREATMENT

The EMTONE treatment takes around 30 minutes depending on how many areas are to be treated. An application cream is applied, and the handpiece is massaged over the treated area. The client feels a comfortable heat and the targeted pressure energy pushes against the skin at a rate of 10 times a second. Four to six treatment sessions are required at weekly intervals. Clients may see an immediate improvement because static lymph and excess fluid in the area has been massaged away. The full effect of the EMTONE will take a full 12 weeks, which is the body’s natural response time to produce new collagen proteins according to the natural reparative process. AM

For further information please visit BTL on btlaesthetics.com or email sales@btlnet.com

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T R E AT M E N T S

TREATMENT NEWS

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Profhilo body protocols

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rofhilo distributor HA Derma has released standardised protocols that allow practitioners to use the skin booster to treat parts of the body.

Following feedback from aesthetic professionals that patients often asked if the product could be used on the body after being treated on the face and neck, manufacturer IBSA Derma looked at developing specific protocols for the décolletage, upper arms, elbows, abdomen and knees.

The protocols mean that practitioners can offer these patients Profhilo’s multi-level dynamic bioremodelling that works by stimulating fibroblasts, keratinocytes and adipoctyes to improve skin laxity, texture and hydration. Practitioners can now achieve consistent, reproducible results, and will be given detailed guidelines with regards to volume and the techniques required in order to achieve the best outcomes in potentially challenging areas.

The official Profhilo body treatment protocols are available to practitioners who have completed HA Derma’s Profhilo training and can be requested from the relevant business development manager. AM

Vaishaly Laser Facelift

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ondon-based Vaishaly Clinic has launched a new treatment known as The Laser Facelift. Clinic owner Vaishaly Patel recently made the new resurfacing treatment available on her menu, having been performing it for her celebrity clients and VIP event attendees for a year. The 25-minute treatment starts with deep cleansing and gentle microdermabrasion to clear away dull, congested skin cells. Then, non-ablative fractional Pixel Q-Switch laser is passed over the skin to treat fine lines and wrinkles while helping shrink the appearance of pores and tackling acne scarring, small veins and redness.

The procedure is pain-free and allows the laser energy to penetrate deeply and stimulate collagen production without wounding the outer layer. Patients can be treated around the eyes and there is no downtime involved. Treatment

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benefits also include lifted, toned and tightened skin, with results visible from one treatment, though a course of six spaced two to four weeks apart is recommended. “I’m really excited to be offering this game-changing treatment at the clinic. Traditional laser skin resurfacing treatments were often

harsh, painful and required significant downtime. Recent innovations in nonablative fractionated skin resurfacing has made this treatment popular with my clients, due to minimal downtime and exceptional results that are visible after just one treatment,” said Patel of the new treatment.

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T R E AT M E N T

REVIEW

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Lighten up Vicky Eldridge tries out the Dermamelan treatment from Mesoestetic with Dr Lori Nigro at Riverbanks Clinic

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first spoke to Dr Lori Nigro, a key opinion leader for mesoestetic, back in the summer about trying out the Dermamelan treatment, but we wanted to find the right time to do it as I was aware there would be some downtime.

January seemed like the perfect time to start.

I have always had freckles but, as I’ve aged, my pigmentation has worsened. As is the case with pigmentation, it can be complex and mine had multiple factors at play. I am really careful in the sun and wear SPF year round but my fair, freckly skin breaks out in patchy pigmentation in the warm weather (more and more each year) and having moved to the coast and spent a lot more time outside this year I was definitely feeling the effects of 2019’s summer sun. I have also been experiencing some hormonal changes, which had definitely contributed to some patchy melasma-like pigmentation on my forehead.

Finally, I had some post inflammatory hyperpigmentation around my cheeks where I have had acne.

I have used Mesoestetic’s products many times over the years and it counts as one of the top five ranges I have ever

Vicky Eldridge and Dr Lori Nigro at Riverbanks Wellness

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used. Their HA Intensifier is a recent favourite and the SPFs are fantastic. I had seen the impressive results from Dermamelan but had never given it a go myself. Now was the right time.

Dr Nigro is based at Riverbanks Clinic in Harpenden and so I arranged to go and stay with a friend as we had scheduled two appointments. The first for consultation, assessment, image taking and a mild preparation peel. I then needed to wait and come back two days later for the Dermamelan mask to be applied.

The Dermamelan treatment is effectively a peel that is designed to improve hormonal pigmentation, such as melasma and chloasma as well as to reduce the signs of photo-damage, regulate oil secretion, reduce pore size and prevent breakouts.

The peel contains kojic acid, phytic acid, ascorbic acid, arbutine, titanium dioxide and retinyl palmitate, which block the production of melanin by irreversibly inhibiting tyrosinase, which is an enzyme involved mainly in melanin synthesis to help reduce pigmentation formation. This process does not make

The mask is applied in clinic

Immediately after the mask is removed

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the melanocytes disappear, but simply paralyses or stops melanin production, without risk of white blemishes appearing, thus, improving the complexion of the skin long term.

It is applied in the form of a mask in clinic. The mask felt no different to a mud mask, although a little more tingly, a bit like the sensation when you use Original Source mint shower gel.

It was not unpleasant but I did have to make the two and a half hour drive home wearing it – praying I did not have to stop to use the services. Luckily I didn’t!

The mask stays on for 10 hours and then you wash it off at home. My skin felt a little tight and sore, like a mild sunburn when I removed the mask. In the morning my face was bright red and stinging like I’d fallen asleep on a sun lounger in Dubai. My eyes were also a little puffy and swollen but nothing I hadn’t expected.

Dr Nigro got me to send regular photos to her so she could see my progress and check in on me. About two days later the peeling started. It was the most I have ever peeled from any treatment. I am used to having treatments and am not necessarily embarrassed by the after effects but the cold weather did allow me to wrap my scarf around my face and pull my hat and hood down to shield myself when I went out. It was hard to resist the urge to pick and scratch. I was shedding like this for a few days before it calmed down but over the next month I was very dry and flaky and the peeling would come in waves. I was using the homecare kit which comprised Recovery Cream, Treatment Mask and a high factor SPF (130).

It is safe to say that during this period my skin did not look it’s best and because the colour of the at home mask is a little brown and the SPF was tinted, so I sort of looked like I had applied a bad fake tan most of the time because I decided to give make-up a break while my skin healed.

About a month later I woke up one morning and looked in the mirror and was genuinely shocked at how different my skin looked. To use the word “transformative” would not an understatement. It looked smoother, more even, some of the more prominent patches of pigmentation had gone, my acne had improved, my pores were less blocked, I looked younger and fresher. I posted a picture on Instagram with no filter because I really didn’t need one.

I am still using the at home products, which I will use for the next six months and will continue to see an improvement in the underlying pigmentation at it rises to the surface. You need to prepare your patients for the downtime with this treatment, however, it is perfectly manageable and more than worth it.

I haven’t ever been so astonished by the results of a single treatment. I am very grateful to mesoestetic and Dr Nigro for what they have done for my skin. AM

The morning after removing the mask

Before the treatment

After the treatment

The peeling begins

A month after treatment my skin was glowing

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HORMONES AND SKIN

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Finding balance Dr Sophie Shotter discusses the link between hormones and skin and how to support menopausal patients

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ormones are the signalling mechanism through which homeostasis is maintained and all physiological mechanisms of the body are controlled. The traditional view of the endocrine system is that we have a set of certain hormone producing organs. With increased medical knowledge it has become clear that we actually have organised communities of organs which emit, receive and co-ordinate molecular signals from distant sources. The skin has all of these functions – it has complex endocrine mechanisms such as expression and

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function of specific hormone receptors, elimination of the hormones in specialised cells and exertion of biological activity.

We are all well versed with the effects of pubertal hormone storms on the skin with increased sebum production and acne commonplace. The effects of menopause on skin are far less widely understood.

OESTROGEN

Oestrogen is one of the main female steroid sex hormones.

Healthy oestrogen levels increase the rate of cell renewal

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and increase collagen and elastin production. It is also responsible for counteracting the effects of other hormones, slowing down hair growth, keeping sebaceous secretions thinner and less oily, and reducing skin levels of hyaluronidase.

Prior to menopause, women will lose dermal collagen at a rate of 1-1.5% per year from the age of 25. Within the first five years of menopause women lose 30% of their collagen, followed thereafter by a continued loss of 2-2.5% per year.

PROGESTERONE

Progesterone goes hand in hand with oestrogen, as the body’s other female sex hormone. It works with oestrogen to help boost immunity and reduce swelling and inflammation. It assists oestrogen in keeping skin firm and with nerve function.

TESTOSTERONE

Testosterone is thought of as the male hormone, but in fact all women produce it in smaller doses to men. In moderation, testosterone increases skin thickness and cell renewal. However, too much can lead to hair growth and excessive sebum production.

CORTISOL

TREATMENT OPTIONS Hormone Replacement Therapy The beneficial effect of oestrogen on skin appearance was first noticed in the 1940s with the dawn of early hormone replacement therapy. Hormone replacement therapy has multiple systemic benefits to women, including reduced bone loss and improved sleep.

Women who take systemic hormone replacement therapy report improved skin appearance compared with women who do not. For many years negative press about the safety of HRT led many women to avoid taking it. Experts now advise that in studies linking HRT use to an increased cancer risk, the significant risk elevation is due to the use of synthetic progestogens.

Over the last five years, women have become increasingly aware of other options such as bioidentical hormone replacement therapy. Using hormones identical in structure to our own, it is possible to address hormone balance more holistically. BHRT will replace not just oestrogen and progesterone, but also testosterone, DHEA and melatonin if required.

The resulting normalisation of hormone balance can enhance systemic health and wellbeing as well as slowing facial ageing.

In a perfect world a woman would have blood tests taken in her mid to late 20s to show her personal optimal balance.

In reality it is very unusual to have this, and we rely on improvement of symptoms as well as blood hormone levels to guide treatment.

Compounding pharmacies which produce bioidentical hormones can also produce topical facial hormone creams. These can be blended to bespoke prescriptions to enhance facial skin health.

“In a perfect world a woman would have blood tests in her mid to late 20s to show her personal optimal balance”

Cortisol is the body’s main stress hormone, and the skin is capable of actually producing cortisol. Any causes of oxidative stress will increase cortisol in the skin, in addition to systemic stress raising cortisol levels.

Excess cortisol levels will inhibit collagen production through limitation of protein synthesis. Stress will simultaneously raise testosterone and DHEA whilst lowering oestrogen, progesterone, growth and thyroid hormones. The result is accelerated ageing as well as increased break outs.

MENOPAUSE

even though testosterone levels aren’t high. This can lead to increased sebum production and an increase in the incidence of adult acne. Women will often also notice new facial hair growth.

So why do we see all the problems we see during menopause? Decreasing oestrogen and progesterone will lead to decreased cell renewal, giving skin a rough texture. As the skin thins and becomes more fragile, so do the blood vessels, leading to increased broken vessels.

The accelerated facial bone loss literally causes their bony framework to shrink.

Immunity is also compromised by hormonal shifts, meaning women often develop new product sensitivities.

Increased levels of hyaluronidase lead to accelerated breakdown of hyaluronic acid, making skin dryer. The accelerated collagen breakdown will also lead to increase wrinkle formation.

Our skin is further affected by the hormonal imbalances which develop. Whilst oestrogen, progesterone and testosterone levels all drop, oestrogen and progesterone drop much more rapidly. This leads to a temporary state of androgen dominance,

MEP Technology Many women are either reluctant or unable to use HRT. This may be due to the many years of negative press HRT has received, or due to a personal or strong family history of breast cancer, for example.

In 2019 a novel skincare range was launched called Emepelle. Emepelle contains synthetic oestrogen receptor activators, which bind to oestrogen receptors on fibroblast cells enabling collagen production to occur. If the MEP technology is absorbed into the blood stream it is deactivated, having no systemic effect.

Historically, we have treated collagen loss aggressively with skincare ingredients such as >

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retinoids, but often, results in peri and post-menopausal women are disappointing.

This is because oestrogen receptor activation is essential for healthy fibroblast activity, and without this collagen output will be minimal. The Emepelle range consists of a serum in the morning and a cream at night, making it very easy to slot into any skincare regime. It can be used for any women with menopausal symptoms, and can be routinely recommended to all women over the age of 40.

Symptomatic treatment Traditional in-clinic treatments and at-home skincare are essential for keeping skin healthy.

Collagen breakdown – Retinoids are the gold standard ingredient for collagen stimulation in the skin. Depending on tolerance this could include prescription products such as Tretinoin, or gentler retinol products. It is important to remember that the skin needs certain nutrients to be able to produce collagen. In particular, a healthy level of vitamin C is important. In-clinic collagen-induction treatments are also perfect in this age group. This could include treatments like microneedling, radiofrequency, peels and Ultherapy. ehydration – Dehydration is caused by depleted levels D of hyaluronic acid in the skin. Stimulation of fibroblast cells with retinoids will also boost hyaluronic acid

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production. A topical hyaluronic acid is an easy and welltolerated addition to a skincare regime. ryness – Dryness is different to dehydration and is D caused by a lack of natural oils in the skin and an impaired lipid barrier. This can be treated effectively with lipid rich cream formulations containing ceramides and fatty acids. air removal – Facial hair removal can be performed H with a laser for pigmented hair or electrolysis for nonpigmented hair. olume loss – The rapid volume depletion which occurs V in menopause due to bone and fat loss can be very effectively treated with dermal fillers.

Menopause is a challenging time for most women, with physical and emotional disruption. Even women who do not choose to pursue systemic hormone replacement therapy will often feel better by being able to address the changing face they see in the mirror. Even if they do not fee “‘normal” inside, it helps to recognise themselves in the mirror.

Working with a colleague who can prescribe BHRT is a useful partnership for every aesthetic practitioner for patients open to the idea. However, excellent skin improvements are achievable for practitioners with practices of all sizes through the use of appropriate targeted topical products. AM

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

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EYE REJUVENATION

EYES

wide open Mr Daniel Ezra explores the surgical and non-surgical options for ageing eyes

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EYE REJUVENATION

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ne of the first places to show signs of ageing on the human body is the skin around the eyes, because the area is sensitive and more delicate than other parts of the body. It becomes even thinner with age due to reduced levels of elastin, collagen and hyaluronic acid, and is also slightly drier as there aren’t as many sebaceous glands around the eyes to keep it moisturised. Since the skin becomes weaker, patients become more prone to unappealing age-related changes such as crow’s feet, dark circles and bags, as well as swelling around or underneath the eyes. The skin contrasts in thickness and function all over the body, and the fragile eye area is distinctive for numerous reasons.

This delicate area comprises hardly any subcutaneous fat tissue, which then also declines in plumpness with age.

Thus, it’s particularly sensitive to stress from facial movements like squinting and laughing, both of which cause wrinkles to form. Ultraviolet rays also contribute to the development of wrinkles, especially if repeatedly exposed. The skin’s elastin proteins and collagen are damaged, meaning the skin thins even more. As a result, fine lines build up – namely crow’s feet – around the eyes. In fact, crow’s feet are often the first wrinkles to show on the face.

When the skin thins, it can also bring about unsightly hollowed regions below the eyes, which look like dark circles or bags, making patients look continually exhausted.

Reduced fat and collagen as well as thinning skin cause the skin to look thinner and more transparent, thus, reddishblue vessels show up more obviously beneath the eyes.

Collagen is also affected by certain internal processes in the body, namely the damaging effect of glycation. This happens when simple sugars affix themselves to collagen and proteins. The contaminated collagen fibres become less strong and flexible, meaning skin becomes looser in this area.

NON-SURGICAL OPTIONS

If my patients don’t need or want to go under the knife, I follow the “relax, refill, resurface” approach: Relax muscles: As the BoNT-A (botulinum toxin type A) clinical lead at Moorfields Private Eye Hospital, I recommend using BoNT to soften facial expressions. Injecting into the tail of the eyebrow and between the brows counteracts the muscle from dragging downwards and decreases lines. This type of treatment for ageing eyes can last for roughly three to four months.

Refill volume: When the skin around the eyes loses volume, it contributes to hollowing, so fat pockets appear more noticeable. The appearance of bags under the eyes can be reduced by using tear trough fillers, which work to fill out the valley and reduce the shadow. Fillers are placed along the orbital rim of the lower eyelid to flatten the area. What’s more, they enable the build-up of collagen, meaning dark circles appear less obvious. That said, fillers won’t improve dark circles caused by brown or purple discolouration.

Resurface texture: One of the most effective treatments for tightening upper and lower lids is microneedling. The treatment involves the application of a numbing cream

“One of the first places to show signs of ageing is the skin around the eyes”

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CLINICAL

EYE REJUVENATION

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and eye shields to a patient’s eyes, before a stamping pen containing several needles is used to pierce the skin. The process encourages collagen production, which tightens skin and enhances texture, tone and rigidity.

A patient will normally undergo three to five treatments per month for roughly two to three years. The treatment can also decrease dark eye circles, with the overall process taking just half an hour, however, one of the side effects is swelling and bruising for up to one week.

SURGICAL PROCEDURES

“Crow’s feet are often the first wrinkles to show on the face”

Upper eyelid blepharoplasty is a popular cosmetic surgery to remove extra or protruding fat pockets under the eyes. It involves removing varying amounts of skin, muscle and fat. If pre-existing upper eyelid hollowness is present, these tissues can be relocated to fill the hollows to attain a younger-looking appearance of the eyelid and to increase the visual field.

A full slit lamp biomicroscope examination is usually performed to ascertain and eliminate any cause for ocular surface irritation before the procedure, as irritations to the eye are normally either due to dry eye or blepharitis.

Following the required amount of removal during the procedure, buried dissolvable stitches are applied to close the skin surface.

If lower eyelid blepharoplasty surgery is needed, this is a little more complicated. An incision is made below the eyelash line, running beyond the corner of the eye. Surplus muscle, skin and fat are then removed or repositioned through this

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incision. Eyelid surgery should be tailored to a patient’s facial balance, employing scar-less hidden incision practises and the most advanced technology available to give the most natural results. A patient is usually able to return to work within one week and the surgery is generally performed in an out-patient or office setting.

There are two approaches to blepharoplasty surgery, the former of which I practice myself: Transconjunctival: An incision is made in the lower lid, which gives direct access to the fat pockets. These fat pockets are removed through heat-induced sculpting or by repositioning. The latter aids in dispersing some of the excess fat into regions that may have volume loss, like the infraorbital rim (tear trough region). Laser treatment and chemical peels may be needed when a patient has extreme wrinkles or minor excess skin.

Transcutaneous: If a patient requires surplus fat and skin to be removed, the lower lid skin and excess fat are directly removed together. This procedure is usually performed if a patient has moderate to excessive surplus skin where skin re-surfacing (chemical peels and laser) aren’t of much use.

Although for any surgery, scarring is a concern, I have undertaken laboratory research on skin cells taken from the eyelids to investigate their scarring potential. I found that the eyelid fibroblasts have a much lower tendency to form scars and are a unique component of eyelid cell biology. My research on this area is published in the Journal of Plastic Reconstructive Surgery. AM

Mr Daniel Ezra is one of the UK’s leading ophthalmic and oculoplastic surgeons. He specialises in lacrimal disease and is the endoscopic lacrimal surgery lead at Moorfields Private Eye Hospital, where he is also the research lead and training director. Another area of his expertise is in cosmetic and reconstructive eyelid surgery.

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