Aesthetic Medicine Magazine April by Aesthetic Medicine

INSPIRING BEST PRACTICE IN MEDICAL AESTHETICS

DAMAGE CONTROL PIGMENTATION

BEAUTY SLEEP PRESCRIBING SLEEP FOR SKIN HEALTH

THE MALE FACE CONTOURING THE LOWER FACE IN MALE CLIENTS

April 2019 | aestheticmed.co.uk

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SWAGGER

DREAM

STYLE

CHEAT

FORTUNE

DARE

KARMA

FLIRT

ADVENTURE

REBEL

CHAOS

SIN

Good

comes to those who

With the broadest choice of fıllers, Restylane gives you complete freedom to personalise your patient’s treatment to fulfıl their every need and bring out their true individuality.

Choice Matters

April 2019

April 2019 | aestheticmed.co.uk

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restylane.co.uk RES19-02-0048a Date of preparation Feb 2019

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

The The secret secret to to a a sharper, sharper, chiselled chiselled ™ The secret a sharper, chiselled jawline with Lyft ™ jawline withtoRestylane Restylane Lyft ™ jawline with Restylane Lyft

with with Aesthetic Aesthetic Practitioner Practitioner and and A&E A&E Consultant Consultant Dr Dr Paul Paul Baines Baines with Aesthetic Practitioner and A&E Consultant Dr Paul Baines

™ II use Restylane Lyft ™ “ use Restylane Lyft “ ™ I use Restylane Lyft for for“95% 95% of of my my work work for 95% of my work on the lower face ” onon the lower face the lower face” DR PAUL BAINES DR PAUL BAINES

”

DR PAUL BAINES

Have youyou seen a rise ininthe Have seen a rise thenumber number Have you seen a rise in the number of people looking workon ontheir their jaw? jaw? of people looking forfor work of people looking for work on their jaw?

Definitely. been workingininfacial facialaesthetics aesthetics for Definitely. I’veI’ve been working for Definitely. I’ve ten been working inused facial aesthetics for years and weused tofind find that that people moremore thanthan ten years and we to people morewere than ten years we used tothe find that looking to filland wrinkles, but in last twopeople years were looking to fill wrinkles, but in the last two years demand contouring werethe looking to for fill facial wrinkles, but in and the sculpting last two has years the demand for facial contouring and sculpting has really grown. There contouring are two features the face has the demand for facial andon sculpting reallythat grown. There are two features onthe the face people notice first – the eyes and really grown. There are two features on themouth. face that people notice first – the eyes and the mouth. recommend treating or and jaw as they frame that Ipeople notice first –the thechin eyes the mouth. I recommend treating the chin jaw as they isframe the lower third of the face, butor the treatment much I recommend treating the chin or jaw as they frame subtlerthird and less noticeable than the lips or the lower of the face, but thetreating treatment is much the lower thirdeyes. of the face, but the treatment is much around The posterior of the the mandible, subtler andthe less noticeable than aspect treating lips or subtler less treating the lipspoints or the and cheek andnoticeable the chin arethan very effective anchor around the eyes. The posterior aspect of the mandible, around the eyes. posterior aspectsupport. of the mandible, to lift the face The and provide structural the cheek and the chin are very effective anchor points the cheek and the chin are very effective anchor points to liftDo the face anda provide support. you have productstructural that you recommend to lift the face and provide structural support. for sculpting the chin and jaw?

Do you have a product that you recommend I use have Restylane Lyft™ for that 95% of my recommend work on the Do you a product you for sculpting the chin and jaw?patented lower face. Ithe really like Galderma’s for sculpting chin and jaw?

technology I useNon-Animal Restylane Stabilised Lyft™ for HA 95%(NASHA™) of my work on the I useas Restylane Lyft™ for 95% of my work on the it provides maximum lift and precision. I like the lower face. I really like Galderma’s patented lower face. I really like Galderma’s patented sharpnessStabilised of the highHA G prime. Non-Animal (NASHA™) technology Non-Animal Stabilised HA (NASHA™) technology as it provides maximum lift and precision. I like the as it provides maximum lift and precision. I like the sharpness of the high G with prime. A patient treated Restylane Lyft™ sharpness of the high G prime.

A patient treated with Restylane Lyft™ A patient treated with Restylane Lyft™

Occasionally I’ll Restylane use Restylane Defyne™ from Galderma’s Occasionally I’ll use Defyne™ from Galderma’s Occasionally I’ll use Restylane Defyne™ from Galderma’s Optimal Balance Technology (OBT™) range as the smaller Optimal Balance Technology (OBT™) range as the smaller Optimal Balance (OBT™)when range as the smaller particle sizesize gives me Technology flexibility, particularly particle gives me flexibility, particularlytreating when treating particle size gives flexibility, particularly when treating women. Restylane has me the range of dermal women. Restylane hasbroadest the broadest range of dermal women. Restylane has the broadest range of dermal fillers, so I can tailor the treatment to each patient and fillers, so I can tailor the treatment to each patient and it’sfillers, important me to have dermal fillertoI can trust. so I to can tailor theatreatment each patient and it’s important to me to have a dermal filler I can trust. it’s important to me have a dermal fillerface? I can trust. What are your tips forto sculpting the lower •

What are your tips for sculpting the lower face? What are your tips for sculpting the lower face? Assess the upper two thirds of the face first,

• as the Assess the upper two thirds the face first, temples, preauricular regionof and cheeks • Assess the upper two thirds of the face first, may to be treated first asneed the temples, preauricular region and cheeks as the temples, preauricular region and cheeks may need treated first • Make sure you to arebe aware of the key safety points, may need to be treated first especially the positioning of the artery • Make sure you are aware offacial the key safety points, • andMake sure you are aware of the key safety points, the parotid gland especially the positioning of the facial artery especially the positioning ofthe themandible, facial artery • Treat progressively the angle of and the parotid– gland and parotid gland then thethe chin and finally the peri-jowl area • Treat progressively – the angle of the mandible, • • UseTreat a product with a high capacity, progressively – lifting the angle of the mandible, then the chin and finally the peri-jowl area predictable and finally robust the clinical data area then theresults chin and peri-jowl • Use a product with a high lifting capacity, • long Use do a product with a high lifting capacity, How you find each lasts?data predictable results andtreatment robust clinical predictable results and data The results can last up to 12 to 15 robust monthsclinical depending onHow the patient provided, but I often long and do the youtreatment find each treatment lasts? long do you each treatment lasts? askHow people to come backfind at three months and six to nine The results can last up to 12 to 15 months depending months for assessment. The results can last up to 12 to 15 months depending

on the patient and the treatment provided, but I often on the patient and the treatment provided, but I often ask people to come back at three months and six to nine ask people to come back at three months and six to nine months assessment. About Drfor Paul Baines months for assessment. Dr Paul Baines divides his time between running The Crescent Clinic and working as About an Accident Emergency Dr and Paul Baines Consultant About Dr Paul Baines at Musgrove Park Hospital in Taunton.

Dr Paul Baines divides his time between

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

AFTER

RES19-03-0085 DOP March 2019

BEFORE BEFORE

He is a member of the Royal College of Surgeons He a member of theknowledge Royal College of Surgeons andishas an extensive of facial anatomy. and has an extensive knowledge of facial anatomy.plastic Dr Baines has worked alongside world-renowned Dr Baines and has is worked alongside plastic surgeons a member of theworld-renowned Galderma Faculty. surgeons and is a member of the Galderma Faculty.

AFTER AFTER

RES19-03-0085 DOP March 2019 RES19-03-0085 DOP March 2019

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

aestheticmed.co.uk

Contents APRIL

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

NEWS AND ANALYSIS

BUSINESS

10 NEWS The latest news from the industry

22 MOTIVATION Alan S Adams on getting out of your comfort zone

16 NEWS SPECIAL REPORT The BCAM annual audit review

24 ASK THE EXPERTS Our experts answer your questions

18 TALKING TO David Alpert, founder of iiaa, talks about the company’s eco ethos

ADVERTISING Jack Diamond

28 REFERRALS Benedetto Cusumano asks, is it time for a new alliance between aesthetic practitioners and trichologists?

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

CLASSIFIED Nur Suleyman

30 COMMENT Dr Rekha Tailor on empowering women in aesthetics

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

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

26 DIGITAL MARKETING Ruth Zawoda on the essential key drivers for a successful online marketing campaign

32 EMPLOYMENT Victoria Vilas on discrimination in the workplace

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

DESIGN AND PRODUCTION ICD www.icd.gb.com

PRINTING Walstead United Kingdom walstead-uk.com

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

Aesthetic Medicine • April 2019

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CONTENTS

IN THIS ISSUE...

aestheticmed.co.uk

SKIN

DENTISTRY

INJECTABLES

DEVICES

OUT AND ABOUT

37 PIGMENTATION SPECIAL Our 11-page special on treatments, products and protocols for tackling pigmentation

68 INVISALIGN Dr Yasmin Shakarchy on Invisalign smile makeovers

74 INTERVIEW We speak to Dr Paul Baines about contouring the lower face in male patients

78 ELECTROLYSIS Gill Morris explains how electrolysis is making its mark in aesthetics

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

52 INGREDIENT SPOTLIGHT Ross Walker discusses some of the myths and misconceptions around hypochlorous

82 EDITOR’S CHOICE Vicky Eldridge tries the NuEra Tight treatment from Lumenis 84 DEVICES NEWS The latest device-based launches

54 NEW TREATMENTS We take a look at some of the newest and most innovative treatments being launched into aesthetic clinics 60 SLEEP AND SKIN Could prescribing shut eye be the key to healthier skin? 64 SKINCARE SPY Dr Amiee Vyas shares what her skincare staples are 66 SKIN NEWS The latest skin product launches

Welcome

to the April issue of Aesthetic Medicine Spring is here and we’ve already had a taste of what’s to come this summer. Like most people I love the sunshine. It boosts my mood and makes me feel happier. However, working in the aesthetics sector for as long as I have, I am acutely aware of the damage that the sun can do to my skin, both in terms of premature ageing and the increasing risk of skin cancer, the fastest growing form of deadly cancer. I wear SPF every day, rain or shine, but I’m lucky that I’ve been exposed to experts who have told me it’s one of the best things I can do to protect my skin and stay looking young and fresh. Many people only wear SPF when they go on holiday and are actively lying out in the sun and, as such, aesthetic clinics see many people coming through the doors for whom years of sun exposure has taken its toll, manifesting as unsightly pigmentation. As the summer approaches, we take a look at the best treatments and products for managing pigmentation and ask aesthetic practitioners what their gold standard protocols are (see this month’s dossier p37-50). I for one am looking forward to the lighter, longer days and everything coming to life this Spring but I’m looking forward to it with my SPF on! Vicky Eldridge - Editor

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

INDUSTRY NEWS

aestheticmed.co.uk

Petition launched to protect children from cosmetic surgery advertising on Instagram Save Face and Cosmetic Surgery Solicitors have launched a petition to urge the UK government to require Instagram to do more to protect young people from having unfiltered access to content from influencers and celebrities that can undermine their self-esteem and stimulate interest in surgical procedures that are unlikely to be suitable for them. The petition follows a survey that discovered 23% of people who see images that promote or demonstrate the effects of cosmetic surgery and cosmetic procedures report feeling more negatively about their own appearance as a result.Significantly, this figure dramatically increased in correlation to how young the survey participant was. These findings follow the 2017 #StatusofMind report from the Royal Society for Public Health (RSPH), which found that, of the top five social media platforms, Instagram has the most negative impact on young people’s mental health. Michael Saul, partner at Cosmetic Surgery Solicitors, said, “Our goal is to protect and support young people on Instagram so they can make a more informed decision.Seeing these kinds of images on Instagram can lead to the normalisation of cosmetic enhancements, which in turn can cause anxiety,

depression, lack of confidence, body dysmorphia and other mental health-related issues among users. This comes as parliament has been debating the impact of social media on the mental health of young people, following the publication of a report from the Science and Technology Committee that described how ‘provocative pictures’ from celebrities and social media influencers ‘can put pressure on young people to replicate that behaviour’.

Six-figure sum of botulunim toxin stolen from raid on Dental Directory warehouse last month Boxes of Azzalure botulinum toxin worth an estimated six-figure sum have been stolen during a raid on a warehouse belonging to Dental Directory’s in Witham, Essex. The break-in happened between 20.00 on Saturday, March 2 and midnight on Sunday, March 3. Essex Police said there were at least four men, and believed a white Ford Transit van was used in the raid. Detective sergeant Richard Newton said, “I’d ask anyone who is involved in cosmetic procedures who has been offered these items for sale recently, and is suspicious of where they came from, to please let us know. We are also keen to speak to anyone who has any information about the burglary.” Paul Charlson, president of the British College of Aesthetic Medicine, commented, “Botulinum toxin is a prescription medicine and each vial will require a prescription. If a supplier does not ask for this they are unlikely to be bona fide. Furthermore, the practitioner has a responsibility to ensure the medicine they inject is safe and comes from a reputable source. The cold chain of transmission also needs to be assured. This is not likely to happen with stolen toxin.” Anyone with information should call Braintree CID on 101 quoting reference 42/30285/19.

MyBreast selected as first UK clinic to participate in FDA-reviewed study for safety in breast implants MyBreast will participate in an international FDA-regulated clinical trial into breast implant safety, sponsored by Motiva USA. Professor Marcos Sforza, aesthetic surgeon and scientific director at MyBreast, is the only UK surgeon enlisted by Motiva Implants® to represent the British research arm of the study. The 10-year research study of breast implants began in April 2018 and includes approximately 40 study sites. MyBreast will work with Motiva USA to focus mainly on primary breast augmentation and candidates will be selected according to the protocol, in compliance with FDA regulations.

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

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INDUSTRY NEWS

Galderma UK plans to appoint sole, preferred distributor for aesthetics solutions business Galderma UK has begun a review of its distribution arrangements, with the intention of moving to a sole preferred distributor relationship. Established distributors have been offered the opportunity to tender for the new operational model, which is anticipated to commence in early September 2019. The preferred company will win a contract to service all customers who purchase Galderma products marketed under the Azzalure and Restylane brands in the UK and Republic of Ireland. Other distributors will continue to be able to purchase Galderma products and services, but the sole-preferred distributor will be supported to deliver a more customercentric proposition, including enhanced levels of tailored support for healthcare professionals. The move is in response to changes in the aesthetics industry. Growing demand is driving an increase in the number of both active injectors and products on the market, which is in turn creating demand for greater focus on quality and industry oversight.

Toby Cooper, medical solutions business unit head, Galderma UK and Ireland, said, “More than ever, healthcare professionals need to have confidence in the quality of the outcomes they can deliver. They need a supplier they trust, providing them with products and support they know they can rely on. By refining our distribution model, we believe that we can enrich the overall relationship with our customers, offering an enhanced level of tailored support as well as a continued, reliable supply of our products.”

Aesthetic practitioners happy but need more business support, says survey A survey of more than 300 cosmetic and aesthetic practitioners across the UK by Hamilton Fraser Cosmetic Insurance has revealed that 75% are happy in their job but need more support.

The study showed that practitioners are distributed evenly throughout the UK and Ireland, although there is a notably slightly higher percentage (14%) that operate in the North-West, with Cheshire and Liverpool leading the way. Most come into the industry in their 30s and 40s seeking a new challenge, with 78% saying they worked part time and 71% claiming to work alone. 70% of respondents said they would like more support when setting up their business, while 88% said they would attend local evening events to learn more about running a successful practitioner business. 58% weren’t members of any relevant professional bodies or associations at all.

Fat cells work different ‘shifts’ throughout the day Fat cells in the human body have their own internal clocks and exhibit circadian rhythms affecting critical metabolic functions, new research in the journal Scientific Reports, finds. Researchers led by Dr Jonathan Johnston from the University of Surrey conducted the first ever analysis of circadian rhythms in human fat taken from people isolated from daily environmental changes. During the study participants underwent regulated sleepwake cycles and meal times before entering the laboratory, where they maintained this routine for a further three days. Participants then experienced a 37- hour ‘constant routine’ during which time they did not experience daily changes in light-dark, feed-fast and sleep-wake cycles. Biopsies of fat tissue were taken at six-hourly intervals and then followed by an analysis of gene expression. Researchers identified 727 genes in the fat tissue that express their own circadian rhythm, many carrying out key

metabolic functions. A clear separation in gene rhythms was identified, with approximately a third peaking in the morning and two thirds in the evening. Dr Johnston said, “This is the first time that we have been able to identify such rhythms in human fat. This provides us with more information about how human metabolism changes across the day and possibly why the body processes foods differently during day and night.”

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

INDUSTRY NEWS

aestheticmed.co.uk

Study investigates whether different-sized cannulas are safer than needles of a corresponding size A study has been published in the journal Plastic Reconstructive Surgery to investigate whether different-sized cannulas are safer than needles of a corresponding size for the application of facial soft-tissue fillers. 294 penetration procedures of the facial and superficial temporal arteries were performed in four fresh frozen cephalic specimens using both needles (20-, 22-, 25-, and 27-gauge) and cannulas (22-, 25-, and 27-gauge). Continuously increasing force was applied and measured until intra-arterial penetration occurred. No statistically significant differences were detected when comparing forces required to penetrate the facial arterial vasculature between different sexes, arteries, or sides of the face (all p > 0.05). Forces needed to penetrate significantly (p < 0.001) decreased with smaller diameter

needles (20-gauge, 1.12 ± 0.29 N; 22-gauge, 1.08 ± 0.25 N; 25-gauge, 0.69 ± 0.24 N; and 27-gauge, 0.70 ± 0.29 N) and in cannulas (22-gauge, 1.50 ± 0.31 N; 25-gauge, 1.04 ± 0.36 N; and 27-gauge, 0.78 ± 0.35 N). Comparing 27-gauge injectors, no statistically significant difference was detected between needles and cannulas; an artery could be penetrated with a similar force independent of whether the injector was a needle or a cannula (0.70 ± 0.29 N versus 0.78 ± 0.35 N; p = 0.558). The authors concluded that cannulas, in all measured sizes except 27-gauge, required greater forces for intraarterial penetration compared with correspondingly sized needles, confirming the safety of 22- and 25-gauge cannulas. However, 27-gauge cannulas required similar forces as 27-gauge needles, indicating that 27-gauge cannulas are not safer than 27-gauge needles.

Microbiome skincare is driving the UK facial skincare market, says Mintel, and is a strong indicator of future trends New research from market analyst Mintel has highlighted products that target the skin microbiome are driving skincare sales in the UK, with more than 37% of the world’s microbiome skincare products launched in the UK last year. Mintel’s Jane Henderson, global president of the beauty and personal care division, said the analyst expects to see the microbiome trend expand in the near future to encompass the exposome – a term used for the external environmental factors that affect our health. Henderson commented, “British skincare brands have been among the first to understand the importance of the microbiome, the natural bacteria found in and on the body which can be balanced through skincare.

“In the next five to 10 years, the skincare industry will expand from simply focusing on the microbiome to also include the exposome (i.e. external environmental factors such as pathogens, fungi, pollution, and plants that interact with our DNA and affect our health). “This will inspire NPD that takes a bespoke and holistic approach to skincare and health, such as exposomemeasuring wearable devices, bespoke ingestibles, personalised DNA nutrition, and products that boost skin health and personal air quality.” “The clean beauty movement started out in skincare and is now quickly moving into colour cosmetics, with the UK leading the way. Consumers are holistically looking to clean up their lifestyles, so clean make-up will become increasingly important in the coming years. “Clean beauty is more than a trend, it’s a lifestyle, and, as such, brands must adapt to the changing landscape to secure their place in the future market.”

Prince Harry visits scar centre at the Queen Elizabeth Hospital Birmingham The Duke of Sussex visited the Scar Free Foundation Centre for Conflict Wound Research at the Queen Elizabeth Hospital Birmingham to learn more about the Centre’s work in piloting piloting tailored psychological treatments to help seriously injured armed forces personnel cope with life with an altered, scarred appearance. The Scar Free Foundation Centre for Conflict Wound Research is a ground-breaking national facility that aims to minimise the psychological and physical impact of living with scars. Among the new treatments being pioneered there is the world-leading UltraPulse CO2 laser therapy by Lumenis to correct scars and a pro-healing protein being

developed within a new biomaterial gel. “It was a pleasure to present our work on transforming burn scarring to HRH”, said Mr Max Murison, consultant plastic and reconstructive surgeon. Eddie Campbell-Adams, Lumenis UK country manager, added, “It was great to meet HRH The Duke of Sussex. He seemed very impressed with the work we do using the UltraPulse CO2 laser to transform the lives of those with life-affecting complex scars. “

Aesthetic Medicine • April 2019

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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 SK:N PLOTS GROWTH AIDED BY A DIGITAL TRANSFORMATION

Clinic group sk:n, which was recently acquired by private equity firm TriSpan, has plans to expand into more locations across the UK. The brand has grown its clinic numbers from 36 to 51 in the past two years and expects a similar level of rollout to continue. As part of its growth plans, sk:n has appointed Birmingham-based agency, Lightbox Digital, to aid its digital transformation by delivering innovative functionality and features to a new and improved website.

RSM TO HOST FACIAL AESTHETICS EVENT IN ASSOCIATION WITH BAPRAS

The Royal Society of Medicine will be the setting for Facial Aesthetics - Contemporary Surgical and NonSurgical Options this month. The education event has been organised in association with the British Association of Plastic, Reconstructive and Aesthetic Surgeons and will be held on April 30. Topics will include the current range of treatment options in facial aesthetics, the role of different types of rhinoplasty, facial anatomy and botulinum toxin, and facial fillers and their potential complications.

CYNOSURE ANNOUNCES MATA AND CIBTAC AS TRAINING PARTNERS

CynoSure has announced a new partnership programme with training leaders MATA (Medical Aesthetic Training Academy) and the international awarding body CIBTAC (Confederation of International Beauty Therapy and Cosmetology) to provide endorsed manufacturer-led training in aesthetic laser technologies. This means that customers undertaking product training with CynoSure can have this count towards their official qualifications, written into the new JCCP (Joint Council for Cosmetic Practitioners) standards and CPSA (Cosmetic Practice Standards Authority) guidelines.

3D-LIPO APPOINTS CAPITAL HAIR & BEAUTY AS UK DISTRIBUTOR

3D-lipo has announced the appointment of Capital Hair & Beauty as the exclusive distributor for 3D-lipo in the UK. 3D-lipo will be available in in more than 50 of its stores, as well as online. This comes at a period of extensive growth for 3D-lipo Ltd, following its diversification into the laser sector throughout 2018, in addition to currently going through the process of ISO certification.

Half of all adults with eczema experience anxiety or depression Fifty per cent of adults with eczema have been diagnosed with anxiety or depression in the past 12 months, or show signs of these mental health problems, according to new research in the British Journal of Dermatology. The research, carried out by dermatologists and allergists in the US, also found the severity of eczema symptoms to be strongly linked to the risk of anxiety and depression. The study included 2,893 adults, 602 of whom had eczema. Participants completed an online survey which was designed to reveal the severity of their eczema if they had the condition and the state of their mental wellbeing. Mental health assessment was completed using the Hospital Anxiety and Depression Scale (HADS), which showed eczema was associated with a significantly higher chance of experiencing symptoms of anxiety and depression. Borderline or abnormal scores for anxiety, depression and for both anxiety and depression were reported in 48.4%, 34.5% and 26.6% of adults with eczema, respectively. Holly Barber of the British Association of Dermatologists said, “There is a strong link between our skin and our mental health. This study confirms the need to ensure mental health services are accessible to patients with skin conditions, and where possible integrate mental and physical care at the earliest opportunity. “Unfortunately, few dermatology departments currently have the resources to consistently apply this approach, to achieve this will require more investment. Those who feel that the level of mental health support they are getting is inadequate should discuss this with their dermatologist or GP.”

IQ signs agreement with JCCP Awarding organisation Industry Qualifications (IQ) has joined EduQual as the second awarding body to sign a memorandum of understanding with the Joint Council of Cosmetic Practitioners (JCCP). Through signing this memorandum of understanding, the JCCP has confirmed that the IQ Level 7 Certificate in Injectables for Aesthetic Medicine meets all necessary guidelines. Laurence Clarke, IQ qualification development and sector lead for aesthetic medicine, said, “Following the signing of this memorandum of understanding, the JCCP will continue to work closely with IQ to ensure that IQ aesthetic qualifications remain the hallmark of quality within the sector.”

NEWS IN PICTURES Sinclair Pharma held its first successful regional event at Healthxchange Academy in Manchester. Speakers included Dr Gareth O’Hare, Dr Saleena Zimri, Dr Ian Strawford and Ffyona McKeating. Sinclair will be rolling out more regional meetings in various locations over the coming months where practitioners will be revealing their tricks of the trade using the Sinclair Pharma portfolio, including Perfectha® HA and Ellansé collagen stimulator. Dates include April 2 (Darlington), April 8 (Birmingham), May 2 (London), and May 29 (Bristol).

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BCAM Audit Dr Paul Myers reports on the BCAM annual audit review

ach year, members of the British College of Aesthetic Medicine (BCAM) provide details of their aesthetic clinical practice as a condition of their membership of the organisation. This process has been in place for the past nine years and helps the BCAM board to obtain a current and detailed review of the clinical practices of its members. The latest clinical review provided pooled data from 334 doctors, which represents 95% of the current BCAM membership. There was an approximate even split in gender of the respondents, (53% were male) with two thirds being aged between 40 and 59 years old. Less than 25% of the membership has been practising for less than four years. In fact, the majority have been in practice for more than seven years and nearly 25% have been practising aesthetic medicine for more than 13 years. Nearly half of all respondents were working full-time in aesthetics, providing no other clinical services, with a further 40% working two or three days per week. When we look at the range of aesthetic treatments provided almost all BCAM aesthetic doctors provide toxin and dermal filler anti-ageing treatments, while nearly half also provide both laser treatments and minor surgery. BCAM doctors also provide a wide range of additional treatments, including hair loss treatment, mesotherapy, chemical peels, various fat removal treatments, and weight loss management.

BOTULINUM TOXIN TREATMENT

The use of botulinum toxin for aesthetic indications was reported by almost all the respondents (96%), and nearly 90% of its use was for aesthetic treatment. However, a significant number of doctors provided botulinum toxin for medical indications too, including hyperhidrosis (16%), blepharospasm, facial asymmetry, and the management of the sequelae of stroke. Respondents to the survey reported reviews of more than 29,400 individual botulinum toxin treatment sessions, an increase in reported activity

of nearly 30% compared with last year. It is considered that this reflects the increase in the number of members contributing to the review as well as an increasing clinical activity, and shows progress in the aims of BCAM in reporting both the activities of the members and in providing more accurate data such as adverse events reporting figures. The clinical data regarding adverse events that have occurred following toxin treatments found that while minor adverse effects, such as eyelid or brow ptosis, or a poor aesthetic result, were reported occasionally, this treatment appears reassuringly safe. In fact, 95% of respondents reported no adverse events at all. Of the total number of individual treatment sessions delivered, 115 incidents were reported by respondents (although it should be noted that this figure included minor problems such as bruising or inadequate efficacy following the treatment). This represents a reassuringly low level of problems with this treatment, the overall prevalence being less than four incidents per thousand treatments. Importantly, it should also be mentioned that there were no major adverse events reported by any doctor. Of the events following toxin treatment, 57 members reported at least one incident of lid ptosis, and 99 for ptosis/brow asymmetry, 55 for excess bruising, three post procedure infection, and 22 â&#x20AC;&#x153;othersâ&#x20AC;?.

DERMAL FILLER/VOLUMISER TREATMENT

With regard to dermal filler management, the survey reviewed more than 28,700 treatment sessions provided by the aesthetic doctors who responded, which represents an increase of 30% activity reporting compared with last year. This treatment was used for facial wrinkles in nearly one third of cases and for volumising treatments in about 40% of patients treated, figures comparable with 2017. For the remainder of patients, dermal fillers were used for lip enhancement or other indications. When the doctors were asked about adverse events following dermal filler treatment, 92% of respondents reported having experienced no adverse events of any sort.

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For the remainder, a total of 665 individual adverse events were described, although the vast majority of these were minor, such as bruising or an insufficient aesthetic result/ failure to meet the patient’s expectations (571). Including all figures, the overall adverse event rates worked out to be approximately 23 per 1,000, but this includes the minor self-limiting episodes. The specific replies by members to the question seeking request for additional information with regard to dermal filler treatments was generally helpful, including replies from 88 respondents. These included reports of allergic reactions, nodule formation, and excess swelling, etc. A small number of vascular incidents or suspected occlusion were reported (five) and this information is particularly helpful to the BCAM board in terms of future instruction education and support of members. In summary, in terms of the prevalence of significant adverse events, the use of dermal fillers appears very safe with the adverse event rate reported as only 3.3 events per 1,000 treatments.

LASER TREATMENT

The review also looked at laser treatments by aesthetic doctors. This treatment was provided by only a relatively small number of doctors (as the 2018 figures showed, only 37% of doctors provide light-based therapies in their practices). As last year, only one third of laser doctors provided more than 11 treatments per month. Again information such as this is helpful to BCAM in planning education and training in the future. The vast majority of laser users provide laser treatments for thread veins (65%), reduction of pigmentation (63%) or for facial rejuvenation (46%). Only a small number if respondents use laser treatments for other dermatological indications and tattoo removal (15%). There was a low prevalence of adverse events reported following laser treatments, with respondents documenting a total of just 83 incidents. The majority of these were minor incidents, such as bruising (14), not managing patient expectations (35), minor pigmentation changes/ hyperpigmentation (20) and hypopigmentation (1). This was in relation to approximately 12,300 treatment episodes reported over the past year. This would give a laser adverse

event rate in relation to burns (14) and pigmentary change of 2.8 incidents per thousand treatment episodes.

SUMMARY

The feedback section was an important part of the clinical review. It enabled doctors to provide a wide range of feedback on their aesthetic work, areas that they wish the BCAM to concentrate on with regards to educated and training, and suggestions for further topics and future audits. One of the other most important functions of the annual clinical review, is to encourage aesthetic doctors to record their workload and the quality of the clinical services they are providing, for this to be documented in a structured way, and to be available in anonymised collated form. This then enables the doctors to look at their own data and compare it with the pooled data provided. By comparing audit data from their own clinical practice with national data from a large sample of aesthetic doctors, the individual doctor can report on the relative safety of their own treatments. This in turn is important information for the doctor to provide as “quality improvement” evidence for their annual appraisal. This pooled data represents analysis of more than 70,000 individual treatment episodes reported by nearly 350 medically qualified aesthetic practitioners from over the past year. The availability of the annual clinical review provides powerful information about the clinical work undertaken by aesthetic doctors and, in particular, emphasises the relative safety of the treatments provided. Over the next 12 months BCAM plans to revise the clinical review to make it more “user friendly”, and we are currently reviewing the data entry process. Progress on this will be reported in due course in the BCAM newsletter. In parallel with this there will be an increasing range of quality improvement initiatives for aesthetic doctors, to be promoted by BCAM, to supplement the quality improvement processes. Examples include the availability of approved clinical audits in relation to aesthetic treatments which are now available on the BCAM website. AM Charts representing responses to “which laser treatments do you provide in your clinic” (left) and “how many years have you worked in aesthetics?” (below).

Paul Myers was a BACD founder member. He has 16 years aesthetic experience and is currently a BCAM board member. He is medical director of Doctors Appraisal Consultancy, an organisation which provides advice and support to independent (non-NHS) doctors undertaking appraisals and working towards their revalidation. He provides appraisal services to a wide range of designated bodies, including NHS England and the British College of Aesthetic Medicine. His current research interest is the quality assurance of doctors’ appraisals.

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Piece of mind As the International Institute for Anti-Ageing (IIAA) celebrates its 25th anniversary, founder David Alpert talks about the company’s eco ethos and why the industry needs to invest in more sustainable practices to help reduce plastic waste

he International Institute for Anti-Ageing (IIAA) is celebrating 25 years in the industry, rising from a small distribution company to one of the sector’s leading names. It distributes advanced skincare brand Environ, mineral make-up range Jane Iredale, and its own brand, Advanced Nutrition Programme (ANP) supplements, to thousands of clinics and salons. The company has made a name for itself not only for its quality brands but also for its strong eco ethos, which is important at a time when the Government is focusing on greater sustainability in all industries. Company founder David Alpert talks us through the business’s eco practices and reveals what needs to be done by larger corporations and high-street clinics and salons alike to reduce their impact on the environment.

David Alpert with wife and IIAA co-founder Tracy Tamaris

Why is sustainability such a hot topic in the beauty industry? Our industry is responsible for billions of single-use packaging items per annum. I visited the Artic last summer, as I have a passion for photography, and on the shore line 10 degrees from the North Pole was tons of plastic packaging, and a lot of it was from big beauty brands. It really brought home the fact that we need to address this issue because what we’re doing as an industry is not sustainable. If we don’t look after the environment it will reach a point of no return. What can clinics and salons do to become more eco-friendly? It starts with a change of mindset. Start small – for example, looking at your cleaning fluids to check they’re eco-friendly and making sure staff switch off computers at night to reduce electrical use – and then build it up. They should also be demanding more from their suppliers in terms of sustainable packaging. For instance, many clinics put homecare products in paper bags for clients to take away, but the rope handle may be made from plastic, not natural fibres – these are the things you need to ask about. When you provide a bag, it should be 100% biodegradable. What sustainable business practices does IIAA have in place? As a distributor, we supply products to thousands of businesses who deal with tens of thousands of clients, which gives us the opportunity to influence a broad

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IIAA’s packing plant and sustainable packaging

range of people and really get the sustainability message out there. We have an internal green team that meets monthly to look at what we can do to make the business more sustainable. We’ve done a lot already: using corn starch chips instead of foam ones when packaging up goods because they dissolve away to nothing after a few minutes in water; only using recycled paper and vegetable ink when printing because it doesn’t present a problem for the environment; and changing shipping from air freight to sea freight to massively reduce our carbon footprint. However, the biggest project was building our packing plant in 2017 so we could switch all of ANP’s plastic packaging to recycled paper cartons. This was unique because no one else in the industry was doing anything like it, and we’re now looking at creating recyclable paper packet vitamin refills that can be poured into the cardboard pots, further reducing waste. We’re also working with other beauty organisations through industry body the Beauty Companies Association (BCA) to show them what we’ve done with sustainable packaging. The hope is that we will influence others to do the same.

You’re launching the IIAA Foundation this year. What is it all about? We wanted to launch something that would effect real change in the world, which is why we’re launching the IIAA Foundation in the coming months. All proceeds will go to our two beneficiaries – the Katie Piper Foundation and WildAid. Clinics and salons donate to the cause by placing orders with us, and as a company we match their contributions. WildAid is an environmental foundation that looks at education as a means to prevent unsustainable practices such as consuming rhino horn or shark fins. It believes that only when the buying stops, the killing can, too. The Katie Piper Foundation was chosen because we wanted to contribute to something beauty industry-related and we felt the Foundation’s work was by far the most meaningful. There are people who have sustained injuries, sometimes by industrial actions, others under malicious circumstances, that have caused the most horrendous facial disfigurements, and being able to help them is such a positive thing. The idea came to my attention after I was invited to a luncheon at the House of Lords. I heard from women with facial disfigurements and I found their stories incredibly moving. AM

What we’re doing as an industry is not sustainable. If we don’t look after the environment it will reach a point of no return

What is the biggest issue facing the professional skincare market? While many other industries are in decline, the beauty sector is growing positively and that is partly because of the internet and social media. Although this is good, it has presented some challenges. Historically, clinic and salon owners have been able to derive a sustainable income from the sale of products, but the internet has changed this. Retail sales have moved online and the line between consumer and professional products has become blurred. It has been a potential threat to the viability of many businesses, reducing their income. To meet this challenge, skincare professionals need to provide value at the point of purchase – keeping clients engaged post-treatment so they will buy on-site rather than shopping around online. Clients will do that if they feel they are getting the right advice.

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BUSINESS

MOTIVATION

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Push yourself Alan S Adams on getting out of your comfort zone and into the ring

our comfort zone is exactly that – a place where you feel most comfortable, where you’re happy to stay, and where you’ve probably been for a while. But just as pushing yourself out of your comfort zone in your personal life can be an extremely rewarding experience, it’s just as important to try new things that might make you feel a little nervous in a professional capacity, too. You’ve already taken a massive leap into the unknown by setting up your own clinic. No matter how much training and experience you have in the industry, taking the decision to set up on your own does involve an element of risk and and sees you taking on new skills in areas such as sales, IT and marketing. Once you’ve established yourself, however, remaining in you comfort zone is likely to see your business stagnate. Unless you try new things, you’re unlikely to find the winning formula that is going to progress your clinic from one that’s simply surviving to one that’s thriving. Is there something you’ve been holding back from doing because it’s not your ‘norm’? It’s easy to make excuses, but in reality, unless you make time to challenge yourself (and perhaps admit to yourself that the real reason you’re holding back is because you’re nervous), you’ll never know how successful you could be, even if it’s outside of the zone you feel comfortable in. Embrace the online world If words like hashtag, viral post, profile picture and impressions mean little to you, and the online world seems a complete mystery, then now is the time to learn the basics of social media platforms like LinkedIn and Twitter. Even if you feel overwhelmed by learning how to promote your business online, the facts are that you’re putting yourself at a disadvantage compared to your competitors if you’re not doing it (and doing it well). Plus, while there might be an initial outlay in terms of accessing the training you need to understand the ins and outs of social media, once you’re all set up and ready to go, it’s a fantastic way of being able to advertise yourself to the world for free.

with you to propel you towards those goals. While there may well be things in the plan that will push you out of your comfort zone, your business coach should have the same overall goal as you: improving the profitability of your business and improving your lifestyle in the process. Upping your prices When I first start working with businesses, many of them simply aren’t charging what they’re worth because it often feels uncomfortable to ask for more money. Fear of losing existing clients, not attracting new ones and the big repercussions of that is very real, however the reality of sticking in your comfort zone and continuing to undercharge means other clinics that don’t have that fear will be bringing in much more profit; and they could be offering exactly the same level of service despite charging more (and they might not even be as good as you are). Knowing your own value, and knowing how to convey that value to the customer, is key here.

Your comfort zone is exactly that – a place where you feel most comfortable, where you’re happy to stay, and where you’ve probably been for a while

Business coaching Having someone come into your business and help you put together a plan for the future could seem a slightly uncomfortable idea – after all, it’s your clinic so why should someone else tell you what to do with it? But coaching isn’t about lecturing you or forcing you to go in a specific direction, it’s about listening to what you want to get out of the company (including the type of lifestyle you want to live: work/life balance, holidays, more time at home, etc) and working

Putting yourself into the spotlight While there has to be a focus on high-quality services provided by a clinic, customers connect with people – so being visible as the face of the clinic is extremely important. Whether that’s becoming a go-to spokesperson for comment and opinion

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BUSINESS

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MOTIVATION

about the latest trends within the industry, making contacts within the media, giving speeches, or putting yourself forward for awards, raising your own personal profile will have a profound impact on the reputation of your clinic. Many people don’t find it natural or comfortable to be in the spotlight, but it will push your business to the next level. So many of the top companies in the world have a figurehead attached to them, so if you want to be the clinic equivalent of Facebook, Microsoft or Virgin, then it’s worth taking a leaf out of their books. Pushing yourself as a person Trying something outside ofyour comfort zone is important in your personal life too. Your life shouldn’t be 24/7 work and taking time away from the clinic can help develop all sorts of skills that are transferrable to your business. I’m always advising my clients to step out of their comfort zones, and wouldn’t ever ask them to do something I wouldn’t do myself – which is why I’ve signed up to take part in an Ultra White Collar Boxing Match this spring. Now, this is well outside my comfort zone: I know nothing about fighting, or how to win a fight, so I’m approaching this exactly the same way that I’d approach a business. The end goal is to win a fight and raise lots of money. The fastest way to learn how to do this is to work with a boxing coach, who’s teaching me the techniques I need to learn to win – I could try to work it out for myself (it is only throwing punches, right?), but this would almost certainly lead to failure. The coach is teaching me things that he’s taken years to learn in a very compressed time frame. AM Visit justgiving.com/fundraising/alansadams to find out more about Alan’s boxing event in aid of Cancer Research UK. Visit thetopcliniccoach.com for more information about his work with clinics.

Alan S Adams is an award-winning business coach and bestselling author. His third book, The Beautiful Business: Secrets to Sculpting Your Ultimate Clinic, focuses on the medical, cosmetic and aesthetic clinic sector. He was selected as a finalist at the The Association of Professional Coaches and Trainers & Consultants Coach of the Year Awards and was recognised by Enterprise Nation as one of the Top 50 Business Advisors in the UK.

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BUSINESS

ASK THE EXPERTS

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Ask the Experts One of my 2019 business goals is to maximise retail but it’s proving tricky. How can I boost sales?

he key to successful retail can be broken down into this formula: staff plus site, plus stock, equals sales. Staff: ‘Teamwork makes the dream work’. The first objective is to determine what motivates your staff. Some are money-orientated, for others its time off in lieu, while some prefer product incentives. Asking key questions will help you decide which route to take. Set achievable unit targets or monetary goals and constantly remind your team to ensure that clients are continuing to use their customised beauty regime at home. There is no point in a client having a monthly facial if they are going home and using face wipes. Work out how much extra money your staff could make if they sell product; once they realise the additional commission they could earn, it will help motivate them. Site: ‘Retail is detail’. Ensure that your merchandise is always in a prime position. Use the posters, images and shelf talkers that are supplied by most brands. Why have a painting of a tree on the wall when you could be promoting the latest product launch or new treatment?

‘Eye level is buy level’; products that are not selling well, or ones that you particularly want to promote, should be placed at eye level on the shelf. Products won’t sell if the customer cannot see them. Stock: Do regular stock counts and know your stock. Here, the number three is key. What I mean by this is to display three of each product, if possible. Any less, and it looks like the products have been sitting there for ages. Always have testers for clients to try before they make the commitment to purchase as it secures the sale. Finally, throw away the key. Visit any successful top department store and you will never see a locked retail unit.

Amanda Coveney has 30 years’ industry experience and is managing director of skincare distribution company Skinbrands.

How often should I get my laser equipment serviced?

ther than buying property, purchasing a laser system is often the single biggest business investment many of us will make, so longevity of your equipment is key – the better your system is maintained, the longer you can expect it to be making money for you. Regular servicing can pick up any issues that might be putting stress on delicate components, which means that they last longer, avoiding costly repairs later down the line. For example, it’s essential that optical components are regularly checked because, over time, even tiny specks of dirt or debris can damage the coating on lenses and mirrors. Regular maintenance also ensures a constant and calibrated output, enabling you to deliver safe and effective treatments for your clients, and retain valid insurance cover. How often your system needs to be checked over will vary depending on the type of laser or light device. IPL systems, on the whole, have fewer delicate optical components and generally just require one service visit per year, but most laser systems require two to three services. Some very high precision lasers, such as those used for corrective eye surgery, are serviced every two months. Speak to your supplier for advice on what is required for your particular system.

Dr Samantha Hills is clinical director at Lynton, the UK manufacturer of lasers and intense pulsed light systems.

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BUSINESS

DIGITAL MARKETING

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Push yourself Ruth Zawoda discusses the essential key drivers for a successful online marketing campaign

linics, product companies and individuals within the medical aesthetics sector that have previously ‘sat in the dark’ when it comes to their digital impetus are now embarking on new digital marketing journeys. While it is great for us marketers to see that people are valuing and understanding the true potential of digital marketing, it is so important that we stress how failing to create and implement a feasible, realistic strategy is all too common. To avoid making this mistake, I would advise that you take note of some imperative, key drivers that are essential when forming and implementing a successful marketing campaign.

DIGITAL MARKETING STRATEGY – GOALS AND OBJECTIVES

There is no point embarking on a beautiful marketing journey if you have no idea what you want to get out of it

First and foremost, you must have goals. There is no point embarking on a beautiful marketing journey if you have no idea what you want to get out of it. There are a number of different ways you can construct goals and aims, but it is important to make sure they are relevant to your aesthetics business and your capabilities. Without purpose or direction, how are you supposed to formulate any kind of strategy and, moreover, how can you analyse and monitor its success? The ‘SMART’ acronym is regularly used to help create goals and aims at the initial planning stages of marketing

projects. This means you should take time to consider the following factors when creating your goals: S – Specific: Your goals should be clear and specific so that you constantly know what you’re setting out to achieve. For example, how many more patients do you want to get from your marketing campaign? M – Measurable: Can you measure your goals? How? There’s no point in setting goals if you can’t measure your progress throughout the project. A – Achievable: Are your objectives achievable? You shouldn’t set goals that are achievable by a multinational clinic chain if you’re an independent practitioner just starting out on your journey. You must be realistic with your budget and targets. R – Relevant: Are these goals relevant to you? Do these objectives align with other goals and aims within your business? T – Time-based: All targets need a timebound requirement. There’s no point in setting goals if you never have a deadline for achieving any of them. A simple marketing calendar can help with time management of your strategy.

MARKET SENSING

Before delving into the specificities of your plan of action, it’s important to understand the environment around you. Your competitors, customers, and even your own employees will shape your strategy. The whole purpose

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of a digital marketing campaign is to communicate with your potential and current client base, which is why it’s so important that you take the time to understand them, how they think, and what it is that they want. You can do more to understand your clients and patients by running surveys and questionnaires, listening to them individually, and acting on their feedback.

LIMITS AND CAPABILITIES

You must know how far your capabilities stretch before you make any moves in the digital world. If you’re planning on using Google Ads or Facebook Ads to generate more enquiries online, then you should understand your monetary limits. When you start out, you are not going to have huge budgets for the marketing of your aesthetics business, but you still need to put enough into the pot in the right way to see results, and it’s important to remember you won’t always see great results in the first few months of a campaign. It’s also important to gauge the knowledge and attitude of your employees or marketing team, as they will be the individuals who help to implement your strategy. Do you know how capable your employees are with following a marketing plan? You shouldn’t implement a highly complicated plan with a team that isn’t knowledgeable or confident enough to execute it effectively. Understanding your limits is key to a successful strategy. If you have limited experience and knowledge inhouse, the best thing you can do is outsource your marketing to a specialist (but, of course, I would say that).

IMPLEMENTATION

Once you’ve outlined your plan and got everything in order, it’s time to implement your strategy. No plan is hitch free, so you must be prepared to change your strategy according to the variables that you could encounter. Your customers may latch onto another product, your competitors might spring a surprise, or your employees might not like the new way of doing things. This requires you to be alert during the implementation phases and spot any problem areas before they fester and render your campaign useless. The implementation of a marketing strategy is usually the most difficult aspect, but if you prepare as well as you can, using the previous steps, you’ll have a good chance of getting it right.

MONITOR AND REVIEW

While you execute your strategy, it’s important to constantly monitor and review your progress. If you’re not getting the results that you hoped for, then you’re probably doing something wrong – or your aims were unrealistic. You need to constantly review your marketing plan, actively identifying its strengths and weaknesses. If you find some of your tactics aren’t working, change things up. For example, you may be getting great results through optimising treatment pages on your website for SEO, but you are seeing minimal interactions on your social media platforms. In this case, it’s time to focus on creating fresh, unique and engaging content for your social media channels. AM

TACTICS

After understanding your market and capabilities, you should brainstorm the different ways in which you can create your digital footprint. There are hundreds of different ways that businesses can now choose to communicate with their customers online, but it’s important to pick the methods that are right for you. As you will have already researched your demographic and taken the time to understand your limits, you’ll know exactly how and where you should communicate with your customers. Creating your digital tactics is also a good time to get creative by telling compelling stories using current trends and making them applicable to your business, too. Just some of the tactics that are generally used by businesses are: SEO management, social media management, social media advertising, email marketing, affiliate marketing and Google Ads.

Ruth Zawoda is managing director of Truly Content. She specialises in online marketing in the aesthetic and private medical sectors, specifically social media management and campaigns, content for SEO, lead generation and email marketing.

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BUSINESS

REFERRALS

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Two heads are better than one Consultant trichologist Benedetto Cusumano asks, is it time for a new alliance between aesthetic practitioners and trichologists?

enerally speaking, many aesthetic practitioners do not possess extensive knowledge of the causes and treatment of hair loss. However, many patients suffering from this type of ailments seek out and discuss their problems with aesthetic practitioners, as hair loss is still commonly regarded as a cosmetic concern. While it is true that hair loss doesn’t have a significant impact on your overall physical health, its effect on a person’s mental and emotional health can be devastating. Hair loss can be caused by a number of different factors, such as lifestyle, diet, hormones, or genetics, and with so many different misconceptions circulated it’s easy for someone to get the wrong advice. Hair loss is a common issue for both men and women and with GPs having very little training in the causes of hair loss, for many patients their first stop is to consult with an aesthetic practitioner. Unfortunately, their lack of knowledge means that the appropriate advice or treatment is not given; let’s face it, most aesthetic practitioners will typically offer the only service they provide, which in most cases is PRP, mesotherapy or laser treatment. So is it not time for aesthetic practitioners to engage the support of trichologists to form a new working partnership and offer patients what they really need?

It could be the case that aesthetic practitioners are not fully aware of the knowledge and expertise that a qualified trichologist can offer. While most trichologists are not medically qualified, they are medically trained in all areas relating to hair and scalp health and will have spent two to four years studying a plethora of subjects. Chemistry, biology, pathology, and genetics are just a few of the basics that underpin the study of diseases and disorders affecting the hair and scalp. In the same way that a trichologist is not trained to do the job an aesthetic practitioner, an aesthetic practitioner does not have in-depth training of the conditions that can affect the hair and scalp. Therefore, I feel that it’s time that the two industries come together to offer patients a service that will truly fulfil their requirements and needs. A trichologist can scrutinise the finer details; lifestyle, diet, medication, and blood work, to help diagnose and correct an issue. It is in everyone’s best interest that medical professionals begin to engage the services of local and qualified trichologists, to help overcome what is a common and taboo issue for a large percentage of people. It is a subject that can be both difficult and distressing to talk about and it is often a challenge to find the right person to talk to. If aesthetic practitioners and trichologists can build a closer working relationship, hair loss can be treated much more effectively. AM

It’s time that the two industries come together to offer patients a service that will truly fulfil their requirements and needs

>> 28

Benedetto Cusumano is a consultant trichologist and founder of the TrichoCentre in Peterborough. He set up the clinic in 2015 because he wanted to do more to help people suffering from hair loss and scalp conditions. He qualified at the prestigious Institute of Trichologists in London and was awarded the John Firmage Certificate of Distinction, in recognition for this work in this field. He is a registered member of The Institute of Trichologists, the International Association of Trichologists, an affiliate member of the British Association of Hair Restoration Surgery (BAHRS), and was shortlisted for the Outstanding Trichologist Newcomer Award at the Hair Science Awards in 2018.

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BUSINESS

COMMENT

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Woman’s world Dr Rekha Tailor highlights the importance of empowering women in the aesthetics industry

riday, March 8, 2019 marked International Women’s Day, a worldwide event that highlights the social, economic, cultural, and political achievements and contributions made by women in our society. The aesthetics industry is full of hardworking and aspirational women – from aesthetic doctors and nurses, to those in clinic support teams, equipment manufacturers and technology developers. Not only is it a honour to work alongside them in such a fast-paced and evolving industry, it’s also a privilege to be able to help our female patients who entrust us with their personal journeys.

It is my belief that it is our responsibility as women in this industry to look after each other, to empower one another, and be supportive in our common goals and ambitions. We, through a commitment to clinical excellence and integrity, will inspire the next generation of aesthetic industry trail blazers, so it’s hugely important that we are communicative, transparent and dedicated to both our individual and collective achievements. At Health & Aesthetics, women make up approximately 86.5% of our patient base, and I know I speak on behalf of our entire team when I say that we feel a great sense of responsibility for each one of them. It is our duty to empower their patient journey by ensuring that we communicate well, educate them and present factual information that will help them make informed choices, and act with integrity at all times.

EFFECTIVE COMMUNICATION

The importance of effective two-way communication should never be underestimated and it’s essential that this is managed from the very first point of contact (whether that be via the website or email, a phone call or face-toface). We always advise that our patients conduct a full and

It is my belief that it is our responsibility as women in this industry to look after each other, to empower one another and be supportive

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COMMENT

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thorough consultation with any prospective practitioner before embarking upon a treatment plan. This allows us to assess the patient’s medical history and current skin condition, discuss treatment processes and the expected outcomes in detail, manage expectations, and develop a plan tailored to the individual’s needs. We encourage honesty throughout this process as it also provides an opportunity to explain the potential risks and side effects of any suggested treatment and offer suitable aftercare advice to ensure the effectiveness of the treatment.

EDUCATION

Equipping patients with all the facts is essential in providing them with empowerment over their treatment journeys. From creating a clear, informative and well-resourced website, to giving a robust consultation process and cooling off period that gives the opportunity to ask any questions that they may have, it’s important that they are presented with all the facts clearly and concisely so that they can make the right decision for them as an individual.

INTEGRITY

Upholding a sense of professional integrity is critical when working in the aesthetics industry. Integrity forms the foundation of our industry and underpins everything we do. It’s what helps us to offer the highest standards of clinical excellence and garners that all important practitionerpatient trust. A great example of the act of integrity within our industry is knowing when to say “no”. There will inevitably be occasions when a patient wants a certain procedure or treatment that you as a doctor will know is completely unsuitable for them and must refuse. Although you have acted correctly and with professional integrity, you may have left a patient feeling disappointed that their desired aesthetics outcome will not be fulfilled in the way they had initially hoped. This is sometimes difficult to manage, but by using effective communication skills and education tools, it is possible to ensure that both practitioner integrity and the patient’s sense of empowerment over their treatment journey remains intact. It is my hope that there is a continued and long-lasting commitment to the empowerment of all women in our industry and that from practitioner to patient, we are as pioneering in empowering each other as we are in developing the latest technological advancements in our industry. AM

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

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BUSINESS

EMPLOYMENT

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Discrimination in the workplace Victoria Vilas discusses discrimination in the workplace

ll employers should be aware that it is not legally acceptable to have a bias against a job applicant or employee because of the colour of their skin, their gender, or their sexuality, but, unfortunately, there are still many acts of workplace discrimination taking place. Don’t take it for granted that you know what constitutes discrimination in the workplace, make sure you have a company policy that both you and your employees understand, and abide by.

WHAT CONSTITUTES DISCRIMINATION?

Discrimination is when a distinction made is based on a group someone belongs to – gender, religion, age, and so on – rather than their individual merits. The Equality Act 2010 includes nine ‘protected characteristics’: age, disability, gender reassignment, sex, sexual orientation,

religion or belief, race, marriage and partnership, pregnancy and maternity. The act applies to all workers, including employees and freelancers, directors and trainees, and applicants in the hiring process, and covers all areas of employment. Discrimination is divided into that which is ‘direct’, where an employer is overtly discriminatory, and that which is ‘indirect’, where a group is not singled out in an obvious manner but is excluded anyway due to a stipulation in a job specification or company policy. For example, if you need someone to sit behind a desk and complete administrative duties, then you are unlikely to have any justified business reason for specifying that they should be female or ablebodied, as the job could be performed by someone male or disabled. This would be an example of direct discrimination. If you specify that an aesthetic therapist must have National Vocational Qualifications (NVQs) and will not accept qualifications recognised as the equivalent to these by British examining bodies and insurers, then that could mean you are indirectly discriminating against those who are from countries that do not operate the NVQ system. Remember that the Equality Act does not only cover your current employees, it covers applicants and interviewees for vacancies at your clinic, too. When you advertise a vacancy, make sure your essential requirements really are essential to the job and are not inadvertently discriminatory.

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EMPLOYMENT

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is acceptable to create a dress code based upon business needs and professionalism; it should not be based on your own personal preferences. Discrimination can be positive, too. If you have two equally strong job applicants and you make your final choice based on balancing out a race or gender imbalance in your workforce, then this may be seen as positive discrimination.

HOW SHOULD I PREPARE FOR A COMPLAINT?

As an employer, you need to ensure that you avoid discrimination and put policies in place so your employees are aware of what is unacceptable behaviour, by you or by them. You should have an equal opportunities policy that details the rights and responsibilities of the employer and the employee, and make it visible to staff members in their contracts, as well as in the company or employee handbooks. Even if you have a happy team and have never needed to follow a complaints process, it is wise to have a process in place so managers understand how complaints should be dealt with, should one occur. You may think of drafting a complaints process for patients, but don’t forget that you should have one in place for employees, too.

As an employer, you need to ensure that you avoid discrimination and put policies in place Do you have a justifiable business reason for needing someone ‘young and energetic’, or do they simply need to have a good level of enthusiasm and self-motivation? You should not set different interview questions for male and female applicants, or ask specific questions based on someone’s age or personal circumstances. Your hiring process should be designed to identify the capability to perform the specified job, not to provide you with a picture of someone’s personal life. For example, you should not ask a young, recently married woman if she plans to have children.

IS DISCRIMINATION EVER ACCEPTABLE?

This may sound like a silly question, but the answer is yes. Discrimination is acceptable where there is a justified business reason for doing so. Discriminating against someone because of their gender is acceptable in certain circumstances, and one of those applies very clearly to many cosmetic clinics. Certain jobs can require a person of a particular sex to fill that role due to reasons of privacy and decency. As aesthetic clinics often offer body treatments that require a patient to undress, or to expose certain intimate areas to their practitioner, it is therefore acceptable for a clinic to opt to employ female practitioners to treat their female patients. Unless there is a justifiable argument for a dress code to be broken for reasons relating to the Equality Act, then employers can set and enforce rules about appearance at work. For example, apart from something that could be classed as a ‘religious marking’, it is acceptable for business owners to prohibit visible tattoos. It may be classified as discrimination if an employer creates dress code rules that are clearly biased in terms of sex or age, however. It

HOW SHOULD I DEAL WITH A COMPLAINT?

It is an employer’s duty to investigate any claims of misconduct in the workplace. Even if you have an inkling that someone is guilty or innocent, you should deal with complaints in an objective manner. Do not take any action or place blame until you have assessed the situation. Speak to those involved and those who have witnessed events, gather evidence, and document the details before making any judgement. If the case is serious, you should get legal advice on the matter.

I AM A CLINIC MANAGER. WHAT HAPPENS IF I AM FALSELY ACCUSED OF DISCRIMINATION?

There is a chance that a disgruntled employee could lodge a false complaint or that an employee may misunderstand what constitutes discrimination. If you are falsely accused of discriminating against a team member, record all information you have, provide an objective report on events as you have experienced them, don’t do anything to retaliate, and wait for your manager or employer to consider the facts. A time limit applies to raising a case for discrimination, so a worker only has three months from the date of the last instance of discrimination, and only under exception circumstances could this be reconsidered. If you are formally accused of workplace discrimination and you believe this to be a false accusation, seek legal advice. AM REFERENCES legislation.gov.uk/ukpga/2010/15/contents equalityhumanrights.com/en/advice-and-guidance/sex-discrimination

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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Pigmentation special Pigmentation takes on many forms and, as such, it is one skin abnormality that aesthetic clinics are regularly called upon to treat. From sun damage to hormonally driven pigmentation issues such as melasma, pigmentation can be unsightly and contributes to premature skin ageing. In this special section, we examine the most effective treatments for pigmentation, from devices to skin peels and topical products.

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P I G M E N TAT I O N S P E C I A L

DERMATOLOGY

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When to refer Dr Nick Lowe advises on acquired pigment lesions – when to treat and when to refer

igment problems of the skin are many and varied. The most important advice for practitioners is to be certain of the diagnosis of the pigment problem or lesion before embarking on treatment.

MECHANISMS OF PIGMENTATION

All skin phototypes have the same skin frequency of melanocytes i.e. one melanocyte to every 10 keratinocytes. It is the ability of individual melanocytes to induce new melanin pigment in packaged melanosomes that varies from skin type and between individuals. For example, redheads do not produce the most common type of melanin that other skin types possess. They produce phaeomelanin which, unfortunately, offers no ultraviolet protection. Increased pigment production in the main is induced by exposure to ultraviolet sunlight, but several other factors can influence the degree of pigmentation. These include hormones (pregnancy and hormonal contraceptives) and medicines, such as amiodarone. In addition, there are a range of congenital pigment abnormalities that this article will not address. Solar lentigo Frequent pigment lesions are solar lentigines which only appear on sun-exposed skin. Benign lentigines must be differentiated by their appearances from lentigo maligna. Other differential diagnoses include face and neck melasma, drug-induced melanosis, post-inflammatory hyperpigmentation from skin diseases (e.g. acne, eczema, lichen planus) and other inflammatory skin diseases. Solar lentigines are likely to recur if the patient does not apply daily broad-spectrum sunscreen and prescription strength hydroquinone 4-5% cream. A variety of other non-prescription product ingredients and options are available that may give minimal or modest degrees of skin lightening, including liquorice extract, niacinamide, azelaic acid, low strength non-prescription retinoids and soy extract. Options for clinic treatments of benign lentigo include pigment-specific lasers, such as the Ruby or Alexandrite lasers and non-pigment specific lasers (e.g. different

Long-pulsed Alexandrite laser and lentigo

Fraxel 1550nm and 1927nm laser for skin lightening and rejuvenation

Combination treatment – Alexandrite on darker areas and Fraxel laser or IPL on the whole hand

wavelengths of fractional lasers such as 1550nm and 927nm). Intense Pulse Light (IPL) using appropriate filters is useful for treating multiple lentigo, however, care needs to be taken with IPL wavelength and energy selection in skin phototypes III and darker. Pigmented naevi Most dermatologists agree that before pigmented naevi are treated it is essential that they are confirmed to be benign. This may involve a skin biopsy after examination by dermoscopy. If the practitioner is satisfied with the benign nature of the pigment naevus appropriate laser treatment

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DERMATOLOGY

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can be considered. If surgical removal is not required, appropriate lasers for benign pigmented naevi include long-pulsed Alexandrite lasers, which in my experience give long-term improvement compared to Q-switched or pico lasers. It is important to inform the patients that both lentigo and benign pigment nevi may recur after laser treatment and require further treatment sessions for maximum improvement. Pigmented naevi must be accurately diagnosed as benign prior to treatment. Any irregularity of pigment outlines other clinical features and the patient ideally should be referred for dermatologic opinion.

PROTECTION AND PEVENTION

Reflecting & UV absorbing sunscreens Antioxidants

When to suspect a melanoma Assymetry

Abnormal

Appearance

Borders

Bleeding

Colour

Change

Diameter

Discolouration

Retinoids interfere with pigment genes

Evolution

The risks of treating a pigmented lesion where the diagnosis is a malignant lesion cannot be overstated. This can delay and confuse correct diagnosis and prompt treatment of a melanoma or pigmented basal cell cancer.

Blocked by: Niacinamide Retinoids Soy proteins

UVB

UVA

MELANOCYTE TYROSINE GENES INCREASE MELANIN

TYROSINASE

MELANIN PIGMENT IN ‘PACKAGES’ MELANOSOMES PIGMENT (MELANIN) TRANSFER EPIDERMIS

Blocked by: Antioxidants Azelaic acid Retinoids Hydroquinone

Retinoids, peels, and exfoliation also lighten by increasing shedding of pigmented areas

Topical treatments for hyperpigmentation

Benign naevus

Melanoma

Melasma Melasma is a frequent problem which usually requires combined treatments with prescription topical products as well as advice for prevention to reduce recurrence after clinic treatment. A variety of melasma treatments are often used in combination to obtain optimum lightening. AM

Topical treatment followed by Fraxel 1927nm x 4 Rx

Melasma pathogenesis

elanogenic hormones increase pigment via M keratinocyte melanocortin receptors Pregnancy, oral contraception or HRT Can take several years to appear Pigment cells then have increased response to sunlight – UVA Latest research – Skin irritation , inflammation, erythema and vascular components and UV absorption increased in melasma areas

Melasma: a logical approach to treatment and maintenance

Reduce skin inflammation and erythema Non-irritating creams Daily reflecting and UV absorbing sunscreens Selective vascular lasers to reduce erythema Non-aggressive lasers or IPL Mild peels Combined treatments: alternate peels and lasers Tranexamic acid 500mg for three months + maintenance

Dr Nick Lowe is a consultant dermatologist at Cranley Clinic, London, and clinical professor of Dermatology at UCLA School of Medicine, Los Angeles. Dr Lowe is a Fellow of numerous societies and colleges, including the Royal College of Physicians, American Academy of Dermatology and American Society of Laser Medicine and Surgery. He is past president of both the Pacific Dermatology Association and the Cosmetic Dermatology Group of the British Association of Dermatology. He has authored more than 450 clinical and research publications as well as 15 scientific and five educational books for the public.

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Pigmentation prevention with AlumierMD With the summer months approaching, pigmentation is a skin concern that becomes increasingly prevalent among clients. Victoria Hiscock discusses the causes and how to tackle it

hile there are a number of treatments and homecare products on the market that can help to tackle the appearance of hyperpigmentation, prevention is key. AlumierMD educator Victoria Hiscock discusses the causes of pigmentation, how to tackle it and, most importantly, how to prevent it with AlumierMD.

WHAT IS PIGMENTATION AND WHAT CAUSES IT?

Melanocytes at the basal layer of the epidermis produce melanin, the pigment in our skin, which acts as our natural sunscreen by absorbing ultraviolet radiation (UVR) and converting it into usually harmless amounts of heat. Melanocytes insert granules of melanin into vesicles called melanosomes. The melanosomes travel to the outer tips of the melanocytes and into the surrounding keratinocytes. Irrespective of skin colour, every human has the same number of melanocytes. Differences in skin pigmentation result from differences in melanogenic activity, the type of melanin produced in melanosomes, and the size, number and packaging of melanosomes. UVR, medications, endocrine influences and other factors can all disrupt how much pigment our melanocytes produce, which can lead to darkened areas of skin on the face and body. This is known as hyperpigmentation. Hyperpigmentation is one of the most complicated skin conditions to treat. Depending on the depth, severity, and cause, hyperpigmentation reduction can become an expensive lifelong enterprise. In today’s aesthetic industry, there are many treatment options for lines, wrinkles, and jowls, but if the skin is not protected from hyperpigmentation, your clients will never reach their full aesthetic potential. Mottled skin tone, solar lentigines (sun spots), and even skin cancer can all give away a person’s age. This is the reason why it is of the utmost importance to prevent hyperpigmentation as part of a comprehensive anti-ageing strategy, both in the clinic and at home.

PIGMENTATION PREVENTION WITH ALUMIERMD

AlumierMD offers a range of hyperpigmentation-busting products, which boast corrective formulas that adhere

to our commitment to clean chemistry, offering your patients an easy and effective way to prevent and reduce hyperpigmentation this summer. Tyrosinase-inhibiting ingredients such as arbutin, kojic acid, and plant extracts in the Intellibright Complex dramatically reduce the appearance of hyperpigmentation on the skin, while Eventone Brightening Serum boasts B-White™, a peptide which targets the root cause of hyperpigmentation in the nucleus of the melanocytes. In clinical trials, B-White™ offered an impressive 30% reduction of pigment in just 56 days. Both of these targeted serums are formulated with niacinamide (aka vitamin B3), which reduces the transfer of melanin from melanocytes to keratinocytes, and tetrapeptide-14, a peptide that decreases pigment-causing inflammation. Combine these two pigment-supressing serums with the freshly pressed 15% L-ascorbic acid in the EverActive C&E serum to target the multiple causes of hyperpigmentation and see dramatic results in skin lightening and brightening. L-ascorbic acid neutralises free radical scavengers, reduces inflammation and interacts with copper ions at the tyrosinase active site. Furthermore, alpha hydroxy acid-rich Bright & Clear Solution helps slough off dead pigmented corneocytes and stimulates the proliferation of new keratinocytes. The most important product to prevent hyperpigmentation is a broad-spectrum mineral sunscreen with an SPF of at least 30. AlumierMD offers a range of physical sunscreens formulated to suit all skin types. For more information on these medical-grade ingredients, visit alumiermd.co.uk

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Damage limitation We examine the issue of sun damage related pigmentation and ask practitioners what their star products and treatments are

un damage is by far the biggest cause of premature ageing and one of the clearest signs that someone’s skin has been damaged is pigmentation. There are many different types of pigmentation, including hyperpigmentation, age spots, brown spots, post-inflammatory hyperpigmentation, freckles, solar lentigines and melasma. Sun damage related pigmentation can affect people of all skin types and ages and aesthetic practitioners and dermatologists are at the front line when it comes to its prevention and treatment.

WHAT CAUSES PIGMENTATION?

Dr Ifeoma Ejikeme, Adonia Medical Clinic, London “At Adonia Medical there are a number of different treatments, used alone or in combination to treat hyperpigmentation including at home medical grade products, a range of chemical peels which include, mandelic, salicylic, glycolic, TCA, Cosmelan, Dermamelan as well as LED light Laser. Sarah* came into the Adonia Medical Clinic after her chloamsa on her face during pregnancy, worsened from sun exposure and continued to persist after pregnancies. She had tried a variety of over the counter products but, frustratingly saw no improvement. Sarah is of mixed European and Caribbean heritage. Although her skin type looks relatively light in the winter months and is a skin type IV on the Fitzpatrick Scale, after exposure to the sun she tans to a skin type V or VI so her heritage played greater importance in assessing her melasma. Skin tone is very important in determining which treatments are suitable, particularly with laser and light technologies. However, heritage will also determine how the melanocytes, (pigment-producing cells), will react when heat is applied to them. This knowledge allows me to truly treat all skin tones safely and effectively with devices. After consultation, I decided the best course of treatment for her was with a course of Obagi Nu-Derm and Tretinoin >

Sun damage is by far the biggest cause of premature ageing and one of the clearest signs that someone’s skin has been damaged is pigmentation

Abnormal skin pigmentation occurs when there is excess in melanin production, which forms deposits in the skin. This can be triggered by a variety of factors including hormones, genetics, medication, the ageing process, skin diseases such as acne and injuries to the skin, but by far the biggest cause is sun damage. Exposure to the sun can cause patches of pigmentation to form on the skin and can worsen existing pigmentation abnormalities such as freckles or melasma, which have been caused by other factors. This happens because melanin absorbs the energy of the sun’s harmful ultraviolet rays in order to protect the skin from overexposure. As such pigmentation is most common on areas of the body that have prolonged exposure to the sun, such as the face, arms, hands and décolletage.

TREATMENT OPTIONS

their favourite products and treatments for pigmentation are.

Although skin pigmentation is in most cases harmless, many people seek treatment for cosmetic reasons. Wearing a broad spectrum sunscreen is the most important factor in preventing skin pigmentation however there are a wide variety of treatments for pigmentation including prescription products such as hydroquinone, tretinoin and Retin-A as well as non-prescription topicals, chemical peels and laser and light treatments. Often these treatments are used in combination for optimal results. We asked a selection of pracitioners what

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TREATMENTS AND PRODUCTS

0.5%, as the majority of pigmentation was epidermal. She was reviewed initially at two weeks then at four weeks to ensure she was using the protocol as advised. The course of treatment was successful with substantial reduction in pigmentation and overall improvement in her skin. There are many causes of disorders of pigment. In my clinical practice, the most common reasons for patients seeking treatment are post-inflammatory pigmentation, melasma/chloasma,scarring, uneven skin tone, (aggregation of pigment around the eyes, mouth and forehead) and ingrowing hair or folliculitis. Pigmentation can be associated with underlying conditions and it’s important to do a thorough history and examination to spot these, as in most cases until the underlying condition is addressed the pigmentation will not fully improve. Conditions that can cause pigmentation include diabetes, Cushing’s disease and Addison’s.”

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“Every case of pigmentation is different so we have a suite of options from dedicated pigment-correcting peels, which we combine with needling, to various lasers and IPL. It’s very important to identify the pigmentation type first, then prepare the skin for treatment with good homecare products. Once treatment is complete, continued homecare products along with good advice should always be given.” Debbie Thomas D.Thomas Clinic

treatments (spaced four to six weeks apart) following protocol, end of course review to assess before and afters.”

Dr Andrew Webber, Bodyvie “The Quanta Q Plus C provides a highly functional multimodality work station for treatment of all coloured tattoos (including green and blue pigments, as well as ghosting) and also pigmentary problems, due to sun exposure, ageing and hormonal melasma.

Dr Rekha Tailor, Health & Aesthetics “Treatment of pigmentation should begin with a topical skincare routine. We highly recommend the use of ZO Skin Health products, specifically starting by getting the skin ready using the wash, scrub and oil control system. Once this has been completed, we recommend a range of ZO Products which could include Hydroquinone products, Melamin, Melamix, Tretanoin and Skin Brightener in addition to your wash, scrub, oil control and SPF to reduce the appearance of pigmentation. We would also recommend skin rejuvenation

Pictures courtesy of Dr Andrew Webber, Bodyvie

Pictures courtesy of Dr Rekha Tailor, Health & Aesthetics

“We know that especially the latter is susceptible to increased pigmentation on laser treatment, and to mitigate the 20% risk, we pre-prepare the skin with retinol and hydroquinone (topical lightening agents) as well as post treatment with hydroquinone. “The Quanta Q Plus C incorporates a Q-switched 1064nm yag and its 532nm harmonic as well as fractional 1064nm for ghosting, together with Ruby and IPL. This is the newest generation, all-encompassing laser which our specialist laser therapists are able to customise to individual requirements dependent on treatment severity, skin types etc. It allows us to treat at different depths with different wavelengths to ensure safety alongside efficacy. “The treatment process is pre consultation (UV digital skin analysis for facial treatments), pre skin preparation (topical creams retinol and hydroquinone), course of

using the Harmony Laser by Alma Lasers which targets pigment in the skin. This is an advanced IPL which destroys the pigmented lesions causing the body to eradicate the damaged tissues and reduce the pigment. This may take six treatments, at two weeks apart to see full results, although results can be seen from the first treatment. “Ongoing prevention of pigment includes excellent skincare routine and always wearing a Broad Spectrum SunScreen such as ZO Skin Health Daily Sheer SPF 50.” Dr Stefanie Williams, Eudelo “For many, pigmentation and dark spots are an unsightly skin condition that can often be resistant to topical products, peels and even lasers. However, studies have revealed that people with irregular skin colouring are not only judged as older and less attractive by others, but even as less healthy

Aesthetic Medicine • April 2019

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P I G M E N TAT I O N S P E C I A L

TREATMENTS AND PRODUCTS

aestheticmed.co.uk

“In terms

hyperpigmentation. [Matts et al. Color homogeneity and of the treatment of Each treatment can visual perception of age, health, hyperpigmentation we will be performed in less and attractiveness of female always do a combination of glycolic than 15 minutes and facial skin. and citric acid, along with polyhydroxy preconditioning the J Am Acad Dermatol. skin is not necessary. The 2007;57(6):977-84.] acids, and LED light therapy in order to VI peel has transformed “Eudelo’s MelaOut is a break up melanocytes. For home use, I will always my thoughts on chemical dermatologist-supervised recommend a 20% citric acid as it’s the best percentage peeling on black skin types. combination treatment. In and molecular weight (192 daltons) for penetration I now consider every client just one month and three beyond the stratum lucidum. I use Exuviance’s 20% as a possible candidate, in clinic visits, which include Vitamin C with Aminofil as it targets pigmentation the sure knowledge they an initial assessment and will achieve great results digital skin scan, a oneand rebuilds collagen.” with a painless procedure and hour peel and a hydrating Pamela Marshall minimal down time.” Dermatology-Grade Facial Clinical Aesthetician & Managing three to four weeks after the peel, Director of Mortar & Milk Kerry Belba, Laser Skin Solutions pigmentation can be treated with “I spent a long time searching for the minimal appointments, unlike other most suitable laser company as I wanted a methods which often require repeated piece of equipment that would be very effective, treatment sessions over months to achieve the safe and reliable. I invested in a LUMINA (Lynton) and it was desired result. Homecare for the first four weeks post-peel the best decision I ever made for my business. The results is included as well as advice on an ongoing skincare regime are fantastic, which means my clients show and tell their to maintain the achieved results is provided. friends, which then results in more word-of-mouth clients The peel and post-peel homecare contain a special for the business. combination of highly effective ingredients such as azelaic “Pigmentation treatment can provide ‘instant’ results acid, kojic acid, phytic acid, citric acid, ascorbic acid, for clients and they can see the results develop. The lesions Arbutine, aalicylic acid, vitamin A and niacinamide among may appear worse initially, as they darken and form a thin others. micro-crust before flaking away within one to three weeks MelaOut is safe for all skin types up to Fitzpatrick leaving the treated area without excess pigmentation. skintype V. Patients can expect to see a pigment reduction Treatments can be administered on both the face and the of up 50% improvement after the one-off peel and up to body resulting in a more even skin tone by lightening or 80% after following the recommended skincare protocol. removing the pigmentation. The treatment can be applied to the face or other skin areas with discolouration (apart from the hands).“ Ros Bown Rosmetics “VI Peels represent the next generation in chemical peels. Each treatment is virtually pain free and includes a specifically formulated post peel kit which is essential for your treatment’s success, ensuring optimal and lasting results. VI Peels are safe for all skin types, including darker skin tones, and offer specifically designed treatments that are convenient with minimal down time to address a variety of indications, including pigmentation. “Unlike other peels VI Peel is a combination peel consisting of TCA, salicylic, retinoic and phenol, all in 15% concentration. The peel requires no skin prep, is self-neutralising and the phenol acts as a numbing agent ensuring that all VI Peels are painless. The VI peel may be performed in a series of two to four peels; spaced one month apart to treat stubborn

“Through Intense Pulsed Light (IPL) or Laser technology, high areas of melanin concentration such as those occurring in a freckle, or an age spot will readily absorb the light emitted. The rapid absorption of light energy heats the melanin and causes destruction of the melanin-rich cells which are causing the dark colouring on the surface of the skin. “The LUMINA combines multiple aesthetic technologies into one stand-alone platform. The 585 Intense Pulsed Light handpiece removes sun-induced pigmentation marks such as age spots, sun spots or freckles. For larger areas of pigmentation, we recommend treatment with the LUMINA active Q-switched Laser for dermal pigmentation and epidermal pigmentation. The deeper penetration is useful for treatment of congenital dermal pigmented lesions, such as Naevus of Ota and Naevus of Ito.” AM

Aesthetic Medicine • April 2019

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P I G M E N TAT I O N S P E C I A L

CASE STUDY

aestheticmed.co.uk

Case study Dr Amiee Vyas shares her results with Cysteamine cream

ysteamine hydrochloride is an intensive pigment corrector that is relatively new to the market and aims to replace hydroquinone in the treatment of hyperpigmentation. The use of hydroquinone despite its high efficacy as a depigmenting agent, is very controversial due to concerns about its toxicity and it being a mutagenic compound. Furthermore it is not always well tolerated by all patient groups, particularly those with sensitive skin types. In these cases treatment alternatives, including kojic acid, retinoids, hydroxy acids, arbutin, azelaic acid and other novel compounds are commonly used, but with inferior efficacy and patient satisfaction. Cysteamine (derived from cysteine) is an amniothiol physiologically produced in human cells. In 1966, Chavin et al. observed significant skin depigmentation

effects of cysteamine in studies on black goldfish skin1 and, in 1968, further studies2,3 proved cysteamine to be significantly stronger than hydroquinone in vivo. In 2000, an in vitro study by Qui et al. showed an 80% reduction of melanin synthesis in B16 melanocytes.4 Its mechanism of action on the melanogenesis pathway is multifold via double enzyme inhibition of tyrosinase and peroxidase, dopaquinone quenching, iron and copper chelation, increase of intracellular glutathione and antioxidant effects which reduce dark melanin in the stratum corneum. Between 2010-2012, the Swiss biotech company Scientis Pharma developed a new formulation of cysteamine, increasing its stability and reducing its odour to make it suitable for topical use. Further studies in the subsequent years showed significant efficacy in the treatment of melasma.5,6 >

The patient had a visible improvement in pigmentation, particularly in the forehead region

Aesthetic Medicine â&#x20AC;˘ April 2019

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P I G M E N TAT I O N S P E C I A L

CASE STUDY

aestheticmed.co.uk

I conducted a case study on a 43-year-old female of Spanish descent who had patchy hyperpigmentation in a mixed picture of photodamage and melasma affecting the forehead and cheeks bilaterally. She was unable to tolerate topical hydroquinone and tretinoin and had previously tried a kojic acid, retinol, and hydroxy acid regime of topical homecare and chemical peels for one year. This improved skin quality but had very little effect on the hyperpigmentation. Cysteamine was trialed for a period of three months with one application at night and an SPF 50 sunscreen used daily during this time. For the first month it was applied as per the packet instructions with an exposure time of 15 minutes. However, as the patient was not satisfied with the improvement at one month, the exposure time was increased to 30 minutes and then to two hours after two weeks. After a course of three months the dose was reduced to 15 minutes exposure twice weekly for maintenance.

freckles, hydroquinone-resistant pigmentation, macular amyloidosis hyperpigmentation, and post-inflammatory hyperpigmentation. The fact that it is non-cytotoxic, nonmutagenic, and non-carcinogenic means it can also be used safely for post-chemotherapy pigmentation – a patient group which is often notoriously difficult to treat. It is also safe for use on mucosal areas including lips and intimate regions making this preparation an exciting development in the treatment of hyperpigmentation concerns. AM Before

After 1 month

After 2 months

After 3 months

RESULTS

It has been clearly demonstrated in the clinical photography, the patient has a visible improvement in pigmentation, particularly in the forehead region, and there is a noticeably more even skin tone throughout. The only side effect experienced was a small patch of redness and irritation which is visible on the right cheek, but this improved during the course of the day and was managed with an emollient moisturiser. This completely resolved after the patient reduced use to the maintenance dose. My case study has shown that cysteamine has proven efficacy in the treatment of mixed picture hyper pigmentation, even in those unable to tolerate hydroquinone. Results can be improved if increased exposure (more than 15 minutes per day) can be tolerated by the patient, but please note that this is not advised unless under supervision. The side effects are minimal with this product, although mild irritation can occur in sensitive skin type when not used as instructed. Dryness, itchiness, and post-inflammatory hyperpigmentation (although this is rare) have been noted, but topical ochranosis is not associated with cysteamine cream. Topical application of cysteamine cream has good tolerability and impressive data on improvement of multiple types of hyperpigmentation, including epidermal melasma,

REFERENCES 1. C havin W et. al. 1966 “Some potent melanin depigmentary agents in the black goldfish.” Die Naturwissenschaften 53(16):413-414 2. Frenk E et. al. 1968 ‘Selective action of mercaptoethylamines on melanocytes in mammalian skin : experimental depigmentation. Arch. Dermatol 97(4):465-477 3. Bleehen SS et. al. 1968 Depigmentation of skin with 4-isopropylcatechol, mercaptoamines, and other compounds. J. Invest Dermatol 50(2):103-117 4. Qui L et. al. 2000 Inhibition of melanin synthesis by cysteamine in human melanoma cells J. Invest Dermatol 114(1):21-7 5. H su et. al. 2013 Cysteamine cream as a new depigmenting product.’ Journal of the American Academy of Dermatology 68:4-1 AB189 6. Mansouri et. al. 2015 Evaluation of the efficacy of cysteamine 5% cream in the treatment of epidermal melisma: a randomized double-blind placebo- controlled trial. BJD 173 (1):209-217 7. F ahrsi et. al. 2018 Efficacy of cystea,ine cream in the treatment of epidermal melisma, evaluating by Dermacatch as a new measurement method: a randomized bouble blind placebo controlled study. J Dermatolog Treat 29(2):182-189 8. Tatsuta M et. al 1988 Inhibitory effect of prolonged administration of cysteamine on experimental carcinogenesis in rat stomach induced by N-methyl-N’-nitro-N-nitrosoguanidine. Int J Cancer (41)423

Dr Amiee Vyas is an aesthetic doctor and cosmetic skin specialist based in Central and North London and an educator for AestheticSource. She undertook her medical training at King’s College London and further medical training at the University Hospitals of Leicester before moving into private practice. During her medical school years, she developed a particular interest in skin and was appointed as a member of the British Association of Dermatologists DermSchool subcommittee. She has since taken an active role in teaching and training for other healthcare professionals.

Aesthetic Medicine • April 2019

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Hyper Pigmentation Whether you are treating PIH, melasma or photoageing, our portfolio of skin brightening products help protect, prevent and target hyper-pigmentation. Whatever pigment issue you are addressing, the sun, medication, hormones or inflammation, our comprehensive portfolio gives you the flexibility to tailor your patient’s treatment plan to their needs and budget. Find out more today by contacting AestheticSource.

AestheticSource treatment guide to treating pigmentation

TOPICAL

CHEMICAL PEELS

INJECTABLE

• Cysteamine®

• NeoStrata® Pro System Peels

• RRS® Whitening

• NeoStrata® Enlighten Range • Skinbetter® Even Tone and Alpharet® • Skin Tech Blending and Bleach & AD Aclarance®

• Skin Tech Peels • Skin Tech Bene Bellum® coming soon

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

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

INGREDIENT SPOTLIGHT

Clean talking

aestheticmed.co.uk

Ever since its discovery more than 100 years ago, the production of hypochlorous has been an inexact science

Ross Walker, commercial director of Clinical Health Technologies, discusses the myths and misconceptions around hypochlorous

kin cleansing and disinfection technology has taken a tremendous step forwards in recent years with the advent of a hypochlorous solution that not only achieves much higher levels of skin cleansing, but is also much more compatible with the skin than traditional skin disinfection chemistries, such as chlorhexidine or alcohol. This ‘high purity’ hypochlorous gives far better protection against infection, but remarkably is also non-cytotoxic, therefore neither irritates the skin or inhibits cell regeneration. This holy grail of skin disinfection has taken an enormous effort to realise, as hypochlorous is a highly sensitive chemistry and its production is not a simple process. Ever since its discovery more than 100 years ago, the production of hypochlorous has been an inexact science – a process involving electrolysis and chemical buffering, which until recently, really hadn’t evolved much during those intervening 100 years. Even the best attempts at harnessing this elusive chemistry only ever produced a hypochlorous of marginal purity, with most containing high levels of hypochlorite. This was a crucial failing, as it is the purity of a hypochlorous solution which determines how effective it is in disinfecting the skin, how safe it is to use on the skin and also how stable the product is. It was because of these low levels of safety, efficacy and stability that hypochlorous has, until now, only seen very limited use in human healthcare applications. When Clinical Health Technologies launched its Clinisept+ range in 2017, it delivered a game changer. The products are manufactured using a completely new method, which delivers a significantly higher level of purity than any other hypochlorous solution currently commercially available. The unique production process involves a chemical reaction which converts hypochlorite – one of Clinisept+’s listed ingredients - into hypochlorous. The result is a hypochlorous solution of extremely high purity making it safe and efficacious. By comparison, many products which claim to be hypochlorous are still produced using the same methods of manufacture as were being applied 100 years ago, and actually contain low levels of hypochlorous and very high proportions of hypochlorite. This matters, because firstly, these solutions don’t deliver effective levels of disinfection (hypochlorite is nowhere near as effective in killing pathogens as hypochlorous) and secondly, they are far less

compatible with the skin because hypochlorite is cytotoxic. Spectroscopy analysis is the only fail-safe way to measure the content of a hypochlorous solution. This identifies not only the proportion of hypochlorous in the solution, but also the proportion of hypochlorite. Independent analysis of Clinisept+ and a competitor product conducted at Oxford University Materials Characterisation Services laboratory clearly shows the difference in chemical composition, with Clinisept+ containing twice as much hypochlorous as the competitor and the competitor containing an almost equal amount of hypochlorite as hypochlorous (below top). Practitioners should also be aware of the claims made regarding hypochlorous product stability. The second chart below shows an analysis of both Clinisept+ and a competitor product. The Clinisept+ sample was tested at the end of its two-year shelf life and was found to be fully functional. By comparison, the competitor sample was tested with 10-months shelf life still to run and was found to be of such poor quality that it would not be considered fit for purpose. Therefore, while hypochlorous is still the Holy Grail, please be aware that not all hypochlorous products deserve the same level of reverence. AM

U-VIS spectroscopy analysis of hypochlorous and hypochlorite content

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Cleans, Calms and Cares.

Not all hypochlorous is created equal… The Clinisept+ range of products are manufactured by a completely new method which delivers a significantly higher level of purity than any other hypochlorous solutions on the market, resulting in a hypochlorous solution of extremely high purity, and therefore efficacy and safety*.

++ ++ ++ ++

UV-Vis spectroscopy analysis is the only unequivocal means of proving the purity (hypochlorous content) of a hypochlorous solution. Analysis by Oxford University has established Clinisept to contain more than 90% pure hypochlorous.

*Data on File

NEW PUMP BOTTLE COMING SOON

Oxford University found the Competitor product to contain only half of the Hypochlorous content of Clinisept+ and over 370% more impurities (hypochlorite bleach) than Clinisept+. Clinisept+ was judged to be a far superior product to the Competitor in every respect

Clinisept + vs Competitor Spectroscopy Analysis Comparison Results

Hypochlorous Acid and Hypochlorite Content Analysis Clinisept + Competitor

• Hypochlorous 0 • Hypochlorite

80 100 120 140 160 180

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

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

NEW TREATMENTS

aestheticmed.co.uk

On the surface of it We take a look at some of the newest treatment protocols. First up is Derma Peel from Cosmo Pro

osmo Pro has recently launched the Derma Peel Resurfacing Facial, an intensive clinical treatment designed to resurface the skin, reduce fine lines and smooth and soften the complexion. It encourages cell renewal by combining dermaplaning with a chemical peel. The results-focused treatment utilises a deep cleansing gel, containing high concentrations of AHA, BHA, retinol and ceramides, followed by a prep solution to degrease the skin, which is applied prior to the dermaplaning procedure. This helps to remove the very outer layer of the epidermis, allowing the peel solution to penetrate deeper. The bespoke peel formula, which contains glutathione, 40% lactic acid, 10% kojic acid and 10% phytic acid, is applied to the face and neck and is left on the skin for five minutes. Once neutralised, a bio-cellulose sheet mask impregnated with calming agents is applied. To complete the treatment, the Cosmed Repair Balm, formulated with clinically proven ingredients to nourish and calm the skin post procedure, is applied. Cosmo Pro has created this quick and effective treatment using its own range of Cosmed Cosmeceutics. A course of three is recommended, however Derma Peel is the type of treatment that clinics can use to attract new customers, as well as promoting it as an on-going monthly treatment to increase the retention of existing clients. Products include Regen-A, a potent serum containing 0.6% retinaldehyde, which works 11 times faster than retinol,

The innovative combination of dermaplaning and skin peel delivers predictable outcomes with compounds that penetrate deeper into the skin than they otherwise would

copper tripeptide to promote wound healing, hyaluronic acid, glutathione and arginine to regenerate the skin. The Protect & Restore Serum is packed with collagen-boosting ingredients, and also contains copper tripeptide in combination with oligopeptide, hyaluronic acid and liquorice root. This can be used in conjunction with microneedling or as a daily serum. Rosey Drewitt Staples, Independent Nurse Prescriber at Pro Aesthetics, says,“The innovative combination of dermaplaning and skin peel delivers predictable outcomes with compounds that penetrate deeper into the skin than they otherwise would, where they are able to enact true cellular change and turnover. The Derma Peel skin treatment is a welcome addition to any professional aesthetic and skin clinic.” Kaytie Chambers, director and lead nurse at Lyla Aesthetics, comments, “I’ve been on the hunt for an amazing treatment to bring to Myla. I’ve researched Obagi, Alumier and other known brands, however after trying the Derma Peel and Cosmed professional range myself which contain the latest clinically proven ingredients, I am very excited to announce that these products will soon be available to my clients – #gamechanger”. AM

Before and after Derma Peel

Aesthetic Medicine • April 2019

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

NEW TREATMENTS

aestheticmed.co.uk

The T-Lift EF MEDISPA has introduced the T-Lift, a 40-minute mini-facelift with local anaesthetic

F MEDISPA has introduced a new treatment to its offering – the Temporal Lift or T-Lift, an innovative new age-defying 40-minute facelift that instantly lifts and tightens the skin to provide a youthful yet natural look. This preventative procedure is ideal for those looking to refresh their appearance with a safe and discreet treatment that has a minimal recovery period. The T-Lift procedure targets the eyes brows and cheeks where commons signs of ageing such as fine lines, wrinkles, and skin sagging can occur. Fantastic results can be achieved from the T-Lift, with patients showing lifted cheek bones, eyelids, brows and subtle sculpting of the jawline. The surgery is performed by plastic surgeon Mr Davood Fallahdar, a member of the Royal College of Surgeons with more than 20 years of experience, and is carried out in EF MEDISPA’s minor operations theatre at Kensington, which is overseen by the clinic’s medical team. “There’s been so much innovation in the aesthetics industry. We now have new techniques for tissue management meaning we can offer smaller, safer surgical procedures, such as the T-Lift, that promise a quicker recovery without comprising on the results,” says Mr Fallahdar. The procedure involves bilateral incisions above each ear within the hairline, allowing the skin to be gently pulled together, sutured, and closed with staples. Performed under local anaesthetic within an hour, the T-Lift promises minimal downtime, enabling patients to carry on with their day and go back to work the same or following day with no visible scars, bruising or swelling. In comparison to a standard facelift, the T-Lift offers a lower risk and extremely safe alternative. Results from the T-Lift can be adjusted

We now have new techniques for tissue management meaning we can offer smaller, safer surgical procedures, such as the T-Lift

Results from the T-Lift & Blepharoplasty

Halfway point : right side untreated, left side treated

halfway during the surgery, where the patient is fully conscious and able to advise the surgeon on their preferred look, determining their final result. The surgery is tailored to the individual and personal experiences and results may vary. All patients require a one-to-one consultation with a EF MEDISPA treatment coordinator to discuss their suitability for the treatment. “I’m thrilled to introduce the T-Life at EF MEDISPA. It’s a discreet surgery that offers incredibe results and it’s perfect for both women and men who are looking to achieve a radiant, youthful and natural looks,” comments Esther Fieldgrass, CEO and creative director of EF MEDISPA. AM

Profile view

Aesthetic Medicine • April 2019

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TECHNOLOGY CLIENT BASE PROFIT OPPORTUNITIES

Trilogy

advanced laser hair removal

SKIN

NEW TREATMENTS

aestheticmed.co.uk

The EM word Dr Rita Rakus introduces HIFEM® technology to her clinic with EMsculpt and EMsella chair treatments

r Rita Rakus is said to have one of London’s busiest clinics, and one of the reasons she’s maintained that reputation throughout her long career in aesthetics is the fact that the clinic is constantly moving with the times and staying ahead of the curve by offering new and innovative treatments alongside trusted staples. Located in the heart of Knightsbridge, opposite Harrods, the clinic is the first in the UK to have both the BTL EMsculpt and BTL EMsella machines, providing a centre of excellence for HIFEM® technology.

EMSCULPT

The natural results of ageing, weight loss and weight gain can have negative effects on skin firmness and the appearance of body shape. For individuals who are not only interested in diminishing stubborn fat, but are also wanting to improve the tone and shape of common problem areas like the butt and stomach, EMsculpt offers a new solution. Having gone through seven independent based clinical trials, testing for safety and efficacy, EMsculpt claims to be the only procedure to help both women and men build muscle and burn fat. It does this by using revolutionary technology to restore the core, sculpt the abs and shape the buttocks – all without surgery and no downtime.

EMsculpt uses non-invasive High-Intensity Focused Electromagnetic (HIFEM®) technology to induce supramaximal muscle contractions which aren’t achievable through voluntary contractions. This means the muscle tissue is forced to adapt to the extreme conditions and responds with a deep remodelling of its inner structure, resulting in effective muscle building and fat burning. As well as significantly improving muscle tone and sculpting the body, this treatment is also the world’s first non-invasive buttock lift procedure to lift, shape and firm the bottom to achieve a perky posterior.

EMSELLA CHAIR

The EMsella chair is the first FDAapproved device that can actually help improve incontinence. Using the same HIFEM® technology to target the pelvic floor region this ‘magic chair’ delivers the same effect as performing 11,000 Kegel exercises in just one fullyclothed session. A course of four treatments has been clinically proven to achieve an 84.5% satisfaction rate for patients and a 75% long-term improvement in this condition. As a global ambassador for the brand and a recognise exeprt in BTL’s technologies, Dr Rakus is also combining the two treatments in one one-hour session for the ultimate in core-tightening. AM

Aesthetic Medicine • April 2019

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

SLEEP

aestheticmed.co.uk

Beauty sleep Not only is getting enough sleep good for your mental and physical health but recommending sleep to your clients can have benefits for the skin too

leep is as important for our bodies as breathing, eating and drinking water and disturbed sleep or lack of sleep can impact us both mentally and physically. Physically not getting enough sleep can lead our immune systems to become weaker and make us prone to illness. Lack of sleep has also been shown to exasperate symptoms of depression and anxiety. 67% of Brits are more stressed now than they were five years ago, with the most common stress triggers being work, sleep and finances, according to new research by mindfulness app Headspace. While the odd late night isn’t going to cause too much damage, inconsistent sleeping patterns over time will have an impact not just on mental and physical wellbeing but on the skin too.

SLEEP AND SKIN

Many clients come into aesthetic clinics wanting to enhance their appearance because they look tired. While this is sometimes due to the effects of the ageing process, it can also be because they genuinely are tired and lack of sleep has negatively impacted their skin. While we are asleep our cortisol levels decrease and cellular regeneration takes place so sleep deprivation can lead to a reduction in collagen production and, as a result, poor skin elasticity. Cortisol also causes blood vessels to swell to accommodate an increased volume of blood. This happens to the blood vessels under the eyes too. Cortisol activates our ‘flight or fight’ response and can also elevate oil production, leading to breakouts. Dark circles under the eyes can also be caused by or exasperated by lack of sleep and our immune systems can be affected when the body is deprived of sleep leading to or worsening rashes and other skin-related problems. There is also a connection between poor sleep and weight gain, with those who don’t sleep enough having increased hunger and lower metabolic rates. So could advising your clients to make sure they get a good night’s sleep enhance the results of your aesthetic treatments? The answer is probably so. A good place to start would be to ask them about their sleep patterns and quality during the consultation, if you are not already doing so.

SLEEP AND YOUR OWN WELLBEING

That old adage of “take your own advice” may be applicable to a lot of things aesthetic practitioners advise their patients to do but sleep is right up there. We all lead busy lives and for those running a business in a competitive market like aesthetics, this can be particularly true. From treating patients to carrying out marketing and social media activities, to managing staff and doing accounts at the same time as juggling families, attending conferences and having some form of social life, it’s no wonder that taking this advice yourself is easier said than done. Lack of sleep however can have a negative impact on cognitive function and while it may seem as though staying up late working gets more done, the negative impact on your ability to think and perform properly the following day can mean it’s counterproductive.

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

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TIPS FOR A GOOD NIGHT’S SLEEP

Here are some easy-to-follow at home tips for both you and your patients. 1. Turn off all electronic devices and televisions at least an hour before bed So many of us are guilty of taking our phones, laptops or tablets to bed with us as well as having TVs in our room or reading on a Kindle. But when we do this we can disrupt our sleep patterns, particularly when sleeping with a mobile phone on next to us. One of the reasons for this is because the backlit ‘blue light’ displays of such devices suppress melatonin production – the hormone that helps you sleep. Exposure to light stimulates a nerve pathway from the eye to parts of the brain that control hormones, body temperature and other functions that play a role in making us feel sleepy or wide-awake. It has also been shown that light emitted from

SLEEP

laptops and mobile phones could also be contributing to premature skin ageing. 2. Go to bed earlier Research has shown that even going to bed one hour earlier can have huge benefits for your body, your mood, and your relationships but why is this? Surely it’s the amount of sleep you get not whether you go to bed at 9pm or 1am? Really its more about the quality of sleep as well as the amount of time spent asleep. Our bodies are in tune to the natural cycles of nature and if we are staying up way into the night and trying to sleep during the day when it is light outside it can be hard. The human body runs on a 24-hour cycle which is regulated by our internal clock, which is known as a circadian rhythm, or chronotype. This internal clock regulates many physical functions, such as telling you when to eat, sleep and wake. An individual’s chronotype leads to people having a natural preference towards waking early or going to bed late. >

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SLEEP

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glucose tolerance, putting them at greater risk of developing type 2 diabetes. Another study noted that being exposed to daylight influenced sleep. Every additional hour spent outdoors was associated with 30 minutes of ‘advance sleep’ and that the noise, ambient lighting and crowding of urban environments can make people in some areas more likely to have a morning or evening preference. The researchers also found evidence that night owls would accumulate ‘sleep debt’ during the working week and would sleep longer at weekends to compensate for this, whereas early birds had smaller differences in their sleeping patterns across the week.

As night owls often eat shortly before bed, their glucose levels are increased when they are about to sleep

In fact research led by Dr Suzana Almoosawi from Northumbria University and published in Advances in Nutrition in November 2018 showed that night owls may have a higher risk of suffering from heart disease and type 2 diabetes than early risers. It showed that people who go to bed later tend to have unhealthier diets, consuming more alcohol, sugars, caffeinated drinks and fast food than early risers. They consistently report more erratic eating patterns as they miss breakfast and eat later in the day. Their diet contains less grains, rye and vegetables and they eat fewer, but larger, meals. They also report higher levels of consumption of caffeinated beverages, sugar and snacks, than those with a morning preference, who eat slightly more fruit and vegetables per day. This potentially explains why night owls have a higher risk of suffering from chronic disease. Eating late in the day was also found to be linked to an increased risk of type 2 diabetes because the circadian rhythm influences the way glucose is metabolised in the body. Glucose levels should naturally decline throughout the day and reach their lowest point at night. However, as night owls often eat shortly before bed, their glucose levels are increased when they are about to sleep. This could negatively affect metabolism as their body isn’t following its normal biological process. One study showed that people with an evening preference were 2.5 times more likely to have type 2 diabetes than those with a morning preference. This also impacts on people who work shifts – particularly rotating shifts – as they are constantly adjusting their body clock to fit with their working hours. The researchers found that this reduces their sensitivity to insulin and affects their

3. Cut down on alcohol intake Even though it might seem as though alcohol helps you sleep, the opposite is actually true. While knocking back a few beverages might help you nod off initially, even just a couple of drinks can affect the quality of your sleep and disrupt your sleep cycle – regular drinking even more so. This is because drinking leads you to spend more time in a deep sleep and less time than usual in the more restful, Rapid Eye Movement (REM) stage of sleep. This can mean that no matter how long you have spent in bed you can still feel over tired the next day and so the cycle continues. 4. Drink soothing herbal teas before bed Herbal teas have been used as natural sleep aids for centuries with ingredients such as chamomile, lavender and valerian root being popular choices. They help to promote relaxation before bed and are a much better option than caffeinated stimulants such as coffee or regular tea. 5. Use soothing essential oils and aromatherapy blends Our sense of smell is strongly linked to our memories and emotion and certain fragrances have been shown to help promote a state of calmness. Essential oils can improve sleep quality and provide relief for disrupted sleep. In a 2017 study researchers found that a blend of sleep promoting essential oils worked more effectively to improve both sleep quality and quality of life than a single essential oil, such as lavender. 6. Meditate Meditation has many benefits, one of which is helping you to relax and calm your mind after a stressful day, therefore helping you to sleep. And the great thing about meditation is that it can be done anywhere, any time for free. Even five to 10 minutes can be beneficial. Useful information The Mental Health Foundation has created a free booklet called Sleep Matters: The Impact of Sleep on Health and Wellbeing which has tips on how to get a good night’s sleep and why sleep is so important for our physical and mental wellbeing. AM

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SKINCARE SPY

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Skincare Spy We take a peek inside the bathroom cabinets of industry professionals to see if they are practising what they preach and what their cosmeceutical staples are

“Flawless skin and minimal make-up is my trademark. I start my morning with a cleanse using Neostrata Foaming Glycolic Wash, followed with the Exuviance SkinRise Bionic Tonic Pads which are my go to every morning. These pads have a gentle PHA formula which stimulates skin renewal and strengthens stressed skin, they’re packed with antioxidants and have a cooling formulation that gives my skin a real fresh hit for my early starts! I use the Neostrata Matrix Support SPF 30 in the day to shield my skin from everyday sun exposure. I use Neostrata Smooth Surface Daily Peel every night without fail, the potent combination gives glowing results from the first use and also keeps my pores at bay. For particularly trying days my ultimate go to has to be Skin Better Science’s Instant Effect Gel EYE which eliminates the appearance of puffy baggy eyes within minutes of application.”

Dr Amiee Vyas, aesthetic doctor and cosmetic skin specialist based in North London and Harley Street Dr Amiee Vyas is an aesthetic doctor with a special interest in skin. She trained in medicine at King’s College London and has worked in both the Midlands and London. During her medical school years, she developed a particular interest in skin and was appointed as a member of the British Association of Dermatologists DermSchool subcommittee. She has since taken an active role in teaching and training for other healthcare professionals and is an educator for AestheticSource. AM

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SKIN NEWS

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mesoestetic unveils new HA product Mesoestetic has announced the launch of a new hyaluronic acid product – ha densimatrix. ha densimatrix is a moisturising, anti-ageing treatment that enhances collagen and elastin synthesis to provide skin tissues with firmness and elasticity, as well as to fill wrinkles. Designed to be used as a daily moisturising treatment or following a hydrating medical-aesthetic procedure to enhance and prolong the results, the product combines three unique complexes that provide synergistic mechanisms of action, such as contribution, protection

and stimulation of hyaluronic acid and elastic fibres. These include: ha densimatrix complex, a combination of hyaluronic acid in several forms and molecular weights with an active ingredient that enhances its endogenous synthesis; antihyaluronidase complex, a plant extract and a potent antioxidant that protects HA from degradation and blocks the oxidation caused by external aggressions; and anti-ageing pro complex, which promotes collagen and elastin synthesis to provide firmness and elasticity to tissues, preventing and to correct wrinkles.

Eye contour imperfections can be targeted with eyecon

Proto-col announces new subbrand for clinic professionals British collagen brand Proto-col is to launch a new sub-brand, with exclusive products and formulations for salons, spas and clinics. Proto-col Clinical will keep collagen technology at its heart and will see the imminent launch of higher strength collagen drinks and innovative vegan superfood supplements. The range will enable practitioners to deliver new treatments as well as supporting business growth through extended on-sales opportunities. A striking new look will accompany the launch that reflects the brand’s passion for high-quality ingredients with scientificallyproven results. The range will feature ingredients that are clinically tested to help with skin elasticity, healthy skin, hair and nails plus further studies in cellulite, acne and wound healing.

mesoestetic Pharma Group has revealed its latest protocol for addressing wrinkles and expression lines, under-eye bags, circles and drooping upper eyelids. global eyecon is a convenient, effective programme combining a peel with the transepidermal solution achieving visible, cumulative results after the first session. The programme comprises six sessions, alternating three periocular peel sessions with three transepidermal sessions. The periocular peel has a depigmenting and antiageing action with a gel-like texture preventing product migration for greater safety during application. The periocular solution is a transepidermal solution containing ingredients with depigmenting and decongestant action in the microcirculation. It is suitable for vehiculation with microneedling or other transepidermal vehiculation systems. After using the microneedling technique, the crystal fiber eye mask will be applied, a hydrogel mask with depigmenting, moisturising and anti-fatigue action that provides soothing, freshness and comfort after the treatment.

AesthetiCare launches Emepelle® as a solution for menopausal skin AesthetiCare has launched Emepelle®, a new class of cosmeceutical to safely and effectively rejuvenate, restore and rebalance skin affected by menopause. Available from April 1, Emepelle® is powered by MEP Technology®, a patented, non-hormonal ingredient which is clinically proven to reinvigorate the natural functions of skin affected by low oestrogen levels during menopause. In clinical studies MEP Technology® has been proven to be safe and effective in helping to address the effects that declining oestrogen levels, caused by menopause, has on the skin, significantly improving hydration, luminosity, elasticity, and appearance of lines and wrinkles. By combining MEP with a synergistic blend of advanced ingredients, Emepelle® helps rejuvenate, restore and rebalance. The Emepelle® range includes two products: Emepelle Serum, and Emepelle Night Cream. Both products are suitable for all skin types and are recommended for women who are in perimenopause, menopause or post menopause. AM

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D ENTISTRY

COSMETIC DENTISTRY

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Straight talking Dr Yasmin Shakarchy discusses the benefits of Invisalign® in short-term orthodontics

n recent years, there has been a dramatic shift in focus towards more conservative aesthetic treatments. In harmony with modernising treatments, the social media boom has increased the patient’s knowledge of the available management options. Currently, Invisalign® short-term orthodontics is gaining popularity exponentially. This is typically coupled with whitening and cosmetic bonding – otherwise known as the ‘align, bleach and bond’ protocol. There is a significant movement away from irreversible, elective aesthetic procedures such as veneers and crowns, particularly among the younger generation. These individuals typically have sound, healthy virgin teeth. Although ‘quick, instant fixes’ remain an attractive proposition, they require aggressive tooth preparation, which can result in potentially serious long-term sequelae of the vitality of teeth.1 It must be remembered that the main cause of cosmetic concerns relates to tooth position. Often teeth erupt misaligned. As a result, correcting tooth position via orthodontic alignment has both aesthetic and functional

benefits, including improvement in bite positioning. Edward Angles classification of malocclusion provides a methodology to classify teeth relationship. Molars, canines and incisors are classified either as class 1,2 or 3.2 By using all this information, a robust treatment plan can be created.

ORTHODONTIC TREATMENT CAN BE CLASSIFIED INTO TWO MAIN TYPES

Comprehensive Orthodontics Treatment using comprehensive orthodontics involves aligning all upper and lower teeth into a perfect ‘class 1 occlusion’. 2 Aesthetics improves secondary to alignment. Typically, teenagers who undergo orthodontic treatment have fixed braces and require approximately 18 to 24 months of treatment. There is also the potential for extractions in excessively overcrowded situations. Short-Term Orthodontics (STO) Also known as ‘cosmetic orthodontics’, STO focuses on the anterior smile teeth. The posterior teeth are occasionally

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left in position. This treatment requires more focus on patient’s wishes and outcomes, rather than the more ideological goals of comprehensive orthodontics. This is an ideal management modality in patients with mild to moderate malocclusions, who desire a shorter overall treatment plan without having to resort to metallic fixed braces. It must be stressed that STO is not a replacement for traditional comprehensive orthodontics, although it is an acceptable alternative treatment option in adults who refuse comprehensive orthodontics. These patients can greatly benefit from STO, particularly as, in the past, there would have been no reasonable, conservative option available. GOALS OF SHORT-TERM ORTHODONTICS Dramatic improvement in the appearance of the patient’s smile, while also improving the overall fit of the teeth in a shorter space of time. The primary focus is the anterior ‘smile’ teeth. These are the teeth on show during talking, smiling and laughing.1 Currently there are numerous systems attempting to address the concept of STO. These utilise either brackets and wires, or clear aligners. The latter is the category Invisalign® falls into.

has been designed specifically for Invisalign® treatment planning.5 The scanner also allows a rough simulation of the potential result, which seems to improve treatment compliance. ClinCheck® A ClinCheck® 3D report allows the patient to understand the entire treatment plan digitally. The movements of each tooth, attachment size and location, as well as the number of aligners can be specifically designed (Figure 1). Figure 1: Digital ClinCheck® report

A. Initial presentation of teeth

THE INVISALIGN® SYSTEM

Clear aligner system technology has progressed since it was first introduced. Invisalign® is one of the most popular and demand for it has soared in recent times, with patients specifically requesting this treatment modality.3 Invisalign® uses ‘SmartForce®’ and ‘SmartTrack®’ technology to provide consistent and accurate control of dental movement. The SmartTrack® material is a transparent polymer designed specifically for Invisalign®. The SmartForce® attachments are tooth-coloured composite resin shapes that are placed accurately and strategically on the teeth. The combination of the aligner and attachments ensures gentle but consistent forces are applied to the desired teeth, enablng the direction of movement to be controlled. The removeable aligners are bespoke. It is recommended that they are worn for a minimum of 22 hours and should only be removed during eating. The aligner is changed every two weeks, although research suggests that, thanks to recent modifications, one week is now acceptable.4 Each aligner moves the desired teeth typically by 0.25mm. The aligners are changed sequentially, allowing stepwise, effective movement of teeth into the desired position. It must be understood that clinical experience with any orthodontic appliance is essential to achieving excellent results. Experienced practitioners are key when planning, executing and monitoring treatment. It is not a treatment someone should perform casually.

TREATMENT TIMELINE

Initial consultation This includes a thorough dental examination, full mouth x-rays, and pre-treatment photography. Silicone impressions of the teeth, or a digital scan should be taken. Advancement of digital dentistry has improved both accuracy and comfort during this stage. The iTero® scanner

B. Attachments and IPR

C. End of treatment results

Built into the ClinCheck® will be the interproximal reduction (IPR) required. The importance of this relates to tooth shape, as well as positioning. Alignment of teeth alone would not adequately restore the aesthetics and, therefore, individual tooth surfaces require recontouring. This improves the shape, as well as creating the required space for movement. Despite IPR and root proximity being matters of debate, data has shown that the treatment of adult crowding with aligner and IPR has a positive effect on interradicular bone volume.6 In most cases, there should >

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be no more than a maximum reduction of 0.5mm of tooth enamel surface, on the desired tooth. The ClinCheck® also shows the types of movement required. The information is relayed in its entirety during the ClinCheck® report appointment. I always recommend that this appointment is conducted in person as it results in improved process understanding and ultimately treatment compliance, as well as being a vital step in obtaining valid consent. Providing aligners Following approval of the plan, treatment may begin. I always begin the first aligner with no attachments on the teeth; this is the ‘trial’ aligner, allowing the patient to begin acclimation. The initial pressures can be uncomfortable, so this allows a more gradual treatment process. A fortnight later, the patient attends for their attachment and IPR appointment. A bespoke template is used to place the attachments on the teeth, followed by interdental diamond strips used for the IPR. IPR can be a staged throughout the course of treatment or performed entirely in one session. No anaesthetic is required, as there is minimal discomfort. The attachments remain throughout the treatment. Certain cases require the use of elastics. The aligners come with hooks or cut outs for this, with the provision of patient information being necessary to ensure this is completed at home. The number of aligners given is tailored individually. If there are difficult rotational movements or extensive crowding, the patient requires more frequent reviews. This needs to be assessed case by case.

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Typically, most cases will finish with cosmetic bonding. This is both minimally invasive, requiring no removal of tooth tissue or use of local anaesthetic.7 Cosmetic bonding involves the use of a composite resin restorative material to reshape the teeth and improve the aesthetics. It is used in combination with enameloplasty (recontouring the teeth) to achieve the final result (Figure 2). Retention Retention is key. The patient must be informed prior to embarking on treatment that retention is lifelong. The gold standard is both a fixed wire retainer and a removable vacuum retainer.8,9,10 The fixed retainer is cemented permanently on the inside of the anterior teeth. A mould or scan is then done to fabricate the removable retainer. Invalisgn produces the Vivera® retainers, which can be worn over the teeth, at night, with the fixed retainers in place (Figure 3).

Bleach and bonding/recontouring An interdisciplinary orthodontic/restorative treatment approach is often vital for a high-quality aesthetic result. Once the teeth are fully aligned, the restorative phase may be performed. The patient is given a course of teeth whitening, followed by a two-week period of colour stabilisation. Figure 3: upper and lower lingual/palatal fixed wire retainer

BENEFITS

‘Invisible’ Invisalign®’s clear aligners make it the most invisible brace currently available on the market, ensuring it goes unnoticed by friends, family, and work colleagues. Before

After Figure 2: The reshaping of the upper incisors (4 front teeth), following Invisalign® and whitening treatment. Note: The initial photo shows the disproportion between the central and lateral incisors, giving a more prominent appearance to the central incisors. The after photo highlights a naturally aesthetic result through alignment, whitening, and composite bonding, particularly of the lateral incisors, to ensure better proportions.

Comfort Being a removable appliance, studies have shown that patients treated with Invisalign® experienced statistically higher satisfaction with eating and chewing compared with bracket-based treatment.11 Furthermore, patients treated with traditional fixed appliances reported greater discomfort and consumed more analgesics than patients treated with aligners.12 SmartTrack® technology The SmartTrack® flexible material makes Invisalign® aligners easier to utilise. The higher elasticity ensures precise fit and better control of tooth movements. It also provides greater consistency of the application of orthodontic forces compared with other aligner systems on the market that use different materials and technology.13

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This case was shortlisted for the Aesthetic Dentistry Awards 2019 - Invisalign® category

Digital iTero® software The use of three-dimensional computer models can give clinicians additional information for decision making.5 Gum health Significantly better gingival health conditions were recorded in Invisalign® patients compared with other orthodontic appliances, particularly fixed braces. The patient can remove the aligner, eat comfortably, and then clean their teeth adequately and with ease before replacing the aligners, unlike the difficulties experienced with fixed braces14 (Figure 4).

has much greater control. As obvious as it may sound, the treatment will not work if patients do not wear the aligners. Furthermore, the minimum wear of 22 hours is essential, so if patients are wearing it for less time, this is also a detrimental factor to the success of the treatment. Teeth lagging Certain teeth can often lag in treatment. For example, if difficult rotations or movements are required, particularly with canine rotations or smaller teeth such as laterals. Appropriate treatment planning must be done, to ensure the forces applied are gradual and ensure eventual successful movement. Should teeth lag during treatment, either the treatment can be stopped and a mid-treatment correction embarked upon, or end of treatment refinement is required. Further aligners and longer treatment courses are the result. Root resorption There is a lot of discussion regarding the risk of root resorption with short-term orthodontic systems. The literature shows that practitioners can be more assured about the low-risk of root resorption associated with clear aligners.15 >

Figure 4: Chronic gingivitis around upper anterior teeth, particularly upper left central, lateral incisors and canine teeth. Compared with resolution and healthy pink gingival tissues post-Invisalign® treatment

LIMITATIONS

Compliance The biggest factor affecting a successful outcome is patient compliance. As this is a removable system, the patient

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CONCLUSION

The results with Invisalign®, bleaching and cosmetic bonding/recontouring of teeth are truly fantastic. Patient satisfaction is extremely high. These life-changing results can only be achieved with thorough initial assessment, diagnosis and treatment planning. Furthermore, a good patient-clinician relationship is paramount to the success of treatment and overall patient satisfaction. AM REFERENCES Luqmani S. The Limitations of Short-Term Orthodontics and Why We Still Need Specialists – A Review of the Current Literature. Dent Update. 2017 Jan;44(1):64-6, 69 Hershfeld JJ. Edward H. Angle and the malocclusion of the teeth. Bull Hist Dent. 1979 Oct;27(2):79-84 Malik OH, McMullin A, Waring DT. Invisible orthodontics part 1: Invisalign. Dent Update. 2013 Apr;40(3):203-4, 207-10, 213-5 Fry R. Weekly aligner changes to improve Invisalign treatment efficiency. J Clin Orthod. 2017 Dec;51(12):786-791 Garino F, Garino GB, Castroflorio T. The iTero intraoral scanner in Invisalign treatment: a two-year report. J Clin Orthod. 2014 Feb;48(2):98-106 Hellak A, Schmidt N, Schauseil M, Stein S, Drechsler T, Korbmacher-Steiner HM. Influence on interradicular bone volume of Invisalign treatment for adult crowding with interproximal enamel reduction: a retrospective threedimensional cone-beam computed tomography study. BMC Oral Health. 2018 Jun 8;18(1):103 Norris RA, Brandt DJ, Crawford CH, Fallah M. Restorative and Invisalign: a new approach. J Esthet Restor Dent. 2002;14(4):217-24 Çifter M, Gümrü Çelikel AD, Çekici A. Effects of vacuum-formed retainers on periodontal status and their retention efficiency. Am J Orthod Dentofacial Orthop. 2017 Dec;152(6):830-835. Shaughnessy TG, Proffit WR, Samara SA. Inadvertent tooth movement with fixed lingual retainers. Am J Orthod Dentofacial Orthop. 2016 Feb;149(2):277-86. Forde K, Storey M, Littlewood SJ, Scott P, Luther F, Kang J. Bonded versus vacuum-formed retainers: a randomized controlled trial. Part 1: stability, retainer survival, and patient satisfaction outcomes after 12 months. Eur J Orthod. 2018 Jul 27;40(4):387-398. Flores-Mir C, Brandelli J, Pacheco-Pereira C. Patient satisfaction and quality of life status after 2 treatment modalities: Invisalign and conventional fixed appliances. Am J Orthod Dentofacial Orthop. 2018 Nov;154(5):639-644. White DW, Julien KC, Jacob H, Campbell PM, Buschang PH. Discomfort associated with Invisalign and traditional brackets: A randomized, prospective trial. Angle Orthod. 2017 Nov;87(6):801-808.

With the introduction of the iTero® intraoral scanner, ClinCheck® system, and improved clinical understanding over two decades these limitations have been reduced. There is high predictability in non-extraction cases with appropriately experienced dentists.16,17,18 Case selection is key to successful treatment, and it is important to understand what cannot be treated by short-term Invisalign® orthodontics. Severe class 3 or reverse overjet discrepancies, severe open bites, excessive crowding and bilateral posterior crossbite cases ideally should be treated by comprehensive orthodontics potentially with or without orthognathic surgery. Should patients opt out of comprehensive orthodontics, shortterm orthodontics should only be embarked upon with the patients full understanding of the limitations.1,16

Condo’ R, Pazzini L, Cerroni L, Pasquantonio G, Lagana’ G, Pecora A, Mussi V, Rinaldi A, Mecheri B, Licoccia S, Maiolo L. Mechanical properties of “two generations” of teeth aligners: Change analysis during oral permanence. Dent Mater J. 2018 Sep 30;37(5):835-842. Azaripour A, Weusmann J, Mahmoodi B, Peppas D, Gerhold-Ay A, Van Noorden CJ, Willershausen B. Braces versus Invisalign®: gingival parameters and patients’ satisfaction during treatment: a cross-sectional study. BMC Oral Health. 2015; 15: 69 Aldeeri A, Alhammad L, Alduham A, Ghassan W, Shafshak S, Fatani E. Association of Orthodontic Clear Aligners with Root Resorption Using Three-dimension Measurements: A Systematic Review. J Contemp Dent Pract. 2018 Dec 1;19(12):1558-1564 Phan X, Ling P. Clinical limitations of Invisalign. J Can Dent Assoc. 2007 Apr;73(3):263-6 Grünheid T, Loh C, Larson BE. How accurate is Invisalign in nonextraction cases? Are predicted tooth positions achieved? Angle Orthod. 2017 Nov;87(6):809-815 Houle JP, Piedade L, Todescan R Jr, Pinheiro FH. The predictability of transverse changes with Invisalign. Angle Orthod. 2017 Jan;87(1):19-24

Dr Yasmin Shakarchy completed her dental training at the University of Birmingham. Her passion for recreating celebrity smiles and the development of a school resources pack as part of Jamie Oliver’s SUGAR SMART campaign have formed the cornerstones of Dr Shakarchy’s career. She became a member of the Faculty of Dental Surgery (MFDS Ed), and simultaneously received a PG certificate in Aesthetic and Restorative dentistry, helping her to primarily focus on smile makeovers and cosmetic treatments. She recently won an award as Best Young Dentist of the Year across the Midlands. All images and case studies used in this article are the work of Dr Yasmin Shakarchy. See her full portfolio on her instagram page @dr_shakarchy.

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INTERVIEW

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Less is more Dr Paul Baines discusses the growing demand for the sculpting and contouring of the lower face Aesthetic Medicine: What do you think will be the biggest dermal filler treatments for 2019 and beyond? Dr Paul Baines: : I would say that jawline treatments have certainly expanded a lot in recent years and they now represent about a third of the dermal filler treatments I undertake in my own practice. The media has played a big role, of course, and people are seeing the results achieved by friends who have had jawline enhancement. Over the last year, I have noticed that people are coming in and booking jawline treatment and I would say that this is the big change moving forward in 2019 and beyond: people know what they want and they’re coming in specifically to ask for it. AM: Why do you think we’ve seen an increase in people seeking treatment for the lower face? PB: I think it comes back to the impact jawline treatment can have. If I ask a patient, ‘If I gave you a magic wand, what would you like to achieve?’, a typical response would be for the patient to raise both of their index fingers, place them into the middle of their cheeks and then push upwards and back and say ‘This is what I want’, quickly followed by ‘but I don’t want to look like I’ve had treatment’. So, essentially, what they’re asking for is a non-surgical lift, which is the challenge we’ve faced in aesthetics for years. Today, however, it’s about how you can achieve this subtly and I believe that less is more. With my patients, I like to use an analogy to explain the ageing process. I ask them to imagine that their face is like a tent. In our youth, the frame of the tent is rigid and the overlying material is tight, but as we age the frame of the tent becomes smaller. The ridge pole of our tent is

the mandible, the jawline itself, and, as it shortens, the tent material starts to gather and sag down – this represents the ever-increasing jowl. I explain that one way of correcting this is to increase the height of our tent again, which is essentially what we’ve been doing for years when we augment the cheek. But this only represents one of the three anchor points of the face. The other two are the anterior and posterior aspects of the mandible. By augmenting the chin and behind the angle of the mandible, we’re extending the length of the ridge pole of our tent again and we’re lifting the jowl back up. What I particularly like about this three-point nonsurgical lift is its subtle effect. Whenever we look at each other and have a conversation, we tend to focus on the eyes and the mouth. As practitioners, this means that we can treat parts of the face that are away from these areas very effectively, without it being apparent as to exactly what the patient has had done. So by augmenting the cheek the eyes look more lifted, and by augmenting the jawline you get this retraction of the jowl and the mouth looks more beautiful. AM: Why do you think this has become a popular treatment for men, in particular? PB: I think that men, like women, still want that push back, that lift, but if you’re not careful the volumisation of the cheek can be feminising. And because the male face varies a lot, you have to be really careful about what the expectations are. For example, you can have more central hollowing, like the David Gandy appearance, whereas some men have a more appley fullness anteriorly, as seen in a young David Beckham. Now, if you volumise the mid-face in men and don’t do this correctly, there is that of softening their features too much. Whereas the chances of feminising by enhancing the jawline are minimal to zero, it gives men a ruggedness and pulls back their jowl. Plus, because the jawline is quite a distance away from the key areas where we focus during a conversation, enhancing it offers a subtle, discrete result. AM: What are the differences in the male and female face and how does this impact your treatment approach, particularly for men? PB: The number one thing to remember is that it’s important not to make any assumptions about what the client is looking for. There are certain things you can do that will masculinise the face. There are three main things really: the male face, particularly the lower part, is thicker and heavier – both in the bone and the muscle mass, the masseter – and treatments that increase the bigonial distance have a masculinising effect. What this means is that when you’re extending the length of the mandible and you’re placing product behind the angle of the mandible, you should also place product on the lateral aspect of the jaw to increase the bigonial distance. A second consideration would be that, anteriorly, the chin is wider in the male; it’s a flatter profile, whereas the female chin tends to >

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I N J E C TA B L E S

INTERVIEW

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come down to an apex. The male chin, anteriorly, is wider and flatter and the more we emphasise this feature, the more masculinising the effect. Finally, the third consideration is along the jawline itself. Because a wider bigonial distance is more masculinising, when you’re placing dermal filler along the line of the jaw in a female augmentation you’re looking to place that filler with a cannula on the inferior aspect of the line of the mandible; whereas in men, you’re looking to place that in a more lateral position to increase width.

Before

After

AM: What is your go-to product for contouring of the lower face, and why? PB: When I’m choosing a filler, the first thing it comes back to is safety. The amount of product that you can potentially place into the jawline can be four or five milliletres. You’re also placing it quite deeply and the duration of effect is going to 12 months plus, so you want to be using a product that has a proven track record and isn’t going to give you any nasty surprises. For me, with 30 million treatments under its belt, Restylane gives me that reassurance. The other thing that the Restylane range gives me is that the NASHA products have a high G prime, which in my experience isn’t surpassed. It gives

me that anterior projection without the lateral volumisation, and that’s what I want when I’m trying to mimic the natural structures of the bone of the jaw, especially anteriorly on the chin and behind the angle of the mandible. I don’t want large areas of swelling around where I want projection – I want precision; I want product exactly where I place it. Also, because the tissues in the chin itself are relatively tight, you want to try to achieve that projection with as minimal amount of lateralising volumisation and swelling as possible. I use Restylane Lyft in the chin and behind the angle of the mandible, while along the jawline itself, I use either Restylane Classic or Restylane Defyne from the OBT Range, which is softer and ideal for contouring the female jawline, usually in conjunction with a canula. AM: What are your top tips for anyone looking to perform a lower face contouring treatment? PB: Number one is a sound understanding of your anatomy. This is critical, as with any aesthetic procedure. A key structure that you’ve got be aware of is the course of the facial artery which passes deeply to the anterior border of masseter, just as it crosses over the line of the mandible. For this reason, treatments in the mid-portion of the jawline should be kept superficial in the deep dermal and subdermal layers. Whereas in the anterior and posterior aspects of the mandible, you are safe to place the product onto the periosteum. Treatments on the chin should be periosteal injections done with a needle – typically, I use a 27-gauge needle. I favour changing the needle with every single injection, because you’re going to be blunting the needle when you touch down onto the periosteum. Plus, by having a fresh needle for each injection, you also have the safety aspect – when you’re aspirating back, it is more reliable. You may also wish to consider a series of treatments. I usually only put four syringes in on a single treatment before bringing the patient back a couple of weeks later. It’s tempting to do more, but to optimise post treatment comfort due to swelling, staged treatment is preferable. AM

Dr Paul Baines has 23 years of medical experience and has been a consultant in accident and emergency medicine at Musgrove Park Hospital in Somerset since 2006. Alongside his work in the NHS, Dr Baines has spent the past 10 years in the field of aesthetic medicine, delivering an holistic approach to skincare from his Skin H¬ealth practice at The Crescent Clinic in Taunton, Somerset. He is a trainer for Galderma and is also a member of the Royal College of Surgeons.

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DEVICES

AESTHETIC ELECTROLYSIS

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Current trend Gill Morris explains how electrolysis is making its mark in aesthetics

here is a new genre of electrolysis treatments and practitioners that is gaining popularity among medical professionals and their patients. Nurses, dentists and other healthcare professionals are undergoing training in blemish and advanced blemish removal with diathermy (which sit at Level 4 and 5 respectively), and it is these practitioners that are referred to as ‘aesthetic electrologists’. They are differentiated from traditional electrologists, who offer hair removal, by carrying out blemish removal and reduction treatments.

THE HISTORY OF ELECTROLYSIS FOR BLEMISH REMOVAL

The use of electrolysis as a blemish removal technique is nothing new. In fact, a number of references reveal that it has been available for more than 140 years, with its roots in the medical profession in the late 19th century:

There is a new genre of electrolysis treatments and practitioners that is gaining popularity among medical professionals and their patients

1875 “Forty Cases of Naevi Successfully treated with Electrolysis” S.J. Knott, medical superintendent of Galvanism of St. Mary’s Hospital, late medical tutor and Pathologist. 1886 “Cases of Orbital Naevi Treated by Electrolysis” Simeon Snell, ophthalmic surgeon 1889 “Treatment of Naevi by Electrolysis” Lewis Marshall, MD 1909 “The Treatment of Naevi and other Cutaneous Lesions by Electrolysis, Cautery and Refridgeration” Edward Reginald Morton, MD.

Electrolysis for hair removal through the early and middecades of the 20th century, was a standalone treatment delivered by specific practitioners (i.e. not doctors or beauty therapists, but electrologists). It was only in the late 1960s and early 1970s that electrolysis was brought into mainstream education when Further Education colleges courses added it to their two year Health & Beauty Therapy courses. It was the most technical and dexterous subject within the course and the one that required the most knowledge. However, standalone electrologists who didn’t want to go down the beauty route, still trained under private tutors and from the 1980s onwards. Young students more interested in beauty found it too much to learn and soon voted with their feet. Electrolysis became an optional subject in the Noughties and, for those without the appetite for anatomy and physiology, it fell by the wayside. Today, however, we are seeing a resurgence in electrolysis for hair removal, as many practitioners who use laser or LED are now training in electrolysis in order to complete their patient’s treatment. The vast majority of newly qualified electrologists are aesthetic electrologists. This means that clients now have access to practitioners with a healthcare background and a vast network of professional support. Aesthetic electrologists can also provide an internal clinic referral for the identification or medical diagnosis of a lesion, which gives clients complete peace of mind when it comes to achieving blemish-free skin.

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DEVICES

AESTHETIC ELECTROLYSIS

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AESTHETIC ELECTROLYSISTM – A NEW GENRE

As has been the case for a number of years, the NHS cannot meet the demand for cosmetic blemish removal. So if a patient is concerned about a gathering of red veins across their cheeks, a dangling acrochordon rubbing under a bra strap or between their legs, or a dark and noticeable facial seborrhoeic keratosis, to name just a few, they can no longer be referred to a dermatologist through the NHS. Instead, patients are seeking help through medical aesthetics clinic chains like sk:n and Courthouse Clinics, as well as numerous independent clinics like MediZen, Pure Perfection Clinic and Aesthetic Solutions. The prerequisite for training is a healthcare qualification. Nurses and dentists are currently the most likely to enquire about blemish removal training and are keen to benefit from the opportunities that are available. Sterex, which has an academy in Birmingham, is a leader in the field of blemish removal training, and has been since the mid-80s. It says that approximately 65% of the enquiries it currently receives for blemish removal training are from those already offering medical aesthetic treatments or those wanting to expand their treatment menu to include it. Delegates who have a nursing or dental qualification can start on the Basic Blemish Removal/Stage 1 course immediately, although Sterex does insist that course is completed before going on to do the Advanced course/

Before

Stage 2. The training can be taken as a Sterex industry certificate, or at Level’s 4 and 5 with the additional course work (i.e. case studies etc). The Blemishes covered on each course are: Blemish Removal –Stage 1/Level 4 – Telangiectasia: linear red veins, spider nevus, cherry angioma/Campbell de Morgan spots, skin tags/acrochordon, milia Advanced Blemish Removal – Stage 2/Level 5 – seborrhoeic keratosis, warts (common, plane, filiform and plantar), mole reduction, xanthelasma, syringoma, age spots, dermatosis papulosa nigra, sebaceous cysts, sebaceous naevi, sebaceous hyperplasia and poikiloderma. The company has also recently published a new textbook – Skin Blemish Removal with Diathermy. A Practical Guide to Levels 4 & 5 – with the foreword written by Dr David Eccelston, clinical director of MediZen. He wrote, “I am delighted to write the foreword for this much-needed text, as there is nothing currently available designed to educate non-dermatologist practitioners in the treatment of benign blemishes and lesions. This is an area within which I am seeing increasing demand. As the medical director of an award-winning clinic, as well as a GP, I know the level of demand for treatment from patients, which cannot be met by the NHS. “Removal of these benign and often unsightly lesions is responsible for a high percentage of our clinic income, and the work that our practitioners carry out not only enhances the confidence of our patients in our services, but is extremely worthwhile, both professionally and financially. “This text is essential reading for any practitioner currently providing these treatments as a reference, by those in training for blemish removal at Level 4 and Level 5, and by anyone wishing to prepare for such training. “Those with medical training will understand the theory, but will gain knowledge and experience from the comprehensive description of these treatment techniques. These are not as ‘aggressive’ as many taught in dermatology, and, importantly, leave the skin as near perfect as it can be following treatment.” >

After

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DEVICES

AESTHETIC ELECTROLYSIS

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hyperplasia, warts and seborrhoeic keratosis, and found that some medical diathermy treatments were too aggressive on the skin. Aesthetic Electrolysis provides the perfect solution, treating all these lesions at low risk, with minimal downtime and no scarring. It has provided me with the skill and equipment to deliver the best results to my patients.

MY JOURNEY WITH AESTHETIC ELECTROLYSISTM

Why did you choose Sterex? I have followed Sterex for many years and I feel that the company really cares about the standards in the industry. After seeing live footage and before and after photos of its treatments and results, I felt Sterex was the best place to go for training. I couldn’t be more satisfied with the level of training I have received.

What made you want to do blemish removal? We have been treating skin disorders and diseases in the clinic for many years with the fabulous ZO Skin Health products. However, we had nothing in our tool box to treat skins disorders such as skin tags, telangiectasia, xanthelasma, moles, sebaceous cysts, sebaceous

What are the benefits of aesthetic electrolysis over other blemish removal treatments? The benefits of using aesthetic electrolysis to treat many skin blemishes are that it is a low cost treatment; low cost to the patient and low cost to the clinic, both to do the training and carry out the treatment. It is also a quick and easy treatment to perform, which has huge physical and psychological benefits to patients who may not be able to get these cosmetic treatments on the NHS. AM

Sara Cheeney is an aesthetic nurse practitioner and director of Pure Perfection Clinic. She explains why she wanted to offer the treatment and undergo training.

Gill Morris has a career in the electrolysis sector spanning four decades and is the co-author of three text books on the subject. She is currently the director of commercial development at Sterex and was the editor of the recently launched text Skin Blemish Removal with Diathermy. A Practical Guide to Levels 4 & 5. She is a regular speaker at conferences including FACE and Aesthetic Medicine North. As a passionate advocate of remedial and aesthetic electrolysis Morris has been involved in training and research and development of equipment and products including machines and accessories and was involved in the launch and International promotion of Sterex Needles; the world’s first pre-sterilised, single use, disposable electrolysis needle and still one of the world’s leading electrolysis brands. * Aesthetic Electrolysis TM is a trademark of Sterex Electrolysis International Ltd, a limited company registered in England under registered number 1666827

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Pag. Le Shape copia.ai

CMY

08/03/19

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DEVICES

EDITOR’S CHOICE

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Lumenis NuEra Tight Vicky Eldridge tries out the new NuEra Tight treatment from Lumenis with Renne Lapino

ellulite. Like most women I have it and it’s only got worse with age. I recently turned 40 and while I’m fitter and in better shape than I ever have been, the backs of my thighs and buttocks have cellulite on them. It’s not that bad but if I could get rid of it and without suffering to do so, then great! So I headed off to Renne Lapino’s amazing new clinic in Kensington to try out the latest device from Lumenis – NuEra Tight – that aside from its many other indications, promises to be a pain-free solution for reducing cellulite. NuEra Tight is an FDA-cleared, temperature-controlled radiofrequency skin smoothing system. From skin tightening, wrinkle reduction, body sculpting, and lymphatic drainage to the temporary reduction in the too much, there’s a noticeable shift as the machine adjusts to appearance of cellulite, NuEra Tight is ideal avoid creating painful hotspots. I have experienced these for those who want to look and feel good, in the past and I’m always on edge during treatments without having to go under the knife or because of this. suffer downtime. One of the best things about the The system emits powerful RF treatment is that you do see results PRACTITIONER VIEW waves at 470kHz with high 250W after only one session, which power, to heat the skin’s surface encourages you to come back for Renee Lapino superficially and to target tissue more. Lapino adds, “After one at a deeper level. By using the treatment the face is noticeably “When I heard about the concept behind the precise frequency and depth of contoured, and the body Lumenis NuEra Tight, I knew it was cuttingheat, NuEra can treat a variety feels smoother and tighter, edge and would completely change the way we of conditions with different with an obvious softening approached radiofrequency treatments – I knew I levels of severity on the of cellulite tissue. As with all had to have the device in my clinic. When I got my abdomen, flanks, buttocks, radiofrequency, a course of hands on the device, I was completely blown away. inner and outer thighs, upper treatment is recommended, The speed and ease of treatment is unparalleled arms, bra and back fat, as well but because of the depth of and the results are nearly instantaneous. as around the eyes, mouth, treatment (with the exception There are no hot spots or spikes in cheeks, and neck. of cellulite) sessions need only be temperature, making the patient The treatment works with one carried out every two weeks. experience not only comfortable resistive bipolar handpiece and “The results in the weekly cellulite but also pleasurable.” two unipolar handpieces with Coated sessions are astounding. So much so that Capacitive Energy Transfer (CCET) as a busy clinic owner I have already booked electrodes in a wide variety of capacitor a course in for myself which I am photographing head sizes – from small to very large. and publically documenting. It’s a remarkable device, and I Lapino says, “The speed and ease of treatment is strongly feel this technology has the ability to change the face unparalleled and the results are nearly instantaneous. There of the radiofrequency market globally.” are no hot spots or spikes in temperature, making the patient I was definitely sold. I almost fell asleep during my experience not only comfortable but also pleasurable.” treatment, which was a marked difference from when I once And she’s not wrong. The treatment is relaxing and tried Acoustic Wave Therapy for cellulite and only managed to comfortable and as soon as you feel the heat beginning to build cope with one thigh being done. AM

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DEVICES

DEVICES NEWS

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4T Medical launches plasma and electrosurgical device 4T Medical has announced the launch of Zeus, a portable multi-frequency plasma and electrosurgical device, into the UK. The Class IIb Medical Device (CE0476) can perform both surgical and nonsurgical procedures in fields such as aesthetic medicine, dermatology, vascular surgery, dentistry and gynaecology. It has flexible settings, offering the practitioner complete control over the frequency, duty cycle, and power systems and enabling the treatment to be tailored to accommodate a patient’s age and skin type. Indications include the removal of skin blemishes, improvement of eye bags and wrinkles and the treatment of certain dermatological diseases among others It can also be used in the operating room for surgical procedures where cutting and cauterisation are required.

Aesthetic Technology expands its portfolio Aesthetic Technology, the manufacturer of Dermalux, has expanded its portfolio with the launch of two new products – the Tri-Wave MD and the Flex. The Tri-Wave MD delivers breakthrough LED technology with proven wavelengths of 415nm, 633nm and 830nm and, according to the company, is the only medical device to deliver all three wavelengths simultaneously at an amplified optical power.

The Dermalux Flex, is targeted as an entry-level device which is fully portable and ideal for in-clinic and mobile use. It delivers the same three wavelengths as the Tri-Wave MD and can be used for the face and the body.

Venus Consept unveils NeoGraft® Venus Concept has announced a new division focussed on hair regeneration with the launch of the NeoGraft® 2.0. By combining next-generation, minimally-invasive surgical techniques with decades of data, the NeoGraft® 2.0 utilises wireless connectivity which enables remote access for diagnostics, maintenance, automatic upgrades, and procedural data. The touchpad operates like a tablet, and software communicates with the hand tools to provide real-time extract and implant graft counts. Restoring hair with a NeoGraft® procedure offers many advantages including no linear scar and fast recovery. The procedure allows practitioners to recreate a full and natural-looking hairline in four steps: extraction of hair follicles; counting, trimming and sorting of grafts; recipient site creation; and placement of the hair grafts. Dr Jack Fisher, a board certified plastic surgeon, explained, “NeoGraft® completely changes the dynamics of introducing hair restoration into an aesthetic practice by providing new advanced technology with the systems and support necessary to create a successful outcome for both the doctor and the patient.”

Venn Healthcare adds Ultraformer III to its portfolio Venn Healthcare has launched a new skin tightening and body-sculpting treatment – Ultraformer III. The non-invasive treatment works deep-down into the SMAS layer and uses HIFU (high-intensity focused ultrasound) technology to lift, tighten, and contour areas of the body. Ultraformer III delivers concentrated waves of ultrasound into multiple layers of the skin and body tissues, transferring temperatures of 65-75°C into the targeted zones. Patients who have received treatment on the face and body report an improvement rate of over 95%, four to 12 weeks post-treatment. Dr Ifeoma Ejikeme, medical director of the Adonia Medical Clinic in London, “We have introduced Ultraformer III into the clinic for those looking for an effective solution to firm up the areas many patients find difficult to shift. Ultraformer III is a great skin tightening device that is comfortable to use on the face and the body with excellent results”. AM

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OUT AND ABOUT

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Professional Beauty London, ExCeL 29,017 visitors attended Professional Beauty London over the course of the two day event at the end of February. The show, which is run by Professional Beauty Group, the owners of Aesthetic Medicine, is a key date in the beauty industry’s calendar, giving professionals the opportunity to keep up with the competition by getting a feel for the products and treatments they are adopting into their businesses, as well as meeting the brains behind the brands. As part of Professional Beauty’s commitment to supporting development of the current and future beauty workforce, visitors had access to over 60 hours of low-cost training and education across the extensive live stage and seminar programme, with CPDaccreditation offered by VTCT to reward and encourage. There was a huge presence at this year’s event from aesthetic brands including 3D-lipo, 4T Medical, ABC Lasers, Advanced Esthetic Solutions, Beamwave, Candela, Celluma, Cutera, Cynosure, Dermalux, Endospheres, Filorga, Fusion GT, iiaa,Image Skincare, Jett Medical, Levura HIFU, Lumenis, Lynton, Pure Swiss Aesthetics, Skinbrands, Skyncare, Smart Group, Venus Concept and Vida Aesthetics. The Advanced Treatment Stage showcased the latest in aesthetic beauty treatments. Popular topics included microneedling and skin peels with Andrew Hansford, director of the Fusion Aesthetic Academy; building an award-winning aesthetics business with Debbie Thomas and Richard Weare from the D.Thomas Clinic; the power of plasma with Dr Vincent Wong on behalf of Jett Medical; dermaplaning with Nicola Russell, director of Skin Geek and advanced LED light therapy with Mariga Sheedy on behalf of Celluma. Hansford said, “I was totally overwhelmed by the turnout for my talk. I couldn’t believe it. Totally honoured.” Denise Ryan, V.P Brand Management, Celluma by BioPhotas commented, “The entire show was fantastic and we’re already re-booked for next year. The Live Stage went extremely well and Mariga drew a great crowd and got many compliments.” The event also saw the annual Professional Beauty Awards take place with Radiance Medispa scooping the award for Medical Aesthetic Clinic of the Year, sponsored by Biologique Recherche. Professional Beauty London 2020 will take place on February 23-24 at ExCeL London.

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OUT AND ABOUT

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MD Codes Tour, London TM

The MD Codes™ Tour, supported by the Allergan Medical Institute (AMI), had its first meeting of 2019, in London last week. Over four days, from February 14, 900 aesthetic professionals were given the opportunity to observe and work alongside world-renowned plastic surgeon Dr Mauricio de Maio as he took them through his Immersion and Dyna Expression curricula. The MD DYNA Codes™ Expression Program focuses on understanding how to treat patients’ dynamic expressions. It introduces MD DYNA Codes™ for each muscle of the face and the MD ASA™ for assessment of favourable and unfavourable features in patients. For the first time, event sessions were live-streamed through the AMI Digital World, including a session designed for clinicians to inject along with Dr de Maio in their own clinics. This allowed a greater number of clinicians to benefit from access to this world-leading educational programme, in line with Allergan’s commitment to improve standards and capabilities in medical aesthetics. Nancy Ghattas, associate vice president for Allergan UK and Ireland country manager, said, “Allergan has a proud history of developing the highest quality aesthetic products and is committed to raising standards in medical aesthetics. Working with thought leaders and experts, the Allergan Medical Institute is dedicated to promoting excellence in clinical practice through the delivery of industry leading and innovative education and training to doctors, dentists and nurses. Our focus on patient safety and outcomes ensures that where our products are used, patients can be confident they will receive safe and effective treatment from appropriately qualified and experienced medical professionals.” To join the AMI Digital World visit allerganmedicalinstitute.com.

A-LIST TRENDS OF 2019 EVENT, ADONIA MEDICAL CLINIC, LONDON Dr Ifeoma Ejikeme welcomed guests to her Adonia Medical Clinic for an event that uncovered the aesthetic A-list trends of 2019. Canapés and drinks were served on arrival, before Dr Ejikeme gave an insight into the aesthetic treatments loved by celebrities such as Kim Kardashian. There was also a demonstration of the new Ultraformer III and AQUAGOLD fine touch devices.

RSM Aesthetics-11, Royal Society of Medicine, London The Royal Society of Medicine in London played host to the RSM Aesthetics-11 conference. Chaired by Dr Patrick Treacy, the event brought together a multi-professional faculty and delegate community to identify and discuss the best options for aesthetic clinical care, with optional workshops also running throughout the day. Dr Treacy said, “This Congress was dedicated to teaching the delegates in a purely scientific fashion. This is the way a field of medicine should be represented, to extend knowledge and not for profit or gain. There were lecturers from 12 nations, five of them professors, each the top of their field in either plastics, oculoplastics, dermatology, aesthetic physicians, dentists and aesthetic nurses. “Everyone’s opinion was reflected and represented. The conference maintained a theme of addressing complications and the patients were invited and allowed to express their opinions and personal journeys.”

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The one stop shop for all your medical aesthetic and clinic supplies.

WINNER 2016

Wholesaler of the Year

London | Loughborough | Online

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ChurchPharmacy.co.uk

ChurchPharmacy

01509 357 300

ChurchPharmacyUK

skincare@churchpharmacy.co.uk