Cosmetic news june 2013

COSMETIC NEWS THE UK’S LEADING TRADE TITLE FOR MEDICAL AESTHETIC PROFESSIONALS

INTRODUCING THE ALL NEW See inside for launch seminar events

I-LIPOXCELL

THE LATEST IN BODY SHAPING & FAT REDUCTION TECHNOLOGY

XCELL IN BODYSHAPING

LAUNCH SEMINAR / 24 JUNE 2013

@ THE ROYAL SOCIETY OF MEDICINE, LONDON SEE INSIDE FOR DETAILS

ALSO IN THE JUNE ISSUE OF COSMETIC NEWS...

MALE TREATMENTS

ACNE

KEOGH REVIEW LATEST

PSYCHODERMATOLOGY

Bocouture® 50 Abbreviated Prescribing Information Please refer to the Summary of Product Characteristics (SmPC). Presentation 50 LD50 units of Botulinum toxin type A (150 kD), free from complexing proteins as a powder for solution for injection.

Indications Temporary improvement in the appearance of moderate to severe vertical lines between the eyebrows seen at frown (glabellar frown lines) in adults under 65 years of age when the severity of these lines has an important psychological impact for the patient. Dosage and administration Unit doses recommended for Bocouture are not interchangeable with those for other preparations of Botulinum toxin. Reconstitute with 0.9% sodium chloride. Intramuscular injection (50 units/1.25 ml). Standard dosing is 20 units; 0.1 ml (4 units): 2 injections in each corrugator muscle and 1x procerus muscle.

May be increased to up to 30 units. Not recommended for use in patients over 65 years or under 18 years. Injections near the levator palpebrae superioris and into the cranial portion of the orbicularis oculi should be avoided. Contraindications Hypersensitivity to Botulinum neurotoxin type A or to any of the excipients. Generalised disorders of muscle activity (e.g. myasthenia gravis, Lambert-Eaton syndrome). Presence of infection or inflammation at the proposed injection site. Special warnings and precautions Should not be injected into a blood vessel. Not recommended for patients with a history of dysphagia and aspiration. Adrenaline and other medical aids for treating anaphylaxis should be available. Caution in patients receiving anticoagulant therapy or taking other substances in anticoagulant doses. Caution in patients suffering from amyotrophic lateral sclerosis or other diseases which result in peripheral neuromuscular dysfunction.

Too frequent or too high dosing of Botulinum toxin type A may increase the risk of antibodies forming. Should not be used during pregnancy unless clearly necessary.

Interactions Concomitant use with aminoglycosides or spectinomycin requires special care. Peripheral muscle relaxants should be used with caution. 4-aminoquinolines may reduce the effect. Undesirable effects Usually observed within the first week after treatment. Localised muscle weakness, blepharoptosis, localised pain, tenderness, itching, swelling and/or haematoma can occur in conjunction with the injection.

Temporary vasovagal reactions associated with pre-injection anxiety, such as syncope, circulatory problems, nausea or tinnitus, may occur. Frequency defined as follows: very common (≥ 1/10); common (≥ 1/100, < 1/10); uncommon (≥ 1/1000, < 1/100); rare

(≥ 1/10,000, < 1/1000); very rare (< 1/10,000). Infections and infestations; Uncommon: bronchitis, nasopharyngitis, influenza infection. Psychiatric disorders; Uncommon: depression, insomnia. Nervous system disorders; Common: headache; Uncommon: facial paresis (brow ptosis), vasovagal syncope, paraesthesia, dizziness. Eye disorders; Uncommon: eyelid oedema, eyelid ptosis, blurred vision, eye disorder, blepharitis, eye pain. Ear and Labyrinth disorders; Uncommon: tinnitus. Gastrointestinal disorders; Uncommon: nausea, dry mouth. Skin and subcutaneous tissue disorders; Uncommon: pruritus, skin nodule, photosensitivity, dry skin. Musculoskeletal and connective tissue disorders; Common: muscle disorders (elevation of eyebrow), sensation of heaviness; Uncommon: muscle twitching, muscle cramps. General disorders and administration site conditions; Uncommon: injection site reactions (bruising, pruritis), tenderness, Influenza like illness, fatigue (tiredness). General; In rare cases, localised allergic reactions; such as swelling, oedema, erythema, pruritus or rash, have been reported after treating vertical lines between the eyebrows (glabellar frown lines) and other indications. Overdose May result in pronounced neuromuscular paralysis distant from the injection site. Symptoms are not immediately apparent post-injection. Bocouture ® may only be used by physicians with suitable qualifications and proven experience in the application of Botulinum toxin.

Legal Category POM. List Price 50 U/vial £72.00. Product Licence Number PL 29978/0002. Marketing Authorisation Holder Merz Pharmaceuticals GmbH, Eckenheimer Landstraße 100, 60318 Frankfurt/Main, Germany. Date of revision of text FEB 2012. Full prescribing information and further information is available from Merz Pharma UK Ltd., 260 Centennial Park, Elstree Hill South, Elstree, Hertfordshire WD6 3SR. Tel: +44 (0) 333 200 4143 Adverse events should be reported. Reporting forms and information can be found at yellowcard.mhra.gov.uk. Adverse events should also be reported to Merz Pharma UK Ltd at the address above or by email to medical.information@merz.com or on +44 (0) 333 200 4143.

1086/BOC/JUN/2012/JH

Date of preparation July 2012

Bocouture® is a registered trademark of Merz Pharma GmbH & Co, KGaA.

Editor’s Letter Welcome to the June issue of Cosmetic News.

The beauty industry has always been dominated by women and, while that is still the case, the male grooming market has seen a phenomenal growth in the last two decades and more and more men are heading through the doors of aesthetic clinics to improve their appearance. As part of this month’s special feature (p2128) we will be looking at the most popular treatment for men. Dr Jo Ward also shares her experiences of treating acne (p32-34) and we find out about the latest innovation in body shaping from Chromogenex iLipoXcell (p42-43).

As well as this we report on a meeting at the House of Lords to discuss dermal fillers in the wake of the Keogh Review (p12-13) and Dr Reena Shah explains the powerful link between psychology and dermatology (p37-38).

I am also excited to tell you about the launch of The Aesthetics Conference, Ireland.

The first meeting of its kind for the Irish market, the conference will take place on Saturday September 28 at the City North Hotel Dublin and we are really looking forward to expanding the Cosmetic News brand. I am also looking forward to finding out about the latest laser innovations at the Fotona meeting in Slovenia. See next month’s magazine for my report.

cosmetic news the uk’s largest trade aesthetics exhibition and conference

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Contents INDUSTRY INSIDER PRODUCT REVIEWS 4 EDITOR’S CHOICE

Vicky Eldridge on RevitaBrow®

42 [COVER FEATURE] TREATMENT SPOTLIGHT

6 INDUSTRY NEWS

We round up the latest industry news

We find out about the latest innovation in fat reduction from Chromogenex - i-LipoXcell

12 NEWS SPECIAL REPORT

We report on a meeting at the House of Lords to discuss dermal fillers in the wake of the Keogh Review

46 PRODUCT FOCUS

14 ON THE SCENE

Everything you need to know about Galderma’s FDA approved selfoccluding topical local anesthetic cream, Pliaglis

Out and about in the industry this month

48 PROMOTIONAL FEATURE

16 AESTHETIC AWARDS

Everything you need to know about entering The Aesthetic Awards 2013-14

We find out how Endocare from AesthetiCare offers an innovative approach to skin regeneration by utilising SCA biorepair technology

CLINICAL PRACTICE

50 PRODUCT NEWS

We round up the latest product news 30 CASE STUDY

Dr Johanna Ward shares her experiences of treating acne

IN BUSINESS 52 BEST PRACTICE

37 DERMATOLOGY

Clinical psychologist and psychodermatology specialist, Dr Reena Shah, explains the powerful link between skin disorders and psychology

RevitaBrow®

Our eyebrows are one of our most noticeable and expressive facial features so it is no surprise that their shape and style has become an important aspect of perceived beauty.

As hair and make-up styles change to reflect the latest craze, so does the ‘look’ of our eyebrows, so much so that they have become a fashion statement in their own right. Thin, barelythere brows used to be all the rage but over time the trend has moved progressively towards eyebrows that are fuller and more natural looking. This is not good news for anyone, like my mum, for example, who, like so many women in the 1960s over plucked her eyebrows and has been left with a virtually non-existent brow, which needs to be drawn in.

Luckily for her I work in an industry where very few beauty bugbears cannot be solved! I gave her a sample of RevitaBrow®, the brow product developed by the creators of RevitaLash®. Distributed by SkinBrands, RevitaBrow® is the ultimate tool for bringing sparse, damaged eyebrows back to life. The natural formula stimulates hair growth leaving brows thicker, fuller and superbly defined.

Utilising the power of peptides and botanicals for a strengthening, conditioning and nourishing formula, the product works to stimulate hair growth for thicker more beautiful eyebrows. Completely safe, RevitaBrow®’s ingredients have been vigorously tested and have excellent safety profiles. The product is applied once a day to a clean, and dry eyebrow hair using several short strokes where hair needs to be thicker and retails at £87.

21-30 [SPECIAL FEATURE] MALE TREATMENTS We look at the most popular aesthetic treatments for men

CLINICAL PRACTICE

Editor’s choice

We give you an update on the latest situation regarding VAT

The results my mum has experienced have been impressive. She now has some fine hairs growing across the whole of her brow where once there were none and has definitely noticed an improvement. I have now started using it on my own eyebrows, which although are quite full, have a few small sparse patches that I would rather do without. Cara Delevingne eat your heart out!

55 BUSINESS FOCUS

Richard Crawford-Small on lessons from Keogh to maximise your business

40 VIEW ON

58 A DAY IN THE LIFE OF…

Dr Patrick Treacy gives his view on the latest media coverage that has shed confusion on whether or not botulinum toxin cures depression

Antonia Mariconda finds out what a typical Day in the Life has in store for Dr Zein Obagi

CONTACT THE COSMETIC NEWS TEAM ON 01268 754 897

Charlotte Body Publisher | charlotte@creativemedialtd.co.uk Vicky Eldridge Editor | M: 07940 083 677 | vicky@creativemedialtd.co.uk Hollie Dunwell Sales Manager | M: 07538 332 171 | hollie@creativemedialtd.co.uk

60 TRAINING NEWS AND DATES FOR THE DIARY

The latest dates for your diary

Sophie Belcher Events/Production | sophie@creativemedialtd.co.uk Peter Johnson Art Director | peter.johnson@creativemedialtd.co.uk DISCLAIMER

The editor and the publishers do not necessarily agree with the views expressed by contributors and advertisers nor do they accept responsibility for any errors in the transmission of the subject matter in this publication. In all matters the editor’s decision is final.

Belotero® now approved by the FDA • One of only 3 HA approved by the FDA currently promoted in the US • Optimal integration1 for superior evenness2 • Minimal local for sustained patient satisfaction4

voted as The Best by our customers in 2011 and 2012

Call Merz Aesthetics Customer Services now to find out more or place your orders: Tel: +44(0) 333 200 4140 Fax: +44(0) 208 236 3526 Email: customerservices@merz.com 1 Histological examination of human skin (eyelid dermis layer). Courtesy Dr. J. Reinmüller, Wiesbaden, Germany 2 Prager W, Steinkraus V. A prospective, rater-blind, randomized comparison of the effectiveness and tolerability of Belotero Basic versus Restylane for correction of nasolabial folds. Eur J Dermatol 2010;20 (6):748-52.

3 Taufig A, et al. A new strategy to detect intradermal reactions after injection of resorbable dermal fillers. J Ästhetische Chirurgie 2009; 2: 29-36 4 Reinmüller J et al. Poster presented at the 21 World Congress of Dermatology, Buenos Aires, Argentina, Sept 30 – Oct 5, 2007. Thereafter published as a supplement to Dermatology News: Kammerer S. Dermatology News 2007; 11: 2-3.

www.belotero.uk.com Merz Pharma Uk Ltd 260 Centennial Park, Elstree Hill South Elstree, Hertfordshire, WD6 3SR Tel: +44(0) 333 200 4140

BEL058/0113/FS

Gold Standard Customer Services

3

SAVE THE DATE FOR THE AESTHETIC AWARDS 2013-14 - DECEMBER 7, 2013

THE AESTHETICS CONFERENCE IRELAND

MAG

Cosmetic News launches Aesthetics Conference, Ireland

Cosmetic News is delighted to announce the launch of The Aesthetics Conference, Ireland.

The first meeting of its kind for the Irish market, the conference will take place on Saturday September 28, 2013 at the City North Hotel Dublin. Bringing together the most prestigious and respected speakers in the industry to discuss the latest topics and demonstrate the most up-to-date techniques, The Aesthetics

Conference, Ireland is an ideal opportunity for Irish delegates to network with peers and gain CPD accreditation on their home turf.

The delegate rate for the event is just € 199 and we expecting a turnout of more than 150 aesthetic professionals for the inaugural conference. The cost of a stand is £1,200 including a table, electricity and lunch for the team. There is limited availability for the event with stands selling fast.

Please contact Charlotte Body directly to discuss opportunities on charlotte@creativemedialtd.co.uk or 01268 754 897.

SUN AWARENESS WEEK

Sun Awareness Week survey results revealed Half of Britons think that their skin is darker than it actually is, putting them at risk of developing skin cancer, according to new research by the British Association of Dermatologists.

The statistics were released to mark the start of Sun Awareness Week and to launch the 2013 Be Sun Aware Mole and Sun Advice Roadshow supported by sun protection and skincare brand, La Roche-Posay. 1,350 people attending the organisation’s 2012 Mole and Sun Advice Roadshow were asked about skin cancer and sun safety. Only 50% of people correctly identified their own skin colour, which was then assessed by a dermatologist, from a list of options, with 48% thinking their skin was darker.

The survey also found that the desire for tanned skin is increasing, despite public health warnings against sunbathing. 62% said that they found tanned skin more attractive than paler skin, compared to 56% of people responding to a similar survey by the association five years ago. 80% of people infrequently or never check their skin for signs of skin cancer, despite this being the UK’s most common cancer type. Furthermore, 69% admitted they have no idea what to look for even if they were to check their skin. However, not knowing the signs of skin cancer is not the only obstacle to early diagnosis. Only half of respondents (50%) are happy to show a skin issue to their doctor, with the remaining half citing embarrassment, lack of time, fear of wasting the doctor’s time, not liking going to the doctor and fear of skin cancer as possible barriers.

Dr Bav Shergill of the British Association of Dermatologists said, “It is a concern that so many people think their skin is darker and tans more easily than is actually the case, as these people are likely to be spending longer in the sun than they should. I think this could be contributing to the increasing numbers of skin cancer cases I see in my clinics. We also need to address the misconception that a base tan is a good way of protecting against sunburn as this view is still very prevalent among men in particular.”

G

New team members for MAG Medical Aesthetic Group has appointed two members of staff to its team. Steve Hussey will be joining the company as director of sales and Nurse Prescriber Pauleen Hume, will be coming on board to organise and host product workshops and provide specialist product information.

The new appointments follow the departure of Katrina Ellison from the company. Managing director David Gower said, “We wish Katrina every success in her new demanding role with Sinclair IS and welcome Steve and Pauline to their new roles with medical aesthetics.”

ELLIPSE

Ellipse and Venus Systems hosts Venus Freeze Open Event Ellipse and Venus Systems will be hosting a Venus Open Event this month. The event will take place on Monday June 24 from 2pm – 8pm at the Ellipse and Venus Systems Head Office at 77 Fulham Palace Road.

Venus Freeze can be used for skin tightening, anti-ageing, cellulite reduction and inch loss for the face and body.

Demonstrations will be given throughout the event with presenters including product and clinical specialist Jacob Sharir and Ellipse and Venus managing director, Michael Dodd.

Smooth texture for a natural look and feel1 ive them a lift with

LaSting volume – up to 18 months1 SatiSfaction – 96% of patients would recommend Juvéderm® vOLumA® with Lidocaine to a friend 2

WITH LIDOCAINE

Talk to your Allergan Product Specialist or to Customer Services on

0808 238 1500 1 ml syringe

Juvéderm® – the world’s no.1 selling dermal filler 4

References: 1. Raspaldo H. J Cosmetic and Laser Therapy, 2008;10:134–142. 2. Fischer TC. Poster presented at EMAA, 1–3 October 2009, Paris. 3. Allergan Data on File (DoF), 2011.

4. Allergan Data on File (DoF) Marketing overview, 2011. Instructions and directions for use of JUvéDeRm® vOLUmA® with Lidocaine are available on request. Lidocaine does not affect the intrinsic performances of JuvéDERM® vOLuMA® and its safety profile, therefore, JuvéDERM® vOLuMA® data is representative of JuvéDERM® vOLuMA® with Lidocaine3

Date of Preparation: January 2013 UK/0008/2013a

INDUSTRY NEWS

see us at

CliniCal Workshops

• successful set up of an aesthetic clinic • 3D in imaging & skin analysis • Get laser smart • Try before you buy!

• Call now for FrEE admission

aesthetic awards 2012-13, triple win for aBc lasers Aesthetic Medical Treatment System

Contact us on: Tel: 0845 1707788 info@a-b-c-uk.com, www.abclasers.co.uk © 2013 Alma Lasers, Ltd. All rights reserved. Alma Lasers Ltd., its logos and Soprano, are trademarks or registered trademarks of Alma Lasers, Ltd. Product specifications are subject to change without notice.

EquipmEnt Brand of thE YEar aBc lasers

trEatmEnt of thE YEar (BodY) soprano pain free hair removal (aBc lasers)

trEatmEnt of thE YEar (facE)

harmony Xl piXel Qs aka the ‘laser face-lift’ (aBc lasers)

SAVE THE DATE FOR THE AESTHETIC AWARDS 2013-14 - DECEMBER 7, 2013

IMPLANT SCANDAL PROBE

COMPARISON WEBSITE

Wales cosmetic surgery probe after breast implant scandal

New era for hospital transparency begins with comparison website

Health Minister Mark Drakeford’s announcement follows the publication last month of a report in England which called for tougher rules. It was set up following the breast implant scandal which exposed lapses in product quality.

A total of 245 patients in Wales have had surgery due to faulty implants. The group will include members of the The National Specialist Advisory Group for Plastic Surgery, The Academy of Medical Royal Colleges in Wales, Healthcare Inspectorate Wales, The Welsh Healthcare Specialised Services Commission, The Welsh Independent Healthcare Association.

The group will report back by July.

BAAPS

BAAPS implements first Government recommendation from cosmetic surgery review In the wake of the findings from the Government enquiry into cosmetic surgery, the British Association of Aesthetic Plastic Surgeons has announced the implementation of one of the report’s major recommendations: for patients to be protected through insurance.

The BAAPS has worked with Lloyd’s of London to create a policy that will safeguard all patients of surgeons who are part of the association.

The ‘Aesthetic Surgery Commitment’ or ‘ASC’ policy is groundbreaking in that not only does it cover corrective treatment of all the most common complications of surgery (such as infection or bleeding) but also – a world first – capsular contracture, an abnormal reaction of the body to breast implants. Up to one in ten women who’ve undergone breast augmentation may develop this condition, but historically would have had to pay for corrective surgery themselves.

According to consultant plastic surgeon and BAAPS president Rajiv Grover, “In line with Sir Bruce Keogh’s recommendations for more safeguards in the aesthetic surgery sector, we are pleased to launch a truly innovative insurance package that will further protect our patients. No procedure is risk-free and ASC covers all common complications, so people undergoing surgery with BAAPS members can enjoy peace of mind that they will be looked after, in the unlikely event of any problems.”

The more common complications such as infection, haematoma (bleeding), seroma (build-up of fluid), nerve injury and others are all covered. Many of the conditions can develop a month or longer after the procedure is undertaken – and in the case of capsular contracture, it could be several months - so the policy automatically activates on the twenty-ninth day after the op and remains live for two years, as during that initial period hospitals would cover any complications.

8

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Matt James, chief executive of PHIN, said: “This first version of the PHIN website marks a significant step forward for transparency and patient choice in private healthcare. Those familiar with the sector will know that it has taken a lot of work and several years to reach this milestone.

Although the initial range of information is modest, we consider it vital to begin publishing now and we have a robust plan for adding more detail throughout 2013.”

Dr Andrew Vallance-Owen, chairman, added: “The healthcare sector as a whole is on a transformative journey towards far greater transparency and better use of information to promote choice and quality. Recent watersheds including the Francis Inquiry into Mid-Staffordshire NHS Trust and the ongoing Competition Commission review of independent healthcare have reinforced the importance of timely, accurate, joinedup information, accessible to those who need it. Independent hospitals must meet raised public expectations of the range of information to support their choices in healthcare.”

SINCLAIR APPOINTMENT

Katrina Ellison joins Sinclair Katrina Ellison has joined the Sinclair team as brand manager for Sculptra and Succeev.

Katrina has been in the industry since 2007 and has previously worked with the Sculptra brand for five years as national sales manger at Sanofi prior to the product’s sale.

She said, “I have a wealth of knowledge about the products as well as the market and am very excited about getting started.”

CORRECTION

Correction On page 24 of the May issue of Cosmetic News in his article ‘No Pain, No Gain’ Mike Murphy mistakenly indicated that the thermal conductivity of sapphire is four times that of quartz.

He says, “In fact, the conductivity of sapphire is actually closer to 30 times higher than that for quartz glass: 40 W/m K compared with 1.3 W/m K. This means that sapphire tips are much more efficient at cooling the epidermis than quartz tips.”

We apologise for any confusion.

cLiNicaL - view oN

N O PA I N – NO GAiN

ing

Skin Tighten

Mike Murphy gives his View On laser and light based ‘pain free’ hair removal

R The zone of good results

TOO HOT TEMPERATURE

It is the surgeon rather than the patient who is billed, but pricing starts as little as £50 for procedures up to the value of £2,000 and cover on a sliding scale is available for surgery worth up to £12,000. Higher cover can be quoted for.

According to consultant plastic surgeon and former president of the BAAPS Nigel Mercer, who worked on developing the policy, “We’re proud to have been working over the last year to help design a tailor-made policy based on comprehensive data and sound statistical analysis. Not only does this product directly address the issues highlighted by the Government’s review but it is also ready to be fully implemented. During these turbulent times in our sector, patients deserve a formal commitment.”

A new public website will enable patients and GPs to directly compare nearly 200 independent hospitals on a range of quality of care indicators for the first time.

Private Healthcare Information Network (PHIN), a collaboration involving almost all independent hospital operators, will publish standardised and directly comparable information drawn from records of both private and NHS treatment. The site enables patients and clinicians to search for local hospitals by procedure and to compare how they perform based on data from the treatment of more than a million patients a year.

duction Fat Re

An expert group is to be set up to consider whether tighter regulation is needed in Wales for cosmetic procedures, including surgery.

UNDER COOKED

ZONE OF GOOD RESULTS!

OVER COOKED

TOO COLD TIME

ecently I have seen more and more hair removal systems claiming to be

I often refer to the ‘zone of good results’ (see figure). This is the zone where the correct

‘pain-free’, particularly the homebased units. This always makes me

combination of temperature and time occur and, hence, good results should always occur.

wince! It clearly shows that the manufacturers/ suppliers do not understand how light energy destroys hair follicles.

As an example, think about boiling eggs. We all know that to boil the perfect egg you need to cook it at a suitable temperature for a sufficient

The bottom line is – no pain, no gain! It’s as simple

time. Cooking tissue is exactly the same – we want to achieve the permanent denaturation

as that. If your patient does not feel something then nothing will happen. The reason for this is

of the target’s proteins, without damaging the surrounding tissues.

due to simple biology. The dermis contains paintemperature nerves which register temperatures up to around 45°C. Beyond that they send pain signals

However, the problem is that patients generally want a pain-free treatment. This can result in many

to the brain to indicate excessive temperatures.

patients not returning for subsequent treatments.

The mechanism behind hair removal is the irreversible denaturation of the follicle germ

The answer to this problem is proper skin cooling during the treatment. The best way to achieve this is by contact surface cooling using a sapphire

cells. If hair germ cells are exposed to a temperature of 45°C they will need to maintain

tip. Sapphire is four times more conductive than quartz (which many IPL system use).

that temperature around for 288 seconds (just under 5 minutes) to ensure complete

Proper contact cooling will draw out heat from

denaturation of the proteins within. Only then will the hair follicle die permanently.

the dermis and epidermis much more efficiently than air cooling or cold gel alone. As long as the sapphire tip is sufficiently cold, I suggest around

The relationship is quite simple - successful tissue reactions occur when the temperature

5°C, then the pain can be successfully mitigated while still achieving good results. Post-treatment

and time combination is right. In practice this means the longer the pulselength the lower

cooling is also a good idea. It helps to sooth the patient’s skin and reduces erythema and oedema.

the temperature required. For a 1ms pulse you need to achieve a temp of approx. 81°C, and for a 50ms you need approx. 69°C, to

The bottom line is, if your patient does not feel something during treatment by laser/IPL then they

achieve irreversible protein denaturation. (These

will most likely not achieve the desired result. The

calculations assume a constant heating over the duration of the pulselength.) The temperature achieved within the tissues is dependent on the

existing hair may fall out but a new one will grow in, over time. The follicle will remain viable.

energy density and wavelengths used.

Sorry, but it really is a case of – no pain, no gain!

Mike Murphy is a physicist/bioengineer who has been involved in medical laser research since 1986 and in the commercial sector since 1989. His original research group developed the scar-free removal of tattoos by Q-switched ruby laser in Canniesburn Hospital, Glasgow. He now runs training courses on IPL systems and aesthetic lasers and their applications. www.dermalase.co.uk

24 www.cosmeticnewsuk.com

Cellulite

INDUSTRY NEWS

Why c • A complete approach to the problem • Prescriptive • Multi-functional • Inch loss • Contouring • Cellulite • Face and Body skin tightening • Highly profitable • No exercise required

Complete start up and support package available from under £400 per month

Before

After

For further information or a demon call: 01788 550 440

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The Next

• successful set up of an aesthetic clinic • 3D in imaging & skin analysis • Get laser smart • Try before you buy!

• Call now for FrEE admission

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• Ltd., SopranoCosmetic Award winning Treatment of the year from its logos and Soprano, areNews trademarks or registered trademarks of Alma Lasers, Ltd. Product specifications are 2011, 2012, 2013 subject to change without notice. © 2013 Alma Lasers, Ltd. All rights reserved. Alma Lasers Ltd., its logos and Soprano, are trademarks or registered trademarks of Alma Lasers, Ltd. Product specifications are subject to change without notice.

aesthetic awards 2012-13, triple win for aBc lasers

soprano ice ad.indd 1

Aesthetic Medical Treatment System

Contact us on: Tel: 0845 1707788 soprano ice ad.indd 1 info@a-b-c-uk.com, www.abclasers.co.uk © 2013 Alma Lasers, Ltd. All rights reserved. Alma Lasers Ltd., its logos and Soprano, are trademarks or registered trademarks of Alma Lasers, Ltd. Product specifications are subject to change without notice.

EquipmEnt Brand of thE YEar

1/7/13 8:43

aBc lasers

trEatmEnt of thE YEar (BodY) soprano pain free hair removal (aBc lasers)

trEatmEnt of thE YEar (facE)

harmony Xl piXel Qs aka the ‘laser face-lift’ (aBc lasers)

1/7/13 8:43 PM

SAVE THE DATE FOR THE AESTHETIC AWARDS 2013-14 - DECEMBER 7, 2013 EXPO EARLY BIRD OFFER

cosmetic news the uk’s largest trade aesthetics exhibition and conference

MICRODERMABRASION SPECIALISTS

ex po 2014

exhibition and conference

8 th - 9 th march 2014

Book your tickets for The Aesthetics Conference at The Cosmetic News Expo 2014 and take advantage of our Early Bird Offer

IMPROVES

ANTI

SKIN

AGEING

CONDITIONS

The UK’s number one Aesthetic event. We are delighted to offer all those who book their place at the Aesthetics Conference 2014 before September 30, 2013 a 10% discount on the price of their delegate ticket. Tickets for the 2014 conference cost £89 for one day or £160 if you book for both days. A complimentary lunch will be incorporated into the delegate package, with refreshments provided throughout the conference breaks.

To book your place visit www.cosmeticnewsuk.com or call the Events Team on 01268 754 897.

COSMETICS REGULATIONS CRYSTAL

Shake up in cosmetic regulations

PEELING

DIAMOND PEELING

RESULTS DRIVEN TREATMENTS

Cosmetic laws in the UK and EU are about to have a significant makeover. From July 11, 2013, the legislation will be brought bang up to date and new rules will take effect.

The new cosmetics regulation (EC 1223/2009) will be directly applicable in every country of the European Union including UK. Anyone who already sells products in the UK and Europe or plans to sell them in the future will be affected. The current rules still apply, but certain areas have been beefed up - particularly on the safety front and there will also be a central EU system for notification of all cosmetic and beauty products.

Key changes include: • Notification of all products (new and existing) will be required prior to launch • The responsible person and the distributor have more responsibility in respect of safety and ensuring compliance with the new Regulation • Product manufacturing must now comply with EU GMP standards • A comprehensive safety assessment of the ingredients and how the product will be used must be carried out by a competent suitably qualified person in the EU

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Actress has Refresh after battle with cancer South African-born actress, Sally Farmiloe, famed for her role in TV’s Howards’ Way, has had Restylane Lip Refresh treatment at Absolute Aesthetics following her battle with cancer.

Sally, who has written a book about her experience called My Left Boob – A Cancer Diary in aid of Royal Marsden Hospital and Yes to Life Cancer Charity, found her lips were left cracked and flaky due to the dehydration caused by chemotherapy.

Dr Kuldeep Minocha who carried out the treatment said, “The beauty of Lip Refresh it its unique ability to rehydrate the lips without plumping. It does this by its advanced hydrophilic nature, restoring the natural hydrobalance of the lips. Sally was very specific that she did not want a ‘trout pout’ or lips that looked as if they had been over-enhanced. I have found that clients suffering with eczema of the lips have benefited significantly. I am using an innovative micro-cannula technique to inject the lips, without the use of a needle.”

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INDUSTRY NEWS

SPECIAL REPORT

Backing the future We report on a meeting at the House of Lords to discuss the future of dermal fillers in the wake of the Keogh Review

W

ith the Keogh Review publishing its findings last month, the spotlight has once again been firmly on the aesthetics industry. Although the review was launched to address concerns about safeguarding the public following the PIP breast implant scandal, one area that has also been subject to serious scrutiny, both during speculation about the review and in the report itself, is dermal fillers.

As a result, Treatments You Can Trust.org.uk chairman, Baroness Trish Morris of Bolton OBE DL, assembled a panel of experts to take forward the agenda on dermal fillers at the House of Lords.

One of the key points of discussion was to be proposals in the Cosmetic Interventions Review that dermal fillers should become prescription only devices.

reclassified as prescription only devices and whether doing his would really help tighten up this unregulated sector.

The meeting was attended by select members of the press, leading manufacturers including Allergan, Lifestyle Aesthetics (Teoxane) and Merz Aesthetics as well as industry leaders, members of the Department of Health Keogh Review Implementation team, the General Medical Council, the British Dental Association, practising practitioners and Treatments You Can Trust Governance Board members.

“The review recommendations cover a broad scope; however what is central is the ambition to make patient safety paramount and to ensure consumers are empowered to make a choice. The lack of available information on the number and descriptions of dermal fillers injected demonstrates the clear need for better data collection. Whilst we wait for the Government’s response to the review and for the recommendations to be implemented, it is important that safety measures remain in place and Treatments You Can Trust should continue to do this.”

The key issues continue to be: who should be injecting dermal fillers, although interestingly the review did not dismiss non-medics administering them, as long as they were properly trained; raising the standards of training and whether or not fillers should be

12 www.cosmeticnewsuk.com

Following short introductions by Sally Taber, director of TYCT, and Baroness Morris, Dr Andrew Vallance-Owen, a member of Sir Bruce Keogh’s Cosmetic Interventions Review team, got up to explain the implications for dermal fillers following the Keogh report.

He said, “The review really came about because of the PIP implant debacle but then they took on a much broader agenda from cosmetic surgery right through to injectables.

Some of us have been lobbying for the Department of Health to get more involved in some of the issues in the private sector for many years but because of the PIP scandal it was the first time they really felt they had to set up a proper working group, led by Sir Bruce Keogh.

Dr Patrick Bowler, co-founder and Fellow of the British College of Aesthetic Medicine, and medical director of Court House Clinics was

Key points discussed at the meeting included: THE NEED FOR DILIGENT DATA COLLECTION AND RECORDING IN THE INDUSTRY • • •

Enable traceability and accountability of individual fillers To monitor the number of fillers carried out and the number of providers Improved reporting of incidents where an adverse reaction occurs

DEFINITION OF A MEDICAL DEVICE •

•

•

• •

Dermal filers do not automatically fall within the definition of medical devices but they will under proposals for revising EU legislation Most dermal fillers that are used in the UK by reputable clinicians and organisations have been subject to the medical devices regulatory process Change of dermal fillers to Prescription Only Devices will require primary legislation which will take time through the legislative framework If this takes place it will contribute to greater control over who is allowed to use dermal fillers Rarely done before- but example of prescription only glasses (i.e. devices) shows it is possible

NEED FOR COHESIVE WORKING WITHIN THE INDUSTRY •

To maintain the impetus already achieved by Treatments you can Trust, all members of the industry must continue to work together to ensure the agenda of patient safety is taken forward and prioritised

•

The willing co-operation between Treatments You Can Trust and manufacturers has already shown safety can be improved quickly by the industry itself

next to speak giving the benefit of his wealth of experience in the field of injectables to examine the UK dermal fillers market, how the industry has evolved over the years and what can go wrong.

Although he was keen to emphasise that severe complications were very rare and not limited to non-medics, the shocking pictures served to strengthen the argument that only medical trained practitioners should be performing fillers because they can recognise and deal with any resulting problems in a way that non-medically trained people may not be able to. He said, “Dermal Fillers for improving facial appearance are worth over £2 billion to the UK cosmetic beauty industry, yet until now are procedures that have been subject to very little regulation. Anyone in the UK- literally anyonecan administer fillers, without training, by obtaining products through the internet. This is despite the fact that they can have major, permanent effects on people’s health and wellbeing. The risks are greater if treatments are given by inexperienced non-medical professionals. Even in the best hands things can go wrong but if serious adverse events are diagnosed early they can be treated with prescription only medication, which can improve the outcome for these patients.”

Next to address the group was John Wilkinson, director of devices at the MHRA, who spoke about the part the MHRA has to play and what medical devices and prescription only devices actually are. He said, “A medical device is any instrument, apparatus, appliance, software, implant, reagent or other article, intended by the manufacturer to be used for one or more specific medical purposes. Under current legislation, not all dermal fillers fit into this definition. Legislative proposals set before the European Parliament will include dermal fillers along with other categories of products that serve cosmetic purposes to

be regulated as if they were medical devices.”

The final speaker was Tania Gerald, regulatory affairs leader for medical devices at Allergan who was there to represent the views of leading filler manufacturers on the recommendations surrounding these products.

She discussed the stringent processes that responsible manufacturers already put in place to ensure safety and efficacy are a number one priority. She also spoke about the responsibilities that the industry as a whole has from the patient and practitioner to the manufacturers and regulators.

The meeting ended with a lively Q&A where some interesting points were raised from the audience.

Cosmetic News editor Vicky Eldridge asked if new mandatory training standards were introduced whether it meant everyone in the industry would be required to re-train or whether experience would count for anything. Dr Vallance-Owen responded, “This is one of the things we will have to look at but whether you are a doctor, a dentist or a nurse you will have to demonstrate you are qualified to do cosmetic injectables. I am sure experience will be taken into account but if you can’t demonstrate that you have had that clinical training in anaphylactic shock, patient anatomy, side effects etc you will need to go through that to assure patients you have that level of training.”

Professor Nick Lowe, who was representing the British Association of Dermatologists, also raised a number of points. He said, “I really welcome all this discussion however there are several things I want to point out. The fact that dermal fillers can be injected ‘anywhere’ seems to me to be one loophole that could be addressed. My own clinic is CQC approved and, as such, I have to report any adverse events to the CQC. If indeed all premises were so similarly approved then surely that would

be one mechanism of collecting adverse data.

The other thing I wanted to address was training.

BAAPS and the BAD have been talking together about training requirements. There are actually some really good precedents for this, one of which is the Diploma in Dermatology, which could be modified to very easily add an aesthetic training programme, which could then be validated.”

Sally Taber commented, “The very fact that the Department of Health implementation team came to listen to the views of the industry demonstrates a willingness to engage with and listen to all stakeholders as the recommendations are considered. There is an industry wide consensus that patient safety should not get overlooked and in the meantime TreatmentsYouCanTrust.org.uk can continue to deliver this whilst also acting as a template and a working register with a set of high standards that ensure best practice.”

Baroness Morris commented, “I have been hugely impressed in the year that I have been chairing the TYCT Governance Group with the professionalism and the expertise. A great deal of what has come out of the Cosmetic Intervention Review are things that we have been striving to achieve. I would like to pay particular tribute to Sally Taber who works tirelessly to make sure the public are well informed, that there are professional standards in the industry and that there is a good and robust complaints division.”

Although we will still have to wait for some time before any changes to the practice of dermal fillers are actually implemented and can still only continue to speculate about what these will be, the timeliness of the meeting showed that the industry is keen to get the ball rolling towards change. The event raised some interesting debate and showed an industry that is untied in its desire to raise standards and promote best practice.

Although there were some notable absences, Sally Taber urged those people not present to put any political differences aside and stand beside their colleagues as we strive to gain back the good reputation of our industry and renew public faith in medical aesthetic treatments.

The very fact that the Department of Health implementation team came to listen to the views of the industry demonstrates a willingness to engage with and listen to all stakeholders as the recommendations are considered www.cosmeticnewsuk.com 13

ON THE SCENE | OUT AND ABOUT IN THE INDUSTRY THIS MONTH

ON TH E S C E N E A DECADE IN AESTHETICS We report on The Consulting Room™ 10th Anniversary Party On May 9, 2003 a unique and innovative website was launched into the UK aesthetics industry. The Consulting Room™ (www. consultingroom.com) was the first resource of its kind to offer unbiased information and advice about cosmetic surgery and medical aesthetic treatments to the general public, whilst assisting them in contacting reputable clinics.

Following the SMART IDEAS event on Saturday April 27, The Consulting Room™ team and many of the medical practitioners, clinic owners and industry suppliers who have supported them over the last decade put on their party clothes for an informal bash to celebrate the website’s 10th anniversary.

Company directors Ron Myers and Martyn Roe, along with founding members Dan Huxley (web master) and Lorna Jackson (editor) and newer members of the team were very proud to celebrate the 10th birthday of both the company and its flagship website, now the UK’s largest aesthetic information resource you will find online.

The evening kicked off with drinks and much tomfoolery for the cameras, which saw some creative poses from party-goers, followed by a buffet and a fun quiz covering the last 10 years of both the industry and current affairs, with much cheating going on thanks to smart phones it seems from the photos! (The winners of the quiz were the table from Persona Medical).

An interval included an entertaining challenge to raise money for Help The Heroes, organised by the Mapperley Park Clinic, which saw some chocoholics attempt to eat as many Ferrero Rocher as they could in a minute, a process which was not as messy as was first thought! With the wine (and champagne!) flowing, along with the home made cup cakes and bags of children’s party sweets (thanks to the main sponsors Syneron Candela and Rosmetics), the atmosphere was celebratory and relaxed. Presentations were made to mark the achievement of 10 years, and some emotional words were said by all concerned making it a pride filled evening. Finally the evening was rounded off with a disco, including a set on the decks by ‘DJ’, Dr Raj Acquilla (and his glamorous assistant Dr Tapan Patel)!

Ron said, “The team at The Consulting Room™ and myself could not be more proud of our achievements, but we would also like to thank all those in the aesthetic industry who have continued to support our efforts during the last decade.”

14 www.cosmeticnewsuk.com

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EVENTS

THE AESTHETIC AWARDS 2013-14

EN T E R I NG TI ME Online entry for the Aesthetic Awards 2013-2014 opened last month so hereâ&#x20AC;&#x2122;s a run down of what you have to do to enter or nominate your favourite companies, people and brands

The Aesthetic Awards is the premier awards event for the aesthetics industry and will once again be celebrating the achievements of the practitioners, clinics, products and treatments that represent the gold standard in cosmetic medicine.

The Awards will take place on Saturday December 7 at The Grange Tower Bridge Hotel, London and will have a Winter Wonderland theme. Entering could not be simpler. Just go to www.cosmeticnewsuk.com and fill out our online entry form.

You can enter as many categories as you like as well as nominating other people, products, companies and associations who you think are worthy winners.

AWARDS FOR MANUFACTURERS AND SUPPLIERS BEST PRODUCT INNOVATION Who is this award for? This award is designed to recognise the most innovative new products on the market. Products should have been launched into the UK market in 12 months before the 2013 awards entries opened (May 2012-2013).

Who can enter/nominate? Manufacturers, suppliers and distributors can nominate/enter their own products in this category. Clinics and practitioners can also nominate their favourite products in this category.

How will the winner be decided? The winning product in this category will be decided based on the number of votes it receives and feedback from the judges.

BEST NEWCOMER (PRODUCT OR TREATMENT) Who is this award for? This award is designed to recognise the newest products and treatments on the market. Products/treatments should have been launched into the UK market in the 12 months before the 2013 awards entries opened (May 2012 -May 2013).

Who can enter/nominate? Manufacturers, suppliers and distributors can nominate/enter their own products/treatments in this category.

Clinics and practitioners can also nominate their favourite products and treatments in this category.

How will the winner be decided? The winning product/treatment in this category will be decided based on the number of votes it receives and feedback from the judges.

COSMECEUTICAL OF THE YEAR This award will go to the best cosmeceutical product range in the UK. This can be any professional use product range that is retailed in UK medical aesthetics clinics.

Who can enter/nominate? Manufacturers, 16 www.cosmeticnewsuk.com

suppliers and distributors can nominate/enter their own product ranges in this category. Clinics and practitioners can also nominate their favourite cosmecuetical product ranges in this category.

How will the winner be decided? The winning cosmeceutical product range in this category will be decided based on the number of votes it receives and feedback from the judges.

INJECTABLE PRODUCT OF THE YEAR This award will go to the manufacturer/UK distributor of the injectable product â&#x20AC;&#x201C; this includes dermal fillers and botlulinum toxin - that is deemed to be the best available in the UK. Who can enter/nominate? Manufacturers/ distributors can nominate/enter their own injectable products in this category. Clinics and practitioners can also nominate their favourite injectable product in this category.

How will the winner be decided? The winning injectable product in this category will be decided based on the number of votes it receives and feedback from the judges.

TREATMENT OF THE YEAR (FACE) This award will be given to the manufacturer/ supplier with the best medical aesthetic treatment for the face. This can be anything from peels to laser or dermal rollering.

Who can enter/nominate? Manufacturers/ suppliers can nominate/enter their own facial treatments in this category. Clinics and practitioners can also nominate their favourite facial treatments in this category.

How will the winner be decided? The winning facial treatment in this category will be decided based on the number of votes it receives and feedback from the judges.

TREATMENT OF THE YEAR (BODY) This award will be given to the manufacturer/ supplier with the best medical aesthetic treatment for the body. This can be anything from peels to laser or dermal rollering.

Who can enter/nominate? Manufacturers/ suppliers can nominate/enter their own body treatments in this category. Clinics and practitioners can also nominate their favourite body treatments in this category.

How will the winner be decided? The winning body treatment in this category will be decided based on the number of votes it receives and feedback from the judges.

BEST SELLING RETAIL PRODUCT This award will be given to the manufacturer/ distributor of the best selling retail product that is currently sold in medical aesthetic clinics in he UK. Who can enter/nominate? Manufacturers/ distributors can nominate/enter their best selling products in this category. Individual products should be entered, separately, not as a range (for this enter Cosmeceutcial of the Year).

Clinics and practitioners can also nominate the products that are the best sellers in their clinics.

How will the winner be decided? The winning product in this category will be decided based on the number of votes it receives and feedback from the judges.

EQUIPMENT BRAND OF THE YEAR The winner of this award will be the manufacturer or UK distributor of what is deemed to be the best equipment brand available in the UK today. This award is not limited to lasers but any supplier of equipment used in the medical aesthetics environment. This award is for the brand as a whole.

Individual products/treatments can be entered into other categories such as Treatment of the Year, Best Newcomer or Best Product Innovation.

Who can enter/nominate? Manufacturers/ distributors can nominate/enter their equipment brands in this. Clinics and practitioners can also nominate the manufacturers/suppliers that they feel offer the best equipment to meet their needs.

How will the winner be decided? The winning equipment brand in this category will be decided based on the number of votes it receives and feedback from the judges.

BEST WEIGHT LOSS/DIET PROGRAMME

A new category introduced at the 2012/2013 awards, this award is designed to acknowledge the new and emerging area of in-clinic weight loss and diet programmes.

Who can enter/nominate? Manufacturers/ distributors can nominate/enter their weight loss and diet programmes in this category. Clinics and practitioners can also nominate the weight loss/diet programme that they feel is most deserving of this award.

How will the winner be decided? The winning weight loss/diet programme in this category will be decided based on the number of votes it receives and feedback from the judges.

THE JANEĂ&#x2030; PARSONS AWARD FOR SALES REPRESENTATIVE OF THE YEAR Re-named in honour of Obagi territory manager JaneĂŠ Parsons who tragically died on the night

BEST ADVERTISING CAMPAIGN BY A MANUFACTURER/SUPPLIER

of the 2012 Aesthetic Awards, this award is designed to acknowledge the hard work and services provided by sales reps working for manufacturers and suppliers in the UK. Who can enter/nominate? If you are a sales rep working for a medical aesthetics company in the UK then you can enter yourself into this category. Anyone working for manufacturers/ distributors in the UK can also nominate their colleagues for this award.Clinics and practitioners can also nominate the sales reps that they feel are most deserving of this award.

How will the winner be decided? The winner in this category will be decided purely on the number of votes they receive from their colleagues and customers.

This award will be given to the manufacturer/ supplier with the most memorable and effective UK advertising campaign.

Who can enter/nominate? UK manufacturers and suppliers/advertising agencies who have created ad campaigns in both the consumer and trade arenas can enter themselves into this category. Clinics and practitioners can also nominate the companies that they feel have created memorable advertising campaigns and are most deserving of this award.

How will the winner be decided? The winner in this category will be decided by a panel of judges with expertise in the areas of advertising and marketing.

BEST CUSTOMER SERVICE BY A MANUFACTURER/SUPPLIER This award will be given to the UK manufacturer/ supplier deemed to offer the best customer service as judged by their customers.

Who can enter/nominate? UK manufacturers and suppliers who are proud of the customer service they offer can enter themselves into this category. Clinics and practitioners can also nominate the companies that they feel offer the best customer service and are most deserving of this award.

How will the winner be decided? The winner in this category will be decided purely on the number of votes they receive from their customers.

AWARDS FOR CLINICS/PRACTITIONERS RISING STAR

This award will be presented to an up and coming practitioner who may not have the longevity of some of their colleagues but who has made an impact in their field.

Who can enter/nominate? You can enter yourself for this award or nominate someone else who you feel is a deserving winner.

How will the winner be decided? The winning practitioner will be judged on the number of votes they receive from Cosmetic News readers as well as their peers, customers and industry representatives.

BEST NEW CLINIC

This award will be presented to the best new clinic in the UK. Who can enter/nominate? Any new UK based clinic can enter into this category. You can also nominate any new clinic that you feel is a deserving winner.

How will the winner be decided? Mystery shoppers will be sent to the clinics who have been shortlisted and their feedback as well as feedback from customers and the number of votes received will determine the winner.

BEST CLINIC CHAIN

This award is designed to recognise clinics who have a chain of practices in the UK. Who can enter/nominate? Any UK based clinic chain can enter into this category. You can also nominate any clinic chain that you feel is a deserving winner.

How will the winner be decided? Mystery shoppers will be sent to the clinics who have been shortlisted and their feedback as well as feedback from customers and the number of votes received will determine the winner.

BEST CLINIC (FOUR ROOMS OR MORE)

This award will be presented to the best large clinic in the UK with four or more treatment rooms.

Who can enter/nominate? Any UK based clinic with four or more treatment rooms can enter into this category. You can also nominate any clinic that you feel is a deserving winner.

How will the winner be decided? Mystery shoppers will be sent to the clinics who have been shortlisted and their feedback as well as feedback from customers and the number of votes received will determine the winner.

DISTRIBUTOR OF THE YEAR

This award is designed to acknowledge the important role played by UK distributors who bring new, international products and treatments into the UK market place.

Who can enter/nominate? UK distributors of medical aesthetics products, devices and treatments can nominate/enter their company into this category. Clinics and practitioners can also nominate the distributor that they feel offers the best products/treatments and service.

How will the winner be decided? The winner in this category will be decided purely on the number of votes they receive from their customers.

NEW AWARD FOR 2013-14 TRAINING PROVIDER OF THE YEAR A new category for the 2013-14 awards, the Training Provider of the Year award is designed to acknowledge the best providers of medical aesthetics training in the UK. Who can enter/nominate? Any provider of medical aesthetics training in the UK can enter this award. Clinics and practitioners can also nominate the training providers that they feel offer the best level of training. .

How will the winner be decided? As training is a somewhat controversial area, the winner in this category will be decided based on three factors: votes and feedback from people who have attend the courses; mystery shopping of the training course and judging.

NEW AWARD FOR 2013-14 TRAINING COURSE OF THE YEAR Another new category for the 2013-14 awards, the Training Course of the Year award is designed to acknowledge the best individual medical aesthetics training course in the UK. Who can enter/nominate? Any provider of medical aesthetics training in the UK can enter a specific course that they offer into this category. Clinics and practitioners can also nominate the training course that they feel is most deserving of this award.

How will the winner be decided? As training is a somewhat controversial area, the winner in this category will be decided based on three factors: votes and feedback from people who have attend the courses; mystery shopping of the training course and judging. www.cosmeticnewsuk.com 17

EVENTS

THE AESTHETIC AWARDS 2013-14

NEW AWARD FOR 2013-14 Hospital Group of the Year A new award for 2013, this award is designed to recognise the hospital groups that work within the medical aesthetics arena offering surgical and non-surgical services.

Who can enter/nominate? Any UK based hospital group offering medical aesthetics services can enter into this category. You can also nominate any hospital group that you feel is a deserving winner.

How will the winner be decided? Mystery shoppers will be sent to the hospital groups who have been shortlisted and their feedback as well as feedback from customers and the number of votes received will determine the winner.

BEST CLINIC (THREE ROOMS OR LESS) This award will be presented to the best small clinic in the UK with three or less treatment rooms.

Who can enter/nominate? Any UK based clinic with three or less treatment rooms can enter into this category. You can also nominate any clinic that you feel is a deserving winner.

How will the winner be decided? Mystery shoppers will be sent to the clinics who have been shortlisted and their feedback as well as feedback from customers and the number of votes received will determine the winner.

BEST MOBILE PRACTITIONER This award will recognise the achievements of solo practitioners who operate out of multiple locations.

Who can enter/nominate? You can enter yourself for this award or nominate someone else who you feel is a deserving winner.

How will the winner be decided? Mystery shoppers will be sent to the practitioners who have been shortlisted and their feedback as well as feedback from customers and the number of votes received will determine the winner.

AESTHETIC NURSE PRACTITIONER OF THE YEAR This award will go to the aesthetic nurse who has gone above and beyond in his/her field this year.

Who can enter/nominate? You can enter yourself for this award or nominate someone else who you feel is a deserving winner.

How will the winner be decided? The winner will be decided on votes from the readers of Cosmetic News, peers and clients of the practitioners shortlisted

AESTHETIC PRACTITIONER OF THE YEAR This award will go to the cosmetic doctor/ dermatologist who has gone above and beyond in his/her field this year.

Who can enter/nominate? You can enter yourself for this award or nominate someone else

18 www.cosmeticnewsuk.com

who you feel is a deserving winner.

How will the winner be decided? The winner will be decided on votes from the readers of Cosmetic News, peers and clients of the practitioners shortlisted.

BEST CLINIC CUSTOMER SERVICE This award will be given to the clinic in the UK with the best customer service as judged by ‘mystery shoppers’ and votes from customers.

Who can enter/nominate? You can enter your own clinic for this award or nominate someone else’s clinic that you feel is a deserving winner.

How will the winner be decided? Mystery shoppers will be asked to rate the clinics on their customer service both on the telephone and in person. You can also get your customers to vote for you online.

BEST CLINIC WEBSITE The most easy to navigate and informative clinic websites will be awarded in this category.

Who can enter/nominate? You can enter your own website for this award or nominate someone else’s website that you feel is a deserving winner.

How will the winner be decided? Mystery shoppers will be asked to rate the websites on ease of use, information and style. A judging panel made up of web experts will also examine the short listed websites and give their feedback on which they think is best.

SPEAKER OF THE YEAR This award will be given to the person deemed to have given the best lecture at a UK conference or educational meeting between May 2012-May 2013.

Who can enter/nominate? You can nominate yourself for this award or nominate someone who you have seen lecture that you feel deserves recognition.

How will the winner be decided? The winner in this category will be decided purely based on the number of votes they receive from the industry.

CLINIC RECEPTIONIST OF THE YEAR This award will go the member of clinic front of house staff who has excelled in 2012.

Who can enter/nominate? You can nominate yourself for this award or nominate a colleague/ friend that you feel deserves recognition for managing front of house.

How will the winner be decided? The winner in this category will be decided based on a mixture of the number of votes they receive, mystery shopping and feedback from their customers.

ASSOCIATION OF THE YEAR This award will be presented to the association that has gone above and beyond in 2012. There will only be one winner in this category.

Who can enter/nominate? Any professional body/industry association that represents medical aesthetics practitioners can enter this award.

Practitioners can also nominate the associations

that they feel are most deserving of this award.

How will the winner be decided? The winner in this category will be decided purely on the number of votes they receive from the industry.

SPECIAL AWARDS SERVICES TO THE INDUSTRY This category will award an individual who has gone above and beyond in their services to the industry.

Who can enter/nominate? You can nominate yourself for this award or nominate a colleague, friend, mentor or peer that you admire and feel deserves recognition for what they have done within the arena of medical aesthetics.

How will the winner be decided? The winner in this category will be decided purely on the number of votes they receive from the industry.

Each person can only vote once. Multiple votes under the same name or from the same email address will be discounted. Voting will open on August 1, 2013.

LIFETIME ACHIEVEMENT AWARD This award will recognise the achievements of an individual who has had a long and fruitful career in the aesthetics industry. Previous winners include David Hicks and Mr Chris Inglefield.

Who can enter/nominate? You can nominate yourself for this award or nominate a colleague, friend, mentor or peer that you admire and feel deserves recognition for what they have done within the arena of medical aesthetics.

How will the winner be decided? There is no short list for this category. One winner will be selected by the Aesthetic Awards panel from the names put forward during the nomination process.

• A NOTE ON VOTING Each person can only vote once.

Multiple votes under the same name or from the same email address will be discounted. Multiple voting from within the short listed finalist’s organizations will also be monitored.

Voting is IP address monitored. Voting will open on August 1, 2013.

This event is always a sell out so book now to make sure you don’t miss out!

Tables cost £1,750. Individual tickets are £180.

For more information visit www. cosmeticnewsuk.com or call our events team on 01268 754 897.

duction Fat Re ing

Skin Tighten

Cellulite

A Powerful Three Dimensional Alternative to Liposuction

No other system offers this advanced combination of technologies designed to target fat removal, cellulite and skin tightening without the need to exercise

Why choose 3D-lipo?

Cavitation

• A complete approach to the problem • Prescriptive • Multi-functional • Inch loss • Contouring • Cellulite • Face and Body skin tightening • Highly profitable • No exercise required

Complete start up and support package available from under £400 per month

Cavitation is a natural phenomenon based on low frequency ultrasound. The Ultrasound produces a strong wave of pressure to fat cell membranes. A fat cell membrane cannot withstand this pressure and therefore disintegrates into a liquid state. The result is natural, permanent fat loss.

Cryolipolysis Using the unique combination of electro and cryo therapy 20-40% of the fat cells in the treated area die in a natural way and dissolve over the course of several months.

Radio Frequency Skin Tightening Focus Fractional RF is the 3rd generation of RF technology. It utilises three or more pole/electrodes to deliver the RF energy under the skin. This energy is controlled and limited to the treatment area. Key advantages of this technology are high treatment efficacy, no pain as less energy is required, shorter treatment services and variable depths of penetration.

3D Dermology Combines pulsed variable vacuum and skin rolling for the effective treatment of cellulite.

What the experts say...

‘As a Clinician I need to know that the treatments we offer are safe, effective, scientifically based and fit in with our ethos of holistic care for our clients.

Before

After

3D-Lipo has delivered this to us’ Dr Mohamed Dewji – GP & Medical Director LasaDerm Ltd (Milton Keynes)

For further information or a demonstration call: 01788 550 440

www.3d-lipo.com www.3d-skintech.com

Join our revolution!

Jane after 32 weeks of Alizonne Therapy®

weight loss 7st 7lbs

Be part of the Alizonne success story

Alizonne -WINNERS 2012-2013

Best Weight Loss Programme/product

Alizonne Therapy is a revolutionary medically supervised treatment program that combines weight loss with body contouring. Designed by our medical doctors, Alizonne Therapy can dramatically improve appearance and long term health. The treatment comprises of four essential elements - ultrasound therapy, connective tissue therapy, medical diet and stabilisation.

Alizonne was first launched in the UK by Dr Mark Palmer from his Leeds clinic in 2006, there are now 21 Alizonne clinics with a further 4 more coming on board in July/August 2013, all licensed by Alizonne UK and managed to our specific uniform standards and protocols.

Clinics currently making a huge success of Alizonne Therapy® include: Having seen the incredible results our Alizonne patients were achieving I couldn’t help but be impressed. Patient feedback is incredible as many receive results they could not have dreamed of. We believed that weight loss and body contouring would be one of the largest growth sectors in our industry and we couldn’t see any other weight loss products with either the same results or medical supervision. We have now expanded to 6 Alizonne clinics including 2 recent additions in Watford & Bournemouth where we have great hopes for 2013. The treatments fit nicely along with our other therapist business and have allowed us to extend our opening hours and benefit our cosmetic business as well.

From my experience Alizonne not only changes your patients' lives but your clinic's finances as well!

Paul Wilkinson.

CEO. Courthouse Clinics

1

Current Alizonne Clinics 1 2 3 4 5 6 7 8 9 10 11

Aberdeen Glasgow Carlisle Newcastle Leeds Blackburn Wilmslow Liverpool Nottingham Cambridge Birmingham

12 13 14 15 16 17 18 19 20 21

Leamington Spa Bristol Watford Maidenhead Brentwood Central London Farnham Southampton Bournemouth Edinburgh

2 21

3

4

6

5 7

8

9 11 13

10

12 18

14 16 15 17

If you would like to be a part of the Alizonne success story...

We are currently recruiting carefully selected independent partner clinics around the U.K. to provide Alizonne Therapy®. If you are an independent clinic and would like further information please contact:

Anne Welford, Operations Director: awelford@alizonne.co.uk

www.alizonne.co.uk

tel: 0844 800 1209

SPECIAL FEATURE - MALE TREATMENTS

YOU’VE GOT MALE As more and more men head through the doors of aesthetic clinics to improve their appearance, we take a look at some of the most popular male treatments

T

he beauty industry has always been

TOP OF THE OPS -

dominated by women and, while that is

MEN AND COSMETIC SURGERY

still largely the case, the male grooming

Whatever the reasons behind it, one thing is clear, cosmetic surgery

market has seen a phenomenal growth

has become more acceptable for men. Although audit figures

in the last two decades. Gay or straight,

released by the British Association of Aesthetic Plastic Surgeons

young or old, it seems men are becoming

earlier this year showed that male surgery overall fell by 4.5%-

more and more concerned about the way

from 4,298 ops performed in 2011 to 4,102 in 2012- men still

they look and are increasingly wanting to

account for roughly one in 10 of all cosmetic surgery patients. More

change the things they don’t like about themselves when they look

interestingly, the most impressive percentage increase across all

in the mirror.

cosmetic surgery was in male brow lifts, which rose by 19%.

Men are rapidly changing their attitudes towards many things that have traditionally been seen as ‘the domain of the woman’ from

Rhinoplasty remained the most popular surgical treatment

face creams and diet pills to cosmetic surgery. But what is driving

for men, although this was down 9% from last year. Male

this change in attitude?

blepharoplasty was up 11%, making it the second most popular cosmetic surgery procedure for men, while face and neck-lifts and

The emergence of the ‘new man’ or ‘metrosexual’ has undoubtedly

fat transfer also saw increases of 14% and 9.5% respectively.

played a part in spurning this new breed of male consumer.

Male breast (or ‘moob’) reduction surgery, possibly shunned in

Influenced by celebrities like David Beckham, this generation of

favour of new non-surgical approaches, was down by 18% - yet still

men has made taking care of your appearance a less of taboo and

maintained its place as the third most popular procedure for men.

more of a ‘manly’ thing to do. Not afraid to admit they take their grooming seriously, they use face creams, hair straighteners, fake

According to Rajiv Grover, consultant plastic surgeon and

tan and have their body hair waxed in a bid to look good. And, in

president of the BAAPS, “The considerable drop in body-shaping

very much the same way as the beauty market opened the door

procedures such as liposuction and tummy tucks may well be due

to women to explore more invasive surgical and non-surgical

to people choosing to head back to the gym (perhaps inspired by an

options, so it has done the same for men, with recent statistics

unforgettable summer of Olympic golds!) or the fact that there are

showing increasing numbers of men are realising the benefits of

now many less-invasive options to target problem areas, such as for

cosmetic surgery and non-surgical cosmetic enhancement.

gynaecomastia or ‘man boobs’.”

In the US, men had almost one million cosmetic procedures, 10%

The internet has also meant that information on treatments

of the total. The number of cosmetic procedures for men increased

is more readily available than ever and the emergence of less

over 106% from 1997. The top five surgical procedures for men

invasive treatments offering more natural results has also

were: liposuction, rhinoplasty, eyelid surgery, breast reduction to

encouraged more men to dip their toes into the aesthetic pool.

treat enlarged male breast, and ear shaping.

www.cosmeticnewsuk.com 21

SPECIAL FEATURE - MALE TREATMENTS

THE MALE SKIN Men’s skin is thicker than women’s and they also have a higher oil content because of the amount of testoterone in their bodies. As such they don’t have the same concerns when it comes to skin.

For men it is less about getting rid of every line and wrinkle and more about improving the quality of their skin. Some of the main skin concerns male clients will have are:

• • • • •

Acne Acne scarring Enlarged pores Rosacea In-growing hairs

Treatments that are popular with male clients to address their concerns include laser and light based rejuvenation, chemical peels and microdermabrasion. While women may be sold on treatments that offer results but are at the same time pampering, men are the opposite. While they certainly don’t want treatments that hurt, they want to feel like something

BRO-TOX –

FA C I A L A E S T H E T I C S F O R M E N

is being done, they want something more results driven than

While surgery may have seen a slight decline for men, the popularity of non-

pampering and are prepared to put up with the downtime

surgical treatments, which offer natural results with minimal downtime, is

more than women.

certainly on the up and is fuelling the increase in the male aesthetics market.

The male attitude to skincare is much the same. You may

While non-surgical statistics are virtually non-existent in the UK, we

think that selling skincare to men would be more difficult

often follow trends set in the United States. Recently released stats by

than with women but, as long as what you are telling

the American Society of Aesthetic Plastic Surgeons (ASAPS) showed that

them is backed by science and results, the male client can

botulinum toxin injections were the most popular non-surgical treatment

actually be a skincare retailer’s dream, as he will be more

with men followed by laser hair removal and hyaluronic acid dermal fillers.

compliant than his female counterparts.

While women are used to using things that don’t work or have

There have been suggestions that this rise in the number of professional

little effect, men want it to do exactly what it says on the tin.

men seeking treatment has been fuelled by the current economic climate,

So when you are dealing with male clients make sure you are

with men feeling the pressure to turn back the clock so they can compete

offering them a programme that is going to get results, as long

with their younger counterparts in the workplace.

as they can see the results, they will be very compliant.

Whatever the reason, botulinum toxin injections have become increasingly more commonplace for men. From Cliff Richard to David Hassellhoff,

Women are more likely to manipulate any skincare

support for the treatment in the male community is such that it’s recently

programme that you put them on by adding in their own

been christened with its own special name: ‘Brotox’.

favourite high street moisturiser, whereas if you tell a male client they need x amount of product used morning and evening they will follow the steps.

However although they may be easier to sell cosmeceuticals to, remember the packaging of the product you are selling still counts. Luckily, unlike the beauty industry, most cosmeceuctical brands sold in aesthetic clinics have very unisex packaging, which makes life easier for clinics trying to encourage male clients to invest in quality skincare.

22 www.cosmeticnewsuk.com

While surgery may have seen a slight decline for men, the popularity of non-surgical treatments which offer natural results with minimal downtime, is certainly on the up

Saturday September 28 the City North hotel. dublin

CosmetiC News is delighted to aNNouNCe the lauNCh of the aesthetiCs CoNfereNCe, irelaNd. The first meeting of its kind for the Irish market, the conference will take place on Saturday September 28 at the City North Hotel Dublin.

Bringing together the most prestigious and respected speakers in the industry to discuss the latest topics and demonstrate the most up-to-date techniques, Call 01268 754 897 The Aesthetics Conference, Ireland is an ideal or book oNliNe CosmetiCNewsuk.Com opportunity for Irish delegates to network with peers and gain CPD accreditation on their home turf. The for staNd opportuNities delegate rate for the event is just 199 Euros and we 01268 754 897 are expecting a turnout of more than 150 aesthetic professionals for the inaugural conference.

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SPECIAL FEATURE - MALE TREATMENTS

rates are bringing more men onto the market, and they want to improve their chances. Data from our patients shows treatments such as Botox® increases their confidence, mood, and self-esteem.

“I regularly have Botox® myself, so I’m speaking as one of the converted. I recently wrote about the link between Botox® and the cure for depression, outlining the data indicating how Botox® can improve the way patients feel about themselves. In 2009 my study on this featured in the Journal of Cosmetic Dermatology, outlining research I undertook with Dr Michael Lewis, and supports what my staff at the clinics are noting: Botox® helps many people to stay positive, especially about their futures as they age.

“Botox® uses botulinum toxin A on frown lines of the face, paralysing the muscles responsible for anything up to six months. The result is a smoother, less-lined forehead, making patients look markedly younger as wrinkles ‘disappear’.

“Men with jobs where stress lead to excessive sweating also seem to be turning to Botox® injections to help. Those with primary idiopathic hyperhidrosis, where there is no perceptible underlying cause of sweating, like diabetes or a thyroid problem, can often find solution in Botox® around the underarm area. Again, city traders aren’t embarrassed to ask for treatment, and emergency doctors and healthcare professionals also frequently request more information. Will Young leads the way in terms of celebs who have had the treatment.

“One of the most attractive reasonings behind Botox® as an anti-ageing treatment is that side effects are very mild. Some treatments can cause Dr Patrick Bowler, medical director of Courthouse Clinics comments,

headaches, but most inflammation and soreness is short-lived and barely

“Brotox has risen over 40% at my treatment centres over the past year, with

noticeable. The chances of anyone at the office noticing that a patient has

up to one in five patients now male. What was once considered a procedure

undergone treatment are very slim- most come back for repeat procedures,

predominantly for women has seen a huge surge in popularity amongst men,

every four to six months, and tell us that colleagues only note that they

and the reasons reflect some fascinating insights into our changing values.

suddenly seem brighter eyed and “fresh”. Botox® isn’t the reserve of females anymore, and the exciting thing is that men aren’t shy about admitting it.”

“Based on anecdotal evidence from my team, I believe that one of the main

Dr Mike Comins adds, “Men want to look less angry or less tired so it is a lot

motives for men pursuing treatment is the economy. There is a collective

of crow’s feet and glabellar. They still want to have some movement and they

consciousness that suggests looking younger and healthier could enhance

don’t want to have arched eyebrows.”

career prospects, particularly in industries where staff are youthful, such as advertising. We see many city traders seeking Botox®, too.

Dermal fillers, particularly for nasolabial folds and volume replacement, are also popular. Again the name of the game is natural looking results. Men also

“Patients have explained how job interviews are easier to navigate with the

don’t like to come back too regularly for treatments, so products that last

added boost of appearing younger and more energetic. Peter Andre has gone on

longer in between visits appeal.

record to say he gets Botox® annually, and Simon Cowell and Gordon Ramsey

“Volume replacement around the cheek area is particularly popular for men,”

also pluck for the anti-wrinkle treatment so that they are camera-ready.

says Dr Comins. “As men get a little bit older it is about replacing volume

“Divorce is also a leading contributing factor. High separation and divorce

around the cheek bones. It is important to keep it masculine.”

There is a collective consciousness that suggests looking younger and healthier could enhance career prospects 24 www.cosmeticnewsuk.com

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15:20:32 15:20:32

SPECIAL FEATURE - MALE TREATMENTS

SHAPING UP

the treatment to help him achieve his dream six pack stomach.

Blue stars Antony Costa and Simon Webbe have also had the

While facial aesthetics are increasing in popularity it is the non-

treatment. Antony, 31, said, “I work out all the time and eat really

surgical body shaping market that has seen the biggest male

well but, like a lot of guys, I need a little bit of extra help just getting

boom. Non-invasive treatments for man boobs plus body sculpting

rid of those stubborn areas around my mid-riff. It is a fantastic

procedures have spurned this growth with body conscious guys,

treatment and it is brilliant that it can be done so quickly and easily.”

who were put off by the thought of surgery, now taking the plunge to enhance their physiques.

Venus Freeze is also proving popular with male clients because of its minimal pain and downtime. The treatment combines multi-

Dr Angelica Kavouni of Cosmetic Solutions, Harley Street, says, “At

polar radio frequency and Magnetic Pulsed Fields causing a thermal

Cosmetic Solutions, we are seeing increasing numbers of men who

response in the skin’s tissue activating the body’s natural healing

are looking to tackle those stubborn pockets of fat that are hard to

response and self-repair mechanisms. Body contouring is achieved

shift through exercise and diet alone. Particularly as they reach their

with Venus Freeze when the temperature of the skin is elevated.

mid to late thirties and above, our clients are finding that fat gathers

The body then releases stress hormones which pass through the

more readily around their stomach and love handles. The typical male

blood stream, and attach themselves to specific receptors on the

patient wants fast and effective solutions which is why Liposonix is

membrane of the fat cell in the hypodermis (the deepest layer of the

such a popular choice. The high intensity focused ultrasound eliminates

skin). The stress hormone, once attached to the receptor, activates

targeted areas of stubborn fat by permanently destroying fat cells and

the hormone sensitive lipase - the hormone that is in charge of

naturally metabolising the waste over a period of eight-12 weeks. The

breaking down triglycerides into free fatty acids. The free fatty acids

average waist reduction is two inches after a single one hour treatment.

exit the fat cell through the blood stream and the volume of the fat

With no downtime, our clients can go straight back to the office the

cell is thus reduced

same day, and back to the gym the very next day.”

giving you a more toned shape.

Offering male only procedures – such as the treatment of

Just as the fairer sex is seeking to slow the effects of age and

gynaecomastia – can really extend the scope of your practice. Dr Mike

gravity , their counterparts are joining in this aesthetic revolution.

Comins is an advocate of VASER. He says, “Because I do a lot of body

Treatments with Reaction™ by Viora are an ideal solution for men

sculpting 50% of my patients are now males. VASER high definition

wanting to achieve results that deliver a young, tighter appearance,

and liposculpture are really popular for torsos and man boobs. A lot of

for face and body. Reaction™ incorporates CORE™, an exclusive,

men have fatty breast tissue but now they realise that one they are not

innovative technology of three singular radio-frequencies, with a

alone and two there are a lot of treatments that can really help them.”

fourth channel incorporating all three frequencies, combined with vacuum therapy that allows practitioners to reach different layers

There is nothing like a bit of celebrity endorsement to drive clients

in the skin so as to customise their treatments for each patient’s

through the door, particularly when it is good looking, metrosexual

symptoms. Treatments are painless, safe and effective, with no

men who have admitted to having a helping hand to achieve their

anaesthesia necessary – ideal for the patient who wants the results

perfect body. One treatment that has been hitting the headlines a

but is reluctant to endure any discomfort.

lot recently with male celebs touting its benefits, is Lipoglaze. The Only Way is Essex (TOWIE) hunk Tom Pearce recently appeared

ReLift, a new concept by Viora, utilising Reaction™, is ideal for

in a steamy photo shoot in New Magazine showing off his buff

men who are starting to dread seeing their reflection while shaving.

body. Tom had visited the LoveLite clinic in Harley Street and told

As ageing occurs, it’s natural for sagging skin and localised fat to

the magazine that, like most normal people, he had that stubborn

occur along the neck and jowl line. The cumulative effect leads to

fatty area on his stomach that he simply could not shift so he had

a heavy jowl line and the disappearance of a manly, chiseled jaw.

Before and after VASER (Pictures courtesy of Dr Mike Comins)

Before and after VASER (Pictures courtesy of Dr Mike Comins)

26 www.cosmeticnewsuk.com

A New Dimension in Non-Surgical Technology

A revolution in the non-surgical aesthetic skincare market... is set to create a revolution in the nonsurgical Aesthetic skincare market. Following the success of the award winning 3D-lipo which combines technologies for the effective treatment of fat, cellulite and skin-tightening we are set to launch a phenomenal new multi-functional device for the face.

Here are just some of the reasons why 3D-skintech will become the brand of choice in 2013 • Complete treatment portfolio for anti-ageing, pigmentation and acne • 4 technologies ensure a prescriptive & total approach to your clients needs • Used in conjunction with medical peel and cosmeceutical skin care line • Unsurpassed results ensures maximum client loyalty • Highly profitable with a multitude of services to offer • Provides you with a competitive edge in your area • Affordable as package price is under £10,000 with a product starter pack worth £1,000 • Available on 3 Years interest FREE finance for the first 50 machines sold

Rotational Diamond Peel Microdermabrasion Utilising the latest technology available you can work in conjunction with topical skincare to ensure that hydration and comfort are not compromised whilst delivering excellent peeling results.

Radio Frequency Tri-polar Radio Frequency is the most advanced technology available for skin-tightening ensuring excellent results without the discomfort associated with mono or bi – polar devices.

Mesotherapy Non-invasive mesotherapy ensures that the active ingredients are delivered where they are needed most without the need for needles.

LED Full canopy LED ensures both rapid treatment time and excellent results are achieved. Available wavelengths Red (640nm - 700nm), Blue (425nm - 470nm), Yellow (590nm) and Green (520 - 564nm) ensures effective treatment for anti-ageing, pigmentation, acne and detoxification.

3D-skintech peels and clinical skincare A compact range of medical grade peels and cosmeceutical skincare products complete the Skintech’s unique offering and enables you to both use as a “stand-alone” service or combine with equipment protocols.

IT’S ALL YOU WILL EVER NEED…

For more information or a demonstration please call 01788 550 440

www.3d-skintech.com www.3d-lipo.com

SPECIAL FEATURE - MALE TREATMENTS

ReLift’s double action gravity-defying procedure provides a solution that

smoother appearance. In addition to facial tightening and contouring, with

minimises volume while tightening sagging skin. The CORE™ technology

Reaction™ practitioners can offer the innovative solution ReFit to patients

produces natural lipolysis to shrink fat cell volume while at the same time

who have undergone extreme weight loss, whether via surgical procedure,

enhancing blood circulation throughout the treatment area. The skin’s

diet or exercise or other reason. Reaction™’s ability to treat different tissue

underlying network of collagen and elastin fibres are gently heated, causing

depths ensures deeper heat penetration, thereby restoring collagen flexibility,

the fibres to shrink, restoring the skin’s elasticity and leaving a tighter,

improving the skin’s firmness and elasticity.

THE HAIR AND NOW

more dense areas to treat.

“We did this as part of our Gentlelaser No shades

The most popular areas treated with Soprano at

Barred Campaign where we wanted to consider

When it comes to men it all seems to be about

Courthouse Clinics are:

the habits of men and women to address a suitable

hair, whether its having too much of it on their

•

33% back

marketing campaign to them assuring them of

bodies or not having enough of it on their

•

25% shoulders

safely and efficacy”, said Michaela Barker.

heads. One of the advantages of treatments a

•

10% full body

clinic offers over traditional methods of hair

•

11% chest

The report used men across the UK that removed

removal, such as shaving and waxing, is that it

•

9% abdomen

hair from their bodies in some way and looked at

gives a permanent reduction of excess hair and

•

8% cheek

what they used currently and how happy they were

means men don’t have to repeatedly return for

•

7% beard

with that method. We asked questions about levels

treatment. A course of laser or IPL hair removal

•

3% other

of embarrassment, price and the amount of pain.

can rid them of problem hair for good and that

•

2% arms

It showed that only 16.2 % men would find

is very appealing to men who feel self conscious

•

2% ears

professional hair removal methods embarrassing,

about their body hair. However it is a widely

the remainder are either not concerned or it does

known fact that men can’t handle pain as well as

Now with Soprano Ice this number is expected to

not bother them. Only 0.4% of men had tried

women, when it comes to beautifying themselves

increase, because with the lighter and improved

laser or light based treatments (compared to 2.9%

that is anyway, so the emergence of ‘pain free’

ergonomic design, Soprano ICE is even easier to

women) 33% of men surveyed who had not tried

hair removal has opened up the door to male

use and can be used to treat small and difficult

laser hair removal would consider it in the future.

clients even more. Dr Bowler says, “Soprano

to target areas like the eyebrows, nose and ears,

43% said pain from methods of hair removal was

painless hair removal has transformed the

making it the ideal treatment for men.

not an issue. In getting down to cost, 36.2% of

laser hair removal experience for men because

Laser hair removal has also seen huge advances

men surveyed said cost is not much of an issue

lets face it men are not very good with pain!

in the variety of skin types that can be treated,

in regards to permanent hair removal and 18%

Treatment time is also quick and results rapid

broadening the scope of your offering to men with

thought it was not a big factor

and this is very appealing to male clients”

darker skin.

Since Courthouse Clinics introduced Soprano

With an anticipated increase in the market for men

more information, 56% of men said they would

in 2009 there has been a 150% increase in men

seeking aesthetic treatments, Syneron Candela

use the internet. Others said they would ask advice

having laser hair removal. Again this is mainly

conducted a Censuswide survey in March to

from a GP or listen to personal recommendation.

attributable to the fact that Soprano is pain free

establish more about male grooming habits when it

But 61.6% actually have no worries if they do not

and very quick making it ideal for men who have

comes to hair removal.

understand how it works – as long as it works.

When asked how they thought they would gather

IN CONCLUSION With so much going on in the male grooming sector it is clear that the male market is not one to be ignored. If you are keen to expand your clinic’s offering to attract men then think about including a ‘treatments for men’ section on your website and/or in your literature. This will differentiate you from competitors who are more focused on female clientele for their core business and who would therefore not be as attractive to men as a place to go for IPL/ laser hair removal or injectables. Using neutral colours on your website and literature and within your clinic will also help appeal to male clientele as will including testimonials and before and after pictures for men on the web, in your clinic literature and on your clinic walls.

28 www.cosmeticnewsuk.com

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AU5234 Azzalure A4 ad_Layout 1 06/06/2011 14:06 Page 1

Azzalure® Abbreviated Prescribing Information Presentation: Botulinum toxin type A (Clostridium botulinum toxin A haemagglutinin complex) 10 Speywood units/0.05ml of reconstituted solution (powder for solution for injection).

Indications: Temporary improvement in appearance of moderate to severe glabellar lines seen at frown, in adult patients under 65 years, when severity of these lines has an important psychological impact on the patient. Dosage & Administration: Botulinum toxin units are different depending on the medicinal products. Speywood units are specific to this preparation and are not interchangeable with other botulinum toxins. Reconstitute prior to injection. Intramuscular injections should be performed at right angles to the skin using a sterile 29-30 gauge needle.

Recommended dose is 50 Speywood units (0.25 ml of reconstituted solution) divided equally into 5 injection sites,: 2 injections into each corrugator muscle and one into the procerus muscle near the nasofrontal angle. (See summary of product characteristics for full technique). Treatment interval should not be more frequent than every three months. Not recommended for use in individuals under 18 years of age. Contraindications: In individuals with hypersensitivity to botulinum toxin A or to any of the excipients. In the presence of infection at the proposed injection sites, myasthenia gravis, Eaton Lambert Syndrome or Amyotrophic lateral sclerosis. Special warnings and precautions for use: Use with caution in patients with a risk of, or clinical evidence of, marked defective neuro-muscular transmission, in the presence of inflammation at the proposed injection site(s) or when the targeted muscle shows excessive weakness or atrophy. Patients treated with therapeutic doses may experience exaggerated muscle weakness. Not recommended in patients with history of dysphagia, aspiration or with prolonged bleeding time. Seek immediate medical care if swallowing, speech or respiratory difficulties arise. Facial asymmetry, ptosis, excessive dermatochalasis, scarring and any alterations to facial anatomy, as a result of previous surgical interventions should be taken into consideration prior to injection.

Injections at more frequent intervals/higher doses can increase the risk of antibody formation. Avoid administering different botulinum neurotoxins during the course of treatment with Azzalure. To be used for one single patient treatment only during a single session. Interactions: Concomitant treatment with aminoglycosides or other agents interfering with neuromuscular transmission (e.g. curare-like agents) may potentiate effect of botulinum toxin. Pregnancy & Lactation: Not to be used during pregnancy or lactation. Side Effects: Most frequently occurring related reactions are headache and injection site reactions.

Generally treatment/injection technique related reactions occur within first week following injection and are transient and of mild to moderate severity and reversible. Very Common (≥ 1/10): Headache, Injection site reactions (e.g. erythema, oedema, irritation, rash, pruritus, paraesthesia, pain, discomfort, stinging and bruising). Common (≥ 1/100 to < 1/10): Facial paresis (predominantly describes brow paresis), Asthenopia, Ptosis, Eyelid oedema, Lacrimation increase, Dry eye, Muscle twitching (twitching of muscles around the eyes). Uncommon (≥ 1/1,000 to <1/100): Dizziness, Visual disturbances, Vision blurred, Diplopia, Pruritus, Rash, Hypersensitivity. Rare (≥ 1/10,000 to < 1/1,000): Eye movement disorder, Urticaria. Adverse effects resulting from distribution of the effects of the toxin to sites remote from the site of injection have been very rarely reported with botulinum toxin (excessive muscle weakness, dysphagia, aspiration pneumonia with fatal outcome in some cases).

Packaging Quantities & Cost: UK 1 Vial Pack (1 x 125u) £64.00 (RRP), 2 Vial Pack (2 x 125u) £128.00 (RRP) IRE 2 Vial Pack (2 x 125u) €187.05 (RRP). Marketing Authorisation Number: PL 06958/0031 (UK), PA 1609/001/001(IRE). Legal Category: POM. Full Prescribing Information is Available From: Galderma (UK) Limited, Meridien House, 69-71 Clarendon Road, Watford, Herts.

WD17 1DS, UK. Tel: +44 (0) 1923 208950 Fax: +44 (0) 1923 208998. Date of Revision: January 2011.

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CLINICAL - CASE STUDY

SPOT O N Dr Johanna Ward on treating acne

A

cne affects 80% of people at some point in their lives

slightly more than males (9.8% vs 9%) and affects people of all ethnic

and is the most common skin condition that people

groups. It is caused by changes in hormone levels at significant points

consult their doctor about. About 20% of acne sufferers

in our lives. Puberty is the most common time to develop acne and it is

will have acne so severe that they will require aggressive

caused by an increase in testosterone, regardless of sex. This testosterone

medical treatment to avoid the risk of secondary

surge affects the pilosebaceous unit and causes enlargening of the

scarring. Acne can have profound and devastating psychosocial

sebaceous gland, a microscopic gland in the skin. This triggers increased

consequences and needs to be treated quickly and effectively.

sebum production from the gland. Sebum is the body’s natural oil that acts to lubricate the skin and helps maintain the integrity of the skin

Many acne sufferers state that their acne has robbed them of their

barrier. Areas most densely populated by sebaceous glands are the face,

happiness and it is not uncommon for an acne sufferer to break down in

chest and upper back hence acne typically affects these areas.

tears during a consultation. Often they have spent years trying over the

Increases in sebum and keratin in the pilosebaceous unit cause a

counter and internet products, beauty salon facials and the like, with little

hyperkeratotic plug to form called a microcomedone. Microcomedones

or no success. This leads to feelings of helplessness and isolation and it is

are the earliest acne lesion and are basically blockages in the follicle.

important that we help them rebuild their sense of self-esteem. Treating and managing acne for this reason is very rewarding professionally and

In these conditions the naturally occurring (but largely commensal)

helps to build a good local reputation for your aesthetic skin clinic.

organism Propionibacterium acnes uses sebum for growth and then

Although the diagnosis of acne is straightforward and effective

proliferates. In a sebum rich blocked follicle P. acnes contaminates the

treatments are available, acne is still a challenging dermatological

follicle and causes significant localised inflammation.

problem. There are several reasons for this. Firstly, people commonly delay consulting their doctor for acne in the hope that it will just go away.

Any effective treatment regime for acne needs to target all four of

In adolescents, the average time between the onset of acne and seeking

these processes:

medical help is about one year, despite the significant impact it has on self-esteem and psychological wellbeing. The second reason is that acne is a chronic skin condition with no quick fixes or overnight cures.

Treatments often take six to eight weeks (or longer) to be effective with

1) Excess sebum production 2) Follicle plugging 3) Propionibacterium activity 4) Subsequent inflammation.

the result that many people give up on their treatments thinking that they haven’t worked. This results in suboptimal or under treatment and is

A treatment that targets just one of these processes is likely to fail. This is

another reason why acne presents such a challenge.

why most effective treatments for acne are combination treatments.

With the NHS already overstretched we are at risk of seeing even more

There are many treatments available for acne, most of which are safe,

acne sufferers feeling helpless and isolated. Many people feel that they

effective and well tolerated. Treatment options for acne include topical

shouldn’t trouble their Gp with problems such as acne whilst others feel

skin creams, oral antibiotics, hormonal preparations, oral isotretinoin

that acne is just a normal part of adolescence and trivialise this medical

(Roaccutane) or more commonly, a combination of these. More recently

condition. Acne is in fact a dermatological disorder that, if undertreated

clinical evidence about the efficacy of blue light has been established

or ignored, can result in significant physical (and emotional) scarring.

in the treatment of acne and provides an exciting new direction. The

It is not uncommon for acne sufferers to report having spent vast

latter part of this article will cover a trial that we undertook at our skin

amounts of money on products for their acne that just haven’t worked.

clinic in Sevenoaks, Kent with the new Lustre Pure Light Pro device. The

With the sudden popularity of aesthetic skin clinics many acne sufferers

results were extremely positive and all participants showed a reduction in

are finding their way into the private medical sector. For those of us

inflammatory acne lesions over a 6 and 12 week period with no reported

involved in this industry it is therefore important that we know how to

side effects. Blue light therapy is especially useful for those who cannot

effectively treat and manage acne.

tolerate conventional medical treatment due to side effects or who wish

Acne affects approximately 650million people globally. It affects females

to avoid pharmaceuticals.

32 www.cosmeticnewsuk.com

Treatments for acne

There are many safe and effective treatments for acne available over the

effects can greatly enhance compliance and overall outcome. For example, if

counter and as a prescription. The main challenge with acne treatment is

starting a patient on a salicylic acid cleanser advise them that their skin WILL

patient compliance. Many patients suffer early side effects such as dryness and

become dry for a few weeks but that with continued use this will settle. Advise

irritation and stop their treatment thinking they are having a skin reaction.

them on a good aqua based skin hydrator so they don’t then go and put oily

Those that proceed often don’t give the treatment the required six to eight

mass produced OTC moisturisers on their skin that will just negate any good

weeks to take effect and stop using the treatment thinking that it hasn’t

the salicylic has done. Attention to detail can be extremely helpful in advising

worked. Six to eight weeks can feel like a very long time when you have facial

patients on their regimes and can help avoid delayed results.

acne lesions.

Acne treatments work to address the four basic processes causing acne: they reduce sebum, normalise shedding into the pore to prevent blockage, kill

It is important to take a thorough medical history and a detailed acne history

propionbacterium acnes and are anti-inflammatory.

during the initial consult, including any OTC and prescription strength

The treatments discussed below are by no means exhaustive as it goes beyond

treatments previously tried. It is worth noting down which ones the patient

the scope of this article to detail all available treatments. What they represent

felt worked and which ones didn’t and why. Careful selection of treatments

is a collection of effective and commonly used products that will help your

and proper guidance about the chosen treatment including possible side

patients manage their acne long term.

Salicylic acid (OTC) Salicylic acid is a beta hydroxyacid derived from willow

Antibiotics (prescription) Topical antibiotics commonly used in the treatment of acne

bark that is lipid soluble so can penetrate sebum and help rid the follicle

include clindamycin and erythromycin. Erythromycin is particularly useful as

of excess oil. It is a very powerful tool in the treatment of acne and the

it is one of the few acne treatments thought to be safe during pregnancy and

effects are fast acting. Salicylic is available over the counter in many acne

breastfeeding, alongside benzoyl peroxide. Oral antibiotics are often reserved

cleansers at a 2% or 3% concentration. It causes an initial dryness of the

for more severe cases of acne but with increasing resistance of P. acnes

skin but this rapidly settles with continued use. Salicylic cleansers can be

worldwide they are becoming less effective. Commonly used antibiotics include

used on a daily basis.

oxytetracycline, lymecycline, doxycycline and erythromycin. Antibiotics need

Glycolic acid (OTC) Glycolic acid is an alpha hydroxy acid and is generally considered one of the safest alpha hydroxy acids. It is derived from sugar

to be used for at least two to three months before any assessment of efficacy can be made. Often they are continued for six months or longer if they are thought to be of benefit. Side effects can include vomiting, diarrhoea, nausea, skin pigmentation and candidal yeast infections.

cane and chemically exfoliates the stratum corneum to remove dead skin cells/microdebris and helps prevent follicular plugging. It is generally felt that doses above 10% are needed to be of any clinical effect. Salicylic and glycolic acid cleansers can be alternated depending on clinical severity,

Hormonal preparations (prescription)

extent of sebum (seborhhea) and follicle plugging. Both of these acids

In females, acne can sometimes be improved with hormonal treatment. The

alter the microsurface of the skin and must be accompanied by high

most effective hormonal preparation is the anti-androgen pill Dianette. It

factor sun protection.

is a combination of cyproterone acetate and ethinylestradiol which reduces

Benzoyl peroxide (OTC) Benzoyl peroxide has been used for over 30 years in clinical

androgenic hormone levels. It has however been linked to the deaths of 6 UK women from blood clots and needs to be carefully monitored. Despite this the MHRA insists it has ‘no new concerns’ regarding Dianette. Caution should be

dermatology and is the cornerstone of treatment for mild to moderate

used however and other options exhausted in the first instance. The combined

acne. To date it seems to have avoided any issues with antimicrobial

estrogen/progestogen pill Yasmin might be a better alternative and has some

resistance since it is technically an antimicrobial not an antibiotic.

positive effect on acne.

Benzoyl peroxide has several functions, it works as an oxidizing agent to kill P. acnes, it unblocks pores and increases skin cell turnover. Benzoyl peroxide is available in 2.5%, 5% and 10% concentrations over the

Topical retinoids (prescription) Retinoids are potent medicines that help normalise the follicle cell

counter, all of which are thought to be equally as effective. It is generally

cycle, improve cellular turnover and unblock pores. They are related to Vitamin

agreed that patients should start at the lowest dose and increase the

A and can have powerful effects on the skin, including skin irritation that tends to

concentration if necessary. It can be quite irritating to the skin (can cause

settle with use. They often cause an initial flare up of acne so warn patients that

an irritant dermatitis) so lower doses and tapered use are preferred when

their acne may get worse before getting better. This class of medicines include treti-

commencing treatment. A small number of people are very sensitive

noin (Retin A), adapalene (Differin) and tazarotene (Tazorac). Topical retinoids

to benzoyl peroxide and will have a severe reaction to it. These people

are especially helpful for stubborn outbreaks of comedones, for inflammatory

should be advised to refrain from its use in the future. This topical

acne and can help improve and resurface superficial scarring. Maintenace of acne

treatment increases sensitivity to the sun so once again a facial SPF needs

remission is usually with a topical retinoid or benzoyl peroxide. It is common to

to be advised.

need maintenance treatment for many years after the outbreak has settled.

www.cosmeticnewsuk.com 33

CLINICAL - CASE STUDY

Patient 1 before

Blue light therapy (OTC)

and after

Blue light (405-420nm) represents an exciting new direction in the treatment and management of acne. It has been clinically proven to kill Propionibacterium acnes and improve inflammatory acne. The mechanism is that a prophyrin produced within P. acnes generates free radicals that kill the bacteria. The great advantage of this treatment is that it has no side effects (no UV light is employed) and can be used in clinic or in the comfort of the patientâ&#x20AC;&#x2122;s home.

Ambicare Health market the leading home blue light device called Lustre Pure Light Pro. It was developed by a number of leading UK scientists and

Patient 2 before

and after

dermatologists and delivers the safe, visible part of the blue light spectrum at 420nm. The newer Lustre Pure Light device (the one we used in our trial) was designed to be used for 20 minutes everyday. When used as recommended it delivers a total dose of 42j/cm2 of blue light per week. This allows patients to achieve results in only 20 minutes per day as opposed to 1 hour with the original device. This new device will be commercially available from June 2013.

Clinically published date shows that Lustre Pure Light Pro delivers: -A 60% improvement in inflammatory acne -A 50% improvement in comedone counts at 12 weeks -And 65% of users reported a moderate to marked improvement in their acne The trial we conducted consisted of six patients ranging from 16 to 64. The trial aim was to demonstrate the efficacy of blue light using the Lustre Pure Light Pro home device. Exposure to blue light was 30 minutes each day and the

Oral Isotretinoin (prescription)

group was split into those that used only blue light for their acne and those that used blue light in conjunction with topical products (Obagi Clenziderm).

The vitamin A derivative Isotretinoin (commonly known as

All participants had facial acne ranging from mild to moderately severe. They

Roaccutane) is reserved for severe cases of acne, acne that is

had all tried various other treatments including topical prescription products,

causing scarring or cases that have proved resistant to all other

oral antibiotics and Roaccutane with little success. All participants were

milder treatments. It is a powerful and potent medicine that needs

looking for a new treatment to help them manage their acne in the short and

to be supervised by a dermatologist because of its known side

longer term.

effect profile (it can affect serum lipids and is a known teratogen).

Isotretinoin has received some negative press and editorial

Participants were evaluated at week seven and week 12 for clinical

comment recently linking it to teenage depression and suicide but

improvement. They were extensively photographed and their comments

these links are yet to be substantiated definitively in the medical

and reflections were filmed. All participants at week seven noticed an

literature. It should however be reserved for those with more

improvement in their inflammatory lesions, comedones and the general

severe acne and when monitored closely and used appropriately

appearance of their skin. At week seven however those on combination

can result in huge improvements in acne. Isotretinoin works by

treatment (Clenziderm and blue light) showed the most significant

reducing secretions from the sebaceous gland so skin dryness and

improvements. At week 12 all participants had noticed significant

occasional nosebleeds (secondary to dry nasal mucosa) can be a

improvements in their acne measured by a reduction in inflammatory

side effect.

lesions, reduction in comedone count and reduction in seborrhea.

Objectively, all participants experienced significant improvements in their facial acne at week 12 regardless of which treatment group they belonged to.

Blue light treatment is an exciting new development in the treatment and

Dr Johanna Ward BA Hons MBBS DRCOG MRCGP Dip Clin Derm (distinction) Dr Johanna Ward is a GP with a special interest in dermatology, minor surgery and cosmetic medicine. She is passionate about clinical dermatology and raising dermatology standards in the aesthetics industry. Dr Ward is the Medical Director of The Skin Clinic Sevenoaks and its sister clinic The Skin Clinic Brentwood and also works as a clinical fellow in dermatology. She holds the prestigious Diploma in Clinical Dermatology from the University of London. Her area of special interest is the management of acne and acne scarring.

34 www.cosmeticnewsuk.com

management of acne. It offers an alternative treatment for acne that carries no risk of side effects and works over a six to 12 week period to improve all grades of acne. It does not require a prescription and can be used as a primary treatment for acne, in combination with topical products or to maintain a remission and help promote a stabilisation of acne in the long term.

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CLINICAL - DERMATOLOGY

PSYCHOLOGY

SPOT

Clinical Psychologist and psychodermatology specialist, Dr Reena Shah, explains the powerful link between skin disorders and psychology

T

he skin is the largest organ of the body and is immediately on show, if not covered up. It represents an external barrier between our internal being and the outside world. Having unblemished skin is perceived by society as a sign of beauty, an idea that is arguably perpetuated by the media.

Dr Reena Shah, CPsychol Dr Reena Shah is a Clinical Psychologist with a special interest in psychodermatology.

She conducted her doctoral thesis within this area and ever since she has been dedicated in working clinically and conducting research within psychodermatology.

People of all ages have reported feeling pressured by the media and society’s influence of looking ‘perfect’. Ritvo et al. (2011) showed that the first thing teenagers and adults noticed about a person with acne was their skin (65% and 75%, respectively). The study suggests that teenagers and adults alike perceive other teens with acne as generally being shy, less socially active, more likely to be bullied, and less successful in terms of finding a job. Overall, the results show that acne has a negative effect on the way people are perceived by others. Some people with skin conditions report becoming preoccupied with covering their skin and often avoid activities where it might be on display.

Hence, people with skin disorders may take various steps to maintain a sense-of-self. This may be due to the belief that other people may stigmatise or reject them because of how they look. Living this way day in and day out, depending on person experiences and coping strategies, can sometimes lead to the development or exacerbation of mental health problems.

Some people living with skin disorders have reported high levels of psychological distress, with some studies indicating that 30% of clients have clinically significant levels of psychological

distress (Gupta & Gupta, 2003). Interestingly, the severity of a visible difference does not correlate with the amount of psychological distress and dysfunction experienced (Rumsey et al., 2004).

For example, someone with a small patch of vitiligo (depigmentary disorder of the skin which causes the occurrence of visible white patches) could feel the same way as someone who has eczema all over their body. Reasons for the psychological distress could be due to various factors, such as past experiences, relationships with others, personal beliefs and one’s upbringing.

Dr Anthony Bewley, consultant dermatologist and head of the London Psychodermatology Service stated, “It is increasingly recognised that the physical and psychological aspects of a disease are very intimately linked. For example, in psoriasis, sufferers usually indicate that a stressful life event initiated the psoriasis, and that living with psoriasis is at least as bad as living with cancer or diabetes.”

It is well recognised that having a skin disorder may have numerous physical (e.g. dryness, itching, scarring and pain) and psychological consequences for people of all ages. The level of psychological morbidity found in research has been supported within clinical practice. A recent survey conducted

by Shah (2012) within in a general dermatology clinic in the NHS indicated that 29% of females and 24% of males scored within the clinical range for anxiety, with 47% of females and 36% of males reaching the borderline range for anxiety.

Interestingly, 89% of females and 97% of males had a high degree of appearance-related concerns.

www.cosmeticnewsuk.com 37

CLINICAL - DERMATOLOGY

Anything from a small blemish on the face to having a widespread skin disorder can lead to embarrassment, humiliation and other negative body image experiences. These negative experiences, together with the influence of others and society’s expectations, can diminish self-esteem and self-confidence, increase selfconsciousness and create a loss of sense-of-self and isolation.

Conversely, research also shows a link between stress and the exacerbation of skin disorders. For example, people with eczema have reported having flare-ups when stressed and people with vitiligo have reported that when they feel stressed they have noticed new patches. It is often difficult to ascertain which element comes first, the physical or the psychological. One theory is that a vicious circle occurs with the spread of the condition being an increasing cause for both worry and possibly rejection, consequently exacerbating a psychological problem such as anxiety or depression.

The most widely cited difficulties are those around social anxiety.

People report difficulty with social interactions and can have relationship difficulties. Coping strategies may include trying to conceal the skin disorder from others, including partners, by avoidance of social situations, such as swimming and other sporting activities. Conversely, others who have learned to cope very positively with their visible difference (including skin disorders) may report few problems.

So what can be done to help? A client who has irregular scars as result of acne, said “I was not given any support into how I felt about my appearance when I was being treated. My scars did affect my confidence and self-esteem and I wished I was treated as a person rather than a NHS number.” This quote highlights that emotional and psychological support is a need, which is not met within all NHS departments.

Optimising medical treatment via their GP and/or dermatologist is the first step for most clients however this is where aesthetic clinics also play a vital role. There are also many charities, such as Changing Faces, that are at the forefront of promoting better health care and providing a supportive environment for people with skin disorders. For example, as a part of their Look at Me campaign, Changing Faces released a preliminary report highlighting the need for better integrated support and advice for people living with skin conditions. They also offer a Skin Camouflage Service which has shown to be effective. Kent (2002) indicated that clients who consulted the British Red Cross Skin Camouflage Service (now run by Changing Faces) felt more confident in and exhibited less avoidance of social situations after their appointment. However physical interventions are not for everyone. Other approaches are more psychological. Changing Faces also offers free confidential information, advice and support and has developed a model of care that includes a social skills training component.

There is a plethora of talking therapies that could help people with skin conditions; however, there is a need for more quality research to guide best practice. Some intervention studies have reported the effectiveness of Cognitive-Behavioural Therapy (CBT) for psoriasis, acne, trichotillomania, eczema and vitiligo, to name a few. For other conditions that lead to mainly scratching, such as urticaria, habit reversal therapy may help to reduce the desire to

38 www.cosmeticnewsuk.com

Interestingly, the severity of a skin condition does not always correlate with the amount of psychological distress and dysfunction experienced scratch. This has also been shown to be effective for people with eczema and skin picking. In clinical practice, using principles of systemic family therapy has also shown to be helpful when exploring relationships and when working with both the client and significant others.

Dr Bewley commented, “In the UK we are beginning to wake up to what our patients have been telling us for years…that the psychological effects of having a skin disease are a priority for our patients. For this reason, the British Association of Dermatologists has just issued a report outlining the psychological support services which should be available for patients with skin disease.”

A range of psychological treatments (such as CBT, systemic therapy, solution-focused therapy) for individuals, couples and families are offered within our clinic. Having family members in the room has proven to be helpful to empower the client and reinforce the feeling of being supported. Clinical Psychologists are able to offer a range of therapies that allow for all treatments to be tailor-made dependent on the client’s needs. For example, for a client with eczema who consistently scratched, habit reversal therapy was shown to be effective in changing the unhelpful habit to something, which is not damaging to the skin. This gives the skin an opportunity to heal, which in turn reduces the eczema and halts the itch-scratch cycle. In some cases, I have found that being more integrative within therapy has been more successful.

For example, using CBT integrated with systemic therapy (e.g. discussing relationships, transitions, family rules and meanings, and interactional sequences) has been useful. Other therapies have also been shown to be clinically effective and offer simpler, brief interventions such as exploring coping strategies to help with social situations.

Due to the limited budget in the NHS, the provision of psychological health care for people with skin disorders is seen as inadequate. In some areas within the UK, psychological services are offered. Perhaps due to the stigma attached to being referred to ‘mental health’ services, some clients have reported that they prefer to see someone within dermatology. A survey conducted within the UK (Shah and Bewley, 2012), showed that within the UK there are only four dermatology departments that have a dedicated psychologist (one in Gloucester and three in London); with only one post, covering two hospitals, being full time within dermatology. Given new national guidelines for vitiligo, skin cancer and increased media coverage stating the importance of psychological interventions for people with skin conditions, this may create impetus for change and lead to development of services within the NHS.

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VIEW ON

EX PRESSI O N O F INTERES T Following on from his article last month on whether botulinum toxin cures depression, Dr Patrick Treacy gives his view on the latest media coverage that has shed confusion on the subject

Dr Patrick Treacy Dr Patrick Treacy is Medical Director of Ailesbury Clinics Ltd and Ailesbury Hair Clinics Ltd. He is Chairman of the Irish Association of Cosmetic Doctors and is Irish Regional Representative of the British Association of Cosmetic Doctors. Dr Treacy is a renowned international guest speaker and features regularly on Irish breakfast television (TV3), RTE and as an expert panelist with the BBC World Service. He had a series on Discovery Health and the Discovery Channel (New York) recently filmed a programme about his work. He is an active member of many international medical societies and is a Fellow of The Royal Society of Medicine.

A recent article by Claire Coleman in the Daily Mail has led to much confusion regarding differing opinion as to role of Botox® in treating or causing depression. The article was based on a study led by Dr Michael Lewis of the School of Psychology, Cardiff, Wales, who followed 25 people who had received Botox® for facial lines and examined the idea of facial feedback - where the expression we make with our faces affect how we feel.

Previous studies have found that the treatment of frown lines left patients feeling less depressed. In 2006, Dr Eric Finzi and Dr Erika Wasserman reported in Dermatologic Surgery that treating clinically depressed patients with Botox® on their frown lines actually got rid of their depression.

Hennenlotter (2009) went one stage further and showed that botulinum toxin treatment to the central frown lines stopped the activation of specific brain regions normally seen during voluntary contraction of the frown muscles. corrugator and procerus muscles. This indicated that feedback from the facial musculature in this region in some way modulated the processing of emotions. Many other researchers have continued down this road with many researchers speculating that the treatment interfered with the ability to decode the facial expression of other people.

More recently, two centres, the Psychiatric University Hospital of the University of Basel, Switzerland and the Medical School Hannover, Germany conducted a randomised, placebo-controlled, double-blind trial.

The authors concluded for the first time that a single botulinum treatment of the glabellar region could reduce the symptoms of major depression.

This effect developed within a few weeks and persisted until the end of the sixteen-week follow-up period. The effect sizes in the study were large and the response and remission rates were high.

So who is right?

Believe it or not – both are and the answer to the apparent medical paradox lies with Charles Darwin!

In 1872, the great explorer stated that the expression of sadness was attributed to the activity of so-called ‘grief muscles’ in the glabellar region. He formulated a new theory in his book The Expression of the Emotions in Man and Animals concerning genetically determined aspects of behaviour. The book was published thirteen years after ‘On The Origin of Species’ and is, alongside his 1871 book The Descent of Man, Darwin’s main consideration of human origins. In this book, Darwin seeks to trace the animal origins of human characteristics, such as the tightening of the muscles around the eyes in anger and efforts of memory. Darwin even sought out the opinions of some eminent British psychiatrists in the preparation of the book, which forms Darwin’s main contribution to psychology. His theory called the ‘facial feedback hypothesis’, implied a mutual interaction between emotions and facial muscle activity. There is experimental evidence that voluntary contraction of facial muscles can channel emotions, which are conversely expressed by activation of these muscles. It is assumed that reduced proprioceptive feedback from the paralyzed facial muscles is a relevant mechanism of mood improvement and this is why it can be used to reduce depression.

However, Dr Lewis and team found that people treated for another muscle (around the crow’s feet) left patients feeling more depressed. This does not contravene Charles Darwin’s original hypotheses, in fact it supports it.

The muscles around the eye are related to happiness and smiling and to restrict their movement must interfere with the facial feedback hypotheses in a converse way to the ones in the frown area. We can only assume that reduced proprioceptive feedback from these paralyzed facial muscles is a relevant mechanism of mood disimprovement and this is why they may increase depression. Accordingly, happiness can make you smile and smiling can make you happy.

It is obvious that the facial musculature not only expresses, but also regulates, mood states. Botulinum toxin injection interferes with the ‘facial feedback hypothesis’ originally postulated by Charles Darwin.

We must remember that botulinum toxin to the glabellar region may be an effective, safe, and sustainable intervention in the treatment of depression. The reason for this has not yet been fully evaluated but we must consider the concept as depression affects over 120 million people globally, making it one of the leading causes of disability in the world.

Because of the long treatment intervals it may also be an economic treatment option and the safety and tolerability record of botulinum toxin injections to the frown area region is excellent.

Maybe, it was my sixth sense but I never really felt right about totally removing crow’s feet around patient’s eyes.

Dr Patrick Treacy

40 www.cosmeticnewsuk.com

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Call free on 0800 63 43 881 and quote: CR01, or visit us online at www.cosmetic-insurance.com Hamilton Fraser Cosmetic Insurance | Kingmaker House | Station Rd | New Barnet | Herts | EN5 1NZ Hamilton Fraser Cosmetic Insurance is a trading name of HFIS plc. HFIS plc is authorised and regulated by the FSA. (*Figure from June 2012)

COVER FEATURE TREATMENT SPOTLIGHT

WAITING TO XCELL

We find out about the latest body shaping innovation from Chromogenex, due to be launched this month, i-LipoXcell Non-invasive body contouring has undoubtedly been one of the biggest growth areas in aesthetic medicine in recent years. One of the areas of aesthetics that truly transcends the gender barrier by appealing to both male and female clients, the global body shaping market has seen a massive boom, a boom that has been driven by advances in technology and efficacy in the minimally invasive sector of the market, which have significantly enhanced the treatment outcomes of these devices.

No longer seen as the ‘poor cousin’ of surgery, these non-surgical body contouring treatments are not designed for ‘weight loss’ but are focused on changing and improving body shape in three key ways: fat reduction and sculpting, skin tightening and cellulite reduction. All of this, coupled with increased demand for more cost effective, lower downtime treatments, makes body contouring potentially one of the most lucrative areas of cosmetic medicine and one that aesthetic practitioners cannot afford to ignore. One of the latest innovations in this field, which is due to be launched this month, is the i-LipoXcell from Chromogenex.

FOUR IN ONE Being touted as ‘the most advanced non surgical fat reduction and body shaping system’, i-LipoXcell utilises third generation technology for fat reduction. i-Lipo is FDA cleared for circumferential reduction and improvement in cellulite. It incorporates four technologies for intelligent body fat analysis and measurement, laser diode fat reduction, IR vacuum massage and radio-frequency skin tightening.iLipo incorporates both visible red and Infra red laser for biostimulation of metabolic pathways resulting in the release of fatty acids and glycerol, shrinking fat cells. Results are seen immediately with an average of 3cm (1 inch) per 3O minute treatment.

FOUR TECHNOLOGIES IN ONE SYSTEM: • Dual wavelength laser • Near Infra Red Vacuum massage • Multi wavelength body analysis • Multi polar radio-frequency

42 www.cosmeticnewsuk.com

M U LT I P L E A P P L I C AT I O N : • i-Lipo is FDA cleared for circumferential reduction • i-Lipo is FDA cleared for improvement in cellulite • Body fat analysis • Stretch market improvement • Targeted fat reduction for all areas of the body

Treatment is safe and comfortable and can target specific stubborn pockets of fat as well as reshaping the body. Laser treatment is followed by combination laser/vacuum massage to enhance lymphatic drainage, improve circulation and achieve deeper penetration of laser into fat cells for improvement in cellulite.

Using multi-polar radio-frequency i-LipoXcell can tighten up loose skin to further enhance results and achieve a firmer skin texture and appearance. The application of RF heat can stimulate metabolic activity and smooth out cellulite.

It also incorporates patented technology to instantly measure body fat and provide detailed analysis including basal metabolic rate, body fat percentage and records in a patient data base reduction in body fat and overall improvement in patient health. Results can be printed out to show the positive results of incorporating i-Lipo laser into a lifestyle-changing programme. The treatment is clinically proven, safe and treatment is comfortable, backed by leading physicians in worldwide multi-centre studies.

“For a compliant patient the results of i-Lipo can be as good as liposuction”

“i-Lipo is a new technique, innovative, painless and very effective” Jon. A. Perlman, MD Beverly Hills. CA

Dr JP Laura, Newport Beach, CA said, “i-Lipo is a true practice builder. It really works. Patients are happy and they keep coming back. i-Lipo is a great patient retention tool.”

Steve Shapiro MD co-director of Gardens Dermatology and associate professor, at the University of Miami added, “I have been in practice for 20 years and have seen many different new technologies. The i-Lipo has been a ‘wow’ in terms of results and no risk with high benefit.”

Dr John Flynn, Cosmedic and Skin Clinic, Australia commented, “It is an extremely gentle means of ridding the body of excess fat, and has proven extremely popular in my clinic.”

Dr Leonard Grossman Plastic Surgeon, New York

CLINICAL STUDIES FDA Study March 2012

Non-invasive circumference reduction with Low Level Laser Therapy: A double blind, randomised, controlled study

Prof. A Chu FRCP Donna Freeman MSc, PhD

GREDECO March 2011

Clinical Evaluation of An Anti-Cellulite device (i-LipoTM)

S Boisnic MD L Benichou MD

Argentina July 2011

‘Non-invasive reduction of local adipose tissue with a diode laser of 630-660nm’ (Published in The Scientific Journal of the Spanish Cosmetic Medicine Society, No 28, July-Sept 2011)

Prof. Dr R Pinto Dr Ricardo Hoogstra

Fat Reduction August 2009

Low Level Laser for Fat Reduction and Body Reshaping – Case Studies with the i-Lipo laser diode system

E Beynon-Williams

100 Patient Review March 2011

Treatment Outcomes recorded in Low Level Laser Diode Treatments for Fat Reduction and Body Reshaping – A Retrospective Review

Donna Freeman MSc, PhD

P R AC TI C E B E N E F I TS • • • •

Outstanding practice support and customer service Technologically advanced combination treatment protocol i-Lipo is FDA cleared for circumferential reduction and improvement in appearance of cellulite World leading brand backed by extensive marketing

PATI E N T B E N E FITS • • • • • •

Clinically proven Safe and comfortable Fast treatment time No side effects Immediate measurable results Encourages lifestyle change and improvement

Chromogenex will be holding a launch for i-LipoXcell on June 24, 2013 at The Royal Society of Medicine from 6-8pm. www.cosmeticnewsuk.com 43

The most advanced non surgical fat reduction and body shaping system

Patient before and after 8 treatments incorporating RF

BEFORE

AFTER

Multi-Platform Body Contour System i-Lipoxcell is the third generation of i-Lipo systems from Chromogenex, a world leader in laser innovation. i-Lipoxcell incorporates four technologies for intelligent body fat analysis and measurement, laser diode fat reduction, radio frequency skin tightening and Ultra vacuum massage for cellulite reduction and lymphatic drainage.

Fat Reduction

Dual Wave Length

Stretch Marks

BFA - Body Fat Analysis

Lymphatic Drainage

i-Lipoxcell is comfortable, safe and clinically proven, backed by independent multi centre studies from leading physicians worldwide.

Clinically Proven

Vacuum Massage for Cellulite improvement

LAUNCH SEMINAR

Radio Frequency

i-Lipo is FDA cleared for Circumferential Reduction

24th June / 6-8pm / The Royal Society of Medicine, London Call +44 (0)1554 755 444 to book your place today, or register online at www.ilipoxcell.com We are currently taking expressions of interest for other venues, register online or book an i-Lipoxcell demonstration near you.

“

4 TECHNOLOGIES IN 1 i-Lipo is a true practice builder. It really works. Patients are happy and they keep coming back. i-Lipo is a great patient retention tool.

Dr. J.P.Laura Newport Beach, CA

FAT CELLS BEFORE & AFTER

For more information visit

www.ilipoxcell.com /iLipoCosmetic

@ilipocosmetic

Call 01554 755444 or email sales@chromogenex.com UK: +44 (0)1554 755444 • USA: 1-855-438-4547 • South Africa: +27(0)11 079 4242 Australia: 1800 827 817 • Brazil: +55 (11) 4702 4451 • Hong Kong (852) 3965-3175

Made in the UK

Leaders in Laser Technology

PRODUCT FOCUS PLIAGLIS

BREAKING THE PA I N B A R R I E R We find out about Galderma’s FDA approved self-occluding cream topical local anesthetic cream, Pliaglis

T

he advent of more advanced technologies in cosmetic skin treatments has seen a growing trend in the use of topical anaesthesia to provide pain relief as general and local anaesthesia are deemed unnecessary. It is also a popular pain management option for needle phobic patients.

Indeed topical anaesthetic cream is still widely used in dermal fillers containing integrated lidocaine to provide additional comfort. However in laser and energy based aesthetic treatments providing adequate pain relief still presents a challenge.

Up to now there has been a tendency to tailor the treatment plan to the patient’s pain threshold, with the patient, perhaps, adopting a slightly stoic approach. But this is set to change with the arrival of Pliaglis (7% lidocaine/7% tetracaine) cream, a new topical anaesthetic, recently launched by Galderma, which enables medical aesthetics practitioners, and in particular dermatologists and laser surgeons, to provide a more comfortable treatment experience for their patients.

Pliaglis is the first and only clinically proven, FDA approved topical anaesthetic that combines the highest concentrations of lidocaine 70mg/g and tetracaine 70mg/g. Its unique self-occluding delivery system provides rapid onset, within 30-60 minutes, and long lasting effect 1,2 which makes Pliaglis suitable for the aesthetic treatments which are known to be painful and where post procedure pain relief is desirable. Pliaglis has a fast onset of action providing effective relief for injectable treatments within 30 minutes. Maximum anaesthetic effect required for the more painful

46 www.cosmeticnewsuk.com

laser ablation treatments is achieved at 60 minutes. When exposed to air, the cream adheres to contours in the skin to form an occlusive barrier.

As it dries, Pliaglis releases lidocaine 70mg/g and tetracaine 70mg/g through the layers of the skin, blocking the transmission of the perception of pain, providing local dermal anaesthesia.

The combination of newer laser technology with the latest advances in topical anaesthesia means that the more painful treatments, e.g. deep skin resurfacing, tattoo removal and hair removal can now be carried out with a topical anaesthetic cream. Dr Sandeep Cliff, consultant dermatologist and laser surgeon, says “Before the arrival of effective topical anaesthetic products, ablative skin treatments using CO2 or Erbium YAG lasers often required the use of intravenous sedation. However in recent years with the introduction of more sophisticated and advanced laser technologies there has been increased use of topical anaesthesia for pain relief, often with adjunctive use of cooling devices to prevent the skin from overheating. Pliaglis is definitely a big step forward in topical anaesthesia because it works fast and provides long lasting numbing effect. It effectively deals with both ‘immediate’ pain and ‘delayed’ post-procedural pain.”

The vasodilating effect of some topical anaesthetics, including Pliaglis, is suitable in

particular for the treatment of rosacea and skin lesions where the ability to increase the target area leads to enhanced treatment results. Dr Cliff shares his experiences. “I have used Pliaglis very successfully in the removal of telangiectasia.

Pliaglis has the ability to conform to skin topography and anaesthetise large irregular surface areas which makes it particularly suitable as effective pain relief for laser based treatments.”

Not limited to laser procedures, experience using Pliaglis is also growing with injectable treatments, such as fillers and medical skin needling. For some patients fear of pain remains a barrier to proceeding to treatment, particularly in relation to lip enhancement and dermal filler treatments around the mouth. Pliaglis represents a significant advance in pain management for the treatment of these indications and has the potential to improve the conversion rate of patients moving from consultation to actual treatment. Mr Max Murison, consultant plastic surgeon, Swansea Laser Centre, explains “Prior to the availability of Pliaglis, it was not possible to discuss treatment options with a new patient and move to treatment in one appointment because, up until this time, the topical anaesthesia available has been limited in its effect; it was always too big a step. However, I believe it is now possible to offer some dermal filler treatments, if appropriate, within the initial appointment because with

Pliaglis, the new patient will find the pain level associated with these treatments acceptable. Nevertheless careful management of pain expectations and careful patient selection is still necessary.”

• EFFECTIVE PAIN MANAGEMENT MAKES A DIFFERENCE Dr Mauro Ercolani, professor of clinical psychology, University of Bologna, has carried out a number of studies investigating the psychological impact of pain on patients.

His research shows how the attitude towards pain has moved from widespread acceptance to the belief today that proper pain management is a fundamental right.

At a recent meeting in Rome of key opinion leaders from around the world, specialising in laser and energy based treatments, the consensus was that pain has a strong influence on the patient treatment experience. Effective pain relief is a key factor in patient satisfaction and should be more greatly valued in improving treatment outcomes and patient retention. Significantly, successful pain management is a pre-requisite for stimulating word of mouth referral and is a powerful differentiator in a crowded marketplace.

A participant at the meeting, US dermatologist Dr Robert Weiss, highlights another advantage of providing effective anaesthesia from the physician’s viewpoint: “Treating a relaxed patient is so much easier and an altogether more pleasant experience. I am able to concentrate on what I am doing without the distraction of worrying about how much pain my patient is feeling. The patient is more co-operative. I can work quickly and more expertly.”

Providing effective pain management is a key objective for medical aesthetics practitioners not only to secure patient satisfaction but also to ensure that treatment strategies are based on achieving optimal results, not guided by the patient’s pain threshold. Mr Max Murison believes that Pliaglis has an important role in achieving these objectives.

“In the case of fractional ablative procedures I believe that Pliaglis will facilitate more intense treatment which, overall, will require fewer patient visits. Undoubtedly this will have a number of benefits including improving patient compliance, treatment results and patient satisfaction levels.”

• PAIN MATTERS Whilst minimally invasive cosmetic treatments are associated with some level of pain, recent research shows that 20% of new patients have concerns about treatment discomfort which deters them from having an aesthetic procedure 3. Pain is also a significant barrier for around a third of patients on a repeat treatment regimen with 42% declining further procedures as a result of the pain experienced3. This resistance may compromise projected

outcomes and may lead to patient disappointment together with reluctance to visit the clinic again.

Mr Max Murison explains “If patients’ expectations of pain are not managed properly and you hurt them, they will not come back. If you try to over-manage patients’ expectations the danger is that you deter them from going forward to treatment. It is hard to find the right balance of information but Pliaglis makes the discussion much easier now.

Certainly some of my most nervous patients have responded well to Pliaglis and tell me that it has transformed their treatment experiences. They only want Pliaglis as pain relief in the future. I want my patients to recall the high quality care and excellent results provided, rather than focus on procedure discomfort.”

• PAIN AND PATIENT BEHAVIOUR Pain is very individual. Studies in psychology show that pain can be learnt behaviour and misconceptions abound. Patients need to have a realistic understanding and expectation of the discomfort associated with their procedure. Being informed and involved in decisions about pain relief helps increase patients’ understanding of the procedure, reduces anxiety and minimises the risk of post-operative complications4.

Pain is influenced by culture, previous pain experience, beliefs, mood and the ability to cope. Whilst pain may be an indicator of tissue damage, it may also stem from a psychological process. Dr Ercolani’s research shows that acute pain, for example experienced after surgical procedures and invasive treatments, may also alter pain perception. Failure to relieve acute pain may result in increasing anxiety, inability to sleep, loss of control, inability to think and interact with others. Pain perception is also affected by early pain experiences, including those from childhood. The complexity of pain is illustrated by recent studies showing that patients can learn to feel pain just by observing other people. A positive experience drives future behaviour and this learning underpins the value of placing greater emphasis on effective pain management in order to provide a more superior treatment experience to secure long term patient loyalty.

“Anxiety, fear and a sense of loss of control contribute to patient suffering” says Dr Ercolani. “Time invested in getting to know your patient in the consultation interview is not wasted time. It requires high level communication skills, appropriate voice tone, charisma and listening skills. Positive patient engagement is more conducive to satisfactory outcomes with the patient feeling less pain. To achieve this patients require full information about all aspects of their treatment. Empowered by information patients feel involved and more in control and will feel less pain as a result.”

ABOUT PLIAGLIS Pliaglis is a prescription only medicine available from Galderma. You will be able to see Pliaglis in action at the forthcoming FACE conference being held on 21-23 June.

[References] 1. Pliaglis Summary of Product Characteristics 2. Alster TS et al. The Lidocaine/ Tetracaine Peel: A Novel Topical Anesthetic for Dermatologic Procedures in Adult Patients.

Dermatol Surg 2007;33: 1073–1081 3. Market research data on file, Galderma 4. Huber et al. Dermatology Nursing/ December 1998/Vol10/No6

www.cosmeticnewsuk.com 47

SKINCARE PROMOTIONAL FEATURE ENDOCARE

ENDO THE LINE We find out how Endocare from AesthetiCare offers an innovative approach to skin regeneration by utilising SCA biorepair technology The cosmeceutical skincare industry has been growing exponentially in recent years and consumers are becoming more and more savvy when it comes to ingredients. Despite this increasing consumer awareness the average woman shockingly still uses 12 products a day, containing 168 ingredients (1) and with such a broad selection of products now available, meeting client demand for the latest, most innovative ingredients and trends is an important factor for aesthetic clinics.

‘Growth factors’ are undeniably one of the biggest skincare buzzwords of the moment but while many consumers are keen to tap into the rejuvenating potential offered by growth-factor based products, many are still wary about using human-derived growth factors in their skincare and with human materials being banned from the use in cosmetics

in the EU (2), clinics need to assess what products in this category they are offering their clients.

Endocare from AesthetiCare is an all-natural skincare range using animal derived naturalgrowth factors to provide clinically advanced natural skin regeneration. Endocare’s patented SCA Biorepair Technology causes the skin to repair itself. The extensive range of elegant daily use dermo-cosmetics can provide clinically proven (3) improvements in the visible signs of ageing through evidence based clinically advanced skin regeneration.

WHAT IS SCA? SCA Biorepair Technology harnesses the power of nature as it is derived from the regenerative and repairing complex produced by the mollusc Cryptomphallus aspersa. The secretion of this mollusc has been used in treatment of radiation induced

dermatitis, with impressive results from baseline to four weeks. This complex has enabled the mollusc to repair its own damaged tissue and survive periods of extreme trauma such as cold, heat, dryness, chemical change and UV irradiation; challenges that in a less severe way are faced by our skin every day. Endocare uses a patented, pharmaceutical-like process to produce from this natural complex the SCA Biorepair Technology, a natural-growth-factor ingredient.

SCA Biorepair Technology and the Endocare® products have been shown in peer reviewed dermatological and scientific publications to provide the following: • Natural-growth-factor stimulation of skinfibroblasts and regeneration of the dermis • Skin-specific anti-oxidant protection and dermal enhancement • Reductions in the visible signs of ageing

T H E E N DO C ARE R ANGE

ENDOCARE® TENSAGE™ RADIANCE EYE CONTOUR

The Endocare cream, serum, radiance eye contour and ampoules, all contain individual Biorepair Indexes, ranging from 6 in the Tensage cream to a staggering 50 in the Tensage Ampoules. (The Biorepair Index identifies the level of SCA Biorepair Technology in each product.) Hero product, the Endocare Ampoules offer super-intensive regenerating and firming properties and give a moisturising, tightening, and lightening effect, on ageing and photodamaged skin. Used as a night serum, the ampoules help smooth out facial lines, plump skin and stimulate new collagen production.

Soothing and silky serum for eye-contour antiageing skin regeneration and smoothness, clarity and radiance enhancement containing: SCA Repair Index 10 and Tensderm™, advanced peptides to reduce puffiness and improve skin clarity, Hyaluronic acid and the natural skin lipid Squalene to provide natural-skin moisturisation of this delicate area, and illuminating lightcapturing pigments to further enhance radiance.

The range includes:

ENDOCARE® TENSAGE™ AMPOULES

ENDOCARE® TENSAGE™ CREAM

‘Skin-booster strength’ unit dose ampoule containing a whopping SCA Repair Index 40, with restorative Vitamin C & E and a skin-hydrating complex. Use every-night for a week to kick-start the regime and periodically thereafter. Ideal as a 7-day prep before regenerative procedures such as Genuine Dermaroller™. Repair Index 40.

A rich creamy gel designed for day and night anti-ageing skin-regeneration, containing; SCA Repair Index 6, Tensderm™, Vitamin E anti-oxidant and an intensive nutritive complex containing natural-skin-lipids to provide sustained moisturisation

ENDOCARE® TENSAGE™SERUM A creamy, silky and rapidly absorbed serum for day and night anti-ageing skinregeneration containing; SCA Repair Index 15, Tensderm™, Vitamin C, E & CoQ10 anti-oxidant complex, Niacinamide for skin brightening and a Hyaluronic acid based skin-hydrating complex.

48 www.cosmeticnewsuk.com

[REFERENCES] 1. Eccles, Louise (12.02.11) ‘The Opposite of Beauty: The chemical make-up ingredients that raise risk of skin damage’ http://www.dailymail.co.uk/health/article-1356212/Make-ingredients-risk-skin-damage.html Accessed: 20th February 2013 2. Hilling, Celeste (30..04.10) “Human Growth Factors as Natural Healers: Current Literature & Application” http://www.cosmeticsandtoiletries.com/formulating/ingredient/active/92518304.html Accessed: 20th February 2013 3. Brieva / Philips / Tejedor / Guerrero / Pivel / Alonso-Lebrero / Gonzalez (21:15 – 22) Skin Pharmacol Physiol, 2008. ‘Molecular Basis for the Regenerative Properties of a Secretion of the Mollusk Cryptomphalus aspersa’

CLEAN, SIMPLE AND FAST ACTING THE FIRST AND ONLY SELF-OCCLUDING TOPICAL ANAESTHETIC

(7% lidocaine & 7% tetracaine) Indications: For use in adults to produce local dermal anaesthesia on intact skin prior to dermatological procedures

Pliaglis Prescribing Information (UK)

Presentation: 1 gram of cream contains 70mg lidocaine & 70mg tetracaine.

Indications: For use in adults to produce local dermal anaesthesia on intact skin prior to dermatological procedures. Dosage and Administration: For procedures such as pulsed-dye laser therapy, Pliaglis should be applied at a thickness of 1mm for 30 minutes. For procedures such as laser-assisted tattoo removal, Pliaglis should be applied at a thickness of 1mm for 60 minutes. After the required time, the peel must be removed from the skin prior to the procedure. The maximum application area should not exceed 400 cm2. For facial procedures, Pliaglis should be applied by healthcare professionals only. Pliaglis should be applied with a flat surfaced tool, never with fingers. Pliaglis is for single patient use. Contraindications: Hypersensitivity to lidocaine, tetracaine, other anaesthetics of the amide or ester type, to paraaminobenzoic acid or any of the other excipients. Should not be used on mucous

membranes or on broken or irritated skin. Precautions and Warnings: Avoid contact with eyes. Treated area should not be occluded before removing Pliaglis from skin.

Should not be applied for a longer time than recommended. Local anaesthetics, including tetracaine, have been associated with methemoglobinemia. It is not recommended to use Pliaglis before injection of live vaccines as lidocaine has been shown to inhibit viral & bacterial growth. Use with caution in patients with hepatic, renal or cardiac impairment, and in patients with increased sensitivity to systemic circulatory effects of lidocaine and tetracaine. Avoid trauma to skin whilst under effects of Pliaglis. Interactions: No interaction studies have been performed. Interactions following appropriate use are unlikely as only low concentrations of lidocaine and tetracaine are found in the plasma after topical administration of recommended doses. Patients taking drugs associated with drug-induced methemoglobinemia are at greater risk for developing methemoglobinemia. Undesirable Effects: In clinical

trials, localised skin reactions at the application site were very common but were generally mild and transient in nature. Reported adverse reactions include: Very common (≥1/10): erythema, skin discolouration; Common (≥1/100 to <1/10): skin oedema; Uncommon (≥1/1,000 to <1/100): pruritus, pain of skin, pain; Rare (≥1/10,000 to <1/1,000): paresthesia, eyelid oedema, pallor, skin burning sensation, swelling face, skin exfoliation, skin irritation; Not known (cannot be estimated from available data): urticaria. Rare allergic or anaphylactoid reactions associated with lidocaine and tetracaine or other ingredients in Pliaglis can occur. Prescribers should consult the SPC in relation to other side-effects. Packaging Quantities and Cost: 15g £22.95 (NHS). MA Number: PL 10590/0059. Legal Category: POM. Full Prescribing Information is Available From: Galderma (UK) Limited, Meridien House, 69-71 Clarendon Road, Watford, Herts, WD17 1DS. UK. Tel: +44 (0)1923 208950 Fax: +44 (0)1923 208998. Date of Revision: December 2012.

Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard.

Adverse events should also be reported to Galderma (UK) Ltd Date of preparation: March 2013

PLI/018/0313

PRODUCT NEWS NEOSTRATA®

SILDERM

New NeoStrata® Skin Active Line Lift with professional strength Aminofil™

SilDerm’s Clinically Proven Scar Gel now available as a spray

New NeoStrata Skin Active Line Lift is now available in the UK. The two step topical line treatment is the latest addition in the clinically proven NeoStrata Skin Active range and contains high strength Aminofil™.

Aminofil™ is a tyrosine amino acid derivative (N-Acetyl Tyrosinamide), which delivers a rapid volumising effect in the deep skin matrix to visibly reduce deep facial lines and wrinkles when applied twice daily.

Dr Beth Briden, CEO of Advanced Dermatology & Cosmetic Institute in Edina, Minnesota, is presenting Skin Active Line Lift at the FACE conference in June. She will discuss compelling data from a double-blind, vehicle-controlled study demonstrating that Skin Active Line Lift is well tolerated and effective in improving the appearance of deep expression lines in women with photodamage when used as a stand-alone treatment. Dr Briden will also discuss how Skin Active Line Lift has an important role to play as a topical adjunct to cosmetic procedures such as neurotoxins, peels, microdermabrasion and light based treatments when tackling difficult to treat lines. Applied twice daily, Skin Active Line Lift targets deep expression lines. In addition to Aminofil™, it contains NeoStrata proprietary formulations NeoCitriate™ and NeoGlucosamine®. These ingredients work together synergistically to help build glycosaminoglycans, including hyaluronic acid and collagen, to provide volume in the deep skin matrix and visibly lift lines that, until now, could not be addressed by an anti ageing topical skincare regimen alone.

Lorna Bowes, director of Aesthetic Source, the distributor of NeoStrata in the UK, says “Skin Active Line Lift represents a significant advance in cosmeceutical skin care and underpins NeoStrata’s commitment to develop the very best clinically proven anti ageing homecare formulations to support in-clinic treatments, helping medical aesthetics practitioners deliver high quality care and provide high satisfaction to secure patient loyalty. Now, for the first time, patients can see visible lifting in difficult to treat target areas with this two step product as part of their daily skincare routine at home.”

Relinquishing the layers in summer means that our bodies are laid-bare for all to see. But for those with scars, especially on highly visible areas of skin such as the face, upper chest, hands, arms or legs, the thought of revealing them can bring a sense of dread, causing psychological distress.

SilDerm Scar Gel and Spray can be used on old or new scars and on large or small scars. The two clinically proven silicone products are desgined to help treat and prevent scar formation and work by bonding to the outer layer of the skin providing a protective barrier against chemical, physical and microbial contamination of the scar site. The Gel and the Spray both dry quickly to form an ultra-thin,breathable, waterproof silicone membrane which allows the scar to heal naturally through normal collagen synthesis.

This also normalises the over production of collagen, which can lead to abnormal scars. This in turn reduces the redness of scars, decreases their volume and reduces the pain and itchiness.

The unique blend of naturally occurring silicones has been proven in clinical studies to flatten, soften and smooth scar tissue. These silicones dramatically reduce the redness and relieve the itching and discomfort often associated with scars. The ingredients have been proven in clinical trials to significantly reduce scarring with post-operative scars. In several meta-analyses of the data on several thousand patients treated with silicone, it has consistently shown that patient’s scars improve over a two to three month period by 80%, as measured by patient satisfaction.

SIGMACON

Sigmacon Launch Lumenis M22 ResurFX Sigmacon is proud to announce the launch of the Lumenis ResurFX an affordable module for the M22™ device, the company’s multi-application, multi-technology platform. The 1565nm fiber laser energy is delivered by patent-pending CoolScan™ scanner to perform non-sequential scanning to maximize efficacy and reproducible results. The module extends the ability of Lumenis’ gold-standard M22 to perform nonablative skin resurfacing and treat some of the most common aesthetic skin concerns including acne and surgical scars, skin discoloration, periorbital wrinkles and stretch marks.

“The new ResurFX module for M22 is a true non-ablative fractional fiber laser technology. It uses a unique algorithm to apply micro-beams

of 1565nm laser energy in a non-sequential pattern to increase patient comfort and minimize non-specific thermal damage using the ‘cool-scanning’ technology pioneered by Lumenis. With over 600 parameter combinations, ResurFX gives me the greatest possible flexibility in treating a wide range of conditions,” said Dr Mitchel P Goldman, MD, principle investigator for ResurFX, Volunteer Clinical Professor of Dermatology, University of California, San Diego and Medical Director, Dermatology/ Cosmetic Laser Associates of La Jolla, Inc. The M22 is the only multi-application, multi-technology platform that combines three proprietary, robust technologies offering more than 40 indications for use in one platform: Intense Pulsed Light with Optimal Pulse Technology™, Multi-spot Nd:YAG and now ResurFX for a complete aesthetic workstation.

LA ROCHE POSAY

La Roche Posay achieves double breakthrough in ultra-high sun protection La Roche Posay has announced the launch of two major formula innovations, which are set to redefine sun protection: Anthelios XL Dry Touch Gel-Cream SPF 50+ and Anthelios XL Invisible Nutritive Oil SPF 50+. Anthelios XL Dry Touch Gel-Cream SPF 50+ is instantly absorbed by the skin, leaving no shine or white streaks. To achieve its dry touch effect, the formula features an innovative sugar-derived polymer to ensure an invisible finish and has a blend of anti-shine powders to ensure an ultra-dry finish. At the core of Anthelios Dry Touch Gel-Cream SPF 50+ is the patented Mexoplex® filter system, which guarantees a very high level of protection against UVA and UVB rays and offers optimal tolerance for sensitive and sun intolerant skin alongside excellent photostability. The UVA protection is reinforced with PPD 31 to combat UVA rays, the main cause of sun intolerance and premature ageing.

Anthelious XL Invisible Nutritive Oil with SPF 50+ combines 13 ingredients to create a suncare oil which is both protective and nourishing, but also hypoallergenic and paraben-free. The product provides ultra-high UVA-UVB protection (SPF 50+/PPD 35) thanks to the inclusion of Mexoryl® XL, and is suitable for even sensitive skin.

ASCLEPION

Asclepion, Germany, launch World’s First 577nm Yellow Light Diode Laser Carleton Medical, the UK distributor for Asclepion Lasers, Germany, have announced the release of the first ever 577nm diode laser for vascular treatments: The Asclepion ProYellow. 577nm is acknowledged as the most optimally absorbed vascular wavelength: better than both 532nm (KTP) and 585nm (Pulsed Dye). This means the ProYellow will perform vascular treatments more efficiently compared to other vascular lasers due to the better absorbency and in turn equates to better patient outcomes and safety. The laser is just 12kg, and has no consumables like dye cartridges used for pulsed dye systems. It also has a scanner hand piece, in built cooling, IPad user operation and a two year parts warranty. Asclepion say that the laser represents ‘the biggest development in vascular lasers in the last 10 years.’ Asclepion have also announced that their Pain Free hair removal laser, the NeXT, has had its parts warranty extended from two to three years.

This represents the longest warranty currently available on the laser market.

DERMACEUTIC

Sigmacon introduces Dermaceutic Laboratoire Professional Skin Care Sigmacon UK is proud to announce that the popular Dermaceutic Skin Care range has been rebranded as Dermaceutic Laboratoire and is now available in the UK exclusively from Sigmacon UK. Recognised in 2012 as one of Europe’s fastest growing Professional Skin Care lines, the range has become extremely popular since Sigmacon UK took over from MA Group in 2012. Led by the Hydroquinone Free Spot Peel, the range is fast becoming an industry leader for Melasma and Pigmentation treatment with outstanding results without the usual downtime.

Sigmacon has partnered with Church Pharmacy for those that require a prescription service.

dermamelan® is a professional whitening treatment designed to eradicate or eradicate or attenuate cutaneous blemishes with melanic origin while it homogenizes skin tone and increases skin luminosity. dermamelan® application inhibits the melanogenesis process paralysing melanin production for a long period of time in which corneum stratum desquamation and the action of macrophage cells drag melanin deposits.

www.mesoestetic.co.uk

BUSINESS - VAT

’

A L L When it comes to medical aesthetics the line between what is classified as medicine and what is purely cosmetic has become somewhat blurred. Even the name ‘medical aesthetics’ puts the two concepts in juxtaposition so it is not surprising that the issue of whether or not aesthetic practitioners should be charging their patients VAT has caused much debate in recent years.

While this topic of discussion is nothing new, it has once again been causing practitioners concern after one doctor was investigated by the HMRC because they deemed the treatments they were offering to be purely cosmetic and therefore VATable.

In light of this, the British College of Aesthetic Medicine (BCAM) has been examining the topic with renewed gusto and has set up a VAT task force to look into the issue and build a case in a bid to offer its members some solid guidelines on what they should be doing. The lack of clarification around the issue has meant this is very much still a grey area and a confusing one at that.

So what does the HMRC actually say? Its website states that: “we will generally accept that cosmetic services are exempt where they are undertaken as an element of a health care treatment programme. Where services are undertaken purely for cosmetic reasons, they will be standard rated.”

When talking about Class 3B and 4 lasers and Intense pulse light source (IPL) machines it says: 52 www.cosmeticnewsuk.com

“Class 3B and 4 lasers and IPL machines are now used in many medical and cosmetic procedures carried out on the premises of approved, licensed or registered institutions.

However, it should not be assumed that all treatments using this equipment are exempt from VAT. “Where the procedure using this equipment is supplied as part of a treatment programme drawn up by a registered health professional following the diagnosis of a medical condition, this treatment is exempt from VAT. But where it is carried out for a cosmetic reason rather than as an element of medical or surgical treatment, this service is taxable at the standard rate of VAT.” Dr Mike Comins is a member of the BCAM VAT group and believes, as doctors, its members have a strong case to argue that none of the treatments they offer, despite their cosmetic nature, should not be liable for VAT. He says, “Medical treatments offered by doctors are exempt from VAT, the law has not changed, however some departments within the HMRC propose that certain procedures that doctors

We update you on the current situation surrounding VAT on aesthetic treatments

offer are purely cosmetic and therefore the client/patient should pay VAT on them. It is just an interpretation of the law. We don’t agree with that.”

Most aesthetic treatments have both a medical and cosmetic benefit so where do you draw the line? Botulinum toxin can be used for a number of medical indications from hyperhidrosis to blepharospasm while fillers can be used for correcting scars or treating lipodistrophy. Laser hair removal may be required because of medical conditions such as polycystic ovaries and many skin treatments from dermal rollers to skin peels are indicated for dermatological conditions such as acne and acne scarring.

With the line between what is cosmetic and what is medical so thin, would this mean charging VAT for patients who came in for cosmetic laser hair removal while not charging it for those who came in for medical reasons all in the same practice?

Dr Comins doesn’t think so. Because a consultation takes place, a medical history is taken, diagnosis reached, management plan agreed and in some cases prescription only medicines are used, he is confident that the treatments cannot be classified as anything other than medical. He also believes the Keogh review will actually help strengthen this argument because there is a focus on taking aesthetic treatments more seriously and classifying them in the realm of the medical rather the realm of the cosmetic. He says, “I find it strange that on one hand we have the authors of the Keogh report emphasizing the medical nature and complications associated with dermal fillers and botulinum toxin yet the HMRC are trying to undermine the medical aspects of these treatments and say they are

Practitioners should stay vigilant about the issue of VAT. There are justified arguments on both sides and you may still find yourself being scrutinised by the taxman. just cosmetic and not medical. We believe that all treatments offered

by Aesthetic doctors are medical treatments used for medical purposes with associated medical side effects and complications and on that basis they are VAT exempt. I feel it would open a can of worms if the HMRC says that the treatments we offer are not medical. How are they going to define what is and what is not? Also if they are saying these treatments are not medical then do you have to be a doctor to do them?

If it is just cosmetic and the patient has to pay VAT what happens if a medical problem results from the treatment?”

Dr Comins believes that there are always psychological aspects that relate to appearance fixing treatments. Many patients who go to medical aesthetic practitioners to seek treatment do so to address self esteem issues and this shouldn’t be belittled or dismissed as just vanity. Dr

Comins explains, “Clearly there are a small proportion of patients whose self esteem is completely dominated by their appearance and it is important that these patients are offered appropriate clinical advice and treatment not necessarily a cosmetic intervention and Aesthetic doctors have the professional training to recognise such problems. However 99% of patients don’t have extreme issues of low self-esteem or depression as a sole result of their appearance but they recognize that physical appearance and how they present themselves to the world is an important and integral part of the complex jigsaw required for general wellbeing and contentment.”

If your practice is offering medical laser treatments and is therefore CQC registered this could further strengthen your case with the HMRC. While having to be CQC registered is frustrating for aesthetic clinics when beauty salons can set up doing cosmetic laser and IPL down the road without being registered, they would not be able to justify avoiding VAT. With the Keogh review looking to tighten up regulation in the sector there is a further advantage to medical aesthetics clinics being CQC registered as it shows a commitment to best practice and differentiates you from non-medical practices at a time when consumer confidence needs to be bolstered.

Practitioners should stay vigilant about the issue of VAT. There are justified arguments on both sides and you may still find yourself being scrutinised by the taxman. While this topic remains shrouded in uncertainty for the time being, let’s hope that on this occasion it doesn’t turn out to be the case that the only certain things in life are death and taxes!

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BUSINESS FOCUS

M A K I N G A S TA N D Richard Crawford-Small on lessons that can be learned from the Keogh review and what changes you can start making in your practice now to help you stand out from the crowd and demonstrate best practice

S

o the months of waiting are finally over, and Sir Bruce Keogh and his team have delivered a report that is quite frankly a brutal assessment of an industry that appears to have put profit before patient for years.

A true professional in the medical aesthetics industry, Richard has enjoyed a career that has seen service in The Royal Navy to Medical Device Sales and Corporate Account Management with Allergan. Richard started RCSConsulting in January 2012 and has successfully used his “Think-Plan-Do” methodology in driving greater success for clients including Allergan, Schuco International, The Hospital Group, Transform and Harley Aesthetics. Richard is also an accomplished speaker and presents regularly at industry conferences and meetings.

The first paragraph in his executive summary is pretty damning; “The cosmetic interventions sector is growing rapidly. The existing regulatory framework has not kept pace with changes and it does not provide enough protection against many of the potential risks from cosmetic procedures”.

We have unconsciously, not consciously designed the patient experience in medical aesthetics, and allowed complacency and poor practice to become acceptable.

Sir Bruce highlights the following key areas as where we can focus; • High quality care • An informed and empowered public • Accessible resolution and redress Clearly Sir Bruce and his team are fans of the rule of three, there is a call to arms and these are

HOW? Use the recommendations in the Keogh report to differentiate your business against your competition.

Differentiation is the strategy of positioning your product or service above your competitors, although essentially your offerings may be the same.

Or Making sure that the good are found, the bad are found out, and no one finds the ugly.

An effective differentiation strategy will enable you to set yourself apart from your competition, retain

more patients and increase your word of mouth marketing.

The fact is that whether you agree with the recommendations in the Keogh Report or not, practices MUST change, and those who embrace and implement these changes quickly will have a head start on those who do not, and I want to highlight a few ways you can set yourself apart in your local markets.

Differentiation tactics are quite individual and subjective, but generally fit into the following categories;

clearly the right battles to fight.

The trouble is, having made a career out of fixing things, I know all too well that there is a significant difference between knowing the issue, fixing the issue and making sure it stays fixed.

We have been at this “knowing” place before, and without the rule of law underpinning these recommendations, history tells us that not many of these recommendations will actually be implemented. Unfortunately Parliamentary timescales mean that these recommendations might not even make it to the houses until the end of 2014.

So business as usual? Well, no. What if I told you that my advice would be to implement as many of these recommendations as quickly as you can? What if I told you that I am certain that doing so will generate revenue for your business?

I’m going to give you a slightly different spin on this report, and suggest to you that there is a BIG opportunity here. Compliance will make you more money. It’s that simple. Now, your are listening aren’t you?

• • • • •

Price Differentiators Product Differentiators Skills Differentiators Environmental Differentiators Perceived Differentiation

The truth is that “Perception is reality”. The differences between clinics, practitioners or products are usually quite small, but they are made large in the mind of the consumer.

The emotional connection between the consumer and your business is the key to keeping them coming back to you.

www.cosmeticnewsuk.com 55

BUSINESS FOCUS Here’s another way to look at it 1. Commodities

2. Goods

3. Services

4. Experiences

5. Transformations

New substances are discovered

New inventions are discovered

New procedures are created

New themes are depicted

New paradigms are determined

The material is the offering

The product is the offering

The operation is the offering

The event is the offering

If we were to take Toxin injections as an example, 1. The COMMODITY is Botulinum Toxin Type A 2. The GOODS are the Brand e,g, BOTOX, Azzalure, Bocouture 3. The SERVICE is the injection Now, you can use Product Differentiation to help you stand out, but thats only going to take you so far, you really need to be operating in the Red Zone to

Here are a few tips to help you stand out…

1.Get your customers to think in terms of “Investment” not “Cost”.

I am told quite often that “patients just care about the price”, and I agree to a point. However, wouldn’t it annoy you to think that all of that time, effort and money spent learning and improving your skills was not seen as important to the consumer?

It would really bug me to hear “Sorry Dude, I’m going to get advice from the graduate because he’s £100 cheaper”. The report highlights that a one day course is not enough, so have your biography on your website, talk about your skills in the consultation, Invest in yourself and educate the consumer on why they should Invest in themselves, not focus on how much it costs.

2. Clearly differentiate yourself with your own code of practice The report recommends adherence to a code of practice that covers handling complaints and redress, insurance requirements, responsible advertising practice and consent practices.

These are your signposts, so why not create your own one page code of practice for your business?

This is your own business charter, your mission, your principles that hold you accountable to your patients. Write it, and live by it, communicate to your staff and hold them accountable to your high standards, it doesn’t have to be lengthy, simply answer these questions; Who are are you and what do you do?

What are your values?

When are you successful?

Email your charter to richard@rcsconsulting.co.uk, the best one gets a free website assessment and Social Media shout out.

3. Use Technology Much has been made in the report for the need for improved record keeping, audit trails,

56 www.cosmeticnewsuk.com

The individual is the offering

really stand out. Most businesses will create an experience of sorts, however if you can really add value transform that patient you will create a “Paradigm Shift” and have a patient for life.

Think back to your last major purchase over £500, how much of a factor was the brand?

What was the differentiator to you (other than price?)

Use the recommendations in the Keogh report to differentiate your business against your competition tracking etc and in my last article I introduced you to iConsultAesthetic. In the post Keogh era systems such as these will become more and more important in ensuring that you can provide evidence of safety, effectiveness and patient outcomes. They also provide transparency to your patients on treatment plans and product, iConsultAesthetic will help you comply with these recommendations and make your paperwork far easier to manage. iConsultAesthetic ensures compliance with 12 of the Keogh recommendations, so give it a try.

Go to www.iconsult-aesthetic.com for more information and a claim your free 10 patient trial.

4. Become an appropriate qualified clinical professional I must admit that I was VERY surprised that the committee did not ban non HCPs outright from performing injectable treatments; instead it recommended that; “Non-healthcare practitioners who have achieved the required accredited qualification may perform these procedures under the supervision of an appropriate qualified clinical professional”.

Some may see this as a green light for therapists to inject toxin and fillers, however I see this as a clear opportunity to......yes you have guessed it, differentiate.

As Healthcare Professionals you MUST be able to clearly articulate WHY the consumer should be treated by you and NOT a Non Healthcare Professional. This is a fundamental, so write down the reasons and ensure that all of your team can communicate this clearly.

5. Make sure that your environment is appropriate This will sound obvious, but the environment that your consumers are treated in is also important, and operating from CQC registered practices would provide all patients, both new and existing with comfort and also set you apart from others in your market. If this is not an option, then at least make sure that you do all you can to make it fit for purpose.

Conclusion There are literally hundreds of ways you can set yourself apart, and as you read the report, think through the changes you can make to your processes.

The next step is to inform your patients, and social media is a key channel for this. Put your “Keogh Compliance” out on Twitter and on your Facebook page and get engagement with your followers.

So, there it is, and while I’m certain that the majority will adopt some of these principles if not implemented already make sure that you clearly communicate these to your customers.

You will not be able to use the Keogh recommendations to differentiate for long as more clinics and practitioners do this the gap reduces, but the great thing is that those who don’t adopt these recommendations will then begin to stand out themselves.

But not for the right reasons!

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Join the conversation on...

IN BUSINESS A DAY IN THE LIFE

The art of Zein

Antonia Mariconda finds out what a typical Day in the Life is like for Dr Zein Obagi

D

r Zein Obagi literally defined and authored the science of Skin Health.

As a leading authority in cosmetic dermatology, he created Skin Health Restoration and Skin Conditioning, the standards by which skin conditions can be successfully treated regardless of skin colour or age. His name has become synonymous with results-oriented skin treatments around the world. Antonia Mariconda spends a day with one of the most revered doctors in aesthetic medicine.

“I live in Beverly Hills, California with my wife, Samar and my three of the younger children, Serene, Zaidal and Sabine and our dog, Gucci. I wake reasonable early, for breakfast I have fresh berries, American coffee, plain yogurt and freshly squeezed grapefruit, (and occasionally egg white omelette).

I go to the gym every morning for an hour.

My office is located in Beverly Hills. I like to drive to work. I listen to news on the radio otherwise I listen to Frank Sinatra and other singers in the 70’s era.

My workday usually starts at 11:00am, on most days; I work for at least 5 hours. I am currently writing a new book and that is what occupies most of my time in-between patients. I see patients until late afternoon.

My unique method is that, I treat any skin problems as part of a total approach, to make skin healthy at the same time. This concept is based on the definition of healthy skin that I created 30 years ago as a part of the science of healthy skin.

58 www.cosmeticnewsuk.com

I was inspired to take my career path when my sister suffered a 3rd degree burn, that resulted in scarring, from that moment, I decided to study dermatology to try to treat and prevent such scars.

and devices that are useless, and for them to spend some of their profits on educating the public about prevention of skin diseases and the importance of maintaining a healthy and natural look.

I have some exciting projects ahead including some new peels that will change the concept of chemical peels I love my work, the gratification that comes from being able to restore the original youth and beauty to every patient, and the ability to restore healthy skin, is priceless.

The frustrations of my work are not being able to spread the concept of skin health and the art of procedures fast enough throughout the world.

I would like to see some changes in the aesthetics industry, namely for manufacturers to stop making false claim about products

I have some exciting projects ahead including some new peels that will change the concept of chemical peels.

I usually end work at 4pm and take long walks before dinner with my wife and kids. I love Italian and Mediterranean food.

In my spare time I read novels and exercise, I also enjoy writing for my book or other publications and continue my research.

My final though of the day? “How can I make tomorrow a more rewarding and better day?”

Antonia Mariconda also known as ‘The Cosmedic Coach’ is a health and beauty writer, and author of four books. She is quoted in national and consumer press such as the BBC, Top Santé, The Evening Standard, Daily Mail, and Metro, for her knowledge on beauty and aesthetics, and cosmetic surgery. Antonia also independently advises clients both from the UK and around the world on where and where not to shop safely for cosmetic surgery, beauty, aesthetic medicine, and anti-ageing treatments.

Her client list includes A-list celebrities, Royalty and VIPs. Follow Antonia on Twitter @ CosmedicCoach or join Antonia on Face book where you will be updated about events and happenings in the world of health and beauty. www.thecosmediccoach.com

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Cosmetic News May 2013

D AT E S F O R THE DIARY WE ROUND UP UPCOMING EVENTS, TRAINING COURSES AND MEETINGS

• JUNE

2 Tear Trough Masterclass Boston International Training Academy Ltd, Bayswater, London, 0207 727 1110, www.bostontrainingacademy.com 8 Masterclass Aesthetox Botox® and Dermal Fillers, Birmingham, www.aesthetox.co.uk 12 Advanced facial treatment (Combined Course), Ely, Cambridgeshire, 01353 777 303/0774 769 6815, Barbara@academyofadvancedbeauty.com, www.academyofadvancedbeauty.com 13 CIBTAC ENDORSED Diamond Microdermabrasion for Face and Body, Ely, Cambridgeshire, 01353 777 303/0774 769 6815, Barbara@academyofadvancedbeauty.com, www.academyofadvancedbeauty.com 14 Obagi Workshop, London, www.healthxchange.com 15 BioSlimming, Ely, Cambridgeshire, 01353 777 303/0774 769 6815, Barbara@academyofadvancedbeauty.com, www.academyofadvancedbeauty.com 14 Infrared for weight loss and detoxification, Ely, Cambridgeshire, 01353 777 303/0774 769 6815, Barbara@academyofadvancedbeauty.com, www.academyofadvancedbeauty.com 15-16 Dermal Fillers and Botulinum Toxin Foundation Course, Boston International Training Academy Ltd, Bayswater, London, 0207 727 1110; www.bostontrainingacademy.com 17 CIBTAC ENDORSED Ultrasound for skin rejuvenation and wrinkle reduction, Ely, Cambridgeshire, 01353 777 303/0774 769 6815, Barbara@academyofadvancedbeauty.com, www.academyofadvancedbeauty.com 18 Pressotherapy for lymphatic drainage and cellulite reduction, Ely, Cambridgeshire, 01353 777 303/0774 769 6815, Barbara@academyofadvancedbeauty.com, www.academyofadvancedbeauty.com 19 Advanced Non-Surgical Facelift, Ely, Cambridgeshire, 01353 777 303/0774 769 6815, Barbara@academyofadvancedbeauty.com, www.academyofadvancedbeauty.com 20 CIBTAC ENDORSED Cosmetic thermotherapy and Cryotherapy, Ely, Cambridgeshire, 01353 777 303/0774 769 6815, Barbara@academyofadvancedbeauty.com, www.academyofadvancedbeauty.com 21 CIBTAC ENDORSED Cryotherapy Induced Lipolysis, Ely, Cambridgeshire, 01353 777 303/0774 769 6815, Barbara@academyofadvancedbeauty.com, www.academyofadvancedbeauty.com 22 Aesthetox Foundation Botox® and Dermal Fillers Manchester, www.aesthetox.co.uk 23 Aesthetox Skin Health and Chemical Peels, Birmingham, www.aesthetox.co.uk 24 i-Lipoxcell Launch UK - Royal Society of Medicine 28 ZO Medical, Wigmore Medical, archie@wigmoremedical.com , www.wigmoremedical.com 29 Botulinum Toxin in Facial Aesthetics: new users - includes all major brands, Central London, www.innomedtraining.co.uk 30 Dermal Fillers in Facial Aesthetics: new users to hyaluronic acid fillers, Central London, www.innomedtraining.co.uk 30 Advanced Botulinum Toxin, Boston International Training Academy Ltd, Bayswater, London, 0207 727 1110; www.bostontrainingacademy.com

• JULY

1 CIBTAC ENDORSED Ultrasound for skin rejuvenation and wrinkle reduction, Ely, Cambridgeshire, 01353 777 303/0774 769 6815, Barbara@academyofadvancedbeauty.com, www.academyofadvancedbeauty.com 4 CIBTAC ENDORSED Diamond Microdermabrasion for Face and Body, Ely, Cambridgeshire, 01353 777 303/0774 769 6815, Barbara@academyofadvancedbeauty.com, www.academyofadvancedbeauty.com

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All supplies conform to current www.academyofadvancedbeauty.com standards Mouthguards EC safetyLaser surgical instruments Laser Support Services Ltd. 12 CIBTAC ENDORSED Cryotherapy Inducedinstruments Lipolysis, Ely, Cambridgeshire, Laser surgical Safety signage School Drive - Ovenstone - Fife - KY10 2RR 01353 777 303/0774 769 6815, Fax 01333-312703 Safety interlocks Tel: 01333-311938 Safety signage www.laser-support.co.uk — Email Enquiries@laser-support.co.uk Barbara@academyofadvancedbeauty.com, Laser safety curtains Safety interlocks www.academyofadvancedbeauty.com Laser Support Services has been supplying laser Laser Support Services has been supplying laser 13 Chemical Peel Systems & Medical Skincare: comprehensive for new products since 1990.course All supplies conform to current Laser safety curtains EC safety standards products since 1990. All supplies conform to users, Central London, www.innomedtraining.co.uk Laser Support Services has been supplying laser current EC safety standards 14 Mesotherapy for localised fat, cellulite & skin rejuvenation: new users, Laser Support Services Ltd. products since 1990. All supplies conformSchool to current Drive - Ovenstone - Fife - KY10 2RR Central London, www.innomedtraining.co.uk Tel: 01333-311938 Fax 01333-312703 EC safety standards www.laser-support.co.uk — Email Enquiries@laser-support.co.uk 10 Obagi Workshop, Manchester, www.healthxchange.com Laser Support Services Ltd. Laser Support Services Ltd. 20 Aesthetox Foundation Botox® and Dermal Fillers, Birmingham, School Drive - Ovenstone - Fife - KY10 2RR School Drive - Ovenstone - Fife - KY10 2RR www.aesthetox.co.uk Tel: 01333-311938 Fax 01333-312703 Tel: 01333-311938 Fax: 01333-312703 20 Masterclass Aesthetox Botox® and Dermal Fillers, London, www.laser-support.co.uk — Email Enquiries@laser-support.co.uk www.laser-support.co.uk — www.aesthetox.co.uk

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• AUGUST

3 Aesthetox Foundation Botox® and Dermal Fillers, Birmingham, www.aesthetox.co.uk 5-6 CIBTAC ENDORSED Ultrasonic Lipo-Cavitation, Ely, Cambridgeshire, 01353 777 303/0774 769 6815, Barbara@academyofadvancedbeauty.com, www.academyofadvancedbeauty.com 7 5 Advanced facial treatment (Combined Course), Ely, Cambridgeshire, 01353 777 303/0774 769 6815, Barbara@academyofadvancedbeauty.com, www.academyofadvancedbeauty.com 8 CIBTAC ENDORSED Diamond Microdermabrasion for Face and Body, Ely, Cambridgeshire, 01353 777 303/0774 769 6815, Barbara@academyofadvancedbeauty.com, www.academyofadvancedbeauty.com 9 Infrared for weight loss and detoxification, Ely, Cambridgeshire, 01353 777 303/0774 769 6815, Barbara@academyofadvancedbeauty.com, www.academyofadvancedbeauty.com 10 BioSlimming, Ely, Cambridgeshire, 01353 777 303/0774 769 6815, Barbara@academyofadvancedbeauty.com, www.academyofadvancedbeauty.com 12 CIBTAC ENDORSED Ultrasound for skin rejuvenation and wrinkle reduction, Ely, Cambridgeshire, 01353 777 303/0774 769 6815, Barbara@academyofadvancedbeauty.com, www.academyofadvancedbeauty.com 13 Pressotherapy for lymphatic drainage and cellulite reduction, Ely, Cambridgeshire, 01353 777 303/0774 769 6815, Barbara@academyofadvancedbeauty.com, www.academyofadvancedbeauty.com 14 Advanced Non-Surgical Facelift, Ely, Cambridgeshire, 01353 777 303/0774 769 6815, Barbara@academyofadvancedbeauty.com, www.academyofadvancedbeauty.com The Dates for the Diary section is now a paid for section of the magazine and is a chance for you to advertise your training courses to our readers both in the magazine and online. Advertisers will get free listings of any training courses as part of their campaign. Anyone else wishing to publish training courses can do so for £300 a year.

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Ellipse Contact: Jane Myerson T: 0208 741 1111 Intense Pulse Light (I2PL) & Laser T: 0208 741 1111 E: sales@ellipseipl.co.uk E: sales@ellipseipl.co.uk Systems E: ashaki@ellipseipl.co.uk W: www.ellipseipl.co.uk W: www.venusconceptuk.co.uk Contact:Services: Jane Myerson W: www.technicalsupport.ellipseipl.co.uk/ UK distributor of IPL & Laser Services: UK distributor of Venus AZTEC Services Services: Onsite service & repairs of T: 0208 741 1111 systems, IPL & Laser training courses Freeze and Swan Radio Frequency (RF) aesthetic systems. UK agent for Ellipse and technical support & Magnetic Pulse (MP) systems Contact: Anthony Zacharek IPL & Venus Radio Frequency systemsE: sales@ellipseipl.co.uk Service: Exclusive UK distributor for Viora W: www.ellipseipl.co.uk Lynton product range Intense Pulse Light (I PL) & Laser Systems TECHNICAL SUPPORT Services: UK distributor of IPL & Laser systems, IPL & delivering the promise Contact: Customer Services T: 07747 865600 Beautylight Technical Services Ltd Contact: Jane Myerson Laser training courses and technical support Venus Freeze T: 0845 6121545 Contact: Jane Myerson Contact: Ashaki Vidale T: 0208 741 1111 E: sales@aztecservices.uk.com Contact:T:Jane Myerson 0208 741 1111 E: info@lynton.co.uk T: 0208 741 1111 E: sales@ellipseipl.co.uk W: www.aztecservices.uk.com E: sales@ellipseipl.co.uk T: 0208 741 1111 W: www.lynton.co.uk E: ashaki@ellipseipl.co.uk W: www.ellipseipl.co.uk W: www.venusconceptuk.co.uk W: www.technicalsupport.ellipseipl.co.uk/ E: sales@ellipseipl.co.uk Services: UK distributor of IPL & Laser Services: UK distributor of Venus Services: Onsite service & repairs of systems, IPL & Laser training coursesW: www.venusconceptuk.co.uk Freeze and Swan Radio Frequency (RF) aesthetic systems. UK agent for Ellipse and technical support & Magnetic Pulse (MP) systems 2 Services: UK distributor of Venus Freeze and Swan IPL & Venus Radio Frequency systems Intense Pulse Light (I PL) & Laser Systems Med-fx TECHNICAL SUPPORT delivering the promise Radio Frequency (RF) & Magnetic Pulse (MP)2 systems Contact: Faye Price Services Ltd Contact: Jane Myerson Ellipse Beautylight TechnicalTechnical Support Jane Myerson T: 01376Contact: 532800 Contact:Technical Ashaki VidaleServices Ltd Bioptica Laser Aesthetics T: 0208 741 1111 Beautylight T: 0208 741 1111 E: sales@medfx.co.uk T: 0208 741 1111 Contact: Mike Regan E: sales@ellipseipl.co.uk Contact: Ashaki Vidale E: sales@ellipseipl.co.uk ashaki@ellipseipl.co.uk W: www.medfx.co.uk T: +44 (0)7917 573466 W: www.ellipseipl.co.uk T: 0208E:741 1111 W: www.venusconceptuk.co.uk W: www.technicalsupport.ellipseipl.co.uk/ E: mike.regan@bla-online.co.uk Services: UK distributor of IPL & Laser E: ashaki@ellipseipl.co.uk Services: UK distributor of Venus Services: Onsite service & repairs of systems, IPL & Laser training courses Freeze and Swan Radio Frequency (RF) W: www.bla-online.co.uk W: www.technicalsupport.ellipseipl.co.uk/ aesthetic systems. UK agent for Ellipse and technical support & Magnetic Pulse (MP) systems IPL Onsite & Venus Radio&Frequency Services: Core of Knowledge Training and Laser Services: service repairs of systems aesthetic systems.

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onfidence is Reliable1,2 Rewarding 3 Performance 4,5 BOTOX® is licensed for the treatment of moderate to severe glabellar lines Delivers long-lasting patient satisfaction, time after time 2,3 Has been used for over 20 years in over 26 million treatment sessions worldwide6 Is the world’s first and most studied botulinum toxin*7

Botox® (botulinum toxin type A) Abbreviated Prescribing Information Presentation: Botulinum toxin type A (from clostridium botulinum), 50 or 100 or 200 Allergan Units/vial. Indications: Temporary improvement in the appearance of moderate to severe vertical lines between the eyebrows seen at frown (glabellar lines), in adults <65 years, when the severity of these lines has an important psychological impact for the patient. Dosage and Administration: See Summary of Product Characteristics for full information. Do not inject into blood vessels. Doses of botulinum toxin are not interchangeable between products. Not recommended for patients <18 or >65 years. Use for one patient treatment only during a single session. Reconstitute vial with 1.25ml of 0.9% preservative free sodium chloride for injection (4U/0.1ml). The recommended injection volume per muscle site is 0.1ml (4U). Five injection sites: 2 in each corrugator muscle and 1 in the procerus muscle: total dose 20U. Contraindications: Known hypersensitivity to any constituent. Infection at proposed injection site(s). Warnings/Precautions: Relevant anatomy and changes due to prior surgical procedures must be understood prior to administration. Serious adverse events including fatal outcomes have been reported in patients who had received off-label injections directly into salivary glands, the oro-lingual-pharyngeal region, oesophagus and stomach. Do not exceed recommended dosages and frequency of administration. Adrenaline and other anti-anaphylactic measures should be available. Reports of side effects related to spread of toxin distant from injection site, sometimes resulting in death. Therapeutic doses may cause exaggerated muscle weakness. Caution in patients with underlying neurological disorder and history of dysphagia and aspiration. Patients should seek medical help if swallowing, speech or respiratory disorders arise. Clinical fluctuations may occur during repeated use. Too frequent or excessive dosing can lead to antibody formation and treatment resistance. The previously sedentary patient should resume activities gradually. Caution in the presence of inflammation at injection site(s) or when excessive weakness/atrophy is present in target muscle. Caution when used for treatment of patients with peripheral motor neuropathic disease. Use with extreme caution and close supervision in patients with defective neuromuscular transmission (myasthenia gravis, Eaton Lambert Syndrome). Contains human serum albumin. Procedure related injury could occur. Pneumothorax associated with injection procedure has been reported. Interactions: No interaction studies have been performed. No interactions of clinical significance have been reported. Theoretically, the effect may be potentiated by aminoglycoside antibiotics or other drugs that interfere with neuromuscular transmission. Effects of administering different botulinum toxin stereotypes simultaneously, or within several months of each other, is unknown and may cause exacerbation of excessive neuromuscular weakness. Pregnancy: BoTox® should not be used during pregnancy unless clearly necessary. Lactation: Use during lactation cannot be recommended. Adverse Effects: See Summary of Product Characteristics for full information on side effects. Based on controlled clinical trial data, the proportion of patients that would be expected to experience an adverse reaction after treatment is 23.5% (placebo: 19.2%). In general, reactions occur within the first few days following injection and are transient. Pain/

burning/stinging, oedema and/or bruising may be associated with the injection. Frequency By Indication: Defined as follows: Very Common (> 1/10); Common (>1/100 to <1/10); Uncommon (>1/1,000 to <1/100); Rare (>1/10,000 to <1/1,000); Very Rare (<1/10,000). Infections and infestations. Uncommon: Infection. Psychiatric disorders. Uncommon: Anxiety. Nervous system disorders. Common: Headache. Uncommon: Paresthesia, dizziness. Eye disorders. Common: Eyelid ptosis. Uncommon: Blepharitis, eye pain, visual disturbance. Gastrointestinal disorders.

Uncommon: Nausea, oral dryness. Skin and subcutaneous tissue disorders. Common: Erythema, Uncommon: Skin tightness, oedema (face, eyelid, periorbital), photosensitivity reaction, pruritus, dry skin. Musculoskeletal and connective tissue disorders. Common: Localised muscle weakness, Uncommon: Muscle twitching. General disorders and administration site conditions. Common: Face pain, Uncommon: Flu syndrome, asthenia, fever. Adverse reactions possibly related to spread of toxin distant from injection site have been reported very rarely (exaggerated muscle weakness, dysphagia, constipation or aspiration pneumonia which can be fatal). Rare reports of adverse events involving the cardiovascular system, including arrhythmia and myocardial infarction, some with fatal outcomes. Rare reports of serious and/or immediate hypersensitivity (including anaphylaxis, serum sickness, urticaria, soft tissue oedema and dyspnoea) associated with BoTox use alone or in conjunction with other agents known to cause similar reaction. Very rare reports of angle closure glaucoma following treatment for blepharospasm. New onset or recurrent seizure occurred rarely in predisposed patients, however relationship to botulinum toxin has not been established. Needle related pain and/or anxiety may result in vasovagal response.

NHS Price: 50 Units: £77.50, 100 Units: £138.20, 200 Units £276.40. Marketing Authorization Number: PL 00426/0074 Marketing Authorization Holder: Allergan Pharmaceuticals (Ireland) Ltd., Westport, Co. Mayo, Ireland. Legal Category: PoM. Date of preparation: December 2012.

Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard Adverse events should also be reported to Allergan Ltd. UK_Medinfo@allergan.com or 01628 494026.

References: 1. De Almeida A et al. Dermatologic Surgery 2007;33:S37–43. 2. Carruthers A et al. J Clin Res, 2004;7:1–20. 3. Stotland MA et al. Plast Reconstr Surg, 2007;120:1386–1393.

4. Beer KR et al. J Drugs Dermatol, 2011;10(1) :39–44. 5. Lowe et al. Am Acad Dermatol, 2006;55:975-980. 6. Allergan data on file. BoTGL/001/SEP 2011 7. Allergan Data on File VIS/006/JUL2011. *Allergan botulinum toxin type A. Global figures. Launched in 1989 in the US. UK/0008/2013 Date of Preparation: January 2013