JANUARY 2025: The Devices Issue

1 DEVICE: 12 TREATMENTS

1 DEVICE: 5 WAVELENGTHS

20-minute pre-programmed services designed for optimum results

420 nm: Blue Light

520 nm: Green Light

590 nm: Yellow Light

633 nm: Red Light

830 nm: Near IR Light

Treatment options include:

08 News

The latest product and specialty news

19 News Special: NICE Releases Plans for NHS Tirzepatide Rollout

Aesthetics reports on NICE’s plans to offer NHS patients weight loss injections

CLINICAL PRACTICE

21 Special Feature: Treating the Neck with Energy Devices

Practitioners discuss considerations for rejuvenating the ageing neck

25 Spotlight On: Mia Femtech

A look at the UK’s first minimally invasive breast implant technology

26 Evolve With the Aesthetics Specialty

Connect with your peers at ACE 2025

28 CPD: Multidimensional Patient Assessment

Dr Rehanna Beckhurst explores multidimensional assessment in aesthetics

32 My Early Experience Using AviClear by Cutera

Dr Anjali Mahto shares her experience of the 1726 nm laser from Cutera

35 Case Study: Post-Operative LED Phototherapy

Kate Monteith-Ross explains how she uses LED to assist wound healing

38 Congratulating The Aesthetics Awards 2025 Finalists

The shortlist for The Aesthetics Awards 2025 is revealed!

49 Utilising CO2 Laser for Nasal Scar Revision

Dr Sonakshi Khorana and Dr Samantha Hills address a nasal scar using CO2 laser

54 Achieving Lip Rejuvenation with Devices

Mr Omer Salahuddin explores needle-free lip rejuvenation using laser

58 Case Study: Using Ultrasound for NSR Complications

Professor Alwyn D’Souza and Dr Farid Hosseini discuss ultrasound in the nose

62 Addressing Stomach Fat with Radiofrequency

Amanda Azzopardi outlines how radiofrequency can firm the stomach

65 Abstracts

A round-up and summary of useful clinical papers with Professor Sebastian Cotofana

IN PRACTICE

66 Optimising Data in Aesthetic Clinics

Ashley and Sheena McKenna explore data metrics to track business growth

68 Embracing Diversity in Clinical Practice

Amy Bird highlights diversity’s importance in enhancing patient care

70 Managing Negligence and Compensation Risks

Michael Saul outlines strategies to minimise negligence risks

73 In Profile: Dr Hen Ifrach

Dr Hen Ifrach shares her medical inspiration and passion for lasers

74 The Last Word

Mary Irving urges practitioners to be open about the psychological impact of vascular occlusions

News Special: NICE Releases Plans for NHS Tirzepatide Roll Out

Page 19

Special Feature: Treating the Neck with Energy Devices

Page 21

Clinical Contributors

Dr Rehanna Beckhurst, since qualifying in 2003 from Riga Stradins University, has become lead medic at Ifab clinic which she established with her husband in 2020. She is an aesthetic tutor, lecturer, global speaker and trainer for Church Pharmacy and Beamwave, and KOL for LG Chem and Hironic.

Kate Monteith-Ross is an independent nurse prescriber and owner of a CQC regulated practice in Kent specialising in non-surgical treatments and surgical support. Monteith-Ross is the co-director and co-founder of The Nurses Network, an organisation guiding medical injectors in safety.

Dr Sonakshi Khorana is a GP with a special interest in dermatology. She is the non-surgical services lead at Kat and Co in Birmingham. She serves as a dermatology expert for renowned skincare brands and holds memberships at the Royal College of GPs, BMLA and ACE Group World.

Dr Samantha Hills is clinical director at Lynton Lasers. She is on the teaching faculty of the British Medical Laser Association, as well as being an honorary lecturer in the Division of Musculoskeletal and Dermatological Sciences at The University of Manchester.

Mr Omer Salahuddin is an aesthetic practitioner with an extensive plastic surgery background and a special interest in scar management. He completed his fellowship in craniofacial surgery from Oxford University, and has worked in various NHS trusts across the UK.

Professor Alwyn D’Souza is a board certified facial plastic surgeon with experience in both surgical and non-surgical facial aesthetics. He is the past president of the European Academy of Facial Plastic Surgery (EAFPS) and British Society of Facial Plastic Surgery (BSFPS).

Dr Farid Hosseini is an aesthetic practitioner with more than 20 years of experience in non-surgical facial aesthetics, based in London. He is an international trainer, researcher and expert in facial ultrasound.

Amanda Azzopardi is an aesthetic nurse prescriber, as well as being the owner and founder of Amanda Azzopardi Aesthetics, based in Liverpool, London and North Wales. trained in aesthetics at Harley Academy, London and has 25 years’ experience in NHS trauma and emergency care.

Shannon Kilgariff Editor & Event Manager @shannonkilgariff

Happy New Year, and welcome to the first issue of the Aesthetics Journal in 2025!

As we step into this exciting new year, I can’t help but feel a buzz of anticipation for everything that lies ahead – innovations, events and endless opportunities for growth in our incredible specialty.

To kick things off, we’re thrilled to announce the long-awaited Aesthetics Awards Finalists in this issue! Turn to p.38 to see who made the shortlist and join us in celebrating the very best in medical aesthetics at the biggest celebration in aesthetics on March 15! Be sure to get your tickets early for the ceremony – it truly is an unmissable evening of recognition, inspiration and celebration of the talent and brands that drive our sector forward.

While you’re in the new year spirit, remember to mark your diaries with the key events in our specialty! The Aesthetics Conference & Exhibition (ACE) will be on March 14-15 (check out p.26 for all the

Clinical Advisory Board

exciting highlights), while the Clinical Cosmetic Regenerative (CCR) Congress will be on September 25-26.

Our January issue of the Aesthetics Journal has a strong focus on devices. This month’s Special Feature on p.21 explores innovative techniques for treating sagging and wrinkled necks – an area that’s increasingly in demand among patients. Additionally, don’t miss our fascinating clinical article on using devices for lip treatments, offering a fresh approach to this popular procedure. We also dive into some powerful modalities that are enhancing outcomes, including RF, CO2 lasers and LED therapies. These technologies are pushing the boundaries of what’s possible in aesthetics, and we’re excited to share insights that can elevate your practice.

Finally, we’ll be heading to IMCAS in Paris this month! The Aesthetics Journal team and I will be exhibiting, so please stop by to say hello. If you’re attending, drop me a message – we’d love to catch up and hear about your plans for 2025! Here’s to a year filled with innovation, growth and success.

Leading figures from the medical aesthetic community have joined the Aesthetics Advisory Board to help steer the direction of our educational, clinical and business content

Sharon Bennett is chair of the British Association of Cosmetic Nurses (BACN), previous UK lead of the BSI committee for aesthetic non-surgical standards, and member of the Clinical Advisory Group for the JCCP. She is a trainer and registered university mentor in cosmetic medical practice, and is finishing her MSc at Northumbria University. Bennett has won the Aesthetics Award for Nurse Practitioner of the Year and the Award for Outstanding Achievement.

Sharon Bennett, Clinical Lead

Mr Naveen Cavale has been a consultant plastic, reconstructive and aesthetic surgeon since 2009. He has his own private clinic and hospital, REAL, in London’s Battersea. Mr Cavale is the national secretary for the ISAPS, president of the Royal Society of Medicine, and vice-chair for the British Foundation for International Reconstructive Surgery.

Miss Elizabeth Hawkes is a consultant ophthalmologist and oculoplastic surgeon. She is the lead oculoplastic surgeon at the Cadogan Clinic, specialising in blepharoplasty and advanced facial aesthetics. Miss Hawkes is a full member of the BOPSS and the ESOPRS, and is an examiner and fellow of the Royal College of Ophthalmologists.

Mr Adrian Richards is a plastic and cosmetic surgeon with over 30 years’ experience. He is the clinical director of the aesthetic training provider Cosmetic Courses and surgeon at The Private Clinic. He is also a member of the British Association of Plastic and Reconstructive and Aesthetic Surgeons and the British Association of Aesthetic Plastic Surgeons.

PORTFOLIO MANAGEMENT

Shannon Kilgariff • Editor & Event Manager

T: 0203 196 4351 | M: 07557 359 257 shannon.kilgariff@easyfairs.com

EDITORIAL

Holly Carver • Deputy Editor & Content Manager

T: 0203 196 4427 holly.carver@easyfairs.com

Kate Byng-Hall • Senior Journalist | T: 020 3196 4389 kate.byng-hall@easyfairs.com

Amer Saleh • Content Writer | T: 020 3196 4270 amer.saleh@easyfairs.com

Mia Sawyer • Content Writer | T: 020 3196 4242 mia.sawyer@easyfairs.com

DESIGN

Caren Johnstone • Callum Benyon • Kitty Butler

Dr Mayoni Gooneratne (MBBS, BSc, MRCS, MBCAM, AFMCP) was an NHS surgeon before establishing The Clinic by Dr Mayoni and founding Human Health – an initiative combining lifestyle with traditional and functional medicine to provide a ‘cell-up’ regenerative approach to aesthetics. She is also the co-founder of The British College of Functional Medicine.

Jackie Partridge is an independent nurse prescriber. She is the clinical director and owner of Dermal Clinic in Edinburgh and a KOL for Galderma. She holds an MSc in Non-surgical Aesthetic Practice and a BSc in Dermatology. Partridge is a stakeholder group member with Scottish Government/HIS, Honorary BACN member and JCCP Fitness to Practice Nurse.

Dr Souphi Samizadeh is a dental surgeon with a Master’s degree in Aesthetic Medicine and a PGCert in Clinical Education. She is the founder of the Great British Academy of Medicine and Revivify London Clinic. Dr Samizadeh is a Visiting Teaching Fellow at University College London and King’s College London.

ADVERTISING & SPONSORSHIP

Judith Nowell • Head of Sales T: 0203 196 4352 | M: 07765 407629

judith.nowell@easyfairs.com

Emma Coyne • Senior Sales Executive

T: 020 3196 4372 | emma.coyne@easyfairs.com

Imogen Preece • Sales Executive

T: 0203 196 4367 | imogen.preece@easyfairs.com

MARKETING

Susana Burguera • Senior Marketing Manager T: 020 3196 4281 | susana.burguera@easyfairs.com

Ella Carey • Marketing Executive

T: 020 3196 4410 | ella.carey@easyfairs.com

Isabell Wise • Marketing Executive T: 020 3793 5845 | isabell.wise@easyfairs.com

Dr Sophie Shotter is the founder & medical director of Illuminate Skin Clinic in Kent and Harley Street, London. Her passion is for natural treatments delivered with utmost attention to safety. She works closely with Allergan as part of their UK and International Faculty.

Dr Anjali Mahto is one of the UK’s leading consultant dermatologists. She is a Fellow of the Royal College of Physicians, member of the Royal Society of Medicine and a spokesperson for The British Skin Foundation. In 2023 Dr Mahto opened Self London, a dermatology and lifestyle clinic aimed at managing skin conditions holistically.

Dr Tapan Patel is the founder and medical director of PHI Clinic, and has more than 20 years’ experience performing aesthetic treatments. He is a KOL for Allergan Aesthetics and Cutera, and is passionate about high standards in aesthetic medicine. In 2023, Dr Patel received The Aesthetics Award for Outstanding Achievement in Medical Aesthetics

Dr Stefanie Williams is a dermatologist with a special interest in adult acne, rosacea and aesthetic medicine. She is the founder and medical director of multi-award winning EUDELO Dermatology & Skin Wellbeing in London, and creator of Delo Rx skincare. She is the author of three books and has published more than 100 scientific articles, book chapters and abstracts.

ARTICLE PDFs AND REPRO

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© Copyright 2025 Aesthetics. All rights reserved. Aesthetics is published by Aesthetics Media Ltd, which is registered as a limited company in England; No 9887184

Talk #Aesthetics

Follow us on Instagram @aestheticsjournaluk

#RSM

Dr Catherine Fairris

@drfairris_skinwessex

I had a wonderful time at the inception and first scientific meeting of the newly launched RSM Aesthetic Medicine and Surgery Section.

#Treatments

Mel Recchia

@melrecchia_ Yesterday was a great day with DermaFocus UK, focusing on polynucleotide regenerative treatments.

#Education

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@dr_manafkhatib

I’m thrilled to have led the BAAPS annual trainee day at the Royal College of Surgeons!

#CharityBall

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@beautyeurope_uk

We were pleased to attend the IAAFA Conference and Charity Ball. Thank you for such a great weekend of opportunity!

#Conference

Dr Jordan Faulkner

@drjordanfaulkner

Imposter syndrome is my favourite discomfort. Speaking at this year’s FACExpo conference, here’s to next year!

Acne

Cutera report reveals impact of acne on patients

A report conducted by aesthetic device company Cutera revealed that 90% of 500 patients find acne insecurities impact their daily lives.

Of the acne sufferers surveyed for The Acne Impact Report, 43% worried that they will never have clear skin, with 30% saying they worry that others only see acne when they look at them. One in four of the participants avoid social interactions because of their skin, and one in four said acne is always in the back of their mind. Only half of those questioned said they feel fully educated about the acne treatment options available. One in three moderate-to-severe acne sufferers are interested in trying out laser treatments, and 81% of those using prescription treatments wish they had access to laser.

Sam Keene, Cutera regional leader UK & Ireland, said, “Acne affects a person’s confidence and quality of life. The latest report shows that laser therapies, particularly AviClear, are the preferred option after prescriptions, chosen twice as often as alternatives. AviClear offers proven, lasting results, restoring both skin and self-confidence.”

Regulation

Wales introduces licensing scheme for special procedures

The Welsh Government has introduced a licensing scheme designed to improve hygiene and safety standards for acupuncture, electrolysis, piercing and tattooing procedures.

The Licensing Rules for Special Procedures in Wales states that every establishment providing one of these procedures must hold a licence to do so, ensuring that correct infection control measures are being taken. The Government shares that if such measures are not taken, it could result in legal action.

Applications for licences must be submitted to individuals’ local authorities by 28 February, 2025. Assessment of applications may take months, but after licences are granted they will have to be publicly displayed in the relevant premises.

Samantha Matthews, head of nursing for infection prevention and control at Public Health Wales, said, “We welcome the enhanced hygiene standards that licensing will bring. The training of practitioners along with inspections of premises will reduce the risks associated with procedures like tattooing, piercing and acupuncture. We hope this will not only raise standards and protect health, but also offer reassurance to those undergoing such procedures.”

Professor David Sines, executive chair of the Joint Council for Cosmetic Practitioners (JCCP), added, “The JCCP has been actively involved at all stages in the generation and consultation of these Licensing Rules, and regards them to provide evidence of the Welsh Government’s commitment to public protection and patient safety. We believe this to be a first sequential step to the licensing of non-surgical cosmetic procedures in Wales, and look forward to working with the Welsh Government to expand the scheme to include more invasive types of procedures.”

The Aesthetics Awards 2025 Finalists

Vital Statistics

have been unveiled

The shortlist for The Aesthetics Awards 2025 has been announced, with 270 lucky Finalists.

26 Winners will be unveiled at the ceremony on March 15 during an evening filled with networking, celebrating and dancing. Led by a celebrity host and complete with entertainment and drinks reception, the event marks the undeniable highlight of the aesthetics calendar.

Some of the categories being presented will include The DigitRx by Church Pharmacy Award for Best New Innovative Product, The PatientPerfect Award for Best Clinic Team and The Sciton Award for Best Clinic North England.

Shannon Kilgariff, editor and event manager of Aesthetics, commented, “The calibre of entries to The Aesthetics Awards this year was excellent, and we are so excited to see who our esteemed judges name the Winners. I am already looking forward to the ceremony and seeing so many friends and colleagues there!”

Turn to p.38 to see the full shortlist and get your tickets.

Advertising

ASA rules against

‘Ozempic

dupe’ supplement claims

The Advertising Standards Authority (ASA) has ruled against a supplement company after misleading weight loss claims.

Across three social media adverts posted in June 2024, the company published claims including, ‘POV: when u have PCOS and try the ozemp*c dupe pills and finally lose weight’, alongside a photo from a Harry Potter film and the text, ‘WHAT KIND OF SORCERY IS THIS’. They also claimed that the product could specifically target ‘menopause weight gain’.

One of the adverts listed benefits – ‘Fast Relief From Cravings’, ‘Boosts Metabolism’, ‘No Side Effects’, ‘Real Results’ and ‘Backed by Science’ –before claiming, ‘APPETITE SUPPRESSION BOOST METABOLISM LOSE 15-20% OF BODY WEIGHT WEIGHT LOSS FEEL FULLER FASTER & LONGER’.

The complainant challenged whether the advertisements were making health claims about specific diseases/conditions, and whether the ads referred to an amount or rate of weight loss, which is prohibited by the UK Code of Non-Broadcast Advertising and Direct & Promotional Marketing (CAP Code).

The ASA upheld this challenge, saying that any health claims made in advertising must be accompanied by a related authorised health claim under the GB NHC Register. It also emphasised that it is prohibited to imply that a food can prevent or cure human disease such as PCOS or menopausal symptoms. The ads must not appear in the same form again, and no future ads can make medicinal claims for unlicensed products.

The company said that the ad campaign was being used worldwide and they had not adapted it to meet the specific requirements of the UK market, but would do so going forward.

Liverpool leads in Google searches for weight loss injections, with 3,225 searches per 100,000

(Second Nature, 2024)

UK studies indicate 6.5 million men and 8 million women face hair loss, often from hormones, stress or seasonal shifts

(The Treatment Rooms, 2024)

A study of 33,000 participants revealed that 9 in 10 women have felt exposed to harmful beauty content on social media

(Dove, 2024)

More than 50% of menopausal individuals experience neuropsychiatric conditions such as depression and insomnia

(Menopause Research and Education Fund, 2024)

Out

of 500 UK adults, 79% agree people should be able to have aesthetic treatment without fear of negative judgement

(Allergan Medical Institute, 2024)

UK research reveals consumer spending on aesthetic treatments rose 28% in two years, shifting from injectables to devices

(Emerald Laser, 2024)

Events diary

30th January-1st February

IMCAS World Congress 2025

14th-15th March

ACE 2025

15th March

The Aesthetics Awards 2025

29th March

Welsh Aesthetic Conference

25th-26th September

CCR 2025

IN THE MEDIA

Tulisa’s I’m A Celebrity debut sparks comments about facial palsy

UK singer-songwriter and TV personality Tulisa Contostavlos’s appearance has been widely discussed in the media, following her debut on I’m A Celebrity in November 2024. Contostavlos was diagnosed with Bell’s palsy in 2020 - a neurological disorder that causes temporary paralysis or weakness on one side of the face. Speaking on Olivia Attwood’s So Wrong It’s Right podcast in October, Contostavlos opened up about her Bell’s palsy experience, “I had a massive burst of inflammation, causing my whole face to droop. My face stayed like that for seven months.” The singer’s appearance has been the subject of widespread discussion, with broadcaster Rylan Clark urging viewers to consider her health journey and refrain from posting negative comments online.

Lorraine Kelly discusses choosing natural beauty over injectables

Speaking to Woman’s Own, a British lifestyle magazine, television presenter Lorraine Kelly expressed her disapproval of women undergoing botulinum toxin treatments, arguing that they are “ruining their faces.” Kelly criticised young women opting for the procedure, stating that they have no need for it. While discussing with Woman’s Own, she said, “So many women have ruined their faces with filler, I think I look fine as I am and I will never go under the knife.” Kelly acknowledged that while the decision to undergo cosmetic procedures is a personal choice, she wishes we could all be “a little more accepting of ourselves and the ageing process.”

Research

Study investigates needle-free botulinum toxin delivery

A new study published in Annals of Dermatology has found that a needle-free microjet drug injector could be a useful method of providing toxin treatment.

The split-face study – from authors Young Gue Koh, Woo Geon Lee and Kui Young Park – aimed to evaluate the effectiveness and safety of the needle-free injector, powered by an Er:YAG laser, for the injection of toxin to treat crow’s feet wrinkles. A five-point scale was used to assess the severity of the wrinkles before and after needle and needle-free treatment.

Ten Korean women participated in the study. Both sides exhibited significant improvement in crow’s feet wrinkles compared to the baseline, with no noticeable differences between the two sides. The microjet injector side showed a significantly lower pain score, while there was no difference between the sides in terms of aesthetic improvement.

The study concluded that the needle-free microjet drug injector may be a useful option for treating crow’s feet wrinkles with botulinum toxin due to its ability to reduce pain.

Faculty

Dr Catherine Fairris joins AesthetiCare faculty

Aesthetic distributor AesthetiCare has welcomed aesthetic practitioner and president of BCAM Dr Catherine Fairris as its newest faculty member. AesthetiCare shares that its faculty includes Dr Paris Acharya, Dr Karen Doherty and Dr Jaskaren Midha. Dr Fairris’ responsibilities include guiding protocol development, enhancing evidence-based data and fostering peer-to-peer inspiration in the field.

Alongside the rest of the faculty, Dr Fairris plays a key role in raising awareness for AesthetiCare and its brand portfolio, which includes ALLSKIN|MED, Biretex and Heliocare.

Dr Fairris shares that she believes the practice of aesthetics is a branch of medicine in its own right, and she strives to provide patient-focused care.

Dr Fairris commented, “I am absolutely thrilled to be invited to join the faculty of ALLSKIN|MED, a renowned skincare brand owned by Cantabria Labs. As a passionate advocate for evidence based skincare and skin rejuvenation, I am excited to join such an esteemed group of experts who are already part of this dedicated team.”

Device

Sisneo releases new radiofrequency treatment device

Aesthetic device company Sisneo has developed new face, hair loss and body treatment device Revicell PRO.

The product integrates Sisneo’s 3DLAYER radiofrequency (RF) technology with biophotonic therapy, with a variable frequency intelligent system providing control over treatment for different skin layers. Sisneo explains that this technology is designed to produce multilayer lifting, while the simultaneous emission of biophotonic therapy and RF enhances collagen production for optimal results.

Lisa Harris, distributor for Revicell PRO, commented, “Revicell contains an exclusive dual energy 3DLayer capability, designed to work specifically on each layer of the skin to produce multi-layer lifting and collagen creating results. Revicell combines radiofrequency with phototherapy for boosted efficacy, creating unrivalled effects.”

What’s trending in the consumer press

DermapenWorld to advocate for networking at ACE 2025

Aesthetic manufacturer DermapenWorld has been unveiled as the sponsor of the Networking Drinks at ACE 2025.

At 5-7pm on Day 1 of the two-day event, DermapenWorld will welcome all ACE attendees to enjoy drinks and continue conversations with fellow practitioners and leaders in the field.

DermapenWorld UK country director Kelly Tobin said, “DermapenWorld UK is delighted to be hosting the networking drinks reception this year at ACE. The drinks play an important part in the overall success of the event, allowing specialty professionals to come together over a glass of wine and share their insights. The reception will be held on our stand L12 at 5pm to 7pm on Day 1. We look forward to sharing some exciting new innovations and product launches – watch this space!”

Turn to p.26 and register free to attend ACE 2025 today!

Injectables

FDA approves Botox for vertical platysma bands

The US Food and Drug Administration (FDA) has approved Allergan Aesthetics’ Botox Cosmetic (onabotulinumtoxinA) to treat moderate to severe vertical platysma bands.

The approval was supported by phase III clinical studies, which showed statistically significant improvement in the appearance of platysma bands with Botox compared to placebo, successfully meeting the primary endpoint.

Allergan Aesthetics has highlighted that Botox provides a non-surgical injectable solution to enhance the appearance of neck bands and improve jawline definition, addressing a key aesthetic concern for many adults. This marks Botox’s fourth approved aesthetic indication and the first for a non-facial treatment.

Darin Messina, senior vice president at Allergan Aesthetics, an AbbVie company, commented, “Until now, treatment options have been limited and with this approval, there is a non-surgical, injectable option to temporarily improve the look of vertical bands connecting the jaw and neck. This fourth indication for Botox Cosmetic represents true innovation. We’re excited to open new doors for patients and providers, helping them to achieve their aesthetic goals.”

Skincare

Teoxane releases new antiageing serum

Aesthetic manufacturer Teoxane has unveiled the new antiageing retinol-alternative [R] Advanced Serum.

The company shares that the product contains bakuchiol and peptide actives to mimic the effects of retinol – collagen synthesis and protection, skin renewal, skin firmness and minimised wrinkles and fine lines. A study of 70 participants found that after 28 days of use, 94% felt their skin seemed firmer, 92% said their skin felt younger and they saw a 10% reduction in the number of wrinkles.

Dr Pamela Benito, aesthetic practitioner and medical director of Clinic Shiro, said, “I highly recommend the Teoxane [R] Advanced Serum. As a great alternative to retinol, it contains bakuchiol which stimulates collagen production with a more tolerable formula. It is effective at reducing fine lines and wrinkles and improving skin tone, but also perfect for sensitive skin!”

BAMAN UPDATES

REGIONAL MEETINGS 2025

BAMAN is excited to welcome members back to another year of Regional Meetings! These agenda-driven events are designed to offer the perfect blend of networking opportunities and educational presentations to enhance your practice while getting social with your BAMAN community.

Kicking off in Sevenoaks, the first meeting will cater to BAMAN’s Kent & Surrey members, but all members are welcome to attend, regardless of location. Events will continue through to Hinxton, Glasgow, Bournemouth, Leeds, Manchester, Belfast, Cardiff, Bristol, London and Solihull all before July 2025. Basic Life Support training will be available at least once per year in each region.

For full details, including meeting agendas and to book your space, visit the BAMAN events page or scan the QR code below.

SPRING SYMPOSIUM 2025

Amidst the buzz of localised Regional Meetings, BAMAN is thrilled to announce the return of the Spring Symposium on April 4, 2025, at the prestigious King’s Fund in London.

Our Spring event is a must-attend, designed for our most advanced practitioners, with dozens of pioneering speakers and cherry-picked leading exhibiting brands.

Following the success of last year’s sold-out event focusing on regenerative medicine, the 2025 agenda promises to deliver cutting-edge content to help attendees stay ahead in their practice and create connections that grow their professional network.

PRESENTATION SKILLS WORKSHOP

We are pleased to confirm that the second Presentation Skills Workshop will be running this January, offering Regional Leaders and BAMAN members the chance to enhance their public speaking and communication abilities. Taking place on January 24, 2025 in Manchester, this session is tailored to provide accessible training for those in the north of England and Scotland, building on the success of the inaugural workshop in London. The day provides attendees with practical training, equipping them to deliver presentations ranging from small local gatherings of BAMAN nurses at Regional Meetings, to large-scale audiences at national aesthetic conferences.

This column is written and supported by BAMAN

15 March 2025, Grosvenor House, London

Celebrate Excellence in Medical Aesthetics

Dr Aggie Zatonska explains the benefits of bringing your team along to The Aesthetics Awards

The Aesthetics Awards 2025 is just around the corner. Taking place at Grosvenor House, London on March 15 after the second day of the Aesthetics Conference and Exhibition (ACE), this prestigious event will bring together the brightest talents, innovative brands and dedicated professionals who have worked tirelessly to elevate patient care and aesthetic standards.

We spoke to last year’s Winner of The Sofwave Award for Best Clinic South England, Dr Aggie Zatonska, about why you should buy a ticket to the biggest event in the aesthetics calendar!

Why should people attend The Aesthetics Awards and bring their team along?

The Aesthetics Awards is an incredible opportunity to celebrate the hard work, dedication and achievements of your entire team. It’s more than just an awards night – it’s a moment to bond, reflect on your successes, and the team that made it possible.

Bringing your team to the event where best clinics and practitioners are celebrated shows them how valued they are and reinforces a shared sense of pride.

What did you enjoy most about the event last year?

The atmosphere was absolutely fantastic. From the anticipation of the awards to the joy of celebrating with colleagues, it was a night to remember. The energy was uplifting, and it was an honour to be among such passionate professionals. Winning was, of course, the highlight, but the sense of community truly stood out.

The event brought together leaders and innovators from across the aesthetics field, making it a fantastic place to connect and share ideas.

Any top tips for choosing an awards outfit?

Go for something that makes you feel confident and comfortable – confidence is your best accessory! And don’t forget the details; great, comfortable shoes and well-planned accessories can elevate any look. For getting ready, give yourself plenty of time to relax and enjoy the process – ACE finishes three hours before the awards starts, so there’s more than enough time! It’s a special night, so let yourself shine.

Scan the QR code to purchase your tickets today!

Education

Allergan Aesthetics offers free business education courses

Pharmaceutical company Allergan Aesthetics, an AbbVie company, has launched Business Education courses on its online platform.

This new addition to the Allergan Medical Institute (AMI) online learning platform is designed to enhance patient service and achieve operational excellence, available for all Allergan Aesthetics customers. The courses are directed towards healthcare practitioners, their staff and their management, with business education practices.

According to Allergan Aesthetics, this training offers practical advice for success in aesthetic practices, along with a downloadable goal-setting worksheet and guidance on telephone conversion.

Glen Curran, senior vice president of US Allergan Aesthetics, commented, “Allergan Aesthetics designed AMI Business to meet providers where they are supporting them with practical, business-focused education related to our products to complement their clinical expertise and help them grow their practices.”

Product Launch

AMP leads the UK launch of Cellenis PRP DermaFiller

Aesthetic Medical Partnership (AMP) has announced the UK launch of Cellenis PRP DermaFiller, a fully autologous regenerative volumiser. Developed by ESTAR, the system is designed to process small blood volumes while removing granulocytes and erythrocytes to optimise the PRP’s biological profile. This approach ensures a higher platelet concentration, enhancing regenerative outcomes, according to the company. Following the AMP launch event in October, the new product is now available to patients, with practitioners trained and ongoing training underway. AMP co-founder and director Martyn Roe said, “We are delighted to be building on the firm foundations Medira have already laid in the UK market. We look forward to adding Cellenis customers to our growing list of AMP partners.”

Laser Devices

Beautology announces UK distribution of Quanta

Laser distribution company Beautology has introduced its partnership as UK distributor of laser device company Quanta Systems. The company has announced that it will be exclusively distributing the Quanta medical range, including the Thunder MT, Duetto MT, QplusC, Chrome and YouLaser devices. Beautology shares that it has nearly 50 years of combined experience in servicing and repairing medical lasers.

John Issac, director of Beautology, commented, “We are thrilled to announce our official partnership as distributors of Quanta Systems in the UK. This collaboration allows us to bring the innovation and quality of Quanta’s products to our customers while maintaining the high standard of customer service that Beautology is known for.”

BAMAN and Evolus reveal 2025 partnership

The British Association of Medical Aesthetic Nurses (BAMAN) has announced a partnership with pharmaceutical company Evolus.

This collaboration seeks to strengthen nurse education and advance the professionalisation of medical aesthetics, according to the companies. In addition to supporting education, Evolus plans to be the headline sponsor for the BAMAN 2025 Annual Meeting, and the primary sponsor at all 13 BAMAN regional events in 2025.

Alongside these key events, the partnership will include three webinars and digital take-overs amongst other elements. Both companies emphasise that this 2025 programme indicates Evolus’ commitment to education and training within the medical aesthetics sector.

Suse Alexander, general manager of Evolus UK and Ireland, commented, “Evolus are big fans of elevating medical aesthetics practice, and we are really pleased to support the evolving mission of BAMAN in 2025.”

Sharon Bennett, aesthetic nurse prescriber and chair of BAMAN, commented, “Through this unique partnership programme with Evolus, I expect to see more nurses involved in innovative research projects and evolving their practices in medical aesthetics.”

Specialty

Royal Society of Medicine launches Aesthetic Medicine and Surgery Section

The Royal Society of Medicine (RSM) has introduced its Aesthetic Medicine and Surgery Section, the first new specialty division in 35 years.

The inaugural event, held on November 28 at RSM’s London headquarters, focused on the psychological aspects of aesthetic practice.

The session was inaugurated by president of the RSM Professor Gillian Leng, alongside the section’s leadership team which included consultant dermatologist Dr Christopher Rowland Payne, plastic surgeon Mr Jonathan Britto and aesthetic practitioner and vice president Dr Souphi Samizadeh. Presentations from Professor Anthony Bewley, Dr William Shanahan and Dr Rowland Payne explored topics including body dysmorphic disorder and the role of psychiatry in medical aesthetics. The event was said to have been well-received for its thoughtful discussions on the intersection of psychology and patient care, according to attendees. The Aesthetic Medicine and Surgery Section aims to foster collaboration across disciplines and promote evidence-based practices within the field. The next event will take place on February 27.

Dr Samizadeh added, “The establishment of the Aesthetic Medicine and Surgery Section marks a pivotal moment for our field. By embracing multidisciplinary collaboration and prioritising evidence-based practices, we aim to redefine standards, integrate psychological insights and advance patient safety – ensuring medical aesthetics evolves with integrity and scientific rigour.”

Managing director of InMode UK and Ireland, Victoria Voysey

What has your first year at InMode been like?

As I celebrate my first anniversary as managing director of InMode UK and Ireland, I’m filled with excitement for the incredible journey this past year has been. Stepping into this role at the start of 2024 marked the beginning of a new era for InMode UK, and it’s been an honour to lead such a dynamic team and translate the company’s global strategy into meaningful results. With more than 24 years of experience in the luxury cosmeceutical skincare and advanced aesthetic specialties, I’ve been fortunate to work alongside some of the world’s leading practitioners. This wealth of experience has shaped my approach to leadership and strategy, and it has been rewarding to bring those insights to InMode.

What is the most important thing to you as a managing director?

At the heart of my leadership style is a commitment to creating empowering environments where teams can thrive. Over the past year, I’ve focused on fostering a culture of collaboration and innovation within the team, and I’m proud of the growth we’ve achieved together. Seeing the team’s passion and dedication drive us toward success has been one of the most fulfilling aspects of this role.

What are you looking forward to and what is in store for 2025?

Looking ahead, I’m inspired by the endless possibilities we have in store. I am committed to continuing the momentum we’ve built over the past year and driving InMode UK to even greater heights in 2025. Our dedication ensures we consistently provide our clients with the most advanced technology. I’m thankful for the exceptional resources, research and development that allow us to stay at the forefront of innovation. With even more groundbreaking technologies set to launch in 2025, stay tuned for the incredible innovations that the year has in store!

This advertorial was written and supplied by InMode Visit www.inmodemd.co.uk

Device

Fotona releases new dual-wave laser SP Dynamis Nx Line

Aesthetic device company Fotona has launched the new SP Dynamis Nx Line dual-wave laser.

Fotona celebrates its 60th anniversary with the UK launch of the SP Dynamis Nx Line. FDA-licensed for more than 100 treatments including acne, rosacea, 4D facelifts, wrinkle reduction, lip plumping, scar revision, snoring reduction, vascular lesion treatment, thread vein removal, lipolysis and hair restoration, as well as photo-biomodulation for pain management.

The flagship model also includes patented integrated Molecular Cool Mist technology for pain-free treatments, real-time surface temperature feedback and AI-driven algorithms for faster, more effective results.

Professor Christian Phillips (KOL) describes it as, “the pinnacle of laser technology”, emphasising that its cutting-edge technology sets a new specialty standard for laser performance, patient comfort and clinical versatility.

For more information or to book a demo, please contact Fotona UK at www.fotonauk.co.uk.

The content is written and sponsored by Fotona.

Education

BDNG hosts

The Dermatology for Aesthetic Nurses event

The British Dermatological Nursing Group (BDNG) hosted ‘The Dermatology for Aesthetic Nurses’ on November 23.

The event, curated by dermatology clinical nurse specialist Emma Button and open to members of the British Association of Medical Aesthetic Nurses (BAMAN), featured presentations from expert nurse prescribers. At the event, Emmanuel Toni discussed skin anatomy and emollients, sparking lively discussions, while Verity Nowlan presented on holistic skincare consultations and the impact of alcohol and smoking on the skin. After a coffee break, Nowlan went on to cover treatments that benefit or harm the skin. Finally, Button presented on acne treatments, emphasising holistic care. Button said, “The Dermatology for Aesthetic Nurses was made possible through the collaboration of BDNG and BAMAN. This partnership successfully brought together experienced dermatology nurses and aesthetic nursing advocates, all committed to sharing evidence-based knowledge and fostering a collaborative, supportive environment for the wider nursing workforce.”

Regulation

DermaFocus issues warning on unauthorised sale of Plinest

Aesthetic distributor DermaFocus has reported a rise in the number of unauthorised online shops and pharmacies selling the Plinest range of polynucleotides.

As the UK’s exclusive distributor of Plinest by Mastelli, the company has warned that products which are not bought directly from them or their approved partners are at risk of safety concerns. The approved partners are: ACRE Pharmacy, Church Pharmacy, Healthxchange Pharmacy, John Bannon Pharmacy, MedivaPharm, Millennium Pharmacy, Wigmore Medical and YouCan Pharmacy.

DermaFocus complies with the Good Distribution Practice (GDP) standards which ensures Mastelli ships products to the DermaFocus pharmaceutical-grade warehouse, guaranteeing sterile conditions, proper ventilation, temperature control and security. Products are checked, stored with batch numbers and shipped to sub-distributors in compliant vehicles, the company explains.

Co-founder and executive director at DermaFocus, Milad Bemana, said, “We urge all practitioners to buy Plinest via DermaFocus or one of our approved partners. If you have any concerns about products bought elsewhere, please get in touch so we can investigate, report to trading standards and work towards putting an end to this risky practice.”

Training

Dermalux launches new LED phototherapy education hub

Medical device company

Dermalux has introduced a new online education hub to deliver teaching for light-emitting diode (LED) phototherapy.

The Dermalux Academy aims to provide training for medical and aesthetic professionals. The programme offers on-demand, interactive sessions, and is tailored to the needs of dermatologists, plastic surgeons, nurses and aestheticians, explains the company.

Some key features of The Dermalux Academy include

flexible access to a wide range of educational materials, live webinars hosted by specialty experts and accredited courses that are CPD certified.

Dr Ian Strawford, aesthetic practitioner and faculty member of Dermalux, commented, “Dermalux supports continuous learning and professional growth. The organisation is committed to supporting its customers with superior education and ongoing support. The Dermalux Academy is more than just an educational platform; it’s a community where professionals can collaborate.”

Masterclass

HA-Derma hosts exclusive masterclass

IBSA Derma’s UK&I exclusive distributor and training provider HA-Derma hosted an Italian masterclass on November 14-15.

Tiziana Rossi, international medical education liaison manager from IBSA, welcomed practitioners from regions including the UK, Slovakia, Jordan and more to the two-day Profhilo Product Line Global Masterclass in Milan.

The two-day event began with an introduction to IBSA Derma and its Profhilo product line. Dr Beatriz Molina, Dr Gabriel Dameto, Dr Piero Fundaro and Dr Editta Buttura presented on Profhilo body, anatomy, rheology, techniques and steps towards regenerative aesthetics.

Day two focused on protocols for enhancing skin quality and combatting ageing, introducing Profhilo Structura and patient consultation strategies. Dr Fundaro also addressed the role of hyaluronidase in aesthetic procedures.

Nurse prescriber Claire McLoughlin added, “The content was excellent and I have benefitted from watching the products in use, learning different techniques and seeing the new protocols. I have learnt new indications for Aliaxin FL which I have not been using in my practice but will be now. The opportunity to network with practitioners from other countries, particularly speaking with Dr Molina regarding her use of the Aliaxin range and Profhilo Structura was unsurpassed.” On the Scene

Annual Beyond the Mirror event explores holistic health

The second annual Beyond the Mirror event took place at Cleaver and Wake in Nottingham on November 23.

The evening, hosted by dentist and aesthetic practitioner Dr Olha Vorodyukhina and her team at Angels Twelve, focused on holistic approaches to beauty and wellness.

Dr Vorodyukhina discussed developments in aesthetic treatments, while Dr Apostolos Papadopoulos, founder of Cropt Intellect, explored the role of gut health and surgery in overall wellbeing. Hair transplant surgeon and aesthetic practitioner Dr Tetiana Mamontova highlighted advancements in hair restoration, and Dr Sameena Rizwan addressed menopause care and hormone replacement therapy.

Nutritionist Donald Gordon provided practical advice on maintaining a balanced and healthy lifestyle.

Dr Vorodyukhina said, “The Beyond the Mirror event has become a highly anticipated annual tradition. It provides the public with powerful insights and expert advice on healthy, active longevity, skin health and medical aesthetics. It features empowering discussions that highlight the importance of safety and ethics in these fields. We’re excited for what next year’s event will bring.”

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The Scottish Aesthetic Conference scheduled to be held in 2025

The Scottish Aesthetic Conference (SAC) is back on March 22 at the Glasgow Hilton.

The conference, now in its third year, continues to welcome medical aesthetic professionals at all levels, including those new to the specialty. The conference is expected to feature a lineup of keynote speakers with clinical and business updates, alongside expert panels and breakout sessions. Attendees will gain insights and knowledge to enhance their practice while learning about the latest advancements in the field, the organisers explain.

Aesthetic practitioner and previous attendee Dr Nestor Demosthenous shared, “The SAC is a fantastic conference where Scottish clinicians get the benefit of learning from both national and international speakers on topics relevant to their day-to-day practice. It offers a wonderful opportunity to network with colleagues, helping to grow a sense of community and solidarity in the drive for clinical excellence and patient care.”

Awards

Northern Irish sector celebrated at the Cosmetic Medicine Awards

The Northern Ireland Cosmetic Medicine Awards 2024 recognised aesthetic excellence at the beautiful Culloden Estate in Belfast.

On November 29, 430 guests attended the ceremony to recognise the Northern Irish aesthetic field’s biggest talents and most impressive achievements, according to the organisers. The event rewarded recipients of 23 awards, including regional clinics, aesthetic companies and outstanding individuals.

The winners included Lisa Waring for the Outstanding Achievement in Cosmetic Medicine, while Professor Bob Khanna was granted the Global Recognition in Cosmetic Medicine Award.

On The Scene

Cynosure Lutronic hosts skin rejuvenation event

Aesthetic manufacturer Cynosure Lutronic held a skin rejuvenation event in London on November 27. The evening featured two of the company’s Key Opinion Leaders, Dr Kaywaan Khan and Mr Ali Ghanem, showcasing its devices Potenza and PicoSure.

Mr Ghanem shared his expertise on the PicoSure Pro Picosecond Laser, highlighting the 755 nm wavelength as ideal for targeting unwanted pigment. He noted its rapid 10-minute treatment time with no downtime, and discussed maximising ROI by integrating this technology into practice.

Dr Khan demonstrated techniques to enhance topical penetration by up to 67%, aiming to achieve effective and long-lasting results. During the event, he performed a live Potenza microneedling radiofrequency facial using the Fusion Tip with semi-insulated needles, which allows for multi-depth tissue treatment and faster procedure times, according to the company.

Mr Ghanem discussed the use of PicoSure Pro with Aesthetics, explaining, “I started using the PicoSure Pro in January 2024, and I was blown away with the results I was able to achieve. I started using it not only as a pigmentation tool, but also as a regenerative tool. It is a great pleasure to share my experience with PicoSure.”

Nigel Franchetti from the Emerald Laser team shared, “We were absolutely thrilled to receive the Highly Commended in ‘Innovative Device of the Year’ award. It’s an honour to be recognised in such a prestigious event, and we couldn’t be prouder of our team’s hard work and dedication.” The Aesthetics Journal was the media partner for the Awards, providing the Winners an opportunity to become automatic Finalists at The Aesthetics Awards. Turn to p.38 now to see the shortlist.

The evening itself featured a drinks reception from headline sponsor BTL Aesthetics, with cocktails from Wild Atlantic Gin alongside live music. After a three-course dinner, the ceremony kicked off with a performance from Stevie Shanks and his team of drummers, followed by James Huish and the brilliant Sonique.

The event was also a great opportunity to fundraise for the ceremony’s chosen charity this year, Cinemagic, supporting their fantastic work helping young people on their journey into film and media. More than £3,000 was raised on the night.

Event organiser Lesley McGaritty reflected, “It’s an honour to bring together such a passionate community of professionals who are dedicated to advancing the field and delivering exceptional patient care. Every moment has been filled with excitement, joy and a sense of unity. It’s been a privilege to be a part of such a memorable evening, and we can’t wait to see what the future holds for this dynamic field.”

Conference Report

FACExpo Conference returns for its third year

The annual FACExpo Conference took place on November 23 at the Queen Elizabeth II Centre, London.

The event, designed to provide education for both junior healthcare professionals and senior practitioners, covered topics from business and regulation, to injectables and regenerative medicine. Particular highlights were on-stage debates discussing whether aesthetics should be a side hustle and growth with different patient demographics.

Speakers at the event included founder Mr James Olding, Professor David Sines, Dr Zainab Al-Mukhtar, Dr Nestor Demosthenous, Dr Ahmed El Houssieny, Dr Sophie Shotter, Mr Ali Ghanem, Dr Ana Mansouri, Dr Alessandra Dall Magro and nurse prescriber Julie Scott.

Scott commented, “For me, FACExpo is truly unique because it’s hand-curated, with every speaker bringing their own exceptional skill and expertise. Together, it creates an incredible synergy, making it such an intimate and inspiring space to share our passions and connect with one another. It was an absolute honour to be one of those people, sharing alongside such talented colleagues.”

On The Scene

IAAFA hosts Aesthetics Conference and Awards

The International Academy of Advanced Facial Aesthetics (IAAFA) hosted its all-day conference and awards ceremony on November 23. The 2024 conference, held at De Vere Beaumont Estate in Windsor, featured a distinguished lineup of specialty leaders, delving into the latest advancements in aesthetic techniques, ethical practice and patient safety, while offering seven hours of CPD sessions to attendees.

The evening transitioned into the IAAFA Charity Ball and Aesthetic Awards Ceremony, where guests enjoyed a three-course dinner, live entertainment and an auction, raising £30,000 for the Chandran Foundation – a charity supporting underprivileged children through education.

The Awards celebrated clinical excellence, with categories such as Best Patient Journey and Best Full Face Sculpting, recognising individuals who set the standard for safety and innovation in aesthetics.

Professor Bob Khanna, aesthetic practitioner and president of IAAFA, shared, “I set up IAAFA with two main objectives in mind. I wanted to unite clinicians from all over the world in one organisation dedicated to the pursuit of clinical excellence in medical aesthetics, to upskill the specialty and enhance patient safety, while also being able to give back to our communities and create a positive social impact.”

News in Brief

Dr Patrick Bowler passes away

Aesthetic practitioner Dr Patrick Bowler has sadly passed away at the age of 74. Dr Bowler, a trailblazer in aesthetics and medical director of Courthouse Clinics, passed away on November 24, leaving a lasting legacy. As a founding member and Fellow of BCAM, he transformed non-surgical treatments and received the Brinkenhoff Lifetime Achievement Award in 2013. His groundbreaking work has set a new benchmark for excellence, inspiring practitioners and enhancing patient care worldwide.

JCCP celebrates reaching 1,000 registrants

The Joint Council for Cosmetic Practitioners (JCCP) has announced its milestone of reaching 1,000 registrants. The organisation shares that this achievement reflects the dedication of practitioners and their shared commitment to striving for a safe, transparent and ethical sector. Andrew Rankin, JCCP trustee and chair of the practitioner register committee, commented, “The JCCP is delighted to announce our 1,000th member has just joined the practitioner register. Thank you to all our registrants and partners who have helped make this happen.”

Sinclair appoints Martin Edwards as head of sales

Aesthetic manufacturer Sinclair has announced the appointment of Martin Edwards as head of sales for the UK and Ireland. Effective since November 2024, Edward’s appointment leverages his 15 years of experience in aesthetics and healthcare, aiming to drive business development and market expansion for Sinclair’s aesthetics portfolio. Edwards commented, “I am excited to leverage my expertise to strengthen Sinclair’s market presence, build robust partnerships and deliver value to healthcare professionals and patients alike.”

Dr Patrick Treacy awarded ‘Irish Man of The Year 2024’

Aesthetic practitioner Dr Patrick Treacy was awarded ‘Irish Man of The Year 2024’ for his humanitarian contributions at the HiStyle Awards. HiStyle hosted its 2024 awards on November 23, celebrating excellence in lifestyle, fashion and hospitality industries. This award recognises Dr Treacy’s humanitarian work in HIV clinics and orphanages in South Africa, Liberia and Malawi, aiding Haiti after the 2010 earthquake and supporting Ghana’s 2007 clean water project.

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NICE Releases Plans for NHS Tirzepatide

Roll Out

Aesthetics reports as 220,000 NHS patients are set to receive weight loss injections to treat obesity in the next three years

The National Institute of Health and Care Excellence (NICE) has released final draft guidance of the NHS roll out of weight loss drug tirzepatide.1 The guidance confirms that the medicine – also known as Mounjaro from Eli Lilly – is recommended by NICE for people in England and Wales with a body mass index of more than 35 and at least one weight-related illness.2 This makes around 3.4 million people in England eligible for the prescription, but the roll out will be gradual.2

The guidance recommends that 220,000 people living with obesity – only those with the highest clinical need – will be offered the weight loss drug, alongside lifestyle advice, on the NHS in England over the next three years.2 The licence for tirzepatide states that it should be considered for weight-related illnesses including: hypertension, dyslipidaemia, obstructive sleep apnoea, cardiovascular disease, prediabetes and type 2 diabetes.2

Professor Jonathan Benger, NICE’s chief medical officer, commented, “The world will look very different in three years, which is why we’ve taken the unprecedented decision to review the way this medicine is delivered to patients. Tirzepatide and other drugs like it will help people living with obesity to lose weight, and as a result will reduce their risk of developing heart disease or having a stroke.”

The final NICE guidance is due to be published early in 2025, with the first NHS patients receiving prescriptions within 180 days.2 The impact of this initiative is set to be felt across the healthcare landscape, including in private practice and aesthetic clinics currently offering weight loss solutions.

Negating preventable deaths

According to an NHS England survey conducted in 2022, 64% of adults are either overweight or living with obesity in England, resulting in obesity being the second largest cause of preventable death in the UK after smoking.2

Dr Kath McCullough, NHS England’s national specialty advisor for obesity, commented, “Obesity is one of the greatest public health issues facing the NHS, and weight loss drugs, such as tirzepatide, are an important tool in helping people lose weight while also reducing the risk of other serious long-term conditions such as diabetes, strokes and heart attacks.”

Dr McCullough went on to emphasise that, “On their own, weight loss drugs are not a magic bullet. They need to be prescribed by a healthcare professional alongside programmes that help people lose weight and live healthier lives by making changes to their diet and physical activity.”

The fall out for aesthetic clinics

Dr Mayoni Gooneratne, aesthetic practitioner and founder of the British College of Functional Medicine (BCFM), feels that this NHS roll out has the potential for a significant positive impact for public health in the UK, if done in the right way. However, when considering aesthetic/ wellness clinics currently offering weight loss solutions, she says, “The effect of this will depend on how these clinics adapt to the changing landscape. Challenges will include increased competition from a medically subsidised treatment, which could reduce demand for private injections, invasive weight loss procedures and some non-invasive treatments.”

She goes on to say that, “Nevertheless, opportunities exist for clinics that can pivot to offer complementary services such as body contouring, skin tightening or lifestyle coaching alongside weight loss injections. Clinics that integrate medical weight loss options with their existing offerings and adapt to patients’ evolving demands are likely to remain competitive.”

Registered nurse and JCCP Trustee

Andrew Rankin emphasises, however, that the proposed cosmetic licensing scheme suggests that CQC-registered clinics should be able to prescribe weight-loss injections for individuals with a BMI of over 30, and 27-30 with a weight-related comorbidity. This means that aesthetic/wellness clinics will still have a cohort of patients able to be treated privately. He says, “The NICE guidance reinforces the importance of a risk-based approach to assessment which identifies clinical need. An important implication for private practice is that if they encounter a patient with a BMI of 35 or above, they should disclose the option to seek weight loss treatment through the NHS.”

The future of weight loss treatments

Professor Benger emphasised that the drug’s roll out must be done in such a way as to not disproportionately impact other NHS services, saying, “NICE will review the situation again within three years and provide further advice on how the roll out of this medicine can be managed using the learning gained from the initial phase.”

It is estimated that the drug’s roll out will cost NHS England around £317.2m per year by the third year of implementation. However, a 2023 study estimated that obesity-related treatment places a £11.4bn burden on the NHS annually, suggesting that money will be saved through avoiding future ill-health.4

Aesthetics will continue to report as further specific details on the NHS plans emerge.

Treating the Neck with Energy Devices

Practitioners discuss considerations for rejuvenating a wrinkled

and sagging neck

The neck is a delicate and often overlooked area of the body, yet it reveals signs of ageing as prominently as the face. Similarly to the face, neck ageing is influenced by a combination of intrinsic factors like genetics and skin structure, as well as extrinsic elements such as sun exposure, lifestyle habits and posture.1 Unlike other areas, the neck’s thin skin and limited support structures make it particularly vulnerable to sagging and wrinkles.1

In this article, three aesthetic practitioners examine the common aesthetic concerns associated with neck ageing, and the energy-based devices that are clinically proven to enhance the neck’s appearance.

Ageing of the neck

Dr Tatiana Mandavia explains that the neck is a very common area of concern. “It’s one that I feel patients are increasingly asking to address. It’s also an area that patients are pre-emptively treating and ‘maintaining’ rather than waiting for more laxity or signs of ageing to develop,” she says.

Dr Sindhu Siddiqi agrees, noting that patients looking for a neck treatment are usually concerned with skin laxity, thin skin, crinkling, crepiness and a lack of jawline definition. She highlights, “People forget to use sunscreen on the neck and often don’t realise that the naturally thin skin in this area is more prone to UV damage.”

Dr Vincent Wong notes that the three main concerns he sees are submental fat (double chin), skin laxity in the submental/neck area (often referred to as turkey neck due its appearance) and horizontal lines, known as ‘tech neck’, caused by looking down at screens too much.

While these can occur due to the natural ageing process – increased skin laxity, disruption of skin texture and collagen, bone resorption, facial volume loss and muscle laxity – the practitioners explain that there are other factors to take into account too.1

“Some people are more genetically predisposed to carrying subcutaneous fat on the chin and neck, even if they are slim; losing the sharpness in their jaw as they get older,” says Dr Siddiqi. She adds, “Others simply don’t have enough bone structure or mandibular support, making sagging more noticeable around the neck area.”1

Dr Mandavia explains that platysmal bands can become more noticeable as a result of a contraction of the platysma muscle, causing increased prominence of the bands and a downward pull on the jawline.2

Dr Wong highlights that rapid weight loss can have an impact on skin laxity, while weight gain will contribute to a double chin.1 He also notes that a patient’s lifestyle will have an influence on their neck’s appearance. “Excessive alcohol intake, smoking and poor diet will all speed up the ageing process and lead to more visible concerns,”3 he says.

The practitioners all highlight that detailed assessment is essential. “Those with underlying medical conditions such as inflammatory disorders are more likely to have poor skin quality,”4 says Dr Wong. Meanwhile, Dr Siddiqi explains, “Some people may not realise that they have large

“The neck is an area that patients are pre-emptively treating and ‘maintaining’ rather than waiting for more laxity or signs of ageing to develop”

Dr Tatiana Mandavia

glands and lymph nodes, which makes the neck appear heavier. While you can’t do anything about this, it highlights why it’s important to assess the patient properly to best manage expectations.”

Treatment options

There are multiple treatment options that can rejuvenate an ageing neck. “Botulinum toxin can be considered if your patient doesn’t want or need to lose facial fat,” says Dr Siddiqi, explaining that it can help reduce the appearance of platysmal bands, horizontal lines and tighten the jawline. She also recommends using Sculptra in combination with Profhilo. “I inject Profhilo to the centre of the neck to enhance skin quality, before using Sculptra – a poly-L-lactic acid – to lift either side,” says Dr Siddiqi. To tackle fine horizontal lines, she uses Newest, a product that combines polynucleotides and hyaluronic acid (HA) to regenerate aged and damaged skin.

“Additionally, I may also use Restylane Vital Skinboosters to treat deeper lines. Its crosslinked HA helps add structure,” she says.

Dr Mandavia also advocates for the use of fillers, highlighting, “Dermal filler can help restore bone contour, while making skin look more refreshed and hydrated.”

Dr Wong uses toxin to treat platysmal bands, and highlights that exosomes and nanofat grafting are other regenerative treatment options that will improve skin quality, while submental liposuction will help address fat deposits.

He also offers thread lifting to improve skin laxity using a technique he has created with colleague Dr Abdulrahman Abdulbaky, using Definisse Anchorage threads by Relife.

In practice, Dr Wong highlights that most patients present with a combination of issues, so a multi-modality approach is usually recommended. “Whilst injectable treatments and threads can provide great outcomes, I personally feel that energy-based devices will enhance these outcomes and escalate what we can achieve non-surgically. With the ability to contract the skin, energy-based devices fill the gap between surgical and non-surgical aesthetics,” he says.

Energy-based devices

The practitioners note that energy-based devices, including radiofrequency, ultrasound and laser technologies, have revolutionised the way we approach neck treatments. These non-invasive or minimally invasive modalities harness the power of targeted energy to stimulate collagen production, tighten skin and improve texture with minimal downtime.

In her practice, Dr Siddiqi uses Sofwave. The device uses Synchronous Ultrasound Parallel Beam Technology, known as SUPERB, which is FDA-cleared to treat the neck and submental area, along with lifting the eyebrow and reducing fine lines and wrinkles.5

The device works by heating the mid-dermal tissue at the precise depth and temperature to rejuvenate collagen fibres and improve the overall appearance of the skin.5 Dr Siddiqi explains that it is applied in what she describes as a ‘basketweave’ pattern, which goes vertically and horizontally, using the specialised Sofwave applicator.

“Suited to the slimmer patient who doesn’t want to lose fat, Sofwave passes ultrasound waves only 1.5mm into the skin to avoid melting fat,” says Dr Siddiqi. She adds, “It does get hot, but only lasts approximately two seconds per application. We use the Cryo blower to help cool the skin and make patients as comfortable as possible.”

When targeting a ‘turkey neck’ appearance, Dr Siddiqi explains that she ensures the head is tilted back so she can access the submental region easily. “This is where I like to concentrate the shots, really pushing into the mandible,” she says.

Treatment lasts 30-45 minutes and most patients see significant improvement after one procedure, with results developing over six months and lasting up to 18 months.5 “Their skin is tighter, elasticity is improved, skin texture is smoother and more hydration is achieved through the stimulation of fibroblasts, creating more collagen and hyaluronic acid in the skin,” explains Dr Siddiqi.

In terms of side effects, patients will experience a slight flush that goes quickly. No device-related adverse events have been reported in clinical studies.5

The IgniteRF workstation by InMode is Dr Wong’s device of choice, but it should be noted that it is only available for doctors and surgeons to use. Combining multiple technologies, it is indicated for procedures requiring soft tissue contraction, electrocoagulation, haemostasis and fractional treatments requiring penetration levels of up to 60mm.6

“Whilst injectable treatments and threads can provide great outcomes, I personally feel that energy-based devices will enhance these outcomes and escalate what we can achieve non-surgically”

Dr Vincent Wong

Figure 1: 55-year-old patient six months after treatment using the Secret PRO device

“For the neck, I will use QuantumRF, which uses radiofrequency to allow practitioners to achieve an effective result without surgery or suction, under local anaesthetic,” he explains, continuing, “Using fractionated bipolar radiofrequency, each pulse delivered using the QuantumRF handpiece affects 1 cubic cm of tissue, contracting the fibroseptal network and creating a 0.03ml ‘dead space’ in the fat layer. Based on clinical examination, we can tailor this treatment by adjusting the number of pulses delivered to achieve the patient’s aesthetic goals.”6

Dr Wong highlights that only one treatment which takes a few minutes to complete is required, with results lasting a number of years, comparable to the longevity of surgical results.6

He follows QuantumRF with three Morpheus8 treatment sessions, one performed immediately after QuantumRF and two additional spaced four weeks apart. Morpheus8 combines fractional RF technology with microneedling to remodel and contour the treatment area, while enhancing the skin’s quality.6

Dr Wong says that patients will see immediate tightening and lifting of the skin, and these results continue to improve over the next three months and last for several years. Morpheus8 treatment can be repeated annually if needed.6

He explains swelling is the main side effect, but this typically subsides in a few days without medical intervention. Patients are advised to wear a compression garment post procedure to accelerate healing.4 Dr Wong adds that, rarely, patients may experience fibrosis of tissue in the treated area, which typically resolves in a few weeks, and temporary nerve irritation, again lasting a few weeks. There is also a small risk of burns, but this is very rare.6

For Dr Mandavia, the Secret PRO from Cutera is her go-to energy device. Featuring four treatment options for skin resurfacing and deep dermal remodelling, this technology can treat multiple concerns, she says, highlighting that it’s very adaptable to the needs of the patient. For neck rejuvenation, she uses Secret RF for fractional radiofrequency microneedling, which stimulates and remodels collagen from the inside out. With two treatment tip options, Dr Mandavia explains that practitioners can customise treatments depending on individual needs, with precision and efficiency.7

Three sessions are conducted, spaced four weeks apart, with fractional CO2 laser added to one of the treatment sessions. She says, “The benefits of the CO2 are that it works on the surface texture, wrinkles, pigmentation and scarring. It’s also great for upper and lower eyelid laxity.”

In terms of technique, Dr Mandavia explains, “I create traction on the skin in the direction of lift and then use the Secret RF to ‘pin’ the skin in the direction of lift. This gives an immediate lifting effect and is particularly useful when treating the jawline.”

She continues, “I also use deeper insertion points and higher energy settings when treating areas with more fat, for example the submental area and jowls, and then switch to more superficial treatment with lower energy settings when working on collagen stimulation and improved elasticity. The principle is that we want to ‘make’ collagen rather than ‘break’ it.”

Following treatment, it is likely that patients will experience some redness and mild swelling for a day. “They may also have some roughness of the skin for around three to five days,” says Dr Mandavia, adding that this can be managed through regular application of a hydrating moisturiser.

In terms of adverse events, Dr Mandavia highlights, “As with any heat-based treatments, there is risk of pigmentation and some scabbing of the skin surface which can last five days.”

Dr Mandavia also notes that the Secret PRO has a ‘younger sister’ called the Secret DUO. She explains, “The DUO combines radiofrequency microneedling with an erbium glass laser, which is great for resurfacing and rejuvenating in all skin tones. This is also a fantastic treatment for those who can’t have the ‘downtime’ of a CO2 laser.”7

Key considerations

Before choosing a neck treatment for your patients, ensure you really understand their concerns, expectations and budgets, the practitioners advise. They also highlight the importance of being aware of contraindications. For each of the treatments, these include open wounds or lesions, severe or cystic acne, pacemakers or other electronic devices in the treatment area.8 Precaution should also be taken in patients who are pregnant, breastfeeding, have cancer or undergoing cancer treatment, have active infections or are on certain medications.8-10

Dr Siddiqi also recommends being clear on cost, highlighting that Sofwave is an investment so is generally better for patients with more disposable income. The good thing, she says, is that treatment can be administered to one area at a time to split the cost. “This is great for those who perhaps want to focus on their neck first before moving to the face, making it more affordable,” explains Dr Siddiqi. Finally, she says, assessment is key, explaining, “If someone has a lot of fat or glandular tissue, they won’t be able to see results as well. You need to be confident that their main issue is skin when using Sofwave.”

Dr Wong emphasises that there is a learning curve associated with the IgniteRF workstation, but it is definitely worthwhile. “It truly elevates the results that you can deliver,” he says. Like most aesthetic procedures, he highlights that best results are usually achieved with a combination of different treatment modalities.

Do your research

Whatever energy device you choose, it is essential that you select one that has clinical research supporting its use, as well as ongoing support from the manufacturer and distributor. Dr Mandavia concludes, “Being able to access training, advice and maintenance as and when you need it is so valuable. These devices are a big investment, so make sure you take your time and do your research to choose carefully!”

Figure 2: Patient before and four weeks after treatment using QuantumRF

Spotlight On: Mia Femtech

A look at the science behind the UK’s first minimally invasive breast implant technology

For many years, surgical implantation has been the only go-to option for breast augmentation. In 2024, this changed when the first minimally-invasive breast implant technology was launched to the UK market.

Created by aesthetic treatment company Mia Femtech, this technology features the first injectable, biocompatible implants designed for a natural look and feel, setting a new standard in aesthetics.1,2 These injectable implants can provide patients with a one or two cup enhancement.3

How it works

The implant used in the procedure (the Ergonomix2 Diamond implant) is uniquely designed to produce a greater projection than a conventional round implant.4 The biaxial symmetry of the implant may reduce or eliminate malpositions in the event of implant flipping.5

Mia utilises a patented tissue preservation technique that eliminates the need for cutting breast tissue. Instead, the procedure employs hydro-dissection and inflatable balloon expansion to create the implant pocket. This gentle approach minimises trauma and preserves the structural integrity of the breast, the company says.1

The incision in a Mia procedure is concealed within a fold in the axilla, and is on average 38-50% smaller than incisions typically reported in traditional transaxillary and inframammary fold breast augmentation.6

Breakthrough technology

Mia is differentiated from traditional surgical augmentation due to:

· Shorter procedure time: The operative time for a Mia procedure is reduced up to 50% compared to published techniques for traditional breast augmentation. The implant placement takes only 15 minutes, with a total clinic time of just 90 minutes.8

· No general anaesthesia required: Most Mia procedures are performed under local anaesthesia, enhancing safety and reducing recovery time.8

Concealed scars: Incisions are hidden within the armpit folds, and they are significantly smaller than those in traditional breast augmentation techniques.1

Results

Clinical studies demonstrate Mia’s efficacy and patient satisfaction:

· Natural appearance: 99% of 100 patients reported satisfaction with the natural look and feel of their breasts.9

· Fast recovery: Patients resume daily activities within three days post-procedure, with minimal discomfort.8 91% of patients reported no difficulties doing vigorous physical activity at six months following the procedure.9 95% of patients reported no difficulties lifting heavy objects at six months following the procedure.9 86% of patients reported no discomfort with their implants during physical activity at six months following the procedure.9

· Durable outcomes: The risk of malposition is as low as 1% at one year, significantly outperforming traditional methods.8 Results are expected to last for at least 15 years.

Practitioner perspective

Consultant plastic and reconstructive surgeon Mr Adrian Richards, one of four surgeons in the UK to be offering Mia Femtech at his clinic, said, “We’ve seen excellent results in clinic, particularly in the recovery period. Procedures are typically performed on a Friday so that the patient can recover over the weekend and be back at work on the Monday. We’ve been giving patients questionnaires after treatment to monitor satisfaction, and they have been delighted by the quick recovery time, no need for anaesthetic and natural results. Many of them had been thinking about breast augmentation for years, but had been put off because of these factors.”

On the difference between an injectable implant and a surgical implant, he comments, “It’s still an implant so it’s made of all the same materials, but it is just a different shape – a diamond shape – which makes it lighter and gives a more subtle result. If a patient would like a larger augmentation and to see a bigger difference in size (more than one or two cup sizes) we would suggest having a traditional surgical augmentation.”

Currently, Mia is only allowed to be performed by plastic surgeons who are fully trained in the procedure. He says, “Although it isn’t widely available at the moment, it definitely is the future of breast augmentation, and I think there will be a huge shift towards its use. I personally prefer performing it to surgical implants.”

The evolution of breast augmentation

Mia represents a modern approach to breast augmentation, focusing on safety and patient convenience. Using injectable implants and minimally invasive techniques, the company explains it offers a solution that combines advanced technology with natural-looking results.

Evolve with the Aesthetics Specialty

Connect with your peers at ACE 2025

Working in medical aesthetics means so much more than just treating surface-level imperfections, it’s about helping the wellbeing of patients, restoring confidence and changing lives. Beyond this, you have to learn to be a business owner, become your own brand, constantly keep up-to-date with the ever developing innovation and learn new techniques, as well as forge your own support network in a mostly lone-working specialty.

Fortunately, as the aesthetics field continues to evolve and innovate, so does the Aesthetics Conference and Exhibition (ACE). Returning on 14-15 March 2025, ACE has developed brand new features creating an intimate, collaborative environment where you can connect with peers, learn from specialty leaders and celebrate the achievements of a thriving field.

Whether you’re seeking to refine your clinical skills, gain fresh business insights or simply share ideas with like-minded colleagues, you can join 3,000 professionals working within the medical aesthetics community by registering FREE for ACE today.

What’s new for 2025…

The Association Zone

The Association Zone allows you to engage with leading associations at the forefront of the specialty. Throughout the two days they will organise talks at the Association Theatre to discuss essential topics such as ethics, safety trends and the latest developments within the field. These associations are also your gateway to creating a support network in the field, so it’s a great opportunity to get to know them and ask any questions you may have.

Some confirmed associations include the British College of Aesthetic Medicine, the British Association of Medical

Aesthetic Nurses, the Nurses Network and representatives from surgical community associations.

More will be announced soon, so whether you’re a seasoned professional or just starting out in the field, the Association Zone is your go-to destination for invaluable resources to elevate your practice.

Allergan Aesthetics Main Auditorium

For its first year as ACE Headline Sponsor, Allergan Aesthetics, an AbbVie Company, will enhance your clinical practice by providing insightful talks and live demonstrations in the Main Auditorium.

Over the course of two days, you’ll experience exclusive injectable content, led by world-renowned Key Opinion Leaders (KOLs).

Stand Seminars

With so much incredible content going on during the show, this agenda stream shines a spotlight on all of the education taking place on the show floor. Exhibitors will host talks on their stands across the two days, creating a more intimate learning environment for visitors. You will be able to see the brands up close and personal, ask them questions and see products live in action. The full agenda will be announced soon!

Other features to look out for…

As well as the above, ACE 2025 will see the return of some incredible features which were new to the show last year.

The Platinum Hall

This experience brings together the specialty’s most sought-after companies in one destination. Prepare to immerse yourself in unrivalled innovation and clinical

expertise as leading aesthetics brands and Platinum Sponsors of the event showcase scientifically-backed products and groundbreaking advancements in the Platinum Hall.

It’s also the go-to destination for the event’s top injectable education, home to the Main Auditorium, featuring two days of leading education by Allergan Aesthetics.

The Platinum Hall experience is located on level one of the venue and is open to everyone, so make sure you head upstairs!

VIP Lounge Powered by Alma

Returning for its second consecutive year, Alma presents the exclusive ACE VIP Experience. Set in a stunning gallery above the Platinum Hall, this premium space serves as an inspiring hub for learning and networking, offering VIPs the opportunity to connect with thought leaders and innovators in medical aesthetics. Last year, guests were treated to complimentary laser demonstrations, refreshments and cocktails, a live DJ, photobooth and professional hair and makeup services.

Stay tuned to find out what they have in store this year!

The VIP Lounge will be accessible by invitation only.

ACE networking drinks with DermapenWorld

What better way to round off the first day of ACE than a drink with your peers? Taking place from 5-7pm, DermapenWorld returns to be the ACE Networking Drinks Sponsor for the second year in a row.

It’s the perfect opportunity to unwind, discuss your favourite learnings of the day and create those all-important connections.

Celebrate aesthetics excellence

The Aesthetics Awards 2025, taking place after the second day of the Aesthetics Conference and Exhibition (ACE), promises to be the most dazzling celebration yet. Returning to remove the luxurious Grosvenor House in London, the prestigious event will bring together the brightest talents, innovative brands and dedicated professionals who have worked tirelessly to elevate patient care and aesthetics standards.

The 2025 Finalists have officially been announced, turn to p.38 to see which exceptional individuals, clinics and companies have made the shortlist. A huge congratulations to all of you!

Remember, you don’t need to be a Finalist to attend the ceremony – it’s a great chance for anyone in aesthetics to attend the largest networking event in the specialty and get immediate access to leaders in the field, gain inspiration from the remarkable achievements of your peers and be part of an unforgettable evening.

Plus, it’s a fantastic night out with drinks, a three course dinner, live entertainment and, of course, the awards ceremony itself with a celebrity host!

Secure your place at the sector’s most glamorous event by heading to p.47. Elite Members of Aesthetics will be able to get tickets at a discounted rate.

Let’s celebrate the outstanding work shaping the future of aesthetics together!

Stay at the forefront of aesthetics

From cutting-edge education to invaluable networking and the unveiling of groundbreaking innovations, ACE 2025 promises an unforgettable experience tailored to the needs of the aesthetics community. Don’t miss this opportunity to connect with the specialty’s best and brightest while staying at the forefront of medical aesthetics.

❍ Aesthetics Journal Members drinks: Day 1 at 3pm

❍ In Practice Zone Networking drinks: Day 1 at 4-5pm

❍ DermapenWorld Networking drinks: Day 1 at 5-7pm

❍ Aesthetics Awards Finalists drinks at the VIP lounge: Day 2 at 2pm Register for ACE 2025 for free now by scanning the QR Code

Assessing Patients Using Multidimensional Approaches

Dr Rehanna Beckhurst explores multidimensional assessment in medical aesthetics, bridging anatomy, ageing, psychology and culture

The field of advanced facial aesthetics presents a blend of medical expertise, artistic sensibility and patient-centred care

This article illustrates the process of assessment, risk evaluation and treatment planning, as well as highlighting the critical role that comprehensive patient assessment plays in formulating a tailored treatment plan. The ideal plan is one that not only addresses aesthetic concerns, but also prioritises patient safety and wellbeing. Incorporating multiple factors into patient assessment is the best way to achieve this.

Initial consultation

The initial consultation holds immense significance within the patient journey. It serves as the foundation for establishing initial rapport with the patient. Through careful patient selection, assessing their suitability for treatment, understanding their expectations, exploring treatment alternatives and ensuring comprehension of these options, a pathway is paved toward heightened patient satisfaction and favourable treatment outcomes. As noted by physician and research Dr Gordon Caldwell, it is imperative for clinicians to get to know the individual before assuming the role of a patient.1 Delving into aspects such as occupation, hobbies, interests and family encourages a deeper engagement and building a good rapport, which in turn will enhance the clinician’s ability to plan and perform treatment and reach optimal goals, as they are more intimately aware of what the patient really wants.1

The establishment of trust through the first consultation also facilitates the clinician’s ability to align patient expectations with potential outcomes – an element critical to achieving a high level of satisfaction post treatment. Stronger bonds between clinician and patient create a positive environment for effective decision-making, where patients are engaged as active participants in the treatment process.1

Looking beyond medical history

Conducting a medical history questionnaire is a must among medical professionals to ensure patient safety. Table 1 summarises and illustrates medical contraindications for dermal filler treatments.2 However, because most clinicians are very familiar with medical suitability for treatments, this article will focus on other factors which are also crucial for patient assessment and treatment planning.

Psychological considerations

People seeking cosmetic treatments often feel unhappy with their looks, but this can sometimes extend beyond typical dissatisfaction into mental health issues. This can include conditions like eating disorders, anxiety or depression, which may be addressed through referral to support groups or mental health practitioners.3 Sometimes, aesthetic treatments can aid with these conditions; for example, facial feedback theory hypothesises that treating the frown lines with botulinum toxin could reduce symptoms of depression.4

A key and recurring concern is body dysmorphic disorder (BDD), where people experience a disconnect between their perception

of reality and actual reality, leading to obsession with aspects of their appearance which can cause distress and have detrimental effects on their lives.5,6

It is critical that clinicians look out for and recognise signs of BDD to safeguard these vulnerable individuals. This can be done through a questionnaire which often incorporates questions looking at comparison with others, preoccupation with appearance, impact of social interactions and more; these can often be found for free online, or incorporated into clinic software systems. If BDD is suspected, clinicians should discuss carefully, avoid labelling and refer to mental health specialists if needed.7 Treating suspected BDD patients is discouraged due to their mental vulnerability causing unrealistic expectations and likely dissatisfaction.3 Furthermore, BDD patients often dislike cosmetic treatment outcomes as their ideas of perfection can be unachievable, and their symptoms can worsen with repeated treatments.7

Social, cultural and religious influences

Gathering information encompassing social, cultural and religious factors is imperative to gain a full picture of each patient as a person, as well as an aesthetic canvas. My consultations are typically 45 minutes to allow time for discussions of this nature; most patients will bring up these motivations themselves, and a good practitioner will listen and engage with the information presented. Amongst social factors, the role of the family is very important, as factors such as motherhood or past traumas can have an impact on aesthetic desires. People’s jobs, hobbies and general lifestyles are also key pieces of information to gauge the potential longevity of treatments; for example, the effects of skincare or chemical peels can be reduced if people spend a lot of time outdoors, and lower face toxin treatments need to be approached with caution in people who play wind instruments. Another important factor to discuss is expectations around budget and possible costs to ensure that the patient is comfortable with the treatment plan you are formulating, and that they do not leave the consultation with inflated expectations of what results they can anticipate.8

Gender roles and sexuality are a very important factor for clinicians. It is important to determine whether a person is seeking a feminine or a masculine look, which can vary depending on how they feel they adhere or do not adhere to typical gender roles – do not assume that a cisgender male is looking for masculinised features, for example.9,10

Religion and the impact of this on diet, beliefs about illness and attitudes to treatment are also a major factor. Some religions don’t support blood transfusions or human/animal origin products for example, therefore, it is important to include this in consultations, such as mentioning the potential presence of human albumin in toxins, the bovine origin of hyaluronidase and the fish DNA in polynucleotides.11

These multicentred considerations ultimately empower clinicians to create treatment plans that resonate with patients’ individuality, aspirations and needs.

Condition

Active skin infection

Inflammatory skin conditions

Other inflammatory diseases

Active localised infection

Active generalised infection

Noninfectious gastrointestinal conditions

Allergy/hypersensitivity

Active psoriasis arthropatic

Systemic viral infections

Conditions potentially causing a Koebner response

Active collagenoses

Other collagenoses

Immune compromise

Autoimmune conditions

Transplant patients

Thyroid dysfunction

Metabolic disorders

Catabolic status

Cachexic state

Conditions affecting skin pigmentation

Skin pigmentation/ depigmentation

Systemic bacterial infections

Active anticoagulant

medication

Haemostatic or coagulation disorders

Cutaneous collagenoses

Food intolerance

Bariatric gastric sleeve surgery

Impetigo, herpes simplex, massive demodex folliculorum, pityrosporum, Propionibacterium acnes, viral warts

Atopic patients, allergic contact dermatitis, status cosmeticus, seborrheic dermatitis, active lichen planus, active acne rosacea X

Pyoderma or osteoarthritis X

Ear, nose or throat infections, dental abscess, periodontitis

Gastroenteritis, urinary bladder infection

Crohn’s disease, ulcerative colitis

Hypersensitivity to filler components including lidocaine, chronic urticaria and Quincke’s oedema

If condition is more arthropatic, caution warranted If condition is more psoriatic, treatment is possible

HIV

Lichen planus, lichen nitidus or lichen scleosus, psoriasis, viral warts

Mixed connective tissue disease, active morphea, active systemic lupus

Marfan syndrome, Ehler-Danlos syndrome

Stablised morphea

Graft versus host disease

Bullous diseases

Active Hashimoto’s disease, mixed connective tissue disease

Dermatomyositis/polymyositis, lupus erythematosus, rheumatoid arthritis

Heart, kidney, liver, bone marrow transplant – beware of increased risk of infections

Not a contraindication to treatment, but physician needs to be aware that eyelid swelling is common (unrelated and unprovoked by filler use)

Diabetes, porphyria

Does not contraindicate treatment, but product may be more visible in patients who lack subcutaneous fat and have thin tissue coverage

Melasma and post-inflammatory hyperpigmentation

Fitzpatrick Types 5 and 6, vitiligo and albinism

Tuberculosis

Thrombolytics

Haemophilia, haemoglobin pathology, thalassaemia

Chronic discoid lupus erythematosus, active but not end-stage scleroderma

Potentially reduced time of aesthetic effect

Table 1: Conditions contraindicating or warranting caution in the use of dermal filler2

Ethnic considerations

Beauty standards differ in different cultures. Skin colour and the shape of individuals’ noses, lips and cheeks vary from culture to culture, as do beliefs surrounding what is considered beautiful. For example, in Asia, jawline reduction is popular as a broader lower face is considered unfeminine.12 Beauty is in the eye of the beholder, so shouldn’t be imposed by a clinician. It is imperative to respect different facial structures and preferences, instead of imposing western beauty standards on all patients.

Promoting cultural awareness, inclusion and consciousness of cultural and racial beauty standards, different skin types and colours defines a culturally informed practitioner.12,13

Physiology of ageing and patient assessment

Visible effects of facial ageing occur as a result of cumulative changes in the skin, soft tissues (subcutaneous fat, muscle and fascia) and structural support as teeth and bone. Manifestations of those changes can be seen over the years, and they reflect effects of gravity, muscle strength, bone resorption, migration of facial fat pads and loss of skin elasticity.11

The major contributing factors of facial ageing are both intrinsic and extrinsic. Intrinsic factors are genetics, skeletal remodelling, redistribution of subcutaneous fat and hormonal imbalance; while extrinsic factors include exposure to UV light and smoking, mental and physical stress, diet, work habits, drug abuse, disease and more.14

When assessing a patient, the clinician should be aware of those issues, and plan treatment accordingly. All people age at a different rate – even both sides of the face may age at a different rate –hence, treatment planning can’t have a ‘one-size-fits-all’ approach.15

Comprehensive assessment should encompass the entire face, looking at the key factors of static and dynamic lines, bone and soft tissue volume loss and skin quality.

The upper face

The upper face (forehead and brow area) loses the subcutaneous fat pad between the muscles of expression and skin during ageing, meaning the skull can protrude or make the orbital rims more pronounced.14 Muscles, which become stronger, gain a ‘bulkier’ appearance with no subcutaneous tissue to soften their outline.16 Skin loses it elasticity, and the rhytids become static and deep.17

As the orbital bone resorbs, it can lead to deeper-set eyes, a more pronounced orbital rim and a sunken appearance.18 This bone loss also exacerbates the visibility of tear troughs.18

Temporal soft tissue volume loss makes temporal blood vessels more evident, as well as creating a lack of support to the orbit which can cause a ptotic appearance.11 In combination with this, increased skin laxity in the upper eyelids means they ‘gain’ excessive skin either hanging over the eye or burrowing into the orbit.11

The

mid-face

The most common ageing concern in the mid-face is volume loss, predominantly caused by loss of superficial fat pads, resulting in loss of malar prominence.14 Lower eyelid skin loses its elasticity and subcutaneous fat, resulting in more evident appearance of infraorbital fat pads and tear trough depression.19 Secondary to this is the downward displacement of infraorbital fat over a weakened orbital septum creating a wider, deeper orbit.19 Loss of skin elasticity and subcutaneous fat in already thin skin leads to static rhytids and darkening of the infraorbital area due to underlying structures transmitting through already thin skin; increased skin melanin deposition also contributes to this.14,20 Cheek fat also descends, creating the nasolabial fold which leaves the malar area even more flat or even concave.14

superficial malar and cheek fat pads into the mandibular border, leading to formation of jowls.27 Mandibular border resorption retreats the structure upwards, and that, combined with the volume loss and reduction of angle of the mandible, creates the appearance of short and squared chin and ‘no mandible’.11 Loss of these supportive structures and skin laxity, exacerbated by the downward pull of platysma muscle, creates the effect of ‘turkey’ neck – a very common complaint in ageing patients.11

The perioral area ages in all dimensions.27 There is volume loss in the lips, meaning they become thinner and sometimes inverted. After this, vertical lines can develop around the lips, and due to the downward pull of the depressor muscles, the corners of the mouth drop, and the upper lip elongates.27 This can sometimes also be caused or exacerbated by reduced support in the area following the loss of teeth.28

The field of facial aesthetics presents a blend of medical expertise, artistic sensibility and patient-centred care

The nose cartilage can be affected, resulting in weakening, loss of volume and resorption, leading to flattening of the nasal bridge, drooping of the nasal tip and less defined appearance.21

A variety of soft tissues are also affected, most notably the glabellas, nasion, upper dorsum and medial orbital part.21 Due to the flattening of the medial forehead, the nasofrontal angle increases, resulting in weakening, loss of volume and resorption, leading to flattening of the nasal bridge, drooping of the nasal tip and a less defined appearance.21 This is exacerbated by progressive ptosis of the tip of the nose due to weakening of attachments between the nasal cartilages, and bone remodelling in the pyriform at the alar base and maxilla, reducing the nasolabial angle.21 As the mandibular bone also undergoes resorption, this causes chin fat to descend and changes the profile and nose projection, contributing to that appearance of a ‘longer nose’.21

The lower face

The lower face tends to reflect all ageing aspects: static and dynamic lines, fat pad migration due to gravitational changes, skin textural changes and volume loss, as well as jawbone resorption, mostly associated with loss of dentition.22 If bone loss prevails, it must be addressed before other treatments are pursued; restoring dentition, bone grafts and/or dentures should be considered in collaboration with the patient’s dental professional.22

When assessing the lower face, the neck and decolletage areas play an important part. Ageing here manifests as skin laxity and thickening of the platysmal bands.23 Treatment options include skin tightening using energy-based devices like radiofrequency, HIFU or laser resurfacing, microneedling or injectable skin boosters, and toxin for the platysmal bands.23-26

Loss of strength in the masseteric ligament allows migration of

Treatment planning

After examining the signs of ageing listed here, it is imperative to pursue the optimal treatment plans for each indication. The following treatment options are not comprehensive, and clinicians should utilise and combine the modalities available to them to achieve the best possible results.

The upper face

The complex anatomy and dynamic underlying muscles makes the pigmentation, laxity, rhytids and subcutaneous volume loss of the periocular region particularly difficult to treat.14 Muscles including the orbicularis oculi, corrugator supercilii, frontalis, procerus, levator anguli oris, zygomaticus major and minor and risorius make this area so dynamic, thus challenging to treat.29 As we age, muscles in this area undergo atrophy and lose their ability to support the upper face’s already thin skin and minimal subcutaneous fat.29

A combination of different modalities, such as injectables (botulinum toxin, hyaluronic acid fillers and skin boosters), energy-based treatments and topical therapy, laser resurfacing, chemical peels, platelet-rich plasma, as well as transdermal drug delivery, is often the best approach to minimally invasive rejuvenation of this area.23,30-32 This principle typically also applies to the forehead and temples, although differences in skin structure and anatomy have to be considered.

The periorbital skin is among the thinnest on our body (0.3-0.5mm).33 There is less collagen and elastin in this area and it is in constant dynamic movement due to active underlying muscles, making the skin in this area more prone to formation of static rhytids.29 Moreover, the thin nature of the skin here transmits more pigment from underlying structures as blood products, blood and lymphatic vessels and muscles; skin tightening treatments can be effective in addressing this.11 Treatment options here depend on the severity of patients’ ageing components. Dynamic lines may be treated with just toxin, while volume loss should be addressed with soft tissue fillers, such as in the forehead (smoothing the bony appearance due to flattening), temples, tear troughs or periocular region in the upper aspect of the zygoma.31,32

Skin laxity is the most frustrating element to treat due to complex anatomy and dynamic underlying muscles, as previously outlined.30 Surgical referral should be mentioned as an option for patients with severe skin laxity and excessive skin. Non-surgical options include ablative treatments like medium peels or laser, or

percutaneous collagen induction therapy.23,31,32 This can include microneedling, fractional radiofrequency microneedling with or without mesotherapy, mesotherapy as a standalone procedure or rejuvenating injectables like hyaluronic acid, hyaluronic acid with calcium hydroxyapatite or polynucleotides.23,31,32

The mid-face

According to a study conducted by neuropsychologist Alfred Yarbus, when considering appearance and ageing, people notice facial shape and contour within the central facial triangle the most, leading to the coining of the term the ‘Yarbus’ triangle, referring to this area.34 Therefore, it is important to address volume re-distribution and face contouring in the mid-face first as part of a full-face rejuvenation approach, as opposed to focusing on separate lines and wrinkles at first, even though most patients tend to turn to this as their main concern.35

Primarily, options of restoring volume with fillers should be discussed with the patient. Most common areas to augment here are the malar and mid-cheek, tear troughs, lateral cheeks and piriform fossa.36 Sometimes, nasolabial fold augmentation is required too. For older patients, while collagen stimulating treatments like Profhilo can be helpful when addressing skin quality, a treatment like thread lifts, higher viscosity fillers, stronger peels or higher-setting laser will be needed to replace volume and lift.36-39 For younger patients (30-40) with milder volume loss, collagen induction by itself can be appropriate.36-39

The lower face

Restoring volume in the mid-face would improve the jowls and nasolabial folds, however, in the case of heavy jowls, they may need to be dissolved with deoxycholic acid injections or alternatives such as targeted lipolysis.40 Jaw augmentation with soft tissue filler can also be beneficial for this concern.41 In this area, care should be taken through pre-mapping to avoid the facial and mental artery.42 Thread lifting would allow for repositioning and lifting residual lax skin in the jaw, ideally after restoring volume and skin tightening.43,44 Patient with signs of heavy jowls, where volume replacement is not sufficient to lift the tissue, would be good candidates for thread lifting.43,44

Lips are a hugely important feature when it comes to widely perceived facial beauty. Natural ageing, intrinsic ageing, photodamage and smoking unfortunately lead to loss of lip volume and surrounding areas, and they can be one of the first signs of ageing. Genetically thin lips or existing asymmetries could also be considered as candidates for lip augmentation. Successful augmentation and rejuvenation require deep knowledge of anatomy and expertise using various techniques.41,45 Topographically, lips should be assessed as: upper lip vermillion border and body, lower lip vermillion border and body, cupid’s bow, philtrum, philtral columns, oral commissures and mentolabial sulcus.45

The orbicularis oris muscle forms the main volume of the lips, as well as subcutaneous fat, skin and mucosa.46 The vermilion of the lips is a modified mucous membrane consisting of hairless, highly vascularised, nonkeratinised,, stratified squamous epithelium.46 This membrane is thinner than the rest of the facial skin (three to five cellular layers as opposed to 16 layers in facial skin), bearing no hair follicles or salivary, sweat and sebaceous glands.46 Blood vessels appear prominent, particularly in those with lighter skin. A wet and dry border divides this skin-like membrane from actual mucosa, where the skin lines cease, and submucosal salivary glands appear.46

A typical approach to treat the lips would entail addressing volume loss, treating the vermillion border and the body of the lips first with volumising a treatment like dermal filler.47-50 Some older patients

may only wish to rejuvenate the hydration of the lips, without any visible shape or size changes; in this case, a lightweight hyaluronic acid product like a skin booster would be appropriate.47-50

A holistic approach

A thorough holistic and personalised approach is essential to achieve optimal outcomes and patient satisfaction in medical aesthetics. The initial consultation is a critical stage when building rapport, managing expectations and assessing suitability. A comprehensive, multicentred assessment that includes social, cultural and medical aspects, alongside a deep understanding of facial anatomy and the ageing process, allows clinicians to create safe, effective and natural-looking aesthetic results.

Test your knowledge!

Complete the multiple-choice questions and go online to receive your CPD certificate!

Questions

1. The main volume of the lips is formed by:

Possible answers

a. Fat

b. Salivary glands

c. Orbicularis oris muscle

d. SMAS

a. Loss of masseteric ligament

b. Mandibular border resorption

2. What contributes to jowl formation?

3. Prior to treatment, the face should be assessed for:

c. Skin laxity

d. Downward pull of the platysma

e. All of the above

a. Upper face, mid-face and lower face and neck/decolletage

b. Symmetry

c. Muscle activity

d. Skin phototypes and ageing type and stage

e. Anatomy and physiology

f. All of the above

a. It is important to get to know the patient as a person before treating them

4. What statement about the initial consultation is true?

5. What statement about periorbital skin is correct?

b. Initial consultation is a formality

c. Only medical health questions are relevant

d. Patient’s belief and personal life shouldn’t be discussed

a. The periorbital skin is less prone to formation of static lines and rhytids

b. There is more collagen and elastin

c. The periorbital skin thickness is 0.3mm-0.5mm

d. The area is less dynamic

Answers: C, E, F, A,C

Dr Rehanna Beckhurst, since qualifying in 2003 from Riga Stradins University, has become lead medic at Ifab clinic which she established with her husband in 2020. She is an aesthetic tutor, lecturer, global speaker and trainer for Church Pharmacy and Beamwave, and KOL for LG Chem and Hironic.

Qual: DDS, MBA, MSc, PgDip Derm

My Early Experience Using AviClear 1726 nm by Cutera

Dr Anjali Mahto shares her experience as the UK’s most experienced user of the 1726 nm laser from Cutera

Acne is the most common skin condition globally, with more than 83% of the UK population suffering with some form of acne during their lifetime. Having suffered ongoing acne since childhood, I know firsthand the emotional and physical toil suffered by the acne patients who now visit my practice for help on solutions to clear their skin.

Exploring new acne treatments

In 2023, I began hearing about a new laser-based acne therapy – the world’s first to be approved for the long-term treatment of mild, moderate and severe acne using a novel 1726 nm wavelength to directly target the sebaceous gland.1

The clinical data I had seen presented by well-known US-based dermatologists was impressive, with trials showing an average 79% reduction in inflammatory lesion count two years post final treatment (n=104). 2

As someone always looking for cutting-edge treatments to help my patients, I knew AviClear was something I wanted to bring to my practice.

Patient preference for AviClear I received the device at Self London in February 2024, and saw good early uptake with my patients.

AviClear is more than just a treatment – it’s a milestone in dermatology and acne treatment

Many of them were keen to try a treatment that offered a long-term solution that does not carry systemic side effects and the same level of follow-up as the oral medications I also offer in the clinic.

This is particularly appealing to a younger patient demographic, many of whom are very health-conscious and looking to avoid pharmacological-based medications such as spironolactone or the gold-standard drug isotretinoin. AviClear fits seamlessly into their lifestyles, providing long-lasting results without the need for lengthy recovery or intensive regimens.

My results with AviClear

Having now treated more than 100 patients at the clinic, I have been very pleased with the clinical results I have achieved. Despite AviClear being delivered monotherapy during all clinical trials prior to launch, in practice I will sometimes combine the treatment with low-dose isotretinoin, spironolactone and/or antibiotics to accelerate

treatment results and help manage any potential flare. I am also treating truncal acne, mostly on the back, using AviClear, and I am seeing good results.

In addition to an average +2 grade improvement in acne, patients report a noticeable improvement in oiliness, a reduction in pore size and generally better tone, texture and overall skin health after three 30-minute session with AviClear.

The treatment is highly tolerable, with patients experiencing mild to moderate discomfort.

One of my patients – 32-year-old Katie – commented after treatment: “I have now finished my course of AviClear. The results are fantastic, and they keep getting better with time. I am feeling so much more comfortable and confident in my own skin!”

A breakthrough in acne treatment

For me, AviClear is more than just a treatment – it’s a milestone in dermatology and acne treatment. It’s the solution I wish I had had during my own struggles with acne, and it is now offering patients an organic type of treatment approach.

As someone who has walked the same path as many of my patients, I know firsthand the profound difference it can make to their lives. Eleven months into my experience using AviClear, I am even more excited about what the future holds for this new treatment and the potential future approvals and indications to follow using 1726 nm.

This advertorial was written and supplied by

Visit https://aviclear.com/en-uk/professionals for more information

Alternatively, get in touch via info.uk@cutera.com or at @aviclear on Instagram

Dr Anjali Mahto is one of the UK’s leading consultant dermatologists. She is a Fellow of the Royal College of Physicians, member of the Royal Society of Medicine and a spokesperson for The British Skin Foundation. In 2023 Dr Mahto opened Self London, a dermatology and lifestyle clinic aimed at managing skin conditions holistically.

Qual: FRCP (Derm), MBBCh, BSc

VIEW THE REFERENCES AT AESTHETICSJOURNAL.COM

Patients before and six months after three 30-minute sessions with AviClear

Case Study: Post-Operative

LED Phototherapy

Independent

nurse prescriber Kate Monteith-Ross explains how she uses LED phototherapy to assist wound healing as part of her clinic’s post-surgery care

Wounds typically follow various stages from the initial trauma. There is haemostasis, swiftly followed by a three key stages. Each stage echoes the distinct phases of healing – inflammation, proliferation and remodelling, the length of which is entirely dependent on the complexity of the procedure and general health of the patient.1-4

Stages of wound healing

Inflammation typically lasts between one and six days; however, this can be longer depending on the significance of the wound. Immediately post surgery there is vasoconstriction, platelets and clotting. This is also a time when the patient is most susceptible to seromas and/or fluid retention. During this stage, granules of histamine and enzymes are released from mast cells, typically presenting as the swelling and redness we see in a wound.1

Proliferation usually begins around day six until day 21 post surgery. The key elements of this phase involve substituting the temporary fibrin matrix with a newly formed matrix composed of collagen fibres, proteoglycans and fibronectin to restore the tissue structure and function. This stage also sees fibroblast activation, angiogenesis and re-epithelialisation. There are no open wounds, the skin is binding well and looking healthy.2-4

The final stage, remodelling, can extend anywhere from day 21 post surgery to 18 months. The patient is healed, but skin tissue continues to undergo collagen cross linking, wound contracture and scar maturation.2

A suitable treatment choice for each phase is light-emitting diode (LED) phototherapy. Without LED phototherapy, post-operative healing might typically include appropriate wound healing care and nutrition guidance. For phases two and three, topical treatments and energy-based devices can also be introduced.

Why LED phototherapy?

LED phototherapy is a non-invasive medical treatment that uses light-emitting diodes to stimulate cellular activity and promote skin rejuvenation.

LED phototherapy is known for its safety, minimal side effects and versatility in skin rejuvenation, addressing several chronic skin conditions.5-7 It is commonly used in dermatology and aesthetics for its ability to improve the appearance of the skin, reduce fine lines and wrinkles, and to treat conditions such as acne, rosacea and hyperpigmentation.5-7 However, it is also effective in many more treatment situations including wound healing, as covered in this case study.

Blue light (lightwave 415 nm)

Blue light has effective antimicrobial properties and reduces the formation of biofilms, making it perfect for infection control during the inflammation stage of wound healing. It is also effective in wound healing through stimulating cellular proliferation and migration, enhancing collagen synthesis and modulating inflammatory responses.8

Near-infrared light (lightwave 830 nm)

Near-infrared light (NIR) encourages the proliferation and migration of fibroblasts and keratinocytes in wound healing.9 It is also proven to offer effective pain relief by modulating pain signalling pathways and reducing the release of pain mediators, assisting during the proliferation stage.10

Red light (lightwave 633 nm)

Red light stimulates collagen production, reduces inflammation and promotes overall skin health. Using the red light during the final remodelling stage of healing supports the aesthetic result for all skin types by reducing the fibrotic tissue and aiding in the improvement of the scarring.11

Case study

A 44-year-old woman contacted our clinic four days after she had received extensive surgery in Turkey, concerned about her wound trajectories. She had undergone a 360-degree abdominoplasty and a breast uplift, plus full body liposuction. She was discharged from the hospital the following day and presented with a fit-to-fly document to return home the next day. Anecdotally, for surgeries such as this it is not typically recommend to fly for two to four weeks following the procedure.

I invited her for a face-to-face consultation in the first instance, something we do with all patients post surgery to ensure we intervene correctly and prioritise health outcomes. This is particularly important for those who come to us following procedures in Turkey, as many patients return much sooner than they should, often with little or no aftercare advice or support if done by non-medical practitioners.

The incisions extended completely around her body. At the back these descended between her buttocks; in the front they extended upwards towards her chest, meeting under her breast incisions. These T-Junctions, in my opinion, are typically a difficult connection and susceptible to compromise during the initial healing stages. She also had extensive bruising on her breasts and several drain sites. The Turkish clinic sent her back to the UK with her drains still in situ. During the consultation, every inch of her wound trajectories were examined, which were intact, but with significant swelling. Because she had undergone significant reconstructive surgery, my priority at this stage was to move her quickly through the wound healing phases to restore her skin integrity. Until then she would be at substantial risk of infections, increased scarring, delayed healing, increased discomfort, fluid accumulation and tissue compromise, which could lead to necrosis and loss of function.12-14 Of course, these could also have a psychological impact on her.

At that point, the patient still had two more days of a course of prophylactic antibiotics. I asked her to inform us if she was prescribed another course of antibiotics or became ill during that time.

For treatment, we decided on treatment using LED therapy. LED treatment can be used as soon as possible after surgery and is always offered to every patient at our clinic as it has such a positive impact regardless of the stage of the wound. Her first treatment

appointment with the Dermalux Tri-Wave MD was arranged for a little more than a week post surgery.

The treatment

The treatment followed our LED phototherapy wound healing protocol, beginning with the inflammation stage. Our focus was on managing the inflammation and helping our patient to mobilise, as when she first arrived at the clinic she could not stand upright or stretch. Mobilising is key for expediting healing and can have an incredibly positive psychological impact, as many patients report feeling isolated and useless when they are unable to physically mobilise. Low mood and depression after surgery are well-documented and can significantly impact recovery and overall health outcomes.15-17

She was treated with blue and NIR light in two, 20-minute sessions (four separate sessions in total) to each side of her body in one week to minimise the risk of infection and improve her healing. Care was taken to include the drain sites, as these can be more prone to infection. Following just two sessions, the patient was able to sit upright, turn and mobilise more easily.

Four days later, the patient was moved onto the proliferation stage of the treatment. This comprised one 20-minute session on each side of her body, once a week for three weeks, continuing to utilise NIR light, but now replacing the blue light with red.

Once the skin was responding well, the patient was transferred to our massage therapist for the third and final stage of the protocol – remodelling.

For our patient, this comprised red light therapy, plus manual lymphatic drainage massage to expedite the healing. The red light therapy serves to support the aesthetic result by reducing the potential of fibrotic tissue and aiding in the improvement of the scarring, which is pivotal to a positive outcome when a patient has extensive scarring. Manual lymphatic drainage offers several benefits following surgery, primarily focused on reducing swelling, improving circulation and enhancing healing.18 When we instigate this stage of the treatment is entirely at our discretion; the most important factor is that the skin is intact and healing well. This final stage of the therapy was completed for twenty minutes, once per week for five weeks.

The results

After just the first two sessions of blue and NIR light phototherapy, our patient demonstrated a marked improvement. Her wounds healed rapidly, and swelling and bruising was significantly reduced (Figure 1 & 2). She was able to stand and sit upright and mobilise with much less discomfort.

The phototherapy accelerated healing and reduced the chance of infection, helped with pain management, modulated her inflammation and minimised scarring for the long term.

The patient was delighted with the results, noting that she was able to return to greater normality which helped her feel ‘less hopeless’. We always recommend red light therapy for anywhere up to 18 months post surgery as it can further help improve skin health and by default the aesthetic result. Patients treated with LED phototherapy can occasionally feel flushed and warm; this is due to the encouraged blood flow and circulation. Some patients do temporarily advise that their skin feels a little itchy; this is due to the skin healing.

Providing appropriate care

Under those three phased protocols, LED phototherapy has become a key part of the post surgery journey for more than 300 of my patients. All practitioners who are supporting patients in their pre- and post-surgical care need to understand how LED phototherapy expedites the healing process. Practitioners should quickly put patients in a position where they are up and about, eating and sleeping properly and able to mobilise, otherwise they’re not giving themselves the nutrients and rest they need to aid their recovery.

Kate Monteith-Ross is an independent nurse prescriber and owner of a CQC regulated practice in Kent specialising in non-surgical treatments and surgical support. Monteith-Ross is the co-director and co-founder of The Nurses Network, an organisation developed to help medical injectors navigate safety in aesthetic medicine.

Qual: BA, MSc, PGCE, INP

Figure 1&2: 44-year-old patient two weeks post-surgery, and following Dermalux Tri-Wave MD treatment

15

March 2025, Grosvenor House, London

Congratulating The 2025 Finalists!

Widely regarded as ‘The Oscars of Aesthetics’, The Aesthetics Awards is the premier event celebrating the achievements of professionals in medical aesthetics. This prestigious event honours both emerging talent and established leaders who have made remarkable contributions to the specialty over the past year.

The Aesthetics team is thrilled to announce the shortlist for the 2025 Awards! With 470 entries and an impeccably high standard, this year’s competition promises to be the most exciting yet. A huge congratulations to all entrants, and a special shoutout to the 2025 Finalists for their exceptional achievements!

We look forward to welcoming the brightest minds in aesthetics to the dazzling awards ceremony on March 15, following the conclusion of the second day of ACE 2025. Don’t miss your chance to join this celebration – get your tickets at aestheticsawards.com now!

Cast your vote for the Winners!

The Winners of certain categories will be decided through a combination of expert judging and community voting, giving you the chance to recognise the products, suppliers and companies that have helped elevate your practice. Votes by Aesthetics Journal readers will contribute 20% to the final score in the applicable categories.

To have your say, simply create a free account and log in at aestheticsawards.com before January 31. Detailed information about the categories open for voting is available on the website.

Please note that voting is monitored by IP address, and individuals may only vote once per category. Duplicate votes under the same name or from the same organisation will be reviewed and may be discounted.

Introducing the judging panel

Feedback on entries

We know how much time, effort, and dedication it takes to write an Aesthetics Awards entry. With so many exceptional entries, the competition is incredibly high, and unfortunately, not everyone can be selected as a Finalist. That’s why feedback is available upon request for those who did and did not make the shortlist. We encourage all entrants to submit again next year and use this constructive feedback to develop future Aesthetics Awards entries. Please contact memberships@ aestheticsjournal.com if you would like to receive feedback on your entry. Requests for feedback close on January 31 and are open to Elite Members.

We’re proud to work with an independent judging panel of more than 100 esteemed aesthetic professionals, each selected for their expertise in specific areas of the field. Every category is reviewed by at least five judges, ensuring a fair and unbiased evaluation process. Judges are also vetted for potential conflicts of interest to maintain the integrity of the Awards. To discover more about our panel of judges, visit the Aesthetics Awards website to meet them.

The stringency of the judging process is assured by the Independent Awards Standards Council which has awarded The Aesthetics Awards an Advanced Trust Mark, recognising our balanced, unbiased and strictly confidential process.

DISTRIBUTOR OF THE YEAR

VOTE NOW!

• AestheticSource

• Church Pharmacy

• Cure Medical

• DermaFocus

• HA-Derma

• Harpar Grace International

• Healthxchange

• Wigmore Medical

Company Finalists

MANUFACTURER OF THE YEAR

VOTE NOW!

• Candela

• Crown Aesthetics

• Evolus

• Mesoestetic UK

• Skinade

• Totally Derma

COMPANY CHAMPION OF THE YEAR

VOTE NOW!

INDEPENDENT TRAINING PROVIDER OF THE YEAR

VOTE NOW!

• A Aesthetics North Coast Academy

• Cliniva Cosmetic Training

• Cosmetic Courses

• Facetherapy Academy

• Inspired Cosmetic Training

• Interface Aesthetics

• SkinViva Training Academy

• Kristina Arshad (Galderma)

• Faye Barrett (Obagi Medical) Ocean Bellamy (GetHarley)

• Lorna Bowes (AestheticSource)

• Caroline Courtney (Crown Aesthetics)

• Chloe Fisher (AlumierMD)

• Natasha Gahagan (SkinCeuticals)

• Ellen Green (Cosmeditech)

• Sian Keene (BTL Aesthetics)

• Gareth Lewis (British Association of Medical Aesthetic Nurses)

15 March 2025, Grosvenor House, London

15 March 2025, Grosvenor House, London

Product Finalists

DEVICE OF THE YEAR

VOTE NOW!

• BYONIK Pulse Triggered Laser (Pure Swiss Aesthetics)

• Emerald Laser (Erchonia)

• EXION (BTL Aesthetics) Gentlo (Beamwave Technologies)

• IgniteRF (InMode)

• LaseMD ULTRA (Lutronic)

• PicoWay (Candela)

• SkinPen Precision (Crown Aesthetics)

• SP Dynamis NX (Fotona UK & Ireland)

• Syndeo (Hydrafacial)

• XCellarisPro TWIST (Dermaroller)

INJECTABLE PRODUCT OF THE YEAR

• Ellansé (Sinclair) Juvéderm (Allergan Aesthetics, an AbbVie Company)

• Nuceiva (Evolus)

• Plinest (DermaFocus)

• Sculptra (Galderma)

SKIN PRODUCT/RANGE OF THE YEAR VOTE NOW!

• Alastin (Galderma)

• ALLSKIN | MED (AesthetiCare)

• CellDerma

• EverActive C&E + Peptide (AlumierMD)

• Hydropeptide (Wigmore Medical)

• Melanopro Peel System (Dermalogica PRO)

• Obagi Medical (Healthxchange)

• P-TIOX (SkinCeuticals)

• PCA Skin (Church Pharmacy)

Revision Skincare (AestheticSource)

• Skinade (Bottled Science)

• skinbetter science (AestheticSource)

• System Lab Range (DIBI Milano)

• ZO Skin Health (Wigmore Medical)

THE DIGITRX BY CHURCH PHARMACY AWARD FOR

BEST NEW INNOVATIVE PRODUCT

• AviClear (Cutera)

• BBL HEROic (Sciton)

• CMT Post-Procedure Cream (Revision Skincare) E-50 HAIR Exosomes (Cosmeditech)

• HA Microneedle Eye Patches (PCA Skin)

• Klira Special (Klira)

• Purasomes (DermaFocus)

• Tri-Wave MD (Dermalux)

• ULTRApulse Alpha (Lumenis)

• V-Tech Serum (Promoitalia UK)

Regional Clinic Finalists

BEST CLINIC SOUTH ENGLAND

• Anna Medical Aesthetics

• Art of Aesthetics

• Balance Wellness

• Cambridge Clear Beauty

• Dr Raquel Skin & Medical Cosmetics

• Dr Tanja Phillips Medical Aesthetic Clinic

• Exthetics Grand Aesthetics Clinic

• Harrow On The Hill Dental & Facial Aesthetics

• Perfect Skin Solutions

• Radiance Aesthetic Clinic

• Romsey Medical Practice

• The Doctor Clinic

• Wellface

THE SCITON AWARD FOR BEST CLINIC NORTH ENGLAND

• Amanda Azzopardi Aesthetics

• Bank Medispa

• Cliniva Medispa

• Dr Kane Aesthetics Co.

• Dr Sobia Medispa

• Dr Yusra Clinic

• Paragon Aesthetics

• Sculpted by Doctors

• The Doctor and Company

THE LUMENIS AWARD FOR BEST CLINIC LONDON

• Adonia Medical Clinic

• Ambra Aesthetic Clinic

• Clinicbe

• Dr Leah Cosmetic Skin Clinics

• Dr Medispa

• Facial Sculpting

• House of Saab

• London Aesthetic Medicine (LAM) Clinic

• London Professional Aesthetics

• PICO Clinic

• Self London

• Takroni Clinic

• The Cadogan Clinic

• The Ghanem Clinic

• Thames Skin Clinic

15 March 2025, Grosvenor House, London

Regional Clinic Finalists

BEST CLINIC MIDLANDS & WALES

• Air Aesthetics & Wellness Clinic

• CJ Aesthetics Clinic

• Dr Ana The Skin Clinic

• Hampton Clinic

• HHC Clinics

• MediZen

• Midland Skin

• Pure Perfection Clinic

• Skintique Beautiful Smiles

• Your Beauty Doctor

• Zenith Cosmetic Clinics

THE INMODE AWARD FOR BEST CLINIC IRELAND & NORTHERN IRELAND

• A Aesthetics North Coast

• Array Aesthetics

• Dr Bonny Clinic

• Eden Medical Clinic

• FaceTherapyNI

• Med Aesthetics

• ORA Clinic

• South William Clinic

THE GALDERMA AWARD FOR BEST CLINIC SCOTLAND

• Age Refined Medical Cosmetic Centre

• Clinetix

• Dermal Clinic

• Est-Ethics Wellness Clinic Estheva

• The Aesthetics Club

15 March 2025, Grosvenor House, London

Other Clinic Finalists

THE SKINCEUTICALS AWARD FOR BEST NEW CLINIC, UK & IRELAND

• Ciao Bella Aesthetics

• Danú Aesthetics

• Dr Olivia MediSpa

• Geneviv Medical

• iQonic Aesthetics

• KinDRed Skin Aesthetics

• Pulse Laser Aesthetic Clinic

• R V Aesthetics

• Skin Therapy Medical Aesthetics

• The Avery Clinic

• The London Regenerative Institute

• The MediShed by Dr Dil

• The One Clinic

• Time Clinic Medical Aesthetics and Wellness

THE PATIENTPERFECT AWARD FOR BEST CLINIC TEAM

• Adonia Medical Clinic

• Blend Skin & Medical Aesthetics

• Cliniva Medispa

• Dermal Clinic

• Dr Sobia Medispa Dr Yusra Clinic

• Hampton Clinic

• Martina Collins Clinic

• Paragon Aesthetics

• South William Clinic Group

• Thames Skin Clinic

• The Aesthetics Club

THE ALLERGAN AESTHETICS, AN ABBVIE COMPANY, AWARD FOR BEST CLINIC TEAM MEMBER

Soulla Alexandrou (Dr Medispa)

• Nicky Barraclough (Cliniva Medispa)

• Emma Costello (SE1 Medical Aesthetics)

• Megan Crooks (Balance Wellness)

• Mandie Golding (Your Beauty Doctor)

• Zoe Rendell (Wellface)

• Alexandra Olaru (South William Clinic Group)

• Ellie Sargent (Simply Clinics)

• Nefise Tasdelen (Dr Ducu London)

15 March 2025, Grosvenor House, London

Result Finalists

THE DERMAFOCUS AWARD FOR BEST INJECTABLE RESULT

• Dr Bonny Armstrong

• Dr Raquel Amado

Dr Shabri Chandarana

• Dr Jordan Faulkner

• Dr Jessica Halliley

• Dr Anna Hemming

• Dr Kiran Judge

• Dr Sita Madaan

• Dr Ana Mansouri

• Mr James Olding

• Mr Hazim Sadideen

• Dr Ahrooran Sivakumar

• Dr Leah Totton

THE CROWN AESTHETICS AWARD FOR BEST NON-SURGICAL RESULT

• Dr Yusra Al-Mukhtar

• Dr Nina Bal

• Dr Rehanna Beckhurst

• Dr Ifeoma Ejikeme

• Dr Uliana Gout

• Dr Anna Hemming

• Dr Cemal Kavasogullari

• Dr Ana Mansouri

• Michelle McLean

• Dr Ahrooran Sivakumar

BEST SURGICAL RESULT

• Mr Florian Bast

• Mr Nizar Hamadeh

• Miss Elizabeth Hawkes

• Mr Konstantinos Kopsidas

• Ms Dhalia Masud

• Ms Aoife Naughton

• Mr Adrian Richards

• Mr Hazim Sadideen

• Mr Rishi Sharma

• Miss Sujatha Tadiparthi

• Mr Michail Vourvachis

15 March 2025, Grosvenor House, London

Individual Practitioner Finalists

THE GETHARLEY AWARD FOR MEDICAL AESTHETIC PRACTITIONER OF THE YEAR

• Dr Raquel Amado

• Dr Nina Bal

• Dr Rehanna Beckhurst

• Dr Lisa Delamaine

• Dr Ifeoma Ejikeme

• Mr Sotirios Foutsizoglou

• Mr Lorenzo Garagnani

• Dr Uliana Gout

• Dr Anna Hemming

• Dr Anjali Mahto

• Dr Ana Mansouri

• Dr Beatriz Molina

• Dr Ahmed El Muntasar

• Mr James Olding

• Dr Dev Patel

• Dr Linda Simpson

THE EVOLUS AWARD FOR AESTHETIC NURSE PRACTITIONER OF THE YEAR

• Danielle Andrews

• Amy Bird

• Sara Cheeney

• Yuliya Culley

• Jude Dunican

• Áine Larkin

• Anna Kremerov

• Linda Mather

• Brenda McKibbin

• Michelle McLean

• Jacqueline Naeini

• Melissa Pugh

• Lisa Waring

• Elaine Williams

THE ALUMIERMD AWARD FOR RISING STAR OF THE YEAR

• Dr Dorota Chudek

• Hollie Evans

• Dr Jordan Faulkner

• Dr Jessica Halliley

• Dr Eleanor Hartley

• Christina Hutchman

• Dr Harry James

• Dr Andrew Kane

• Dr Cemal Kavasogullari

• Dr Sonakshi Khorana

• Dr Carol Mastropierro

• Dr Hazel Parkinson

• Dr Ed Robinson

• Dr Bethany Rushworth

• Dr Ahrooran Sivakumar

• Dr Ben Taylor-Davies

March 2025, Grosvenor House, London

15 March 2025,

Clinic Support and Organisation Finalists

BEST SERVICE/SOLUTION PROVIDER

VOTE NOW!

• Aesthetic Nurse Software

AesthetiDocs

• Aesthetics Comply

• Elius Group Limited

• Hamilton Fraser

• Ignite Growth

• Inspire to Outstand

• LTF Design and Marketing

• PatientPerfect

• Quirky Frog

• SJ Partnership

• Transformational Leadership Consulting

• Zenoti

BEST INITIATIVE/STRATEGIC PROJECT IN AESTHETICS

VOTE NOW!

• A List Conference

• AestETHICS from IBSA Derma

• Allergan Aesthetics, an AbbVie company, MD Codes Worldwide Tour

• Beyond the Mirror

• British Association of Medical Aesthetic Nurses (BAMAN) Education & Training Committee

• British College of Aesthetic Medicine (BCAM) MBCAM Award

• Joint Council for Cosmetic Practitioners (JCCP) Online Complaints Portal

• SKCIN Melanoma and Skin Cancer Education Programme (MASCED Pro)

Nominations are open!

THE AESTHETICS JOURNAL AWARD FOR OUTSTANDING ACHIEVEMENT

At The Aesthetics Awards, the prestigious Outstanding Achievement Award recognises one exceptional achievement by a star within the specialty. The honoured individual and their accomplishment will have made a significant positive impact on the sector and their peers, while exemplifying a career characterised by excellence and best practice.

If you wish to nominate yourself or a colleague, visit aestheticsawards.com and complete the nomination form, explaining why you believe the individual deserves this honour. Nominations close on January 31, 2025.

The recipient of the Aesthetics Journal Award for Outstanding Achievement in Medical Aesthetics will be chosen by the Aesthetics team based on community nominations. This award does not have finalists or a voting process. The Winner will be announced at The Aesthetics Awards ceremony on March 15, 2025.

Best of luck to all nominees!

Grosvenor House, London

Last year, tickets for The Aesthetics Awards sold out weeks ahead of the event, so secure yours now to avoid missing out!

Set against the stunning backdrop of the luxurious Grosvenor House in London, the ceremony promises to be the most glamorous event of the year. After two enriching days at ACE, join your colleagues to celebrate the remarkable achievements of the specialty.

A ticket to The Aesthetics Awards includes a drinks reception, three-course meal, celebrity host, entertainment, photo opportunities and after party to dance the night away in style!

• Individual ticket – £375 + VAT

• Table of 10 – £3750 + VAT

Paying Elite Members of the Aesthetics community are eligible to receive the Early Bird ticket rate all year round. If you are unsure if you are a paying Elite Member, please contact the team memberships@aestheticsjournal.com who will be able to check your membership and send across a discount code, if applicable.

We can’t wait to see you there on March 15, and good luck to all our Finalists!

Case Study: Scar Revision with CO2 Laser

Dr Sonakshi Khorana and Dr Samantha Hills address a nasal scar using CO2 laser therapy

A scar is a fibrous tissue that forms as part of the body’s natural healing process, replacing normal tissue that has been damaged due to trauma, surgery, infection or disease. Scars are composed primarily of collagen, and their appearance can vary based on factors such as the wound’s depth, size, location and individual

Scarring can negatively influence individuals’ self-esteem and self-confidence, potentially leading to anxiety, depression and This can in turn affect their

In this article, a case study is presented exploring the treatment of an atrophic scar on the nasal ridge of a 31-year-old male patient. This report evaluates the efficacy of the treatment protocol, the healing process and the patient’s outcome following

Whilst in normal tissue, the elongated collagen fibres are arranged uniformly, in scar tissue they become more tightly packed and disorganised. The most common type of scars are atrophic, hypertrophic and keloid scars, and they can be found in any part of the body, although certain areas, such as the sternum, and those with excessive stretching or tension across the wound, can be

Atrophic scars tend to be depressed or sunken, and are often associated with acne or chicken pox (Figure 1). Hypertrophic scars on the other hand tend to be firm, raised and thickened, and result from the uncontrolled proliferation of fibroblasts and excess Figure 2). Keloid scars form in a similar fashion to hypertrophic scars, but they grow beyond Figure 3). While most scars are harmless, their texture, pigmentation and elevation can affect aesthetic outcomes or functional mobility, and they can have a significant effect on a person psychologically. For these reasons, many people will seek treatment to improve the appearance of

All types of scars can be treated with lasers, although careful pre-treatment consultation is always required as expectation management is critical. Treatment of scars can be challenging, and it is rare that a scar can be completely removed, but improvements in colour, pliability and texture are all possible.3

Laser treatment for scar revision

A variety of lasers can be used for scar management. For red scars, lasers that target the haemoglobin chromophore can be especially useful.3 The pulsed dye laser has been shown to be particularly effective in dealing with vascular scars, and there is evidence that early intervention with this laser can reduce the incidence of scar formation.4 However, for smoothing scar texture in both raised and atrophic scarring, ablative lasers that target water in the skin, such as the CO2 and Er:YAG, are most commonly used.5

Ablative lasers

Ablative lasers, generally at wavelengths above 2,000 nm, are highly effective for treating scarring due to their ability to precisely target damaged skin while promoting collagen production and stimulating tissue regeneration.5 Full ablative resurfacing can give dramatic results, particularly on acne scars, but re-epithelisation can take 10-14 days, which can increase infection risk, cause unpredictable healing and result in prolonged erythema, sometimes lasting for several months.5 For this reason, ablative lasers are now more commonly delivered fractionally.

Fractional resurfacing laser

Fractional resurfacing treatments deliver precise microbeams of laser light to the skin, resulting in narrow columns of ablation, surrounded by a microscopic zone of thermal damage which triggers the body’s natural healing process.6 This stimulates the formation of new, healthy tissue and helps to remodel existing tissue in all variations of scar.6 If this kind of laser is being used to resurface the skin, wavelengths between 2,940 and 10,600 nm are typically used.6

Unlike traditional ablative lasers, fractional lasers treat only a fraction of the skin at a time. Since these zones are surrounded by healthy epidermis, keratinocyte migration means we see rapid epithelialisation within days rather than weeks, reducing recovery times and drastically reducing the risk of unwanted reactions.6

Er:YAG and CO2 lasers

Er:YAG lasers at 2,940 nm have a higher water absorption profile than CO2 lasers, which limits tissue penetration, but makes them suitable for sensitive areas or shallow scarring.7,8 The lower water absorption at 10,600 nm means that CO2 lasers show deeper penetration into tissue and more thermal deposition than Er:YAG lasers.7,8 This results in excellent collagenesis, but recovery times may be longer.7,8 This combination of deep penetration and controlled skin damage makes fractional CO2 lasers particularly useful for improving the texture, colour and appearance of a variety of scars.9,10

Figure 2: Example of a hypertrophic scar

Figure 3: Example of a keloid scar

Case presentation

Patient information

A 31-year-old male patient presented to clinic looking for treatment of a post-traumatic, atrophic nasal scar following a car accident in December 2023 (Figure 4). A patch test was carried out in February 2024 using the SmartXide Touch CO2 laser from DEKA/Lynton Lasers, using a scanner to deliver the output fractionally.

The patient was informed that two to three sessions might be necessary to achieve optimal results, and that while the appearance of the scar would improve, it would be unlikely to achieve full resolution. Fractional CO2 treatments are suitable for most skin types, but contraindications include isotretinoin use within the last six months, active skin infection in the area being treated and recent sun exposure.

Treatment and aftercare

three months after the first treatment before considering a second so the results can emerge, but six months was the earliest availability of this particular patient. At this point, the patient already showed a marked improvement in the scar’s appearance, with a decrease in erythema and an improvement in skin texture (Figure 4). The settings used for the second treatment were: power – 9W; dwell time – 700 µs; spacing – 400 µm; stack – 2; mode – SP. A phone consultation was conducted one week later, and the patient reported no complications. He was advised to return for another follow-up in four months if further treatment was desired.

Complications to consider

Following the use of a CO2 laser, all patients may experience erythema, dyspigmentation, peeling, blistering, weeping, swelling and skin fragility. Patients should also be aware of complications such as the formation of milia, acneiform eruptions, skin infections and worsening of scarring, but they are rare.12

While most scars are harmless, their texture, pigmentation and elevation can affect aesthetic outcomes or functional mobility

One week after the patch test, the first treatment was scheduled. A week beforehand, the patient was advised to use the AlumierMD SensiCalm gentle cleanser, HydraDew moisturiser and Clear Shield SPF to prepare the skin.

The treatment was carried out using the following settings: power –8W; dwell time – 600 µs; spacing – 500 µm; stack – 2; mode – SP. The treatment is generally tolerated well following the application of topical anaesthetic 45 minutes before the procedure to increase the patients’ comfort, as was done in this case. Cold air was also applied during the treatment via the Cryo 6 unit. Some mild pin-point bleeding was seen during treatment, as can sometimes be expected at these settings.

After the treatment, the patient used the AlumierMD SensiCalm Cleanser every morning and evening and applied Vaseline every one to two hours for the first week. Use of occlusives such as Vaseline can result in less serous crust forming, which helps to reduce the inflammatory reaction and promotes rapid healing.11

The patient and was told to apply the AlumierMD Clear Shield SPF whenever stepping outside, although he remained indoors. Sun avoidance or the use of high factor SPF is crucial following treatment to minimise the risk of post-inflammatory hyperpigmentation. One week after the procedure, the patient had fully healed with only mild residual erythema.

A second session was carried out in June 2024, with the same pre and post-procedure care advice. It is typical to wait around

Herpes simplex virus (HSV) reactivation can also occur (in patients with a known history), and these patients should receive prophylactic antivirals prior to treatment.13

Demarcation lines between treated and non-treated skin may also occur and can be avoided using a ‘feathering’ technique by treating the margins of the resurfaced areas with less energy.13

Outcome and discussion

The patient showed significant improvement after just one session of fractional CO2 laser treatment. Following the first treatment, healing occurred within a week, with only mild erythema. The patient’s compliance with pre- and post-treatment care protocols contributed to the favourable outcome, reducing risks of complications such as infection or prolonged erythema.

A successful treatment modality

This case highlights the successful use of fractional CO2 laser treatment for post-traumatic scar revision. The patient showed substantial cosmetic improvement after just one session with minimal downtime and no unwanted side effects. This case supports the efficacy of CO2 laser therapy in treating facial scars, particularly when paired with appropriate pre- and post-treatment care.

Disclosure: The authors work with and represent Lynton Lasers

Dr Sonakshi Khorana is a GP with a special interest in dermatology. She is the non-surgical services lead at Kat & Co in Birmingham. She serves as a dermatology advisor for renowned skincare brands and holds memberships at the Royal College of GPs, BMLA and ACE Group World.

Qual: MBChB, MRCGP, PGDip Clinical Dermatology (Dist)

Dr Samantha Hills is clinical director at Lynton Lasers. She is on the teaching faculty of the British Medical Laser Association, as well as being an honorary lecturer in the Division of Musculoskeletal and Dermatological Sciences at The University of Manchester.

Qual: PhD, BSc

Figure 4: 31-year-old patient before and after one treatment with SmartXide fractional CO2 laser from DEKA/Lynton Lasers (results after two treatment not pictured due to practitioner being on maternity leave)

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Achieving Lip Rejuvenation with Devices

Mr Omer Salahuddin explores needle-free lip rejuvenation using laser as an effective new treatment modality

Full, well-defined lips can enhance facial symmetry and balance, drawing attention to the smile and eyes. In many cultures, luscious lips are a symbol of health, beauty and vitality, often associated with youthfulness and allure.1,2 As a result, lip augmentation has become one of the most sought-after non-surgical aesthetic procedures without the need for invasive treatments.3 Traditional methods, such as hyaluronic acid (HA) fillers, have long been the go-to solution, offering immediate volume and contour with minimal downtime. Laser lip volumisation is a fairly new treatment option that represents a promising frontier in non-surgical lip enhancement, offering an option to stimulate collagen production and improve lip shape without the use of injectables. Unlike HA fillers, which rely on the direct injection of substance into the lip tissue, laser techniques work by promoting natural tissue regeneration and collagen remodelling through controlled energy application.4 This needle-free approach is appealing to patients seeking a more natural-looking, painless and less invasive experience with potentially longer-lasting results, making it ideal particularly for those suffering from needle phobia, low pain threshold or those not keen for more injectable treatments.4

Existing treatment modalities

Lip volumisation treatments can be broadly categorised into surgical and non-surgical methods. Surgical options include lip augmentation surgery such as lip lifts or the application of implants or tissue grafting to create fuller lips.5,6 These options are more permanent, but come with longer recovery times and potential risks of scars, foreign body reaction and implant protrusion.5,6 Among non-surgical options, dermal fillers are the most popular method, using HA fillers to add volume and contour to the lips.7-9 Results are immediate and can last from six to 12 months. Lip fillers make up a significant proportion of these treatments, with more than two million lip filler injections

administered globally each year.10 When performed correctly, the filler can give immediate desired results. However, achieving symmetry and adequate volumisation has a steep learning curve, with the potential for downtime associated with bruising, swelling and lumps/ granuloma formation.11-13

Microneedling can also be used to improve the overall texture and fullness of the lips over time, but is best employed when used in combination with other technologies.14 Chemical peels are better suited for improving skin texture and tone around the lips, rather than directly adding volume.15

Platelet-rich plasma (PRP) therapy in this area involves injecting PRP derived from the patient’s blood into the lips to promote healing and stimulate collagen production. This can improve the colour and fine texture of the lips, but does not add to the volume.16

Fat grafting is a procedure whereby fat is harvested from another part of the body (commonly the abdomen) and injected into the lips. The volume and muscular architecture changed by ageing can be corrected by injection of autologous fat in respective planes (nano and micro fat grafting). This method provides longer-lasting results compared to fillers, but requires fat to be extracted, processed and injected into the lips – a process which often deters patients. Overcorrection of up to 50% is required, as fat can be resolved after injection.17

Laser lip treatments

Laser volumisation is an emerging treatment modality for treating this area. The technique uses focused laser energy to stimulate collagen and elastin production in the lip area. The laser emits energy that penetrates the skin, causing controlled photo-acoustic or photothermal injury. This stimulates the body’s natural healing response, leading to increased collagen production and improved skin texture. As a result, the lips gradually appear fuller and more youthful.4,19,20 It is worth noting that volume comparable to that achieved with

filler is not yet possible with laser treatment, but research is ongoing in this area.

Common lasers used for this purpose include CO2 laser and the recently popularised Q-switch ND:YAG.4 While CO2 lasers are traditionally associated with ablative skin resurfacing, the fractional CO2 technology has made it a viable option for non-invasive lip volumisation. This approach is gaining popularity with my patients as they increasingly seek more natural, subtle and longer-lasting enhancements with minimal downtime.

Beyond volumisation, CO2 laser treatment can improve the texture and smoothness of the lip skin by reducing fine lines and wrinkles.19 The tightening effect can also help improve the overall contour of the lips, including the vermilion border and Cupid’s bow, which often show signs of ageing. This can be beneficial for ageing lips or those with lip asymmetry caused by skin laxity. Unlike injectables or fat grafting, which require a great precision to deliver the product, laser therapy has less chances of complications such as overfilling or uneven distribution of filler.

The Q-Switch Nd: YAG laser, in my case Alma ClearLift, is a versatile tool, recognised for its efficacy in various skin treatments. Although still an off-label indication, recently it has gained attention for its application in lip volumisation and colour enhancement, providing a non-invasive alternative to traditional methods. This laser operates by delivering high-intensity pulses of light to the skin, which can stimulate collagen production and improve circulation. This laser also targets pigmentation, leading to enhanced uniform lip colour and overall appearance.4 The laser promotes the production of collagen and elastin in the lip area, which can lead to a natural plumping effect generally achieved through five to six sessions every two weeks (Figure 1).4 In my experience, the volumisation is gradual, subtle, pain-free and natural, and can also improve small contour irregularities and lip asymmetries.

The laser also effectively targets melanin, reducing hyperpigmentation in the lips, resulting in a more uniform colour (Figure 2).4 By stimulating blood flow, I have seen that the Q-Switch Nd:YAG laser can enhance the natural colour of the lips, giving them a healthier appearance. This modality was originally designed for women over 40 who were looking for subtle volume, but I have seen good results for patients as young as 30.

Weighing up options

I have encountered that laser lip volumisation has the following advantages:

Aspect Laser lip volumisation

Results onset Gradual, over several weeks to months

Longevity

Maintenance

Complications

Patient satisfaction

Nine months to two years (with maintenance)

Periodic treatments every nine to 12 months

Redness, swelling, pigmentation (5-10%); rarely burns (CO2, 0.2-0.5%)4,19,22

>90% for colour, texture and overall patient experience18

Dissolving complications N/A

Global popularity Emerging, less widespread

Cost Generally higher due to multiple sessions and technology

· Minimal downtime: Patients can typically resume normal activities immediately after the treatment with almost zero downtime.4,19

· Customisable treatments: The settings of the Q-Switch Nd:YAG laser can be adjusted to meet individual needs for both volumisation and colour enhancement.4

· Dual benefits: Addresses both volume and pigmentation concerns in a single session with additional benefit of treating perioral rhytids at the same time.19

· Reduced risk of allergic reactions: As laser volumisation does not involve injecting foreign substances, the risk of allergic reactions is significantly lower than with HA fillers.4,11,18

HA lip fillers

Immediate (within 24-48 hours), although some techniques now suggesting gradual multiple sessions of filling to avoid overfilling22

Six to 18 months, with maintenance every six to 18 months

Regular top-ups every six to 12 months

Swelling, bruising, migration, granuloma formation, lumpiness (10-15%); vascular occlusion (1 in 1,000 to 3,000)11,23

85-90% for immediate results and volume8,9

Hyaluronidase required in 1-5% of cases for overfill, nodules, granulomas, asymmetry, occlusion23

Extremely popular worldwide with over two million treatments annually10

Varies by clinic, typically lower per session than lasers

However, some of the disadvantages of this treatment approach may include:

· Subtle results: While effective, the volumisation achieved is typically less pronounced than with traditional fillers.

· Multiple sessions required: Optimal results may require a series of treatments – typically five to six sessions every two weeks.

· Mild discomfort: Although not a published correlation, in my experience, patients with dental crowns or dentures can experience mild discomfort during the treatment (possibly due to increased tooth sensitivity to heat or cold), which can be reduced by using a wooden spatula or wet gauze between the lips and teeth.

Contraindications of laser volumisation

Despite its benefits, laser volumisation is not suitable for everyone. Several contraindications must be considered, including:

· Active cold sores or herpes simplex virus (HSV): Individuals with active outbreaks of cold sores should avoid laser treatments in the lip area, as lasers can trigger flare-ups or further irritation.18,19

· Use of photosensitising medications: Some medications can increase sensitivity to light, making laser treatments risky.22

· Permanent tattooing: Lip tattooing can be disrupted with laser treatment and should be avoided.

· Certain medical conditions: Patients with conditions that affect healing, such as autoimmune disorders, may not be ideal candidates.18

· Recent cosmetic procedures: Those who have recently undergone lip fillers or other lip treatments should wait a recommended period (at least three weeks) before considering laser volumisation to avoid complications.18

· Pregnancy and breastfeeding: Safety during pregnancy and lactation is not well established, so it is advisable to avoid the procedure during this time.18,24

Diversification of treatment options

The desire for fuller, more youthful lips has led to a variety of options for lip volumisation, ranging from non-invasive treatments like HA fillers to advanced laser techniques. While laser may not replace traditional injectable fillers for immediate and significant volumisation, the long-term benefits of enhanced skin quality and overall rejuvenation make it a promising option for patients seeking a more natural, less invasive approach to lip enhancement.

The use of laser technology for lip rejuvenation is in a nascent stage, and more research is required in this arena to establish standardised treatment approaches and safety protocols.

Mr Omer Salahuddin is an aesthetic practitioner with an extensive plastic surgery background and a special interest in scar management. He completed his fellowship in craniofacial surgery from Oxford University, and has worked in various NHS trusts across the UK.

Qual: MBBS, MRCS, FCPS (Plast.)

Table 1: Comparison of laser volumisation vs. HA fillers

Before After two sessions

After five sessions

Figure 1: 48-year-old patient before (with asymmetry in right cupid bow and vermillion border), after two Alma ClearLift sessions and after five sessions, performed three weeks apart with improved lip symmetry,, and reduced lower lip wrinkles

Before

After four sessions

Figure 2: 35-year-old patient before and after four sessions with Alma ClearLift for lip colour enhancement and texture

PRESCRIBING INFORMATION - UK

BOCOUTURE® (botulinum toxin type A (150 kD), free from complexing proteins) 50/100 unit vials. Prescribing information: Please refer to the Summary of Product Characteristics (SmPC) before prescribing. Presentation: 50/100 units of Clostridium Botulinum Neurotoxin type A, free from complexing proteins as a powder for solution for injection. Indications: Temporary improvement in the appearance of moderate to severe upper facial lines (glabellar frown lines, crow’s feet lines, horizontal forehead lines) in adults ≥18 and <65 years when the severity of these lines has an important psychological impact for the patient. Dosage and administration: For intramuscular use only. Unit doses recommended for BOCOUTURE are not interchangeable with those for other preparations of botulinum toxin. BOCOUTURE should only be administered by an appropriately qualified healthcare practitioner with expertise in the treatment of the relevant indication and the use of the required equipment, in accordance with national guidelines. The intervals between treatments should not be shorter than 3 months. Reconstitute with 0.9% sodium chloride. Glabellar Frown Lines: Total recommended standard dose is 20 units. 4 units into 5 injection sites (2 injections in each corrugator muscle and 1 injection in the procerus muscle). May be increased to up to 30 units. Injections near the levator palpebrae superioris and into the cranial portion of the orbicularis oculi should be avoided. Crow’s Feet lines: Total recommended standard dosing is 12 units per side (overall total dose: 24 units); 4 units injected bilaterally into each of the 3 injection sites. Injections too close to the Zygomaticus major muscle should be avoided to prevent lip ptosis. Horizontal Forehead Lines: The recommended total dose range is 10 to 20 units; a total injection volume of 10 units to 20 units is injected into the frontalis muscle in five horizontally aligned injection sites at least 2 cm above the orbital rim. An injection volume of 2 units, 3 units or 4 units is applied per injection point, respectively. Contraindications: Hypersensitivity to the active substance or to any of the excipients. Generalised disorders of muscle activity (e.g. myasthenia gravis, Lambert-Eaton syndrome). Infection or inflammation at the proposed injection site. Special warnings and precautions: It should be taken into consideration that horizontal forehead lines may not only be dynamic, but may also result from the loss of dermal elasticity (e.g. associated with ageing or photo damage). In this case, patients may not respond to botulinum toxin products. Should not be injected into a blood vessel. Not recommended for patients with a history of dysphagia and aspiration. Caution in patients with botulinum toxin hypersensitivity, amyotrophic lateral sclerosis, peripheral neuromuscular dysfunction, or in targeted muscles

displaying pronounced weakness or atrophy. BOCOUTURE should be used with caution in patients receiving therapy that could have an anticoagulant effect, or if bleeding disorders of any type occur. 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. Should not be used during breastfeeding. 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, undesirable effects are observed within the first week after treatment and are temporary in nature. Undesirable effects independent of indication include; application related undesirable effects (localised pain, inflammation, swelling), class related undesirable effects (localised muscle weakness, blepharoptosis), and toxin spread (very rare - exaggerated muscle weakness, dysphagia, aspiration pneumonia). Hypersensitivity reactions have been reported with botulinum toxin products. Glabellar Frown Lines: Common: headache, muscle disorders (elevation of eyebrow).

Crow’s Feet Lines: Common: eyelid oedema, dry eye, injection site haematoma. Upper Facial Lines: Very common: headache. Common: hypoaesthesia, injection site haematoma, application site pain, application site erythema, discomfort (heavy feeling of frontal area), eyelid ptosis, dry eye, facial asymmetry, nausea. For a full list of adverse reactions, please consult the SmPC. Overdose: May result in pronounced neuromuscular paralysis distant from the injection site. Symptoms are not immediately apparent post-injection. Legal Category: POM. List Price: 50 U/vial £90.00, 50 U twin pack £180.00, 100 U/vial £180.00, 100 U twin pack £360.00. Product Licence Number: PL 29978/0002, PL 29978/0005 Marketing Authorisation Holder: Merz Pharmaceuticals GmbH, Eckenheimer Landstraße 100,60318 Frankfurt/Main, Germany. Date of Preparation: April 2024. M-BOC-UK-0540. Further information available from: Merz Aesthetics UK Ltd., Ground Floor Suite B, Breakspear Park, Breakspear Way, Hemel Hempstead, Hertfordshire, HP2 4TZ Tel: +44 (0) 333 200 4143

Adverse events should be reported. Reporting forms and information can be found at https://yellowcard.mhra.gov.uk/. Adverse events should also be reported to Merz Aesthetics UK Ltd at the address above or by email to UKdrugsafety@merz.com or on +44 (0) 333 200 4143.

1.BOCOUTURE Summary of Product Characteristics. Merz Pharmaceuticals GmbH: https://www.medicines.org.uk/emc/product/600/smpc (Last accessed December 2024).

REASONS TO CHOOSE BOCOUTURE

• Results seen as early as 7 days, lasting up to 4 months in upper facial lines1

• A well characterised safety profile1

• Convenient – no refrigeration needed prior to reconstitution1

Access injection technique videos now

Merz Aesthetics Exchange (MAX) is a promotional website developed and funded by Merz Aesthetics UK & Ireland.

PRESCRIBING INFORMATION - IRELAND

BOCOUTURE® (botulinum toxin type A (150 kD), free from complexing proteins) 50/100 unit vials. Prescribing information: Please refer to the Summary of Product Characteristics (SmPC) before prescribing. Additional information is available on request. Presentation: 50/100 units of Clostridium Botulinum Neurotoxin type A, free from complexing proteins as a powder for solution for injection. Indications: Temporary improvement in the appearance of moderate to severe upper facial lines (glabellar frown lines, crow’s feet lines, horizontal forehead lines) in adults ≥18 and <65 years when the severity of these lines has an important psychological impact for the patient. Dosage and administration: For inatramuscular use only. Unit doses recommended for BOCOUTURE are not interchangeable with those for other preparations of botulinum toxin. BOCOUTURE may only be administered by physicians with suitable qualifications and the requisite experience in the application of Botulinum toxin type A. The intervals between treatments should not be shorter than 3 months. Reconstitute with 0.9% sodium chloride. Glabellar Frown Lines: Total recommended standard dose is 20 units. 4 units into 5 injection sites (2 injections in each corrugator muscle and 1 injection in the procerus muscle). May be increased to up to 30 units. Injections near the levator palpebrae superioris and into the cranial portion of the orbicularis oculi should be avoided. Crow’s Feet lines: Total recommended standard dosing is 12 units per side (overall total dose: 24 units); 4 units injected bilaterally into each of the 3 injection sites. Injections too close to the zygomaticus major muscle should be avoided to prevent lip ptosis. Horizontal Forehead Lines: The recommended total dose range is 10 to 20 units; a total injection volume of 10 units to 20 units is injected into the frontalis muscle in five horizontally aligned injection sites at least 2 cm above the orbital rim. An injection volume of 2 units, 3 units or 4 units is applied per injection point, respectively. Contraindications: Hypersensitivity to the active substance or any of the excipients. Generalised disorders of muscle activity (e.g. myasthenia gravis, Lambert-Eaton syndrome). Infection or inflammation at the proposed injection site. Special warnings and precautions: It should be taken into consideration that horizontal forehead lines may not only be dynamic, but may also result from the loss of dermal elasticity (e.g. associated with ageing or photo damage). In this case, patients may not respond to botulinum toxin products. Should not be injected into a blood vessel. Not recommended for patients with a history of dysphagia and aspiration. Caution in patients with botulinum toxin hypersensitivity, amyotrophic lateral sclerosis, peripheral neuromuscular dysfunction, or in targeted muscles displaying pronounced weakness or atrophy. BOCOUTURE should be used with caution in patients receiving anticoagulant therapy or therapy that could have an anticoagulant effect, or if bleeding

disorders of any type exist. Too frequent or too high dosing of botulinum toxin type A may increase the risk of antibodies forming. Should not be used during pregnancy. Should not be used during breastfeeding. 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, undesirable effects are observed within the first week after treatment and are temporary in nature. Undesirable effects independent of indication include; application related undesirable effects (localised pain, inflammation, paraesthesia, hypoaesthesia, tenderness, swelling, oedema, erythema, itching, localised infection, haematoma, bleeding and/ or bruising), class related undesirable effects (localised muscle weakness, blepharoptosis), and toxin spread (very rare – excessive muscle weakness, dysphagia, aspiration pneumonia). Serious and/or immediate hypersensitivity reactions have been reported with botulinum toxin products (anaphylaxis, serum sickness, urticaria, soft tissue oedema, dyspnoea, swelling, erythema, pruritis, rash). If serious and/or immediate, appropriate medical therapy should be commenced. Glabellar Frown Lines: Common: headache, Mephisto sign. Crow’s Feet Lines: Common: eyelid oedema, dry eye, injection site haematoma. Upper Facial Lines: Very common: headache. Common: hypoaesthesia, injection site haematoma, injection site pain, injection site erythema, discomfort (heavy feeling of frontal area), eyelid ptosis, dry eye, brow ptosis, facial asymmetry, Mephisto sign, nausea. For a full list of adverse reactions, please consult the SmPC. Overdose: May result in pronounced neuromuscular paralysis distant from the injection site. Legal Category: POM. List Price: Ireland 50 U/vial €103.50, 50 U twin pack €207.00, 100 U/vial €207.00, 100 U twin pack €414.00 Market

Authorisation Number: PA 1907/003/001, PA 1907/003/002 Marketing Authorisation Holder: Merz Pharmaceuticals GmbH, Eckenheimer Landstraße 100, 60318 Frankfurt/Main, Germany. Date of Preparation: April 2024. M-BOC-IE-0042. Further information available from: Merz Aesthetics UK Ltd., Ground Floor Suite B, Breakspear Park, Breakspear Way, Hemel Hempstead, Hertfordshire, HP2 4TZ Tel: +44 (0) 333 200 4143

Adverse events should be reported. Reporting forms and information can be found at https://www.hpra.ie/homepage/about-us/report-an-issue. Adverse events should also be reported to Merz Aesthetics UK Ltd at the address above or by email to UKdrugsafety@merz.com or on +44 (0) 333 200 4143.

Case Study: Using Ultrasound for NSR Complications

Professor Alwyn D’Souza and Dr Farid Hosseini explore the role of ultrasound in non-surgical rhinoplasty procedures

Non-surgical rhinoplasty (NSR) using dermal fillers can be performed to correct the shape, adjust the size and enhance the overall appearance of the nose to make it more harmonious with one’s facial features.1 The procedure has gained popularity for its perceived safety, affordability, and, more importantly, the minimal downtime. 2 Additionally, non-surgical rhinoplasty with dermal fillers offers a minimally invasive solution for patients dissatisfied with their surgical results.

However, previous surgical alterations can add complexity, as scarring and altered anatomy may increase the risk of vascular compromise during filler injections. 3 In this case study, the use of ultrasound guidance is examined to safely assess post-surgical nasal anatomy and achieve precise, targeted filler placement, ultimately enhancing the patient’s nasal contour and symmetry.

Anatomy and vascular considerations

The nose’s complex anatomy necessitates precise knowledge during filler procedures to avoid complications like skin necrosis or blindness. Key vessels include the dorsal nasal, lateral nasal and angular arteries, which supply the nasal tip and upper nose.4 Ultrasound mapping aids in safely avoiding critical vascular structures, especially in post-surgical cases where scarring alters vessel position. Real-time imaging helps to ensures precise filler placement and can reduce the risks associated with intravascular injections, making it especially valuable in patients with prior rhinoplasty.5

Case study

Patient history

The patient is a healthy 40-year-old female without any medical conditions or regular medications. She underwent surgical rhinoplasty five years ago, but was dissatisfied with the final outcome. Her primary concerns were nasal asymmetry and an incomplete correction of the dorsal hump ( Figure 1 ).

She also reported what she assumed to be an irregularity in the nasal bony septum, which she was eager to address. Wanting to avoid another surgical intervention, she preferred a non-surgical solution for minimal downtime and reduced risk.

Consultation

During the consultation, the patient’s aesthetic goals were discussed, particularly her desire for a smoother dorsal profile and improved nasal symmetry. Given her surgical history, we outlined the risks associated with using fillers on post-surgical tissue. These included an increased risk of vascular compromise due to scarring and anatomical changes from the original surgery. The patient was informed that this could potentially lead to skin necrosis and further scarring. 2,6,7 The extremely rare possibility of blindness was also explained in detail.6,8,9,10

To address these concerns and ensure better safety, we recommended using ultrasound to guide the safe filler placement. Ultrasound allowed us to visualise post-surgical scar tissue and assess vascular structures, reducing the risk of intravascular filler placement.11 This approach provided the patient with added confidence, as it ensured a safer, customised plan tailored to her altered nasal anatomy.

During her initial ultrasound assessment using Silarious 10-14 MHz handheld ultrasound probe, a cystic lesion was identified on the midline of her nose, at a depth of 2.2mm. The lesion measured 5.5mm by 3.2mm. This appeared as a small nodule (Figure 4). This cyst, 5mm by 3mm, with a depth of about 2mm, was the cause of the irregularity the patient had mistaken for an issue with her nasal septum. To address her immediate concern, the cyst was drained with an 18G needle under ultrasound guidance, which minimised any tissue disruption and reduced the likelihood of scarring.

This finding underscores the importance of an ultrasound scan before any NSR procedure, as it provides a detailed understanding of nasal anatomy.11

Four weeks later, the patient returned, satisfied with her initial treatment, and requested a non-surgical rhinoplasty using filler to refine the nasal contour and enhance symmetry (Figure 2). The Silarious handheld ultrasound probe 16-20 MHz was used to review the anatomical layers and vascular patterns of the nose.

Treatment plan

After reviewing her anatomy with ultrasound (Figures 5&6) and discussing her goals, we determined that a hyaluronic acid-based filler would provide a flexible and reversible solution for subtle contour adjustments. This type of filler offers precise control for post-surgical refinements while allowing for potential adjustments in case of unforeseen issues.

Four weeks - side view 1

weeks - side view 2

Figure 1: 40-year-old woman’s side view presenting with nasal asymmetry and dorsal hump following surgical rhinoplasty and prior to non-surgical treatment

Figure 2: Side view patient of patient four weeks after drainage of the cyst

Figure 3: Side view of the patient after the NSR treatment

Ultrasound guidance and risk mitigation

Utilising ultrasound technology played a pivotal role in both anatomical mapping and patient education, enhancing the precision and safety of the procedure. This was done by:

· Anatomical mapping: Ultrasound identified areas of scarring and enabled the localisation of vascular structures in relation to her altered anatomy, particularly the dorsal nasal and lateral nasal artery, which may have shifted or been obscured by scar tissue.

· Patient education: The ultrasound images were shared with the patient to demonstrate how the assessment would guide filler placement and minimise potential risks, thereby reinforcing her confidence in the procedure’s safety.

Procedure details

Product choice and injection technique

A medium-viscosity hyaluronic acid filler (FILLMED, art filler-universal) was chosen to enable controlled contouring and gentle volume adjustments. Given her surgical history, precision in injection technique was prioritised to avoid altering the structural support of the nose.

Injection sites and ultrasound guidance

Ultrasound was used for anatomical assessment and vascular mapping of the nose, helping to guide injection points, especially over scarred areas:

· Radix: Small amounts of filler (0.3ml) were injected using 30G needle, above and below the dorsal hump in supra-periosteal level in the midline to smooth the septum

· Nasal tip: Additional filler (0.15ml) was applied with a 30G needle at the nasal tip on top of the cartilage to provide subtle definition

The needle was chosen over the cannula due to its precision and the vascular mapping was performed with ultrasound prior to the injection. Additionally, introducing the cannula through post-surgical scar tissue would have been difficult and less accurate.

Immediately after the procedure, the patient was satisfied with the results (Figure 3). The patient was then monitored for any signs or symptoms of vascular compromise, which may include one or more of the following.7,9,10,11

· Pain or discomfort: at the injection site or in a distant area

· Skin colour changes: The skin may appear white, pale or dusky due to reduced blood flow. This blanching can be transient, but if it persists, it can become irregular and follow the path of restricted blood flow

· Delayed capillary refill: A capillary refill time greater than three seconds can indicate vascular compromise

The patient was discharged with post-procedure instructions which included reporting back to the office if any of the above were noted.

Safety discussion

Filler-based NSR is a safe procedure when in the hands of an experienced and appropriately trained medical professional, though it does carry a risk of significant complications.2 It is important for injectors to be aware of these risks and well-informed about both immediate and subsequent management strategies.

A recent systematic review and meta-analysis reported an overall rate of adverse outcomes across all cohort studies of 2.52%.3 The most commonly reported complications were bruising (1.58%) and haematoma (0.13%). While uncommon, several major complications have been reported, including 30 episodes of vessel occlusion (0.35%), seven cases of skin necrosis (0.08%), eight instances of vision loss (0.09%) and six cases of infection (0.07%).3

The three proposed mechanisms of vascular occlusion associated with aesthetic injections are intravascular embolism, extravascular compression and vascular spasm. These complications require an urgent and appropriate treatment to ensure quick and satisfactory resolution.2,3,9,10

Risk reduction strategies

NSR with filler is often considered relatively higher risk compared to filler procedures in other areas of the face, although it is generally safe when performed correctly. The risk is particularly elevated when performing NSR on patients who have previously undergone surgical rhinoplasty due to the altered anatomy of the nose. In such cases, the use of ultrasound is strongly recommended to minimise the likelihood of vascular adverse events.11

Ultrasound plays a critical role in both the initial assessment and management of complications. In our view, all practitioners performing nose filler procedures should be trained in this field to reduce the risk of complications.

Professor Alwyn D’Souza is a board-certified facial plastic surgeon with experience in both surgical and non-surgical facial aesthetics. He is the past president of the European Academy of Facial Plastic Surgery (EAFPS) and British Society of Facial Plastic Surgery (BSFPS).

Qual: MBBS, FRCS Eng, FRCS (ORL-HNS), PGCertMedEd, EBCFPRS, IBCFPRS

Dr Farid Hosseini is an aesthetic practitioner with more than 20 years of experience in non-surgical facial aesthetics, based in London. He is an international trainer, researcher in facial ultrasound.

Qual: MD, PhD, MSc

Sagittal view of the radix

Sagittal view of the nose tip

Horizontal view of the radix

Horizontal view of the nose tip

Figure 5: Assessment of the nose with 20 MHz handheld ultrasound showing vascular structures, including the dorsal and lateral nasal arteries, displaced by scar tissue

Figure 6: Assessment of the nose with 20 MHz handheld ultrasound showing vascular structures, including the dorsal and lateral nasal arteries, displaced by scar tissue

B mode Doppler mode

Figure 4: Assessment of the nose with 14 MHz handheld ultrasound sagittal view of the radix depicting a cyst visible in the images

14 & 15 March 2025

Business Design Centre, London

Recognise and celebrate excellence

Discover, network & celebrate medical aesthetics

(disclaimer: *AbbVie has part sponsored this event, this includes provision of a stand and/or a speaker program/medical symposium. AbbVie has had no influence over the content/topics covered in other parts of the agenda.)

The UK’s leading resource for medical aesthetic professionals

Uniting the specialty to shape the future of medical aesthetics

Addressing Stomach Fat with Radiofrequency

Nurse prescriber Amanda Azzopardi outlines how radiofrequency can lift, tighten and firm the stomach

Radiofrequency (RF) is an advanced technology based on converting the energy of an electromagnetic wave into heat.1 This interacts with the tissues to generate thermal change.1 RF is an increasingly popular option for treating stomach fat due to its non-invasive nature and ability to target all three layers of the skin, thus targeting the adipose tissue for more sustained results. 2

This article will delve into how RF treatments are used to treat stomach fat, the science behind it, choosing the appropriate patient and integrating it within your business model.

How RF tackles stomach fat

RF generates heat in different tissues via transferring energy through three basic components from an electromagnetic field.4 This includes orientation of electric dipoles that exist in the atoms and molecules in the tissue; polarisation of atoms and molecules to produce dipole moments; and displacement of conduction electrons and ions in the tissue.4 A large quantity of heat that comes from RF electromagnetic waves is absorbed by subcutaneous adipose tissue, muscles, body fluids and parenchymal organs.4 Rising temperatures lead to the expansion of blood vessels and enhanced tissue metabolism, affecting the connections between collagen fibres.4 Both the skin and underlying tissues experience similar levels of heating. Typically, devices emitting RF incorporate skin cooling measures to safeguard the outer layer of skin from heat-related harm. RF waves can be administered continuously or in pulses. When delivered in pulse mode, the therapy produces a milder temperature increase but allows for deeper penetration into the tissues.4

Reducing adipose tissue

The adipose tissue (fat cells/adipocytes) contain the fat stored in the form of droplets of triglycerides. These fat cells vary in size from small to large (mature), in which they typically hold a spherical shape. At body temperature, the lipid in the fat cell is present in the form of liquid oil. It consists of triglycerides, each one composed of three molecules of fatty acids esterified with glycerol.5

Lipolysis is the natural process through which fat stores are mobilised, releasing stored fat for energy utilisation in metabolic functions. Free fatty acids (FFA) represent the specific molecular fuel derived from lipolysis, serving as an alternative energy source to glucose for various bodily tissues.5

Similar to other biochemical reactions within biological systems, enzymatic processes, including those involved in adipose tissue breakdown (lipolysis), are influenced by

temperature. Elevating the temperature of fat cells by 10°C leads to a two-fold increase in the rate of lipolytic activity, effectively doubling the speed of fat release. For the reduction of cellulite, it is advisable to concurrently heat both the dermis and the subcutaneous fat layer selectively.5

RF treatments appear to be effective in treating adipose tissue by affecting the fat cell itself, inducing short-term metabolic size reduction and permanent fat cell death.6 This is advantageous in comparison to other medical modalities/devices that reduce the adipocyte size but do not permanently damage it, thus creating short-term results.6 Temperature controlled RF allows for the adipose tissue to be automatically maintained at the therapeutic thermal endpoint.6 This successful targeting of the adipose tissue makes RF a highly acceptable treatment for treating stubborn fat on the abdomen (Figure 1).

Research

Long-term outcomes of RF

A study conducted by Fritz and Salavastru focused on the effects of a non-invasive RF device treating stomach fat and circumferential reduction, evolving over four years.7 The initial study of 13 patients showcased weight ranges pre-study ranging from 62.2kg to 85.5kg. The patients lost and maintained collectively an average 4.42kg over the four year period, as well as losing 5.9cm of waist circumference.7 Four years on, the same individuals had an average reduction of 4.4cm compared to the baseline, while gaining on average 0.5kg.7 Patients maintained an average of 75.2% of the original contouring transformation after the four years, measured on circumference. There were no long-term side effects that would correlate to the RF treatments.7

Mechanisms of DRQF

Non-invasive fat reduction has historically been challenging to measure. Duncan, Kim and Temaat conducted a study with 29 females, using dynamic quadripolar radiofrequency (DQRF) to penetrate the skin, stimulate collagen production, reduce adipocytes and rejuvenate skin.6 The study showed progressive fat cell breakdown, from initial membrane delamination at two weeks to significant adipocyte clumping and volume reduction by eight weeks, proving DQRF effective for stubborn abdominal fat.6

Duncan and others found that with four to six sessions of RF spaced 15 days apart, consistency in temperature of 41°C, and 90° placement of the handpiece perpendicular to the skin fat interface,

Figure 1: 51-year-old patient before and after six sessions of treatment on stomach fat using the Novaclinical 4Plus radiofrequency device. Images demonstrate a 5% reduction in abdominal fat, 9% reduction in the flank appearance and an overall circumferential reduction of 19cm.

alongside moderate pressure for 10 minutes in four quadrants, would positively influence the destruction of adipocyte activity.6 Assuming the treatment totalled 40 minutes with an endpoint of moderate erythema and controlling of the internal electrical field by the above methods, the end result would be lethal thermal damage to the adipose tissue, however lower temperatures were found to result in delayed adipocyte death.6

Advantages of combined modalities

Da Silva investigated whether combining ultracavitation, which uses mechanical stimulus to promote fat reduction with RF and enhances the destruction of subcutaneous fat cells, could improve outcomes. This study focused on subcutaneous abdominal fat in 45 women aged 20 to 45.11 The studies were limited and divided into three groups, the control group receiving no treatment, the ultracavitation group in isolation, and the RF combined with the ultracavitation. The inclusion criteria were a BMI of 18.5–29.9, with between 1 to 4cm of infraumbilical localised fat, no previous metabolic disease or lipolysis treatments in the week previous. Overall, the mean size of the subcutaneous adipocyte was reduced on tissue biopsy between the cavitation group and placebo group. Rupturing of the cell is caused by the cavitation method inducing adipocyte destabilisation allowing movement of the triglycerides and lipids into the extracellular space, and transportation through the lymphatic system to the liver or directly entering muscle cells to be used as energy. However, the difficulty with cavitation alone was found to be skin laxity, remaining after the fat cell loss. Whereas connective tissue is reorganised with RF, collagen fibres are contracted through the activation of fibroblast cells, leading to the remodelling of connective tissue, increased metabolism, and a reduction in fat.11

Patient experience and satisfaction

It was found that the group receiving RF alone experienced a greater reduction in adipose tissue, as the higher temperatures achievable with this treatment allowed for better results while still maintaining a comfortable experience for the patient. The combination treatment of administering mechanical waves and thermal effect provided a lipolytic response and contraction of the connective tissue, reaching optimal results highlighted by improved skin firmness, thus ranking highest for patient satisfaction.11 It has typically been demonstrated that achieving consistent results relies on monitoring and adjusting the intensity and

duration of RF waves during treatment to ensure optimal outcomes. Depending on the specific concerns being addressed, the treatment can last anywhere from 20-60 minutes, without any downtime. The first treatment creates instant, visible results of more hydrated, plump skin, while a true and sustained transformation comes from gradual treatments thereafter. Cumulative sessions create noticeable improvements in the skin’s texture, firmness and overall appearance – approximately six sessions act as the recommended course for most treated areas.10

Side effects and patient considerations

Potential side effects might include slight redness in the area and some discomfort, potentially with a little erythema and swelling. RF is a very safe treatment with minimal side effects and is suitable for most patients, however it should be avoided for anyone with broken or infected skin in the treatment region, pregnancy or breastfeeding, patients with implantable devices, as well as cancer patients.4

Often the slight swelling can be misinterpreted as a very positive treatment outcome, however, this must be managed pre-treatment in discussing patient expectations and advising that the true results will come 10 to 15 days after the initial treatment. The results will appear gradually after three to four sessions at least 10-15 days apart. The best results will be achieved three to six months after treatment. Patient expectations and perceptions of treatment outcomes must be considered and managed in the initial consultation – skin unevenness and discoloration are key factors which should be discussed if applicable.6

There are more invasive surgical techniques that yield more impressive, longer-term outcomes, and options should be discussed with the patient prior to treatment. However, on average, only one in 10 will seek out a more invasive procedure, while nine out of 10 will seek less invasive, risky and painful, non-surgical procedures.10 A study showed 20 prospective females with an average age of 36.6 years, experiencing increasing obesity and generalised obesity-induced medical disorders. These individuals were opting for non-surgical procedures over more invasive surgical options.6

Before integrating RF into your business model, it is essential to carefully select patients who demonstrate a commitment to improving their nutrition and lifestyle, as this will help manage expectations throughout the treatment process. Ideal candidates are those who are psychologically prepared for

change, willing to track their food intake through a food diary and able to set and regularly review small, achievable goals. Additionally, patients should be open to engaging with supportive networks, increasing physical activity, reducing sedentary behaviours such as excessive TV watching, making informed choices by reading food labels and ensuring that their caloric intake is balanced with energy expenditure.12

It is also important to utilise the initial consultation to establish the suitable course of treatment sessions within their budget. RF is more suitable for candidates who are maintaining a steady weight range, yet have stubborn pockets of fat. Their BMI would generally range from 25-30; if this is higher, they may consider GLP-1 agonist treatments to reduce overall obesity, while also making diet and lifestyle changes to begin with.

The practitioner should always try to improve the patient’s health and longevity, explaining that undertaking this treatment and maintaining the results will take long-term commitment and maintenance sessions, with changes and modifications to diet and exercise routines.

A growing treatment

Research supports RF as an effective method to reduce localised abdominal adipose tissue while minimising cutaneous flaccidity due to the high temperatures achieved, leading to fat cell destruction and connective tissue activation for skin tightening. Patients experience maximum comfort, optimal results and high satisfaction, with reports of long-term, maintained outcomes that improve quality of life. Although the long-term risk of cardiovascular or chronic disease does not decrease, thorough consultations and lifestyle modifications in nutrition and exercise can optimise overall health outcomes.

With the implementation of a thorough medical consultation, business planning, patient engagement and support from your in-house team, a RF device can instantly diversify your patient treatment pathways at any stage of the ageing journey.

Amanda Azzopardi is an aesthetic nurse prescriber, as well as being the owner and founder of Amanda Azzopardi Aesthetics, based in Liverpool, London and North Wales. She trained in aesthetics at Harley Academy, London and has 25 years’ experience in NHS trauma and emergency care.

Qual: ANP/INP, NMC

A Summary of the Latest Clinical Studies

The latest research highlight from Professor Sebastian Cotofana and The Harley Academy Research Group

World-renowned anatomist Professor Sebastian Cotofana shares a key study influencing the world of medical aesthetics.

Title: When to Change Needles During Neuromodulator

Injections — An Electron-Microscopy Investigation into Needle Tip Deformation

Authors: Akintilo E, et al

Published: Journal of Cosmetic Dermatology, November 2024

Keywords: Adverse Events, Botulinum Toxin, Needle Size

Neuromodulator injections are the most commonly requested and the most frequently performed aesthetic procedure in the minimally invasive field, according to current global statistical data. One reason for their popularity is the ease of performing the procedure, and the limited profile of adverse events. Such events are typically minor, with eyelid ptosis, dysphagia and asymmetric smile being among the most severe.

A recent study conducted by a research group from Miami, USA, investigated the degree of deformation of needle tips following various facial neuromodulator treatments. The authors performed three, five or 10 injection passes with the same needle and inspected the needle tip under an electron microscope. The authors found that the degree of deformation was 14.8% for three

Title: Photobiostimulation Therapy (PBST) and Pulsed Electromagnetic Field Therapy (PEMF) in Hair Loss Treatment: Multicentric, Retrospective, Case-Control Study

Authors: Gentile P, Lee S.

Published: Aesthetic Plastic Surgery, December 2024

Keywords: Energy Devices, Hair Loss, Photobiostimulation

Abstract: The combined use of microneedling, growth factors and low-level light/laser therapy, here identified as photobiostimulation therapy (PBST) and pulsed electromagnetic field therapy (PEMF), is a hair loss treatment that needs to be standardised as it seems to have promising effects on hair regrowth. The study compared the clinical and instrumental results obtained in patients affected by androgenic alopecia and hair loss related to COVID-19 treated using PEMF combined with PBST, versus those obtained by only PBST. Forty patients (20 females and 20 males) were analysed after exclusion and inclusion criteria assessment. Twenty patients were treated with the combined use of PEMF and PBST, while 20 patients were treated with PBST. Hair regrowth was evaluated through photography, physicians’ and patients’ global assessment scales, in addition to standardised phototrichograms. The promising results in study group patients, represented by a hair count increase of 14 hairs/0.65 cm2 at T1 after 16 weeks in the targeted area, compared with the baseline results (41 ± 2 hairs/0.65 cm2 at T1 versus 27 ± 2 hairs/0.65 cm2 at baseline), were observed using computerised trichograms. The comparison between groups indicated that PEMF combined with PBST was a more efficient strategy in hair regrowth in terms of hair count improvement than PBST alone.

injection passes, 19.6% for five injection passes and 29.3% for 10 injection passes. The degree of deformation increased from 4.2 deformed regions at three injection passes, to 4.8 deformed regions at five injection passes and 5.6 deformed regions at 10 injection passes. These results indicate that a maximum amount of five injection passes per needle should be performed with the same needle. If more than five penetration cycles are performed with the same needle, the degree of needle tip deformation can result in increased dermal damage at the needle entry site, limiting the needle’s ability to reach the targeted structure and ultimately reducing precision in the administration of the neurotoxin product.

A remarkably interesting finding of this experimental study was the revelation that larger needle sizes sustained greater damage than smaller needle sizes: 30G with 20.3% deformation, 31G with 18.8% deformation and 32G with 16.9% deformation. This finding was surprising for the authors, as one would have expected the opposite result. However, smaller needle sizes appear to generate less penetration force during dermal puncture compared to larger needle sizes, resulting in reduced damage to the needle tip. This finding, though surprising, aligns with a 2019 publication by Pavicic et al. which investigated arterial penetration forces using various needle and cannula sizes. The study found that smaller needles and cannulas required less force to penetrate an artery, leading to the recommendation to avoid using 27G cannulas for filler injections.

Clinically, the results of this interesting electron microscope study provide valuable insights into the procedural treatment with neuromodulators. Future clinical implementations will need to show how feasible the change of the needle tip or the syringe is after only five injection passes.

Title: Modified Orbicularis-tarsus Fixation in Double Eyelid Blepharoplasty: A New Approach Using Conjoined Fascia Readhesion

Authors: Zhang Z, et al

Published: Journal of Craniofacial Surgery, December 2024

Keywords: Blepharoplasty, Double Eyelid, Supratarsal Folds

Abstract: Traditional fixation methods for double eyelid blepharoplasty, such as orbicularis-levator and orbicularis-tarsus techniques, have achieved satisfactory results but face challenges like shallow or disappearance of supratarsal folds. To address these limitations, the authors introduced a modified orbicularis-tarsus fixation approach incorporating conjoined fascia readhesion. This technique involves dissecting the orbicularis oculi muscle from the conjoined fascia, allowing for scar-based readhesion between these structures, resulting in enhanced stability of the supratarsal fold. A total of 67 patients underwent double eyelid blepharoplasty by the same surgeon using this modified technique. Patients were followed up from three to 24 months, with a mean period of 10.3 months. Of the 67 patients, 62 (92.54%) were very satisfied, and five (7.46%) were satisfied with the surgical results. Four patients experienced relatively pronounced early swelling, all resolved without particular treatment within eight weeks. This novel approach by using conjoined fascia readhesion ensures a firmer fixation and improves the aesthetic outcomes. It is a highly applicable and reliable approach for upper-eyelid blepharoplasty. More research is needed into this technique to confirm the universality of the treatment modality.

Optimising Data in Aesthetic Clinics

Ashley and Sheena McKenna dive into the most important data metrics to track and boost growth in aesthetic businesses

Running an aesthetic clinic today is a bit like walking a tightrope. On one side, you need to deliver top-notch patient care, and on the other, you’re managing a business that needs to thrive. So, how do you keep your balance? The answer lies in making data-driven decisions. By leveraging the right insights, you can streamline your operations, keep your patients happy and free up valuable time to set your clinic on a path to sustainable growth.

In this article, we will explore the 12 key data metrics to keep track of in your clinic, and how these insights can be used to optimise your business’ success.

The power of a clinic dashboard

A dashboard is a visual display of key data points and metrics, designed to give you an at-a-glance overview of your business’s performance ( Figure 1 ). Imagine having something that provides a crystal-clear view of everything happening in your clinic, all in one place. Research has consistently shown that businesses leveraging data-driven decision-making are more likely to outperform their peers.1 In fact, a study by McKinsey & Company found that data-driven organisations are 23 times more likely to acquire customers, six times as likely to retain customers and 19 times as likely to be profitable.1 To create one, you collect data from various sources and use data visualisation software like Microsoft Power BI, Tableau or Google Data Studio to organise and present it in charts, graphs and tables that update in real time.1

Consider a recent experience we had with one of our clients – a successful clinic owner who was concerned about declining profitability despite increasing patient volume. By developing a tailored clinic dashboard, we were able to provide them with a detailed breakdown of their service profitability. The data revealed that one of their most popular treatments had quietly slipped into the red. A series of cost increases in consumables and associated maintenance uplift had eroded the margins to the point where the service was no longer making money.

This clinic owner encountered a common challenge – failing to adjust their pricing strategy in response to rising costs of goods sold (COGS). Many clinics unknowingly

absorb incremental costs, impacting their profitability. Once the dashboard was implemented, this became obvious. Our advice was two-fold: first, to review the supplier contract to identify any potential cost reductions, and second, to reassess the pricing strategy across all services to ensure sustained profitability. This case is a powerful example of how a well-designed dashboard doesn’t just monitor performance; it uncovers hidden issues before they become critical, enabling timely and informed decision-making.

Top 12 essential metrics for your clinic dashboard

It is crucial to tailor your dashboard to contain the most relevant data to provide insight into how your clinic is running. Here are some of the most useful insights you can collect.

Revenue generation

1. Treatment return on investment (ROI): Get a clear picture of which treatments are the most profitable by weighing the revenue they bring in against the costs involved.

2. Revenue growth rate: Keep an eye on how your clinic’s revenue is growing over time.

3. Marketing ROI: Understand which marketing campaigns are giving you the best bang for your buck.

4. Patient referral rate: Track how many of your new patients are coming from referrals.

5. Patient lifetime value (LTV): Understanding the total revenue you can expect from a patient over the course of their relationship with your clinic will help with upselling and is crucial for long-term planning.

6. Average revenue per patient: See how much each patient is contributing to your bottom line. It’s a key metric for understanding your clinic’s financial health.

7. Revenue by service: Break down where your income is coming from by service. This gives you a clear view of your top revenue drivers.

8. Revenue split by service type: Take it a step further by categorising your revenue by service type (e.g. facial treatments vs. body treatments).

Time saving

9. Treatment conversion rate: Measure how well your consultations are turning into booked treatments.

10. Patient satisfaction rate: Gather and analyse patient feedback to ensure you’re meeting, or exceeding, their expectations.

Figure 1: Example of a clinic dashboard created using Tableau

11. Patient demographics: Get to know your patients by age, gender, location and more. This data is gold when it comes to tailoring your services and marketing efforts.

12. Inventory turnover rate: Make sure your product inventory is being used efficiently.

The remainder of this article will take a deeper look into how each metric can provide insights to help boost your business.

Understanding your clinic’s growth potential

Before diving into growth strategies, it’s essential to understand your clinic’s current performance. Evaluating key metrics can help identify barriers that might be holding you back. Start by tracking profit margin by service to pinpoint low-margin offerings that may need price adjustments or cost management. Additionally, monitor your patient retention rate to reveal any issues with patient satisfaction, loyalty or experience. Finally, keep an eye on the appointment no-show rate – a high rate could signal scheduling inefficiencies or lack of follow-up reminders, impacting your revenue flow.

If you’re running a new clinic, your focus will always be on building a solid patient base. Tracking metrics like patient referral rate and revenue by service can help you see how well you’re doing in attracting and retaining patients. For more established clinics, the emphasis might shift to refining operations and boosting patient retention through patient LTV and patient satisfaction rate. From there, you can decide how to adjust your marketing strategies, treatment offerings, consultation techniques or even staff members to help your clinic grow.

Saving time with data-driven efficiency

Time is one of your most valuable resources, and understanding where it’s being wasted or could be used more effectively can significantly boost your clinic’s efficiency. Metrics like the treatment conversion rate help ensure that consultation time is translating into booked treatments, making sure your team’s efforts are worthwhile. Additionally, tracking the average time it takes to complete different treatments alongside each treatment’s profitability can uncover valuable time-saving insights. For instance, if certain treatments take longer but yield lower profits, you may consider adjusting scheduling or focusing more on high-profit, low-time treatments. Patient satisfaction rates can also reveal if time is

being wasted through long waiting times or rushed appointments, while monitoring inventory turnover rate ensures that time isn’t lost managing excess stock.

Boosting profitability through informed decisions

By leveraging data, you can identify which services are your top performers and adjust your offerings accordingly. For instance, treatment ROI allows you to identify the most profitable services, helping you focus on promoting and prioritising those. By measuring the ROI of marketing campaigns, you can ensure that your budget is directed towards efforts that attract high-value patients. ROI also helps optimise resource allocation by revealing which treatments are worth the investment of staff time and resources. For clinics investing in new equipment, ROI analysis can highlight which devices deliver the highest return, informing future purchasing decisions. Additionally, analysing the ROI of bundled services or treatment packages uncovers the most profitable combinations. In these ways, ROI insights streamline operations and improve financial performance, helping your clinic thrive.

Understanding patient demographics is also essential for refining both your marketing and business strategies. For instance, if your data shows a high number of patients aged 25-35 seeking non-invasive treatments, you can focus on targeted Meta ads (Facebook and Instagram) to reach this specific group. Using Meta’s advanced geo-targeting features, you can direct ads to people within postcodes or neighbourhoods, ensuring that your marketing resonates with the local audience most likely to engage. Additionally, you can create ad variations based on specific demographics or interests, such as targeting users interested in wellness or beauty. By leveraging these precise targeting options, you ensure that your advertising budget is spent efficiently on trying to seek out your ideal patient base.

Data-driven growth strategies

Data is your best friend when it comes to scaling your practice effectively. Whether you’re considering opening a second location or growing your existing facility, key metrics like revenue growth rate, patient LTV and clinic capacity are essential for making informed decisions. Calculating your clinic’s capacity – how many patients you can serve within your current operational limits – can reveal when demand is outpacing your ability to deliver quality care. For example, in a recent clinic assessment, we identified

the potential benefit of hiring an additional aesthetician, which would contribute to an increased clinic capacity of more than £150,000. This shows that expansion isn’t always about adding physical space; sometimes, strategic hiring can help you meet demand and grow revenue.

Metrics like revenue growth rate allow you to assess the financial trajectory of your clinic, indicating whether your current resources can support expansion. Patient LTV, on the other hand, provides insight into the long-term value of each patient, helping you forecast profitability as you scale.

By continuously monitoring these key performance indicators (KPIs), you can make strategic decisions that support sustainable growth without sacrificing the quality of patient care. Expansion, whether through adding staff, broadening service offerings or opening new locations, becomes a calculated step supported by data, ensuring consistency and success across your practice.

The strategic advantage of data-driven decisions

In the competitive world of medical aesthetics, data-driven decisions are your secret weapon. By leveraging a comprehensive clinic dashboard and focusing on key performance indicators, you can enhance efficiency, boost profitability and ensure sustainable growth, all while delivering exceptional patient care.

By integrating these principles into your practice, you can navigate the complexities of running an aesthetic clinic with confidence, knowing that your decisions are backed by solid data.

Ashley McKenna brings clinics a roadmap to sustainable growth through financial efficiency and data-driven strategy. At EQUALS3, Ashley uses their expertise in retention, operational improvement and tailored growth planning to help clinics streamline operations, increase patient loyalty and unlock new revenue streams.

Qual: BSc (Hons), MBA

Sheena McKenna’s background in global business management and client acquisition within regulated industries provides clinics with strategic growth and compliance insights. At EQUALS3, she helps clinics develop patient-centred marketing and structured expansion plans, guiding them to scale effectively, retain the right clients and build a competitive edge in the aesthetics specialty.

Qual: BA (Hons), CIM

Embracing Diversity in Clinical Practice

Nurse prescriber Amy Bird discusses the importance of embracing diversity and how it can enhance patient care

In today’s interconnected and multicultural world, diversity is a critical consideration across specialties, and the field of medical aesthetics is no exception. For businesses in this sector, embracing diversity means taking a comprehensive approach to patient care by recognising differences in skin types, cultural backgrounds, gender identities and individual aesthetic goals.

This article delves into how medical aesthetic practitioners can embrace diversity in all aspects of their practice, and the positive impact of this on businesses.

Understanding diversity in medical aesthetics

True diversity involves recognising, respecting and addressing the varying needs of individuals based on their skin type, ethnicity, cultural background, gender, age and aesthetic preferences, while also considering potential systemic health issues or autoimmune diseases such as diabetes. This holistic approach ensures patients know that treatments are safe, effective and respectful of each patient’s unique identity.

Why it matters

Adopting a diverse approach is crucial for the following reasons:

· Patient safety: Treatments such as chemical peels, laser therapies and injectables affect individuals differently based on skin type and biology. Missteps can result in adverse outcomes like hyperpigmentation or scarring – the total opposite of the desired outcome in any patient journey.

· Cultural sensitivity: Aesthetic goals often reflect cultural values, and practitioners must understand and respect these nuances to provide satisfying results. A helpful tip is to ask thoughtful questions and ensure you fully understand your patient’s desires and expectations before recommending any treatments. This level of detail and consideration will be what keeps your patients coming back, and recommending you to their friends.

· Inclusivity and reputation: Clinics that represent and celebrate diversity attract a wider patient-base and establish themselves as trustworthy, innovative and relevant healthcare providers.

Practical approaches to embrace diversity

Understanding and treating different skin types

The Fitzpatrick Skin Type Classification is a foundational tool for practitioners, categorising skin tones from Type I to Type VI (pale while skin to dark brown, black skin).1,2 Each type requires tailored approaches for procedures like microneedling or laser treatments to

avoid complications such as burns or post-inflammatory hyperpigmentation.

Practitioners and aestheticians specialising in skin health should be well-versed in ethnic-specific skin conditions, such as melasma, that is commonly influenced by hormonal fluctuations and sun exposure, and keloid scarring, which has a genetic predisposition and is more prevalent in individuals with darker skin tones.4 A deep understanding of the pathophysiology of these conditions allows practitioners to offer tailored, culturally inclusive skincare solutions that minimise adverse outcomes.5

Gender diversity

Aesthetic goals can vary significantly across genders. In my experience, men often prioritise treatments for a more defined jawline, while women typically focus on contouring or volume restoration. Non-binary patients may seek gender-neutral enhancements. By offering gender-specific approaches, clinics can ensure that all patients feel understood and supported in achieving their unique aesthetic aspirations, ultimately enhancing patient satisfaction and loyalty.

Age-inclusive treatments

Different age groups present distinct needs for aesthetic treatments. Grounded in prior experience younger patients often focus on preventative care, while older patients tend to seek rejuvenation. Educating all patients on the ageing process and how skin structures change over time helps practices better address evolving needs, building trust and ensuring long-term patient retention.

To cater to diverse patient needs, practitioners need to offer a variety of treatments. Based on patient history, younger individuals often benefit from acne treatments, preventative care and light chemical peels to maintain skin health, while mature patients frequently find non-surgical options like botulinum toxin and dermal fillers effective for enhancing their appearance.

Personalising treatment plans

Cultural sensitivity is essential when developing treatment plans that honour diverse beauty ideals. Drawing standards can vary significantly across cultures and time periods, evolving in response to historical trends, societal influences and globalisation. For instance, some patients may prefer natural, minimal enhancements that subtly accentuate their features, while others may seek more dramatic, transformative changes.6,7 A key aspect of cultural sensitivity is recognising and respecting these preferences, while offering expert advice to help patients understand what is achievable and safe for their unique skin types and anatomical features.

Inclusive operations and communications

Staff training and policies

Ensuring that staff undergo cultural competency training is a vital first step in creating an inclusive environment. This can include utilising the training resources available, such as specialty-specific courses, professional development workshops or external experts. For CQC-registered clinics, it is important to utilise the mandatory training provided through compliance specialists. Training should cover both the clinical aspects, such as understanding of diverse skin and hair types, and the interpersonal aspects, like effective communication across cultural and linguistic differences. Clinics should also adopt inclusive policies that support diverse patient needs, such as providing multilingual communication options and ensuring accessibility for individuals with disabilities.

Diversity strategies

To truly embed inclusivity, clinics should:

Ensure that all staff members are trained to address diverse patient needs with respect, offering culturally competent care at every stage of the patient journey. Make mandatory cultural competency training a cornerstone of your practice. This is not just a one-time session but an ongoing commitment, as inclusivity and cultural understanding evolve with time.

Hire a diverse team that reflects the demographic diversity of your patient base. A team that mirrors the community it serves is more likely to connect with patients on a personal level.

Regularly review and update clinic policies to ensure they support inclusivity in consultations, treatments and post-care. For example, offering a translator service can be invaluable in ensuring patients who speak different languages feel fully understood during their interactions.

Cultural competence matters

Creating a team that mirrors the diverse backgrounds of your patients not only fosters a more inclusive environment, but also enhances patient trust and satisfaction. To ensure your job advertisements attract a wide range of applicants, consider

using inclusive language that highlights your commitment to diversity, including awareness of cultural and religious observances. For example, mentioning flexibility around significant religious celebrations such as Eid or Diwali, or recognising dietary restrictions during fasting periods like Ramadan or Lent can demonstrate an understanding of your team’s varied cultural practices. Additionally, acknowledging holidays like Lunar New Year or embracing cultural attire preferences can further foster a sense of belonging and respect. Moreover, incorporating diversity into your mandatory training programmes is vital. A more inclusive training framework that covers different cultures, religions and social backgrounds equips staff with the tools needed to address patients’ unique needs with empathy and professionalism. By integrating diversity-focused modules into your recruitment and training processes, such as workshops on cultural competency, religious accommodations and communication styles, you enhance patient care and create a supportive and respectful workplace.

Marketing and representation

Clinics should ensure that their marketing materials use inclusive imagery and language. Featuring patients of different ages, genders and ethnic backgrounds in advertisements can help make a clinic feel more welcoming to a wider audience. In addition, multilingual communication options are key in bridging language barriers. For clinics located in areas with diverse populations, offering materials in different languages or providing access to interpreters helps ensure that language does not become a barrier to care. This also fosters a sense of inclusion, showing that the clinic values its diverse patient base and is proactive in addressing their needs.

Enhancing the patient journey

The patient journey should be inclusive from start to finish. From pre-consultation systems that use inclusive language and imagery, to post-care options that cater to diverse lifestyles and preferences, clinics should ensure that inclusivity is embedded in every touchpoint. Active listening during consultations helps ensure that the patient’s goals are fully understood and respected, leading to more personalised treatment recommendations.

Pre-consultation

Automated systems that send out forms, questionnaires and materials that reflect inclusive language and imagery. An example is the Aesthetic Nurse Software that accommodates clinical documentation.8

These can include visual depictions of diverse skin tones and expressions of beauty across cultures, which will help patients feel immediately comfortable and represented.

Consultation

Practitioners should employ active listening to fully understand and honour the patient’s aesthetic goals. This involves asking open-ended questions to explore the patient’s desires while being sensitive to their cultural and personal preferences. It’s important to ensure that patients feel heard and respected, and that their values are integrated into the treatment recommendations.

Treatment

Customise treatment approaches based on individual needs, evidence-based practices and the appropriateness of specific procedures. This may involve adjusting treatments to account for skin type, age, gender and cultural expectations. Tailoring treatments shows a level of attentiveness that can help build patient trust and loyalty.

Post-treatment care

Provide follow-up options that are flexible and respect diverse lifestyles, preferences and cultures. This may include offering different types of post-treatment care materials (e.g. in various languages) or offering follow-up communication through preferred channels, such as text, email or phone depending on the patient’s convenience.

Embracing diversity

Embracing diversity in medical aesthetics is more than a trend – it’s a commitment to delivering personalised, inclusive and culturally sensitive care. By understanding the unique needs of each patient and creating a welcoming environment, clinics can enhance trust, satisfaction and reputation.

In a diverse and dynamic world, inclusivity isn’t optional – it is essential for success. By prioritising understanding, adaptability and respect, medical aesthetic clinics can lead the way in creating a truly inclusive space for ageing solutions and wellness.

Amy Bird is a nurse prescriber with more than a decade of experience in medical aesthetics. Founder and lead nurse at her practice, KAST Medical Aesthetics in Cheshire, she is also a recognised leader in BAMAN, holding a position on the education and training committee. She is a recognised trainer for Croma, Evolus and Teoxane.

Qual: NMP, MAPIQ

Minimising Negligence and Compensation Risks

Solicitor Michael Saul discusses strategies to minimise negligence risks and maintain professional standards

Aesthetic practitioners face unique challenges when it comes to managing the risks of negligence. The potential for even minor oversights to lead to serious legal consequences, financial losses and reputational harm continues to grow with increasing public attention. This article examines the operational and legal measures that can be employed to minimise these risks. Key strategies include maintaining rigorous patient safety protocols, upholding the highest professional standards, implementing robust legal safeguards and ensuring clear, transparent communication with patients.

Understanding medical negligence

Medical negligence occurs when a healthcare professional’s action, or lack thereof, falls below the standard of care expected, leading to harm or injury to a patient. In medical aesthetic practice, this standard of care requires not only technical proficiency, but also comprehensive patient consultation and communication.

Proving negligence elements

To establish a claim of negligence in a medical context, several key elements must be proven. These elements provide the foundation for demonstrating liability and securing compensation:

· The existence of a duty of care

· A breach of that duty

· Causation linking the breach to the harm

· The resulting damages experienced by the patient

In medical aesthetics, negligence may manifest in various ways. Inadequate pre-procedure assessments, such as failing to review a patient’s medical history or to identify contraindications, can compromise outcomes. A common issue includes incomplete or unclear informed consent, where patients may not fully understand potential risks, side effects or realistic expectations of the procedure. Procedural errors, whether due to inadequate training or lack of adherence to established guidelines, can further contribute to potential claims.1

The impact of negligence can extend beyond immediate physical complications, including long-term psychological distress for patients. This can lead to more complex claims involving emotional damages, which, on top of physical damage, can increase compensation demands – especially if this led to additional care requirements or loss of earnings.2 Additionally, delayed recognition of clinical negligence or management of post-procedure complications, such as infections or adverse reactions, can worsen outcomes and escalate the potential for legal action.3

Preventing negligence

Preventing negligence in aesthetic practice begins with prioritising patient safety and maintaining rigorous clinical standards. Comprehensive pre-procedure assessments are fundamental to this approach. These assessments should include an in-depth review of patient medical histories, screening for contraindications and ensuring that patient expectations align with realistic outcomes. Such assessments would go over any issues that can occur post procedure. Establishing a systematic consultation protocol helps identify potential issues before any procedure takes place, thereby reducing the risk of complications.4 An effective protocol will go over the patient’s goals and expectations from the procedure, their medical history and risks associated with the procedure.

Informed consent serves as both a patient safety measure and a legal safeguard.5 Effective informed consent requires more than a signature; it involves detailed discussions outlining the procedure’s benefits, risks, limitations and possible complications. Medical professionals should allow patients the opportunity to ask questions and should verify

patient understanding through active engagement. Practitioners should also inform a patient of the advantages and disadvantages of all reasonable treatment options, including the possibility of not pursuing any treatment. This comprehensive process fosters trust and reduces the likelihood of patient dissatisfaction and subsequent legal challenges.

Maintaining professional standards through continuous education is critical in avoiding negligence. As aesthetic procedures, techniques and technologies evolve, regular training ensures that practitioners remain proficient and aware of new safety measures. Attending workshops, obtaining updated certifications and participating in peer-reviewed sessions contribute to a practitioner’s ability to perform procedures safely and competently. Adherence to current guidelines and recommendations from regulatory and professional bodies reinforces both patient safety and the practice's reputation.6,7

Standardising procedural protocols and documentation can further mitigate negligence risks. Detailed documentation of consultations, consent discussions, procedural steps and post-procedure care provides clear evidence of the care provided. Consistent record-keeping is vital for demonstrating adherence to professional standards, and can serve as a valuable defence in the event of a negligence claim.8 Additionally, employing digital tools, such as Pabau, Cliniko, or Acuity Scheduling for record management

Top tips

● Prioritise patient safety: Conduct thorough pre-procedure assessments, including medical history and screening for contraindications

● Realistic expectations: Ensure patient goals align with achievable outcomes

● Informed consent: Go beyond a signature – discuss benefits, risks and treatment options, including the choice to not proceed

● Continuous education: Stay updated with the latest techniques and safety protocols through ongoing training and certifications

● Standardise protocols: Use clear, consistent procedures and documentation to ensure transparency and legal protection

● Regular audits: Conduct internal reviews to identify risks and improve practice protocols

can enhance the accuracy and accessibility of patient records, supporting a practice’s commitment to transparency. Practices may also benefit from implementing regular internal audits to identify any gaps in protocol and areas needing improvement. These audits can provide an opportunity to address potential risks proactively, and reinforce a culture of continuous quality improvement. By embedding these preventive strategies into daily practice, aesthetic practitioners can uphold patient trust, minimise the likelihood of negligence claims and promote better overall patient outcomes.

Managing compensation claims

When a compensation claim arises, prompt and strategic action is necessary to manage the situation effectively and minimise further repercussions. The first step involves thorough documentation as previously mentioned. These detailed records can substantiate that due care was taken and be a crucial asset in defending against negligence claims.

Transparency is another key component when addressing potential compensation claims. Open communication with the patient can help de-escalate the situation and may prevent the claim from advancing to formal legal action. Acknowledging the patient’s concerns and providing a clear explanation of what occurred, as well as outlining any corrective measures, can foster trust and reduce adversarial tensions. In some cases, offering solutions such as a follow-up consultation or corrective treatment may be appropriate to demonstrate a commitment to patient care.

Cooperation with legal advisors should be prioritised once a claim is filed. Typically, a doctor will need to contact their insurer, who would then seek the advice of their lawyers to pass on to the doctor.8 Consulting with solicitors can provide insights into best practices for navigating the legal process. They can assist in assessing the merits of the claim, determining liability and advising on an appropriate response. Seeking expert legal counsel early can help practitioners make informed decisions and minimise the risk of prolonged disputes.

An internal review process should follow any claim to identify procedural weaknesses or gaps in practice that contributed to the issue. This evaluation is not only beneficial for understanding what led to the claim, but also serves as a learning opportunity to prevent future occurrences. Lessons learned from these reviews should be used to inform staff training and revise protocols as needed.

By incorporating these management strategies, aesthetic practitioners can protect both their reputation and financial

stability, maintaining trust within their patient community.

Top tips

● Document thoroughly: Keep detailed records to demonstrate due care and support your defence

● Be transparent: Communicate openly with the patient, acknowledge concerns and explain what happened to build trust

● Offer solutions: Consider offering follow-up consultations or corrective treatments to show commitment to patient care

● Consult legal advisors: Contact your insurer and legal counsel early to guide you through the claims process

● Conduct internal reviews: Assess internal practices to identify weaknesses and prevent future issues

Legal safeguards and best practices

Legal safeguards are crucial in minimising negligence risks and compensation claims in aesthetic practice. Compliance with regulations, maintaining licensure and securing insurance provide foundational protection. Robust documentation of consultations, consent, treatment plans and follow-up care offers essential evidence of care standards, while adherence to updated clinical guidelines ensures patient safety and legal compliance.

Routine audits, peer reviews and professional development help identify and address procedural gaps, fostering accountability and improvement. Preparing for inspections with accessible, compliant records reinforces credibility. Together, these measures uphold professional standards, protect patient trust and mitigate financial and reputational risks.

Financial and reputational impact

The financial repercussions of negligence claims in the field of medical aesthetics can be significant, extending beyond immediate compensation payments. Costs associated with defending a claim, including legal fees and increased insurance premiums, can place substantial financial strain on a practice. These legal costs could amount to up to circa £100k or more in a case defended to trial. However, a practitioner or clinic’s insurer should cover these costs. Additionally, the impact of a negligence claim can lead to long-term financial implications, such as the loss of potential revenue due to a diminished patient base.

The reputational damage that follows a negligence claim can be equally, if not more, detrimental. A practice’s reputation, built over years of consistent patient care and trust, can be quickly eroded by reports of a negligence case. Even when a claim is successfully defended, the association with legal disputes can negatively influence public perception and deter new and existing patients. This reputational harm can have enduring effects on a practice’s growth and sustainability.

Top tips

● Invest in comprehensive insurance: Ensure robust coverage to handle legal fees and increased premiums

● Focus on patient satisfaction: Consistent, quality care helps retain patients and protect revenue

● Maintain clear documentation: Strong record-keeping can help defend against negligence claims

● Proactive reputation management: Address complaints quickly and openly to prevent long-term damage

● Legal preparedness: Regularly review protocols to minimise legal risks and stay compliant

High standards as the best mitigator

Minimising negligence and compensation risks in aesthetic practice requires a proactive and comprehensive approach. Ultimately, maintaining a commitment to high standards of patient care, coupled with clear communication and adherence to legal and professional guidelines, helps safeguard a practice’s reputation and financial stability. These measures not only protect practitioners, but also promote better patient outcomes.

Michael Saul is a partner at Cosmetic Surgery Solicitors. He is a passionate advocate for ensuring patients are fully informed before undertaking cosmetic surgery and has obtained a law degree from Newcastle University in 1996 and a diploma in legal practice from York College of Law in 1997. Saul is aware of the negative consequences of the lack of regulation in the specialty, and takes issue with the practice of profits before patients and commerce before ethics.

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“It’s my mission to improve quality of life for as many people as possible”

Dr Hen Ifrach shares her journey into regenerative and preventive medicine

Dr Hen Ifrach is a Milan-based aesthetic practitioner and laser specialist who focuses on regenerative medicine and non-invasive treatments.

Dr Ifrach, born and raised in Israel, moved to Milan to study Art before transitioning to Medicine. At the age of 11, she witnessed her brother suffer third-degree burns, and as his skin recovered, Dr Ifrach observed "the incredible potential for healing and regeneration, and the positive impact on wellbeing." She refers to this memory as a pivotal moment in her journey into medical aesthetics, with medical laser devices being of particular interest.

She completed a six-year medical degree, graduating from the Faculty of Medicine and Surgery at the University of Milan in 2015. She later earned a Level II Master's in Aesthetic Surgery from Humanitas Research Hospital, but quickly realised patients' preference for non-invasive treatments. She further advanced her laser expertise with Harvard Medical School's course, The Future of Lasers.

Building on her educational background and clinical experience, Dr Ifrach has encountered a wide range of skin conditions treatable with laser therapy. She outlined the emotional and physical impact that conditions like acne can have on her patients, demonstrating her desire to help them. "They can't even rest their face on a pillow because it's too painful," Dr Ifrach explains further, stating, "My mission is to make these breakthroughs accessible and life-changing for my patients."

Her fascination with lasers led her to develop Protocol Grace, a laser-based treatment device that stops the proliferation of Propionibacterium acnes, while enhancing scarring outcomes. This laser therapy targets acne, rosacea and skin rejuvenation using advanced energy-based devices. She also shares that her approach often involves combining treatments, sometimes utilising up to five different lasers and wavelengths, personalising the approach to suit each patient’s need.

Dr Ifrach took a leap of faith earlier this year and opened up her own practice. Initially, she operated from a clinic in Piazza Duomo, the cathedral square in Milan. However, despite the remarkable location, the space proved too small to support her work. To accommodate the advanced lasers she uses, she upgraded to a larger, privately-owned clinic, remaining in Milan but expanding to meet her needs.

“My patients often say my practice, Hanuna Clinic, feels like a blend of a luxury hotel and an art gallery,” she shares. Displayed in her clinic is an art piece of Albert Einstein, along with a quote that is typically attributed to him, ‘Insanity is doing the same thing over and over again and expecting different results’. Dr Ifrach explains how this philosophy reflects Protocol Grace, “No two treatments are the same. I customise each session based on an

in-depth analysis of my patients’ skin.”

She emphasises that every individual’s skin is unique, and she holds this value close to heart. The motto Dr Ifrach practices in her clinic is that "Aesthetics is about more than appearance. It's about transformation –physical, emotional and spiritual."

Outside of her clinic, Dr Ifrach is a Key Opinion Leader (KOL) for Alma. Her role with Alma requires her to travel globally for congresses and educational initiatives, particularly throughout Europe and Asia, reflecting her goal to make regenerative medicine a global reality. She has participated in several international conferences, such as IMCAS World Congress in Paris, where she contributed to sessions on advanced laser treatments.

While reflecting on her role as a KOL, she highlights the educational benefits, “It’s very inspiring, as you find yourself learning just as much as you are teaching. The field of aesthetics is constantly advancing, offering us sophisticated and painless tools to deliver incredible results.” Dr Ifrach emphasises the fulfilling experience of sharing her knowledge with peers at conferences, stating, “It allows me to contribute meaningfully to the specialty, while also stimulating my own professional growth through discussions and the exchange of ideas.”

While sharing her knowledge, Dr Ifrach advocates for continued learning, and recognising your responsibility as a practitioner to focus on patients’ quality of life. “Always prioritise education, invest in your skills and remember that the intersection of beauty and wellbeing is where the magic happens.”

If you could choose a career outside the medical field, what would it be?

I would love to be a seaplane pilot, flying in flip-flops, combining adventure with freedom.

Who is your role model, in the specialty or outside of it?

Albert Einstein has always been my greatest inspiration. His curiosity, creativity, and profound wisdom (and yes even his iconic hair!) have motivated me since childhood.

Do you have a mantra you stick to?

Where beauty becomes wellbeing.

Practitioner Wellbeing Post Vascular Occlusion

Nurse prescriber Mary Irving argues that practitioners would benefit from being more open about the psychological impact of causing a vascular occlusion

In the event of a vascular occlusion (VO), it is undeniable that the priority is always the patient and their safety. However, with the emphasis always being on the patient’s wellbeing, we as practitioners can tend to overlook our own feelings.

Following a recent VO in my clinic, I realised how taboo it is to discuss our emotional response to adverse events. This is despite the fact that of 370 practitioners surveyed in 2021, 28.6% reported causing at least one VO in their career.1

It is my belief that the aesthetics specialty should be more receptive to conversations around complications, as this openness can lead to improved practitioner wellbeing.

A source of dread and shame

Practitioners are taught to fear and dread potential VOs. Regardless of background, knowledge and experience, it’s our worst-case scenario during any injectable procedure as it can happen at any time and can have a real impact on our practice. Practitioners are bound to face a plethora of emotions after such an event.

After the recent VO in my clinic, I spent hours running through what I did, how it was caused, what I could have done differently. I was left preoccupied with the potential lasting impact on my reputation if my other patients found out, and, perhaps most worryingly, if there would be any legal implications. For weeks afterwards, I dreaded speaking to the patient in case any issues arose. Despite all these worries, I was reluctant to share my experience with colleagues in case I was judged or labelled a ‘bad practitioner’ or ‘rotten egg’ in the specialty. I am sure I am not the only

practitioner who has had these fears after a complication has occurred.

Asking for help

I feel there is a stigma and shame that is extremely counter-productive when it comes to practitioner wellbeing. Embarrassment can prevent peer-to-peer discussion, which is often the best way to get invaluable advice and alleviate concerns.

This can certainly be the case while an adverse event is still ongoing, as having two clinical eyes on a situation can aid towards its resolution. Whether it’s clinic advice or just moral support that you need, contact with a peer can help give you the confidence to get the occlusion resolved. This can either be sought through your peers or local support groups, as well as complications groups like Aesthetic Complications Expert (ACE) Group World or Complications in Medical Aesthetic Collaborative (CMAC). In the aftermath of a VO, there is no shame in telling those close to you that you struggled with the situation and found it stressful. In my view, our attitudes in the field need to change so people no longer feel like a nuisance or inadequate for reaching out for support during a complication.

It is also crucial to report any complications that occur to the Medicines & Healthcare products Regulatory Agency (MHRA) through its Yellow Card system to ensure patient safety is monitored across the country.2

I believe that transparency is the best way forward, on both a personal and wider scale. For example, social media platforms

can be used as a platform of candour. We should promote case studies that haven’t gone well, as well as those that have, and discuss how we coped. Writing articles on adverse events and their management can also help raise awareness and break down stigma.

With the evolution of the aesthetics sector and the constant introduction of new technology, those of us on the aesthetics front line should be vocal in our positions, both by sharing our experiences and supporting others through theirs.

Supporting your peers

If a practitioner reaches out to you personally or on a public platform looking for help, I feel the best approach is to ask what kind of support they need rather than assuming what would be best for them. This might be simple emotional reassurance, kind words or a non-judgemental approach to problem solving. It is worth being mindful of a concept a lot of us heard during the pandemic – psychological PPE. This concept promotes the idea that healthcare teams should be provide care and mental health support even after a shift has ended.3 There is no room for personal judgment when dealing with a person that is in professional, clinical need. This straightforward, compassionate approach will be best for both practitioner and patient, in my view.

Encouraging honesty

After almost a decade in the field, my attitude towards VOs is changing. Through open and honest conversations with colleagues, I no longer view my emotional response towards such situations as negative, even if they can still be hard to deal with. I consider feeling stressed, overwhelmed, worried or fearful to be a sign of being a conscious and caring individual, as long as I am able to deal with the situation calmly. It makes me feel safer knowing that my emotional triggers will spur me on to tick all boxes thoroughly when addressing an adverse event. If you’re facing a particularly difficult case, adverse event or complication, take a deep breath, collect your thoughts, ask for help and take a moment to debrief what went well and what could be improved for future practice.

Mary Irving is an independent nurse prescriber working in the heart of Essex. Starting her career in adult nursing before moving into aesthetic practice, Irving founded her company Micosmeticsuk in 2016.

Qual: NIP

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