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Special Feature: Best Practices for Chemical Peeling Page 25
Clinical Contributors
Professor Mark Birch-Machin is professor of molecular dermatology at Newcastle University, and chief scientific officer of Skin Life Analytics Ltd. His research has focused on the response of human skin to the environment, alongside additional commercial and media applications.
Dr Jessica Moor is a researcher in dermatological sciences at Newcastle University, and research associate placement in Skin Life Analytics Ltd. Dr Moor has five years’ experience investigating the biochemical, molecular and cellular biology effects of skin interventions.
Emma Button is an advance nurse practitioner and lead clinical nurse specialist working in dermatology in a highly regarded NHS London Trust. She is the events education lead for the British Dermatological Nursing Group, taking a special interest in atopy conditions, acne and women’s health.
Dr Ethan Hausman-Marquis is a paediatric oncological surgeon, with a clinic specialising in aesthetic and regenerative medicine in London. He has a PhD in Cell Biology and is member of the American Society of Regenerative Medicine.
Emma Coleman is a dermatology nurse practitioner qualified to Clinical Dermatology Diploma level. Emma Coleman opened her first clinic at her home in Kent in 2015, and has since launched her own skincare range, procured CQC registration and now operates two holistic skin clinics in Bromley.
Cigdem Kemal Yilmaz is a chemical engineer, skincare formulator, educator and founder of Skin Masterclass. She graduated with a master’s degree in chemical engineering from the University of Bath and has created a CPD-certified skincare education and consultation platform.
Dr Bisma Hussain, an emerging aesthetic practitioner and hair transplant surgeon, specialises in genetic testing for personalised hair restoration treatments. Educated at the University of Nicosia Medical School, she focuses on individualised care and innovative approaches to combat hair loss.
Dr Ducu Botoaca is the founder and medical director of Dr Ducu Clinics. He specialises in advanced aesthetic services, including hair and eyebrow transplants, as well as non-surgical BBL. He has developed and patented unique techniques for both eyebrow transplants and non-surgical BBL procedures.
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As we transition into the vibrant colours of autumn, the September issue of the Aesthetics Journal shines a spotlight on the foundation of all aesthetic practices – skin health. While injectables and devices often steal the show, the power of topicals cannot be overstated. This month, we deep dive into how skincare and topical products are transforming patient outcomes and elevating practices.
Our Special Feature explores the fascinating world of chemical peels, breaking down the different depths of peeling and how they can be tailored to meet individual patient needs (p.25). You’ll also find insightful articles on using topicals to manage eczema (p.38), hair loss (p.54) and expert advice on selecting the perfect skincare regimen for your patients (p.51).
In addition to our clinical content, we’re addressing a topic that’s unfortunately been affecting many in our community – redundancies.
Clinical Advisory Board
If you’ve been impacted by recent job losses, be sure to check out our business feature, which offers practical advice on navigating this challenging time (p.58).
Another of our business articles this month offers top tips for crafting an award-winning Aesthetics Awards application! It’s got some fantastic advice, so do have a read (p.63) and remember to submit your entries by October 25th via aestheticsawards.com
Looking to October, myself and the team are excited to invite you to the Clinical Cosmetic Regenerative (CCR) Congress next month. As the UK’s largest event bringing together the medical aesthetics community, it’s an unmissable opportunity to learn, network and be inspired by peers and leaders in the field.
Finally, we’re adding a bit of fun to this issue with a giveaway featuring CellDerma’s hero product (p.21). Want to win? Guess how many times the word ‘skincare’ appears in this issue and comment your answer on our Instagram post - @aestheticsjournaluk! The winner will be announced on Instagram later this month!
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.
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 Souphiyeh 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.
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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.
We had the pleasure of hosting an exceptional masterclass aimed at revolutionising regenerative aesthetics!
Toxin
Galderma
toxin Relfydess
receives positive results for two indications
Pharmaceutical company Galderma has announced that Relfydess (relabotulinumtoxinA) has been indicated for temporary treatment of frown lines and crow’s feet for patients under 65.
The company shares that it has completed the European decentralised procedure (DCP) for Relfydess, and now awaits national approvals from 16 European nations. Once these approvals are granted, the product will be the first neuromodulator in Europe to have indications for two areas simultaneously.
Galderma states that Relfydess is the first and only ready-to-use liquid neuromodulator developed using its PEARL Technology – a highly active formulation, designed to optimise activity and purity.
#Training
Dr Catherine Fairris @drfairris_skinwessex
Thank you to Melissa McKay for an enjoyable training session with the new Profhilo Structura!
#Education
Julie Scott @nursejuliescott
Had a wonderful time at Interface Aesthetics! Good to see these faces again.
#Travel Dr Elizabeth Hawkes @dr_elizabethhawkes
Wrapping up an amazing trip to Turkey! Can’t wait to share the exciting projects I’ve been working on!
#Collaboration
IVMedispa @ivmedispauk
Today we were delighted to have our gorgeous Alma representers - Ryan and Chloe - it’s been a pleasure!
Galderma shares that it is preparing to launch Relfydess in the UK in H1 2025 following the International Recognition Procedure, together with other European countries.
Global head of R&D at Galderma Dr Baldo Scassellati Sforzolini commented, “As an innovation entirely developed and manufactured by Galderma using our state-of-the-art PEARL Technology, Relfydess exemplifies our commitment to delivering the broadest and most diverse injectable aesthetics portfolio. We’re pleased that with this positive decision for use in Europe, we’re one step closer to bringing this ready-to-use liquid neuromodulator to multiple countries as national approvals are now under finalisation.”
Galderma is Headline Sponsor of CCR 2024. Turn to p.22 to register free now.
Advertising
ASA issues ruling after ads directed at under-18s on studying platform
The Advertising Standards Authority (ASA) has ruled against a cosmetic surgery clinic after its adverts were displayed on online studying platform Quizlet.
Two adverts were displayed on the website – which is commonly used by students while revising – including one showing two before and after photos of a woman’s torso, with the after photo appearing slimmer.
Complainants challenged whether the ads were directed at those under 18 years of age due to the context in which they appeared. In response, the clinic in question said they were aware of the age restrictions on its adverts, and they did not intend them to appear on Quizlet. They said it had implemented block lists for their ads and have since added education sites including Quizlet to the list. Quizlet said they had blocks on adverts related to medical procedures, but this relies on the companies correctly categorising their ads.
The ASA ruled that the advertisements had, intentionally or not, been directed to under-18s. It explained that ads for cosmetic interventions should not be placed in media aimed at under-18s, or in which 25% or more of the audience profile is under 18. The ASA said the advertisements should be appropriately targeted in future.
Full educational agenda for CCR 2024 unveiled
The full agenda for CCR 2024 is now confirmed, featuring two days of clinical presentations, live demonstrations, connection opportunities and more.
The main location for independent educational content across the two days is the Aesthetics Journal Arena, featuring mini agendas including a Toxin Takeover, Injectable Considerations for Full Face Rejuvenation, Optimising Skin Health, Regenerative Aesthetics and more. Taking to the stage will be world-renowned speakers including Dr Raul Cetto, Dr Kate Goldie, Dr Tapan Patel, Dr Tunc Tiryaki, Dr Anjali Mahto and many more.
The conference’s four other stages will also showcase enlightening content, placing focus on product innovations, treatment protocols, functional wellness innovations, business expertise and more, with the chance to connect with our leading speaker line-up.
Also featured are two Lunchtime Takeover sessions from DermaFocus, discussing the regenerative potential of polynucleotide HPT and the role of exosomes in regenerative medicine. The sessions will be taking place on the Symposium Stage, which DermaFocus will sponsor across the two days. CCR will also be an excellent opportunity to network with the field’s top practitioners and companies at the DermapenWorld Networking Drinks from 5-7pm on day one of the conference.
Shannon Kilgariff, Aesthetics editor and event manager, commented, “CCR is fast approaching, and we couldn’t be more excited! We are very proud to be working with so many well-respected practitioners and companies on our agenda this year, and the content is sure to be insightful for both experienced clinicians and keen newcomers. The networking at CCR is also second-to-none, and I for one cannot wait to meet even more of you this year.”
CCR 2024 will take place at ExCeL London on October 10-11. Turn to p.22 to register for free now.
ISAPS study reveals 14 years of aesthetics trends
A study published by the International Society of Aesthetic Plastic Surgery (ISAPS) in Aesthetic Plastic Surgery has shown an increase in procedures from 2009 to 2013.
The study states there has been a ‘more pronounced’ increase in both surgical and non-surgical procedures since 2021, with a 40% overall uptick in the last four years. Body and extremity procedures have seen a significant boost, with more than 5.1 million in 2023 compared to 2.6 million in 2009. Face and head procedures have remained the most popular, with the top non-surgical procedures being botulinum toxin, hyaluronic acid, hair removal, chemical peels and non-surgical fat reduction. The top five most popular surgical procedures are liposuction, breast augmentation, eyelid surgery, abdominoplasty and rhinoplasty – a list which has stayed largely the same over the 14 years. The authors concluded, “Despite the obvious cultural and social differences from country to country that make certain procedures more desirable in some geographic areas, and less so in other parts of the world, the results of this study show a significant overall increase in all surgical and non-surgical procedures aimed at improving aesthetic appearance.”
Vital Statistics
Out of 250 British people, 59% of children under 18 have been sunburnt at least once (British Skin Foundation, 2024)
Of 1,000 men in the UK aged 18-50, 9 out of 10 are worried about the effect cost of living related stress is having on their appearance (Onepoll, 2024)
Out of 2,000 UK adults, 80% spend £1,200 on beauty treatments per year, with an average of £100 per month
(Capital Hair and Beauty, 2024)
The medical aesthetic market is set to exceed $212.5 billion by 2032, with an annual growth rate of 12.7% (ISAPS, 2024)
Out of 1,000 18-25-yearolds, 72% understand consistency in skincare, saying they have a morning and night routine (Kyra, 2024)
Based on 2,000 UK consumers, 34% of 25-34-year-olds believe UV rays cannot reach you through a window (La Roche-Posay, 2024)
Events diary
6th-7th September
RSM Aesthetics 2024
21st September
BCAM Annual Conference 2024
26th-27th September
BACN Autumn Conference 2024
10th-11th October
CCR 2024
IN THE MEDIA
Dr Ahmed El Muntasar critiques ‘DIY SPF’ trend
Aesthetic practitioner Dr Ahmed El Muntasar has spoken out against a new ‘DIY SPF’ trend that has been circulating on social media. The trend, which has gained traction following a video by 22-year-old influencer Nara Smith, involves creators sharing homemade sun protection solutions. The recipe for this SPF alternative includes ingredients such as beeswax, shea butter, coconut oil and zinc oxide powder. Dr Muntasar has advised against the ‘DIY SPF’ trend, saying, “It’s difficult to make SPF at the right consistency and concentration. You may think you are being protected but if you mess up the ingredients, you’re not getting the protection that you want. SPF is the most important step in your skincare routine as it helps protect your skin from UV light, prevents signs of ageing and maintains the integrity of your skin.”
Reality star Jasmine Saunders discusses her under-eye treatment
Made In Chelsea reality TV star Jasmine Saunders recently took to TikTok to discuss her experience with polynucleotides under-eye treatment. The 23-year-old expressed to her followers that she felt apprehensive about the use of fillers, so this treatment appealed the most to her. “Ever since I was 14, I have had the biggest insecurity about my under-eyes. I have tried every under-eye cream there is. I am happy I got it done and my confidence is so much better,” she said. Saunders thanked Dr Edward Robinson for her positive experience, despite being “so scared.”
SkinCeuticals introduces new HA Intensifier Multi-Glycan
Skincare company SkinCeuticals has launched the new HA Intensifier Multi-Glycan serum to provide enhanced plumping effects. SkinCeuticals explains that the product contains glycosaminoglycan (glycan) compounds which are naturally present in the skin, providing hydration, skin firmness and structural support.
The multi-glycans in the serum include 1.3% hyaluronic acid, 2% dipotassium glycyrrhizate, 0.2% purple rice extract and 2% post-biotic ferment, according to the company. SkinCeuticals shares that this formulation is designed to visibly plump and reduce the appearance of fine lines.
SkinCeuticals is Registration Sponsor and In Practice Theatre Sponsor at CCR 2024. Turn to p.22 to register free now.
Aestheticare welcomes expert practitioner Faculty
Aesthetic provider Aestheticare has introduced its new Faculty of medical aesthetic and skincare specialists.
The company explains that the board – which features top practitioners including Dr Paris Acharya, Dr Karen Doherty, Khatra Paterson, Anna Miller, Dr Jaskaren Midha and Caroline Hall – will support Aestheticare’s mission for innovation and clinical excellence.
The board will offer advice on best practice, post-procedure care, optimal skincare regimens and more, focusing on the brands ALLSKIN|MED, Biretex and Heliocare, according to the company.
The group first met at the at the Pullman Hotel in London on August 12 to discuss future plans for clinical research, and how to best support Aestheticare providers.
Rebecca Walton, commercial director of Aestheticare, said, “We are incredibly excited to see the positive impact that the Aestheticare Faculty will have on the specialty. With the team’s collective expertise and vision, we hope to bring innovative solutions and elevated standards. This is a significant moment for Aestheticare, and we look forward to the contributions the Faculty will make in shaping the future of regenerative medicine.”
Crown Laboratories merges with biotechnology company Revance
Aesthetic manufacturer Crown Laboratories has announced a merger agreement with biotechnology company Revance.
The companies explain that Revance focuses on the development, acquisition and commercialisation of aesthetic and therapeutic products, including botulinum toxin DAXXIFY. By the end of this year, Revance will be wholly owned by Crown. Plans for distribution of Revance products in the UK are yet to be disclosed.
Jeff Bedard, founder and CEO of Crown, reflected, “This is a significant step forward in Crown’s vision to become a fully integrated global aesthetics and skincare company. Revance has an impressive track record in developing innovative aesthetics offerings that will complement Crown’s innovative line of skincare products. We have the opportunity to create a comprehensive portfolio of high-growth products for all stages of life.”
Crown Aesthetics is exhibiting at CCR 2024. Turn to p.22 to register free now.
Skincare
The Aesthetics Awards wins bronze at national ceremony
The Aesthetics Awards has taken home a Bronze prize for Best Longstanding Awards Event at the Awards Awards 2024.
Held at City Central at the HAC, the ceremony marked the best events, venues, suppliers and awards providers in the UK. The Aesthetics Awards has been recognised for its outstanding contribution to the medical aesthetic specialty, its stringent judging process and luxurious ceremony. Its Advanced Accreditation from the Independent Awards Standards Council proves the quality of the entry standards and process.
BACN UPDATES
The Aesthetics Awards has now been recognised two times in as many years, after receiving the Best Development of an Existing Awards Event accolade at the 2023 ceremony. Shannon Kilgariff, editor and event manager at Aesthetics, reflected, “It is such a proud achievement to win a prize at the Awards Awards yet again. Every single year, The Aesthetics Awards team, judges, entrants and sponsors put in so much effort to make it the highlight of the aesthetics calendar, and it is lovely to be recognised for doing so. We cannot wait to do it all over again next year and make it bigger and better than ever!”
Entry for The Aesthetics Awards is open now at aestheticsawards.com until October 25. You must be an Elite Member of Aesthetics to enter. Head to aestheticsjournal.com to sign up now.
Aesthetic manufacturer Teoxane has enhanced its product authentication process with holographic seals and distribution QR codes.
Teoxane explains that from July 2024 onwards, every product box from the company now includes a holographic seal of authenticity. Each box also has a unique LOT number so its progress through the manufacturing and distribution process can be tracked to ensure authenticity. A QR code on the box will allow practitioners to double check the authenticity of this process, ensuring it has been safely delivered to the UK.
Hannah Nolan, national sales manager at Teoxane UK, said, “As one of the world’s leading dermal filler brands, we integrate expertise and meticulous attention to detail into every step of the process, so that our partners and their patients can be assured that every box of Teoxane dermal filler is safe and of the highest quality that they have come to expect. The introduction of our new two-step authentication process will help to fortify and protect our HCPs and patients, ensuring the legitimacy of the Teoxane products.”
NAME CHANGE
Following a membership vote and Extraordinary General Meeting held on July Friday 12, the resolution to change our association name from The British Association of Cosmetic Nurses (BACN) to The British Association of Medical Aesthetic Nurses (BAMAN) has been passed.
More than 96% of votes approved the association’s new name, and we are now starting the re-branding process. This will be a long process, but we will transition to our new identity, British Association of Medical Aesthetic Nurses, over the next few months.
AUTUMN CONFERENCE
With BACN Autumn Aesthetic Conference just next month and 75% of tickets already sold, this year’s event is shaping up to be our biggest yet. On September 26 and 27, the BACN will be welcoming an exceptional line-up of speakers, sponsors and exhibitors to The Eastside Rooms, Birmingham.
Join us to hear from experts like pharmacist Gillian Murray on ‘The Latest in Prescribing in Medical Aesthetics’, cosmetic physician Dr Bibi Maryam Ghalaie on ‘Optimising the Cleft Lip: A Non-Surgical Approach’ and ‘Polynucleotide HPT: The Formula to Improve Skin Quality with a Focus on Periocular Area’ with nurse prescriber Julie Scott.
With 15 nurses already announced on the line-up, this year’s conference is a testament to the ongoing recognition of the importance of nurses’ contributions. We are so proud to provide a place for nurses to gather, share research and contribute their invaluable expertise.
We’ve kept ticket prices as low as possible to ensure accessibility for everyone, making this an inclusive event for all medical professionals. View the full agenda and get your tickets online now at www.bacn.org.uk/events or via the QR code below.
This column is written and supported by the BACN
Event Spotlight: Explore Integrated Skincare with SkinCeuticals
Aesthetics speaks to medical relations manager
Ines Benassou about what we can expect from SkinCeuticals at CCR 2024
Why did SkinCeuticals want to be Registration Sponsor and In Practice Sponsor?
We’re a brand that’s backed by science and that supports science. We’re proud sponsors of CCR, as it aligns with our education mission and provides prime development and support for medical aesthetic professionals. It’s an honour to continue to sponsor the In Practice stage, a prime example of quality upskilling highlighting local and international key opinion leaders. What can CCR attendees expect from SkinCeuticals this year?
It’s all about ‘Protecting your Investment with SkinCeuticals Integrated Skincare’ this year. We’ll be highlighting this in two panel presentations: Beyond the Beam and Beyond the Needle, respectively exploring integrated skincare in laser procedures and with injectables. In these presentations and at the booth, we’ll be highlighting this year’s new launches: Cell Cycle Catalyst, P-Tiox and HA Intensifier Multi-Glycan. The incredible clinical results from the UK aesthetic experts panel cases speak for themselves!
When it comes to integrating skincare with in-clinic procedures, from peels to injectables to lasers, there is a SkinCeuticals routine that was specifically developed and clinically tested to optimise results. At a time when patient retention is crucial, SkinCeuticals offers the results that patients need, the products patients look for and the support to businesses to enhance profitability while continuing to provide superior services.
What are you most looking forward to about CCR?
It’s such a wonderful event to reconnect with peers and professionals in the specialty. We look forward to building new connections and identifying new business opportunities. Beyond this, we’re excited to upskill the attending healthcare professionals and get invaluable feedback to continue to improve our offering and support.
Recruitment
Dr Sophie Shotter is appointed as Aesthetics CAB member
Aesthetic practitioner Dr Sophie Shotter has been appointed as a member of the Clinical Advisory Board (CAB) for the Aesthetics Journal.
Dr Shotter is a leading aesthetic practitioner known for her expertise in advanced skincare and non-surgical treatments. She founded Illuminate Skin Clinics, offering patients a range of advanced aesthetic treatments. Beyond her work at Illuminate, Dr Shotter has established herself as a global trainer, sharing her expertise with other professionals in the specialty and joining the BCAM board of trustees.
The CAB is a panel of experts in the medical aesthetic field that help shape the editorial direction of the Aesthetics Journal, ensuring it remains a trusted source of information in the aesthetics speciality. Dr Shotter’s dedication to patient safety and innovative techniques have made her an exemplary candidate for the CAB.
Dr Shotter commented, “I’m delighted to have been appointed to the Clinical Advisory Board. The Aesthetics Journal is committed to providing the best educational platform and the best events in the UK, and to be asked to be a part of that journey means a huge amount.”
Dr Shotter is speaking on behalf of Crown Aesthetics at CCR 2024. Turn to p.22 to register for free now.
Distribution
Dermapure adds Epionce to distribution portfolio
Aesthetic distributor Dermapure has adopted skincare brand Epionce. Dermapure explains that it has been in business for 18 years, making its adoption of Epionce almost seamless. The skincare brand takes an ‘education first’ approach, the companies explain, with a broad range of skin product options for practitioners to share with their patients.
Gary Baulch, CEO of Dermapure Clinical, said “I am excited to work with Epionce, having admired their products and ethos for many years. Working with Epionce will enable us to expose more clinics to our unique approach to skincare distribution, focusing on education and training. We look forward to forming new connections with like-minded skincare professionals.”
Treatment
Pure Tone introduces LED and infrared treatment
Aesthetic device company Pure Tone Aesthetics has launched the Beauty Rock LED light and infrared skin treatment device.
The device uses high-grade LEDs to deliver a range of colour wavelengths, integrating near- and far-infrared technologies to address various skin conditions and reduce signs of ageing, according to the company. Pure Tone states that the device aims to reduce the appearance of fine lines and wrinkles and diminish signs of ageing by increasing collagen production.
Steven Ballard, director at Pure Tone, said, “The overwhelmingly positive response and transformative results from Beauty Rock LED have exceeded our expectations, affirming our commitment to innovation and excellence in aesthetic technology.”
Pure Tone Aesthetics is exhibiting at CCR 2024. Turn to p.22 to register.
Device
Hydrafacial launches Verified Provider Programme
Aesthetic device company Hydrafacial has debuted its Verified Provider Programme, guiding patients towards certified practitioners through the use of stickers in clinic windows.
The company explains that the Programme was set up in response to copycat and counterfeit products emerging on the market, hence they were keen to highlight those practitioners trained to deliver genuine treatments.
Aesthetic practitioner and certified Hydrafacial provider Dr Kamran Amjed said, “I’ve been passionate about Hydrafacial since my medical school days, and it has remained a cornerstone treatment throughout my career. Hydrafacial was our first investment – an obvious choice given its unparalleled results. Being recognised as a Verified Provider affirms our dedication to delivering premium, versatile treatments that consistently exceed expectations.”
Hydrafacial is exhibiting at CCR 2024. Turn to p.22 to register free now.
Threads
Sinclair Silhouette Soft threads receive EU MDR certification
Aesthetic manufacturer Sinclair has announced that its Silhouette Soft line of threads has received EU MDR Class III Certification.
The company explains that the certification demonstrates the safety and efficacy of the range, in line with the high standards of the MDR regulatory framework. The threads are designed for face and neck reconstruction to improve asymmetry and ptosis, according to Sinclair.
Sinclair’s chief marketing officer Philip Norstrand commented, “Sinclair prides itself on delivering innovative and unique solutions to directly address the needs and challenges of our customers. This certification validates our ongoing focus to provide products that are backed by extensive research and testing.”
Conference
BCAM shares details of
upcoming conference
The British College of Aesthetic Medicine (BCAM) is set to hold its annual conference on September 21. The association has shared that the event agenda will welcome 22 speakers across the day. One brand new session is the Complications Case Studies where members can anonymously share complications cases to be reviewed by an expert panel. The BCAM Research Award is also set to reward exemplary research, and BCAM Examinees will be recognised in a congratulatory presentation. The exhibition will showcase 23 exhibitors, including headline sponsors Allergan Aesthetics and Evolus, and a drinks reception will be hosted by Hydrafacial.
BCAM trustee Dr Sophie Shotter commented, “I am so excited to bring together the agenda for this year’s BCAM Conference. We have some amazing speakers attending from the UK and beyond, and will continue with our TED-x style agenda of shorter, highly impactful talks. The conference will provide great opportunities to catch up with friends and colleagues.”
BCAM is at CCR 2024. Turn to p.22 to register.
60
Kelly Harding, National Sales Manager and Clinical Lead EBD at Sinclair UK…
Tell us about your background in aesthetics…
Following qualifications in anatomy and physiology, and BTEC in laser and light tissue interaction, I started working in clinics specialising in energy-based devices. I instantly found myself drawn to laser technology and how impactful it can be for a wide range of concerns, both cosmetic and medical. After a decade treating patients, I moved on to the manufacturing side of the industry – specifically in clinical leadership. I very quickly realised that this side of the specialty is where I am best placed, and I thrive on making changes to how technology can enhance business.
Favourite product from the Sinclair portfolio?
My favourite product in the Sinclair portfolio is Primelase due to its speed and effectiveness for hair removal, as well as the option to add additional handpieces to enhance treatment offerings and create additional revenue streams.
What are you looking forward to in 2025?
The past year has been focused on building internal processes as a new division of Sinclair. In 2025, I am looking forward to building relationships with new customers, diversifying our portfolio and working with our injectables customers to support their journey with Sinclair devices.
One piece of advice that has stuck with you…
Both my parents were hairdressers in London and had their own salon. They would always talk to my sister and I about the importance of professionalism and how, in any circumstance, customer service and experience should be at the forefront of everything. I have kept this with me throughout my whole career and it remains my top priority.
This advertorial was written and supplied by Sinclair
Jackie Partridge’s Expert Insights
Jackie Partridge is a nurse prescriber and clinical director of Dermal Clinic. She is a founding board member of the BACN, and is now an honorary member.
Here, Aesthetics shares her tips on holistic treatments for patients…
How do you assess what topical treatments are suitable for patients based on their skin condition?
When assessing patients’ skin, I use a VISIA scanner to see fundamentally what’s happening with the skin. We use a lot of vitamin A products and other actives so we can step patients up or down, depending on reactions to topical skincare. By combining topicals like this with medications, we can target most common conditions for patients.
What are your preferred topicals to use for skin rejuvenation?
It depends on the individual presentation. For example, I might use azelaic acid for a patient with rosacea, whereas I might use prescription medication for a patient who has acne-prone skin. It is dependent on the patient, and a case-by-case approach is necessary.
How do you balance patients’ profiles when treating both the lips and chin?
Profiling is something I’m passionate about. When I’m presenting or teaching for Galderma, I emphasise that it’s crucial to assess the patient. I scan patients’ thirds from superior to inferior, as well as the fifths across a patient’s face, looking at balancing and assessing on animation too.
What are your top pieces of post-treatment skincare advice for after injectable procedures?
Less is more. I don’t want any overly active skincare ingredients to be used on their skin, and I want my patients to avoid any vigorous massages when applying post-treatment skincare. So, whatever patients are using, I want them to do it gently. And of course, SPF is a must.
As a trainer for various treatments, can you tell us about any upcoming educational talks/events you have planned?
I’m presenting at CCR on Thursday October 10 with Galderma, which I am really looking forward to. I’ll be discussing product selection, as well as the importance of understanding anatomy when looking at augmenting a patient’s temple.
LED Treatment
Dermalux debuts Tri-Wave MD
LED device
LED phototherapy provider Dermalux has unveiled its new Tri-Wave MD. The company explains that the device incorporates the largest adjustable four-pod head in the Dermalux range, providing LED treatment using multiple wavelengths over broad skin areas.
The device uses blue light with antibacterial purposes, red light to accelerate activity in the skin and near infrared light to aid skin function with up to 240 j/cm² in a single treatment session, according to Dermalux. The Tri-Wave MD also features a patent-pending Cooling System to improve patient comfort.
Nurse prescriber Kate Monteith-Ross reflected, “The Dermalux Tri-Wave MD stands alone in the specialty, there is no comparison – there is nothing else which is able to achieve what it can achieve. In my opinion, in a few years’ time, having a Dermalux device in every clinic will be a necessity and not a choice. It’s not a matter of if, but when.”
Dermalux is exhibiting at CCR 2024. Turn to p.22 to register free now.
Aesthetic Supplier
Online pharmacy Complete Clinic Supply launches
New pharmacy Complete Clinic Supply (CCS) has opened to provide a range of aesthetic injectables, devices and accessories.
The company explains it will offer products including dermal fillers, toxins, radiofrequency devices and lasers, alongside other essentials such as consumables, scrubs, clinical photography equipment and more.
Co-founder and aesthetic practitioner Dr Mohamed Harb commented, “I’m so excited to launch CCS, introducing my one-stop shop for clinics and practitioners and addressing the specialty’s supply chain challenges head-on. As a practitioner myself, I’m passionate about creating practical solutions. This is just the beginning – the vision for CCS is being more than just another supplier. Our commitment to growth focuses on empowering our customers and their businesses to thrive alongside us.”
Skin
DIBI Milano expands Body Vitality skincare line
Jackie Partridge is speaking at CCR on Optimising Outcomes with Restylane. Turn to p.22 to register.
Dermocosmetic skincare company DIBI Milano has extended its Body Vitality range with the addition of two new skincare products.
The Body Vitality Retinol Smoothing Cream contains retinol in cyclodextrin, which aims to promote skin renewal and improve tone, says the company. The cream, suitable for dry skin, also includes centella asiatica to aid epidermal repair.
The Body Vitality Revitalizing Bath Cream includes probiotics for gentle daily cleansing, according to the company. Key ingredients include lacto-probiotic and probiotic, intended to maintain the skin’s natural barrier.
Andrea O’Donnell, head of education at DIBI Milano, commented, “The new revitalising cleanser is enriched with probiotics. Complete your routine with our advanced anti-ageing body cream, infused with retinol, and designed to smooth texture and reduce wrinkles, leaving your skin firmer and brighter.”
DIBI Milano is exhibiting at CCR 2024. Turn to p.22 to register free now.
Distribution
Dermaze introduces two aesthetic devices
Aesthetic distributor Dermaze has launched in the UK, distributing two devices to aesthetic clinics.
Set up by nurse prescriber Alison Taylor, Dermaze provides the Ultra Wave and Laser Trim devices. She explains that Ultra Wave uses 12D HIFU and lipo HIFU for skin tightening and contouring of the face and body. Meanwhile, the Laser Trim is a green, low-level 532 nm laser designed for fat loss, targeting the subcutaneous fat layer so no fat cells are destroyed, she says.
Dermaze is exhibiting at CCR 2024. Turn to p.22 to register free now.
Skincare distribution company AestheticSource has introduced the at-home Exuviance Retinol Correcting Peel.
The company shares that the peel pads are designed to be used weekly in order to address dark spots from age and signs of sun damage, aiming for a more even complexion. The product is formulated with 0.3% pure retinol, plus 10% CitraFill to support the skin’s natural collagen.
Founder of AestheticSource Lorna Bowes commented, “The Exuviance brand has been a firm favourite for years; the exceptional formulas take known ingredients to new levels of efficacy and customer experience. This home peel lives up to its name and is a powerhouse worth exploring.”
Practitioner Support
Rent My Clinic launches new platform
Rent My Clinic, a new peer-to-peer marketplace platform, aims to transform the rental market in aesthetics by connecting clinic owners with healthcare professionals.
The platform looks to address the challenge of securing professional clinic spaces when expanding to new locations. This initiative aims to streamline the process of finding and renting clinic spaces, benefiting both clinic owners and healthcare professionals in the aesthetics specialty.
Rent My Clinic explains that clinic owners can list underutilised spaces on the platform, creating opportunities for passive income and optimising the use of the available space.
According to the company, healthcare professionals can have the flexibility to choose the workspace based on their specific needs, allowing them to deliver their service in a professional environment. Rent My Clinic is exhibiting at CCR 2024. Turn to p.22 to register free now.
Complications HSCAMP debuts patient complaint management service
Health and Social Care Complaint Adjudication Management Partners (HSCAMP) has unveiled an adjudication service for complaints made by patients after aesthetic procedures.
HSCAMP explains that practitioners and clinics can subscribe to the service whereby patient complaints are referred to a third party, potentially allowing complaints to be resolved in 28 business days without the need for an investigation or court appearance. Having a provision such as this in place can also be beneficial for Care Quality Commission (CQC) validation, the company states.
Plastic surgeon and co-founder Mr Rohit Seth said, “External adjudication through HSCAMP significantly enhances trust, accountability and efficiency in healthcare complaint management. By using the established principles of the Parliamentary and Health Services Ombudsman (PHSO) and CQC, HSCAMP provides independent, transparent and data-driven solutions, fostering a culture of continuous improvement and support for healthcare providers, and delivering better patient outcomes and satisfaction.”
Supplements
Minerva reformulates two Gold Collagen supplement products
Supplement provider Minerva has unveiled new formulations for the Forte Plus and Pure Plus liquid collagen products.
The company shares that Gold Collagen Forte Plus, which is formulated specifically for women over the age of 40, now contains 8,000 mg of hydrolysed marine collagen. Out of a clinical trial on 120 subjects, 95% felt the product made their skin feel more hydrated, 92% noticed an increase in skin elasticity and 87% said they felt younger.
The Gold Collagen Pure Plus now contains 8,000mg of hydrolysed bioactive marine collagen, aiming to promote youthful skin, support hair growth and enhance overall wellness.
Jennifer Lozano, research and development specialist, said, “Our relaunch of Gold Collagen PURE PLUS and FORTE PLUS marks an exciting step forward. Now enhanced with 8g of collagen, PURE PLUS features 17 active ingredients, while FORTE PLUS boasts 23. These upgraded formulas incorporate advanced technology, offering enhanced skin hydration, reduced wrinkles and support for healthy hair, nails and overall wellbeing.”
Rebuild. Replenish. Recover.
Introducing NEW Obagi Medical Rebalance Skin Barrier Recovery Cream.
of study participants felt that the product soothed and hydrated post procedure skin* 94%
of the study participants felt that the product was well tolerated by their sensitive skin* 94%
of study participants showed an improvement in skin hydration after the �irst use*
Connections
BCAM hosts first Regional Meeting education event
The British College of Aesthetic Medicine (BCAM) hosted its first Regional Meeting at Bank MediSpa in Cheshire.
The event was coordinated by aesthetic practitioner and BCAM Full Member Dr Ahmed El Houssieny. The agenda incorporated a live Hydrafacial demonstration, a talk on regulation and education with Dr Tamara Griffiths and an update on BCAM’s current and future projects by chief operating officer Jamie Lennon.
Dr El Houssieny commented, “I am honoured to have led the first BCAM Regional Event here in the North West. BCAM are strong advocates for raising standards and protecting the public. It was a pleasure to connect with colleagues old and new outside of London, and to provide education and networking opportunities.”
BCAM explains that the Regional Meetings are designed to enhance education and networking on a local level, and are currently looking for Regional Leaders to host meetings: North East and Scotland; North West and Yorkshire; West and East Midlands; West and Wales; South West; South East; Northern Ireland and Ireland.
Suncare
Princess Beatrice highlights sun safety with BSF
HRH Princess Beatrice of York has visited a London school to raise awareness of the British Skin Foundation’s (BSF) sun safety campaign.
The princess joined nine- and 10-year-old students at St Mary’s & St John’s CE School in North London as part of the BSF’s More, More, More campaign. The charity explains that this is designed to help children become aware of how to protect their skin. The campaign followed a BSF survey of 250 British parents which found that 60% agreed school staff encourage sun safe behaviours, but only 15% said their children are taught about sun safety in lessons. Only 8% of the parents said their children have access to sunscreen dispensers while at school.
Consultant dermatologist Dr Anjali Mahto helped the children understand the importance of wearing more protective clothing, using more sunscreen and seeking more shade during the summer.
HRH Princess Beatrice said, “Protecting your skin from a young age is essential for overall skin health. It was fantastic to see the children at St Mary’s & St John’s learning about the British Skin Foundation’s More, More, More campaign.”
Event
BACN Autumn Aesthetic Conference returns
The British Association of Cosmetic Nurses (BACN) Autumn Aesthetic Conference 2024 is set to return to Birmingham on September 26 and 27 at The Eastside Rooms. According to the BACN, the venue serves as a central hub for more than 300 members traveling from across the UK.
The Autumn Aesthetic Conference 2024 will feature a line-up of speakers, presentations and demonstrations. The exhibition space has also been expanded to accommodate Headline Sponsors Church Pharmacy and PCA Skin, along with others such as DermaFocus, FILLMED, Hydrafacial and 5 Squirrels.
Gareth Lewis, head of operations at BACN, commented, “The BACN Autumn Aesthetic Conference is a real highlight in the aesthetics calendar, and encapsulates the BACN’s commitment to supporting members in their pursuit of best practices. The award-nominated conference provides medical professionals with two full days to engage with peers and enhance their expertise in an educational setting.”
BACN is exhibiting at CCR 2024. Turn to p.22 to register.
News in Brief
Dr Yusra Al-Mukhtar launches Radiesse training
Dr Yusra Al-Mukhtar has introduced a Radiesse Masterclass as an approved Merz Training provider. She explains this is a full training programme to include on- and off-label use of Radiesse, including hyperdilute Radiesse for collagen stimulation and texture refinement. The trainers Dr Al-Mukhtar, Dr Aneesha Ahmed and nurse prescriber Helen Blanchard will also explain anatomical considerations for the face, neck, décolletage, hands and injection techniques for face and body. The first masterclass will be in Liverpool on October 24.
CACI introduces new advanced energy boosters
Skincare solution brand CACI has launched new Super Charge Energisers sachets designed to boost microcurrent treatments and enhance conductivity. Each sachet contains electrolytes, along with vitamin C, marine collagen and niacinamide, to help contribute to skin hydration, according to the company. Niki Bassil, CACI’s marketing manager, said, “Incorporating Super Charge Energisers into your CACI treatment options can offer enhanced results at a minimal additional cost, making it a win-win for both you and your patients.”
Phorest presents new video ad feature Software provider Phorest has introduced a new video ad feature in its ads manager, with the aim to improve how clinics engage with patients. According to the company, this update allows clinics to create and manage video ads for Instagram, enhancing engagement by influencing dynamic content.
Phorest’s new feature offers clinics new options for showcasing their services and allows them to monitor reach, impressions, click rate and bookings, says the company.
Edyta Laveryd, Phorest senior product manager, commented, “This medium allows clinics to showcase their work, environment and team spirit in a format that users love and engage with the most.”
Lynton announces rebrand Aesthetic manufacturer Lynton is rebranding to celebrate its three core components: heritage, education and good humans.
The rebrand’s key features include a refreshed visual identity, updated digital platforms and increased investment to support customers. Managing director Dr Jon Exley said, “We are excited to continue building on our success and supporting our customers with every interaction.”
Lynton is at CCR 2024. Turn to p.22 to register.
Discover the wonder of polynucleotides
An Italian excellence Since 1952
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Tackling Counterfeit Products
Aesthetics investigates the measures companies are taking to fight the problem of counterfeit products
This month, two leading companies in the medical aesthetics field have announced new measures to prevent practitioners from being misled into accidentally purchasing counterfeit products.
Aesthetic manufacturer Teoxane has upgraded its product authentication with holographic seals and distribution QR codes. Starting from July 2024, every product box now features a holographic seal and a unique LOT number for tracking through the manufacturing and distribution process. The company explains that a QR code allows practitioners to verify the products’ authenticity and safe delivery to the UK.
In a similar vein, aesthetic device company Hydrafacial has debuted its Verified Provider Programme, guiding patients towards certified practitioners through the use of stickers in clinic windows. The company explains that the programme was set up in response to copycat and counterfeit products emerging on the market.
These are not the only instances in the aesthetics sphere of preventative measures being implemented, with international pharmaceutical company IBSA Derma having introduced a new hologram label on Profhilo products last year.1 Other brands such as AlumierMD and FILLMED have also already enforced similar measures. Counterfeit products are clearly emerging as more and more of an issue in the aesthetics specialty. The World Health Organisation (WHO) issued a global warning in June regarding fake versions of weight loss injection Ozempic, after the Medicines and Healthcare products Regulatory Agency (MHRA) seized batches of pre-filled pens falsely labelled as Ozempic from two UK wholesalers in October 2023.2 Thousands of pounds of unlicensed products used in cosmetic injections were also seized from a warehouse in Scotland earlier this year.3
We spoke to Andrew Rankin, board trustee of the Joint Council of Cosmetic Practitioners (JCCP), and HA-Derma’s sales and marketing director Iveta Vinklerova to find out how practitioners can source legitimate products and protect patients.
What are counterfeit products?
The supply chain for cosmetic medical products involves a series of regulated steps from the manufacturer to the final seller, with varying regulations for medicines, medical devices and other products. Each supplier in the chain is responsible for maintaining product safety. A counterfeit product is one that enters this chain illegally or bypasses it entirely, often originating from organised crime. Counterfeits may be imitations or stolen legitimate products reintroduced into the system, making it difficult for the end user to detect them.4 Counterfeit products pose risks to public safety and professional credibility, says Rankin. “The problem of fake and counterfeit products has long been a concern to all the responsible manufacturers that the JCCP work with, and it is increasingly a concern in the cosmetic sector for trading standards and environmental health officers as part of their enforcement activity. They often lack the necessary safety standards and may contain harmful ingredients.” He adds that these products are known to have been a cause of death in some countries. “There is much evidence in the UK of harm associated with non-compliant weight loss injections, and some suggestion of harm associated with non-compliant dermal fillers,” he explains. Not only are they harmful to patients, but Vinklerova warns that using them can also negatively impact the reputations of the practitioners and aesthetic companies involved. “Ensuring that only genuine products are used helps maintain trust and credibility with patients,” she says. Using counterfeit products can also make your insurance invalid.4 Vinklerova explains that the rise in counterfeit products can be attributed to online marketplaces. She says, “The rise of online platforms, social media and online wholesalers has made it easier for counterfeit products to reach consumers. There is no regulation in terms of the online sale of medical devices. Anybody can open an online shop and start selling. These platforms allow counterfeiters to sell fake goods directly to consumers,
often bypassing official channels and regulatory oversight.”
Spotting counterfeit products
While counterfeit products can be difficult to detect, a visual inspection remains an important element of due diligence for the practitioner, explains Rankin. He says, “Outer packaging must be intact with the product details legible in English, and with the CE or UKCA mark clearly displayed for medicines and medical devices. Inside the outer package, the product must also be intact and the patient information leaflet or instructions for use must be present and legible. For additional security, some manufacturers incorporate a holographic seal as a guarantee of authenticity.”
He adds that other initiatives, including by Teoxane for example, include a QR code which can be used both to confirm authenticity and to determine that the product has been safely managed throughout the distribution channel.
Vinklerova notes that prevention is the best way to tackle counterfeit products, explaining that practitioners have a duty of care to only source the products from the official supplier or wholesalers who are part of the official supply chain.
Reporting counterfeit products
To counter criminal activity and to help ensure continued public safety, Rankin says that all suspected counterfeit medicines and medical devices must be reported to the MHRA via the Yellow Card Scheme.5 “It is likely that, under a future framework of licensing, practitioners will need to have the appropriate policies and procedures in place to demonstrate legitimate product sourcing through authorised routes, and the JCCP will be publishing guidance to assist practitioners in making these determinations. To protect both themselves and their patients, the simple step of identifying a supplier that has been authorised by the manufacturer (or their UK representative) is a key approach the practitioner should take,” he states.
Vinklerova encourages anyone who has experienced counterfeit products to tell the official supplier/manufacturer and share information about the product with other clinicians. “Practitioners should also ensure any future purchases are made from authorised distributors or directly from manufacturers to avoid counterfeit products,” she concludes.
Hero Products: Topicals
A selection of trending products to revitalise the skin
Night Repair Therapy
Consultant dermatologists Professor Chris Griffiths OBE and Dr Tamara Griffiths have developed The Skin Diary Night Repair Therapy. Designed to rebuild collagen and elastin, the formula is proven to the highest level of scientific evidence: double-blind, placebo-controlled clinical studies in human skin. The formula’s bilberry acts as a potent inhibitor of hyaluronidase, collagenase and elastase, which cause tissue degradation. Lycopene protects from photo-oxidative stress, while retinyl-ester and cell-communicating peptides rebuild the cellular structure. A published human skin study indicated increased fibrillin and collagen equivalent to retinoic acid. Ceramides, fatty acids and humectants optimise active ingredient absorption and skin barrier function.
RRP £135
GF5TM Next Generation
The revolutionary GF5TM Next Generation super-serum from CellDerma delivers an innovative combination of 25 active ingredients to complement every skin type! Experience the “magic” many users refer to, from trauma survivors, including those with burns, to individuals receiving treatments like Morpheus8 or simply opting for an at-home treatment. Contact us at hello@cellderma.com and quote ‘AJ10’ to become a stockist, and receive an exclusive discount on your opening order until 30 th September.
RRP £165
Azelaic Forte 25
NOON Aesthetics™ Azelaic Forte 25 is a medical-grade formula combining 25% Azelaic Acid and 5% Alpha Arbutin, targeting textural irregularities, dullness and uneven skin tone while intensely focusing on problematic pigmentation without affecting overall melanin production. Complete with NOON Aesthetics™ patented DermShield™ technology, this allows for the highest potency of ingredients without irritation and inflammation. Exclusive to clinics. To enquire about becoming a stockist, visit our website or email info@noon-aesthetics.co.uk.
RRP £55.50
noon-aesthetics.co.uk
Elevate your Expertise
CCR unites the medical aesthetics community, bringing cutting-edge innovations and the latest scientific research
In an ever-changing and fast-paced field, medical aesthetics is constantly evolving, with new innovations and techniques emerging. This rapid pace makes it challenging for practitioners to stay updated with the latest evidence-based solutions to optimise patient outcomes - making collaboration and discussion absolutely essential.
This year’s Clinical Cosmetic Regenerative (CCR) Congress, brought to you by Aesthetics, will be like no other. On October 10 & 11 at ExCeL London, you can discover world-class educational programmes, innovative solutions and unparalleled networking opportunities, allowing you to elevate your expertise and keep updated in this ever-changing environment.
Immerse yourself in the latest products and solutions
CCR offers a prime opportunity to explore cutting-edge products and solutions covering all areas needed in your aesthetics clinic, from clinical innovations to business solutions. Connect with your favourite brands, including key sponsors such as Alma, Crown Aesthetics, DermaFocus, DermapenWorld, SkinCeuticals and Zenoti plus many more.
Returning as the Headline Sponsor, leading pharmaceutical company Galderma will deliver exclusive, ground-breaking presentations at CCR covering its whole portfolio of aesthetic solutions. Don’t miss this chance to witness innovations, test and benchmark solutions, and foster valuable relationships with leaders in the field.
NEW: Injectable Avenue
Step into the new Injectable Avenue, showcasing the latest hyaluronic acid fillers and botulinum toxin treatments and techniques, and enjoy direct access to the unmissable Aesthetics Journal Arena. Among the brands represented are Galderma’s Restylane portfolio, Skin Tech Pharma’s RRS range, Sisthaema’s Hevo-T bio-stimulator, iD Clinica’s fillers, Medfx’s range of injectables, the leading BCAM and BACN associations, plus more!
Discover cutting-edge aesthetics at the Korea Zone
South Korea has long been recognised as a trailblazer in the medical aesthetics specialty, consistently leading the charge with innovations that often reach global markets years later. Korean aesthetics is synonymous with cutting-edge technology, meticulous techniques and a deep cultural emphasis on flawless skin. But what are the newest trends emerging from Korea, and how can we in the UK stay ahead of the curve?
One way to stay updated is by exploring the Korea Zone at CCR, presented in partnership with IBITA. This unique platform brings the best of Korean innovations directly to you, offering a firsthand look at the products, techniques and technologies driving the future of aesthetics.
From revolutionary skincare formulations to advanced medical devices, the Korea Zone is your gateway to understanding and adopting the next wave of aesthetic trends. By engaging with leading Korean companies and experts, you can gain invaluable insights into the future of aesthetics, ensuring that your practice remains at the cutting edge of the specialty.
Expand your knowledge and gain CPD points
As ever, CCR is not simply about the products and solutions, but the community that has been built around it. This year’s conference offers inspiring CPD-verified educational sessions led by world-renowned thought and key opinion leaders (KOLs) discussing injectables, devices, skincare, medical longevity, business strategies and more.
Aesthetics Journal Arena
Sponsored by Galderma Brought to you by the Aesthetics Journal, enhance your clinical practice with insightful talks and live demonstrations showcasing cutting-edge research and techniques. Empower your development with top-level lectures, including the Toxin Takeover, Injectable Considerations for Full Face Rejuvenation, Enhancing Injectable Treatments by Optimising Skin Health and Regenerative Aesthetics. Learn new methods and elevate patient care with protocols and live injectable demonstrations.
Key features for 2024
· NEW: Meet the Mentor
Speed Dating
NEW: Injectable Avenue
· NEW: Stand Seminars
The Aesthetics Journal Arena
· Medical Longevity Summit
LIVE demonstrations on the Symposium Stage
· In Practice Zone
Galderma Networking Lounge
· Aesthetics Awards Trail
BCAM Breakfast with Crown Aesthetics
· DermapenWorld
Networking Drinks
Innovation Trail
Medical Longevity Summit
Returning for its second year, the Medical Longevity Summit at CCR is a must-attend event for healthcare practitioners focused on promoting healthier, longer lives for patients. The two-day agenda, curated by Dr Mayoni Gooneratne and supported by the British College of Functional Medicine, will delve into evidence-based holistic care and wellness. It will feature top speakers and companies discussing longevity in medical aesthetics, patient testing, nutrition, hormonal health regenerative medicine and more.
Symposium Stage
Sponsored by DermaFocus
New: Stand Seminars
Amidst the wealth of knowledge offered on the show theatres, the Stand Seminars highlight essential educational sessions happening right on the show floor. Over the course of the two days, brands including Amedica, Dermalux, DermapenWorld, Galderma, SkinCeuticals and Solta will bring skilled practitioners to present insightful talks at their stands. This makes it easier than ever for you to plan and maximise your schedule with valuable learning opportunities.
This unmissable agenda will feature leading KOLs speaking on behalf of the biggest brands such as DermapenWorld, InMode, Lynton Lasers, Mastelli and Purasomes by DermaFocus. These sessions will enhance your knowledge, skills and confidence, enabling you to deliver outstanding and safe results for your patients.
In Practice Theatre
Sponsored by SkinCeuticals
Elevate your clinic’s success at the In Practice Theatre. Stand out from the competition and expand your business acumen. Learn the latest insights on building a brand, opening a clinic, patient relations, marketing, finance and more. Led by entrepreneurs and award-winning practitioners, these sessions provide essential commercial support to drive your clinic's success.
Innovation Stage
The Innovation Stage offers revolutionary guidance through 30-minute workshops and live demonstrations, showcasing the latest products, protocols and techniques from the specialty’s leading device and skincare suppliers. Open to all attendees, these sessions will introduce you to groundbreaking solutions that are transforming patient care and elevating clinic offerings. Expect to learn about the latest in LED technology, exosomes, pulsed light innovations and skin biome care, plus much more.
Take time out and build lasting connections
Whether you're new to aesthetics or a seasoned practitioner, CCR offers the perfect opportunity to forge valuable relationships with leading suppliers, peers and KOLs. Explore a variety of networking events, reconnect with old friends, gain insights and create new connections that will support and enhance your career in the dynamic field of aesthetics.
New: Meet the Mentor Speed Dating
Unlock your full potential in medical aesthetics by meeting a mentor in the field who is well-established in clinical practice and business skills. Our new Meet the Mentor Speed Dating is your opportunity to gain personalised insights and expert guidance, and make meaningful connections in a fun, fast-paced format. This free event is designed to pair aspiring professionals with experienced experts in medical aesthetics. Over one hour each day, engage with a variety of mentors, including Dr Zainab Al-Mukhtar, Anna Baker, Dr Max Greenfield, Miss Elizabeth Hawkes, Dr Bhavjit Kaur, Paula O'Sullivan, Julie Scott, Dr Souphiyeh Samizadeh and Dr Olha Vorodukhina.
Networking Drinks
Sponsored by DermapenWorld
Wrap up Day 1 with the DermapenWorld Networking Drinks at the Galderma Networking Lounge on October 10, from 5-7pm. Enjoy complimentary refreshments, catch up with peers, reflect on key takeaways and explore future partnership opportunities.
BCAM Breakfast with Crown Aesthetics
Start the last day energised by joining BCAM and Crown Aesthetics for a Networking Breakfast at stand D50. This unique opportunity allows doctors and dentists to connect with peers, BCAM board members and fellow practitioners over tea, coffee and pastries and discover how BCAM can support your practice.
& 11 October 2024
London
Please note, some sessions at CCR are restricted to practitioners on certain medical registers only. Full information will be on the website agendas and event app. CPD points are automatically gained by attending CCR sessions, however you must be an Elite member of Aesthetics to receive a personalised CPD certificate. Please visit aestheticsjournal.com to become a member.
CRAFT THEIR LIPS
When
Adverse events should be reported. UK reporting forms and information can be found at https://yellowcard.mhra.gov.uk or via the MHRA Yellow Card app, available at Google Play or Apple App stores. Adverse events should also be reported to AbbVie on ProductSurveillance_EAME@allergan.com.
* After treatment, Juvéderm® VOLBELLA improved lip fullness for up to 12 months in 48% of patients (N=58), including those who received repeat treatment. 4 In the study, 60 patients received initial treatment overall and 15 patients received top-up treatment at 2 weeks. Study product did not contain lidocaine. 4
Best Practices for Chemical Peeling
An exploration of different peel depths and how they should be used for optimal skin rejuvenation
Chemical peels have a long history in aesthetics, dating back to Egyptian times.1
Available in superficial, medium and deep formulations, they continue to be a common and efficacious treatment approach for lines, wrinkles, post-inflammatory hyperpigmentation, melasma, age spots, acne scarring, rosacea and more.
Here we talk to three experienced peel practitioners and trainers, focusing on each depth of peel, the typical active ingredients within the peel and how they should be used appropriately.
Superficial peels
Depth: Epidermis.
Mode of action: Mild chemoexfoliation of the corneal cell layer down to the basal cell layer.2 They produce reactive inflammation in the upper dermis, which stimulates neocollagenesis by activating fibroblasts that synthesise new collagen and elastin.3
Targeted concerns: Mild cases of hyperpigmentation, photoageing, acne, acne scarring and fine lines and wrinkles.3
Patient suitability: Fitzpatrick Skin Types I-VI (depending on formulation).2
Aesthetic nurse prescriber Anna Baker explains how a superficial peel is a perfect example of a ‘lunchtime treatment’ – a procedure that doesn’t take too long and has minimal downtime, allowing patients to get back to their daily lives immediately. “It’s also a great introductory treatment as they’re very comfortable and create a visible difference in the skin with an immediate brightening effect, while improving clarity and texture,” she says.
Active ingredients
“Generally, we’re looking for ingredients that improve cell health within the epidermis,” explains Baker, noting that superficial peels can use multiple types of ingredients, chosen based on each patient’s skin concerns. Alpha hydroxy acids (AHAs) that can exfoliate and moisturise the skin while building collagen are popular choices that can be used on all skin types, with options that include glycolic, lactic, citric, mandelic, malic and tartaric acids.2 Salicylic acid is a beta hydroxy acid (BHA) that is widely used thanks to its more intensive exfoliating properties, which can unclog pores, clear acne and prevent acne breakouts.2
“Even retinol and vitamin A compounded peels are really nice superficial formulations,” comments Baker, adding, “Gluconolactone, which has a larger molecular structure to other AHAs,4 is another lovely polyhydroxy acid (PHA) ingredient that I see good results with and is great for sensitive skin.”
She explains that she uses a broad selection of peels in her practice, which
includes the HydroPeptide lunchtime-based peels, AHA-based peels from the NeoStrata and Exuviance lines, and the skinbetter science peels.
Skin preparation and application
Baker will perform skin analysis with her Observ device prior to treatment to review concerns, and agree with the patient exactly what is being treated and what ingredients will be used. “Rarely do we see people coming in with a single concern –most patients’ skin is quite complicated and requires a blend of ingredients to deliver results,” says Baker.
For some patients, skin prep isn’t always necessary. “This is usually with patients who already have a good skincare regimen, so their skin is in good condition. It’s acclimatised to active ingredients, which means I’d be happy to perform the peel straight away,” explains Baker.
“We have to apply a deep peel slowly, and we must take breaks of 10-15 minutes between each section”
Dr Xavier Goodarzian
On the other hand, Baker says preparing the skin before a superficial peel treatment is particularly important for new patients who are aiming to amplify their skin health and skincare. “They may not be accustomed to the strength of the product, so prepping their skin can take a lot of risk out of doing the treatment on the day, as we’ll know how their skin responds to the ingredients and brand we’re going to use,” she explains.
Skin prep also means that skin cells will be well conditioned before they’re stimulated further with the peel. “We want to encourage inflammation and active pigment cells to behave and calm down before we treat them – this will really help boost results,” advises Baker.
She adds that the skin prep and peel application will largely depend on the brand of peel being used, with each having their own protocol and recommended number of treatments.
Downtime and aftercare
Patients can expect their skin to be slightly red and it may flake for a couple of days after treatment, but it shouldn’t impact their day-to-day life.2 Baker will provide her patients with supportive homecare products – usually products from the same brand of peel that she has used to maximise effect.
“I’m of the opinion that superficial peeling can be done all year around to continue to reprogramme skin to behave well and address continuous signs of ageing,” says Baker. She will step up the intensity of treatment after summer, when patients usually have more hyperpigmentation as a result of increased sun exposure.
“Maintenance can be provided monthly or every other month, depending on your patient’s budget and skin sensitivity,” she advises, highlighting that homecare is essential if they want to see improved results.
Risk of complications
Even superficial peeling can cause damage, warns Baker, noting the particular risk to dark skin types. “Post-inflammatory hyperpigmentation (PIH) is the main risk, but there’s also the potential for
hypopigmentation; while rare, it’s not as easy to reverse.3
Baker continues that all complications can be avoided with proper skin acclimatisation, knowing the technology you’re using inside out and assessing the skin beforehand. She says, “If the skin has any sign of dryness or the patient comments that it feels quite tight on the day of treatment, then we must be very cautious. In these areas I will apply an occlusive solution like Vaseline to create a barrier to protect skin. I also always add a barrier to the lips because they will not recover as quickly from a chemical burn.” I also provide eye protection for patients, which is essential safe practice.
Medium peels
Depth: Papillary dermis.
Mode of action: Skin regeneration from medium peels occurs from the cells of the follicular epithelium, which generate new layers of epidermis and stimulate the synthesis of collagen and elastic fibres.2
Targeted concerns: Moderate causes of concerns with tone and texture, sun damage, dyschromia, superficial scarring, congested skin, fine lines and wrinkles and hyperpigmentation.3
Patient suitability: Fitzpatrick IV-VI (depending on formulation).2
Aesthetic nurse prescriber Julia Mansell is an avid user of medium-depth peels. She says, “They create a controlled injury that penetrates through the epidermis, down to the papillary and just above the upper reticular dermis. This is the area we need to target if we want to create a structural change on a cellular level. The initial phase is fresh new skin, followed by improvements in pigmentation and collagen production once the skin has gone through a full cycle (usually four to six weeks).”
Active ingredients
Traditionally, the main active ingredients used to formulate medium-depth peels was 35-50% trichloroacetic acid (TCA).2 Mansell says, “These peels have always carried a higher risk of complications due to the unpredictability of the acids in the
Figure 1: Before and after one medium-depth peel with The Perfect Peel. Images courtesy of Kelly Saynor.
percentage required to reach the target depth.” They can cause crusting, scarring and prolonged healing time, while being unsuitable for patients with Fitzpatrick skin types of IV or higher.3 Now, however, there are “new kids on the block,” says Mansell, explaining, “Blended peels are the new generation of medium-depth peels, utilising a variety of acids at lower percentages. This approach results in a much-improved safety profile while still allowing them to address a multitude of concerns.” She uses The Perfect Peel (a blend of TCA, salicylic, retinoic, kojic and phenol acids, along with glutathione, vitamin C and minerals)⁶ and The Perfect Peel Super Blend (glutathione, resorcinol, pure retinol, kojic, TCA, lactic, ethyl ascorbic, mandelic and azelaic acids).7
The main highlight of blended peels, says Mansell, is that they’re suitable for all skin types.6,7
Skin preparation
Like Baker, Mansell will decide whether to prep skin prior to treatment on a case-by-case basis. “When we talk about ‘prepping’ it is usually advising the use of a pigment suppressor and/or vitamin A. Previously, this was always recommended for skin of colour patients, and the reason was to suppress the melanocyte response to the ‘injury’ to reduce the risk of PIH. With The Perfect Peel and The Perfect Peel Super Blend, the lower percentage of blended acids and inclusion of pigment inhibitors greatly reduces the risk of PIH, so prepping is often not necessary,” she explains.
If Mansell does feel like a patient would benefit from skin prep, she will start them on Hit Reset from the Glutaceuticals range. This contains an encapsulated retinol and pigmentation suppressors, as well as hydrating agents and other beneficial properties.8 She may also consider a skin barrier repair protocol if the patient has inflammation associated with pigmentation concerns, while also ensuring all patients stop the use of vitamin A products 10-14 days before treatment to control the depth of penetration of the peel.
Peel application
Mansell explains that different products will have their own application protocols, which may include rubbing the product into the skin with gloved hands or using a special brush or applying with gauze.
Peels are applied in ‘passes’ or ‘layers’, says Mansell, highlighting that this is where knowledge of the skin comes in. “It’s vital to meticulously examine the skin between applications, and record all reactions observed. Erythema, frosting and swelling are expected with medium peels, but need to be monitored as they may indicate a point at which to stop,” she advises.
The number of treatments will depend on the desired outcome, but generally comprises a single treatment or a course of two to three.
Downtime and aftercare
According to Mansell, patients can expect their skin to start peeling on the third day post facial peel, lasting until the seventh day.
“Some areas of the body may experience longer peeling time, or if a booster was used to increase the peel’s intensity, then this will of course prolong the peeling,” she says.
As you’d expect, the peeling will be more intense than a superficial peel, with Mansell describing that it will be ‘more like epidermal sheets than flaking’ and that intensity will depend on skin thickness, condition and use of homecare products.
She explains that during the peeling time, patients are advised on restrictions around face washing, makeup application, use of saunas/heavy exercise, and over moisturising, which can inhibit the peeling process. They may experience some itching and mild irritation, so advice is given on how to manage discomfort with over-the-counter analgesia and/or a cold compress.6,7
Risk of complications
“There is a risk of scarring, PIH and chemical burns when a single agent, high percentage acid peel is used,” warns Mansell. She also notes that acne may worsen in some patients at around week three, so should be warned that it may happen.
Deep peels
Depth: Reticular dermis.
Mode of action: Penetrate to the mid reticular dermis by denaturing epidermal keratin and dermal proteins. They produce protein coagulation, observed clinically as frosting. In these cases, epidermal regeneration also develops from the cells of the follicular epithelium, and there is intense synthesis of collagen and elastin that can persist for years after performing the peel.2
Dr Xavier Goodarzian notes that a deep peel, as the most invasive type of chemical peel, is usually a one-off treatment providing truly transformative results. You can also perform a deep peel in partial areas of the face, known as a regional peel, highlights Dr Goodarzian. He explains, “We’ll do a medium peel on the majority of the face, then a deep peel in areas requiring more extensive treatment such as the periorbital area or above the upper lip.”
Figure 2: Before and 12 months after one phenol-based deep peel. Patient is not wearing makeup on her skin and had not had any other treatments during this time. Images courtesy of Dr Xavier Goodarzian.
Active
ingredients
“A traditional deep peel is performed with phenol, which must be mixed with croton oil. This is a substance that makes phenol oily and allows it to penetrate deeper into the skin. The more croton oil you have in a phenol solution, the deeper it will go,”⁹ explains Dr Goodarzian.
Sometimes, peels that have a concentration of more than 50% TCA are considered deep.9 There are also solutions that use a combination of phenol and TCA,² however Dr Goodarzian notes that while these are effective, they do not give the same level of results.
The brand of peels he uses is Skin Tech. Within the range there are products that combine 8% TCA, 15% phenol and 0.5% croton oil, 12% TCA, 30% phenol and 0.5% croton oil, and the deepest that reaches 60% phenol with 1% croton oil.10
“Blended peels are the new generation of medium-depth peels, utilising a variety of acids at lower percentages. This approach results in a much-improved safety profile”
Julia Mansell
Skin preparation
Patient selection is key before any treatment moves forward. Deep peels are not advised on patients with dark skin, with Dr Goodarzian noting, “There are some practitioners who would do it on type IV, but I personally wouldn’t – it would be too risky.”
Prior to treatment, Dr Goodarzian says, “We would always advise vitamin C and sunscreen for at least three weeks, and a product with anti-tyrosine kinase ingredients for patients with pigmentation concerns is also useful.”
He continues, “For evening skincare, we can usually recommend things like glycolic, retinol and tretinoin, but we must be careful with a deep peel as overpreparing the skin with retinoids can encourage the phenol to penetrate deeper, leading to side effects. I generally don’t give tretinoin before a deep peel as it just makes the skin too sensitive.”
Peel application
Before beginning a deep peel treatment, Dr Goodarzian advises you must prepare your working environment appropriately. “It’s important to have good ventilation as you will invariably breathe in the fumes of a phenol peel,” he says, adding, “Make sure the windows and doors are open, so you get plenty of oxygen to reduce the exposure.” Appropriate PPE use is also essential.
The patient’s face is then cleansed thoroughly. They are given a combination of strong analgesics and localised injectable anaesthesia to ensure the treatment is comfortable, before the face is divided into sections to allow you to treat one step at a time. “We have to apply a deep peel slowly – it generally takes 15 minutes per section – and we must take breaks of between 10-15 minutes between each section,” explains Dr Goodarzian. This is because the use of phenol can lead to cardiac-related complications, so the patient has to be monitored carefully throughout the procedure.11,12 The number of coats applied should be based upon the severity of lentigines, rhytids and photodamage, as well as the patient’s skin thickness.9
Once the full face has been treated, an occlusive tape is applied over the entire face which will remain in place for about 12-24 hours.12
Downtime and aftercare
As expected, a deep chemical peel will come with pain and downtime. While pain is managed during the procedure itself, the anaesthesia will wear off and the inflammation will kick in once patients are home. “The face swells up and gives a hot, throbbing sensation which can be very painful and last up to eight hours. We give patients painkillers to use for the first 24 hours and sleeping pills so they can rest until the pain wears off,” explains Dr Goodarzian.
If you use a phenol of more than 15%, patients will not be able to touch or wash their face for a week, apart from to apply an antibiotic ointment in the areas where the occlusive mask has cracked,12 he advises, continuing, “From day eight, patients should use a very hydrating moisturiser and SPF 50 sunscreen, and from days nine to 10 they can start wearing makeup.”
Risk of complications
Like less invasive peels, the most common types are hypo- and hyperpigmentation. Two of the more common risks are infection and scarring. 3
Cardiac arrhythmia is generally the most feared complication associated with deep chemical peels, but Dr Goodarzian emphasises it is extremely rare, particularly now with modern techniques and formulations available.11 Deep peels have also been associated with kidney and liver toxicity.3 “If practitioners follow protocols appropriately then the risk is very small,” he comments.
Investing in chemical peels
Given the breadth of the different technologies out there, Baker notes that it is worth investing time in doing due diligence by talking to different colleagues within the community and getting some honest advice and feedback on what brands they work with and why.
Once you’ve found a brand you like and want to pursue training, ask about the ongoing support the company provides. She emphasises, “You need to know who to contact if you have a problem. Burning the skin is scary and it can still happen with superficial peeling. The key is quick intervention that will build trust and confidence with patients.”
Dr Goodarzian says you must be confident in using medium TCA peels before moving to deep peeling. Good training is of course essential. While Dr Goodarzian only performs around 10 deep chemical peels a year, he says the patients who do go ahead are always extremely pleased with their results.
Mansell concludes, “Remember, chemical peels are not a silver bullet. Patient education for management and prevention of conditions is vital. Keep learning, chemical peels are fascinating!”
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Mitochondria as a Skin Health Biomarker
Professor
Mark Birch-Machin and Dr Jessica Moor introduce mitochondrial damage
as a way to track skin ageing
Skin ageing, including the phenotypes of wrinkle formation, uneven skin tone and loss of elasticity, results from the progressive loss of cellular function. A key determinant in this process is the mitochondria, as they generate cellular ATP bioenergy. Mitochondrial damage accumulates with age in skin cells, which is further accelerated by external factors such as sunlight and pollution in 21st century life.
This article explores the connection between the role of mitochondria in the ageing process, and how mitochondrial damage can be used as a reliable and tractable marker of skin ageing for monitoring skin health and the effectiveness of skin interventions.
The structure of the skin
The skin is the body’s first defence barrier to the external environment, and is the largest organ of the human body, accounting for 15% of total body weight.1,2 There are three distinct layers of the skin: the epidermis, dermis and subcutaneous fat. The epidermis is the uppermost layer and consists mostly of densely packed keratinocyte cells that play an essential role in barrier protection, together with Langerhans cells which are involved in immune responses, and melanocytes which produce melanin for skin pigmentation.2,3 In the uppermost layer of the epidermis (stratum corneum), the keratinocytes undergo constant turnover to replace cells which have been damaged by environmental insults.2,3
The dermis is the structural connective tissue layer beneath the epidermis, with the dermal-epidermal junction separating the two layers. The primary cell type in the dermis is fibroblast cells, which provide strength and elasticity to the skin through synthesis of elastin and collagen.4 The dermis has a role in skin nourishment, extracellular matrix remodelling and skin immune response.4
The subcutaneous fat layer is made up of adipose cells, blood vessels, glands and hair follicles, and serves a purpose as an energy store and insulating layer.5
Mitochondria
Mitochondria are dynamic, energy producing organelles found in plant and animal cells, with energy produced mostly by oxidative phosphorylation via the electron transport chain (ETC), generating adenosine triphosphate (ATP).6 The number of mitochondria in each cell varies depending upon the energy requirement of the cell type, with skin cells having very low demand in comparison to skeletal muscle cells.6
However, mitochondria have a vital role in skin cells by providing energy for cell signalling, wound healing and skin homeostasis.
Unlike other organelles, mitochondria contain their own circular, double stranded DNA (mtDNA) which are found in multiple copies in the cell, encode 37 genes and contain 16,569 base pairs of DNA.7,8 Mitochondria have two separate membranes, with the ETC located in the inner membrane, which is folded to form cristae with the space inside the inner membrane known as the matrix (Figure 1).6
Human mtDNA is double-stranded, consisting of a heavy strand and a light strand. MtDNA encodes for two ribosomal RNAs (16S and 12S subunits), 22 transfer RNAs (represented by corresponding amino acid abbreviations) and 13 subunits of the respiratory chain: Complex I (ND1-6 and NDL4), Complex III (cyt b), Complex IV (COXI-III) and Complex V (ATP6 and ATP8).7,8 The D-loop is the non-coding, control region. PH, promoter of heavy strand replication; PL, promoter of light strand replication; OH, origin of heavy strand replication and OL, origin of light strand replication.7,8
Figure 1: Structure and genome of human mitochondrial DNA.6 Underline represents encoded on the light strand.
Mitochondrial damage accumulates with age, further accelerated by external factors such as sunlight and pollution
The ETC has five complexes which have roles in transferring electrons, establishing a proton gradient and ultimately ATP synthesis. However, during this process, reactive, oxygen species (ROS) are produced as a by-product due to electrons leaking from the complexes.9
Processes of skin ageing
Intrinsic skin ageing is a natural process which is inevitable in every individual, albeit at different rates due the an influence of genetics. Signs of intrinsic skin ageing typically present earlier in women than in men.10 The clinical features often appear as fine wrinkles, loss of elasticity and dryness, all of which can be exacerbated by extrinsic factors such as ultraviolent radiation (UVR) from the sun.11 Intrinsic skin ageing occurs because of age-dependent impairment of the body’s endogenous defence system that combats the naturally produced ROS, using antioxidants such as superoxide dismutase to maintain a healthy redox balance.12
Extrinsic factors such as UVR, pollution and smoking exacerbate the effects of intrinsic ageing, making visible ageing signs more apparent. Oxidative stress from the generation of reactive oxygen species has been increasingly implicated as a driving force in skin ageing, leading to loss of skin structure and function.6,14 These environmental factors can be modified to an extent, as they are often the result of individual behavioural choices, particularly regarding individual sun habits and perceptions leading to the damaging consequences of UVR.13-14
Measuring mitochondrial damage in skin over time provides a means of monitoring or tracking the efficacy of skin interventions
Notwithstanding, it is widely accepted that as mitochondria are the batteries in our cells, producing bioenergy in the form of ATP, they become inefficient as we age, concomitant with the increase of mtDNA damage and associated decline in mitochondrial bioenergetics function.14,18 This leads to decreased bioenergy and an increase in DNA damage, as well as an increase in oxidative stress.14 Eventually, this downward trend leads to skin ageing as bioenergy declines and oxidative stress increases, causing fatigued, ageing skin in combination with other age-related cellular events.14
Mitochondrial DNA as a skin damage biomarker
Mitochondria and skin ageing
The Free Radical Theory of Ageing was proposed by biogerontologist Dr Denham Harman in 1956, which suggested that when free radicals saturate antioxidant defences, the accumulation could cause cellar damage and contribute to skin ageing.15 The theory was further developed in 1972 to encompass mitochondrial involvement in the ageing process, as mitochondria are producers of copious quantities of ROS.16 This is known as the Mitochondrial Free Radical Theory of Ageing.16
Additional research led to the Vicious Cycle Theory in 1990 that proposed a cycle of damage involving ROS, thought to contribute to the ageing process (Figure 2). This theory states the accumulation of ROS can cause mtDNA damage as mtDNA repair mechanisms are limited, and this can cause mutations in mtDNA, resulting in further ROS being produced. Antioxidants can reduce excess ROS, but excessive doses of antioxidants may deplete free radicals, with low levels required for cellular communication. ROS and free radicals are damaging, but mitohormesis uses free radicals for cells to communicate with each other.17 Therefore, healthy cell communication requires a level of free radicals in the cell according to the theory. This is supported by the fact that the mtDNA is especially vulnerable to oxidative damage by ROS due to its proximity to the source of ROS from the ETC.18 However, the exact details of the theory are still under debate as the process of ageing is complex, with many aspects remaining unknown.19 More work is currently being done, with the goal of proving it beyond reasonable doubt.
It is well known and there is extensive evidence showing that chronic exposure to UVR can cause a multiplicity of effects to the skin, including skin cancer and photoageing.6,17
However, the study and use of nuclear DNA as a biomarker for skin damage has proven to be unreliable.6,14,18,22 This is largely due to inter-person differences in the context of the ability to repair UVR-induced damage in nuclear DNA. Studies have shown mtDNA to be a more useful biomarker (in terms of sensitivity and reliability in detecting cellular stress related damage) compared to nuclear DNA for several reasons.14,20-22 For example, mitochondria do not have nuclear excision repair pathways (although they exhibit some oxidative damage repair and recombinational and mismatch repair), and therefore do not have the ability to repair pyrimidine dimers caused by UVR exposure.23
Figure 2: The Mitochondrial Vicious Cycle Theory.
Mitochondria have a vital role in skin cell signalling, wound healing and skin homeostasis
Additionally, there are many genomes within mitochondria and the mitochondrial syncytium in the cell, which contrasts with nuclear genes where there are only two copies of each gene – a maternal allele and a paternal allele.6,14 Therefore, in contrast, mtDNA is present in multiple copies per cell (termed polyploidy), ranging from several hundred to several thousand dependent upon the cell type.6,14
As a result, a mixture of wild-type and damaged or mutant mtDNA can be present within the same cell. This condition or phenomenon of both wild-type and mutant mtDNA genotypes within a cell is known as heteroplasmy.6,14,23-25 This allows mitochondrial genomes to tolerate high levels of damage DNA as the mtDNA has the capacity to form a mixture of wild type and mutated mtDNA genomes.6,14,23-25 This is because mtDNA mutations are functionally recessive, so the remaining wild-type molecules compensate for any deleterious effects of mutant genomes (termed complementation) along the mitochondrial syncytium.6,14,23-25
This means that cellular dysfunction may not occur until the ratio of mutated to wild-type mtDNA exceeds a threshold level.6,10 This threshold level differs according to the oxidative capacity of the particular tissue as well as the type of mtDNA damage, whether it be deletions or point mutations.6,10 In a typical cell, this threshold level is often observed around 50% for deletions,14-17 but the threshold level is generally higher for point mutations in the range from 60% to 90% mutant mtDNA.6,14,18–20 Historically, the vast number of reports of mtDNA damage (deletions, point mutations and rearrangements) in tissues has been associated with muscle and neurodegenerative diseases, but, as a result of increased communication between dermatologists and neurologists, there is an increasing proportion which also exhibit skin manifestations such as skin cancer and premature ageing with exposure to stressors.10,24-25
Mitochondria have unique properties, such as their limited repair capability, their unprotected DNA (i.e. lack of histone) and their ability to tolerate high levels of mitochondrial damage.25 This provides a
means of using mitochondria as a sensitive and reliable biomarker or sensor of damage in cells. This idea was tested and developed in human skin by Birch-Machin’s research group in 1995 as they identified particular types of mtDNA damage in human perilesional skin from biopsies of skin cancer patients. The resulting research played a groundbreaking part in the process of pioneering this field, and the subsequent amplification of research and various applications (medical and commercial) in this area of technology.25-29
Sun exposure, pollution and mitochondrial DNA damage
Sunlight that reaches skin is comprised of 6% ultraviolet radiation (UVR), 40% visible light and 54% infrared radiation (IR).30 UVR-induced mtDNA damage includes deletions point mutation, and strand breaks.30 The 4977 base pair (bp) ‘common deletion’, the 3895bp deletion and tandem duplications have been identified in sun-exposed human skin compared to more sun-protected areas.25,31-36 Furthermore, 3715bp and 6278bp deletions have been identified in the mitochondrial genome regarding non-melanoma skin cancer.25,37 These mtDNA deletions remove portions of the genome that encode complex I (e.g. common deletion and 3895bp) but also complex IV (common deletion), which may affect ATP production and therefore contribute to skin fatigue.25,31,32,36
Similarly, the T414G point mutation or ‘ageing mutation’ has been shown to increase not only as the skin ages, but also following sun exposure as it accelerates the accumulation of this mtDNA mutation in human skin.38 Single and double strand breaks of mtDNA have been associated with UVR exposure, with the measurement via qPCR providing information of mitochondrial function.39-40 Photoaged skin is characterised, therefore, by increased types of mtDNA damage, which can act as useful markers of photoageing rather than chronological skin ageing.25,27 DNA damage is greater after exposure to lower wavelengths, hence why UVB has greater potential to damage DNA than UVA.25 An action spectrum study of
UV-induced mtDNA damage showed that the sensitivity of mtDNA damage induced by different wavelengths varies depending on cell type.41 In this study, human neonatal dermal fibroblasts and primary human adult keratinocyte cells were irradiated with increasing doses of UVR. Dose response curves of mtDNA damage were produced for each of the UVR sources and cell types, and an action spectrum for each cell type was determined by mathematical induction. Longer wavelengths found in the visible and IR regions of the solar spectrum may also have an impact on mechanisms involved in skin ageing.41 Visible and IR light together were shown to increase MMP expression, as well as damage to mtDNA and nuclear DNA and ROS generation, and visible light alone increased ROS and MMP expression.42,43
Air pollutants that affect the skin include tobacco smoke, particulate matter (PM), ozone and polycyclic aromatic hydrocarbons (PAH) that cause damage through the generation of ROS, leading to oxidative stress.44 Studies have indicated that exposure to high levels of air pollution results in antioxidant depletion, thereby promoting ROS generation and skin damage as a result of the increased oxidative stress.44-45 Tobacco smoke is one of the most studied air pollutants, and is widely recognised for being detrimental to skin health.46-49 PM includes harmful contaminants in the air, typically from vehicles and industrial fossil fuel usage, and affects more individuals than any other air pollutant.50-51 Exposing human primary dermal fibroblasts to PM has been shown to induce changes associated with skin ageing, as well as the novel observation of inducing changes in mitochondrial respiratory chain enzymes and transcripts.52-53 Ozone is thought to be one of the strongest known oxidants to which human skin is frequently exposed, contributing to extrinsic ageing of human skin, particularly in combination with PM in terms of cellular biomarkers.54-56 PAHs are capable of adsorbing into the surface of PM and exerting their own damaging effects.44,51,52-53
Mitochondrial DNA in monitoring skin health and ageing
The analysis of the role of the mitochondria in oxidative damage and skin ageing is an increasing area of dermatological research and commercial applications. Although many routine dermatotherapeutics modulate mitochondrial function, dermatological therapy rarely targets the mitochondria. There is therefore a window of opportunity and rationale for ‘mitochondrial dermatology’-based approaches to be applied to therapeutics.57
Sunscreens are topical agents that provide UVR protection to the skin when applied as instructed. There are two main categories of sunscreen: organic sunscreens containing chemical UV filters, and physical sunscreens containing mineral UV filters. Usually, products contain a combination of active ingredients which work synergistically to increase protection and photostability.58 Using mtDNA as a biomarker, a study has shown cosmetic sunscreen formulations and antioxidants are able to offer protection against UVR-induced damage.59 Fibroblasts and keratinocytes were exposed to physiological doses of solar simulated light, and it was shown that they were more protected from UVR-induced mtDNA damage with an SPF30 sunscreen in comparison to a formulation with no sun protection.59 The sunscreen was spread at a concentration of 2mg/cm² on a UV transparent solid platform suspended between the light source and the monolayer of cultured skin cells. The DNA was extracted from the irradiated skin cells and mtDNA determined by real time PCR technology. This study provides an example of how sunscreen protection can be assessed at the molecular level in vitro.59
Antioxidants reduce the amount of cellular damage to the skin due to oxidative stress.14 Such compounds are produced endogenously by the body, but can be sourced externally via diet and topical application.60 Topical application of exogenous antioxidants which target the mitochondria, such as mitoquinol and plastoquinone, offer mtDNA protection in oxidatively stressed skin cells.61-64 A study showed restoration of mitochondrial integrity and metabolic output by nicotinamide (niacinamide) in primary dermal fibroblasts from older aged donors.65 Treatment of older fibroblasts with nicotinamide restored mitochondrial function to apparent younger cell levels.65 Niacinamide also increased the activity of the complexes of the mitochondria respiratory chain which are important in ATP bioenergy production.65 Furthermore, there has been a body of clinical evidence on skin benefits of carotenoids.66 One example involved a randomised clinical trial which provided evidence that a diet rich in lycopene via tomato paste exhibited protection against UVR-induced mtDNA damage (as well as erythema and MMP1 induction), compared to the control group.67
Analysing the mitochondria in clinic
Mitochondrial damage presents itself before the skin ageing phenotypes appear; therefore measuring damage in patients gives clinics the ability to observe these early changes at the molecular level before they become visible as typical skin ageing phenotypes.31,68 Measuring mitochondrial damage in skin over time provides a means of monitoring or tracking the efficacy of skin interventions at the early stage molecular level.
The availability of ‘off the shelf’, non-invasive methods of acquiring skin cells as opposed to skin biopsies, coupled with sensitive and reliable proprietary real-time polymerase chain reaction (PCR) methodology, provides a current commercial opportunity to track the level of mitochondrial damage over time.68 This provides quantitative data to the clinic and the patient that allows for a continuation of an intervention treatment plan, or a pivot to a new one that may lead to decreased mitochondrial damage and improvement in skin bioenergy.
A novel way to track skin ageing
Skin ageing is the result of a progressive loss of cellular function. The mitochondria, as they generate cellular ATP bioenergy, play a pivotal role in skin and its ageing process, including the phenotypes of wrinkle formation, uneven pigmentation and a reduction in elasticity.31 Therefore, it is no surprise that the mitochondrial damage (including mtDNA and mitochondrial dysfunction) which accumulates with age in skin cells is further accelerated by external factors, such as sunlight and pollution.14,53,60
However, there is always a balance between treatment interventions that may help to decrease skin damage, factors that might negatively contribute to skin health and threaten to overwhelm skin interventions and lifestyle that benefit the skin in 21st century living.69-71 Measuring mitochondrial damage in skin over a period of time provides an opportunity to monitor the effectiveness of skin interventions at the early stage molecular level against the background of lifestyle stressors of an individual. This provides an enhanced customised approach to the individual, thereby helping skin practitioners treat patients more effectively.
Test your knowledge!
Complete the multiple-choice questions and go online to receive your CPD certificate!
Questions Possible answers
1. Which is the primary skin cell type involved in the skin ageing process?
2. Which of these components is NOT a direct part of the Vicious Cycle Theory?
3. Which repair pathway mechanism is completely absent in mitochondria?
a. Keratinocytes
b. Melanocytes
c. Fibroblasts
d. Langerhans cells
a. MtDNA damage
b. Reactive oxygen species
c. Changes in telomere length
d. Mitochondrial dysfunction
a. Nucleotide excision repair
b. Recombinational repair
c. Mismatch repair
d. Oxidative damage repair
a. The mix of nuclear and mitochondrial genomes
4. The term heteroplasmy refers to…
5. Which of these is the most likely to damage mitochondria?
b. The mix of the different respiratory chain complexes
c. The mix of repair mechanisms in the mitochondria
d. The mix of mutated and wild type mtDNA
a. Hydrogen peroxide
b. Niacinamide
c. Lycopene
d. Mitoquinol
Answers: C, C, A, D, A
Professor Mark Birch-Machin is professor of molecular dermatology and Newcastle University, and chief scientific officer of Skin Life Analytics Ltd. Over the last 35 years, his research has focused on the response of human skin to the environment, particularly in regard to skin ageing, alongside additional commercial and media applications.
Qual: PhD
Dr Jessica Moor is a researcher in dermatological sciences at Newcastle University, and research associate placement in Skin Life Analytics Ltd. Dr Moor has five years’ experience investigating the biochemical, molecular and cellular biology effects of skin interventions, sunscreens and skincare products on biomarkers of skin function and bioenergy.
Qual: PhD
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Holistically Addressing Atopic Eczema
Dermatology clinical nurse specialist Emma Button examines the aetiology and treatment options for atopic eczema
Atopic eczema is a common, chronic skin condition. The word ‘eczema’ originates from the Greek word ‘to boil’.1 It is described as being itchy and dry, with erythema which can have a thickened appearance.1 It can also present with weeping, blistering and crusting.1 The condition can be very uncomfortable, and can have an adverse effect on patients’ quality of life.1
This article will share clinical insights and discuss the presentation of atopic eczema, its assessment, considerations for any differential diagnoses, advice for topical management and when to seek medical support in a specialist dermatological setting.
The impact of the condition
‘Atopic’ refers to associated disease development including asthma, allergic rhinitis and food allergens.2 In certain inherited instances, immunoglobulin E (IgE) antibodies are produced in response to environmental factors.3 This subsequently leads to conditions such as ‘atopic eczema’.3 In the UK, clinicians often refer specifically to ‘atopic eczema’, however globally, particularly in the US and mainland Europe, ‘atopic dermatitis’ is more commonly used.3 There are an approximate 223 million people living with atopic eczema around the world, and its prevalence is thought to be increasing.4 This increase is thought to be caused by a combination of environmental, biogenetic, social and lifestyle factors, as well as nutrition.10 Social factors which have a negative impact, such as stress, are also
thought to contribute to the increasing prevalence of atopic eczema, while environmental factors, including climate change and increase in pollution, can cause further impact.10,11
Atopic eczema is ranked 15th in the world in terms of non-fatal disease burden, and is the number one skin disease in terms of impact on the patient.4 Pain and itchiness, described as a burning sensation with tingling or stinging of the skin, is often described by those with eczema.20 Lifestyle activities can be limited, with complex emotions and feelings towards the burden of having the disease; 14% of adults who have experienced eczema believe it has hindered their career or academic advancement.20
It is essential to remember that it is a difficult condition to manage, and there are multiple possible approaches available, including referral via general practice into secondary care or to a private dermatologist. This may be especially pertinent for patients with moderate to severe atopic eczema, or where the disease is having a significant negative impact on quality of life.
It is essential to note that diagnosis of a medical skin condition like this should be carried out by a practitioner with dermatological experience.21
The physiology behind atopic eczema
The exact aetiology of atopic eczema is not fully understood, and dispute of the exact underlying cause remains. What is clear is
that a multitude of complex interactions –both genetic and environmental, inclusive of immune dysregulation, microbiome changes and skin barrier dysfunction – play a part.4 The stratum corneum (SC), the outer layer of the epidermis, provides protection from environmental factors, with keratinocytes forming a brick-like structure within the SC.7 Keratin is tightly compacted by filaggrin (FLG), along with other intracellular proteins.8,9 This supports the protective mechanisms of healthy skin, as it does not allow irritants and allergens to enter the skin barrier and prevents dehydration through water loss. However, in those with atopic eczema, there is likely immune dysregulation, with changes and dysfunction of the proteins, including FLG, contributing to the disruption of the skin barrier.8,9
Assessment of atopic eczema
When considering a diagnosis of atopic eczema, it is essential to think about patient history. Is the individual reporting their concerns to you as a new presentation? Are they informing you of specific triggers, for example, when using certain topical products, shampoos, treatments or laundry detergents? In this case, exploring the diagnosis of contact dermatitis appears preferable, due to potential exposure to an external irritant or allergen.22
Or, are they informing you that this is a chronic presentation which has been ongoing since their younger years, including childhood? Does it fluctuate in severity? Bear in mind, however, that as a chronic condition it can also develop in adulthood.4 When holistically assessing a patient, with consent and the option of a chaperone for physical examination, it is important to consider the presentation and site areas of impact. Atopic eczema in younger years often involves the scalp, face and cheeks, with extensor surface involvement of arms and legs.4 Whereas, in adolescent populations, flexural and fold involvement is likely to occur.4 The importance of a head-to-toe assessment will help establish the main impacted areas.
In dermatology, particularly in our inflammatory nurse-led clinics, we use scoring aids such as the Eczema Area and Severity Index (EASI) to assist in standardising evaluation.5 The scoring aids are particularly useful, alongside medical imaging, when reviewing a patient and referring onwards for further medical treatment. DermNet provide a useful guide with supportive imaging when scoring and assessing the current condition of the skin.6 It is worth noting that other conditions may present similarly to eczema; for example, cutaneous lymphoma, a rare form of cancer, can have a comparable presentation.25
There are an approximate 223 million people living with atopic eczema
around the world
Holistic approach to topical treatment
Treatment of dermatologic conditions including atopic eczema comprises of four main management components: treatment, cleansing, moisturiser and photoprotection.15 A comprehensive approach will aim to address barriers of product selection and the application process.15
Traditional treatments include the use of emollients (also known as moisturisers), topical corticosteroids and calcineurin inhibitors. The latter can only be provided through secondary care, hence are beyond the scope of this article. With more advance specialist therapies in secondary care, for those with more advanced to very severe atopic disease, these include use of oral systemics (immunosuppressants), and in more recent years biologic and Jak inhibitor therapies.12
Cleansing
Cleansing can support the removal of dirt, allergens and irritants. For those with eczema, suffering with dry and/or broken skin, gentle cleansing can be beneficial to help prevent overexposure for the body.28 It is advised that lukewarm water be used for cleansing; once a day is adequate, with avoidance of scrubbing.28 In dermatological practice, it is common that prescribed emollients are suggested as soap substitutes to avoid irritation.29
Emollients
Topical management is essential to support the skin, and treatment guidelines advise daily application of emollients used regularly and liberally throughout the day.13 Successful emollient application comes down to education and personal choice, for example, strong odour and grease may not be as preferable to one individual as it is to another. It is thought around 20% of the population is sensitive to a fragrance, hence for those with eczema it is best to avoid fragranced products where possible.14,23 Therefore, the choice of emollient in those with atopic eczema, as well as understanding whether the skin barrier is compromised even without a visible active flare, is key to ensuring consistency of application.13 Using emollients can reduce the need for more advanced therapies.13,14
There are a considerable number of emollients available, both over the counter or which can be prescribed. They are all somewhat different from each other.14 For dry skin, many may be sufficient, however in those with more moderate atopic eczema, there is an emphasis on occlusive barrier protection for the skin with an emollient that has a good humectant effect.13
Emollients have multiple functions, with one aim to hydrate the stratum corneum where dryness has impacted the skin barrier. It is important to understand why some formulations may support a patient’s skin barrier function, while others could cause further deterioration.14 The ideal formulations for treating eczema should include properties that foster occlusive skin barrier protection with a strong humectant effect.13 Selection of emollient, listening to your patient’s experiences and advising on topicals must be thoroughly thought through, thus creating concordance.
Topical corticosteroids
Patients diagnosed with atopic eczema, as some point, are likely to be offered topical corticosteroids (TCS) in conjunction with emollients as treatment. Whilst mild to moderate TCSs can be accessed over the counter upon speaking with a pharmacist, more potent TCSs require a prescription. They are acknowledged for their effectiveness, with a reported relative safety profile, and when used appropriately, side effects are less common. The Nottingham Eczema Society provides information on appropriate application and is a resource many dermatology clinicians utilise and share with patients.17,24 It is important to acknowledge that with prolonged use or inappropriate potency, TCSs have had reported side effects including striae, atrophy, telangiectasia and solar purpura.17 The timelines and potencies which can cause these effects vary on a case-by-case basis.17
You may have come across the term topical corticosteroid withdrawal (TSW). It remains a challenging condition to understand. With patient information and healthcare professionals as the primary source of reporting, there is a need for further evidence-based research to understand TSW.18 The British Association of Dermatologists has released a joint position
statement, with a view to supporting counselling with patients and healthcare professionals when discussing TSW.19 It covers reported signs and symptoms of TSW, but reminds us that we must consider other medical conditions that could be contributing to how a patient presents.19
Sun protection
Those with eczema are often susceptible to suffering more severe symptoms in the heat.26 It is well recognised that sun protection should be carried out by all, but for those with a chronic skin condition, the application of certain sunscreens can contribute to unwanted side effects such as additional skin irritation.26
There can be a preference towards mineral-based sunscreen that reflects the sun for eczema sufferers, rather than chemical absorbers.26 However, it is essential to understand that what works for one individual many not work for another, so some trial of different options may be needed.26 Suggestions for sunscreens that eczema patients have found to be ‘user friendly’ can be found on the National Eczema Society website.26
In addition to sunscreen, measures to avoid midday sun exposure and appropriate clothing to support sun protection can be discussed with patients.
Managing a chronic condition
It is important to inform patients that atopic eczema is a chronic condition that requires a holistic care approach, and can have periods of exacerbation despite treatment. A combination approach of medical and therapeutic complementary care can often be beneficial to those with chronic atopic eczema.
Understanding the pathophysiology of atopic eczema, the need to consider differentials and the importance of referring onwards to an appropriate medical professional are all crucial elements to consider to ensure a tailored, person-centred care and treatment plan.
Emma Button is an advanced nurse practitioner and lead clinical nurse specialist working in dermatology in a highly regarded NHS London Trust. In addition to this, she is the events education lead for the British Dermatological Nursing Group. Her passion is for dermatology, with a specific interest in atopy conditions and acne, alongside women’s health and aesthetics.
Qual: DipHE Adult Nursing, BSc Specialist Community Public Health Nursing, Health Visitor, PgCert
Treatment Focus
Exploring Synthetic Exosomes in Aesthetics
Dr Ethan Hausman-Marquis explores the science, technology and clinical applications of synthetic exosomes for topical skin rejuvenation
Cutaneous ageing is a complex, multifactorial process characterised by the gradual decline of skin structure and function, resulting in wrinkles, laxity and dyspigmentation.1
Intrinsic ageing is primarily determined by genetic factors and involves a programmed reduction in cellular activity, leading to epidermal thinning and dermal atrophy.1 Telomere shortening and altered gene expression, including reduced production of collagen, elastin and hyaluronic acid, further contribute to the ageing process.1,2
Extrinsic ageing is mainly caused by environmental factors, particularly chronic exposure to ultraviolet (UV) radiation.3 UV radiation induces oxidative damage, leading to accelerated cellular senescence and apoptosis.3 It also activates matrix metalloproteinases (MMPs), which degrade collagen and elastin fibres, compromising skin integrity and elasticity.4 Additionally, UV radiation promotes inflammation, further exacerbating skin ageing.5,6
This article will explore how synthetic exosomes can be applied topically to address some of the concerns relating to cutaneous ageing.
Mechanisms of action
Exosomes are nano-sized extracellular vesicles secreted by cells, and are a promising therapeutic modality in cutaneous rejuvenation.8 Their ability to transfer bioactive cargo, including proteins, lipids and nucleic acids, to recipient cells has sparked interest in their potential to ameliorate the multifactorial processes associated with skin ageing.8
Exosomes can be derived from a variety of different cell types, but those derived from mesenchymal stem cells (MSCs) can suppress cellular senescence in dermal fibroblasts by modulating key signalling pathways such as AKT/mTOR, and inhibiting the expression of senescence-associated markers like p16 and p21.9,10 This leads to increased collagen synthesis, enhanced fibroblast proliferation and improved skin elasticity.9,10
Exosomes also possess potent antioxidant properties, effectively counteracting the deleterious effects of oxidative stress.11 They can scavenge reactive oxygen species (ROS)
and upregulate the expression of antioxidant enzymes like superoxide dismutase (SOD) and catalase, thereby protecting skin cells from oxidative damage.12
Exosomes play a pivotal role in modulating the inflammatory response – a critical factor in skin ageing.13 They can suppress the production of pro-inflammatory cytokines like interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α), and promote the release of anti-inflammatory mediators like interleukin-10 (IL-10).14 This immunomodulatory effect helps mitigate chronic low-grade inflammation – a hallmark of ageing skin.14
In addition to their direct effects on skin cells, exosomes can influence the extracellular matrix (ECM) by stimulating collagen and elastin production, while inhibiting the activity of matrix metalloproteinases (MMPs) – enzymes responsible for ECM degradation.15 This remodelling of the ECM contributes to improved skin texture, firmness and resilience.15
Synthetic exosome production
Synthetic exosomes, also known as exosome-mimetics or artificial exosomes, are engineered nanovesicles that mimic the structure and function of naturally occurring exosomes, which are derived from plant, animal or human origins.16 These vesicles hold significant promise as drug delivery vehicles, therapeutic agents and diagnostic tools due to their inherent biocompatibility, stability and ability to interact with specific target cells.16 These engineered vesicles present an opportunity to overcome limitations inherent to natural exosomes, such as heterogeneity and inconsistent composition.19
In the UK, the Human Tissue Authority (HTA) imposes stringent regulations on human-derived biological materials, meaning that human-derived exosomes (either natural or synthetic) are prohibited.39 The evolving nature of the regulatory framework for exosome-based therapies necessitates meticulous adherence to guidelines. Synthetic exosomes can be produced in large quantities with consistent quality, making them suitable for commercial-scale production and clinical applications. 31 This is a complex and evolving field, involving several approaches.
Top-down approach
This method involves the isolation of natural exosomes from plant and animal donor cells. These cells could include MSCs, dendritic cells, tumor cells and other cell types. This is followed by modification of their surface properties or cargo, which can be achieved through:
· Extrusion: Passing cells through filters with defined pore sizes to generate nanovesicles resembling exosomes17
· Sonication: Applying high-frequency sound waves to disrupt cell membranes and form exosome-like vesicles18
· Chemical modification: Conjugating specific ligands or molecules to the surface of isolated exosomes to enhance their targeting abilities or therapeutic efficacy 19
Key considerations in synthetic exosome production
1
Lipid composition: The choice of lipids plays a crucial role in determining the physical properties, stability and biodistribution of synthetic exosomes.23
2
Surface modification: Functionalisation of exosome surfaces with specific ligands, antibodies or peptides can enhance their targeting and therapeutic potential.24
3
Cargo loading: Efficient loading of therapeutic agents, nucleic acids or imaging probes is essential for the successful application of synthetic exosomes. Various methods like electroporation, incubation and sonication are employed for cargo loading.25
Bottom-up approach
This approach entails the de novo synthesis of exosome-like vesicles derived from plant or animal cells, using various techniques:
· Serial extrusion: Lipids and other exosomal components are passed through membranes with progressively smaller pores to form uniform nanovesicles19
· Microfluidics: Precise control of fluid flow in microchannels allows the formation of monodisperse vesicles with defined size and composition20
· Nanoprecipitation: Mixing hydrophobic and hydrophilic components in a controlled manner, leading to the self-assembly of nanovesicles21
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-Dr Manav Bawa
depending on individual needs and the The treatment is generally well-tolerated. Common reactions may include transient redness, swelling, hardening or itching at the injection site. These symptoms subside
Most individuals and normal skincare routines immediately By following the recommended precautions, patients can ensure the best possible outcomes for
Synthetic exosomes represent a promising immunogenicity, offering a safe and effective
Pre-clinical and early clinical data supports ageing on the skin. By modulating cellular senescence, counteracting oxidative stress, regulating inflammation and promoting ECM remodelling, synthetic exosomes offer a holistic approach to cutaneous rejuvenation. While further research is needed here, the results obtained thus far are encouraging,
anticipate the development of increasingly sophisticated exosome-based therapies, tailored to address specific skin conditions
engineering and manufacturing, the future
the full potential of these nanovesicles in transforming the landscape of skincare and
oncological surgeon, with a clinic specialising in aesthetic and regenerative medicine in London. Holding a PhD in Cell Biology from the Karolinska Institute, he is also a member
Medicine and The American Academy of
THE 1ST LIQUID FORMULATION BOTULINUM
TOXIN TYPE-A IN EUROPE
ONSET FROM 24H*1
DURATION UP TO 6 MONTHS1
Alluzience, 200 Speywood units/ml, solution for injection -
Prescribing Information (United Kingdom)
Presentation: Each vial contains 125 Speywood units of Clostridium botulinum toxin type A haemagglutinin complex in 0.625 ml of solution. Indications: Alluzience is indicated for the temporary improvement in the appearance of moderate to severe glabellar lines (vertical lines between the eyebrows) seen at maximum frown in adult patients under 65 years, when the severity of these lines has an important psychological impact on the patient. Dosage: Botulinum toxin product units differ depending on the medicinal products. Botulinum toxin units are not interchangeable from one product to another. Doses recommended in Speywood units are different from other botulinum toxin preparations. Paediatric Population: The safety and efficacy of Alluzience in children aged up to 18 years have not been established. The use of Alluzience is not recommended in patients under 18 years. Method of administration: Alluzience should only be administered by a healthcare practitioner with appropriate qualifications and expertise in this treatment and having the required equipment, in accordance with national guidelines. A vial of Alluzience should only be used to treat a single patient, during a single session. Remove any make-up and disinfect the skin with a local antiseptic before administration. The intramuscular injections should be performed using a sterile needle with a suitable gauge. Dosing and treatment intervals depend on assessment of the individual patient’s response. The median time to onset as reported subjectively by patients was 3 days (the majority of patients reported an effect within 2 to 3 days with some patients reporting an effect within 24 hours). An effect has been demonstrated for up to 6 months after injection. The treatment interval should be no more frequent than every 3 months. Administration instructions: The recommended dose is 0.25 ml of solution (50 Speywood units) divided into 5 injection sites, 0.05 ml of solution (10 Speywood units) administered intramuscularly into each of the 5 sites: 2 injections into each corrugator muscle and one into the procerus muscle, near the nasofrontal angle. The anatomical landmarks can be more readily identified if palpated and observed at patient maximum frown. Before injection, place the thumb or index finger firmly below the orbital rim in order to prevent extravasation below the orbital rim. The needle bevel should be pointed upward and medially during the injection. In order to reduce the risk of ptosis, avoid injections near the levator palpebrae superioris muscle, particularly in patients with larger brow-depressor compl–exes (depressor supercilii). Injections should be made into the central part of the corrugator muscle, at least 1 cm above the orbital rim. General information: In the event of treatment failure or diminished effect following repeat injections, alternative treatment methods should be employed. In case of treatment failure after the first treatment session, the following approaches may be considered: • Analysis of the causes of failure, e.g. incorrect muscles injected, inappropriate injection technique, and formation of toxin-neutralising antibodies • Re-evaluation of the relevance of treatment with botulinum toxin A. Contraindications: Hypersensitivity to the active substance or to any of the excipients. Presence of infection at the proposed injection sites. Presence of myasthenia gravis, Eaton Lambert Syndrome or amyotrophic lateral sclerosis. Precautions and Warnings: Care should be taken to ensure that Alluzience is not injected into a blood vessel. Injection of Alluzience is not recommended in patients with a history of dysphagia and aspiration. Adverse reactions possibly related to the spread of toxin effect distant from the site of administration have been reported very rarely with botulinum toxin. Swallowing and breathing difficulties are serious and can result in death. Very rare cases of death, occasionally in the context of dysphagia, pneumopathy (including but not limited to dyspnoea, respiratory failure, respiratory arrest) and/or in patients with significant asthenia have been reported following treatment with botulinum toxin A or B. Patients should be advised to seek immediate medical care if swallowing, speech or respiratory difficulties arise. Alluzience should be used with caution in patients with a risk of, or clinical evidence of, marked defective neuro-muscular transmission. These patients may have an increased sensitivity to agents such as botulinum toxin, and excessive muscle weakness may follow treatment. It is essential to study the patient’s facial anatomy prior to administering Alluzience. Facial asymmetry, ptosis, excessive dermatochalasis, scarring and any alterations to this anatomy, as a result of previous surgical interventions, should be taken into consideration. Dry eyes have been reported with use of Alluzience in periocular regions. Attention to this side effect is important since dry eyes may predispose to corneal disorders. Protective drops, ointment, closure of the eye by patching or other means may be required to prevent corneal disorders. The recommended dose and frequency of administration for Alluzience must not be exceeded. Patients treated with the recommended dose may experience exaggerated muscle weakness. Caution should be taken when Alluzience is used in the presence of inflammation at the proposed injection sites or when the targeted muscle(s) show excessive weakness or atrophy. As with all intramuscular injections, use of Alluzience is not recommended in patients who have a prolonged bleeding time. Each vial of Alluzience must be used for a single patient treatment during a single session. Any excess of unused product must be disposed of and specific precautions must be taken for the inactivation and disposal of any unused solution. Antibody formation: Injections at more frequent intervals or at higher doses may increase the risk of neutralising antibody formation to botulinum toxin. Clinically, the formation of neutralising antibodies may reduce the effectiveness of subsequent treatment. Traceability: In order to improve the traceability of biological medicinal products, the name and the batch number of the administered product should be clearly recorded. Sodium content: This medicine contains less than 1 mmol sodium (23 mg) per 125U vial, that is to say essentially ‘sodium-free’. Interactions: Concomitant treatment with Alluzience and aminoglycosides or other agents interfering with neuromuscular transmission (e.g. curarelike agents) should only be used with caution since the effect of botulinum toxin may be potentiated. No interaction studies have been performed. Pregnancy, Breastfeeding and Fertility: Pregnancy: There are only limited data from the use of botulinum toxin type A in pregnant women. Animals studies do not indicate direct or indirect harmful effects with respect to reproductive toxicity. As a precautionary measure Alluzience should not be used during pregnancy. Breastfeeding: It is unknown if Alluzience is excreted in human milk. Alluzience should not be used during breast-feeding. Fertility: There are no clinical data examining the effect of Alluzience on fertility. There is no evidence of direct effect of Alluzience on fertility in animal studies. Effects on ability to drive and use machines: Alluzience has a minor or moderate influence on the ability to drive and use machines. There is a potential risk of localised muscle weakness or visual disturbances linked with the use of this medicinal product which may temporarily impair the ability to drive or operate machinery. Undesirable Effects: A majority of adverse reactions reported with Alluzience in clinical trials were of mild to moderate intensity and reversible. The most frequently reported adverse reactions were headache and injection site reactions. The incidence of adverse reactions tended to decrease with repeated treatments. Adverse effects related to the spread of toxin effect distant from the site of administration have been very rarely reported with botulinum toxin (excessive muscle weakness, dysphagia, aspiration pneumonia with fatal outcomes in some cases). Adverse Drug Reactions Observed in Clinical Studies were as follows: Very common (≥ 1/10): Headache, injection site reactions (periorbital haematoma, haematoma, bruising, pain, paraesthesia erythema, swelling, pruritus, oedema*, rash*, irritation*, discomfort*, stinging*), asthenia*, fatigue*, influenza-like illness*; common (≥ 1/100 to < 1/10): Facial paresis*, eyelid ptosis, eyelid oedema, brow ptosis, dry eye, lacrimation increased, asthenopia*, muscle twitching (twitching of muscles around the eye)*; uncommon (≥ 1/1,000 to <1/100): Dizziness*, eyelid twitching, visual impairment*, vision blurred*, diplopia*, hypersensitivity (eye allergy, hypersensitivity, rash), rash*, pruritus*; rare (≥ 1/10,000 to < 1/1,000): Eye movement disorder*, urticaria*
*additional adverse drug reactions only observed with powder formulation of the same active substance in clinical trials
Post-marketing experience Frequency not known: hypoaesthesia, muscle atrophy
Prescribers should consult the summary of product characteristics for further details. Packaging Quantities and Cost: Pack containing x2 vials: £ 160.00 excluding VAT. MA Number: PL 03070/0009 Legal Category: POM Further information is available from: Galderma (UK) Ltd, Evergreen House North, Grafton Place, London, NW1 2DX. Telephone: +44 (0)300 3035674
Date of Revision: May 2023
Adverse events should be reported. United Kingdom Reporting forms and information can be found at www.mhra.gov.uk/yellowcardor search for MHRA Yellow Card in the Google Play or Apple App Store.
Adverse events should also be reported to Galderma (UK) Ltd: E-mail: medinfo.uk@galderma.com Tel: +44 (0)300 3035674
This information is intended for Healthcare Professionals only. This advertisement has been created and funded by Galderma.
*The exact timepoint in the first 24 hours was not captured.
Reference: 1. Alluzience SmPC.
Managing Skin Conditions Holistically
Dermatology nurse practitioner Emma Coleman explores how psychological and lifestyle factors can contribute to skin conditions in patients
According to a national survey conducted by the British Association of Dermatologists, a total of 17% of dermatology patients need psychological support and a further 14% have a psychological condition which exacerbates their skin disease 1 Research also provides a strong positive correlation between lifestyle factors – including smoking tobacco and alcohol consumption – and inflammation at the skin level.2-4 Practitioners who take the time to explore triggers, provide education and involve patients in the prescribing process will achieve better treatment outcomes.5
There is growing evidence supporting the efficacy of holistic approaches to dermatology in increasing success rates and relapse prevention. Combining these alternative approaches with traditional medical treatments yields better, long-term outcomes.6-9
Psychodermatology
Psychodermatology addresses interactions between mind and skin, and has recently seen a rise in popularity in UK dermatology clinics.10 This is possibly contributed to by a pilot study of 68 subjects, which showed that 86% of dermatology subjects who received psychological input at the Royal London Hospital were discharged after just one follow-up appointment.11 The link between the emotional state and skin disease connection is well documented. Numerous human and murine studies provide evidence that skin has its own hypothalamic-pituitary axis, perpetuating stress responses where cortisol levels are raised even for short bursts of time.12-17 This causes skin barrier compromise, reduced epidermal hydration and thickness, and disruption of mitochondrial DNA repair and production.12-17 Furthermore, many studies have provided evidence of significant symptom improvement when stress-reducing therapies are implemented in combination or alongside orthodox medicine. For example, combining biofeedback-assisted relaxation therapy (BART) with cognitive therapy reduced acne severity in 30 patients.6 Furthermore, combining Psoralen UVA therapy (PUVA) – which involves UV light exposure with the application of topical light-sensitising agents – or UVB light therapy with audio-mindfulness accelerates psoriatic lesion clearance in patients with moderate to severe disease, even in short bursts.7
A total of 93% of alopecia araeta patients will experience depression,18 and one study of 21 subjects provided evidence that six sessions of hypnotherapy accelerated hair regrowth in 57% of alopecia areata (AA) patients, which continued after hypnosis cessation.19 Symptom improvement and reduced topical agent use was seen in atopic dermatitis patients treated with combination therapies including group, cognitive behavioural and autogenic.8,9
It is also important to realise that skin conditions themselves can cause anxiety, sadness, feelings of embarrassment and humiliation in individuals, irrespective of their severity or type.20 There is evidence of increased suicidal ideation in patients with psoriasis (7.2%) and acne vulgaris (5.6%) compared to the general population.21
Many societies around the world perceive that skin which is unblemished is tantamount to beauty and even success, with the images we face through social media exhibiting perfection, which may induce feelings of inadequacy.20 Nevertheless, evidence suggests social media interactions can reduce feelings of isolation and anxiety, boosting self-esteem.22
Psychodermatology provision nationally declined between 2003 and 2011.1 As a result, the British Association of Dermatologists provided guidelines for setting up psychodermatology branches in clinics in 2012. They emphasised the importance of allowing adequate time during initial assessment for investigating the psychological status of each patient, and using psychometric tools such as Annual DLQI and Skindex 29 for those with long-term and/or disfiguring skin conditions.23,24
The guidelines suggested accessing referral networks in the local community and undertaking appropriate staff training (Figure 1).1 Undertaking this process may seem challenging for busy practitioners, but the long-term implications for better treatment outcomes and time saving is evident.11
Lifestyle factors
Stress
Certain lifestyle choices which place the body and mind under stress are known to disrupt skin barrier function and cause inflammation.16-18 Over a third of Brits experience stress for up to nine days each month, and the most common triggers are work, finance and health concerns. 26,27
To prevent and control inflammatory flare-ups, I produce plans for my patients including realistic and attainable choices to counteract stressors in their lives.
One example is implementing yoga or at least regular episodes of yoga breathing, as there is evidence to suggest that 10-30 minutes of daily pranayama (yogic breathing exercises) significantly reduces free radicals, systolic and diastolic blood pressure, as well as reactions to further stressful stimuli. 28,29
Fresh air and moderate exercise such as walking in a rural location can also significantly improve feelings of wellbeing. 30
Alcohol
There is much evidence supporting prolific incidence of alcoholism in psoriatic patients and increased risk of pustular lesions, 31 with up to 30% of sufferers having difficulties with alcohol. 32
One large-scale US study of 59,575 people showed that women with a history of consuming seven or more alcoholic drinks weekly, particularly white wine and spirits, displayed an increased risk of melanoma and non-melanoma skin cancer development. 33 Another large-scale study of 82,737 people conducted over 14 years, including 4,945 female rosacea patients, showed a significant increase in flare-up risk, particularly in those who regularly consumed white wine and spirits. 2 Whilst there is a link between alcohol consumption and raised Immunoglobulin E levels (lgE), there is no current evidence supporting significant links with atopic dermatitis. 34,35 Raised IgE indicates an immune response. There is some data showing that 15% of vitiligo sufferers are addicted to alcohol, likely to lead to poor treatment compliance and significant increase in disease duration and severity. 36
Diet
Although controversial, some studies highlight a link between psoriasis, insulin resistance and a tendency for obesity. 37,38 One study of 82 subjects provided evidence that a low-calorie diet administered to patients with non-pustular psoriatic lesions, improved skin lesions. However, 38% of subjects experienced significant weight loss. 38 Another Italian
study highlighted significant links between consumption of carrots, tomatoes and fresh fruit with psoriatic lesion clearance. 39
Acne vulgaris is viewed as a disease of Western culture, affecting 79-95% of adolescents and 40-54% of men and women aged over 25 in these societies. Yet it is practically non-existent amongst Asian populations, thought to be attributed not only to genetic factors but also diet. 3 There is evidence that a daily consumption of two glasses of full fat or skimmed milk significantly increases acne risk, whilst a low BMI and eating fish three times weekly appears to exert a protective effect.40
Another Turkish paper describes a positive correlation between high glycaemic index, diet and acne development in 50 subjects.41 In regard to skin cancers, an Australian case control study of 88 subjects highlighted a link between frequent fish consumption, pulses, green and dark coloured vegetables and lowered non-melanocytic cancer risk.42
‘Milkshake’ diets have grown in popularity amongst several of my patients looking for accelerated weight loss in preparation for an upcoming event or new relationship. Links between hair loss and diet have been well documented, believed to be due to iron and zinc deficiency causing a reduction in hair follicle and hair matrix energy supply.43,44
Smoking and e-cigarettes
Today, more than 10% of US, European and Asian populations use e-cigarettes.45 Early murine studies suggest that vaping disrupts skin healing in the same way cigarette smoking does, due to additives such as propylene glycol. These can trigger allergic immune responses like
eczema, rhinitis and asthma in users.45,46 Long-term dermatological effects of e-cigarette use remain unknown at present.
Traditional smoking also doubles the risk of squamous cell carcinoma development, due to mutation of p53 gene expression.47,48 In psoriasis, there is a strong association between pustular lesion formation and female smokers, 39 while discoid lupus erythematous lesion increases ten-fold with smokers.47
One national study provided evidence of significant links between hand eczema and smoking, confounded by the presence of allergic medical history. 35 Smoking contributes to hair loss in many ways: through disruption of dermal hair papilla microcirculation, follicular inflammation and fibrosis, hair follicle DNA damage and lowered estradiol levels caused by increased hydroxylation.59
Sleep
Patients with pruritic skin conditions often experience a worsening of itching at night causing sleep disruption, thought to be due to natural cortisol trough at this time of day. 21 Approximately 94% of patients with chronic dermatology conditions report sleep problems, due to substance P stimulation which affects mood and skin inflammation, but further research is needed.49
Correlations between chronic skin disorders, mood and sleep have been documented, with issues such as anxiety and depression likely to worsen sleep quality.50
Probiotics
Around 70 years ago, two dermatologists – Dr John Stokes and Dr Donald Pillsbury – hypothesised that the emotional state of a person, including factors like depression, anxiety and worry, affects the gut micro flora by causing small intestine bacteria overgrowth (SIBO). This contributed to skin inflammation, particularly in cases of acne vulgaris, atopic dermatitis and rosacea.51-53 Findings from one study suggest that lactobacillus paracasei therapy inhibits substance P-induced inflammation.52 Whilst a combination of pre- and probiotics
is recommended for symptom control in atopic dermatitis patients, more work is required in this area.51 I regularly prescribe probiotics for the aforementioned patients in my practice, and have seen many positive outcomes when combined with other treatments, including reduction in symptoms such as itching, xeroderma (dry skin), erythema and acne lesions.
Skincare and cosmetics
There is evidence to suggest that certain skin cleansers and soaps with a pH of 8.0, as well as hair pomade products, are comedogenic and likely to cause or worsen acne eruptions.54,55
The protective, moisturising and anti-inflammatory benefits of flavonoids, curcuminoids, niacinamides and peptides found in polyphenols are being increasingly explored and documented as helping to combat effects of environmental and emotional stressors.56 Topical lipids such as ceramides, alongside emollients, help to restore stratum corneum homeostasis and skin barrier function.57
Continuing research
Many studies quoted are small-scale, and further global, long-term research is required to pinpoint exact mechanisms of how balancing mind and body leads to better skin health. Further studies on how gene p53 and substance P functions are affected by psychosocial and lifestyle factors would also be beneficial in helping to gain a better understanding of causes and treatments.
Development of psychodermatology clinical governance protocols by the British Association of Dermatologists would facilitate private clinicians in implementing a psychodermatology branch within their clinic.1 This should include an in-clinic policy to manage the situation, including a list of possible agencies to refer patients on to.
Emma Coleman is a dermatology nurse practitioner qualified to Clinical Dermatology Diploma level. Coleman opened her first clinic at her home in Kent in 2015, and has since launched her own skincare range, procured CQC registration and now operates two holistic skin clinics in Bromley. Alongside her dermatology work, her passion lies in working closely with her patients to provide holistic treatments with the aim of promoting rejuvenated, healthy, conditioned skin Qual: RGN
Figure 1: The stepped approach to psychodermatology25
Alma welcomes Revanesse to the family, elevating patient results and clinic success. Together, we are stronger.
Ask the Alma Hybrid™ Experts
How to excel in scar revision and advanced rejuvenation
Dr Cemal Kavasogullari
What drew you to the Alma Hybrid™?
We had already pushed the limits of our existing energy-based modalities like IPL and NFRF, and we needed something that could take our treatments to the next level. Specifically, we were looking for a device that could effectively treat the periorbital area. We wanted something that was versatile and could deliver high-impact treatments that would set us apart from other clinics. The Alma Hybrid™ offered exactly that – a broad range of treatment options, including non-surgical blepharoplasty, and the ability to treat surgical, hypertrophic and acne scars much more effectively. Plus, let's be honest, it looks incredibly cool – it’s like the Ferrari of CO2 lasers.
What does the Alma Hybrid™ do?
The Alma Hybrid™ combines two powerful technologies: ablative CO2 and non-ablative 1570nm wavelengths. This combination allows for precise skin resurfacing while also stimulating deep collagen production. What sets the Alma Hybrid™ apart is its Impact ultrasound handpiece, which can deliver growth factors and other cosmeceutical products directly into the right layers of the skin, enhancing treatment outcomes.
How is this different from other CO2 devices available? It allows us to offer both ablative and non-ablative treatments in the same session, which is something most other devices can’t do. The non-ablative setting focuses on skin tightening, promoting more elastin production, which is key for maintaining a youthful appearance. Additionally, the Alma Hybrid™ comes equipped with a
Nurse Khatra Patterson
How many treatments in a course?
The number of treatments needed varies based on the severity and type of scars or skin needing treatment. Generally, a series of three to six sessions spaced six to eight weeks apart is recommended for best results. Patients typically begin to see great improvements within a few weeks after the first treatment session.
How long does it take to perform the treatment?
Each Alma Hybrid™ session typically lasts between 30 to 60 minutes, depending on the size and number of areas being treated. A small scar area, like Amy’s forehead in this case study, can take five to 10 minutes, whereas treating a full face and neck for acne scarring or skin rejuvenation can take 45-60 minutes.
What are the post-treatment expectations?
After treatment, patients may experience redness, swelling and a sensation similar to sunburn. Depending on the treatment intensity chosen by your patient, these are typically mild and subside within a few days. You might notice the grid formations on your patient’s skin – these are microchannels we then push cosmeceuticals through with the ultrasound handpiece as part of the treatment process. This trans epidermal delivery helps provide incredible results and further reduce downtime.
Pro-Scan handpiece for faster fractionated treatments, and a surgical handpiece for precise removal of skin lesions. Another great feature is the Impact handpiece, which we can even use after microneedling sessions. This means the device is always in use, ensuring that our investment is continually delivering value to our clinic and, more importantly, to our patients.
Case Study 1: Full face rejuvenation
Patient history: 56-year-old female patient. No previous treatments.
Treatment protocol: Patient started with skin boosters and skincare for six weeks. Three Alma Hybrid™ non-surgical blepharoplasty treatments and two full face Alma Hybrid™ treatments. Sessions were six to eight weeks apart. Completed with HA dermal filler for volume restoration to temples, cheeks, naso-labial and peri-oral areas. Added anti-wrinkle treatment for three areas at the same session.
Case Study 2: Traumatic scar
Patient history: A 42-year-old female with a traumatic, hypertrophic scar on the forehead following a fall.
Treatment protocol: Three sessions with Alma Hybrid™ spaced five to seven weeks apart, combined with Tri-Wave MD and botulinum toxin.
Outcomes: Substantial improvement in scar elevation and pigmentation, leading to a more uniform skin tone and smoother texture.
Facial rejuvenation, treated by Dr Cemal Kavasogullari
Scar reduction, treated by Khatra Paterson
Choosing Skincare Ingredients for Different Skin Types
Human skin types differ, with each having their own unique characteristics and care needs.1,2 They can also be affected by several factors that include genetics, hormonal changes and imbalance, medication and stress.3-7
Understanding a patient’s skin type is crucial to determining what skincare ingredients and product types will result in the best treatment outcome for them, and, according to many dermatologists, it is the most important factor in determining the best treatment plan for the individual.8
Skin type classification
While there is no global standard for identifying skin types, it is generally accepted that there are five primary types: oily, dry, normal, combination and sensitive.9 Various classification systems are used by professionals to identify skin types during consultations, often combining different scales with advanced software and assessment machines.10,11 The following are examples of commonly used skin typing scales:
Fitzpatrick scale
Developed by Thomas Fitzpatrick in 1975, this numerical scale classifies skin types based on melanin content and sun sensitivity:12
· Type I: Pale white, always burns, never tans
· Type II: White to fair, usually burns, tans with difficulty
· Type III: Medium to olive, mild burn, tans gradually to olive
· Type IV: Olive to moderate brown, rarely burns, tans easily
· Type V: Brown to dark brown, very rarely burns, tans very easily
· Type VI: Very dark brown to black, never burns, deeply pigmented
Sebaceous gland activity
This method involves the patient assessing their skin by touching their forehead, cheeks, chin and nose to check for roughness or oiliness and pore size:13
· Dry: Under-active sebaceous glands
· Oily: Over-active sebaceous glands
· Combination: Oily T-zone
· Normal: Well-balanced
Baumann skin type system
This system examines four parameters (hydration, sensitivity, pigmentation and elasticity) to create sixteen skin phenotypes, applicable to all ethnicities, ages and genders. It uses a 64-item questionnaire called The Baumann Skin Type Indicator (BSTI).14
Of course, there are new technologies coming to the fore that do classification for you, like skin analysis devices/machines.
Consultation process
The consultation process is integral to determining patients’ skin type and should be used to tailor their treatment plan and product recommendations.
Additionally, understanding the percentage of active ingredients is critical to successful outcomes, as it can make a significant difference in the efficacy and tolerability of products. Striking the correct balance between effectiveness and patient tolerability will be key to the outcome. Finally, it is important to consider the consistency and texture of the product. Looking at the top five ingredients on the ingredient list will give a very rough estimation of texture and viscosity.
Oily skin
Seborrhoea (oily skin) is a common dermatologic concern that typically affects men and women between puberty and 60 years of age.15 It presents as a shiny or greasy appearance on the skin (particularly on the T-zone: forehead, nose and chin). Numerous factors have been proposed to play a role in the pathogenesis of oily skin,16 however it is generally characterised as the production of a quantity of sebum which is excessive for the age and sex of the individual (hypersecretion).17,18 There is no definitive prevalence of seborrhoea, although some studies have shown that it is present in up to 75% of young people aged between 15 and 20.19-21
Sebum is produced by sebaceous glands which are microscopic exocrine glands that are located in the mid dermis.22 It is fundamental to the structure and function of the skin, providing 90% of its surface lipids, and uniquely produces squalene and fatty acids.23,24
Understanding the percentage of active ingredients is critical to successful outcomes
Formulations Choosing Skincare
The majority of sebaceous glands are connected to hair follicles with an outlet via the follicular canal, but some also work alongside sweat glands and open directly at the skin’s surface.25-28
Various factors contribute to excess sebum production (and consequently the appearance of seborrhoea on the skin), including androgen fluctuation, enlarged sebaceous glands due to overgrowth of sebocytes (sebaceous hyperplasia), environmental aggressors and lifestyle factors (including diet and stress), as well as Fitzpatrick skin type and genetic factors.29-36
Patients with oily skin often present with enlarged pores and a propensity for acne, including comedones. This skin type is frequently associated with a thicker epidermis and a sallow complexion due to retention of dead skin cells.37-39
Non-comedogenic ingredients
Non-comedogenic ingredients are beneficial in the treatment of oily skin types as they have been shown, through testing, not to block pores, thus minimising the risk of acne developing.40
The comedogenicity of ingredients in topical treatments is often rated on a scale from 0 to 5, with 0 being non-comedogenic and 5 being highly comedogenic. Ingredients rated 0 to 2 are generally considered safe for acne-prone skin.40
Effective non-comedogenic ingredients include:
· Tea tree oil – has antimicrobial and anti-bacterial properties without clogging pores41
· Salicylic acid (1-2%) – is an exfoliating agent that with comedolytic properties42
· Kaolin clay – gently draws out impurities and absorbs excess oil43
· Sulfur (0.5-5%) – is keratolytic, antibacterial, sebum-regulating and anti-inflammatory44
· Niacinamide (2-5%) – reduces inflammation, regulates oil production and improves skin barrier function45
· Retinoids – normalise sebum production and accelerate skin cell renewal46
Humectants
Humectants are also a useful ingredient group when treating oily skin as they attract and retain moisture from the environment or deeper layers of the skin. This provides hydration without adding any oil, which is crucial for oily skin types that need moisture but not additional oil. When the skin is properly hydrated, it is less likely to produce excess oil to compensate for dehydration. Additionally, dehydrated skin can trigger an increase in sebum production as a compensatory mechanism. By ensuring the
Key management strategies for sensitive skin include the use of mild, fragrance-free cleansers and moisturisers containing soothing ingredients which help to calm inflammation
skin is well-hydrated with humectants, this overproduction can be minimised, leading to less oily skin.
Humectants can also improve the overall texture of the skin, making it smoother and more supple. This can help reduce the appearance of large pores, which are often a concern for individuals with oily skin.47,48
Effective humectants include:
· Glycerin – powerful humectant that draws moisture to the skin, helping to keep it hydrated and balanced49
· Mandelic acid – powerful alpha-hydroxy acid that regulates sebum production, reducing excess oiliness that can contribute to acne and shine50
· Sodium PCA (pyrrolidone carboxylic acid) – naturally occurring humectant in the skin that helps maintain a healthy moisture balance51
· Propylene glycol – this ingredient attracts water and maintains hydration without leaving a greasy residue52
· Hyaluronic acid – this can hold 1,000 times its weight in water, providing significant hydration without being heavy or greasy53
Oily skin will benefit more from the consistency of lotion, oil-free creams and gel-cream textures and serums, as these product types will offer moisture without adding extra oil.54
Dry skin
Dry skin, also known as xeroderma, xerosis cutis or asteatosis, is characterised by a lack of moisture in the most superficial layer of the epidermis – the stratum corneum.55 The stratum corneum is crucial in maintaining hydration. It consists of dead skin cells (corneocytes) embedded in a lipid matrix. These lipids include ceramides, cholesterol and fatty acids, which create a barrier to prevent water loss.56,57 It plays a significant role in skin barrier function as it limits penetration of and reaction to microbes, allergens, irritants and toxins, as well as preventing
transepidermal water loss (TEWL).58 If the stratum corneum’s structure or composition is compromised, this can cause reduced levels of natural moisturising factors (NMFs) and diminished sebaceous gland activity.59-61 This leads to increased TEWL and impaired desquamation processes.62,63
Clinically, patients with dry skin often present with fine lines, scaling and a dull complexion leading to a rough, flaky and sometimes itchy or tight-feeling skin surface. This condition is frequently exacerbated by environmental factors such as cold weather, low humidity and harsh soaps or detergents, which strip the skin of its natural lipids.64 Intrinsic factors, including ageing and genetic predisposition, also play significant roles in the development of dry skin.65
Effective management of dry skin involves the use of occlusive ingredients, emollients and humectants which help to restore hydration and reinforce the skin barrier.
Occlusive ingredients
Occlusive ingredients physically block TEWL by forming a hydrophobic film on the skin surface and within the superficial interstitium between corneocytes. These ingredients form a film on top of the skin, trapping the moisture inside.66
Effective occlusive ingredients include:
· Dimethicone (0.5-5.0%) – silicone occlusive that smooths skin by filling in gaps where damaged corneocytes are missing from the stratum corneum67, 68
· Petrolatum – is the most effective classic occlusive moisturiser. A minimum concentration of 5% can reduce TEWL by more than 98%, with 170-times water vapour loss resistance as compared to olive oil69,70
· Lanolin – composed of cholesterol and fatty acids, which mimic the natural lipids in human skin. Lanolin forms a protective barrier on the skin, reducing water loss while also providing some emollient benefits to soften the skin71
· Shea butter – forms a protective barrier to prevent TEWL; is anti-inflammatory and nutrient-rich to support overall skin health and resilience72
· High gamma-linolenic acid oils – is anti-inflammatory and enhance the skin’s lipid barrier73
Emollients
Like occlusives, emollients can form a barrier to reduce TEWL by plugging the gaps between corneocytes.74 Emollients prevent dryness and protect the skin by acting as a barrier and healing agent, as well as soothing and softening the skin by filling the space between skin flakes with a droplet of oil.75,76
Examples include:
· Ceramides – replenish the natural lipids lost due to environmental exposure77
· Urea – act as a potent emollient and keratolytic agent78,79
· Squalane – mimics the skin’s natural oils, providing excellent emollient properties without leaving a greasy residue80
· Jojoba oil – is a wax ester with a consistency and structure similar to human sebum, which lends itself to helping smooth dry skin and reduce skin flaking81,82
Usually, people with dry skin will appreciate a moisturiser with a thicker texture such as a buttery moisturiser, oil or balm. If you notice no water in the ingredients list, and instead it is made from oils and esters i.e. emollients, this will indicate it is a 100% oil product. If there is no wax, it will be classed as a facial oil. If there is wax, it will be classed as a balm. These products are only suitable for dry skin.83
Sensitive skin
Sensitive skin is a prevalent skin condition that is characterised by an exaggerated response to external stimuli, leading to symptoms such as redness, itching, burning and dryness. It is slightly more prevalent in women than men, with studies suggesting that 60-70% of women and 50-60% of men report having some degree of sensitive skin.84,85
Patients with sensitive skin often report discomfort and visible signs of irritation following exposure to various environmental factors, including temperature extremes, wind, pollution and topical products containing fragrances, alcohol or harsh chemicals.86 This skin type is commonly associated with conditions such as rosacea, eczema and allergic contact dermatitis.87,88
From a histological perspective, sensitive skin exhibits a compromised skin barrier function, increased TEWL and heightened inflammatory responses. This is often
due to a reduced lipid content in the stratum corneum and a higher density of sensory nerve endings, making the skin more reactive.89
Key management strategies for sensitive skin include the use of mild, fragrance-free cleansers and moisturisers containing soothing ingredients which help to calm inflammation and strengthen the skin barrier. Avoidance of known irritants and allergens is crucial, along with the application of broad-spectrum sunscreens to protect against UV-induced damage.
Soothing ingredients
Aloe vera – is an inflammatory ingredient that contains a variety of bioactive compounds, including vitamins (A, C, E and B12), enzymes, minerals, sugars (polysaccharides), amino acids, salicylic acids and phytosterols90-92
· Allantoin (0.2-2%) – is keratolytic, moisturising, calming and has anti-irritant qualities93
· Colloidal oat – induces the expression of genes related to epidermal differentiation, tight junctions and lipid regulation in skin, and provides pH-buffering capacity 94
· Cantella asiatica extract – in vivo test formulations containing 5% of centella asiatica extract showed the best efficacy in improving skin moisture by increase of skin surface hydration state and decrease in TEWL. They also exhibited anti-inflammatory properties based on the methyl nicotinate model of microinflammation in human skin95
· Snail secretion filtrate – is gentle, yet effective, and offers numerous benefits for sensitive skin, including deep hydration, anti-inflammatory effects, skin repair and regeneration, plus antioxidant protection96
Similar to oily skin, sensitive skin will benefit more from the consistency of lightweight lotion, oil-free creams and gel-cream textures and serums that will provide the necessary hydration and barrier support without causing irritation or heaviness. It’s also important to choose products specifically formulated for sensitive skin to ensure they are free from common irritants like fragrances and harsh preservatives.
Combination skin
Combination skin types are relatively common and are characterised by the skin being dry or normal in some areas but oily in others. For example, the cheeks may present as skin type, but the nose, forehead and chin (the T-zone) are likely to be oily. Congestion and comedonal acne can still be observed.
Understanding the complexities of combination skin is crucial for developing effective treatment regimens that can balance oil production, maintain adequate hydration and improve overall skin health, catering to the unique requirements of different facial zones.97
Ingredients, consistency and texture
This is very much dependent on the individual’s skin, but in general, gentle, non-stripping cleansers are essential to avoid exacerbating dryness while controlling excess sebum. Lightweight, non-comedogenic moisturisers that provide hydration without clogging pores are ideal.98 Additionally, ingredients like salicylic acid can help manage oiliness and acne in the T-zone, while humectants like hyaluronic acid can provide moisture to drier areas.99,100
Normal skin
Normal skin types present as well-balanced skin with few to no imperfections and an even, smooth, soft skin texture. Skin does not feel too dry, nor too oily. The skin looks fresh, but it is common to turn drier with age. The focus for normal skin types should be on skin health and quality.101
Ingredients, consistency and texture
Recommend a barrier-protecting, skin brightening and firming moisturiser with skin conditioning ingredients. Also formulations rich in ceramides, peptides, amino acids and antioxidants with a good quality, broad-spectrum sunscreen of at least SPF 30.102
Creating bespoke treatment regimens
Effective topical skincare treatment outcomes are reliant on a combination of understanding a patient’s skin type, implementing a thorough skincare consultation process and robust skincare science knowledge. This will help create skincare regimens bespoke to the individual patient, and will ensure that the correct balance of ingredient potency, product consistency and patient tolerance is achieved.
Cigdem Kemal Yilmaz is a chemical engineer, skincare formulator, educator and founder of Skin Masterclass. She graduated with a Master’s degree in chemical engineering from the University of Bath, and has created a CPD-certified skincare education and consultation platform for skin professionals looking to upskill their knowledge and scale their skincare consultation business.
Qual: Meng (Hons), AMIChemE
Understanding Topicals for Hair Loss
Dr Bisma Hussain and Dr Ducu Botoaca outline topical treatments for hair rejuvenation
Hair loss is a prevalent condition with significant psychosocial impact.1 Studies have revealed that low self-esteem, depression, introversion and feelings of unattractiveness are just some of the issues linked to hair loss.1,2,3 In the pursuit of effective interventions, the spotlight increasingly turns to topical treatments.
Reasons for experiencing hair loss
Genetics
Hereditary pattern baldness, also known as androgenetic alopecia (AGA), is the most common form of hair loss and is responsible for 95% of hair loss experienced by men.4,5 Altogether this form of hair loss and hair thinning affects around 85% of men and 40% of women by the age of 50.2,5,6 Genetic predisposition plays a significant role in the onset and progression of hair loss, with variations in genes such as AR, SRD5A2 and ESR1 contributing to susceptibility.4
Hormonal factors
Hormonal imbalances, particularly fluctuations in androgen levels, can trigger hair loss. Conditions such as polycystic ovary syndrome (PCOS) and male and female pattern baldness (AGA) are often associated with elevated levels of dihydrotestosterone (DHT), a potent androgen implicated in hair follicle miniaturisation and eventual hair loss.7
Lifestyle factors
External factors such as stress, poor nutrition, smoking and certain medications can also contribute to hair loss.8 Chronic stress, for example, can disrupt the
hair growth cycle, leading to increased shedding and thinning of the hair.8
Telogen effluvium
Telogen effluvium is a common form of hair loss characterised by excessive shedding of hair due to a disruption in the hair growth cycle. It can be triggered by a variety of factors, including physical or emotional stress, illness, surgery, childbirth, rapid weight loss or certain medications.9 Telogen effluvium is often temporary and reversible, with hair regrowth typically occurring within six to twelve months after the triggering event.
Alopecia areata
Alopecia areata is an autoimmune condition characterised by the sudden onset of patchy hair loss, typically in small, round areas on the scalp or other hair-bearing areas of the body. It affects approximately between 0.57% and 3.8% of the population and can occur at any age, although it most commonly presents during childhood or early adulthood.11 While the exact cause of alopecia areata remains unclear, it is thought to involve a complex interplay of genetic predisposition and immune dysregulation.12
Traction alopecia
Traction alopecia results from prolonged or repeated tension on the hair follicles, typically due to tight hairstyles such as braids, ponytails or extensions. It is particularly common among individuals with tightly coiled or textured hair, and can lead to hair loss along the hairline or in areas of frequent pulling. The prevalence
of traction alopecia varies depending on cultural practices and hairstyling habits, but is estimated to affect up to 30% of individuals with textured hair.13
Treating with topicals
Topical treatments for hair loss are designed to target the underlying mechanisms responsible for hair follicle miniaturisation and eventual hair loss. Several ingredients can be used, including minoxidil, finasteride, ketoconazole and dutasteride. As AGA is the most common form, most topicals are primarily used to address this form of hair loss. More studies are required on the effects of topicals on other forms of hair loss.
Minoxidil
Minoxidil, originally developed as an antihypertensive vasodilator, is now widely used topically for hair loss treatment and is currently the sole US FDA-approved topical treatment for hair loss.16 It enhances nutrient delivery to hair follicles by increasing blood flow and prolonging the growth phase (anagen) of the hair cycle.16 Clinical studies demonstrate significant hair count increases, such as a trial on 300 Japanese men with AGA showing a 50% higher hair density in the treatment group after four months of 5% minoxidil use compared to placebo.17 It has also been indicated that increased dosage leads to better therapeutic results with a 48-week trial on 381 women showing a 30% average increase in hair count with 5% minoxidil as opposed to 18% with 2% minoxidil.18 Primarily used for AGA, there is little data available on its efficacy in other forms of hair loss.
Finasteride
Finasteride, a 5-alpha-reductase inhibitor, is primarily administered orally but can also be compounded into topical formulations for localised application to treat AGA. By blocking the conversion of testosterone to DHT, finasteride effectively reduces DHT levels in the scalp, preventing further follicular miniaturisation and preserving existing hair follicles. A systematic review drawing data from several studies found that topical finasteride significantly decreased scalp and plasma DHT levels, reduced hair loss, increased total and terminal hair counts, and promoted positive hair growth.19 One of the studies compared oral and topical finasteride in 45 men and showed that both forms significantly increased hair counts with similar therapeutic effects. 20
A 48-week trial showed a 30% average increase in hair count with 5% minoxidil, as opposed to 18% with 2% minoxidil
Ketoconazole
Ketoconazole, an antifungal agent commonly used to treat dandruff and seborrheic dermatitis (SD), has also been shown to possess anti-androgenic properties. By inhibiting the production of androgens and reducing scalp inflammation, ketoconazole may help mitigate the effects of androgenetic alopecia and promote hair regrowth when used topically. Clinical studies have demonstrated that ketoconazole shampoo can improve hair density and diameter, as well as reduce scalp inflammation in patients with androgenetic alopecia. 21,22
Topical dutasteride
Dutasteride, similar to finasteride, is a 5-alpha-reductase inhibitor that has been investigated for topical use in treating androgenetic alopecia. By inhibiting the conversion of testosterone to DHT, dutasteride helps prevent further follicular miniaturisation and preserve existing hair follicles. Although clinical studies on topical dutasteride are limited, preliminary findings suggest its efficacy in improving hair growth parameters. 23
Non-pharmacological topicals
Some popular non-pharmacological treatments include:
Caffeine: Caffeine has demonstrated promising results in promoting hair growth by stimulating hair follicle proliferation and prolonging the anagen phase of the hair cycle. Clinical studies have shown improvements in hair density, thickness and overall hair growth with topical caffeine formulations.24,25
Saw palmetto: Saw palmetto extract, known for its 5-alpha-reductase inhibitory properties, may help prevent follicular miniaturisation and preserve existing hair follicles. Clinical studies investigating topical saw palmetto formulations have reported improvements in hair growth parameters, although further research is required.26,27
Essential oils: Essential oils such as rosemary oil, peppermint oil and lavender oil have shown potential in promoting hair growth and reducing hair loss. Clinical studies have demonstrated
improvements in hair density, thickness and overall hair health with topical essential oil formulations.28,29
Redensyl: Redensyl, a patented blend of plant extracts, has been shown to stimulate hair follicle stem cell activity and promote hair growth. Clinical studies evaluating topical Redensyl formulations have reported significant improvements in hair density, thickness and overall hair growth. 30,31
It’s important to note that data on non-pharmacological agents is limited. Therefore, further research is needed to fully understand the mechanisms of action and long-term benefits of these topical formulations.
Combining different topicals for enhanced efficacy
Combining different topical treatments can significantly enhance the efficacy of hair loss interventions by targeting multiple underlying mechanisms simultaneously. For instance, combining minoxidil with finasteride can address both vascular and hormonal contributors to AGA hair loss, leading to better outcomes than using either treatment alone. 32,33 Lee’s systematic review highlighted the superiority of combination over mono therapy. In one study involving 33 male subjects, topical minoxidil 3% alone was compared to minoxidil 3% and finasteride 0.1%. Both groups showed increased hair count, but more significant improvement from baseline was observed in the minoxidil and finasteride group. Moreover, minoxidil and finasteride demonstrated significantly higher efficacy in global photographic assessment compared to minoxidil alone.19
Similarly, combining minoxidil with topical ketoconazole or caffeine can provide synergistic benefits, such as improved scalp health and reduced inflammation, further promoting hair growth.19-23 A pilot study involving 15 men found all patients who demonstrated signs of SD reported significant improvement of their SD, a condition which can exacerbate hair loss.16 Ketoconazole’s anti-androgen and anti-inflammatory properties combined
with minoxidil vasodilatory effects naturally provide more optimal results in select patients. By knowing the patient specific factors contributing to hair loss and the additive effects of topicals, practitioners can select the most effective treatments and dosages.
Topicals can also be combined with clinic based non-surgical procedures such as platelet-rich plasma, microneedling, mesotherapy and more recently popularised procedures including polynucleotides and exosomes. However, more data is required to evaluate and compare the efficacy of these non-surgical procedures and any combination therapies including them.
Where topicals and combination treatments have not proven effective, or if the hair loss is more advanced, the patients may consider more invasive options, such as hair transplant surgery. While newly implanted hair is generally permanent and unlikely to fall out, existing hair can still be prone to hair loss after the transplant. Therefore, it is important for practitioners to establish a regimen to prevent further hair loss and maintain optimal hair density as much as possible.
An individualised approach to topicals
Topical treatments for hair loss offer a targeted approach to addressing the underlying mechanisms contributing to hair thinning and baldness. By leveraging the synergistic effects of different topicals and customising treatment plans to individual patient needs, practitioners can significantly enhance the efficacy of hair loss therapies, providing patients with more effective and sustainable solutions.
Dr Bisma Hussain, an aesthetic practitioner and hair transplant surgeon, specialises in genetic testing for personalised hair restoration treatments. Educated at the University of Nicosia Medical School and trained at Dr. Ducu Clinics, she focuses on individualised care and innovative approaches to combat hair loss.
Qual: MD
Dr Ducu Botoaca is the founder of his clinic Dr. Ducu Clinics, specialising in advanced aesthetic services, including hair and eyebrow transplants, as well as non-surgical BBL. He has developed and patented unique techniques for both eyebrow transplants and non-surgical BBL procedures.
Qual: MD
The Corrective Serum Taking Volume to a New Dimension
NEW FORMULATION: HA Intensifier Multi-Glycan by SkinCeuticals
Over the past two decades, the landscape of dermal fillers has significantly evolved. Initially, the focus was on surface volume, with the first generation of hyaluronic acid fillers providing simple yet incredibly effective plumping effects. Today, advancements in filler technology enable not only surface volume, but also structural volume by addressing the deeper layers of the skin.
Multi-Glycan technology works on a similar mechanism of action to provide more comprehensive support to the skin’s structure.
Understanding glycans: the foundation of youthful skin
Glycosaminoglycans (glycans) are essential compounds naturally present in the skin, providing hydration and structural support. As we age, the skin’s most abundant glycan – hyaluronic acid – diminishes, leading to wrinkles and a loss of plumpness. The remaining glycans contribute to the skin’s strength and structure. The new formulation of HA Intensifier Multi-Glycan from SkinCeuticals leverages this knowledge to deliver a cutting-edge corrective serum solution for ageing skin.
Introducing SkinCeuticals
HA Intensifier Multi-Glycan – proven to visibly plump and reduce the appearance of fine lines.*
From the brand recommended by 9/10 dermatologists in the UK and Ireland* comes the new HA Intensifier Multi-Glycan. Renowned for the multi-award-winning HA Intensifier serum, this updated formula from SkinCeuticals has been formulated with the addition of multi-glycans to visibly plump and reduce the appearance of fine lines. With consistent use, HA Intensifier Multi-Glycan offers tangible results in contouring and volume.
Key ingredients and triple formula efficacy
HA Intensifier Multi-Glycan has been formulated with three key objectives in mind: surface plumping, skin smoothing and structural volume boosting through the addition of multi-glycans in the formula.
This powerful natural humectant provides long lasting hydration to improve the look of skin texture.
x ALT: Three forms of a powerful, natural humectant (high molecular weight, low molecular weight and acetylated) to provide long lasting hydration to improve the look of skin texture.
· 0.2% Purple Rice Extract
12% ProxylaneTM
x 20% more than the previous HA Intensifier formula
Supports skin’s hyaluronic acid levels to help improve the appearance of skin firmness.
x Helps support skins firmness and improve skins texture.
Why Choose SkinCeuticals?
SkinCeuticals bridges the gap between professional treatments and skincare, offering formulations that complement and maximise in-clinic procedures, making it the go-to partner for the world’s leading aesthetic physicians. SkinCeuticals treatments not only enhance post-treatment results, but often exceed expectations. SkinCeuticals’ commitment to scientific rigour and innovation, spearheaded by its founder Dr Sheldon Pinnell, ensures advanced skincare solutions endorsed by dermatologists and aesthetic professionals worldwide.
This advertorial was written and supplied by
For more information and to become a stockist please scan the QR code
*Based on a survey of 121 Consultant Dermatologists in the UK
**Protocol: A 12-week, single-centre clinical study was conducted on 81 females, ages 35 to 65, Fitzpatrick I-VI, with mild to moderate skin softness, firmness, and elasticity on the cheeks, as well as fine lines, wrinkles, skin smoothness, plumpness, lifting, skin tone evenness, radiance, and overall appearance of skin condition on the global face, including crow’s feet wrinkles, undereye wrinkles, perioral wrinkles, forehead lines, marionette lines, and nasolabial folds. The product was applied twice daily alongside regular cleanser, moisturiser, and sunscreen. Efficacy evaluation was conducted at baseline, post-application, and at weeks 1, 4, 8, and 12.
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: Identifying Levels of Competency in Aesthetic Medicine: A Questionnaire-Based Study
Authors: Cotofana S, et al
Published: Aesthetic Surgery Journal, April 2024
Keywords: Adverse Events, Anatomy, Injectables
In this recent publication, the authors conducted an online survey and discovered interesting aspects of medical aesthetics. The design of the study was a community-based survey which utilised social media to reach the global aesthetic community. 386 respondents from 61 countries provided feedback on various aspects of aesthetics, including their perception of dangerous and difficult facial regions to treat with soft tissue fillers, biostimulators and neuromodulators.
Title: Are We Overlooking Harms of BDDE-Cross-Linked Dermal Fillers? A Scoping Review
Authors: Wojtkiewicz M, et al
Published: Aesthetic Plastic Surgery, August 2024
Keywords: BDDE, Dermal Fillers, Patient Safety
Abstract: 1,4-Butanediol ether (BDDE) is widely used as a cross-linker for hyaluronic acid in dermal fillers. The purpose of this scoping review was to determine the state of knowledge about the behaviour of cross-linked substances and safety of BDDE application. The rationale behind the review came from the clinical experience of the corresponding author, who noticed adverse reactions after BDDE-linked hyaluronan application. Results were charted according to six subtopics: rheological properties, hydrogel stability, BDDE toxicity, immunogenicity, tissue interactions and clinical studies. In vitro, cross-linked hydrogels were characterised as effective fillers in terms of viscosity and elasticity; however, previously uncharacterised by-products of the cross-linking reaction were found. Most in vivo studies reported increased dermis regeneration, vascularisation and anti-inflammatory cytokine release after implantation of BDDE-cross-linked substances. In clinical studies, BDDE was shown to sensitise subjects to 1,6-hexanediol ether and other substances found in epoxy resin systems. Occupational dermatitis and hypersensitivity reactions were documented. Our review shows that BDDE may have long-term adverse effects, which are overlooked in the safety assessment of fillers. Reviews on BDDE conducted so far have mostly been sponsored, potentially leading to incomplete reporting of adverse effects.
It was confirmed that the aesthetic medical community is in agreement about which facial regions pose the greatest risk for causing severe adverse events when administering soft tissue fillers and biostimulators: 1. nose, 2. glabellar and 3. forehead. These facial regions all receive direct arterial blood supply from branches of the ophthalmic artery, which opens up the pathway for the injected product to flow backwards into the ophthalmic artery circulation, which includes the various layers of the retina.
Interestingly, the facial regions that were perceived as most difficult to treat and achieve a perfect aesthetic outcome (if such an outcome exists) were 1. nose, 2. tear trough and 3. forehead. This showcases that the tear trough, despite not having a high vascular risk, carries a high degree of difficulty to treat; separating for the first time the intrinsic risk (facial danger zones) from procedural risk. For neuromodulator injections, the ranking of facial regions for causing adverse events was 1. perioral, 2. forehead and 3. masseters. This showcases that these facial regions are most frequently associated with toxin-related adverse events and that more research needs to be conducted. When looking at the facial regions that are most difficult to treat in order to achieve a perfect aesthetic outcome with neuromodulators, the ranking was 1. perioral, 2. jawline and 3. forehead. Again, the perioral region was listed first, which emphasises the need for the aesthetic research community to focus on this region. For daily clinical practice, the results of this study provide insight into the injector community’s perception of risk and ease of various injectable treatments. Future studies will need to focus more on the lower face to address those needs.
Title: Predictors of Initiating Biologics in the Treatment of Psoriasis
Authors: Linnemann E, et al
Published: International Journal of Dermatology, August 2024
Keywords: Biologics, Psoriasis, Topicals
Abstract: Biologics are among the most effective therapies for psoriasis. However, many patients are only introduced to them at advanced stages of the disease course. Our aim was to identify predictors of initiating biologic therapy in patients with psoriasis and compare patients initiating biologics early versus late in their disease course. Our primary analysis included 233 psoriasis patients. Cox regression showed that age at diagnosis, general physical wellbeing and nail psoriasis severity were significantly associated with time to biologic initiation. Our secondary analysis, the comparisons between patients starting biologics early versus later in the disease course, included a total of 378 patients. The median age at diagnosis was 34.5 years for patients initiating biologics within five years, compared to 22.0 years for patients initiating biologics later. The median age at initiation was 37.0 and 45.0 years for patients initiating biologics earlier versus later than five years. Age at diagnosis, general wellbeing and severity of nail psoriasis significantly predicted future initiation of biologic treatment. Patients initiating biologics early in their disease course were generally older at diagnosis but younger at the time of biologic initiation compared to patients initiating biologics later in their disease course.
Navigating Life After Redundancy
CEO Sue Thomson provides advice for individuals experiencing redundancy fears
The recent news of SK:N Group companies entering liquidation sent shockwaves throughout the UK medical aesthetics specialty. Leaving 800 professionals unemployed, it was announced the clinic chain and several aesthetic distribution businesses would cease trading with immediate effect.1
The abrupt closure of this well-known clinic chain underscores the importance of being prepared for unforeseen changes in the job market, such as liquidation or redundancy. When a company enters liquidation, all employees, lose their jobs immediately, as the process – whether solvent or insolvent – marks the end of the company’s operations. Redundancy, however, is different; it occurs when roles are eliminated due to cost-cutting measures, the role becoming obsolete, business relocation or new processes that render certain positions unnecessary.
In this article, I will explore the best practices for navigating redundancy, offer practical tips for job hunting and discuss how to manage the mental health challenges that can arise when you lose your job in such a specialised field.
Current redundancy landscape
While many variables affect the recent events in our specialty, we also know that according to the Office for National Statistics (ONS), the redundancy rate in the UK for the three months leading to May 2024 was 3.6 per 1,000 employees.2 This is a decrease from the 4.1 per 1,000 employees reported in the previous quarter.2 The number of redundancies in this period totalled around 120,000, reflecting a general decrease as the labour market stabilises post-pandemic.2 The Chartered Institute of Personnel and Development (CIPD) also stated that the Labour Market Outlook for Spring 2024 indicates that while the net employment balance (the difference between employers planning to increase and decrease staff) remains positive, it is on a downward trend.3 This suggests that while job creation is still occurring, the pace is slowing.
Whilst there are no set rules to follow in terms of redundancy, if there are fewer than 20 redundancies planned, it is good practice for a company to fully consult
employees and their representatives.4 Collective redundancy on the other hand is the process referred to when there are more than 20 employees and a process of consultation is followed that can take between 30 to 45 days. This period allows employees to be informed of why there may be redundancies and they will also have the opportunity to discuss if there are ways to avoid redundancy.4
Experiencing redundancy
Losing your job, especially unexpectedly, can be a deeply traumatic experience, and it’s important to acknowledge the emotional toll it can take and allow yourself time to process the change. Having been made redundant myself twice in my career, I’m fully aware of the rollercoaster of emotions that we can feel and it’s all completely normal. Whilst the first redundancy was a shock and I was scared and angry, during the second redundancy I was more prepared and able to quickly adapt and take more positive actions. Common feelings can include shock, anger, sadness and anxiety about the future; recognising and acknowledging these emotions is the first step in moving forward.
As you begin to fully realise the reality of being made redundant, it’s critical that you take the time to know your redundancy rights. This ensures that you are treated fairly, receive the compensation and support you are entitled to, and can effectively plan for and manage the transition to new employment. It also helps protect against unfair or discriminatory practices, contributing to your overall wellbeing during a challenging time. Whilst some of the following may not be relevant for the recent redundancies as a result of liquidation, it is important to understand your legal position and rights.5,6,7
Entitlement to redundancy pay
Employees who have been with their employer for two years or more are entitled to statutory redundancy pay. Knowing this can help you secure the financial compensation you are due, which can be critical in supporting you while you search for new employment.5 There are redundancy calculators available online to assist you in understanding redundancy
payments.8 With the advent of the new Labour government, there are changes anticipated around the timelines of entitlement to redundancy.
Notice period
You have the right to a minimum notice period based on your length of service. Being aware of this helps you plan for the transition period and gives you sufficient time to prepare for your next steps.5
Alternative employment and retraining opportunities
Employers are often required to offer suitable alternative employment within the organisation if available. Having knowledge of your legal rights can help you explore these opportunities, which might prevent redundancy altogether. Additionally, there might be support for retraining, which can be beneficial for your future career prospects.5
Consultation process
Employers must consult with employees before making redundancies, especially in collective redundancy situations (20 or more). Understanding this process ensures that you have a voice in the discussions and that the employer considers your input and potential alternatives to redundancy. As you approach consultation meetings, you can prepare for these by considering drawing up some questions for your employer, which could include:7
1. Are there ways to avoid being made redundant?
2. Why have you been selected for redundancy?
3. Is there an opportunity for you in any other role that your skill sets are suitable for?
4. If you have any challenges or concerns with the process, this is the perfect time to discuss them.
Challenging unfair redundancy
Knowing your rights can help you challenge your redundancy through appropriate legal channels, such as employment tribunals, if you believe your redundancy is unfair. This can lead to reinstatement, compensation or other remedies. When challenging an unfair dismissal, it will be important to collect any evidence that you can to support your claim. For instance, has the company employed someone quickly for the role that has been made redundant? Has the role remained the same but the employer has just changed the role title? Collating this information in relation to what you believe is an unfair dismissal can help you with any future claims.5
Protection against discrimination
Redundancy should not be used to cover up discrimination. Understanding your legal protections helps ensure that you are not being selected for redundancy based on protected characteristics such as age, gender, race, disability, etc. If you are unsure of what your rights are, there are open sources available such as Citizens Advice and ACAS where they can provide you with support and advice for any potential next steps.6,7
Access to benefits and support
Understanding your entitlements also includes knowing what government support and benefits you may be entitled to, such as Jobseeker’s Allowance or Universal Credit, which can provide a financial safety net while you seek new employment.5
Practical tips for job hunting
The next step after redundancy is to look for a new job, which can be daunting for many people, especially if the decision is out of your hands.
Below are a few tips to help you stand out to potential employers.
Update your CV and LinkedIn profile
Ensure your CV reflects your most recent experiences and accomplishments – make sure to highlight any specialisations or advanced training in medical aesthetics. A well-crafted LinkedIn profile can help you connect with peers and potential employers. This includes adding an up-to-date profile picture and background photo, a short and impactful ‘about statement’ and adding any specific career highlights. You should also join relevant groups and engage in discussions to increase your visibility.
Leverage your network
Reach out to former colleagues, contacts and professional organisations – personal recommendations can be incredibly valuable. These could include local networking groups such as the Northern Aesthetic Practitioners group or the larger bodies such as the British Association of Cosmetic Nurses or British College of Aesthetic Medicine.
You should also try to attend conferences like CCR or ACE, webinars and events to expand your network and learn about job openings.
Tailor your job applications
Customise your CV and cover letter for each job application. Emphasise your unique skills and how they align with the specific needs of the employer, which you can typically find in the job description
of job listings. Research the company and demonstrate your knowledge of its products, services and market position.
Further education and training
Use this time to enhance your skills and qualifications. There are many online courses and certifications available in medical aesthetics that can make you a more competitive candidate. Consider your current skills, how you would like to improve them or what skills you would like to add. Specialty journals are a great source of information where details of courses that are either being led by manufacturers or by clinical leads in the country are available.
Explore different roles
While you may have specialised in one area, consider expanding your job search to include related roles. For example, roles in product development, sales or training can all benefit from your clinical experience.
Coping mentally
Supporting your mental health during redundancy is crucial. Establishing a daily routine can provide much-needed structure, ensuring you allocate time for job searching, physical activity and relaxation. Seeking professional support, such as a career coach, can offer personalised advice and strategies, while therapy or counselling can address the emotional impact of redundancy, with many services available remotely. Staying connected with friends, family and professional networks can prevent feelings of isolation, anxiety and depression. Engaging in self-care activities that you enjoy, like exercise, reading or hobbies, helps you relax and maintain a positive outlook. Additionally, setting realistic goals and breaking down your job search into manageable tasks can keep you motivated and foster a sense of accomplishment. These tasks could be to:
· Define your job search criteria –what role would you like to attain?
· Consider the location to avoid finding roles that are not within a realistic travel distance.
· Set a specific amount of time aside each day where you will focus fully on the job search.
· Create a simple spreadsheet to keep a record of the roles you apply for.
Utilise the community
Redundancy can be a daunting experience, but it also presents an opportunity for growth and new beginnings. The medical aesthetics specialty in the UK continues to evolve, with new treatments and technologies emerging regularly which require new roles and skills. By staying proactive, leveraging your network and taking care of your mental health, you can navigate this challenging period and find new opportunities that align with your skills and passions.
With the right approach, you can turn this setback into a stepping stone for future success. Remember, every end is a new beginning, and with perseverance and support, you will find your next opportunity in the medical aesthetics field. What has been truly heartwarming is the pulling together of the specialty as a whole, as companies and individuals share their support and their opportunities. Aesthetics themselves have set up a new page on LinkedIn called the Aesthetics Recruitment Support Network UK, where you can access the latest available roles that companies and clinics have available. If you’re in the process of looking for a new role, do check it out.
Since the liquidation of SK:N Group Companies Clinics, Optical Express has announced its acquisition of the five companies affected by the liquidation, and I’m aware that they have invited recent employees to come forward giving light and hope for future opportunities. To those who have been recently affected by the SK:N liquidation, I urge you to stay resilient, explore new opportunities and remember that support and guidance are available to help you navigate this challenging time.
Sue Thomson is the CEO of SJ Partnership and is an accomplished international sales leader with a background in pharmaceutical and medical device industries. She has supported clients in achieving award-winning product development and commercial goals, while building and leading successful sales teams.
WHAT MAKES HARLEY ACADEMY THE LEADER IN POSTGRADUATE AESTHETIC
MEDICINE
TRAINING?
Whether you're a seasoned practitioner or new to the �eld, our courses provide the skills and knowledge needed to excel. We o�er various training options, from introductory courses to full quali�cations, fostering a community of skilled and passionate professionals dedicated to excellence.
Innovators in Aesthetic Medicine Training
Harley Academy is at the forefront of medical aesthetics education, spearheading the Ofqual-regulated Level 7 qualification in injectables. Our evidence-based courses in injectables and cosmetic dermatology produce confident, ethical and highly skilled practitioners.
State-of-the-Art Facilities
Train at our bespoke City of London locations, home to the UK's largest medical aesthetics campus. Our state-of-the-art facilities and dedicated training clinic, The Academy Clinic, serves over 1,000 patients per month. This ensures that trainees receive the best hands-on experience in an optimal learning environment.
A World-Class Team
Founded by Dr Tristan Mehta, our courses are led by industry experts and experienced practitioners who bring a wealth of knowledge and expertise.
With insights from our Board’s renowned professionals such as Professor Sebastian Cotofana, Professor Nichola Rumsey, OBE, Dr Tapan Patel and Professor David Sines, CBE, you’ll learn from the very best in the field.
Why Medical Professionals
Choose Harley Academy
1:1 Training with Your Own Patients:
Gain hands-on experience and build your confidence through personalised training sessions within a real clinic environment.
Innovative Curriculum:
Benefit from our evidence-based courses designed to proudly deliver safe, effective and natural results.
Accredited Qualifications:
Achieve nationally recognised qualifications and certifications, boosting your employability and career prospects.
Extensive Support Network:
Get access to ongoing support from our dedicated team and exclusive alumni community.
Diversify Your Treatment Portfolio:
We are always expanding our range of courses to support practitioners to offer a range of services.
We’re very proud to announce that Harley Academy is the only official injectables training partner of HA-Derma, the UK distributor of Profhilo® products.
We will be rolling out our new Profhilo® Structura course this Autumn, contact us to join our waiting list.
Dr Jaymi Lad began her journey into the aesthetics field in 2016. Initially lacking confidence after a one-day course, she enrolled in the Level 7 Diploma with Harley Academy whilst continuing her work for the NHS.
“Without the 1:1 training and mentorship, I do not believe I would have felt confident to work independently in the field.”
Her hard work and commitment led to the establishment of her own clinic in 2020. Although she didn't initially plan for a full-time career in aesthetics, her passion grew as she saw the transformative impact of her work.
Since training with Harley Academy, Dr. Lad now specialises in facial injectables and has a special interest in treating skin of colour and addressing concerns such as acne, scarring and hyperpigmentation. Dr. Lad leverages this expertise to teach and support our trainees throughout the Harley Academy Cosmetic Dermatology course
Jaymi finds the most rewarding experiences come from long-term patient relationships, witnessing first-hand the confidence boost her treatments provide.
Enjoying the flexibility in her work-life balance. Her professional time is currently split between teaching at Harley Academy and working closely with patients in her busy clinic.
Explore our wide range of courses
• Foundation Training in Botox & Dermal Fillers
• Level 7 Diploma in Botox & Dermal Fillers
• Fast Track Level 7 Diploma
• Combined Level 7 Diploma
• Cosmetic Dermatology Foundation Training
• Cosmetic Dermatology Course
• The Aesthetics Accelerator
Dr Janine Rothburn, a Dental Surgeon, found her passion for aesthetics during her tenure in oral & maxillofacial surgery.
Working alongside experts in facial reconstruction ignited her interest, leading her to pursue specialised training in aesthetic medicine.
Through our range of Injectable Masterclasses, Dr Rothburn supports other practitioners in delivering profile-balancing treatment plans by mastering facial assessment and refining injectable techniques.
“I am a firm believer that in order to thrive, you have to learn from and associate with the industry leaders and specialists – Harley Academy offered exactly that opportunity”
She is driven by the evolving nature of aesthetic medicine and the daily challenges it presents, believing in continuous learning and collaboration.
Often consulting with colleagues to navigate complications and improve patient outcomes, her holistic approach ensures bespoke, elegant and natural results for her patients.
“The most rewarding aspect of my work is the patient satisfaction. Patients are excited to come into clinic to boost their confidence and feel better about themselves which is extremely fulfilling.”
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Harley Academy
Harley Academy
THE CLINICAL TRAINERS ELEVATING AESTHETICS STANDARDS
Shantel Noble, RGN transitioned from a career as a paediatric nurse to aesthetics, seeking better work-life balance and autonomy. Her passion for skincare and a rounded approach to patient care led her to Harley Academy, where she completed the Level 7 Diploma.
Shantel now combines her nursing skills with her aesthetic expertise to offer comprehensive and patient-centred treatments.
She enjoys the transformative power of aesthetics, from improving skin health to restoring facial harmony. A particularly memorable transformation involved a multi-area filler treatment:
“I just turned back the clock by about 15 years in an hour session and she cried when she saw herself in the mirror, she was so happy she looked just like herself still, but a younger version.”
Shantel addresses challenges by adhering to evidence-based practices and maintaining high ethical standards.
Due to Harley Academy’s dedication to 1:1 mentoring, Shantel believes that this personalised trainer-to-trainee guidance is the key to success in starting out in aesthetic medicine.
She also believes that professional growth in aesthetics requires comprehensive education, continuous learning and active engagement in the industry.
Want to have a conversation with our experts...
Book a call with a member of our team today
DR JENNIFER MACLSSACC DERMATOLOGIST, USA
KATHY TARANTO MINT AESTHETICS, USA
LOURETTE DU TOIT DERMOLOGY, SOUTH AFRICA
DR ANJALI MAHTO DERMATOLOGIST, UK
DR JENNY DOYLE OCULOPASTIC SURGEON, UK
DR TONI CAMPO DERMATOLOGIST, SPAIN
DR ARNAUD LAMBERT COSMETIC DOCTOR, FRANCE
DR SHERRIF IBRAHIM DERMATOLOGIST, USA
DR JASON EMER COSMETIC SURGEON, USA
Achieving Career Progression By Entering Awards
Aesthetics Awards winning clinic owner Dr Chris Hutton shares his top advice for entering awards, and why it has changed his practice
Entering awards in your sector can be a daunting prospect, especially if they are on the scale of The Aesthetics Awards. Putting these entries together takes time and effort, but the rewards can be huge. At my clinic Array Aesthetics in Belfast, we are proud and humbled to be two-time winners of the Best Clinic Ireland & Northern Ireland Award in 2023 and 2024.
These wins did not come easy. We thought long and hard about how to craft meticulous answers and supporting documents before submitting our entries, and I believe this effort was the key to our success. In this article, I will share some of my key pieces of advice for achieving success at awards in your sector.
Why enter awards?
First, it is imperative to consider why entering a ceremony like The Aesthetics Awards would be a good move for you. At Array Aesthetics, we decided to enter because the objective, open and peer-recognised nature of The Aesthetics Awards is held in the highest regard within the specialty.
However, given the time and effort required, you must consider whether now is the right time for you to enter. Being squeezed for time, not having enough supporting evidence or just not being in a place from a development perspective are all good reasons not to enter. If you are feeling like this, review the entry questions anyway and aim for next year… Remember, there are some categories such as Best New Clinic UK & Ireland, Rising Star of the Year and Best New Innovative Product which are designed specifically to accommodate newcomers, so do not be deterred! Just make sure you have the time to put together exceptional entries, following the principles of my guidelines.
Chart your path to success
If you have a goal to win awards, create a long-term plan to be competition-ready. For The Aesthetics Awards, the questions are all available to view online now so you can
begin to consider how you want to structure your entry. Do your homework and thoroughly study the questions to have a good understanding of what the judges are looking for. This preparation will help you and your team set specific targets and focus your energy on the appropriate adjustments and improvements needed to put you in a stronger position for success. Quick tip: Create a schedule in advance for your awards application, including time to strategise and set goals. When it comes time to write your entries, you’ll be more than ready.
Prioritise accuracy and precision
Your application may be beautifully written and impressively presented, but the judges have a lot of submissions to get through and need to mark entries against a very specific set of criteria. Read each question carefully and pay close attention to the wording. Note keywords within the question, as they indicate precisely what the judges are looking for in your answers. Perform a thorough final read-through before clicking submit to catch typos and ensure your answers are grammatically correct, as this will help you avoid losing valuable marks unnecessarily.
Quick tip: Ask someone with excellent attention to detail to proofread your application before submission.
Keep your answers concise
The Aesthetics Awards entry process incorporates a strict word limit for each question in every entry (200 words per question), so concision is key. As much as we want to include every last detail in each question to support our application, think of the word limit as an opportunity to score points for professionalism and excellent communication by providing clear and concise answers. Keeping within the word count is an opportunity to demonstrate your ability to communicate effectively under constraints. At the same time, the judges can penalise you if your answers are too short, so try and get as close to the 200-word limit as you can. Focus on delivering the most impactful information within the limit to give your application a better chance of making the shortlist.
Quick tip: Bullet points are useful to highlight key information, keep your word count down and improve clarity and impact.
Every picture tells a story
A powerful way to demonstrate excellence in your services and patient care is with compelling before and after photos. All clinic and practitioner categories, as well as some product categories, will require you to submit a significant case study as part of your application, so making sure this really showcases your skills is of paramount importance.
You should to have a system in place to capture your patient case studies so you’re ready to use the very best in your entries. To impress the judges, the photos themselves have to be of a high clinical standard, with uniform lighting, standardised angles, no makeup or other obstruction of results and no selfies.
Don’t forget to gain permission from patients at the time of taking the photos and before sharing them in your application to ensure compliance with privacy regulations and ethical standards.
Quick tip: Capture success stories that play to your strengths, showcase advanced techniques and directly support the content of your application.
Harness high ratings and reviews
If you’re providing excellent care and your patients are consistently delighted with the results, it’s crucial to capture and showcase this success to effectively demonstrate your competitive edge. You will be asked to share both qualitative and quantitative data about your patient experiences in your Aesthetics Awards entry. Our booking software includes a quick and convenient option for patients to rate and review their experience, providing us with fantastic soundbites and measurable data that can be used to impress the judges and strengthen our application. If this option is not available to you, consider putting together an online feedback form that you can send out to your patient database to get their comments.
Quick tip: Make it as easy as possible for patients to give you five-star feedback by setting up an automated rate and review system, and promoting the option for your patients to post a public review on platforms like Google or RealSelf.
More facts, less fluff
We all work hard to achieve outstanding results and provide the highest level of care for our patients, but what sets us apart from our competitors? Pay attention to exactly what makes you unique, what value you are adding and how you’re driving innovation. Don’t just say ‘We go the extra mile’ – back up your words with hard evidence by providing data and clear examples of how you do it. As mentioned, the questions are very specific about what the judges are looking for, so make sure your answers are also targeted and well-supported, making your USP shine.
Quick tip: Write in your own, original words to connect with the judges and show off your unique qualities. AI tools can help here, but should be mainly used for condensing copy, proofreading and grammar checks.
Give yourself enough time
Ever heard of the planning fallacy? It’s a phenomenon that explains our tendency to be overly optimistic about how much time we have to complete a task. If you have ever been involved in a house extension, opened a clinic or dabbled with flat-pack furniture, you can probably relate. Preparing an awards application is no different. To be in the running as a Finalist, allocate plenty of time to write, edit and polish your application. Additionally, you need time to prepare supporting information and gather the best images and videos that will help your application truly stand out from the competition. Do not overestimate your ability to throw together an entry at the last minute – it’s harder than it sounds! I would allow at least six to eight weeks to put your answers together.
Quick tip: Now the Aesthetics Awards categories are live, review them thoroughly with your team. Understand the requirements, create a checklist and estimate a realistic timeline that does not involve submitting your entry the day before the deadline!
Reaping the benefits
Alongside making us very proud, becoming winners of prestigious awards in our sector has benefited our team and business in a number of ways, such as:
1. Bringing well-deserved recognition to our team for all their achievements, which also hugely boosts their morale.
2. Showcasing our expertise in Ireland and Northern Ireland’s rapidly growing aesthetics market. This has helped boost our reputation among other members of the community.
3. Enhancing our reputation among prospective and existing patients – having our trophies on display in our clinics, on our website and across social media confirms our status as a leading clinic that patients can trust.
Now that we have given away our secrets to success, we look forward to competing with you at the next Aesthetics Awards. Best of luck with your application!
Dr Chris Hutton is an aesthetic practitioner who, in partnership with his wife Dr Judith Storm, is at the helm of the award-winning Array Aesthetics Clinic and Array Academy in Belfast, Northern Ireland. Dr Hutton is a highly experienced injector and trainer, and is proudly an innovation partner for Merz Aesthetics.
Qual: MB, BCh, BAO (QUB), PG Cert. (QMUL)
Dr Chris Hutton will be sharing more advice on entering awards on the CCR In Practice Stage at 10:10am on Thursday October 10. CCR 2024 will take place at ExCeL London on October 10-11. Register for free now on p.22 to attend.
15 March 2025, Grosvenor House, London
Entry for The Aesthetics Awards 2025 is open now! Become an Elite Member to have unlimited entry to the Awards. Submissions close on October 25, so get entering now via the QR code. Good luck!
Clinic Management
Boosting Revenue
Optimising Clinic Checkout
Healthcare payment specialist Jared Aron discusses the strategies for boosting profitability and improving patient experience at clinic checkout
Patient checkout is a clinic’s ‘superpower’. The journey to optimal checkout begins the instant your patient’s treatment concludes and extends until they walk out your clinic. To optimise this process and maximise revenue, it’s crucial to reframe the role of your receptionist and integrate strategic financial tools into your practice. However, this process is often overlooked, despite its potential to drive sustainable revenue growth.
In this article we will explore how patient checkout can, and should, serve as your clinic’s most compelling profit centre, turning a routine transaction into a powerful driver of business growth.
Anatomy of checkout
Let’s start by establishing checkout-specific language. Here’s the cheat sheet:
· Dwell time: the time spent at reception following treatment, before departure
· Rebooking rate: the frequency of booking a follow-up appointment
· Payment acceptance: the way payment is collected
· Lifetime value (LTV): the total revenue generated from a single patient relative to what it costs to serve them
· Cost to acquire a customer (CAC): the expense associated with bringing in a new customer
· Unit economics: the ratio of LTV to CAC, which reveals the profitability profile per patient
Reframe the receptionist’s role
The journey to optimal checkout starts with reframing the role of your receptionist. Delivering optimal checkout requires a fundamental shift for receptionists to think and act like revenue managers. Your
clinic’s key commercial metrics such as rebooking rates and revenue growth are reflective of the receptionist’s success rate in optimising checkout. ( Table 1) provides insight on how to reframe the role of the receptionist. True transformation requires reinforcement and continuous practice, like learning a new sport. The process requires the engagement of the entire clinic, including practice leaders, consultants and therapists. Afterward, professional development and training can be offered to instil this practice. Recognise that reception is a business-critical function directly tied to revenue. In the past, I have seen an engaged reception team double digit revenue growth with £0 additional spend on acquiring new patients.
When receptionists become revenue managers, patients feel a greater sense of connection to the practice because you have built a high-trust relationship. Revenue managers are the first and last point of contact, and therefore are integral to the patient journey in helping create value.
Scrutinise your checkout profit and loss
As a practice leader, you will have regular sight of your profit and loss (P&L) statement. But hiding inside your practice-level P&L is a micro-P&L specifically related to checkout. As in any P&L, we can think of your checkout P&L in terms of revenue and cost.
Thinking like a receptionist Thinking like a revenue manager
Rebooking
Payment acceptance
Patient education
The practitioner recommended a follow-up appointment in three weeks, so I will rebook the patient in three weeks.
The patient is in a rush; I’ll take payment by phone or at their next appointment.
Success means patients can be in and out quickly, without any friction.
Revenue growth I need to promote a new aftercare product to meet my targets.
Cost cutting
Profitability
I need to renew the annual plan with our payment provider.
Assesses revenue captured per treatment.
The practitioner recommended a follow-up in three weeks, so I will review the treatment plan and, if relevant, book the remainder of the treatment course at three-week intervals.
The patient is in a rush; I’ll send a payment link in the final minutes of their treatment so they receive and settle it before leaving the clinic.
Success means that patients enjoy a smooth in-clinic experience, and leave informed about relevant services and products we offer.
I need to discover what motivates patients to buy aftercare products and ensure that the messaging is tailored accordingly.
I need to actively search for and engage with different payment providers to ensure the best value.
Assesses the ratio of lifetime value to cost to acquire a customer (unit economics).
Table 1: Turning a receptionist into a revenue manager
Cost
Checkout costs are most easily identified as the cost of card machines (usually a monthly fee per device) and the cost of accepting payment (fees per transaction).
Understanding the cost of card machines is relatively straightforward – you pay money to get the machine. However, payment processing fees aren’t as easily understood. Card processing fees are typically a percentage of the transaction value, comprised of:
1. The interchange fee charged by the card issuing bank (e.g. Barclays or HSBC)
2. The scheme fee set by the card issuer (e.g. Visa or Mastercard)
3. The card acquirer markup (e.g. Stripe or Square)
Card processing fees usually have a fixed and variable element:
· Fixed: A set fee, say £0.20+ per transaction
· Variable: A % of transaction value, say 2%
Rates may vary for in-person vs. remote payment, too. This can confuse and misdirect practice leaders, ultimately leading them to make rushed, costly decisions. In general, practices spend far too much collecting payment.
There has been extraordinary innovation in payments in recent years. As the economy transitions to digital-first, some payment companies have met the call to modernise where others have failed. New technologies, enabled by open banking regulations, offer a solution. Pay by bank allows clinics to accept an instant bank transfer from their patient. Patients simply scan a QR code or click a link, redirecting them to their mobile banking app with pre-populated transfer details.
Similar to paying a credit card bill via an app, this method can be used in clinics to take payments at virtually no cost. Paying by bank takes 15 seconds longer than tapping a card, but it is time well spent considering the associated savings of card processing fees. If you haven’t explored modern payment solutions and instead rely on the same brand names that have been around since 2010, you’re leaving value on the table.
Revenue
Returning to your checkout-specific P&L, we need to also think about revenue growth. Checkout revenue should not be defined as the revenue from a treatment in one given visit. Using this definition implies that the team is not thinking like revenue managers and maximising profit.
It is a good idea to keep unit economics at the forefront of your clinic’s priorities. This is worked out by subtracting the cost of service from the patients’ total spend, then comparing the resulting value to the acquisition cost. Assume a patient spends £500 in your clinic over five treatments. If each treatment costs £25 to deliver (in supplies, labour etc.), then the cost of service is £25 x 5 or £125. The patient’s lifetime value (LTV) is £500 minus £125, or £375. If your cost of acquiring the customer (CAC) through marketing methods is £275, then your unit economics are £375 earned:£275 spent on acquiring the customer.
By emphasising the revenue generated from each patient, clinics may neglect critical factors such as the costs involved in serving and acquiring those patients. The oversight can lead to a misunderstanding of the true profitability of each patient. Many practices don’t accurately measure their lifetime value (LTV) to cost of acquiring a new customer (CAC) ratio. In the above scenario, for example, the ratio would be 1.3:1. Although this doesn’t indicate profit loss, it’s far from a significant contributor to clinic profitability. Top tip: if LTV divided by CAC is less than one, you have a problem. With each subsequent treatment at your practice, LTV increases while CAC doesn’t.
Great practices can achieve an average LTV to CAC ratio of 4:1, implying the average customer contributes to clinic profitability four times the amount spent to attract them to the business in the first place. This can be achieved by building retention into the service you’re providing and extending lifetime value, such as adding a three to six month follow-up as part of the initial treatment. Unit economics of 4:1 are rare for small businesses, but healthcare practices benefit enormously from repeat, high value patients. Therefore, building unit economics into your practice’s DNA is mission-critical.
Make payments a value driver
During my time working with clinics, I have confronted many pitfalls around payment acceptance, all of which contribute to wasting time and money:
1. Over-reliance on practice management software
What practices think they get in efficiency (e.g. integrated payments with practice management software), they can lose in flexibility and cost. Just like you source specialist equipment for different medical procedures, you should similarly source payment products geared towards healthcare clinics for your practice.
Most payment acceptance products are generic in that they are designed to be used in different sectors. Healthcare-specific payments allow you to collect payment as effectively and efficiently as possible. There aren’t many, but they do exist.
2. Paying too much
Everyone loves Amex. Except, no one ever stopped seeing their healthcare practitioner because Amex isn’t accepted. Your patients’ preferred methods of payment should not influence your business decisions. Amex tends to charge significantly more than standard Visa and Mastercard transaction fees, so I would recommend not accepting it. Rates can climb as high as 3%, which is a real tax on the business.
3. Excessive gateways
We often see practices rely on too many payment acceptance products: point of sale/card machine, online booking, direct debit and bank transfer. Each additional payment gateway creates inefficiency and bloat in reconciliation. Payments done right should be seamless for patients, and cost- and time-effective for practices. Don’t underestimate the time savings that come from having all payment data in one place.
Managing a variety of payment methods such as direct debit, card payment and pay by bank isn’t necessarily a problem if you can manage all methods from one portal.
Empowering receptionists to boost revenue
Patient checkout is vital in maximising a clinic’s profit, cultivating relationships built on trust and creating a loyal patient following. Practice leaders should aim to scrutinise their checkout profit and loss, overall cost and revenue, and most importantly, reframe the receptionist’s role. A question I will leave you to ponder is: are your front-of-house team empowered to act like revenue managers? If not, some of the advice in this article might just help you boost your business.
Jared Aron is the director of Coherent Healthcare where he partners with clinics seeking to boost profitability and achieve financial coherence. Previously, he led the development of the LightSense laser system, a novel medical laser indicated for tattoo removal, and launched and directed NAAMA Studios, a world-leading tattoo removal clinic with flagship locations in London.
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“I am always looking to grow, both as a person and an aesthetic practitioner”
Dr Sophie Shotter shares her journey into aesthetics and discusses how she contributes to the specialty
Dr Sophie Shotter is an aesthetic practitioner renowned for her expertise in advanced skincare and non-surgical treatments. As the founder of Illuminate Skin Clinics, she has transitioned from anaesthetist to global trainer and podcast host.
Dr Shotter grew up in Kent until her father’s job moved her family to Lincolnshire when she was eight years old. Growing up, she knew she was academically bright, but hadn’t thought about what she would go on to study, saying, “When I was 14 years old, I did some work experience in law and I hated it, it just wasn’t for me. After that, I asked myself, what do I really enjoy? At the time, I loved sciences and caring for people.”
Her innate passion for helping people led her to gain work experience in a care home and, later, on a diabetes ward in hospital. This sparked her interest in the medical field. “I really enjoyed it, and I knew if I loved this, I would love medicine. From that moment, I didn’t look back,” she recalls.
She completed her five-year medical degree at Leeds University, qualifying in 2008, alongside an additional Bachelor of Science (BSc) in Genetics in Relation to Medicine. She knew back then that “genetics were the future,” however she didn’t entirely enjoy it. “I’m not someone who is good at being stuck in a laboratory, but I enjoyed the clinical side of genetics,” she says.
After she graduated, Dr Shotter worked in various specialties. Debating what to specialise in was hard, but she chose to pursue anaesthetics and intensive care over the route of surgical training. “My time in the NHS was one of the most rewarding and memorable periods of my life. It is still the biggest privilege to have been involved in that line of work, but I found, too often, that I took it home with me,” she explains.
Halfway through her anaesthetic training as a registrar, she found that she couldn’t shake her curiosity for injectables. She says, “At the time, I had a friend who was a nurse and had undergone some training. One day I just thought, ‘I’m going to give it a go!’”
Dr Shotter booked her first training course in 2012, and completed many one-to-one sessions with Cosmetic Courses after that. Knowing she couldn’t devote her time to working in both the NHS and aesthetics, she decided to leave the NHS in 2014 and open her own clinic, Illuminate Skin Clinics. “I strive to achieve the highest standard in everything I do, so I chose aesthetics, and it wasn’t a hard decision because I had fallen in love with it,” she says. Alongside running a clinic, Dr Shotter has been a key opinion leader for Allergan Aesthetics since 2018, working on its UK and international faculty as well as its complications board. Recently she was invited to a mentorship programme under world-renowned plastic surgeon Dr Mauricio de Maio, an opportunity to hone her techniques and live injecting skills. She notes that she has worked with several other companies including AestheticSource, Sofwave, Candela and more, adding, “All the companies I partner with are committed to excellence. There is a huge amount of knowledge to share and it’s a privilege to be able to contribute to that.” She adds, “I got some of my best education in aesthetics through the training I had with AestheticSource and Allergan – I hugely benefited from it.”
She commits to being involved as a specialty trainer in the hopes of helping “inspire people along the way.” Her own inspiration, she says, comes from her peers, “Dr Tapan Patel is a great friend and a huge inspiration. Dr Kate Goldie is also awesome and it’s great to see a strong, empowering woman on the global stage.” She credits many “pivotal moments” in her injecting career to Dr de Maio. When asked who her mentor was, she says CEO of
AestheticSource Lorna Bowes has been pivotal in her journey.
In 2023, Dr Shotter was awarded Medical Practitioner of the Year at the prestigious Aesthetics Awards. She expresses that this moment was “humbling,” and it was an honour to have been recognised by her peers. She says, “It still sits on my desk. I even took it to Thailand with me! I recommend that everyone in the field enter the Awards, as it really is an amazing accolade.”
Whilst this moment was validating, she says her commitment to constantly elevating herself is reflected in her thirst for education, “I’m doing a Master’s in Business Administration right now at Imperial College. I am always looking to grow, both as a person and an aesthetic practitioner.”
On top of clinic work, training, doing her Master’s and being on the BCAM board of trustees, Dr Shotter also hosts the podcast ‘Age Well with Dr Sophie Shotter’ where she discusses a variety of topics including skincare, aesthetics, health and longevity. She notes that her latest accomplishment is her recent appointment as a member of the Clinical Advisory Board for the Aesthetics Journal
Looking ahead, Dr Shotter advises those new to the specialty to find a mentor to help them grow. She says, “It’s a different field now because it’s more crowded, so you must really ask yourself, what makes you stand out from the noise? Once you find that, you can attract your tribe of patients.”
What’s your favourite sunscreen product?
Neova Silk Sheer Sunscreen! It has DNA repair enzymes in it so as well as helping protect your skin from the sun, it’s also helping to repair DNA that is already damaged.
If you could choose a career outside the medical field, what would it be?
I could spend my life in the water so I would be a professional diver.
Do you have a mantra you always stick to?
Don’t let the world tell you who you are.
Dr Sophie Shotter is speaking on behalf of Crown Aesthetics on Friday October 11 at CCR 2024. Turn to p.22 to register for free now
Dr Sophie Shotter
The Last Word
Nurse prescriber Khatra Paterson debates the use of payment plans in your clinic
In the dynamic realm of aesthetics, offering payment plans to patients is gaining traction. This trend is largely driven by the current cost of living crisis, which has increased the demand for financial flexibility among consumers. It has been noted by online payment platform PayPal that one in three online shoppers use a payment plan, and it has been predicted that by 2026 an estimated 100 million shoppers will choose a buy now pay later payment option.1 This shift reflects the growing need for flexible payment options, particularly now aesthetics is no longer just for the rich and famous.
I believe that all aesthetic clinics should consider adding a payment plan option for their patients in order to help households face rising costs and economic uncertainty.
Benefits of payment plans
Introducing payment plans in aesthetic clinics offers a practical solution for patients seeking to better manage their finances while accessing desired treatments. This model allows individuals to spread the cost of non-surgical procedures, such as injectables and laser treatments, over manageable monthly payments. This financial flexibility is particularly beneficial in today’s economy, where many face significant financial pressures. By providing 0% finance options, fintech companies like PLIM and Klarna eliminate the burden of interest charges, further easing financial strain and making these treatments more accessible.
From a patient’s perspective, the ability to pay for treatments over time rather than in a single lump sum is invaluable. Non-surgical cosmetic procedures often play a crucial role in self-care, significantly enhancing an individual’s self-esteem and overall satisfaction with their appearance. As practitioners, we know that often a combination of treatments may be necessary to achieve the desired results, which can of course increase the cost significantly to the patient. I believe maintaining these self-care routines without compromising financial stability can boost mental and emotional wellbeing.
From a practitioner’s perspective, offering payment plans can significantly expand their patient base. By providing more flexible payment options, clinics can attract patients who might otherwise be deterred by the upfront costs of treatments.
This approach has the potential to increase overall revenue and patient retention. I found that the introduction of a finance option at KP Aesthetics helps patients to budget more effectively and enhances their financial control. Approximately 10% of my patients now opt for payment plans as a smart way to manage finance.
According to a report by Citizen Advice, businesses that adopt flexible payment options often experience improved cash flow and increased financial resilience, highlighting the dual benefits for both patients and clinics.2 Although patients make monthly payments, clinics typically receive the full cost of treatments upfront from the finance provider. This arrangement reduces the risk of missed payments, providing financial security for the clinic. Receiving the lump sum payment upfront ensures that clinics can maintain a steadier income stream, allowing for better planning and allocation of resources.2
Concerns over flexible pay
Despite the numerous benefits, some practitioners remain hesitant to adopt payment plans due to the commission fees associated with these financial services. The fees can range from 3% to 15% of the treatment cost, which can impact the overall profit margin for treatments, especially in a market where margins are already tight.3 Another consideration is the cost and time involved. Although some providers do not charge setup fees, there may still be ongoing administrative time and costs to cover the need for staff training. These additional expenses can be a burden for smaller clinics or those operating on tighter budgets. Furthermore, there can be delays in patients being accepted by the finance company, which can slow down the treatment scheduling process and create uncertainty for both the clinic and the patients.
Additionally, there is a concern that offering payment plans might encourage patients to overextend themselves financially, leading to potential issues with payment defaults. However, payment solution providers typically carry out robust credit-check processes to ensure that patients are suitable for a payment plan, thus mitigating this risk. These checks help ensure that only patients with an adequate credit rating are approved, reducing the likelihood of defaults.
It is essential to weigh these concerns against the potential loss of revenue from patients who choose not to undergo treatments due to financial constraints. Statistics from Global Medical Aesthetics Market indicate that 30% of potential revenue is lost in clinics due to financial barriers faced by patients.4 This data highlights the significant impact that financial flexibility can have on patient decisions and clinic profitability.
Offering patients a choice
The introduction of payment plans in aesthetic practices presents a significant opportunity for both patients and clinics. Offering a variety of payment options, ranging from short-term plans with no interest to longer-term plans with minimal interest rates, provides patients with choices that best suit their financial situations. Ensuring that the payment plans are interest-free can mitigate the risk of financial strain on patients and make the options more appealing; however, practitioners should carefully consider the potential financial implications of offering these payment plans. While interest-free options can make treatments more accessible and appealing to patients, they may incur costs for the clinic, particularly if you absorb the financing costs yourself. By choosing the right financial partners, maintaining transparency with patients and evaluating the impact of these plans, I believe clinics can enhance their service offerings and improve financial accessibility for patients. Embracing these financial options can lead to increased patient satisfaction and long-term business growth. At my clinic, the use of payment plans provides patients with the flexibility they need to achieve their aesthetic goals without compromising their financial stability. By making these treatments more financially accessible, finance options play a crucial role in helping individuals maintain their self-esteem and overall quality of life.
Khatra Paterson is a qualified aesthetic nurse prescriber and the owner of KP Aesthetics. She spent 32 years as a nurse, midwife and health visitor before establishing her clinic in 2017. She has recently opened a private surgical suite KP Surgical. Qual: BSc, BA
