Dr Tiina Meder Formulator of Meder Beauty Science
A Powerful Synergy of Scientific Skincare and Equipment for Accelerated Treatment Outcomes
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IN THIS ISSUE WINTER VOLUME 34. 2017 INDUSTRY REPORTS, NEWS AND PRODUCTS
SCIENTIFIC RESEARCH, TREATMENTS AND TECHNOLOGY 16-18
Understanding Rosacea
20-23
Training imperative for the
safe use of topical
anaesthetics
26-30
Healthy Microbiome and
their role in maintaining skin
health 64-65
Myo-Fix - Non-invasive eye
brow lifting 70-71
Exploring the growing trends in
body shaping procedures
80-83
Why Selenium is important for skin
and health
92-95
Scientific News
102-106
Astragalus - Supporting Telomere
Integrity 120-122
Drug-Free ways to Help Balance
Female Hormones and assist with
Menopause
8-9
Heart-2-Heart
10-12
Cover story
32-24
A Dream come true
60-62
A Hidden Country Gem
76-77
Product innovations
108-111
Aesthetic Industry Bulletin
REGULATIONS, STANDARDS AND EDUCATION 24
Advance course: Safe use of
topical anaesthetics 78-79
How remedial massage can
benefit your clients and
business 84-86
Neoplastic Lesions of the Skin
96-97
Incorporating Cosmetic
Medicine in your Business
112-113
Transdermal Delivery in
Cosmetics
BUSINESS AND PERSONAL AND PROFESSIOAL DEVELOPMENT 36-37
What does your brand say?
42-44
Improving quality of life
through Mindfulness
54-59
Tips for Better Business
88-90
Let us reason about
transformation
98-100
Contract Law
114-115
The Power of Perception and
Relationships
118-119
How to boost your clinic’s
Social Media Presence in five
easy steps
SEMINARS, EXPOS AND CONFERENCES
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38-40
A Conference overview - A5M
46-49
Wrapping up a full day of Education
- APAN Brisbane
66-69
Insight and update on Industry
Trends - ASAPS Conference
APJ REGULAR CONTRIBUTORS TERRY EVERITT
Terry Everitt is regarded as a 'Master Skincare Professional' due to his extensive knowledge of the art and science of skincare. A very competent educator and regular lecturer on aesthetic and medical conferences where he presents up-to-date information from an evidence-based scientific perspective. Terry is the Director of Aesthetic Educators Pty Ltd. To contact Terry you can email him aestheticeducators@gmail.com.
CAROLINE NELSON
Caroline Nelson is a beauty industry expert with over 40 years industry experience. She specialises and is passionate in helping clinics and spas develop their brand, improve productivity, and increase bottom-line profit. To learn more about her step-by-step program for salon spa success visit www.SalonSpaBusiness.com or phone 041 0600 440.
GAY WARDLE
Gay Wardle is a well-known multi-awarding winning industry expert and a renowned lecturer who conducts advanced skin analysis training for businesses and their staff on all issue pertaining to skin science. If you would like you and your staff to undertake training with Gay please contact her on 0418 708 455 or book on-line www.gaywardle.com.au. You can also email her on gay@m-da.com.au
SUZANNE SPARROW-CRISP
Suzanne Sparrow-Crisp is the Director of The Sparrow Group, specialists in tailor-made insurance for salons and clinics. They provide excellent cover and peace of mind to businesses and beyond. Sue is passionate about education and is committed to helping simplify the often complex subject of insurance through regular articles and lectures. You can contact Sue on 07 5502 8326 or Email: sue@thesparrowgroup.com.au
DR ZAC TURNER
Dr Zac Turner has a broad medical background specialising in regenerative, aesthetic and cosmetic medicine. Aesthetically, Dr Zac feels that a natural look is best, and truly believes that his “less-is-more� approach using perfectly placed products gives the optimum outcomes. Over the past few years Dr Zac has become involved in both the men's health and preventative health space. He is passionate about this as he sees prevention and body optimisation as the ultimate way to prevent chronic disease, obesity, and many other conditions. He has owned and currently involved with clinics in the holistic health arena and believes that through a holistic assessment of someone's health we can enable them to live longer, healthier, and happier. You can contact Dr Zac by Email: zac@drzac.co
TRISH HAMMOND
Trish Hammond is an award-winning Blogger and Social Media expert and the Director of Plastic Surgery Hub. She is renowned for her skilful writing and interviews in all facets of the Social Media space. Her company specialises in the Aesthetics, Cosmetic Surgery and Cosmetic Medicine industry sectors for which she provides personalised and comprehensive services to help businesses communicate powerfully, grow their brand and capture new clients and patients. If you would like to speak to Trish about her services please contact her on 0429 264 811 or Email info@plasticsurgeryhub.com.au.
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EDITOR’S NOTE
By Katherine McCann OVER the past couple of months the Aesthetics industry has been abuzz with activity, ranging from identification and emergence of trends and technologies, delivery of new techniques and services, right through to educational course launches, National Expos, conferences and professional development programs, as well as a call for national regulation and review of current industry standards and more. Having participated in, or been involved first-hand in much of the abovementioned, I am excited to share with you some of the insight gained and lessons learned within this APJ Spring edition. In this issue we’ve got some really interesting business articles that address new and emerging industry trends including globalisation, technological integration, 24/7 interconnectivity and convergence of both new and traditional service modalities, these are some of the biggest points of interest because they’re changing the game as we know it. It’s also important to understand how these changes can act as a double-edged sword, through the creation of unparalleled opportunism and presentation of challenges – all of which can often leave businesses in a constant state of flux trying to navigate the ever-changing ripple effect. We also take a look at new research, which clearly links the shift in consumer demand and provides insight into heightened consumer savviness and what this means when it comes to the integration and overhaul of traditional services. You’ll also find out where you can go to access free media opportunities as well as practical tips to build your brand, creating powerful relationships in order to get noticed and connect with your clients in order to take your business to the next level. I also had the opportunity to attend a number of professional conferences and Expos and inside you will find a fabulous wrap up and summary of key points
from the ASAPS Non Surgical Symposium, which was held earlier this year on the Gold Coast, as well as our APAN Aesthetics Conference in Brisbane, followed by the Advanced Course in Topical Anaesthetic training held directly after the APAN Conference. As an industry we have also faced some heavy criticism due to unprofessional conduct that are putting consumers at risk. As an industry we must raise to the occasion and take responsibility to work within regulatory guidelines and where they do not exist seek to support industry standards as they are identified by our peek industry bodies such as APAN. As a professional you have a duty-of-care to connect with our industry bodies and support best practice industry position statements, uphold those standards and values regardless as to whether they are part of a regulatory framework or not. Many exciting articles in this issue that will give you food for thought. I wish you every success in your business in the upcoming months and hope that you’re able to utilise some of the educational and practical elements we have included in this edition. APJ Until next time, happy reading!
“Never underestimate the power of your position, be the change you want and create your momentum!” – Katherine McCann
fl www.apanetwork.com | info@apanetwork.com APJ 6
WELCOME TO APJ Editor Katherine McCann (07) 5593 0360 info@apanetwork.com www.apanetwork.com Typesetting & Graphics Angus Thompson TEV Group Advertising & Marketing Tina Viney Phone: (07) 5593 0360 info@apanetwork.com Fax:(07) 5593 0367 Mobile: 0412 177 423 Aesthetics Practitioners Advisory Network PO Box 5448, Q Super Centre QLD 4218 Australia Publisher TEV Group Pty Ltd Design & Production Artwork and Editorial TEV Group Pty Ltd Unit 7D 76-84 Robina Town Centre Drive, Robina QLD 4226 Australia Phone: (07) 5593 0360 info@apanetwork.com Fax:(07) 5593 0367 Mobile: 0412 177 423 Printed For Aesthetics Practitioners Advisory Network ACN: 136 987 169 ABN: 25 136 987 169 Accounts Payable Aesthetics Practitioners Advisory Network PO Box 5448, Q Super Centre QLD 4218 Journal Advisory Board Terry Everitt - Education Features Wendy Neely - PR and Marketing Dr Douglas Grose - Scientific Content Caroline Nelson - Business Features National Advisory Council John Fergusson Terry Everitt Bill Anton Gill Fish Vanessa Kirkham Maureen Houssein-Mustafa ISSN: 1836-9812 Pint Post Approved [100000257] Circulation 6900
Front Cover Distributed by Spectrum Science & Beauty 1300 766 198 sales@spectrumsciencebeauty.com.au For further information see pages 10 and 11, 64 and 65
The Aesthetics Practitioners Journal is the official publication of the Aesthetics Practitioners Advisory Network Pty Ltd, a network organisation established to service the needs of the aesthetics industry in the area of professional development and business networking. The Aesthetics Practitioners Journal is published quarterly for the benefit of its members and subscribers and aims to inform and educate its members on better business practices and industry advancements. All editorials and articles that are submitted for publishing remain the property of Aesthetics Practitioners Advisory Network Pty Ltd. Reproduction in part or in whole is not permitted without prior written authorisation by the publishers. Every effort has been made to ensure that all scientific and technical information presented is as accurate as possible at the time of publishing. However, members and readers are highly recommended to also seek external advice from their accountant, registered financial adviser or healthcare professional for their recommendations.
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Heart-to-Heart A message from the President and CEO DON’T let anyone tell you that the industry is slowing down because I can assure you the opposite is true. Having said that, with the huge influx of cosmetic medical practitioners and the ever-expanding beauty and cosmetic medicine franchises, the competition is becoming fierce, so there are risks to be considered. This brings to mind the great song by Billy Ocean “When the going gets tough, the tough get going”. It’s a great song with a wonderful message that we should from time to time be reminded of. If you want to listen to it check it out on Youtube. DON’T GIVE UP ON YOUR BUSINESS I know there are a lot of Baby Boomers in our industry. Most of you are amazing therapists and business owners who have worked hard for many years and now you want to slow down, but you are faced with on-going challenges and new advances that require that you apply yourself even more. I know it can get too much at times – I hear this so often. However, I want to encourage you not to give up. Often when you are busy doing your thing, you lose sight of your business’s real value. Setting up a new business today is a huge undertaking, not to mention the risks. If you have worked hard to build your business, remember, it is worth something – it is a sellable entity that can help someone springboard from where you left it to where they want to go. I am saying this because I am amazed at the number of business owners who just want to shut down their businesses and retire. Please close the door to this thought for a moment. First, consider getting a business broker to give you an independent evaluation of your business before you make any further decisions. Your business has value, so it has a price. You may be pleasantly surprised what the outcome of this exercise may uncover for you. THE INDUSTRY IS GROWING I have a real passion for this industry and one of the ways that I believe I can help businesses retain their competitive advantage and help practitioners expand their scope of
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practice is to present future predictions that are backed by extensive and credible research on new advances and how they will fuel growth. I spend in excess of three hours per day on this task and what I am seeing is very exciting. It’s incredible, but the global economic downturn a few years ago has created a shift in consumer interest, from investing in property and accumulating material wealth, to enjoying life and living in the moment. We can see this reflected in the popularity of international holiday travel. Cruise liners are booked out and the interest in anti-ageing and wellness solutions is constantly gaining new interest. Life is short and we want to make the most of it on what really matters to us. Over the past 10-15 years we have seen light-based technologies gaining incredible momentum. Laser and IPL treatments are now very much mainstream and one could say the market is getting saturated with businesses offering these services. So what is the next best thing we can offer? Going by my research and the information I am gaining by attending 4-5 cosmetic and anti-ageing medical conferences a year, I see the future very clearly – we are moving into a era specialisation and integrative collaboration. Let’s take a look at both these areas: Specialisation: Consumers now have many choices on who to go to, so they are progressively screening for their best choice, seeking the best “expert” they can find who specialises in exactly what they want. I cannot stress enough that you need to stay true to what you love doing. If it is skin corrective treatments then invest in growing your knowledge in this area and be known as the “specialist” in it. If it is cosmetic tattooing, then be the very best, the most qualified, the most experienced practitioner in this modality. This will require that you continue to invest in your training, finetuning and perfecting both your techniques, as well as deepening your understanding of the science and the art behind what you are doing. Never stay static with yesterday’s knowledge. I attend many training programs and I can tell you that the
best practitioners are the ones who always make the time to attend conferences, training and even enrol to further their education. Did you know that we now have three tertiary level degree programs, as well as several advanced diplomas in dermal therapies, Graduate Certificates (Level 7) in IPL and Laser, just to name a few? Knowledge is power. It opens up our horizons and allows us to gain new insight into information that we did not comprehend before. This knowledge brings with it new opportunities to expand our scope of practice. Last year I was speaking to a member and she told me that sometimes she struggles to understand some of the science that we present in APJ Journal. “However,” she said, “this doesn’t intimidate me, it actually makes me realise how I could benefit from this information and allows me to find answers in better servicing my clients.” She is now determined to enrol towards further studies. Academic knowledge is not just theory. It offers practitioners new insight and new tools to achieve so much more in their practice. Just the ability to critically think and scientifically-analyse and interpret a skin manifestation with the knowledge that you can go beyond your basic equipment training protocols to put together a more customised approach based on your knowledge is very empowering. It is this professional approach that will help you build trust and gain loyalty with your clients. Integrative collaboration: I want to take you back to our song “when the going gets tough, the tough get going”. Consider this. When your competition is focusing on just cosmetic enhancement you have the opportunity to diversify and offer consumers solutions also in other area - enhanced wellbeing through stress management, weight management, pain management, areas that consumers are looking for solutions. Coming back to the promise of specialisation, your best choice is to access qualified experts to undertake these services and service your clients in all these areas under the one roof. Your roof. Integrative collaboration can
include not just injectables, it can include remedial massage, regenerative medicine (for hormonal testing and balancing), naturopathy, nutrition, fitness and movement experts, just to name a few. It is not necessary that you are the expert in all these areas. You can expand your business by proving professional services on a variety of modalities. You can book your injecting doctor or nurse once a fortnight, your naturopath one day a week, your remedial massage therapist two days a week, etc. All you need is an extra room, good planning and marketing. It’s not an issue of working harder, but in working smarter. Of course there are other modalities you can include, such as cosmetic tattooing and other grooming services. The key is to only use qualified experts and the sky is the limit. APAN’S NEW DIRECTION IN 2018 Going from the feedback we are receiving from our conference programs, many of you are seeking to expand your knowledge through cutting-edge workshops. In 2018 APAN will be launching workshops independently of our conference program and in conjunction also with them. This will allow us to accommodate the needs of both staff and business owners to expand their understanding in new concepts, while also growing their skills. The industry is moving forward rapidly and so must we. If you are not already a member please join APAN today and be part of a vibrant, forward-thinking, likeminded professional community that is passionate about integrity, standards and business success. We want you to be the BEST and we are committed to fostering programs and professional communities to make that happen. APJ
APJ 9
COVER STORY
MEDER BEAUTY SCIENCE
Raising the benchmark in professional skincare ALWAYS vigilant in their commitment to quality, innovative technologies in support of results and business success, Spectrum Science and Beauty have recently added another winning product range that is making waves in the industry.
Meder Beauty Science’s professional treatments offer an ideal alternative for clients with contraindications, or an aversion to injective treatments and include a complete wrinkle-reduction and rejuvenation program:
MEDER BEAUTY SCIENCE is a new-generation skincare line with an amazing treatment profile that brings a new dimension to advanced treatment results. Purity, anti-inflammatory and enhanced bioavailability makes it the perfect partner when combined with cutting-edge equipment technology.
Myo Fix, Lipo Oval, a solution for non-invasive facial liposculpture to combat changes in facial contour and effectively reduce saggy chins
APJ spoke with Ben Skeggs, Managing Director of Spectrum to uncover more about Meder Beauty Science and the latest company plans to support business sustainability and growth. APJ Q1: As part of meeting salon and clinic needs Spectrum Science and Beauty are extending their product range to include an exciting skincare. Can you tell us a little about the range and what made you select this skincare over other brands? The Meder Beauty Science skincare includes professional facial treatments that are supported by a skincare for home use. It is designed by a dermatologist and manufactured in a lab in Switzerland that combines the latest biotechnological peptides, plant extracts, prebiotics, vegetable stem cells and other ingredients. The key differentiator of Meder Beauty is that all the ingredients are scientifically-proven to have a beneficial effect on the skin cells. The brand’s creator, Dr Meder, proposes a unique skin preparation protocol enabling the penetration of active ingredients deeper into the skin without extra stimulation. It is a very gentle approach yet highly effective - such that I have never seen before. Another important point, is the clinical and ethical aspect of the brand. Meder Beauty doesn’t support media-induced unnatural and unhealthy beauty standards with traumatic means to anti-ageing therapy. They believe that a person can have glowing younger-looking skin without any cosmetic procedures that can be potentially dangerous to their health, or even remotely painful, therefore no harsh, or aggressive components are used in Meder. All of the products are cruelty-free.
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Arma Lift, a non-invasive filler targeting lines and folds and delivers fast restoration of elasticity and skin tone Hydra Fill for quenching thirsty skin Eu Seb for acne therapy. In addition, premium home skincare products that pioneer the latest advances in biotechnology and natural ingredients enhance the salon treatments results. Meder is extremely innovative and an example is the new method they use to treat acne. Traditionally acne has been treated by trying to eliminate harmful bacteria from the skin, usually by traumatic means, like acids. While being effective in many cases, this approach can damage the skin’s flora, regardless as to whether it’s harmful or beneficial, which in turn can make the skin dry, susceptible to UV damage, sensitive and in many cases the problem still persists. Meder Beauty professional Eu-Seb treatment was based on research that states that the human skin’s microbiome (the bacteria living on our skin), is not only as individual as a fingerprint, but also essential for our health. It is the imbalance of the bacterial species that needs to be corrected rather than just trying to burn all the microorganisms from the skin’s surface. Operating with this principle what (EuSeb) prebiotic does, is essentially restore the skin’s healthy bacteria balance allowing the bacteria deal with each other in a more natural way. Other ingredients, such as aloe extract and chamomile, calm the irritation and relieve the unpleasant symptoms, like redness, inflammation and discomfort. There are therefore no unpleasant sensations (burning, itching, further redness, peeling, etc.) for the client and after a treatment, the skin looks calmer and immediately soothed. Since the skin’s surface is not damaged, there is no risk of increased exposure
to UV, which in Australia is a key factor. And it can take the problem away without traumatising the skin. Eu-Seb has been found to be safer, completely painless and comfortable for the client, through a more natural and scientifically-based approach of rebalancing the skin’s microbiome. Every one of Meder Beauty Science cosmetic solutions guarantees a real noticeable effect and best of all have great combined therapy protocol for working in synergy with technology. APJ Q2: What are some of the Star Performers in this skincare range that give it a competitive advantage? The first star performer as mentioned above is Eu-Seb, prebiotic treatment and targeted skincare products for acne, oily skin and rosacea. Prebiotics are a hot topic right now, because we are beginning to understand the role of our microbiome in health, both for the skin and body. It is now proven that the bacterial flora living on the skin is essential for its health and is as unique as a fingerprint. Eu-Seb tackles the old acne problem from a completely new angle. It does not destroy all the flora, pathogenic and beneficial alike, but instead corrects the balance and restores the eco-flora. Healthy balanced flora can stop inflammation, reduce and even eliminate acne, regulate sebum production and make the skin look more matte, healthy and brighter. Being ahead of its time, Meder Beauty Science introduced this treatment back in 2013, when the words probiotic and prebiotic were not understood in skincare that well, and they have been showing great results with this treatment. Another star performer is Myo-Fix a safe and efficient way of smoothing frown lines without having to inject. Today there are many ways to reduce mimic wrinkles, the most popular and widespread are injectables. However, in recent years a non-invasive method of affecting the tone of mimic muscles has been developed. The wrinkle correcting peptides in the Meder Beauty Myo-Fix program are small lipophilic molecules able to penetrate into the skin over the epidermal barrier and denervate the mimic muscles fibres at the points of their attachment to the skin. Basically, the client is perfectly able to preserve their natural facial expression after the treatment, only frown when they really want to, and the visible wrinkles smoothed out. The results last for 6-10 months, depending on the person’s skin characteristics and number of treatments. APJ Q3: How do you see the synergy of the skincare working with your equipment towards improving treatment outcomes? There is great synergy between our equipment and skincare. First, results will be achieved much quicker and in a more comfortable way. The risk of complications and side-effects is reduced to a minimum. Combining equipment with skincare using a proven protocol allows the practitioner to affect both the deeper skin layers, and the skin’s surface, while increasing the client’s satisfaction and results. The client really feels like they have been given all possible attention and care through a comfortable, yet efficacious treatment. Furthermore, Spectrum has worked with Dr Tiina Meder to create specific protocols for combined therapy treatments
using equipment and skincare to enhance results with the following technologies: IPL plus skincare treatment LED light therapy plus skincare Microdermabrasion plus skincare Hydrodermabrasion plus skincare Fractional RF plus skincare PixelPen plus skincare For example, our Spectrum IPL is a recommended technology that can be effectively combined therapy with other treatments from acne through to photorejuvenation, pigmentation, and vascular. For skin rejuvenation IPL is recommended to be combined with Hydra-Fill and/or Arma-Lift skin treatments with the key treatment objectives being skin brightening, anti-ageing and correction of the existing signs of ageing. If the skin is dry, dehydrated and/or presents with pigmentation we provide protocol using Hydra-Fill skincare. To fight the loss of elasticity and to reduce wrinkles, we provide a protocol using Arma-Lift. We recommend combining IPL and skincare in cases of moderate and severe acne, and as a primary therapeutic solution for mild acne. When capillary changes are present, IPL can be used as a part of combined therapy along with skincare.
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Another example is Radio-frequency lifting, which can be combined with various treatments for stronger effect. To improve the skin’s elasticity, smooth wrinkles, tighten pores and reduce post-acne scars apply Arma-Lift. To enhance the firming, face sculpting effect, restore the facial contour and improve elasticity affected by gravitation-related changes combine RF with Lipo-Oval. Combined therapy treatment with technology/equipment and skincare can provide clinics with a competitive advantage through improved results and client comfort. APJ Q4: What other exciting innovation has Spectrum launched to help business performance? Spectrum has been working hard to differentiate our prod-
ucts and services by offering a turn-key full support solution meaning our clients receive the tools, skills, knowledge and support to optimally launch, implement and grow their business with the latest in aesthetic technologies, marketing, payment solutions, clinical support and skincare. To achieve full-support solutions we have introduced new innovative products and services that add value and a competitive advantage to our clients’ businesses. We have partnered with Alma Lasers who are global innovators in our industry (an example of Alma’s innovation is that they are the inventors and patent holders of SHR - Super Hair Removal, which has gained global recongition) and we have introduced their technology to the Australian market at a first-time affordable price-points for a strong return on investment. Another major innovation we have launched is BeautyPay, which is a payment solution customised for beauty businesses helping them stay at the forefront of payment technology. BeautyPay was designed for Beauty Salons/ Clinics and is a tool they can use to offer their clients affordable payments solutions for their treatments, removing any financial roadblocks. As a result, the feedback we are receiving is very exciting. APJ Q5: What business advice would you give a salon or clinic when planning for their future growth? In today’s market, I believe it is not only important to purchase a high-quality product, but it is also equally important to align oneself with a business that has the infrastructure to provide complete support and service that will compliment and help grow their business. At Spectrum, we have invested heavily in building our infrastructure to support a large customer base across Australia and New Zealand. This includes investing in leading trainers, clinicians, technicians, partnering with leaders in marketing and a business strategy that focuses on understanding our industry and our clients’100 needs. APJ 95 75
For further information on MEDER BEAUTY SCIENCE and SPECTRUM SCIENCE AND BEAUTY Technologies 25 and business tools contact 1300 766 198 or email sales@spectrumsciencebeauty.com.au 5 0
APJ 12 Bitmap in CEO Report Mar17
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NEWQUALIFICATIONS
How qualifications can TRANSFORM A BUSINESS Rebecca Hiscock’s Story
WHILE I am a qualified beauty therapist, I discovered that my real passion was with treatments that are skin-focused and aim to achieve the best possible results. However, one area that I felt I wanted to improve, was in my skills and knowledge in the use of IPL and laser technologies, so when Tina Viney contacted me to undertake the NAT10038 Graduate Certificate in Cosmetic Laser and Light Therapies with the support of government funding I was absolutely thrilled. This was a government-approved Graduate Certificate Level 7 qualification - I was impressed and very excited. I would like to share my journey with this experience with the hope of encourage others to pursue this amazing qualification for their own benefit. With the encouragement of Angela Todd, Principal of Beauty Therapy Training Australia and Tina Viney from APAN I crazily submitted my application for government funding to undertake NAT 10038 Graduate Certificate in Cosmetic Laser and Light Therapies on the 22nd December 2016 at 11.30pm and just made it before closing date the following morning. You can imagine my delight when I was finally told in April that my application had been successful. From the very first day of getting my theory books and throughout my training, right through to my completion of my qualification this has been by far the best thing I have done in my career to date. Angie and the trainers at BTTA have been nothing but encouraging and supportive throughout my whole training journey. The learning environment that Angie has created and in which I was immersed was comfortable and conducive to training at a well-balanced pace. Angie was extremely approachable with any questions, or concerns that I had and this allowed me to appropriately pace my learning. I have had the opportunity to receive one-on-one training, which I considered so valuable as every single question and every detail was discussed in full. My training “models”, which were provided to us to work on, were from all walks of life and with very different skin concerns, this enabled me to gain skills and experience in a diverse range of skin conditions, which was invaluable. I also found that doing my practical training in an operating clinic environment enabled me to develop my skills, from setting up the room in accordance with the appropriate protocol, to treating the clients from the very first contact through to rebooking, as well as monitoring the clients’ results after each treatment. With doing the block training I was able to see client’s for follow-up treatments. I was also pretty excited when a client actually requested me to be the one she wanted to deliver all her follow-up treatments. Although I did LOVE my one-on-one training with Angie it was also great to work alongside other practitioners and learn from them and their experiences. I found that the course content was broad and thorough. It covered everything I needed to know to run a successful business. When it came to selecting devices, or questions I had regarding any
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other equipment I found Angie to be completely unbiased in her opinion and advice and I felt I could easily discuss any concerns with her and get very honest answers. A little background on me I have been in the Beauty Industry for over 18 years now. Over the years I have held many different positions from management, to college trainer at a private college in Brisbane delivering the Diploma of Beauty Therapy. However, my favourite practice (before owning my own salon) was as an IPL technician. This is where I discovered my love and passion for treating various skin conditions. However, in recent times an opportunity arose for my partner and I to purchased a hair and beauty salon. The salon has four treatment rooms and provides a diverse range of services. We offer treatments from waxing through to microdermabrasion and Omnilux LED light therapies. This year we celebrated our 10th year in business and now with the qualification I have received I am ready to get back to my first love, which is specialising in skin treatments. As a result of my training the salon is taking a different turn as we are now able to expand out treatment options offering everything under the one roof. My whole team consists of wonderful experts who specialise in their own unique areas. We have a hair extension specialist, a lash technician, master colourist, and now me, who will be focusing on skin, bringing what I have learnt from my training into my business. I’m so excited with the next chapter of my business and cannot thank Angie and APAN enough for giving me the opportunity to expand my scope of practice and grow my business. I look forward to any new conferences and training opportunities that both APAN and BTTA can provide. Thank you for giving this opportunity to small business owners. Without APAN I would have never been able to gain this qualification. Thank you for setting such a high standard for our industry and providing pathways for us to achieve them. Rebecca Hiscock - Everton Park Hair & Beauty, Everton Park, Queensland Ph: 07 3355 2559. APJ For further information contact Beauty Therapy Training Australia Phone 07 5599 5568 Email: contact@ beautytherapytraining.com.au
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SKINSCIENCE
Causes and treatments Understanding ROSACEA by Jacine Greenwood
ROSACEA is a well-recognised, although frequently untreated, chronic skin condition presenting primarily as redness of the central facial region. It is a condition that is increasingly being presented in skin clinics and this is because statistics are indicating that rosacea is becoming more prevalent than in past years. In Australia rosacea was previously thought to affect approximately 5% of the population, however, more recent studies establish prevalence at approximately 10%, although some specialists suggest the majority of more minor and moderate cases are never diagnosed, despite the benefits that treatment can offer. Rosacea affects more women than men, although in men the condition tends to be more severe. It is also more common in fair-skinned individuals, those who blush easily, have sun-damaged skin and those who have relatives with the condition. Diagnosis is typically between 35 and 50 years of age, however the cardinal sign of rosacea – persistent flushing – can occur from as early as the teenage years, where early treatment is thought to reduce the likelihood of progressively worse disease in later years. In this scholarly article Jacine Greenwood presents the latest scientific findings on the causes of rosacea and treatment options. The skin condition rosacea has a range of clinical symptoms. These include facial flushing, the appearance of telangiectasia and persistent redness of the face, eruption of inflammatory papules and pustules on the centre of the facial features, and hypertrophy of the sebaceous glands of the nose, with rhinophyma [3]. And it is not just the skin - rosacea can also affect the eyes. Ocular changes are present in more than 50% of rosacea patients with symptoms ranging from mild dryness and irritation to blepharitis and conjunctivitis.
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Rosacea clients experience sensitive skin and have dry flaking dermatitis due to the increased TEWL that occurs with this condition. Exacerbating factors include heat, alcohol, sunlight, hot beverages, stress, menstruation, certain medications and spicy foods [5]. TYPES OF ROSACEA There are four predominant types of rosacea that have been identified and one variant called Granulomatus Rosacea. The subtypes are Erythematotelangiectaic, Papulopustular, Phymatous and Ocular [1]. Erythematotelangiectatic rosacea is predominantly characterised by persistent erythema and telangiectasia in the central region of the face. What differentiates the erythema and flushing associated with rosacea from blushing is the length of time the erythema lasts for. The flushing with erythematotelangiectatic can last for over 10 minutes. The small dilated blood vessels (telangiectasias) often appear as the condition worsens to grade 2 or 3 [2]. People with this subtype of rosacea have extremely sensitive skin that can be rough, or scaly and usually report itching, burning and stinging sensations in response to topical application of creams to the skin even those prescribed to treat the condition. Patients with Papulopustular rosacea often present with symptoms of type one rosacea combined with persistent papules. The papules can be up to 10 mm in diameter. Pustules also occur, which are smaller. In severe cases the papules and pustules can form an inflammatory plaque. This condition was originally described as acne rosacea however the presence of telangiectasias, more persistent erythema and the absence of comedones can assist the skin therapist in distinguishing the two. Phymatous rosacea presents as thickening of the skin accompanied by irregular nodules usually concentrated in
the nasal region, rhinophyma but can occur on the ears forehead, cheeks and chin. This condition can occur in conjunction with the first two subtypes but can present spontaneously without any other symptoms. This is the least common subtype of rosacea and has been reported to be up to 20 times more common in men and at its most severe stage this condition requires surgical correction [4]. The pathophysiology of rosacea involves the following: * Innate immunity * Vascular changes * Reactive oxygen species * Ultra violet radiation * Microbes. Environmental triggers such as sunlight exposure and temperature change are thought to play a part in disease pathophysiology by contributing to vascular changes in susceptible individuals. Vascular abnormalities result in blood vessel dilation with increased capillary permeability and oedema, which in turn provide a favourable setting for Demodex colonisation and proliferation. Demodex is the name given to tiny mites that live in the hair follicle. In humans, Demodex is found on facial skin especially the forehead, cheeks, sides of the nose, eyelashes and external ear canals.
the cathelicidin peptides and LL-37. The cathelicidin peptide and LL-37 induces the expression of proinflammatory cytokines in keratinocytes, chemotaxis of adaptive immune cells and angiogenesis [15,16]. This is the reason of abnormal inflammation and vascular reactivity in facial skin of individuals with rosacea. Thus in rosacea, cathelicidin peptides are abnormally processed to forms that induce cutaneous inflammation and a vascular response. UV exposure also increases the amount of ROS and damage to the skin. ROS activates cellular signaling in keratinocytes [17,18]. ROS increase the production of matrix metalloproteinases (MMP). Increased ROS activity in the skin enhances inflammatory reactions and degenerates the dermal matrix. The use of sunscreen can help attenuate some of this damage. Vacular Abnormalities The skin of patients with rosacea is found to have elevated express of vascular endothelial growth factor (VEGF), CD31, and lymphatic endothelium maker D2-40 [20]. VEGF proliferate vascular endothelial cells as well as increase permeability of vessels. CD31 is platelet/endothelial cell adhesion molecule (PECAM1 in gene symbol), and anti-CD31 antibody recognizes the endothelial cells.
Additional inflammatory actions, including the release of oxygen free radicals, also contribute to dermal and blood vessel damage.
UV irradiation also induces VEGF in human keratinocytes and skin, which explains the exacerbation of rosacea after sun and UV exposure. The innate immune system also triggers hyper vascularity in rosacea. Injection of cathelicidin peptides LL-37 in mouse skin induced vasodilatation, and application of LL-37 resulted in neovascularisation in a rabbit model of hind-limb ischemia [21]. Cathelicidins induce endothelial cell changes through several signaling pathways.
Our innate immunity responds to environmental stimuli such as UV, microbes, physical and chemical trauma. Triggering the innate immune system normally leads to a controlled increase in cytokines and anti-microbial molecules in the skin [8]. One of these anti-microbial molecules is a peptide known as cathelicidin [12]. Some forms of cathelicidin peptides are known to have a unique capacity to be both vasoactive and proinflammatory.
Demodex and its role The potential causative role of Demodex mites and associated commensals in the induction of rosacea has been under debate for many years. Demodex mites are dermal mites that colonise human skin and feed on sebum. There are two species that inhabit humans, Demodex folliculorumare usually located in the hair follicles while Demodexbrevisburrow deeper into the sebaceous and meibomian glands.
Individuals with rosacea express abnormally high levels of cathelicidin [8]. Cathelicidins are proinflammatory peptides linked to inflammation. Importantly, the cathelicidin peptide forms found in rosacea are not only more abundant but are different from those in normal individuals. These forms of cathelicidin peptides promote and regulate leukocyte chemotaxis[9], angiogenesis [10], and expression of extracellular matrix components [11]. The presence of the vasoactive and inflammatory cathelicidin peptides in rosacea is subsequently explained by abnormal production of local protease kallikrein 5 (KLK5), which controls the production of cathelicidin peptides in epidermis.
Bacillus Oleronius is a bacteria that has been found in the gut of demodex mite. Research is discovering that this bacterium may play more of a role in the pathogenesis of rosacea than previously thought. B oleronius produces antigenic proteins that may play a role in papulopustular and ocular rosacea.
Demodex stimulates inflammation, increasing the likelihood of papulo-pustular, or granulomatous lesions.
Vitamin D and its role in Rosacea Significant evidence shows that vitamin D plays an important role in modulating the immune system. Patients with rosacea have relatively high serum vitamin D levels. Ultraviolet B (UV-B) irradiation and microbial components increase vitamin D3 and toll like receptor 2 expression in keratinocytes leading to an increase of cathelicidin production. The production of cathelicidin, an antimicrobial peptide (AMP), is strongly increased in rosacea[13]. In the pathogenesis of rosacea, UV irradiation increases the level of vitamin D [14]. Subsequently, vitamin D increases
A further recent study has demonstrated that patients with erythematotelangiectatic rosacea show serum reactivity to 2 proteins from B oleronius suggesting that this bacterium may play a role in the induction of erythematotelangiectatic rosacea. The proteins implicated were found to be similar to heat shock protein and an enzyme involved in regulating stress response of the bacterium [19]. Topical Treatments Rosacea patients often have extremely sensitive skin and therefore moisturisers and cosmetics must be chosen carefully and daily use of sunscreen (at least factor 15) is recommended. Many of the agents most commonly used to control rosacea, such as tetracyclines, azelaic acid, retinoids and metronidazole inhibit reactive oxygen species (ROS) production, subsequently leading to a clearance of symptoms. Management by the client includes cosmetic camouflage,
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5. Kligman AM. A personal critique on the state of knowledge of rosacea. Dermatology 2004;208:191-7. 6. Kanada KN, Nakatsuji T, Gallo RL. Doxycycline indirectly inhibits proteolytic activation of tryptickallikrein-related peptidases and activation of cathelicidin. J Invest Dermatol 2012;132:1435-42. 7. 14. Wise RD. Submicrobial doxycycline and rosacea. ComprTher 2007;33:78-81. 8. Yamasaki K, Di Nardo A, Bardan A, Murakami M, Ohtake T, Coda A, et al. Increased serine protease activity and cathelicidin promotes skin inflammation in rosacea. Nat Med 2007;13:975–80. [PubMed: 17676051]
cooling, and avoidance of irritants and triggers (extremes of temperatures, sunlight, diet, alcohol, exercise, acute psychological stressors, medications, menopausal hot flashes) are recommended for all patients with rosacea. The use of photo-protection is particularly important in that it may prevent a flare triggered by UV exposure, as well as help avert photodamage skin changes such as erythema and telangiectasias that only contribute to vascular changes of rosacea. Azelaic Acid is an ingredient commonly used to treat rosacea. It works by inhibiting ROS and acting both as an anti-inflammatory and antimicrobial. Doxycycline is the most common antibiotic prescribed for rosacea clients. It has been shown to have an effect on rosacea by the down regulation of inflammatory cytokines [6]. This reduces the amount of neutrophil infiltration into the surrounding tissues. Doxycycline has been shown to reduce the amount of KLK-5. Its method of action is by indirectly inhibiting the matrix metalloproteinase enzymes responsible for generating activated kallikrein[7]. Antibiotics have also been shown to inhibit the degradation of the dermal matrix by inhibiting matrix metalloproteinases. A novel peptide by Lipotec has also shown promising results for Rosacea. Telagyn (Acetyl Tetrapeptide 40) works by inhibiting the inflammatory effect of LL-37. It decreases the appearance of facial redness and telangiectasia caused by an exaggerated inflammatory response. The number of topical actives that work specifically on the cytokines involved with Rosacea are limited, however favourable results have been shown with the actives above. Rosacea clients should focus on minimising flares by avoiding conditions known to aggravate the condition. APJ References: 1. Wilkin J, Dahl M, Detmar M, Drake L, Feinstein A, Odom R, et al. Standard classification of rosacea: report of the National Rosacea. 2. Crawford, G.H., Pelle, M.T. & James, W.D. (2004) Rosacea: I. Etiology, pathogenesis, and subtype classification. Journal of the American Academy of Dermatology, 51 (3), p.pp.327–341. 3. Wilkin JK. Rosacea. Int J Dermatol 1983;22:393-400. 4. Powell, Frank C (2005) Rosacea. The New England Journal of Medicine, 352 (8), p.pp.793-803.
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9. De Y, Chen Q, Schmidt AP, Anderson GM, Wang JM, Wooters J, et al. LL-37, the neutrophil granule- and epithelial cell-derived cathelicidin, utilizes formyl peptide receptor-like 1 (FPRL1) as a receptor to chemoattract human peripheral blood neutrophils, monocytes, and T cells. J Exp Med 2000;192:1069–74. Koczulla R, von Degenfeld G, Kupatt C, Krotz F, Zahler S, Gloe T, et al. An angiogenic role for the human peptide antibiotic LL-37/hCAP-18. J Clin Invest 2003;111:1665–72. [PubMed: 12782669] 10. Gallo RL, Ono M, Povsic T, Page C, Eriksson E, Klagsbrun M, et al. Syndecans, cell surface heparan sulfate proteoglycans, are induced by a proline-rich antimicrobial peptide from wounds. ProcNatlAcadSci U S A 1994;91:11035–9. [PubMed: 7972004] 11. Dorschner RA, Pestonjamasp VK, Tamakuwala S, Ohtake T, Rudisill J, Nizet V, et al. Cutaneous injury induces the release of cathelicidin anti-microbial peptides active against group A Streptococcus. J Invest Dermatol 2001;117:91–7. [PubMed: 11442754] 12. Schauber J, Gallo RL. The vitamin D pathway: a new target for control of the skin’s immune response? ExpDermatol 2008;17: 633– 639. 13. Schauber J. Antimicrobial peptides, vitamin D and more. How rosacea may develop. Hautarzt 2011;62:815–819. 14. Bagot M, Chaure D, Lesc MC, et al. Immunosupressive effects of 1,25-dihidrokxyvitamin D3 and its analogue caciportriol on epidermal cells. Br J Dermatol 1994;130:424–431. 15. 19. Schauber J, Gallo RL. Antimicrobial peptides and the skin immune defense system. J Allergy ClinImmunol 2008;122: 261–266. 16. Peus D, Vasa RA, Beyerle A, Meves A, Krautmacher C, Pittelkow MR. UVB activates ERK1/2 and p38 signaling pathways via reactive oxygen species in cultured keratinocytes. J Invest Dermatol 1999;112:751–6. [PubMed: 10233767] 17. 38. Peus D, Vasa RA, Meves A, Pott M, Beyerle A, Squillace K, et al. H2O2 is an important mediator of UVB-induced EGF-receptor phosphorylation in cultured keratinocytes. J Invest Dermatol
1998;110:966–71. [PubMed: 9620307]
18. Layton, A and Thiboutot, D. Emerging therapies in rosacea. (2013) American Academy of Dermatology 19. Gomaa AH, Yaar M, Eyada MM, Bhawan J. Lymphangiogenesis and angiogenesis in non-phymatous rosacea. J CutanPathol 2007;34:748–53. 20. Koczulla R, von Degenfeld G, Kupatt C, Krotz F, Zahler S, Gloe T, et al. An angiogenic role for the human peptide antibiotic LL-37/hCAP-18. J Clin Invest 2003;111:1665–72.
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TOPICALANAESTHETICS
TRAINING IMPERATIVE FOR THE SAFE USE OF TOPICAL ANAESTHETICS Chris Testa B.Bus; B.Pharm
IF you are delivering a treatment that imposes pain you will need some level of pain management. This will most likely require the use of a topical anaesthetic. However, topical anaesthetics are classified as drugs and have strict regulatory restrictions in Australia on who can apply them. At this stage non-medical practitioners are not permitted to apply them to a client. This contentious issue is currently under investigation by the regulators because of the risks that topical anaesthetics pose with incorrect use. As more and more practitioners undertake treatments such as cosmetic tattooing, microblading, dermal needling etc, without appropriate qualification the risk of incidents is becoming alarmingly greater. The only way that the industry can be protected, is through the demonstration that appropriate educational courses are available for practitioners. In a proactive manner, APAN has approached Compounding Pharmacist Chris Testa, who has developed two educational units for aesthetic therapists and clinicians who are required to work with topical anaesthetics. While these courses do not alter the terms of the current legislation, they are a valuable stepping stone and a tool that APAN can use towards a legislative process.
The challenge for all members of the healthcare team (doctors, pharmacists, nurses, specialty aesthetic practitioners) and policy makers is to prepare for the waves of change the technological advances are rapidly directing towards us. An important element I strongly support is organising structured education of all stakeholders in the area of new aesthetic procedures. Practitioners need to be well informed and have a thorough understanding of the topical preparations available, their safe application, early warning signs of adverse reactions and appropriate response. Also patients and practitioners need to be aware of and comply with regulatory requirements in terms of acquiring topical anaesthetic preparations. Training and continuing education can answer a number of questions necessary for safe use of topical anaesthetics: What are some basic principles for safe use of topical anaesthetics e.g. the lowest effective strength, the smallest effective quantity over the smallest surface area applied for the least time? What are the relative potencies of each ingredient in a topical preparation?
In this article Chris Testa provides valuable insight into the risks associated with the use of topical anaesthetics and the value of appropriate education in ensuring client and patient safety.
How quickly do they start to work and how long will they last?
With the advances in technology and the emergence of new dermatological and laser procedures, the need, in fact, the demand by patients for more effective topical anaesthesia is growing. Until technology develops beyond the need for pain elimination or reduction, this demand will continue to grow.
How do these agents make their way into the bloodstream and what are the risks of systemic absorption?
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What is their mechanism of action?
How much of a topical preparation is likely to be absorbed based on the best available clinical data?
What are the incidents of true allergic reactions to each agent? What effects do combining anaesthetic agents have on their collective potency, side effects and potential systemic toxicity? What are the common side effects and reactions to each agent? How do you treat or respond to the reactions? What are the serious and life threatening reactions to each agent? What is the difference with regard to systemic absorption between a topical anaesthetic applied to mucous membrane (no stratum corneum), damaged skin, or healthy intact skin? How to recognise early signs and progression of serious side effects to topical anaesthetics? What is a logical and safe strength or combination to use for a particular procedure? How does the body deal with topical anaesthetics that are systemically absorbed? What medication or medical condition would indicate caution or preclude the use of a topical anaesthetic? We know with some procedures that care is needed with different skin types and colour. What consideration do we need to apply to topical anaesthetics in these circumstances? How to calculate the quantity of anaesthetic drug present in each gram of a particular topical anaesthetic gel or cream? How much is safe to apply? TOPICAL ANAESTHETICS USE AND WHAT ARE THE RISKS Anaesthetic drugs used on their own, or in combination include lignocaine (Lidocaine), prilocaine, tetracaine and benzocaine. Each have their own characteristics in terms of onset and duration of action, potency, clearance from the body following systemic absorption as well as potential adverse reactions and toxicity.
and died from toxic effects of the anaesthetic drugs. A much wider range of anaesthetic agents are used in the hospital setting for minor and major surgery. However, some of the anaesthetics used topically for dermal procedures still have a role in surgery. The Australian and New Zealand College of Anaesthetists conducted a review of anaesthesia related mortality reporting in Australia and New Zealand across private and public hospitals between 2006 and 2008. NSW, Victoria, Western Australia and Tasmania contributed which represents about 2/3 of Australia’s population. Of the 917 deaths reviewed in these four States, 124 were attributed to anaesthetic factors. Casual or contributing factors included anaesthetic technique, anaesthetic drug selection and dosage, crisis management, monitoring, post-operative management and supervision. In 89 cases the medical condition of the patient was a significant factor. The anaesthesia was administered by specialist anaesthetists in 86% of cases. In 2012, the FDA again issued a health communication alerting health professionals to concerns about a rare, but possibly fatal condition called Methoglobinemia associated with benzocaine. Methemoglobinemia is a condition where too much of the hemoglobin in red blood cells is unable to bind and carry oxygen. In the USA, benzocaine spray solutions such as Hurricane, Cetacaine, Exactacaine, and Topex are used during medical procedures to numb the mucous membrane of the mouth and throat. The FDA over a number of years had received 319 reports of methemoglobinemia associated with benzocaine sprays. Of these, 7 cases resulted in death, 32 were categorised as life threatening, and 216 were categorised as serious. A review of all these cases indicated that development of methemoglobinemia may not be related to the amount of benzocaine applied to mucous membrane. Cases where reported after a single spray as well as other instances of excessive application. In addition, the amount of benzocaine in a spray varied across the different brands, the residual volume in the container, spatial orientation of the container when sprayed, and how long the actuator was pressed. WHY ANAESTHETICS NEED TO BE TREATED SERIOUSLY?
Topical anaesthetics work by blocking pain sensation in the skin. Consequently some of the anaesthetic can pass into the bloodstream. Systemic absorption can be influenced by the concentration of the anaesthetic drugs, or combination of drugs in the topical preparation, the amount applied, the sight of application, the surface area covered, the duration of application, and the condition of the skin at the site of application. If too much is absorbed, serious side effects and ultimately death can occur.
All topical anaesthetic preparation must be treated seriously. The active ingredients are potent drugs that if overused can cause serious harm and tragedy. Constant care and vigilance is needed.
In fact, in the USA, several fatalities have been reported involving topical lignocaine combined with other anaesthetic drugs applied over large areas of the body with or without occlusion.
In their quest for knowledge, online communities of like-minded individuals have developed, sharing information about products, procedures and experiences. This technological revolution has provided almost effortless online access to quite potent topical anaesthetics available overseas, but not licensed for use in Australia. Patients are attempting to access these products based on online claims with, in many cases, insufficient information about their safe use and more precisely, appropriate application to the specific dermal procedure they are about to undertake. Individuals are seeking these overseas available products in many cases due to unsatisfactory experiences with the
In 2007 the US Food and Drug Administration (FDA) issued a warning to healthcare professionals regarding potential risks associated with unsupervised patient use of topical anaesthetic products. This followed the death of two (2) women who applied topical anaesthetic combinations of lignocaine and tetracaine to their legs with occlusion for an extended period prior to laser hair removal. Both women had seizures
Only a few years ago it would have been difficult to imagine the enormous use of social media, smart-phones, tablet applications and internet access to information and the international market place.
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limited range of Australian licensed alternatives. For example, some of these overseas products are providing superior numbing due to the combination and strength of anaesthetics. Others include a vascular constrictor to reduce swelling, bruising and bleeding or are formulated at a suitable pH for application near the eye.
or meet the quality and safety standards expected in Australia. How safe are they for their patients?
UNDERSTANDING THE ROLE OF PH IN ANAESTHETIC SAFETY
Education and training relating to the safe use of these products is essential and should be an important, and perhaps compulsory, component of professional training in all aesthetic procedures that utilise topical anaesthetics.
Practitioners, including medical specialists, quite often are commenting that products commercially available in Australia are not suitable for many aesthetic procedures. For example, a high pH (alkaline) topical cream such as Emla (pH 9-9.2) is not safe for use anywhere near the eyes.Even if the pH is safe, the practitioner must take extreme care to ensure the topical anaesthetic does not come into contact with the eye. A desensitised eye is more susceptible to inadvertent corneal abrasion with the patient unaware until sometime later as the anaesthetic wears off. Additionally, it appears unclear what effect an alkaline topical preparation may have on dermal healing or even tattoo pigments. In some cases, the commercially available product is not able to achieve the level of pain relief necessary for many patients to continue or complete an aesthetic procedure. In other cases, a liquid or more viscous liquid preparation is required rather than a gel or cream. Also, body temperature can decrease the viscosity of some preparations after application allowing the topical anaesthetic to run into the eyes of a patient. It appears in a small number of cases, unlicensed, overseas manufactured topical anaesthetics are being illegally imported and on-sold to unwary practitioners and patients. Practitioners under these circumstances will be unaware that they are taking a great risk. These overseas and unlicensed formulations may be approved for use in their country of origin, but may not be manufactured under Good Manufacturing Principles (GMP)
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Not only are patients placed at risk, but how will the practitioner’s indemnity insurance view any claim in the event of an adverse reaction?
In Australia, it is an offence to supply medicines that are not registered or listed on the Australian Register of Therapeutic Goods (ARTG). This Register is administered by the Therapeutics Goods Administration (TGA). Medicines that are included in the ARTG have an AustL or AustR number displayed on their packaging. For example: Emla Cream AustR 12886 Blackmores Co Q10 150mg AustL 211661 Amongst other things, this registration ensures that these medicines are manufactured in facilities governed by the “Code of Good Manufacturing Practice� (GMP) ensuring these products meet the quality and safety standards expected by Australian consumers. However, as already discussed, many medicines are unavailable in suitable forms for particular patients. In fact, the small size of the Australian market precludes registration of products required for small but significant patient populations. In addition, many products are unavailable or discontinued for economic rather than safety reasons. Where a suitable commercial product is not available, compounders are exempt from registration by the TGA under strict and specific criteria. The medication must be prepared by a compounder: For a particular person For therapeutic application to that person
In a pharmacy with the appropriate facilities, equipment and qualified staff.
Medicine, the safe use of which may require advice from a Pharmacist and should only be available from a Pharmacy.
There is no exemption for the making of batches or bulk supply for surgery or clinic use. Supply to another party for re-labelling or on a wholesale basis for resale is also considered manufacturing and is not exempt from the ARTG licencing regulations.
Preparations for topical use containing greater than 10% or not included in Schedule 2, are Schedule 4 or Prescription Only Medicines. That is, substances where the use or supply should be by, or on the order of, a registered medical practitioner(a person permitted by State or Territory Legislation to prescribe). These preparations should only be available from a Pharmacist on prescription.
In summary, manufacturing means preparation of medicines or therapeutic goods for general supply and not for a specific patient. There is no need to seek those unlicensed overseas products. Australian pharmaceutical compounders have for generations, provided the solution to many formulation challenges. Australian compounders specialise in developing medicines for patients whose individual needs cannot be met by commercially available medicines. We can tailor a formulation to meet the unique, precise needs of a patient and their specific procedure.
Products obtained over the internet are subject to the same laws as registered or listed medicines. If they contain Scheduled Medicines, as all topical anaesthetics do, they are subject to the same laws with regards to who is authorised to possess and use them. APJ
Topical anaesthetics in Australia are legislated as Scheduled Medicines. Each State has its own Health Regulations covering the Scheduling of drugs and poisons.
For Topical Anaesthetics Educational Courses contact APAN on E: info@apanetwork.com | Ph: 07 55930360 or visit www.apanetwork.com
With a view to promote uniform Scheduling of poisons across all States and Territories, the Commonwealth has established the “Standard for Uniform Scheduling of Medicines and Poisons� (SUSMP).
If you have completed the first INTRODUCTION TO THE SAFE USE OF TOPICAL ANAESTHETIC you now can undertake the ADVANCE COURSE IN TOPICAL ANAESTHETICS.
Topical anaesthetic preparations containing 10% or less of total anaesthetic agent (in combination or as a single agent) are regarded as Schedule 2 - that is, they are a Pharmacy
For Compounded anaesthetics products contact Tugun Compounding Pharmacy Ph 07 5598 2411
APJ 23
PROFESSIONALDEVELOPMENT
Another successful professional development training
ADVANCE COURSE: SAFE USE OF TOPICAL ANAESTHETICS AS PART of their commitment to professional development APAN hosted on the 31st July after the APAN Aesthetics Conference the Advanced Course: Safe Use of Topical Anaesthetics presented by Compounding Chemist Chris Testa and held at the beautiful location at Stephanies Urban Spa headquarters in Brisbane. Professionals who had completed the Introductory Course: Safe Use of Topical Anaesthetics qualified to undertake the Advanced Course. This initiative is part of APAN’s on-going plan to present to regulators the industry’s commitment for constant improvement of their skills and knowledge on this topic.
non-medical practitioners who have completed appropriate education and training to be given permission to work with greater scope than in the past. It is important to note that all this is a process and APAN has a clear objective in defending the rights for appropriately educated practitioners to be given license to work with anaesthetics in a less cumbersome way and with less restrictions that are currently in place.
The course was very comprehensive and provided eager practitioners a greater understanding and knowledge on the topic of topical anaesthetics. Being a beautiful sunny day, allowed us to enjoy a wonderful outdoor lunch at a nearby tavern and also enjoy commitment to progsome fun and networking.
As a ress it is important that all practitioners who practice cosmetic tattooing, dermal needling and other procedures that require pain management demonstrate their industry support by updating their knowledge through key industry educational initiatives. Regulators consider such evidence when reviewThis course empowered practitioners with ing legislative updates. Eager practitioners attended this training that allowed them increase their knowledge in this important subject. Currently only medical practitioners can apply topical anaesthetic to their clients or patients as anaesthetics are classified as dugs and come under the Drugs and Poisons regulations. If non-medical practitioners are to be seriously considered during any legislative update we must be able to demonstrate that the industry is committed and proactively preparing to qualify through on-going education.
a more in-depth understanding on anaesthetic chemistry, the signs of systemic absorption based on recent clinical data. Chemical analysis of various anaesthetics and how each one can respond to treatment requirements. With this information practitioners are able to step-up their academic understanding on how to identify the right formulation for the treatment they are performing.
While this course does not alter the current status of the regulations it does provide a mechanism for APAN to pursue a change in current legislation. Ultimately, the aim is for
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The next course will be conducted on the Gold Coast on Sunday 22nd October. If you have completed the Introductory course you can now complete the Advanced Course as part of your professional development on this subject.
As a commitment to progress it is important that all practitioners who practice cosmetic tattooing, dermal needling and other procedures that require pain management demonstrate their industry support by updating their knowledge through key industry educational initiatives. Regulators consider such evidence when reviewing legislative updates. Please Register for Part 2 - Advanced Course if you have completed Part 1 - Introduction to the Safe Use of Topical Anaesthetics. APJ If you have not completed the Introductory course you can access this on-line. It pays to be vigilant with your knowledge and pro-active with your knowledge and skills. For further information please phone APAN 07 5593 0360.
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APJ 25
SKINSCIENCE
HEALTHY MICROBIOME AND THEIR ROLE IN MAINTAINING SKIN HEALTH by Terry Everitt
FOLLOWING from the recent Australasian Anti-Ageing and Aesthetic Medicine (A5M) conference, which had Gut Health: The Cornerstone of Wellbeing, as the conference theme and our (well at least we are claiming him as ours) scientifically orientated Master Educator, Terry Everitt, as the Master of Ceremonies (and speaker) of the Aesthetic Medicine stream, prompted this article about how microbes affect the skin and the importance of keeping the balance of optimal healthy, as opposed to harmful, microorganisms for continued skin wellbeing. Evidence presented at the recent Australasian Anti-Ageing and Aesthetic Medicine (A5M) conference from an array of domestic and international speakers showed more than a prevailing belief in the causal link between ill-health and unbalanced gut microbiota, and that it is the Western lifestyles that are affecting the composition and diversity of the gut microbiota leading to many chronic health problems. Yet despite the rapid rise in allergy related skin-health problems in the developed world, parallel research into the role of the skin microbes and the body’s immune system responses on overall health has been limited. What we do know is that the skin microbiota plays a role in both maintenance of skin health and the development of skin conditions/diseases. DEFINING THE DEFINITIONS Here is a brief outline of common words used in this article and their meaning to help refresh your memory in the amazing subject of microbiota: Commensal is the termed use to denote the harmless microorganisms that are part of the natural microbiota. Dysbiosis is a term for a microbial imbalance. Microbiome is the genetic material within a microbiota and sometimes referred to as the metagenome of the microbi-
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ota. Microbiota is the collection or community of microorganisms. Prebiotics are ingredients that selectively stimulate the growth and/or activity of beneficial organisms. Probiotics are live microbes that, when administered in adequate amounts, confer a health benefit on the host. Synbiotics are synergistic combinations of prebiotics and probiotics. MICROBIOTA AND THE SKIN The academic medical literature on skin microbiota (previously known as the skin microflora) has concentrated on the pathogenic roles of different types of microbiota on the skin, yet this is fast changing to focus now on the influence of resident cutaneous microbiota on skin health, rather than skin disease. We are going to hear much more about the microbe cutaneous defence that inhabit our skin. Many of these I am sure, you would not have heard before, going beyond the usual four genus of microbes which are common to all; Staphylococci, Propionibacteria, Streptococcus and Corynebacteria. Malassezia is the most common yeast found on most, if not all skins. In addition to the P. acnes, you will soon to be familiar with names such as P. avidum, P. granulosum,Actinobacteria, Escherichia coli, Pseudomonas aeroguinosa and Micrococci. All play various roles in our natural cutaneous microbial defence system. Most perhaps think of the bacteria that reside in our bodies are mainly in the gastrointestinal (GI) tract. While this is true, the skin supports a delicate ecosystem of microorganisms,
including yeast, fungus and bacteria species. It its difficult to have a precise number of the microbes on the skin, however it is generally accepted that in each cm2 of skin, there is 104 – 106 of living microorganisms (Ouwehard, Kirsti and Lathinen2010). Now that is a lot of bugs – thankfully most of them are the good ones. Recent research suggests that somehow different microbiome locations throughout the body are connected and communicate with each other. As is becoming very clear, gut health is often reflected in the skin; additional, yet apart from the microbiomes on the skin. The Western world seems to be suffering from an allergy epidemic with the alarming rise in skin ailments and allergic conditions such as atopic dermatitis (eczema) and other dermatoses. SKIN MICROBE POSITIVES The skin microbiota includes main species of propionibacteria, staphylococci, Malassezia spp., (previously known as Pityrosporum) which is a yeast, Micrococci and Corynebacterium. There are many very specific actions that the resident microbiota undertakes, yet collectively they can be grouped into three main actions: Growth of specific microorganisms on skin lowers the pH, by releasing short-chain free-fatty acids (lactic and propionic acids) which makes it more difficult for competing (pathogenic) microorganisms to grow. Compete with potential pathogens for nutrients., which makes it more difficult for them to become established and cause infections. Attachment of the microbiota to receptor sites block potentially undesirable microorganisms from attaching to cells to initiate an infection. ARE FACIALS HARMING THE SKIN? There is no doubt that application of cosmetic products directly influences the ecological balance of skin microbiota by introducing inhibiting factors such as antimicrobials and preservatives. These may act indiscriminately and produce changes in environmental conditions on the skin. While the short-term effects may be minimal as the skin can ‘correct its self’, the long-term effects of consistent, repeated application are unknown, and concerns about antimicrobial tolerance and resistance continue to pervade literature and the media. The skin is exposed daily (hopefully) to cleansers that are applied to remove undesirable surface contaminants. This also is believed to decrease the microbe environment of the cleansed skin and was always a concern in leaving the skin without the normal microbe population as a defence mechanism. Just think of how many times you might wash/clean the skin in a normal facial treatment – not just the actual cleansing to begin with, yet the removal of various product applications such as masks or massage oils. So then, with what you do in treating the skin, are you depleting the skin’s surface of one of its major protective barriers? Luckily the answer is now known as ‘possibly,not really’. OK,
so it is not an absolute, however, two et al (2016) showed via many ‘skin insult’ tests, using different antimicrobial compounds, that using such, compared with water, did not reveal a major difference in the similarity of the bacterial community in most subjects, pre/post wash. This is a little different to earlier findings of Blaser &Falkow (2009), mentioned later in this article. The difference in results appears to be in the cleansers used – much has changed in cosmetic chemistry between 2009 and 2016. The capacity of some detergents did transiently alter antimicrobial peptide abundance however this was not of major significant values in the results of Two et al (2016). It appears that the microbiome has some serious adhesion mechanisms at work connecting to, and keeping on, the skin surface. Another major positive is the composition of the microbiome within a given individual appears to remain fairly stable over time (Oh et al., 2016). The microbiota seems to balance itself in numbers – yet to be discovered how it produces more if low and somehow slows microbe population growth if too many. So, while washing does not seem to affect the commensal microbiota to great detriment, evidence does show that the pyrogenic organisms are decreased and the longer the wash with antibacterial detergent agents, rids the skin of more of these harmful organisms. Keep washing those hands to decrease infection and cross contamination. What we do not know, is how does the multiple applications of different products (as in a facial) effect the microbial count, as studies so far have all been on one or two wash protocols; not multiple products application and removal. This is complicated by how much of a commensal biofilm does the client have to begin with? While there should be billions of these little critters in every square cm of skin, how do we know? Does the client have a healthy commensal biofilm? How do you work that into your consultation? MULTIPLE SPECIES There are of course, different methods of analysis in determining the cutaneous microbiota. While below examples remain in the realm of the laboratory, I think it is not so far in the future that we will have the ability to quickly define the microbiota of the client within your consultation. Metagenomics is the name given to the culture-free sequence-based method now utilised to collect, analyse and understand the skin microbiome. I will very briefly reference the three main methods currently used: (1) Many of the studies trying to solve the mystery of what microbes are on the skin is via the 16S rRNA gene. Ribosomes within the cell can’t translate mRNA without their 16S rRNA component, which all microbes contain. Basically, a molecular clock, comprised of conserved and variable regions, which can be mapped, in turn indicating different strains of the same microbe species. (2) Once the strains and species are known, something called the Shannon Diversity Index is used to work out and summarise the diversity of a population in which each member belongs to a unique group – that is, how many of each species and the homogeneity of the species of microbes.
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(3) Much work and knowledge acquisition is being achieved via HDACs (Histone Deacetylase), which are specialised enzymes involved in regulating gene transcription, among other roles they play as with inflammation, immune and allergic responses as examples. It was from earlier HDAC work that found that when this group of enzymes were reduced, a reduction was also with the commensal microbiota and thus a compromised immune defence system was created. It is difficult to established what ‘perfect’ skin looks like and what minimum diversity level below which, could confidently predict that skin was ‘unhealthy’ and liable to disease or damage. While many studies have been completed, they all differ in the results. This is primarily because the microbial diversity is so great, even in different body areas of the same person, let alone the differences between people in the same geographical area. An interesting study by Gontcharova et al (2010) showed intact skin of diabetics was significantly more microbial diverse than the wounded skin of diabetics. However, healthy diabetic skin was still reduced in diversity compared to non-diabetic skin. This change in biodiversity is correlated by Wallen-Russell (2017) who found that “healthy skin untouched by Western practices harbours a higher microbial diversity than normal ‘Western’ skin; damaged skin always harbours a reduced diversity of microbial species compared to healthy or normal skin on the same subject.” As previously mentioned, left to its own devices, the skin will naturally recreate an environment that will encourage the correct levels of symbiotic microbes to protect the skin and enhance its natural immune defences. The problem is that we do not let the skin ‘do its own thing’. The exposure of normal skin to twenty-first-century cosmetics, soaps, medication (antibiotics, steroids) and showering, does appear to have altered the natural microbiota environment of the skin (Blaser & Falkow2009). In our rush to be super clean, we have stripped the skin of its essential lipids and
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bacteria. Reducing and at times eliminating our skins natural defence mechanisms. It is of no surprise we are having this epidemic of dry, itchy, raw skin. One theory has been put forth that as a person ages, their immune system becomes less capable of fighting bacterial infections. So then, by enhancing their skin’s microbiome, rather than administering antibacterial agents, some infections could be avoided, or at least the frequency or severity could be decreased. Many organisms previously thought to be pathogens, such as Staphylococcus aureus, Staphylococcus epidermitis and Propioni bacterium acne has been identified as members of microbial populations isolated from healthy skin. To look at this in more detail, I will take two commonly known in skincare as ones to get rid of – the dreaded Propionibacterium acnes (p. acnes) and Demodex. PROPIONIBACTERIUM ACNES (P. ACNES) Even after decades of studying Propionibacterium acnes and its contribution to acne pathogenesis, the role it plays is still very unclear and debated, especially as it is a major commensal of normal skin microbiota. Did you know there are over 1,000 different strains of P. acnes that have been identified (Fitz-Gibbon et al 2013). Some go on to cause the inflammation of acne while other strains provide protection to the skin. There are significant differences in P. acnes population structure between acne and normal skin even within the same loci in the same person (Fitz-Gibbon et al 2013). This knowledge was achieved by 16S rDNA sequences. From this work, we have knowledge of strains of P. acnes that are involved in the characteristic subtypes of acne (comedonal, pustular, inflammatory, cystic). As we know, this inflammatory affect in acne is due to the P. acnes production of free fatty acids that irritate the follicular wall, and bacterial cell wall components including lipoteichoic acid that provoke immune response resulting in the pustular result. Science is working out which strain does what and in time will provide specific targeted therapeutic approach in treatments for the different acneic types.
At the same time, P. acnes undertakes to ferment glycerol, a metabolite that naturally occurs in human skin, into several short-chain fatty acids. This time however, results in decreased intracellular pH within Staphylococcus aureus to inhibit its growth. These findings suggest that P. acnes may function to prevent pathogen growth in human skin, and could also be used to develop novel probiotic treatments for MRSA (Methicillin-Resistant Staphylococcus Aureus) infections. Given that p. acnes are both the good and bad guys, the use of synbiotic combinations are on the horizon to treat the strains of problematic p. acnes while sparing the commensal strains of p. acnes. This indicates yet another complexity of the skin and the need to be specific in what we are talking about – the more I study and know about the skin, the more complex it becomes. DEMODEX There are some 65 species of Demodex identified with two of concern on the skin. Demodex congregate around the hair follicle. Demodex folliculorum is found in the hair follicle and Demodex brevis is in the sebaceous gland (Palopoliaet al 2015) as a part of the normal and natural microbiota. Increased numbers of this microbe results in the condition termed demodicosis, indicated by inflammation and itching. This is associated with acne, chronic blepharitis and papulopustular rosacea. A recent study by Forton & De Maertelaer (2017), provides interesting details of the association of Demodex and inflammatory conditions and the interaction of Demodex and Malassezia in providing damaging outcomes for the skin. This is added to a very new (Sept 2017) meta-analysis of Demodex with Rosacea by Chang & Huang (2017) which showed significantly higher prevalence and degrees of Demodex mite infestation than control patients, in playing a role in both erythematotelangiectatic and papulopustular rosacea. Again, we are still to find out how such normal skin microbiota can change to become such a critical component of inflammation and damage to the skin. IMMUNE FUNCTION It seems that the normal microbiome also may protect and contribute to skin health through (mostly unknown) sophisticated mechanisms such as educating the immune system to recognise commensal microbiota and secreting antimicrobial compounds to prevent colonisation by pathogens. We know that keratinocytes continuously sample the microbiota colonising the skin’s surface through pattern recognition receptors (PRRs), such as Toll-like receptors (TLRs), mannose receptors and the NOD-like receptors (Nucleotide oligomerization domain receptors). These TLRs and NOD-like receptors recognize ‘Pathogen-Associated Molecular Patterns’ (PAMPs), such as lipopolysaccharides in the outer membrane of Gram-negative bacteria, and lipoteichoic acid components in the cell wall of Gram-positive bacteria. The activation of keratinocyte PRRs by PAMPs immediately initiates the innate immune response, resulting in the secretion of antimicrobial peptides (AMPs), cytokines and chemokines. Engagement with TLRs stimulates the release of nuclear factor kB (NF-kB), a transcription factor that regulates genes responsible for innate and adaptive immune response.
We now understand why such microbial life is not attacked by the immune systems Langerhans cells. The Langerhans cells have low expression of bacterial-specific TLRs (specifically TLR2, TLR4 and TLR5) which contribute to tolerance of commensal bacteria (Romani, Brunner and Stingl 2012). Additionally, the normal commensal bacteria on the skin prevent colonisation of pathogens by creating unfavourable conditions and by producing antimicrobial substances. Specifically, lactic acid bacteria and propionic acid bacteria secrete organic acids creating a low-pH environment that discourages growth of other species along with secretion of bacteriocins. There is a constant interplay among keratinocytes, immune cells and microorganisms that is modulated by AMPs, cytokines, chemokines and microbial peptides to keep the normal microbiota active and to detect variation of pathogenic microbes. We know that some skin diseases are associated with a specific stage of life, a specific topographical location and/or specific micro-organisms. Dysbiosis is a hallmark of atopic dermatitis (AD), which is still referred to as eczema. A study just released ahead of print (Dybboe et al 2017), outlines how this is so with interaction between species in atopic dermatitis.They found a depletion of Malassezia species and high non-Malassezia fungal diversity instead of the expected normal ratios which has Malassezia as the main fungal yeast. Additionally, elevations of Staphylococcus aureus and Staphylococcus epidermis found with simultaneous depletion of the Propionibacterium genera. It would appear that AD results from a change in the microbiota profile. What is yet to be discovered is, are these skin problems driven by the endogenous microbial community structure, or more importantly, deviations to the norm? This remains to be determined although seems most likely to be a causative factor. SKINCARE PRODUCTS Research and emphasis has moved from ingredients to inhibit microbes to the study of ingredients that can work with the commensal microbes yet inhibit the pathogenic ones. It might be great to have live healthy bacteria in cosmetics, yet this poses major technical hurdles; one being live cells just cannot survive in a cosmetic preparation; the same problem encountered with stem cells. Stability is problematic also. However, increasing evidence has shown that cellwall fragments,bacterial lysates and dead bacteria, referred to as probioactives, are possible and subject to much study currently in cosmetic chemistry. While probiotics are great for ingestion, prebiotics will be the topical alternative. Many continue to live in a Pasteurian view of the world. This is where the microbiome is still regarded as pathogenic bacteria. Bacteria is bad as it causes disease, so needs to be eradicated or at least pasteurised. Many are not ready for the idea to have bacteria in a positive when talking about the skin, or about a product containing microbes destined to be applied to the skin. As much as many can now accept we need good bacteria for our insides, the application of such to our outsides, is not yet comprehendible for many. If you have such clients, you will need
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to educate them on the viability of adding microbes to their skin. Admittedly a little difficult as we have spent so much time trying to get rid of microbes on the skin. There is no doubt we are on the cusp of a new age in skin care ingredients. As we find out more as to how ingredients and products interact with our native microbes, we will see ingredients no longer used. Replaced with ingredients that are essentially pro or at least prebiotic to replenish the required microbial growth and diversity so important for healthy skin. Vitreoscillafiliformis biomass has been used in skin care emollients and has been shown to stimulate mRNA expression and antimicrobial peptides in the epidermis and successfully used for Atopic Dermatitis. Lactobacillus or Enterococcus faecalis have also successfully been incorporated into topical solutions as prebiotics. If you’re a bit queasy with the thought of have faecalis on the skin, I guess you are not ready for the thought of faecal transplants (a highly successful treatment in gastroenterology). Coming to a skin care label soon will be a whole new wave of terminology; such as Prevotella; Lactobacillus johnsonii; Bacteroides fragilis; Lactobacillus ruminus; and Lactobacillus infantitis. Lactobacillus johnsonii bacteria strain is used to inhibit the ability of pathogenic microbiota to adhere to skin, literally pulling the rug out from beneath them. It’s not too far-reaching to envision this microbe-on-microbe tactic in future product applications. You need to gain knowledge and understanding of how the skin microbiota functions; bringing that knowledge to your clients and taking some basic steps to help preserve that robust balance between our body and their microbial partners. Soon, I think we will have a cartography of bacteria’s adhesion and growth capacity on the skin which will allow specific biofilm production of differing components of commensal microbes. In time, these will be I believe, you will be able to custom make such requirements for each client. Research is well under way as to the appropriate microbes for use in wound care, anti-ageing, dermatosis and UVR damage. Varying results have been obtained and it is clear now that it needs to be an exact strain of microbe and not the genus that makes such a difference. The next complex to overcome is having the strain in a product stabilised for the product and ready to be bioavailable when finally used on the skin. CONCLUSION The human microbiome is being explored at a rapid pace. Connections have been made from our circumstances at birth, to our present habits and lifestyles in adulthood. While the past has gone the present can be used to nourish and protect our microbiome through nutrition and wise lifestyle choices, including skin care provision, to ensure that our microbiome is as healthy as it can be for the future. Skin health will be maintained or even increased with a new armamentarium of microbe based products and treatments. Knowledge now gives us the ability to be able to predict which people are more likely to be prone to skin ailments such as AD and psoriasis to pathogenic microbial imbalances such as acne, ulcers and lesions.
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Who knew the dawning of a new age in skin care would be about the very thing we have been trying so hard to get rid of – the multitude of bugs on our skin. APJ
Terry Everitt continues to write current academic and scientifically sound information as an internationally recognised Master Educator in the Aesthetic Sciences. His knowledge and educational abilities are acknowledged as a speaker at Medical conferences. APAN appreciates his time and wisdom on APAN’s National Advisory Council and the Journal Advisory Board for the Aesthetic Practitioner Journal, and for the compilation of the International Aesthetic Show Calendar for each edition of this journal. Terry is also the Director of Aesthetic Educators Pty Ltd, aestheticeducators@gmail.com
References
Blaser MJ, Falkow S. (2009). What are the consequences of the disappearing human microbiota? Nature Reviews Microbiology. 7. 12. pp 887–94. Chang, Y. Huang, Y. (2017). Role of Demodex mite infestation in rosacea: A systematic review and meta-analysis. Journal of the American Academy of Dermatology, 77. 3. pp441 - 447. Dybboe, R., Bandier, J., Skov, L., Engstrand, L. and Johansen, J. D. (2017), The Role of the Skin Microbiome in Atopic Dermatitis: A Systematic Review. British Journal of Dermatology. Accepted Author Manuscript. doi:10.1111/bjd.15390. Fitz-Gibbon, S. Tomida, S. Chiu, B. Nguyen, L. Du, C. Liu, M. Elashoff, D. Erfe, M. Loncaric, A. Kim, J. Modlin, R. Miller, J. Sodergren, E. Craft, N. Weinstock, G. Li, H. (2013). Propionibacterium acnes Strain Populations in the Human Skin Microbiome Associated with Acne. Journal of Investigative Dermatology. 133. pp2152–2160. doi:10.1038/ jid.2013.21. Forton, F., & De Maertelaer, V. (2017). Two Consecutive Standardized Skin Surface Biopsies: An Improved Sampling Method to Evaluate Demodex Density as a Diagnostic Tool for Rosacea and Demodicosis. Acta dermato-venereologica, 97. 2. pp242-248. Gontcharova V, Youn E, Sun Y, Wolcott RD, Dowd SE. (2010). A comparison of bacterial composition in diabetic ulcers and contralateral intact skin. Open Microbiology Journal. 4. 1. pp8–19. Oh, J. Byrd, A. L. Park, M. Kong, H. Segre, J. (2016). NISC Comparative Sequencing Program, Temporal stability of the human skin microbiome. Cell. 165. 4. pp854-866. Ouwehard, A. Tiihonen, K. Lathinen, S. (2010). The Potential of Probiotics and Prebiotics for Skin Health. In Farage, M. Miller, K. Maibach, H. (Eds). Textbook of Ageing. Helilberg, Germany. Springer-Verlag. Palopolia, M. Fergusb, D. Minota S. Peia, D. Simisond, B. Fernandez-Silvad, I. Thoemmesc, M. Dunnc, R., Trautweind, M. (2015). Global divergence of the human follicle mite Demodex folliculorum: Persistent associations between host ancestry and mite lineages. Proceedings of the National Academy of Sciences. 112. 52. PP15958–15963. doi: 10.1073/pnas.1512609112 Romani, N. Brunner, P. N. Stingl, G. (2012). Changing views of the role of Langerhans cells, Journal of Investigative Dermatology 132. 3. pp872–881. Two, A. Nakatsuji, T. Kotol, P. Arvanitidou, E. Du-Thumm, L. Hata, T. Gallo, R. (2016). The Cutaneous Microbiome and Aspects of Skin Antimicrobial Defense System Resist Acute Treatment with Topical Skin Cleansers. Journal of Investigative Dermatology.136, pp1950e1954. doi:10.1016/j.jid.2016.06.612. Wallen-Russell, C. and Wallen-Russell, S. (2017). New Link between Skin Microbiota Diversity and Skin Health: Proposal to Use This as a Mechanism to Determine Whether Cosmetic Products Damage the Skin and Are a Cause of the Skin Allergy Epidemic. Cosmetics. 4. 14; doi:10.3390/cosmetics4020014
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MEMBERPROFILE
A DREAM COME TRUE
An interview with Lucy Larwood LOCATED 43 kilometres North of Adelaide, Gawler is the first country town on the Australian mainland in the state of South Australia, and is named after the second Governor (British Vice-Regal representative) George Gawler. It is in this country town that Lucy Larwood established her clinic - Beautify SA. Lucy is the perfect example of how nursing can provide the perfect launching pad for a career in aesthetics and dermal therapies. Her journey is quite unique and we are delighted to profile it in this issue of APJ. APJ Q1: Lucy share with us a little about your qualifications and expertise and what attracted you to this industry? I came from a nursing and midwifery background having qualified as a registered nurse and paediatric nurse in 1983 and in 1991 I also qualified as a midwife. Furthermore, my husband is a gynaecologist so my work was very much hospital-based. While I loved and enjoyed my profession I progressively found the long hours of shift work quite strenuous so I looked at what else I could study and leverage off my current profession. My search led me to undertake a Vocational Graduate Certificate in Cosmetic Nursing, which I completed with AACDS. I thoroughly enjoyed my studies and was delighted to be part of an exciting industry that was able to give me back my life with a better work/life balance option. Having worked shift-work for 30 years in a hospital environment I was ready for a change. I could see great potential in providing a valuable service in a rural setting such as Gawler and so my husband Dene decided to open up our business Beautify SA in Gawler and I have never looked back. APJ Q2: What technologies do you work with and how do you view the collaboration between the use of various technologies and injectables in terms of results?
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My first priority is to optimise skin health and I achieve this through various techniques and technologies including chemical peels, skin needling, IPL treatments and LED light therapy. I also utilise cryotherapy for lesion removal and also offer platelet-rich plasma (PRP) stem cell therapy, which also offers amazing skin-improvement results. My approach is to utilise combination therapies that are customised to works best for my clients and patients. I also use quality cosmeceuticals and mineral makeup to ensure that both clinic and home use are well supported for on-going skin improvement. Once the skin is improved where I address dehydration, broken capillaries and any pigmentation to create a beautiful canvas, I then consider moving to injectables to further enhance the features with additional lifting and facial contouring. I use a wide variety of dermal fillers that have specific and proven efficacy. I attribute the success of my treatments to the thorough consultative process, where I examine not just the skin, but also lifestyle, health considerations, budgetary issues and of course, the desired outcomes. I work very closely in partnership with my clients where I encourage their activity participation in their skin improvement journey. In that way we can transition from corrective treatments to maintenance and establish a trusting, long-term collaborative relationship with on-going improvement and guaranteed results. APJ Q3: What do you believe is the most common, primary consideration for most of your clients and patients and has this changed over the past 10 years? What is the new approach? There is no doubt that cosmetic enhancement has now become mainstream, with consumers not as frightened to have fillers as in past years. The real change that I see is that most individuals now want to ensure the end result, is natural and undetectable as having any form of enhancement.
I cannot express the joy and buzz I receive when I have completed a treatment and give the mirror to my client and see the smile and sometimes even tears of joy in seeing their improvement. I consider it a privilege to offer them amazing results. I get so much contentment at the end of a long day. APJ Q5: Recently you have chosen to introduce a mobile clinic to other regions, what motivated you to do that and do consumers in regional and country areas have different needs to city clients and patients? With time I have developed a reputation for my work and many of my colleagues in the city, as well as other people, have requested that I provide my services to them by visiting them. Even though they are in another destination to my own clinic I still maintain the same approach of achieving the desired results through a progressive, collaborative strategy where skin improvement and enhancement is achieved through an on-going relationship with clients and patients. APJ Q6: Do you have any aspirations for your professional future?
They just want a younger version of themselves. With the possibility of such results appearance enhancement now has a much broader consumer appeal, so more and more men and woman are happy to embark on a complete treatment program. While they are concerned about lines and wrinkles they also want to achieve overall skin improvement.
My aim is to constantly invest in my own education and ensure I am keeping up-to-date and staying abreast of new trends and advances so that my knowledge is always current and in high demand by consumers. This is very much a constantly changing industry. As a sole practitioner keeping my knowledge and skills up-to-date ensures me of a strong client base that I enjoy servicing.
I always educate my clients on the importance of sun protection and ways to reduce skin cancer potential. The new approach is a more holistic one where the practitioner examines all areas of health, giving consideration to issues of health including checking hormone levels, diet and lifestyle issues that contribute to the state of the skin. As Dene is a gynaecologist he can also address the hormonal issues to ensure the best possible outcomes for the client/patient not just for the skin, but also for their overall wellbeing. As the skin is a living organ, changes are constant. I always work with evidence-based solutions such as Retinol, Vitamin C and glycolic acid when addressing skin correction. Once the skin looks healthy I then consider wrinkle relaxants. I find that injectables are best when they are introduced progressively. I try to create an on-going relationship with my clients, developing trust, improving their education and allowing them to feel comfortable with any enhancement I introduce. That way I can address specific areas of the face such as the mid-face, or plasma band for the neck through progressive improvement ensuring that it meets with my client’s expectations. Today we have numerous fillers that can achieve very different properties and effects. Some achieve better lifting, while others offer better feature shaping. I work with over 11 different fillers. As for my clients, they vary in age from 18 to 74 with a constant increase in male clients, who request both skin improvement, injectables, as well as hair reduction, predominantly for back, neck and chest. APJ Q4: What aspect of your work excites you the most?
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APJ Q7: Tell us a little about your cat Jewel? My can Jewels in the clinic mascot. Her breed is Sphynx and this breed have a lot of wrinkles. We use her in our ads with statements such as “come and see me, I can help you with my wrinkle relaxants,”. She is very much the talking point and she so effectively communicates the message of how I can help my clients. APJ Q8: Why did you join APAN and what do you value the most about your membership? I have to say that APAN is an absolutely essential component of my business. At any time I can reach out with a phone call and get valuable, professional information. APAN is amazingly resourceful. They have provided me with support to access the best products and equipment, financial advice and how to best manage my workload. They thoroughly understand my needs and offer me valuable advice and support. I wouldn’t be without them. I strongly believe that everyone who is starting out needs to join APAN as a member. It will save them a lot of time and money in achieving their business success. Lucy is reaching her dream of continuing to improve both the appearance and the quality of life of her clients. She has truly found her vocation in life. APJ
You can contact Lucy Larwood at Beautify SA on 0408 800 798 or email l_larwood@yahoo.com.au
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SALONBUSINESS
What Does Your Brand Say? By Caroline Nelson
FOR SOME people in businesses there is a level of confusion about the meaning of the term Brand and whether it refers to the name, or the logo of a business. While both are part of ‘branding’ a brand is much more than a name or an attractive image.
whether they are a multinational, or a small business, to be fully aware of what their brand stands for. In our industry, which is classified at “personal services”, the brand must relate to the entire client experience including both services and products.
The true purpose of a brand could best be described as how to identify the business and/or its products and services in such a way that separate it from competitors and make it more memorable to consumers. Additionally, it encompasses the public perception of quality and reputation.
The elements of brand identity must be incorporated in every step of the potential client’s journey, from the first encounter of the business name, logo, website, social media, advertising, to the way the phone is answered and all the way through to how the client is greeted and the services they receive.
It is vitally important for any business, regardless as to
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Whatever forms of marketing platforms you chose to use your brand, along with the quality and reputation it projects must always be at the forefront. Above all, it must send out a strong and clear message from its USP (unique selling position) to potential customers and current clients alike of what the brand stands for. In other words what makes this business stand apart from other competitors and why it would best address the consumer’s needs. CONSISTENT MESSAGE To achieve your unique selling position it is important to ensure that all marketing messages are consistent. Be wary of sending mixed-message type marketing because this can confuse both current and old clients, and can even create a sense of unreliability that is linked to your brand. Consumers need to know that they will receive consistent information, service, and even guidance when they commit to a brand and a business. Consistency helps you get ahead of the competition and create authority through your business identity. Here are a few ways to ensure that your marketing efforts are not creating mixed messages: When considering the business name there are three main elements to consider when selecting a name in the aesthetics industry. The first two are typical of most business names, regardless of type of business. The third however, is more relevant to our specific industry and its various versions from the Beauty Shoppe to the Medispa. Let’s look at the three key elements to consider when determining a business name: 1. The Distinctive Element: This could be one word or several words, which could even be your own name that clearly separates your business name from other competitors’ names in the trade area. 2. The Descriptive Element: This should describe the nature of the business, or the services or products you offer. This could even be an image in the logo. 3. The Longevity Element: The name has to last and be relevant for the entire life of the business be that two, five or 10 years, or beyond. In essence, the business name should be distinctive and easily recognised. It should include part description so that potential clients will instantly know what the business will provide. The name must also have staying power for the life of the business. It should never be a name that is hard to pronounce, hard to spell, or hard to remember, and it should not be one that is cute, or just relevant to the current marketplace, but maybe not as relevant in the future. Another consideration is to ensure that you pick a name that is significant to the public at large and not just to you personally. A good example of a successful ‘longevity element’ brand name would be the TV reality series “The Block”. The Block has been running since 2003. Is very distinctive and recognisable. The image in the logo has a descriptive element and the brand has lasted through many seasons and changes, by simply tagging onto the original. For example there has been “The Block All-Stars” “The Block Sky High” and, the current “The New Block”. To create a memorable brand you need to take into consideration the business’s philosophy. This should encompass the overall purpose and goals of the business, it’s organisa-
tional objectives, how you intend to do business, manage the business, and the beliefs, ideals and ethics that a consumer can expect you to uphold. This is the ‘heart’ of what you want your business be and represent. Branding is part of the business blue-print and needs to be aligned with the business vision, or ideally where you would like the business to be sometime in the future. The vision should aim to guide the organisational direction, purpose, and reflect the big picture that your employees need to embrace if the business is to reach its full potential. Therefore the vision should reflect the unique strengths, culture and business direction you want your team to embrace and commit to. It should inspire employee loyalty and encourage them to outdo themselves to reach and exceed targets and goals. The business vision is supported by a mission statement of the ideals you want brought to the business and how this is projected to the public. This mission doesn’t need to be long. It could be a short 30-second statement, for example: “With the power of our highly qualified (business name) team, we dedicate ourselves to provide our valued clients with superior and personalised aesthetic care, supported by the most cutting-edge treatment and professional strength home care products. Our services have been created to deliver advanced results in a calm professional clinical environment. We are committed to continually improving ourselves and providing outstanding customer service.” You may recall earlier that I mentioned the importance of not giving mixed marketing messages. Another element of this is making sure the physical aspects of the business reflect both the name and marketing message. For example if you have used a Mission Statement similar to the one above a potential client would be expecting to see more of a ‘clinical’ environment. One that looks crisp, clean, uncluttered, and professional. And not like a glitzy boudoir style salon, or a single room tucked away in the back of a messy hair salon. The décor of the reception should always carry through with the brand message especially as it is the ‘profit sales hub’ of professional skincare and make-up. A skin analysis technology area designed into the reception area would seriously extend the branding and maximise retail sales. The professional skincare and make-up display cabinets should include light-box lit logos of the brands stocked. Linking your business with highly reputable companies will also add higher visibility and recognition to your brand. I think you will agree branding is not just about your logo and advertising, but how your business is perceived from any angle. Branding should be the Unique Selling Position of high standards, quality control, excellence in customer service, and it should be so memorable that it has people returning again and again. APJ © Copyright Caroline Nelson 2017
Caroline Nelson is a beauty industry expert who specialises in helping businesses develop their brand, improve productivity and increase bottom-line profit. To learn more about her step-by-step program for salon spa success visit www.SalonSpaBusiness.com or phone 0410 600 440.
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A5MConference
A Conference Overview
11th A5M Annual Anti-Ageing & Aesthetic Medicine Conference THIS year the A5M Annual Anti-ageing and Aesthetic Medicine Conference featured GUT HEALTH: The Cornerstone of Wellbeing as its key theme. The event was once again held in Melbourne at the Sofitel on 5-6th August. APAN recognises this conference for its broad and diverse educational content, depth of knowledge and scientifically-sound education on the very latest evidence-based findings in preventative, personalised and aesthetic medicine. While cosmetic and aesthetic medicine is now become mainstream, there is a progressive, consumer-driven trend for care beyond the skin and appearance to issues of wellbeing, such as stress and pain management, nutrition, weight-management and overall issues of health support as part of skin and age-management. The 2017 conference program feature a series of dynamic, innovate key leaders who have played a significant role in shaping the direction of the industry and pioneering the anti-ageing and personalised medicine movement. Leading local and international experts covered a variety of incredible topics. Many of the speakers stressed the massive increase in inflammation and endocrine disorders as well as immune diseases that have their origins in compromised gut health,
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not just for digestive issues but also for depression, mental health as well as skin disorders. Dr John Tickell discussed the importance of not just life expectancy, but health expectancy. As the average life expectancy is now estimated in the 80s it is important to move into our senior years with quality of life, not just longevity of age. This cannot be achieved without establishing life habits that support good health - good diets and nutrition, movement, adequate sleep, stress management and a positive mindset. He presented some alarming Australian health statistics: Cancer – 400 new diagnosed cases each day, 500 type 2 Diabetes diagnosed cases each day and in terms of overweight, Australian is one of the top six nations in the world for overweight and obesity. Many of us also spend much of our working life sitting down and indoors. Another amazing lecture was presented by Dr Peter Fields, a regenerative and orthopaedic surgeon who spoke on the new and highly effective regenerative approach using Prolotherapy, PRP and Stem Cell therapy to address painful mobility issues such as joints pain due to injury or arthritis, as well hip degeneration.
Prolotherapy utilises a Dextrose solution that is injected into the damage ligament or tendon and stimulates the proliferation of cells assisting the body to heal itself . Platelets PRP therapy can released platelet-derived growth factors creating an exponential increase in cell proliferation that occur as platelet proliferation. This activity contributes to permanent bone repair. Furthermore, stem cells proliferation is the gold standards that completes the healing trinity. It was amazing to see people in wheel-chairs who were able to gain full mobility again and walk without the need for surgery. Gut health protocols of course were discussed by many speakers at length and the important role of gut microbiota as part of the body’s defence mechanism and how deficiencies in appropriate microbiota can contributed to microscopic inflammatory changes that interfere with inhibited nutritional absorption compromising vitamins A, D and E absorption as well as omega 3 essential fatty acids. It was also pointed out that a compromised digestive system contributed up to 85% to irritable bowel syndrome, 50% toward liver sclerosis, 100% toward fibromyalgia, 20-60% of type 2 diabetes and 59% colonic dysfunction. They also discussed how gut dysfunction contributes to neuropsychological disorders as well as skin conditions, such as scleroderma, rosacea and a variety of skin rashes. Several new functional testing were presented to identify a more specific diagnosis, as well as examining the genetic profile was among the strategies discussed. There were also several excellent lectured that covered the importance of working closely with your client/patient through a collab-
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orative, partnership to address appropriate lifestyle changes as well as the imperative of a team effort with other professionals as the most effective approach to achieve the best possible outcomes for patient outcome. Lifestyle changes included stress management, quality sleep, movement and exercise and an appropriate diet to support gut health and nutritional absorption without which the body with suffer from hormonal imbalances and nutritional deficiencies. It was also stressed the role of non-digestible fibre to create prebiotic bacteria and mitigate dysbiotic sugar cravings. While many of these strategies ultimately effect skin health there were also several lectures that were specifically dedicated to aesthetic procedures. These included PRP and Stem Cells therapy, hormone health and the skin, bio-revitalisation: new advances in cosmetic medicine as well new injectable techniques and new advances in thread treatments for lifting and facial shaping. Business was also covered through several lectures including a step-by-step guide to building a content marketing program, how to hire the right people to make your business more profitable and marketing ideas for your practice. I must also mention that Terry Everitt presented a brilliant lecture on Increasing business success: Interfacing with allied health professionals to provide integrative healthcare for better patient outcome. These and many more lectures allowed delegates to gain a wealth of knowledge as well as ready-to-implement strategies enriching client/patient care and treatment outcomes through more advanced approaches and techniques.
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All-in-all an amazing weekend of quality education and serious networking and fun. APJ In 2018 APAN will be exploring way to work more closely with A5M for the benefit of introducing some quality workshops that will enrich our members understanding of wellness through a strategic educational approach.
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PERSONALDEVELOPMENT
IMPROVING QUALITY OF LIFE THROUGH MINDFULNESS By Tina Viney
In the era of information overload we are constantly bombarded with news, images, ideas and opinions, research data, not to mention the on-going marketing and promotional information that our inboxes are loaded with. Additionally, it is not uncommon for us to often be required to multi-task as we juggle the needs of our private life, family and work. Taking time out to relax and regroup our thoughts is so important to our wellbeing and productivity. Mindfulness is a technique that can help us cope better and allow us to mitigate some of the influences of stress, improving our quality of life. As care-givers we can often be caught up with an accumulation of mental and emotional overload. Mindfulness is a very useful technique that is simple to apply and can offer us great benefit. WHAT IS MINDFULNESS? Mindfulness is the basic human ability to be fully present, aware of where we are and what we’re doing, and not overly reactive or overwhelmed by what’s going on around us. While mindfulness is something we all naturally possess, it’s more readily available to us when we practice on a daily basis. Whenever you bring awareness to what you’re directly experiencing via your senses, or to your state of mind via your thoughts and emotions, you’re being mindful. And there’s growing research showing that when you train your brain to be mindful, you’re actually remodelling the physical structure of your brain.
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RESEARCH FINDINGS Extensive research has been conducted to identify the benefits of mindfulness both physiologically and psychologically. Large population-based research studies have indicated that the practice of mindfulness is strongly correlated with greater well-being and perceived health. Studies have also shown that stress and worry contribute to mental illnesses such as depression and anxiety, and that mindfulness-based interventions are effective in the reduction of both rumination and worry. Clinical psychology and psychiatry since the 1970s have developed a number of therapeutic applications based on mindfulness for helping people who are experiencing a variety of psychological conditions. For example, mindfulness practice is being employed to reduce depression symptoms, to reduce stress, anxiety, and in the treatment of drug addiction. The practice of mindfulness also appears to provide numerous therapeutic benefits to people with psychosis, and may also be a preventive strategy to halt the development of mental health problems. Clinical studies have documented both physical and mental health benefits of mindfulness in different patient categories as well as in healthy adults and children. Programs based on Kabat-Zinn’s and similar models have been widely adopted in schools, prisons, hospitals, veterans’ centres, and other environments, and mindfulness programs have been applied for additional outcomes such as for healthy ageing, weight management, athletic performance, for children with
special needs, and as an intervention during the peri-natal period. The necessity for more high-quality research in this field has also been identified – such as the need for more randomised controlled studies, for providing more methodological details in reported studies and for the use of larger sample sizes. HOW MINDFULLNESS CAN BENEFIT YOU Practising mindfulness can help you cope with everyday life and deal with tough times. Here are some different strategies you can use to build mindfulness, plus tips on what to do if you’re finding it hard. When can mindfulness help: * If you have trouble focusing * If you often find yourself worrying or stressed about things * If you want to improve your mental and physical wellbeing.
it happens, which has a really positive impact on your mental and physical health. Simple ways to practise mindfulness You don’t need a guru to be mindful – in fact, you can develop mindfulness during regular activities like walking, driving or even doing something as basic as brushing your teeth. Of course it is also beneficial to take a little time out every day to practice mindfulness as a deliberate relaxation technique. Here are some simple ways to become more mindful: Focus only on the present moment – what is happening for you right now? Is your breathing fast or slow? Are you tired? Are you hungry? How do you feel?
“You can become blind by seeing each day as a similar one. Each day is a different one, each day brings a miracle of its own. It’s just a matter of paying attention to this miracle. ” – Paulo Coelho
Why practise mindfulness? Mindfulness is about focusing on the present and living in the moment. When you practise mindfulness, you don’t dwell on the past or worry about the future. There’s a lot of evidence that mindfulness can help you to: Clear your head and slow down your thoughts Be more aware of yourself, your body and the environment Slow down your nervous system and aid your sleep Concentrate Relax Cope with stress, depression and anxiety. Being mindful helps you enjoy every little moment of life as
Concentrate on what’s happening around you – do you feel hot or cold? What does the air feel like on your face? What sounds can you hear?
Try not to be judgemental about anything you notice – don’t label things as ‘good’ or ‘bad’. Just notice them and let them be. When you’re ready to delve a little deeper into developing your mindfulness, here are some techniques to try. Mindful meditation Mindful meditation involves sitting quietly and focusing on your breathing, or a word, or phrase you repeat quietly. Allow your thoughts to come and go and try not to judge them. When your mind starts to wander, gently lead it back to your breathing or the word or phrase you’ve chosen. You can practise mindful meditation by yourself, or if you want some guidance, there are several apps that you can access
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that can guide you into this practice. Mindful breathing Take a few extra minutes to focus on your breathing. What does your breathing feel like? What happens to the different parts of your body with each breath you take? What does your breathing sound like? Progressive muscle relaxation This relaxation training involves tensing and then relaxing different parts of your body. It can work wonders for stress and anxiety and help you release tension and relax. What if I’m finding it difficult? Becoming more mindful involves training your brain, so, like most things you learn, it can take time. Don’t expect to be able to hold your focus for very long, especially when you’re just getting started. Also it’s completely normal for your thoughts to wander. The goal isn’t to have a totally ‘blank’ mind, it’s more about noticing and gently guiding your mind back when your thoughts do wander. The more you practise mindfulness, the better you’ll become at it. If you’re struggling with a particular strategy, try a different one. Every person is different, and you may find some strategies easier than others. What improvements you can Expect With continud practice of mindfulness you will start to notice overall improvement in various areas of your life. Here are just some: You may feel a greater sense of vitality
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Many of us are self-preoccupied. We go through our lives only partially present to the world because we are so preoccupied with our internal experience. Mindfulness will help you to shift your attention to the world around you, the fresh new world that you are encountering each moment. The details of life may start to come into focus, bringing with them increased joy, engagement and appreciation. You may notice that your relationships are improving. This shift of attention may deepen your appreciation for the relationships you are in and the gifts that you receive through them. You may find that a positive ripple begins running through your relationships as you pay attention in a new way. You may experience practical benefits You may remember exactly where you put your pen and eyeglasses because you were present when you put them down. As you ruminate less and focus more, you may make fewer careless mistakes, work with greater efficiency and enjoy your efforts more fully, both on the job and off. And, you will learn more about the world as you pay attention to what is right in front of you. CONCLUSION Get into the habit of practising mindfulness every day – even if it’s just for a few minutes while you brush your teeth. A good time to set aside is first thing in the morning, or right before bed. Stick to your schedule for a week. I guarantee you will experience some level of both physical and psychological improvement. APJ
TATTOO REMOVAL AND THE SKINIAL METHOD UP until a few years ago, laser treatment was the only way to get rid of tattoos, whether body tattoo or cosmetic tattoo. That is not the only way anymore. We are introducing a more gentle, natural alternative based on lactic acid. Non-Laser tattoo removal methods have been gaining momentum since 2000. Despite this acceleration of development, the market for non-laser tattoo removal is still in its early stages. There are few concepts in the marketplace, most of which don‘t comply with EU legislation. Deanne Carney is the Australia Master, Training Coordinator and Distributor for SKINIAL Australia and New Zealand, the largest worldwide non-laser tattoo removal company. Deanne shares with us the benefits of the SKINIAL method to both consumers and business owners. APJ Question 1 Tell us about your background and why you became involved in SKINIAL After teaching for more than 20 years I decided to change my career path. I trained in Cosmetic and Paramedical tattoo and a few years later opened my own clinic, Skin Deep Cosmetic and Paramedical Tattoo Clinic, in Banora Point, NSW. With the rapid growth of the body tattoo industry I could see that an effective removal method was going to be needed and, as every cosmetic tattoo artist knows, even though there is a place for camouflage, colour correction and shape alteration in what we do, there comes a time when removal is necessary. So I began my search. The products that I found might fade a tattoo but nothing could take the ink out of the body. There were many negatives associated with laser tattoo removal and health implications which, only recently, are becoming more widely understood. I found SKINIAL Non Laser tattoo removal in 2012 and opened Skinial Gold Coast South and Northern NSW in conjunction with my clinic. Now, after 5 years of removing tattoos, I am Training Coordinator, Distributor and SKINIAL Australia and New Zealand Master. I have Master Trainers in several states and there are currently 13 Skinial studios in Australia and New Zealand. Our training is practical based, comprehensive and face to face and we only train experienced aesthetics and medical professionals to add SKINIAL non laser tattoo removal services to their business. APJ Question 2 What are the advantages of using the SKINIAL method for tattoo removal.
Firstly, SKINIAL-Ex is a natural product based on a low concentrate of simple lactic acid, buffered to make it ‘skin-friendly’. Within 30 minutes of a treatment there is no residue left in the body. Laser can be very painful, has an increased risk of scaring, skin damage, destruction of hair follicles and the heat of a laser has been shown to create highly toxic fissions that are then left for the body to remove. And, as I mentioned earlier, other non-laser methods might fade a tattoo but nothing could take the ink out of the body! The method is suitable for every kind of tattoo, but also for correcting or completely removing permanent make-up (PMU) of the eyebrows. PMU removal can be done in just a few sessions and there is almost no risk, or side effects such as scarring. PMU on the lips can be removed, above the lip vermillion. Eyeliner cannot be removed with this method, because of the close proximity to the eye. It poses too much of a risk. Layered tattoos (“cover ups”) can also be treated without problems. This is practically impossible with a laser. So, every colour without exception, all kinds of ink, even those which are may have toxic ingredients can be removed safely with SKINIAL. There is less risk of scarring compared to other methods because we only work in the epidermis and once an area is treated there is no need for a repeat treatment. APJ Question 3 Does the lactic acid used carry any risks? The “patch test” is always part of the pre-treatment discussion. We always provide patients with thorough information and go through their medical history and check for contraindications. The lactic acid used is a low concentrate of simple lactic acid, buffered to make it ‘skin-friendly’. It does not harm the skin. It is the chemical equivalent of the lactic acid, produced by our bodies. It turns into lactate after being used, which in turn is converted to glucose by the human body and is used by cells as adenosine triphosphate (ATP) for energy management. This means there is no residue left in the body. APJ Question 4 How does the method work? 1. A cartridge micro pigmentation device is used to roughen the epidermis to allow the removal laid to be massaged in. 2. This allows the removal liquid to seep into the dermis to where the ink has been implanted. 3. As soon as the macrophages come into contact with the liquid, they release the ink molecules. The ink molecules are identified as foreign bodies and are ejected. 4. A crust holding the ink quickly forms and, as healing occurs underneath, falls off taking the ink with it. 5. A new skin, free of ink, forms underneath.
APJ
IF YOU ARE INTERESTED IN FURTHER INFORMATION ABOUT TRAINING OR THE BENEFITS OF INTRODUCING SKINIAL TO YOUR BUSINESS, PLEASE CONTACT DEANNE EMAIL: australia@skinial.com PHONE: +61 423 621764 WEBSITE: au.skinial.com
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APANCONFERENCE
WRAPPING UP A FUN DAY OF EDUCATION
we are employees, sole practitioners of large business owners. Her lecture covered an updated definition of beauty services, dermal and aesthetic therapies and cosmetic medicine – the focus of each category and how we are moving more toward specialisation and this driven by the ever-demanding consumers.
ANOTHER glorious day in the middle of winter saw the 2nd APAN Aesthetics Conference held at the amazing Stamford Plaza in Brisbane July 30th 2017. APAN Conferences provide industry professionals with updates that cover a diverse range of topics including science, regulations, industry updates, business and consumer trends
Tina also presented key take-home messages from the ASAPS conference, which took place just a month earlier on the Gold Coast. ASAP this year combined four Societies:
We were delighted to welcome Associate Professor Derek Richard, who spoke on the amazing new advances in epigenetics the new frontier in health and skincare. Derek is the Scientific Director, Cancer and Ageing Research Program at Queensland University of Technology. He is also part of the CARP program team (Cancer and Ageing Research Program). In his lecture he presented new advances in epigenetics that are creating breakthroughs not only in providing solutions for cancer prevention, but also in innovative solutions for a new breed of skincare that can offer greater anti-ageing benefits. This lecture uncovered some exciting new advances that we can look forward to. Derek also invited APAN to organise a group of delegates to visit the amazing research laboratories at QUT as a field trip to gain greater insight into the incredible CARP program.
2. Cosmetic Physicians College of Australasia (CPCA)
Tina Viney stressed the importance of embracing transformation and not remaining static, regardless as to whether
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1.The Australasian geons (ASAPS)
Society
of
Aesthetic
Plastic
Sur-
3. Australasian Society of Cosmetic Dermatologists (ASCD) 4. New Zealand Society of Cosmetic Medicine (NZSCM) This collaborative effort delivered an incredible amount of information and due to the ASCD there was a great deal of valuable educational information on innovative skin treatments as well as other modalities, that are covered in the ASAPS conference report in this journal. Facing the future, Tina mentioned APAN’s current plans to also work more collaboratively with other Societies that can allow the industry to embrace new modalities and move forward with greater support and ease. Caroline Nelson’s lecture Reboot for Profit was one of the best
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she has ever presented. Being methodically systematic, Caroline stressed the importance of knowing your purpose and where you want to go and then establishing an appropriate workable plan that you and your whole team can implement to bring about the desired business growth. She addressed effective ways of engaging media tools to bring out the results you a looking for in a more cost-effective manner. She discussed time management techniques and the necessary systems and processes to support your goals. Following Caroline, Gay Wardle addressed the important topic of Hormones and the Skin and how the activity of the endocrine system, when it is out of balance, can adversely affect your treatment results and sabotage your clients expected treatments outcomes. Gay clarified how to identify dysfunction within the endocrine system and why it is important to understand these and address them appropriately if you are achieve the new level of treatment results that your clients are now expecting. She also discussed treatment options and solutions. Chris Testa spoke on Topical Anaesthetics – Education, Qualifications and Regulations. His lecture covered an update on the regulatory position and why it is important for the industry to support and commit to educational programs that will allow them to be recognised by government bodies as a committed and responsible professionals who, while taking on more advanced procedures, are also updating their education as part of their duty-of-care to their profession and their clients. Chris clarified areas of concern and the risk that topical anaesthetics pose if used incorrectly.
Our last speaker was Naturopath Miesha Marie, but due to a sudden health issue was not able to attend. As a result we were delighted to welcome a multi-award winner, Public Relations expert Annette Densham of Publicity Genie who presented a compelling and engaging lecture on how to grow your influence and business through free publicity opportunities. The overall feedback was very positive and over 95 per cent of delegates requested that some of these topics be made available to them through full-day workshops. As a result APAN is planning a more comprehensive educational program in 2018 that will help support industry demand and empower businesses and their staff to grow their skills and knowledge as well as their competitive advantage. APJ Expect new positive changes from APAN in 2018. If you currently are not a member and wish to be first to benefit from these program, while securing your members discount please join our community of practice and be part of the most dynamic industry advances. Visit www. apanetwork.com today and download a membership application form. It will be well-worth the benefits you will receive.
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STARPERFORMER
Innovation for Superior, Consistent Results
CLAIRDERM MEDICAL AESTHETICS THERE IS no doubt that today’s consumers are looking for better and more advanced results when it comes to their skin and body care. Body-image consciousness has become mainstream and is driving consumers insatiable need for non-surgical treatment options like microdermabrasion and LED phototherapy to address premature ageing and other concerns. ADVANCED, RELIABLE TECHNOLOGIES AND A COMPETITIVE TREATMENT MENU CREATE A COMPETITIVE EDGE Now more than ever before if aesthetics professionals want to retain their competitive position in the market it’s paramount that they rely on advanced and reliable technologies that deliver the expected consumer outcomes and constantly re-examine their services and treatment offerings against their competition. EQUIPMENT DESIGN ENSURES EASE OF USE AND OPTIMAL PERFORMANCE The Australian company, Clairderm Medical Aesthetics, has over 20 years’ experience manufacturing and supplying Proudly Australian made non-surgical aesthetic, medical and beauty equipment. Not only does the equipment use state-of-the-art technologies, but specific consideration has also been given to design features for ease of use. Clairderm Medical equipment offers advanced ergonomic features that enables them to be moved easily from room to room, while ensuring ease of use by the practitioner. The slimline compact designs ensure they take up minimal space and can fit virtually anywhere. They are also designed compatible both for right and left-hand use thus offering appropriate flexibility to the practitioner. These design-features make a huge difference to the equipment’s ease-ofuse and performance.
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INNOVATION FOR SUPERIOR AND CONSISTENT RESULTS Ongoing research and development ensures that Clairderm Medical Aesthetics keeps Australian salons at the forefront of aesthetic treatments. The company is committed to driving business success and clinics can rely on it to provide them with equipment that uses the most advanced and reliable technologies that deliver the best consumer outcomes consistently. Clairderm Medical Aesthetics are expert innovators of LED phototherapy equipment. PhotonSmart, the most versatile and advanced LED phototherapy system for aesthetic and medical applications, was their first innovation. PhotonLite is their latest innovation in LED phototherapy. Driven by the need for a smaller, more compact and affordable LED machine that focuses on aesthetic treatment outcomes. PhotonLite combines two technologies in one system -- LED phototherapy and diamond microdermabrasion. This makes it the professional choice for non-surgical skin rejuvenation with the added benefit of reliable skin improvement. PhotonLite is packed with features: 3 colours,12 builtin-programs, highly adjustable head, 2-year warranty, user friendly, compact, lightweight and powerful. Outstanding results can be achieved when treating age spots, photo-ageing acne, skin texture, scars, fine lines and wrinkles with no recovery time. Clinics can also offer a profitable and comprehensive treatment menu of single or combination treatments that are safe and painless. APJ
To view Clairderm Medical Aesthetics comprehensive range of equipment and skin care visit www.medicalbeautyequipment.com or contact us on 1300 781 239 or office@clairderm.com
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Where luxury meets science for outstanding results The new Timeless Prodigy line from SKEYNDOR features home care of The Serum and The Cream and a professional Facial treatment that is a serene ritual and a journey of pure indulgence. Timeless Prodigy merges all the components …. extravagant and sensory elements, rare, exotic and active ingredients. In addition, its formula features multi-genic action to reduce the ageing aspects of skin cells. RESULTS TO BE PROUD OF This next generation line answers the ‘passage of time challenge’by restoring a youthful genetic profile and regulating the specific genes connected with cellular ageing, offering: 100% rejuvenated skin appearance 100% softening in wrinkling 91% improvement in state and appearance of the skin and, 90% improvement in tone and radiance The 90-minute Timeless Prodigy Facial Ritual taps into the extraordinary, using 25 concentrated and noteworthy ingredients and three (3) specific rejuvenation processes: Cell Genesis Activators of Damask Rose Stem Cells to boost cell numbers and volume, Cell Quality Perfectors such as White Truffle Extracts to protect cell integrity, address skin firmness and vitality and Cell Functionality Enhancers such as Kombucha Tea to promote cell activity and brighten the complexion. It also combines ultra-sophisticated and lavish aromas from the Rose family with the top notes of Bergamot and Wild Raspberry, the exquisite hues of Jasmine and Magnolia and the alluring touches of Patchouli, all set in a base of Amber and Musk. This luxurious journey of relaxation and science, includes Thai and Shiatsu massage and Chakra balancing techniques, the benefits of lymphatic drainage, the lush elixir of Damask Rose Stem cells and the finishing touches of rich White Truffle Cream. To encourage well-being, deep, deep relaxation and dissolve stress, the Timeless Prodigy ritual begins with a welcome massage and energy balancing techniques to soothe ruffled spirits, nurture tense neck and shoulder muscles and comfort hands and feet. After a thorough face and neck cleansing, a Champagne Jelly charged with anti-oxidants is applied and a lymphatic drainage massage follows to detox and purify. The skin is then swathed in the Damask Rose Stem Cell Concentrate, a revitalizing, regenerating and exceptionally hydrating Gel to target and reduce the effects of ageing. It follows with the 3D Collagen Mask to firm and tone and
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kick-start collagen production. To complete the journey, the skin drinks in the benefits of the buttery and rich White Truffle Cream that has the power to stimulate youthful genes while it re-densifies, intensely moisturizes and offers radiance and a new energy to tired, listless skin. More than a facial, the Timeless Prodigy Ritual not only focuses on significantly reducing the passing of time but also brings in the elements of indulgence, stress relief and relaxation. While it targets ageing, every skin can benefit with results far beyond expectations. The Serum is the ultimate in texture with an unexpected sensory experience. Light, airy and velvety, it features a concentrated formula of 15 powerful and active ingredients, including Piedmont White Truffle and the revitalising power of 50 million Damask Rose Stem Cells for an exceptional rejuvenating effect, micro-collagen bio-actives, A, B and C Vitamins and Tea Kombucha. Available in 30ml. The Cream is rich and lush that melts in for a ‘second skin’ effect. Enhancing DNA repair, protecting and delaying the ageing process, it contains the jewel in the crown: 50 million Damask Rose Stem Cells, the legendary Piedmont White Truffle for its highly prized anti-oxidant power, trace elements and Amino Acids for complete and absolute care of the skin. Available in 50ml. APJ For more information on the Avant garde Timeless Prodigy and the future in skincare, please email info@ vogueimage.com.au, call 1 800 554 545 or visit www. vogueimage.com.au.
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Tips for Better Business
Business & Legislation, New Tools and Research Outcome Deputy Chair Dr Michael Schaper said. “Our message to business is that you are not allowed to add on any of your own internal costs when calculating what surcharge you will charge customers. The only costs businesses can include are external costs charged to you by your financial provider.” If businesses want to set a single surcharge across multiple payment methods, the surcharge must be set at the level of the lowest cost method, not an average. For example, if a business’s cost of acceptance for Visa Debit is 1 per cent, for Visa Credit is 1.5 per cent, and for American Express is 2.5 per cent, the single surcharge would be 1 per cent as that is the lowest of all payment methods.
EXCESSIVE PAYMENT SURCHARGE BAN As of the 31st August every business across Australia will be banned from charging customers excessive surcharges for using certain types of EFTPOS, Mastercard, Visa and American Express cards to make payments. The excessive surcharging ban has applied to large businesses since September last year and now extends to all businesses that are either based in Australia or use an Australian bank. The ban does not affect businesses that choose not to apply a surcharge to payments. The ban restricts the amount a business can charge customers for using an EFTPOS (debit and prepaid), MasterCard (credit, debit and prepaid), Visa (credit, debit and prepaid) and American Express cards issued by Australian banks. “The good news for consumers is that businesses can now only surcharge what it actually costs them to process card payments, including bank fees and terminal costs. For example, if a business’s cost of acceptance for Visa Credit is 1.5 per cent, consumers can only be charged a surcharge of 1.5 per cent on payments made using a Visa credit card,” ACCC
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“Our advice for businesses wanting to set a single surcharge regardless of the type of card their customers use is it must be the lowest of all the payment methods. You can’t use an average of all payment methods or you will land yourself in trouble,” Dr Schaper said. Businesses should have received merchant statements from their financial institutions in July setting out their cost of acceptance for each payment method. The RBA indicated as a guide that the costs to merchants of accepting payment by debit cards is in the order of 0.5 per cent, by credit card 1-1.5 per cent and for American Express cards around 2-3 per cent. The ACCC has found that some merchants have incurred higher costs than these but any surcharge level imposed by merchants cannot be higher than the costs incurred by them for accepting that payment method. “If businesses are unsure about their cost of acceptance, they should contact their financial institutions,” Dr Schaper said. The ACCC has been given new powers to enforce the ban. A surcharge will be considered excessive where it exceeds the permitted cost of acceptance, as defined by the Reserve Bank of Australia.
The RBA’s website also provides detailed inforamation for businesses about the Standard, including how businesses can identify and quantify those costs that can be passed on to a consumer as a surcharge.
Another valuable exercise is to belong to a mastermind group with other fellow women service business owners to get together over a conference line and discuss problems and solutions.
Payment types that are not covered by the ban include BPAY, PayPal, Diners Club cards, American Express cards issued directly by American Express, cash and cheques.
While many busy business owner agreed that it is tough to find time to network, but getting better at networking and making contact can pay dividends in the future.
Running a business can often be daunting and to achieve success can sometimes require commitment in specific
2. Be Very Specific With Your Goals One valuable strategy on achieving a daunting goal is to break a big goals into smaller ones. It is also wise to have long and short-term goals - 10 year ultimate goals, three year goals and one year goals, as well as quarterly goals for your business. When it comes to financials, break them up into smaller numbers. For example if you want to achieve a say $10,000 monthly revenue increase, break that down in how this can be achieve. What weekly activities will need to be achieved to reach this target. Make sure that each employee has dashboard with their goals that shows their progress, then it’s easier to determine how to achieve it. These kind of realistic goals drive your actions. Building a performance-driven culture all starts with being very specific about goals- for yourself and your employees.
SEVEN TIPS FROM SUCCESSFUL SMALL BUSINESS OWNERS areas. Here are seven tips from several successful small business owners that are worth paying attention to. Many long-time small business owners would agree with the line from the 1970s song by the band Faces: “I wish that I knew what I know now.” Over years of running a small business, owners inevitably gather many lessons about how to grow and run a business more effectively. Thankfully, many of these owners are more than happy to share their insights. Here are seven tips from several successful small business owners that are worth paying attention to: 1. Build a Support Network For many small business owners, can be an isolating experience at times, especially if you’re a solo business owner, you can lose touch with other business owners. Many businesses that have overcome challenges have confirmed that the crucial solution is to stay networked in the larger business community. That means meeting with a personal business coach or an industry consultant for an hour on a regular basis. The objective is to locate an expert who can help you find solutions to problems and work through tough decisions with your business. Taking time out even just one hour a day to remove yourself from the activity of the business and look down on it really helped you see the problems that were bothering you. Many business owners indicated that in just one hour you can walk away with clarity and an action plan to move forward.
3. Delegate Whenever Possible Do what you are good at and delegate the rest to others. Here is an example. When the Marks Group, a technology consultancy, started in 1994, it was just Gene Marks and his dad. “He was doing sales and I was doing service,” Marks recalls. Then his dad died. “When he passed away, I took it over and realised I couldn’t do it all, and hired some new employees. I’ve learned that you can make a lot more money when you have other people doing it for you.” As he hired more people, it dawned on Marks that he had been doing work that he was pretty bad at doing. The revenue of the business soared as he brought on new people because he was hiring people who were better than him at certain jobs. “I just sort of learned the hard way: focus on what you do best, and delegate the rest.” 4. Keep Your Overhead Low Keep tabs of costs and identify ways that you can better manage your overheads. Buy bulk, negotiate periodic payments with your supplier, going buying groups that can get you a better deal. Cutting down on overheads can give you peace of mind especially when times are touch. 5. Find Your Best Niche--Stick With It Trying to do too much too soon? Feel like you need to be all things to all clients? Maybe diversifying in too many areas isn’t always the best strategy. Maybe it’s time to let some services go and put your energies in the services that are not labour intensive without sales potential. Concentrate on what can help the business grow best without the extra stress of having to be all things to all people. If it means you need to evolve as a specialist and the demand is there, take that option. Finding your niche and continually innovating around that niche is a path to success.
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6. Keep Your Day Job Just a Little Longer It is a common trap: Many practitioners want to step out and establish their own business. However, if the funds aren’t there it may pay to remain as an employee for a couple more years until you can save and start with sufficient funds behind you.
those who appear to “get things done” and fail to recognise that the problem re-manifests because systemic issues lying beneath the surface have not been addressed. If you’re intent on solving a problem, opportunities may well arise but for the moment, you need to exercise scrutiny and caution. What can you do?
Setting up a business is a huge undertaking, and while there is a wonderful romantic notion to doing that, there are also risks. Calculate those carefully before stepping out.
Identify and clarify the issue or problem Be clear what the problem actually is. In The Power of Self Discipline, Brian Tracy suggests taking time to identify the true nature of a problem rather than leaping to conclusions. If you don’t get to the root of the problem, he says, it reappears in different forms later. For example, when dealing with staff, an attitude problem may stem from problems at home or gossip that circulate within the staff. If you do not identify the route of the problem and address it you will only be caught up with the symptoms.
7. Avoid Distractions at All Costs Mary was excited in purchasing a salon from her boss. She spent the first six month improving the culture and making changes that best reflected her own values and the niche she wanted to the business to be servicing. While on a high about these changes, an opportunity arose to purchase another salon at a very good price not far away, so Mary decided to purchase the salon and duplicate the same standards. However, she soon realised that it was really stretching her. It became very clear to her that successful entrepreneurs don’t do the minimum on their company, they constantly work to grow it, evolve it, and prepare it for the future. Undertaking a second venture so close to the first one was challenging because she soon realised that it also required 100 per cent attention, focus and effort. Avoiding distractions applies not just to external issue but also completing internal tasks. It is important to evaluate your energy levels. If they are best in the morning, complete the most challenging tasks first and get them out of the way. Keeping yourself organised and on-task is the real key to small business success.
Understand and respect all stakeholder interests Involve the relevant parties or stakeholders, and seek their input, making it clear that solutions don’t necessarily rest with you alone. Some will also challenge the way you’ve defined the problem and this can be very useful. There is always more than a single definition of the problem. If there is staff unrest, it is good to have a meeting and allow everyone to have input in finding a solution. Teamwork is not just for achieving outcomes, the team can also contribute to ensuring a harmonious relationship within the workplace. Determine your path and set your deadline It may be one or more options — that is, make a decision or at least set a deadline for how you will go about tackling the problem. Sometimes you won’t be able to wait for a perfect solution to the problem, in which case you’re better off proceeding with what’s doable, and breaking the scale of the problem down as you go. Document specific plans Describe the course of action and those involved. Assign responsibilities for tackling the problem — it shouldn’t be down to you alone (some problems are very knotty, and self-empowerment mantras won’t necessarily kick goals for you).
THE MOST SUCCESSFUL WAYS TO SOLVE PROBLEMS
Know the back-up plan Things don’t always work despite our good intention, so have a back-up plan. If you approach to a solution is not working consider your options. If it didn’t work, you need to be clear about what parts worked and why and what didn’t work. For example, if you have a staff issue pertaining to attitude, you will be required to have a private meeting with the staff member to investigate the matter further and allow them to explain. While you may give them every opportunity to comply with the necessary standards of conduct, you will need to determine if there is no breakthrough, whether the next step is a redundancy.
Problems are life’s ingenious habit of tossing a curly one in our path, just when things are going smoothly or when they couldn’t be worse. If you are a salon or clinic owner you would be well aware that if problems are not solved they will escalate to often devastating proportions. In business, people often adopt a very black and white approach to solving problems; too often, business rewards
Go back to step one if solution did not succeed The above is a useful method of nutting out issues as they arise, but as everyone knows, a series of problems has the potential to overwhelm. Here’s where a valuable psychological insight comes to the fore. According to many experts a leader must never view a problem as a distraction, but rather as a strategic enabler for continuous improvement.
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Handled issues that arise with maturity, accountability and courage, problem-solving becomes a seamless process for people and their organisations to grow. HERE ARE THREE STEPS FOR TRANSFORMING A PROBLEM TO A LONGER-LASTING SOLUTION:
STUCK FOR A LEADERSHIP COACH? HOW TO FIND SOMEONE YOU TRUST TO HELP GROW YOUR BUSINESS
1. Encourage transparent communication. Leaders need to encourage people to speak freely and feel they can do so without losing their jobs. Very often problem-solvers are the quiet doers in organisations, who may be unable to get their teeth into solving a dilemma because there’s a grandstanding meerkat nearby who believes that the only brains in the room belong to him/her. The meerkat could be their manager, and therefore people remain silent about the true causes of a problem. Leaders can override this by inviting all input, making it clear that everyone will be listened to and their participation valued.
Sometimes when you are too involved as a practitioner in running your business it becomes very challenging to put on the switch and view the business from a management, or entrepreneurial point of view. This is when gaining external expert advice is often very valuable in helping you identify lost opportunities and ways of optimising your business profitability.
2. Understand the power of open minds. Open-minded people drive innovation and are willing to take risks whereas those with closed minds turn things around to make it more about themselves. When you’re next confronted with a problem, see where the open and closed minds reside within your organisation. Clue: the closed minds will often create chaos to disguise their inefficiencies, thereby slowing down the process of getting problems solved.
What do you want, and what do they have? Two of the most common forms of professional development relationships are mentorships and business coaching, and while these formats are very different, business owners need to think carefully about compatibility issues with both these areas before they agree to any guidance.
3. Develop a solid strategy. Effective problem solvers don’t shoot from the hip. They know how to gather the right people, resources, budget and draw on their past experience. They perceive opportunities, but plan carefully and with input from others. They have a good idea of where they want to get to, can spot the nuances between different situations and personalities, and map realistically to reach their destination. Every business has to face challenges, however successful problem solvers learn from experience and develop a love of solving problems rather than letting them overpower them. Often through challenges and pain we experience growth, change and innovation. Choose to make it a positive experience.
Here are some key questions experts say you should ask before agreeing to entrust your business to someone who says they can help push your business further.
So what is the difference between a mentor and a coach? Mentors are usually experts that have rich experiences in the area of business that you may have a need in. Often mentors can be accessed in an informal basis e.g. someone you have met at a business meeting that you choose to meet up from time-to-time for coffee and to chat and exchange or brainstorm ideas. They are valuable in helping you conceptualise a potential idea or direction. A mentorship can be formal or informal, but it is not usually a paid-for service, while business coaches ask for a fee to guide you through challenges. There are guidelines on how to identify a good fit with your coach, however, it is imperative that from the outset you know exactly what you want to achieve out of this relationship. Map out what areas you are struggling with and that you would like to achieve breakthroughs. These are often identified through a business needs analysis, which your coach will ask you to complete, however, it is useful to personally determine your needs prior to even selecting the right coach. When choosing a coach consider the following: 1. What training do they have? 2. Do they have any knowledge or experience specific to your industry that will best fit your business? Do they actually understand your industry? 3. Can they give you any referrals of people who have benefited from their coaching that you could contact and get some feedback from their experience? 4. Are they good listeners who can connect with where you are at, or do they just want to steer you in the direction of a formula strategy that may and may not be the right fit for you? A good professional coach should offer excellent advice and strategies, as well as have the ability
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to be a good listener. Research also confirms that good listeners that support you to start talking through things are a great asset. This exchange helps you gain clarity with your own ideas and you’re are able to develop your own thinking. They are like a mirror that allows you to get a sense of how valid your ideas are. Finding the relationship that will be a good fit can be critical for business owners to stay focused on growth, while allowing the coach to also be a good sounding board to fine-tune goals and boost confidence. Be prepared to do the work Many business owners approach a coach with the notion “I have a problems, solve it for me”. However, most coached will steer you in the right direction, but you must be prepared to do your homework on how the principles and strategies they present to you will unfold in your business environment, and this part you will have to do. A successful coach will give you the tools to change the way you think. They will guide you to gain the skills you need to steer your business towards growth. It is important to note that they are not your employee that will be doing all the work - their aim is to help you gain the necessary skills to solve your own problems and become the competent leader and manager of your business. For this you should be prepared to put time aside to work on the business and not just in it. Coaching should be viewed as a “skills development process”. Once you’ve identified your needs, start to view the coaching process as one that you will have to complement with your own actions. It is also important to note that effective coaching sessions often require that you work together with your coach for six to eight months. In this process you will learn how to both think differently and what strategies you will need to implement so that the business can move forward with greater clarity, direction and profitability.
There are many costs associated with starting a business. Up until July 1, 2015 certain costs paid by business owners could never be claimed as a tax deduction, and were labelled black hole expenditure. As a general taxation rule capital costs of purchasing an income-producing asset are not tax-deductible, apart from those costs that the tax legislation allows to be written off over a number of years, while costs associated with maintaining and running a business are tax-deductible. Not all costs of starting a business are deductible. This principle of costs associated with starting a business not being deductible applies not only to when a business is purchased, but it also applies when a qualification must be obtained to allow a person to go into business. Examples of this are a degree required by a doctor before commencing in medical practice, and a trade qualification required by an electrician to start a contracting business. Here are some common questions with new business owners: Question: I have started a small business as a sole trader as a beauty therapist after having completed a course that lasted 12 months, and then qualifying in February 2017. I have an ABN and began charging clients after registering my ABN. I paid for all my start-up costs of approximately $3500 in February and March 2016, which included the cost of the training course and course materials. Can I claim the costs incurred in the 2016 tax year against my 2017 income? ANSWER: Your question raises a number of points with regard to the deduction of business expenses, and the ability to deduct a loss from other income earned. The costs of you completing your beauty therapy diploma are a capital cost of you obtaining a qualification, that enabled you to start the business, and are not tax-deductible. The only start-up costs that are deductible, as a result of the black hole expenditure legislation being passed and applying from July 1, 2015, are expenses associated with obtaining professional advice from lawyers, accountants, associations membership about starting a new business. An immediate tax deduction can also be claimed for government fees, such as those charged by ASIC, that are included in the formation of a business structure such as a company or discretionary trust. Other costs associated with establishing a business, which includes borrowing fees and other costs associated with setting up the business structure, which are not government fees, can be claimed as a tax deduction over a five-year period.
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If your deductible business start-up costs and the running costs since commencing your business in February 2017, are greater than your beauty therapy treatment income, the loss may be deductible against other income you earned in the 2017 financial year. To do this you will need to pass the business turnover test
of $20,000. This test requires a business to have an annual turnover of at least $20,000 to offset losses against other income earned. As you were operating from February 2017 your business income for those five months would have needed to be at least $8333.
While salons my consider department stores as competitors, this trend heralds a return to the “try and buy” purchasing style, which is good news for all cosmetic stockists including salons and clinics. BEST BUSINESS CONDITIONS IN A DECADE, NAB MONTHLY SURVEY SHOWS Business conditions have reached their highest level in a decade while consumer confidence stagnates, highlighting the widening gulf between the profit prospects of business and workers struggling with low wage growth. The National Australia Bank monthly business survey of more than 400 business released last month found conditions had risen by one point in June to their highest level since early 2008.
IN-STORE COSMETIC PURCHASES BACK IN FAVOUR WITH CONSUMERS While on-line purchases have causes a lot of face-to-face businesses grief, a new consumer trends is raising hopes again that consumers are happy to visit stores again for their cosmetic purchases. It has been dubbed lipstick wars in the past, but now the retail landlords are embracing the cosmetics sector as one of the most favoured tenant in their malls. While beauty and cosmetics are sought-after online, the stores, such as Sephora and Mecca Cosmetica, have successfully breached the barriers between the internet and bricks and mortar as their shops offer an experience. In the latest results for the retail landlords, cosmetics was one of the best performers in terms of sales. As a result, as apparel brands close or look for smaller premises, the cosmetic retailers are moving in. Sephora will open its 11th Australian store in Westfield Bondi Junction, which adds to Sydney’s five stores in Pitt Street Mall, Broadway, Macquarie, Warringah, Macarthur Square and the soon to open Charlestown in the Hunter Valley location. It launched in Australia in 2014 and is owned by LVMH. Libby Amelia, the Sephora Australia country manager, said it’s been a big year for Sephora Australia, and there’s no sign of the brand slowing down.
Reserve Bank holds cash rate For the eleventh consecutive month, the RBA keeps the cash rate on hold at 1.5 per cent. “We remain apprehensive about how the disconnect between the business and consumer sectors will be resolved, especially in light of sluggish retail conditions in July,” NAB group chief economist Alan Oster said. “Additionally, the hurdles to growth, elevated underemployment, household debt and housing construction remain firmly in place.” The improvements were driven primarily by professional services, after retail and wholesale softened on the back of difficulties facing households. Labour costs growth eased in July to 0.6 per cent, while the bank found Australia could expect an extra 240,000 jobs over the next year, or 20,000 a month, which would edge the unemployment rate below the current 5.6 per cent. Job advertisements rose for the fifth straight month to 178,000 ads, a six-year high and an increase of 12.8 per cent on this time last year. Job ads can be a good indicator of business activity, with employers looking to hire only if they expect strong results in the months ahead. “The situation is akin to economic nirvana - solid business conditions but with few signs of inflation emerging,” CommSec chief economist Craig James said. APJ
“On August 21 we launched a new Wellness category on Sephora.com.au, and Westfield Bondi Junction will be one of our first retail locations to house the new in-store hub, really completing the loop on our omni-channel offering,” Ms Amelia said. “With brands like KORA Organics, The Beauty Chef and WelleCo, alongside luxe haircare brand Ouai and natural efficacious skincare like Peter Thomas Roth and Ole Henriksen, we are bringing Bondi the best in beauty, from the inside out.” Westfield regional manager, Scott Moore, said Bondi Junction customers seek the best of international and Australian brands and “we’re thrilled to welcome Sephora to Westfield Bondi Junction”.
The Reserve Bank said last week it expected growth to revive and held interest rates steady at 1.5 per cent.
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MEMBERPROFILE
A Hidden Country Gem THEY say that valuable gems are often found hidden in remote, or distant locations such as within the earth, or pearls found in the depths of the sea. However, we have located an amazing human gem by the name of Claire Martinez. Claire is one of our recent members and is a medical cosmetic tattooist located in the beautiful country town Traralgon. For those who are not familiar with Traralgon, it is located in the east of the Latrobe Valley in the Gippsland region of Victoria. Traralgon is the largest and fastest-growing town in the greater Latrobe Valley urban region, which has a population of more than 75,000 and is administered by the City of Latrobe. It is believed that the origin of the name Traralgon is derived from words from the Gunai language: tarra meaning “river” and algon meaning “little fish”. Clair is an amazing, passionate professional who is making her mark in the region as a reputable and committed cosmetic tattooist who is renowned for her compassion and her love for helping others through her incredible skills in the art and science of cosmetic tattooing and medical cosmetic tattooing. We are delighted to share her story with you. APJ Q1: Claire, can you share with us a few highlights of your professional journey and how you got started in this industry?
Rennison at the Melbourne Institute of Plastic Surgery and Sydney Cosmetic Tattooing Australia with Val Glover Hovan. From the beginning my theory, technique and style in cosmetic tattooing is to replace what has been lost due to sun exposure, hormones, trauma or ageing by creating definition, balance and natural beauty. I have instilled in my clients, that my work isn’t makeup, or more importantly cosmetic tattooing, it is primarily about replenishing the their beauty. A highlight in my career has been becoming a member of the American Society of Permanent Cosmetic Professionals (since 2012); The Association of Cosmetic Tattooing Australia and APAN. I continue to improve my skills and knowledge with ongoing training and attendance at conferences in the USA and Europe. The training I have experienced and networking with some of the best practitioners in the world has been life changing. I highly recommend to all cosmetic tattooing practitioners that they should join industry bodies and societies to ensure they are having an opportunity to meet with peers, share experiences and set the highest standards in our profession. APJ Q2: What prompted you to specialise in Cosmetic Tattoo and in fact in a specialised area of cosmetic tattooing?
From early childhood I knew I wanted to help people with their skin and confidence. The combination of skin, science and art was my calling. I commenced my studies of Beauty Therapy in 2004, and I instantly felt I had found my passion. I went on to learn Advanced Therapies and became a Laser Technician in 2010.
Paramedical tattooing is a practice where colour theory, pigment manufacturing, medications, anatomy, anaesthetics, blood bound pathogen, cross contamination, facial and body architecture and specialist application techniques, all need to be considered when practising the art of cosmetic tattooing and this is the reason I was drawn to specialise in this modality.
I began my career as a cosmetic tattoo practitioner in 2012, studying Cosmetic and Paramedical Tattooing with Suzanne
Throughout my time as a beauty therapist (7 years) I was especially interested in my clients’ skin concerns and I found
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that I was often ‘covering’, or preventing areas of concern but, I was unable to address all concerns. I then started to think of ways I could use my skills in a more holistic and permanent way. I must admit I wasn’t a fan of cosmetic tattooing at the beginning, however, my mum (and biggest supporter) had her brows tattooed by an amazing cosmetic tattoo specialist in Melbourne (Suzanne Rennison) and it was when I saw her work that I realised the world of cosmetic tattooing had advanced dramatically and natural enhancements where achievable. Contracting to six state-of-the-art clinics spread all over Victoria, gives me the opportunity to always be informed and educated of what’s happening in our industry. I work alongside award-winning advanced aesthetic nurses at Gippsland Laser Clinic (Warragul), passionate, highly trained dermal clinicians and beauty therapists with over 30 years experience at Skin Sense Dermal Clinic (Traralgon) and Jools for Jim (Bendigo), exceptional medical staff at Pakenham Medical Astra Clinic, leading plastic surgeons at Body Recon in Geelong and Melbourne. Surrounded by these remarkable people, has given me an abundance of knowledge and allowed me to fully dedicate my career to Cosmetic and Paramedical Tattooing and at times return to my origins in the beauty therapy field. APJ Q3: Share with us your experience in working collaboratively with medical practitioners and what are their key considerations in ensuring the success of such a venture? I especially love helping both men and women with scars, skin abnormalities and cancer survivors. Seeing these clients confidence grow through a cosmetic tattoo procedure is my biggest reward. Paramedical cosmetic tattooing is an alternative method of creating a realistic looking areola, nipple, or camouflaging trauma-related injuries. I have preformed camouflage treatments on scars caused by self harming, hair simulation due to a cherry angioma rupturing and replaced mastectomy client’s nipple areola with the illusions and enhancements created by cosmetic and paramedical cosmetic tattooing procedures are endless.
Working alongside leading plastic surgeons has given me the opportunity to perform life-changing results for clients. Balance is the key, not only for the face, but the body as well. Being recognised for what I can achieve artistically by leading medical professionals is very satisfying and allows me to work collaboratively in the medical world. I would have never thought this possible, coming from such humble beginnings in country Victoria. I have found that the key to a successful relationship with medical practitioners is open communication, being clear about what the client’s requests and requirements are, respecting each other’s skills and knowledge and working together to ensure the client feels supported throughout the entirety of their treatment. APJ Q4: You obviously love your work, can you share with us an experience you have had with a client/patient that made you feel content and proud in assisting another valuable human being? This is my favourite question: at the end of every day, even if it is 15-hours long , I think about all the individual people I have meet and the positive impact they have had on me. I learn something new from every client that comes to visit me. I don’t see what I do as work - it’s my passion and keeping educated drives me and the results keep me striving for even more improvement in this ever growing industry. Of course, the cosmetic side of cosmetic tattooing is very rewarding too, replacing somebody’s brows with either simulating the appearance of ultra fine hair strokes, performing a powdered ombre appearance under the brow hairs or even creating the illusion of fuller eye lashes with a pigment blend placed in the base of the lashes. These procedures are all fantastic cosmetic enhancements. One particular client that stands out for me was a beautiful, mature-aged woman who as a child had a reconstructive cleft palate repair, this meant she had much smaller uneven lips. I preformed a cosmetic tattooing procedure
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on her lips to create fuller symmetrical, healthy-coloured lips over two applications, which I performed eight weeks apart. I contacted my client a month after her last appointment, I knew the true colour of her lips would be visible then and I wanted to hear her feedback. She told me she never had her photo taken her whole life as she had avoided cameras, however since her cosmetic tattooing procedure with me she was confident enough to get her photo taken and felt as though her life had changed dramatically, in a positive way. Imagine, never having a family photo or birthday picture taken and then to finally feel that was possible later in life was amazing to witness. There is no price that can give the satisfaction I felt after seeing this client and many others in similar situations.
they can continue to benefit from. APJ Q5: What are your professional aspirations for the future?
I like to see my clients regularly, I want to maintain my work and assess how the pigmentation has softened due to colour retention, this is affected by skin types, exposure to UV, certain medications, skin peeling and some products, such as alpha-hydroxy acids. My clients know that I’m always there for them, not just on the day of the treatment, but also a month later and for many years to come. I love seeing what life has brought their way, and they love seeing and hearing what I have been up to and what new techniques
I also want consumers to know if this has happened to them, there are people who can help and ensure any future treatments are safe and applied with the care and respect everyone deserves and protect the reputation of the industry. I want to embrace the opportunity as a business owner to increase awareness of associations that aren’t recognised enough for what they are achieving, for example the Vitiligo and Alopecia Associations. Through a monthly donation, I inform clients of Associations and let them know how they too can donate.
I have so many goals within the cosmetic tattooing profession that I feel as though I have only scraped the surface of an ever-evolving profession. I want to encourage more networking with other highly qualified cosmetic tattoo practitioners so everyone can benefit, not only the clients. It concerns me that there are so many “botched” procedures that are currently taking place by unregulated, poorly-trained practitioners.
I want to volunteer my cosmetic tattooing skills to individuals whose disfigured appearance may have prevented cultural acceptance. I currently donate my time and services here in Australia and I would love to extend this altruistic element of my business to overseas networks. I am committed to applying myself to new advancements in techniques and challenging myself in ways that I thought would not be possible even five years ago. I love learning and improving and I cannot wait to see what the future holds for this amazing industry and to work with many more inspirational and truly beautiful (inside and out) clients. APJ
Claire Martinez can be contacted 0400 412 391
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STARPERFORMER
BEFORE
MYO-FIX NON-INVASIVE EYEBROW LIFTING By Oksana Shatrova, MD
WHILE injectables can help to smooth out lines and wrinkles, there is now a new, gentle, non-invasive treatment option that is delivering amazing results in relaxing mimic muscles. The procedure is painless and combines cutting-edge peptides, botanical and minerals administered through protocols that enhance their delivery through the epidermis. The program is part of a new-generation skin treatment system developed by Swiss skincare manufacturer Meder, which is distributed in Australia by Spectrum Science and Beauty. Dr Oksana Shatrova, is a dermatologist who has been appointed to develop the treatment protocols combining her knowledge of ingredients and procedures bringing a new to ensure a new level of treatment outcome that meets with the current demands of consumers. The human face is incredibly expressive: a person can convey their joy, anger, pleasure or disgust or any other thoughts and feelings without actually saying a word. Mimicry - complex associated movements of mimic muscles is what makes the non-verbal communication of the human face possible. Over one million non-verbal signals (both mimic and gestural) used by people in different countries have been described
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and catalogued. Amazingly, unlike spoken communication, the non-verbal communication is in fact international, this is because we can explain many things with our facial expressions even if we don’t speak the other person’s language. Mimic movements are possible because mimic muscles are different from skeletal muscles in a very important way. Skeletal muscles are always attached to the bone to at least two points. When the muscles contact, or relax, the musculoskeletal tendons move allowing people to move or walk. On the other hand mimic muscles are only attached to the bone at one point - the points of the attachment are located on the facial bones. The second attachment point is basically a knot of muscle fibre entwined directly into the facial skin. Unlike the skeletal attachment points, the outside or cutaneous ones can be located in many different ways and their anatomy varies significantly from person to person. Mimic muscles attached to the skin are intertwined in the deep layers of the skin, but the surface fibres can rise even to the dermal level and are found in the papillary layer. And when certain mimic patterns, such as a habitual grimace or a particular facial expression prevail, a constant local compression of the skin leads to the development of defects of a dermal level and this is how creases and wrinkles appear on the face. The more varied a person’s mimicry is, the longer their face appears young, although the general health and the skin’s condition certainly affect the wrinkle appearance as well.
AFTER The formation of wrinkles is accelerated by various factors such as poor nutrition, free radicals, sleep deprivation, smoking, excessive sun and high stress levels. MYO-FIX - A NEW SOLUTION FOR MIMIC WRINKLES Today there are many ways to reduce mimic wrinkles, most popular is through injectables such as botulinum toxins. However, in recent years a non-invasive method of affecting the tone of mimic muscles has been developed through the application of biologically active neurotransmitter modulating peptides onto the active mimic zone. These wrinkle-correcting peptides are available through the Meder Beauty Science Myo-Fix program. The system provides solutions that consist of small, lipophilic molecules able to penetrate into the skin over the epidermal barrier and denervate the mimic muscle fibres at the point of their attachment to the skin. To ensure the maximum penetration of the peptides during the procedure the skin needs to be prepared through a three stage process. This specific protocol ensures full penetration of the peptides due to nicotine induced vasodilation and antioxidant protection. In the process of preparing the skin blood vessels are strengthened and tissue metabolism is activated in the areas where preparation solutions are applied. The Myo-Fix program can be used for correction of mimic wrinkles and skin rejuvenation, as well as brow lifting and visible rejuvenation of the eye area and the upper third of the face.
A course of non-invasive wrinkle correction can reduce wrinkles in the upper and middle third of the face, smooth out nasolabial folds and lines around the mouth, lift the outer section of the brows making the face looking more revived and youthful. The duration of the procedure take one hour to perform. A course of five treatments is usually recommend. If the client has very active mimicry or very deed wrinkles a two-course treatment program is performed in a row. The Myo-Fix treatment plan consists of an effective treatment protocol combining powerful peptides, combined with minerals and botanicals to deliver excellent results in minimising mimic wrinkles without the need for invasive procedures. Dr Oksana Shatrova has over 15 years of experience in medical dermatology. Besides medical practice, she conducted her own research and participated in international research programs studying psoriasis and atopic dermatitis. She is currently the head of Meder Beauty International training team in Eastern Europe. Her professional interests are non-invasive skin therapy, sensitive skin, rosacea and atopic dermatitis. APJ Myo-Fix is part of the Meder Beauty Science and is distributed in Australian by Spectrum Science and Beauty. For further information phone 1300 766 198.
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MEDICALCONFERENCE
INSIGHT AND UPDATES ON INDUSTRY TRENDS ASAPS CONFERENCE WRAP-UP
THE 2017 NON-SURGICAL SYMPOSIUMS was held on the Gold Coast this year on the weekend 22-25 June. The event attracted a record number of over 900 delegates and exhibitors and featured leading speakers from around the world who addressed the very latest advances in technologies, procedures, global trends and constantly evolving new techniques to satisfy the ever-growing consumer appetite for youthfulness and improved appearance. The Non-Surgical Symposium is a collaborative initiative between four professional bodies: the Australasian Society of Aesthetic Plastic Surgeons (ASAPS) the Cosmetic Physicians College of Australasia (CPCA) the Australian Society of Cosmetic Dermatology (ASCD) New Zealand Society of Cosmetic Medicine (NZCM) The event was opened by ASAPS President Mark Magnusson with welcoming addresses by the CPCA President Dr Doug Grose and ASCD President Dr Greg Goodman. As there were numerous lectures I would like to present a snapshot of some of the key take-home messages from the wealth of knowledge that was presented by industry leaders. One of the keynote speakers was Dr Patricia Ogilvie an internationally renowned biochemist and dermatologist from
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Germany who spoke on the latest research findings on Beauty versus attractiveness - what we need to know to optimise patient care. Dr Ogilvie defined beauty as the quality in a person which draws interest or imagination, while attractiveness is more linked to mating qualities. Research confirms that the channels used to increase attractiveness do not require for them to look younger. In fact, when this is forced it actually has a detrimental effect on making a person look more beautiful or attractive. According to studies the two key considerations that determine how attractive or beautiful someone looks are: 1. The average factor - in other words, changes that make a person stand out are considered extreme signals and are not considered attractive. This confirms that the trend for soft, healthy, natural look is gaining consumer votes from both male and females as being one of the most important qualities to determining a person’s attractiveness. She warned practitioners to avoid over-exaggeration of features as research confirms this is a turnoff. 2. Skin condition - clean, fresh, blemish-free skin with a rosy undertone is considered essential in defining attractiveness, and considered the hallmark of youthfulness and health. The role of a healthy, vibrant skin is gaining top marks as the ideal identifiable quality that defines beauty and attractiveness. That is of course good news for our industry. In sum-
mary Dr Ogilvie stated that the treatment outcomes for the skin is to reduce any contrast as this is considered better for the human eye in defining attractiveness. This includes colour contrasts such as pigmentation, capillary visibility, pore size, shadows on the face due to wrinkles. Dr Ogilvie also clarified that SYMMETRY does not necessarily impart attractiveness and warned clinicians to not overstress symmetry, which aims to match the right and left side of the face as being the ideal. She identified that most people unless they have perfect genes have slight differences between the two sides of the face and that contributes to their own unique identity. Harmonisation of features to create a better balance is considered the preferred objective. Dr Ogilvie also stressed the differences between male and female attractiveness and to avoid feminising men by using similar techniques to female attractiveness. The role of testosterone in males contributes to a continuation of bone growth to the age of 30, while for women with oestrogenic changes means that bone changes are slowed down by the age of just 14. For this reason, Dr Ogilvie stated, if you broaden a woman’s face you make her look more masculine, while if you elongate a man’s face you make them look more feminine. In terms of skin quality male dermis maintains much of it integrity right up to the age of 50. This is because the male terminal facial hair growth is supported by sebum quality and activity and the active hair growth also holds and supports skin elasticity, while the natural oil secreted by the sebaceous glands maintain the skin’s integrity.
Dr Ogilvie also stated that the microbiome is different in men than in women. Additional as the oestrogen production drops by 20% in women after menopause this results in pigmentation changes due to these hormonal changes and not just from the sun. Understanding the physiological differences between male and females will allow practitioners to address the various needs specific to gender they are treating. According to a recent study the demand for cosmetic procedures for women has increased by 22%, while repeat services are accessed at almost at the same rate of 20%. On the other hand, we are currently experiencing a 20% increase in men pursuing cosmetic procedures and repeat services are at just 14%. This suggests that the satisfaction rate may not be as high. Dr Oglivia suggested this may be due to the fact that the male treatments may not be sufficiently satisfactory in maintaining their masculinity. Australian dermatologist Dr Greg Goodman presented a detailed report that made headlines recently on why Australian women age 20 years faster than US, Canada and European women (featured also in the winter issue of APJ). His comprehensive findings concluded the following: Many Australia women fall within a Fitzpatrick scale skin type of 1-3. Being of fairer complexion they are more prone to sun-damage. Other contributing factors are that Australians are predominantly coastal dwellers, who love the outdoors and 60% of youth love a tan. As a result 50% of the population in Australia will experience some form of skin cancer in their lifetime.
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Ageing of the skin is predominantly volumetric with Aussie women starting to experience skin volume loss from the age of 30 compared to the US, where is predominantly manifests from 40 years of age and above. While applying sunblock is a good practice this often means that many women feel safer to remain expose to the sun for longer periods of time. The findings confirmed that Australian women age at a rate of 20 years more rapidly than US or Canadian women. At a further lecture understanding your skin Dr Goodman, shed light on the manifestations of a healthy skin. While he covered basic physiology he clarified that from a dermatological perspective the signs of a youthful skin are evident in a health dermis. Clear skin reflects collagen quality. Thus epidermal disorders hinder the irregular reflection of light. Pigmentation and blochy skin is perceived ageing because it interrupts the look of a healthy collagen. Dr Goodman’s definition of a healthy and youthful skin is one with a rosy milky hue, manifested from a robust collagen reflection that gives the skin both volume, a healthy colour and smooth, hydrated, satin texture that is not excessively shiny. On the other hand an ageing skin will manifest as dull skin surface, lacking colour and a healthy glow. While desquamation procedures will aim to remove dying cells, moisturising should seek to mimic what is happening within the skin at a dermal level. Melanocyte changes occur also as we age contributing to not tanning as well or unevenly. When aiming to rejuvenate the skin it is important that we target not just the papillary superficial cells, but also the reticular dermis supporting and strengthening collagen and dermal integrity. Strategies should be introduced that will best protect from photo-ageing, enhance immunity, while rashes and tumours are restrained. As each lecture was 20 minutes numerous topics covered offering delegates a broad spectrum of information presented both the latest scientifically-validated data as well as key advances in industry trends. While many of the trends were only subtle shifts from what we already know, collectively they present a clear direction of consumer expectation and how beauty and attractiveness is progressively changing it its interpretation. In summary here are the key areas that were identified: 1. THE SKIN - The importance of starting first with a youthful skin that reflects transparency to the dermis. Eliminating any epidermal abnormalities that hinder that reflection – such as pigmentation, dullness, lesions, dehydration or enlarged pores. 2. BODY SHAPING - Cryolypolisis taking over from liposuction and surgical procedures. Cool Sculpting based on published papers have demonstrated excellent results. New devices don’t require heavy anaesthetics, less suction, less side effects. Also there are new devices that treat arms, with less bruising, less pressure, less discomfort and have different applications for customised full body treatments. A recent study conducted by Dr Grant Stevens confirmed that men are now undergoing these procedures with an increase over the past three years of 40%, while women still hold the top position of 60%. With regards to the ages of individuals who are seeking body sculpturing these vary extensively from 20s to well into their 50s. The diversity of age group is a clear indication of the broad appear and growing popularity of non-invasive body shaping treatments.
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3. HAIR LOSS - 85% of men experiencing hair loss, 25% before the age of 25. Females, 40% experience thinning of hair particularly during menopause. New laser treatments combined with PRP increase vascularisation resul ting in 20 - 50% increase in hair growth. Combination therapy PRP and Laser therapy deliver great results. Microneedling combined with PRP was also confirmed to increase growth factors in the hair follicles. 4. VAGINAL REJUVENATION - Declining sex hormones during menopause are reportedly contributing to vaginal atrophy, lack of sexual function and pain during intercourse as well as urinary incontinence. The statistics indicate that these dysfunctions are being experienced by women at epidemic rates. New hybrid fractional lasers can reduce treatment time from 30 minutes to just three minutes were also presented. These treatments require medical oversight, but can be designated to an appropriately qualified cosmetic nurse or aesthetician. Treatment can be delivered with topical anaesthetic and is life transforming. 5. ADVANCES IN MULTIPLE TECHNOLOGIES - Advances in existing and new technologies with innovative ways of combining them synergistically are contributing to impressive results. Technologies that were identified were lasers, radiofrequency, LED and micro-focused Ultrasound (MFU). In particular MFU’s were identified as being able to go deeper to stimulate new collagen and give a good lifting effect through the shrinkage of proteins. Benefits were identified as improving skin laxity, volume loss and sun damage. When also combined with fillers, MFU treatments can offer excellent results, while when combined with microneedling cellulite conditions can also experience great improvement. It was also stressed that practitioners should not limit themselves to set protocols, but assess the degree of the problem and constantly evaluate progress to identify what will work best and deliver best results. 6. ETHNIC SKINS - There were several speakers who presented how various ethnic skins age different e.g. Asian, compared to Indian and Caucasian skin. It was quite evident that different ethnic groups, age differently in the way that volume loss is experienced and ways of rebalancing features that were also presented. They also demonstrated how orbital and maxillary angles change as we age with 15-25% bone deterioration of the extracellular matrix, bone matrix starting to shift as early as 30 years of age and start to become more noticeable by age 40. 7. NEW INJECTABLES - The evolution of new fillers were also presented offering different benefits and delivered through a variety of new techniques were also presented as well as other innovative advances such as new absorbable threads for facial contouring and lifting were also discussed. The overall predictions were that the number of consumers seeing appearance improvement and body procedures is to be expected to continue to grow, but also the age of consumers seeking these services will progressively become younger. While some of these shifts may be subtle, they do point to the direction of demand and therefore potential business growth. That is the beauty and value of observing statistics as they highlight the direction that the industry is advancing. Utilise this data to ensure you grow in the right direction. APJ For further details about the ASAPS 2018 conference visit www.asaps.org.au
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BODYSHAPING
EXPLORING THE GROWING TREND IN BODY SHAPING PROCEDURES An Interview with Dr A. Jay Burns AT this year’s Non-Surgical Symposium (ASAPS) many international speakers presented areas of their expert knowledge. One interesting lecture was on the rise in consumer demand in body sculpting as well as vaginal rejuvenation presented by renowned plastic surgeon Dr A. Jay Burns. Dr Burns private practice is located in Dallas, Texas at the Plastic Surgery Institute. Dr Burns is recognised as an exceptional surgeon as well as a great educator in new innovative advances in technologies and techniques. He was a frequent and captivating lecturer at the symposium and we were delighted to catch up with him for a brief interview to discuss the rise in these new consumer trends and how technology is making these treatments readily available. Our world is constantly changing. If you are planning for business growth, this information and statistical data could be valuable to you to identify new opportunities to move confidently towards areas of growth that are well supported by research. APJ Q1: Dr Burns, share with us your experience in the rise in demand for body shaping treatments, who is the average candidate for these treatments and what is the ratio of male to female clients who are seeking these treatments? A recent study conducted by Dr Grant Stevens confirmed that men are now undergoing these procedures with an increase over the past three years of 40%, while women still hold the top position of 60%. With regards to the ages of individuals who are seeking body sculpturing these vary extensively from their 20s to well into their 50s. The diversity of
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age group is a clear indication of the broad appeal and growing popularity of non-invasive body shaping treatments. APJ Q2: More specifically, can you please tell us how the demand for body shaping treatments has grown over the past few years? In general non-invasive procedures have experienced an exponential growth of 597% in the past 3-4 years. What is surprising is that a growing number of millennials or GenYs (these are individuals born in 1977 to 1994) are now seeking non-invasive procedures without downtime to improve their appearance. The evidence specifically for body shaping procedures as a guaranteed growth market can be demonstrated by Allergan’s (the company behind Botox TM) recent acquisition of Zeltiq. Allergan spent approximately $2.48 billion to buy Zeltiq Aesthetics Inc. and its CoolSculpting system for reducing fat. This shows you how confident the company was in the future growth in demand of this procedure. AJP Q3: Does CoolSculpting permanently change the shape of the body? The Zeltiq - cool sculpting will freeze the fat cells through a process called cryolipolysis, without affecting other tissues. The fat in the adipocytes (fat cells) will freeze at a controlled temperature inducing cellular apopotisis (programmed cell death) hence a permanent solution. That said, not all the adipocytes in the targeted area will commit suicide only about a third of them will. However, with repeated treatments over the same area this induces apoptosis of further fat cells. As such, this procedure is excellent for abnormal accumulation of fat that does not seem to decrease, or at a much slower
rate and only from dieting. We see this phenomenon frequently with stomach and outer thigh bulges. CoolSculpting offers great solutions by improving body shape by effectively decreasing fat in stubborn areas. APJ Q4: Are there any risk factors or contract-indications for these body sculpting procedures? Not really. There are very few risks or contra-indications to these procedures. The key considerations for risk are individuals who are overall hugely obese rather than in just a localised area. In those instances, for example, someone with a large abdomen usually carries fat that is not just under the skin, but also distributed internally around the organs, so other strategies are best introduced first. Another consideration for contraindication is if the skin is too loose to respond well to local fat reduction. APJ Q5: Dr Burns, what are the most common areas that are targeted for fat reduction? By far the most common procedures in demand are tummy and “love handles” around the hips. The demand for these treatments is constantly on the rise. With facial fat reduction, the chin and neck are the most popular procedures, but these treatments require the addition of skin tightening procedures to ensure the outcome is overall positive and satisfactory. APJ Q6: What exciting developments do you envisage into the future? It is quite amazing but one of the largest growth area is procedures for non-surgical vaginal rejuvenation/tightening and urinary incontinence particularly for women after menopause. The procedure is performed by a laser to stimulate neocollagenesis of the thinning vaginal walls and helps improve discomfort and pain experienced during intercourse. I was not aware of the severity of this problem for many women. It is huge and this procedure is offering new hope and improving quality of life for many woman who are suffering from this condition. While traditionally this procedures takes approximately 20-30 minutes to perform, new laser technology is improving both the outcome and time frame for delivering this treatment. The new Diva vaginal therapy for example is a laser treatment used to address changes in vaginal health often caused by childbirth and menopause. It may also be used to treat side effects in women who have undergone a hysterectomy or chemotherapy. The device’s laser handpiece is inserted into the vagina, delivering controlled energy pulses into the tissue in just 3-4 minutes per treatment rather than the traditional 20-30minutes. The same company also offers diVaTyte, a treatment to firm the exterior part of the vagina (the vulva). That device uses infrared energy to heat the tissue and stimulate collagen production. It provides a non-invasive alternative to labiaplasty. APJ Q7: With the constant new advances in both product formulations and technologies offering non-surgical solutions, for example, nasal shape improvement with fillers, more efficient threads for enhancing facial lifting and numerous injectable formulations, have these advances decreased the demand for surgical procedures? The public is becoming increasingly comfortable to access short and long-term solutions for looking fresher and more
youthful so are the expectations for new and better ways to achieve the outcomes they are looking for. In my experience this has only increased the demand also for a surgical procedure if it is identified the best option for providing the best result for them. If anything, the demand for surgery is constantly increasing. CONCLUSION The value and benefit of understanding trends is that you can identify where the growth opportunities lie and minimise your risk of moving in a direction that may not be experiencing as much demand. Even if you are not offering body treatments, knowing that this is a growing trend will allow you to consider your options in moving forward and remaining competitive. About Dr A. Jay Burns Dr. Burns has his private practice in Dallas as a partner in Dallas Plastic Surgery Institute. He graduated from Baylor University magna cum laude and was honoured as Outstanding Junior Alumni of Baylor University in 1994. Dr. Burns graduated with honours (AOA) from the University of Texas South-western Medical School in Dallas. He completed an internship and residency in general surgery at the University of Utah Affiliated Hospitals in Salt Lake City followed by a residency in plastic surgery at the University of Texas South-western Medical School. He then went on to complete specialty training in vascular anomalies and birthmarks at Harvard Affiliated Hospitals. He is board certified in plastic and reconstructive surgery. Dr. Burns is a noted national and international authority on lasers and cosmetic surgery, vascular anomalies, and birthmarks. Dr. Burns is a past President of the American Society for Laser Medicine and Surgery and also a member of the American Society of Plastic Surgeons, the American Society for Aesthetic Plastic Surgery, Inc., and the American Association of Plastic Surgeons. He has been a national spokesperson for both societies and served as Travelling Professor for the Aesthetic Society for the years 2001 to 2003. He has been voted numerous times by his peers to both D Magazine’s “Best Doctors” and Texas Monthly’s “Texas Super Doctors”. He was featured on the Oprah Winfrey “Medical Miracles” show. Dr. Burns and his wife of 38 years, Ginny, have two children, and two grandchildren. He is committed to his faith and family and is the founder of the Prodigal ministry, which serves families who are struggling with addiction. APJ For further information visit http://drjayburns.com
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HIGHEREDUCATION
The future of Aesthetics and why Tertiary qualifications are gaining popularity By Carmen Perkins
PREDICTIONS, based on statistical figures both globally and here in Australia, indicate that the growth in consumer demand for personal care services and premium cosmetic sector will continue to experience robust growth. Additionally, the forecast is that consumer expectations with go beyond skin and facial improvement to body shaping and wellness. New technologies are constantly breaking new ground in treatment possibilities. Furthermore, new techniques are targeting the dermis improving collagen integrity and bringing skin rejuvenation to a whole new level. New breakthroughs in technology are providing amazing solutions for body shaping and toning, bringing new opportunities for business growth. As a result of these advances the knowledge-level of practitioners is now required to be much higher. This is where a Bachelor of Health Science (Aesthetics) can best support both the rising industry standards, as well as meet the demands of consumer expectations. Meanwhile, cosmetic medicine is also providing new possibilities through more invasive solutions enticing a constantly growing number of diverse consumers who are progressively becoming more comfortable with their options of looking better, or more youthful. Non-medical aesthetic practitioners now have strong competition. A NEW ACADEMIC STANDARD Torrens University believes education should reflect the realities of an evolving industry, as well as provide the skills for critical thinking and global perspectives in the approach we take within the treatment environment. Integrating relevant insights and the desired skill sets through their active conversations with industry has allowed Torrens to develop a dynamic qualification for the evolving and changing needs of the modern workplace where more advanced clinical results are increasingly required by the discerning consumer. This industry need has contributed to the development of the Bachelor of Health Science (Aesthetics) which is already gaining great popularity. With strong academic units as well as a comprehensive practicum component this qualification offers the graduate the ability to face the future with great-
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er skills, knowledge and confidence and pursue a successful career in aesthetics. This qualification is also available to qualified beauty therapists or nurses who wish to increase and extend their current skills and knowledge through a tertiary level qualification in aesthetics and dermal therapies allowing them to expand their professional scope and career possibilities for a brighter future. The Bachelor of Health Science (Aesthetics) has been carefully designed in consultation with industry professionals to ensure it meets with the growing needs of salons and clinics enabling them to access industry-ready graduates that are able to support their current and future business growth. OUR QUALITY ASSURANCE While VET sector offers sound qualification, the units within a tertiary qualification, such as the Bachelor of Health Science (Aesthetics) offer a more comprehensive and stronger academic foundation that also includes several clinical, health and wellness units equipping the graduate to offer salons and clinic the ability to extend their scope of service and provide more advanced clinical outcomes. In Australia, tertiary qualifications are overseen by a national regulatory and quality agency for higher education – the Tertiary Education Quality and Standards Agency (TEQSA). TEQSA was established by the Australian Government to monitor quality, and regulate university and non-university higher education providers against a set of standards developed by the independent Higher Education Standards Panel. WHAT YOU CAN EXPECT FROM OUR GRADUATES Graduates of the Bachelor of Health Science (Aesthetics) will bring a new level of critical thinking and problem solving to their practice. Their depth-of- knowledge will allow them to assess client and patient needs through a new understanding of pathophysiology that will enable them to achieve more advanced clinical outcomes. APJ If you wish to gain further information on the Bachelor of Health Science (Aesthetics) please contact Torrens University Australia Phone: 1300 575 803, Email: enquiries@torrens.edu.au
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STARPERFORMER
AUSMED LAUNCHES NEW CO2 LASER THERAPY SYSTEM With some amazing applications Ausmed is launching a new-generation C02 Laser with some amazing applications that can help your clinic provide additional services. The three applications include: Skin resurfacing and removal of lesions: Freeze and elimination of unwanted lesions and skin tags, sun-damaged and ageing skin through carbonising and evaporation application Scar cure: For the breakdown of scar tissue Vaginal rejuvenation: For gynaecological applications New research is confirming the growing number of pre and post-menopausal women who are experiencing vaginal dryness, making it painful during intercourse. Other gynaecological conditions include urine incontinence. The C02 Laser can penetrate the vaginal wall and stimulate fibre cells to regenerate and rebuild extracellular matrix of the vaginal mucosa and recombining collagen fibre and matrix to tighten the vagina. It achieves this by recovering the nutrient capacity and function of the tissue, allowing it to once again restore its youthfulness and vitality. LASER MODE: Superpulse mode (SP) * High peek power * Low average power * Small heat damage range Continuous mode (CW) * Low peak power * High average power * Big heat damage power TREATMENT MODES OF HANDPIECES There are three modes of application: Surface mode For superficial sun damage, fine lines and wrinkles Indepth mode For deeper sun damage, severe wrinkles and acne scars, etc. Union mode Union with Surface and Indepth modes for severe sun damage and more complex acne scars more advanced wrinkles.
APJ
The new C02 Laser system from Ausmed offers amazing applications that will allow your clinic to attract and services more severe rejuvenation concerns. Contact AUSMED INTERNATIONAL PTY LTD PH: 02 8957 2177 or Mobile: 0424 795 652.
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Med-QLaser
TM
Q-Switched ND:
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For Effective Removal of Tattoos and Pigmented Lesions Med-QLaser TM is a new-generation device integrated with real-time energy monitor, energy auto-changing by adjustable handpiece, water filtration system, guaranteeing safety and efficacy during usage. It offers dual-wavelength switching of 1064nm and 532nm pulse width shot to 5nm and energy output up to 1000mJ. New UI ergonomic design makes user experience simpler and more convenient.
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www.ausmedlaser.com.au
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LIQUID MINERALS WITH ANTI-AGEING PROPERTIES You have taken care of your client’s skin and achieved a wonderful result, so now what is the perfect makeup that will continue to support the skin with on-going anti-ageing benefits? Jane Iredale’s Liquid Minerals with its light-reflecting formula will provide sheer to medium coverage. Liquid Minerals will support the skin by providing hydration, diminishing the appearance of fine lines and wrinkles, minimising the appearance pores and evening out skin tone to perfection. Liquid Minerals adheres so well to the skin so there is minimal transference or smudging. For more information please visit www.margifox.com. au or call 1300 850 008
PRODUCT SLEEPING NIGHT OIL WITH DUAL-ACTION If you have never tried the ETERNAL Sleeping Night Oil by Skeyndor here is your chance to do so. This classification of oils are the latest trend, they combine active ingredients to renew and rebuild the skin when sleeping, while including soothing ingredients to help the mind relax and induce quality restful sleep to also help renew the mind. Sleeping Night Oil contains several actives to stimulate stem cells and protects epidermal stem cell DNA, thanks to the potent properties of Sea Kale extract. In addition, SKEYNDOR merges Sea Fennel Extract with five exquisite natural oils including Avocado, Wheatgerm, Macademia and the exquisite essential oils of Jasmine, Ylang Ylang and Bitter Orange to boost wellbeing and promote a more restful sleep, which accelerates the skin’s ability to regenerate even further. Clients using ETERNAL can expect a significant and long lasting improvement in deep and superficial lines, hydration levels, volume, clarity and skin texture. The new Sleeping Night Oil is part of the ETERNAL line now which also features a professional treatment, four home care facial products Serum, Cream, Night Oil and Icy Eye Cream in addition to the Body Repair Serum. Please email info@skeyndoraustralia, call 1 800 554 545 or visit www.skeyndoraustralia.com
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NATURALLY GLAM - SPRING COLLECTION Rich, vibrant, but totally wearable colour just in time for the spring season. The Naturally Glam Kit by Jane Iredale takes our popular Naturally Matte Kit and dials it up a notch – still wearable neutrals, but with super-saturated colour and a touch of shimmer. Then you decide if you want a more understated port wine lip or a powerful red lip – this collection brings both options to you. And then finish it off with the sweetest pink golden shimmer for the cheeks. The Naturally Glam Kit is the latest spring collection just in time for the warmer days. The colours are subtle, but cheerful reminiscent of new bloom. For more information please visit www.margifox.com. au or call 1300 850 008
INNOVATIONS
DIOMED-100 LASER FOR HAIR REDUCTION If you prefer to work with a laser then Ausmed’s DioMedi-100 is an amazing device specifically designed for hair reduction. It can emit laser light at 808 nm wavelength that can be absorbed by melanin located in the hair follicle. The hair shaft can also absorb the energy destroying the hair follicle for effective removal. It offers safe energy delivery, continuous contact cooling to the epidermis, while it ergonomically designed finger trigger offers easy comfortable operation. Ausmed offer the very latest cutting-edge technology in laser and light-basted therapies for a variety of application delivering leading treatment results to boost your reputation. Phone AUSMED INTERNATIONAL PTY LTD : 02 8957 2177 or mobile: 0424 795 652 or visit www.ausmedilaser.com. au
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REMEDIALMASSAGE
HOW REMEDIAL MASSAGE CAN BENEFIT YOUR CLIENTS AND BUSINESS An interview with Greg Morling
AS KNOWLEDGE increases we are moving into the era of specialisation. Many modalities are gaining so much new information that practitioners are branching out and become specialists in the discipline they love the most. It is not uncommon to see beauty therapists that have a passion for skin improvement choosing to specialise in skin management, while dropping, or delegating other practices they have been trained in to colleagues, who are also becoming specialists in their chosen modality. In recent years several new units have been included in Remedial Massage bringing this modality to a more therapeutic level with amazing benefits to a diverse range of consumers. Greg Morling is a lecturer and auditor in Remedial Massage. He also has extensive experience in working synergistically with beauty therapy and skin clinics offering the benefits of Remedial Massage as an adjunct therapy to provide a valuable synergy to businesses through a diverse range of client services that can capture a new client base for salons and clinics. In this interview Greg shares with us ways that businesses can benefit from introducing remedial massage to their clients. APJ Q1: Most beauty therapist have completed a massage course as part of their diploma of Beauty Therapy. As a trainer and auditor has does that level of training differ from remedial massage? Within the Beauty Training Package Swedish massage is included and while it offers great benefits to consumers it is very different to remedial or therapeutic massage. The focus of remedial massage is essentially more therapeutic and can address a variety of different conditions including injuries and aches and pains. Remedial massage is a varied therapy and combines a number of different techniques including trigger points, myofascial release and lymphatic drainage techniques as well as stretching technique to work on damaged or sore muscles, soft tissue or joints. The new training
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package has more extensive units in anatomy and physiology as well as pathophysiology. These units are similar to the study of nursing. The current qualifications available are Certificate IV in Massage Therapy (HLT42015) or Diploma of Remedial Massage (HLT52015) and the training is approximately 18 months to two years. APJ Q2: Do you believe that massage therapy is a specialised modality and what should a business look for when attempting to identify a qualified massage therapist practitioner who can deliver consistent and reliable results. When considering to hire a massage therapist you need to check two areas: their qualifications and their experience. First, check their qualifications and then look at their experience. I recommend that they have 4-5 years experience if you are looking for a highly skilled massage practitioner. Questions you should ask are: “what areas have you worked, or specialised in?” These may include lymphatic drainage for conditions such as lymphedema, arthritic or sports injuries. Their knowledge should go way beyond Swedish massage to include therapeutic modalities. This will allow you to extend your current services as well as attract new clients. It is also highly recommended that you trial their work to determine if they are a good fit for you and whether they will suit your environment. Explore the various styles they offer to determine new treatment options you can introduce to your clients. I have worked with salons and I was able to bring a completely new cohort of clientele by introducing therapeutic massage to the salon. Qualified and skilled massage therapists are often looking to provide their services within a salon or clinic for one-to-two days a week. If you have a spare room you can organise bookings for them and establish a contractual, collaborative arrangement adding an additional
service and another income stream to your business. APJ Q3: What are some of the benefits of remedial massage and do you have any recent research finding? There have been a number of evidence-based studies on the benefits of therapeutic massage. I would like to recommend Professor Tiffany Field from the Doctoral Faculty, School of Psychology, Fielding Graduate University in Florida, USA. She has contributed to over 30 years towards research on the therapeutics effects of touch. Field and her colleagues at have conducted studies on topics including autism, ADHD, anorexia, pregnancy, low-back pain, fibromyalgia, migraine, cerebral palsy, spinal-cord injury, asthma and many more. (For a complete list, visit www6.miami.edu/touch-research.) Due to some this research findings physicians are increasingly taking notice of the benefits of massage as part of the therapeutic approach to numerous health conditions. There is also quite a large body of research supporting the benefits of therapeutic massage for lower back pain, arthritic conditions, scoliosis problems, as well as several other pathologies such as benefits of massage for diabetic and hormonal conditions by improving circulation and lowering cortisol levels in conditions such as adrenal and chronic fatigue. Research has confirmed evidence of both biomechanical as well as psychosomatic benefits of remedial touch. It is also important to remember that massage is a science as well as an art, so the practitioner’s approach to their client/patient and the techniques they use with the appropriate empathy can provide great relief and benefit for the individual they are treating. Another interesting area that is now included in the training of therapeutic massage is identifying skin lesions on the body. This is an excellent cross-over with skin therapists where suspect lesions can be picked up and addressed. Other skin conditions such as with diabetic patients and other ailments that manifest circulatory problems, remedial massage can assist in improving blood supply to the skin increasing oxygen and nutrients as well as lymphatic drainage. Remedial massage works in a targeted way on the vascular, nervous and muscular systems providing great relief with pain and tension in localised areas. APJ Q4: How can a salon or clinic specialising in skin improvement benefit from a collaborative arrangement with a qualified remedial massage therapist. How do you see the two modalities working together to achieve better treatment outcomes as well as a win /win situation for both business and therapist? In my years of experience with salons and clinics there is a wonderful synergy on many levels where a collaborative relationship can provide benefits to both clients and the business on so many levels. A salon’s clients may also have other ailments that can gain relief and benefit through therapeutic massage as this modality can address a diverse range of conditions through various techniques including stretching to improve mobility. Both existing clients and new clients could benefit from these services. I have often seen women introduce their husbands who may have sports injuries, or other pathologies who can gain great benefit from these services. In fact, therapeutic massage is very popular with male clients, so here is a chance for the business to extend their treatment offerings. In summary remedial massage can address issues such as:
* * * * * * * * * *
Muscle tightness and pain Arthritis Frozen shoulder Tennis elbow Whiplash Neck, shoulder and back pain Scoliosis Headaches Sports injuries Fibromyalgia
Remedial massage can holistically address the whole body to ease out tension, and repair damage to muscles, joints, tendons and soft tissue. When it comes to the skin, we all know that pain creates a level of inflammation and it contributes to increased stress that can be viewed on the face. If you are treating a client’s skin who is suffering from aches and pains, managing their pain will not only give them additional relief, it will also indirectly support their skin treatment results. Most people today value and appreciate a holistic approach to their appearance as well as their wellbeing. The synergy between aesthetician and remedial massage therapist can provide a more complete solutions to clients, while also increase the businesses revenue. APJ APAN is working closely with Greg Morling to provide a register of qualified and reputable remedial massage therapists that their members can access as an extension to the services they provide. If you believe this service could benefit you please contact APAN on 07 5593 0360.
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NUTRITIONALSCIENCE
Why Selenium is important for skin and health by Tina Viney
We are all aware that antioxidants have an enormously positive impact on the health, but rarely does anyone specifically cite the significance of selenium, a powerful nutrient that double up as an antioxidant. Its positive impact on the immune system, brain health, reproductive system as well as the skin is something that doesn’t get the attention it deserves. Neither do the negative health impacts of selenium deficiency. Part of the reason that selenium deficiency is become so prevalent is because our soil is often depleted of this important mineral. Eating foods grown in selenium-poor soil, or even digestive and intestinal ailments such as celiac disease which as we know is becoming more and more common, can contribute to selenium deficiency. SYMPTOMS OF DEFICIENCY In recent times there is significant research supporting the benefits of selenium and I will be highlighting some of these later in this article. However, let’s first look at some of the symptoms of deficiency as well as the health benefits of selenium for skin and body. Foggy Memory Feeling spacey? A cloudy mind coupled with short-term (and even long-term) memory issues could be a sign of a selenium deficiency. While many people are ready to pass off memory problems as a natural part of ageing, that may not be the case. A lack of selenium has been shown to interfere with cognitive function. This isn’t limited to memory; analytical thinking skills and concentration can also be affected. Fatigue Selenium is necessary for converting the T4 thyroid hormone (thyroxine) into the active hormone T3 (triiodothyronine). If these hormones are off, the risk for developing hypothyroidism - a condition associated with lethargy, depression, and
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uncontrolled weight gain - increases. While iodine is also necessary for proper thyroid health, a deficiency in selenium also contributes to protecting the thyroid and regulating important hormonal function. Chronic Cold or Flu Selenium supports the immune system and contributes to your body’s natural defences against the cold, flu, and other immune-compromised conditions. Hypothyroidism, a condition that can be influenced by selenium deficiency, negatively interferes with the immune system’s response to invading germs. The immune system also requires cells to communicate with each other when dealing with germs and bacteria. Selenium, as an antioxidant, supports this communication. Memory Infertility Infertility can stem from many causes and willy-nilly ascribing fertility issues to selenium deficiency isn’t the best protocol. However, selenium does affect sperm quality and motility. In fact, the combination of selenium and vitamin E seem to work synergistically to promote male fertility. Slow Wound Healing Part of the benefit of selenium being an antioxidant is that it helps cell tissue repair. For us dealing with the skin selenium is important for skin healing. When wounds don’t heal, or heal very slowly, it’s worth examining your selenium status as research suggests that selenium may help wounds heal faster. [5] Getting Enough Selenium While one or more of the above problems may indicate a selenium deficiency, it should be noted that not everyone who experiences these issues is experiencing selenium deficiency. Regardless, it’s something to keep in mind. If you have any of these problems, double check your nutritional intake and consider adding more foods rich in selenium to your diet (see chart for further details). Supplementation may
also be something to consider but be sure to get a high-quality selenium supplement. More on that later in this article. Top 10 Foods High in Selenium Brazil nuts 1 oz (6-8 nuts): 544 mcg (over 100% DV) Yellowfin tuna 3 oz: 92 mcg (over 100% DV) Halibut, cooked 3 oz: 47mcg (67% DV) Sardines, canned 3 oz: 45mcg (64% DV) Grass-fed beef 3 oz: 33 mcg (47% DV) Turkey, boneless 3 oz: 31 mcg (44% DV) Beef liver 3 oz: 28 mcg (40% DV) Chicken 3 oz: 22 mcg (31% DV) Egg 1 large, 15 mcg (21% DV) Spinach 1 cup: 11 mcg (16% DV) BENEFITS OF SELENIUM FOR THE SKIN Specifically for skin health selenium can play an important role offering the following benefits: It protects cells from damage: Selenium neutralises free radicals and other skin-damaging compounds before they can lead to wrinkles. It’s similar to vitamin E and actually works with the vitamin to safeguard cell membranes, the protective coating around cells. That makes selenium a key player when it comes to slowing the signs of ageing. In fact, research has shown that it’s a triple treat, protecting against UV-induced cell damage, skin inflammation and pigmentation. Recent studies continue to emphasize the importance of selenium and other antioxidants on skin health and reducing the risk of skin cancer. It helps skin fight infection: Your immune system relies on selenium to function well. In fact, it’s selenium, along with other minerals, that bolsters your body’s army of white blood cells and strengthens your response to infections - including those on the skin, since skin is your body’s first line of defence. It tempers inflammation: Inflammation caused by UV light, stress and other factors is known to age the skin, contributing to the breakdown of collagen (which is where wrinkles get their start). Selenium may help thwart the production of inflammatory cytokines, molecules that can build up in the body and harm healthy skin. TOPICAL APPLICATION OF SELENIUM Here is what happens when you apply selenium topically: It soothes redness and sensitivity. Due to its antioxidant and anti-inflammatory properties, selenium is a powerhouse for calming inflamed, irritated skin. Look for selenium in sprays known as thermal spring water mists. Sourced from natural springs, these mineral-rich water sprays feel incredibly refreshing and may alleviate redness and irritation (they’re the perfect follow-up to a chemical peel or microdermabrasion treatment). They also make a gentle, skin-soothing alternative to toners. For best results, spray on the mist after cleansing your face or body and apply
moisturizer while skin is still damp. It treats dandruff. A form of selenium called selenium sulfide is an effective antimicrobial that’s known to fight the yeast that causes dandruff and its symptoms, a flaky and/ or itchy scalp and rough, scaly patches - as well as fungus that leads to itchiness and discoloration on the scalp and skin. Look for the ingredient in anti-dandruff shampoos and conditioners. HOW MUCH DO YOU NEED? It’s not difficult to get the recommended 55 mcg (men and women need the same amount daily) of selenium. Although Brazil nuts tout the highest amount of the mineral (just one nut delivers almost double what you need), if you include seafood (shrimp, crab and salmon), beef, poultry and grains, like brown rice and wheat germ, in your diet, you’re sure to get enough; each of these foods delivers between 15 and 40 mcg of selenium per serving. However, the selenium content of vegetables and grains, and indeed grass and grain fed animal meat, is dependent on the amount of selenium in the soil where the plants are grown. SELENIUM AND CANCER - SCIENTIFIC FINDINGS Recent research has uncovered some interesting information on selenium and its role in the prevention of cancer. In one study they also identified various types of selenium and their therapeutic benefits. Below is just a brief glimpse of some of these findings. If you would like to access the full article please contact me at info@apanetwork.com Selenium Insufficiency Increases Cancer Risk Until the late 1950s, selenium was not recognised as having any role in human nutrition.1 The reality is that selenium is a “trace” element involved in many different functions of the human body.2 However, it has been identified that selenium acts as a co-factor for several key antioxidant enzymes called selenoproteins that recycle cellular antioxidants such as glutathione.4 This process reduces oxidative stress, a cause of premature aging and chronic disease.1,2,5,6 Large-scale epidemiologic studies have repeatedly demonstrated that populations with low selenium levels are at significantly increased risk for developing many different types of cancer including breast cancer.1,2,7 These studies confirm that adequate dietary selenium exerts preventive effects on prostate and colorectal cancer, two of the most common types of malignancies.8-10 Multiple studies reveal that low selenium levels in the blood, hair, or nail clippings are associated with a two to threefold increase in overall cancer risk.11,12 For specific tumours such as thyroid cancer, the risk rises to nearly 8-fold.13 Selenium insufficiencies are now known to increase risk of cancers of the bladder, lung, stomach, esophagus, and liver.5,14-17 As early as 1996, selenium supplementation was shown to lower overall cancer rates, with specific reductions in lung, colorectal, and prostate cancers.3,7 A 2011 meta-analysis of nine randomised controlled clinical trials, that included 152,538 participants, established that selenium supplementation cut risk for all cancers by 24%. The cancer-preventive effect rose to 36% in people with low baseline selenium levels.18 As we’ll now see, selenium biology is a complex area. Several forms of selenium are required to provide cancer preventive
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tralize organic carcinogenic toxins 6. Inhibition of DNA alterations, precursors to initiation of cancerous changes 7. Inactivation of molecular transcription factors required by cancer cells to support their growth and development 8. Shutting down of the essential cell replication cycle needed by cancer cells to produce their explosive growth 9. Induction of apoptosis, the programmed cell death, a natural feature of all normal body cells that is missing in cancerous cells, allowing them to continue to reproduce indefinitely 10. Enhanced immune system activity to detect and destroy incipient cancer cells 11. Down-regulation of sex hormone receptors used by certain cancers to sustain their growth25 benefits. Research shows that the levels of selenium needed for optimal effects are higher than those previously thought to be needed simply to support antioxidant enzyme activity.5 DIFFERENT FORMS OF SELENIUM Most people, including physicians, fail to realise that selenium is available in several different forms. Sodium selenite, L-selenomethionine, and selenium-methyl L-selenocysteine are the three forms which are of primary importance in cancer prevention. Each of the three major forms of selenium confers a unique spectrum of cancer-preventive effects, making it mandatory to supplement with appropriate amounts of all three nutrients. Cells in your body undergo potentially cancerous transformations thousands of times each day. No chemoprevention strategy is likely to change that; rather, our goal should be to enhance your body’s own natural protective mechanisms for terminating cancer cells’ survival as early as possible, thereby stopping their potential outgrowth into malignant tumours. Selenium acts by multiple, complementary pathways to prevent cancers from developing.23,2,8 This phenomenon, known to scientists as pleiotropy, allows selenium to attack cancer on many different fronts, at many different stages.5,24 Pleiotropy is a vital characteristic in any cancer preventive strategy, because cancers all have multiple causes and mechanisms of their own, readily overcoming single-targeted therapies. Detailed studies now reveal the following 12 distinct mechanisms by which selenium prevents potentially cancerous cells from attaining full-blown tumour status:2 1. Regulation of lipoxygenases, enzymes that produce inflammatory molecules that promote cancer growth 2. Direct reduction of oxidative stress that causes free radical damage 3. Protection of the antioxidant-recycling seleno-proteins 4. Detoxification of cancer-inducing metals 5. Induction of protective “phase II” liver enzymes that neu-
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12. Limiting effects on tumour invasion and metastasis These 12 mechanisms act together to maximize cancer protection, and new mechanisms are still being discovered.26,27 But unlike most nutrients, not every form of selenium produces all of the same beneficial effects. THE EPIDEMIC OF IMMUNOSENESCENCE Age is a major risk factor for many cancers. Although this is usually viewed in the context of the cell biology, immunity may also contribute to the age-associated increasing incidence of most cancers. This is because cancers are immunogenic (at least initially), and the immune system can and does protect against tumour-genesis. However, immune competence tends to decrease with age, a phenomenon loosely termed “immuno-senescence”, implying that decreased immuno-surveillance against cancer could also contribute to increased disease in the elderly. FLAWED SELENIUM STUDY Many experts have since questioned the SELECT trial’s methodology and conclusions.21 One problem with that study was that it used only a single form of selenium.19,22 This selenium compound is just one of several different forms in which selenium is available for nutritional supplementation. The major flaw in this study is that it used synthetic alpha tocopherol, which displaced critical gamma tocopherol from cells, thereby increasing cancer risk.19,69 Known as SELECT (for Selenium and Vitamin E Cancer Prevention Trial), the study appeared to show that selenium, alone or in combination with vitamin E, had no detectable effect on preventing cancers.19,20 The overwhelming scientific evidence supports selenium’s anticancer activity, and favors prudent dietary supplementation with selenium. Confusion arose, however, in 2009 with the publication of a single negative study, one that has contributed to substantial misinformation about the value of selenium in cancer prevention. Notably, those with false negative results may teach us more about selenium’s role in preventing malignancies than more positive reports. THE THREE FORMS OF SELENIUM ARE REQUIRED FOR CANCER PREVENTION Generally, we ingest selenium from a variety of plant and animal sources in several different forms, each of which has its
own unique suite of activities. However recent studies have identified the three forms of selenium most important in cancer prevention as mentioned previously are sodium selenite, L-selenomethionine, and selenium-methyl L-selenocysteine. These three compounds differ in the way your body handles them, and in their impact on your risk for cancer.31 For example, the organic selenium compound L-selenomethionine is better absorbed than inorganic sodium selenite.32 But inorganic sodium selenite more effectively increases genetic expression of the main selenium-containing antioxidant enzyme glutathione peroxidase.33 In general, the three selenium compounds complement one another in the ways they affect your body’s expression of important proteins involved in cancer prevention and suppression.34 In addition, all three selenium compounds induce cell death in various cancer types, but each compound is better at destroying some cancers than others.34,35 Within the organic compounds, differences exist. L-selenomethionine increases cancer cell death by apoptosis, for example, only in cells with an intact “suicide” gene called p53.34 Selenium-methyl L-selenocysteine, on the other hand, induces apoptosis in mutated cancer cells that lack this vital control mechanism.34 The totality of this data indicates why both the organic forms of selenium (L-selenomethionine and selenium-methyl L-selenocysteine), plus inorganic sodium selenite, are required to kill off all incipient cancer cells that might be developing in your body. IN SUMMARY Selenium is a trace element now recognised to be essential in human nutrition. It has attracted increasing scientific interest over the past few years for its powerful cancer-preventing potential. Selenium occurs in multiple forms in nature, three of which are especially important in preventing human cancers. Each of these three forms of selenium has produced intriguing findings. Laboratory studies reveal the reason: each form of selenium has a unique suite of mechanisms, and each affects different cancer types somewhat differently. APJ References:
1. Brozmanova J. Selenium and cancer: from prevention to treatment. Klin Onkol. 2011;24(3):171-9. 2. Naithani R. Organoselenium compounds in cancer chemoprevention. Mini Rev Med Chem. 2008 Jun;8(7):657-68. 3. Clark LC, Combs GF, Jr., Turnbull BW, et al. Effects of selenium supplementation for cancer prevention in patients with carcinoma of the skin. A randomized controlled trial. Nutritional Prevention of Cancer Study Group. JAMA. 1996 Dec 25;276(24):1957-63. 4. Ganther HE. Selenium metabolism, selenoproteins and mechanisms of cancer prevention: complexities with thioredoxin reductase. Carcinogenesis. 1999 Sep;20(9):1657-66. 5. Rayman MP. Selenium in cancer prevention: a review of the evidence and mechanism of action. Proc Nutr Soc. 2005 Nov;64(4):52742. 6. Fleet JC. Dietary selenium repletion may reduce cancer incidence in people at high risk who live in areas with low soil selenium. Nutr Rev. 1997 Jul;55(7):277-9. 7. Peters U, Takata Y. Selenium and the prevention of prostate and colorectal cancer. Mol Nutr Food Res. 2008 Nov;52(11):1261-72. 8. Yoshizawa K, Willett WC, Morris SJ, et al. Study of prediagnostic selenium level in toenails and the risk of advanced prostate cancer. J Natl Cancer Inst. 1998 Aug 19;90(16):1219-24. 9. Ghadirian P, Maisonneuve P, Perret C, et al. A case-control study of toenail selenium and cancer of the breast, colon, and prostate. Cancer Detect Prev. 2000;24(4):305-13. 10. Willett WC, Polk BF, Morris JS, et al. Prediagnostic serum seleni-
um and risk of cancer. Lancet. 1983 Jul 16;2(8342):130-4. 11. Salonen JT, Alfthan G, Huttunen JK, Puska P. Association between serum selenium and the risk of cancer. Am J Epidemiol. 1984 Sep;120(3):342-9. 12. Glattre E, Thomassen Y, Thoresen SO, et al. Prediagnostic serum selenium in a case-control study of thyroid cancer. Int J Epidemiol. 1989 Mar;18(1):45-9. 13. Mark SD, Qiao YL, Dawsey SM, et al. Prospective study of serum selenium levels and incident esophageal and gastric cancers. J Natl Cancer Inst. 2000 Nov 1;92(21):1753-63. 14. van den Brandt PA, Goldbohm RA, van ‘t Veer P, et al. A prospective cohort study on selenium status and the risk of lung cancer. Cancer Res. 1993 Oct 15;53(20):4860-5. 15. Helzlsouer KJ, Comstock GW, Morris JS. Selenium, lycopene, alpha-tocopherol, beta-carotene, retinol, and subsequent bladder cancer. Cancer Res. 1989 Nov 1;49(21):6144-8. 16. Taylor PR, Qiao YL, Abnet CC, et al. Prospective study of serum vitamin E levels and esophageal and gastric cancers. J Natl Cancer Inst. 2003 Sep 17;95(18):1414-6. 17. Lee EH, Myung SK, Jeon YJ, et al. Effects of selenium supplements on cancer prevention: Meta-analysis of randomized controlled trials. Nutr Cancer. 2011 Oct 17. 18. Klein EA, Thompson IM, Jr., Tangen CM, et al. Vitamin E and the risk of prostate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA. 2011 Oct 12;306(14):1549-56. 19. Lippman SM, Klein EA, Goodman PJ, et al. Effect of selenium and vitamin E on risk of prostate cancer and other cancers: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA. 2009 Jan 7;301(1):39-51. 20. El-Bayoumy K. The negative results of the SELECT study do not necessarily discredit the selenium-cancer prevention hypothesis. Nutr Cancer. 2009;61(3):285-6. 21. Marshall JR, Ip C, Romano K, et al. Methyl Selenocysteine: single-dose pharmacokinetics in men. Cancer Prev Res (Phila). 2011 Aug 16. 22. Fleming J, Ghose A, Harrison PR. Molecular mechanisms of cancer prevention by selenium compounds. Nutr Cancer. 2001;40(1):42-9. 23. Sinha R, El-Bayoumy K. Apoptosis is a critical cellular event in cancer chemoprevention and chemotherapy by selenium compounds. Curr Cancer Drug Targets. 2004 Feb;4(1):13-28. 24. Fang MZ, Zhang X, Zarbl H. Methylselenocysteine resets the rhythmic expression of circadian and growth-regulatory genes disrupted by nitrosomethylurea in vivo. Cancer Prev Res (Phila). 2010 May;3(5):640-52. 25. Bhattacharya A. Methylselenocysteine: a promising antiangiogenic agent for overcoming drug delivery barriers in solid malignancies for therapeutic synergy with anticancer drugs. Expert Opin Drug Deliv. 2011 Jun;8(6):749-63. 26. Bhattacharya A, Turowski SG, San Martin ID, et al. Magnetic resonance and fluorescence-protein imaging of the anti-angiogenic and anti-tumor efficacy of selenium in an orthotopic model of human colon cancer. Anticancer Res. 2011 Feb;31(2):387-93. 27. Spallholz JE. Selenium and the prevention of cancer Part II: Mechanisms for the carcinostatic activitiy of Se compounds. The Bulletin of Selenium-Tellurium Development Association. 2001 October;October 2001:12. 28. Brozmanova J, Manikova D, Vlckova V, Chovanec M. Selenium: a double-edged sword for defense and offence in cancer. Arch Toxicol. 2010 Dec;84(12):919-38. 29. Mahn AV, Toledo HM, Ruz MH. Organic and inorganic selenium compounds produce different protein patterns in the blood plasma of rats. Biol Res. 2009;42(2):163-73. 30. Barger JL, Kayo T, Pugh TD, et al. Gene expression profiling reveals differential effects of sodium selenite, selenomethionine, and yeast-derived selenium in the mouse. Genes Nutr. 2011 Aug 17. 31. Burk RF, Norsworthy BK, Hill KE, Motley AK, Byrne DW. Effects of chemical form of selenium on plasma biomarkers in a high-dose human supplementation trial. Cancer Epidemiol Biomarkers Prev. 2006 Apr;15(4):804-10. 32. El-Sayed WM, Aboul-Fadl T, Lamb JG, Roberts JC, Franklin MR. Effect of selenium-containing compounds on hepatic chemoprotective enzymes in mice. Toxicology. 2006 Mar 15;220(2-3):179-88. 33. Suzuki M, Endo M, Shinohara F, Echigo S, Rikiishi H. Differential apoptotic response of human cancer cells to organoselenium compounds. Cancer Chemother Pharmacol. 2010 Aug;66(3):475-84. 34. Lunoe K, Gabel-Jensen C, Sturup S, Andresen L, Skov S, Gammelgaard B. Investigation of the selenium metabolism in cancer cell lines. Metallomics. 2011 Feb;3(2):162-8.
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SKINSCIENCE
Neoplastic Lesions of the Skin By Gay Wardle
According to a recent study Australian skins age more quickly and are prone to skin cancers predominantly because we are fringe dwellers and love the outdoors. With the winter months over and moving into the summer months, this is a good time to brush up on understanding the various types of lesions that may become more frequent as the months progress. In this article Gay Wardle present a useful description of neoplastic skin lesions and their level of risk of malignancy, as well as a useful evaluation tool when evaluating a lesion. The summer months are not the only months of year that we should be thinking about protecting our skin from developing skin cancers. The incidence of skin cancer in Australia and around the world has increased dramatically over the past few decades. Despite preventative public health measures (national advertising campaigns), it is projected that there will be continued increases in skin cancers. It is astounding to know that skin cancers account for one quarter of all new malignancies with 99% off these being basal cell carcinoma, squamous cell carcinoma and melanoma. Fortunately, skin cancer lends itself well to prevention and early diagnosis, which improves the chances of cure. We are lucky enough here in Australia to have clinics that specialise in diagnosing early symptoms of skin cancer.
BCC
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SCC
Sadly this year my family lost a dear friend to melanoma so this disease resonates all too well with me. Melanoma is the eighth most common malignancy in the world and in UK incidences have more than tripled over the last 25 years. Skin types 1 and II with traits like red hair and ephilades (freckles) are associated with and increased risk of skin cancers and melanoma although melanomas can in rare instances, occur on the palms of the hands and soles of the feet, under finger nails and toe nails as well as genital areas. A risk factor, although not always, is the presence of increased numbers of moles and the presence of bigger moles with irregular or ill-defined edge, know as atypical moles. Moles are acquired proliferative lesions, which appear from early childhood until mid-adult life. Melanocytic nevus is a type of lesion that contains types of melanocyte cells. I am going to list and describe just a few of these cells in this article: Basal cell carcinoma: This is the most common form of skin cancer. They are shiny or have a translucent pink colour with a presence of multiple surface telangiectasia. Most BCCs
EPIDERMAL NEVI
SEBORRHEIC KERATOSIS
develop on the face and can cause local tissue destruction if left un detected. They grow slowly, although this can be variable at times. There are variations to these lesions: Nodular BCC Superficial BCC Morphoeic BCC Pigmented BCC
with pigmented keratinaceous debris. Typically found on the face, trunk , neck and upper extremities. It the association of nevus comedonicus with abnormalities in the central nervous system, skeletal system and skin. Clear Cell Acanthoma: This is a benign solitary epidermal papule, or nodule most commonly located on the lower extremities of the middle-aged and elderly. Presents as a red nodule that can mimic a vascular neoplasms.
The growth rate of basal cell carcinomas varies considerably from several months to several years, with some growing in bursts and others remain static for years.
Typically these lesions are seen in older clients/patients but that does not mean we don`t see these in younger clients as well.
BCCs are not life threatening and can be cured. Recurrences usually develop in the first three to five years post treatment. Treatment includes minor surgery, cryotherapy, topical creams and radiotherapy.
It is critical that when treating skin conditions that a historical evaluation is a determination of the duration of the any lesions in question. The ‘ABCDEs’ is a useful strategy that will help you define individual pigmented lesions.
Squamous cell carcinoma: These are the second most common cutaneous malignancies. Clients/patients with auto-immune disease seem to be at risk for developing SCCs. The lesions that tend to appear in auto-immune suppressed patients tend to be more aggressive in growth. They appear as growths that develop over weeks and months and ultimately develop into ulcers, or plaques. There is a thickening at the edge, or base of the lesion with variations including:
THE ABCDE STRATEGY
Ulcers Plaques Nodules Surgery is the key option for removing SCC. Epidermal Nevi: These are benign lesions that result from overgrowth of the epidermis either in localised areas of the skin, or more extensively, covering large areas. They usually appear at birth, or within the first year of life though could develop later during childhood or adulthood. They are normally skin-coloured or brown in colour. Seborrheic keratosis: This is a very common benign tumor commonly found in older individuals. They present as one or more, light brown flat lesions with a velvety verrucous surface. They have a suck-on-the-skin appearance and feel very rough to touch. They can be removed with a cryo pen. Warty dyskeratoma: This is an uncommon neoplasm that presents as whitish solitary hyperkeratotic papule with an umbilicated centre. Worty dyskeratona is also commonly found on elder patients and found mostly on the head, neck or back. Nevus Comedonicus: This is a rare disorder of pilosebaceous development. The lesions present at birth, or in early childhood. It is a collection of dilated follicular ostia plugged
WARTY DYSKERATOMA
“A” refers to asymmetry. A typical pigmented lesion is usually asymmetrical. This description particularly applies to lesions of dysplastic nevus, lentigo and melanoma. However, some benign pigmented lesions are also asymmetrical (Albright pigmented macule nevus spilus and the ink spot lentigo) and conversely, not all symmetrical melanocytic proliferations are benign. Nodular melanomas or minimal deviation melanomas are usually symmetrical lesions that expand into round growths. “B” refers to border. The borders of most dysplastic melanocytic proliferations are irregular. In general, the greater the degree of border irregularity, the greater is the degree of melanocytic atypia. The border may be pronounced, or exaggerated because of induration (the process of becoming hard) and/or colour prominence. Lesions manifesting irregular borders may be benign, such as the Albright melanotic macule, the solar lentigo and the nevus spilus. “C” refers to colour. The colours of melanoma are highly variable within a given lesion. The radius of the growth phase of superficial melanoma demonstrates the most variation in colour, where some lesions may exhibit hues of red, white, blue, brown black and gray. Congenital nevi have a regular pattern of hyperpigmentation around follicular orifices. Nevus prilus often shows a reticulated pattern of darker pigmentation on a pale brown background. Dysplastic nevi can manifest irregularity in pigmentation, but the colours will be in the brown colour range. Melanomas show an irregular haphazard pattern of coloration and include greater shade ranges which include red,
NEVUS COMEDONICUS
CLEAR CELL ACANTHOMA
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purple and black colours. “D” is for diameter. Most benign common acquired nevi have a diameter no greater than 4-5mm. “E” is for elevation. Many melanomas show surface irregularities with asymmetrical foci of palpable nodularity. Radial growth of lentiginous melanomas is more commonly flat. Benign lesions are typically uniformly and /or symmetrically elevated. IN CONCLUSION
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A complete evaluation of the patient must be systematically performed and any pigmented lesions should be evaluated according the “ABCDE” rules. It is likely that the incidence of melanoma can be reduced by wide spread reduction in exposure to ultra-violet radiation. Complete sun avoidance is a ridiculous option and clearly not a good one. With the summer months approaching us, be vigilant to check your clients/patients carefully for any suspect lesions and refer them to a dermatologist or a skin cancer clinic. You could potentially save a life. Remember to educate clients and patients to be careful not to get burnt, wear protective clothing and sunscreens may be simple solutions, but they must be stressed because they are still the best options.
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PROFESSIONALDEVELOPMENT
LET US REASON ABOUT TRANSFORMATION by Tina Viney
IN REVIEWING new advances I am become very much aware of the need for transformation. It is a term that is surfacing quite a lot in the business world these days. In fact, I spoke about it at the last APAN conference we had in Brisbane. It is a term that has compelled me to review how I relate to it as an individual and as the head of an organisation. But, what is transformation and what does it mean? Furthermore, why is it important for businesses to identify the benefits of transformation in their professional and business operations. I would like to take a closer look at transformations as I believe it could be the key to our future survival and that fact makes it important enough reason to understand and embrace it. WHAT IS TRANSFORMATION? In an organisational context, transformation describes a process of profound and radical change that orients a business in a new direction and takes it to an entirely different level of effectiveness. Unlike ‘turnaround’ (which implies incremental progress on the same plane) transformation implies a basic change of character, or concept that may result in changes that may take the business to a whole new level giving it little or no resemblance to its past configuration, or structure. This may seem scary, but if there is sufficient evidence to support the need for radical change then this approach may allow the business to rapidly take advantage of change.
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Here is a simple example. If you are a salon owner, in the past you may have printed newsletters and sent them out to alert your clients of new treatments or products. A transformational approach may direct you to get rid of the printed newsletter, create an on-line one that you email to your clients and then target your clients through Facebook, other social media platforms and through a personalised text. This is a transformational approach where there is a shift towards a totally different approach that does away with past systems for a more modern approach that can render better outcomes for the business. WHY AND WHEN IS TRANSFORMATION NEEDED? In our rapidly changing world new advances can create a game-change to our business world as the race is often to the swift. One example is the introduction of laser or IPL hair reduction. In the past waxing was the only option and required your clients to visit approximately every six weeks to maintain a hair-free face or body. However, when IPL and Laser technologies were introduced they offered another, more efficient option. While there is still a place to remove hair through waxing and sugaring, many businesses have chosen to do away with the old methods altogether and just offer hair reduction through light-based technologies. Implementing a transformation process in your business should have as the ultimate goal to maintain your clients and outperform your competitors on an ongoing basis. It should affect your business across all of your targeted objectives or Key Performance Indicators. This is because transformation relies on implementation of effective market and stay-in-
business strategies that attract more profitable clients from your target market, while lowering operating costs. HOW DO I DETERMINE IF I NEED TO TRANSFORM MY BUSINESS? A simple way to determine if you need transformation is to ask yourself three simple questions: Do we need to reinvest in new opportunities as the market needs evolve? Are our offerings and our performance superior to our major competitors?
A few weeks ago I was contacted by a business owner who was struggling to sell treatment packages because she said “people just don’t have the money.” As a result she had dropped her packages to $99 and was getting almost no interest in them, so she was blaming the economy.
Many businesses today appear to get lost in the chase for growth and change. They are often fearful of embracing change, let alone transformation. But look at it this way - the whole objective of holistic transformation is to become visibly more competitive, while at the same time identify better and more cost-effective ways of running your business and achieving greater profits.
Is our competitive advantage strong enough to allow us to leverage off existing clients for further business growth? If the answers to any or all of these issues are doubtful, you need to change your approach. If you don’t change and your competitors change, you will potential lose clients to them.
When I asked her what she was trying to sell for $99 she said “three microdermabrasion treatments”. My response to her was that stand-alone microdermabrasion treatments went out over 10 years. Today’s client wants a more comprehensive skin management package that includes a variety of technologies that can, not just remove dead skin cells, but can also focus on building collagen integrity, improving skin hydration, minimising lines and wrinkles as well as addressing any pigmentation.
HOW DO I FIND OUT WHAT AREAS OF MY BUSINESS I NEED TO TRANSFORM? Even if you find that business is slowing down and something needs to change, you still need to determine what new strategy you need to implement to turn things around. To do this you will need to look at three key areas:
Today, for a complete package using a variety of technologies and techniques to achieve a desired outcome in skin improvement most salons and clinics can ask for $2000 and still find interesting consumers ready to invest in such a program. In essence, the problem with the said business owner was not her price or the economy, but what she was offering no longer had the appropriate appeal and did not measure up to what other businesses were offering.
1. What are you offering? With new advances and changing consumer expectations, is it possible that what you are currently offering is becoming outdated and losing its competitive advantage?
Indeed, here is a perfect example of a need for a total transformation on what services were provided and ways of promoting their benefit to best meet with new consumer expectations.
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2. How are you communicating and marketing your services and products? OK, you are proud of your up-to-date services and products which you have updated, but how are you getting your message across to maximise consumer engagement? Understanding your target market and any changes on how they wish to be communicated to is so important in this day and age of social media. To determine the best approach it’s useful to survey your clients on their preferred method they wish to be notified of your services. Do they prefer email, text, other social media platforms or a phone call? Utilising the preferred method of communication will ensure a greater response rate for your business. If you are not an expert in this area is may be beneficial to talk to someone who specialises in social media services and management. 3. How are you educating your staff? It is pointless updating technology and marketing strategies unless these changes are communicated to all your staff. Appropriate policies and procedures must also be updated, but most importantly, your staff will need to receive the necessary training and education on the new business services, techniques and technologies that will now define your business. For your transformation strategies to succeed all who will be responsible for driving these changes must be appropriately trained. EXAMINING THE GLOBAL PERSPECTIVE As a business owner you are very focused on achieving the very best results with the technologies, culture and the methodologies that define what your business promises and stands for. However, while you are focusing on your date-to-day operations in perfecting what you do you may be missing out on the subtle changes that will shape the future of both the industry as well as new consumer trends. So
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how do you gain the global perspective? As part of its duty-of-care to its members APAN spends over three hours per day researching and monitoring changes that are happening both with new industry advances, regulations and consumer trends. This valuable data can benefit businesses by bringing clarity to specific key important areas that are influencing the changing landscape of the industry. Each year APAN hosts conference programs in various States. At these events some of this information is communicated through appropriate lectures allowing delegates and business owners to gain an objective, global perspective on how the industry is changing and how it is influencing consumer trends. Gaining insight of this global perspective allows business owners to stay one step ahead of change and maintain their competitive advantage. CONCLUSION Many businesses today appear to get lost in the chase for growth and change. They are often fearful of embracing change, let alone transformation. But look at it this way - the whole objective of holistic transformation is to become visibly more competitive, while at the same time identify better and more cost-effective ways of running your business and achieving greater profits. Now isn’t this something worth considering! APJ
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Experts agree that effective, advanced post-graduate courses must be based on practical, hands-on experience. At the Clinical Therapies and Laser Institute we understand that a person’s future is determined by their passion and propelled by excellence, confidence and commitment. Students are taught using practical, hands-on strategies, emphasising a face-to-face relationship between trainer and student. A focus on excellence in safety and results allows our students to be supported in their commitment to educational superiority, quality service and career advancement. In an environment where questions are answered, talents are enhanced and excellence made achievable, a Learning by Doing approach is emphasised. Our students are equipped with a superior skill set to ensure that they can become experts in their field of passion.
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• Chemical & Enzyme Peels • Photo-facial Skin Rejuvenation • Dermal Skin Needling • Fat & Cellulite Reduction • Fractional Laser Rejuvenation • Fractional Radio Frequency • Laser Tattoo Removal • Laser Wrinkle Reduction • Microdermabrasion
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Students of the Clinical Therapies and Laser Institute will become valued and capable members of the industry and leaders in various fields of aesthetic practice. APJ 91
SCIENTIFIC NEWS
Always committed to research Terry Everitt will now oversee the Scientific News section of APJ. While much of the information presented here will be medical, the segment can also provide interesting news and information for non-medical practitioners.
MISSING SKIN PROTEINS MAY HOLD KEY TO FINDING CURE FOR ECZEMA Missing proteins may be the trigger for eczema, a recurrent, inflammatory skin condition, according to the latest research. The finding could bring new hope – and, eventually, a cure – to the millions of people who now suffer from the disorder, says Judy Hu, M.D., of Advanced Dermatology, PC. Dr. Hu cites a study, published in the journal Nature Genetics in June 2017, indicating a genetic mutation is behind the loss of a protein that plays a critical role in protecting skin from invading microbes, allergens and environmental pollutants. The study was conducted by a team of scientists from the National Institute of Allergy and Infectious Diseases (NIAID). “Without this protein, the skin becomes ‘leaky,’ allowing water to escape and irritants to penetrate it,” said Dr. Hu, a board-certified dermatologist and a fellow of the American Academy of Dermatology. In a second study published in May 2017 in the Journal of Allergy and Clinical Immunology, scientists from Newcastle University in the United Kingdom pointed to a missing skin-barrier protein called filaggrin as a key element in development of eczema. “What’s so encouraging about these studies is that they are helping us learn more about this skin disease and leading the way to development of more targeted – and effective – treatments,” Dr. Hu says. Researchers have long suspected a combination of genetic and environmental factors as playing a role in eczema, but lack of a comprehensive understanding of the condition has made it difficult to find completely effective treatments, says Dr. Hu. Eczema, also called atopic dermatitis, causes skin to become red, dry and, oftentimes, intolerably itchy – and painful. The disease, which is not contagious, affects as many as 15 million Americans and tends to occur in families. Most eczema patients are infants and children, many of whom eventually outgrow the disease, but some 2 percent to 10 percent of adults suffer from the condition, Dr. Hu says. The Eczema Association of Australasia estimates that the average outof-pocket amount spent on products per year to treat one patient with atopic dermatitis is $425, with costs ranging
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from $13.50 to more than $2,000 per individual. As Heather Jacobs, the National President of the Eczema Association of Australasia, says in their website, eczema really is a common, frustrating and often debilitating skin disease that can have a significant physical and emotional toll on sufferers and their carers’ quality of life. Sometimes called the “itch that rashes,” eczema can occur almost anywhere on the body, but most frequently on the neck and the flexures of the arms and legs. In addition to intense itching and sometimes a burning sensation, the condition is characterized by a red rash with bumps that may ooze and become crusty when scratched. Dr. Hu advises parents of children with a suspicious skin condition and adult patients to see a dermatologist for any rash that does not clear up within a few days. Although eczema is normally more bothersome than dangerous and, in some cases, cosmetically unsightly, the disorder can lead to complications, especially if the irritated skin breaks down and becomes infected or the patient has a weakened immune system or a medical condition like diabetes or cancer. Although no permanent cure for the condition has yet been found, eczema can be controlled and flare-ups of the disorder minimised with appropriate use of prescribed and topical skincare, moisturisers and medications, Dr. Hu says. Dr. Hu also recommends that patients with the disorder: Bathe briefly in warm, non-soapy water and apply an emollient to the wet skin to “seal in the moisture.” Take short, lukewarm showers or baths and use only a mild, fragrance-free soap or body wash to prevent dry skin. Refrain from heavy exercise during flare-ups of the condition because sweating only further irritates the rash. Apply a non-prescription steroidal cream to the eczematous skin two times to four times daily. Otherwise, follow the directions of a topical medication prescribed by your dermatologist. Limit scratching; the dermatologist can suggest an antihista-
mine cream or a medication in pill form to counter the itching sensation. “Eczema patients should try to moderate their lifestyle as well by refraining from wearing tight-fitting clothes, practicing relaxation techniques to lower stress levels and avoiding certain foods and other substances that can cause allergic reactions,” Dr. Hu says. Ref: HealthNewsDigest.com
TATTOOS: DOES INK TRAVEL THROUGH YOUR BODY? The body stores tattoo ink in cells and between collagen bundles in the dermis. But some pigment particles go on a longer journey. What happens when tattoo ink is injected into your skin? Most of it remains firmly lodged there, but some pigments travel to lymph nodes or even destinations in your body that are farther afield. All the while, you are left sporting a new tattoo. From elaborate designs and sports team badges to the names of loved ones, tattoos come in all shapes and sizes. Their popularity has increased in the past 20 years, with 29 per cent of the population of the United States reporting to have at least one tattoo. But the inks used in tattoos are actually not developed for use in humans. They are mostly made for other applications, such as the car paint or printing industries. The U.S. Food and Drug Administration (FDA) have, in fact, not approved any pigments for tattoos, and skin reactions to tattoos are not uncommon. Although some tattoo inks are known to contain carcinogens, there is no concrete evidence that the chemicals in tattoo ink can cause cancer. Solid needles are used to deposit ink into the deep layer of the skin. The body recognises tattoo pigments as foreign particles and tries to clear them from the skin, but the chemistry of the ink used in tattoos makes this process quite difficult for the body. Hence, most of the colour stays in the skin. But why is it necessary to inject the ink so deeply? Pigments are lodged in the dermis
The tattoo needle punctures your skin around 100 times per second, with the aim of depositing the ink in a region of 1.5 to 2 millimetres below the surface of the skin. The reason for this depth of penetration is to bypass the outer layer of the skin, or the epidermis. As we know, the epidermis is constantly renews itself. Every day, thousands of epidermal cells are shed from our skin and replaced with new cells. Ink injected into the superficial skin layer would simply come off within three weeks. In order to give the ink a permanent home in your body, the tattoo needle must travel through the epidermis into the deeper layer, or the dermis. Nerves and blood vessels are located here, which is why getting a tattoo hurts and your skin tends to bleed. The bleeding is part of the skin’s natural defence against injury. The result is an influx of immune cells to the site of injury. Macrophages are specialised immune cells, whose job it is to engulf foreign particles and clear them from the tissue. But this process is only partially successful when it comes to tattoo ink. Some macrophages loaded with ink particles remain in the dermis, while other pigment particles are taken up by the main dermal residents, which are called fibroblasts. Clumps of pigment particles have also been found to stick between the dense collagen fibres of the dermis. Although every new tattoo will display some pigment loss, the majority of the ink will stay in the skin. A study in mice reported that 42 days after tattooing, 68 per cent of the dye was still located at the injection site. But where is the rest of the ink? Colorful lymph nodes, remote destinations In most cases, macrophages carry the ink particles to the lymph nodes closest to the site of the tattoo. Because the cells cannot break down the particles, they become lodged there. The side effect is that the lymph nodes take on the same colour as your tattoo. There is also some evidence to suggest that tattoo ink particles can travel through the blood and become lodged in the
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liver. Tattoos therefore might not just grace our skin; they may also impart your internal organs with a unique colour display. Ref: Medical News Today
SCIENTISTS FOUND A WAY TO RADICALLY REDUCE SCARRING, THANKS TO SEA CREATURES Scientists have developed a scar-reducing would glue using one splecific ingredient = gloop secreted from muscles. The mussel gloop is added to a piece of the skin protein called “decorin,” and a molecule that binds collagen to help skin to heal. From combat to everyday injuries, wound care is a vital part of healthcare. Patients in nursing homes, those recovering from amputations and diabetes complications, and so many more battle ongoing wounds. In fact, chronic wounds often take enormous amounts of time to heal, some never fully healing at all. However, in almost all of these cases, patients are left with scars, visible reminders of their trauma and pain. However, thanks to one new development, scar care might be getting a strange, but incredible, makeover. Scars are formed as a result of “broken” collagen. When collagen fibres regrow it is in a different pattern that creates the visible scars that we’re familiar with. But scientists may have found a way to circumvent this process. Goop secreted by mussels, yes, those bivalve mollusks, has been shown to be a crucial ingredient in a glue that could revolutionize wound care, according to a new study published in Biomaterials. Allison Cowin from the University of South Australia, who wasn’t involved in the study, said in an interview with New Scientist, “If this can be replicated in humans, it might be the next big thing for scar therapy.” Mollusk Care The impact of this discovery could be huge because scars can interfere with personal image, self-esteem, and longterm happiness. Previously, doctors used the skin protein decorin to reduce scars, but it is difficult to synthesize and produce. Other researchers have developed alternative means of
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dealing with scars, like developing new compounds to restore skin to its natural structure, but Hyung Joon Cha and his colleagues at Pohang University of Science and Technology in South Korea decided, instead, to create a simpler version of decorin. Their “glue” uses the mussel gloop, a piece of the decorin protein, and a molecule that binds collagen. The team tested their glue with rats and, according to New Scientist, “By day 11, 99 percent of the wound was closed in the treated rats compared with 78 percent in the control group. By day 28, treated rats had fully recovered and had virtually no visible scarring. In comparison, control rats had thick, purple scars.” This glue could completely change how we heal and move on from injuries. So many people have surgeries, stitches, or cuts of some kind. If this glue is as effective as it promises to be, large visible scars could be a thing of the past. https://futurism.com/scientists-found-a-way-to-radically-reduce-scarring-thanks-to-sea-creatures/
MICRONEEDLING MAY PROVIDE ALTERNATIVE TO LASERS FOR ACNE SCARRING A study investigating the treatment of atrophic acne scars using microneedling compared to laser therapy identified some interesting information on how many treatments were needed to achieve positive results. The study conducted in 2016 was published in the journal Dermatologic Surgery found that “both non-ablative fractional laser 1,340 nm and microneedling are comparable and effective in the treatment of atrophic acne scars,” with microneedling having fewer side effects and less down time. The patients received three dermaroller microneedling sessions one month apart. Six months post-treatment, investigators saw no difference between results of the two therapies. “The main difference was that with lasers, people had two to three days of redness, compared to one day on the microneedling side. Also, after microneedling, there was no PIH,” Dr. Weinstein Velez says.
In a randomised split-face study published in a January issue of Dermatologic Surgery, investigators treated 30 patients with atrophic acne scars (skin types III through V) with fractional erbium:YAG laser on one side and automated microneedling (one session monthly for five months) on the other.
and most get to apoptosis (cell suicide). These ‘internal body’ cells are dealt with via the immune system. Several cells do not apoptose completely due to a small number of inhibitor mechanisms. Such cells cause accumulative damage to tissue and thus degenerative ageing or mutate to become cancerous.
At three months post treatment, the laser treated side averaged approximately 70% improvement as compared to 30% for microneedling (p> 0.001).4 Patients who received laser treatment experienced more side effects, including erythema, swelling and total downtime. One patient with skin type V developed PIH on the laser-treated side.
Senolytic drugs selectively target the faulty inhibitor mechanisms of the cell to complete senescence, similar to chemotherapy targeting cancer cells without the downsides of chemotherapy treatments. Experimental drug names such as navitoclax and piperlongumine have shown great results. Exciting news is that the Mayo Clinic is working on fisetin, which is a flavonoid plant polyphenol, available in many fruits and vegetables, which shows low toxicity levels.
An article published in the Journal of Clinical and Aesthetic Dermatology in July 2015 however, reported “statistically significant” improvements in scarring for 10 patients who received six sessions of microneedling with a dermaroller at two week intervals. It would appear that positive results can be achieved, but are determined by the appropriate number of treatments. Ref: http://dermatologytimes.modernmedicine.com/ dermatology-times/news/microneedling-may-provide-alternative-lasers
To be clear, research of such drugs is still in the infancy and in vitro (laboratory) and no drugs are available yet. This is a new and fast-moving field in which researchers are in a rush to publish and (presumably) pharmaceutical companies are taking pains to keep their results hushed up, until they can bring to market. APJ
‘STOP AGEING’ DRUGS ON THE WAY You might not have heard of senolytic drugs; they are a new branch of pharmacological research that investigates molecules (drugs) that can be used to complete apoptosis of senescent cells. Senescent cellshave has two meanings – one being with cells that have reached the end of their cell division span termed replicative senescence, or the Hayflick limit. The other meaning is when an individual cell has reached the end of its life cycle, such as a keratinocyte becoming a corneocyte at the outer layer of the Stratum Corneum. Different cells have different processes
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INDUSTRYSTANDARDS
What you need to know INCORPORATING COSMETIC MEDICINE IN YOUR BUSINESS The APAN Position Statement APJ 96
IN light of the tragic event in Sydney that have occurred recently and the subsequent death of Jean Huang after a cosmetic filler procedure that went wrong, APAN has received numerous enquiries for a statement about the incident. It is understood that Jean Huang was the manager of the Medi Beauty Laser and Contour Clinic and accepted to undertake a breast enhancement procedure through fillers by a Chinese tourist who allegedly stated that she was a doctor, even though she was not a licensed medical practitioner in Australia. The incident led to a cardiac arrest and to her subsequent death. As an industry we cannot afford to take a passive position and we need to demonstrate responsibility and ongoing commitment to the highest level of professionalism and best practice. This should be evident though education that requires adherence to strict protocols in these higher risk areas in order to protect the consumer and the wider public. Failure to demonstrate this will result in potential knee-jerk reaction by leading medical bodies and regulatory bodies such as Australian Health Practitioners Regulatory Agencies (AHPRA) who will deem the need to implement harsh restrictions. The industry is outranged for the complete lack of disregard and breach of Australian standard protocols that are adhered to by the majority of industry and who operate with professionalism and are committed to maintaining the integrity of the industry. We need to recognise that this unfortunate incident has occurred as a result of an unlicensed tourist acting alone and outside of Australian standards and does not reflect standard industry practice. Although we welcome a legislative review, this needs to relate to the surrounding facts of this incident. We approached Chris Testa, a senior university lecturer and Compounding Pharmacist for his expert opinion on the technical aspects of the incident. Chris stated that without all the relevant facts it is difficult to provide an accurate technical response, however, based on what has been reported there are several danger-signs that raised many questions. His concerns included: 1. Tramadol, that was administered is a very powerful pain reliever and nervous system depressant. The daily recommend dose should not exceed 400mgs (it was reported that the person in question had supposedly administered 1.5 gms), which is a very high dose. Furthermore, the practitioner administered lidocaine via injection, which could contribute to potential organ overload. An additional consideration is how was the lidocaine delivered, was it delivered slowly and with frequent aspiration? 2. When it comes to the filler, what filler did she use and what dosage did she administer? As is customary, did the filler also include lidocaine? Any practitioner administering anaesthetic either topically, or through injections must have appropriate training and knowledge on drug-interactions. They must be familiar with the signs of toxic reactions so that they can take immediate action, as well as understand how the anaesthetic they are using is systemically absorbed and how it is metabolised, whether through the liver or bloodstream and how they compete in the body with any other substances. Before using any drug, or anaesthetics the practitioner must thoroughly examine the patient’s medical history
and take into account any medications they may be using. For example, if they are on any anti-depression medication these could have an inhibiting or accumulative effect. Do they have a seizure disorder, are they aware that the anaesthetics they are using can potentially affect their seizure threshold. While topically applying anaesthetic the stratum cornium is encountered as a barrier, when administered by injection the drug goes straight into the site, giving a much higher serum concentration. Chris stated that the lesson learnt here is the importance of education. Having a thorough knowledge on medications, their interaction and safety considerations when working with these drugs is imperative to the safety of the patient. GUIDELINES As an industry body, we are committed to protecting the industry and fostering pathways to relevant education and ongoing professional development. For salons or clinics who wish to undertake a partnership and offer injectable treatments to their clients and patients, we offer Professional Guidelines to assist them to stay within the regulatory guidelines and ensure the safety of the consumers. These guidelines include information for reviewing appropriate qualifications of the injecting practitioner and also state that if the injector is a nurse, they must present evidence of their appropriate qualifications and be operating under the guidance and authority of a medical practitioner. Each patient’s treatment plan must be viewed and approved by the doctor. All drugs used must be TGA approved and practitioners should also be requested to provide evidence of their work and their commitment to on-going professional development. Additionally, the practitioners must provide their own Medical Malpractice insurance as well as Public Liability insurance, while the owner must also include Vicarious Liability within their insurance policy. This professional collaboration must also be bound by a legal contract that clearly outline the terms and conditions as well as the mutual responsibilities of the parties concerned. PROFESSIONAL DEVELOPMENT While currently the use of topical anaesthetics has restrictions for non-medical practitioners, APAN pioneered and developed in conjunction with Chris Testa an in-depth two part course on the Safe Use of Topical Anaesthetics for cosmetic purposes, which outlines the chemistry of anaesthetics, their activities and interaction with the body, contra-indications, identification of reactions and safety issues. This course has been proven beneficial to all practitioners whose patients, or clients require the use of topical anaesthetic when performing a procedure. Our intention in developing these courses is to provide quality education in the safe use of anaesthetics. We also wish to demonstrate to regulators that we are continuing to invest in responsible education that will allow our practitioners to gain a better understand on how these drugs interact with the body and safety considerations. We believe that responsible education can work in our favour toward future regulatory considerations. APJ
Further information on these courses can be accessed on the APAN website www.apanetwork.com
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LEGALMATTERS
CONTRACT LAW Do you know what makes a contract? An interview with Pointon Partners Lawyers At OUR APAN office we regularly receive enquiries about formalising an agreement with an interested party. While we have templates for HR Agreements for staff employment there are also other instances where contract should be in place, such as sub-contractors, leasing of equipment, or renting of the property for business premises. Most business owners wish to ensure that their contracts are covering their interests and have reached out to us to gain some understanding of contract laws. As contracts are governed by contact law, we approached our legal representatives Pointon Partners Lawyers with some questions order to assist members and readers better understand contract law. In this interview Associate Director Brigid O’Dwyer is joined by trainee lawyer Jess Tomlinson to answer for key questions when it comes to this subject. APJ 1: Can you identify instances when having a contract is imperative to a business owner. What are the potential risks of not having a contract?
Associate Director Brigid O’Dwyer and Jess Tomlinson (trainee lawyer)
importance to the business – for example in relation to the provision of marketing services, or purchase of key equipment; a clear articulation of each party’s obligations and expectations will benefit both – a prime example being a contract of employment; or there is room for doubt about what has been agreed to – such as trading terms, time for payment, the legal entities involved in the transaction, etc. A written contract can provide certainty between the parties, with proof of what was agreed to and can help to prevent or minimise misunderstandings or disputes. It can be professionally drafted by lawyers, which may assist in identifying matters for consideration, such as dispute resolution and termination provisions. At the very least, a list of key points, may be written down and agreed to by the parties. VERBAL AGREEMENTS
We enter into contracts every day of our lives. Whether we are purchasing a car, a house or simply buying our morning coffee, we are entering into a legally binding contract.
While verbal, or implied contracts can still be legally binding, there are inherent problems with proving the existence of an agreement, and there will often be differing opinions as to what was agreed. This in turn can lead to disputes and a risk that a Court will not enforce a contract due to the inability to prove the existence of a contract, or its terms.
Businesses also enter into contracts for many reasons - for example: when hiring equipment, employing staff, purchasing products, leasing premises and selling products or services.
Given how expensive and time consuming such disputes can be, it is a worthwhile investment as part of the business planning process to consider which agreements should be in writing, and bring these into effect.
Therefore, it is important for a business, or individual to consider the type of contract appropriate to each circumstance and this will dictate whether the contract should be written, verbal, or a combination of both and the level of detailed required
APJ 2: To prove that a contract exists what are the three elements that need to be in place?
In some circumstances, such as a sale of property the law requires a written contract, however in others, where no method is prescribed, it is up to the parties as to how they enter their agreement. It makes good business sense to have a written contract in circumstances where: transactions are of a high value, or otherwise of significant
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The law sets out basic elements which must be proved for a contract to exist. Broadly, there must be: (a) agreement, comprised of offer and acceptance; (b) consideration; and (c) intention to create legal relations. There must also be legal capacity to enter into the contract, and consent and formalities required for particular contracts must be met. Let’s have a look at these requirements in more detail:
(a) Agreement
stances in which the agreement was made.
For a valid contract there must be an agreement, which normally consists of an offer and acceptance, with sufficient certainty as to what is being agreed – the legal terminology is that what is required is ‘a meeting of the minds’.
It is widely understood that a commercially-based agreement will be seen as including a rebuttable intention to create legal relations.
Many people believe that an offer is simply “I want to buy some paintings from you”. This is not an offer as there is no agreement as to crucial elements such as quantity, quality, price and style. A statement of this nature is a mere willingness to deal or negotiate – the legal terminology is that it is only an‘invitation to treat’, and not an offer. An offer needs to definitively promise to be bound to do (or not do) something, if the other party to whom the offer is made makes a promise in return, e. g. to do, or not do, something. For example: Beauty Therapist: “I’ll perform an IPL treatment for $150. 00. I have an appointment free at 12. 00”. In order to accept the offer made, the party answering the offer will need to make a statement (oral or written) or accept via an act and this acceptance must be communicated. For example: Customer: “Yes please! I’ll be there at 12. 00”. Or the receiving party may make a counter offer. For example: “No, I’m only prepared to pay $150. 00 if you do a full head of foils”. This is a counter offer, which the hairdresser can choose to accept, or reject, or ignore. A counter offer ‘kills’ the original offer, which is no longer open for acceptance, unless the person who made the offer chooses to renew it, as a new offer, which can then be accepted. And on it goes! (b) Consideration In exchange for the promise of one party to do, or not do something, a price must be paid by the other. This is known as consideration. Consideration paid needs to be something of value, but does not need to be money, and must come into existence either with, or after the promise. It can be a right, interest or benefit going to one party or a detriment or loss, suffered or undertaken by another. Importantly, the consideration does not need to be given directly to the party who is promising to do (or not to do) something. For example: The Customer will pay $150 for the IPL treatment. The therapist, who is providing the service, can ask the customer to pay the $150 to her landlord. If there is an agreement where no consideration is given, it is possible to execute a sealed document such as a deed. Deeds do not require consideration in order to be legally binding. An example where a deed is often used is an agreement to vary the terms of a lease. (c) Intention to create legal relations The parties to a contract must intend to enter into a legally binding contract. This is usually inferred from the circum-
Further the presence of consideration will usually be evidence of the intention to create legal relations and be bound to the contract as the promisor has specified something as the price for the promise. For example: offering your friend a ride home from the city is not usually intended to create a legally binding relation. In comparison, booking an Uber home from the city will create legal relations. APJ 3: If a contract is viewed, dated, but not signed by both parties will it still hold up in Court? As noted above, a contract can be written, verbal or partly written and partly verbal. Therefore, a contract does not need to be signed in order to be enforceable in Court. The Court will look at whether a concluded bargain has been reached. If a written contract has been viewed, dated and agreed to, even if not signed, then the Court is likely to find that the parties intended to be bound by those terms, and that a contract has been entered into. The High Court of Australia has determined three classes into which an unsigned contract may belong: (a) “where the parties have reached final agreement on the terms of the contract and agree to be immediately bound but wish to restate those terms in a fuller or more precise way in a formal document; (b) where the parties have reached final agreement on all terms and intend not to depart in any way from them but the performance of some part of the contract is made conditional on the execution of a formal contract; (c) where the parties don’t intend to have a concluded contract unless and until a formal document is executed”. In each of the first two cases there is a binding contract. However, the third is fundamentally different as parties do not intend for the terms of the agreement to have any binding effect of their own. It can often be difficult for parties to prove whether or not an agreement has been reached – there have been numerous long and expensive Court cases conducted on precisely this topic, with the Court required to consider the context of any written terms, the conduct of the parties, the surrounding circumstances known to the parties and the purpose/ object of that agreement. Therefore, once again, it comes down to the guiding principle that the more important something is to the business, the more time and care the business should invest in properly articulating and recording it, and getting it signed off by the other party. APJ 4: What are unfair contract terms? The Australian Consumer Law (ACL) regulates unfair terms of consumer contracts and small business contracts, and has recently included provisions as to unfair contract terms. It is important to note that the provisions of the ACL in relation to unfair contract terms will only apply to consumer
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contracts and small business contracts. A consumer contract is a contract for a “supply of goods or service, or a sale, or grant of an interest in land to an individual who acquires the goods, services or interests wholly or predominantly for personal, domestic or household use or consumption”. A contract is a small business contract if: “the contract is for a supply of goods or services, or a sale or grant of an interest in land; and at the time the contract is entered into, at least one party to the contract employs fewer than 20 persons; and either of the following applies: the upfront price payable under the contract does not exceed $300,000; the contract has a duration of more than 12 months and the upfront price payable under the contract does not exceed $1,000,000”. So what is an unfair term? A term of a consumer contract or small business contract is unfair if: “it would cause a significant imbalance in the parties’ rights and obligations arising under the contract; and it is not reasonably necessary in order to protect the legitimate interests of the party who would be advantaged by the term; and iit would cause detriment (whether financial or otherwise) to a party if it were to be applied or relied on”. The ACL provides examples of unfair terms, which includes a term that permits, or has the effect of permitting, one party (but not another party) to: avoid or limit performance of the contract terminate the contract vary the terms of the contract; or
vary the upfront price payable under the contract without the right of another party to terminate the contract. For example: terms giving one party the right to say what is and isn’t a breach, or to interpret the contract may be unfair. If a term “defines the main subject matter of the contract, sets the upfront price payable under the contract or is a term required, or expressly permitted, by a law of the Commonwealth, State or Territory”, that term will not be considered an unfair term of a consumer or small business contract for the purposes of the ACL. APJ 5: If a contract is agreed upon and signed by both parties, but does not meet the Unfair Contract Terms will it still hold merit in a dispute? A term of a consumer contract or small business contract will be void if the term is found to be unfair and the contract is a standard form contract. In determining whether the term is unfair the Court can take into account such matters as it thinks relevant, but must take into account: the extent to which the term is transparent – i. e. the term is expressed in reasonably plain language, is legible, presented clearly and readily available to any party affected by the term; and the contract as a whole. The Court will look at whether the infringing term can be severed from the contract. This will depend upon whether the contract can still operate without the unfair term. If so, the contract will continue to bind the parties however the unfair term will be void, and unenforceable and as such will no longer form part of the contract. APJ
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RESEARCHFINDINGS
ASTRAGALUS - Supporting Telomere Integrity By Tina Viney
EPIDEMIOLOGY of human longevity is a fascinating study and one that we have featured regularly in APJ Journal. Both articles on telomeres and their role in life extension, as well as interviews with experts have addressed this topic on a regular basis. In 2015 we also featured an interview with Dr Bill Andrews the American molecular biologist and gerontologist whose career has centred on searching for a cure for human ageing and the specific association of human telomerase activity with immortal cells and cancer. At the time Dr Andrews had discovered several natural agents that protected the integrity of telomeres from shortening. However, further studies were needed to validate the effectiveness. Research has now moved forward identifying several herbs and plants that are proven effective against telomerase. In this issue I would like to profile the amazing plant astragalus, which is promising positive results in supporting the immune system, as well as protecting telomere integrity. However, before we review astragalus, let’s take a brief look on the role of telomeres in longevity. WHAT ARE TELOMERES? Inside the nucleus of a cell our genes are arranged along twisted, double-stranded molecules of DNA called chromosomes. At the ends of the chromosomes are stretches of DNA called telomeres, which protect our genetic data making it possible for cells to divide and hold some secrets to how we age and get cancer. The word telomere (tel-uh-meer) comes from the Greek word telos (end) and meros (part). In simple terms telomeres are the caps at the end of each strand of DNA that protect our chromosomes, like the plastic tips at the end of shoelaces. Without this coating, shoelaces would become frayed until they can no longer do their job. Likewise, without telomeres, DNA strands become damaged and our cells can’t do their job.
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Telomeres therefore keep chromosome ends from fraying and sticking to each other, which would destroy or scramble an organism’s genetic information. However, each time a cell divides, the telomeres get shorter. When they get too short, the cell can no longer divide; it becomes inactive or “senescent”, or it dies. This shortening process is associated with ageing, cancer, and a higher risk of death. As a result, telomeres have been compared with a bomb fuse. In short, telomeres are an essential part of human cells that affect how our cells age, and in fact, how long we live. There are several simple, lifestyle strategies that can help keep our telomeres healthy and impact on telomere length. Here are just a few: Get your fill of omega-3 fats Studies show that the omega-3 fats found in cold water fish such as salmon, mackerel and herring, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) protect telomeres. California scientists assessed blood levels of these fats and telomere length in subjects with heart disease and followed them for five years. Those with the lowest omega-3 levels came up shorter on telomere length. Up your fibre intake and include plenty of antioxidant-rich options While many people still think of fibre simply as a remedy for irregularity, it’s a nutrient linked to protection against telomere shortening. Include whole grains, fruits, vegetables, legumes and nuts to up your intake. As the process of oxidation is linked to telomere length, a diet chock full of these same foods also supply a variety of antioxidants. Include meatless days in your weak When Australian researchers assessed telomere length in colons for four weeks in subjects after eating various amounts of red and white meats, telomere length decreased as the percentage of meat increased. But the good news was the addition of resistant starch tempered the effect. Legumes such as lentils and beans and whole grains such as
oats are all sources of resistant starch. So make the switch to meatless meals more often and when you do have meat on the menu, partner it with assorted goodies like beans and lentils. Practice weight management You hear it everywhere you turn: Get rid of excess pounds. But now science is providing even more reason to do it as research shows obesity can cause damage at the cellular level due to telomere shortening. There is good news, though, about the impact of weight loss on telomere length. As high waist measures are linked to an increased risk of colon cancer, Australian researchers looked at telomere length in the lower gastrointestinal tract in obese men before, during and after a weight loss program. And as they predicted, shedding excess weight actually lengthened these important cell protectors leading to a decreased odds of developing colon cancer.
search confirms that only two of the over 2,000 species of astragalus, astragalus membranaceus and astragalus mongholicus, are used medicinally. Astragalus contains three components that allow the plant to have such a positive impact on human health: saponins, flavonoids and polysaccharides, which are all active compounds contained in certain plants including astragalus, as well as some fruits and vegetables. Saponins are known for their ability to lower cholesterol, improve the immune system and prevent cancer. The flavanoids found in astragalus provide health benefits through cell signalling. They show antioxidative qualities, control and scavenge of free radicals and can help prevent heart disease, cancer and immunodeficiency viruses. Research also confirm that polysaccharides are known to have antimicrobial, antiviral and anti-inflammatory capabilities, among other health benefits. Let’s take a closer look at the benefits of astragalus.
Get rid of chronic stress Astragalus Benefits Chronic stress can lead to hormonal changes that go handIn traditional Chinese medicine, the herb was hailed as a in-hand with telomere shortening. But for those who carry protector against stresses, both mental excess weight, the combination of overand physical. Astragalus provides health weight and stress appears to have a synergistic effect on telomeres. In other words, In traditional Chinese medi- benefits to a number of body systems being overweight together with being un- cine, the herb was hailed as and ailments. Because of the tremendous der stress can lead to more damage than if a protector against stresses, success of so many research studies and each occurred on its own. trials, new information about astragalus both mental and physical. is coming to light all the time. In general, Astragalus provides health its greatest strength is preventing and proLet’s get physical Here’s another healthy living recommentecting cells against cell death and other benefits to a number of dation that we hear about endlessly: reg- body systems and ailments. harmful elements, such as free radicals ular exercise is good for you. It’s key for and oxidation. Because of the tremendous easier girth control as well as offers heart healthy perks such as boosting levels of success of so many research According to continuing research, astragathe beneficial HDL-cholesterol. In addition, lus health benefits include: studies and trials, new it helps in maintaining healthy blood pres- information about astragasure and blood sugar readings. lus is coming to light all the 1. Acts as an Anti-Inflammatory Inflammation is at the root of most diseasIt also provides advantages for those un- time. In general, its greatest es as well as skin ageing. From arthritis to strength is preventing and heart disease, it’s often the culprit of the der stress. While it’s known that exercise can help to reduce levels of stress hor- protecting cells against cell damage. Many studies show that thanks to mones, California scientists investigated death and other harmful ele- its saponins and polysaccharides, astragalus can reduce inflammatory response in the impact of exercise on telomere length ments, such as free radicals connection to a number of illnesses and in women under stress. They predicted and oxidation. that exercise might protect from telomere conditions, from helping to heal wounds shortening in those under stress. And they and lesions to reducing inflammation in were right. They tested healthy women undiabetic kidney disease. der stress and found that those who were sedentary had shorter telomere length than women who engaged in regu2. Boosts the Immune System lar vigorous exercise. Another reason to put on some workIn terms of reputation, boosting the immune system is asout shoes. tragalus’ claim to fame and has been used in this capacity for thousands of years. A recent study from Beijing displayed its RESEACH UNCOVERS THE BENEFITS OF ASTRAGALUS ability to control T-helper cells 1 and 2, essentially regulating the body’s immune responses. Progressively the full extent New research is discovering the benefits of certain herbs of the herb’s capabilities are being determined, with suffiand plants that also offer protection in maintaining telomere cient evidence to suggest that astragalus used as an adjunct therapy, will soon be used to cure many diseases. length. One of these is astragalus. Astragalus is a plant within the Leguminosae (beans or legumes) family, with a very long history as an immune system booster and disease fighter. Its roots are in traditional Chinese medicine, in which it’s been used as an adaptogen for thousands of years, meaning it helps the body fight off stress and disease. Today, astragalus medicinal healing and treatment uses span many different illnesses and diseases. Astragalus roots are harvested from 4-year-old plants and are the only part of the plant that’s used medicinally. Re-
3. Slows or Prevents the Growth of Tumours Many recent screenings have shown the success of astragalus saponins, flavonoids and polysaccharides in decreasing, or eliminating tumours. In instances of chemoresistance treating liver cancer, studies have confirmed that astragalus has shown potential in reversing multidrug resistance and as an addition to conventional chemotherapy, according to a study published in the Journal of Pharmacy and Pharmacology.
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4. Protects the Cardiovascular System The flavonoids present in astragalus are antioxidants that help prevent plaque buildup in arteries and narrowing of vessel walls by protecting the inner wall of the vessel. In addition, a 2014 study published in the Chinese Journal of Integrative Medicine suggests injection of astragalus, combined with conventional treatment for viral myocarditis (inflammation of the middle layer of the heart wall), makes treatment more successful in heart conditions. Other studies have shown its ability to reduce blood pressure and level of triglycerides. High levels of triglycerides put individuals at risk for many forms of heart disease, such as stroke, heart attack and hardening of artery walls. Many individuals experience mild heart attacks without recognising them. However, during a heart attack, heart muscle damage occurs when there is a lack of blood supply and oxygen. At that time, calcium overload creates secondary damage. Astragalus can prevent additional heart muscle damage by regulating calcium homeostasis in the heart. 5. Regulates and prevents Diabetes and illnesses related to Diabetes Astragalus has been studied progressively as an antidiabetic. Studies show its ability to relieve insulin resistance and treat diabetes naturally. The herb’s collection of saponins, flavonoids and polysaccharides all are effective in treating and regulating type 1 and 2 diabetes. They’re able to increase insulin sensitivity, protect pancreatic beta cells (the cells in the pancreas that produce and release insulin) and also act as an anti-inflammatory in areas related to diabetes symptoms. Kidney disease in diabetics is also a common problem, and astragalus has been used to treat kidney illness for many years. More recent studies have shown astragalus can slow the progress of kidney problems in diabetics and protect the renal system. RESEARCH FINDINGS A recent study examined the functional assessment of pharmacological effects of astragalus on telomerase activation in human T cells. The study was conducted by Whittier College, Department of Biology, California. Further studies were also conducted by UCLA Department of Pathology and Lab
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Medicine. Both studies concluded some interesting findings. This section is quite scientific, however it is worth including aspects of the study in this article as it demonstrates the extent of research in this area and current findings. Here is what the studies uncovered: Some human cells, such as epithelial cells in the skin and cells of the immune system require many cell divisions in order to carry out their physiological functions. These cells show detectible, albeit low, telomerase activity. However, when T cells are stimulated, either through their T cell antigen receptor or with mitogens, they are able to upregulate telomerase activity that is in the same range as that observed in tumour cells [7]. Activation of robust telomerase within T cells is critical, since low telomerase activity has been shown to lead to a premature decline of the immune system. T cell induction of telomerase is, nevertheless, a transient event, and decreases significantly with increasing rounds of cell division; thus, T cell’s telomeres ultimately shorten to a critical length and signal senescence [8,9]. As further evidence of the critical role of telomerase in ageing, a number of in vitro and in vivo studies have shown that activating telomerase can not only delay ageing but also reverse age tissue degeneration [10,11]. Since both normal and abnormal (including cancer) cells must maintain genomic integrity, telomere and telomerase research has been a key area of investigation in such diverse fields as aging, cancer and pathogen-driven chronic degenerative diseases [12]. Moreover, given the demographic shift and the ever-growing ageing population, regenerative medicine is also focused on strategies to maintain telomere length. Gene therapy with hTERT, the catalytic component of telomerase, though successful in cell culture, is not a practical medical intervention. An attractive alternative would be a chemical telomerase activator, which would allow for a more precise control over the dose and timing. Several extracts from the Astragalus membranaceus root were studied as possible telomerase activators [11,13,14].
THE GOAL OF THE STUDY Several different extracts from the Astragalus membranaceus root were documented to activate telomerase activity in human T cells. The objective of this research was to compare two extracts from Astragalus membranaceus, TA-65 and HTA, for their effects on both telomerase and proliferative activity of human CD4 and CD8 T cells. This preliminary study highlighted the importance of comparative assessments of new activators of telomerase within single experiments in evaluating them as treatments for age-associated pathologies or for immuno-compromising chronic diseases. MAPK Specific Inhibitor Blocks TA-65 Induced Telomerase Activity Previous telomerase activators tested in earlier studies were linked to MAPK/ERK pathway [13]. To elucidate whether TA65 also activates telomerase through the MAPK pathway, compared the ability of MAPK and AKT inhibitors to block TA-65 induced telomerase activity. Results show that TA-65 likely uses the MAPK pathway to activate telomerase, based on the reduction of the telomerase activity in the presence of the MAPK inhibitor. This result was observed in both CD4 and CD8 T cells but most pronounced in CD8 T cells that have been stimulated for a second time. The AKT pathway similar to previous results with other telomerase activators did not seem to have a significant effect on telomerase activity on either CD4 or CD8 T lymphocytes. Telomerase Activator TA-65 but not HTA Increases T Cells Proliferation Previous research on the TAT-2 telomerase activator had shown that the enhanced telomerase activity was associated with increased long-term proliferative capacity of the T cells [13]. For this study the researchers decided to test for the earliest significant telomerase activity. Here, they showed that exposure to TA-65 at a dilution 10−5 gm/mL for even as short a period as three days is able to induce significant increases in proliferation. Indeed, both CD4 T cells and CD8 T cells experienced greater degrees of proliferation in the presence of TA-65 following both the first and second rounds of stimulation. This effect would be particularly critical during acute viral infection, since rapid early vigorous proliferation is essential for effective immune control over the infection. By contrast, exposure to HTA failed to induce increased proliferative activity during the 3-day culture period after either first or second stimulations. In the current study the research characterised the effects of the two extracts of Astragalus membranaceus, TA-65 and HTA, for their ability to induce telomerase activity and cell proliferation on both CD4 and CD8 T cells. The research showed that TA-65 increased CD4 and CD8 T cells telomerase activity by 1.3-3.3-fold over the control treatment (p < 0.05) in six out of six donor cultures, but HTA treatment caused mild telomerase increases in only two of the six donor cultures. The TA-65 telomerase enhancement was in the same range as that documented in our previous work with the TAT2 telomerase activator on CD8 T cells from persons infected with HIV [13]. In that study they observed telomerase enhancement of 1.5 to 2.5 fold increase over control, a change that was associated with a significant increase in the ability of the T cells to reduce HIV virus production when co-cultured with infected cells. Thus, their data suggest that TA-65 may be useful in treating both HIV disease and other clinical situations requiring
enhanced T cell telomerase activity. This study also demonstrated that the TA-65 induction of telomerase activity was most likely mediated via the MAPK, rather than the AKT pathway due to the higher sensitivity to MAPK inhibitors, consistent with results from TAT2 [13]. Importantly, their experiments highlighted donor variability with respect to the cell proliferation effects of both compounds. The results show that TA-65 increased proliferative capacity of T cells, but there was variability among the donors; the 10−5 gm/mL dilution worked on all cultures, whereas the 10−6 gm/mL dilution only worked with some donors. By contrast, no statistical difference in cell growth over the control cultures was observed for HTA for all concentrations tested. The results also accord with several in vivo studies done on both rodents and humans using telomerase activators [11,14]. In one study, mice treated with TA-65 showed similar increased telomerase enzymatic activity, and increases in health span indicators [11]. This study showed that the effects of the TA-65 included not only rescuing critically short telomeres, but also improving health parameters such as glucose tolerance, osteoporosis and skin fitness [11]. The report describing initial research in humans treated with TA-65 showed enhancement of certain immune parameters that had previously been associated with beneficial health effects [14]. The most important T lymphocyte-related observation made in that study was the decline in the proportion of T cells with a senescent phenotype (i.e., CD8+CD28-), thus restoring the peripheral blood T cell composition to a more youthful profile. The ability to regulate telomerase activity is viewed as very therapeutically important in the fields of ageing and cancer. Studies on the dynamic link between telomeres, cancer and ageing in the 1990’s dramatically increased interest in the field of telomere and telomerase biology. Early seminal papers described the discovery that telomere length functioned as a cellular mitotic clock for ageing [15,16]. Other key studies that further elucidated the relationship between cellular senescence and cancer involved genetic modifications of telomerase expression, leading to immortalisation of primary epithelial tissue without inducing cancer [17]. Astragalus membranaceus root extracts have traditionally been used for centuries as Chinese herbal teas for their health-promoting properties. Although most claims are anecdotal in nature, some have been substantiated in recent scientific studies [21,22,23]. However, no studies have directly compared the different compounds from the Astragalus membranaceus roots extracts (i.e., TA-65, TAT2, HTA and Astragaloside IV). RESULTS It stands to reason that not all Astragalus membranaceus roots extracts can stimulate telomerase activity to the same degree, hence the interest in the current study. Although the results indicated that the HTA in cultures stimulated telomerase activity in T cells in only two out of six donors, the small sample size may be a weakness to this study. Further studies should include a larger sample size, which could help confirm or change our observations. Nevertheless, the researchers feel that this preliminary study begins to lay the foundation for, not only comparing different Astragalus membranaceus root extracts, but also other natural telomerase activators. APJ
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16. Allsopp, R.C.; Vaziri, H.; Patterson, C.; Goldstein, S.; Younglai, E.V.; Futcher, A.B.; Greider, C.W.; Harley, C.B. Telomere length predicts replicative capacity of human fibroblasts. Proc. Natl. Acad. Sci. USA 1992, 89, 10114–10118. [Google Scholar] 17. Bodnar, A.G.; Ouellette, M.; Frolkis, M.; Holt, S.E.; Chiu, C.P.; Morin, G.B.; Harley, C.B.; Shay, J.W.; Lichtsteiner, S.; Wright, W.E. Extension of life-span by introduction of telomerase into normal human cells. Science 1998, 279, 349–352. [Google Scholar] [CrossRef] 18. Parish, S.T.; Wu, J.E.; Effros, R.B. Sustained CD28 expression delays multiple features of replicative senescence in human CD8 T lymphocytes. J. Clin. Immunol. 2010, 30, 798–805. [Google Scholar] [CrossRef] 19. Hooijberg, E.; Ruizendaal, J.J.; Snijders, P.J.; Kueter, E.W.; Walboomers, J.M.; Spits, H. Immortalization of human CD8+ T cell clones by ectopic expression of telomerase reverse transcriptase. J. Immunol. 2000, 165, 4239–4245. [Google Scholar] 20. Migliaccio, M.; Amacker, M.; Just, T.; Reichenbach, P.; Valmori, D.; Cerottini, J.C.; Romero, P.; Nabholz, M. Ectopic human telomerase catalytic subunit expression maintains telomere length but is not sufficient for CD8+ T lymphocyte immortalization. J. Immunol. 2000, 165, 4978–84. [Google Scholar] 21. Denzler, K.L.; Waters, R.; Jacobs, B.L.; Rochon, Y.; Langland, J.O. Regulation of inflammatory gene expression in PBMCs by immunostimulatory botanicals. PLoS One 2010, 5, e12561. [Google Scholar] 22. Auyeung, K.K.; Mok, N.L.; Wong, C.M.; Cho, C.H.; Ko, J.K. Astragalus saponins modulate mTOR and ERK signaling to promote apoptosis through the extrinsic pathway in HT-29 colon cancer cells. Int. J. Mol. Med. 2010, 26, 341–9. [Google Scholar] 23. Collins, R.A. A ten-year audit of traditional Chinese medicine and other natural product research published in the Chinese Medical Journal (2000–2009). Chin. Med. J. (Engl) 2011, 124, 1401–1408. [Google Scholar]
Are you a Cosmetic Tattooist who is committed to high COSMETIC TATTOO standards of education APAN REGISTERED PRACTITIONER (CTARP) excellence and best practice?
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To join CTARP the following prerequisite will be required:
! Must be a current financial member of APAN ! Government-Approved qualification in Cosmetic Tattooing
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AESTHETIC INDUSTRY BULLETIN
AN AWARD WELL-DESERVED
and spa owners face during their day-to-day operations.
Caroline Nelson is well-known in the industry for her dedication in helping businesses achieve success through her skills and knowledge, not just as a business coach, but also having first-hand experience of the salon environment as a previous salon business owner. With a strong beauty therapy background, she has an in-depth understanding of the industry and the various realities and challenges that salon
At this year’s ABIA Awards night Caroline was inducted into the Hall of Fame. This was a well-deserved award after her many years of serving the industry and helping to make a difference to 100’s of businesses who have sought her services. Congratulations Caroline. If you would like to access Caroline to assist you with your business visit www.SalonSpaBusiness.com.
UNDERSTANDING MEN IN THE AESTHETIC MARKET
It’s not just females who are seeking to look good, the male aesthetic market is now becoming a serious contender which is experiencing a consistent growth as more men are feeling
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This section presents the latest news, training dates and other Aesthetic Industry information
comfortable to seek treatments to help them look fresher, more attractive and more youthful. Men are increasingly image-conscious, and it is becoming more acceptable for men to care about their looks.
mentioned above, men are increasingly more conscious about their looks, and it has become socially acceptable for them to have aesthetic treatments. Some popular treatments that men are seeking include:
Understanding the male mentality around treatments, the physiology and biology of the male skin, and their consumer behaviours will benefit businesses to target this growing market.
“Manscaping” which includes waxing, shaving and grooming all areas of the body. Facials, including blackhead extraction, razor burn treatment, hydrating treatments, scrubs and anti-ageing treatments
THE MALE CLIENT Men have a particular interest in minimally invasive cosmetic procedures with little downtime. They are now more confident and inclined to purchase skincare and grooming products that are tailored directly to their skin and for them as males. As studies confirm this, subsequently manufacturers are launching more products to suited to men.
Microdermabrasion, which can refresh the skin’s appearance by dulling fine lines, reducing sun damage, making those enlarged pores look smaller, and just giving an overall smooth texture to the skin
Men are largely driven by a need to be competitive and youthful in the workforce, and it is now more socially-acceptable to have certain cosmetic procedures, such as hair removal and microdermabrasions. However, the more invasive treatments are also gaining popularity and momentum. UNDERSTANDING MALE BIOLOGY Men’s skin is quite different than women’s. Men have more testosterone, which makes their facial hair and skin thicker and oilier. Also, men shave their faces, which can wreak havoc on their facial skin and put them at increased risk for ingrown hairs and razor burn. Men are also less likely to use sunscreen, wear an appropriate moisturiser, or even wash their faces thoroughly at the end of the day, so there is a great deal of scope in educating them. TARGETING MEN THROUGH MARKETING In order to target the male client, you will need to appeal to his consumer side. He won’t be likely to visit a salon or clinic that is overly feminine, so, try to decorate and cater your business décor to a more neutral or male-inspired taste. Avoid colours and palettes that are clearly feminine, stay with neutral colours. Adorn the waiting room with gender specific reading materials and perhaps have a television that is playing programs targeted at both the female and male patients. Be sure to offer a retail skincare section that highlights your male skincare line (if you carry one). Make the environment as masculine, yet relaxing, as possible. AGE GROUP While in the past it was mainly the more mature male who was seeking cosmetic treatment younger men are now comfortable to include their own grooming and skincare routine. The market has therefore broadened with age span as young as 18 to70 plus, with each age group having its own needs.
Botox® is one of the most popular non-invasive treatments in the aesthetic market today, and it is gaining popularity for men too. Botox works by relaxing the underlying muscles that cause the skin to crease and develop lines or wrinkles. Chemical peels for refining skin texture. Dermal fillers plump lines and wrinkles and replace lost volume in the skin, usually with a hyaluronic acid solution. They can also fill out hollows in the cheeks or under the eyes and assist in facial chin implants. Laser lipolysis is a non-invasive sculpting procedure that removes pockets of fat in areas such as the love handles and double chins. Since these areas are traditionally plagued by the most stubborn kinds of fat, lipolysis is very effective and can target fat that diets can’t. It’s quite fascinating to understand and study what is motivating men to seek out aesthetic treatments. One theory is that male’s genetic survival dependent on his ability to provide resources for his mate and family, and the observations that he possesses the physical adaptations to provide these resources. Translated: from an evolutionary standpoint, he wants to look healthy, strong and attractive so to show his mate and offspring that he can provide for them. This is nothing new, as genetics have always played a role in selection; however, it is a bonus that male aesthetic treatments are now readily available and socially accepted. Practices looking to target these patients need to know how essential it is to understand these driving factors behind the male client, and to adjust their practices accordingly. Retrieved from: International Association for Physicians in Aesthetic Medicine https://iapam.com/understanding-men-in-the-aesthetic-market.html
TREATMENTS THAT MOTIVATE THE MALE CLIENT It’s not just waxing that men are looking for anymore. As
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NATIONAL WINNER! Katherine McCann is a multi-talented woman. Not only is she a qualified therapist and cosmetic tattooist, she also hold a degrees in Journalism and Political Science as well as in Human Resource Management. Her recent passion is in taking up the role of Editor of APJ, which she is more than capable of handling and we are delighted for her to undertake this role.
Kat is also highly dedicated her other passion, which is cosmetic tattooing - a skill that she has only qualified in, in recent years. This year Kat was awarded national winner of the Novice Category in Cosmetic Tattooing, present by the Australian Cosmetic Tattoo Association. It was wonderful to see her gain this recognition. Congratulations Kat, we are so proud of you. comfortable sharing their [cosmetic procedure] results,” LaVecchia says. “Obviously you still need consent for the doctors’ social media postings. But most millennials will gladly post on their own social media, without asking for anything for it. They’re happy to do it, because they’re part of an Uber mindset. They tend to share and over-share their experiences, and cosmetic procedures are no different.”
SHARING IS CARING: MILLENNIAL PATIENTS AND SOCIAL MEDIA Marketing to millennials, sometimes called the selfie generation, can be a shoo-in for aesthetic practices. Why? Millennials are happy to share. While Generation-Xers, baby boomers and older generations were unlikely to want to share cosmetic and aesthetic procedure experiences, millennials, from about ages 21 to 37, not only tell their friends and family, but also their social media networks, according to Tom LaVecchia, president of X Factor Digital Marketing. “Research shows that two-thirds of millennial patients are
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Today’s coveted millennial patients are not only having rhinoplasties, breast surgery and liposuction, but also filler and botulinum toxin injections, cosmetic tattooing and other non-surgical procedures according to statistics. To create social media marketing campaigns to reach the younger set, aesthetic practitioners should first understand their own personality types and ultimate comfort level with social media; then, they should focus on a campaign that is congruent with their practices and that connects with these younger patients, according to LaVecchia. Lisette Hilton (adapted to Aesthetics) Retreived from: http://aestheticchannel.modernmedicine.com/node/440478
COSMETIC NIGHT OILS THE NEW TREND
ucts, and more particularly from Nordic berry seeds.
The new cosmetic trend is called the “Midnight Shift”. The trend is seeing several companies formulating Overnight Facial oils that promise dual action - improve hydration, skin tone and elasticity as well as enhance relaxation and support quality, peaceful sleep.
Sustainable extraction VTT has also developed various methods to extract and enrich these actives. For berries with large seeds and various fruits, a specific sanding method can be used. For example, 20% of a cloudberry seed’s weight can be sanded using this method to recover the husk. “One kilo of berries yields 10gms of seed husk fractions, but a small amount suffices for cosmetics products,” explains the centre.
These multi-purpose oils utilise exotic and herbal extracts, herbs, peptides, enzymes, nutritive oils such as jojoba and rosehip, and are also infused with delicate aromas of jasmine, lavender and rose to sooth and relax the mind while working overnight to rejuvenate and a boost to collagen in the skin. Across the cosmetic industry, companies are turning to branding that includes stars, moons, planets and other parts of the cosmos as a means of showcasing how some of the simplest aspects of nature can inspire such power, awe and wonder. Polyphenols extracted from berry seeds can have a selected antimicrobial effect, finds Finnish research centre VTT Technical Research Centre of Finland Ltd has developed a new method to recover active substances from the fruit juice industry by-products. The Finnish organisation focused on the extraction of natural antimicrobial and antioxidant ingredients from seed husks. The new actives may have selected effects on the numerous microbes inhabiting the human skin. One kilo of berries yields 10 grams of seed husk fractions. VTT has manufactured a range of test products from seed husks, which have received extremely positive feedback from customers. When manufacturing fruit juice, the food industry produces large amounts of press cakes containing a range of useful compounds for the skin, such as polyphenols known for their antimicrobial and antioxidant properties. Until now, the industry has largely confined itself to extracting seed oil from press cakes. Despite the potential for new product concepts, no other high-value-added products are currently made from these press cakes. This is why VTT has been searching the best way to extract actives from fruit by-prod-
Then, active substances from seed husk fractions are extracted using the so-called hydrothermal extraction technology. “The whole process is free from no toxic agents or solvents,” claims VTT. The final product tends to be light-coloured, powdery, water-soluble, food-grade fractions. After sanding, seed oil can be extracted from the remaining seeds. VTT has optimised and patented the process for a variety of berry seeds. Natural anti-microbial actives One of the most interesting properties of the substances extracted from the husks of berry seeds is their ability to prevent the growth of harmful microbes. Indeed, research conducted by VTT show the new actives may have selected effects on the numerous microbes inhabiting the human skin. The company confirmed that berry seed husks contain large amounts of antimicrobial compounds which can help to maintain a natural microbial balance in the skin, by suppressing the growth of harmful microbes, while beneficial ones flourish. “This is based on nature’s way of protecting seeds from threats such as fungi,”explains Riitta Puupponen-Pimiä, Principal Scientist at VTT.”We have investigated how the microbes typically found in human skin and those that hide in cosmetic products react to polyphenols contained in berries. At a general level, you could say that seed husk fractions and the resulting extracts prevent harmful microbial growth in the skin, but do not suppress the growth of good microbes,” she adds. These findings could be of high interest for the cosmetics industry which is looking for natural alternatives to synthetic preservatives as well as for innovative methods to protect the skin’s microbiota. Ref: Premium Beauty News APJ
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COSMETICFORMULATIONS
How safe are your ingredients TRANS EPIDERMAL DELIVERY IN COSMETICS Dr Zac Turner
AS MOST of us know, the skin is the largest organ of the human body. It protects from invaders, heals after injury, provides sensation, and regulates through continuously turning over new skin cells. The hydrophobic nature of the phospholipid bilayer is its greatest weapon by far. Think of the skin as a filtration system plugged in at all times taking in (and keeping in) what it wants and not allowing invading microbes to cross. However with today’s technologies we have found ways to bypass this phospholipid bilayer and transport a variety of substances transdermally, for example, nicotine, birth control, peptide delivery into the skin. With that said many over the counter skincare products contain a massive load of compounds unwanted to the body. These products are secretly wreaking havoc on society as they have been known to contain a variety of toxins many of which are carcinogens. Consider the skin as a gateway. This gateway is being manipulated by some skincare products using a variety of chemical compounds to ‘hydrate’ the skin, support collagen growth etc. Some studies have found that though these products many indeed be hydrating the skin and retaining moisture, but has anyone stopped to ask at what cost does this transport method come? A product is indefinitely penetrating the phospholipid bilayer and bringing with it whatever compounds within, accessing the blood stream. Once the compound has reached the blood stream it can connect to almost any part of the body that it can ‘reach’. Studies have found that some products that reach certain parts of the endocrine system can lead to a variety of health complications. The changing of a physiological systematic processes within the body over longer periods of time can lead to multiple health complications and some believe some substances give rise to certain types of cancers. It’s important to know that the key point here is to know the composition of the products you are using. What you put onto your skin will eventually be absorbed by the skin. Read the label on the back that these companies by law are re-
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quired to state the ingredients. Here is a list of some of the harmful ingredients seen in today’s over the counter skincare products that in most cases goes unnoticed: 1. BHA, butylated hydroxyanisole and BHT, butylated hydroxytoluene • synthetic antioxidants used as preservatives most commonly seen in lipsticks and moisturisers • BHA is labeled as a possible human carcinogen by the International Agency for Research on Cancer, and also labeled as a Category 1 priority substance based on the evidence in that it interferes with hormonal function of the body. 2. DEA, diethanolamine • Used in the formulation of creams also used as a pH adjuster to balance acidic pH from other ingredients commonly found in soaps, cleaners and shampoos. • The European Union classifies any DEA-related ingredients, even at low residual levels, to be seriously harmful to overall health with prolonged exposure • Laboratory experiments have found that mild high dose of DEA and related ingredients have been linked to liver cancers and precancerous changes in the skin and thyroid. 3. DBP, dibutyl phthalate • Most commonly found in nail products as a solvent for dyes and a plasticiser which prevents polishes from becoming brittle • However, although not classified as a mutagen itself, it can enhance the capacity of other chemicals to cause genetic mutations. • DBP is labeled as a suspected endocrine disruptor on the evidence that it interferes with hormone function, this was confirmed by certain studies in Europe.
4. Paraben: methylparaben, butylparaben, and propylparaben • Parabens are the most commonly used preservative in cosmetics, estimated at around 75-90 percent of overall cosmetics
7. Siloxanes: cyclotetrasiloxane, cyclopentasiloxane, cyclohexasiloxane, and cyclomethicone • A silicone-based compound used in cosmetics to soften, smooth and moisten. Used extensively in moisturisers and facial treatments.
• Parabens also suspected to interfere with hormone function, also know to mimic estrogen, and in one study parabens were found in human breast cancer tissues.
• The European Union classifies cyclotetrasiloxane, also known as D4, as endocrine disruptor based on the evidence that it interferes with human hormone function and even a possible reproductive toxicant.
• Methylparaben applied on the skin reacts with UVB leading to increase in skin damage and DNA damage. • On study conducted in the U.S. found four different parabens in human urine samples, despite the low levels in products they were using. 5. Parfum (giving of any fragrance) • Usually representing a complex mixture of dozens of chemicals to give an aromatic fragrance to a product. Fragrances commonly used in perfumes, colognes, deodorants, nearly every type of personal-care product. Parfum is hard to avoid in cosmetics. • Research found that perfumes can be an irritant that can trigger allergies, migraines, and asthma symptoms, triggering attacks in nearly three out of four asthmatics. 6. PEGs, polyethylene glycols • Petroleum-based compounds that are widely used in cream bases for cosmetics as thickeners, solvents, softness, and moisture carriers. • Depending on the manufacturer some PEGs may contain amounts of 1,4-dioxane, labeled as a carcinogen by the International Agency for Research on Cancer. • This is why it can act as a transdermal enhancer, increasing permeability to allow greater absorption, including any potential harmful ingredients.
This is just a short list compared to what many substances available by many laboratories worldwide. These chemicals and their capacity for permeability through the skin, or through their ability to attach themselves to other chemicals that are high permeable cross the epidermal skin barrier can eventually find themselves through the blood stream very easily. This process is known as passive diffusion. This diffusion is the movement of molecules across a membrane without requiring an energy source and this can be achieved very easily. The skin is a defense organ, but also a very sensitive one. Sensitivity can result from the brutal assault it can take throughout the day coming from the external environment. In addition to the day-to-day wear and tear, harmful chemicals from lotions, shampoos and cosmetics that it is exposed to can weaken its defense and even contribute to compromising the overall health of the skin and the internal physiological functions that are undergoing in the body. IN CONCLUSION As new technology finds ways to reach ingredients within the deeper lays of the skin through improved bioavailability, it is important to reexamine what substances are we really introducing into the skin and how save are they if they can ultimately reach the blood, especially with continued and long-term use. APJ
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PUBLICRELATIONS
How to use PR to stand out THE POWER OF PERCEPTION AND RELATIONSHIPS
By Annette Densham - Publicity Genie ANNETTE DENSHAM is a multi-award winner renowned for her genius as a public relations expert. We first met her at the Brisbane APAN Aesthetics Conference when she charmed us with her wit and wisdom on how businesses can increase their exposure and capture new clients. Sharing the does and don’ts as well as some of her professional tips on how to make it in a competitive world of business, Annette thrilled her audience with her down-to-earth, yet humorous approach to publicity. In this article she shares with us more specifically about the power of perception and relationships through the use of PR. By its very nature, public relations (PR) is all about getting attention, standing out, being noticed and creating relationships with an audience - your ideal audience. PR is creating powerful relationships to build your brand. It is about telling stories that connect. More than ever people want to do business with people who actually care about them. Using different PR strategies, you can create a ripple effect of connection and relationships that will boost your business in ways paid advertising and traditional marketing never will. Forget everything you know about mainstream PR – which is getting your name in the media (you still want todo that). It is so much more – it is everything you say, everything you do and everything others say about you. It is the way you interact at a networking event. The blog you write every week. Your posts and interactions on Facebook. The information you share on LinkedIn. The information you share freely. The podcast interview you do. The great customer service experience you provide. The way you answer your phone. Everything you do in service of your business, your clients and prospective clients is about PR.
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CAUGHT IN A TRAP Many businesses fall into the trap of working IN their business and not ON their business. Caught up in the day-today activities of servicing clients, marketing and PR are overlooked. The 21st century catch cry of ‘I’m too busy’ is not going to get anyone new clients or the media attention craved. There are so many platforms for you to use – Facebook, Snapchat, Instagram, Pinterest, blog sites, LinkedIn, articles, networking, presentations etc. You can take one piece of content and adapt it for these platforms, making your life so much easier. Think of PR as planting a seed. A plant will only grow if you get the basics right – good soil, fertiliser and water. PR is the same … let’s start with the basics and where many people go wrong. MAKE THE RIGHT TURN There is something to be said about planning for success. So many start a business because they are awesome at what they do. If you want people to take notice, have the marketing basics in place. Target audience nailed – so you know who you are talking to Content – the story of your business and you so people can connect with you Overall brand – logo, key messages, pitch, images, brand promise Marketing and PR plan – it does not have to be complicated An idea how you are going to generate leads, calls to action, marketing materials
publicitygenie.com Website with content that not only sells but tells a story. Social media platforms that speak to your audience. If you get this right, marketing and promoting is much easier. PLANTING SEEDS Once you have the basics in place, you can then start planning your PR campaign. Remember, it does not have to be complicated. You do have to be consistent. You also have to think outside the box. So many people in business are scrambling to be featured in mainstream media – be interviewed on a popular breakfast TV program or be in a daily metropolitan paper. Great for the ego … but not helpful to build your profile on an ongoing basis. What you want to strive for is a mix of PR – stories in mainstream and local newspapers, an interview on radio, engaging social media content, podcast interviews, articles contributed to online magazines your target audience reads, blogs, videos, webinars, eBooks, books, talks, networking … Digging for story gold Once you tick off nailing your business foundations, created a plan and identified your key PR tools, it is time to start generating content. These are the stories that will engage, inspire, empower, educate and connect with your prospective client. Before you protest you have nothing to say, the answer is you have a product/service you’ve developed that meets a need in the market … something people want or need. If that is the case, and there are people willing to buy from you, they are also willing to learn, connect and build a relationship with you. Business in the 21st century is no longer about features and benefits; people want to do business with people, not a logo or business name. Your prospective client wants to know who you … and you care beyond closing a sale.
To find story fodder, use these 5 ideas to get started: 1. Your business story – How and why you got into business. 2. A controversial topic - Do you have an opposing or conflicting view to a topic? Can you share little known facts or secrets in your industry? 3. How tos and lists – create stories based around the problems you solve. 4. Google it – find stories in your industry/topic/niche and put a new spin on them. What can you add to the conversation? 5. Sign up to SourceBottle – journalists are always looking for good stories. They post here daily YOUR BRAND. YOUR STORY Seth Godin says “The brand is a story. But it’s a story about you, not about the brand.” Why? “The story includes expectations and history and promises and social cues and emotions.” We want to connect with people. Businesses that tell stories as part of their marketing mix stand out because they understand as human beings we want more than an exchange of dollars for product. Yet, knowing stories are the great connector and how people want to do business now, so many people in business shy away from storytelling because they do not want to brag about themselves or they feel they have nothing to share or don’t know where to start. If you want to get noticed, rise about the clutter, you have to embrace storytelling (or get someone to do it for you). APJ
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The Highest Professional Standards now has a New Name As the Aesthetics industry continues to advance so has the need to identify its leading practitioners through a new Standards Recognition Registration Classification.
APAN REGISTERED AESTHETICS PRACTITIONERÂŽ (ARAP)
Is the new industry Registration. Applicants will be assessed on their qualifications, knowledge, skills and standards. Industry professionals are invited to apply for Registration. There are five Registration Classifications:
] Registered Aesthetics Practitioner Clinician ] Registered Aesthetics Practitioner ] Registered Aesthetics Practitioner Associate ] Registered Aesthetics Practitioner Master Educator ] Registered Aesthetics Practitioner Educator
AP
APAN
PRACTITIO N
AN
AESTHET IC
ER
ED
S
REGISTE R
Who can apply:
ARAP
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Dermal Clinicians Dermal Therapists Cosmetic Nurses Skin Therapists Aesthetic Practitioners Educators A Quality Assurance Officer will assess each application on their qualifications and merits and determine eligibility.
APPLY TODAY For further information visit www.apanetwork.com and complete an ARAP Online Application Form. If you require further details please phone APAN 07 5593 0360.
Let us help you find them CTITIO NE PRA and keep them S
AD
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ORK
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Happy, Productive Staff are the Backbone of a SUCCESSFUL BUSINESS
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Phone today to learn how!
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Aesthetics Practitioners Advisory Network (APAN) P: 07 5593 0360 | info@apanetwork.com
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HOW TO BOOST YOUR CLINIC’S SOCIAL MEDIA PRESENCE IN FIVE EASY STEPS Trish Hammond - Director Plastic Surgery Hub
Trish Hammond is an industry specialist blogger with award-winning recogntion. Her skills are second to none and she is possesses a wealth of knowledge. Here she shares with us some of her wisdom on how to grow your business by optimising your social media Without question, content and social media marketing can help increase your audience and client/patient base. However, trying to increase your popularity without the right experience, or knowledge can make success elusive. This explains why knowing the basics is a real must. To reach your audience effectively, you need to understand how they think and feel. Your enhanced ability to fully understand what makes your market tick, will be your basis for constructing a simple, but strategic campaign that can catapult your online presence to more profitable heights. Here are a few valuable steps: Step 1: Listen to your target market’s pulse Informing your audience of your clinic’s services is easy. But differentiating yourself from the competition by proving your competency is challenging. To establish a unique online presence, you have to take some time to listen to what your market (ie audience) is saying. Go over your online content and join discussions on your social media networks and other relevant sites. Once you are familiar with their needs and wants, you can create or source content that adds value to their lives, while promoting your clinic’s stellar qualifications and service. Step 2: Stick to topics that are in line with your clinic’s purpose Diversifying your content can help maintain, or boost en-
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gagement. But if you have no focus or don’t know what you want out of your social media, do not expect that you can establish your clinic’s identity, let alone distinguish yourself from your competitors. The secret lies in streamlining your topics in such a way that they are either directly connected or can be connected to your clinical and marketing objectives. Step 3: When it comes to connections, value quality not quantity To boost your online presence, you need to work on building a community of active connections. When it comes to strengthening your online presence, keep in mind that it is always better to have 1,000 connections that engage actively (read, share, and participate) than 10,000 who become completely passive after making the initial connection. Step 4: Always keep your content quality above par High-quality content automatically projects a strong image for your clinic, displaying positive traits that will help you increase your audience and patient base. Quality content draws quality followers who do not only read, but also promote your clinic by sharing it with a wider audience. This process of online sharing and discussing boosts your Google rankings in turn, familiarising more people with your clinic by making it easier for them to find and follow you online. Step 5: Tap the right online influencers To reach a wider market, it helps greatly to connect with online influencers whose active followers will be interested in your clinic’s services. In tapping their assistance, you will successfully connect with your intended market and build a healthy relationship that translates to having a bigger and stronger patient and customer base.
FIVE SOCIAL MEDIA MARKETING TIPS YOUR CLINIC NEEDS TO KNOW ABOUT Social media marketing allows clinics and practitioners to reach a wider audience and to tap into new patient markets without the high costs of traditional advertising. However, despite its seeming simplicity, there is a methodical science at work behind it. Every feature and channel presents networking opportunities that could boost your clinic’s popularity. The key lies in knowing how to connect with your audience effectively and which social media channels will best serve your purpose, as well as how to use them the right way. 1. Launch a Facebook and/or LinkedIn Page (You can also set up an account on any of the following: Twitter, Instagram, and Pinterest) Joining any of these networking sites is easy and free. With regards to identity theft, you have nothing to worry about provided you exclude personal details, which you don’t want the public to know, in your profile page. After launching, the next step is to come up with a weekly or monthly plan to streamline your campaign. It does not have to be complicated. All it takes is to focus on your purpose, highlight key events, and manage your accounts every day or as often as necessary. 2. Focus on 1 or 2 social media channels only – and do it well! Although you can easily set up an account with any of the social media networks mentioned in the previous tip, focusing on more than two could prove disadvantageous. It’s more practical and effective to concentrate on managing diligently just one or two channels than struggle with many.
3. Keep your audience engaged by hosting social events Building a supportive community becomes easier when you hold online events focused on and for your followers. Launch these on a bi-weekly or monthly basis and make sure to include a hashtag (e.g. #BeautyConnectSunday). Post an invitation early in the morning and supplement it with 1-2 more posts throughout the day to keep your followers well-informed. 4. Always include images on your posts and updates In social media, images are powerful come-ons that go hand in hand with market-centric content and copy. Choose an eye-catching image and complement it with interesting text like questions or intriguing comments that encourage your audience to answer or follow up. 5. Streamline your focus by posting relevant content Relevant content concentrates on promoting the stellar qualities of your clinic or practice. Post blog entries, articles, quotes, memes, news snippets, and images whose themes and topics are in line with your services. In creating or choosing posts, a little creativity goes a long way. Even if you choose to cater to the general public’s interest (e.g. cats, dogs, food, etc.), remember, there will always be ways for you to connect these ideas with your marketing objectives. APJ
If you need help, or just want someone to do it all for you, drop us an email to info@plasticsurgeryhub.com. au or call 0429 264 811.
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DRUG-FREE WAYS TO HELP BALANCE FEMALE HORMONES AND ASSIST WITH MENOPAUSE By Tina Viney
ESSENTIAL OILS have been used for millennia to treat a myriad of health concerns. Given their potency, versatility and effectiveness, it comes as no surprise that essential oils can be useful in helping you balance your hormones. Many women have been successful in applying essential oils topically to alleviate premenstrual syndrome (PMS), menstrual cramping and other symptoms. Some enjoy essential oils aromatically by diffusing them into the air, while others combine them with Epsom salts for a therapeutic bath. Evidence continues to emerge suggesting essential oils can play a beneficial role during menopause. As women approach menopause, or have already entered menopause the use of essential oils can be very beneficial and can add an addition dimension to your treatment program. However, let’s first take a brief look at menopause as a condition. Menopause and Hormone Replacement Therapy Although you may think of menopause as a season of life, it
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is medically defined as marking the cessation of a woman’s menstrual period for 12 months. Menopause signals that your ovaries are producing less oestrogen and you no longer have the ability to become pregnant. While some arrive at this stage earlier or later, the typical range for menopause is 45 to 55 years of age. The average age is 51, but most women experience this “change of life” at an age similar to that of their mothers. Previously, women going through menopause had limited options for managing the wide range of signs and symptoms that accompany it. One of the primary treatments that was popular over a decade ago was hormone replacement therapy (HRT). However, as HRT had subsequently been linked to some forms of cancer, many physicians including mine, did not recommend the use of HRT for more than two years. This often throws many women back into the dreaded symptoms of hot flashes, fluid retention, weight gain, headaches, mood swings and numerous other symptoms.
Hot flushes, particularly at night Mood changes, including anxiety, depression and irritability Vaginal dryness and pain during intercourse Irregular periods during pre-menopause Muscle loss Night sweats Muscle loss Weight gain Voice change Bone loss and brittle bones Beyond HRT, doctors will often recommend treatment or medications to target specific symptoms that arise before and during menopause rather than attempting to treat a collection of individual symptoms. In my experience a qualified regenerative medical practitioner can take a more comprehensive approach with bio-identical hormones that can be prescribe for you. This usually follows comprehensive blood and saliva texting. This approach is more customised to your specific needs and can offer, not just relief to your symptoms, but also support overall health including skin improvement. This is because hormonal balancing goes beyond just oestrogen to address a variety of other hormones as well. While menopause symptoms can be annoying, with proper treatment, they generally should not diminish your overall quality of life. That said, some women may experience horrifically debilitating symptoms before and during menopause. In such instances it is important to recommend a consultation with a physician before undertaking any form of treatment, especially prior to experimenting with alternative remedies.
In this article I want to look at some simple natural strategies including essential oils that can assist with improving overall wellbeing and offering some level of relief from many of the symptoms. However let us first look at some background information on the conditions and its symptoms. The Women’s Health Initiative (WHI) in the US, which involved a landmark study of 160,000 postmenopausal women, showed that hormone therapy involving oestrogen and progestin may not be suitable for all women. In fact, for women who had not had a hysterectomy, HRT dramatically increased their risk of breast cancer, dementia and strokes. Signs and Symptoms of Menopause If you have already reached menopause, you are likely familiar with many of the common signs and symptoms that accompany it. Keep in mind some of the following concerns may also arise during peri-menopause, the transitional phase leading up to menopause, which may last as long as eight to 10 years. When you are doing a client consultation look out for these symptoms because they can sometime start to creep in without being identified as hormonal changes: Hair changes, including texture or thickening, or increased body or facial hair Libido impact - decreased interest in sex Sleep changes including insomnia
CONVENTIONAL TREATMENTS VERSUS ESSENTIAL OILS If you are among the growing segment of women who feel uncomfortable with the idea of using conventional HRT to treat menopause or peri-menopause symptoms, especially given the outcome of the WHI studies, you may want to consider essential oils. While more studies are necessary to validate their efficacy, essential oils may be useful to help you manage certain menopause-related symptoms. Obviously, each woman’s body is unique and will respond differently to any form of treatment, including oils. For optimal results, I recommend you work with your doctor and other holistic health practitioners to find the remedies that will best address the concerns. With proper medical supervision, essential oils may be the missing ingredient your body wants and needs. Essential oils could provide you with the “best of both worlds” by helping to relieve some, or all, of the nagging and bothersome symptoms of menopause, thereby avoiding potentially harmful, conventional treatments. For certain, the risks of adverse outcomes are significantly reduced when using natural substances like essential oils. During my aromatherapy training there were several essential oils that offered positive effects on menopause. Below are just some of the most popular that have recently received research support to ameliorate menopausal symptoms. Many of these I have also used successfully. Essential oils are a wonderful natural, therapeutic tool to include in your salon or clinic. It is therefore well worth investing in quality training in order to determine safety perimeters, doses and of course, a better understanding of the various therapeutic constituents of these natural hormones. A
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study, well worth investing in. However, for hormonal balancing you only need small quantities and this allows them to be relatively safe. Here are some of the most popular: CLARY SAGE: Known to alleviate PMS pain, relieve hot flashes, soothe stressful feelings and improve hormone balance. GERANIUM: Has been shown to help balance hormones and improve mood, as well as promote menstrual cycle regularity during peri-menopause; also thought to have anti-anxiety and antidepressant effects. LAVENDER: Long known to promote relaxation and sleep; now thought to aid in balancing hormones, easing cramps, soothing stress and alleviating menopause-related headaches, heart palpitations and hot flashes. PINE: Believed to help reduce bone loss and protect against osteoporosis. ROSE OTTO: Proposed as a strengthener of the uterus, which may result in improved mood and a reduction in hot flashes. Vitex agnus-castus: Also known as chasteberry and Abraham’s balm; long professed to help with irregular menstrual periods and mood swings. Vitex can also be purchased in capsule form and is excellent for breast tenderness. You may want to use these oils aromatically by diffusing them into the air, which will enable you to realise their many benefits without the potential safety risks of applying them topically or internally. Essential oil diffusers are readily available online or from your local natural health store. Menopausal symptoms also gain great relief with a fullbody massage. Combining these essential oils can add an additional dimension to improving wellbeing. By creating a 3% blend you could offer a 50ml quantity to your client for home use as well. Diluted in a carrier oil of almond oil, coconut oil or jojoba oil is ideal. While peppermint oil is not specifically recommended for menopause, it has been shown to have a positive effect on headaches. With headache sufferers a dilution of 3% in a carrier oil can soothe a headache very quickly. Just make sure you keep it away from the eyes. Another way to use it is with a cool compress of cold water with 1-2 drops of peppermint. ESSENTIAL OIL BLENDS THAT HELP SOOTHE PMS Here are several recipes for essential oil blends designed to promote a sense of well-being around your monthly menstrual cycle by adding them to a soaking bath or massage oil. PMS Bath Blend: Mix 5 drops of clary sage, 2 to 3 drops of chamomile, 2 drops of geranium, 2 to 3 drops of lavender essential oils and 1 Tbsp. of jojoba oil with a handful of Epsom salts and add to warm bath water. Try spending at least 45 minutes in the bath for good results. PMS Hormonal Balance Blend: Mix 2 drops of clary sage, 1 drop of geranium and 1 drop of ylang ylang essential oil. Menstrual Massage Blend: Mix 5 drops of lavender, 5 drops of cypress, 10 drops of peppermint and 10 drops of nutmeg essential oils into 30 ml of a carrier oil like coconut or jojoba oil. Try massaging this blend onto the whole abdomen or lower back daily, both before and during your period, or add to a bath. You can also combine 3 drops of clary sage, 3 drops of ju-
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niper and 3 drops of chamomile into 30 ml of a carrier oil. Gently massage this blend clockwise around the abdomen. Risks and Cautions Related to Using Essential Oils It almost goes without saying that simply because essential oils are natural, does not mean they’re safe for you in every instance. Formulations, dosing and quality vary widely. If you are seeking to use them for their therapeutic benefit please access your oils from a reputable company such as the Sydney Essential Oil Company Ph: 02 9565 2828 or Select Botanicals Ph: 02 9817 0400. ADDITIONAL STRATEGIES There are three surefire strategies to start with: 1. Phytoestrogens. Taking Phytoestreogens or plant-estrogens before menopause can moderate day-to-day estrogen levels, so that when menopause comes, the drop won’t be so dramatic. Weak estrogens that block stronger forms, phtyoestrogens are found in licorice and alfalfa. Royal Maca also seems to be an amazing adaptogenic herbal solution for menopause that has helped many women. Be sure to avoid the inexpensive ones, as they typically don’t work. Get the real deal from Peru. 2. Omega-3. Take high quality, animal-based omega-3 fats. A high quality animal-based omega-3 supplement, such as krill oil or salmon or are excellent choices. Balance omega-3 and omega-6 by eating foods rich in these oils. 3. Green tea. Polyphenols are associated with a lowered risk of heart disease, and green tea like Royal Matcha tea which is rich in polyphenols that can be more effective than those in red wine -- plus 17 times the antioxidants of wild blueberries. One study shows green tea can also reduce the risk of breast cancer in younger women under 50, and now, certain polyphenols have been shown to have some HRTlike benefits, without the drawbacks. For foods to avoid that will exacerbate menopausal symptoms these include refined carbohydrates, sugar, caffeine and alcohol. Once you’ve covered the three musts to start with, add the following to your lifestyle regimen: Black Cohosh: It may help regulate body temperature and hot flashes. Go organic: Locally grown, organic food. Exercise! Start a program that you know you’ll do at least 3 times a week, even if it’s just 15 minutes a day to start. Vitamin D: Another amazing adaptogen that supports overall health as well as menopausal symptoms. CONCLUSION Regardless as to which strategy you feel comfortable to use the best solution is always a combination of stress management, diet, exercise and other combination therapies. If you are serious about providing a solution for menopausal and pre-menopausal women it would be worthwhile to work with a healthcare practitioner to put together a program that includes a variety of approaches. I can assure you it will be very popular. APJ
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