APJ Vol 42 2019

Spring Volume 42 2019

Aesthetics Practitioners Journal is the official publication of the Aesthetics Practitioners Advisory Network PTY LTD.

PLASMA SKIN TIGHTENING

Leading the way in training and technology integrity.

APJ 1

APAN

Aesthetics Conferences 2020

PREMIUM EDUCATIONAL EVENTS

QUEENSLAND

SYDNEY

PMU QLD

25 MAY

8 AUGUST

13 & 14 SEPT

APAN is stepping up its conference programs in 2020 with three dynamic educational conference events – TWO Aesthetics and ONE specifically for Cosmetic Tattooists.

WHO SHOULD ATTEND?

Continuing to enhance the format and content these must-attend events will provide you with amazing value, educational excellent and dynamic networking opportunities.

• Dermal Clinicians

NEW FORMAT is continuing to evolve providing you with greater value:

• Trainers and Educators

• Education at its best

• Industry Suppliers

• New scientific updates

These are industry-certified educational events.

Attend and gain 6CPD POINTS towards your professional development as an ARAP or CTARP registered Practitioner.

• Regulation updates • Winning business strategies

• Aestheticians • Dermal Therapists • Cosmetic Nurses • Cosmetic Tattooists • Students

• Exciting new technologies • Advanced techniques for leading solutions • Ingredient science

fi

@apan.page #apanconf

07 5593 0360 info@apanetwork.com www.apanconf.com

IN THIS ISSUE SPRING VOLUME 42. 2019 APAN INDUSTRY REPORTS, NEWS AND PRODUCTS

77

8-9

74-78

10-15

102-105

30-32

94-97

CEO’S REPORT COVER STORY PRODUCT INNOVATIONS

REGULATIONS, STANDARDS AND EDUCATION 18

POINTON PARTNER LAWYERS LAUNCHES A SOCIAL MEDIA POLICY

26-27

ARE YOU OPERATING OUTSIDE OF YOUR SCOPE OF PRACTICE?

34 - 35

LET THERE BE LIGHT!

APAN CONFERENCE 2020

38 - 41

MELBOURNE APAN CONFERENCE WRAP-UP

02

BUSINESS TIPS

66

NEW GIFT CARD LAWS NOW GO NATIONAL

42-44

DYSMORPHIA AND ITS IMPACT ON APPEARANCE PERCEPTION

58-59

PIGMENT REGULATIONS ARE COMING!

60-63

PMU CONFERENCE - A GREAT SUCCESS

SCIENTIFIC RESEARCH, TREATMENTS AND TECHNOLOGY 20-23

BLUE LIGHT - GIVING THE SKIN THE BLUES

28-29

64-65

THE ART AND SCIENCE OF COMPOUNDING FORMULATIONS

TRADITIONAL AND MODERN DELIVERY SYSTEMS

66-69

46-48

80-81

DERMAL FILLERS - HOW LONG DO THEY REALLY LAST? 50-52 INFLAMMATION AND THE ROLE OF NUTRITION IN WOUND HEALING

54-56

RESEARCH REVEALS A NEW APPROACH TO ACNE THERAPY

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SCIENTIFIC NEWS

36

SEMINARS, EXPOS AND CONFERENCES 2-3

AESTHETICS BULLETIN

CERAMIDES AND SKIN BARRIER HOMEOSTASIS KAKADU PLUM AUSTRALIA’S AMAZING SUPERFOOD FOR SKIN AND BODY

82-83

THE CROWINING GLORY OF LAUREL BAY

88-90

THE POWER OF PEELS FOR SKIN REJUVEANTION

51 86

BUSINESS, PERSONAL AND PROFESSIONAL DEVELOPMENT 70-71

THE EXPANSION AND DISRUPTION OF BUSINESS OVERSUPPLY

72-73

SETTING THE BENCHMARK IN THE NORTHERN TERRITORY

84 -85

MAKING ROOM FOR JOY AND SUCCESS

86-87

DEALING WITH MENTAL HEALTH IN THE WORKPLACE

92-93

A JOURNEY TO SUCCESS

98-99

IN REVIEW: THE HYALURON PEN 106 APAN’S STANDARDS RECOGNITION PROGRAM NOW LINKED TO PROFESSIONAL DEVELOPMENT (CPD) PROGRAM

207

UPGRADE YOUR SKILLS AND KNOWLEDGE IN MICRONEEDLING

108

NEW - SAFE USE OF TOPICAL ANAESTHETICS COURSE

Editor Katherine McCann (07) 5593 0360 info@apanetwork.com www.apanetwork.com

Printed For Aesthetics Practitioners Advisory Network ACN: 136 987 169 ABN: 25 136 987 169

Typesetting & Graphics Angus Thompson TEV Group Pty Ltd

Accounts Payable Aesthetics Practitioners Advisory Network PO Box 5448, Q Super Centre QLD 4218

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

26

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 Chris Testa Gill Fish Vanessa Kirkham Carole Jackson Julia Grinberg ISSN: 1836-9812 Pint Post Approved [100000257] Circulation 6900

Spring Volume 42 2019

Front Cover PLASMEDIC info@plasmedic.com.au 0470 044 186

Aesthetics Practitioners Journal is the official publication of the Aesthetics Practitioners Advisory Network PTY LTD.

PLASMA SKIN TIGHTENING

Leading the way in training and technology integrity.

For further information see pages 10-15

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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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EDITOR’S NOTE Katherine McCann

I LOVE THIS INDUSTRY because it offers so much diversity and when you discover what you really enjoy the most, you can choose to specialise in it and make a successful career out of doing what you love the most and expresses you the very best. For me, other than my position as editor of APJ, I love my cosmetic tattoo practice.

And talking about cosmetic tattooing, we have just finalised a highly successful PMU Conference that APAN launched in September. The response has been fabulous and plans are already underway for a larger two-day event next year.

I love to keep my brain stimulated with quality education because it fuels my creativity and helps me identify how I can do things differently and better, both for my clients, my profession and my business. It is so exciting because with our practices we have the power to change people’s lives.

While most Cosmetic Tattooists attend workshops to upgrade their techniques, our PMU Conference was different, it not only discussed techniques, but also covered other pertinent educational topics that clarified regulatory issues, health and safety requirements,

anaesthetics, pigment retention, advanced techniques and valuable information to minimise risk and improve business performance.

The theme of this conference was Contextual Integration of Art and Science, so I want to take a few minutes to clarify exactly what that means.

The word contextual relates to relevance to the topic or theme. It means that the information presented – in this case the educational content - is presented in a way that is consistent and relevant to the topic that is being clarified or addressed.

In the case of this conference it looked at how science and art can “talk to oneanother” in a way that enhances the integrity of this profession giving it greater credibility, not just through artistry, but also through evidence-based science as it pertains to cosmetic tattooing procedures. In other words, we reviewed the intellectual perimeters that define Cosmetic Tattooing – underpinning concepts, psychological, safety and regulatory issues and the role they plan in supporting and enhancing the reputation of cosmetic tattooing as a profession, not just a trade.

In that regard we definitely succeeded, going by the feedback we received and so I am excited that next year we will be moving to bigger and better things. Check out dates for next year’s events on the inside cover of this journal and include them in your diary – they will be well-worth the investment.

In this issue of APJ you can read all about both the PMU Conference as well as our Aesthetics Conference in Melbourne, which was equally successful.

As always, this issue is jam-packed with quality educational article to keep your mind stimulated with quality and credible education and help pave the way for you to make good decisions, as well as positive food for thought to help you stay motivated and on the winning path.

Until, next time stay well, committed and successful in everything you do.

fi

@apan.page

k.mccann@apanetwork.com www.apanetwork.com APJ 6

OUR REGULAR APJ CONTRIBUTERS TERRY EVERITT Terry Everitt is regarded as a ‘Master Skincare Professional’ due to his extensive knowledge in 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 at 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 Gay on 0418 708 455 or book online at www.gaywardle.com.au. You can also email her on gay@m-da.com.au.

JACINE GREENWOOD Jacine Greenwood is an internationally recognised educator who is known within the industry for her up-to-date knowledge and her ability to deliver training in an easy to understand method.

Jacine holds six Diplomas, including a Diploma of Cosmetic Chemistry and a Bachelor of Nursing.

Her knowledge is highly respected in the cosmetic industry. With over 22 years experience in the industry and a background of cosmetic formulation, Jacine has an immense knowledge of current trends in research and new developments in the industry. Contact her on 07 3807 1429 or email jacine@roccoco.com.au.

DR ZAC TURNER Dr Zac Turner has a broad medical background specialising in regenerative and aesthetic medicine.

Aesthetically, Dr Zac feels that a natural look is best, and truly believes that his ‘less-is-more’ approach. Dr Zac is involved in both the men’s health and preventative health space. He sees prevention and body optimisation as the ultimate way to prevent chronic disease, obesity, and many other conditions. He has owned and is currently involved with clinics in the holistic health arena and believes that through an holistic assessment of someone’s health we can enable them to live longer, healthier, and happier. Contact Dr Zac by Email: zac@drzac.co.

TRISH HAMMOND Trish Hammond is an award-winning blog 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 your blogging needs please contact her on 0429 264 811 or Email info@plasticsurgeryhub.com.au.

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I choose….

To live by choice, not by chance To be motivated, not manipulated To be useful, not used To excel, not compete I choose self-esteem, not pity I choose to listen to my inner voice, not to random opinion of others I continue to do the things you won’t so I can continue to do the things you can’t.

Tina Viney A message from the CEO

AS WE NAVIGATE AROUND OUR DAILY TASKS how focused are you? Are you achieving what is really important to you? I ask this because many business owners in our industry often experience overwhelm and high levels of stress.

information that daily enters our inboxes, how do we decipher what we take up and what we let go? As this phenomenon is becoming a reality for most of us, I have come to realise that wise choices and planning has to become our most valuable point of rescue.

I am sure that every business owner reading this would have started their business with a plan of what they stood for and what they wanted to achieve. Moving forward, as we navigate through the bombardment of

Unless you plan your life and establish priorities, you’ll be pressured by other people to do what they think is important. Every day you either live by priorities or you live by pressures, there is no other option. It’s easy to

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operate under the tyranny of the urgent, to come to the end of your day and wonder, “have I accomplished anything that is truly meaningful?” “I used up a lot of energy and did a lot of things, but did I achieve anything important?” Busyness is not necessarily productivity. You may be spinning in circles, but not accomplishing anything of real value.

Preparation causes you to be at ease. Or to put it another way, preparation prevents pressure, whereas procrastination produces pressure. Good organisation and good preparation reduce stress because you know who you are and what you want to accomplish. Having clearly defined goals simplifies life. So, spend a few minutes at the beginning of every day reviewing your plan for the day. Then look at the list and decide if you are willing to exchange the next 24 valuable hours for these activities. The right answer to this question will lower your stress level by helping you prioritise. Make wise choices, it will change your life. I too, remind myself of this each day!

EXTENDING TO THREE CONFERENCES This has been a very exciting year for us here at APAN. We not only changed our two conference programs from six to 16 speakers, but we also added an additional event – our inaugural PMU Conference that we launched on the Gold Coast in September. All events were a huge success and we have determined to make this the model that we will be adopting in 2020 with additional changes, as we endeavour to keep improving.

These events provide everyone with a great opportunity for incredible community engagement and the networking is not only invaluable to all who attend, it also allows us as an

concerned have gained greater value. I recently read a report from Dr Marc Rosenberg, a world thought-leader in business development and leadership. He said, “Get ready! If you think you are overwhelmed with information right now, you haven’t seen anything yet. I was shocked, yet also unsurprised, when I read IBM’s prediction that by 2020, knowledge will likely be doubling every 11 to 12 hours”.

THE KNOWLEDGE EXPLOSION How precise is this prediction? Hard to tell. But the trend is incontrovertible. Knowledge is increasing at an everaccelerating rate. The graph below tells the story. In 1982, Buckminster Fuller introduced his “knowledge-doubling curve.” To this, IBM added its post-1982 predictions.

We can no longer rely on just last year’s knowledge, let alone camp around what we learnt when we graduated. Education should never end. It needs to be an on-going process, or you will get left behind. In line with these realities we have adopted our conference programs to substantially provide you with an incredible amount of quality education, by increasing our content 300% to better equip you for the future.

EUROPEAN SOCIETY OF TATTOO AND PIGMENT RESEARCH We are pleased to report that APAN is establishing a formal strategic alliance with the European Society of Tattoo and Pigment Research. The issues of safety and sustainability are increasingly becoming a priority for consumers. Regulators are now reviewing with greater scrutiny what goes into products including Cosmetic Tattooing pigments.

NEW MEDICINES AND POISONS LEGISLATION – INKS FOR COSMETIC TATTOOIST AND BODY ART TATTOOISTS Additionally, on the 27th August, we met in our offices with government officials to discuss a new Medicines and Poisons Legislation for inks used in cosmetic tattooing and body art. This is currently being researched and reviewed with new regulations being proposed by as soon as the middle of next year. This makes our alliance with the European Society of Tattoo and Pigment Research valuable as we attempt to support regulations that are cohesive with international standards.

And then there is the update and changes to the Beauty Training SHB BEAUTY SERVICES TRAINING PACKAGE which we released for review in September. As the industry evolves with on-going advances and changes it’s now important that you stay informed to determine your best choices for the future. Please consider joining APAN and let us continue to serve you, now and into the future.

Figure 1: Buckminster Fuller’s Knowledge Doubling Curve, with post-1982 addition by IBM.

industry body to connect with you in a meaningful way and better understand your needs and what is important to you.

From the feedback we received, the increase in educational topics and content has been met with great appreciation as all

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COVERSTORY

PLASMEDIC TREATMENTS

Advanced Technology in Skin-Tightening NEW ADVANCES IN anti-ageing technologies are flooding the market offering solutions for wrinkle reduction and even elimination, and while many of these treatments are delivered through injectables and surgery, non-invasive technologies are now surfacing offering a less invasive, yet highly effective solutions for ageing skin. One such technology is Plasma skin tightening.

Danielle Kurukchi and Beata Trapp are the passionatelydriven business owners of PLASMEDIC SKIN TIGHTENING technology. Mindful of the risks of poor training and poor devices, they are highly vocal about their mission – to provide exceptional training and introduce this technology through high-quality and credible medical-grade devices that can deliver consistent and safe treatment outcomes.

Here Danielle and Beata shares with us some valuable information about the technology, what it can offer and what one can expect from their training and their products and services.

APJ Q1: DANIELLE AND BEATA, WHERE DID PLASMEDIC ORIGINATE FROM – GIVE US A LITTLE HISTORY ABOUT THE COMPANY AND THE COUNTRY OF ORIGIN? Plasmedic is an Australian owned company that we (Danielle Kurukchi and Beata Trapp) created together. We have a combined total experience of over 45 years in the Beauty/ Aesthetic Industry, owning a total of six salons and two training schools. We are the Exclusive Australian and New Zealand distributor for one of the highest quality Plasma devices in the world, Plasma IQ. Plasma IQ has been manufactured by Italian and Polish engineers, Berger & Kraft in Poland and is included on the TGA’s ARTG register.

APJ Q2: WHEN AND WHY DID YOU UNDERTAKE TO INTRODUCE THIS TREATMENT TO THE AUSTRALIAN MARKET?

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After keeping a close eye on Plasma/Fibroblast treatments in Europe for a number of years and seeing the results Fibroblast specialists were receiving, we felt Plasma Skin Tightening treatments definitely had its place in Australia, so we decided to look into the treatment even further.

After undertaking several training courses ourselves locally, conducting lots of research and personally testing over 10 devices, we were shocked to notice how many companies were training in these treatments without having the correct knowledge, or even a true understanding of how the treatment works themselves, utilising cheap “mole removal” devices not designed (and way too powerful) for skin tightening.

We knew this treatment had the potential to offer amazing results, however, we wanted to ensure that what we provided delivered the utmost safety and efficacy, so we undertook further training with a doctor in Europe. This gave us the confidence to be able to deliver safe and correct in-depth training to Australian salons/clinics wishing to introduce this service to their clients and patients.

APJ Q3: CAN YOU DESCRIBE TO US EXACTLY HOW THE TECHNOLOGY WORKS? As many people will already know Plasma is the fourth state of matter. Unlike the other three states of matter such as solid, liquid and gas, Plasma does not exist freely on earth and therefore needs to be artificially generated by energy being applied to gas. Plasma causes the skin to contract and shrink excess skin, as well as stimulate the Fibroblasts in your skin to produce more collagen, elastin and hyaluronic acid.

AP Q4: PLASMA SKIN TIGHTENING HAS HAD SOME CONTRAVERCY. WHY IS THAT? There is so much false and misleading information being

thrown around about Plasma treatments, especially on social media that professionals are not being informed correctly.

Unfortunately, some companies offering poor training and the wrong device have given fibroblast treatments a bad name.

Of course, like every single treatment available today there are risks, but it all comes down to the operator. Even with correct training, if the operator is not complying with what was taught in training and performs the treatment in a careless or incorrect manner, of course there are going to be issues. Not just with plasma skin tightening, burns can be experienced with many technologies – laser, IPL, HIFU, all come with their own set of risks. In fact, something as simple as waxing can cause significant burns if the operator is not correctly educated or careless.

APJ Q5: IS PLASMA SKIN TIGHTNING FOR EVERYONE? The simple answer to that is, no. A thorough consultation is needed to determine if the client is suitable for treatment, or not, however the treatment certainly has its place and we are seeing many satisfied clients who are seeing brilliant results.

Plasma treatments are not just being used for skin tightening either. We have had medical professionals tell us how amazed they are with what else plasma can treat, such as Xanthelasma (Cholesterol deposits) and treating the eye area has even helped with Dry Eye! APJ Q6:Â WHAT ARE THE QUALIFICATION PREREQUISITES THAT YOUR COMPANY REQUIRES BEFORE TRAINING SOMEONE TO INTRODUCE THIS TREATMENT TO CONSUMERS? At Plasmedic we only train Beauty or Medical Professionals who already have sound skin anatomy and physiology knowledge and experience. Those who have a clear

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understanding of the skin and a thorough knowledge of wound healing.

APJ Q6: WHAT DOES YOUR TRAINING SPECIFICALLY FOCUS ON? We pride ourselves on our Plasmedic training. It is without a doubt the most in depth training that is available. We are constantly re-training students who have already trained elsewhere and were unhappy, not feeling confident and felt like they did not cover all there is to know.

Safety is one of the main focusses in our Plasmedic Training.

We teach students how to perform this treatment safely, limiting the chance of scarring/pitting and post-Inflammatory hyper/hypopigmentation, while achieving amazing results is our upmost priority.

Along with our theoretical training, students watch a full demonstration by one of our educators. Students then treat eight different areas on four models. Our training classes are kept small so each of our students receive close attention and more personal training.

A lot of work, time and energy has been put into our training course to make sure we are teaching our students every single thing there is to know about Plasma Skin Tightening so they leave feeling confident and ready.

APJ Q7: WHAT QUALITY ASSURANCE CAN YOUR COMPANY PROVIDE WITH REGARDS TO YOUR PLASMA DEVICE? Our Plasma device is manufactured in Poland and has the highest medical certifications in Europe the EC Conformity Certificate 93/44/EEC issued by a notified body in the EU. There are only a few devices in Australia that have this certification and are included on the ARTG register and we are one of them.

The device has gone through the correct channels through the TGA and is now included on the ARTG as a Class2b Medical Device. The device also comes with two years warranty.

APJ Q8: CAN THIS PROCEDURE BE COMBINED WITH OTHER MODALITIES, AND CAN YOU GIVE US SOME EXAMPLES?

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Plasma treatments work well in conjunction with LED and Skin Needling. LED can be used prior to the treatment (as close to the same day) and we recommend LED no sooner than dayfour post treatment.

Skin Needling can also be performed at least 6-8 weeks post a Plasma treatment, but this depends on the skin type.

APJ Q9: HOW IMPORTANT ARE PRE AND POST-CARE PRODUCTS? Pre and post-care products are just as important as the treatment itself. Not all skin types are suitable for this treatment, some skin types (such as those who are prone to hyperpigmentation) need to be prepped for several weeks first. Some skin types need to be strengthened before undertaking a Plasma treatment. The skin also needs the correct ingredients and products to help facilitate the healing process post-treatment.

At Plasmedic we have had five pre and post-care products

a device that has been through all the vigorous testings in Europe first in order for the TGA to revue it for consideration it for an ARTG listing. They will also have access to all of our products formulated specifically for plasma treatments ongoing life- time support, not just by our educators, but also from us as the company owners. APJ

formulated by our very own Plasmedic Chemist right here in Australia. Every single product is formulated with the highest quality ingredients and only available to our Plasmedic Therapists, which helps them to have a point of difference and offer their clients the best skin support pre and posttreatment.

APJ Q10: WHY WOULD A BEAUTY OR MEDICAL PROFESSIONAL CHOOSE PLASMEDIC? With so many companies jumping on board we understand it is hard to know which company to choose. When training with us and become a Plasmedic Therapist you can be assured you are trained with a company that has conducted extensive research and development to ensure that the utmost safety and professional results are delivered with our device and products. As owners and educators, we are personally performing these treatments on our own clients on a daily basis, so we are highly experienced in this technology.

PLASMEDIC™ COMBINDING SCIENCE AND BEAUTY Danielle Kurukchi Ph: 0449 175 454 NSW, QLD, ACT, NT Beata Trapp Ph: 0470 044 186 VIC, SA, WA, TAS

Beauty and medical professionals can be assured that our training will be at the highest level. They will be receiving

info@plasmedic.com.au www.plasmedic.com.au APJ 13

COVERSTORY

AN INTERVIEW WITH

Petra Mackin

PETRA MACKIN is a registered nurse and an APAN member who owns her own clinic NQ INJECTABLES & AESTHETICS in Bushland Beach, regional Queensland.

As a committed professional to anti-ageing result and a Plasmedic practitioner, we asked her to share with our readers her experience with this technology.

I introduced Plasma fibroblast to my clinic because I loved the result it gave me on my upper eye lids! I had been contemplating a blepharoplasty, but have always worried about the anaesthetic, scarring, downtime and cost. I found that although a surgical blepharoplasty is the gold standard in reducing hooded eyelids, the plasma Fibroblast treatment offers less invasive, less costly and reduced risk to achieve a similar result. Patients that have been to me for one area have come back to have another two or even three other areas treated, because they were happy with the results.

Another reason to bring the treatment into my clinic is because it offers my patients an alternative to cosmetic injectables. Great results can be achieved with Plasma Fibroblast technology in conjunction with other modalities as well.

HOW DOES THE TECHNOLOGY WORK? Plasma fibroblast technology works by introducing a fine probe close to the skins’ surface. As the electrical discharge is made from the device an ionisation occurs in the atmosphere producing a plasma arc between the probe and the skin. A lightning bolt is seen between the probe and the skin, the skin evaporates and tightens instantly and a tiny carbon burn is left. The Carbon burn starts to create the trauma/healing cascade. The sub-dermal heat causes an inflammatory

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response, fibroblast activity, as well as collagen and elastin remodelling etc. The patient is left with tiny dark scabs, which must be kept dry until they are ready to drop off.

With this treatment the patient can see the best results at approximately 2-3 months after the remodelling and healing has occurred. If another treatment is needed on the skin that is still quite lax or saggy, then this is when the treatment may be done again.

The beauty of this treatment is that the skin sublimates (turns from solid to gas) before your eyes causing a wrinkle to stretch out, a sunspot to disappear, a skin tag to drop off, a stretch mark to fade and as a practitioner this is very exciting to witness!

EDUCATIONAL PREREQUISITES For any treatment that is going to cause trauma to the skin it is absolutely essential that the practitioner has fundamental knowledge in anatomy and physiology. The practitioner needs to have a recognised qualification in at least dermal therapy.

For any medical practitioner it is strongly advised to refresh in facial and skin anatomy and potentially study dermal therapy at a deeper level. We have all seen the results of failed treatments to the skin where a novice therapist has bought a device from Ebay and caused irreparable damage by not understanding the skin adequately and the risks of incorrectly treating it. Plasmedic was my company of choice because it offers a TGA approved device with sound clinical training, researched results, real models, and support.

WHAT ABOUT SKIN TYPES CONDITIONS TO TREAT? In my experience, Plasma Fibroblast treatment can offer tightening of skin where laxity is present. Perfect for upper

lids, lower lids, crows-feet, turkey neck, frown lines, removal of superficial chloasma or liver-spots, reduced pore size, certain scars, moles and stretch marks. It also offers great results for wrinkles on the back of the hands, knees and "mummy tummies" are also treatable areas!

It works best on loose skin so older skin sees great results but may need two sessions depending on how much extra skin is present. Of course, this procedure is not recommended for people with darker skin types (Fitzpatrick 4 and above), or for people with pigmentation issues, such as vitiligo, hypo or hyper-pigmentation, those with active herpes, dermatitis or eczema. Also it is not recommended for people with slow healing or auto immune dysfunction, certain medications, allergies, epilepsy, diabetes, pregnant or breastfeeding.

There are quite a few contraindications to treatment, which is why I always consult with my patients in-depth first to see if they are a good candidate. I show them photos of what to expect, I give them reading material, I also may give them a pre-treatment cream containing a tyrosinase inhibitor if there is even the slightest risk of pigmentation, organise a scripted topical anaesthetic for that patient, go through a consent form and make sure the patient understands the treatment before going ahead.

WHAT IS THE BEST AGE? In my experience, the best age to treat is over 35 where I see more skin laxity and see the best skin sublimation, while I have had great results in jowl lifting, brow lifting and "lip flips" in under 40-year-old patients, I have also had some amazing results in the over 40 age group after just one treatment to the upper and lower lids and lower face. One of the best results I have had is with skin elastosis of the peri-oral area.

Another treatment is needed, but we had a great result after one session.

HOW LONG DO THE RESULTS LAST WITH PLASMEDIC SKIN TIGHTENING? The results can last until new skin laxity is noticed, which happens with ageing. This of course occurs due to inherent genetic factors and environmental stresses on the skin.

We all know that sun, pollutants, diet and lifestyle are all contributors to the ageing process so the length of time until the next treatment in the same area could be five to seven years. If a second or third treatment is needed to an area it is recommended to wait three months between treatments

until full healing is achieved. I love this treatment because it addresses the skins' surface as well as the sub-dermal layers.

COMBINING FILLERS AND FIBROBLAST TREATMENTS The use of muscle relaxants and fillers with Fibroblast treatments (although not at the same time) can substantially boost the results! If the muscle cannot form a wrinkle then it’s a win/win situation. The skin has been flattened out and the muscle cannot reform a wrinkle because it is a temporarily relaxed state. The patient looks more refreshed and less tired as the skin looks healthier and more radiant without having had a surgical face lift, or laser resurfacing. APJ

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BUSINESS

REDEFINING THE FUTURE An interview with Moon Warner MOON WARNER is perhaps one of the most passionate and committed beauty therapists we have ever interviewed, whose hunger for knowledge is helping her push past boundaries to create a new career path for herself. She is studying the Bachelor of Applied Health Science (Clinical Aesthetics) and is in her third year of her degree with the Australasian College of Health and Wellness.

We believe that conceptually she is on the cutting-edge of where the industry is heading and she is preparing to meet consumer needs at the highest level of their expectations when it comes to their skin and age-management. Here she shares some highlights of her journey and we trust it will inspire you on your own road to success.

APJ Q1: MOON, TELL US ABOUT YOUR BACKGROUND AND WHAT MADE YOU CHOOSE TO STUDY THE BACHELOR OF APPLIED HEALTH SCIENCE (CLINCAL AESTHETICS) AT THE AUSTRALASIAN COLLEGE OF HEALTH AND WELLNESS? Moon: For as long as I can remember I have always had a keen interest in health science. My first job was as a medical receptionist, which gave me a good grounding and continued to stimulate my interest in the subject. A few years later I completed a diploma in Beauty Therapy and after graduating, I worked for 15 years in this area. While I loved the care and nurturing side of what I did, I often experienced frustration when I encountered that my current knowledge contributed to limitations as to the level of results that I wanted to achieve in my skin treatments.

This led me to pursue further studies, so I enrolled at the Endeavour College of Health and Wellness and studied nutritional medicine for two years. This was great, as it expanded my knowledge.

Subsequently, my husband’s role at his work became redundant, I became pregnant with our first child and this resulted in us moving overseas for four years. But this didn’t

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dampen my thirst for knowledge and as I continued to study, I become more and more aware that I wanted to specialise in skin therapy, but this time I wanted to be able to deliver more clinical results. So, on our return to Australia I decided to embark on further studies.

As dermal therapies were now available through tertiary qualifications, I investigated my options. In Victoria where I am based, I found that the Victoria University degree was making a lot of references to spa therapies and that was not where I wanted to go. I finally came across the Australasian College of Health and Wellness and immediately felt a synergy with their curriculum, which had a strong health science focus with in-depth wellness, nutrition, ageing and stressmanagement components, so I identified that this was a better fit for me in order to prepare me for my next step.

This led me to make the decision to enrol in the Bachelor of Applied Health Science (Clinical Aesthetics). I am currently in my third year and I have never looked back.

APJ Q2: WHAT ARE THE SUBJECTS YOU ARE ENJOYING THE MOST? Moon: I love that this degree has a strong focus on the foundations of health science. We don’t just look at treatments and machines, the focus is more about the consultation and making sure you are guided by that in designing the best possible approach for the treatment outcome. I love that I can use my deeper knowledge in chemistry, nutrition, anatomy and physiology to identify root causes rather than symptoms when treating the skin. This information is forcing me to think where I can go. It gives me far more options that I didn’t have before.

At the moment I am fascinated with the issue of stress and stress management and the role of genetics and epigenetics in understanding the mechanisms that influence the skin, as well as overall health. Stress impacts every cell and tissue in the body. The further you delve into the subject the more you

discover and learn. I am gaining an in-depth understanding of the inexhaustible study on the microbiome. While there has been a great deal of research on this subject, there is constantly new information coming to light on how the microbiota impacts the skin and our overall wellbeing. I have come to understand at a much deeper level that if you do not manage stress, it can impact every system of the body, this is why treating the skin can be a complex matter, as we also need to consider the activity of what is happening at a cellular and molecular level of the body.

APJ Q3: SHARE WITH US SOME OF THE HIGHLIGHTS FOR YOUR STUDY EXPERIENCE? Moon: I have to say that my studies have opened me up to a whole new world where I can investigate the skin in ways that I was not able to before. Understanding how to interpret cellular metabolism and identify that something is going on, and recognising the plasticity of how, with the correct tools, we can help the body restore itself to homeostasis is so exciting. I have also gained a better appreciation not just about the skin, but also body issues such as cellulite and how to address this from its root cause. This knowledge is definitely expanding my scope of practice.

Another highlight of my study experience is the privilege of being appointed as a student/peer mentor. This is not a role that every student gets. It allows me to help others along their learning journey. Being a mother trying to juggle study and other responsibilities, I know that the journey, as rewarding as it may be, can also be challenging at times. I can therefore guide students in ways of dealing with some of these challenges and even help them emotionally to cope better. Mentoring is so important, as this journey is something new for many and support and understanding, as well as some valuable tips, can go a long way.

We are also privileged because ACHW is one of the most flexible institutions I have ever been involved with. It is

supportive, understanding and compassionate. If you are stuck you can reach out to them for guidance. As there are many mature-aged students at the college they fully understand that they have “another life� outside of college, so they are willing to be flexible and supportive. Many of the units can also be studied on-line allowing you to fit your studies with other aspects of your life.

Another highlight for me is the benefit that as a student, I have the privilege of learning from incredibly knowledgeable and experienced lecturers, some who are pioneers in the industry, such as Gay Wardle and Terry Everitt. Despite their extensive knowledge, I have always found them to be warm, compassionate and understanding. They are considerate of the fact that apart from our assignments we also have other compelling priorities in life. This level of support is invaluable to me.

APJ Q4: WHAT ARE YOUR PLANS FOR THE FUTURE? Ultimately, I would love to work for myself, but I am determined to first put to practice my new-found knowledge and gain experience over thousands of hours working on clients. This will be a very exciting time when I can finally translate my this knowledge and understanding of the skin and body and see where it will take me in terms of treatment outcomes. I am also keen to work this time with medical professionals, such as surgeons or dermatologist so my knowledge can continue to grow. It will be a new era, when the sky will be the limit! APJ To start your own journey and expand your knowledge and career contact the Australasian College of Health and Wellness for further details.

Flexible learning options are available.

1300 227 603 of visit www.tachw.edu.au

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LEGALMATTERS

POINTON PARTNER LAWYERS LAUNCHES

A Social Media Policy THE RISE OF SOCIAL MEDIA has created an opportunity for businesses to expand and grow. However, as social media continues to develop, employers need to be aware of the impact social media can have on all stages of employment, including harassment and bullying, reduction in productivity and reputational damage of the employer when comments are posted by employees.

to become familiar with the updates on the legal status of behaviour within the social media space.

It is therefore important for employers to take proactive steps to help minimise the risk of social media use by employees, including having a social media policy.

The policy clearly defines the expected staff conduct, both within, as well as outside of work hours relating to any comments that may be considered inappropriate and impact their role, or the business negatively, will have consequences.

SOCIAL MEDIA POLICY Pointon Partners has created a Social Media Policy for you to implement into your business that defines what is acceptable use of social media in an employment relationship. Without such a policy in place you may not be in a position to discipline employees who misuse social media in a way which adversely affects your business.

APAN is acutely aware of the challenges and heartaches that many businesses experience when staff grievances are aired on social media for all to see. This is progressively becoming a regular phenomenon as many consider Facebook and other platforms an acceptable platform to vent their frustrations.

With the new defamation laws on Social Media and the need for protection of intellectual property, senior partner from Pointon Partner Lawyers, Michael Bishop recently presented at the PMU Conference a legal update that all practitioners and business owners should be made aware.

To assist business further, Pointon Partner Lawyers have recently finalised a SOCIAL MEDIAL POLICY that all business owners are recommended to have in place for their staff and

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The SOCIAL MEDIA POLICY has now become part of APAN Standards Position and APAN recommends that all business owners incorporate this policy as part of best practice.

Non-compliance of staff members to the terms of the policy with be subject to disciplinary action as the business sees fit.

It also covers public comment, bullying and harassment, conflict of interest, confidentiality, security risks and reporting.

It is important that staff also recognise that the clients they are servicing must not be contacted for private business, as the business’s database is the property of the business. APJ This Social Media Policy has been legally prepared by Pointon Partner Lawyers and endorsed by APAN as part of best practice requirements. The cost is $595, however, contact APAN to qualify for the special introductory price of $396.

Call APAN on 07 559 30360 or email info@apanetwork.com with your contact details.

This document is a must for all business owners and their staff.

PT SE S ! & KE E N LY TA OP JU IN W O N

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Visit tachw.edu.au or call 1300 227 603 for more information Australasian College of Health & Wellness Pty Ltd; ABN 16 139036 721, TEQSA ID PRV13002; an approved FEE-HELP provider; Level 21, 580 George St. Sydney NSW 2000

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RESEARCH

BLUE LIGHT - GIVING THE SKIN THE BLUES

New Research Findings Identify Adverse Effects Terry Everitt

IF YOU ARE USING BLUE LIGHT in your treatments either LED or other sources, this article is a must-read. Presented by Terry Everitt, our resident science-based aesthetic thoughtleader, it gives disturbing evidence that blue light, so loved by many in LED treatments, is harmful for the skin. Terry once again, highlights that some of our aesthetic processes need careful thought backed by recent research. Terry provides articulation as to why things happen, not just mentioning that things happens. His views are backed by credible studies that warrant serious consideration.

Approximately 40% of the solar radiation reaching the earth’s surface is infrared light (> 800 nm), while 55% is visible light (400–800 nm) and ~7% is UV light (200–400 nm) (DuevaKoganov et al., 2014).

Recent years have seen increasing use of light therapy using the lower end of the visible light spectrum; blue light, often with a broad range of wavelengths and containing a considerable proportion of UVA light (380–400 nm). In addition, many blue light–emitting lamps that have emission maxima at wavelengths of 400–500 nm are readily available, marketed with claims that they enhance wellness.

More problematic concern is when individual wavelengths are harnessed in isolation and intensified in power via machinery such as computer screens, tablets, smartphones, but mostly from light-emitting diodes. The wavelengths not only affect the skin, but have adverse effects on the eyes, including potential retinal damage and digital eye strain.

ACNE BLUES Blue light one way or another, has been used for acne treatment for many years, yet the science behind this use is not complete; recent information shows how this is achieved and also shows that blue light ages the skin.

We know that acne in its various presentations is a chronic skin disorder of the pilosebaceous unit. One of the difficulties in treating acne is the multiple pathogenic factors for acne, which need to be addressed such as sebum production, APJ 20

obstructed pilosebaceous units by abnormal follicular keratinisation mixing with the sebum and the resulting overgrowth of Cutibacterium acnes and inflammation that this causes.

Yes, we have had a name change – previously known as Propionibacterium acne (P. acnes), is now officially known as Cutibacterium acnes (C. acnes). This is to account for genomic adaptive changes and to differentiate it from other Propionibacterium Species. However, it remains allowed to be referred to as P. acnes in dermatology. For our purposes I will refer to Cutibacterium acnes (C. acnes).

Sadly, there is at present not one treatment that effectively ameliorates all the pathogenic acneic factors. In terms of the bacterial count topical antibiotics are most effective. However, there is a downside to this treatment method in terms of the overuse of antibiotics and bacterial adaptation due to the C. acnes being a gram-positive bacterium.

Oxygen therapy has proven useful as the C. acnes are anaerobic yet getting oxygen down to them is difficult, apart from the resulting free radical exposure inherent in this method.

BLUE LIGHT PHOTO-BIOMODULATION Photo biomodulation (PBM) was a great discovery – shining a blue light on the C. acnes reduced the numbers significantly.

A very effective, but simple concept only recently finding out that this treatment option also has a downside (more about that soon).

Blue light therapy for acne typically involves administration of high energy photons (405–450 nm) at irradiances of about 10–100 mW/cm2.

A study released by Boyd et al., (2019), showed the effectiveness of low-level (50 uW/cm2) 449 nm blue light photo-biomodulation kills Cutibacterium acnes.

This researches also studied 422 nm wavelength finding it

effective, yet 449 nm was more effective.

Great limitations to the study in that it was in vitro with agar plates and not in vivo and the presence of oxygen was required. This is not surprising given C. acnes is anaerobic.

May be the oxygen was responsible and not the blue light?

WHY ALL THE FUSS OVER A FEW BACTERIA? While a skin commensal, C. acnes is thought to provide protection for skin from colonisation of pathogens such as Staphylococcus aureus, multiple studies suggest that C. acnes can act as an opportunistic pathogen. This is dependent on the strain of C. acnes that is present.

This in part explains why all have C. acnes present, yet only some develop acne as a result of this microbe. [If you want to know more on this, I suggest Johnson, Kang & Li (2016) study titled ‘Strain-Level Differences in Porphyrin Production and Regulation in Propionibacterium acnes Elucidate Disease Associations.’

Primarily the bacterial count receives a lot of attention in acne treatment due to the damage it implodes within the follicle. The retentive hyperkeratinisation mixes with the sebum causing a blockage in the follicle. It is this extra sebum component that the C. acnes feed on, rapidly increasing in numbers.

C. acnes is part of the natural microbiome of the skin, it is the excess value that becomes problematic. As the numbers increase, so does increasing damage occur.

I have previously written about how C. acnes contributes to inflammatory acne by activating Toll-like receptors (TLRs) and stimulating skin cells to produce interleukin (IL)-1a, tumournecrosis factor (TNF)-a, and chemokines (e.g., IL-8), while inducing tissue injury directly. For example, C. acnes isolated from acne lesions has been shown to produce chondroitin sulfatase and hyaluronidase which cause extracellular matrix degradation leading to tissue injury.

The current treatment thought with blue light has come from two studies. Omi et al., (2004) studied the effects of

administration of high irradiance (200 mW/cm2) 410– 420 nm blue light delivered with fluence of 180 J/cm2. Acne lesions were reduced by 64% at the end of the study with no adverse events reported. This was followed by Morton et al., (2005) using 409–419 nm blue light 40mW/cm2 for either 10 or 20 minutes for a total dosage of 24 or 48 J/cm2 per treatment, with optimal clearance of acne lesions being achieved within 8–12 weeks. Must be noted that Morton et al., (2005) provided treatment twice weekly with Omi et al., (2004) providing biweekly treatments.

Many companies have produced equipment with various of wavelength and irradiances each stating they are the best due to the parameters of the machine.

Manufacturers have reported ranges from 0.62–40mW/cm2, with most administering irradiances greater than 10mW/ cm2, and corresponding fluences ranging from 47 to 192 J/ cm2 per treatment with wavelengths from 407 to 450 nm, though many use higher-energy short-wave photons 405–420 nm. This has created much confusion as to what is the ‘best’ wavelength and power usage. Additionally, blue light is often suggested to be combined with other treatments such as red light, confounding the impact of blue lights effect on the skin.

Boyd et al., (2019) provided evidence demonstrating that sub-milliwatt/ cm2 levels of long-wave blue light (449 nm) effectively kill C. acnes, showing that low irradiance and fluence of long-wave blue light significantly impact C. acnes viability.

Current research is regarding Coproporphyrin III (CpIII), a specific porphyrin (a proinflammatory metabolite) produced by the C. acnes. CpIII displays clear photoexcitation at both 415 and 440 nm, indicating that both wavelengths are capable of initiating CpIII photoexcitation at low incident light intensities.

DOES BLUE LIGHT INCREASE HYPERPIGMENTATION? Although visible light (390-700 nm or 400-800 nm, depending on which text you read) [the confusion I think is that APJ 21

typically, the human eye can detect wavelengths from 380 to 700 nanometres, which accounts for approximately 4550% of solar spectrum. However, its effect on melanocyte pigmentation and skin colour was largely unknown until recently. Of course, our attention has been focussed on the non-visible Ultraviolet Radiation spectrum of 200-400 nm.

As you are aware, visible light has been used extensively in laser therapy, intense pulse light therapy, and photodynamic therapy, yet very little is known about its effect on the time, course and quality of pigmentation, and its effect on different skin types. Most earlier studies were on Caucasian skin which did not have great melanin to begin with so they did not significantly react to the light, leading to the belief that all was safe to use.

Mahmoud et al., (2010) showed on melanocompetent volunteers with skin types IV–VI, that heat from the light source caused changes in the melanin pigment. Additional concern was that the heat could lead to dilatation of deep dermal vessels.

As a control they also tested the same parameters on Fiztpatrick II skin with no results apparent.

In 2014, Duteil et al., published their paper showing via colorimetric and clinical assessments, a clear dose effect with the 415‐nm irradiation, in both skin type III and IV subjects, inducing hyperpigmentation lasting up to 3 months, whereas the red wavelength 630 nm did not induce hyperpigmentation.

Early in 2018, Regazzetti et al., defined previous thought pathways of how blue light caused pigmentation via Opsin 3 (G protein-coupled light sensors described in the eye). Both keratinocytes and melanocytes express varying levels of five different opsins (OPN1-SW, OPN2, OPN3, OPN4, and OPN5) that absorb shorter wavelengths of visible light (de Assis et al., 2016).

Due to a series of chemical pathways blue light-activated opsin3 induces a unique pathway involving CaMKII (calcium/ calmodulin-dependent protein kinase II, activated via increased cytosolic calcium flux) as shown in the image by Rao, & Setty, (2018).

BLUE LIGHT ON HUMAN DERMAL FIBROBLASTS Not only do the melanocytes take a hit from blue light, so do

the fibroblasts. In an elegant study, Opländer et al., (2011) investigated the effects of blue light at distinct wavelengths (410, 420, 453, 480 nm) emitted by light-emitting diodes on viability, proliferation and antioxidative capacity of human dermal fibroblasts.

The study found that irradiation with 410, 420 nm led to intracellular oxidative stress and toxic effects in a dose and wavelength dependent manner, which did not occur with 453 nm and 480 nm.

Additionally, irradiations at 410, 420 and 453 nm reduced fibroblast proliferation. They surmised that blue light at different wavelengths induce varying degrees of intracellular oxidative stress with different physiological outcomes, which could contribute to premature skin photoageing.

As skin care professionals, you know already how you can counterbalance this to prevent the ongoing damaging effects from blue light.

It appears that blue light interacts with porphyrin containing enzymes and flavoproteins causing generation of reactive oxygen species like singlet oxygen and hydrogen peroxide within the fibroblasts, thus causing antiproliferative effects on the fibroblasts.

Singlet oxygen is prevalent in higher numbers with 410 nm and 453 nm inducing higher hydrogen peroxide proliferation.

These findings confirm previous studies (not referenced in this article) that postulated blue light increased free radical production.

On the positive side, knowing the effects of blue light on fibroblast proliferation, this could be useful in treatment of hypertrophic scarring where fibroblastic hyperproliferation is the problem, so isolating the blue light emission to the scar tissue only could provide a new approach to scar treatment.

BLUE-LIGHT IRRADIATION REGULATES PROLIFERATION AND DIFFERENTIATION OF KERATINOCYTES LED derived blue light up to 453 nm reduces proliferation of keratinocytes was found to be the case by Liebmann, Born, & Kolb-Bachofen (2010). They found increased expression of the proliferation markers involucrin, keratin-1, and keratin-10 and an increase of cellular ATP content. Contrastingly, massive reactive oxygen species generation was noted that appeared to emolliate the proliferation markers thus reducing rather than increasing differentiation of keratinocytes (p. 266).

One major difference noted was in the use of fluences used - high or very high fluences is cytotoxic for skin cells in a dosedependent as well as cell-type-dependent manner so use of lower fluence settings is desirable.

On one hand using blue light slows down the proliferation of keratinocytes – not exactly what we need, yet on the other hand this is very useful in proliferative skin conditions.

BLUE LIGHT STRESSING THE SKIN Nakashima, Ohta, & Wolf (2017) exposed human skin to blue light contained in sunlight depressed flavin autofluorescence, demonstrating that the visible component of sunlight has a physiologically significant effect on human skin. They found an increase in superoxide free radical production suggesting that blue light contributes to skin ageing as like UVA.

During melanocyte development, paracrine Kit/Kitl signalling activates intracellular signal transduction which is independent of light activation. Rao, S., & Setty, G. (2018, p. 14).

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They also found that the photon efficacy of blue light to oxidise glutathione was only 25% of UVA, Blue light is more than twice as abundant in sunlight as UVA, suggesting the contribution of blue light to reactive oxygen species

production might be about half that of UVA. Again, antioxidants to the rescue.

A previous study by Liebel et al., (2012) showed that blue light induced the expression of MMP-1 and the pro-inflammatory chemokine IL-8. However, there was no formation of pyrimidine dimers, as seen with UV light. Therefore, it seems that blue light contributes primarily to photoageing and inflammation.

One compound, β-Carotene, has a rich vein of science behind it, showing light-absorbance maxima in the blue

Blue light per sae is not a danger, however if using blue light, be aware of the irradiances and fluences and use only for a short time period. Given its prime use in aesthetics is for acne, adequate antioxidant defence and as always total sun protection, should suffice in keeping the skin from long- term damage of blue light use.

The use of specific irradiances (power per area) and fluences (radiation dose per area) for purpose is the way to safely use blue light, not in ‘board array’ LED panels, but having the ability to modulate parameters to better suit a client or for presentations.

I trust you take great care in the use of light. While Laser and IPL are perhaps more damaging than other forms of light therapy, none is without possible complications requiring careful consideration.

Do not be complacent thinking that LED is innocuous and completely safe, as it is not. So much so, that one dermatological leader, Dr Leslie Baumann stated in Dermatology Times, June 2019 (pp. 40-43) that she now avoids using blue light due to the ageing aspects. APJ Terry cites 17 studies in this article – due to space limitations these are not published, however the complete reference listing is available from the editor.

Inhibition of blue light-induced dermal ROS formation (MendrokEdinger et al., 2018)

light spectrum and how protective it is against blue light yet paradoxically is also destroyed by blue light. β-Carotene is a particularly blue light-sensitive molecule that rapidly quenches reactive oxygen species, such as singlet oxygen and peroxides (Stahl & Sies, 2012), with Vandersee et al., (2015) showing a significant decrease in cutaneous carotenoids (21%) directly after blue light irradiation at 100 J/cm2.

IN CONCLUSION While this article has explored only a little of the scientific literature showing that blue light has potential to harm and thus age the skin, if you undertake a scientific literature review on the subject you will find a plethora of studies over the last two decades on the subject of blue light damage, so with your care, this damage should not happen.

We have seen that the damage from the use of blue light is wavelength and irradiance specific causing primarily free radical inducement effecting cellular function via various oxidative stress reactions.

Blue light would be expected to contribute to skin ageing not by overwhelming cellular antioxidant defences, but by continuously producing low levels of oxidative stress by free radicals that escape the body’s defences to cause permanent DNA damage.

I use the term oxidative stress to indicate a short-term increase in free radicals, but this should not be interpreted to imply any lasting harm to skin or cells if adequate protection against this stress is provided.

APJ 23 Bitmap in CEO Report Mar17 Friday, 15 September 2017 3:32:07 PM

BUSINESS

CLAIRDERM MEDICAL AESTHETICS

Breathing New Life into the Professional, Non-surgical, Skin Rejuvenation Practice THERE IS NO DOUBT that consumers are looking for effective, non-surgical skin rejuvenation options, that can be scheduled in between working hours, with minimal inconvenience, pain, discomfort, immobilisation and recovery time.

Now more than ever before if aesthetics professionals want to retain their competitive edge it’s paramount that they rely on ongoing innovations in advanced and reliable technologies, which deliver profitable, superior and consistent rejuvenation results versus their competition.

Australian microdermabrasion innovators, Clairderm Medical Aesthetics, are committed to ongoing research and development. This helps to keep aesthetic professionals at the forefront of non-surgical, aesthetic treatments that deliver the best consumer outcomes consistently.

CELL TURNOVER – THE KEY TO SKIN REJUVENATION As we age collagen and elastin synthesis decreases, which contributes to the reduction in cell turnover. This can result in a build-up of dead skin cells on the surface of the skin, which can reduce the penetration and efficacy of topical products and light-based therapies and trigger enlarged pores. This negatively impacts on skin rejuvenation.

Microdermabrasion the professional skin rejuvenation “must have” Microdermabrasion, the professional’s

APJ 24

choice that’s safe for all Fitzpatrick skin types, is a non-invasive, gentle process that mechanically exfoliates layers of dead and damaged skin cells that negatively impact on cell turnover and the penetration of topical products and light-based therapies. This procedure aids skin rejuvenation for several reasons. The intense exfoliation, resurfacing and removal of dead skin cell build-up helps to improve the penetration and efficacy of topical products 4-5 times, as well as light-based therapies. Additionaly it will have to reduce the appearance of enlarged pores. The micro-trauma helps to increase microcirculation, bringing fresh oxygenated blood and nutrients to the skin’s surface, stimulates the production of collagen deep in the dermis and hence facilitates cellular renewal. Furthermore, the vacuum suction promotes lymphatic drainage and stimulates the lymphatic system.

Clairderm Skin Trio breathes new life into microdermabrasion Proudly Australian made, Clairderm Skin Trio, combines 3 microdermabrasion modalities, crystal, diamond and hydrabrasion, in one device for medical and aesthetic applications. This gives the practitioner the flexibility of offering either a gentle or more powerful skin resurfacing and rejuvenation procedure in one treatment. Not only does the equipment use state of the art technology, but specific consideration has also been given to design. This makes a huge difference to ease-of-use and performance. The slimline, compact design ensures that it takes up minimal space and the right and left-hand use offers flexibility. The combination of its stylish slimline design, highest standard for quality and hygiene and superior results makes it a “must have” for any clinic.

Clairderm Trio microdermabrasion - A popular choice What makes Clairderm Trio microdermabrasion so popular with consumers is that it provides truly amazing results! The procedure is hygienic, non-invasive, safe and can be scheduled in between working hours with minimal inconvenience, pain, discomfort, immobilisation and recovery time. Hydrabrasion is a favourite, with customers enjoying its soothing, cooling and hydrating effect on the skin.

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STANDARDS & REGULATIONS

ARE YOU OPERATING OUTSIDE OF YOUR SCOPE OF PRACTICE? Tina Viney THERE IS MUCH TALK lately that as professionals, we are required to operate within our “scope of practice”. So, what does the term “scope of practice” mean and why is it important?

In this article, I would like to provide not just a definition, but I would also like to attempt to contextualise its meaning in terms of our industry.

WHAT IS SCOPE OF PRACTICE? A scope of practice can be broadly defined as the permissible activities for the members of a healthcare profession to operate. In many cases, the scope is determined by laws within a particular jurisdiction, an industry body, or a professional standards body, and the administrators of specific healthcare facilities. The key objective of establishing a Scope of Practice is to ensure the safety of the consumer.

Members of a healthcare, or an allied health profession, are typically trained to understand the limitations on their professional tasks and responsibilities and to seek assistance from others when appropriate.

Healthcare workers who violate these laws risk not only losing their professional license, but may be subject to criminal prosecution and civil lawsuits.

In many areas, laws define the appropriate scope of practice for different healthcare professions. This is intended to ensure that the public is receiving services only from those who are actually qualified to offer them.

These laws are often developed in consultation with professional bodies, who can advise lawmakers as to the expected competencies of individuals in a specific occupation.

This is one of the tasks that APAN is involved and committed to for the benefit of our industry. While we would agree that regulations in our industry are very slow in coming forward, we envisage changes in the coming future as risks from ingredients and procedures are identified and as our practices move close to allied health and healthcare.

When considering the scope of practice there are three key areas that we need to understand:

a. The range of roles that you will be performing: This is determined by education, training and development in the wider sense, as well as qualifications for a range of activities that you will be performing. These could be skills identified as APJ 26

needling, microblading, IPL or Laser, plasma skin tightening, levels of skin peeling etc. b. The function and responsibilities: This area defines the required competence to undertake this procedure, the currency of knowledge and the framework to which you can operate. An example may be that you have received a qualification in say laser, but you are still required by your local council to have a laser license.

You may have a qualification to perform cosmetic tattooing, or skin needling, but you are still required to have a skin penetration license that outlines specific functions and responsibilities relating to safety. These licences may need to be renewed each year. c. The decision-making capacity the professional performs in the context of their practice: This may require that while you can perform certain procedures, aspects of what you deliver may require a medical script such as a topical anaesthetic for pain management. So, while you can deliver the skin needling procedure, the ultimate decision as to an appropriate topical anaesthetic for that procedure will ultimately be the responsibility of the prescribing professional – the compounding chemist, or the medical doctor, if they are giving you a script. Another example of “decision-making capacity” could be a registered nurse who is qualified to deliver a cosmetic injectable procedure, however, the authority to access the filler or specific injectable lies with the appropriately trained medical practitioner under whose jurisdiction the nurse is required to operate in order to access the appropriate injectable drug.

BUT ISN’T A SCOPE OF PRACTICE REQUIRED ONLY FOR MEDICAL PRACTITIONERS? The question you need to ask yourself is this, “do the procedures you perform reach areas where there are nerves, blood and lymphatic flow? Are you using equipment that target the dermis, or introducing products that are delivered within the dermal region? Can the procedure create bleeding? Can they cause pain? Can it potentially burn the skin?” If your answers to any of these questions is yes, then your treatment would fall within the perameters of allied health. If your procedure creates a wound, you need to have a comprehensive understanding of wound healing. On the other hand, if you are working with multidisciplinary health

practitioners your work will also fall within the scope of allied health.

c. What are the safety measures incorporated in the design and engineering?

In essence, if you are helping to create change to the skin or body, then there are risks involved and you will need to demonstrate that what you perform will be safe and cause no harm. You will therefore be required to operate within your scope of practice.

d. Does it meet with Australian standards and TGA regulations if applicable and do they have scientific studies to support their safety and efficacy?

DOES OUR INDUSTRY HAVE AN ETHICAL REQUIREMENT REGARDING SCOPE OF PRACTICE?

e. What scientific knowledge is required for you to operate this device and do you possess the appropriate qualifications and knowledge to understand the technology? This goes beyond you being shown how to use the device.

Scope of practice basically requires that one operates responsibly within the scope of their knowledge and qualifications.

f. What training are they offering and do they offer technical support?

There are three key jurisdictions that determine conduct:

h. It is also important to ensure that the company you will be dealing with is reputable and has a proven track record and provide timely and expert service.

1. Regulatory and Legal requirements: These are the strictest requirements and are mandatory and enforceable by law. They are usually governed by State and Federal licences and by regulatory bodies.

2. Industry Ethical requirements: Where a specific qualification is not enforceable by law it is up to the Association or Society that represents that industry to establish self-regulatory requirement through a Code of Ethics and/or a Code of Conduct. It is the responsibility of your industry body to establish and define a Position Statement. In fact, the Australian Government has encouraged us to define our industry standards and establish self-regulation measures, through recognition of education and standards. Our ARAP and CTARP Registration process is one of our self-regulatory measures

g. Are the trainers qualified or just sales people?

i. We also recommend that you request to speak to at least 4-6 of their customers that can provide you with evidence of the performance of their devices. j. Contact your association and request their recommenation. We regularly protect members from unreputable purchases as we conduct due-diligence on companies we recommend.

This is the role of your industry body and practitioners have an ethical responsibility to abide by their endorsed industry standards, qualifications and Code of Ethics.

DETERMINING YOUR SCOPE OF PRACTICE In consideration of this, it is important you have a sound understanding of your professional and individual scope of practice. While a task might be within scope of practice for your profession, it may not be within your individual scope of practice. For example, you may have qualified as a Beauty Therapist, but you are moving into more advanced procedures, such as dermal needling or laser. However, these were not units of study within your qualification. While you definitely have the underpinning knowledge to move and introduce these procedures, they are not currently within your scope of practice. It would be both ethical and prudent to seek an appropriate post-graduate course or a recognised study unit that will allow you to gain and consolidate specific skills and knowledge within the specific practice area that you wish to introduce. If there is a recognised qualification, that would be your most credible choice.

APAN’s Code of Ethics and Code of Practice have been presented to several Medical Societies and are considered to be of the highest standard.

As a professional, you are also responsible to constantly self-assess and look at ways to continue to improve your own competence and scope of practice.

In reference to the above issues raised, within the APAN Code of Ethics, Section 1: Practitioner/client relations, Clause 1 states:

Some useful questions to assist in determining if an activity/task is within your scope of practice include: • Is it in the best interest of my client?

APAN is also heavily involved in curriculum development of qualifications both at a VET and also at higher education levels. We also provide recommendation through consultation of the need for the various modalities entering our industry to also have an educational pathway in support of best practice.

In every way consider your client’s wellbeing and always treat them with courtesy and compassion abiding by the ethical position of “first, do no harm” (primum non nocere).

Further down in Clause 8 it states: Ensure that you only perform treatments that you are professionally qualified to do and conduct your professional activities within the scope of regulatory requirements and your professional limitations.

3. Self-regulation: When a new procedure enters the market, you have a duty-of-care before you rush to introduce it that you examine the options carefully: a. Does the device have an international certification? b. Does the manufacturer offer a warranty?

•

Is it within the scope of practice for my profession (legislative, professional association guideline documents)? Is it accepted practice within your profession?

•

Is there organisational support (e.g. guidelines, within job description, management approval, or industry position?

•

Is it within my own scope of practice - do I have education preparation and clinical practice? Am I competent and confident to perform the task safely? APJ

If you are seeking to introduce new technologies and would like to discuss this with an idependent industry expert please contact APAN 07 55930360. We can provide you with credible companies and solutions in advancing your scope of practice.

APJ 27

SKINCARE

Traditional and Modern Delivery System in Skincare Dr Donna Lee Marçal, PhD Dermatonics Co-Founder IN THE AGE WHEN skincare results must be apparent and measurable, understanding the biotechnological mechanisms on how active ingredients can penetrate the skin to create change is an important consideration when choosing your skincare products.

Dr Donna Lee Marçal is a specialist in human Biochemistry with a doctorate from The University of Ottawa. Her work on inflammation and how the body reacts to foreign materials has been ground-breaking research. Dr Donna has been awarded several international research fellowships for her work.

In this article she presents both traditional as well as some modern, innovative delivery systems that are playing a key role in the efficacy of today’s skincare.

A key goal of modern skincare is to deliver the best actives possible into our clients’ skin to achieve outcomes. Seems simple right? However, effective, and more importantly, safe delivery of active ingredients into the deeper layers of skin takes years of engineering, formulation and testing.

they were first discovered in 1961. They are microscopic in size, ranging between 0.15 – 3.5 um. They were first used

by Dior in 1986 in their Capture skincare range. Liposomes are useful in that they help protect active ingredients and they allow actives to penetrate deeper and can allow to target specific cell types. Some of the disadvantages include their higher production costs and lower solubility of some preparations. Liposomes can also break down during storage, thus having a shorter shelf-life than other products, or requiring higher concentrations of preservatives.

NANOPARTICLES These are nanomaterials that range in size from 1 to 100 nm.

An example of this would be micronised zinc for sunscreen applications. Nanoparticles help to cover the skin with less ‘pastiness’. Nanoparticles range quite substantially in their size and application. Some of them now have a bad name in regards to safety, particularly if they become airborne entering the lungs and coating the alveolar wall. To summarize the various applications of nanoparticles, they have been listed below with their benefits in terms of skincare active delivery:

There are some tried and tested delivery systems that have been around and employed for decades, some with great track records and some, with health warnings as we learn more about them. There are also some pretty sophisticated delivery systems being developed today that are not yet on the market. But what do these all mean for our skincare products and our clients? Here we touch on some of the delivery systems that have been used in skincare and ones to watch out for in the future.

•

Nanoemulsions – for their ability to prolong the shelf life of personal care products

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Nanocapsules – for their controlled release of actives

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Sold lipid nanoparticles – for their enhanced UV blocking

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Nanocrystals – more effective passage through the skin

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Nanosilver and nanogold – for their enhanced antibacterial properties

LIPOSOMES This is probably one of the most well recognised types of skincare delivery systems. Liposomes have been around since

•

Hydrogels – for their prolonged effect at the site of application

APJ 28

•

Buckminster fullerine (buckyballs) – for their potential to scavenge free radicals and slow down the ageing process

MICROCAPSULES These are slightly larger structures ranging in size from 1 um to 1 mm. The type of material that is used for encapsulation varies greatly, with examples including polysaccharides, lipids as well as synthetic polymers. A typical example of these are microcapsules that you would see in a hand sanitizing gel. These little microcapsules would contain a moisturising agent to help deliver moisture on application. This would hold a few functions, including protecting the ingredients in the capsules and also making the product more aesthetically pleasing. A hand sanitising gel is typically clear, and if we saw a cloudy moisturiser mixed in, it wouldn’t look ‘normal’ to the consumer. Another great example is microencapsulated retinol. We know that retinol can be quite unstable and is a highly reactive molecule, losing its activity and benefits quite easily. Therefore, encapsulation would be a good method to increase its stability, deliver your skin a more potent molecule and prolong the shelf life of the product.

Now, what about microbeads? We’ve heard quite negative discussions about microplastics and microbeads. Microbeads are typically solid particles that are made of synthetic polymers, so essentially solid plastic. They are made to bulk up a product, or as an abrasive (think scrubs or those beads in some toothpastes). Microbeads are now banned in some countries, unfortunately they are not yet banned in Australia.

However, many companies have stopped using them in their products. The good thing is, microcapsules are different to microbeads. Microcapsules, as above, are hollow structures that deliver an active that is contained inside. The shell being a polymer or wax, the much safer option (for us and the environment) being natural products or biosimilar capsule materials.

BIOMIMETIC DELIVERY SYSTEMS If you haven’t heard of biomimicry, it is the imitation of the systems, element and models of nature for the purpose of solving complex human problems. These can be either synthetic or natural. In skincare delivery, this means using ingredients that are similar to the skin cell membranes so they get absorbed and delivered into the deeper skin layers.

An example of a natural biomimetic is Jojoba Oil. This oil is the wax ester produced by the Jojoba bean and is biosimilar to the structure of the protective wax produced by the human skin that helps keep it smooth and moisturised. Because of this, and the fact that Jojoba oil is ‘mimicking’ our skin’s natural oils, our cells readily absorb it. This is a great way to deliver oils and thus hydration into our cells. As a result, other actives (especially if they are smaller in size) will be readily absorbed much easier along with its Jojoba oil carrier.

Bicosomes(R) are a synthetically manufactured delivery system (derived from naturally sourced components) that interacts with the skin and imitates the skin’s natural processes. Since it is a proprietary material, we don’t know the specifics of the material. The inspiration for the delivery system is the skin’s lamellar bodies. However, it is stated that when it is applied on the skin, the outer vesicle fuses on the skin surface and the ‘smart disks’ penetrate selectively through the inter-corneocyte spaces reaching target skin layers and helping to reinforce the stratum corneum matrix and delivering active molecules.

CUBOSOMES – THE NEW KID ON TH BLOCK These are one of the new and innovative technologies that are not yet on the market, but highly anticipated by big cosmetic companies. Cubosomes are nanostructured liquid crystalline

particles. They are considered to be the next generation of smart lipid nanoparticles. They are a cube structure of organised nanomolecules that make up the cube. Think a bit like a Rubiks Cube, but much smaller and each inner cube contains actives. They have a cubic crystallographic symmetry formed by self-assembly of amphilic (having both a hydrophobic and hydrophilic end) molecules. A major advantage is that they seem to be highly stable. For such a complex delivery system, their cost will be relatively low and the potential for controlled release is high as they can encapsulate hydrophobic, hydrophilic and amphiphilic substances. They contain biocompatible molecules and seem to be thermodynamically stable. They certainly sound like an amazing delivery mechanism.

DENTRIMERS One last delivery mechanism to mention are unique structures called dendrimers. This is a highly branched polymer-based delivery system with a compact, symmetric and spherical shape. Essentially, these are a threedimensional ‘star’ shaped, branched network that forms a sphere. The advantage of dendrimers is that they can drastically increase the water-solubility of certain molecules. A specific example was published by Pentek et al (2017) where they synthesised dendrimers of Resveratrol. Their studies showed that by organising Resveratrol into dendrimers, they could significantly increase the solubility into water, both at a low pH and neutral pH. Resveratrol is typically completely insoluble at low pH and the solubility is very poor at a neutral pH. This is a fantastic way to deliver such amazing molecules in a simple, yet effective manner.

IN CONCLUSION There are several ways that active ingredient delivery can be enhanced in skincare products. They don’t all have to be fancy, just as long as they are effective. Some delivery systems can drive up the price of a skincare product. This is where education about the ingredients and delivery systems in a product is key. Understanding the point of difference in your skincare products you use on your clients and how their ingredient diversity and delivery mechanisms make them effective will help you translate this product knowledge to your clients, allowing them to appreciate the benefits. APJ a bit more of an investment and why they are effective.

For a list of references, please contact the editor.

APJ 29

PRODUCTS

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RE-WRITE THE SKIN’S FUTURE With Clairderm’s 3-in-1 DERMAPRO SKIN NEEDLING SYSTEM

Clairderm Medical Aesthetics’ DermaPro 3-in-1 professional skin needling system offers effective non-surgical skin tightening, rejuvenation and semipermanent make-up. It incorporates three dermal needling systems in the one pen. The Nano-needle System gently removes dead skin cells, an ideal standalone treatment or prior to micro-needling; The Microneedling System creates microscopic punctures to help stimulate collagen and elastin production to rejuvenate and tighten the skin. The Semi-permanent “makeup” System offers single or multiple treatment applications. DermaPro is safe, hygienic, fast (18000 cycles per minute), it offers five-speeds with both plug in and rechargeable battery power options and comes with full training.

For more information about the amazing promotional packages please contact Clairderm 1300 781 239 office@clairderm.com www.clairderm.com

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EHANCE SKIN-BARRIER FUNCTION WITH CERAMIDE BOOSTER BY ROCCOCO

A fusion of hydrating ingredients that restore the skin barrier, reducing moisture loss. It offers immediate relief from dehydration, soothes the skin and provides a sense of comfort to irritated skins. This is our most hydrating booster serum. Hydration levels in the skin increase the absorption of other actives, therefore Ceramide Booster increases the efficacy of active ingredients in other products.

Contact Roccoco Ph. 07 3807 1429, sales@roccoco.com.au, www.roccoco.com

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4 3

POWERFUL SPRING-HYDRATION DUO

LOOKING to help get your clients’ skin spring-ready?

Winter is harsh and the arid climate of Australia is unforgiving. At Dermatonics, we have an active ingredient packed duo to help rejuvenate, repair and hydrate the skin. Our Dermatonics Beauty Elixir is scientifically formulated with patented Nutridermaceutical technology to deliver ultra-pure natural active ingredients. This moisturiser is packed with natural antioxidants and anti-inflammatory ingredients that are also collagen-boosting to stimulate internal cellular pathways. Our method of ingredient purification and product formulation ensure that our ingredients are truly active and ensures bioavailability in the skin. Our Nourishing Face Oil helps provide the extra hydration needed when applied both day and night. With a Jojoba Oil base and including our signature powerful natural active, Curcuma xanthorrhiza, this face oil helps calm the skin and contribute to skin barrier repair. The ultimate spring hydration duo.

Contact Dermatonics today! info@dermatonics.com.au www.dermatonics.com.au

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AKORAH BODY CARE RAISES RELAXATION AND NURTURE TO A NEW LEVEL

AKORAH is an all-Australian, quality body range that will relax and nurture your clients at a very deep level. Beautifully-presented and in generous sizes of 200mls AKORAH utilised traditional ingredients of the purest and highest quality. Each product is Infused with one of their three amazing aromatherapy signature blends: DREAM: Lavender, chamomile and cinnamon, blended to evoke calmness and relaxation.

SPIRIT: Juniper, mint and citrus blend is excellent for purifying and detoxifying. THRIVE: Rosewood, lemongrass and ylang ylang come together to uplift and energise.

AKORAH is a boutique quality body range that will deliver impressive results. To refresh from “within” the range also offers Organic Herbal Teas.

Formulated with healing Australian native botanical extracts such as Kakadu Plum, Macadamia nut oil, Shea Butter and Lilly Pill. AKORAH offer winning products that are so easy to sell.

To view the full range www.akorah.com.au Ph: 02 4225 2522, relax@akorah.com.au APJ 31

PRODUCTS

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THREE POWERFUL SERUMS

BY DR ANNE-MARIE’S DERMALCARE

Serums are an important part of targeted skin support. They are loaded with actives that help boost treatment results and maintain your treatment outcomes for longer. New from Dr Anne-Marie’s Dermalcare three powerful serums bring new hope to skin improvement.

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Vitamin C and Kakadu Plum Serum: This serum contains -L-Ascorbic Acid (15%), Kakadu Plum and Davidson Plum in a hydrating base. L-Ascorbic Acid is a strong anti-oxidant and assists in brightening the skin, reducing the signs of ageing as it supports collagen and elastin synthesis.

Vitamin B, Hyaluronic Acid and Tasmanian Pepper-leaf: This serum contains Vitamin B3, Vitamin B5, Hyaluronic Acid to hydrate and brighten the skin and Tasmanian Pepper-leaf with its strong antioxidant properties. This serum is suitable for use on Acne prone skin and may assist in regulating sebum flow and refining the pores of the skin.

Vitamin A, Squalene and Sandalwood Serum: This oil-based serum contains 0.2% Retinol and 1% Tocopherol in a squalene base. Retinol assists in reducing the signs of ageing and sun-damage. It also contains Bisabolol and Native Sandalwood Seed Oil for their anti-inflammatory properties.

All three serums come packaged in the beautiful MIRON bottles to preserve their freshness and longevity. Miron glass is a novel glassware that has demonstrated outstanding capabilities of preserving substances contained in it for extended periods without the need for added preservation.

Please contact Dr Anne-Marie’s Dermalcare: 0403 846 622, info@dramdermalcare.com.au

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“SEEING IS BELIEVING” with Clairderm’s SKIN ANALYSER

One of the secrets to healthy skin is a customised skin management plan that effectively repairs the past, treats the present and protects the future. This can only be achieved if the overall health of the skin, both inside and out, is completely understood. The Clairderm Skin Analyser enables the clinician to do this in under 60 seconds. The HD camera and lens provide a superior skin analysis of both the epidermis and dermis. In addition, the three spectrums, PL, RGB and UV, ensure an in-depth diagnosis of 10 different skin conditions. Furthermore, it makes treatment recommendations based on the clinic’s products and treatments and conducts a comparative analysis of the treatment results over time. Undoubtedly, clients will see that their skin management plan is really working.

For more information contact Clairderm Medical Aesthetics on 1300 781 239 or email office@clairderm.com or visit www.clairderm.com

APJ 32

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APJ 33

TECHNOLOGY

LET THERE BE LIGHT The Magma 808nm diode laser is one of the first systems that is suitable to treat all skin types, including skin type VI. This is due to its flexible pulse durations from 5ms to 400ms and chilled-tip cooling system.

Laser expert, Kevin Williams, looks back at the history and evolution of the laser and light-based technologies and presents some interesting facts about the new advances with the diode Magma Laser and its incredible capabilities.

TODAY LASER AND IPL SYSTEMS are used in every aspect of life for an ever-increasing number of aesthetic conditions including hair removal, skin rejuvenation, acne, vascular lesions, pigmented lesions, onychomycosis and tattoo removal. The market, according to some reports, reached $2 billion for the year 2018 and will reach $3 billion for 2019.

Laser is the acronym for Light Amplification by Stimulated Emission of Radiation. Interestingly it was originally going to be called “Light Oscillation”, which would have led to an unfortunate acronym of LOSER. Albert Einstein first explained the theory of stimulated emission in 1917, which became the basis of laser. He postulated that when the population inversion exists between upper and lower levels among atomic systems, it is possible to realise amplified stimulated emission and the stimulated emission has the same frequency and phase as the incident radiation. However, it was in the late 1940s and 1050s that scientists and engineers did extensive work to realise a practical device based on the principle of stimulated emission.

Notable scientists who pioneered the work included Charles Townes, Joseph Weber, Alexander Prokhorov and Nikolai G Basov.

THE INTRODUCTION OF THE FIRST LASER Despite the pioneering work of Townes and Prokhorov, it was left to Theodore Maimanin 1960 to invent the first laser using the ruby as a lasing medium that was stimulated using highenergy flashes of intense light.

In 1960, only a year after lasers were invented, dermatologist Leon Goldman began his research at the university of Cincinnati and later established a laser technology laboratory at the school’s medical centre in 1963. He became the first physician to test the effects of this laser on human skin.

It was however the theory of “selective photo-thermolysis” that revolutionised the medical laser industry. In 1983, Anderson and Parrish described the theory of selective photothermolysis, which actually revolutionised laser therapy by APJ 34

explaining a method of producing localised tissue damage sparing the surrounding tissues. In order to understand this, we need to understand certain terms including wavelength, absorption, fluency and the thermal-relaxation time (TRT) of the intended target.

For tissue damage to occur, a wavelength should be preferentially absorbed by the chromophore in the target tissue and not absorbed by the surrounding tissue. It therefore needs to be delivered in a pulse duration which is less than or equal to the thermal relaxation time of the target. This theory led to safer and more effective treatment procedures.

The first category of lasers to gain popularity in the UK was the C02 laser, introduced by an Israeli company that supplied the first laser to the Albert Einstein Hospital in 1973. In the early 80s these were popular in hospitals for surgical procedures in ENT and gynaecology departments for vaporisation of tissue. The high absorption in water made them ideal for this application. It wasn’t until the introduction of micro-pulsing technology, developed for char-free ablation of endometriosis and such conditions, that they caught the eye of dermatologists and plastic surgeons. It soon became apparent that this technology could be used for skin rejuvenation and in the 90s people had years taken off their appearance with these treatments. Unfortunately, the downtime became an issue and it wasn’t until 2005 and the development of fractional technology that the C02 laser saw a second birth.

Today this combination of very short pulse durations and microzone injuries caused by fractional delivery heads is the gold standard for wrinkle and scar reduction.

LASER FOR HAIR REMOVAL The biggest impact however in the aesthetic laser industry came with the introduction of the first lasers for hair removal in 1994. There were two groups of scientists reporting potential results with a ruby laser for the application of hair removal. Anderson and his colleagues at the Massachusetts General Hospital developed a long-pulsed ruby laser and reported results on lighter skinned patients for hair removal.

In the UK, professor Clement from Swansea University and

Dr Gault from Mt Vernon Hospital were reporting good results on skin graft patients where post excess hair became a problem on the grafted skin using the Chromos 694 ruby laser. It was actually professor Clement that got me hooked on lasers during one of his lectures. It was during one of our meetings where he showed me his bald patch from an accident with a ruby laser, when he was a student.

“This was something I repeated several years later and 18 years later I still have the bald patch,” he said. The subsequent launch of this system saw an explosion in the UK with many companies looking to develop technology for this market sector.

The trials indicated high absorption characteristics, which provided evidence as to why the ruby laser was ideal for this application, which confirmed high absorption in melanin and deep penetration to target the bulb of the hair.

Unfortunately, the high absorption in melanin and the short pulse duration of less than 3ms meant that the laser could only be used on skin types I and II. The ruby laser was also very slow due to the combination of small spot size and a slow repetition rate.

The ruby laser was quickly followed by the introduction of the Alexandrite laser, using a slightly longer wavelength of 755nm and longer pulse duration, up to 40ms, these became the industry standard for treating patients with skin type I to III. The larger spot size and 3Hzrep rates enabled treatments to be performed much faster than before.

This however, left a gap in the market for the treatment of darker skin types, so, scientists started to experiment with other wavelengths and discovered that the NdYag laser (1064nm) could be effective on darker skin types. Tests however, demonstrated that the NdYag was less absorbed in melanin than Alexandrite so it therefore doesn’t face the same problems on darker skin types. It does however, require higher energies and due to the high absorption of water, is a much more painful treatment. Until recently it has been the treatment of choice for darker skin types.

THE INTRODUCTION OF IPL Another major milestone in the market was achieved when Dr Eckhouse and Dr Shraga from Israel introduced the Intense Pulsed Light (IPL) system. Unlike a laser system this emitted a wide spectrum of light from 400nm to 1200nm. Optical filters were used to block out lower wavelengths enabling the IPL to be used for different applications. One of the great advantages of the technology was the fact that energy could be delivered through a Sapphire block enabling the operator to press into the tissue, increasing the absorption of the light into the hair follicle.

The early systems were introduced to treat various vascular and pigmented lesions and later developed for hair reduction.

The cheaper manufacturing costs and reduced development times opened the door for many companies to enter the market and moved hair removal business into the high street.

Unfortunately, large variations in specifications meant that hair removal results were not always as good as those seen with laser systems with some clinics reporting treatments upwards of 15 to achieve good results.

For me, the IPL is a great treatment tool that is still my first choice for the treatment of fine hair and for general facial rejuvenation where the concern is redness and pigmentation.

I worked on an interesting theory with my colleague Dr Freeman as well as Dr Haziza, where we looked at destroying the bulge rather than the bulb. We know that the germ cells multiply in the bulge before growing down to form the bulb.

Our theory was to target the blood vessels feeding the bulge.

Using a 3ms IPL with a wavelength of 500nm-1200nm we showed promising results on finer, lighter hair.

DIODE LASERS In the past few years the introduction if diode laser technology has seen the industry move toward Platform technology with various wavelengths including 808nm, 820nm, 1320nm and 1064nm available.

Diode lasers possess all the characteristics of lasers, but are engineered from semi-conductor plates stacked together with an optical grove to produce the lasing action. They only require a low voltage to energise them and therefore do not need the larger power supplies required for traditional laser systems. Diode lasers are generally delivered to the tissue via a sapphire block, which can be cooled to protect the epidermis. They are small, compact units that can be easily fitted into the delivery handpiece – these are taking the industry to a new dimension.

One of the most recent and exciting innovations in diode laser technology is the Magma system developed in Israel, which combines IPL, with 808nm and 1064nm diode lasers.

Interestingly one of the chief scientists behind the innovation is Dr Shraga, one of the original team members behind the development of the first IPL system. This innovation allows treatment plans to be tailored to the individual patient’s requirements.

I used this for the first time seven years ago. The results have been incredible, I was able to achieve amazing results in just two treatments using 808nm diode head with a pulse width of 50ms. His first treatment was performed on an active tan.

The Magma 808nm diode laser is one of the first systems that is suitable to treat all skin types, including skin type VI. This is due to its flexible pulse durations from 5ms to 400ms and chilled-tip cooling system.

Clinical trials in Israel showed an 86% clearance after three treatments and many UK users are reporting excellent results after only four treatments.

Platform lasers are already a reality, something which could have only been dreamt of 30 years ago. Who knows what the next 30 years will bring, but one thing is for sure, the flexibility of diode lasers will be at the heart of the next generation - the future is indeed very exciting. APJ Article submitted by ClinicalPro 1800 628 999 07 3350 6898 www.clincalpro. com.au Printed by permission.

APJ 35

TECHNOLOGY

NEW GIFT CARD LAWS NOW GO NATIONAL EARLIER THIS YEAR THE ACCC RELEASED laws in NSW regarding the issuing of gift vouchers. In our opinion, some of the terms and conditions were better suited to the retail industry, rather than the service industry. APAN did communicate this to the ACCC. Since them new updated laws have been released and will be applicable nation-wide.

The new laws have been slightly amended and recently released by the Australian Consumer Law (ACL) with the aim of protecting consumers using gift cards across Australia.

While they are still not ideal, they are now the laws with which all businesses must comply. The new laws apply to gift cards supplied to consumers on or after 1 November 2019.

Cards and vouchers sold before 1 November 2019 continue to have the same expiry period and applicable fees as at the time of purchase.

This article will only summarise the terms of the new legislation and adapt it to our industry, However, please review the full regulation document for further details.

PREPARING FOR THE CHANGES From the 1 November 2019 most gift cards will be required to comply with the following: • Be valid for at least three years •

Clearly show the expiry date on the voucher, and

•

Cannot indicate that additional admin or supply fees will be added when redeemed

The three-year requirement does not apply to gift cards in certain circumstances. These include: • The gift card is donated for promotional purposes e.g. a business is handing out $15 vouchers to passersby for its grand opening. These can have an expiry date less than three years.

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Supplied as a promotion must be redeemed for a specific time e.g. $60 voucher for a massage valued at $100.

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Part of an employee reward scheme – reaching sales target. This voucher can have a short expiry date.

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Part of a client loyalty program – thank you voucher for introducing a friend

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Part of a temporary marketing promotion e.g. book a treatment with us and we will give you a voucher valued at $40 to use with the hairdresser next door.

As you can see, the exemptions to the three-year expiry date can only apply to specials or promotions, they do not apply to an open gift voucher, whether the voucher specifies that it is for a specific service or product, or whether the amount is simply monitory e.g. $100 to use as you please. In these cases the expiry date must be clearly stated as three years.

APJ 36

CURRENT CONCERNS The key concerns that business owners have is that if a gift voucher that specifies a service, let’s say a deluxe facial worth $110, but the recipient redeems the voucher after three years and this treatment is now worth $140 due to rising costs of salaries, product costs and overheads, you cannot ask for any additional fee for that treatment. The business must incur the financial loss of delivering that service at that later date.

So, is there an alternative solution to protecting against future price rises?

The only way around this is to sell vouchers with a dollar value e.g. $50, $100, etc. Then if the recipient chooses to undertake a treatment in three years-time, they will be required to redeem their voucher based on current costs. So, if the facial was worth $110 at the time of purchase, but is now $140, they will need to pay the difference. The law is silent about that, but it does not allow administration charges to redeem the voucher. That is illegal.

WHAT IF I SELL MY BUSINESS WILL THE NEW OWNER NEED TO HONOUR VOUCHERS PURCHASED THREE YEARS AGO? If the business changes owners, the new owner must honour existing gift cards and vouchers if the business was: • Sold as a going concern e.g. assets and liabilities of the business were sold by the previous owner to the new owner •

Owned by a company rather than an individual, and the new owner purchased the share in the company

If you are purchasing an existing business that has issued unredeemed vouchers check with your solicitor to determine if you can be compensated for unredeemed vouchers.

WHAT DO I NEED TO DO TO GET READY? Here are some suggestions as to how you can get ready for the changes and be ready by 1 November 2019: • Update internal systems, training and compliance manuals •

Update your gift card terms and conditions on your website and other promotional material, including on physical gift cards.

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Place signage on gift card displays and at the point-of-sale

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Make note of the changes on any receipts issued when a gift card is purchased

PENALTIES FOR NON-COMPLIANCE A breach of the law could attract a $6,000 fine for individuals.

In addition, the ACCC has the ability to impose infringement notices. Each infringement notice is 55 penalty units (currently $2,420) for individual persons. APJ TO VIEW THE FULL LEGISLATION visit https://www.legislation.gov.au/Details/C2018A00133

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MELBOURNE APAN AESTHETICS CONFERENCE WRAP-UP FACING THE FUTURE WITH REAL ANSWERS was the theme of this year’s Conference in Melbourne, held at the beautifully appointed Grand Hyatt, on a chilly morning Monday 12th August. It was education and luxury at its best!

The new format of 16 speakers was met with a great deal of appreciation as industry professionals were brought up-todate with industry advances and new developments, quality education, as well as excellent problem-solving segments that allowed practitioners and business owners to gain valuable solutions to common challenges experienced in the daily life of a salon or clinic practice.

The event presenter was non-other than the lovely Gay Wardle, who contributed to the success of the conference through her trademark qualities of passion and warmth, which endear her to all in the industry. A huge thanks to Gay for her love and support.

Here are just some of the highlights of the day: Tina Viney opened the conference with her topic of Discovering Your Zone of Genius. She presented updates in neuroscience and stressed the importance of a winning mindset.

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On the regulatory front, Donna Cameron from the Victorian Department of Health and Human Services presented an update and the mandatory requirements in this area for Victorian practitioners. She emphasised Victoria’s specific requirements in the area of skin penetration and infection control compared to other states. As a key contributor to the development of the recent updates to the infection prevention and control guidelines, Donna was able to bring clarity to this subject, answering any questions from business owners.

When it comes to business, Deb Farnworth-Wood presented a very compelling lecture on Theft in the Workplace. She highlighted several unassuming areas that can contribute to financial loss, coining the term “Hole in the Bucket”, areas such as time loss on mobile phones, lack of financial accountability with appropriate policies and procedures, regular stocktakes and numerous other areas that can open the way for theft to occur. Perhaps the most revealing of all was the fact that theft can occur not with your problematic staff, but sometime with your most trusted and long-standing staff member.

Dr Ben Chan was also a newcomer to APAN. He presented

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key considerations when treating Asian and ethnic skin types through IPL, Laser and other phototherapy modalities. His lecture highlighted risks and how to avoid them, as well as the appropriate setting to achieve positive outcomes.

manage their own social medial. Addressing the current increase in litigations, Suzanne-Sparrow Crisp presented an alarming update on how consumer behaviour is changing in recent times and how to protect your business.

On the subject of laser and IPL Metro-Dora Clifford presented a comprehensive lecture on important considerations when treating pigmented skin and how to differentiate melasma from hyperpigmentation and the effective protocols for both.

The conference also included a panel of astute business women who are respected as industry thought-leaders and who shared their experiences, highlighting winning strategies that worked for them. Several innovative strategies were presented, most of which allowed businesses to clearly define their point-of-differencein the area of expanding their service offerings as well as their product development and distribution. Our thanks to Terry Everitt who introduced the panel, as well as to the panel contributors – Jiulia D’Anna, Danielle Hughes, Gay Wardle, Melanie Rumler.

Nancy Abdou addressed the most effective ways to layer your technologies in order to achieve the best results – an area that is currently not included in standard training and of great value to many.

The all-important and hot topic of microbiota and gut health and its impact on the mind and body was covered by naturopath Tanja Vrljic who also shared how she addresses these considerations in her skin clinic.

Dr Donna Marcal shared the latest developments in biotechnology and what they bring to cosmetic formulations.

Terry Everitt stressed the importance of evidence-based practices for credibility and in achieving best practice. Chris Testa presented how novel cosmeceutical formulations can be achieved through personalised compounding.

Phillip Fernandez expanded on the power of human connection in building your brand identity, enhancing business productivity with your staff, as well as creating longlasting client engagement. Trish Hammond presented a new program designed to empower business owners to expertly

On the social media platform, our sincere thanks also to Angus and Lauren Thompson, who were able to record on camera some incredible interviews with some of the key speakers, as well as supervise the photography capturing some very special moments of the event.

The event was a great success due to the amazing contribution of our expert speakers who shared their knowledge, our exhibitors and sponsors who gave the event added value, our incredible staff, colleagues and friends and of course, the amazing industry professionals who took time out of their busy schedule to attend this event. At the end of the day it is all about you.

Check out our 2020 conferences program with three leading programs (check our inside front cover). APJ

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PSYCHOLOGY

DYSMORPHIA AND ITS IMPACT ON

APPEARANCE PERCEPTION Ashley Gilmour – Clinical Psychologist WHEN IMPROVING ONE’S APPEARANCE practitioners need to be mindful of underlying factors that may affect the client’s acceptance of the end result and this often has a great deal to do with their self-esteem and even, mental health. With the incidences of dysmorphia constantly on the rise APAN invited Ashley Gilmour to address the issue, as well as off-shoots of this condition at the recent PMU Conference. Ashley is a qualified and experienced Clinical Psychologist and her lecture offered invaluable advice to delegates who attended this event.

In this article she presents some of the highlights of her lecture on mental health and BDD and explains how to identify the symptoms in a client or patient, as well as contributing factors.

Body Dysmorphic Disorder (BDD) is a mental disorder included in the latest of the Diagnostics and Statistical Manual of Mental Disorders, 5th Edition (DSM-V) in which the sufferer cannot stop thinking about one or more perceived defects in their appearance – flaws that to others, are either minor, or not observable. This thinking about the defect/flow becomes obsessive.

BDD affects about 2.4% of the population. It usually starts in adolescents and affects both males and females. However, Muscle Dysmorphia is more prevalent with males. It is considered a subtype of BDD where the person perceives their body as being too small or insufficiently muscular and mostly affects males.

DIAGNOSITIC CRITERIA OF BDD There are key considerations to look for when determining if someone is diagnosed with BDD and these include, but are not limited to:

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APPEARANCE PREOCCUPATIONS The individual is preoccupied with one, or more nonexistent or slight defect or flaw in their physical appearance.

“Preoccupation” is usually operationalised or thinking about the perceived defect for at least an hour a day.

REPETITIVE BEHAVIOURS At some point during the course of the disorder, the individual performs repetitive, compulsive behaviour in response to the appearance concerns. These compulsions can be behavioural and thus observed by others, for example, mirror checking, excessive grooming, skin picking, reassurance seeking, or clothes changing. Other BDD compulsions are mental acts – such as comparing one’s appearance with that of other people (if all criteria here met, OCD would be diagnosed instead).

CLINICAL SIGNIFICANCE Their preoccupation must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. This criterion helps to differentiate the disorder BDD, which requires treatment from more normal appearance concerns that typically do not need to be treated with medication or therapy. It is also important to ensure that the person presenting symptoms is not indicative of some other type of mental disorder. However, a person with BDD is often diagnosed with another mental disorder first, before they are correctly diagnosed with BDD, due to the overlap of symptoms.

CAUSES OF BDD There are many underlying causes of BDD including: • Low-worth or low self-esteem. These can be caused by many factors including lack of love and acceptance from parents and peers, bullying, being criticised or rejected.

•

Fear of being alone or isolated

•

Having current or a history of depression, anxiety or OCD

•

Having a need for perfection or to be/look perfect

•

Having a parent with BDD (could be inherited or learned/ observed behaviour)

•

Not being able to stop thinking about the perceived flaw/s with their appearance

•

Intense shame and distress about their perceived flaw that the suffer will often not want to be seen by another and thus avoid going out in public

•

Frequently looking in the mirror inspecting and analysing the perceived flaw

•

Avoiding mirrors altogether

•

Believing that one takes special notice of one’s appearance in a negative way

•

Frequent cosmetic procedures with little satisfaction

•

Excessive grooming such as hair plucking

•

Feeling extremely self-conscious

•

Refusing to appear in pictures

•

Skin picking

•

Comparing appearance with that of other (including via Social Media)

•

Avoiding social situations

•

Wearing excessive make-up or clothing to camouflage perceived flaws

BDD AND SOCIAL MEDIA There is a new mental health issue that is arising as a result of obsession with Social Media that has been dubbed “SnapChat Dysmorphia”.

According to Dr Anjali Chhabria, psychiatrist and psychotherapist, Snapchat is gaining a lot of popularity among the young and old alike. It stems from the addiction of using filters to alter or enhance their features, which are addictive.

Distortions in the perception of one’s self is a BDD trait, which is coincidently also a feature of the app filter.

According to Cosmetic Surgeon Dr Tijion Asho, who is based in London’s The Esho Clinic UK, a few years ago patients would come into his clinic with photos of their celebrities that they wanted to look like. Nowadays, his patients typically come in with images of filtered versions of themselves of how they want to look. He stated that this is particularly prevalent among young people aged 18-20 years old. They are using apps to make their teeth whiter, their noses straighter, skin smoother, lips appear larger and plumper and their jawline looking tight.

A study published on 2 August 2018 in JAMA Facial Plastic Surgery Viewpoint concluded that image editing apps across social media platforms had indeed sparked an increase in patients looking to emulate the physical perfection that the filters achieved.

The study found that US plastic surgeons who surveyed in 2017 reported an increase of 42 per cent in 2015 to 44 per cent in 2016 of patients requesting enhancement that would improve their appearance in selfies.

APPS THAT ENHANCE APPEARANCE So, what are the popular apps that enhance appearance for

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face and body include, but are not limited to: •

FaceTune

•

Abode LightRoom

•

Perfect365

•

Pixtr

These apps can do the following: •

Whiten teeth

•

Change nose shape and length

•

Plump cheeks and lips

•

Widen eyes

•

Adjust colour and texture of skin, eyebrows, lips, whites of the eyes and change hair colour

•

Adjust lighting to give a glowing appearance

•

Change image background

•

Thin waist and legs

•

Enhance bust size

BDD, SOCIAL MEDIA AND THEIR IMPLICATIONS IN YOUR PRACTICE The issue of patients wanting to look like their filtered images is not only becoming more common in cosmetic surgery clinics, but also in cosmetic tattooing and other beauty clinics.

Filtered social media images are giving people unrealistic expectations of how they can look, or desire to look, by a standard that is not real. This can be problematic when they visit a clinic and expect that the enhancement you are providing them may never reach the level of change that they app can achieve. Furthermore, the obsession ultimately becomes a mental disorder where the person is never satisfied with the end result, with the perpetual need to push for even greater change which may then contribute to deformity instead of enhancement.

As a professional you have a choice to not allow yourself to be coerced into something you feel does not meet with your professional ethics, or that in your professional opinion, you believe is excessive. In such instances it is advisable that you recommend your client have a discussion with a mental health professional. APJ ASHLEY GILMOUR is a qualified Clinical Psychologist. She is the founder of Vitality Unleashed Psychology and runs her private clinic on the Gold Coast. She provides assessment, diagnosis, prevention and treatment for all age-groups with mild to severe mental health issues including depression, anxiety disorders, eating disorders, trauma/ PTSD, grief, as well as Body Dysmorphic Disorder and selfesteem. For further details visit www.vitalityunleased. com.au/ and MindFit Lab visit www.mindfitlab.com

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A photographer asked teenagers to editor their photos until they thought they looked Social Media ready. The shots show not only how simple it is to change your appearance in a few minutes, but also the pressure young people are under to look a certain way.

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COSMETICS

DERMAL FILLERS – HOW LONG DO THEY REALLY LAST?

New Evidence Provided Through MRI Scanning Tina Viney

DR GAVIN CHAN THE TREND TOWARDS DERMAL FILLERS for increasing volume as the face ages is now considered mainstream, with the number of consumers who are seeking these treatments to counteract sagging skin or volume loss is growing each year.

The new global technique approach to feature-enhancement recognises that adding volume progressively in small amounts through dermal fillers is the most efficient way of enhancing a youthful look with a more natural finish. It also allows the face to gain a refreshed look with little evidence of volume-enhancement. While this is a definite improvement on past methodologies (that utilised high volume of fillers) and a more desirable way of introducing someone to dermal fillers, the regular repeats can progressively still contribute to undesirable changes, especially as the fillers “age”.

Dr. Gavin Chan from the Victorian Cosmetic Institute has a background in intensive care, anaesthesia, and emergency medicine. Since 2004, Dr. Chan has provided cosmetic procedures, including anti-wrinkle injections, dermal fillers, liposuction, fat transfer, skin needling and laser treatments.

He has extensive training in various dermal fillers and antiwrinkle injectables. As an expert in cosmetic medicine Dr Gavin Chan recently investigated the life-span of fillers and came across some incredible findings. In this article we present how MRI scanning has uncovered new evidence as to the longevity of fillers

has made an interesting discovery about dermal fillers that has ‘blown him away’ regarding their longevity. He explains, “traditionally we’ve been told that dermal fillers last for between 6 and 12 months, perhaps 18 months. If you search the Internet, ask other cosmetic physicians who regularly inject dermal fillers and then ask patients about how long dermal fillers last, the answer is usually the same; 6, 12 or 18 months.”

But over the past year, Dr Gavin Chan has started to question how long dermal fillers actually last and decided to test this matter in greater detail. The results amazed him. This trailblasing enquiry began when he noticed patients who had tear-trough dermal filler treatments a few years ago came back for follow-up dermal filler treatments. Many of them came in worried that they had puffy bulges under their eyes, with some patients putting it down to the natural ageing process.

After seeing this pattern occurring a few times, Dr Gavin Chan decided to research why this was happening. He hypothesised that maybe there were dermal fillers still present that created the bulging eye bag appearance. To see if this was the case, he used hyaluronidase (a dermal filler dissolver) and almost miraculously the eye bulges disappeared.

Over the past couple of decades dermal fillers have become a popular nonsurgical method to enhance the lips, face, cheeks and brow area. Composed of a substance that’s naturally found in our body, more people are discovering that dermal fillers can help slow down the effects of the natural ageing process.

While Dr Gavin Chan knew it could be dermal filler present (sometimes after 6, 7 or 8 years) he needed to have scientific proof. Some dermal filler brands estimate that fillers only last 6 to 12 months, so Dr Gavin Chan discussed this theory with his colleague Dr Mobin Master, who suggested Magnetic Resonance Imaging (MRI) scans as the best imaging. Dr Mobin Master is qualified in both Radiology and Cosmetic Medicine, the perfect medical practitioner to investigate these types of dermal filler issues. He now works as a specialist in radiology for over 15 years and combines it with cosmetic injectables – a new sub-speciality called cosmetic radiology.

For the past 15 years, Dr Gavin Chan and his team of highly trained and experienced cosmetic doctors and cosmetic nurses, have been using dermal fillers on patients to transform their faces. However, in recent times Dr Chan

Dr Mobin Master explains, “I think MRI is an underused tool in Cosmetic Medicine. Using this tool enables us to see exactly where the dermal filler is present in the lips, cheeks and eye areas.”

HOW LONG DO FILLERS LAST?

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DR MOBIN MASTER

Over many years, one of Dr Gavin Chan’s patients had received quite a few millilitres of dermal filler in her lips. After referring her for an MRI to Dr Mobin Master, it was clear there was residual filler still present in the bottom and top part of the lips. The MRI also revealed that the dermal filler had migrated upwards above the lip-line and below the nose.

There was clear evidence in the MRI image that there was dermal filler present in an area of the face that wasn’t injected into. This confirmed what Dr Gavin Chan and Dr Mobin Master have been noticing over the past few years. With the popularity of dermal filler treatment rising and the increasing number of clinics offering ‘cut-price’ dermal filler treatments, people are having more dermal filler injected into their lips resulting in a duck-like protrusion.

Dr Gavin Chan’s and Dr Mobin Master’s theory that the dermal lip filler has migrated upwards has been confirmed by using MRI scans. Dr Chan explains, “I see this as the new frontier of Cosmetic Medicine. We are clearly seeing lip filler migrate upwards towards the nose. When patients come back to me after three weeks of having dermal lip-filler treatment and say that the dermal filler has ‘all gone’, I now know it hasn’t just dissolved.”

Dr Mobin Master suggests that there needs to be larger MRI studies on longevity and migration of dermal fillers.

He currently is running clinical trials at the Lake Imaging Specialist and Research Centre in Melbourne.

In the past, Dr Gavin Chan and his team would have agreed with the patient and proceeded to inject more dermal filler in to the lips. Instead, they are now often suggesting that the dermal filler be dissolved, before injecting new dermal filler into the lips. As a result of the outcome of this investigation, both Dr Gavin Chan and Dr Mobin Master are taking a new approach.

MORE DERMAL FILLER TREATMENTS NOT THE ANSWER With more people deciding to get dermal filler treatments, there seems to be an expectation from patients that ‘the more dermal fillers they have injected, the better.’ Combine this with the effect of social media influencers having nonsurgical cosmetic treatments, it’s no wonder that patients can start to believe this. Dr Mobin Master noted, “the problem with dermal fillers is that patients forget what they look like before they had them.” He reminds his patients what they looked like before their dermal filler injections and advises them that more dermal filler doesn’t result in a better-looking face. He also cautions his patients who have developed a bulge above the lip, to get the dermal filler dissolved before new dermal filler is injected.

Dr Gavin Chan agrees, “patients are becoming acclimatised to getting more and more dermal filler. A good cosmetic doctor or cosmetic nurse working at a reputable medical clinic specialising in these non-surgical procedures will have had the training and experience to keep their patient’s ‘in line’. They’ll be able to recommend with kindness that they’ve had enough dermal filler for now.” He cautions that some practitioners may be driven by money and profit-making, and subconsciously suggest to patients to have more dermal filler treatments when not needed.

DERMAL FILLER LIP TREATMENTS CAN MIGRATE With clear evidence from the MRI scans that dermal filler lip treatments can migrate upward, Dr Gavin Chan has a theory about why this happens. He explains ‘the mouth is very active, particularly the orbicularis oris muscle which controls movements of the mouth and lips. This muscle is constantly contracting, and it makes sense that over time, the fillers could migrate north as a result of this lip movement.’ While MRI scans can be expensive, many patients consider it’s a worthwhile investment to work out what’s going on.

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DERMAL FILLER EYE TREATMENTS CAN ALSO MIGRATE Over the past 12 months Dr Gavin Chan has been referring patients to Dr Mobin Master, particularly when he needs to know if the swelling under the eyes is a result of old dermal filler or fat deposits. He notes, “we need to know if it’s fat or filler. If it’s dermal filler, we can dissolve it. If it’s fat and they’re worried about it, they’ll need to consider having eyelid surgery (Blepharoplasty).

DERMAL FILLER CAN LAST LONGER THAN EXPECTED The MRI scans also proved that dermal fillers can last longer than the dermal filler brands say they will. Dr Mobin Master also explains that the overuse of dermal filler in the face can result in a “chipmunk” style face – the direct opposite of what most patients are striving for.

On the other hand, Dr Gavin Chan has noticed that when patients he saw a few years ago come back after seeing other practitioners, their face had expanded and looked watery and swollen, noting, “it’s like they’ve lost the beautiful slender shape they used to have.

Constantly adding dermal filler to the face results in a swollen-looking face – it’s not natural and definitely not the type of look the patient originally came in for. But over time they don’t notice that they’re looking swollen and unnatural, as they become conditioned to their new look.”

Dr Gavin Chan’s ground-breaking revelation has changed the way all cosmetic doctors and cosmetic nurses at his clinics inject dermal fillers. By seeing his patient’s MRI scans he now believes that a conservative, minimalist approach to injecting dermal fillers creates the best results.

He notes, “a few years ago it was thought that 1mil of dermal filler would be used for one part of the face: 1ml for the lip and 1ml for the cheek area.

Today, I’m only using 1ml of dermal filler for the entire face.

I’m also only treating patients with dermal filler every 12 months or so – this has resulted in my patients looking more natural. They get the benefits of dermal filler but without the swollen, unnatural look.”

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Dr Mobin Master agrees stating, “we should take a lot more care with dermal fillers and really treat them as a semipermanent non-surgical treatment. Some dermal filler brands don’t last as long as others. And once fillers have been in the face for a year or so, it can become harder to dissolve them with hyaluronidase. This is when I send patients for an MRI scan, so I can ascertain where the fillers are.”

Dr Gavin Chan explains, “the gold standard for patient care with dermal fillers should be to review them every 12 months.

If they’re happy with how they look, that’s fine. But if the dermal filler hasn’t met their expectations it’s time to dissolve it.”

QUESTIONS THAT PATIENTS SHOULD ASK BEFORE UNDERTAKING INJECTABLES FILLERS: •

What training and experience have you had?

•

Do you know how to dissolve dermal fillers if I don’t like the result?

•

Are you aware of the side effects of dermal fillers (including blindness)?

•

How long will the dermal filler last?

•

Is it permanent or semi-permanent? There’s now evidence temporary fillers are more permanent than first thought.

•

What’s the long-term effect going to be on my face if you keep injecting dermal filler into it?

•

Would having less dermal filler injections make me look more natural?

•

Where could the filler migrate to if I keep having dermal filler injections? APJ

Contact Dr Gavin Chan at Victoria Cosmetic Institute 300 863 824 www.thevictoriacosmeticinstitute.com.au Contact Dr Mobin Master at Victorian Dermal Group 03 9853 9264 www.victoriandermalgroup.com.au

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SKIN

Inflammation and the Role of Nutrition in Wound Healing Gay Wardle

IN TODAY’S SKIN CLINIC ENVIRONMENT many of the procedures we perform contribute to inflammation.

Whether induced, or existing, it is imperative that we understand the role of nutrition in strengthening the immune system and supporting the healing and repair process of the skin. In this article Gay Wardle explains what is inflammation and key diagnostic considerations and nutritional factors that will help support and enhance skin repair.

The acute inflammatory phase involves and includes the following: •

Coagulation cascade to achieve platelet activation and hemostasis

•

Mitogenesis and chemotaxis of growth factors

•

Controlled tissue degradation

•

Hypoxia and the regulatory function of oxygen to cells

WHAT IS INFLAMMATION?

•

Control infection

Inflammation is the body`s immune system reaction and is essential for orderly, timely healing. Normal time frame for inflammation is 3-4 days sometimes lasting up to 7 days. Inflammation involves colour changes to the skin, for example, there will be erythema (redness), temperature changes (heat) and swelling. All of these are essential for inflammation, without them the wound will not progress and heal.

•

Neutrophil, macrophage, mast and fibroblast cell function

•

Keratinocyte activation

The reason for inflammation is to provide for hemostasis and the breakdown and removal of cellular, extracellular and pathogen debris. Macrophage cells (neutrophils) are involved in the initiation of inflammation.

Mast cells also play a crucial part of providing inflammation.

These are all part of the immune system and will always mount a response in any injury, regardless as to how small or large that injury may be.

Cytokines and growth factors released at the time of injury within the wound communicate with other cells to assist in regulation and repair of the wound site.

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All of the above are essential as to why we need to have inflammation with wound repair.

Peptides are growth factors and are sometimes referred to as cytokines. Growth factors deliver chemical messages that are released to non-immune cells and result in cell proliferation and migration, cytokines communicate with immune with immune cells and attract those cells to the site of injury.

Growth factors provide key biochemistry for the wound healing process. Growth factors are critical to wound repair and occur in the inflammatory phase.

Without the actions of these cells, inflammation will be prolonged into a chronic stage. Chronic inflammation develops into infection that can take a long time to heal.

NUTRITION The role of nutrition is often the forgotten factor in wound repair. More than just food, nutrition includes nutrients,

calories and fluids that is taken into the body, all of which are vital to the healing of wounds and the reduction in inflammation.

Poor nutrition and an inadequate diet are risk factors for prolonged inflammation. A well-balanced diet with adequate carbohydrate, protein, fat, water, vitamins and minerals are necessary to maintain skin integrity. And that is just internal, the same nutrition is required topically to maintain a healthy barrier function and skin microbiome.

that are the building block of proteins are also very essential to be used as topically applied actives prior to any clinical treatments. This will ensure that the inflammation that has been induced in a treatment is somewhat controlled.

Fluids: Water constitutes about 60% of an adult’s body weight. It is distributed in the body in three compartments: •

intracellular

•

interstitial, and

SUPPORTING SKIN REPAIR

•

intravascular

When assessing factors that will support skin repair, I would first take a look at proteins, water, zinc and vitamin C, as these are often promoted to assist with reducing inflammation and aiding with wound repair. Let’s take a closer look at each of these factors:

When a person becomes dehydrated, their body does not have the capability to repair itself. Water is essential in helping to reduce internal inflammation. If the body does not have sufficient water, not only is the gut affected, but so are the hormones. When the hormones in the body are imbalanced, the risk of increased inflammation is higher.

Internal inflammation will increase the risk of skin disorders as well as slow down wound repair.

Protein: Protein is essential and needed for tissue repair, as well as maintaining the integrity of tissue structure. Protein is responsible for the synthesis of enzymes, cell proliferation and the synthesis of connective tissue that are all needed for wound repair. If protein is inadequate in the diet then the time for a wound to heal will take longer, and therefore resulting in further scar formation.

On the other hand, if a person is digesting way more protein than they need, they will need to increase their fluid intake.

If they do not increase their fluid intake inflammation will increase and wound repair will be prolonged.

It is important to understand that protein is an important component of the antibodies that are needed for a healthy immune system. And not just for internal nutrition. Peptides

Vitamin C: So why is vitamin C important in the repair process? The production of proteins by the fibroblast is greatly reduced if there is a deficiency of vitamin C. Another consideration is that the immune system will become greatly compromised if there is insufficient vitamin C in the tissues.

It is important to note that vitamin C cannot be stored in the body, therefore deficiencies can develop quickly if adequate intake is not maintained.

Zinc: Zinc is a vital mineral for wound healing and skin repair and it is a well-known fact that most of us are zinc deficient.

Zinc is essential because it plays a key role in the formation

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immune system. Combining all these factors will affect how the body reacts to inflammation.

Negative emotions such as those evoked by depression or anxiety have the ability to change the functions of the skin.

Stress and depression induce the release of pituitary and adrenal hormones that affects the immune function.

Cortisol stimulated by stress, can up or down-regulate proinflammatory mediators that affect and decrease macrophage and immune cell function, as well as suppress fibroblast cell proliferation. We must recognise that when high stress is present, it will increase inflammation and reduce wound repair.

Look for stress both through internal and external factors.

Also, look out for environmental factors that may be externally stressing the skin and impacting the skin’s microbiome.

WHAT HAPPENS WHEN INFLAMMATION IS ABSENT? The inability of the body to present an immune response to a wound is known as the absence of the inflammatory phase.

There are many causes for absence of the inflammatory phase – nutrition deficiency, immunodeficiency, cancer, diabetes, drug use, medications and radiation therapy - the list can be quite long. and function of white blood cells and lymphocytes. It is safe to say that if we are low in zinc, wound repair will most likely be compromised.

I do not want to be misleading here and only talk about these few essentials that are vital to wound repair, as these are just a few. We need to be mindful that the body and the skin need nutrition to maintain integrity and vital health.

There are many skin disorders where inflammation is persistent and often this is due to the fact that the skin biome is very unbalanced because of a lack of topical nutrition.

Treatments alone are not enough. The skin needs to be regularly fed with important nutrients to heal and flourish, just like your garden needs fertilizer.

RISK FACTORS FOR WOUND REPAIR Intrinsic factors relating to a client’s medical status and physiologic wellbeing, can also affect skin integrity. Things to consider are age, disease, nutrition, digestive system, hormones, nervous system and the immune system, which will all have an impact on inflammation.

Inflammation, cell migration, proliferation and maturation responses all slow down with age. The skin also becomes much thinner as we age and the function of fibroblast cells slows down and this affects collagen and elastin production.

There is atrophy to the dermis, which increases the risk of wound dehiscence.

Also, look out for steroid medications, as these are immunosuppressive medications, that will influence skin integrity whether they are applied topically, or taken internally. Steroids will delay all phases of wound repair including inflammation. They will also reduce the immunity of both the body and the skin.

The role of stress is a strong contributing factor to inflammation. Stress can impact the body by interacting between the nervous system, endocrine system and the APJ 52

The issue here is that the absence of an inflammatory response prevents the wound from progressing through the stages of repair. This will result in an infection and further scarring. For any wound to heal there needs to be inflammation. There is no progression to the further stages of wound repair without inflammation.

IN CONCLUSION There are so many treatments being performed in today’s clinics that rely heavily on creating inflammation to reduce the signs of ageing. The use of light-sourced equipment, peeling, microdermabrasion, blading, stimulating massage all create inflammation.

During the skin and body consultation process it is so important to understand and identify the risks involved with these treatments if the skin and body is malnourished.

Internal and topical nutrition needs to be assessed before commencing clinical treatments.

With continued development of equipment and actives being used in clinics today, knowledge and a comprehensive understanding of wound repair and inflammation are essential.

The role of the aesthetician is not just to apply product and perform treatments, he/she must have a comprehensive understanding of all the systems of the body.

Consultations need to be thorough and potential risks need to be evaluated and addressed. And remember, excessive signs of acute inflammation is a huge red flag of impending wound infection. APJ To further enhance your knowledge and understanding of the skin and the various factors that contribute to skin health, we recommend you undertake Gay Wardle’s Advanced Skin Analysis training. For information visit http://gaywardle.com.au/

SOCIALMEDIA

DIY SOCIAL MEDIA

Let Us Show You How to do It Right Trish Hammond Social Media Made Easy for Your Aesthetic Clinic Online Course was Launched on Monday 16th September.

FACEBOOK has 1.2 billion users.

Instagram has 95 million photos and videos shared every single day. LinkedIn has 380 million members worldwide.

This is how we communicate. Advertise.

Shop. Buy. Get educated. Socialise. Keep in touch. Make appointments. Schedule meetings. Discover a new treatment. a clinic offering that treatment. Join support groups. Get advice. Give advice.

Social media is pretty much where we do EVERYTHING. If you are an aesthetic business and haven’t jumped on the social media marketing and advertising train yet you’re being left behind at the station.

Truce Media (aka Plastic Surgery Hub) specialise in helping aesthetic businesses with their social media and digital marketing. We are about to launch our “AESTHETIC SOCIAL HUB training school” where we will be offering our many courses, starting with our first online “Social Media Made Easy For Your Aesthetic Clinic”. Just as the name suggests, it is specifically

designed for aesthetic clinics and to help either jump-start, or kick on your social media profile across a range of social media platforms. We give you the tools you need to manage your own social media, step by step. We make it easy. This sixmodule course includes everything from Client Profiling, Goal Setting, Facebook Page Optimisation, Instagram Profile Optimisation, Facebook Analytics, Instagram Insights, Hashtag Strategy and Growing Your Following - and that’s just in the first module! By the completion of this course you will feel a lot more confident about your social media, have a strategy and a content calendar, have more followers and a great plan to move forward and grow your business.

So, if you’re feeling overwhelmed by the massive amounts of info, websites and “experts” telling you what you should and shouldn’t be doing, or have already started your social media but don’t know where you’re going with it, you’re not alone. Most aesthetic businesses who haven’t got their social media together say they just don’t have the time, or it’s too confusing, or too hard. Don’t let this be you, it’s easy when you know how.

The beauty of this course is that you can do it at your own pace. Just take it one step at a time. Work your way through the videos, modules, workbooks and checklists and before you know it you’ll have your head wrapped around it all and hopefully will even be excited by social media! But most importantly, you’ll have it working FOR you and your business.

To enrol: trish@trucemedia.com.au 0438 599 833.

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SKIN

RESEARCH REVEALS A NEW APPROACH TO ACNE THERAPY

Clean Skin is Healthy, But Not if Excessively Clean Dr. Tiina Meder MD, Dermatologist, and founder of Meder Beauty Science (Switzerland).

IF YOU SUFFER FROM ACNE or oily skin don’t despair, we’ve got good news. Apparently, before the completion of the great and awesome Human Microbiome Project we hadn’t known all causes of acne. Now it seems that we do.

Let’s revise what we’ve known for a long time now.

The skin becomes oily when the grease-producing sebaceous glands are overly active.

The key function of the sebaceous glands is in fact to produce sebum, a complex substance consisting of various lipids.

Normally, sebaceous glands secrete a small amount of semitranslucent liquid, which spreads over the skin’s surface, soaks up the keratinous layer mixing with the skin’s own lipids and provides protection from external damage. This thin lipid layer shields us from infection, toxic damage and nanoparticles brought about by urban pollution and at the same time, it gives the skin comfort and softness. Not enough sebum means the skin is dry and sensitive. Too much sebum though is suffocating.

THE IMPACT OF HORMONES ON SEBACEOUS SECRETION The activity of sebaceous glands is defined by hormones, mainly testosterone, male sex hormone which women also have. However, to affect the glands, this hormone needs to transform with the help of an enzyme called 5-alpha-reductase. This enzyme grooms and preps the unsophisticated testosterone moulding it into an attractive active form called dihydrotestosterone (DHT), able to seduce the sebaceous gland cells into an increased sebum synthesis.

DHT binds to the androgen receptors, activating the expression of genes which increase the activity of sebaceous glands. The more testosterone a person has, the higher chances of acne and oily skin. Which explains why young men have spots and a greasy shine more often than women — their testosterone levels are higher. This is why women are routinely prescribed contraceptive pills as acne therapy:

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among other things, the pills subdue the male hormones and as a result, improve the skin’s condition.

The catch is, activity-provoking 5-alpha-reductase enzyme can be active without the presence of excessive testosterone, and in this case oral contraceptives won’t work for acne.

WHAT CAUSES ACNE? Both hormone and enzyme activity can increase during puberty, at the end of menstrual cycle, during pregnancy and menopause, at times of stress or in the course of a disease.

Bottom line – oily skin can happen to anyone. However, oily skin is not in itself a cause of acne. Apparently, it’s a little more complicated than that.

Our epidermis includes not only skin cells, but also a “living layer” called microbiome, actively interacting with the full epidermis structure. The good news is that most of our “micro-friends” are harmless and even useful to us. One of the most famous bacteria is Propionibacterium acnes (recently officially changed its name to Cutibacterium acnes). C. (ex. P.) acnes is a common skin commensal, functioning to protect the skin from infections and contributing to the barrier of the skin significantly. C.acnes is hydrolysing sebum’s triglycerides: that’s a process leading to the release of free fatty acids with antimicrobial properties to the skin. Also, C. acnes secretes protein enzyme RoxP, the natural antioxidant protective skin cells from oxidative stress and diseases, likely more powerful than all known antioxidants before. Additionally, C. acnes is contributing to the acidic pH of the skin surface (+-5.0) inhibiting the growth of common pathogens.

When sebum is overproduced, what happens is that friendly C. acnes panic —"it’s too much, we can’t process it in time, oh what do we do?” Well, the evolutionary response is to up the number and bacteria begins to propagate quite maniacally.

When their numbers becomes excessive, the good bacteria

become a cause of inflammation. They were actually discovered as such and given a menacing name as a main cause of acne. Until very recently, dermatologists wrongly assumed that these bacteria singlehandedly caused acne and are generally harmful for the skin.

As it turned out, people with acne simply have more Propionibacterium acnes than they normally should. Besides this, the bacteria itself doesn’t directly cause the acne — but rather products of their lifecycle - two enzymes called cyclooxigenase-2 (COX2) and 5-lipooxigenase (5LOX). Both are converting arachidonic acid into inflammatory mediators causing pain, systemic chronic inflammation and destroying pilosebaceous units. Inflammation, in its turn, leads to a speedier skin cell renewal, which makes the skin thicker. Dead cells are not shed in time and seal the mouths of sebaceous glands, where our former friends, the bacteria, are still having their reproduction orgy.

Another interesting revelation that the Human Microbiome Project uncovered, was that we are living in a close symbiosis with billions of microorganisms, most of which are good for us (unless for some reason they are out of control).

Thousands of bacterium species live on the skin and they counterbalance each other and co-exist in harmony keeping the skin healthy.

The traditional acne therapy implies 2 key strategies: First, the decontamination of the skin and extermination of Propionibacterium acnes. The poor little things are cleansed away from the skin with antiseptics, such as benzoyl peroxide and various acids, mostly salicylic acid. This would of course cause collateral death and destruction on a massive scale of all other, friendly or neutral civilian bacteria, and the improvement is usually short-lived and followed by a new flare of acne.

The second acne treatment strategy is fairly recent: It uses retinol and its derivatives to help control the activity of 5-alpha-reductase, eventually decreasing the sebum production. Less sebum produced means worsening of Propionibacterium acnes’ living conditions, so acne-inducing processes slow down and inflammation eases.

However, retinoids irritate the skin and significantly reduce its barrier functions, while their anti-acne effect is not necessarily permanent. Simply, the initiation of acne lesion was explained by overgrowth of C.acnes and excessive lipid production by sebum glands, so the strategy was based on two milestones of decreasing sebum production and antibacterial actions with the use of antiseptic products.

THE NEW APPROACH FOR TREATING ACNE The new concept of acne pathogenesis explains the development of this condition by metabolic shift leading and followed by oxygen depletion consecutively, which is again followed by the inflammation promoted by microbial metabolites. The excessive sebum production is leading to the C. acnes overgrowth forming the microbiome dysbiosis, pathogenic biofilms when C. acnes is fermented becoming cytotoxic. So, the interaction of host (human skin) and intraspecies (microbiome) is disturbed and unbalanced, more or less severely.

The newest strategy is based on restoration of the skin’s micro-community, or the microbiome aka eco-flora as microbiologists put it. The beneficial bacteria takes control over acne bacteria’s multiplication, drive away harmful bacteria species, and produce anti-inflammatory agents, effectively suppressing, not only the overzealous 5-lphareductase, but inflammatory enzymes as well.

The difference with an old acne therapy concept is an

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approach to the microbiome: before we have dried off and disinfected the skin’s surface. Nowadays we are effectively decreasing the sebum production using 5-alpha reductase inhibitors such as retinol, retinol derivatives or alternative (Butyl avocadate/Avocutin), while simultaneously retaking a control of microbial healthy population without global antiseptic approach.

Long story short, the old concept was based on the motto “Healthy skin is the clean skin” and the new one is based on “Healthy skin is naturally protected by microbiome skin”.

The skin’s eco-flora is restored by more or less the same solutions that people now use to rebalance their gut bacteria: prebiotics and probiotics.

WHAT ARE PROBIOTICS AND PRE-BIOTICS? Probiotics are live beneficial bacteria, like the ones that live in yoghurt. Cosmetic use of these is complicated though: just to keep them alive in a bottle of face cream (and not break a dozen cosmetic safety regulations at the same time) is an almost impossible task at this time. Prebiotics, on the other hand, are very usable: they are agents and substances that serve as nutrients to friendly bacteria and are sometimes also toxic to the harmful ones.

One of the most well-studied and effective prebiotics is a small saccharide molecule, called BioEcolia. It has been demonstrated, repeatedly, that its application to the skin causes the friendly bacteria to multiply and the perpetrators to die. At the same time, Cutibacterium (Ex Propionibacterium) acnes, which as we now know is in fact, a friend and ally, is simply slowed down to a healthier propagation rate, in the space of just a few days the normal numbers of this bacteria are able to go back to their beneficial routine work, providing the natural anti-inflammatory effect, restoring the acidic pH of the skin (without any acids use!) and protecting the skin from free radicals.

It is very important to remember that microbiome-friendly acne treatment will not work in combination with antibiotics, disinfecting and antibacterial agents, such as alcohol, acids or benzoyl peroxide. As cosmetic ingredients these will interfere with the propagation and activity of our bacterial allies and eventually destroy them along with the harmful flora.

The use of prebiotics is not limited to oily skin or acne.

Prebiotics reduce skin sensitivity, calm down irritation, help avoid complications in healing after skin injury and even reduce the skin’s UV sensitivity. Consistency is key here, prebiotics must be applied continually for a few weeks.

However, even at this initial stage of researching skin microbiome and dysbiosis, the achieved results open up a lot of possibilities for the treatment of skin diseases and aesthetic correction.

Moreover, there is a shift in our understanding of skin cleansing, too. Bearing in mind, that the skin’s function is enabled by, apart from the tissue itself, a complex of mutually active cells and a live biological conglomerate of microorganisms. We are therefore faced with the necessity to reconsider, on a conceptual level, our treatment of many cell diseases and conditions. In effect, we are suggesting a possibility of correcting the skin’s condition by changing the microbiome and actively restoring the balance of microorganisms, which makes up the skin’s healthy (or eco-) flora.

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CHANGES TO THE WAY WE CARE AND TREAT SKIN DISEASES The study of human microbiome through The Human Microbiome Project, changes not only the way we care about skin and treat the diseases of skin and gut, but our general view of the human body. In essence, a human body is not an individual organism, but rather a complex of human cells and various microorganisms which can’t be separated and shouldn’t be regarded and studied on their own.

The number of microorganisms colonising a human body exceeds the number of human cells by about 10 times.

Microorganisms make up from 1% to 3% of body mass, i. e. on average a human weighing 100 kg carries about 2 kg of microorganisms. We have 360 times more protein-coding genes of microbial origin than our own human genes. It would appear that humans and microorganisms are inseparable, and this new knowledge should make us reconsider the use of biocides in cosmetic care that has become so widespread in the last decades.

Cosmetic skincare with antiseptic and antibacterial properties is in a way an anti-prebiotic and perhaps it is time to treat it with more caution. We cannot stress enough, that the use of microbiome-friendly solutions implies that the application of all biocides, including such common favourites as alcohol and alpha-hydroxy acids (AHA-acids) must be suspended or terminated altogether.

THE MICROBIOME-FRIENDLY SOLUTION The development of microbiome-friendly skincare has just begun and still many questions remain unanswered. It is obvious that any development in this area will require certain changes in legislation, amendments and elaborations in marketing and claim regulations (as of today not all solutions claiming the use of probiotics and prebiotics are in fact using them as ingredients; it is not uncommon to see a probiotic claim on a solution of entirely plant origin). Besides, research base in this field is still insufficient and we are only just beginning to accumulate relevant knowledge. However, even the practical experience we have gained so far clearly demonstrates that microbiome-friendly skincare is extremely effective and can be applied almost without limitations, unlike many solutions where visible results are achieved by a rather aggressive impact on the skin.

MEDER BEAUTY SCIENCE SOLUTIONS FOR ACNE For Meder Beauty Science solutions, we recommend at least a 5-week course of Eu-Seb professional treatment followed by prebiotic therapy at home.

Yes, we have plenty of prebiotic-containing solutions, and even a few with probiotics (as specially processed kindly bacteria). All of our products are universal, and for acne — absolutely indispensable.

NET-APAX PREBIOTIC CLEANSER — a gentle cleansing gel with prebiotics for sensitive and inflamed skin.

EU-SEB CONCENTRATE — prebiotic concentrate for acne and oily skin therapy.

EQUA-DERM CREAM — prebiotic face cream for oily skin suppresses the activity of 5-alpha-reductase (3% Avocutine) and reduces sebum production by 30% in the first few weeks of use. Equa-Derm Cream helps decrease hormone-related skin sensitivity, tightens pores and reduces redness and swelling. APJ If you want to find out further information contact Spectrum Science & Beauty | 1300 766 198 | sales@ spectrumsciencebeauty.com.au www.spectrumsciencebeauty.com.au

THE ALL IN ONE GAME CHANGING SKIN ANALYSER Here is why we are excited for you!

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Analysis includes 10 dermis & epidermis skin problems.... plus 2 future predictions RGB Spectrum: RGB Pore, RGB Spot, RGB Wrinkle UV Spectrum: UV Moisture, UV Pigmentation, UV Porphyrin, UV Damage PL Spectrum: PL texture, Sensitive area, Brown area Prediction: Aging and Beautifying Call 1300 766 198 Today And Quote "APJ" To Save $500!

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Visit the Spectrum website today www.spectrumsciencebeauty.com.au

TATTOOPIGMENTS

REGULATORY UPDATE

Pigment Regulations Are Coming!

Robert McGowan

WHAT ARE THE PIGMENTS that are used for cosmetic tattooing? What makes the beautiful shades of brown that make great ombre brows? What makes the luscious reds that makes those full lips ‘pop’? What is in those black, blue, green or even violet eyeliner pigments that can be stunningly vivid?

In total, there are probably not many more than 50 different colours (called colorants) that are mixed together to make every different pigment on the market, across all the 20 plus brands you can buy. Some are simple black, red or yellow iron oxides that have been used for decades, others are highly complex synthetic organic chemicals that in some cases are considered toxic. The composition of pigments has changed dramatically in recent years as manufacturers develop their own colour ranges and try and get the best possible pigment retention.

THE ISSUE OF PIGMENT SAFETY In many countries, including Australia, the composition of pigments has so far been unregulated. This means that there are no rules to say what a cosmetic tattooist can place in the skin of their client, and because most technicians are not familiar with the complex field of pigment chemistry, they will often assume that a well-known manufacturer will only use safe chemicals.

Unfortunately, in many cases that is simply incorrect.

In Europe, there has been a lot of work on pigment safety and the European Union (EU) is ready to bring in many changes to guidelines and regulations. In 2008 the EU introduced a resolution on pigment ingredients that became guidelines for the whole of Europe, and these were then adopted into law by seven countries. The focus was on colorants considered carcinogenic, mutagenic and reprotoxic (CMR) that were in body art and cosmetic tattoo (permanent make-up) pigments at the time.

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Since 2008 the number and range of pigments on the market has expanded enormously, and with the introduction of new brands and ranges, many new colorants are being used, and many more are considered CMR or otherwise toxic. The EU is proposing to ban 37 colorants currently in use. Based on research by THink Aesthetics, 10 of these colorants are currently being used in one or more cosmetic tattoo pigment brands used in Australia.

The EU is not just concerned about colorants, and the new guidelines or regulations will control the presence or concentrations of three other types of chemicals: •

Amines – approximately 10 carcinogenic amines will be effectively banned (only very low concentrations allowed).

•

Polycyclic Aromatic Hydrocarbons (PAHs), substances commonly associated with carbon black, will be effectively banned.

•

Heavy metals such as arsenic, lead, nickel and a toxic form of chromium will need to be at very low concentrations.

These controls are effectively to set standards for purity to make sure there are minimal levels of toxins in pigments.

INTRODUCTION OF NEW POISONS REGULATION So, what has this got to do with Australia? The Federal Government and each State and Territory either has, or will have new poisons legislation for the stricter control of harmful substances. The 2019 the new Act will supersede legislation that typically dated back to the 1970s, so it was very outdated. It is through all this new legislation that regulations for pigments will be enforced.

So how will the regulations be applied? First, the National Industrial Chemicals Notification and Assessment Scheme (NICNAS) has completed investigations of pigment imports.

NICNAS controls the import of chemicals into Australia, and pigment distributors should hold a NICNAS licence to operate legally. In theory NICNAS are the ‘gatekeepers’ who can control imports.

State and Territory governments are also engaged in the implementation of the new legislation. Queensland Health provided a presentation to APAN recently on the proposed new regulations, which are intended to exactly follow those in the EU. Australia adopting the EU regulations in fact makes a great deal of sense. An enormous amount of work and research has gone into the regulations being proposed by the European Chemicals Agency. There is no need for Australia to try and do its own research. Also, almost all cosmetic tattoo pigments are currently either made in Europe or made in the USA and exported to Europe. There are no pigments manufactured in Australia. As a result, there should be a good range of pigments fully compliant with the new EU regulations able to be imported to Australia.

CHANGES WILL BE COMPLICATED While this all sounds straightforward, the changeover to compliance with the new EU and Australian regulations will be complicated. Many pigment brands will need to make major changes to their pigment ranges. Some brands will be largely unaffected as they are already in compliance with the colorant requirements, although they may need to do more purity testing.

The big question for most cosmetic tattooists is, which brands and pigments are affected? That is obviously highly commercially sensitive information. The list of colorants as produced by the EU and being used by Australian authorities

is not yet available for public release because of this. In addition, compliance with the strict testing standards for purity will be both expensive and possibly very difficult to achieve for some pigment manufacturers. It may be that some brands will disappear.

Does the industry have a say in what is happening? APAN is the most substantial national industry body representing the interests of cosmetic tattooists and was approached

by NICNAS in 2017 to comment on their proposals, and subsequently, by Queensland Health this August to comment on the draft state regulations. APAN approached THink Aesthetics to provide technical assistance with the details of regulating pigment chemistry.

It is particularly important that the regulations are applied over a timeframe that allows manufacturers, testing laboratories, suppliers, wholesalers and technicians to adjust.

Initially Queensland Health advised APAN that they wanted full implementation within three to six months and were told that this was completely unrealistic. The year 2022 was suggested, but more likely implementation will occur during 2020. Further discussions are required with NICNAS (at the federal level ) and the various states and territories to try and ensure there is a practical and coordinated approach.

Over the coming months there will be a lot of development on the proposed regulations and how they will be implemented. Read your APAN journal for updates, as well as your newsletter. Concerned technicians are also welcome to contact the author at THink Aesthetics for further explanation.

You can reach Robert McGowan at robert@thinkaesthetics.com

ADVANCED COSMETIC TATTOOING MASTERCLASSES JANETTE ZAKOS is a nationally-accredited trainer with 26-years of experience in Cosmetic Tattooing. Her advanced techniques will allow you to learn the secret of how to perform exquisite eyebrows, eyeliner and full-lip cosmetic tattooing without the need for repeat visits.

She is renowned for her highly artistic work and delivers training on a one-on-one basis.

Step-up your current knowledge to a higher level & learn from the master!

LIP MASTERCLASS • Learn how to master full-lip tattooing no repeat visits

POWDERED EYEBROW MASTERCLASS • Learn to master the new technique of powdered eyeliner

•

Models provided

•

•

Lip block by registered doctor

TATTOO REMOVAL • Learn non-laser tattoo removal •

Models provided

Models provided

EYELINER MASTERCLASS • Learn how to master the latest eyeline technique in one treatment •

Three models will be provided

THESE ARE ADVANCED MASTER-CLASSES. STUDENTS MUST HOLD A COSMETIC TATTOO CERTIFICATE TO ENROL Cost: $1400 incl GST per masterclass Full training in just one day each.

BOOK YOUR TRAINING TODAY! CALL JANETTE ZAKOS ON 0414 389 603.

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APJ

PMU CONFERENCE

A Great Success!

IT WAS A WARM SEPTEMBER SUNNY DAY on the Gold Coast as Cosmetic tattooists – both practitioners and business owners, arrived at APAN’s inaugural PMU Conference at the Mantra Legends Hotel.

Robert McGowan provided valuable information on tattoo removal, outlining methods and alerting to the risk that practitioners must carefully consider. This session was loaded with excellent strategic education.

While most cosmetic tattooists usually attend technique workshops to improve their skills, this event provided a more comprehensive focus delivering a diverse range of topics through 14 lecture- segments. The event delivered on its promise of a Contextual Integration of Art and Science.

Artists and practitioners came from various states – WA, S.A, Victoria and NSW, as well as throughout Queensland, seeking to enrich their knowledge through the expertise of the various speakers.

Danielle Scott presented a compelling presentation on working with cancer patients who have undergone a mastectomy and are seeking to regain their dignity through the redesigning of their nipple areolas. Danielle shared very valuable strategies both in dealing psychologically with these patients, as well as showing some of her amazing 3D techniques that provide a very natural and effective nipple restoration through skilful artistry.

With the growing phenomenon of dysmorphia delegates benefited from Psychologist Ashley Gilmour’s lecture on Dysmorphia and its impact on Appearance Perception.

Ashley provided an in-depth explanation of the origins and symptoms of this mental condition and the complications that it brings to the cosmetic tattoo practitioner, as well as effective ways to deal with individuals who manifest dysmorphia.

Kiyomi McPherson shared her new Mapping and design techniques for better brow outcomes. Her out-of-the box approach on the way she assesses a customised eyebrow design was refreshingly different as she shared her method through non-conventional principles that look at not just the face, but also the client’s personality, their body-shape and their lifestyle.

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With the new defamation laws on Social Media and for the protection of intellectual property, senior partner from Pointon Partner Lawyers, Michael Bishop presented a legal update that all practitioners and business owners should be made aware. Pointon Partner Lawyers have also drafted a SOCIAL MEDIA POLICY available to all business owners and recommended to have in place for their staff. He stessed the imporantance of becoming familiar with the updates on the legal status of behaviour within the social media space. If you require a copy of the policy please contact APAN on 07 5593 0360 info@apanetwork.com Following was a panel of experts who took questions from delegates and provided insight in how businesses can achieve winning results from their photography, marketing and promotional strategies to enhance their point of difference.

Our thanks to Katherine McCann, June Warry, Liz McGowan and Carol Dinis who contributed to these discussions.

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June Warry is well-known for her advanced techniques in brow design. With over 20 years in the industry, she has travelled the world and is highly skilled with not just advanced techniques that she has learned over the years, but she has also developed her own methods. Her frank and heartfelt presentation delivered technical, as well as conceptual information and effective strategies to grow a cosmetic tattooing business.

Katherine McCann presented two powerful segments – her first, on interpreting the information in the Consultation Form, which she skilfully used to identify client needs, fears and reservations, as well as issues that pertain to their health and lifestyle and how this information can contribute to helping her create a well-designed procedure that will be tailor-made for the individual. Katherine’s second segment introduced a new “hybrid” way of designing and performing lip procedures in a way that requires less anaesthetic and trauma as well as a softer and more natural finish with a broader appeal.

The issue of skin penetration and infection control regulations

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was presented by David Gould, Principal Environmental Health office. This was a very engaging session and several delegates having previously insufficient knowledge of their obligation were able to gain guidance and clarity in this allimportant aspect of their practice.

Carlye Pymble discussed the issue of pigment-retention and factors that can contribute to problems in this regard.

This issue often contributes to client dissatisfaction and the presentation delivered valuable information to help minimise this risk. Carlye addressed, technique, health considerations, anaesthetics and the pigments themselves. Her lecture also included an update of the new proposed pigment regulations which are currently being investigated and drafted by the Drugs and Poisons division Qld Health Department. This part of her presentation was delivered by Robert McGowan, who is involved with APAN as part of the working group reviewing this regulatory process.

Chris Testa then followed with an update on the evolution of topical anaesthetics and current regulatory changes in their formulation to ensure greater safety.

Suzanne Sparrow-Crisp gave an alarming update on the rapid increase in suing and consumer litigation specifically relating to cosmetic tattooing procedures. She discussed the issue of “buyer’s remorse”, which is becoming more prevalent, how to minimise risk and the safest way to respond when these events occur to minimise risk and stress.

Once again, Mantra’s amazing chef and his team outdid themselves with an incredible buffet lunch as guests gained the opportunity to meet him and to personally be served by him.

NEW COSMETIC TATTOOING QUALIFICATION Preceding the conference on Monday, on Sunday 22nd September APAN held a board meeting where RTOs and other stakeholders congregated from various states to discuss the update of the new Cosmetic Tattoo qualification SHB50319 DIPLOMA OF COSMETIC TATTOOING that is going to replace the current Unit of Competency SHBBSKSOO3 DESIGN AND PROVIDE COSMETIC TATTOOING. The group carefully reviewed the relevance of the service units and

prerequisites to determine specific consideration to both safety and practicality. Key consideration was to ensure the qualification can gain maximum acceptance by the industry moving forward.

All delegates at the conference were given a feedback form to provide us with comments about the units and a comprehensive report is being prepared to submit to SkillsIQ. Feedback from the Conference was very positive and encouraging. Plans are already under way for the event to grow in 2020 offering a more comprehensive twoday event. To ensure you are informed please consider joining APAN www.apanetwork.com or contact APAN to ensure you are included on the mailing list 07 5593 0360.

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TOPICAL ANAESTHETICS

THE ART AND SCIENCE OF COMPOUNDED FORMULATIONS An interview with Chris Testa EVEN THOUGH THERE ARE NUMEROUS MEDICATIONS that can be compounded, most of us in the aesthetics industry are mainly familiar with compounded topical anaesthetics.

Regardless of the medication, compounding is both a science and an art and its prime objective is to deliver a formula that is tailor-made to suit the specific needs of an individual and provide both a targeted therapeutic outcome, delivered in a safe manner.

Chris Testa is recognised as an authority in both compounding formulations, as well as an educational authority. His commitment to high standards has gained him the reputation as a leader in his field, with others aspiring to reach his status.

APAN is thrilled to be working collaboratively with Chris in the delivery of an industry-endorsed educational unit The Safe Use of Topical Anaesthetics. If you are performing skin needling, cosmetic tattooing, or any other skin penetration procedure that requires a numbing agent then this industry endorsed course is a must. Contact us for the next training date near you.

To help our readers better understand what is involved in the process of compounding, we interviewed Chris Testa, who shared with us his background and some of the amazing dynamics that make up the compounding process.

APJ Q1: WHAT IS THE DIFFERENCE BETWEEN A COMPOUNDING PHARMACY AND A RETAIL PHARMACY? We are all very familiar with retail pharmacies in Australia, the same trusted model has been around for generations.

We are very comfortable and confident in the quality of medicine dispensed, for example, if you have a prescription for Amoxil (an Antibiotic) filled at your local pharmacy, but then you travel to another state, you can expect that the repeat order will be of exactly the same high quality. It might

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even be from the same TGA Licensed manufacturer and perhaps even the same batch.

On the other hand, compounding is quite different. A compounder is making the medicine from scratch. Obtaining the ingredients, validating their quality, then formulating and making that product. In such a process, consistent quality and precision of each element of production is critical. You cannot deliver high quality most of the time – you must ensure that quality is precise and consistent every time. For example: •

The ingredients in each product must be of the highest quality and pharmaceutical-grade

•

Free of contaminants: heavy metals (mercury, lead etc.) and pesticides

Formulating must meet a very high standard i.e. putting together a number of ingredients in the right way and order to develop a precise dose is an art.

Surprisingly, formulating is no longer taught at university.

We have to seek training from technical support and suppliers such as Medisca and PCCA. In fact, my formulating pharmacists have formal qualifications from the cosmeceutical industry.

The laboratory facilities are also critically important, and in fact, are a huge expense. Different laboratories are required for different classes of medication and compounding processes need to be safely contained in their own dedicated areas. Would you feel confident if your topical anesthetics were made in the same laboratory and with the same equipment as thyroid, testosterone or potent antibiotic products? They really need a different manufacturing environment.

We have environmentally-controlled laboratories for different categories of medication. We can independently monitor and adjust each laboratory for temperature, humidity and air pressure.

Each laboratory is HEPA filtered to ensure air purity and laboratory staff work within HEPA filtered powder containment hoods.

You just cannot set up a room with a split system air conditioner and hope for the best. You must take responsibility and be prepared to invest in facilities that ensure staff and customer safety, eliminate the risk of product cross contamination and guarantee consistent quality compounds.

I always encourage doctors, clinicians and patients to visit our facility to view the different laboratories and see where their products are made.

You should always visit your compounder to see for yourself e.g. you would not want your family’s medication cross contaminated with other medication, or prepared in a less than pristine laboratory environment.

APJ Q2: IS COMPOUNDIND EXPENSIVE? Not as expensive as you might imagine when you consider everything is hand-made from scratch in a laboratory setting by trained, qualified staff.

The raw materials are purchased in much smaller quantities than by manufacturers. Also, our processes are very laborintensive. Everything is hand-made. Even though we have access to specialised and sophisticated equipment, such as precision scales, mills, blenders, mixers etc. we are not automated with large mechanised production lines. In fact, the very reason for our precision is the small scale and human element at every step of the compounding process.

APJ Q3: WHY DO WE HAVE COMPOUNDING PHARMACIES? The making of medicines and health products including, vitamins and laser equipment is highly regulated in Australia by the TGA as well as various state health authorities.

Compounders are only allowed to make medicines when a suitable product is not commercially available for an individual patient. In addition, the request for a compounded product must come from an appropriately qualified Healthcare Professional. Compounders are not manufacturers and are not allowed to prepare product in

anticipation of finding a customer, or for on-selling to another party who wishes to retail that product.

Quite often I’m asked to compound product for a particular practice for them to on-sell to their patients at the time of a medical appointment. Even though this may seem logical, practical and convenient for the patient it is not permitted and technically any product prepared in this way is unlicensed and illegal.

APJ Q4: WHERE DID YOU LEARN TO COMPOUND? I am a second-generation Compounding Pharmacist. My father graduated as a Pharmacist in the 1950’s at a time when eight out of every 10 prescriptions were hand-made and just before the advent of large-scale manufacturing.

He was my mentor for over 30 years and he and his colleagues were able to pass on enormous amount of knowledge that is no longer taught at University.

Unfortunately, nowadays only simple compounding is taught and only during the last year or two of a Pharmacy Degree. Simple compounding is the basic preparation of uncomplicated creams, gels and mixtures.

Modern compounding is involved in quiet complex compounding that needs to be carried out in the appropriate facilities with the best equipment and highly trained pharmacists and compounding technicians. APJ CHRIS TESTA is the owner and Direct of the largest and most experienced compounding pharmacy in Queensland - Tugun Compounding Pharmacy, which is the compounding pharmacy of choice for GPs, medical specialists, veterinarians, dentists, naturopaths, dermal and aesthetic therapists, as well as cosmetic tattooists.

The facility comprising three laboratories and a research, development and training area. Since its inception the facility has undergone four major upgrades to incorporate growth and advances in technology.

To contact Tugun Compounding Pharmacy phone 07 5598 2411.

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SCIENCE

Ceramides and Skin Barrier Homeostasis Jacine Greenwood CERAMIDES ARE OFTEN referred to as ingredients found in skincare and while this is true, they also present in the structure of the skin and play a key role in its defense and support. In this scholarly article Jacine Greenwood presents some in-depth research on the role of ceramides in the skin’s barrier homeostasis.

The stratum corneum is a key player in the maintenance of the skin barrier and permeability of the skin (Elias, 2004).

It provides a physical barrier to exogenous substances penetrating the skin readily. Ceramides are involved in the formation of the lipid bilayers and are a major lipid of the stratum corneum, constituting nearly 50% of the epidermis by weight. It is known that depletion of ceramides is a contributor to the development of xerosis (dryness) and barrier disruption. The lamellar bodies in the upper layer of stratum granulosum are responsible for the production of ceramides.

One of the most important properties of a lipid bilayer is the relative mobility (fluidity) of the individual lipid molecules and how this mobility changes with temperature. This response is known as the phase behavior of the bilayer. Broadly, at a given temperature a lipid bilayer can exist in either a liquid or a solid phase. Unlike liquid phase bilayers, the lipids in a gel phase bilayer are locked in place and exhibit neither flip-flop nor lateral mobility.

Due to this limited mobility, gel bilayers lack an important property of liquid bilayers: the ability to reseal small holes.

Liquid phase bilayers can spontaneously heal small voids, much the same way a film of oil on water could flow in to fill a gap. This functionality is one of the reasons that cell membranes are usually composed of fluid phase bilayers.

The physical state of the lipid membrane is described by its fluidity (or viscosity). Phospholipids are part of the molecular

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makeup of the cell membrane and they are integral for the membrane to be fluid. The lipid organisation of the membranes of skin is unique and distinctly different from other biological membranes, in that two lamellar phases are present, which form crystalline lateral phases mainly.

The distance between the spacing of these lamellar phases are of importance in regards to fluidity of the lipid bilayer. If the gaps are too wide, they lack the ability to fill in the gaps in the skin.

THE METABOLISM OF PHOSPHOLIPIDS During the skin differentiation process phospholipids are metabolised into free fatty acids, glycosphingolipids and ceramides. The enzymes involved in sphingolipid metabolism were first discovered from the yeast Saccharomyces cerevisiae.

The Saccharomyces enzymes were found to be similar to the same enzymes in mammals. The metabolism of these lipids involves numerous enzymes that take ‘simple’ sphingoid bases (e.g. sphingosine) and convert them into sphingolipids (e.g. sphingomyelin and glycosphingolipids). One of the most important modifications of sphingoid bases is acylation of the free primary amine group to produce ceramides.

Ceramides are a structurally complex group of sphingolipids containing derivatives of sphingosine bases, which are linked via amides with a variety of fatty acids. Differences in chain length, type and extent of hydroxylation and saturation are responsible for the heterogeneity of the epidermal sphingolipids (Coderche et al 2003). Ceramides belong to the family of Sphingolipids, which are a type of lipid that has an important role in cellular signaling and differentiation. It has been shown that sphingolipids are involved in apoptosis and other biological activities (Hannun, 2008). The increase of ceramide levels in the skin results in the down regulation of cell proliferation.

Any change to the amount of lipids or quality of the lipids leads to an increase in barrier permeability and a decrease in barrier function. Alteration of this ratio results in trans-epidermal water loss and subsequent skin barrier disruption. Clients with Atopic Eczema for example, are known to have a deficiency of Ceramides Spingomyelins are another large group of epidermal sphingolipids, which have been reported as precursors of ceramides. (Schmuth et al., 2000) (Uchida et al 2000)(Holleran et al 2006). Cholesterols and fatty acids are also major skin lipids, and cholesterol-3-sulfate is a ubiquitous metabolite of cholesterol, which is involved in cornified envelope formation (Nemes et al., 2000).

THE FOUR PATHWAYS TO CERAMIDE PRODUCTION Ceramide production pathways are regulated at multiple levels in the skin. There have been four pathways so far that have been identified: the de novo pathway, the sphingomyelinase pathway, the salvage pathway, and the exogenous ceramide-recycling pathway (Kitatani et al., 2008). In the de novo pathway, serine and fatty acyl-CoA are the initiators of a series of reactions. CER synthases 1–6 have an important role as each of them has specificities on synthesizing certain ceramides (Mizutani et al., 2009). Other enzymes such as palmitoyltransferases, dihydroceramide desaturase, and 3-ketodihydro-sphingosine reductase are also key enzymes in the de novo pathway (Merrill, 2002).

During generation of the stratum corneum barrier lipids, ceramide synthesis via the de novo pathway is thought to be upregulated in the suprabasal cell layer. Ceramides newly synthesised by the de novo pathway are immediately converted to glucosylceramides (glucosyl-CER) and sphingomyelins (SM). The glucosyl-CER and SM are then packaged into epidermal lamellar bodies (LB), unique secretory organelles whose quantities increase in the later stages of keratinocyte differentiation. Glucosyl-CER and SM are transported and secreted to the interface of the stratum granulosum and SC, where they are converted back to their ceramide species via hydrolysis by beta (b)glucocerebrosidase and sphingomyelinase, respectively (Uchida et al. 2000) (Holleran, 1993) (Holleran 1994). All

stratum corneum ceramides can be derived from glucosylCER, but only two stratum corneum ceramide species, NS and AS, are generated to a significant degree from SM (Uchida et al. 200) (Hamanaka et al. 2002).

The salvage pathway has been reported recently as a complex mechanism, commencing as the catabolism of complex sphingolipids into glucosyl-ceramide by glucosylceramide synthase and followed by the formation of ceramides by acid beta-glucosidase (Ogretmen, 2002) (Becker, 2004). These ceramides can be broken down into sphingosines by ceramidases (Asah1 and Asah2), which are reused to produce ceramides. (Bernardo et al 1995) (Koch et al 1996) (Li et al 1998) (Tani et al 2000) (Mao et al 2008).

In the sphingomyelinase pathway, ceramides are formed by hydrolysis of sphingomyelins, and the reverse reaction is controlled by sphingomyelin synthase (Marchesini and Hannun, 2004). Exogenous short-chain ceramides can also be utilised to generate sphingosine, thus leading to the synthesis of endogenous long-chain ceramides (Ogretmen, 2002; Sultan et al., 2006).

Biosynthesis of ceramide in vivo starts by condensation of serine and palmitoyl-CoA to form 3-keto-sphinganine, which is subsequently reduced to dihydrosphingosine. In the next steps, a fatty acyl group is added to the dihydrosphingosine moiety via an amide linkage giving dihydroceramide and a trans-4, 5-double bound is introduced to yield ceramide ( Rother 1992).

CERAMIDE FRACTIONS The stratum corneum ceramides are composed of 11 different ceramide fractions that differ from each other in terms of the polar head group structure, number of

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free hydroxyl groups and the mean fatty acid chain length (Ishikawa et al, 2010). Ceramide 1 has been found to be of great importance to the normal barrier function of the skin and for the organization of the intercellular lipids.

The distinctive ceramides in the skin are derived mainly from glucosylceramide (two forms also arise from sphingomyelin), synthesised in specific organelles termed 'lamellar bodies' in the epidermal cells. These organelles must fuse with the apical plasma membrane of the outermost cell layer of the epidermis in order that their lipid and contents can be secreted. It is only then that the final step of hydrolysis of the lipid precursors with generation of ceramides occurs. This mechanism ensures that ceramides, with their potentially harmful effects, never accumulate within nucleated cells.

In diseased skin, there is often an altered lipid composition and organisation and impaired barrier properties. Thus, diminished levels of ceramide in the epidermis, reflecting altered sphingolipid metabolism especially in relation to the esterified and non-esterified omega-hydroxy- ceramides and trihydroxy bases, have been implicated in such skin disorders as psoriasis and atopic dermatitis.

Ceramides with a terminal omega-hydroxyl group in the fatty acyl moiety are bound covalently to the proteins of the cornified envelope. These ceramides can be covalently bound or remain free. Both types of ceramides are involved with the epidermal barrier function. The free lipids align parallel to the corneocyte and they form the intercellular cement of the stratum corneum. The covalently bound lipids are involved in the formation of the corneocyte lipid envelope in the epidermis. Failure of the corneocyte envelope to form properly results in subsequent barrier disruption. For example ceramides that have a terminal omega-hydroxyl group as their fatty acyl moiety normally have the O-acyl linoleate as their fatty acyl. The linoleate can be replaced by oleate, which subsequently leads to abnormalities in the cornified envelope. This represents a change in the “quality� of the lipids.

The ratio of lipids in the epidermis is of critical importance.

Numerous studies have shown that ceramides, cholesterol and free fatty acids are required to be in an equimolar ratio of 1:1:1 for normal and healthy skin barrier homeostasis (Elias et al., 1991; Feingold, 2007). Any change to the amount of lipids or quality of the lipids leads to an increase in barrier permeability and a decrease in barrier function.

Alteration of this ratio results in trans-epidermal water loss and subsequent skin barrier disruption. Clients with Atopic Eczema for example, are known to have a deficiency of Ceramides (Ishikawa et al, 2010).

PETROLATUM AND SKIN-IDENTICAL LIPIDS It has been shown that a damaged skin barrier can be restored by the topical application of petrolatum (Man et al 1995). The petrolatum integrates however into the stratum corneum and can displace the existing lipids. It can trick the skin into thinking it has been repaired. Petrolatum works by occlusion of the skin, which has been shown to stop the secretion of ceramides from the lamellar bodies. Petrolatum therefore should only be used very short term or in conjunction with skin identical lipids. The topical application of ceramides, cholesterol and free fatty acids in a ration of 3:1:1 not only restored barrier function, it accelerated the recovery. The skin identical lipids are incorporated into the nucleated layer of the epidermis (Man 1996). The combination of skin-identical lipids, as well as petrolatum leads to the fastest barrier recovery, than either individual treatments.

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THREE LIPIDS CRUCIAL FOR SKIN BARRIER HOMEOSTASIS A study on Moisturizers versus Current and Next-Generation Barrier Repair Therapy for the Management of Atopic Dermatitis conducted by Elias P.M, Wakefield J.S, and Man M.Q Man led to discoveries that contributed to the development of ceramide dominant moisturisers for skin diseases and dysfunction. This was the first study ever to report accelerated recovery of skin barrier disruption by modulation of topical application of lipids. Interestingly, when they applied ceramide, cholesterol, or free fatty acid alone, or a mixture of two of these, the barrier recovery was delayed.

Only when they applied a mixture of all three lipids at a specific relative ratio was the barrier recovery accelerated (Man 1996). These results suggest that a balance of the three lipids is crucial for skin barrier homeostasis.

Upon disruption of the skin barrier lamellar bodies start secreting more fatty acids and cholesterol, followed by a delayed synthesis of spingolipids (Menon 1992) (Feingold 1991) (Holleran 1991). Once the barrier recovery is completed, the enzyme activities gradually return to baseline levels and decreases in transepidermal water loss are observed (Elias 1992) (Grubauer 1987) (Holleran 1995) (Feingold 1997).

AGE AND CERAMIDE PRODUCTION Another interesting factor is that the distribution of ceramides in the skin changes, in particular with women in relation to age and sex. Female hormones have a significant influence on the composition of the stratum corneum ceramides. There is a significant increase in Cer 1 (EOS) and Cer 2 (NS) with a corresponding decrease in Cer 3 (NP) and Cer 7 (AP) from prepubertal age to adulthood in females. Thereafter, from young adult to elderly women, the ratio of Cer 2 (NS) to total sphingolipids decreases with age in contrast to Cer 3 (NP), which shows an increase (Denda et al 1993).

THE IMPACT OF SURFACTANTS ON CERAMIDES There are biological exogenous factors that can influence the amounts of ceramides in the skin. Surfactants and the different classes of them are one example. Non-ionic surfactants have demonstrated an insignificant effect on the lamellar structure of stratum corneum lipids (Fulmer 1986; Treffel 1996) (Stamatas et al 2012). SLS (Sodium Lauryl Sulfate) on the other hand has had significant studies showing that it increases TEWL and removes lipids from the skin.

The impact of the surfactant of SLS on the skin barrier contributes to a subsequent decrease in Cer 1 (EOS) and Cer 9 (AP) decline after the use of SLS on the skin. Clients who have low levels of these ceramides are those who are more prone to developing contact dermatitis following exposure to detergents (Di Nardo 1986).

The ceramides that are depleted or disrupted after surfactant exposure can be replenished through the topical application of ceramides, cholesterol and free fatty acids (Berardesca 1992).

It has also been demonstrated that when cholesterol, free fatty acids, ceramides, or even acylceramides are applied alone to solvent-perturbed skin, to stripped skin, (Mao-Quiang 1993) (Mao-Quiang 1996) and to some surfactant-treated skin they aggravate rather than improve the barrier. Likewise, any two-component system of the three key stratum corneum lipids is deleterious.

In contrast, three-component mixtures of the three key lipids or two-component mixtures of acylceramides and cholesterol

allow normal barrier recovery and can even accelerate barrier recovery, depending on the final proportion of the key lipids (Mao-Quiang 1996). The aggravation and amelioration mechanism of the barrier function resulting from the topical application of physiological lipids is the same: It has been suggested that whereas complete mixtures result in normal lamellar bodies and intercellular bilayers, incomplete mixtures yield abnormal lamellar body contents and disorder intercellular lamellae (Grubauer G 1987).

Ceramide dominant moisturisers focus on physiologic lipid replacement therapy to restore normal balance of the epidermal barrier. In comparison with other emollients (e.g. petrolatum) that form a more superficial occlusive barrier, ceramide-dominant moisturisers permeate the stratum corneum and are synthesized in the keratinocytes, processed in lamellar bodies, and secreted back into the stratum corneum to become a part of the dermal matrix (Anderson 2009). Interestingly, while cholesterol, ceramides, and fatty acids are all required for repair, individually they encumber rather than facilitate barrier recovery (Man et al 95).

Incomplete mixtures can also result in suboptimal recovery, underlining the importance of proper physiological ratios of individual components to achieve maximal efficacy and has been shown to repair its integrity and function (Elias ). While several reports have shown that the 3:1:1 ratio seems to be important in barrier repair, (Man et al 95) it appears that the "3" does not necessarily need to be a ceramide, as both three-fold higher ratios of a fatty acid or cholesterol rather than a ceramide can significantly improve barrier function when compared to vehicle alone (Man 1996). In addition to assisting in restoration of the lipid defect in AD, these products also help to normalize the pH of the skin, which itself is separately associated with a decrease in epidermal barrier integrity, increased inflammation, and reduced antimicrobial defenses (Elias 2005) (Emer 2011).

Another over-the-counter OTC ceramide-based barrier repair cream is CeraVe. It is the first OTC product featuring multilamellar vesicular emulsions (MVEs), which are similar to liposomes, but facilitate a slow 24-hour controlled timereleased delivery of the contents. This delivery advance offers once-daily application, thereby encouraging adherence to a simplified regimen of moisturiser use.

Berardesca et al. has demonstrated that treatment with Cer 1 (EOS) fortifies the skin barrier against minor sodium lauryl sulfate-induced damage. Lintner et al. applied a synthetic Cer type 2 (N-stearoyl-DL-erytro-sphinganine) in an emulsion and showed a repairing effect on sodium lauryl sulfate–insulted skin and a barrier reinforcing effect on stripping-insulted skin.

CERAMIDES CURRENTLY IN SKINCARE FORMULATIONS Ceramide II Ceramide II is a new type additive in the modern functionary cosmetics. It is the analogue of the ceramide intercellular substance, which it can strengthen the cohesion force of the epidermal cells, and improve the water preservation capacity of the skins.

Ceramide III (Ceramide NP) Ceramide III consists of a Phytosphingosine backbone acylated with a saturated fatty acid (stearic acid). All Ceramides based on the Phytosphingosine backbone have three stereo-active groups. Of the eight possible active groups and possible configurations, only the 2S,3S,4R configuration is naturally found in the human skin. It is a skin identical ceramide which is used at percentages as low as 0.05% in a formula.

Ceramide VI Normalises the skins desquamatory process and reinforces the skin barrier function. Complementary to its protective role as barrier lipid, Ceramide VI also has other interesting properties. Due to its AHA like structure, Ceramide VI normalises the skins natural desquamatory process, resulting in a smoother, softer complexion. As a natural skin barrier lipid, it is particularly suited as a mild desquamation agent for sensitive skin products. It rejuvenates dull, rough, and tired skin, and reduces the appearance of fine lines.

ENHANCED CERAMIDE SYNTHESIS IN SKIN DISORDERS THROUGH DELIVERY OF PRECURSORS Linoleic Acid An alternative to improving barrier function by topical application of the various mature lipid species is to enhance the natural lipid-synthetic capability of the epidermis through the topical delivery of lipid precursors. The earliest work in this field relates to the alleviation of essential fatty acid deficiency in humans. Topical application of formulations containing linoleic acid in the form of natural oils leads to enhanced synthesis of Cer 1 (EOS) linoleate and subsequent normalization of the linoleate/oleate ratio, which is modified in many skin diseases. Direct topical application of linoleic acid has also been shown to alleviate the symptoms of dry skin. The topical application of nicotinamide has also been shown to stimulate de novo synthesis of ceramides, with upregulation of serine palmytoyl transferase and other intercellular lipids of the stratum corneum.

Niacinamide Nicotinamide (Niacinamide) is another active ingredient that has been shown to be a pre-cursor for the production of ceramides. Topical application of Nicotinamide has been shown to increase the production of glucosylceramide and sphingomyelin production. The result is a reduction in transepidermal water loss.

Vitamin C Vitamin C has also been shown to increase the production of ceramide production. The mechanism by which Vitamin C increases ceramide production is by increasing both the expression and activity of serine palmitoyltransferase (SPT) and ceramide synthase (CerS).

Xylitylglucoside and Xylitol Xylitylglucoside and Anhydroxylitol and Xylitol are all sugar molecules. Sugar molecules have been shown to increase the hydration status of the stratum corneum. In particular they have been shown to increase the production of Ceramide 1and 2 by 139%.

As previously discussed, ceramides are the main components of the multilayered lamellar bilayers between the corneocytes and, thus, a key factor in water retention and overall integrity of the barrier.

Chemically, they are amide-linked free fatty acids with longchain amino alcohol sphingoid bases, which are amide linked to hydroxylated, x-hydroxylated or nonhydroxylated fatty acids, and shown to also have functions in apoptosis, cell growth, senescence, and cell cycle control. The major lipid components isolated from the cornified epidermal layers are ceramides, which belong to the class of sphingolipids, cholesterol and free fatty acids; their biosynthesis is in tight relationship with the cutaneous barrier function. APJ

For a list of references, please contact the editor.

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BUSINESS

The Expansion and Disruption of BUSINESS OVERSUPPLY Giulia D’Anna THE ADVENT OF THE FRANCHISE phenomenon has created a feeling that the servicing of the aesthetic market is affected by oversupply, causing what is known as business disruption.

In our industry, the entrance of cosmetic medicine, which is no longer confined to only deliver injectable services, but moving into areas of skin treatments that traditionally were exclusively serviced by beauty therapists and laser and IPL practitioners, is adding to this concern. The boarders between cosmetic, skin treatments, and cosmetic medicine are blurring contributing to this disruption.

Jiulia D’Anna is very familiar with this phenomenon. As a qualified dentist, she has experienced the business disruption that has affected independent dental clinics, which are progressively overshadowed by the advent of the franchise dental chains - Access Dental Care, Advanced Dental and Spa, Aim Dental Group – just to name a few. However, instead of panicking, she decided to look at studying the changing consumer trends and looking at ways that she could add value to her clients through a complementary service that would save them time and meet an additional need. As a result, she has expanded her scope of practice to include the option of cosmetic services to her dentistry and is experiencing incredible business growth. Jiulia, who also spoke at the APAN Melbourne Conference this year, offered to share her story as she believes it will provide hope for business owners who are experience similar challenges through oversupply and adverse competition. We trust you will find her article helpful.

Many years ago, I graduated from the University of Melbourne as a dentist. My role was defined, and I was eager, ready to work and be in control of my future. And I did work. Very, very hard. I started a brand-new practice, and worked long hours.

After about 10 years, I felt like I was ready for a new challenge, so back to university I went for another three years, all while working full-time within my dental practice. This time I was

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focussing on gaining a much deeper knowledge of the studies I knew already. So again, I came out ready to take my career and practice to new heights.

THE EMERGING CHANGES And then a couple of years later, change started to happen around me, and in fact, there was more than one change.

In the healthcare sector, health funds appeared to have much greater influence over the choices that the public were making in their healthcare provider. Add to this challenge, the economy was stalling, but, on the other hand the number of healthcare providers was exploding. Many private practices were and are still being purchased by large corporations, so essentially Goliath is taking over.

Instead of seeing all these changes as barriers, I saw them as an opportunity for further growth and change. Accordingly, I knew I had to change too, so I returned to university to study again, but this time in a field not usually related to dentistry. I completed study in the field of cosmetic dermal therapies, or as some call it, skin science. My goal was to combine dentistry with skin health, considering that I look at people every single day. Instead of just looking inside the mouth, now I was able to also examine the outside of the face as well.

So why am I telling you my story? Because my journey is not unique, and the challenges that are confronting the healthcare sector, are faced by many businesses in the aesthetics industry every single day. This is disruption, where a previously stable business sector has new competitors that completely challenge the stability of that sector. Think of what happened to the taxi service when Uber services entered the market. The same thing happened to McDonalds when the health consciousness of the general consumer changed.

Businesses in every industry need to accept that major changes are happening in the area of competition and move with it, to avoid disruption.

Personally, I could see disruption coming and took the chance to expand my business and education to add a new dimension to what I was doing. No longer am I just a general dentist, but I am now very involved in the cosmetic skin industry and love to incorporate both facets into my practice. It makes total sense that we can now look after both the dental and the skin health of our clients. I have the base knowledge in health sciences, and expanded to incorporate more options for clients. I have opened the treatment options beyond what is traditional within my chosen vocational field.

And these are lessons that other businesses can learn from my story so far.

CHANGE IS INEVITABLE If you are not changing and evolving, you are already well behind. I am sure that you have heard that the next generation will have occupations that don’t even exist yet.

There are so many emerging businesses ready to fill gaps in your sector. You need to examine what you are doing and see what more you can do for your clients. I did this exact examination within my business, and found that the most common thread in any person’s life is the lack of time. Time, or time saving opportunities, is the greatest commodity that you can offer a client.

Look at your business and focus on ways that you can help your client become more efficient. In other words, think of the time that your clients spend with you and consider ways that you can add value to that time, so that clients have less need to make up the time elsewhere. What additional services can you offer your clients? Is it possible to incorporate services within your business to fill an additional need? What can you change? Perhaps it may mean a change in your service hours so that you are available before or after hours, or maybe you need to be mobile to deliver your service directly to the client in their office. Perhaps you could align your services with another business to offer unique services that are linked and enhance the client experience, while meeting another need they may have that they value solutions for.

DISRUPTION IS AROUND THE CORNER Disruption will happen. It is simply a matter of when. If we look at the example of McDonalds, their menu is no longer just fries and Big Macs. Alongside the traditional fast food offerings, you can order a skinny latte and a Caesar salad. Not only that, you can get it delivered. This is brilliant evolution in the face of disruption. Essentially, McDonalds is trying to deliver to two markets, the traditional fast food market, but now also to the health food sector too, both of which are time poor.

In my clinic, clients can get a dental check and clean and complete their visit with a hydrating facial, while picking up some skincare too. If you look at your market and clients, identify areas that are potential threats, and instead think of them as possibilities. Perhaps there is opportunity to expand into an area you would normally consider a competitor.

For example, in Europe you will commonly find a butcher selling cooked meats and meals for lunch and dinner. I love this, because it means that you now have the option to buy the raw product to use, but can also enjoy the same raw ingredients immediately as a prepared meal, without the need to spend time in the kitchen. And you know it is fresh because it is all there in the one space. So essentially, this is meeting the needs of those that like to shop and choose their ingredients, and those that love to know what ingredients were used, but are time poor and enjoy a prepared meal.

EDUCATION AND ALIGNMENT I am a firm believer that you can never have enough knowledge. Upskill yourself, and definitely include your staff in the education plans. Identifying and discussing potential

disruption with your staff is an opportunity to grow together, and make plans for filling niche areas that you may expand into. The more you and your staff know, the better you will do it, because you can definitely not take this journey alone.

I have heard so many business people, and in particular dentists, worry about the cost of training staff. I understand the costs, and I totally “get it”. Believe me I do. There is always the worry that you will spend the money to train your staff, only to have them leave shortly after. But the cost is so much higher if your staff stay loyal with you, and you don’t train them. I mean how could your staff do more within your business to avoid disruption if they don't have the skillset?

Your staff are your business, and without upskilling these vital members, you are selling your clients, business and your staff short. New skills add interest and job satisfaction for your staff. This translates to better performance and a new dimension to your business. And what that ultimately means is increased sales, and avoidance of disruption.

THE JOURNEY NEVER ENDS Enjoy the ride that business gives you. Of course, there will be challenges, I am sure you know that already. But challenges are just an opportunity to look at your business and learn how to change and evolve. I love working with clients and my staff every single day, and I accept the challenges as a growing experience. Look for new pathways in everything you do, and don't forget to include the passions of the people you work with. You will be surprised at how excited you will become about your work.

Your staff will be given a new energy, and most of all your clients will accept change when it assists them too. Many businesses worry that their clients will move away because the business is evolving. Your clients spend their time and money with you, because they already love what you do.

Change is the perfect opportunity to move in a direction that is mutually beneficial to the business and the client. Think about time efficiencies you can give your client, or value that you can add to their experience. Educate your clients about the benefits to them, and they will evolve with you. Most of all, find your passion, and grow your business with passion to avoid disruption. APJ

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PROFILE

Setting the Benchmark in the Northern Territory An Interview with Holly Copping EACH ISSUE OF APJ we love to feature the stories of some of our members and allow them to share their journey and their achievements. In that way, we are honouring them, while at the same time encouraging others to gain some strength and inspiration from their story.

In this issue we profile Holly Copping, owner of Territory Laser Clinic, a dermal therapist based in Winnellie, Northern Territory.

APJ Q1: Holly, when and what motivated you to enter this industry and specifically in establishing your own clinic?

I was born and bred in the Northern Territory and from a very young age of just 12 I started having facial treatment to help clear my skin as I suffered from acne. By the time I was 29 I moved to Queensland and decided to study beauty therapy and completed my diploma at AIAS in 2007. What motivated me to study beauty therapy was due to my own experience and frustration with my skin condition and as a result, I developed a real compassion for others with skin problems.

I really felt that making this my profession would give me the opportunity to help people.

On my return to Darwin I soon became aware of the limitations of my current knowledge, so I pursued dermal therapies and completed an Advanced Diploma of Cosmetic Dermal Science through AACDS in 2010, which was the highest course available with them at the time. After graduating, I worked as a dermal therapist for two years. At the time Darwin was quite insular and I wanted to continue to grow my knowledge, this led me to move to Canberra and gained some work experience there.

In 2012 I returned to the Northern Territory and set up my own clinic. Having gained experience working for other clinics I was ready to set up my own practice. This was a natural progression for me as it gave me the flexibility to establish my own programs and treatments based on the new experience I gained. Once again, my motivation was to help others, having first-hand understanding of the emotional toll that my

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acne had on me, allowed me to help others with similar skin conditions on so many levels..

APJ Q2: Why did you choose to specialise in dermal therapies and laser and how are you coping with competition in Darwin?

I became very much aware of the limitations of beauty therapy in addressing more acute and chronic skin conditions and as a natural progression, I was thrilled to be able to advance my knowledge and qualifications in dermal therapies. In fact, I was the first qualified dermal therapist to operate in the Northern Territory. This qualification also expanded my skills and scope of practice including other modalities such as laser and IPL. While in my original studies the theoretical side of laser was covered (WA did not permit no-medical practitioners to operate a laser), my practical training was therefore only in IPL. However, moving to another State I was able to gain further training and invaluable extensive experience also in laser.

As far as competition is concerned, I don’t follow, or watch what others are doing. I don’t feel the need to, because I believe I have my own strong point-of-difference. We also communicate that we are not part of a business chain. I am highly qualified, and recognised by peak industry bodies for my qualifications (I am ARAP registered (Aesthetics Registered APAN Practitioner), I am an APAN member as well as an ASDC member. What we can promise is results. Our best advertising is through referral from own clients who can vouch for the level the service and results they gain from us.

APJ Q3: Share with us an amazing story that has made your professional journey rewarding?

One of our clients, Stephanie, came to us because she was suffering with cystic acne. We worked with her skin condition for a year. Stephanie was so impressed that she decided to study dermal therapies. At the time she was studying Biomedical Science and we encouraged her to complete these studies first. Today she has beautiful skin and having now also completed her dermal therapies studies, she has been employed by us for over three years. It is so rewarding that

we were not only able to turn her life around, but also inspire her to pursue studies in dermal therapies and make this her profession and career choice. This is so rewarding for me and it gives me joy to know that I can use my skills, care and compassion to change someone’s life.

APJ Q4: Being in a remote region like Darwin how do you stay up-to-date with progress?

Yes, I acknowledge that Darwin is quite isolated, however, in my past positions while I was in other states, I gained a great deal of training and experience with both skincare companies, as well as with different equipment technologies, so I became aware of the various advances within our industry.

Throughout these experiences I was supported by some amazing mentors including doctors, with whom I developed a strong working relationship. Today, I still reach out to them when I need advice, or further mentoring.

I always try to stay in touch with progress and attend as many training sessions as I can. There are two medical specialists who fly to Darwin and work with us regularly, as we also offer injectables, as well as tattoo removal. I read regularly and also benefit from the many educational articles in APJ Journal.

Our equipment is upgraded annually and we try to integrate something new that other clinics may not have.

APJ Q5: The Northern Territory has pretty much the same temperature all year round, how is this impacting the skin and what are your most successful treatment in helping to restore sun damage?

I have to say that the two most common treatments that we specialise in are acne and sun damage. In Darwin the weather is constantly hot, with high temperatures all year round – we don’t have the weather peaks and troughs like other states – it is hot all the time so everyone is exposed to sun and UV radiation constantly. There is therefore a lot of UV damage as many do not wear sunscreen.

APJ Q6: What services and products do you provide?

We offer quite a few advanced treatments including peels and medi-facial treatments. We use several technologies,

including laser treatments for skin rejuvenation, hair reduction, vascular lesions and tattoo removal. We utilise lasers to address epidermal pigmentation, as well other lasers to address deeper pigmentation and to treat melasma.

We conduct a thorough consultation with every client and also use the Visia Skin Analyser systems to ensure we capture both surface and the internal condition of the skin. With our light therapies we also include an LED combination light therapy.

Additionally, we offer ablative radiofrequency treatments and injectable cosmetic medical treatments, as well as provide cosmetic tattooing services.

We carry several ranges of leading cosmeceutical skincare products and educate our clients in the essential homecare of their skin. All our products and devices are either made in Australia or the USA. APJ Q7: What is your brand’s focus and what do you pride yourself in doing well?

Our focus is on the more challenging skin conditions and our treatments deliver results. We only work with highly qualified dermal therapists who have the appropriate knowledge and skill to successfully work with skin correction at various levels and who specialise in skin treatments. We deliver our services with empathy and compassion and aim to develop personal relations with our clients and to improve their selfesteem. As a result, many of our clients have been with us for several years. Our reputation is based on achieving excellent treatment outcomes on a variety of skin conditions.

APJ Q8: What does the future hold for you and your clinic?

My aim is to continue to offer cutting-edge treatments delivered with care and compassion. We are committed to staying current with industry advances and offer our clients the very best treatment outcomes. I am determined to remain in the Northern Territory and to continue to help Territorians change their lives through our quality services. APJ Holly Copping is located at Territory Laser Clinic.

She can be contacted on 08 89 844 110, email info@ territorylaserclinic.com.au APJ 73

AESTHETICS INDUSTRY BULLETIN

SURGEONS BEHIND BAN OF KARDASHIAN BUTT LIFT LIFE MAY BE A LOT FLATTER for Kim Kardashian and her sisters as a movement builds among the medical community to ban Brazilian Butt Lifts after more and more patients end up maimed, or even dead.

Once upon a time in the ’80s, big boobs were the THING. But now, cup sizes have taken a back seat to, well, backseats. Thanks to the curvy bodies of Kim Kardashian, big butts are considered the ultimate symbol of sexiness. So, women (and even some men) of all shapes are buying into the dream that they, too, can have a derriere like Kim + co. with just a few thousand dollars and a few hours of surgery thanks to buttock augmentation, known as a Brazilian Butt Lift. The procedure is performed by a doctor over the course of 90 minutes to two hours under anaesthetic. It involves liposuction of fat from your midsection, back or thighs, which is then injected into your buttocks.

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In theory, it’s a relatively simple procedure that should leave patients with the hourglass figure they’ve been after. American Society for Aesthetic Plastic Surgery reports that the procedure’s popularity jumped 26% from 2016 to 2017, thanks in no small part to the #Belfie trend and the celebs/influencers who love their own rear view.

“The result you achieve should be permanent [but] some of the fat initially placed will be absorbed and lost over the first few weeks after surgery,” says Orlando-based surgeon Dr Armando Soto. “Whatever fat ‘takes’ and is present after the first month or six weeks is what you should get to keep.”

The fat that doesn’t stick around often leaves dimples and divots in the skin, sort of like cellulite. So, revision can be necessary — either by undergoing another procedure to add more fat or by using an injectable like Restalyne to fill in the dimples, which is less invasive and safer but very costly. And unfortunately, this may be the bestcase scenario.

Lea Cambridge, a 29-year-old British mum of three, died on a Turkish operating table this summer while undergoing a butt lift, and she’s hardly the first case. This summer, a Miami doctor named James McAdoo was hit with a formal malpractice complaint from the Florida Department of Health after his patient, 29-year-old Heather Meadows, died following a butt lift.

Dr. McAdoo allegedly injected the fat he took from her body into her deep gluteal vein that caused the fat to hit her circulatory system and travel to her lungs and heart, which caused her organs to fail.

Dr Lara Devgan, a renowned NYC-based, board-certified plastic surgeon (who some say is responsible for half the flawless faces you see at the Met Gala!) has stopped doing BBLs altogether.

“Brazilian Butt Lifts are the single most dangerous procedure in plastic surgery, with a death rate of one in 3000,” warned Dr. Devgan. “I stopped performing BBLs as a result of these recent mortality studies. My field set up a safety task force to investigate.” APJ

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LESSONS ON ENTREPRENEURSHIP FROM DREW BARRYMORE Image credit: Axelle/Bauer-Griffin | Getty Images

DREW BERRYMORE is a renowned actress, but she is also an astute business woman. Launching her own skincare line Flower Beauty has been a great success for her.

At a recent event for American Express in New York, Drew reflected on the progress of her thriving cosmetic company. Here is some down-to-earth advice that she shared.

1. Many entrepreneurs are selfeducated Barrymore had a contract with CoverGirl for six years before launching her company, so she'd already received a hands-on education in running a beauty products powerhouse. Then she meticulously applied what she learned to her own beauty empire.

“And in my own experience, when I opened my first business repairing and manufacturing commercial signs, I was able to hit the ground running because I already knew the space well. I learned it from a great boss and mentor in Utah, who encouraged me, while I was

still in his employ to start my own company in my home state of Idaho,” she said.

The story of the student becoming the master is as old as entrepreneurship itself. You don't need to graduate from business school to establish a successful company. Paying close, passionate attention to life as it happens around you can yield a treasure trove of knowledge, ideas and inspiration.

2. You have to be intensely committed Barrymore used an in-your-face expression that you may have not heard before. Speaking to a hypothetical employee whose performance fell short of their capabilities, she promised to "crawl up your butt and build a house there." In other, more traditional, words, she wouldn't leave them alone until they met their full potential.

Based on her business acumen, it seems Barrymore demands no less of herself. Her direct, energetic, won't-take-no-foran-answer attitude - sprinkled liberally with good humour - is something any budding entrepreneur would do well to

emulate.

3. Stick to your core values Barrymore talked about pursuing a potentially lucrative deal for her company, which she abandoned at the last minute when she decided that she couldn't square it with her values. Many business owners could relate to the challenging nature of a decision like this, because many spend a lot of time thinking about money.

Personally, I remember countless nights feverishly worrying about money: Would I be able to pay the rent? Make payroll? Buy new supplies? Cash is to business what blood is to the body: The second it stops flowing, everything shuts down.

Abandoning your values for a momentary respite from financial worry, on the other hand, is another kind of "death." Even if you don't feel it now, a compromise like this can undermine your confidence and motivation.

It can have a toxic effect on company culture and introduce hypocrisy and discord to an environment that requires a unified vision to move forward.

So do your best without sacrificing your principles. APJ

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AESTHETICS INDUSTRY BULLETIN BOBBI BROWN’S GUIDE TO SUCCESS: GO TO FEWER MEETINGS, TAKE MORE ACTION

Image courtesy of Bobbi Brown MAKEUP LEGEND BOBBI BROWN started from humble beginnings.

In 25 years and in her late 50s BOBBI BROWN products are now distributed to 70 countries and the company was sold in recent times to non-other than Estée Lauder.

In building multiple new brands, she took her own advice, which is based on simple principles. Here is what she shared at a recent interview: You made your name in a time before the phrase personal brand existed. Did you ever think of yourself as a brand?

Not even a little bit. I didn’t know what a brand was back then. I was a makeup artist. I just wanted to make something that was better than what was on the market, and that I got really excited about.

I hear that a lot from famous people -- that they weren’t strategic about building themselves up. It’s such a contrast to now, where people consciously treat themselves like brands.

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A lot of them come to me for advice, and the only advice I have is: “OK, go home and just do it. Put your head down, figure out what it takes, and

just do it. And if it doesn’t work, then do it, but do it a little bit differently.”

Everyone wants to talk about doing it and planning and strategising, but people are forgetting you actually have to do it. I’m a doer.

Did anybody give you that advice at your start?

No. The only advice I got at my start was from someone who said, “The world doesn’t need another cosmetics company. You don’t know what you’re doing.” So, I said, OK, and I just kept on doing what I was doing, which was making a lipstick that didn’t smell bad, that was actually the colour of your lips, and that wasn’t dry or greasy. I met a chemist at a photo shoot and told him what I wanted, and he made it for me, and I said, “Wow; people are going to love this,” and he said, “All right. I’ll make it, you sell it for $15 - you get $7.50, I get $7.50.” I said, “Deal!” And that’s how I started.

“The world doesn’t need another cosmetics company” sounds dismissive, but I wonder if it’s also good advice. Because the world doesn’t need another cosmetics company any more than it needs, say, another beverage company.

Which means an entrepreneur really

needs to make the case for what they’re creating.

Right. When times were quiet, I thought, Well, to make some extra cash, let me go

into a salon and do makeup for women.

So, I worked with mothers and aunts and sisters, and I would teach them makeup, and they’d be like, “Oh my God -- I love this. It’s so simple.” And as my brand grew and my career grew, it just was common sense. My brand became the teaching brand.

You’ve said that if you wrote a business book, you’d call it Duh. Do you feel like, at its heart, business is actually quite simple?

Yes, and I find people waste time, energy, and money on things that don’t matter.

So, I want you to walk into an imaginary business right now and tell people to stop doing things. What should they stop?

Well, first of all, stop putting your head down in your computer. At least once a day, raise your head, get some fresh air, and talk to people. And stop having so many meetings. Honestly, sometimes a discussion just takes two seconds.

You left Bobbi Brown Cosmetics in 2016, after 25 years of building the same company. Now you’re doing totally different things - supplements, lodging, content. Is that disorienting?

This section presents the latest news, training dates and other Aesthetic Industry information

No. It’s honestly no different. Because I’m someone who thinks about a project, thinks about what it is, how it could be better, how to really explain it to people, how to curate it, how to Instagram it, and how to visualise it.

Doing Evolution_18 (her new brand) is the same thing I did when I was creating colours for the season or product categories. You know, you just make things up. An entrepreneur really is just someone who likes to make things up and likes to get them done.

Fatone. I’m not the smartest in the room, but I’m sure the most curious.

Not everything you’ve tried since leaving Bobbi Brown Cosmetics has worked out, like a stint as a Yahoo beauty editor. Do you worry about failure?

I’m not afraid of failure. If something doesn’t work out, I look at it and say, “OK. That was fun. That was interesting.

This is why it didn’t work.” Because I always like to learn from it. I’ve done things where I say, “I don’t want to do it again, but it was interesting to see.”

If podcasting had existed at the very beginning of your career, do you think you would have done it the same way -- just walk into a room and go?

No, not at all! I mean, the good thing about being experienced and getting older is that your confidence gets stronger. And honestly, after all these years, people want to know from me: How do you become confident?

The only thing confidence is, is being comfortable in your skin. I’m comfortable to make mistakes. I’m comfortable to admit what I don’t know. I just think it’s interesting not knowing things, so long as you’re not afraid to ask questions and say, “Wait; what do you mean?”

I’d bet that’s really freeing. When you’re not afraid of failure, you’re willing to take more risks.

Totally. Like, I’ve been given an opportunity to have a podcast. I don’t know anything about interviewing people. I don’t prep. I’m handed a piece of paper, I go into a room, and I just talk to the person -- you know, anyone from Mickey Drexler to Jeff Raider to Joey

Speaking as someone who interviews people for a living, I can say: That’s the right way to do it.

If you use prewritten questions, you won’t listen to what someone is saying and ask follow-ups.

Prewritten questions are the death of conversation.

Well, that’s good to know, because I don’t look at them anyway!

People would rather you ask the question and learn, rather than pretend you know it and don’t.

Right, exactly. And for some reason, people think that to be a successful entrepreneur, you have the fairy dust: Just sprinkle some on me! And it’s like, guys - what I have is that I just keep going forward. APJ

“CLEAN” BEAUTY PRODUCTS NOT ALWAYS SAFE, DERMATOLOGISTS SAY THE TREND FOR “CLEAN”

Skincare products that are free of certain chemicals are not always safer than their traditional counterparts, dermatologists warn.

Arbitrary descriptions of products as “clean” or “natural” are not regulated, and many of these products contain high concentrations of ingredients that can cause irritation and allergies, the authors write in an editorial in JAMA Dermatology.

“We wanted to shed light on the fact that the ‘clean beauty’ movement is more of a business model and marketing tool that plays on the trend of people wanting to use natural rather than synthetic products right now,” said Dr. Bruce Brod of the University of

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AESTHETICS INDUSTRY BULLETIN Pennsylvania in Philadelphia, who co-wrote the editorial.

“Instead, we need to take a more balanced approach when choosing which products to use on our skin,” Brod said in a phone interview.

Between 2017 and 2018, the natural skincare market grew by 23% to $1.6 billion, accounting for about a quarter of the $5.6 billion annual skincare sales in 2018, Brod and co-author Dr. Courtney Blair Rubin, also a dermatologist in Philadelphia, point out.

Brod said they decided to write the editorial after seeing a trend in recent years of patients reporting allergic reactions to natural beauty products.

Every few weeks they see new cases of contact dermatitis, or itchy rashes that pop up on the face and hands, he said, which are linked to botanical or natural ingredients in beauty products.

“Many of these products are marketed and sold to consumers who are misled to think the products are superior,” he told Reuters Health.

“We support free enterprise but want to make sure patients have all the available knowledge at their fingertips and choose products with their eyes wide open.”

Brod and Rubin note that some chemicals in traditional products are “demonised” without proof they’re unsafe. Wellness and lifestyle blogs have ignited fear among consumers, who are calling for safe and nontoxic beauty products, Brod and Rubin write.

However, the FDA doesn’t define “clean” or “natural,” which leaves the labels open to interpretation.

And in an effort to go “green,” many companies and retailers have released lists of ingredients that shouldn’t be used. For instance, Whole Foods’ 2018 list of unacceptable ingredients, which includes more than 400 compounds, included petrolatum,

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which dermatologists recommend to patients because it is so nonallergenic.

Plus, it’s cheap and accessible for people of all backgrounds.

Similarly, the Campaign for Safe Cosmetics tells consumers to avoid parabens, which the American Contact Dermatitis Society named the 2019 “nonallergen of the year.” Parabens have some of the lowest rates of allergic reactions, between 0.5% and 1.4% of users, the authors note.

“The commercial personal care products industry is accountable to high standards,” Brod said. “Products that include synthetic ingredients are created to prevent those adverse reactions on the skin, and preservatives are meant to prevent those complications.”

On the other hand, many natural products contain high concentrations of botanical extracts that can cause rashes and allergies, particularly perfumes, creams, lotions and essential oils, Joel DeKoven of the University of Toronto, Canada.

“We’ve seen horrible reactions from kids being exposed to undiluted oils,” said DeKoven, who wasn’t involved in the editorial. “There’s no guarantee about the efficacy and safety of these products, which you’d think would be everyone’s concern if they really thought about it.”

Koven belongs to the North American Contact Dermatitis Group, comprised of dermatologists who report patch test results on patients with skin allergies to a composite database.

They then analyse the data for trends.

Methylisothiazolinone, a preservative often used in place of parabens in personal care products that are trying to be “paraben-free,” continues to show the highest rates of allergic reactions, he noted.

“Poison ivy is natural, arsenic is natural, and poisonous mushrooms are natural, so the term ‘natural’ doesn’t carry the mystique or cachet from a scientific point of view,” DeKoven said.

“What we’re concerned about as dermatologists is the safety of the products that consumers are interested in, as well as what it costs.”

Ref: Beauty Business Journal on sales. APJ

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APJ 79

NUTRITION

KAKADU PLUM

Australian’s Amazing Superfood for Skin and Body Eva Boyd I LOVE RESEARCHING THE BENEFITS OF NEW SKINCARE INGREDIENTS and I particularly get excited when the ingredient is readily available in nature and does not require a lot of pharmacological intervention to enhance its effectiveness. One that recently has attracted my attention is the Kakadu Plum – one of Australia’s most prominent superfoods. So, let’s take a closer look at some interesting information on this unassuming, yet amazing little plum and what makes it so special for skincare and health.

WHAT IS KAKADU PLUM Kakadu Plum is also known as Gubinge, Billygoat Plum or Murunga. As a native plant, it grows along the top end of Northern Australia. For thousands of years, Indigenous people across Arnhem Land have been using this incredible superfood for everything from a source of food, to a healing remedy and antiseptic. These thriving trees come to fruit around the start of each dry season in May. Kakadu plums are yellow in colour (when ripe) and usually oval shaped, containing a large seed.

Kakadu plums have many benefits, whether they're found in gourmet jams, sauces, pharmaceuticals or skincare products!

What is extraordinary about Kakadu plums is their vitamin C content. Kakadu plums have been identified as the world's richest source of Vitamin C. Research confirms that these plums contain 3000mg of Vitamin C per 100g of fruit. This is more than 50 times the amount found in oranges. It is no wonder this fruit is considered a superfood, as it's full of antioxidants, bioactive and medicinal properties. Kakadu plums are also rich in phytochemical, which have anticarcinogenic, anti-fungal, antiviral and anti-inflammatory properties. For this reason, as we will see later in this article, Kakadu plums are also used to preserve food from contamination.

GETTING ‘SUPERFOOD’ STATUS The rise of the Kakadu plum to international fame as

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a “superfood” may appear to have come about almost overnight. But this story has been a long time in the making.

Aboriginal people have valued this plant for thousands of years for its food and medicinal properties. The health benefits of the fruit were certainly recognised, but more specifically, the red inner bark was used to treat skin conditions and sores.

BUSH TUCKER’S TIME TO SHINE The Kakadu plum has risen to prominence only recently as scientists having put them through rigorous laboratory testing have been able to confirm their worth. These findings have also been published in prestigious journals.

Dr Yasmina Sultanbawa at the Queensland Alliance for Agriculture and Food Innovation, a University of Queensland institute, jointly supported by the Queensland Government, is one such scientist, grounding on an emerging industry that has brought together the funding, the science, the buyers and the Indigenous community. The particular industry they studied is one of Australia’s favourite seafoods – the prawn.

It rests squarely on the Kakadu plum because of its high antimicrobial properties that are powerful enough to extend the storage life of food – particularly prawns which are so prone to contamination.

In 2010, with funding from the Rural Industries Research and Development Corporation, Dr Sutanbawa set out with the goal of finding a way to commercialise native plants in a way that engages indigenous communities.

At the same time, the Australian Seafood Cooperative Research Centre and Aquaculture Prawn Farmers Association were looking for a way to extend the self-life of cooked chilled prawns, and to improve the colour and retain the fresh prawn flavour.

Dr Sultanbowa, in collaboration with scientists from the

Queensland Department of Agriculture and Fisheries, screened a range of promising native plants for antioxidant and antimicrobial properties, and found that the Kakadu plum showed the greatest promise against spoilage microorganisms, thanks to the high level of ellagic acid.

DAF Senior Chemist Dr David Williams says the Kakadu plum has great potential in numerous sectors.

“It has a unique phytochemical profile that allows many and varied applications in the food industry, as well as cosmetic and nutraceutical industries,” he says.

The team then validated these findings with lab, pilot plant and farm trials and delivered a major breakthrough for Queensland’s largest aquaculture sector, which contributes about $80 million to the economy annually.

The Kakadu plum solution is now used by 15 per cent of the Queensland aquaculture industry, extending the self-life to 14 days.

KAKADU PLAN AND SKIN BENEFITS With scientific evidence of its benefits, Kakadu plum is now starting to surface in serums and a comprehensive array of skincare products, both Australian and international brands.

As we know, vitamin C is essential for glowing skin – it plays a key role in collagen integrity and in firming the skin. It helps to fade dark spots and can help fade acne scarring, and improves the way skin responds to UV light—all crucial issues, especially within Australia and our long summer days that will soon be upon us. With the high content of vitamin C in Kakadu plum – 55 times more than an orange, it offers great support, both for skin protection and skin integrity.

Natural acne-fighter The Kakadu plum is used by local tribes as medicine—and it’s especially known as a traditional antibiotic and anti-

inflammatory. This means that, when applied to skin, it can reduce swelling, redness and even help get rid of bacteriallyinduced acne.

Antioxidants We know the importance of antioxidants in helping to protect the skin from environmental damage, like UV damage and pollution. While we can gain antioxidants from foods we eat, such as fruit and vegetables, it is important to also apply them topically. Kakadu plum does not just contain Vitamin C, but additional lesser-known antioxidants like Gallic acid (good for restoring the skin’s natural barrier) and Ellagic acid (helps restore elasticity to skin). In fact, the Kakadu plum contains such powerful antioxidants that it’s now also being studied in Alzheimer’s trials.

It’s sustainable So this plant is amazing for the skin - and that’s fantastic, but perhaps the best thing about it is that it’s also good for the planet; Kakadu plum is the epitome of a socially responsible, sustainable crop. Isolated indigenous communities, who already have access to this wild-growing plant, are able to cultivate and harvest the fruit, which creates jobs and helps establish horticulture as a sustainable industry in the area.

Now isn’t that a good thing?

IN CONCLUSION The promise of additional health benefits of the Kakadu plum have recently resulted in the Northern Territory receiving a $500,000 grant from the Australian Government for the purpose of further research. However, when it comes to skincare, there is sufficient evidence to support the vitamin C and antioxidant benefits of Kakadu plum. Keep your eye out for further research on this little plum, as I am convinced that we will be amazed at further benefits in the near future. APJ

For a list of references, please contact the editor.

APJ 81

AROMATHERAPY

THE CROWNING GLORY OF

Laurel Bay Eva Boyd

ONE OF MY ALL-TIME FAVOURITE essential oils would have to be Laurel Bay. It may not be one of the most common essential oils, but I believe it delivers some incredible benefits, more so for overall body health and lymphatic support rather than for skin. However, in my opinion, it is a “must” for all health enthusiasts and practitioners who are working on body shaping and wellness programs.

Apart from the essential oil you probably know bay leaves as a lovely herb that you can find in the spice rack of your local supermarket wrapped in small transparent bags, and most likely, you have used them in cooking, soups, stews and various meat dishes. But there is more to the bay leaf than meet the eye.

Greek mythology makes several interesting references to Laurel Bay and its symbol of achievement and supremacy.

Here are some highlights to Laurel Bay’s illustrious history since antiquity.

LAUREL WREATH, SYMBOL OF LOVE, VICTORY AND POWER The laurel bay leaf wreath has its origin in the god Apollo. He was in love with Daphne, who was the daughter of the River god, Peneus (identification varies). Daphne desired not to marry, so she fled from Apollo’s desire into the woods, where he chased her. She asked her father to help her escape, so he turned her into a laurel tree. From that day on, Apollo resolved to wear a wreath of laurels on his head.

Pausanias wrote that this association with Apollo was probably the only reason that the Laurel Crown was awarded in the Pythian games since they were held at Delphi, sacred to Apollo. Although we tend to think of all these ancient Greek events as “games,” they were also big religious festivals, and the Pythian festival was in honour of Apollo. These games are sometimes known as “Crown Games” because of the wreaths awarded.

Laurel wreaths were also given in many other important

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areas, such as the arts, literature, government, and education.

The Romans took up this tradition and gave laurel wreaths to important people such as military leaders, and others. The laurel wreath was a symbol of power for Kings, and Emperors.

It is also well-known that Julius Caesar wore a laurel wreath as a symbol of his supremacy.

Caesar declared the wreath to be the one symbol of a supreme leader and so, during the Roman Republic, only the supreme leader wore the Laureate Corona. These had ceased to be made with actual laurels, and were made instead with gold and precious stones. This led to the modern crown of Kings and Emperors.

In later years Napoleon also chose to wear a “Laurel Wreath Crown,” from from there on, he declared himself to be Emperor of France.

OLYMPIC GAMES In the first “modern” Olympics games, held in Athens in 1896, second place winners received a bronze medal, a laurel wreath crown, and a certificate. First place winners received an olive crown and a silver medal. Gold medals were not given out until the 1904 Games in St. Louis. The expression “rest on your laurels” comes from these traditions. And in education, the term baccalaureate and bachelor are derived from the word baccalaureus or laurel berry, stemming from the Roman tradition of awarding great scholars or poets with laurel wreaths.

LAUREL BAY – BOOSTING EVERYTHING FROM CREATIVITY TO YOUR DIGESTIVE TRACT Laurel Bay or Sweet Laurel as it is sometimes known, is an evergreen shrub or tree that has dark green lanceolate leaves and small clusters of yellow flowers. Aromatically, Laurel Bay essential oil (Pimenta racemosa) has a fresh, camphorous and spicy aroma and works well with soft, sweet and fruity/ floral notes. It has several notable therapeutic properties. Its chemical constituents are as follows:

The leaves contain about 1.3% essential oils (ol. lauri folii), consisting of 45% eucalyptol, 12% other terpenes, 8-12% terpinyl acetate, 3–4% sesquiterpenes, 3% methyleugenol, and other α- and β-pinenes, phellandrene, linalool, geraniol, terpineol, and also contain lauric.

LAUREL BAY FOR THE DIGESTIVE SYSTEM This oil can stimulate your digestive tract. Studies show it can even overpower drug-resistant strains of Campylobacter jejuni, which is the most common bacterial cause of diarrhoea.

COMMON PROPERTIES AND USAGE OF LAUREL BAY One of the most common properties of Laurel Bay is its incredible uplifting aroma that is almost masculine in nature, and its composition is very complex. It contains elements of nearly all of the 12 main chemical groups, which explains why it can do so many great things for you!

LAUREL BAY FOR THE LYMPHATIC SYSTEM Professor Kurk Schnaubelt is considered an authority in aromatic medicine. His research supports the action of Laurel Bay in improving your entire lymphatic system. All you have to do is rub a few drops of Laurel Bay on your swollen lymph nodes and you will gain instant relief. Try it after a shower, and you’ll be in heaven! For this reason, it is also an excellent oil to include with cellulite and body shaping treatments, as well as in overall in treatments to support the immune system.

LAUREL BAY FOR THE MIND Because its scent is so fresh and uplifting Laurel Bay is often used to overcome poor concentration, memory problems, and chronic nervous debility. If you lack energy, this oil can give you an instant boost.

LAUREL BAY FOR MOTIVATION “Stimulating” is the best way to describe Laurel Bay, because it can help people do amazing things. Laurel Bay opens up your channels of creativity, and it helps to silence the channels of doubt. It will help you overcome your fears and develop more self-esteem, making it the perfect oil to use when you’re starting a new job or moving to a new town where you don’t know anyone.

LAUREL BAY FOR THE RESPIRATORY SYSTEM Because it is an expectorant with mucolytic properties, Laurel Bay is a good antiseptic for the respiratory system. It can improve and open up the sinuses and enhance the lungs, which is why it’s used to treat colds, the flu, and even chronic bronchitis. It’s very pleasant as its aroma is not as strong as, for example eucalyptus or peppermint, but in comparison to these oils, it is gentler yet highly effective.

LAUREL BAY FOR ROMANCE Because of its strong masculine smell, Laurel Bay is considered sexually arrogant. And, because it inspires creativity, it can be the perfect way to spice up a romantic evening.

CREATING YOUR OWN BLEND Laurel Bay should always be diluted (use no more than 12 drops per 50 mls of carrier oil). If you want to support your immune system apply to key lymphatic node areas once a day. Just remember, if you put it on your skin too frequently, it can lead to sensitisation and irritability because of the high eucalyptol (45%) content.

If you have never experienced it, I highly recommend to seek it out. I have to say that Laurel Bay with its pleasant and refreshing aroma and its unique properties for alertness and immune support, is a must-have for my wellbeing and will always be included in my aromatherapy oil collection. APJ

APJ 83

PERSONALDEVELOPMENT

MAKING ROOM FOR JOY AND SUCCESS Tina Viney

EACH OF US will face daily challenges in life. Not just financial pressures, but also personal and relational issues, such as betrayal, or injustice from the behaviour of others – a colleague has stabbed you in the back, misinformation that may be communicated about you or your business, a lack of appreciation from those close to you - whether at home or at work, these experiences can leave you feeling empty and deeply wronged. Life isn’t always fair.

While we may quickly dismiss some of these incidences, if not appropriately addressed, they can leave their residue of disappointment and poison our ability to function from a free heart of love, care and compassion.

WHY FORGIVENESS? And here I would like to share with you my person revelations on forgiveness. So why am I bringing this up?

In my position as CEO of APAN I often consult with business owners, so I have first-hand experience of some of the areas that hinder many from moving forward. It is true that most salon owners take good care of their staff and consider them often as family. But life being what it is, misunderstandings can occur and in my experience one of the hardest areas that business owners face is letting go of disappointment, even when the issues have been resolved.

While we can review our policies and procedures and handle matters intelligently, we cannot truly move forward without also taking a closer look at the state of our thoughts and our heart. When an issue is uncomfortable, we often dismiss it with a “let’s not talk about it”, but burying a disappointment will only allow it to resurface. It will not do. You need a clean slate and you cannot truly achieve that without forgiving the past and truly letting go.

But they don’t deserve it! Maybe they don’t. But what most people don’t realise is that forgiveness is not about the person who has wronged or hurt you. It’s about YOU. You don’t need to forgive them for their sake, you need to do it for your own. What I have come to realise is that the path to radical success in life, to fulfilling personal accomplishments and living a joyful life, isn’t necessarily drive, hard work, money or even a streak of good luck – it’s about letting go and APJ 84

forgiving others and ourselves in areas of failure so that we can welcome hope, joy and new beginnings that will lead us to where we want to go.

If you spend enough time fuming internally, the pain you felt in the past invites itself into the present. You’re refreshing your pain every time you think about that situation where you got screwed over. Every time you interact with someone who reminds you of the person who betrayed you. Every time you look in the mirror and remember that you bit that line, you fell for that trick and bought that machine that failed you, or you signed onto the deal that you shouldn’t have, your mind internalised that feeling and it integrates it into the way you anticipate and thinking about the future.

Your mind may go “Okay, person A hurt me in the past, which means I definitely need to be careful not to trust person B. Maybe they will turn out the same.”

“I tried introducing this service in my business and failed miserably, so why bother, my next one will probably be a disaster too.”

Do you know how many times I’ve heard that when I speak to business owners who cannot go passed a failure? By not letting go of pain, they carry it forward and it becomes a self-defeating pattern. That is WHY we have to forgive others, even our own failings and let them go.

Forgiveness is not about dismissing or justifying what went wrong, or someone else’s wrongdoing. It’s about finally letting yourself walk free into a better future that is waiting for you and into the bigger person that you are capable of becoming.

To enter into the next phase of your life, you need to let go of the deadweight of your past so that you can enter into the incredible life that you deserve.

DISCOVERING THE GENIUS WITHIN In my lecture at the APAN Conference in Melbourne I spoke about Discovering the Genius Within.

I would like to share just a few thoughts from this lecture here that relate to operating from a reference point of our true identity.

Each one of us is a unique human being – there is no other person in the world that is exactly like you. I know this not just from science, but also first-hand. I am an identical twin, and while I have many similarities to my twin sister, we still have differences.

POSITIVE THOUGHTS • Enable the synapses of the brain (connecting neurons) to increase dynamically allowing us to identify problemsolving opportunities •

Increase mental productivity by improving cognition

When you were born, you were endowered with gifts and talents that are intended for you to do something exceptional with your life – that is your purpose. You have within you the makings of a genius – we all do.

•

Intensify ability to pay attention to detail and improve focus

•

Improve ability to think and analyse incoming data

•

Improve ability to enhance creativity and find solutions

•

Allow us to be more inclusive and engaging with others

None of us are born to be a failure, but in life we will experience both good and bad – injustice, unfairness, cruelty or abuse and these experiences can leave their ugly marks on us long after the events are over – they can leave us broken. This brokenness in us when given expression, or being allowed to manifest, hinders the real us from shining.

We say things like “I can’t handle this, or this type of person.”

Progressively, we start to reflect the identity of the broken person instead of our true gifts and attributes. As we behave in a way that reflect the brokenness, this is what other will also see, so they relate to us as having those impediments of deficiencies rather than seeing us through our true gifst and tellents.

But you and I have a choice! We don’t need to camp around the past, because these events are just the staff that happened to us. They don’t define who you are. You are more than your failures or your misfortunes. To do this, we need to make a concerted effort to choose to forgive and let go of negativity and the misadventures in our lives and focus on life-giving thoughts that will help us to move forward with hope and positive expectations.

RESEARCH FINDINGS Behavioural scientists have observed some interesting differences between optimists and pessimists. Besides the fact that optimists are more preserving and successful in life, they also tend to have better physical health. Being optimistic “involves highly desirable cognitive, emotional, and motivational components” (Raynolds, 2011).

Here is just a snap-shot of a recent study on how positive and negative thoughts influence our brain and productitivity.

NEGATIVE THOUGHTS • Slow down brain coordination •

Make it difficult to process thoughts, or find solutions

•

Hinder creative ability

•

Decrease activity in the cerebellum

•

Impact the left temporal lobe (fear factor), affecting mood, memory and impulse control

•

Make us more withdrawn, isolated, inhibiting our ability to connect with others

There is a whole body of neuro-science that provides us with validated studies that confirm how our thoughts influence our behaviour and contribute to our successes or failures.

The science of neuroplasticity clearly confirms that we have influence to change our brain and therefore our future. We do not need to be locked into the past.

Letting go of disappointments, forgiving others and ourselves is an important part of this process. A free heart and a free mind will help us to identify and be more receptive to new opportunities, new ideas and to develop effective, problemsolving capabilities.

Set your heart free and experience the life that you deserve.

APJ

For a list of references, please contact the editor.

APJ 85

BUSINESS

Dealing With Mental Health in the Workplace An Interview with Phillip Fernandez

THE ISSUE OF MENTAL HEALTH is something that we encounter in all walks of life – home and business. However, how do we address this issue in the workplace?

In this interview Tina Viney speaks with Human Strategies and Business Coach Phillip Fernandez about affective ways to address this delicate topic when it is encountered in a work environment.

APJ Q1: There is much community awareness about mental health, so let’s talk about this in this interview.

What are your thoughts about improving mental health in the workplace? What tools do you recommend when addressing staffing issues relating to mental health?

Yes, there is Tina. It seems to be rising more and more in the workplace. It is a very complex issue and must be addressed in a very careful, empathetic and sensitive manner. First, these issues unfortunately, do not come up in an interview and are sometimes difficult to detect, as the applicant is usually putting forward their best behaviour. Once noticed, or if the staff member does share their issues with you, then one needs to first and foremost find out if they are seeing a psychologist, or engaging with any form of self-help, as mental health issues can stem from a varied number of sources and mostly, it comes from outside of work.

Second, you will need to address how this plays out in their job and in their day-to-day activities. How does this impact on their motivation, passion and ownership to perform to the best of their abilities? Mental health issues will often show up as lacking confidence, anxiety, and in severe cases, APJ 86

depression. These manifestations can affect team morale and even their ability to carry out simple tasks that are required in their job. One has to be very careful in showing empathy and also ensuring due diligence in supporting the staff member to cope and deal with their issue that comes under the umbrella of mental health, whatever it might be. The Salon Owner needs to be very careful that they don’t give the message of discrimination, due to lack of performance, if it’s based on the mental health state. They need to address these two issues separately showing fairness and transparency.

In Australia currently 2.71 million or around 1 in every 6 (16.6%) people suffer from some form of anxiety or depression. If you are not properly skilled in these areas then contracting a reputable business, self-development coach, NLP coach, or even a life coach that specialises in addressing behaviour, anxiety and obstacles towards performing to the requirements of their job could be a path to take. Obviously, this is only if you feel that the staff member has got a lot to offer the business.

APJ Q2: While we know that there can be genuine cases where people are suffering with depression or anxiety, in your opinion, how should businesses guard against “fake” cases when people are just jumping on this bandwagon and use it to their advantage? How can you guard against that?

This is a good question Tina. In my years of experience dealing with salons, clinics and other businesses, this is quite a minefield and all owners of businesses need to be very careful in how they handle the ones that allegedly use

the “anxiety”, or “depression“ trump card to get out of tasks and to be the brunt of the “victim” mentality. This can also override into bullying or harassment in the workplace that causes anxiety and even depression. On top of that if they are good actors they could even fool their doctor in prescribing depression pills and provide them with a reason to offload their work at their place of employment.

To avoid this, here are some steps to put in place:

1. Make sure you have a strategic and sound Recruitment and Selection system in place. I am so particular about this when it comes to recruiting staff. I was a HR Director for some time in my corporate life and spent a lot of time in this area. It is a science and I have since developed a system based on specific behavioural traits required of your staff that includes a numbering system that takes the emotion out of recruitment and a very effective questioning technique to bring out the traits you seek in your future employee.

2. When in the job, set the KPI requirements from day one and assess performance in the first three months.

If anxiety and depression come into play in that time, do not waste time, end their employment only based on their lack of performance in meeting their KPIs and nothing to do with their mental health condition.

3. If you have a long-standing employee that suddenly develops anxiety, or so-called depression, then you also need to address it in the same way, but also showing concern for them simultaneously.

APJ Q3: What about prevention? What can businesses put in place to prevent mental health issues in the workplace?

In spite of whether the issue is genuine or fake, it is our responsibility as a business owner to ensure that the workplace is safe and that there are systems in place to prevent or address anxiety, depression or genuine mental health issues. Here are some key areas to consider:

1. It starts from the top. Owners and managers must always practice these four rules in managing staff’s performance: Be Firm, Fair, Transparent and Clear.

FIRM: This means not changing who you are, but drawing a line in the sand, showing this is the expectation with required benchmarks.

FAIR: Everyone is treated the same in spite of any illness, anxiety, etc.

TRANSPARENT: You have nothing to hide. What you see is what happens in the business.

CLEAR: Be crystal clear in your direction, empowerment, understanding KPIs and with performance appraisals. This is paramount to the business.

Also ensure that your Policies and Procedures Manual addresses bullying, harassment and good culture where employees have freedom of speech and that they are supported at all times. Provide clear guidelines that addresses acceptable behaviour and what is not acceptable.

They must understand that they need to take ownership of their performance and want to come to work every day They also need to know that the workplace meets all the

In Australia currently 2.71 million or around 1 in every 6 (16.6%) people suffer from some form of anxiety or depression. safety requirements in the OH&S manual.

APJ Q4: In your experience, when not addressed correctly, how can mental health issue affect staff performance and business growth and productivity?

When mental health issues are ignored, or not addressed correctly the consequences could be detrimental for the business. Here are some areas that can be affected:

1. Staff morale is the first to be affected. The team starts to divide and productivity can be diminished.

2. Owner and management become agitated, nervous and not sure which way to proceed.

3. The employee that is in this state of anxiety, or depression can use the “victim” card very effectively to their advantage, if they are faking it. If they are genuine, their mental health is at great risk of worsening.

4. Finally, their performance and productivity will go downhill and so become a liability for the business.

I have found that if a business follows the following four steps for addressing concern, addressing due diligence and also being clear about productivity that makes a business viable, they can handle employees in this state without landing up in a tribunal.

a. Resupply: Are you providing the right resources and adequate support? b. Retrain: Do you need to retrain and keep their skills up either through in-house or external training? c. Refit: If they are genuine and trying hard, but still struggling, consider refitting or tailoring their job if you have the capacity. I call this the “Round peg round hole theory”. d. Release: If there is still a lack of ability, and therefore no productivity, or improvement in their anxiety or depression issues, then “Let them Go”. This should be done with genuine concern, as you cannot afford to keep them. APJ Phillip Fernandez is a Human Strategist, Business and Personal Development Coach, NLP Practitioner, Author.

Wizard Business Consulting www.businesswizards.com.au

APJ 87

SKINPEELS

THE POWER OF PEELS FOR SKIN REJUVENATION Dr Zac Turner

WHEN WORKING TOWARD SKIN IMPROVEMENT the role of chemical peels can play an important role in enhancing the appearance of the skin. There is actually strong body of scientific evidence to prove they work. However, they require both an understanding of their properties, as well as appropriate training and education.

Acid peel treatments are not just good for the face, they can also help to improve the neck and even the back of the hands from lines and pigmentation. The peels improve the skin’s overall appearance and texture. They can also benefit in improving mildly scarred tissue, treat sun damage, reduce fine lines beneath the eyes and around the mouth, reduce the appearance of pore size, and reduce age spots and certain types of melasma.

The intensity of the treatment is dependent on the patient’s goals, skin type and damage to the skin. Acid peels (depending on their strength) require down time to follow the treatment. During this time the skin slowly flakes off The patient must not scrap or peel the skin, and must stay out of the sun. It is important that the skin peels off naturally in order to avoid any scarring.

Multiple acid peels at low concentraton, over the course of a year can offer best results, as progressively they can give the skin a more refreshed, clearer texture and a ‘brand new’ appearance.

TYPES OF PEELS • There are several types of chemical peels and each one can offer different benefits. However, the most common are: •

Glycolic

•

Lactic

•

TCA peels

WHAT IS A GLYCOLIC ACID? Glycolic acid is also known as alpha hydroxy acid or (AHA) APJ 88

the name refers to its chemical makeup. Products featuring this active ingredient come in many different forms: cleansers, serums, moisturisers, eye creams, and facial peels, just to name a few.

Glycolic acid is made from sugarcane. This differs from other acids, like lactic acid, for example, which is made from sour milk. Lactic acid is much milder and very gentle. The recovery time is faster, and it's a great option for sensitive skin.

Despite the fact that they are not as mild as lactic acids, glycolic acid reigns supreme as far as chemical peels go.

Glycolic acid is generally considered the gold standard in chemical peels due to its proven ability to transform the health and appearance of a multitude of skin types.

Glycolic acid has a small molecular structure, giving it the ability to travel deep into the layers of the skin. Once there, the acid dissolves excess sebum and dead skin cells, revealing smoother, brighter, and younger-looking skin. Lactic acid, on the other hand, has a larger molecular structure. "This means that lactic acid is not able to penetrate as deeply into the layers of the skin. That doesn't necessarily sound like a good thing, but it can be. The benefit of this difference is that lactic acid is mild and it's more suitable for dry to sometimes even sensitive skin types. This is a favourite ingredient for brightening and also for exfoliating dry, sallow skin.

GLYCOLIC ACID SKIN BENEFITS The benefits of glycolic acid peels are endless. They are excellent for stimulating natural collagen production, along with diminishing the appearance of fine lines and wrinkles over time. It's much more than an anti-ageing treatment, as glycolic acid also lightens the skin and diminishes discolorations, such as sun and age spots. It can even help oily skin that is prone to blackheads, whiteheads, and acne by keeping pores unblocked. Glycolic acid has the capacity to penetrate deeply into the skin to refine texture and improve skin that is dull. It leaves skin looking refreshed, bright, and refined. As a treatment, topically applied at a 30% strength will render good results. Strengthes above 30% are considered a medical, and require further training.

Again, it all comes back to molecular size as glycolic acid has the smallest of all acids used in skin treatments that’s why it's able to penetrate so deeply and exfoliate so thoroughly.

Are There Any Side Effects?

There are a few considerations you need to know before using a glycolic acid peel, if you're using glycolic chemical exfoliation products at home. Chemical exfoliants used in conjunction with retinol or vitamin C can increase sensitivity and dryness. Overworking the skin with too many actives can start to break the bonds between healthy skin cells and thin the skin. Look for products with ceramides, hyaluronic acid, and peptides to strengthen the skin barrier. In other words, hydrate, hydrate, hydrate post-treatment.

WHAT IS A LACTIC ACID PEEL? Derived from milk, lactic acid also belongs to a class of alphahydroxy acids (AHAs).

So how can lactic acid peel benefit the skin? A chemical peel works by using a chemical — in this case, lactic acid — on bare skin. It removes the top layer of skin (epidermis). Some stronger formulas may also target the middle layers of skin (dermis).

Despite the name, your skin doesn’t noticeably “peel” off.

What is noticeable, though, are the effects underneath the removed epidermis: smoother and brighter skin. Lactic acid is specifically used to treat hyperpigmentation, age spots, and other factors that contribute to a dull and uneven complexion.

Other benefits of AHAs like lactic acid include improved skin tone and reduced pore appearance.

However, unlike AHAs such as glycolic acid, lactic acid is a bit milder. This makes a lactic acid peel a better choice for sensitive skin. Lactic acid may also be an option if you’ve tried another AHA in the past and found the product too strong.

Are side effects possible?

Despite the milder nature of lactic acid, it is still considered

to be a powerful AHA. Its “peeling” effects will make the skin more vulnerable to the sun’s ultraviolet (UV) rays, so sunscreen is key, as it is for glycolic acid. Make sure your client applies sunscreen every morning and re-apply as needed throughout the day. Over time, unprotected sun exposure can lead to more age spots and scarring and it may also increase the risk of skin cancer.

Lactic acid peels can cause irritation, rash, and itchiness.

These effects are usually mild and improve as your skin gets used to the product. If the side effects persist after the first few applications, advise your client to discontinue home use and return to you for a further assessment.

You shouldn’t use a lactic acid peel if you have: • eczema •

psoriasis

•

rosacea

TCA OR TRICHLOROACETIC ACID PEELS TCA is the abbreviation for trichloroacetic acid, a chemical commonly used in a wide range of chemical peels. TCA peels use a type of acid that can be customised to a variety of applications and strengths, from a quick lunch-break treatment to a complete restart for your skin. At high doses TCA peels are considered as medical peels and require thorough training.

Trichloroacetic acid is a derivative of acetic acid (vinegar) and is used to remove the top layer of cells for a smoother, clearer complexion. It has more risks and requires thorough training before its use. However, with correct training, it can help improve conditions of melasma, sun damage, actinic keratoses, lentigos, texture, and wrinkles.

The strength of TCA depends on what condition is being treated. Medium and deep peels, including those that involve TCA, usually require a week or two of downtime as the old skin peels off.

APJ 89

SIDE-EFFECT CONSIDERATIONS Unfortunately, TCA peels do not work for everyone. If you fall into the below categories, do not get a TCA peel done:

What are TCA peels best used for?

• Brown spots and age spots •

Sun damaged skin

•

Hyperpigmentation

•

Melasma

•

If you are using Roaccutane (Accutane) or have used it in the last 24 months

•

If you are pregnant or lactating

•

Acne and acne scars.

•

If your skin is prone to keloids (or raised scars)

•

•

If you have dark skin

As you can see, TCA peels have the capacity to work more deeply into the skin and therefore are used for more stubborn skin corrective treatment purposes.

•

If you have herpes simplex and/or are prone to cold sores

•

If you are undergoing chemotherapy or radiation treatments

•

If you are HIV positive or have AIDS

If the skin is prone to keloid scarring (or getting raised scars after a wound is healed), you should definitely avoid TCA peels because by "damaging" the skin on your face with the peel, you risk getting keloids anywhere you peel.

Darker skin tones should also avoid getting TCA peels.

Light to olive coloured skin tones are good candidates for TCA peels, but dark skin tones need to be wary because TCA peels can cause uneven pigmentation (either through hyperpigmentation or hypopigmentation).

When you are performing a TCA peel, the main side-effects you need to worry about include: •

Burning sensation of the skin

•

Persistent facial redness (erythema)

•

Skin pigmentation changes

•

Scarring or infection

•

Post-peel breakouts

•

Sun sensitivity

These side effects sound scary, but they are generally avoidable if the skin is properly prepared before and after a TCA peel. To what degree the above side effects will affect, will also depend on the skin type and the strength of the peel.

Using too strong a TCA solution and leaving it on the skin for too long contributes to skin damage and persistent redness.

Therefore, it's always good to start slow and build your way up. Never use a strong TCA peel before you have acclimated the skin to weaker ones.

APJ 90

IN SUMMARY Glycolic and lactic acid peels are superficial peels and work more in improving the surface of the skin, expediting cellular turnover rates and improving fine lines and wrinkles, dry and dehydrated skin, mild acne scarring and pigmentation irregularities. Their small molecular structure however, allows them to contribute to significant skin improvement when regularly used in low doses.

Lactic acid molecules are much larger than glycolic acid molecules and tend to be less irritating. Lactic acid peels are primarily used to hydrate and brighten the appearance of the skin. As the glycolic acid molecule is smaller it will penetrate deeper into the dermis and the patient can have a harder ‘burner’ sensation vs lactic acid.

TCA, trichloroacetic acid peels can either be a deep or medium-depth peels. This is dependent on their concentration. Low to medium concentrations of the acid is a monolayer application and medium to high concentrations are multilayer applications. For those with deep acne scarring of the face this is a great peel to help reduce the size of the scar tissue. The down time is longer than less invasive acid peels and can last anywhere between 2-4 weeks.

Chemical peels should only be used after a thorough consultation to determine the treatment objectives. You should also consider potential contraindications, particularly with the higher Fitzpatrick skin types, as they will be more prone to hyperpigmentation. Whichever peels you are using on your clients, it is imperative that they are given strict aftercare and the use of sunscreen should be used at least once to twice a day. Also make sure you gain comprehensive training, follow the manufacturer’s recommendations and make sure you balance the skin’s pH after the treatment.

These are only three types of peels, there are many more.

With correct application, they are a useful treatment to have in your toolkit in helping improve the skin. APJ

STARPERFORMANCE

STEP INTO THE LIGHT

Clairderm SPF50+ Moisturising Daily Defence Lotion has you covered AUSTRALIA HAS ONE OF THE highest rates of skin cancer and premature photo-ageing in the world, which is caused primarily by the skin’s exposure to harmful UV radiation. Fortunately, sunscreen offers the first line of defence against this harmful UV radiation by either absorbing or reflecting it.

Therefore, to help reduce sun damage, solar keratosis, photo aging and in extreme cases skin cancer it’s essential to apply a SPF50+ sunscreen every day.

Proudly Australian made, Clairderm SPF50+ Moisturising Daily Defence Lotion, offers SPF50+, broad spectrum protection against UVA and UVB rays. It has been specially formulated for every day use and pre-and post IPL, Laser, Dermal Skin Needling and Microdermabrasion treatments to help protect the new skin cells and optimize results.

Invisible protection you won’t even know you’re wearing it There’s nothing worse than trying to apply your make-up over a sunscreen that has left your face shiny and covered with a white residue. Clairderm Moisturising Daily Defence Lotion offers invisible coverage and leaves the skin with a matte finish with no “ghosting” on the skin after application. This makes it perfect to use under make-up and over serums.

Stick to sun protection without the shine Most people, especially those who have oily skin prone to breakouts, hate the feel of a thick, oily and sticky sunscreen on the skin that takes “forever” to rub in. This tempts them to skip applying a sunscreen every day. Clairderm Moisturising Daily Defence Lotion is fast absorbing, extra light and leaves no traces of stickiness and oiliness on the skin. This makes it ideal for use on all skin types. Furthermore, it’s fragrance free and leaves the skin feeling soft, supple and moisturised.

For more information about this exciting new product and our amazing introductory offers contact us below.

Clairderm 1300 781 239 Office@clairderm.com www.clairderm.com APJ 91

BUSINESS

A JOURNEY TO SUCCESS An interview with Catherine Hottes

CATHERINE HOTTES has an amazing reputation as a woman of excellence. She is a highly qualified and dedicated expert in all things skin. Her clinic. which is located in Sydney, is always busy as her growing number of loyal clients constantly flock to her to experience her magic touch. An expert with incredible knowledge, not just about the skin, but also in numerous technologies and advanced procedures, Catherine Hottes’ name comes up in excited conversations among local Sydney skin connoisseurs as frequently as it is praised in the circles of international dermatological clinicians.

Catherine’s expert knowledge and holistic approach to skin health, coupled with her overall understated sophistication, makes her a stand-out professional who offers a smorgasbord of treatments to a highly discerning clientele. She developed her concepts based on her own dermatological journey and considers overall good health to be crucial to a glowing complexion. Catherine’s believes that while it is key to mitigate the damaging effects of the environment, it is just as important to support our skin’s wellbeing from the inside out.

Along with being a clinical educator, Hottes welcomes an impressive following of powerhouse women to her permanent Sydney treatment space. Being an ardent skin enthusiast, she can also be found travelling the globe and taking international appointments at world-class hotels for anyone who is simply unwilling to do without and attends to high-profile devotees from the fashion, film and political arena alike - all of whom are prepared to go out of their way for the magic that this therapist delivers through her unique techniques and impressive results as well as her ever-careful discretion.

We caught up with Catherine for her to share her journey and concepts with us: APJ Q1: CATHERINE, WE ALL KNOW THE IMPORTANCE OF THE CONSULTATION PROCESS IN IDENTIFYING AREAS OF RISK, HOWEVER, THE SUCCESS OF THIS PROCESS WILL DEPEND ON THE INTERPRETATION OF WHAT IS CAPTURED THROUGH THE CONSULATION PROCESS. CAN YOU GIVE US SOME TIPS ON AREAS THAT WOULD RING ALARM BELLS AND INDICATE THE NEED FOR PRECAUTION?

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Every consultation should seek to identify areas of weakness that may contribute to complications. For example, examining if the client bruises easily, is susceptible to scarring, does not heal easily, is prone to pigmentation, or is easily prone to reactions or sensitivity. When I identify any of these issues, I usually probe deeper to discover when these symptoms started to occur, how frequently do they occur and how severely do they manifest. This is critical information to obtain so I can determine appropriate laser or IPL settings, depth of dermal needling, patch testing observations and even a contraindication to the intended treatment when an alternative treatment could be preferable. The consultation is the most important activity that must be thoroughly conducted before a treatment plan can be determined. I usually spend up to two hours just on the consultation.

Armed with this valuable information I can then make a safe decision as to what will work best for that client.

APJ Q2: WHAT ELEMENTS OF EDUCATION DO YOU CONSIDER THE MOST IMPORTANT WHEN TRAINING SOMEONE IN A NEW TECHNOLOGY AND WHAT SKILLS AND QUALIFICATIONS DO YOU CONSIDER ESSENTIAL BEFORE SOMEONE TRAINS IN A NEW TECHNOLOGY FOR THE PURPOSE OF DELIVERING A HIGH-QUALITY SKIN IMPROVEMENT PROCEDURE? If someone is looking at taking on a new technology to step up their level of skin treatments results it is important that they first and foremost gain comprehensive training in advanced skin analysis and the consultation process.

They will also need to complete an advanced course on the integumentary system that goes beyond what is covered in basic beauty therapy training. Without a thorough and scientific understanding of the skin you should not be undertaking any skin corrective procedures.

There is no excuse not to step-up your knowledge to this level, as today there are so many amazing trainers and courses in these areas that are available to enhance your knowledge. It is also important for nurses who are entering our industry to also undertake this training, as while they may have impressive qualifications, they are not skin experts. We all have a duty-of-care to work within our scope of practice.

If you do not have advanced training in skin refrain from administering treatments that aim at changing the skin or you

could destroy it.

Anyone who works outside of their scope of practice and takes advantage of an unregulated industry, regardless as to whether they are a beauty therapist, nurse or microblader, will be prone to poor standards that will contribute to collateral damage that may not be seen on skins for years to come.

APJ Q3: IN YOUR EXPERIENCE WHAT AREAS OF RISK ARE THE MOST CONCERNING IN OUR INDUSTRY THAT YOU WOULD LIKE TO SEE IMPROVED? I am greatly concerned at seeing unqualified people doing 2-3 day courses in microblading without a fundamental training in cosmetic tattooing and of the skin. I see therapists who do collagen induction therapy (CIT) and think all they are doing is helping to penetrate their skincare at a deeper level. It is amazing how many people I come across who are performing needling or microblading and don’t even know what an Infection Control qualification is, let alone have one.

Many don’t even know that it is required as part of their state regulation. This is very dangerous.

It is also alarming to see newly trained people in microblading believing they are now entitled to train others, contributing to the industry’s disrepute. Where there is a qualification, we should all respect and aspire to achieve training that is recognised. Any procedures where blood or fluids are released the risk for both the client and the therapist inceases dramatically.

APJ Q4: WE UNDERSTAND YOU ARE EXTREMELY BUSY IN YOUR PRACTICE, WHAT ARE THE FOUR MOST IMPORTANT THINGS THAT YOU BELIEVE HAVE CONTRIBUTED TO YOUR EXCELLENT REPUTATION AND YOUR SUCCESS?

So, if I were to summarise the four most important things that define how I view my profession and how I operate they would have to be: •

Education is a never-ending, on-going pursuit that I am committed to

•

I am not quick to access a new technology. I first do thorough research and probe deep to make sure I am making the right decision for me and my clients – safety and good manufacturing standards that are recognised are key considerations before taking on a new technology

•

My work standard is consistent – I work to a standard and always try to achieve a level of excellence in what I do.

Money is never the priority.

•

I treat everyone as an individual and whatever treatment or package I recommend, they are always bespoke – tailormade for the individual.

APJ Q5: WHAT ARE YOU MOST PASSIONATE ABOUT IN YOUR WORK AND WHAT IS YOUR VISION FOR THE FUTURE? My aim is to continue to improve and specialise in what I do and my real passion is “all things skin” – delivering positive changes for each and every client. I also love sharing my knowledge, so training is something I also love. I am really committed to seeing our industry gain the recognition and the respect of the consumer and this can only happen if we APJ continue to raise our standards as an on-going concern.

Catherine Hottes is both an expert practitioner as well as the distributer and educator for Arc Aesthetics.

She can be contacted on 1300 862 685 Email: sydney@ catherinehottes.com.au

I do value education greatly and I commit each year to completing at least 7-10 educational studies to ensure I am kept up-to-date and maintain currency in my knowledge and skills.

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TIPS FOR BETTER BUSINESS Improving communication with customers by making T’s and C’s easier to understand and prohibiting unfair contract terms are two key recommendations put forward by the report.

Being more upfront with consumers about the handling of their data and strengthening privacy laws is also essential, according to the ACCC. “Loyalty schemes should consider whether consumers are being misled or subject to unfair contract terms,” the report says.

RETAILERS PUT ON NOTICE OVER UNFAIR LOYALTY SCHEMES LOYALTY SCHEMES are a very popular way for businesses within our industry repeat business and attract new clients. However, the ACCC is warning that the terms and conditions of your loyalty program must be honest and transparent.

Customer loyalty programs have come under intense scrutiny in an ongoing review from the consumer watchdog. Thousands of consumers have complained about being misled by loyalty programs, according to a draft review into customer loyalty schemes from the ACCC. The ongoing probe into loyalty schemes like Flybuys, Woolworths and Priceline’s Sister Club has urged retailers not to mislead customers or subject them to unfair terms and conditions.

The ACCC’s draft report, released in October, calls on customer loyalty schemes such as frequent flyer programs, supermarket and credit card operators to put consumers first – with 90 per cent of Aussie consumers estimated to be a member of a loyalty program.

The watchdog’s draft report flags

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serious concerns about some retailers failing to present terms and conditions in a way that consumers can readily understand, unfair changes to T’s and C’s and the misuse of consumer data.

“Further, loyalty schemes should review their approach to presenting terms and conditions to ensure consumers have a genuine opportunity to review and understand their policy and operation.”

The ACCC is urging consumers to come forward with any concerns of malpractice. The watchdog’s final report is due later this year and stakeholders are being invited to make submissions. APJ

Retailers failing to advise consumers about critical components of loyalty schemes are leaving consumers in the dark, the report says.

“The ACCC has received complaints from customers concerning loyalty schemes that alleged they had not earned, maintained or redeemed their points in the manner they anticipated, with these consumers reporting that they did not obtain any benefits from participation at all.”

The major review focuses on whether consumers are properly informed and receive the benefits spruiked by these schemes, how data is used and the potential impact of loyalty schemes on competition.

An increasing number of complaints about loyalty programs sparked the review after the consumer watchdog received more than 2000 reports about loyalty schemes in five-year period.

Retailers urged to rethink schemes The report calls on retailers to reevaluate business practices to ensure they comply with the consumer law.

THE LATEST PROVEN STRATEGIES FOR IMPROVING STAFF PERFORMANCE WHILE IN THE PAST improving staffperformance was aligned to goals and performance assessment, in recent time there is a strong shift toward principles

Business & Legislation, New Tools and Research Outcome

that incorporate improving trust, relationships and emotional wellbeing in order to achieve staff engagement and contribution to the achievement of their goals, rather than just measuring tools that determine their performance.

5. Culture Encourage employees to find a personal fit with the company culture. Develop a culture that stands for excellence as well as heart.

Here are a few key strategies experts are identifying that when implemented, are improving staff engagement and performance:

6. Let staff tell their own stories Encourage them to tell their own stories about what they are doing to support company strategies or embody organisational values.

1. Communicate clear goals and expectations to your employees The majority of employees want to be part of a compelling future and want to know what is most important at work and what excellence looks like. For targets to be meaningful and effective in motivating employees, they must be tied to dynamic organisational ambitions that they can get excited about.

2. Encourage open communication You can get insight into what things are important to the employee by using surveys, suggestion boxes and team meetings. Be open-minded and encourage them to express their ideas and perspectives without criticism. This means putting into practice everything you have learned about effective listening.

Address their concerns in the best way you can.

3. Actively promote organisational effectiveness, reputation, values and ethics Actively promote organisational effectiveness, reputation, values and ethics. Employees want to feel good about their leaders, where they work, the products they sell and the reputation of their company.

4. Not communicating, or communicating late, can damage engagement Hearing about an important update from media, colleagues or family and friends can have a negative impact on employee engagement. Ensure employees hear these messages from the business as soon as possible.

7. Trust Employees need to trust each other as well as their leadership. Employees are constantly watching leadership to see how their decisions affect the strategic direction of the organisation and if their behaviours reflect what they say.

8. Build engagement Show that you’re genuinely concerned about employees’ opinions and use social media as a communications tool to build engagement.

9. Encourage innovation Engaged employees are innovative. They’re always looking for a better way.

10. Create a strong team environment Strong employee engagement is dependent on how well employees get along, interact with each other and participate in a team environment.

11. Sense of belonging Non-work activities that foster relationships increase employee engagement.

12. Provide constant feedback on the positives When people know what they’re doing well, they’ll keep doing it – or even better, do more of it.

Providing someone with a little recognition of what they’re doing well can go a long way toward boosting morale. This is not to say “ignore the weaknesses” – just don’t make the weaknesses the only focus area of feedback.

This doesn’t mean you should

not create accountability, it actually means the opposite – but, if all you do is criticise, people will learn how to hide their mistakes or shift blame.

13. Give immediate feedback Feedback is a two-way communication. It is the opportunity to share opinions and find solutions. Too many managers make this a formal activity of an annual personnel revue. It’s not. It should be a on-going practice.

14. Show how feedback is being used Demonstrate to staff how their feedback is being used.

15. Support employees in their work and growth How many of you have responded to a subordinate’s idea as brilliant or even good?

Success begets success.

You can support employee growth by providing education and learning opportunities, cross training, coaching, and any other interactions that support employees’ personal development.

16. Collaborate and share on problem-solving When employees get the idea that their manager or leader is the one who has to solve all the problems, it takes away from their sense of empowerment, and ultimately is likely to decrease engagement over time. Encourage team members to take responsibility, and work through problems or issues on their own, or collaboratively. It’s not the manager’s job to fix everyone else’s problems.

17. Incentives Managers who want their employees to be engaged recognise that incentives must be allocated based on objective criteria and that different employees are motivated by different things.

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TIPS FOR BETTER BUSINESS 18. Celebrate both financial and non-financial achievements Employees need to feel validated and that they are a valued part of the organisation.

Managers need to show how much they care for their employees and show recognition for efforts: “If you want something to grow, pour champagne on it”. APJ

INCENTIVES TO HELP CLIENTS BUY MORE

COMING TO THE END OF THE YEAR is a prime time to implement strategies to engage your clients and provide them with incentives to improve their purchasing power and increase your revenue.

While every business relies on financial transactions to grow, how you achieve “sales” in a service-based environment requires a very different engagement approach. Here are a few to consider: People Buy Benefits People don’t buy products they buy the results that product or services will give. Start your process of identifying your ideal client by making a list of all of the benefits that your client will enjoy by using your products, or services. To determine what results, they would

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consider of value, consider the following issues: their age group, are they employed, do they have children and what is their age-group, what financial bracket would they come under, their educational levels and what are their key interests? Are they an indoor or outdoor person? Are they physically active or passive? By gleaning this information, you will be able to determine what products or services will best suit them?

team up products and services that target their specific needs.

Identify the Problem Clearly From what you know about them, what are the problems they are currently facing and can you provide them with a solution. These may not just be skin issues, they may also be issues such as stress, poor sleep, aches and pains or even weight issues that you could provide support to help them lose a few kilos.

that promote:

Develop Your Competitive Advantage Define your competitive advantage, the reason for buying your products or services, in terms of the benefits, results or outcomes that your client will enjoy and find beneficial. How can you provide them with something unique that may not be available from a competitor?

Focus on the benefits of what makes your product better than others and

Use Content and Social Media Marketing to Your Advantage There are so many more ways to get your product to your clients than ever before. What’s the best part? They’re all free! You can use social media such as Facebook, Twitter, and your blog to your advantage. By building relationships with your clients through these channels you can access more people than ever.

Create short, but engaging posts

•

The treatment outcomes they can expect to receive from you and your business

•

Your ethos, values and what you stand for

•

What is the atmosphere you create for your clients that they may value

•

Whatever you promote on social media make sure it reflects the standards of your brand

•

Let them know about your knowledge and expertise – share your qualifications and your professional alliances to industry bodies -consumers do look for those as well.

While your services and products may not always be the cheapest, they must

Business & Legislation, New Tools and Research Outcome

reflect quality, expertise and integrity.

This must be your point of difference.

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DOCUMENTS THAT REFLECT BEST PRACTICE BEST PRACTICES are a set of guidelines, ethics or ideas that represent the most efficient or prudent course of action, in a given business situation.

Best Practices may be established by regulatory bodies and industry bodies and businesses that operate with best practice principles are considered to operate at the highest standards.

APAN, through their solicitors, has prepared over 38 documents that would contribute to best practice.

These documents are available for purchase and provide a stress-free way for business owners to streamline their operations to function efficiently, professionally and in compliace with regulatory requirements.

Some of the most essential documents that every business should have include:

1. PRIVACY POLICY: The gathering of information from your clients is essential for you to assess how to determine their treatments.

However, there are rules that govern how this information is stored and used. It is advisable

for all business owners to have a Privacy Policy in place not just for the benefit of their client’s protection, but also to ensure

outlines behaviour both when at work as well as during private hours that pertain to issues of defamation and

that all staff are made aware of the privacy law requirements on how this information is both stored and used, as well as how they may be accessed. If you do not have a Privacy Policy in place you can purchase one from APAN 07 5593 0360 or email info@apanetwork.com

slander, which are regularly articulated as a workplace frustration, but which can have detrimental effect on both the businesses reputation and also detrimental financial consequences. More information on this policy in this journal in the article on “legal matters”.

2. HR POLICIES AND PROCEDURES: This document is 43 pages and has been drafted by our solicitors as a template that the business can edit and customise to their specific requirements. It covers all the legal requirements relating to conduct in the workplace. The HR Policies and Procedures is an invaluable document that all businesses who employ staff should have in place. It not only sets the expected standard of conduct, but also provides an agreement that meets with the regulatory requirements. It can contribute to preventing staff misunderstandings.

4. CANCELLATION POLICY AND REFUND POLICY: Both these documents are important and can save businesses a lot of heartache, as well as financial loss, particularly from noshows of inconsiderate nature.

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If we can assist you in streamlining aspects of your business please phone APAN 07 5593 0360 to discuss your needs.

3. SOCIAL MEDIA POLICY: Recently drafted by our lawyers, the new Social Media Policy

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TECHNOLOGY

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IN REVIEW: ‘THE HYALURON PEN’

What the Clever Marketing, Expo Excitement and Sales Spin Does Not Tell You! Danielle Hughes TRENDING AT THE Sydney International Beauty Expo this year was a ‘hot’ new treatment with the highly sought-after promise of ‘injection-free fillers’. It’s not hard to understand why the crowds flocked to see demos and find out more about how they could implement ‘lip-fillers’ into their salon business. But like all new trends, it’s critical to dive a little deeper than the shiny marketing brochure and sales-chatter to determine working mechanisms, safety and legalities surrounding scope of practice.

WHAT IS THE HYALURON PEN AND HOW DOES IT WORK? A technique used successfully for decades, most notably for administering insulin to diabetics. The Hyaluron Pen is a simplistic device that allows a practitioner to ‘load-up’ a solution, in this case Hyaluronic Acid (HA) filler, and generate enough pressure to launch the solution into the skin, (the claim being) without the use of a needle. Marketed as the “safest way to offer your clients lip fillers and contouring” with a “uniform and quick administration of the drugs that are being used”.

The name ‘Hyaluron Pen’ was first coined in 2018, hence little to no scientific research or proof of working mechanism, nor were the devices we saw at Expo registered with the TGA. WHAT ARE THE CLAIMS? “Injection free fillers”, “beauty without pain and bruises”, safest way to offer your clients lip fillers and face contouring”, “lasts for up to six months” – phrases synonymous with consumer demand and capitalising on the alternative traditional way of using Hyaluronic as a filler.

But one must consider the true structure of proven HA filler systems, with most brands identifying that it is a gel matrix that provides longevity to the injected HA filler. This poses the questions – is it perhaps too large a structure to penetrate using simply ‘pressure’ or is the useable solution for a pen simply not going to have the gel matrix to give it the claimed results life?

IS THIS A BEAUTY (OR EVEN DERMAL) TREATMENT? In one word, NO. It’s easy to accept that a treatment on show at a Beauty Expo would be legal to perform by a beauty therapist – however in the case of the Hyaluron Pen, one needs to think again! The major roadblock here is that HA Filler (like any dermal filler) is a Schedule 4 drug – available only to medical practitioners for purchase and administration.

It was shocking to hear a salesperson openly advising Expo attendees that they could purchase their Hyaluron filler online (which of course is true) to use with the pen in their salons.

The harsh reality is that as a beauty therapist, or even dermal clinician, it is illegal to administer HA filler to your clients.

It is well documented that fillers have the potential to cause blindness if not administered by an experienced medical practitioner who understands the anatomy of the face. To start dabbling in this field and throw caution to the wind is a sure-fire recipe to cast a very dark shadow over our industry.

DON’T BE FOOLED – KNOW YOUR SCOPE, AND KNOW THE LAW Scope of Practice is not ‘sexy’. It is rarely part of a hot marketing campaign to promote a new trend, however, it’s a very real consideration to undertake prior to investing in ANY new technique.

The Department of Health in Western Australia published a Warning surrounding the use of Hyaluron Pens: “… The Hyaluron Pen itself is considered a therapeutic device and would therefore require registration with the Therapeutic Goods Administration. Given the medical restrictions on both injectable hyaluronic acid and the needless injecting device, these procedures may only be offered by registered medical professionals. If you become aware of a beauty therapist offering such services, please advise your Health Department.”

THE MORAL OF THE STORY Undertake your own research prior to any new purchase of equipment and ensure:

a. The treatment is legal for you to perform with your qualified scope of practice a. The working mechanism and long-term outcomes are supported by good photos and sound documentation a. That you at least have the assurance for the supply of equipment in Australia. That it’s purchase is backed for your use by the supply of products for that equipment from the same company.

(This is a prudent general practice when buying equipment because it means that a lack of results can’t be blamed on your choice/sourcing of the products used with the equipment).

There are so many new innovations entering the market.

Make sure before you undertake anything that promises changes to the skin or appearance of the face, ensure that you review not just the promises, but also the risks and legal position as to whether you are considered qualified to introduce it to your clients. If you are not sure, contact APAN for a professional and regulatory opinion.

Danielle Hughes is the Managing Director of Skinfaktor Australia who distribute the Technology and Skincare of the European Group, Dermia Solutions. Her career over the past 12 years in the hair and beauty industries has included roles as Australian Education Manager and National Brand Manager for leading imported cosmeceutical brands and currently includes an international role as Marketing Manager using digital communications for a new to market European Medical and Aesthetics provider with patented technology. APJ Danielle Hughes can be contacted on 04370 13777 E: danielle@skinfaktor.com.au APJ 99

SCIENTIFIC NEWS

POTENTIAL ASSOCIATION BETWEEN ROSACEA AND CANCER GROWING EVIDENCE suggests that rosacea increases the risk of systemic diseases, but studies of the relationships between rosacea and cancer are rare.

A recent study published in The Journal of Dermatology found an association between rosacea and a higher incidence of breast cancer and glioma.

The study of 7548 patients with newly diagnosed tumours that also had a diagnosis of rosacea were enrolled, with 8340 rosacea diagnosed matching age cancerfree control cohort over a two-year period. The data showed there was no relationship between rosacea and lung, gastrointestinal, nasopharyngeal and gynaecological cancer.

Compared with patients without rosacea, the study found that patients with rosacea had an increased breast cancer risk (odds ratio [OR], 5.0; 95% CI, 4.026.2; P <.001), which is significant.

Of the 190 female breast cancer patients with rosacea, 98.95% had the erythematotelangiectatic subtype of rosacea, 48.42% had

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chloasma and 76.31% of them were Fitzpatrick skin type III and IV. Of interest the study found that patient age with breast cancer and rosacea was lower than patients with breast cancer without rosacea.

It was discovered that those with rosacea were more likely to have an estrogen receptor (ER)-positive status, high low-density lipoprotein levels and low high-density lipoprotein levels.

Conversely, the researchers also found a lower prevalence of hematologic cancer in patients with rosacea than those being rosacea free.

Long, J., Li, J., Yuan, X., Tang, Y., Deng, Z., Xu, S., Zhang, Y., & Xie, H. (2019). Potential association between rosacea and cancer: A study in a medical center in southern China. The Journal of Dermatology, 46 (7), 570-576. doi:10.1111/1346-8138.14918 The study did not identify underlying mechanisms that require further studies to explain, although speculated it may possibly be related to their shared relationship with inflammation.

One great limitation is that the study was in one centre so the cause may be geographic rather than be generalised for all with rosacea. APJ

PIGMENTS IN AMERICAN TATTOO INKS AND THEIR PROPENSITY TO ELICIT ALLERGIC CONTACT DERMATITIS AN INTERESTING STUDY recently published in the Journal of the American Academy of Dermatology investigated 1416 tattoo inks used in America. 44 distinct pigments were found with the average product containing three different pigments.

10 of these contained metallic pigments, including iron, barium, zinc, copper, molybdenum, and titanium, with remaining 34 pigments containing variations of carbon, azo, diketopyrrolopyrrole, quinacridone, anthraquinone, dioxazine, or quinophthalone dyes. Only 11 of the pigments are suspected of causing an irritant or allergic contact dermatitis.

Liszewski, W., & Warshaw, E. (2019).

Pigments in American tattoo inks and their propensity to elicit allergic contact dermatitis. Journal of the American Academy of Dermatology, 81(2), 379–385.

Most people think perhaps that tattoo ink contains one pigment giving the ink its colour. This is of course not so, with inks comprising of several pigments.

The real news coming from this study is highlighting the diversity of pigments

Research and Scientific New Developments In every issue of the journal, Terry Everitt our scientific educator, conveys a few items of scientific interest.

In italics, are his thoughts on the subject matter of the research study.

and the change from metallic pigments.

If patch testing for reactions to tattoo pigments, then this needs to be considered as false negatives will be apparent if APJ testing against the metal pigments.

A simplified overview of the pathophysiology seen in atopic dermatitis, and its relationship to cellular and immunologic mechanisms seen in allergic contact

of atopic skin patients by Milam, Jacob, & Cohen (2019), who also found that the standard allergen testing did not cover the array of allergens such patients face and need to contend with.

Milam, E., Jacob, S., & Cohen, D. (2019). Contact Dermatitis in the Patient with Atopic Dermatitis.

Journal of Allergy Clinical Immunology Practice, 7 (1), 18-26. doi.org/10.1016/j.jaip.2018.11.003 Ozbagcivan, O., Akarsu, S., Dolas, N., Fetil, E. (2019). Contact sensitization to cosmetic series of allergens in patients with rosacea: A prospective controlled study [published online May 20, 2019 ahead of print]. Journal of Cosmetic Dermatology. doi:10.1111/ jocd.12989

PATIENTS WITH ROSACEA HAVE HIGH PREVALENCE OF CONTACT SENSITISATION TO COSMETIC ALLERGENS WE ALL KNOW that those with rosacea have sensitive skin and react to known allergens.

Rosacea, much like atopic dermatitis, is a multifaceted immunologic skin disease with complex genetic and environmental influences.

A study from Turkey has helped to quantify the range of sensitivity in showing that a higher proportion of participants with rosacea had ≥1 positive allergic reaction compared with control patients (60.2% vs 24.0%, respectively), however most of the allergic reactions identified in patients were weak reactions.

103 adults with rosacea and 104 without rosacea had 48-hour patch testing to the upper back with 49 cosmetic allergens.

dermatitis. IFN-a, Interferon-a; TNF-a, tumor necrosis factor-a; TSLP thymic stromal lymphopoietin. (see diagram below).

(Milam, Jacob, & Cohen 2019, p. 21) The most common allergens giving positive results were octyl gallate (10.68%), dodecyl gallate (8.74%), tert‐Butylhydroquinone (7.77%), thimerosal (6.80%), euxyl K400 (6.80%), cocamidopropyl betaine (5.83%), and 2,6‐Di‐tert‐butyl‐4‐ cresol (4.85%).

This is concordant with a further study

The results are not surprising and would be expected, however, it possibly does suggest that mild forms of contact hypersensitivity may mimic or trigger the exacerbation of the underlying rosacea in patients.

Both studies show a wider array of potential allergens than previous thought or known. Disturbingly, some of these allergens are common and well-regarded antioxidants and preservatives allowed in food: * Octyl gallate and dodecyl gallate are commonly used as an antioxidant and preservative in both food and cosmetics products. * Tert-Butylhydroquinone is a type of hydroquinone compound – again common in food as an antioxidant, for lipids and has some use in skincare. *Thimerosal is effective as an antiseptic and antifungal agent. Was used extensively as a preservation agent in vaccines. Very rarely used in Australia as a preservative. * Euxyl K400 is a trade name of a preservative

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SCIENTIFIC NEWS primarily made of Phenoxyethanol.

Effective spectrum of effect against bacteria, yeasts and mould fungi. * Cocamidopropyl betaine is a surfactant and not used in products for sensitive skins. Used in wash off products. “natural’ lines tend to avoid using although comes from palm oil.

of different preparations, such as the molecular size, a method and degree of cross-linking, and the region of injection.

Vison loss from dermal fillers is rare in total numbers, yet is the most catastrophic adverse event possible and these events are on the rise.

and the facial artery and supratrochlear artery. Any occlusion of any branching vessel can cause complications – it is not just injection around the eye being problematic, precision knowledge of the anatomy is essential. APJ

* 2,6‐Di‐tert‐butyl‐4‐ cresol is a phenol derivative – also known as 2,6-Di-tert-butyl-4methylphenol, a food additive antioxidant and also used in skincare. APJ

Number of blindness cases due to various soft-tissue fillers (Chatrath et al., 2019, p. 3).

A meta-analysis study has identified 190 cases of blindness due to softtissue fillers of which 90 (47%) cases were attributed to autologous fat alone, and 53 (28%) cases were caused by HA. The rest of the cases were attributed to collagen, calcium hydroxylapatite, and other fillers.

IS BLINDNESS A REAL THREAT FROM DERMAL FILLERS? THERE IS A PLETHORA of soft-tissue fillers available in Australia and much more available in other countries.

Dermal fillers have become so common that many think they are risk free, which is far from the truth.

This lowered risk thought is primarily due to the rise of hyaluronic acid (HA) based fillers, which can be neutralised to a point with injection of hyaluronidase to break down the HA, if wrongly placed.

HA injections are not as safe as many believe due to the vast array

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Injecting into the vasculature is the base problem which causes occlusion of the vessel and its branches, primarily the ophthalmic or retinal arteries.

Chatrath, V., Banerjee, P., Goodman, G., Rahman, E. (2019).

Soft-tissue Filler–associated Blindness: A Systematic Review of Case Reports and Case Series.

Plastic and Reconstructive Surgery Global Open, 7, e2173; doi: 10.1097/ GOX.0000000000002173; This study is, I believe, required reading for anyone who is injecting dermal fillers as the process is not as simple as many believe. The ophthalmic artery is the prime risk as it branches supplying the glabella, nose, periorbital zone, and forehead. This is complicated by known anastomoses of the ophthalmic artery

MORE UNDERSTANDING ON HOW THE SUN DAMAGES OUR SKIN WE ALL KNOW that UVR is not great for the skin. Confusingly of course is that in small doses part of the UVR spectrum is good for the skin, but only in very small doses.

Previous studies have documented how each type of UV radiation penetrates to different depths into the skin and that prolonged exposure can lead to skin cancer, but exactly how it damages human skin in other ways has received less attention.

How does UVR damage the skin is a little closer to understanding from the recent work of Zachary et al., (2019) from Binghamton University, State University of New York, who discovered two important aspects.

The researchers found that no UV range is more harmful than another—rather, the damage scales with the amount of UV energy that the skin absorbs.

Research and Scientific New Developments In every issue of the journal, Terry Everitt our scientific educator, conveys a few items of scientific interest.

In italics, are his thoughts on the subject matter of the research study.

Perhaps more importantly, the study shows that UV weakens the bonds between cells in the stratum corneum.

This was due to increase in protease activity in the stratum corneum from UV irradiation disrupting the structural effectiveness of desmoglein, a major component of corneodesmosomes, that help the cells to adhere together. This results in mechanical degradation and the peeling of sunburn.

Lipsky, Z., German, G. (2019).

Ultraviolet light degrades the mechanical and structural properties of human stratum corneum, Journal of the Mechanical Behavior of Biomedical Materials (2019). DOI: 10.1016/j.jmbbm.2019.103391

have debated whether skin collagen was arranged randomly or had ordered orientation.

It has been thought that the collagen and elastin fibres must be in a geometric orientation like a rhomboidal net, thus allowing the dermal pliability. Using high powered multiphoton microscopy, this study team found clear evidence that the collagen fibres were arranged in a mesh-like lattice, and not in the clear geometric orientation as previously hypothesised.

This study advances our knowledge of how UVR causes the damage we have always known to occur. As more research uncovers the detail of damage, this can be used to research and discover how adaptative events can be produced to prevent or at least ameliorate the damage from occurring. APJ

K., & Suzuki, S. (2019). Combined multiphoton imaging and biaxial tissue extension for quantitative analysis of geometric fiber organization in human reticular dermis. Scientific Reports, 9(1) DOI: 10.1038/s41598-019-47213-5 As each generation of microscopy is developed, more detail can be seen, which has been a problem as the dermal fibres are so tightly packed, it was impossible to determine if their orientation is ordered or random.

This newer generation of multiphoton microscopy has allowed more precise viewing of the individual fibres and how the interaction between elastin and collagen take place.

Understanding the geometric organisation of fibres in the skin can lead to a better insight into the mechanisms of underlying human skin pliability. APJ

The study showed a high degree of local similarities observed between the orientation angles of collagen and elastic fibres, which could provide insight into skin elastogenesis (flexibility).

CLEARER UNDERSTANDING OF THE ARCHITECTURE OF COLLAGEN AND ELASTIC FIBRES

Second harmonic generation (SHG) images show architectural changes in collagen fibers (a,b) whereas two-photon autofluorescence (TPAF) images show architectural changes in elastic fibers (c,d) and then both merged (collagen in red) (Ueda, et al., 2019, p. 8).

ASIDE FROM ALL THE IMAGES you see of collagen arrangements, researchers

Ueda, M., Saito, S., Murata, T., Hirano, T., Bise, R., Kabashima,

TATTOOING HAS GONE DIAGNOSTIC AN INTRIGUING STUDY from Germany discusses how they developed permanent dermal sensors that can be applied as artistic tattoos.

A colorimetric analytic formulation

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SCIENTIFIC NEWS was injected into the skin instead of tattoo ink. The pigmented skin areas varied their colour when blood pH or other health indicators changed.

Initial testing was for pH, glucose and albumin.

A rather simple (according to the researchers) pH indicator consisting of the dye’s methyl

Further studies will explore whether tattoo artwork can be applied in an ongoing diagnostic setting.

Extension to this technology would be in time, micropigmentation used to denote health aspects of the client. This is very exciting in its possibilities. Possibly for the first time, people might be happy that their tattoo has changed colour. APJ

Kim, J., Park, M., Li, W., Qureshi, A., & Cho. E. (2019). Association of Vitamin A Intake With Cutaneous Squamous Cell Carcinoma Risk in the United States. Journal of the American Medical Association Dermatology, 2019; DOI: 10.1001/jamadermatol.2019.1937.

This is interesting, yet a long way from saying Vitamin A reduces skin cancer as this was not a randomised clinical trial – no definitive cause and effects can be established.

It may be another factor helped by a generally healthier lifestyle of these Vitamin A eaters. The participants of this study were mostly well-educated, white healthcare professionals.

However, I don’t believe it would hurt to increase our carotenoid intake. APJ

red, bromothymol blue, and phenolphthalein when injected into the skin, turned from yellow to blue if the pH was adjusted from five to nine.

HIGHER VITAMIN A INTAKE LINKED TO LOWER SKIN CANCER RISKS

The glucose sensor consisted of the enzymatic reactions of glucose oxidase and peroxidase, which, depending on the glucose concentration, led to a structural change of an organic pigment, and a yellow to dark green colour change.

The albumin sensor was based on a yellow dye that, upon association with the albumin protein, turned green.

RESEARCHERS FROM Brown University have found that people who ate high levels of vitamin A were 17 per cent less likely to get squamous cell carcinoma, the second-most-common type of skin cancer years later.

Yetisen, A., Moreddu, R., Seifi, S., Jiang, N., Vega, K., Dong, X., Dong, J., Butt, H., Jakobi, M., Elsner, M., & Koch, A. (2019). Dermal Tattoo Biosensors for Colorimetric Metabolite Detection. Angewandte Chemie International Edition, 131 (31), 10616-10623. DOI: 10.1002/ anie.201904416

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The finding from analysing data from two long-term observational studies; the Nurses’ Health Study, which followed 121,700 U.S. women from 1984 to 2012, and the Health Professionals Follow-Up Study, which followed 51,529 U.S. men from 1986-2012.

This study grouped the participants into five categories by vitamin A intake level. The highest category reported eating on average the amount of vitamin A equivalent to one medium baked sweet potato or two large carrots each day.

SIGNALS FROM SKIN CELLS CONTROL FAT CELL SPECIALISATION AMAZINGLY, WE MIGHT be able to impact obesity via skin treatments.

There are two main types of fat cells: white adipose tissue or “white fat” that stores energy and contributes to obesity, and brown adipose tissue or “brown fat” that consumes energy and helps prevent obesity. Humans tend to have more white than brown lipocytes.

Research and Scientific New Developments In every issue of the journal, Terry Everitt our scientific educator, conveys a few items of scientific interest.

In italics, are his thoughts on the subject matter of the research study.

a high concentration, which renders them aggressive.

Researchers then found existing therapies known to inhibit cytokines and TGF beta which have never been used to treat melanoma.

Golan, T., Parikh, R., Jacob, E., Vaknine, H., Zemser-Werner, V., Hershkovitz, D., Malcov, H., Leibou, S., Reichman, H., Sheinboim, D., Percik, R., Amar, S., This study shows that fibroblast growth factor 21 (FGF21) promotes differentiation into brown fat cells, while Bone morphogenetic protein 2 (BMP2) inhibits this process. This means that suppressing BMP2 can decrease the number of white fat cells and increase brown fat cells.

(Ueyama et al., 2019, p. 30) Paracrine-based differentiation signalling occurs in both directions between cells in the epidermis and intradermal layers. This revealed the potential for transforming the type and composition of subsurface fat cells by controlling the signals from surface skin to subsurface skin and fat layers.

Ueyama, T., Sakuma, M., Nakatsuji, M., Uebi, T., Hamada, T., Aiba, A., & Saito, N. (2019).

Rac-Dependent Signaling from Keratinocytes Promotes Differentiation of Intradermal White Adipocytes. Journal of Investigative Dermatology, (In press prior to publication).

DOI: 10.1016/j.jid.2019.06.140 Don’t be totally confused with bone morphogenetic protein 2 as only being involved in bone growth. BMP2 has multiple effects in various biological pathways and is found as part of the TGF-β family of proteins. Primarily growth factor activity, but also has retinol dehydrogenase activity among 40 known involvements.

This study revealed that BMP2 and FGF21 secreted from keratinocytes regulate the ratios of skin fat cells. By adjusting levels of BMP2 and FGF21, we could potentially control the ratio of white to brown fat cells. This could include a skin-based antiobesity treatment. APJ

LIPOCYTES PLAY A KEY ROLE IN THE DANGEROUS TRANSFORMATION OF MELANOMA PERHAPS THERE IS an answer to a major question that has preoccupied scientists for years - what makes melanoma change form, from limited growth to lethal metastatic cells?

Melanoma is not so serious if it remains in Stage 1, that being in the epidermis, as is easily treatable and removed without further damage.

Melanoma turns fatal when it spreads to the dermis, then metastasising in vital organs.

Researches found that lipocytes near the melanoma transferred specific cytokines affecting gene expression to the melanoma cells. The cytokines reduces expression of the gene miRNA211, which inhibits receptor sites on the melanoma of TGFβ. While the skin has concentrations of TGFβ, it appears the melanoma cells absorb

Brenner, R., Greenberger, S., Kung, A., Khaled, M., & Levy, C. (2019).

Adipocytes sensitize melanoma cells to environmental TGF-β cues by repressing the expression of miR-211. Science Signaling, 12(591), eaav6847 DOI: 10.1126/scisignal. aav6847.

It does seem strange that lipocytes can cause melanoma to become malignant melanoma (MM).

Researchers are now looking at substances in clinical trials for other cancers such as pancreatic, prostate, breast and ovarian as possible treatments for malignant melanoma.

I believe that evidence of how lipocytes will be some time away, as the research was on animal models which of course, are different to humans, but it does provide a pathway of possible treatment.

While it might seem simple just to inhibit TGFβ, thereby restraining the metastatic process, TGFβ is essential for so many other biological pathways.

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APAN’s standards recognition program now linked to continuing PROFESSIONAL DEVELOPMENT (CPD) PROGRAM As of July 2018, the CTARP and ARAP programs are now linked to a more comprehensive Continuing Professional Development (CPD) Program.

‘Let your credibility be your competitive advantage’

APPLY TODAY!

AESTHET I

PRACTIT I

ER ON

D

CS

REGISTERE

For further information visit www.apanetwork.com/arap and complete an online Application Form.

APA N

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There are five ARAP registration classifications: • • • • •

Practitioner Clinical Associate Educator Master Educator

Who can apply: • • • •

Aesthetic practitioners Dermal therapists Dermal Clinicians Educators

UPGRADE YOUR SKILLS AND KNOWLEDGE IN

MICRONEEDLING Dr Lance Setterfield, M.D. On-line study course now available in Australia WORLD-RENOWNED as one of the leading masters in Collagen Induction Therapy, Dr Lance Setterfield has updated his on-line study course in line with his manual The Concise Guide to DERMAL NEEDLING: Revised and Expand Manual - Third Medical Edition.

•

Enable clinicians to achieve and maintain the best result using this modality

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Enable clinicians to grow their business substantially through the introduction of micro-needling services as the foundation for all other cosmetic treatments

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Determine the appropriate skincare products to use (which ingredients to use and which to avoid)

The course is non-product aligned and covers the application of both rollers and pens. However, the knowledge you will gain will go far beyond the use of Micro-needling. It includes valuable information on how you can combine this “treatment” with a variety of other modalities to optimise results, while avoiding complications.

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Determine which device to use and what needle depth for the desired outcome

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Determine if the inflammatory response should be provoked and sustained

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Gain the skills and knowledge on how to combine micro-needling with other modalities for optimising results

•

Gain the knowledge on how to avoid complications

WHO SHOULD UNDERTAKE THIS COURSE? Medical professionals and non-medical professionals. (Clinicians who are performing or overseeing microneedling procedures.)

COURSE GOALS AND EXPECTATIONS: •

Expand practitioner's scope of practice by ensuring enhanced foundational knowledge accepted as standard practice in the industry

COURSE OBJECTIVES AND COMPETENCIES:

COST: $699 – If you do not have The Concise Guide to Dermal Needling – Third Medical Edition you will need to also purchase that. The cost is $135 + freight.

Completing this course will earn you 10 CPD points toward your professional development.

WHAT DO I DO TO ENROL? Contact APAN to make your payment. You will then be given the access Code to download the study course. You will also need to read and agree to the terms and conditions of accessing the course.

Contact APAN today for further details: 07 5593 0360 or email info@apanetwork.com

APJ 107

NEW

PREVIOUSLY TWO COURSES – COMBINED AS ONE

Safe Use of Topical Anaesthetics IF YOUR SERVICES REQUIRE the use of numbing creams this course is a must for you.

Topical anaesthetics are classified as drugs and carry potential risk of toxicity and other adverse reactions if used incorrectly, or inappropriately applied.

This course combines two previous courses: • The Introduction to the Safe Use of Topical Anaesthetics • The Advanced Course in the Safe use of Topical Anaesthetics.

The curriculum has been updated to be delivered in one day allowing you to update your skills on this important subject.

LECTURER: Chis Testa, Compounding Chemist and senior lecturer and educator WHAT YOU WILL RECEIVE: •

You will be provided with a kit and your Manual

•

Professional Development Certificate

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Morning and afternoon tea

COST: $595 – If you have completed the online course please contact us for your discount price of $395.

Register Today!

For further information visit www.apanetwork.com APJ 108

WHAT YOU CAN EXPECT TO LEARN •

With a strong practical focus, the course with present the various formulas and how they are used

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Interpreting the consultation form:

a. Drug interaction b. Contra-indication

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Comprehensive principles of safety

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Nature and characteristics of the various topical anaesthetics

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The relevance of pH where applicable, and the risk and safety consideration in relation to their application

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How various topical anaesthetics are absorbed and differ in affecting the body

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Explanation of the current regulations and your obligations

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How to apply the safety principles of the actual formula in use

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Different protocols relating to difference medications

c. Factors that can affect process