Body Language Issue 66

november

66

The UK and International Journal of Medical Aesthetics and Anti-Ageing bodylanguage.net

BODY LANGUAGE IS NOW PUBLISHING 10 ISSUES A YEAR REGISTER FOR YOUR FREE SUBSCRIPTION! See page 57 for details

HAIR LOSS

ORIGINS, TECHNIQUES AND EQUIPMENT FOR SURGICAL TREATMENT

EVOLUTION The roots of hair restoration surgery

I

HAIR TRANSPLANTS Achieving the best results in the art of hair transplantation

I

STANDARDS New legislation and training

AN INVITATION TO AN AESTHETIC WORKSHOP IN MANCHESTER

Building a Successful Aesthetic Practice A Workshop for any Aesthetic Practitioner setting up or expanding a Practice WHERE: The Studio, 51 Lever Street Manchester M1 1FN WHEN: Friday | 5th December | Registration 10.30am Workshop 11.00am to 4.00pm

IN FOCUS Lumenis Aesthetic Workshops are an excellent way to familiarise yourself with state-of-the-art laser and light-based (IPL速) technologies.

Understand the basic science behind Laser and IPL速 technology Learn from the personal experiences of an Expert Practitioner See the latest Lumenis systems in the marketplace Explore the finance options

THE PRESENTERS Dr Askari Townshend, BMedSci, BMBS, MCCS, Aesthetic Doctor Dr Elizabeth Raymond Brown, CRadP, MSRP Training and Education Consultant, Laser Education Ltd David Rose, Siemens Financial Services Ltd

Book online NOW and view further details at http://guest.cvent.com Event Code: 25NVXD6KQSM

LUMENIS AESTHETIC

body language I CONTENTS 3

12

16

33

contents EDITOR Helen Unsworth 020 7514 5981 helen@face-ltd.com

7 OBSERVATIONS

COMMISSIONING EDITOR David Hicks 020 7514 5989 david@face-ltd.com

12 SURGICAL

EDITORIAL ASSISTANT Arabella Tanyel 020 7514 5989 arabella@face-ltd.com SALES EXECUTIVE Monty Serutla 020 7514 5976 monty@face-ltd.com ASSISTANT SALES EXECUTIVE Simon Haroutunian 020 7514 5982 simon@face-ltd.com PUBLISHER Raffi Eghiayan 020 7514 5101 raffi@face-ltd.com CONTRIBUTORS Dr Greg Williams, Dr Bessam Farjo, Dr Manal Sheta, Mr Edward Ball, Dr Nilofer Farjo, Owen LaBeck, Brenda Cumming, Dr Ludmila Stanislavovna, Lorna Jackson, Dr Raina Adami, Dr Beatriz Molina

ANALYSES Reports and comments

THE EVOLUTION OF HAIR RESTORATION SURGERY The origins of hair restoration surgery lie far further back than one might expect, but the methods used over half a century ago closely resemble many of those used today.

Dr Greg Williams explores the history of this fascinating field

16 TECHNIQUE HAIR TRANSPLANT SUCCESS How do you achieve the best results in the art of hair transplantation? Is it about FUE, strip surgery or the tools?

Dr Bessam Farjo discusses how to achieve success using state-ofthe-art techniques

19 EQUIPMENT ISSN 1475-665X The Body Language® journal is published six times a year by AYA Productions. All editorial content, unless otherwise stated or agreed to, is © AYA Productions 2014 and cannot be used in any form without prior permission. Printed by Buxton Press Ltd. Enquiries, orders and all other mail should be addressed to Body Language, 2D Wimpole Street, London, England, W1G 0EB. To contact Body Language by telephone, please call us on +44(0)20 7514 5989. Editorial e-mail: editorial@ face-ltd.com Advertising: advertising@face-ltd.com Body Language can be ordered online at www.bodylanguage.net

ARTIFICIAL HAIR IMPLANTS The Medicap biocompatible artificial hair implant offers an alternative or complement to other treatments. Dr Manal Sheta

explains the product and the procedure

23 EQUIPMENT ROBOTIC FUE HAIR TRANSPLANTS Mr Edward Ball was the first hair surgeon in Europe to introduce a hair transplant robot to his practice. He discusses the technology, its development, its benefits and limitations and a look to the future

27 STANDARDS THE FUTURE FOR THE SURGICAL TREATMENT OF HAIR LOSS Dr Nilofer Farjo and Dr Greg Williams address the issues surrounding new legislation, training and staffing requirements for hair loss treatment

33 MARKETING HAIR LOSS IN THE MEDIA PR specialist Owen LaBeck outlines the media’s changing attitudes to hair loss, how the public feels about it and what opportunities the untapped market affords practitioners

4 CONTENTS I body language

editorial panel

37

Dr Jean Carruthers MD, FRCSC, FRC is clinical professor in the department of ophthalmology and visual sciences at the University of British Columbia in Vancouver. With her husband, Dr Alastair Carruthers, she has received the Kligman award from ASCDAS .

Mr Ravi Jandhyala is a member of the Royal College of Surgeons of Glasgow, and a founding member of the UKBTGA. He is also a member of the Faculty of Pharmaceutical Medicine and is an expert in the science behind botulinum toxins for aesthetics.

Professor Syed Haq trained at Harvard Medical School, Massachusetts General Hospital and Tufts University, New England Medical Center. Professor Haq is Director of The London Preventative Medicine Centre, Harley Street.

Professor Andy Pickett has worked on botulinum toxins for over 23 years. Andy has lectured around the world on the products, translating the science into practical understanding for injectors. In 2011 Andy founded Toxin Science Ltd and is head of development at Q-Med.

Anthony Erian FRCS (Erg) FRCS (Ed) is an aesthetic plastic surgeon with more than 30 years’ experience. He is a member of the American Academy of Aesthetic and Restorative Surgery and chairman of the European Academy of Aesthetic Surgery.

Dr Stephen Bassett is medical director of the Aesthetic Training Academy and ShapeCYMRU Cosmetics. He is a Syneron luminary and member of the Merz academy.

He is a barrister, fellow of the Society of Advanced Legal Studies and a legal consultant.

Elizabeth Raymond Brown, Phd, CRadP, MSRP authored the internationally recognised BTEC qualifications in medical and aesthetic laser/IPL therapies and national occupational standards in light-based therapies.

She is now director of education at LCS Academy Ltd.

Dr Séan Cummings MBBS T(GP), DRCOG, DFFP, MRCGP, LLM is a cosmetic doctor practising in Harley Street. Dr Cummings has more than 20 years’ experience as a practitioner and has a masters degree in medical law.

Dr Cummings works as an expert witness.

37 SKINCARE PLANT STEM CELLS Brenda Cumming demystifies the origin and role of plant stem cells in clinical skincare today

41 CASE STUDY TEMPERATURE MEASUREMENT In selective radiofrequency treatments little has been studied regarding in-depth tissue temperatures. Dr Ludmila Stanislavovna ELLIS of the Aesthetic & Medical Centre in Bulgaria shares her findings on online temperatures during radiofrequency treatment

43 REGULATIONS ADVERTISING STANDARDS

Dr Raj Persaud FRCPsych is a consultant psychiatrist who has worked at the Bethlem Royal and Maudsley NHS Hospitals in London from 1994-2008, and as an honorary senior lecturer at the Institute of Psychiatry, University of London.

Lorna Jackson talks about advertising standards compliance in the medical aesthetic industry and how to avoid the pitfalls

Dr Bessam Farjo MB ChB BAO LRCP&SI is a fellow International College of Surgeons, founder member British Association of Hair Restoration Surgeons and president of the International Society of Hair Restoration Surgery.

49 PRODUCTS ON THE MARKET

Dr Masud Haq BSc, MRCP, MD is a consultant in diabetes and endocrinology.He is a graduate of Guy’s and St Thomas’s Hospital, and trained at Johns Hopkins in the US and in Melbourne. He has a particular interest in the thyroid and menopause.

Fiona Collins and Marie Duckett are registered nurses and members of the Royal College of Nursing forum for nurses in aesthetic medicine. Their clinic, Fiona and Marie Aesthetics Ltd, is based in Harley Street, London, UK.

52

The latest medical aesthetic products and services

52 MEDICAL AESTHETICS FROM MOUTH TO DERMIS Dr Raina Adami looks at oral nutraceuticals and whether ingesting ingredients really can create anti-ageing solutions from within

59 EDUCATION TRAINING A comprehensive course calendar

61 EXPERIENCE A PASSION FOR AESTHETIC MEDICINE Born in the south of Spain, Dr Beatriz Molina trained as a doctor and came to England on a surgical rotation. She developed an interest in noninvasive surgery, and discusses her path to becoming a leading authority in the aesthetics industry

LOOK HOW YOU FEEL Azzalure Abbreviated Prescribing Information (UK & IRE) site(s) or when the targeted muscle shows excessive weakness or (twitching of muscles around the eyes). Uncommon (≥ 1/1,000 to Presentation: Botulinum toxin type A (Clostridium botulinum toxin A haemagglutinin complex) 10 Speywood units/0.05ml of reconstituted solution (powder for solution for injection). Indications: Temporary improvement in appearance of moderate to severe glabellar lines seen at frown, in adult patients under 65 years, when severity of these lines has an important psychological impact on the patient. Dosage & Administration: Botulinum toxin units are different depending on the medicinal products. Speywood units are specific to this preparation and are not interchangeable with other botulinum toxins. Reconstitute prior to injection. Intramuscular injections should be performed at right angles to the skin using a sterile 29-30 gauge needle. Recommended dose is 50 Speywood units (0.25 ml of reconstituted solution) divided equally into 5 injection sites,: 2 injections into each corrugator muscle and one into the procerus muscle near the nasofrontal angle. (See summary of product characteristics for full technique). Treatment interval should not be more frequent than every three months. Not recommended for use in individuals under 18 years of age. Contraindications: In individuals with hypersensitivity to botulinum toxin A or to any of the excipients.

In the presence of infection at the proposed injection sites, myasthenia gravis, Eaton Lambert Syndrome or Amyotrophic lateral sclerosis.

Special warnings and precautions for use: Use with caution in patients with a risk of, or clinical evidence of, marked defective neuro-muscular transmission, in the presence of inflammation at the proposed injection Date of preparation: March 2013

atrophy . Patients treated with therapeutic doses may experience exaggerated muscle weakness. Not recommended in patients with history of dysphagia, aspiration or with prolonged bleeding time. Seek immediate medical care if swallowing, speech or respiratory difficulties arise. Facial asymmetry, ptosis, excessive dermatochalasis, scarring and any alterations to facial anatomy, as a result of previous surgical interventions should be taken into consideration prior to injection.

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

Generally treatment/injection technique related reactions occur within first week following injection and are transient and of mild to moderate severity and reversible. Very Common (≥ 1/10): Headache, Injection site reactions (e.g. erythema, oedema, irritation, rash, pruritus, paraesthesia, pain, discomfort, stinging and bruising). Common (≥ 1/100 to < 1/10): Facial paresis (predominantly describes brow paresis), Asthenopia, Ptosis, Eyelid oedema, Lacrimation increase, Dry eye, Muscle twitching

<1/100): Dizziness, Visual disturbances, Vision blurred, Diplopia, Pruritus, Rash, Hypersensitivity. Rare (≥ 1/10,000 to < 1/1,000): Eye movement disorder, Urticaria. Adverse effects resulting from distribution of the effects of the toxin to sites remote from the site of injection have been very rarely reported with botulinum toxin (excessive muscle weakness, dysphagia, aspiration pneumonia with fatal outcome in some cases). Prescribers should consult the summary of product characteristics in relation to other side effects. Packaging Quantities & Cost: UK 1 Vial Pack (1 x 125u) £64.00 (RRP), 2 Vial Pack (2 x 125u) £128.00 (RRP), IRE 1 Vial Pack (1 x 125u) €93.50, 2 Vial Pack (2 x 125u) €187.05 (RRP). Marketing Authorisation Number: PL 06958/0031 (UK), PA 1609/001/001(IRE). Legal Category: POM. Full Prescribing Information is Available From: Galderma (UK) Limited, Meridien House, 69-71 Clarendon Road, Watford, Herts. WD17 1DS, UK. Tel: +44 (0) 1923 208950 Fax: +44 (0) 1923 208998. Date of Revision: March 2013

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

Adverse events should also be reported to Galderma (UK) Ltd.

AZZ/020/0313

Not all HA dermal fillers are created equal.

Intelligent manufacturing technology creates a variable density gel1 resulting in...

Optimal tissue integration2 Greater dermal compatibility3 Superior cosmetic results4 High patient satisfaction5 Contact Merz Aesthetics NOW and ask for Belotero .

Tel: +44 (0) 333 200 4140 Email: customerservices@merz.com

OPTIMAL

TISSUE

www.belotero.uk.com

INTEGRATION

Injectable Product of the Year 2013

1. BEL-DOF3-001_01. 2. Tran C et al. in vivo bio-integration of three Hyaluronic Acid fillers in human skin: a histological study. Dermatology DOI:10.1159/000354384. 3. Taufig A.Z. et al., J Ästhet Chir 2009 2:29 – 36. 4. Prager W et al. A Prospective, Split-Face, Randomized, Comparative Study of safety and 12-Month Longevity of Three Formulations of Hyaluronic Acid Dermal Filler for Treatment of Nasolabial Folds. Dermatol Surg 2012, 38: 1143 – 1150.

5. Buntrock H, Reuther T, Prager W, Kerscher M. Efficacy, safety, and patient satisfaction of a monophasic cohesive polydensified matrix versus a biphasic nonanimal stabilized hyaluronic acid filler after single injection in nasolabial folds. Dermatol Surg. 2013; 39(7):1097-105.

BEL092/0314/FS Date of preparation: April 2014

body language I NEWS 7

observations

CONTOURING PROCEDURES CAN HELP TO KEEP WEIGHT OFF Researchers find that body contouring after bariatric surgery can help obese patients with long term weight loss A new study by researchers at Henry Ford Hospital has concluded that patients who undergo plastic surgery to recontour their bodies after bariatric procedures, tend to maintain “significantly greater” weight loss than people who do not have surgery after bariatric procedures.

Dr Donna Tepper is a senior author of the study and a Henry Ford plastic surgeon. She claims that there is a high incidence of patients who regain weight after bariatric surgery.

“Bariatric surgery has a measurably significant positive impact on patient illness and death,” Dr Tep-

per says. “However, even with the technical and safety advancements we’ve seen in these procedures, their long-term success may still be limited by recidivism.”

The study looked at 94 patients at Henry Ford Hospital who had undergone bariatric surgery from 2003 to 2013. Bariatric surgery covers several types of procedures to help obese people lose weight.

These can include removing part of the stomach or using a gastric band to limit what the stomach can hold.

After significant weight loss, some previously obese patients choose to have plastic surgery to reshape their body, including lifts to breasts, face, stomach, upper arms and buttocks. Of the patients monitored in the study, 47 went on to have one or more of these body recotouring procedures.

Each patient’s Body Mass Index (BMI) was recorded by the Henry Ford researchers both before their bariatric surgery and 2.5 years after the procedure, to determine their degrees of obesity.

“Of the patients who underwent contouring surgery, the average decrease in BMI was 18.24 at 2.5 years, compared to a statisti-

INVESTIGATING SAFER APPLICATIONS OF TOXINS Researchers gain new insights into improving the safety of botulinum neurotoxins In a recent study scientists have compared all known structures of botulinum neurotoxins (BoNTs) to gain a clearer understanding of how they interact with cells. Researchers have uncovered new clues as to how we can improve the safety and effectiveness of toxin treatments.

The study, conducted by Kammerer et al, offers a detailed review of BoNTs structures, their subtypes and complexes with cell-surface receptors.

“If we know from high-resolution structures how botulinum neurotoxins interact with their receptors, we can design inhibitors or specific antibodies directed at the binding interface to prevent the interaction,” said Richard Kammerer of the Paul Scherrer Insititute in Switzerland. “Furthermore, it may be possible to engineer safer toxins for medical and cosmetic applications.”

BoNTs are well known for being used in cosmetic treatments but are also sometimes used to treat muscle conditions in

cally significant 12.45 at 2.5 years for those who did not have further surgery,” Dr. Tepper explains.

“As plastic and reconstructive surgeons, we are encouraged by the idea that improved body image can translate into better long-term maintenance of a healthier weight, and possibly a better quality of life for our patients.”

The study suggests that reshaping procedures following bariatric surgeries may contribute to improving long-term weight loss results.

However future studies will look specifically at the different types of contouring procedures and how they can maintain weight loss, as well as following changes in previously obese patients BMI after five years.

patients with cerebral palsy, multiple sclelorsis and other medical issues. It’s important that injected toxins are safe as they can spread to unwanted areas, causing those muscles to shut down.

When the neurotoxins reach neurons, they bind to receptors at the cell surface and eventually a portion of the toxin is released inside the cell. The light-chain portion acts as a protease to specifically cleave a protein important for the release of acetylcholine, a neurotransmitter important for signalling from nerve to muscle. This results in muscle paralysis which, if affecting any muscles required for breathing, can be fatal.

“The wide range of BoNT/A dosage used in medical or cosmetic applications bears the substantial risk of accidental BoNT/A overdosage,” the researchers conclude. Their results specifically mention the BoNT/A1–SV2C complex crystal structure, which they say is expected to have important implications for the development of specific BoNT/A antibodies. The BoNT/A1 variants with attenuated SV2 binding properties are ‘promising candidate proteins for safer applications of the toxin.’

Whilst Kammerer et al have begun to identify how toxin safety could be improved in the future, they have also identified important questions which need answering in order to fully understand BoNTs and their interactions with cells.

8 NEWS I body language

events

A new study looks at the relationship between breast implants and lymphoma

Wigmore Medical Open Day, Royal Society of Medicine, London, 29th November

NOV

DEC

3 NOVEMBER, 3rd National Aesthetic Nursing Conference, Cavendish Conference Centre, London W:eventsforce.net

3-6 DECEMBER, Cosmetic Surgery Forum, Las Vegas, USA W: cosmeticsurgeryforum.com

6-9 NOVEMBER, ASDS Annual Meeting 2014, San Diego, USA W: asds.net

4-7 DECEMBER, 12th International Darmstadt Live Symposium, Darmstadt, Germany W: live-symposium.de

7-9 NOVEMBER, American Academy of Aesthetic Medicine 11th Annual Congress, Las Vegas, USA W: aaamed.org

IMPLANT RELATED LYMPHOMA

JAN

25-26 NOVEMBER, NHS England CNO Summit, Hilton Deansgate, Manchester W: cnosummit.co.uk

24 -25 JANUARY, Congrès de Médecine Morphologique et Anti-Âge, Paris, France W: sofmmaa.org

29 NOVEMBER, Wigmore Medical Open Day, Royal Society of Medicine, London, UK W: wigmoremedical.com

27-29 JANUARY, Big DiP 2015, London, UK W: bigdatapharma-europe.com Send events to arabella@face-ltd.com

COMPARING TREATMENTS comparethetreatment.com launches to assist patients in selecting treatments Despite the implication of the name, this new website is not for comparison of treatment price, but has been designed to help simplify the patient’s cosmetic treatment journey. It aims to do this by highlighting the different treatments available for any indication, and raise awareness of the options.

CEO, Tim Moloney says “We believe that patients’ website research patterns have changed, and the majority of searches now carried out are treatment-led rather than searching for a clinic by name or location.”

Google statistics seem to concur, showing over 10 million treatment searches are carried out each month in the UK. As the choice of treatments expands, comparethetreatment.com aims to package all of the information prospective patients may need in one place, and help patients make informed decisions.

This new resource has three key components; to allow patients to explore all their options and increase knowledge; to ask questions to an expert panel of doctors and to search for a local clinic for further consutation and treatment.

Breast implants have been linked to rare occasions of anaplastic large cell lymphoma (ALCL) across the globe in 71 known cases. A new study has found clues as to how breast implants could cause ALCL and how we should define implantrelated ALCL. Researchers at University of Cambridge, together with specialists in Austria, Australia, Liverpool and Swansea were funded by Leukaemia & Lymphoma Research to carry out the study. They looked at patient case reports and medical literature on the subject to identify common traits and behaviours.

Researchers found that patients who developed ALCL after breast augmentation were on average, aged 50 and developed it 10 years after their procedure.

The study, published in the journal Mutation Research, estimates that implant-related ALCL is so rare it only occurs in between one and six cases for every three million breast implant procedures. Dr Matt Kaiser, Head of Research at Leukaemia & Lymphoma Research, said: “It’s important to remember that any breast implant-associated lymphoma is incredibly rare.” “ It is, however, important to investigate any possible links to what causes these cancers, so that we can help people balance benefits versus risks and so that we can work out how we might be able to prevent the risks altogether.”

Most lymphoma is found in the lungs, skin, liver, lymph nodes and soft tissue and is almost never found in the breast without an implant. In implant-related ALCL the tumours develop in the scar tissue surrounding the implant capsule. The study explains that in many cases capsulotomy, the removal of scar tissue, is enough to treat the ALCL. This sug-

gests that ‘the implants provide the biological stimulus’.

People who develop ALCL can be divided into two types. The first are those whose cancer cells express an abnormal protein called anaplastic lymphoma kinase (ALK) inside the cell. Eight in ten patients with ALKpositive lymphoma survive for five years or more. However just under half of patients survive after five years when they are ALK-negative and do not have the protein.

Despite this, in implant-related ALCL, the study found that most patients had a very positive prognosis although nearly all were ALK-negative.

More research is needed but the study shows that implant-related ALCL has its own unique biological characteristics and could be thought of as a separate clinical entity to other types of ALCL. Progress was available on 49 of the cases looked at, and of these there were only five reported deaths. The simplest way of treating the lymphoma was the removal of the breast implant and surrounding scar tissue.

Although there was a lack of evidence, due to the longevity and numbers of the study, chemotherapy treatments showed no significant survival increase in patients.

Whilst there is no clear answer as to why some women develop ALCL after breast augmentation, these findings suggest that it is the body’s abnormal immune response to the implant that may cause the cancer.

Dr Suzanne Turner led the research at the University of Cambridge. She says, “It’s becoming clear that implant-related ALCL is a distinct clinical entity in itself. There are still unanswered questions and only by getting to the bottom of this very rare disease will we be able to find alternative ways to treat it.”

Experience all the benefits of VYCROSSâ&#x201E;˘ technology.

Treat various areas of the face using only 3 products.

Itâ&#x20AC;&#x2122;s that versatile.

Instructions and directions for use are available on request.

Allergan, Marlow International, 1st Floor, The Parkway Marlow, Buckinghamshire SL7 1YL, UK Date of Preparation: August 2014 UK/0880/2014

Syneron Candela Launches Breakthrough Technology. Again.

Introducing PicoWay. PicoWay is a remarkably innovative dual wavelength picosecond laser from Syneron Candela, the most trusted brand in lasers. With both 532nm and 1064nm wavelengths, PicoWay can treat a very broad range of pigmented lesions and tattoo types and colors on any skin type.

PicoWay has the highest peak power and the shortest pulse duration of any picosecond laser for superior efficacy, safety and comfort. Proprietary PicoWay technology creates the purest photo-mechanical interaction available to most effectively impact tattoo ink and pigmented lesions, without the negative thermal effects of other lasers.

And, PicoWay has the reliability physicians want.

www.syneron-candela.co.uk | info@syneron-candela.co.uk | Tel. 0845 5210698

Š2014. All rights reserved. Syneron and the Syneron logo are registered trademarks of Syneron Medical Ltd. and may be registered in certain jurisdictions. PicoWay and Candela are registered trademarks of the Candela Corporation. PB85961EN

body language I NEWS 11

RESVERATROL UNCOVERED AS TREATMENT FOR ACNE An antioxidant found in grapes could be used for combined acne treatments A new study by UCLA researchers has detailed how resveratrol—an antioxidant from grapes often used red wine— works to safely stop the growth of the bacteria which causes acne.

The study claims that acne is the most prevalent skin disease in the world, affecting 85% of adolescents and over 10% of adults. Antibiotics used to treat acne can eventually build a resistance to the drug and treatments such as retinoids and benzoyl peroxide can have undesirable side effects, including irritation.

Resveratrol works by stopping the formation of free radicals in the body, which cause cell and tissue damage. The antioxidant also showed ‘sustained antibacterial activity’ against acne bacteria, whereas benzoyl peroxide only ‘demonstrated a short term bacterial response.’

Whilst resveratrol has been studied before, knowledge of how it works has been limited. By using electron microscopy researchers revealed altered bacterial morphology, with the bacteria losing structure and definition of their outer membranes—they seemed to be structurally weakened by resveratrol.

Resveratrol has less cytotoxicity compared to benzoyl peroxide which means it’s less toxic to the skin cells that the medication may not want to target. However the study claims that ‘acne is a multifactorial disease, attributed also to sebum production which is not currently known to be addressed by resveratrol, and which may therefore limit its use as a monotherapy in the treatment of acne.’

Published in the Journal Dermatology and Therapy, this research has found that by combining resveratrol with the commonly used benzoyl peroxide, there is an increase in how much bacteria is killed. This has led to a strong argument for the development of a new combined treatment.

“It was like combining the best of both worlds and offering a two-pronged attack on the bacteria,” said senior author Dr. Jenny Kim, professor of clinical medicine in the division of dermatology at the Geffen School.

Both substances stop bacteria, but whereas resveratrol is a preventative antioxidant, benzoyl peroxide is an oxidant that creates free radicals to kill the acne bacteria that’s already there.

“We initially thought that since actions of the two compounds are opposing, the combination should cancel the other out, but they didn’t,” said Dr. Emma Taylor, assistant clinical professor of medicine in the division of dermatology at the David Geffen School of Medicine at UCLA. “This study demonstrates that combining an oxidant and an antioxidant may enhance each other and help sustain bacteria-fighting activity over a longer period of time.”

Taylor has suggested that these findings could lead to less irritating topical acne treatment, as it has very effective antibacterial effects but minimal toxicity to other skin cells. “We hope that our findings lead to a new class of acne therapies that centre on antioxidants such as resveratrol,” Taylor said.

EVIDENCE PYRAMID BAAPS calls for measuring system to clarify evidence level behind products and procedures A new study presented at the Annual Scientific Meeting of the British Association of Aesthetic Plastic Surgeons, has uncovered that clinical papers for popular treatments can be scarce, with many new products and procedures distinctly lacking supporting published scientific articles.

With a rise in reporting on cosmetic procedures in the mainstream media of almost 8,000% in the last 20 years, this raises deep concerns. The BAAPS is therefore calling for the media and public to employ a measuring system to clarify the levels of evidence behind new medical aesthetic procedures and claims.

According to research from LexisNexis, there were only 45 articles published in national newspapers throughout 1991 relating to cosmetic surgery.

An enormous rise of 7,900% was noted by 2013, when 3568 features on the topic appeared in print.

Further research by PubMed uncovered the amount of mainstream coverage for the four most popular medical

devices totalled 600 features appearing in consumer press compared to a mere 25 papers in medical journals.

The study also focused on evaluation of peer-reviewed data for non-invasive liposuction technologies, revealing only 16% of studies involved more than 100 patients. All but one study were based on less than six months follow up, and more than a third of authors admitted financial or conflict of interest.

The BAAPS proposed system to aid consumers to evaluate clinical research will adopt a similar approach to medical journals, using a colour coded ‘Evidence Pyramid’ with four levels of ‘evidence’: New BAAPS President, Mr Michael Cadier said, “New so-called ‘clinically proven’ treatments promising unbelievable results are launched almost on a daily basis. We believe that asking the right questions, doing a bit of research and engaging in a dose of scepticism is the healthiest approach for the public.”

12 SURGICAL I body language

The evolution of hair restoration surgery The origins of hair restoration surgery lie far further back than one might expect, but the methods used over half a century ago closely resemble many of those used today. DR GREG WILLIAMS explores the history of this fascinating field

H

air restoration surgery, simply put, is the replacement of hair where it has been lost for whatever reason. Causes may be genetic, as in male pattern hair loss and female pattern hair loss; accidental from trauma, burns or surgery; der-

matological from scarring and nonscarring alopecias; or self-inflicted from eyebrow plucking, traction alopecia, or compulsive hair-pulling.

The search for a solution sparked the evolution of flap and graft surgery, scalp reduction surgery, strip follicular unit transplant surgery

(strip FUT) and follicular unit extraction surgery (FUE).

Flap and skin graft surgery We know that the Indians were doing nasal reconstruction using forehead flaps from 700 BC and that in Europe nasal reconstruc-

FARJO HAIR INSTITUTE

body language I SURGICAL 13

The modern surgical set-up required to perform strip FUT surgery

tion was done with forearm flaps in the 1700s. These early pedicled flap procedures were the ancestors of the Juri (temporo-parietal) flap, which was once commonly used for hairline restoration in burn scars and receding hairlines but which had devastating long term aesthetic consequences if male pattern balding occurred behind the flap.

Similarly, a long full thickness hair-bearing skin graft strip, if it survived, might have produced a temporarily acceptable hairline for the above indications but would be unlikely to have a long standing aesthetic benefit if hair loss progressed behind the graft.

With the advent of tissue expansion technology, large post traumatic and post-surgical hair defects can now be reconstructed successfully using a variety of local flaps but attention still needs to

be paid to the potential for future genetically determined patterned hair loss.

Scalp reduction surgery Scalp-reduction surgery may have seemed like an intuitively sensible thing to do at the time it was popularised for treating advanced male pattern hair loss, and was quite easy to perform surgically. However, although the bald area was reduced, the anatomical result was often unnatural in appearance. Common complications from excessive tension of the wound closure included tissue necrosis and widened scars.

Many novel and innovated techniques were introduced to avoid stretching of scars but there was usually a stretch-back tendency causing the remaining bald scalp to expand again and scalp reduction surgery for male pattern hair loss is

now relegated to the history books.

Strip FUT surgery The Japanese dermatologist Sasagawa, in 1930, reported his experiments on the implantation of hair shafts into the skin, and then, in 1943, Tamura implanted grafts of only one to three hairs that he harvested from spindle-shaped strips of scalp skin. This was all published in the Japanese medical literature at the time, but remained unknown in the Western world until the early 1950s, due to the outbreak of the war.

In the 1980s, Carlos Uebel in Brasil and others in the USA began using smaller and smaller micrografts, with fewer and fewer hairs for strip FUT procedures. However, it was not until 1988 when Bob Limmer described that hairs grow in follicular units (groups

14 SURGICAL I body language









There is a great deal of misinformation in the public domain regarding the pros and cons of the strip FUT versus FUE methods.

Both have advantages and disadvantages that should be explained to prospective patients so they can make informed decisions.

In summary, the evolution of hair restoration surgery for male and female pattern hair loss has involved a progression from open flap based procedures to less invasive hair transplant based techniques. The hair transplants have also become more refined using smaller grafts from the 1960s and 70s when plug grafts were used (10 to 25 hairs per graft) to the 1980s and 90s when mini and micro grafts were used (3-8 hairs per graft) and finally to the modern era of follicular unit grafts (1-4 hairs per graft) by either the strip FUT or FUE methods that give patients the stunningly natural results that are now the expected norm.

Dr Greg Williams is a Plastic Surgeon and the lead Hair Transplant Surgeon at the Farjo Hair Institute’s London clinic W: farjo.com

FARJO HAIR INSTITUTE

Modern hair restoration surgery Today, hair restoration surgery for male and female pattern hair loss is almost exclusively hair transplant based. Entirely natural looking and almost undetectable results can be achieved if patients are selected carefully and designs incorporate the possibility of future hair loss progression.

FARJO HAIR INSTITUTE

FARJO HAIR INSTITUTE

FUE surgery The origins of FUE are also in Japan, starting in 1939, when Akuda described a method using islets of skin measuring 2mm to 4mm to reconstruct eyebrows and moustaches in burn victims. In the West, the father of hair transplant surgery is often named as Norman Orentreich, who worked in New York and in 1959 published almost a decade’s worth of work. He used a 4mm metal cylindrical punch to take out grafts from the occipital scalp region and then used the same cylinder to create recipient sites, into which he transplanted the grafts.

Surgeons used this technique to try and thicken thinning hair.

What we have learned now is that those results were not long-lived, and we still see today patients who come in with the results of surgery that they had using this archaic

plug technique where the ‘pluggy’ transplanted grafts remain isolated after the natural hair has completed disappeared due to male pattern hair loss .Thankfully, we now have modern hair transplant surgical techniques to reconstruct these aesthetic disasters.

Japan returns to the history of FUE again in 1988, when dermatologist Inaba described using a 1mm needle to extract follicular units. This was then successfully done in the West, first in Australia,

by Ray Woods in the late 1980s, and then formally described in the medical literature by Bill Rassman and Bob Bernstein in 2002. However modern FUE grafts are just very refined small plugs.

 

FARJO HAIR INSTITUTE

of 1-4 hairs), and that these grafts gave more natural results than the ones resulting from the coarser mini and micrografts, that the era of the modern strip FUT procedure began

1 & 2: Old strip FUT scar and modern strip FUT scar. 3 & 4: Old plug graft donor scars and modern FUE donor scars. 5 & 6: An example of an old ‘pluggy’ hair transplant that has been repaired using modern techniques

EMERVEL – MORE CHOICE AND CONFIDENCE IN MID-FACE FILLER SOLUTIONS Volume is key to maintain facial balance and restore the faces natural contours. Emervel has gel textures especially designed for lifting capacity and volume restoration, optimised especially for the mid-face regions.

EMERVEL DEEP FOR SHAPE REDEFINITION

EMERVEL VOLUME FOR VOLUME RESTORATION

Emervel Deep for patients who require mid-face shape redefinition due to flat zygomatic bones or mild-to-moderate facial asymmetry.

Emervel Volume for patients who require midface volume restoration due to volume loss caused by ageing.

INTRODUCING EMERVEL VOLUME 1ML – AVAILABLE SEPTEMBER 2014 SMOOTHER FLOW • Optimized gel texture: Homogenous gel particle calibration enables smooth and regular extrusion • 27 G Ultra-thin-wall needles improve flow rate and reduce extrusion force

GREATER WORKING COMFORT • Lightweight, ergonomic syringe for more comfortable handling • Lower extrusion force for reduced fatigue

OPTIMISED CHOICE • Emervel Volume available in 1ml or 2ml - Your choice of comfort and flexibility depending on your patients’ needs.

Galderma (UK) Ltd Meridien House, 69-71 Clarendon Road, Watford, Hertfordshire WD17 1DS Tel: 01923 208950 Email: info.uk@galderma.com For more information visit www.galderma-alliance.co.uk EME/030/0714 Date of prep: July 2014

You can sign up to receive email & text message alerts through Galderma (UK) Ltd’s A&C subscription service for Healthcare Professionals and Non-Medical Aesthetic Clinic Staff. Scan here, or visit www.galderma-mail.co.uk

16 TECHNIQUE I body language

Hair transplant success One day and one month after FUE treatment

Robotic FUE before and immediately after treatment

How do you achieve the best results in the art of hair transplantation? Is it about FUE, strip surgery or the tools? DR BESSAM FARJO discusses how to achieve success using state-of-the-art techniques

A

chieving the best result depends on a wide variety of factors. As with any treatment you always start with assessing, consultation and patient selection. You can have the best tools, the best skill but if you choose the wrong patient you’ll never achieve the right results. For example, you treat somebody surgically, you produce a good result but they continue to lose more hair and the transplant looks very silly. This patient should be on finasteride, minoxidil, lasers or perhaps PRP and the like before you get into surgery.

Hairline design One of the most common causes of dissatisfaction with surgery is that the hairline is not in the right place. When you’re designing, it’s important to have macro-variation and micro-variation—once you’ve done an irregular hairline, irregulate it even more so that there’s no evidence of a pattern.

Hairline artistry

Naturally transplanted hairline

Donor area management The donor area yields a limited amount of hair. When we remove the hair we must extract these hairs intact, avoiding transecting the follicles. If more than a third of the follicle is transected then you get no regeneration and these hairs are lost to the patient forever.

Harvesting methods There are two methods to harvest the donor area: follicular unit extraction, FUE, and strip technique, commonly referred to as FUT. Manual FUE requires a high level of skill, using punches between 0.7mm and 1mm. You can use a mechanised drill, which is faster; perhaps less precise. Whether it’s manual or motorised, you drill cylindrical shapes out and pick out the grafts with fine forceps.

The advantage of FUE is that you get no linear scar. You do, however, end up with these little dot scars that may or may

body language I TECHNIQUE 17

not be visible when the hair is almost shaved depending on the patient. You get minimal post-op pain, much less than the strip operation. You have less donor dissection involved so you need fewer staff. The disadvantage of FUE is that it’s time-consuming and therefore more expensive for the patient, and it generally requires that the patient shave their head on the day.

People with spiky hair, where you can see right through to their scalp, they tend to be good candidates for FUE as a linear scar is more difficult to hide. Or a young patient with uncertain future family history, if you do FUE they keep the option to have their hair short in the future and not have any more transplants if they don’t want to.

The advantage of strip surgery is it’s less time-consuming and therefore cheaper. You can move higher numbers of grafts per operation and shaving the scalp is not required. Usually you get a lesser rate of transection because you can visualise everything under the microscopes. The main disadvantage of strip harvesting is the linear scar. Done skilfully, it will be very difficult to find, but no matter how thin it is, it’s there. They do get more pain after the surgery either because of the stitches or staples.

The scalp elasticity can be an issue. But it is good for people unwilling to shave their donor hair and people who have small donor areas, where you don’t have enough space to remove the spread-out FUEs. Graft preparation There’s not much point doing all these grafts and then a significant number of them die because you’ve not preserved them well. We used to keep them in normal saline, now we use Ringer’s lactate. We add ATP to it, some people use organ transplant solutions with a variable level of success.

In the strip type procedure, the initial dissection step is called slivering, producing this slices that are passed on to technicians who separate the individual groupings. We don’t want to be transplanting skin; we want to mainly transplant hairs. But you don’t want to trim too much and skeletonise the graft, because then it can be damaged easily and may not grow correctly. But if you leave too much skin then it can lead to unnecessary scarring. Then you separate the individual follicular units, which can range between one and four hairs.

You then design the process—most of us would choose to put single hairs at the front, two hairs behind and the three and four hairs are used to produce density in areas that are not directly visible.

ARTAS robotic FUE harvest

Slivering

Part of strip and grafts

Sites Some surgeons use a needle and implanter in one, an implanter that makes the incision and you plunge the graft at the same time. It’s a matter of personal preference. The incision has to be right. If it’s too big the graft will move within the incision and grow differently. If the incision is too tight it can compress the graft and heal in a dip or the hairs compress together and it gives you an angry and artificial look.

When you walk into a transplant room it’s more like a manufacturing plant than an operating room. There is so much happening, everything has to be right, every single part of the process that goes wrong could result in an undesirable result.

Dr Bessam Farjo is a Hair Transplant Surgeon and Founding Director of the Farjo Hair Institute W: farjo.com

Dissected grafts

IRESOLVEI

EFFECTIVE PIGMENTATION RESOLUTION THAT'S KIND ON SKIN EXCELLENT CLINICAL DATA Clinically-proven results in a variety of skin types and conditions ranging from photo-damage to melasma

TACKLES MELANIN PRODUCTION AND TRANSFER A unique, multi-action formulation with evidence-based ingredients tackling every stage of the melanin production cycle

KIND ON SKIN AND GREAT TO USE Skin-kind, cosmetic tolerability and an excellent safety profile encourages daily use

EFFECTIVENESS OF NEORETIN速 SKIN CARE REGIME (GELCREAM/DAY + SERUM/NIGHT)

74% reduction in the area and severity of melasma as measured by clinicians* BEFORE TREATMENT

ASK US ABOUT

3 MONTHS AFTER TREATMENT

CPD CERTIFIED TRAINING WORKSHOPS

The skin; anatomy & physiology, functions & mechanisms, ageing & problem conditions

Evidence-based skincare ingredients and products

Client consultations and evidence-based regimes

WORKSHOPS

EVERY MONTH

ACROSS THE UK

FOR FURTHER DETAILS, SCIENTIFIC & CLINICAL INFORMATION PLEASE CONTACT AESTHETICARE 速 0800 0195 322

息 AesthetiCare速 2014 6765/10.14

neoretin.aestheticare.co.uk

info@aestheticare.co.uk

@aestheticareuk

facebook.com/aestheticareuk

Photo courtesy of *Truchuelo M et al, Hospital Ramon y Cajal, Madrid, in press J Cosmet Dermatol (data on file awaiting publication)

body language I EQUIPEMENT 19

Artificial hair implants The Medicap biocompatible artificial hair implant offers an alternative or complement to other treatments. DR MANAL SHETA explains the product and the procedure

M

any types of artificial hair implant began to be developed in the 1970s as a quick solution for the coverage of the baldness. However many were banned due to patient discomfort, scarring and the low success rate.

This was mainly due to the type of the materials used for the fibres, which were rejected by the body.

Also the lack of medical regulation played a part.

Biocompatible fibres In 1983 Medicap began development of a biocompatible fibre called Biofibre, made from the same material with which we su-

ture woundsâ&#x20AC;&#x201D;a polyamide. This is not harmful for human body and it produces a keratin plug that prevents microbial agents from penetrating. These fibres meet all the biocompatibility and safety requirements established by international standards on the medical devices, and the body will not reject the material of the fibre.

Biofibre is aesthetically identical to the natural hair, it does not lose its colour and does not die with aggressive products.

Medicap creates several lengths, colours and shapes from 15, 30 or 45 centimetres; available in straight, wavy or curly. It can be washed and dried like natural hair

and is available as single hair or triple high density.

Treatment The Biofibre hair implant procedure is not in competition with any other hair restoration technique, but it is a good alternative or complementary treatment for the patient.

It is suitable for patients with a healthy scalp but with a poor donor area. It is also ideal for patients who cannot shave their head or who cannot wait for a shaved head to regrow after the FUE or FUT medical transplant, where immediate results are required. It can also be used if needed to increase the

Use of artificial hair implants can be an alternative treatment for male and female baldness

20 EQUIPMENT I body language

volume of a patients hair following normal hair implant procedures.

The instrument used for the implant is the automatic implant machine or the manual implanter.

We take the knot by the tip of the needle and then implant into the scalp at 45 degrees.

Advantages Using the Biofibre implants offers high hair density within a very short time, with natural aesthetic results and the related psychological and physical wellness for the patient. The implant is a simple and virtually painless outpatient procedure, which it is safe for the patient because it uses biocompatible material.

The use of this product allows the patient to lead an active lifestyle even soon after the implant procedure. The artificial hair also will not ageâ&#x20AC;&#x201D;it will not turn whiter.

Disadvantages One disadvantage of this technique is that it requires patients to have suitable hygiene of the scalp and aftercare, so we have to choose appropriate patients. The treatment is not recommended for patients suffering from scalp diseases or infections, like psoriasis, certain types of dermatitis and some autoimmune diseases like lupus. Additionally small yearly implant sessions are needed to maintain the results.

Post-procedure Immediate post-implant care requires the use of betadine and saline spray by the patient alternatively for three days and to wash using ketoconazole shampoo. Antibiotics systemic coverage is recommended for one week after implant and a laser hair comb is useful to maintain a healthy scalp.

Dr Manal Sheta is an Egyptian Cosmetic and Dermatological Physician specialising in hair restoration and aesthetic laser surgeries. She is the owner of Al-Mansour Hospital in Kuwait city, and trains physicians on the Biofibre hair implant and surgical threads. E: drmanalsheta@ hotmail.com

Before and after treatment with Biofibre implants

HIGH TECHNOLOGY HAIR IMPLANT SYSTEM INDICATIONS  when an immediate aesthetic result is required  when patients ask for a soft surgery  to have a gradual thickening  for all types of male and female baldness  as integration with other hair restoration techniques

BIOFIBRE IN THE WORLD BIOFIBRE HAIR Implant System® is exclusively performed in primary clinics specialized in dermatology, plastic surgery and aesthetic medicine to always ensure optimal results to patients worldwide.

Keratin Sheath

Epidermis Keratin Sheath

Dermis

Subcutaneous Layer Galea Aponeurotic Subgaleal Space Pericranium

ADVANTAGES Natural aesthetic result Painless outpatient surgery Ease and rapidity of execution Big quantity of hair in a very short time Safety for the patient Allows an active and sporting lifestyle immediately after implant  Affordable price

     

Cranium

AUTOMATIC BIOFIBRE HAIR IMPLANT More than 20 years of clinical and scientific research allowed Medicap ltd to develop the exclusive Biofibre Hair Implant System® a soft, simple, effective hair restoration technique that allows to quickly cover thinned or bald scalp areas, ensuring an immediate aesthetic result.

HIGH QUALITY OF BIOFIBRE Biofibre® is our medical device for male and female hair restoration. Biofibre is approved for implant by Certifications CE0373, TGA and many others. Biofibre is biocompatible, high flexible and resistant. These characteristics ensure a safe and long-lasting implant.

GOOD AND LONG LASTING RESULTS The lasting benefits of the Biofibre Hair Implant System® are guaranteed by the following factors: Qualified medical doctor experienced in Biofibre implant. Suitable patient with good health and healthy scalp. Compliance with post-implant indications.

SAFETY GUARANTEES Extensive clinical trials and histological studies ensure that the Biofibre Hair Implant System® is safe for the patient since: Biofibre® is biocompatible. The keratin layer surrounding Biofibre® protects the newly-formed follicle from external contamination. Biofibre® can be completely extracted without leaving scars.

Produced and distributed by MEDICAP, Italy

www.biofibre.com

info@biofibre.com

body language I EQUIPMENT 23

Robotic

FUE hair transplants MR EDWARD BALL was the first hair surgeon in Europe to introduce a hair transplant robot to his practice. He discusses the technology, its development, its benefits and limitations and a look to the future

P

atients desire full and natural looking hair. For years we have been able to achieve these goals with the strip technique, which involves removing a piece of skin from the back of the head. However, patients also want minimal scarringâ&#x20AC;&#x201D;itâ&#x20AC;&#x2122;s no good having a great hair transplant with a troublesome scar.

The development of follicular unit extraction (FUE) has been a huge step forward because the removal of individual follicular units leaves tiny dot scars, rather than

the linear scar from a strip procedure. This gives far more flexibility in hair style or length. However, there are limitations to FUE. It is a skill that takes time to learn and it is labour intensive. Each follicular unit is extracted individually in a process that can take several hours.

This can lead to patient and surgeon fatigue and a potential loss of graft quality.

Hair surgery involves fine precise movements of a repetitive nature and this is an area in which robots excel. A robotic system can

provide a solution that is precise, consistent and efficient and, of course, robots do not fatigue. A robotic harvest can produce robust, high quality grafts thousands of times in a single session. This accuracy and consistency can enhance the patient and surgeon experience whilst optimising graft survival and growth.

A robot for hair surgery I use the ARTAS system, which utilises an image-guided robotic arm, which assists the surgeon by

A robotic system can provide a precise and efficient solution

24 EQUIPMENT I body language

dissecting the individual follicular units, allowing them to be extracted by a manual forceps technique.

The remainder of the hair transplant process is currently no different to manual FUE surgery.

A magnified image of the patient’s scalp is displayed on a 55 inch screen, providing detailed visual access to the donor area. Viewing the skin in three dimensions, the ARTAS Robotic System uses programmed algorithms to select the follicular units, adjusting for variations in hair angle and direction, as well as skin texture and depth, to achieve a consistent harvest. Taking readings 50 times per second, the robot is able to safely compensate for any patient movement.

It has a unique two punch system—an inner sharp needle and an outer rotating dull punch. The sharp needle scores the skin, anchors the punch and opens the way for the outer, blunt punch to dissect down around the follicle. Minimising the sharp dissection reduces the risk of transection damage to the follicle. The surgeon is able to adjust the settings without interrupting the procedure, producing extraction rates of approximately 400-800 grafts per hour, depending on the patient’s hair and skin characteristics.

Patients are prepared for the robot in much the same way as for a manual FUE procedure. Their hair must be cropped short (grade 0) at the back and sides. We dye the donor hair if it’s fair, grey or white because the robot has to be able to see the hairs. Without the need for stitches, patients can experience a comfortable recovery and may return to work within a few days of the procedure.

A team of four individuals is required to operate the robot.

This comprises the surgeon with a

handset controller (responsible for tensioner placement and managing dissection parameters, follicle selection and graft quality), a technician manning a desktop computer (assisting the surgeon), a technician performing forceps extraction of the dissected grafts alongside the robotic punch mechanism and a technician at a microscope who inspects and counts the grafts and performs any limited graft trimming as required.

Origins The ARTAS System, developed by Restoration Robotics, showed during the preliminary studies a tran-

66 A magnified image of the patient’s scalp is displayed on a 55 inch screen, providing detailed visual access to the donor site 99

section rate of 8% was compared to a figure of 26% for manual FUE. There have been numerous updates to the software that has seen increases in efficiency and automation. The transection rate is now close to 5% and with the latest update we are able to achieve harvests 500 to 1000 grafts per hour.

Robot-assisted surgery certainly reduces fatigue and patients enjoy the aesthetic and comfort benefits associated with a lack of stitches or linear scarring. Patients can potentially undergo larger sessions than might be achieved manually, therefore creating greater recipient density and coverage.

Limitations Some patients find the chair uncomfortable during longer sessions. In order to enable the robot to access various areas of the head, the chair requires positional adjustments during the case. The tensioner device, which stretches the skin and orientates the robot, can be tricky to position well in certain

We dye the donor hair if it is fair, grey or white because the robot has to be able to see the hairs

body language I EQUIPMENT 25

Robot-assisted surgery reduces fatigue and patients benefit from lack of stitches or linear scarring

parts of the scalp and in patients with very lax or mobile skin. The requirement to shift the tensioner each time a new area of donor hair is to be harvested can slow down the extraction process. Some parts of the head can present a challenge to harvest with the robot, highlighting the importance of a surgeon’s competence in the manual FUE techniques.

The 1.0mm diameter of the sharp inner needle is larger than some manual FUE devices and may, therefore, leave slightly larger dot scars. However, the patient’s skin characteristics tend to hold more influence over scar appearance than small variations in punch diameter. The robot’s larger needle may, in fact, help to produce more robust grafts with greater tissue support.

Future developments So what’s next? A smaller punch has just become available. It measures 0.9 mm and will provide greater flexibility, enabling the surgeon to tailor the punch size to the patient’s hair calibre and donor density.

I’d like to see some more surgeon control, including the ability to choose precisely which units are to be harvested and to specify a certain number of one, two or three hair follicular unit grafts. I expect this will soon be possible.

In the US, the robot can already make recipient site incisions and I have little doubt that it will ultimately be able to actually extract the grafts and place them into the recipient area.

I find it is an amazing piece of technology which is capable of pro-

ducing remarkable hair restoration results. With the right patient it produces excellent grafts with efficiency and consistency. However, I don’t think there will ever be one solution to all patients’ needs. I believe that a hair surgeon should also be skilled in the manual FUE technique, allowing them to select the best approach for each particular patient. It is hard to beat the artistic skills of an experienced doctor but a robot is certainly an excellent tool that has a great deal to offer both surgeons and patients. I have no doubt that robotic hair restoration is here to stay and it’s going to be very exciting to see where it takes us in the future.

Mr Edward Ball is a hair transplant surgeon in London and clinical director for Ziering UK

body language I STANDARDS 27

The future for the surgical treatment of hair loss

FARJO HAIR INSTITUTE

DR NILOFER FARJO and DR GREG WILLIAMS address the issues surrounding new legislation, training and staffing requirements for hair loss treatment

A

nybody who is interested in setting up a hair transplant service, and those who currently are offering hair transplants, will have concerns about what effects legislation might have on them in the future.

At the moment there is very little legislation regarding hair transplant

surgery except that, as with any form of surgery, it needs to be done in a Care Quality Commission registered and regulated environment.

One of the big questions currently being debated around the world is ‘who can perform hair transplants’?

The Royal College of Surgeons

Hair transplant is a meticulous procedure and the work requires a great deal of concentration from all the team members

has no definition of what ‘surgery’ actually is. This is understandable, since it is a very difficult thing to define. At a very basic level, if one tries to define ‘surgery’ as ‘any procedure involving an incision in the skin’ then something as simple as taking blood, or giving an immunisation, would be considered surgery. One of the reasons why this is relevant to hair transplant surgery is to determine whether follicular unit extraction (FUE) is actually surgery at all. Some might argue that FUE harvesting is really no different to a dermatological punch biopsy—it is just being done many times. Likewise, the incision that is made to implant hairs with a hypodermic needle is not really any different to the incision made for taking blood, it is just done many times. Most clinicians would agree that hair transplants involving removing a strip of skin and then stitching or stapling constitutes ‘surgery’ but there is less agreement as to whether FUE is ‘surgery’.

In January 2013, the Royal College of Surgeons published its Professional Standards for Cosmetic Practice and within this guidance cosmetic or aesthetic surgery was defined as: “operations and all other invasive medical procedures where the primary aim is the change, the restoration, normalisation, or improvement of the appearance, the function, and wellbeing at the request of an individual.”

By this definition, all forms of hair restoration surgery, even the FUE technique, can be considered cosmetic or aesthetic surgery.

Having agreed that all hair transplant procedures constitute surgery, should they therefore only be done by a doctor who is registered and in good standing

28 STANDARDS I body language

There is a strong suggestion from the government that all cosmetic practitioners not registered with a regulatory body should be part of a voluntary register 99 with the General Medical Council (GMC)? The legality involved with creating FUE incisions, in other words doing surgery, without a medical license is unclear in the UK. In many countries around the world it is considered a criminal offence to operate without a medical license. The GMC does not comment on the legality of this in the UK as they only regulate offences by doctors. However, if a complaint or an allegation was made to them regarding an individual performing surgery who was not a doctor, then they would investigate and report the matter to the police.

In July 2013 the British Association of Hair Restoration Surgery (BAHRS) agreed, and published, Professional Standards both for Hair Transplant Surgeons and for Hair Transplant Surgical Assistants. All members, both surgeons and assistants sign a Code of Conduct agreeing to abide by the relevant Professional Standards which both include a clause that FUE incisions (in other words, surgery) will only be performed by doctors.

In this area, the UK is well ahead of most of the rest of the world.

The International Society for Hair Restoration Surgery (ISHRS) has professional standards, but there is nothing that requires members to follow them.

In April 2013 the Keogh Review of the Regulation of Cosmetic Interventions was published and there were three key areas of suggested change that were needed: high quality care with safe products, skilled practitioners, and responsible providers was the first. An informed and empowered public to ensure that people get accurate advice and that the vulnerable are protected was the second and accessible redress and resolution in case things go wrong was the third.

The Department of Health official response to the Keogh review was published in February 2014

and one of the outcomes has been to look at the training required for persons delivering cosmetic interventions. The Royal College of Surgeons has been mandated with overseeing the requirements for surgical cosmetic procedures and Health Education England (HEE) for overseeing the requirements for non-surgical cosmetic procedures.

As hair restoration surgery is carried out mostly by doctors without a formal surgical qualification, it was decided it was better placed with HEE rather than the Royal College of Surgeons.

So what is the implication of the Keogh review for hair transplant surgical assistants, who for the most part will not be registered with a regulatory body (the exception being those assistants who are nurses)? There is a strong suggestion from the government that all cosmetic practitioners who are not registered with a regulatory body should be part of a voluntary reg-

ister. This is available through the BAHRS for hair transplant surgical assistants. As part of being on the voluntary register they would be obliged to sign up to professional standards and codes of conduct thus giving the public a degree of assurance that they are acting in a responsible and professional manner.

Training availability Currently there is no formal training available in the UK for hair restoration surgery. However there are some learning themes in common with the education required for the other modalities that are being overseen by HEE and that were addressed in the Keogh review including botulinum toxins, dermal fillers, chemical peels and lasers.

It is envisioned that any credentialing for hair transplant surgeons would follow the same process as for those surgeons being credentialed for specific surgical cosmetic procedures, or groups of cosmetic procedures, by the Royal College of Surgeons.

It is worth noting that there are a few International Society of Hair Restoration Surgery (ISHRS) fellowships (most in the USA) and there is an American Board of Hair Restoration Surgery (ABHRS) examination available for interested doctors. Continued on p30

While there is also no formal training for hair transplant surgical assistants in the UK that results in a recognised qualification, each hair transplant surgeon or hair transplant clinic will have their own method of training assistants

FARJO HAIR INSTITUTE

66

Did you know that we provide surgery insurance to protect your business?

Our Surgery Insurance is specifically tailored to suit your cosmetic practice…

Whether you run one cosmetic clinic or a chain of clinics, it is important to make sure you have adequate insurance in place should the unexpected happen.

We can provide tailor made insurance to protect your cosmetic clinic, drugs and equipment against loss or damage caused by insured events such as storm, flood, escape of water and theft.

Insurance tailored to suit you and your cosmetic clinic…

✓ Quick and competitive quotes ✓ Providing insurance for medical professionals since 1996

✓ 24 hour legal helpline ✓ Up to £5 million liability cover Call our expert advisers free today on 0800 or visit us online at

www.cosmetic-insurance.com

Hamilton Fraser Cosmetic Insurance | Kingmaker House | Station Rd | New Barnet | Herts | EN5 1NZ Hamilton Fraser Cosmetic Insurance is a trading name of HFIS plc. HFIS plc is authorised and regulated by the FCA.

63 43 881

30 STANDARDS I body language

Recently the ISHRS has extended the fellowship program to make distance learning modules available.

It had been suggested that hair transplant surgical assistants could form part of the HEE training framework which would result in a recognised qualification, as they too would have had learning themes in common with the education required for the other modalities that are being overseen

by HEE. However the critical difference between them and other individuals progressing through the HEE training pathway is that they will never function autonomously or have full responsibility for patient care as they would always work under the direct supervision of the hair transplant surgeon.

Whilst there is also no formal training for hair transplant surgical assistants in the UK that results in a recognised qualification, each hair transplant surgeon or hair transplant clinic will have their own method of training assistants.

Training for doctors Hair transplant training for doctors involves a combination of knowledge and skills.

Knowledge can be gained from textbooks, journals, training modules, conferences and workshops.

The ISHRS has published a Core Curriculum and Core Competencies that cover all the educational content required to pass the ABHRS examination.

The ISHRS also has annual scientific meetings where there is always a beginner’s course and an advanced review course for doctors who want to sit the ABHRS examination.

The British Association of Hair Restoration Surgery has one or two meetings a year and one of these at least has educational content.

How does a doctor learn the hands-on skills needed for hair restoration? The ISHRS sponsors surgery workshops and there is one in Orlando every springtime.

Internationally there are usually somewhere between one and three sponsored workshops each year and some of these include cadaver workshops, so attendees can actually get some hands-on experience using cadaver tissue.

At the annual ISHRS conference there are also ‘hands-on’ workshops where attendees can learn how to cut grafts and practice placing grafts on simulated tissue.

It is not quite the same as learning on a patient, but at least it gets one started.

Setting up a surgical facility State of the art consultation rooms have computer screens where patients can be shown before and after photographs, as well as magnified views of their scalps using portable video-microscopes. Examination stations ideally have mirrors set up so the patient can be shown the back of their heads from different angles with optimal lighting.

Good clinical photography forms an important part of the medical record and photos are best taken in a designated area that has the standardised lighting and background.

There are two methods of harvesting donor hairs—the strip technique and the FUE technique—and there are differences in the surgical facilities required for

the two methods.

The strip technique requires a typical treatment room surgery set-up but there are a number of assistants needed to cut the grafts (typically one assistant per very 400 grafts and up to 5000 grafts may be harvested in one sitting) who need to be accommodated at ergonomically comfortable cutting stations.

Operating time is often six to eight hours, so the dental-type operating chair needs to be well padded. Patients should ideally be provided with some entertainment like a TV and refreshments as required.

The FUE technique may only require the surgeon and one or two staff members so it can be performed in a smaller room with less equipment. The majority of surgeons doing FUE tend to have their patients lying down in the prone position for the graft extraction so an attachment for the operating chair/table similar to that on a massage table is required to allow the patient to have their head face down and still be able to breathe.

Whichever method is used, a hair transplant is a meticulous procedure and the work requires a great deal of concentration from all the team members. If the team, led by the surgeon, lacks the motivation required to pay attention to meticulous detail for several hours at a time then they will not achieve the ultimate goal which is a patient satisfied by a natural hair transplant result.

Dr Nilofer Farjo runs the Farjo Hair Institute with her husband Dr Bessam Farjo and Dr Greg Williams is the lead Hair Transplant Surgeon in their London clinic

Not all HA dermal fillers are created equal.

Intelligent manufacturing technology creates a variable density gel1 resulting in...

Optimal tissue integration2 Greater dermal compatibility3

Superior cosmetic results4 High patient satisfaction5

Injectable Product of the Year 2013

Contact Merz Aesthetics NOW and ask for Belotero .

1. BEL-DOF3-001_01. 2. Tran C et al. in vivo bio-integration of three Hyaluronic Acid fillers in human skin: a histological study.

Dermatology DOI:10.1159/000354384. 3. Taufig A.Z. et al., J Ästhet Chir 2009 2:29 – 36. 4. Prager W et al. A Prospective, Split-Face, Randomized, Comparative Study of safety and 12-Month Longevity of Three Formulations of Hyaluronic Acid Dermal Filler for Treatment of Nasolabial Folds. Dermatol Surg 2012, 38: 1143 – 1150. 5. Buntrock H, Reuther T, Prager W, Kerscher M. Efficacy, safety, and patient satisfaction of a monophasic cohesive polydensified matrix versus a biphasic nonanimal stabilized hyaluronic acid filler after single injection in nasolabial folds. Dermatol Surg. 2013; 39(7):1097-105.

MZ020 1/4 PAGE BODY LANGUAGE ADVERT 171 x 62.indd 1

Tel: +44 (0) 333 200 4140 Email: customerservices@merz.com

www.belotero.uk.com

BEL093/0314/FS Date of preparation: April 2014

09/05/2014 14:37

IREJUVENATE & RESOLVEI

THE AHA PEEL YOU NEED IN A PACKAGE YOU’LL LOVE STRAIGHTFORWARD PRODUCTS AND PROTOCOLS 30%, 50% and 70% Glycolic Acid Exfoliating Peel Pads 10% and 15% Glycolic Acid Home Use Exfoliating Peel Gels 30% Glycolic Acid Home Use Exfoliating Heel Peel ENHANCED COMFORT Skin-kind taurine helps to improve results & reduce irritation HANDY SACHETS In-clinic peels in ready-to-use individual sachets

FOR FURTHER DETAILS, SCIENTIFIC & CLINICAL INFORMATION PLEASE CONTACT AESTHETICARE ® 0800 0195 322

© AesthetiCare® 2014 6730/09.14

peels.aestheticare.co.uk

info@aestheticare.co.uk

@aestheticareuk

facebook.com/aestheticareuk

SMARTER TOOLS FOR SMARTER WORKING INTRODUCING TWO REVOLUTIONARY NEW SYRINGES

GREATER WORKING COMFORT Feels light and comfortable in the hand

1

STURDY AND SECURE CONSTRUCTION Robust needle and cannula attachment Tamper-proof seal ERGONOMIC FLOW

INCREASED PRECISION AND CONTROL WITH SMARTCLICK SYSTEM New audible dosage indicator Lets you focus on injection technique rather than the amount injected Easily switch the dosage indicator on and off, for added treatment versatility

Low extrusion force2

his ! t ing life r B e to g pa

SEE WHAT THE NEW RESTYLANE SYRINGES HAVE TO OFFER YOU AND YOUR PATIENTS Download the Layar app, free of charge, from the App Store (iPhone) or Google Play (Android)

Hold your smartphone over the whole advert and scan using the Layar app

References: 1. Galderma Restylane fillers Data on File (4). 2. Galderma Restylane fillers Data on File (5).

RES/018/0514 Date of preparation May 2014

body language I MARKETING 33

Hair loss in the media PR specialist OWEN LABECK outlines the media’s changing attitudes to hair loss, how the public feels about it and what opportunities the untapped market affords practitioners

H

air loss within the media is very much a game of two halves, and that, primarily, is because of Wayne Rooney. Before Wayne announced his hair transplant across social media it was a taboo subject.

The media weren’t really interested in it.

There did, however, exist opportunities for female hair loss to be discussed, including treatments that make the hair thicker, fuller, longer. Post Wayne, the media were very interested in hair loss. They wanted to know, not only about hair transplant surgery, but the various different types of treatments available for men and for women.

The impact of hair loss Losing your hair can have a huge emotional impact. I’ve spoken to hundreds of case studies over the years and it’s something that affects their confidence and self-esteem greatly. A lot of people speak about the additional stress that it has caused in their life.

From a global perspective, one in four women suffers from hair loss or thinning hair. 70 million Americans are dealing with some level of hair loss; six out of every 30 people in the world have some form of baldness.

What’s more, there are more women seeking methods of nonsurgical hair restoration. It’s up 31.8% between 2004 and 2008.

Beyond this, the number of people

seeking some form of treatment has increased by 85% between 2004 and 2012.

According to recent statistics, almost 40% of hair loss sufferers

Losing your hair can have a huge emotional impact

34 MARKETING I body language

According to recent research, hair loss is the body issue that women feel would make them least attractive to men

would spend their life savings to regain a full head of hair. Roughly a third, 30% of hair loss sufferers, would give up sex, if it meant they could have a full head of hair.

About three-quarters, 77% of adults, would be concerned if they were in their 20s, starting out in their careers and experiencing hair loss. That’s also something that we hear from a lot of people in their 30s and 40s, who are still very much in the prime of their career.

60% of hair loss sufferers would rather have more hair than money or friends. Hair loss is the body issue that women feel would make them least attractive to men, and British men are the most likely in Europe to worry about balding,

but they’re also the least likely to do anything about it.

Effects and opportunity So, what does all of this tell us?

Well, there is a receptive audience out there, and there are lots of people who would be receptive to treatment messages. Increased media exposure combined with improved treatments means that there was a huge spike in growth for the industry as a whole.

It’s also estimated that only 3% of hair loss sufferers actively seek treatment. Less than 1% of those go on to actually have a hair transplant, meaning more than 2% have some form of non-surgical treatment. But what’s really exciting is

that 97% are not seeking any form of treatment at all. There’s a real opportunity there!

Particularly since a lot of people are still completely unaware of the treatments that are available to them. How can practitioners take advantage of this? It starts with holding consultations, investigating the cause of hair loss. You can make a diagnosis and recommend treatments, whether it’s medication, such as Regaine, Propecia, laser therapies, or camouflage and cosmetic products—these are all things that could be done in clinics and practices.

Something else to consider is that a lot of the people are treating women with toxins, fillers, laser therapies, etc. Ultimately, practitioners could also be treating them for hair loss, if they are suffering from that issue.

Hair loss is a condition that affects 40% of women. And women talk, to their partners, husbands, boyfriends, brothers, fathers and sons. Many referrals from cosmetic surgeons who aren’t treating female patients for hair loss, but who speak to their husbands, partners etc— they’re literally doing the marketing.

British men are the most likely in Europe to worry about balding, but they’re the least likely to do anything about it, so there’s plenty of opportunity to take advantage of.

Owen LaBeck is the Creative Director at Weber Shandwick in Manchester, a PR and creative agency with offices all over the globe. W: webershandwick.co.uk; E: olabeck@ webershandwick.com

beautifully matured The unique CaHA collagen stimulating dermal filler 10 years’ experience with almost 5 million syringes sold FDA Approved

no wonder you Best Customer Service RAD092/0314/FS Date of Preparation: March 2014

Voted in 2011, 2012, & 2013

Tel: +44(0) 333 200 4140 Fax: +44(0) 208 236 3526 Email: customerservices@merz.com

NOW IN PARTNERSHIP WITH

IREJUVENATE & RESOLVEI

THE LEADING LIGHT IN LED PHOTOTHERAPY Harnessing the power of pure light to naturally stimulate skin rejuvenation and resolve problem skin conditions TARGETED AND CONTROLLED Evidence-based red, blue and near-infrared wavelengths used at a skin-enhancing intensity and dose ADVANCED High-quality, precisely controlled LEDs give the option to deliver all three wavelengths concurrently FLEXIBLE Standalone treatment or used to enhance other treatments; excellent results and great return on investment SAFE AND COMFORTABLE A non-invasive treatment for all skin types no pain or downtime

The Dermalux® is affordable, quick and easy to use, has no downtime and has a high patient satisfaction rate. Deciding to purchase the Dermalux® is a no brainer!

Dr Rekha Tailor, Health + Aesthetics, Farnham

FOR FURTHER DETAILS, SCIENTIFIC & CLINICAL INFORMATION PLEASE CONTACT AESTHETICARE ® 0800 0195 322

© AesthetiCare® 2014 6765/10.14

dermalux.aestheticare.co.uk

info@aestheticare.co.uk

@aestheticareuk

facebook.com/aestheticareuk

The Science of Great Skin NeoStrata: Scientifically advanced, clinically proven dermatologist developed skincare to target specific patient needs.

NeoStrata professionals: Leading medical aesthetic clinics.

Practitioners requiring effective skincare.

Building successful business solutions.

Aesthetic Source: Multi award winning UK distributor.

World renowned proven skincare options for professional aesthetic clinics.

We deliver: Comprehensive training and support.

Focussed marketing and PR campaigns.

Skincare you and your clients will love:

Meeting the needs of your business, delivering high satisfaction to your patients Call us on 01234 313130 info@aestheticsource.com www.aestheticsource.com

body language I SKINCARE 37

Plant stem cells BRENDA CUMMING demystifies the origin and role of plant stem cells in clinical skincare today

P

lant stem cells are one of the fastest growing trends in the world of skincare today. The trend has arisen over the last couple of years due to the many moral and ethical implications of using embryonic, human stem cells in skincare. Scientists and innovators began looking for an alternative and discovered botanical stem cell technology.

History When I was in Hong Kong in 2007, I met the scientist who developed the rare Swiss apple plant stem cell culture, the Utweiler Spätlauber apple. This was the original (and continues to be the most studied) plant stem cell in the skincare market. They found that if they took the stem cell culture and grew it, exposing it to high doses of UV radiation, these cells remained viable.

This is where all the excitement started.

When you think about the Swiss apple, it’s exposed to harshest of all climates. It has survived for hundreds of years – it can survive in the cold and with high levels of sun.

Plants are the oldest and largest organisms on Earth. We have redwood trees in California that are hundreds and hundreds of years old. They endure harsh climates and fires, yet they still thrive.

There are naturally undifferentiated cells located in the plant meristems. These are the origins of the plant’s energy, and supply nutrients throughout the plant’s structure thereby forming various plant tissues and organs. This system preserves the plant’s life as its immobility restricts it from fleeing from danger. If there’s a forest fire, the tree can’t pick up roots and take off, whereas humans can. We have that fight and flight response.

Using plant stem cells So what does a plant’s stem cell do?

In skincare we want to create new cells to grow or replace specialised tissue cells.

Botanical stem cells have the potential to develop into any cell types. They’ll repair the plant from environmental assaults and they’ll provide wound-healing abili-

66 Plants are the oldest and largest organisms on Earth.

They endure harsh climates and fires, yet they still thrive 99

38 SKINCARE I body language

ties for the plant. We want to harness that ability in our own skin.

Botanical stem cells never undergo the ageing process and their immortality gives rise to specialised and unspecialised cells. They have the potential to grow into any organ, tissue or cell in the body and, by being multi-functional, they create a powerful nutrient balm; a wealth of amino acids, sugars and proteins that you’re extracting and putting into the product.

Harvesting plant stem cells Scientists will take a plant stem cell and they’ll create a wound. So they’ll traumatise it and create a callous. Once the callous is healed they go in, get the extract (the nutrient balm) out of it and grow it in a Petri dish with either glycol or water.

It’s a similar to making tea! The result is the plant stem cell culture that is blended into into skincare formulations.

These stem cells help increase the reconstruction of traumatised skin. They act as powerful antioxidants, and are important for inflammation, UV protection and slowing down the ageing process of the cell.

You can grow and harvest plant stem cells on a large scale, so we can be mindful

66 As well as the Utweiler apple, edelweiss is another popular plant stem cell culture.

This helps to heal tisue with damage caused by inflammation or trauma 99 of our ecology. You don’t need to use a lot of water during the harvesting process and it doesn’t involve pesticides, herbicides, genetic modification or heavy metals.

Types of plant stem cell culture As well as the Utweiler apple, edelweiss is another a very popular plant stem cell culture. This helps to heal tissue with damage caused by inflammation or trauma. It works in the dermal and epidermal repairing properties and it’s a potent antioxidant, combating internal and external ageing factors. It also aids the skin’s adaptability to regulate to extreme climate conditions.

A new stem cell that’s out in the market right now is the lilac plant stem cell

culture. Studies are showing that the enzyme produced by that culture reduces acne lesions by up to 40%. It also helps to slow down sebum production and it’s a tyrosinase inhibitor. We’re all working the lilac stem cell into skin-lightening products too as it has some useful benefits for post-inflammatory hyper-pigmentation.

It’s an anti-inflammatory and reduces the trans-epidermal water loss—it’s a very powerful antioxidant, which is a common thread with these stem cell cultures.

Another new botanical stem cell on the market right now is the argan stem cell. Studies show that it accelerates the natural repair process and helps to tighten, tone, and firm the skin, revitalising and protecting the dermal skin cells. A

body language I SKINCARE 39

lot of the studies from the manufacturers who produce these stems cells, say that this is working in the dermis. It reduces the wrinkle depth by up to 26% and increases skin density, encouraging collagen and elastin growth.

The stem cells above are a few of probably 20 that are out in the market. There are many plants that are being studied to grow these mediums and cultures to put into skincare products.

The effect on skincare It’s a culture grown from a medium and so, as mentioned, it’s going to be a nutrient balm. Those sugars, proteins and amino acids are going to stimulate and invigorate sluggish skin cells whose growth and regeneration slow down as we get older.

By improving the health of skin cells, plant stem cell technology is going to offer strong free-radical resilience. This is going to help combat cell decay and the nutrients extracted from this culture are going to help fully preserve skin function.

Benefits for today’s skincare We want to provide first aid for the skin; we want it to recover, we want to restore

and we want to repair. Stem cells are not going to take the place of alpha hydroxy acids. Powerful antioxidants like resveratrol, peptides, Vitamin C and retinoic acid which help to stimulate the skin are going to be supported and enhanced by plant stem cells.

We aim to energise the cell regeneration, repair the skin, aid in UV protection, and deliver high potent antioxidants into the skin, complementing active ingredients in product formulation.

Along with their inherent benefits, we have been impressed by the removal of the moral and procurement concerns associated with human stem cells. The minimal ecological impact was intrinsic to our decision-making and our philosophy is to heal the skin while addressing a wide variety of skincare concerns, so our plant stem cells will only reinforce our mission.

Botanical stem cells enhance the benefits of our product line, whether it’s addressing anti-ageing concerns or environmental damage. They keep inflammation at bay, minimising social downtime.

We first encountered botanical stem cell research in the mid-2000s when the

concept and research were in their infancy, and it’s still in its infancy, in my opinion. We have a long way to go, the door’s just cracked open into the future of plant stem cell research.

Future Looking at tomorrow, we’re investigating several of the myriad options available including the argan, the butterfly bush and many more. New plant stem cells become available every year, enhancing additional skin benefits. They’re highly sustainable eco-friendly ingredients.

They also complement telomere technology, the skincare products promoting anti-inflammatory benefits.

More independent studies are presented every year confirming the anti-ageing benefits of plant stem cell technology.

Our primary goal is increasing stem cell regeneration, enabling youthful skin to return.

Brenda Cumming is an Aesthetic Nurse Specialist and has operated Medical Aesthetics, a skin rejuvenation practice, for over 12 years. Brenda is on the Board of Directors at Lira Clinical.

body language I CASE STUDY 41

Online temperature measurement In selective radiofrequency treatments little has been studied regarding in-depth tissue temperatures. DR LUDMILA STANISLAVOVNA ELLIS shares her findings on online temperatures during radiofrequency treatment using the Vanquish from BTL Industries imager after the 45 minute protocol based therapy. The therapy surface temperatures were captured by camera over the measured area.

I

n the growing aesthetic market, radiofrequency is one of the most popular technological modalities for skin tightening and body shaping treatments. Compared to some other technologies, its main principle has been well studied and is widely known.

The principle of fractional heating in tissue, the mechanism of temperature induced apoptosis in porcine models and the discontinuous temperature measurements have all been published, but there is lack of clinical evidence around in-depth tissue temperature during the therapy.

Without real-time in vivo temperature measurement, some areas might reach temperatures that are too high, whilst other areas might not reach the therapeutically optimal temperatures needed.

One of the main complications in online in-depth temperature measurement is the interference of thermal probes with the source of energyâ&#x20AC;&#x201D;radiofrequency. The selective radiofrequency device delivers the energy contactless to the fat tissue thanks to its different electromagnetic properties.

The aim of this particular study was to prove selective delivery of energy in vivo and the temperature levels and exposure needed for apoptosis induction.

Case study The study was conducted on two patients who were both males in their early 40s and selected according to specific inclusion and exclusion criteria. Fluorescent optical probes were injected into the abdominal fat area 5 cm right and left away from the umbilicus using a metallic needle.

After correctly positioning the probe and verifying its position was in the proper depth by an ultrasound device, the metallic needle was removed while the probe remained in the tissue.

After the probe positioning, each patient was administrated to the therapeutic position and the device applicator was set over the abdominal area. The temperature of the fat layer was continuously measured.

The distance of the skin from the applicator was 1 cm. The therapy power was initially set to 200W and adjusted during the therapy, according to the patientâ&#x20AC;&#x2122;s feeling. The patients tolerated the therapy well. The average set power was 198W, average delivered energy was 192W and the total therapy duration was 45 minutes.

The surface temperature was captured by infrared thermal

Results We found that the average temperature after reaching 43C, which is the therapeutic threshold, was 43.7C in the depth of 1cm while in the depth of 2cm the average temperature in the same time was 42.6C. The temperature of 43C was reached in 1cm in 9 mins on patient number 1 and in 16 mins on patient number 2. So on average this was 12.5 min.

This means that the therapeutic range of temperatures was kept in the 1cm fat tissue for the 32.5 mins on average, for the remaining time of the therapy. The temperature difference between the skin surface and in the 1cm depth at the end of the therapy was 3.2 C on patient 1 and 4.2 C on patient 2, making it an average of 3.7 C. The temperature difference between the skin surface and the 2 cm depth at the end of the therapy was 2.9 C on patient 1 and 3.1 C on patient 2 with an average of 3 C. So while the temperature on the surface stayed relatively low, the temperature of the fat tissue reached higher in both depths measured. Also, in both cases the temperature in the depth of 1cm was higher compared to the 2 cm depth and the skin surface.

The thermal gradient between the skin surface and fat tissue has proven that the thermal focal point is in the depth of about 1cm below the skin surface in the fat tissue. From the measured temperatures and according to the literature we can conclude that the total exposure of the fat tissue in focal depth during the selective radiofrequency treatment is sufficient to influence fat tissue and induce apoptosis.

References: 1. McDaniel D, Weiss R, Weiss M, Mazur C, Griffin C. Two-Treatment Protocol For Skin Laxity Using 90-Watt Dynamic Monopolar Radiofrequency Device With Real-Time Impedance Monitoring.

Drugs in Dermatol 2014;13(9):1112-1117 2. Franco W, Kothare A, Ronan SJ, Grekin RC, McCalmont TH. Hyperthermic injury to adipocyte cells by selective heating of subcutaneous fat with a novel radiofrequency device: feasibility studies. Lasers Surg Med 2010; 42(5):361-370.

3. Weiss R, Weiss M, Beasley K, Vrba J, Bernardy J. Operator Independent Focused High Frequency ISM Band for Fat Reduction: Porcine Model. Lasers Surg Med 2013; 45(4):235-239.

4. Elmore S. Apoptosis: A Review of Programmed Cell Death.

Toxicol Pathol 2007; 35(4):495-516.

5. Baisch H, Bollmann H, Bornkessel S. Degradation of apoptotic cells and fragments in HL-60 suspension cultures after induction of apoptosis by camptothecin and ethanol. Cell Prolif 1999; 32(5):303-319.

6. Atiyeh BS, Dibo SA. Nonsurgical nonablative treatment of aging skin: Radiofrequency technologies between aggressive marketing and evidence-based efficacy. Aesthetic Plast Surg. 2009; 33,(3)283-94.

Our NEW training will help put a smile on your face SILHOUETTE SOFT® is the latest innovative thread technology which both lifts and regenerates • Immediate natural lift: - Progressive restoration of collagen - Entirely re-absorbable component - No incision • 30 minute procedure with long lasting effect for up to 18 months • FDA submitted. CE marked • NEW comprehensive training workshops

er 2014 b m e t p e S m running fro s p o sicians, h y s h k p r o ic W t e h t o aes rgeons: u s and open t ic t e m s ists and co dermatolog

training - Full day ss expert - World cla trainers el demo - Live mod on gain hands experience one box of - Includes threads

“SILHOUETTE ENHANCED THE CONTOURS OF MY FACE AND PUT A SMILE UPON IT” Valérie Kaprisky French Actress

www.silhouette-soft.com

re sorbable sutu Bidirectional re t incision hou with cones wit eck for face and n

ettetraining u o h il s : il a E-m harma.com @sinclairp more d

ooking an for dates, b information

Date of preparation: August 2014 UK/SIPGEN/14/0001

body language I REGULATION 43

Advertising standards LORNA JACKSON talks about advertising standards compliance in the medical aesthetic industry and how to avoid the pitfalls

A

dvertising is a form of marketing communication. It is used to encourage, or persuade an audience to either continue to take an action or to take a new action. It drives consumer behaviour in relation to a commercial offering; for our industry, it’s about getting people to visit a clinic for a treatment.

There are two types of advertising media; broadcast media, which is television and radio, and non-broadcast media, which is a much broader category that I will focus on. This includes magazines, newspapers, brochures, direct mail, posters, SMS or text messaging. It also encompasses online media, from websites to social media, banner advertising, pay-per-click advertising, YouTube and more.

Non-broadcast media Regulations in this area are generally governed by two things, self-regulatory guidance and enforcement, and the advertising of medicines legislation which is a very small part of the Human Medicines Regulations Act. The Medicines and Healthcare products Regulatory Agency (MHRA) have also produced their ‘Blue Guide’ which is a guidance document regarding the advertising of medicines in the UK. This broadly says that you can’t advertise prescription only medicines (POMs) to the public. The area that we mainly focus on is the British Code of Advertising, Sales Promotion and Direct Marketing—colloquially referred to as ‘the Code’.

So who are the police within this industry? We have the Committee of Advertising Practice (CAP)—the people who create, revise and enforce the code for nonbroadcast advertising. Then there are the Advertising Standards Authority (ASA), who are more widely known. They police, investigate

and produce adjudications when they receive a complaint about a piece of advertising. Finally, we have the MHRA who look after the advertising and promotion of medicines and also get actively involved in advertising within private healthcare industries.

In terms of sanctions that the ASA have; if an advertisement is judged to be in breach of the code they will ask that it should be withdrawn or amended before it’s used again. If you consistently fail to comply with what they’ve said, they have effective sanctions which augment in scale, so it’s in your interest not to get too far down that road.

Ultimately it’s best to get your advertisements right the first time, as it stops you wasting your time.

Your time is valuable and you want to be getting on with your business.

You don’t want to be dealing with the ASA. It also has a cost implication and it can affect your reputation.

Post Keogh advice What came from the Keogh report, was that they wanted to encourage the ASA to take a more proactive stance and monitor our industry

more closely.

They also suggested that professional organisations, such as doctor and nurse associations, should ensure that their members act more responsibly when marketing their services, and that they should actively provide guidance to the clinicians who are members of these trade organisations. Keogh also encouraged the ASA to look at hidden advertising, such as that in reality television shows.

The Keogh report also decided that certain advertising practices should be considered to be ‘socially irresponsible’ and thus should be prohibited. This looked at things like time limited deals, financial inducements, buy-one-get-one-free and refer-a-friend offers. The concept of giving competition prizes that related to cosmetic procedures was also deemed to be socially irresponsible.

The ASA had to respond at the point of publication of the Keogh report and they said that they would review this area. In November 2013, they produced their ‘Help Note’ on the Marketing of Cosmetic Interventions (surgical and non-surgical).

I would strongly urge reading this

Non-broadcast media includes magazines, text messaging and online media

44 REGULATION I body language

document. It has more specific content and guidance than their previously published documentation and has many more examples to help understand exactly what you should and shouldn’t be doing with advertising.

There are also a multitude of other smaller help guides on the CAP website which are split down into individual treatments and treatment areas so you can get specific dos and don’ts. On their website you can find the Advice Online section which contains an A to Z list to browse through.

66 To help with how you can advertise the likes of toxins, the MHRA have published an advice document on advertising prescription only medicines on websites 99 Do’s and Don’ts When we’re looking at advertising within our industry, there are some key points that we ought to be getting right. In general, all adverts must not mislead the public, and must not make unsubstantiated, unrealistic or exaggerated claims.

Avoid using words and terminology like ‘revolutionary’, ‘turns back time’, ‘cures’ or ‘eliminates’—all of these count as little more than fluffy jargon that you can’t back up with evidence. If you say a procedure is ‘pain free’ or ‘scar free’, you will need to make sure that there is evidence to substantiate it. The ASA have regularly admonished people for claiming things like ‘pain free laser hair removal’ when the clinical data behind the device they are using does not prove the claim.

The code also advises you to avoid the use of unqualified claims, even words like ‘rejuvenate’, as they can be seen as a little bit wishywashy. They prefer the use of terms such as ‘temporarily reduces the appearance of…’. Most aesthetic treatments are not long-term solutions and will need maintenance, so it’s advised to use wording which doesn’t imply a permanent result.

Make sure that your ‘before and

after’ photos are of genuine patients and that they’re unaltered—no using photo editing software. Images should reflect the treatment that’s being advertised and be in line with the annotations that you have provided for the photos. It’s also important that you have documented consent for patient permission granting the use of those photos in any of your marketing materials.

There have been situations where there’s been a complaint which was principally about the photograph being representative of the treatment advertised. Yet, when the ASA have dug a little deeper, they have concluded that there wasn’t enough evidence that proper consent had been sought for the use of those photos, so they adjudicated on that as well.

There are some areas that are important to highlight from the code and one of those is clinic reputation.

If you use phrases like ‘a leading clinic’, that would be seen to refer to the clinic and not just the practitioners that are working there. So you really need to demonstrate that your clinic has equipment, facilities and other things that most of your local competitors don’t have.

Be really careful when using terms such as ‘best’, ‘foremost’, ‘renowned’, ‘specialist’, ‘leading’ or ‘qualified’ to describe your clinicians, because you’re going to need to substantiate those claims and those qualifications. Don’t link yourself to Harley Street if you’re not actually carrying out any consultations or active clinical practice there. Similarly, if you’ve got one clinic in Manchester and one in London, you cannot claim to be a nationwide business.

Laser Hair Removal Considering hair removal with IPL and lasers, it’s really important that you’re claiming ‘permanent hair reduction’ and not ‘permanent hair removal’. The Code bases this restriction on the US FDA approvals for the devices which notes that the only modality that is allowed to claim permanent hair removal is electrolysis. The efficacy of lasers also varies according to skin type, hair type and hair colour, so it’s best to avoid claiming that your laser hair removal is effective for all consumers and all skin types that

you’re treating.

It’s worth noting that the ASA have upheld complaints where people have said that their lasers were painless.

Injectables With dermal fillers the code notes that you should claim that they can ‘temporarily reduce the appearance of lines and wrinkles’; any suggestion of permanent elimination will get you into trouble.

If you offer dermal fillers and botulinum toxins, you can advertise using words like ‘cosmetic fillers’ and ‘injectable fillers, but you mustn’t name a botulinum toxin or any of the brand names directly in any of that advertising.

However, if botulinum toxin is all you do and you don’t provide dermal fillers, and you advertise that you do ‘cosmetic fillers’, the ASA can pull you up on it as being an indirect promotion of a prescription only medicine. It can seem a bit silly but it’s in their documentation and worth noting.

To help with how you can advertise the likes of botulinum toxins, the MHRA have published an advice document on advertising prescription only medicines on websites. It’s called Advertising of Medicines: Guidance for consumer websites offering medicinal treatment services. It esentially says that you should have no reference to a named prescription-only medicine on your homepage. Your links may refer to conditions but not to the toxin and this includes images, logos, icons, hover text, small print and hidden text. Your website URL itself should not include the toxin brand name.

The MHRA have been actively writing letters to clinics and telling them to cease and desist from various activities in relation to their websites and web addresses. They don’t mind about the meta tag information, which forms the underlying code, for instance the title for your page, any meta descriptions or keywords that are embedded for search engine optimisation of your website, because these are not public facing.

The ASA take a much harder line than the MHRA on the advertising of botulinum toxins. The MHRA for instance have actually admitted in a written document that they simply don’t have the internal resources Continued on p46

Alternatively you can find out more by calling 01628 522 252

46 REGULATION I body language

In order to comply with the code, the consultation itself needs to be the suject of the advert

to police more than the home page of clinic websites. As far as ASA are concerned, the promotion of botulinum toxins, whether it’s directly or indirectly, is in breach of the code and they will investigate a complaint by looking at your whole website or other related advertising.

As an example, in March 2012 there was a Groupon advert which claimed, when challenged, that the ‘facial injection treatments’ advertised by the clinic were for dermal fillers, despite the deal advert offering a choice of crow’s feet, between the eyebrows and the forehead area. Given that dermal fillers are not marketed for areas in that way, it was clearly obvious to the ASA that this was an indirect promotion of a botulinum toxin and they were told not to do that again.

There are however, limited exceptions when a clinic can offer consultations for conditions, at which point you can actually mention botulinum toxin. That covers both wrinkles as a condition and hyperhidrosis as well.

This first came to light in an adjudication published in July 2012 when the ASA decided that it was acceptable for a website to make ‘balanced and factual references to botulinum toxin as a treatment option if the advertisers emphasised the promotion of the consultation rather than the use of an associated

prescription only medicine’. They also said that during that consultation, a range of therapeutic options would be discussed which may or may not lead to the provision of a botulinum toxin. However, if the content or context of claims in the advert go beyond balanced and factual references, then they’re likely to consider that as a promotion.

At the beginning of 2014 there were two complaints made by the Independent Healthcare Advisory Service (IHAS) to the ASA. These were in relation to the websites for two well known clinics and how they had included and advertised botulinum toxin on their website.

The key points that came from these complaints were that the use of phrases such as ‘anti wrinkle’ or ‘wrinkle softening treatment’—instead of botulinum toxin or one of the brand names—does not make the website compliant if visitors who click on that hyperlink then get directed to information about botulinum toxin.

In order to comply with the code, the consultation itself needs to be the subject of the advert, only referencing botulinum toxin treatment as a potential outcome of that consultation. The ASA also said that the written copy on the botulinum toxin needs to be presented in a way that’s similar to the content you’d find in the SPC for the actual brand that you’re using.

The other key point is that in practice, although aesthetic clinics are using some of these toxins for off-label indications, references to that would actually constitute a promotion. So be very careful about describing the uses of botulinum toxin products and whether you’re or not you’re actually advertising an off-label use for those.

They go on to stipulate that photographs are likely to be acceptable within your advertising, providing they are explaining just the area that you’re treating—such as what is a glabellar line or crow’s feet. If you’re trying to show a before and after, an efficacy claim of what the toxin product can do, then that constitutes a promotion according to the ASA. It can be a really tricky one to get right, so think about how you use photographs within this information or whether you just steer

clear of photographs in terms of your advertising content on the use of a prescription only medicine.

Keys to advertising success • Don’t ‘big up’ your qualifications, skills or your clinic’s reputation unless you can back up your claims.

• Don’t directly or indirectly promote prescription only medicines such as the botulinum toxin brands, but promote the consultation for a condition that you’re trying to treat.

• Don’t exaggerate the results that products and devices can realistically achieve or compare them to the results achieved by other devices if you cannot prove that yours does too.

• Don’t just rely on copying supplier literature without confirming its credibility. If somebody questions or queries any claim you make in your advertising, you must be able to substantiate the proof; putting the blame on copied supplier content will not wash.

• Don’t assume that websites and particularly social media don’t count as advertising. You don’t have to go far on Facebook and Twitter these days to see clinics actively advertising botulinum toxin treatments. It’s only a matter of time before more complaints about this are received and actioned upon by the ASA. • Seek advice on your adverts before you publish anything, particularly if you’re going to be spending a lot of money on them. You don’t want to waste money on print media and then find that you have to cease use of it. The CAP have Advice Teams that you can contact, as well as a variety of online assistance.

• Get your advertising right first time and avoid the stress, the cost and the potential for reputation damage.

Lorna Jackson is Editor of the consultingroom.com, the UK aesthetic information website for the public as well as aesthetic information for clinics References: 1. http://www.cap.org.uk/Advice-Trainingon-the-rules/Help-Notes/Cosmetics-interventions-marketing.aspx 2. http://www.cap.org.uk/Advice-Trainingon-the-rules/Advice-Online-Database.aspx 3. http://www.mhra.gov.uk/home/ groups/pl-a/documents/websiteresources/ con031140.pdf

In support of

Time for life—with two limited edition timepieces in support of Doctors Without Borders/Médecins Sans Frontières. Each watch raises £100 for the Nobel Peace Prize winning humanitarian organization. And still these handcrafted mechanical watches with the red 12 cost the same as the classic Tangente models from NOMOS Glashütte. Help now, wear forever. £100 from every product sold is paid to Médecins Sans Frontières UK, a UK registered charity no. 1026588. NOMOS retailers helping to help include C S Bedford, C W Sellors, Catherine Jones, Fraser Hart, Hamilton & Inches, Mappin & Webb, Orro, Perfect Timing, Stewart's Watches, Stuart Thexton, Watches of Switzerland. Find these and other authorized NOMOS retailers at nomos-watches.com, or order online at nomos-store.com

The smartest extension of your hand

body language I PRODUCTS 49

on the market The latest products in aesthetic medicine 1. BTL have launched the Protégé Intima— the first high frequency device for nonsurgical non-invasive labia remodelling and sexual satisfaction enhancement. The device emits oscillating electrical current with forced collisions between charged molecules and ions. The collisions are transformed into heat, and the heat temporarily changes the helical structure of the collagen and changes the structure of elastin. BTL say the result is micro-inflammatory stimulation of fibroblasts to produce new collagen and elastin to enhance dermal structure. The Protégé Intima has automatically adjusted output to ensure no sudden surges in energy, and is said to offer increased safety and confidence that the patient will receive optimal heating of the skin. Advantages of treatment are said to include; no downtime, long-lasting results, comfortable treatment and it can be used for patients with all skin types.Results from BTL conducted tests showed 80% of subjects evaluated improvement in appearance as significant, moderate to significant or excellent. 60% of test subjects reported improvement in sexual satisfaction as significant, moderate to significant or excellent.

BTL Industries, T: 01782 579 060; W: btlaesthetics.com

1

2. The Duetto MT is the world’s first ‘mixed technology’ laser, and has jsut been introduced

by Lynton Lasers—a company with over 20 years expertise in laser and IPL. This new system simultaneously delivers two wavelengths—alexandrite (755nm) and long pulsed Nd: YAG (1064nm). Lynton Lasers say that this technology tackles restrictions of traditional single wavelength lasers through effectively treating fine hairs and all skin types including tanned skin. In traditional mode, the Duetto MT can be used for hair removal treatments on all skin types, and the ‘mixed mode’ offers practitioners flexibility and opens up new treatment possibilities.

Lynton Lasers Ltd, T: 01477 536975; W: lynton.co.uk

2

3

3. Skin Active Triple Action Firming Neck Cream, new from NeoStrata, has been formulated to address sagging discoloured skin on the neck and décolletage, to help it look smoother and younger. The product contains NeoCitrate and N e o Glucos amine to help promote the production of hyaluronic acid and colagen to even pigmentation as well as plumping and firming the skin. Skin Active Triple Firming Neck Cream also contains pro-amino acid and Swiss apple stem cell extract.

Dermatologist Dr Sandeep Cliff says it is, “an essential skincare product to improve the appearance of the neck and décolletage areas which can be tricky to treat.”

Aesthetic Source, T: 01234 313130; W: aesthetic source.com

50 PRODUCTS I body language

4

4. MACOM has relaunched Crystal Smooth with a refreshed identity. The matte black leggings which use emana fabric, can be worn as everyday or exercise wear, and MACOM say they are a technological breakthrough in everyday cellulite treatment. They can also work as a complemetary product used in conjunction with professional cellulite treatments, or be added to any exercise regime as they are said to regulate thermal balance whilst improving microcirculation.

Macom T: 020 7351 0488; W: macom-medical.com 6. The new Fotona Dynamis and Spectro Laser Systems have just been launched featuring a brand new design with a touch screen display control panel and temperature feedback control applicators. The products are Ndâ&#x20AC;?YAG, Er:YAG or dual wavelength and include a new non-invasive gynaecological functionality (more information can be found by visiting balg.co.uk).

Beehive Solutions Ltd T: 020 8550 9108; W: beehive-solutions.co.uk

6

5 5. Lamelat is a new cream to help treat hyperpigmentation. It is said to inhibit melanin synthesis and uses technology based on the β-white peptide and produces a significant skin lightening effect after four weeks of use, while also reducing the appearance of pigmented spots.

Euromedical Systems Limited, T: 01949 838111; W: euromedicalsystems.co.uk

www.wigmoremedical.com I 020 7491 0150 | Tel 0207.514.5975 Stand 68 Benjamin Britten Lounge | www.wigmoremedical.com

52 MEDICAL AESTHETICS I body language

From mouth to dermis DR RAINA ADAMI looks at oral nutraceuticals and whether ingesting ingredients really can create anti-ageing solutions from within

C

ollagen is the most abundant protein in the human body, accounting for about 30%. It’s found almost ubiquitously in skin, joints, ligaments, tendons, bone, blood vessels, eyes and gut. It is vital for skin elasticity and strength.

We know that with age, our total collagen decreases. There are many types of collagen, about 28, but we’ve got three main types which are collagens 1, 2 and 3. In the skin we have collagens 1 and 3, and the ratio of 1 to 3 decreases as we grow older.

As an amino acid collagen imparts a very good tensile strength.

All collagens are a triple-helical amino acid structure containing glycine, proline and hydroxyproline. Hydroxyproline is the most predominant type, made mainly of hydrocarbons with nitrogen and oxygen giving strength and structure.

It’s the main component of the extra-cellular matrix, which is also called the ground substance, found in the dermis. The dermis is the active part of the skin and it is essential for skin elasticity. All collagens serve the same purpose, to help tissues, any tissue, withstand stretching.

Hyaluronic acid and skin ageing Hyaluronic acid is a class of glycosaminoglycan, which is a lubrication proteoglycan. It’s very highmolecular weight and consists of repeating disaccharide units of glucuronic acid and N-acetylglucosamine. It is hygroscopic and absorbs

and retains up to a 1,000 times its weight in water. This is why there is almost always a degree of oedema when we inject hyaluronic acid.

However, this property is what makes skin remain youthful by retaining its turgor, its resilience and its pliability, due to the high content of water. It maintains levels of intracellular water, as well as absorbing water into the extracellular matrix.

It also has a function of toxin elimination, nutrient transport, and it acts as a shock absorber to the skin.

It is the glycosaminoglycan hyaluronic acid found in the highest quantities in the extracellular matrix. The extracellular matrix consists of collagen, elastin and glycosaminoglycans. A lack of fluid results in a lack of elasticity and therefore wrinkles and dry, dull, sallow skin. It is present in most of the body and it is critical to anatomical function. Almost 50% of hyaluronic acid however, is found in the dermis and epidermis.

Hyaluronic acid modulates the lifecycle of skin cells and it helps shed the most superficial layer of the stratum corneum. It has a very short half-life—its longest half-life is in the cartilage of the joint and is between two to three weeks. In the blood, its half-life is just a couple of hours and in the skin, it’s about a day. Here we’re referring to endogenous hyaluronic acid. Hyaluronic acid we inject is artificially cross-linked, that’s why it retains its viscosity.

As the body ages, the hyaluronic acid production decreases. At about the age of 25, our fibroblasts,

body language I MEDICAL AESTHETICS 53

which are the working cells in the dermis, slowly become quiescent and do not remain as efficient. So the breakdown then exceeds the production and we start noticing the depletion of collagen, elastin and hyaluronic acid at about the age of 28. That’s just chronological ageing and what happens with time, irrespective of the insults we subject our skin to.

Intrinsic skin ageing, which is what I’ve just been speaking about, is the unpreventable ageing process which is mainly influenced by hormonal changes over a lifetime.

Extrinsic ageing is the external influences of ageing such as smoking, UV damage and photo-ageing, pollutions and chemical stress.

Oxidative stress and reactive oxygen species play a very major role in all types of ageing. Antioxidants basically don’t allow the cells to repair themselves, they stop the reactive oxygen species from stopping the cells from repairing themselves.

Matrix metalloproteinases, or what we call MMPs, basically work in synergy with reactive oxygen species and oxidative stress accelerates degradation and increases the synthesis of collagen and hyaluronic acid.

The epidermis in the chronological ageing remains normal. However with photo-ageing it becomes thicker with an acanthotic layer, because the stratum corneum is thicker and there is a keratinocyte irregularity.

The dermis has irregularly-arranged elastin fibres in chronological ageing but in photo-ageing, the elastin and the collagen become what we call elastotic. They’re still there, but they’re abnormally stored, so they do not impart that elasticity to the skin and to the dermis.

Healthy skin depends on the organisation and the quantity of collagen fibres in the dermis and extracellular matrix, which are synthesised by the fibroblast. With ageing, activity of the fibroblast decreases

and ageing causes the collagen fibres in the dermis to disorganise.

Why do we bother with skincare? Very often patients just come to us and they just want to fix the problem, but there isn’t a one-stop shop. We always have to give them an ongoing treatment. If we fix them by meta-component with toxins and their structural component with fillers or surgery, but we don’t fix the outer envelope, their face will look out of sync.

The fleshy envelope is the first component to meet the eye and we always have to explain to patients that the skin is not a static organ, it is the most dynamic organ. It reacts to whatever goes on inside the body, to stress, to hormone levels and it reacts to the insults we throw at it every day in the environment.

Everybody who comes to me goes home with a skincare plan. If they need my extra help, then I’ll give them a peel. This is their skincare, and I’m just pressing the accelerator. Patient compliance is the most important factor here.

Ingestible skin care Is it too good to be true? As healthcare professionals, we see a patient as a patient, rather than a beauty client. So we always take a history, examine the patient, diagnose a problem, we correct it, we maintain the correction, and we prevent any further damage.

We’d like to think that collagen drinks are new and they’ve just come out recently, but they’re not new at all. Liquid collagen drinks claim to boost the body’s natural production. These drinks are often marine-based and there was doubt as to how efficiently these were absorbed, due to destruction by the enzymes in the digestive system.

However, clinical studies have shown that a particular hydrolysed—and by hydrolysed we mean pre-digested and broken down into

66 We’d like to think that collagen drinks are new and they’ve just come out recently, but they’re not new at all 99

54 MEDICAL AESTHETICS I body language

Drinking green tea offers a little protection from UV damage due to the proanthocyanidins

three kDa molecules—bovine collagen, Arthred is absorbed through the small intestine and it does stimulate collagen production.

This is very interesting for us. Remember when toxins were discovered, they were discovered as a side-effect of treating squints. They realised that everybody who’s had this medial squint treated, couldn’t frown.

Arthri-D was prescribed to patients suffering from osteoarthritis and rheumatoid arthritis, to try and boost the collagen in their joints, make them more supple and basically rub together more smoothly.

What they found was that these patients had better looking skin, better looking nails and better looking hair.

When they took blood tests, they found the serum hydroxyproline.

Arthri-D is a patented low-molecular weight, pharma grade, hydrolysed bovine collagen product.

It is made through a proprietary process that breaks down the collagen into small pieces. Basically, the proteins are not inactivated. It is extremely digestible, highly absorbable and hypoallergenic. We say hypoallergenic because some of the marine collagens were found to cause anaphylaxis.

Bovine collagen more closely relates to human collagen. The predominant amino acids are glycine, proline, hydroproline, hydroxylysine, and lysine. These comprise about 50% of the substance.

The bio-availability is superior to freeform amino acids. Grayling in 1998, shows that a 10g supple-

mentation of Arthri-D significantly increases the collagen characteristic amino acids in the blood serum.

Hydroxyproline, which is the main component, rises in the blood by 550% after Arthri-D ingestion.

In 1993, Beuka performed a double-blinded placebo control study in which he measured the blood levels of 52 athletes who were taking Arthri-D on a long term period. The marker used was hydroxyproline. This hydroxyproline was continuously and significantly elevated during the supplementation, when compared to the placebo group. By week 10 the hydroxyproline levels were already doubled.

We cannot pick and choose where the collagen we ingest goes.

It doesn’t go preferentially to joints in arthritic patients. It doesn’t go preferentially to facial skin in wrinkled patients. It is distributed according to the collagen distribution in the body. So, the skin will become supple everywhere, basically. Absorption and distribution clearly differs from that of free amino acids and it helps serum collagen amino acids become concentrated in the bodily tissue.

In 1999, Seratal carried out studies over roughly a ten year period, but in 2003, he carried out an 11day study which showed that collagen is transported to cartilage, and positively stimulated, by collagen neosynthesis. In 1999 he investigated the time-course of hydrolyzed collagen absorption in mice, via radio-labelled Arthri-D

cells and then calculated plasma and tissue radioactivity over the next 192 hours.

95% of orally administered Arthri-D hydrolyzed collagen is absorbed within 12 hours. It’s FDA-approved and it meets pharmaceutical standards.

An animal study showed that statistically significant results, saying that SynovoDerma appears to provide the same bodily function as endogenous hyaluronic acid.

Again, a radio-labelled study was carried out, showing that it is not excreted, but is absorbed.

A few studies have been done in Japan, at Toho University and Otsuma University where they’ve show that people taking SynovoDerma or its analogue, showed an increase in skin moisture and smoothness, and a decrease in wrinkles.

L-ascorbic acid, which is a vitamin C, is known to stimulate collagen-specific mRNA for collagen synthesis, as collagens cannot form their healthy triple-helical structure without it. Trace elements such as, copper, manganese and zinc are also very essential for healthy collagen, due to cross-linking because of the lysyl oxidase. Copper is an essential co-factor for this enzyme.

Other antioxidants are grape seed extract from the Chardonnay grape. The proanthocyanidins protects from UV damage. Drinking green tea gives you a little bit of protection, although you get more in a concentrated form. Alphalypoic acid is a water and fat-soluble antioxidant, capable of regenerating other antioxidants.

So, it would appear that ingesting specific ingredients in a specific formula—which have been treated to be easily absorbed—can actually create anti-ageing solutions from within, with statistically significant clinical results. However, they need to be specific, of optimal quality, and high purity in order to ensure therapeutic levels and that the bio-availability is translated for utilisation within the skin.

Dr Raina Adami is a Surgeon specialising in non-invasive aesthetic medicine. She runs Aesthetic Virtue in London’s Harley Street and in Malta and is also the Medical Director of The Academy of Aesthetic Excellence

Aneva Derma TM

Advanced Nutritional SKIN Beverage Anti-Ageing from Within

The Pinnell Award for Product Innovation Aneva Derma

www.aneva.co.uk

Best Anti Ageing Product Aneva Derma

Meeting the needs of your business, delivering high satisfaction to your patients Call us on 01234 313130 info@aestheticsource.com www.aestheticsource.com

Raising the Bar for Skin Health.

New Protocols and Solutions for Creating Healthy Skin.

ZO® Therapeutic Solutions

ZO Skin Health Circle ®

™

Comprehensive & Continuous Solutions

ZO® Daily & Preventive Skincare

Dr. Zein Obagi, Medical Director

ZO World Premiere ®

Under the guidance of Dr. Zein Obagi, ZO Skin Health, Inc. has developed a wide spectrum of new therapeutic treatments and daily skincare solutions that create and maintain healthy skin. Based on the latest innovative advances in skin therapy technologies – unique delivery systems, bio-engineered complexes and exclusive formulations – these products and protocols help physicians provide continuous skin health for all skin types, genders and ages.

ZO Medical ®

ZO Medical therapeutic products and protocols have been optimized to treat a wide range of skin conditions for every type of patient seeking healthier skin. ®

ZO Skin Health ®

Ideal for maintaining the results of therapeutic treatments, providing effective daily skincare and protection from the environment, ZO® Skin Health products support comprehensive and daily skin health.

ZO Skin Health Circle™ ®

With the introduction of these comprehensive solutions – therapeutic, maintenance, daily skincare and protection – the new world of skin health is waiting for you.

World Premiere Video

www.zopremiere.com ZO Skin Health, Inc. and Dr. Obagi have no business relationship with Obagi Medical Products, and Obagi Medical Products does not sell or endorse using any ZO product. “ZO” is a registered trademark of ZO Skin Health, Inc.

ZO is distributed in the UK by Wigmore Medical +44(0)20 7491 0150 +1 949 988 7524 www.zoskinhealth.com

O

DY LAN

G

B

Read, learn and apply

IS

TI

GE

FIED •

UA CP

D CE

R

Medical aesthetics is at your fingertips. Body Language passes on the knowledge of leading practitioners, who will help you with your technique

We are now publishing 10 issues of Body Language per year, and you can subscribe to have hard copies of the Journal delivered to your door for FREE. You will also have full access to our digital archive of back issues. Register now at bodylanguage.net for instant access

july/aug 2011

may/june 2014

july/aug

46

may/june

The UK Journal of Medical Aesthetics and Anti-Ageing www.bodylanguage.net

jan/feb

61

The UK Journal of Medical Aesthetics and Anti-Ageing

mar/apr 2014

jan/feb 2014

63

www.bodylanguage.net

mar/apr

The UK Journal of Medical Aesthetics and Anti-Ageing

november 2014

www.bodylanguage.net

sept/oct 2014

62

The UK Journal of Medical Aesthetics and Anti-Ageing

sept/oct

www.bodylanguage.net

body language

66

Non-surgical reduction

FERE

EN D

A

AND

D IN SI

NCE

Brighten dark circles

E

MELANOMA EPIDEMIC Patient education and prevention strategy

I

LIFESTYLE AND AGEING

FACE FACIAL AESTHETIC CONFERENCE AND EXHIBITION

PREVIEW INSIDE

BODY LANGUAGE IS NOW PUBLISHING 10 ISSUES A YEAR

The effect of diet on skin ageing processes

Eating behaviours and the role of CBT and hypnosis for weight loss

See page 57 for details 28/04/2014 15:11

Non-invasive fat reduction

HAIR LOSS

volume 16 issue 6 number 66

23/12/2013 14:59

BL62 Covers.indd 7

ORIGINS, TECHNIQUES AND EQUIPMENT FOR SURGICAL TREATMENT

EVOLUTION The roots of hair restoration surgery

BL66 Covers.indd 8

I

HAIR TRANSPLANTS Achieving the best results in the art of hair transplantation

I

COSMECEUTICALS

STANDARDS

CORRECTING OTHER PRACTITIONERS’ MISTAKES

BL46 covers.indd 7

15/06/2011 13:58:08

Expression

A NEW LIGHT I SKINCARE PRODUCTS I ROSACEA Alternatives to hydroquinone

Our expert panel provide their recommendations

A comprehensive skincare regime

05/03/2014 22:48

volume 16 issue 5 number 65

Combination body lift for men

volume 16 issue 2 number 62

REGISTER FOR YOUR FREE SUBSCRIPTION! BL63 Covers.indd 8

ShAping Up i COgniTiVE BEhAViORAL ThERApY i FAT FREEZing

Filler nightmares

volume 13 issue 4 number 46

SKIN HEALTH

HYDROXYACIDS FOR ANTI-AGEING SKINCARE body language

AG

C CON

ON

body language

volume 16 issue 3 number 63

volume 16 issue 1 number 61 BL61 Covers.indd 7

BODY AESThETiCS

AL

HETI

body language

body language

FACI

AEST

bodylanguage.net

PERIORBITAL MELANOSIS

bodylanguage.net

E FAC IBITI

The UK and International Journal of Medical Aesthetics and Anti-Ageing

HOW TOXINS HEAL WOUNDS

The UK and International Journal of Medical Aesthetics and Anti-Ageing

EXH

65

SCAR THERAPY

body language

november

THE LATEST RESEARCH ON USING TOXINS TO TREAT DEPRESSION

GLYCATION I LASER COMPLICATIONS I BRUXISM How antioxidants can help

Reduce risk and avoid adverse events

BL65 Covers.indd 8

New legislation and training

27/10/2014 10:53

As new procedures, products and services are launched and patients’ demands intensify, your own knowledge needs to keep up with change. Whether you wish to know about the efficacy and contraindications of a new filler or borrow tips from a master injector of toxins, you can rely on Body Language to keep you informed and up to date.  Body Language is now a monthly journal aimed at all medical practitioners in medical aesthetics and anti-ageing. It is full of practical information written by leading specialists with the intention of helping you in your pursuit of best practice.  Assisting professionals in the medical aesthetics, Body Language has taken stock of developments and investigates the methods of experienced practitioners around the world, commissioning experts to pass on their knowledge in our editorial pages. Our editorial also provides you with professional accountancy and legal advice.  You can also help yourself to continuing professional development (CPD) points. You can determine how many within the CPD scale that our articles are worth to you and self-certify your training.  As a subscriber, you will have access back issues of Body Language online which is a helpful time-saver, allowing you to re-read past articles by referring to them online in seconds.  Body Language continues to be at the forefront of publications in the medical aesthetics sector. Its leading position owes much to it being a practical journal that puts theory into practice and assists you to do your job as best as you can.

REGISTER FREE OF CHARGE ONLINE AT BODYLANGUAGE.NET OR CALL 020 7514 5989

Treatment approaches

27/08/2014 14:59

eTwo & CO2RE

™

™

For the Treament of All Types of Scars Sublative with eTwo: ™

•

Fractionated bi-polar radio frequency technology

•

Heat energy is placed effectively into the upper dermis for a significant increase in both collagen and elastin with minimal epidermal disruption

•

Acne scar treatment with improvement of various textual irregularities

•

Smoother, rejuvenated appearance of the skin

CO2RE : ™

•

A versatile fractional CO2 system with precision-control over the intensity, pattern and depth of ablation

• Unique Fusion Mode that treats both superficial and deep skin layers simultaneously •

Traditional CO2 resurfacing and ablation, laser excision of lesions and minor dermal excisions

•

Fast and effective solution for scar treatment, skin resurfacing and wrinkle treatment

Photos: Stephen Bassett, M.D.

Before

Photos: Alain Braun, M.D.

Post 2 Sublative Treatments Photos: Amy Taub, M.D.

Before

Post 1 CO2RE Treatment Photos: Alain Braun, M.D.

Before

Post 3 Sublative Treatments

Before

Post 3 CO2RE Treatments

info@syneron-candela.co.uk | Tel: 0845 521 0698 | www.syneron-candela.co.uk

Not for use in the U.S. market. © 2013. All rights reserved. eTwo, Sublative and CO2RE are trademarks of Syneron Medical, Ltd. Syneron and the Syneron logo, Candela and the Candela logo are registered trademarks. PB81281EN

body language I EDUCATION 59

training TF

TOXINS AND FILLERS

4 November, Botulinum Toxin Level 2, The DrBK Training Institute, Reading W: drbobkhanna.com 5 November, Dermal Fillers Level 1, The DrBK Training Institute, Reading W: drbobkhanna.com 6 November, Advanced Fillers, Wigmore Medical, London W: wigmoremedical.com 8 November, Botox & Dermal Fillers Foundation, Birmingham W: cosmeticcourses.co.uk 18 November, Dermal Fillers Level 3 - Part 1, The DrBK Training Institute, Reading W: drbobkhanna.com 19 November, Dermal Fillers Level 3 - Part 2, The DrBK Training Institute, Reading W: drbobkhanna.com 20 November, Botulinum Toxin Level 3 (Oral Facial), The DrBK Training Institute, Reading W: drbobkhanna.com 20-21 November, Introduction to Toxins and Fillers, Wigmore Medical, London W: wigmoremedical.com 22 November, Foundation Botox and Dermal Filler Training, Buckinghamshire W: cosmeticcourses.co.uk 11-12 December, Introduction to Toxins and Fillers, Wigmore Medical, London W: wigmoremedical.com 13 December, Foundation Botox and Dermal Filler Training, Buckinghamshire W: cosmeticcourses.co.uk

I

INJECTABLES

9 November, Platelet Rich Plasma (PRP), Wigmore Medical, London W: wigmoremedical.com 15 November, Microsclerotherapy, Wigmore Medical, London W: wigmoremedical.com 21 November, PRP Training, The Paddocks Clinic, Buckinghamshire W: cosmeticcourses.co.uk 11 December, PRP Training, The Paddocks Clinic, Buckinghamshire W: cosmeticcourses.co.uk 16 December, Microsclerotherapy, Wigmore Medical, London W: wigmoremedical.com

S

SKINCARE

4 November, Chemical and Physical Remodelling, Birmingham W: skinmed.co.uk 4 November, Epionce Skincare and Peel Training, Eden Aesthetics, Glasgow W: edenaesthetics.com 4 November, Basic ZO training, Wigmore Medical, London W: wigmoremedical.com

5 November, Microneedling Training, Eden Aesthetics, Essex W: edenaesthetics.com 6 November, Agera Skincare and Peel Training, Eden Aesthetics, London W: edenaesthetics.com 6 November, Intermediate peel training, Skinceuticals Training Centre, Birmingham W: skinceuticals.com 10th November, Epionce Skincare and Peel Training, Eden Aesthetics, Bristol W: edenaesthetics.com 10 November, Medik8 Dermal Roller, Wigmore Medical, London W: wigmoremedical.com 10 November, Advanced NeoStrata, Wigmore Medical, London W: wigmoremedical.com 10-11 November, SkinSynergy Seminar, AesthetiCare Training, Birmingham W: aestheticare.co.uk 11 November, Chemical and Physical Remodelling, South Molton Street, London W: skinmed.co.uk 12 November, Advanced gloTherapeutics, Wigmore Medical, London W: wigmoremedical.com 17 November, Level 4 Chemical Peeling, Hagley training centre, Birmingham W: sallydurant.com 18 November, Chemical and Physical Remodelling focusing on Acne and Rosacea, Crow Wood Leisure, Burnley, Lancashire W: skinmed.co.uk 18 November, Level 4 Dermal Roller, Hagley training centre, Birmingham W: sallydurant.com 20 November, Microdermabrasion (Face & Body), Academy of Advanced Aesthetics, Cambridgeshire W: academyofadvancedaesthetics.com 24 November, gloTherapeutics, Wigmore Medical, London W: wigmoremedical.com 24-25 November, Level 4 Non-Surgical Blemish Removal, Hagley training centre, Birmingham W: sallydurant.com 24-25 November, SkinSynergy Seminar, AesthetiCare Training, London W: aestheticare.co.uk 25 November, Agera Skincare and Peel Training, Eden Aesthetics, Essex W: edenaesthetics.com 25 November, Agera Skincare and Peel Training, Eden Aesthetics, Warrington W: edenaesthetics.com 25-26 November, ZO Medical Basic & Intermediate, Dublin, Ireland W: wigmoremedical.com 26 November, Medik8 Dermal Roller, Wigmore Medical, London W: wigmoremedical.com 26 November, Epionce Skincare and Peel Training, Eden Aesthetics, Essex W: edenaesthetics.com 26 November, Epionce Skincare and Peel Training, Eden Aesthetics, Warrington

W: edenaesthetics.com 26 November, Dermaroller Training, The Paddocks Clinic, Buckinghamshire W: cosmeticcourses.co.uk 27 November, ZO Medical Advanced, Dublin, Ireland W: wigmoremedical.com 27 November, Chemical Peel Training & Starter Kit, The Paddocks Clinic, Buckinghamshire W: cosmeticcourses.co.uk 27 November, Chemical Peel Training Only, The Paddocks Clinic, Buckinghamshire W: cosmeticcourses.co.uk 27 November, Advanced peel training, Skinceuticals Training Centre of Excellence, London W: skinceuticals.com 27 November, Microdermabrasion Training, Eden Aesthetics, Liverpool W: edenaesthetics.com 1-3 December, ZO Medical Basic, Intermediate & Advanced, Wigmore Medical, London W: wigmoremedical.com

13 November, Pressotherapy, Academy of Advanced Aesthetics, Cambridgeshire W: academyofadvancedaesthetics.com 14 November, 8 Point Face Lift Training, Buckinghamshire W: cosmeticcourses.co.uk 15 November, Cryotherapy Induced Lipolysis (Cryolipolysis), Academy of Advanced Aesthetics, Cambridgeshire W: academyofadvancedaesthetics.com 16 November, Acoustic Wave Therapy, Academy of Advanced Aesthetics, Cambridgeshire W: academyofadvancedaesthetics.com 16 November, Mini Thread training, Wigmore Medical, London W: wigmoremedical.com 17 November, 8 Point Face Lift Training, The Paddocks Clinic, Buckinghamshire W: cosmeticcourses.co.uk 19-23 November, Holism in the Ayurvedic Tradition for Practitioners, Reading, UK W: tri-dosha.co.uk

9 December, Chemical and Physical Remodelling focusing on Acne and Rosacea, London W: skinmed.co.uk

21 November, Ultrasound for Skin Rejuvenation, Academy of Advanced Aesthetics, Cambridgeshire W: academyofadvancedaesthetics.com

10 December, Skincare & Peels, Wigmore Medical, London W: wigmoremedical.com

25-26 November, Product Knowledge, Skinceuticals Training Centre of Excellence, London W: skinceuticals.com

15 December, Medik8 Dermal Roller, Wigmore Medical, London W: wigmoremedical.com

27 November, Mini Thread training, Wigmore Medical, London W: wigmoremedical.com

17 December, gloMinerals, Wigmore Medical, London W: wigmoremedical.com

27 November, Managing Complications, Wigmore Medical, London W: wigmoremedical.com

A

AESTHETIC TRAINING

4-5 November, Product Knowledge, Skinceuticals Training Centre, Birmingham W: skinceuticals.com 9-10 November, Ultrasonic Lipo-cavitation, Academy of Advanced Aesthetics, Cambridgeshire W: academyofadvancedaesthetics.com 11-12 November, Radio Frequency (RF) Face and Body, Academy of Advanced Aesthetics, Cambridgeshire W: academyofadvancedaesthetics.com

28 November, CPR & Anaphylaxis Update, Wigmore Medical, London W: wigmoremedical.com 1-20 December, Silhouette Soft 1:1 Refresher Training, London, Midlands, Glasgow W: silhouette-soft.com 14 December, Mini Thread training, Wigmore Medical, London W: wigmoremedical.com 15 December, 8 Point Face Lift Training, Buckinghamshire W: cosmeticcourses.co.uk Send training dates to arabella@face-ltd.com

WIGMORE MEDICAL TRAINING YOUR COMPLETE TRAINING EXPERIENCE  For over a decade, Wigmore Medical have been running competitively priced courses, including all the latest trends, products and techniques to ensure top quality training.  Whether you are a newcomer to the medical aesthetic industry or an established practitioner, we feel there is always a training course or two that we can offer you.  Wigmore Medical offer an extensive range of training courses to choose from, including toxins, fillers, chemical peels, Sculptra, Dermal Roller, platelet rich plasma and microsclerotherapy.  All our hands-on training courses are run to a maximum class size of five delegates to ensure a quality learning environment. Unlike some training providers, we do not overfill the training room with delegates.  Our training is doctor-led, medically-based and independent. Our courses focus on the skills you desire and all our trainers are extremely reputable within their field of expertise.  The dedicated team has always taken pride in looking after all of its clients, with the added personal touch where needed.  Please see below for our upcoming course dates and call us now to register your interest and benefit from our professional training and continuous support.

W: WIGMOREMEDICAL.COM/EVENTS I

TRAINING

DATES

* Only available to doctors, dentists and medical nurses with a valid registration number from their respective governing body.

All courses in London unless specified.

E: TRAINING@WIGMOREMEDICAL.COM

I T: +44(0)20 7514 5979

NOVEMBER

DECEMBER

JANUARY

FEBRUARY

4 ZO Medical Basic 6 Advanced Fillers-TT* (am) 6 Advanced Fillers-CH* (pm) 10 Advanced NeoStrata 11 Advanced NeoStrata 12 Advanced glōTherapeutics 14 Angel PRP* 15 Microsclerotherapy* 16 Mini-Thread Lift* 19 Skincare & Peels 20 Intro to Toxins* 21 Intro to Fillers* 24 glōTherapeutics 25 ZO Medical Basic (Dublin) 26 ZO Medical Interm. (Dublin) 26 Medik8 Dermal Roller (pm) 27 ZO Medical Adv. (Dublin) 27 Mini-Thread Lift* 27 Managing Complications 28 CPR & Anaphylaxis Update

1 ZO Medical Basic 2 ZO Medical Interm.

3 ZO Medical Adv. 8 Dracula PRP* 10 Skincare & Peels 11 Intro to Toxins* 12 Intro to Fillers* 14 Mini-Thread Lift* 15 Medik8 Dermal Roller (pm) 16 Microsclerotherapy* 17 glōMinerals 19 Intro to Toxins*

19 Dracula PRP* 20 Skincare & Peels 20 ZO Medical Basic (Dublin) 21 ZO Medical Interm. (Dublin) 21 Intro to Toxins* 22 Intro to Fillers* 27 ZO Medical Basic 28 ZO Medical Interm.

29 glōTherapeutics 30 Advanced Fillers-TT* (am) 30 Advanced Toxins* (pm) 31 Mini-Thread Lift*

1 Microsclerotherapy* 5 Sculptra* 6 Advanced Fillers-TT* (am) 6 Advanced Fillers-CH* (pm) 7 Mini-Thread Lift* 17 ZO Medical Basic 18 ZO Medical Interm.

23 CPR & Anaphylaxis Update 23 Medik8 Dermal Roller (pm) 24 Skincare & Peels 24 ZO Medical Basic (Dublin) 25 ZO Medical Interm. (Dublin) 25 Intro to Toxins* 26 Intro to Fillers*

FOLLOW @WIGMORETRAINING ON TWITTER FOR THE LATEST UPDATES AND COURSE INFORMATION

Advanced Fillers sessions breakdown: CH = Cheeks/mid-face F = Forehead LF = Lower face TT = Tear troughs

body language I EXPERIENCE 61

A passion for aesthetic medicine Born in the south of Spain, DR BEATRIZ MOLINA trained as a doctor and came to England on a surgical rotation. She developed an interest in non-invasive surgery, and discusses her path to becoming a leading authority in the aesthetics industry

I

was born in the south of Spain, in Andalucia, near Cordoba but I never lived there. Our family moved to different cities every three or four years because of my father’s job as an accountant for a large corporation.

I’m the oldest of three girls— my sisters are two years and four years younger than me. My mum Mari was, and is, a housewife and home-maker and she did a fabulous job. We had such a happy childhood together. My dad Jose Luis was always very proud of the four women in his house and he always helped us in our studies even after a long day in the office. He was, and is, an amazing dad.

My mum took really good care of all of us and is very loving and kind. She will always do anything for anyone. Like my dad, she has always been very supportive and she always listened to us. I would love for her to live closer to us now as I really miss her.

In Spain we were brought up to enjoy dressing up—for us it was very much a cultural thing. We always dressed up to go out, used make up from an early age as well

has having our hair done at salons.

This was normal for us. As a result, I’ve always spent time on ‘me’ and

66 My dad Jose Luis was always very proud of the four women in his house and he always helped us with our studies even after a long day in the office 99

my mother was always there to help—and she did the same for my sisters.

I always hated my nose after suffering a fracture when I was 11 years old. I was actually about five years old when I told my family I was going to be a doctor.

Very early on I was more attracted to surgery, particularly plastic surgery after I fractured my nose and felt concerned about the way it looked.

In Spain, we were brought up to enjoy dressing up

62 EXPERIENCE I body language

Dr Molina was born in the south of Spain, in Andalucia

In the end I started training as a doctor and came to England on a surgical rotation during my medical training and worked at Frenchay Hospital in Bristol. I then went on to become a General Prac-

66 I firmly believe that cosmetic surgery can provide numerous benefits for those who undertake a course of treatment­—it can help increase confidence 99

titioner in Somerset, a job which I enjoyed for a decade.

During that time I became increasingly interested in non-invasive cosmetic surgery and started to research the subject. I was intrigued by the emerging use of the botulinum toxin. I went on to undertake extra training to develop my expertise. It seemed to bring together my interest in surgery as well as my innate feeling that if someone feels great about their face and body, this will impact on all aspects of their wellbeing.

Having this background and interest in surgery, aesthetic medicine became a passion and I made a life-changing decision to set up my

first Medikas clinic in Street, Somerset offering high quality, medically backed cosmetic procedures.

This meant leaving my job as a GP so it was a risk. My aim was to put quality and patient safety at the heart of everything and that hasn’t changed.

My Somerset clinic thrived and I subsequently opened a second in the city of Bath and this year, a third flagship clinic in the Clifton area of Bristol. This was the culmination of a year’s work. In the latter clinic, I’ve been joined by my new business partner, Dr Ian Strawford, who is a GP in Somerset who also has a passion for high quality non-invasive aesthetic medicine.

I firmly believe cosmetic surgery can provide numerous benefits for those who undertake a course of treatment. It can help with issues around depression, can increase confidence and it’s that aspect of my work which I find the most satisfying.

I know this to be the case as I’ve discovered it for myself by benefitting as a patient myself. Given my negative feelings about my nose, I did for many years consider plastic surgery instead I’ve opted for dermal fillers to correct this.

Today I have a great life, I work very hard in managing my clinics and travelling the world as a speaker in this field. My vision is for everyone to recognise Medikas for being at the front of the cosmetic industry as one of the best and I want to continue to be a leading voice in aesthetic medicine.

Dr Beatriz Molina is the founder of Medikas which offers high quality non-invasive aesthetic procedures in the south west of England. She is one of the world’s leading authorities and opinion leaders on aesthetics and in 2014 was appointed vice president of the British College of Aesthetic Medicine. She’s also a consultant for Galderma UK, speaking all over the world about best practice in this area of medicine.











SKINCARE We offer a handpicked collection to suit all applications and benefit your practice

EQUIPMENT We provide a wide range of equipment to ensure practitioners stay ahead of the competition

INJECTABLES Our extensive range allows practitioners to tailor order products to best suit their patient

PHARMACY For the last 30 years we have supplied medical equipment and drugs to practitioners UK wide

TRAINING Unique courses combine leading expertise, intimate group sizes and hands-on training

Wigmore Medical The aesthetic industry’s preferred partner 23 WIGMORE STREET, LONDON, W1G 0EB I E: CUSTOMERSERVICES@WIGMOREMEDICAL.COM I W: WIGMOREMEDICAL.COM I T: 020 7491 0150

COMPOSED • CONFIDENT • MY CHOICE

PURIFIED1• SATISFYING2,3,4 • CONVENIENT5

Now approved for crow’s feet lines

Bocouture® 50 Abbreviated Prescribing Information Please refer to the Summary of Product Characteristics (SmPC) before prescribing. 1162/BOC/AUG/2014/PU Presentation 50 LD50 units of Botulinum toxin type A (150 kD), free from complexing proteins as a powder for solution for injection.

Indications Temporary improvement in the appearance of moderate to severe vertical lines between the eyebrows seen at frown (glabellar frown lines) and lateral periorbital lines seen at maximum smile (crow’s feet lines) in adults under 65 years of age when the severity of these lines has an important psychological impact for the patient. Dosage and administration Unit doses recommended for Bocouture are not interchangeable with those for other preparations of Botulinum toxin. Reconstitute with 0.9% sodium chloride. Glabellar Frown Lines: Intramuscular injection (50 units/1.25 ml).

Standard dosing is 20 units; 0.1 ml (4 units): 2 injections in each corrugator muscle and 1x procerus muscle. May be increased to up to 30 units. Injections near the levator palpebrae superioris and into the cranial portion of the orbicularis oculi should be avoided. Crow’s Feet lines: Intramuscular injection (50units/1.25mL). Standard dosing is 12 units per side (overall total dose: 24 units); 0.1mL (4 units) injected bilaterally into each of the 3 injection sites. Injections too close to the Zygomaticus major muscle should be avoided to prevent lip ptosis. Not recommended for use in patients over 65 years or under 18 years. Contraindications Hypersensitivity to Botulinum neurotoxin type A or to any of the excipients. Generalised disorders of muscle activity (e.g. myasthenia gravis, Lambert-Eaton syndrome). Presence of infection or inflammation at the proposed injection site. Special warnings and precautions. Should not be injected into a blood vessel. Not recommended for patients with a history of dysphagia and aspiration. Adrenaline and other medical aids for treating anaphylaxis should be available. Caution in patients receiving anticoagulant therapy or taking other substances in anticoagulant doses. Caution in patients suffering from amyotrophic lateral sclerosis or other diseases which result in peripheral neuromuscular dysfunction. Too frequent or too high dosing of Botulinum toxin type A may increase the risk of antibodies forming. Should not be used during pregnancy unless clearly necessary. Should not be used during breastfeeding. Interactions Concomitant use with aminoglycosides or spectinomycin requires special care. Peripheral muscle relaxants should be used with caution. 4-aminoquinolines may reduce the effect. Undesirable effects Usually observed within the first week after treatment. Localised muscle weakness, blepharoptosis, localised pain, tenderness, itching, swelling and/or haematoma can occur in conjunction with the injection. Temporary vasovagal reactions associated with pre-injection anxiety, such as syncope, circulatory problems, nausea or tinnitus, may occur. Frequency defined as follows: very common (≥ 1/10); common (≥ 1/100, < 1/10); uncommon (≥ 1/1000, < 1/100); rare (≥ 1/10,000, < 1/1000); very rare (< 1/10,000). Glabellar Frown Lines: Infections and infestations; Uncommon: bronchitis, nasopharyngitis, influenza infection.

Psychiatric disorders; Uncommon: depression, insomnia. Nervous system disorders; Common: headache. Uncommon: facial paresis (brow ptosis), vasovagal syncope, paraesthesia, dizziness.

Eye disorders; Uncommon: eyelid oedema, eyelid ptosis, blurred vision, blepharitis, eye pain. Ear and Labyrinth disorders; Uncommon: tinnitus. Gastrointestinal disorders; Uncommon: nausea, dry mouth. Skin and subcutaneous tissue disorders; Uncommon: pruritus, skin nodule, photosensitivity, dry skin. Musculoskeletal and connective tissue disorders; Common: muscle disorders (elevation of eyebrow), sensation of heaviness. Uncommon: muscle twitching, muscle cramps. General disorders and administration site conditions; Uncommon: injection site reactions (bruising, pruritis), tenderness, Influenza like illness, fatigue (tiredness). Crow’s Feet Lines: Eye disorders; Common: eyelid oedema, dry eye. General disorders and administration site conditions; Common: injection site haemotoma.

Post-Marketing Experience; Flu-like symptoms and hypersensitivity reactions like swelling, oedema (also apart from injection site), erythema, pruritus, rash (local and generalised) and breathlessness have been reported. Overdose May result in pronounced neuromuscular paralysis distant from the injection site. Symptoms are not immediately apparent post-injection. Bocouture® may only be used by physicians with suitable qualifications and proven experience in the application of Botulinum toxin. Legal Category: POM. List Price 50 U/vial £72.00 Product Licence Number: PL 29978/0002 Marketing Authorisation Holder: Merz Pharmaceuticals GmbH, Eckenheimer Landstraße 100, 60318 Frankfurt/Main, Germany. Date of revision of text: August 2014. Further information available from: Merz Pharma UK Ltd., 260 Centennial Park, Elstree Hill South, Elstree, Hertfordshire WD6 3SR.Tel: +44 (0) 333 200 4143 Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard Adverse events should also be reported to Merz Pharma UK Ltd at the address above or by email to medical.information@merz.com or on +44 (0) 333 200 4143.

1. Bocouture 50U Summary of Product Characteristics. Bocouture SPC 2014 August available from: URL: http://www.medicines. org.uk/emc/medicine/23251.

2. Prager, W et al. Onset, longevity, and patient satisfaction with incobotulinumtoxinA for the treatment of glabellar frown lines: a single-arm prospective clinical study. Clin. Interventions in Aging 2013; 8: 449-456.

3. Sattler, G et al. Noninferiority of IncobotulinumtoxinA, free from complexing proteins, compared with another botulinum toxin type A in the treatment of glabelllar frown lines. Dermatol Surg 2010; 36: 2146-2154.

4. Prager W, et al. Botulinum toxin type A treatment to the upper face: retrospective analysis of daily practice. Clin. Cosmetic Invest Dermatol 2012; 4: 53-58.

5. Data on File: BOC-DOF-11-001_01 Bocouture® is a registered trademark of Merz Pharma GmbH & Co, KGaA. 1182/BOC/OCT/2014/LD Date of preparation: October 2014

PURIFIED1• SATISFYING2,3,4 • CONVENIENT5

Botulinum toxin type A free from complexing proteins