Body Language Journal #68 by Body Language Journal

february

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

PHOTOAGEING HOW TO DIMINISH SKIN DAMAGE CAUSED BY SOLAR ENERGY

INJECTABLE Dr Pierre Nicolau looks at the characteristics of dermal fillers

‘BEAUTY IS BEASTLY’

PRP

Dr Raj Persaud and Dr Peter Bruggen review the latest research

Combination treatments and future developments

A perfect match. Sophie Anderton

A complete HA range perfectly designed for your needs Sinclair IS Pharma. 1st Floor Whitfield Court, 30-32 Whitfield Street, London W1T 2RQ. United Kingdom www.sinclairispharma.com Date of preparation: January 2015 UK/SIPPER/14/0003

body language I CONTENTS 3

contents EDITOR Helen Unsworth 020 7514 5989 helen@face-ltd.com ASSISTANT EDITOR Lousie Renwick 020 7514 5989 louise@face-ltd.com COMMISSIONING EDITOR David Hicks 020 7514 5989 david@face-ltd.com EDITORIAL ASSISTANT Arabella Tanyel 020 7514 5989 arabella@face-ltd.com SALES EXECUTIVE Monty Serutla 020 7514 5976 monty@face-ltd.com PUBLISHER Raffi Eghiayan 020 7514 5101 raffi@face-ltd.com CONTRIBUTORS Dr Raj Persaud, Dr Peter Bruggen, Ms Shashi Gossain, Dr Pierre Nicolau, Dr Charlene DeHaven, Mr Taimur Shoaib, Dr Victoria Dobbie, Mr Kambiz Golchin, Dr Elizabeth Raymond Brown, Dr Bessam Farjo 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 2015 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

14 PSYCHOLOGY

• 26 AGENDA OVERVIEW

‘DON’T HATE ME BECAUSE I’M BEAUTIFUL’ —WHEN BEAUTY IS BAD FOR YOU

In addition to regular Injectables, Skin, Business, and now Hair seminars at FACE, BODY Conference will now feature, creating a complete high-end educational aesthetic conference

Dr Raj Persaud and Dr Peter Bruggen examine the latest research exploring whether assumptions based on appearance lead to discrimination of attractive women

19 DERMATOLOGY MIXING IT UP Ms Shashi Gossain has spent 35 years looking at the ingredients that actually work when treating darker skin types with hyperpigmentation

24 CONFERENCE • FACE 2015 Held at the QEII Centre in London’s Westminster on June 4th -7th, FACE 2015 will host a world-renowned speaker panel, delivering a complete educational programme to keep you up to date with the latest developments in medical aesthetics

• 28 THE FACE EXHIBITION With over 80 exhibitors, a packed agenda of exhibitor workshops spanning three days and a choice of comprehensive exhibitor symposiums, FACE 2015 offers delegates every opportunity to explore the latest medical aesthetic products and services

31 INJECTABLES MOVERS AND SHAPERS Dr Pierre Nicolau looks the characteristics of dermal fillers and discusses his experience with polycaprolactone.

31 SKINCARE PHOTOAGEING Solar energy is a huge contributor to skin damage, Dr Charlene DeHaven looks at how this happens and what we can do to diminish it

4 CONTENTS I body language

editorial panel

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.

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.

41 MEDICAL AESTHETICS PRP AND COMBINATION TREATMENTS There are many possible PRP combination treatments in aesthetic and reconstructive medicine. Mr Taimur Shoaib discusses how we can put these to use

47 INJECTABLES TREATING THINNING HAIR Dr Victoria Dobbie looks at how miniaturised hair follicles stimulated by PRP scalp injection can create thicker more manageable hair

51 TECHNIQUE

57 EDUCATION TRAINING DATES A comprehensive course calendar for the industry

59 PRODUCTS ON THE MARKET The latest anti-ageing and medical aesthetic products and services

GETTING TO GRIPS WITH PRP

61 EXPERIENCE

Mr Kambiz Golchin gives an overview of PRP today, looking at what we know and how PRP is developing

THE ART OF HAIR RESTORATION

55 TRAINING LIGHTING THE WAY Dr Elizabeth Raymond Brown

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.

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.

discusses why the ‘Core of Knowledge’ course isn’t always sufficient training for laser and light-based practitioners and the future of education and training for cosmetic interventions

After training as a surgeon in Ireland and England, Dr Bessam Farjo went on to become a leading hair transplant surgeon after a chance encounter changed the course of his career

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

Focused on Results • Focused Ultrasound Fat Cell Destruction for Non-Invasive Body Contouring • Measurable and noticeable long-lasting results after just two weeks • Over 300,000 treatments performed worldwide www.syneron-candela.co.uk | info@syneron-candela.co.uk | Tel. 0845 5210698

This is not intended for use in the U.S. market. ©2014. All rights reserved. UltraShape, Syneron, the Syneron logo and elōs are trademarks of Syneron Medical Ltd. and may be registered in certain jurisdictions. elōs (electro-optical synergy) is a proprietary technology of Syneron Medical. Candela is a registered trademark of the Candela Corporation. PB84611EN

body language I NEWS 7

observations

ROYAL COLLEGE OF SURGEONS PROPOSES A REGISTER OF CERTIFIED COSMETIC SURGEONS. Existing regulation does not provide enough protection for patients A register of certified surgeons should be available to the public to help them make informed decisions and allow employers to ensure that a surgeon is appropriately trained says the Royal College of Surgeons in proposals that include giving patients access to a register of approved cosmetic surgeons. Under current legislation, a medical surgeon must be registered and licensed by the GMC to undertake procedures. However, in the realm of cosmetic surgery there is no common accreditation available because of the variety of surgical areas covered. The proposals have been made by the Cosmetic Surgery Interspecialty Committee (CSIC), set up by the Royal College of Surgeons in 2013 after a review of the regulations of cosmetic interventions, which showed a lack of protection for patients against potential risks of cosmetic procedures. The CSIC recommendation is that private patients undergoing surgery for aesthetic, rather than medical reasons, should be aware of and have access to clear, credible and independent information about the procedure, the surgeon and where their operation will take place. The proposed register will require surgeons to meet new standards of training and certification in order to be included. Patients selecting a surgeon from the register can be assured that they meet the GMC’s standards in the area of training that covers their specialism and the operation they wish to perform. Besides ensuring that listed surgeons have the appropriate professional skills to perform cosmetic surgery, the certification will confirm that all listed surgeons will have undertaken a minimum number of procedures within the relevant region of the body, in a clinic recognised by the health regulator. Practitioners will also have

to provide evidence of the quality of their surgical outcomes. Committee chairman Stephen Cannon, vice president of the Royal College of Surgeons, said the plans could bring a consistency to the standard of care provided. “We are determined to ensure there are the same rigorous standards for patients undergoing cosmetic surgery in the UK as other types of surgery,” he said. “This consultation provides the next step in establishing clear and high standards for training and practice so that all surgeons in the UK are certified to the same level, irrespective of where they trained.

“We want patients, surgeons and providers of cosmetic surgery to respond to this consultation and give us their views so we can develop these new standards.” There are 13 proposed major areas of certification which require speciality training, including head and neck surgery, periorbital surgery, nose surgery, ear surgery, facial contouring, facial skeletal surgery, breast surgery and genital surgery. This consultation is open until Friday 6 March 2015, although responses will be accepted by the Royal College of Surgeons until Friday 20 March 2015

8 NEWS I body language

LOOK-ALIKE SURGERY IS ON THE RISE Media obsessions are informing patients’ surgery requests

FAT STEM CELLS FOUND TO BE BARRIER TO INFECTION New evidence shows dermal fat cells below the skin protect against germs Researchers at the University of California have discovered a new function for adipocytes—they protect the body from invading bacteria and pathogens. The finding was made by researchers at the University of California, San Diego School of Medicine headed by Prof Richard Gallo, MD, PhD, chief of dermatology at the School of Medicine. “It was thought that once the skin barrier was broken, it was entirely the responsibility of circulating (white) blood cells like neutrophils and macrophages to protect us from getting sepsis,” said Gallo. “We now show that the fat stem cells are responsible for protecting us.” This is a welcome discovery for clinical medicine in an age when anti-biotic resistant strains of bacteria such as Staphylococcus aureus, which causes soft tissue infection, are emerging more regularly. In a previous study his researchers noted an increase in the amount and size of fat cells where infection began when laboratory mice were exposed to S. aureus. They also found that the fat cells produced an antimicrobial peptide, AMP, called cathelicidin antimicrobial peptide (CAMP). This peptide kills invasive pathogens, including bacteria, viruses and fungi. “AMPs are our natural first line defence against infection. They are evolutionarily ancient and used by all living organisms to protect themselves,” said Gallo. “The key is that we now know this part of the immune response puzzle. It opens fantastic new options to optimise care.” Gallo is continuing to study the potential clinical applications of the finding.

More consumers want to look like their celebrity idols according to an annual survey by the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) who found that 13% of facial plastic surgeons saw an increase in requests for procedures that replicate celebrities’ features. Angelina Jolie’s lips and cheekbones topped the list of most wanted celebrity features in 2014, with Beyonce’s facial structure, Kim Kardashian’s eyes and jawline, Brad Pitt’s nose and Natalie Portman’s nose not far behind. “Some people are attracted to the power, fame and attention that being a celebrity brings,” says Stephen S.Park, MD, FACS, president of the AAFPRS. “It’s important to remember that simply changing your appearance will not give you the same level of recognition. Celebrity photos are so often re-touched that their images are distorted which can result in unrealistic expectations that propel consumers to seek excessive or extreme surgeries”, he warns. Undoubtedly, social media has played a pivotal role in surging levels of self-awareness, particularly amongst those under age 30. “Selfies” and trends of posting videos, which unlike still photographs cannot be manipulated to reduce a double chin or dynamic wrinkles, have taken vanity to a new level for image conscious consumers according to Dr Park. “One of the best methods to soften dynamic wrinkles is by having neuromodulator injections, as in Botox or Dysport or Xeomin. The 2014 statistics showed that the desire for these treatments is stronger than ever and growing every year.” Park said. The scope of these trends are global—the AAFPRS—the world’s largest specialty association for facial plastic surgery surveys it’s 2,550 facial

plastic and reconstructive surgeon members globally, to uncover industry trend like these. Reconstructive work related to skin cancer is another area that, surgeons are noticing a rapid increase. Despite awareness of the dangers of sun exposure, 87% of surgeons surveyed reported seeing patients for reconstructive facial work associated with skin cancer. The nose was the most common site on the face—for 68% of patients—ahead of cheeks, ears and forehead where procedures using grafts and flaps are a growing industry. “Cosmetic and reconstructive surgery are beginning to merge,” says Dr Park. “Patients desire a beautiful, natural-looking result, but there is also a functional component to a lot of what we do. Nearly half of our members saw an increase in patients seeking reconstructive nasal surgery to correct a problem that arose from a prior cosmetic rhinoplasty. Expectations are high to combine form and function.” In fact the nose is leading the way as the site of most requested surgical procedures for the fifth year, amongst both men and women. While toxins remain most popular for 35 to 55 year olds and fat injections, peels and lasers most appealing to those aged over 35.

Before

After

16 weeks use of NeoStrata Skin Active 4 product regimen; an advanced, comprehensive antiaging regimen, to target all the visible signs of aging with state-of-the-art technologies 1 1.

Farris PA, Edison BL, Brouda I et al.: A High-Potency Multimechanism Skincare Regimen Provides Signiﬁcant Antiaging Eﬀects: Results From a Double-Blind, Vehicle-Controlled Clinical Trial. Journal of Drugs in Dermatology 11(12) 1447-1454, 2013

Cellular Restoration Reduces the eﬀects of glycation

Ingredients 5% Maltobionic Acid a bionic polyhydroxyacid 5% Gluconolactone a polyhydroxyacid

5% Glycolic Acid an alpha hydroxy acid

Formulated to synergistically restore skin’s essential cells

Peptides

Designed to rebuild the deep matrix for skin that is ﬁrmer and more lifted

SuperFruit Antioxidants including Chardonnay Grape Seed Extract

Reduces oxidative damage

Apple Stem Cell Extract A poster presented to the American academy of dermatology in 2014 showed that polyhydroxyacids and bionic polyhydroxyacids eﬀectively inhibit non-enzymatic glycation. 2 Therefore long-term use of these advanced hydroxyacid ingredients will maintain healthy skin as well as reducing exposure to the damaging and cosmetically distressing eﬀects of AGEs. 2 2.

NeoStrata Skin Active Best Cosmeceutical Range WINNER in both 2013 & 2014

NeoStrata Skin Active Best Cosmeceutical Range 2014

Aesthetic Source Best Customer Service 2014

Green B, Edison B et al, Antiaging Bionic and Polyhydroxyacids Reduce Non-Enzymatic Protein Glycation and Sallowness. Poster presentation 72nd Annual Meeting of the American Academy of Dermatology, March 2014.

Call us on 01234 313130

Tel: 0207 491 0150

info@aestheticsource.com

orders@wigmoremedical.com

www.aestheticsource.com

www.wigmoremedical.com

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

63 43 881

body language I NEWS 11

HAS EXTREME SURGERY GONE BUST? Figures show 9% decrease in cosmetic procedures since 2013 The British Association of Aesthetic Plastic Surgeons (BAAPS) has revealed figures that show more rational attitudes towards breast augmentation and body transformation procedures amongst Britons, after last year’s wave of glamour model inspired alterations. BAAPS, the only professional organisation solely dedicated to safety and education in cosmetic surgery, which represents NHS-trained consultant plastic surgeons in UK private practice, confirms a 9% nose-dive in the number of cosmetic procedures carried out since 2013, alongside evidence of a change to aesthetic ideals. According to Rajiv Grover, consultant plastic surgeon and former President of the BAAPS who has responsibility for the UK national audit of cosmetic surgery, “Aesthetic preferences naturally evolve over time—2014 saw men sporting bushy beards and women bushy eyebrows, as well as a number of ‘enhanced’ celebrities downgrade their implant sizes. In cosmetic surgery the natural, less-is-more look is definitely on the rise as patients opt to be ‘tweaked’ rather than ‘tucked’.”

These preferences are echoed in the statistics, which alongside a shift to the ranking of popularity of different procedures for the first time in five years, show a dramatic drop in demand for more conspicuous procedures such as tummy tucks and rhinoplasty. The numbers of more subtle fine-tuning anti-ageing procedures such as eyelid surgery, facelifts and fat transfer, remain largely untouched however. These figures show alongside a 23% plunge in demand for breast augmentation, which continues to remain the most popular procedure. Despite the boom in male surgery during the past decade, the number of male procedures dropped by 15% last year—likely amidst the current male trend for facial hair and more rugged appearances. Eyelid surgery became men’s the most popular aesthetic procedure, and akin to overall trends, it was the more subtle procedures that remained the most favoured. There is little doubt that acceptance of and confidence in these types of procedures will have grown thanks to celebrities like Alan

WOMEN The top ten surgical procedures for women in 2014 (41,364 total—a fall of 9% from 2013) Women had 91% of all cosmetic procedures in 2014. 2014 figures for women in order of popularity: Breast augmentation: 8,609—down 20% from last year Blepharoplasty: 6,903—static Face/neck lift: 6,075—up 1% Breast reduction: 4,823—up 3% Liposuction: 4,138—up 10% (up to 5th from 6th place in 2013) Rhinoplasty: 2,977—down 20% (down to 6th place from 5th) Fat transfer: 2,914—down 4% (up to 7th from 8th place in 2013) Abdominoplasty: 2,608—down 20% (dropped to 8th place from 7th in 2013) Brow lifts: 1,836—down 5% Otoplasty: 481—down 25%

Sugar and other men in the media spotlight seeking a revitalised appearance. According to Michael Cadier, consultant plastic surgeon and BAAPS President; “With demand for the most subtle antiageing procedures such as eyelid surgery and facelifts holding steady, it’s clear that the public of 2014 were after a refreshed or youthful appearance rather than more conspicuous alterations. Proven treatments such as surgical liposuction also continued to rise which is unsurprising, when so many non-surgical alternatives for fat removal seem ineffective. “The message to the aesthetic sector is clear” he continues “patients want subtle and understated – most refreshingly, they are doing their research, taking their time and coming to us with realistic expectations. At the BAAPS we consider this to be a triumph and, as the only organisation based at the Royal College of Surgeons solely dedicated to advancing safety and training in aesthetic surgery, we’re committed to continue in our mission of promoting education and sensible decision making in cosmetic procedures.”

MEN The top ten surgical procedures for men in 2014 (4,042 total—a fall of 15% from 2013) Men had 9% of all cosmetic procedures in 2014. 2014 figures for men in order of popularity: Blepharoplasty: 849—down 4% from last year Rhinoplasty: 713—down 30% (down to 2nd place from 1st in 2013) Breast reduction: 705—down 10% Liposuction: 489—down 10% Otoplasty: 461—down 15% Face/neck lift: 327—down 10% Fat transfer: 241—down 9% Brow lifts: 142—down 19% Abdominoplasty: 105—down 15% Breast augmentation: Static

12 NEWS I body language

INACTIVITY MORE DANGEROUS THAN OBESITY Taking a brisk 20-minute daily walk could lessen an inactive person’s risk of early death, a University of Cambridge study has revealed Research reported in the American Journal of Clinical Nutrition, found that lack of exercise is twice as likely to cause early death as being overweight or obese. As part of the European Prospective Investigation into Cancer and Nutrition (EPIC) Study, the research led by sports medicine professor Ulf Ekelund assessed 334,161 men and women across Europe to consider the link between lack of exercise, obesity and early death. Data gathered over 12 years included the height, weight, waist size measurements and self-reported physical activity levels of participants, who were followed between 1992 and 2000, during which time 21,438 of them died. Links between early death and physical inactivity were observed across all levels of overweight and obesity measures – both in terms of overall

BMI and abdominal obesity. When comparisons were made between the number of deaths linked to obesity and to inactivity the study revealed that double the number of deaths were linked to lack of physical activity. Physical activity levels— combining leisure and at work activity, categorised 22.7% of participants as inactive based on self-reporting of having no recreational activity and being sedentary at work. “Just a small amount of physical activity each day could have substantial health benefits for people who are physically inactive.” Says Prof. Ekelund who led the research in the University’s Medical Research Council (MRC) Epidemiology Unit. The research analysis found that burning just 90110 calories daily—the equivalent of a 20-minute brisk walk—was enough to move an individual from the inac-

events 02.15 12-14 FEBRUARY, 49th Annual Baker Gordon Educational Symposium, Miami, USA W: bakergordonsymposium.com

15-18 FEBRUARY, 7th AmericanBrazilian Aesthetic Meeting (ABAM), Park City, Utah, USA W: americanbrazilianaestheticmeeting.com

12-15 FEBRUARY, DERMACON 2015 - National Conference of the Indian Association of Dermatologists, Venereologists and Leprologists, Mangalore, Karnataka, India W: dermacon2015.com

26-28 FEBRUARY, 6th ISDS Spring Meeting, Cartagena, Colombia W: isdsworld.com

12-16 FEBRUARY, South Beach Symposium, Miami, Florida, USA W: southbeachsymposium.org 12-18 FEBRUARY, The American Brazilian Aesthetic Meeting, Park City, Utah, USA W: americanbrazilianaestheticmeeting.com

26 FEBRUARY – 1 MARCH, AESURG 2015 - Annual Conference of the Indian Association of Aesthetic Plastic Surgeons, Neemrana, India W: iaaps.net 27 FEBRUARY – 1 MARCH, Study Group of Cosmetic Dermatology, Indonesia W: perdoski.org For the full annual list of events, go to bodylanguage.net/events

tive to the moderately inactive group and reduce their risk of early death by 16-30%. Although the effect of exercise was greatest among participants of normal weight, the analysis showed that physical activity also benefited overweight and obese participants. Prof. Ekelund reminds 20 minutes remains a minimum recommendation for all since “physical activity has many proven health benefits and should be an important part of our daily life.” Co-author Professor Nick Wareham, Director of the MRC Unit at Cambridge, agrees that

although public health efforts that reduce levels of obesity are important, we should also be helping people increase overall activity as this could be easier to achieve, maintain and can have significant health benefits. Evidence of the benefits of recreational activity, outside of the confines of what is traditionally considered exercise, has been found in other studies, including a recent study published in the European Journal of Preventative Cardiology which found that yoga is just as good as walking, cycling and aerobics in reducing the risks of cardiovascular disease.

LLLT EFFECTIVE FOR TREATMENT OF ANDROGENIC ALOPECIA SAYS STUDY Results of recent LLLT trials published in the International Journal of Trichology has shown it as a potentially effective treatment for both male and female AGA, either as monotherapy or concomitant therapy. The research was a study to ascertain whether the HairMax LaserComb could provide added efficacy when the device was added as simultaneous therapy to either minoxidil, finasteride, minoxidil and finasteride, or as monotherapy after discontinuation of drugs. Subjects in the study who were treated with the HairMax LaserComb as monotherapy, “two patients (one female, one male) showed significant improvement, four patients (one female, three male) moderate improvement, and zero patients showed no improvement”.

14 PSYCHOLOGY I body language

‘Don’t hate me because I’m beautiful’ —when beauty is bad for you

DR RAJ PERSAUD and DR PETER BRUGGEN examine the latest research exploring whether assumptions based on appearance lead to discrimination of attractive women

esearchers based at the University of Colorado and the Illinois Institute of Technology have just published a study which examines what they describe as a ‘subtle form of sex discrimination’, occurring when attractive women are discriminated against in job interviews, because they are pretty. This is part of a wider phenomenon by which women are more likely to attract stereotyping about their personality and job skills, according to their looks. The study was partly inspired by a now infamous incident when

in April 2012, Samantha Brick, a writer, producer and freelance journalist, published a column in The Daily Mail newspaper titled, ‘‘There are downsides to looking this pretty: Why Women Hate Me for Being Beautiful.’’ The subsequent backlash and media criticism reflected the widespread opinion that the massive beneﬁts of physical attractiveness probably far outweigh any possible disadvantages. The authors of this new study, Stefanie Johnson, Traci Sitzmann and Anh Thuy Nguyen, point out that physically attractive women

are probably particularly discriminated against when applying for jobs seen as more masculine – this would include jobs in construction, for example, as opposed to, perhaps, working as a receptionist. This phenomenon is known within academic psychology as the ‘beauty is beastly’ effect, and reflects a strong tendency to stereotype women according to their looks. This involves often unconscious yet powerful assumptions about what work women will be good at, or not, based solely on appearance. The authors of this new study

body language I PSYCHOLOGY 15

Unconcious assumptions are made about what work women will be good at, or not, based soley on appearance

quote examples of where women who violate their gender roles in the workplace are characterised as the opposite of the female nurturer— as the ‘quintessential ‘bitch’’ who is not at all concerned for others, but only about herself. For example, studies have shown that successful female managers are perceived as abrasive, untrustworthy, selﬁsh, pushy, bitter, quarrelsome, deceitful, and devious. This new study titled ‘Don’t hate me because I’m beautiful: Acknowledging appearance mitigates the ‘‘beauty is beastly’’ effect’ involved a series of experiments set-

ting up a mock job selection where participants were told that they would be evaluating four ﬁnalists for a job in construction. This industry was picked as representing a more ‘masculine’ type of job in which physical attractiveness is theoretically unimportant. The authors of the study contend that be-

ing a more attractive woman in this situation should elicit the infamous ‘beauty is beastly’ effect. The experiment investigated whether they were tactics that women could adopt when applying for jobs which could help overcome stereotyping they might face over appearance and gender.

66 The ‘beauty is beastly’ effect reflects a strong tendency to stereotype women according to their looks 99

16 PSYCHOLOGY I body language

The study involved a series of experiments setting up a mock job selection in construction. This industry was picked as representing a more ‘masculine’ type of job in which physical attractiveness is theoretically unimportant

Acknowledgement One strategy in this predicament is to find a way to openly ‘acknowledge’ what the interviewer might be thinking. In a previous experiment, which partly inspired the current study, mock-job interviews were set up in which an interviewee was in a wheelchair, and either acknowledged or did not acknowledge his stigma. ‘Acknowledgement’ as a tactic in this case took the form of the statement, ‘‘When people meet me, one of the first things that they notice is that I use a wheelchair.’’ The experiment found stigmatised individuals were more likely to be hired when they acknowledged their disability. ‘Acknowledgement’ as a tactic in the current experiment was achieved by altering the response to a question regarding why the applicant should be hired. One group of applicants ‘acknowledged’ their physical appearance by saying in the application, ‘I know that I don’t look like your typical construction worker, but...’. Elsewhere in the application another statement was inserted to the effect: ‘I know that there are not a lot of women in this industry, but...’. The results of the experiment were that the physically attractive applicant performed significantly better when she acknowledged either her appearance, or sex, compared to when she did not. The physically unattractive applicant performed significantly worse when she acknowledged her appearance, yet there was no effect of acknowledging her sex.

One theory is that acknowledging one’s appearance and sex interrupts automatic stereotyping—it gives the female applicant a chance to point out that she does have the ability to do the job and allows the perceiver to make a more substantive evaluation of the job candidate. The study found that when an attractive female applicant acknowledged her appearance, she was perceived as higher in masculine traits required to succeed in construction. Furthermore, she was rated as lower in ‘bitch like’ traits associated with successful women in a male world, than when she did not acknowledge her appearance. It is of particular significance perhaps that the ‘acknowledgement’ tactic reduced discrimination against attractive women among raters high in hostile sexism. This is particularly important as ‘hostile sexism’ is not uncommon and relates to resentful attitudes toward women, such as seeing them as competitive, manipulative, devious, and threatening to men. As a result ‘hostile sexism’ evokes particularly negative reactions when women violate their gender role, such as when women pursue careers outside the home. If the acknowledgement strategy was a significant antidote to ‘hostile sexism’, then this is a vital finding. Another key result from the study, published in the academic journal Organizational Behavior and Human Decision Processes, is that the unattractive applicant was rated signiﬁcantly worse in terms of suitability for the job, when she acknowledged her appearance.

This shows that ‘acknowledgement’ as a strategy has to be used skilfully, for example, a previous study found that acknowledging obesity resulted in more negative ratings in an employment context, and another study found that acknowledging race resulted in more negative evaluations of Barack Obama in the 2008 election, among highly prejudiced individuals. The authors of the current study argue that the beneﬁts of acknowledging a stigma are enhanced when acknowledgment occurs early in the social interaction, and when it is accompanied by hard information that contradicts the stereotype in question. The ‘acknowledgment’ strategy, in this study, seems to result in more negative repercussions if one is not as physically attractive as she believes. The authors conclude that individuals should possess accurate self-perceptions (for example about appearance) before using acknowledgment to reduce the negative effect of stigmas. Raj Persaud and Peter Bruggen are joint podcast Editors for the Royal College of Psychiatrists and a new free to download app entitled ‘Raj Persaud in Conversation’ contains many interviews with mental health experts from around the world and a cutting edge information on the latest research findings in psychiatry, psychology and neuroscience: play.google.com/store/apps/details?id=com. rajpersaud.android.rajpersaud itunes .appl e.com /u s /app/dr raj-persaud-in-conversation/ id927466223?mt=8

Aneva Derma

Advanced Nutritional SKIN Beverage

Anti-Ageing from Within

Aneva Derma™ is a new, clinically proven, nutraceutical drink supplement. The ingredients in Aneva Derma™ Advanced Nutritional SKIN beverage are digested and distributed via the blood vessels into the deeper layer of the dermis, where they multiply and stimulate fibroblast cells to produce more collagen and hyaluronic acid in the dermis. • Boosts collagen production, HA and skin hydration. • Improves overall skin health and supports ageing skin. • Once daily, pleasant tasting, easy to digest.

www.aneva.co.uk

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

50 YEARS young

and still going strong!

• Fotona QX MAX

Ultimate Laser combination for full colour tattoo removal, pigmentation & more. www.laser-tattoo.co.uk

• Fotona Aesthetics & Dermatology

Next generation multi-application platform Nd:YAG & Er:YAG • Laser Hair Removal Avalanche / Fast / Virtually Pain-free / 20 mm spotsize / treat a back in under 20 minutes • Acne & Acne-scar revision • Skin Resurfacing and Rejuvenation • Vascular lesions • Massive application range > 100

• Fotona Laser Podiatry

Verrucae & Onychomycosis treatments www.laser-onychomycosis.co.uk

• Fotona Gynaecology

Wide range of gynaecological treatments • IncontiLase – Stress Urinary Incontinence • IntimaLase – Vaginal Tightening

Finance Terms available / Marketing / Full Training Given

2 Year Warranty / Superb Service Level

For full product details visit www.fotona.com For more information, contact Beehive Solutions today.

Call 0208 5509 108

Email laser@beehive-solutions.co.uk Visit www.beehive-solutions.co.uk

body language I DERMATOLOGY 19

Mixing it up MS SHASHI GOSSAIN has spent 35 years looking at the ingredients that actually work when treating darker skin types with hyperpigmentation

kin types three to six on the Fitzpatrick Scale—the darker skin types—need to be treated very differently to skin types one and two. The more compacted layers of the darker skin types, need more detailed ingredients that work on different layers at different intervals. Each ingredient I use, has published clinical trials. These are trials done by universities on individual ingredients which we put together to give the best efficacy because they work on different layers. Traditionally the topicals used were hydroquinone, retinoic acid and steroids. However the problem with hydroquinone, particularly in

the dark skin tones, is that it causes ochronosis, the blue-grey invisible area that you can’t normally see by naked eye until it’s too late. You can also get rebound hyperpigmentation and a hydroquinone halo around the hyperpigmentated patch. Once that stage has been reached it’s very difficult to reverse the damage. To avoid the damage in the first place it’s best simply not to use hydroquinone, especially in skin types three to six. There are also well-known and well documented problems with retinoic acid and topical steroids. With retinoic acid, you get photosensitivity and with topical steroids you get skin atrophy. You can use it

with caution, but we have seen in our work in South Africa that it’s generally a big no-no. Ingredients What we found works best is combination therapies where there are more alternative ingredients that can give much better results with fewer side-effects. You need a combination of exfoliants and bleaches. The well-known exfoliants are alpha hydroxy acids, glycolic acids, citric acid, mandelic acid and malic acid. The retinoids are retinaldehyde and retinol. Originally we used a lot of glycolic acid but this caused hotspots and cannot be used over a long pe-

20 DERMATOLOGY I body language

riod of time on darker skin tones. Now we use mandelic acid—a much bigger molecule that’s absorbed very slowly into the skin. It doesn’t just penetrate the skin and cause a hotspot. There are only one or two products in the world that use mandelic acid at the moment, but it is the one magic ingredient that we see working on skin types three to six. There are also well-known bleaches such as arbutin, dioic acid, kojic acid, licorice extract, vitamin C, azelaic, phytic and ferulic acid. Dioic acid is a new one – the octadecanoic acid. It’s a big carboxy molecule which works much better with skin types three to six, giving superior results than hydroquinone, with no side effects. The high strength traditionally used depigmenters and exfoliants are kojic acid 4%, azelaic acid 10%, phytic 5% and glycolic 8%. Clinical trials are always carried out at these strengths because they don’t work at lower strengths. There are many topical creams that claim to have all these ingredients at such low percentages that they don’t really work. Before you can even look at any combination, you must make sure that they have at least those percentages. Serum absorption is much better through the skin as these are suspensions. I’ve worked on the stability of these and found it is absolutely imperative that the product is put into an airless pump, because all these acids react with oxygen and the environment and can disintegrate very quickly. High strength depigmenters and exfoliants are an excellent combination for pre-procedures and can be used in conjunction with other laser treatments, such as Fraxal or Q-switched. Studies The proven synergy between kojic acid 4% and glycolic acid 8% in a 39 patient split phase study, comparing glycolic and kojic acid to glycolic with hydroquinone, showed better results with kojic acid. A double-blind, multi-ethnic study comparing hydroquinone with kojic acid and glycolic acid combination showed equal results

with no side-effects—you’re using much safer products without the side-effects. With azelaic acid and glycolic acid there’s a multi-centre randomised double-blind study comparing the hydroquinone 4% with the azelaic and glycolic acid combination which gave equal results, but the latter had fewer side-effects. Retinaldehyde 0.25% in glycolic acid converts the retinaldehyde to retinoic acid. This combination gives much better delivery of high amounts of retinaldehyde into the skin, while preventing the sideeffects which you would otherwise normally get with a topical. A US study shows this. Azelaic acid and retinoic acid synergy is well-known in reducing hyperpigmentation. Azelaic acid was studied on its own at 9%, so we know any product with less than 9% won’t work. Another study was done on cultured human melanoma using arbutin 3%. The melanin synthesis was reduced by 24%, and a further Japanese study showed 60% reduction in melanin with alpha arbutin 3% and beta arbutin 3%. They inhibit tyrosinase together in a non-

competitive action. I test everything myself and I’ve come to the conclusion that there are very few, if any, products that use the concentration that clinical trials have actually documented so you must check.

Glycolic and TCA have a higher tendency to create hotspots in phototypes three to six. For darker skin types, it shouldn’t be used

Melanin Our biggest enemy is the production of melanin from the sun. We have to look at mechanisms which stop production and the synthesis in several stages. Octadecanoic acid has competitive inhibitors; a tyramine that fights for the same cell receptors. This means there is 50% reduction straight away. Looking into the mechanisms of melanin synthesis and where you can block is very important, because we want the end result of the melanin to be minimal. One study was done with the

66 High strength depigmenters and exfoliants are an excellent combination 99

novacutis

22 DERMATOLOGY I body language

66 Phytic acid 5% is one of the new ingredients used more in treatments for hyperpigmentation or skin brightening 99 dioic acid 1% and hydroquinone just 2%. This was an open comparative 12 week study on a 96 female patients with melasma. The dioic acid is like azelaic with 18 carbon atoms instead of nine and is made from yeast so it’s a natural product which gave much better results than hydroquinone did. We also saw a significant reduction in melanin which we measured with a Chroma Metre or a Maxi Metre to get the percentages. This was performed on a 20 patients of Indian and Pakistani origin and we got fantastic results. Tyrosinase production was reduced by 52%, the melanin synthesis— actual production was reduced by 46% in the first instance and the tyrosinase production by 54%. Ferulic acid and vitamin E synergy is an effective whitening agent. This is also an antioxidant with an anti-melanogenic activity. Ferulate is vitamin E and that’s also a significant inhibitor of tyrosinase. Licorice extract is also wellknown. It’s called glabridine and is an anti-inflammatory with a tyrosinase inhibitor. Trials show good results with not too many side-effects. Phytic acid 5% is one of the new ingredients used more in treatments for hyperpigmentation or skin brightening. There’s synergy between phytic acid and ascorbic acid, with fantastic results on a double-blind trial on 30 patients, randomly done over three months. The study showed statistically significant improvements between the drug and the vehicle. Treating hyperpigmentation There are three ways you can treat hyperpigmentation. First of all is dermarolling with skin brightening agents. Second is to use a serum with a combination of clincally proven ingredients. These are combinations of minimum eight to 12 ingredients. If you really want

to see a difference, very high percentages of these ingredients have individual clinical efficacy documented. We use these together in one single preparation. The third way I treat hyperpigmentation is with chemical peels. The chemical peeling that is used for phototypes three to six is totally different to treatment for phototypes one and two. I would recommend mid-depth skin peeling which includes the papillary dermis and is essential for the removal of melanin. There are several stages and several depths of melanin. We have a superficial peel and then we have the mid-depth peel. Rapid acting acids—for example glycolic and TCA—have a higher tendency to create hotspots in phototypes three to six. These hotspots can easily convert to dark skin patches. For Asian skin types and certainly for darker skins, it’s a big no because it creates hotspots. Mandelic acid is the magic ingredient. It’s a stronger acid than glycolic acid and it has a large molecule, giving slow penetration into the skin. It’s safe to use on a longacting face mask, which should be left for eight to 12 hours, without hotspots. It’s actually incorporated into what we call a ‘skin-whitening’ face mask which has to be left for a minimum of eight hours to make sure all the skin whitening ingredients seep into the skin over a period of time. It’s not something you can do in a short period of time and expect a quick result. It’s better to go gently, doing just the one treatment. The patient will start flaking in day three and day four, so there’s a four day downtime. I have found this to have great results. One patient treated who had a lot of pigmentation, saw at least 50% reduction after 2 weeks. Six weeks later it was completely cleared. In the Philippines we did

the same treatment on a patient who showed 80% reduction in four weeks. We’ve carried out this treatment many times and it has absolutely or vastly cleared pigmentation, to the point where marks are invisible or barely visible. To conclude, there is sufficient evidence that skin bleaching agents with slow acting exfoliants are safe and effective in managing hyperpigmentation in skin types three to six. Shashi Gossain is a pharmacist and cosmetic scientist with four specialist hyperpigmentation clinics around the world

Licorice extract is an anti-inflammatory with a tyrosinase inhibitor

24 FACE 2015 I body language

Held at the QEII Centre in London’s Westminster on June 4th -7th, FACE 2015 will host a world-renowned speaker panel, delivering a complete educational programme to keep you up to date with the latest developments in medical aesthetics

his year FACE 2015 enters its 13th year as the UK’s premier aesthetic conference in the heart of London’s Westminster. A strategic alliance with EuroMediCom, one of the largest worldwide medical aesthetic conference organisers, means that the standard of the conference will be at the highest possible level, attracting delegates from across Europe and beyond. FACE 2015 will now be one of the largest conferences in the world dedicated to aesthetics and will continue to dominate the high end UK market of medical aesthetics. In addition to the regular Skin, Business, and now Hair seminars at FACE, the BODY Conference will also be coming to FACE 2015 creating a complete high-end educational aesthetic conference. The FACE 2015 weekend will be of a similar format to previous years for delegates and exhibitors with lectures across different agendas taking place throughout the day, along with exhibitor workshops and seminars. FACE 2015 will follow on from previous years

by having a low-cost entry ticket allowing access to the exhibition area and exhibitor workshops which has proved very popular and successful in encouraging new delegates/ entrants into the market alongside a wider range of clinic personnel who may not normally attend the traditional scientific congress. With the marketing power of EuroMediCom and FACE’s 12 year heritage as a premier educational and scientific forum, this conference is on course to be the biggest and the best the UK has ever seen. Advanced masterclass For the first time in FACE history, there will be a pre-conference Advanced Training Masterclass on Thursday 4th June, with Dr Ali Pirayesh as the Scientific Director on ‘Essential anatomy and techniques for aesthetic procedures’. Aimed at medical aesthetic practitioners across all levels of expertise, the course will be created with a view to keep the delegate in tune with noninvasive strategies and understand the key anatomy of the full face. Clinically related presentations

highly focused on practical aspects will include cadaveric anatomy videos and how to avoid and manage complications. By the end of the course, the delegate will be able to integrate and apply this information into their practice with confidence whilst improving and excelling in their clinical performance on aesthetic and rejuvenation procedures. Live stream to Singapore With CFA Singapore 2015 —Clinical Facial Aesthetics Singapore, taking place on the same day, for the first time ever FACE 2015 will be streaming live coverage of the Pre-Conference Advanced Training Masterclass all the way to our delegates and friends in Singapore.

The pre-conference Advanced Masterclass with Dr Ali Pirayesh will be live streamed to Singapore

body language I FACE 2015 25

SPEAKERS INTERNATIONAL LINE-UP FACE 2015 As always, FACE will present a stellar speaker line-up from around the world lecturing in their areas of expertise. Here, you will find just a handful of experts who are already confirmed to attend and speak at FACE 2015. Keep an eye out in our February and May pre-programmes as well as online at faceconference.com/ speakers for up to date speaker listings.

DR BETH BRIDEN DERMATOLOGIST, US Dr Briden is founder and medical director of Advanced Dermatology and Cosmetic Institute and specialises in chemical peels, lasers and cosmetic dermatology.

DR CHARLENE DEHAVEN PHYSICIAN, US Dr DeHaven is the clinical director of iS Clinical, and is a board certified physician with an emphasis on age management and health maintenance.

DR RACHAEL ECKEL COSMETIC DERMATOLOGIST, TRINIDAD AND TOBAGO Dr Eckel is a global key opinion leader in her field, and principal trainer for ZO Europe, regularly lecturing on skincare advances.

MR TONY GEDGE DENTAL PRACTICE GROWTH STRATEGIST, UK Mr Gedge specialises in marketing to women, and along with his wife Cally, coaches 97 cosmetic dentists.

DR ZEIN OBAGI CONSULTANT DERMATOLOGIST, US Dr Obagi is an innovator, scientist, published author, lecturer, board certified dermatologist and founder of ZO Skin Health Inc.

DR ALI PIRAYESH CONSULTANT PLASTIC SURGEON, NL Dr Pirayesh has a special interest in cosmetic surgery of the face, breast, bodycontouring injectables and lasers.

DR CHRISTOPHER ROWLANDPAYNE, CONSULTANT DERMATOLOGIST, UK Dr Rowland-Payne is secretary general (and past president) of the European Society for Cosmetic and Aesthetic Dermatology.

DR MARK TAGER AESTHETIC PHYSICIAN, US Dr Tagar is an industry educator. He has a keen interest in physician leadership and provider-patient communication, as well as the latest innovations in healthcare.

DR CARL THORNFELDT CLINICAL DERMATOLOGIST, US Dr Thornfeldt had 30 years of skin research experience and has spent almost two decades researching the skin barrier and cutaneous inflammatory conditions.

26 FACE 2015 I body language

Agenda overview In addition to regular Injectables, Skin, Business, and now Hair seminars at FACE, BODY Conference will now feature, creating a complete high-end educational aesthetic conference  INJECTABLES Friday through Sunday will host national and international lecturers to help delegates maximise results and minimise problems when using cosmetic injectables for total facial contouring. Different techniques, new treatment approaches and concepts will be explored alongside practical demonstrations. GROUND FLOOR, CHURCHILL AUDITORIUM Friday/Saturday/Sunday  For more agenda information visit faceconference.com

INJECTABLES AND ADVANCED

BODY

 SKIN With many different competing skincare lines, it can be confusing to establish which brands to choose. FACE provides a forum for practitioners to meet the true experts who understand ingredients, formulations and the arguments behind competing concepts and brands. This three day forum will focus on new topical approaches to preventing and treating signs and symptoms of ageing skin alongside the latest specific approaches to treating acne, rosacea and hyperpigmentation. 4TH FLOOR, ST JAMES’S SUITE Friday/Saturday/Sunday SKIN

 BODY As the BODY aesthetics market continues to grow with an ever increasing range of non-surgical solutions and indications, we will incorporate lectures on a wide range of treatment options into the traditional Equipment agenda sessions. The market is evolving

with many platform systems having indications for both body and facial aesthetic treatments—and the BODY agenda will explore the latest concepts, practical tips and business models currently available. 4TH FLOOR, WESTMINSTER SUITE Friday/Saturday/Sunday

body language I FACE 2015 27

 HAIR With so many different non-surgical and surgical treatment options now available for the treatment of androgenetic alopecia, alongside growing demand for solutions to hair loss, FACE are hosting a special one day symposium devoted to exploring this sector of the aesthetic market. A panel of experts will explore in depth the different potential treatment solutions available. 4TH FLOOR, RUTHERFORD ROOM Saturday

HAIR

 BUSINESS In an increasingly competitive market everyone needs to raise their game and FACE provides a unique two day forum for clinic owners, managers and marketeers to explore a wide range of topics related to the art of marketing. Professional speakers including specialist marketeers, web designers, and social media gurus will give you the latest information on techniques that work specifically in the aesthetic market. 4TH FLOOR, HENRY MOORE ROOM Friday/Saturday

BUSINESS

 AESTHETICIANS This event is tailored specifically to exploring advanced treatments that are performed by nonmedically qualified practitioners with different skill sets, interests and backgrounds. The last 10 years has seen the role of beauty therapists, laser technicians and other practitioners working in the aesthet-

THREADS

 THREADS The concept of the use of different types of threads for facial rejuvenation has been in development since the late 1990s and since then many other other types of threads have been actively promoted to the aesthetic community. This special one day workshop will explore the latest data evaluating the efficacy and long term safety of threads for facial rejuvenation, alongside the technical issues of placing threads and the experience required to deliver these treatments in aesthetic practice. 4TH FLOOR, RUTHERFORD ROOM Friday

AESTHETICIANS

ics market rapidly evolve and many of the lectures are delivered by therapists who have specialist expertise and experience in their chosen field, with FACE providing a dedicated forum to share knowledge and stimulate debate amongst therapists. 4TH FLOOR, ABBEY ROOM Friday/Saturday

28 FACE 2015 I body language

The FACE exhibition With over 80 exhibitors, a packed agenda of exhibitor workshops spanning three days and a choice of comprehensive exhibitor symposiums, FACE 2015 offers delegates every opportunity to explore the latest medical aesthetic products and services

his year delegates will be able to attend our largest programme of exhibitor workshops to date to learn about the latest products and services available to the industry. Workshops run for up to an hour and a half and can include lectures, presentations and live demonstrations as well as targeted Q&A sessions at the end. Please note, there will also be additional extended half day and full day sponsored Workshops to look out for too which will take place in separate rooms at the QEII Centre.

BRONZE SPONSORS

           

4TH FLOOR CHAUCER/KEATS/SHELLEY/ WORDSWORTH ROOMS Friday/Saturday/Sunday

  DIAMOND SPONSOR MERZ AESTHETICS Stand 85

    

PLATINUM SPONSOR WIGMORE MEDICAL Stand 86

  

GOLD SPONSOR GALDERMA Stand 36

GOLD SPONSOR SKINCEUTICALS Stand 84

  

SILVER SPONSOR AESTHEITC SOURCE Stand 12

SILVER SPONSOR SYNERON CANDELA Stand 87

  

3D Aesthetics Stand 27 Aestheticare Stand 75 Avita Medical Stand 46 Boston Medical Stand 09 BTL Aesthetics Stand 77 Consulting Room Stand 55 Cynosure Stand 67 Device Technologies Stand 18 Eden Aesthetics Stand 70 H&P Design Stand 97 Hamilton Fraser Stand 69 Institut Hyalual Stand 80 Invasix UK Stand 64 iS Clincial Stand 96 JMSR Stand 72 Lifestyle Aesthetics Stand 49 Lumenis Stand 11 Lynton Lasers Stand 45 Magic Needle Stand 74 Q Medical Technologies Stand 01 Restoration Robotics Stand 43 Rosmetics Stand 94 Sinclair Pharma Stand 92 Solta Medical Stand 58 TSK Laboratory Stand 98 Tavger Stand 63 Wisepress Stand 79 Zeltiq Stand 14

JUNE 4TH - 7TH QEII CENTRE LONDON Twitter: @face_ltd Facebook: facebook.com/faceltd T: 020 7514 5989 E: info@face-ltd.com W: faceconference.com

Please complete the form, ticking the relevant boxes for attendance options and return to 2D Wimpole Street, London, W1G 0EB. To book via phone call 020 7514 5989 or visit faceconference.com to register online.

BEFORE 28.02.15

AFTER 28.02.15

 £300

PASS 2: FULL DELEGATE PASS INCLUDING ADVANCED MASTERCLASS June 4th, 5th, 6th and 7th—access to all lectures and advanced masterclass (includes lunch and refreshments) * Student certification will be required

 £599 Student*  £350

 £699 Student*  £350

PASS 3: FULL DELEGATE PASS June 5th, 6th and 7th—access to all lectures (includes lunch and refreshments) * Student certification will be required

 £399 Student*  £250

 £499 Student*  £250

PASS 4: SECOND TIER AGENDA PASS June 5th, 6th and 7th—access to main lecture programmes excluding injectables agenda (includes lunch and refreshments)

 £250

PASS 5: VISITOR PASS June 5th, 6th and 7th—workshops and exhibition only (does not include lunch and refreshments)

 £150

PASS 1: ADVANCED MASTERCLASS ONLY June 4th—one day course (includes lunch and refreshments)

PAYMENT DETAILS PAYMENTS CAN BE MADE BY CARD OR BY CHEQUE MADE PAYABLE TO FACE LTD CHEQUE  VISA  MASTERCARD  SOLO  AMERICAN EXPRESS  CARDHOLDER’S NAME: CARD NUMBER: START DATE: EXPIRY DATE: ISSUE NO: SECURITY CODE: SIGNATURE OF CARD HOLDER 

* Student certification will be required. All prices are inclusive of VAT. Cancellations received before May 24th, 30% of registration retained. Cancellations received after May 24th, 100% of registration fee retained.

DELEGATE DETAILS NAME (inc. title): MEDICAL SPECIALITY: CLINIC/COMPANY: ADDRESS:

POST CODE: TELEPHONE: WEBSITE: EMAIL (MANDATORY) 

Confirmation will be sent by email, please write clearly

body language I INJECTABLES 31

Movers and shapers DR PIERRE NICOLAU looks the characteristics of dermal fillers and discusses his experience with polycaprolactone.

t the beginning of 2000, we started to see a lot of complications with fillers. It was surprising that there were no real studies of the biological affect of fillers in the body. We know that anything we place within the body has the potential to trigger a foreign body reaction to isolate or eliminate a potentially dangerous element. If what we place in the body is recognised it will stimulate a reaction, but if it isn’t, then there will be no reaction. This is the same for fillers— some are designed to fill while others to stimulate and fill. The aim of fillers is to bring volume, but also to create new tissues—mainly a collagen matrix for a filling which will last once the product has disappeared through the produced collagen. For these cases and for these products, the biological reaction is sought after ahead of the ones that are designed only to fill—the socalled volumisers. These volumisers bring injected volume with no reaction. Any reaction will be unfavourable, as the product has not been designed for it. Filler characteristics To have a favourable reaction, a filler must have several characteristics. The particles of the material have to be more than 25 to 30 microns to avoid phagocytosis—one of the first active reactions around the product. The particles have to be spherical as this leads to less inflammation, plus have a smooth surface as this is proven to mean

less enzymatic activity. Eventually we would like to see a positive electric charge on the surface, to have a better reorganisation of the collagen bundles. It’s extremely important that the particles do not degrade since this will change the physical characteristics of the product and will trigger a second reaction. It should also not migrate, or be displaced. Migration is caused by weight or muscular activity, while displacement is an active change of position, mainly through phagocytosis.

We have seen a lot of problems due to the permanent foreign body reaction which is within the collagen capsule. Non-permanent fillers will change with time and that will modify two very important characteristics—the size and volume. If they become smaller, less than 25 microns, it will trigger a second phagocytosis, which will maintain the inflammation. The morphology will change the spherical shape and the smoothness which will trigger a sedentary inflammation.

Some fillers may fill and stimulate and others may only fill

WORLD NOVELTY WITH DEPTH-EFFECT Visit us at the AMWC in Monaco 26 to 28 March 2015 Booth H8 - Ravel Hall

With its innovative mode of action EVENSWISS oﬀers a worldwide unique approach in anti-aging care. The patented active ingredient Dermatopoietin® (a full equivalent of the human epidermal cytokine interleukin-1 alpha) aﬀects the dermal skin layer without penetrating skin by triggering a cascade of reactions which propagates from the surface to the depth of skin. This way it stimulates the natural production of collagen and elastin. 53- YEAR OLD SKIN COLLAGEN LOSS

BEFORE

AFTER TREATMENT

The results are clinically proven and visible: skin rejuvenates in the most natural way.

www.evenswiss.ch

body language I INJECTABLES 33

change in shape or volume, you have the same type-3 collagen reaction and once the product is totally encapsulated, that will stop the inflammatory reaction. There is then time to produce new type-1 mature proper soft collagen. However if the product starts to degrade it will trigger an inflammatory reaction again. A histological study shows that after nine months and 18 months with this type of material, you get the production of type-3 first and then gradually you get the production of more type-1 mature collagen than type-3. The final collagen is of a good quality and not just an immediate protection against a foreign body.

Inflammation means you are going to produce a collagen which is a reaction

The surface of your product has a trigger surface area below which there is no body reaction. However if you augment the surface of contact just slightly you can trigger a very strong inflammatory reaction. A product that becomes porous, will tremendously increase the surface of contact. This explains why we sometimes have very acute inflammatory reactions for up to six months with a product without any apparent reason. Bio fill is certainly much more important as a trigger. Any inflammation through this mechanism will persist for as long as the product particles are present. Inflammation Inflammation means the body will produce a collagen, which is a reaction. A type-3 collagen, like scar tissue, is produced very fast. There are six or seven different types of

collagen in the skin which are mainly type-1, but ‘immature’ collagen has an imbalance with more of type-3, which is long and thick. Main injections in the superficial tissues—dermis and sub-dermis will lead to fibrosis and very rigid looking skin. And there is no evidence that this type-3 will be gradually replaced by type-1. The half-life of collagen is 15 years, but that does not mean the result will last for 15 years or 30 years, rather that changes to skin structure will be maintained for many years. When the product does not

No-degradation products A very interesting study by Mario Cattell, a dermatologist in Dubai, compared a polycaprolactone product with Radiesse. The first case was injected with 4.5 cc of Radiesse and after three months 50% of the volume injected had disappeared. The second case had 1.5 cc and after three months 60% of the volume disappeared. The third case had almost no product left at seven months. She did the same with polycaprolactone. Up to 10 weeks saw a 48% increase of the injected volume of 4 cc. 1 cc saw over 50% increase at 20 weeks. In the chin area, which is not very easy to fill, there was 21% increase at three months. In young patients you can get up to double the injected volume, but for other patients it is around a 20% to 30% increase. They are very small quantities and you need very little product because you know it is going to blow up and you never over correct. Volume and bio-stimulation So do we want volume? Or do we want bio-stimulation? What for? And where? The answer is in know-

66 Main injections in the superficial tissues— dermis and sub-dermis—will lead to fibrosis and very rigid looking skin 99

34 INJECTABLES I body language

ing how the different elements are involved. We know there are bone changes and they can be treated mainly by deep injection of the bone level to compensate for the changes. With deep injections, it’s very important that you don’t compensate the bone by changing the skin and fat. There are several layers of fat in the face including 57% superficial fat in the cheek. 43% is deep fat so we have to think about that, because this superficial fat is equivalent to the body’s amount of the superficial fat. This fat does not really change with age, it changes with weight. If you put on weight, your face will fill with superficial fat. Deep perivascular fat, diminishes with age not the superficial one. The role of the muscles is also very important. We thought for a very long time that muscles would relax with ageing. We now know that this is the opposite. It is contracture that displaces the deep fat and to compensate for that we have to put our volume at a deep level to reposition these displaced deep stretches. With sub-dermal improvement we do not want to change normal anatomy, so do we really need volume in the superficial layers? If you inject the filler in the sub-dermal plane, a smile would cause the fat there to just lift up with the move-

ment and then it would come below your injection side. A superficial layer of sub-dermal fat between dermis and superficial layer of this mass does not change with age, so sometimes we do need it. Occasionally you get protruding veins in places like the temples. With strong veins you have to be careful because you might get a block which will last for quite a few weeks. This is very unpleasant, so in these cases I would tend to do a deep injection. One lady asked me if I could do something for her nose and with .2 ml of polycaprolactone in the tip she had a striking improvement, with very little product. This result will last a long time. I cannot obtain this result with any other product because none of them are mouldable and easy to inject like polycaprolactone. With hands, you have the veins and tendons and in the superficial layer and the tendons in the deep layer. If we manage to inject superficially to the veins we are very safe and there’s no pain because there is structure. I either use a 22 70 gauge or a 25 gauge needle and I inject with the product which is either not diluted or slightly diluted with .2 to .3 of a ml of lidocaine on introspection. This has great, instant results, some of which are very interesting because you can get a very

light thickening to hide deeper structures. When no volume is needed, we use the pure bio-stimulation that we get for the collagen, which is to improve the skin quality. A lady I treated for her lips did not want toxins, peels, or laser treatment. We tried the diluted polycaprolactone because I did not want to put any volume in. I diluted in a 1 to 1, although now I dilute less. She saw fantastic results after three months of just .4 of a ml of total volume injected in the upper lip. She said she was so happy with the results she didn’t want to come back for another session. After six months the results are still incredible and no other product has given me similar results. For a de-volumiser, I want good volume, something that is going to stay where I inject it and be mouldable eventually. I want a product which is not displaced and that will spread if I have to massage to prevent clusters or nodules. Fibres are a real issue, because if you get fibrosis in the fat layer that will show and block the face creating a terrible mass appearance of very tight immobile skin. This is where for me this product has been a complete change. Dr. Pierre Nicolau is a consultant Plastic Surgeon at the University Hospital Saint Louis, in Paris

Superficial fat does not really change with age, it changes with weight. If you put on weight your face will fill up through the superficial fat.

For more information on our 2015 training workshops please email: ellansetraininguk@ sinclairpharma.com

Ellansé™ for natural, youthful and longer-lasting results Ellansé™ dermal fillers provide immediate lift for the correction of wrinkles and folds and stimulate the generation of the body’s own collagen Ellansé™-S

1 year

Ellansé™-M

2 years

Ellansé™-L

3 years

Ellansé™-E

4 years

www.ellanse.com For more information please contact us at Sinclair IS Pharma. 1st Floor Whitfield Court, 30-32 Whitfield Street. London W1T 2RQ. United Kingdom Telephone +44 (0) 207 467 6920 www.sinclairispharma.com Date of preparation: January 2015

SoMUK

Society of Mesotherapy UK

17th Annual Meeting

13th AMWC 2015

Aesthetic & Anti-Aging Medicine World Congress. Annual congress 2015 Paris.

13th Aesthetic & Anti-Aging Medicine World Congress. 26 - 27 - 28 - March, 2015

January 29 - February 1

Monte-Carlo from 26 to 28 March 2015 and will be held under the High Patronage of H.S.H. Prince Albert II of Monaco.

he Society of Mesotherapy UK (SOMUK) has confirmed that it has become a partner of IMCAS Paris and Scientific Partner of AMWC Monaco. The collaboration means that members of the society will be offered free registration to the Anti-Ageing Teaching Course. SOMUK confirmed that in 2015 they are also set to partner Euromedicom, Face2Face (Cannes) and AAAMC (Azerbaijan). President of the society, Philippe Hamida-Pisal, explains that the SOMUK was created in December 2013 as an initiative to generate an academic

dialogue amongst practitioners interested in mesotherapy. One of the Society’s principal aims is to incentivise academic institutions in the United Kingdom to include mesotherapy as a key alternative treatment in practitioners syllabus. We have achieved this by becoming a partner or scientific partner of a number of important aesthetic congresses.

«Not only does this provide our members with an international reference and access to expert knowledge where the practice of Mesotherapy is more prevalent, but also benefits our members by providing access, at the reduced fee, to the respective congresses where the SOMUK is partner, improved networking as the Society grows from strength to strength, and access to expert advice through the society and network in the UK.»

The SOMUK next Annual Conference will be held on the 11th of April 2015.

partner

body language I SKINCARE 37

Photoageing Solar energy is a huge contributor to skin damage, DR CHARLENE DEHAVEN looks at how this happens and what we can do to diminish it

olar light is energy composed of free radicals termed photons. When sun strikes skin, these free radicals also bombard the skin. Skin experiences much more free radical damage than any other organ in our body. It is exposed to the same type of free radical damage as our internal organs and, in addition, experiences free radical damage from the external environment including solar light and multiple other sources. Inflammatory processes are then initiated related to sunlight, pollution and other toxins in our environment. In the interior of the body, free radical damage occurs primarily from the generation of energy within each cell. Each cell has a function and in order to perform its job, the generation of energy by the cell is required. The generation of energy within the cell—or metabolism—is a free radical process. Nature provides excess energy creation as a way of insuring that we have enough during times of physical stress. The extra free radical energy bounces around inside of cells and damages vital cellular structures. Skin experiences that intracellular damage along with all other cells. However, skin is unique in being exposed to sunlight. This additional very large amount of free radical damage from sun exposure contributes to ageing—we call this photoageing. A free radical contains an unpaired electron in its outer orbit and therefore is chemically unstable. In an effort to stabilise , the free radical will steal another electron from whatever structure it first touches. For example, if it touches another molecule within the cell wall of a skin cell, it stabi-

 lises itself by stealing a an electron from that molecule. This process of electron theft then damages the cell wall because it alters its molecular structure. Furthermore, during this process another free radical is created and that free radical is also trying to stabilise itself. It, in turn, will steal the first electron it encounters. This ongoing process of electron theft and free radical generation results in ever-increasing amounts of cellular damage and continuing free radical creation. Free radicals are thus justly considered to be very dangerous substances. Sunlight consists of two primary wavelengths that penetrate our planet’s cloud cover—UVA and UVB. Both UVA and UVB rays damage skin and both contribute to photoageing and cancer risk. When free radicals from sunlight relentlessly hit skin cells, eventually the cell walls will start to breach. When the cell wall is breached, the cellular interior is exposed and free radicals damage it also. Inside the cell are various cell structures called organelles—the tiny organs within the cell itself. Also within the cell’s interior is the nucleus containing the chromosomes, the DNA material. The bases adenine, thymine, cytosine and guanine bond to each other along the double helix of the DNA. In a normal base binding pattern, adenine binds to thymine and cytosine binds to guanine. After free radical damage to DNA, however, an abnormal base pairing occurs with thymine binding to another thymine. These are the DNA lesions most strongly implicated in the development of skin cancer and they certainly also contribute to photoageing. A thy-





mine dimer results when thymine abnormally bonds to another thymine. The normal architecture of the double helix can be destroyed. In addition to telling instructing a cell to divide and replicate a new cell, DNA can also be considered the cellular “command center.” For example, if the cell’s job is to make collagen then the DNA within that cell directs correct collagen manufacture. Damaged DNA cannot give correct instructions and impaired collagen synthesis results. In a standard research proto-

1: an illustration of a free radical molecule containing an unpaired electron in its outer orbital rim—the remaining electrons all occur in pairs. 2&3: free radical damage from photons contained within sunlight bombards cell walls. Free radical damage also occurs within the cell, having penetrated the cell wall. Chromosomes containing DNA are the X-shaped structures within the cell.

38 SKINCARE I body language

col, skin exposed to full spectrum sunlight containing both UVA and UVB rays can be biopsied and stained for thymine dimers. Finding many thymine dimers— thymine abnormally binding to another thymine—indicates large amounts of DNA damage from solar free radicals. However, skin exposed to full spectrum sunlight but with sun-

screen applied before exposure showed no visible thymine dimers. If an instrument is used to quantitatively measure thymine dimers, a few will be detected but there are far, far less than without sunscreen. A negative control examined skin in complete darkness and without sunlight or sunscreen and then compared it to solar exposed skin with the benefit of prior sun-

66 Sunscreens are of two general types — physical blockers and chemical sunscreen actives. 99

screen application. In this study, fewer thymine dimers were found with sunscreen used in the presence of sunlight than there were with skin in the dark. This strongly suggests there is an additional protective factor or factors against internal free radical damage with the sunscreen used in this study. This is an interesting subject that could be further explored. Another type of DNA damage in sun exposed skin results in sunburn cell creation. Sunburn cells are located just above the dermal epidermal junction (DEJ) They are foamy, pink, large cells with heavily pyknotic nuclei consistent with very damaged DNA.

Research regarding the actual application of sunscreen by individuals has shown that subjects put on only about one-third to onefourth the amount of sunscreen required for adequate protection

body language I SKINCARE 39

to sun exposure protected this skin from the formation of sunburn cells and DNA damage. Sunburn cells are so severely damaged by sunlight that they enter into a biologic process called apoptosis or programmed cell death. The body uses apoptosis in positive ways to remove cells with damaged genetic material. But since no biologic process is one hundred percent efficient, some of these cells escape apoptosis. Sunburn cells surviving apoptosis have a very high statistical probability of becoming malignant or cancerous. This is one very important mechanism for skin cancer development . Practical implications Individuals over the age of forty— or even younger—illustrate the effects of accumulated photoageing. As physiologic reserve declines related to ongoing free radical damage over many years, the signs of ageing become visible. Wrinkling, sagging, pigmentary irregularities and uneven skin texture result from photoageing. Photodamaged skin contains microscopic DNA lesions with thymine dimer formation and sunburn cell creation. In a practical sense, we all have a higher risk of developing skin cancer and a very increased rate of photoageing without the use of sunscreen. Sunscreen use can greatly mitigate the visible signs of photoageing. In the same study mentioned previously, skin that was exposed to sunlight but with sunscreen application prior to exposure contained no visible sunburn cells. These study results show that the application of the sunscreen prior The photomicrograph on the left shows intense brown staining within the cells of the epidermis consistent with thymine dimer formation after full spectrum solar exposure. No thymine dimers are seen on the right when sunscreen was applied 20 minutes prior to sun exposure.

Types of sunscreens Sunscreens are of two general types —physical blockers and chemical sunscreen actives. Both shield us from photoageing and the damage of sun exposure but they work via different mechanisms. The physical block-

ers are inert and do not interact with the skin so there is no accompanying risk of photosensitivity associated with them. Chemical sunscreens harness a chemical reaction to absorb solar energy. Solar energy is absorbed by the sunscreen and used to convert the sunscreen active into another chemical. Most of the resulting chemical converts back to the sunscreen although a few secondary molecules are generated as byproducts. These secondary byproduct molecules can be carcinogenic. After much debate in the medical literature, the prevailing opinion at present is that the overall protection against skin cancer development given through sun protection outweighs the potential carcinogenic effects of the byproducts. Sunscreen use Research regarding the actual application of sunscreen by individuals has shown that subjects put on only about one-third to one-fourth the amount of sunscreen required for adequate protection. Persons may also mistakenly believe that selection of a higher SPF sunscreen allows them to apply less but still achieve acceptable solar protection. Educating patients and clients in the proper amounts of sunscreen to apply is extremely important. Every professional should investigate individual sunscreens and their formulating technology, choosing those best for their particular patient population. The best sunscreen is always the sunscreen that the person will actually use. Dr Charlene DeHaven is Clinical Director of iS Clinical Cosmeceuticals, developer of iS CLINICAL products, based in California.

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

ÂŠ2014. 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 MEDICAL AESTHETICS 41

PRP and combination treatments There are many possible PRP combination treatments in aesthetic and reconstructive medicine. MR TAIMUR SHOAIB discusses how we can put these to use

lot of the treatments that we use in our aesthetic practice— certainly some of the very good ones— have a background in reconstructive treatments, and PRP is no exception. In orthopaedic surgery it’s been used for joint pain, tendonitis, Achilles heel tendonitis and knee injuries. There have even been reported cases of famous sports people who have had PRP to aid their recovery and to bring them back to their competitive states. I have a special interest in head and neck plastic surgery. About nine years ago we began using PRP for the treatment of osteoradionecrosis—where a patient with oral

cancer has radiotherapy and the radiotherapy cuts off the blood supply to the mandible. The mandible is a stress bearing bone and so dies back and needs to be replaced with a vascularised piece of bone either from the hip or the leg. The vascularity of the neomandible was not compromised in any way, but at the edge of the native mandible, sometimes there would be delayed bone healing. Therefore we started using all different types of PRP in cases of osteoradionecrosis. We would double-spin it and add thrombin to get a suturable material to be placed in-between the native mandible and the neomandible. PRP also has a background in

the treatment of diabetic foot ulcers, dramatically improving healing time. Systematic reviews show there is no doubt that PRP favours the healing process for diabetic foot ulcers, indicating infection rates are lower and wound healing more rapid. PRP has a favourable effect on wound healing in general—even the topical application of PRP onto a wound decreases the infection rate associated with the overall treatment for that particular condition. The addition of platelets or PRP to a wound works due to the release of growth factors and cytokines. We know that there are a number of different growth factors and cy-

42 MEDICAL AESTHETICS I body language

tokines that are released and are involved in the cascade of wound healing and repair and regeneration. From our experience in reconstructive surgery and treatments, PRP has made its way into our aesthetic practices. PRP has many uses; we can activate the platelets with thrombin agents and calcium chloride, and use PRP in combination treatments with lasers, dermal rollers, ReCell and fat injections. ReCell and PRP ReCell is effectively “spray-on skin”. A postage stamp sized skin graft is put through a series of enzymes which break down the epidermis from the dermis. It allows us to scrape off the epidermis, including the melanocytes. They are then mashed up, and from a skin graft the size of a postage stamp we can get epidermis to cover the area of an A4 sheet of paper. This is useful where epidermis is of a premium, for example with burns patients. ReCell has its background in treating burns, but it’s also used for stable vitiligo, as we take melanocytes from an area of normal skin and can apply them to vitiligo patches. Sometimes when performing reconstructions we use skin flaps which invariably have a different colour to the reconstructed area. In order for ReCell to work we have to ablate the skin first, removing a layer of epidermis so that the sprayon epidermis will take as a graft onto the ablated area. ReCell is one area in surgery where PRP is being used in combination. It’s currently undergoing investigation—we are unsure how much PRP to use with spray-on skin, at what concentration, and how the proportions may make a difference. We need to perform scientific studies to determine the best treatments and the best combination treatments for these particular uses. Fat injections Fat injections are an important part of our cosmetic and reconstructive practice for restoring volume. The

body language I MEDICAL AESTHETICS 43

advantage of using fat over dermal filler treatments, is that we have a larger volume of fat that can be used over a larger area and fat injections are permanent. As well as importing fat cells, fat injections also import stem cells, so the skin is rejuvenated as a side effect. The main problem with fat grafts is the unpredictability of the final result in terms of the volume achieved. Generally speaking, we tell patients that approximately half of the fat graft will not survive. If you have two fat cells, one of which survives and one of which does not survive, your body will simply dissolve the non-surviving fat cell—but it will take about six months. This means we need to overfill patients by a small amount to achieve desired longer term results. Patients will often say they liked the result three months post-surgery but over time the volume decreases. This is the main degree of unpredictability of fat grafts. If you have just under 50% of the fat graft taking on one side of the face and just over half surviving on the other side, then you can have a significant difference in the volume and quantity of fat that survives. Our reconstructive indications for fat grafting are conditions like HIV, drug associated lipodystrophy or acquired hemifacial atrophy, where half the face starts undergoing atrophy. I’ve also used fat injections following tumour treatments where people have had radiotherapy and chemotherapy to their face during childhood, and the development of their facial soft tissues and bony tissues has been compromised as a result. Sometimes following cancer treatment, patients will have as-

sociated volume defects, and fat grafting is a method of restoring volume once the patient is relatively risk-free of having a recurrence of that cancer. This is because fat cells transport stem cells that release growth factors, which we don’t want to use in cancerous tissue. Fat transfer can be used for volume loss associated with connective tissue disorders where we probably don’t want to use hyaluronic acid fillers because the hyaluronic acid injections will just increase the amount of auto antibodies that a patient has within their bloodstream. PRP has been known to improve the take of a fat graft. Every graft you can think of will require neovascularisation, and the addition of growth factors with PRP will aid this. The controversy is how much PRP should be used for fat grafts. The current thought is that about a third of the injectable should be PRP and two thirds should be fat. We know that PRP helps fat grafts survive in rats and rabbits, but we don’t know whether it works in humans because the methodology of these papers are probably not what you would want to use in humans. It would be good to be able to quantify this and have a better idea of the concentration of PRP to use in our fat grafts. Laser We use a CO2 laser with a fractionated head and additionally an ultrasound head built into it which delivers topically based treatments into the dermis. We start off by creating a series of fractionated perforations with the laser, after which PRP is applied topically to the skin. Then the ultrasound head is used to pass the topically applied

66 The advantage of using fat over dermal filler treatments, is that we have a larger volume of fat that can be used over a larger area and fat injections are permanent 99

44 DEBATE I body language

product through to the underlying dermis. We know the laser and PRP work effectively. In a paper by Shin, they performed fractionated laser therapy on one side of the face alone. On the other side of the face they performed fractionated laser therapy in combination with PRP injections and the healing was more rapid and the effect more pronounced. We also know that you get reduced erythema when you combine PRP with laser treatments. From our wound healing experience we know that infection rates are lower as well. When we set our lasers quite high and we perform fractionated laser treatments, the risk of infection is certainly something that we discuss with our patients. Dermal rollers You can use PRP with dermal rollers especially those with the longer needle length of 2.5mm, so it will pierce into the dermis.

The recovery time is a little longer and the controversial “sandwich” technique is often discussed. This involves treating with a dermaroller to create channels in the skin, then application a topical PRP, then a second dermal roller treatment to mulch the PRP into the dermis. Some people believe this damages the platelets as by spiking them, you cause injury and reduce their efficacy. Anecdotal evidence however, seems to suggest that dermal rollers can be used with PRP to good effect. Again, we don’t know what length of dermal roller is ideal, how many platelets to use—perhaps 10cc of blood or more—and if the platelet damage is a significant factor. In summary, PRP can be used in conjunction with other treatments including surgical treatments such as ReCell and fat injections, as well as aesthetic treatments with laser and dermal roller. PRP alone of course is used for repair, generation and volume restoration, but I think

66 Anecdotal evidence suggests that dermal rollers can be used with PRP to good effect 99 combination PRP is something that we’re increasingly using in our clinics to improve the viability of grafted tissues and to promote wound healing. Mr Taimur Shoaib is a fully accredited specialist consultant plastic surgeon on the General Medical Council’s specialist register for plastic surgery and has his own practice in Glasgow at the La Belle Forme Clinic and in London where he consults at Harley Street. Reference Shin MK, Lee JH, Lee SJ, Kim, Ni (2012) Platelet-rich plasma combined with fractional laser therapy for skin rejuvenation. Dermatol Surg 38(4): 623–30

You can use PRP with dermal rollers especially those with the longer needle length of 2.5mm, so it will pierce into the dermis

Hyabell

is a new generation of hyaluronic acid dermal filler with lidocain • immediately visible • giving natural and long lasting results • is suitable for various indications in the dermis and subcutis • reduces pain and enhances patients satisfaction

More than a promise!

0297 Find out more:

ADODERM GmbH Elisabeth-Selbert-Str. 5 D-40764 Langenfeld Germany www.adoderm.com

World #1 in Automated Hair Transplant with

S.A.F.E.R. /NeoGraft 速

速

(SUCTION ASSISTED FOLLICULAR EXTRACTION & REIMPLANTATION)

WORKSHOPS and TRAININGS -1 day demonstration and practice, February 27th - 3 days intensive hands-on training, February 19-21 Contact us for more information

Tel: +33 1 46 56 24 04 www.medicamat.com contact@medicamat.com

FDA Registered VISIT US at

Booth

AMWC Anti-Aging Medicine World Congress

Monaco, 26 to 28 March 2014

Benefits of S.A.F.E.R.速/NeoGraft速 Minimally invasive procedure, highly improving the accuracy of hair follicles harvesting Patented suction system, allowing the grafts to be extracted without any trauma (transection rate close to 0%) All focus is dedicated to the aesthetic results Less pain, les downtime, faster recovery Reduces the duration of the surgery by more than half compared to manual FUE

MEDICAMAT is a certified ISO 9001 & 13485 french company, specialized since 1978 in manufacturing and distributing innovative and patented aesthetic, medical and surgical devices worldwide - Follow us on

body language I INJECTABLES 47

Treating thinning hair DR VICTORIA DOBBIE looks at how miniaturised hair follicles stimulated by PRP scalp injection can create thicker more manageable hair

M The pattern of androgenic alopecia can be classified by the Norwood scale

ale pattern baldness is characterised by hair receding from the lateral sides of the forehead (known as a “receding hairline”) and/or a thinning crown (balding to the area known as the ‘vertex’). Both become more pronounced until they eventually meet, leaving a horseshoe-shaped ring of hair

around the back of the head. More than 95% of hair thinning in men is male pattern baldness, or androgenic alopecia the pattern of androgenic alopecia can be classified by the Norwood scale. Plasma therapy (PRP) can be useful in treating I-IV on the norwood scale were there are miniaturised hair follicles. PRP cannot active dormant follicles although it has been shown that up to 70% of patients experience extra hair growth from active follicles. Female hair thinning 80 % of women also suffer from hair thinning by the time they are 60 years old. The traditional pattern of loss is different to men. The hair thins along the mid-line and thins over a wide area. However I am seeing women in my clinic with thinning more similar to male pattern hair loss and no underlying medical conditions of PCOS or thyroid function. Womens hair loss is more diffuse so they do not have the same options of surgical transplant or medication. PRP is an effective and safe option for women. ISHR estimates that 21

million women in the USA suffer from hair thinning. Hair loss especially in patients under 30 years can lead to low selfesteem, depression, neuroticism, feeling unattractive and introverted. In fact a survey conducted by International Society of Hair Restoration ISHR came up with startling statistics which give an insight into what a negative effect hair thinning has on patients. 47% of hair loss sufferers asked would spend their life savings to regain a full head of hair. 60% would rather have more hair than money or friends, and 30% would give up sex if it meant they would get their hair back. PRP Platelets are probably best known as components of the blood clotting system. When injury disrupts a blood vessel and causes bleeding, platelets are quickly activated and contribute to formation of a clot that stems the flow of blood. Platelets contribute to clot formation by participating in release of a cascade of chemical factors essential to the clot-forming process, and changing shape and interlocking with one

48 INJECTABLES I body language

66 Every platelet is a biochemical storehouse of regulatory, signalling and growth-factor molecules 99 another to plug the bleeding site by forming a physical barrier to blood flow. This physical barrier consists of interlocked platelets and strands of fibrin. But platelets are more than just first-line responders to bleeding injury. Every platelet is also a biochemical storehouse of regulatory, signalling and growth-factor molecules that participate in recovery and healing of tissue as well as emergency response to injury. Growth-factor molecules associated with platelets include: • Platelet-derived growth factor (PDGF)—promotes blood vessel growth, cell replication, skin formation; • Vascular endothelial growth factor (VEGF)—promotes blood vessel formation; • Epidermal growth factor (EGF)—promotes cell growth and differentiation , blood vessel formation, collagen formation; • Fibroblast growth factor-2 (FGF-2)—promotes growth of specialised cells and blood vessel formation; • Insulin-like growth factor (IGF)—a regulator of normal physiology in nearly every type of cell in the body. • NGF stimulates hair growth and slows down apoptosis However, NGFjp75NTR promotes apoptosis and inhibits hair growth. NGF acts as a stress mediator and may explain the correlation between stress and hair-loss. All of these growth factors initiate and enhance physiologic processes that contribute to tissue recovery and health after injury. The growth factors are also involved in normal physiologic processes for healing. Treatment protocols There is no consensus on treatment protocols and they vary widely

from a single treatment to five treatments. Our current protocol is to provide three treatments each two weeks apart. A blood sample of 8-16ml is taken and processed with the Regen Kit-BCT. Approximately 3-6ml of PRP is prepared and ready for immediate injection in to the thinning areas of the scalp. The scalp is sensitive especially in the temple area so suitable analgesia is applied, depending on the area to be treated and the length of hair. The U225 meso gun is a welcome addition to allow rapid placement of plasma precisely in to the scalp, whist reducing the discomfort of the procedure significantly. Medical needling with the EDS derma stamp improves the circulation to the hair follicles and enhances the end result. Side effects are minimal, discomfort during the procedure, slight erythema and tenderness for twelve hours. In our clinic the experience of our patients is they experience a noReferences 1. International Society of Hair Restoration Verified: 21/01/2015 publishes annual statistics on the number of hair restoration treatments carried out by its members. 2. Trink A, Sorbellini E, Bezzola P, Rodella L, Rezzani R, Ramot Y, Rinaldi A randomized, double-blind, placebo- and active-controlled, halfhead study to evaluate the effects of platelet-rich plasma on alopecia areata. 3. WellsPA, Wilmoth T Russell RJ 1995 “Does fortune favour the bald?” / “Psychological correlates of hair loss in malea” BR J Psychol 86 pt 3 337-344 4. PDGF Takakura N et al involvement of platelet derived growth factor receptor-alpha in hair canal formation J Invest dermatology 1996 107(5) 770-7 5. Yano et al Control of hair growth and follicle size by VEGF- mediated angiogenesis J clin Invest 2001:107(4) 409-17 6. Sharov A et al Changes in different melanocyte populations during hair follicle involution J Invest Dermatology 2005 1259-67 7. Mak KK Kingston SY Epidermal growth factor as a bilological swith

ticeable reduction in hair loss. Fine miniaturised hair starts to thicken and this is usually noticeable by three months so the patient finds their hair easier to manage, thicker and in better condition. Patients are highly satisfied with the results and continue to have maintenance treatments every six months. Conclusion PRP for thinning hair is a safe and effective treatment for hair thinning on the Norwood scale I-IV for men and female hair thinning. More and larger studies are needed to understand ,how to collect and process the PRP, whether or not to activate before injection and at what depth to place the PRP to obtain optimal results. Dr Victoria Dobbie Dental Surgeon has over 12 years of purely aesthetic practice. She has 2 years of experience providing PRP treatments from her aesthetic clinic in Edinburgh. in hair growth cycle J Biol Chem 2003; 278(28) 26120-6 8. FGF Mak KK Kingston SY. A transgenic mouse model to study the role of epidermal growth factor EGF in hair and skin development Hong Kong university 2002 9. IGF Rosenquist TZ. Martin GR. Fibroblast growth factor receptor and ligand genes in the maturing hair follicle Dev Dyn 1996 205(4) 379-86 10. NGF Peters EMJ, Paus R, KlappBF. Arck PC L6 neuroimmunological hair growth control is stress-sensitive: an old paradigm revisited. 11. Greco J Brandt R “Our experience utilizing autologous PRP in all phases of hair transplant surgery Hair transplant Forum International” 2007;17(4)131-2 12. Betsi Germain Dec 2012 Eur J Plast Surg 13. RegenKit –BCT En Budron B2 CH – 1052 Le Mont-Sur-Lausanne (CH) 14. Evanthia, Betsi , Germain Kalbermatten, Tremp , Emmenegger Platelet-rich plasma injection is effective and safefor the treatment of alopecia Eur J Plast Surg 14/03/13 15. Amgar,Bouhanna. Platelet Rich Plasma a therapy for hair growth 28/05/2013 PRIME Magazine

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

body language I TECHNIQUE 51

Getting to grips with PRP MR KAMBIZ GOLCHIN gives an overview of PRP today, looking at what we know and how PRP is developing

he very first published report of PRP 1987, was a cardiac surgery case. However knowing what I know about PRP, I believe it may have been a German dentist, back in 1968 that actually started using it. The difficulty at the time was that the technology was quite expensive, so it wasn’t really practical for use. PRP became popular in the orthopaedics, the maxillofacial and the dental field, before it hit the dermatology and the aesthetic side. Part of this demand is patients looking for more natural treatments. The problem we have today is that some people are a bit lost. They don’t know who to believe or what to believe. Does it work, does it not work? Is there science behind it, or isn’t there? Those people who use PRP regularly may be experiencing this: cognitive dissonance. This is a psychology term. This is when you have two ideas, and you believe both ideas, but the ideas actually contradict each other. So, we’re using PRP and we like the fact that we’re using PRP, but we’re a little bit uncomfortable because we don’t know if there’s enough science behind it. Back to basics We know that the platelets are the nature’s power-house and on the platelets, there are alpha granules—little bags or sacks. These alpha granules contain various good factors like chemokines and cytokines. Through an activation process these granules come to the surface and release all their goodness. This is the basic physiology. What happens next is quite interesting, because the growth factors go through a mechanism of binding to receptors. The receptors are found on different cells, like stem cells, epidermal cells, fibroblast, osteoblasts etc, but the growth factors don’t actually enter the cells. This is quite interesting, because this has a number of advantages from a safety point of view. Once this binding happens, it results in an expression of normal healing, but at a much faster rate. You can see this between the different growth factors, and the chemokines, the platelets; once they release their growth factors, they can influence the different parts of healing at different stages. From the coagu-

lation part to the fibroblast activity, all the way to the collagen synthesis and remodelling, the platelets can actually make a difference to the whole process of healing from start to finish. So, it is a cocktail of the chemokines and cytokines, which basically produces this tissue re-genesis, the scaffolding and the angiogenesis that goes on. Growth factors signal the cell proliferation for growth. The important growth factors of the platelets are all growth factors—the fibroblast, the transforming, the veg-F, which is the vascular and arterial growth factors. Chemokines, on the other hand basically recruit other cells. One of the important functions of platelets, once they release their chemokines, is to call for help. They call for adult stem cells to come into the area, because they know there’s an injury that’s taken place. They want these cells to start transforming and producing the different tissues. Key points of PRP The volume of blood that’s actually required can vary between different kits and different systems. There’s a lot of debate about the time and the speed of centri-fusion, how those platelets are actually collected and concentrated and so on. The addition of any activating agent makes a difference too, for example adding calcium chloride, calcium gluconate, adrenalin or thrombin. It can affect the pH of the product and changing the pH obviously changes the patient’s experience from a pain point of view, but it also actually changes the release and also the amount of growth factors. The final product depends on the number of platelets and the amount of growth factors—the red cells and the white cells— that are in the concentration. So there are about eight different variables and depending on each of these factors, you could actually have an entirely different PRP. Therefore the idea of all PRPs being the same it’s actually not true. Matsuko, in a paper in 2009, stated that not every PRP is born equal. In their study they found that even using similar methods for platelet gel preparation, you can have different levels of growth factors. The mechanism of release could be dif-

52 TECHNIQUE I body language

66 For chronic wounds—from diabetic, vascular and pressure ulcers to bed sores I’ve seen nothing respond as well as with PRP. 99 ferent, but whether that makes a difference clinically or not, is another question. There are lots of different systems and kits on the market, and essentially, the technology is either single-spin or doublespin. With single spin you spin your blood sample, and that separates the plasma and red cells. In the middle you have what’s known as the buffy coat, which contains the red pack, which is your red cells and your neutrophils. Double-spin technology spins the product a second time at a different spin rate, to basically enhance that buffy coat. Platelet counts There’s been a lot of interesting debates about platelet counts. Weibrich, et al, looked at platelet count and the different growth factors and transforming factors and found substantial variations between growth factors in terms of PRPs. So depending on your platelet count, your growth factor levels will increase or decrease. It’s kind of stating the obvious in a way, because we started by saying we’ve got these little bags on the platelets that contain all the growth factors. So the more you have, the more growth factors you’re going to have, up to a point. Interestingly, Hainsworth showed that proliferation of the stem cells and their call to action is actually going to depend on the platelet concentration. So you need an optimal platelet concentration for adult stem cells to actually be attracted to the area, and for them to start transforming and start working. That concentration is a classic bell-shaped curve, so there is an optimum and either side it’s going to be useless. There are actually automated systems that are used in most NHS hospitals in the cardiac units, to estimate the platelet count for PRPs, but you could actually manually work out the number of platelet count, based on your blood volume. Look at the average platelet count, look at how much blood you’re taking and your final product. Depending on your kit, these are simple calculations where you can actually get a ratio of your baseline increase concentration. Other elements The white cell count is really interesting, because the increase in the white cell count increases the metalla proteinases. When you get the free radicals and the cytokines, which drives a lot of inflammation they are actually quite pro-inflammatory and cyto-toxic. Thrombin does the same; thrombin increases the interleuken 1B, so, you could conclude that low volumes of white cell count is actually better in a PRP setting. However, it’s been shown that higher levels of white cell count, create more tissue augmentation than PRP alone. So is it better, or is it not better? Red cells are also interesting, because if you have more red blood cells, you’re going to more of the oxidative burst. You’re going to get the release of the ferrous component of the haemoglobin, which means free radicals, leading to inflammation and vascular injury and cell death. The hemosiderin can also cause

staining. Activation of platelets could be an androgynous process, or it could be exogynous, which is what we normally use in a clinical setting. However androgynously, platelets can become activated by exposure to collagen, so that’s quite a normal part of tissue response. If you’re injecting PRP in an area that has been traumatised, whether intentionally by any modality that you are using, whether it’s needling or laser or surgically, there is exposed collagen. This causes activation of the platelets. You can control this, and use calcium chloride or calcium glutenates, for example, to have a more controlled release of the growth factors, based on controlling the activation of the platelets. From all this information, we see that each one of the components of PRP can make a difference in the final product. I think it’s reasonable to assume the idea of a condition-specific PRP, depending on the clinical setting, which is something that clinically we’re actually seeing more and more. So when you’re using PRP in terms of scars, as opposed to chronic wounds and fat grafting, rather than using a stand-alone and aesthetically, there are different formulations that are needed. For example, there are noticeable results with application of PRP for hair growth. This could be during a hair grafting, in terms of hair transplantation, or it could be used to re-invigorate dormant hair cells and stimulate new growth. There are nice publications too, that support this. With fat grafting, there’s a lot of evidence and from a clinical point of view it’s something that we’ve all noticed – when you add PRP to fat, it improves the survival of the fat cells. Traditionally one of the problems with fat grafting and to a large extent the reason HA fillers became so popular, is that fat grafting was unpredictable. You could lose anything from 40 to 60 percent of your fat cells in terms of fat grafting, whereas HA is predictable, you know how it’s going to behave. PRP is changing that, because that survival can be up to about 70 percent. Still not a 100 percent, but it’s much better than before. Most of the studies show that it improves the vascularisation, and you get this hyper-vascular state. Because there’s better blood supply to the grafted adipose sites, survival seems to have improved. For chronic wounds—from diabetic, vascular and pressure ulcers to bed sores I’ve seen nothing respond as well as with PRP. We’ve seen closure of 77 percent in two weeks, which is phenomenal. Another example is 93 percent closure in eight days which needs a specific type of PRP formulation. It’s so encouraging, that the Queen Elizabeth Hospital in Birmingham have set up a fully randomised control trial, to start at the end of 2014. Other clinical trials of PRP are expanding—from using PRP as a stand-alone procedure in aesthetic use, to combining it with fat grafting, with stem cell therapy, hair transplant, and chronic wound care—in combination with HA, toxins, or with other technologies. Whether it’s lasers, RF or needling, essentially whatever you have in your practises, you could combine them with PRP. What’s ahead? We still don’t have the hard science that we need for PRP. However what we’re noticing in terms of the application of PRP is very encouraging. Now we must find the right formulation and the right application for the right condition, and then I think then we’ve got something magical. Mr Kambiz Golchin is a consultant ENT & Facial Plastic Surgeon

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

body language I TRAINING 55

Lighting the way DR ELIZABETH RAYMOND BROWN discusses why the ‘Core of Knowledge’ course isn’t always sufficient training for laser and light-based practitioners and the future of education and training for cosmetic interventions

he ‘Core of Knowledge’ is just one element of training that Local Authorities and the Care Quality Commission (CQC) expect practitioners using lasers and intense light sources (ILS) to evidence. The Medicines & Healthcare products Regulatory Agency (MHRA) Guidance Document 2008, contains the Core of Knowledge syllabus, set out in Appendix C. It is a list of 19 topics, considered the minimum training requirement and is best described as the safety orientated ‘sandwich filling’ between laser/ILS equipment and procedural training expected of practitioners. In the latest revision was in 2008 but the ‘Core of Knowledge’ remains a generic syllabus, applying to all laser/ILS applications and all practitioners from consultants through to nurse practitioners. It is essentially a safety syllabus, describing equipment hazards, control measures and safety management such as risk assessment, legislation, quality assurance, the role of the laser protection advisor (LPA), and the laser protection supervisor (LPS). The MHRA guidance document suggests the ‘Core of Knowledge’ syllabus can be delivered in lectures totalling no more than three hours—and this is why I believe it should not be regarded as the ‘be all and end all’ of training for laser/ILS practitioners. The ‘Core of Knowledge’ does not include details about treatment protocols or settings, and in this respect it has limitations in terms of helping practitioners identify the essential knowledge they need to understand in order to deliver safe and effective treatments. As a new laser or light based practitioner, you need to know the

significance of skin typing and the presenting condition in relation to treatment settings, contraindications to treatment, pre and post treatment care—none of which is included in the ‘Core of Knowledge’ syllabus. And this is the obvious flaw in suggesting that ‘Core of Knowledge’ is sufficient to deem someone ‘competent’. Given that three hours is all it suggests for course delivery, if a practitioner can get insurance based purely upon a certificate of attendance, they can, in theory, start treating immediately. I prefer to deliver my ‘Core of Knowledge’ courses in the clinical setting, which allows me to teach around the particular laser or ILS, and discuss exact equipment features, treatment settings, practical tips and details, leaving topics such as risk assessment, safety legislation to the supporting reference notes for use, as and when they are needed. MHRA Guidance includes the phrase ‘Authorised User C’, with statements such as; ‘understand the nature of optical radiation’, ‘familiar with hazard control procedures’, ‘aware of precautions for non-routine activities’. However, ‘c’ is a much over-used term, and although we would like all our laser/ILS practitioners to be able to demonstrate competence in this specialism, there is no compulsory requirement for a written assessment, exam or observation of skills, and therefore no evidence of competence from attending/completing a ‘Core of Knowledge’ course. Education versus training When choosing a laser/ILS, we like to think that practitioners will take their time, ask appropriate questions and do some research as to

what best suits their needs. Unfortunately, this approach isn’t always taken when selecting the most appropriate training or educational programme. But this is important—treat it as an investment in yourself, just as you would an investment in a device. The laser/ILS training market has grown significantly over the last few years, and there is now an array of providers, course formats, durations and prices for ‘Core of Knowledge’ training. Whilst the syllabus is defined by the MHRA guidance document, it does not mean you always get the same emphasis on topics, course delivery, or quality of information. And if the only course you plan to take is the ‘Core of Knowledge’, then this alone will not make you a competent practitioner. But which matters more—a well-educated practitioner, or a well-trained one, and does either one carry more weight? In fact, they both matter, but are two very different things. Sometimes, the most important thing for a practitioner to identify is when they need training, and when education is called for. Education is not training as such, but they are both facets

56 TRAINING I body language

of learning. Obviously, educational programmes will include training in the skills and knowledge of the subject, but should go further than training alone. For example, it is relatively straightforward to ‘train’ a practitioner to use a laser or ILS for facial hair reduction. We could ‘train’ someone to identify a skin type by appropriate questioning, and then ‘set’ the treatment parameters accordingly. However, if that patient presents with a complicated medical history, or an unusual skin/hair combination, such as fine hair on darker skin, practitioner ‘education’ becomes more important than training alone. An educated practitioner will know to investigate the medical history, can understand the link between thermal relaxation time (TRT) of the target and pulse duration, and know when, and how to adjust for competing chromophores in a darker skin type. This is a mind-set, allowing them to approach and solve problems, that training without education could not do. The future of laser/ILS education and training Whilst the ‘Core of Knowledge’ syllabus serves a purpose as a laser/ILS safety syllabus, and is the starting point for a training course, education in light based therapies is the key to safe and effective practice. Health Education England (HEE) has recently issued the stakeholder consultation document on the qualification requirements for cosmetic procedures. The proposed qualification framework covers five modalities; • botulinum toxins • dermal filler • chemical peels and skin rejuvenation treatments (microneedling and mesotherapy) • laser, intense pulsed light (IPL), and LED treatments • hair restoration surgery Each modality has different learning outcomes, but shares common modules across all treatments such as; consultation, communication, emotional and psychological support, clinical photography, de-

cision making skills etc. It is intended that the education and training requirements will apply to all practitioners, regardless of previous training and professional background. The requirements also take into account the Government response to the Keogh review, which accepted the majority of the review’s recommendations, including those relating to education and training. Practitioners can bring existing prior knowledge, experience and learning into the framework, which is very important for professional and personal development. The document sets out the learning outcomes according to modality and ‘level’, the lowest qualification being Level 4 (Foundation Degree), rising to Level 7 (Postgraduate) education. This is recognised educational curriculum development, deepening and integrating learning by reinforcing and building on knowledge and skills from previous levels, and dealing with issues in an increasingly complex way. As an academic, what pleases me most is reference to the requirement of evidence-based practice, acknowledging the need for education to boost and support current training provision. There are still questions over the exact details of the proposed qualifications, but the intentions are clear and sound in principle. Continuing your education Look upon your training and education as an investment. It is what will keep you ahead of your competitors, but more importantly should make you a safe and knowledgeable practitioner. Be self-critical and be honest about your training and educational needs. Identify your current skills and knowledge, and the gaps that you need to address. Then find the course or educational programme that suits you—if you’re a face-to-face learner, find a face-toface course, if you prefer to learn at your ‘pace and place’, look for blended learning programmes. You have to find the right fit for you, because we all learn in very different ways, and even the best course,

delivered in a way that doesn’t suit you, won’t further your education and personal development. Reading journals and research publications is very important. This is an essential element of our postgraduate programme in nonsurgical facial aesthetics (NSFA), in the School of Medicine and Dentistry at UCLan, Preston., and a skill we encourage our healthcare professionals to develop from the outset. Recognised education and qualifications are going to become a valuable currency for practitioners in the cosmetic interventions sector, particularly as the HEE qualifications framework takes shape. So actively seek out your learning opportunities; conferences, workshops, seminars, short courses, master-classes and formal educational programmes such as postgraduate qualifications. Reflecting upon the ‘Core of Knowledge’, typically delivered as a three-hour training course, I hope you will appreciate it is not a substitute for education. As a teacher and an academic, I see the difference that education makes in practice, because education shapes and changes behaviour, and many experts now believe that change is needed if cosmetic therapy patients are to be protected and the quality of care improved. Dr Elizabeth Raymond Brown is a chartered radiation protection professional and accredited laser/ IPL protection advisor. She is also the academic lead in non-surgical facial aesthetics at UCLan, Preston. W: laser-ed.co.uk References 1. MHRA Device Bulletin. Guidance on the safe use of lasers, intense light source systems and LEDs in medical, surgical, dental and aesthetic practices. DB2008(03). April 2008 2. Health Education England. Qualification requirements for cosmetic procedures. Stakeholder consultation document. 9 December 2014 3. https://www.gov.uk/government/uploads/system/ uploads/attachment_data/file/279431/Government_response_to_the_review_of_the_regulation_of_cosmetic_interventions.pdf 4. MSc Programme. Non-surgical facial aesthetics. Visit: www.uclan.ac.uk/nsfa

body language I EDUCATION 57

training TF

TOXINS AND FILLERS

W: honeyfizz.co.uk

3 February, Bespoke Botox & Dermal Filler Training The Paddocks Clinic, Essex W: cosmeticcourses.co.uk

29-30 April, Intro to Toxins and Fillers, Wigmore Medical, London W: wigmoremedical.com

5 February, Bespoke Botox & Dermal Filler Training The Paddocks Clinic, Essex W: cosmeticcourses.co.uk

2 May, Combined Basic Training Courses – Dermal Filler & Botulinum Toxin, Honey Fizz, Newport W: honeyfizz.co.uk

6 February, Advanced Fillers—Lower face (am) and Cheeks (pm), Wigmore Medical, London W: wigmoremedical.com

5 May, Advanced Botox & Azzalure Training, Honey Fizz, Newport W: honeyfizz.co.uk

7 February, Botox & Dermal Filler Training Foundation Course, The Paddocks Clinic, Birmingham W: cosmeticcourses.co.uk

8 May, Advanced Botulinum Toxins (am) and Fillers—Lower face (pm), Wigmore Medical, London W: wigmoremedical.com

7 February, Combined Basic Botulinum Toxin & Dermal Filler Training, Honey Fizz, Newport W: honeyfizz.co.uk

20-21 May, Intro to Toxins and Fillers, Wigmore Medical, London W: wigmoremedical.com

9 February, Intro to Toxins, Wigmore Medical, London W: wigmoremedical.com

11 February, Hyperhidrosis Training, Honey Fizz, Newport W: honeyfizz.co.uk 12 February, Bespoke Botox & Dermal Filler Training, The Paddocks Clinic, Birmingham W: cosmeticcourses.co.uk 24 February, Lip Masterclass, Honey Fizz, Newport W: honeyfizz.co.uk 25-26 February, Intro to Toxins and Fillers, Wigmore Medical, London W: wigmoremedical.com 28 February, Botox & Dermal Filler Training Foundation Course, The Paddocks Clinic, Birmingham W: cosmeticcourses.co.uk 28 February, Combined Basic Training Day – Dermal fillers and Botulinum Toxin, Honey Fizz, Newport W: honeyfizz.co.uk 6 March, Advanced Botulinum Toxins (am) and Fillers—Forehead (pm), Wigmore Medical, London W: wigmoremedical.com 11 March, Hyperhidrosis Training, Honey Fizz, Newport W: honeyfizz.co.uk 21 March, Botox & Dermal Filler Training Foundation Course, The Paddocks Clinic, Birmingham W: cosmeticcourses.co.uk 21 March, Dermal Filler & Botox Training—Advanced Course, The Paddocks Clinic, Buckinghamshire W: cosmeticcourses.co.uk 25-26 March, Intro to Toxins and Fillers, Wigmore Medical, London W: wigmoremedical.com 29 March, Botox & Dermal Filler Training Foundation Course, The Paddocks Clinic, Buckinghamshire W: cosmeticcourses.co.uk 7 April, Basic Botulinum Toxin Training Day, Honey Fizz, Newport W: honeyfizz.co.uk 10 April, Advanced Fillers—Tear Troughs (am) and Cheeks (pm), Wigmore Medical, London W: wigmoremedical.com 11 April, Combined Basic Training – Dermal Filler and Botulinum Toxin, Honey Fizz, Newport W: honeyfizz.co.uk 21 April, Basic Botulinum Toxin Training Day, Honey Fizz, Newport

OTHER INJECTABLES

1 February, Microsclerotherapy, Wigmore Medical, London W: wigmoremedical.com 5 February, Sculptra, Wigmore Medical, London W: wigmoremedical.com 7 February, Mini-Thread Lift, Wigmore Medical, London W: wigmoremedical.com 9 February, Microsclerotherapy Training, The Paddocks Clinic, Buckinghamshire W: cosmeticcourses.co.uk 18 February, Platelet Rich Plasma Training, The Paddocks Clinic, Buckinghamshire W: cosmeticcourses.co.uk 19 February, Dracula PRP, Wigmore Medical, London W: wigmoremedical.com 8 March, Mini-Thread Lift, Wigmore Medical, London W: wigmoremedical.com 16 March, Dracula PRP, Wigmore Medical, London W: wigmoremedical.com 28 March, Microsclerotherapy, Wigmore Medical, London W: wigmoremedical.com

12 February, Microdermabrasion Training, Eden Aesthetics, Liverpool W: edenaesthetics.com 12 February, Epionce Training Sessions, Eden Aesthetics, London W: edenaesthetics.com 16 February, Epionce Training Sessions, Eden Aesthetics, Danbury W: edenaesthetics.com 17 February, Agera Training, Eden Aesthetics, Danbury W: edenaesthetics.com 17-18 February, ZO Medical Basic and Intermediate, Wigmore Medical, London W: wigmoremedical.com 23 February, Medik8 Dermal Roller (pm), Wigmore Medical, London W: wigmoremedical.com 24 February, Skincare & Chemical Peels, Wigmore Medical, London W: wigmoremedical.com 24 February, Epionce Training Sessions, Eden Aesthetics, Warrington W: edenaesthetics.com 24-25 February, ZO Medical Basic and Intermediate (Dublin), Wigmore Medical, London W: wigmoremedical.com 25 February, Agera Training, Eden Aesthetics, Warrington W: edenaesthetics.com 26 February, Chemical Peel Training with Microdermabrasion, The Paddocks Clinic, Buckinghamshire W: cosmeticcourses.co.uk 26 February, Free One Day Seminar, Eden Aesthetics, Warrington W: edenaesthetics.com 26 February, Free One Day Seminar, Eden Aesthetics, London W: edenaesthetics.com 3 March, Micropigmentation Induction Day, Finishing Touches, West Sussex W: finishingtouchesgroup.com

24 March, Skincare & Chemical Peels, Wigmore Medical, London W: wigmoremedical.com 24-25 March, ZO Medical Basic and Advanced (Dublin), Wigmore Medical, London W: wigmoremedical.com 26 March, Epionce Microneedling Training, Eden Aesthetics, Liverpool W: edenaesthetics.com 26 March, Epionce Microneedling Training, Eden Aesthetics, Danbury W: edenaesthetics.com 31 March, Agera Training, Eden Aesthetics, Warrington W: edenaesthetics.com 1 April, Epionce Training Sessions, Eden Aesthetics, Warrington W: edenaesthetics.com 7 April, Micropigmentation Induction Day, Finishing Touches, West Sussex W: finishingtouchesgroup.com 13 April, Medik8 Dermal Roller (pm) , Wigmore Medical, London W: wigmoremedical.com 21-22 April, ZO Medical Basic and Intermediate, Wigmore Medical, London W: wigmoremedical.com 28 April, Skincare & Chemical Peels, Wigmore Medical, London W: wigmoremedical.com 28-29 April, ZO Medical Basic and Intermediate (Dublin), Wigmore Medical, London W: wigmoremedical.com 5 May, Micropigmentation Induction Day, Finishing Touches, West Sussex W: finishingtouchesgroup.com 19 May, ZO Medical Basic (Dublin), Wigmore Medical, London W: wigmoremedical.com 19 May, Skincare & Chemical Peels, Wigmore Medical, London W: wigmoremedical.com 20 May, ZO Medical Intermediate (Dublin), Wigmore Medical, London W: wigmoremedical.com

9 April, Sculptra, Wigmore Medical, London W: wigmoremedical.com

3 March, Epionce Training Sessions, Eden Aesthetics, Glasgow W: edenaesthetics.com

11 April, Mini-Thread Lift, Wigmore Medical, London W: wigmoremedical.com

4 March, Agera Training, Eden Aesthetics, Glasgow W: edenaesthetics.com

20 April, Dracula PRP, Wigmore Medical, London W: wigmoremedical.com

10-11 March, Basic and Advanced GloTherapeutics, Wigmore Medical, London W: wigmoremedical.com

2-5 February, Cosmetic Eye, Lip and Brow Workshops, Finishing Touches, West Sussex W: finishingtouchesgroup.com

12 March, Microdermabrasion Training, Eden Aesthetics, London W: edenaesthetics.com

16-18 February, Three Day Medical Masterclass, Finishing Touches, West Sussex W: finishingtouchesgroup.com

16 March, Agera Training, Eden Aesthetics, Danbury W: edenaesthetics.com

23 February, CPR & Anaphylaxis Update (am) , Wigmore Medical, London W: wigmoremedical.com

17 March, Epionce Training Sessions, Eden Aesthetics, Danbury W: edenaesthetics.com

13 April, CPR & Anaphylaxis Update (am) , Wigmore Medical, London W: wigmoremedical.com

17-19 March, ZO Medical Basic, Intermediate and Advanced, Wigmore Medical, London W: wigmoremedical.com

9-10 March, Two Day Areola Masterclass, Finishing Touches, West Sussex W: finishingtouchesgroup.com

19 March, Agera Training, Eden Aesthetics, London W: edenaesthetics.com

23-26 March, Four Day Scalp Masterclass, Finishing Touches, West Sussex W: finishingtouchesgroup.com

9 May, Mini-Thread Lift, Wigmore Medical, London W: wigmoremedical.com 30 May, Microsclerotherapy, Wigmore Medical, London W: wigmoremedical.com

SKINCARE

2 February, Epionce Microneedling Training, Eden Aesthetics, Danbury W: edenaesthetics.com 3 February, Micropigmentation Induction Day, Finishing Touches, West Sussex W: finishingtouchesgroup.com 5 February, Epionce Microneedling Training, Eden Aesthetics, Liverpool W: edenaesthetics.com

26-28 May, ZO Medical Basic, Intermediate and Advanced, Wigmore Medical, London W: wigmoremedical.com

OTHER TRAINING

DY LAN

Read, learn and apply

FIED •

UA CP

D CE

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

may/june

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

jan/feb

The UK Journal of Medical Aesthetics and Anti-Ageing

mar/apr 2014

jan/feb 2014

www.bodylanguage.net

mar/apr

The UK Journal of Medical Aesthetics and Anti-Ageing

november 2014

www.bodylanguage.net

sept/oct 2014

The UK Journal of Medical Aesthetics and Anti-Ageing

sept/oct

www.bodylanguage.net

body language

Non-surgical reduction

HETI

FERE

AND

Brighten dark circles

MELANOMA EPIDEMIC Patient education and prevention strategy

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

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

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

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

NCE

IN SI DA

C CON

body language

volume 16 issue 3 number 63

volume 16 issue 1 number 61 BL61 Covers.indd 7

BODY AESThETiCS

AEST

body language

FACI

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

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.

Treatment approaches

27/08/2014 14:59

body language I PRODUCTS 59

on the market The latest anti-ageing and medical aesthetic products and services 1

1. Lumie has announced the launch of Bodyclock Iris, an alarm clock that combines aromatherapy with a simulated sunrise and sunset, designed to help relax at bedtime and wake you fully refreshed. Bodyclock Iris integrates the features of Lumie’s wake-up lights with an aromatherapy function so that users may benefit from their favourite essential oils. Studies have shown that wake-up lights like Lumie Bodyclock, that gradually turn on and get brighter during the last 30 minutes of sleep, can reduce complaints of sleep inertia. The light stimulates production of hormones that help us to get up and go, like cortisol, while suppressing those, like melatonin, that bring on sleep. Oversleeping in the morning could also indicate that your body clock is set at a later time than desired. Bodyclock can help to reset the body’s natural rhythms to suit the working day better and help you wake up brighter. Lumie, W: lumie.com 3. Lynton Lasers have released YouLaser MT, a new resurfacing treatment that combines non-ablative gallium arsenide (GaAs) and ablative CO2 laser wavelengths. This new combined treatment is said to maximise the advantages of each laser wavelength, providing stronger results and less down time than single wavelength lasers. Posttreatment, the skin is said to appear tighter due to the process of collagen shrinkage and the long-term stimulation of fibroblasts that will usually produce new collagen for the next six months. Lynton Lasers, W: lynton.co.uk

5. SkinCeuticals will be launching Mineral Eye UV Defense, a new anti-ageing and sun protection eye formula in April 2015. The product is designed to protect the delicate skin around the eye with mineral SPF 30 UVA and UVB protection, enhance and unify the skin tone around the eye area and optimise make up application with a smooth non-migrating base for use under make up. SkinCeuticals conducted a study and found that 40% of people don’t wear sunscreen daily on the face, even less apply sunscreens to the eye area, citing irritation when the products run into the eye, or interferes with makeup. Overexposure of the skin around the eye to UV radiation can result in wrinkling, laxity, hyperpigmentation and an increased risk of skin cancer. RKM Communications, W: rkmcom.com

2. Novacutis announce the launch of RushOLash, the latest technology in eyelash enhancement serum. Clinical and ophthalmological tests have proven the safety and efficacy of this product over a period of 24 months. RushOLash is a natural product based on polypeptides, and the manufacturer say it has shown a growth in length and density of eyelashes of up to 80% within four weeks, while being biocompatible to even most sensitive skin types. RushOLash, W: rusholash.com

4. Scandinavian Skincare Systems UK announce the official launch of MÖ Scandinavian Cosmeceuticals, a collection of skincare products for both women and men. The collection contains active ingredients and offers high-technology performance along with botanicals that are said to deliver skin-refining results. MÖ Scandinavian Cosmeceuticals targets skin on a molecular level in order to speed up the cell renewal process. The formulations have been clinically tested and results are said to include wrinkle depth reduction, improvement in elasticity, enhanced collagen production, pigment and sebum balancing properties and smoothing and desensitising of irritated skin. The range is paraben-free, natural and organic, and vegan certified with no animal ingredients. Scandinavian Skincare Systems UK, W: scandinavianskincaresystems.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.

E: TRAINING@WIGMOREMEDICAL.COM

I T: +44(0)20 7514 5979

FEBRUARY

MARCH

APRIL

MAY

1 Microsclerotherapy* 5 Sculptra* 6 Advanced Fillers-LF* (am) 6 Advanced Fillers-CH* (pm) 7 Mini-Thread Lift* 9 Intro to Toxins* 17 ZO Medical Basic 18 ZO Medical Interm. 19 Dracula PRP* 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*

6 Advanced Toxins* (am) 6 Advanced Fillers-F* (pm) 8 Mini-Thread Lift* 10 glōTherapeutics 11 Advanced glōTherapeutics 16 Dracula PRP* 17 ZO Medical Basic 18 ZO Medical Interm. 19 ZO Medical Adv. 24 Skincare & Peels 24 ZO Medical Basic (Dublin) 25 ZO Medical Adv. (Dublin) 25 Intro to Toxins* 26 Intro to Fillers* 28 Microsclerotherapy*

9 Sculptra* 10 Advanced Fillers-TT* (am) 10 Advanced Fillers-CH* (pm) 11 Mini-Thread Lift* 13 CPR & Anaphylaxis Update 13 Medik8 Dermal Roller (pm) 20 Dracula PRP* 21 ZO Medical Basic 22 ZO Medical Interm. 28 Skincare & Peels 28 ZO Medical Basic (Dublin) 29 ZO Medical Interm. (Dublin) 29 Intro to Toxins* 30 Intro to Fillers*

8 Advanced Toxins* (am) 8 Advanced Fillers-LF* (pm) 9 Mini-Thread Lift* 19 Skincare & Peels 19 ZO Medical Basic (Dublin) 20 ZO Medical Interm. (Dublin) 20 Intro to Toxins* 21 Intro to Fillers* 26 ZO Medical Basic 27 ZO Medical Interm. 28 ZO Medical Adv. 30 Microsclerotherapy*

All courses in London unless specified.

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

The art of hair restoration After training as a surgeon in Ireland and England, DR BESSAM FARJO went on to become a leading hair transplant surgeon after a chance encounter changed the course of his career

was born in Iraq, but started school in England at the age of four as my dad was doing his orthopaedic surgery training in the UK. After finishing school in Baghdad, I left for the last time in 1982—at the age of 19—and went to medical school at the Royal College of Surgeons in Dublin. It was there that I met my future wife and practice partner, Nilofer. After graduation, I worked for five years as a hospital doctor and trained as a surgeon in Ireland and England, before meeting a Canadian hair transplant surgeon in Toronto changed the course of my career. It was 1992, and I decided to take three months off work in England to train in hair restoration surgery in Toronto. When I returned—with a doctor wife and seven month-old daughter in tow—we opened a part time clinic while continuing my day job in the hospital. After several months of learning about private practice and networking with colleagues and other businesses, it was clear where my heart lay—with a burning desire not only to perform excellent hair transplant surgery but to also build a reputable and successful medical practice in this field. The truth is that Nilofer and I both realised early on that it was going to be tough for both of us to have busy hospital careers without sacrificing family life. As it turned out, when you run your own show, you work 24/7, and if you and your spouse

work together then you are literally married to your work! It’s amusing thinking back to those early and pre-internet days. The public lacked decent information and the field in general suffered from malaise and a bit of an opportunistic image. All the media was interested in was to ridicule anyone having a hair transplant,

making it very hard to push stories about the progress the field was making. The vast majority of patients didn’t want anyone to know, and men even used to come for a hair transplant without telling their wives—or having the intention of ever doing so! Although we realised that we had to run a business, we couldn’t

66 In 1992 I decided to take three months off work in England to train in a hair restoration surgery in Toronto 99

Dr Bessam Farjo in 1996

62 EXPERIENCE I body language

Dr Bessam Farjo: when you are confident, participate, engage and share your knowledge and experience

think of ourselves as anything other than doctors, and our ‘clients’ as patients. One of the constant words of wisdom I tell newcomers now is to never worry about saying no. I even ran a live workshop for 70 doctors last year on the issue of patient selection. You have to establish trust to maintain credibility. It wasn’t a speedy road to financial success, but one built on solid ground. Another piece of advice I usually give for colleagues asking about training and getting started is to go to at least a couple of meetings or workshops a year. When you are confident, participate, engage and then share your knowledge and experience. That was something lacking in the UK hair restoration field when I started and it gave me an opportunity to be recognised. Coming from the UK, I found that people from the around the world want to hear what you have

to say and look up to you if you command their respect. I must have said a few useful things when I started presenting at almost every meeting since 1997, because soon after that I was being invited to be on the Board of almost every international body or society going in hair surgery. In 2007, I thought I reached the pinnacle when I was elected President of the International Society of Hair Restoration Surgery, the largest hair transplant surgery organisation in the world. I was the first from Europe to take the hot seat and it was certainly a moment of immense pride. My father, a retired orthopaedic surgeon who worked with me for a few years in later life, was much more excited! Sadly he passed away half way through that year and before he could attend the ceremonies with me. We threw everything into our work and really felt a duty to help

drag the field from the unfortunate image that it had at the time. We wanted it to be much more than hair transplants. The internet and various celebrity endorsements have transformed hair transplants into an almost daily positive news item. In 2000, we got involved with university and commercial research centres around the country in order to make scientific advances in hair biology and hair loss research, and to establish strong links between academic research and commercial clinical practice. First there was Queen Mary University, followed by University of Bradford, Unilever plc, University of Manchester, Durham University—and there will be more to come, I’m sure. We have published papers on potential treatments, environmental influence and genetics as well as case studies and surgical technique. All this culminated a couple of years ago in a prize that undoubtedly topped the last one. Nilofer and I were jointly awarded the ISHRS Platinum Follicle Award for ‘Outstanding achievement in basic scientific or clinically-related research in hair pathophysiology or anatomy as it relates to hair restoration’. Nothing beats recognition from your peers. For a change, I was speechless. Dr Bessam Farjo is a hair transplant surgeon and co-founder of the Farjo Hair Institute, W: farjo.net; T: 08453 132 131

66 In 2007 I was elected President of the International Society of Hair Restoration Surgery—it was certainly a moment of immense pride 99



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

Injectable Product of the Year

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 . OPTIMAL

TISSUE INTEGRATION

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

www.belotero.co.uk

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.

BEL152/1214/DS Date of preparation: December 2014