Body Language Journal #78

february

78

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

Killer heels

THE TECHNIQUE OF USING DERMAL FILLERS IN FEET TO ADDRESS STILETTO METATARSALGIA

SWEAT SMART

UNWANTED HAIR

HAND AGEING

The latest treatments for patients presenting with hyperhidrosis

Treatment for women with PCOS and male to female gender dysphoric patients

Regaining a more youthful appearance with remodelling treatments

body language I CONTENTS 3

07

28

41

contents 07 NEWS OBSERVATIONS Reports and comments

18 LASER TREATING UNWANTED HAIR 18

Christine Hart examines the treatment of unwanted facial hair in male to female gender dysphoric patients and women with polycystic ovary syndrome

25 EQUIPMENT A SMARTER WAY OF MANAGING SWEAT Annie Eccleston looks at the latest treatment options for hyperhidrosis

28 INJECTABLES KILLER HEELS Dr Mark Hamilton walks us through the use of dermal fillers in feet to address stiletto metatarsalgia

incorporate physicianbased treatments with patient education to encourage patients to make lifestyle changes that will significantly reduce acne flares and promote healthy skin

41 NON-SURGICAL EVOLUTION OF CRYOLIPOLYSIS Dr Farid Kazem traces how cryolipolysis has evolved, from its inception to today’s new innovative treatments

44 MARKETING THE DO’S AND DON’TS OF TALKING TO JOURNALISTS Fiona Scott offers her advice on how to build mainstream media relationships and increase your press coverage

49 PRODUCTS ON THE MARKET

33 MEDICAL AESTHETICS

The latest medical aesthetic products and services

HAND REMODELLING TREATMENTS

52 EQUIPMENT

Hands show signs of ageing early—Debbie Thomas explores the ageing process and what can be done to regain a more youthful appearance

36 SKINCARE PREVENTING AND CLEARING ACNE Dr Zein Obagi is on a mission to

ELEVATING NON-SURGICAL FACIAL LIFTING Dr Roberto Pizzamiglio explains how Silhouette Soft sutures with bidirectional cones can be used for elevating facial tissue

59 EDUCATION Training dates Course calendar

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.

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.

44 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 Christine Hart, Annie Eccleston, Dr Mark Hamilton, Debbie Thomas, Dr Zein Obagi, Dr Farid Kazem, Fiona Scott, Dr Roberto Pizzamiglio, Dr Leah Totton 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 2016 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

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body language I NEWS 7

observations

TOXINS + DERMAL FILLERS = LONGER LASTING RESULTS A simple technique has been found for for prolonging the effects of HA dermal fillers: using them together with botulinum toxin Chemodenervation using botulinum neurotoxin-A (BoNT-A) can prolong the life of the HA fillers by reducing muscle activity in the treated area, according to a study by Dr Ismail Küçüker, recently reported in Plastic and Reconstructive Surgery.

For augmentation patients, the early degradation of HA fillers limits the duration of their cosmetic improvement. The extent of an improvement is affected not only by the properties of the HA fillers, but also by application of other forces, including contractile forces of neighbouring muscles.

Using HA fillers in combination with muscle paralysing BoNT-A-best has been found to reduce this and evidence from several studies suggest

that this chemodenervation procedure improves the clinical results of HA filler injection.

For this study, Dr Küçüker and colleagues studied rabbits’ ears—injecting a small amount of HA filler under the skin in front of each ear—knowing that this part of a the ear corresponds to the forehead region in humans-a common area for dermal filler treatment.

On one side, HA filler alone was used. On the other, HA was used with the muscle paralysis inducing BoNT-A. MRI scans three months later compared the amount of filler remaining on the two sides and confirmed that BoNT-A decreased the degradation rate of the HA fillers by 42%, plus remaining volume

of HA filler was 50% greater on the side where BoNT-A was used. The difference was not only measurable, it was visible—supporting the clinical experience that BoNT-A injection provides longer-lasting outcomes in patients.

“This study showed that HA filler application in combination with BoNT-A significantly decreases the degradation process and increases the remaining volume at the end of the paralysed period,” Dr Küçüker and colleagues conclude.

ROYAL COLLEGE OF SURGEONS TAKE A STAND AGAINST CROWD-FUNDED SURGICAL PROCEDURES Surgeons risk being banned from practicing in move to tackle increase of website financing Doctors in the UK caught performing cosmetic procedures for women who have crowd-funded their surgery risk being banned from practising under new guidelines published by the Royal College of Surgeons.

The move is an attempt to tackle the increase in the number of women using sites such as myfreeimplants.com to find men willing to pay for their augmentation. Alarmingly, since 2005, more than 1,000 women worldwide have received

procedures after raising funds for their treatment using the site.

As part of ‘selling’ themselves to interest a potential investor in their procedure, women often feel compelled to send naked photos of themselves, webcam and even write erotic stories.

“The concept of websites such as myfreeimplants is exploitative of very vulnerable women, said Mary O’Brien, a spokesperson for BAAPS. “It is a wholly inappropriate environ-

ment in which to discuss a major surgical procedure and we’re quite horrified that young women are absorbed into this frenzy where they put intimate photographs of themselves and engage in online conversations about these intimate photographs with strangers in return for money.” O’Brien continued.

Doctors found in breach of the new rules, “could find themselves in front of the GMC and potentially banned from practising”, the GMC said.

8 NEWS I body language

ANTIOBIOTIC FILLED IMPLANTS AID HEALING Rice University researchers are developing temporary implants for facial reconstruction, which incorporate a unique way to deliver time-released antibiotics to ward off infection while a patient heals Materials developed in the Rice laboratory of bioengineer Antonios Mikos help repair severe craniofacial injuries from trauma or pathological defects like tumour removal. The lab’s specialised plastic space maintainers are designed to keep a pocket for new bone open while the overlying soft tissue heals. In later surgery, the implant is removed to make way for reconstruction of the bone.

In the latest advance, porous polymethylmethacrylate (PMMA) implants are filled with a gel that leaches its protective antibiotic contents to surrounding tissue, which protects the tissue from infection for several weeks.

“Infection is an important problem that needs to be considered with medical devices because bacteria can prevent the body from being able to heal,” Mikos said. “If the infection gets too severe, it can even cause tissues that were previously healthy to die.”

The researchers led by Rice alumnus Paschalia (Lina) Mountziaris noted that infections from the external environment and from neighbouring structures such as the nasal passages, the sinuses and the mouth can attack vulnerable tissue. Several studies have indicated wound infections from gunshot injuries to the face are common, they noted.

Soldiers are at particular risk, said Mikos, as battlefield injuries are often prone to infection from multidrug-resistant species of bacteria that invade between the time of injury and treatment.

Labs at Rice and elsewhere have experimented with porous implants but found they are susceptible to invasion by infectious bacteria. The Mikos lab’s solution is to fill the pores at the point of care with a thermogel that infuses the spacer as a liquid and turns into a gel when exposed to body heat.

This special thermogel consists of a block copolymer, a self-assembling combination of two polymers that is also under investigation for the controlled release of chemotherapy drugs.

“Block copolymers can offer a lot of benefits since they are designed to take advantage of the strengths of individual

polymers,” Mikos said. “The block copolymer we used for our study was designed to be able to take on water, become a gel at body temperature and slowly degrade over the course of implantation.”

Porous implants have been tested in humans, but PMMA with thermogel has not, Mikos said. In experiments, the Rice lab infused the gel with colistin, a lastresort antibiotic with strong side effects.

He said the PMMA and copolymer combination enabled tight control of its release without disrupting its antibacterial activity. In testing, the implants initially released a burst of the antibiotic through diffusion. Over time, degradation of the

copolymer would continue to release lesser amounts of the drug for up to 28 days.

Mikos said the thermogel can be customised at the time of implantation with the appropriate antibiotics, which also affect the rate and duration of release, before infusion into the prefabricated spacer.

The project is part of a $75 million, five-year Armed Forces Institute of Regenerative Medicine grant to Rice, the University of Texas Health Science Center at Houston and collaborating institutions to develop technologies to treat soldiers on the battlefield and advance care for the public.

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body language I NEWS 11

STANDARDISED TRAINING Comissioned by the Department of Health, new reports set out qualification requirements to improve safety of non-surgical cosmetic procedures

CUT ALCOHOL TO REDUCE CANCER New guidelines from all four UK chief medical officers warn that drinking any level of alcohol raises the risk of a range of cancers The update aims to prevent a broad range of diseases including cancer, as well as injuries and accidents. It’s also influenced by evidence that even low level drinking can increase the risk of some cancers.

Adverse effects from drinking alcohol on a range of cancers was not fully understood in 1995 when the Sensible Drinking report was published. After analysis of evidence from 44 systematic reviews and meta-analyses published since 1995, it’s now understood that these risks start from any level of regular drinking and then rise with the amounts of alcohol being drunk.

The analysis concluded that there was strong evidence that the risk of a range of cancers, particularly breast cancer, increased directly in line with consumption of any amount of alcohol.

The guidelines came out at the same time as a report from the Committee on Carcinogenicity, a UK non-statutory advisory body, which said that between 4% and 6% of all new cancers in the UK in 2013 were caused by alcohol consumption.

The Chief Medical Officers’ new weekly guideline for both men and women who drink regularly and frequently is that: • You are safest not to drink regularly more than 14 units per week, to keep health risks from drinking alcohol to a low level.

• If you do drink as much as 14 units per week, it is best to spread this evenly over three days or more.

• If you have one or two heavy drinking sessions, you increase your risks of death from long term illnesses and from accidents and injuries.

• The risk of developing a range of illnesses (including, for example, cancers of the mouth, throat and breast) increases with any amount you drink on a regular basis.

• If you wish to cut down the amount you’re drinking, a good way to help achieve this is to have several drink-free days each week.

Health Education England has published two reports aimed at improving and standardising the training available to practitioners who carry out hair restoration surgery and non-surgical cosmetic procedures, such as botulinum toxins, chemical peels and laser hair removal.

Commissioned by the Department of Health, the reports set out ‘qualification requirements’ for practitioners who perform these types of treatments—regardless of any previous training they might have had or their professional background. The aim is to ensure patients’ safety is a priority by demanding that people are properly trained in the use and application of any products that they use. This work follows an intensive engagement process with key figures from the cosmetics industry, regulators and professional bodies.

Part One sets out the qualification requirements, which include guidance on the application of the requirements for different groups of practitioners working in the cosmetics or aesthetic field. Part Two describes the second and final phase of the project to produce the detailed qualification requirements for delivery of non-surgical cosmetic interventions and hair restoration surgery.

12 NEWS I body language

US FDA PROPOSE TO BAN UNDER-18s USING TANNING BEDS Dangers of UV radiation exposure in children and teenagers puts them at greater risk UV radiation exposure in children and teenagers puts them at a greater risk for skin and eye damage later in life, as the effects of exposure to UV radiation add up over one’s lifetime. Wise to the risks that tanning beds pose for under-18s the US FDA has proposed two new rules that include banning their use for minors.

Alongside the proposal restrict to restrict use of sunlamp products to individuals 18 and older. Users will have to sign a risk acknowledgement certification that states that they have been informed of the potential health risks from use of sunlamp products—before their first first tanning session and every six months thereafter.

Indoor tanning is a known contributor to skin cancer, including melanoma, yet 1.6 million minors indoor tan each year, increasing their risk of skin cancer and other damage (based on data in the 2013 National Youth Risk Behavior Survey).

According to the American Academy of Dermatology, those who have been exposed to radiation from indoor tanning are 59% more likely to develop melanoma than

those who have never tanned indoors.

“Today’s action is intended to help protect young people from a known and preventable cause of skin cancer and other harms,” said acting FDA Commissioner Dr Stephen Ostroff, “Individuals under 18 years are at greatest risk of the adverse health consequences of indoor tanning.”

The FDA also issued a second proposed rule that would require that sunlamp manufacturers and tanning facilities take additional measures to improve the overall device safety. These include requiring an emergency shut off switch, or “panic button” and improvements to eye safety by introducing limits the amount of light allowed through protective eyewear.

“The FDA understands that some adults may decide to continue to use sunlamp products,” continued Dr Stephen Ostroff, “These proposed rules are meant to help adults make their decisions based on truthful information and to ensure manufacturers and tanning facilities take additional steps to improve the safety of these devices.”

INCREASE IN SCOTTISH OVER 65s HAVING SURGERY ‘Lifestyle’ OAPs push up Scotland’s cosmetic surgery rates Bucking the latest UK figures from the British Association of Aesthetic Plastic Surgeons, the Scotsman has reported findings of a surge of more than 20 per cent in procedures in Scottish over-65s in the past year.

They highlight the case of an 80-year-old widow who had a facial rejuvenation after noticing men at her ballroom dancing class were overlooking her in favour of women in their sixties Experts like FACE speaker Dr Taimur Shoaib, a former consultant plastic surgeon at Glasgow Royal Infirmary suggest demand is being driven by people living longer, higher divorce rates among older people, and high-profile celebrities such as Helen Mirren, Dame Judy Dench and Joanna Lumley whose looks defy their years.

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14 NEWS I body language

events 11-14 FEBRUARY, South Beach Symposium 2016, Miami Beach, USA W: southbeachsymposium.org MARCH 16 - 19, AAFPRS: Facial Rejuvenation Meeting, Beverly Hills, USA W: embers.aafprs.org 31 MARCH - 2 APRIL, AMWC 2016, 14th Aesthetic & AntiAging Medicine World Congress W: euromedicom.com 30 MARCH - 3 APRIL, ASLMS 2016, Annual Conference of the American Society for Laser Medicine and Surgery, Boston, USA W: aslms.org 30 MARCH - 2 APRIL, AMWC 2016, 14th Aesthetic & AntiAging Medicine World Congress, Monte-Carlo, Monaco W: euromedicom.com 28 APRIL, British Association of Sclerotherapists 2016 Annual Meeting, The Ark, Basingstoke, UK W: bassclerotherapy.com 27-30 APRIL, 32nd Annual American Academy of Cosmetic Dentistry Scientific Session, Toronto, Canada W: aacdconference.com 19 - 22 MAY, 13th EADV Spring Symposium, Athens, Greece W: eadvathens2016.org 16 - 18 JUNE, 3rd ICAD Brazil – International Congress of Aesthetic Dermatology and Healthy Aging Medicine, Sao Paulo, Brazil W: euromedicom.com

DENTAL IMPLANT COMPLICATIONS AND PERI-IMPLANTITIS Dental implants to replace lost teeth can have biological complications Several studies have been published in the Journal of Dental Research which expose the biological complications of dental implants and the great challenges associated with predictable implant therapy.

Dental implants have become an important treatment for the replacement of teeth lost due to disease, injury or congenital tooth agenesis. Over the past 30 years, the incorporation of dental implants into everyday clinical dental practice has resulted in major improvements in oral health of patients through enhancements in function, easthetics and phonetics.

“While dental implant therapy remains an important treatment modality to replace missing teeth, these studies also underscore the importance of tooth preservation in patients susceptible to gum in-

fections such as periodontitis. The caution is that careful assessments and treatment planning amongst dental generalists and specialists should be performed to optimise the clinical decision-making for patients receiving advanced reconstructive implant or periodontal therapy,” said Journal of Dental Research editor William Giannobile.

“We believe the outcomes of these studies will be beneficial to patient care and oral health.”

The erroneous belief of implants yielding a better long-term prognosis than teeth has now clearly been rejected in several comparative studies and systematic reviews.

Teeth even compromised because of periodontal disease or endodontic problems may have a longevity that surpasses that of the average implant in many cases.

16 - 19 JUNE, Facial Aesthetic Conference & Exhibition—FACE 2016, London, UK W: faceconference.com 1 - 3 JULY, IMCAS Americas 2016, Cancùn, Mexico W: imcas.com 29 - 31 JULY, IMCAS Asia, Taiwan W: imcas.com 16 - 17 SEPTEMBER, AMWC Eastern Europe 2016 – 4th Aesthetic & Anti-Aging Medicine World Congress Eastern Europe, Moscow, Russia W: euromedicom.com 23 - 27 OCTOBER, 23rd Congress of ISAPS, Kyoto-shi, Japan W: isapscongress.org 3 - 5 NOVEMBER, 3rd AMWC Latin America, Medellin, Columbia W: euromedicom.com 24 - 26 NOVEMBER, ICAD 2016, Bangkok, Thailand W: euromedicom.com Send events for consideration to arabella@face-ltd.com

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body language I INDUSTRY 17

industry news

ALLERGAN ACQUIRES ANTERIOS Acquisition will expand their neurotoxin pipeline Allergan has acquired clinical stage biopharmaceutical company Anterios, Inc, which is developing a next generation neurotoxin delivery system and botulinum toxin-based prescription products. Under the terms of the agreement, Allergan acquired Anterios for $90 million up front, plus potential development and commercialisation milestone payments related to NDS— Anterios’ proprietary platform delivery technology that enables local, targeted delivery of neurotoxins through the skin without the need for injections.

In addition to NDS, Allergan has acquired global rights to ANT1207, an investigational topical formulation botulinum toxin type A in development for the potential treatment of hyperhidrosis, acne, and crow’s feet lines.

The NDS platform technology and ANT1207 add to Allergan’s

strong neurotoxin pipeline, with BOTOX Cosmetic currently in development for treating forehead lines, masseter hypertrophy and platysma bands and BOTOX Therapeutic in development for osteoarthritis and depression.

“The acquisition of Anterios bolsters Allergan’s commitment to innovation and maintaining its leadership position in neurotoxin development and commercialisation,” said David Nicholson, Executive Vice President and President, Global Brands Research & Development at Allergan. “This acquisition demonstrates our ability to apply our tremendous scientific leadership in neurotoxins to further extend our already deep neurotoxin pipeline by advancing a new delivery system and formulations that are appealing to both patients and physicians.”

“Allergan has a long history in dermatology and aesthetics, a deep

commercial and development network across these professional communities, and a strong commitment to innovation. They were the natural fit for us as we sought a partner to take our NDS platform technology and ANT-1207 program to the next stage of development and eventual commercialisation,” said Jon Edelson, MD, CEO and Founder of Anterios.

“The potential for a novel delivery system like NDS and a new topical neurotoxin is exciting for the medical dermatol-

ogy and aesthetic communities, given that our patients are seeking noninvasive approaches to treat their dermatologic and aesthetic conditions,” said William Coleman, III, MD, Clinical Professor of Dermatology and Adjunct Professor of Plastic Surgery, Tulane Health Science Center. “Offering products that provide an enhanced delivery mechanism and an effective topical formulation to today’s injectable botulinum toxin products would be an important advance for our specialty.”

UK’S FIRST ALL FEMALE LED SURGICAL CLINIC Five highly skilled surgeons will provide facial cosmetic surgery A team of five female surgeons have launched the UKs first surgical clinic led by women. At the Face Surgeon run by Miss Sarah Osborne (ophthalmology), Miss Caroline Mills, Miss Katherine George and Miss Helen Witherow (maxillofacial surgery), and Miss Sarah Little (Ear Nose and throat surgery) all highly skilled surgeons undertake facial cosmetic surgery associated with their respected specialities.

In 2014, Miss Caroline Mills identified a need for patients requiring or requesting facial surgery to be able to access an environment where all three specialists

could work together. She identified four other colleagues in London to collaborate in surgery, resulting in great clinical care and excellent surgical outcomes.

Thanks to the collaboration whatever facial treatment patients are seeking, a member of TFS team will have the expertise to ensure the best possible results. “For anybody contemplating facial surgery, this is often a daunting prospect. Some people are told they have to have surgery; other choose to have surgery for aesthetic reasons. Either way, who you choose as your surgeon is of paramount importance,” explains Miss Caroline Mills.

“The mission of our clinic is to provide anyone who requests surgery to have the best possible advice from a true UK specialist in their field of care. We are a multi-skilled team and the first all-female led clinic in the country which is very special,” says Miss Sarah Little.

Whether patients are seeking antiageing surgery in the form of a facelift or eye-bag removal, facial feminisation surgery to help the transgender community, ear, nose and throat surgery, maxillofacial or ophthalmic surgery, this elite multidisciplinary team tailors treatment plans to the individual.

18 LASER I body language

Treating unwanted hair CHRISTINE HART examines the treatment of unwanted facial hair in male to female gender dysphoric patients and women with polycystic ovary syndrome

T

he hair follicle has three very distinctive phases of growth. Anagen is the growth cycle where the cells at the base of the follicle divide and form the new hair. As the cells divide, the hair is pushed up and out through the surface of the skin. Once the hair is fully formed the cells stop dividing and the formation of the hair is complete. The follicle is then said to be in catagen where the hair is fully formed and remains attached to the follicle. The last phase of the hair growth cycle is telogen when the attachment between the hair and the follicle loosens and the hair is shed. Our aim with hair removal, is to heat and destroy the follicle and therefore prevent re-growth of hair.

Selective photothermolysis Although laser and intense pulsed light are different technologies they both rely on the process of selective photothermolysis. This is the selective destruction of a target beneath the surface of the skin. Light en-

ergy is used to selectively heat and destroy the target whilst passing harmlessly through the surrounding skin tissue.

Methods of electrolysis There are three methods of electrolysis—galvanic, shortwave diathermia and blend. Galvanic, is a chemical reaction that produces sodium hydroxide underneath the skin, but is an incredibly slow method of electrolysis. Shortwave diathermia—also known as thermolysis—is a cauterisation of the base of the follicle. Blend is a blend of shortwave diathermia and galvanic—the heat from the thermolysis speeds the chemical reaction of the galvanic, which is very useful for treating distorted follicles because the sodium hydroxide reaches the base of the follicle.

Indications and contraindications Hair and skin colour are important considerations. Medication must also be taken into consideration when considering patients for

body language I LASER 19

light assisted hair removal. Care should be taken when considering any patient for laser treatment or VPL—we have to be cautious with certain skin types and would never ever treat anybody who has a suntan. Electrolysis however can treat any hair and any skin colour. The main contraindications are epilepsy, heart conditions, skin disorders and broken skin.

Treatment methods The preferred treatment methods we use at my clinic are the Chromos 694 Ruby Laser—a very old machine with a wavelength of 694 nanometres that works wonderfully on pale skin and dark hair; and Energist Ultra Variable Pulse Light—which like the Ruby relies on selective photothermolysis. We also use electrolysis for grey hair and some red hairs.

Polycystic ovary syndrome (PCOS) In those suffering from this condition, the hormones oestrogen and progesterone aren’t produced in the right proportions, and this affects the function of the ovaries.

The incidence of PCOS in the UK is thought to be between 5% and 22%, so there are potentially huge numbers of patients. The symptoms include irregular bleeding or absence of periods altogether, infertility, obesity, acne and excess male pattern hair growth. Patients will not all have all of those symp-

toms, but when it comes to hair growth it’s estimated that 64% of the people with polycystic ovarian syndrome report to have problems with male pattern facial hair and sometimes body hair. This affects up to 4.5 million women in the UK. Psychological effects of treatment Some clients can be so unhappy about their condition that they become suicidal. Having treatment for facial hair removal is life changing and has a profound effect on mental health and quality of life.

One of my patients reported: “Taking various medications for years with no results, I wanted this to be different, but there was no way in my wildest dreams I could’ve imagined how different I would feel. I can walk down the street with my head held high. I can go out without my husband as an escort. I can stand in the shop knowing nobody will snigger, or laugh, or point at me. Laser treatment has given me back something I honestly thought I’d lost—that something is my life.”

With many women with polycystic ovaries we find that, it’s not just a case of removing hair. People have really deep emotional problems as a result which also need to be addressed and although obviously we’re not counsellors, we do need to cosset some patients I think.

Polycystic ovary syndrome (PCOS) PCOS is a condition in which the ovaries do not produce the hormones oestrogen and progesterone in the correct proportions.  Incidence 5% (1,576,002) -22% (6,934,409) of the female population* Symptoms  Irregular/absent periods  Infertility  Obesity  Acne  Excessive male pattern hair growth 64% (between 1,008,641 – 4,438,022)*

20 LASER I body language

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Case study 1 1. This patient presented with full male pattern facial hair. She had pale skin and very dark hair growth. She was age 30 to 37 at the time she presented at the clinic. She was very shy, continually referred to herself as a freak and had taken every medication that the doctors could give her to no avail. She was very reluctant to go out in public.

2. This is just prior to treatment two with Chromos and shows that her cheeks are starting to respond. A test patch four weeks before had no adverse reactions either seen or reported, so full face was treated at the first session with great results.

3. This shows the patient prior to treatment three, showing a dramatic reduction of hair growth on the cheeks, plus the neck starting to reduce.

4. This picture shows the typical redness after treatment. On rare occasions it can last 24 hours, but it’s usually gone within about 20 minutes.

Gender Dysphoria Gender dysphoria refers to psychological distress caused by a discrepancy between the person’s gender identity, sex assigned at birth, and primary and secondary sexual characteristics. The incidence of gender variance in the UK is 1% of the population according to the Equality and Human Rights Commission. New referrals to gender identity clinics from 2012 to 2013, were 2,500—so there’s an annual increase in referrals to GICs of 20%. It is impossible for many gender dysphoric patients to live in their chosen female gender role with facial hair growth. They run the fear and the risk of ridicule, of harm.

After ten treatments, we tend to see that the majority of the cheeks have cleared, but the upper lip and

5. This is prior to treatment ten. There are just small amounts of hair growth left on the chin and the outer edges of the lip.

6. Just before treatment ten we again see a great improvement.

7. Before treatment 11 we see a difference in hair. Prior to this treatment this woman had never been to the hairdressers because she was terrified of ridicule because her hair growth was so bad, so from a psychological point of view we were making a huge difference to her life.

8. After 15 treatments the patient has hardly got any hair growth left. You can see odd tiny follicles if you look very closely. The patient had been treated every four weeks and then as the hair growth had reduced dramatically we went to six weeks.

The period of major treatment has now ended, but because her hormones are still fluctuating she comes in for treatment when she feels she needs. Maybe every 18 months or two years she’ll pop in and she’ll have a treatment where we are searching for any hair growth.

the chin take another five to reach optimum of what we would say is going to respond to laser, then we recommend patients have electrolysis. We tend to reach a point— usually around eight or ten treatments—where the hair growth has slowed down and we are able to do laser and then a couple of weeks of electrolysis. To grow the hair for electrolysis isn’t as distressing because there’s hardly any dark hair there, so it’s not as obvious.

One of my patients commented; “I have occasional hairs on my chin and under my nose on my upper lip, but these are very weak and can be tweezed out easily. I would estimate 25% of my hair growth was white and this was dealt with after laser with electrolysis and, again, has almost been completely eliminated. Taken into consideration, I feel the combination of laser and electrolysis was effective and seven years after treatment I still have no

66 Gender dysphoria refers to a psychological distress caused by a discrepancy between the person’s gender identity, sex assigned at birth and primary and secondary sexual characteristics 99

22 LASER I body language

Case study 2 1. This lady is a schoolteacher with polycystic ovarian syndrome and every day she was ridiculed because of her hair growth.

If she shaved in the morning, she’d have to shave at dinnertime as well because she couldn’t possibly go through the day.

This shows her after about five treatments.

She was treated at four-weekly intervals.

She was again treated with the Chromos and had no adverse reactions. You can see where the chin, particularly two areas on either side of the chin, are always the most resistant and the upper lip. We find the cheeks and neck clear after about ten treatments, the upper lip takes more.

2. This shows the same patient two years after treatment. Again, you can see longevity of results, which is one of the major issues.

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After laser treatment with Chromos 694 Ruby Laser, the patient said, “I cried during my appointment, not because of hairs, but because for the first time I didn’t feel like a freak and I realised something could be done to help. The freedom and relief you get from not having to deal with this problem on a daily basis is unbelievable. If only I’d realised when I was 17 that my facial hair problem could be treated so easily.”

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visible hair growth, apart from the aforesaid.”

Research into optimal treatment efficacy In 2013 NHS England decided to fund some treatment for transgendered patients, but they came up with a figure of eight treatments, which left people nowhere in terms of treatment effectiveness. In response, I carried out a small study of patients to prove that the treatment was necessary and effective long-term.

We chose 14 patients at random over two clinic sites and treatments were conducted by several different laser clinicians, but all using an identical protocol. Average age of the patients was 37 years and seven months. The youngest patient was 23 and the oldest patient 57. The endpoint was considered to be where no intervention was required after nine months, or we felt we’d reached the end of what we could do. Treatment dates commenced between 2002 and 2009, and the last treatment was done in 2013.

All patients were diagnosed with gender dysphoria. All were male to female receiving facial hair removal.

All patients were taking feminising hormones, although some of them weren’t taking those feminising hormones at the beginning of their treatment, but somewhere along the line they were taking them. All patients were skin types two and three.

All patients had a mixture of hair colours, and the patients received treatment with either the Chromos Laser, the Ultra VPL or a combination of both.

Trial results As we expected our results showed that reduction in the hair growth is something people see right from the very first treatment. However, what we note in the clinic is when that reduction is making the difference to people’s everyday life, so for example they tell us they shave less.

The earliest reduction was after treatment two and the last reported reduction was after treatment five.

On average after the third treatment people noticed improvement

in their everyday living.

When we look at treatment progress out of the sample of 14, two records didn’t report anything in terms of writing down the improvement. Out of the other 12 patients, the cheeks and neck required an average minimum of 12 treatments. The quickest results were seen after five treatments, and the slowest was after 18 treatments.

In terms of the maintenance, when we get to what we feel is the Gender dysphoria Refers to psychological distress caused by a discrepancy between the persons gender identity, sex assigned at birth and primary and secondary sexual characteristics.  Incident of gender variance: 1% (634,892) of the U.K. population*  New referrals to Gender Identity Clinics (GIC’s): England 2012/13 2500 patients**  Annual increase in referrals: 20%**  Parity between transgendered male to female and female to male** * Equality and Human Rights Commission ** NHS England

body language I LASER 23

end of what we can achieve with laser, the patient then has a choice to move onto electrolysis, or to go onto a maintenance programme.

They make a choice about what they want to do if they have any dark hair left. Nine people went onto the maintenance programme and in the first year of maintenance those nine people had four treatments. That gradually reduces until year six, when only one patient required two treatments that year.

Seven patients used the Chromos Laser, and the average number of treatments there was 14.5. Four patients used the Ultra VPL, and the average number of treatments was 14.3. Three patients used a combination of treatments and the average number of treatments taken went up to 15.6, but we think that’s because they have red hair and these patients seem to be more difficult to treat.

In terms of adverse reactions, although we do give patients verbal and written aftercare, which

66 In summary, an average number of treatments to see improvement is three 99

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obviously includes not going in the sun, one patient who went out in the sun immediately after treatment had hyper-pigmentation. We had to suspend that patient’s treatment until the skin had gone back to normal, but there were no longterm effects.

In summary—an average number of treatments to see an improvement is three. In treating full face and neck, we see the neck and cheeks clear first, and the upper lip and the chin are most resistant.

Our research shows that the average number of treatments lies between 15 and 16 and the treatment schedule is four to six weeks. There is very little difference between the use of the Ultra VPL and the Chromos Laser, but the patients in the trial are all only up to skin type three. Limits to the study included the number of patients and the study duration.

There’s nothing at all that looks long-term at patient results. We need to be able to prove longevity of treatment and we can only do that if we all start to get together and collect data, meaningful data, and do some clinical trials.

At my clinic we treat patients, from far and wide with laser treatment, but when they move to having electrolysis they need to be treated somewhere more local.

We need people that we can refer onto and to create a support system for patients and for therapists to know that they’re going to get the best quality of treatment and care, beneficial for the patients and it’s beneficial for everybody’s business. I would welcome interest from anybody interested in joining with us to do some clinical trials and to build up a referral system, particularly when it comes to our NHS patients.

The future: collaborative working We achieve great results at Cristianos and I’ve got absolutely no doubt in my mind that other people across the country are achieving great results. However, in terms of longevity of treatment all of the current data looks at patients who’ve had treatment who were followed up after six months.

Chris Hart is a qualified electrologist who has used laser in her practices since 1997. She is the MD at Cristianos Laser Clinic, which has five clinics in London, Liverpool, Manchester, Lancashire and Leeds.

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Case study 3 1. This shows a gender dysphoric patient before treatment.

2. After two treatments you can start to see that the lip looks

Reference 1. Gillings-Smith C. Franks S. Polycystic Ovarian Syndrome Repord Mev Rev 2 (1993) : 15-32

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prominent against the cheek where the cheek has cleared.

3. After ten treatments we see the vast majority of the cheeks and the neck cleared.

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body language I EQUIPMENT 25

A smarter way of managing sweat Primary and secondary hyperhidrosis can have a major impact on patients’ lives—ANNIE ECCLESTON looks at the latest treatment options

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yperhidrosis is defined as an excessive amount of sweating.

We all sweat to maintain thermal regularity, but when people sweat excessively it becomes a problem for them.

Hyperhidrosis affects both sexes and all races and can be divided into two categories: primary and secondary. Primary hyperhidrosis symptoms are complaints of sweaty armpits, sweaty hands, sweaty feet—all of which are treatable. Generally, onset is in adolescence during puberty, there’s usually a family history and it’s always bilateral.

Secondary hyperhidrosis is usually caused by a medical condition.

Sometimes it’s unilateral; it can be drug induced, and it can also be caused by an injury. Both primary and secondary hyperhidrosis can have a major impact on people’s lives. For example men who are too embarrassed to remove jackets in social situations, or at work, because of their sweat marks. Where I work, treatment for hyperhidrosis is also common amongst people who do a lot of close contact work—such as nurses and doctors. Many patients who present complaining of sweaty hands also have axillary and plantar hyperhidrosis. People with hyperhidrosis need to use very strong, sometimes prescribed anti-perspirants which contain aluminium salts and can cause irritation and soreness to the skin. Most, if not all, are seeking another more permanent solution to abate their sweating.

Traditional treatments Many years ago, sympathectomy was the only permanent solution.

This invasive treatment—requires general anaesthetic, deflation of the lung, and cutting the sympathetic nerve in the correct area to stop sweating in the axilla and hand. The problem with this approach is that the nerve still thinks it’s working and breakthrough or compensatory sweating can occur elsewhere on the body, which may then have to be controlled with medication.

Botulinum toxin treatment Toxins work by blocking the nerve stimulation to the sweat gland, and have become a common treatment for hyperhidrosis. However, since botulinum toxin’s effects gradually wear off over time, this is a process that patients have to repeat.

We have many happy clients who have regular toxin treatment and are testament to the effectiveness of this procedure, though results can vary between injectors if they are not properly trained in the appropriate technique. The most effective results are from when it is placed very superficially, and if that’s not done then it won’t last as long as it should do. Botulinum toxin may be great for underarms, but treating hands and feet with toxins is very painful and requires local anaesthesia, or even a nerve block, which makes it more difficult to perform.

Iontophoresis Treatment with Iontophoresis involves placing hands and feet in a shallow bath of water and passing an electric current through it for 20 minutes or so. This process temporarily inactivates the sweat

Sweat Smart Centres Sweat Smart Centres (sweatsmart.co.uk) have been developed to offer a complete range of advice and professional solutions for people suffering from focal primary hyperhidrosis. As access to treatment with iontophoresis and toxins via the NHS has become increasingly difficult, sufferers are looking for specialist advice and help in the private sector— rather than someone who mainly promotes toxins for wrinkles, and just happens to also offer this procedure for sweating.

People can contact a Sweat Smart centre for free advice, and there is also a supportive forum, so people can get information that they require and discuss treatments.

glands and stops them working.

It’s a proven treatment for hands and feet and although how exactly it works is still unknown, patients can use this to effectively control symptoms from the comfort of their own home.

It’s necessary to treat daily to start with, for two to four weeks.

After that, patients get to know their own body and how often is necessary, although most people can get away with using the machine once or twice a week. To treat the armpits, you have wet pads that you place underneath the axillae, but of course the contact

26 EQUIPMENT I body language

isn’t fantastic, so it doesn’t work particularly well here.

Human histology slides showing the tubular structures of sweat glands at baseline, 10 days and 180 days post treatment

miraDry This is new microwave technology treatment that’s been in the UK for two years. By using controlled thermolysis miraDry targets the area just above the subdermal fat to create a zone of heat of up to 60 degrees, which denatures the sweat glands and stops them from working. The device also has a cooling element on it, so it protects the upper epidermis. Unlike hair follicles and potentially fat cells, sweat glands don’t regenerate. The effect is permanent since we don’t develop any more than the number we were born with.

The treatment is non-invasive, and it has a very strong patient satisfaction rate and safety profile.

On the electromagnetic spectrum of waves, which includes x-ray and radio waves, miraDry’s microwave technology sits somewhere in the middle, which makes it very safe.

It’s been used in medical technology for a long time now in devices that use microwaves for treating prostatic cancers and various other tumours. When used correctly in very focal areas, it works very well indeed.

The safety data on miraDry is excellent, it’s localised in its effect and there are no reported long term issues from its use since FDA approval in 2011 and over 40,000 patients treated.

The target anatomy when treating with miraDry is the sweat glands, of which there are two types—eccrine glands produce watery sweat, and the apocrine glands produce the odour. Both types reside in the interface of the subdermal fat, which is the area that

we’re targeting when we do our treatment.

A miraDry session lasts about 90 minutes and one treatment costs around £1,500—offering a permanent solution to underarm sweating. Currently the miraDry system is only treating underarms, but handpieces are being investigated to treat the hands Evidence Peer reviewed clinical studies have demonstrated an average of 82% measured long term sweat reduction in patients suffering from axillary hyperhidrosis Long-term data from the USA has shown that 100% of those treated who suffered with bothersome sweat, are no longer bothered by their sweat two years later. In addition, 89% of patients found that they were less troubled by bothersome odour at the end of the two studies. In reviews of the treatment on the American website RealSelf. com, an independent patient review website, miraDry scores 90% compared to IPL 59%. Our data is changing all the time, because it’s a fairly new procedure, but as the treatment protocols are refined, we are finding that more people are now satisfied after just one treatment.

Human histology Human histology slides show the tubular structures of the sweat glands and effects post treatment.

Studying human histology slides we can see that ten days post treatment, the sweat glands have gone and 180 days post treatment, they’re still gone.

We use starch iodine tests on our clients on a regular basis and you can see the area of treatment

three months, two years and three years later.

Hair removal Not only does miraDry inactive the sweat glands, it can destroy hair follicles as well, because the two reside in the same area. For ladies who are happy to remove armpit hair, this is an added benefit of treating the axillae. The treatment is colour blind (effective for white, grey and red hair) and has recently been FDA cleared as an additional indication in the US—however, this is currently restricted to underarm hair only.

Treatment Protocol We apply a semi-permanent tattoo, which we then remove after treatment, and that tells us exactly where to inject anaesthetic and exactly where to place the handpiece during treatment. All treatments are carried out under local anaesthetic and begin with injecting lidocaine with a 4mm 30 gauge needle in armpit area.

The miraDry machine is straightforward to use, and is simpler than operating a laser or radiofrequency device. The only downtime is localised soreness and swelling after treatment. But as long as someone can continue with cooling (using ice packs) for 2448 hours post-treatment, they can return to work the following day.

We’ve treated women in our clinic who had treatment on the Wednesday and then continued to stay at work on the Thursday because they had access to a freezer and could do regular cooling.

Many people offering treatment in the USA are finding the largest market is clients who are ‘sweat bothered’ (those who are not strictly hyperhidrotic, but would just like to not have to use antiperspirants on a daily basis), and I believe that we’re also seeing—and will continue to see—more and more of these patients in the UK. Annie Eccleston is a Registered General Nurse with a wide range of experience having worked as an Intensive Care Nurse and as a specialist nurse in general practice. She has worked at MediZen alongside husband, Dr David Eccleston, since 2004

28 INJECTABLES I body language

Killer heels DR MARK HAMILTON walks us through the use of dermal fillers in feet to address stiletto metatarsalgia

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t’s all too common that women will compliment the lovely shoes each other are wearing on a night out, but by the end of the night significant number are walking around, holding those heels in their hand. Despite this, most women continue to wear heels nowadays and the reality is it’s a real fashion accessory. So what is it about high heels that’s making everyone want to wear them?

Why do we wear heels?

The truth is heels are always in fashion. They give the wearer a little bit of extra height; they seem to create good posture for the wearer; the bust and bum seem to be enhanced; legs look better, and some even argue that they have a better sex life.

Research undertaken by Italian

urologist Dr Maria Cerruto and published in the Archives of Italian Urology and Andrology Journal presented a study of 66 women under 50, which measured electrical activity in the pelvic muscles. Her research suggested that muscles are at optimum position for strength and contraction when wearing heels.

I agree with Christian Louboutin when he says that he is certain that heels have never been as high as they are now. Louboutin is also a man who recognises that everybody has different pain thresholds—for some, a one inch heel will be the pain threshold that they can deal with, but often the threshold of pain becomes a threshold of pleasure, and of course, the fetish shoe—the eight inch stiletto heel – is coming into mainstream fashion.

Foot pain High heels are now an integral part of a woman’s outfit, and despite the balls of the feet taking abuse like never before, women are refusing to give them up. Stiletto metatarsalgia is the pain secondary to the wearing of high heels. There are some other common causes of foot pain—plantar fasciitis is probably the most popular one; arthritis; corns and calluses; gout; neuromas are all common causes of foot pain.

Metatarsalgia is pain caused in the ball of the foot and is well localised. When wearing high heels, the whole weight of the body is transmitted through the metatarsal joint, and in a high-heeled shoe, there is constant pressure applied.

Cushioning under the metatarsal is inadequate, so when that distal metatarsal joint is flexed into that

body language I INJECTABLES 29

high ankle position, the fat pad is displaced posteriorly and the cushioning becomes inadequate.

Cross section showing the fat pad and the area to be injected into

Solutions to metatarsalgia Changing footwear would the sensible option, but we’ve already realised that women are reluctant to do that. The irony is that turning to flat shoes can however be a trigger for plantar fasciitis and interestingly sufferers of plantar fasciitis find that going into a heeled shoe can actually sometimes bring some relief. Many women use gel cushioning inserts, but the problem with that is that these shoe inserts change the fit of the shoe and can Subcutaneous exposure

Medial plantar fascia Lateral plantar fascia

Plantar aponeurosis

Tuberosity of calcaneus with overlying fat pad partially cut away

cause pressure and friction elsewhere on the feet.

With the evolution of dermal fillers it’s possible to use these as a way of cushioning the ball of the foot. Once inserted, the filler is constantly there and attempts to recreate the cushioning effect of this fat pad that has been displaced posteriorly. The technique for delivery is very simple, there’s minimal downtime and it’s relatively safe.

This use of dermal fillers is not yet something that’s well studied and very little research has been carried out into it. There is one case reporting on the use of collagen injections in the treatment of metatarsalgia3 and about failed relief of metatarsalgia from a collagen dermal filler. Evolence discussed the use of collagen within the feet for cushioning—something I advised against, because my experience was that it was really the HA fillers that were providing the real cushioning and I wasn’t sure that Evolence was ever going to create any sort of cushioning effect.

Foot anatomy Underneath the distal metatarsal head, are little sesamoid bones, which must be paid attention to during a treatment. With the metatarsal head in a flexed position, the sesamoid bones are taking a lot of the weight, so you must be careful when you’re injecting that you’re not interfering with them. If interfered with and moved to the side, the weight that’s transmitted through that metatarsal head can become quite uncomfortable.

There are some unique aspects to the skin of the sole of the foot.

It is the thickest part of the body; it lacks hair and pigmentation and the sweat pores themselves lack sebaceous glands. It is an incredibly sensitive area, but it’s the fibrofatty chamber surrounded by thick connective tissue that we’re looking to enhance and to treat.

In terms of landmarking, it’s important to know of the location of the deeper intrinsic and extrinsic muscles in the foot, but you really should not be in this area with the needle. Working this deep is danger territory—activity should be

restricted to the subdermal area and not anywhere near the deep intrinsic anatomy of the foot.

Examination protocol When a patient comes to talk about this metatarsalgia I begin by taking a full history, in order to determine whether it really is metatarsalgia and eliminate all other causes of foot pain. I’ll take a quick foot assessment and palpate the foot, while looking for obvious callouses and thickening of the skin, which usually highlights the area that is taking all the weight. Also I often I take an impression of the foot on some impression foam.

Once the patient’s foot is cleaned and prepped, I usually apply topical anaesthetic for about 20 minutes beforehand. I then infiltrate using 2% lidocaine with adrenaline—because adrenaline is very useful at causing basal constriction and it reduces bruising.

The sole of the foot is not particularly vascular; it’s particularly just the subdermal region and this fibro-fatty compartment that we want to treat, but using the 2% lidocaine with adrenaline is great as a way of reducing the risk of bruising and allowing you to treat the patient in a degree of comfort.

I mark the sole of the foot by palpating the area, flexing the toe and feeling the metatarsal head— it’s a very straightforward technique. Its possible to feel areas of thickening of the skin and where the fat pad is, which is where want to inject into. I use a 27 gauge needle and my preference is to use a soft hyaluronic acid like Belotero Basic in most of my patients. In the past, I used Sub Q with the understanding that thicker fillers would give a better cushioning effect, but the reality was that these thicker filler patients took much longer to get comfortable. We want to give patients immediate comfort so they can get into their heels straight away with minimum downtime.

Post treatment Post treatment, after I’ve injected the filler, I use about two mils of Belotero on each metatarsal head and a small amount of careful moulding. If you use something

30 INJECTABLES I body language

Toxins Is there some benefit from using toxins? Personally, I don’t use toxins in the feet. I can understand some of the logic behind using it in the feet—you can relax some of the muscles in the feet that are in spasm in high heels, and actually give some analgesic effect.

Although the mechanisms are not completely understood for everyone a paper in Neurology Journal showed that patients who were injected with Botox in the soles of their feet experienced significant reduction in pain after 12 weeks, so it’s something definitely to look at but not something that I personally use.

Dr Mark Hamilton is a full time cosmetic doctor and surgeon, published author and conference speaker working in the UK and Ireland who has been practicing in aesthetics for the last 12 years. He has recently opened a new clinic in Merrion Square, Dublin city centre.

W: hamiltonfaceclinic.com

An example of an impression of the foot, showing particular areas that take any extensive weight of the foot

straightforward, like Belotero Basic or Juvederm Ultra 3, you’ll find that that HA moves very easily within the tissues and you don’t get any hard lumps or bumps.

I ask the patients to wear comfortable sports shoes for 24-48 hours. However, it’s not unusual for the patients to go straight into their heels again immediately after the treatment. It can be very frustrating when patients don’t come prepared with their flat shoes, particularly since we try to give them that information beforehand. However, many people are really keen just to get back into heels and back to normal again, and that’s why I use products like the Belotero Basic, the very soft fillers, because it will allow patients to get straight back into wearing their shoes again.

Sometimes we ask them to just use common sense oral analgesia, if the pain is a little more than they’re expecting, and a slow introduction to high heels as comfort dictates.

Precautions Try not to use too much filler all in

one session—a couple of mils of a soft HA filler are perfect in one session. You may end up having to go back and add a few more after a few months, and that’s fine, but in my experience it’s always been much easier to add a little more filler, or do a little more treatment a month or two later than regret doing too much all in one session.

Be aware of intra-articular injection. However, if you’re injecting the face and you’re familiar with straightforward injections, you should have no problem injecting the foot.

Managing expectations Correct patient selection is really important. It’s generally not possible to help older patients, who have arthritis in their feet.

Many patients have very high expectations for this treatment. It’s wise to advise patients that this is just a comfortable treatment that should increase the comfort of wearing high heels, but that you’re not going to eliminate all of the pain.

The sole of the foot is marked by palpating the area, flexing the toe and feeling the metatarsal head

References 1. Cerruto M; Archives of Italian Urology and Andrology; Dec 2012; 84(4):184-8.

2. http://www.dailymail.co.uk/femail/article-2130989/ Christian-Louboutin-sympathy-women-struggle-stilettos.html 3. Dhinsa BS et al; Journal of Foot & Ankle Surgery; 2010 Nov-Dec;49(6):565.e5-7.

4. Yuan RY; Neurology Journal; 2009 Apr 28;72(17):1473-8.

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In life as in art, the beautiful moves in curves

Introducing Radara™ A new innovation in micro-channelling skincare Radara™ offers a targeted and painless approach to skin rejuvenation, using micro-channelling patches and a high purity HA serum. This unique system reduces lines and wrinkles by an average of 35%, delivering smoother, firmer skin in just four weeks.* The five-minute daily application restores skin radiance and quality, with no pain, no fuss and no downtime!

Available Nationwide Visit radara.co.uk to find your nearest stockist. * 8-week trial, independently assessed by clinical dermatologists. Data on File, Innoture Medical Technology Ltd.

body language I MEDICAL AESTHETICS 33

Hand remodelling treatments The hands are often one of the first areas to display visible signs of ageing, leading patients to seek rejuvenating treatments. DEBBIE THOMAS explores the ageing process and what can be done to regain a more youthful appearance

I

nvariably hands will show the first signs of skin damage caused by UV light and other free radical causing aggressors, visually ageing faster than the face and other areas of the body.

That is because the skin itself on the back of the hands is not only much thinner than on your face, there is also very little subcutaneous fat present here, so even with a minimal amount of collagen or elastin fibre degradation, glycation and fat loss it’s going to have a noticeable impact on your hands.

The resulting effects are clear to see and feel, wrinkly, crepe-like skin texture that doesn’t bounce back, the noticeable appearance of prominent veins and the bones from loss of volume and pigmentation spots or mottled skin discoloration from UV and IR exposure. These visible changes in the skin are very strongly associated with ageing so clients become worried that it makes them look old, often trying to hide their hands as much as possible.

Taking care The majority of skin on the body and face will respond in a similar way to both negative and positive factors. The hands suffer as much as they do simply because we do not take as much care of them as we do as our face with carefully applied skincare, and they do not get the protection from the elements as areas of the body covered by clothes. We additionally readily expose them to a torrent of drying, irritating factors like water and cleaning chemicals.

For many a good home care regime started at a young age will dramatically improve the skin on the hands in later life. My recommendations for the hands are similar to the face; in the am apply a high quality antioxidant that will protect against free radical damage followed by a hand cream containing SPF 30 or above. The hand cream will need to be reapplied readily throughout the day, every two hours and after washing the hands. For pm, we need a renewing product so retinol works well or a AHA containing cream or serum.

In a professional clinic setting

we tend to see clients once the area has already started to show signs of damage, this damage is associated with ageing but really are the signs of years of UV, IR, environmental and chemical damage.

Fillers Losing even a minimal amount of fat padding on the backs of the hand creates a aged look, the skin no longer has the support structure it needs to look and feel firm the way they used to Traditionally the professional hand care treatment of choice is fillers. Fillers are used to add vol-

34 MEDICAL AESTHETICS I body language

ing on the light treatment you opt for, it can take one to six treatments to clear the skin of existing pigment. You may need to offer one or two top-up treatments per year to maintain the skin and manage new pigment coming through.

Laser and IPL treatments carry a small risk of discomfort, redness, mild swelling, and further pigmentation problems especially in skin types 4, 5 and 6. No tan should be present at the time of treating and good sun care is strongly advised.

Before and three weeks after two EnerJet treatments

ume, replacing the lost volume and padding out the area. You would use a filler that is thicker in consistency, and once the product of choice has been injected it is massaged to smooth out bumps and be evenly spread. Treatment should take about 20 mins and the results will be visible after approximately two weeks. Unlike on the face with less moving muscles, on the backs of the hands the filler can last up to two years. Evidence now has shown that fillers can actually help stimulate your own collagen production so over time you may need less and less product.

The main risk with fillers is the formation of bumps under the skin.

This is rare and can be avoided by massaging the area directly after treatment. Extra caution should be taken with ethnic skin that is prone to keloid scar formation.

Laser skin resurfacing Unlike full ablative laser treatments—that cause significant trauma, long recovery time and a reasonable risk of adverse side effects—pixelated lasers create tiny pinholes in the skin that stimulate your body to produce more of its own collagen and elastin, with minimal redness and a very short recovery time.

By stimulating new collagen and elastin production, the skin’s underlying support structure is strengthened and fortified, resulting in smoother, plumper more youthful looking skin.

The new collagen fibres are permanent, but are not immune to the

factors that break them down in the first place. A good home care routine will boost and prolong the results, while continued sun exposure will damage even this newest of collagen.

Due to the peeling nature of the laser it can also help reduce pigmented areas. Generally three to six successive treatments are needed to get the best result followed by one to three top-up treatments per year to maintain the benefits.

Non-ablative laser Age spots, liver spots, sun spots or solar lentigo—whatever you call them, no one wants these unsightly pigmented lesions.

These brown patches are a natural part of the ageing process, but UV light has a big part to play.

The more sun exposure you have had, the more brown spots will appear with age. For those who think they will worry about it or be good “when I’m older”, the majority of sun damage happens when we are very young, so even if you look after your skin in later life the damage occurred during our younger years will eventually show. It is believed that solar lentigo take 20-50 years to show visibly on the skin, and new ones can continue to surface over time.

Various lasers and IPL have been designed to target and remove these excess patches of melanin in the skin. The melanin absorbs the light energy which turns to heat, this heat damages the melanin cells making them nuisance cells that the body will get rid of. Depend-

EnerJet The EnerJet is an easy procedure suitable for all skin types that is performed in-clinic. The skin remodelling platform reverses the visible signs of ageing using Jet Volumetric Remodelling (JVR) technology to introduce and disperse a diluted hyaluronic acid dermal filler. The pneumatically accelerated jet penetrates the epidermis, and upon reaching the dermis, spreads laterally in all directions. The heavy HA molecules are directed sideways to create effective dispersion. These HA particles act as “nano bullets”, disrupting the dermal cells in their passage and initiating the wound healing process to provide collagen remodelling.

It delivers immediate and longlasting aesthetic results without thermal heating or needles using precise and controlled pneumatic technology to deliver hyaluronic acid into the dermis. This facilitates absorption and retention properties to produce an immediate aesthetic improvement, making the skin appear fuller, hydrated and rejuvenated.

The JVR technology can also help restore the hands by removing visual veins (dermal thickening).

The combination of kinetic energy and dermal filler effect, results in a wound healing process which simulates the skin to produce more collagen and helps restore the hands to a more youthful appearance by hydrating the skin and thickening the dermal layer.

Debbie Thomas is a Skincare Expert and Super Facialist. She is the Founder of the Debbie Thomas Clinic in Chelsea, London.

W: debbiethomas.co.uk

36 SKINCARE I body language

Preventing and clearing acne DR ZEIN OBAGI is on a mission to incorporate physician-based treatments with patient education to encourage patients to make lifestyle changes that will significantly reduce acne flares and promote healthy skin

I

nstead of just prescribing a “quick fix� topical cream to temporarily resolve a current acne flare, my strategy has been to develop the most effective treatments that focus on cleansing the skin regularly with products formulated to restore the natural balance of the skin. This long-term approach allows patients to achieve renewed equilibrium and to maintain a clear complexion.

Acne classifications in current use (mild, recalcitrant, severe; com-

edogenic, cystic adult acne (conglobata, necrotica, keloidae) are merely descriptive terms that can cause confusion for physicians as well as patients. I have developed a new classification model that provides more clear objectives and frees physicians from the restrictions that conventional wisdom has imposed on proper treatment.

Type 1 (comedogenic acne) can be prevented. Acne is often attributed to genetics or hormonal imbalance. Contributing factors, or acne triggers, may also include

ZO ACNE CLASSIFICATIONS 1.

Comedogenic Comedones without cysts or scars

2.

Cystic, no scars Acne with cysts but no visible scars

3.

Cystic, with scars Cystic acne with visible scars

lifestyle choices, such as diet, sleep patterns, hygiene, sun exposure, and stress. Some forms of acne require topical or oral prescription medication with or without clinical procedures. Recommendations

body language I SKINCARE 37

for topical acne skincare should be based upon the severity of acne, presence of discolouration, age of the patient, and probability of resultant scarring.

Begin with prevention My approach to dealing with acne

is based on the belief that acne can be prevented. However, it is only preventable when an aggressive therapeutic intervention is introduced in the early stage. Ideally, prevention will be most effective when closed and open comedones begin to appear, but before sebuminduced inflammation can trigger the immune response. Every effort should be made to eliminate these lesions in the early, non-inflammatory stage. They can be extracted with a comedone extractor that applies equal pressure circumferentially around the comedone and causes the sebum and follicular debris to be expelled outwards. Patients should be instructed to avoid any manual picking, as this can drive the sebum and follicular debris deeper and induce inflammation and possibly cyst formation.

An effective acne preventative programme consisting of cleanser, scrub, and a sebum-lowering agent, can help eliminate open and closed comedones in the early stages.

However, if inflammatory acne form cysts manifest, intralesional corticosteroid injections (triamcinolone acetonide diluted to a concentration of 2.5 mg/cc), should be used to prevent or arrest the focal inflammation early. Intralesional corticosteroids are commonly used in clinical dermatology as an adjunct to topicals. Local adverse effects are dependent on the strength of the preparation, the amount administered, the area of the body, and the specific skin condition being treated. The most common side effect is atrophy, which can be avoided by a conservative approach to treatment.

It should be noted that P. acnes does not directly cause acne. Rather, these bacteria play a secondary role in the condition. The complete pathophysiology of acne has not yet been elucidated, and the etiology appears to be multifactorial. Fo-

66 In actuality, sebum and the resulting inflammation are the main problems in acne, and the control of sebum may be the key to acne prevention and treatment 99

cusing on bacteria does not address the pathogenesis of the condition and may lead to unnecessarily high rates of reoccurrence and treatment failure. In actuality, sebum and the resulting inflammation are the main problems in acne, and the control of sebum may be the key to acne prevention and treatment.

Optimised treatment plan When the skin is maintained in a healthy condition, it is less susceptible to acne. Accordingly, the treatment objective should not be to only temporarily slow down sebaceous gland activity and dry up lesions, but to restore skin health while concomitantly correcting all of the contributing factors responsible for causing acne.

A thorough patient history and an in-depth physical examination is a prerequisite of formulating a treatment plan. If an underlying systemic hormonal abnormality is suspected as contributing to the patient’s acne, appropriate blood tests should be ordered and an endocrinology consultation may also be recommended. In teenage females, some birth control pills can be helpful to regulate the hormonal factors that contribute to their acne condition. These include medications that counteract the androgens that drive sebum production.

Additionally, spironolactone or insulin resistance agents may also be prescribed in certain cases. You should also determine whether systemic antibiotics or isotretinoin (RoAccutane) are indicated.

The practitioner must determine the acne type (comedogenic, cystic/non-scarring, or severe (cystic/scarring). Based on the acne type observed, then outline the optimal treatment recommendations. Patient compliance with a daily treatment regimen is essential.

The topical approach to treating acne, while at the same time improving overall skin health, includes multiple steps: skin preparation, addition of disease-specific agents (if indicated), exfoliation and stimulation of epidermal renewal, barrier repair, Stimulation of the dermis (for deep repair), hydration and calming (only if necessitated to relieve skin dryness), and broad spectrum sun protection.

38 SKINCARE I body language

Heavy moisturisers, oil-based foundations and camouflage makeup should be avoided, even if they are labeled ‘non-comedogenic,’ as these can alter skin barrier function and increase skin irritability, which can lead to inflammation and cystic acne. Furthermore, it has been found that many products currently on the market claiming to be ‘non-comedogenic’ are actually not.

Treatment should begin with appropriate topical agents; systemic agents can be added as needed. Among the most important components of the ZO Skin Health anti-acne regimen is ZO Medical Cebatrol Oil Control Pads that contain three exfoliating agents, 2% salicylic acid, mandelic acid and glycolic acid. These soft pads and infused with an effective acne prevention solution that remove oil, normalise pore size, helps smooth the skin’s surface and soothes irritation. Using these pads twice daily, AM and PM removes dead skin cells, debris and excess oil from pores.

Clinical procedures Practitioners should also take steps to resolve some of the patient’s most pressing acne issues when they come into the clinic. These may include extracting comedones, intralesional steroid injection into inflammatory acneform nodules, and initiation of a short course of oral steroids. Furthermore, to help unclog pores and dry cystic lesions faster, it may also be helpful to add exfoliative procedures or products, including AHAs, beta hydroxy ac-

ids (BHAs), or exfoliative chemical peels after the first maturation cycle of treatment (six weeks) has been completed.

Procedures, such as ZO Stimulation Peel and photodynamic therapy (PDT), with blue or red light, can be used to assist treatment, but never as the first line of treatment. For example, if PDT is going to be used, one should start with all essential and supportive topical agents. Once acne is somewhat controlled and skin is more tolerant (for example, after at least six weeks on a topical regimen containing essential topical agents), PDT sessions can be added to the overall treatment plan to accelerate and improve results. The topical photosensitising agent applied before PDT treatment collects preferentially in sebaceous glands, and the subsequent exposure to light of the

appropriate wavelength destroys those glands.

In light of the fact that the pathophysiology of acne vulgaris depends on active sebaceous glands, the selective destruction of sebaceous glands may also prove to be helpful in acne prevention. Several studies have shown clinically and statistically significant improvement of inflammatory acne following a series of treatments. For some patients, this therapy may be an effective method for long-term prevention of acne flares that is well tolerated.

Dr Zein Obagi is a board certified dermatologist in Beverly Hills, California, and the Medical Director of ZO Skin Health and is responsible for the development of new skincare treatments, protocols and products to achieve healthy skin.

W: zoskinhealth.com

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Triple action nourishing system minimises bacteria that can cause acne and provides nourishing benefits to prevent inadequate healing that can lead to post-inflammatory hyperpigmentation.

Correct & Conceal provides an instant, natural, long-lasting matte coverage, while minimising the redness and irritation associated with acne lesions. It is intended to use two or three times daily or as needed.

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body language I NON-SURGICAL 41

Evolution of cryolipolysis DR FARID KAZEM traces how cryolipolysis has evolved, from its inception to today’s new innovative treatments

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he potential for cryol ipoly si s — c ont rol led cooling to selectively target undesirable subcutaneous fat—was first recognised by researchers R. Rox Anderson, MD, and Dieter Manstein, MD, PhD, from the Wellman Center for Photomedicine at Massachusetts General Hospital, a teaching affiliate of Harvard Medical School. Based upon case reports of cold-induced panniculitis, they investigated controlled cooling and realised that lipid-rich fat cells are more susceptible to cold injury than surrounding waterrich cells. The cryolipolysis technology was exclusively licensed to ZELTIQ Aesthetics in 2005 and the CoolSculpting system was developed to non-invasively reduce subcutaneous fat. CoolSculpting received FDA clearance in the US for non-surgical reduction of fat in the flank area in 2010. FDA clearance followed for the abdomen in 2012, for the thighs in 2014, and for the submental area in 2015.

CoolSculpting is approved for fat reduction in over 70 countries worldwide, throughout Europe, and including Canada, Brazil and Australia.

Safety After more than 15 years of research and development and over 60 clinical publications in peerreviewed journals, CoolSculpting has been established to be safe, effective, well-tolerated, and long lasting. Today, CoolSculpting has

grown in popularity, but there are many counterfeit systems entering the market. These counterfeits claim to be as safe and effective as CoolSculpting, yet they’re sold mainly to beauticians and beauty salons. Some counterfeit systems have advantages such as having no disposables and consumables and being lower cost.

The greatest differentiation between CoolSculpting and counterfeit cryolipolysis systems is safety and consistent efficacy.

This is due to the significant research and development that went into CoolSculpting before it was introduced to market. Educating our patients is very important, so they can make the right decision.

I have seen patients injured by counterfeit cryolipolysis systems, seeking help for serious freeze burns. These counterfeit device injuries have also been reported in the literature by Dr Grant Stevens and Dr Brian Biesman. For proven safety and efficacy, CoolSculpting

Educating patients is very important as counterfeit cryolipolysis systems can cause serious freeze burns

42 NON-SURGICAL I body language

is the only choice for non-surgical body contouring.

Non-surgically fat reduction When we first started with CoolSculpting, we began by treating discrete areas, such as “love handles” on the flanks and abdominal bulges. With additional clinical experience, we realised that patients don’t just want to treat individual bulges, they want to have a total transformation. We moved on to Treatment to Transformation, multiple CoolSculpting cycles delivered to multiple treatment areas, to achieve the dramatic results our patients were seeking.

There are now numerous CoolSculpting applicators, which allow treatment of different body areas.

Treatment focus began with the abdomen and flanks using the CoolCore, CoolMax, and CoolCurve+ applicators, then the CoolFit applicator was developed for treating the inner thighs, and the CoolSmooth applicator was introduced for reducing fat on outer thighs. We also treat the arms with the CoolFit applicator and male breasts with the CoolCurve+ applicator.

New Developments CoolSmooth PRO has recently been introduced. Compared to the CoolSmooth applicator which takes about two hours to complete a treatment cycle, CoolSmooth PRO reaches colder temperatures and thus takes a shorter duration, only 75 minutes, to achieve the equivalent effect.

The CoolMini Applicator has just been introduced, mainly for the submental area, or double chin. This small volume applicator will also be useful for reducing fat above the knees and around the axilla. I am also interested in CoolMini for treating the area parallel to the nasolabial fold and reducing fat in the cheek.

Clinical studies on submental treatment were carried out in the US and in Mexico. A CoolMini European pilot evaluation has been carried out, too. Kazem Aesthetica was one of the pilot sites. Preliminary results show the submental area, the area just above the knee, and the axillary puffs can all be

safely and effectively treated with the new CoolMini applicator.

A changing market By offering CoolSculpting, we’re drawing even more patients to our practice, patients who normally would not consider plastic surgery. These patients are interested in non-invasive aesthetic technology. Dr Grant Stevens published how his practice has grown dramatically since he started offering CoolSculpting for non-surgical body contouring. He now has eight CoolSculpting systems. If I look at my practice with three CoolSculpting systems, I see similar trends.

We have about 60% new patients coming in for CoolSculpting and of that 60%, about 40% would consider doing other surgical procedures, even breast enlargements.

I believe the aesthetic market is changing and we have to adapt as surgeons. Looking back at 1997, about half of our procedures were surgical and the other half were non-surgical. If you look at the trends now, we see that there are

about 80% non-surgical and only 20% surgical procedures. Whether clients choose liposuction or CoolSculpting, we can achieve beautiful, natural body contouring results.

Dr Farid Kazem is a Plastic Surgeon. In 2000, he founded a private practice for aesthetic plastic surgery near Amsterdam in Leimuiden, the Netherlands. Dr Kazem has extensive experience in aesthetic breast surgery, oculoplastic surgery, and many non-invasive procedures, such as laser and skin tightening procedures.

He is well known for his interest in innovative technology.

The new CoolMini Applicator has been introduced mainly for the submental area but can also be useful for reducing fat above the knees and around he axilla

References 1. Stevens WG, Spring MA, Macias LH. Counterfeit Medical Devices: The Money You Save Up Front Will Cost You Big in the End. Aesthet Surg J. 2014 Apr 21;34(5):786-788.

2. Biesman BS, Patel N. Physician alert: beware of counterfeit medical devices. Lasers Surg Med. 2014 Sep;46(7):528-30.

3. Stevens WG, Pietrzak LK, Spring MA. Broad overview of a clinical and commercial experience with CoolSculpting. Aesthet Surg J. 2013 Aug 1;33(6):835-46.

44 MARKETING I body language

The do’s and don’ts of talking to journalists FIONA SCOTT offers her advice on how to build mainstream media relationships and increase your press coverage

H

ave you ever thought you would like more PR coverage in the mainstream media, or do you feel anxious because other companies offering similar services are more ‘out there’ than you?

Maybe you are frustrated because you only see the ‘bad news’

stories around aesthetic treatments—if any of this applies to you, read on.

Journalists’ view of the aesthetics industry Take it from me—as a journalist you can reach—I represented the general view the mainstream press

has of aesthetics industry.

My misconceptions were: • It’s about vanity • There’s too much risk involved • It’s far too expensive • You could end up looking like you’ve been in a wind tunnel or you’ve got a severe allergy to shellfish.

body language I MARKETING 45

• How can anyone trust someone who offers such a service outside of a hospital setting?

• It’s all about the money and little about safety I’ve generalised here, but that’s a broad theme of views out there if you are not a specialist journalist in this field.

Each week I get requests from journalists across the UK asking for examples of people who’ve had “botched” cosmetic surgery or procedures. They wouldn’t keep asking if they didn’t keep getting those stories. There’s work to be done at a strategic level in this sector.

Remember the news agenda Bear this in mind about the news agenda—good news is very common, so you have to work harder to be seen and heard.

Bad news is very unusual and it’s easy for a journalist to find as it often involves the organisations which speak to the media routinely, for example, the police, the fire service, the ambulance service and the court service.

Unusual news is what makes headlines—the kind of stories which get the emotions going, whether that’s anger, fear or laughter. That doesn’t mean good news stories aren’t valid but they have to work much harder to be seen or heard.

If you don’t believe me try an experiment on social media.

Write a post (appropriately of course) about something (not someone) which really annoys you.

Then see how many people come in to agree, disagree or comment.

It’s well known in the media that the most read stories—especially for online news services—are those which involve crime or some kind of conflict or jeopardy.

However, news services need content, and the majority of that content is good news, information led or educational stories. With the explosion of the internet and online news sources the appetite is huge.

Working on the negative When I was asked to work with Medikas in Bristol I went to check out the clinic first as I did not want to be aligned in any way with a business which could be in any way,

shape or form be seen as “dodgy”. I was carrying my misconceptions about the industry—though I’d still be cautious today.

I was blown away by the clinic, the environment, the credibility and background of Dr Beatriz Molina and Dr Ian Strawford.

The key thing here, is while you might not like this general negative view of the aesthetic sector, you have to accept it. For the moment it is what it is.

I do believe it is changing, especially in London, and aesthetic procedures are becoming more common but there’s a way to go yet.

In accepting this, and deciding you do care about it, then you can plan to do something positive.

images of younger people to draw the eye to their paid-for advertising and artwork, their leaflets, their websites and sometimes their social media. In fact I’ve seen a strong resistance against doing anything else on promotional literature.

I was delighted at the BCAM conference to see some literature with women in their 50s looking fabulous—but it was not the norm.

Ask yourself: • How many of your customers actually look like that?

• Are your images creating a barrier to sales?

• It may be aspirational, but is it deceptive?

Also it can make paid for adverts appear as an homogenous

Journalists are not there to advertise your business— that’s a by-product only If you want strong PR for your brand and your business you have to remember these key things.  Journalists are not interested in your advertising, details of your treatments—unless they are writing about those specific things.  They are interested in a story.  Stories which fit their agenda—not your agenda.  Stories fall into four main categories:  People—within and without the business.  Events—something is happening in their patch.  Topical Issues—something is being discussed in their patch.  Location—which patch do they cover?

Do you have any stories at all which might fall under these headings?

Advertising imagery Journalists—apart from specific niche journalists or writers working in this specific sector—represent people. It’s all about people.

The people they routinely see in the aesthetic sector are beautiful people, having treatments they seem not to need, often young and, for many, ridiculously aspirational because many of us know we can never actually look like that.

Is your imagery honest? Why do they see this? That’s the image the industry seems to project. The sector seems very keen on stock

mass. If you are advertising in a glossy magazine in the health, beauty or aesthetic section, how does a potential customer choose one above another?

Newspapers, on and offline, have also got so used to the aesthetic industry paying for advertising, they have come to expect it.

When did you ask yourself if you should perhaps do something different? Assess the paid-for advertising spend?

There’s nothing wrong with paid-for ads—I help people with this too—but it’s not the only way.

46 MARKETING I body language

Don’t sell I attended an event in London run

by Enterprise National called Meet The Journalists. There were a panel of journalists all from national publications.

This event was sold out, packed with small business people and PR people like me—working with small businesses.

As soon as the floor was opened to questions, small business owners put their hands up but not one asked a question.

Instead they launched into a loud description of their business, what they sold, where they got their products from—trying to download their detail in 30 seconds flat.

When you meet someone at a business event and they come up to you and launch into such a speech – how do you feel? Do you feel like you are being listened to? Or are you being subjected to a sales pitch?

Journalists are no different.

Build rapport Build a relationship—like any other business relationship, and you can now do this online first.

Help a journalist find someone for the story they are looking for that day and then they’ll remember you for the day they need your story.

Before I went to Meet The Journalists, I’d done my research, tweeted a couple of the journalists and got responses, so they felt the ice was broken before I’d stepped into the room. It didn’t feel like I was meeting a distant stranger, and my opening line sounded like: “Hello Beth, I’m Fiona, we tweeted each other earlier today…”

Lack of time Another thing which happened at that event was a cacophony of whining from businesses complaining they were so busy, their lives were very hard, how they try to get publicity but are ignored and how they don’t have time to make the effort to engage these journalists.

Doubtless this can be true, but as with so many things in business there’s no quick fix—PR is a slow burn which requires effort, attention and dedication.

If you want media support and

you haven’t got the time, then you can pay someone to help you.

However you have to be realistic—even with media support, it takes time and effort on both sides.

Never complain to a journalist about how hard your work is unless you are saving lives. Journalists work long hours, and may often have given up several relationships to their career, so they simply won’t hear you and will probably switch off.

Their agenda, not your’s Journalists operate to their own agenda and you have to meet their needs just like with any of your clients—they are not there to meet your needs. This is a common mistake small businesses—and experts in their field—make, just because it’s interesting to you, it may not be interesting to them.

Also the news agenda is very fluid and it’s subjective. What’s interesting on Monday may be boring on Tuesday.

How will a journalist choose you?

When my turn came to Meet The Journalists I asked one key question: if you could choose between three small companies all doing the same thing—how do you pick the best case study?

The Answer: Journalists will look at who they know first, so a close association with a journalist is utterly invaluable.

If they don’t know someone relevant, just like a customer these days, they will do research before making a decision—online first and foremost.

They will often start with a website and they will judge you accordingly. Do think about what makes a good website and does it match your brand—and what makes it different from every other aesthetic website. This is particularly true if you are using stock imagery.

If you pass the website test, a journalist will search online for any other story about you. This builds credibility especially for the national press. It gives them confidence this is a business with background, energy and has the potential for being media friendly.

What if you are the one compa-

66 PR is a slow burn which requires effort, attention and dedication 99 ny which doesn’t have any of this?

Does that matter to you?

Conclusion My final tips are these—if PR is of interest and you engage with all or some of the above, don’t fall at the last hurdle.

You need to be easy to find and available at short notice.

When that call comes through and they want you on the tv or on the radio at 6am in the morning in Manchester, say yes. Get on that train, because if you don’t someone else will.

If you do these things your profile will be organically raised, you’ll become front of mind and business will come—but it’s a process, a journey, an experience.

Fiona Scott is a journalist and runs a media consultancy working across the SME sector offering support from training to ongoing media support including high end video production. W: fionascott.co.uk; Twitter @TheFionaScott Where do you start with stories?

To build up stories, start with your diary.  What are you doing today, tomorrow, next week, next month?  Ask yourself is that a story? For social media?

For the general press?

Certain stories can be a winner—a celebrity connection can help.  Or being outspoken about issues and topics around your sector.  Or being successful in winning awards.  Or being charitable in your community.

All of these things are credible stories.

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body language I PRODUCTS 49

on the market The latest anti-ageing and medical aesthetic products and services  SculpSure Laser and light-based aesthetic treatment company, Cynosure have unveiled their new FDA approved body sculpting laser treatment, SculpSure, said to rid fat in just 25 minutes. Cynosure say that the new body-sculpting laser offers convenient, comfortable, non-invasive fat reduction for any body and skin type. Cynosure spokesperson Bill Kelley, said: “SculpSure is a revolutionary, highly advanced procedure, is a clever combination of the science of laser technology with the art of body contouring”. SculpSure will officially launch to consumers in March 2016.

W: cynosure.com

 Anti-Ageing Blemish Control The Murad Anti-Ageing Blemish Control range is designed to specifically target blemishes in an adult skin while simultaneously addressing the signs of ageing. Murad are now expanding this range to include the new Advanced Blemish & Wrinkle Reducer and AntiAgeing Moisturiser SPF 30 for blemish-prone skin.

W: murad.co.uk

 3JUVE Lynton Lasers introduce the release of the 3JUVE anti-ageing system, which combines three unique technologies to provide what Lynton say is the “ultimate, natural looking anti-ageing result” as well as being “2016’s answer to diminishing the key signs of ageing”. 3JUVE uses three individual, noninvasive technologies into one simple treatment protocol to help tackle the three main signs of ageing: Resurface, Rebright and Remodel. The mix of technologies can be customised to give results you really want.

W: lynton.co.uk  Advanced Perfecting Shield SPF30 Teoxane Cosmeceuticals launch their new Advanced Perfecting Shield SPF30, a day cream that is said to work on four levels to hydrate, offer advanced protection, revitalise and restructure in one, leaving skin protected whilst addressing deeper skincare concerns. Prolonged sun exposure can cause water to evaporate from skin and dehydrated skin can take longer to heal and be more susceptible to environmental aggressors. Advanced Perfecting Shield SPF30 contains Teoxane Cosmeceuticals’ core formula that is designed to ensure optimal retention of hydration levels.

Advanced Perfecting Shield SP30 contains resilient hyaluronic acid (RHA), dermorestructuring complex and NovHyal along with solar filters including TINOSORB (M + Ethyl Hexylmethoxicinnamate), antioxidants, carcinine, Matrixyl 3000, liquorice extract and potentiated HA + Sodium PCA to provide next level protection.

W: teoxane.co.uk

 Deep Hydration Gel Cream Agera have launched their new Deep Hydration Gel Cream, to help restore skin’s natural hydrating ability, reverse signs of dehydration, improve skin texture and plump lines and wrinkles. It is designed to offer a silky feel of a light weight, fast absorbing serum with the intense hydration benefits of a cream. Formulated with a proprietary combination of three types of hyaluronic acid it is said to be a powerful hydrator that effectively restores skin’s youthful qualities.

W: agerarx.co.uk

50 PRODUCTS I body language

ANTI CELLULITE SLEEPWEAR  Nordlys by Ellipse Ellipse has built a system to deliver new shorter pulses that previously were only treatable with pulsed dye lasers. Ellipse say that their new medical device offers dermatologists, plastic surgeons and aesthetic physicians simple and safe solutions for a variety of conditions, including benign vascular and pigmented lesions, hair removal and other indications amenable to light-based therapy.

W: ellipseipl.co.uk

 Crystal Smooth Sleepwear MACOM announces the imminent launch of their Crystal Smooth Sleepwear range.

The sleepwear has been designed for patients directly after their first professional treatment as part of their maintenance programme. MACOM also recommend that it be worn as a second stage garment after liposuction procedures, ideally introduced at 4-6 weeks after surgery and worn for a least 6 weeks for best results to smooth and firm the treated area.

W: macom-medical.com

 The mct injector Mesoestetic presents a new injection gun for mesotherapy—the mct injector—a device that administers two complementary techniques: SLEEP mesotherapy and carboxitherapy. The new gun is designed to be convenient for doctors and comfortable for patients. By combining these two techniques in the same or in alternate sessions, Mesoestetic say that doctors will have a comprehensive tool for performing numerous facial and body treatments. The new gun can be used in treatments to normalise skin pigmentation, soften expression lines and wrinkles, improve local micro-circulation and to restore firmness to sagging tissue.

W: mesoestetic.com

CRYSTALSMOOTH GOODBYE TO CELLULITE • TRANSFORM YOUR SKIN

 TA-65 For Skin Skin Geeks introduce TA Sciences’s new TA-65 for Skin, harnessing technology that is said to put a hold on DNA ageing. It is designed to improve skin firmness, decrease skin redness, reduce fine lines and wrinkles, protect skin hydration and improve skin contrast for a more uniform complexion. The TA-65 compound incorporated in the TA-65 For Skin is said to contain a ‘Telomerase Activator’ that can lengthen and strengthen telomeres— the barometer of our DNA’s capability to repair and maintain healthy, youthful looking skin.

W: tasciences.com

 BioSkinJetting Sterex has announced the re-launch of wrinkle-reduction treatment BioSkinJetting.

It is a natural treatment for winkles, developed to improve small imperfections in the skin. Designed for use in combination with the radio frequency, the BioSkinSmoothing machine can be used to treat both atrophic and hypertrophic wrinkles scars and imperfections. Sterex say that immediately following the very first treatment the wrinkle or blemish is visibly less deep. The treatment is precise and can treat small areas specifically targeting the area directly under the wrinkle leaving the surrounding skin untouched.

W: sterex.com

 Perfect Skincare Sinclair IS Pharma introduce a new range of skincare, designed to complement the results of the Perfectha range of HA treatments.

PERFECT SKIN BRIGHTENING SERUM, to brighten skin immediately and sculpt features; PERFECT EYE CONTOUR to act on expression lines visible in the eye area offering an anti-ageing and lifting-tensor effect, resulting in the gradual relaxation of microwrinkles; ANTI WRINKLE 5HA INTESIVE CREAM, an intensive anti-wrinkle face cream designed to increase collagen synthesis and improve the skin’s barrier function; and PERFECT LIPS FILLER, a lip-plumping, anti-age treatment which uses a patented active ingredient (Maxi-Lip) to stimulate the synthesis of collagen and hydrate.

W: perfectha.co.uk

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

52 EQUIPMENT I body language

Elevating non-surgical facial lifting DR ROBERTO PIZZAMIGLIO explains how Silhouette Soft sutures with bidirectional cones can be used for elevating facial tissue

S

utures with bidirectional cones provide a non-surgical treatment option for aesthetic doctors to elevate tissue without surgery. Some plastic surgeons may be apprehensive about using the technique—because the skin elevation is less dramatic than the surgical results they are used to achieving. How-

ever an increasing number are using it as a transitional treatment where patients are not yet ready for a full face lift, are contraindicated, when they don’t want to have a general anaesthetic or countenance considerable down time. With the appropriate patient selection it is being used to achieve impressive results.

The Silhouette Soft Lift The Silhouette Soft Lift is a contemporary variation on the “traditional” thread lift, using specialised sutures which are introduced into the subcutaneous layer of the skin with a very fine needle, to lift tissue and improve skin texture. The idea is to “lift” the tissue with sutures interspersed with bi-directional

body language I EQUIPMENT 53

fat compartment in the jaw drops, but we have retainer ligaments that maintain the aesthetic position of the jaw. Add to this a reduction of the bone and the relaxation of the tissue and the process brings about the changed look of our ageing jawline.

cones, in a minimally invasive fashion, and is most suited to patients with mild ageing characteristics.

Application The ageing process brings about a three-dimensional change in the shape of the face. As we age, the

66

Structure The active parts of Silhouette Soft sutures are the cones, which act as an anchoring system. When the Silhouette Lift was introduced in 2006 as a surgical procedure, the cones were a hybrid permanent suture, with resorbable cones designed to grasp the tissue. A totally resorbable bidirectional suture has since been developed and was launched in 2013. This advance enabled the suture to be used without the need for surgery as this kind of suture can be inserted in the subcutaneous tissue, and not in the dermis. The cones remain the same, creating an anchor to facilitate the tissue lift, but also allow compression of the fatty tissue.

The first sutures to be introduced featured eight bidirectional cones and two needles which were needed because the suture was inserted in two steps. The first insertion for the first half of the suture and first series of cones; the second needle to insert second half of the suture, from the same entry point.

Silhouette Soft has undergone an evolution, and now also features 12 and 16 cone sutures to enable the whole face and neck to be treated effectively. However the difference is not only the number of the cones on the sutures, but also the length of the area which is grasped by the cones—the distance between the nodes has increased from 5mm to 8mm, allowing a larger area of subcutaneous tissue to be treated.

The cones are fabricated from a mixture of polylactic acid and glycolic acid, and are absorbed by the body in around one year. The

The cones are fabricated from a mixture of polylactic acid and glycolic acid, and are absorbed by the body in around one year 99

suture material is also made from polylactic acid which is absorbed in around two years. The collateral effect of the polylactic acid is stronger fibrous tissue production.

Polylactic acid stimulates type III collagen, which is a structural and solid collagen. This builds around the cones and when the cones are absorbed, fibrosis around the knot remains and maintains the support of the tissue.

In terms of the “lift” effect, the suture does not produce a lift as such; it’s the movement and support of the tissue it brings about, which creates a fresher shape. For a patient who wants tightened skin, surgical intervention may be necessary as the suture procedure is designed to support the tissue in the appropriate position.

Procedure When using an eight-cone suture the distance between the two entry points must be 10cms. From the first entry point, the first half of the suture is inserted into the subcutaneous layer of the skin, followed by the second needle from the same entry point, and the second half of the suture in the opposite direction. The technique is versatile, enough to be used in an angled part of the face—for example to create traction in the jawline and create better refraction and improved jaw definition.

A longer suture would usually be used in a loop configuration rather than straight line. The 12-cone suture is 18cms and the 16-cone is 20cms. However, it is necessary to change from the bidirectional principle of the suture to the double unidirectional position of the suture because the cones work in the same direction. The technique for a longer suture is slightly different because two entry points are needed instead of one, but the way to insert the suture and the depth of the sutures remains the same.

Probably the most frequently treated areas are the mid and lower face. When these areas are treated in a straight pattern it is recommended that two sutures with the eight-cones are used for each area.

When using eight-cone sutures we suggest using a minimum of

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Creating the

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Help your patients rediscover a more defined facial outline that’s both natural and discreet with SILHOUETTE SOFT®.

Using innovative technology, SILHOUETTE SOFT® sutures both lift and provide volume for an immediate and long lasting effect.

Bidirectional cones provide traction to support and lift the subcutaneous tissues, while polylactic acid stimulates progressive restoration of lost collagen.

SILHOUETTE SOFT® Training Workshops are available to GMC/GDC registered professionals, e-mail: silhouettetraininguk@sinclairpharma.com For more information, visit www.silhouette-soft.com Sinclair IS Pharma. 1st Floor Whitfield Court, 30-32 Whitfield Street, London W1T 2RQ. www.sinclairispharma.com Date of preparation: September 2015 UK/SIPSST/15/0003

body language I EQUIPMENT 55

two sutures to create enough support and compression of the tissue.

Even in the jowl area of the lower face, two sutures can be used—for example one at an angle and one straight. These different vectors improve the jaw definition.

Adopting the new ‘U’ technique Using a new advanced ‘U’ technique to configure the sutures provides several advantages. One advantage is that with one suture we can treat one area—for example just one suture can be enough to treat the jaw. The second is that the entry points are placed posteriorly, or sometimes behind or at the level of the hairline, so they are not visible. Using the ‘U’ configuration and the eight-cone suture, allows compression of the fatty tissue, so one can create more malar projection in the mid-face, if desired.

The ‘U’ technique also produces greater elevation of the tissues and less projection when the tissue is sagging, so can be more useful to reposition it in the right place.

It is possible to work horizontally, but generally we change the vectors according to aesthetic outcome we are seeking, so we can stay more vertical or even cross the vector.

This technique can also create improvement of the upper part of the neck and better definition of the jaw. Whilst it’s not a neck ‘lift’ in the true sense, we can use the ‘U’ technique if skin tightening is required, or we can cross the midline when we have to support the platysmal bands. A 12-cone suture is useful here because of the dimensions of the neck, and if the

neck is bigger, a 16-cone suture can be used.

The ‘U’ suture configuration also makes it possible to treat thicker skin successfully. The insertion technique starts with creating an entry point using an eight-inch needle. The hole is the same diameter, more or less, as the base of the cone and then from that hole the first needle of the suture is inserted.

To treat the brow, we work with two sutures—two eight-cone sutures in an ‘L’ rather than ‘U’ shape. The suture is inserted into the asymmetrical part of the brow because the distal cones have to grasp the soft tissue at the tail of the brow, and the proximal end of the suture goes to the temporal area and elevates the tail of the brow.

Insertion To insert the sutures correctly it’s essential that the first needle remains vertical. The needle has a mark at the 5mm distance from the tip that disappears when the tip is 5mms into the subcutaneous tissue. With Caucasian skin the average of the thickness between the epidermis and the dermis is usually 2.8mms. With thicker skin—for example with Asian patients—it could be 4-5mm, so you have to go deeper to be sure of staying in the subcutaneous tissue.

After inserting the suture, the tissue must be compressed. It’s a self-blocking suture—so doesn’t need to be fixed in any part—and the presence of the cones in the opposite direction collects the tissue over the centre of the suture. This increases the projection and the

66 Using the new advanced ‘U’ technique to configure the sutures means just one suture can be enough to treat an area, for example, the jaw 99 base of the cone will not release the traction. Staying a minimum of 5mm from the entry point, in the central part, ensures the suture is placed at the proper depth.

The ‘U’ technique uses two entry points—created with the same needle at the same time. The eightinch needle can be inserted from the first point and can exit out of the second one, and we use the needle like a trocar. We can work in front of, or behind the hairline. Initially we suggest inserting in front to avoid fighting with the hair, but when one is more experienced behind the hairline so any puckering caused by the elevation of the skin—which lasts for one or two days—will not be visible.

We insert the suture in the adipose tissues, we compress the tissue and create elevation through mobilisation or compression of the tissue.

Danger zones When inserting the sutures it is important to visualise the underlying position of the veins, arteries and nerves. A pinch to a vein can cause a hematoma and in the temporal area we have an artery, so of course there’s a more serious risk of hematoma here. Nerves,

The Silhouette Soft Lift uses specialised sutures which are introduced into the subcutaneous layer of the skin with a very fine needle

56 EQUIPMENT I body language

especially the three branches of the facial nerve, can also be a danger spot. For this reason it is important to pay particular attention to the temporal branch of the facial nerve, which is very superficial and usually on top of the superficial parieto-temporal fascia, between the superficial and the deep temporal fascia. The mandibular part and the zygomatic branches however are really deep, so it’s impossible to create any injury to these nerves because of their depth.

How to check the patient Start by simulating the desired skin lift manually with your hands. If you see the anticipated result with a very moderate elevation of the tissue, it’s possible to obtain the same result by using the bidirectional sutures. Sometimes we want to treat the neck, but with the traction of the fingers we don’t see any result in the anterior cervical area. In this case, because of the fat, we would not achieve the desired results. If we have a fat problem, first we have to treat the fat and eventually after two to three months we can treat with the sutures.

Indications The indications for treatment of the face with bidirectional sutures range from the brow to the neck including the nasal area—for aesthetic or functional purposes or for nasal valve collapse. In fact, wherever we want to mobilise the tissue, we can use the sutures. In the mid face using eight-cone suture fat compression, we can bring about malar projection and usually, between two to four months we observe an improvement in the result due to the contraction of the capsule around the suture and then it remains stable. After one and a half years to two years the result is less marked and a repeat of the treatment is needed.

In the neck we can achieve improvement of the cervical angle with the goal of creating better definition of the jaw, and this is more effective when treated in combination with the jaw area itself. We can also successfully treat

the brow area.

The only rule is to be sure to work 5mm deep vertically inside and to check where the tip of the needle is every time. This is the way you can ensure that you are in a perfect plane. The tip of the needle has to be mobile and free – if we can elevate the tip of the needle we are in a safe level, because if you can’t elevate the tip, you are under the fascia. A traction of the skin due to the tip of the needle, means we are in the dermis.

Once the needle has been inserted under the skin it needs to be removed. The first four cones start to go into the tissue and we create

a gentle contra-traction allow their correct positioning. Once the first four cones are embedded, we have to treat the second half, taking the second needle vertically by 5mm into the same entry point. Then we turn the needle to a horizontal position and we go through the proximal exit point, maintaining the same depth. Here we have less adipose tissue but we have to stay between the fascia and the dermis.

If we can’t feel when the tip is near the exit point, it’s good to put the other needle on top of the skin and push down to see exactly where the tip is rather than going over the exit point and potentially creating

The treatment is most suited to patients with mild ageing characteristics

body language I EQUIPMENT 57

an injury to the vessels in the temporal area.

By knowing where the tip of the needle is we know where the suture will be inside. When the second needle is inside the loop of the first suture is just visible, the first cones start to go in and we just have to perform the second contra-traction to allow the recession of the suture.

Avoiding complications The best way to avoid complications such as breaks to the suture, dimples or bruising, infection or skin folds is to know which areas are contraindicated to treatment with sutures. The principal contraindication is the presence of fillers, but if you have any patient who has been treated with permanent filler and you feel the capsular, do not put the suture in the

same area. Pinching to the capsular can also cause an unpredictable reaction. Other minor complications might include hardness, pain or parestasia for a maximum of one to two days.

Combination treatments In many cases suture treatment is not something we use to avoid doing something else, but in combination with other treatments.

Most of the time when repositioning the tissues, we may also need to replace volume, so we can use the sutures as part of full-face non-surgical bio-revitalisation.

We suggest combining treatments or using the bidirectional cone sutures a month before or after the volumisation procedure. This combination can give a notably more effective result compared with a single treatment alone.

Silhouette Soft case study Dr Leah Totton completed treatment with Silhouette Soft for the full face including the brow Patient profile: 64 year old Australian-born Jackie Genova was a high profile model in the 70’s, fronting campaigns for global brands such as coca cola and Levi’s before turning her hand at TV aerobics where she was known as the “Queen of Aerobics” throughout the 80’s. She wanted to refresh her appearance to restore her confidence but did not wish to go under the knife.

Treating Doctor: Dr Leah Totton is a medical doctor and the 2013 winner of UK The Apprentice, her business plan was a doctor led cosmetic clinic which specialised in non-invasive treatments which give natural looking results with little or no downtime. She now co-owns Dr Leah cosmetic Skin Clinic with business partner Lord Alan Sugar and is one of the first UK doctors to be offering Silhouette Soft facelift for the full face and neck.

Treatment: Silhouette soft thread lift is a non-surgical facelift treatment which involves placing dissolvable sutures under the skin to lift and enhance appearance. The treatment previously has been used to treat jowling but has recently obtained its license in the UK for use on the brow and neck, facilitating its use to transform the entire face and offering itself as an alternative to a full face and neck lift. Treatment was performed with local anaesthetic making it pain free, and takes approximately 1 hour to complete, with minimal downtime. Results last approximately 18 months.

Dr Totton comments: “The neck, despite being one of the areas which patients most commonly note signs of ageing, is notoriously hard to treat non-surgically and a treatment which can improve this area is invaluable.

Brow hooding is a similarly common presentation associated with ageing.

This is another step forward in the innovative field of aesthetic medicine.”

Conclusion The advantage of bidirectional sutures is that we can perform a non-surgical skin lift in our clinic.

The treatment can be minimally invasive, using local anaesthesia and can be used to treat the face or body using the position of the suture to achieve our goals.

Dr Roberto Pizzamiglio has been Scientific Consultant and Teaching Course Director for Silhouette Lift since 2006 and more recently became the Director of Training for Silhouette Soft. He is considered to be a world expert in the Silhouette Soft procedure. Since 1997 he is has been based in Spain where he is Director of the Aesthetic Surgery Unit at the USP Hospital in Marbella. He is also a Professor of the postgraduate Masters in Cosmetic Surgery at the University of Padua.

58 EDUCATION I body language

training TF

TOXINS AND FILLERS

11 February, Advanced Botox and Dermal Filler Training, The Paddocks Clinic, Buckinghamshire W: cosmeticcourses.co.uk

13 March, Non-surgical rhinoplasty, Wigmore Medical, London W: wigmoremedical.com 18 March, Lip Masterclass, The Paddocks Clinic, Buckinghamshire W: cosmeticcourses.co.uk

13 February, Foundation Botox & Dermal Filler Training, The Millhouse Clinic, Birmingham W: cosmeticcourses.co.uk

18-19 March, Mini Threads, Wigmore Medical, London W: wigmoremedical.com

15 February, Dermal Filler Complication Management, Cosmex Clinic, Cambridge W: cosmexclinic.co.uk

21 March, Dracula PRP, Wigmore Medical, London W: wigmoremedical.com

15 February, Foundation Botox & Dermal Filler Training, Harley Health Village, London W: cosmeticcourses.co.uk

24 March, Sculptra, Wigmore Medical, London W: wigmoremedical.com

19 February, Advanced Toxins (am) and Fillers—Cheeks/Midface (pm), Wigmore Medical, London W: wigmoremedical.com

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22 February, Botox and Dermal Filler Training Refresher, The Paddocks Clinic, Buckinghamshire W: cosmeticcourses.co.uk

SKINCARE

9-11 February, ZO Medical Basic, Intermediate and Advanced, Wigmore Medical, London W: wigmoremedical.com 12 February, Epionce skincare and peel training, Upper Wimpole Street, London, UK W: edenaesthetics.com

24-25 February, Intro to Toxins and Fillers, Wigmore Medical, London W: wigmoremedical.com

15 February, Agera skincare and peel training, Upper Wimpole Street, London, UK W: edenaesthetics.com

27 February, Foundation Botox & Dermal Filler Training, The Paddocks Clinic, Buckinghamshire W: cosmeticcourses.co.uk

16 February, Surface Whitebox, Wigmore Medical, London W: wigmoremedical.com

11 March, Advanced Toxins (am) and Fillers— Tear troughs (pm), Wigmore Medical, London W: wigmoremedical.com 14 March, Dermal Filler Complication Management, Cosmex Clinic, Cambridge W: cosmexclinic.co.uk 16-17 March, Intro to Toxins and Fillers, Wigmore Medical, London W: wigmoremedical.com 18 March, Foundation Botox & Dermal Filler Training, Skindustry Clinic, Leeds W: cosmeticcourses.co.uk 19 March, Foundation Botox & Dermal Filler Training, The Paddocks Clinic, Buckinghamshire W: cosmeticcourses.co.uk

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OTHER INJECTABLES

16-17 February, ZO Medical Basic and Intermediate, Wigmore Medical, Dublin W: wigmoremedical.com 18 February, Dermaroller Training, The Paddocks Clinic, Buckinghamshire W: cosmeticcourses.co.uk 19 February, Neostrata Chemical Peel Training, The Paddocks Clinic, Buckinghamshire W: cosmeticcourses.co.uk 19 February, Microneedling training, Upper Wimpole Street, London, UK W: edenaesthetics.com 15 February, Advanced Skin Assesment Workshop, Hagley Centre W: sallydurrant.com 19 February, Microdermabrasion training Upper Wimpole Street, UK W: edenaesthetics.com

8 February, Dracula PRP, Wigmore Medical, London W: wigmoremedical.com

13 February, Microsclerotherapy, Wigmore Medical, London W: wigmoremedical.com

23 February, Agera skincare and peel training, Medics Direct, Glasgow, UK W: edenaesthetics.com

14 February, Non-surgical rhinoplasty, Wigmore Medical, London W: wigmoremedical.com

24 February, Epionce skincare and peel training, Medics Direct, Glasgow, UK W: edenaesthetics.com

22 February, Non-Surgical Facelift Training, The Paddocks Clinic, Buckinghamshire W: cosmeticcourses.co.uk

25 February, Microneedling training, Medics Direct, Glasgow, UK W: edenaesthetics.com

26 February, Platelet Rich Plasma Training, The Paddocks Clinic, Buckinghamshire W: cosmeticcourses.co.uk

3 March, Dermaroller Training, The Paddocks Clinic, Buckinghamshire W: cosmeticcourses.co.uk

27-28 February, Mini-Thread Lift, Wigmore Medical, London W: wigmoremedical.com

4 March, NeoStrata Chemical Peel Training, The Paddocks Clinic, Buckinghamshire W: cosmeticcourses.co.uk

12 March, Microsclerotherapy, Wigmore Medical, London W: wigmoremedical.com

7 March, The Physiology of Ageing and Skin Regeneration Practices, Hagley Centre W: sallydurant.com

23 February, Skincare and Peels with NeoStrata, Wigmore Medical, London W: wigmoremedical.com

8 March, Understanding and Treating Acne Vulgaris, Hagley Centre W: sallydurant.com

W: cosmeticcourses.co.uk 29 March, Photo-Ageing and Pigmentation Irregularities of the Skin, Hagley Centre W: sallydurrant.com

8 March, Agera skincare and peel training, Eden Aesthetics, Essex, UK W: edenaesthetics.com

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8-9 March, ZO Medical Basic and Intermediate, Wigmore Medical, London W: wigmoremedical.com

29 February, An Introduction to Vascular and Pigmentation, Lynton Clinic, Cheadle W: lynton.co.uk

9 March, Epionce skincare and peel training, Eden Aesthetics, Essex, UK W: edenaesthetics.com

2 March, Intense Skin and Laser Applications (with University of Manchester), Lynton Clinic, Cheadle W: lynton.co.uk

10 March, Microneedling training, Eden Aesthetics, Essex, UK W: edenaesthetics.com 10 March, Microdermabrasion training, Eden Aesthetics, Essex, UK W: edenaesthetics.com 15 March, Epionce skincare and peel training, Skin First Warrington, UK W: edenaesthetics.com 14 March, Advanced Skin Assessment Workshop, Hagley Centre W: sallydurrant.com 15 March, Skincare and Peels with NeoStrata, Wigmore Medical, London W: wigmoremedical.com 15-16 March, ZO Medical Basic and Advanced, Wigmore Medical, Dublin W: wigmoremedical.com 16 March, Agera skincare and peel training, Skin First Warrington, UK W: edenaesthetics.com 18 March, NeoStrata Chemical Peel Training, The Paddocks Clinic, Buckinghamshire

LASERS/RF/ULTRASOUND

9 March, Core of Knowledge (with the University of Manchester), Hilton London Euston W: lynton.co.uk 22 March, Advanced Skin and Laser Applications (with University of Manchester), Lynton Clinic, Cheadle W: lynton.co.uk

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OTHER TRAINING

1 February, CPR & Anaphylaxis Update (am), Wigmore Medical, London W: wigmoremedical.com 3 February, CPR & Anaphylaxis Update (am), Wigmore Medical, London W: wigmoremedical.com 7 March, CPR & Anaphylaxis Update (am), Wigmore Medical, London W: wigmoremedical.com

If you would like to submit details for medical aesthetic training courses to be featured in Body Language Journal and online, contact arabella@face-ltd.com

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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

RESTYLANE SKINBOOSTERS – SHOW YOUR SKIN AT ITS BEST Restylane Skinboosters are a brand new approach to nourishing your skin, especially designed to deliver lasting moisturisation and improvements in the skin.

Restylane Skinboosters are clinically proven for treating the face, neck, hands, and décolletage3. Visible improvements to the skin can be seen after a course of treatments resulting in skin with a radiant glow. A series of tiny injections, made more comfortable with anaesthetic lidocaine, improves skin elasticity1, firmness2 and radiance.3 What you and everyone else will notice is fresh and wonderful skin.

IMPROVE YOUR SKIN QUALITY FOREHEAD AREA

PERIORBITAL AREA

FACE REJUVENATION * ACNE SCARS

RES/039/1214 Date of preparation December 2014

PERIORAL AREA

NECK AREA

HANDS

DÉCOLLETAGE

Galderma (UK) Ltd Meridien House, 69-71 Clarendon Road, Watford, Hertfordshire WD17 1DS Galderma Switchboard: 01923 208950 Email: info.uk@galderma.com

1. Kerscher M et al. Dermatol Surg 2008;34:1–7

2. Williams S et al. J Cosmetic Derm 2009;8:216–225

3. Streker M et al. J Drugs Dermatol 2013; 12(9):990–994