Body Language #82 by Body Language Journal

june

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

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How social media platforms are changing the media landscape in 2016

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*stimulates new collagen and elastin which can reverse the signs of ageing References: 1. Ulthera System Instructions for Use, 1001393IFU Rev H 2. Sasaki GH & Tevez A. JCDSA. 2012; 2: 108-116 3. Alam M, et al. J Am Acad Dermatol. 2010;62:262-269 4. Lee HS, et al. Dermatol Surg. 2011;1-8 5. Brobst RW, et al. Facial Plast Surg Clin N Am. 2014;22:191-202 6. ULT-DOF-003 Ultherapy Treatment Duration. Merz - July 2015 7. http://www.accessdata.fda.gov/cdrh_docs/pdf13/k134032.pdf Accessed May 2016 8. CE Certificate 3808396CE01, DEKRA April 2012 Adverse incidents must be reported. Reporting forms & information can be found at www.mhra.gov.uk/yellowcard. Adverse incidents must also be reported to Merz Pharma UK Ltd by email to ukdrugsafety@merz.com or on +44 (0) 333 200 4143

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body language I CONTENTS 3

contents 07 NEWS

SYSTEMS

OBSERVATIONS

Charles Southey examines how clinic management systems can help to maximise the the productivity and profitability of a medical practice

Reports and comments

17 REPORT INDUSTRY NEWS Headlines and updates

18 CONFERENCE FACIAL AESTHETIC CONFERENCE AND EXHIBITION FACE 2016—the UK’s premier medical aesthetic conference returns to London this summer showcasing an expanded lecture programme, hands on training and FACE rewind

BUSINESS BUILDING Gary Conroy looks at the power of branding in a clinical setting

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

24 NON-SURGICAL

57 EQUIPMENT

POLYDIOXANONE THREAD LIFTING

TATTOO REMOVAL

Prof Syed Haq discusses the popularity of thread-based technology to bring about skin rejuvenation, skin tightening and lifting of the face, as well as treating other body parts

32 MEDIA WORKING WITH THE NEW MEDIA Wendy Lewis offers her observations on how social media platforms are changing the media landscape in 2016 32

47 BUSINESS

41 TECHNOLOGY CLINIC MANAGEMENT

Dr Klaus Hoffmann talks about picosecond laser treatment of European tattoos

61 ANTI-AGEING DENDRITIC CELLS Dr Stefan Lipp discusses the role of dendritic cells in preventative and anti-ageing medicine

65 MEDICAL AESTHETICS CHITOSAN FOR ANTI-AGEING Dr Alexandre Guerry explains a new anti-ageing approach from BIOXIS, which is based on using natural and biodegradable chitosan polymers

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.

57 PRODUCTION 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 Simon Haroutunian 020 7514 5976 simon@face-ltd.com PUBLISHER Raffi Eghiayan 020 7514 5101 raffi@face-ltd.com CONTRIBUTORS Professor Syed Haq, Wendy Lewis, Charles Southey, Gary Conroy, Dr Klaus Hoffmann, Dr Stefan Lipp, Dr Alexandre Guerry 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

PSORIASIS AND OBESITY MAY SHARE GENETIC SOURCE Research that shows a link between psoriasis, type 2 diabetes, BMI, and obesity Affecting 6.7 million American adults (according to a NHANES study), psoriasis is an autoimmune disease that involves the rapid growth of skin cells, creating symptoms including patches of thick, red skin with silvery scales that can itch or be painful. Existing research has linked metabolic disorders and psoriasis—both genetically and through environmental exposures and lifestyle choices, such as smoking, alcohol, stress, physical activity levels and shared immunoinflammatory pathways. According to this new research from the University of Copenhagen in Denmark people with psoriasis also have a greater risk of high BMI and obesity than those without psoriasis. The study led by Dr Ann Sophie Lønnberg, looked at data for 33, 588 Danish twins aged 20-71 years. More than half the participants were women. Participants completed a questionnaire about psoriasis, which was then matched with diagnoses for type 2 diabetes and body mass index. The prevalence of psoriasis in the total twin sample was 4.2& (630 men and 771 women); the prevalence of diabetes was 1.4% (235 women and 224 men). The average BMI for the study group was 24.5; obese individuals with a BMI from 30 to 34 accounted for 6.3% of the population.

Crucially, psoriasis was present in 7.6% of those with diabetes, but it was only present in 4.1% of those without diabetes. Those with psoriasis had, on average, a BMI of 25—higher than the BMI of those without psoriasis, which was 24.4. In 720 sets of twins, only one twin out of the pair had psoriasis. The twin with psoriasis also had a higher BMI and was more likely to be obese than the co-twin without psoriasis. The study analysis suggests the association between psoriasis and

obesity could partly be the result of a common genetic cause, though the authors cannot infer causation. Psoriasis could predispose individuals to a more sedentary lifestyle, leading to behaviours that predispose them to obesity and diabetes, or these conditions could be a cause of psoriasis. "Psoriasis, type 2 diabetes mellitus and obesity are strongly associated in adults after taking key confounding factors such as sex, age and smoking into account. Results indicate a common genetic

etiology of psoriasis and obesity. Conducting future studies on specific genes and epigenetic factors that cause this association is relevant," the study concludes. "Psoriasis, type 2 diabetes mellitus and obesity are strongly associated in adults after taking key confounding factors such as sex, age and smoking into account. Results indicate a common genetic etiology of psoriasis and obesity. Conducting future studies on specific genes and epigenetic factors that cause this association is relevant."

8 NEWS I body language

TEEN LABIAPLASTY SURGERY IS ON THE RISE An increasing number of under 18's are worried about appearance and symmetry of the labia An increase in the number of girls under 18 asking their doctors to perform cosmetic surgery on their labia is showing that growing adolescent concern over body image goes well beyond what is shared on social media. Despite natural variations in size and shape of the labia between women, an increasing number are becoming more worried about appearance and symmetry of the labia. It seems that the appearance and symmetry can have particularly distressing psychological effects on young women. In fact, the number of girls aged 18 and under undergoing labiaplasties nearly

doubled from 2014 to 2015. In 2014, 222 girls underwent the procedure, up to 400 in 2015, according to the American Society of Aesthetic Plastic Surgery. Labiaplasty surgery reduces the size of the labia, and is mainly requested for cosmetic reasons but the surgery comes with the risk of serious complications, including, pain, infection and scarring. The American College of Obstetricians and Gynecologists has issued guidelines about how doctors should talk to adolescents about labiaplasty. “Variety in the shape, size, appearance and symmetry of labia can have particu-

larly distressing psychological effects on young women,” said Julie Strickland, the chair of ACOG’s Adolescent Health Care Committee and the lead author of the guidelines. Alongside the suggestion that young women are increasingly considering labiaplasty because of "increasing trends in pubic hair removal, exposure to idealised images of genital anatomy, and increasing awareness of cosmetic vaginal surgery", the paper encourages gynaecologists to recommend nonsurgical alternatives, educate and give reassurance to adolescents seeking medical treatment.

AUSTRALIA’S TOUGH NEW COSMETIC SURGERY GUIDELINES Australia's Medical Board are introducing new guidelines for doctors working in the booming cosmetic surgery industry The industry is set to undergo a major shake-up, with the introduction of new parameters for practice under which all doctors will have to provide: • A seven-day cooling off period for all patients considering a major procedure; • A three-month cooling off period for patients under

18 years old, plus mandatory counselling by a psychologist, psychiatrist or GP; • The treating practitioner to take "explicit responsibility" for post-operative care, as well as emergency facilities when using anaesthesia; • Mandatory consultations either in person or via Skype

for patients considering prescription-only injectables like toxins and fillers; and • Detailed written information about costs for patients. Chair of the Medical Board, Dr Joanna Flynn, said all doctors performing cosmetic surgery would have to follow the new rules to protect

the public. "We are aware that there are some practitioners who continually come to our notice as a result of complaints with poor outcomes," she said. "We think this will make it very clear what is expected of them and we hope they will modify their practices."

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body language I NEWS 11

‘SECOND SKIN’ MAY REDUCE WRINKLES AND EYEBAGS An invisible film to offer skin added elasticity

SKIN AND TONIC Anti-ageing gin promises to fight off wrinkles as you drink Aptly named Anti-AGin, a gin has been created that is purported to have anti-ageing properties. The gin is distilled with ingestible collagen and age-defying botanicals. Heralded by its creators as “the alcoholic equivalent of a facial”, this is the first ever gin created with skin-boosting ingredients. Anti-aGin also contains a mix of antioxidant and skin-healing botanicals including green tea, witch hazel, nettle and gotu kola—which the bottle claims can help reduce cellulite and sun damage. Consuming collagen is nothing new, however. In Japan, a burgeoning number of "beauty restaurants" have long been serving food containing chunks of collagen, and supermarkets have been responding to growing demand for collagen-rich foods, such as sweets and noodles. The gin—commissioned by Warner Leisure Hotels—was created by food and drink alchemists Bompas & Parr. Collagen and other nutritional supplements are one of the fastest growing beauty trends—the market for these ‘nutricosmetics’ is estimated to be worth £4.8bn by 2020.

An invisible film that can be painted onto skin to give it the elasticity of youth, dissolve wrinkles and bags under the eyes in seconds may sound like a miracle, but scientists at Harvard and M.I.T. have discovered that it could be a reality. In a pilot study of 170 subjects, published in Nature Materials, researchers created a “second skin” composed of commonly used chemicals deemed safe by the FDA, which was used to successfully treat wrinkles and eye bags. Using a large collection of siloxanes—which form long chains of polymers—the researchers modified molecular features such as the chain length, to create those with the properties they desired. They then devised a two-step process – initially applying a clear polymer, followed by a stronger product that links them together. By modifying the chemistry of the chains it’s possible to alter the properties of the second skin, depending on it’s planned use—a more permeable second skin might be used for under-eye bags, while a less permeable one might hold a medication in place. The skin can be removed with a solution that dissolves the polymer and so far no irritation or allergic reactions have been reported. The “skin” can last for more than a day. One of the first applications, said Dr Barbara A. Gilchrest, a dermatology professor who is part of the research team, was on undereye bags. “We wanted something that is elegant, and the ultimate test is right there on your face,” she said. “You really can’t see it. It’s there. It looks normal. We saw that as a very high bar. If you can achieve that you’ve done something impressive.” Gilchrest told the New York Times To test the solution on the under-eye area, people were randomly assigned to use second skin or a placebo under their eyes. Trained observers graded the subjects on the appearance of the undereye skin. The product’s durability was tested in volunteers who wore it while running in heat and working up a sweat, while swimming, and while going out in a rainstorm. According to the researchers one of the important uses is in treating eczema and irritable ageing induced dry skin patches on the back and legs that disturb sleep. The second skin can keep drugs like cortisone creams on the skin—where less than 10 percent of what is applied stays. The researchers emphasise that these tests of the product as a cosmetic treatment, where most subjects responded, are separate from medical product testing, where response rate is not yet known.

12 NEWS I body language

YOUTHFULNESS GENE DISCOVERED Scientists claim for the first time to have found a gene that specifically affects how old people look Scientists claim for the first time to have found a gene that specifically affects how old people look. The gene came to light when researchers noticed that people who carried mutations in the gene appeared, on average, two years older than they were. Researchers from Unilever and the Erasmus University Medical Centre in Rotterdam, made the discovery

through a study of the facial features of 4,000 people. The team determined perceived age through more than 100,000 assessments of photographs, then examined 8 million variants in the participants’ DNA to see whether those who looked young for their age carried different variants from those who looked old for their age.

This first-of-its-kind research—published in the journal Current Biology— discovered that individuals with one form of the MC1R gene looked two years older than those with a different form. Unilever senior scientist and study co-leader Dr David Gunn says: “This research is tremendously exciting and opens up brand new under-

standing of why some people maintain a more youthful appearance as they age. By learning the ‘secrets’ of those who look young for their age, we can find innovative ways to help everybody keep younger looking for longer. There is more work to be done but we are hopeful that this discovery could influence future product development at Unilever.” Study co-leader Professor Manfred Kayser from Erasmus MC University says: “Discovering this first gene involved in perceived age is important because it opens the door for identifying more, which we know exist and we now know are possible to find. Our finding marks another step in understanding ageing differences between people and provides new leads to identify the molecular links between perceived age, chronological age and biological age. “The next step is to understand on the molecular level why looking younger implies that you are healthier, eventually allowing us to comprehend healthy ageing.”

FOUR YEAR SENTENCE FOR FAULTY BREAST IMPLANT MAKER A French appeals court has upheld a four-year prison sentence against a man who made fraudulent breast implants that were given to tens of thousands of women worldwide The French appeals court found JeanClaude Mas, 76, the founder and former owner of the French company PIP, guilty of aggravated fraud and fined him 75,000 euros. The judges, upholding a 2013 lower court judgment, barred Mas from any job in the health sector and from running any company for life. He hasn't been jailed during the appeals, which could continue.

The implants of his company, Poly Implant Prothese, or PIP, contained industrial-grade silicone instead of medical silicone and were prone to leakage. They weren't available in the U.S., but at least 125,000 women worldwide received them until sales ended in early 2010. Alexandra Blachere, 38, president of a victims' association, said she feels relieved

by the verdict, but that it was a "big disappointment for the victims" to see Mas walk free. More than 7,000 women victims of PIP breast implants filed complaints against Mas and his company in this case. Philippe Courtois, a lawyer for some of them, said the court granted 4,000 euros (4,600 euros) in damages to each of the plaintiffs for their "harm of anxiety."

body language I NEWS 13

events 3-4 JUNE, Global Academy for Medical Education’s 6th Annual Summit in Aesthetic Medicine, Newport Beach, United States W: globalacademycme.com

THOMASDECO / SHUTTERSTOCK.COM

3-4 JUNE, Journées Parisiennes du Laser, Paris, France W: congres-medical-congress.com 10 JUNE, Oculoplastic@Bordeaux 2016, Bordeaux, France W: congres-medical-congress.com 16 - 18 JUNE, 3rd ICAD Brazil, International Congress of Aesthetic Dermatology and Healthy Aging Medicine, Sao Paulo, Brazil W: euromedicom.com 16 - 19 JUNE, Facial Aesthetic Conference & Exhibition—FACE 2016, London, UK W: faceconference.com

"DR MIAMI" USES SNAPCHAT TO RECORD SURGERIES Miami plastic surgeon Dr Michael Salzhauer has managed to gather one of the largest followings on Snapchat by using it to document procedures In a recent profile for Vanity Fair, Salzhauer allowed the world a behind-the-scenes look at how he got nearly 821,000 people to watch him perform plastic surgery every day. Salzhauer, better known as “Dr Miami,” has millions of Snapchat fans and hundreds of new patients as a result of using the app during his patients’ surgeries. “Snapchat and social media has allowed us to show our work to an audience that we would never be able to reach if I had run a local commercial, you know?” Salzhauer told ABC News’ “Nightline.” “Social media allows us to draw patients from really everywhere. I have a travel concierge now.” Salzhauer was banned for Instagram for being too graphic, so his 16-year-old daughter introduced him to Snapchat. He now has two full-time employees who Snapchat his activities from the moment he walks through the door and into the operating room. Things have matured since Salzhauer first started documenting his surgeries using Snapchat, when

maybe one in three patients would allow to him to record their surgeries—people now come asking to be on Snapchat. Salzhauer insists that Snapchat doesn’t distract him in the operating room, and so far, Salzhauer said, no lawsuits stemming from his Snapchat use have come his way. “We’re careful. We hope it never happens, but I think, like, body cameras on police and cameras in schools are a good thing too, you know? It keeps everybody focused, and, you know, it’s helpful to go back to the videotape and see,” Salzhauer told ABC News. “I think all surgery should be on tape. I feel like that— what’s wrong with transparency?” Every Snapchat is orchestrated to maximise the impact on social media, he says, and his popularity only seems to be growing. He came in second place for the 2016 Shorty Award Snapchatter of the Year, losing to DJ Khaled. And his practice has also exploded. Salzhauer has had to stop accepting new appointments, currently has a backlog of appointments stretching forward for more than a year—and there’s a waiting list.

1 - 3 JULY, IMCAS Americas 2016, Cancùn, Mexico W: imcas.com 6-8 JULY, AFPSS 7th Functional Septorhinoplasty Course in conjunction with 7th Asian Facial Plastic Surgery Society Congress, Singapore W: entfortnight2016.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 19-23 OCTOBER, DASIL—Dermatologic Aesthetic Surgery International League, Dubai, United Arab Emirates W: thedasil.org 21 OCTOBER, AMEC 2016 - 12th Aesthetic & Anti-aging Medicine European Congress, Paris, France W: congres-medical-congress.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 6-16 NOVEMBER, 11 Days of Plastic Surgery 2016 — 3rd Singapore Advanced Rhinoplasty Fresh Frozen Cadaveric Dissection Course, Singapore W: singaporeentcourses.com.sg 16-19 NOVEMBER, 2nd EPSC 2016 - Middle East — 2nd Emirates Plastic Surgery Society Congress 2016 - Middle East, Dubai, United Arab Emirates W: epsc.ae/ 24 - 26 NOVEMBER, ICAD 2016, Bangkok, Thailand W: euromedicom.com Send events for consideration to arabella@face-ltd.com

One powerful hand piece. The Ellipse Frax 1550 for Nordlys - New fractional non-ablative laser with high clinical efficacy and outstanding results. A new and unique technology allows doctors to set pulse time and energy independently when treating with Frax 1550 and thereby control the thermal impact of the skin. The treatment results are outstanding, and at the same time patients experience less pain and limited downtime. The Frax 1550 allows users the ability to treat a new range of conditions, that supplement those the Nordlys already treats so well. Ellipse chose a wavelength that supplements the treatment of scars, by including acne scars and stretchmarks. All three are conditions that affect millions of people worldwide, and all three show great improvement if treated with the 1550nm wavelength – even better if this is pre-treated with our existing Selective Waveband Technology (SWT). Skin resurfacing completes the pack, and works by supplying controlled heat into the dermis, which boosts production of collagen and helps ageing skin to look younger and fresher. Coupled with SWT, this gives us a complete solution to treat all the signs of ageing skin – redness, dyschromia and fine lines and wrinkles.

The future of aesthetics Through creation of “micro thermal zones,” Ellipse fractional laser modalities offer a favourable side-effect profile compared to other non-fractional counterparts.

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The innovative Nordlys narrowband platform from Ellipse Rather than cumbersome sequential combinations of multiple individual light sources, Nordlys offers SelectiveWaveband Technology (SWT®) – a tightly controlled spectral wavelength band from 555 to 950 nm and 530 to 750nm. Selective Waveband Technology (SWT®), combined with Perfect Square Pulse technology allows the device to treat all skin types without active skin cooling. An onboard 1064nm Nd:Yag laser, which is helpful for resistant Port wine stain, incorporates SoftCool technology to cool treated skin without constricting underlying vessels. The result is safer, more effective and predictable treatments, with less pain and downtime than traditional lasers.

A single wavelength is often insufficient to effectively address such complex anatomical structures. Through the device’s mobile touch screen interface, users simply select the patient’s skin type, tan level, vessel colour and thickness. The system automatically adjusts its spot size, energy level and pulse duration for optimal settings. Conversely, advanced users can define every individual pulse or pulse train themselves with unsurpassed flexibiloity. The Nordlys platform also stores client and treatment data, making it easy to delegate the procedure.

I am very excited to be speaking at FACE 2016 on the versatility of the new Ellipse Nordlys device on June 18. Dr Neil P J Walker FRCP Honorary Consultant Dermatologist

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16 INDUSTRY I body language

industry news

BOCOUTURE APPROVED TO TREAT UPPER FACIAL LINES Merz Aesthetics announces Bocouture has been approved by the MHRA for treatment of upper facial lines Merz Pharma UK Ltd has announced that Bocouture has been approved by the MHRA for the treatment of upper facial lines, including horizontal frown lines, lateral periorbital lines and glabellar frown lines. Bocouture is currently the only neurotoxin approved in the UK for this combined upper facial lines indication. “Merz is a global leader in the aesthetics space and is proud to be able to provide patients and physicians in the UK with the first and only aesthetic neurotoxin approved for combination treatment of upper facial lines,” stated Stuart Rose, Managing Director of Merz Pharma UK. “This expanded indication for Bocouture is a result of our ongoing investment in research and development and supports our Vision to become the most Admired, Trusted and Innovative aesthetics and neurotoxins company worldwide.” Recent market re-

search has indicated that the rejuvenation of upper facial lines is one of the most requested aesthetic procedures among both existing patients and those considering treatment. In clinical practice, many patients request combined treatment of upper facial lines in a single session to achieve optimal treatment outcomes. “As the only neurotoxin treatment approved for the simultaneous treatment of upper facial lines, Bocouture supports

aesthetic practitioners in their day to day practice and enables them to provide their patients with well tolerated and effective treatments with confidence,” said Lucy Dowling, Brand Manager, Merz Aesthetics. “We are very proud of the fact that, while Bocouture was not the first toxin to enter the UK aesthetics market, it is the first product to achieve this important milestone.” The approval of this new treatment indication

is based on the results of a pivotal randomised, double-blind, placebocontrolled Phase 3 study with 156 patients from United Kingdom, France and Germany receiving treatment of upper facial lines with Bocouture. Clinical trial data demonstrates that Bocouture has a favourable safety and efficacy profile in treating upper facial lines, both combined and separately, with treatment effects maintained for up to four months.

JOHNSON & JOHNSON TO ACQUIRE NEOSTRATA NeoStrata develops and markets clinically proven, dermatologist-developed skincare Johnson & Johnson Consumer Inc. has announced that it has entered into a definitive agreement to acquire global dermocosmetics leader NeoStrata Company, Inc. The acquisition will include NeoStrata's affiliates and parent company TriStrata, Incorporated, a privately-held company. NeoStrata, based in Princeton, N.J., has a history of innovation that includes breakthrough research in Alpha hydroxy acids, which have become a standard among anti-aging technologies in the beauty category. The Company develops and markets a range of clinically-proven, dermatologist-developed, skin care products that meet the needs of every skin type. "Drs Ruey Yu and Eugene Van Scott formed NeoStrata in 1988 and continue to make significant contributions to the science of skincare. NeoStrata's legacy in dermocosmetics will

complement our global Consumer portfolio and enable us to deliver advanced skin care brands to consumers around the world," said Jorge Mesquita, Worldwide Chairman, Consumer, Johnson & Johnson. "NeoStrata and Johnson & Johnson share a strong history of innovation and together we will work to discover important new skin care solutions grounded in deep human insights and compelling science. We look forward to working closely with NeoStrata's distributors around the world and having their outstanding team of employees join Johnson & Johnson Consumer later this year." The acquisition is subject to clearance under the Hart-ScottRodino Antitrust Improvements Act and other customary closing conditions and expected to close in the first half of 2016.

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18 FACE 2016 I body language

Facial aesthetic conference and exhibition FACE 2016—the UK’s premier medical aesthetic conference returns to the heart of London this summer showcasing an expanded lecture programme, hands on training and FACE rewind

JUNE 16TH – 19TH 2016

ACE 2016 marks the 14th year of the UK’s premier aesthetic conference in the heart of London. With the strategic partnership and alliance with EuroMediCom and Informa—the organisers behind a host of international medical aesthetic conferences and events including AMWC in Monaco—FACE is constantly creating changes to the conference experience, allowing more content to be seen by more delegates every year. FACE 2016 sees the regular INJECTABLES, BODY, SKIN, HAIR and THREADS Agendas take place across three days in their own dedicated rooms and lecture theatres. Changes to the Agenda for FACE 2016 include a Live BUSINESS Agenda taking

place within a new section of the Exhibition Hall located on the 1st Floor. This will enable access for all delegates and exhibitor representatives to participate in our ever popular and interactive business talks which have proven to be key for everyone working within the medical aesthetics industry. Also new to FACE 2016 is the addition of Advanced Hands-On Training Courses, which will run throughout the event focusing on injectable treatments. Each session will consist of five to 10 delegates. The Sunday schedule will also be enhanced for 2016, as running alongside the Injectables Agenda, will be a ‘FACE Rewind’ lecture programme. This will take place across two rooms, and will repeat some of the most popular talks

from the weekend which delegates might not have been able to see in their first few days of attendance. FACE 2016 will—for the first time—host a Sexual Aesthetics Agenda. Over the last few years there has been an explosion in the number of treatments targeted at both aesthetic and functional improvement of the genital area. From fillers, PRP and threads, to lasers and radiofrequency; research and development investment and clinical experience has grown significantly. This session aims to explore the evidence behind different modalities and their potential combined uses, alongside practical tips from experts pioneering the use and promotion of these treatments in their clinics.

FACE 2016 is held at the QEII Centre in London’s Westminster

body language I FACE 2016 19

Pre-event "faces of the world" advanced injectable masterclass Global trends and ethnic and cultural differences demand a bespoke approach for each client which meets their needs and desires

08:30 I 09:30 REGISTRATION 09:25 I 09:30 Chairman’s introduction, Dr Ali Pirayesh 09:30 I 10:00 Lectures The five biggest treatments in my practice in India, Prof Mukta Sachdev My approach to aesthetics in the USA and in China, Dr Brian Kinney 10:00 I 11:00 Live injection workshop: forehead and temple Chair: Dr Ali Pirayesh Moderator: Dr Kate Goldie Injectors: Dr Raj Acquilla, Dr Tom Van Eijk, Dr Brian Kinney, Prof Mukta Sachdev 11:00 I 11:30 REFRESHMENTS 11:30 I 12:00 Lectures Chairs: Dr Frank Rosengaus and Prof Berend van der Lei Facial analysis and ethnic views on aesthetics, Dr Kate Goldie Combining plastic surgery with injectable toxins and fillers, Dr Ali Pirayesh The boundaries between surgical and non-surgical aesthetic care, Prof Berend van der Lei 12:00 I 13:00 Live injection workshop: midface—eyes, noses and cheeks Chairs: Dr Raj Acquilla and Mr Colin Morrison Moderator: Dr Ali Pirayesh Injectors: Dr Frank Rosengaus, Dr Uliana Gout, Mr Ash Mosahebi and

ue to the incredible popularity of our first pre-event injectables masterclass delivered in 2015, Thursday at FACE will once again host an Advanced PreCourse agenda. The concept of “total facial contouring” with fillers/toxins and threads continues to become increasingly appealing to an ever wider audience of both men and women of all races and backgrounds around the world. However, for practitioners living in cosmopolitan areas, the technical challenge of delivering excellent results safely is enhanced when dealing with patients of different ethnicities and cultural backgrounds. This unique one day masterclass will be headed by an expert panel who will explore these challenges and provide personal insights into the cultural differences

Dr Ekaterina Gutop

of aesthetics and beauty alongside variations in technical approaches required to ensure that patients are treated safely and effectively with the outcomes that they desire. Subjects covered in this unique workshop include:  Anatomy: With a special focus on ethnic differences and anatomical variations  Concepts in Beauty: What are the differences in ideals between women from different continents.  Safety: Recommendations in altering techniques in facial contouring for different indications dependent upon ideals and ethnicity  Adverse events: Exploring any differences in complication rates and how to deal with them when dealing with people from different ethnic backgrounds In addition, there will be a number of live demonstration sessions delivered by our expert faculty

13:00 I 13:45 LUNCH 13:45 I 14:45 Lectures Chairs: Mr Colin Morrison and Dr Uliana Gout Korean concepts of beauty and what treatments are hot, Dr Kwon Han Jin Laser and light in coloured skin—my approach, Mr Ash Mosahebi Changes in the use of toxins and fillers in Holland in the last five years, Dr Tom van Eijk Anatomical approach to Hispanic aesthetics—my philosophy, Dr Frank Rosengaus Cosmeceuticals for different skin types, Dr Uliana Gout What does the Russian aesthetic medicine client need and want? Dr Ekaterina Gutop 14:45 I 15:45 Live injection workshop: lower face—perioral, chin, jawline, masseter Chairman: Dr Brian Kinney Moderator: Prof Dario Bertossi Injectors: Dr Kwon Han Jin, Dr Ali Pirayesh, Dr Kate Goldie and Mr Colin Morrison 15:45 I 16:00 REFRESHMENTS 16:00 I 17:00 Lectures Chairs: Dr Tapan Patel and Dr Ekaterina Gutop Approach to male aesthetic medicine different ethnicities, Dr Raj Acquilla Non-surgical aesthetic care in my UK plastic surgery practice, Mr Colin Morrison The Italian Job; medical rhinoplasty and dealing with celebrities, Prof Dario Bertossi 17:00 I 17:30 Questions and Close: Full Panel

highlighting the practical variations required in terms of facial assessment, consultation techniques, and facial rejuvenation approaches.

20 FACE 2016 I body language

FRIDAY 17.06.16

CHAIR: PROF BOB KHANNA

INJECTABLE AGENDA

BODY AGENDA

SKIN AGENDA

BUSINESS AGENDA

09:25 I 09:30 Conference introduction

09:25 I 09:30 Conference Introduction

09:30 I 09:55 The comprehensive treat09:30 I 10:00 The evolutionof injectables over the last 20 years, Prof Nick Lowe

ment of acne scars, Dr Mark Taylor 09:55 I 10:15 A novel cryo-system delivering precise single treatment for excessive scars, Dr Welf Prager 10:15 I 10:35 Innovative melanin reader

10:00 I 11:00 Practical injection workshop session, Dr Raj Acquilla

11:00 I 11:30 REFRESHMENTS

to improve safety of laser treatment, Dr Saquib Bashir

bio-stimulator: patient selection and treatment, Prof Nick Lowe

09:30 I 09:55 Vertical growth on a global scale: how cosmeceuticals and disruptive

Chiza Westcarr

tech are driving the market, Deirdre Kelly

09:55 I 10:20 Ageing facts and myths, Dr Charlene DeHaven 10:20 I 10:45 Oral photoprotection: fact or fiction? Dr Maria Vitale-Villarejo

10:35 I 11:00 Q&A

10:45 I 11:00 Q&A

11:00 I 11:30

11:30 I 11:50 Microablative laser with 11:30 I 12:15 Poly-Caprolactone

09:30 I 09:55 Inflammation and accelerated skin ageing (inflammaging),

spatially modulated ablation (RecoSMA) technology for facial skin rejuvenation, Dr Jean Paul Meningaud

11:30 I 11:50 Active ingredients of meristem plant cells for skin rejuvenation: myths and reality, Prof Liudmila Korkina

12:15 I 13:00 Agarose fillers vs HA— differences in chemistry, injection and

to treating hypo and hyper pigmentation in

PRP for the correction of facial wrinkles, Dr Maria-Angeliki Gkini, Dr Maria Goisis

Prof Nick Lowe

acne? Dr Zein Obagi 15:20 I 15:40 Treating rosacea: the 5 star

Dr Patrick Treacy

approach, Dr Rachael Eckel

15:30 I 15:50 The treatment pyramid

15:40 I 16:00 Panel debate on the

approach to improving skin health,

treatment of acne and rosacea, Prof Nick

Dr Zena Gabriel

Lowe, Prof Mukta Sachdev, Dr Zein

15:50 I 16:00 Q&A

Obagi and Dr Rachael Eckel

16:00 I 16:30 REFRESHMENTS

technology to treat stretch marks,

injectables workshop, Dr Britta Knoll

17:30 I 18:00 Ageing morphotypes classification and treatments, Dr Vladlena Averina

16:30 I 16:50 Stem cell activation, Dr María Vitale-Villarejo

practitioners, Wendy Lewis

15:45 I 16:00 Q&A

16:00 I 16:30 REFRESHMENTS

practice management software in 2016? Dr Ross Perry

16:30 I 17:15 Complications and management following thread lifting, Dr Raffaele Rauso

16:50 I 17:10 Using cosmeceuticals as with clinic management software,

16:50 I 17:10 Picosecond laser for tattoo

17:10 I 17:30 An overview of the clinical

Charles Southey

removal, Dr Klauss Hoffman

uses of a supersaturated topical oxygen

17:10 I 17:30 A novel skin rejuvenation

emulsion—from photodamage to PDT,

17:15 I 17:35 Setting your clinic to auto

device, Dr Askari Townshend

Dr Mark Rubin

pilot, William Brandham

17:50 I 18:00 Q&A

16:00 I 16:30 REFRESHMENTS

16:30 I 16:55 What makes the best CRM/

16:55 I 17:15 How to grow your business

Dr Steve Eubanks

Dr Kwon Han Jin

the 'social' in social media for aesthetic

ment, Dr Ekaterina Gutop

facial rejuvenation using radiofrequency,

13:00 I 14:30 LUNCH AND EXHIBITION

stration of the Ultra V Lift, 14:30 I 16:00 The S-Factor: how to keep

a holistic approach for age related treat-

17:30 I 17:50 Different approaches to

12:45 I 13:00 Q&A

14:30 I 15:45 Presentation and demon15:00 I 15:20 When is it too late to treat

15:10 I 15:30 What's new in IPL/LBD?

Dr Natalia Volkova 16:50 I 17:30 Mesotherapy and lipolytic

aesthetics, Veronica Donnelly

14:30 I 15:00 The changing face of acne,

spatially modulated ablation (RecoSMA)

Dr Irfan Mian

12:30 I 12:50 An update on VAT and

with body contouring, Dr Sweta Rai

16:30 I 16:50 Microablative laser with

11:30 I 12:45 Dr Irfan Mian’s ‘MASH’ technique for PDO thread lift treatments,

12:10 I 12:30 TBC

14:30 I 14:50 Complications associated

16:30 I 16:50 A preliminary study comparing nanograft plus PRP vs hA plus

Dr Kate Goldie

13:00 I 14:30 LUNCH AND EXHIBITION

laser resurfacing, Dr Stephen Mulholland

11:00 I 11:30

11:30 I 11:50 Social styles,

13:00 I 14:30 LUNCH AND EXHIBITION

aggressive single session fractional RF and

16:00 I 16:30 REFRESHMENTS

11:00 I 11:30

13:00 I 14:30 LUNCH AND EXHIBITION

Dr Ravi Jain

Christopher Rowland Payne

10:40 I 11:00 How to set up and run a clinic

10:15 I 11:00 PLLA soft sutures with bi-directional cones, Dr Kuldeep Minocha

using energy based devices, Dr Vivek Mehta

12:50 I 13:00 Q&A

14:50 I 15:10 Mesocaine technique for more

15:30 I 16:00 Eyebrow ptosis—uni-

Dr Uliana Gout

12:50 I 13:00 Q&A

portfolio—a doctors point of view,

versal destiny? Causes and solutions, Dr

12:30 I 12:50 The latest topical approaches Asian skin, Prof Mukta Sachdev

rejuvenation, Dr Benji Dhillon

a successful aesthetic practice using one

ing competitive advantage,

consultation, Wendy Lewis

12:30 I 12:50 Ultrasound for skin

14:30 I 15:30 How to build and sustain

Dr Amanda Wong Powell

10:20 I 10:40 Tips and tricks to maintain-

11:50 I 12:10 New rules of the

clinical results, Dr Brian Kinney

13:00 I 14:30 LUNCH AND EXHIBITION

bination with dermal filler contouring,

and litigation, Norman Wright

role in skincare, Mr Paul Banwell

plasty, Mrs Sabrina Shah-Desai

non-surgical face lift, Dr Amanda Wong Powell 09:55 I 10:15 PDO thread lifting in com-

11:50 I 12:10 Nutraceuticals and their

12:10 I 12:30 Truth and lies in blepharo-

and biostimulators to achieve a natural

09:55 I 10:20 See the person behind the

approaches, Dr Raj Acquilla

12:10 I 12:30 Tretinoin and vitamin C dual

09:25 I 09:55 Combination use of absorbable Poly-L-Lactic acid sutures

patient—how to reduce patient complaints

11:50 I 12:10 Facial skin tightening

purpose treatment possibilities, Dr Zein Obagi

THREADS AGENDA

17:15 I 17:45 Thread lifting—my approach, Dr Aamer Khan

17:30 I 17:50 Umbilical cord lining stem cells; it's not a miracle, it's science, Dr Daniel Sister 17:50 I 18:00 Q&A

17:35 I 18:00 Panel debate

17:45 I 18:00 Panel discussion

body language I FACE 2016 21

SATURDAY 18.06.16

CHAIR: DR BESSAM FARJO

INJECTABLE AGENDA

BODY AGENDA

SKIN AGENDA

BUSINESS AGENDA

HAIR AGENDA

09:25 I 09:30 Conference Introduction

09:30 I 09:50 Wellbeing effect of photobiomodulation, Dr Francois Michel

09:30 I 09:50 Pigmentation process of skin, Dr Charlene DeHaven

09:30 I 09:50 Advertising standards update—where clinics can go wrong, Lorna Jackson

09:30 I 09:50 Introducing hair to your practice, Dr Greg Williams

09:50 I 10:10 Treating dark skins safely with energy based devices, Prof Mukta Sachdev

09:50 I 10:10 Skincare creams and regulation, Cuross Bakhtiar

09:50 I 10:10 The business of skin, Sharon Cass

09:50 I 10:10 Classification of hair loss and common problems, TBA

10:00 I 10:30 Filler injection of the periocular area, Dr Michael Kane

10:10 I 10:30 CO2 lasers and their use in dermatology, Dr Benji Dhillon

10:10 I 10:30 The importance of skin checks during an aesthetic consultation, Dr Paul Charlson

10:10 I 10:30 Marketing new treatments for intimate areas: build a strong foundation for long-term success, Caitlin Farrell

10:10 I 10:30 Nutrition in relation to hair and hair loss, Zoe Passam

10:30 I 11:00 Rheology and how to choose the right filler, Dr Frank Rosengaus

10:30 I 10:50 Vascular lasers in aesthetic medicine, Dr Christine Dierickx

10:30 I 10:50 What’s new in combining topical cosmeceutical treatments with procedures, Dr Hema Sundaram

10:30 I 10:50 Increasing patient retention in an increasingly competitive market, Gary Conroy and Mandy Cameron

10:30 I 10:50 Low level lasers for hair loss, Iain Sallis

10:50 I 11:00 Q&A

11:00 I 11:30

11:30 I 11:50 The world’s first laser treatment for non-invasive lipolysis, Dr Benji Dhillon

11:30 I 11:50 Topical anti-ageing cosmeceuticals, Elliot Isaacs

11:30 I 11:50 The value of training in an unregulated industry, Glenda Bailey Bray and Tracy Butler

11:30 I 11:50 Medications for androgenetic male & female loss, Dr Martin Wade

11:50 I 12:10 Cryolipolysis for body contouring, TBA

11:50 I 12:10 New delivery techniques in dermocosmetics, Dr Gabriel Serrano

11:50 I 12:10 How mentoring programmes and postgraduate education will standardise training in aesthetics, Dr Tristan Mehta and Dr Vikram Swaminathan

11:50 I 12:10 Medical treatments for female pattern loss, Dr Patrick Treacy

12:10 I 12:30 Radiofrequency for body contouring, Dr Hema Sundaram

12:10 I 12:30 Skin ageing research and innovation, Prof Mark Birch-Machin

12:10 I 12:30 TBA, TBA

12:10 I 12:30 Who is a good candidate for hair transplantation, Dr Bessam Farjo

12:30 I 12:50 Ultrasound for body contouring, TBA

12:30 I 12:50 New technologies in topical skincare we might expect in the next decade, Elliot Isaacs, Dr Gabriel Serrano, Prof Mark Birch-Machin

12:30 I 12:50 European standards in non-surgical aesthetics: an update, Mike Regan

12:30 I 12:50 Scalp micropigmentation, Dawn Forshaw

12:50 I 13:00 Q&A

13:00 I 14:30 LUNCH AND EXHIBITION

14:30 I 15:00 Soft surgery demonstration, Dr Sotirios Tsioumas

14:30 I 14:50 Cancer treatments and the skin, Dr Charlene DeHaven

09:30 I 10:00 Non-surgical nasal contouring, Mr Ash Labib

11:30 I 12:00 Anatomy of the cheek and lid-cheek junction: how to inject safely, artistically and avoid complications, Mr Rajiv Grover

12:00 I 13:00 Practical injection workshop, Dr Andre Braz

13:00 I 14:30 LUNCH AND EXHIBITION

14:30 I 15:15 Lips and peri-oral complex with toxins and fillers, Dr Uliana Gout, Dr Philippe Garcia, Dr Igor Rudenko, Dr Wolfgang Redka-Swoboda

15:15 I 16:00 Male facial contouring workshop, Dr Sebastian Torres

16:00 I 16:30 REFRESHMENTS

16:30 I 17:15 Doing toxins well: tips and tricks for upper and lower face, Dr David Eccleston

15:00 I 15:20 New RF non-excisional face and neck lifting techniques, Dr Stephen Mulholland

15:10 I 15:30 Retinol: more and less: getting more efficacy with less irritation by combining ingredients, Dr Sandeep Cliff

15:20 I 15:40 TBC, Dr Shaimaa Nassar

15:30 I 15:50 Deep peeling—the science of TCA and Phenol, Dr Rodrigo Arroyo Sanchez

15:40 I 16:00 Before and afters of our patients: using dynamic videos, Dr Emmanuel Elard

15:50 I 16:00 Q&A

16:00 I 16:30 REFRESHMENTS

16:30 I 16:50 What's new in laser hair removal for the treatment of ethnic skins, Dr Rahul Pillai 16:50 I 17:10 Epilation treatment with a unique in motion alexandrite technology, Prof Nicola Zerbinati

17:15 I 18:00 Dealing with complications, Dr Kate Goldie, Dr Patrick Treacy, Dr David Eccleston, Constance Campion

14:50 I 15:10 Pathways to skin fitness: building a comprehensive clinic menu, Lorna Bowes

17:10 I 17:30 Latest advances in hair removal technology, Prof Mukta Sachdev 17:30 I 18:00 How to maximise efficacy and minimise adverse events with laser hair removal, Prof Mukta Sachdev, Dr Rahul Pillai, Prof Nicola Zerbinatti

14:30 I 15:30 Secrets of a successful clinic website, Adam Hampson

15:30 I 15:50 Complaint handling in aesthetics, Naomi Di-Scala

15:50 I 16:00 Q&A 16:00 I 16:30 REFRESHMENTS

16:30 I 17:00 3 M's for marketing magic, Dr Harry Singh

16:30 I 18:00 Chemical peels workshop, Dr Uliana Gout, Dr Mariya Serheyeva, Dr Tatjan Pavicic, Dr Natalia Mikhaylova

14:30 I 14:50 Follicular unit extraction technique in hair transplant surgery, Dr Edward Ball 14:50 I 15:10 Advances in robot assisted FUE hair transplant surgery, Dr Bessam Farjo 15:10 I 15:30 Strip follicular unit transplant surgery overview and graft care, Dr Greg Williams 15:30 I 15:50 Type VII MPB a challenge for the hair surgeon, Dr Humayun Mohmand 15:50 I 16:00 Q&A 16:00 I 16:30 REFRESHMENTS 16:30 I 16:50 How do I train in hair restoration, Dr Nilofer Farjo 16:50 I 17:10 PRP for the treatment of androgenetic alopecia in diverse health condition, Dr Paulina Kubasik 17:10 I 17:30 PRP for hair rejuvenation, Vicki Smith

17:00 I 18:00 A full circle approach to marketing—how a multifaceted communication strategy can drive your brand forward, Carl Frascina

17:30 I 17:50 Stem cells, cloning and other future therapies, Paul Kemp

17:50 I 18:00 Q&A

22 FACE 2016 I body language

SUNDAY 19.06.16 INJECTABLE AGENDA

BUSINESS AGENDA

SEXUAL AESTHETICS AGENDA I CHAIR: DR SHERIF WAKIL

CHURCHILL AUDITORIUM

WESTMINSTER SUITE

ST JAMES’S SUITE

09:25 I 09:30 Conference Introduction

09:30 I 09:50 Bio-dermal restoration with a new and advanced rapid

09:30 I 09:50 How Montgomery will influence aesthetic practice,

09:30 I 09:45 Overview of the impact of aesthetic treatments on sexual

polymerising collagen, Mr Chris Inglefield

Elise Bevan and Alison Johnson

function and sexual disorders, Dr Beata Cybulska

09:50 I 10:10 How well is my business really doing? How to measure

09:45 I 10:00 Sexual rejuvenation with PRP, the O Shot and P Shot,

the most important information, Dan Parry

Dr Charles Runels

09:50 I 10:10 Beyond rheology: innovations in filler science and breakthrough strategies for volumetric skin remodelling, Dr Daniel Cassuto and Dr Hema Sundaram 10:10 I 10:30 Bacterial biofilm formation in aesthetic medicine— what we know about it? Dr Elena Rumyantseva

10:10 I 10:30 Imaging—the business case, Nick Miedzianowski-Sinclair 10:30 I 10:50 Newtech: video imaging and Office 2.0—welcome to the dynamic era! Dr Emmanuel Elard

10:30 I 11:00 Long term results using hyaluronic acid and toxins,

10:00 I 10:15 Intimate area rejuvenation, Dr Dawid Serafin 10:15 I 10:30 TBC, TBA 10:30 I 10:45 TBC, TBA

Dr Gerhard Sattler

10:50 I 11:00 Q&A

10:45 I 11:00 TBC, TBA

11:00 I 11:30 REFRESHMENTS AND EXHIBITION

11:30 I 12:00 Lights, camera, attraction: the power of video marketing,

11:30 I 11:45 Botulinum toxin treatment of pelvic floor disorders and

Pam Underdown

genital pain in women, Dr Fernando Aznar

11:30 I 12:00 An objective comparison of Botulinum formulations, Dr Michael Kane

11:45 I 12:00 Radiofrequency for vaginal rejuvenation, 12:00 I 12:30 How to create clients, not customers, Richard Crawford-Small

12:00 I 12:15 TBC, TBA 12:15 I 12:30 TBC, TBA

12:00 I 13:00 Neck and décolleté rejuvenation, Dr Wolfgang Redka-Swoboda

Dr Süleyman Eserdağ

12:30 I 13:00 Why your front of house staff need training and what this training should cover, Gilly Dickons

12:30 I 12:50 Demonstration with machine for vaginal rejuvenation, Dr Sherif Wakil 12:50 I 13:00 Q&A

13:00 I 14:30 LUNCH AND EXHIBITION 14:30 I 15:00 An analysis of specialist aesthetic consultation, Constance Campion 15:00 I 15:45 The art of the aesthetic consultation, Prof Bob Khanna

13:00 I 17:00 LUNCH AND EXHIBITION

CONFERENCE CLOSE

15:45 I 16:05 Nanofat graft vs dermal fillers in facial rejuvenation, Miss Amanda Wong-Powell 16:05 I 17:00 Fat vs filler debate, Miss Amanda Wong-Powell, Mr Awwad Awwad CONFERENCE CLOSE

FACE rewind Don't miss out—new to FACE 2016 you can catch up on past lectures If as a delegate, you have missed certain talks throughout the Friday or Saturday sessions (because you simply cannot be in more than one lecture theatre at any given time), we will repeating highlighted lectures and presentations from the BODY, SKIN, THREADS and HAIR Agendas on the Sunday. The full FACE rewind agenda for Sunday June 19th is available to view on the FACE Conference website, faceconference.com

body language I FACE 2016 23

Hands-on injectable training Dr Frank Rosengaus and Dr Tom van Eijk are hosting exclusive small group training sessions focusing on facial injectables

6-1 Masterclass Course with Dr Frank Rosengaus FACE Conference will be hosting three highly personalised and VIP hands-on training sessions, reviewing all the different facial areas in order to obtain a “Full Face Balance”. The sessions will include a short preview of the most advanced and sophisticated concepts and procedures, with emphasis on facial anatomy and correct clinical assessment to gain amazing results and avoid complications. The course will be practical with constant supervision during application. Techniques like rhinoscuplting, “The Happy Face Treatment” for oral commissures and marionette lines and “3D volumisation + vector lifting” for the midface will be addressed. There will be three sessions held over the course of the Conference, with only six delegates in each session: Friday 09:00 – 13:00 Friday 14.30 – 18.30 Saturday 14.30 – 18.30 Practice Sessions with Dr Tom van Eijk 1) Periorbital—tear trough, under eyelid, 4-D rejuvenation, toxin and fillers

2) Acne Scarring—entropy, scar tissue management, when to fill and when to strengthen, toxin in scars 3) Jaw lines—non-surgical options, limitations and pitt falls, toxin and fillers 4) Lips—shapes, sizes, ages, wrinkles, fillers and toxins There will be four sessions held over the course of the Con-

ference, with only six delegates in each session: Friday 09:00 – 13:00 Friday 14.30 – 18.30 Saturday 09.00 – 13.00 Saturday 14.30 – 18.30 Delegates for either course are required to provide their own model. Places are extremely limited so early booking is advised, by visiting faceconference.com

COURSE LEADERS  Dr Frank Rosengaus Facial Plastic Surgeon, Mexico Dr Frank Rosengaus is Mexico’s premier board certified facial plastic surgeon. With over 20 years of experience, he is recognised as a world renowned leader in cosmetic and aesthetic plastic surgery.

Dr Tom van Eijk  Cosmetic Doctor, Netherlands Dr Tom van Eijk, based in Amsterdam, is one of Holland’s most famed cosmetic doctors. He has been dedicating his full attention to cosmetic injectables since 2003, and developed the Fern Pattern Technique.

A unique opportunity to learn from world-leading practitioners

24 NON-SURGICAL I body language

Polydioxanone thread lifting PROFESSOR SYED HAQ discusses the popularity of thread-based technology to bring about skin rejuvenation, skin tightening and lifting of the face, as well as treating other body parts

mproved understanding of the use of Polydioxanone (PDO) threads as the principal underlying device in aesthetic/ cosmetic non-surgical interventions, alongside correct patient selection and the increased experience of clinicians in the United Kingdom, has created a significant

upsurge in their use in the past five years. Invariably this has led to improved patient outcome in general, though the application of this powerful technology has to be taken in the correct context. PDO PDO is a colourless, crystalline,

biodegradable synthetic non-animal based polymer. Chemically it is based on a polymeric structure composed of multiple repeat etherester subunits. It is obtained by ring-opening polymerisation of the monomer p-dioxanone. The medical device manufacturer Ethicon first used polydiox-

body language I NON-SURGICAL 25

anone suture technology worldwide for over a decade as a means of wound closure. In South Korea polydioxanone has seen a revolution with PDO threads being

66 Historically, the earliest reports of surgical facial rejuvenation go back as far as 1911 by Koll et al 99

used for the last seven years both for orthopaedic and cosmetic indications. History Historically, the earliest reports of surgical facial rejuvenation go back as far as 1911 by Koll et al. The use of endoscopic malar and midface suspensions were reported by Anderson and Lo et al. in 1998, which paved the way for the future use of thread lifting suture technology as a means of facilitating facial augmentation non-surgically. It was

not until four years later in 2002 when Sasaki and Cohen provided the first definitive report of malar fat pad elevation, using a variety of suture material from polypropylene, polyglactin 910, Gore-Tex and Vicryl. This work was further supported in 2002 when non-barbed suture suspensions were used with temporal fascia fixation in bringing about midface augmentation. The first description of barbed suture suspensions to be commercialised was presented in 186 patients by Sulamanidze et al. when the Aptos

body language I NON-SURGICAL 27

[anti-ptosis sub-dermal suspension] was described. In 2004, contour threads permanent non-absorbable sutures were introduced to anchor temporal fascia, derived once again using a polypropylene base. These barbed threads were configured in a helicoidal pattern, but failed to gain momentum owing to their “permanence”. PDO has a long safety record in surgery. In South Korea, Polydioxanone has been used for over seven years in orthopaedics (to treat frozen shoulders, tennis elbow, golfer’s elbow, etc.) and in cosmetics (for skin rejuvenation, skin tightening and face ‘lifting’ indications). The popularity of PDO threads can be attributed to the safety of Polydioxanone, ease of insertion of the threads, excellent reproducible and sustainable results, minor side effects and the very low incidence of complications. More recently, in 2011 the Korean FDA approved the use of non-barbed absorbable suture suspensions using polydioxanone as an indication in lipolysis, collagen regeneration, neo-vascularisation in the subcutis and dermis. Why use polydioxanone? The main advantage is that PDO is biodegradable. This synthetic polymer is highly versatile and was originally used as a mono- or multi-filament thread. Biodegradation of PDO occurs through a process of hydrolysis over a time period of between six to eight months. The main method of elimination is via the kidneys. In contrast, the introduction of a poly-L lactic acid coated fine suture using bidirectional cones, was also introduced as means of addressing issues of facial rejuvenation a number of years ago. Silhouette Soft is inserted in the sub-dermal and adipose tissue. A number of issues using this type of technology have been identified from its underlying weak tensile strength, issues of repositioning of the cones, granuloma formation, an increased risk of skin puckering, cone visibility and a lack of lipolysis are limiting factors. The principal mode of action of polydioxanone in the dermis

A) HE×20. Arrow: PDO (polydioxanone thread). B) HE X 100 Lymphocytes, histiocytes, and eosinophils, fibrosis observed around the PDO due to a foreign body reaction. C) Treated side Elastica Van Gieson (EVG) stain ×20. D) Control side EVG×40. E) Treated side EVG×100. F) Treated side Victoria Blue ×20

was first thought to be wholly reliant on the creation of new collagen by a foreign body reaction, which promoted wound healing through tissue contraction. This traditional view of shortening of collagen failed to fully explain what was happening on a histological level. Howe and co-workers in 2006, identified that subcutaneous tissue fibroblasts exhibited greater pleomorphism than originally postulated being responsible for cytoskeletal remodeling, and this was evidenced by a process defined as mechano-transduction, where fibroblasts are able to self sense, process and respond to mechanical stimuli in their microenvironment and importantly regulate physiological function nearby. The overall effect of this sees actin polymerisation following matrix

deformation by external mechanical stimuli. The polymerised actin facilitates cell contraction and activation of the mitogen activated protein kinases (extracellular signal regulated kinases 1 and 2 ERK1/2) which in turn regulates gene expression, protein synthesis, extracellular matrix modification, cell differentiation, and potentially promotes tissue growth. The underlying mechanisms that define the regenerative changes that take place in the dermis and subcutis from polydioxanone threads includes neo-collagenesis (Fig 1C/E) from a foreign body reaction (Fig 1B), microcirculation stimulation, increased metabolism, lipolysis, muscle relaxation and increased tissue adhesion. In summary, a foreign body reaction is observed together with

Figure 1 Histological changes associated with PDO threads (Suh et al., 2015)

28 NON-SURGICAL I body language

elastic fibrosis around the area where the thread is inserted. Importantly, studies have shown that increasing the density of threads, that is when placed either in multilayers and or in close apposition, creates a more dense structural supporting framework. Indications Apart from the way in which threads are placed, the diversity amongst the different types of PDO threads currently available allows the experienced and wellinformed clinician to tackle many of the aesthetic issues requiring augmentation. The indications for PDO threads are as follows: 1. Face Contouring Cheek enhancement Jawline lift Brow lift Nose augmentation 2. Wrinkle attenuation Crows feet and peri-orbital zone Forehead Cheeks Upper lip Volumisation 3. Skin rejuvenation—general and of atrophic scars 4. Skin tightening 5. Pore size reduction 6. Volume reduction (lipolysis) 7. Hair rejuvenation 8. Neck lift Double chin reduction Platysmal relaxation—vertical and horizontal 9. Muscle relaxation Masseter Glabella Soleus Corrugators Orbicularis (infero-lateral) Back 10. Body contouring Upper arm and chest tightening Abdominal tightening and reduction Cellulite Knee lift Ankle reduction 11. Tissue healing and pain control Tendonopathies Currently, various knotless thread lifting devices using PDO are popular in aesthetic clinics. The

Figure 2. Schematic figure of the knotless PDO thread device (adapted from Suh et al., 2015)

Figure 3. Various knotless PDO thread devices (adapted from Suh et al., 2015)

Categories of different types of PDO threads: 1. Monofilament (single - plain) [Figures 2 and 3A] 2. Multi filament (double-, three- and five-ply types) [Fig 3C] 3. Screw type - in which the principle is to use a highly coiled thread (single or double) to increase the overall surface to volume ratio of the thread so as to increase the level of collagen per unit volume. The theory behind this approach is to increase the level of remodelling, with the knots acting as additional supporting points for lifting). The higher the pleat density the greater the effect. 4. Barbed threads (uni- [Fig 3D], bi- [Fig 3E] or multi-directional types Fig 3F]) 5. 2D/3D or 4D Cogs (with two, three or four dimensional projections—not shown)

thread forms a V-shape with portions residing outside the needle/ cannula and the other half inside the caliber. After inserting the needle or cannula, one simply removes the needle or cannula resulting in the thread ﬁxation inside the skin without anchorage or knots. An example of the use of multiple monofilament PDO threads provides an alternative approach to

facial augmentation by not using cog PDO thread technology. This type of approach is most commonly used in S. Korea. The advantage of using monofilaments facilitates a quick and simple procedure. Mono-filament PDO threads are also being used for wound suturing that require prolonged tensile strength. In general Polydioxanone threads remain

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30 NON-SURGICAL I body language

in situ, taking about six months to be fully absorbed, which is longer than both Vicryl and Dexon, providing an added advantage in aesthetic augmentation. The use of cog threads should be one of caution. Both uni- and bi-directional cogs have inherent issues with slippage and dimpling. This is less common than with multi-directional cogs. In my experience the most

stable lifting cog is based on the three-dimensional projection. This for the uninformed should not be confused with the spiral thread. 3D cog threads provide excellent lift of the face or neck provided the anchor point is well chosen and the threads are placed at the level of the superficial muscular aponeurosis (Figures 5 and 6). Whether mono/ screw or cog, if the PDO threads

are placed correctly with respect to tissue depth and vector orientation, a patient should experience improved clinical changes over the first four months. The most important limitation of this procedure is that it is only indicated for a modest degree of facial soft tissue laxity. Careful patient selection through experience in midface lifting using absorbable

Figure 5. Case history PDO face lift. Top, before and after 4-point cog 21G/90mm facelift; Bottom, before and after 3 point cog 21G/90mm midface lift; Haq et al. 2016, unpublished.

Figure 4. Monofilament based face treatment (Shimizu et al., 2013)

body language I NON-SURGICAL 31

transition group of patients will continue to expand – provided that further studies are conducted using PDO thread therapy that explore and deliver long-term clinical results without compromising safety. To that end it is a fundamental requirement that standardisation in the method, techniques, training and product quality are at the heart of the PDO thread therapy movement. Strict regulatory control and the establishment of non-profit organisations like the Association of PDO Thread Therapy UK will be paramount to ensure that the highest levels of outcome with patient safety are adhered to. Acknowedgments I would like to take this opportunity in dedicating this article to my family and friends both past and present, with particular reference to Dr Sayyid Azizul Haq and Mrs Fazilatun N. Haq. I would also like to pay particular thanks to my mentor in this area Dr Jacque Otto, who with his wife Amanda and son Vernon have been outstanding throughout. SH – 10 Harley Street London W1G 9PF Tel: 0207 467 8458 Email: info@invictushumanus.com Correspondence: shaq2704@gmail. com visit www.professorhaq.com

Figure 6, PDO neck lift. Top, before and after 3-point neck lift cog 21G/60mm and 21G/90mm; Middle, before and after 2-point neck lift cog 21G/90mm; Bottom, before and after3 point neck lift cog 21/90mm with 26G/50mm double screws; Haq et al., 2016, unpublished

3D cog sutures is more effective than using barbed bi- or multidirectional sutures. The reason for this is due to better techniques in fixation, combination thread use and better quality cogs being made available. The most favorable anatomic characteristics for absorbable thread lifting are low body mass index, minimal fullness to the soft tissues, strong underlying bony projections to support the elevated tissue, and good skin quality.

Many changes have taken place in PDO thread technology over the past three years. The clinical indications for use seem to be ever expanding. At present PDO thread lifting appears to be providing a viable solution for those patients who either choose not to undergo surgical intervention to resolve their clinical issues, or for those patients who are caught between the standard non-surgical and surgical approaches. I believe that this

References 1. Sulamanidze M, Sulamanidze G. Clinics in Plastic Surgery 2009 ;36:281–306 2. Shimizu Y, and Terase K. Journal of Japan Society of Aesthetic Plastic Surgery 2013 Vol.35 3. Suh DH, Jang WH, Lee SJ, Lee WS, and Ryu JH. Dermatol Surg 2015; 41:720–725 4. Rachel JD, Lack EB, Larson B. Incidence of complications and early recurrence in 29 patients after facial rejuvenation with barbed suture lifting. Dermatol Surg 2010; 36:348–54 5. Paul MD. Barbed sutures in aesthetic plastic surgery: evolution of thought and process. Aesthet Surg J 2013; 33:17S– 31S 6. Wu WT. Barbed sutures in facial rejuvenation. Aesthet Surg J 2004; 24: 582–7.

32 MEDIA I body language

Working with the new media WENDY LEWIS offers her observations on how social media platforms are changing the media landscape in 2016

s social media is igniting at a rapid pace and new platforms are emerging on a daily basis, the value it can bring to brands is also on the rise. Aesthetic practitioners and clinics are discovering the ways social media can contribute to success and growth by generating more customers, increasing their traffic to their website, blog and Facebook page, and generating buzz for their brand. Social media is undoubtedly transforming how businesses communicate directly and honestly with their customers, and it has also revolutionised how we receive and share news and information. The pendulum swinging from print to online in terms of how people around the world consume news, has had a massive effect on the way media work. Journalists now use social me-

dia in their day-to-day hunt for great story ideas and expert sources to interview. Over the past decade, digital tools and mobile platforms have had a significant impact on journalistic practices and they are providing value as a media tool that can help reporters research story ideas. In light of these developments, now is the perfect time to revamp how clinics can generate publicity and elevate their profile with local, regional and national media outlets. Digital is the new print Up until very recently, brands relied mainly on print media to get their message out. That has changed considerably with the advent on digital media. Online is the new print, and it continues to be the most popular source for news. More and more people are getting their news from digital sources and on their mobile devices. Even de-

vout newspaper readers are increasingly consuming content on their smartphones and tablets. This represents a sea change in peoplesâ&#x20AC;&#x2122; consumption habits, and explains why many popular magazines and newspapers have shut down their print editions in favor of going online only. Many other magazines are staffing up their online outlets

body language I MEDIA 33

More and more people are getting their news from digital sources and on their mobile devices

and scaling down their print teams. The large majority of online outlets also have way higher circulations than traditional print publications. So if you are keen to get ink, donâ&#x20AC;&#x2122;t only focus on print media outreach. Online placements will optimise your web presence andboost your ranking on search engines. Online also offers a 24-

hour news cycle, so you can share breaking news without delay. Print outlets may have super long lead time; long lead glossy magazines may start working on their April or May issue by January 1. Print outlets also cannot deliver the instant gratification that consumers today demand. It can take months or even a year or more from the time

you relay your message, connect with a journalist, until the story appears in print. Another plus is that online content lasts forever and are easy to find and recycle, which is a big benefit to your media campaign. Managing your message in the virtual world is a critical part of this equation. A strong press re-

34 MEDIA I body language

lease outlining why the topic is significant or interesting is key. The most effective releases tie into current news, announce a new treatment, or share a key industry development. Press releases and pitches can attract the attention of bloggers who have tons of fans and followers. Getting the attention of top-tier bloggers with a huge social media presence can help to catapult your brand in a matter of clicks. The downside is that when a story goes live online, it is nearly impossible to recall. If a blogger or writer gets some facts wrong, you can possibly reach out to ask for a correction, but that may only be done at their discretion. They are

not under any obligation to revise their feature. So, give some thought about how your news item will be picked up and repackaged on social media before you send out a pitch to control your message. New rules for press releases The purpose of a press release is to get your story in front of as many people as possible. By posting a press release to a newswire service, it will be sent out to thousands of publications, and will get reposted on other outlets online. Newswire services will also distribute releases directly to social media channels, especially Twitter, for broader reach. The more journalists who

view your press release, the more likely it will be picked up by other publications. However, journalists literally get hundreds of press releases daily so it is getting harder and harder to stand out. Press releases are a lot less effective at actually generating media coverage now, especially in the era of social media. In fact, lots of press releases will be deleted before they ever get read, particularly if the release was not targeted to the right media at the right time, or if it is not well thought out or written badly. Before you contemplate sending out a release, ask yourself if the information you are planning to share is remotely newsworthy? For example, if you have surveys, clinical study results, or trend data to share with media that they can useâ&#x20AC;&#x201D;a new procedure, combination therapy, case studyâ&#x20AC;&#x201D;these make for good reading. Awards and milestones are fair game because they will elevate your clinicâ&#x20AC;&#x2122;s status and profile. Launching a new website or blog is definitely not of interest to media, so these cheesy SEO tactics should be abandoned. A great headline and wellcrafted lead paragraph are the most critical things to get right in your release. The opening paragraph should summarise your story succinctly and in a way that will generate interest. Include a sharp subject line if you are sending the release via email, and also visuals whenever possible. Visuals including logos, photos, and video clips can make your content more interesting and thus, more likely to get noticed. The good source A journalist who covers a regular beat, such as health, beauty, or lifestyle, will find himself talking to the same people on a fairly regular basis. Actively participating in conversations on various

66 If you have surveys, clinical study results or trend data to share with media, these make for good reading 99

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platforms is the new normal way to forge relationships with sources that they may not have otherwise come across. This especially helps when a journalist needs a source at the last minute. There will always be someone on Twitter or Facebook who will respond in record time to a query when a reporter is on deadline. Sources for stories almost always share the stories, and their audiences will often comment which can lead to new story ideas.Â In recent years, social media has notably impacted the direction and practice of journalism. While these platforms are not replacing the industry all together, they are adding another layer and providing access to a wider range of subjects and sources. Social media platforms have also changed how we store, publish, search and consume news.

The online universe continues to provide would-be bloggers and journalists with a platform to disseminate their messages, actively promote their work, develop their own online presence and engage with readers at a very personal level. To become a media darling, respecting deadlines is crucial. All writers and reporters are on tight deadlines and will come back to sources over and over again who respond in a timely manner and give them what they need. The preferred way editors want to reach their sources are: email, mobile phone or text, or through their PR. Nailing the interview Before taking an interview with the media, brush up on current events that may affect you, your community or aesthetic medicine

66 Respecting deadlines is crucialâ&#x20AC;&#x201D;all writers and reporters are on tight deadlines and will come back to sources over and over again who respond in a timely manner 99

in general. Check current news stories about trends, statistics, and any negative stories that may have surfaced. You can never be too prepared! A great sound bite can make the difference between getting media coverage and ending up by being cut from the story. Jot down a few key messages that you want to get across. Review them with your colleagues, staff, marketing manager or publicist. Come up with some memorable sound bites. Typically a sound bite is 10-15 seconds of video or audio time, which translates to about two or three short sentences in print or text. A sound bite should begin with a conclusion. Offer one or two brief points of explanation and support. Explain how the information will affect the viewer/reader, or what action you want them to take away from the sound bite or what you want them to think about. Convey your message with every answer. Think about what the writerâ&#x20AC;&#x2122;s readers would want to know. Ask yourself why the reporter should care, and why his readers, viewers or listeners will care. Guide your sound bites so they will

In recent years, social media has notably impacted the direction and practice of journalism. While these platforms are not replacing the industry all together, they are adding another layer

38 MEDIA I body language

Be genuine, friendly, timely and prepared to tell the truth and provide honest, factual commentary

catch the reader or listener’s attention. Incorporate phrases such as: "The most important issue here is that...,” or "We want to educate consumers to avoid that risk..." Be genuine, friendly, timely and prepared to tell the truth and provide honest, factual commentary. Never lie or fib to media or they will remember it and may never use you again. Listen and respond to the questions being asked. Use brief sentences and keep your answers on point. Don’t feel like you have to fill every void in the interview. Add anecdotes, a human element, new angles or news hooks to make the topic more interesting. Repeat yourself if necessary, or if you are not sure the interviewer understood what you are trying to say, especially when it comes to explaining anatomy or specifics about treatments. Don’t use medical jargon or technical terms. Show

them visuals instead of talking them through it. Today’s beauty writer may have been on the food or home décor desk last week. Use facts, anecdotes, data, statistics, and point to trends whenever possible. If you don’t have specific figures, emphasise your point more generally, such as “In my clinic, I have seen a 25% increase in men coming in for fillers in the past three years…” Perhaps the worst thing you can do is to get angry, defensive, dismissive or spew negative comments about colleagues or competitors. If you don’t like a question, give a brief answer only, and try to shift the focus to turn it into an opportunity to deliver your message the way you want to. For example, “I would rather talk about solutions instead of problems…” Do not say ‘no comment’ ever, as that can be misconstrued in myriad ways, and come back to bite you.

No member of the media is going to let you read the story before it goes to print, so it is better not to even ask them. At best, you may have an opportunity to check your comments or quotes. Far fewer long lead publications have a staff of researchers and fact checkers to confirm the validity of features. In fact, many do not even have sub editors or assistants on board due to budget cuts. Television programmes may have researchers to vet a story idea before it gets developed and ultimately filmed, but the local news producer is probably going to be working solo to get a story on air. The sad truth is that most media outlets today are operating on a skeleton crew, which is all the more reason to make their job easier if you want them to work with you. Lastly, keep in mind that anything you say can show up in print, or be blogged about or tweeted, so never say anything that may not be in your best interest to share. I have spent countless sleepless nights rethinking comments I have made and wishing I hadn’t said something. Even if you state up front that your comments are “off the record,” real reporters are not bound to abide by that request, even if you think you have a good relationship with the reporter. If you are in the position of being a source, media is not necessarily going to be your ally forever, so avoid getting too friendly—it can lead to missteps you may regret down the road. If you are serious about getting your name out there through consumer print and online media, and seeing your face on TV, consider hiring a professional, beauty-savvy, well connected publicist to guide you and help you stay out of trouble. They may just be worth their weight in gold. Wendy Lewis is President of Wendy Lewis & Co Ltd. a global marketing communications and social media boutique (wendylewisco.com) based in New York City, and the author of 11 books on cosmetic beauty and skin care, and Founder/Editor in Chief of Beautyinthebag.com. She has contributed to numerous publications, websites, journals and textbooks in the USA and Europe.

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Clinic management systems CHARLES SOUTHEY examines how clinic management systems can help to maximise the the productivity and profitability of a medical practice

irtually all of a clinician’s time is spent with their patients. So much of each day is spent ‘in the business’ that very little time remains to focus ‘on the business’. Often essential elements to the future success of a medical practice, such as marketing and strategy planning are left by the wayside, in the hope that they’ll either sort themselves out, or a win-

dow of opportunity will miraculously appear to solve them. Whilst it’s impossible to slow down time, I believe it is possible to make more efficient use of time, and allow technology to help out. One way doctors can make better use of technology to free up more time is to use a clinic management system (CMS). A CMS provides the tools to run

your practice more efficiently. It can help you to take patient notes and store them digitally (i.e. without the need for paper), manage patient contact details, coordinate practitioner diaries and appointments, provide a billing platform as well as providing critical commercial information and access to the metrics that inform, at a glance, how the clinic is doing as a business.

42 TECHNOLOGY I body language

aspects of the clinic that are not viable as they are can be re-thought or eliminated.

By using a system that stores and generates this information on request you can start to see trends and patterns

It’s important to be aware of your progress towards achieving your revenue goals, whether stock control is in hand, how many patients missed appointments and how profitable you are. Having information like that, that's easily accessible at any given moment is a process adopted by successful businesses and those without it should follow suit. It’s how you use your data that’s important Accessibility of your clinic data is key. Using the Cloud you can access your clinic information, your patient information and critical data, from anywhere at any time and from any device, quickly, easily and securely. It’s useful to examine the quality of the data you’re collecting, whether you’re collecting enough, or even any. For example, can you use your current system to generate treatment history and which products have been used on a particular patient? By using a system that stores and generates this information on request you can start to see trends and patterns.

Do you have the means to digitally capture and store before and after pictures to complement each patient history? Historically, to get this data may have meant ages getting reports together and using old records. Today this data needs to be quick to gather and easily accessible—and that’s entirely possible. This is the information which helps you grow the clinic. If you focus on aspects of the clinic which are working really well and discover the things that aren't, by working with that data, you can start to run your practice more efficiently and profitably. For example if a particular type of treatment is popular and the data you are collecting confirms this, you can then focus more attention on that. Likewise

Marketing Having marketing data is vital. Acting upon it is equally as important. Your CMS should offer a true and current reflection as to which marketing schemes are working well and which are not. It’s well known that half the money spent on advertising is wasted—but one can never be sure which half. You can spend a lot of time, effort and money on marketing, but you need to be sure of what is financially worthwhile. Your system needs to identify where your new patients have come from, for example a self-referral from your website or a referral. That information needs to be easily accessible and in front of you. With this information you can tailor your marketing strategy to your clinic. It’s worth considering whether your patients know the full extent of your services. If you're looking to increase the amount of treatments from existing patients, then they need to know what you offer. A process of increasing awareness of available treatments needs to be integrated into your CMS system. In fact everything from the marketing aspects, to e-mail, all needs to be integral to your CMS system so you can start to track your patients’ journey from start to finish. For patients to be able to book directly via your website is expected, especially in the facial aesthetics field. People want convenience, they want quick and easy options. Your system can have this functionality integrated. Patient delight Once you've worked really hard to attract patients and to build rela-

66 If you focus on aspects of the clinic which are working and discover the things that aren't, you can start to run your practice more efficiently 99

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tionships with them, you want to keep that relationship strong. Upto-date email marketing informing patients of clinic news and new treatments is an effective way of generating new bookings from current patients. Likewise allowing patients to feedback on their treatments can be a great way of tailoring your practice to patient needs. Your system could even incorporate a satisfaction metric such as net promoter score. This is an advocacy metric which asks your patients on a scale of one to ten how likely they are to recommend you and, if they're a nine or a ten, whether they would consider being an advocate of the practice.

things stand today, this week and this month in terms of revenue, cost and profitability, helps you plan for growth.

Financial insight Financial reports, tend to be created at month end, but you need to be able to assess your financial position on demand. Knowing how

Reports With a CMS reports are automated, and generated with very little effort on your part. A system that offers you the vital data and infor-

Integration It’s important to ensure your system is integrated. It’s possible to have lots of different systems that do all these different things, but really to have a proper workflow, you need to have a single system where everything works seamlessly together. Your system should be enjoyable and intuitive to use—from appointment through to invoicing to followup. It should be able to give you that data you really need.

mation you need on your practice saves time. Summary Ultimately you're a clinician, so you patient satisfaction and professionalism are the most crucial aspects of your business but a CMS system can help you grow your clinic as a business. If you invest in a really good management system that handles the business aspects of the practice, you will then be able to focus on patient care without the distraction of complicated administration. Charles Southey is Co-Founder of Digital Results, makers of Clinic Solutions, the refreshingly different Clinic Management System. He has been involved in the development of software for the past six years and has worked with dentists, doctors, lawyers, chemists and everything in between.

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body language I BUSINESS 47

Business building GARY CONROY looks at the power of branding in a clinical setting

ommunicating the value of the service you offer to your clients or patients is important—but it’s equally important to highlight what differentiates you from your local, or national competition in the medical aesthetics market. With consumer culture changing over the past ten years, medical aesthetic treatments have become much more acceptable. People are far more willing to discuss them openly and this rapidly growing market is now expanding from a

number of different avenues. Examining new initiatives by companies—such as Galderma collaborating with Sharon Stone recently—show that medical aesthetics are becoming a much more accepted option for people to look more attractive, stay younger, be more competitive, and more successful in life. So there are many more patients moving into the market. Alongside a great number of treatment options, patients can undergo multiple treatments to achieve the results they want, or

opt for less invasive or more invasive treatment options. There are also a plethora of different price points that patients can now access, meaning patients of all levels of affluence can now access some form of medical aesthetic treatments. Increasing competition 10 or 12 years ago, few practitioners were advertising medical aesthetics in the UK. However, as the growth of events like the FACE Conference are testament to, we’ve seen a huge growth in the number of practitioners who offer treatment.

48 BUSINESS I body language

66 Branding is far more than just a logo or a trademark and developing a brand really does carry value in a service-based clinical environment 99 The promotional activity directed to patients to recruit them and educate them has also increased. This is driving growth of the market, but it’s also driving competition in the market. We are now in a competitive world of pop up clinics and people advertising on price reductions. When the price falls and margins fall, everybody starts competing. To be successful, it’s important to know how to become separate from this downward spiral where market prices are being cut but the service isn’t necessarily increasing. Differentiation beyond price point A clinic with 100 patients this year will be able to keep somewhere be-

tween 70 and 90 of those patients into next year as this competition continues to grow. The market is growing at an estimated 7.5% per year, so unless your clinic is doing something different, the number of patients will slowly be eroded as new clinics open up within your area. Certainly this will be the case if you behave like they do—just on a price point. Understand how patients differentiate Search for a wrinkle treatment clinic using Google and then try to differentiate the results—it isn’t easy. Clinics seem to differentiate on price and often on free consultation, or by showing off about their Harley Street location, but what

Patients want is to know you can identify what their problem is and find a solution to their problem. If you can start to think from a patient’s perspective as opposed to your own, you’re on the right path to differentiating yourself within a very crowded market space. Branding Branding is far more than just a logo or a trademark and developing a brand really does carry value in a service-based clinical environment. There is value not only in recruiting patients or retaining current patients, but as your business evolves and as the market evolves, a brand can ensure that your business becomes more viable and more secure. Brands have come along way since the beginning of the last century in the USA where a brand was essentially a mark applied to something that people could affirm ownership. As we moved into the 1950s and ‘60s, brands took on a much greater tangible value and started to become a hallmark of quality and brand value. If you start

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HOW TO START DEVELOPING AN EXTERNAL SERVICE PROPOSITION Identify your customer base Consider some of the key characteristics of your customers, for example: are they male or are they female? What age are they? What is the social economics? What schools do the kids go to? What dentists do they attend for dental treatment? Where do they live? Who influences them in the media? What are the problems they have? How do they compete with their friends? All of those elements need to be identified. Carry out customer satisfaction surveys Very few people do focus groups with patients and try and understand what the patients need. Even fewer people do focus groups with their target patients—the people who they believe might become future clients of theirs. Qualitative research will allow for a deeper understanding of what your patients’ needs are.

the workplace coming up who they have to compete with. People who are just divorced may want to attract a new boyfriend. What not to do: Promises not products Don’t talk about products rather than promises to people. Patients don’t want smarter lipo, they want a slimmer waist; and they want a slimmer waist because they want to be more attractive, or they want better jobs, or they want to fit into a size ten. Understanding that becomes much more communicative to the patient and their needs. Don’t ask friends or family what they think of your adverts Ask your patients for their feedback on your marketing. Try and find some loyal patients who feel comfortable enough to give you critical feedback or whatever feedback it might be. And if you understand their needs, you’re more likely to get closer to them.

Unless patients’ needs are understood, we can’t really represent a solution to their problem. This is where clinics end up stuck trying to gain customers through promoting a £99 treatment, a Harley Street physician or the latest technology that really isn’t what the patients are after. In reality patients care about results—they want to be more beautiful or more successful.

Don’t compete on price Cutting your price because the clinic next door does is likely to only result in you ending up having disloyal patients, who keep looking around to get the cheapest possible treatment available.

Meet patient needs Identifying and meeting patient needs should be the foundation of your business plan. All your efforts should be around those people with those problems and that’s your external service proposition. Identify what your target audience is after and pitch to that. People in their fifties know that there are younger people in

Keeping your prices as competitive as you can, but keeping your promise high and delivering on your promise means that people will be too afraid to go elsewhere. Patients who really want to look good and are happy with what you’re delivering aren’t going to risk a bad job for the sake of saving £150. That fear, means that your brand becomes much more valuable for them.

applying that mentality to medical aesthetics, a hallmark means that people are getting a good quality of treatment, that you understand their needs and you can give solutions and really care about what their outcomes are going to be. Bearing this in mind your brand will suddenly become something that they trust and can rely on and it will carry a lot of value. The current interpretation of branding has moved on forward. Today branding really is the junction between making a promise to your clients, how you can deliver that, meet their expectation and

then grow your brand. Why do we buy Starbucks coffee rather than a cheaper cup? Starbucks promise us that we’re going to get a half-decent cup of coffee, in a nice environment, with a friendly member of staff. They aren’t just offering coffee, they’re saying—we know you need a break, you need time out your life—why not come here and charge your phone, catch up with your emails and have a nice cup of coffee while you’re doing it? So actually their promise to you is very different from the café on the street that’s selling the 99p coffee.

The 99p coffee is like your £99 pop up toxins clinic. External service proposition If your promise meets expectation, your brand suddenly takes on additional value. One problem with the information that clients get from google searches is that nobody is telling anybody that they understand their problem and they’re certainly not giving them a solution. Clinics are taking an industry perspective as opposed to a patient’s perspective on what might be worrying patients—caught up

52 BUSINESS I body language

At the most basic level of building your brand everybody in the clinic needs to understand what it is you’re trying to do to meet your customers’ needs

in concerns over unqualified practitioners, safety, costs. Whereas our patients actually want different things and have different problems. Understanding what the patient’s problems are allows you then to develop your skill set to say, this is how I can help those patients achieve what it is they’re after. Your external service proposition is the promise that you understand your patient’s concerns and their needs and how you communicate how you’re going to meet those expectations or needs, and then what you actually do within the clinic in order to do that. A strong visual identity or logo is important but it’s also vital to recognise that the logo is only one part of your external service proposition. It may be a stamp of authority, but the rest of your brand is much deeper. Creating customer loyalty The service-profit chain is Harvard Business School’s basis on how to build a sustainable business. Profit

and growth are stimulated primarily by customer loyalty—so how do we get to a point of customer loyalty through the element of developing a brand? Starting within is key. Every single aspect of your business must focus on the customers’ needs. Does the receptionist understand what the customers’ needs are? Does the person who answers the phone understand what they think? Does every single piece of literature within your clinic communicate to the patient about what their needs are and how you’re going to solve them? Is everybody’s raison d'être for their job to be there to satisfy the customer’s needs and deliver those solutions? At the most basic level of building your brand everybody in the clinic needs to understand what it is you’re trying to do to meet your customers’ needs. Every part of your business plan is aimed at meeting your customers’ needs as opposed to selling your services.

So it’s really customer needs first. Once you’ve got the internal structure, you can then start to develop your external service value and communicate that to your patients. And that becomes your promise. When you start to meet that promise with the current clients you have, you’ll get customer satisfaction. When expectation meets promise, then you’ve got a brand. The minute you’ve got a brand, you’ve got customer loyalty. And the minute you’ve got customer loyalty, you’ve got renewable revenue and growth because you’ve got referral. Loyal customers are going to do all the advertising and promotional work for you because they’re going to recommend your clinic, because you understand their needs, care about what they want and fix problems. Move with the market Once your brand is established if you can build that brand to promise people a solution to something that they’re concerned about and you can deliver that solution, they’ll be quite happy to buy that brand again for future treatments, wellbeing or anything they might need as things change. The message here is it’s worth developing your brand, it’s worth looking at your external service proposition, understanding your patient better, understanding their needs and building your brand around that, not around you. Gary Conroy is the co-founder and director of Five Squirrels. He’s got over 12 years’ experience in the aesthetics industry, having previously been head of medical aesthetics at Sanofi-Aventis and laterally sales and marketing director at Ambicare Health. Gary has extensive knowledge of market research, consumer behaviour and strategic marketing planning. With 5 Squirrels he hopes to support clinic owners to realise the power of their own brands and offer some protection to the many customers he has worked with over the years from online erosion of their client base by mainstream skincare brands with the companies mantra: build your own brand, not someone else’s.

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body language I PRODUCTS 55

on the market The latest anti-ageing and medical aesthetic products and services  REFORM SKINCARE Advanced Esthetics Solutions have announced the launch of REFORM Skincare, a new cosmeceutical brand formulated to treat and look after each of the skin's essential needs. W: reformskincare.co.uk

 EFFACLAR DUO [+] Effaclar DUO [+] is the winner of the Latest in Beauty, CEW and Stylist awards in 2015 and combines effective ingredients, recommended and used by dermatologists for the treatment of acne-prone skin. W: laroche-posay.co.uk

 TEOXANE R E [CO V E R] CO M PLEXION SPF50, is a premium hybrid moisturising skincare and make-up product which is suitable for postprocedure, irritated or sensitised skin. W: teoxane.com

 HYDRAFACIAL H ydra Facial — the non-invasive skin renewal and hydrad ermabrasion treatment—has announced that Karren Brady CBE, is their new face and brand ambassador for 2016. W: hydrafacial.co.uk

 MELAMIN-C Melamin-C Skin Bleaching & Correcting Crème has been created to help even skin tone by inhibiting melanin production—it contains 4% hydroquinone. W: zo-skinhealth. co.uk

 VIVEVE The Viveve System is a new patented monopolar radiofrequency device with a controlled cooling system, which has been purpose built for gynaecological applications. It is intended for the functional improvement of vaginal tissue in order to renew sexual sensation and satisfaction. W: viveve.com

 BABOR AGE ID BABOR have released their first make-up range, in collaboration with make-up artist Peter Schmidinger. The range has been developed using anti-ageing active ingredients, and will conceal minor flaws. It is said to provide instant lifting effects and is available in a range of flexible shades. W: babor.co.uk

 FRAX 1550 Frax 1550 is a new and unique fractional non-ablative laser. It has been developed for nonablative skin resurfacing including texture, fine lines and wrinkles, and also to treat stretch marks, acne scars and surgical scars. W: ellipse.com

body language I EQUIPMENT 57

Tattoo removal DR KLAUS HOFFMANN talks about picosecond laser treatment of European tattoos

n the early days of tattoo removal, lasers were used which more or less cooked the pigment with thermal action and often left scarring. These procedures mainly involved the use of Alexandrite laser 755 nm and Nd:YAG lasers 1064 and 532. They worked beautifully for black, and also for some dark colours, but not so well for the other colours. In 2012 about ten treatments were needed to remove at least 58% of black tattoos and 15-20 treatments was the norm. The need for greater effectiveness and speed has pushed things forward and with the new technologies such as Q switched laser it’s now possible to give a reduced number of sessions and get better results with a wider range of colours—so patients may be paying higher prices per session for new technology, but they get more effective and faster results. Q Switched A Q-switched laser uses flashlamps to pump energy in a special laser medium. By using two mirrors the energy is captured in a tube and is released in one big pulse with extremely high peak power. Q-switched lasers can used to remove tattoos by shattering tattoo pigment into particles that are cleared by the body's lymphatic system. In 2013 the picosecond laser was introduced which showed better results with colours such as green and light blue which had until then been more difficult to remove.

Picosure Newer lasers using picosecond technology like Picosure claim better clearance with fewer treatments and less fluence without injuring the surrounding skin. This means the skin isn’t cooked and it’s less likely to cause scars and eodoma—

66 A picosecond is one trillionth, or one millionth of one millionth of a second 99

since it penetrates less deep—so removal is easier. The Picosure in burst modus can go down to 550 picoseconds. This powerful device also offers the option to change the hertz, the delivery rate, the size of the spot and also the joules per square cm. A zoom hand-piece allows the focus and energy to be changed. Meanwhile, there’s an additional hand-piece available which delivers 532nm, which is an additional laser pumped by the 755nm device—so essentially a picosecond laser, on

58 EQUIPMENT I body language

the colour a little bit lighter—so this must be removed as well as the colour.

HE Stained light microscopy. Top: Shows different sides of Pigment particle. Bottom: illustrates what the 100µm coagulation zone and the bubble in the upper right corner

a picosecond laser. The previous weaknesses of the 755nm in some of the red tattoos is covered now by this 532nm hand piece. Technology continues to evolve, and by the end of 2016 a new system will be available that adds 670nm (Ruby) with full picosecond versatility also. Inks The tattoo artist does not have a single needle, he has different needles and can use several at the same time. He can work very deeply, or very superficially. Even after seeing hundreds of tattoos its still impossible to know exactly how much ink has been used, how deep it sits, or to know how each patient will react to the tattoo ink. Single tattoo ink particles aggregate and then agglomerate together within the skin. There are different particle sizes in different depths and often in different inks. Black ink is standard carbon. The inorganic pigments that are also used for red, yellow and orange are a little more complicated. Within an ink there are binders, pigments, solvents and additives. Normally, only the inorganic pigments, this 32% that makes the colour, are spoken about. However, there are many other things surrounding these inorganic pigments such as titanium and silica. For example, in a red tattoo the red molecule is between the silica—used to make

Removal The system for tattoo removal works on melanin. Melanin does the same as the colours in the depth and forms three-dimensional crystal structures. The situation is the same as for black ink—the structure can be diminished, by physical forces, by the photo acoustic effect. Once it has been hit and broken off, then the body is able to remove the structures. Melanin absorbs 755nm beautifully and there is then an avalanche process within the melanin as the melanin molecules form aggregates like a crystal – this explains why

the photoacoustic pressure wave can smash them. In addition, the plasma formed by the pulse has several biological effects due to increased biosignal from cytokines and several other pathways. The pulse duration of Picosure is extremely short, extremely powerful and far superior to older systems. Compared to the Accolade, it’s 90 times better and the peak power is an extreme 360 MW— enough to eliminate for several picoseconds. Using a long pulse laser and overheating the pigment in the depth, will cause damage and the patient has to face side effects. The effects of picolaser are the same as from dye lasers—the dye laser blows the vessel. With pico-

body language I EQUIPMENT 59

second, structures are blown by photo acoustic effects, rather than mechanical effects, and a shorter pulse will hit smaller particles. At least three companies have come to the conclusion that 700 picoseconds is the time duration of choice. It makes no sense to go deeper, because at greater depth and with more power a so-called plasma threshold is reached. The plasma that is formed within the skin and over the skin blocks the in-depth penetration of the photons and makes it impossible to penetrate. Photo acoustic effect The photo acoustic effect involves heating up the surface of a structure, in an extremely short pe-

Much of the tattoo treatment industry’s focus today is not merely the removal of something—at least 50% is cover up. A survey carried out in Germany with data comparable to other European countries, found that 10% of the 7 million person German population is tattooed. Of those aged 20-30 it’s 30%, and from age 30-35 it’s at least 25%. Within Germany, 10% of those tattooed are looking for removal or cover up per year—a market of about 700,000 patients per year.

In the black on the dome from the dragon, some yellow remains, and because this was tattooed over three or four times you also see some scarring that was caused by the tattoo artist

riod of time, with extremely high energy. This causes the particles to expand, hit together and then break apart. Particle fragmentation is linearly dependent on the laser fluence and quadratically dependent on the pulse duration. To remove very tiny particles requires a shorter pulse duration. The Picosure Boost can go down to 550 picoseconds, allowing removal of very tiny particles, under the size of 40 nm. In theory this can have impact on red and some effect with yellow. Yellow is harder to move than other colours. When comparing 6% pigments in black and 26% pigments in yellow—there are lots of extremely tiny particles which are harder to remove than with other colours. Bigger particles are blown to dust and this dust is taken by macrophages in the lymph. When it comes to removing yellow, the Picosure now can solve the problem with the 532. It takes several days for the aggregates in the depths to really form, so trying to remove a tattoo immediately after application will be very effective. Sometimes I’m asked to remove tattoos that people regret after a couple of days and am extremely successful. Often when a tattoo is in the lumbar region a lot of ink, has penetrated very deep, in several layers of the skin, and very high energies are needed to get it out. It’s often best to work stage by stage here and we accept some blistering. Removing a tattoo that has

been covered up two or three times, means you have a lot of ink to face and it’s harder to remove. Summary Picosecond can hit black tattoos 3-5 times faster than it was possible in the past. Melanin is hit best by 755—it can be removed effectively and does not require treatment with laser or heat within the skin The picosecond technology is a completely new world. It will be something the adds new possibilities not only for tattoo removal but for skin rejuvenation and treatment of different hyperpigmentations as well. Dr Hoffmann is head of the German Laser Center ZELM-NRW supported by the local government with about 21 different lasers plus three IPL’s including both new picosecond lasers. He is organiser of the congress www.cosmedica.de, the largest German congress with live surgery, plenary sessions as well as workshops. He has experience in about 100 clinical trials since 1987. He is honorary president of the International Society for Bioengineering and Imaging of the skin. He has introduced high frequency ultrasound and several other noninvasive measuring techniques to dermatology. Reference 1. http://aktuell.ruhr-uni-bochum.de/mam/content/tattoostudie.pdf

body language I ANTI-AGEING 61

Dendritic cells DR STEFAN LIPP discusses the role of dendritic cells in preventative and anti-ageing medicine

endritic cells (DCs) were first described in the skin in 1868 and take their name from their dendritic shape and the Greek word dendronâ&#x20AC;&#x201D;meaning tree. The use of DCs in medicine started in the late 1980s, with the discovery of new technologies for collection and administration of blood cells and subsets. The first clinical studies with DCs were in four patients with follicular lymphoma, performed at Stanford University. The function of dendritic cells is to teach the T lymphocytes what to do in the body, what to find, and what to eliminate. A seminal event in dendritic cells was the approval of the therapy for prostate cancer by the FDA in 2010. In 2011 Professor Steinman who was leading the research into dendritic cells at Stanford, was the first person to ever receive the Nobel Prize post-mortem. He died

in the year he was awarded for his work on dendritic cells, having survived cancer for five years with dendritic cell therapy. DC vaccination The dendritic cells are the professional antigen-presenting cells of the human system. The DC vaccination strategy usually requires that DC precursor cells are collected from the patient and then differentiated into DCs in vitro in the laboratory. Subsequently these ex-vivo-generated DCs are loaded with tumour-associated antigens, or TAAs and reinjected into the patient. The basis of the DC therapy is basically in the cancer therapy. DCs for cancer There are more than 200 clinical trials going on using different kinds of DCs in different kinds of cancers. Three types of DCs are used in clinical studies: the monocyte-

derived DCs, the stem cell-derived DCs, and the DCs which are directly obtained from the blood by leukopheresis. Each type of DC has its own characteristics and the impact of the DC on the final outcome of the therapy is still being explored. Most studies carried out to date make use of autologous DCs derived from monocytes. And in all published studies, DC vaccination has been well tolerated throughout the different clinical trials, across all variations and treatment protocols, with only minor or mild side effects usually occurring for one or two days. I have also had DC vaccination myself and I had no side effects. What happens in the laboratory? In the laboratory, DCs are isolated, then matured and presented to parts of the tumour, or tumour cells that can be found in the blood of the particular patients, by autologous transplantation. During

62 ANTI-AGEING I body language

this processing the DCs will carry out lymphocyte priming. The DCs learn about this particular tumour, carry out an antigen processing, then present this antigen to the T lymphocytes—the so-called killer cells. Cancer cells sometimes mask themselves and the DCs cannot identify them, but young, fresh DCs that are generated in a laboratory can identify these particular cancer cells. The antigen will be given to the patient as a vaccination, which can teach the patient’s lymphocytes about this particular cancer. Lymphocytes can circulate in the lymphatic system and in the blood system and can develop many different activities which are yet unknown. Laboratory process The laboratory of Ad Lentus GmbH in Germany takes about 200ml of full blood directly from the patients. Other laboratories use leukapheresis to collect the mono DC cells from the blood, but the Germans in this laboratory think that is harmful, so they collect from the patients, then they work on it in the lab. Next they centrifuge it. After a few days the lab has young, fresh dendritic cells that are not harmed by the cancer. These young dendritic cells are then later injected into the patients, with vaccination syringes that can contain ten or maybe even 12 million young, fresh dendritic cells. That is the key that brings us to preventive and anti-ageing medicine. Maturation protocols Dendritic cells can be primed to different kinds of cancers. They can be taught in the laboratory to attack different kinds of cancers based on what the patient has. All these loading possibilities are in research at the lab and we are starting to look into a new option of using this for anti-ageing medicine. For proper production, the disease needs to be capable of producing immunostimulatory cytokines and costimulatory molecules, in parallel with the antigen presentation. It will take seven days in the laboratory to mature the dendritic cells, the precursor cells later becoming fresh dendritic cells, which will then be

presented to different antigens to teach them what to do in the body. The clinical impact of DC vaccination also relies on the maturation status of the DCs, so different maturation protocols are used. The best results are seen with the mature DCs. DCs have been given intravenously, intradermally, and subcutaneously as an anti-ageing strategy. Weekly, biweekly, and monthly vaccinations have all been reported and further investigation via the Internet will reveal very different treatment protocols. Injection process Upon injection into the patients, the DCs migrate to the secondary lymphoid organs, where they come in contact with T lymphocytes. As a result of this complex cellular meeting, cytotoxic T lymphocytes specific for the tumour antigens are introduced by the DCs. Then these specific CTLs migrate all throughout the body, lymphatic, and blood system and create a wide variety of anti-ageing aspects. Outcomes More than a thousand patients have been treated in different clinics that the laboratory I work in serves—so we have experience with more than 1,000 injections all through Europe. In all cases, T cellular response could be evoked alongside an increase in cytotoxic lymphocytes. We have a high proportion of patients with stable DCs in combination with chemotherapy or with surgery or with both. In all injections we saw an improvement overall and we had an increase in cytotoxic lymphocytes. The uprise of the immune system is really visible, activities get much better, mobilisation is faster, and time in clinic is shorter. The future Stanford University—a key player in the DC field—is talking about DCs as the cancer vaccination of the future. This is an area that requires much more research and there are currently phase-three trials going on in Dresden with very promising data. The FDA itself also calls dendritic cells a cancer vaccination. Harvard is looking in the same

66 DCs have been given intravenously, intradermally, and subcutaneously as an anti-ageing strategy 99 direction and as we know, a cancer vaccination would mean perfect anti-ageing and preventive medicine. The effect of 10 million fresh, young DCs working in your body for preventive and anti-ageing medicine is profound. Although the FDA is calling DCs a cancer vaccine, the effect for anti-ageing is obvious. Stanford University are at the head of the trials and the clinical investigations going on, so I’m sure after the prostate approval of the FDA for DCs there will be others. Results coming from current studies are very promising and it is my hope that we can push together in the right direction and see what we can do for our patients in terms of anti-ageing and preventive medicine. Dr Stefan Lipp Ph.D. became a fellow doctor in the General Medicine Department at Goethe University in Frankfurt am Main and assistant physician in Germany, USA and Italy before shifting his focus to aesthetic medicine in the year 2000. Since then, Dr Lipp continues to develop his interest in minimum invasive aesthetics and share his expertise with other doctors through lectures for various world-renowned institutions. He developed strong interest in autologous cell therapies and serves as medical advisor in a leading laboratory for dendritic cells and stem cells in Germany. He is a fellow doctor in the Teacher Team at Teoxane Germany in Freising. At present, Dr. Lipp is Executive Director and CMO of Aesthetic Center Gmbh & Co KG and a Member of International Society of Aesthetic Medicine EV. Reference 1. Improvements in observed and relative survival in follicular grade 1-2 lymphoma during 4 decades: the Stanford University experience. Blood. 2013 Aug 8; 122(6):981-7.Epub 2013 Jun 18.

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

body language I MEDICAL AESTHETICS 65

Chitosan for anti-ageing DR ALEXANDRE GUERRY explains a new anti-ageing approach from BIOXIS, which is based on using natural and biodegradable chitosan polymers

IOXIS Pharmaceuticals have used their expertise in regenerative medical devices and research and development of chitosan medical devices for the aesthetic field, to create the Monophasic Tissular Inductor—the first injectable medical device based on chitosan. This industry first Monophasic Tissular Inductor is based on an injectable chitosan matrix: MTI12. Uniquely formulated with a chitosan matrix for regenerating collagen while repairing soft-tissue, this technology aims to change the way doctors are repairing soft tissue ageing. Liquid-to-gel delivery mechanism MTI-12 technology is formulated from a chitosan derivative, which is a liquid solution until it enters the skin. In solution, chains of chitosan are flexible and mobile. After injection, the physiological media trigger to the chains’ organisation into a chitosan network and after several minutes the solution turns into gel due to pH change. Unlike chitosan solution, chitosan matrix exhibits mechanical properties such as elasticity and a strong non covalent hydrogen bond, in which no crosslinked toxic agent is needed. This allows more flexibility in term of shaping and modelling before complete gelification. Thinner needles can be used, making injection easy and painless, and precision high. Post-injection, the doctor has three to five min-

utes—before the filler becomes a gel—in which to sculpt and adapt the dermal filler at the area of injection for a perfect result. Controlled collagen stimulation MTI-12 technology induces a controlled generation of neo-tissues. Over time, the chitosan implant degrades naturally and is replaced by more complex neo conjunctive

tissue, including vascular tissue. The degradation is due to natural hydrolysis, mechanical stress, scavenger properties, and slow degradation by a non specific enzyme. MTI-12 regeneration process The technology induced tissues are naturally textured and uniformly sustained, without loss of volume between the resorption of the implant and the creation of the neo-

After injection the solution turns into gel due to a pH change

66 MEDICAL AESTHETICS I body language

tissues (Estimation based on in vivo pig model). Examination of histology images shows how injection of MTI12 technology triggers a controlled regeneration of tissues such as collagen and vascular tissue, at the interface between the implant and the host tissues. The neo-tissues stimulation is based on the presence of inflammatory cells. The interaction between chitosan and macrophage establishes a favourable environment for the formation of collagen and the resorption kinetic of chitosan allows the maturation of tissues. The generated tissue is more closed than classic scar tissues. With time, the chitosan implant is progressively replaced by matured tissues. Seven days after injection, the regenerative response is largely initiated and the first collagen fibres are synthesised by fibroblasts around the implant and start to invade it. After 12 weeks, the implant is still intact in large areas, but has been degraded at the surface by anti-inflammatory macrophage. The chitosan implant is separated from the cutaneous muscle by a thin collagen band. Alongside the formation of these neo conjunctive tissues, neovascularisation is at work—new functional vessels were founded in vivo studies. From this pig model study we can conclude that since the chitosan hydrogel has mostly disappeared by 12 weeks, the observed volume effect is mostly the result of neo-tissue synthesis. Evidence exists that shows that during its degradation process, the fragments are phagocytised by macrophage and/or polynuclear cells, implying a chitosan bioresorption at cellular level.

collagen than that induced by PPF fillers, or during skin reconstruction after a skin accident such as burns. Currently, BIOXIS owns three patents on its chitosan technology and is undertaking the CE marking of its MTI-12 dermal filler product with commercial launch planned for 2017. After the CE mark is granted in 2017, some longer term human clinical studies will be undertaken to determine more precisely the long-lasting effects of the ‘biological’ filling of MTI-12 injectable implant. Based on the superiority of MTI-12 technology observed in the comparative study with PPF’s and HA fillers, this time may be estimated to be between 14 and 18 months (Estimation based on in vivo studies).

Long lasting effect BIOXIS Pharmaceuticals has undertaken comparative studies, which demonstrate a clear advantage over leading “volume-effect” products in terms of neo-tissue induced. In rats, MTI-12 monophasic technology was found to have stimulated 25% more collagen growth than its nearest rival. This collagen is also closer to natural

Chitosan MTI-12 technology is based on BIOXIS Pharmaceuticals expertise in chitosan, a natural polysaccharide derived from chitin, found in fungus, insects and shellfish. Chitosan is composed by long chain of glucosamine: a natural residue already found in human body. Contrary to over formulation based on polysaccharide (hya-

Safety MTI-12 technology is the first particle-free monophasic tissular inductor. The absence of particles is an important benefit for doctors and patients as it could significantly lower the number of adverse side effects, such as granulomas and nodules that can develop under the skin. Moreover the polysaccharide nature of chitosan allows its complete degradation and natural metabolisation. The security of MTI-12 has been tested in five in vivo studies. In addition, an in vitro cytotoxicity test conducted according to the ISO 10 993-5:2009 directive demonstrated that chitosan is biocompatible and does not induce specific toxicity in direct contact. This technology also has all naturally occurring advantages of chitosan including a biodegraded and bioresorbed matrix, antibacterial and hypoallergenic characteristics.

66 MTI-12 technology is the first particle-free monophasic tissular inductor 99 luronic acid, CMC…), the human body does not produce specific degradation enzymes against chitosan. This characteristic permits to chitosan to be formulated without toxic crosslinked agents. Chitosan is already used in agricultural, industrial, cosmetic and medical device industries. Because it is biocompatible, biodegradable, non-toxic and antimicrobial, it is an attractive biomaterial for tissue engineering. In the health sector, several chitosan-based tissue regenerating scaffold devices are already available in the market for cartilage regeneration or hemostatic dressing. Bioxis are a Lyon based company who work in cooperation with the French National Center of Scientific Research (CNRS), the Lyon 1 University and the National Institute of Applied Science (INSA). The company have been supported by major organisations of the French biotech ecosystem, such as BPI France, Medicen (healthcare cluster of the Paris region), Ministry of Foreign affairs (COOPOL), LyonBiopole (healthcare cluster of the Lyon) & I-Care (healthcare technology cluster of Rhône-Alpes region). References 1. A review of chitin and chitosan applications, By: Kumar, MNVR, Reactive & Functional Polymers Volume: 46 Issue: 1 Pages: 1-27 Published: Nov 2000 2. BIOXIS Pharmaceuticals study : Pig model—3 months, 2014 3. BIOXIS pharmaceutical study: Rat model—3 months, 2013 4. Evaluation of the biocompatibility of a chitosan scaffold in mice, By: VandeVord, PJ; Matthew, HWT; DeSilva, SP; Mayton, L ; Wu, B; Wooley, PH, Journal of Biomedical Materials Research Volume: 59 Issue: 3 Pages: 585-590 5. There are over 2 000 source related deviations. 6. Chitin and chitosan: Properties and applications, By: Rinaudo, Marguerite, Progress in Polymer Science Volume: 31 Issue: 7 Pages: 603-632 Published: JUL 2006

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Adverse incidents should be reported. Reporting forms & information can be found at www.mhra.gov.uk/yellowcard. Adverse incidents should also be reported to Merz Pharma UK Ltd by email to ukdrugsafety@merz.com or on +44 (0) 333 200 4143.

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Contact Merz Aesthetics NOW and ask for Belotero Tel: +44 (0) 333 200 4140 Email: customerservices@merz.com 1. BEL-DOF-003 V2 Belotero® technology, June 2015. 2. Tran C et al. in vivo bio-integration of three Hyaluronic Acid fillers in human skin: a histological study. Dermatology DOI: 10.1159/000354384.