The Consulting Room™ Industry Magazine Edition 119, April 2013

[COVER]

From The Editor's Desk Welcome to The Consulting Room™ Industry Magazine For April 2013 Oh Keogh...where are you?? It seems that there is a delay as the much anticipated Keogh report did not arrive by the end of March 2013 as promised.

However, this may not be a bad thing, and may simply reflect the overwhelming levels of evidence and opinion submitted to the panel by the various stakeholders and industry participants consulted throughout the process. As well as announcing the delay, the panel did release a ‘leak’ of one recommendation likely for cosmetic injectables, more on this in our Legislation Section, along with CEN news.

Our Feature Article for this April edition of the Member Magazine looks at the dos and don’ts of advertising standards compliance with some tips to help you get it right.

We congratulate one of our advisors, Marea Brennan Thorns who won an Aesthetic Nurse of the Year Award and report on recent ASAPS cosmetic procedure statistics in our Latest News.

Lorna Jackson

Our Business Corner takes a detailed look at the recent European Court of Justice’s decision on aesthetic VAT exemptions and how this may be interpreted by HMRC in the UK. As always the magazine is packed with our Business Corner, New Product Reviews, Clinical Information, ASA Adjudications and Interesting News Articles and Blogs That You May Have Missed.

DOH Changes Website But Fails to Redirect All Links!

On 26th March 2013, The Department of Health website was integrated into the GOV.UK website which replaced the previous DirectGov site. The site is designed to make everything “simpler, cleaner and faster” but many links to past DOH reports (related to the Keogh process and PIP breast implants for example) and other useful info pages have ceased to work as the designers have not thought to redirect them! Many of you may already have seen me ranting...I mean bringing this oversight to the attention of the team at the DOH via Twitter as it makes a mockery of public education if they move links to important content without so much as a backwards glance.

We have updated The Consulting Room™ for all known references within our Blog and Treatment FAQ pages mostly, however if you find any other broken links, please do let us know so we can update them with the new locations (if we can find them!)

Additionally, if you have links to the DOH on your own website, it would be advisable to check if they still work or need updating as many have simply been left with a ‘page not found’ result as the site has been replaced. The new home for the DOH is here: www.gov.uk/government/organisations/department-of-health

Client Referral Emails – Key Points to Note Many of you will be in receipt of new client referral emails generated by our site on a weekly basis. We hope that you are actioning these as promptly as possible to turn them into appointment bookings and ultimately paying customers. One way to increase your chance of referrals is to review the content in your profile and update if required.

Here are just a few pointers to help you understand the generation of the referral emails and how to use them.

1) Referral emails are generated by a site visitor performing a search of our clinic directory to locate a provider either by town, treatment or product alone or a combination of town and treatment/product or using our name searches for clinics and practitioners.

On finding a clinic profile they like they then complete the email contact form, at which point they can also choose to get comparative quotes from other clinics in the surrounding area or just from the clinic they have chosen.

2) We have no control over what people type into the message box in terms of the information that they are seeking so you may get erroneous requests for information on treatments/products which you don’t provide simply due to the individual looking solely at clinics on a geographical basis rather than service provision. By all means just ignore these. Where we see cases of spamming, such as sales contacts, recruitment or offensive behaviour we do investigate. We are more than happy to look into any such cases if you wish to bring them to our attention. We have measures in place to avoid automated spamming.

3) It is important to note that the emails generated directly to you are automated emails from The Consulting Room so please DO NOT REPLY directly to them in response to the enquiry, but instead use the email address listed within it to contact the potential client direct regarding their request.

4) To make sure that you don’t miss any referrals, please make sure that the email address that we hold for you is correct and that your email system permits emails from admin@consultingroom.com so they are not treated as spam by your email client/server.

If you have any questions about the referral emails you are getting, please feel free to contact admin@consultingroom.com.

New Addition To The Team!

We are delighted to announce that Consulting Room Director, Martyn Roe is the proud father of a bouncing baby girl! His daughter, Alara Roe was born to Martyn and his wife Banu in the early hours of Monday 18th March, weighing 7lbs 4oz, just hours after St Patrick’s Day, much to Martyn’s disappointment for future pub trips!

To the delight of all in the company Martyn has swapped his iPhone and briefcase for a nappy bag and late night feeds and delights us all with tales of his progress on Facebook. The Consulting Room™ Team would like to congratulate them both and request that Alara continues to test Martyn’s patience with nappy changes!

Anyone wishing to pass on words of wisdom or congratulations can email martyn@consultingroom.com.

Some Recent Blogs You May Have Missed Dental Hygienists & Therapists : Should they also be offering Botox to the public?

By Lorna Jackson Working within the Aesthetic industry for a decade now there has been one debate which rumbles on and on; just who should be permitted, both legally and ethically, to administer botulinum toxin brands, such as Botox® to the general public? In the past we have looked at various healthcare and non-medical specialities entering this lucrative marketplace with the help of training course companies and medical indemnity insurers facilitating their business models, including Beauty Therapists and Podiatrists, and now the latest rise in involvement seems to be from Dental Hygienists and Dental Therapists. www.consultingroom.com/blog/363

Free Cosmetic Surgery Consultations or No Free Consultations?

By Mr Jonathan Staiano It is a question that has divided plastic surgeons. Should we offer free consultations or not? The arguments for free consultations...The arguments against free consultations... And the third way – free ‘mini’ consultations... www.consultingroom.com/blog/364

About Antioxidants and the Skin

By Dr. Stefanie Williams ‘Antioxidants’ is one of the biggest buzzwords in skincare these days. I get countless questions about them in clinic every day.

There seems to be a lot of confusion about what exactly antioxidants are and how they should be used. So I have summarized the most important facts about antioxidants. www.consultingroom.com/blog/362

Giving Bolam a Nip and a Tuck For Clinical Negligence in Private Cosmetic Surgery

By Nigel Poole Q.C. If there is one passage in one clinical negligence judgment which all clinical negligence practitioners know, it is McNair J's in Bolam-v-Friern HMC [1957] 1WLR 582. The Bolam test has been applied not just to surgeons and medical practitioners, but to dentists, nurses, midwives and health visitors. The difficult question in relation to say, private cosmetic surgery practice, is to identify what is a responsible or reasonable body of opinion. www.consultingroom.com/blog/361

The Consulting Room™ 3rd Annual Golf Challenge Day Whether you're an amateur or experienced golfer join us to eat, drink, play, relax, network and play a round of golf. After the success of the last two Consulting Room Golf Days in 2011 and 2012 we are pleased to announce the th date for our 2013 tournament: 18 May 2013 at Old Thorns, Surrey.

We will be looking for clinics to enter a team of two and to compete for the Consulting Room Challenge Cup. If you can't find a partner, we'll aim to find one for you on the day, which will be a great opportunity to enjoy a round of golf - with a competitive edge, whilst networking with industry colleagues and friends. Spa options are available for non-golfing partners!

Consulting Room Members Get 5% Discount on all Bookings!

For more information and to reserve your place, please visit www.consultingroomgolf.co.uk

Looking For Best Prices on Toxins & Fillers? This Month’s Deals The Consulting Room™ Product & Price Comparison Charts for Dermal Fillers and Botulinum Toxins are available in the Product Comparisons section (login required) within our Members Area where you can compare the prices and bulk deals available through direct purchase from manufacturers/distributors or through the major third party wholesalers and pharmacies such as Wigmore Medical Ltd, Health XChange Pharmacy and Med-fx.

Offers this month: Prices ex.VAT Botox 100U / 50U Azzalure 2 x 125U (Twin pack)

Wigmore Medical

Health XChange

Med-fx

N/A £100.00 4+ Packs @£91.00 each

£140.00 / £76.01 N/A

£118.00 / £53.95 10+ Packs @ £107.00 each / 20+ Packs @ £51.00 each £89.50

N/A

£145.00 £95.00 Buy 5 @£84.00 each* £64.50 Buy 5 @ £54.50 each* £119.90 / £53.00

£83.24

N/A

£95.50

Azzalure 1 x 125U (Single) Xeomin 100U / Bocouture 50U

Restylane 1ml Juvéderm Ultra 2 (2 x0.55ml)

£85.00 *Buy any 2 Fillers & get 2 Recovery Creams FREE £93.35 st

th

* offers valid 1 Mar - 30 Apr 2013

Nip & Tuck - Facts & Stats

59%

£4,800

of women would prefer to have cosmetic surgery than eat healthily and exercise to improve their physique.

Cost to UK taxpayer for NHS 36DD breast implants for aspiring model who claimed emotional distress to GP.

Source: Survey of 1,743 by www.Sweatband.com

Source: The Sun

7 Times More rhinoplasty procedures are performed in Iran than in the USA. Source: The Rhinology Research Society of Iran

$2 billion

‘Face Ironing’

Amount Americans spent on cosmetic injectable procedures in 2012.

A term coined by the media to describe the Thermage® radiofrequency treatment!

Source: ASAPS

Source: Daily Mail

Latest News U.S. FDA Approves First Botulism Antitoxin for Use in Neutralising All Seven Known Botulinum Nerve Toxin Serotypes The U.S. Food and Drug Administration announced today that it has approved Botulism Antitoxin Heptavalent (A, B, C, D, E, F, G)-(Equine) to treat patients showing signs of botulism following documented or suspected exposure to botulinum neurotoxin. The product is derived from horse plasma and contains a mixture of antibody fragments that neutralise all of the seven botulinum nerve toxin serotypes known to cause botulism.

Botulism is a rare but serious illness caused by ingesting or inhaling a botulinum nerve toxin, or by exposure arising from toxin secreted by Clostridium bacteria in a wound or the intestine. Patients with botulism develop severe muscle weakness that progresses from the head to the rest of the body. If untreated, the illness may progress to total loss of muscle function and inability to breathe. This heptavalent antitoxin is the only product available for the treatment of botulism in adults, and for cases of infant botulism caused by nerve toxins other than types A and B. “This product approval meets an urgent unmet medical need for the treatment of sporadic cases of life-threatening botulism and provides a medical countermeasure should botulinum nerve toxins be used in a terrorism event,” said Karen Midthun, M.D., director of the FDA’s Center for Biologics Evaluation and Research.

The effectiveness of the product was studied in animals because it was not feasible or ethical to conduct efficacy studies in humans. These results provided substantial evidence that the antitoxin is reasonably likely to benefit humans with botulism. Under the FDA’s Animal Rule, the agency may approve a biological product when the results of well-controlled animal studies demonstrate that the product is reasonably likely to be effective, in addition to establishing safety in humans. This is the first approval of a plasma derivative using the Animal Rule. The safety of the product was tested in 40 healthy human volunteers and also monitored in 228 patients who received the antitoxin experimentally under a botulism treatment program administered by the Centers for Disease Control and Prevention (CDC). The most commonly observed side effects were headache, fever, chills, rash, itching and nausea. Since the product is manufactured from horse plasma it may cause allergic reactions and a delayed hypersensitivity reaction (serum sickness) in people sensitive to horse proteins.

The product is manufactured by Cangene Corporation, based in Winnipeg, Canada. It was developed with support from the Biomedical Advanced Research and Development Authority within the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response. The antitoxin will be maintained in the Strategic National Stockpile and distributed through the CDC’s Drug Service.

Consulting Room Comment: “Given cases of botulism in the USA in the last decade caused by inappropriate use of research-only grade botulinum toxins by clinicians looking to source cheaper product, and the influx of counterfeit or generic copy toxin products from the Far East and over the Internet for DIY use, it will probably not be long before this antitoxin is called into use to ‘rescue’ a patient from botulism poisoning following illegal or poorly managed cosmetic procedures by unqualified individuals.”

LipoTRON RF Device Manufacturer in Trouble With U.S. FDA During an inspection of RevecoMED International Inc. in Fullerton, California on August 23 through September 5, 2012, an investigator from the United States Food and Drug Administration (FDA) determined that the firm manufactures the LipoTRON 3000 (also known as RFLipo System, Model DETCBF140).

During the inspection, the FDA learned that the firm claims that it is marketing the LipoTRON 3000 as a therapeutic massager which is exempt from premarket notification requirements. Devices of this generic type work by delivering vibration and contain moving components on them that deliver massage, or knead the tissue. However, according to the LipoTRON 3000 User Reference Manual, the device delivers heat to the body via radio frequency energy. Because the LipoTRON 3000 employs a different fundamental scientific technology, it exceeds the limitations of the exemption described and is not exempt from premarket notification. Because there is no premarket clearance or approval for the device, the LipoTRON 3000 is adulterated under the Act according to the FDA, because the firm does not have an approved application for premarket approval (PMA). The FDA notes that the firm should take prompt action to correct the violations addressed in their letter. The full copy is available here.

Aesthetic Source Gains Strong Recognition in NeoStrata International Awards Aesthetic Source received strong recognition at the recent international NeoStrata meeting in Miami when awarded Best NeoStrata Re-launch.

Aesthetic Source Director, Lorna Bowes, has twenty years experience in the medical aesthetics and is thrilled. She says “This is an exciting award for Aesthetic Source. It is very satisfying to work with NeoStrata with its reputation for developing science-driven skin technologies and I am delighted that more exciting times are ahead for us with many innovative products in the pipeline.We will continue to support our customers by offering NeoStrata products at a competitive price point whilst strengthening our training and marketing programmes.”

Over the past year Aesthetic Source has launched the innovative NeoStrata Skin Active and Enlighten ranges.

Unlike other skin creams that rely on one approach or key active, Skin Active contains many novel ingredients like Maltobionic acid, NeoGlucosamine™, and Swiss apple stem cell extract that work together to stimulate cell renewal, even pigmentation, boost collagen and protect against oxidative damage. The Enlighten range is clinically proven to reduce pigmentation and promote a brighter, more even skin tone. It provides an effective anti-ageing skin treatment programme for patients with photodamaged skin tackling dull skin tone, unwanted pigmentation, melasma spots and fine lines and wrinkles.

Aesthetic Source is also undertaking a media campaign to raise awareness about the benefits of cosmeceutical skincare with regular coverage about NeoStrata skin products now appearing in the consumer press.

Later this year in the UK, Aesthetic Source will launch NeoStrata’s ground breaking technology which was well received at the annual meeting of the American Academy of Dermatology meeting in Miami in March 2013.

For more information, please visit www.aestheticsource.com

Marea Brennan Thorns Wins Aesthetic Nurse of the Year Award The British Journal of Nursing Awards 2013, held in London on 22nd March saw aesthetic nurses recognised for the first time by the BJN. Marea Brennan Thorns INP, co-owner of Qutis and MBNS Clinics and Consulting Room Adviser from Thame in Oxfordshire, won the Aesthetic Nurse of the Year Award.

Marea was presented with the award by Esther Rantzen with the BJN noting that she has been instrumental in helping aesthetics to become a recognised form of nursing by chairing the first RCN forum. Malti O'Mahony won second place and Julie Brackenbury won third place.

Marea accepted the award and gave a short speech thanking all the staff and patients who had nominated her, particularly the teams at Qutis and MBNS clinics. Marea went on to say; “the field of aesthetic medicine is full of extraordinary nurse entrepreneurs; many of whom have stuck with the vision that nurses can be leaders and business owners and still keep patients at the heart of all they do”.

Marea began practising aesthetic treatments over 15 years ago. She was a former chair of the aesthetic nurse forum and contributed to the training and development now used across the whole of the industry.

ASAPS Reports Over 10 Million Cosmetic Procedures th

The American Society for Aesthetic Plastic Surgery (ASAPS) released their 16 annual multi-specialty procedural statistics. In 2012, over 10 million cosmetic surgical and non-surgical procedures were performed by the board certified doctors in the United States who are most likely to perform cosmetic procedures. The most frequently performed surgical procedure was breast augmentation. Cosmetic surgical procedures increased more than 3% in the past year, with almost 1.7 million procedures in 2012. Surgery accounted for 17% of all procedures performed representing 61% of total patient expenditures.

The top five surgical procedures were:     

Breast Augmentation: 330,631 Liposuction: 313,011 Abdominoplasty: 156,508 Eyelid surgery: 153,171 Rhinoplasty: 143,801

Women had more than 9.1 million cosmetic procedures, 90% of the total. The number of cosmetic procedures for women increased over 252% from 1997. The top five surgical procedures for women were: breast augmentation, liposuction, tummy tuck, eyelid surgery, and breast lift.

Men had almost 1 million cosmetic procedures, 10% of the total. The number of cosmetic procedures for men increased over 106% from 1997. The top five surgical procedures for men were: liposuction, rhinoplasty, eyelid surgery, breast reduction to treat enlarged male breast, and ear shaping.

Americans spent almost $11 billion on cosmetic procedures in 2012. Of that total $6.7 billion was spent on surgical procedures; $2 billion was spent on injectable procedures; $1.8 billion was spent on skin rejuvenation procedures; and over $483 million was spent on other non-surgical procedures, including laser hair removal and laser treatment of leg veins.

The most popular nonsurgical procedure was injections of Botulinum Toxin Type A (including Botox® and Dysport®). Cosmetic minimally-invasive procedures increased over 10 percent in the past year, with almost 8.5 million procedures in 2012. Nonsurgical procedures accounted for 83% of the total number of procedures performed representing 39% of total expenditures.

The top five minimally-invasive procedures were:     

Botulinum Toxin Type A: 3,257,913 Hyaluronic Acid: 1,423,705 Laser Hair Removal: 883,893 Microdermabrasion: 498,821 Chemical Peel: 443,824

This is the second year this survey asked the doctors for the total number of non-surgical procedures being performed in their practices by BOTH physicians and their physician assistants and nurse injectors. When procedures performed by physician assistants and nurse injectors are included, the total number of cosmetic surgical and nonsurgical procedures performed in the United States in 2012 increases to 12.7 million.

Below is the TOTAL number of procedures performed in the practices surveyed:     

Botulinum Toxin Type A: 4,125,179 Hyaluronic Acid: 1,806,806 Laser Hair Removal: 1,224,920 Chemical Peel: 718,465 Microdermabrasion: 672,430

The Aesthetic Society, which has collected plastic surgery procedural statistics since 1997, says the overall number of cosmetic procedures has increased 250% since the tracking of the statistics first began. “We are confident that these statistics continue to accurately report cosmetic procedure trends as performed by the physicians who are most likely to perform them,” said Leo R. McCafferty, MD, President of the American Society for Aesthetic Plastic Surgery.

Round-Up of ASA Health & Beauty Adjudications The Advertising Standards Authority polices the content of Health & Beauty advertising through all mediums in accordance with rules set out in the CAP (Committee of Advertising Practice) code. This month we did a quick round-up of the naughty advertisers in our industry, in the hope that we can all learn a thing or two:

Make sure your claims can be substantiated – relying on manufacturer info and stock before and after images is not enough!

A regional press advert for Ultherapy stated "Your Future Face ... Treat your face, neck, brow, jowls, skin etc from inside out in one treatment ... Ultherapy The only technology that treats your face from the foundation up ...

WITHOUT A SINGLE INCISION ... FDA Approved Lifting Modality". The advert included two sets of before and after photos.

The complainant challenged 1) whether the efficacy claims were misleading and could be substantiated; and 2) whether the before and after photos were genuine and gave an accurate representation of what could be achieved with the treatment.

Lamphall Ltd t/a Epilight New Skin Clinics provided various documents which they said supported the advertised claims. The documents consisted of clinical trials, trial summaries, manufacturer’s brochures and media stories. They said the non-invasive treatment had been widely used by many top surgeons and doctors for the last four years because of its efficacy, it provides more choice and is an alternative to other aesthetic treatments. Lamphall said the treatment resulted in visible skin improvement, firming and tightening with measureable lift of facial contours which developed over time as tissue regenerated. They said the treatment had been carried out with positive results and had very high patient satisfaction ratings. They also provided the product’s US Food and Drug Administration (FDA) approval. They said they understood that no one surgical or non-surgical procedure would address every issue associated with ageing and Ultherapy was offered as a treatment package alongside a patient consultation. They submitted further information from the manufacturer.

They said research on Ultherapy had been published that examined the use of the product on the face, neck and body of over 320 subjects. They said there were also over 30 unpublished pilot and pivotal studies for face and body treatments conducted on hundreds of patients. To support this, they submitted a bibliography and trial summaries.

In relation to the before and after images, Lamphall said all photographs were genuine and provided to Ultherapy by the doctors and surgeons who used the treatment. They submitted documents which included various before and after pictures from the manufacturer which they said supported the before and after effects of the device.

The ASA upheld both complaints. The ASA considered the advert gave the impression the treatment would improve the overall appearance of several areas of the face. The advert also implied the treatment could be an alternative to aesthetic surgery due to the wording "one treatment", "without a single incision" and "FDA Approved Lifting Modality". They also considered that the before and after photographs emphasised this impression.

The ASA considered the various documents supplied by the advertiser. However, as two studies were conducted on cadaver skin and one on pork skin, they did not consider them sufficient evidence to support efficacy claims for living humans. Of the studies conducted on consumers, they did not consider these sufficiently robust due to the use of a prototype device, small study size, limited facial areas treated and lack of long-term follow up. Additional trials considered the efficacy of the device on several areas of the face and neck. However, some did not examine all areas featured in the advert, for example, under the chin or jowls. Whilst some trials claimed an effect, individual results were not included and therefore it was not possible to analyse the results in full. They acknowledged the bibliography of trials and the manufacturer's assertion that the device had been tested on hundreds of patients. However, they pointed out that summaries of evidence or references would not suffice as evidence as it would not be possible to assess the trials in full.

They acknowledged the document from the FDA, and a further approval was also submitted. However, because the CAP Code stated that the rules applied to marketing communications and not the products, they needed Lamphall to demonstrate that the advertised claims were supported with evidence. They concluded that because the evidence did not support the efficacy claims made for the treatment, the advert was misleading.

The ASA noted the before pictures featured consumers with notable under eye sagging and the after pictures had significantly reduced sagging. They considered the manufacturer’s before and after pictures but these did not appear to include the consumers featured in the advert. They asked the advertiser for signed and dated proof that the photos were genuine and that they had not been manipulated. This information was not supplied. Because they had not received robust evidence that the pictures were genuine or gave an accurate representation of what could be achieved, they concluded they were misleading.

The advert must not appear in its current form. They told Lamphall to hold robust evidence before making efficacy claims and to ensure before and after photos were genuine.

Full Adjudication

Time limited cosmetic surgery offers – a no-no !

A radio advert for a cosmetic surgery clinic, heard on Rock FM during the breakfast show on 22 November, included the voice-over "Christmas is here and the New Birkdale Clinic's amazing voucher offer is back. Buy your Christmas voucher now and get £5,000 worth of cosmetic surgery for just £2,500. Yes, £5,000 worth of cosmetic surgery for only £2,500. So visit [website]. That's [website] and buy your voucher today, but hurry, offer must end midnight this Friday the 23rd of November".

The complainant challenged 1) whether the time limited offer trivialised the risks associated with plastic surgery; and 2) whether the advert was unsuitable for broadcast at a time when children might be listening.

Liverpool Cosmetic Surgery Ltd (LCS) t/a New Birkdale Clinic stated that the advert had been created on their behalf by Rock FM. Rock FM stated that the advert was developed by another radio station and had been cleared for broadcast by the RACC with no day-part scheduling. They said the script promoted a financial offer to those in the market for cosmetic surgery and that it did not encourage young people to consider cosmetic surgery or communicate any safety messages associated with any medical procedures. They said it was therefore considered appropriate for broadcast at a time when children might be listening. They said they had received an assurance from the advertiser that they did not offer cosmetic surgery to anyone under 18 years of age and that anyone considering cosmetic surgery with the company had to undergo a thorough consultation process prior to any surgery.

The RACC said it considered the promotion of the offer as acceptable and that the advert targeted adults and the details were presented in a factual manner. They said that because they did not consider the content of the advert to be unsuitable, socially irresponsible or harmful or distressing to children, they did not advise a timing restriction.

The ASA upheld the first complaint but did not uphold the second. The ASA noted the advert offered consumers the opportunity to obtain the discount against the cost of cosmetic surgery providing the voucher was purchased within days of hearing the broadcast. Although the advert did not suggest that cosmetic surgery was desirable or necessary, they considered the short response time and, in particular the statement "...but hurry, offer must end midnight this Friday the 23rd of November", trivialised what was a significant decision to have an invasive procedure. Whilst listeners may only have been able to take advantage of the offer by themselves making a significant financial contribution, they considered that the time limited offer could encourage individuals to make a decision to have cosmetic surgery when otherwise they would not have done without significant and lengthy consideration. This was further exacerbated by the fact the advert made no references to any consultations or cooling off periods, meaning that listeners who had agreed to the offer may have already committed themselves both financially and mentally to going ahead with surgery. The ASA considered that the time-limited nature of the advert trivialised the decision to agree to cosmetic surgery and therefore concluded that it was irresponsible.

The advert did not contain any content which stated or implied that cosmetic surgery was socially necessary or desirable and made no reference to physical appearance. Furthermore, the clinic did not offer any cosmetic procedures to people under 18 years of age. The ASA considered that the advert was unlikely to appeal to children and contained no content which was considered inappropriate for them to hear. They therefore concluded that a scheduling restriction was unnecessary. On this point they did not find it in breach.

However, the advert should not appear again in its current form.

Full Adjudication

New Product Reviews An Innovative Approach to Skin Regeneration With Unique SCA Biorepair Technology to Fight the Visible Signs of Ageing and Sun Damage With Clinically Proven Endocare® The average woman uses 12 products a day, containing a shocking 168 ingredients (1). But how do we know what is in our daily creams? With human materials being banned from the use in cosmetics in the EU (2), Endocare from AesthetiCare is an all natural skincare range. Using animal derived natural-growth factors to provide clinically advanced natural skin regeneration, Endocare’s unique patented SCA Biorepair Technology causes the skin to repair itself. The extensive range of elegant dailyuse dermocosmetics can provide clinically proven (3) improvements in the visible signs of ageing through evidence based clinically advanced skin regeneration.

What is SCA? SCA Biorepair Technology harnesses the power of nature as it is derived from the regenerative and repairing complex produced by the mollusc Cryptomphallus aspersa. The secretion of this mollusc has been used in treatment of radiation induced dermatitis, with impressive results from baseline to 4 weeks.

This complex has enabled the mollusc to repair its own damaged tissue and survive periods of extreme trauma such as cold, heat, dryness, chemical change and UV irradiation; challenges that in a less severe way are faced by our skin every day. Endocare uses a patented, pharmaceutical-like process to produce from this natural complex the SCA Biorepair Technology, a natural-growth-factor ingredient. SCA Biorepair Technology and the Endocare® products have been shown in peer review dermatological and scientific publications to provide the following:   

Natural-growth-factor stimulation of skin-fibroblasts and regeneration of the dermis Skin-specific anti-oxidant protection and dermal enhancement Reductions in the visible signs of ageing

The Endocare Range; unique SCA Biorepair Technology The Endocare cream, serum, radiance eye contour and ampoules, all contain individual Biorepair Indexes, ranging from 6 in the Tensage cream to a staggering 50 in the Tensage Ampoules. (The Biorepair Index identifies the level of SCA Biorepair Technology in each product.) Hero product, the Endocare Ampoules offer super-intensive regenerating and firming properties and give a moisturising, tightening, and lightening effect, on ageing and photodamaged skin. Used as a night serum, the ampoules help smooth out facial lines, plump skin and stimulate new collagen production.

RRP Prices: Endocare® Tensage™ Cream £37.50 for 30ml Endocare® Tensage™ Serum £37.50 for 30ml Endocare® Tensage™ Radiance Eye Contour £37.50 for 15ml Endocare® Tensage™ Ampoules £80.00 10 x 2ml (1 month supply) The range is available from authorised clinics only. For more information please visit: http://endocare.aestheticare.co.uk 1. Eccles, Louise (12.02.11) ‘The Opposite of Beauty: The chemical make-up ingredients that raise risk of skin damage’ http://www.dailymail.co.uk/health/article-1356212/Make-ingredients-risk-skin-damage.html 2. Hilling, Celeste (30..04.10) “Human Growth Factors as Natural Healers: Current Literature & Application” http://www.cosmeticsandtoiletries.com/formulating/ingredient/active/92518304.html 3. Brieva / Philips / Tejedor / Guerrero / Pivel / Alonso-Lebrero / Gonzalez (21:15 – 22) Skin Pharmacol Physiol, 2008. ‘Molecular Basis for the Regenerative Properties of a Secretion of the Mollusk Cryptomphalus aspersa’ * Please note no snails are harmed in the making of Endocare!

Advertorial

1 Church Street, Fintona, Co Tyrone, Northern Ireland, BT78 2BR Tel: 07594534735

Biomimetic Skin Rejuvenation with Nanopeptides Technology Dr. Gabriela Mercik is Medical Director of Hebe Anti-Aging and Aesthetic Medicine Clinics and is founder and Medical Director of Dermagenica Ltd. Her research career began in Poland 15 years ago in cardiology and internal medicine. She worked in the Heart and Lung transplant hospital for 10 years. She carried out research in field of LDL-apheresis and published in the American Journal of cardiology. For the last 5 years she has been working in hospitals in Northern Ireland in General Medicine, Cardiology, and Palliative Care and Rehab departments. She developed an interest in aesthetics three years ago and has studied Dermatology with a special interest in Skin Rejuvenation. She is an advanced aesthetic trainer in Biomimetic Skin Rejuvenation Mesotherapy, dermal fillers and botulinum toxin, training Doctors and Nurses all over the UK and Ireland in Biomimetic Skin Rejuvenation. She is also highly sought after all over Europe and beyond to speak at many conferences and congresses on this subject. She practices cosmetic medicine in her clinics in Belfast and Omagh.

Nanopeptide technology Dr Mercik introduced the UK Cosmetic Market to Biomimetic Skin Rejuvenation with with Nanopeptides technology 12 months ago, having used the product herself in her clinics here in northern ireland for quite some time before that. Her ecpericence with this product is like no other in the UK. The nanopeptide technology offers a non surgical approach to skin rejuvenation by superficially injecting small amounts of the solution into the dermis.

Peptides represent short chains of amino acids that occur naturally in human, plant and animal organisms. Their rejuvenation works by stimulating the skin cells to synthesize collagen and elastin. With age, the number of natural peptides decrease and their synthesis slows down. As a result wrinkles, and furrows, pigmented lesions appear on the skin and it loses flexibility and moisture. This is where biomimetic peptides comes with help. German biologist Professor Günter Blobel started studies on peptides and was awarded the Nobel Prize in 1999, for his work on the mechanism and identification of signals managing the transport and localization of proteins in cells.

Nanopeptides Mesotherapy for Skin Rejuvenation The use of peptides in mesotherapy gives results that imitate the biological conditions found in young healthy skin. Different peptides stimulate different areas for example Acetyl Decapeptide – reduces and prevents lines and wrinkles by actively generating new skin cells, Oligopeptide minimises scars on skin by forming new skin cells, Tripeptide hydrates dry skin and maintains its optimum moisture balance. Each treatment has up to five different peptides working within it. They can be used to aid, stimulate hair regrowth, brighten skin i.e.: dark circles and skin discoluration, revitalise the skin, hydration of dull, dry skin and tighten pores to name but a few. This revolutionary new mesotherapy can reverse the aging process by around 20 years.

Nanopeptides Mesotherapy for Cellulite Traditional mesotherapy with nanopeptides a revolution in medicine. Dermaheal contains: L-Carnitine which is responsible for transporting fat cells into mitochondria, where they decay, also has a detoxifying effect. Hydrogenated Lecithin which is the synthetic version of Phosphatydylocholine causes the breakdown of triglycerides and their excretion. Oligopeptide-2 supports melting and fat burning, is responsible for tension and smoothing the skin. Mesotherapy injections in turn penetrate through the basement membrane and into the deeper cellular levels or the Mesoderm. Unlike other medical treatments, mesotherapy is administered directly to the desired area.

How does Nanopeptides mesotherapy work for hair loss?

One of the most effective therapies to strengthen and thicken the hair is Nanopeptides mesotherapy. Nanopeptide inactivates +5 alpha reductases which inhibits the conversion of testosterone to DHT and delays the process from Anagen to Categen Anti Hair Loss. Dermaheal HL contains 4 peptides each having a separate job. 1 Decapeptide – 4 which strengthens the hair while stimulating follicles to produce strong hair shafts. 2. Oligopeptide – 41 Stimulates hair cell proliferation and migration.

3. Acetyl Decapeptide – 3 which revitalises hair follicles by newly regenerating hair cells. 4. Copper Tripeptide – 1 Helps to strengthen hair while stimulating hair follicles to product strong hair shafts and helps with blood circulation in the scalp and revitalises hair follicles.

Food For Thought Should Cosmetic Surgery Come with a Mental Health Warning?

With an increasing number of people seeking cosmetic surgery, the demand for therapeutic support has risen. Pre- and post-operative evaluation is essential in helping the surgeon to assess the Emotional, Psychological & Relational (ERP) wellbeing of the patient.

One group that appreciates the importance of good therapeutic support is The Wright Initiative (TWI). Headed by respected psychotherapist Norman Wright, TWI specialises in offering patients one-to-one support, both before and after undergoing cosmetic treatment. Norman has devised the PaPPS Initiative. Pre & Post Procedure Support. http://thewrightinitiative.com/papps-initiative/ The goal of The Wright Initiative is a simple one: they believe that every patient should be able to make an informed decision about the procedure they are interested in. This means ensuring that the patient considers, among other things, the impact that cosmetic treatment may have on their ERP wellbeing, both in the short-term and in the more distant future. Is the patient prepared – mentally and physically – for the changes they will experience after surgery?

It is these issues that have impelled TWI to launch the PaPPS Initiative – Pre- and Post-Procedure Therapeutic Support. The programme grants patients the opportunity to obtain reassurance about the procedure and to establish that they are ready for the changes that cosmetic surgery will engender.

The specially-devised programme takes the form of focal sessions that are held in TWI’s Nottingham and Harley Street clinics. During the course of a 60-minute assessment, the patient will attain the peace of mind that comes from knowing that their ERP welfare is being cared for.

The patient feedback on their experience has been positive: “ My session allowed me the time to reflect and ask myself some questions about what I needed emotionally to get through my surgical procedure and come out psychologically comfortable” “My PaPPS session made me reflect upon questions I would not have normally asked myself” “ I welcome PaPPS and feel very strongly that it should be part of everyone’s journey” For cosmetic surgeons, the PaPPS Initiative is to be welcomed, for it provides an added safeguard, ensuring that patients who elect for surgery are mentally prepared and are comfortable with the decision they have made.

Surgeons who recommend the PaPPS Initiative to their patients will be able to demonstrate that they have their patients’ wellbeing at heart and see them, not as clients, but as people with ERP needs. Mr Sultan Hassan of Elite Surgical is working with TWI offering PaPPS as part of the patient journey. http://www.elitesurgical.co.uk/Patient-Support-105-c.html Proper patient selection is an integral part of cosmetic surgery. Because the process is initiated by the patient, it is the surgeon’s prerogative to screen each patient and ensure that they are suited to and ready for the procedure in question. As Adam Searle from BAAPS notes: “Plastic surgeons need to be alert to the possibility that some patients may have an underlying psychological disorder...Ultimately, a reputable practitioner will use his or her best judgment, perhaps in consultation with a mental health professional, to determine whether or not a particular patient can reasonably be expected to benefit from aesthetic surgery."

BAAPS has gone so far as to issue guidelines for aesthetic surgeons to consider during patient selection. These are designed to help surgeons identify patients who may be suffering from body image issues. A comprehensive checklist enables the surgeon to consider the patient’s physical and mental wellbeing and satisfy themselves that the procedure should go ahead. By offering dedicated PaPPS, The Wright Initiative aims to support both surgeons and patients, making sure that cosmetic surgery is performed safely and with the patient’s best interests at heart.

For more information on The Wright Initiative and PaPPS, call 0115 8890 330 or email enquiries@thewrightinitiative.com

Editorial

Feature Article Advertising Standards For Aesthetics – Avoiding Common Mistakes When Promoting Your Clinic Advertising...something of a dirty word in the aesthetic and cosmetic industry at the moment with various organisations seeking to outlaw advertising for all cosmetic interventions, be they surgical or non-surgical. There are those championing a full-on ban, and those advocating a more measured approach to avoid irresponsible advertising which trivialises the medical nature of treatment through time limited or discount deals.

Whatever your view, and Keogh is also looking into the options for this, every business will advertise and more importantly is likely to ‘need’ to advertise in order to recruit new clients to their services. No matter which method of advertising you use to promote your cosmetic treatments, rules do apply and it’s important to know them, to try not to get caught by them and to realise that those policing it are not doing as effective a job as you might otherwise think!

Hopefully this article will give you a few tips on the dos and don’ts of advertising in aesthetics and an understanding of the rules. For those interested in a more in-depth overview of this subject, with an opportunity to discuss the complexities of it, please visit www.smartseminar.co.uk to book your place on our next event where I will be presenting this subject to delegates.

So, let’s crack on with the basics. Advertising, put simply is a form of communication for marketing. It is used to encourage or persuade an audience to continue to ‘take an action’ or ‘take a new action’. The audience can be viewers, readers or listeners or another specifically filtered and targeted group such as your existing client base.

The goal as we all know is to drive consumer behaviour in relation to a commercial offering, in this case drive new clients and existing clients to seek first time or repeat treatment at your clinic.

In terms of the media used for advertising, most of us don’t have the deep pockets needed for broadcast adverts on television so we will focus on non-broadcast medium such as magazines, newspapers, billboards, posters, brochures, direct mail (including printed, email and SMS text messaging), as well as Internet based material such as web sites, blogs, social media (Facebook, Twitter etc) and banner or pay-per-click advertising.

The Police In the UK, the British Code of Advertising, Sales Promotion and Direct Marketing (the Code) is the rule book for non-broadcast advertisements, sales promotions and direct marketing communications. The Committee of Advertising Practice (CAP) is the self-regulatory body that creates, revises and enforces the Code; and the Advertising Standards Authority (ASA) is the independent body set up by the advertising industry to police the rules laid down in it. The Medicines and Healthcare products Regulatory Agency (MHRA) also policies the advertising and promotion of licensed medicines, and has published guidance on the legal requirements for this in its Blue Guide.

Additionally, the UK legislative base for the control of advertising, particularly that of medicines, was contained in The Medicines (Advertising) Regulations 1994 and The Medicines (Monitoring of Advertising) Regulations 1994, however from August 2012 this became Part 14 of the Human Medicine Regulations 2012.

As well as setting out basic and general rules governing all non-broadcast advertising, the CAP Code also details specific rules applicable to the advertising of health & beauty products and cosmetic therapies. In general these rules broadly state such things as; medical or scientific claims should be backed by evidence, marketing materials should not encourage public self-diagnosis, or imply a product is safe because it is ‘natural’, or use scientific words for common conditions to baffle consumers. With respect to medicines, the Code states, in conjunction with the legislative acts, that prescription only medicines (such as botulinum toxin or Botox®) must not be advertised to the public; and that advertisers should not use health professionals or celebrities to endorse medicines.

The specific rules aimed at cosmetic treatments also state, more significantly, that references to the relief of symptoms or the superficial signs of ageing are acceptable if they can be substantiated; however, unqualified claims such as 'cure' and 'rejuvenation' are not generally acceptable. The general rules are not to mislead, make unrealistic claims or claim anything which you cannot substantiate if required. This also applies to the use of before and after photos, which should be genuine patients, with unadulterated images and be direct representations of a treatment being advertised. (Harley Medical Group, November 2010).

The ASA will reactively investigate complaints made about an advertisement and if your advert is judged to be in breach of the Code by them, then the likely request is that it must be withdrawn or amended. In general the vast majority of advertisers comply with this and the adjudication becomes a matter of public record, (opinions on the effect of this in terms of reputation are pretty subjective in terms of wide public knowledge of their existence). If the advertiser does not comply then the ASA does have effective sanctions which it can impose.

I think most would agree that it’s perhaps in our best interests to avoid having to deal with a complaint, in terms of time, energy, financial implications and the stress, so getting it right is the best option, to be on the safe side.

The Nitty Gritty of The Code Surgical, Non-Surgical, Minimally Invasive, Non-Invasive?

Words we are all familiar with when describing the myriad of treatments now available with the advancement of medical technologies. Sensibly it would be misleading to claim that invasive surgery was a ‘minor procedure’, and one must also not imply unrealistic claims in relation to the complexity or duration of the operation, the pain experienced either during or after the operation, the length of the recovery time or the potential side-effects, as well as the outcomes achievable.

Examples to illustrate would include that the permanent removal of localised areas of fat (through liposuction) will prevent subjects from gaining fat elsewhere, that tattoos can be removed ‘without trace’ or that surgically replaced hair will last permanently.

But can something be described as non-surgical? Well the simple answer is yes; if it is being used to distinguish between surgical and non-surgical procedures offered by a clinic, but treatments such as Laser Lipolysis for example, which is not, in itself, surgical cannot be described as ‘non-surgical’ or ‘non-invasive. (The Norton Clinic Ltd, 2008).

Bigging Up Your Status!

We all want to shout loudly about how good we are but when making claims about the status of your clinic or the skills of your practitioners, there are some fairly large pitfalls that you could fall into by using what seem like inconsequential statements.

Claims such as ‘a/the leading clinic’ are likely to be seen to refer to the clinic and not purely to the doctors/surgeons it uses. Therefore you should be able to demonstrate, if questioned, that the clinic has qualities, such as a proven track record, outstanding facilities and additional staff that would put it above most or all other clinics. The same goes for practitioners, be wary of terms such as ‘qualified’, ‘highly qualified’, ‘fully qualified’, ‘experienced’, ‘skilled’, ‘leading’, ‘foremost’, ‘specialist’, to name but a few, as all require demonstrable evidence which may be overlooked when writing your marketing copy!

Worth also noting is that surgeons may be described as ‘cosmetic surgeons’ if they have chosen to specialise, and have received training and gained experience, in plastic surgery; oral and maxillofacial surgery; ENT or ophthalmological surgery.

Another common pitfall would be linking oneself or ones business to renowned locations such as Harley Street; this is not acceptable unless you can show that you carry out consultations or treatments/procedures there. Equally when noting how many branches or clinic locations you have around the country, you should only include those premises where you carry out consultations or treat, and be wary of using ‘nationwide’ if you have only one clinic in Manchester and one in London!

Interestingly, the ASA also views that dentists referring to themselves using the title ‘Doctor’ or ‘Dr’ is misleading, unless they hold a medical qualification or a relevant PhD/doctorate, despite the GDC allowing this honorary title.

Several example adjudications have upheld complaints of this nature. (Woodvale Clinic, February 2009 and December 2012).

Cosmetic Injectables Please note that for the purposes of ease in this section, and to avoid over use of the primary brand of botulinum toxin (namely Botox), I will use the terminology BoNTA to describe all the brands currently available in the UK, (Botox®, Vistabel®, Azzalure®, Dysport®, Bocouture® and Xeomin®).

According the CAP, if you offer BoNTA and other injected treatments in your clinic you may advertise using the term ‘cosmetic fillers’ or ‘injected fillers’, however, you may not name a BoNTA brand directly or describe the treatment in any way that would imply BoNTA’.

But, and this is where is gets silly! If BoNTA is the only one you offer, (i.e. you do not carry out dermal fillers as well) then you should not advertise ‘fillers’ because that would be an indirect promotion of a prescription only medicine, namely the BoNTA! But as above, if you also offer dermal fillers, you may advertise ‘fillers’. Thankfully, most clinics and practitioners would have both treatment options within their armament to offer clients so this small complexity is unlikely to trip most advertisers up.

In respect of dermal filler products, irrespective of composition, you may refer to them as being capable of ‘temporarily reducing the appearance of fine lines and wrinkles’ but you should not suggest either that treatment can ‘cure’ or ‘rejuvenate skin’ or that ‘lines and wrinkles will be permanently eliminated’. Similarly, unqualified claims, such as ‘wrinkle reduction’, are likely to be unacceptable.

BoNTA is a prescription only medicine which cannot be advertised to the public, so the promotion of BoNTA, whether direct or indirect is likely to breach both Code and MHRA (legislation) rules. Being ‘sneaky’ and thinking that you’re not ‘really’ mentioning it won’t work either as an advert on the daily deal site Groupon proved which tried to claim that the advert related to a dermal filler treatment when the terminology used in the advert stated, “facial injection treatments on one, two or three areas” and “choice of crow’s feet, between the eyebrows and forehead area”. Needless to say the ASA did not buy that argument and deemed it to be indirect promotion of BoNTA. (MyCityDeal Ltd t/a Groupon (Bath Facial Aesthetics advert), March 2012).

The MHRA has issued a document entitled, ‘Advertising of Medicines: Guidance for consumer websites offering medicinal treatment services’, which highlights its advice for those wishing to include information about POMs, such as BoNTA on their website. They request that there be no reference to named POMs on your home page, no hover text (tool tips), small print, hidden text or icons/logos naming a POM and that links from the home page may refer to conditions but not to the POM itself. Additionally, the website URL itself should not include the POM name, e.g. www.wesellbotox.com. However they are not interested in the meta tag information for a website, used to assist in Search Engine Optimisation (SEO) such as keywords, titles and descriptions as they are deemed to be not public facing, thus these elements may name a POM. As you will have noted, the MHRA is only interested in policing the home page of a website, which they put down to resource difficulties but this naive view leaves them wide open to not effectively policing non-compliant content on other pages within a site which have been SEOed to appear higher in Google™ rankings than the home page!

Although, the MHRA are proactively checking sites on a region by region basis and writing to clinics about their website if it is deemed to be in breach. Offenders are also named and shamed in quarterly reports on their website.

It is true though that the ASA takes a harder line than the MHRA on the advertising of BoNTA and will for example look at a website as a whole, but there may be limited exceptions for clinics offering consultations for treating specific conditions for which BoNTA brands may be used.

In looking at a particular complaint against a clinic, the ASA considered that it was acceptable for a website to make balanced and factual references to BoNTA as a treatment option IF the advertisers emphasised the promotion of the consultation rather than any associated POM AND, during that consultation, a range of therapeutic options would be discussed; that consultation may or may not lead to the provision of BoNTA. But, if the context or content of claims in the advert go beyond balanced and factual references to BoNTA as one of several treatment options likely to be discussed during a consultation, the ASA is likely to consider the advert promotes the use of a POM to the public. (Anesis Spa, July 2012). (Skinboost, February 2012).

You may therefore refer to a consultation for lines and wrinkles (or for hyperhidrosis/excessive sweating) on your website and include a price list with a range of treatments available but the price list should not include product claims or actively encourage viewers to choose a product based on the price.

CAP recommend that advertisers who wish to refer to BoNTA on websites keep their wording as close as possible to the information provided in the summary of product characteristics or patient information leaflet.

This is of course the most controversial aspect of advertising standards in relation to aesthetics and one which everyone knows is flouted daily, particularly with the advent of social media.

Hair Removal – Permanent or Not? Many of you will have come up against the two phrases ‘permanent removal’ and ‘permanent reduction’ when describing treatment options for hair removal. In terms of the types of devices used, we are referring to electrolysis and laser/IPL. Electrolysis is the only one which can make the claim for permanent removal of hair, but it cannot make claims for being painless. With light emitting devices, the Code takes its lead from the US FDA who have given market clearance for some devices to claim ‘permanent hair reduction’ but not ‘permanent hair removal’, thus this applies when the ASA investigate complaints here.

Additionally the efficacy of laser treatments can vary depending on a person’s skin type (colour), as well as their hair colour, therefore it is important to avoid giving the impression that laser or IPL hair reduction will be effective or is suitable for all consumers. Similarly the ASA has upheld complaints against advertisers for failing to prove claims they made that their laser treatments were ‘painless’, substantiation and evidence is key.

Lasers and Light For Skin Treatments As mentioned above, the ASA does not like unqualified claims such as ‘rejuvenation’ or ‘rejuvenate’, yet this is often the terminology used to describe treatments to improve the appearance of the skin using ablative and nonablative laser and light treatments. They do however accept that skin can be ‘resurfaced’, but urge the use of phrases such as ‘temporarily rejuvenate the skin’s appearance’ when promoting laser treatments.

Similarly Intense Pulsed Light (IPL) treatments are often marketed as ‘photo-rejuvenation’, so you could be asked to disclaim or delete the name if you use it to advertise your treatment.

The claim that lasers can ‘reduce the superficial appearance of wrinkles’ is generally accepted, but claims that the treatment can ‘remove wrinkles or the signs of ageing’ are not. This was highlighted in a complaint where the phrase ‘remove fine facial lines and wrinkles permanently’ was used as a claim for CO2 laser resurfacing. Although the advertiser submitted evidence which showed that CO2 laser resurfacing could improve the appearance of static facial lines, the studies showed those lines could return within a year, especially if the lines were caused by the movement of underlying muscles so ‘permanent’ removal could not be substantiated and was thus misleading.

(West of England Laser Centre, 2004).

Other Aesthetic Treatments The ASA and CAP accepts that cellulite exists but does not accept that it is a distinct type of body fat; therefore you cannot claim that a treatment can specifically target “cellulite”, nor can you claim that treatments, such as Endermologie™ can ‘remove’ or ‘eliminate’ cellulite, claims must be limited to ‘temporarily reduce the appearance of cellulite’.

CACI (Computer Aided Cosmetology Instrument) is a popular micro-current treatment for the face and body, but claims such as ‘non-surgical face lift’ are considered unacceptable because they imply the product is equivalent to surgery, and has immediate and permanent results which it does not, so claims should go no further than ‘temporarily tones and tightens the skin’ and should make it apparent that repeat and maintenance treatments are needed.

The ASA accepts that microdermabrasion can slough off the dead layer on the skin’s surface, to reveal younger looking or smoother skin but will not accept claims which go deeper such as that it can stimulate collagen production. Interestingly this view also applies to chemical peels, irrespective of depth of penetration.

CAP note that they have seen no evidence that the technique of mesotherapy (using multiple injections of vitamins and homeopathic medicines) can work and thus advises that it should be advertised only as the fact that it is available from a clinic. (A.Y. Eternal Youth, 2008)

Conclusion It is very clear that although there are many guidelines laid down and enforced by the ASA, CAP and MHRA regarding appropriate advertising of cosmetic surgery, aesthetic treatments and prescription only medicines used

for cosmetic purposes there are literally hundreds of examples of clinics and practitioners currently breaking these rules and guidelines.

When asked about this during past presentations that I have given on this topic, the audience have always been quick to point out that they know of local competitors who are ‘breaking the rules’ so wonder what incentive they have to stick to them themselves!

Most ‘offences’ are partly due to a lack of knowledge regarding the specific CAP guidelines, but many clinics flout the rules in the knowledge that policing of these guidelines is currently ineffective and with the simple hope that none of their ‘enemies’ in this cut-throat industry will shop them to the regulators, which most frankly won’t for fear of ‘what goes around comes acround’. Clinics wishing to market their aesthetic services within current guidelines often complain that they are operating at a disadvantage to local competition that don’t, and can be tempted to follow suit if they think they are losing customers.

Press and media coverage certainly appear to pay no heed to MHRA guidelines with regard to prescription medicines, with BoNTA in the form of Botox® being featured in virtually every television programme covering aesthetic procedures or make-overs.

Representative industry bodies, such as doctor and nurse associations appear to do little to help reinforce appropriate advertising guidelines amongst membership, although recognition of that is occurring and some, such as BAAPS are quite out spoken on their views on advertising regulations and best practice.

Regulatory bodies such as the MHRA are taking a more proactive stance, but openly admit to not having the resources to really investigate to any great depth, leading to many loopholes being wide open to their ‘policing’.

Most regulation of advertising compliance is therefore reactive which, although makes examples of a few offenders, does little as a deterrent when most think that they simply won’t get caught, or that “everyone else is doing it too so why shouldn’t I, and there are no ‘real’ penalties if I do get investigated and found to be in breach”.

Even if the Keogh report does provide recommendations in terms of advertising and clamps down on certain practices, there is still likely to be a question of whether it will have any teeth if it simply gets included in the current self-regulatory arrangements of the ASA which relies on reactive policing. Perhaps sanctions ought to be elevated (even for first offenders) to deter more from the simple ‘slapped wrist’ approach doled out to offenders currently.

For advice and guidance, direct from CAP, please visit their Advice Online Database and look under anti-ageing, before and after photos, breast enhancing, cosmetic surgery, hair, hyperhidrosis, lasers, mesotherapy, microsclerotherapy and teeth whitening.

Lorna Jackson Lorna has been Editor of The Consulting Room™, the UK’s largest aesthetic information website, for over nine years. She has become an industry commentator on a number of different areas related to the aesthetic industry, collating and evaluating statistics and writing feature articles, blogs, newsletters and reports for The Consulting Room™ and various consumer and trade publications, including Aesthetic Medicine, Cosmetic News and Aesthetic Dentistry Today.

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Give Your Aesthetic Business a Competitive Edge & Attend

LAST CALL FOR REGISTRATION ONLY A FEW PLACES LEFT!

Practical Business Strategies & Product Ideas to Increase Your Profits in 2013 The Consulting Room™ are again hosting several special SMART Ideas events during 2013, in conjunction with the world’s largest laser and radiofrequency device manufacturer - Syneron Candela, and cosmetic injectables manufacturer – Merz Aesthetics.

Saturday 27th April 2013 in London This unique seminar includes a full day business agenda, featuring the very latest practical business and marketing tactics related to running an aesthetic clinic, alongside a parallel agenda devoted to the latest devices, injectable aesthetic techniques and other concepts that you can incorporate to increase your clinic's profits during 2013. CPD Points applied for and Registration from just £15 inc. lunch.

See details of the two agendas here: www.smartseminar.co.uk/agenda The SMART Ideas format provides an opportunity for you to explore the very latest product innovations, alongside reviewing core business principles related to running an aesthetic clinic.

SMART ideas provides an informal and friendly opportunity for you to explore unique new products, have personal demonstrations, discuss your business model and network with industry colleagues all in one day! A range of industry exhibitors will also be attending the events.

Delegates attending these unique seminars will learn the very latest information related to practical use of cosmetic injectables for total facial contouring; lasers and RF devices for hair removal and skin rejuvenation; topical skin lightening treatments; and web marketing and business development techniques.

To register your interest please call Danny Large on 01788 577 254 or visit www.smartseminar.co.uk/Register/

Still Undecided About Attending?

Watch this short video of comments from delegates who have attended past SMART IDEAS Seminars to hear what they gained from the day. www.youtube.com/watch?v=qA67ncb4a3I

Eye Spy With My Industry Eye BACN Business Workshop Consulting Room Director, Ron Myers and Editor, Lorna Jackson attended the British Association of Cosmetic Nurses (BACN) Business th Workshop in London on 11 March 2013. Both were very honoured to be asked to present at the event, alongside a packed day of interesting speakers.

The event, held at the The Royal College of Obs and Gynae, aimed to help nurses to improve their aesthetic practice, covering new ideas and concepts, business planning and implementation, misconceptions and how to understand the bottom line to achieve better results and increased profits.

Ten speakers in all presented on the day with topics ranging from selling techniques and retaining customer loyalty to business models, web marketing and cloud based clinic management.

Peter Roberts explained business models that work and putting them into action, while Marcus Haycock discussed improving your practice with key reports and measurement indicators Jack Cottle demystified the process of climbing the Google ladder and blogging, while Ron Myers talked about Web marketing strategies and discounting decisions. Richard Crawford Small launched his new iConsultAesthetic, a new i-Pad based app that allows access, via a personal cloud storage, to patients, photo galleries, consent, and treatments charts, wherever you are. Dr Jason Williams talked about "psyching" up your profits and ethically improving profitability through direct marketing with language that works.

Emma Davis talked about nurses selling, while Alison Telfer took it even further discussing how to intelligently select and stock products to improve your practice, while Lorna Bowes then talked about the holy grail of customer loyalty – the 20-year patient!

Finally, Lorna Jackson rounded off the day with some lessons on the dos and don'ts of advertising to stay out of trouble with the Advertising Standards Authority.

Feedback from the event was very positive and The Consulting Room team were certainly proud to have been part of such a well organised and relevant agenda.

Business Corner European Court of Justice Looks at Aesthetic VAT Exemptions The European Court of Justice (ECJ) has delivered its judgment in what has become known as the PFC Clinic case. This could have a significant impact on the UK VAT position and should be of interest to all providers of UK cosmetic treatments and surgical procedures.

The background of the case is that the PFC Clinic (based in Sweden) offers plastic surgery and cosmetic treatments, providing both cosmetic and reconstructive plastic surgery. Some procedures are carried out to treat patients who, as a result of an illness, injury or a congenital physical impairment, are in need of plastic surgery. In other cases, they are performed solely because the patient wishes to alter or improve his/her physical appearance.

From a medical point of view the same procedure is performed either way, and carried out by the same personnel.

PFC submitted a claim to the Swedish Tax Authorities in 2007 for input tax incurred on costs. They argued that the supply of cosmetic treatments should be subject to VAT which entitled it to recover the VAT on the costs it incurred.

The Swedish Tax Authorities disagreed and argued that the supply of cosmetic treatments and surgical procedures should be exempt from VAT. This is on the basis that cosmetic treatments and surgery constitute healthcare and fall within the exemption for healthcare in Article 132 (1) (b) and (c) of the VAT Directive. This would deny PFC Clinic its input tax recovery as VAT cannot be recovered on costs which relate to exempt supplies.

The ECJ judgment (the full account of which is available from here) confirms that cosmetic treatments and surgery are exempt from VAT where the procedure is intended to diagnose, treat or cure diseases/health disorders; or to protect maintain or restore human health, i.e. for ‘medical reasons’. Psychological issues and their treatment are within the term medical. Where procedures do not have this purpose, and are purely cosmetic, the procedures will be subject to VAT. This supports the current interpretation of the law by HMRC in the UK who have long held the position that there needs to be some other medical purpose for it (a treatment/procedure) to fall within the exemption. However, the EJC decision does provide some clarification on the tests for determining whether a procedure is for a ‘medical reason’ or not.

The view of the patient is not determinative as to whether a procedure is for a ‘medical reason’. Paragraph 34 of the judgment states that: “……the subjective understanding that the person who undergoes plastic surgery or a cosmetic treatment has of it is not in itself decisive for the purpose of determining whether that intervention has a therapeutic purpose.”

This is an important part of the decision for providers of cosmetic treatments and surgery in the UK. Historically, many providers of cosmetic procedures determine the VAT treatment on the basis that patients certify the procedure is for a medical reason (often psychological). It is strongly suggested by the ECJ that it is necessary for a medically qualified person to determine whether a procedure is undertaken for a ‘medical reason’. Paragraph 35 states that: “Since that is a medical assessment, it must be based on findings of a medical nature which are made by a person qualified for that purpose.”

This could place a significant additional burden on aesthetic businesses, as where there is no assessment by a medically qualified person to confirm the procedure is for a ‘medical reason’ the decision suggests the procedure will be subject to VAT. There may be room for some discretion on this but the decision imposes stricter tests than currently applied in the UK. Now it’s a waiting game to see how HMRC will react to the judgment (no response at time of writing). The HMRC may decide that the case makes their current position untenable, in which case they could withdraw from the current litigation against UK clinics and release guidance on the dividing line between medical and non-medical criteria.

However, they may simply take comfort in the statement that surgical treatment provided solely for cosmetic purposes is not deemed medical, so is not VAT exempt, which is a position that they have always publicly taken. In this case they may suggest that the case taken as a whole supports their view and continue to cause problems for aesthetic clinics. We can expect more legal challenges ahead no doubt.

Only in America! Rapping Surgeon Dance Video And the winner of the most bizarre marketing campaign for a Plastic Surgeon in the history of the global cosmetic industry goes to….

His video, viewed over forty thousand times since June 2012 shows Plastic Surgeon Michael Salzhauer M.D. from Miami, Florida performing a parody of the Justin Bieber song “If I was your boyfriend” as “If I was your SURGEON”.

Those who share the video by social media could bag themselves some free Botox treatment!

I don’t think we need to say any more. If your chin is not on the floor after you have watched this then maybe this is the marketing campaign for you too! Enjoy….and yes you can watch it again if you can’t quite believe your eyes! https://www.youtube.com/watch?v=uLHNBod4wAc

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Employment Law: Parental Leave Survey Under rules brought in by the European Parliament, from March this year UK employers will have to allow parents to take 18 weeks’ parental leave per child instead of the current 13 weeks.

Currently, parental leave is available to employees on completion of one year’s service, is unpaid and has to be taken before the child’s fifth birthday.

Almost half of SME’s are unaware of the changes coming in and the effect it may have on their business according to a nationwide survey by employment law specialists Citation.

As the start date of the new legislation looms, Citation, based in Wilmslow, Cheshire, contacted SME business owners across the UK to understand their awareness of this important new change to employment law.

They were asked to answer ‘yes’ or ‘no’ regarding their knowledge of the new legislation and when it comes in. And also share their opinions on the involvement of the EU in the UK’s employment law.

Andrea O’ Hare, Head of Personnel and Employment Law said: “This additional five weeks of parental leave per parent per child, to be taken before the child’s fifth birthday, means that every working parent of a child under five will be entitled to take an additional week off work each year.

Our survey showed that 45% of businesses asked stated they didn’t know about the new legislation. This is surprising considering the impact it is likely to have, on SMEs in particular.

55% think the new legislation will have an impact on their business; including 1 in 10 who believe it will have a major impact.

The survey also reveals the worrying number of business owners concerned by the EU’s increasing involvement in the UK’s employment laws; 63% rated the EU as having too much involvement.”

Operating throughout the UK since 1995, Citation provides professional advice and compliance packages to over 7,500 clients, mainly SMEs with between six and 200 employees. Independently endorsed at the highest level, its market leading services provide guaranteed protection in the high risk areas of employment law and health and safety regulations.

For further details call 0845 844 1111 or visit www.citation.co.uk/affinity/abs.

Legislation Keogh Review into Cosmetic Interventions Gives Us Taster of Recommendations to Come for Dermal Filler Providers Keogh Review says Beauty Therapists and Doctors should have ‘formal qualification’ to provide dermal fillers The Department of Health and the review panel, headed up by NHS Medical Director Sir Bruce Keogh, into the provision of cosmetic interventions in England have announced that their long awaited report will be delayed by one month, until the end of April 2013.

Despite the announcement arriving on 1st April, it was no Fool’s Day stunt and the content of a press release chose to also highlight and give a ‘sneaky peak’ at one of the recommendations likely to come from Sir Keogh’s review in relation to cosmetic injectable products, namely dermal fillers and those currently providing them.

In a statement, the review panel noted that non-surgical treatments, such as dermal fillers and laser treatments make up 90% of the UK cosmetic intervention sector, yet it remains largely unregulated when compared to the cosmetic surgery side. This means that there are currently few controls on who can perform these treatments and where they can be carried out, something which concerns many within the industry who are well aware of the complications which can occur with use of such products, (albeit often rare depending on the temporary or permanent nature and composition of the products), including allergic reactions, lump formation, skin necrosis and some reported cases of blindness.

They went on to say that the review is expected to call for new laws to ensure that anyone performing these treatments, doctors, nurses and beauty therapists is ‘competent and accountable’.

In their own words this would mean; “...getting either a qualification to perform and supervise aesthetic treatments, or a qualification to perform aesthetic treatments under the jurisdiction of a qualified clinical professional. Further work will be carried out to assess which professional groups either qualification should be open to, and to develop the qualifications”.

Professor Sir Bruce Keogh, NHS Medical Director, said in a statement; “I am concerned that some practitioners who are giving non-surgical treatments may not have had any appropriate training whatsoever. This leaves people exposed to unreasonable risks, and possibly permanent damage. And our research has shown that the public expect procedures that are so widely available to be safe whereas they are largely unregulated. There is a clear need for better quality, recognised training for the people performing these operations. My review will make a number of recommendations for making sure people who choose to undergo these procedures are in safe hands.”

This ‘snippet’ or ‘taster’ of what’s to come has been cautiously received by industry participants such as the British Association of Aesthetic Plastic Surgeons (BAAPS). They agreed that specialised training is needed, including for doctors, but argued that these procedures should be administered only by medical professionals (i.e. not beauty therapists) as they are capable of not only correct patient selection for treatment but also dealing with an complications, from minor to more severe, which may occur.

Current BAAPS President and Consulting Room Adviser, Consultant Plastic Surgeon, Rajiv Grover said about the plans; “Non-surgical does not mean non-medical. Treatment with dermal fillers have clear benefits but also risks – it is not just about who can wield a syringe but who will have the capabilities to deal with any possible complications.

We agree that specialised training is required and certainly more extensive than the many widely-promoted weekend courses currently available, but aesthetic injectables should only ever be provided by medical professionals. It is known that dermal fillers have a physiological (‘biological’) effect on skin – such as stimulating the production of collagen, and many of them also contain local anaesthetic. These factors make these substances, in essence, a medicine.”

He went on to say; “Not only should those administering these procedures be capable of handling possible complications – which can range from bruising or swelling to necrosis, which is when the skin ‘dies’ – but, perhaps more importantly, be able to properly assess and select patients. People seeking aesthetic treatments may present with medical or even psychological issues, and experienced medical professionals are able to explore their histories and expectations to ensure the most satisfactory outcome. We call on the Government to regulate who is able to perform these procedures – and in the absence of tight controls, we urge manufacturers to adhere to a ‘Moral Charter’ whereby they agree to only distribute their products to medical professionals.”

Many within the industry have taken to Twitter to discuss the revelations thus far from the Keogh review.

Former BAAPS President, Nigel Mercer pointed out the obvious mistake in this ‘recommendation’; “Keogh's proposals for injectables are at variance from The Aesthetic Surgical and Aesthetic Non-Surgical Medical Services Standard.”

While Dr Dan Dhunna also noted; “the Keogh report will pale in comparison with the better, tighter, stronger European CEN ruling; only prescribing medics for Botox & Fillers.”

The independent review, which was commissioned just over a year ago, following the PIP breast implant scandal, will look at a variety of issues in an effort improve protection for those considering undergoing cosmetic procedures, both surgical and non-surgical. It has assessed and will report on the current regulatory framework in place (in England) for products or devices used in cosmetic interventions, e.g. breast implants or dermal fillers, practitioners of cosmetic interventions, be they health professionals or non-health professionals e.g. beauty therapists, providers, be they large providers of surgical interventions or small high-street beauty clinics, insurance and indemnity requirements and information provision, consent and advertising of cosmetic interventions to the public.

If this insight is any clue to the recommendations that we can expect later this month, I think it might be a safe bet that many within the industry will feel a mixture of emotions, as although there may be some positive steps towards better regulation, there are likely to be many compromises to satisfy all sides of the argument, leading many to be disappointed and perhaps feel a little cheated. Although, noted as an independent review, the process is still within the government umbrella and thus we do not know if there is an underlying remit to avoid any recommendations to impose statutory regulation for the industry, given that we know this is something that the country can ill afford to put into practice, particularly at the expense of more ‘worthy’ public spending initiatives. We will simply have to wait and see, so counting down the days begins again now...

UK Laser Expert Wins Prestigious American Award At this year’s ILSC (International Laser Safety Conference) held in Orlando Florida, Bioptica Consultant Roy Henderson was awarded the prestigious Rockwell Award.

The objective of the Rockwell Award, which is administered by the LIA (Laser Institute of America), is "to recognize outstanding contributions in laser safety education", such as significant involvement in conventional training and educational courses, publications including books, journal articles, pamphlets, development of significant software, significant involvement in laser safety–related conferences, development of on-line training and educational courses or development of significant education web sites (traditional or non-traditional).

Roy Henderson is a Certificated LPA (Laser Protection Adviser) and has an international reputation as a leading specialist in laser safety. He established Bioptica in 1990 to offer safety training and consultancy services to both users and manufacturers of laser equipment. Roy has written two books on laser safety (one as co-author) and regularly serves on the Advisory Board for the International Laser Safety Conference (ILSC). In addition to providing laser safety support throughout the UK and Ireland (including the training of other LPAs), he has also given laser safety courses in Europe, the USA and Asia.

Currently Chairman of the European CENELEC committee for laser safety (CLC/TC76) and Project Leader of ISO/TC94/SC6 for laser eye protection, he has been actively involved in international standards for laser safety since 1997.

Harley Medical Collapse to be Probed by ‘Maxwell Investigator’ Remember the late Robert Maxwell (the one who fell off the boat!) and his hidden fortune, or the missing assets from the collapsed claims management company, The Accident Group? Well, the same investigators who championed those searches have now been appointed to probe into the dealing of the now defunct Harley Medical Centre Ltd, which previously traded as the Harley Medical Group before some swift reorganising late last year after going into administration as a consequence of claims by thousands of women fitted with faulty breast implants supplied by French firm Poly Implant Protheses (PIP).

Paul Stanley, a partner at Begbies Traynor, has now been appointed joint liquidator of Harley Medical Group and will look into a number of transactions including the payment at the company of a dividend of more than £1m in 2010. He said: “The company accounts show large dividends were removed in 2010 and the creditors are concerned whether the directors at this time should have known that they were facing problems. I have been appointed to trace all these transactions to make sure that the business was being run in a proper manner by the directors prior to the administration and to investigate possible claims against the UK distributor of PIP implants.”

The Harley Medical Group was deluged with complaints from women wanting their PIP breast implants removed after it emerged that the manufacturer had used non-medical grade silicone in them. The clinic chain was the largest fitter of PIP implants in the UK having used around fourteen thousand. The women are understood to have made a claim against the company for around £15m after it emerged in March 2010 that the implants were faulty.

Faced with a claim of that size, the London office of Leonard Curtis was appointed administrator of Harley Medical Centre Ltd in November 2012 and sold the business to the Directors through a new vehicle, Aesthetic and Cosmetic Surgery Ltd in a pre-pack deal.

Now creditors of Harley Medical Centre Ltd have appointed Mr Stanley to investigate a number of transactions. Mr Stanley has more than 30 years’ experience carrying out insolvency and proceeds of crime-related investigations and asset tracing on behalf of creditors, government departments and financial institutions.

2nd Public Consultation on Draft Aesthetic Standard Now Open The first public consultation process held last year for the European CEN Standard for Aesthetics Surgery Services, EN 16372, has been reviewed by the European committee and as a result the draft has undergone significant changes including a name change from ‘Aesthetic Surgery Services’ to ‘Aesthetic Surgery and Aesthetic Non-Surgical Medical Services’ to reflect its wide scope. The revised draft is now going out for a second public consultation. The final version is expected to be published in 2014.

EN 16372 is a proposed European standard and has to take in to account the nature and country variances across the European marketplace with regards to aesthetic surgery and treatments. To accommodate the UK’s country requirements with regards to aesthetics, a number of exceptions or deviations have been included in the second draft for review. These can be found in Annex C of the draft and are detailed as follows: In relation to Section 2.11 Practitioner of the standard which states: “medical doctor authorized by national competent authority to practice autonomously” The London Local Authorities Act 1991 allows certain local authorities (the London Boroughs and Nottingham) to require "special treatments" to be licensed before they can be offered to the public. This covers locations where cosmetic laser and ILS (Intense Pulsed Light Systems) services are provided. This includes the licensing of laser and ILS services offered by non-medical practitioners that provide treatments such as hair reduction and other nonsurgical laser and ILS treatments. The Local Authorities recognize that the range of people who are suitably trained can be licensed to provide such services and many of those licensed come from the beauty therapy sector and also nurses using lasers and ILS. The Act ensures that these services provided by non-medical practitioners can be licensed and regulated.

The Misuse of Drugs (Amendment No.2) (England, Wales and Scotland) Regulations 2012 allows a nurse independent prescriber.

In addition dentists are appropriate practitioners according to the Medicines Act 1968 (as amended).

In the UK the public consultation for the second draft commenced on 19th March 2013 and will end on 20th May 2013. You can view and comment on it by visiting: http://drafts.bsigroup.com/Home/Details/51036

Educational Opportunities

Training, Events, Mentoring etc...

Ensure that you are kept up to date with all educational opportunities, including webinars, seminars and conferences. www.cosmetictraining.co.uk is a focused directory that brings together key training opportunities and events. The dedicated and unique reference site will provide information about all areas of the Aesthetic business:

Cosmetic Training Features:      

Conferences & Meetings Bespoke Training and Mentoring Cosmetic Industry Qualifications Training Venues for Hire Training Courses & Webinars Business Related Seminars

With over 40,000 Procedures performed in Britain in 2010 we are constantly seeing emerging trends, new innovations, new products and new procedures. Therefore it’s important for you and your staff to keep constantly updated on all the changes in this fast paced business.

Receive a FREE monthly email update on the upcoming and latest events and opportunities.

For those members who offer training/mentoring or rooms for hire we also offer a range of competitively priced advertising options - including listing of training courses in our directory, targeted banner advertising in our training search results pages and opportunities to sponsor our monthly training update e-newsletter. Click on the image to learn more.

www.cosmetictraining.co.uk

Conferences Dates For Your Diary FACE Conference 2013 FACE 2013, the UK’s premier medical aesthetic conference and exhibition is moving to a larger venue in 2013 to help accommodate the growing lecture programmes. For more information as the agendas unfold, please visit: www.faceconference.com 21st – 23rd June 2013 at the QEII Conference Centre, Westminster, London

Clinical Cosmetic & Reconstructive (CCR) Expo A business-to-business event that will bring the international surgical and non-surgical community together under one roof. The expo will showcase over 120 international exhibitors: from cutting edge surgical equipment and supplies through to non-invasive products, business services, training and consultancy. There will be 14 days of Continuing Professional Development (CPD) content, including workshops, conferences and live demonstration theatre. For more details, please visit: www.ccr-expo.com 11th – 12th October 2013 at the Olympia, London

IAAFA 2013 The International Academy of Advanced Facial Aesthetics (IAAFA) annual meeting will be later this year, being held in November. The event also includes a charity ball. For more details, please visit: www.iaafa.net 29th & 30th November 2013 at the Royal College of Physicians, London.

Aesthetic Awards 2013-14 in Association With Cosmetic News – Change of Date The date has been changed for the glamorous Aesthetic industry awards this Autumn. Previously scheduled for the 30th November, the event has been moved due to the clash with the IAAFA meeting. Nominations will start soon. th

7 December 2013, London.

Cosmetic News Expo and Aesthetics Conference 2014 Cosmetic News Magazine are delighted to announce the dates for the Cosmetic News Expo and Aesthetics Conference 2014. The two-day event will take place the Business Design Centre in Islington (London) on Saturday th th March 8 to Sunday March 9 , 2014 so put the date in your diary! More details when available.

For details of all upcoming UK and Non-UK conferences and exhibitions please visit our Cosmetic Training website.

FACE 2013 – UK’s Premier Facial Aesthetic Conference and Exhibition, 21st – 23rd June The FACE Conference is the UK’s largest scientific and business congress for practitioners of all specialities, business owners, clinic managers and marketers working in the field of facial aesthetics. Whether you work as a sole practitioner, or part of a large clinic team, FACE provides the best opportunity to learn about the latest treatments, procedures, scientific data, practical treatment tips, and marketing and business strategies - all delivered by leading experts in their respective fields.

FACE2013 will build on its heritage as THE scientific forum devoted to facial aesthetics by combining it with the largest dedicated medical aesthetics exhibition ever seen in the UK, at the QEII Conference Centre, London.

FACE 2013 Features 3 Days of UNPARALLELED Choice Including:        

Over 100 National and International Expert Speakers 3 Day Facial Cosmetic Injectables Agenda 2 Day Facial Aesthetic Equipment Agenda NEW: 2 Day Aesthetic Therapists Forum 3 Day Agenda Focusing on Business & Marketing SKIN Forum – 1 Day Devoted to Cosmeceuticals,1 Day Treating Ageing Skin Multiple Alternative Exhibitor Workshops Running Over the 3 Days Access to the UK’s Largest Aesthetic Exhibition

Facial Injectables Agenda This is the most comprehensive agenda devoted to facial injectables ever seen in the UK. A host of national and international lecturers, trainers and clinical triallists will feature, providing scientific updates and practical pearls to help you maximise results and minimise problems when using cosmetic injectables for total facial contouring.

Different techniques, new treatment approaches and concepts will be explored alongside practical demonstrations.

This year we are devoting a two hour session to exploring the evidence for the use of Platelet Rich Plasma “Vampire Facelift” as a treatment for facial rejuvenation. If you are passionate about cosmetic injectables then FACE2013 is an essential entry in your professional diary. You won’t find a better industry focused event anywhere in the world this year.

Facial Aesthetic Equipment Agenda The use of Lasers, Radiofrequency, Ultrasound and other aesthetic equipment for facial rejuvenation has exploded over the last decade, providing new approaches to the treatment of skin lesions and skin ageing. This two day agenda allows delegates the opportunity to explore the latest equipment, protocols and treatment approaches to a wide range of different skin problems; all delivered by an international panel of experts in their particular fields.

Aesthetic Therapists Forum The last 10 years have seen the role of beauty therapists, laser technicians and other non-medically qualified practitioners working in the aesthetics market rapidly evolve, enabling them to work alongside medical practitioners or expand their own skill set in salons or their own businesses. We’re excited to announce a new two day event tailored specifically to exploring advanced treatments that are performed by practitioners with different skill sets, interests and backgrounds. As this is the first time we have run this event, we are not limiting topics covered to just facial treatments, but are also encompassing Laser and IPL hair removal and non-surgical body contouring, including practical demonstration sessions. Many of the lectures are delivered by therapists who have specialist expertise and experience in their chosen field. The aim is to share knowledge and stimulate debate amongst therapists working in this exciting and rapidly developing market.

Business Agenda In a broader economic environment, that will continue to be challenging for the foreseeable future, mastering the wide range of skill sets required to market and run a business profitably is essential. This 3 day event explores a wide range of topics related to the ‘nitty gritty’, day to day challenges of making decisions and creatively marketing an aesthetic business. This provides a unique opportunity for clinic managers, marketers and aesthetic business owners to learn from respective experts in their fields, network and share ideas with peers and come away with practical solutions to maximise profitability.

SKIN Forum – Cosmeceuticals and Treating Ageing Skin This two day forum will focus predominantly on topical non-injectable/non-device approaches to preventing and treating signs and symptoms of ageing skin. Cosmeceuticals are an important adjunctive approach to in-clinic treatments, both to enhance results and as a valuable, additional revenue source. A scientific approach to selecting products from the bewildering array of topical treatments available today will be explored, alongside practical tips to effectively and safely treat darker skin types.

See the detailed agendas and register by visiting www.faceconference.com

Clinical Information

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Evaluation of Self-Esteem and Depression Symptoms in Depressed and Nondepressed Subjects Treated with OnabotulinumtoxinA for Glabellar Lines.

Hexsel D, Brum C, Siega C, Schilling-Souza J, Forno TD, Heckmann M, Rodrigues TC. Brazilian Center for Studies in Dermatology, Porto Alegre, Brazil; Pontificia Universidade Católica de Porto Alegre, Porto Alegre, Brazil.

Dermatol Surg. 2013 Mar 6.

BACKGROUND: Botulinum toxin type A (BoNT-A) injection has become the most popular cosmetic nonsurgical procedure, and it has been suggested that BoNT-A injections may improve emotional states when frown lines are treated.

OBJECTIVES: To evaluate symptoms of depression and self-esteem before and after onabotulinumtoxinA (ONA) injections in the glabella in subjects with and without depression.

METHODS: Twenty-five subjects with depression were allocated into one group and 25 subjects without depression were matched to those according to demographic characteristics. The Beck Depression Inventory (BDI) and Rosenberg Self-Esteem Scale (RSES) were used to assess depression symptoms and self-esteem, respectively. Patients were assessed up to 12 weeks after the intervention.

RESULTS: Patients with depression had significant improvement in depression symptoms after ONA injections.

The maximum effect occurred within the first 8 weeks after treatment. A significant reduction from baseline in BDI score and significant improvement in self-esteem were also observed in patients with depression.

CONCLUSION: This research presents new data regarding BoNT-A as a potential treatment to improve depression symptoms in patients with Major Depressive Disorder. Self-esteem scores alone cannot explain the improvement in depression symptoms.

A clinical study to assess the effectiveness of a hyaluronic acid-based procedure for treatment of premature ejaculation.

Littara A, Palmieri B, Rottigni V, Iannitti T. Centro di Medicina Sessuale, Milan, Italy; Istituto di Laser-Chirurgia Sessuale, Milan, Italy.

Int J Impot Res. 2013 Apr 4.

Premature ejaculation is a sexual debilitating condition affecting a large number of men worldwide and leading to important dysfunctions influencing the patients' affective and emotional life. Hyaluronic acid is a natural and safe compound that has been widely used not only in the aesthetic medicine clinic, but also for treatment of osteoarthritis. The present study shows the effectiveness of a hyaluronic acid-based procedure for treatment of premature ejaculation. A hundred and ten male patients were treated with hyaluronic acid injections in the deep dermis of their glans penis to increase the volume and the circumference of their penis to prevent male premature ejaculation and improve the patients' and their partners' sexual satisfaction. The intravaginal ejaculation latency time increased significantly from a baseline value of 88.34±3.14 s to 293.14±8.16 s after 6 months from the procedure. Maximal glandular circumference increased from 98.51±0.71 mm to 114.35±0.66 mm after 6 months from the procedure. At 6-month follow-up, patients' self-rated satisfaction was 5.3±0.07 (range: 4-6). At the followup, partners' self-rated satisfaction was 5.1±0.09 (range: 3-6). The present clinical study showed that hyaluronic acid injection is a promising treatment for premature ejaculation. The effect of the procedure in the long-term follow-up needs to be clarified.

Malar augmentation with a polymethylmethacrylate-enhanced filler: assessment of a 12-month open-label pilot study.

Mills DC, Camp S, Mosser S, Sayeg A, Hurwitz D, Ronel D. Dr Mills is a plastic surgeon in private practice in Laguna Beach, California.

Aesthet Surg J. 2013 Mar;33(3):421-30.

Background: Most filler procedures in the United States are performed with hyaluronic acid (HA) derivatives.

Artefill (Suneva Medical, Inc, San Diego, California), the only polymethylmethacrylate (PMMA)-enhanced dermal filler approved by the US Food and Drug Administration (FDA), has been well tolerated by patients for treatment of nasolabial folds and has a safety profile similar to other approved fillers.

Objectives: The authors investigate the safety and efficacy of Artefill for malar augmentation.

Methods: This prospective, multisite, open-label study included a total of 24 patients with age-related lipoatrophy.

Only patients with mild to moderate lipoatrophy were considered candidates for treatment. Artefill was injected in the supraperiosteal layer of the malar region, at a maximum volume of 6 mL (3 mL/side). Touch-up injections were performed at weeks 4 and 6, up to a maximum total volume of 8.8 mL. Standardized assessments of results were made at 2, 6, and 12 months. Outcome measures included the Global Aesthetic Improvement Scale (GAIS), change in malar lipoatrophy grade, and patient satisfaction. Standardized photographs of each patient were collected.

Results: Average patient age was 48 ± 5 years. Average volume of injections was 5.55 ± 1.87 mL. Based on both the patient- and physician-rated GAIS, 95.8% of study participants were reported as being "improved" or "very much improved." The change in malar lipoatrophy grade was significantly improved from baseline to 1 year by 0.96 ± 0.98 (P < .0003). Patients also reported high levels of satisfaction, with 87.5% being "satisfied" or "very satisfied."

There were no reported adverse safety events in the study.

Conclusions: Artefill demonstrated improvement in malar atrophy with a high level of patient satisfaction and an excellent safety profile. The absence of any adverse events in our study patients was notable, and we believe this is a result of the uniform nature of the PMMA particles in the Artefill and the strict and sterile manner in which this PMMA dermal filler is produced.

Necrotizing Metachronous Facial Ulcerations After "Stem Cell Face Lift" Dobke M, Bailey J, Bhavsar D, Saba S, Mailey B. From the Division of Plastic Surgery, School of Medicine, University of California San Diego, San Diego, CA; and Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, KS. Ann Plast Surg. 2013 Mar 11.

INTRODUCTION: A 63-year-old woman underwent face and neck lift with autologous fat transfer-called by her physician a "stem cell face lift."

METHODS: Fatty aspirate from her abdominal wall was enriched by hyaluronic acid, triiodothyronine, thyroxine, insulin, dimethylaminoethanol, estriol, dexamethasone, indomethacin, and fibroblast growth factor before injection into the face.

RESULTS: At approximately 4-weeks postoperative, the patient developed facial swellings, erythema, necrotizing ulcers, and an orocutaneous fistula. New lesions continued occurring up to 16 weeks after surgery. After multiple surgical debridements and an oral course of rifampin, a decisive reduction in inflammation and healing was observed. Differential diagnosis included (1) mistaken transfer of allogeneic fat (ruled out), (2) toxic impurities in transferred material, (3) microbial contaminant(s) from multiple use liposuction cannula or tissue markers, and (4) endogenous anaerobic orofacial infection (history of previous radiation for tonsillar cancer and dental implants).

CONCLUSIONS: The most probable etiology was mycobacterial infection. This is based on a single colony of mycobacterium isolated, histologic finding revealing granulomatous inflammation, and the favorable response to rifampin. The patient underwent subsequent autologous fat transfers, which successfully reduced some disfigurement and scarring.

A Comparison of Cell-Enriched Fat Transfer to Conventional Fat Grafting after Aesthetic Procedures Using a Patient Satisfaction Survey.

Mailey B, Saba S, Baker J, Tokin C, Hickey S, Wong R, Wallace AM, Cohen SR. From the Division of Plastic Surgery, School of Medicine, University of California San Diego; and Faces, San Diego, CA. Ann Plast Surg. 2013 Mar 11.

INTRODUCTION: The role of regenerative cells in adult human fat is still unfolding. At present, limited clinical studies comparing patient satisfaction with cell-enriched fat transfer (CEFT) to conventional autologous fat transfer (AFT) for aesthetic indications have been performed. Herein, we present our data obtained from patient satisfaction questionnaires.

METHODS: Patients undergoing fat grafting received AFT or CEFT. Study participants were surveyed for overall satisfaction, symmetry, deformity, scarring, and pigmentation. Hospital charts were reviewed for complications, and patient survey responses between the groups were compared.

RESULTS: Between January 2009 and September 2011, 36 patients had 6-months follow-up and were mailed surveys. Of these, 17 (12 CEFT and 5 AFT) returned completed Patient Satisfaction Rating surveys. At a median follow-up time of 10.7 months, the overall mean satisfaction rate was 5.2 of 6 (5.3 vs 5.0 for CEFT and AFT, respectively, P = 0.42). There were no significant differences about deformity (5.1 vs 4.7, P = 0.50), symmetry (4.5 vs 5.0, P = 0.48), or scarring (5.3 vs 4.5, P = 0.23). However, pigmentation was improved in the CEFT vs the AFT groups (P < 0.001). No patients in the AFT group noted skin pigmentation improvement, whereas 7 of 12 receiving CEFT noted improvement in skin pigmentation.

CONCLUSIONS: Cell-enriched fat transfer to the face and body of aesthetic patients produces high satisfaction rates. Our preliminary data demonstrates similar satisfaction with regard to symmetry, scarring, and deformity in patients treated with CEFT versus AFT, without any complications. Unexpectedly, a clinical and statistical improvement in pigmentation was seen for patients treated with CEFT over AFT. Further studies need to be done to better understand this phenomenon.

Depilatory laser: a potential causative factor for inguinal hyperhidrosis: Report of three cases.

Obeid G, Helou J, Maatouk I, Moutran R, Tomb R. Department of Dermatology, H么tel-Dieu de France Hospital Affiliated to The Saint-Joseph University , Beirut , Lebanon.

J Cosmet Laser Ther. 2013 Mar 6.

Hyperhidrosis has recently been described as a novel adverse effect of laser-assisted hair removal in the axillary area. Inguinal Hyperhidrosis (IH) is a localized and, typically, a primary form of hyperhidrosis affecting the groin area in individuals before age 25. IH has been reported in the literature after traumas and as a dysfunction of the central sympathetic nervous system. To the best of our knowledge, IH has never been reported as secondary to laser-assisted hair removal. Herein, we report three cases of IH following depilatory laser of the inguinal zone.

Three female patients with no relevant medical history presented with the complaint of excessive sweating in the inguinal area after undergoing full bikini depilatory laser sessions. Although never described before, depilatory laser seems to trigger the occurrence of hyperhidrosis in the inguinal zone.

These Things Take Time: Logistics of Building a Laser Practice for the Treatment of Hypertrophic Burn Scars.

Hultman CS, Edkins RE, Cairns BA, Meyer AA. From the Division of Plastic Surgery and NC Jaycee Burn Center, University of North Carolina Health Care System, Chapel Hill, NC. Ann Plast Surg. 2013 Mar 28.

INTRODUCTION: Although lasers can improve burn scars, such treatment has not been adopted universally, due to operational challenges starting a practice and the perception that such a program is not financially viable. We report the logistics of building a laser practice for the treatment of hypertrophic burn scars.

METHODS: We analyzed the clinical, operational, and financial components of our laser practice, focusing on treatment of hypertrophic burn scars, using pulsed dye laser, fractional CO2 laser, and intense pulsed light. Cases were performed in an operating room, with anesthesia, after preauthorization. We examined professional charges and collections, case time, variable and indirect expenses, and breakeven volumes.

RESULTS: Our practice grew as follows: 2008, 1 case; 2009, 44 cases; 2010, 169 cases; and 2011, 415 cases.

Overall collection rate was 32.1%. Expenses incurred by the provider, per 8-hour session, included laser rental/lease ($2375), personnel salaries ($1900), and physician overhead ($808), for a total cost of $5083. Mean charge was $1642 per case; mean collection was $527 per case. Median case time (procedure plus turnover) was 40 minutes. In this model, breakeven volume is 9.7 cases per day; breakeven time is 49.7 minutes. Provider profit margin for 10 cases per day, or 83% capacity utilization, is $187 per day (income - expenses = $5270 - $5083).

CONCLUSIONS: Despite high costs associated with starting and operating a laser practice for the treatment of hypertrophic burn scars, a sustainable enterprise can be achieved when the provider has accrued enough volume to batch cases over an entire day. Critical to achieving breakeven is preauthorization, controlling overhead, and efficient throughput.

Metabolic and structural effects of phosphatidylcholine and deoxycholate injections on subcutaneous fat: a randomized, controlled trial.

Reeds DN, Mohammed BS, Klein S, Boswell CB, Young VL. Dr Reeds is an Assistant Professor of Medicine at Washington University School of Medicine, St Louis, Missouri.

Aesthet Surg J. 2013 Mar;33(3):400-8.

Background: Phosphatidylcholine and deoxycholate (PC-DC) injections are a popular nonsurgical method to eliminate unwanted fat. The safety and efficacy of this approach is uncertain.

Objective: The authors evaluate the effects of PC-DC treatments on body composition, adipocyte function, and mechanisms responsible for fat loss.

Methods: This randomized, open-label study enrolled 13 women with a body mass index (BMI) â&#x2030;¤30 kg/m(2) and lower abdominal subcutaneous fat suitable for small-volume liposuction. Patients were randomized by the final digit of their Social Security numbers and received between 2 and 4 PC-DC treatments, spaced 8 weeks apart. One side below the umbilicus was injected with PC-DC. The contralateral, control side received no treatment. Adipose tissue biopsies were performed on the treated side at baseline, 1 week after the first treatment, and 8 weeks after the final treatment. The primary outcome was change in adipose tissue thickness at baseline and 8 weeks after the final treatment.

Results: Seven women completed the study. Treatment with PC-DC significantly reduced the thickness of the anterior subcutaneous abdominal fat (P = .004). Adipose tissue showed rapid increases in crown-like structures, macrophage infiltration, and reduced expression of leptin, hormone-sensitive lipase, adipose tissue triglyceride lipase, and CD36. Plasma C-reactive protein, lipid profile, and plasma glucose concentrations were unchanged.

Conclusions: PC-DC injections can effectively reduce abdominal fat volume and thickness by inducing adipocyte necrosis. These treatments do not appear to increase circulating markers of inflammation or affect glucose and lipid metabolism. Level of Evidence: 3.

SOURCE: PubMed

Interesting News Articles You May Have Missed Due to global copyright laws the Consulting Roomâ&#x201E;˘ is unable to reproduce entire news articles; therefore we provide an abstract and a link to the original news article. Although every effort is made to ensure that these links continue to function, there are occasions when third party websites will remove or archive the news article, leading to a broken link. We apologise if you find such a problem, and woul d appreciate it if you would inform us by emailing admin@consultingroom.com so we can make every attempt to remedy it.

Strain Of Acne-Causing Bacteria Found To Actually Preserve Skin Everyone has acne-causing bacteria living on their skin, but researchers at the Washington University School of Medicine have identified that there are "good" and "bad" strains of the bacteria, which determine the frequency and severity of developing pimples. The findings, which were published in the Journal of Investigative Dermatology, reveal that not all acne bacteria trigger pimples, they even identified one strain that can actually help maintain healthy skin.

SOURCE: Medical News Today

Matrixyl: Scientists find 'miracle' anti-wrinkle ingredient in face creams DOES work Researchers have found the chemical Matrixyl, used in many creams, can nearly double the amount of collagen skin produces.

The "miracle ingredient" boasted about in many anti-wrinkle cream adverts may have been found by scientists.

SOURCE: Daily Mirror

Most Patients Found To Have A Successful Second Facelift 10 Years After First Performed an average of a decade after initial facelift surgery, a "secondary" facelift can achieve similarly lasting results with a low complication rate, according to a paper in the March issue of Plastic and Reconstructive SurgeryÂŽ, the official medical journal of the American Society of Plastic Surgeons (ASPS).

SOURCE: Medical News Today

Australia: Cut-price cosmetic surgery a risk to patients Dangerous cosmetic treatments are occurring daily, the head of Australia's peak body for plastic surgeons says. He has called for procedures being carried out in risky environments to be outlawed. Doctors have supported the call, with a senior research fellow from the University of Melbourne's centre for health policy, programs and economics saying the patients that came forward to complain were just ''the tip of the iceberg''.

SOURCE: Sydney Morning Herald

Lithera Initiates Phase 2b Clinical Trial of LIPO-202 Targeting Aesthetic Reduction of Subcutaneous Abdominal Fat Lithera, Inc., a clinical stage pharmaceutical company focused on lifestyle and medical indications in aesthetic medicine and ophthalmology, announced today that the first patient has been treated with LIPO-202 (Salmeterol Xinafoate for Injection) in its 500-patient Phase 2b "RESET" trial. LIPO-202, Lithera`s lead product candidate, is a novel injectable pharmaceutical product designed to produce localized reduction of subcutaneous fat.

SOURCE: PRNewswire

1 in 5 `unsuitable for cosmetic surgery - patients dangerously misinformed by salespeople As the country gears up for the results of a Government enquiry into cosmetic surgery due out later this month, the British Association of Aesthetic Plastic Surgeons unveils today the results of an internal poll of its members, which highlights the importance of true ‘informed consent’ on the part of the patient. The survey reveals how dangerously misinformed people undergoing cosmetic surgery can be when their consultations are held with brokers, salespeople, ‘customer advisors’ or even other medical professionals, rather than with the surgeon who is performing the operation.

SOURCE: BAAPS

TMB Cosmetic Surgery Discovers Fake CoolSculpting® Machines in Toronto Canada Renowned cosmetic surgeon Dr. Trevor Born warns beauty seekers: “These counterfeit CoolSculpting machines are dangerous and pose a great health and safety risk.” Consumers need to make more informed choices about their purchases in order to stem the illegal sale and trade of potentially dangerous counterfeit goods. In the case of CoolSculpting, serious harm can be caused to a person if the counterfeit machine is faulty, or if proper treatment protocol is not followed.

SOURCE: PRWeb

Women who wax or shave their bikini lines are more likely to get a viral skin infection, warn doctors Research published in the BMJ suggests that the 'micro trauma' caused by waxing and shaving can spread the highly contagious virus Molluscum contagium. 'Brazilians' and other pubic hair removal may increase the risk of a highly contagious viral skin infection, French researchers have warned.

SOURCE: Daily Mail

PIP breast implant patients should be referred for review, says GPC The GPC has urged GPs to ignore guidance from surgical associations asking them to examine patients affected by the PIP breast implant scandal, and instead refer patients for review in secondary care. The Chief Medical Officer advised GPs in a letter last year that they would be the first port of call for concerned patients and issued guidance on what symptoms to look for. But the GPC has now advised GPs to refer all PIP breast implant patients to a consultant breast surgeon for review.

SOURCE: Pulse

A new wrinkle for botox: Research reveals how botulinum toxins affect neuron survival Researchers from Harvard Medical School have investigated the effect that all seven botulinum toxins have on neuron survival. They have discovered that not all botulinum toxins are equally safe for neurons.

SOURCE: Medical Express

No Animal Testing Necessary With New Skin Sensitization Test In an advance in efforts to reduce the use of animals in testing new cosmetic and other product ingredients for skin allergies, scientists are describing a new, highly accurate non-animal test for these skin-sensitizers. Their study appears in ACS' journal Chemical Research in Toxicology.

SOURCE: Medical News Today

Advertisement ABC Cryo Premium The most powerful cooling system on the market The revolutionary cryogenic skin cooling device from ABC Lasers hygienically cools the epidermis, before and after treatment, and dramatically reduces pain for a wide range of aesthetic treatments including IPL, Laser Tattoo Removal, Botox®, Injections, Fractional CO2 Laser therapy, Skin Resurfacing and more ablative IPL procedures.      

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For more information see ABC Lasers’ website at www.abclasers.co.uk

Great Member Special Offer Receive a Free Pair of NoIR LaserShields® IPL Shade 3 Style 35 Goggles when you buy Yamamoto Patient Eye Safety Guards. *** OFFER EXTENDED! *** This great offer is only available to Consulting Room members.

The Yamamoto YL-800w safety eye guard provides high quality protection for your patients eyes when using IPL/Lasers/Radiofrequency and Microdermabrasion.

Suitable for combined Radiofrequency/Laser/IPL devices as they do not conduct any electrical current.    

Colour of eyecup: white Detachable and adjustable rubber strap Comes with nose bridge size medium (can be interchanged with small and extra large bridges included for tailored patient comfort) Softcase included

Purchase these superb Yamamoto patient eye safety guards for only £105.75 (inc. VAT) – that’s a saving of £17.63 on non-member prices already - and receive the NoIR IPL Shade 3, Style 35 goggles (worth up to £52.88) absolutely free!

Take advantage of this great offer!

For more information on the products and to discuss this and other great laser/IPL eye protection deals, call us on 01788 577254.

Equipment Sales SaveOnKit pride themselves on excellent customer service. They stock a large inventory of high quality medical, dental and beauty equipment at vastly reduced prices. They are very pleased to offer a high quality service for all your equipment needs. All orders are processed quickly and sent to UK addresses free of charge; they will ship worldwide.

Below are the various devices that they currently have for sale.

Lutronic Mosaic non-ablative Fractional Laser Er:Glass skin-resurfacing System In good condition and full working order For Sale at £14,000 + VAT *PRICE REDUCED £13,300 + VAT* More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=506 Chromogenex NLite V Pulsed Dye Laser Hair removal Rejuvenation System In good condition and full working order For Sale at £3,800 + VAT More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=458 Lynton Lumina IPL Laser Hair Removal + YAG Skin Rejuvenation Acne Beauty System In very good condition and full working order For Sale at £9,500 + VAT More info - www.consultingroom.com/services/equipment-display.asp?equipment_id=651 Depilex Dermapeel Professional Microdermabrasion System In good condition, full working order For Sale at £912 *PRICE REDUCED AGAIN £570 + VAT* More info – www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=537 RVB active 7 touch beauty machine facial toning professional System This unit has had very minimal use and the condition reflects this some items are new in original packaging For Sale at £475 More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=599 Yperion L900 SR PSR002012 beauty treatment head Brand new, in original box. For use with L900 Hair removal and photolifting beauty machine.

For Sale at £912 *PRICE REDUCED £760* More info – www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=539 Eporex K69 Mesotherapy Cellulite Fat Reduction and Skin Rejuvenation System In good condition and full working order, costs £20,000 brand new For Sale at £8,400 + VAT *PRICE REDUCED AGAIN £3,166 + VAT* More Info - http://www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=446 E Light IPL Laser Hair removal Rejuvenation Wrinkle Vascular salon beauty System For Sale at £3,800 + VAT More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=496 Cosmopro Eye-O-Matic facial restore & skin rejuvenation Full working order. Helps restore and rejuvenate the face and delicate eye contour maximising product absorbency.

For Sale at £285 + VAT More info – www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=598 Nemectron Noblesse for Face and Body Facelift Wrinkles In good condition and full working order For Sale at £1,500 + VAT *PRICE REDUCED AGAIN £950 + VAT* More info - http://www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=437 Beauty Scope BS-888 Skin and Hair Analyser Intelligent skin/sebum/moisture/pigment diagnosis system For Sale at £300 + VAT *PRICE REDUCED £237.50 + VAT* More info - http://www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=438

Over line Xilia Stim 8 Face + Body Skin tightening System In good working order complete with attachments, cables, user manual and stand.

For Sale at £1,400 + VAT *PRICE REDUCED AGAIN £1187 + VAT* More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=434 Nemectron Nembrasion Professional Microdermabrasion System In good condition and full working order For Sale at £1,425 + VAT More Info - http://www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=439 Smart Peel Microdermabrasion with LED Light Therapy professional system In good working order complete with attachments For Sale at £2, 280 *PRICE REDUCED £1,425 + VAT* More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=535 Caci Future-Tec Skin Rejuvenation Beauty Machine In good working order complete with attachments - Vaculase, Microlase, Actuator attachments & foot pedal For Sale at £1,700 + VAT More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=367 Bio –Therapeutic L.A. Smile Teeth whitening system Cost £12,600 new in 2006. Current model, in good condition, had very little use.

For Sale at £3,000 + VAT *PRICE REDUCED £1,900 + VAT* More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=325 Biotec Bioskin LAS Skin Resurfacing Microdermabrasion System Bioskin Las Technology utilises a unique two-element approach to activate skin regeneration.

For Sale at £1,425 + VAT More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=344 Nora Bode OxyJet Star Oxyaroma Oxyspray facial and body treatment salon machine In very good condition, had had low usage and in full working order For Sale at £7,500 +VAT *PRICE REDUCED £6,175 + VAT* More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=516 Pollogen ReGen Tripollar Radio Frequency skin body facial beauty machine salon Very good condition, full working order. Unit was removed from a small clinic which closed shortly after it opened For Sale at £8,000 +VAT *PRICE REDUCED AGAIN £7,125 + VAT* More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=515 No+Vello IPL Laser Hair Removal & Skin Rejuvenation Treatments Beauty System In very good condition and full working order. Supplied new in 2010 For Sale at £6,650 + VAT More info - www.consultingroom.com/services/equipment-display.asp?equipment_id=638 Beau Visage Facial Skin Imaging Diagnosis Treatment Beauty Therapy System In very good condition and full working order For Sale at £3,800 + VAT *PRICE REDUCED £3,325 + VAT* More info - www.consultingroom.com/services/equipment-display.asp?equipment_id=640 CACI Flash 1 IPL Hair Removal & Skin Rejuvenation Acne Treatments Beauty System In good condition and in full working order For Sale at £4,000 + VAT More info - www.consultingroom.com/services/equipment-display.asp?equipment_id=649 New Meridian Lapex BCS Pro 2000P Liposuction Cellulite Fat Laser Beauty Machine New in original packaging. Supplied to a clinic which closed shortly after opening in Late 2011. Unit never used.

For Sale at £9,500 + VAT More info - www.consultingroom.com/services/equipment-display.asp?equipment_id=677 Biorem Skin Master Plus Multi-functional Ultrasonic Beauty Treatment Machine In good condition and full working order For Sale at £1,330 + VAT More info - www.consultingroom.com/services/equipment-display.asp?equipment_id=678

Clinical Lasers are a team of dedicated professionals with a single vision, to change the face of the Clinical Laser supply industry by leveraging value from all aspects of the supply chain using cutting edge proprietary technologies, unmatched knowledge assets and a repository of thought leadership techniques that will deliver considerable advantages to your business. Our team consists of Technology Evangelists, Medical Professionals and Product Specialists who provide pre and post sales support. We are in the business of "Care Pathways". What this means to you is additional value by way of total quality outcomes instead of buying a box with "theoretical" treatment protocols. When you procure from us you own a part of what we do, which is to research, develop and create meaningful ways of helping people to do get new and empowering results, or "get better" faster, more comfortably. We are constantly developing new proprietary Low Level Laser (LLLT) systems to treat a whole number of conditions. Below are the various devices (new and ex demo) that they currently have for sale.

Contact: Steve Shawsh and the Online Sales Team, 0844 589 6378, sales@clinicallasers.com

Ex Demo Sigma Lumislim 48 Retails at £3,490. Save £2,290 !! Only ever used as a demo machine.

Sigma LumislimPro 48 comes with 4 paddles with 8 Laser Diodes plus 2 small Lymph paddles. That's 6 in total - Available now, best value on the market.

This is the model everyone has been waiting for. Maximise treatments and results.

With more options and a choice of configurations to suit your needs, Lumislim continues to evolve whilst gaining a larger slice of the market daily.

Lumislim will augment your business and keep you at the forefront of your market, Priced sensibly, LumiSlim gives you the opportunity to offer treatments at a price that your clients are comfortable with, Non invasive laser liposuction has taken the world of cosmetic surgery by storm.

This method offers painless fat reduction and body sculpting . Two of the most important benefits here include the quick visible results, as well as the fact that non invasive laser lipo is completely safe, with no down time.

Price: £1,400 plus VAT (inc. training)

Sigma LumiVeress F-Light + RF + Laser Combi Introducing the latest combi package F-Light + RF + Laser tattoo removal machine all accessed for one easy to use touch screen interface.

Main product features:  Treat More conditions and offer more services  Keylock protection  Long lamp life 150000 pulses  Dual Colour touch screen  Intuitive easy to use menu  High quality impact resistant plastic case Applications: Hair removal, Removing Freckles, Treating skin pigmentation, Acne repair, Sun damage, Vein removal, Skin rejuvenation, Wrinkles, Liver spots, Stretch Mark reduction and Soft Peel

Price: £5,4000

New Sigma Nexus 2 with RF and F-light technology IPL with the new faster F-light technology, RF for non surgical face lifts.

Touch screen colour user interface, 1 touch treatment buttons Large spot size, German lamp Multiple income streams

Price: £3,799.00

Sigma Hanya IPL with the new F-Light technology The very latest in IPL technology comes built into the brand new Sigma Hanya 2.

Based on our top selling Hanya model, this pro series machine is a full 2kw machine with 2 hand pieces, meaning more treatments and more revenue.

Price: £4,8000 (VAT Included)

Sigma LumiSpa 1 Laser Lipo The first low cost professional Laser Lipo system. Now you can offer this revenue busting machine with total peace of mind and a money back guarantee, if it does not pay for itself in its 1st year. Add Laser Lipo to your treatment menu and watch the bookings flood in. What’s more, this machine comes with training from a Harley Street Practitioner and Registered Nurse who has treated hundreds of patients.

Price: All this and free delivery for just £1,350.00

Sigma Sapphire Body Contouring System Question ......which is best Laser Lipo?

Cryo lipo?

RF Contouring?

Ultrasound Cavitation?

Answer .....All of the above!

All of the beneifts of Laser Lipo with the combined advantage of RF for targeted fat loss, offering fast results.

6 large Diodes per paddle plus RF, Cavitation and Cryolipo, means that Sapphire is simply fantastic value. A simple easy to user touch screen user interface allows the user to quickly provide a quality service and maximise income potential. No other vendor offers such a complete and powerful solution in one package.

Sigma Sapphire comes with 4 paddles, each with 6 large diodes, offering more in terms of value than any other fat loss system on the market.. This is our new mid range solution that offers those with a lower budget the opportunity to compete with high end Lumislims, Ilipos or Strawberry.

Sigma Sapphire is simple to use but more powerful at delivering results as any other machine on the market. It's simple touch screen operation makes it the perfect choice for those who want a machine that is as sophisticated as high end machines, but at a sensible price.

Price: £5,200.00 plus VAT (Including delivery & training)

For more information, please see www.clinicallasers.com

Visit www.consultingroom.com/services/equipment.asp for a full list of classified sales.

Classifieds FOR SALE N-lite V Pulsed Dye Laser – Chromogenex Skin Rejuvenation, vascular and acne treatment laser.

Very good working order.

Included - fibre optic cable, vascular and acne treatment hand pieces, foot switch, 2 pairs eyewear plus black out goggles.

Price: £5,000, offers considered Contact: Emily Wilson, 01752 561738, info@laserasesouthwest.co.uk

Lumenis Quantum SR (560nm) IPL System Year 2000 - Shots: 31,115 Ask about service, training and financing options.

Includes: 560nm treatment heads, calibration disk, eyewear and operators manual. Upgradable to HR (hair removal). Integrated cooling. Touch screen. Laser safety glasses.

Whether your practice needs a full time system for skin treatments using photorejuvenation or you want a single system that can treat a multitude of applications, the Quantum allows you the flexibility to build the system that best meets the need of your practice. As your practice changes, the Quantum platform can expand to meet your growing needs. True versatility and simplicity together.

Treats: Rosacea, Telangiectasia, Vascular Lesions, Hemangiomas, Port Wine Stains, Leg Veins ,Solar Lentigines, Epidermal Pigmented Lesions, Dermal Pigmented Lesions, Skin Treatments Using Photorejuvenation.

Price: £13,000 Contact: Edmond, 07876687610

I-lipo ( 8 pads ) machine from Chromogenex Selling a hardly used I-lipo ( 8 pads ) machine from Chromogenex, bought about one year ago.

Original price was £15000 plus VAT, selling for £8000. Will consider offers......if not too far from asking price.

Please contact for any questions....

Price: £8,000 Contact: Katia, 07775993675, katia81b@libero.it

Alma Accent Ultra Very good condition. 2009. From Alma Lasers, Accent Ultra Ultrasound plus Radio Frequency (RF).

Includes 2 heads: 1) Ultrasound fat reduction head 2) UniLarge RF head

Price: £13,990 plus VAT

Alma Accent XL Very good condition. 2009. From Alma Lasers, Accent Excel Radio Frequency (RF).

Includes 2 heads: 1) UniLarge 2) Uniform

Price: £14,990 plus VAT Contact: David, 07812 166168

Tri Pollar TriPollar Radio Frequency (RF) technology is an innovative, proprietary 3rd generation RF technology. TriPollar overcomes the limitations of previous mono-polar and bi-polar technologies. Simple to use and extremely efficient, TriPollar treatments deliver immediate visible body and facial contouring effects from the first treatment – and longlasting results without surgery or downtime.

Recently Serviced and updated in Israel

Price: £9,900 Contact: Dr K Sarmand, 07941213114, kayvan@sarmad.net

For more second hand and ex-demo aesthetic equipment please visit www.consultingroom.com/services/equipment.asp.

Advertisement S.A.F.E.â&#x201E;˘ System Surgical Smoke Evacuation The Smoke Evacuator vacuums the plume created by laser and electrocautery treatments such as hair removal, tattoo removal and erbium procedures and protects physicians and staff performing these operations.

The U.S. FDA approved and European CE marked SAFE System smoke evacuator is built to handle any type of surgical smoke. Costs are low to purchase and operate.

Application:

The removal and filtration of laser and surgical smoke

Used by:

Hospitals, Plastic Surgeons, Cosmetic Surgeons, and more

Economical:

Due to the real time filter life pressure gauge

Compact:

9" x 9" footprint, 14" high

Quiet:

Less than 52dBA, quieter than the competition

Filtration:

ULPA: 99.999+%@ 0.12 micron

Weight:

24 lbs.

Electrical:

100-120 VAC, 50/60 HZ 220-240 VAC, 50/60 HZ

Regulatory:

UL, CSA, CE

Tubing:

Vacuum Tubing 7/8" x 8'

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