The Consulting Room™ Industry Magazine Edition 111, August 2012

[COVER]

From The Editor's Desk Welcome to The Consulting Room™ Industry Magazine For August 2012 Like our Wild West themed cover?

In this issue for August, our Feature Article looks at the clean up going on in the so called Wild West Aesthetic Industry with a round-up of the recent changes surrounding the remote prescribing of botulinum toxins, including the background, the industry comments and some discussions on the future.

The Consulting Room™ are also feeling very patriotic and would like to congratulate Team GB on their outstanding performances at London 2012!

Latest News this month includes details of a new ‘implant’ register from dermal filler manufacturer Aquamid, plus the launch of a great e-book on PR for cosmetic practitioners from the voice of BAAPS Tingy Simoes. We also take a look at some recent adjudications by the Advertising Standards Authority against Health & Beauty advertisers. Our Legislation section details the new Chair of the Treatments You Can Trust Governance Board and we have details of a worrying cold calling scam for fake charity advertising in our Business Corner.

Lorna Jackson

As always the magazine is packed with Clinical Information, Equipment Sales and Interesting News Articles and Blogs That You May Have Missed.

Thanks For The Response But WE WANT MORE of Your Before and After Images More and more consumers want to see the results achievable with medical aesthetic and cosmetic surgery procedures on real patients before they choose which treatment option to invest in, particularly when many options and technologies exist to correct the same indications.

So to get REAL PATIENT images we need to go to REAL CLINICS – that’s you, our members. We need before and after photographs that we can add to both our surgical and non-surgical image galleries within our Treatment FAQ pages.

Specifically we have a large number already for the more common facial aesthetics of dermal fillers, botulinum toxins etc. but are keen to expand our content for areas such as medical skin needling (dermarollers), laser treatments and surgical procedures such as face lifts and breast augmentation. We’ll be pleased to look at any before and after photos which you have available, particular brand, product, device specific ones or interesting treatment combinations so don’t be shy in sending them over or pointing us to your website.

All supplied images must be your own (no stock manufacturer images), and you must have permission from your patient for their republication. Any which are used on our site will carry courtesy statements, which can either be for your clinic or for the particular practitioner who treated the client in the photograph, please advise.

If you have any before and after images which you would like featured on The Consulting Room™, then please email them to the Editor, lorna@consultingroom.com, and include annotations regarding the time frames of the photos, number of treatment sessions (as appropriate) and the area(s) treated. We cannot guarantee that all photos submitted will be used on the site but the more your send us the more chance you will have something which we need!

Consulting Room Takes on the ‘Coast to Coast’ Challenge The Countdown Begins! Less Than 3 Weeks To Go! PLEASE SPONSOR OUR TEAM

Some of The Consulting Room Team, including Ron Myers, Martyn Roe, Dan Huxley, Danny Large and Danielle Lowe will be taking part in the Coast to Coast (C2C) cycling challenge on 31st August & 1st September 2012, as Editor I’m washing my hair on that day! They will be joined by Adrian Myrick, Paul Simmonds and Gary Barker, the husband of UK General Manager Michaela Barker from Syneron Candela.

The C2C 2012 takes two days, riding through the Northern Lakes and over the Pennines. It is said to be the ultimate ride through the heartlands of unspoilt Lakelands – through villages just off the beaten track.

From the start in Whitehaven, the team will cycle over Whinlatter Pass to Keswick then on to Penrith and then overnight in Garrigill at the 77 mile halfway point. Bright and early the next day they will negotiate four big hill climbs as they travel through Stanhope, Consett and on to Newcastle and Tynemouth where they will finish by dipping the front wheels of their bikes in the sea – and no doubt themselves!

The C2C is rightly considered the most popular of Britain’s great shore-to-shore odysseys.

I am assured that training schedules are running to plan and all are gearing up to get fit for the challenge, with the ultimate obstacle – how not to get a sore bottom being hotly debated!

The team will be raising money for various charities close to their hearts including Chester Childbirth Appeal and a fund for a specially designed wheelchair for a lady in Rugby who contracted a rare condition called arachnoiditis following complication after back surgery.

To donate and sponsor our crew, please visit this Virgin Money Giving page. Be sure to include the Gift Aid.

Some Recent Blogs You May Have Missed Surgeon, Doctor, Dentist - are they really who they say they are?

By Lorna Jackson The Royal College of Surgeons (RCS) recently called on the government to legally protect the title of “surgeon” in the interests of patient safety, as currently there are no restrictions on who can use it. Similarly others specialties are using titles which may be either confusing to the public or blurring the lines between professions, such as dentists referring to themselves as doctors when practising in facial aesthetics. www.consultingroom.com/Blog/Display.asp?Blog_ID=302

Consent to Cosmetic Surgery

By Nigel Poole Q.C. Patients and surgeons should be aware that much of the litigation that arises out of cosmetic surgery concerns pre-operative advice rather than the performance of the surgery itself. I have conducted many cases involving the issue of consent to cosmetic surgery.

Here are a few matters for patients, surgeons, litigants and their representatives to consider... www.consultingroom.com/Blog/Display.asp?Blog_ID=308

Face Lift Bungee: the latest craze for knife free nip `n` tucks

By Lorna Jackson A woman in American claims to have invented the most minimally invasive facelift of them all with the bizarrely named Face Lift Bungee! www.consultingroom.com/Blog/Display.asp?Blog_ID=307

A Bum Note: What is causing an increasing number of women to turn to surgery in search of the perfect bottom?

By Edward Roberts-Beardsell The Perfect Bottom: So when did this obsession for the perfect bottom begin? Perhaps as early as the 1960s when the male population lusted after celebs such as Marilyn Monroe and Brigitte Bardot? Or back in the 80s, when 'girls-next-door', Felicity Kendal and Anneka Rice were voted rears of the year? www.consultingroom.com/Blog/Display.asp?Blog_ID=306

Don’t Forget to Visit Our Cosmetic Videos Site With ‘Members Only’ Content The Member’s Only section of our new specialist video website – www.cosmeticvideos.co.uk contains videos that are more instructive and aimed at purely at medical professionals, relating to detailed explanations of concepts, techniques, procedures, protocols and dealing with problems.

If you haven’t accessed this section already, it’s quick and easy.

Simply Register using your Consulting Room membership information (username or email address and password) and if everything matches you will be authorised automatically and you can then log in to the Cosmetic Videos Members Only Area whenever you like; all free of charge to Consulting Room members.

Members Only Featured Video This Month (Log-in required):

EndyMed PRO Facial Tightening Training Video A training video illustrating the use of radiofrequency device EndyMed Pro as a facial tightening treatment.

Looking For Best Prices on Toxins & Fillers?

Compare Prices With The Consulting Room™ The Consulting Room™ Product & Price Comparison Charts for Dermal Fillers and Botulinum Toxins have been recently updated with some of the head line products highlighted below. Located in the Product Comparisons* section within our Members Area 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. (*Login required.)

Prices ex.VAT Botox 100U Azzalure 2 x 125U (Twin pack) Restylane 1ml Juvéderm Ultra 2 (2 x0.55ml)

Wigmore Medical

Health XChange

Med-fx

N/A £100.00 4+ packs @ £91 each Buy 10 double packs get 1 vial free # £89.50 Buy 8 @ £67 and get 1 free # N/A

£140.00 N/A

£145.00 £95.00

£83.24

£98.11

£96.88

£93.35

st

# Offer ends 31 August

Nip & Tuck - Facts & Stats

1 in 10

€92,450

men admit using cosmetic treatments bought online & self administered; like teeth bleaching, dermal filler & tanning injections

2011 pre-tax loss for Harley Medical Group Ireland Ltd following PIP implants scandal, (vs 2010 pre-tax profit €232,642)

Source: Sovereign Health Care Survey

Source: Irish Independent

£250,000 Compensation awarded following UK ‘botched’ laser eye surgery procedure which left women with blurred vision.

Source: Daily Mail

48%

‘toe-besity’

UK sales growth of British made breast implants by Nagor following the PIP breast implant scandal.

The latest buzzword to describe the rise in surgical procedures on ‘fat’ toes to cosmetically reshape and reduce the width of toes!

Source: Scotsman

Source: Daily Mail

www.syneron-candela.co.uk

Latest News Aquamid™ Takes Ethical Stance With Launch of Dermal Filler Patient Implant Register The makers of long term volumising dermal filler brand Aquamid have taken a leaf out of the book of learning following the PIP breast implant scandal and have launched a formal patient safety register specifically for their product.

Contura UK insist that they have done this primarily for ethical reasons in terms of patient safeguarding as in doing so they have made it compulsory to be on the register of specialist UK practitioners and trained in the provision of Aquamid treatments before anyone can purchase, and thus administer the product. Records must then also be kept within the online patient register, which came into force in March 2012 and will overseen by an independent surgical advisory board.

Aquamid, a polyacrylamide gel based filler used for indications such as facial volumising, hand rejuvenation, correction of minor deformities and body contouring is only available through supply either direct from Contura UK or through pharmacy company Wigmore Medical Ltd. With a smaller number of UK certified Aquamid users (including cosmetic surgeons, cosmetic doctors and registered nurses) it is in fact easy for the manufacturers to keep track of who is using their product; particularly when compared to more widely used hyaluronic acid based products where records would be almost impossible to audit due to the number of users and the complex supply chain, yet by its long term nature in line with an implant, such historical record keeping of Aquamid use is seen as far more appropriate than for a product which the body metabolises in less than a year.

Plastic Surgeons Mr Dalvi Humzah and Mr Chris Inglefield, who also provide the UK training in the use of Aquamid have advised Contura UK on the structure and functionality of the new Patient Safety Register which allows all registered practitioners to access patient history based upon unique patient ID information which is given to individual patients upon their first treatment via a handy credit card sized record. Detailed information about treatments (amount of product, placement etc.) and top-ups, as well as any adverse event reporting can also be tracked via the register.

According to Brian Whitley, Director of Contura UK Ltd, this scheme is also leading to better patient loyalty to the Aquamid brand and more importantly the combination of a list of approved users and a patient register has enabled them to investigate and disprove cases where patients have complained direct to Contura about a treatment with ‘Aquamid’ when in fact the practitioner has been passing off imported Chinese product as the genuine product to the patient. The records documenting the use of Aquamid meant that Contura were able to report the practitioner to the appropriate authorities for passing off a product as the genuine brand unbeknown to the receiving patient.

I believe that Contura UK are to be commended for what is a step in the right direction for responsible industry practice in terms of patient safety, which ought to be adopted for the tracking of a variety of products and devices used within everyday medical aesthetic practice in the UK. In fact Mr Chris Inglefield agrees having said; "a formal register of all long term implants is needed to ensure that there is full traceability from surgeon back to manufacturer. There is no formal breast implant register in the UK and manufacturers and surgeons would be wise to work together to create one."

Who knows where Contura UK leads, others may follow. It all helps.

Anyone interested in training in and providing Aquamid can call 0208 742 1358 or visit www.aquamid.co.uk

PR ‘Guru’ Tingy Simoes Launches New e-Book Tingy Simoes is owner and MD of Marketing and PR agency Wavelength Marketing Communications, best known as the voice of the British Association of Aesthetic Plastic Surgeons (BAAPS).

She has extensive experience from the world of PR for medical professionals in both the UK and the USA and has written a book to pass on some of her knowledge direct to those operating businesses in the medical aesthetic and cosmetic surgery arena.

“With the advent of 24-hour news cycles, the requirement for expert comment in the media has exploded. Medical spokespeople are regularly approached to demystify new technology and advances, or give their learned opinion regarding the latest developments.

Specifically in cosmetic surgery and medicine, relatively lax regulation has led to a proliferation of unscrupulous behaviour, aggressive marketing and a rise in horror stories about people going to backstreet clinics for everything from Botox to buttock enhancement – creating an urgent, ever-increasing need for reputable spokespeople to provide reliable guidance and advice to the public”; notes the PR savvy Tingy.

Publishing in September 2012 and available from Informa Healthcare for just £50, Tingy’s 160 page book (available as an e-book) is an invaluable resource and guide on how to manage difficult situations to prevent them becoming disasters.

"How to Cut it in the Media" will cover both ‘Reactive’ media relations, i.e. when the press need (usually urgently) comment from a clinician or professionals in the healthcare arena, as well as ‘Proactive’, when physicians themselves voluntarily seek to liaise with the media to highlight an issue of public interest – or to raise their own personal profiles. The book offers a guide to knowing and understanding journalists’ motives; the press outlets and their audiences; trade v consumer press, national v regional, encompassing print, radio, television and the latest in social media. It also outlines the pros and cons of ‘sticking one’s head above the parapet’ and includes guidance on interviews and how to deal with difficult, intrusive and even accusatory questions.

This fascinating guide also highlights how to maximize good publicity and ensure good self-marketing, particularly through the use of social media.

This is of as much interest and relevance to seasoned medical and surgical professionals as to those new to the area; nurses and other practice personnel. Written in laymen’s terms, the handbook will follow a similar style to practical ‘DIY’ and in the straightforward, plain-speaking spirit of ‘Dummies’ guides, with top 10 lists, case studies and humorous anecdotes.

“Questions that strike terror in the hearts of all PRs are 'why wasn't I in that?' and 'why was he/she quoted and not me?' I've created this guide, in essence, as an answer to those queries. This e-book addresses - in a light hearted manner - what the press needs and why they would speak with you, but also why they may choose another expert instead of you!

After a decade of running my own healthcare PR agency, and focusing particularly in cosmetic surgery, I'm delighted that Informa Healthcare saw the potential in this project and believed in my expertise.

I'm hoping that doctors and surgeons will find it useful as well as an enjoyable read"; concludes Tingy.

Now you know what to ask Santa for in your stocking this year!

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: Botox advertised on websites – the ASA will investigate if they’re highlighted to them!

The website www.anesis.co.uk, which promoted spa treatments, included a page that was headlined "Facial Rejuvenation Clinic - Botox Treatments". Further text stated "Available now at our Clapham Branch in London. Dr. Natalia (Natty) Burgess BDS is a qualified Dental Surgeon … Natty is specially qualified in facial injection rejuvenation treatments and loves seeing the renewed confidence that people gain from the results. Natty says “Facial injection rejuvenation treatment is not about 'stopping facial expression' or 'freezing the face' … The goal is to gently slow down and/or reverse much of the visual impact of wrinkles appearing on the face over a number of years, and can offer a long term solution to these issues. When applied with the care and attention of an expert, patients will enjoy a greatly rejuvenated confidence both privately, and in their public appearance."

The advert gave details of the types of wrinkles that could be treated with Botox: frown wrinkles, forehead wrinkles and eye wrinkles. The cost of treating one, two or three areas was stated. The advert also included a video, which showed Dr Burgess preparing a patient for the treatment. The patient was also shown discussing the treatment afterwards.

The complainant challenged whether the advert was irresponsible, because it advertised a prescriptiononly medicine (POM) to the public; and used a health professional to endorse a medicine.

The ASA upheld both complaints and although they acknowledged that Anesis Spa were willing to amend their website advertising. They noted, however, that they offered Botox treatments and that the claims in the advert included references to the benefits of Botox which they considered promoted the use of Botox to the public.

They considered that it was acceptable for a website to refer to the POM as a treatment option, presented in the context of the promotion of a consultation where a range of therapeutic options would be discussed, provided the focus was on the promotion of the consultation rather than any associated POM. They considered, however, that those, and other claims in the advert, went beyond balanced and factual references to the POM as a treatment option, presented in the context of the promotion of a consultation where a range of therapeutic options would be discussed. Because it promoted the use of a POM to the public, they concluded that the advert breached the Code.

They also noted that the advert included quotations from a qualified dental surgeon, whose professional credentials were detailed and who was pictured and also appeared in the video on the website. They noted that Botox was a POM and considered the overall impression of the advert was such that it was likely to be interpreted as suggesting a qualified dental professional endorsed treatment using the POM and they therefore concluded that the advert breached the Code for responsible advertising.

The ASA stated that the advert must not appear again in its current form and told Anesis Spa to ensure they did not advertise POMs to the public in future and to ensure future advertising did not use health professionals to endorse medicines.

Full Adjudication

Hair raising evidence required to satisfy the ASA The website for the Belgravia Centre, www.belgraviacentre.com, stated "The primary hair loss treatments that form the core of most of Belgravia 's hair loss treatment programmes are medically proven to prevent hair loss and regrow hair and most men who use our treatment combinations will achieve this goal ... How We Prevent Hair Loss and Regrow Hair for Most Men - Firstly, it is important that you know exactly why genetic male pattern hair loss takes place - There are enzymes in men and women who are genetically predisposed to hair loss ..."

The complainant challenged whether the advertiser’s claim to "Prevent Hair Loss and Regrow Hair for Most Men" was misleading and could be substantiated.

The Belgravia Centre said that the website page referred directly to the "primary treatments". They said those treatments were Finasteride and Minoxidil, which were two clinically proven, licensed treatments for hair loss, and the HairMax LaserComb, for which they also believed there was clinical evidence for hair loss prevention and regrowth. Because of that, they considered that the claim "Prevent hair loss and regrow hair for most men," which they said referred only to men who used their treatment courses and which they said was made about those products, was factually correct.

The ASA upheld the complaint and noted that Finasteride and Minoxidil were licensed treatments for hair loss and that clinical trials had demonstrated both to be effective in improving hair growth, with the best effects obtained if they were used at the earliest possible stage of hair loss. They noted that a previous ASA adjudication, Health Innovations, published in January 2012, had found that the LaserComb had been clinically proven to promote hair growth but that the evidence did not suggest that the improvement was significant to the user in those cases. They therefore considered that the wording of the Belgravia Centre's claims went beyond the claims the ASA had previously accepted.

Furthermore, while they accepted that Finasteride and Minoxidil were effective treatments for hair loss, they considered that advertisers needed to hold additional evidence if they wanted to claim that effective treatment was achieved through their programmes rather than the use of Finasteride or Minoxidil alone.

Because Belgravia had not supplied evidence that hair loss would be prevented and hair would regrow in most men if they used their treatment programmes, or evidence for efficacy claims for treatments or methods in addition to Finasteride or Minoxidil, they concluded that the Belgravia Centre had not substantiated the claim and that it was misleading. The advert must not appear again in its current form.

Full Adjudication

Twitter and marketing communications, make sure you make it clear!

Two tweets posted from Gemma Collins' Twitter account stated "In @Toniandguylside having such a wonderful time defo got my hair back to good condition 10% off call today and quote #gemma x" and "10% off @Toniandguylside I have the most amazeballs hair colour and condition best salon ever call and say #gemma for discount xx".

The complainant challenged whether the tweets were marketing communications, and should therefore be identified as such.

Toni and Guy (Lakeside) Ltd (T&G) said that Gemma Collins had visited the salon for an appointment and that they had decided to waive the cost of their services. They said she had been pleased with the service provided and it was therefore suggested that she tweet about it. They said Gemma had asked whether she should mention a discount and it was agreed that a discount should be offered. They said the tweets had been compiled by Gemma on the spur of the moment and that they were not part of any formal advertising campaign. They believed that, whilst the tweets did not include the terms "marketing", "sponsored" or "advertisement", the mention of a 10% discount made it clear that the tweets were marketing communications.

The ASA upheld the complaint and considered the average Twitter user would follow a number of people on the site and they would receive a number of tweets throughout the day, which they might scroll through quickly. They noted the Code did not just require adverts to be identifiable as marketing communications but that they must be obviously identifiable as such.

The tweets appeared to have been written on a spontaneous visit to the salon and users could have interpreted them as referring to a pre-existing 10% off sales promotion, which Gemma Collins had herself taken advantage of on her visit. The tweets did encourage users to quote “#gemma” but, in the context of the whole tweets, users could have overlooked the significance of that or not understood that it related directly to Miss Collins. In the absence of an identifier such as “#ad”, they considered the tweets were not obviously identifiable as Toni and Guy marketing communications and therefore concluded they breached the Code.

The adverts must no longer appear and the ASA told Toni & Guy to ensure that its advertising was obviously identifiable as such.

Full Adjudication

New Product Reviews Introducing a revolution in Antioxidant Skincare: Rechargeable Vitamin C™ by Medik8® Medik8 will soon be introducing its latest innovation in Vitamin C technology: CEThione™, a radical new concept in skincare; Rechargeable Vitamin C™.

Vitamin C is available in many forms and it is clinically proven to have an anti-ageing effect on wrinkles, but L-Ascorbic Acid (the bioavailable form) most commonly used in skincare is incredibly unstable and oxidises easily in water turning it from being an antioxidant into a pro-oxidant which means you are applying free-radicals to your skin!

Because of the risks associated with unstable L-Ascorbic acid products, Medik8 have responded to consumer demand for a water-based vitamin C product and have developed a highly stable L-Ascorbic acid complex that is 100% stable for two years.

After more than 3 years of research and development, Medik8 scientists led by Founder Elliot Isaacs, have mimicked how the body naturally keeps vitamin C stable in the skin.

That is, the vitamin C is “recharged” by having two antioxidant ‘buddies’ in solution with it.

They are vitamin E and Glutathione. These three antioxidants, when in perfect balance, work in such a way as to recharge each other so that they stay potent and active while on the skin and exposed to the atmosphere.

CE-Thione™ is the most effective way to deliver a stable form of Vitamin C while guaranteeing that it works at its highest potential in the skin. It helps neutralise free radicals, build collagen, and provide high antioxidant protection.

CE-Thione™ helps improve the appearance of skin tone, texture, minimise pigmentation marks and early signs of skin ageing. All in a luxurious serum that smells great and does not feel greasy - a common complaint with first generation stable water-based vitamin C products so there is no compromise between elegance and efficacy!

CE-Thione™ has been formulated for daily (morning) application to the skin. It is suitable for any skin concern with ageing. Not only is it 100% stable for 2 years but it sells for the price of a normal premium serum, (RRP £69 for 30ml).

This new Medik8 product will be available from UK distributor www.skinbrands.co.uk.

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Feature Article Cleaning Up The “Wild West Aesthetic Industry”...

Sheriff GMC Bans Botox Remote Prescribing Many commentators have likened the current state of the U.K. aesthetic industry to the ‘Wild West’ of Hollywood spaghetti westerns with plenty of troublesome cowboys, where regulation is poor and practices are going on which most regard as although not strictly unlawful, certainly not 100% safe, moral or ethical.

So it seems quite apt that Sheriff GMC rode into town this summer and declared that he was banning the remote prescribing of Botox (and other botulinum toxin brands) by U.K. Doctors; about time too many have said.

This ‘clean up’ has certainly shaken the saloon bar up a bit and many of its occupants are left wondering what they’re going to do now to keep their various business models going.

Consulting Room™ Director Ron Myers said of the GMC move; “This unequivocal statement from the GMC would seem to be the final nail in the coffin for remote prescribing business models of Botox for cosmetic purposes. The NMC have been clear on this for a while, but the GMC now comes into line and should halt the march of nonprescribers of any speciality seeking to offer this treatment via a remote consultation business model. This decision has become increasingly important as we have even seen these prescription medicines getting into the hands of people without any medical qualifications.”

“Remote prescribing was introduced to save lives in remote communities, not to treat wrinkles;” said Former BAAPS President, Consultant Plastic Surgeon Nigel Mercer when summing up the situation.

In this article we will look at the development and outcome of events, what it means for many within the industry and some ways forward for those involved.

Background th

On 12 July 2012 an official press release was issued by the General Medical Council (GMC) following an appearance by Niall Dickson, GMC Chief Executive on BBC London News which had run an undercover investigation into the botulinum toxin remote prescribing services of Dr. Mark Harrison and his company Harley Aesthetics. In the investigation Dr. Harrison was seen talking about his methods for performing remote consultations, including some which were performed retrospectively following treatment of a patient by a nonprescribing nurse. He also detailed methods that nurses could use to obtain ‘stockpiles’ of toxin products, a practice which is forbidden for nurses and even independent nurse prescribers, by sourcing scripts in the names of family and friends through his company supply chain which goes against laws governing the scenario where a drug is prescribed for one individual and used on another.

We first broke this story, gathering industry opinions from doctor and nurse groups, as well as regulators in our blog. You can read the full background here.

In the official statement the GMC said; “Doctors are to be banned from prescribing Botox by phone, email, video-link or fax under new guidance from the General Medical Council (GMC).

The change means that doctors must have face-to-face consultations with patients before prescribing Botox and other injectable cosmetics to ensure they fully understand the patient’s medical history and reasons for

wanting the treatment. Under current GMC guidance doctors must adequately assess the patient’s condition before prescribing remotely and they must be confident they can justify the prescription. Where doctors cannot satisfy these conditions, they must not prescribe remotely.

The new guidance, which came into force on 23rd July (2012), updates and strengthens these rules. It introduces a complete prohibition on prescribing cosmetic injectables, such as Botox, without a physical examination of the patient. Doctors who continue to prescribe Botox or similar products remotely will be putting their registration at risk.

The guidance, which will be issued to every doctor in the UK, states: ‘You must undertake a physical examination of patients before prescribing non-surgical cosmetic medicinal products such as Botox, Dysport or Vistabel or other injectable cosmetic medicines. You must not therefore prescribe these medicines by telephone, fax, video-link, or online.’

For the largest number of individuals affected by this GMC announcement, namely nurses, this really isn’t what you could call ‘new’ news, as their regulator, the Nursing & Midwifery Council (NMC) stated to its members over a year ago in April 2011 that; “The advice, ‘Remote prescribing and injectable cosmetic medicinal products’ makes clear the NMC’s position that remote prescriptions or directions to administer should not be used to administer injectable cosmetic medicinal products such as botulinum toxin (Botox®).”

So the NMC have been clear on this stance for some time, in fact similar earlier drafted statements from them go back 5 years to 2007 (see bottom of page one of this PDF document), meaning that nurses themselves ought to have already been aware that practicing botulinum toxin injections using remote prescribing services went against NMC standards. But clearly with no real precedence in terms of severe reprimand following fitness to practice hearings and widespread mis-information, the situation has carried on until now.

Discussing this Mai Bentley RGN NIP, Director of Training at Intraderm Limited told us; “The GMC, NMC and MHRA have been totally aware of this situation for over two years but no significant action has been taken until now. We have tried hard to raise awareness amongst nurses about the many problems associated with some remote prescribing services but this was not welcomed by some doctors, nurses and companies within the aesthetic industry. We have always been concerned that many nurses have been misled as to the legalities of some remote prescribing services but with little support from the appropriate governing bodies and the aesthetic industry, this has been impossible to address in the correct manner.”

She went on to explain some of the terms used in the NMC guidance, including the definition of ‘directions to administer’; “A direction to administer is basically the instructions that a nurse must follow to administer a drug. It tells the nurse the name of the drug, the dilutent required, the amount of dilutent to use, the route of the drug e.g. intramuscular, orally etc, the dose to be given and so on. It must be for a specific named patient and must be signed by the prescriber and placed in the patient notes. It must comply with NMC Standards for Medicines Management 2007.

‘You must undertake a physical examination of patients before prescribing nonsurgical cosmetic medicinal products such as Botox, Dysport or Vistabel or other injectable cosmetic medicines.

You must not therefore prescribe these medicines by telephone, fax, videolink, or online.’

General Medical Council Guidance

The direction to administer should ALWAYS be given to a non prescribing nurse before she administers a drug in any setting not just an aesthetic one.

They (the NMC) are saying that a direction to administer given remotely i.e. by telephone or other remote means is only acceptable for emergencies...a direction to administer should normally be given to a nurse after a face to face consultation with the patient. Again, it is the word REMOTE that is important.”

Equally the General Dental Council (GDC) took a stance on this over 12 months ago when it issued a statement to its members in May of 2011 stating:

“Remote prescribing should not be routinely used to facilitate treatment, or in the provision of non-surgical cosmetic procedures such as the prescription or administration of injectable cosmetic medicinal products.”

So it seems that it’s taken a public media investigation into a high profile Doctor, like Mark Harrison to make the GMC come into line with statements from the NMC and GDC in order to then make the whole industry (nurses, insurers and suppliers alike) sit up, take notice and examine this practice. What does this say about the GDC and NMC if everyone is happy to ignore what they say and carry on a practice regardless, but as soon as the GMC says no, everyone listens? This just continues to underpin recent reports which damned the NMC as an ineffective regulator of nurses one could argue.

Whatever your views on the legalities of remote prescribing in facial aesthetics; with insurers and the NMC being explicit for some time now, why has it taken the GMC statement for everyone to suddenly look at this issue from a “risk management” perspective if they have been involved in this model for some years? It’s hard to tell, but it does show the influence that some individuals can have over others in persuading them to follow them in pursuit of their business model and monetary aims.

Some estimate that Dr Mark Harrison (via his company Harley Aesthetics) built up a group of over 400 nurses receiving remote prescriptions for botulinum toxins at a cost of £30 per telephone call. Dr. Harrison was recently suspended by the GMC for his practices pending a hearing. He is not alone though and many other Doctors and Dentists have sought to replicate this profitable model and have also prescribed for podiatrists, physiotherapists, and beauty therapists, along with other specialties and non-medics.

"I would hope that this now closes the door to Doctors who are prescribing remotely to Beauty Therapists and other non-medics."

Yvonne Senior, Co-Founder of the Private Independent Aesthetic Practices Association (PIAPA).

We have raised awareness of these issues in several blogs over the years looking at whether beauty therapists should be allowed to inject Botox and dermal fillers and equally Podiatrists – and when we try and pin this down, there is often a similar scenario to the above with someone “championing the cause” for a particular specialty and actively persuading insurers to cover them. Examples include Molly Hanson-Steel and her organisation CTIA (Cosmetic Treatments & Injectables Association) which backs beauty therapists and Fluent Health Academy promoting facial aesthetic (fillers and toxin) training courses to podiatrists.

Emma Davies RGN and founder member of the British Association of Cosmetic Nurses (BACN) stated; “We have been concerned for some time with Doctors presenting convincing, but misleading reassurances to nurses, that remote prescribing was legal and met NMC standards. We are relieved that the practise has been exposed and we can move forward with absolute clarity.”

Dr. Samantha Gammell, President of The British College Of Aesthetic Medicine (formerly the British Association of Cosmetic Doctors) said in a statement; “The aim of the British College Of Aesthetic Medicine is to advance the effective, safe and ethical practice of aesthetic medicine and we therefore welcome the new General Medical Council (GMC) guidelines on remote prescribing. We understand that the new guidelines make specific reference to injectable cosmetic medicines such as Botulinum Toxin and therefore there can be no further claims of ambiguity by any medical professional.”

Sally Taber, Director of the Independent Healthcare Advisory Services (IHAS) and responsible for the management of the Standards and Training principles for www.TreatmentsYouCanTrust.org.uk, also responded by saying; “www.TreatmentsYouCanTrust.org.uk applauds the move from the General Medical Council (GMC)... The inappropriate practice of remote prescribing by Doctors has to date been one of the biggest issues within the cosmetic injectable industry. Following its launch nearly two years ago, the Department of Health backed register of regulated cosmetic injectable providers www.TreatmentsYouCanTrust.org.uk has campaigned for the GMC to review its remote prescribing guidance and close the loophole which had put patients at risk by providing unqualified providers without a clinical background with Botox®.”

So where do we go from here?

This isn’t the end for non-prescribing nurses who have a significant botulinum toxin business model, as many options still exist for them to continue their operations in line with both NMC and GMC guidelines. All options however pose a challenge and in most cases there is an additional financial burden or loss to be incurred.

Many have stated that non-prescribing nurses should just become Independent Nurse Prescribers (INPs) or Nurse Independent Prescribers (NIPs), however the V300 NIP course is not the answer for everyone for a variety of reasons, including the costs (upwards of £2,000), the time commitment, the level of independent study needed (equivalent to degree level) and the prerequisite qualifications required to enrol in the first place.

Independent Nurse Prescriber and Owner of Regenix Medical Aesthetics Clinic Andrew Rankin who embarked on his prescribing qualification in 2007 explains why there is more to this route than many initially think; “Being able to prescribe is about more than just convenience though. It allows the prescriber to enhance their practice and importantly, enhances the client’s experience. For instance, if a client is treated for acne prescription only topicals might now be considered. If pain control is a problem, perhaps lidocaine is now an answer. Does the client suffer from cold sores – prescribe oral acyclovir for them. These are just a few examples of how prescribing can be used to enhance patient care. As nurses we need to be able to justify and evidence our decisions, therefore my advice would be to approach the course, and work with your DMP (Designated Medical Practitioner), with these thoughts in mind.”

So called “buddy prescribing” systems do also appear to be a potentially workable (if less profitable) route for nonprescribing nurses going forward, but will require a lot of trust and organisation on both sides of the operation. The exact mechanisms of action for this model are the hottest topic of debate currently amongst nursing groups, but it’s likely that NIPs will take the business of script provision services away from Doctors in the future, as the time versus reward ratio for Doctors is not financially attractive for face-to-face consultation services.

The British Association of Cosmetic Nurses explained legal practicing guidelines for its members by saying; “Nurses who have undertaken the Nurse Independent Prescribing (NIP) Course and satisfied the examiners at the NMC, and maintain both their general nursing qualification and NIP qualifications are legally able to prescribe and administer botulinum toxins and all other prescribable items within their area of competence, and have equal prescribing rights to all UK doctors. The NIP qualification has a pass mark of eighty percent for pharmacology and one hundred percent for mathematics.

Non-prescribing qualified nurses working in partnership with doctors or nurse prescribers are also working within the correct legal framework, when their patients are consulted by the prescriber who then delegates an order to administer to the nurse. This consultation process involves a physical face to face full consultation and examination by the prescriber."

But what about the Doctors, those previously providing remote consultations services will now suddenly also find themselves with a hole in their revenue stream and no great desire to move their services to more time consuming and less profitable face-to-face consultations. However with an anticipated increase in the number of nurses choosing to embark on NIP courses it is expected that many will move into offering their services as a Designated Medical Practitioner (DMP), a required ‘mentor’ or supervisory service needed by those enrolling on a V300 course, which can generate approximately £1,000 - £1,500 per candidate with no limit on the number a Doctor can assist.

Now that the ‘rules’ on remote versus face-to-face consultations for botulinum toxins have been defined, you’d think all would be clear but frankly it seems to be something of a can of worms as it’s prompted yet more and more questions in terms of whether a Doctor or NIP needs to carry out a face-to-face consultation before every single treatment (to produce the script and directions to administer), or whether ongoing or repeat prescriptions are possible and if so how many.

Take the following example; a member of the public, we’ll call her Claire, goes in for her first appointment for botulinum toxin treatment. She sees the prescriber (in this case a Doctor) face-to-face, a script is issued for glabellar line treatment which is then administered by a separate person (non-prescribing nurse or any other nonprescriber).

As would be considered standard best practice for a new client, Claire is called back for a review with the nurse two weeks later. It’s not uncommon that a slight adjustment might need to be made as the dose/positioning of the units may not have been sufficient to achieve the desired results. However, this requires the issuing of a new script and a new specific direction to administer for the non-prescribing nurse, surely? So does this mean that Claire has to wait some more time for another face-to-face consultation with the prescribing Doctor for her top-up?

Then say after 3 months, Claire goes back to see the nurse because she’s a little unhappy that it didn’t last very long, so another dose adjustment is required. Presumably this would need yet another face-to-face consultation to be arranged with the prescriber in order to issue a suitable script with another specific direction to administer with the altered doses to achieve a longer lasting effect?

Now, what if in another 4 months time Claire goes back to see the nurse again and decides that she also wants her crow’s feet treated (an unlicensed indication). As this is a new indication, presumably Claire would need yet another face-to-face consultation with the prescriber to assess her suitability for treatment in that region and another specific direction to administer to comply with NMC guidelines for the non-prescribing nurse?

All in, Claire, our patient has had 4 separate face-to-face consultation appointments and 4 separate treatment appointments, not very convenient for her for one thing! So, are we saying that repeat prescriptions without the prescriber seeing the patient are all fine and fully comply with NMC practice to deal with this situation or that in this case as there is a dosage change each time, borne out in the direction to administer then a new face-to-face consultation is indeed needed each time?

The devil truly is in the detail here and must be 100% clarified to ensure that (in the event of a problem) the prescribers (doctors, NIPs, dentists), the non-prescribing nurse injecting the toxin and the consumer are all fully protected by medical indemnity cover and that their respective medical bodies are happy with the protocol used.

A spokesman from the GMC press office said, when questioned about repeat prescriptions and the new guidance; “Our guidance says face to face consultations are necessary to ensure safe and appropriate treatment. Before prescribing any injectable cosmetic, a doctor must have a face to face consultation with the patient. This means doctors can't sign 'repeat' prescriptions without seeing a patient however they may write a single prescription which specifies it be dispensed in stages.”

Confused? Yes, so are we. Would this cover Claire and her changing dose requirements or is this just a simple way of facilitating ongoing repeat prescriptions for Botox where there is no change to the adjunctive direction to administer? The key in all of this is that practitioners should not be trying to find ‘loop holes’ as otherwise we’re just going to end up straight back in a Wild West shoot out between those practicing at the edges of the ‘law’ based on their interpretation of the guidelines whilst the rest watch in despair and disdain. It’s important that the industry work together to layout acceptable practice.

And that is exactly what the British Association of Cosmetic Nurse (BACN) is hoping to do. They hope to be releasing guidelines for their members during mid-August. Speaking on behalf of the team behind this initiative is NIP Andrew Rankin; he told us; “The key areas that we have focused on are in fact based on the questions raised by members. We cover in detail the issues of repeat prescribing and the need for patient specific directions. Demarcation of responsibility that surrounds delegation is covered and the issues of assessment and documentation are included. We have brought together several NMC standards to achieve a BACN best practice guideline. It is a working document and therefore subject to change in the light of future needs. Indeed through the process many ideas have come to light which represent work (and progress) for the future.

We have tried to take a pragmatic approach, realising that it takes time to enrol upon and complete the V300 course. However we are obliged to make NMC guidelines our priority in formulating the document. It will necessarily be restrictive therefore to those whose business model relied upon remote prescribing. Thus the objective for the non-prescribing nurse could be seen to be either to follow these guidelines whilst undertaking the prescribing course or to utilise a different business model, probably involving a true business partnership with a prescriber.

(One issue not covered in the guidelines is that of what is a reasonable charge. The guidelines are not the place for this but the group will nevertheless be considering this point with a view to issuing guidance.)”

Andrew concluded on a personal note by saying; “My sincere hope is that this is just a first step to achieving a unified approach to medical aesthetics, not only amongst nurses but, by bringing partners closer together, within the industry.”

Another way in which this is possible is through the insurance provisions available to UK practitioners, hence only those working in line with the NMC, GDC and GMC guidelines covering the remote prescribing ban should be granted medical indemnity policies.

For example, Eddie Hooker, CEO of the largest insurer for the industry, Hamilton Fraser Cosmetic Insurance said in a statement at the time of the GMC announcement that; “Hamilton Fraser Cosmetic Insurance has always made its position clear in respect of remote consultations and the prescription of medicines in the absence of the patient. All malpractice insurance policies offered to our clients are conditional on the practitioner following the professional guidelines laid down by their governing bodies, in this case the GMC, GDC and NMC.” So in the case of their historical stance one wonders if there was a question all along over the validity and value of insurance cover given to nurses operating using remote prescribing services in the past and whether their insurance would even have covered them in the event of a claim as they would not have been practising in line with NMC guidelines.

To clarify the ongoing position, Hamilton Fraser go on to say; “We welcome the recent clarification from the GMC on this issue. Hamilton Fraser will only indemnify the practitioner if they are acting under the direction of an authorised prescribing practitioner, such as a doctor, dentist or nurse prescriber, and the patient has had a face-to-face consultation with that prescribing practitioner.”

Mr Hooker went on to point out; “I should also say that we will not be policing remote consultations, this is down to the governing bodies. We will point out to practitioners that should a claim be presented by a patient that was treated without a face-to-face consultation the claim may not be honoured. The prescribing practitioner that issues the script without the consultation may also be reported to their governing body by the insurers and any disciplinary hearing’s defence costs cover provided under their insurance policy (if we are insuring them) will be withdrawn.”

Ron Myers indeed believes that they key to ‘policing of the industry’ and ‘filling in the loopholes’ lies with the insurers and underwriters of the policies. He said in a recent blog; “If practitioners can’t get insured, they most likely will not offer the service. The more we can do as an industry to educate the insurance brokers issuing the bits of paper (i.e. the indemnity policies) and be crystal clear on the practitioner groups who should not be involved (and the mechanisms of access to drugs if non-prescribers), the closer we’ll get to a practical solution in making sure that the industry is at least restricted to the professionals who have the fullest possible support from the aesthetic industry in general.”

Lorna Jackson Lorna has been Editor of The Consulting Room™, the UK’s largest aesthetic information website, for 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.

If you have any comments or suggestions regarding this article, please email clinicarea@consultingroom.com

Business Corner Charity Advertising Scam – Beware of Cold Calls A publishing and advertising scam hit the headlines over a year ago but it seems that this practice is very much alive and well despite police and legal interventions with some of our members having reported to us that they have been in receipt of scam calls in recent months.

Back in July 2011, The Insolvency Service warned people to be very wary of anyone cold calling them asking them to place an advertisement in a Wall Planner, Diary, Children’s Fun Book, Drug Awareness Book, Magazine for Emergency Services Personnel, Guide or other publication.

The caller will usually claim to be calling on behalf of or associated with a charity who will receive a donation or free books for resale. Alternatively they may be claiming to be from one of the emergency services or promising to distribute their magazine to an audience such as off duty emergency services personnel.

The service, part of the Government’s Department for Business Innovation & Skills issued a list of Do’s and Don’ts to help people avoid being conned, as follows: 

DON’T agree to place an advert over the telephone unless you are absolutely happy with the publisher with whom you are dealing and what you are being offered.



DON’T speak to them unless you’ve got time to ask all the questions you want.

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DON’T agree to something to get rid of them – you could be making a binding agreement.

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DON’T take their word for it that you have placed an order previously or that someone in your organisation has agreed to take an order– this is a ploy used by some companies to trick you.



DO make it clear in ALL telephone calls that you are NOT placing an order – they often record the second “confirmation” phone call – this is carefully worded to sound like you are agreeing to the order even if you have just requested further information.



DO insist on seeing written details and a copy of the publisher's full terms and conditions before placing an order.

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DO ask them some detailed questions about the publication.

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DO get details including the number of any charity mentioned and check this with the Charity Commission at www.charity-commission.gov.uk.



DO get them to send you an example of a publication they have produced with details of its circulation – if they refuse DON’T agree to go any further.



DO make a record of all contact with these companies – time, date of calls, person you spoke to, what they said etc.

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DO make sure all your staff know about this advice on dealing with these cold callers and to be aware of unsolicited invoices.



DON’T feel guilty – there are other ways of giving to charity.



If in doubt DO find your LOCAL Trading Standards at www.tradingstandards.gov.uk.

More information and advice can be found on the Trading Standards website by clicking on the links below for the following UK regions.

England, Wales and Northern Ireland

Scotland

HSE Fee For Intervention (FFI) – What businesses need to know From October, the Health & Safety Executive will have the power to charge a business, whenever it finds a health & safety breach, or “contravention”, at the rate of £124 per hour under a new charging regime called “Fee For Intervention”.

We spoke to Alastair Hall, Head of Health & Safety at compliance specialists Citation plc, about what these changes mean for business owners.

Why is the HSE charging businesses for its time?

The HSE has had its budget cut by 35%. To bridge that gap, the Government has imposed a legal duty for the HSE to recover its costs from non compliant businesses from October.

The HSE has already closed down its free helpline, which took over 750,000 calls per annum to assist businesses and the public. This would appear to be the end of free verbal 1-2-1 health and safety advice in the UK. What are the chances my businesses will be inspected?

There has been a reduction in the number of proactive HSE inspections. The HSE must spend a greater proportion of its time on securing compliance from high-risk industries and duty-holders businesses and poor performers rather than helping more compliant businesses improve. So the focus is on finding this rather than on helping businesses to improve. This is a shift in approach. Presumably to ensure it can recover all of its budget deficit.

However, the HSE does have the power to conduct unannounced inspections and will do so where it feels necessary – so no business is “safe” from scrutiny.

Also, since business owners have a duty to comply with RIDDOR (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995), businesses will be on the HSE’s radar through any reportable accidents, incidents, whistleblowers or complaints made by members of the public.

So if the HSE inspects my business premises I’ll be charged £124 per hour?

Not necessarily. You will only be charged if, and from the moment, the HSE finds a contravention.

The charges will include the time it takes the inspector for writing and sending you an email or letter, and the time it takes to deal with documenting the contravention.

How have these charges been quantified?

The HSE has calculated the following costs whenever a contravention is found:  Inspection resulting in an email or a letter: £750 (or six hours work)  Inspection resulting in an a notice being issued: £1,500 (a day and a half’s work)  To investigate an incident taking 4 days of a HSE Inspectors time £4,000.

Full investigation – Could be tens of thousands of pounds.

For multiple contraventions, these charges are likely to be higher, particularly where more than one inspector or a specialist support is needed.

Is there a limit on how much my business can be charged?

Theoretically, no. However in practical terms, the FFI charges can only be stopped by one of the two following things taking place.

1) You resolve the contravention(s) by the time the HSE inspector conducts a follow-up inspection – the time for which you will also be charged for.

2) When court proceedings are issued following your failure to comply with HSE enforcement notice. Your business will still be liable for any billable time up until that point.

FFI charges are of course aside from any fines and associated legal costs associated with any charge brought to your business by the HSE. What are the risks to business owners?

We find an average of 24 contraventions on a first health & safety visit to a new client, regardless of whether they already have systems in place.

When you consider this with how the HSE has calculated its costs, there is a significant financial risk, which many businesses will already be exposed to without even knowing it.

Why haven’t we heard of these changes in the press or from other compliance companies?

The HSE has always stated that it will not actively publicise these changes.

Citation has been speaking about this for some time now, for example we have recently spoken to the BBC about what the FFI regime will mean for businesses.

However, there does seem to be a very small number of Health & Safety compliance providers who are actually talking about it.

Why do you think that is?

I think it’s mainly to do with confidence and service levels.

Also, most providers will not offer a warranty of compliance and won’t cover the FFI charges if their clients face them. Even most insurance policies that “protect” companies from legal action have multiple exclusions and a prospect of success clause.

To further my point about service levels, Citations Health & Safety consultants can be found on the Occupational Safety and Health Consultants Register (OSHCR) register, for example.

What should I do if I think my business isn’t covered?

The first thing to do is make sure your risk assessments are carried out and all related documentation is up to date.

Secondly, if you already have a compliance provider, make sure that you read the terms of your contract and, if you have an insurance policy, check it to see if you’re covered for FFI charges.

Any good provider will give you a written guarantee whereby, if you follow their advice and you still face charges from the HSE, they will pick up the costs on your behalf.

Does Citation cover FFI charges?

Yes. If our clients get into trouble with the HSE because they’ve followed our advice, we pick up the tab.

It’s important to state that we don’t do this with insurance, however. We used to sell an insurance policy with our services but we felt that, simply by offering it, we were undermining our service.

Our clients were, quite rightly, asking “why do I need an insurance policy if you’re giving me the “best” advice available?”

The answer was of course that, if what we’re saying is true, they shouldn’t need insurance. We decided to switch to an advice guarantee whereby we take accountability for the advice we give – that advice has to stand up to scrutiny in order for Citation plc to exist.

Our Advice Guarantee is unique in our industry, and it was one of the main reasons why our service won a Queen’s Award for Enterprise in the innovation category - so we know it works!

Citation plc are the UK’s leading Health & Safety and Employment Law compliance consultancy. If you would like to know more about the services of Citation plc, the HSE FFI Scheme or any other aspect of Health & Safety or Employment Law, please call 0845 844 1111 or visit www.citation.co.uk/affinity/abs.

Legislation Treatments You Can Trust Announce New Governance Chair www.TreatmentsYouCanTrust.org.uk is very pleased to announce Baroness Trish Morris of Bolton OBE DL as the new Chair of the 16 strong Treatments You Can Trust Governance Group.

Baroness Morris was an Opposition Spokesperson for Health in 2004 to 2006 and 2009 to 2010 and also Shadow Minister for Women in 2005 to 2010. She is very keen that patients are able to receive safe cosmetic treatments from appropriate providers and also that they are protected from the escalating number of unqualified providers. Baroness Morris echoes the Parliamentary Under-Secretary of State for Health, Anne Milton, in backing the work www.TreatmentsYoucanTrust.org.uk does to ensure safe practice for injectable cosmetic procedures and exclude unregulated beauty therapists.

Baroness Morris says: “Whilst the beauty industry provides an important service, with well-trained therapists in beauty treatments, it is important to ensure patients are made aware that they are not appropriately qualified to administer cosmetic injectables, and only Registered providers may display the www.TreatmentsYouCanTrust.org.uk quality mark. I am very pleased to assume the Chair of the Governance Group and to lead the nationwide campaign in the interests of safeguarding patient safety.”

Sally Taber, responsible for the management of the Standards and Training Principles, and speaking for the members of the Governance Group, says: “We look forward to working with Baroness Morris joining us as Chair to lead forward our patient safety agenda. She brings with her years of experience as Shadow Health Minister and Shadow Minister for Women. We are confident that Baroness Morris will lead the scheme from strength to strength.”

Baroness Morris of Bolton will lead the 16 people strong Governance Group. This has the crucial role of ensuring patient safety. The Group has responsibility for monitoring and developing the www.TreatmentsYouCanTrust.org.uk scheme, a key industry-supported Standard focussed on patient safety. Governance Group Members are drawn from medical, nursing and dental professional bodies, consumer advocates, patient representative bodies, the Government and industry commercial interests.

IHAS Certified as Provider of ‘Safe, Reliable, High Quality Healthcare Information

COMING SOON! Laser Registration Scheme The laser registration scheme will operate a register with an online applications scheme with its own website and Standards (now available). The fees for the scheme have been agreed and final checks to the website are being made in preparation for a launch date.

IHAS has been certified as a provider of high quality health and social care information by The Information Standard scheme having met the scheme’s criteria of producing safe and reliable information. IHAS has consequently been awarded The Information Standard quality mark, which it can display on its literature and website illustrating to the public that its information can be trusted.

The IHAS certification includes the important stream of information addressed to patients by both the Independent Sector Complaints Adjudication Service (www.iscas.org.uk) and Treatments You Can Trust Register (www.treatmentsyoucantrust.org.uk).

According to a survey carried out by The Information Standard, the majority of the general public (72%) believe that they would be better able to manage their own and their family’s health if they had quick and easy access to health information they could trust. The Information Standard, which is supported by the Department of Health, was launched to provide this kind of assurance. Any organisation that produces health and social care information can apply to become a certified member of the scheme.

Book Review Get 20% Off* Books From Informa Healthcare With The Consulting Room™!

This month's book offer: Published December 2010

Botulinum Toxins in Clinical Aesthetic Practice, Second Edition Edited By: Anthony V. Benedetto, Dermatologic Surgi-Center, Philadelphia, (USA) This high-quality, well illustrated manual has proved itself the perfect guide to the clinical use of the different types of botulinum toxins, for both aesthetic and medical purposes. This second edition retains all the features that made its predecessor so successful, such as detailed anatomic drawings, a review of the different formulations available, and specimen forms. It has been revised and updated throughout and features additional new material on medico-legal considerations and psychological and cultural factors that may affect the intentions of patients and the results that can be achieved.              

Preface Why Cosmetic Dermatology Medico-legal Considerations of Cosmetic Treatment Pharmacology, Immunology and Current Developments Facial Anatomy and the Use of Botulinum Toxin Cosmetic Ues of Botulinum Toxin A in the Upper Face Cosmetic Uses of Botulinum Toxin A in the Mid Face Cosmetic Uses of Botulinum Toxin A in the Lower Face, Neck and Upper Chest Muscle Contouring with Botulinum Toxin: the Asian Experience Other Dermatologic Uses of Botulinum Toxin Botulinum Toxins A Other than BOTOX® Botulinum Toxin B Botulinum Toxin in the Management of Focal Hyperhidrosis Appendix: 1. The Preparation, Handling, Storage and Mode of Injection of BOTOX® and Other Botulinum Toxins 2. Consent Form to Have Botulinum Treatments for Facial and Body Wrinkles 3. Patient Treatment Record Appendix 4. Muscles of Facial Expression 4. Side-effects and Contraindications to BOTOX® and Other Botulinum Toxin Injections

Hardback, 304 pages.100 colour illustrations. Published: December 2010, ISBN: 9780415476362

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To order call +44 (0)20 7017 5540 quoting promo code GOCGOLD, or use the order form www.consultingroom.com/Storage/CA_Legislation/PDF/Informa_ConsultingRoom_orderform.pdf.

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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 IAAFA Annual Conference & Charity Ball 2012 The dates for this year’s IAAFA conference have been announced, including a Bollywood themed charity ball on the Saturday evening.

The event will feature a number of highly distinguished speakers, who between them offer comprehensive and extensive experience in all fields of facial aesthetics. An exhibition will be held for both days alongside the conference. To download the conference flyer (PDF), please click here.

Friday 31st August & Saturday 1st September 2012 at The Royal Society of Medicine, London.

BCAM Autumn Conference 2012 Organisers expect a delegation of at least 200 members at this event and this year they are opening it up to members of BACN and BACD (dentist). The event includes the BCAM Open Golf Championship at the famous 2010 golf course on the Sunday. To register your interest and to find out more email: registrations@BCAM.ac.uk or telephone 0845 450 2875. th

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Saturday 15 & Sunday 16 September 2012 at The Celtic Manor Resort, Newport, Wales.

BAAPS Annual Meeting 2012 The programme will include guest speakers such as Fritz E Barton from Dallas Texas who will talk about avoiding problems following lower lid blepharoplasty and his integrated approach to facial rejuvenation surgery. Dr Claude Le Louarn from Paris will speak on body contouring, pan facial treatment with Botox and midface lifting. Dr Alexis Verpaele from Ghent, Belgium will speak on reducing capsular contracture following breast augmentation as well as techniques for fat grafting to the face and modifications of the MACS lift. For more information, please visit: www.baaps.meeting.org.uk 20th – 21st September at The Royal College of Physicians, London

BACN Annual Conference 2012 The BACN are happy to announce their third annual conference being held in London on the 6th October 2012.

They have managed to secure a great team of speakers to make this a wonderful informative day with drinks and canapés to allow you to relax, wind down and network before your journey home. Click here for more information. th

6 October at the IET London Savoy Place, London

BODY Conference 2012 BODY2012 is the sister conference to FACE – the UK’s largest conference on facial aesthetics. It follows the same format in aiming to provide the highest quality national and international speakers in their respective fields of scientific interest to update your clinical knowledge and explore new market opportunities in the dynamic BODY aesthetics industry. Detailed agendas will be available soon. For more information, please visit: www.bodyconference.co.uk 3rd & 4th November at the Royal Society of Medicine, London

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

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Uncommon foreign body reaction caused by botulinum toxin.

Pontes HA, Pontes FS, de Oliveira GF, de Almeida HA, Guimarães DM, Cavallero FC. From the Department of Surgery and Oral Pathology, "João de Barros Barreto" University Hospital, Belém, Brazil.

Clinical Information

J Craniofac Surg. 2012 Jul;23(4):e303-5.

ABSTRACT: Botulinum toxin is composed of 7 botulinum toxin antigenic subtypes. It is produced by Clostridium botulinum bacterial fermentation. Several botulinum toxin subtypes are under investigation for clinical use, but only botulinum toxin type A (BTX-A) is currently approved for cosmetic use because of its clinical safety profile and efficacy. The use of BTX-A in cosmetic facial procedures is a reliable way to enhance aesthetics in the face and is becoming commonplace in oral and maxillofacial surgery.

This article reports an uncommon complication after Botox injection in the upper lip, for cosmetic reasons, originating a mass in the anterior region of the maxilla, which leads to failure in orthodontic treatment. Knowledge of the site anatomy, pharmacology, and dose of BTX-A before its use in cosmetic surgery should be strengthened.

Comparative evaluation of the potency and antigenicity of two distinct BoNT/A-derived formulations.

Brown M, Nicholson G, Ardila MC, Satorius A, Broide RS, Clarke K, Hunt T, Francis J. Department of Biological Sciences, Allergan Inc, 2525 Dupont Dr, Mailstop RD3-3B, Irvine, CA, 92612, USA. J Neural Transm. 2012 Jul 29.

IncobotulinumtoxinA (Xeomin(®)) and onabotulinumtoxinA (BOTOX(®)) are unique botulinum neurotoxin type A (BoNT/A)-derived drugs. IncobotulinumtoxinA utilizes the naked 150 kDa holotoxin portion of BoNT/A, whereas onabotulinumtoxinA uses the complete native 900 kDa complex as drug substance.

On the basis of purportedly similar pharmacological characteristics, these formulations were evaluated for potency

by LD(50) and mouse Digit Abduction Score (DAS) bioassays. DAS was also used to assess antigenicity.

Full-range DAS dose-response profiles were achieved with four lots of each product, with similar observations between lots for a given product. Between products, however, the mean DAS potency of incobotulinumtoxinA (ED(50) range 7.0-10.2 U/kg) was significantly lower than that of onabotulinumtoxinA (ED(50) range 4.4-6.4 U/kg), consistent with lower measured potencies in the LD(50) assay for incobotulinumtoxinA (potency range 62-82 U).

In assessments of DAS duration of effect at similar unit doses, the observed lower potency of incobotulinumtoxinA translated into decreased peak efficacy and dose effect over time (i.e. shorter duration). In contrast, at equiefficacious doses yielding near-maximal DAS responses, both toxin formulations were uniformly inhibited in a statistically significant manner when preincubated with rabbit-derived, onabotulinumtoxinA-neutralizing antibodies, supporting the position that inhibition of 150 kDa holotoxin serves as the common basis for neutralization and, therefore, incobotulinumtoxinA would not be expected to be effective in onabotulinumtoxinA-immunoresistant subjects (and vice versa).

Further, with lower lot-to-lot relative potency, incobotulinumtoxinA is not dose-equivalent or interchangeable with onabotulinumtoxinA, suggesting that various aspects of drug product formulation may influence observed pharmacology.

Efficacy and tolerability of two commercial hyperpigmentation kits in the treatment of facial hyperpigmentation and photo-aging.

Fabi S, Massaki N, Goldman MP.Goldman, Butterwick, Fitzpatrick, Groff, & Fabi, Cosmetic Laser Dermatology, San Diego, CA. J Drugs Dermatol. 2012 Aug;11(8):964-8.

Background: Hyperpigmentary disorders are common aesthetic skin conditions that can be very concerning to patients and both challenging and time-consuming for the physician to treat. Several companies commercialize hyperpigmentation kits for the lightening of dark spots and improvement of overall skin dyschromia. Unfortunately, clinical data from controlled studies to support the efficacy and tolerability of these kits are typically lacking Objective: This investigator-blinded, randomized trial was undertaken to compare two commercial hyperpigmentation systems (kits) used for the treatment of facial hyperpigmentation and photo-aging.

Methods: Female subjects with at least mild facial hyperpigmentation and photo-aging were randomized to treatment with either the four product SkinMedica (SKM) regimen or the 7-product Obagi (OMP) regimen.

Evaluations were conducted at baseline, 4, 8, and 12 weeks. Subjects were evaluated by the blinded investigator for clinical efficacy and tolerability using grading scales. Standardized digital photographs were taken at baseline and week 12. Self-assessment questionnaires were completed at week 12. Thirty-five females (SKM=17, OMP=18) completed the 12-week study.

Results: Both treatment regimens showed a significant improvement at week 12 (compared to baseline) for Overall Hyperpigmentation, Global Photo-aging and Sallowness. At week 12, there was no significant difference between treatment groups in Global Response to Treatment. Tolerability was good for both regimens based on investigator assessments. Subject self-assessments showed no consistent differences in efficacy between the two regimens.

Similarly, there was no significant difference in subject satisfaction or intent to continue use between the two regimens.

Conclusion: This clinical study demonstrated that both systems were equally effective at reducing hyperpigmentation and global photo-aging in females with mottled pigmentation and photodamaged facial skin.

Lidocaine/tetracaine peel in topical anesthesia prior to laser-assisted hair removal: Phase II and Phase III study results.

Alster T, Garden J, Fitzpatrick R, Rendon M, Sarkany M, Adelglass J. Washington Institute of Dermatologic Laser Surgery , Washington, DC , USA. J Dermatolog Treat. 2012 Jul 25.

Background: Patient comfort is essential during dermatologic procedures. Objective: To evaluate anesthetic efficacy in laser-assisted hair removal of a self-occluding topical anesthetic (lidocaine 7 mg/tetracaine 7 mg, "LT peel"), which air-dries and can be peeled off 30 minutes post-application.

Methods: Studies A (Phase II) and B (Phase III) were randomized, double-blind, placebo-controlled and paired.

Applications of LT peel and placebo were concurrent: in Study A, 60 subjects were randomized to 30, 45, or 60minute groups, and in Study B, 50 subjects had 30-minute applications. After drug removal, the investigator assessed for erythema, edema, and blanching. Efficacy evaluations followed the procedure: subject's pain [Visual Analog Scale (VAS), no to worst pain (0-100)], subject's/investigator's impression of anesthetic adequacy, and investigator's pain ratings. Adverse events (AEs) were recorded.

Results: VAS scores were significantly lower (P<.05) for LT peel: mean scores were 26.7 for LT Peel vs. 44.3 for placebo (Study A total population, similar between application times) and 23 vs. 31.7 (Study B), respectively. For both studies, subject's/investigator's ratings favored LT peel (P<.05 vs. placebo). Mild skin reactions occurred more frequently for LT peel.

Conclusion: After a 30-minute application, LT peel was effective and well-tolerated in providing anesthesia for laser-assisted hair removal.

Intense Pulsed Light and Low-Fluence Q-Switched Nd:YAG Laser Treatment in Melasma Patients.

Na SY, Cho S, Lee JH. Department of Dermatology, Seoul National University Boramae Hospital, Seoul, Korea.

Ann Dermatol. 2012 Aug;24(3):267-73.

BACKGROUND: Recently, low fluence collimated Q-switched (QS) Nd:YAG laser has drawn attention for the treatment of melasma. However, it needs a lot of treatment sessions for the substantial results and repetitive laser exposures may end up with unwanted depigmentation.

OBJECTIVE: We evaluated the clinical effects and safety of the combinational treatment, using intense pulsed light (IPL) and low fluence QS Nd:YAG laser.

METHODS: Retrospective case series of 20 female patients, with mixed type melasma, were analyzed using medical records. They were treated with IPL one time, and 4 times of weekly successive low fluence Nd:YAG laser treatments. At each visit, digital photographs were taken under the same condition. Melanin index (MI) and erythema index (EI) were measured on the highest point on the cheekbones. Modified melasma area and severity index (MASI) scores were calculated by two investigators using digital photographs.

RESULTS: The mean values of MI and EI decreased significantly after treatments. The modified MASI score has decreased by 59.35%, on average. Sixty percents of the participants did not require any more treatments, and no clinical aggravations were observed during the follow-up period (mean 5.9 months).

CONCLUSION: IPL and low fluence laser may elicit a clinical resolution in the mixed type melasma with long term benefits.

Photographic Measurements in 301 Cases of Liposuction and Abdominoplasty Reveal Fat Reduction without Redistribution.

Swanson E. Leawood, Kans. From the Swanson Center.

Plast Reconstr Surg. 2012 Aug;130(2):311e-22e.

BACKGROUND: There are no published studies of liposuction or abdominoplasty in a large number of patients using measurements of body dimensions. In the absence of rigorous data, some investigators have proposed that fat returns after liposuction.

METHODS: A prospective study was undertaken among predominantly nonobese consecutive patients undergoing 301 liposuction and abdominoplasty procedures meeting the study criteria (inclusion rate, 70.7 percent). Lower body dimensions were measured using standardized photographs taken before and at least 3 months after surgery. Upper body measurements were compared between women who underwent simultaneous cosmetic breast surgery (n = 67) and a group of women who had breast surgery alone (n = 78) to investigate the possibility of fat redistribution.

RESULTS: The average weight change was a loss of 2.2 lbs after lower body liposuction (p < 0.01) and 4.6 lbs when combined with abdominoplasty (p < 0.001). Liposuction significantly reduced abdominal, thigh, knee, and arm width (p < 0.001). Midabdominal and hip width were more effectively reduced by lipoabdominoplasty than liposuction alone (p < 0.001). There was no difference in upper body measurements when comparing patients who had simultaneous liposuction and/or abdominoplasty with patients who had cosmetic breast surgery alone.

Measurements in patients with at least 1 year of follow-up (n = 46) showed no evidence of fat reaccumulation.

CONCLUSIONS: Both liposuction and abdominoplasty are valid techniques for long-term fat reduction and improvement of body proportions. There is no evidence of fat regrowth.

Efficacy of mesotherapy in facial rejuvenation: a histological and immunohistochemical evaluation.

El-Domyati M, El-Ammawi TS, Moawad O, El-Fakahany H, Medhat W, Mahoney MG, Uitto J. Department of Dermatology, Al-Minya University, Al-Minya, Egypt Moawad Skin Institute for Laser, Cairo, Egypt Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, USA. Int J Dermatol. 2012 Aug;51(8):913-9.

Background Mesotherapy, commonly known as "biorejuvenation" or "biorevitalization", is a technique used to rejuvenate the skin by means of a transdermal injection of a multivitamin solution and natural plant extracts that are thought to improve the signs of skin aging.

Objectives This prospective study aimed to evaluate the clinical effect of mesotherapy applied to periorbital wrinkles and to quantitatively evaluate histological changes in the skin occurring in response to the same treatment.

Methods Six volunteers with Fitzpatrick skin types III or IV and Glogau class I-III wrinkles were subjected to a three-month course of mesotherapy injections in the periocular area (six sessions administered at two-week intervals). Standard photographs and skin biopsies were obtained from the treatment area at baseline, at the end of treatment, and at three months post-treatment. Quantitative evaluation of collagen types I, III, and VII, newly synthesized collagen, total elastin, and tropoelastin was performed using a computerized morphometric analysis.

Results The clinical evaluation of volunteers at baseline, end of treatment, and three months post-treatment revealed no significant differences. Histological and immunostaining analysis of collagen types I, III, and VII, newly synthesized collagen, total elastin, and tropoelastin showed no statistically significant changes (P > 0.05) after mesotherapy injection.

Conclusions The present study indicates that mesotherapy for skin rejuvenation does not result in statistically significant histological changes or clinical improvement.

The relation between sunscreen layer thickness and vitamin D production after ultraviolet B exposure: a randomized clinical trial.

Faurschou A, Beyer DM, Schmedes A, Bogh MK, Philipsen PA, Wulf HC. Department of Dermatology, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark Department of Clinical Biochemistry, Vejle County Hospital, Vejle, Denmark.

Br J Dermatol. 2012 Aug;167(2):391-5.

Background Sunscreens absorb ultraviolet B (UVB) and it is a major concern that sunscreen use may lead to vitamin D deficiency.

Objectives To investigate the relation between the amount of sunscreen applied and the vitamin D serum level in humans after UVB exposure under controlled conditions.

Methods Thirty-seven healthy volunteers with fair skin types were randomized to receive an inorganic sunscreen with sun protection factor (SPF) 8 of 0 mg cm(-2) , 0•5 mg cm(-2) , 1 mg cm(-2) , 1•5 mg cm(-2) , or 2 mg cm(-2) thickness on the upper body, approximately 25% of the body area. Participants were irradiated with a fixed UVB dose of 3 standard erythema doses 20 min after sunscreen application. This procedure was repeated four times with a 2- to 3-day interval. Blood samples were drawn before the first irradiation and 3 days after the last to determine the serum vitamin D level expressed as 25-hydroxyvitamin D(3) [25(OH)D].

Results The vitamin D serum level increased in an exponential manner with decreasing thickness of sunscreen layer in response to UVB exposure. For all thicknesses of sunscreen, the level of 25(OH)D increased significantly after irradiation (P < 0•05), except for the group treated with 2 mg cm(-2) , in which the increase in 25(OH)D was not statistically significant (P = 0•16).

Conclusions Vitamin D production increases exponentially when thinner sunscreen layers than recommended are applied (< 2 mg cm(-2) ). When the amount of sunscreen and SPF advised by the World Health Organization are used, vitamin D production may be abolished. Re-evaluation of sun-protection strategies could be warranted.

SOURCE: PubMed

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Syneron Receives FDA Clearance for elos Plus™ Next Generation Multi-Platform Device Offers up to eight in-demand treatment options with higher performance in a compact upgradable system Syneron Medical Ltd. (NASDAQ: ELOS), www.syneron.com, the global leader in medical aesthetic products and technology, announced today that it has received United States Food and Drug Administration (FDA) clearance for elos Plus™, a next generation multi-platform system featuring the Company's proprietary elos technology. The FDA clearance for elos Plus™ follows on the recent international launch in Europe and Asia.

SOURCE: PRNewswire

Exclusive: PIP Implants Company For Sale A UK company that provided the controversial PIP breast implants, which affected thousands of women in Britain, is set to be sold.

A major stake in one of Britain’s biggest providers of the controversial PIP breast implants is poised to change hands following a review of its ownership. General Healthcare Group (GHG), which trades under the name BMI Medical, is to explore options for its 42% shareholding in Transform Cosmetic Surgery Group. I have learned that a review of its stake in the joint venture with Lloyds Banking Group, the state-backed bank, is expected to take place during the summer.

SOURCE: Sky News

Propecia: Baldness drug `could cause permanent impotence and shrink genitals in some men` A hair-loss medication reportedly tried by Wayne Rooney may cause prolonged and possibly irreversible impotence, scientists have claimed.

Men taking medication for hair loss may suffer from prolonged and possibly irreversible impotence, according to scientists from the University of Washington. Doctor reveals twenty percent of patients he interviewed for Propecia study experienced persistent sexual dysfunction for more than five years.

SOURCE: Daily Mail

Pioneering plastic surgery records from First World War published Medical records detailing the pioneering plastic surgeries performed on wounded First World War soldiers have emerged and can now be viewed by veterans’ families. The surgical records detail the groundbreaking work of Dr Harold Gillies, the pioneering plastic surgeon who developed some of the world’s first successful skin grafts during the Great War. SOURCE: The Telegraph

Surgeons `seek to protect title` Leading doctors are calling on the government to legally protect the title "surgeon" so the public can be clear about practitioners' qualifications. A Royal College of Surgeons (RCS) poll of 2,000 people found 95% expect someone using the title "surgeon" to be medically qualified.

SOURCE: The BBC

Worries over regulation of laser hair removal treatment Leading skin specialists say they are worried about the lack of regulation for laser hair removal.

Leading doctors call for a change in the law to stop people getting burned during laser hair removal treatments because of a lack of training. Thousands of people have the procedure every year in the UK and it is supposed to have permanent results. There are no official figures but it is estimated hundreds have suffered burns, mainly women with darker skin.

SOURCE: BBC Radio 1 Newsbeat

Leading Harley Street Botox doctor suspended A Harley street doctor exposed in a BBC London investigation encouraging nurses to order potentially dangerous Botox drugs in one person's name for use on another has been suspended. Dr Mark Harrison will not be able to practise as a doctor for up 18 months pending a review. The General Medical Council (GMC) will decide whether he will face a fitness to practise panel.

SOURCE: BBC News

Comment By Ann Clwyd MP: Regulating cosmetic surgery will stop the butchers New laws must protect the public from rogue cosmetic surgeons and their dangerous procedures for breast implants, nose jobs, liposuction. “I think the operating table was a dental chair," someone wrote to me recently, describing their experience of liposculpture in a London clinic.

SOURCE: Politics.co.uk

Fat Cells Don’t Return to Treated or Untreated Areas After Liposuction New Study Refutes Previous Findings Claiming Fat Returns, Redistributes to Other Areas of the Body Since it made its debut in North America 30 years ago, liposuction has promised to permanently remove excess fat from stubborn areas, barring extreme weight gain. New research reveals liposuction lives up to its promise.

According to a study in the August issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS), fat cells neither return to treated areas nor get redistributed to untreated areas of the body after liposuction.

SOURCE: ASPS

Men at Higher Risk of Wound Complications after Body Contouring Surgery Increasing Number of Males Undergoing Lower Body Lifts and Abdominoplasty Certain types of wound complications are more frequent in men undergoing body contouring after weight-loss (bariatric) surgery, compared to women, suggests a study in the August issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

SOURCE: ASPS

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Equipment Sales SaveOnKit (formerly Moorgate Consulting) 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 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 Depilex Multivac Plus suction cup machine with Stand Vacuum for facial treatment to de-congest and improve circulation. Good condition and full working order For Sale at £570 *PRICE REDUCED £380 + VAT* More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=536 Depilex Dermapeel Professional Microdermabrasion System In good condition, full working order For Sale at £912 *PRICE REDUCED £760 + 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 Body Ultimate Skincare Facial Toning System In good working order complete with attachments, bands and pads For Sale at £1,500 + VAT *PRICE REDUCED AGAIN £760 + VAT* More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=455 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 Luxury Natural Wood Style beauty treatment table, seat + trolley In pristine condition, top quality natural wood style For Sale at £500 + VAT each (2 available) *PRICE REDUCED £380 ex VAT each* More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=432 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

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 Lumenis Aculight HR HR655 HR695 HR745 Treatment heads and warranty For Sale at £400 + VAT More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=145 Ultimate Skincare Body Contour System Latest Model Designed to achieve body toning by stimulating nerve endings to improve tone in the muscle tissue.

For Sale at £700 + VAT More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=185 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 £7,600 + VAT* More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=515

Classifieds FOR SALE Laserscope Lyra-i Nd:YAG/1064nm laser system Bought new in July 2007. Mint condition. Low usage. Full service history. Reason for sale: relocation Supplied with Versastat variable focus and fixed 10mm probes, 2 pairs of YAG laser glasses, and patient eyewear.

Also supplied with a chiller unit to improve safety and client comfort. Training manual and information supplied, also included is paperwork for registering your clinic with the CQC or HIW. Effective for permanent hair reduction on all skin types (FDA approved for all skin types including Type 5 – 6). Excellent for leg veins removal. Can also be used for wrinkle reduction, acne treatment and for shaving bumps.

Price: Cost new over £35,000.

Offers near to £10,500.

Contact: Prashant Murugkar, Tel: 07983 411193 Email: pmurugkar@gmail.com

Thermacool TC Thermage system System comes complete with trolley, 2 hand-sets, 2 eye pieces and a supply of coupling fluid, return pads and spare coolant canisters.

Fully operational and up for sale as I have sold my clinic and the machine was not part of the sale as purchaser already owned system. Has provided 5 years of excellent service on face eyes and body.

Purchaser may opt to use system as a trade in for latest Thermage machine (rep had quoted £20k to £25k against upgrade).

Collection is an option but will arrange delivery if desired. * Free delivery if paying the asking price*

Price: £10,000 Contact: Simon Connolly Email: simon.connolly63@gmail.com For a full list of second hand equipment sales, please see: www.consultingroom.com/Equipment

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