The Consulting Room™ Industry Magazine Edition 110, July 2012

[COVER]

As we went to publish the July 2012 edition of The Consulting Room™ monthly member magazine, the following important news for the U.K. medical aesthetic industry hit our TV screens thanks to a BBC London News undercover investigation.

Remote prescribing of Botox by Doctors over telephone and internet banned by GMC This week the General Medical Council (GMC) will issue new rules to its members, UK Doctors, stating that the practice of remotely prescribing prescription only botulinum toxin products, such as the brands Botox, Vistabel, Azzalure, Dysport, Xeomin and Bocouture will no longer be permitted and Doctors must see a patient face-to-face before issuing a prescription for the drug; (although they may still delegate the administration of it to someone under their supervision, such as a nurse).

This means that the ongoing loop-hole of writing prescriptions for Botox following a telephone call, fax, email or voice over internet connection (i.e., Skype etc.) will from this week mean that a Doctor is practicing outside of the GMC rules and could face disciplinary charges in the form of a fitness to practice hearing.

"There are good reasons why these are prescription-only medicines and we believe doctors should assess any patient in person before issuing a prescription of this kind," said Niall Dickson, chief executive of the GMC. The story broke on the BBC London Evening News on 9th July which highlighted an investigation into the practice of remote prescribing services following concerns that were raised to the broadcaster. The BBC sent a researcher undercover to investigate operations by infiltrating training sessions with one of the UK’s largest purchasers of botulinum toxin products, Dr. Mark Harrison, who runs Harley Aesthetics a company which provides training courses and remote prescription services for registered nurses up and down the UK.

Continued......

To read the full story, including comments from the British College of Aesthetic Medicine (formerly the British Association of Cosmetic Doctors), the British Association of Cosmetic Nurses (BACN), the Private Independent Aesthetic Practices Association (PIAPA), the Treatments You Can Trust register, a nurse prescribing training course provider and a response statement from Dr. Mark Harrison himself, then please visit our blog.

Feel free to add your opinions on this move by the GMC to the debate using the comment system provided; If you’re a nurse affected by this stop in remote prescribing of BTX-A

by Doctors, we’d love to hear from you too. www.consultingroom.com/Blog/Display.asp?Blog_ID=305

From The Editor's Desk Welcome to The Consulting Room™ Industry Magazine For July 2012 So the Summer is upon us...no honestly it is! The sun may not be here but we hope that this edition of our newsletter magazine will brighten your day!

In this issue for July, our Feature Article looks at a round-up of the recent FACE 2012 conference, including details of some of the key presentations, themes and discussions over the three day event.

Latest News this month includes more on the PIP breast implant scandal with the final report issued by the Department of Health. Podiatrists being trained in and administering botulinum toxins and dermal fillers is our topic up for debate in Food For Thought. Product Reviews highlight some of the new skincare and cosmetics lines being launched by existing popular ranges. We look at a petition to recognise beauty therapists administering botulinum toxins in our Legislation section and some up to date techie news in our Business Corner.

Lorna Jackson

Finally we cover FACE 2012 and the Aesthetic Industry Summer Ball at Madame Tussauds in our Eye Spy With My Industry Eye. As always the magazine is packed with Clinical Information, Equipment Sales and Interesting News Articles and Blogs That You May Have Missed. I hope you enjoy it!

We Need 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 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, Jonathan Hunt, Paul Simmonds and 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.

Information on sponsoring them will be set up soon on The Consulting Room site and we will be sure to let you know nearer the time, but anyone wishing to donate can contact dan@consultingroom.com for updates.

And that’s not all...

Mud Glorious Mud! Consulting Room Director Ron Myers, along with the team at MediZen Clinic in Sutton Coldfield, Birmingham also recently took part in the Mudrunner event at the end of June and raised £1,500 for Birmingham Children’s Hospital.

Not content with that mud bath, Ron and Danny Large are also planning to take part in the Tough Mudder event in the North West in November.

Details of this and any fund raising will be updated nearer the time.

Some Recent Blogs You May Have Missed Men`s Skincare; Just being yourself, because you`re worth it!

By Lorna Jackson As the now well known saying goes “...men are from Mars and women are from Venus”, and it would seem that this sentiment on the differences between the sexes is also borne out in the skincare marketplace, and more noticeably in how products are targeted and marketed differently to men and women. www.consultingroom.com/Blog/Display.asp?Blog_ID=302

Polyurethane coated silicone breast implants - the latest big thing from Brazil

By Mrs Chien C Kat The only way is Brazil. I am a fan. Christ the redemptor statue, Copacabana beach, Bossa nova music, Pele and football (not really), the list goes on.

But top of my list is what my patients call the 'posh Brazillian implants'. www.consultingroom.com/Blog/Display.asp?Blog_ID=301

Indocyanine (ICG) Green Dye shown to increase effectiveness of laser treatment for leg thread veins

By Lorna Jackson A recent study by German researchers has shown that the addition of indocyanine green (ICG) a medical pigment increased the results achievable with diode laser therapy in the treatment of telangiectatic leg veins, thread veins present in the legs, without incurring any short term to medium term side effects. www.consultingroom.com/Blog/Display.asp?Blog_ID=300

Which cosmetic treatments are best for your `first time`?

By Dr. Stefanie Williams An effective skincare regime is important for maintaining healthy, beautiful looking skin, but there might come a time when you want to do a bit more to turn back the clock. Thanks to a wide range of minimally invasive aesthetic procedures, we can now diminish the signs of ageing effectively and achieve natural appearing results non-surgically. www.consultingroom.com/Blog/Display.asp?Blog_ID=299

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):

How to undertake a Basic Epionce Sal-e Peel A video illustrating how to apply and remove a Basic Epionce Sal-e (Salicylic Acid) Peel, suitable for the treatment of both rosacea and hyperpigmentation.

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)

Wigmore Medical

Health XChange

Med-fx

N/A £100.00 4+ packs @ £91 each

£140.00 N/A

£145.00 £95.00 Buy 10 @ £84 each & get 2 single packs free*

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

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*Offer valid until 31 July

Nip & Tuck - Facts & Stats

“MMM”

30%

Lacey Wildd is obsessed with making her L-cup breasts bigger and is preparing to have another breast op to become size MMM!

The rise in the number of people in Israel electing to have cosmetic surgery from 2010 to 2011.

Source: Times of Israel

Source: The Sun

2 Times Higher Rate of PIP rupture around 6 - 12% after 5 yrs, rising to 15 - 30% after 10 yrs (compares to 10 - 14% after 10 yrs for other brands).

Source: DOH Expert Group

19.6% VAT

8 million

The current tax rate in France which the government is considering applying to cosmetic surgery procedures.

The number of cosmetic procedures performed in 2011 by American Society for Dermatologic Surgery (ASDS) members.

Source: Agence France-Presse

Source: ASDS

ADVERT

Latest News DOH: Final expert report on PIP breast implants published The NHS Medical Director’s expert group, which has been looking at PIP th breast implants published its final report on 18 June 2012.

The group, lead by Professor Sir Bruce Keogh, has been collecting and reviewing all available data including estimated rupture rates, data on clinical findings when implants are removed, and further examination of the chemical make-up of PIP silicone gel.

The expert group studied information on 240,000 implants of different makes used throughout England, which have been given to 130,000 women, along with detailed findings from 5,600 removal operations.

The group recognises the anxiety that many women have suffered during this episode and is determined that they receive help that addresses their problems fully.

The expert group has found that:     

Exhaustive worldwide testing of the PIP gel material has not revealed anything that could cause a longterm threat to human health – they are not toxic and not carcinogenic.

PIP implants do have a higher rupture rate – around 2 times higher. The rate of rupture appears to be around 6 to 12% after 5 years, rising to 15 to 30% after 10 years (this compares to 10 to 14% after 10 years for other brands of implants).

PIP implants have a higher concentration of certain compounds called siloxanes – chemically similar to silicone but of a lower molecular weight and found in many consumer products, including hair and skin care products, antiperspirants and deodorants – but this does not present a health risk.

Although the contents are not harmful and the gel has not been shown to contain any toxic substances, the inferior mechanical strength of the implants led the group to consider this a substandard product.

If the implant does rupture, it has been found to cause local reactions around the implant area in a small proportion of women, which can result in symptoms such as tenderness or swollen lymph glands. There is no evidence that this causes any more significant general health concern however.

The expert group has said that the advice to women who have PIP implants remains unchanged.

The group is aware that women who underwent breast augmentation surgery had an expectation that their implants contained medical grade silicone. The providers of cosmetic surgery have a recognised duty of care to minimise the health risk to their patients. The group agrees that anxiety over possible health effects is in itself a form of health risk.

It is now clear that PIP implants are more likely than other implants to rupture early, and that some patients who experience implant rupture will develop local reactions to silicone. In line with good clinical practice those surgeons and clinics that have used PIP implants have a responsibility to take proactive steps to contact their former patients and to share with them the latest information regarding the health implication, including the evidence summarised in the report.

Currently:   

7,098 women who had their PIP implants put in privately have been referred to a specialist on the NHS 4,349 scans have been done 490 women have decided to have their implants removed on the NHS

The Poly Implant Prothèse (PIP) breast implants: final report of the Expert Group is available here www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_134624

Food For Thought Podiatrists Injecting Botox! – Just where does the foot end?

The thorny issue of just who should and shouldn’t be allowed to inject botulinum toxins (e.g. Botox®) into paying customers, aside from who practically can and can’t has raised its ugly head again. Following recent debates over beauty therapists, dental hygienists and other non-medics involvement in this marketplace, we now see Podiatrists or foot specialists wanting to get in on the action too with training companies and insurers prepared to back them and actively promote this business option to them.

(Cue music...)

“The toe bone's connected to the foot bone, The foot bone's connected to the ankle bone, The ankle bone's connected to the leg bone... but it’s a long old way to the face (bone)!”

Joking aside, it has come to our attention, and that of the many and varied industry associations and key opinion leaders within the UK medical aesthetic industry that some training companies are openly targeting and promoting training courses in prescription only botulinum toxins (and dermal fillers) direct to ‘Healthcare Professionals’, in this instance those registered as Podiatrists.

This latest ‘nonsense’, as dismissed by some, is provoking all sorts of debate and anger amongst trade associations which represent medical professionals such as Doctors and Nurses, as well as regulators like the IHAS Treatments You Can Trust Register of Cosmetic Injectable Providers, and industry suppliers, participants and medical indemnity insurers most of whom do not support this specialty’s involvement with facial aesthetics. In fact, all the manufacturers of botulinum toxins licensed for aesthetic use in the UK have openly stated that they do not support the use of their products by anyone other than Doctors, Dentists, Nurse Independent Prescribers and Registered Nurses; so what is going on, why are so many other ‘people’ wanting to and being given the means to wield this drug in the faces of unsuspecting members of the public and is this really a huge problem for the industry?

We didn’t have to go far in our hunt to find podiatrists offering services to the public as ‘qualifed aesthetics practitioners’ now happily promoting dermal filler and botulinum toxin injections, some even with a banner outside the clinic declaring that they now do Botox! – A complete no-no in terms of medicines regulations given its POM status! Here are just a few of the operators that we found from a quick Internet search showing a wide distribution across the country – Holistic Health Facial Aesthetics just outside Newcastle-Upon-Tyne run by Podiatrist Michelle Scott and The WalkWell Clinic in Rugby where Podiatrist Vicky Morley now includes facial aesthetics.

The latter is the clinic with the banner, who also compound their lack of awareness of the regulations governing the advertising of prescription only toxins to the public as they are quite prepared to promote it on Twitter as well.

As well as new operators, we found a variety of companies offering such training courses to podiatrists, including this one run by MasterClass Presentations Ltd in Tamworth; a company which was set up by two Health Professionals and runs a variety of courses for UK Doctors, Dentists, Nurses and Podiatrists in facial aesthetics and mesotherapy.

They proudly state on their website; “Many Podiatrists work in close proximity to aestheticians and for years it was a source of untold frustration to many that, for example, RGN’s with diplomas could train in facial aesthetics injections but Podiatrists with good honours degrees often complemented by Health PGC’s PGDip’s, Masters or PhD degrees were denied such training. After a substantial amount of work convincing insurers and underwriters that Podiatrists could be an exceptionally ‘safe pair of hands’ and developing what is widely regarded as the most intensive syllabus of learning in its field, we were able to start training LA qualified Podiatrists as aestheticians and it has been the success story of the decade.”

Another company who is at the forefront of this push is Fluent Health Academy, a training company based in Bolton who offer a 2 day, combined foundation course in Botox and dermal fillers from £1,150.

Fluent Health Academy is run by Directors Lisa Moore and Michael Wilshaw. Lisa whose past CV, freely available on LinkedIn, includes being Head of Podiatry at NHS Sefton and owner of a private podiatry practice for 7 years from 1998 is clearly championing the inclusion of practitioners from her specialty within the aesthetic industry.

Michael, an experienced manager within the NHS, joined Lisa as business adviser and aid to their growing franchise business model for trained practitioners.

They introduce themselves on their own website as: “We are an exciting, clinically experienced and registered training centre providing medical Aesthetics courses and non invasive injectable cosmetic surgery for health care professionals such as Doctors, Dentists, Podiatrist, Paramedics, Dental Nurses & Nurses who can evidence they meet our minimum entrance criteria.”

They go on to say on their site: “After the basic foundation course you will be able to offer injectable cosmetic surgery treatments to your patients such as Botulinum Toxin A (Botox) and Dermal Fillers increasing your earning potential exponentially. As all of our courses are recognised by Hamilton Fraser, the leading Insurance broker in the industry, on production of the "Fluent Health Certificate of Completion", you will be guaranteed to get insurance with them after successfully completing our courses.”

All sounds so simple...and easy!

As well as taking a stand at a recent Society of Chiropodists & Podiatrists conference, a quick Internet search revealed some of their promotional activities direct to Podiatrists, including posts on forum site www.podiatryarena.com where they offered podiatrists a £150 voucher code for a discount on the training course.

Despite targeting this specialty, it seems that not all within the podiatry world are supportive or interested in this deviation from their existing profession. One forum member, a podiatrist in both the NHS and Private Practice wrote: “Whilst I am rather vocal about Podiatric recognition, using our full scope of practice etc. I must say if I were ever looking into getting Botox, dermal fillers I would not see a Podiatrist. Surely this is also a mine field waiting to happen, can you imagine the press PODIATRIST MADE ME LOOK LIKE I HAD A STROKE. All practitioners have adverse outcomes, but particularly practising outside your anatomic speciality is just asking for trouble and could potentially give us bad press.”

Another says: “If people feel the need to exploit this loophole don't do it under their professional title. People who have gone before me have worked hard to get rights that have enhanced but are connected to our scope of practice. This would only erode some of the respect I think has been built for the profession.”

To put minds at rest for those concerned about the views of the HPC (Health Professions Council) who regulate podiatrists, in terms of practicing cosmetic injectable delivery as a podiatrist where undertaking the procedure is well outside of the scope of practice, Fluent Health Academy advises that in fact once qualified the individual would practice and be insured as an Aesthetics Practitioner meaning that it falls outside of their HPC registration. In other words, they would not practice as a ‘Podiatrist offering Botox’ but as an ‘Aesthetics Practitioner offering Botox’ (who happens to be a podiatrist by trade!)

We approached the HPC for their thoughts on this. In a statement they said: “We set standards for entry to our Register, setting out what podiatrists must know, understand and be able to do before they start practising. Once on our Register, podiatrists must continue to meet those standards relevant to the work they do. A podiatrist can move into new areas of practice, so long as they have the knowledge and skills to be able to practice lawfully, safely and effectively.

All chiropodists/podiatrists must practice only within their scope of practice. This means that they should only practise in the areas in which they have the necessary skills, knowledge and experience to be able to practise lawfully, safely and effectively. This requirement is set out in our standards of conduct, performance and ethics, which are available here: http://www.hpc-uk.org/aboutregistration/standards/standardsofconductperformanceandethics/ In relation to facial aesthetics, they can be administered in the following situations:   

Where it is self-administered; Where it is administered by an appropriate practitioner; or Where it is administered in accordance with the directions of an appropriate practitioner

Appropriate practitioners are in this case, doctors, dentists, or, subject to certain limitations, nurse or pharmacist independent prescribers and supplementary prescribers.

This means that a podiatrist can administer facial aesthetics, such as Botox, where they are directed to by an appropriate practitioner such as a doctor. Alternatively, a podiatrist could administer specified medicines if they were following an established patient group direction (which is an instruction setting out various factors including the patients that a drug can be administered to and the conditions to be treated).

We regulate individual professions, including chiropodists/podiatrists. However, medicines legislation, which sets out the law around administration of medicines, is managed by the Medicines and Healthcare Products Regulatory Agency.”

Similarly The Institute of Chiropodists and Podistrists (IOCP) have also issued a position statement on podiatrists and facial aesthetics which is a much more detailed document. In this statement they note various points; “...In order to clarify the situation of Podiatrists also involved in this market sector, the following key guidance points are given. 

Prescribing or administration rights may only be used within the scope of podiatry, for example prescribing purified botulinum toxin type-A for a dynamic equinus foot deformity is within scope, prescribing it for facial aesthetics is not.



Podiatrists working as aestheticians must ensure that clear boundaries exist between their activities as a podiatrist and those as an aesthetician.



Botulinum toxins are prescription-only medicines throughout most of the western world, including the UK, and as such can only be obtained against a prescription issued by an appropriate practitioner. To be ‘appropriate’ that practitioner must be working within their scope of practice.

...In considering the prescribing of, for example Botox®, by a podiatrist prescriber, use of the term ‘appropriate practitioner’ used in the applicable legislation should be noted. Therefore, in the event that a podiatrist prescriber wished to prescribe and administer prepared botulinum toxin type-A for dynamic equinus foot deformity due to spasticity in ambulant paediatric cerebral palsy patients, two years of age or older where this was clinically assessed to be a suitable treatment, they would be judged ‘an appropriate practitioner’ and plainly acting within the defined scope of practice of podiatry. The foregoing procedure would naturally be subject to them having appropriate training in the product and its administration.

In the event that a podiatrist prescriber wished to prescribe Botox® for facial aesthetic treatments, this would be clearly outside their scope of practice and they would not be ‘an appropriate practitioner’.

Therefore any prescription issued by them for this purpose would be in contravention of the medicines act 1968 and subsequent amendments and therefore illegal. ...It is recognised and it is indeed entirely lawful and within their human rights, that podiatrists, particularly those in private practice, may wish to gain alternative skills in, for example, manipulation therapy, herbal medicine, acupuncture, hypnotherapy, counselling or any number of other personal care related skills. Such skills where they impact on area’s that are clearly not within the scope of podiatry must however be practised as standalone procedures and not as ‘extensions’ of podiatry. The same conditions must apply if podiatrists choose to undertake training in the administration of facial aesthetics products. Any procedures that are performed should be demonstrably performed not as a podiatrist, but within the scope of any training that they have received in such procedures, and strictly according to law as applicable to any products used. ...In the event that someone working as an aesthetics practitioner, who was also a podiatrist (whether a prescriber or not) wished to administer botulinum toxin type-A for facial aesthetics, as in the case of any other individual they must note that to comply with the law it should only be done under the named patient-specific direction of an ‘appropriate prescriber’ who takes responsibility for such administration. Irrespective of the fact that they may be highly knowledgeable and skilled in the pharmacology and use of botulinum toxin type-A for procedures within the scope of podiatry, a podiatrist cannot be an ‘appropriate practitioner’ for the purposes of prescribing botulinum for facial aesthetic purposes.

In such cases the Institute, although recognising that this is not a podiatry matter, would advise individuals performing such procedures who were also podiatrists, to ensure in writing via consent forms or similar, that people to whom they administer such procedures clearly understand that this is not a podiatry procedure and the practitioner is not acting as a podiatrist.”

Hence, both the regulatory body and trade association for podiatrists agree that they should only practice, as podiatrists, within the scope of their specialty which facial aesthetics in not, yet if they wish to branch into this market, they can do so along as they have received appropriate training, follow medicines regulations and above all do not practice this service in their capacity as a podiatrist. So does that mean you shouldn’t run the two services side by side in the same clinic as many are doing?

Earlier this year, Director of Fluent Health Academy Michael Wilshaw posted on his Twitter feed that accreditation for their training courses with bSOAP (now renamed tSOAP) was going through. tSOAP, the Society of Aesthetics Practitioners is a not for profit professional body who claim to be ‘seeking to further the aesthetics profession and the interests of individuals engaged in that profession’.

On their website they go on to say; “As the public demand for cosmetic injectable treatment continues to rise, so too does the demand for qualified practitioners. Once qualified existing clinicians are often dismissed by their current professional bodies as the skill is deemed as “out of scope” and not recognised by their insurance. Yet this has not stopped clinician’s continuing to practice. Aesthetics practitioners need support and professional recognition, much like they did when practicing as a nurse, podiatrist, dentist, paramedic or Doctor. tSOAP has been established as the first Multidisciplinary Professional Body for fully trained or clinicians wishing to train in injectable aesthetics.” tSOAP will only accept membership applications from clinicians whom have been on an ‘approved training course’, such which Fluent Health Academy is hoping to be listed as.

We approached tSOAP for comment and they told us; "As a society we represent qualified clinical practitioners who are both eligible and capable of prescribing and / or administering botulinum toxin A and dermal filler treatments safety, including Doctors, Dentists Nurses and a range of appropriately qualified and registered AHP professions. The latest guidance from the Department of Health (Dec 2005, Gateway Ref:5910) to patients clearly identifies that patients must only be treated, (i.e. Duty of Care undertaken) by a prescribing clinical professional, i.e. a Doctor or Dentist. With the following confirmation that 'The Doctor or Dentist may delegate the administration to a suitably qualified and competent other person'.

What is clear is that since this guidance was produced the Department of Health has extended the scope of practice for a broad range of clinicians, including Nurses and certain AHP professions within the NHS. Already a range of professionally qualified AHPs have clinical 1st and post graduate degrees with qualifications to undertake minor surgery and supplementary prescribing within the present range of NHS services. It is a high probability that these treatment and prescribing capabilities will be further extended by the end of 2013. Therefore, a range of Nursing and selected AHP grades and professions will have the capability to independently as well as supplementary prescribe for a range of treatments and conditions. So far the NMC are the only body to presently provide clear guidance to its members on the boundaries for prescribing Aesthetic treatment drugs.

The qualifications and capabilities of all clinical professionals are both relevant and important to accommodate in the strive for regulation, safety and quality within the Aesthetics sector. We would only ever support the prescribing and administration of botulinum toxin A and dermal filler products by appropriately registered and qualified clinicians. However the move to restrict both practice and training by profession rather than professional registration, clinical qualifications to practice or fully assessed capability is a degenerate rather than progressive move in the fight to establish standards and regulation in the sector.

We would like to see a range of standards made legally mandatory, with baselines for training and practice including professional registration, POMS and LA certification before clinicians are eligible to train or go on to practice lawfully. These and other standards should apply to and across all professions to ensure patients are able to access treatments that will be safe, convenient and professionally delivered."

When we asked Fluent Health Academy for a comment on their decision to promote courses specifically to the podiatry profession, (as well as to Doctors and Nurses), they told us that; “Unfortunately at the moment Fluent Health Ltd is not in a position to comment or be quoted in such articles due to other commitments”.

We also approached aesthetic industry insurer Hamilton Fraser, who have backed this training course for their comment.

Managing Director, Eddie Hooker said; “In 2010 Hamilton Fraser began trialling medical malpractice insurance cover to Podiatrists who are registered with the HPC and are qualified supplementary prescribers who are also permitted to administer local anaesthetic. Since this trial began, which involves 50 such practitioners, we have only received one notification of a potential claim. From a statistical point of view this volume of both practitioners and potential claims represents a very low risk to insurers. Provided practitioners continue to act within Standards of Conduct, Performance and Ethics set down by the HPC we are able to continue to provide insurance cover for Podiatrists under certain circumstances.

We continuously review and monitor the performance of all practitioner types and treatments to ensure that the risk to the industry, consumers and insurers remains at or below an acceptable level. We are aware that due to the size and diverse nature of this industry there will always be a difference of opinion as to which practitioners should be undertaking which treatments. Whilst we are not, and do not wish to become regulators for the cosmetic industry, it is right that we continue to take into account all available points of view so that we can provide protection in a responsible manner when we are approached with new opportunities.”

Podiatrists themselves may argue that they are better qualified to administer cosmetic injectables than some nurses as according to NHS Careers, “...to become a podiatrist...a recognised course of study leading to a Bachelor of Science (BSc) honours degree in podiatry... full-time course takes three or four years to complete...courses are modular...half the time being hands-on clinical experience.” A career in nursing is not always predicated on a degree, with diplomas of higher education and BTEC national diplomas all being routes to the profession.

As noted, current legislation permits podiatrists to administer or supply prescription only medicines under a patient group direction whereby a written instruction for the supply or administration of medicines to a certain group of patients is agreed and signed by a Doctor. Almost a year ago, the Department of Health and the Medicine and Healthcare products Regulatory Agency (MHRA) issued a public consultation on proposals to introduce independent prescribing for physiotherapists and podiatrists. This consultation concluded on 30th December 2011 and so far no follow up has been published.

Depending on your point of view the theory that podiatrists are more qualified than nurses may well be true, however many would also find it hard not to agree that there is a world of difference, and for most people at least 5 feet (excuse the pun!) of difference between say using Botox for plantar hyperhidrosis (which few podiatrists do anyway) and using that same drug in the glabellar frown lines as clearly facial anatomy differs significantly to that of the foot which they have studied for 4 years and subsequently practiced on. That’s not to say that all nurses have good knowledge of facial anatomy either, but the collective ‘we’ must draw the line somewhere on which healthcare and medical practitioners can truly be regarded are ‘qualifed’ and ‘safe’ to work in this arena for the sake of public safety at least.

At the recent FACE Conference in London, Consultant Ophthalmic Plastic and Reconstructive Surgeon Omar Durrani noted that there are 15 cases of blindness reported in clinical papers due to the use of dermal fillers, apparently in the hands of ‘experts’!

So does this really just come down to money? We know that a cash strapped NHS is cutting podiatry services, leaving many within the profession out in the cold and facing a choice – Do I go into private practice and hope there are enough people with foot complaints who are willing to seek a private referral and pay for something which was once freely available on the NHS? Or do I diversify and find the nearest ‘cash cow’ that will generate more income for me and pay my mortgage – top of the list being the facial aesthetics market? A similar parallel could be drawn with the recent surge in dentists moving into facial aesthetics who find themselves in a similar situation where NHS work dries up and become unprofitable, private practice is crowded so facial aesthetics seems like a handy income generating adjunct. Yet at least dentists already spend all day looking at and dealing with facial anatomy which podiatrists don’t; so is a 2 day course really going to teach them all they need to know – we doubt it!

At The Consulting Room we always aim to be independent, unbiased and above all accurate in our presentation of the facts about a topic, especially those as controversial as this. We hope we have been able to give a voice to all sides of the debate and present the evidence thus far so that you, the reader, can judge for yourself.

Why not leave your thoughts here - www.consultingroom.com/Blog/Display.asp?Blog_ID=303

New Product Reviews YoungBlood® Starter Kit Now Available Help your customers go from flawed to flawless with YoungBlood® Mineral Basics kit that introduces new foundation shade combinations including a new offering in Tan. YoungBlood® Mineral Basics lets your customers experience first-hand the supreme colour matching of the award winning Natural Mineral Foundation that effortlessly conceals imperfections while imparting a naturally radiant glow.

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By having the YoungBlood® Mineral Basics as part your range of products, you can encourage and educate your customers with confidence to have a new makeup routine leaving them with a flawless, natural, and unblemished finish.

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Leave Scars Behind with SkinMedica® Scar Recovery Gel with Centelline™ SkinMedica® Scar Recovery Gel (RRP £75.00) is the first and only topical scar product clinically proven to minimize the appearance of scaring according to the manufacturers.

This revolutionary product harnesses the unique properties of Centelline™ and combines naturally derived ingredients with scientific innovation to support scar formation from beginning to end.

Centelline™ is made up of three key ingredients: 

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Yellow African Bulbine Leaf Sap (Bulbine frutescen); provides deep hydration by leaving a layer of fatty vesicles on the skins surface. It is also responsible for fibroblast remodelling, increasing mature collagen, protein and DNA production for rapid wound healing.

Centella Asiatica Extract; is rich in antioxidants to help control inflammation. Studies on the active triterpene compounds have shown they decrease scar formation and help to balance collagen.

Olive leaf Extract (Oleuropein); also has anti-inflammatory properties and maintains skin elasticity to prevent damage.

In a clinical study of 60 subjects who received small incisions from various plastic surgery procedures, 80% of those using Scar Recovery Gel demonstrated the best possible scar resolution (to Grade 1) in as little as 6 months compared to 13% of those receiving no treatment. In another study of 30 patients who received large incisions, 80% of those using Scar Recovery Gel along with an adhesive tape demonstrated scar resolution to Grade 1 as compared to only 20% of those using adhesive tape alone.

According to the company SkinMedica® Scar Recovery Gel is a must for those with new or recent scars and is a first-of-its-kind treatment. Simply apply this light weight gel twice daily to problem areas.

For more information on the SkiMedica range, please contact Skin Brands Ltd, the UK distributor www.skinbrands.co.uk

Special Members Only Offer From Our E-Shop Buy One Get One FREE on Hand Sanitisers The Advanced Hygiene Systems Hand-Giene foam based, alcohol free hand sanitiser kills 99.99% germs, provides longer term protection than toxic alcohol based gels, contains Aloe Vera so leaves hands feeling soft. It’s rinse free and breaks through dirt with no water required, without leaving a residue. In all, one of the most cost effective hand sanitiser on the market.

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Business Corner Want to Run a Competition on Your Facebook Page? Did You Know There Are Rules?

If you are thinking of running any kind of contest or competition for your customers or potential customers using your Facebook page, you’d think it would be a pretty simple thing to do, but be careful, there are rules and if you don’t follow them your page could get shut down.

Now unfortunately these ‘rules’ are not something that Facebook shouts about so most page owners simply don’t even know they exist and happily set up posts for competitions which request that a fan ‘likes’ the post or comments on the post or shares it to their wall or similar in order to win a prize or be entered into a draw or similar – all of which is against the Facebook rules.

Similarly so is using the new ‘cover image’ feature on the timeline layout for pages to advertise a competition.

This is not something which Facebook has gone out of their way to warn people about however, as the details are buried in the general terms for having a page on Facebook and page owners are not pointed in their direction with much effort, especially given the penalty which could be imposed – “We reserve the right to reject or remove pages for any reason”; state Facebook.

The crux of it is that promotions (contests, sweepstakes, competitions, prize draws etc.) must be administered with a (third party) ‘App’ attached to your main Facebook page. Well known and popular Apps for this, most of which come with fees either based on the features and number of days the promotion runs for or based on the size of your fan base, include Wildfire, Offerpop and Easypromos who offer your first for free, There are however others.

The details of the promotions must also include various disclaimers to make sure that the entrant is aware that it has nothing to do with Facebook themselves.

As mentioned above you are not allowed to make it a condition of entry or registration for the promotion that the entrant takes an action on Facebook other than the acts of liking a page, checking into a place (e.g. your clinic) or actually connecting to your app and a person doing any of these activities must not constitute an automatic registration for a promotion – in other words you need to get them to fill in something like a competition entry form as well.

Other actions such as liking a wall post on your page, commenting on a post or uploading a photo to your wall are not allowed as mechanisms for entry into a competition.

Wouldn’t it be easy if you could just put all the names of your fans into a hat and pick out a winner? It would but this is a no-no as this goes against the rules as you would be effectively getting Facebook to collect entries by dint of your fan or like list, you must use an App and encourage your fans to go through that to be entered into your prize draw, thus entries are collected through the App. If you manage to get past that and create an App for your competition, the rules don’t stop there. When you have a winner you must not notify them of their win through Facebook! So no using the internal Facebook messaging system or online chat or posting on their timeline.

As you can see, quite specific rules which many, even big companies and big advertisers have all fallen foul of in recent times. It only takes your local competition to report you and you could be one of those who loses your page!

The full rules on promotions can be found here https://www.facebook.com/page_guidelines.php#promotionsguidelines

Twitter and LinkedIn Part Company All good romances often come to an end (well not all but a lot!) and that’s the case for LinkedIn and Twitter who after a partnership of three years have decided to part company. It would seem that LinkedIn is the ‘jiltee’ and Twitter is the ‘jilter’ with LinkedIn announcing that it will no longer integrate tweets on people’s profiles due to some recent developments and guideline changes for partners at Twitter.

Previously, myself included, as Editor of The Consulting Room and a LinkedIn user, one could link a Twitter account to your LinkedIn profile and any tweets you posted would automatically pop up both on the top of your own profile but also in the LinkedIn newsfeed which people linked to you would see if they accessed the LinkedIn home page whilst logged in. From the end of June this is no longer the case You can however still work the other way; in other words LinkedIn users can post things from LinkedIn on to Twitter via the 'share' button, which will update both LinkedIn connections and Twitter followers of anything new that you post in LinkedIn.

Citation Urges Employers to Prepare for “Summer of Sickies” Hangovers and dodging work following the Euro championships and the Olympics could spark a “summer of sickies “, an employment expert predicts.

Lindsay Hill, boss of Citation plc employment law specialists, has issued advice to UK firms about minimising the impact of expected record sick leave during a bumper summer of events, and how to spot fakes.

With the Olympic Games starting in London just weeks after the UEFA European Championships in the Ukraine, UK industry is bracing itself for a wave of unauthorised absences. Citation is advising employers to make sure they act to minimise the impact of employee absences, but urges caution so as to not overstep any legal boundaries that could see them end up in court.

Anticipated “sick” leave around key Euro 2012 games is compounded by a recent poll which revealed that 30% of employees plan to pull a sickie during the Olympics. Managing director, Lindsay said: “Many employers are fearing the worst about losing productivity during the summer months due to sickies. We are urging employers to take practical steps in order to mitigate this risk.”

Mr Hill says there are things employers can do, such as reminding staff of their sickness policy before major events or games. Conversely, if employers do think staff are not absent through genuine illness, disciplinary action taken in haste could backfire.

Mr Hill continued: “Some people think going off sick is an easy way to recover from a night of celebration, particularly after staying up late watching sport. But evidence is needed that the illness isn’t genuine, and appropriate steps must be taken to ensure employers don’t fall foul of the law. We recommend taking steps to discourage staff from throwing sickies.

“For example, make sure the employee knows they have to speak to a line manager when calling in sick. This makes it much more difficult for staff, and one which tests the nerve as well as the acting skills of the most determined skiver. Insisting on a phone call to notify of sick leave, rather than text or email, is another useful deterrent - and it never hurts morale to provide access to TV coverage in the office at appropriate times.”

In a survey of all Citation customers, employers said that managing sickness was their biggest headache.

Citation plc is one of the UK’s largest Health & Safety and Employment Law firms, with over 6,500 UK businesses as clients. For further details call 0845 844 1111 or visit www.citation.co.uk/affinity/abs.

Legislation Petition Started for Recognition of Beauty Therapist Botox Training A website dedicated to providing information on training courses in botulinum toxins and dermal fillers for beauty therapists – www.botoxtrainingforbeautytherapists.co.uk has recently surfaced. This site doesn’t offer ACTUAL cosmetic injectable training courses to beauty therapists, it is in fact several pages of information on the types of courses generally available, their content, the qualification prerequisites, plus information on insurance options for therapists who train in facial aesthetics, and then there is a form to fill in to access information on course providers (of which we know several that exist); so essentially a referral service for which they take an introduction fee from the training provider.

Although the site does make a point that they see themselves as more than that by saying; “Beyond connecting you with training providers, BotoxTrainingForBeautyTherapists.co.uk aims to be your support and information source for all things related to advanced aesthetics training for beauty therapists.

We will provide information on clinical best practices, important legislation updates and the best marketing practices in order to obtain clients.”

In line with this the site recently launched a petition (including a rather grotesque campaign image – see above) in which it hopes to gather support for beauty therapists entering this marketplace. This has gathered plenty of responses from the medical community as one would expect!

The petition states;

Dear Beauty Therapists, At the moment in the UK, there are 100′s of beauty therapists administering Botox and other advanced medical aesthetics treatments in unsafe and unhygienic conditions.

We believe that beauty therapists are able to administer Botox and other injectable cosmetic treatments safely, providing they are suitably trained and educated. Beauty therapists, more than most, know the in-depth the principles required for aesthetic treatments since this is part of our day to day training and work.

We have partnered with leading training providers to give experienced beauty therapists safe and quality training in order to be able to provide timely aesthetic services to your clients while minimising potential side effects and adverse reactions.

We believe the time has come for the government to help promote the regulation of injectables by beauty therapists. The government has already funded and partnered with the IHAS (Independent Healthcare Advisory Services), an industry-led body which regulates most clinics administering injectable aesthetic treatments.

However, the IHAS discriminates against beauty therapists by purposefully excluding them from eligibility to their organisation. As stated on the IHAS website, the organisation accepts only doctors, dentists and registered nurses into their quality assurance scheme.

We believe in several key tenets:



Beauty therapists, with proper training, are able to administer injectable aesthetic treatments safely.



Government regulation is needed in order to guarantee quality assurance.

By joining this petition, you will help join us and send our message to the Department of Health. 

Allow beauty therapists to join the IHAS quality assurance scheme OR alternatively recognise and fund an alternate body devoted solely to administration of injectable aesthetic treatments by beauty therapists.



Officially recognise the right of beauty therapists to administer injectable aesthetic treatments.

By signing this petition, you will help do the following: 

Improve the quality of injectable treatments provided by beauty therapists to the public.



Improve the safety of the public and decrease adverse events.



Help reduce insurance premiums for beauty therapists administering Botox.



Increase public recognition and acceptance of advanced aesthetic treatment administration by beauty therapists.

If you agree with our cause, please sign this petition. Let you friends and family know and get them to join the cause.

Thankfully so far only 28 people have ‘Liked’ the campaign to add their support; the site has ambitious plans to reach 1,000 supporters but on the whole the resulting comment thread on the site is negative towards this initiative; something which is very much to be expected.

Highlights in the subsequent comments include: “This is a travesty. If any beauty therapist thinks they can inject botox after a one day course they are sadly mistaken”; from someone calling themselves Doc Botox.

But don’t be mistaken, not all the negativity comes from the medical fraternity. One beauty therapist writes; “No doubt that government regulation is needed. Even experienced beauty therapists need to be properly accredited and trained in this highly specialised field. Not for me though, need more training!”

The issue of beauty therapists and cosmetic injectables is not new territory and is something The Consulting Room highlighted in a blog over a year ago, but it certainly seems to be gaining more momentum and more ‘air time’ than ever before.

BABTAC is actively campaigning for this arena to be looked at and for beauty therapist inclusion and training courses are openly being offered by newly created beauty therapist organisations such as the Cosmetic Treatments and Injectables Association (CTIA) who now boast backing from the government in terms of funding for course fees from the Department of Work and Pensions (DWP) for those therapists looking to increase their skill level by training in facial aesthetics or re-enter the workplace after absence and who are currently unemployed or on low income. Pre-requisites include NVQ Level 3 or equivalent, skills in electrolysis or micropigmentation and 3 years plus working experience. Not quite the same as a 5 year medical degree and several more years with no sleep as a Junior Doctor!

This debate is unlikely to go away any time soon, but I’d like to leave you with this great comment left on the petition: “Mad, bad and dangerous! I don't want an NVQ'd (not very qualified) person near my face :(” The test as always will be with the public – educating them is the key as then it won’t matter how many beauty therapists are ‘trained’ if the public choose, sensibly, not to go to them.

To add your thoughts to their petition, visit - http://botoxtrainingforbeautytherapists.co.uk/petition/

Eye Spy With My Industry Eye FACE 2012 th

The Consulting Room™ Team attended the 10 annual Facial Aesthetic Conference & Exhibition – FACE 2012 held over the weekend of the 15th to 17th June 2012 at the Royal College of Physicians in London.

The event was attended by huge numbers of delegates this year, including many of our members so we were all very busy, both on our exhibition stand and in our role as assisting with the management and running of the event, plus we also took time to enjoy the Aesthetic Industry Summer Ball held at Madame Tussauds for a second time.

Feature Article Facial Aesthetics Conference & Exhibition 2012 Review For the 10th year running The Consulting Room™ was involved in the agenda format, management and practical running of the conference on behalf of the organising committee of Dr Tim Flynn (Consultant Dermatologist, USA) and Mr Rajiv Grover (Consultant Plastic Surgeon, UK), and the conference owners, FACE Ltd. This month’s feature article is a summary of some of the most interesting points to come out from this year’s event.

Over the three days from Friday 15th to Sunday 17th June, over 600 aesthetic practitioners – encompassing cosmetic dentistry, cosmetic dermatology, aesthetic nurse practitioners, plastic surgeons and cosmetic doctors attended the Facial Aesthetic Conference and Exhibition (FACE) - the UK’s largest facial aesthetic conference, held at the Royal College of Physicians in Regents Park, London.

The annual conference, which celebrated its 10 year anniversary, has become a staple event within the industry, attracting internationally renowned speakers from all over the globe. The 2012 event again broke records by attracting the highest audience numbers ever, as well as squeezing in the growing number of specialist exhibitors involved in promoting a wide range of aesthetic products and services to the UK market place in every corner of the venue possible. The audience and exhibitor numbers have now grown so much so that it must now say goodbye to the RCP and move to a larger venue, the QEII Conference Centre in Westminster for FACE 2013 (21st - 23rd June).

Attendees of FACE 2012 were treated to five separate agendas featuring interactive lectures on cutting edge technologies, practical tips and advice, workshops, insight into the latest innovative technologies and exhibits from global industry suppliers, product launches and of course the chance to meet industry colleagues.

This year FACE included parallel agendas running over the three days in two lecture theatres including a surgical and non-surgical agenda, alongside a skin of colour and skin disease and hair loss day. It also hosted a variety of exhibitor workshops from industry leaders such as Solta Medical, Invasix, Nordson Micromedics and Syneron Candela.

These exhibitor workshops ran throughout the weekend with suppliers unveiling a range of new and innovative technologies.

Viora highlighted their technology Reaction™ which is the first multi-frequency bi-polar device to combine radiofrequency (RF) energy and vacuum technologies for facial and body contouring including skin tightening and cellulite and circumferential reduction.

The Selphyl system for Platelet Rich Plasma (PRP) & Platelet Rich Fibrin Matrix (PRFM) was explained by German Dermatologist Dr. Sabine Zenker.

Invasix also championed the latest editions to their current portfolio which already includes the BodyTite RFAL system with the UK launch of Fractora and Fractora Firm which they refer to as “the most advanced fractional radio frequency treatments providing anti-ageing improvements on skin tone and texture through ablation and skin resurfacing, combined with a deep dermal and sub dermal heating.”

Dr Martyn King and NIP Sharon King also gave an overview of their year long experience with the Artiste assisted injection system from Nordson Micromedics in the indication of lip augmentation.

Following the success of last year’s “An Evening with Tim Flynn and Wendy Lewis”; this year saw the turn of the ‘Grandfather’ of dermatology Dr. Zein Obagi, (pictured far right with FACE Chairman David Hicks).

This informal and extremely enjoyable evening featured an insight into his journey to the present day including personal anecdotes, interesting career facts (he joined the U.S. Navy as a doctor at one point) and a few humorous and touching stories to reveal the man behind the world renowned Obagi skincare brand to the audience. We learnt that the young Zein decided to become a doctor when he saw that medics couldn’t help his own sister when she suffered burns from a kitchen scolding accident she experienced as an infant and when there seemed to be no solutions for his acne ridden teenage friends!

Friday saw the parallel agenda for Skin Disease & Hair Loss running alongside the Main Non-Surgical agenda. This agenda provided alternative presentations for clinicians wishing to explore other aspects of growing their business. It was noted that as NHS funding contracts, the management of common skin diseases such as acne and rosacea, alongside lumps and bumps including moles, skin tags, warts and seborrheic keratosis provide an opportunity for suitably qualified and trained practitioners to extend their services into the disease dermatology market place.

Speakers highlighted the key skin diseases and lesions seen in private medical aesthetic practice and looked at LED and micro-needling treatments for acne, alongside topical and cell therapy solutions for dermatologic indications.

In addition, opportunities to offer a range of options related to the treatment of hair loss for both women and men were also discussed, including the application of light, carboxytherapy, growth factor and stem cell solutions, some of which can be easily incorporated into an aesthetic business model.

On Saturday morning attendees in the alternative agenda theatre were present for a unique concurrent scientific debate in which 7 speakers from some of the largest global skincare suppliers highlighted the benefits of their respective products in terms of topical antioxidants for the prevention and treatment of skin ageing.

The audience heard exclusive perspectives from representatives from brands including Jan Marini, Epionce, Medik8, SkinCeuticals, Neostrata, Obagi and IMAGE Skincare.

This was followed by a dedicated Surgical agenda which included presentations on blepharoplasty, modern rhinoplasty, face lifts and facial contouring, fat transfer and new liposuction techniques and permanent lip implants.

Sunday’s parallel agenda covered Skin of Colour. This agenda included lectures on a wide range of subjects predominantly devoted to the treatment of hyperpigmentation, with a special focus on treating patients who present in aesthetic clinics with skin of colour. From age spots to melasma, the effective resolution of hyperpigmentation can be a challenge for aesthetic practitioners, particularly in patients with darker skin types.

Dr. Zein Obagi and Dr. Mukta Sachdev provided insights from many years experience in treating patients with darker skin types on a daily basis. They, along with other speakers looked at topical treatments, chemical peels and lasers and light in terms of the safe and effective use of a variety of different concepts and also explored potential complications, managing patient expectations and learning how to avoid problems to ensure that you achieve consistent results for your patients.

In addition, the unique one day ‘FACE of The Clinic’ meeting, chaired by renowned Independent Beauty th Consultant Wendy Lewis from the USA ran for a 5 year and expanded to a two day event, running on the Saturday and Sunday. This meeting was devoted specifically to helping develop the skills of Clinic Managers by updating their knowledge and awareness of critical business factors related to running a successful aesthetic practice.

Topics covered included social media marketing, optimising your website and blog to grown your clinic, customer relationship management, business development, receptionist training, clinic branding, dealing with the media to generate a buzz for your clinic, effective retail within a clinic, vouchers, deals and insurance.

In the main lecture theatre, Friday’s Main Non-Surgical agenda, informally known as ‘equipment day’, saw a number of speakers highlighting a variety of modalities including RF (fractional and non-fractional) devices such as Fractora, Pelléve and EndyMed 3Deep, fractional radiofrequency ‘microneedling’ with the Intracel and ePrime devices, non-ablative and ablative fractional lasers, including the increased use of fractional CO2 lasers, focused ultrasound therapy with Ulthera, alongside nitrogen plasma for skin rejuvenation with the relaunch of Portrait PSR3 and advanced electrolysis techniques for dermatologic indications.

Saturday’s Main Non-Surgical agenda started by taking a look at regulations within the facial aesthetics arena following the recent PIP breast implant scandal and whether lessons from this could be learnt by the dermal filler market. Regulation of these products was compared in terms of U.S. FDA approval processes and what are considered more lax European CE Marking requirements.

An update of the process towards the new European CEN Standard for Aesthetic Surgery Services was also given my Mike Regan the Chair to the Aesthetic Surgery Services Committee of the British Standards Institution. The final version of the standard, following the recent public consultation is currently expected to be published in the first half of 2013.

The rest of the day saw presentations on facial aesthetics including the use of microdermabrasion, in particular with the newer techniques of hydradermabrasion, a great entry level treatment for new clients; fractional lasers and the use of cosmetic injectables for facial volumising and treating the cheek and lid cheek junction.

Dr. Nick Lowe also took us on a tour of his 20 years of personal use and study into botulinum toxins, including the interesting fact that the word ‘botulus’ means sausage in Latin – thank goodness for modern refrigeration!

Dr. Lowe pointed out that despite the widespread use of this drug (BTX-A) making it the most popular cosmetic treatment across the globe, it is still only approved (across all brands in all territories) for one aesthetic indication, that of glabellar frown lines, making all other uses which have become second nature, crow’s feet, forehead lines etc., still essentially off-label.

He also noted that he would only use the type B toxin available in those patients with a known or acquired resistance to type A toxin due to the increased pain for the patient as it has an acidic pH along with the need for more frequent treatments (and more cost to the patient) as longevity is impaired over type A toxins. This session also featured demonstrations on various blunt cannulae techniques for the delivery of dermal fillers.

As everyone recovered from the Aesthetic Industry Summer Ball, held at Madame Tussauds, the Sunday main agenda kicked off with myths about botulinum toxins from Andy Pickett, Director and Founder of Toxin Science Ltd. He pointed out that there are still statements made and commentaries given about the botulinum toxin products used aesthetically that are based on no science or clinical evidence and which are simply incorrect. He noted that generally, these “facts” have been used as marketing tools to convince clinicians of the benefits of some products and the issues related to others. He finds it even worse that these “facts” are still published today as though they were clear science and clinical evidence when in fact they are not.

Examples he highlighted include the incorrect speculation about diffusion differences of the products which continues to be used to differentiate them. Modern data have provided us with explanations that there is no such thing as the “toxin complex effect” on diffusion.

The different products are already free neurotoxins in the vial before injection. Clinicians are always injecting free BoNT neurotoxin, regardless of which product they use.

He made it clear that there are no product differences in respect of diffusion and that the dose is the most important factor affecting the results that can be obtained aesthetically, closely followed by knowledge of anatomy and the actual targets of BoNT, the neuromuscular junction positions.

This was followed by presentations on how to avoid and manage any resulting complications from the use of the various toxin brands available and an on-stage demonstration by American trio Dr. Tim Flynn, Dr. Michael Kane and Dr. Raj Kanodia – two of whom pointed out that Tim Flynn was the only one not wearing trainers with their smart suits!

The same team joined us after coffee for a look at dermal fillers; again looking at avoiding and managing the many possible complications.

It was highlighted that taking a good medical history is vital as patients taking vitamin and herbal supplements (aside from actual medication), which they may not think to mention can have an effect on coagulation leading to an increased chance of bruising from the treatment, something which they will blame the practitioner for. Examples to listen out for included ginseng, ginko biloba, vitamin E and garlic. In contrast, herbal solutions which you can give patients for reducing any bruising such as vitamin K and arnica were also discussed.

Dr. Kane then focused his subsequent presentation on discussing how to create the right jawline for the various ethnicities and thus facial shapes and concepts of beauty within the human race.

The day and the meeting was rounded up with lectures on an alternative to BTX-A which uses focused cold therapy to reduce dynamic forehead lines, the concept of adding antioxidants such as mannitol to hyaluronic acid dermal fillers and platelet rich plasma for dermal rejuvenation.

Many of the speakers, invited from across the globe, presented recent clinical data or new concepts as yet unseen by a UK audience. We would like to highlight some of those which caught our eye.

Dr. Klauss Hoffman, a Dermatologist from Germany detailed a study in which he examined a series of 20 patients undergoing wrinkle and acne scar revision treatment with the fractionated CO2 Laser Encore in Deep FX as well Active FX mode. The treatment created a wound bed of similar depth in each patient. He noted that despite its benefits, fractional laser therapy usually requires a series of treatments over the course of several sessions.

In order to decrease the treatment time and increase the effectiveness of this wrinkle revision treatment, he used ReCell – Spray-On Skin, a skin-regeneration therapy, and applied it to the wound bed following a deeper or more

aggressive laser treatment. ReCell, a keratinocyte cell spray, uses the patients’ own epidermal skin cells to enhance skin regeneration.

He found that this novel technique decreases healing time and results in a better pigmentation match between the wound site and surrounding skin and by combining fractional laser therapy with the ReCell application, the patient down time is considerably reduced by requiring only one treatment visit, and a better overall outcome is expected.

Yannis Alexandrides, an American Plastic Surgeon discussed a novel concept, the use of Focused Cold Therapy (FCT) developed by Myoscience Inc. to treat dynamic facial wrinkles without the need for injection of biologic agents or other drugs such as botulinum toxins. The technology is approved in Europe and Canada for the treatment of wrinkles, pain, and for tissue ablation with Myoscience anticipating approval in the US for dynamic wrinkles by 2014.

Dr. Alexandrides noted that the technology works on the well-established principles of cryotherapy to cool nerves and prevent signal transduction in sensory or motor nerves, but that it represents an evolution in cryotherapy devices by allowing for percutaneous automated delivery (using 27G needles – 32G available soon) of controlled temperatures to targeted nerves. He feels that for the indication of dynamic wrinkles it addresses an unmet need to treat them in patients who are averse to the use or concept of toxins.

To qualify the treatment he highlighted prospective, non-randomized clinical studies which were used to support the European CE Mark approval. The treatment target was the temporal branch of the facial nerve which controls frontalis movement and the primary endpoint was a 1 point reduction in line severity in animation at 30 days post treatment as rated by the investigator. Secondary endpoints included duration of treatment effect, and subject’s global assessment of change in appearance. One hundred subjects received treatment with the myoscience device with a response rate of 94% at 30 days. Results lasted 60 to 120 days post treatment with common side effects including bruising, and swelling. Adverse events included headaches and skin lesions, but no serious adverse events or unanticipated adverse device effects were reported.

At the time of giving his presentation Dr. Alexandrides said the device has been used on over 480 subjects in Europe and the USA for dynamic forehead lines. Although simple for the practitioner to operate, preset parameters in a hand-held device with an on/off switch, the patient does require a local anaesthetic such as lidocaine (a POM) for pain relief when administering the cooling to the nerve. Certainly one to watch, but we don’t anticipate this as a significant threat to the BTX-A market.

Leslie Fletcher a registered Nurse who is Medical Esthetic Professional Certified from the USA enlightened the audience on her ArqueDerma™ Artistic Restoration Lift™ technique for delivering dermal fillers which is patent-pending. The method is design to address the three basic signs of facial ageing: loss of volume, lax skin, and skin deterioration in a way that corrects more areas using 40% less dermal filler, and lasts significantly longer than conventional methods of filling, according to Leslie.

The concept involves “blanketing” thin strands of hyaluronic acid dermal filler product, placed in strategic multidirectional vectors, to create an artistic lift of the lax tissues. Dermal fillers are administered applying an intentional, controlled force on the tissues stimulating the fibroblasts and causing them to stretch.

This is based on the controlled injury theory in which type I and type III collagen production occur at accelerated rates post trauma, this mechanical stretching leads to an increase of collagen production which translates into longer-lasting results, and leaves a hydrating effect on the skin’s texture in the treated areas.

Leslie explained the technique in more detail, although training courses are the recommended method for learning how to perform it. The practitioner uses the needle to create a modest subcuticular undermining effect which disrupts fragmented collagen strands and replaces them with purposeful, vectored strands of promoted neocollagenesis. This effect results in sustaining the desired lift longer than conventional methods of filling. She highlighted that a major advantage to being able to lift and redirect the patient’s now separated tissue is the ability to use the patient’s own lax skin and reposition it upward, lifting it back to its point of origin.

With the ArqueDerma™ technique Leslie claims that it opens a world of possibilities for difficult to treat areas such as the jowls and marionette lines of the lower face and that the outcomes are achieved using almost half of the dermal filler when compared to conventional filling methods.

There is no doubt that the use of dermal fillers has come along way in the last decade, from the first FACE conference in 2003 when it was all just about ‘filling’ up naso-labial lines to techniques today involved in volumising, contouring and depth of product placement.

Reoccurring themes at this year’s FACE conference included the use of micro or blunt cannulae for the administration of dermal fillers, this technique seems to becoming more and more popular so it will be interesting to see if this becomes the ‘gold standard’ over needles as time moves on. Another dominating factor was radiofrequency, which appears to be kicking lasers into touch as the modality of choice for dermal remodelling in skin rejuvenation procedures, granted it can’t affect pigmentation but skin tightening without surgery is the new Holy Grail and RF and more over fractional RF via microneedle delivery is the latest buzz.

Finally there was much debate on should you or should you not treat the tear trough on its own. Both Cosmetic Surgeon Rajiv Grover and Cosmetic Doctor Raj Acquilla discussed treating this area, including video demonstrations of techniques by Dr. Acquilla with Mr. Grover highlighting that the key lies in the malar fat pad and its decent through ageing and gravity. He argued that treating this region means that you can forget about treating the tear trough in isolation as the improvement in the malar fat pad zone synergistically improves the tear trough region. Dr Acquilla agreed, but highlighted that on occasion, despite addressing this cheek and lid cheek junction there are still patients who require direct treatment of the tear trough, a skill which is not to be rushed.

There were many excellent presentations and workshops at this year’s FACE meeting, more than we could hope to cover in this review; however selected proceedings from the meeting will be published in Body Language Magazine later this year.

FACE provides a vital information portal for practitioners to keep up to date in what has become an increasingly complex and fast-moving market place, if the last ten years are anything to go by the developments we will see in the next ten will no doubt blow our minds!

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

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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Conferences Dates For Your Diary Clinical Excellence in Medical Aesthetics - Journal of Aesthetic Nursing Launch Event Clinical Excellence in Medical Aesthetics is an independent, nurse-led event promoting safe and effective practice. Celebrating the launch of the Journal of Aesthetic Nursing, the event will provide an exciting platform for nurses to enhance their skills and engage in lively discussion and debate with their peers. To download the event brochure (PDF), please click here.

18th July 2012 at America Square Conference Centre in London

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.

Saturday 15th & Sunday 16th 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. th

6 October at the IET London Savoy Place, London

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

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.

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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.

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Smoking in Relation to Age in Aesthetic Facial Surgery.

Deliaert AE, van den Elzen ME, van den Kerckhove E, Fieuws S, van der Hulst RR. Department of Plastic Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.

Clinical Information

Aesthetic Plast Surg. 2012 Jun 19.

BACKGROUND: Smoking is a major cause of premature facial aging. Skin aging in general, often accompanied by wrinkling and furrowing, plays a significant role in the decision to undergo aesthetic surgery. Smoking may therefore be related to the demand for cosmetic surgery. This study aimed to compare smoking habits with respect to a standard cosmetic procedure (blepharoplasty) in the general population and to evaluate whether the age at surgery differs between smokers and nonsmokers.

METHODS: A questionnaire was sent to 517 patients with valid reports describing dermatochalasis of the upper eyelid who subsequently underwent an upper-eyelid correction in 2004. Smoking habits, socioeconomic status, and medical history were evaluated. The patients were classified as smokers, ex-smokers with at least 1 year of smoking cessation, and never-smokers.

RESULTS: Of the 353 questionnaires (68.3 %) returned, 345 were eligible for statistical analysis. The smoking habits did not differ between the blepharoplasty group and the general population. However, the smokers underwent surgery an average of 3.7 years earlier than the ex-smokers (p = 0.0007) and 3.5 years earlier than the never-smokers (p = 0.006). No significant difference was observed between the ex-smokers and the neversmokers.

CONCLUSIONS: This is the first study to describe an association between smoking habits and an earlier need for upper-eyelid correction among ex- and never-smokers. The mechanism of skin restoration could result in a regenerative mechanism among ex-smokers, but further research is needed to support this hypothesis.

The Potential Effect of Botulinum Toxin Type A on Human Dermal Fibroblasts: An In Vitro Study.

Oh SH, Lee Y, Seo YJ, Lee JH, Yang JD, Chung HY, Cho BC. Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Chungnam National University, Daejeon, South Korea.

Dermatol Surg. 2012 Jun 28.

BACKGROUND: The use of botulinum toxin type A (BoNT) continues to expand. Some physicians have noted a face-lifting effect after intradermal injection of BoNT, although the effects are controversial.

OBJECTIVE: To investigate the in vitro effects of BoNT on human dermal fibroblasts.

METHODS: The proliferation and toxic effects of BoNT on human dermal fibroblasts were measured. To understand the mechanism of BoNT on collagen production of fibroblasts, procollagen type I carboxy-terminal peptide (PIP) was measured using enzyme-linked immunosorbent assay, and collagen production was monitored using Western blotting. To examine the effect of BoNT on collagen degradation, we evaluated matrix metalloproteinase (MMP) production using gelatin zymography.

RESULTS: BoNT did not stimulate the proliferation of or show toxic effects on human dermal fibroblasts. Levels of PIP increased significantly in fibroblasts grown in the presence of BoNT, and BoNT upregulated the expression of type I collagen and decreased the production of some MMPs in fibroblasts that prevent collagen degradation.

CONCLUSIONS: This study shows interesting effects of BoNT on collagen production and degradation of human dermal fibroblasts in vitro. This research provides the experimental background for using intradermal BoNT injection for remodeling of dermal tissues in aged skin.

Clinical experience with complications of hand rejuvenation.

Park TH, Yeo KK, Seo SW, Kim JK, Lee JH, Park JH, Rah DK, Chang CH. Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, 108 PyungDong, Jongno-Gu, Seoul 110-746, Republic of Korea; Institute for Human Tissue Restoration, Department of Plastic and Reconstructive Surgery, Yonsei University, Seoul, Republic of Korea.

J Plast Reconstr Aesthet Surg. 2012 Jul 2.

PURPOSE: Prominent signs of ageing of the hands have recently been treated with permanent or longer-lasting injectable dermal fillers. However, few previous studies have described the long-term complications of such hand rejuvenation. The purpose of our report was to share our experience of 15 cases with long-term complications following hand rejuvenation using various medical fillers.

PATIENTS AND METHODS: We performed a retrospective review of the management of 15 patients who presented with complications from the injection of synthetic fillers for hand rejuvenation at a tertiary medical centre over a period of 10 years from March 2002 to January 2011.

RESULTS: Injected materials included polymethylmethacrylate (PMMA) microsphere filler, calcium hydroxyapatite filler, hyaluronic acid filler, poly-l-lactic acid (PLLA) filler and other medical fillers. Of the total study sample of 15 patients, nine underwent surgical excision, six patients with a history of PMMA or PLLA filler injection received intralesional steroid therapy and three patients with a history of hyaluronic acid filler injection received injection therapy using hyaluronidase.

CONCLUSIONS: Hand rejuvenation complications can be successfully treated according to our proposed algorithm.

Oral lesions associated with injected hydroxyapatite cosmetic filler.

Daley T, Damm DD, Haden JA, Kolodychak MT. Professor, Department of Pathology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2012 Jul;114(1):107-11.

OBJECTIVE: The purpose of the study was to present the clinical and microscopic features of oral foreign body granulomas associated with the injectable dermal filler Radiesse, and to increase awareness of this potential complication as the use of dermal fillers by the aging Baby Boom generation increases.

STUDY DESIGN: Demographic and clinical data of 8 patients with foreign body granulomas containing the characteristic microscopic appearance of hydroxyapatite microspheres were studied. Analysis of the microspheres of 1 case was carried out by energy dispersive x-ray microanalysis to confirm the calcium and phosphorus content.

RESULTS: The clinical and microscopic appearance of Radiesse-induced foreign body granulomas is illustrated and discussed.

CONCLUSIONS: Foreign body granulomas containing hydroxyapatite microspheres in patients receiving treatment with the cosmetic filler Radiesse have a characteristic microscopic appearance. Oral Radiesse-induced nodules occur more often in older women, most commonly in the lips and the mandibular labial vestibule.

Migrated Periocular Filler Masquerading as Arteriovenous Malformation: A Diagnostic and Therapeutic Dilemma.

Malik S, Mehta P, Adesanya O, Ahluwalia HS. University Hospital Coventry and Warwickshire NHS Trust, United Kingdom.

Ophthal Plast Reconstr Surg. 2012 Jun 27.

Migration of dermal filler is a rare complication in the periocular area. We describe a case that highlights the diagnostic and therapeutic dilemmas posed. A patient presented with a bluish swelling involving the left brow, temple, and glabella. It was ill-defined, mobile, and nontender. An MRI suggested a vascular malformation, while an ultrasound suggested a dermoid. On further questioning, the patient revealed having a permanent polyalkylimide filler injected to the glabella 10 years ago. This raised the possibility of delayed migration. The eyebrow, temple, and glabella were explored through a skin-crease incision. Transparent gel was expressed and cicatrized granulomas were excised. The patient made an excellent recovery through an inconspicuous incision.

This case emphasizes the importance of taking a detailed history and revisiting the diagnosis, if necessary. We describe a relatively scar-free approach to remove widely distributed migrated fillers. Clinical and radiologic features of migrated filler can mimic tumor.

Always read the label: a case report of a penile burn.

King I, Lipede C, Varma S. I King, MA (Oxon), MBBS, Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle, NE1 4LP, UK C Lipede, MRCS, Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle, NE1 4LP, UK S Varma, FRCS (Plast.), Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle, NE1 4LP, UK. Int Wound J. 2012 Jun 21.

A 32-year-old man presented with chemical burns to his penis following accidental application of depilatory cream to the area. The gentleman consequently sustained deep dermal burns to his penis, experiencing genital swelling and dysuria. This injury was managed conservatively in our burns unit and the patient was discharged shortly after.

We present this unusual case of penile burns which has not previously been described in the literature despite depilatory creams being inexpensive and relatively easy to use, and subsequently popular choice amongst available hair removal options.

The safety and efficacy of combining poly-L-lactic Acid with intense pulsed light in facial rejuvenation: a retrospective study of 90 patients.

Fabi SG, Goldman MP. Goldman, Butterwick, Fitzpatrick, Groff & Fabi Cosmetic Laser Dermatology, San Diego, California.

Dermatol Surg. 2012 Jul;38(7 Pt 2):1208-16.

BACKGROUND: Poly-l-lactic acid (PLLA) is an effective treatment for panfacial volumization. Typically, patients who are candidates for volume restoration can benefit from lasers and light sources for photorejuvenation.

OBJECTIVE: To evaluate the safety and efficacy of combining PLLA with intense pulsed light (IPL) in facial photorejuvenation.

MATERIALS AND METHODS: This was a retrospective, single-center study of 90 patients treated with IPL immediately before or as early as 6 days after PLLA injection from January 2003 and June 2011. Patients were contacted with regard to efficacy and adverse reactions after their treatment.

RESULTS: One hundred fifteen patients had IPL treatments to the face from immediately before to up to 700 days after PLLA injection to the face. Ninety patients responded; 19% experienced edema, 17% bruising, 10% erythema, 7% nodule formation after PLLA injections with 0 nodules occurring after IPL, and 12% mild discomfort during the IPL treatment. The majority of patients (86.7%) reported at least mild photorejuvenating effects from the combination of PLLA and IPL treatments, with 64.4% reporting good to excellent correction independent of number of treatments.

CONCLUSION: The combination of PLLA with IPL in photorejuvenation of the face is safe and effective.

Quantitation of the results of abdominal liposuction.

Cohen SR, Weiss ET, Brightman LA, Geronemus RG, Locke KW, Maytom MC, Dobak JD. Dr Cohen is a plastic surgeon in private practice in San Diego, California.

Aesthet Surg J. 2012 Jul 1;32(5):593-600.

Background There are few objective techniques to accurately measure the outcome of liposuction. Consequently, there is also a paucity of data quantifying the results of this procedure.

Objectives The authors compare changes in abdominal volume and circumference with several objective measurement techniques in a relatively homogeneous group of individuals undergoing liposuction in a single, defined abdominal region.

Methods This clinical study enrolled 23 patients with a body mass index (BMI) <25 kg/m(2) who had a localized anterior abdominal contour defect. Patients underwent standard suction-assisted tumescent liposuction. Changes in abdominal volume and circumference in the operative area (60 mm above to 80 mm below the umbilicus) preoperatively and 10 weeks postoperatively were assessed using a 3-dimensional (3D) digital photographic system and a standardized constant-tension manual tape measure procedure.

Results The majority of the patients in this study were Caucasian women with a mean age of 42 years, a mean weight of 65.8 kg, and a mean BMI of 23.8 kg/m(2). In the study population, mean abdominal volume and umbilical circumference were reduced by 231.0 mL (~30% of subcutaneous fat) and 1.7 cm, respectively, at 10 weeks postoperatively as determined by 3D digital imaging. Fat volume in the surgical aspirate (mean = -183.3 mL) was a poor predictor of individual outcome, as assessed 10 weeks postoperatively by both the 3D digital imaging and multilevel constant-tension tape measure assessment tools.

Conclusions Both 3D digital photographic imaging and a standardized manual tape measurement procedure proved to be reliable tools for objectively assessing changes in abdominal circumference and volume produced by standard liposuction of a single, defined abdominal region.

SOURCE: PubMed

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

Dermal bra technique matures Researchers have published a study showing successful outcomes for the dermal bra technique for mammaplasty and ptosis correction.

Study investigators, from several universities and medical facilities across China, studied 347 patients who underwent the technique between October 2003 and October 2011. Of these, 213 were followed for three months to two years after the procedure.

SOURCE: Modern Medicine

Volumizing anti-aging skin care ingredient Volumizing is now available for skin care, following the recent launch of a skin care ingredient with a proprietary delivery system from Lucas Meyer that is being billed as an alternative to dermal fillers.

SOURCE: Cosmetic Design News

Spray tanning is safe, argues CTPA In the wake of comments from US scientists prompting fears over the safety of spray tanning, the Cosmetic, Toiletry and Perfumery Association (CTPA) has spoken out in support of the industry.

The CTPA said that the European Commission’s independent expert scientific committee, the SCCS, has reviewed the self-tanning ingredient DHA. The SCCS looked at data to support the use of DHA in cosmetic formulations and specifically its use in spray cabins. The SCCS found that the use of DHA as a self-tanning ingredient in spray cabins “will not pose a risk to the health of the consumer”.

SOURCE: Professional Beauty

Human Cadaver Course for Aesthetic Treatments in Israel Dr. Monica Elman and Dr. Eli Raviv to Administer New Course for Medical Practitioners A new course, approved by the Israel Ministry of Health, is available to physicians for the study of aesthetic treatments, utilizing the human cadaver. The course, offered for the first time in Israel, will be administered by Dr. Monica Elman, an internationally recognized dermatologist and Dr. Eli Raviv, Associate Professor at McGill University, Montreal, Canada.

SOURCE: PRWeb

Anti-aging still driving skin care market with US women winning the face-off American women are the most likely to use anti-aging facial creams in a bid to hold back the signs of aging and preserve an image of beauty, according to new market research.

Carried out by Mintel, the study found that women in the US use far more anti-aging facial skin care products than their European counterparts in France, Germany and the UK, and this has led to a substantial growth in the past five years of the $2.3 billion US anti-aging skin care market.

According to Mintel, 37 percent of US women have used anti-aging creams and serums for the face, compared to 23 percent of UK women, 24 percent of the female population in France, 25 percent of women in Germany and 26 percent of women in Spain.

SOURCE: Cosmetic Design News

Move to stop botched ops (in South Africa) Despite several cases of horrific mutilation of women`s breasts through botched plastic surgery, loopholes continue to allow some general practitioners to perform cosmetic surgery. But these loopholes could soon be sewn shut when the Health Professions Council of SA finishes drawing up regulations on which procedures medical practitioners may perform.

SOURCE: Times Live

Botox For Young Women? A 24-Year-Old Explains Why She Started Getting Injections How young is too young for Botox? We're hearing more and more stories about young women getting "preventive Botox," so we reached out to one who has tried the wrinkle-stopping treatment: 24-year-old Danielle Dunsmuir, a surgical technologist and medical assistant at Advanced Surgery Center in New York. We asked her why she started Botox (along with lip injections) in her early 20s. Here's her story.

SOURCE: Huffington Post

Screening tool tailors care to cosmetic patients' needs Researchers from the Centre for Appearance Research at the University of the West of England have finished the first round of testing on a new psychological screening tool for prospective cosmetic surgery patients.

The test was developed in response to rising aesthetic procedures in the U.K. SOURCE: Modern Medicine

New Survey Results from the American Society for Dermatologic Surgery Demonstrate Broad Scope of Practice for Dermatologic Surgeons ASDS Members Perform More Than 8 Million Procedures in 2011.

New statistics released today by the American Society for Dermatologic Surgery (ASDS) demonstrate the broad scope of practice and breadth of experience of dermatologic surgeons. In addition to more than 2.6 million skin cancer treatments in 2011, ASDS members continue to be a leading provider of a diverse range of cosmetic and other medical procedures among patients across the country.

SOURCE: ASDS

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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/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/Eq0uipment/Display.asp?Equipment_ID=446

Lumenis Aculight HR HR655 HR695 HR745 Treatment heads and warranty For Sale at £400 + VAT More info - www.consultingroom.com/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/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/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/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/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/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/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/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/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/Equipment/Display.asp?Equipment_ID=516 Pollogen ReGen Tripollar Radio Frequency skin body facial beauty machine salon In very good condition, full working order The 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/Equipment/Display.asp?Equipment_ID=515

For a full list of second hand equipment sales, please see: www.consultingroom.com/Equipment

Classifieds Recruitment Opportunities Medical Aesthetics Clinical Training and Development Manager £30,000 to £40,000 DOE Medical Aesthetics Clinical Training and Development Assistant £25,000 to £30,000 DOE Medics Direct (Europe) Ltd is a medical aesthetics organisation providing the highest level of training and support to Aesthetic Practitioners in the UK and internationally.

We are looking for motivated, friendly, enterprising medical professionals to provide first class training and mentorship, to our Aesthetic Practitioners.

As the Medical Aesthetics Clinical Training and Development Manager, you will be in the charge of delivering our training strategy. The post will involve business development and sales as well the delivery of regular aesthetics training courses to all levels of practitioners. You will be responsible for quality control and upholding Medics Direct reputation as a professional, world class provider of clinical excellence in the field of aesthetics. You will write and develop new courses and show creativity in driving the company forward. You should be an experienced trainer (in this or other fields) and have a passion for teaching.

It will require an advanced level of aesthetics practice. You must have extensive experience of administering Botulinum Toxin and Dermal Fillers. You must be keen and willing to learn and teach new treatments as they are introduced. You should enjoy working under your own initiative with confidence and professionalism.

As the Medical Aesthetics Clinical and Training Assistant you will help deliver first class aesthetics training to all levels of practitioner. As well as teaching delegates, you will be in charge of scheduling, organising, setting up and running training courses in the Manchester and London areas. You will provide hands-on mentoring to aesthetics practitioners as well as promote courses through sales and promotion.

This job will require an advanced level of aesthetics practice. You must have extensive experience of administering Botulinum Toxin and Dermal Fillers. You must be keen and willing to learn and teach new treatments as they are introduced. You should enjoy working under your own initiative with confidence and professionalism.

These posts provide you with the opportunity to work with an energetic, forward-thinking company and to develop your skills in the field of aesthetics with ongoing training and an ever-expanding range of treatments and products.

Candidates should be registered Doctors, Nurses or Dentists.

Location: Manchester-based with regular UK-wide travel Please email rebecca@medicsdirect.com for the application process and more information. th

Closing date: 27 July 2012

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

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

Application:

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Used by:

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Economical:

Due to the real time filter life pressure gauge

Compact:

9" x 9" footprint, 14" high

Quiet:

Less than 52dBA, quieter than the competition

Filtration:

ULPA: 99.999+%@ 0.12 micron

Weight:

24 lbs.

Electrical:

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

Regulatory:

UL, CSA, CE

Tubing:

Vacuum Tubing 7/8" x 8'

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