The Consulting Room™ Industry Magazine Edition 114, November 2012

[COVER]

From The Editor's Desk Welcome to The Consulting Room™ Industry Magazine For November 2012 So the nights are drawing in and the chilly weather is with us, but cheer up, all is not lost, this is probably going to be one of your busiest times of the years as clients gear up for office Christmas parties and New Year celebrations and want to look their absolute best! We recently attended this year’s BODY Conference and have a full round-up of the event and the topics discussed in our Feature Article for the November issue of our Member Magazine.

Our Legislation section is full this month with details of a Beauty Therapist who got her GDC conviction for illegal tooth whitening withdrawn, the launch of the ‘Safer Injectables Campaign’ by Dr. Hilary Jones & TYCT and now that the Keogh report ‘Call For Evidence’ had ended we look at the responses submitted by key organisations.

This month’s New Product Reviews features the EndyMed™ iFine handpiece for RF treatments with 3DEEP™ in the eye area, new clinically advanced antiageing UV protection products from Heliocare® and Vitage® Advanced Antioxidant Skincare™ Skin Calming Aloe Gel.

Lorna Jackson

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

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):

Platelet Rich Plasma (PRP) Therapy Prep with RegenKit A video demonstrating the RegenKit single use device for Autologous Cell Therapy. The video illustrates the collection of whole blood, centrigugation, the collection of platelet rich plasma (PRP), and the application method of injection.

Some Recent Blogs You May Have Missed Illegal Tooth Whitening Crackdown by Government & Dentists, EU Directive Now in Force in the UK

by Lorna Jackson Writing on Dentistry.co.uk parliamentary correspondent Anika Bourley noted that the Government and Trading Standards must step up and deal with the illegal practice of teeth whitening following a new European Directive.

The EU Directive on teeth whitening products was implemented in the UK on 31st October 2012. However, it is feared by dental regulators such as the British Dental Association (BDA) and the General Dental Council (GDC) that emphasis of the regulation will focus on where non-dentists are obtaining the products, rather than the fact they are being used and compromising patient safety. www.consultingroom.com/blog/334

Florid Rash Caused by Vitamin B12 Injections Administered by Nurse in Beauty Salon?

by Dr. David Eccleston This is a case report highlighting an unusual presentation of a woman suffering from acne like symptoms potentially associated with high levels of Vitamin B12. The woman presented with a florid, red, spotty and pustular rash over her face, neck and shoulders. Upon taking a history, the woman, who had not suffered from acne before, had recently received 3 weekly injections of vitamin B12, administered privately by a nurse in a local beauty salon without any screening for vitamin B12 deficiency. www.consultingroom.com/blog/333

The Facts About Moles

By Dr. Ross Perry Moles are a fact of life for most of the UK population. The medical name for a mole is a naevus; the plural is naevi (in the US spelt nevus/nevi). Moles are very common. While the average adult will have around 30 moles, some people have up to 400.. www.consultingroom.com/blog/332

Why you should only have fillers done by a Doctor/Nurse and not a Beauty Therapist

By Lorna Jackson Cosmetic Doctor, Dr. Mervyn Patterson has released a very useful infographic to explain the issues and dangers from seeking dermal filler treatments via un-medically qualifed Beauty Therapists as compared to medically trained Doctors and Nurses. In it he explains the differing levels of training and competence between Doctors/Nurses and Beauty Therapists and their corresponding abilities, or not, to deal with complications and adverse events. www.consultingroom.com/blog/328

Confused about UVA and UVB Skin Damage? Don`t worry there`s an App for that!

By Danielle Lowe With the arrival of climate change, many people are spending more and more time in the sun. However, basking in the sun, especially without protecting your skin can lead to wrinkles, premature aging and, worst of all, skin cancer.

Yet doctors and aestheticians say that while people are more aware of the sun’s harmful effects, a lot of people still do not apply sunscreen correctly if at all. Suncare experts La Roche Posay have developed a new app to be used in the battle against Melanoma and raise awareness of the damaging effects of UVA and UVB rays to the skin. www.consultingroom.com/blog/327

Podcasts Podcast: Cosmetic Business Strategies In this podcast Adrian Richards talks to Ron Myers from The Consulting Room. They discuss business strategies within the cosmetic industry including the trend of cosmetic surgeons to specialise, the most cost effective treatments, building your cosmetic business to sell, the economics of your cosmetic business, bringing a new clinical specialist into your business and planning your exit strategy. www.consultingroom.com/blog/331

Looking For Best Prices on Toxins & Fillers? This Month’s Deals 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 / 50U Azzalure 2 x 125U (Twin pack) Xeomin 100U / Bocouture 50U

Restylane 1ml

Wigmore Medical

Health XChange

Med-fx

N/A £100.00 Buy 10 @ £84.00 each#

£140.00 / £76.01 N/A

£118.00 / £53.95 10+ Packs @ £107.00 each / 20+ Packs @ £51.00 each £55.00#

N/A

£145.00 £95.00 Buy 5 @ £86.00 each* Buy 10 @ £84.00 each* £119.90 / £51.00

£83.24

N/A

£96.88

Juvéderm Ultra 2 (2 x0.55ml)

£72.00 Buy 6 Get 2 FREE* £93.35

st

th

# offers end 31 December 2012

* offers end 30 November

Nip & Tuck - Facts & Stats

$7 billion

32.2%

the U.S. market for cosmetic surgery, facial aesthetics and medical lasers is expected to exceed this figure by 2019

of the value of the total UK cosmetic procedures industry market in 2011 is attributed to nonsurgical procedures.

Source: KeyNote

Source: iData Research

1 in 3 girls would consider cosmetic surgery to change their appearance. Pressured to look like celebrities.

Source: 2012 Girl Guides Attitudes Survey

9%

£25,000

the forecasted growth in value in 2012 of the UK cosmetic surgery and procedures market compared to 2011. (8.4% forecast in 2013.)

Compensation award to a Lincolnshire woman following faulty breast surgery and a correction operation in Harley Street.

Source: Key Note

Source: The Lincolnite

Latest News Alma Lasers Signs Exclusive Distribution Agreement With Orscan Technologies Ltd Alma Lasers, distributed in the UK by ABC Lasers, has announced an exclusive distribution agreement with 3D imaging developer Orscan Technologies Ltd. Under the terms of the agreement, Alma Lasers will distribute the ClearVision3D imaging workstation to its clientele of dermatologists, plastic surgeons and other medical aesthetic practitioners.

“ClearVision3D is a 3D imaging platform that allows medical aesthetic practitioners to provide patients with high quality 3D imaging that accurately captures improvement following aesthetic procedures.

As patients who undergo aesthetic procedures are increasingly demanding evidence of treatment success, the solution which ClearVision3D provides confidence to patients that the practitioner will meet their expectation.

ClearVision3D's high definition cameras and specialty filters bring aesthetic medicine to the next level by capturing not only the top layer of skin, but also that which is happening underneath.

Practitioners can now offer their patients additional treatments by viewing pigmentation, vascular lesions and imperfections in skin tone which are still not visible to the eye, deciding on the appropriate action, and then performing a follow-up image to assure treatment success.”

Dr. Ziv Karni, Alma Lasers Founder & CEO, explained the benefits of this strategic agreement; "Alma Laser's mission has always been to provide dermatologists and other medical aesthetic professionals with the widest range of advanced technologies. Today's professionals are finding more often the need for accurate documentation of their patient's progress throughout the treatment, and by offering the ClearVision3D imaging system along with our industry proven lasers and other aesthetic technologies, Alma Lasers will be the first company in its industry to offer an advanced and competitive imaging solution that is so crucial for the success of our clientele."

For more information please contact ABC Lasers on 0845 170 7788 or email info@a-b-c-uk.com

UK Feminista Says “Cut it Out” to Cosmetic Surgery Advertising UK Feminista, ‘a movement of ordinary women and men campaigning for gender equality’, has been reviewing the advertising of cosmetic surgery, both in women’s magazines and online via social media and believes that it is fuelling and exploiting issues relating to body image and trivialising surgery. They have published an 18 page report entitled “Cut it Out – End Cosmetic Surgery Advertising” in which they detail their findings.

They state; “This report brings together evidence that urgent restrictions need to be placed on the cosmetic surgery industry to prevent clinics from advertising their procedures.

Unlike rules governing prescription medicines, it is legal to advertise for medically unnecessary invasive surgery and there are few restrictions on how and where this advertising can take place. As a result, some clinics engage in marketing practices that exploit and perpetuate women’s widespread body insecurities and recklessly

trivialise the inherent risks of invasive surgical procedures. These practices are both socially irresponsible and dangerous.

As the evidence outlined in this report demonstrates, the practice of advertising for cosmetic surgical procedures is a danger to public health. The profit motive at the heart of cosmetic surgery advertising puts patients/customers at clinical risk. The advertising drives demand, working to normalise the idea of undergoing invasive surgery to address appearance dissatisfaction. The adverts themselves fuel poor body image and trivialise the inherent risks of surgery.

Voluntary guidelines and best practice recommendations are wholly inadequate, failing even to prevent the most egregious examples of cosmetic surgery advertising, such as time-limited financial offers and marketing targeted at particularly vulnerable groups.

There is strong support for the prohibition of cosmetic surgery advertising from key bodies within the industry itself, including BAAPS and the Medical Women’s Federation. In the interests of public health it is crucial that the Government acts to create a prohibition on advertising cosmetic surgical procedures.”

The full report can be seen here: http://ukfeminista.org.uk/wp-content/uploads/2012/03/Cut-It-Out-End-cosmetic-surgery-advertising.pdf

Struggling to Find Prescription Services for Botulinum Toxin? New Service Now Available Progressive Aesthetics was set up as a support network for non-prescribing aesthetic nurses, to enable them to continue with their non-surgical cosmetic businesses.

They are a national network of doctors and nurses providing face to face consultations for the safe prescribing of botullinium type A. They meet the GMC and NMC guidelines regarding the safe administration of botullinium type A. All their doctors and nurses are trained in the administration of ‘botox’ and are contractually obliged to take part in rigorous training and continuous professional development to guarantee that at consultation they are equipped with relevant expertise and guidance.

They only require 2 days notice to arrange a prescriber, due to their large network of doctors and nurses.

Progressive Aesthetics is forward thinking and always looking to improve their services and want to ensure aesthetic businesses thrive within this tough economic climate. They are a friendly, reliable company who want you to succeed and they will offer ongoing support and advice to help you service your aesthetic business.

What they offer:        

A supportive network for non-prescribing nurses Face to face ‘botox’ consultations by doctors and prescribing nurses Five client group bookings, £30 per client Four client group bookings, £37.50 per client A prescriber at two days notice Ongoing support for Progressive Aesthetic members Stock ordering Case notes on request

To join or find out more, call their friendly team on 01625 598910 or email jennie@pureskintheclinic.co.uk for more information or visit www.instituteofprogressiveaesthetics.co.uk

Editorial Changing Regulatory Environment for Cell Therapies Vavelta is a suspension of human dermal fibroblasts manufactured by Intercytex Ltd. When it was first developed in the 2008 for use in aesthetic surgery, the Medicines and Healthcare products Regulatory Agency (MHRA) agreed with Intercytex that it wasn’t a medicinal product for these indications. It didn’t treat a disease or act by immunological, pharmacological or metabolic mechanism which are the requirements for a material to be designated a medicinal product and such medicinal products require a marketing license.

Although not requiring a license from the MHRA at the time, the product still had to be produced

by Good Manufacturing practice at a licensed facility and the oversight of this was carefully monitored by the UK’s Human Tissue Authority (HTA).

The regulatory situation in the rest of the EU member states concerning whether Cell Therapies were Medicinal Products or not was not clear and in order to provide a coherent regulatory system throughout the whole EU the Advanced Therapy Medicinal Product legislation was developed. This classified Vavelta as a “Tissue Engineered ATMP” as it was “administered to human beings with a view to regenerating, repairing or replacing a human tissue”.

As a Tissue Engineered ATMP, Vavelta will require a full marketing license from the European Medicines Agency (EMA) from December 30 th 2012.

This will take time for Intercytex to obtain and will involve the Company carrying out a series of clinical trials and other studies.

Until it is able to obtain a license, Intercytex will not be able to advertise, promote or market Vavelta.

It will however still be manufacturing the product under GMP for its own clinical studies.

There are provisions in the legislation for instances where a patient may have special clinical needs that cannot be met by licensed medicinal products and Vavelta could be provided under these circumstances where there is a bona fide unsolicited order and the product is formulated in accordance with the requirement of a Doctor registered in the UK and the product is for use by their individual patients on their direct personal responsibility. Vavelta could not be provided however, if an equivalent licensed product is available that could meet the patient’s needs.

For more information or to answer any questions, please contact Intercytex Ltd on 0161 606 7204 or visit www.intercytex.com

Feature Article BODY2012 – Getting Bigger Every Year!

The BODY conference, sister to the very successful FACE conference held in the summer, and now itself in its 3rd year, was held at the Royal Society of Medicine in London on the 3rd and 4th November 2012. It has now grown to become the biggest event of its kind, open to all participants working in the Body Aesthetics market, be that surgical, non-surgical body contouring or laser disciplines such as hair and tattoo removal, and attracted over 200 delegates during the event this year.

Consulting Room™ Director, Ron Myers, in conjunction with David Hicks, Chairman of FACE Media Ltd and Consultant Plastic Surgeon, Mr. Shailesh Vadodaria organised 70 national and international speakers who covered a wide variety of topics featured in two parallel surgical and nonsurgical agendas, as well as a dedicated agenda on laser hair removal and laser body treatments which all ran consecutively over the weekend.

Plastic Surgeons, Cosmetic Doctors, Dermatologists, Nurses and a wide range of industry practitioners learnt about different and innovative concepts and treatment methods for body contouring and rejuvenation, alongside other potential services that can be incorporated into an ‘aesthetic clinic’ business model including weight loss programmes, antiageing solutions and internal medicine. Additionally sessions were held focusing on the involvement of psychological evaluations and nutrition in line with aesthetic procedures, as well as the ‘nitty gritty’ of running an aesthetic business, including tools for marketing and PR and litigation concerns.

From fat to cellulite, stretch marks and ‘mummy tummies’ to breast and buttock augmentation, the two day meeting also covered weight loss, genital surgery and the rejuvenation of hands and feet; a true conference on the body!

In terms of new concepts covered this year, we saw presentations on treatments classed within the arenas of regenerative and internal medicine including Platelet Rich Plasma therapy (PRP), bio-identical hormones and biomimetic mesotherapy techniques. Dr. Terry Loong summed it up nicely by saying; “Aesthetic Practitioners are artists in their own right helping their patients maintain their youthful looks. However, I see a much bigger role for Aesthetic Practitioners, in helping patients age gracefully both inside and out.”

That said, many clinics are realising the opportunity for generating significant additional revenue by entering the non-surgical body contouring market specifically for the reduction of fat and cellulite. Although many new developments have been made in surgical body contouring, including the advent of laser, radio-frequency, ultrasound, and water assisted liposuction; these treatments are invasive, require recovery time and are expensive for patients.

Similar to the non-surgical facial rejuvenation market, as new treatment concepts have been launched and heavily publicised in the main stream press, the market demand for effective, but minimally or non- invasive options for body contouring is now many times larger than the more traditional surgical sector. Patients are looking for that ‘quick fix’ with minimal downtime and are more and more reluctant to go ‘under the knife’ or ‘under the cannula’ to achieve it. Yet, as the market has expanded, conversely it has become more difficult for practitioners and clinics to evaluate and choose which concept(s) to offer that are effective, safe and profitable. The plethora of devices and modalities targeting this indication is now mind-boggling.

The weekend kicked off with talks on a whole range of body contouring devices and technologies from the truly non-invasive to the surgical with presentations on low level cold laser technology with Zerona™, cryolipolysis with CoolSculpting™; “great for treating those people with ‘grab-able fat’ in the flanks” said Dr. Tracy Mountford, combined ultrasound and mechanical massage with Ultrashape™ and Velashape™, combination treatments targeting both the subcutaneous fat layer using high intensity focused ultrasound with Liposonix™ and the dermis with radio frequency through Thermage™, plus the use of newer radiofrequency devices including Exilis, with combined ultrasound in one device and Endymed 3DEEP™ RF.

Plastic Surgeon, Dr. Chris Inglefield highlighted the fact that when choosing a non-surgical approach for his patients and their demands he looks for devices which cause no pain or downtime and are safe and effective when compared to advanced liposuction techniques now available to patients, which can produce the long term results and value for money which patients seek.

With technologies which have marked differences in their approach to targeting adipose cells in terms of cell membrane rupture (which can repair post lipid loss) as seen with the Zerona device or cell destruction noted with Zeltiq CoolSculpting™ and Ultrashape™; the audience were quick to ask questions of their peers who demonstrated much experience in the practical use and evaluation of the various devices.

The Zerona low level laser device which emits 635nm at 17.5mw provides for 360° treatment of all areas in just 40 minutes and is the only non-invasive treatment FDA cleared to treat the waist, hips and thighs, and as of July 2012 adds the treatment of the upper arms. The device triggers a photochemical response in the fat cell that creates a transitory pore allowing for the release of intracellular lipids into the interstitial space, which results in fat cell collapse but not death. The manufacturers Primcogent Solutions note that the mechanism and resulting clinical outcomes are supported by 17 peer-reviewed publications in major medical journals.

Meanwhile the surgical speakers focused on the merits of all the available liposuction methods now at the disposal of surgeons including traditional suction assisted liposuction, updates on radiofrequency assisted liposuction with the BODYTite™ device, the use of VASER® lipo for true high definition body sculpting and an insight into the use of ultrasound assisted liposuction and its particular role in addressing more fibrous areas of the body such as the torso , with the take home message being the need to tailor the use of a particular liposuction technique to the indication being treated.

Professor Nichola Rumsey, co-Director of the Centre for Appearance Research (CAR) reminded the audience that approximately 5 to 15% of the general population suffer from Body Dysmorphia, with disordered eating also more commonplace. With the Keogh report currently in process she felt that psychological assessment of patients may indeed be a factor in the investigation findings and urged all clinicians to have a referral process in place to address any concerns they have with patients who present to them.

She also highlighted the importance on making sure that patients fully understand the risks of any procedures that you have explained to them and suggest getting someone else in your clinic to check the patients have heard and understood by getting them to repeat it back to them post-consultation. A handy tip as it seems things often do go ‘in one ear and out the other’ and expectations could be altered and misunderstood because of it. With the need to pay more attention to the mind-set of potential aesthetic patients, even those presenting for non-surgical treatments, CAR are currently trialling and evaluating a brief screening and audit tool called RoFCAR to assess feasibility and acceptability as a simple psychological evaluation tool for the industry.

Dr. Pablo Naranjo, the self proclaimed Spanish ‘striae-ologist’ highlighted his years of experience, successes and failures searching for the holy grail in treating stretch marks. With the key to their treatment depending on the stage of their developments, initial red, raised striae rubrae or the older, white striae alba. He highlighted some interesting points that in his opinion ultrasound technologies send energy too deep to treat stretch marks, whilst light is too superficial, preferring instead the use of radiofrequency, both bi-polar (or multisource) or the newer RF micro-needling technologies.

Commenting on a previous talk and demonstration given by Brazilian, Dr Clara Santos on the use of carboxytherapy for stretch marks, Dr. Naranjo stated that although he likes this approach for some patients, in his experience he has found it to need lots of sessions for the production of the best results, something which he feels isn’t always practical for both clinician and patient.

Dr Sach Mohan was the final speaker to look at the troublesome stretch mark and the use of micro-needling techniques where patient satisfaction is currently poor, concluding that we simply need more data, as currently there are no clinical papers on the use of combination treatments, such as the use of topical like glycolics and retinoids with micro-needling or transdermal delivery systems for the indication of striae.

Another area of much discussion and debate was the breast. In the aftermath of the PIP scandal, the surgical agenda focused a whole morning looking at the techniques and aesthetics involved in addressing the variety of breast shapes which present in clinic to ultimately create the ‘natural look’ that patients are now predominantly seeking when they come for breast implants.

Anatomical implants and newer polyurethane coated implants which claim to lower the instance of capsular contracture and limit migration or rotation due to a ‘velcro effect’ within the tissues were discussed by Plastic Surgeons Mr Nick Percival and Mrs Chien C Kat. Additional speakers covered how to manage issues such as glandular ptosis, upper pole concavity and tuberous breasts to create a good surgical outcome with the variety of implant sizes and shapes now available, along with the avoidance of complications such as pseudo ptosis or ‘bottoming out’ of an implant over time, and the dreaded ‘double bubble’ effect. Additional talks were given by Mr Ajay Mahajan and Mr Jonathan Britto into the best approaches available for breast reduction and mastopexy surgeries. The morning’s presentations were then followed by a round-table and open house discussion session for surgeons in attendance on breast aesthetics and complication cases and management.

Meanwhile, breasts were not left out on the non-surgical agenda either with Dr. Daniel Sister showing a very innovative non-surgical solution to breast rejuvenation and minor correction now that Macrolane™ is no longer indicated for the breast region. Using hyaluronic acid sub-dermally (but not into the breast gland area) and then napping over it with a preparation of Platelet Rich Plasma (PRP) or alternatively mixing the HA and PRP together in the same syringe prior to injection, he is able to improve a cleavage, correct inverted nipples or minor breast asymmetries with longer lasting results than with HA alone.

When it came to the prize for the presentation exploring the most innovative and perhaps novel treatment to be included in the BODY Conference agenda, it had to go to Dr. Mark Hamilton who both discussed and demonstrated the latest treatment demanded by those ladies who live for their ‘killer heels’ made famous by shoe styles from designers such as Christian Louboutin which require gravity defying postures and put significant pressure on the metatarsal bones within the foot.

Dr. Hamilton demonstrated a ‘cushioning’ treatment, likened to inbuilt Scholl™ ‘Party Feet’ using hyaluronic acid dermal filler injections into the hardened skin and fat pad over the join between the metatarsal and phalange bones of the big toe to provide extra padding on this pressure area for the treatment of metatarsalgia. His product of choice is Belotero® Basic and he pointed out that this was because, as well as the danger of using too much filler and making it feel uncomfortable to walk for the patient (the exact opposite of what you are trying to achieve), the use of the wrong kind of filler, namely one which is too firm or highly viscous can have the same effect, so a hyaluronic acid with low viscosity is ideal.

Additionally a topical and/or local anaesthetic is usually required as the plantar nerve makes this a very sensitive area for patients; those fillers with inbuilt lidocaine could also be used. Dr Hamilton injects 2mls of HA, subcutaneously into the big toe fat pad region and massages the area well. Additional areas of pressure, which can be determined by having the patient stand on foam moulds can also be injected in the same way. Results are expected to last approximately 6 months.

A great treatment option indeed for all that Christmas and New Year partying in high heels, yet a note of caution is needed when learning about and understanding the exact anatomy of the foot and how the individual’s feet present and how they walk, which is not the same for every patient.

A separate agenda was also available covering Laser Hair Removal and Laser body treatments and saw presentations on some interesting and nitty gritty aspects to these provisions including treating dark skins safely with lasers and the treatment of resistant hairs. 20 year, seasoned laser professional Jo Martin from Mapperley Park Clinic looked at issues relating to training and compliance in the use of lasers and light whilst five leading lasers/IPL devices for hair removal were compared. The agenda was finished off with lectures on treating the decolletage and neck with lasers, their use to treat scars and in vaginal relaxation syndrome, followed by the use of lasers in podiatry with many devices now on the market aimed at treating onychomycosis (fungal nail infections) and verrucas.

As well as a trade exhibition floor of nearly 30 exhibitors, additional exhibitor workshops also ran all weekend from a variety of suppliers including Aestheticare, Syneron Candela, Zeltiq, Aqtis Medical, Solta Medical, Cynosure and BTL Industries.

An adjunct to the main conference programme saw delegates enjoy ‘An Evening With Dr Alfredo Hoyos’ on the Saturday evening. A Colombian Plastic Surgeon and self titled ‘geek’ who took inspiration and passion from the likes of Thomas Edison and Nikola Tesla as a child, he took the audience on a journey through his early medical career, his passion for drawing and inventing and how he sought to find his true calling, culminating in various patents for the invention, refinement and use of advanced and high definition liposuction techniques for true body sculpting, most notably famed for VASER Hi-Def and creating those ‘6 packs’ without needing to go to the gym!

The BODY conference now provides a focussed agenda to explore the plethora of non-surgical and surgical options that can be potentially added into a business focussed on facial aesthetics. As the market has developed, better evidence of efficacy and safety for different concepts has evolved, and although there are dangers investing in new concepts (some of which require significant capital investment), the rewards are definitely there for clinics brave enough and focussed with their marketing to exploit the growth in demand for body aesthetic treatments.

We are all ageing, failing to diet effectively and looking for ‘quick fixes’ in our busy lifestyles for the parts of our bodies which embarrass or upset us; aesthetic practitioners find themselves in a lucrative position to both educate and treat patients with programmes for nutrition, supplementation, anti-ageing and body maintenance by building a long-term relationship and revenue stream with patients to keep them looking and feeling young.

If you haven’t been to BODY before, this round-up should give you a ‘taster’ of what you can expect from this event, which both differs from and marries well with the FACE conference event in the summer. You may want to consider attending both or one in 2013 as they cover many different business opportunities available to aesthetic practitioners, a chance to engage with your peers within the field and provides an easier way to research the market and learn about income streams from treatments than reading about or talking to sales representatives alone. Keep up-to-date with plans for both events at www.faceconference.com & www.bodyconference.co.uk.

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.

New Product Reviews EndyMed™ iFine Handpiece AesthetiCare® is pleased to announce the release of the EndyMed™ iFine handpiece for use with the EndyMedPRO™3DEEP® Radiofrequency machine.

EndyMed™ 3DEEP® Radiofrequency Skin Tightening has made huge advances in leading medical aesthetic clinics around the world and increasingly so in the UK. The tightening, lifting and opening out of the delicate eye contour area is a major desire for patients and clinics alike and achieving significant results non-surgically is now being taken to new levels with the launch of EndyMed™ iFine. The unique and clinically advanced EndyMed™ iFine hand piece allows complete non-surgical tightening and lifting treatment of the eye area. It provides a highly targeted, controlled and comfortable treatment that delivers proven results.

Renowned Specialist Plastic Surgeon, Mr Chris Inglefield talks about the EndyMed™ iFine’s use in his clinic stating, “The launch of the iFine has revolutionised non-surgical eye treatment in my clinic.

In over a year we have treated approaching 400 patients with EndyMed™ 3DEEP® for the face and body and they are delighted with the results. The launch of the iFine has transformed the lifting and tightening of the whole eye contour area and the results we can achieve non-surgically. With EndyMed™ 3DEEP® iFine we can provide significant results to those patients who want and need their eye area tightened, lifted and opening out but are too young or not suitable for surgery, and we can even enhance our surgical results”.

The eye is notoriously one of the most difficult areas to treat non-surgically and is often one of the most tell-tale signs of ageing, with many patients expressing the wish to address it when visiting aesthetic clinics. Prior to the launch of the EndyMed™ iFine, the non-surgical options were limited and surgery is not always an appropriate or desired alternative. The revolutionary iFine handpiece offers unparalleled results in reducing fine lines and wrinkles in the periorbital area (under the eyes and brow area), as well as the perioral area (around the mouth). The benefits of the new EndyMed™ iFine include:     

Smoother, tighter skin around the eye Reduced under eye sagging and improved eye contour Reduced hooding to reveal more of the eyelid More youthful, less tired-looking eyes Softening of fine lines enabling easier application of make-up

EndyMed™ iFine provides instant tightening and lifting of the skin around the eye to lift the brow and open the eye out. The immediate results will initially soften but the cumulative and long-term regenerating effect of a course of treatments produces predictable and high level results. The unique iFine technology works by providing controlled and focused heating of the collagen in the delicate eye area; it is pain-free and has a high safety profile. It is also effective for treating fine lines and wrinkles on the upper lip as the precise hand piece allows for a thorough and targeted treatment.

EndyMed™ 3DEEP® a unique and patented radiofrequency dermatological technology is the only device to use multi-source phase controlled radiofrequency and is both certified as a medical device in Europe and FDA cleared.

The development of this technology has overcome the issues faced when using bi-polar or mono-polar radiofrequency devices and as a result of this EndyMed™ 3DEEP® is setting the standard and providing the next generation of radiofrequency skin tightening treatments around the world.

For more information contact AesthetiCare on 01937 541122 or visit https://endymed.aestheticare.co.uk

New Products From Heliocare® - Clinically Advanced Anti-ageing UV Protection AesthetiCare® is pleased to introduce the two newest additions to the Heliocare® range. Heliocare® Advanced SPF50 XFGel and Heliocare® Advanced SPF50 Gelcream Color Light.

The Heliocare® range of high or very high UVB and UVA protection products is designed to enable specific presentations to be matched with an individual’s skin type, lifestyle, skin-health and the time of year.

With its NEW and exclusive eXtra- Fusion formulation, Heliocare®'s high level UV and skin-biological protection is taken to new skin-loving levels. When applied, the fantastic XFgel formulation literally melts into the skin for invisible total skin-comfort. Also providing enhanced UVA, skin anti-oxidant and DNA protection, makes it the perfect choice for everyday anti-ageing protection.

Heliocare® has also introduced Heliocare® Advanced SPF50 Gelcream Color Light. Already available for those with a darker skin tone, with it's great to use skin-feel and skin tone enhancing bronzer it is ideal for masking uneven areas of skin-tone and blemishes.

A key ingredient in every product in the Heliocare® range is the unique, patented and natural Fernblock Photoimmunoprotection Technology.

Fernblock® is extracted from Polypodium leucotomos, a fern originating in Central America. Originally an aquatic plant, it adapted to life on land, developing its own natural protective mechanisms against UV radiation and has been used for centuries in the treatment of dermatological conditions.

The power of nature has been combined with advances in science and following 12 years of research and clinical investigation conducted in conjunction with the Harvard Medical School and leading experts in the field of photoprotection, the patented P. Leucotomos extract known as Fernblock® Photoimmunoprotection Technology was created.

Fernblock® has been proven in extensive scientific and clinical studies published in peer review dermatology and scientific journals around the world, to be a powerful natural skin specific anti-oxidant and skin-protector and enhancer helping in the fight against UV damage.

Heliocare® is a diverse and advanced UV protection range providing medical aesthetic practitioners and their patients clinically proven skin anti-ageing and health protection and enhancement Heliocare® Advanced SPF50 XFGel SRP £28.00 With its NEW and exclusive eXtra-Fusion formulation, Heliocare®'s high level UV and skin-biological protection is taken to new skin-loving levels. The fantastic XFgel formulation provides enhanced UVA, skin anti-oxidant and DNA protection. When applied it literally melts into the skin for invisible total skin-comfort making it the perfect choice for everyday antiageing protection Heliocare® Advanced SPF50 Gelcream Color Light SRP £28.00 Providing the same high levels of skin-protection and with a great to use skin-feel, the skin tone enhancing bronzers in Heliocare® Advanced SPF50 Gelcream Color Light make it ideal for masking uneven areas of skin tone and blemishes.

For more information, contact AesthetiCare on 01937 541122 or visit http://heliocare.aestheticare.co.uk/

Vitage® Advanced Antioxidant Skincare™ Skin Calming Aloe Gel Vitage® has released its new Clinical Essential product, Skin Calming Aloe Gel (RRP £19), to provide the professional therapist with a multi-tasking, skin soothing solution for a wide range of treatments and clients.

Vitage® Skin Calming Aloe Gel is a professionally formulated Aloe Vera treatment gel to instantly cool, soothe and hydrate all skin types. Made from 100% organic Aloe Vera to deeply hydrate and soften dry or tired skin it is infused with natural extracts of Calendula and Chamomile to heal, calm and restore the skin.

This anti-redness formula is gentle enough to use on stressed skin and can be applied following professional treatments such as IPL, laser, waxing and microdermabrasion to balance and reduce post treatment irritation. Skin Calming Aloe Gel is water based and completely absorbed and can be used as a serum under masks and homecare products to boost their hydration and calming abilities.

Vitage® Skin Calming Aloe Gel can be twinned with Vitage® Skin Defence SPF 30 to provide a total clinical solution to manage post-operative irritation and environmental protection after a range of treatments making it indispensable in any professional skincare environment.

People to Target    

All skin types, especially sensitive Stressed skin in need of instant comfort Excellent post treatment product or use as an after sun Apply to any inflamed areas to instantly calm and cool

Other Clinical Essential products from Vitage® include Vitamin C Radiance Serum and Mask, Enzyme Lifting Mask and Age Defence Power Skin Repair.

For more information, contact Cosmeceuticals Ltd on 0845 555 2121 or visit www.cosmeceuticals.co.uk

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

Beware of ‘inch loss’ and ‘slimming’ claims with body contouring The ASA investigated two press adverts for The Slimline Clinic. The first ad stated "Become slimmer in time for summer, with rapid Inch-Loss therapy at The Slimline Clinic! You will achieve the size & shape you desire after treatment with the latest, painless Ultrasonic Liposuction technology. Inches lost from Stomach, Back, Hips, Legs & Arms, Average permanent inch-loss is 15 after a 12 session course".

The second advert stated "Get the perfect beach body with Non-Surgical Ultrasonic Liposuction from The Slimline Clinic. The Slimline Clinic's Non-Surgical Ultrasonic Liposuction therapy has already helped thousands of men & women achieve the bodies they always wanted. It is fast, effective and 100% pain free ... Drop a dress size in 6 weeks, Lose up to 2 inches per session, Permanent inch loss, Sessions consist of a full consultation before an ultrasonic massage given privately by a qualified and experienced consultant, followed by a complimentary 10 minute session on our vibration plate to maximise inch loss. For fastest results treatments should be conducted twice weekly".

The complainant, who had purchased a 12-session course, challenged whether the efficacy claims could be substantiated.

The Slimline Clinic responded by saying that all their machines had a CE approval which demonstrated that they met regulatory requirements and that, if regulators required clinical trials, they were carried out prior to CE approval. They also said it was the responsibility of the manufacturer to provide such evidence but that, while the manufacturer made performance claims, the claims in their marketing communications were based on their own experience and data.

They said the claims "Become slimmer in time for summer", "You will achieve the size and shape you desire", "Get the perfect beach body" and "The Slimline Clinic has already helped thousands of men and women achieve the bodies they always wanted" were subjective claims that were based on feedback from their customers. They also said the claims that their treatment was "fast and effective" and resulted in "permanent inch loss" were factual and that the claims "2 inches per session" and "average permanent inch loss is 15 inches" could be substantiated by a study they conducted titled "Reduction of Subcutaneous Adipose Tissue Using a Novel Low Frequency Ultrasound - Cavitation Technology Device". They submitted a copy of the study which they said showed that, based on a single measurement around the waist of 24 subjects, a mean average of 3.58 inches were lost after 12 sessions and reduced body fat in the top, middle and bottom areas. They also submitted a table which they said summarised five clinical studies that were carried out by surgeons or medical companies and demonstrated that the average centimetre loss per treatment was between 1.7 and 3.2 per treatment for each patient. They submitted several articles about ultrasound treatments, one of which referred to a study for an ultrasound, non-invasive fat reduction and body contouring system and said the results were similar to their own study.

They said, because slimming was a whole body process and they did not offer a whole body treatment, they were not a weight-loss or slimming company and the weight control and slimming rules did not apply to them. They said their treatment was more like body contouring and removed fat from a specific area in order to change the shape to what the client wanted.

The ASA however upheld the complaint as they considered inch loss claims constituted slimming claims and that readers would understand that any claimed inch loss would be a result of weight reduction achieved by loss of body fat.

Because the CAP Code stated that it was unacceptable to claim that people could lose a precise amount of weight within a stated period, or that weight or fat could be lost from specific parts of the body except through invasive procedures, they concluded these claims were in breach of the Code. They concluded that these were objective slimming claims that either directly or indirectly implied that the therapy offered by The Slimline Clinic could result in the reduction of fat and therefore needed to be substantiated by robust documentary evidence.

The Slimline Clinic said they conducted a study that evaluated the efficacy of low frequency ultrasound in reducing unwanted local adipose tissue by measuring the abdominal circumference of 24 female patients aged 30 to 76 years before each of 12 treatments they received.

However, the study was conducted by the Company Director of The Slimline Clinic, rather than a third party and the results were based on circumference measurements, rather than loss of body fat. Furthermore, there was no evidence that demonstrated that any measurement reduction was a result of the therapy, rather than other factors during the 72 hours after treatment and before final measurements were taken. The study was therefore insufficient in supporting any slimming claims, including those that related to inch loss. The table submitted indicated that, in addition to The Slimline Clinic's study, five clinical studies had been conducted. It stated various authors, number of treatments and subjects and loss of inches. However, full details of each study had not been included. Because they had not received robust trials to support the efficacy claims in the two adverts, the ASA concluded that they had not been substantiated and were in breach of the Code.

The adverts must not appear again in their current form. The ASA told The Slimline Clinic not to claim that people could achieve a precise inch loss within a stated period, or that weight or fat could be lost from specific parts of the body. They also told them not to make inch loss or other slimming claims unless they held rigorous trials to demonstrate that any such loss was achieved by the loss of body fat caused by the therapy.

Full Adjudication

Even ‘Taglines’ and ‘Mission Statements’ can land you in hot water!

The website www.bmihealthcare.co.uk, for a private healthcare provider, included the repeated claim, which also appeared with the company logo, "BMI Healthcare - THE CONSULTANTS' CHOICE".

The complainant challenged whether the advert misleadingly implied that consultants in the medical profession were more likely to recommend BMI Healthcare than other such providers.

BMI Healthcare Ltd (BMI) responded by saying that extensive research was conducted prior to adopting the tagline "THE CONSULTANTS' CHOICE" in 2008. They said it did not suggest that consultants preferred the BMI over any other healthcare provider, including the NHS, and did not state or indicate that consultants would recommend BMI to patients over other healthcare providers or that they were better than other healthcare providers. They said the claim was justified by the fact that more consultants chose to work across the BMI group.

Approximately 7,000 consultants, all independent contractors who were under no obligation, worked at BMI hospitals, which they said was materially more than any other healthcare provider in the UK. BMI said it was a consultant's individual choice to do so and the numbers practising with BMI suggested that BMI was indeed their choice. They said the research demonstrated the reasons why consultants chose to practise at particular hospitals as well as their views on the performance of BMI and other healthcare providers.

BMI said the research included stakeholder interviews, hospital visits and desktop research as well as a consultant survey carried out by a third party. They said the survey showed that consultants that used both BMI and other private independent hospitals ranked BMI hospitals higher on the factors that were viewed as most important to consultants when choosing an independent healthcare provider. Those factors included quality of nursing and theatre staff, perceived hospital cleanliness and hospital infection rates. They submitted a table of the scores BMI and a competitor had achieved on the four aspects seen as most important in the survey as well as a summary of the research. They said the outcome of their research, in which they were rated higher in 10 of 13 areas, clearly showed that it was the consultants' choice to work in BMI hospitals compared to all healthcare providers at the time, including NHS private patient units.

They said the strap line, which was a comment made by BMI and not an individual or group of consultants, was therefore not misleading but a reflection of research they had undertaken. They said they had not been made aware of any significant concerns regarding the claim in the past.

However, the ASA upheld the complaint and noted "THE CONSULTANTS' CHOICE" was intended to mean that more consultants chose to work for BMI than other private healthcare providers. They considered, however, the claim, which was general and not qualified, was likely to be interpreted as suggesting consultants in the medical profession were more likely to recommend BMI to patients than they were other such providers.

They noted that BMI said their research, including the results of the survey of consultants submitted, showed that it was the consultants' choice to work in BMI hospitals, rather than to recommend their services to patients. The ASA therefore considered it was not directly relevant to the claim as it was likely to be interpreted. Nevertheless, they noted that while BMI ranked more highly than the competitors on 10 of 13 elements included in their overall comparison, the differences in scores, which ranged from 0.18 to 0.88 points for the top four elements considered to be most important in choosing where to place their private practice by the consultants surveyed and a maximum of 1.35 for the other elements, which totalled 17, were small. They were also concerned that the results of the survey, which 339 respondents completed in 2007, were used to support a claim that was likely to be interpreted as currently relating to consultants in general. For the reasons given, they considered the evidence submitted was insufficient to substantiate the claim and concluded that the advery was misleading.

The advert must not appear again in its current form. The ASA told BMI to ensure they did not imply they had been more widely recommended than was the case in future. They also told them to ensure they held adequate evidence to support their future objective claims.

Full Adjudication

Seems it’s a fine line between appealing radio adverts and trivialising cosmetic procedures A regional radio advert for a cosmetic surgery clinic featured music in the style of the television programme, Sex and the City and two women with American accents talking. The first woman said, "Hey! You look great! Did you have a fab' vacation?" and the second woman replied, "Yeah, amazing!" The first woman said, "Oh, I am dreading wearing a bikini this summer! My stomach seems to get bigger and my chest seems to get smaller! If only I could take the fat off my hips and put it into my breasts!" and the second woman replied, "Well actually, that's what I did!"

The first woman said, "Seriously!! How?" and the second woman replied, "At the Stratford Dermatherapy Clinic.

They can remove fat and, if you want, transfer it to another part of your body, like your breasts, your hands or face and it's all done under local anaesthetic!" A voice-over then stated, "Looking for that sculpted body shape you've always dreamed of? Get a FREE consultation with the professionals at the Stratford Dermatherapy Clinic."

The complainant, who had heard the advert on a Saturday morning, challenged whether it was offensive and inappropriate for broadcast at a time when children might be listening. They also challenged whether the advert irresponsibly suggested that cosmetic surgery was a minor procedure.

Stratford Dermatherapy Clinic (SDC) explained that the advertised procedure was called Autologous Fat Transfer (AFT). Patients were consulted twice before the procedure and, on the day, were prepared in an operating theatre.

The procedure was performed under local anaesthetic, was minimally invasive without cuts and scars and lasted approximately two hours. Patients went straight home after the procedure and, although there was no overnight stay, all patients had a 24-hour mobile contact number and were called two to three times during the following week. Additionally they were followed up at week 1, week 4 and 3 months. Risks of the procedure were minimal and were local in terms of discomfort, pain, swelling and potential infection.

SDC said they believed it was the word "breasts" that had caused concern to the complainant. They did not believe that the word "breasts" constituted an inappropriate term, it was neither rude nor offensive and in no way sought to sexualise or to use gutter slang for that part of the body. They said the content of the advert was no different to that which was freely available in many daytime discussion medical forums on TV, the news and the Internet. They said the advert contained lightly-weighted wording and friendly information which was inoffensive and had been remarked upon by many of their patients as attractive in its presentation. They had run similar adverts before and this was the first complaint they had received.

The Radio Advertising Clearance Centre (RACC) said they did not feel that the advert warranted scheduling away from when young children could hear it as they did not believe that its content was graphic, offensive or inappropriate. They felt that the advert highlighted an acceptable cosmetic procedure in a factual, responsible manner.

SDC said the relaxed nature of the advert did not trivialise the nature of the treatment, which was a very serious undertaking for any patient. Rather they had sought to make it sound more achievable and available to the normal women they targeted without making it over-scientific and using medical jargon which might confuse a listener. The aim was to attract an educated audience into considering an alternative to silicone implantation and facial rejuvenation, and to invite them to come for a consultation, where a more formal structured consultation might take place.

The RACC said that the casual manner and the Sex and the City-type creative treatment were consistent throughout the advert. This explained why the two women discussed feeling nervous wearing a bikini in the summer and described the surgery in the same conversation and the same manner. Furthermore, by the advert stating clearly what the cosmetic surgery actually involved, i.e. "remove fat and ‌ transfer it to another part of your body, like your breasts, your hands or face", it alerted listeners to the procedure in a responsible, rather than irresponsible, way. Listeners were invited to follow up via a free consultation with a qualified surgeon.

The ASA did not uphold the first complaint. The advert featured a number of references to the female body and a description of how AFT might change a woman's breasts and hips. The ASA considered that some listeners would find those descriptions, and particularly the statement "If only I could take the fat off my hips and put it into my breasts!" delivered in brash American accents in the context of a Sex and the City-style treatment, distasteful.

However, they considered that the references to the female body were relevant to the procedure being advertised and they understood that the description of the procedure itself was essentially accurate. They therefore did not consider that the advert was gratuitous or overly graphic, or used language in a way that was likely to cause serious or widespread offence, or result in harm to any children who might hear it.

They considered that, as a clinic offering immediate weight loss surgery (i.e. the removal of fat from a part of the body), SDC was a slimming establishment for the purposes of the BCAP Code, which required that adverts for such establishments not be aired in or adjacent to programmes commissioned for, principally directed at or likely to appeal particularly to under 18s. They understood that the station's target audience was those over 25 and they considered that, although some children would still hear the station, its easy-listening style was unlikely to appeal particularly to those under 18. They therefore considered that the advert had not been scheduled in a programme directed at or likely to appeal particularly to those under 18 and therefore had not breached the Code on this point.

However they did uphold the second complaint. They understood that fat transfer was not as involved or as invasive as some other types of cosmetic surgery, however, it was a medical procedure which required anaesthetic, resulted in permanent changes to the body, had a number of side effects including pain and swelling, required several follow-up appointments and carried a, albeit low, risk of infection.

They noted that there was a reference to a consultation at the end of the advert. However, they considered that the Sex and the City creative treatment and the casual manner in which the second woman described the procedure suggested that such a procedure was something to be undertaken lightly. They concluded that, in making that implication, the advert trivialised cosmetic surgery in a way that was irresponsible.

The ad must not be broadcast again.

Full Adjudication

Don’t get your Lasers and Intense Pulsed Lights mixed up!

A website for beauty services www.sisabeautyclinic.co.uk included a page entitled "Laser Hair Removal" where text stated "Our Ellipse hair removal treatment offers clinically-proven, safe and effective long-term removal of unwanted hair .... Well controlled pulses of light penetrate the upper skin layer ... the visible light produced by the Ellipse Flex and Ellipse Light systems are carefully controlled".

The complainant challenged whether the claim "Laser Hair Removal" was misleading because he understood the service being offered was Intense Pulsed Light (IPL).

Sisa Beauty Clinic (Sisa) did not respond to the ASA's enquiries. The ASA upheld the complaint and was concerned by Sisa's lack of response and apparent disregard for the Code, which was a breach of CAP Code (Edition 12) rule 1.7 (Unreasonable delay). They reminded them of their responsibility to respond promptly to their enquiries and told them to do so in future.

Because Sisa had not provided evidence to demonstrate that term "Laser Hair Removal" had been accurately used in relation to the product they concluded that the advert was misleading.

The advert must not appear again in its current form and the matter was referred to the CAP Compliance team.

Full Adjudication

Don’t rely on SEO and PPC companies to keep your adverts compliant!

A sponsored link on Google for a cosmetic surgery clinic stated "Remove Your Stretch Marks". The website for the clinic, www.sknclinics.co.uk, stated "Stretch Mark Removal Stretch marks don't have to be forever - treatment can reduce or eliminate the appearance of stretch marks".

The complainant challenged whether the claims "Remove Your Stretch Marks" and "eliminate the appearance of stretch marks" were misleading and could be substantiated, because she understood that stretch marks were impossible to remove.

Sk:n clinics (Sk:n) explained that most of their digital marketing was carried out by third-party suppliers. They stated that their website was maintained by one agency, whilst their Search Engine Optimisation and Pay-Per-Click advertising programs were managed by two other agencies. They explained that, until very recently, these agencies had been given a relatively large amount of freedom and that their management revolved around issues such as budgets and campaign direction. Sk:n highlighted, however, that they had recently recruited a Digital Marketing Manager and Executive to ensure that their third-party suppliers were managed more rigorously and that any changes to their digital campaigns were approved and signed-off centrally. They therefore hoped that that change would mitigate the risk of any further complaints regarding their advertising.

Sk:n acknowledged that not all stretch marks could be completely removed. They said, however, they offered the best treatments available which could improve the appearance of affected skin so it closely resembled normal skin surface patterns.

Sk:n said the terminology they used to promote their stretch mark treatments had been adopted in response to consumer behaviour and demand. They provided data from Google which stated that an average of 74,000 searches were performed per month globally for the phrase "stretch mark removal". Similarly, they highlighted that "remove stretch marks" and "getting rid of stretch marks" received a high number of searches per month at 40,500 and 74,000 respectively. They stated that, like many of their competitors, they had responded to consumers' search behaviour by bidding on key words and phrases such as "remove stretch marks", and included them in their online adverts and their website. They said that ensured that sk:n maintained a strong online presence, particularly on search engine result pages.

Sk:n also asserted that they adopted such terminology to help those consumers who were looking for stretch mark treatments. They highlighted that individuals with stretch marks did not search Google for phrases such as "how can I improve the appearance of straie?", and instead used layman's terms such as "stretch mark removal". They stated that because consumers were using those keywords when searching for stretch mark treatments, and businesses were responding to that search behaviour and optimising their advertising campaigns by using them, those keywords had become accepted terminology in the health and beauty industry.

Sk:n also highlighted that any individual who, as a result of an advert, enquired about the treatments sk:n offered for stretch marks, would be fully informed about the procedure and the likely outcome. They explained that they had a seven step process which they followed for each client to manage their expectations with regard to a treatment and asserted that they "would not offer treatments which did not match the expectations of the individual patients".

The ASA upheld the complaint and understood that sk:n's treatments could reduce the appearance of stretch marks but did not remove them altogether. In fact, they noted that they were yet to see any evidence of a treatment for stretch marks that was able to remove them completely. They acknowledged that sk:n had adopted phrases such as "Remove Your Stretch Marks" and "eliminate the appearance of stretch marks" to meet the search demands of consumers and to ensure they had the same online presence as their competitors. They considered, however, that many consumers would not be aware of the available treatments for stretch marks or the efficacy of those treatments, and when using Google to search for phrases such as "stretch mark removal" might genuinely believe, or hope, that a treatment resulting in permanent removal existed. They therefore considered that consumers might not understand the meaning of the terminology used and might be encouraged to seek more information regarding a treatment because they misunderstood the outcome that could be achieved. They understood that sk:n's treatments for stretch marks did not remove them but instead improved their appearance, and they therefore concluded that the claims exaggerated the effectiveness of sk:n's treatments and were misleading.

The claims must not appear again in their current form. They told sk:n to not make claims unless they held robust evidence to substantiate them.

Full Adjudication

Workplace Temperature As winter approaches and the temperatures fall even lower, we get a lot of calls to our helplines regarding workplace temperatures and what obligations you may have as an employer.

Regulation 7 of the Workplace (Health, Safety and Welfare) Regulations states ‘during working hours, the temperature in all workplaces inside buildings shall be reasonable’ In addition, the Management of Health and Safety at Work Regulations requires employers to make a suitable assessment of the risks to the health & safety of their employees, so temperature should be included within this assessment.

All business premises are varied in layout and function and because of this your assessment should be individual and specific to your own business. This will allow you to address any temperature issues that may arise.

Although there is no legal minimum or maximum temperature set for an indoor workplace, generally the temperature should provide reasonable comfort without the need for specific clothing.

The HSE guidance recommends that workrooms should normally be maintained at a temperature of at least 16°C. If the work involves severe physical effort, involving lots of movement such as manual handling, etc. then the recommended minimum temperature should be at least 13°C. Of course, if these temperatures are impractical, e.g. due to the layout of the premises or a space where vehicles can enter the work area, then employers are required to take reasonable steps to achieve a temperature which is as close as possible to comfortable. These steps could include:    

Insulating hot pipes or flooring as appropriate Providing air conditioning, ventilation or fans Shading windows with curtains or blinds Provision of localised heating or cooling, as appropriate

Of course, sometimes it will be difficult to maintain these temperatures as it may be that the workplace needs to have open air access or needs to have the temperature at a certain level. If this is the case your risk assessment should consider additional measures such as:      

Ensuring employees take regular breaks to allow them to warm up/cool down Task rotation Limiting the amount of time employees may be exposed to uncomfortable temperatures Provision of facilities to make or obtain hot or cold drinks Providing suitable personnel protective clothing if the task requires it such as gloves/hat, etc.

Installing self closing doors to retain heat/exclude drafts

Of course, one person’s perception of whether they are feeling too hot or too cold can differ markedly from another, and so your assessment may not be a perfect fit simply due to the number of environmental and personal factors involved, but by producing a constructive document, you should be able to provide a comfortable working environment for your employees.

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.

Business Corner Have Millions of Fake Accounts Fooled Twitter?

by Dave Larson from TweetSmarter Twitter CEO Dick Costolo has mentioned several times that millions of people use Twitter only for reading information, and rarely if ever tweet themselves. But how much does he know?

Fake Twitter Accounts Companies that sell followers create fake Twitter accounts that rarely tweet, and just have them follow people for money.

So the fact that there are millions of Twitter accounts that rarely tweet doesn’t mean those are people that use Twitter passively for reading without tweeting (much) themselves. Many—most?—of them are fake accounts being sold to people who want to buy followers.

Of course, some of them are real people, but Twitter can’t tell the difference! Twitter hasn’t figured out how to stop fake accounts from being created, and can’t tell the difference between them and real people in order to suspend them. So how many people are just using Twitter “passively?” No one knows…except perhaps the spammers creating fake accounts. But since automated hacking tools are widely available for creating fake Twitter accounts, and it’s estimated that selling Twitter followers brings in nearly $50 million each year, it’s fair to say there could be millions of fake accounts.

Spam Of course, some fake accounts are created in order to send spam. But accounts created only to be sold as fake “followers” never spam, because that would risk them getting suspended, and if they were suspended, they couldn’t be sold as followers.

Fortunately, even if hackers find a lucrative way to break into your account or computer just by getting you to click a link, those fake accounts are unlikely to switch over to sending spam, because they make a LOT of money being sold as followers. And that’s good, because otherwise, millions of fake accounts could suddenly start spamming Twitter.

So How Do You Check if You or Your Competitor Have Fake Followers?

A neat little tool is now available on the Internet from StatusPeople.com which allows you to simply login with via your Twitter account or type in your Twitter username (@ name) or that of anyone else that you wish to ‘check up on’. The developers of the tool use algorithms to check for real and fake followers attached to your account as well as inactive ones which, as detailed above, may or may not be real people who simply read, lapsed account or could also be a signal of fake accounts, although this cannot be proven currently.

Visit http://fakers.statuspeople.com/ and check for yourself.

Legislation Beauty Therapist Gets Conviction for Illegal Teeth Whitening Withdrawn A Merseyside beautician who was successfully prosecuted by the General Dental Council (GDC) in August 2012 for unlawfully practising dentistry by carrying out tooth whitening when she was not registered with the GDC contrary to the Dentists Act 1984 and for unlawfully carrying on the business of dentistry when she was not entitled to do so contrary to the Dentists Act 1984 managed to get the convictions withdrawn a few weeks later.

According to the GDC; “Tooth whitening is the practice of dentistry and only those registered with the General Dental Council, specifically dentists, dental hygienists and dental therapists working on a dentist’s prescription may lawfully offer tooth whitening as a treatment.”

The court case originated after a patient complained about the way her teeth had been whitened. The beauty therapist Elaine Taylor-Valles was fined £600 for each of the two offences and ordered to pay £3,277 towards the GDC’s costs.

Three weeks later, the GDC was informed that Ms Taylor-Valles had subsequently made a statutory declaration which means the convictions no longer stand. The statutory declaration stated that she did not know anything of the proceedings until afterwards. The convictions are therefore cancelled and the GDC will decide in the very near future whether or not to re-institute these proceedings.

During correspondence with the GDC, Ms Taylor-Valles admitted to being a ‘fully qualified beautician’, a title which is not recognised by the GDC. The GDC are keen to point out that the making of the statutory declaration by Ms Taylor-Valles does not affect the position of the GDC regarding its view that tooth whitening should only be carried out by registered professionals.

Safer Injectables Campaign launched by Dr. Hilary Jones and Treatments You Can Trust As demand for cosmetic injectable treatments continue to rise, the Treatments You Can Trust industry self-regulatory scheme for treatment providers is concerned that patients are at risk from so th called ‘Botox Cowboys’. Because of this it was announced on 19 October 2012 that Dr. Hilary Jones, the well known ‘TV Doctor’ and member of the TYCT Governance Board has joined forces with Baroness Trish Morris of Bolton, Chair of TreatmentsYouCanTrust.org.uk to launch a new Safer Injectables Campaign to the public.

Launching ahead of the peak period for cosmetic injectable treatments, traditionally the months leading up to the Christmas and New Year party season, the campaign aims to advise consumers on the best and safest approach to Botox® (and other botulinum toxin brands) and dermal fillers whilst the review of cosmetic procedures, led by Sir Bruce Keogh, awaits conclusion in the Spring of 2013.

TYCT notes that over 1,500,000 injectable treatments have been conducted so far this year with figures set to rise further in 2013; they are warning that patients are at an increasing risk from accepting treatment from providers with no medical background or appropriate level of training, practising in unsafe and unhygienic environments.

Therefore the Safer Injectable Campaigns launches the ABC’s of Safer Injectables urging consumers to ‘Always Background Check’ their provider and know how to spot and avoid bad practice.

More on this and the ensuing debate on this campaign in our blog, including statements from BCAM and BACN.

Keogh Report ‘Call For Evidence’ Ends; But What Did Everyone Say? At the end of January 2012, following the fall-out from the PIP breast implant scandal which brought the cosmetic surgery industry to the forefront of public awareness and concerns, the Health Secretary Andrew Lansley asked the Department of Health to investigate the whole industry. This job was given to NHS Medical Director, Professor Sir Bruce Keogh along with an expert panel, and their Scope of Practice was laid down.

“I am working with experts from the plastic surgery field to look at what we can do to make sure people who choose to have cosmetic surgery and other cosmetic procedures are safe. I will be looking at all aspects of regulation – at the regulation of implants and fillers, at whether the people who carry out cosmetic interventions have the right skills, at whether the clinics look after the care and welfare of their patients. This would include treatments such as cosmetic surgery, botox injections and dermal fillers and other cosmetic treatments where there is a potential risk to health”; said Sir Keogh at the time of the announcement of the plan for a review.

The review launched with a ‘call for evidence’ to include experiences and views from both the industry and patients in order to assist the inquiry. The submission for this consultation ended on 15th October 2012.

Along with Sir Keogh, an expert panel has been convened to assist in the evidence gathering and the making of recommendations to government, based on the criteria being looked at and the results of the public consultation.

The expert panel and Sir Bruce Keogh will make their recommendations to the government by March 2013.

Many prominent industry organisation submitted evidence and opinions to the ‘call for evidence’ to help shape the future of the industry. Here’s what some had to say...

British Association of Aesthetic Plastic Surgeons (BAAPS) According to Consultant Plastic Surgeon, Consulting Room™ Adviser and BAAPS President Rajiv Grover; “The call for evidence by the Keogh review has given our sector an ideal platform to air issues that have long been concerning many of us. It is of paramount importance that the growing area of largely unregulated dermal fillers be controlled and we have put forward for consideration the simple measure of reclassifying these injectables as medicines. This will ‘kill three birds with one stone’: regulating which ones come on the market, automatically banning their advertising and defining who is qualified to dispense them. We are also calling for the term ‘surgeon’ to be legally protected, for practitioners to be audited and listed on a compulsory register run independently and for an insurance scheme to help protect patients from another medical device scandal. We propose as well that overseas surgeons who operate in Britain have UK-based indemnity insurance, and – if it cannot be outright banned – for cosmetic surgery advertising to be severely restricted to protect the young and vulnerable.”

Points put forward by the BAAPS: NON SURGICAL PROCEDURES & PRODUCTS 

    

Fillers reclassified as Medicines not medical devices – “Killing three birds with one stone” 1. Will regulate which come on the market and after proper testing 2. Will automatically ban advertising as they are a “Medicine” 3. Will automatically regulate who can give them as they are a “Medicine” Who should perform non-surgical procedures? This is likely to be addressed by the new EU standards.

The potential reclassification of fillers as medicines would also have an effect on dictating which practitioners can perform which procedures.

Regulation of the non-surgical sector similar to the “Treatments You Can Trust” scheme but this should be mandatory, and run by an independent entity such as the Care Quality Commission rather than the IHAS The need for compulsory audit of procedures and complications: this will strengthen revalidation and allow it to be a mechanism for promoting clinical governance.

Full records and note keeping required for patients having nonsurgical treatments just as for surgical procedures.

BAAPS denounces the deregulation of laser and light treatments.

SURGICAL PROCEDURES & PRODUCTS  

 

  

The word “Surgeon” should be protected and used only for someone on the Specialist Register for a surgical speciality. This has been strongly recommended by the RCS also.

Who can perform which operation? Credentialing of which type of surgeon can perform which procedure in accordance with CEN guidance due out in 2013. Aesthetic surgery forms an integral part of surgical subspecialty training in the UK so surgeons on the specialist Register of the GMC are trained within their anatomical region. Which procedures they can safely perform is likely to be answered by the work of CEN committee The need for compulsory audit of procedures and complications. This will strengthen appraisal and revalidation, allowing it to be a mechanism for promoting clinical governance.

Medical negligence claims should be reported by Doctors when they perform their annual appraisal and revalidation. Perhaps Defence Organisations should also report this to the GMC so that it compulsorily forms part of the appraisal and revalidation process because it is a true and objective measure of poor outcome Ensuring that foreign surgeons who operate in the UK, also have medical insurance in the UK. Otherwise patients needing to seek legal redress may not be able to fight a claim for negligence.

Strengthening of the regulation of implants (Breast and others) so they undergo FDA style pre market testing and post market surveillance.

The setting up of a national breast implant register so prostheses are correctly monitored and records of devices are not lost even if a clinic closes.

PROTECTING PATIENTS 

  

Improving the consent process by ensuring that any consultation is with the operating surgeon only, is at least 30 minutes long, allows for a second consultation if required before deciding and under no circumstances should surgery be booked without a cooling off period of two weeks minimum. If necessary, psychological assessment and support should be available.

A ban on cosmetic surgery advertising, or at the very least, the incorporation of the 12 recommendations outlawing the “dirty dozen” advertising practices that can mislead the public.

A ban on unethical marketing practices such as time limited offers, BOGOF and refer a friend as well as packages that prey on the vulnerable (e.g. divorce feel good” etc) Development of an ABTA-type insurance scheme to protect patients who have a breast or other permanent implant, such that if there is product failure, the patient is insured for further treatment regardless of whether the original provider is accessible.

British Association of Plastic, Reconstructive & Aesthetic Surgeons (BAPRAS) Tim Goodacre, Chair of Professional Standards at BAPRAS noted that; “BAPRAS exists to support the highest levels of practice within plastic and aesthetic surgery, for the benefit of the whole population. We have patient interests at our core, and seek to maintain best practice through education and training, standard setting, high quality information development, and research into better care in its’ widest sense.

We therefore warmly welcomed this review and we look forward to hearing what changes will be proposed when Sir Bruce announces the results in March 2013.”

Here is a summary of a few key areas of feedback that they have provided to the review committee: Overview  

Majority of Cosmetic Surgery procedures are demanding in technique, judgement, and patient management and cannot be practiced safely without extensive training including extensive preliminary observation and rigorous training that cannot be encompassed in short courses.

Cosmetic Surgical procedures are frequently trivialised by mass media and marketing organisations.

The surgeons and practitioners   

Should have Specialty Fellowship examination standard before subsequent sub-specialty training in cosmetic operations.

Should be on GMC Specialist Register in their respective parent specialty.

Should only perform operations within the acknowledged remit of their parent specialty (for example, ENT surgeons could do nose reshaping, but should not do breast or abdominal surgery etc).

 

Overseas doctors entering UK with only basic medical qualifications and no UK validated assessment of surgical competence / ability should not be permitted to operate independently. This practice should stop immediately.

All practitioners using fillers and toxins by injection should be required to maintain full records of treatments and record outcome data to a standard that can be audited independently. They should also be able to demonstrate appropriate training in the field, which cannot be undertaken in short day courses as currently encountered.

The Provider Institutions 

  

Should be required to participate and maintain full data on who does what, where, and how well within their institution. This would require full cooperation with a centrally supported data collection mechanism that BAPRAS has urged be developed, to be hosted within the Royal Surgical Colleges/Specialty Association structure.

Should be mandated to provide appropriate systems to support patients with unexpected adverse events after surgery, some of which are inevitable in every area of care. This is not currently the case when commercial imperatives are allowed to take precedence over good patient care.

Must be transparent in all areas of case management alongside regular and rigorous auditing of outcomes.

Must participate in the 'ABTA-style' proposal to support patients affected by provider bankruptcy (within the DH review document) if it is developed. However, BAPRAS believes that much more common is poor or frankly negligent aftercare for procedures from practitioners and providers which would not be covered by such arrangements.

Advertising    



A significant proportion of those seeking cosmetic surgery fall within a 'vulnerable' category, and should be protected from unreasonable promotion of procedures which can be trivialised, and subtly promoted as delivering objectives far beyond what can be considered realistic.

BAPRAS has serious concerns about current state of advertising of cosmetic procedures in the UK. The fine line between informing and persuading is frequently transgressed, and abuse of advertising and thinly veiled promotion in supposedly 'educational' features is widespread.

We urge a rapid and rigorous review of the regulations surrounding advertising of cosmetic procedures, with especial attention paid to on-line material which is largely unregulated.

We would like the establishment of an 'Ofcom' style organisation to manage concerns around poor compliance with better and speedier action. We would like to see the ASA sanctions strengthened to enable control of individual websites which contain misleading information, unreasonable persuasion, and erroneous presentation of credentials.

We believe that self regulation by the 'industry' at present has failed (despite the existence of the IHAS code of practice) and urge that advertising in future is co-regulatory rather than self-regulatory according to the ASA rules.

Materials and devices   

All injectable materials (fillers both absorbable and permanent) should be registered as pharmaceutical products, and subjected to the full gamut of regulations as such. This would bring the UK into line with normal practice in the United States under FDA law.

Breast Implants should be registered, with an 'opt out' mechanism of presumed participation by all patients and providers unless specifically requested.

BAPRAS urges consideration of the well-developed system suggested by the Australian Society of Plastic Surgeons, which recommends collecting a basic dataset across international boundaries to improve rapid detection of problems that might present with any device.

Association of Laser Safety Professionals (ALSP) Mike Regan, Chair of ALSP said; “The PIP breast implant scandal has focused government attention on the safety of patients undergoing cosmetic surgery. We responded to the consultation to highlight the patient safety issues related to laser and IPL treatments and to call for a sensible and proportionate regulation scheme covering all facilities in which these treatments are offered, from high street beauty salons to hospitals.”

Q3: Are any further changes needed to the categories of devices and implants subject to regulation in addition to the likely changes set out in section two of the call for evidence?

Response: Clarification is needed as to whether all cosmetic uses of lasers and IPLs are being considered in the Review, which we believe should be the case. The reason we ask for this clarification is that the information in section 2 of the Call for Evidence is unclear. The only example given is hair removal, which is one of the lower risk procedures compared to, for example, skin resurfacing, birthmark removal, tattoo removal etc.

Q4: Are there any other areas where additional strengthening of the regulatory system is required that will not be addressed in the forthcoming revision of the medical devices legislation?

Response: The hair removal example in section 2 suggests that no changes are plannedto this legislation covering this procedure at least, i.e. it is intended to continue to rely solely on the Health and Safety at Work Act (HSAWA), with local licensing schemes in place in some parts of the country, leading to a wide geographical variation in registration requirements. We believe that, regardless of the legislative basis, a national registration / licensing scheme for laser / IPL users would be a more effective way of ensuring that basic standards are consistently met regardless of geographical location.

A particular issue with aesthetic laser and IPL equipment is that it can be sold without having to be certified for CEmarking by a third party (e.g. a Notified Body under the Medical Devices Directive) but instead can be self-certified for CE-marking by the manufacturer / supplier. This lack of control opens the market to very low quality, often imported, devices, which are attractive to many operators due to their low cost, but which we feel have the potential to contribute significantly to the risk in this sector.

Q5: Earl Howe’s review of the actions of the MHRA and Department of Health in relation to PIP silicone breast implants recommended that this review should ‘examine ways of promoting a stronger culture of clinical governance, clinical audit and reporting in cosmetic surgery. Routine incident reporting and review of outcome data by individual surgeons and providers should be the norm.’ How can health providers, professional bodies, regulators and patient groups promote the best possible understanding of the role of the incident reporting system and ensure that professionals in particular understand what they have a duty to report?

Response: For laser / IPL users, we would promote this via the aforementioned registration / licensing scheme.

Q8: Do people who deliver cosmetic interventions like fillers, Botox®, laser treatments or chemical peels, have the appropriate skills to deliver them? How could their performance be monitored?

Response: For laser / IPL treatments the experience of some of our Members would suggest that the short answer to this is “no”, in particular where services are offered by beauticians. The key issues are ensuring (i) appropriate training of those delivering treatments, (ii) delivery of treatments according to appropriate medical protocols with access to expert medical support and (iii) that appropriate laser/IPL safety measures are in place with access to expert laser safety advice from an LPA. We suggest that all three of these should be included as requirements in the aforementioned registration / licensing scheme and that the presence of appropriate laser/IPL safety measures should be confirmed by a certificated LPA. Please see also our answer to Q13 for further discussion of these issues.

Mike Regan noted that he would like to clarify the ALSP response to question 8 to avoid any confusion. He said; “The first part currently reads as follows: “Q8: Do people who deliver cosmetic interventions like fillers, Botox®, laser treatments or chemical peels, have the appropriate skills to deliver them? How could their performance be monitored?

Response: For laser / IPL treatments the experience of some of our Members would suggest that the short answer to this is “no”, in particular where services are offered by beauticians.”

In retrospect I am a bit concerned that that part of our response might be read out of context, as being overly critical of ALL beauticians. Therefore I would like to clarify our response to Q8, concerning skill sets - and in particular those of beauticians. We recognise the excellent work that is being done by various organisations to develop suitably accredited training schemes for laser and IPL treatments. Our point was not to criticise that in any way, but in fact to support it, and to point out that in our view the real underlying problem is that since the deregulation of the sector October 2010, a member of the public walking into a beauty salon has no guarantee that s/he is going to be treated by someone who has correspondingly adequate and accredited training.”

Q10: Should practitioners be required to ensure that records of all cosmetic interventions are kept? This is generally done for implants but is it reasonable to do for other devices such as dermal fil lers?

Response: From the laser / IPL perspective, yes, records should be kept either in the patient notes, in a simple machine logbook, or both. This is to enable patients to be recalled in the event of any equipment fault / incorrect calibration etc being uncovered, or to enable investigation of incidents. Members with experience of equipment

maintenance have also found access to a logbook useful in spotting any trends (e.g. recurring faults or gradual calibration drift) when performing routine servicing.

Q13: Do you think the existing regulation of lasers and lights is proportionate to the risks they present with regard to cosmetic interventions?

Response: The current system, based on the HSAWA with council licensing schemes in some locations, is insufficient because it leaves many providers totally unchecked unless the Health and Safety Executive (HSE) are called to investigate an incident. There are some real risks to control here, and although the HSAWA may be sufficient as a regulatory framework, some sort of national registration / licensing scheme is also needed. As stated in our response to Question 8, this should include requirements for those delivering treatments to be suitably trained, for treatments to be delivered according to appropriate medical protocols with access to specialist medical advice, and for appropriate laser / IPL protection measures to be in place including access to advice from a qualified LPA. Whilst the majority of incidents resulting from laser/IPL treatment are likely to relate to adverse treatment response, we consider that the risk of eye injury should not be understated. In particular, we would question whether the use of an economic analysis, such as that used to justify the October 2010 deregulation, is appropriate. A retinal eye injury is likely to be “for life”, and because sight is so important, we refute the validity of a purely cost / benefit approach to this aspect of laser safety. Our Members have regularly come across examples of poor practice that would lead to risks to the operator or patient, in particular where the incorrect protective eyewear was being used.

Also, whilst risks to the general public with IPL are limited, several of our Members have audited laser clinics in which there was a real risk to the general public (e.g. passers-by) due to their location in busy shopping areas and the presence of windows in the shop unit. The operators of such establishments are not necessarily aware of these risks, hence clearly demonstrating the need for involvement of an LPA in the implementation of appropriate controls.

We also wish to draw attention to the current standards work being done in CEN in respect of the aesthetic sector.

(CEN is the European Committee for Standardisation). One of our Members sits on the mirror BSI Committee for this work. Both Committees have the title “Aesthetic surgery services”, and the Committee references are CEN/TC 403, and BSI CH403 respectively. CEN is developing the new pan European EN 16372 “Aesthetics surgery services” Standard, which includes both non laser and laser procedures. The word "surgery" in the title is unfortunately somewhat misleading, and is being reviewed. The Standard in fact covers all aesthetic procedures, from major invasive procedures such as facelifts and liposuction, through invasive and non-invasive laser treatments, down to and including, for example, IPL hair reduction.

The EN 16372 Standard that the CH403 Committee has been working on since August 2010, in collaboration with colleagues throughout Europe, was discussed at the CEN/TC Meeting in Delft on 24-25th August 2012. The almost unanimous view across Europe (with the exception of the UK) was that laser and light treatments should be restricted to medical doctors, or other healthcare professionals working under the direct supervision of a medical doctor. However, in line with the reality of the current situation in England, the BSI Delegation at that Meeting successfully lobbied CEN for an “A Deviation” for lasers and lights, which allows allow suitably trained and supervised non-healthcare professionals to carry out these treatments. This “A Deviation” was achieved on the basis of the 1991 Local Authorities Act. Given the basis on which this “A Deviation” was achieved, we would support the strictures for lasers and lights treatments pertaining to London (via the 1991 Local Authorities Act) being extended to all other parts of England as part of the implementation of a national registration / licensing scheme.

In due course we believe that a similar level of legislation should apply to the rest of the UK, although we assume that such a legislative extension would be out of direct scope of the Review as it is currently defined. We note, in particular, the current and ongoing situation in both Wales and Northern Ireland. Our understanding is that although the Care Standards Act 2000 was repealed in England, the equivalent legislation is still in statute in Wales and Northern Ireland, resulting in the continued statutory regulation of lasers and light treatments.

Q15: Should providers of non-surgical cosmetic interventions delivered in nonhealthcare settings, for example beauticians administering dermal fillers or laser hair removal, be required to audit their processes and ensure that all their practitioners take part in clinical audit?

Response: Our view is yes, but at a simple level commensurate with the service that they are providing.

Q17: Should providers be required to take out an adequate indemnity arrangement and/or to participate in a bond arrangement such as provided by ABTA in the travel industry? If so, for how long?

Response: Our view is that yes, all providers should be required to take out an indemnity arrangement, and in general it should cover any damage that can be shown to be caused by the treatment in perpetuity. This would ensure that, in the case of implants, for example, the patient is covered in the event of any problems “for life”.

However, in the case of laser / IPL treatments, it may be possible to define a shorter timescale that would be ample to cover any emergent adverse effects, perhaps a year.

Q19: What can be done to protect patients if their provider goes out of business?

Response: An insurance backed bond arrangement as in Question 17 should achieve this.

Q21: Should providers be required to carry out a two-stage consent process (ie allowing a ‘cooling-off' period between consultation and surgery)?

Response: This is standard practice for laser / IPL treatments due to the need for skin /patch testing prior to the first treatment.

Independent Healthcare Advisory Services (IHAS)/Treatments You Can Trust (TYCT) Sally Taber, Head of IHAS said; “The Independent Healthcare Advisory Services (IHAS) is delighted to respond to the Review of Cosmetic Interventions, on behalf of the Cosmetic Surgery/Treatments workstream and the Treatments You Can Trust (TCYT) Governance Board.”

“IHAS, and all our members, are committed to safety, and we strive to ensure a safe, well-regulated industry that provides the best standards – and achieves the best outcomes – for patients. We work closely with the MHRA, and we also welcome the recent proposed updates to the EU Medical Devices Directive. Universal statutory regulation costs can often act as a useful ‘barrier’ to entry to the lowest quality providers who carry the highest risks.

Nevertheless, we feel strongly that there is a continued role for self-regulation that should not be overlooked, in particular with the voluntary accreditation scheme shortly to be launched by the Professional Standards Authority.

We welcome moves to improve the industry’s standing by increasing the training and qualification standards required to carry out cosmetic interventions – for example, including a cosmetic surgery speciality on the Specialist Register – and all cosmetic facial injectables should only be carried out by appropriately trained clinical professionals. However, it must be recognised that, in many cases, aesthetic medicine is already practised to an extremely high standard by doctors, dentists and registered nurses with aesthetic training, complementing the service provided by cosmetic and plastic surgeons. We believe that moving to a purely ‘consultant-only’ model would not be in the best interests of patients or the wider profession.”

“IHAS also recommends that the Cosmetic Intervention Review Team take into consideration the disparity for patients as well as providers of four countries regulatory mechanisms; in particular Scotland, which has no requirement to register cosmetic clinics or cosmetic lasers1 services within their current regulatory framework at all, and Wales, where there is proportionate regulation for cosmetic lasers.”

1

For the purposes of this document, “lasers” includes Class 3B, Class 4 laser and Intense Light Systems

IHAS key recommendations: 1. All cosmetic facial injectables should only be administered by doctors, dentists and registered nurses.

2. All IHAS members are behind the principles and framework of TYCT but believe it should be mandated, promoted and financially assisted by the DH. 3. There have been calls from within the industry for dermal fillers to be reclassified as prescription only medicines (POMs). Dermal fillers should not be reclassified as POMs in the short term.

4. The Committee should consider how new technologies can be introduced within its new framework.

5. The regulation of the laser industry, including intense light systems, is not acceptable, effective or consistent.

6. The MHRA should carry out regular audits and spot checks on manufacturers at short notice.

7. We believe all cosmetic surgeons should be on the Specialist Register.

8. Every organisation that undertakes surgical cosmetic interventions should audit its practitioners.

9. Providers must always ensure that comprehensive patient records are kept by both surgeons and providers, including details of the implants and devices used.

10. IHAS strongly believes that all providers should be covered by indemnity provisions based on their level of risk, and on a ‘claims-made’ basis.

11. On balance, IHAS believes the existing advertising regulations are proportionate, but inadequately enforced, especially when it comes to advertising Botox®.

12. Insurance should be taken out by the MHRA so it can step in to cover the liabilities of failed manufacturers.

13. The Breast Implant Registry should be re-instated and its use made compulsory.

A more detailed explanation of the key recommendations is available direct from IHAS www.independenthealthcare.org.uk.

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

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Introduction Chapter 1: Introduction to volumetric rejuvenation Chapter 2: Overview of injectable fillers Chapter 3: Approach to choosing the ideal filler

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Educational Opportunities

Training, Events, Mentoring etc...

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

Cosmetic Training Features:      

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

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

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

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

www.cosmetictraining.co.uk

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

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

Give Your Aesthetic Business a Competitive Edge & Attend

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

Provisional dates for 2013 include:

Saturday 26th January in Manchester Saturday 27th April in London The SMART Ideas format provides an opportunity for you to explore the very latest product innovations, alongside reviewing core business principles related to running an aesthetic clinic.

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

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

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

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Clinical Information

Self-Reported "Worth It" Rating of Aesthetic Surgery in Social Media.

Domanski MC, Cavale N. Department of Surgery, Washington Adventist Hospital, 7600 Carroll Avenue, Takoma Park, MD, 20912, USA. Aesthetic Plast Surg. 2012 Oct 6.

BACKGROUND: A wide variety of surveys have been used to validate the satisfaction of patients who underwent aesthetic surgery. However, such studies are often limited by patient number and number of surgeons. Social media now allows patients, on a large scale, to discuss and rate their satisfaction with procedures. The views of aesthetic procedures patients expressed in social media provide unique insight into patient satisfaction.

METHODS: The "worth it" percentage, average cost, and number of respondents were recorded on October 16, 2011, for all topics evaluated on the aesthetic procedure social media site www.realself.com . Procedures were divided into categories: surgical, liposuction, nonsurgical, and dental. For each group, procedures with the most respondents were chosen and ordered by "worth it" score. A literature search was performed for the most commonly rated surgical procedures and the satisfaction rates were compared.

RESULTS: A total of 16,949 evaluations of 159 aesthetic surgery topics were recorded. A correlation between cost of the procedure and percentage of respondents indicating that the procedure was "worth it" was not found. The highest-rated surgical procedure was abdominoplasty, with 93 % of the 1,589 self-selected respondents expressing that abdominoplasty was "worth it." The average self-reported cost was $8,400. The highest-rated nonsurgical product was Latisse, with 85 % of 231 respondents reporting it was "worth it" for an average cost of $200. The satisfaction scores in the literature for commonly rated surgical procedures ranged from 62 to 97.6 %. No statistically significant correlations between literature satisfaction scores and realself.com "worth it" scores were found.

CONCLUSIONS: Abdominoplasty had the highest "worth it" rating among aesthetic surgical procedures. Aesthetic surgeons should be wary that satisfaction scores reported in the literature might not correlate with commonly achieved results. Social media has opened a new door into how procedures are evaluated and perceived.

OnabotulinumtoxinA: A Meta-Analysis of Duration of Effect in the Treatment of Glabellar Lines.

Glogau R, Kane M, Beddingfield F, Somogyi C, Lei X, Caulkins C, Gallagher C.Department of Dermatology, University of California at San Francisco, San Francisco, California.

Dermatol Surg. 2012 Nov;38(11):1794-803.

BACKGROUND: Duration of effect of aesthetic treatments with botulinum toxin potentially influences subject satisfaction, treatment frequency, and annual costs, but quantitative outcomes for measuring duration of effect and correlations with subject satisfaction have yet to be fully elucidated.

METHODS AND MATERIALS: Phase III clinical trials with similar designs were identified and their data pooled to ascertain duration of clinical effect of onabotulinumtoxinA in glabellar muscles. Duration was calculated using the Kaplan-Meier method for investigator-rated Facial Wrinkle scale (FWS) scores and subject global assessment (SGA) of glabellar lines. Responders were determined according to FWS score at maximum contraction and at repose 30 days after injection.

RESULTS: Data from four trials with 621 onabotulinumtoxinA-treated (20 U) subjects were analyzed, 523 of these (84.2%) were identified as day-30 responders on the FWS at maximum contraction. Pooled median duration of effect for day-30 responders was 120 days for FWS at maximum contraction and 131 days for FWS at repose.

Higher day 30 SGA scores were correlated with a greater duration of effect on dynamic, but not static lines.

CONCLUSION: Treatment of glabellar lines with 20 U of onabotulinumtoxinA resulted in sustained clinical benefit for 4 months in more than 50% of responders; subject satisfaction increased with duration of effect.

Dry Eye Symptoms and Chemosis Following Blepharoplasty: A 10-Year Retrospective Review of 892 Cases in a Single-Surgeon Series.

Prischmann J, Sufyan A, Ting JY, Ruffin C, Perkins SW. Arch Facial Plast Surg. 2012 Oct 15:1-8.

OBJECTIVES: To determine the incidence of and risk factors associated with dry eye symptoms (DES) and chemosis following upper or lower blepharoplasty. To examine the outcomes among long-term blepharoplasty data to better understand the incidence of and risk factors associated with dry eye symptoms (DES) and chemosis, to evaluate the known risk factors for DES in the general population, and to analyze intraoperative procedures (such as forehead-lift, midface-lift, canthopexy, and canthoplasty) to determine their effects on DES and chemosis.

METHODS: A retrospective medical record review was performed among all the cases of upper or lower blepharoplasty performed by the senior author during a 10-year period (January 1999 through December 2009). A self-reported dry eye questionnaire was used to collect baseline and follow-up data. Patients with incomplete medical records, multiple (>1) revision procedures, less than 3 weeks of postoperative follow-up data, or a history of SjÜgren syndrome, severe thyroid eye disease, histoplasmosis ocular infection, periocular trauma causing eyelid malposition, or radiotherapy for nasopharyngeal cancer were excluded from the study. Binary logistic regression analyses were performed to analyze the relationship between 13 preoperative and anatomical variables and DES or chemosis. χ2 Tests were performed to analyze the relationship between intraoperative risk factors and DES or chemosis.

RESULTS: In total, 892 cases met the study inclusion criteria. Dry eye symptoms and chemosis following blepharoplasty were reported in 26.5% and 26.3% of patients, respectively. The incidences of DES and chemosis were significantly higher in patients who underwent concurrent upper and lower blepharoplasty (P < .001) and in patients who underwent skin-muscle flap blepharoplasty (P = .001). Hormone therapy use and preoperative scleral show were associated with DES after blepharoplasty (P < .05). Male sex, preoperative eyelid laxity, and preoperative DES were associated with an increased incidence of chemosis following blepharoplasty (P < .05).

Intraoperative canthopexy significantly increased the risk for developing chemosis (P = .009), and postoperative lagophthalmos significantly increased the risk for DES following blepharoplasty (P < .001).

CONCLUSIONS: Dry eye symptoms and chemosis are common following blepharoplasty, and the risk for developing these conditions may increase with intraoperative canthopexy, postoperative temporary lagophthalmos, concurrent upper and lower blepharoplasty, and transcutaneous approaches violating the orbicularis oculi muscle.

Patients with a preoperative history of DES, eyelid laxity, scleral show, or hormone therapy use may be at greater risk for developing dry eyes or chemosis following surgery.

Botulinum toxin to improve lower facial symmetry in facial nerve palsy.

Sadiq SA, Khwaja S, Saeed SR. Manchester Royal Eye Hospital, Manchester, UK, The University of Manchester, Manchester Academic Health Science Centre, Central Manchester Foundation Trust, Manchester, UK. Eye (Lond). 2012 Sep 14.

Introduction In long-standing facial palsy, muscles on the normal side overcontract causing difficulty in articulation, eating, drinking, cosmetic embarrassment, and psychological effects as patients lack confidence in public.

Methods We injected botulinum toxin A (BTXA) into the normal contralateral smile muscles to weaken them and restore symmetry to both active and passive movements by neutralising these overacting muscles.

Results A total of 14 patients received BTXA (79% women, median age 47 years, average length of palsy 8 years). They were all difficult cases graded between 2 and 6 (average grade 3 House-Brackmann). All 14 patients reported improved facial symmetry with BTXA (dose altered in some to achieve maximum benefit). Average dose was 30 units, but varied from 10 to 80 units. Average time to peak effect was 6 days; average duration of effect was 11 weeks. Three patients had increased drooling (resolved within a few days).

Conclusion The improvement in symmetry was observed by both patient and examining doctor. Patients commented on increased confidence, being more likely to allow photographs taken of themselves, and families reported improved legibility of speech. Younger patients have more muscle tone than older patients; the effect is more noticeable and the benefit greater for them. BTXA improves symmetry in patients with facial palsy, is simple and acceptable, and provides approximately 4 months of benefit. The site of injection depends on the dynamics of the muscles in each individual patient.

Arm dynamic definition by liposculpture and fat grafting.

Hoyos A, Perez M. Dr Hoyos is an Associate Professor at Universidad de San Martin, Bogota, Colombia.

Aesthet Surg J. 2012 Nov 1;32(8):974-87.

Background: The contour of the arm is determined by muscular shape and volume. Liposuction in this area is challenging due to the difficulties of achieving symmetry and the high risk of contour irregularities due to fat structures in the region.

Objective: The authors describe a new technique to achieve muscular definition in the arm.

Methods: From January 2005 to December 2011, a total of 651 arm-sculpting procedures were performed in consecutive patients. Patients with body mass index (BMI) >30 kg/m(2) and/or severe skin laxity were excluded.

Fat grafting was performed in the deltoid area in selected cases. The areas of fat extraction and grafting were specific to gender: in men, an athletic, muscular look was preferred, whereas in women, a slimmer and less-defined shape was desired.

Results: Of the 651 patients, 158 were men (24.3%) and 493 were women (75.7%). Most patients (98.3%) were satisfied with the results in arm dynamic definition. All patients underwent other body contouring procedures at the time of arm enhancement. Complications (n = 21) included 1 soft tissue abscess in the posterior arm, 2 unilateral hematomas, and 3 unilateral seromas that required puncture, along with 15 cases of minor asymmetry. Transitory hardening of the skin of the posterior arm was frequent (n = 104) due to superficial fat extraction, but all cases resolved within 6 months.

Conclusion: The authors were able to achieve natural results with this new procedure in arm contouring. The technique is safe and effective with reproducible results when performed through multilayer fragmentation and liposuction with an anatomical extraction. Fat grafting can be performed for contouring with no additional complications.

A Intense focused ultrasound tightening for the treatment of infraorbital laxity.

Suh DH, Oh YJ, Lee SJ, Rho JH, Song KY, Kim NI, Shin MK. J Cosmet Laser Ther. 2012 Oct 11.

Background: Infraorbital laxity is a common problem that increases with age. Blepharoplasty with lipectomy is a very commonly performed surgical procedure to treat this problem; however, it is invasive and is associated with the potential for reemergence. Therefore, young patients may prefer a non-surgical procedure to a surgical procedure. Intense focused ultrasound (IFUS) has emerged as an effective non-surgical tissue tightening procedure.

Objective: This study assessed the safety and efficacy of IFUS (Ulthera™ system, Ulthera Inc, Mesa, AZ, USA) for facial tightening in Asian patients with infraorbital laxity.

Methods: We studied 15 patients who were treated with an IFUS device applied to both lower eyelids. The primary outcome measure was an objective improvement in a paired comparison of pretreatment and post-treatment (6 months) photographs. A secondary outcome measure was patient satisfaction as measured by a questionnaire.

Results: The mean patient age was 50 years (range, 27-69). All patients received one to two treatments with intense focused ultrasound. All patients in the study experienced both subjective and objective improvement.

Conclusion: IFUS can be used as a noninvasive skin tightening procedure for infraorbital laxity. No serious, permanent, or delayed side effects were noted up to 6 months post-treatment. Thus, this procedure can be effective and safe in the treatment of decreased laxity of the lower eyelids.

Combination Therapy of Hyaluronic Acid Mesotherapic Injections and Sclerotherapy for Treatment of Lower Leg Telangiectasia Without Major Venous Insufficiency: A Preliminary Clinical Study.

Iannitti T, Rottigni V, Torricelli F, Palmieri B. Clin Appl Thromb Hemost. 2012 Oct 17.

Background. Telangiectasia is the dilation of dermal capillaries mainly due to hypertension and vein insufficiency.

Treatments of choice for this condition are sclerotherapy with foam liquid or intradermal fiber optic laser energy delivery.

Aim. The aim of this study was to assess the efficacy of a new therapeutic approach consisting in the use of polymerized hyaluronic acid mesotherapic injections following sclerotherapy in the areas of the skin affected by telangiectasia in patients without major vein insufficiency.

Materials and Methods. A total of 20 women, aged between 19 and 64 years, affected by recurrent lower leg telangiectasia, were included in this study. Patients were preliminarily submitted to echo color Doppler sonography to rule out severe saphenofemoral valve and lower limb major vein insufficiency. All patients underwent 3 sessions a month of polidocanol 1% capillary injections for 2 months. This was followed by 0.1 ml cross-linked hyaluronic acid introduction in the polidocanol 1% needle track. A total of 50 mesotherapic injections (0.05 ml each) were performed on the skin surface where an ice pack was previously applied for 4 to 5 minutes. A follow-up visit was performed at 3 months. The results, based on photographic examination, were rated as follows: poor improvement (0%-50%), good improvement (51%-75%), and very good improvement (76%-100%). The side effects of the clinical procedure, in terms of pain, itching, paresthesia, ecchymosis, and relapse of telangiectasia over the treated skin surface, as well as a persisting pigmentation in the injection spots and induced benefits related to leg heaviness and comfort, were recorded.

Results. In total, 6 patients displayed a slight venous insufficiency, 3 patients displayed patent venous insufficiency, and 11 patients did not show any venous insufficiency. Before treatment, itching was present in 18 out of 20 patients, paresthesia in 15 out of 20 patients, ecchymosis in 16 out of 20 patients, and leg heaviness in 15 out of 20 patients. At the 3-month follow-up, an improvement of 0% to 50% was observed in 4 patients who had a relapse in telangiectasia. A 51% to 75% improvement was observed in 3 patients and a 76% to 100% improvement occurred in 13 patients. At the 3-month follow-up, itching persisted only in 4 patients; paresthesia was absent in 12 patients, while 3 patients still presented this symptom; ecchymosis was absent in 16 patients; 15 patients reported a feeling of lightweight legs. Among the patients with relapsing telangiectasia, 2 patients reported pigmentation due to hemosiderin deposit in the skin at the 3-month follow-up. The slight venous insufficiency, observed at the beginning of the study, improved in 5 out of 6 patients. The patients' compliance with the procedure was high and 16 out of 20 patients declared their willingness to repeat the whole clinical procedure, if necessary.

Conclusions. This pilot clinical study supports the use of hyaluronic acid mesotherapic injections following sclerotherapy for treatment of lower leg telangiectasia without major venous insufficiency. We propose that the prolonged persistence of cross-linked hyaluronic acid, across the microvascular venous areas, is able to induce a stronger stromal tissue, thus preventing relapse. Further clinical studies, comparing this new approach with existing clinical procedures, are needed in a larger number of patients.

SOURCE: PubMed

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 admin@consultingroom.com so we can make every attempt to remedy it.

Fat compartments direct surgical approach Tear trough deformity may require surgical aesthetic treatment while the glabellar fold may be a simpler area to correct, according to researchers who assessed subcutaneous fat compartments to determine adequate treatment modalities. Investigators from University of Kiel examined nine non-fixed male and female cadaver heads ranging in age from 72 to 89.

SOURCE: Cosmetic Surgery Times

Patients prefer implants for butt augmentation Patients appear to be more satisfied with buttock augmentation with implants compared to fat grafting, according to results of a recent study.

Cosmetic surgeons at the Chugay Cosmetic Surgery Institute, Long Beach, Calif., conducted a comparative study to examine whether one technique is superior to the other in terms of complications, postoperative pain and patient satisfaction. The researchers retrospectively reviewed 129 patient cases between 2008 and 2011. Thirty-three had undergone buttock augmentation using fat transfer with stem cell therapy and 96 with silicone prosthesis. Patients who received implants for their augmentation were significantly more satisfied, 76 percent, with their results compared to those who received fat transfer, 69.7 percent.

SOURCE: Cosmetic Surgery Times

New study shows success in treating acne with photodynamic therapy The most exciting news regarding photodynamic therapy (PDT) involves a new study showing significant results in treating acne, says the study's primary investigator.

"Acne is one of those indications where PDT has been thought about a lot and tried with different combinations of photosensitizers and light sources. Theoretically, it should work," said David M. Pariser, M.D., immediate pastpresident, American Academy of Dermatology, at the 2012 Fall Clinical Dermatology Conference. However, he adds, previous clinical trials haven't shown that PDT is any more effective than treatment with the light source alone — until now.

SOURCE: Dermatolgoy Times

Breastlight: Thousands misled by torch that claims to detect breast cancer The advertising for the Breastlight, which is sold online and in Boots, is 'misleading' and 'irresponsible' according to the Advertising Standards Authority.

The £86 Breastlight device – which is sold online and in Boots – claims to help women spot the first signs of tumours. More than 20,000 of the torches have been sold worldwide since they were launched in 2006.

SOURCE: Daily Mail Full ASA Adjudication

Hong Kong woman dies after cancer `beauty` treatment One of four Hong Kong women struck down with septic shock after receiving a "beauty" treatment normally given to cancer patients has died.

The 46-year-old died at a local hospital one week after receiving DC-CIK therapy through the DR beauty center, local authorities said. According to the Hong Kong Health Department, the DC-CIK procedure involves the "concentration and processing of blood taken from the person, and subsequent infusion of the mixture back into the patient."

SOURCE: CNN News

BAPRAS: Guidelines on body contouring BAPRAS member Mark Soldin outlines how the Association is working to put together guidelines to help ensure patients requiring body contouring surgery after massive weight loss can receive appropriate care.

The British Association of Plastic, Reconstructive and Aesthetic Surgeons has been caring for patients with severe obesity, the problems associated with this disease and the sequelae of treatment for some time.

SOURCE: BAPRAS

The 2p drug that can banish ugly scars forming once a wound has healed Called verapamil, the drug is already widely used in the NHS to treat a variety of heart-related conditions such as high blood pressure, abnormal heart rhythms and chest pain. It helps to widen blood vessels and one pack of 84 tablets costs just £1.45. Now scientists in Australia are looking to see if the drug could also prevent the formation of ugly scars once a wound has healed.

SOURCE: Daily Mail

Botox – don’t risk patient safety, dentists told Dentists should under no circumstances prescribe Botox for a patient outside their supervision. This advice comes in the wake of the recent GMC announcement that doctors must only prescribe Botox and other injectable cosmetics after having face-to-face consultations with their patient.

SOURCE: Dentistry.co.uk

BUAV forces Government to ensure animal testing for cosmetics botox to end The BUAV has welcomed a commitment by the Home Office relating to the testing of botulinum toxin (commonly known as botox). The new approach has been promised as a result of the BUAV’s investigation into the animal testing of Dysport (a type of botox) at the UK contract facility, Wickham Laboratories, and subsequent Judicial Review proceedings.

SOURCE: BUAV

Sunbed salons in Cardiff flouting laws, investigation finds Many sunbed salons are flouting laws introduced a year ago to protect the public from the risks of skin cancer, a BBC Wales investigation has found. BBC Wales' X-Ray programme sent a 14-year-old schoolgirl into every tanning salon it could find in Cardiff. The girl was admitted to two-thirds and only five salons checked her age.

SOURCE: BBC

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

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

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

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

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

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

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

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

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

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

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

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

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

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

For Sale at £1,425 + VAT More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=344 Nora Bode OxyJet Star Oxyaroma Oxyspray facial and body treatment salon machine In very good condition, had had low usage and in full working order For Sale at £7,500 +VAT *PRICE REDUCED £6,175 + VAT* More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=516 Pollogen ReGen Tripollar Radio Frequency skin body facial beauty machine salon Very good condition, full working order. Unit was removed from a small clinic which closed shortly after it opened For Sale at £8,000 +VAT *PRICE REDUCED £7,600 + VAT* More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=515 No+Vello IPL Laser Hair Removal & Skin Rejuvenation Treatments Beauty System In very good condition and full working order. Supplied new in 2010 For Sale at £6,650 + VAT More info - www.consultingroom.com/services/equipment-display.asp?equipment_id=638 Beau Visage Facial Skin Imaging Diagnosis Treatment Beauty Therapy System In very good condition and full working order For Sale at £3,800 + VAT More info - www.consultingroom.com/services/equipment-display.asp?equipment_id=640 CACI Flash 1 IPL Hair Removal & Skin Rejuvenation Acne Treatments Beauty System In good condition and in full working order For Sale at £4,000 + VAT More info - www.consultingroom.com/services/equipment-display.asp?equipment_id=649 New Meridian Lapex BCS Pro 2000P Liposuction Cellulite Fat Laser Beauty Machine New in original packaging. Supplied to a clinic which closed shortly after opening in Late 2011. Unit never used.

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

Classifieds FOR SALE Lynton Lumina IPL Machine The machine is IPL only but you can add on the laser hand piece and also the tattoo removal head piece, it is only just two years old and just had its first service, it has three hand pieces which are all as new with hardly any usage, the 650 advanced with only 4065 shots, the 650 with 6372 shots, the 585 with only 366 shots, bare in mind that the average yearly usage is 20,000 shots, the unit is unmarked and very clean .

IT IS ADVISABLE TO CHECK OUT HOW MUCH THIS MACHINE IS WITH LYNTON AND YOU CAN SEE IT IS A BARGAIN Here is some info from Lynton about the machine.

LUMINA is unrivalled in its system lifetime and flexibility. Ideal for the treatment of deep and superficial vascular lesions, unwanted hair, superficial and dermal pigmentation, photo-rejuvenation, active acne treatment and multi-coloured tattoo removal.

LUMINA has many unique features, including integral printer for treatment record keeping, patient database for instant and accurate records and digital imaging, as well as Interchangeable Light Guide (ILG) technology, all in a platform designed to accept application upgrades. Uniquely, LUMINA can be taken as an ‘IPL only' specification at first and upgraded to add further IPL and laser hand pieces as required onto its small single platform, giving a truly lifetime service.

ALL IN ALL THIS IS A VERY ADVANCED PIECE OF EQUIPMENT AT A BARGAIN PRICE!

Price: £18,000 Contact: Andrew, 07979598423

Strawberry Laser Lipo 10 Paddle Machine Treatment times as low as 10 minutes. This machine is fully upgradeable to use: • Eye bag reduction • Stretch Mark Removal • Removal of Double Chin and Jowls Comes fully equipped with 10 paddles, EN probes, 1 x stomach strap, 2 x arm straps, 2 x leg straps, safety glasses.

I am selling it as I have a second Strawberry and don’t need both machines.

1 year old with only 64 hours usage. Serviced by Strawberry in June 2012

Price: £8,500 Contact: Rebecca, beakydrew@aol.com

Lynton Luminette IPL Machine 16 months old - light use only, recently serviced.

Been very well looked after and in excellent condition. Has 2 handsets for Hair Removal and Pigmentation, Acne, Skin Rejuvenation, Rosacea and Thread Vein Head.

Comes with handbooks and 2 large and 2 small pairs of Goggles and trolley to stand on

Price: £8,000 ONO Contact: Heather Willis, info@future-beauty.co.uk

Soprano Blue 4yrs old, new 810 applicator for hair removal and skin tightening applicator.

Price: £27,000 Contact: Stuart Morrod, stu5759@live.com

RENTALS Energist Ultra & Ultra + ENERGIST ULTRA platform (RENTAL) - fully serviced, calibrated and takes 610 and 530nm handpieces.

Alternatively, ENERGIST ULTRA + (RENTAL) which has the same handpieces and the option of the acne handpiece and the new high powered mini treatment block but that is only for use by a doctor - this applicator is for use on larger veins and results comparable to ND: YAG. The suggested rental figure of £175 per week would be for the ULTRA base unit and cost per shot for the applicators, at cost price.

The rental figure for the ULTRA + would be dependent upon the applicators used and would be negotiable.

Laser-Light would be responsible for Annual Maintenance but your Clinic to Insure.

We can also offer training except for the Core of Knowledge which is run by Godfrey Town LPA, alternatively a clinic visit if CQC require.

There is a video demo on www.laser-light.co.uk website.

Price: price on enquiry Contact: Registered Manager, 01608 645423, registeredmanager@laser-light.co.uk

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

Advertisement S.A.F.E.™ 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.

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Due to the real time filter life pressure gauge

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Quiet:

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ULPA: 99.999+%@ 0.12 micron

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Electrical:

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

Regulatory:

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