PRIME March/April 2025

ETHICS IN MEDICAL AESTHETICS WHAT YOU NEED TO CONSIDER

NECK WRINKLES ASSESSMENT AND TREATMENT

CELLULITE AN INJECTABLE SOLUTION

TREATING THE UNDER-EYE CHALLENGES AND INNOVATIONS

AS AESTHETIC MEDICINE CONTINUES TO EVOLVE, WE'RE EXCITED TO SHARE

A selection of insights and innovations reshaping the industry. From the power of medical-grade skincare in practice growth and the latest research from AMWC China, highlighting emerging trends in fat grafting, facial rejuvenation, and longevity science, this issue explores how innovation is setting new standards in aesthetics and anti-ageing.

One of the most significant shifts in the industry is the rise of GLP-1 agonists, originally used for diabetes management but now widely recognised for their role in weight loss and potential longevity benefits. However, with the popularity of these treatments comes the need for a strategic approach to patient care. Five Keys to Aesthetic Success in a GLP-1 Agonist Age explores how weight loss can lead to facial volume depletion and skin laxity, underscoring the necessity of complementary treatments such as fillers, biostimulatory agents, and body contouring to maintain aesthetic balance.

Technology continues to be a driving force in aesthetics, with high-quality imaging systems revolutionising consultations and treatment planning. The Aura 3D Imaging System, featured in Modern High-Quality Imaging: Pictures Worth More Than a Thousand Words, is redefining patientpractitioner interactions. With AI-driven analysis and advanced skin mapping, practitioners can now provide objective, high-resolution visuals to track changes over time.

Meanwhile, the business of aesthetics is evolving beyond traditional procedures, with retail skincare emerging as an untapped opportunity. Audrey Neff's Unlocking the Retail Skincare Opportunity in Your Aesthetic Practice explores how integrating medical-grade skincare can enhance patient outcomes while significantly boosting clinic revenue. Many practices underutilise this sector, yet when skincare regimens are combined with in-clinic treatments, results are prolonged and optimised, ultimately leading to higher patient satisfaction and long-term loyalty.

Affiliated partners:

International Journal of Aesthetic and Anti-Ageing Medicine

Informa Australia, Level 4/24 York St, Sydney, NSW, 2000, Australia ISSN 2159-8908 (print) ISSN 2159-8916 (online)

Editor Balraj Juttla balraj.juttla@informa.com

Art Director David ‘Spike’

On the global stage, AMWC China continues to drive innovation and excellence in aesthetic medicine. With the industry in China projected to grow 10–15% annually, last year's conference celebrated groundbreaking clinical research and transformative case studies. As detailed in AMWC China: Celebrating Excellence in Medical Aesthetics, young physicians showcased groundbreaking work in fat grafting, facial rejuvenation, and regenerative medicine. The competition underscored the importance of evidence-based research and multidisciplinary collaboration in advancing the field of aesthetic medicine.

Enjoy the issue, and I'm sure I will see many of you at AMWC Monaco, which takes place on March 27th to 29th, for three days of lively debates, excellent scientific content, and world-class products on show.

Balraj Juttla Editor, PRIME balraj.juttla@informa.com

March/April 2025

AESTHETIC FEATURES

7 Phitogen Beauty Labs announce expansion into Brazil following ANVISA approval 8 Evolus Announces FDA approval of two new hyaluronic acid gels

10 AMWC China: Celebrating excellence in medical aesthetics

PRIME speaks to the winners of the second Young Physician Medical Research competition and the inaugural Facial Rejuvenation Case Competition, awarded during AMWC China 2024 in Chengdu

14 Modern high-quality imaging: pictures worth more than a thousand words Precision imaging is transforming aesthetic consultations. The Aura 3D Imaging System delivers consistent, high-quality visuals and AI-driven analysis, allowing practitioners to track subtle changes, enhance patient communication, and optimise treatment outcomes

18 Five keys to aesthetic success in a GLP-1 agonist age

As the popularity of GLP-1 agonists for weight loss surges, we explore strategies for providers to successfully integrate these medications into their services, address potential side effects, and enhance overall aesthetic outcomes through complementary treatments

22 Introducing augmented endermologie® by LPG®

This global player in aesthetics has been taking health, beauty, and wellness seriously since 1986

26 Cellulite: from psychological to cellular burden and a new injectable solution

Dr Andreea Boca, MD, PhD, presents preliminary results of a trial to treat cellulite with SuneKOS Cell15 injectable MD Class III

30 Aqualuna Aesthetics horizontal neck wrinkles scale: An assessment and treatment strategy

Horizontal neck wrinkles, a key sign of ageing, can be effectively treated with advanced HA technologies and a layered approach, as outlined by the Aqualuna Aesthetics horizontal neck wrinkle scale

36 The multifaceted impact of ethics in medical aesthetics: Beyond the physician's perspective

Navigating the ethical complexities of medical aesthetics, Sylvia Ramirez, MD, and Gunther Scherz explore how shared decision-making, informed consent, and patient-centred care uphold professional responsibility in elective treatments

40 Injectable Treatments for the under-eye area:

Challenges and innovations

Oksana Pashkovska, MD, explores the latest techniques in under-eye injectables, addressing key challenges like volume loss, oedema, and the Tyndall effect to enhance patient safety and aesthetic outcomes

PRACTICE MANAGEMENT

44 Unlocking the retail skincare opportunity in your aesthetic practice

Enhancing patient outcomes while boosting practice revenue, Audrey Neff explains how retail skincare is an often-overlooked but essential component of a successful aesthetic practice

PRIME PROMOTION

48 Global-Repair Advanced Cream and Elixir

50 SeduSkin: Advanced biorevitalisation for radiant and youthful skin

54 The science behind PDLLA: Natural volumising with a new adipocyte

56 1 million treatments make EMFACE the fastestgrowing facial lifting procedure in the category

60 A groundbreaking approach to autoimmune skin and hair disorders

EVENTS

62 A round-up of the major industry events around the world over the next 12 months

NEWS

A

round-up of news stories in the aesthetic and anti-ageing medicine industry

PHITOGEN BEAUTY LABS ANNOUNCE EXPANSION INTO BRAZIL FOLLOWING ANVISA APPROVAL

MILESTONE STRENGTHENS ITS POSITION IN THE $1.15 BILLION BRAZILIAN AESTHETIC MARKET

On January 23, 2025, Phitogen Beauty Labs Srl, a company owned by RP GROUP, obtained the Certification issued by ANVISA, the Brazilian Health Regulatory Agency, attesting that the entire facility complies with the technical requirements of GMP, qualifying it as 'GMP approved' for medical devices.

GMP, which stands for Good Manufacturing Practices, is a system for ensuring that products are consistently produced and controlled according to high-quality standards.

Before awarding the prestigious Certification, the Brazilian Regulatory Agency has conducted a thorough and comprehensive evaluation of the company, examining both production and the quality management system.

Phitogen has therefore consolidated its position as a leading company in the sector, as its production system is aligned with pharmaceutical standards in terms of safety, hygiene, and quality, strengthening trust with consumers and business partners.

This represents a new opportunity for the development of innovative projects and the

achievement of more ambitious objectives. Brazil's commercial potential, in particular, is considerable. Indeed, the market for aesthetic medicine devices in this country is estimated to be worth $1.15 billion in 2025 and is expected to reach $1.93 billion by 2030, with a CAGR of 10.88% over the forecast period (2025–2030).

Moreover, compliance with ANVISA's GMP facilitates allows for entry into other South American and international markets, as many

countries recognise or rely on similar standards, and at the same time helps to obtain other global certifications.

Phitogen Beauty Labs now stands out among Italian and foreign competitors that do not have this certification, and this allows it to attract new and demanding customers while consolidating its brand reputation in the beauty sector.

The recognition achieved is clearly the outcome of deliberate improvements to the infrastructure and updates to the quality management system, all designed to optimize processes, enhance production traceability, and, most importantly, ensure the unequivocal compliance of the third-class Medical Devices manufactured at the facility.

Phitogen Beauty Labs now stands out among Italian and foreign competitors that do not have this certification, and this allows it to attract new and demanding customers while consolidating its brand reputation in the beauty sector.

(Above left) Phitogen Beauty Labs facility, (Above right) Mr. Roberto Gabrielli, CEO of Phitogen Beauty Labs.

EVOLUS ANNOUNCES FDA APPROVAL OF TWO NEW HYALURONIC ACID GELS

APPROVALS MARK EVOLUS’ ENTRY INTO THE US HA FILLER MARKET

Evolus, Inc., a performance beauty company with a focus on building an aesthetic portfolio, announced that the US Food and Drug Administration (FDA) has approved Evolysse™ Form and Evolysse™ Smooth injectable hyaluronic acid (HA) gels, the first two products in the Evolysse™ collection. These approvals mark Evolus’ entry into the US HA dermal filler market, expanding Evolus’ total addressable market by 78% to approximately $6 billion.

'This milestone represents an exciting new chapter in our long-term strategy to expand our portfolio and transition from a single-product company to a multi-product innovator, strengthening our leadership in performance beauty,' said David Moatazedi, President and Chief Executive Officer of Evolus. 'Evolysse™ Form and Evolysse™ Smooth represent the first major technological breakthrough in HA dermal fillers in a decade, offering our customers and consumers a new standard in performance and innovation. The launch of these products is a catalyst in our growth as we are focused on achieving at least $700 million in net revenue and non-GAAP operating income margin of at least 20% by 2028.'

Evolus plans to launch Evolysse™ Form and Evolysse™ Smooth in the US market in Q2 2025. This launch will leverage Evolus’ scalable cash-pay business model and existing digital infrastructure, creating tremendous synergy with the company’s fast-growing neurotoxin business and driving significant value for both customers and consumers.

Cold-X™ Technology and future expansion plans

Evolysse™ Form and Evolysse™ Smooth are part of a collection of injectable HA gels designed by Symatese, which utilizes innovative Cold-X™ technology that aims to better preserve the natural structure of the HA molecule for long-lasting, naturallooking results. 'We are proud to partner with Evolus in bringing the Evolysse™ collection of injectable HA gels to the US market. With decades of experience in biomaterial science and aesthetics, Symatese has a strong legacy of developing innovative aesthetic products that meet the

evolving needs of practitioners and their patients. With one of the largest clinical trial programmes undertaken for an injectable HA technology, Evolysse™ products are being evaluated for safety and effectiveness in over 2,000 patients globally,' said Jean-Paul Gérardin, Chief Executive Officer of Symatese.

Dr. Rui Avelar, Evolus Chief Medical Officer and Head of R&D, added, 'The FDA approval of Evolysse™ Form and Evolysse™ Smooth reflects our commitment to bringing high-quality, innovative aesthetic products to market. These additions to our portfolio reinforce Evolus’ dedication to the highest standards of patient safety and efficacy. With the introduction of Cold-X™ technology, Evolysse™ offers a differentiated approach to the dermal filler category, providing healthcare practitioners with new options to address the unique needs of their patients with precision and confidence.'

Dr. Michael Kaminer, MD, lead investigator for the US NLF pivotal study and an internationally recognized expert in cosmetic surgery, commented, 'The Evolysse™ Form and Evolysse™ Smooth injectable HA gels demonstrated impressive safety, efficacy, and versatility, with the unique property of being injectable at various depths in the skin. These products allow practitioners to achieve precise, natural-looking results, while delivering high patient satisfaction with their effectiveness and longevity.'

Global growth

Evolus previously announced that EU Medical Device Regulation (MDR) approval was received for four unique injectable hyaluronic acid (HA) gels under the brand name Estyme® (pronounced 'esteem'), reflecting the product’s compliance with the highest regulatory standards. Evolus is also introducing Estyme® through a limited experience programme with select physician partners in Europe, to continue to expand global experience with the product’s performance. A broader European launch remains on track for the second half of 2025, further expanding Evolus’ footprint into the global dermal filler market and reinforcing its position as a leader in performance beauty.

RELFYDESS™: LONG-LASTING EFFECTS ON FROWN LINES

Single dose relabotulinumtoxinA demonstrated rapid onset, long-lasting duration of aesthetic efficacy and high patient satisfaction for the treatment of frown lines, Galderma announced in a press release.

Presented at the International Master Course on Aging Science World Congress 2025, results from the new phase 3b RELAX clinical trial showcased the long-lasting effects of relabotulinumtoxinA (Relfydess, Galderma) on frown lines.

These results echo similar results found in the phase 3 READY trial program, which also demonstrated the drug’s rapid onset and long-term efficacy for both frown lines and crow’s feet.

'We are proud to share our latest relabotulinumtoxinA data, which reaffirm the sustained clinical effect and patient satisfaction observed in our READY clinical trial program,' Baldo Scassellati Sforzolini, MD, PhD, MBA, global head of R&D at Galderma, said. 'These findings, together with our proprietary PEARL Technology, reinforce relabotulinumtoxinA as a safe, effective and innovative treatment option.'

The multicentre, randomised, doubleblind, placebo-controlled trial included 132 adults with moderate to severe frown lines. Each patient received a single injection of relabotulinumtoxinA and were observed over a 12-month period.

Results showed that 40% of participants reported an aesthetic improvement on day 1 that lasted through 6 months. 92% of subjects were satisfied with their treatment outcomes 1 month after treatment, whereas 69% and 60% were satisfied at months 6 and 12, respectively.

According to investigator assessments, 98% of patients saw a 1-grade or higher improvement in their frown lines from baseline at month 1. They also reported that these clinical improvements were maintained by 57% and 28% of patients at months 6 and 12, respectively.

No serious treatment-related adverse events were reported.

World’s 1st post-treatment care in medical device quality

Hydro-active wound dressing for optimal post-treatment care after laser, light, and energy-based treatments, and surgical procedures

AMWC CHINA CELEBRATING EXCELLENCE IN MEDICAL AESTHETICS

PRIME speaks to the winners of the second Young Physician Medical Research competition and the inaugural Facial Rejuvenation Case Competition, awarded during AMWC China 2024 in Chengdu

Returning for its highly anticipated fourth edition, AMWC China 2025 will take place from October 17–19 in Chengdu, bringing together over 180 esteemed experts from around the world. As the second-largest AMWC conference globally, this event serves as a leading platform for knowledge exchange in anti-ageing medicine, cosmetic surgery, and dermatology. With the Chinese medical aesthetics market projected to grow by 10–

15% annually, AMWC China 2025 offers attendees an opportunity to explore the latest technological advancements, treatment innovations, and industry trends shaping the future of aesthetic medicine.

Beyond the scientific sessions and expert-led discussions, AMWC China 2025 will also celebrate the next generation of talent with the AMWC Facial Rejuvenation Case Competition and the AMWC Young Physician Medical Research Competition. These prestigious competitions highlight the skills and creativity

of rising practitioners, recognising groundbreaking clinical cases and pioneering research that push the boundaries of medical aesthetics.

In this article, we speak to last year’s competition winners to learn more about their cases, the clinical insights behind their work, and what this achievement means for their careers and the future of aesthetic medicine. By spotlighting the industry’s brightest minds, AMWC China continues to drive excellence and shape the next era of medical aesthetics.

AMWC Young Physician Medical Research Competition Winner: Dr Junrong Cai

Plastic and Aesthetic Surgery, Nanfang Hospital, Resident Doctor, Southern Medical University, China

Dr Junrong Cai, as a PhD from the United States and a young expert in fat sculpting, could you share your academic background and main accomplishments?

I currently hold two national projects with the National Natural Science Foundation of China and the Foundation’s Youth Project. Both projects are centred on the important regulatory role of the plastic transformation of adipocytes in tissue regeneration. In the past 5 years, I have published relevant research as the first author or corresponding author in top journals in the field of plastic surgery and regenerative medicine, such as Cell Metabolism (one article, IF=29, Zone 1, first author), JAMA Dermatology (one article, IF=10.9, Zone 1, last corresponding author), Plastic and Reconstructive Surgery (16 articles, Zone 2, top journal in the field of plastic surgery), and Stem Cell Research and Therapy (4 articles, IF: 7.5, Zone 2), with a total impact factor of more than 200 points. I was also invited to serve as a reviewer for journals such as Plastic and Reconstructive Surgery, Stem Cell Research and Therapy, and Molecular Metabolism in the field of fat transplantation and fat metabolism. The applicant’s work has also been recognised by domestic and foreign academic circles: the applicant was invited to attend the Global AntiAging Conference in France in 2019 and made an oral report. In 2024, he went to the United States to attend the American Society of Plastic Surgeons, made an oral report, and won the Outstanding Paper Report Award. In addition, he won first place in the Youth Paper Exchange Competition of the 19th Medical Cosmetology Academic Conference of the Chinese Medical Association, first place in the Young Physicians Forum of the 20th National Academic Exchange Conference of the Plastic Surgery Branch of the Chinese Medical Association, and second prize in the Outstanding Paper Award for Young Physicians at the 19th National Plastic and Cosmetic Physicians Conference.

What techniques do you excel in during your practice in plastic surgery?

I mainly engage in fat medicine and aesthetic injection. Fat medicine includes facial fat transplantation, large-volume fat transplantation and liposuction sculpting, while aesthetic injection includes injections of fillers and botulinum toxin.

What makes the case you submitted in the second AMWC Young Physician Medical Research Competition unique?

The content of this submission is my research published in Cell Metabolism (one article, IF=29, zone 1, first author). Adipose tissue, as an essential source of adipose stem cells, is an important research object in regenerative medicine. In addition, the role of adipocytes in disease regulation has been a research hotspot in recent years, and important research findings have been made in the fields of tumours, cardiovascular, and immunity. Adipose tissue is widely distributed in the human body and is closely adjacent to the surrounding organ structures. It can affect the surrounding

tissues and organs through various pathways, such as paracrine and energy metabolism, and is closely related to the occurrence and progression of various diseases. Changes in the properties and functions of adjacent adipose tissue affect the progression of various diseases and are a new hotspot in current research. Adipocytes are closely related to skin regeneration. In recent years, studies have found that adipocytes can participate in skin regeneration through direct migration, production of antimicrobial peptides, release of fatty acids to activate macrophages, and transdifferentiation into fibroblasts. Related studies have been published in top journals such as Science, Cell Stem Cell, Nature Communication, The Journal of Clinical

Adipose tissue, as an essential source of adipose stem cells, is an important research object in regenerative medicine. In addition, the role of adipocytes in disease regulation has been a research hotspot in recent years, and important research findings have been made in the fields of tumours, cardiovascular, and immunity.

Dr. Junrong Cai

Investigation. However, these studies are all centred on the role and mechanism of dermal adipocytes in skin regeneration, while the effect of subcutaneous fat on skin regeneration has not been reported. I reported for the first time the key role of subcutaneous fat in wound repair, and the relevant research was published in Cell Metabolism

How do you integrate internationally advanced plastic surgery techniques with local practices?

I would say, maintain a learning attitude towards cutting-edge science and advanced clinical technology, keep pace with the times, and update your own learning tools, whether it is artificial intelligence, code learning or various new data platforms. At the same time, I actively participate in academic conferences at home and abroad, keep in touch with the outside world, and understand the differences between domestic and foreign technologies. Only by adhering to the idea of going out and bringing in can we better combine internationally advanced plastic surgery technology with local practice.

What technological innovations do you have in the field of plastic surgery?

As a core member of the Nanfang Hospital Adipose Medical Team, I have participated in the innovative inventions of many fat transplantation processing technologies, including fat gel preparation technology, frozen fat technology, and component fat transplantation technology.

How do these technological innovations impact clinical treatment and the recovery of patients seeking aesthetic procedures? These technologies greatly increase the effect of fat transplantation, not only improving the retention rate of fat transplantation but also reducing the risk of overfilling, reducing postoperative swelling, speeding up postoperative recovery, and reducing the risk of swell-up. In addition, fat cryopreservation technology can greatly improve the tolerance rate of fat transplantation and save patients from the pain of secondary liposuction.

How do you apply fat grafting facial filling techniques to create youthful skin and how do you use them in facial contouring?

Fat transplantation technology is based on component fat transplantation and fat cryopreservation technology. Component fat transplantation refers to the physical treatment of fat to obtain fat products of different components. Some of them are rich in fibrous tissue, have high support force, and are suitable for deep support; some are soft and ductile, suitable for superficial filling. Through component fat technology, we optimise the properties of fat tissue as a filler, thereby improving the long-term effect and early recovery of fat transplantation.

What are your views on the current trends in the medical aesthetics industry, especially in facial rejuvenation and fat transplantation?

I think the domestic medical beauty market will become more and more diversified, including diversified demands, products, and concepts. As a plastic surgeon in a public hospital, my responsibility in the medical aesthetic industry is to make the industry standardised, scientific, and evidence-based. At present, the industry is booming in China, and more and more technologies and products are being launched in the market. Doctors in private hospitals can contact and use the latest products and technologies when available, which is something that doctors in public hospitals cannot always do. However, our advantage should be the dialectical and evidence-based thinking of medical technology. For the implementation and promotion of any new product, we should rigorously and objectively evaluate the efficacy and provide feedback to customers, patients, manufacturers and the market to guide the survival

of the best products.

What are your plans for the future? How do you intend to continue contributing to the field of medical aesthetics?

Taking into account both scientific research and clinical work, solving clinical needs and clinical problems through scientific research and evidence-based data is what I think a public hospital doctor should do for the aesthetic medical market. I hope to make greater breakthroughs in academic research, solve some scientific problems in skin and soft tissue regeneration, and help our medical beauty field to have new product directions. I also hope that my clinical technology will continue to improve in future work and provide better treatment effects for those seeking aesthetic treatments.

AMWC Facial Rejuvenation Case Competition Winner: Dr Zhulin Xue

Clinical Doctor and Postdoctoral Fellow in Orthognathic Surgery at Peking University School and Hospital of Stomatology

Dr Zhulin Xue, can you tell us about your professional background and main research direction?

I am a clinical doctor and Postdoctoral Fellow in Orthognathic Surgery at Peking University School and Hospital of Stomatology. My main research directions are clinical research on orthognathic surgery for dentofacial deformities, digital surgical techniques, and basic and clinical research related to bone biology.

How do you perceive the role of oral and maxillofacial surgery in facial rejuvenation?

On the one hand, oral and maxillofacial surgery, especially orthognathic surgery, is an important treatment method that can effectively achieve facial rejuvenation; on the other hand, facial rejuvenation is also an important concept that maxillofacial surgeons need to follow in their clinical aesthetic diagnosis and treatment work.

What was your initial motivation for participating in the inaugural AMWC Facial Rejuvenation Case Competition?

For patients with severe dentofacial deformities, in addition to treating their jaw deformities through orthognathic surgery, it is also necessary to collaborate with plastic surgeons and cleft lip and palate specialists to complete treatments such as fat transplantation and nasolabial shaping.

Dr. Zhulin Xue

As most professionals in the field of facial rejuvenation are plastic surgeons or dermatologists, as a doctor in orthognathic surgery, I hope to share and exchange some of our team’s related work with industry experts and receive guidance; on the other hand, we also hope to learn more new treatment concepts from different perspectives through the competition to better carry out clinical work in the future.

During the preparation process for the competition, what do you consider to be your biggest challenge, and how did you overcome it?

The challenge may also lie in the professional concepts, as most of the participating cases use injection, optoelectronics, or medication to achieve facial rejuvenation. It is uncertain whether the concept of orthognathic surgery to enhance facial rejuvenation for patients can be recognised. However, from another perspective, this is also a completely new perspective, and I hope to communicate with colleagues.

Could you introduce your award-winning facial rejuvenation case? What innovations does it feature?

The case is entitled: ‘Bone Anti-ageing: Facial Rejuvenation Orthognathic Surgery Treatment for Patients with Skeletal Class III Malocclusions.’ In this case, we increased the bone volume and support in the midface during orthognathic surgery to counteract the congenital maxillary deficiency and the reduction in bone volume caused by surgery, ultimately achieving the ‘bone anti-ageing’ treatment strategy of improving soft tissue and facial rejuvenation. This effectively solved the aesthetic problem of ‘facial ageing’ in patients with skeletal class III malocclusion after surgery and achieved a youthful treatment effect.

What technical or conceptual challenges did you encounter during the implementation of the case?

We have integrated the concept of injecting MD codes in the field of medical aesthetics into orthognathic surgery treatment, and our cases and subsequent clinical studies have shown that

patients have achieved satisfactory treatment outcomes.

How do you view the integration of oral and maxillofacial surgery technology with facial rejuvenation technology?

I believe that the integration of multiple technologies is a clinical trend, with the ultimate goal of providing better treatment and prognosis for patients. With the gradual increase in public demand for facial aesthetics, whether for patients in maxillofacial surgery, orthognathic surgery, or medical aesthetics, doctors need to integrate multiple technologies to meet the needs of patients. Integrating oral and maxillofacial surgery techniques with facial rejuvenation techniques will be beneficial for patients.

What interdisciplinary collaboration experiences have you had in your career?

For patients with severe dentofacial deformities, in addition to treating their jaw deformities through orthognathic surgery, it is also necessary to collaborate with plastic surgeons and cleft lip and palate specialists to complete treatments such as fat transplantation and nasolabial shaping. For patients with more complex craniofacial syndromes, such as Crouzon syndrome, Lefort III osteotomy combined with distraction osteogenesis is needed. Owing to the complexity of the overall condition of children, collaboration with multiple professional teams, such as neurosurgical, respiratory, and otolaryngology teams, is necessary. Through multidisciplinary consultation and collaboration, we can provide patients with more comprehensive and systematic treatment.

What are your thoughts on the future development trends of facial rejuvenation treatments?

The future development trend of facial rejuvenation treatment may revolve around technological innovation, personalised treatment, safety improvement, interdisciplinary integration, and other aspects to provide patients with safer, more effective, and personalised treatment plans.

How do you think facial rejuvenation technology will evolve in the future, especially in the field of oral and maxillofacial surgery?

The development trend of facial rejuvenation technology in the field of oral and maxillofacial surgery will be a combination of technological innovation and multidisciplinary cooperation. By introducing advanced technology and equipment and conducting relevant clinical research, the treatment effect and patient experience can be continuously improved. In the field of oral and maxillofacial surgery, it is also necessary to introduce new technologies to provide patients with minimally invasive, safe, and effective treatment plans.

What are your plans for your career? What specific research and career development goals do you have for the next 3 years?

In the future, I will continue to engage in clinical work on dentofacial deformities and perform more clinical and basic research related to bone anti-ageing and facial rejuvenation. In the next 3 years, multidisciplinary and multi-technology integrated treatment plans will be developed to provide patients with more comprehensive treatment plans in clinical practice.

How do you plan to continue contributing to the field of facial rejuvenation?

In the future, we will continue to study, practice, explore, and collaborate in the field of facial rejuvenation and conduct in-depth clinical and basic research. Technologically, interdisciplinary technology integration should be strengthened, treatment plans should be optimised through technological innovation, patient needs should be truly addressed, treatment effectiveness should be improved, clinical applications from patient feedback should be refined, and patient satisfaction should be increased.

For more information: amwcchina.com

MODERN HIGHQUALITY IMAGING: PICTURES WORTH MORE THAN A THOUSAND WORDS

Precision imaging is transforming aesthetic consultations. The Aura 3D Imaging System delivers consistent, high-quality visuals and AI-driven analysis, allowing practitioners to track subtle changes, enhance patient communication, and optimise treatment outcomes

IT'S BEEN SAID THAT A PICTURE IS WORTH A thousand words. In aesthetic medicine, images are worth much more in fact, they are everything. Even as the concepts of 'wellness' and integrative medicine sweep the landscape, aesthetic medicine is still about what people see and how they feel about it. As such, photography has always played a key role in aesthetic medicine. Plastic surgeon Maurizio Cavallini, MD, practices in Milan, Italy. 'The hope is that photographs provide an objective perception of the appearance before or after treatment, mostly for the purpose of comparison,' he said. 'It helps both the patient and doctor see what has changed. However, capturing consistent, high-quality images is not always easy, and failure to do so compromises their comparative value.'

The modern image-capturing system, of which there are several prominently known offerings, may provide a lot more, Dr. Cavallini added. 'With modern imaging, we can not only get more consistent high-quality photographs, software analysis may reveal aspects of the skin which provide valuable insight that we would not otherwise have, enhanced by artificial intelligence (AI) which is constantly evolving.'

An example of idealised next-generation precision imaging, the Aura 3D Imaging System (Aura Reality, Switzerland) provides powerful photographic imaging technology with versatile software analysis capabilities to the aesthetic practice. The sleek and portable device, launched in 2024, is reportedly very intuitive to operate despite the complexity of its capabilities, making it an asset

for aesthetic practices of any size. Clinicians can make better-informed decisions based on more accurate data and visualise the transformation on a variety of levels.

'Remarkably, many clinics use phone cameras to capture before and after images,' said plastic surgeon Fabrizio Vignoli, MD, CEO of Studio Vignoli in Bologna, Italy. 'This can capture detailed images, but at best will be inconsistent and of limited value compared to what one can experience with Aura.' Dr. Vignoli was involved and contributed to the development of Aura. 'In aesthetic medicine, so much is subjective. It's not like cardiology where you have specific objective diagnostic tools and tests which then provide specific treatment vectors one may choose from based on those assessments. Aura is designed to make analysis and assessment easy, rapid, and more objective in the aesthetic practice.'

Transforming aesthetic consultations with 3D imaging Aura, part of Hexagon, harnesses what's termed 'digital twin technology' to create photorealistic images of the face and neck so powerful that they reshape the consultation, providing a common frame of reference and understanding between clinician and patient at every stage of the process. Hexagon has been relying on this AI-enhanced technology for numerous industrial applications around the globe for decades. 'I've been unhappy with my ability to standardise photography in my practice for more than 10 years,' said aesthetic physician Jennifer Owens, BDS(Hons), MSc, founder of The Glow Clinic with offices in Dublin and Cork, Ireland. 'Aura's 3D imaging has simplified the tricky process of capturing consistent photography while simultaneously

With modern imaging, we can not only get more consistent high-quality photographs, software analysis may reveal aspects of the skin which provide valuable insight that we would not otherwise have, enhanced by artificial intelligence (AI) which is constantly evolving.

raising the bar for what's possible. With it, any of my staff can create a reliable 3D simulacrum of the patient quickly and easily, streamlining our consultations as well as making them dramatically more productive. The patient experience is also very comfortable and convenient because there is no helmet, box, or hood required. Aura's 13 digital cameras and integrated lighting do the heavy lifting.'

'Patients often come into the clinic with their own ideas for treatment in mind. This makes Aura invaluable for the consultation and diagnosis,' Dr. Cavallini explained. 'The high-quality images and software analysis can detect subtle imperfections due to the variability in skin condition over the face. It can highlight pigmentation and superficial vascular lesions (such as rosacea, superficial microvessels, or irregular erythema) as well as asymmetries and displacement of the fat pad due to volume loss. This provides us and the patient with better, more objective information leading to better evaluation and treatment planning, to give the patient what they really want based on the evidence. This level of objectivity is also essential for effective research.'

For plastic and reconstructive surgeon Isil Akgun Demir, MD (Istanbul, Turkey), her perspective on patient care has evolved considerably over the years, as she embraced nonsurgical options as well as surgical intervention, catapulting her practice beyond what she had originally envisioned. 'Aura's imaging capabilities have become an important part of this because it provides objective evidence that helps me educate patients, form an individualised treatment plan, and manage expectations,' she said. 'First, its elegant design captivates patients as they enter the room, fostering a welcoming atmosphere harmonised with the clinic's aesthetic. The intuitive operation and straightforward learning curve enable new users to adapt quickly, ensuring that the technology enhances rather than complicates patient interactions. As we move forward, patients appreciate witnessing their progress over time, which boosts their motivation for ongoing interventions. This is especially important when results manifest over time because it allows us to reveal aspects of progress and maintain patient enthusiasm.'

That sentiment was echoed by aesthetic physician Sophie Shotter, MBChB, BSc(Hons), MBCAM, who practices in London, UK. 'Energy-based treatments have become so effective over the last decade, but the tissue response isn't immediate,' she said. 'This makes the journey tougher on the patient because they often do not readily see an immediate difference. Aura helps to clearly elucidate what is

happening as patients come in for follow-up, maintaining their engagement and enthusiasm, which helps maximise patient satisfaction.'

Advanced skin analysis: a new level of precision

'The image quality and software analysis capabilities of Aura are exceptional,' Dr. Demir added. 'The ability to quantify treatment outcomes adds a gratifying dimension to the practitioner-patient relationship. With its scoring system, Aura provides crucial insights into the effectiveness of particular treatments, enabling timely modifications to treatment plans and meticulous data management. Additionally, Aura's capabilities extend beyond skin quality assessment; its volumetric and vectorial analysis makes it an incredibly versatile tool in daily practice. For regular neurotoxin patients, positive feedback from their social circles often serves as a powerful testament to treatment effectiveness. Demonstrating these changes through vector analyses and the reduced appearance of wrinkles allows for more professional and data-driven communication with patients.' Aura's capabilities are further enhanced by its seamless integration with common OS platforms such as

capability of the naked eye. 'This basic imaging is what we use most often because it gives the patient a look at their appearance at rest in ways one doesn't normally experience,' Dr. Owens explained. 'Whatever else we use will depend on the patient's needs and our treatment plan, choosing whatever will be most helpful for our continuing evaluation.' In addition, Aura will analyse angles, distances, and proportions using golden thirds and fifths ratios to help users craft customised treatment plans for each unique patient.

Aura is a valuable asset to any aesthetic practice because it elevates the standard of care in many ways, but is also extraordinarily easy to use.

Volumetric changes and vectors are assessed and can be tracked to reveal even subtler effects of treatment. Video recording captures facial expressions in situ to help monitor changes in facial dynamics and visualise the desired outcomes as they develop. The device can also compare before and after images—photorealistic digital twins to help manage expectations and highlight improvements. 'I find features such as the volume, vector, and video recording particularly helpful because they provide easy to understand visual evidence of things that are otherwise difficult to explain,' Dr. Shotter said. 'These are invaluable for injectables patients.' Moreover, a drawing function allows practitioners to mark up and highlight for emphasis as needed during consultation and treatment planning.

Boosting ROI and patient satisfaction through imaging

According to Dr. Owens, Aura can arguably improve ROI for every treatment in the clinic. 'We don't charge for the use of Aura separately from the consultation,' she stated, 'because the real return comes from engaged patients who are more likely to accept treatment planning, enthusiastic throughout the process, and satisfied at the end. In my experience, they are also more likely to seek additional treatments and give us valuable word-of-mouth advertising, which attracts their friends and family to the practice.'

Windows, MacOS or iOS, with straightforward transfer of digital information for easy EMR storage and retrieval. Perhaps prime among its software capabilities is advanced skin analysis made possible through 3D visualisation, which starkly reveals discolouration, fine lines and wrinkles, texture, scoring, and pores beyond the

The place of Aura in Dr. Shotter's clinic encapsulates the power of imaging in the aesthetic practice. 'Aura is a valuable asset to any aesthetic practice because it elevates the standard of care in many ways, but is also extraordinarily easy to use,' she explained. 'We can take the device between treatment rooms and use on any patient at any time, giving us better images that benefit the patient and the physician before and after treatment. These images can be analysed to reveal additional information not available to even a well-trained naked eye. So armed, every consultation is a direct and informed interaction, for more efficient communication and better decision-making. The images and information provide the proof that helps us manage expectations but also drive patient satisfaction. We use it with all our patients.'

Written by Kevin Wilson, contributing editor

Figure 1 Before and after treatment volume analysis using the Aura system. Photos courtesy of Dr. Cavallini

Figure 2 Before and after treatment measurement of landmark distances using the Aura system. Photos courtesy of Dr. Vignoli

Figure 3 A 60-year-old woman is exploring non-surgical options for facial rejuvenation. She underwent laser treatments paired with regenerative therapies. Having responded positively to the treatment, she finds encouragement in the results documented through the Aura system, motivating her to proceed with additional sessions. Photos courtesy of Dr Demir

Lead the future of aesthetic medicine with AURA - 3D facial analysis technology

By seamlessly combining awardwinning hardware with intuitive software, Aura transforms 3D facial analysis into a visual, collaborative experience. With a single capture, it generates a photo-realistic digital twin of a patient’s face and neck, empowering dermatologists, plastic surgeons, and aesthetic clinicians with the clarity they need to analyze, plan, dermatologists, plastic surgeons, and aesthetic clinicians with the clarity they need to analyze, plan,and communicate with confidence. Find

FIVE KEYS TO AESTHETIC SUCCESS IN A

GLP-1 AGONIST AGE

As the popularity of GLP-1 agonists for weight loss surges, we explore strategies for providers to successfully integrate these medications into their services, address potential side effects, and enhance overall aesthetic outcomes through complementary treatments

AESTHETIC PRACTICES WORLDWIDE

have likely encountered people on or asking about glucagon-like peptide-1 (GLP-1) agonists, such as exenatide, liraglutide, dulaglutide, semaglutide and tirzepatide.

Increasing research, popular news stories and social media have elevated these medicines to mighty multitaskers, capable of helping people shed pounds, reduce cardiovascular risks, control glucose, and so much more. But while these medications could offer health in a pill, like most drugs, they have side effects, sometimes no efficacy, and might do more harm than good for those who take them.

Recent research1 examining the drugs’ benefits and risks found: 'Compared to usual care, GLP-1RA use was associated with a reduced risk of substance use and psychotic disorders, seizures, neurocognitive disorders (including Alzheimer’s disease and dementia), coagulation disorders, cardiometabolic disorders, infectious illnesses and several respiratory conditions. There was an increased risk of gastrointestinal disorders, hypotension, syncope, arthritic disorders, nephrolithiasis, interstitial nephritis and drug-induced pancreatitis associated with GLP-1RA use compared to usual care.'

Weight loss wins

Johnny Franco, MD, a plastic surgeon in Austin, Texas, US, knows the power of GLP-1 agonists personally and professionally. He started taking the medicine in 2022 and lost 90 pounds in the first year. He has since stabilised but chooses to stay on the medicine, potentially for heart health benefits.

After experiencing what GLP-1 agonists could do for him, Dr Franco started offering the medicines to patients and, today, he sees about 1,500 weight loss patients a month at his plastic surgery practice.

Key to success #1: Commit

'You really have to make a decision that this is going to be part of your practice, and you are going to be involved in it,' Dr Franco told PRIME. Knowledge about the benefits and drawbacks of GLP-1 agonists is in its infancy. Aesthetic practices need a physician champion or other provider who understands the data, available medications and investigational drugs, as well as how to safely and optimally help patients along their weight loss journeys, according to Dr Franco.

Patients also have to commit, planning to be on the medication for at least 6 months, according to Dr. Franco. Additionally, experts say this is not for the patient who wants to be on a GLP-1 agonist to lose a quick five or ten pounds.

'The medication has been so impactful because it can actually change an individual’s relationship with food. It has for me, personally,' Dr Franco said.

Key to success #2: Learn best practices

Sometimes it is better for patients when providers don’t adhere to GLP-1 agonist manufacturers’ dosing regimens, according to Dr Franco.

'Now we realise that we don’t necessarily need to keep pushing people up on dosage just because they hit a timeframe,' he said. 'This is where we have seen a lot of patients being sick, having nausea. Like most medications, we just want to get them to an effective dose.'

Some believe that patients have to be sick with side effects for the drugs to be effective. That is simply not true, according to Dr. Franco. Rather, patients experiencing side effects might be in the small percentage of people who cannot tolerate GLP-1 agonists or might need a reduced dose adjustment, he said.

Key to success #3: Prepare for an uptick in demand for core services

When used for weight loss, GLP-1 agonists, like Wegovy (semaglutide, Novo Nordisk), can result in undesirable aesthetic effects, such as facial volume depletion and skin laxity. Because of this, they are typically combined with treatments like dermal fillers and body contouring procedures (such as cryolipolysis, high-intensity focused ultrasound (HIFU), and radiofrequency (RF)) to address these concerns and optimise overall aesthetic outcomes, according to Diala Haykal, MD, a cosmetic doctor and laser expert in private practice at the Centre Laser Palaiseau, Palaiseau, France.

'A commonly favoured approach is to pair dermal fillers (hyaluronic acid, poly-l-lactic acid (PLLA)) for volume restoration with energy-based devices … like RF or HIFU for skin tightening. This combination addresses both volume loss and skin laxity, which are significant post-weight loss concerns, providing patients with a more comprehensive and long-lasting rejuvenation,' said Dr. Haykal, author of the recent paper, The Role of GLP-1 Agonists in Esthetic Medicine: Exploring the Impact of Semaglutide on Body Contouring and Skin Health

Aesthetic practitioners should be aware of these changes and anticipate the need for comprehensive interventions to address facial and body concerns. Monitoring psychological impacts, such as body image dissatisfaction or emotional distress, is important, Dr Haykal noted.

Nearly half of the members of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) reported a noticeable rise in patients seeking procedures to mitigate the cosmetic effects of these medications, according to the AAFPRS 2024 Annual Trends Survey2 .

Demand for Dr Franco’s core services, including surgical and nonsurgical options, has risen thanks to GLP-1 agonists.

'It has changed our practice. We see so many more excisional surgeries than we did before and in very young patients,' he said. 'Facelifts have gone up, circumferential body lifts, thigh lifts.'

When used for weight loss, GLP-1 agonists, like Wegovy, can result in undesirable aesthetic effects, such as facial volume depletion and skin laxity. Because of this, they are typically combined with treatments like dermal fillers and body contouring procedures to address these concerns and optimise overall aesthetic outcomes.

JOHNNY FRANCO, MD, plastic surgeon, Austin, Tex., USA; DIALA HAYKAL, MD, cosmetic doctor and laser expert, Palaiseau, France; PATRICK BYRNE, MD, MBA , facial plastic and reconstructive surgeon and president of AAFPRS, Washington DC, USA; JENNIFER LEVINE, MD, facial plastic surgeon, NY, USA

Key to success #4: Beware, GLP-1 agonists are associated with suboptimal outcomes

Timing is crucial in optimising aesthetic outcomes for patients taking GLP-1s. Many recommend that providers begin nonsurgical treatments, like dermal fillers and RF, after weight loss stabilisation ideally once the weight is maintained for 3 to 6 months, Dr Haykal told PRIME

Italian plastic surgeons authored a paper3 of two case reports that showed delayed wound healing and fat necrosis in patients undergoing breast surgery while

'Injectables such as dermal fillers should be performed once the patient’s weight is stable, but in some cases, early intervention may help reduce complications. Using biostimulatory agents (like calcium hydroxylapatite (CaHA) or PLLA) could be started in the earlier phases of weight loss to help stimulate collagen production,' Dr Haykal said. 'Body contouring procedures like cryolipolysis or HIFU may be initiated when the patient has achieved a significant portion of their weight loss but before the skin has begun to sag severely. Timing these procedures around the weight loss phase helps prevent further skin laxity.'

Patrick Byrne, MD, MBA, facial plastic and reconstructive surgeon and president of AAFPRS, told on his experience, both significant weight gain and significant weight loss can negatively impact the long-term results of facelifting and neck lifting procedures.

'Small weight fluctuations don’t typically make much of a difference, but when patients gain or lose more than 10 to 15 pounds, an initially excellent surgical result may start to lose some of its effect over time,' Dr Byrne said. 'For any facial fat grafting procedures, I would be cautious about performing them on patients still actively losing weight, as their facial fat distribution is still changing. Similarly, minimally invasive skintightening treatments may not provide the desired long-term results if significant weight loss continues.'

Plastic and cosmetic surgeons should also be aware of surgical complications that can arise in patients taking weight loss medications. Italian plastic surgeons authored a paper delayed wound healing and fat necrosis in patients undergoing breast surgery while receiving GLP-1 receptor agonists for weight management. These complications, they wrote, had not been previously described in the literature.

New York City-based facial plastic surgeon Jennifer Levine, MD, said cosmetic surgery plays an important role in the effective treatment of skin laxity.

'Whether patients are having general anaesthesia or even sedation, the risk of aspiration can increase on the medication, which is why we have the patient stop the medication [2 to 4 weeks] before the surgery,' said Dr Levine, adding she keeps many off the medication for 6 weeks post-op.

also occur in nonsurgical patients who are nutritionally deficient.

Key to success #5: Look holistically to achieve the best outcomes

Dr Haykal and coauthors wrote that a holistic approach addressing physical and psychological outcomes is critical to ensuring patient satisfaction and long-term well-being.

Physical exercise, particularly weightlifting, can play a significant role in improving muscle tone and skin elasticity, especially when combined with weight loss medications like GLP-1 agonists. Weightlifting helps build muscle mass, which can prevent excessive sagging of the skin, especially in areas like the arms, abdomen, and thighs, according to Dr Haykal.

'Nutritional support is equally important, focusing on protein-rich foods to support muscle maintenance and collagen production (which can be supported by supplements like vitamin C, amino acids, and omega-3 fatty acids). Offering advice on micronutrition and the role of supplements can complement aesthetic interventions, particularly when considering the accelerated ageing process due to rapid weight loss,' Dr Haykal

Dr Levine added that the goal is for patients to be

'We have the Inbody scan in our office that lets you know how much fat you have, muscle distribution and how much visceral fat. We monitor that on a monthly basis. If the patient is losing muscle, we take steps to make sure they maintain their muscle mass,' Dr Levine said.

For patients who might not lift enough weight to improve muscle mass, Dr Levine offers treatment with the Emsculpt NEO (Body By BTL), which can help them maintain muscle

In the big picture of aesthetic medicine, these drugs are a useful tool that work effectively. But they’re not for every

'You have to be judicious in your use of GLP-1 agonists in practice, and you have to use them responsibly,' Dr Levine

Lisette Hilton, contributing editor

References

More research needs to be done to determine whether poor healing in some surgical patients is a direct result of the medication or because patients on the medication can become nutritionally depleted.

Dr Levine reasoned that suboptimal outcomes might

1. Xie, Y., Choi, T. & Al-Aly, Z. Mapping the effectiveness and risks of GLP-1 receptor agonists. Nat Med (2025). https://doi. org/10.1038/s41591-024-03412-w 2. AAFPRS REVEALS NEW STATISTICS AND

TRENDS IN FACIAL PLASTIC SURGERY. February 4, 2025. available at: https://www.aafprs.org/ Media/Press_Releases/2024_Annual_Trends_ Survey.aspx 3. Taraschi, F., Salgarello, M. GLP-1 Agonists in Plastic Surgery: Impact on Aesthetic Outcomes—Two Case Reports. Aesth Plast Surg (2025). https://doi.org/10.1007/ s00266-025-04703-4

INTRODUCING AUGMENTED ENDERMOLOGIE® BY LPG®

This global player in aesthetics has been taking health, beauty, and wellness seriously since 1986

THIS UNIQUELY DIVERSE COMPANY WAS originally founded in 1986 as a medical brand to treat cervical pain. It was only later that LPG® developed non-invasive treatment solutions for the body and face and thus became a coveted beauty brand. In a global market that consistently turns out whatever is new, the rich history of LPG® stands apart. The company takes pride in never deviating from its original core values that have stood the test of time.

'Since the first Cellu M6® was launched in France over 39 years ago, LPG® has continued to innovate the brand. Our aim has been to strengthen our leadership position in the fast-paced non-invasive health and beauty market,' says Thierry Gée, LPG® Group CEO. 'Our newest innovation, Cellu M6 Infinity®, is a true successor to the 10 generations that have preceded it.'

LPG's newest 'jewel in the crown'

The next innovation that hails from LPG® scientists, engineers, and their board of physicians is the Cellu M6 Infinity®, their newest system.

Among the innovative benefits, this state-of-the-art system targets the connective tissues of the body and face, including skin, muscle, fascia, blood, and lymphatic circulation. The Cellu M6 Infinity® advances deep tissue mobilisation for a wide range of beauty, wellness, and

WENDY LEWIS is Founder/ President of Wendy Lewis & Co Ltd, Global Aesthetics Consultancy since 1997, author of 13 books, and frequent presenter on the international stage. Her first textbook, Aesthetic Clinic Marketing in the Digital Age (CRC Press) debuted a second edition in 2024.

email: wl@wendylewisco.com

aesthetic applications.

According to Christian Gagnière, Vice President Medical & Scientific, 'Our state-of-the-art technology works in tandem to address the modern needs of providers across all specialties, from plastic surgeons, dermatologists, and cosmetic doctors, to spas, nurses, physiotherapists, aestheticians, trainers, and more.'

'By stimulating the skin to reactivate dormant cellular activity, endermologie® treatments offer a wide range of medical, beauty, and wellness benefits,' he says. 'We are taking a consumer-centric approach while working closely with our partners to develop a range of head-to-toe therapies using mechanical stimulation for those seeking a functional holistic approach.'

The Cellu M6 Infinity® system focuses on uniquely versatile medical and aesthetic indications. These include scars, lymphatic drainage, oedema, burns, body sculpting, cellulite reduction, and age-defying therapies.

'This versatile system combines LPG®'s most important elements from their heritage while further enhancing its unique capabilities,' says Gagnière.

The Infinity 80 IW™ smart treatment head is a groundbreaking innovation, uniting four patents for the first time. The remarkable power unlocks the potential of cellular communication, maximising results like never before.

'LPG® has always been dedicated to supporting women

and men in their pursuit of well-being through innovative health, beauty and wellness solutions. We pride ourselves on strengthening the trust we have with our clients that has been built on "proven efficiency" over many years,' says Lydie Hayek-Rocque, Vice President of Marketing, Digital & Training.

'Our global team prides ourselves on delivering on our promise of faster, more visible, and longer-lasting results for patients, that are safe and effective. Cellu M6 Infinity® takes our technology to the next level,' she says.

Ultra advanced R&D

Cellu M6 Infinity® takes a pioneering leap as a leading authority in cutting-edge engineering, with seven exclusive patents, including four dedicated to the Smart Head (body), optimising precision and effectiveness, and three focused on advanced pneumatic control and algorithms, ensuring greater adaptability and treatment personalisation.

These patents represent the evolution of LPG®'s expertise, culminating in the next generation of innovation: augmented endermologie®.

This breakthrough is built upon three core pillars.

Augmented efficacy

'The new treatment head for Infinity 80 IW™ represents the pinnacle of ultra-advanced R&D engineering. Featuring triple motorisation and innovative tissue mobilisation modes, the Infinity 80 IW™ delivers unparalleled tissue maneuvers, offering advanced multidimensional cellular stimulation,' says Yegor Domanov, Vice President of Innovation, Research & Development.

'This enables the operator to target connective tissue from the most superficial layers to the deepest, delivering even more precise and visible aesthetic and therapeutic results. Intelligent, ergonomic and more compact, the new body treatment head tracks movements in real-time. An advanced calculation algorithm analyses the type of tissue being treated, guiding the practitioner's hand with exceptional precision and ensures immediate results,' according to Domanov.

Augmented wellness

The patented 30Hz vibrations delivered through Cellu M6 Infinity® combine with stimulation modes for an enhanced wellness experience.

With a focus on wellness integrated into each LPG®

Optimal results following Cellu M6 Infinity® treatments

● -5.8 cm waistline circumference*

● 93% smoothed cellulite**

● 92% firmer skin**

● -50% heavy legs*

*Study BeScored 2024: measured loss of waist circumference of up to 5.8 cm after 12 sessions and a 50% reduction in the sensation of heavy legs from the very first session.

** Study BeScored 2024: after 12 sessions, 93% of women noticed a smoother orange-peel skin appearance, while 92% reported improved skin firmness.

LYDIE HAYEK-ROCQUE VP Marketing, Digital & Training

THIERRY GEE LPG® Group CEO

CHRISTIAN GAGNIERE VP Medical & Scientific YEGOR DOMANOV VP Innovation, Research & Development

Wellness benefits of endermologie® treatments

● Boosted vitality: +9.4% of T lymphocytes, boosting natural defences

● Reduced stress and anxiety: -50.9%

● Enhanced relaxation: -44.6% cortisol

● Improved quality of sleep: -54.7% sleepless nights

● Muscle pain relief: -69%

Source: Impact of an LPG Cellu M6 Alliance® multi-session programme. Effect on cognitive performance, sleep quality, stress levels and immunity in stressed individuals. Prof. Christophe Hausswirth, PhD; Dr. Alexandre Coste, PhD; Dr. Vincent Raimondi, MD, PhD; Dr. Cyril Schmit, PhD; Dr. Anis Aloulou, PhD; Dr. François Duforez, MD; Nathalie Paradis and Pr. Damien Léger, MD, PhD

Practitioners of many specialties around the world recommend LPG® technology for their clients and patients

According to Dermatologist Michael Gold, MD, Gold Center, Nashville, TN, 'Having experience with the original LPG® brand in the early days, we have been very impressed with the novel LPG® technology of today. The new systems have the advantage of offering patients aesthetic treatments as well as addressing therapeutic indications to improve their overall health and well-being. They are easy to delegate to staff and the treatments are very affordable for patients in medical practices as well as spas, so they keep coming back.'

Guendalina Gennari in the UK, deemed by the Financial Times to be one of the world's super-facialists, offers LPG® treatments to her upscale clients. 'The beauty of LPG® is that the treatment is very adaptable, so depending on what the client needs on the day are, we can target more drainage or cellulite or just relaxation. It's an incredible machine that can target every single need for every single client! I always tell my clients that the journey with LPG® is a commitment, you can't just do it once and hope for the best results. It has to be part of your lifestyle, if you have the treatment once a week, you're going to see incredible results! Seriously, it is the ONE thing everyone needs because it does miracles!'

Claire Adeline, physiotherapist and founder of La Clinique du Monde in France, specialises in advanced treatments to improve the well-being of her clients. 'We have found the Cellu M6® from LPG® to be a remarkable system. We have been using their systems for many years, and our clients return for more treatments because they see what we can achieve. The new Cellu M6 Infinity® is a revelation. The results from two sessions with this technology are even better than with the earlier generations.'

endermologie® Skincare

By popular demand, LPG® created a unique range of elegant skincare to complement their clients' professional treatments in their own homes.  This proprietary range was developed to complement endermologie® sessions by enhancing the client's experience. The main benefit they have found with this unique skincare range is that clients are seeing dramatic results and 50% faster when combined with LPG® treatments. It's a win-win.*

*At the time of publication of this article, the LPG® skincare range is not sold in the USA.

signature protocol, the scientists at LPG® have proven that the technology can work to reduce cortisol, enhance immunity and improve sleep quality.

Stress, anxiety, and fatigue have been found to have a direct impact on our physical and mental health. In fact, over 90% of the population is affected by stress, which can result in anxiety, fatigue, depression, and insomnia. It can also affect our immune system, which can make us more vulnerable to health issues.

'Chronic stress may persist for weeks, months, or longer if not addressed. Long-term symptoms of stress have been shown to cause wear and tear on the body that may not resolve without therapy. Finding ways to relieve some of your daily stress can help [you] feel better and get the rest you need for your body and your mind,' says Christian Gagnière.

Body enderrmologie® treatment with Cellu M6 Infinity®

Cellu M6 Infinity® now features a fully redesigned and modernised software interface, transforming health and beauty professionals into personalised coaches.

LPG® teams at VALENCE (France, Drôme) World headquarters

'This is why we invested in an important clinical study about the benefits of LPG®'s unique Vitality, Stress, and Sleep (VSS) treatment protocol by the French beScored Institute in conjunction with the European Sleep Center, the University of Sydney, and the Cerballiance laboratory. Our goal was to scientifically confirm the benefits of this 40-minute treatment protocol designed to improve quality of life through better physical, mental and emotional health and well-being,' he adds.

According to Professor Christophe Hausswirth, the trial's independent clinical research director, 'This is the first trial to conclusively prove that a series of mechanical massage treatments designed to target the lymphatic system can have such significant effects on so many aspects of mental health.'

Augmented experience

The Cellu M6 Infinity® is equipped with four new treatment heads, which combine motorised rolls and flaps with tissue grasping modes for improved ergonomics and ultimate treatment comfort.

Cellu M6 Infinity® now features a fully redesigned and modernised software interface, transforming health and beauty professionals into personalised coaches. Using the advanced endermolink™ application, providers can support their clients in achieving their individual goals, whether aesthetic, therapeutic, or related to their overall wellness.

The seven new clinical results

Following the success of the Vitality, Stress, Sleep clinically-trialled protocol, a treatment proven to have a life-changing impact on physical, mental, and emotional health and wellbeing LPG® has progressed with yet another cutting-edge, scientific study for the launch of Cellu M6 Infinity®.

The ultra-advanced efficiency of Cellu M6 Infinity® is supported by studies carried out by the beScored Institute, led by Prof. Christophe Hausswirth, evaluating extraordinary results after 12 sessions across seven target areas of concern:

■ Satiety: improved eating behaviour

» Study Results (average): Better Eating Behavior +15.4%. Leptin (the hormone that makes you feel full) +4.3%

■ Perfusion: improved nutrient and oxygen intake

» Study Results (in 1 session): Oxygen and Nutrients +14.7%

■ Heavy Legs: reduction of heavy leg sensation

» Study Results (In one session): Reduction of Heavy Legs Sensation -50%

■ Remanence: persistence of results

Key benefits of endermologie® treatments

● Deliver smoother, tighter, more youthful skin

● Body treatments: Address skin tone, reduce cellulite, release localised resistant fat

● Facial treatments: Target fine lines, wrinkles, brighten skin tone

● Multi-dimensional treatments for visibly improved skin quality

● Increased client loyalty and ROI

● Affordable series pricing to attract and keep new clients coming back

» Study Results (average): Maintained and improved results after 1 month

■ Slimming: body circumference reduction and improved silhouette

» Study Results (up to): Belly: -5.8cm, Hips: -4.4cm, Thighs: -2.4cm. Satisfaction 86%

■ Anti-cellulite: improved cellulite grade, reduction in sclerotic areas, and better blood circulation

» Study Results (average): Reduction 1 to 2 Grades. Satisfaction 93%

■ Firmness: increased derm density and improved body firmness

» Study Results (average): Knees: +5.3%, Buttocks: +14.1%, Belly: +8.9%, Thighs: +14%. Satisfaction 92%

The future of endermologie® looks bright

Thierry Gée, CEO of LPG® Group, shares his vision for where the iconic brand is going next.

'We are very proud of the uniqueness of LPG® and recognise the future potential of this novel and diverse technology with a rich history of over 39 years.'

'Our clients share how LPG® addresses numerous challenges for their patients. It is far more than just another beauty device like so many others on the market. It is not just another technology. This novel technology continues to offer unique therapeutic advances plus wellness-based treatments that to-date continue to keep clients coming back to the clinics to look good and feel great. LPG® remains committed to further exploring the benefits of all facets of wellness with our innovative technology.'

Their team of engineers in the south of France, with their medical team, are determined to keep expanding the range of solutions to meet and exceed the needs of their diverse clients. With their newest addition to the LPG® portfolio, Cellu M6 Infinity®, this global health and beauty brand offers another best-in-class system that ticks a lot of boxes for aesthetic practices, spas and medical spas.

For more information, visit LPG-Group.com

CELLULITE FROM PSYCHOLOGICAL TO CELLULAR BURDEN AND A NEW INJECTABLE SOLUTION

Dr Andreea Boca, MD, PhD, presents preliminary results of a trial to treat cellulite with SuneKOS Cell15 injectable MD Class III

ABSTRACT

Cellulite is a common condition affecting skin texture and appearance, with multifactorial causes, including mechanical, vascular, and inflammatory factors. Our study evaluates the efficacy of a novel regenerative injectable therapy targeting the root causes of cellulite: SuneKOS Cell15 (CE MD Class III).

Patients with moderate to severe cellulite underwent three treatment sessions with SuneKOS Cell15. Outcomes were assessed using standardised visual grading scales, objective measurements of skin elasticity and texture, and validated psychological well-being scales.

Preliminary findings demonstrate significant improvements in cellulite severity, with enhanced skin texture and elasticity observed through both clinical evaluation and imaging techniques. Psychological assessments indicate a positive impact on patient self-perception and quality of life.

Sunekos Cell15 shows promising potential as a comprehensive cellulite treatment by addressing its underlying causes.

CELLULITE IS A PRIMARILY AESTHETIC, CHRONIC SKIN CONDITION

rooted in a multifactorial etiopathogenesis: initially considered a mechanical consequence of prominent adipocytes, the worsening of cellulite following liposuction, as well as weight loss, speaks to a deeper, more complex interplay between causes and risk factors 1 .

Classically, risk factors for cellulite include gender, age, genetic predisposition, race, increased subcutaneous fat, diet, a sedentary lifestyle, pregnancy, postural disorders, and wearing tight clothes. Summing up, scientific literature reports an incidence of 85-98% of cellulite in women2, contrasting with a 2% incidence in men3

This is explained, in part, by architectural differences in predominant fat lobules and septa orientation, with women with cellulite presenting thick, perpendicular septa, which form channels as adipocyte volume increases, yielding the appearance of dimples and prominences. Men possess more septal connections in the superficial fatty layer, leading to less tension on each individual septa4

The vascular hypothesis of the development of cellulite explains the progression of cellulite to sclerotic lesions: following the alterations to the precapillary arteriolar sphincters, capillary permeability is increased, leading to fluid extravasation into interstitial spaces, manifesting in oedema and tissue hypoxia. In turn, this leads to thickening and sclerosis of the fibrotic septa5.

KEYWORDS

Cellulite, Sunekos Cell15, injectable

The third hypothesis posits the presence of low-grade septal inflammation, leading to dermal atrophy and endothelial damage, contributing to the progression of oedema, tissue hypoxia, and sclerosis of the septa5

After establishing the multifactorial nature of cellulite, it stands to reason that treating

DR ANDREEA BOCA, MD, PHD, Dermatologist, DEA Clinic, ClujNapoca, Romania

cellulite requires a multifactorial approach, from maintaining a healthy weight and consumption of unprocessed foods that alleviate systemic inflammation and glycation to targeted regenerative treatment to restore the hypoxic, fibrotic tissue locally. With an approach based on regeneration instead of lysis, Sunekos Cell15, a class III medical device registered with therapeutic indication, supports physiological tissue function by providing noncrosslinked hyaluronic acid, a patented cluster of amino acids and bicarbonate and carbonate salts, effectively mitigating local inflammation, restoring the components of the ECM and providing the building blocks of healthy, flexible septa. By supporting local homeostasis, SuneKOS Cell15 provides medical support to the management of a chronic, aesthetically visible condition.

The implications of cellulite

The significant incidence of cellulite among the female population hasn’t led to its normalisation and acceptance; on the contrary, this benign, usually painless condition is accompanied by profound negative psychosocial effects: from body dissatisfaction, distress, and anxiety, cellulite impacts the quality of life in a significant proportion of the 85–98% of the women who experience it.

A pilot study by Hexsel et al.6, delving into these psychosocial effects, states that around 78% of volunteers were embarrassed about their cellulite, with their fears being confirmed by receiving an embarrassing comment in 41% of cases. The beach seems to be a common stressor for patients experiencing cellulite, with 87% of them reporting feeling discomfort in this situation, and 76% considering outings to the beach a stressful situation. Only 4.3% of the volunteers in the study reported no discomfort regarding their cellulite.

After establishing the multifactorial nature of cellulite, it stands to reason that treating cellulite requires a multifactorial approach, from maintaining a healthy weight and consumption of unprocessed foods that alleviate systemic inflammation and glycation to targeted regenerative treatment to restore the hypoxic, fibrotic tissue locally.

This significant source of psychological distress is still coupled, in mainstream culture, to excess weight. This is why, out of the same study group, findings consistent with irregular eating habits were revealed: compulsive ingestion of food in 84.4% of volunteers, feelings of guilt around meals up to the point of inducing vomiting, and using weight-loss medication, regardless of having received medical advice for the use of this.

A glimpse into the methodology of our study

Our prospective, multicentric study was focused on female participants between 18–40 years of age, with cellulite grades 1 to early 4 on the Curri classification. The two centres involved in this study were located in Romania (Dr. Andreea Boca) and Italy (Dr. Elena Fasola). The injection schedule involved three injections of 1 unit (15 ml) of Sunekos Cell15 on targeted areas: gluteal, trochanteric, or thighs.

The efficiency and tolerability of the product were evaluated by way of standardised photographs, Likert pain scale and PR-CR-PCSS scale ratings, and the impact on quality of life was investigated using the OBC scale.

Follow-up appointments were scheduled at 3 months after the first injection (T0) and 6 months after T0.

Preliminary

results

On the GAIS scale, supported by PR-CR-PCSS, on the third visit (final injection), 22.7% of patients reported seeing improvement in their cellulite, 52.3% stated it was much improved, and 18.2% saw exceptional improvement. At 3 months, 30.9% of patients noticed improvement, with 38.1% reporting much improvement and 28.5% exceptional improvement. Some visual examples may be found in Figures 1-2

On the results of the Likert scale of tolerability, 31.8% of patients were satisfied with the treatment, and 43.1% were very satisfied at T3.

Psychological improvement

The psychological repercussions of this improvement in the appearance of cellulite were measured using the OBC questionnaire, which showed statistical improvement in all three areas investigated: surveillance, body shame, and control aspects (Figure 3A-C, respectively). While values in the surveillance and body shame aspects

References

1. Allam NM, Elshorbagy RT, Eid MM, Abdelbasset WK, Elkholi SM, Eladl HM. Comparison of Extracorporeal Shock Wave Therapy versus Manual Lymphatic Drainage on Cellulite after Liposuction: A Randomised Clinical Trial. Evid Based Complement Alternat Med. 2021 Aug 10;2021:9956879. doi: 10.1155/2021/9956879. PMID: 34422085; PMCID: PMC8371620.

2. Guirro E. C. O., Guirro R. R. J. Fisioterapiadermato-Funcional. 3rd. Barueri, Brazil: Revisada e Ampliada Barueri/SP Manole;

of the scale dropped acutely at 3 months after the first visit, values on the control scale exhibited a steady rise across visits, culminating at the 6-month follow-up.

This translates to our participants feeling less shame regarding their bodies, less obsessive-like thoughts and an increase in the sense of control of their own appearance, essentially empowering our participants in the belief that they can achieve their aesthetic goals while freeing up their minds from obsessive thoughts revolving around shame.

The informal feedback received from our patients during these studies, coincidentally, echoes the painpoints described in scientific literature: from feeling confident at the beach, to feeling empowered to post a bikini-selfie without searching for the right angle and seeing their favourite dress lay flat across their backs, without the dimpling of cellulite.

Conclusion

Sunekos Cell15 improved cellulite in objective and subjective metrics, thus proving its efficacy and safety.

Declaration of interest None

Figures 1–3 © Dr

2004. Fibro edema gelóide; pp. 347–389.

3. Gabriel A, Chan V, Caldarella M, Wayne T, O'Rorke E. Cellulite: Current Understanding and Treatment. Aesthet Surg J Open Forum. 2023 Jun 21;5:ojad050. doi: 10.1093/asjof/ojad050. PMID: 37424836; PMCID: PMC10324940.

4. de Matos Lourenço L, Colla LA, Ortiz de Noronha MG, Izzo TR, Sigrist R. Square technique-A treatment for cellulite with large size particle hyaluronic acid. Skin Health Dis. 2023 Sep 23;4(1):e290. doi: 10.1002/ski2.290. PMID: 38312247; PMCID: PMC10831568.

5. Gabriel A, Chan V, Caldarella M, Wayne T, O'Rorke E. Cellulite: Current Understanding and Treatment. Aesthet Surg J Open Forum. 2023 Jun 21;5:ojad050. doi: 10.1093/asjof/ojad050. PMID: 37424836; PMCID: PMC10324940.

6. Hexsel  D, Siega  C, Schilling-Souza  J, Stapenhorst  A, Rodrigues  TC, Brum  C. Assessment of psychological, psychiatric, and behavioral aspects of patients with cellulite: a pilot study. Surgical Cosmetic Dermatol. 2012;4(1):131–136.

Boca

Figure 1 Posterior incidence, (A) before treatment (B) versus 3 months after T0

Figure 2 Lateral semiprofile incidence, (A) before treatment (B) versus 3 months after T0

LUO, MD; YUAN DENG, MD; LIANGSEN ZHAO, MD; YONG LIAO, MD; Department of Medicine, Bloomage Biotechnology Corporation Limited, Beijing 100000, China

email: liaoyong8337@sina.cn

AQUALUNA AESTHETICS HORIZONTAL NECK WRINKLES SCALE: AN ASSESSMENT AND TREATMENT STRATEGY

Horizontal neck wrinkles, a key sign of ageing, can be effectively treated with advanced HA technologies and a layered approach, as outlined by the Aqualuna Aesthetics horizontal neck wrinkles scale

ABSTRACT

This article presents the Aqualuna Aesthetics horizontal neck wrinkles scale as an assessment and treatment strategy for horizontal neck wrinkles. The scale system classifies horizontal neck wrinkles into four levels based on severity, offering a combined method for evaluating this common sign of neck ageing by using both static and dynamic assessments. The treatment strategy uses two hyaluronic acid (HA)-based products from Aqualuna,

HORIZONTAL NECK WRINKLES ARE transverse lines that form on the neck due to a combination of endogenous and exogenous factors. Often regarded as a prominent sign of neck ageing, these wrinkles have garnered increasing attention in the field of medical aesthetics. They not only diminish the neck's visual appeal but also disrupt the aesthetic balance between the face and neck, potentially impacting the self-confidence and social interactions of the patients.

HA complex solutions and low cross-linked HA, tailored to the different levels. These treatments aim to restore skin hydration, stimulate collagen regeneration, and enhance neck skin quality, with strategies involving skin care products, energy devices, botulinum toxin, and thread lifting for severe cases. This approach provides a comprehensive, personalised strategy for the rejuvenation of horizontal neck wrinkles.

ageing across various neck layers, leading to the formation and exacerbation of horizontal neck wrinkles. The onset and severity of these wrinkles are highly individualised and characterised by complex mechanisms and diverse clinical presentations. These features pose significant challenges for standardising assessment methods and developing personalised and comprehensive treatment strategies3

Mechanisms of horizontal neck wrinkle formation

KEYWORDS

Horizontal neck wrinkles, Aqualuna

Aesthetics scale, hyaluronic acid, aesthetic treatment, neck rejuvenation

The underlying mechanisms of horizontal neck wrinkles involve multiple anatomical layers related to the encompassing skin ageing, structural changes in the superficial fascia, degenerative processes, and the dynamic function of the platysma1. Exogenous factors, such as ultraviolet radiation, contribute to the degradation of collagen fibres and the degeneration of elastin fibres2

Unhealthy lifestyle habits such as smoking, skincare habits, and certain neck movements further accelerate

The formation of horizontal neck wrinkles is a complex, progressive process driven by the interplay of pathological and biomechanical changes in the multi-layered anatomical structures of the neck. Neck skin is characterised by a relative scarcity of appendages, which also experiences a decline in fibroblast quantity and functionality during ageing. This results in reduced collagen synthesis and accelerated degradation4. The breakdown of dermal collagen fibres, alongside the degeneration of sun-exposed elastic fibres, induces degenerative changes in the

YUXIAOXIAO

Scale-based treatment for horizontal neck wrinkles has emerged as a notable focus in aesthetic medicine. The mechanisms underlying their formation are complex, and clinical presentations vary significantly.

Figure 1 Aqualuna Scale for horizontal neck wrinkles dermal extracellular matrix5. These changes lead to progressive skin laxity, rendering the skin increasingly vulnerable to deformation caused by biomechanical forces and gravity. Moreover, the non-synchronous ageing of the subcutaneous superficial fascia's fibrous septa and the redistribution of subcutaneous fat, along with the repeated dynamic tension exerted by the platysma contractions, are significant contributing factors6.

Figure 2 Comparative analysis of skin structure before and after treatment with Aqualuna HA composite solution. (Left column) Clinical images showing visible improvement in horizontal neck wrinkles before (top) and one month after treatment (bottom). (Right column) Ultrasound imaging captured using DermaLab (Cortex Technology, Hadsund, Denmark), demonstrating increased dermal thickness and enhanced collagen density post-treatment.

Research indicates that the development of horizontal neck wrinkles is closely linked to specific structural characteristics of the subcutaneous superficial fascia, particularly the fibrous septa and fat distribution in this region. The fibrous bundles in the superficial fascia not only allow for multi-directional activities of the neck but also generate mechanical tension to maintain the stability of the superficial fascia. These bundles are tightly connected to the dermal layer of the deeper platysma. In certain neck areas, the fibrous septa may thicken locally, forming short, robust fibrous bundles or 'pseudo-ligaments' that play a crucial role in limiting skin displacement and subcutaneous fat in the superficial fascia during ageing7. Repeated contractions of the platysma impose tension on the overlying subcutaneous

fat and skin, substantially contributing to the formation of dynamic neck wrinkles. The fibrous septa between the platysma and skin stabilise the neck during dynamic activities. However, with ageing and prolonged tension, these fibrous tissues undergo non-synchronous degenerative changes. The non-synchronous degeneration of these reinforced fibrous bundles, compared with other fibrous septa, leads to fat redistribution in the superficial fascia, further exacerbating neck wrinkles and grooves8. The interaction of these factors progressively manifests as the primary feature of neck ageing—horizontal neck wrinkles. Thus, the formation of horizontal neck wrinkles is not solely attributed to skin ageing but is intricately linked to alterations in the subcutaneous structural and functional tissues of the neck, offering valuable insights for future research on its pathophysiological mechanisms and the development of targeted assessment and therapeutic strategies9.

Background for developing the Aqualuna Aesthetics horizontal neck wrinkles scale

Scale-based treatment for horizontal neck wrinkles has emerged as a notable focus in aesthetic medicine. The mechanisms underlying their formation are complex, and clinical presentations vary significantly. Multiple factors contribute to the development of horizontal neck wrinkles, including intrinsic ageing, ultraviolet (UV) radiation, gravitational forces, repetitive multi-directional activities, and environmental and lifestyle factors. The multi-layered structure of the neck is affected by the interaction of these factors, leading to pathological and physiological changes in the related tissues, ultimately contributing to the gradual onset and progression of horizontal neck wrinkles. Therefore, a standardised evaluation method that incorporates both dynamic and static assessments

alongside personalised treatment strategies is urgently required. The primary objective of this protocol is to establish a scientifically based assessment and treatment pathway by developing individualised, graded treatment plans rooted in the pathogenesis of horizontal neck wrinkles, integrating both dynamic and static evaluation.

Aqualuna, under Bloomage Biotechnology Corporation Limited, includes two products for treating static wrinkles: low cross-linking HA (micro-particle size HA) and HA composite solutions. These products, with their complementary and differentiated properties, offer distinct clinical advantages in the aesthetic scale-based treatment of horizontal neck wrinkles. The HA composite solution (containing sodium hyaluronate at 12 mg/mL with small, medium, and large molecular weight components, and amino acids glycine, proline, leucine, and lysine at 1.8 mg/mL) is produced using the MoPA self-crosslinking technique. This solution exhibits specific viscosity and incorporates the four amino acids into the hyaluronic acid molecule, providing hydration, antiinflammatory, and nutritional effects that rejuvenate the extracellular matrix (ECM) structure and function, thus improving wrinkles. Low cross-linking HA (0.6% BDDE, sodium hyaluronate at 12 mg/mL, lidocaine hydrochloride at 3.0 mg/ mL, with a particle size of approximately 200 μm) offers mild supporting properties and moderate duration of effect, compared to traditional non-crosslinked and high cross-linked HA products. It is suitable for micro-filling and supporting static wrinkles while also promoting local collagen regeneration and ECM rejuvenation by altering local biomechanical forces. The combined use of low cross-linking HA and HA composite solution enables an individualised layering treatment strategy for varying severities of horizontal neck wrinkles, achieving comprehensive and lasting improvements. According to the authors, based on their differentiated product characteristics, the combination of

Table 1 Pre-evaluation preparation

ITEM

Environmental Conditions

Patient Preparation

Recording Equipment

REQUIREMENTS

Single light source, avoiding reflections; background should be a solid colour (preferably black or grey).

Cleanse the neck area, remove makeup, and ensure collarless clothing to expose neck lines fully.

High-definition recording equipment (resolution≥1080p), standardised angle measurement tools

Table 2 Standard evaluation process

STEP OPERATIONAL REQUIREMENTS

Position Setting

Evaluation Content

Dynamic Evaluation

Capture images from three standardised angles: natural gaze (0°), 45° upward tilt, and extreme upward tilt.

Evaluate the visibility, quantity, depth, and width of horizontal neck wrinkles, documenting findings through imaging and standardised evaluation forms.

Observe changes in horizontal neck wrinkles during dynamic neck extension at different angles.

Aqualuna products provides an effective and safe foundational treatment for horizontal neck wrinkles. When combined with other aesthetic treatments, this multi-layered, multi-target approach significantly enhances efficacy and patient satisfaction.

Aqualuna Aesthetics horizontal neck wrinkles scale

The assessment and treatment strategy combines static and dynamic evaluations for optimising therapeutic outcomes3.

SCALE MANIFESTATION FEATURES

Scale 0 (Normal)

Scale 1 (Mild)

Scale 2 (Moderate)

Scale 3 (Severe)

Scale 4 (Extremely Severe)

No horizontal neck wrinkle is visible at any angle

Mild: Superficial horizontal neck wrinkles visible only at 0°; completely improved at 45° head tilt.

Moderate: Visible horizontal neck wrinkles at 0°; partially improved at 45° head tilt; completely improved at extreme head tilt.

Severe: Deep horizontal neck wrinkles visible at 0°; no significant improvement at 45° head tilt; partially improved at extreme head tilt.

Extremely severe: Visible horizontal neck wrinkles at all angles; no significant improvement in dynamic evaluation, with obvious laxity and abnormal fat distribution.

OBSERVATION ANGLES

0°

0° , 45°

0°, 45°, Extreme angle

0°, 45°, Extreme angle

All angles

ANATOMICAL CHARACTERISTICS

The structure and function of skin collagen and elastic fibres are intact. The superficial fascial structure is stable, with fibres linking the skin to the platysma muscle, ensuring proper fat distribution. The platysma muscle maintains uniform static tension, showing no signs of ageing.

Mild skin degenerative changes in collagen and elastic fibres, accompanied by slight skin laxity and ageing. The superficial fascial structure remains stable, and the platysma muscle retains uniform static tension. Wrinkles can completely improve with neck extension, resulting from passive stretching of the platysma.

Moderate skin degenerative changes in collagen and elastic fibres, along with moderate skin laxity and ageing. Mild degenerative changes in the superficial fascia and some loosening of the fibrous septa. The platysma muscle maintains uniform static tension. Wrinkles can completely improve at extreme neck extension.

Severe skin degenerative changes in collagen and elastic fibres, along with significant skin laxity and ageing. Moderate degenerative changes in the superficial fascia, with asynchronous loosening of the fibrous septa and fibre bundles. The platysma muscle exhibits uneven static tension. Some improvement in wrinkles is observed at extreme neck extension.

Extremely severe skin degenerative changes in collagen and elastic fibres, with marked skin laxity and ageing. Severe degenerative changes in the superficial fascia, along with asynchronous loosening of fibrous septa and bundles, result in fat redistribution. The platysma muscle displays significant uneven static tension. No notable improvement in wrinkles is observed with extreme head tilt.

Table 3 Aqualuna scaling standard for horizontal neck wrinkles

The Aqualuna Aesthetics scale-based treatment strategy offers tailored approaches for each level of horizontal neck wrinkles, integrating Aqualuna products with other aesthetic treatments for optimal outcomes.

Static and dynamic assessment of horizontal neck wrinkles

Static and dynamic assessments form the foundation for evaluating horizontal neck wrinkles. Integrating these assessments into a standardised process enables the comprehensive analysis and scaling of horizontal neck wrinkle characteristics and severity based on anatomical structures.

Aqualuna Aesthetics scale-based treatment strategy

The Aqualuna Aesthetics scale-based treatment strategy offers tailored approaches for each level of horizontal neck wrinkles, integrating Aqualuna products with other aesthetic treatments for optimal outcomes.

Scale 1 (Mild): For mild wrinkles, the goal is to enhance neck skin hydration and nourishment, stimulate dermal collagen regeneration, promote ECM remodeling, and improve overall skin quality. The recommended Aqualuna Injection Protocol involves using Aqualuna HA complex solution injected into the dermis of the horizontal neck wrinkles with needles, along with Aqualuna HA complex solution using an automatic injector. Combined treatments include incorporating cosmeceuticals.

Scale 2 (Moderate): In cases of moderate wrinkles, the treatment aims to enhance hydration and nourishment, stimulate collagen regeneration and ECM remodeling, restore dermal and superficial subcutaneous volume, improve local tension in the superficial fascial fibre septa, and optimise the subcutaneous biomechanical structure. The Aqualuna Injection Protocol includes Aqualuna HA complex solution injected into the dermis and superficial subcutaneous layer with a needle or cannula, alongside Aqualuna HA complex solution using an automatic injector. Combined treatments may involve cosmeceuticals and energy devices (e.g., IPL, laser, radiofrequency, or focused ultrasound).

Scale 3 (Severe): For severe wrinkles, the strategy focuses on enhancing hydration and nourishment, promoting collagen regeneration and ECM remodeling, restoring dermal and subcutaneous tissue volume with supportive, micro-particle size HA filler, improving local tension in the superficial fascial fibre septa, strengthening the

References

1. Zhao Y, Feng B, Lee J, Lu N, Pierce DM. A multi-layered model of human skin elucidates mechanisms of wrinkling in the forehead. Journal of the Mechanical Behavior of Biomedical Materials. 2020 May 1;105:103694.

Key points

Horizontal neck wrinkles result from skin ageing, subcutaneous structural changes, and repetitive platysma muscle contractions, compounded by UV damage and lifestyle habits

Aqualuna’s dual-product strategy, using low cross-linking HA and HA composite solutions, provides a multi-layered, personalised treatment for static and dynamic wrinkles

The Aqualuna Aesthetics horizontal neck wrinkle scale integrates static and dynamic assessments, establishing a structured, individualised pathway for grading and treating neck wrinkles effectively.

subcutaneous biomechanical structure, and adjusting platysma muscle tension. The Aqualuna Injection Protocol combines Aqualuna HA complex solution with Aqualuna low cross-linked HA injected into the dermis and superficial subcutaneous layer using a needle or cannula, along with Aqualuna HA complex solution using an automatic injector. Combined treatments include cosmeceuticals, energy devices, and botulinum toxin injection.

Scale 4 (Extremely Severe): In extremely severe cases, a multi-modal approach is used to target multiple layers, rebuilding the overall structure and function of the neck. The aim is to restore the dynamic and static biomechanical stability of the skin, superficial fascia, and platysma muscle, improving signs of neck ageing and reshaping the neck’s contour. The Aqualuna Injection Protocol involves Aqualuna HA complex solution combined with Aqualuna low crosslinked HA injected into the dermis and superficial subcutaneous layer with a needle or cannula, alongside Aqualuna HA complex solution using an automatic injector. Combined treatments encompass cosmeceuticals, energy devices, collagen stimulators (e.g., CaHA or PLLA), botulinum toxin injection, and thread lifting techniques.

Declaration of interest The authors of this manuscript are employed by Bloomage Biotechnology Corporation.

2. Imokawa G, Ishida K. Biological mechanisms underlying the ultraviolet radiation-induced formation of skin wrinkling and sagging I: reduced skin elasticity, highly associated with enhanced dermal elastase activity, triggers wrinkling and sagging. Int J Mol Sci. 2015 Apr 8;16(4):7753–75.

Mar;12(1):35–43.

3. Roberts, W.E. and Cheng, T. Neck Aging and Rejuvenation: A Balanced Approach to Assessment and Treatment. Dermatological Reviews. 2024 June 5;3:e238.

4. Cole MA, Quan T, Voorhees JJ, Fisher GJ. Extracellular matrix regulation of fibroblast function: redefining our perspective on skin aging. J Cell Commun Signal. 2018

5. Amano S. Characterization and mechanisms of photoageing-related changes in skin. Damages of basement membrane and dermal structures. Exp Dermatol. 2016 Aug;25 Suppl 3:14–9.

6. Sandulescu T, Stoltenberg F, Buechner H, Schmidt-Park H, Linnerz F, Jast J, et al. Platysma and the cervical superficial musculoaponeurotic system - Comparative analysis of facial crease and platysmal band

development. Ann Anat. 2020 Jan;227:151414.

7. Minelli L, van der Lei B, Mendelson BC. The Superficial Musculoaponeurotic System: Does It Really Exist as an Anatomical Entity? Plast Reconstr Surg. 2024 May 1;153(5):1023–34.

8. Takaya K, Sakamoto Y, Noji S, Imanishi N, Kishi K. Three-dimensional adipofascial and dermal structures involved in forehead crease formation. Clin Anat. 2024 Apr;37(3):321–8.

9. Roy D. Neck rejuvenation. Dermatol Clin.

2005 Jul;23(3):469–74, vi.

10. Engerer N, Frank K, Moellhoff N, Alfertshofer M, Giunta RE, Green JB, et al. Aging of the Neck Decoded: New Insights for Minimally Invasive Treatments. Aesthetic Plast Surg. 2022 Aug;46(4):1698–705.

11. Doh EJ, Kim J, Lee DH, Park JY. Neck rejuvenation using a multimodal approach in Asians. Journal of Dermatological Treatment. 2018 May 19;29(4):400–4.

BENEFICENCE NON-MALEFICENCE ETHICS JUSTICE

THE MULTIFACETED IMPACT OF ETHICS IN MEDICAL AESTHETICS: BEYOND THE PHYSICIAN'S PERSPECTIVE

Navigating the ethical complexities of medical aesthetics, Sylvia Ramirez, MD, and Gunther Scherz explore how shared decision-making, informed consent, and patient-centred care uphold professional responsibility in elective treatments

ABSTRACT

Ethical practice in medical aesthetics requires a delicate balance between patient desires and professional responsibility. This article explores how core principles such as autonomy, beneficence, non-maleficence, and justice shape ethical decision-making in aesthetic care. It highlights the importance of shared decision-making, thorough informed consent, and managing patient expectations to foster transparency and trust. Additionally, it addresses the ethical challenges of psychological assessments, evidence-based practices, and responsible marketing.

KEYWORDS

Ethics, medical aesthetics, beneficence, non-maleficence, justice

ETHICAL PRACTICE IN MEDICAL

aesthetics requires navigating a complex relationship between patient desires and professional responsibility. In the realm of medical aesthetics, our ethical obligations are particularly heightened due to the elective nature of these procedures, which are not lifesaving but aim to enhance the appearance and, in some cases, self-esteem. Unlike pharmaceutical products, which undergo rigorous testing and regulatory oversight before reaching the public, many aesthetic treatments enter the market with limited clinical evidence regarding long-term safety and efficacy. Additionally, patients who seek aesthetic treatments may be particularly vulnerable, often influenced by societal or external pressures to conform to certain beauty standards. This can lead them to pursue treatments without fully understanding the potential risks and benefits, placing an even greater ethical burden on practitioners to guide their decisions responsibly.

In a landscape where practitioners vary widely in their

training and expertise, it is essential for those of us in the field to champion transparency, informed consent, and patient-centred care, fostering an environment where patient safety and autonomy are prioritised over industry pressures and superficial demands.

The balance between patient empowerment and professional responsibility is essential. As patients become more informed and assertive in choosing aesthetic treatments, the role of the physician shifts from an authoritative figure to a collaborative partner. This article discusses how ethical principles apply to the practice of medical aesthetics, focusing on practical applications for physicians in the field.

Autonomy in aesthetic medicine

Informed consent is the cornerstone of respecting patient autonomy in any medical practice. In aesthetic medicine, however, autonomy takes on additional dimensions as patients often approach treatments with personal, appearance-driven goals rather than therapeutic needs. These goals may be heavily influenced by societal trends,

media portrayals, or personal insecurities, which adds complexity to the practitioner’s responsibility to support patient autonomy while ensuring sound clinical decisionmaking.

Key considerations: Shared decision-making

Shared decision-making (SDM) is a collaborative process that enhances patient autonomy by involving patients directly in choosing treatment options. In aesthetic medicine, SDM goes beyond merely presenting choices; it requires actively engaging patients in discussions to align their values and expectations with medically appropriate options. Using frameworks like the AHRQ’s Shared Decision-Making Tool, physicians can help patients explore options with a balanced understanding of risks, benefits, and potential outcomes. Practically, SDM involves asking open-ended questions, encouraging patients to voice concerns, and providing unbiased information. This process ensures that patients’ decisions are informed not only by facts but also by a meaningful dialogue that takes into account both the medical perspective and the patient's personal values.

Informed consent

While informed consent is fundamental in all medical fields, its scope must be expanded in aesthetic medicine. For every procedure, a thorough consent should include a comprehensive explanation of risks, even those that are rare but severe, such as blindness resulting from dermal fillers. Unlike life-saving interventions, aesthetic procedures carry significant variability in outcomes, and the stakes can be high if complications occur, even though the initial decision may seem less critical due to the elective nature of the treatment. Physicians should confirm that patients fully comprehend potential risks, limitations, and realistic outcomes of treatments to prevent disappointment or harm from unmet expectations. Additionally, aesthetic practices should adopt a standard approach to obtaining consent for all procedures, no matter how routine, to reinforce patient autonomy and maintain ethical transparency.

Patient expectations

Managing patient expectations is crucial in aesthetic medicine, where individual desires can sometimes lead to unrealistic goals. Patients may be influenced by idealised images on social media, making it essential for physicians to provide a clear perspective on what can—and cannot—be achieved. Realistic discussions about the limitations of procedures, as well as visual aids or before-andafter photos, can help patients form grounded

expectations that align with achievable results, preventing disappointment and potential psychological distress.

Psychological assessment

Another layer of respecting autonomy involves assessing the patient’s psychological readiness and motivation. Physicians should determine whether a patient's interest in treatment stems from a desire for self-improvement or external pressures that could hinder genuine, self-directed decision-making. Screening tools, such as the Body Dysmorphic Disorder Questionnaire (BDDQ), can be useful to identify patients at risk of psychological distress or those seeking repeated procedures to correct perceived imperfections. In cases where patients display signs of Body Dysmorphic Disorder (BDD) or appear to be unduly influenced by external pressures, it may be ethical to refuse treatment to prevent psychological harm. By doing so, the physician supports the patient’s autonomy in a more holistic way, ensuring that decisions are made from a healthy, well-informed perspective.

Beneficence and patient well-being

email: dr.sylvia@ cutislaserclinics.com

Beneficence in aesthetic medicine requires practitioners to prioritise patient well-being and strive to maximise both physical and psychological positive outcomes. While aesthetic treatments are often associated with beautification, evidence suggests that these procedures can significantly enhance self-esteem, psychological well-being, and quality of life, making beneficence a multidimensional goal. Studies have shown that patients who feel more confident about their appearance can experience greater social engagement, reduced anxiety, and improved mental health, underscoring the meaningful impact of aesthetic medicine beyond mere physical enhancement.

Key considerations: Evidence-based practice

Aesthetic physicians should adhere to scientifically validated treatments to ensure patient safety and efficacy. Although new technologies and techniques can be enticing, their introduction should be measured and cautious, with full transparency about the level of clinical evidence available. This approach prevents patients from undergoing unproven treatments and maintains the integrity of the practitioner’s duty to do no harm.

Customisation of treatments

While aesthetic treatments are often associated with beautification, evidence suggests that these procedures can significantly enhance self-esteem, psychological well-being, and quality of life, making beneficence a multidimensional goal.

In a consumer-driven field like aesthetics, it is essential that practitioners maintain a commitment to what truly benefits the patient rather than simply fulfilling requests. Individualised treatment plans that align with each patient's physical

SYLVIA RAMIREZ, MD, Medical and Scientific Director of Cutis Medical Laser Clinics, Singapore; GUNTHER SCHERZ, Co-founder and Managing Director, Cutis Medical Laser Clinics, Singapore

and psychological needs are key to optimising outcomes and ensuring long-term satisfaction. Customisation requires careful evaluation of each patient’s medical history, physical health, aesthetic goals, and psychological readiness. For instance, a minimally invasive approach may be more beneficial for a patient with certain health risk factors, even if the patient initially requested a more aggressive treatment. The need for customisation is particularly challenging in aesthetic medicine, where patients often enter consultations with specific requests influenced by social media trends or celebrity endorsements. Here, the physician’s role is to discern and advise on what is in the patient's best interest, even if it means guiding them toward a less popular but safer or more suitable option.

Follow-up care

The physician’s responsibility does not end with the procedure; comprehensive follow-up care is critical in ensuring patient satisfaction and well-being. Regular followup appointments allow for early identification and management of any complications, as well as an ongoing assessment of the patient's physical and psychological adjustment to their aesthetic changes. By offering clear post-treatment guidelines and encouraging open channels of communication for follow-up consultations, practitioners demonstrate their commitment to patient-centred care and further strengthen the physician-patient relationship. Beneficence, in this sense, includes a sustained investment in the patient’s overall experience, supporting both their physical and emotional health as they navigate the changes that result from aesthetic treatment.

Non-maleficence: minimising harm

In aesthetic medicine, the principle of non-maleficence—'do no harm'—is especially significant given the elective nature of these procedures. Physicians must be vigilant in preventing both physical and psychological harm, prioritising the patient’s well-being over any potential financial or reputational pressures that may accompany consumer-driven aesthetic practice.

Key considerations: Risk management

A thorough pre-treatment assessment is essential to minimise risks and ensure that the chosen procedure aligns with the patient’s health profile. This includes reviewing the patient’s medical history, identifying any contraindications, and using screening tools to detect conditions like body dysmorphic disorder (BDD) that could lead to psychological harm. Risk management must go beyond physical safety to encompass the psychological readiness and motivation behind a patient’s decision.

The ability to decline treatment

Physicians have an ethical responsibility to decline

In a field often linked with consumerism and luxury, the ethical responsibility to ensure distributive justice becomes particularly significant, especially as aesthetic procedures become more influential in shaping societal ideals of beauty and selfworth.

procedures that could cause more harm than benefit, even if the patient insists. Non-maleficence requires that doctors be comfortable saying 'no' when a treatment will not yield genuine benefit or when it could compromise the patient’s well-being. However, some practitioners may feel pressured to proceed for fear of losing the patient or due to financial incentives. Upholding non-maleficence means resisting these pressures and prioritising ethical decision-making, especially in cases where the treatment requested is unlikely to produce a satisfactory or safe outcome.

Avoiding the 'overfilled syndrome'

One specific example of non-maleficence in aesthetic medicine is the prevention of the 'overfilled syndrome,' where excessive filler use leads to an unnatural and distorted appearance. This syndrome can occur when physicians yield to patient demands for more filler rather than guiding them toward a balanced, natural look. By emphasising moderation and adhering to aesthetic principles that prioritise the patient’s long-term well-being, physicians can avoid this complication and maintain the integrity of their practice.

Choosing science-backed treatments

Ensuring that all administered treatments are scientifically proven and backed by strong evidence is another critical aspect of non-maleficence. As the aesthetics field rapidly evolves, new techniques and products are constantly introduced, some with limited evidence regarding safety or efficacy. Physicians should commit to using only scientifically validated treatments and remain transparent about any potential limitations. By adopting evidencebased practices, practitioners reduce the likelihood of adverse outcomes and contribute to a higher standard of care in aesthetic medicine.

Transparency about potential complications, no matter how rare, ensures that patients make fully informed decisions. By maintaining a commitment to non-maleficence, physicians safeguard patient trust and uphold the ethical standards that should define all aesthetic practices.

Justice: fairness and accessibility

The principle of justice in aesthetic medicine calls for treatments to be provided fairly, without discrimination, and for access to care to be as equitable as possible. In a field often linked with consumerism and luxury, the ethical responsibility to ensure distributive justice becomes particularly significant, especially as aesthetic procedures become more influential in shaping societal ideals of beauty and self-worth.

Key considerations: equitable access and avoiding a two-tiered system

As aesthetic procedures become more widespread, there is a risk of creating a twotiered system of beauty where those with financial means have enhanced access to appearance-improving treatments, further widening societal divides. For individuals who may not be able to afford these services, the lack of access could

contribute to disparities in self-esteem, social interactions, and perceived attractiveness, impacting quality of life. Treatments like reconstructive surgery after trauma or for disfiguring scars are especially critical, as they serve not only cosmetic purposes but also contribute to functional and psychosocial recovery. The distinction between aesthetic 'luxury' and medically necessary treatments can blur, emphasising the importance of equitable access to care across socioeconomic groups.

Sliding scale fees and community outreach

To address these disparities, aesthetic practices can consider sliding scale fees or providing pro bono services for patients whose conditions have significant psychosocial implications but who may lack financial resources. Additionally, outreach initiatives can help connect underserved populations with aesthetic treatments, broadening access to the benefits of aesthetic medicine and reducing the socioeconomic gap in access to care.

Lessons from GLP-1 analogues and the ethics of demand-driven access

A recent example illustrating issues of access in consumerdriven medicine is the GLP-1 analogue semaglutide, a drug initially designed for diabetes but repurposed by many in Hollywood for weight loss, leading to shortages and reduced access for patients with genuine medical needs. This scenario underscores the importance of distributive justice in aesthetic medicine, where popularity and media influence can drive demand, potentially depriving those who could benefit most from limited resources. For aesthetic treatments, particularly those that may become 'trendy' or status symbols, practices should carefully consider how such demand influences both ethical obligations and accessibility.

Cultural sensitivity and avoiding financial conflicts of interest

Justice also involves providing culturally sensitive care that respects diverse beauty standards and individual values. Each patient’s aesthetic goals may be shaped by unique cultural or personal perspectives, and physicians must strive to understand and respect these while offering individualised recommendations. Equally important is ensuring that financial incentives do not compromise ethical care. In a consumer-driven field, avoiding conflicts of interest such as recommending higher-cost treatments over equally effective alternatives is essential to maintaining fairness. Transparency and objectivity in treatment options help prioritise patient well-being and align with ethical standards.

Ethics in advertising and marketing

Distributive justice in aesthetic medicine extends to ethical advertising practices. Marketing should avoid promoting unattainable beauty ideals or leveraging patient insecurities to drive demand. Instead, practitioners can focus on educating patients with accurate, realistic information, helping them make well-informed choices. By fostering transparency, aesthetic practices can support a more just

Key points

Practitioners in medical aesthetics face heightened ethical obligations due to the elective nature of procedures, requiring a balance between patient desires and professional responsibility.

Informed consent is essential, demanding comprehensive discussions about risks and expected outcomes. Practitioners must ensure patients fully understand their options to respect autonomy and promote informed decision-making.

Engaging patients in a collaborative decisionmaking process enhances their autonomy by aligning treatment options with their values and expectations while providing a balanced understanding of the associated risks and benefits.

Addressing and managing patient expectations is critical in aesthetic medicine, with a focus on realistic outcomes to prevent disappointment and psychological distress.

and patient-centred approach that resists the creation of an elitist standard of beauty and prioritises ethical principles over profit-driven motives.

Conclusion

In conclusion, ethical practice in medical aesthetics is a multidimensional endeavour that calls for practitioners to carefully balance the principles of autonomy, beneficence, non-maleficence, and justice. While aesthetic procedures are elective, their impact on physical, psychological, and social well-being can be profound, underscoring the need for a strong ethical framework. Practitioners must act as both medical advisors and ethical stewards, guiding patients through complex decisions to achieve safe, meaningful, and sustainable outcomes. Emphasising patient-centred care, clear communication, and scientific integrity helps build trust and ensures that patients’ interests remain at the forefront of each treatment decision.

Furthermore, as the field of aesthetic medicine grows, physicians must remain vigilant against the pressures of consumer-driven demands and financial incentives that can lead to compromised care. By upholding non-maleficence, practitioners can avoid unnecessary harm and decline requests that may jeopardise a patient's physical or psychological well-being, even in the face of potential financial or reputational gain. Additionally, evidence-based practices and personalized treatment planning further safeguard patient outcomes, promoting sustainable, natural results that enhance both appearance and well-being without succumbing to the pitfalls of 'quick-fix' solutions or overfilled aesthetics.

Ultimately, ethical practice in aesthetic medicine is about enhancing lives with integrity and transparency. By focusing on patient-centred care, fostering open communication, and maintaining high scientific standards, practitioners can ensure that the aesthetic journey is both safe and fulfilling. In doing so, aesthetic medicine can continue to positively impact individuals' lives, rooted in principles that prioritise health, confidence, and meaningful patient outcomes over transient trends or superficial demands.

Declaration of interest The authors of this manuscript has no conflicts of interest to disclose.

Additional Reading

1. Ramirez S, Scherz G. Redefining Medical Ethics in Esthetic Practice: Balancing Patient Empowerment and Professional Responsibility [Internet]. Global Bioethics - Current Challenges, New Developments, and Future Directions [Working Title]. IntechOpen; 2025. Available from: http:// dx.doi.org/10.5772/intechopen.1008821

2. Ramirez S, Cullen C, Ahdoot R, Scherz G. The Primacy of Ethics in Aesthetic Medicine: A Review. Plast Reconstr Surg Glob Open. 2024 Jun 25;12(6):e5935

3. Ramirez SPB, Scherz G, Smith H.

Characteristics of Patients Seeking and Proceeding with Non-Surgical Facial Aesthetic Procedures. Clin Cosmet Investig Dermatol. 2021 Mar 1;14:197-207. doi: 10.2147/CCID.S296970. PMID: 33688232; PMCID: PMC7935348.

4. Beauchamp, T. L., & Childress, J. F. (2019). Principles of Biomedical Ethics (8th ed.). Oxford University Press.

5. Beauchamp TL. Autonomy and consent. In: Miller F, Wertheimer A, eds. The Ethics of Consent: Theory and Practice. Oxford University Press; 2010:55–78:chapter 3.

6. Nuffield Council on Bioethics. (2017). Cosmetic Procedures: Ethical Issues. Retrieved from Nuffield Council Website.

7. The SHARE Approach. Agency for healthcare research and quality. Available at https://www.ahrq.gov/health-literacy/ professional-training/shared-decisi.... Updated March 2023. Accessed November 2024

8. Sarwer, D. B., & Crerand, C. E. (2008). Body image and cosmetic medical treatments. Body Image, 5(1), 50-58.

COVERSTORY

INJECTABLE TREATMENTS FOR THE UNDER-EYE AREA CHALLENGES AND INNOVATIONS

Oksana Pashkovska, MD, explores the latest techniques in under-eye injectables, addressing key challenges like volume loss, oedema, and the Tyndall effect to enhance patient safety and aesthetic outcomes

OKSANA PASHKOVSKA, MD, is a dermatologist, author of the ABCD classification of skin types, expert at the International Association of Anti-Aging Medicine, international trainer at Hyalual, and CEO & founder of Face Zone Clinic, Kyiv, Ukraine

email: pashkovskaia@gmail.com

ABSTRACT

This article reviews the methodologies in injectable correction of the infraorbital area, detailing key anatomical considerations and potential risks. The findings underscore the importance of a comprehensive understanding of facial anatomy, proper filler selection, and tailored injection techniques to optimise outcomes in periocular rejuvenation.

THE PERIORBITAL REGION PLAYS A crucial role in facial aesthetics and expression1. This area is central to interpersonal communication, as the eyes are often referred to as the 'window to the soul'2. Changes in this region can significantly impact the overall appearance and aesthetic perception of the face.

With age, the periorbital area undergoes a series of anatomical and clinical transformations that profoundly affect facial aesthetics. One of the primary changes is subcutaneous fat atrophy, leading to volume loss and the formation of hollows under the eyes. This phenomenon results from the reduction and downward displacement of fat compartments due to gravitational forces3

Furthermore, weakening of the ligamentous apparatus and periorbital muscles contributes to wrinkle formation, skin sagging, and the appearance of under-eye bags. Specifically, stretching and thinning of the orbital septum allows fat pads to protrude, creating visible swelling and puffiness4

the orbital aperture and deeper-set eyes. This exacerbates the aesthetic deterioration of the periorbital area as soft tissues lose support and descend6.

The combination of these changes is influenced by both intrinsic ageing factors and external factors, such as ultraviolet radiation, smoking, and environmental pollution, which accelerate structural degradation and impact the overall aesthetic quality of the periorbital region.

Excess volume and the risk of ptosis

Filler injections into the periorbital area can lead to excessive volume, which, in turn, contributes to the development of ptosis. This phenomenon, known as facial overfilled syndrome, is characterised by the distortion of natural facial contours due to excessive or improperly placed fillers7.

Over time, under the influence of gravity and age-related changes, these excess volumes may further exacerbate tissue ptosis, particularly in the delicate periorbital region8

A study by Mobin Master demonstrated that hyaluronic acid fillers can persist in tissues much longer than previously expected. Magnetic resonance imaging (MRI) revealed that fillers may remain at the injection site for several years, increasing the risk of volume accumulation and ptosis development9

Tyndall effect

KEYWORDS

Infraorbital rejuvenation, periorbital aesthetics, injection techniques, dermal fillers

Another important factor is skin thinning in this area. As the skin loses elasticity and becomes more transparent, underlying structures such as blood vessels and muscles become more visible, contributing to the appearance of dark circles5

Additionally, changes in the facial bony structures, particularly orbital rim resorption, lead to an increase in

The Tyndall effect occurs when light scatters on filler particles that have been injected too superficially, resulting in a bluish or cyanotic discolouration of the skin. This phenomenon is particularly noticeable in the periorbital region due to the thinness of the skin10

Incorrect injection technique or the use of an inappropriate filler can contribute to the development

With age, the periorbital area undergoes a series of anatomical and clinical transformations that profoundly affect facial aesthetics.

BAFigure 1A After marking the injection site, 0.4 ml of Alexa Volume filler is injected via bolus supraperiosteally into the G-point using a 27G x 0.5 inch (0.4 x 12 mm) needle per side. Figure 1B Linear retrograde technique with Alexa Volume filler along the zygomatic arch and into the projection of deep fat compartments

Figure 2 First, the lower eyelid skin is cooled using a cryogen and treated with antiseptic. The patient is positioned semi-seated, looking upward. A 30G x 0.5 inch (0.3 × 13 mm) needle, bent at a 45-degree angle, is used. The needle is inserted superficially in the subdermal layer, and the filler is injected linearly and retrograde, with slow pressure on the syringe plunger (Figure 2A). The average volume per injection is 0.025–0.05 ml. Subsequent injections (Figures 2B, 2C) are performed without gaps between the filler deposits to ensure continuous distribution. The injection depth remains consistent, and care is taken to avoid contour irregularities. Approximately 1 mm before the needle is removed from the skin, pressure on the plunger ceases to prevent filler deposition in the dermis. The total amount of filler per eyelid is 0.1–0.2 ml, with a slight under-correction of approximately 20%. After injection, a gentle sculpting massage is performed along the filler distribution line.

Figure 3 Alexa Fillers demonstrate a ratio of absorbed fluid to the amount of gel used as 1:1, resulting in a predictable correction volume (Internal Hyalual company research, 2018).

Swelling factor

Alexa

of this undesirable effect, which may persist for an extended period, making correction challenging11

Oedema

Hyaluronic acid fillers have the ability to attract water, which can lead to oedema at the injection site. In the periorbital region, where the tissues are particularly sensitive, this can become a significant issue12

Incorrect filler selection, excessive injection volume, or inappropriate injection technique can increase the risk of oedema. Additionally, the depth and area of filler placement play a crucial role in minimising this complication13.

Techniques

With age, a decrease in the maxillary angle is likely the cause for the expansion of the inferior orbital rim and, thus, of an anterior positioning of the orbital septum. Therefore, a pseudoprolapse of the intraorbital quarter retroseptal fat pads, fat compartments located behind the orbital septum in the lower eyelid, can lead to the palpebral bags becoming more apparent. Also, the orbicularis retaining ligament might lose its horizontal position toward a more inferior inclined alignment, causing a loss of stability to the adjacent orbicularis oculi muscle, which forms the anterior wall of the underlying fat compartments below the aperture, that is, the suborbicularis oculi fat (SOOF)14.

The injection technique described in the works of Casabona and Bernardini considers the ligamentous structure of the face to optimise lifting and volume restoration. This method involves injecting filler into a specific anatomical point, known as the G-point, located in the lateral portion of the SOOF. Filler placement in this area enhances midface elevation and improves the contour of the periorbital region. Studies have demonstrated that this technique achieves significant aesthetic improvement with minimal filler volume15

Therefore, as the first step in infraorbital correction for most patients, I perform filler injection into the dermal location termed the G-point16 (Figure 1). This point is determined by the intersection of three reference lines:

■ A line connecting the inferior aspect of the nasal ala and the tragus

■ A line connecting the lateral canthus and the corner of the mouth

■ A connecting line between the intersection of the two lines and a perpendicular line connecting to the lateral canthus.

If there are indications for midface volume restoration, filler can also be injected using a cannula under the SMAS layer in a fan-shaped, linear retrograde technique along the zygomatic arch and into the projection of deep fat compartments. Alternatively, a bolus injection with a needle can be performed directly into the deep fat compartments and along the zygomatic bone (Figure 1B).

For the first step in infraorbital correction, I use Alexa Volume filler (Hyalual, Switzerland). The second stage of infraorbital correction involves working directly with the lower eyelid to reduce the transition between the eyelid and the cheek. While a cannula is generally considered

A Balong the hollow between the eyelid and the cheek on each side

A B

Figure 5 Case 2. In this patient, 0.5 cc of Alexa Volume was injected using a cannula under the SMAS layer in a fan-shaped, linear retrograde technique into the projection of deep fat compartments, Lateral Suborbicularis Oculi Fat (SOOF), and Deep Medial Cheek Fat, as well as supraperiosteally along the zygomatic arch on each side. Additionally, 0.2 cc of Alexa Medium was injected subcutaneously using a linear retrograde technique along the hollow between the eyelid and the cheek on each side

Figure 6 Case 3. In this patient, 0.4 cc of Alexa Volume was injected as a bolus supraperiosteally into the G-point, and 0.2 cc of Alexa Medium was injected subcutaneously using a linear retrograde technique along the hollow between the eyelid and the cheek on each side. Additionally, 0.3 ml of Alexa Volume was injected using a cannula in a linear retrograde technique into the projection of the Deep Medial Cheek Fat on each side.

References

1. Schlessinger J, Cohen JL. Periorbital rejuvenation: strategies for treatment. Dermatol Surg. 2015;41 Suppl 10:S143–S147.

2. Carruthers J, Carruthers A. Aesthetic indications for botulinum toxin injections. Plast Reconstr Surg. 2003;112(5):23S–27S.

3. Rohrich RJ, Pessa JE. The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Reconstr Surg. 2007;119(7):2219–2227.

4. Hwang K, Kim DJ, Hwang SH. Surgical anatomy of the orbital septum and periorbital fat

pads. J Craniofac Surg. 2007;18(2):387–391.

5. Wulc AE, Sharma P, Czyz CN. The anatomic basis of midfacial aging. Facial Plast Surg Clin North Am. 2015;23(2):191–202.

6. Pessa JE, Chen Y. Curve analysis of the aging orbital aperture. Plast Reconstr Surg. 2002;109(2):751–755.

7. Lim T. Facial overfilled syndrome. Dermatol Clin. 2024;42(1):121–128.

8. Cotofana S, Lachman N. The facial overfilled syndrome: anatomy, causes, and prevention.

safer, its use in the periorbital area may cause trauma to the orbital septum, damage to retaining ligaments, and injury to lymphatic capillaries, which can lead to complications.

Considering these factors, in some cases, the use of a needle for superficial subdermal filler injection along the orbital ligament is a more predictable and controlled approach (Figure 2).

The disadvantages of this technique include the potential for filler contouring and the Tyndall effect. Therefore, it is crucial to prioritise a filler that distributes evenly, is easy to mold, and has a low tendency for swelling.

Key points

Successful infraorbital rejuvenation relies on a thorough understanding of facial anatomy, particularly the ligamentous structures and fat compartments, to achieve natural results while avoiding complications such as ptosis and the Tyndall effect.

Common risks include excessive volume leading to tissue sagging, fillerinduced oedema due to water retention, and visible discoloration when fillers are placed too superficially, highlighting the need for careful filler selection and precise injection methods.

The G-point technique, which involves filler placement at the intersection of key facial landmarks, offers enhanced midface support and aesthetic improvement with minimal product, while the choice of filler with appropriate rheological properties is essential for optimal results and safety

In my practice, for this area, I use Alexa Medium filler (Hyalual, Switzerland), which meets these requirements. Due to its phosphate-buffered saline composition and rheological properties, Alexa has a volumisation factor of 1:1 (Figure 3).

The periorbital region is critically important for the aesthetic perception of the face, and its correction requires a deep understanding of the anatomical and physiological characteristics of this area. Further research and the development of new treatment methods will contribute to improving the effectiveness and safety of procedures aimed at enhancing the appearance of this delicate region.

Declaration of interest

The author, Oksana Pashkovska, is a Key Opinion Leader (KOL) for Hyalual, but the views expressed are solely her own. Every effort has been made to provide an objective analysis of the product.

Aesthet Surg J. 2022;42(4):343–350.

9. Master M, Mobin MB. Hyaluronic acid filler longevity and localisation: magnetic resonance imaging evidence. Plast Reconstr Surg. 2021;147(1):50e–53e.

10. Sundaram H, Fagien S. Considerations for hyaluronic acid fillers in the periorbital area. Plast Reconstr Surg. 2021;147(5):888–902.

11. Lowe NJ, Lask GP, Yamauchi PS. Blue discoloration after hyaluronic acid filler injection: Tyndall effect and its management. J Cosmet Laser Ther. 2007;9(3):182–187.

12. Swift A, Remington K. Periorbital edema and hyaluronic acid fillers: causes, prevention, and treatment. J Clin Aesthet Dermatol. 2020;13(8):55–62.

13. Gold MH, Alam M, Burgess C. Avoiding and managing adverse effects of hyaluronic acid fillers in the periorbital area. Dermatol Surg. 2019;45(12):1582–1592.

14. Cotofana S, Fratila AM, Schenck TL, Redka-Swoboda W, Zilinsky I, Pavicic T. The anatomy of the aging face: a review. Facial Plast Surg. 2016;32:253–260.

15. Casabona G, Bernardini F, et al. How to best utilise the line of ligaments and the surface volume coefficient in facial soft tissue filler injections. J Cosmet Dermatol. 2019;18(6):1452–1460. DOI: 10.1111/jocd.13245.

16. Casabona G, Bernardini FP, Skippen B, et al. How to best utilise the line of ligaments and the surface volume coefficient in facial soft tissue filler injections. J Cosmet Dermatol. 2019;00:1–9. DOI: 10.1111/jocd.13245.

Figure 4 Case 1. In this patient, 0.4 cc of Alexa Volume was injected as a bolus supraperiosteally into the G-point, and 0.2 cc of Alexa Medium was injected subcutaneously using a linear retrograde technique

UNLOCKING THE RETAIL SKINCARE OPPORTUNITY IN YOUR AESTHETIC PRACTICE

Enhancing patient outcomes while boosting practice revenue, Audrey Neff explains how retail skincare is an often-overlooked but essential component of a successful aesthetic practice

IN THE EVER-EVOLVING LANDSCAPE OF aesthetic medicine, achieving practice success involves more than just offering cutting-edge treatments. A comprehensive approach to incorporating retail skincare adoption is pivotal. Why? It doesn’t just improve patient outcomes it has a direct impact on your business's bottom line. Unfortunately, most practices fall short in this arena.

Medical aesthetic practices face a persistent challenge in effectively integrating and boosting retail skincare sales without undermining their core services. The gap between

expectation and delivery of skincare in aesthetic practice affects multiple stakeholders, including practice owners, medical staff, and patients. For practice owners, limited retail sales mean reduced profitability and patient retention, as patients might seek other providers who offer more comprehensive care. Staff members miss an opportunity to enhance their roles as educators and brand ambassadors, which can impact their professional development. Patients, on the other hand, are at risk of not achieving optimal treatment outcomes, leading to dissatisfaction.

This article discusses tactics to implement in your

aesthetic practice to improve retail skincare sales, providing a structured guide for practitioners looking to optimize patient outcomes, recurring revenue, and patient lifetime value.

The current state of skincare in aesthetic medicine

The total global sales for medical-grade skincare exceeded $3.8B in 2023, representing roughly 11% of the global aesthetic market1. Through 2025, total market sales are expected to continue to rise 7.9% per year1. As this sector continues to grow, modern aesthetic practices also need to understand the valuable opportunity skincare presents to not only your patients but also for the overall success and profitability of your practice.

Retail skincare sales account for a significant yet often underutilized portion of revenue in aesthetic practices. What percentage of gross non-invasive revenue should retail skincare account for in an aesthetic practice? Believe it or not, it's around 15–20%. However, the industry average lingers around a mere 3% to 5%.

Four powerful tactics to boost retail skincare revenue

1. Harnessing before and after photos as educational tools

Before and after photos are quintessential for bridging the credibility gap and affirming the potential results clients can expect from their investments in aesthetic treatments. Patients search for reliability and relatability, and seeing the tangible results of others with similar concerns, skin types, or dermatological backgrounds can significantly reduce hesitancy. Practices should incorporate these visuals as a fundamental element of consultations. Leverage photos of previous patients as benchmarks for potential clients, which increases trust and promotes higher consultation conversions.

with full purchasing power expected to pick up market share over the next few years2

2. Enhancing your consultation approach

A second strategy to improve skincare revenue in your practice is to assess your current consultation process. Are you spending enough time with a prospective patient during their initial first visit? Spending enough time (30–60 minutes) and incorporating a full-facial analysis are two tactics that can dramatically enhance your current processes. Leverage the patient consultation as an opportunity to design long-term, personalized treatment plans, embodying the principles of combination therapy merging clinical treatments with skincare regimens for optimal outcomes. By educating clients about the benefits of using medical-grade skincare products alongside their treatments, practitioners can provide superior patient outcomes, thereby bolstering retention rates and establishing loyalty.

Regardless of whether a patient initially comes into your clinic interested in a single 'gateway' service such as a facial, neuromodulators, or HA filler, the responsibility falls on the medical provider to properly educate the patient on all the necessary treatments/products that should be used in conjunction with one another to achieve the best clinical outcomes possible.

Another strategy that can be useful when educating a patient on your skincare products is to physically have the products in the treatment room with you. Allowing them to try the product(s) on their hands or face, while simultaneously educating them on the features and benefits of the products, can also be effective at increasing adoption.

What percentage of gross non-invasive revenue should retail skincare account for in an aesthetic practice? Believe it or not, it's around 15–20%.

It is strongly recommended that practices have a documented process in place for taking before and after photos. There should be consistency with backgrounds, angles, and lighting to ensure the full clinical transformation(s) can be perceived by prospective patients. Additionally, ensure you have a bulletproof consent process in the clinic. Ideally, you should have two separate consents one for internal use between the provider and patient, and the second for a patient to consent for their photos to be used in external marketing efforts such as on social media or your practice website. As the demographics in aesthetics continue to shift with generational changes, younger patients (Millennials and older Gen-Z) are often more willing to share their results and experiences on social media vs. Generation X or Baby Boomer patients. This represents a valuable opportunity that will continue to expand for practices, considering the fact that Millennials make up less than 30% of the global medical aesthetic market yet are the only consumer group

With more price-conscious consumers, consider offering three different tiered options for a treatment plan, with each one increasing in cost and commitment. Providing more than just one option for patients can help maximize consultation conversation rates. Offering flexible patient financing is another tactic practices should implement in 2025 and beyond.

Selling your skincare in 'packages or systems' can also be effective at simplifying a recommended skincare protocol. For instance, develop an acne, mature skin, or hyperpigmentation-specific protocol or bundled system that includes all AM/PM skincare products with branded step-by-step instructions for addressing those specific concerns.

According to an industry study3, 86% of patients expect providers to recommend a pre-treatment skincare regime, but only 14% of patients were recommended any at-home skincare. Additionally, 91% of patients expect a recommended post-treatment skincare regime, but only 30% of patients in the study were recommended post-care skincare products.

This exhibits a massive gap in patient care, as providers are doing a disservice to their patients by not educating

AUDREY NEFF Senior Director of Marketing Strategy for PatientNow, Boca Raton, FL, USA

them on the need for using at-home skincare to protect their investment in aesthetic treatments.

Incorporating pre and post-treatment protocols for all lasers or energy-based device services is another proven way to drive retail skin care adoption and practice revenue. You can either bundle the skincare in with the total cost of the package/series or offer it as a value-add or upgrade to enhance clinical results. While not universally applicable, many practices find this method reduces the pressure of upselling and assures patients receive the best posttreatment care.

The broader implications of such integration extend beyond immediate sales. They foster patient trust and enhance the overall perception of value within the practice. By ensuring patients adhere rigorously to prescribed skincare regimens, practices not only uplift patient satisfaction but also affirm their credibility and reliability in delivering exceptional clinical results.

3. Maximizing marketing channels for patient education

Beyond the consultation or treatment room, strategic use of digital platforms and in-practice education to elevate patient awareness and, consequently, retail sales is another impactful tactic.

Dedicate time to create content for social platforms such as Instagram by leveraging posts, reels, stories, and highlights. Applicable examples include filming videos talking about different skincare products, educational posts explaining the key benefits, and Instagram live Q&A sessions.

Additionally, the scope of before and after photos stretches beyond consultation support. They serve as powerful marketing assets when shared across social media and digital platforms, emphasizing transparency

Beyond the consultation or treatment room, strategic use of digital platforms and in-practice education to elevate patient awareness and, consequently, retail sales is another impactful tactic.

televisions with relevant before and after photos throughout the practice.

4. Invest in staff training and cultural buy-in to your skin care products

The marketing strategy extends into the practice itself with detailed staff training a cornerstone for increasing retail sales. Your staff needs to be trained and culturally bought into your practice’s treatments and products. The impact of enthusiastic, knowledgeable staff cannot be overstated, particularly when they become brand ambassadors for the skincare products offered.

Training encompasses building an understanding of the value and efficacy of products and empowering staff to overcome potential consumer barriers related to pricing. Practices should begin by training staff comprehensively on the features and benefits of their skincare products, ensuring they are well-prepared to engage patients in meaningful discussions about their skincare needs. Regular workshops or seminars, possibly supported by vendors, could enhance ongoing education.

Overall, team engagement and ongoing education are pivotal. Practices should ensure all employees are wellversed in all product line(s) and that they are also enthusiastic users. Your staff are your biggest advocates, and their genuine belief in your products can be one of your strongest sales tools.

Obstacles like competitive pricing from online retailers can be mitigated by offering exclusive in-office promotions, VIP programs, memberships, or value-added services like bundled procedural packages with built-in skincare essentials, ensuring patients receive unparalleled value for choosing in-practice products.

Conclusion

In conclusion, retail skin care is essential in crafting a resilient and sustainable practice. Why? Because you are not 'just selling retail.' You are selling an experience, outcome, and clinical result to better serve your patient base. Practices adept in harnessing comprehensive consultations and photogenic proof, supported by skilled staff and robust marketing efforts, will position themselves as leaders within the industry. They cater to evolving consumer expectations and carve out a distinctive advantage, transforming each interaction into an opportunity to elevate reputation, trust, and results.

References

1. Physician Dispensed Topicals Market Research Report. Medical Insights. 2024. Available at: https://cdn.shopify.com/s/files/1/0594/8909/1684/files/PDT_2024_Executive_ Summary-043024.pdf?v=1714516384

2. Neff AM. Connecting With the Untapped Millennial Market: Simple Strategies to Boost Conversion, Loyalty, and Per-Patient Spend in Your Aesthetic Practice. Plast Aesthet Nurs (Phila). 2022 Jul-Sep 01;42(3):143-151. doi: 10.1097/PSN.0000000000000459. PMID: 36450056. https://pubmed.ncbi.nlm.nih.gov/36450056/

3. The Skincare Opportunity. Modern Aesthetics. 2015. Available at: https:// modernaesthetics.com/articles/2015-sept-oct/the-skincare-opportunity-tips-forintegration

GLOBAL-REPAIR ADVANCED CREAM AND ELIXIR

Global-Repair Advanced Cream and Elixir by Laboratoire Filorga enhances anti-ageing and post-micro-invasive procedure results, improving skin hydration, firmness, and recovery

AS WE AGE, OUR SKIN undergoes profound changes: wrinkles deepen, firmness diminishes, and pigmentation becomes uneven. These transformations, exacerbated by environmental stressors, are most visible on the face and can significantly impact psychological well-being.

With a growing elderly population worldwide, the demand for effective anti-ageing solutions is growing. This growth is reflected in the increasing use of anti-ageing cosmetics and a burgeoning demand for minimally invasive aesthetic procedures. Yet, micro-invasive procedures could benefit from improved recovery and synergy with cosmetic products.

The Global-Repair Advanced line from Laboratoire Filorga

(France) offers promising options. The line offers a thick cream with a smooth and shiny appearance and a luxurious Elixir with a velvet finish. Both are designed to enhance skin recovery and rejuvenation through a blend of innovative ingredients.

Methods

The products

The Global-Repair Advanced Cream and the Elixir feature a patented biomimetic lipid complex that works synergistically with nutrirevitalising oils and ceramides to reinforce the skin's natural barrier. Additionally, the Damask rose extract imparts radiance, while the Tree of Life botanical extract (Tabebuia avellanedae) helps prevent cellular ageing. Collagen boosters are included to restore dermal density and structure, addressing multiple signs of ageing simultaneously. Both products are intended to be applied twice daily to the face, neck, and décolleté.

Participants and ethics

The Global-Repair Advanced Cream was evaluated on 36 subjects, and the Elixir on 34. Pilot studies involving six participants assessed the combined use of either of the products with micro-invasive procedures. All studies adhered to the Declaration of Helsinki, with participants providing

written informed consent.

Clinical evaluations

Instrumental evaluations were conducted at baseline and after 28 days and 56 days of daily use with either product. Wrinkle depth and skin smoothness were quantified in the crow's feet area using the Primos 3D. Firmness and tonicity were evaluated with a Cutometer. Transepidermal water loss (TEWL) measurements with a Tewameter enabled the assessment of the skin barrier function, while skin hydration was measured with a Corneometer. Colourimetric measurements (CM-700d Spectrophotometer) enabled skin brightness and complexion homogeneity to be determined.

Micro-invasive procedures

We evaluated two micro-invasive procedures:

■ Biostimulation with dermal injections of hyaluronic acid and amino acids

■ Deep cleansing procedure combined with microneedling. These procedures were assessed alone and in conjunction with either the Global-Repair Advanced Cream (biostimulation) or the Elixir (deep cleansing and microneedling).

Results from micro-invasive procedures with and without Cream or Elixir applications were evaluated by a

dermatologist using standardised scales. A sevenitem Global Aesthetic Improvement Scale (GAIS) was used to rate subjects’ and investigator’s satisfaction. Results were normalised on a scale from 0 (poor) to 10 (excellent).

Statistics

Data generated post-product applications following microinvasive procedures were compared to baseline. Statistical analyses were conducted using Student's t-tests.

Results

In clinical evaluations, both products demonstrated significant improvement across all assessed parameters after 28 days, with further enhancement after 56 days (Table 1). Both products effectively reduced wrinkles and smoothed the skin. They also strengthened the barrier function and enhanced skin firmness and tonicity. Complexion brightness increased as well. For the Elixir specifically, improvements in skin hydration and complexion homogeneity were observed. When applied twice daily for 30 days following the biostimulation procedure ( Figure 1A ), the Global-Repair Advanced Cream significantly improved complexion homogeneity (p<0.05). There was evidence of improvements

Prof. Luca PIOVANO, MD, is a Professor of Plastic Surgery with a primary focus on Aesthetic Medicine and an internationally recognised expert in micro-invasive techniques

in cheek fold severity and increased skin radiance. Similarly, after the microneedling procedure, twice daily application of the GlobalRepair Advanced Elixir for 30 days demonstrated improvement to all assessed parameters (cheek fold severity, skin radiance, complexion homogeneity, hydration, Figure 1B ). Both combinations resulted in higher satisfaction among subjects and the investigator.

Discussion

Results from the ex vivo and clinical evaluations of the GlobalRepair Advanced Cream and Elixir show that both products offer marked benefits for ageing signs. Their ability to increase elastin fibre length translates into improved skin elasticity and firmness, effectively reducing wrinkle severity. By strengthening barrier function, they improve skin hydration, tackle age-related dryness, and contribute to a smoother microrelief that diminishes the visibility of fine lines. Additionally, their capacity to enhance skin brightness mitigates the adverse effects of photo-ageing.

When used after post-microinvasive procedures, the Cream and Elixir demonstrate recoverysupporting properties. Most importantly, the combination enhances the outcomes of the aesthetic procedures. By

Biostimulation followed or not by Global-Repair Advanced Cream application Cheek folds

“By strengthening the skin barrier and boosting elasticity, Global-Repair Advanced optimises both everyday skincare and postprocedure recovery for visibly radiant skin."

DO (Baseline) Day 30 with biostimulation Day 30 with biostimulation + GRA Cream application

delivering targeted nutrients, they accelerate skin renewal, helping to minimise downtime. These benefits translate to smoother, more radiant skin and improved procedure results.

Thanks to their unique composition acting at several levels within the skin, the Global-Repair Advanced Cream and Elixir not only combats ageing signs but also optimises skin recovery and amplifies post-procedure outcomes. As we continue exploring innovative skincare solutions, this line stands at the forefront of anti-ageing technology. By introducing comprehensive strategies, this study represents a pivotal advancement in the management of aesthetic patients, poised to significantly influence and shape future practices.

Find out more at: int.filorga.com/

Deep cleansing and microneedling followed or not by Global-Repair Advanced Elixir application

DO (Baseline) Day 30 with microneedling Day 30 with microneedling + GRA Elixir application

Figure 1 Effect of micro-invasive cosmetic procedures followed or not by twice daily application of the Global-Repair Advanced Cream (A) or Elixir (B).

Investigator’s GAIS

Subjects’ GAIS

Subjects' GAIS

Investigator's GAIS Cheek folds

Table 1 Evolution of ageing signs upon twice daily application of the cream or elixir

SEDUSKIN: ADVANCED BIOREVITALISATION FOR RADIANT AND YOUTHFUL SKIN

SeduSkin offers advanced biorevitalisation solutions that deliver radiant, youthful skin through deep hydration, regeneration, and anti-ageing benefits

SEDUSKIN PRESENTS A premium range of biorevitalising products developed with the latest innovations in regenerative medicine. Manufactured by Laboratoire Global Skin France, Seduskin combines advanced dermatological technology with natural ingredients, SeduSkin sets itself apart as an excellent choice for individuals seeking optimal skin health and rejuvenation.

Each formula is meticulously designed to target specific skin concerns, delivering profound hydration, firmness, and antiageing benefits. With a commitment to scientifically backed skincare, SeduSkin integrates cutting-edge ingredients that enhance skin cell renewal, elasticity, and overall resilience.

The science behind SeduSkin

SeduSkin products are backed by clinical studies performed under dermatological control. Each product has demonstrated high tolerability and significant cosmetic efficacy, ensuring safe and effective results for all skin types. By harnessing the power of bioremodelling ingredients, SeduSkin helps users restore their youthful glow and combat the signs of ageing with visible improvements after just a few sessions. The research has also shown that SeduSkin’s formulations not only enhance

immediate skin hydration but also contribute to long-term structural improvements, preventing future signs of ageing.

With a unique combination of advanced dermatological technology and nature-inspired ingredients, SeduSkin stands out as a premium choice for individuals seeking optimal skin health and rejuvenation.

The SeduSkin portfolio consists of four groundbreaking products:

■ Hyla-PDRN

■ Hyladerm 2%

■ Hylagen 3

■ Evolution.

Hyla-PDRN: cellular regeneration and deep hydration

The standout ingredient, polydeoxyribonucleotide (PDRN), is a DNA-derived drug from salmon that possesses several properties: tissue repairing, anti-ischemic, and antiinflammatory. These therapeutic properties suggest its use in

regenerative medicine and even in diabetic foot ulcers. Additionally, PDRN may also protect cells from UV-induced DNA damage1. The healing efficacy of PDRN was also confirmed in a smaller group of patients suffering from pressure ulcers. In a further study, a topical application of a gel containing PDRN and hyaluronic acid was compared with a gel containing only hyaluronic acid in patients suffering from venous ulcers of the lower limbs. The endpoint was full skin repair 45 days after the start of treatment. Complete wound healing was obtained in 67% of patients treated with PDRN and hyaluronic acid, while only 22% of patients receiving only hyaluronic acid achieved the therapy target2

Furthermore, PDRN has been shown to enhance the growth rate of numerous cells, such as fibroblasts, chondrocytes, pre-adipocytes and osteoblasts in primary cultures at therapeutic concentrations. Another important aspect in regenerative medicine is the PDRN’s ability to promote in vitro the proliferation of human pre-adipocytes, confirming that PDRN may be used for therapeutic and regenerative purposes1

To guarantee outstanding results, we have tested our products, and the outcomes speak for themselves.

Clinical efficacy

A 28-day clinical study on Hyla-PDRN demonstrated its exceptional anti-wrinkle effects,

showing a significant reduction in fine lines and improved skin texture. Participants reported that the serum intensely hydrated the skin, making it softer, revitalised, and firmer. 73% of users expressed satisfaction with the product’s texture and absorption. Dermatologists noted a noticeable improvement in skin elasticity and collagen production, ensuring a longerlasting youthful appearance3

Hyladerm 2%:

high - concentration hyaluronic for ultimateacid moisturisation

Due to this exceptionally strong water absorption property, HA is able to hydrate both the stratum corneum and the dermis. It has typically been classified as a humectant moisturiser, since it draws water from the dermis to epidermis. Dermal fibroblasts provide the synthetic machinery for dermal HA and are considered to be the target of pharmacologic attempts to enhance skin hydration4

Several experimental studies have demonstrated that hyaluronic acid injected into the skin can stimulate fibroblasts to express collagen type 1 (Col-1), matrix metalloprotease-1 (MMP-1), and tissue inhibitor of matrix metalloproteinase-1 (TIMP)5

A study was conducted involving a panel of healthy human subjects to assess the skin acceptability of Hyladerm 2%. The evaluation aimed to determine its cosmetic efficacy through clinical scoring and to appreciate its cosmetic qualities

“With a unique combination of advanced dermatological technology and nature-inspired ingredients, SeduSkin stands out as a premium choice for individuals seeking optimal skin health and rejuvenation."

and effectiveness after repeated applications under normal usage conditions over a period of 28 consecutive days.

Clinical efficacy

Hyladerm 2% was tested on a diverse group of women aged 30-70, proving its effectiveness in reducing wrinkles and enhancing skin suppleness. Participants noted a restoration of natural skin hydration, a revitalised complexion, and a slower formation of fine lines. The product received a 95% satisfaction rate among users. Globally, the product was well

appreciated by the test subjects for its cosmetic qualities and efficacy, particularly for the following items:

■ The serum leaves the face hydrated

■ The face feels revitalised

■ The skin feels softer

■ The natural skin hydration is restored

■ The serum slows down the appearance of wrinkles and fine lines

■ The product is suitable for your skin type

■ The consistency of the product is pleasant to the touch

■ The product is generally pleasant to use.

Clinical assessments revealed significant improvements in skin barrier function, ensuring longer-lasting hydration and enhanced skin resilience6.

Hylagen 3: triple-action skin renewal

Collagen is the primary component in human skin. With age, there is loss of skin elasticity and collagen, resulting in wrinkle formation and reduction in skin appearance. Reduction of fibrillar (types I and III) collagen is a characteristic feature of

Figure 1 (A) Before and (B) after 4 sessions of 2ml injections of HYLA-PDRN with dermapen

Figure 2 (A) Before and (B) after 4 sessions of 2ml of HYLAGEN 3 with dermapen

PROMOTION

chronologically aged skin and is further advanced with photodamage. Ageing damages the elastic capacity of the skin, and thus, ageing skin is marked by a lack of elasticity, fragmentation, and collagen bundle fragility5. The aim of mesotherapy with Hylagen 3 in skin rejuvenation is maintenance and/or restoration of healthy and youthful skin texture. The desired final effect is firm, bright, moisturised skin obtained by the injection of this product, which is perfectly biocompatible and totally absorbable, in the superficial dermis. In fact, injection of mesotherapy products promotes skin rejuvenation by increasing both hydration and fibroblast activation7

In conclusion, these new minimally invasive mesotherapy techniques, can improve the clinical appearance of the skin in different age groups, via action on the maintenance and/or restoration of healthy and youthful skin texture.

Clinical efficacy

Hylagen 3 was subjected to *dermatological testing for 28 days, revealing **remarkable anti-ageing effects. Users experienced increased hydration, improved elasticity, and softer skin. 64% of participants were highly satisfied with the texture and feel of the product. The formula was particularly effective in reducing the depth of wrinkles and enhancing skin smoothness.

Botanical extracts provide soothing effects and enhance the skin’s natural healing processes8

Evolution: The ultimate anti-ageing formula

It is the greatest revolution in aesthetic treatment, a unique product due to its formulation that combines three biotechnology ingredients of all three products to deliver unmatched skin revitalisation.

The product exerts its effects on the cell comprehensively upon its introduction into the dermis, functioning in three phases that work synergistically.

Hyaluronic acid (HA) is a crucial component of the extracellular matrix, found abundantly in connective tissues, skin, and synovial fluid. Its unique properties, including hydration capacity and viscoelasticity, play pivotal roles in tissue hydration, lubrication, and wound healing9.

Collagen type III can stimulate fibroblasts to proliferate, meaning it encourages these cells to multiply. This can be beneficial in wound healing and tissue repair10.

Collagen type III also improves the adhesion and migration of fibroblasts, helping them move to the areas where they are needed most. Promoting fibroblast activity, collagen type III can enhance the production of the extracellular matrix, which provides structural support to tissues11

PDRN provides a reservoir of nucleotides, which are the

building blocks of DNA. This helps in the synthesis of new DNA in damaged tissues, aiding in the repair process.

Key benefits

■ Redensifies mature skin and combats loss of volume and firmness

■ Hydrates and improves skin texture

■ Brightens the complexion and reduces hyperpigmentation

■ Strengthens the dermoepidermal junction, ensuring long-term skin resilience

■ Promotes skin barrier repair for enhanced resistance against external stressors

■ Delivers long-term rejuvenation benefits, making the skin appear visibly younger

References

1. Galeano, M., Pallio, G., Irrera, N., Mannino, F., Bitto, A., Altavilla, D., Vaccaro, M., Squadrito, G., Arcoraci, V., Colonna, M. R., Lauro, R., & Squadrito, F. (2021). Polydeoxyribonucleotide: A Promising Biological Platform to Accelerate Impaired Skin Wound Healing. Pharmaceuticals, 14(11), 1103. https://doi.org/10.3390/ ph14111103.

2. Squadrito, F., Bitto, A., Irrera, N., Pizzino, G., Pallio, G., Minutoli, L., & Altavilla, D. (2017). Pharmacological Activity and Clinical Use of PDRN. Frontiers in Pharmacology, 8. https://doi.org/10.3389/fphar.2017.00224

3. Mainardi, L. (2024). Human in use test under dermatological control hyla-pdrn [review of human in use test under dermatological control hyla-pdrn]. EUROFINS Italy: STUN724AA0101-2 EUROFINS Evic France: STUVY24AA0235-1

4. Bravo, B., Correia, P., Gonçalves Junior, J. E., Sant’Anna, B., & Kerob, D. (2022). Benefits of topical hyaluronic acid for skin quality and signs of skin aging: From literature review to clinical evidence. Dermatologic Therapy, 35(12). https://doi.org/10.1111/dth.15903

5. Varani, J., Dame, M. K., Rittie, L., Fligiel, S. E. G., Kang, S., Fisher, G. J., & Voorhees, J. J. (2006). Decreased Collagen Production in Chronologically Aged Skin. The American Journal of Pathology, 168(6), 1861–1868. https://doi.org/10.2353/ajpath.2006.051302

6. Mainardi, L. (2024). Human in use test under dermatological control hyladerm 2% [review of human in

and healthier over time.

For dermatologists and skincare professionals looking to offer premium regenerative treatments, SeduSkin presents an elite solution for modern aesthetic medicine. Whether used individually or in a combined protocol, the SeduSkin range provides a customised approach to skin renewal, making it an asset in the professional skincare industry.

Visit: www.seduskin.com to discover the future of biorevitalisation

Laboratoire GlobalSkin France

Technopole Bordeaux Montesquieu, 4 rue Jacques Monod, 33650 Martillac, France

use test under dermatological control hyladerm 2%]. Eurofins italy: stun724aa0101-1 eurofins evic france: stuvy24aa0235-1

7. Savoia, A., Landi, S., & Baldi, A. (2013). A New Minimally Invasive Mesotherapy Technique for Facial Rejuvenation. Dermatology and Therapy, 3(1), 83–93. https://doi. org/10.1007/s13555-012-0018-2

8. Mainardi, L. (2024). Human in use test under dermatological control hylagen3 [review of human in use test under dermatological control hylagen3].

9. Abdul Bari Hejran, Ashrafi, H., Abdul Qadeer Baseer, Sarwari, A., Abdul Wahid Monib, Mohammad Hassan Hassand, Sayedwali Sediqi, Uzair Mohammad Kakar, Niazi, P., & Mustafa Rahime. (2024). The Importance of Hyaluronic Acid in Biological Systems. European Journal of Theoretical and Applied Sciences, 2(2), 730–743. https://doi. org/10.59324/ejtas.2024.2(2).65

10. Tiedtke , J., Marks, O., & Morel, J. (2007). Stimulation of Collagen Production in Human Fibroblasts [Review of Stimulation of Collagen Production in Human Fibroblasts]. Cosmetic Science Technology .

11. Wang, J., Hu, H., Wang, J. et al. Characterization of recombinant humanized collagen type III and its influence on cell behavior and phenotype. J Leather Sci Eng 4, 33 (2022). https://doi.org/10.1186/s42825-022-00103-5

Figure 3 (A) Before and (B) after 1 session of 0.5 ml of HYLADERM 2% with dermapen

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THE SCIENCE BEHIND PDLLA: NATURAL VOLUMISING WITH A NEW ADIPOCYTE

Professor Kyung-A Byun explains how PDLLA fillers go beyond volume restoration, stimulating adipose tissue regeneration through macrophage modulation and Piezo1 activation, offering a groundbreaking approach to facial rejuvenation

What inspired you to conduct this study?

As we age, subcutaneous white adipose tissue (sWAT) decreases, and adipose-derived mesenchymal stem cells (ASCs) lose their adipogenic potential, leading to facial volume loss and sagging. This study explores whether PDLLA fillers offer more than just volume restoration by potentially promoting adipose tissue regeneration.

How was the study designed?

We used two models: an in vitro senescent macrophage and ASCs model and an in vivo aged mouse model. These enabled us to assess PDLLA's effects on macrophage type 2 polarisation, growth factor secretion (e.g., FGF2), and ASC proliferation and differentiation.

What is the mechanism by which increasesPDLLAsubcutaneous fat volume in aged skin?

When PDLLA is injected, its particles interact with macrophage type 2, altering cell morphology and activating Piezo1 channels. This triggers macrophage polarisation and increases IL-10 secretion, reducing ASCs senescence and creating an anti-inflammatory environment that supports ASCs survival. IL-10 also promotes FGF2 secretion, aiding adipose tissue regeneration. As a result, ASCs proliferate and differentiate into mature adipocytes, increasing sWAT thickness and skin volume. Adipogenic gene expression and sWAT thickness continued to increase over time and were highest at 8 weeks post-injection.

Can you explain Piezo1 in more detail and its role in the mechanism?

Piezo1 is an ion channel that regulates calcium ion (Ca²+) entry in response to mechanical stimuli, activating key cellular pathways. When triggered by PDLLA, it enhances interactions between aged macrophages and ASCs. Increased intracellular Ca²+ promotes macrophage type 2 polarisation, boosting IL-10 expression. IL-10 supports ASCs survival and proliferation, leading to more adipocytes and increased

subcutaneous fat tissue volume.

What positive changes can this mechanism produce in the human body?

Our study confirmed that PDLLA increases adipose tissue volume, restoring skin fullness and reducing age-related sagging. This highlights PDLLA’s potential as a therapeutic agent for

subcutaneous tissue regeneration and rejuvenation.

To view the full study, visit: www. mdpi.com/1422-0067/25/23/12739

References

PROF. KYUNG-A BYUN , Professor, School of Medicine Department of Anatomy & Cell Biology, Gachon University, Incheon, Korea.

1. Byun KA, Seo SB, Oh S, Jang JW, Son KH, Byun K. Poly-D,L-Lactic Acid Fillers Increase Subcutaneous Adipose Tissue Volume by Promoting Adipogenesis in Aged Animal Skin. Int J Mol Sci. 2024 Nov 27;25(23):12739.

Figure 3 Before and After Lenisna treatment. The results are shown 1 month after the 2nd session

Figure 1 (Right) Mechanism of PDLLA increasing the volume of subcutaneous fat in aged skin

Figure 2 (Below) Effect of PDLLA increasing the volume of subcutaneous fat in aged skin

1 MILLION TREATMENTS MAKE EMFACE THE FASTEST-GROWING FACIAL LIFTING PROCEDURE IN THE CATEGORY

Discover how EMFACE has become the fastest-adopted noninvasive facial lifting treatment, while toning facial muscles and enhancing skin quality without injections or surgery

WITHIN THE FIRST two years of its introduction, more than 1 million EMFACE procedures have been performed globally, making it the fastest-adopted non-invasive facial lifting procedure of its kind in history. In the rapidly evolving field of aesthetic medicine, non-invasive treatments have gained tremendous traction, but it is primarily the breakthrough concept of EMFACE that drives its rising popularity.

'The face has always been people's number one concern when it comes to aesthetics,' says Dr Leopoldo de Velasco, a certified dermatologist from Mexico City.

'What we are seeing now, however, is a growing preference for procedures that are not only less invasive but also deliver more natural results. This shift is steering

focus away from traditional interventions that tend to be more aggressive or require injections,' he adds.

Understanding facial ageing beyond the skin

For years, non-surgical facial treatments have primarily focused on the outer layers of the face specifically the dermis. However, deeper facial structures, including muscles, play a crucial role in the ageing process. As muscles lose tone over time, they contribute to facial sagging and the downward pull of the upper tissue layers. 'Imagine this as two opposing forces. We use all these devices to keep the skin tight, but the underlying structure is pulling everything down like a weight. It's a fight we can't win,' describes Dr Peter Peng, ISDS Treasurer and DASIL PresidentElect, Taiwan.

EMFACE addresses these limitations by targeting and toning facial muscles without the need for injections or surgery, transforming the landscape of facial rejuvenation. Dr Carolyn Jacob, a Harvard-trained cosmetic surgeon and boardcertified dermatologist from Chicago, Illinois, explains: 'Treating the skin - whether through resurfacing, injectables, or collagen stimulation - only provides partial improvement. EMFACE is the first non-invasive, hands-free procedure that selectively tones elevator muscles while simultaneously improving the skin, creating a more natural and effective lifting effect.'

How EMFACE works

EMFACE utilises synchronised radiofrequency and high-intensity muscle stimulation (HIFES™) to specifically target facial elevator muscles. Depending on the applicator used, these include the

MUSTAFA KARATAS, MD, owner of a medical aesthetic clinic in Istanbul, Turkiye; CAROLYN JACOB, MD a Harvard-trained cosmetic surgeon and boardcertified dermatologist, Chicago, Illinois, US; LEOPOLDO DE VELASCO, MD, a certified dermatologist from Mexico City, Mexico; PETER PENG, MD, ISDS Treasurer & DASIL President-Elect, Taiwan

Figure 1 A 41-year-old EMFACE clinical study patient demonstrating overall facial lifting. (A) Before and (B) after fourth treatment Courtesy of: Joel L. Cohen, MD.

“By performing EMFACE before, we can achieve more natural-looking results with less filler and toxin. This aligns with the growing trend in aesthetic medicine toward subtler, more natural enhancements."

zygomaticus major and minor, frontalis, anterior belly of the digastric, and the lower portion of the orbicularis oculi.

'By restoring muscle tone, EMFACE helps reposition the face to its youthful structure. This has not been possible with any other energy-based device or injectable,' summarises Dr Mustafa Karatas, owner of a medical aesthetic clinic in Istanbul and one of the first-ever users of neurotoxins and fillers in Turkey. By addressing the foundational structures of the face, the procedure increases cheek volume, smooths facial wrinkles, and lifts the eyebrows.

A versatile and expanding platform

Over the past year, EMFACE has continuously evolved, offering even more possibilities to medical practitioners. The platform now includes two additional procedures EMFACE Submentum, designed for jawline contouring, and EMFACE Eyes for periorbital rejuvenation, targeting eye bags, dark circles and crow's feet. Both double chin and eye bags rank among the top concerns for patients seeking aesthetic treatments. This expansion has made EMFACE one of the most versatile energy-based devices for facial rejuvenation. 'What I like about EMFACE is that it keeps evolving, allowing us to offer more and

more treatments to our patients', shares Dr Jacob, one of the first EMFACE practitioners globally.

Why top injectors choose EMFACE

The aesthetics industry is shifting towards less aggressive, more natural-looking treatments. EMFACE's rise aligns perfectly with this trend, enabling practitioners to achieve noticeable lifting and firming without the risk of overfilling or the frozen expressions often associated with excessive injectables.

According to Dr de Velasco, an internationally recognised trainer

and spokesperson for multiple injectable companies, EMFACE is revolutionising the way injectables are used.

'By performing EMFACE before, we can achieve more naturallooking results with less filler and toxin,' says Dr de Velasco. 'This aligns with the growing trend in aesthetic medicine toward subtler, more natural enhancements. Patients love that they can maintain their facial expressiveness while still looking refreshed and lifted.'

EMFACE has rapidly become a staple in aesthetic clinics worldwide, both as a standalone treatment and as part of

Figure 3 Example of midface volume improvement 3 month after EMFACE treatments. Courtesy of: Charles M. Boyd, MD.

Figure 2 The easy procedure setup makes EMFACE popular among both doctors and patients.

combination therapies. Several leading aesthetic practitioners have praised EMFACE for its innovative approach to facial lifting. Dr Peng highlights its advantages in clinical settings. 'What sets EMFACE apart is its ability to tone facial muscles while simultaneously enhancing skin quality. This dual-action approach provides results that are more balanced and long-lasting compared to traditional treatments that only address one aspect of ageing,' he explains.

Dr Karatas further notes that the treatment is particularly effective for patients in their 30s and 40s who are noticing early signs of ageing but are not yet ready for surgical interventions. 'These patients often seek ways to maintain their youthful appearance without undergoing invasive procedures. EMFACE offers them a powerful, preventive solution.'

One of the standout features of EMFACE is its completely handsfree application, ensuring a seamless and comfortable patient experience. Unlike injectables,

which require precise administration by a skilled provider, EMFACE can be applied without the need for extensive manual manipulation, making it a highly efficient option for busy aesthetic clinics.

Patients report that the treatments are comfortable, often describing the sensation as a mild tingling or muscle contractions. Dr Jacob explains: 'One of the biggest concerns patients have with traditional procedures is pain and downtime. EMFACE eliminates both of those concerns. Patients can resume their daily activities immediately, a significant advantage for those with busy lifestyles.'

Leading the market with 1 million treatments

Now used in more than 90 countries, EMFACE's rapid expansion is a testament to its effectiveness and versatility. It has gained significant traction across North America, Latin America, Europe, and Asia, cementing its status as a leader in non-invasive

“With

over 17 peerreviewed studies and more ongoing research, EMFACE's effectiveness is supported by strong scientific data. As the aesthetic industry shifts away from overfilling and embraces more natural-looking enhancements with reduced filler use, EMFACE aligns with this trend by offering a comprehensive approach to facial rejuvenation.”

facial rejuvenation. Reaching the 1-million milestone at this pace is unprecedented.

'In our clinic, the treatment continues to rise in popularity. Patients are increasingly aware of the role muscles play in ageing. With EMFACE expanding to four unique procedures, we can now treat different areas of the face and neck, attracting an even broader range of patients,' concludes Dr Velasco.

With over 17 peer-reviewed studies and more ongoing research, EMFACE's effectiveness is supported by strong scientific data. As the aesthetic industry shifts away from overfilling and embraces more natural-looking enhancements with reduced filler use, EMFACE aligns with this trend by offering a comprehensive approach to facial rejuvenation. With the recent introduction of EMFACE Submentum and EMFACE Eyes, the treatment now provides full-face coverage. Meanwhile, BTL, the company behind EMFACE, remains

committed to further expanding the platform. Ongoing advancements in protocols ensure that EMFACE stays at the forefront of non-invasive aesthetics.

Experts predict that EMFACE will continue evolving, adding new features to further improve patient outcomes. 'We haven't seen any technology advance this quickly,' says Dr Karatas excitedly. 'This is just the beginning,' says Dr Peng. 'As research progresses, we will likely see even more applications for EMFACE, solidifying its role as an essential tool in modern aesthetic medicine.'

For more information about EMFACE and its revolutionary technology, visit: www.emface.com

Figure 4 Results of the latest EMFACE innovations— EMFACE Eyes. (A) Before and (B) 1 month after fourth treatment. Courtesy of: Melanie Palm, MD.

Figure 5 Results of the latest EMFACE innovations— EMFACE Submentum. (A) Before and (B) after fourth treatment. Courtesy of: Chris W. Robb, MD.

A GROUNDBREAKING APPROACH TO AUTOIMMUNE SKIN AND HAIR DISORDERS

Rose stem cell-derived exosomes (RSCE) offer a groundbreaking, non-invasive approach to managing autoimmune conditions like dermatomyositis and frontal fibrosing alopecia, delivering remarkable improvements in skin health and hair regrowth

DERMATOMYOSITIS AND frontal fibrosing alopecia (FFA) are two challenging autoimmune conditions that significantly impact patients' quality of life. Dermatomyositis, an idiopathic inflammatory myopathy, presents with muscle weakness, distinctive skin rashes, and an increased risk of malignancy. In contrast, FFA is a scarring alopecia, primarily affecting postmenopausal women, characterised by progressive hairline recession and scalp discomfort.

Traditional treatments for both conditions rely heavily on immunosuppressants, which often come with substantial side effects and limited efficacy. Recent clinical cases have demonstrated that topical rose stem cell-derived exosomes (RSCE) offer a promising,

non-invasive therapeutic alternative for managing these conditions.

An 80-year-old man diagnosed with dermatomyositis had suffered from chronic skin rashes and multiple recurrent benign and malignant skin growths for over eight years. His condition was further complicated by calcinosis and severe reactions to prescribed topical treatments, which led to non-compliance and a decline in his quality of life. He experienced significant side effects, including swelling, itching, burning, and stinging, which resulted in depression, exhaustion, and insomnia. Given his intolerance to conventional therapies, he was advised to discontinue all previous treatments and initiate an intensive RSCE topical regimen twice daily. Within two weeks, visible improvements were noted, including reduced inflammation and healing of superficial erosions and ulcerations. By the fourth week, his symptoms had significantly resolved, and

ongoing maintenance therapy with RSCE-based skincare continued to provide relief. Similarly, a 60-year-old woman diagnosed with FFA had struggled with progressive hair loss for over a decade. Despite multiple steroid injections and topical treatments under dermatological care, her condition continued to worsen, leading to atrophic, paper-thin skin along the forehead and severe scalp inflammation.

Recognising the limitations of traditional therapies, a novel approach involving microneedling-assisted RSCE application was implemented. The patient underwent three RSCE treatments at four-week intervals, followed by maintenance therapy every 12 to 14 months. By her second treatment, remarkable improvements were observed, including new hair growth and enhanced hair quality. At her 13-month follow-up, her hair remained significantly fuller and healthier than at baseline, with no

additional treatments required during this period.

Both cases underscore the transformative potential of RSCE in treating autoimmune-related dermatological conditions. The patient with dermatomyositis achieved significant symptomatic relief and improved adherence to treatment due to the absence of adverse effects. Likewise, the FFA patient experienced unprecedented hair regrowth, a breakthrough given that scarring alopecia is typically refractory to treatment. Notably, FFA patients are not candidates for hair transplantation due to the autoimmune nature of the disease, making RSCE therapy a vital alternative.

These are just two of the many cases I have treated that showcase the remarkable potential of RSCE—not only as a game-changer in aesthetic medicine but, more importantly, as a source of hope and lifechanging results for patients in desperate need.

JULIAH TBARANI O'SHEA , MBBCH, BAO, NUI, LRCP, MICGP, CEO/MD, Likha Aesthetic Clinic, Ireland

Figure 2 (A) Patient 10 years after being diagnosed with frontal fibrosing alopecia and treated with sessions of steroid injections and topical prescriptive medicine. (B) 4 weeks after first rose stem cell-derived exosome treatment

Events

Industry events in 2025 for the aesthetic and anti-ageing market

EUROPE

27–29 MARCH 2025

AMWC Monaco 2025 Monte Carlo, Monaco www.amwc-conference.com

29–31 MAY 2025

5-CC World Congress Lisbon, Portugal www.5-cc.com

29–31 MAY 2025

EURAPS 2025

Palma de Mallorca, Spain www.euraps.org

6–7 JUNE 2025

12th Congress of Aesthetic and Laser Medicine

Prague, Czech Republic www.kongres-esteticke-mediciny.cz/en

12–14 JUNE 2025

Beauty Through Science Stockholm, Sweden www.btsstockholm.com

26–27 JUNE 2025

FACE Conference 2025 London, UK www.faceconference.com

1–3 JULY 2025

Annual Meeting of the British Association of Dermatologists Glasgow, UK badannualmeeting.co.uk

17–20 SEPTEMBER 2025

EADV Congress Paris, France eadv.org/congress

REST OF WORLD NORTH AMERICA

24–26 APRIL 2025

ASLMS Annual Conference Orlando, Florida aslms2025.eventscribe.net

29–31 MAY 2025

Vegas Cosmetic Surgery & Aesthetic Dermatology Las Vegas, Nevada www.vegascosmeticsurgery.com

26–29 JUNE 2025

The Aesthetic Show Las Vegas, Nevada www.aestheticshow.com

2–4 MAY 2025

AMWC Asia Taipei, Taiwan www.amwc-asia.com

26–28 JUNE 2025

Plastic Surgery Congress 2025 Sydney, Australia www.plasticsurgerycongress.com

1–3 OCTOBER 2025

AMWC Dubai Dubai, UAE www.amwc-dubai.com

1-2-3 OCTOBER 2025