Cosmetic News May 2012 by webwax

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THE VOICE OF REASON The BACN on dermal fillers

DERMATOLOGY SPECIAL

From skin cancer to skincare protocols, we explore the dermatological side of aesthetics

also inside this issue of cosmetic News A W M C

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Date of Preparation: February 2012 RES/004/0212

NEW RESTYLANE FOR LIPS. IRRESISTIBLE SOFTNESS.

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Welcome to the May issue of Cosmetic News. Last month saw our annual conference and exhibition, the Cosmetic News Expo, taking place in London but as this issue went to print before the show you are going to have until next month to find out what went on! With another successful show under our belts we are now turning our attentions to our other not to be missed annual event – the Aesthetic Awards. Our inaugural awards in 2011 received a phenomenal response and we cant wait to unveil the details of this year’s event which will take place on Saturday December 1 at The Grand Connaught Rooms in London. We will be announcing full details of how to enter in the coming weeks on both www.cosmeticnewsuk.com and in the magazine. Also check out our Facebook page Cosmetic New S and follow us on twitter #cosmeticnewsuk for regular updates. On to this month’s issue… May sees the British Association of Dermatologists and La Roche-Posay launch its nationwide skin cancer awareness roadshow. The UK’s biggest skin cancer awareness tour to date, The Mole and Sun Advice Roadshow will provide thousands of people with free mole and sun protection advice and education from dermatologists, as well as free sunscreen samples. This is such an important issue especially for people working in the medical aesthetics industry who are often on the front line when it comes to providing sun protection advice and treating sun damage. With this topic in mind dermatologist Dr Harryono Judodihardjo explores the link between climate change and the rise in incidences of skin cancer (p45-46) and skin cancer expert, Mr Paul Banwell, has written an article about skin cancer and aesthetic practice (p26-28) . Our Dermatology Special also sees Dr Sotirios Foutsizoglou gives us a comprehensive overview of the role of cosmeceuticals in the combat against cutaneous ageing (p33-40). I hope you enjoy reading what we have to offer this month and as always welcome your feedback. Just email me at vicky@creativemedialtd.co.uk.

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Cosmetic news May

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04 EDITOR’S CHOICE Vicky Eldridge on the VisageH20 treatment

0 6 I ND U ST R Y N E W S We round up the latest industry news

12 NEW SPECIAL REPORT: AWMC We report on the annual AWMC meeting in Monaco

14 ON THE SCENE Out and about in the industry this month

16 PEOPLE IN PROFILE We chat to Allergan’s president for Europe, Africa and Middle East, Doug Ingram

18 VIEW ON The British Association of Cosmetic Nurses gives its View On the current status of the CEN proposals and their potential impact on aesthetic nurses

2 0 T H E B I G D E B AT E Ron Myers on whether fillers are going to be the next industry scandal

2 6 - 4 6 D E R M AT O L O G Y S P E C I A L 2 6 Mr Paul Banwell on skin cancer and aesthetic practice 3 3 Dr Sotirios Foutsizoglou on the role of cosmeceuticals in the combat against cutaneous ageing 4 5 Dr Harryono Judodihardjo on skin safety and climate change

4 8 T R E AT M E NT S P O T L I G H T Dr Ingrid Arion on why the AIS electronic injection system for filling and rehydrating products is not simply a ‘gadget’ but a real asset for practitioners and their patients

50 Q&A We talk to Dr Christine Coffey about the PronoKal diet

5 2 I NN O V AT I O NS We find out about the latest innovation from OXYjet

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c h o i c e VisageH 20

Consumers are becoming more and more demanding when it comes to medical aesthetic procedures and one thing on top of their list is procedures that are pain free and effective with minimal downtime. I am not ashamed to admit that I am one of those people, so when I was offered a chance to try out the new VisageH20 treatment from Carlton Professional it was right up my street. VisageH20 is an innovative machine, which uses Aquabrading®, a combination of high-pressure air and water (Hydrofloral Solution) ‘jetted’ onto the skin. Like microdermabrasion, Aquabrading® offers an effective anti-ageing and rejuvenating treatment, taking the natural process of skin renewal, which slows down as we age, and hastening it. Two modes are available on the machine: Jet and Spray. The Jet mode uses a pen to facilitate the flow of Hydrofloral Solution onto the skin. The strong air compressor accelerates the kinetic energy of the microsized droplets of air and solution. Hydrofloral Solutions are produced as part of the distillation process of essential oil extraction. These floral waters contain water-soluble constituents, with micronised droplets of essential oils suspended in the water. Using the Jet Mode, the outer layer of keratinised dead skin cells is removed, leaving the skin feeling revitalised, energised and soft to the touch. The treatment can be tailored, due to the controllable level of pressure, making it suitable for any skin type from sensitive to oily. This ‘control’ also allows the level of abrasion to be reduced around sensitive areas, such as the eyes and forehead. The Spray Mode uses micronisation of product, via a chosen VisageH20 ampoule appropriate for the client’s condition, to facilitate the transdermal delivery of supplements to the skin. As micronised droplets are only a few microns in diameter they are incredibly easily absorbed for superb results. Used in combination or separately, the Colour Therapy treatment stimulates the skin’s cells to facilitate change. The inclusion of four colours (red, green, blue and yellow) using LED lights and set at varying wavelengths offers a wide range of benefits. For example, green cools and reduces redness, blue reduces swelling and offers antibacterial effects for the treatment of acne, red rejuvenates and stimulates the lymphatic system, whilst yellow tones and smoothes the skin, as well as promoting the production of collagen. The treatment is cooling and soothing but also provides a stimulating effect on the skin. It feels incredibly refreshing and your skin feels amazing afterwards. The experience is also an enjoyable rather than uncomfortable one, which makes it an excellent addition to any aesthetic clinic wanting to offer their patients something non-invasive and pampering without compromising on clinical efficacy.

54 PRODUCT FOCUS We find out about the new Skin Active range from NeoStrata®

58 PRODUCT NEWS We round up the latest product news

Meet the Cosmetic News team Charlotte Body Publisher 01268 754 897 charlotte@creativemedialtd.co.uk

Peter Johnson, Art Director 01268 754 897 peter.johnson@creativemedialtd.co.uk

Vicky Eldridge Editor 01268 754 897 M: 07940 083 677 vicky@creativemedialtd.co.uk

Loraine Winter Designer 01268 754 897 loraine@creativemedialtd.co.uk

Antonia Mariconda visits The Westbourne Clinic

Raechel Waldon Account Manager 01268 754 897 raechel@creativemedialtd.co.uk

Shauna Peters Production Assistant 01268 754 897 shauna.peters@creativemedialtd.co.uk

6 4 DAT E S F O R T H E D I A R Y

Carly Macfarlane Sales and Events Assistant 01268 754 897 carly.mcfarlane@creativemedialtd.co.uk

6 0 A B ST R A C TS We round up the latest clinical studies

62 CLINIC REVIEW

Training course, conference and meeting dates

DISCLAIMER The editor and the publishers do not necessarily agree with the views expressed by contributors and advertisers nor do they accept responsibility for any errors in the transmission of the subject matter in this publication. In all matters the editor’s decision is final.

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News - Industry News

Galderma acquires Emervel Galderma has acquired the award winning dermal filler Emervel® and its technological platform from its partner Symatese. Emervel® is now a 100% Galderma owned product and management of it has already transferred to the Q-Med (A&C) division in Uppsala (Sweden). Production is scheduled to be moved to Uppsala at the end of this year or early next year. “This strategic move places Q-Med, a division of Galderma, in an even stronger position to offer UK practitioners the complete toolkit, covering all needs for both dermal fillers with both Emervel® and Restylane® and botulinum toxin with Azzalure®”, said David Wall. Head of Corrective & Aesthetic Business (UK & Ireland) and Director OTC & Retail (UK & Ireland). “Combined with the further portfolio of dermatology led Galderma products, the company is in a fantastic position to become a true partner to any aesthetic clinic.”

Consulting Room™ poll says NO to cosmetic surgery advertising ban

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In the wake of the PIP scandal calls were made by the British Association of Aesthetic Plastic Surgeons (BAAPS) for a ban on all advertising of cosmetic surgery which they believe as medical procedures should not be

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publicised, in the same way that prescription only medicines such as Botox® are not allowed to be advertised to the public as part of medicines regulations. A ban on cosmetic surgery advertising is already in place in France, however, a recent poll by The Consulting Room™ (www.consultingroom.com) showed that the industry was largely against this, but that regulation around advertising should be tightened.

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68% of respondents said they didn’t agree with the concept of a UK ban on cosmetic surgery advertising. Medical

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advertising of the procedures which can be performed by medics using their surgical equipment or devices were wholly against a ban, as were internet marketers involved in the industry such as those running patient referral websites. One survey respondent summed up the dilemma and commented: “Advertising can be used to educate as much as it can be used to sell. If you remove the option of advertising altogether then it shrouds the procedure in mystery and the public are then unable to educate themselves adequately. They are then entirely reliant on their practitioners to educate them. Rather than banning advertising - change the way in which it is done. Remove the option of special offers - the “bring a friend and get a discount” type offer but don’t stop advertising. Give us (the public) the option of choice.”

Hamilton Fraser signs up to investors in people Hamilton Fraser has recently announced its commitment to work towards achieving Investors in People. In working towards Investors in People recognition, the organisation has signed up to reviewing how effective it is at planning, implementing and evaluating its strategies, as well as making a commitment to continuous improvement. Eddie Hooker, managing director of Hamilton Fraser, said, “Since setting up Hamilton Fraser Insurance in 1996 we have always placed great importance on the wellbeing and progression of our staff. It is a cliché but our staff really are our most important asset. Our company values and culture has always helped to set us apart from our competitors, but in these financially troubling times we felt we needed to manage our growth more effectively and further improve our performance, therefore we turned to the Investors in People (IIP) programme. Using the principles of IIP we have been able to re-focus our attention and plan our strategic direction for 2012 and beyond. The whole process has provided our business with a new energy and most importantly the changes are starting to benefit our people, our customers and ultimately our bottom line.”

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John Telfer, managing director of Investors in People South, said, “I am delighted that Hamilton Fraser has committed to Investors in People and am confident that they will see real business benefits as a result. Research shows that working with Investors in People really enhances business performance, bringing increased employee engagement and benefit to the bottom line. I hope that Hamilton Fraser’s commitment will encourage other organisations in their sector to sharpen their competitive edge by choosing to work within the Investors in People framework.

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News - Industry News

Aesthetic Awards 2012 dates announced Our Philosophy?

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The Grand Connaught Rooms in Central London will be the setting for the second annual Aesthetic Awards. Taking place on Saturday December 1, the glamorous event will have a Moulin Rouge theme and will be a fantastic opportunity to once again celebrate the achievements of our industry. Our inaugural awards in 2011 was received a phenomenal response and we cant wait for this year’s event. We will be announcing full details of how to enter in the coming weeks on both www.cosmeticnewsuk.com and in the magazine. Also check out our Facebook page Cosmetic New S and follow us on twitter #cosmeticnewsuk for regular updates.

Read Cosmetic News on the go While many of us still love nothing more than flicking through the pages of a magazine, nowadays more and more people are reading Cosmetic News electronically. So we are excited to announce that you can now read the magazine on your Android or iOS devices, such as iPhones and iPad. Simply go to www.cosmeticnewsuk.com and register for an account and you will be able to access the current issue and past issues on your phone. Not only does receiving the magazine this way help save the environment by cutting down on printing, but it is also a great way to make sure you have a chance to read our latest issue, even if you are on the go.

iaafa announces details of annual conference The annual IAAFA conference will take place this year on Friday August 31-Saturday September 1. The event is being held at the Royal Society of Medicine and will feature a wide variety of speakers across the two days. Topics include: The use of toxin for alleviating head, neck and back pain (Dr Bob Khanna); How to successfully build facial aesthetics into your practice (Dr Kim Taylor); Liposuction for the head and neck region (Dr Ravi Jain); Recession busting strategies to a successful and prosperous practice (Mr Ashley Latter); 10 keys to a successful clinic – a business perspective (Mr Chris Barrow); Psychology of aesthetics (Dr Lea Hofel); Assessing the patients for facial aesthetic treatments (Mr Jonathan Britto) and The role of social media in an aesthetic clinic – a clinicians viewpoint (Dr Elaine Halley). An exhibition will be held for both days alongside the conference and in addition there will be a Bollywood themed Charity Ball on the evening of Saturday September 1 at the Portman Radisson Hotel in aid of the Make a Wish Foundation. For more information visit www.iaafa.net; e-mail info@iaafa.net or call 01344 891235.

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CODE The Association for Facial Aesthetics (CODE-AFA) is being given a facelift after announcing Martin MacKenzie as its new chief executive. Martin is currently appointing board members as he announces ground-breaking new developments set to transform the AFA for its members in the coming months. “My aim is to re-invigorate the AFA and this will start by updating the website, training modules and the appointment of a new board of dynamic people from across the facial aesthetics industry that include members from both the dental and medical professions”, he said. “Each Board member will bring a specific area of expertise that, when brought together, can speak for the broad range of medical professionals and practice owners that make up our membership.” The new look Association will work hard for members, making its voice heard on key industry issues such as; regulation, best practice and standards as well as forging even closer links with membership and encouraging new people to join. Paul Mendlesohn, Chief Executive of the wider CODE organisation, will be working with Martin. Together they will develop AFA’s strategies and build closer links with other key industry associations to create a louder voice for facial aesthetics and associated industries. Other changes include the introduction of a new consultancy service for medical clinics seeking CQC registration, based on the existing CODE Assure clinical governance system for dental practices. “I want the AFA to remain relevant to members and become an increasingly valuable resource in helping them to manage and grow their aesthetic businesses. I would also like to see the AFA being a forum for members to share tips, ideas and best practice too,” added Martin. For more information contact 01409 254 354 or e-mail martin@the-face.co.uk

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News - Industry News

Medical tourism: 9 out of 10 would do it again

Skinceuticals launches city recovery facial treatment for men SkinCeuticals has launched a new, highly effective facial treatment for men to correct and prevent damaged skin caused by environmental aggressors. The SkinCeuticals City Recovery Facial Treatment tackles the skin issues of the male client exposed to damage triggered by ‘city living’. Free radical attacks, caused by pollution, smoke and UV light can lead to premature ageing and poor skin function and are common place for the average city worker. The treatment is ideal for those who live a high octane lifestyle and need regular, effective, hard-working facials. It consists of deep pore cleansing, extractions and exfoliation using the salicylic and mandelic acid SkinCeuticals SM Gel Peel and SkinCeuticals Clarifying Clay Masque. “I imagine the new SkinCeuticals City Recovery Facial is going to become a great favourite with our clientele”, commented Deborah Gayle, General Manager of The Refinery. “Gentlemen who live fast-paced, dynamic lives tend to suffer with dull and

A major new study has revealed the latest trends in travelling overseas for

dehydrated skin. This new and exclusive facial enables us to deliver a powerful solution,

medical treatment, including cosmetic surgery or dentistry.

whilst at the same time enabling the client to unwind and enjoy a period of relaxation – a

More than 1,000 patients took part in the study, the largest of its kind in the UK

perfect affiliation”.

and Europe. The report, commissioned by independent medical tourism advice site www.treatmentabroad.com, showed that nine out of 10 respondents would definitely or probably go abroad for treatment again and the same number would recommend going abroad for treatment to a friend or relative. 84% would go back to the same doctor, dentist or clinic. 42% of the UK patients in the study went abroad for cosmetic surgery, 32% for dental treatment, 9% for obesity surgery, and 4% for both infertility treatment and orthopaedic surgery. Hungary was the most popular destination for dental treatment (chosen by 38% of UK dental travellers) while Belgium was most popular for cosmetic surgery (18%). Cost was cited by 83% of participants as the most important reason for travelling abroad for treatment. Dental patients also cited the ability to combine treatment with a holiday while cosmetic surgery patients cited worries about hospital infection in the UK. 71% said they had saved more than £2,000 by travelling overseas. 12.7% said they had saved more than £10,000 by going abroad for treatment.

TreatmentsYouCanTrust has unveiled a new look website. www.

This has also coincided with new providers in

TreatmentsYouCanTrust.org.uk has a new design and improved

Leamington Spa, West Bromwich and Kent joining the

functionality to allow the public to easily search for clinics and

nationwide scheme so far this year. They join over 260

practitioners in their area that are appropriately qualified to

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References: 1. Raspaldo H. J Cosmetic and Laser Therapy, 2008;10:134–142. 2. Fischer TC. Poster presented at EMAA, 1–3 October 2009, Paris. 3. Allergan Data on File (DoF), 2011. 4. Allergan Data on File (DoF) Marketing overview, 2011. Instructions and directions for use of JUvéDeRm® vOLUmA® with Lidocaine are available on request. Lidocaine does not affect the intrinsic performances of JuvéDERM® vOLuMA® and its safety profile, therefore, JuvéDERM® vOLuMA® data is representative of JuvéDERM® vOLuMA® with Lidocaine3

Date of Preparation: January 2012 UK/0023/2012

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News SPECIAL - AMWC

In Principality We report on the annual Anti-Ageing Medicine World Congress (AMWC) in Monte Carlo, Monaco

Monte Carlo is known for its glitz and glamour so it is no surprise that the annual Anti-Ageing Medicine World Congress (AMWC) attracts the glitterati of the aesthetics world. The three-day event, now in its 10th year,

treatment regimes for individual patient needs, JUVÉDERM®

is attended by thousands of aesthetic

VOLUMA® with Lidocaine is now available either in a 2x1ml

practitioners from across the globe keen to

syringe package or a 1x2ml syringe, improving flexibility in

find out about the latest European advances

treatment for aesthetic practitioners and enabling injection

and to enjoy a few days in the French Riviera.

with a smoother flow and more precise application compared

Held at the Grimaldi Forum, overlooking the

to a particulate filler. Dr Raina Zarb Adami says “JUVÉDERM®

city’s stunning mountainous coastline, the

VOLUMA® already produces excellent results for my patients,

AWMC, focuses on aesthetic dermatology

so I am delighted to hear about the addition of lidocaine to the

and surgery, anti-ageing, preventive

formula. Not only will this offer my patients a more comfortable

medicine and medi-spa. Elite sponsors

treatment experience, but it may also make the treatment more

included Laboratories Teoxane (Teosyal),

appealing to those people who have previously been nervous

Allergan and Q-Med/Galderma.

about trying facial injectable treatments. I look forward to including it in my portfolio of dermal fillers”.

One of the hot topics at the event was the launch of Allergan’s

Top: Teosyal launched PureSense Redensity 1 at the show Middle: Dr Sach Mohan, Dr Tapan Patel and Charlotte Body Bottom: Raechel Waldon, Charlotte Body, Julia Kendrick, Vicky Eldridge and Janet Kettels

Quality is Key Campaign. The campaign could not have been

Other major product launches included Teosyal PureSense

more timely with the PIP scandal leaving in its wake questions

Redensity 1. The new treatment is designed to redensify the

about the way the aesthetics industry, as a whole, operates.

dermis and is a new

With its portfolio of products including fillers, toxins and

concept between

breast implants, Allergan is well placed to take a lead when

filling techniques

it comes to this issue and the landmark public awareness

and mesotherapy

campaign and education initiative aims to focus on why

to restore the skin’s

quality matters in medical aesthetics, to help proactively

ability to reflect light.

address these concerns and to restore consumer confidence

The treatment offers

in the wider industry (see our interview with Allergan’s Doug

visible and cumulative

Ingram on p16-17 for the full story on the campaign).

results from the first

The meeting also saw the launch of JUVEDERM® VOLUMA®

injection session.

with Lidocaine. This new filler builds on the success of

The 11th annual

JUVÉDERM® VOLUMA®, and is the only product indicated for

AWMC meeting will

volume restoration in a 1ml syringe, providing a lifting effect

take place on April

for facial areas affected by ageing or weight loss. To better tailor

4-6, 2013.

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on the scene

ON THE SCENE Out and about in the industry this month

NeoStrata® Skin Active launch, London Award for Wai Aesthetic practitioners and members of the press were invited to meet NeoStrata’s vice president, Leigh Ann Catlin, and executive director, Catherine Mueller, at a press launch in Knightsbridge for the brand’s latest range – Skin Active. Following an introduction and welcome by Lorna Bowes, director of Aesthetic Source, the UK distributor for NeoStrata®, Leigh Ann, who is the vice president of international business for NeoStrata® Company Inc gave an overview of the NeoStrata® brand as a global success in aesthetic skincare, focusing on the ethos behind the range and its roots and looking to the future by introducing the new technologies and emerging trends. Catherine, who is the executive director of international markets for the company then showcased the new Skin Active range presenting on the new ingredients and technologies it harnesses including: Maltobionic Acid, the next step in Hydroxy-acids; Chardonnay Grape Seed Extract, the new anti-oxidant; Swiss Apple Stem Cell, which promotes skin cell longevity and NeoGlucosamine for building the skin matrix. See this month’s Product Focus for our overview of the new range (p54). Catherine Mueller, Lorna Bowes and Leigh Ann Catlin

Liposonix Model2 System Launch, the Sanderson Hotel, London A champagne and canapé reception was held at the Sanderson Hotel in London to mark the launch of the Liposonix Model 2 system in the UK. Sergio Blumenblat of Solta Medical opened the presentation and introduced the key speakers, Dr Rita Rakus, Dr Anna Gout, personal trainer Matt Roberts and jean guru Donna Ida, before introducing the treatment system and HIFU technology and Dr Rita Rakus and Matt Roberts handing over to Dr Rakus. Dr Rakus presented on the treatment, comparing benefits of the new Liposonix system to the old and recommending the Liposonix Model 2 system as a body contouring treatment. Dr Gout then presented the technology in more detail. Case studies were referred to throughout both Dr Rakus’ and Dr Gout’s presentations. Sergio then presented the results gained from the treatment, whilst encouraging questions from guests. Celebrity personal trainer Matt Roberts then stood to present to attendees on his expertise in health and fitness. Matt described how important it is to be healthy and active, particularly when considering Liposonix, and gave exclusive health and fitness tips. He highlighted the fact that treatment results will be more effective in conjunction with exercise and a healthy diet. Matt said that he was very impressed with the treatment and what it can offer and that he will be recommending it to his clients. Matt then handed over to designer jean guru Donna Ida who presented on the key concerns that women have when looking for their perfect pair of jeans. The presentation was brought to life with Donna’s models who demonstrated different body shapes and jean fits.

Hamilton Fraser’s Cosmetic Insurance Manager, Wai Chan, has won the Central Region competition for the BIBA Young Broker of the Year Award 2012. The national competition is organised by the British Insurance Brokers Association (BIBA) of which Hamilton Fraser Insurance is a member, with each of BIBA’s 13 Regions submitting theirown winner to the finals held in May each year. The award is designed to reflect the importance of ambitious younger members of the broking community, 35 or under, who will shape the future of the industry. In a difficult market, it is an ideal opportunity to recognise and reward our young employees’ excellence, as well as raising the profile of both the nominee and the company they work for. In this respect, Wai will be allowed to use a ‘Regional Winners Logo’ on his letters and emails for the next year to advertise his success to Hamilton Fraser’s clients. As a more tangible reward, Wai will receive a regional prize of £250. Wai now goes forward to the national competition where three finalists from the 13 regions will be selected to attend the BIBA Conference in Manchester on May 16-17. The overall winner will receive another cheque, this time for £1,500 and the two runners-up will each receive another cheque for £500. Hamilton Fraser has also raised £1,173.92 for charity after the cosmetic insurance team took part in the Sports Relief Mile (see below).

The Liposonix Model 2 system treatment machine was a focal point after the presentations and guests were offered the chance to try and ‘pinch an inch’ with Dr Gout and Sergio to see if they would be suitable candidates for the treatment.

For further information about STYLAGE®

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After x3 treatments

Before

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PEOPLE IN Profile - DOUG INGRAM

Quality time

We meet Allergan’s president for Europe, Africa and the Middle East, Doug Ingram, to talk about the company’s latest groundbreaking new initiative – the Quality is Key Campaign

Some people are a pleasure to interview and Allergan’s president for Europe, Africa and the Middle East, Doug Ingram, definitely ranks high up there. I was the last journalist to interview Doug at the end of a very long day at the AWMC meeting in Monte Carlo. He had been sat in a very small, stuffy room having meetings and giving back-to-back interviews for the last few hours, yet he still greeted me with a huge smile and with the same enthusiasm you imagine he had at the start of the day. This is a man who clearly has unwavering passion for his job, so it was no effort for him to wax lyrical about the company’s latest initiative, which embodies everything that Allergan stands for – quality. In the wake of the PIP scandal the entire aesthetics industry has been under both public and media scrutiny with faith in the safety and efficacy of treatments called into question. As a manufacturer of breast implants, botulinum toxin and dermal fillers, Allergan was quick to respond and the result is The Quality is Key Campaign, a three tiered campaign aimed at raising consumer and physician awareness about product quality and at raising standards in the industry as a whole for the future. Here is what Doug had to say…

Cosmetic News: Tell us about your background and your current role at Allergan. Doug Ingram: I joined Allergan in 1996, so I have been at the company for 16 years now. I came from a law firm where I was practising in the area of complex commercial litigation. I thought I would come to Allergan, stay for about a year and a half and then go back to my law firm, that was my goal, but Allergan changed my goals. I am now Allergan’s president for Europe, Africa and the Middle East so I am responsible for Allergan’s regional pharmaceutical and medical device operations, overseeing the company’s strategic planning, marketing, development and general management. CN: What are the major differences between the US aesthetics market and the European, African and Middle Eastern markets? 16

cosmeticnewsuk.com

DI: The number one thing is the complexity of the market outside of the US. The US, of course, is a big market for all of our products – there are 350 million people there, and therefore a lot of healthcare scope and a lot of aesthetic scope – but the US is one market, one language, one regulatory system and one insurance system. Coming out to Europe, Africa and the Middle East it is the opposite of that – the regulatory systems are all different, the cultures are all different, the languages are all different and the products, by country, are different, which makes this a very complex job but which makes it exciting and the reason to get out of bed in the morning. The number of competitor products and potential innovation in this region is also very different to the US. The process for getting medical devices approved in the US is very long and there are pros and cons to that. What it means is that Europe tends to innovate faster and medical aesthetic practitioners are often more advanced. They use products earlier than the US does and they have experience with products for longer, so that is a big part of the difference. Competition is good, it inspires innovation and it makes us better because we have to fight harder to make sure we are serving our customers, however, it has to be the right competition, from the right companies, with the right products and the right commitment to quality.

CN: How do you think the PIP scandal has affected the industry? DI: The PIP issue has been very unfortunate – it has been a global scandal and there has been a lot of harm done to thousands of patients in terms of the stress and fear of what it might mean for them. In the long run, I think things like this could unfairly risk the reputation of the medical aesthetics industry. There has been a lot of media coverage regarding PIP and it is not positive about the medical aesthetics industry at all, so that to me has been a big downside, however, there is a silver lining in all this discourse because it has given the industry an opportunity to raise the bar and to raise the dialogue on medical aesthetics. The initial reaction is always to put additional regulations in place. Without a doubt there is always opportunity to improve and when something like PIP happens it is an opportunity to step back for a moment and reflect on things and enhance the processes and make the process better. But this idea that regulation is going to solve the entire issue is not true. If the allegations about PIP are true they acted outside of the law, they acted criminally, so putting in more laws doesn’t solve that. You just end up restricting the wrong people and people who are willing to violate the law will continue to do so. What we can do is help physicians and consumers make the right choices about the products they are using based on quality, and that is where the Quality is Key Campaign comes in. CN: What was the inspiration behind the Quality is Key Campaign? DI: The Quality is Key Campaign is interesting, is landmark and is ambitious. There are a number of issues that inspired it. As I have said there are a lot of competitor products in Europe so what we did was we stepped back and asked ourselves ‘what should differentiate all these products?’ In our view it should be their quality and that quality is things like how they are manufactured, the amount of money that is investedinqualitycontrol,manufacturingandR&D, auditing and what regulations they fall under and

™

comply with. All of that is the responsibility of the manufacturer.

the medical aesthetics community is as vibrant 10 years from now as it is today.

One of the dangers of all this competition is that people lose sight of the fact that medical aesthetic products have aesthetic outcomes but they are medical, they are being put in the body, and patients deserve their safety to be put above things like profit which, if the allegations are true, is precisely what happened with the PIP implants.

CN: How will the campaign be rolled out? DI: First we have a big, unbranded awareness campaign to consumers. It is going to be web, advertising and public relations led and it is going to be across Europe (UK, France, Germany, Italy and Spain). The goal is to say to consumers there are five questions that you can ask when you go into a doctor’s office that will give you confidence about the product they are using. What products are they using? Why do they use it? What clinical trials support it? Those are the kind of questions.

Physicians have a big part to play because they have to choose which products to use on their patients. Manufacturers historically have not provided physicians with enough information about the quality of their products so they have had to make choices about quality based on statements without facts and marketing campaigns. We have beautiful boxes for our products but beautiful boxes say something about the quality of our boxes, they don’t say anything about the quality of the products. Then we have the consumer. The consumer is going to play a bigger and bigger role in all this. There have been a lot of questions asked on the internet about medical aesthetics following the PIP scandal and there is definitely a loss of confidence in the industry. Patients have questions and they

That in itself is interesting but we would be doing a disservice if we didn’t also answer those questions for the physician so the next part of the campaign is supporting them in the consultation and providing them with the tools and information they need about our products to open up that dialogue with the patient and to make sure they know that they are choosing the right products based on quality.

So what can we do about it? This is the concept of the Quality is Key Campaign. Number one we want to find a way to make a differentiation about the quality of the products. The quality should become the thing that people use to differentiate between medical products, not whose product is the cheapest. Second of all we want to increase the confidence that consumers have in seeking out medical aesthetic treatments and about being able to ask the right questions so that they feel confident that the products that are being used are safe and appropriate for them. Thirdly we want to ensure that

A Revolution in Administering Medically Approved Dermal Fillers • Longer-lasting, more dramatic, natural results • Strategically redistributes the patient’s tissue into facial hollows • Utilizes less filler. Seeing immediate results, most patients request additional syringes • Effective marketing, PR and social media drive clients to our Licensed ArqueDerma™ Practitioners

We spend hundreds of millions of dollars on our manufacturing facilities and they all exceed the standards of not one country but the highest standard of any country. They are all inspected

“The aesthetics business is an extremely important part of our business so we have an invested interest in ensuring that the standard is high”

want to ask them but a lot of patients just don’t know what questions to ask and they don’t think it is appropriate to ask them or they are asking the wrong questions so they don’t feel confident about the treatments. With the advent of the internet and social media and the media interest in aesthetics consumers are asking more and more questions. The good thing about the quality campaign is that we are saying ‘that’s great, ask questions, but these are the right questions to ask’.

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by the FDA. We were subject to 50 audits last year, which involves a lot of work but is exactly the right thing to do. We have got 140 people worldwide whose only job is compliance. We have lots of data we can supply to doctors about research and development because R&D says you know what your product does. We have 160,000 people who have participated in clinical trials for our breast implants. We have great data on our fillers and great data on Botox® involving thousands of patients and thousands of peer reviewed studies. In 2012 we are going to spend just under a billion dollars in research and development so this sets the bar. Now physicians will have that information and now we are treating these products like medical products. Allergan has been around for 65 years so we have seen a lot of things come on to the market and go out, but that is not us. The aesthetics business is an extremely important part of our business so we have an invested interest in ensuring that the standard is high. We are very excited about it.

before

after

Leslie Fletcher, RN, MEP-C, creator and founder of ArqueDerma™ Artistic Restoration Lift™, developed the technique while working with thousands of patients in the U.S. over a ten year period. There are currently 250+ Licensed ArqueDerma™ Practitioners, worldwide. Become a Licensed ArqueDerma™ Practitioner in the U.K. this Spring • April 30: London, Cosmetic News Expo • May 20: Chorley • June 18: London, FACE 2012 • July 29: Chorley • August 26: Chorley Contact Leslie: info@ArqueDerma.com ArqueDerma™ is patent-pending and a registered trademark of InjectAbility™ Institute

www.ArqueDerma.com

VIEW ON

The

v oic e

of reason The BACN recieves its Aesthetic Award for Association of the Year

The British Association of Cosmetic Nurses (BACN) gives its View On the current status of the CEN proposals and their potential impact on aesthetic nurses Unless you have been living under a stone for the past six months or more you will know that there has been increasing frustration and anger amongst aesthetic nurses in connection with a set of European standards being drafted in aesthetics. The CEN – Comité Européen de Normalisation, the Brussels-based European committee handling standardisation – is working towards the development of a Best Practice Standard in Aesthetic Surgery Services (known as EN16372). The CEN has 31 member countries, including the UK. The UK delegation is led by the British Standards Institute (BSI) and a committee has been working on this document for over 18 months. The document will not just recommend best practice for aesthetic surgery but also for non-surgical cosmetic procedures and laser treatments. Sharon Bennett, RGN, NIP, Vice-Chair of the British Association of Cosmetic Nurses (BACN), is representing aesthetic nurses through the BACN, which is deeply concerned that the document - initiated by surgeons in continental Europe - does not recognise nurses or dentists as being suitably qualified or skilled to be included as able practitioners. The Europeans and some UK doctors and surgeons are recommending that only doctors should be recognised as practitioners on this document and that nurses may only work under supervision of a doctor. The draft CEN proposals relating to training are geared towards surgeons and it is not clear on whose authority the European Union of Medical Specialists (UEMS) can lay down specific education requirements for the UK and whether they have consulted with the Royal Colleges and Higher Educational Authorities. Once adopted, a CEN document becomes a European Standard (EN) in the member countries, and in the UK, through the BSI, it then automatically becomes a BS (British 18

cosmeticnewsuk.com

Standard). Standards are adopted voluntarily by

Forum, now dissolved, were responsible for the writing

many organisations to demonstrate that they are operating to best practice and have a commitment to proving the quality of their service. There are, however, cases where standards have been referred to in government guidance and can be cited as a way of complying with legislation – when they are not, as yet, a regulatory requirement.

and publication of the RCN Aesthetic Competencies, a clear, defined and impressive document which has been used and adopted by other disciplines, as well as the RCN Assessment Tool and the Guide to Good Practice. Nurse training in the UK differs hugely from the rest of Europe. UK nurses are given responsibilities within and outside the NHS that our European counterparts are not. Reducing the independent nurse’s autonomy would have a repercussive impact on the delivery of services within the NHS. Following the PIP breast implants scandal it is unlikely that the UK Government will make any statement relating to the aesthetics industry until the completion of Professor Sir Bruce Keogh’s review next March. Therefore, speculation regarding any enforcement role, expansion of the role for the Care Quality Commission, or another independent authority, is currently premature. The BACN urges that cosmetic and aesthetic

What does this situation mean for aesthetic nurses? To exclude nurses from this CEN document, on the basis that they are not skilled or suitably qualified, devalues and harms the reputation of aesthetic nurses and such regulation could lead to aesthetic or cosmetic nurses practising in the UK being unable to work autonomously in their chosen profession. Historically, nurses in the UK have been treating patients with dermal fillers for over 20 years and are the lead trainers for the biggest international companies such as Allergan, Q- Med, Galderma and

“To exclude nurses from this CEN document, on the basis that they are not skilled or suitably qualified, devalues and harms the reputation of aesthetic nurses” Merz. Many nurses in aesthetics are Advanced Nurse Practitioners, have qualifications such as BSc, MSc, Nurse Independent Prescriber (this demands a degree level of education) and have additional dermatology qualifications. To just sweep all nurses aside, preventing them from working in a profession where they have clearly demonstrated their commitment to safe practice and professional development, is unfathomable – and unacceptable to the BACN. UK aesthetic nurses have shown their expertise many times over. The committee members of the Royal College of Nursing Aesthetics

nurses must strenuously protect themselves, work rapidly towards the development and institution of a minimum standard of education and perhaps map it with the documents developed by the RCN Aesthetics Forum. Aesthetic nurses are a highly motivated group of professionals, fully accountable, and doing their very best to follow the Nursing & Midwifery Council Code of Conduct. Meanwhile, Sharon Bennett will continue to represent the best interests of her colleagues in this field and communicate progress of the BSI Committee’s work with the CEN via the BACN.

MEDICAL AEsthEtICs:

itâ&#x20AC;&#x2122;s A Question

of QuAlity

stand 27

At Allergan, we passionately believe in quality. Our 35 years of commitment to science and innovation in medical aesthetics means that practitioners and their patients can make decisions with confidence. We are launching a landmark public awareness and education campaign to help start a conversation between practitioners and patients about why quality matters. Ask your AllergAn representAtive for more informAtion.

March 2012 UK/0326/2012

35 years of quality, science and innovation

Azzalure® Abbreviated Prescribing Information Presentation: Botulinum toxin type A (Clostridium botulinum toxin A haemagglutinin complex) 10 Speywood units/0.05ml of reconstituted solution (powder for solution for injection). Indications: Temporary improvement in appearance of moderate to severe glabellar lines seen at frown, in adult patients under 65 years, when severity of these lines has an important psychological impact on the patient. Dosage & Administration: Botulinum toxin units are different depending on the medicinal products. Speywood units are specific to this preparation and are not interchangeable with other botulinum toxins. Reconstitute prior to injection. Intramuscular injections should be performed at right angles to the skin using a sterile 29-30 gauge needle. Recommended dose is 50 Speywood units (0.25 ml of reconstituted solution) divided equally into 5 injection sites,: 2 injections into each corrugator muscle and one into the procerus muscle near the nasofrontal angle. (See summary of product characteristics for full technique). Treatment interval should not be more frequent than every three months. Not recommended for use in individuals under 18 years of age. Contraindications: In individuals with hypersensitivity to botulinum toxin A or to any of the excipients. In the presence of infection at the proposed injection sites, myasthenia gravis, Eaton Lambert Syndrome or Amyotrophic lateral sclerosis. Special warnings and precautions for use: Use with caution in patients with a risk of, or clinical evidence of, marked defective neuro-muscular transmission, in the presence of inflammation at the proposed injection site(s) or when the targeted muscle shows excessive weakness or atrophy. Patients treated with therapeutic doses may experience exaggerated muscle weakness. Not recommended in patients with history of dysphagia, aspiration or with prolonged bleeding time. Seek immediate medical care if swallowing, speech or respiratory difficulties arise. Facial asymmetry, ptosis, excessive dermatochalasis, scarring and any alterations to facial anatomy, as a result of previous surgical interventions should be taken into consideration prior to injection. Injections at more frequent intervals/higher doses can increase the risk of antibody formation. Avoid administering different botulinum neurotoxins during the course of treatment with Azzalure. To be used for one single patient treatment only during a single session. Interactions: Concomitant treatment with aminoglycosides or other agents interfering with neuromuscular transmission (e.g. curare-like agents) may potentiate effect of botulinum toxin. Pregnancy & Lactation: Not to be used during pregnancy or lactation. Side Effects: Most frequently occurring related reactions are headache and injection site reactions. Generally treatment/injection technique related reactions occur within first week following injection and are transient and of mild to moderate severity and reversible. Very Common (≥ 1/10): Headache, Injection site reactions (e.g. erythema, oedema, irritation, rash, pruritus, paraesthesia, pain, discomfort, stinging and bruising). Common (≥ 1/100 to < 1/10): Facial paresis (predominantly describes brow paresis), Asthenopia, Ptosis, Eyelid oedema, Lacrimation increase, Dry eye, Muscle twitching (twitching of muscles around the eyes). Uncommon (≥ 1/1,000 to <1/100): Dizziness, Visual disturbances, Vision blurred, Diplopia, Pruritus, Rash, Hypersensitivity. Rare (≥ 1/10,000 to < 1/1,000): Eye movement disorder, Urticaria. Adverse effects resulting from distribution of the effects of the toxin to sites remote from the site of injection have been very rarely reported with botulinum toxin (excessive muscle weakness, dysphagia, aspiration pneumonia with fatal outcome in some cases). Packaging Quantities & Cost: UK 1 Vial Pack (1 x 125u) £64.00 (RRP), 2 Vial Pack (2 x 125u) £128.00 (RRP) IRE 2 Vial Pack (2 x 125u) €187.05 (RRP). Marketing Authorisation Number: PL 06958/0031 (UK), PA 1609/001/001(IRE). Legal Category: POM. Full Prescribing Information is Available From: Galderma (UK) Limited, Meridien House, 69-71 Clarendon Road, Watford, Herts. WD17 1DS, UK. Tel: +44 (0) 1923 208950 Fax: +44 (0) 1923 208998. Date of Revision: January 2011.

Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard. Adverse events should also be reported to Galderma (UK) Ltd.

Azzalure® is indicated for the temporary improvement in the appearance of moderate to severe glabellar lines seen at frown, in adult patients under 65 years, when the severity of these lines has an important psychological impact on the patient.

The passage of time

A secret to reveal beauty

Azzalure® is a Botulinum Toxin Type A for aesthetic use. • Fast onset of action (median time to onset 2-3 days)1 • Long duration of action (up to 5 months)1 • High level of patient satisfaction (93% after 6 months, following one treatment session)2

References 1. Azzalure® Summary of Product Characteristics. 2. Ascher B et al. J Am Acad Dermatol 2004; 51: 223-33. Azzalure® is a registered trademark of Galderma. Date of preparation: February 2012 AZZ/005/0212

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an aesthetic choice

the big debate – Dermal Fillers

Notes on a

scandal Y

ou don’t have to look far on a surf around the internet to come across websites and forums with distressing stories from angry and upset members of the public who have experienced the sometimes horrific side effects from what were perceived to be genuine, approved, quality dermal filler products; brand names like Evolution®, Outline®, Bio-Alcamid™ and Dermalive® will be familiar to many of you. Even high profile ‘celebrities’ such as Dead or Alive singer Pete Burns, who received both Outline® and Evolution® in his lips, have suffered from traumatic complications involving surgical excision and reconstructive cosmetic work to get rid of the substances and trauma that they have caused. In this case the practitioner was the one paying the (out of court) damages and not the manufacturer. At The Consulting Room™ we have had a number of emails from people reporting granuloma formation and migration with Bio-Alcamid™. Well known UK cosmetic practitioner, Dr Lisa Delamaine, recently discussed her difficulties with this product in a blog for Consulting Room™, in which she said: “A few years ago I was looking for a solution for my patients who required cheek augmentation and volumising. At the time options for non-surgical treatments were limited. Then I was introduced to Bio-Alcamid™ , a polyacrylamide gel that according to the manufacturers would be the answer to my dreams. As it turns out it has been my worst nightmare. It is a polyalkylimide gel that when injected in the correct volume and tissue plane becomes encapsulated by connective tissue. As a result this prevents the gel from migrating, being non-allergenic and pyrogenic and easy to remove if necessary or required. So you can imagine my horror when patients started to present months to years after their treatment with lumps all over their faces. As it turns out Bio-Alcamid™ does migrate, can cause low grade chronic infection and is extremely difficult to remove if possible at all. This has been the single most horrifying experience in my medical career and has bought me close to giving up the job I love and am good at. But the single most distressing thing about all of this is the total lack of support and advice from the manufacturers of BioAlcamid™. In fact to this day, complete denial that there is anything wrong with their product.” One lady who contacted us following Dermalive® implantation had to have the substance removed by a surgeon, which led to significant scarring. She shared her photos with us as a warning to others. Another filler to appear on the scene with a big fanfare in January 2010 at IMCAS Paris was Novabel® by Merz Aesthetics, who were keen to promote the uniqueness of their product which was made from polysaccharide extracted from marine algae, but following some early UK trials and publicity, unfortunately many on well known UK tabloid journalists, the product was withdrawn from sale in June 2010 due to a few cases of adverse effects on those treated in the infra-orbital area. It is unlikely to return. At the 2012 IMCAS meeting in Paris there was a consensus amongst a panel during a session that over 20% of people experienced oedema from tear trough treatment with dermal fillers, sometimes long

Ron Myers, director of The Consulting Room™, asks whether it is just a matter of time before we have another scandal in the cosmetic industry when it comes to dermal fillers term. Yet many practitioners still offer this as a treatment using dermal filler brands as manufacturers often mark the indication as appropriate for their products, yet they seldom train practitioners in this application. One doctor at the meeting also mentioned that the injection of a dermal filler product into the temporal area had resulted in a case of blindness. Additional clinical papers back up such stories including a case in South Korea reported as recently as November 2011 of an HA filler used for nose augmentation which resulted in ocular ischemia with hypotony, with problems persisting after a six month follow-up. Similarly, a case reported in August 2011 in Canada, noted blindness and opthalmoplegia (eye muscle paralysis) following treatment of a peri-orbital region with subcutaneous poly-L-lactic acid. Such incidents, although rare are truly scary for any practitioner. Whenever I go to IMCAS in Paris, I’m always amazed at the number of new dermal fillers that I see being promoted in the exhibition hall; brand X, Y and Z are added to the seeming over supply of products now available for European clinics and practitioners to buy, as the market appears to have been saturated for years now. Yet it can be argued that more danger lies in counterfeit or generic products, most often manufactured in China and sold either direct to physicians around the world (dare we say unscrupulous ones with cost saving and not their patients in mind), most commonly via unsolicited fax and e-mail messages, or direct to consumers through online retailers who will kindly give you all the DIY kit, including a helpful video, and let you get on with it in front of your bathroom mirror! Who knows what substances are in these, let alone the potential complications from self-injection by a nonmedic. In a recent interview with The Times newspaper Sally Taber, head of the Independent Healthcare Advisory Services (IHAS) said: “The next thing will be that a patient will have a dangerous dermal filler that’s come in from China and it will be ‘how on earth did we let this happen?’ We need to work together to cut out some of the appalling practice.”

Post Dermalive Surgery cosmeticnewsuk.com

the big debate – Dermal Fillers So is it just a matter of time before this erupts like the PIP scandal? Chatting to a doctor at IMCAS 2012, they summed up the recent furore concerning PIP breast implants by saying that “patients receiving these have lost trust in their surgeons and surgeons have lost trust with the suppliers”. No relationship or industry can function effectively where there is a lack of trust on either side.

So are we ‘this’ close to a public dermal filler scandal?

A QUESTION OF TRUST It’s not just the products, which are to blame; providers might not be all they’re cracked up to be either... Dermal fillers can provide fantastic results in the right hands, and disastrous, sometimes permanent disfiguration in the wrong ones. For consumers buying cosmetic treatments like dermal fillers, most will reasonably trust (without questioning) that the clinics offering these treatments have practitioners that: 1. Are appropriately ‘qualified’ to deliver dermal filler treatments. 2. Have been adequately trained and assessed in the use of dermal fillers for all of the areas that they inject (i.e. lips, tear troughs, mid-face volumising etc.). 3. Are using the right products for the correction required. 4. Are using hygienic methods for delivery (i.e. not saving partially used syringes of fillers from previous patients!) 5. Are adequately insured. 6. Buy CE Mark approved products from approved distribution routes. In turn the practitioner or clinic must trust that: 1. Their supplier has gone through the proper testing and European registration process for their filler product. 2. The product is manufactured according to the registration standards requirements. 3. The batches are being regularly checked and monitored for quality.

No one is suggesting that dermal filler manufacturers might be embarking on fraudulent or illegal activity such as has been seen with the PIP breast implant manufacturer, who post CE Mark approval deliberately substituted the medical grade silicone used in production for a cheaper industrial grade concoction, but there is nothing really to stop it happening again. With so many dermal filler manufacturers out there, all with CE Mark approved products and a lack of scrutiny by the European CE regulators, as demonstrated with PIP, it could be quite simple and tempting in such a price sensitive marketplace for someone to cut corners. And what would happen if a batch of a product was found to be contaminated or adulterated? What could even be done? Not a lot. With no central register of dermal filler treatments it would be practically impossible to link up affected batch numbers with patients; individual clinics would be required to check their own data and for most that would be an admin nightmare and difficult to gather as even electronic patient record software is not designed to pull out records of patients by product batch numbers. Even if all the people affected were ‘found’, unlike a breast implant which is an encapsulated object which can be removed, filler substances are simply not easy to remove – think of all the horror stories in America where industrial silicone has been injected into unsuspecting people who have either died or faced agonising surgery to have it removed. If what the PIP company did was done by a well-known and widely used dermal filler manufacturer the consequences simply wouldn’t bear thinking about and would make the 50,000 affected PIP patients look like a drop in the ocean! In reality in the UK, because dermal filler treatments are regulated as medical devices, no formal separate regulation is required in order to set up an injection service, the manufacturers have no control over the commercially organised training programmes and little control over distribution of their product; it’s becoming increasingly possible for someone to fall into the hands of a non-medically qualified practitioner who is using products derived from the Internet after a few hours ‘training’ with limited or no insurance cover. The TreatmentsYouCanTrust register of cosmetic injectable providers can help lead people through to clinics that operate to a certain level in terms of standards, but it still doesn’t guarantee a good result and it’s not a mandatory scheme. Many people have discussed this for a number of years, but the market has run away with itself without proper checks and balances relating to the basics in how these products are used. Company representatives will tell you that even some people who have been involved in the industry for a number of years may still be poor injectors as there 22

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simply isn’t any validation of injection practice going on. It’s easy for people to kid themselves that they’re doing it ‘okay’, but when you hear stories of scary complications such as blindness, it brings it home somewhat. Knowing how to use a product (or a number of products) for a wide range of indications is paramount, a training course on nasolabial lines isn’t going to make a practitioner skilled in contouring lips, treating under the eye or attempting deep volumisation, all of these indications are potentially difficult and fraught with problems so a lack of adequate training in the main and cross product use (assuming training in one product applies to any new product they decide to buy and use) is something to be taken seriously. Other problems are starting to arise from the practice of product layering, both intentionally and by a lack of adequate patient history taking or patient knowledge of previous product use. Practitioners are known to have layered, for example, Sculptra, Radiesse® and HAs without really knowing what, if any, problems might occur; the manufacturers simply don’t know either as there is no evaluation of scientific data on this practice being carried out. The assumption that if ‘Product A’ is safe and so is ‘Product B’ and thus if you use them both in the same place it’ll be fine, is perhaps a little naive, if not a little irresponsible as we simply don’t know that to be true. Additionally with stories of HAs being mixed into the same syringe as botulinum toxins, we might as well be going back to the days of alchemy as practitioners seem to be experimenting somewhat to find ‘gold’ within cosmetic injectable treatments! Add to that the cut-throat nature of competition within the industry and the drive of marketing a new technique, something different to distinguish themselves from other clinics and practitioners, the kudos of being an industry leader and all the opportunities for training revenue that it can bring and practitioners will ‘play’ somewhat to come up with the next best use, method or combination treatment. Often this is embraced by the manufacturers themselves, who get swept along in a media frenzy and back the practitioner and their new ‘fantastic thing’ without always knowing the scientific implications behind it. Surely the industry is ‘this’ close to a fall-out...

So how can we raise standards and protect consumers? In the United States there are currently 16 Food & Drug Administration (FDA) approved dermal filler brands/products, (six of which are no longer commercially available due to obsolescence). Approved brands include Restylane®/Perlane, Juvéderm® (Ultra, Ultra Plus, XC), Belotero® Balance, Elevess, Sculptra Aesthetic, Radiesse®, Prevelle Silk and Captique. Several of these are not available in the UK as yet and other well known brands are marketed under slightly different names, and/or compositions. That is to say, those which are approved by the US regulator can be commercially marketed and sold by manufacturers and distributors and then used by practitioners on patients. The use of all other, non-approved products (unless specially dispensated within a clinical trial environment) would be considered to be illegal and practitioners could face prosecution. However, when it comes to the UK and Europe, we simply don’t have an

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the big debate – Dermal Fillers exact number of the ‘approved’ or CE Marked dermal filler products that are available to buy and use within the European Union; estimates range dramatically from 150 to 250 individual product brands stemming from all over the world. In the UK, there are approximately 16+ known brands in widespread use, available through the primary pharmacy supply chain. In the USA, FDA approval of dermal filler products is based on the review of data collected from controlled clinical studies that evaluated the safe and effective use of the products when injected into the nasolabial folds. Some of the temporary products are approved for the ‘correction of moderate to severe facial wrinkles and skin folds’ which includes marionette lines and crow’s feet. The FDA has also approved one filler for lip augmentation in patients over the age of 21. However they have not approved dermal fillers to augment (volumise) or alter the shape of cheeks or noses or rejuvenate the hands. This increased regulation over the EU in itself doesn’t represent the Holy Grail of safety nets as complications may occur from a filler product which is perfectly suited to use in the naso-labial region but would be ill-advised to be used in say the lips or infra-orbital regions and many US practitioner will use an approved filler in an off-label indication. In Europe, fillers are classified as medical devices and thus clinical trial data requirements are much less rigorous, certainly when compared to our medicines regulations, in fact the CE marking relates more to the production methods of the product than it does its safety and efficacy when used in humans. Because of this some people within the industry are therefore advocating that UK practitioners should only use those products which are also FDA approved, more clinical data, more evidence of safety and long term efficacy has got to be good, right? Yet many of the now FDA approved dermal fillers only got their body of evidence for approval application from decades of use and trial data in the European market, take Restylane® as a prime example. So there are clearly issues with both regulatory models and neither is perfect. Additionally there have been calls by the industry for dermal fillers to be reclassified as medicines (prescription only) which would make them subject to much stricter regulations in the UK and Europe, both in terms of product scrutiny as well as providers. This would need legislative changes on a European level for the UK to be able to implement this, something which it is feared by many to be an impossible task. When it comes to practitioners offering dermal fillers it’s a simple case of ‘who’ and ‘how’. Who should be providing such treatments in the first place and how should they be adequately trained in order to do so. Predominantly dermal fillers have always been provided in the UK by doctors (including dermatologists and cosmetic surgeons), dentists and registered nurses. This stance is very much backed by the main manufacturers of wellknown brands. Yet there is currently no legislation to uphold this practice and ‘anyone’ can offer them to the public, with little to no recourse. With no real regulation in this area, BABTAC, the industry body for beauty therapists is now making a case for them to been seen as reputable practitioners when it comes to dermal fillers, quoting those with experience in electrolysis and micropigmentation as the most ‘qualified’ to undertake filler treatments. Their magazine for February/March this year stated: “BABTAC is keen to be involved in the development of a level 4/5 (NVQ) qualification for suitable practitioners, including therapists to train practitioners to have all the necessary skills to carry out safe and effective injectable cosmetic procedures”. Conversely the recent public draft of the new European CEN Standard for Aesthetic Surgery Services is causing widespread controversy as this document currently states that nurses and dentists should be excluded from providing dermal fillers, unless under the supervision of a medical doctor. So if Europe wants even the medics split down the middle and only doctors to perform dermal fillers treatments, surely the beauty therapists stand little chance of acceptance. But again, when the standard, once ratified, comes 24

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into existence, it too won’t be a mandatory requirement, just a ‘best practice’ aim for those clinics wishing to be heads above the rest.

So what are the practical solutions? At the start of 2012, the TreatmentsYouCanTrust Governance Group announced seven challenges that it would be targeting in the future. Some of these related to dermal fillers and included the reduction in the number of dermal fillers available in the UK market, citing the worry that stricter guidelines are not in place to evaluate the safety data relating to dermal filler products. The restriction of the foreign supply of dermal fillers to the UK, where they noted that non-CE marked dermal fillers or even counterfeit versions of established leading brand names are also promoted via Internet shops from the Far East providing additional concerns regarding patient safety. And the need to track the use of dermal fillers amongst appropriately qualified providers, pointing out that several manufacturers including Merz, Lifestyle Aesthetics and Allergan all have on the side of the boxes of their respective dermal filler brands that they should only be supplied to doctors and nurses. The challenge is how this distribution can be monitored to restrict the use of their products by beauty therapists. There is currently no formalised, approved training in dermal fillers and manufacturers lost control of this many years ago as private training course companies and independent doctor/nurse trainers took over. Although the TreatmentsYouCanTrust scheme and insurers such as Hamilton Fraser will only recognise competence from qualifications obtained from a certain number of ‘approved’ trainers for inclusion in the injectors register or for medical indemnity insurance, this doesn’t mean that there isn’t a wide range of courses available out there with no agreed guidelines, verification of ability or a control on product supply and insurance for attendees. And what if you were trained a decade ago? No one asks you to retrain. Many practitioners will attend conferences each year or small group workshops where they can top up their CPD points but this isn’t a requirement in order to offer dermal fillers to the public. When the FACE meeting first started, almost a decade ago it was all about filling lines and folds, now it’s all about volumising and facial structure rather than just tracing a line with a needle and syringe. If practitioners don’t retrain and continue to learn this can only breed poor practice and complacency. To reduce the risk of trauma and potential harmful effects from the administration of dermal fillers, particularly for HA use, many are now advocating the use of blunt cannulae instead of sharp needles. A cannula will glide along connective tissue fibres instead of actually puncturing them like a needle, thus are considered to be less traumatic and less invasive as it’s more difficult to damage a blood vessel with a blunt cannula. Similarly, some practitioners are now using assisted injection systems such as Nordson’s Artiste, or the Anteis Injection System as an additional tool to help deliver product into the skin. These new delivery options are not liked by all experienced practitioners, and may not be suitable for all indications, but may well prove to be a useful solution to reduce the incidence of complications. And what about learning about problems? How many practitioners for example learn about the effective use of hyaluronidaise for the dissolution of HA fillers? How many practitioners know what to do when a complication arises from a filler product or who the experts are to turn to for help? The implementation of a referral service may mean that unfortunate patients get a satisfactory resolution much quicker. As well as learning about problems and how to deal with them, there is an argument for learning from problems. A centralised reporting mechanism for adverse events occurring through the use of the many dermal filler products may stop continued use of products by unsuspecting practitioners who have just been sold the next ‘Bio-Alcamid’. Unless we get things sorted within this field, we are definitely in danger of adverse media publicity, sooner rather than later!

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dermatology special - Skin Cancer

A growi n g

co n c ern Mr Paul Banwell and Dr Natasha Wielogorska on skin cancer and cosmetic practice

A Mr Paul Banwell Paul Banwell is a plastic and cosmetic surgeon based in the South East. Paul has developed an international reputation in the fields of cosmetic surgery, skin health and skin cancer and lectures worldwide on these subjects. He has published extensively and is a visiting professor of Plastic Surgery to Harvard Medical School. He has been listed in the Times Magazine as one of the UK’s Top 100 Doctors and is a familiar face in the national media both on TV and in the Press.

ll doctors and nurses practising cosmetic medicine should be aware of the potential threat of skin cancer and be able to offer patients sound advice and a referral pathway to a skin cancer specialist if required. Furthermore, integrating skin health advice and treatments should form the cornerstone of any cosmetic medicine practice and offers many benefits for both patients and practitioners alike. In this article, Mr Paul Banwell, consultant plastic and cosmetic surgeon and skin health expert, along with one of his team Dr Natasha Wielogorska, discuss skin cancer facts, the merits of patient education and the benefits of alliances with fellow health professionals.

Introduction As the cosmetic medicine arena grows exponentially, practitioners are always (and should be) looking to expand their offering and exploring new ways to improve their practice. At the same time, patients are becoming more discerning and are constantly looking for quality indicators and value-added benefits from their practitioner. Whilst traditionally the focus has been on non-surgical skin treatments for ‘anti-ageing’, there has been a subtle paradigm shift to now discussing and treating ‘skin health’ in a more holistic fashion. Mr Banwell’s personal ‘Skin Health Matrix’ includes not only the traditional modalities of advanced skincare (cosmeceuticals), microneedling, fillers and toxins, to name but a few, but also focuses on the important role of prevention and patient education in skin cancer. Teaching patients about their skin, with a particular focus on sun safety and skin cancer can be, not only rewarding, but helpful

in reinforcing the reasons for recommending ‘skin health’ treatments in the first place (with concomitant business benefits). Furthermore, early recognition of pathological skin conditions is vital and cosmetic medicine (skin health) practitioners are in a unique position to screen, diagnose and refer. When to treat or not to treat a pigmented patch on the face is a critical decision – for instance, recently Mr Banwell has had to manage someone who was having ‘cosmetic’ laser treatments on a melanoma for a couple of years!

Skin Cancer Facts Skin cancer is the most common cancer in the Caucasian population (ahead of breast, lung and colon). In the UK there were over 85,000 nonmelanoma skin cancers (NMSC) and over 11,000 melanoma skin cancers diagnosed in 2007. If we compare these to the 2000 figures, where 62,200 NMSC were diagnosed, we can see an exponential increase. Furthermore, the WHO estimates over 130,000 newly diagnosed cases of melanoma worldwide per annum, a figure which is undoubtedly increasing due to continuing detrimental changes in the ozone layer and continuing lack of sun exposure precautions. The American Association of Dermatologists have translated their estimations into plainer figures: in the US one person dies every hour from melanoma, a cancer that only represents 3% of all skin cancers in America. These figures are more worrying if we consider that melanoma can be treated if caught early. If rates of skin cancer are rising, climatic impact intensifying and individual accountability remaining

Table 1: Seven point checklist for suspected malignant melanoma Major signs • If an existing mole gets larger or a new one is growing • If the mole has an irregular outline • If the colours are mixed shades of brown or black

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Minor signs • If the mole is bigger than the blunt end of a pencil • If it is inflamed or has a reddish edge • If it is bleeding, oozing or crusting • If it starts to feel different: for example, itching or painful

What to look out for

“What is most difficult of all? It is what appears most simple; to see with your eyes what lies in front of your eyes.” Goethe The major and minor signs mentioned in Table 1 can be a screening tool for suspected abnormal moles. However, an alternative schemata concentrates on pattern recognition – the so-called A,B,C, D,E approach -ASYMMETRY, BORDER, COLOUR, DIAMETER, ELEVATION.

5 1 Asymmetry means that one half of the mole does not match the other half 2 Borders may be ragged, altered or blurred 3 Different colours within the mole 4 Diameter – moles that are larger than a pencil should be checked out by a doctor and if necessary referred to a skin specialist. As a point of note, benign moles are usually less than 6mm in diameter 5 If moles change in size or become raised (elevated) – refer!

Examples of skin cancer Melanoma

Squamous cell carcinoma

Basal Cell Carcinoma

low, we have an expanding public health issue. Currently plastic surgeons, dermatologists and general practitioners represent the main triad of education, identification and early treatment; however, perhaps it is cosmetic practitioners who should also be at the forefront of screening and patient education too as the majority of their patients are being treated for the effects of photodamage.

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Skin Cancer Types Skin cancer comprises both melanocytic and nonmelanocytic lesions. NMSC includes Squamous Cell Carcinoma (SCC) and Basal Cell Carcinoma (BCC). SCC is often preceded by precursor lesions which have a metastatic risk of 0.5-3.3%. Once a SCC is established, the metastatic risk ranges from 0.5-40%, whereas BCCs (the most common of all cancers) arise directly as slow growing, locally invasive lesions with an extremely low metastatic potential. Melanomas occur less frequently but carry higher risk of metastasis and death and may occur in the younger population (melanoma is the second most common cancer in the 20-39 age group). They often evolve from pigmented nevi (moles) but can initiate in any melanin (pigment)-containing tissue, particularly in areas of successive sun exposure. It is therefore the melanomas that need to be identified early as well as their precursor lesions – lentigo maligna and dysplastic naevi.

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Skin Cancer Aetiology The development of photodamage and cutaneous malignancy is multifactorial and strongly related to UV exposure. Although all forms of UV radiation have carcinogenic potential, UVB is known to be more potent than UVA and effects damage directly on cellular DNA. Chronic sun exposure patterns are more associated with development of SCC, as opposed to episodic sun burning which is linked to development of dysplastic naevi and melanoma. Other risk factors include increasing age, genetic susceptibility, immunosuppression, some cutaneous conditions and constitutional factors such skin colour (especially Fitzpatrick Skin types I & II) and number of typical and atypical nevi. Sun beds merit separate mention as they deliver intense, concentrated UV radiation and there is NO place for their use – a report by Cancer Research UK demonstrates an increased risk of melanoma of 75%! Despite increased awareness of skin cancer and the need for modified behaviour to UV exposure, skin cancer rates continue to rise – it is therefore vital that we as health care professionals reinforce the important message of daily sun protection and use of SPFs.

Premalignant Lesions Premalignant lesions include Actinic Keratosis (AK) and Bowen’s disease (BD) which lie on a spectrum of photo-related lesions between photo-ageing and SCC. Of course, not all precursor lesions develop into invasive

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UVB skin radiation could reduce cancer development risk. Studies emphasising the disparity between intentional sun protection use and actual application demonstrate the need for SPF to be included in daily moisturisers as part of national skin cancer prevention. Recent studies suggest we are still losing the behavioural battle as secondary school age students report poor sun protection use despite being well informed about skin cancer risk! There is some good evidence to support use of topical products such as retinoids, anti-oxidants, vitamin C and E to reduce the carcinogenic potential of UV exposure. The evidence for use of cosmeceuticals and chemical peels to promote skin health and reduce the risk of malignant transformation is therefore gaining tremendous support.

Cosmetic Practitioners asi gatekeepers Sun beds are a no-no

Have a higher index of suspicion in patients with lots of moles

Examples of actinic keratosis (AKs)

carcinoma. AKs are the most common dysplastic epidermal lesions, with a prevalence of up to 60% of adults over 40 years old. They present as areas of crustiness which may exhibit cyclical episodes of falling off then re-occurring The risk of progression from a singular AK to malignancy is low; however, risk increases with the number of lesions and the degree of field change or regional photodamage. AK can be graded on a clinical scale which can guide treatment such as cryotherapy, curettage or medical treatments. However, if these lesions recur despite these modalities it is likely they are more active and will require more urgent action with surgery. In comparison, Bowen’s disease is Squamous Cell Carcinoma In Situ (CIS) and will ultimately progress to invasive carcinoma if untreated. Bowen’s presents as red erythematous plaques with crusty areas and can sometimes be mistaken as psoriasis.

Treatment

Bowen’s disease of the leg

“Ultimately, cosmetic practitioners are in an excellent position to promote skin cancer awareness”

The mainstay of treatment for skin cancers is usually definitive excisional surgery but medical treatments (solarase, 5-fluorouracil, imiquimod and photodynamic therapy) are increasingly being employed for pre-malignant lesions (and for some skin cancer subtypes such as superficial BCCs).

Prevention

The mainstay of treatment for skin cancers is usually definitive excisional surgery

Examples of medical immunomodulants: Efudix and Aldara 28

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In response to the global increase in skin cancer, it is increasingly important for cosmetic practitioners to have an awareness of premalignant and malignant lesions, including metastatic risk. As treatment modalities broaden, the evidence for topical treatments in combination or as field therapy offers potentially more efficacious treatments, with excellent cosmetic effects. Additionally, accelerating trends combined with behavioural downfalls suggests we are all are not doing enough to emphasise the importance of the use of SPF and sun avoidance. Ultimately, cosmetic practitioners are in an excellent position to promote skin cancer awareness and

Despite effective treatments, prevention represents a key role of the cosmetic practitioner. Primary prevention through sun avoidance, use of protective products and education, is the most effective intervention in reducing the risk of photodamage. Despite an established link between cutaneous malignancy and sun damage, there are still considerable failings in peoples’ attitudes. Sunscreen has been shown to reduce incidence of SCC and precursor lesions. Furthermore UVB-induced genetic point mutations have been identified in the development of BCC and SCC, suggesting reducing

behavioural change secondary to patient education. Emphasising the importance of sun protection and the link between photoageing and skin cancer development is crucial – sun creams truly are antiageing! Additionally, by keeping up to date with the beneficial effects of many cosmeceuticals and chemical therapies means practitioners can better inform treatment choices. Lastly and perhaps most importantly, links with specialists in skin cancer (plastic surgeons or dermatologists) will facilitate a streamlined pathway for your patients should any adverse pathology be picked up. This link and pathway inspires confidence in patients and can further enhance the quality and scope of your practice.

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dermatology special - Skincare Protocols

A comprehensive guide to

skincare Dr Sotirios Foutsizoglou on the role of cosmeceuticals in the combat against cutaneous ageing

Dr Sotirios Foutsizoglou Dr Sotirios Foutsizoglou is the medical director of the London Slimming and Cosmetic Centre and founder of SFMedica. He is a full member of the British Association of Cosmetic Doctors (BACD) and a member of the European College of Aesthetic Medicine (ECAM), Society of Cosmetic Physicians and Surgeons and International Academy of Advanced Facial Aesthetics (IAAFA). He works as a cosmetic surgeon and non-surgical aesthetic practitioner with expertise in the areas of cosmetic dermatology, medical slimming and cosmetic injectables, among others. His work has been published in various Greek, UK and French magazines, journals and newspapers.

kin ageing is a multi-factorial complex biological process that cannot be halted. However the right combinations of high-potency skincare regimens have been proven to provide anti-ageing benefits through the synergistic effects of their active ingredients and the diverse range of their mechanism of action. The regimens below reflect my experience in the use of high quality cosmeceutical products (Table 1) in the field of cosmetic and anti-ageing medicine that are suitable for all skin types and ages. The recommended products have been used by a large number of people with a variety of skin problems producing excellent results. This is a chart developed to provide general guidelines for using preventive, protective, and corrective products and is intended for use as a guide only. Skincare protocols may vary considerably depending on the individual’s age, skin type and problems. Prior to customising a skincare protocol based on the patient’s skin needs I cannot stress enough how important it is to allow for plenty of time –preferably at the first consultation - for a thorough skin analysis and an honest discussion with regards to their expectations and concerns, why the particular products are recommended and the logic behind them in lay terms, how they need to be used and in which order (both in writing and verbally), how long it will take them to start seeing results, and any potential side effects – be ready to modify your recommended protocol if side effects develop (e.g. intolerance due to skin sensitivity, hyperpigmentation, etc) or no signs of improvement are noticeable after at least a couple of months of continuous use. It also needs to be emphasised that skincare is a lifelong process and not only for a short period of time. Before and after pictures are highly recommended; that can save practitioners from complaints and dissatisfied clients. Morning regimen

Table 1. Features of a good quality skincare formula

4 Highly stable 4 Lightweight formula 4 High epidermal penetration 4 Fast absorbing 4 Safe to use 4 Well tolerated 4 pH balanced 4 Non-drying, nonsensitising and nonirritating 4 Non-acne aggravating and non-comedogenic 4 Dose-dependent potency

4 Synergistic action 4 Helps protect DNA against oxidative damage 4 Delivers anti-ageing and corrective benefits 4 Noticeable and sustainable results 4 Fragrance-free 4 Paraben-free 4 No petrochemicals 4 Preservative free 4 Cost-effective 4 Contained in a glass clear bottle

Table 2. Skin conditions that can be effectively treated with high-tech cosmeceuticals

Dehydration Dry, Flaky skin Eczema Psoriasis Loss of Moisture Photoageing Premature Ageing Thin Skin Fine Lines Wrinkles Loss of Elasticity Rosacea Sensitive Skin Redness Dilated Capillaries Broken Capillaries

Pigmentation Melasma Age Spots Sun Spots Uneven Skin Tone Blemishes Dull Skin Congested Skin Problematic Skin Rough Texture Tired Skin Overly Oily Skin Clogged Pores Blackheads Whiteheads Acne

First Step: Cleanse and Tonei Cleansers Ideally a cleanser should remove impurities and make-up without damaging the skin, as well as controlling the sebum production. Reducing sebum production is of paramount

importance, particularly in oily skin as sebum reduces the efficacy of topical agents and may increase the rate of complications following procedures. Therefore, for acneprone skin, I favour the use of an exfoliating daily wash, such cosmeticnewsuk.com

dermatology special - Skincare Protocols as the Foaming Glycolic Wash (AHA 20) by Neostrata or the Purifying Foaming Wash by SkinMedica, which combines 2% salicylic acid (i.e. a beta-hydroxy acid (BHA) with keratolytic activity) with 2.5% benzoyl peroxide (i.e. an antibacterial agent against Propionibacterium acnes). For all skin types including ageing and sensitive skins I would recommend either the Cleanse or the CLEANSING GEL by HydroPeptide which combine mild exfoliating agents (i.e. AHAs) with numerous peptides that help reduce wrinkles and fine lines.

4 Cleanse and the Cleansing Gel by HydroPeptide

Tip: HydroPeptide® Cleanse contains massaging Jojoba beads that should be gently massaged with small circular motions on dry or damp face for one to two minutes while cleansing. This allows for its peptides to penetrate the skin while cleansing and exfoliating.

For normal or dry skin a light cream cleanser or lotion is needed preferably with a moisturising formula to gently cleanse the skin and leave it smoothly textured. A good combination would be hydroxy acids which remove dead skin cells along with botanical extracts such as chamomile, aloe or organic sweet orange oil known for their soothing, moisturising and healing properties. Other recommended products: Facial Cleanser by PRIORI, creamCleanse™ by Medik8. For sensitive skin including post laser resurfacing, microdermabrasion, or chemical peels, a non-irritating, moisturising, fragrance-free, non-allergenic and emollient Foaming containing cleanser is recommended. Post procedure I like 4 Tone by HydroPeptide Glycolic Wash (AHA 20) by Neostrata using 4% PHA (gluconolactone) which is a mild yet effective cleanser that moisturises while it gently exfoliates the skin without stripping essential oils, in combination with botanical extracts such as Chamomilla Recutita, Calendula Officinalis or Cucumber which have proven anti-inflammatory, soothing and moisturising properties. Recommended products: Sensitive Skin Cleanser by SkinMedica, Gentle Cleanser by SkinCeuticals, Neostrata, Facial Cleanser (PHA 4) by Neostrata.

4 Rejuvenative Toner by SkinMedica

Toners People often ask: is a toner necessary? If make-up use is heavy or face feels oily, a toner can remove any last traces of debris and balance skin. Toners can also smooth skin, lightly hydrate, and provide anti-oxidant protection as well as improving the penetration of treatment creams and serums that follow its application. Tip: After cleansing, moisten cotton pad with your chosen toner and smooth over entire face. Reapply on areas of concern, or problematic skin (e.g. acne, hyperpigmentation).

4Phloretin CF: Improvement in laxity and the appearance of mottled skin after 4 weeks of continuous use

4Phloretin CF: Reduction of erythema and hyperpigmentation

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For all skin types I like using the Tone by HydroPeptide with collagen-boosting peptides, mild exfoliators and performance anti-oxidants. HydroPeptide® Tone minimises the appearance of enlarged pores, helps reduce fine lines, tones and balances without drying, and brightens skin tone. The frangrance-free, oil-free Equalizing Toner by SkinCeuticals is a very good toner for combination or oily skin as it combines hydroxy acids with botanical extracts such as rosemary, witch hazel, aloe and chamomile with anti-bacterial and anti-inflammatory properties. It also helps

restore the skin’s protective pH mantle. For acneic skin I use the Blemish + Age Skincare System by SkinCeuticals which consists of a cleanser containing capryloyl salicylic acid and glycolic acid to remove impurities and excess oil, a toning solution which removes surface cells, decongests pores and resurfaces skin, and a serum containing 2% dioic acid and alpha- and beta-hydroxy acids to prevent acne formation and help correct acne associated hyperpigmentation. For normal, dry, ageing and sensitive skin I would recommend the Rejuvenative Toner by SkinMedica, which contains AHAs (i.e. Lactic Acid, Glycolic Acid, Citric Acid and Malic Acid) creating a mild exfoliation that removes excess oil and impurities. AHAs also help reduce the appearance of wrinkles and improve skin texture. Rejuvenative Toner is also rich in salicylic acid, a beta-hydroxy acid, with antiseptic and skin clearing properties along with Camelia Oleifera (Green Tea) extract which is known for its anti-oxidant and antiinflammatory properties.

Second Step: Anti-oxidant Treatment i As the outermost organ exposed directly to the pro-oxidative environment, the skin is equipped with an elaborate system of anti-oxidant substances and enzymes, including a network of redox-active anti-oxidants. The endogenous anti-oxidant capacity of the skin is a major determinant in its response to oxidative stress-mediated damage. Normal ageing process, as well as environmental stress, can deplete the epidermis of protective anti-oxidants. Thus, anti-oxidants constitute an important group of pharmacological agents capable of preventing the occurrence and reducing the severity of UV-induced skin damage and skin ageing. Although there are many known anti-oxidant substances, their efficacy is limited if they fail to penetrate skin. A systematic study of endogenous anti-oxidants resulted first in a topical formulation of l -ascorbic acid, which was maximised for chemical stability, concentration, availability, and subsequent photoprotection for skin. Addition of a-tocopherol improved stability and photoprotection, demonstrating the interacting balance achieved by combination anti-oxidants. Investigation of plant phenolic anti-oxidants revealed that ferulic acid improved the stability of the anti-oxidant formulation of l-ascorbic acid and a-tocopherol (CEFer) as well as its photoprotective properties. SkinCeuticals has combined Vitamin C, E and Ferulic Acid along with Sodium Hyaluronate in one formulation. Hyaluronic acid is capable of attracting and retaining 1,000 times its own weight in water; it also assists as a carrier for other agents to be delivered below the skin’s surface. This is one of the best anti-oxidants available. According to studies it has been shown that the C E Ferulic serum delivers up to 90% of anti-oxidant protection, 8x photoprotection and 96% sunburn cell reduction providing superior anti-ageing benefits. This is the most popular anti-oxidant serum in my clinic, along with SkinCeuticals’ Phloretin CF, which works better on younger and oilier skins. Phloretin CF prevents thymine dimmers, DNA mutations and protects against the range of reactive oxygen species (ROS) on the skin. Phloretin CF comes as a gel or serum. They both provide the same broad-range efficacy. Alternatively I would recommend Medik8’s CE-Tetra which contains 7% Tetrahexyldecyl

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dermatology special - Skincare Protocols Ascorbate, an oil-soluble Vitamin C ester, plus synergistic d-alpha (natural) vitamin E. PREVAGE® MD is another potent anti-ageing treatment with the key ingredient Idebenone which is one of the most powerful topical anti-oxidants available in skincare products. The 1% strength of Idebenone can be obtained only from a doctor. I have used it mainly for photo-damaged skin with noticeable improvement in firmness, tightness and elasticity of the skin. PRIORI Idebenone Superceuticals also provide a range of Idebenone containing professional skincare products for correction and prevention of premature ageing due to both external and internal oxidative stress. For anti-oxidant protection of acneic skin I would recommend blue AOX by Medik8, which is a noncomedogenic, oil and fragrance free formula making it suitable for problematic, oily and combination skin. Last, but definitely not least, is my favourite newly launched anti-ageing serum Biometa Essential Serum by SkinMedica, an anti-ageing serum which combines Pichia Pastoris Ferment Filtrate (BiometaTM) obtained by the fermentation of a growth media by the microorganism Pichia pastoris, with anti-oxidants, peptides, tyrosinase, matrix metalloproteinase and neuromuscular inhibitors (i.e. alpha arbutin, blackberry extract, gamma aminobutyric acid), and hyaluronic filling spheres. Biometa Essential Serum is arguably one of the best antiageing treatments for all skin types and ages. It has recently replaced TNS Essential Serum for the European market.

by HydroPeptide which is an anti-wrinkle stem cell regeneration serum that unites peptides that restore skin’s structural integrity with regenerative stem cells. HydroStem+6 increases hydration and elasticity, firms and prevents collagen loss.

Fourth Step: Moisturisei 4SkinCeuticals’ Phloretin CF, Medik8 CE-Tetra and AOX by Medik8

4Before and after 4 weeks of daily use of Biometa Essential Serum

Other recommended anti-oxidants include: SERUM 10 by SkinCeuticals , TNS Recovery Complex by SkinMedica, Vit E Anti-Oxidant by Skin Tech, C Serum by Fusion Mesotherapy, which contains high concentration of vitamin C and various enzymes

Third Step: Hydrate, Calm or Correcti For ageing and dry I use SkinCeutical’s Retexturing Activator, formulated with 25% Hydroxyethyl Urea/ Amionosulfonic Acid Compound, Kombucha and Hyaluronic Acid as a complementary agent in all of my skincare regimes. It provides mild exfoliation by reinforcing and hydrating the skin’s barrier whilst resurfacing the skin and leaving it smoother. Please note that water-soluble substances such as urea, filaggrin, and amino acids make up the natural moisturising factor (NMF) of the skin. In addition, I also use Retexturing Activator in all skin types and ages, for at least two weeks, in order to prime the skin prior to chemical peels. For normal /combination or dry skin I would recommend the Dermal Repair Cream by SkinMedica which hydrates and replenishes dry skin with anti-oxidants (i.e. Vitamin C & E) and hyaluronic acid. Ideal for ageing and problematic skin as it reduces the appearance of age spots and conditions and firms the skin. For the thinning appearance of the mature skin caused by intrinsic ageing processes such as glycation I would recommend the A.G.E INTERRUPTER by SkinCeuticals. For soothing and hydrating the skin I would recommend Neostrata Ultra daytime Smoothing Cream for normal or sensitive skin or Neostrata Oil free Lotion or Re-Nutriv ACE by Skin Tech for oily or acne skin. Finally, for all skin types, I also like using the HydroStem+6 36

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4Neostrata

Ultra daytime Smoothing Cream

Experience has taught me that the most effective moisturising formulae should combine moisture binding agents (e.g. hyaluronic acid, panthenol) with mild exfoliating agents which help the skin get rid of the dead cells, allow young cells to surface, and enhance the penetration of the moisturiser. In addition, preventing transepidermal loss by using hydrophilic waxes such as a complex of esterified vegetal waxes (Acacia decurrens/Jojoba/Sunflower Seed Wax/Polyglyceryl-3 Esters) as seen in OXYNERGY Paris products can provide long-lasting moisture. On that note my favourite products include: • The MesoVita cream by INSTITUTE BCN is a potent dermal infusion cream, rich in polyunsaturated fatty acids, omega-3 & 6, linoleic and linolenic acids. It also combines a wide range of vitamins commonly used in Mesotherapy (A, E, C, F, B-complex, K) with manganese, iron, zinc, magnesium and calcium to revitalise and rejuvenate the skin. • 15% AHA/BHA Cream by SkinMedica which combines alpha- and beta- hydroxy acids providing mild exfoliation of dead skin cells, tocopheryl acetate (i.e. a stabilised ester of vitamin E) and pro-vitamin B5 (panthenol) that binds moisture to surface skin layers; • MesoAge Hyaluronic Treatment by INSTITUTE BCN for all skin types. It contains hyaluronic acid, which is a natural moisture-retaining molecule that is critical to the structural integrity of the dermal collagen matrix. • Hydrating B5 Gel by SkinCeuticals is recommended to be used with Vitamin C treatments to maximise its benefits; DAILY MOISTURE or EMOLLIENCE by SkinCeuticals for normal or oily skin and sensitive skin respectively; • Moisturizing Facial Cream by PRIORI A good mosturising treatment is also the Eternal Line by SKEYNDOR, which consists of the Eternal Intensive Serum and Eternal Cream containing plant origin stem cell nanoliposomes to rejuvenate, firm and moisturise the skin.

Fifth Step: Sun protectioni 4HydroStem6, A.G.E.Interrupter

I cannot stress enough the paramount importance of skin protection from UV radiation, which can have catastrophic effects in the overexposed skin. Ultraviolet radiation is composed of electromagnetic energy with wavelength from 400nm to 200nm. The UV spectrum is divided into UVA (400-315nm), UVB (315-290nm) and UVC (290200nm). UVA radiation is responsible for actinic (ageing) damage to the skin and can act as co-carcinogen with UVB radiation. UVB radiation is responsible for sunburn and can induce skin cancer. The oncogenic effect occurs as a result of photochemical damage to epidermal cell DNA, damage to DNA repair mechanisms and suppression of cellmediated immunity. UVC radiation is highly carcinogenic, but is mostly absorbed by the ozone-rich stratosphere. However with ozone depletion, UVC radiation may become a more important factor in skin cancer in the future.

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dermatology special - Skincare Protocols

4PRIORI’s Radical Defence

4Power Lift by HydroPeptide

4Red blood cells leak from blood

vessels and explode in the skin, releasing haemoglobin

Ultraviolet-induced photodamage in the human skin is characterised by the following macroscopic and cellular changes : • Erythema •S unburn - epidermal apoptotic cells resulting from extensive UV damage. •T hymine dimers - signature DNA damages resulting from UV irradiation that appear to be important in the generation of non-melanoma skin cancer. •p 53 - cellular protein induced by UV irradiation as a response to DNA damage. •M MP-9 or type IV collagenase - induced by UV irradiation; it degrades basement membranes. •L angerhans cells CD1a - epidermal antigen-presenting cells of the skin essential for initiating the immune response. They are reduced in number, and their morphology is altered by UV irradiation. Use of sunscreens for skin photoprotection prevents the penetration of harmful UV rays into skin and should be part of all skincare regimes. Anti-oxidants exert protective effects from inside skin and, because they stimulate cellular defence mechanisms, remain active for several days. Since sunscreens and anti-oxidants work by different mechanisms, they should be used as complimentary to each other. I have found PRIORI’s Radical Defence a very effective skin protection as it combines UV photo-protection (SPF 30) along with idebenone, a powerful anti-oxidant. Equally good is the Environmental Defence Sunscreen SPF 30+ by SkinMedica, which combines zinc oxide (physical sunscreen) with octinoxate (chemical sunscreen) along with Hyaluronic acid, Vitamin E and Ceramide 3 (helps skin restore its lipid barrier; influences the water-holding capacity of the skin). Other recommended sunscreens include: Aloe Sunscreen (SPF 30) by Forever and Mesoestetic’s Sunscreen range for both the body and face.

Retinoic acid • Stimulates epidermal turnover through increased mitosis, replacing damaged cells with new cells and reducing melanin production • Stimulates collagen and elastin fibre production slowing down thinning of the skin • Increases blood flow in the dermis • Reduces collagen breakdown • Is the core topical agent used when conditioning the skin (e.g. prior to resurfacing procedures) • Is suitable for all skin types, including facial and non-facial skin

Third Step: Hydrate, Correct and Preventi A great product called Power Lift by HydroPeptide can either be used following the application of a retinoid at night time or on its own as an alternative to retinol products, particularly in those cases where retinoic acid causes skin hypersensitivity and irritation. Power Lift is an age-defying, anti-wrinkle concentrate that combines long-lasting humectants with wrinkle-lifting peptides. Advanced skincare using peptides is the latest development in our combat against ageing skin with promising results. Peptides are indicated for all ages and skin types including very sensitive skins that cannot tolerate retinoic acid. Why peptides? Peptides are chains of amino acids, the biochemical building blocks of our body. They also function as cell messengers counteracting effects of ageing by enhancing collagen III production and protecting against the effects of glycation, free radicals and ROS. When used regularly peptide enhanced skincare can help protect the skin from accelerated environmental-based ageing and rebalance the chronological skin ageing process. Tip: For the peptides to produce optimal results they need to be applied regularly without breaks covering the entire skin area to be treated.

Evening regimen

First Step: Cleanse & Tone As per morning regimen.

Second Step: Vitamin A based products

4AOX+ Eye Gel and Eye 9.19

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Vitamin A should be a very important part of night skincare as it improves skin texture and helps with rejuvenation. Many of my clients ask me if I had to choose the three most important ingredients for a successful skincare protocol which ones I would recommend. The answer is simple: an anti-oxidant and sunscreen for the day and a retinol cream for the night. I believe in the effectiveness of vitamin A as a therapeutic agent. I always use it as an essential part of the vast majority of skincare regimens that I customise for my clients treating a variety of skin problems ranging from acne vulgaris to severely photoaged skin. My opinion is that everybody, independent of age and phototype, should be using retinoids as the acquired benefits can massively outweigh any potential side effects such as skin sensitivity or irritation. Vitamin A in the forms of retinoic acid, tretinoin, and isotretinoin are strong tissue stimulators and are available only by prescription. The retinoids used in cosmeceuticals are the alcohol and ester forms of retinoic acid (retinol, retinyl acetate, retinyl palmitate) and have less irritating effect than prescription retinoic acid. These compounds are converted in the skin into active retinoic acid (but in mild concentrations).

Eyes Infra-orbital shadows or “dark circles” under the eye area are caused by an accumulation of haemoglobin and coloured degradation products (bilirubin and iron) in the dermis and epidermis. I find products that contain Haloxyl very effective in the treatment of dark circles. Haloxyl is a well-established anti-ageing formula that contains a variety of ingredients including N-Hydroxysuccinimide, Chrysin and Glycerin. Chrysin stimulates the enzyme (UGT1A1) leading to the clearance of bilirubin. N-Hydroxysuccinimide makes the iron soluble, allowing it to be eliminated. Haloxyl also contains Tetrapeptide (aka Rigin), which suppresses the body’s production of interleukins, particularly IL6, the chemical messengers that trigger the body’s acute inflammatory response. Like DHEA, Tetrapeptide may help restore cytokine balance. Finally Glycerin actively hydrates and reduces transepidermal moisture loss in the sensitive area around the eyes. A product that combines Haloxyl with special optical particles which reflect the sunlight to create an extra camouflage over eye shadows making thus dark circles less visible is Dark Circles by Medik8. In addition: •E LASTIderm by Obagi is a one of a kind eye treatment restoring skin’s elasticity and building collagen around the eyes. It is clinically proven to help regenerate elastic fibres in

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dermatology special - Skincare Protocols the delicate periorbital skin. • Biometa Eye Repair contains the patented anti-ageing ingredient Biometa™, peptides, high concentrations of anti-oxidant vitamins C and E and hyaluronic acid. Although I have a limited experience in using this eye product my clients describe it as well tolerated and effective in improving fine lines and dark circles. •P owerPatch by Mesoestetic optimises the properties of a transdermic patch with the application of iontophoresis to achieve higher penetration of active ingredients in the skin around the eyes •A GE EYE COMPLEX for puffy, tired eyes and under-eye bags or the EYE CREAM for early signs of ageing by SkinCeuticals •T NS Illuminating Eye Cream for dark circles and puffiness and the TNS NIGHT EYE REPAIR, used at night, with NouriCelMD, peptides, high concentrations of vitamins A, C and E and hyaluronic acid by SkinMedica •N eostrata Eye Cream – PHA 4 by Neostrata for all skin types; • Eternally Eye Cream by SKEYNDOUR •A OX + Eye Gel by SkinCeuticals constitutes a powerful triple anti-oxidant therapy to combat photoageing and signs of fatigue around the eyes • I also find the Radiance® eyelift by Mesoestetic a very good eye cream for younger skins that need to keep the blood and lymphatic circulation in their best condition. •E ye Contour Cream by OXYNERGY Paris, which contains oxygenation factor, low-molecular-weight hyaluronic acid, lipopeptides, organic silicon, N-hydroxy-succinimide and chrysin. The synergy of which creates a very effective treatment for loss of firmness, wrinkles, dryness, under eye bags and dark circles. ACNE For acne prone skin I would recommend the Blemish + Age Skincare System by SkinCeuticals which consists of a cleanser containing capryloyl salicylic acid and glycolic acid to remove impurities and excess oil, a toning solution which removes surface cells, decongests pores and resurfaces skin, and a serum containing 2% dioic acid and alpha- and betahydroxy acids to prevent acne formation, help correct acne associated hyper-pigmentation and reduce the appearance of fine lines and wrinkles. I use this for the treatment of acne grades I, II, III & IV. Sun protection coupled with anti-oxidants are a must for optimal results. Alternatively you can use SkinMedica’s Acne System which utilises Salicylic Acid and Benzoyl Peroxide to control acne conditions and excess oil with minimal irritation. It consists of the purifying foaming wash (Salicylic Acid 2.0%), the purifying toner with salicylic acid 2.0% which has keratolytic as well as antiseptic and fungicidal properties, and the acne treatment lotion with 2.5% benzoyl peroxide. Another good anti-acne product is the Betagel by Medik8. The gel contains azelaic acid, salicylic acid and niacinamide (also known as vitamin B3) and can be used on all skin types. Betagel can be applied directly onto blemishes after cleansing in the morning and/or evening. It can also be used on the whole of the acneic skin to control more severe acne. Betagel by Medik8 comes as part of the Anti-Acne Kit with betaRecovery™, working in unison to provide 24 hour treatment. For anti-oxidant protection of the acneic skin I would recommend blue AOX by Medik8, which is a non-comedogenic, oil and fragrance free formula making it suitable for problematic, oily and combination skin. 40

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Table 3. Acne Grades Grade I: Comedones (open & closed) Grade II: Comedones (not inflammatory), papules and pustules Grade III: Comedones, papules and pustules over entire face. No dermal infection, nodules or cysts. Grade IV: More extensive papules and pustules over the face than grade iii and may exhibit some nodules and cysts. In which case treatment is contraindicated and this must be referred to a dermatologist. Grade V: Nodular or cystic acne – refer to dermatologist. 4Neostrata Eye Cream – PHA 4,

Biometa Eye repair

4 Blemish + Age Skincare System by SkinCeuticals

4 SkinMedica Redness Relief

CalmPlex

4Before and after 12 weeks of continuous use of Redness Relief CalmPlex

4 At baseline and after two weeks using Redness Relief CalmPlex

4 Before and four weeks after using Red Alert Serum

Hyperpigmentation For mild to moderate hyperpigmentation I would recommend the Pigment Regulator by SkinCeuticals, which brightens and refines the uneven appearance of photodamaged skin. Other recommended products for correction of pigmented and photodamaged skin include the MESOBLANCHE Melano Treatment by INSTITUTE BCN which combines mild exfoliating agents along with built-in sun protection (SPF 30) or the Superceutical Anti-ageing Treatment by PRIORI. Redness For skin redness secondary to sun exposure, acne, rosacea or cosmetic treatments such as microdermabrasion or chemical peels I prefer using SkinMedica’s Redness Relief CalmPlex which contains a proprietary bioactive ingredient that addresses visible redness. All skin practitioners who deal with skin problems have come across people with particularly sensitive skin who are unable to tolerate any kind of skincare products. Skin hypersensitivity is manifested by chronic erythema, facial thread veins, skin irritation and reactivity to environmental aggressors including inappropriately used skin formulations. For this type of hypersensitive skins I find Medik8’s Red Alert Serum an excellent product that can be used as a preconditioning therapy for more aggressive treatments. It contains teprenone originally used in the treatment of gastric ulcers and has now been approved for cosmetic use. Studies show that Teprenone extends the life of the cell’s telomeres (part of the chromosome), which effectively means the cells can divide for longer without dying. Post procedure After all non-surgical cosmetic procedures I like using the Collagen Mask by Oxynergy. Collagen masks are activated directly on the skin by adding liquid, allowing the collagen to form a hydrating film, and the release of collagen fragments to moisturise and soothe the treated skin. Mesoestetic do excellent collagen masks (Collagen 360). Alternatively the INNO-PEEL Refresh Mask can be applied to calm the injured skin and stimulate collagen production. I also find the Restylane Recover Cream very soothing and calming and, if applied regularly for up to two weeks after procedures involving the skin, it can significantly reduce swelling and bruising. For post-operative or post-procedure bruising, Chelaskin works great even after one single application. Following peels or CO2 laser resurfacing treatments I use SkinMedica’s Ablative Post-Procedure Kit, which is formulated to protect fragile post-procedure skin, minimise complications, and support patients’ recovery.

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R OYA L CO L L E G E O F PHYSICIANS LONDON

15th – 17th June 2012

THE UK’S PREMIER MEDICAL AESTHETIC CONFERENCE AND EXHIBITION

3 DAY CONFERENCE PROGRAMME

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Hear the world’s leading facial aesthetic experts speak on the latest developments in Facial Aesthetics. As with 2011 FACE will include many parallel lectures to allow all topics within facial aesthetics to be covered with even more Exhibitor Workshops and Specialist Meetings.

Celebrating 10 Years of FACE

Opportunities to learn new and advanced techniques from leading practitioners in this limited space full day training course. 2012 Will mark the start of on going training courses through the weekend which will also offer hands on trainign for all participating delegates.

FACE Conference has provided over 2500 delegates from around the world the chance to see some of the most enterprising speakers, treatments and topics in Aesthetic Medicine. In 2012 FACE will be celebrating 10 years of being the UK’s premier medical aesthetic conference. From the first 5 hour evening meeting in 2002, FACE has grown into a congress with over 70 hours of lectures heldby some of the worlds best practitoners and pioneers in facial aeshtetics.

EXHIBITION

Wendy Lewis, Beauty Consultant

ADVANCED TRAINING

A concurrent exhibition and exhibitor workshops help you keep up to date with leading-edge products with over 50 of the industry’s key manufacturers and distributors.

FACE OF THE CLINIC

A concurrent business meeting providing an invaluable opportunity for you to invest in quality education for key personnel within your business. 2012 will see also much more focus on the marketing of your clinic as well as day to day managment. FACE of the Clinic will be spread over 2 days in 2012 in order to cover all aspects of Business Managment and Maintenance.

AN EVENING WITH...

This will be the 4th incarnation of an evening with and once again we will have one of the industry greats explain the methods used to have a thriving clinic and a healthy business model. FACE is proud to confirm that Dr Zein Obaji will be entertaining all delegates at An Evening With in 2012.

WWW.FACECONFERENCE.COM

0207 514 5989

“FACE is the most important aesthetics congress in the UK and an absolute must for any vendor doing business in the region.”

Dr David Goldberg, Clinical Dermatologist “One of the most dynamic and exciting cosmetic meetings I have ever lectured at.”

Dr Tess Mauricio, Clinical Dermatologist “FACE has been wonderful, able to bring together world leaders in aesthetics. Definitely the conference to go to.”

Dr Aamer Khan, Cosmetic Doctor “FACE is the pinnacle of our industry, educates and brings people together.”

INFO@FACE-LTD.COM

The

AESTHETIC INDUSTRY 2012

Summer Ball

HENRY STUART

Saturday June 16th

Madame Tussauds, London

London will be even more special this June. Join FACE on the eve of the Summer Olympics to celebrate in style at our 10th anniversary. You can expect doubles all round at Madame Tussaud’s on Saturday 16th June at the Aesthetic Industry’s 2012 Summer Ball. Join us and your favourite stars. Raise your glass, let your hair down and enjoy a dance or two.

Sponsored By:

To book your place at the Aesthetic event of the year, call 020 7514 5989 or email info@face-ltd.com for more information

SKIN

Skin is the most visible organ affected by ageing and a variety of common skin diseases such as acne and rosacea. This year, in conjunction with the usual wide range of lectures devoted to treating ageing skin, we also have sessions related to treating common skin diseases and dealing with the unique problems associated with treating skin of colour.

HAIR

With recent widely publicised hair transplant, the market for treatments that increase the thickness and density of hair is more buoyant than ever. For the first time at FACE, we are devoting a session to examining different non-surgical and surgical options for the treatment of alopecia and exploring the business opportunity in this market segment.

SURGICAL FOCUS

Although the largest sector of the facial rejuvenation market is now dominated by nonsurgical procedures, it is vital that we understand when to refer to a Surgeon in order to achieve the more dramatic results that patients sometimes need. Our new Surgical session will explore the boundaries between non-surgical and surgical treatments alongside the latest techniques that are being employed in the Facial Cosmetic Surgery market.

ANTIOXIDANTS – THE DEBATE

A comparison of studies is the ideal way for a practitioner to decide on what product to use, and with skincare sales at an all time high, what better than a debate on the different antioxidants available.

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MICROMEDICS

dermatology special - Skin Cancer and Climate Change

Consultant dermatologist Dr Harryono Judodihardjo on skin safety and climate change

ADVICE FOR STAYING SAFE IN A WARMING CLIMATE Dr Harryono Judodihardjo MB BCh, MSc in Dermatology, PhD Dr Harryono Judodihardjo is the founder and medical director of the Cellite Clinic and treasurer of The British Association of Cosmetic Doctors. A consultant cosmetic dermatologist he is a fellow of the European Academy of Cosmetic Surgery and a member of the International Academy of Cosmetic Dermatology and European Society of Cosmetic and Aesthetic Dermatology. He is also an associate member of the British Association of Dermatologists, a Fellow of the Royal Society of Medicine and a member of the American Academy of Cosmetic Surgery.

The warmest years on record have all been in the last decade. So what implications does this have for skin cancer? And how can we protect ourselves and still lead a normal life? Global temperatures are on the rise, and the trend looks set to continue as worldwide temperatures are predicted to be 0.37°C above the long-term average. And as the UK climate becomes hotter and brighter, the population becomes increasingly at risk from skin cancer. Skin cancer incidence continues to rise in the UK and over 100,000 people are newly diagnosed with the disease every year. It is also now the fastest rising cancer type in young people aged between 15 to 24. I believe that the key to keeping safe from this potentially life-threatening disease lies in public education, such as Australia’s well-documented Slip! Slop! Slap! awareness campaign. Although Australia still has one of the highest rates of skin cancer in the world, the number of young people going outside for the purpose of getting a tan has dropped by 45% in the last three years. Australia’s high rate of skin cancer is exacerbated by the depletion of the ozone layer, and the fact that a largely light-skinned population lives in a tropical latitude.

l Avoid exposure during the hottest part of the day 11am-3pm l Don’t be fooled by the temperature – it is still possible to burn on a cold clear winter’s day l Be aware on breezy days - the wind chill may cool the body down, but it will not diminish the ferocity of the sun’s rays l Apply sunblock with a minimum SPF15 at least half an hour before going out, then reapply just before leaving the house to ensure that the skin is adequately covered. Reapply frequently throughout the day if you are going to stay outdoors l There’s no such thing as a waterproof sunblock - after swimming or sweating it will need to be reapplied l Don’t be tempted to stay longer in the sun because you are wearing sunblock l Children are particularly vulnerable ensure that they don’t burn by keeping them adequately clothed - long sleeved shirts, trousers, a hat and shades - and limit their exposure to strong sunshine l Beach shelters are excellent for providing shade, but check the manufacturer’s information - some are too flimsy to filter out UV light adequately cosmeticnewsuk.com

dermatology special - Skin Cancer and Climate Change

As climate change kicks in, we could face similar problems here. Fairskinned people do not have natural pigmentation in the skin, which is designed to deflect the damaging effects of fierce sunlight. The three most common forms of skin cancer are Squamous Cell Carcinoma, Basal Cell Carcinoma, and melanoma. l Squamous Cell Carcinoma relates to long-term exposure to sunshine; and the damage accumulated over a protracted period results in cancer on exposed areas such as the face, neck, and backs of hands. l Basal Cell Carcinoma is the most common of the three types of skin cancer. It also corresponds with accumulated exposure, but is more strongly associated with the number of sunburn episodes over the course of a lifetime, particularly childhood sunburn. l Melanoma is the least common but most deadly form of skin cancer. It grows very aggressively and metastasises rapidly. Melanoma is strongly related to severe sunburn, particularly during childhood. The number of melanoma cases world-wide are increasing faster than any other cancer, and in the UK the incidence of melanoma has risen by 40% in the past decade. Exposure to UV radiation in sunlight is the main cause of skin cancer. Most cases could be prevented if people protected themselves in the sun, and took care not to burn. As the life-threatening melanoma is linked to sunburn in childhood, it is essential that children are protected from the sun. In addition to the dangers of skin cancer, around 80-90% of skin ageing is caused by the sun and only 10-20% is due to time.

“In addition to the dangers of skin cancer, around 80-90% of skin ageing is caused by the sun” Three types of ultraviolet light are emitted from the sun: • UVC - which is filtered out by the earth’s atmosphere • UVB - which is mostly responsible for skin cancer • UVA - which is the most damaging in terms of ageing the skin Astounding though it might seem the majority of skin ageing wrinkles, sagging, freckles, sunspots - is caused by exposure to sunlight. Obviously, keeping out of the sun altogether is not an option, particularly for those who enjoy outdoor activities. However, I would strongly advise protection from damaging rays by wearing long trousers, long-sleeved shirts, a hat and sunglasses, and frequent and liberal application of a sunblock with a minimum SPF factor of 15. And don’t forget to check that it protects from UVA rays as well as UVB. There is no such thing as a safe tan or a healthy tan. A tan is a sign that the skin has been damaged. 46

cosmeticnewsuk.com

On the road This month sees the launch of the UK’s biggest ever skin cancer awareness roadshow. The Mole & Sun Advice Roadshow is organised by the British Association of Dermatologists (BAD), the UK’s leading skin cancer experts and supported by dermatological skincare brand La RochePosay. It will provide thousands of people with free mole and sun protection advice and education from dermatologists, as well as free sunscreen samples. The roadshow will tour eight of the UK’s major festivals and events throughout the summer months in the hope of raising awareness of the use of appropriate sun protection and the early detection of skin cancer. Survey results from the pilot Mole & Sun Advice Roadshow in 2011, revealed that 92% of the general public who were asked, said they had experienced sunburn, and many had been burnt multiple times. The survey also found that 83% of respondents agreed that the risks of skin cancer were not exaggerated and yet 64% (twothirds) had never checked their skin for signs of cancer. Malignant melanoma, the most deadly form of the disease, is the fastest rising common cancer and causes over 2,000 deaths in the UK each year. Most cases are curable if detected early, but if diagnosis is delayed and the cancer spreads then your chances of surviving are greatly reduced. This is why the BAD and La Roche-Posay are urging more people to pay attention to their skin, as early detection really can be the difference between life and death. The 2012 Mole & Sun Advice Roadshow aims to make people aware of skin cancer risks and how to enjoy the sun safely. Through practical, face-to-face demonstrations and engagement with the public the Mole & Sun Advice Roadshow hopes to encourage people to check their skin, seek the appropriate form of UV sun protection for their skin, and go to their GP if they notice any changes to their skin. The 2012 Mole & Sun Advice Roadshow aims to make people aware of skin cancer risks and how to enjoy the sun safely. Through practical, face-to-face demonstrations and engagement with the public the Mole & Sun Advice Roadshow hopes to encourage people to check their skin, seek the appropriate form of UV sun protection for their skin, and go to their GP if they notice any changes to their skin. The one-to-one consultations with dermatologists will teach people first-hand how to check their skin and what to do should they notice any abnormal changes. The on-site team of dermatologists and dermatology nurses expect to see over 200 people each day during each event. Speaking in support of the Mole & Sun Advice Roadshow MP Sian James, chair of the Melanoma Taskforce said, “We still see far too many cases of UV exposure with damaging long term heath effects. The message that we have to get out to young people in particular is that it’s cool to stay safe in the sun.”

The Mole & Sun Advice Roadshow will be attending the following events in 2012: Windsor HorseShow, May 11-13 HertfordshireCounty Show, June 2-3 Isle of WightFestival, June 22-24 RAF Fairford Air Tattoo Show, Gloucestershire, July 7-8 Latitude Music Festival, Suffolk, July 12-15 CLA Game Fair, Grantham, Leicestershire, July 20-22 WOMAD Music Festival, Wiltshire, July 27-29 Edinburgh Festival, August 30 – September 1

treatment spotlight

All systems go Dr Ingrid Arion on why the AIS electronic injection system for filling and rehydrating products is not simply a ‘gadget’ but a real asset for practitioners and their patients

If Paris is the world capital of medical cosmetics, it is because the ‘French Cosmetic Touch’, characterised by the search for highly natural results, corresponds to the deep and increasingly widespread aspirations of practitioners and their patients. I belong to this group of highly experienced Parisian doctors who are pioneers and resolutely avant-garde in the field of facial modelling through injections, for whom the search for techniques and systems offering sophisticated results and increased safety is a constant priority. I was attracted by the Anteis Injection System (AIS) as soon as it appeared in January 2010, but I wanted to check, first of all, that this system could suit my working practices by adapting to the various injection techniques; secondly, that it was part of a real improvement process; finally, that it could really improve the medical anti-ageing results of remodelling and rehydrating through micro-injections. In this article I am delivering my impressions and conclusions regarding the Anteis Injection System. I wish to specify that the opinions I express are entirely my own.

What is it about?

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cosmeticnewsuk.com

The AIS comprises three parts: • A central unit on which the preliminary adjustments are made: type of injection flow (continuous flow or ‘drop by drop’), speed of injection flow, size of droplets • A double pedal enabling to start or stop delivery of the gel • A hand-piece on which the syringes are fixed and which the practitioner holds like a pen (as this is what the unit resembles) The doctor no longer needs to exert any pressure on the pedal: the force of ejection required for the even delivery of gel is automatically developed by the Anteis Injection System

Two injection modes are available: the ‘flow’ mode and the ‘drop’ mode. The ‘flow’ mode is recommended for linear filling (antero-tracing or retro-tracing techniques), modelling and multi-puncture. The ‘drop’ mode is reserved for mesotherapy or to fill wrinkles according to the serial puncture technique. Each parameter is controllable: the size of the droplets, the speed of delivery, and the volume of the flow. It is easy to change one of the parameters and to transfer from one injection mode to the other. And this can be done several times in a same session without any problem. The user protocol is relatively simple. Anteis offers additionally a complete range of pre-filled syringes ready-to-use with AIS.

The AIS: for whom and for what treatments? The Anteis Injection System is suitable for everyone. For the least experienced cosmetic practitioners it will prove to be a precious aid. The more experienced practitioners of manual injections should break the force of habit and enjoy the relative comfort of handling this system, which will also enable them to carry out special treatments. Personally, I have preferred using the AIS for remodelling checkbones and the oval of the face. I have found it easy to use, with a light hand-piece and a compact unit. I not only benefited from greater freedom of movement, I also obtained results that

prepared with a hyaluronic acid base than those exclusively made by Anteis. Even if Anteis’ hyaluronic acid range is very complete and effective, I think that this is an interesting possibility.

actually lived up to my expectations. The patients found the session comfortable and painless. Note: the injections left no mark on the skin.

What I appreciate in the AIS Innovation and modernity of the AIS The AIS appeared to me to be an innovative, modern system, an automated ‘assistant’ for injections. The control of the various parameters (especially the speed of flow and the size of the droplets) provides great precision giving the desired results. The even distribution of the HA produces perfectly uniform results. However, I feel it is important to specify that although the user protocol is simple, the practitioner must learn it thoroughly. Especially for modelling, the volume to be injected should be carefully planned in advance and the chosen flow volume adapted accordingly. Good handling of the injector is therefore essential and this requires a variable adaptation time depending on the practitioners. Safety Since 2010, 569 systems have been sold according to the Anteis company and no complaints have been made. So, to date, the AIS appears to be a safe system. Personally, I have not encountered any inconvenience with the AIS during my consultations whether for mesotherapy or facial remodelling.

Design and user-friendliness The Anteis company deserves congratulations for the design of the AIS. This system is aesthetic and consequently a pleasure to present to patients. It is also very easy to use. The hand-piece is particularly light and easy to handle. Personally, I appreciated the high degree of freedom and the gracefulness in operation. This enables you to carry out high precision work with extreme delicacy, while respecting and being of value to the treatments and the hand and eye of the practitioner. Other impressions I am not in a position to comment on the reduction of pain during the injections or the reduction of post-operational bruising. I think that, as long as the anatomical parameters are properly controlled, the transcutaneous passage of the needle and too high an injection speed prove to be the two real sources of discomfort for the patient. The first parameter is controllable with anaesthetising creams; only the second depends on the practitioner’s hand. According to the experience and the dexterity of the practitioner, the patient may consequently not feel a real difference. I still perform certain treatments manually (without the AIS); in particular the under eye area where the ‘direct’ feeling and the manual dosage appear to me essential, at least up to the present time. Probably a question of habit.

“The AIS could easily mark a new key stage in the development of our medical injection techniques”

Use of the canula or the needle For injections, the practitioners now use either needles or canulas, depending on the treatments. In a same session, and more specifically for ‘full face’ sessions, it is essential to be able to combine the use of both needles and canulas of different diameters and different lengths. With the AIS, you can very easily pass from one to the other and both are equally easy to handle. As I require total freedom when I perform remodellings, I consider this flexibility to be of particular interest. Some of us, and especially those with more experience, get used to using specific injectable products. While it is good to be able to test new products, it is also important to be able to continue to work with the ones that give us satisfaction and about which we know the rheological properties and behaviour. The AIS can be used with other gels

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In conclusion Every year, innovations come and go. In the field of aesthetic medicine, many new processes rapidly reveal to the world the undesirable effects that they produce. That is why I waited before trying the AIS. As there was no negative feedback, I tested it and adopted it. It assists the perfectibility of the aesthetic results sought through injections whether for filling, modelling or rehydration. During the last 20 years, the practice of aesthetic medicine has considerably developed under the impulse of new innovations: new generations of hyaluronic acid based gels, more effective botulic toxins, canulas, PRP etc. The Anteis Injection System could easily mark a new key stage in the development of our medical injection techniques.

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01903 768 386 info@thecarltongroup.co.uk www.thecarltongroup.co.uk PROUD TO BE A BRITISH MANUFACTURER

Q&A

We talk to Dr Christine Coffey about the PronoKal diet

are fully aware of the medical nature of this method. It

can loose 7-10kg per month and see a real difference

is not intended to be a yo-yo / fad program but rather

in their weight very early on in the program. I find that

a thorough medical re-education (both psychological

this really keeps their motivation up and encourages

and physiological) to the patient’s benefit. Many patients

commitment and perseverance with the program.

who start on the program have co-morbidities and it is

PronoKal places such an emphasis on re-education

Cosmetic News: What is the PronoKal diet?

important that these are noted and that the prescribing

throughout the program and this brings about great

Dr Christine Coffey: The PronoKal diet is a medically

doctor work with the patient, and their GP if necessary, to

results long-term: patients changing their eating habits,

supervised weight loss program set within a very

attain the best result for the patient.

and the ways in which they view food, to give long-term

supportive MDT setting putting the patient at the

positive results in respect of their body image and

very centre of a support system comprising of: the

CN: How is this different to other diets out there?

more importantly their health. Patients and doctors

patient’s doctor, PronoKal dieticians, physical exercise

CC: There are many diets and weight-loss programs

have also anecdotally described improvements in sleep

coach, psychological coach and chef/cooking advice.

on the market at the moment and many have great

patterns, joint problems exacerbated by weight gain,

This MDT setting gives the patient the support and

individual aspects to them. The difference with

improvements in skin texture as well as improvements

encouragement to help them through the program

PronoKal is that it incorporates all of those positive

in PCOS, hypertension, type II diabetes, patients on the

and give them the best chance at success, and at

aspects into one program: it is based on rigorous

cusp of developing metabolic syndrome and progressing

changing their eating and dietary habits permanently.

scientific studies; provides specialised MDT support; is

from there, and dyslipidaemias to name a few conditions.

The diet comprises of two stages: Active Stage 1 and

medically-supervised throughout; enables rapid weight

Many patients have come off their hyper-cholesterol and

Re-education Stage 2. In Stage 1 the patient aims to

loss initially; emphasises and incorporates dietary

hypertensive medication and even seen reversal of Type

loose 80% of the total weight loss target whilst on a VLCD

re-education; and provides two-year follow-up for all

II Diabetes with this method.

(very low calorie diet). This is done by taking advantage

patients completing the program. No other weight-loss

of the natural fat mobilising effect of Ketosis. In this stage

program provides all of these aspects grouped around

CN: Are there any contraindications to the diet?

patients can expect to loose between 7-10kg per month.

the patient at its centre. I do strongly believe that this is

CC: As with many diets, there are contraindications

In Stage 2, the patient undergoes dietary re-education as

where PronoKal’s success lies.

to PronoKal, perhaps the most relevant concern the

foods are introduced in a step-wise fashion over time to

liver and kidneys. We need to make sure that these

re-educate both the patient in psychological terms and

CN: How has it fitted into your practice?

two organs are functioning optimally before patients

in physiological terms with pancreatic re-education.

CC: I find that my PronoKal patients fit very well into my

start on the program as we need these two organs to

All this is done with the aid of PronoKal’s products: high

practice and that there is an increasing overlap between

respectively produce and process the Ketone Bodies

biologically value protein meals and with micronutrients

my aesthetic patients and my PronoKal patients. There is

generated as a by-product of the fat-burning metabolic

to supplement the patient’s meals and under medically

huge scope for advertising and marketing the program

mode (Ketosis) exploited during Active Stage 1 of the

supervised MDT support throughout the program. In

to your existing patients and PronoKal is very supportive

diet. This is why PronoKal stresses the importance

addition to this, PronoKal follows-up each patient, who

in providing all kinds of multimedia marketing and

of training all prescribing doctors thoroughly and

has successfully finished the program, for two years after

advertising tools. I find that patients who have been on

supporting all doctors throughout. Before a doctor can

they complete the program.

the PronoKal program are so happy with the results and

begin prescribing they must attend a training session

the positive change to their life, well-being and health,

with myself and then a practical session with one of our

CN: Why is it so important that the diet is medically

that they recommend very enthusiastically and many

PronoKal dieticians. It is also important that all patients

supervised?

of my PronoKal patients come to me by word of mouth.

are medically cleared to start the program before

CC: The WHO has declared obesity a disease and doctors

Running the PronoKal method in my practice has been

commencing. This is done at the initial appointment

have a duty of care to treat overweight and obese

incredibly personally satisfying and fulfilling seeing the

where a full medical history and examination are carried

patients. As well as the aesthetic and life-style benefit of

enormous changes that can take place in a person’s life

out and blood tests are ordered.

weight-loss there is the very important health aspects

with effective and supported weight loss. It has also

and benefits of weight loss. There are many patients who

been financially rewarding and is a good opportunity

CN: What place do you think diet and nutrition has in

will gain enormous health benefits from commencing on

to financially supplement any field of medical practice.

medical aesthetic clinics?

this program: patients with metabolic syndrome, PCOS,

I have trained a large range of prescribing doctors

CC: I think there is an increasing cross-over between

patient with hypertension, patients with joint problems

ranging from endocrinologists, GP’s, aesthetic doctors to

weight-loss and aesthetics. Many patients coming

exacerbated by being overweight, pre-op patients, patients

gynaecologists and more.

in for skin-tightening and body contouring would benefit hugely from the PronoKal medically supervised

struggling with post-pregnancy weight gain, to name a few. It is very important that any significant weight loss should

CN: What kind of results can people expect?

weight-loss program and similarly, I find that many of my

be done under medical supervision to ensure that there

CC: Patients can expect fantastic results and I have seen

patients who have been through the PronoKal method

are no contraindications to starting the diet, no concerns

some wonderful results from all of my patients who have

will be interested in aesthetic procedures post-weight

once commencing the diet and to ensure that patients

committed to the program. In the active stage patients

loss.

cosmeticnewsuk.com

BEST UK AESTHETIC TRAINING PROVIDER as voted by our customers!

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Innomed Training Acadamy offers professional CPD-verified courses that not only give you the necessary grounding in your chosen treatment; they also set you on the path to building your experience and enjoying success in medical aesthetics.

What we can do for you... l

Training in Small Groups to give you a more personal learning experience.

Medically-led independent full-day courses run by professional trainers.

CPD-verified course content - you receive CPD points for attendance.

Hands-on training on live course models - giving you lots of hands-on practice.

FREE after-course help and support as you build your confidence.

Post-course reference information Includes; copies of presentations, leaflets, literature, medical history & consent forms and treatment forms to take away.

Practical advice marketing, insurance, pricing, client care, websites, ordering.

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Easy-to-get-to locations centres in London, Southampton, Birmingham, Newcastle, Greater Manchester.

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Forthcoming hands-on course dates... 2011 April

DATE HANDS-ON COURSE

LOCATION

Sun 1st

BASIC DERMAL FILLERS - for beginners (buy-one-get-one-free for first order of Stylage or Rennova when bought from MAS)

Fri 13th

SCULPTRA with Dr Xavier - for beginners Session 1 of 2 PLUS Session 2 will be on 25th May (includes FREE PRODUCT WORTH £900)

Sat 28th

COMPREHENSIvE CHEMICAL PEELS AND MEDICAL SkINCARE (buy-one-get-one-free for first order of peels or skincare when bought from MAS)

Sat 28th

BASIC BOTULINUM TOXIN - for beginners (includes buy-one-get-one-free offer)

June

July

Southampton

London Newcastle

BASIC DERMAL FILLERS - for beginners Sun 29th (buy-one-get-one-free for first order of Stylage or Rennova when bought from MAS)

May

London

Newcastle

MESOTHERAPy FOR CELLULITE, FAT AND SkIN REjUvENATION Sun 29th (buy-one-get-one-free for first order of Simildiet products when bought from MAS )

London

PHySIOLOGy OF AGEING AND SkIN REGENERATION Mon 28th TREATMENTS (DAY 2 takes place on June 12th)

London

Sat 2nd

BASIC BOTULINUM TOXIN - for beginners (includes buy-one-get-one-free offer)

London

Sun 3rd

BASIC DERMAL FILLERS - for beginners (buy-one-get-one-free for first order of Stylage or Rennova when bought from MAS)

London

Sat 30th

COMPREHENSIvE CHEMICAL PEELS AND MEDICAL SkINCARE (buy-one-get-one-free for first order of peels or skincare when bought from MAS)

London

Sun 1st

MESOTHERAPy FOR CELLULITE, FAT AND SkIN REjUvENATION (buy-one-get-one-free for first order of Simildiet products when bought from MAS)

London

A personalised one-to-one mentoring service also available.

Call to book or more information 023 80 67 67 33 or book online at www.innomedtraining.co.uk Innomed Training 265mm x 95mm half page

Cosmetic News April 2012

INNOVATIONS

Something in the air W

We find out about the new OXYjet Leo De Luxe system from Nora Bode

ithout oxygen there is no human life on earth. All our vital functions depend on a sufficient supply of oxygen to our body cells, so that nutrients and vital substances can be converted into energy. Of course this also applies to our skin cells: They also need to be supplied with energy constantly in order to have the best results. The epidermis is a particularly active part of the skin, especially its deepest cell layer, the stratum germinativum with its basal lamina. This is the place where cell division and growth of the surface skin take place, important immunological processes occur and not least the formation of the skin colouring melanin occurs in the localised melanocytes. The dermis below is playing an important role in the skin’s ageing process. Collagen and hyaluronic acid structures are formed there, which make our skin appear tight and youthfully smooth because of their water binding capacity. Young skin does not suffer from lack of energy, its epidermis is adequately supplied with oxygen and nutrients through the blood vessels of the dermis. It appears fresh and vital. Older skin is badly supplied with blood, the microcapilleries of the dermis have degenerated and are no longer in the position to provide sufficient oxygen and nutrients to the skin cells.

OXYJet Based on oxygen generation technology the OXYjet concentrates the oxygen from the surrounding air. The air is made up of about 21 % oxygen and 78 % nitrogen, the remainder being made up of other gases. The OXYjet system draws in the surrounding air, purifying it through a series of filters, including two molecular sieve chambers. These sieve chambers separate the oxygen and the nitrogen molecules by their different sizes. The nitrogen is then removed, leaving only pure oxygen. By the use of pulsed oxygen pressure highly effective cosmetic formulations and pure concentrated oxygen are pulsed into the deep layers of the skin – without needles gentle, effective and safe. The so formed deposit of active ingredients deep in the skin unfolds its positive effects over a long time. At the same time the oxygen acts as a vitalising energiser. All cosmetic problem areas can be treated without pain and side effects including the delicate skin around the eyes and mouth, neck, decollete and body. The latest product in the OXYJet range is the Leo De Luxe facial and body machine – the UK’s first Diamond Head OXYfusion technique in microdermabrasion. This compact and portable machine also offers Cry02, red and blue light technology alongside the scientifically tested OXYjet pressure injection, spraying and breathing. The Leo De Luxe offers 20+ different, completely natural body and facial treatments and is fully portable.

Some of the key applications of the Leo range include: OXYdiamond – The Oxygen Diamond Peeling •

Concentrated oxygen and diamond peel heads in different corn sizes

applied. •

remove cornifications and stimulate the skin. •

OXYjet – The Pulsed Oxygen Pressure Injection •

inflammations and together with synergistically acting oxygen cares for a

Cell division in the deeper layers of the epidermis is activated so that skin regains its youthful appearance time after time.

fine pored, rosy teint with lifted contours.

OXYtone disk – The Oxygen Intensive Body Massage •

subcutaneous tissue. In combination with OXYjet Bust Form Treatment the

the appliance of high-pulsed pressure and formulate a deposit of active

build up of the breast is enhanced and its contour lifted. In combination

ingredients in the deep layers of the skin. The skin appears smooth and

with OXYjet Body Slim Treatment the local fat deposits are broken up and

The pulsed oxygen vitalises and energises the skin and makes it look fresh

the skin beyond is firmed. •

and healthy.

Bio Red Light penetrates deep into the subcutaneous tissue, stimulates the activity of the fat cells and by that helps to reduce the local fat deposits.

OXYtone – The Oxygen Face-Lift

•

The unique polyrotation head stimulates and tightens the muscles and

OXYtone roller – The Detoxifying Oxygen Massage

the connective tissue of the skin. The face contours are visibly lifted. In

•

Concentrated oxygen refreshes and vitalises the skin Specially formed for the appliance on arms and legs the OXYtone roller

combination with OXYtone serum eye bags are gently reduced.

helps to reduce accumulations of the lymph and to detoxify the dermal

•

Concentrated oxygen refreshes and vitalises the skin at the same time.

and subcutaneous tissue. Unsightly irregularities of arms and legs are

•

Depending on the skin‘s appearance Bio Blue Light smoothes sensitive skin, Bio Red Light stimulates mature, atrophic skin.

reduced, the surface appears smoother. •

CRYO2 – The Cool Oxygen Lifting •

The special rotating massage disk intensively stimulates dermis and

Special cosmetic formulations and oxygen penetrate the epidermis by

firm, pigmentation disorders and impurities are reduced. •

Stimulating, cool pressure tightens the skin, reduces swellings and

A cool tingly fresh cocktail of coldness, oxygen and active ingredients is

cosmeticnewsuk.com

In combination with OXYjet Cool Body Spray and Bio Blue Light arms and legs are firmed.

•

Concentrated oxygen refreshes and vitalises the skin.

The Most Advanced Clinically Researched UV Skin Protection Range stand 56

Heliocare® provides optimum UVA & UVB protection with proven skin-enhancing anti-oxidant activity in great to use skin-loving formulations.

Heliocare®: Essential for every day anti-ageing use, periods of high UV exposure and after medical-aesthetic procedures. •

High or very high level UVA and UVB protection with great to use skin-loving-gel formulations

•

Clinically and scientiﬁcally proven skin-speciﬁc anti-oxidant and dermal protection action

•

The essential and primary step in any anti-ageing and UV skin protection regime

WITH

For Product and Scientiﬁc Information please contact AesthetiCare Tel: 0800 0195 322 email: info@aestheticare.co.uk

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Product Focus

GETTING ACTIVE We find out how NeoStrata® is combining the latest state of the art skin technology and new star performing ingredients in its latest range – Skin Active Founded by internationally recognised dermatologist, Dr Eugene Van Scott, and dermatopharmacologist, Dr Ruey Yu, NeoStrata® has long been a pioneer in the field of cosmeceuticals. But while aesthetic practitioners across the globe rave about the products, the brand has been more of a quiet success story in the UK. However, now under new distributorship with Aesthetic Source, NeoStrata® is finally making some noise with the launch of its latest range – Skin Active. The Skin Active cosmeceutical range combines NeoStrata’s clinically proven skincare technologies with today’s most advanced benefit ingredients and is designed to lift, firm, plump and restore skin tone for a noticeably younger and healthier complexion. The new high performance ingredients in the Skin Active range include Maltobionic acid, NeoGlucosamine™ and Swiss apple stem cell extract that work together to stimulate cell renewal, even pigmentation, boost collagen and protect against oxidative damage. When used as a daily regimen, the complementary mechanisms of action work synergistically in all skin layers to deliver outstanding rejuvenating effects, including significant improvement in the appearance of deep wrinkles, crow’s feet, sagging and uneven pigmentation. Presenting the new range in London, Leigh Ann Catlin, vice president of NeoStrata® said, “Thoughtful selection and precise blending of multiple potent cosmetic active ingredients presented in one system makes the NeoStrata® Skin Active range unique. Some ingredients are long proven, such as retinol, peptides, sun screen and potent anti-oxidants, like chardonnay grape seed extract; while others, such as Maltobionic acid, NeoGlucosamine™ and Swiss apple stem cell, are the newest, highly efficacious antiageing ingredients which are exclusively combined in Skin Active to address multiple signs of ageing.” Maltobionic acid – delivers potent anti-oxidant and skin conditioning benefits to product firmer skin. NeoGlucosamine™ – a non-acid proprietary amino acid, a building block of hyaluronic acid, which provides a number of anti ageing benefits. It enhances cell turn over to exfoliate existing pigmented spots and inhibits the production of melanin. 54

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The Skin Active Products in a nutshell Exfoliating Wash

strengthening, along with a

• Soap free cleanser, cleanses

potent anti-oxidant complex to

without irritation

help further protection

• Formulated to stimulate cell renewal • Lightly exfoliates without over drying • Gluconolactone and Maltobionic Acid

• Matrixyl™ 3000 Peptides help

• Glycolic Acid increases collagen production for plumper, fuller skin • Maltobionic Acid and Gluconolactone help repair

increase collagen production

damage in deep skin layers

• NeoGlucosamine™ and Retinol

• Grape seed extract and anti-

enhance plumpness and

oxidant extracts of pomegranate,

diminish appearance of wrinkles

blueberry, and acai protect

• Pomegranate, Vitamins A & E and

against cell ageing

• Stimulates cell turnover to

coffee arabica berry help protect

enhance texture and clarity

skin’s matrix against further

Intensive Eye Therapy

• Aloe, Chamomile, Cucumber, and

damage

• Builds and plumps the layers

Rosemary Extracts soothe and refresh skin

of delicate skin around the Cellular Restoration

eye. The eye area appears

• A night cream designed to

more lifted and crow’s feet

Matrix Support SPF 20

protect the longevity of skin

• Formulated to repair the matrix

stem cells to rebuild the deep

support structure, increase

skin matrix and reduce oxidative

cell turnover and reduce the

damage for skin that is firmer,

appearance of uneven pigment

more lifted and vibrant.

for firmer, smoother, more luminous skin. Includes three clinically proven technologies,

• Apple Stem Cell Extract helps to delay the effects of ageing • Peptides enhance collagen and

are smoothed. Caffeine helps deflate puffiness. • Apple Stem Cell Extract preserves youthful look and vitality of skin • Peptides stimulate matrix components to produce more collagen • NeoGlucosamine™ reinforces

each with a unique action,

reduce the appearance of deep

collagen’s surrounding support

for greater skin repair and

wrinkles

structure

Swiss apple stem cell extract – causes old cells to behave like younger cells and boost collagen production. The Skin Active range brings together these latest ingredients with proven ingredients such as: Retinol – derived from Vitamin A, enhances cell renewal, promotes collagen synthesis, reduces pigmentation and works in combination with NeoGlucosamine™ to increase the production of hyaluronic acid in the skin. Chardonnay Grape Seed - a polyphenol anti-oxidant known for its anti-inflammatory properties.

Scientific Evidence Developmental studies for NeoStrata Skin Active show

high efficacy, good tolerability and remarkable results. In Consumer Use Testing, users of the full regimen reported noticeable benefits beginning as early as one month and continuing through three and six months of use. The target users for the range are people over 40 who want strong potent anti-ageing. The Skin Active range delivers superior antiageing benefits across formulations from new complementary and synergistic technologies by combining the best of NeoStrata’s transformative technologies with additional state of the art ingredients. This provides aesthetic practitioners with a highly effective anti-ageing skincare regimen that will satisfy their needs as well as the needs of their patients.

The cosmetic practitioner’s first choice for insurance The cosmetic industry’s most recognised insurance company since 1996 ✓ Medical Liability Insurance and Salon & Surgery Insurance packages tailored to your individual needs

✓ From medispas to hospital groups to individual mobile practitioners ✓ Most comprehensive cover available in the cosmetic industry ✓ Free advice from our industry experts ✓ No excess to pay for medical malpractice claims* stand 52

Call free on 0800 63 43 880 and quote: CN04, or visit us online at… w w w . c o s m e t i c - i n s u r a n c e . c o m Hamilton Fraser Cosmetic Insurance | Kingmaker House | Station Rd | New Barnet | Herts | EN5 1NZ Hamilton Fraser Cosmetic Insurance is a trading name of HFIS plc. HFIS plc is authorised and regulated by the FSA. (*conditions apply)

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Introducing Aesthetic Source the NEW UK distributor of NeoStrata products and peel ranges For information on our exciting support and training packages, please contact us Tel: 01234 313130 Email: training@aestheticsource.com

www.aestheticsource.com

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LS is

advertorial

m o re

We find out about the SkinLS range of products When it comes to aesthetic equipment LS is definitely more. SkinLS is the exclusive UK distributor for leading IPL equipment and slimming devices including EXIMIA, Lipoglaucin™ and IPL Advance, offering discerning cosmetic practitioners a complete range of aesthetic solutions. The company prides itself on the service it offers its clients, seeing them as strategic business members and offering them knowledge and professional support each time. With each purchase you will receive treatment training, servicing contracts, medical protocols regarding each treatment and marketing tools to satisfy all your needs, so that you can improve sales. They also offer affordable options to hire or rent equipment, including IPL equpiment rental from £55 a week.

EXIMIA – The Number 1 International Body Contouring Machine EXIMIA is an international market leading body contouring device, which gives instant results from the first session. It is the only machine to use a unique combination of two patented technologies Endolift and Ultraporation. EXIMIA massages, drains and tones up whilst dissolving, reducing and sculpting simultaneously. The repetition of the four-phased cycle: vacuum suction, release, vacuum suction and vibration, stimulates the metabolic activity of adipose tissue to ensure improved oxygenation and microcirculation, leaving visibly smooth skin tone and improved elasticity. The combination of three technologies, interactive software and accurate diagnostic tools, provides clinics and salons with a solution to all body contouring needs in just one room and with just one therapist. EXIMIA is in line with the latest European Commission Legislation as the technologies are completely safe and approved. Leasing options are available. Lipoglaucin™ - Liposuction in a cream! Lipoglaucin™ is designed to attack problems involving fat accumulation and cellulite. The bio conductive product has an extraordinary slimming, anticellulite and firming activity, due to its incomparable efficiency. Using its patented formula of leech actives, neuropeptides and molecules to stimulate lipolysis, protects the skin against the oxidative processes and inhibits the appearance of new adipocytes, constituting an effective anti-cellulite and contour modeling treatment. Lipoglaucin™ is deal for use with other body contouring treatments, such as mesotherapy, ultrasound and radio-frequency, or for resale.

cosmeticnewsuk.com

IPL Advance – The Worlds FIRST IPL to Include ‘Tan&Safe’ Technology for Dark Skin The IPL Advance system is the fastest and most powerful 60J/cm IPL machine on the market. It gives one shot per second through its large spot headpiece (8x40mm) and is perfect for hair removal, skin rejuvenation, wrinkle reduction and treatment of skin pigmentations/age spots and acne. l The first IPL in the World to use ‘Tan&Safe’ technology for tanned and dark skin types V and V1 l Exceptional Xenon lamps that last way beyond 100,000 shots guaranteed l Advanced filters with double wavelength, avoiding UV penetration on the skin l Refrigeration sub zero intense® system cools skin below 0 and acts as a local anaesthetic l Powerful Multipulse system that allows us division of the main pulse up to six times. l Multiprotection system – barometer and gage show water temperature and safe working conditions l Automatic shut down if temperature rises above safe level to prevent equipment damage

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T H ETHMEOM S TO SATDVA A DVA NC ENC D EHDYAHLU YARLU O NR IOCNAI CC IADCFI DI L LFEI LRL E R WITH WITH A NEW A NEW STATE STATE OF THE OF THE ARTART PACKAGING PACKAGING DESIGN DESIGN

www.obvieline.com www.obvieline.com

Product News Innosearch Agreement with Medical Aesthetic Group Medical Aesthetic Group is now representing the complete InnoSearch range in the UK. The range includes: Inno-Roller®, Inno-Derma®, Inno-Peel, Inno-TDS® and InnoCaps®. Innosearch formulate and manufacture all the products in their own modern facilities in Barcelona, which ensures consistent high quality and reliability of deliveries. Under the direction of Dr Fernando Bouffard, Innosearch uses its knowledge and pharmaceutical experience to offer a fully integrated range of products based on the biology of the skin, which work synergistically to produce genuine and visible results. David Gower, managing director of Medical Aesthetic Group says, “Inno-TDS has always been one of our best selling ranges and our decision to bring in the full range has been influenced by the demand from our clients for a fully comprehensive range of products that better meet the needs of a growing aesthetic industry.”

LPG® Endermologie UK Launch New Cosmetic Line LPG® has launched a brand new face and body skincare line. Offering the next generation in antiageing and cellulite reduction, this new line of Soins Techniques LPG® will give clients a innovative way to enhance the results they enjoy in salon from LPG professional treatments. These solution-based home care products draw on the brand’s expertise in cellulite reduction and anti-ageing. They contain a high concentration of active ingredients with scientifically-proven effectiveness, and are free of parabens and phenoxyethanol. Designed to combat the visible signs of ageing, the new line of facial products include an ‘Essential Day and Night’ range with three results-driven face creams and a ‘specialised’ range of three targeted products. The products have been specially formulated to target the three main effects of ageing; sagging, hollowing, and thickening, with active ingredients that stimulate natural cellular activity of anti-ageing functions. The five new body care products are formulated to reduce the appearance of cellulite, and address loss of volume and loose skin by stimulating the natural release of stored fat, and preventing new fat from accumulating.

Viora introduces ReFit Viora has developed a new protocol for body contouring using its leading Reaction™ system. With a relatively short treatment course, results showed a noticeable improvement in both lax, sagging skin on the abdomen as well as stretch marks on the flanks with the ReFit treatment. The procedure is ideal for anyone who has had extreme, rapid weight loss, including postpartum women. Viora’s Reaction™ is designed for non-invasive body contouring and skin tightening treatments, featuring the new-age CORE™ (Channeling Optimised RF Energy) technology. Winning the support of leading physicians and dermatologists worldwide, CORE™ offers three distinct RF treatment modes along with a multi-channel mode, optimising treatment accuracy and delivery of exceptional clinical results.

cosmeticnewsuk.com

Anthelios now available in 300ml bottles La Roche-Posay is launching bigger 300ml sized bottles as part of its Anthelios XL sunscreen range.

The new 300ml sizes will be available in both the Anthelios XL Spray SPF 50+ and Anthelios XL Lotion SPF 50+ both specifically created to protect the body from UV damage. Anthelios XL offers the highest UV protection currently available on the market. Suitable for allergy-prone, sun intolerant and sensitive skin, Anthelios XL provides highly effective and dermatologically tolerated products to protect skin against cell damage caused by UV rays. Anthelios Melt-in Cream SPF50+ gives broad spectrum protection for normal to dry skin types and is now available on prescription for skin conditions and adverse effects caused by UV rays. La Roche-Posay, the brand of choice of 25,000 dermatologists worldwide, has demonstrated its efficacy via 21 clinical studies carried out in vivo on patients suffering from sun intolerance reactions; particularly those caused by UVA rays. The combination of patented filters Mexoryl® SX and Mexoryl® XL enables the Anthelios filtering system to ensure efficient protection against the entire spectrum of UVB-UVA rays; whatever their intensity.

SilDerm™ launches Celfix™ DNA-based skin rejuvenation treatment SilDerm Group has launched SilDerm™-Celfix™, a range of new DNA based skin treatments that use natural enzymes to repair the fine lines, wrinkles and age spots caused by the damaging effects of the sun. Celfix contains natural enzymes, which get to the cause of the problem. They actually repair the damaged DNA, so the skin cells repair themselves and become rejuvenated and more like cells in younger skin. When these new cells divide, they then pass on the repaired DNA to the new cells so the effects of Celfix are long lasting. As the old skin cells are replaced by the new rejuvenated cells, the skin takes on the appearance of younger skin with fewer fine lines and wrinkles and the sun spots fade. The beneficial effects of Celfix can be seen after just a couple of weeks as the old skin cells are replaced by the new but Celfix it can take up to 12 weeks to attain the 70% improvement achieved in the trials There are three different products in the SildermCelfix range of skin treatments: Celfix DNA Youth Recovery Facial Serum; Celfix DNA Ceramide Renewal Nourishing Cream and Celfix DNA iQuad Infusion Total Eye Complex.

Clinically Proven Skin Collagen Regeneration THE POWER OF NATURE, THE SCIENCE OF ENDOCARE®

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ENDOCARE® PROVIDES EVIDENCE BASED SKIN COLLAGEN AND DERMAL REGENERATION For when you need to fight the visible signs of ageing and sun-damage, Endocare’s clinically-proven, unique and naturally-derived SCA Biorepair Technology harnesses the power of nature to provide:

WITH

• Natural ﬁbroblast-growth-factor stimulation and regeneration of the dermis • Skin-speciﬁc antioxidant protection and dermal enhancement • Elegant daily-use regenerating dermo-cosmetics with enhanced evidence based formulations For Product and Scientific Information please contact AesthetiCare Tel: 0800 0195 322 email: info@aestheticare.co.uk

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abstracts

Abstracts

We summarise some of the most recent studies you may have missed Title: Low fluence–high repetition rate diode laser hair removal 12-month evaluation: Reducing pain and risks while keeping clinical efficacy Author: Daniel Barolet MD Published: Lasers Surg. Med. 44:277–281, 2012 Abstract Background and Objective: High fluence diode lasers with contact cooling have emerged as the mainstay modality for hair removal. However, the use of these devices is associated with pain and side effects, especially in patients with dark or tanned skin. A novel concept of depilation at low fluence using 810 nm diode laser has been introduced as a solution to these shortcomings. The purpose of this study was to evaluate the lasting efficacy and safety of low-level fluence 810 nm (15 J/cm2) and high repetition rate (5 Hz) F1 Diode Laser™ therapy on hair reduction in patients with various skin types.

Study Design/Materials and Methods: This randomised, controlled, bilaterally paired withinpatient, double-blind study compared low level fluence 810 nm (15 Joules/cm2) laser diode therapy to nontreated shaved control areas on long-term hair reduction. Seventeen patients with skin type II–V were treated four times at 1 month intervals. Hair count was assessed monthly over 10 months using an objective computerised method. Safety and tolerability were assessed by adverse reactions monitoring. Results: Statistically significant differences in hair count between treated and control sites were observed at each follow-up visit. The majority of patients reported a slight but bearable sensation of heat during the laser treatment, and transient erythema post-treatment. Conclusions: This study showed that laser hair removal with the F1 Diode Laser™ system was generally well tolerated, safe, and efficacious in this small sample study of patients with various skin types. After just four treatments, permanent hair reduction following one complete hair cycle has been shown. Controlled studies on larger groups of patients within each skin phototype are needed to confirm these promising results.

and increased lipid storage within the adipocytes as well as changes in the dermal architecture. Aim: In our studies the ability of cosmetic agents Furcellaria lumbricalis, Fucus vesiculosus, retinoid, conjugated linoleic acid (CLA), and a glaucine mixture to stimulate in vitro1) lipolysis in human adipocytes and 2) production of pro-collagen I by fibroblasts was investigated in vitro. The ability of these ingredients to improve cellulite condition in vivo was also determined. Patients/Methods: Mature adipocytes and ‘aged’ fibroblasts were used for in vitro studies. The assessment of cellulite in vivo was performed by dermatological grading and ultrasound measurements. Results: Mature adipocytes treated with combined actives resulted in a significant synergistic increase in free glycerol release. On “aged” fibroblasts, combined treatment of F. vesiculosus and F. lumbricalis stimulated pro-collagen I production. CLA increased pro-collagen I production, but the glaucine mixture had no effect. The clinical study demonstrated a significant improvement in cellulite grading by a dermatologist after eight and 12 weeks vs. vehicle, and ultrasound imaging showed a significant decrease in fat thickness compared with placebo after 12 weeks. Conclusions: Our studies revealed a potent cocktail of ingredients that when combined together can act in vitro to markedly improve lipolysis mechanisms and by way of stimulating pro-collagen I can also have an effect on the surrounding extracellular matrix. The in vitro actions of the ingredients were translated in vivo, where a clinical improvement of cellulite condition was observed.

Title: Bleeding Risks of Herbal, Homeopathic, and Dietary Supplements: A Hidden Nightmare for Plastic Surgeons? Authors: Wendy W. Wong, MD, Allen Gabriel, MD, G. Patrick Maxwell, MD, Subhas C. Gupta, MD, CM, PhD, FACS, FRCSC Published: Aesthetic Surgery Journal March 2012 vol. 32 no. 3 332-346 Abstract

Title:

Effect of cosmetic ingredients as anticellulite agents: synergistic action of actives with in vitro and in vivo efficacy Authors: Tamara Al-Bader PhD, Adam Byrne PhD, Johanna Gillbro PhD, Andrea Mitarotonda PhD, Adeline Metois Engineer, Francis Vial PhD, Anthony V Rawlings PhD, Aurelie Laloeuf MSc Published: Journal of Cosmetic Dermatology, Volume 11, Issue 1, pages 17–26, March 2012

Abstract Background: The pathophysiology of cellulite involves changes in the subcutaneous adipose layer and the extracellular matrix (ECM) that supports it together with overlying dermal layer. Cellular mechanisms governing cellulite are not fully understood. However, it is accepted that changes include enhanced lipogenesis, decreased lipolysis,

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The utilisation of complementary and alternative medicine has increased tremendously in the last two decades. Herbal products, homeopathic medicines, and dietary supplements are extremely popular and are available without a prescription (which likely contributes to their popularity). Despite their “natural” characteristics, these remedies have the potential to cause bleeding in patients who undergo surgery. The high use of these supplements among cosmetic surgery patients, coupled with increasing reports of hematomas associated with herbal and homeopathic medicines, prompted the authors to conduct a comprehensive review focused on bleeding risks of such products in an effort to raise awareness among plastic surgeons. This review focuses on 19 herbs, three herbal formulas, two herbal teas, and several other supplements that can cause bleeding perioperatively and postoperatively.

In addition to being aware of such adverse effects, plastic surgeons must adequately screen all patients and educate them on the possible dangers associated with these treatments.

Title: Radio-frequency-Assisted Liposuction Device for Body Contouring: 97 Patients under Local Anesthesia Authors: Spero J. Theodorou, Robert J. Paresi and Christopher T. Chia Published: Aesthetic Plastic Surgery, Online First™, March 31, 2012 Abstract Background: Radio-frequency-assisted liposuction involves the delivery of a controlled amount of energy to treated tissue resulting in fat liquefaction, accompanying hemostasis, and skin tightening. The purpose of this study is to report experience with a larger sample size using the BodyTite™ radio-frequency-assisted liposuction (RFAL) platform, and its first use with local tumescent anesthesia. The Bodytite™ device is currently awaiting FDA approval. Methods: We prospectively included 97 patients who underwent radio-frequency-assisted liposuction under local anesthesia under IRB approval. We treated 144 anatomical areas in 132 operations and collected the following data: age, sex, height, weight, body mass index (BMI), anatomical area of treatment, operative time, amount of tumescent solution used, amount of fat aspirated, amount of kilojoules (kJ) delivered, and the incidence of infections, seromas, adverse effects from medications, and thermal injuries. Patients were asked to complete an online survey assessing the aesthetic outcome and quality of life after treatment with RFAL-assisted liposuction. Three independent plastic surgeons were asked to evaluate photographs of our sixmonth postoperative results in comparison to the preoperative photos. Results: The average age and BMI of our study population was 37.6 years and 28.2 kg/m2, respectively. The study population was 88% female. The mean amount of lidocaine given per treatment session was 32.7 mg/kg (range = 3.8–83.3 mg/kg). The mean amount of tumescent fluid given per anatomical treatment area was 1,575 cc. The average amount of total aspirate across all anatomical treatment areas was 1,050 cc, with an average total aspirate of 1,146 cc per treatment date. The overall incidence of major complications was 6.25% and the incidence of minor complications was 8.3%. Overall patient satisfaction was 82% for the degree of skin tightening and 85% for the body-contouring result with the BodyTite™ device. Three independent plastic surgeons graded the improvement in body contour as good to excellent in 74.5% of patients and the improvement in skin tightening as good to excellent in 58.5% of patients. Conclusions: The BodyTite™ RFAL platform is a safe and effective device for use as an energybased liposuction technique under local tumescent anesthesia in the awake patient.

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Clinic Review

Go West

Antonia Mariconda visits The Westbourne Clinic I’ve heard the expression ‘One Stop Shop’ often used by clinics hailing to have everything you need in cosmetic medicine under one roof, but stepping through the doors of The Westbourne Centre, I discovered that premier clinics that cater 360 degrees to patients needs really do exist.

treatment over run by a few minutes. It’s inspiring to see a clinic work like clockwork, and for someone like me an unforgiving critic to try and scrutinise and analyse in minute detail something for me to say such as ‘your waiting room could do with improving’ or ‘I notice you don’t offer that particular treatment’ but clearly the truth of my tea and tour with Hannah at Westbourne indicates that really in a

he Westbourne Clinic is an imposing period

The pioneering surgeons at Westbourne are specialist

quite delightfully non imposing or pretentious way

mansion nestled in the heart of one of

surgeons performing surgical procedures under local

Westbourne really is a super clinic and demonstrates

Birmingham’s premier residential locations

anaesthetic, a dozen or more of their most notable

how you can marry an extensive combination of

Edgbaston. The CQC registered premises

pieces of press coverage which include national

services under one roof and run them all smoothly

are home to the services of cosmetic surgery, cosmetic

newspaper spreads newspaper and photographs from

and efficiently.

medical treatments and dental service.

a well known morning television programme proudly line the clinic hallways to demonstrate the remarkable

Westbourne is exactly the kind of place that as an

A beaming and rather gorgeous Hannah Potter

advances in cosmetic surgery and anaesthesia which is

independent writer and coach advising consumers on

was my tour guide for the day. Hannah who looks

of their unique sales point. “Would you have a surgical

how and how not to shop for safe surgery and cosmetic

after Westbourne’s business development and

procedure whilst awake?” asks Hannah, “I would if it

medicine, that I would say ‘use this clinic as a template

communication says, “I really can’t think of a lovelier

was here” I reply, I make that conclusion based on the

standard’. I had a great afternoon with Hannah at

place to work”, and I can see why, the light bright airy

fact that my fast scans of each press piece hanging

Westbourne, it was time to return back to HQ and grab

building is bustling with staff consisting of nurse and

in the hallways report positive(all the faces beaming

some dinner so on the note of food being my parting

theatre professionals, expert anaesthetists, experienced

back look happy), but with Fazel Fatah at the helms of

thought I’d like to summarise my tour of Westbourne

leading aestheticians and top cosmetic surgeons

Westbourne I’d make a pretty good judgment call that

along the lines of a restaurant review;

amongst which the Westbourne credits BAAPS current

I’d probably be in a pair of the safest surgical hands I

president Fazel Fatah.

could find.

Starter: Dentistry – healthy and balanced

The first floor of Westbourne is where cosmetic

There are people that constantly enter and

Main: Non Surgical Treatments – fabulous presentation,

aesthetic treatments take place, treatments ranging

exit Westbourne, a steady flow of traffic which

good assortment, quality ingredients

from anti-wrinkle injections, dermal fillers, semi-

encompasses men, women and children (mostly for

Dessert: Cosmetic Surgery – creative mastery, tempting

permanent makeup, laser hair removal, laser facial

dentistry) but none the less, it’s great to know your

and sweet light after taste

treatments, sclerotherapy injections, and varicose

child is in safe hands having a dental check over

vein treatments are just part of the exhaustive list at

whilst you slip out downstairs for a quick spot of

All in all The Westbourne was a delicious experience

Westbourne. The second floor is home to the cosmetic

microdermabrasion, oh and don’t worry about little

that tantalised the beauty buds in me and for this

and restorative studio’s which cater for all aspects of

junior; Westbourne have their own paediatric nurse

reason I believe it deserves none other than a very

cosmetic dentistry and specialist restorative dentistry as

on hand to take care of your little angel should your

rarely awarded five stars.

well as specialised services such as oral and maxillofacial surgery even though the studios scream state-of-theart! The dentist’s chair seems bizarrely inviting for a little sit down. The jewel in the crown of Westbourne has to be the second floor, as Hannah explains, “This is where the really good stuff happens!” The second offers patients an extensive array of cosmetic surgery procedures ranging from breast augmentation, liposuction, tummy tuck surgery all the way through to complete body lift surgery for post weight loss patients, (incidentally they also boast an amazing weight management service that includes gastric bypass, balloon, banding or sleeve).

cosmeticnewsuk.com

The time has come for those injectable cosmetic providers who believe in the highest quality treatments to stand up and be counted. For too long, unqualified practitioners with little regard for best practice have compromised the industry’s image and put patients at risk. Now there is an opportunity to restore consumer confidence in the industry. Registration for this Government-backed register is now open. Once accepted, providers will be listed on the register’s public website Treatments You Can Trust, which will launch to the public in September. To ensure providers are directory enabled by this time, they can just follow the five easy stages of registration:

THE TIME HAS COME

STAGE 1: Initial Expression of Interest – Providers to pay £50 +VAT to record their initial interest in the scheme, enables access to the standards and training principles which all providers must meet to gain registration. STAGE 2: Self Assessment against Standards and Training Principles – Providers are required to complete self-assessment forms and submit evidence of their practice and pay the full registration fee of £500 +VAT for individual practitioners or £1000 +VAT for larger organisations. Review of the evidence will take a maximum of 10 working days. STAGE 3: Assessment and Award of the Quality Mark – Practitioners will be contacted by email to inform them of whether they have been awarded the Quality Assurance Mark they will then be issued with a certificate to display in the practice demonstrating that they achieved the standards required for the quality mark STAGE 4: Inspection – Inspections will be conducted of registered organisations.

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To find out more on how to register, providers can visit www.treatmentsyoucantrust.co.uk or email the CHKS at Ihascosmetics@CHKS.co.uk

STAGE 5: Annual Renewal – Registration is valid for 12 months, after which time practitioners will need to complete the process again and pay the appropriate renewal fee. HOW TO APPLY The web-based applications are being managed by CHKS, the UK’s leading independent provider of healthcare intelligence and quality improvement services.

REVANESSE & REDEXIS

BOSTON

DERMAL FILLERS

INTERNATIONAL

Train in g A ca d emy Ltd .

I N T E R N AT I O N A L TRAINING ACADEMY FOR AESTHETIC EXCELLENCE

Before

After

Before

After

MEDICAL AESTHETIC TRAINING COURSES: Tear trough master class Lips master class Practical dermal fillers (beginners welcome) 1:1 Dermal fillers Advanced Botulinum toxin Mesotherapy - face, body & hair Futher post-course development, mentoring, shadowing

AFTER

FREE TRAINING AVAILABLE 0207 727 1110 41 Moscow Road, Bayswater, London W2 4AH

info@boston-medical-group.co.uk www.boston-medical-group.co.uk

29TH - 30TH APRIL 2012 BUSINESS DESIGN CENTRE, ISLINGTON, LONDON

STAND 87

29TH - 30TH APRIL 2012 BUSINESS DESIGN CENTRE, ISLINGTON, LONDON

STAND 87

“for complete facial aesthetics, where knowledge & skill come first”

Please contact us for dates& prices.

0207 727 1110 41 Moscow Road, Bayswater, London W2 4AH

info@bostontrainingacademy.com www.bostontrainingacademy.com

Dates for the Diary

may

diary

july

june

4 Chemical Peel Training, Newport South Wales, www.honeyfizz.co.uk 7 Foundation Level Botulinum Toxins and Fillers, Aberdeen, www.inspiredcosmetictraining.com 8 Genuine Dermaroller™ Medical Device Training, Dublin, www.genuinedermaroller.co.uk 8 AesthetiCare® EndyMedPRO™ workshop, London, info@aestheticare.co.uk 8 Medex Training, Level 2 Advanced Toxin (Easy Switching Between Toxins), Loughborough, medextrainingcourses@gmail.com 8 Medex Training, Level 2 Advanced Toxin – Lower Face, Loughborough, medextrainingcourses@gmail.com 9 Mapperley Park Core of Knowledge, London, www.mapperleypark.co.uk 9 Dr Bob Khanna Training Institute, Botulinum Toxin - Beginners, www.drbobkhanna.com 10 Dr Bob Khanna Training Institute, Botulinum Toxin - Advanced, www.drbobkhanna.com 10 Laser/IPL Core of Knowledge, London, www.lasersafe.co.uk 10 Medex Training, Glyderm Skin Care and Glycolic Acid Peels, Loughborough, medextrainingcourses@gmail.com 11 Dr Bob Khanna Training Institute, Dermal Fillers – Beginners, www.drbobkhanna.com 11 Skin Needling Course, London www. whitelotusantiaging.co.uk 11 Genuine Dermaroller™ Medical Device

Training, Yorkshire, www.genuinedermaroller.co.uk 12 Botulinum toxin and dermal fillers Foundation Course, Birmingham, www.aesthetox.co.uk 12 Sclerotherapy Course, Birmingham, www.aesthetox.co.uk 12 Cosmetic Courses Foundation Botulinum Toxin and Dermal Filler Training. www.cosmeticcourses.co.uk 14-15 SkinCeuticals Training, Cheshire, www.SkinBrands.co.uk 15 Medex Training, Level 1 Basic Toxin – Upper Face, Loughborough, medextrainingcourses@gmail.com 15 Medex Training, Level 1 Basic Toxin – Hyperhydrosis, Loughborough, medextrainingcourses@gmail.com 18 Smart Ideas Seminar, The Belfry Hotel, Birmingham, www.smartseminar.co.uk 19-20 Consulting Room Aesthetic Industry Golf Day, The Belfry Hotel, Birmingham, www. consultingroomgolf.co.uk 19 Cosmetic Courses Advanced Botulinum Toxin and Dermal Filler Training. www. cosmeticcourses.co.uk 21 AesthetiCare® EndyMedPRO™ workshop, Yorkshire, info@aestheticare.co.uk 21-22 Medik8 Training, Cheshire, www. SkinBrands.co.uk 22 Genuine Dermaroller™ Medical Device

We round up upcoming events, training courses and meetings

Training, London, www.genuinedermaroller.co.uk 22 Medex Training, Level 2 Advanced Toxin – Lower Face, Loughborough, medextrainingcourses@gmail.com 22 Medex Training, Level 2 Advanced Toxin (Easy Switching Between Toxins), Loughborough, medextrainingcourses@gmail.com 22-23 SkinCeuticals Training, London, www.SkinBrands.co.uk 24 Dental Infiltration, Newport South Wales, www.honeyfizz.co.uk 24 Growing Your Medical Aesthetic Practice Masterclass, Aberdeen, www.inspiredcosmetictraining.com 24-25 Medik8 Training, London, www.SkinBrands.co.uk 24-26 Microsclerotherapy for Thread Veins of the Leg, Guildford, www.theclinicalexchange.com 25 Genuine Dermaroller™ Medical Device Training, Lancashire, www.genuinedermaroller.co.uk 26 Botulinum toxin and dermal fillers Foundation Course, London, www.aesthetox.co.uk 30 Foundation level, Botox and Dermal Filler Training course, www.inspiredcosmetictraining.com 30 Foundation Level Botulinum Toxins and Fillers, Glasgow, www.inspiredcosmetictraining.com 30 Dermaroller Training, Newport South Wales, www.honeyfizz.co.uk

2 Innomed Training Botulinum Toxin in Facial Aesthetics: New Users (incl. all major brands), London, www.innomedtraining.co.uk 2 Basic Botox Training, Newport South Wales, www.honeyfizz.co.uk 3 Basic Dermal Filler Training, Newport South Wales, www.honeyfizz.co.uk 3 Innomed Training Dermal Fillers Facial Aesthetics: New Users to Hyaluronic Acid, London, www.innomedtraining.co.uk 4 Genuine Dermaroller™ Medical Device Training, Yorkshire, www.genuinedermaroller.co.uk 7 Dr Bob Khanna Training Institute, Dermal Fillers – Advanced, www.drbobkhanna.com 8 Dr Bob Khanna Training Institute, Oral Facial, www.drbobkhanna.com 9 Botulinum Toxin and Dermal Fillers Advanced Course, Birmingham, www.aesthetox.co.uk 11-12 SkinCeuticals Training, Cheshire, www.SkinBrands.co.uk 12 Medex Training, Level 2 Advanced HA Filler Lip Course, Loughborough, medextrainingcourses@gmail.com 14 Laser/IPL Core of Knowledge, Birmingham, www.lasersafe.co.uk 18 Dr Bob Khanna Training Institute, Botulinum Toxin - Beginners, www.drbobkhanna.com 18 Areola Artistry Workshop, The Royal College of Surgeons, London, 0845 230 1210/1310. 18-22 Btec Award Laser, Light and Associated Aesthetic Therapies, London, www.mapperleypark.co.uk 19 Dr Bob Khanna Training Institute, Botulinum Toxin - Advanced, www.drbobkhanna.com

19 Genuine Dermaroller™ Medical Device Training, London, www.genuinedermaroller.co.uk 19 Medex Training, Level 1 Basic HA Filler, Loughborough, medextrainingcourses@gmail.com 20 Dr Bob Khanna Training Institute, Dermal Fillers – Beginners, www.drbobkhanna.com 23 Foundation Level Botulinum Toxins and Fillers, Inverness, www.inspiredcosmetictraining.com 23 Marketing Your Medical Aesthetic Business, Inverness, www.inspiredcosmetictraining.com 23 Foundation level, Botox and Dermal Filler Training course, Inverness, www.inspiredcosmetictraining.com 23 Botulinum Toxin and Dermal Fillers Foundation Course, Birmingham, www.aesthetox.co.uk 25 Genuine Dermaroller™ Medical Device Training, Scotland, www.genuinedermaroller.co.uk 25-26 Medik8 Training, Cheshire, www.SkinBrands.co.uk 26 Medex Training, Level 2 Advanced HA Filler - Lower Face Shaping, Loughborough, medextrainingcourses@gmail.com 26-27 SkinCeuticals Training, London, www.SkinBrands.co.uk 29 Genuine Dermaroller™ Medical Device Training, Hampshire, www.genuinedermaroller.co.uk 30 Innomed Training Chemical Peeling Systems: Comprehensive Course for New Users, London, www.innomedtraining.co.uk

1 Innomed Training Mesotherapy for Fat, Cellulite and Skin Rejuvenation: New Users, London, www.innomedtraining.co.uk 2-3 SkinCeuticals Training, Cheshire, www.SkinBrands.co.uk 3 Medex Training, Microsclerotherpy, Loughborough, medextrainingcourses@gmail.com 5-6 SkinMedica Training, London, www.SkinBrands.co.uk 7 Chemical Peel Course, Birmingham, www.aesthetox.co.uk 9-10 Medik8 Training, Cheshire, www.SkinBrands.co.uk 10 Dr Bob Khanna Training Institute, Gel Peel, www.drbobkhanna.com 10 Medex Training, Level 3 MasterClass Toxin, Loughborough, medextrainingcourses@gmail.com 11 Dr Bob Khanna Training Institute, Botulinum Toxin - Beginners, www.drbobkhanna.com 12 Dr Bob Khanna Training Institute, Botulinum Toxin - Advanced, www.

drbobkhanna.com 12 Laser/IPL Core of Knowledge, London, www.lasersafe.co.uk 13 Dr Bob Khanna Training Institute, Dermal Fillers – Beginners, www.drbobkhanna.com 16 SkinMedica Training, Cheshire, www.SkinBrands.co.uk 17 Medex Training, Level 4 Canula Filler Masterclass, Loughborough, medextrainingcourses@gmail.com 19 Medex Training, Genuine Dermaroller Training , Loughborough, medextrainingcourses@gmail.com 21 Botulinum Toxin and Dermal Fillers Foundation Course, Manchester, www.aesthetox.co.uk 24-25 SkinCeuticals Training, London, www.SkinBrands.co.uk 26 Medik8 Roller, London, www.SkinBrands.co.uk

cosmeticnewsuk.com

• If you have any dates you would like to add to our Dates for the Diary section please email vicky@creativemedialtd.co.uk •

recrui t me n t

to advertise in the recruitment section of Cosmetic News please call Carly Macfarlane on 01268 754 897 carly.macfarlane@creativemedialtd.co.uk RC_ADV_AES_EN_V1

repair, restore, regenerate your skin Medi-Spa Physician - Careers at sea Medi-Spa Physician - Careers at sea

Medi-Spa Physician - Careers at sea

Do you have the following Do you have thequalifications? following qualifications? • •

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current valid medical license (int’l or US) • Hold Hold a medical degree fromlicense alicense recognized college or university • aHold a current valid medical current valid medical

and a current valid medical license (int’l or US) Doato you want worklicense inopportunity an amazing Do you work in antomedical amazing on-board cruise liners? • want Hold current valid on-board cruise liners? Then we opportunity have the perfect job for you!

you want to the work incruise anjob amazing SteinerDo hasThen operated onboard luxury ships over 40 years and wespas have perfect forforyou! haswitnessed operated spas onboard luxury cruise ships for over duringopportunity thatSteiner time has the spa, beauty and cruise industry transform from on-board cruise liners? 40niche years markets and during time the has vacationing witnessed the spa, beauty andSince our appealing to tothat serving public at large. Then we have the from perfect job for you! cruise industry appealing to niche markets to beauty, spa early beginnings, Steiner transform has offered cruise ship jobs to over 50,000 serving vacationing at large. Sincecruise our early beginnings, Steiner hasthe operated spaspublic onboard luxury ships for over and fitness professionals, giving them the opportunity to see places that others only Steiner has offered cruise ship jobs to over 50,000 beauty, spa and 40 yearsImagine and during thatfortime has witnessed the spa, beauty and dream about. workinggiving thethem leading spa operator on board 131 fitness professionals, the opportunity to see placesto thatluxury cruise industry transform from appealing to niche markets cruise ships. Steiner Transocean operates hair, beauty, Medi Spa and fitness centres others only dream about. serving the vacationing public at large. Since our early beginnings, on board cruise ships worldwide. If this sounds interesting and is something that Imagine working for the leading spato operator on board 131 luxury Steiner offered cruise ship jobs you would likehas to do, then please contact us. over 50,000 beauty, spa and cruise ships. Steinergiving Transocean hair, beauty, Spa that fitness professionals, themoperates the opportunity to Medi see places fitness centres on board cruise ships worldwide. dream about. Southothers Uk and & only London If this sounds interesting and is something that you would like to do, Contact Donna Allencontact - 07789938334 - DonnaA@onespaworld.com then working please us.leadingemail Imagine for the spa operator on board 131 luxury Northcruise Uk ships. Steiner Transocean operates hair, beauty, Medi Spa Contact 07831365828 angelav@onespaworld.com South Uk &-London andAngela fitnessVickery centres on board cruiseemail ships-worldwide. Ireland &Contact Scotland Jenny Millar If this sounds interesting and -is07789938334 something that you would like to do, Contact Aoife Jennings – us. 00353872308483 email - aoifej@onespaworld.com email - contact jenniferm@onespaworld.com then please North Uk

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Regenerating ageing and damaged skin ReCell® Spray-On Skin® is a revolutionary clinical solution that provides the ability to regenerate, repair and restore areas of damaged, scarred or discoloured skin. ReCell technology takes advantage of the natural regenerative ability of skin. Working with a small sample of the patient’s own skin, ReCell is able to create a cell suspension that activates a natural re-growth of healthy skin. For more information contact Avita Medical T: +44 1223 341150 E: info.eu@avitamedical.com W: www.avitamedical.com

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Avita Medical Ltd 2012

email -Jenny angelav@onespaworld.com Contact Millar - 07789938334 Ireland & Scotland email - jenniferm@onespaworld.com

Contact Aoife Jennings – 00353872308483 North Uk email - aoifej@onespaworld.com

Contact Angela Vickery - 07831365828 email - angelav@onespaworld.com www.onespaworld.com

Ireland & Scotland

Contact Aoife Jennings – 00353872308483 email - aoifej@onespaworld.com

www.onespaworld.com

Sales Executive (Territory Manager) Ideally based near Southampton/Winchester; a fabulous opportunity awaits a high calibre sales professional to work with the UK’s leading aesthetics supplier, Healthxchange Pharmacy

Please submit your CV to mr@healthxchange.com

UK sales agenTs reqUired AZTEC Services, exclusive UK distributors for the Viora product range and the Lutronic range, are looking for sales agents throughout the UK. This is a commission only role selling the products in a designated territory. For more information visit the AZTEC Services website at www.aztecservices.uk.com, the Viora website at www.vioramed.com, and the Lutronic website at www.Lutronic .com

To apply please email az@aztecservices.uk.com Ellipse MARCH 1 1/2/12 09:23 Page 1 or6x2:Layout call 07747 865600 INTENSE PULSED LIGHT (IPL) TRAINING The most comprehensive IPL training in the field by the market leader The Knightsbridge Laser Clinic A team of expert trainers offer high quality training in our school based between Harrods & Harvey Nichols in Knightsbridge, London. Gain knowledge and practical experience in IPL Hair Removal, Skin Rejuvenation, Acne & Facial Thread Vein Removal.

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