cosmeTic news The UK’s leading Trade TiTle for medical aesTheTic professionals
VEINS SPECIAL TreaTmenTs for Thread veins
also in the april issue of CosmetiC news... Hair Loss
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Editor’s Letter Welcome to the April issue of Cosmetic News. Thread veins are largely considered to be a cosmetic problem and as such many medical aesthetics clinics have branched into treating veins as part of their clinic’s offering. As part of this month’s special feature we will be examining vascular treatments from laser to microsclerotherapy and ThermaVein® (p20-32). We also examine the shocking truth behind the cost of aesthetic insurance claims (p4445) and find out about the new training principles that have been developed by the IHAS (p46-47). Also make sure you turn to page 16 to find out the latest about The Aesthetic Awards 2013-2014. Please note that due to an unfortunate clash of dates with the IAAFA meeting, which is usually held in September but is now taking place on the original weekend of the Aesthetic Awards, we have decided to push the date back a week so our clients who want to attend both don’t have to miss out. This means the awards will now be held on Saturday December 7 NOT Saturday November 30 as previously advertised. The theme will be A Winter Wonderland. And don’t forget to add the dates for the 2014 Cosmetic News Expo and Aesthetics Conference to your diary too. The two-day event will take place at the Business Design Centre in Islington on Saturday March 8 to Sunday March 9, 2014.
cosmetic news the uk’s largest trade aesthetics exhibition and conference
exp o 2014
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8 th - 9 th march 2014
Contents INDUSTRY INSIDER
38 Q&A Innosearch founder and
Vicky Eldridge on MD Lash Factor
CEO Dr Fernando Bouffard Ph.D. of the Innosearch Skin Academy facilities discuses the Innosearch range
6 INDUSTRY NEWS
40 TREATMENT SPOTLIGHT
4 EDITOR’S CHOICE
We round up the latest industry news 12 KEOGH REVIEW
Vicky Eldridge on the pending Keogh Review 14 ON THE SCENE
Out and about in the industry this month 16 EVENTS
The Aesthetic Awards 2013-14 CLINICAL PRACTICE 18 VIEW ON
Dr Patrick Bowler gives his view on developments in botulinum toxin
We find out about the body-jet® water-jet assisted liposuction (WAL) procedure 42 PRODUCT NEWS
We round up the latest product news IN BUSINESS 44 BUSINESS FOCUS
Eddie Hooker and Bevan Brittan on litigation and the non-invasive cosmetic procedure 46 TRAINING
We look at the new training standards that have been developed by the IHAS
20-32 VEIN SPECIAL
20 Professor Mark Whiteley on on assessing and treating leg thread veins 24 ThermaVein® - are you brave enough to take on the charity challenge? 26 We talk to vein expert Keith Rose about why microsclerotherapy is his choice
of treatment for thread veins 30 Jo Martin, clinical director of Mapperley Park Clinic on treating vascular lesions and much more with the Pulsed Dye laser 32 We take a look at Energist’s range of vascular lasers 34 HAIR LOSS
In the second part of his article on hair loss, Dr Sotirios Foutsizoglou looks at the surgical treatment options PRODUCT REVIEWS 36 TRIED AND TESTED
Dr Rupert Gabriel on why he chose the NeXT hair removal laser from Asclepion
48 TECHNOLOGY
Editor’s choice
MD Lash Factor Long, full eyelashes are one of the many things we associate with youth and beauty and, in recent years, they have even become a fashion statement, with false eyelashes coming back en vogue. Although my natural lashes are quite dark, they are fairly short, so I rarely go out without my falsies on! I have used both the ‘glue on’ variety and the more permanent extension, both of which can be damaging to your natural lashes and irritate your eyes and let’s face it, if I could have natural lashes that looked longer and fuller rather than having to stick them on (a fiddly task!), I would. Luckily for me I work in an industry where aesthetic enhancement is the name of the game and I was offered to try the latest lash product to be launched in the UK by Medical Aesthetic Group – MD Lash factor. MD Lash Factor is a physician formulated eyelash conditioner with unique patented technology that improves the appearance of natural lash length, thickness and fullness. Developed by Dr Susan F Lin, a practising physician in women’s health, anti-ageing and aesthetic medicine for over 21 years, the prostaglandin free formula combines the latest skincare science with safe, results oriented ingredients. In a one month study 95% of users reported an improvement in the overall appearance of lashes.
The active ingredients contained in the product include Cytokine Complex, which delivers nutrients necessary to develop fuller, thicker, longer looking lashes and Thiotaine, a powerful mushroom derived peptide, that conditions and helps protect and nourish lashes. It also allows them to develop to their fullest potential. The benefits for me of this product is not only that it is physician formulated and ophthalmologist tested but it is also safe for contact lens wearers, which I myself am. You need to apply the product to a clean, dry lash line once a day and results can be seen in as little as 30 days with maximum results being achieved between two to four months. I have only been using it for around three weeks and have already noticed a difference in the thickness and length of my natural lashes so I am looking forward to seeing the effects after a couple of months! I will be posting about it on the Cosmetic News Facebook page – Cosmetic New S – and on my Twitter account, so follow me at vick79 to see how I get on!
Richard Crawford-Small on the new iConsultAesthetic 50 A DAY IN THE LIFE OF…
Antonia Mariconda finds out what a typical Day in the Life has in store for psychotherapist and founder of The Wright Initiative, Norman Wright 52 TRAINING NEWS AND DATES FOR THE DIARY
The latest dates for your diary
ContaCt the CosmetiC news team on 01268 754 897
Charlotte Body Publisher | charlotte@creativemedialtd.co.uk Vicky Eldridge Editor | M: 07940 083 677 | vicky@creativemedialtd.co.uk Sophie Belcher Events/Production | sophie@creativemedialtd.co.uk Peter Johnson, Art Director | peter.johnson@creativemedialtd.co.uk Sean Rice Senior Designer | sean.rice@creativemedialtd.co.uk 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.
the aesthetic awards 2013-14 - december 7, 2013 cynosure
EXPRESS SLIMMING PROGRAMME
MOISTURISING AND TONING
Cynosure to buy Palomar Medical in $294M deal Cynosure is buying Palomar Medical Technologies Inc. in a cash-and-stock deal valued at about $294 million. Both Cynosure and Palomar’s products include cosmetic laser and intense pulsed light systems. Cynosure Chairman and CEO Michael Davin said in a statement on Monday that the deal will provide it with complementary products, strengthen its global distribution network, create new cross-selling opportunities and give it more than 40 additional patents. Davin will serve as chairman and CEO of the combined company. Palomar Chairman, President and CEO Joseph Caruso will become vice chairman of Cynosure’s board once the acquisition closes and will serve as president. Timothy Baker, executive vice president, treasurer and chief financial officer at Cynosure, will serve as executive vice president, chief operating officer and CFO of the combined company. Both companies’ boards unanimously approved the deal, which is expected to close in the third quarter. It still needs the approval of Cynosure and Palomar shareholders. Cynosure said that it plans to relocate its headquarters from Westford, Mass., to Palomar’s facility in Burlington, Mass.
spire regency hospital
Spire Regency Hospital launches non-surgical cosmetic clinic COMBATS
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A new non-surgical cosmetic clinic has opened at Spire Regency Hospital in Macclesfield supporting a campaign calling for non-medics to be banned from administering Botox. Renew Medical Aesthetics will reassure patients undergoing non-surgical cosmetic treatments in an industry which has become flooded with High Street beauty salons offering treatments like Botox and dermal fillers with a lack of or very limited training. Verlie Brazel, Spire Regency hospital director, said: “We took the decision to link up with a highly credible, medically trained cosmetic team to provide a range of non- surgical cosmetic treatments in a safe and sterile environment and we are delighted with the outcome.” Renew Medical Aesthetics is owned and run by managing director Justin Saynor and his partner, Kelly Wilson, who is a qualified nurse turned cosmetic procedure specialist with 10 years experience working in the aesthetics field. Kelly said, “Justin and I are delighted to be on board with Spire Regency – a long-established and well respected private healthcare provider. It is the perfect partnership and really complements our commitment to providing a professional service which people can trust. Our main aim is delivering natural-looking results following detailed consultations with clients, during which the most appropriate treatment is decided upon and the results each individual can expect are discussed.”
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award for sharon hilditch
SHARON HILDITCH MBE SCOOPS WOMEN IN BUSINESS AWARD 2013 Sharon Hilditch, MBE, founder of leading anti-ageing skincare brand Crystal Clear, has won the “Decade in Excellence in Business” Award. The beauty entrepreneur received the award at the inaugural Women in Business Awards 2013, which was held last month at the Hilton Hotel in Liverpool by Downtown Liverpool in Business together with Merseyside based The Women’s Organisation.
01903 768 386 info@thecarltongroup.co.uk www.thecarltongroup.co.uk PROUD TO BE A BRITISH MANUFACTURER
Since 1995, Sharon has won numerous awards and inspired many upcoming female entrepreneurs. She was named winner of the prestigious Natwest Everywoman UK “Female Entrepreneur of the Year” Award in 2004 and was the deserving recipient of the Prince Philip Medal 2008. Also in 2008, Sharon was honoured with an MBE in recognition of her outstanding contribution to British business.
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industry news
save the date for the aesthetic awards 2013-14 - december 7, 2013
cen enquiry
aesthetic source
Second CEN Enquiry gets under way
Aesthetic Source gains strong recognition in NeoStrata International Awards
The launch of the second CEN enquiry on prEN 16372:2013 ‘Aesthetic surgery and aesthetic non-surgical medical services’ is now underway after a delay threatened to stall it.
Aesthetic Source received strong recognition at the recent international NeoStrata meeting in Miami when awarded Best NeoStrata Re-launch.
The public consultation process held last year for the European standard for Aesthetic Surgery Services, EN 16372, received a large number of comments from European countries, including the UK. The comments have now been reviewed by the European committee and as a result the draft has undergone significant changes. The revised draft is now going out for a second public consultation before moving on to the final stage in its development process. EN 16372 is a proposed European standard and has to take in to account the nature and country variances across the European market place with regards to aesthetic surgery. The enquiry opened, as planned on March 14, and will close on July 14, 2013. To comment on the document visit http://drafts.bsigroup.com/ Home/Details/51036
Aesthetic Source Director, Lorna Bowes, has 20 years experience in the medical aesthetics and is thrilled. She says “This is an exciting award for Aesthetic Source. It is very satisfying to work with NeoStrata with its reputation for developing sciencedriven skin technologies and I am delighted that more exciting times are ahead for us with many innovative products in the pipeline. We will continue to support our customers by offering NeoStrata products at a competitive price point whilst strengthening our training and marketing programmes.” Over the past year Aesthetic Source has launched the innovative NeoStrata Skin Active and Enlighten ranges and is now undertaking a media campaign to raise awareness about the benefits of cosmeceutical skincare with regular coverage about NeoStrata skin products now appearing in the consumer press. Later this year in the UK, Aesthetic Source will launch NeoStrata’s ground breaking technology which was well received at the annual meeting of the American Academy of Dermatology meeting in Miami in March 2013.
mission statement for code afa
dalvi humzah appointment
New name and mission statement announced for CODE AFA
Dalvi Humzah appointed as UK regional advisor for West Midlands
CODE AFA Chief Executive Martin MacKenzie has unveiled a new name for the Association from April 2013 as well a new mission statement, aimed at taking the association forward.
Cosmetic surgeon Dalvi Humzah has been appointed UK regional advisor for the West Midlands by the Royal College of Physicians and Surgeons of Glasgow. Working as part of a UK wide network of surgeons, Mr Humzah will promote the benefits of College membership, develop a local network of professional members and facilitate educational activities in the region to champion the highest standards of health care. Importantly, Mr Humzah, whose private practice Plastic and Dermatological Surgery (PDS) is based at Nuffield Health Cheltenham Hospital, Nuffield Health Wolverhampton, Solihull Bupa Wellness Centre and Ramsay Healthcare West Midlands Hospital – will work with local surgeons and physicians to encourage development and provide training across a wide range of medical and surgical specialities. “Having been a fellow of the College since 1992, I’m delighted to take on this role in the West Midlands,” commented Mr Humzah. “Importantly, the four year position enables me to support fellow clinicians and ensure the highest possible standards of private health care in the region. I am committed to giving something back to the industry I serve and helping to promote on-going education and training remains top of my agenda.” Head of membership services at the Royal College of Physicians and Surgeons of Glasgow, Dr Linda Irvine said: “The role of the UK regional advisor is a key aspect of the College’s plans for development and growth. Our advisors comprise physicians, surgeons and dentists who form a local support network and offer a range of services, including education, training and professional development to Fellows and Members; they also promote the many benefits which our multi-disciplinary membership brings to clinicians at all stages of their careers.”
The new name, the “Association for Medical Aesthetics” (CODE AMA) is designed to better-reflect that members and their clinics are now performing treatments that are not limited to the face. Commenting on the name change Martin explained, “When the association was established in 2006 it was dedicated to supporting members who were largely dentists, entering the facial aesthetic market offering treatments such as botulinum toxin and dermal fillers. However, over time, membership has grown to include doctors and medical nurses and the range of treatments that members are offering to patients has grown to include a wider range of treatments such as; peels, collagen stimulation treatments, lasers and light-based treatments and, of course, some of these are not limited to the face and are performed on the neck, décolleté, back of hands and also other parts of the body. It seemed to me that the name had become slighted outdated and had to better reflect what our members were providing.” Following on from the name change a new Mission Statement entitled “Your Partner in Medical Aesthetic Practice” has also been announced to better explain what the Association stands for and how it aims to support members in practice. Martin adds, “We have redefined our mission to more closely reflect a new range of member services and support. As your ‘partner’ in medical aesthetics, our range of practical services is designed to help you run your clinic at both a day-to-day and strategic level”.
6
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aesthetic awards 2012-13, triple win for aBc lasers EquipmEnt Brand of thE YEar Aesthetic Medical Treatment System
Contact us on: Tel: 0845 1707788 info@a-b-c-uk.com, www.abclasers.co.uk © 2013 Alma Lasers, Ltd. All rights reserved. Alma Lasers Ltd., its logos and Soprano, are trademarks or registered trademarks of Alma Lasers, Ltd. Product specifications are subject to change without notice.
aBc lasers
trEatmEnt of thE YEar (BodY) soprano pain free hair removal (aBc lasers)
trEatmEnt of thE YEar (facE)
harmony Xl piXel Qs aka the ‘laser face-lift’ (aBc lasers)
save the date for the aesthetic awards 2013-14 - december 7, 2013
valeant/obagi
laser hair removal
Valeant to buy Obagi Medical
Bikini laser hair removal on the rise
Canadian drugmaker Valeant Pharmaceuticals International Inc is to buy Obagi Medical Products Inc for more than $300 million to boost its dermatology business. The company said it expects the transaction to close in the first half of 2013 and immediately add to its cash earnings per share. The deal is expected to save at least $40 million in annual costs within six months of closing. Valeant, Canada’s largest publicly traded drugmaker, has been building up its dermatology and aesthetics portfolio in the United States over the past year. It has acquired about a dozen smaller companies over the past year, including the purchase of US-based Medicis Pharmaceuticals Corp in December that added Botox® competitor Dysport®and other skincare drugs to its products. Chief executive J Michael Pearson told Reuters in February that Valeant was in talks for more acquisitions and was also open to discuss a potential ‘merger of equals’. Obagi had a revenue of about $120 million in 2012. “Obagi is a leader in the physician dispensed market and enjoys a strong brand perception among physicians. The addition of their products will expand our market presence with dermatologists and plastic surgeons,” Pearson said.
G
More than 80% of women seeking a well groomed bikini line are opting for laser hair removal, according to new statistics from Courthouse Clinics. Of these women more than half (56%) chose the basic Brazilian, which involves hair removal from just outside the bikini or underwear line. Just fewer than 25% went one step further and opted for complete hair removal with the Hollywood. The clinic uses the Soprano XL laser hair removal system, which offers a variety of different shapes and styles, just like waxing. All treatments utilise the Soprano XL IN-Motion™ gentle sweeping laser technology which generates pulses of infrared diode laser energy which gradually heat the hair follicles until they can no longer produce new hair. According to Dr Patrick Bowler, Medical Director of Courthouse Clinics, “Patients actually enjoy Soprano XL as it is painless compared to conventional laser hair removal treatments. It can also be used on patients with darker skins providing an increased safety margin without any reduction in efficacy. This really is a big step forward in the treatment of unwanted hair anywhere on the body”
acne developments
New study finds bacteria can help prevent acne and improve skin New research has found that instead of simply killing all bacteria that causes acne, as is typical of standard anti-acne treatments, actually increasing strains of certain good skin bacteria can help ward off acne. The new study, carried out by scientists at the University of California in LA and published in the March edition of the Journal of Investigative Dermatology, found that while ‘bad’ strains of bacteria that live in skin pores cause acne, good strains of skin bacteria, called P. acnes, can actually help prevent acne and also protect skin by inhibiting the growth of bad skin bacteria.The scientists compared the good ‘acne’ bacteria as being similar to the good bacteria found in live yoghurt that can help protect the gut and keep bad gut bacteria from multiplying. In DNA samples taken from the nose skin of both acne sufferers and volunteers with clear skin. The bacteria taken from skin suffering from acne looked very different to the skin taken from people with clear skin. Two unique strains of bacteria were consistently found in the skin DNA taken from acne sufferers that was not found in skin DNA from clear skin. A third strain of P.acnes. bacteria was found, but only in the skin DNA of test subjects with clear skin, which suggested that a higher presence of ‘good’ skin bacteria is present in the skin of people with clear skin, while a higher presence of bad skin bacteria is present in the skin of people suffering from acne. The study conclusion was that a higher presence of ‘good’ skin bacteria gives the skin a natural defence mechanism with which to attack and destroy bad skin bacteria before it has a chance to infect pores while leads to acne. This new finding, researchers concluded, could lead to new breeds of acne treatments that don’t simply destroy all skin bacteria but that only destroy bad skin bacteria while preserving certain good skin bacteria.
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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 2013 UK/0008/2013a
industry news
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• ABC www.almalasers.com Lasers -Equipment brand of the year for 3 years running or visit: 2013 Alma Lasers, Ltd. All rights reserved. Alma Lasers • ©Ltd., SopranoCosmetic News Award winning Treatment of the year from its logos and Soprano, are trademarks or registered trademarks of Alma Lasers, 2011, 2012, 2013Ltd. Product specifications are subject to change without notice. © 2013 Alma Lasers, Ltd. All rights reserved. Alma Lasers Ltd., its logos and Soprano, are trademarks or registered trademarks of Alma Lasers, Ltd. Product specifications are subject to change without notice.
aesthetic awards 2012-13, triple win for aBc lasers
soprano ice ad.indd 1 Aesthetic Medical Treatment System
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EquipmEnt Brand of thE YEar
1/7/13 8:43
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trEatmEnt of thE YEar (BodY) soprano pain free hair removal (aBc lasers)
trEatmEnt of thE YEar (facE)
harmony Xl piXel Qs aka the ‘laser face-lift’ (aBc lasers)
1/7/13 8:43 PM
Your partner in injectable facial aesthetics
Belotero® now approved by the FDA • One of only 3 HA fillers approved by the FDA currently promoted in the US • Optimal integration1 for superior evenness2 • Minimal local inflammation3 for sustained patient satisfaction4
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Call Merz Aesthetics Customer Services now to find out more or place your orders: Tel: +44(0) 333 200 4140 Fax: +44(0) 208 236 3526 Email: customerservices@merz.com 1 Histological examination of human skin (eyelid dermis layer). Courtesy Dr. J. Reinmüller, Wiesbaden, Germany 2 Prager W, Steinkraus V. A prospective, rater-blind, randomized comparison of the effectiveness and tolerability of Belotero Basic versus Restylane for correction of nasolabial folds. Eur J Dermatol 2010;20 (6):748-52. 3 Taufig A, et al. A new strategy to detect intradermal reactions after injection of resorbable dermal fillers. J Ästhetische Chirurgie 2009; 2: 29-36 4 Reinmüller J et al. Poster presented at the 21 World Congress of Dermatology, Buenos Aires, Argentina, Sept 30 – Oct 5, 2007. Thereafter published as a supplement to Dermatology News: Kammerer S. Dermatology News 2007; 11: 2-3.
www.belotero.uk.com Merz Pharma Uk Ltd 260 Centennial Park, Elstree Hill South Elstree, Hertfordshire, WD6 3SR Tel: +44(0) 333 200 4140
new special
Keogh review
AWA itiNg A respoNse As the industry eagerly awaits the publication of the findings of the Keogh review, Cosmetic News editor Vicky Eldridge gives her opinion on what has been one of the most talked about news items in aesthetic medical history. If there is one thing that has got everybody talking in the aesthetic market place over the last year, it is the Keogh review. Since it was announced that the NHS medical director, Sir Bruce Keogh, would be carrying out a thorough review of the industry, in the wake of the PIP sandal, we have all been waiting with baited breath to see what the outcome of the report would be and whether it will actually mean that change is finally afoot in our unregulated sector. The expert panel was due to publish its findings in March but as Cosmetic News went to print on March 27, there was still no word. So all we can continue to do for now is speculate about what the report will say. Although the launch of the review came off the back of a turbulent few months in terms of negative press about the industry, it was actually seen as a positive thing and welcomed by many who recognised the need for something to be done before the industry got out of control. Yet, while the review has been much talked about, there has always been an air of scepticism about whether or not it will actually change anything or have any teeth, no matter what its findings. The lack of any regulation, legislation or core standards has seen the aesthetics market become somewhat of a free for all with every man and his dog trying to jump on the lucrative cosmetic enhancement bandwagon. But have we already gone too far and will anyone actually take notice of what the report recommends unless some kind of legal enforcement is in place? Those who operate outside of the parameters of good practice will no doubt continue to do so and may even go more underground now the spotlight
12 www.cosmeticnewsuk.com
is being shone their way. But what is the answer? How do we really stop unethical, unscrupulous and dangerous practitioners from ruining the good reputation of our industry? In my mind we all have a part to play from the Government itself to the practitioners, training providers, manufacturers and suppliers and even the press and patients. I never agreed that the industry should be self-regulated as I felt it somewhat trivialised these ‘medical’ treatments. I would personally like to see tighter control in place that enables some form of enforceable action to be taken against bad practice, particularly for cosmetic injectables and lasers. But whether that has to be in the form of regulation or not remains to be seen. I continue to be shocked at the fact that a clinic doing medical laser treatments has to be registered with the CQC yet an untrained nonmedic can set up a laser clinic down the road and start offering cosmetic treatments without going through the same vigorous registration process. They may now get stung for VAT by not being CQC registered as offering medical laser treatments but that is a whole different story. One of the reasons I would like to see tighter control on cosmetic injectables, is to settle once and for all the issue of who should and shouldn’t be doing these treatments. The thing that most annoys me is vets, beauty therapists and anyone else who can find a tenuous link between what they do and ‘injecting’ trying to fight for their right to carry out these specialist treatments which can have serious side effects if in the wrong hands. You wouldn’t go to a plastic surgeon for a bikini wax so why on earth would I go to a beauty therapist for cosmetic injectables?
There are hundreds of other treatments therapists can perform very well and I am not disrespecting their skills or place in the aesthetics market, but leave the injectables to medical professionals. It is not just about knowing the anatomy, it is having the skills to manage if something goes wrong. Putting a needle in someone’s face and injecting a filler or toxin is not the same as having your nails done and I wish people would stop treating it as such! I am not naïve enough to think that stopping non-medics from injecting will be the end of our problems and negative headlines. Unfortunately there are also doctors, nurses and dentists who think it is ok to offer substandard treatments in places that are not fit for practice, without undergoing adequate training. I know not everyone thinks regulation is the answer, after all it only gives you the power to do something when something goes wrong – it doesn’t prevent it from happening in the first place – but in my mind it may be enough of a deterrent to stop a proportion of people whose ethics and standards are below par from entering the market. I would also like to see the professional bodies such as the GMC, NMC, GDC continuing to make a stand in this sector by making an example of those who seem to have forgotten their Hippocratic oath and think that because it is aesthetic it is not medicine. As a professional industry we need to come together and stand up against bad practice so that the good reputation of the majority of clinics is not undermined by the few. It will be an interesting few months ahead that’s for sure and I am looking forward to getting my teeth into the Keogh Review and reporting back to you on what the implications will be.
“I’M LIVING MY LIFE IN COLOUR” When I fulfil my potential, my personality shines through
Galderma (UK) Ltd, Meridien House, 69-71 Clarendon Road, Watford, Hertfordshire WD17 1DS Galderma Switchboard: 01923 208950 Email: info.uk@galderma.com For more information visit www.galderma-alliance.co.uk
RES/006/0313 Date of prep: March 2013
RELEASE YOUR BEST YOU
on the scene | out and about in the industry this month
O n th e S c e n e Absolute Aesthetics chArity open evening Cosmetic News editor Vicky Eldridge was one of the guest speakers at the Absolute Aesthetics Charity open evening in Guildford last month. The event was held to raise funds for Breast Cancer Care and raise awareness of medical aesthetics treatments. Vicky spoke about the regulation of the industry and the pending Keogh review. There were also demonstrations going on in treatment rooms throughout the clinic. Director of Education for Sterex Electrolysis International Ltd, Elaine Stoddart, was showcasing the advanced electrolysis technique while skincare specialist Lee Harrison from HealthXChange was demonstrating the Obagi Blue Peel Radiance. Absolute Aesthetics doctor, Kuldeep Minocha demonstrated cosmetic injectables and Sigmacon showed guests the immediate lifting and anti-ageing effects that can be achieved with Pellevé.
true grAce pr AnnuAl summer beAuty showcAse press DAy Syneron-Candela took part in the True Grace PR annual Summer Beauty Showcase Press Day last month. The company launched the GentleLaser No Shades Barred hair removal campaign to over 20 national journalists and provided test patches to interested journalists. Dr Ariel Haus hosted the press day at his 10 Harley Street Clinic providing consultations and treatments to the press who attended. As expert spokesperson for Syneron-Candela, Dr Haus has helped to launch several of the company’s treatments to the media including the Sublime Collagen Creator facial treatment, Sublative Rejuveneyes treatment and his newly created line-up of VelaShape II Brazilian Beach treatments, that his name has become synonymous with. Adding to the popular VelaShape II Brazilian Bottom treatment he launched last summer, Dr Haus provided press with trials for his new Brazilian Beach Belly and Brazilian Beach Pins treatments.
The event raised £1,186 for Breast Cancer Care and each guest was given a commemorative Swarovski crystal pin, designed by Julien Macdonald.
Dr ritA rAkus wins pellevé pArtner AwArD
british JournAl of nursing AwArDs
The award for clinical and aesthetic excellence for “The World’s Biggest User of Pellevé-GlideSafe” was presented to Dr Rakus in recognition of her commitment and loyalty to the Pellevé system at the recent Ellman International Pellevé Users Meeting. She said, “I’m honoured and delighted to be receiving this award – I find the treatment to be very versatile and it differs from other radio frequency treatments as it can be used on very delicate and intricate areas of the face to great effect. I find Pellevé especially effective for treating; the décolletage, jaw line, neck, hands, eyes and lips”.
Aesthetic Nurses were recognised for their contribution to aesthetic medicine at the recent British Journal of Nursing Awards. Marea Brennan Thorns was named as the winner of the Aesthetic Nurse of the Year award for her instrumental role in helping aesthetics to become a recognised form of nursing by chairing the first RCN forum. Malti O’Mahony was the runner up with Julie Brackenbury in third place. The aesthetic nurses award was sponsored by the British Association of Aesthetic Nurses and Merz Aesthetics. The award ceremony took place at Shakespeare’s Globe Theatre on the Southbank and was presented by Esther Ranzen. Marea said, “The field of Aesthetic Medicine is full of extraordinary nurse entrepreneurs, many of whom have religiously stuck with the vision that “nurses can be leaders, nurses can be business owners & nurses can combine all of these things & still have their patients at the heart of all that they do.” 14 www.cosmeticnewsuk.com
Dr Rita Rakus has been named as the first winner of the Premier Pellevé Partner award.
AwArD for riverbAnks The Riverbanks clinic in Bedfordshire has scooped another industry award. Clinical director, Dr Ravi Jain, collected the award for Medical Aesthetics Clinic of the Year at the Professional Beauty Awards in London recently. He was presented with the gong by Adrian Merrick from Syneron Candela who sponsored the award. Dr Jain said, “We were so delighted when we were announced winners, especially with the very high standard of competitors. It’s a team effort – and I’m lucky to have really top notch team – everyone plays their part in treating and looking after our patients.”
Q-MeD
aCaDemy annual praCtitioner meeting, royal College of physiCians, lonDon Last month marked the 10th anniversary of the annual Q-Med Academy Practitioner Meeting at the Royal College of Physicians, London. The event has grown from strength to strength with this year’s meeting seeing record numbers. Chaired, as always, by consultant plastic surgeon Mr Rajiv Grover, the meeting saw the unveiling of the new vision for Galderma’s Aesthetic and Corrective Division, of which Q-Med is a part. The Power of Positive Transformation is the theme for the new message and a message that was strongly portrayed through the re-branding and fresh, dynamic new imagery for the Galderma brands. Larry Potgieter, managing director of Galderma UK and Ireland opened the meeting by presenting the new direction for the brands. He said, “Underpinning our new position is a simple belief that aesthetic change is about much more than the surface. It is a core understanding that even the smallest external alternation can have an immeasurable effect on a person’s confidence, emotional health and ultimately their whole life. Our range of treatments, holistic approach to facial aesthetics and customised services for aesthetic clinics make positive transformation possible for patients.” After a welcome by Mr Grover, Dr Beatriz Molina gave a fantastic presentation addressing the technology of Emervel and the science that makes it different to other dermal fillers on the market. She talked about how it compliments Restylane in providing the full palette of tools to practitioners. The next speaker was Dr Daniel Cassuto who gave an inspiring presentation and live demonstration of the Emervel range utilizing the pix’L microcannula to show that great results can be achieved with little trauma, and relatively small volumes of product when using the technology of Emervel. After lunch Mr Brian Leatherbarrow gave an insightful talk on the delicate eye area – providing many considerations before treating this area. He highlighted the importance of technique and using the right products, which, in his practice, are Restylane and a pix’L microcannula. Lou Sommereux was next to the podium talking about the benefits of Restylane Skinboosters – both clinically to your patients, but practically to your clinic. Lou shared her experience of a consultantation with a patient and how she discusses
the skin first before any additional treatment. She also shared a fantastic hand case study which wowed the audience with the results, and the patient herself shared the positive emotional impact this treatment had had on her as an individual.The final session of the day saw the charismatic Dr Sandeep Cliff talk about dermatology in aesthetics. Drawing on his wealth of experience in the dermatology and aesthetics fields, he spoke about common skin conditions and how to offer a more complete and in-depth service to meet patient needs. Dr Daniel Galimberti was next to take to the stage to speak about Pain Management in Aesthetic Dermatological Procedures. He talked about the necessity and impact of optimal pain management and potential solutions available to address the issue. The day ended with a heated panel discussion on industry legislation with Mr Grover, BCAM chair Dr Samantha Gammell and BACN chair Emma Davies. Hot topics were of course the Keogh review and the issues surrounding cosmetic injectables that have been raised as a result as well as the VAT issue and whether or not aesthetic medicine practitioners will have to start paying VAT. Galderma product manager Jen Pain said, “The 10th Q-Med Academy meeting has been a fantastic success. The level of presentations from our speakers has been outstanding, and we were so pleased with the level of attendance at the event. After 10 years of Q-Med Academy meetings it was fitting to have Mr Rajiv Grover chair this celebratory event – which he did fantastically. At the meeting not only were we celebrating 10 years of educational excellence, but also the launch of a new beginning for the Aesthetic & Corrective division of Galderma. We were so excited to be able to share the new brand look and feel for all our products to our practitioners – and the feedback has been amazing so far! This was a worldwide exclusive as the big reveal to the rest of the world will be at AMWC in Monaco”. The event ended with a networking reception during which a special 10th birthday cake was cut. A cheque for a staggering £13,000 was also presented to Operation Smile. The money was raised from the fees paid by practitioners to attend the event, which has now raised thousands for charity over the last nine years. Galderma is Operation Smile’s longest standing corporate partner and has helped to change the lives of over 550 children over the past 10 years. www.cosmeticnewsuk.com 15
events
the aesthetic awards 2013-14
a
Satur day
d e cembe r
Chan g e
o f
7
D at e
We announce the date and details for the third annual Aesthetic Awards 2013-2014
You may have already had a Save the Date card for The Aesthetic Awards 2013-2014 however due to a clash of dates with the IAAFA meeting, which is being held on the same weekend, we have decided to push the date back a week so our clients who want to attend both don’t have to miss out. The awards will now be held on Saturday December 7 NOT Saturday November 30, as previously advertised. Entries for the awards, which are held in association with Cosmetic News, will soon be going live so if you are looking to enter for 2013-2014 here are just a few things you need to know...
WHAT ARE THE AESTHETIC AWARDS? The Aesthetic Awards is the premier awards event for the aesthetics industry and is designed to celebrate the achievements of the exciting and dynamic sector of aesthetic medicine. WHO CAN ENTER? The aesthetic awards are open to all aesthetic practitioners, clinics, manufacturers and suppliers working in the field of cosmetic medicine and are designed to recognize excellence, innovation and the gold standard in products, treatments and practice. Training providers can now also enter with the addition of two new categories: Training Provider of the Year and Training Course of the Year. WHY SHOULD I ENTER THE AESTHETIC AWARDS? Why not? Entering the awards is a fantastic chance to celebrate the successes and achievements of your business. By taking part, you can show that you are proud of what you do and what you have achieved. Being a shortlisted finalist or winner in the awards is a fantastic marketing tool, enabling you to show your clients that you stand out from the crowd and have gone that extra mile. If you are proud
16 www.cosmeticnewsuk.com
of what you do or know someone you think deserves recognition then make sure you enter – you have to be in it to win it! WHEN WILL THE AWARDS TAKE PLACE? The 2013-2014 Aesthetic Awards will take place on the evening of Saturday December 7, 2013. WHERE? The awards will take place at a venue to be confirmed and will have a Winter Wonderland theme. HOW DO I ENTER? In the coming weeks we will be opening the online entry for the Aesthetic Awards. Simply log on to www.cosmeticnewsuk.com and enter yourself into as many of the categories as you want. You can also nominate other people, products, clinics or companies that you feel are worthy winners. You only have to enter/ nominate in each category you wish to once – nominations/entries do not count as votes. You do not have to nominate in every category but you can if you wish. In some categories we will ask you to supply some supporting material stating why you, your clinic, organisation, company, product or treatment should win. An explanation for how each category is entered, voted for and judged will accompany the online entry form and be published in Cosmetic News magazine but if you still have any queries you can contact the Aesthetic Awards team on 01268 754 897.
THE CATEGORIES The categories for the 2013-2014 Aesthetic Awards are… Awards for Manufacturers and Suppliers • Best Product Innovation • Best Newcomer (Product or Treatment) • Cosmeceutical of the Year • Injectable Product of the Year • Treatment of the Year (Face) • Treatment of the Year (Body) • Best Selling Retail Product • Equipment Brand of the Year • Best Weight Loss/Diet Programme • The Janee Parsons Award for Sales Representative of the Year • Best Customer Service by a Manufacturer/ Supplier • Best Advertising Campaign by a Manufacturer/Supplier • Distributor of the Year • Training Provider of the Year • Training Course of the Year Awards for Clinics/Practitioners • Rising Star • Best New Clinic • Best Clinic Chain • Best Clinic (four rooms or more) • Best Clinic (three rooms or less) • Best Mobile Practitioner • Aesthetic Nurse Practitioner of the Year • Aesthetic Practitioner of the Year • Best Clinic Customer Service • Best Clinic Website • Speaker of the Year • Clinic Receptionist of the Year • Association of the Year Special Awards • Services to the Industry • Lifetime Achievement Award
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clinical
view on/botulinum toxin
iN My vieW
Dr Patrick Bowler on developments in botulinum toxin
The medical community is currently awaiting the industry’s biggest review of cosmetic surgery legislation. Professor Sir Bruce Keogh, the NHS Medical Director, is expected to give his report, commissioned in response to a request from the Prime Minister, to the Health Secretary this month.
Dr Patrick Bowler MS.BS LRCP MRCS DRCOG Dr Patrick Bowler qualified in 1974 at the Royal London Hospital and is a pioneer of non-surgical cosmetic treatments with over 20 years experience. He is the medical director of Court House Clinics (www.courthouseclinics.com) and is a founder member and Fellow of the British College of Aesthetic Medicine (formerly the British Association of Cosmetic Doctors). He is also a member of the Society for Laser Medicine and Surgery and sits on the advisory board for Treatments You Can Trust. He is the author of The Nervous Girl’s Guide to Nip & Tuck and his opinion on the aesthetic industry is highly respected; he is frequently quoted in the media and on TV.
Pressure is mounting for new laws that ban nonmedics from giving injectable treatments, and Keogh is working with experts from the fields of cosmetic and plastic surgery to ensure optimum safety for patients. Existing legislation for things like heart valves and replacement joints is being held up as an example of the kinds of regulations the industry needs. Key areas for consideration include Botox®and dermal fillers, which currently can be executed by high street beauty salons. As it stands now, beauticians with no formal medical training can legally administer Botox®. The lax legislation on the neurotoxin has seen a rise in its unrestricted use at “Botox®parties”, and in turn a spate of negative press because of the ensuing undesired results and improper aftercare that working with an unregistered technician can result in. The Royal College of Surgeons has called the ethics of companies who offer these parties “wholly incompatible” with professional standards. With beauty salons, at-home parties and rough discount traders, often there is no on-site medical practitioner who patients can return to or contact should questions or problems arise. The procedures, when done in questionable circumstances like these, don’t ensure the levels of safety patients deserve.Nowhere else in Europe tolerates this and the RCS recognises the urgency for change. President of the organisation, Prof Norma Williams, said: “We have serious concerns that not all who offer cosmetic procedures are adequately qualified, or that patients are getting accurate information prior to treatment.”
18 www.cosmeticnewsuk.com
It is being encouraged that all patients for any kind of cosmetic treatment must undergo a psychological assessment before surgery, as well as be taught how to select the best clinic, treatment and doctor for themselves, irrespective of price. With cosmetic surgery it is absolutely an issue of quality. Efforts are in an attempt to quash the perceived value of surgery. The BBC last month published figures that reveal only half of those considering surgery take into consideration the qualifications of their doctor. The BBC also report that of the 1,762 people ComRes interviewed, many considered the cost of the surgery to be more important than qualification or aftercare. It’s staggering, really. Consensus amongst professionals is that only those with recognised qualifications and training should carry out procedures, in a registered clinic, with correct equipment and resources to deal with emergencies or unplanned circumstance. Measures must also be taken to limit “discount surgery”, with schemes like social vouchers, or time-limited discounts that encourage impulsive buying over considered decisions. Steve Cannon, chairman of the working party and RCS council member concludes: “With the demand for cosmetic surgery and non-surgical treatments rising year on year, it is crucial that the highest level of professionalism is maintained amongst practitioners.” The entire cosmetic surgery community is awaiting the verdict on the future of our industry- and patient welfarewith breath that is baited.
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clinical
vein special
on
the right vein Professor Mark Whiteley of The Whiteley Clinic, Guildford and London on assessing and treating leg thread veins
Professor Mark Whiteley MS FRCS (Gen) FCPhleb Consultant Mark Whiteley is a Consultant Vascular Surgeon specialising in walk-in, walk-out surgery for varicose veins. He trained at St. Bartholomew’s Hospital in London and was a lecturer in surgery at Oxford University from 1995 to 1998. Mark was appointed Consultant Vascular Surgeon in 1998 and performed the first endovenous “keyhole” surgery for varicose veins in
Leg veins, particularly thread veins of the legs, are one of the commonest conditions to affect adults. As such, many aesthetic clinics are becoming interested in the treatment of leg thread veins. However unlike most aesthetic conditions where the assessment is made by observation alone, leg thread veins are frequently associated with more complex underlying problems.
seen in patients with thinner skin and in certain areas of the body such as behind the knees. - Varicose veins are the large bulging veins of the legs that appear on standing and disappear on lying down and elevating the legs. They may appear greenish or bluish in colour if the skin is thin, or appear skin coloured if the veins are deeper or the skin is thicker.
Any practitioner or clinic starting a leg thread vein or varicose vein service needs to be aware of the complexities of the subject to ensure that they give their patients optimal advice and treatment, and to reduce the risks of complaints and medicolegal complications.
As all of these veins can be seen on the surface, many people think these are the only veins they need to know in the legs – hence that is why most articles only mention these veins. Unfortunately, the leg is a threedimensional structure and underlying these visible veins are other veins intimately related to those seen on the surface. These deeper veins can only be picked up by specialist methods such as hand held Doppler examination or venous duplex ultrasound.
the UK in March 1999. As the founder of The Whiteley Clinic and The Whiteley Protocol, his aim was to bring the very best treatments for varicose veins and vein problems, such as thread veins and leg ulcers, to the UK public.
Before discussing the assessment and treatment of thread veins, it is useful to know which veins of the legs may be involved. Firstly we will look at the simple veins that can be seen with the naked eye. Thread veins, reticular veins and varicose veins - simple leg veins that can be seen:
20 www.cosmeticnewsuk.com
Feeding veins, “hidden varicose veins”, incompetent perforators and pelvic veins other less simple leg veins:
- Thread veins are the tiny veins that are red, purple or blue that can be seen on the skin of the legs. They are also known as spider veins, venous flares or “burst capillaries” although medically they are properly called telangiectasia. They lie within the dermis and rarely get wider in diameter than 1 mm.
- Feeding veins is the name given to any unnamed vein that is allowing blood to fall the wrong way down it (venous reflux) and into a visible group of thread veins. In many cases, it is just like a reticular vein that is just a little deeper and therefore cannot be seen on the surface. Reticular veins can be thought of as feeding veins that are visible.
- Reticular veins are the green veins that are seen through the skin and should not bulge on standing. They lie just underneath the dermis and are usually between 1 and 3 mm in diameter. They are more easily
- “Hidden varicose veins” is the name that I gave to venous reflux in my book “Understanding venous reflux-the cause of varicose veins and venous leg ulcers”, to try to help health professionals and the
pre-procedure
public understand that not all varicose veins are visible on the surface. Although some 20% of the population have visible varicose veins, the same number again have the same underlying problem of venous reflux in the major truncal veins of the legs but without any bulging veins on the surface to indicate a problem. Without specialist tests such as hand held Doppler or venous duplex ultrasound, these veins will continue to allow blood to reflux back down them, causing increasing numbers of thread veins, aching, inflammation of the lower leg, swelling, skin damage or other deterioration without any veins being visible to give away the cause. - Incompetent perforating veins are very controversial at present in the venous world. Although every normal leg has over 100 perforating veins taking blood from the surface veins through the muscle and into the deep veins, when this one-way system breaks down in one or more of these veins, blood can squirt outwards during high pressure such as when walking. There is mounting evidence that this high pressure jet of blood can cause the local varicose veins, thread veins or even skin damage. - Pelvic venous reflux has become one of the hottest topics in the venous world over the last few years. Research from The Whiteley Clinic has shown that one in five women who have had children and who have leg varicose veins also have varicose veins in the pelvis, connected to those in the legs. In many of these patients there are bulging veins visible on standing in the vulva, vagina or upper inner thigh next to the vulva, or surface veins running diagonally down the back of the thigh. Research that has recently been presented in America from The Whiteley Clinic has also suggested that failure to identify this as a cause of varicose veins is one of the major causes that veins come back
post-procedure
again after treatment1. It can be seen from these two sections above that the venous system of the leg is much more complex than we used to imagine. However anyone launching into treatment of leg thread veins or varicose veins must be aware of these complexities to be able to identify patients that require more involved investigations and treatments. We will now look at thread veins in more detail.
the legs and as most aesthetic practitioners are used to treating what they see, it is very tempting just to treat the visible thread vein without any thought that the might be an underlying problem. Unfortunately, unlike most other aesthetic conditions, thread veins are frequently associated with an underlying problem. In the case of most thread veins, the underlying problem is blood coming from underlying incompetent veins, whether the underlying veins are visible on the surface or not. A study performed in Australia published in 1993 showed that when duplex ultrasound scanning was performed around leg thread veins, 89% of patients were found to have other veins feeding into the thread veins3. As such, assessment of leg thread veins by eyes alone is clearly inadequate and will lead to incomplete and incorrect treatment in many patients. You may wonder if this is important and many people merely treat the visible thread veins ignoring the possibility of any underlying problem. However failure to treat an underlying problem is highly likely to be problematic.
Thread veins of the legs: As stated above, leg thread veins are one of the commonest aesthetic conditions to affect women. The Edinburgh vein study showed that over 80% of the adult population suffer from these. Indeed so many women suffer from these (88% in this study), leg thread veins can almost be considered the norm2. Aesthetic clinics are frequently approached by patients wanting treatment for leg thread veins. It is interesting to note that very few men request treatment for thread veins. Traditionally this has been put down to the fact that men have hairy legs and tend to keep them covered. On the other hand women are more health-conscious, show their legs and so it is thought that they tend to seek help for thread veins more often. The Edinburgh Vein Study did show that fewer men than women suffer from telangiectasia (thread veins) although they did find telangiectasia present on the legs of 79% of men. Hence it appears that the reason women present more often than men is both that thread veins are less common in men but also they are less concerned about them. Leg thread veins are seen on the surface of
Firstly, if the underlying vein is feeding the thread veins and this feeding source is not identified and treated, the chances of the thread veins coming back again after treatment are more likely. More worryingly, if the thread veins are treated and the underlying feeding veins are only semitreated, the feeding veins can thrombose, leaving brown stains on the skin. Finally, most textbooks on thread vein treatments will discuss a horrible complication of thread vein treatments called “telangetic matting”. This is a dense red mass of capillaries that can appear after treatment for leg thread veins and, when it does occur, is exceptionally difficult to treat. At The Whiteley Clinic, we now look for and treat any underlying varicose veins or “hidden varicose veins” before treating the thread veins. Since instituting this policy over 10 years ago, we have not seen any telangetic matting at all. Furthermore, patients coming from elsewhere with telangetic matting invariably have an underlying vein feeding into the area - either a feeding vein refluxing blood into the area or an incompetent perforator coming through the muscle and into the telangetic matting. For these reasons, until randomised studies have been done to show the effect of treating
www.cosmeticnewsuk.com 21
clinical
vein special
the underlying veins, the evidence suggests that anyone presenting with leg thread veins should have a full assessment for varicose veins and underlying venous reflux (“hidden varicose veins”) and that any such underlying problem should be treated before embarking upon any leg thread vein treatment. Treatment of leg thread veins: Following on from the understanding of the venous system outlined above, it is clear that before any treatment of thread veins of the legs can be considered, a proper assessment must be carried out. The patient must be examined lying down to see that the thread veins are visible when being treated. Any history of or scars from previous varicose vein surgery means that a venous duplex ultrasound scan is necessary, as the thread veins will almost certainly be associated with underlying recurrent varicose veins. The patient is then stood up to see if any of these bulging varicose veins appear in the leg. If any bulging veins appear on standing, even if they are nowhere near the thread veins, a venous duplex ultrasound scan is necessary as there will almost definitely be underlying veins feeding into the thread veins.
hidden under the skin, it has always seemed ridiculous to me to use any treatment that only treats the visible part of the thread veins. Therefore I would not use or recommend any treatment such as laser, IPL or other light therapy and neither would I use any electrolysis or radio-frequency needle technique. These are useful in thread veins of the face and areas above the heart, where gravity does not have an effect on the blood feeding the thread veins, but they are not a logical treatment for leg thread veins. Hence I would always advocate microsclerotherapy as the treatment of choice for leg thread veins. Not only does microsclerotherapy treat a reasonable area of thread veins with each injection, but will also treat any remaining feeding veins that are not visible on the skin surface. Finally there are a large number of tablets and creams that are advertised for leg thread vein treatments on the Internet and in magazines and newspapers. There is no proper scientific evidence that any of these have any effect at all on leg thread veins and until any such research exists, they should not be recommended as a treatment.
pre-procedure
post-procedure
why leg thread veins should NOT be treated with laser
Further information: For information on thread veins that includes a full assessment of the venous system and teaches the use of the hand held Doppler to assess venous reflux please see www.thread-vein-courses.co.uk. For further reading on how veins work see the book:
Summary: If the thread veins appear simple and there are no other reticular veins, varicose veins or scars, then a hand held Doppler should be used both in the local area and over the great saphenous vein and small saphenous vein to make sure there is no venous reflux (“hidden varicose veins”). If this proves positive, or there is any doubt at all, a venous duplex ultrasound scan should be arranged before proceeding with thread vein treatments. Only once you are confident that it is only the thread veins of the legs that need treatment, or your patient has had the underlying veins investigated and treated, then you can start treatment of the leg thread veins. As the majority of leg thread veins have been shown to have feeding veins associated with them which are usually
22 www.cosmeticnewsuk.com
When treating any leg veins, particularly thread veins of the legs, it is essential to remember that in the majority of cases there is more going on underneath the skin than meets the eye. Treatment should only be considered after a full assessment has been performed including a minimum of a hand held Doppler examination, by practitioners who have an understanding of the venous system and who have been trained in hand held Doppler techniques. Microsclerotherapy treats not only the thread veins that are visible but any underlying feeding veins, giving a more complete treatment than any light, electrolysis or radiofrequency technique. There is no evidence that any tablets or creams have any effect at all on leg thread veins.
Understanding venous reflux - the cause of varicose veins and venous leg ulcers. Mark S Whiteley. Whiteley Publishing 2011 ISBN: 978-1908586001 References: 1] AM Whiteley, DC Taylor, MS Whiteley. Pelvic Venous Reflux is a Major Contributory Cause of Recurrent Varicose Veins in more than a Quarter of Women. Journal of Vascular Surgery: Venous and Lymphatic Disorders 2013; 1: 100-101 2] Ruckley CV, Evans CJ, Allan PL, Lee AJ, Fowkes FG. Telangiectasia in the Edinburgh Vein Study: epidemiology and association with trunk varices and symptoms. Eur J Vasc Endovasc Surg. 2008 Dec;36(6):719-24. 3] Somjen GM, Ziegenbein R, Johnston AH, Royle JP. Anatomical examination of leg telangiectases with duplex scanning. J Dermatol Surg Oncol. 1993 Oct;19(10):940-5.
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clinical
vein special/thermavein®
are you ready for The ThermaVEIn® chaLLenge? We find out how ThermaVein® is putting its efficacy to the ultimate test by challenging practitioners and competitors to a head to head challenge – and all in the name of charity
W
Something old, something new
treated in excess of 50,000 patients for
use words like ‘unique’, ‘market leading’,
Although ThermaVein® is a newcomer to
manner of failed treatments resulting in
‘innovative’ or ‘the best’ to promote
the aesthetic, beauty and spa markets –
patient issues from laser, IPL, electrolysis
their brand, and who can blame them?
launched in August 2012– the technology
and diathermy. We took the decision to
They wouldn’t be doing their job if
it is based on has been tried and tested
improve the technology, which has been
they did not try to pitch their system
over the last 15 years in the international
used in the medical industry for many
as in some way superior or different
medical markets without issue and is
years, for the aesthetic market. The unit
to what else is out there. However,
backed by extensive independent double
is simple to learn and operate, training is
with so much technology on the
blind randomised clinical trials.
around half a day. It is also safe, instant
hen any new technology comes onto the market manufacturers and suppliers
market, aesthetic practitioners
ThermaVein® is medically-acclaimed
Dr Newman says, “I have successfully facial veins. In this time I have seen all
and effective - the holy trinity when
sometimes find it difficult to separate
technology that provides instant, safe and
considering treatment options, if you
the marketing spiel from the truth.
permanent removal of facial veins, also
can’t satisfy this criteria then you
Even clinical trials (if they are not
referred to as telangiectasia.
should be looking elsewhere.
independently carried out) can
Before and after treatment on the nose. These pictures were taken just a few minutes apart (pictures courtesy of Dr Peter Forrester, cosmetic doctor, esher, Surrey)
be weighted one way or another, depending on who they are sponsored by, and in many areas of aesthetic medicine clinical data is often lacking anyway. So how do you make a decision on what treatments, products and devices to invest your hard earned cash in?
Developed and pioneered by consultant
Distributed in the UK and Ireland by
vascular surgeon Dr Brian Newman MD,
Tekno Aesthetics and brought to market
FRCS, the technology ThermaVein® is
by Landmark Investments, ThermaVein®
money where its mouth is’, to show
based on is known as ‘thermocoagulation’.
is manufactured in the UK and has been
how confident it is in its claims, is
The treatment works in a very different
launched here before Europe or the US.
ThermaVein®. The company has
way to alternatives such as laser, IPL or
Landmark is currently in advanced talks
just launched a nation-wide Charity
epilation and is safe, instant and effective.
with a number of international territories
Challenge where it is challenging
Results are also instant -
and has worldwide rights to distribute
both competitors and practitioners
a move away from traditional methods
which will see the FDA certificated
to put it to the test. And if they lose?
which can take many weeks to show a
technology going global. But for now
They will donate £5,000 to charity.
result and can be painful to the client.
UK practitioners have a chance to make
One company that is ‘putting its
24 www.cosmeticnewsuk.com
their mark using the system first. The technology has featured on TV shows such as Embarrassing Bodies
does sell itself to patients and users
have priced very competitively to ensure
once they have seen it in action.
as many people as possible have access
“A patient should be able to go for a
to the technology. It is our firm goal to
and GMTV with Lorraine Kelly where
treatment and leave with the condition
ensure ThermaVein® is the treatment
it has wowed people with its fast,
cleared. The days of waiting six to eight
of choice for both patients and users.
effective and instant results.
weeks for a result and courses of eight
“Our market research indicated
Dr Newman adds, “The technique is
treatments are a thing of the past. Users
customers were fed up of the captive
different to anything else available and
and customers want instant results with
consumables model whereby there
seals the vein rather than trying to fade or
no downtime, ThermaVein® offers a
is an ongoing cost of use controlled
burn it. As a Consultant Vascular Surgeon
real walk in, walk out treatment.”
by the supplier. The probes used by
I am well aware that sealing the vein is
Dr Newman comments, “When we
ThermaVein® are not proprietary to
the safest and easiest way to remove it.
developed this technology we didn’t
us and although we do supply them
After the vein has been sealed it is simply
think how much we could earn, how
they can also be widely obtained
reabsorbed by the body.”
fast or cheap we could manufacture,
elsewhere. This is not the most profitable
Esther Loughran, sales manager at
far from it. I qualified 45 years ago in
route for us but we had to listen to
Tekno Aesthetics says, “I think the real
1968 and the first consideration then
the customers, without them we don’t
difference with other technologies is that
was the same as it should be now - if
exist. The cost per use of the unit is
we don’t just tell you how good it is we will
the treatment doesn’t make the patient
around 50p and we provide enough
show you. The majority of our product
better will it make them worse?”
consumables with the unit to generate
demos feature at least one live treatment,
Mark Hawthorn, managing director
more than the cost of the unit itself.
there is a real “wow” factor as you watch
of ThermaVein® adds, “The returns the
In addition all training and support
the veins disappear. The machine really
unit generates are second to none and we
is included in the unit price.”
Before & After
ThermaVein® charity challenge Win £5,000 for the Charity of your choice ThermaVein® is so confident in the ability of its technology in removing facial veins that the company has created a Charity Challenge to find out which is the best technology. The rules are simple: • Both parties will treat a set number of patients each • Independent judge to be agreed in advance • Results judged on clearance achieved, time taken and patient experience • £5,000 to be deposited in solicitors account before starting • The loser’s £5,000 goes to the Charity of the winner’s choice The challenge is open to suppliers and users alike. To enter or simply nominate your provider email info@thermavein.com www.cosmeticnewsuk.com 25
clinical
vein special
TH R EA D W O R K We talk to vein expert Keith Rose about why microsclerotherapy is his choice of treatment for thread veins
B
oth thread veins and varicose veins are largely considered to be a cosmetic problem and as such many medical aesthetics clinics have branched into treating veins as part of their clinic’s offering.
are red, blue, or purple in colour. Rose explains, “Varicose veins are the bulging lumpy ones that stand out on the legs and thread veins are the fine spidery vessels that do not stand proud – they are just level with the skin.”
Varicose veins are dilated veins, which you can often see bulging on the surface of the legs. Keith Rose FRCS who has spent more than 20 years treating veins both in the NHS and the independent sector and now works with Court House Clinics as well as running sclerotherapy for Totally Aesthetics. says, “Varicose veins are caused by failure of the one way valves in the veins allowing blood at increased pressure to flow down the veins.”
“Thread veins are largely inherited”, adds Rose. “They are also hormone dependent so they tend to start in pregnancy and can sometimes improve after delivery. They are also more common in ladies on HRT.”
Varicose veins are more serious than thread veins and although some people get no other problems apart from the cosmetic appearance, there are many who complain of pain and aching particularly towards the end of the day. “The NHS has labelled varicose veins as cosmetic but I think we all agree that actually many are not. If they are very mild they are cosmetic but all varicose veins are progressive and the majority will eventually cause problems in several years time.” Thread veins or spider veins are different to varicose veins and are the most common type of vein treated in aesthetics clinics. Thread veins are usually very near the surface of the skin and
26 www.cosmeticnewsuk.com
If you are treating veins in your clinic it is vital to distinguish between the two types of veins and to address any underlying problems with varicose veins before treating thread veins as the treatment will be ineffective if you don’t. If you are not adequately trained to treat varicose veins, refer to someone who is. “The reason people really need to know what
before
they are doing is that you commonly get presentation of thread veins and varicose veins at the same time”, explains Rose. “If you inject thread veins in the presence of venous incompetence, which may not even have showed up yet as varicose veins, you can make the thread veins worse. So it is very important to identify those patients who are at risk of developing varicose veins. If they have got varicose veins or there is any suggestion of venous incompetence i.e the larger reticular veins might raise suspicion, then these patients must have ultrasound scanning to confirm or exclude venous incompetence. “A hand-held Doppler is a very useful tool for screening and is less expensive than a colour duplex ultrasound scan, which is what you would have to do if the hand-held Doppler confirms any incompetence. It is obligatory that you do this. If venous incompetence is confirmed you must
after
treat the varicose veins first and this must be someone who knows what they are doing.“ Microsclerotherapy There are a variety of different options for treating thread veins including microsclerotherapy, laser and electrolysis. Microsclerotherapy is considered the gold standard for treatments on the legs while laser treatment, IPL (Intense Pulsed Light), Thermavein (see p24-25) and electrocoagulation or electrolysis are best for thread veins on the face. Microsclerotherapy is one of the most tried and tested thread vein treatments and many specialists, like Rose, use it as their treatment of choice. The treatment involves using tiny needles to inject problem veins with a substance known as a ‘sclerosant’ (usually a chemical). This destroys the vein making the walls of the veins fibrose (or stick) together. “There are several different solutions that can be injected” explains Rose. “The most commonly used in this country is STD, which is a very mild detergent. What it does is destroy the lining of the small blood vessels. The body then treats it as damaged tissue and reabsorbs it, which is why it takes three months to get the main benefit and why the veins can also continue to improve for up to a year.” As microsclerotherapy closes the veins by inflammation of the wall, most patients get a patch of inflamed skin over the site of the injection, which lasts for up to two weeks. This inflammation is actually very good – it is the body’s way of removing the dead vein. The area then settles down but the full benefit can take up to 12 weeks to be seen. The veins often continue to improve for up to a year after the treatment. Depending on the number of thread veins on the legs, several sessions may be needed to get the required results. Microsclerotherapy is normally used for
before
before
“It is like all of these treatments – it is very easy to do but what you must learn is what not to do to avoid complications” the treatment of leg veins rather than facial veins where the vessels are usually too small to get a needle into. The treatment can be uncomfortable and patients can experience some stinging or burning during injection. Rose considers microsclerotherapy to be the gold standard in thread vein treatment. He says, “Microsclerotherapy is superior to laser. It is quick, it is almost painless and you can do large patches with just a single injection if all the vessels are connected. The results are superior and of course it is less expensive. Laser tends to be more painful and I find the results to be inferior – you tend to get lots of tiny little white scars, which on darker skin types can show up. There have been various published studies comparing laser and microsclerotherapy that have showed you get better results with microsclerotherapy.” As with any medical procedure, there are some risks involved, but complications with microsclerotherapy are very rare and are generally of a very minor nature: Some 30% of people can get brown marks – usually very mild and usually fading over several weeks or months. Very occasionally the brown stains can be dark. “With the larger vessels you can get a bit of faint skin staining after –like a mild sort of coffee coloured stain, which is still much better than what you started with”, says Rose.
after
before
“That stain nearly always fades but it may take several months to do so. In very rare cases patients can get a little break down of the skin – called a chemical ulcer. This can be very tender for a few weeks and then usually heals with a small scar. This scar can be permanent, but such a small scar is usually better then the thread veins that were there before the treatment. Allergies are often quoted as a problem but they are exceptionally rare. Rose concludes, “It is like all of these treatments – it is very easy to do but what you must learn is what not to do to avoid complications. The most important, but least common, is that the patient can be allergic to what you are injecting so you have to be able to resuscitate a patient who has gone into anaphylactic shock. You can get little ulcers at the injection site if the solution leaks out of the vein or you inject intradermally having missed the vessel. “Contraindications include anyone who is on any medication that may interfere with the action of the solution – so anti-coagulants for example. These days there are a lot of people on different combinations of drugs and there isn’t a great deal of data about combinations of drugs and the sclerosants so you just have to be very cautious as this may cause the treatment to be less effective.”
after
www.cosmeticnewsuk.com 27
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CLINICAL
up up up up Beam up me up
VeIN SpeCIAL/produCt FoCuS
Jo Martin, clinical director of Mapperley Park Clinic on treating vascular lesions and much more with the Pulsed Dye laser “Jo Martin is the Clinical Director of The Mapperley Park Clinic in Nottingham. Since establishing the clinic in 1993, Jo has introduced an extensive range of skin treatments, from laser tattoo and hair removal, to more high end facial rejuvenation treatments. The clinic also boasts a fully equipped minor operations theatre, and offers surgical solutions for varicose veins, lumps, bumps, moles and cysts and unwanted fat - amongst others. Jo centres her clinic around the clients’ needs - as such, the staff are not target driven, and treatments are selected and recommended only if they are appropriate for the client’s individual problem. The clinic celebrated its 20th anniversary this year - and has a large and loyal client base.”
The ability to treat a range of vascular
clients with particularly reactive skin
lesions is a must if one is going to offer
it is possible to finish the treatment
a comprehensive service. There is little
with a single pass on a healing setting
to be gained by being able to treat
to reduce, if not eliminate, adverse
straight forward telangiectasia and
reactions.3
nothing else since a high proportion of clients will end up being turned away
Because the VBeam has a variable
and therefore unhappy.
pulse duration it is possible to treat Port Wine stains very effectively with
Even most straightforward clients
minimum discomfort or down time.
often present with a mixed picture of
Short pulse durations of 0.45ms to
Type VI skins are possible.4
visible telangiectasia and background
1.5ms are ideal for this purpose and,
I find that using the VBeam laser on
erythema, both of which need
following a test patch, can be used over
what we refer to as the healing setting
addressing in order to achieve excellent
reasonable sized areas to effect good
is one of its most useful applications.
and proactive results likely to last a
fade of the lesion with a moderate
Using a short, and therefore normally
reasonable period of time. It is a given
number of sessions. By passing over the
purpuric, setting of 0.45 ms combined
that vascular clients, treated well and
area with the healing mode prior to the
with a fluence of 2.5j/cm2 and a spot
effectively, will remain faithful to the
actual treatment, it is possible to use
size of 12mm can produce a remarkable
clinic forever since even the best laser
slightly higher settings whilst reducing
effect on skin. Various clinical trials
treatments are only ever able to provide
risks of crusting and haemociderin
have demonstrated the release of
management, rather than cure.
staining.
chemical cytokines such as TGF Beta
The benefit of using a VBeam PDL
By varying spot size and pulse duration,
only promotes rapid healing but also
laser is that it is possible to target large
it is possible to treat most vascular
has an anti-inflammatory and analgesic
vessels initially, using the 3x10mm
lesions from tiny haemangiomas up to
spot, which “traces” the vessels
larger venous lakes. Having the ability
accurately and effectively, sealing
to choose pulse durations ranging from
them with a longer pulse duration,
0.45ms (ideal for purpuric treatments
such as 20-40ms. This can then be
such as PWS and warts and verrucas1 )
followed immediately with a “blanket”
to 40ms (ideal for Campbell de Morgan
effect so it is a perfect partner for
treatment of background erythema
spots and venous lakes) there are few
more invasive procedures such as CO2
using a 10mm spot, a 10ms or 6ms
vascular lesions which cannot be treated.
resurfacing, when I use it immediately
within 30 minutes of lasing. This not
[References] 1. Bonnie S. Ross, MD, Vickie J.levine, MD, Kishwer Nehal, MD, Yardy Tse, MD, Robin Ashinoff, MD; Pulsed Dye Laser Treatment of Warts: An Update. (Dermatologic Surgery, Inc. 1999;25:377-380). 2. Alster TS, et al, Use of high energy pulsed CO2 laser singly and in combination with a 585nm pulsed dye laser in the treatment of scars. (Dermatol Surg. 1997) 3. Tan SR,Tope WD, Pulsed dye laser treatment of rosacea improves erythema,symptomatology,and quality of Life (J Am Acad Dermatol 2004;51: 592-9) 4. Splete H; Pulsed dye lasers could help erase post-surgical scars. (Dermatol Surg, 2003 Jan)
pulse and fluences of 6-10j/cm2 to
after the first laser and again at two
reduce superficial vasculature. This is
to three days post op. We also use it
especially useful in treating rosacea
following all our surgical procedures.2
because it is possible to drastically Overall, given that we tend to think of
reduce the effects of flushing by Hypertrophic scars respond extremely
lasers as “One Trick Ponies”, because
well to short pulse durations such as
they have a single wavelength, this is a
0.45 ms and fluences of up to 12j/cm2.
remarkably versatile and effective laser.
It is possible to devascularise and flatten
One of my colleagues once said “If they
them with a short course of treatments.
came to take my VBeam away I would
This also helps a lot to reduce itching
barricade myself in the room and arm
create the redness, which in turn
and irritation of the scar tissue, as well
myself with a shotgun”. Well, I wouldn’t
reduces the embarrassment factor
as improving tissue pliability. Recent
go that far but I can fully understand
and stress of flushing. For rosacea
trials are indicating that even scars on
her reticence to part with it!
reducing the superficial vessels, which
30 www.cosmeticnewsuk.com
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CLINICAL
VeIN SpeCIAL/produCt FoCuS
The EnEr-Gist of iT We take a look at Energist’s range of vascular lasers
Laser treatment of vascular lesions has progressed significantly in recent years and has become one of the staple treatments for this indication in medical aesthetic clinics. A variety of different vascular problems can be treated effectively with laser from spider or thread veins to port wine stains, rosacea and spider naevus. As a leading manufacturer of laser and light based
Laser is designed
treatments Energist has three different systems that can
for both hair removal
be used to address vascular problems: The UltraPlus VPL;
and vascular lesion
the MedArt®VariMed™ and MedArt®ILVO™.
treatment. The MedArt VariMed
UltraPlus VPL
is an effective,
The high-powered UltraPlus VPL is the latest VPL™
versatile and compact
system from Energist. Using world renowned and proven
laser. The wavelength
Variable Pulsed Light Technology, the UltraPlus VPL
of 810nm makes it
offers the power and versatility you need to offer not just
ideal for the treatment of various vascular lesions.
• Local anesthesia only
vascular treatments but also tailored hair removal, skin
Treatment safety is guaranteed by the effective combination
• Cost effectiveness
rejuvenation and acne treatments to clients with skin
of super long pulse technology and contact cooling. The
types I-V.
super long pulse technology makes it possible to work
The procedure is fast, requires no general anaesthesia,
Supplied as standard with two treatment specific
with pulses up to 1000msec to treat even the darker skin
and the patient can immediately resume normal activities
handpieces covering treatments such as facial and body
types. The pre, parallel and post treatment contact cooling
after the procedure. Side effects are minimal in terms of
hair removal, thread veins, rosacea, age and sun spots,
highly increases patient comfort and minimizes any risk
pain and bruising with long-term results comparitive to
wrinkles and fine lines, this industry-leading platform
of unwanted side effects. The MedArt®VariMedTM has a
traditional surgery. Virtually all patients are candidates
offers the added option of two additional handpieces,
simple user interface and stores up to 16 preprogrammed
for treatment whether for a first time occurrence or
each unique to the UltraPlus. This includes the new
settings. The system is small and compact and only
reoperation, providing the saphenous vein can be
Specialist High Energy handpiece offering up to 108J/
requires a minimum of maintenance. Running costs are
accessed by the laser fibre. Since there is no requirement
cm2 for more aggressive treatment of pigmented and
very low with only a minimum of consumables required
for general anaesthesia and the procedure only leaves
vascular lesions. With 840 different pulse variations,
even during long-term use.
a small puncture site, this procedure can be done in
specific treatment presets and energy output levels
an outpatient setting. This saves on costs and time
up to 108J/cm², the enhanced treatment options of
MedArt®ILVO™
the UltraPlus VPL provide you with total treatment
The MedArt®ILVO™ laser is designed for the endovenous
solutions for your client. The increased flexibility of the
treatment of greater and lesser varicose saphenous veins
The MedArt®ILVO™ laser comes with 15 watt
UltraPlus VPL system allows you to perform a wide
and has become the preferred treatment method over
power output, and the option of 810nm or 980nm
range of treatments with a single system, maximizing
traditional surgery due to:
wavelengths. All lasers have an inbuilt power meter to
resources for the busy clinic.
your investment and widening your treatment offer to
confirm actual laser power through the fibre tip.The • Minimal risk of side effects
MedArt®ILVO™ is a small, table-top sized unit that fit
• Improved aesthetic results
easily into any clinical setting. The specially developed
MedArt®VariMedTM
• No post-op downtime
600 mµ fibre and catheter kits are safe, easy to work
The MedArt®VariMedTM Super Long-Pulsed 810nm Diode
• Fast outpatient procedure
with, and cost effective.
your clients.
Name
Type
Wavelength
Treatment
Output
Pulse length
Accessories
UltraPlus VPL
Variable Pulsed Light
530 – 950nm
Telangiectasia (up to 1mm diameter), haemangioma, Port Wine Stains, Rosacea, Spider naevi
Up to 108 J/cm2
Variable
4 specialist applicators. VPL technology allowing user to manipulate pulse delivery or use preset options. Unique super-high energy applicator delivers up to 108J/cm2 for more effective treatment of vascular lesions
MedArt VariMed
Diode laser
810nm
Transcutaneous treatment of vascular lesions and varicose veins including telangiectasia, spider naevi, haemangioma, reticular veins up to 4mm diameter, PWS, rosacea, venous lakes Endovenous treatment of Vena Saphena Magna & vena saphena parva
Up to 200 J/cm2
0.3 – 100 Hz max
Ergonomic scanner with integrated skin cooling pre, parallel and post treatment. Range of focused vascular Treatment handpieces. Endovenous option enables to connection of a bare 600micron fibre for varicose vein treatment.
MedArt ILVO
Diode laser
1470nm
Endovenous treatment of Vena Saphena Magna & vena saphena parva
15W
10-3000ms
Compact 4.5kg system, QSC Quick-connect adaptor for 600µm fibre, fibre introducer kits
32 www.cosmeticnewsuk.com
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clinical hair loss
AT A loss? In the second of a two part article on hair loss Dr sotirios Foutsizoglou looks at the surgical options
Hair transplant surgery
Dr Sotirios Foutsizoglou is a member of the Royal College of Surgeons of England and performs hair transplant surgery in Harley Street, London. He is also a member of the International Society of Hair Restoration Surgery and the founder of SFMedica. He specialises in cosmetic surgery and aesthetic medicine with numerous publications in UK journals, magazines and newspapers. He is also one of the senior trainers in nonsurgical procedures with KT-Training Medical Aesthetics.
Hair restoration surgery has gone through a vast array of changes since its introduction by Japanese dermatologist Okuda in 1939. Hair transplant surgery is becoming increasingly popular in the UK. A number of celebrities including Wayne Rooney, Jason Gardiner, etc have publicly admitted to having undergone hair restoration surgery. Nowadays hair transplantation is considered safe and new techniques and equipment have been devised in order to give a naturally looking, permanent and aesthetically pleasing result. It is worth mentioning that with new transplanting techniques the hairline no longer appears pluggy or “Barbie doll hair” or “corn rows” as much smaller grafts are used. In addition, experienced surgeons achieve more than 90% survival of transplanted grafts producing a substantial cosmetic improvement. The goal of modern hair transplant is to re-establish the aesthetic balance lost in the hair thinning process. A successful surgical outcome restores the aesthetic function of scalp hair which is complimentary to the other facial features giving the appearance of a natural, pleasant and balanced whole.
There is no upper limit above which surgery should be denied, unless there is a medical condition that may compromise the safety of the patient. A family history of complete baldness should be a contraindication to hair transplantation, especially if the patient presents at a young age. Every patient should be assessed on an individual basis including a psychological evaluation in order to detect any signs of body dysmorphic disorder or unrealistic expectations. Nowadays patient satisfaction is more than 90% provided that potential candidates for hair restoration surgery are carefully selected and an excellent channel of communication has been established between the doctor and the patient. It is very important to explain clearly to patients the anticipated course of their hair loss, the limited amount of donor hair available, and the need to maintain realistic goals. Even when surgical technique and hair survival is excellent, the patient may be dissatisfied because of poor communication and mismatched expectations. We, as doctors, have the moral and legal obligation to act in the patient’s best interests even if that means going, sometimes, against patients’ desires and wishes with regards to density and design.
FUE versus FUT
Fig.3. Strip Method: A) During donor strip harvesting and B) immediately after a two-layer closure of the resulting scalp skin defect 34 www.cosmeticnewsuk.com
The most commonly performed techniques in hair transplantation are the, • Strip Method (or FUT) where the surgeon applies local anaesthetic to the donor area he/she wants to take the hair from, usually the occipital “permanent” zone, and then a thin strip of hair bearing skin is removed which is subsequently slivered under the microscope into follicular grafts. These follicular unit grafts are then placed into pinprick incisions in the recipient area. The strip method of hair transplants is the “Gold Standard” as the most effective technique for transplanting hair and donor utilisation.
•
FUE which stands for Follicular Unit Extraction. This technique uses a microscopic biopsy punch to remove individual hair grafts, in the same way as an apple corer removes the core of an apple. FUE is a relatively new technique, and only really established itself in the early years of this century.
FUE
FUT
•
No linear scar
•
Yields high quality grafts from the permanent zone
•
Important for those who wear their hair very short
•
Smaller donor region is required for sufficient number of grafts
•
Less follicular transection (damage to grafts) compared to FUE
•
Since the extraction process is quicker than FUE, smaller procedures are needed to get an equal amount of grafts when compared to FUE
•
Less costly procedure for the patient
•
Decreased healing time in the donor area
•
Less post-op discomfort in the donor area
•
Provides an alternative when the scalp is too tight for a strip excision
•
Makes it possible to harvest non-scalp hair (e.g. beard or body hair)
Hair transplant surgery for women Contrary to the common belief the majority of women with FPHL are good candidates for hair restoration surgery. However it should be noted that women have, generally speaking, smaller and thinner donor areas than those found in men’s “safe” donor zone and therefore lower graft densities should be used in order to produce satisfying results in women. Even in high grades of FPHL (Fig. 5), unlike men, women preserve their hairline. Hence it is well accepted that smaller operations for women confined to an area just behind the hairline, to reduce the “see-through” effect of thinning is more advantageous and cosmetically pleasing.
Fig.5. Ludwig pattern of hair loss in women
Tips to remember
Fig.4. FUE: A) Transplanting into thinning frontal area and hairline B) During graft extraction Comparison between FUE and FUT Less popular types of hair restoration surgery includes: • Frechet Scalp Reduction performed mainly on the crown area of the scalp, or ‘the monk’s bald spot’. In this procedure, the bald skin on the crown is removed and the hair bearing sides of the scalp above the ears are drawn together. This procedure usually requires three steps whereby some of the bald area is excised after skin has been stretched by using a Frechet extender (a thin sheet of silicone elastomer) affixed to galea for four weeks and finally a transpositional flap is used to relocate the final scar and hair direction into the classic crown swirl. •
Scalp Expansion Surgery involves stretching the scalp with a silicone balloon under the skin over a period of weeks before the bald scalp tissue is surgically removed. This stretching results in increased elasticity of the scalp and the ability to remove more balding scalp. The scalp expansion procedure requires two procedures – one for inserting the expanding balloon and the second for its removal along with the excess loose bald skin.
•
Scalp flap surgery is a method of moving a hairy “flap” of scalp skin and underlying tissue to a bald area. This is a highly skilled surgical procedure which can be performed for both reconstructive and cosmetic reasons.
It is now widely accepted that follicular unit transplanting (FUT) at densities up to 30 FU/cm2 usually carry minimal risk of causing any post-op complications including “shock loss” involving the pre-existing hair of the recipient area – if any –within the first two or three weeks after a transplant. Recipient FU density of 25-30 FU/cm2 usually produces a satisfactory result for most patients. When FUT strip-graft numbers exceed 3,000, problems with the wide donor site scar and recipient site necrosis become more common. Moreover studies have shown that transplanted hair survival is diminished if grafts are planted too closely together, probably due to the extra trimming that grafts may need to undergo to fit in a tighter space. Excessive trimming leaves follicles vulnerable to injury. The FUE technique leaves only tiny scars, however when pushed to the limit, the cumulative tissue trauma and fibrosis (i.e. scarring) becomes a serious obstacle to a satisfying result. In addition, “megasessions” associated with the use of large numbers of grafts, leave less permanent donor hair in reserve for a potentially growing area of MPB. Dissecting white or light-grey hair into follicular units is extremely difficult. White hair is transparent and can be easily injured during the sectioning of the tissue in the delicate process of preparing follicular units. UV light, methylene blue, hair dye, or more recently a FDA-approved product called Meladine have all been used in an effort to reduce transection rate in white hair transplantation.
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product tried and tested
N e X T
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Dr Rupert Gabriel on why he chose the NeXT hair removal laser from Asclepion
Choosing a hair removal laser can be a confusing business. With so many technologies available, it is vital that any clinic makes a number of considerations before committing to a purchase. It is essential to compare systems on specification, but also on ownership costs and other criteria.
“With so much choice now in the laser and IPL market, making the right equipment decisions can be critical to the success of your business”
At Snowberry Lane, our incumbent 1064nm Nd:Yag had become slow and laborious for hair removal. We decided to update the technology and ideally wanted a laser that provided virtually pain free hair removal on all skin types and in fast treatment times. We decided to look at a dual wavelength system to get as many applications as possible.As well as proven efficacy, another consideration was maintenance costs. In our experience, lamp powered systems had proven costly over the long term. IPLs and certain lasers required lamp changes regularly and these costs added up over a number of years were considerable. We therefore concluded that a diode powered laser system was the best option, as there are no lamps to change, eliminating this extra outlay. A long warranty was also important, as was build quality. Handpiece replacement costs and shot count was also an area that we know from experience can prove exceptionally costly, so a system with a robust handpiece that didn’t need replacing every couple of years at a huge cost was essential. After considering a number of options, one laser met all the above criteria, combining an industry leading specification with low and transparent ownership costs; The Asclepion NeXT 810/940nm. The NeXT is the latest hair removal platform from German based manufacturer Asclepion. At 12 shots per second, it is the fastest hair removal laser in today’s market. Combined with a large spot size of 14x10mm, the NeXT delivers FDA approved Pain Free hair removal for all skin types, all year round. With the additional capacity to perform acne, rejuvenation and vascular treatments using the additional
36 www.cosmeticnewsuk.com
940nm wavelength, the NeXT offered more in terms of specification and applications than any other laser we considered, with the lowest running costs. It has an unmatched two year parts warranty, whilst the handpiece is guaranteed for a quite astounding 15 million shots. At just 35kg, the system is portable and lightweight. It is also easy and intuitive to use, with in-built parameters depending on the treatment and skin type selected. Set up and treatments are therefore hassle free, fast, safe and delegable. Having used the system for a considerable time now, the difference in the hair removal treatments offered at our clinic has been significant. Patients are much more comfortable during treatments compared to our old Nd:Yag system, whilst the unique PainFree Smooth Pulse Mode (12Hz) offers exceptional results and a unique method of treating larger areas. Like for like treatment times are also reduced. We used to allow 45 minutes or more to treat an entire back but this has been reduced to just 15 or so minutes. This means we can treat more people each day than we could with our old laser, which has obvious advantages. With so much choice now in the laser and IPL market, making the right equipment decisions can be critical to the success of your business. In choosing the NeXT, we ensured that our hair removal treatments were faster and more comfortable than before, whilst also knowing that the cost of ownership over the long term was as low as possible, maximising the value of our investment. With excellent training and support, I would highly recommend the NeXT as a pain free hair removal solution.
T h e
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p o w e r
d i o d e
T e c h n o l o g y
Asclepion neXT DioDe:
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• The world’s fasTesT hair removal diode laser@12 hz • pain free smoothpulse Mode • fda cleared for all sKin Types including black, asian and tanned skin • huge 14x10mm spot size • 15 million shots per handpiece • portable, lightweight at just 35kg • dual wavelength 810/940nm for hair removal, acne, rejuvenation and Vascular treatments • industry leading 2 year warranty • precision german engineering with expert sales, training and support
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810/940nm diode laser
carleton Medical formerly known as
Supply Chain
Contact us on: 01633 838081 www.carletonmedical.co.uk sales@carletonmedical.co.uk
product Q&a
Q& A Innosearch founder and CEO Dr Fernando Bouffard Ph.D. of the Innosearch Skin Academy facilities discusses the Innosearch range Cosmetic News: Tell us about your background Dr Fernando Bouffard: I graduated from the University of Barcelona in 1991 with a Pharmaceutical degree and I am a Doctor in Galenic Pharmacy by the Department of Pharmaceutical Technology of the University of Barcelona and a Master in Pharmacy and Pharmaceutical Technology. I am a Deputy Professor of the Masters course in Skin Cosmetics and Technology at the University of Barcelona and Professor of the Portuguese Association of Aesthetic Medicine and the Union Internationale de Medecine Esthetique. I am also a Technical Advisor in Skin Cosmetics and Anti-aging Cosmetology Association and the Skinscience Group. In addition to being the founder and Technical Director of Innosearch Lab I am also the Technical Director of pH Formula Internacional and Quality assurance manager of División Farmamagnum and Interclinic (Barcelona) and a Consultant for Gerson Lehrman Group International. CN: What is the INNOSEARCH philosophy? FB: INNO products are based on formulas designed to provide specific solutions for aesthetic problems. Rigorous research leads us to select the latest generation ingredients and create unbeatable combinations to achieve solutions to address specific skin problems and the signs of ageing. A combination of skin specialists made up of dermatologists, pharmacists and aesthetic doctors develop our products, supported by science and our own experience. We carry out rigorous scientific research, which seeks the best ingredients for each indication. Our exclusive formulas contain the correct ingredients in the right concentrations to achieve optimum results when treating the different symptoms of ageing, likewise to maintain or improve results achieved with professional treatments. Our aesthetic treatments employ chemical substances which react with the upper-mid layers of the
38 www.cosmeticnewsuk.com
skin, causing a controlled damage at various levels and hence, both superficial and deep stimulus for dermal structure renewal. CN: What does the INNO range offer? FB: Inno-TDS® is a trans dermal release mesotherapy system that includes products formulated according to efficacy guidelines based on high concentrations of active ingredients that are highly effective yet safe for the skin. The range offers weight, cellulite, hair loss and antiageing solutions. Inno-Roller® is a line of solutions designed to be used with a dermaroller as an apparatus for transdermal delivery and the stimulation of cell renewal. The solutions have a unique combination of active ingredients which act specifically on the condition being treated including, hair loss, cellulite, anti ageing, scars and stretch marks. INNO peels were introduced six years ago based on 20 years of experience in the market with other peeling products that offer a comprehensive treatment system composed of chemical peels with different acid strengths, designed to produce various degrees of exfoliation based on individual needs. Our aesthetic treatment employs chemical substances which react with the upper-mid layers of the skin, causing a controlled damage at various levels and hence, both superficial and deep stimulus for dermal structure renewal. The balance of acids and the different peels for different needs of the skin. Inno-Derma® provides basic daily skin and body care that gives effective solutions to the different signs of ageing and offers the latest generation of active ingredients formulated in the correct combination for optimum effectiveness. Inno-Caps® is a range of nutricosmetic products that provide a comprehensive treatment from the inside out and can enhance the results of all other InnoSearch treatments and products CN: What inspired your recent workshop collaboration with the UK? FB: We have worked with David Gower and Medical Aesthetic Group for many years and together created a series of workshops that take place over two days at the Innosearch Skin Academy facilities in Barcelona. This allows doctors from the Uk direct access to me, the pharmacist, who creates the formulas and produces the products. This encourages inter action and the exchange of ideas and practical knowledge. The feedback has been extremely positive. Also we are very good at entertaining and the balance between theory and fun is exactly right!!
t h e awa r d s e v e ni ng f or you r i ndu st ry
save the date for the industry event of the year
7
th
december 2013
w w w. c o s m e t i c n e w s u k . c o m
treatment spotlight
the WritiNg’s oN the WAL We find out about the body-jet® water-jet assisted liposuction (WAL) procedure
Liposuction has long been one of the most popular cosmetic surgery treatments and advances in techniques and technology have seen less invasive procedures with fewer associated risks and downtime become the gold standard over traditional methods. One such treatment is body-jet®. The body-jet®system was developed by human med®and is distributed in the UK by Sigmacon. Launched in 2004 the body-jet®is a water-jet based infiltration, irrigation and aspiration system for removing undesired subcutaneous fat deposits and ecrine glands. A fundamental new approach to perform liposculpting, perspiratory gland removal and surgical treatment of lipoedemas, the body-jet®is the only device approved for water-jet assisted liposuction (WAL). WAL can be performed under general anaesthesia, sedation or local anaesthesia. However, WAL is tailored for – and most commonly practised under – local anaesthesia. Many surgeons prefer a mobile patient during the procedure in order to improve results and to eliminate risks associated with general anaesthesia.The low drug and pain level makes WAL the predestined method to go local.
normal volume 2. Irrigation and aspiration 3. Drying
Benefits of the treatment are: Safety • •
Effectivity • •
There are three stages to the treatment: 1. Infiltration for local anesthesia use 20-30% of 40 www.cosmeticnewsuk.com
Precise real-time contouring (you see what you’ll get) Low correction rate
Convenience •
WAL uses tumescent fluid, but not the tumescent technique. Whereas other liposuction methods (SAL, PAL, UAL, LAL) are based on the same principle – more or less large volume of tumescent liquid is pumped into the body to prepare tissue for fat removal – body-jet®uses the flushing power of water. The concept is that a slightly pressurised, fan-shaped laminar jet of water is enough to release undesired fat cells from its connective tissues while more fibrous structures (such as nerves and vessels) are spared. This eliminates extensive exposure of TLA solution to the body as WAL utilises TLA solution just as carrier for local analgesic and vasoconstriction, making high volume infiltration of TLA to prepare fat fragmentation (the basic principle of present tumescence methods) not necessary.The body-jet®system uses a sterile applicator system with integrated pressure pump (disposable); infiltration cannulas (resterilisable) and irrigation and aspiration cannulas (resterilisable). It comes with a cannula cleaning set, three litre disposable suction bag and reusable canister for suction bags.
Patient is less exposed to TLA, operation risk is minimised Less tissue trauma, haematomas and bruising
•
Less pain, physical and emotional stress to the patient Shorter procedure and recovery time (walkin-walk-out)
This results in a reduction of procedure risk; improvement of aesthetic results; promotion of liposuction business and superior harvesting method for fat transfer
is done during liposuction automatically. Another advantage is that the sterility of the harvested fat is easily maintained as the container does not need to be opened – the fat is extracted through incoming socket – and the fully autoclavable system means disposable costs are minimal. Dr Klaus Ueberreiter, a plastic surgeon from Berlin, Germany explains, “For breast augmentation, at the very least you need approximately 500 ccs of fat. Harvesting and grafting fat with the traditional method of small syringes takes approximately five or six hours, or even longer.” By using the body-jet®, Dr Ueberreiter has been able to perform breast augmentation in about one hour by harvesting fat as a byproduct of standard liposuction.
Fat harvesting for breast augmentation has been much talked about but techniques have often been lacking, resulting in inconsistent and unpredictable results. The body-jet®is proving to be a useful tool in this area.
By featuring a two-cannula system, the body-jet® can irrigate and aspirate simultaneously. “A water beam is directed straight into the fatty tissue. It more or less washes out the fat in an emulsified state,” Dr. Ueberreiter explained. “You have good quality adipose tissue containing small fat cells ready for transplantation, without needing to centrifuge.”
Its superior, clinically proven fat harvesting method means that the fat is exposed to less mechanical stress as it is flushed out, not dissected. The cells are therefore exposed to less local anesthetics due to reduced infiltration and immediate separation. This results in a better re-injectable material as the ‘islands of adipocytes’ are smaller. The procedure is also time-saving for practitioners as no centrifuging is required – the fat is harvested with approx. 25% liquidity and there is no extra time needed for collecting/processing the fat as it
A special system with an additional filter function allows for the sterile collection of fat. Hence, fat can be reinjected into the body without further preparation. Over the past 18 months, Dr Ueberreiter has performed close to 50 breast augmentation procedures with the body-jet®. “This is a safe and reliable method, the results are excellent and patients are very satisfied”, he says. The system is now being used in the NHS for high volume breast reconstruction after mastectomy.
Fat harvesting for breast augmentation
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Interested to learn how LightSheer速 can add revenue to your practice? Call for a no obligation demo on 020 8955 7982 or email: daleavery@sigmacon.co.uk Sigmacon (UK) Limited, Heriots Wood, The Common, Stanmore, Middlesex HA7 3HT
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product news sigmacon
aesthetic source
Sigmacon introduces ‘pain-free’ Lumenis LightSheer® DUET™ Sigmacon has launched the Lumenis LightSheer® DUET™, a highly effective, clinically proven system for high-speed permanent hair reduction. The LightSheer DUET’s highspeed hand piece has a spot size of 22 x 35 mm, enabling you to treat a back of a man in less than 10 minutes. The unique, vacuum-assisted technology enables a painless application and effective results with less fluence. The LightSheer DUET also includes the ET ChillTip hand-piece (9 x 9 mm) allowing comfortable treatment for areas requiring higher fluence or precision. LightSheer DUET offers the optimal combination between efficacy, safety and speed, making it the best investment for best results. In addition to permanent hair reduction and hair removal, the LightSheer DUET is cleared for treatment of pigmented lesions, vascular lesions, pseudofolliculitis barbae and leg veins.
jmsr europe
JMSR launches Regeneration Booster JMSR Europe Ltd. has launched Regeneration Booster, a cuttingedge anti-ageing product proven through independent studies to significantly improve the appearance of ageing skin. Maximum results are delivered through a concentrated combination of advanced ingredients including cycloastragenol, TGF Beta-1, coenzyme Q10, multiple beneficial growth factors and peptides and anti-oxidants. In an independent 12-week study conducted by Robert Weiss MD, Regeneration Booster showed significant improvement in the appearance of each of the eight measured categories of ageing skin. Measured categories included the appearance of wrinkles, texture, pore size, elasticity, skin colour/clarity, erythema, hydration and overall skin quality. 100% of subjects noted improvement in overall skin quality and noted positive user experience (ease of use, smell, texture, feel). Visible results were seen after just two weeks of use and there were no cases of sensitivity, acclimation or irritation.
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Study shows benefits of Matrixyl™ Scientists at the University of Reading have discovered that the Matrixyl peptide, used in the NeoStrata Skin Active range, doubles the amount of collagen produced and has skin boosting properties. The research, published in Molecular Pharmaceuticals, demonstrates that Matrixyl has skin boosting benefits if the concentration is high enough. Matrixyl 3000 peptide is one of the star performing ingredients used in the NeoStrata Skin Active range to stimulate new collagen. It is found in the Skin Active Matrix Support Cream and Skin Active Firming Collagen Booster Serum. The Skin Active range is distributed in the UK by Aesthetic Source.
laser physics
LASER PHYSICS EXPAND PATIENT PROTECTION RANGE Laser Physics has added the PatientShield from NoIR to its range of patient protection. Made from fiber-reinforced polymer the new goggle style PatientShield are suitable for both Laser and IPL treatments with an Optical Density of 190-10600 nm 7+. The goggles whilst being re-usable offer a close fit for the patient’s protection with an elasticated headband suitable for use for all head sizes. The PatientShield offers a new option to Laser Physics range of patient protection, which includes; I Block II, I-Shield, SpectraShield, Durette III and their range of disposable eye shields. The goggles are CE Certified for: 190-315 D LB8 + IR LB4 >315 1400 D LB6 + IR LB7 + M LB7Y >1400-11000 DI LB3.
primequal
Primequal extends Talent BT™ range Primequal is extending its Talent BT™ aesthetic range with four new devices. These new Talent BT™ devices were designed to resolve problems caused by botulinum toxin dilution. Talent BT™ is the world’s first automatic dosing system for botulinum toxin. The single use, disposable automatic syringe is filled in front of the patient, immediately before it is applied. It is identical to a standard syringe pumping out from a vial. Depending on the botulinum toxin that is used, there is a choice of device with a customised number of units per click. Simply follow the number of units per bottle and the volume that is required for reconstitution to identify the Talent BT™ that should be used. Pierre-Yves Chassot, Primequal R&D director said, “Dilution is a central problem with botulinum toxin. There are plenty of scientific publications but no clear answer to help the practitioner tackle this problem. Talent BTTM 1 click 1 unit™ brings a simple and reliable answer for both dilution and dosing mastery. Talent BT™ is a successful injection assistant!”
silderm
SilDerm’s clinically proven scar gel now available as a spray SilDerm’s clinically proven Scar Gel is now available in a spray. SilDerm™ Scar Spray works by bonding to the outer layer of the skin providing a protective barrier against chemical, physical and microbial contamination of the scar site. Like the gel, it dries quickly to form an ultra-thin, breathable, waterproof silicone membrane which allows the scar to heal naturally through normal collagen synthesis. This also normalises the over production of collagen, which can lead to abnormal scars. This in turn reduces the redness of scars, decreases their volume and reduces the pain and itchiness. The product contains a unique blend of naturally occurring silicones that has been proven in clinical studies to flatten, soften and smooth scar tissue. In several meta-analyses of the data on several thousand patients treated with silicone, it has consistently shown that patients scars improve over a two to three month period by 80%, as measured by patient satisfaction.
mesoestetic®
mesoestetic® launches radiance DNA mesoestetic® is extending its range of anti-ageing programmes with radiance DNA: a line designed to effectively address aesthetic concerns associated with stage IV skin ageing. radiance DNA has been created to increase cell longevity, supporting the DNA repair and protection process with three steps: cosmeceuticals for topical use; an intensive nutricosmetic treatment and a professional treatment. radiance DNA includes in its formula the innovative [meso]recovery complex®, a combination of active substances, especially selected for their cell DNA anti-oxidative, protecting and repair properties. Its exclusive technology is based on specific release biovectors,that are able to vehicle and release the complex of substances “unchanged” in the cell core, thereby ensuring an unprecedented efficacy. Products include: radiance DNA intensive cream (50 ml) for reactivating vital skin functions, strengthening the protective barrier action and preventing transdermal water evaporation; radiance DNA night cream (50 ml) which uses the natural resting state of the skin to readjust cell metabolism and induce the activity of the genes responsible for skin renewal during sleep; radiance DNA eye contour (15 ml) for a three-fold effect against wrinkles, under-eye bags and circles and radiance DNA essence (30 ml) a concentrated remodelling serum specifically formulated to reconstitute the skin in depth, ensuring solid cell cohesion and potent rejuvenating action. The range also includes radiance DNA elixir, a regenerating, highly anti-oxidant nutritional complement, formulated to reactivate the cell metabolism of the dermis and help reverse its ageing.
dermamelan® is a professional whitening treatment designed to eradicate or eradicate or attenuate cutaneous blemishes with melanic origin while it homogenizes skin tone and increases skin luminosity. dermamelan® application inhibits the melanogenesis process paralysing melanin production for a long period of time in which corneum stratum desquamation and the action of macrophage cells drag melanin deposits.
www.mesoestetic.co.uk
in business business focus
under litigation Eddie Hooker and Bevan Brittan on litigation and the non-invasive cosmetic procedure Non-invasive cosmetic procedures are a growing part of the UK’s cosmetic industry. An increasing number of claims for compensation are being made against clinics and medical practitioners who perform non-invasive procedures. All non-invasive treatments which are negligently administered may result in a claim. This includes botulinum toxin, fillers, cosmetic peels/derma roller, and laser/IPL.
F
illers and laser/IPL claims represent the greater proportion of non-invasive claims. A typical claim relating to a filler will usually involve an allegation that it has been incorrectly injected. For example it may be alleged that the filler has been injected in the wrong quantity or in the wrong place, and that it has left an adverse cosmetic result such as bruising, swelling or on occasion semi-permanent or permanent lumps at the site of injection. A typical laser claim will involve blistering, burns or depigmentation of the skin, sometimes with the allegation that there has been permanent scarring. Botulinum toxin procedures tend to generate fewer claims; however the claims can allege serious injury seeking large amounts of damages. One recent claim alleged that botulinum toxin had been administered incorrectly which caused the client temporary paralysis in her eye and cheek.
wh at D o Cl i e nt s C l a i m f o r ? Those bringing claims for negligently performed non-invasive procedures will seek to claim damages i.e. compensation for cosmetic disfigurement. The amount of damages will depend on the severity of the disfigurement, the location on the body, the prognosis of the injury and the age and gender of the patient. Damages are frequently claimed for psychiatric injury where the cosmetic disfigurement causes depression or exacerbates any underlying psychiatric condition. If there is any additional loss for example loss of earnings as a consequence of taking time off work or the cost of a remedial procedure compensation may also be sought to cover such losses. wh at D o e s t h e p r a Ct i t i o ne r Do if a C l a i m i s t h r e at e ne D o r bro u g h t a g a i ns t t h e m ? A practitioner may become aware that a client is thinking about bringing a claim for a negligent non-invasive procedure when a complaint is
The amount of damages will depend on the severity of the disfigurement, the location on the body, the prognosis of the injury and the age and gender of the patient 44 www.cosmeticnewsuk.com
made or when there is a request for treatment records to be released to them. As soon as a practitioner becomes aware that a claim may be brought, he or she should notify their insurer. A delay in notification may prejudice whether insurance cover is provided. Your insurance company may instruct solicitors to act on your behalf. If you are not insured, you should consider instructing solicitors yourself to defend the claim. If the client decides to pursue a claim he or she may send you a Letter of Claim. This is a letter that is sent before court proceedings are commenced to establish whether there is a valid claim and to explore whether a compromise can be agreed at an early stage without incurring significant legal costs. A claim cannot be defended without detailed input from the practitioner. Claims can be time consuming and stressful for a practitioner. To investigate a claim it will be necessary as a minimum to review the treatment notes and any photographs that there may be of the treatment area, Treatment protocols will be checked to establish that the non-invasive procedure was administered in line with current guidelines and manufacturer’s guidance. It may be necessary to obtain a report from an independent expert who will review the treatment provided.One key area that concerns practitioners when a claim is brought is reputational damage particularly if the client shares details of their claim with other clients or on the internet. Unfortunately there is little that can be done to prevent disclosing details of a claim more widely.
av o iDing Claims Fortunately, claims are the exception for the careful practitioner who keeps good treatment notes, follows product use guidance and has robust assessment and consent procedures in place. Key actions that can be taken to minimise the risk of legal action are: • Maintain good, thorough notes of all assessments and appointments with your clients. • Assess your clients carefully before accepting them. Do not treat clients that you think might have unrealistic expectations about treatment outcomes. • Obtain a full medical history from the patient including whether they have undergone non-invasive procedures in the past and whether there has been any adverse affects from the products. Be aware that patients can have unforeseen reactions to products that cannot always be predicted. • Ensure that the client is consented carefully for the procedure. Make sure you explain the risks of the treatment clearly to them. If there are alternative, more suitable treatments tell them about the treatment. Make sure that they sign the consent form to indicate they understand the information that has been provided to them. • Ensure that the procedure is carried out within the product guidelines. If a treatment has been undertaken outside the guidelines it is very difficult to maintain that the treatment was appropriate. • Take clear before and after photographs of the treated areas and make sure these are stored safely. • Make sure you record the settings that are used on the equipment and perform all of the necessary patch tests and skin assessments prior to the treatment being administered. • Be aware that patients do not always follow guidance such as avoiding the sun or applying adequate sun block. If they have not done so, it is your responsibility to refrain from treating the patient on that occasion. • Keep all of your notes for 10 years after you provide the treatment, it is usually a condition of your insurance
If you are able to demonstrate the above you are much more likely to be able to defend a claim.
in business training
in prinCiple Training is one of the key areas that was highlighted in the call to evidence by the Keogh review as being lacking, particularly when it comes to cosmetic injectables, and with no training standards in place, picking the right course can be a minefield. We look at the new training standards that have been developed by the IHAS to meet this need.
As the industry eagerly awaits the outcome of the Keogh review, many faculties within the industry have been working to tighten and strengthen the standards we already have in place as part of the self-regulatory framework. As the organisation in charge of managing Treatments You Can Trust, the IHAS has now developed a set of training principles to complement the Standards for Injectable Cosmetic Treatments and to provide guiding principles for providers to identify and select appropriately qualified trainers and validated courses. The document has been written to identify the principles upon which training models for botulinum toxin and dermal fillers should be developed, however it can also provide a framework for developing a range of training courses in the future. It is not intended to replace generic guidance or requirements of any particular accreditation process but should be read in conjunction with and compliment them. The principles recognise the new and evolving nature of the speciality and the diversity of current training courses. The principles are the minimum requirements expected for a course to be accepted as an appropriate training course. The principles can also be used by employers and clinicians to identify training needs and select appropriate training courses. Each principle is accompanied by a brief description to guide you in selecting a training course or to help you when developing or updating new and existing training courses.
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There are seven key principles outlined in the document: 1. The training course must have trained and experienced tutors and a clear entry criteria for participants • Basic requirements for tutors should ensure that their level of competency is over and above the training level being delivered and they must have undergone further enhanced training in education /teaching skills, for example a Train the Trainer Course or a Teaching and Assessing Course. Existing course tutors should demonstrate that they are currently undertaking enhanced training in education. In appropriate circumstances, grandfather rights may used. • Where a module is being delivered by a supporting specialist tutor who is not practising within the speciality, the tutor must be competent to deliver the module. For example a Pharmacist may deliver a module on pharmacology. • The course outline must clearly state the entry criteria for the course. The criteria should include the required qualifications and relevant experience of potential participants. • To comply with the IHAS Standards for Injectable Cosmetic Treatments only doctors, registered nurses and dentists should be trained to inject dermal fillers or botulinium toxin. 2. The training course must be evidence based and follow current guidance, local and national policy and best practice • Current guidance includes the recommendations of The Expert Group Report (DH 2005), Guidance on Good Medical Practice in Cosmetic Surgery/ Treatments (IHAS 2011), Good Medical Practice (GMC 2013 not 2009) – (Good Medical Practice has just been updated this month). 3. The content and objectives including outcomes must be clearly defined • The course curriculum should clearly identify the aims, learning outcomes and scope of the course. • This should include a clear definition of what cosmetic injectables are, their type and use and which injectables are covered by the course. It should detail the assessment process and the certificate or qualification awarded on successful completion of the course. • It should outline the need for continuing professional development, encourage
• •
• •
•
• •
participants to recognise their responsibility to enhance their skills and incorporate portfolio development, mentoring and the need for supervision. It should be delivered in a clinical environment. It should also include development and practice of injection technique using live models not simulations. It should incorporate a participant’s course evaluation and a complaints procedure. The number of delegates attending courses should appropriately match the number of course tutors e.g. for a basic/ introductory training course where practical hands on training is included at the point of treatment the number should be at least one tutor to four delegates. Where the training includes a practical demonstration then the ratio should be one tutor to eight delegates. It would be beneficial for trainers/ trainees to have a supervised log book of procedures after the training course. There should be a completion certificate to satisfy CPD issues as well as skills based. The course should be assessed by a Question and Answer methodology.
4. The course must satisfy the criteria for appropriate training • The course should either have an accreditation or qualification base as a minimum and should include an assessment of knowledge and skills. The assessment process must be validated by a second person - this may be a visiting tutor or an external trainer who is competent in the specialty. All courses should have a process in place to regularly review and update the course. • Courses should demonstrate that they have insurance particularly in relation to models/ patients that are treated during the practical session of a training course. • They should provide evidence that all models/patients have given consent and are aware that they are being treated as part of a training course. They must be provided with aftercare advice and a point of contact should they suffer a complication or adverse event.
5. Details of the recognition and/or the qualification awarded to successful candidates must be included in the course outline • Courses from an external body must define how and by whom they are recognised/ accredited. This should be a qualification based recognition which is awarded by a nationally recognised awarding body for example Higher Education Institute. Alternatively some courses will have been through an accreditation process by a recognised body. This accreditation must relate to the course content and clearly articulate the learning outcomes and the assessment process. Existing courses which do not have recognition from an external body must define the entry criteria, learning outcomes and assessment process for the course. • The assessment process must be competency based and incorporate an assessment of both knowledge and practical skills. • There should be an overview process to ensure that the assessment decisions are validated. 6. The course content must identify how it will support the participant to achieve the stated competencies. As a minimum the course will detail the pre-defined units. A model course will include: Theory • Pharmacology & Toxicology and include efficacy of the product • Anatomy & Physiology Administration • Storage, Handling & Disposal of Medicines and Clinical Waste • Record Keeping & Image Recording Patient selection and consultation • Consultation, Informed Consent & treatment costs • Contraindications • Pre and Post Client Care • Ethical Issues Treatment Issues • Pre-treatment procedure
• • • • • • •
Product selection, dosage & syringe selection Positioning the client Injection techniques Post treatment procedures Handling complications Handling and reporting Adverse Events Practical Experience of Injection Techniques
Continuing Professional Development • Practitioners Responsibility for maintaining and enhancing skills and knowledge • Supervision and mentoring 7. The Course should include a grandfather clause to enable existing practitioners (doctors, dentists or registered nurses) to demonstrate to the course tutor that they meet the required competency • It would not be realistic to insist that experienced practitioners have to complete a training course. However, there should be a requirement to evidence how they meet all the competencies of the course. This might include a professional portfolio and /or practical assessment. Only doctors, dentists and registered nurses who have a current registration with their regulatory body will be eligible to exercise the grandfather clause. To be awarded the Quality Mark, the following criteria will need to be met: • A desktop review of the training material • Validation of the professional registration of the trainer (registered with GMC,GDC or NMC) • Checking of attendance lists to ensure only qualified professional are accepted • Random sampling of the training delivery of one of the training days to be notified to the organisation within 24 hours of CHKS attendance • Overview report to the organisation and the governance group • An annual registration fee of £1200 would be charged. It is also essential that the course can demonstrate that it adheres to Principle 5, specifically: To comply with the IHAS Standards for Injectable Cosmetic Treatments only doctors, registered nurses and dentists should be trained to inject dermal fillers or botulinium toxin.
a note on aCCreDitation Another concern the IHAS has with regards to training is the claims by some courses to be ‘accredited’ when they are actually not or the accreditation they are claiming to have does not hold any weight as it has not been given by a University. The definition of accreditation is: Accreditation is a process in which certification of competency, authority, or credibility is presented. Organizations that issue credentials or certify third parties against official standards are themselves formally accredited by accreditation bodies. The accreditation process ensures that their certification practices are acceptable, typically meaning that they are competent to test and certify third parties, behave ethically and employ suitable quality assurance.
www.cosmeticnewsuk.com 47
in business technology/practice management
A great i-dea
Richard Crawford-Small on the new iConsultAesthetic
I
am Richard Crawford-Small, and I am very excited. I am excited because I finally get to talk to you all about the iConsultAesthetic System, and I am very proud to confess that it really is something to talk about.
But first, I need to share with you some of the insights that I have gained on this journey, and what I saw convinced me that leaving Allergan and getting back into software was a good idea. Read on, because even if you don’t use iConsultAesthetic these insights will help improve your business profitability. If you have been on the Practice Transformations course, or heard me speak, you’ll know how a business can improve its profitability by creating compelling customer experiences. If you can master “adding value” to your processes you’ll generate a strong emotional attachment between your brand and your customers. One thing generally unifies companies that are great at adding value; Coca Cola, Apple, Rolex, Google, Nike, Porsche, Amazon etc. They are market leaders, and very, very profitable. Regardless of the size of your business, you can apply the same logic if you want to become the market leader. Don’t just think of markets as global, a market is a street, a town or a postcode
The practice transformations pathway and if you work to create compelling customer experiences you will achieve this. The practice transformations pathway isolates the key phases of the patient journey and creates a map you can follow to improve. By using the key principles that a patient is not a patient all the way through this journey, and that they have different goals at each phase, you actively transition them 48 www.cosmeticnewsuk.com
through these phases, take control and provide a compelling journey, an experience. We have unconsciously, rather than consciously defined the user experience in Medical Aesthetics, and there are three challenges that we need to face if, as an industry, we are to embrace a culture of excellence and improve. • • •
The technology The consumer The environment
A CRM, or clinic management system is probably the main software system you will use, and they are very capable but can prove expensive to buy and complicated to use. These may be very powerful systems, but what is the point of all of this capability if you need a computer science degree to use them effectively?
Now the challenge isn’t addressing all of these, but proving that you do. Record keeping in most clinics is a paper process which may be quick and easy, but it can’t be measured, audited or benchmarked. It can’t be used to prove to your customers that you are the best, and therefore cannot be used as a tool to differentiate your excellent business. We needed a new approach; Really good consultation tools, that would engage the patient and enhance the journey A really easy way to record patient data A way to manage this data, provide transparency and patient access I knew how to do this and I needed to do it, the best way to predict the future is to create it! Meet iConsultAesthetic
Further to this, our Consumer is growing very tech savvy. They demand information and the increase in mobile device searching is creating a whole new set of demands and criteria that businesses need to fulfill in order to simply generate online share of voice. The final challenge, is the environment, and with this I mean the regulatory environment. The impending Keogh Report will ask for changes, and I have captured some key words used in the “Summary of cosmetic interventions call for evidence responses” document. If you have not read it I urge you to go to http://www.dh.gov. uk/health/2012/12/ responses-cosmeticsurgery/ and read it. This document is a mirror, it’s the industry telling itself HOW to create compelling user experiences, all you need to do is put the word “Improve” in front of them. These key words are; • • • • •
safety transparency accountability compliance Integrity
iConsultAesthetic is not just a data recording solution. It is not just a data management system. It is not just a consultation tool. Its is all three. And more. iConsultAesthetic is a clinical ‘Digital Ecosystem’ designed to look after you, your business and most importantly - your client. Its everything you need on one of these Portable - If you’re mobile all you need is WiFi /3G Cloud based - All your data is backed up Cutting edge - There is nothing else like this!
scanning, when technology allows us to record a full and detailed medical history that can be reviewed and easily updated at every visit. The history is broken down into sections and only needs to be completed once or if Key features; • Patient Imaging When i surveyed the iConsultAesthetic test group, 100% said that before and after images were crucial, and yet only 23% actually recorded them on a computer, most left them on the camera. iConsultAesthetic allows you to take up to six images before treatment and use the images in a visual consultation tool, so now you can really engage with the patient and demonstrate how a treatment plan would benefit them. This was plainly evident when one of the first test patients chose to have 3 areas of BTX-A as opposed to the one she originally wanted, when she saw her image on the iPad. Happy patient, £200 and proof of concept all in one. I smiled.
Digital Consent Process iConsultAesthetic also has a fully digital consent process that provides real professionalism and enhances the patient experience. The system currently contains consent for 17 procedures, from Toxin to Peels and IPL. You choose the treatments to perform after the consultation, and the system displays the relevant consent forms, go through the forms with the patient, ensuring that they have read and inwardly digested the content. There is an area where you can add material information, and provide a really individual patient consent, that will protect both you and the them. The final part of the process is that your patient signs on the iPad, Feedback from test is that this is a keystone in the process and really adds to the patient experience. We should no longer be using paper records and
there are any changes. This gives both you and your patient full visibility and ensures that a full medical history is taken at every visit. Another cutting edge tool is the product usage map, from here you can complete the treatment process by recording the product used.
Data Management System The system is not just an app, but also a powerful and secure portal that records the information from the app and allows you to login and view. It operates on three levels - clinic, injector and client. The patient is able to review their before and after images, consent and medical history online, and iConsultAesthetic is the only system that has this unique patient passport feature. This again, helps to build the trust relationship and enables your patients to become advocates by showing off what you can do.
This is just a few of the great features that iConsultAesthetic has, for more information you can; www.iconsult-Aesthetic.com, www.facebook.com/IConsultAesthetic www.twitter.com/iConsultsoft
We have included many of the popular products you use and given you the ability to record where you have placed them. If you combine this with the Visual Consultation Tool and Digital Consent this gives you a complete record of what you used with a patient and in the event of a complaint you will able to recall all of the elements of the treatment. When we consider the Keogh report, this is a very useful tool that will help protect your patient and business.
www.youtube.com/user/iConsultAesthetic How do you get it? Just download iConsultAesthetic from the Apple AppStore, or link to it from www.iConsult-Aesthetic.com. and create your account. Do it in April and I’ll give you your first 10 consultations free of charge. Can’t say fairer than that! Welcome to the future, I hope you like it.
How much does it cost? The million dollar question, only its not a million dollars. We have three flexible pricing models, and you pay for what you use. Plan Name
Description
Cost
OnDemand
bundles of 10, 50 or 100
£2.50
Monthly Subscription
Unlimited Usage Paid Monthly
£100
Annual Subscription
Unlimited Usage Paid Annually
£1,000
The “OnDemand” pricing would be perfect for a business that will use the system less than 25 times per month. You buy through the payment gateway on the iConsultAesthetic web portal, and the subscriptions provide unlimited usage and is invoiced one month in arrears
A true professional in the medical aesthetics industry, Richard has enjoyed a career that has seen service in The Royal Navy to Medical Device Sales and Corporate Account Management with Allergan. Richard started RCSConsulting in January 2012 and has successfully used his “Think-Plan-Do” methodology in driving greater success for clients including Allergan, Schuco International, The Hospital Group, Transform and Harley Aesthetics. Richard is also an accomplished speaker and presents regularly at industry conferences and meetings.
www.cosmeticnewsuk.com 49
in business a day in the life
the Wright Way Antonia Mariconda spends a Day in the Life of leading psychotherapist and founder of The Wright Initiative, Norman Wright
With the British government now shining a spotlight on the cosmetic surgery industry with proposals for reforms and tighter regulations to be implemented, leading psychotherapist Norman Wright, MSc, Dip Sup, Dip SW, and founder of The Wright Initiative has pioneered a support programme for prospective aesthetic and cosmetic surgery patients to address their emotional wellbeing as well as their desire to improve their physical appearance. Here, Norman takes time out from a hectic schedule to talk to Antonia Mariconda about a day in his life. “Home is Nottingham, where there is never a dull moment, I am blessed with a fantastic family; which includes a wonderful son and daughter. I wake at 6.30am every morning. This is my time! We’re strange creatures of habit us humans aren’t we? Hence why I always start my day with a slice of wholemeal toast, real orange juice and real coffee, the real stuff makes all the difference.I confess I am not a dedicated gym visitor but I do my morning crunches and my morning Yoga Asanas as well as meditation. I travel to work by car, I listen to Jazz FM which uplifts and soothes me in preparation for my day ahead, my working day normally starts at 8.30am. When I arrive at work I check the emotional temperature of the space and how it fits in with my own. I then meet with my practice manager to go through my day. There is no set routine in what I do, so it would be hard to describe a ‘typical’ morning, but I usually will see a combination of clients and do some reading for the panels I sit on or mark various assignments for my students on their BSc programme. My mornings are always busy and diverse. Variety is a wonderful thing to work with in any profession: variety.I am a pescatorian and my absolute favourite is sea bass, so whenever I get the chance I will stop for lunch. I qualified from Derby University and The Sherwood Pyschotherapy and Training Institute 50 www.cosmeticnewsuk.com
in Nottingham. My previous role was changing so much that I decided to retrain in order to do a job that actually makes a difference to people’s lives as well a realising my own value, worth and skills. There have been so many people that have inspired me in my life including my Mother, Frantz Fanon, and Homer Simpson. It is an honour and privilege to journey with clients and students as they embrace, discover and appreciate themselves in a new way. I have pioneered my PaPPS Initiative (Pre and Post Procedure Support) as a consequence of becoming aware that as a Psychotherapist the skills I have can be extremely beneficial in addressing the Emotional, Relational & Psychological wellbeing of cosmetic surgery and aesthetic patients. This is currently lacking in the cosmetics and aesthetics industry. I created PaPPS to satisfy the consumer driven market that patients need.The British Government are now realising and looking
at the psychological wellbeing of patients as an integral part of the journey. PaPPS is a support programme that not only addresses the psychological wellbeing it also ensures peace of mind for both the patient and the surgeon. I encourage all surgeons and clinics to have PaPPS as part of their patient pathway. We are being constantly reminded how important it is to be mindful of our body image and it seems to me that the idea of looking as good as you can for as long as you can is an innate need of human beings that is being capitalised by society in many ways.The cosmetic surgery and aesthetics industry is constantly growing and evolving, clearly many treatments and procedures increase the self-esteem and confidence of patients, but more support is needed for when things do go wrong as we know that they do. Much like my mornings, my afternoons will include the addition of clinical supervision or my own personal supervision or teaching as well as SKYPE sessions with clients. A typical day is always busy, and no two days are ever the same. Since time immemorial, human beings have strived to make themselves as attractive as they can. I do not see this going away anytime soon. With the addition of developing technology and media, the concepts relating to the importance of body image have become even more pronounced in society as a whole. In five years time I hope to complete my PhD and start up a number of retreats for Mind, Body and Soul. I end my hectic days with a glass of port to ruminate on my day, to which I usually conclude that Life is not about what you have done. Life is not about what you should have done. Life is not about what you could have done… it is about what you can do and what you will do.”
Antonia Mariconda also known as ‘The Cosmedic Coach’ is a health and beauty writer, and author of four books. She is quoted in national and consumer press such as the BBC, Top Santé, The Evening Standard, Daily Mail, and Metro, for her knowledge on beauty and aesthetics, and cosmetic surgery. Antonia also independently advises clients both from the UK and around the world on where and where not to shop safely for cosmetic surgery, beauty, aesthetic medicine, and anti-ageing treatments. Her client list includes A-list celebrities, Royalty and VIPs. Follow Antonia on Twitter @CosmedicCoach or join Antonia on Face book where you will be updated about events and happenings in the world of health and beauty. www.thecosmediccoach.com
Alizonne -WINNERS 2012-2013
Best Weight Loss Programme/product
Be part of the Alizonne success story!
Carl Lost 3st 12lbs with 10 weeks of treatment
Judith Lost 5st
with 20 weeks of treatment
Carl before treatment
Judith before treatment
Alizonne Therapy is a revolutionary medically supervised treatment program... that combines weight loss with body contouring. Designed by our medical doctors, Alizonne Therapy can dramatically improve appearance and long term health. The treatment comprises of four essential elements - ultrasound therapy, connective tissue therapy, medical diet and stabilisation. Alizonne was first launched in the UK by Dr Mark Palmer from his Leeds clinic in 2006 and now consists of two wholly owned successful clinics, one joint venture clinic and a total of 17 independent partner clinics with 6 further clinics coming on board in 2013, all licensed by Alizonne UK and managed to our specific uniform standards and protocols.
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If you would like to be a part of the Alizonne success story...
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We are currently recruiting carefully selected independent partner clinics around the U.K. to provide Alizonne therapyÂŽ. If you are an independent clinic and would like further information please contact
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Anne Welford, Operations Director awelford@alizonne.co.uk
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temple medical aesthetics I became interested in Alizonne when I was considering what next to add to our treatment repertoire. Having made the decision to take on Alizonne I do not think I would have ever managed if it had not been for the constant support, advice and guidance that I came to rely upon from Alizonne UK. Alizonne is certainly not an add on, it has become a major part of our core business. An added benefit from providing Alizonne treatment is that the majority of clients learn about the other facilities and treatments available from the clinic when they have lost weight and started to enjoy their appearance. They are then more inclined to consider aesthetic treatments and clearly, having developed a trusting relationship with us, do not look elsewhere for these treatments!
Having seen the incredible results our Alizonne patients were achieving I couldn’t help but be impressed. Patient feedback is incredible as many receive results they could not have dreamed of. We believed that weight loss and body contouring would be one of the largest growth sectors in our industry and we couldn’t see any other weight loss products with either the same results or medical supervision. We have now expanded to 6 Alizonne clinics including 2 recent additions in Watford & Bournemouth where we have great hopes for 2013. The treatments fit nicely along with our other therapist business and have allowed us to extend our opening hours and benefit our cosmetic business as well. From my experience Alizonne not only changes your patients' lives but your clinic's finances as well!
Dr Sam Robson. Medical Director. Temple Medical Aesthetics Clinic location : Aberdeen
Paul Wilkinson. CEO. Courthouse Clinics Clinic locations : Watford, Maidenhead, Brentwood Birmingham, Bournemouth
www.alizonne.co.uk
Current Alizonne Clinics 1 Aberdeen 2 Glasgow 3 Carlisle 4 Newcastle 5 Leeds 6 Blackburn 7 Wilmslow 8 Liverpool 9 Nottingham 10 Cambridge
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Birmingham Leamington Spa Bristol Watford Maidenhead Brentwood Central London Farnham Southampton Bournemouth
tel: 0844 800 1209
training news LyNTON LAUNCHES VASCULAR AND PIGMENTATION MASTERCLASS Lynton has launched a new Vascular and Pigmentation Masterclass. The Masterclass offers a detailed insight into several specific areas, such as hair removal, tattoo removal, and vascular and pigmented lesions. Along with knowledge enhancing theory, attendees get the chance to practice a range of practical skills; allowing them to gain some important hands-on experience. Lynton is pleased to announce the introduction of the Vascular and Pigmentation Masterclass as demand for this type of treatment has grown. All Lynton’s training courses are delivered in conjunction with the University of Manchester and take place at the Lynton Clinic in Cheadle.
The training centre at The Lynton Clinic in Cheadle, where the courses are held
Dr Samantha Hills, who runs Lynton’s training courses, says, “Our courses are designed to be suitable for both beginners and those who already have experience in performing Laser and IPL treatments. The courses cater for a range of needs, can complement existing training or can teach you all you need to know. The small class sizes promise a much more focused learning experience and the Masterclass is a great opportunity to gain some hands-on experience and see some real results on the day.” For more information, please visit www.lynton.co.uk or call 01477 536 975.
ANOTHER SMART IDEA The Consulting Room™ will be hosting another of its popular Smart Ideas seminars this month. The event will take place on Saturday April 27 at the Radisson Blu Hotel in London. Entitled ‘Practical Business Strategies and Product Ideas to Increase Your Profits in 2013’, the event is supported by Syneron Candela, Merz Aesthetics and the BACN. For more information visit www.smartseminar.co.uk.
NOUVEAU CONTOUR LAUNCHES PERMANENT MAKE-UP CONVERSION COURSE Nouveau Contour has created a new conversion course for permanent make-up technicians. The course will involve two days practical training and a practical assessment as well as examining troubleshooting and improving skills such as perfecting the 3D hair stroke technique for brows. The company is also offering two extra theory days at no extra cost, if needed. Those who successfully complete the course will qualify at Nouveau Contour Bronze level or higher depending on their experience). 52 www.cosmeticnewsuk.com
dates for the diary
D at e s f o r the Diary
we rounD up upComing events, training Courses anD meetings
• APRIL 2-3 Ultrasonic Lipo-cavitation The non-invasive alternative to Liposuction, Cawood House, Sutton, Ely, Cambs, 01353 777 303/07747 696 815, barbara@academyofadvancedbeauty.com, www.academyofadvancedbeauty.com 4 Advanced Facial Treatment (combined course), 01353 777 303/07747 696 815, barbara@academyofadvancedbeauty.com, www.academyofadvancedbeauty.com 5 Diamond Microdermabrasion for Face and Body, 01353 777 303/07747 696 815, barbara@academyofadvancedbeauty.com, www.academyofadvancedbeauty.com= 6 Infrared for Weight Loss, Detox and other Health Benefits, 01353 777 303/07747 696 815, barbara@academyofadvancedbeauty.com, www.academyofadvancedbeauty.com 10 Epionce and The Canvas of the Skin Seminar with Dr Carl Thornfeldt, The Academy of Medical Sciences, London, lucy@edenaesthetics.com 11 Obagi Blue Peel Workshop, London, www.healthxchange.com 13 Chemical Peel Systems & Medical Skincare: Comprehensive Course For New Users, Central London, www.innomedtraining.co.uk 13 Aesthetox Foundation Botox and Dermal Fillers Birmingham, www.aesthetox.co.uk 14 Mesotherapy for Localised Fat, Cellulite & Skin rejuvenation: New Users, Central London, www.innomedtraining.co.uk 19 Obagi Workshop, London, www.healthxchange.com 21 Micro-needling, Bayswater, London, 0207 727 1110, www.boston-medical-group.co.uk 25 NeoStrata Training, Envisage Training, 40 Harley Street, London, www.aestheticsource.com 27 Revanesse Dermal Fillers, Bayswater, London, 0207 727 1110, www.boston-medical-group.co.uk 27 Aesthetox Skin Health and Chemical Peels, Birmingham, www.aesthetox.co.uk 28 Aesthetox Foundation Botox and Dermal Fillers, London, www.aesthetox.co.uk 28 Advanced Botulinum Toxin, Boston International Training Academy Ltd, Bayswater, London, 0207 727 1110, www.bostontrainingacademy.com
• MAy 7 NeoStrata Training, Wigmore Training, 23 Wigmore Street, London, www.aestheticsource.com 11 Aesthetox Foundation Botox and Dermal Fillers, Birmingham, www.aesthetox.co.uk 11 Aesthetox Foundation Botox and Dermal Fillers Manchester, www.aesthetox.co.uk 12 Tear Trough Masterclass, Boston International Training Academy Ltd, Bayswater, London, 0207 727 1110, www.bostontrainingacademy.com 14 NeoStrata Training, Purple Aesthetics, 54 Spenser Avenue, Perton, Wolverhampton, www.aestheticsource.com 14 Obagi Workshop, Glasgow, www.healthxchange.com 14 Obagi Workshop, Glasgow, www.healthxchange.com 18 Revanesse Dermal Fillers, Bayswater, London, 0207 727 1110, www.boston-medical-group.co.uk
dates for the diary 18 Advanced Botulinum Toxin: Lower Face, Neck, Under-arm Hyperhidrosis,Central London, www.innomedtraining.co.uk 19 Mesotherapy – Face, Body and Hair, Boston International Training Academy Ltd, Bayswater, London, 0207 727 1110, Laser Support Services www.bostontrainingacademy.com 19 Advanced Dermal Fillers: Facial Contours, Lip Refinements, SkinPatient protective eyewear Hydration, Central London, www.innomedtraining.co.uk Laser safety eyewear Disposable Laser, IPL and LED eyewear Laser Support Services 25 Aesthetox Foundation Botox and Dermal Fillers London, Mouthguards www.aesthetox.co.uk Laser surgical instruments
Laser Support Services • Patient protective eyewear • Laser safety eyewear • Disposable Laser, IPL and LED eyewear • Mouthguards • Laser surgical instruments • Safety signage • Safety interlocks • Laser safety curtains
Patient protective eyewear
Safety signage
• June
Laser safety eyewear
Safety interlocks
Laser Support Disposable Laser, IPL and LED eyewear
Laser safety curtains
Services
Mouthguards 2 Tear Trough Masterclass Boston International Training Laser Support Services has been supplying laser Laser surgical instruments products since 1990. Alleyewear supplies conform to current Patient protective Academy Ltd, Bayswater, London, 0207 727 1110, Safety signagewww. Laser Support Services EC safety standards Laser safety eyewear Safety interlocks bostontrainingacademy.com Disposable Laser, IPL and LED Laser eyewear Support Services Ltd. Laser Support Services Laser safety curtains School Drive - Ovenstone - Fife - KY10 2RR Mouthguards 8 Masterclass Aesthetox Botox and Dermal Fillers, Birmingham, Laser Support Services has been supplying laser Tel: 01333-311938 Fax 01333-312703 Laser surgical instruments — Email Enquiries@laser-support.co.uk products sincewww.laser-support.co.uk 1990. All supplies conform to current www.aesthetox.co.uk Patient protective Safety signage ECeyewear safety standards Patient protective eyewear Safety interlocks 14 Obagi Workshop, London, www.healthxchange.com Laser Support Services Ltd. Laser safety eyewear Laser safety eyewear Laser safety curtains School Drive - Ovenstone - Fife - KY10 2RR 22 Aesthetox Foundation Botox and Dermal Fillers Manchester, Disposable Laser, IPL Tel: and 01333-311938 Laser Support Services has been supplying laserFax 01333-312703 Disposable Laser, IPL and LED eyewear LED eyewear www.laser-support.co.uk — Email Enquiries@laser-support.co.uk products Mouthguards since 1990. All supplies conform to current www.aesthetox.co.uk standards Mouthguards EC safetyLaser surgical instruments 23 Aesthetox Skin Health and Chemical Peels, Birmingham,Laser Support Services Ltd.
Laser surgical instruments Safety signage Safety signage
School Drive - Ovenstone - Fife - KY10 2RR Tel: 01333-311938 Fax 01333-312703 www.laser-support.co.uk — Email Enquiries@laser-support.co.uk
Safety interlocks
Laser safety curtains www.aesthetox.co.uk Safety interlocks Laser Support Services has been supplying laser 15-16 Dermal Fillers and Botulinum Toxin Foundation Course, Laser Support Services has been supplying laser products since 1990. All supplies conform to current Laser safety curtains Boston International Training Academy EC Ltd, Bayswater, safety standards London, products since 1990. All supplies conform to Laser Support Services has been supplying laser Laser Support Services Ltd. 0207 727 1110; www.bostontrainingacademy.com current EC safety standards products since 1990. All supplies conformSchool to current Drive - Ovenstone - Fife - KY10 2RR 29 Botulinum Toxin Facialstandards Aesthetics: new users - includesTel: all01333-311938 Fax 01333-312703 ECinsafety www.laser-support.co.uk — Email Enquiries@laser-support.co.uk Laser Support Services Ltd. major brands, Central London, www.innomedtraining.co.uk Laser Support Services Ltd. School Drive - Ovenstone - Fife - KY10 2RR 30 Dermal Fillers in Facial Aesthetics: new users hyaluronic acid- Fife - KY10 2RR Schoolto Drive - Ovenstone Tel: 01333-311938 Fax 01333-312703 Tel: 01333-311938 Fax: 01333-312703 fillers, Central London, www.innomedtraining.co.uk www.laser-support.co.uk — Email Enquiries@laser-support.co.uk www.laser-support.co.uk — 30 Advanced Botulinum Toxin, Boston International Training Email Enquiries@laser-support.co.uk Academy Ltd, Bayswater, London, 0207 727 1110; www.bostontrainingacademy.com
• July 6 Aesthetox Foundation Botox and Dermal Fillers, Birmingham, www.aesthetox.co.uk 6 Botulinum Toxin in Facial Aesthetics: new users - includes all major brands, Greater Manchester, www.innomedtraining.co.uk 7 Dermal Fillers in Facial Aesthetics: new users to hyaluronic acid fillers, Greater Manchester, www.innomedtraining.co.uk 13 Chemical Peel Systems & Medical Skincare: comprehensive course for new users, Central London, www.innomedtraining.co.uk 14 Mesotherapy for localised fat, cellulite & skin rejuvenation: new users, Central London, www.innomedtraining.co.uk 10 Obagi Workshop, Manchester, www.healthxchange.com 20 Aesthetox Foundation Botox and Dermal Fillers, Birmingham, www.aesthetox.co.uk 20 Masterclass Aesthetox Botox and Dermal Fillers, London, www.aesthetox.co.uk
• August 3 Aesthetox Foundation Botox and Dermal Fillers, Birmingham, www.aesthetox.co.uk 17 August Masterclass Aesthetox Botox and Dermal Fillers, Birmingham, www.aesthetox.co.uk The Dates for the Diary section is now a paid for section of the magazine and is a chance for you to advertise your training courses to our readers both in the magazine and online. Advertisers will get free listings of any training courses as part of their campaign. Anyone else wishing to publish training courses can do so for £300 a year. For more details contact 01268 754 897
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Beautylight Technical Services Ltd Suite 1A & 2A, Elsinore House, 77 Fulham Palace Road, London W6 8JA
directory ABC Laser Contact: Guy Gouldsmit T: 08451 707 788 E: info@a-b-c-uk.com W: www.abclasers.co.uk
Aesthetic Source Contact: Sharon Morris T: 01234 313 130 E: sharon@aestheticsource.com Services: NeoStrata and Exuviance Innovation in Aesthetics delivered to you.
Aesthetox Academy Contact: Lisa Tyrer Service: Training T: 0870 0801746 E: treatments@aesthetox.co.uk W: www.aesthetox.co.uk
Allergan - Contact: Customer Service T: 0808 2381500 W: www.juvedermultra.co.uk
AZTEC Services Contact: Anthony Zacharek
Service: Exclusive UK distributor for Viora product range T: 07747 865600 E: sales@aztecservices.uk.com W: www.aztecservices.uk.com
Bioptica Laser Aesthetics Contact: Mike Regan T: +44 (0)7917 573466 E: mike.regan@bla-online.co.uk W: www.bla-online.co.uk Services: Core of Knowledge Training and Laser Protection Adviser (LPA) Services.
Boston Medical Group LTD Contact: Iveta Vinklerova T: 0207 727 1110 E: info@boston-medical-group.co.uk W: www.boston-medical-group.co.uk
Candela UK Ltd Contact: Michaela Barker T: 0845 521 0698 E: MichaelaB@syneron-candela.co.uk W: www.syneron-candela.co.uk
54 www.cosmeticnewsuk.com
Carlton Group Beauty & Spa (The) Contact: UK Sales Office T: 01903 761100 E: info@thecarltongroup.co.uk W: www.thecarltongroup.co.uk
Laser Physics Contact: Customer Services T: 01829773155 E: info@laserphysics.co.uk W: www.laserphysics.co.uk
Carleton Medical Ltd Contact: Nick Fitrzyk T: 01633 838 081 E: nf@carletonmedical.co.uk W: www.carletonmedical.co.uk Services: UK distributor of Asclepion Lasers
Lifestyle AestheticsContact: Sue Wales T: 0845 0701 782 E: info@lifestyleaestheics.com W: www.lifestyleaesthetics.com
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Bocouture® 50 Abbreviated Prescribing Information Please refer to the Summary of Product Characteristics (SmPC). Presentation 50 LD50 units of Botulinum toxin type A (150 kD), free from complexing proteins as a powder for solution for injection. Indications Temporary improvement in the appearance of moderate to severe vertical lines between the eyebrows seen at frown (glabellar frown lines) in adults under 65 years of age when the severity of these lines has an important psychological impact for the patient. Dosage and administration Unit doses recommended for Bocouture are not interchangeable with those for other preparations of Botulinum toxin. Reconstitute with 0.9% sodium chloride. Intramuscular injection (50 units/1.25 ml). Standard dosing is 20 units; 0.1 ml (4 units): 2 injections in each corrugator muscle and 1x procerus muscle. May be increased to up to 30 units. Not recommended for use in patients over 65 years or under 18 years. Injections near the levator palpebrae superioris and into the cranial portion of the orbicularis oculi should be avoided. Contraindications Hypersensitivity to Botulinum neurotoxin type A or to any of the excipients. Generalised disorders of muscle activity (e.g. myasthenia gravis, Lambert-Eaton syndrome). Presence of infection or inflammation at the proposed injection site. Special warnings and precautions Should not be injected into a blood vessel. Not recommended for patients with a history of dysphagia and aspiration. Adrenaline and other medical aids for treating anaphylaxis should be available. Caution in patients receiving anticoagulant therapy or taking other substances in anticoagulant doses. Caution in patients suffering from amyotrophic lateral sclerosis or other diseases which result in peripheral neuromuscular dysfunction. Too frequent or too high dosing of Botulinum toxin type A may increase the risk of antibodies forming. Should not be used during pregnancy unless clearly necessary. Interactions Concomitant use with aminoglycosides or spectinomycin requires special care. Peripheral muscle relaxants should be used with caution. 4-aminoquinolines may reduce the effect. Undesirable effects Usually observed within the first week after treatment. Localised muscle weakness, blepharoptosis, localised pain, tenderness, itching, swelling and/or haematoma can occur in conjunction with the injection. Temporary vasovagal reactions associated with pre-injection anxiety, such as syncope, circulatory problems, nausea or tinnitus, may occur. Frequency defined as follows: very common (≥ 1/10); common (≥ 1/100, < 1/10); uncommon (≥ 1/1000, < 1/100); rare
(≥ 1/10,000, < 1/1000); very rare (< 1/10,000). Infections and infestations; Uncommon: bronchitis, nasopharyngitis, influenza infection. Psychiatric disorders; Uncommon: depression, insomnia. Nervous system disorders; Common: headache; Uncommon: facial paresis (brow ptosis), vasovagal syncope, paraesthesia, dizziness. Eye disorders; Uncommon: eyelid oedema, eyelid ptosis, blurred vision, eye disorder, blepharitis, eye pain. Ear and Labyrinth disorders; Uncommon: tinnitus. Gastrointestinal disorders; Uncommon: nausea, dry mouth. Skin and subcutaneous tissue disorders; Uncommon: pruritus, skin nodule, photosensitivity, dry skin. Musculoskeletal and connective tissue disorders; Common: muscle disorders (elevation of eyebrow), sensation of heaviness; Uncommon: muscle twitching, muscle cramps. General disorders and administration site conditions; Uncommon: injection site reactions (bruising, pruritis), tenderness, Influenza like illness, fatigue (tiredness). General; In rare cases, localised allergic reactions; such as swelling, oedema, erythema, pruritus or rash, have been reported after treating vertical lines between the eyebrows (glabellar frown lines) and other indications. Overdose May result in pronounced neuromuscular paralysis distant from the injection site. Symptoms are not immediately apparent post-injection. Bocouture ® may only be used by physicians with suitable qualifications and proven experience in the application of Botulinum toxin. Legal Category POM. List Price 50 U/vial £72.00. Product Licence Number PL 29978/0002. Marketing Authorisation Holder Merz Pharmaceuticals GmbH, Eckenheimer Landstraße 100, 60318 Frankfurt/Main, Germany. Date of revision of text FEB 2012. Full prescribing information and further information is available from Merz Pharma UK Ltd., 260 Centennial Park, Elstree Hill South, Elstree, Hertfordshire WD6 3SR. Tel: +44 (0) 333 200 4143 Adverse events should be reported. Reporting forms and information can be found at yellowcard.mhra.gov.uk. Adverse events should also be reported to Merz Pharma UK Ltd at the address above or by email to medical.information@merz.com or on +44 (0) 333 200 4143.
1085/BOC/JUN/2012/JH
Date of preparation July 2012
Bocouture® is a registered trademark of Merz Pharma GmbH & Co, KGaA.
C
onfidence is Reliable1,2 Rewarding 3 Performance 4,5 BOTOX® is licensed for the treatment of moderate to severe glabellar lines Delivers long-lasting patient satisfaction, time after time 2,3 Has been used for over 20 years in over 26 million treatment sessions worldwide6 Is the world’s first and most studied botulinum toxin*7
Botox® (botulinum toxin type A) Abbreviated Prescribing Information Presentation: Botulinum toxin type A (from clostridium botulinum), 50 or 100 or 200 Allergan Units/vial. Indications: Temporary improvement in the appearance of moderate to severe vertical lines between the eyebrows seen at frown (glabellar lines), in adults <65 years, when the severity of these lines has an important psychological impact for the patient. Dosage and Administration: See Summary of Product Characteristics for full information. Do not inject into blood vessels. Doses of botulinum toxin are not interchangeable between products. Not recommended for patients <18 or >65 years. Use for one patient treatment only during a single session. Reconstitute vial with 1.25ml of 0.9% preservative free sodium chloride for injection (4U/0.1ml). The recommended injection volume per muscle site is 0.1ml (4U). Five injection sites: 2 in each corrugator muscle and 1 in the procerus muscle: total dose 20U. Contraindications: Known hypersensitivity to any constituent. Infection at proposed injection site(s). Warnings/Precautions: Relevant anatomy and changes due to prior surgical procedures must be understood prior to administration. Serious adverse events including fatal outcomes have been reported in patients who had received off-label injections directly into salivary glands, the oro-lingual-pharyngeal region, oesophagus and stomach. Do not exceed recommended dosages and frequency of administration. Adrenaline and other anti-anaphylactic measures should be available. Reports of side effects related to spread of toxin distant from injection site, sometimes resulting in death. Therapeutic doses may cause exaggerated muscle weakness. Caution in patients with underlying neurological disorder and history of dysphagia and aspiration. Patients should seek medical help if swallowing, speech or respiratory disorders arise. Clinical fluctuations may occur during repeated use. Too frequent or excessive dosing can lead to antibody formation and treatment resistance. The previously sedentary patient should resume activities gradually. Caution in the presence of inflammation at injection site(s) or when excessive weakness/atrophy is present in target muscle. Caution when used for treatment of patients with peripheral motor neuropathic disease. Use with extreme caution and close supervision in patients with defective neuromuscular transmission (myasthenia gravis, Eaton Lambert Syndrome). Contains human serum albumin. Procedure related injury could occur. Pneumothorax associated with injection procedure has been reported. Interactions: No interaction studies have been performed. No interactions of clinical significance have been reported. Theoretically, the effect may be potentiated by aminoglycoside antibiotics or other drugs that interfere with neuromuscular transmission. Effects of administering different botulinum toxin stereotypes simultaneously, or within several months of each other, is unknown and may cause exacerbation of excessive neuromuscular weakness. Pregnancy: BoTox® should not be used during pregnancy unless clearly necessary. Lactation: Use during lactation cannot be recommended. Adverse Effects: See Summary of Product Characteristics for full information on side effects. Based on controlled clinical trial data, the proportion of patients that would be expected to experience an adverse reaction after treatment is 23.5% (placebo: 19.2%). In general, reactions occur within the first few days following injection and are transient. Pain/
burning/stinging, oedema and/or bruising may be associated with the injection. Frequency By Indication: Defined as follows: Very Common (> 1/10); Common (>1/100 to <1/10); Uncommon (>1/1,000 to <1/100); Rare (>1/10,000 to <1/1,000); Very Rare (<1/10,000). Infections and infestations. Uncommon: Infection. Psychiatric disorders. Uncommon: Anxiety. Nervous system disorders. Common: Headache. Uncommon: Paresthesia, dizziness. Eye disorders. Common: Eyelid ptosis. Uncommon: Blepharitis, eye pain, visual disturbance. Gastrointestinal disorders. Uncommon: Nausea, oral dryness. Skin and subcutaneous tissue disorders. Common: Erythema, Uncommon: Skin tightness, oedema (face, eyelid, periorbital), photosensitivity reaction, pruritus, dry skin. Musculoskeletal and connective tissue disorders. Common: Localised muscle weakness, Uncommon: Muscle twitching. General disorders and administration site conditions. Common: Face pain, Uncommon: Flu syndrome, asthenia, fever. Adverse reactions possibly related to spread of toxin distant from injection site have been reported very rarely (exaggerated muscle weakness, dysphagia, constipation or aspiration pneumonia which can be fatal). Rare reports of adverse events involving the cardiovascular system, including arrhythmia and myocardial infarction, some with fatal outcomes. Rare reports of serious and/or immediate hypersensitivity (including anaphylaxis, serum sickness, urticaria, soft tissue oedema and dyspnoea) associated with BoTox use alone or in conjunction with other agents known to cause similar reaction. Very rare reports of angle closure glaucoma following treatment for blepharospasm. New onset or recurrent seizure occurred rarely in predisposed patients, however relationship to botulinum toxin has not been established. Needle related pain and/or anxiety may result in vasovagal response. NHS Price: 50 Units: £77.50, 100 Units: £138.20, 200 Units £276.40. Marketing Authorization Number: PL 00426/0074 Marketing Authorization Holder: Allergan Pharmaceuticals (Ireland) Ltd., Westport, Co. Mayo, Ireland. Legal Category: PoM. Date of preparation: December 2012.
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 Allergan Ltd. UK_Medinfo@allergan.com or 01628 494026. References: 1. De Almeida A et al. Dermatologic Surgery 2007;33:S37–43. 2. Carruthers A et al. J Clin Res, 2004;7:1–20. 3. Stotland MA et al. Plast Reconstr Surg, 2007;120:1386–1393. 4. Beer KR et al. J Drugs Dermatol, 2011;10(1) :39–44. 5. Lowe et al. Am Acad Dermatol, 2006;55:975-980. 6. Allergan data on file. BoTGL/001/SEP 2011 7. Allergan Data on File VIS/006/JUL2011. *Allergan botulinum toxin type A. Global figures. Launched in 1989 in the US. UK/0008/2013 Date of Preparation: January 2013