Cosmetic News UK Sept 2012 by webwax

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Cosmetic News The UKs leading trade title for medical aesthetic professionals

visit us online at www.cosmeticnewsuk.com | september 2012 edition

Inside k o o l w e your n s w e n c i cosmet

Injection Loaded

clinical

special feature - toxin for hyperhydrosis

s w eat >>> Dr Sotirios Foutsizoglou on botulinum toxin for treating hyperhidrosis <<<

hyperhidrosis, whereas severe cases can reach up to 0.1% of the population. The production

caused by an exaggerated response to increased body temperature (hot weather, exercise, fever)

conditions that can truly be described as both a medical and cosmetic problem. Caused by hyperfunction of the eccrine sweat

and excretion of sweat are mediated by the sympathetic nervous system and regulated by a gland in our brain called hypothalamus.

or emotion. Secondary hyperhidrosis may be due to a variety of medical conditions such as thyroid problems, hormone imbalance, diabetes, obesity, certain drugs, etc.

glands it is increasingly being treated by aesthetic practitioners because of the indication of botulinum toxin injections in its treatment.

Sweating plays an important role in the regulation of body temperature. Sweat glands produce an odourless liquid which, when decomposed by the action of bacteria, acquires a characteristic,

>> What is hyperhidrosis? Hyperhidrosis is the excessive production of sweat. It usually begins in either childhood or

unpleasant smell. Hyperhidrosis can either be generalized or localized to specific parts of the body as shown in table 1.

adolescence. Although any site on the body can be affected, the sites most commonly affected are the palms and soles (palmoplantar hyperhidrosis) and/or axillae (axillary hyperhidrosis) due to the

modalities including antiperspirants, deodorants, iontophoresis, antimuscarinic topical agents (e.g. Glycopyrrolate cream), oral medication such as oxybutynin or beta-blockers.

This condition may be idiopathic or secondary to other diseases, metabolic disorders, febrile illnesses, or medication use. Idiopathic or primary

Those with severe hyperhidrosis may resort to surgical procedures such as endoscopic thoracic sympathectomy (ETS) to alleviate symptoms. Affected people are constantly aware of their

yperhidrosis or excessive sweating is one of the few

relatively high concentration of sweat glands. Axillary problems tend to start in late adolescence, while palmoplantar excessive sweating often

hyperhidrosis usually starts around puberty and peaks in adulthood. Studies show that there is a genetic component predisposing to the condition. Primary hyperhidrosis is estimated

begins earlier, average age 12-13 years. 1-2% of the global population have some form of

at around 1% of the population, afflicting men and women equally. Primary hyperhidrosis is

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

Hyperhidrosis is a distressing condition and sufferers have usually tried a variety of

condition and try to modify their lifestyle to accommodate this problem. This can be disabling in professional, academic and social life, causing embarrassments. Many routine tasks become impossible chores, which can have devastating emotional effects on one’s individual life. Excessive sweating of the hands interferes with

We summarise the results of a study comparing two Botulinum Toxin Type A preparations for treating crow’s feet

CONCLUSION: Both botulinum toxin A products displayed high efficacy and good tolerability at a dose ratio of 1:1, with no statistically significant differences between them. The high response rates observed after four months suggest a good effectiveness beyond this observation period. This study was funded by an unrestricted educational fund from Merz, which also supplied the study medication.

otulinum toxin A (BTX-A) has played an important role in the treatment of mimic wrinkles of the upper and lower face for many years.1,2 By blocking the presynaptic release of acetylcholine, BTX-A causes complete but reversible muscle relaxation,3 which in turn leads to a reduction of mimic wrinkles in the treated area.4,5 A number of studies have proven the high efficacy of BTX-A, especially in treating periorbital lines.1,6 According to the consensus papers, the recommended dose of BTX-A for treating crow’s feet is 8 to 16 mouse units (MU) in women and 12 to 16MU in men.1,2,7 This dose is usually divided between three or four injection sites. Lowe and coworkers concluded that the optimum dose of botulinum toxin type A complex (BTXCo; Botox/Vistabel, Allergan, Inc., Irvine, CA) is 12MU per side.8 Because of a large variation of distribution and severity in periorbital lines, the exact number of injection sites and dose distribution should be adjusted to individual patients’ needs. BTXCo contains a botulinum toxin type A complex as active ingredient. The successful treatment of periorbital lines with BTXCo has been shown in several clinical trials.8–10 In contrast to BTXCo, the more recently developed BoNTA (Xeomin/Bocouture, Merz Pharmaceuticals, Frankfurt, Germany) is free of complexing proteins, which are not needed for its therapeutic effects. The foreign protein load in BoNTA free of complexing proteins has been reduced through means of a unique purification process.11–13 A high load of foreign protein is thought to be one of the most important risk factors for formation of neutralizing antibodies, with subsequent loss of therapeutic efficacy.14,15 Blu¨mel and colleagues confirmed in an animal study that there was no neutralizing antibody formation against BoNTA, even after administration of high

26 www.cosmeticnewsuk.com

plus

After

provide a solution—not curing the condition, but providing a good cosmetic result that helps

and cosmetic surgery that refers to the technique of inserting flesh-toned pigments into the

rebuild patients’ confidence.

skin to aesthetically improve a wide range of dermatological and surgical issues. The

Technique, equipment and pigments

technique is routinely used to conceal various skin conditions including surgery scars; hyper or hypo pigmented skin (the darkening or

Historically, physicians used the same equipment for micropigmentation as tattoo artists, however,

lightening of skin); vitiligo; alopecia,birth marks; cleft palates, trauma scars; stretch marks, burns, “Port-wine stains”; as well as a variety of other surface skin imperfections.

now a range of medical grade electrical and digital apparatus consisting of a tube and needle system exists that are able to puncture and inject pigment into the skin upwards of 180 times per second. Pigments used in micropigmentation are

Much of the work I do involves either ‘normalising’ irregular skin colour or matching

doses at short injection intervals.16,17 There are now also a number of clinical studies published examining the aesthetic use of BoNTA, including treatment of periorbital lines.18–22 comparative studies between BoNTA and BTXCo have only been performed for neurological conditions such as torticollis and blepharospasm. Five clinical trials (phase I–III) with more than 800 patients have indicated high efficacy and good tolerability for BoNTA and BTXCo at a dose ratio of 1:1.23,24 The clinical outcomes with regard to efficacy, onset of action, and duration of effects and the side effect profiles were similar.17,25–27

Before

these conditions, micropigmentation can

Micropigmentation or permanent skin camouflage is a subdivision of dermatological

What is Micropigmentation?

Authors: Welf Prager MD,Estherwissmu Ller MD, Bianca Kollhorst MSc, Stefanie Williams MD and Ina Zschocke PhD

RESULTS: One month after treatment, the percentage of responders was slightly higher for the BoNTA side (95%) than the BTXCo side (90%). After four months, both sides still showed good efficacy, with an 84% response rate and greater than 30% FWS reduction (no statistically significant difference between the products). After one month, FWS score at rest was approximately 66% lower for BoNTA, versus 63% lower for BTXCo. After four months, FWS reduction was approximately 50%.

Case 1: Patient was referred through Stanford Dermatology Out Patient Centre in the US following mohs surgery for a basal carcinoma. She was reconstructed with a paramedian forehead flap. Patient had medical pigments inserted into scar during two sessions scheduled 6 weeks apart.

as a result of childhood mishaps, surgical procedures, trauma, illness

cases, they can be a daily reminder of a traumatic

Crow-tox// PATIENTS AND METHOD: Twelve U of each product were compared in an intra-individual study in 21 participants with a facial wrinkle scale (FWS) score of 2 to 3. Evaluations were done for up to four months. Subjects with an improvement of at least 1 point on the FWS were considered responders.

Theresa Bush, M.B.B.S on medical micropigmentation for scarring, birthmarks and other surface skin impefections he majority of the population has scars of one kind or another. Whether

a handshake. or unpleasant event, and affect the way we dress, style our hair or carry ourselves. I have come across people who have given up their

clinical

ABSTRACT

clinical

Dermatology - Skin camouflage

Scared to be Scarred…

many routine activities, such as securely grasping or skin complaints, and most of us are not objects. Some hyperhidrosis sufferers avoid greatly affected by their presence. However for others, scars can have a debilitating effect on situations where they will come into physicalself-confidence and self-image, compromising psychological contact with others, such as greeting a person with and emotional wellbeing. In some

22 www.cosmeticnewsuk.com special feature - toxin for hyperhydrosis

BACKGROUND: This is the first double-blind, randomized, proof-of-concept study to compare the clinical effectiveness of botulinum toxin type A (BoNTA) free of complexing proteins with a BoNTA complex (BTXCo) in the treatment of crow’s feet.

Botulinum Toxin Special

>> INDICATIONS for treatment

damaged skin to the surrounding area so it blends naturally. Despite advances in treating pigmented nevi, post-inflammatory hyperpigmentation, hypopigmentation, vitligo and striae, such abnormalities can resist treatment. However, for many patients with

dermatological hypoallergic, nontoxic, tissuestable pigments. Micropigmentation pigments differ from traditional tattoo inks in that they do not contain phenylenediamine and consist of minute particles of less than one micron suspended in a liquid, as opposed to fully dissolved inks which are used for traditional tattooing. Depending on skin type, condition treated and level of exposure to the sun, skin pigmentation

Theresa face Theresa Bush, M.B.B.S is a leading micropigmentation specialist. Theresa holds numerous advanced certifications in medical micropigmentation and works exclusively with pigment restoration and skin abnormality issues alongside leading teaching hospitals, universities, surgeons and dermatologists both within the UK and internationally. She is a member of the European Society for Cosmetic and Aesthetic Dermatology – ESCAD, as well as the American Academy of micropigmentation, amongst other relevant organisations. Theresa Bush set up ‘DermInk’ in 2005 and currently splits her time between her clinic in San Francisco and her new clinic in Hampstead, north London. Patients are routinely referred through prominent Plastic/ Cosmetic Surgeons, Dermatologists and GP’s nationwide. For details, visit www.dermink.com

will last anything from 1 to 5 years and in some cases indefinitely.

Case 1 Procedure (see above) To minimize patient discomfort a local or prescription topical anesthetic is used. Pigment dye is then selected from a range of flesh tone medical pigments and blended to match the patient’s natural skin colour surrounding the affected area. Predicting the colour outcome is dependent on the experience of the practitioner. Once pigments are decided and the area being treated is numb, pigments are then inserted between the superficial and middle dermal layers of the skin, permanently fixing the pigments intracellularly and extracellularly, within dermal mononuclear cells and collagen fibers, respectively. The area being pigmented is stretched taunt with the thumb and index finger while making vertical movements over the surface of the skin in an overlapping manner. Hemostasis is maintained by applying pressure on the area. A dressing, along with topical antibiotics and anti-inflammatory drugs, may be given postoperatively. Treatments are scheduled 4 to 6 weeks apart until the desired effect is achieved. At 6 months some patients may require a “touch-up”. Standard tattoo inks must not be used as these inks have a high rate of oxidation, migration and are known to change colour in the skin, and in

The big debate

Should Podiatrists inject?

some instances cause severe allergic reaction and granulomas. www.cosmeticnewsuk.com 39

The aim of our proof-of-concept study was to compare the efficacy and tolerability of BoNTA with that of BTXCo in aesthetic use treating crow’s feet at a dose ratio of 1:1. This was a prospective, randomized, double-blind, intraindividual, split-face comparison.

Patients and Methods Twenty-one adult participants (2 men and 19 women, aged 44.878.7) with moderate to severe periorbital lines (grade 2 to 3 on a 4-point facial wrinkle scale) were included. The wash-out period for previous botulinum toxin therapy was six months. The ethics committee of the Medical Council Hamburg approved the study.

Treatments

also inside...

A German board-certified dermatologist performed all treatments. One vial (100MU) of BoNTA was reconstituted with 2.0mL of 0.9% sterile saline solution. One vial (50MU) of BTXCo was reconstituted with 1.0mL of 0.9% sterile saline. Each participant was injected with a total dose of 12MU BoNTA and 12MU BTXCo (randomized assignment of study products to left and right side) into the lateral aspects of their orbicularis oculi muscles. The total dose on each side of the

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Editorâ&#x20AC;&#x2122;s Letter Welcome to the new look Cosmetic News!

fter three years bringing you the latest and most up-to-date news and views on the industry, we decided that it was time that Cosmetic News had a bit of a facelift of its own. The magazine has been re-designed to give it a fresh look and has been restyled and restructured to include a greater emphasis on authoritative and clinical editorial content. The new look magazine has been split into four sections: Industry Insider (news and views on what is happening in the industry); Clinical Practice (clinical and independent editorial on treatments and protocols); Product Reviews (product specific editorials and news); and In Business (editorial focused on the business side of aesthetic practice). The aim is to make the magazine more readable as well as making it quicker and easier for you to access the information you are looking for. I hope you like what we have done and, as always, welcome your feedback to vicky@creativemedialtd.co.uk.

The other big news that has been creating an air of excitement in the Cosmetic News offices this month is the announcement of the Aesthetic Awards shortlists! Once again we have been inundated with entries from those hoping to win one of the coveted 30 awards being presented on the night. The Awards is being hosted at a glamorous Moulin Rouge themed event at the Grand Connaught Rooms in Covent Garden on December 1 and promises to be a night to remember. Turn to pages 16-19 to find out who has made the final shortlist and donâ&#x20AC;&#x2122;t forget to book your tickets as they are running out fast!

Vicky Eldrigde

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Contents INDUSTRY INSIDER 6 EDITOR’S CHOICE Vicky Eldridge on the SilkPeel Dermalinfusion 8 INDUSTRY NEWS We round up the latest industry news 14 VOICE OF THE INDUSTRY Vicky Eldridge on remote prescribing 16 AESTHETIC AWARDS 2012/2013 Check out who has been shortlisted for a coveted Aesthetic Award

46 BODY CONTORUING [ADVERTORTIAL] We find out about Lynton’s latest body contouring device 48 SKIN PEELS [ADVERTORTIAL] The latest innovation in skin peeling from SkinCeuticals 50 Q&A We find out about the latest product from Obagi, ELASTIderm® Eye Complete Complex™ 52 PRODUCT NEWS We round up the latest product news

22 BIG DEBATE Should podiatrists be allowed to administer boutlinum toxin and dermal fillers?

53 TRIED AND TESTED Kathryn Revell on the Silkann range of cannulas

CLINICAL PRACTICE

IN BUSINESS

[INJECTABLES] BOTULINUM TOXIN SPECIAL 26 Dr Sotirios Foutsizoglou on botulinum toxin for treating hyperhidrosis 30 We summarise the results of a study comparing two Botulinum Toxin Type A preparations for treating crow’s feet

54 BEST PRACTICE Alison Rohland, Superintendent Pharmacist at Healthxchange Pharmacy on remote prescribing

37 [DEVICES] MICRONEEDLING AND RF Antonia Mariconda on why microneedle radio-frequency systems are so sought after 42 [DERMATOLOGY] SKIN CAMOUFLAGE Theresa Bush, M.B.B.S on medical micropigmentation for scarring, birthmarks and other surface skin impefections

56 CUSTOMER SERVICE [ADVERTORIAL] We speak to Med-fx customers to find out why the single-source supplier is their number one choice for buying aesthetic products 58 BUSINESS FOCUS Finding commercial property 60 A WORKING DAY IN THE LIFE OF… Antonia Mariconda finds out what a typical day has in store for CC Kat 62 DATES FOR THE DIARY Training course, conference and meeting dates 66 COSMETIC NEWS EXPO/ AESTHETIC CONFERENCE 2013 We reveal the preliminary programme for the Aesthetics Conference 2013 and tell you how you can take advantage of our exclusive early bird booking offer

PRODUCT REVIEWS 44 PRODUCT FOCUS We find out about Syneron Candela’s New Ultimate MultiPlatform System, the elõs Plus

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Editor’s choice SilkPeel Dermalinfusion

f your clients are looking for a noninvasive treatment that gives their skin a smoother more youthful complexion and healthy glow then one of the latest treatments from SilDerm, SilkPeel Dermalinfusion, could be just wat you are looking for. SilkPeel is the next generation of skin rejuvenation techniques, launched into the UK by SilDerm Group earlier this year. This new system combines a non-invasive exfoliation of the stratum corneum with simultaneous infusion of clinically proven nutrient rich skin treatments deep into the epidermal/dermal layer to revitalise the appearance of the skin. Exfoliation is carried out using a medical grade diamond tip head that works under vacuum to gently remove dead skin cells together with any surface hyperpigmentation and discolouration and buffs away fine lines and wrinkles. As the exfoliated cells are removed, the SilkPeel system infuses specially formulated hydrating and reparative agents deep into the dermis to stimulate collagen production, encourage new cell growth and enhance skin health. As well as improving skin tone and elasticity SilkPeel Dermalinfusion is effective for a range of skin conditions including dehydrated or dull skin, hyperpigmentation spots, acne scarring and discolouration, enlarged pores and the fine lines and wrinkles resulting from sun damage to the skin. There is also a body hand piece, which is excellent at treating stretch marks and cellulite. Treatment takes around 20 minutes, and as it’s a non-invasive technique, customers can have their treatment during their lunch break and then return to work without suffering the discomfort that is associated with most dermal abrasion procedures. Visible results can be seen after a single treatment but lasting and significant results will be seen after four to six treatments at 14-day intervals. As it works under positive pneumatic pressure, the treatment also stimulates lymphatic function so it helps encourage the removal of waste and toxins from the face. This is especially beneficial in post-surgical oedema and enhances the vibrancy and glow of the complexion. SilkPeel is an effective, adjunct and complementary treatment to other popular cosmetic procedures because it enhances effectiveness, increases overall outcome, speeds healing and recovery time by removing dry, flaky skin, and aids in the reduction of lymphatic or mild oedema. In summary, SilkPeel is fast and effective so it’s an excellent introduction for customers new to cosmetic procedures and an excellent profit centre for aesthetic clinics. Contact the Cosmetic News team on 01268 754 897

Charlotte Body Publisher charlotte@creativemedialtd.co.uk

Loraine Winter Senior Designer loraine@creativemedialtd.co.uk

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

Emma Bridges Events/Production emma.bridges@creativemedialtd.co.uk

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

Carly Mcfarlane Sales and Events Assistant carly.mcfarlane@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.

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REMOTE PRESCRIBING

Dr Mark Harrison suspended after remote prescribing Dr Mark Harrison has been suspended for 18 months pending investigation by the General Medical Council (GMC) for remote prescribing botulinum toxins form his offices in Harley Street. The suspension came after Dr Harrison was secretly filmed by the BBC telling nurses on his training course that prescriptions could be acquired in one person’s name for use on someone else and promoting the practice of remote prescribing over the phone. The GMC issued a clear position statement on the subject following the report on BBC London, which aired in July. They said: “You must undertake a physical examination of patients before prescribing non-surgical cosmetic medicinal products such as Botox®, Dysport® or

Vistabel® or other injectable cosmetic medicines. You must not therefore prescribe these medicines by telephone, fax, video-link, or online.” The GMC will decide whether Dr Harrison will face a fitness to practise panel over the allegations. Niall Dickson, chief executive of the GMC, said, “There are good reasons why these are

prescription-only medicines, and we believe doctors should assess any patient in person before issuing a prescription of this kind.” Dr Harrison, the director of Harley Aesthetics, had built up a network of hundreds of nurses who phoned him on his mobile from across the UK to receive authorisation to inject patients immediately with botulinum toxin. This continued even after the Nursing and Midwifery Council (NMC) issued guidance to its members in November 2011 stating that nurses engaging in treating patients with botulinum toxins following a remote consultation will be going against the NMC standards and thus risk their registration. See Voice of the Industry (p14).

AESTHETIC AWARDS

PIP

Review of cosmetic surgery launched A major review into and how much advice is given to those cosmetic surgery, following considering surgery. Mr Lansley has the PIP scandal, was specifically asked the review to consider launched last month. implementing a national implant register, The enquiry will be led by NHS for products such as breast implants, medical director Sir Bruce Keogh. It to identify all those who received the Sir Bruce Keogh was requested by Health Secretary product and details of their operation. Andrew Lansley after concerns about cosmetic Fazel Fatah, president of the British Association surgery were raised following the public outcry of Aesthetic Plastic Surgeons (BAAPS), said, “We over faulty PIP breast implants and could lead to are delighted that the review is now under way. The tighter regulation of the industry. BAAPS has been campaigning for many years for Sir Bruce said, “The recent problems with PIP better regulations of the cosmetic surgery sector to breast implants have shone a light on the cosmetic protect patients. The BAAPS will fully co-operate with surgery industry. Many questions have been raised, the process at all its stages as we would like to ensure particularly around the regulation of clinics, whether a positive outcome from the review that provides all practitioners are adequately qualified, how well safety and security for patients who choose to have people are advised when money is changing hands, cosmetic surgery, and to end unethical practices of aggressive marketing techniques, and what protection patient inducements on the basis of cost.” is available when things go wrong. That’s why I have Sir Bruce later said there was a “cacophony of put together this review committee to advise me in concern” about “grubby practices” in the cosmetic making recommendations to Government on how surgery industry. He told BBC Breakfast: “There are we can better protect people who choose to have people who are concerned about the regulation, surgery or cosmetic interventions.” there are people who are very concerned about An expert panel, including PIP campaigner, the qualifications of those who are conducting, Catherine Kydd, former medical director of in the dark recesses of the cosmetic industry, Bupa, Andrew Vallance-Owen, and editor of procedures that they are not qualified to do. Marie Claire magazine, Trish Halpin, will gather “I don’t want anybody to get the impression evidence before making recommendations to the that the cosmetic surgery industry is all tarred with Government next March. one particular brush. There are parts of it that are Members of the public are also being asked to run extremely well, very ethically with very, very share their experiences of cosmetic surgery and high standards. There are, sadly though, some views on issues including the safety of products used parts where there are some pretty grubby practices in such procedures, care during and after treatment, going on and that’s why we’re having the review.”

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Kelo-cote® sponsors Aesthetic Awards Cosmetic News is delighted to announce that Kelo-cote® will be Bronze Sponsors of the Aesthetic Awards 2012/2013. The product, distributed by Sinclair Pharmaceuticals Ltd, has a patented formulation and is recommended by physicians all around the world. Kelo-cote® forms a bond with the outer layer of the skin, protecting the scar and allowing it to mature through normal collagen synthesis cycles. This improves the physiologic and cosmetic appearance of the scar. Kelo-cote® softens and flattens raised scars; reduces redness and discolouration and relieves itching and discomfort. Kelo-cote® gel self-dries to a waterproof, gas permeable membrane. Cosmetics can be applied, once the Kelo-cote® has dried. It is suitable for children and people with sensitive skin. Kelo-cote® is available in a gel formulation (15g and 60g) or a spray (100ml). It is also available in a UV gel formulation (15g), which has SPF 30, so that scars can be protected and healed, without additional damage from the sun.

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INDUSTRY News IHAS

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Stamp of approval for TreatmentsYouCanTrust IHAS have been awarded the Information Standard quality mark. Angela Coulter PhD, Hon FFPH, Hon FRCGP, an independent healthcare analyst who advises on the scheme, commented, “Organisations that become certified members of the scheme, and therefore display the Information Standard quality mark on their health information or social care materials, have proven that they adhere to the very highest standards of information production. “The public can feel confident that if they see the Information Standard quality mark on health and social care websites or leaflets then the information can be trusted and relied upon.” Sally Taber, director of IHAS, who is responsible for www.TreatmentsYouCanTrust.

org.uk, says of its certification, “We are pleased that our information for patients and those who treat them has been recognised as being of high quality. We always strive to give clear, objective, evidence-based information since a high proportion of the independent healthcare providers and many patients rely on us. The register of those qualified to administer cosmetic injectables www.TreatmentsYouCanTrust.org.uk is particularly important to patient safety and its message has to be clear and unmistakable.”

TRENDS

AWARD

Professional Skincare Market Unblemished for Second Consecutive Year, Reports Kline

Tatler nod for Kirwan

The professional skincare products market experiences a second year of growth, posting a 5.3% increase in 2011, according to the latest Professional Skin Care Global Series: Market Analysis and Opportunities by international consulting and research firm Kline & Company. While the overall tendency suggests a continued recovery of the market following the onset of the recession, subtle trends behind the figures paint a more undecided picture. With 4.0% growth in 2011, sales for the European market come close to pre-recession peak levels as consumers return to professional venues for skincare treatments. Despite this resurgence, consumers continue to cautiously spend on their post-treatment

purchases and remain highly value-conscious. Sales through beauty institutes and salons, the largest purchase channel in Europe representing almost 60% of the market, increase by 3.7% in 2011. However, the strongest growth is experienced in the medical care providers channel in both Europe and the United States. The European market is highly fragmented with leading brands, Guinot, followed by Clarins, enjoying strong growth. The U.S. market is relatively consolidated, with the top five brands accounting for a 38% market share. Brands entrenched in the medical care providers channel, such as SkinCeuticals and SkinMedica in the United States, and Dermaceutic and Pangaea Laboratories’ Medik8 in Europe, post the strongest gains in 2011.

Tatler magazine has named cosmetic surgeon Laurence Kirwan as the best surgeon for fixing tummies and breasts, for the second year in a row, in its Beauty & Cosmetic Surgery Guide 2012. Commenting on the accolade, Dr Kirwan said, “It’s an honour to be recognised for doing what you love and I am extremely pleased to get this recognition two years in a row. It tells me that my patients like my work and that it’s making them happy and my patients’ happiness is my top priority.”

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

Date of Preparation: January 2012 UK/0023/2012

The department of Health backed register of cosmetic injectables www. TreatmentsYouCanTrust.org.uk has been given a stamp of approval by the Information Standard scheme, reinforcing to the public that its information can be trusted. The Independent Healthcare Advisory Services (IHAS), which manages the register, was certified as a provider of high quality health and social care information, by the scheme. The IHAS certification includes the important stream of information addressed to patients by its register of injectable cosmetic providers www.TreatmentsYouCanTrust.org.uk. Meeting the scheme criteria of producing safe and reliable health and social care information,

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INDUSTRY News

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BAPRAS MICRODERMABRASION SPECIALISTS

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BAPRAS responds to news that Transform will launch patient care charter BAPRAS has responded to the news that the Transform cosmetic surgery clinic will launch a patient care charter. Tim Goodacre, Head of Professional Standards at BAPRAS and a leading consultant plastic surgeon said, “The PIP controversy over the last six months has shown the public that there is a real need for a change in the way some clinics promote cosmetic surgery procedures, often targeting a very vulnerable section of the population with sophisticated marketing techniques. “BAPRAS welcomes any commitment to improving standards in patient care, however, we believe that what is needed now is not a new patient care charter, but a wholesale change in practice. Whilst a self-imposed voluntary code of marketing practice for clinics is a step in the

CRYSTAL PEELING

right direction, we would like to see the end of irresponsible cosmetic surgery ‘deals’ with an industry wide, compulsory code which sees swift action taken against those who break the rules. “It is somewhat surprising that this selfimposed code should be announced at this time, when the work commissioned from Sir Bruce Keogh by the Secretary of State in January to address the whole regulatory process of cosmetic surgery in England, is to be delivered by March 2013. Following our involvement in the Government’s Expert Group on PIP breast implants, we continue to lead the call for establishing a compulsory register of all operations using breast implants to ensure the highest standards of patient care and industry regulation”.

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Lynton announces exciting new partnership Lynton has joined forces with business training expert Gill Morris to deliver unique training courses based on business development, customer care and confidence building. Attendees can expect to have fun whilst learning cutting edge sales techniques to help broaden their minds and achieve their goals. Lynton, a leading UK manufacturer and provider of cosmetic laser solutions and aesthetic equipment, also provides a range of training courses to help new and existing customers learn the necessary skills. Courses, which are held at its state-of-the-art training centre, can be found in Skin Laser Applications, Core of Knowledge and a variety of more specific Masterclasses. Gill, the founder of GMT Business Training, delivers business training specifically to those in

the world of beauty, spa, and medical aesthetics. She has owned salons, worked for the supply side of the industry in equipment research and development, new product development and general marketing. She is also an author and offers management and marketing consultancy services. She said, “I am delighted to be working with the Lynton team. Lynton has great customers and I’m looking forward to helping them on their journey to becoming even more profitable.” Lynton’s customer service manager, Dr Samantha Hills, added, “This is a fantastic opportunity for our customers to learn business skills from someone with such extensive experience. We are extremely excited to have her on board!”

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

THE TIME HAS COME

STAGE 1: Initial Expression of Interest – Providers to pay £50 +VAT to record their initial interest in the scheme, enables access to the standards and training principles which all providers must meet to gain registration. STAGE 2: Self Assessment against Standards and Training Principles – Providers are required to complete self-assessment forms and submit evidence of their practice and pay the full registration fee of £500 +VAT for individual practitioners or £1000 +VAT for larger organisations. Review of the evidence will take a maximum of 10 working days. STAGE 3: Assessment and Award of the Quality Mark – Practitioners will be contacted by email to inform them of whether they have been awarded the Quality Assurance Mark they will then be issued with a certificate to display in the practice demonstrating that they achieved the standards required for the quality mark STAGE 4: Inspection – Inspections will be conducted of registered organisations. STAGE 5: Annual Renewal – Registration is valid for 12 months, after which time practitioners will need to complete the process again and pay the appropriate renewal fee.

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

HOW TO APPLY The web-based applications are being managed by CHKS, the UK’s leading independent provider of healthcare intelligence and quality improvement services.

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INDUSTRY INSIDER VOICE OF THE INDUSTRY

The end of the debate? Vicky Eldridge on remote prescribing

t has been an eventful summer in the aesthetics industry, with the subject of remote prescribing once again opening up a fiery debate. Unfortunately, this time, it was not behind the closed doors of the industry but in the very public arena of the national media. In a year where the PIP implant scandal dominated the headlines for weeks on end – the backlash of which we are still feeling – the last thing the industry needed was more bad press. So when BBC News London did an expose on remote prescribing, filming undercover at Dr Mark Harrison’s Harley Aesthetics training courses, I am sure I was not alone in putting my head in my hands. That is not to say I was surprised that this subject was picked up by the national media (it was only a matter of time), but what has surprised me is that it took this 10 minute news item to finally make some people sit up and take notice about an issue that, in my opinion, should have been cut and dry ever since the NMC came out with a very clear statement to its members in November 2011 about its position on remote prescribing of botulinum toxin. For me, and no doubt many others, that should have been the end of the story, yet the loophole has continued to be exploited. I am pleased that the GMC has finally followed suit but it amazes me that people are all of a sudden surprised that this situation has come to a head. What could be clearer than the NMC saying that: “nurses engaging in treating patients with botulinum toxins following a remote consultation will be going against the NMC standards and thus risk their registration (which could be withdrawn following a disciplinary hearing) if they operate via that business model.” I have heard all the arguments for and against remote prescribing, however the arguments for are all moot – when your professional body comes out and very specifically says you should not be doing something, don’t do it! If I was a doctor and I knew I was putting nurses at risk of getting in trouble I would not be remotely prescribing to them, whatever my opinion on the rights and wrongs of it were. Equally, if I was a nurse, the thought of being hauled up in front of the NMC on a disciplinary hearing, or worse, being struck off, would have been enough for me to change the way I practise. To me this whole situation smacks of putting making money before professional integrity and what is in the best interests of the patient.

When your professional body comes out and very specifically says you should not be doing something, don’t do it! There are so many ethical, hard working and talented nurses and doctors working in aesthetics, so it frustrates me that our industry is constantly being shown in a bad light because of the actions of a few people who think that the lack of regulation in this sector is an excuse to behave in a way that is frankly unprofessional and unethical, just to make a quick buck. The phrase ‘it may be cosmetic but it is still medical’ has been bandied around a lot in recent years but it is a relevant one. If medical aesthetics is ever going to be taken seriously as a sub specialty of medicine then the industry as a whole needs to come together and fight against bad practice. This whole controversy should have been resolved long before there needed to be another media scandal. But once again the entire industry is having to deal with the ramifications of bad press because a select few think it is ok to work outside of their professional remit. Now the GMC has made itself clear and made an example of Dr Harrison by suspending him for 18 months, you would hope this would be the end of the matter, but I doubt this will be the last time we publish something on the subject and don’t even get me started on people writing prescriptions for beauty therapists to inject .

MEDICAL AEsthEtICs:

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of QuAlity

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

March 2012 UK/0326/2012

35 years of quality, science and innovation

Aesthetic Awards 2012/2013 sponsored by

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And the nominees It’s the event that everyone is talking about, but who is on their way to winning a coveted Aesthetic Award? We announce the shortlisted finalists

ver the past few weeks the entries have been flooding in for the second annual Aesthetic Awards in Association with Cosmetic News. With so many high calibre entries to sort through, picking the final shortlisted nominees has not been an easy task. Those who have been lucky enough to make the final cut will now be in with a chance of taking home a gong on the night. With a total of 30 categories, the awards have been designed to acknowledge those who have gone that extra mile over the last year. The Aesthetic Awards is the first and premier awards evening in the industry that gives both practitioners and suppliers a chance to celebrate their achievements with their friends and peers. The Aesthetic Awards is being sponsored by Syneron Candela (Silver Sponsor) and Kelo-cote® (Bronze Sponsor), and will take place at a glamorous Moulin Rouge themed event on the evening of Saturday December 1 at The Grand Connaught Rooms in Covent Garden.

The nominees are…

16 www.cosmeticnewsuk.com

INDUSTRY AWARDS Awards for Manufacturers and Suppliers Best Product Innovation The most innovative new products on the market will be recognised in this category. This year the votes from readers of Cosmetic News and customers of the selected products will only count for 50% of the final result. The other 50% will be made up of votes from an independent panel of judges who will individually examine evidence on each of the products and rate them in order of which they think is most deserving of the award. To vote for the product that you think is the most innovative visit www.cosmeticnewsuk.com. The shortlisted products are: • Dermapen™ • EndyMed™ 3DEEP (AesthetiCare) • Harmony® XL Pixel Q Switch handpiece (ABC Lasers) • Lustre (Ambicare Health) • SkinCeuticals Phloretin CF Gel (L’Oreal) • Stylage® (Medical Aesthetic Group)

Best Newcomer (Product or Treatment) This award is designed to recognise the best new product launched in the UK market since the beginning of 2012. This year the votes from readers of Cosmetic News and customers of the selected products will only count for 50% of the final result. The other 50% will be made up of votes from an independent panel of judges who will individually examine evidence on each of the products/treatments and rate them in order of which they think is most deserving of the award. To vote for the product that you

think is the most deserving winner visit www. cosmeticnewsuk.com . The shortlisted products are: •D ermaquest Stem Cell 3D Complex (Dermapure) •e Lase Motif laser hair removal (Syneron/Candela) • INTRAcel (Healthxchange) •N eoStrata® Skin Active Intensive Eye Therapy (Aesthetic Source) •R estylane® Lip Refresh (Q-Med/ Galderma) • Silkann Aesthetic Cannulas (Sterimedix)

Cosmeceutical of the Year This award will go to the best cosmeceutical product range in the UK. This year the votes from readers of Cosmetic News and customers of the selected products will only count for 50% of the final result. The other 50% will be made up of votes from an independent panel of judges who will individually examine evidence on each of the products and rate them in order of which they think is most deserving of the award. To vote for the product range that you think is the most deserving winner visit www.cosmeticnewsuk.com. The shortlisted ranges are: • • • • • • •

Epionce (Eden Aesthetics) Heliocare (AesthetiCare) Image Skincare (Skin Geeks) Medik8 (SkinBrands) Obagi (Healthxchange) PRIORI (Cosmeceuticals) SkinCeuticals (L’Oreal)

MOULIN ROUGE

are…

Treatment of the Year (Body)

This award will go to the manufacturers/ distributors of the best injectable product available in the UK. This year the votes from readers of Cosmetic News and customers of the selected products will only count for 50% of the final result. The other 50% will be made up of votes from an independent panel of judges who will individually examine evidence on each of the products and rate them in order of which they think is most deserving of the award. To vote for the product that you think is the most deserving winner visit www.cosmeticnewsuk. com. The finalists are:

This award will be given to the manufacturer/ supplier with the best treatment for the body. This year the votes from readers of Cosmetic News and customers of the selected treatments will only count for 50% of the final result. The other 50% will be made up of votes from an independent panel of judges who will individually examine evidence on each of the treatments and rate them in order of which they think is most deserving of the award. To vote for the treatment that you think is the most deserving winner visit www.cosmeticnewsuk.com

• • • •

Emervel (Q-Med/Galderma) Juvederm Voluma (Allergan) Radiesse (Merz) Restylane Lip Volume/Restylane Lip Refresh (Q-Med/Galderma) • Revanesse (Boston Medical Group) • Stylage (MAG) • Teosyal Redensity (Lifestyle Aesthetics)

• • • •

Cellulaze (Cynosure) CoolSculpting® (ZELTIQ) Genuine Dermaroller (AesthetiCare) Soprano Pain Free Hair Removal (ABC Lasers) • Velashape (Syneron/Candela) • VaserShape (Sound Surgical)

Best Selling Retail Product Treatment of the Year (Face) This award will be given to the manufacturer/ supplier with the best treatment for the face. This year the votes from readers of Cosmetic News and customers of the selected treatments will only count for 50% of the final result. The other 50% will be made up of votes from an independent panel of judges who will individually examine evidence on each of the treatments and rate them in order of which they think is most deserving of the award. To vote visit www.cosmeticnewsuk.com •A Q Skin Solutions/Dermastamp (Skin Geeks) • e2 Sublime and Sublative (Syneron/ Candela) • Genuine Dermaroller (AesthetiCare) • Harmony XL Pixel QS aka the ‘laser face-lift’ (ABC Lasers) • HydraFacial (SkinBrands) • Idebenone Superceuticals Peel (Cosmeceuticals)

Clinics will be able to vote for their top selling retail product in this category. The finalists have been selected from the number of nominations they received from clinics. To vote for the brand that you think is the most deserving winner visit www.cosmeticnewsuk.com. The nominees are: • Heliocare SPF 50 • Image Skincare Vital C Anti-Ageing Serum • La Roche-Posay Anthelios XL • Medik8 Retinol 3TR • Obagi Blue Peel Radiance • SkinCeuticals Sheer Mineral Defence • Vitage Skin Defence SPF 30

other 50% will be made up of votes from an independent panel of judges who will individually examine evidence on each of the products and rate them in order of which they think is most deserving of the award. To vote for the brand that you think is the most deserving winner visit www.cosmeticnewsuk. com. The finalists are: • • • • •

ABC Lasers 3D Lipo (Biotherapeutic) BodyTite (Invasix) Ellipse Syneron/Candela

Best Weight Loss/Diet Programme/Product A new category for 2012/2013, this award is designed to acknowledge the new and emerging area of in-clinic weight loss and diet programmes. The winner will be decided based on votes from Cosmetic News readers and clinics using the diet programmes. An independent panel of judges will also cast their vote in this category. As in other categories they will individually examine evidence on each of the products and rate them in order of which they think is most deserving of the award. The judges votes will count for 50% of the final total with votes from readers and customers making up the other 50%. To vote for the weight loss/ diet programme/product that you think is the most deserving winner visit www.cosmeticnewsuk.com. The finalists are: • • • • •

Alizonne FullFast Pronokal Proteifine (Ysonut) SlimScription

Equipment Brand of the Year The winner of this award will be the manufacturer/supplier of what is deemed to be the best equipment brand. This year the votes from readers of Cosmetic News and customers of the selected products will only count for 50% of the final result. The

Sales Representative of the Year This award is designed to acknowledge the hard work and services provided by sales reps working for manufacturers and suppliers in the UK. The finalists in this category are t

•

Injectable Product of the Year

Aesthetic Awards 2012/2013

those who received the most nominations from their customers. The winner will be decided by the number of votes they receive from their customers. To vote in this category please visit www.cosmeticnewsuk.com. The nominees are: • Deidre MacMahon – Merz Aesthetics • Frank Ward – Galderma • Iveta Vinklerova – Boston Medical Group • Kalvinder Kent – Allergan • Katy Bacon – Cosmeceutcials • Martyn Roe – Syneron/Candela • Paula Dene - Merz Aesthetics • Terina Denny – SkinGeeks

Best Customer Service by a Manufacturer/Supplier This award will be given to the manufacturer/supplier with the best customer service as judged by their customers. To vote for the manufacturer/supplier who you think offers the best customer service visit www. cosmeticnewsuk.com . The nominees are: • • • • • • • • •

ABC Lasers AesthetiCare Allergan Hamilton Fraser Healthxchange Med-fx Merz Aesthetics SkinBrands Syneron/Candela

Best Advertising Campaign by a Manufacturer/Supplier This award will be given to the manufacturer/supplier with the most memorable and effective UK advertising campaign. The finalists are: • • • • • •

Allergan – Quality is Key Campaign Syneron/Candela – Re-branding MAG – Stylage Merz – Belotero Restylane – Launch of Restylane Lip Volume and Restylane Lip Refresh

Distributor of the Year This award is designed for any UK distributor of aesthetic products or systems. To vote for the distributor who you think deserves to win visit www.cosmeticnewsuk.com. The nominees are: • AesthetiCare • Church Pharmacy • Healthxchange • Med-fx • SkinBrands • Wigmore Medical 18 www.cosmeticnewsuk.com

Awards for Clinics/Practitioners Rising Star This award will be presented to an up and coming practitioner who may not have the longevity of some of their colleagues but who has made an impact in their field. The shortlisted finalists were selected based on the nominations they received. The winning practitioner will be judged on the number of votes they receive from their peers, customers and industry representatives. To vote in this category please visit www.cosmeticnewsuk.com. The nominees are: • • • • •

Dr Dan Dhunna Dr Natalie Blakely Dr Terry Loong Dr Sam Bunting Sharon King

Best Clinic Chain The shortlisted finalists in this category are all clinics who have a chain of practices in the UK. Mystery shoppers will be sent to the clinics and their feedback as well as feedback from customers will determine the winner. If your clinic has been shortlisted then you can get your customers to vote for you by visiting www. cosmeticnewsuk.com. The finalists are: • • • • •

Court House Clinics Destination Skin EF Medi-Spa Sk:n The Private Clinic

Best New Clinic A new category for 2012/2013, this award will be presented to the best new clinic in the UK. Mystery shoppers will be sent to the clinics who have been shortlisted and their feedback as well as feedback from customers will determine the winner. If your clinic has been shortlisted then you can get your customers to vote for you by visiting www.cosmeticnewsuk.com. The finalists are: • London Bridge Plastic Surgery (LBPS), • Wimpole Street, London • Medikas Medi-Spa, Bath • Q Clinics, Bristol • Renew Clinic, Nantwich • Skin Associates, Wimpole Street, London • The Skin Clinic, Sevenoaks

Best Clinic (four rooms or more) This award will be presented to the best large clinic in the UK with four or more treatment rooms. Mystery shoppers will be sent to the clinics who have been shortlisted and their feedback as well as feedback from customers will determine the winner. If your clinic has been shortlisted then you

can get your customers to vote for you by visiting www.cosmeticnewsuk.com. The finalists are: • • • • •

Dermal Clinic, Edinburgh Xavier G Medi-Spa, Southampton Woodford Medical, Danbury, Essex Face etc Medi-Spa, York Naked Health, Wimbledon, London

Best Clinic (three rooms or less) This award will be presented to the best small clinic in the UK with three or less treatment rooms. Mystery shoppers will be sent to the clinics who have been shortlisted and their feedback as well as feedback from customers will determine the winner. If your clinic has been shortlisted then you can get your customers to vote for you by visiting www.cosmeticnewsuk.com. The finalists are: • • • • • •

European Dermatology, London Medikas, Somerset Persona Cosmetic Medicine, Bexley Temple Aesthetics, Aberdeen Lumley Aesthetics, Sevenoaks The Evergreen Clinic, Liverpool

Best Cosmetic Dental Clinic Another new category for 2012/2013, this award will be presented to the best cosmetic dental clinic in the UK. Mystery shoppers will be sent to the clinics who have been shortlisted and their feedback as well as feedback from customers will determine the winner. If your clinic has been shortlisted then you can get your customers to vote for you by visiting www. cosmeticnewsuk.com. The finalists are: • The Kensington Clinic, London • Lubiju, London/Edinburgh • Tracey Bell Clinics, Liverpool/Isle of Man • Visage Lifestyle Clinic, Glasgow

Best Mobile Practitioner This award will recognise the achievements of solo practitioners who operate out of multiple locations. The shortlisted finalists have been chosen based on the number of nominations they received. Mystery shoppers will be sent to the practitioners who have been shortlisted and their feedback as well as feedback from customers will determine the winner. If you have been shortlisted then you can get your customers to vote for you by visiting www. cosmeticnewsuk.com. The finalists are: • Anna Baker • Hannah Orchard • Karen Lockett • Teena Williams

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Unit 54-55, Shrivenham Hundred Park, Majors Road, Shrivenham, Wiltshire, England. SN6 8TY T: 0845 0701782 E: info@lifestyleaesthetics.com Web: www.lifestyleaesthetics.com

Aesthetic Awards 2012/2013 Aesthetic Nurse Practitioner of the Year This award will go to the nurse practitioner who has gone above and beyond in her field this year. A new addition to the awards line up for 2012/2013 this category has been designed to acknowledge the important role that aesthetic nurse practitioners play in the UK aesthetics industry. The winner will be decided on votes from the readers of Cosmetic News , peers and clients of the nurses shortlisted. To vote in this category please visit www.cosmeticnewsuk.com. The finalists are: • • • • • •

Belinda Done Emma Davies Helen Hannigan Mai Bentley Marie Dolan Monica Berrange

Aesthetic Practitioner of the Year sponsored by This award will go to the cosmetic doctor who has gone above and beyond in his/her field this year. The winner will be decided on votes from the readers of Cosmetic News , peers and clients of the practitioners shortlisted. To vote in this category please visit www. cosmeticnewsuk.com. The finalists are: • • • • • • •

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Beatriz Molina David Eccleston Lisa Delamaine Raj Acquilla Robin Stones Stefanie Williams Tapan Patel

Cosmetic Dentist of the Year This award will go to the cosmetic dentist/facial aesthetic practitioner who has gone above and beyond in his/her field this year. The winner will be decided on votes from the readers of Cosmetic News, peers and clients of the practitioners shortlisted. To vote in this category please visit www.cosmeticnewsuk.com. The finalists are: •D r Emma Ravichandran, Clinetix, Glasgow •D r Ian Hallam, Meon Facial, Hampshire • Dr Tracey Bell, The Tracey Bell Clinic, Liverpool/Isle of Man • Dr V J Vadgama, Woodbury Dental and Laser Clinic, Tenterden, Kent 20 www.cosmeticnewsuk.com

Best Clinic Customer Service

Association of the Year

This award will be given to the clinic in the UK with the best customer service as judged by ‘mystery shoppers’ and votes from customers. If you have been shortlisted then you can get your customers to vote for you by visiting www. cosmeticnewsuk.com. The shortlisted finalists are:

This award will be presented to the association that has gone above and beyond in 2012. There will only be one winner in this category. To vote for the association that you think deserves to win this award, please visit www. cosmeticnewsuk.com. The nominees are:

• Dr Xavier G Medi-Spa Clinic, Southampton • European Dermatology, London • CC Kat Aesthetics, Birmingham • LBPS, Wimpole Stret, London • Medizen, Sutton Coldfield • Naked Health, Wimbledon, London • Persona Cosmetic Medicine, Bexley, Kent • Skin Associates, Wimpole Street, London

•B ritish Association of Aesthetic Plastic Surgeons (BAAPS) •B ritish Association of Cosmetic Nurses (BACN) •B ritish College of Aesthetic Medicine (BCAM - formerly British Association of Cosmetic Doctors) •P rivate Independent Aesthetic Practices Association (PIAPA)

Best Clinic Website The most easy to navigate and informative clinic websites will be awarded in this category. Mystery shoppers will be asked to rate the websites on ease of use, information and style. •A esthetic Virtue aesthetic-virtue.co.uk • CC Kat Aesthetics cckat.com • Clinica Fiore Skin Medica clinicafiore.co.uk • Destination Skin, destinationskin.com • EF Medi-Spa, efmedispa.com • The Island Cosmetic Clinic, islandcosmeticclinic.co.uk

Speaker of the Year This award will be given to the person deemed to have given the best lecture at a UK conference or educational meeting in 2012. The shortlisted finalists were chosen based on the number of nominations they received. They are: • • • • •

Dr Beatriz Molina Dr Raj Acquilla Dr Tapan Patel Dr Toni Phillips Mr Dalvi Humzah

Clinic Receptionist of the Year This award will go the member of clinic front of house staff who has excelled in 2012. Mystery shoppers will be sent to the clinics who have been shortlisted and their feedback as well as feedback from customers will determine the winner. If you have been shortlisted then you can get your customers to vote for you by visiting www.cosmeticnewsuk.com. • Kym Pulham, Court House Clinics, Brentwood • Lucia Pawlak, Dermal Clinic, Edinburgh • Rosie Claremont, Aesthetic Virtue, London • Jasmin Byrne, EF Medi-Spa, Kensington • Tina Jobburns, Cosmedic Skin Clinic, Tamworth • Sue Blake, Q Clinics, Bristol

Special Awards

sponsored by

The Baroness Ritchie Award for Services to the Industry This category will award an individual who has gone above and beyond in their services to the industry and has been named in honour of Baroness Ritchie of Brompton, the former chair of the Treatments You Can Trust Governance Group who campaigned tirelessly for improved standards in cosmetic injectables. As with the lifetime achievement award, there will only be one winner in this category. We had so many fantastic nominations in this category that we have decided to create a shortlist and let people in the industry vote on who they think deserves to win. To vote in this category please visit www. cosmeticnewsuk.com. The nominees are: • Emma Davis • Mr Dalvi Humzah • Lynne Thomas (Flipside PR) • Ron Myers • Sally Taber

Lifetime Achievement Award

This award will recognise the achievements of an individual who has had a long and fruitful career in the aesthetics industry. The recipient of this award has been selected by the Aesthetics Awards team from the nominations submitted and there will only be one winner who will be announced on the night. sponsored by

Voting now open In some of the categories the winners will be decided by the readers of Cosmetic News. Visit www.cosmeticnewsuk.com to cast your vote now! Voting closes on Monday October 15.

BOOK YOUR TABLE! Tickets for the Aesthetic Awards are running out fast so, to make sure you don’t miss out, book your table or individual tickets now by contacting our events team on 01268 754 897. Tickets cost £165 plus VAT each or £1,600 plus VAT for a table.

June 2012 SIP/KEL/484b

INDUSTRY INSIDER THE BIG DEBATE

Feet first Lorna Jackson, Editor of The Consulting Room, on whether podiatrists should be injecting Botox®

he thorny issue of just who should and shouldn’t be allowed to inject botulinum toxins (e.g. Botox®) into paying customers, aside from who practically can and can’t has raised its ugly head again. Following recent debates over beauty therapists, dental hygienists and other non-medics involvement in this marketplace, we now see podiatrists or foot specialists wanting to get in on the action too with training companies and insurers prepared to back them and actively promote this business option to them. Some training companies are openly targeting and promoting training courses in prescription only botulinum toxins (and dermal fillers) direct to ‘Healthcare Professionals’, in this instance those registered as podiatrists. This latest ‘nonsense’, as dismissed by some, is provoking all sorts of debate and anger amongst trade associations which represent medical professionals such as doctors and nurses, as well as regulators like the IHAS Treatments You Can Trust Register of Cosmetic Injectable Providers, and industry suppliers, participants and medical indemnity insurers most of whom do not support this specialty’s involvement with facial aesthetics. Sally Taber, director of the IHAS comments, “We have evidence of a podiatrist who applied to be on TreatmentsYouCanTrust and lied saying she was a dentist. This was picked up as she was using remote prescribing. Also the chief executive of the company training podiatrists was found to be breaking MHRA rules by advertising ‘Botox® parties’ in conjunction with the fraudulent use of logos. I am very saddened by this practice when TYCT is trying to raise standards.” In fact, all the manufacturers of botulinum toxins licensed for aesthetic use in the UK have openly stated that they do not support the use of their products by anyone other than doctors, dentists, Nurse Independent Prescribers and registered nurses; so what is going on, why are so many other ‘people’ wanting to and being given the means to wield 22 www.cosmeticnewsuk.com

this drug in the faces of unsuspecting members of the public and is this really a huge problem for the industry? We didn’t have to go far in our hunt to find podiatrists offering services to the public as ‘qualified aesthetics practitioners’ now happily promoting dermal filler and botulinum toxin injections, some even with a banner outside the clinic declaring that they now do Botox®! – A complete no-no in terms of medicines regulations given its POM status! As well as new operators, we found a variety of companies offering such training courses to podiatrists, including this one run by MasterClass Presentations Ltd in Tamworth; a company which was set up by two health professionals and runs a variety of courses for UK doctors, dentists, nurses and podiatrists in facial aesthetics and mesotherapy. They proudly state on their website; “Many podiatrists work in close proximity to aestheticians and for years it was a source of untold frustration to many that, RGN’s with diplomas could train in facial aesthetics injections but podiatrists with good honours degrees often complemented by Health PGC’s PGDip’s, Masters or PhD degrees were denied such training. After a substantial amount of work convincing insurers and underwriters that podiatrists could be an exceptionally ‘safe pair of hands’ and developing what is widely regarded as the most intensive syllabus of learning in its field, we were able to start training LA qualified podiatrists as aestheticians and it has been the success story of the decade.” Another company who is at the forefront of this push is Fluent Health Academy, a training company based in Bolton who offer a two day, combined foundation course in Botox® and dermal fillers from £1,150. Fluent Health Academy is run by directors Lisa Moore and Michael Wilshaw. Lisa whose past CV, includes being Head of

Podiatry at NHS Sefton and owner of a private podiatry practice for seven years from 1998 is clearly championing the inclusion of practitioners from her specialty within the aesthetic industry. They say on their site: “After the basic foundation course you will be able to offer injectable cosmetic surgery treatments to your patients such as botulinum toxin A (Botox®) and dermal fillers increasing your earning potential exponentially. As all of our courses are recognised by Hamilton Fraser, the leading insurance broker in the industry, on production of the “Fluent Health Certificate of Completion”, you will be guaranteed to get insurance with them after successfully completing our courses.” As well as taking a stand at a recent Society of Chiropodists & Podiatrists conference, a quick internet search revealed some of their promotional activities direct to podiatrists, including posts on forum site www.podiatry-arena.com where they offered podiatrists a £150 voucher code for a discount on the training course. Despite targeting this specialty, it seems that not all within the podiatry world are supportive or interested in this deviation from their existing profession. One forum member, a podiatrist in both the NHS and private practice wrote: “Whilst I am rather vocal about Podiatric recognition, using our full scope of practice etc. I must say if I were ever looking into getting Botox® or dermal fillers I would not see a podiatrist. Surely this is also a minefield waiting to happen, can you imagine the press PODIATRIST MADE ME LOOK LIKE I HAD A STROKE. All practitioners have adverse outcomes, but particularly practising outside your anatomic speciality is just asking for trouble and could potentially give us bad press.” To put minds at rest for those concerned about the views of the HPC (Health Professions Council) who regulate podiatrists, in terms of practicing cosmetic injectable delivery as a podiatrist where undertaking the procedure is well outside of the scope of practice, Fluent Health Academy advises that in fact once qualified the individual would practice and be insured as an aesthetics practitioner meaning that it falls outside of their HPC registration. In other words, they would not practice as a ‘podiatrist offering Botox®’ but as an ‘aesthetics practitioner offering Botox®’ (who happens to be a podiatrist by trade!) We approached the HPC for their thoughts on this. In a statement they said: “All chiropodists/podiatrists must practice only within their scope of practice. This means that they should only practise in the areas in which they have the necessary skills, knowledge and experience to be able to practise lawfully, safely and effectively. This requirement is set out in our standards of conduct, performance and ethics. A podiatrist can move into new areas of practice, so long as they have the knowledge and skills to be able to practice lawfully, safely and effectively.

“In relation to facial aesthetics, they can be administered in the following situations: • Where it is self-administered • Where it is administered by an appropriate practitioner; or • Where it is administered in accordance with the directions of an appropriate practitioner “Appropriate practitioners are in this case, doctors, dentists, or, subject to certain limitations, nurse or pharmacist independent prescribers and supplementary prescribers. “This means that a podiatrist can administer facial aesthetics, such as Botox®, where they are directed to by an appropriate practitioner such as a doctor. Alternatively, a podiatrist could administer specified medicines if they were following an established patient group direction (which is an instruction setting out various factors including the patients that a drug can be administered to and the conditions to be treated).” The Institute of Chiropodists and Podistrists (IOCP) have also issued a position statement on podiatrists and facial aesthetics which is a much more detailed document. In this statement they note various points; “...In order to clarify the situation of Podiatrists also involved in this market sector, the following key guidance points are given. • Prescribing or administration rights may only be used within the scope of podiatry, for example prescribing purified botulinum toxin type-A for a dynamic equinus foot deformity is within scope, prescribing it for facial aesthetics is not. • Podiatrists working as aestheticians must ensure that clear boundaries exist between their activities as a podiatrist and those as an aesthetician. • Botulinum toxins are prescription-only medicines throughout most of the western world, including the UK, and as such can only be obtained against a prescription issued by an appropriate practitioner. To be ‘appropriate’ that practitioner must be working within their scope of practice. ...In considering the prescribing of, for example Botox®, by a podiatrist prescriber, use of the term ‘appropriate practitioner’ used in the applicable legislation should be noted. Therefore, in the event that a podiatrist prescriber wished to prescribe and administer prepared botulinum toxin type-A for dynamic equinus foot deformity due to spasticity in ambulant paediatric cerebral palsy patients, two years of age or older where this was clinically assessed to be a suitable treatment, they would be judged ‘an appropriate practitioner’ and plainly acting within the defined scope of practice of podiatry. The foregoing procedure would naturally be subject to them having appropriate training in the product and its administration. In the event that a podiatrist prescriber wished to prescribe Botox® for facial aesthetic treatments, this would be clearly outside their scope of practice and they would not be ‘an appropriate practitioner’. Therefore any prescription issued by them for

INDUSTRY INSIDER THE BIG DEBATE

C o mmittee o f M edicine S tatements The Medicines Committee has sought and received approval from the College of Podiatry Board of College Governors/Podiatry Academic Board on two matters of College of Podiatry policy. The first issue relates to college policy on the use of Botox® by podiatrists. Following advice from the Medicines Committee, the College of Podiatry takes the view that the use by podiatrists of Botox® for the purposes of facial aesthetics falls outside the recognised scope of podiatric practice. Whilst the college acknowledges the legitimate use of Botox® by podiatrists for treatments relating to the foot, ankle and associated structures, in line with current evidence, it does not support the use of Botox® for the purposes of facial aesthetics by podiatrists. Members who choose to undertake the use of facial Botox® treatments, should do so in a capacity other than that of a podiatrist. Members will be aware that, at present, podiatrists are able to undertake training to become supplementary prescribers, and the

Department of Health AHP Medicines Project is seeking to attain independent prescribing rights for podiatrists and physiotherapists. Should this move be successful, podiatrists would have further prescribing rights than they do at present. In order to ensure our policy remains up to date, the Medicines Committee sought and received college approval for the following statement relating to the prescribing of medicine by podiatrists: Following advice from the Medicines Committee, the College of Podiatry has endorsed the following statement relating to the prescribing of medicines by podiatrists:”The College of Podiatrists/ Society of Chiropodists & Podiatrists agree that it is necessary to direct those members who are engaged in the practice of prescribing of medicines to ensure that they concern themselves only with those medicines which are relevant to the treatment of disorders affecting the foot, ankle and associated structures, in line with current practice and consistent with published professional guidance”.

this purpose would be in contravention of the medicines act 1968 and subsequent amendments and therefore illegal. ...In the event that someone working as an aesthetics practitioner, who was also a podiatrist (whether a prescriber or not) wished to administer botulinum toxin type-A for facial aesthetics, as in the case of any other individual they must note that to comply with the law it should only be done under the named patient-specific direction of an ‘appropriate prescriber’ who takes responsibility for such administration. Irrespective of the fact that they may be highly knowledgeable and skilled in the pharmacology and use of botulinum toxin type-A for procedures within the scope of podiatry, a podiatrist cannot be an ‘appropriate practitioner’ for the purposes of prescribing botulinum for facial aesthetic purposes. In such cases the Institute, although recognising that this is not a podiatry matter, would advise individuals performing such procedures who were also podiatrists, to ensure in writing via consent forms or similar, that people to whom they administer such procedures clearly understand that this is not a podiatry procedure and the practitioner is not acting as a podiatrist.” Hence, both the regulatory body and trade association for podiatrists agree that they should only practice, as podiatrists, within the scope of their specialty which facial aesthetics in not, yet if they wish to branch into this market, they can do so as along as they have received appropriate training, follow 24 www.cosmeticnewsuk.com

medicines regulations and above all do not practice this service in their capacity as a podiatrist. So does that mean you shouldn’t run the two services side by side in the same clinic as many are doing? Earlier this year, director of Fluent Health Academy Michael Wilshaw posted on his Twitter feed that accreditation for their training courses with bSOAP (now renamed tSOAP) was going through. tSOAP, the Society of Aesthetics Practitioners is a not for profit professional body who claim to be ‘seeking to further the aesthetics profession and the interests of individuals engaged in that profession’. tSOAP will only accept membership applications from clinicians who have been on an ‘approved training course’, which Fluent Health Academy is hoping to be listed as. We approached tSOAP for comment. They issued this statement: “As a society we represent qualified clinical practitioners who are both eligible and capable of prescribing and/or administering botulinum toxin A and dermal filler treatments safety, including doctors, dentists nurses and a range of appropriately qualified and registered AHP professions. The latest guidance from the Department of Health (Dec 2005, Gateway Ref:5910) to patients clearly identifies that patients must only be treated, (i.e. Duty of Care undertaken) by a prescribing clinical professional, i.e. a doctor or dentist. With the following confirmation that ‘The doctor or dentist may delegate the administration to a suitably qualified and competent other person’. “What is clear is that since this guidance was produced the Department of Health has extended the scope of practice for a broad range of clinicians, including Nurses and certain AHP professions within the NHS. Already a range of professionally qualified AHPs have clinical 1st and post graduate degrees with qualifications to undertake minor surgery and supplementary prescribing within the present range of NHS services. It is a high probability that these treatment and prescribing capabilities will be further extended by the end of 2013. Therefore, a range of nursing and selected AHP grades and professions will have the capability to independently as well as supplementary prescribe for a range of treatments and conditions. So far the NMC are the only body to presently provide clear guidance to its members on the boundaries for prescribing aesthetic treatment drugs. “The qualifications and capabilities of all clinical professionals are both relevant and important to accommodate in the strive for regulation, safety and quality within the aesthetics sector. We would only ever support the prescribing and administration of botulinum toxin A and dermal filler products by appropriately registered and qualified clinicians. However the move to restrict both practice and training by profession rather than professional registration, clinical qualifications to practice or fully assessed capability is a degenerate rather than progressive move in the fight to establish standards and regulation in the sector.

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

that same drug in the glabellar frown lines as clearly facial anatomy differs significantly to that of the foot which they have studied for four years and subsequently practised on. That’s not to say that all nurses have good knowledge of facial anatomy either, but the collective ‘we’ must draw the line somewhere on which healthcare and medical practitioners

chiropodists/podiatrists must practice only within their scope of practice

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

We also approached aesthetic industry insurer Hamilton Fraser, who have backed this training course for their comment. Managing Director, Eddie Hooker said, “In 2010 Hamilton Fraser began trialing medical malpractice insurance cover to podiatrists who are registered with the HPC and are qualified supplementary prescribers who are also permitted to administer local anaesthetic. Since this trial began, which involves 50 such practitioners, we have only received one notification of a potential claim. From a statistical point of view this volume of both practitioners and potential claims represents a very low risk to insurers. Provided practitioners continue to act within Standards of Conduct, Performance and Ethics set down by the HPC we are able to continue to provide insurance cover for Podiatrists under certain circumstances. We continuously review and monitor the performance of all practitioner types and treatments to ensure that the risk to the industry, consumers and insurers remains at or below an acceptable level. We are aware that due to the size and diverse nature of this industry there will always be a difference of opinion as to which practitioners should be undertaking which treatments. Whilst we are not, and do not wish to become regulators for the cosmetic industry, it is right that we continue to take into account all available points of view so that we can provide protection in a responsible manner when we are approached with new opportunities.” Podiatrists themselves may argue that they are better qualified to administer cosmetic injectables than some nurses as according to NHS Careers, “...to become a podiatrist...a recognised course of study leading to a Bachelor of Science (BSc) honours degree in podiatry... full-time course takes three or four years to complete... courses are modular...half the time being hands-on clinical experience.” A career in nursing is not always predicated on a degree, with diplomas of higher education and BTEC national diplomas all being routes to the profession. However many would also find it hard not to agree that there is a world of difference between using Botox® for plantar hyperhidrosis (which few podiatrists do anyway) and using

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

clinical

botulinum toxin special - hyperhidrosis

sweat >>> Dr Sotirios Foutsizoglou on botulinum toxin for treating hyperhidrosis <<<

yperhidrosis or excessive sweating is one of the few conditions that can truly be described as both a medical and cosmetic problem. Caused by hyperfunction of the eccrine sweat glands it is increasingly being treated by aesthetic practitioners because of the indication of botulinum toxin injections in its treatment.

>> What is hyperhidrosis? Hyperhidrosis is the excessive production of sweat. It usually begins in either childhood or adolescence. Although any site on the body can be affected, the sites most commonly affected are the palms and soles (palmoplantar hyperhidrosis) and/or axillae (axillary hyperhidrosis) due to the relatively high concentration of sweat glands. Axillary problems tend to start in late adolescence, while palmoplantar excessive sweating often begins earlier, average age 12-13 years. 1-2% of the global population have some form of

hyperhidrosis, whereas severe cases can reach up to 0.1% of the population. The production and excretion of sweat are mediated by the sympathetic nervous system and regulated by a gland in our brain called hypothalamus.

body temperature (hot weather, exercise, fever) or emotion. Secondary hyperhidrosis may be due to a variety of medical conditions such as thyroid problems, hormone imbalance, diabetes, obesity and certain drugs, etc.

Sweating plays an important role in the regulation of body temperature. Sweat glands produce an odourless liquid which, when decomposed by the action of bacteria, acquires a characteristic, unpleasant smell. Hyperhidrosis can either be generalised or localised to specific parts of the body as shown in table 1.

>> INDICATIONS for treatment

This condition may be idiopathic or secondary to other diseases, metabolic disorders, febrile illnesses, or medication use. Idiopathic or primary hyperhidrosis usually starts around puberty and peaks in adulthood. Studies show that there is a genetic component predisposing to the condition. Primary hyperhidrosis affects men and women equally. Primary hyperhidrosis is caused by an exaggerated response to increased

26 www.cosmeticnewsuk.com

Hyperhidrosis is a distressing condition and sufferers have usually tried a variety of modalities including antiperspirants, deodorants, iontophoresis, antimuscarinic topical agents (e.g. Glycopyrrolate cream), oral medication such as oxybutynin or beta-blockers. Those with severe hyperhidrosis may resort to surgical procedures such as endoscopic thoracic sympathectomy (ETS) to alleviate symptoms. Affected people are constantly aware of their condition and try to modify their lifestyle to accommodate this problem. This can be disabling in professional, academic and social life, causing embarrassments. Many routine tasks become impossible chores, which can have devastating emotional effects on oneâ&#x20AC;&#x2122;s individual life. Excessive sweating of the hands interferes with many routine activities, such as securely grasping objects. Some hyperhidrosis sufferers avoid situations where they will come into physical contact with others, such as greeting a person with a handshake. I have come across people who have given up their studies as they could not write on a piece of paper

T a b l e 1 . C auses o f H y pe r hid r o sis G ene r ali z ed

L o calised

• •

•

• • • • • • •

Fever Metabolic abnormalities (e.g. hyperthyroidism, hypoglycemia, menopause) Drugs {e.g. tricyclic antidepressants, Pilocarpine Hydrochloride (= systemic treatment for xerostomia), Levothyroxine etc } Neoplastic disease (e.g. Hodgkins) Neurological (e.g. autonomic dysregulation) Alcoholism Anxiety Phobias (e.g. panic attacks, agoraphobia) Cardiac Pathology (e.g. arrhythmias) Tuberculosis

• • •

• •

Emotionally induced (palmoplantar sweating is controlled by the cerebral cortex and responds to emotional stimuli rather than to increase in temperature; palmoplantar, unlike axillary, sweating does not occur during sleep or sedation!) Frey syndrome Endocrinopathy Glomus tumour (also known as glomangioma, or nonchromaffin paraganglioma) Viral infections (e.g. Herpes Zoster) Eccrine hamartomas

M edical

S u r gical

~Pharmacotherapy • Aluminium chloride based antiperspirants are usually tried as a first option. • Anticholinergic agents – They inhibit the binding of acetylcholine to the cholinergic receptor. Clinical effects usually occur within days. Better to be avoided as they may cause systemic side effects. • Neuromuscular blocking agents (i.e. Botox®) – The most popular

~Sympahthectomy reserved as the final treatment option. Upper thoracic sympathectomy has been performed for many years as therapy for hyperhydrosis and several other diseases. There are various surgical approaches available. Prior to the advent of endoscopic transthoracic sympathectomy (ETS) which involves the use of an endoscope to identify the second through fourth ganglia, these approaches involved either painful back or neck incisions with possible risk of brachial plexus, or phrenic nerve injury, or Horner’s syndrome.

Tap water iontophoresis involves applying a low intensity electrical current to the hands and/or feet or axillae by means of an iontophoresis machine and water baths containing ordinary tap water. Exactly how tap water iontophoresis works remains unclear; however the treatment has been shown to be effective in a great number of people without any significant side effects making it a safe first line treatment option.2

>> TREATMENT Hyperhidrosis is difficult to treat effectively. There are numerous options ranging from pharmacotherapy to surgical sympathectomy (see Table 3). BTX-A is a very effective treatment particularly for the axillary hyperhidrosis as will be discussed later.

T a b l e 3 . M edical vs S u r gical t r eatment f o r h y pehid r o sis

~ Iontophoresis (tap water vs anticholinergic iontophoresis)

severe cases, shirts must be changed several times during the day. Hyperhidrosis can also affect the face, neck and scalp and it tends to affect men more than women occurring later on in life. The area most commonly affected in facial hyperhidrosis is the upper band of the forehead where studies suggest that the density of sweat glands is greater, followed by upper lip and cheek. The scalp may also be affected. These areas can also be effectively treated with botulinum toxin injections. Botulinum toxin is a safe and effective treatment of excessive sweating for most people who think that their perspiration interferes with their quality of life.

With the introduction of ETS the success rate for palmar and facial hyperhidrosis is in excess of 98%, with limited side effects or serious complications. The most common side effect is compensatory truncal sweating, in about 50% of patients. ~Finally surgical excision of the affected sweat glands or subcutaneous liposuction -removes eccrine glands along with adipose tissue- can also be used mainly for axillary hyperhidrosis. Least popular methods.

A variety of machines are available for use in NHS hospitals or at home. without soaking it with sweat or musicians who had to change career as using their musical instruments became ‘mission impossible’. Hiding embarrassing sweat spots under the armpits limits the sufferers’ arm movements and pose. In

>> Contra-indications Patients suffering with myasthenia or amyotrophic lateral sclerosis, as well as patients taking certain antibiotics (e.g. aminoglycosides), and pregnant or breastfeeding women should not undertake treatments involving botulinum toxin injections.

>> How does the BTX-A work in hyperhidrosis? Sweat glands are part of skin’s adnexa (also known as skin appendages) along with hair, arrector pili muscle, sebaceous glands and nails. They can be divided into eccrine (or merocrine) and apocrine glands (see Table 2). Sweat glands are exocrine glands, found in the skin of all mammal species. In humans an extensive system of eccrine and apocrine sweat glands constitutes the primary means of thermoregulation whereas in most animals that usually have much fewer sweat glands than humans – additional thermoregulatory channels, such as panting, are required in order to achieve effective temperature regulation. Both apocrine and merocrine sweat glands contain specialised epithelial cells, called myoepithelial cells whose contractions squeeze the gland and discharge the accumulated secretions. The secretory activities of the gland cells and the contractions of myoepithelial cells are controlled by both the autonomic nervous system and by the circulating hormones.3 Physical activity, emotional stress and internal or external high temperature will stimulate sweat glands. Sequence: Autonomic nervous system activation -> contraction of myoepithelial cells -> discharge of sweat glands. Finally sweat contains mainly water as well as minerals (i.e. sodium, potassium, calcium, magnesium), trace elements, urea and lactate. Botulinum toxin A injections can effectively treat www.cosmeticnewsuk.com 27

clinical

BOTULINUM TOXIN special - hyperhidrosis T a b l e 2 . D iffe r ences between the tw o t y pes o f sweat glands E cc r ine sweat glands

A p o c r ine sweat glands

~Coiled secretory structure in subcutaneous tissue with a single duct passing to the surface. ~Decreased or absent in skin grafts, leading to dryness.

~Found in the axilla and inguinal regions ~Secrete into hair follicles ~Become active at puberty

localised hyperhidrosis by blocking the smooth muscle activity of the sweat glands. The anhidrotic effect of BTX-A can last up to nine months. In addition, treatment with BTX-A showed marked improvement of unpleasant body odour by reducing the moist environment, which is favourable for bacterial overgrowth.

>> Axillary hyperhidrosis

last up to nine months. Other areas that can be treated with BTX-A include • Palmar hyperhidrosis • Foot hyperhidrosis • Facial hyperhidrosis • Scalp and neck hyperhidrosis • Frey’s syndrome (= refractory localised hyperhidrosis occurring after parotid surgery)

Patients are advised to shave their armpit two to three days prior to the procedure. On the day of the procedure the doctor identifies the worst affected area by performing an iodine test. An iodine solution followed by a starch solution will be applied under the armpit. The sweating areas take a blue colour which will guide the doctor’s injection points. A tiny amount of muscle relaxing toxin is injected in a grid like pattern

Intradermal botulinum toxin treatment for Palmar Hyperhidrosis

> > A tr e a t m e n t a l g o r i t h m f o r a x i l l a r y a n d pa l m o p l a n t a r h y p e r h i dr o s i s i s p r o p o s e d b e l o w < < F o c a l H y p e r h y dr o s i s Botulinum toxin injections for the treatment of Axillary Hyperhidrosis. A starch iodine test is used to outline the area of excessive sweating

over the affected area. The injections cause minimal discomfort as they are conducted on a superficial level with an extremely fine needle. However sensitive patients can benefit from a topical anaesthesia. The effect starts being felt two days after the injections, the action of the treatment gradually increases and reaches peak efficacy after one month. The duration of action varies according to the patient, the toxin’s concentration and the total injected dose. I personally use 50U of Botox® per armpit in a dilution of 4ml of bacteriostatic 0.9% sodium chloride for greater diffusion. However in severe cases up to 200 units of Botox® per axilla can be used. Results can

t o p i c a l a n t i p e rs p e r a n ts ( m e t a l s a lts )

btx-a

ta p wat e r i o n to p h o r e s i s

btx-a

l o c a l e x c i s i o n o f s w e at g l a n ds ( o r t h o r a c a l s y m pa t h e c t o m y )

t h o r a c a l s y m pa t h e c t o m y

References Schwartz R.A, Altman R. http://www.hyperhidrosiscare.com/ Elkhyat A & Agache P. Treatment of hyperhidrosis by iontophoresis of weakly mineralised water. 1993. Cutaneous Biophysics Laboratory, Department of Functional Dermatology, 25030 Besancon, France. http://en.wikipedia.org/wiki/Sweat_gland

28 www.cosmeticnewsuk.com

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clinical

botulinum toxin special - clinical study

Crow-tox// We summarise the results of a study comparing two Botulinum Toxin Type A preparations for treating crow’s feet Authors: Welf Prager MD,Estherwissmu Ller MD, Bianca Kollhorst MSc, Stefanie Williams MD and Ina Zschocke PhD

ABSTRACT BACKGROUND: This is the first double-blind, randomised, proof-of-concept study to compare the clinical effectiveness of botulinum toxin type A (BoNTA) free of complexing proteins with a BoNTA complex (BTXCo) in the treatment of crow’s feet. PATIENTS AND METHOD: Twelve U of each product were compared in an intra-individual study in 21 participants with a facial wrinkle scale (FWS) score of 2 to 3. Evaluations were done for up to four months. Subjects with an improvement of at least 1 point on the FWS were considered responders. RESULTS: One month after treatment, the percentage of responders was slightly higher for the BoNTA side (95%) than the BTXCo side (90%). After four months, both sides still showed good efficacy, with an 84% response rate and greater than 30% FWS reduction (no statistically significant difference between the products). After one month, FWS score at rest was approximately 66% lower for BoNTA, versus 63% lower for BTXCo. After four months, FWS reduction was approximately 50%. CONCLUSION: Both botulinum toxin A products displayed high efficacy and good tolerability at a dose ratio of 1:1, with no statistically significant differences between them. The high response rates observed after four months suggest a good effectiveness beyond this observation period. This study was funded by an unrestricted educational fund from Merz, which also supplied the study medication.

30 www.cosmeticnewsuk.com

otulinum toxin A (BTX-A) has played an important role in the treatment of mimic wrinkles of the upper and lower face for many years.1,2 By blocking the presynaptic release of acetylcholine, BTX-A causes complete but reversible muscle relaxation,3 which in turn leads to a reduction of mimic wrinkles in the treated area.4,5 A number of studies have proven the high efficacy of BTX-A, especially in treating periorbital lines.1,6 According to the consensus papers, the recommended dose of BTX-A for treating crow’s feet is eight to 16 mouse units (MU) in women and 12 to 16MU in men.1,2,7 This dose is usually divided between three or four injection sites. Lowe and coworkers concluded that the optimum dose of botulinum toxin type A complex (BTXCo; Botox®/Vistabel®, Allergan, Inc., Irvine, CA) is 12MU per side.8 Because of a large variation of distribution and severity in periorbital lines, the exact number of injection sites and dose distribution should be adjusted to individual patients’ needs. BTXCo contains a botulinum toxin type A complex as active ingredient. The successful treatment of periorbital lines with BTXCo has been shown in several clinical trials.8–10 In contrast to BTXCo, the more recently developed BoNTA (Xeomin®/Bocouture®, Merz Pharmaceuticals, Frankfurt, Germany) is free of complexing proteins, which are not needed for its therapeutic effects. The foreign protein load in BoNTA free of complexing proteins has been reduced through means of a unique purification process.11–13 A high load of foreign protein is thought to be one of the most important risk factors for formation of neutralising antibodies, with subsequent loss of therapeutic efficacy.14,15 Blu¨mel and colleagues confirmed in an animal study that there was no neutralising antibody formation against BoNTA, even after administration of high doses at short injection intervals.16,17

There are now also a number of clinical studies published examining the aesthetic use of BoNTA, including treatment of periorbital lines.18–22 comparative studies between BoNTA and BTXCo have only been performed for neurological conditions such as torticollis and blepharospasm. Five clinical trials (phase I–III) with more than 800 patients have indicated high efficacy and good tolerability for BoNTA and BTXCo at a dose ratio of 1:1.23,24 The clinical outcomes with regard to efficacy, onset of action, and duration of effects and the side effect profiles were similar.17,25–27 The aim of our proof-of-concept study was to compare the efficacy and tolerability of BoNTA with that of BTXCo in aesthetic use treating crow’s feet at a dose ratio of 1:1. This was a prospective, randomised, double-blind, intraindividual, split-face comparison.

Patients and Methods Twenty-one adult participants (two men and 19 women, aged 44.8 + 8.7) with moderate to severe periorbital lines (grade 2 to 3 on a 4-point facial wrinkle scale) were included. The wash-out period for previous botulinum toxin therapy was six months. The ethics committee of the Medical Council Hamburg approved the study.

Treatments A German board-certified dermatologist performed all treatments. One vial (100MU) of BoNTA was reconstituted with 2.0mL of 0.9% sterile saline solution. One vial (50MU) of BTXCo was reconstituted with 1.0mL of 0.9% sterile saline. Each participant was injected with a total dose of 12MU BoNTA and 12MU BTXCo (randomised assignment of study products to left and right side) into the lateral aspects of their orbicularis oculi muscles. The total dose on each side of the face was divided into three injections of 4MU

A Figure 1. Clinical photographs of a 47-year-old woman at rest before treatment (A and B); at maximum contraction before treatment (C and D); at maximum contraction 1 month after treatment with botulinum toxin type A complex (right side) (E) and 1 month after treatment with botulinum toxin type A free of complexing proteins (left side) (F)

each (0.08mL volume per injection site). The injections were performed 1cm lateral to the orbital rim at the level of the superior and inferior orbital rim and the lateral canthus.

Evaluation of Efficacy and Tolerability An evaluation of efficacy and tolerability was performed after one (T1), three (T2), and four months (T3). At baseline (T0) and after treatment (T1, T2, T3), the injecting dermatologist took standardised photographs at rest and at maximum contraction of the orbicularis oculi muscle (FotoFinder, Teachscreen Software, Bad Birnbach, Germany). The primary efficacy criterion was crow’s feet at maximum contraction (laughing). A second, blinded, independent investigator evaluated standardised clinical photographs after completion of the study. The assessments of baseline (T0) and follow-up photographs (T1T3) were performed according to a validated 4-point Facial Wrinkle Scale (FWS: 0 = no, 1 = mild, 2 = moderate, 3 = severe crow’s feet). Responders were defined as participants displaying an improvement of at least 1 point on the FWS at maximum contraction. The secondary efficacy criterion was crow’s feet at rest. The blinded, independent investigator also assessed this using standardised photographs.

For statistical analysis a McNemar chiquadrat test (two-sided testing, significance level a = 0.05, p = 1.0) for testing of

increased to 1.74 (BoNTA, free of complexing proteins) and 1.68 (BTXCo) (Figure 2). While the response rate after one month was

differences between the treatment products was performed at months one, three, and four. In addition to the investigator evaluation, participants assessed treatment effects at maximum contraction according to a wrinkle scale ranging from _4 (very strong worsening of crow’s feet) to 14 (very strong improvement of crow’s feet). Participants rated tolerability using a 5-point scale (very good, good, moderate, bad, very bad).

found to be 95% on the facial side treated with BoNTA, free of complexing proteins, there was a 90% response rate on the BTXCo treated side. The response rate after three and four months was 89% and 84%, respectively, in both groups (Figure 3). No statistically significant differences in response rates were found between the two treatment sides in the entire observation period of four months. The periorbital wrinkle severity at rest was moderate at baseline with a wrinkle score of 2.05 on both sides. One month after treatment this improved to 0.7 (BoNTA, free of complexing proteins) and 0.75 (BTXCo). At four months the wrinkle score increased slightly to 0.95 (BoNTA, free of complexing proteins) and 1.0 (BTXCo), which translates to 53% (BoNTA, free of complexing proteins) and 51% (BTXCo) of baseline values (Figure 4).

Results Of the 21 enrolled participants, two participants had to be excluded at T1 and T2, respectively, due to lack of compliance. Therefore 20 participants were included into statistical analysis at month one (T1) and 19 participants at months three (T2) and four (T3).

Investigator Assessments At baseline (T0), participants showed moderate to severe wrinkles at maximum contraction, with an average FWS score of 2.6 on both sides (Figures 1 and 2). One month after treatment, participants were found to display only mild wrinkles with a mean FWS score (at maximum contraction) of 1.0 and 1.15 on the side treated with BoNTA, free of complexing proteins, and BTXCo respectively. The mean FWS score at T3

Patient Self-Assessment One month after treatment the majority of participants (70% for BoNTA, free of complexing proteins and 65% for BTXCo) assessed the severity of their crow’s feet on both sides of the face as markedly or very markedly improved (Figure 5). After four months 15% of participants in both treatment groups rated their crow’s feet as markedly or very markedly improved.

Figure 2. Mean Facial Wrinkle Scale scores at maximum contraction before and after treatment with botulinum toxin type A free of complexing proteins and botulinum toxin type A complex evaluated by a blinded investigator.

www.cosmeticnewsuk.com 31

clinical

BOTULINUM TOXIN special - CLINICAL STUDY

Figure 5. Subject self assessments 1 month after treatment: 9-point wrinkle scale ranging from _4 (very strong worsening of crow’s feet) to 14 (very marked improvement of crow’s feet).

Figure 3. Response rate at maximum contraction after treatment with botulinum toxin type A free of complexing proteins and botulinum toxin type A complex. Responders are defined as participants with an improvement in Facial Wrinkle Scale score of at least 1 point.

Tolerability The majority of participants (>68%) rated tolerability (evaluated according to a subjective 5-point self-assessment scale) as very good over the entire observation period. One serious adverse event (facial nerve paralysis due to a herpes simplex infection eight weeks after treatment with BoNTA) was reported during the study, although this was most likely not treatment related.

Discussion BTX-A is a well-established treatment for facial mimic lines. One of the most commonly and successfully treated areas in this context is lateral periorbital lines (crow’s feet). Comparative studies of BoNTA and BTXCo for torticollis and blepharospasm have confirmed dose equivalence between these products.17,26,27 No differences in diffusion characteristics are expected between BoNTA and BTXCo.28,29 The outcome of our randomized, double-blind clinical study confirmed good efficacy and tolerability for both products in the treatment of periorbital wrinkles. The split-face design allowed for intraindividual comparison, which greatly reduces the risk of confounding influences. The moderate to

[References] 1. Carruthers J, Fagien S, Matarasso SL, and the Botox® Consensus Group. Consensus recommendations on the use of botulinum toxine type A in facial aesthetics. Plast Reconstr Surg 2004;114(Suppl 6):1–22. 2. Sommer B, Bergfeld D, Sattler G. Konsensusempfehlungen zum Gebrauch von Botulinumtoxin A in der a¨sthetischen Medizin – Klinische Erfahrungen und Empfehlungen langja¨hriger Anwender. JDDG 2007;5(Suppl 1):1–29. 3. Brin MF. Botulinum toxin: chemistry, pharmacology, toxicity, and immunology. Muscle Nerve 1997;20(Suppl 6):146–68. 4. Fagien S. Botox® for the treatment of dynamic and hyperkinetic facial lines and furrows: adjunctive use in facial aesthetic surgery. Plast Reconstr Surg 1999;103:701–3. 5. Pierard GE, Lapir CM. The microanatomical basis of facial frown lines. Arch Dermatol 1989;125:1090–2. 6. Klein AW, Carruthers A, Fagien S, Lowe NJ. Comparison among botulinum toxins: an

Figure 4. Mean Facial Wrinkle Scale scores at rest before and after treatment with botulinum toxin type A free of complexing proteins and botulinum toxin type A complex evaluated by a blinded investigator.

severe wrinkles at maximum contraction before treatment were 62% lower for BoNTA and 56% lower for BTXCo 1 month after treatment, which is equivalent to mild expression lines. At that time,

efficacy of both products. One month after treatment, 70% of patients receiving BoNTA and 65% of patients receiving BTXCo rated the severity of their crow’s feet as markedly or very

the response rate on the BoNTA side (95%) was slightly better than on the BTXCo side (90%), although this difference was statistically not significant. After four months, at the end of the study period, both sides still showed a very good response rate of almost 85%. At this time, the severity of wrinkles was still 30% lower on average on both sides. The response rates at the end of the study indicate that both products might be effective beyond the observation period of four months, but further studies are needed to examine the duration of action in more detail. We observed an even stronger improvement of lateral periorbital lines at rest. The initially moderate severity of wrinkles at rest at baseline was approximately 66% lower for BoNTA and 63% lower for BTXCo one month after treatment. After four months wrinkle severity was still 50% lower on both sides. The significant improvement of crow’s feet at rest demonstrates the importance of muscular action for periorbital lines, even when the muscle is supposedly relaxed. Participant self-assessment confirmed the good

markedly improved.

evidence-based review. Plast Reconstr Surg 2008;121:413e–22e. 7. Carruthers JD, Glogau RG, Blitzer A. Facial Aesthetics Consensus Group Faculty. Advances in facial rejuvenation: botulinum toxin type A, hyaluronic acid dermal fillers, and combination therapies - consensus recommendations. Plast Reconstr Surg 2008b;121(5 Suppl):5–30. 8. Lowe NJ, Ascher B, Heckmann M, et al. Botox® Facial Aesthetic Study Team. Double-blind, randomized, placebo-controlled, doseresponse study of the safety and efficacy of botulinum toxin type A in subjects with crow’s feet. Dermatol Surg 2005;31:257–62. 9. Lowe N, Lask G, Yamauchi P, et al. Bilateral, double-blind, randomized comparison of 3 doses of botulinum toxin type A and placebo in patients with crow’s feet. J Am Acad Dermatol 2002;47:834–40. 10. Matarasso SL. Comparison of botulinum toxin types A and B: a bilateral and double-blind randomized evaluation in the treatment of canthal rhytides. Dermatol Surg 2003;29:7–13. 11. Bigalke H. Properties of pharmaceutical products of botulinum Neurotoxins. In: Jankovic J, Albanese

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A, Atassi MZ, Dolly JO, Hallett M, Mayer N, editors. Botulinum Toxin Therapeutic Clinical Practice & Science. Amsterdam: Elsevier; 2009, chapter 32. 12. Dressler D, Benneck R. Pharmacology of therapeutic botulinum toxin preparations. Disabil Rehabil 2007;29:1762–8. 13. Dressler D. Pharmacological aspects of therapeutic botulinum toxin preparations. Nervenarzt 2006;77:912–21. 14. Borodic G. Immunologic resistance after repeated botulinum toxin type A injections for facial rhytides. Ophthal Plast Reconstr Surg 2006;22:239–40. 15. Lee SK. Antibody-induced failure of botulinum toxin type A therapy in a patient with masseteric hypertrophy. Dermatol Surg 2007;33:105–10. 16. Blu¨ mel J, Frevert J, Schwaier A. Comparative antigenicity of three preparations of botulinum neurotoxin type A in the rabbit. Neurotoxic Res 2006;9:238. 17. Jost WH, Blu¨ mel J, Grafe S. Botulinum neurotoxin type A free of complexing proteins (Xeomins) in focal dystonia. Drugs 2007a;67:669–83.

After four months, this had dropped to 15% of participants in either group. The majority of participants evaluated tolerability as good to very good throughout the entire observation period. A facial nerve paralysis, a serious adverse event, that occurred eight weeks after treatment in the context of a herpes simplex infection was most likely not related to the study product.

Conclusion The outcome of our four-months intra-individual, double-blind comparison of periorbital lines (crow’s feet) demonstrated that both botulinum toxin A products (used in a 1:1 dose ratio) offer good efficacy and tolerability. Small differences observed between the products were statistically not significant. In summary, BoNTA and BTXCo have been found to be long-lasting, effective, safe therapeutic options for periorbital lines, without a significant difference between them.

18. Prager W, Zschocke I, Reich C, et al. Beeinflusst die Verdu¨ nnung das kosmetische Ergebnis von BoNTA zur Behandlung der Glabellafalte. Hautarzt 2009;10:815–20. 19. Schleyer V, Berneburg M. Wirksamkeit und Sicherheit von Botulinum Neurotoxin Typ A (Xeomins) in der Behandlung der Glabellafalte. Kosmet Med 2008;3:36–9. 20. Prager W, Zschocke I, Turnbull K, Steinkraus V. Wirksamkeit und Vertra¨ glichkeit des neuen, komplexproteinfreien Botulinumtoxins (Xeomins) bei der Behandlung von mimischen Falten – Untersuchungsergebnisse. Kosmet Med 2007;2:81–4. 21. Fritsch C. Wirksamkeit des neuen, komplexprotein-freien Botulinumtoxins (Xeomins) in der Therapie mimischer Lachfalten. Kosmet Med 2006;3:124–9. 22. Khorram R. Faltentherapie mit einem neuen deproteinisierten Botulinumtoxin A (Xeomins) bei 40 Patienten. Plast Chir 2006;6(Suppl 1):55. 23. JostW, Grafe S, Comes G. Efficacy of NT 201 (Xeomins) in focal dystonia. Mov Disord 2008;23:80. 24. Benecke R, Grafe S, Sassin I, Comes G. Clinical

safety of NT201 (Xeomins): a meta-analysis. Mov Disord 2008;23:170. 25. JostW. Efficacy and safety of botulinum neurotoxin type A free of complexing proteins (NT201) in cervical dystonia and blepharospasm. Future Neurol 2007;2:485–93. 26. Roggenkamper P, Jost WH, Bihari K, et al. Efficacy and safety of a new botulinum toxin type A free of complexing proteins in the treatment of blepharospasm. J Neural Transm 2006;113: 303–12. 27. Benecke R, Jost WH, Kanovsky P, et al. A new botulinum toxin type A free of complexing proteins for treatment of cervical dystonia. Neurology 2005;64:1949–51. 28. Maack M, Kru¨ ger J, Bayrhammer J, et al. Beeinflussen Komplexproteine das Diffusionsverhalten. Der Deutsche Dermatol 2007;55/8:562–3. 29. Wohlfahrt K, Kampe K, Bigalke H. Pharmakokinetic properties of different formulations of botulinum neurotoxin type A. Mov Disord 2004;19(Suppl 8):65–7.

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clinical

DEVICES - RF Micro-Needling

M akin g Waves

Antonia Mariconda on why micro-needle radio-frequency systems are so sought after

s ‘The Cosmedic Coach’, I am always excited to read and see new devices entering the aesthetics market, especially when they make tempting promises. My clients have been consulting with me over the last few months, both in the office and on Twitter and Facebook, asking me if micro-needling techniques really deliver what they promise. One new device that has caught my eye more recently is the very discreet emergence of an aptly named Secret RF – that is, Radio-frequency – making silent but powerful ‘waves’ in the aesthetic ocean. The RF Aesthetics ‘Secret’ is a Micro-Needle Fractional RF System. Based on the synergistic effect of precisely controlled bi-polar radiofrequencies combined with minimally invasive micro-needles, its creators say that it is perfect for non-surgical face-lifting, wrinkle reduction and scar reduction by dermal coagulation.

Apparently, this combination reduces both treatment time and downtime by significant amounts when compared to fractional laser-based treatments. What I found particularly interesting was that the RF Aesthetics ‘Secret’ is suitable for treating all skin types – including darker skin, with a low risk of skin burns and PIH. A multifaceted device, the Secret RF is designed for facial treatments including; • Nons-urgical face-lifting • Wrinkle reduction • Skin tightening • Skin rejuvenation • Acne scars• Age spot reduction • Pore reduction Body Treatments • Scars • Stretch Marks • Keratosis Pilaris

Before and after treatment (Pictures courtesy of Secret RF)

How does it work? Precisely controlled bi-polar RF energy is delivered to a specific depth of epidermis through minimally invasive micro-needles to induce dermal coagulation. The micro-needle penetration depth can be adjusted from 0.5 to 3.5mm selectively for different target areas and symptoms.

Before and after treatment (Pictures courtesy of Secret RF)

Less pain, less damage A fractional laser penetrates the skin and causes an inverted triangle of damage to the epidermis. This damage to the skin is even more extensive if the target area is deeper. Meanwhile, the RF Aesthetics ‘Secret’ delivers precisely controlled RF energy only to the target areas by adjusting the proper depth selectively with minimally invasive micro-needles. Such precisely controlled depth by micro-needles minimises both pain and downtime in comparison with fractional laser treatment. Upon visiting Wimpole Aesthetics to find out more about Secret RF, Dr Joshua Berkowtiz, who has recently acquired the device, stated that: “In respect to Thermage and Pelleve, I think the Secret RF is achieving some positive results, as it eliminates a lot of the ‘guess work’ involved

Antonia Mariconda, also known as The Cosmedic Coach, is recognised as a leading authority on health, beauty and cosmetic surgery in the UK. Quoted in publications such as Top Santé, and newspapers such as The Evening Standard, and Daily Mail, Antonia is also a national health and beauty journalist and the author of The Essential Guide to Acne published in September 2009 (Forward Press), and most notably The Cosmetic Surgery Companion – Look and Feel Beautiful (Apple Press) 2010. In her role as The Cosmedic Coach, Antonia advises clients around the world on where and where not to shop for cosmetic surgery, beauty and anti-ageing treatments. Her client list includes A-list celebrities, royals and VIPs.

Before and after treatment (Pictures courtesy of Secret RF)

in these previous treatments. With the Secret RF I have found that patients have experienced some excellent results, with minimal downtime and less expense financially. This is making it popular and patients are returning for further treatment elsewhere on the face and body. More importantly, the device works brilliantly on darker skin types, making it now one of the most newly acquired but sought after procedures in my clinic.” Dr Berkowtiz further added, “I have seen some promising results emerge from the Secret RF device. In comparison to other micro-needling RF devices currently marketed within the aesthetics industry, it seems to be the most price effective when comparing unit cost”. Micro-needling with radio-frequency certainly gets my thumbs up, and I’m going to be sending patients your way if you have this technology in your clinics. If you haven’t already discovered the benefits, it’s about time you considered the long www.cosmeticnewsuk.com 37

clinical

DEVICES - RF Micro-Needling term benefit of investing in this treatment type in your clinic. The savvy consumer and the press and media are constantly asking me for aesthetic procedures that really make a difference; I like technology such as Secret RF, Intracel, ePrime, and Fractora. These are treatments I can advocate as being safe, effective and great alternatives to those which already exist.

The Alternatives Thermage The aim of Thermage, as with many facial treatments, is to smooth and tighten the skin. This non-invasive procedure, with its muchtouted deep-heating technology, promises to renew patients’ collagen with just a single treatment, working across the entire spectrum of the face; nose, chin, cheekbones, nasolabial folds and jaw line. With Thermage, energy is delivered to the underlayer of the skin, stimulating and tightening collagen to engender immediate results. Side

effects, meanwhile, are minimal, with rare instances of swelling, bumps and redness cropping up among a minority of users. While wholly safe and an entirely viable alternative to lasers or injections, a small number of individuals do not to respond to Thermage for various reasons; in my opinion and experience of referring patients for Thermage, a lot of guess work has to be factored into this treatment, as results really can be unpredictable. Pelleve Also espousing a non-surgical alternative to tackling wrinkles is the romantically-named Pelleve. The Pelleve Wrinkle Reduction System, to give it its full title, works its magic in under an hour, and, according to some recipients of the treatment, feels more like a warm, gentle massage than a jolt of radio-frequency energy. With Pelleve, these radio-frequencies radiate deeply into the skin, stimulating heat in the area where skin and fat conjoin. The resultant heat is said to modify the structure of the skin’s collagen ‘bundles’, leading to contraction and fresh

collagen growth. In other words, it yields a visible improvement in smoothness and tone. Virtually painless, quick and entailing zero downtime, Pelleve has proven to be a popular wrinkle-reduction treatment for just these reasons. Thanks to its renewal of collagen, Pelleve improves skin texture and firmness for at least six months after the initial procedure. Consumers, of course, are a fickle bunch, and are ever eager to try out the latest treatments that are receiving critical acclaim. Genuine Dermaroller Dermaroller is a treatment that I am constantly asked about; Dermaroller has replicated Pelleve’s success, and quickly set about grabbing its fair share of the skincare market.Dermaroller works by producing thousands of micro-medical holes in the dermis, impelling the skin to repair, regenerate and, ultimately, produce fresh cells and elastin. While less of a quick fix than the aforementioned treatments, Dermaroller is a proven procedure that delivers tangible results. Practitioners advocate three separate Dermaroller

Before and after Rit nissim non henim dolorercil delisi elessequipit alit wisit ut lum nibh et utpate. Per iriurero dolese min eummodo loreet inim iriure dolortie doloreetOborperiusci et vel ulla feum

procedures with six weeks between them; as a consequence, Dermaroller treatment is more expensive than single treatment solutions. Within a few weeks of receiving Dermaroller treatment, your skin should become livelier, fresher and altogether smoother. In my opinion, Micro-Needle Fractional RF Systems can achieve the same results in fewer sittings. This makes it a seriously viable alternative, and one that I advocate and prefer. With science in the field advancing rapidly, it is not just Dermaroller that embodies the latest technology. Micro-needling with radio-frequency ticks the same boxes as conventional facelift procedures; as well as tightening skin, drastically reducing wrinkles and reducing pore size, this procedure is refreshingly brief – it can be carried out in the space of just an hour. Micro-needling with radio-frequency is comparable to Dermaroller treatments in that

38 www.cosmeticnewsuk.com

it utilises ultra-fine gold needles to penetrate the skin. This may sound painful, but thankfully the face is numbed with local anaesthetic for 40 minutes beforehand, ensuring that discomfort is kept to a minimum. The radio-frequency energy is deployed inside the skin itself, heating the deep (reticular) dermis and delivering a considerable volumetric improvement in skin tone to reduce the signs of ageing. As with all of the above treatments, microneedling with radio-frequency stimulates the client’s production of fresh collagen; as new fibres tighten and reconstruct, damaged cells are denatured and the skin’s volume is revitalized. It’s important that the thermal effects of microneedling with radio-frequency are understood. Because the deep tissue of the skin is targeted, the top layer is left unaffected, and it does not overheat. In fact, the only visible signs recipients

can expect in the immediate aftermath of micro-needling treatments are some faint facial markings. These microscopic needle points swiftly fade, however - and when they do, expect reduced pore sizes, an improvement in the appearance of scars or blemishes and a more youthful glow.

Other Micro-Needle Radiofrequency Devices Making Waves... Intracel Intracel is a treatment for stimulating skin without the downtime of total resurfacing using traditional invasive treatments. The treatment works by fractional radiofrequency and dermal needling, heating the deep dermis and causing stimulation of the tissue to produce the important deep elements of healthy skin, such as collagen and elastin. Uniquely highly effective doses of radiofrequency can be used, as the tiny insulated needles heat

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Before

After x3 treatments

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INTRAcel is innovative; produces reliable results; reduces the signs of ageing; eliminates wrinkles and corrects scarring all with little or no downtime, allowing your patients to resume daily life quickly. INTRAcel can help with: • Fine lines • Wrinkles • Skin texture

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clinical

DEVICES - RF Micro-Needling

only the dermis leaving the superficial skin smooth and undamaged, with short-acting redness. The problem: Sagging skin due to weight loss or ageing; stretch marks or even scarring. The treatment: Tiny insulated needles that penetrate deep into the dermis and heat the tissues for micro-seconds. The surrounding tissue is left unaffected, so the healing time is much faster than if the entire area is treated at once. The results: The natural healing process of the body produces new, healthy and tighter skin structure in the treated area and the surrounding skin. Downtime: None, you can return to normal activities straight away. Leading dermatologist, Dr Nick Lowe on Intracel, “Intracel is the latest and safest treatment of its kind in my opinion; it can be used on any part of the body and on any skin type. It can be used for an array of problems, from scar damaged skin, acne, and loose skin, as well as for wrinkles and skin tightening. Because it does not damage the epidermis, it is very safe to use on skin of any colour. What sets it apart from other systems is that the Radio-frequency is delivered through multiple microscopic needles at whatever depth you want it at, and therefore it avoids injury to the epidermis. We’ve used it for over a year; there are some different devices out there which we have tested, but we prefer insulated needles. We use Intracel in combination with some of our creams and treatments. Recovering from the Intracel only takes a day or so, and you can also use it with more superficial surface treatments such as Fraxel and IPL. It’s a very versatile device by itself, but it also works well in combination with others.”

ePrime Elevate with ePrime is a minimally invasive aesthetic treatment which is designed to lift, tighten and volumise the skin from its deeper layers in just one single 45-minute treatment. The non-surgical skin rejuvenation treatment harnesses the deep delivery of bi-polar radio-frequency to the dermis, in order to provide results around 37% effective compared to a traditional face-lift procedure, 40 www.cosmeticnewsuk.com

The ePrime treatment

The advantage with ePrime against all other devices it has direct feedback, with ePrime you are delivering a very precise treatment but at a fraction of the recovery costs. ePrime is hailing itself as a safe and effective alternative to surgeries such as face-lifts, without the downtime. Illustrating its efficacy and popularity, the country’s leading cosmetic physicians Dr David Eccleston, Dr Helen Fernandez and cosmetic surgeon Dr Alex Karidis are all ePrime Practitioner Partners. Dr Karidis comments, “Up until now, all RF devices have deployed their radio-frequency energy to the surface of the skin and not directly into the skin. The problem has been that it was never quite certain what precise amount of energy was actually getting into the deeper parts of the skin, and whether that was enough to stimulate collagen production sufficiently. This led to an increased variability of results. With the ePrime, however, treatment variables are eliminated and therefore a practitioner can now be assured that ePrime will deliver the exact treatment temperature which they specify, wherever they want it.” Dr David Eccleston adds, “The ideal candidate for the ePrime procedure is typically someone who has some mild to moderate degree of skin laxity, and who wants to improve their skin firmness and volume without undergoing a skin-tightening procedure such as a face-lift. For these types of patients, I think that the ePrime will prove to be very successful. The advantage with ePrime against all other devices it has direct feedback,

with ePrime you are delivering a very precise treatment. Patient feedback has generally been very good, and discomfort is routinely 1/10. Down time is probably from two to five days, you can wear makeup straight away. The heat does cause some swelling in some more than others. You do not get a lot of bruising with ePrime” Fractora Fractora is a fractional radio-frequency treatment which provides anti-ageing improvements to skin tone and texture, for a more radiant appearance through ablation and skin resurfacing. Fractora delivers radio-frequency energy to the skin via an array of pins, which produce localised heat and small micro-lesion dots in the treatment area. The gentle heat generated by the Fractora pins in the sub-dermal tissue promotes collagen restructuring for skin rejuvenation and an improved appearance in the skin. The methodical scattering of micro-lesions allows the skin to heal faster than if the entire area was ablated. Physicians can offer a versatile fractional treatment which can provide results up to 1mm in depth ranging between non-ablative and minimally ablative. Fractora can be used in areas that demonstrate fine or deep wrinkles, scars, and discolored red or brown skin tones. The most common areas of treatment are the lower eyelids, upper eyelids, smile lines, cheeks, mouth and neck.

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dermatology - scarring

S cared to be scarred … Theresa Bush, M.B.B.S on medical micropigmentation for scarring, birthmarks and other surface skin impefections

he majority of the population has scars of one kind or another. Whether as a result of childhood mishaps, surgical procedures, trauma, illness or skin complaints, and most of us are not greatly affected by their presence. However for others, scars can have a debilitating effect on self-confidence and self-image, compromising psychological and emotional wellbeing. In some cases, they can be a daily reminder of a traumatic or unpleasant event, and affect the way we dress, style our hair or carry ourselves. Micropigmentation or permanent skin camouflage is a subdivision of dermatological and cosmetic surgery that refers to the technique of inserting flesh-toned pigments into the skin to aesthetically improve a wide range of dermatological and surgical issues. The technique is routinely used to conceal various skin conditions including surgery scars; hyper or hypo pigmented skin (the darkening or lightening of skin); vitiligo; alopecia,birth marks; cleft palates, trauma scars; stretch marks, burns, “Port-wine stains”; as well as a variety of other surface skin imperfections.

What is Micropigmentation? Much of the work I do involves either ‘normalising’ irregular skin colour or matching damaged skin to the surrounding area so it blends naturally. Despite advances in treating pigmented nevi, post-inflammatory hyperpigmentation, hypopigmentation, vitligo and striae, such abnormalities can resist treatment. However, for many patients with these conditions, micropigmentation can provide a solution—not curing the condition,

After

but providing a good cosmetic result that helps rebuild patients’ confidence.

Technique, equipment and pigments Historically, physicians used the same equipment for micropigmentation as tattoo artists, however, now a range of medical grade electrical and digital apparatus consisting of a tube and needle system exists that are able to puncture and inject pigment into the skin upwards of 180 times per second. Pigments used in micropigmentation are dermatological hypoallergic, nontoxic, tissue-stable pigments. Micropigmentation pigments differ from traditional tattoo inks in that they do not contain phenylenediamine and consist of minute particles of less than one micron suspended in a liquid, as opposed to fully dissolved inks which are used for traditional tattooing. Depending on skin type, condition treated and level of exposure to the sun, skin pigmentation will last anything from 1 to 5 years and in some cases indefinitely.

Case 1 Procedure (see above) To minimize patient discomfort a local or

42 www.cosmeticnewsuk.com

prescription topical anesthetic is used. Pigment dye is then selected from a range of flesh tone medical pigments and blended to match the patient’s natural skin colour surrounding the affected area. Predicting the colour outcome is dependent on the experience of the practitioner. Once pigments are decided and the area being treated is numb, pigments are then inserted between the superficial and middle dermal layers of the skin, permanently fixing the pigments intracellularly and extracellularly, within dermal mononuclear cells and collagen fibers, respectively. The area being pigmented is stretched taunt with the thumb and index finger while making vertical movements over the surface of the skin in an overlapping manner. Hemostasis is maintained by applying pressure on the area. A dressing, along with topical antibiotics and anti-inflammatory drugs, may be given postoperatively. Treatments are scheduled 4 to 6 weeks apart until the desired effect is achieved. At 6 months some patients may require a “touch-up”. Standard tattoo inks must not be used as these inks have a high rate of oxidation, migration and are known to change colour in the skin, and in some instances cause severe allergic reaction and granulomas. An aftercare package is given to the patient that includes antibiotic gel, vitamins A and D ointment as well sun block. Procedures are scheduled 4-6 weeks apart. The results of this approach are immediate and its non-invasive nature has made it a preferred option for many patients. The procedure does not require surgical sedation or hospitalisation.

Birthmark before treatment Before

After

Before

After

Case 2: A 24-year-old female of Caribbean descent presented with severe stretch marks following child birth resulting in negative self-confidence and low self esteem. Patient tried numerous oils, creams and laser treatments with no noticable improvement before undergoing medical micropigmentation. 6 weeks following medical micropigmentation a significant improvement was noted. While many patients see an improvement in just one treatment, 3-4 treatments are generally required to see noticeable results with improved texture and appearance of mature, white striae in skin types I-IV. Factors Affecting Micropigmentation No two individual skin tones are exactly alike. Melanin content, vascularity, translucency, laxity, thickness, health, age, topography, scar tissue, condition, capillary blood flow and overall skin tones need to be taken into consideration before implanting pigments. Dermis thickness varies, but is generally at a depth around 1.5 mm from the surface of the skin. In order for the pigment to be retained uniformly in the dermis, the optimum level of deposition is in the upper and midpapillary layers. Pigmented injected into the epidermis is short lived through natural exfoliation. Pigment deposited too close to the surface will not retain colour as a majority of the pigment will be lost postoperatively when a crust (pigment extrusion) forms and falls off between 7-14 days after treatment. Pigment deposited too deeply is carried away by the macrophages (pigment migration) after 2 to 3 months.

Adverse Effects Immediate adverse effects of micropigmentation are few and if present at all will usually become evident in the first week following a procedure. These typically stem from poor quality inks, inexperience of the practitioner, improper technique or lack of adherence to asepsis. Bruising, heavy crusting, edema lasting more than a week, reactivation of herpes simplex virus, and secondary bacterial infection and in rare cases allergic reaction to pigments may occur (1 in 5 million). One major concern, particularly in the UK is that micropigment procedures can currently be performed by non-medical and non-professional persons with little or no knowledge of dermatological conditions, as well as procedures being performed in spas and beauty salons. The risk of transmission with transfusion-transmitted diseases (TTDs), particularly hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are considerable in non-sterile environments. Other risks involved may be photosensitization allergy. If a patient is prone to pigmentary or textural changes, micropigmentation is not recommended as paradoxical hyperpigmenting may occur. If a patient forms a blister or crust post treatment, it is imperative that it be left alone. Early removal of a blister or crust increases the chances of pigment loss and the formation of a scar. Patients prone to keloidal scarring or those with unstable Vitiligo are not suitable candidates. Additionally patients with active infections should wait until the infection has subsided before seeking treatment.

During procedure

Case: 3 Erica P had suffered with a Vascular Nevus birthmark from birth that covered a large part of her right cheek, Post 4th Treatment ear and eye. It had been stable for many years and had been similarly resistant to Q-switched laser. She would spend several hours a day applying make-up in attempt to mask the stain, but found that this would rub off on clothes and especially when she began to sweat. The treatment was performed over five sessions each lasting approximately 90 minutes (30 minutes numbing). Because of its size, the procedure was broken into two sections, lower and upper face. Starting at the lower left corner of the birthmark and pigmenting small circular areas of between 2 and 3 inches at a time (See Figure 1.2). Treatments were scheduled 6 weeks apart.

CONCLUSIONS: The procedure is minimally invasive, provides permanent camouflage, and is generally devoid of any significant adverse effects. However, a number of infections can be transmitted from one patient to another if the universal precautions for sterilization of instruments used for micropigmentation are not adhered to. Micropigmentation offers patient another treatment option in the field of dermatology, as well as a finishing step in surgical procedures craniofacial surgery, plastic/ cosmetic and reconstructive operations. Other areas of application of micropigmentation include radiation therapy, endoscopic surgery, and ophthalmology. Procedures require an experienced specialist with advanced training and understanding of various dermatological conditions before undergoing procedures, as pigment removal is difficult without significant risk of scarring.

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O n the +plus side We find out about Syneron Candela’s New Ultimate Multi-Platform System, the elõs Plus

his summer saw Syneron Candela launch its latest innovation, the elõs Plus or ePlus into the UK aesthetic market. elõs Plus is a complete aesthetic workstation on the ultimate multi-application platform, bringing together radio-frequency, IPL, laser and pain free laser hair removal. elõs Plus provides a full range of the most in demand applications and is upgradeable with 10 different applicators for a wide and growing range of clinical indications. The elõs Plus system utilises Syneron’s proprietary elõs combination of optical energy and bi-polar radio-frequency. elõs Plus was officially introduced to the UK marketplace at the FACE conference in London by VP of product development James Bartholomeusz, who described the robust technology as having “the capabilities of the eMax with the brains of the eTwo.” James illustrated to delegates the exciting new features, such as legacy applicators, improvement in cooling system technology which now accommodates 1Hz rep rate at all fluencies, new RF electronics measuring RF 10 times faster at reducing/removing bad and partial correct issues. Having personally worked on developing the elõs Plus, James also discussed how software integration of IFS over all existing applicators improves RF efficiency by up to 30% whilst enabling full 200w IFS controlled RF on all applicators. This fractional delivery of RF energy allows for strong wound healing while also minimising the damage to the epidermis which helps accelerate the healing process, leading to a smoother, rejuvenated appearance of the skin improving fine lines, wrinkles, texture, tone, laxity, acne scars, scars and straie. The Sublative™ fractional applicator places bi-polar RF energy effectively into the upper dermis for a significant increase in both collagen and elastin with minimal epidermal disruption. The Sublime™ applicator uses the elõs combination of safe and effective 44 www.cosmeticnewsuk.com

The new ePlus from Syneron Candela

levels of infrared light and bi-polar radiofrequency energies to remodel the deep dermal layer of the skin by stimulating new collagen growth. It features an intuitive touch screen user interface that incorporates full guided treatment modes for all 10 applicators and allows for simultaneous connection of up to three applicators. The elõs Plus system includes the full facial rejuvenation functionality of the recently launched eTwo tabletop system,

including eTwo’s Sublime™ and Sublative™ applications and new Sublative™ iD treatment tips, which maximise treatment options and results. elõs Plus also supports Syneron’s recently introduced Motif Modes of operation, providing fast, effective and virtually pain-free hair removal and skin treatments. The proprietary Active Dermal Monitoring™ feature which monitors the skin’s impedance changes throughout the treatment, as well as the Intelligent Feedback System (IFS) and integrated sapphire contact cooling ensure a strong safety profile for all applications. The sleek portable design features grab handles on the back of the system with screen and applicator holders that disconnect to ensure maximum mobility. This is aided by a tilting screen for various viewing angles, easy to connect / disconnect single turn applicator connectors with an easy to access water bottle located in the front of the unit which intelligently informs the user when the water needs to be changed. With maximum patient safety and comfort in mind the elõs Plus includes short / long pulse selection sub-pulse frequency optimised tip geometry on Motif HR applicator. Louis Scafuri, CEO of Syneron Medical, said, “The elõs Plus system is an exciting new offering that incorporates the treatment capabilities and functionality of several of our most popular elõs-based systems into a single, upgradeable work station. Its intuitive touch screen interface is designed to enhance workflow and clinical outcomes by guiding practitioners through each of the system’s treatment options. It is also designed to enhance the patient experience with features such as the Motif Mode for pain-free treatments. We believe the elõs Plus system will be well received in its international launch, particularly as customers look to maximize their facility and capital investments with our advanced and versatile system that can grow with their practice.”

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take it to the max Established in 1994, Lynton has been manufacturing laser and Intense Pulsed Light systems for a wide range of applications. As the UK’s leading supplier of aesthetic equipment to the NHS, cosmetic, and beauty industries, Lynton is constantly evolving and looking for new ways to create cutting edge technology.

ver the past two years, Lynton has researched the body shaping market extensively, leading to the development of the 3 Max Lipo; a brand new multi-functional device that can treat all areas of the body, as well as the face. The 3 Max Lipo has been uniquely designed to offer the three most popular body treatments: cellulite reduction, inch loss and skin tightening. Cosmetic News speaks to Dr Samantha Hills, Lynton’s clinical and training manager, to find out more about this cutting edge device.

system can be used all over the face and neck, including small treatment areas such as around the eyes and the mouth. The combination of radiofrequency and vacuum suction on the specialised facial applicator, promotes the formation of new collagen and elastin, producing smoother, tighter skin and reducing the appearance of fine lines and wrinkles. The small handpieces make it extremely safe and comfortable for the patient, and produce instant results. Not only is the radio-frequency great for eye and neck lifting, but the introduction of vacuum at this stage offers excellent results for puffy eyes and general skin rejuvenation.”

Cosmetic News: What are the benefits to a business when using the 3 Max Lipo? Dr Samantha Hills: The 3 Max Lipo utilises not just one but three different technologies to target several concerns and ensure maximum clinical results are achieved in every treatment. The system is compact, non labour intensive and extremely versatile. There are six different applicators which allow treatments on every area of the body, including the arms, thighs, tummy, hips, knees, ankles and the face; so a business can introduce several different options to the treatment menu and maximise its return on investment. There are also no consumables to worry about.

CN: How does the 3 Max Lipo work? SH: The ultrasound handpiece produces sound waves resulting in cavitation. This is basically the formation of little bubbles within the water in the subcutaneous layer; and as the bubbles collapse, they affect the permeability of the fat cells, which allows transport of triglycerides out of the cell. This gives instant inch-loss as well as a long term reduction in the really stubborn areas of fat that are typically resistant to exercise such as the abdomen or outer thigh. The multipolar radio-frequency technology, with vacuum, acts by delivering thermal energy into the dermis and 46 www.cosmeticnewsuk.com

How many treatments are needed and what kind of results should the patient expect to see?

The 3 Max Lipo

subcutaneous fat, stimulating the formation of collagen and promoting skin tightening. Particularly good results are seen on post pregnancy ‘lax’ skin. The multipolar radiofrequency also helps to promote blood circulation, improving the appearance of cellulite and the overall skin condition. The radio-frequency, vacuum massage, LED lights and vacuum suction all help to maximise the efficacy of the treatment.

CN: How effective is the 3 Max Lipo for use on the face? SH: The specialised facial applicator uses bipolar radio-frequency with vacuum massage. This

SH: Immediate results can be seen after one session and patient satisfaction is extremely high. The best results come after 6-10 sessions, depending on the severity of the concern to begin with. Most people experience a reduction in body circumference measurements after only a few sessions, and in many cases inch loss is apparent after just the first treatment. Clients will see a reduction in the appearance of cellulite, and tighter, firmer skin on the body. All 3 Max Lipo systems are backed by Lynton’s exceptional aftersales service, which includes clinical, technical and business support. To find out more or book a 3 Max Lipo demonstration, contact Lynton on 01477 536 977 info@lynton. co.uk or visit www.lynton.co.uk/3maxlipo

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NeXt GeNeratIoN HaIr remoVaL Key Facts: • FDa approved treatments for skin types I-VI, even tanned skin • Up to 12Hz repetition rate: fastest coverage in the industry • Large 14x10mm spotsize • 800 - 950 nm wavelengths range • No consumables • Hair removal, vascular, rejuvenation, skin tightening and acne treatments all from one laser • two year parts warranty* *Sign up to Asclepion Web Club. Free service.

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ADVERTORIAL/SKINCEUTICALS

Peel pioneers We find out about the latest additions to the SkinCeuticals peels portfolio

kin peeling is one of the best beauty secrets in the book yet many aesthetic clinics are not realising its full potential. In terms of profit, peels are a low cost, high mark up treatment that can be offered as part of, or in combination with, other aesthetic procedures. They are more affordable for clients than some other aesthetic treatments designed to rejuvenate the skin and, as a course is usually required to gain optimum results, as well as regular top up/maintenance treatments, you will get repeat business with clients coming back on a regular basis. Peels are also a great way to help your retail sales of homecare products as the results of peeling are enhanced and improved on when used in conjunction with proper skin preparation and aftercare.

>> SkinCeuticals Leaders in Advanced Professional Skincare SkinCeuticals has always been at the forefront of the cosmeceutical skincare market. Founded in 1997 by renowned American dermatologist Dr Sheldon Pinnell, with the formulation of the original, stabilised topical vitamin C serum, the philosophy of the brand is to ‘Prevent’, ‘Protect’ and ‘Correct’. Its cutting edge products are hugely popular with skin savvy aesthetic clients and, when used alongside professional in-clinic treatments, can achieve phenomenal results in improving the quality of the skin. The latest additions to the SkinCeuticals portfolio are its two new glycolic acid peels: Micropeel 20 and Micropeel 30, which join Pigment Balancing Peel and Gel Peel SM as part of its professional only, in-clinic treatment line up. Designed to brighten dull skin and improve the skin texture through epidermal exfoliation, the peels are indicated for hyperpigmentation, photoageing and blemishes as well as for reducing fine lines, wrinkles, dry/rough skin and acne.

>> Micropeel 30 and Micropeel 20 Micropeel 30 is a 30% glycolic acid clinical grade peel while Micropeel 20 is a 20% glycolic preparation. The peels resurface the skin by removing the outer epidermis and stimulating collagen remodeling to improve hyperpigmentation, fine lines and wrinkles, 48 www.cosmeticnewsuk.com

Why offer SkinCeuticals Peels? > High degree of efficacy and instant results. > INDU STRY-LEADING PEEL EXPERTISE, over 10 YEARS OF EXPERIENCE > Reliable, TESTED AND SAFE TECHNOLOGIES > STRONG LINK TO HOMECARE >C USTOMISED APPLICATION MINIMISES WASTE AND COST > LITTLE TO NO FLAKING > EASE OF APPLICATION

texture, and skin impurities. The Skin Benefits of Micropeel 30 and Micropeel 20 are: • Improves the appearance of epidermal lines • Evens the appearance of epidermal pigmentation • Refines the appearance of pore size • Makes skin appear smoother and feel softer • Reduces the appearance of dull skin

>> Integrated Skincare Performing professional in-clinic peel treatments using SkinCeuticals peels affords you a unique opportunity to offer an efficacious treatment and ensure your customers purchase homecare products. The importance of homecare is paramount and it is not only a disservice to to your client if you do not recommend the appropriate products but it can also provide an extra revenue stream for those clinics that invest in product recommendation.

>> The SkinCeuticals Homecare Offering Pre-condition homecare products help effectively prime the skin to enhance corrective procedures while post procedure aftercare products can accelerate healing and protect compromised skin. Daily use homecare products can further enhance the corrective results of treatments, prevent future damage and protect healthy skin. SkinCeuticals is famed for its range of vitamin C serums, which help to prevent free radical damage,

the result of UV rays and daily aggressors such as stress, smoke and pollution. The range includes the celebrated antioxidant serums Phloretin CF and CE Ferulic, iconic products that cement SkinCeuticals’ position as the antioxidant authority in the cosmeceutical industry today. Immediately post procedure, products such as Phyto Corrective and Epidermal Repair provide a rehabilitative balm to soothe, calm and aid in repairing the skin. Patented broad-spectrum sunscreens then help to protect skin from future damage from the sun’s harmful UVA/UVB rays. Alongside these preventative products the brand has a wide range of corrective products designed to correct existing issues in the skin, such as dehydration, pigmentation, ageing and imperfections. This range includes the awardwinning hyperpigmentation product Pigment Regulator, a highly potent facial brightener proven to be as effective as the standard medical treatment. This works particularly well along SkinCeuticals’ Pigment Balancing Peel, a customisable, professional-only treatment that is ideal for patients with photodamage including hyperpigmentation, brown spots, freckles and dark patches and uneven, dull skin tone. It combines high-performance brightening agents with a peeling acid solution which accelerates cell renewal and diminishes uneven skin tone and localised hyperpigmentation in only four to six treatments. A study performed by Dr Martina Kerscher, University of Hamburg, showed a 38% reduction of hyperpigmentation spots in 60 days and a 67% reduction after 84 days. The 25 subjects were all women with facial hyperpigmentation and a Fitzpatrick skin type of 1-3. Six in-office Pigment Balancing Peel applications were performed in conjunction with the use of homecare products (Pigment Regulator, Epidermal Repair, Ultra Facial Defense SPF 50). Evaluation was based on blinded expert rating, clinical evaluation and a subject questionnaire. SkinCeuticals prides itself on its science and research and it is evidence like this that shows how effective combining its professional treatments and at home skincare can be for you and your clients.

For more information on the SkinCeuticals range of professional treatments call 05603 141 956

ONE TAKES OFF THE DAY THE OTHER TAKES OFF THE YEARS

From the lead inventor of Sonicare,® the Clarisonic® Skin Cleansing System uses patented sonic technology to remove more dirt, makeup and sebum than manual cleansing. Proper cleansing each day better prepares your patient’s skin for treatments – allowing them to work more effectively. The Clarisonic Opal Sonic Infusion is the second major product in the Clarisonic family and utilises the same sonic technology to gently massage Anti-Ageing Sea Serum into the area around the eye where it matters most. The Sonic micro-massage visibly infuses more serum beneath the surface than finger tapping and starts to work immediately on the appearance of fine lines. For more information contact uksales@clarisonic.com, clarisonic.co.uk Clarisonic is a registered trademark of Pacific Bioscience Laboratories, Inc. Sonicare is a registered trademark of Philips Oral Healthcare Inc., which is not affiliated with PBL or Clarisonic. © 2011 Pacific Bioscience Laboratories, Inc.

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R oll on the Day We find out about the latest product from Obagi

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TECHNOLOGY

RESULTS DRIVEN TREATMENT

TIGHTER FIRMER SKIN

THREE IN ONE

hat happens when you wake up first thing in the morning and you need a pick me up? Do you reach for the kettle to make yourself a brew? Or do you start up the coffee machine to get your caffeine kick? Introducing Obagi Medical Products’ latest addition to the Obagi family – ELASTIderm® Eye Complete Complex™ Serum – the newest caffeine boost for your eyes. The Californian manufacturers are the number one skin care brand and choice of physicians specialising in anti-ageing and skin health worldwide*. They have created this nextgeneration eye formulation that contains caffeine to help tighten the delicate skin that surrounds the eyes. Find out below why your patients should be the proud owner of new ELASTIderm® Eye Complete Complex™ Serum.

What is ELASTIderm® Eye Complete Complex™ Serum?

RADIO FREQUENCY – ANTI-AGEING VACUUM – LYMPHATIC DRAINAGE CHROMATHERAPY – RED AND BLUE RESULTS DRIVEN TREATMENT AFFORDABLE QUALITY

ELASTIderm® Eye Complete Complex™ Serum is the latest product to be launched by Obagi as part of their established ELASTIderm® Eye range. For best results, it should be applied twice daily, once in the morning and once at night. It is an ideal complement for the products already in that series, the Eye Cream and the Eye Gel, which are recommended to be applied as part of the night time beauty regime, as well as others within the wider Obagi collection.

What makes this eye serum unique all others?

01903 768 386 info@thecarltongroup.co.uk www.thecarltongroup.co.uk PROUD TO BE A BRITISH MANUFACTURER 50 www.cosmeticnewsuk.com

The secret to this eye serum lies in its use of caffeine, differentiating it from other eye serums and from the existing ELASTIderm® Eye series. Caffeine is an antioxidant and according to a 2009 “CBS News” report, it can decrease swelling when in applied to the skin. Further evidence comes from skin science expert Jeanette Graf, M.D., who explains that when caffeine is applied topically under the eyes, it constricts blood vessels under the skin,

The secret to this eye serum lies in its use of caffeine, differentiating it from other eye serums and from the existing ELASTIderm® Eye series reducing “puffiness”, which in turn helps to minimise dark circles. As with all Obagi treatments, it is the unique formulas that combine to make their respected and trusted products deliver results. In the ELASTIderm® Eye Complete Complex™ Serum, a bi-mineral complex helps replenish elasticity and support collagen, leading to tighter, smootherlooking skin, and malonic acid stimulates the production of healthy skin cells for overall skin improvement. Combine that with the innovative rollerball technology which optimises the delivery of the serum and you have an extremely exceptional product.

How have customers reacted to the product thus far? The product was first launched in the US earlier this year. ELASTIderm® Eye Complete Complex™ Serum has been considered better or much better than the product customers usually used. The majority stated that the serum met or exceeded their expectations, with an overwhelming number saying that they would purchase the serum again in the future**. *Kline report, 2010 **OMP Inc., Internal Data

Stylage is the first patented single-phase gel consisting of cross linked hyaluronic acid (IPN-Like technology) and mannitol, a natural antioxidant that means less swelling and increased longevity of results. It can be used for filling and smoothing of wrinkles, natural lip correction, volume restoration, hydration, chin remodelling, tear trough correction, neck, décolleté & hand rejuvenation. Stylage is perfectly suited for use with a cannula. Dr Elisabeth Dancey has been using Stylage® for the last 18 months

My clients will not tolerate swelling for any more than a few hours… especially in the lips or eye area. This is why I prefer Stylage® to other HA fillers. We can safely say that all HA fillers are perfect tools for the job, but Stylage® has the added benefit of shortened recovery time and increased duration of results.

For further information about STYLAGE® call Medical Aesthetic Group on 02380 676733 or visit www.magroup.co.uk

PRODUCT News AMALIAN

VISTABEL

Amalian launches in the UK

New packaging for VISTABEL®

The amalian product range has now arrived in the UK and in will be exclusively distributed by 4T Medical. The German brand includes a complete range of monophasic and biphasic dermal fillers, a booster for eyelash revitalisation and an advanced skincare product line. The 4T medical team has been involved in the medical device industry at global level for over 15 years and is committed to providing excellent service and customer care through a clear, reliable, responsible and controlled UK distribution strategy. Julien Tordjmann, 4T medical’s Director said, “In association with our German partner, we aim to bring the very best products to the UK market.”

In response to feedback from its customers, Allergan has created new packaging for VISTABEL®. Healthcare professionals had commented that the current VISTABEL® carton was difficult to open and so the company has re-designed it to improve the ease of use. The new VISTABEL® packaging has a perforated side-opening carton, replacing the top opening sticker – making it easier to open and more user-friendly.

SELAMEDICAL

Selamedical announce UK launch of ‘PRINCESS’ Selamedical has announced the launch of ‘PRINCESS’ by Croma into the UK. PRINCESS consists of a line of injectables designed to achieve immediate, natural and long-lasting results with minimal risk of side effects or inflammation. PRINCESS is produced with 100% non-animal hylauronic acid using a unique monophasic and reticulated cross-linking method called SMART. This has been developed by Croma to ensure not only are the fillers incredibly smooth with the longevity the patient desires, they also have a very low injection force giving the practitioner far more control and the patient a far more comfortable treatment. A cutting edge purification process coupled with Croma’s stringent quality control means that there is little to no risk of side effects or inflammation. The PRINCESS range comprises of three

NEW

VISTABEL products with distinct features and specific indications. The products differ in their formulation, level of cross-linking and elasticity and include: PRINCESS Filler; PRINCESS Volume and PRINCESS Rich. There are also two facemasks designed to repair, protect and support skin rejuvenation and boost moisture levels. These can be used as an additional treatment in clinic or sold as a retail item to patients for home care use.

AMRED

Amred launches Pro-Sil Amred healthcare Ltd has launched a new scar product into the UK. Pro-Sil is a silicone glide (much like a lip balm) indicated for treatment of scars, Keloids’ and hypertrophic scars as well as burns. The product is manufactured in the US by Biodermis and comes in 17g, 4.25g and a kids’ 4.25 glide (stick). The clinically

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OLD

proven product is easy to use and cost effective and has a shelf life of more than eight years.

Lynton launches the LUMINA R Lynton has launched, the LUMINA R. The diverse skin rejuvenation platform utilises multiple technologies including Fractional 2940 Erbium:YAG laser for a whole host of skin concerns such as acne, pigmentation, vascular lesions, acne scarring, surgical scarring, wrinkles, millia, stretch marks, sun damage and congestion. Further technologies can be added to offer laser hair removal and tattoo removal. Dr Philip Hampton says, “The Lumina is delivering excellent results for our rosacea patients with widespread facial telangiectasia.”

PRODUCT News

PRODUCT

TRIED AND TESTED

KENTEK

Colour enhancing innovation for dye laser users Kentek have launched their new KXL870C-CE laser safety eyewear, specifically designed to address visibility problems that occur when operating dye laser systems. Fitted with a colour enhancing light purple glass curved lens, it offers the wearer the protection they require whilst providing clarity of vision. The special filter enables the user to clearly see the treatment area ensuring they face no unnecessary risk during procedures. The KXL (OveRxProtectTM) frame, with adjustable wire core temples has been designed to fit over most prescription eyewear and combined with the colour enhancing lens it ensures the user has remarkable visibility. The new eyewear is fully CE marked and rated to the latest version of the EN207 laser safety eyewear standard.

Cannula convert Kathryn Revell of the Kathryn Revell Cosmetic Clinic in Cork on the Silkann range of cannulas

LASER PHYSICS

Laser physics introduce neoheal hydrogel dressing Laser Physics has launched Neoheal, a new hydrogel laser treatment pad, as a replacement for Geistlich Pharma’s Hydropad. Neoheal can be used in a wide range of dermatological and aesthetic procedures, and with all laser systems in a wavelength of 400-1100nm, as well as used for cooling and soothing after dermabrasion and peeling operations. Placed between the laser head and the skin, Neoheal is a sterile treatment pad which provides; gentle cooling of the skin, optimal visability of the target structures, accurate, clean contact between the skin and the laser head and protection against splatters and fumes caused by lasers. Available to purchase from Laser Physics UK, Neoheal has been recommended as a perfect replacement to Geistlich Pharma’s Hydropad.

MEDIK8

Medik8 launches Growth Factor Serum Medik8 has launched a new Growth Factor Serum to help smooth out lines and wrinkles to refine skin texture. The product includes the active complex ShOligopeptide-1 which helps inhibit and prevent cellular breakdown. The youth activating complex with triple-filtered EGF regulates cell production that slows in efficiency with age. By applying the Growth Factor Serum on a regular basis, it stimulates the growth of fibroblast cells, which are responsible for collagen and elastin formation.

p until IMCAS, Paris, at the beginning of this year, I had pretty much decided that, as an injector of 14 years, I had more precision with a needle and there was no need for cannulae in my practice. I had previously done a training course on cannulae but found it tricky and a bit fiddly. Then I went to a workshop in Dublin in February, given by Dr Kate Goldie, and that changed everything. At the workshop we decided that my husband, who is 54 and had had no previous treatment, should be the model – unconvinced and a bit skeptical, he agreed. Kate demonstrated to all of us at that meeting how a cannula can be used effectively and how it could enhance our businesses. Four syringes of Radiesse were administered for a non-surgical face-lift, and at that workshop I was converted. In the areas that my husband was injected in using the cannula there was no bruising, swelling or adverse events. But for the following two weeks, areas where the cannula was not used were bruised. Since then I decided to introduce cannulas into my practice and I can honestly say it has revolutionised it. The main advantages are: • Accurate product placement • Patient satisfaction • Speed of treatment • No downtime • No bruising Having used various cannulae I became very comfortable with Silkann Cannulae (Sterimedix). Their safety profile and the fact that they were previously used in eye surgery procedures gave me an added sense of security. Their range of gauges and lengths have proved ideal for my treatments and I now use them exclusively for templar, mid facial , jaw and lip treatments and my surgical colleagues also find them invaluable in use with fat transfer using larger gauges. www.cosmeticnewsuk.com 53

business Best PRACTICE

Face to face facts Alison Rohland, Superintendent Pharmacist at Healthxchange Pharmacy on remote prescribing

any will say ‘not before time’ however the new rules on Remote Prescribing (RP) have caused some confusion. By necessity there is some ambiguity as RP is an important part of normal clinical practice and patients do have the right to waive their rights to a face-to-face consultation. Indeed advances in the delivery of clinical dermatology include remote diagnosis using remote visual technologies. However, the three main medical regulators, the GMC, GDC and NMC have taken a position on certain injectables. They have issued guidelines for RP which cover what is termed a ‘cosmetic injectable’ such as Botox®, Dysport®, etc and dermal fillers. Even though dermal fillers are ‘medical devices’ the same rules apply; prescriptions are only to be issued after a face-to-face consultation. Setting aside arguments that many healthcare professionals have that the term ‘cosmetic’ is vague and erroneous as it describes a treatment which excludes a medical need or purpose, the use of the word cosmetic arguably trivialises the consultative, psychosocial elements and skilled intervention required in such treatments,. We do however appreciate the purpose of such regulation and welcome the recognition that these treatments and the prescribing of medicine should not be undertaken lightly.

>> So, what can we do to comply and what would be best practice? It is abundantly clear that our regulators would take a very dim view of a doctor (or other prescriber) writing a prescription for cosmetic injectables for a patient that he/she has not seen face-to-face. So, doing a favour for your favourite nurse down the road could lose you your license to practice. A qualified prescriber cannot issue repeat prescriptions for ‘cosmetic’ patients as a face-to-face consultation is required each time but you can prescribe enough medication to be administered to complete the course of treatment at the initial consultation. However, it is expected that prescribers use their judgement as to the quantity of items prescribed in this way and are advised to conduct further consultations with the patient where they consider this necessary to ensure safe and appropriate treatment. Each new course of treatment requires a face-to-face consultation.Medicines which are labelled for that patient can only be used for that patient.

>> Best Practice for Cosmetic Injectables If you are an injector, but not a qualified prescriber, you will not be insured if you obtain the medication illegally or contrary to the regulatory guidelines. You should ensure that each patient has had a proper face-to-face consultation with a prescriber, instructions for administering are given and both the patient and prescriber are aware of the duty of care the issuer has to the patient. If a course of treatment is 54 www.cosmeticnewsuk.com

not issued at the initial consultation, then the prescriber will need to see the patient again before further medication is made available. A doctor or dentist can hold a stock supply of medicines (except unlicensed medicines) for use for those patients who just turn up for treatment: a nurse cannot - not even an NIP - it is unlawful. If you are an NIP you will need to see your patients face-to-face before prescribing and treating. There is a legal and ethical process, which if ignored, may lead to the loss of ‘your right to prescribe’. You cannot hold stock of medicines pending a new patient attending. You may of course look after a patient’s prescribed items until they attend for treatment after their first face-to-face consultation. As prescribed medicines cannot be shared between different patients, consideration should be given to the size of ampoule prescribed. Large ampoules such as Dysport® ‘500’ are likely to be too large for single patient use. Botox® ‘100’, whilst being licensed for treatment such as hyperhidrosis, and within the correct therapeutic range for such treatments, may lead to wastage in terms of cost for glabellar treatments and may be suitable for more ‘multiple area’ treatments. Similarly much smaller ampoules such as Azzalure®, which might be adequate for the licensed indication of glabellar frown lines may prove inadequate if the clinician deems more extensive treatment desirable. Botox® ‘50’, which also has a licen4ce for cosmetic use, may be more appropriate in those circumstances. Best practice and prescribing guidance dictates that a licensed product should be used when available over one which does not have a licence. This should be taken into clinical consideration when prescribing for example, for hyperhidrosis (Botox® 100) and glabellar frown lines (Botox® 50). Remember, when you put your pen to paper you may be called to account for your actions and your licence may be at risk if you ignore guidelines, regulations and the law.

4056 silkann 1/2 page ad_Layout 1 25/05/2012 10:54 Page 1

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ADVERTORIAL MED-FX

The customer is always right We speak to Med-fx customers to find out why the single-source supplier is their number one choice

In a competitive market and tough economic times it is the little things that make a huge difference between running a practice like clockwork and getting bogged under. One company that prides itself on making life easier for aesthetic professionals is Med-fx. The largest single source supplier of medical aesthetic products in the UK, Med-fx’s simple and efficient service enables aesthetic clinics up and down the country to purchase everything they need from one place, saving them time and money and making administration simpler by providing them with one invoice. The company’s distribution centre in Witham, Essex – which it shares with its sister company, The Dental Directory – has expanded to cover more than 100,000 square feet and includes three adjoining state-of the art warehouses. But it is not just about size with Med-fx, it is about service. Med-fx offers an extensive range of competitively priced professional products and consumables with free of charge next day delivery and the added benefit of an on-site pharmacy. To add to this its highly knowledgeable and passionate staff make sure that its customer service is on another level.

you choose your products from Med-fx the prices are competitive and your overheads are lower because you are not having to pay for delivery. The brochure is also really well laid out so it is easy to find what you want and their communications to customers and the special offers they run are very good. It is a very efficient system.” Dr Beatriz Molina of the Medikas Clinics says,

Fast, efficient next day delivery

Expert team

Med-fx epitomises the concept of the single source supplier. Its team of expert buyers make sure that it has the widest range of products and consumables available, without compromising on quality, and its state-of the-art ordering systems mean products are picked, packed, and shipped without practitioners having to worry that they will be out of stock or send the wrong products. In fact, its sophisticated and bespoke automated systems, which were developed in house, utilise some of the most up-to-date technology there is and are capable of processing and dispatching orders placed online or over the phone within minutes and getting them on the lorry for next day delivery. Martin MacKenzie, client services director of the Xavier-G Medi-spa in Southampton explains, “I love the fact that you can pick up the phone and the delivery is very next day and it is free of delivery charges.. When

One thing Med-fx customers rave about is its staff. The sales team, led by Faye Price, is integral to the service the company provides, and it is their friendly manner and extensive product knowledge that makes them stand apart. Dr Molina says, “The staff are fantastic on the phone, they are very friendly, and it is nice to have that help, they are always very helpful.” Martin comments, “It is literally all about customer service. The girls at Med-fx know their stuff, they are always happy to help and there is always a friendly voice. You never feel that anything is too much trouble. That makes a big difference when you are running a clinic and you are very busy. They also always seem to be ahead of the game. If they don’t have something then they will get it for you, within reason obviously.” Angela adds, “The girls are very, very nice. We speak to them on a regular basis, because we

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“They are very good on delivery. They are very quick and very professional. They also don’t have a minimum order, which really helps with cash flow. You often order more than you need anyway but some companies have a very large minimum order and it puts you off.” Anglea Patel director of Dermcare Direct says, “They offer a great service because they have got a good selection of products. If you order before 2pm you get your products the next day so that is great for us as an internet business. We do order from the other UK distributors as well but on a daily basis we deal with Med-fx. When we started our business we needed to carry a lot of stock so it was great for us as a business starting out because as we were using Med-fx we didn’t have to have so much stock we could just order it when we needed it and get it the next day. It is a great concept.”

order from them nearly every day. We have got a great relationship with them.”

Bespoke pharmacy The pharmacy at Med-fx is unique and offers a number of advantages to practitioners. Not open to the public, the pharmacy, based within the company’s state-of the art warehouse in Essex, deals purely in medical aesthetics and dermatology prescriptions coming through its automated ordering system The superintendent pharmacist, Peter Smith, has a particularly specialist knowledge of the needs of medical aesthetic practitioners. As the only specialist facial aesthetics pharmacy in the UK that the Med-fx pharmacy does not have a licence to dispense NHS prescriptions and as result does not deal with the general public enabling the pharmacy to focus purely on aesthetic products and its practitioners requirements.. The state-of-the-art computerised systems at Med-fx mean that the audit trail for products and prescriptions is exemplary, which gives piece of mind for practitioners should any products ever need to be re-called. If such a situation arose Med-fx would have a record of exactly what products have been prescribed, who the prescriber was and to which patients they were sent In order to make life as easy for the prescriber as possible, prescriptions can be received by post and are actioned on the day they arrive. Copies of prescriptions can be received by fax or email, with hard copy originals sent by post the next day. Deliveries are scheduled to arrive on a day and time convenient to the prescriber and their practice. Dr Molina comments, “The fact they have the pharmacy as well is one of the main reasons we use them because we do a lot of prescriptions and it means we can order everything from one place.” It is this combination of factors that makes Med-fx stand apart. Martin concludes, “For me it is a combination of things, the customer service, the ease of use, the attention to detail and the competitive prices. We buy most of our stuff from Med-fx, have done for years and will continue to do so.”

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business FINDING COMMERCIAL PROPERTY

HOT PROPERTY David Burkinshaw, development director at Muse Developments, on acquiring space for your practice

here are many important decisions to be made when acquiring a new business property. One of the most immediate and problematic challenges is often sourcing the right premises. A medical practice will require a particular planning use approved by the Local Authority, and will have specific property and fit-out requirements, which means this may not be an easy route to negotiate. As the business park provides an ideal location for this type of organisation, the team at Cheadle Royal has particular expertise in developing properties for medical and other health businesses. Here’s a quick-fire rundown of some of the key propertyrelated questions practitioners should be asking themselves:

Where should the practice be located? The first priority is to define the parameters of your search area. In order to attract customers, clinics are traditionally situated in accessible locations, with good visibility and in areas close to target demographic markets. It’s worthwhile considering whether a city centre or out-oftown location is appropriate for your business. Rents in town centres are significantly higher and available properties often lack flexible accommodation, as well as client parking facilities. It’s also worth bearing in mind whether your clinic’s location will also affect the degree of privacy afforded to patients visiting the practice.

Is the building appropriate for medical use? As cosmetic surgery clinics fall under D1 use classification – allowing the building to be used for medical or health services – finding the right premises, with this planning classification already in place, is unlikely. Therefore, it may be necessary to seek a change of use through the

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submission of a planning application. In cases where shortages in suitable property stock make finding a property more of a challenge, the best option may be to consider bespoke design and build (D&B) accommodation. The advantage of purchasing or leasing space off-plan is that it gives you a chance to influence the specification and design of the building, to ensure that it meets your specific needs. Cosmetics practices have specialist fit out requirements to accommodate small consulting rooms, larger procedure rooms, and appropriate equipment storage areas. Therefore, a D&B option may provide advantages because the ‘fitting out’ can be planned and programmed into the construction, avoiding retrospective alterations to an existing building after purchase.

Are there any other factors which could affect my choice of premises? Premises that are inflexible and inefficient will inhibit your business’ future growth, so it’s important to consider space, as well as location, when picking out a property. Try to anticipate your needs for the years ahead – perhaps considering premises that provide scope for expansion if your clinic is expected to grow. A lot of tenants focus their property decisions on the headline rental. In order to provide a more accurate assessment, however, other costs should be taken into account. Service charges, business rates, car parking and running costs all add up, so factor in less obvious attributes – such as a building’s green credentials – when evaluating any prospective property.

What contract options are available once I’ve found an appropriate property?

Commercial property is usually leased on a relatively long-term basis (typically 15 years plus). That being said, leases normally contain ‘break clauses’ that allow the tenant to end the lease ahead of term, on a specific date. When negotiating the form of lease try to include clauses that will allow you to assign or sub-let part of your space if, for any reason, your practice does not perform as expected. This would mean that, should your premises prove to be too large for your current requirements, you have the opportunity to recover rent by sub-letting surplus space or, in the case of assignment, you are able to assign the entire lease obligations to a new tenant. It’s also worth noting that lease flexibility does come at an added cost. Break clauses in a lease will normally reduce the incentives (such as a rent free period) available to the incoming tenant, or will incur a penalty, such as a one-off payment to the landlord, if the break is exercised. Carefully consider how likely it is that you will require a break clause, as you’ll be in a stronger position to negotiate an incentive package without one. Assuming a break clause is agreed, don’t file your lease away and forget about it! Work towards these dates when re-assessing your property needs, so that you don’t find yourself tied to the full lease agreement should you decide that your current premises is no longer fit for purpose. There are many things to consider to ensure your location and practice reflect your current and future needs. The key is to ask the right questions from the outset and always keep your property requirements at the forefront of business planning!

Feel the difference Your skill â&#x20AC;&#x201C; Artisteâ&#x20AC;&#x2122;s technology. The perfect partnership delivering a new level of performance.1,2

Precision in practice

www.experienceartiste.com help@nordsonmicromedics.com Micromedics, Inc.: 00 1 651 452 1977 European Distributor: +44 (0) 1582 691905 References: 1. Micromedics Inc. Clinical study data on fi le 2. Micromedics Inc. Survey results on fi le

MICROMEDICS

business A DAY IN THE LIFE/CC KAT

The Kat that got the

cream

Antonia Mariconda spends a day in the life with plastic surgeon CC Kat

n a field largely dominated by men, CC Kat is one woman who is flying high. We find out what a typical day has in store for this glamorous plastic surgeon… “My husband calls me at 6.30am and I just about manage to drag myself out of bed by 7am whereby coffee and cereal is the way I start my day. I’d love to say that I go to the gym everyday but the thing is, I don’t! I find the gym way too boring. I think that the constant fast-paced daily routine of my life means that I’m keeping myself fit by keeping on the move all the time. Even with my work there is an element of toning in walking, performing surgery, and generally being a nonstop kind of person. I travel to work in my red Porsche, but given the choice I would opt for chauffeur driven travel as I am a terrible driver. When I am flying long-haul I do like Emirates airlines (business), I admit I am a little spoilt. When I am in the car I like to listen to Capital FM, I’m a huge fan of big music like Vanghelis, and Buddha Bar, I equally like big voices like Adele, Leona Lewis and Adam Lambert. I also listen to this kind of music in the operating theatre when I am working. I get to hospital by 7.55am. I see my first two patients in their rooms, take photos, discuss their surgery and obtain consent. I change into theatre scrub-suits and start operating on the first patient – autologous fat injection into the cheeks, nasolabial fold, marionette lines and chin. Fat was harvested from the abdomen, centrifuged and re-injected into the above areas. This is a very effective way of rejuvenation, that is more permanent than synthetic fillers. The procedure takes about an hour and I then spend about 10 minutes typing the operating notes. While the anaesthetist is putting my next patient to sleep, I nip out to see and consent the third patient so that when I return to theatre in about 10 to 15 minutes, the second patient is asleep, already cleaned and prepared by my regular scrub nurse, ready for me to start operating. My typical morning will be around four patients in surgery, although this can vary a lot depending on patients and procedures. 60 www.cosmeticnewsuk.com

About 1pm and I eat the sandwich that my husband has prepared for me whilst I am typing up the previous patient’s op notes. I do not take a formal lunch break but eat on the go, and by now I have had about four cups of coffee – busy day with caffeine inputs is usual! The afternoon continues with more surgery. My fifth patient has an abdominoplasty, which takes about two and a quarter hours. I am excited about the improvements I have made to patient post-operative care. Patients now no longer have drains in but instead a very small cannula feeds into the abdomen constantly infusing the wound with a local anaesthetic. This positive change now leaves patient more pain free, so they can mobilise earlier, which reduces the risk of DVT, pulmonary embolus, and chest infection. I go into the ward to check on my first two patients. They are both doing extremely well so I send them home. The sixth patient has a straightforward breast implants surgery. This takes me about 45 minutes and is one of my favourite procedures because it is short, effective, and has very little complications. The patient started as a 32B cup and went up to a D/DD cup. The last patient has liposuction to the inner and outer thighs and inner knee area. Liposuction is almost always put as the last case, as it is quite strenuous work and best left to the end of the day so it doesn’t tire the hand too much. From the time I could remember I always wanted to be a surgeon, it was a natural choice and I never really considered any other career. This was the right career choice for me and I am passionate about my work the gratification from transforming lives is immense and I work for the pleasure that it gives me as a surgeon and more so my patients. People think that being a plastic surgeon is rather glamorous, but it is a job and, like so many others, we have our highs and lows and we too experience unhappy customers just as in so many other businesses. The important thing is to stay positive and remained focused and calm and do our best always for the patient, no matter how challenging the situation. There have been so many people that have inspired me in my life,

people that have shaped my determination drive and passion. My mother was a huge role model to me and people like Steve Jobs and Bill Gates are visionaries who combine innovative ideas with functionality and then have the drive to inspire others with their great achievements. CC Kat Aesthetics Clinic is now expanding and we should have four more rooms by September/ October 2012. Minor surgeries like the one stitch face-lift is really taking off. Non-surgical procedures like our CO2 laser skin resurfacing treatments are also popular, as are Botox®, fillers and laser hair removal. We have a bright young skin/beauty therapist who will be developing the beauty side of the clinic. Around about 8pm. I change back to my normal clothes and do a ward round of all the patients, giving them a run down of the procedure and findings. I check my diary for next day, which is another 8am start with a patient who is undergoing a mastectomy and a reconstruction, followed by a clinic that starts at 1pm and usually ends at about 9pm. I like to relax and end my day with time at home, dinner with my husband and golf at weekends. I love, people, travel, music and many of the fine things in life that make working hard all the more worthwhile. Life is too short, everything is possible if you want it enough so go out and get it!”

t w o e v e n t s u n d e r o n e r o o f ; t h e a e s t h e t i c s s e a s o n s ta r t s h e r e !

Book your stand now for the ukâ&#x20AC;&#x2122;s largest aesthetic exhiBition 1 6 th a n d 1 7 th f e b r u a ry 2 0 1 3 , t h e b u s i n e s s d e s i g n c e n t r e , l o n d o n

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t h e f i r s t m e e t i n g i n t h e U K f o r e d U c at i o n , n e t w o r K i n g a n d n e w b U s i n e s s 1 6 th & 1 7 th f e b r U a ry 2 0 1 3 C a l l t o d ay a n d s p e a k t o a m e m b e r o f t h e C o s m e t i C n e w s s a l e s team on 01268 754897

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october

We round up upcoming events, training courses and meetings 31-4 (October) The Dermatologic & Aesthetic Surgery International League, The Westin Dragonara Resort, St Julian’s, Malta, www.thedasil.org

1 Botulinum toxin and dermal fillers Foundation Course – Birmingham, www.aesthetox.co.uk 3 Obagi Workshop, London, www.healthxchange.com 3 Advanced laser training course, London, www.advancebeautytraining.com 4 Sigmacon Aesthetic Workshop – Building a Successful Aesthetic Practice (Half Day event 1.30pm-5.30pm), London, 01923 266339 or clive@cliveswan.com 5 Obagi Workshop, Manchester, www.healthxchange.com 8 Inspired Cosmetic Training - Botulinum toxin and Dermal Filler Training Courses, Scotland, www.inspiredcosmetictraining.com 8 Innomed Training Chemical Peeling Systems: Comprehensive Course for New Users, Central London, www.innomedtraining.co.uk 9 Innomed Training Mesotherapy for Fat, Cellulite and Skin Rejuvenation: New Users, Central London, www.innomedtraining.co.uk 10 Obagi Workshop, Glasgow, www.healthxchange.com 10 Genuine Dermaroller™ Medical Device Training, London, www.genuinedermaroller.co.uk 10 Core of knowledge, Belfast, www.advancebeautytraining.com 11 Core of Knowledge Laser / IPL Training, London, latoyahallen@mapperleypark.co.uk 10-12 Laser/IPL hair removal course, Belfast, www.advancebeautytraining.com 15 Botulinum toxin and dermal fillers Foundation Course – London, www.aesthetox.co.uk 15-16 British College of Aesthetic Medicine Autumn Meeting, The Celtic Manor Resort, Newport, South Wales, registrations@BCAM.ac.uk 16 Chemical Peel Course – London, www.aesthetox.co.uk

16 White Lotus Anti Aging Holistic Skin Needling, www.whitelotusantiaging.co.uk 17 Dr Bob Khanna Training Institute, Botulinum Toxin Beginners Course, www.drbobkhanna.com 17-18 SkinCeuticals Training, Cheshire, www.SkinBrands.co.uk 18 Dr Bob Khanna Training Institute, Botulinum Toxin Advanced Course, www.drbobkhanna.com 19 Dr Bob Khanna Training Institute, Dermal Filler Beginners Course, www.drbobkhanna.com 20 Obagi Ireland Workshop, Belfast, www.healthxchange.com 20-21 BAAPS Annual Meeting 2012, Royal College of Physicians, London, www.baaps.meeting.org.uk 23 BIAE One Day Skin Seminar Benign and Malignant Skin Lesions and Inflammatory Skin Disorders, Victory Services Club, London, www.electrolysis.co.uk 24 Genuine Dermaroller™ Medical Device Training, Yorkshire, www.genuinedermaroller.co.uk 24-25 Medik8 Training, Cheshire, www.SkinBrands.co.uk 25 Advanced laser training, Dublin, www.advancebeautytraining.com 25-26 SkinCeuticals Training, London, www.SkinBrands.co.uk 26 SkinMedica Training, Cheshire, www.SkinBrands.co.uk 27 Medik8 Roller, London, www.SkinBrands.co.uk 27 Laser/IPL Core of Knowledge, London, www.lasersafe.co.uk 27-29 Microsclerotherapy for Thread Veins of the Leg, Guildford, www.theclinicalexchange.com 27-30 European Academy of Dermatology and Venereology, Prague Congress Centre, Prague, Czech Republic, www.eadvprague2012.org 28 SkinMedica Training, London, www.SkinBrands.co.uk 29 Botulinum toxin and dermal fillers Foundation Course – Birmingham, www.aesthetox.co.uk 29 Innomed Training Botulinum Toxin in Facial Aesthetics: New Users (incl. all major brands), Birmingham, www.innomedtraining.co.uk 30 Innomed Training Dermal Fillers in Facial Aesthetics: New Users to Hyaluronic Acid Fillers, Birmingham, www.innomedtraining.co.uk

1-2 SkinCeuticals Training, Cheshire, www.SkinBrands.co.uk 3 Inspired Cosmetic Training - Botulinum toxin and Dermal Filler Training Courses, Scotland, www.inspiredcosmetictraining.com 4 Obagi Ireland Workshop, Dublin, www.healthxchange.com 4-6 BDTA Dental Showcase 2012, ExCel, London, www.dentalshowcase.com 8-9 Medik8 Training, Cheshire, www.SkinBrands.co.uk 10 Core of Knowledge Laser / IPL Training, Nottingham, latoyahallen@mapperleypark.co.uk 11 Dr Bob Khanna Training Institute, Dermal

Fillers – Advanced, www.drbobkhanna.com 12 Dr Bob Khanna Training Institute, Oral Facial Course, www.drbobkhanna.com 13 Chemical Peel Course, Birmingham, www.aesthetox.co.uk 15 Dr Bob Khanna Training Institute, Botulinum Toxin Beginners Course, www.drbobkhanna.com 15 Blue Peel Workshop, London, www.healthxchange.com 15-17 Laser hair removal training, Dublin, www.advancebeautytraining.com 16 Dr Bob Khanna Training Institute, Botulinum Toxin Advanced Course, www.drbobkhanna.com 17 Dr Bob Khanna Training Institute, Dermal

Filler Beginners Course, www.drbobkhanna.com 19 Obagi Workshop, London, www.healthxchange.com 22 Core of knowledge, London, www.advancebeautytraining.com 22-24 Laser hair removal course, London, www.advancebeautytraining.com 27 Botulinum toxin and dermal fillers Foundation Course, Birmingham, www. aesthetox.co.uk 28 White Lotus Anti Aging Holistic Skin Needling, www.whitelotusantiaging.co.uk 30-31 SkinCeuticals Training, London, www.SkinBrands.co.uk

Friday August 31-Saturday September 1 IAAFA annual meeting, Royal Society of Medicine, www.iaafa.net Saturday September 1 IAAFA Charity Ball in aid of the Make a Wish Foundation, Portman Radisson Hotel, London

15-16 British College of Aesthetic Medicine Autumn Meeting, The Celtic Manor Resort, Newport, South Wales, registrations@BCAM.ac.uk 1-2 Medik8 Training, London, www.SkinBrands.co.uk 3-4 BODY Conference and Exhibition, The Royal Society of Medicine, London, www.bodyconference.com 5-6 SkinCeuticals Training, Cheshire, www.SkinBrands.co.uk 10 Botulinum Toxin and Dermal Fillers Foundation Course, Manchester, www.aesthetox.co.uk 12-13 Medik8 Training, Cheshire, www.SkinBrands.co.uk 13 Core of Knowledge Laser / IPL Training, London, latoyahallen@mapperleypark.co.uk 13 Dr Bob Khanna Training Institute, Gel Peel Course, www.drbobkhanna.com 14 Dr Bob Khanna Training Institute, Botulinum Toxin Beginners Course, www.drbobkhanna.com 15 Laser/IPL Core of Knowledge, Birmingham, www.lasersafe.co.uk 15 Dr Bob Khanna Training Institute, Botulinum Toxin Advanced Course, www.drbobkhanna.com 16 Dr Bob Khanna Training Institute, Dermal Filler Beginners Course, www.drbobkhanna.com 17 Inspired Cosmetic Training - Botulinum toxin and Dermal Filler Training Courses, Scotland, www.inspiredcosmetictraining.com 19 SkinMedica Training, Cheshire, www.SkinBrands.co.uk 24 Botulinum Toxin and Dermal Fillers Foundation Course, Birmingham, www.aesthetox.co.uk 24 Botulinum Toxin and Dermal Fillers

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

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DIRECTORY A

For less than ÂŁ25 per month, you can list your company details here. For more information contact Carly MacFarlane 01268 754897 carly@creativemedialtd.co.uk

C Contact: Guy Gouldsmit T: 08451 707 788 E: info@a-b-c-uk.com W: www.abclasers.co.uk

Chromogenex Service: Laser System Manufacturer Contact: Lauren Roberts T 01554 755444 E: lroberts@chromogenex.com W: www.chromogenex.com

Aesthetic Academy + Training Contact: Chantalle Coombes T: 0845 519 4823 W: www.aestheticstraining.co.uk E: training@aestheticacademy.co.uk Allergan T: 0808 2381500 W: www.juvedermultra.co.uk Aesthetox Academy Service: Training T: 0870 0801746 E: treatments@aesthetox.co.uk W: www.aesthetox.co.uk

DermaFx Micropigmentation Service: Permanent Make Up Contact: Evie Adams T : 08703002078 E: dermafx@evieadams.com W: www.evieadams.com

product range Contact: Anthony Zacharek T: 07747 865600 E: sales@aztecservices.uk.com W: www.aztecservices.uk.com

E Beehive Medical Solutions Contact: Kevin Rendell T: 020 8550 9108 E: enquiries@beehive-solutions.co.uk W: http: //www.beehive-solutions.co.uk/ catalog BioActiveBeauty Hydropeptide...the next generation of

M: 0791 941 6392 E: info@bioactivebeauty.com

Mayfair Medical Contact: Mike Filapiuak T: +44 02076296269 E: mike@ericson-laboratoire.co.uk W: www.ericson-laboratoire.com

Galderma Contact: Azzalure Sales Team T: 01923 208950 E: info.uk@galderma.com W: www.galderma.co.uk

T: 07766 591 085 E: roy@biotica.co.uk W: www.bioptica.co.uk Blue Horizons Marketing T: 01242 236600 E: info@bluehorizonsmarketing.co.uk W: www.bluehorizonsmarketing.co.uk Services: Websites, patient literature, referral literature, brand image, advertising, e-marketing and more. 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

H Hamilton Fraser Contact: Wai Chan T: 0845 3106 300 E: cosmetic@hamiltonfraser.co.uk W: www.hamiltonfraser.co.uk Harley Aesthetics Contact: Dr Mark Harrison T: 02074872772 E: enquiries@harleyaesthetics.com W: www.harleyaesthetics.com Services: Training

Merz Aesthetics Contact: Merz Aesthetics Customer Services T: 0333 200 4140 E: info@merzaesthetics.co.uk Morning Star Surgical S.A. (Pty) Ltd Contact: Brian Nielsen T: +27 (82) 667 2506 E: brian@morningstar-medical.com W: www.morningstarsurgical.co.za My Cells/Scandinavian UST Ltd Contact: John Tucker T: +35361 312979 E: info@mycells.ie W: www.my-cells.net

Q-Med, a Galderma Division Contact: Customer Service T: 01923 208950 E: info.uk@galderma.com W: www.q-medpractitioner.com/uk

RECOVA COMPRESSION GARMENTS Contact: Eva Sanchez-Smith E: eva.sanchez@recovapostsurgery.com W: www.recovapostsurgery.com T: 0207 000 1044

S SkinBrands Contact: Tracey Beesley T: +44 (0) 2089978541 E: tracey@skinbrands.co.uk W: www.skinbrands.co.uk Skin Geeks Ltd Contact: Customer Services T: +44 (0)1865 338046 E: info@skingeeks.co.uk W: www.skingeeks.co.uk Specialist Make-Up Services Ltd Contact: Mike Lawrence T: 0845 2302021 E: enquiries@permanent-makeup.com W: www.permanent-makeup.com Services: Permanent Make-Up Surface ImageingSolutions Contact: Nick Miedzianowski-Sinclair Service: Skin Analysis systems & services Telephone : +447774802409 E: nms@surfaceimaging.co.uk W: www.surfaceimaging.co.uk

Med-fx Contact: Faye Price T: 01376 532800E: sales@medfx.co.uk W: www.medfx.co.uk Medical Aesthetic Group Contact: David Gower T: 02380 676733 E: info@magroup.co.uk W: www.magroup.co.uk

Polaris Lasers Contact: Neil Calder T: 01234841536 E: njc@polaris-laser.com W: www.polaris-laser.com

Eden Aesthetics Contact: Anna Perry T: 01245 227 752 E: info@edenaesthetics.com W: www.edenaesthetics.com

Pronokal Service: Medically supervised weight loss programme E: info@pronokal.co.uk T: 0845 604 8834 W: www.pronokal.co.uk

Lifestyle Aesthetics Contact: Sue Wales T: 0845 0701 782 E: info@lifestyleaestheics.com W: www.lifestyleaesthetics.com

MACOM Compression Garments Contact: MACOM Customer Services T: 020 7386 0011 E: info@macom-medical.com W: www.macom-medical.com

Energist Contact: Andrew Snoddon T: 01792 798768 E: enquiries@energist-international.com W: www.energist-international.com

T: 01753 830931

Contact: Roy Henderson

Lynton Contact: Customer Services T: 0845 6121545 E: info@lynton.co.uk W: www.lynton.co.uk

E-Clinic Contact: Mark Lainchbury T: 01274 530 505 E: info@e-clinic.uk.com W: www.e-clinic.uk.com

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Lawrence Grant, Chartered Accountants Service: Chartered Accountants Contact: Alan Rajah FCCA T: +44 (0) 20 8861 7575 E: lgmail@lawrencegrant.co.uk W: www.lawrencegrant.co.uk/specialistservices/doctors.htm LCS Academy Contact: Dr Elizabeth Raymond Brown T: 0845 0037315 E: admin@lcsacademy.co.uk W: www.lcsacademy.co.uk

Service: Exclusive UK distributor for Viora

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Cutera (Europe) Contact: Stephen Ritchie T: 07969993296 E: sritchie@cutera.com W: www.cutera.com

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Healthxchange Pharmacy Contact: Steve Joyce T: +44 (0)1481 736837 F: +44 (0)1481 736677 E: SJ@healthxchange.com W: www.healthxchange.com W: www.obagi.uk.com

Clarisonic UK Service: Skincare Contact: Ann Terrington E-mail: uksales@clarisonic.com Website: www.clarisonic.co.uk Telephone: 0800 988 4864

Contact: Customer Service

AZTEC Services

P Candela UK Ltd Contact: Michaela Barker T: +44 08455210698 E: alex@alexsilver.co.uk W: www.candelalaser.co.uk

ABC Laser

V Vaser Lipo/ Sound Surgical Technologies LLC Contacts: Simon Davies T: +44 (0) 7971 686114 E: SDavies@soundsurgical.com W: www.vaser.com

W Wellness Trading Contacts: Adam Birtwistle T: 01746 718123 E: contact@wellnesstrading.co.uk W: www.wellnesstrading.co.uk

Z Zanco Models Contacts: Mr Ricky Zanco T: 08453076191 E: info@zancomodels.co.uk W: www.zancomodels.co.uk

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.

1086/BOC/JUN/2012/JH

Date of preparation July 2012

Bocouture® is a registered trademark of Merz Pharma GmbH & Co, KGaA.

two

events under one roof ; the

1 6

& 1 7 business design cent

t h

1 6 th a n d 1 7 th f e b r u a ry 2 0 1 3 , t h e b u s i n e s s d e s i g n c e n t r e , l o n d o n

cosmetic news the uk’s largest trade aesthetics exhibition and conference

e x h i b i t i o n

a n d

2013 c o n f e r e n c e

Why you should book now for the UK’s largest aesthetic exhibition and conference They say the early bird catches the worm and that is why there is no better time to book your place at the Cosmetic News Expo 2013. Now in its fourth year, The Cosmetic News Expo, and adjoining Aesthetics Conference, is the UK’s largest aesthetic conference and exhibition, bringing together more aesthetic practitioners than any other meeting. The Expo will once again take place at the Business Design Centre in Islington and is being held this year at the earlier dates of Saturday February 16 and Sunday February 17, 2013. Traditionally held in April or May, for 2013 the dates have been moved to February to make The Cosmetic News Expo and Aesthetics Conference the first major meeting of the year in the UK aesthetics calendar. Sponsored by Merz Aesthetics (Gold Sponsors); Syneron/Candela (Silver Sponsors) and Obvieline (Hospitality Sponsors), the event offers aesthetic professionals the chance to gain CPD accredited education at the same time as networking and exchanging information with their peers and finding out about the latest technologies and products on the market, all under one roof.

E a r ly B i r d O f f e r We are offering all those who book their place at the Cosmetic News Expo 2013 conference before September 30 a 10% discount on the price of their ticket. Tickets for the 2013 conference cost £49 for one day or £85 if you book for both days, if you book in advance. A complimentary lunch will be incorporated into the delegate package, with refreshments provided throughout the conference breaks.

To book your place visit www.cosmeticnewsuk.com or call the Events Team on 01268 754 897.

aesthetics

season starts here !

f e b r u a r y re, london, islington Get CPD accredited education at the Aesthetics Conference 2013 Re-branded as the Aesthetics Conference, the educational programme at the Cosmetic News Expo is an excellent opportunity to see the very best UK and international speakers, discussing the latest topics and demonstrating the most up-to-date techniques, at the fraction of the cost of other industry events. This year the conference not only has a new look and a new name but, for the first time, is being organised by an independent consultant with years of knowledge and experience of the aesthetics industry to make it even more cutting edge.

Here’s a taster of what the conference programme will contain…. C o s m e t i c N e w s E x p o 2 0 1 3 P r e l i m i n a ry C o n f e r e n c e P r o g r a m m e

S at u r d ay F e b r u a ry 1 6 t h

S u n d ay F e b r u a ry 1 7 t h

10am-11.30am Session 1: New Trends in Facial Volumising and Shaping (including live demonstrations) A masterclass in facial volume replacement focusing on anatomical placement and risk management using the most effective products and techniques.

10am-11am Session 1: Multi-Application Lasers With so many lasers on the market how do you choose what to use? This session will explain the value of a multi application laser and how it can benefit your bottom line while offering your patients the best results with the least downtime.

12pm-1pm Session 2: New Trends with Toxins: A Scientific Approach Each presenter to have 15 mins to present the science, indications and clinical evidence behind their toxin followed by open debate and questions

11.30am-1pm Session 2: Energy-Based Anti-Aging Skin Treatments This session will discuss combination energy-based treatments for skin resurfacing and skin tightening as well as technology for other applications and skin types.

3pm-4pm Session3: Next-Generation Anti-Ageing and Therapeutic Skincare Products This session will provide insight into the many categories of available products and ingredients commonly used in skincare products and cosmeceuticals both for anti-ageing and therapeutic indications. Due to recent scientific advancements there is a new ingredient on the market that can replace lost and damaged cells: plant stem cells that can fight common signs of ageing – fact or fiction!

3pm-4pm Session 3: Working together – Aesthetic Combination Treatments Today’s aesthetics practitioners have a wide and varied palate of materials to use. This session will focus on how to best use them in combination to get the best results for your patients.

4pm to 5pm Session 4: Plasma Rich Protein and Fat Grafting for Facial Rejuvenation Regenerative medicine and strategies using the patient’s own tissue are the most modern effective approach for rejuvenation and soft tissue augmentation. Autologous Platelet Rich Plasma (PRP) and autologous fat grafting are two unique techniques for this modern treatment today.

4pm-5pm Session 4: Hand and Neck Rejuvenation The most effective rejuvenation treatment for problem areas like the hands and neck. Treatments include mesotherapy and micro droplet injections of fillers

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onfidence is Reliable1,2 Rewarding3 Performance4,5 BOTOX® is licensed for the treatment of moderate to severe glabellar lines Delivers long-lasting patient satisfaction, time after time2,3 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. 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. 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 preganancy 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. The following other adverse events have been reported since the drug has been marketed: dysarthria; abdominal pain; vision blurred; pyrexia; focal facial paralysis; hypoaesthesia; malaise; myalgia; pruritus; hyperhidrosis; diarrhoea; anorexia; hypoacusis; tinnitus; radiculopathy; syncope; myasthenia gravis; erythema multiforme; dermatitis psoriasiform; vomiting and brachial plexopathy; rash; psoriasiform eruption; anaphylactic reaction (angiodema, bronchospasm); alopecia and madarosis. Adverse reactions possibly related to spread of toxin distant from injection site have been reported very rarely (exaggerated muscle weakness, dysphagia, or aspiration pneumonia which can be fatal). 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: November 2011.

Adverse events should be reported. Reporting forms and information can be found at www.yellowcard.gov.uk 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/1010/2011 Date of Preparation November 2011