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VOLUME 3/ISSUE 4 - MARCH 2016
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Granuloma
Management CPD
Dr Beata Cybulska discusses granuloma
formation and treatment
Eyelash
Transplants
Mr Asim Shahmalak
shares his techniques
for successful eyelash
transplants
Treating Facial
Thread Veins
with Lasers
Mary White examines
how to use lasers to
treat thread veins
The Benefits
of Bloggers
Mike Nolan explains
how to engage with
bloggers for marketing
opportunities
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Contents • March 2016
06 News
The latest product and industry news
16 Conference and R&D Reports
Aesthetics reports on IMCAS Paris, the Neauvia ‘New Art Aesthetics’ World Congress and research and development at mesoestetic
18 On the Scene
Out and about in the industry this month
22 News Special: Cosmetic Surgery on the Rise
Aesthetics reports on the latest BAAPS annual audit figures and examines why cosmetic treatments are on the rise
24 Aesthetics Conference and Exhibition 2016
A look at the free clinical content available at ACE 2016
Special Feature
Treating Hair Loss
Page 27
CLINICAL PRACTICE
27 Special Feature: Managing Hair Loss
Practitioners discuss their preferred treatment options for thinning and declining hair
32 CPD: Granuloma Management
Dr Beata Cybulska discusses the treatment of granulomas following dermal filler injections
38 Treating the Post-pregnancy Body
Mr Taimur Shoaib shares treatment options for aesthetic concerns following childbirth
43 Eyelash Transplants
Mr Asim Shahmalak examines the history of eyelash transplants and provides treatment advice
49 Peri-ocular Ageing
Mrs Sabrina Shah-Desai explains how to treat peri-ocular ageing in different ethnicities
53 Treating Facial Thread Veins with Lasers
Aesthetic nurse prescriber Mary White describes laser functions and thread vein treatments
57 Abstracts
A round-up and summary of useful clinical papers
IN PRACTICE
58 The Benefits of Bloggers
Mike Nolan explains how to attract patients through partnering with online bloggers
61 The Big Brand Theory
Roydon Cowley discusses branding strategies and how to separate yourself from the competition
64 How Google Influences New Patients
Jay Cruiz examines Google’s impact on clinic reputation and advises practitioners on how to manage online reviews
67 In Profile: Dr Beatriz Molina
Dr Beatriz Molina reflects on her journey into medical aesthetics and shares her passion for making it a recognised specialty
68 The Last Word
Dr Joney De Souza debates the use of voucher websites as a portal for selling cosmetic treatments
NEXT MONTH
• IN FOCUS: Combination Treatments • Mid-facial Rejuvenation
• PDO Threadlifting • Benefits of 3D Imaging
Subscribe Free to Aesthetics
Subscribe to Aesthetics, the UK’s leading free-of-charge journal for medical
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In Practice
How Google Influences
New Patients
Page 64
Clinical Contributors
Dr Beata Cybulska is a board-registered dermatovenereologist (Poland) and an aesthetic practitioner
with more than 20 years of experience of working
in teaching hospitals in London and Bristol as an
associate specialist.
Mr Taimur Shoaib is a consultant plastic surgeon
with more than 20 years’ medical experience. He
qualified from the University of Glasgow in 1992, before
establishing his cosmetic surgery practice, La Belle
Forme, in 2009.
Mr Asim Shahmalak is a hair transplant surgeon
and gained his medical degree from the University of
Karachi, Pakistan in 1988. He founded the Crown Clinic
in Manchester eight years ago and also has consulting
rooms in Harley Street.
Mrs Sabrina Shah-Desai is a consultant oculoplastic
surgeon with experience in non-surgical aesthetic
peri-orbital rejuvenation with botulinum toxin and dermal
fillers. She is a keen educator and runs surgical training
wet labs and regularly speaks at national conferences.
Mary White is an aesthetic nurse prescriber and
specialises in dermatology laser and aesthetic
injectable treatments. White owns an award-winning
clinic in Worcestershire and has been a clinical trainer
for two leading suppliers of medical lasers in the UK.
Register for the Aesthetics
Conference and
Exhibition 2016 15-16 April
www.aestheticsconference.com
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Editor’s letter
The month in which we turn the clocks forward
and spring arrives is finally here. Personally I can’t
wait for the equinox, when the sun crosses the
celestial equator – that imaginary line in the sky,
and we are on the summer countdown!
Amanda Cameron
Before we focus on what’s to come in summer,
Editor
we have a conference to attend. All is nearly
ready for the biggest and best aesthetic congress of the year, the
Aesthetics Conference and Exhibition (ACE) 2016, taking place on
April 15 and 16. We now have a fantastic line-up of expert speakers
and hot topics to engage everyone, whatever your speciality. This
year, we have created eight Conference sessions, each dedicated
to key anatomical facial and body areas. Book either a 1-day or a
2-day Pass to update your knowledge and understanding of full facial
rejuvenation, treating the neck, breasts, buttock and thighs, and vaginal
rejuvenation. Alternatively, with free registration, you have access to the
Expert Clinics, Masterclasses, Treatments on Trial and Business Track
agendas, where you can discover new treatments and techniques,
learn about the use and efficacy of new products, and enhance
your business skills, with comprehensive advice from the UK’s most
knowledgeable aesthetic professionals. We have also introduced
innovative and exciting technology to enhance the sound and viewing
of sessions to ensure you don’t miss out on anything taking place.
Read more about ACE 2016 on p.24.
So what articles do we have for you this month? Dr Beata Cybulska’s
CPD article (p.32) on the management of granulomas will be relevant
to all aesthetic practitioners offering dermal filler injections, so I urge
everyone to read it carefully to aid your understanding of the formation,
pathophysiology and treatment of this delayed complication.
Hair loss can be a significant aesthetic concern for both men and
women, and, thankfully, there is range of treatment options available,
which are increasingly being performed in aesthetic clinics. Turn to p.27
to learn more about successful procedures and how you can expand
your offerings. Hair loss doesn’t solely occur on the scalp, it can also
affect eyebrows and eyelashes, as I found out in Mr Asim Shahmalak’s
fascinating eyelash transplant article. Turn to p.43 to enhance your
understanding of this complex procedure.
Please do let us know what you enjoyed reading this month and the
sessions you’re looking forward to attending at ACE 2016 by tweeting
us @aestheticsgroup or emailing [email protected]
Editorial advisory board
We are honoured that a number of leading figures from the medical aesthetic community have joined Aesthetics journal’s
editorial advisory board to help steer the direction of our educational, clinical and business content
Mr Dalvi Humzah is a consultant plastic, reconstructive and
aesthetic surgeon and medical director at the Plastic and Dermatological Surgery. He previously practised as a consultant plastic
surgeon in the NHS for 15 years, and is currently a member of the
British Association of Plastic, Reconstructive and Aesthetic Surgeons
(BAPRAS). Mr Humzah lectures nationally and internationally.
Dr Raj Acquilla is a cosmetic dermatologist with over 11 years
experience in facial aesthetic medicine. UK ambassador, global
KOL and masterclass trainer in the cosmetic use of botulinum toxin
and dermal fillers, in 2012 he was named Speaker of the Year at
the UK Aesthetic Awards. He is actively involved in scientific audit,
research and development of pioneering products and techniques.
Sharon Bennett is chair of the British Association of
Cosmetic Nurses (BACN) and also the UK lead on the BSI
committee for aesthetic non-surgical medical standard. Bennett
has been developing her practice in aesthetics for 25 years and
has recently taken up a board position with the UK Academy of
Aesthetic Practitioners (UKAAP).
Dr Tapan Patel is the founder and medical director of VIVA
and PHI Clinic. He has more than 14 years of clinical experience
and has been performing aesthetic treatments for ten years.
Dr Patel is passionate about standards in aesthetic medicine
and still participates in active learning and gives presentations
at conferences worldwide.
Dr Christopher Rowland Payne is a consultant
dermatologist and internationally recognised expert in cosmetic
dermatology. As well as being a co-founder of the European
Society for Cosmetic and Aesthetic Dermatology (ESCAD), he was
also the founding editor of the Journal of Cosmetic Dermatology
and has authored numerous scientific papers and studies.
Mr Adrian Richards is a plastic and cosmetic surgeon with
12 years of specialism in plastic surgery at both NHS and private
clinics. He is a member of the British Association of Plastic and
Reconstructive Surgeons (BAPRAS) and the British Association of
Aesthetic Plastic Surgeons (BAAPS). He has won numerous awards
and has written a best-selling textbook.
Dr Sarah Tonks is a cosmetic doctor, holding dual
Dr Maria Gonzalez has worked in the field of dermatology
qualifications in medicine and dentistry. Based in
Knightsbridge, London she practices a variety of aesthetic
treatments. Dr Tonks has appeared on several television
programmes and regularly speaks at industry conferences on
the subject of aesthetic medicine and skin health.
for the past 22 years, dividing her time between academic work
at Cardiff University and clinical work at the University Hospital
of Wales. Dr Gonzalez’s areas of special interest include acne,
dermatologic and laser surgery, pigmentary disorders and the
treatment of skin cancers.
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Audit
Talk #Aesthetics
Follow us on Twitter @aestheticsgroup
#Moles
Dr Anjali Mahto
@DrAnjaliMahto
#Skincancer clinic done
this morning. Learn to
examine your moles
#WorldCancerDay
#melonoma
#Confrence
Dr Askari Townshend @Dr_AskariT
Back in the UK after a great weekend catching up with &
learning from fellow experts #imcas2016. You can never
know too much!
#Conference
Dr Uliana Gout @UlianaGout
A pleasure to lecture at the E3 Summit
and the Ukranian Aesthetic Consilium
Conference 2016 @Media_Consilium
#Regulation
SkinLizzie @LPALimited
My #Skin & #aesthetics #service is regularly inspected &
audited via #saveface & #CQC #standards
#Presenter
Dr Raj Acquilla @RajAcquilla
Very honoured to present at the @RoySocMed #London
with #KoenDeBoulle and friends.
#Survey
Gary Ross @ukaesthetic
Cosmetic surgery with BAAPS surgeons increasing.
Great to be part of the safety audit. Thanks @BAAPSmedia.
#Genetics
Dr Doris Day
@DrDorisDay
Opening the conversation re:
genetics and beauty, starting with my
daughter! #mumgenes #happymama
#workispleasure
New data suggests
cosmetic procedures in
Britain have risen by 13%
The annual audit released by the British Association of Aesthetic
Plastic Surgeons (BAAPS) suggests a ‘record number’ of Britons
underwent cosmetic surgery in 2015.
The data, collected by BAAPS, states that 51,000 Britons underwent
procedures last year – a 13% rise since 2014. Women’s cosmetic
surgery is said to have risen by 12.5% from 2014, with breast
augmentation remaining the most popular procedure, rising a further
12% from 2014. A rise in men having cosmetic surgery is also noted
in the report, with face/neck lifts climbing 14%, eyelid surgery up
15% and brow lifts 15.5%. The most significant rise in male cosmetic
surgery was liposuction, which rose by 20% from the previous year.
Consultant plastic surgeon and BAAPS president, Mr Michael Cadier,
said, “There’s no doubt that we are seeing an increase in demand
for cosmetic surgery from both men and women. Whether this is
inspired by celebrity culture and a recognition that the results of
modern aesthetic procedures in the right hands can be subtle,
natural-looking and attractive, what is most important is for patients
to remember that surgery is, on the whole, life-changing and
irreversible – far from a trivial ‘status symbol’ beauty treatment.”
The report suggests that a trend in celebrities openly confessing
to having procedures could be helping to de-stigmatise cosmetic
surgery and fuel growth. Mr Rajiv Grover, consultant plastic surgeon
and former president of BAAPS said, “The 2015 BAAPS audit has
shown that demand for cosmetic surgery continues to increase
following the quieter period in 2014 which mirrored the British
economy. Perhaps the decline of the ‘hyper-masculine’ look
fashionable last year, which has given way to a sharper, more
slimline shape, has influenced men – and it certainly appears
both genders seem encouraged by a new openness in glamorous
celebrities admitting they have had ‘a little surgical help’ to enhance
their looks.”
Suncare
AesthetiCare launches
new mineral formulation
Skincare manufacturer AesthetiCare has
introduced a new sun protectant mineral
formulation to its Heliocare 360˚ range.
The Heliocare 360˚ Mineral is designed to
provide the skin with a hydrating, antiageing
layer that aims to protect the skin from harsh
UVA and UVB rays.
The Heliocare 360˚ range contains
formulations of antioxidant activity with the
polypodium leucotomos extract fortified with
ferulic acid and caffeic acid, combined with,
amongst others, an antioxidant complex
of vitamins C and E, and green tea extract. AesthetiCare claims the
product can be used under makeup and is suitable for all skin types.
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
aestheticsjournal.com
@aestheticsgroup
Aesthetics Journal
Aesthetics
Conference
Meet the experts at ACE 2016
Delegates will have the special opportunity to meet leading aesthetic nurses,
doctors, surgeons and other industry experts at the Aesthetics Conference
and Exhibition (ACE) on April 15 and 16. Prominent practitioners will be present
at the Aesthetics stand throughout the two days, to meet and greet delegates
and to answer any industry questions they may have.
In attendance will be consultant plastic and reconstructive aesthetic surgeon,
Mr Dalvi Humzah, cosmetic dermatologist Dr Raj Acquilla, consultant plastic
surgeon Mr Taimur Shoaib, cosmetic practitioner, Dr Tapan Patel, consultant
plastic and cosmetic surgeon, Mr Adrian Richards and dermatologist Dr Maria
Gonzalez. Aesthetics journal editor and ACE programme organiser Amanda
Cameron said she is looking forwarding to introducing the experts to attending
delegates. “This is the first time at ACE where we will have some of the industry’s
top practitioners available for delegates to speak to at the Aesthetics stand.
I am so glad we can give attendees this unique opportunity. They can ask
their individual questions face to face in a more personal environment, whilst
networking with their peers.” For more information and to register for ACE 2016,
please visit www.aestheticsconference.com
Countdown to ACE 2016
Latest programme updates
Professor Andy Pickett will
discuss the risks associated with
fake and counterfeit aesthetic
products at his Business Track
session.
Dr Julian De Silva’s Expert
Clinic session will include details
of his techniques for non-invasive
nose reshaping using fillers.
Mr Paul Banwell’s Expert Clinic
session, sponsored by 3D-lipo Ltd,
will discuss the benefits of the latest
developments in non-surgical facial
rejuvenation using HIFU technology.
Skincare
SkinCeuticals launches
addition to Correct range
Skincare company SkinCeuticals has added the
Triple Lipid Restore 2:4:2 to its Correct skincare
range. The Triple Lipid Restore is an antiageing
lipid replenishment cream that aims to stimulate
lipid replenishment, barrier protection, hydration
and repair in ageing or dry skin. According to
SkinCeuticals, the Triple Lipid Restore is the
first product to effectively harness potent lipid
combinations. It combines a ratio of lipids in a concentration of 2% ceramides, 4%
cholesterol and 2% omega-fatty acids to correct and nourish skin by replenishing
the lipid ratio and restoring natural hydration and skin barrier function.
The product is part of the Correct portfolio, which aims to prevent further skin
damage due to collagen breakdown, closer cell turnover and loss of moisture,
as well as correct and restore the skin for a healthier and youthful appearance.
Investigation
Clinics found to be offering
under-18s cosmetic procedures
An investigation by The Sun claims that 12 clinics across five major UK cities
considered treating children as young as 15 years old. Doctors, nurses and a
paediatric surgeon are said to have discussed treatment with the under-18s, with
the surgeon apparently telling a 15-year-old he could “100% convince” her mother
to allow her to have botulinum toxin and lip fillers. An undercover reporter took the
15-year-old girl to consultations at clinics across the UK where she asked for dermal
fillers to make her lips bigger, botulinum toxin to smooth forehead wrinkles or semipermanent makeup. Each clinic was given the girl’s date of birth. Twelve clinics were
found to consider treating the girl and six booked her in to have lip filler or botulinum
toxin. Mr Nilesh Sojitra, consultant plastic surgeon said, “At such a young age, a patient
does not require any ‘antiageing’ treatment. To suggest otherwise is irresponsible.”
Insight
Cosmetic practitioner and
international speaker
Dr Tapan Patel says:
“Year on year there has been an
increasing attendance at ACE
and I think this conference will only get bigger
over time. As a regular speaker, I can say we are
incredibly well-looked after, the organisation is
top-notch, the audio-visual team is fantastic, and
it’s always a real privilege to be part of the show.
As an advanced practitioner, I attend conferences
to continually progress my learning, and I would
advise any injector, no matter how experienced,
to do the same. The learning process is a
dynamic one, techniques are constantly evolving
and our knowledge of anatomy is constantly
expanding; I believe investing in continuous
medical education is vital.”
What delegates say
“Excellent range of exhibitors and
speakers, with a variety of topics covered.”
Aesthetic nurse prescriber, Ireland
“Good exhibitors, friendly environment,
easy to get to. Excellent variety of
lecturers and great value for money.”
Cosmetic doctor, Swansea
www.aestheticsconference.com
HEADLINE SPONSOR
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
@aestheticsgroup
Aesthetics Journal
Aesthetics aestheticsjournal.com
Suncare
Industry
Pfizer and Allergan
announce new division
and leaderships
US global biopharmaceutical company Pfizer will
create a new division following the completion of its
merge with Allergan, scheduled for the second half of
this year. The new operating segment, named Global
Specialty and Consumer Brands, will include Pfizer’s
Consumer Healthcare unit and Allergan’s ophthalmology
and aesthetics businesses. The current executive vice
president at Allergan, Bill Meury, has been announced
as the group’s president. Pfizer also stated that after the
closing of the transaction, the company’s Global Innovative
Pharma and its Vaccines, Oncology and Consumer (VOC)
business will be combined, under the leadership of Albert
Bourla, who is currently group president of VOC. At this
time, the company also said it will continue to manage the
combined company’s commercial operations through two
distinct businesses; Innovative Products and Established
Products. Ian Read, chairman and chief executive officer of
Pfizer, said, “We are designing the combined company to
preserve and enhance our option to potentially separate
the innovative and established businesses into separate
companies in the future, and continue to expect to make a
decision about any potential separation by no later than the
end of 2018.”
Vaginal rejuvenation
Lumenis launches
FemTouch for
intimate area
Laser device manufacturer Lumenis has launched a fractional
CO2 laser for an in-clinic treatment of health-related vaginal
conditions. The FemTouch aims to help post-menopausal
women suffering from symptoms such as vaginal atrophy
and stress urinary incontinence, and works by promoting
the remodeling of the vaginal mucous epithelium layer. The
fractional laser is applied along the vaginal wall, without the
need of anaesthesia, resulting in a gentle controlled ablation
and coagulation of the vaginal lining. According to Lumenis, the
treatment requires two to four sessions of around two minutes
each to reach optimal outcomes. “FemTouch is an effective,
safe and fast treatment for women who want to improve their
vaginal health,” said gynaecologist, Dr Massimiliano Marziali. He
continued, “I am excited to add this treatment to my practice as
the patients I have treated so far are satisfied with the clinical
outcomes and with the overall procedure, which takes only a
few minutes and is generally comfortable for them. I believe
that FemTouch is the future of vaginal health as its simplicity of
usage also leads to good clinical outcomes and it could also be
effective for additional gynaecological indications.”
New NICE guidelines
uncover the risks and
benefits of sunlight exposure
The National Institute for Health and Care Excellence (NICE) has
released new guidelines that outline the risks and benefits of sunlight
exposure. The guidelines, Sunlight exposure: risks and benefits, urges
practitioners to communicate the risks of excessive sun exposure to
their patients, as well as inform them of the increased risk of low vitamin
D status due to underexposure. NICE has made 18 recommendations
in the guidance, including suggestions to practitioners which include
offering one-to-one tailored advice to individual patients, communicating
the risks and benefits of sun exposure to their patients and supporting
community health programmes to raise awareness of under and
overexposure to sunlight.
Deputy chief executive and director of health and social care at NICE,
Professor Gillian Leng, said, “We need to better identify groups at risk of
over or underexposure to sunlight and give them better understanding
of why they may need to modify their behaviour and how. Our new
recommendations will help tailor public health activities focused on those
groups most at risk from over or underexposure to sunlight. They will
ensure that all activities and campaigns take a balanced, consistent and
effective approach, and ultimately make the sun more friend than foe.”
Education
Dr Beatriz Molina and Mrs
Sabrina Shah-Desai launch
new training course
Consultant ophthalmic plastic and reconstructive surgeon Mrs Sabrina
Shah-Desai and aesthetic practitioner Dr Beatriz Molina will hold a
facial rejuvenation course together in Coventry on April 11.
The course, titled, ‘Anatomical Basis of Facial Rejuvenation with Dermal
Fillers and Management of Complications Wet Lab,’ will provide
delegates with a unique, hands-on experience in how to avoid and treat
complications from non-surgical filler treatments.
“Industry comments have indicated that there is a growing need for
expert training in the management of acute and chronic complications
of dermal fillers – particularly the use of hyalase, the doses and how to
manage vascular complications,” said Mrs Shah-Desai. “Delegates can
expect a highly interactive day, where the training is not didactic and
theoretical, but practical, evidence-based, hands-on and relevant to
clinical practice,” she said.
Attendees will have the opportunity to obtain an understanding of facial
anatomical layers using cadaver pro-sections and will be able to practice
anatomical surface marking on frozen cadavers.
The ‘wet lab’ will cover basic, intermediate and advanced safe
reproducible filler injection techniques for the forehead, temple, tear
trough, superior sulcus, perioral and jawline, as well as practical sessions
using hyaluronidase. Mrs Shah-Desai and Dr Molina will also discuss
common dermal filler complications, such as the Tyndall effect and
overfilling, and will provide their advice on the management of these
complications.
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
aestheticsjournal.com
@aestheticsgroup
Aesthetics Journal
Skincare
Teoxane adds UV
protectant to skincare range
Aesthetic manufacturer Teoxane Laboratories has
introduced the Advanced Perfecting Shield to its
Teoxane Cosmeceutical range. The Advanced Perfecting
Shield is an SPF 30 day cream that aims to hydrate,
revitalise and restore the skin while offering advanced
UVA/UVB protection.
The formula consists of Teoxane Cosmeceutical’s
Resilient Hyaluronic Acid, which aims to provide optimal
hydration to visibly smooth, plump and strengthen the
skin. Dermo-Restructuring Complex is also included,
which contains antioxidants, amino acids, glutathione,
alpha lipoic acid and minerals, as well as vitamin B6
to revitalise and protect the skin from oxidative stress.
NovHyal (N-acetyl glucosamine-6-phosphate enzyme) is also a part of this
formula, which aims to restructure the skin by stimulating HA production.
The Advanced Perfecting Shield comprises solar filters with ingredients that
aim to inhibit hyaluronidase reaction, have an anti-glycation effect and SPF
30 daily sun protection from UVA/UVB rays. The cream has been designed
to be a makeup base and is lightly tinted so can be used both as a tinted
cream and for mixing with foundation.
Aesthetics
Vital Statistics
2,006
In a survey of
respondents, nearly a third
of UK adults would have aesthetic
treatment for a change in job or career
(Intraline Medical Aesthetics survey)
41%
It is estimated that 41% of women
over the age of 50 have
varicose veins
(Chicago Vein Institute)
In a survey of 2,104
people, 88% said they
trust online reviews
as much as personal
recommendations
(Local Consumer Review Survey 2014
Awards
by Bright Local)
New sponsor announced
for Aesthetics Awards 2016
Enhance Insurance will sponsor
the Training Initiative of the Year
category at the Aesthetics Awards
in December this year. The category
recognises high quality aesthetic
training programmes that deliver
engaging, relevant content with
a continuous development and
improvement platform, resulting in measurable outcomes for delegates.
“Enhance are proud to be sponsoring the Aesthetics Award for Training
Initiative of The Year in 2016, in order to highlight the gold standard industry
training courses,” said Holly Markham, business development executive
at Enhance Insurance. She continued, “It is imperative that high quality
training is available to practitioners wanting to pursue a career or continue
to develop and improve their knowledge and skills in aesthetics. From
an insurance perspective, practitioners involved in aesthetics should be
looking to continually up-skill, positioning themselves with continued
comprehensive technical ability, a solid understanding of anatomical theory,
as well as education, which encompasses consultation skills and knowledge
surrounding health, safety and clinical compliance.”
Enhance Insurance is part of Vantage Professional Risks, a London-based
independent insurance and risk management broker. The company has more
than 30 years’ experience in providing insurance services for professionals in
the medical and aesthetics sector.
The Aesthetics Awards 2016 will be held at the Park Plaza Westminster
Bridge Hotel in London on December 3. To see last year’s winners and
a gallery of images visit www.aestheticsawards.com
The global dermal facial
fillers market is forecast to
grow at a rate of 13.07%
during 2014-2019
(Global Dermal Facial Fillers Market 2015-2019 Report)
In a study of 3 million
user interactions, results
showed that Instagram has
58 times more engagement
per follower than Facebook
(Forrester report)
40% of men will have noticeable
hair loss by the time they are 35
(International Society of Hair Restoration Surgery)
In a survey of 7,000
mothers, one to two
years after giving birth,
86% of women say their
stomach still hasn’t
returned to normal
(BabyCenter survey 2008)
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
@aestheticsgroup
Events diary
4th – 8th March 2016
American Academy of Dermatology Annual
Meeting, Washington DC
www.aad.org/meetings/2016-annual-meeting
31st March – 2nd April 2016
Aesthetic & Anti-aging Medicine World Congress
2016, Monte Carlo
www.euromedicom.com
4th – 6th April 2016
British Society for Investigative Dermatology
Annual Meeting 2016, Dundee
www.bad.org.uk
15th – 16th April 2016
Aesthetics Conference & Exhibition, London
www.aestheticsconference.com
28th April 2016
British Association of Sclerotherapists 2016
Annual Meeting, Basingstoke
www.bassclerotherapy.com
11th – 15th May 2016
Face Eyes Nose Conference, Coventry
www.faceeyesnose.co.uk
29th June – 1th July 2016
British Association of Plastic, Reconstructive and
Aesthetic Surgeons Summer Scientific Meeting
2016, Bristol
www.bapras.org.uk
Conference
ACE 2016
registrations and
consumables
partner announced
Facial aesthetic product supplying company,
Med-fx will be the registrations and consumables
partner of the Aesthetics Conference and
Exhibition 2016 on April 15 and 16. Med-fx is a
market-leading provider of aesthetic products
and business support services supplying a wide
range of products from botulinum toxins, dermal
fillers and cosmeceuticals to surgery consumable
products. Sales manager Dyan Williams said,
“Med-fx are ideally placed to support the huge
clinical agenda for 2016, which features an array
of interesting and relevant content such as the
Expert Clinics and Masterclasses from the UK’s top
practitioners.” To register for ACE visit
www.aestheticsconference.com
Aesthetics Journal
Aesthetics aestheticsjournal.com
Advertising
BAAPS condemns timesensitive discount deals
The British Association of Aesthetic Plastic Surgeons has criticised time-sensitive
deals in cosmetic treatments that ‘continue to flourish unchecked’.
Despite the Government enquiry into cosmetic surgery condemning time-linked
offers for treatments such as facial injectables as unethical, BAAPS has expressed its
concern over Valentine’s Day-themed offers that appeared on the internet, with one
clinic offering breast implants as a ‘Valentine’s Day prize’.
“If despite Government directives, providers can continue to advertise timesensitive deals and prizes for what should be deemed as medical treatments,
what message does that send about our sector?” said Mr Rajiv Grover. He
continued, “It is outrageous that despite the warnings in the Keogh Review and
the Government’s response, clinics continue to behave without a conscience by
putting their profits before common sense. A warning from the Advertising Standards
Agency in response to aggressive marketing and advertising is a bark without any
bite, and clinics repeatedly flout this token slap on the wrist – yet will gain a database
of patients who have not considered any risk.”
Dermal filler
IBSA launches new hyaluronic
acid hybrid Profhilo
Profhilo, a new hyaluronic acid (HA) stable hybrid
cooperative complex for bioremodeling skin laxity,
launched globally at the International Master Course
on Aging Skin (IMCAS) on January 31 in Paris. The new
product is manufactured by pharmaceutical company
IBSA Farmaceutici Italia and is a BDDE-free, thermally cross-linked HA hybrid that
aims to remodel and restore firmness to the skin and nourish cells. According
to IBSA, Profhilo is biocompatible as it is composed of a pure HA produced by
biofermentation and has a reduced risk of side effects, as it is absent of additives.
Aesthetic distributor HA-Derma will officially launch Profhilo in the UK in June,
however practitioners can attend the company’s stand at ACE 2016 on April 15 and
16 for more information on the product. ACE 2016 will take place at the Business
Design Centre in London on April 15 and 16. For more information and to register
visit www.aestheticsconference.com
Dermal filler
DERMAFILL now available in
more than 350 UK clinics
The DERMAFILL product range, which was launched into the UK at the
Aesthetics Conference and Exhibition last year, is now available in more than
350 clinics. Managing Director of Breit Aesthetics, Jazz Dhariwal, said, “Within the
first 12 months of launch we have had a tremendous response to our UK launch
of DERMAFILL with more than 350 UK clinics now using the DERMAFILL range
ahead of conventional HA technologies. We have chosen Cosmedic Pharmacy as
our exclusive provider for all prescription requests.”
The distributor Breit Aesthetics claims DERMAFILL is the first of a new fourth
generation of safer, more effective, pure monophasic injectable dermal fillers.
The company also claims the product exceeds the stricter standards of the FDA’s
very low level of 1,4-Butanediol Diglycidyl Ether (BDDE) controls.
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
@aestheticsgroup
Aesthetics Journal
Aesthetics
Skin rejuvenation
Naturastudios launches
the Jet Peel 3V
Naturastudios has released multi-platform system Jet
Peel 3V for skin rejuvenation. The Jet Peel 3V uses air
pressure to deliver saline or medical gas to stimulate biorejuvenation of the skin. The high velocity of the treatment
is said to allow for transdermal delivery without the use of
needles or heat. The machine’s three patented handpieces,
powered by medical grade gas, connects to the machine
and injects water, saline or vitamin infusion into the epidermis.
The company claims that the high velocity air breaks down water, saline or vitamin
infusions into micro-droplets, creating a kinetic energy, allowing deeper penetration
with little or no downtime. The jet-stream of micro-droplets aims to gently and
painlessly cleanse and exfoliate the skin, resulting in skin rejuvenation. The Jet Peel
3V treatment also aims to leave skin feeling fresher, fade blemishes and imperfections,
fine lines and wrinkles, and improve the appearance of scars and stretch marks.
Appointment
Swisscode UK announces
Dr Shirin Lakhani as new
brand ambassador
Cosmeceutical skincare manufacturer, Swisscode UK, has
appointed aesthetic practitioner Dr Shirin Lakhani to represent its
brand in Kent and Guernsey.
Dr Lakhani has worked as an NHS practitioner with experience
in general medicine, general surgery, urology, and accident and
emergency. She later trained as an anaesthetist, where she became skilled at
injection techniques and practical procedures. Dr Lakhani now consults for a number
of London and Guernsey aesthetic clinics and runs her own clinic in Kent, Elite
Aesthetics, which she opened in 2013. Swisscode UK CEO, Teresa Da Graca, said,
“We are delighted to have the expert skincare knowledge of Dr Shirin Lakhani to
support our brand as we continue on our successful growth in the UK aesthetic clinic
market place.” Swisscode is a skincare line that consists of concentrates and serums,
which aim to deliver products that boost the skin’s rejuvenation process.
Antiageing
Sterex relaunches wrinkle
reduction treatment
Roydon Cowley, founder
and managing director
of 3D-lipo
What’s your primary focus and
key to your success?
We focus on supplying treatments
to the majority of patients, not
the minority. What we have done
is taken high quality, expensive
technologies and managed to bring them all
together into one device – bringing down the price
and therefore allowing the majority of patients
to have access to these treatments. This new
idea, along with successful branding and national
awareness campaigns, as well as associations with
key industry figures such as leading consultant
plastic and cosmetic surgeon Mr Paul Banwell,
has built a brand that has been a success for the
patients of more than 450 UK clinics.
How are your products different and unique?
We don’t stand behind trends. We developed
a three-dimensional platform that uses different
technologies that work best on the individual
indications. Therefore, with our equipment,
practitioners can be very bespoke in their
approach, as they don’t need to have four or
five different machines in their clinic in order to
address the needs of each individual patient. With
our platform, you can put together a very tailored
programme to make sure you get the best
possible treatment outcomes for every patient.
Building on the success of 3D-lipo, what are
your plans for the future?
Following the success of the 3D-lipomed, which
was a multi-technology body platform, it was
inevitable that we would want to replicate that
achievement with a non-surgical device for the
face. We have developed the 3D-skinmed, which
has become an extremely popular platform for
treating the face. It’s again, three-dimensional,
offering HIFU and radiofrequency technology,
plus impact infusion. The fact that this device is
affordable and three-dimensional, means that the
future brings these treatments to the majority of
patients, not the minority.
This column
is written and
supported by
Skin Tightening
A Powerful Three Dimensional Alternative to Liposuction
Cellulite
Aesthetic manufacturing company Sterex Electrolysis International Ltd
has relaunched BioSkinJetting, a treatment used in conjunction with the
radiofrequency BioSkinSmoothing machine to treat wrinkles, scars and
imperfections. Sterex managing director Laurie Cartmell said the relaunch was
a necessary move to re-introduce the treatments to the aesthetic industry. She
explained, “This time around, treatments based on subcision are accepted and
embraced. BioSkinJetting is built upon the same principle as dermarolling and
stamping, but when we launched previously, were simply before our time.” According
to Sterex, the treatment aims to stimulate the skin underneath the wrinkle to form new
tissue containing regenerated collagen and elastin fibres, which the company claims
results in long-lasting, natural and visibly less-deep wrinkles and blemishes.
60
duction
Fat Re
aestheticsjournal.com
No other system offers this advanced combination of
technologies designed to target fat removal, cellulite
and skin tightening without the need to exercise
Why choose 3D-lipo?
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
Cavitation
• A complete approach to the problem
• Prescriptive
• Multi-functional
Cavitation is a natural phenomenon based on low frequency
ultrasound. The Ultrasound produces a strong wave of pressure
to fat cell membranes. A fat cell membrane cannot withstand this
pressure and therefore disintegrates into a liquid state. The result is
natural, permanent fat loss.
@aestheticsgroup
Aesthetics Journal
Injectables
‘Thinnest needle in the world’
introduced to the UK
Consultant plastic and aesthetic surgeon
Mr Dalvi Humzah and cosmetic nurse
practitioner Anna Baker have been chosen
as part of a select few in the UK to use the
THE INViSIBLE NEEDLE. TSK Laboratory,
manufacturer of THE INViSIBLE NEEDLE,
claims its the first needle of its kind and the
thinnest needle available to date. Technological
advancements have made it possible to make
the needle 33% thinner than the needle used in insulin syringes (30G) – usually used
for botulinum toxin injection – and 14% thinner than the 33G needles currently used at
Mr Humzah’s practice, the AMP Clinic. Mr Humzah said, “The extremely thin diameter of
THE INViSIBLE NEEDLE results in a nearly painless experience for patients and is ideal
for botulinum toxin injections. One of the biggest fears patients have when it comes to
having these injections is a painful needle injection, but THE INViSIBLE NEEDLE may
relieve this fear and greatly improve the overall patient experience.” The needle was
launched on January 28 at IMCAS in Paris, which was attended by Mr Humzah and
Baker, who shared their experience of using the needle with delegates.
Device
3D-lipo to launch new
shockwave therapy device
Aesthetic device manufacturer 3D-lipo has announced
it will launch its latest product, the 3D-shockwave, at the
Aesthetics Conference and Exhibition on April 15 and 16.
The three-dimensional device is designed to stimulate
skin tightening, reduce cellulite and improve stretch marks.
It uses a probe against the skin to emit radial waves,
which works by stimulating the breakdown of fat, collagen
synthesis and lymphatic drainage. According to 3D-lipo, a
course of 8-10 individual, 45-minute treatments, twice per
week will achieve the best results, which will be seen within the first four treatments.
To achieve accelerated results, the company suggests combining 3D-shockwave
treatments such as cryolipolysis.
Cosmeceuticals
5 Squirrels launches new edition
to Your Signature Range
Private label cosmeceutical supplier, 5 Squirrels, has introduced a foaming cleanser
to its Your Signature Range. Reveal is a foaming clinical strength glycolic wash, which
the company claims has been developed and tested in consultation with aesthetic clinic
patients. Director of 5 Squirrels, Gary Conroy believes this product will help practitioners
extend their own brand of skincare to their patients. “The feedback on the quality of our
products and offering has seen us grow enormously in the past 12 months, both from
number of patients repeat purchasing the range, and in the number of clinics adopting
our solution as a means of improving client retention, increasing brand awareness and
staving off competition from online discounters for skincare.” Reveal is the ninth product
in the range, and additional products are scheduled to be released later in the year.
Aesthetics aestheticsjournal.com
News in Brief
New medical insurance platform
launches
Insurance company Vantage Professional
Risks has introduced a specialist medical
and aesthetics platform, Enhance Insurance.
Divisional director of Enhance Insurance,
Martin Swann, said, “Having listened to
the frustrations of the industry surrounding
insurance, we felt it was time to draw upon
our expertise to put in place a new offering
specifically designed for the medical
aesthetic sector.”
Teoxane releases photo app for
clinical practice
Teoxane Laboratories has launched a photo
application to assist practitioners in their
day-to-day treatments. Teoxane Aesthepic
can be used to store patient data, treatment
information, before and after photographs
and relevant reminders. The new app aims
to organise, optimise and improve the clinic’s
day-to-day activity. The app is available for
download from iTunes and Play Store and
can be used on a mobile, tablet or via a
desktop device.
Classys launches new fat freezing
device
Aesthetic medical device manufacturer
Classys has released new fat freezing
machine, CLATUU. The product, which aims
to remodel the shape of the body with no
downtime or pain, features a 360-degree
cooling panel and a dual handpiece,
which aims to work simultaneously over
the treatment area to increase coverage
and reduce treatment time. The controlled
cooling system aims to have long-lasting
results, improving the skin’s firmness and
texture, reshaping the body and reducing
fat deposits.
HA-Derma appoints new product
specialist
Aesthetic distributor HA-Derma has
announced Hana Te Reo as its new product
specialist. Te Reo has worked in the aesthetic
industry for 11 years, previously working at
the Boston Medical Group and Harley Street
Treatments. HA-Derma is hoping her past
experience will play a key role in the launch
of new products, such as Aliaxin, which will
officially launch at the Aesthetic Conference
and Exhibition 2016 in April, and Profhilo,
which will launch in June.
“I’m really excited to be working with the
team at HA-Derma,” Te Reo said, adding
“I share the same goals of supplying safe,
cutting-edge products that are clinically
proven and science-based.”
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
BOOK YOUR FREE DEMONSTRATION
Skincare
DERMEDICS launches
in the UK
International skincare and treatment
company DERMEDICS has launched
in the UK. DERMEDICS products aim to
offer solutions to overcome common
skin problems for people of all ages
and skin types through professional
therapies and take-home treatments.
“I am so pleased to introduce
DERMEDICS Paramedical Skincare
range,” said UK director for DERMEDICS,
Kate Lovland. “We combine superior
product formulations with aesthetic
medical treatments to give our
customers incredible results. With
skincare heritage in 32 worldwide
markets we are able to bring truly international expertise to the
UK, which is fully supported with training and ongoing customer
service.” Practitioners who are new to using DERMEDICS products
are eligible for complimentary one-day training sessions and starter
packs. DERMEDICS is also offering extensive training programmes
for facials and weight loss, skin peels, microdermabrasion, nappage
mesotherapy, derma roller, skin needling and dermaplanning, and
contour body wraps. The courses will be available to attend in
Manchester and can also be accessed online.
Melanoma
Study indicates
melanoma rates are
higher in younger women
A new study examining associations between indoor tanning
and melanoma has suggested a melanoma diagnosis is more
common in younger women.
The population-based case-controlled study conducted by DeAnne
Lazovich et al in the US, studied 681 patients who were diagnosed
as having melanoma between 2004 and 2007, of which 68.3%
were women. It compared this with 654 control patients who hadn’t
had the disease, of which 68.2% were women. All participants in
the study were aged between 25 and 49 years old. Researchers
looked at how often the participants used indoor tanning and how
old they were when they first started doing it. Nearly 80% of the
women surveyed said they had been indoor tanning, in contrast to
44% of men. Compared to women aged 40 to 49 years old who
on average initiated tanning aged 25 years, women younger than
40 years initiated indoor tanning at a younger age, 16 years, and
reported more frequent indoor tanning sessions. The study reported
that women under 30 years old were six times more likely to be in
the case group than the control group if they tanned indoors. “That
almost all of the risk of melanoma relating to indoor tanning was
among women was surprising, as was the very strong association
among the youngest women,” said Lazovich.
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16/02/2016 11
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Antiageing
Aesthetics Journal
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Research
Mesoestetic launches Beauty
Bar nutraceutical cocktails
International pharmaceutical manufacturer,
mesoestetic Pharma Group, has introduced its
new range of Beauty Bar drinkable antiageing
cocktails to the UK. The company explains that
the Beauty Bar cocktails are a way for clinics
to incorporate nutraceuticals, natural products
made from plant extracts, oligo elements and
vitamins that aim to enhance the beauty of the
skin. It’s claimed by mesoestetic that the products
are quickly absorbed by the body and prevent
skin ageing by fighting flaccidity and cellulite to
improve the skin’s structure and appearance.
Three cocktails are available in the range, the
Collagen 360 Elixir, which aims to firm the skin, the Radiance DNA elixir, which
aims to provide antiageing treatments and Whitening Elixir, which aims to even
out skin tone. The cocktails are composed of collagen, hyaluronic acid or grape
extract and are served with mixtures of either ginger, lemon, strawberry or
pineapple juice.
Cosmetic surgery
industry delivers the
best customer service
A new report published by Intently indicates that
the cosmetic surgery industry is among the best
businesses for customer service. Researchers analysed
the email response rate from more than 16,000 service
providers around the world. The research indicated
that cosmetic surgery is in the top five businesses that
deliver the best customer service, with an email response
rate of 32%, compared to the worst rated business –
technology services – which was 5%. Neil Harris, CEO
at Intently – a platform for connecting consumers to
service providers, said, “Given that cosmetic surgery is
such a personal matter, it’s been amazing to see how
often these procedures have been requested on Intently.
Even more pleasing is that this service group came third
out of 160 categories. It’s a growing industry and the
service providers have a strong grasp of the need for
outstanding customer service.”
Sclerotherapy
BAS to hold CPD accredited
meeting in April
The British Association of Sclerotherapists (BAS) will hold its annual meeting at
the Ark Conference Centre in Basingstoke on April 28. Dr Martyn King, a BAS
board member, said, “This promises to be a lively and highly informative CPD
event, unmissable for anyone wishing to broaden or update their sclerotherapy
skills.” The day will include a full programme of stimulating presentations by
distinguished vascular surgeons and leading aesthetic doctors and nurses,
as well as offering live demonstrations of foam and microsclerotherapy, and
ultrasound assessment.
Confirmed speakers include consultant vascular surgeon Mr Philip Coleridge
Smith and associate specialist in vascular surgery Dr Stephen Tristram; topics will
include complications and how to avoid them, compression after sclerotherapy,
and marketing your clinic effectively.
In addition to increasing their skills
and knowledge, delegates will
have the opportunity during the live
demonstrations to question leading
professionals on their techniques,
and there will be ample time for
networking with peers.
The evening before the meeting,
delegates can choose to
attend the BAS dinner, another
opportunity to meet and get to
know industry peers. An aesthetic
nurse who attended last year said
of the event, “Great up-to-date
info, well presented, varied and
entertaining; I learnt a lot. It was
great to meet other professionals.”
Skincare
iS Clinical launches
new face cream
Cosmeceutical skincare
brand iS Clinical has
launched a new daily
face cream. The Youth
Intensive Crème is said to
show skin improvement
from the first day of
use, revealing smoother, firmer skin and a more radiant
youthful complexion – according to iS Clinical. Ingredients
in the face cream include: superoxide dimutase (SOD),
which aims to safely absorb free radicals to combat
photoageing and cell damage; botanically derived
hyaluronic acid microspheres, which aim to act like tiny
sponges and expand, filling in wrinkles; vitamin C, which
aims to lighten skin by inhibiting melanin synthesis;
and copper tripeptide-1 growth factor, which aims to
stimulate the synthesis of collagen in skin fibroblasts.
An independent clinical study by Bioscreen Testing
Services looked at 35 female participants, ranging from
42 to 68 years old, who used the Youth Intensive Crème
twice daily for four weeks. The testers evaluated skin
hydration, skin firmness, skin tone and skin texture using
instrument measurements, clinical grading and subject
questionnaires. From the study, 77% of participants
noticed an increase in skin firmness, 91% said their
skin was more volumised and 100% said they saw an
improvement in skin hydration. The Youth Intensive Crème
is suitable for dry and sensitive skin types.
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
@aestheticsgroup
R&D at mesoestetic
Aesthetics visits the production
site and research and development
headquarters for mesoestetic
Pharma Group’s dermatological and
cosmetic medicines
mesoestetic Pharma Group is
a pharmaceutical laboratory
founded in 1984. A family business,
currently employing 90 people
at its headquarters in Barcelona,
Spain, its aim is to provide aesthetic
professionals with complete and
effective solutions through its
consistent efforts in research,
development and innovation.
The company develops, manufacturers
and markets advanced medical and
aesthetic products, which includes a consumer range, a professional
range, a medical range and medical-aesthetic devices. The facility
prides itself on its ability to produce products from the research stage,
to production, to the clinical trial stage, to the marketing and distribution
stage, all at one location. The facility is home to mesoestetic’s head
office, production plant, biotechnology unit, monitoring and follow-up
Neauvia ‘New Art
Aesthetics’ World
Congress 2015,
Warsaw
Aesthetics reports on the highlights
from Neauvia’s international
training seminar in Warsaw
Around 170 aesthetic practitioners, nurses, doctors and distributors
from more than 30 countries gathered in Warsaw to attend the
Neauvia Organic dermal filler ‘New Art Aesthetics’ World Congress
on January 29 and 30.
The event began with an introduction to Neauvia Organic, a
new line of Swiss dermal fillers developed by Matex Lab SA and
manufactured in Italy. The talk discussed how the fillers use a new
cross-linker polyethylene glycol (PEG) polymer, which is nontoxic and completely degradable in the tissue, instead of BDDE.
According to the company, this makes Neauvia Organic the most
biocompatible filler on the market. This PEG polymer aims to
reduce the risk of immunological reaction, reduce inflammation
and granuloma formation, and delay the degradation and the
bioabsorption of the implant. Dermatologist Dr Nicola Zerbinati,
who ran the event, started working with Neauvia three years ago.
“We have created a new concept of filler; we use a new crosslinker that gives us an incredible new hyaluronic acid matrix. It is
Aesthetics Journal
Aesthetics aestheticsjournal.com
unit, and the logistics platform, which serves more than 60 distribution
partners in more than 90 different countries. Carles Font, son of
mesoestetic founder Joan Carlos Font, is currently involved in the
export and business developments. He said mesoestetic’s involvement
and commitment to further development makes it stand out. “We
consider that if we have a good reputation and are well-known in
the market, it’s because of our products and the results that we are
providing to all of our clients,” he said. “So in order to keep providing
the best products to our customers, we reinvest 40% of our benefits
into the research and development department and have been doing
this since the beginning.” The company starts its development process
by testing different kinds of human cells with raw materials to determine
the most effective ingredients. These results are used to produce
products, which are then used in clinical trials and subsequently
distributed all over the world. Independent nurse prescriber, and
manager of facethefuture clinic, Kate Bancroft, visited the mesoestetic
site and was impressed with the company’s research and development
efforts. She said, “This visit was a really nice way of understanding how
much R&D goes into mesoestetic products and how it comes to the
end user in a perfectly packaged form.” Deputy chairman of Absolute
Aesthetics, Victoria Smith also journeyed to the laboratory and said
the experience confirmed the company’s scientific philosophy. “The
mesoestetic facilities were extremely impressive and reflected a true
scientific ethos. Absolute Aesthetics has been using the Dermamelan
peel in our practice for some time. The trip gave us the opportunity to
find out more about the range of products available and the results that
can be achieved,” she said.
the only filler in the market with this PEG cross-linker,” he said. Eight
international aesthetic practitioners presented their views of the
four different dermal fillers available for various anatomical areas
and treatments, including rhinoplasty, nasolabial fold, lips, jowl line,
hand rejuvenation, zygomatic area, periocular area and vaginal
rejuvenation. Highlights of the session included Dr Dawid Serafin’s
presentation on using Neauvia for vaginal rejuvenation. The theory
presentations were complemented with a second day of live
demonstrations on 55 different models. Dr Katrina Felberg shared
advice on peri-ocular treatment techniques, while Dr Peter Caspari
demonstrated the use of Neauvia on the nasolabial area. After the
live demonstrations, delegates were presented with the before
and after images of the models to determine their opinions on the
product’s results. Aesthetic practitioner Dr Kathryn Taylor Barnes,
founder of The Real You Clinic said, “I am really excited about the
formulation of this product being organic, that appeals to a lot of the
modern day men and women.”
Neauvia sales director for the UK and Ireland, Kevin Eley introduced
the products to practitioners in January, and said, “Physicians have
commented on the superior filling ability of the products and have
also been surprised at the smaller levels of pain and swelling with
the Neauvia line.” Facial plastic and laser surgeon Dr Ayham AlAyoubi, who has
already started using
Neauvia in his clinic
on Harley Street
said, “It’s definitely
an additional product
which each cosmetic
doctor has to add
into their portfolio.”
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
@aestheticsgroup
Wigmore Medical Open
Day, London
Practitioners attended the launch
of the latest antiageing skincare
technology created by Innoture, as
well as mini thread lift demonstrations,
at the Royal Society of Medicine on.
Korean aesthetic dermatologist and
surgeon Dr Kwon Han Jin performed
the mini thread lift demonstrations while
providing attendees with helpful technique advice and engaging
in a question and answer session. The Radara seminar provided
delegates with an introduction to the Radara skincare system that
consists of rejuvenating micro-channelling patches and hyaluronic
acid serum, which aims to reduce fine lines and wrinkles. Leading
the seminar was aesthetic surgeon Dr Benji Dhillon, who explained
the technology behind Radara, gave an overview of clinical data,
and explained how to treat patients with the product and how to
incorporate it into a clinic. “My belief is that this is a new product
that bridges the gap between topical treatments and injectables
and serves as a first-step for someone who doesn’t want to have
injectables yet,” said Dr Dhillon. “The feedback we have had so far
has been really positive and supports the fact that it works. Users like
that it’s a once-nightly treatment and, by using it, reminds them to do
other things, so their nightly beauty regime becomes more consistent.”
Also speaking at the seminar was Ryan Bamsey, who was involved in
the commercialisation of the Radara microneedling platform, and Sue
Thomson, the aesthetic sales director of the manufacturing company
Innoture. “I think the day has been really good, we have been able
to attract the attention of people who have seen Radara in the media
so it has been really exciting,” said Thomson. Radara is owned and
manufactured by Innoture Aesthetics, a medical technology company
based in Chelsea, London.
Aesthetics Journal
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SculpSure pre-launch,
London
Laser and light-based aesthetic treatment and manufacturing
company, Cynosure, introduced its new laser treatment SculpSure
to practitioners at the Home House in London.
Practitioners were invited to learn about the new body-sculpting laser
technology through live demonstrations and discussions. Delegates
who attended included Dr Tapan Patel, founder and director of PHI
Clinic, which is the first clinic to treat patients with the SculpSure
laser. Also in attendance was Lisa Littlehouse, managing director of
Cavendish Clinic, Dr Nicholas Lowe, consultant dermatologist and
founder of Cranley Clinic, Dr Faizeen Zavahir, medical director of Juvea
Clinic, Ms Lena Andersson, founder of Anelca Clinic, and dermatologist
Dr Beata Cybulska. SculpSure, which has been approved by the
Food and Drug Administration, aims to offer convenient, comfortable,
non-invasive fat reduction for any body and skin type. Cynosure
spokesperson, Bill Kelley, said, “SculpSure is a revolutionary, highly
advanced procedure, comprising a clever combination of the science
of laser technology with the art of body contouring.”
SkinCeuticals Triple Lipid Restore 2:4:2 Medical
Preview Event, London
SkinCeuticals welcomed aesthetic practitioners, nurses,
dermatologists and medical professionals to Somerset House
for a preview of the new Triple Lipid Restore 2:4:2 on February 2.
Guests were greeted with a drinks and canapés reception, before
taking their seats in the main room to hear from a panel of UK and
international aesthetic practitioners and scientists.
Hosted by beauty journalist Alice Hart-Davis, the evening began with
a talk on skin ageing and clinical challenges presented by Dr Hema
Sundaram, a US dermatologist, who explained the roles of lipids
in the skin and how they deplete with age. Dr Sundaram revealed
that 12.9 billion dollars was spent on cosmetic procedures in the
US in 2014. Next, Jim Krol, global scientific director of SkinCeuticals,
unveiled the science behind the lipid replenishment cream and the
results of two years of research. In an eight-week clinical study on
55 patients, who applied the product twice daily, Triple Lipid Restore
2:4:2 was said to ‘significantly improve’ the appearance of key signs
of accelerated ageing: clarity, evenness, radiance, smoothness, laxity
and pore appearance. The female-only participants recorded a 40%
improvement in the texture and smoothness of their skin and an 18%
improvement in pore appearance, compared to baseline.
Finally, aesthetic practitioner Dr Tapan Patel spoke on how to
integrate the product into clinical practice and identify the correct
patients for the treatment. Dr Patel explained the importance of
treating the condition of the skin first, and stated, “If the skin isn’t
right, then the treatment won’t be quite right either.” Speaking after the
event, Dr Sundaram said, “Having worked behind the scenes with the
SkinCeuticals R&D team in developing Triple Lipid Restore 2:4:2, it was
a pleasure to present
this unique product to
our UK practitioners and
discuss the benefits
that our science-led
approach to skincare
can have for their
everyday clinical
practice.”
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
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Aesthetics Journal
Aesthetics
Dr Kieren Bong London
Two Point Eye Lift
Masterclass, London
Ten delegates attended a training day
with aesthetic doctor Dr Kieren Bong
who demonstrated his Two Point Eye Lift
technique at the Wigmore training facility at
the Royal Society of Medicine. The session
focused on the anatomy of the eye area, how
to choose the right patient for the Two Point
Eye Lift, a technique for rejuvenating hollow
eyes with dermal fillers, and a discussion of
how to prevent possible complications.
Dr Bong uses Teosyal Redensity II for the lift, a dermal filler product with semicross-linked hyaluronic acid that aims to specifically treat the under eye hollows
and tear trough. Dr Lina Strachan, a dentist and facial aesthetic consultant from
A & L Clinics in Ipswich, who attended the masterclass, said, “The workshop
was great and Dr Bong is an outstanding specialist and an artist in the aesthetics
field. I have been to several of his courses before, and after every one of them I
felt confident that I learned something new that will take me and my practice to
the next level. The day was well structured and a perfect working environment.”
Dr Bong also provided a one-on-one practical session where delegates were
able to treat a model under his direction and supervision. The Two Point Eye
Lift technique is used in more than 20 countries and, according to Dr Bong, is
internationally recognised as one of the safest and most effective techniques for
rejuvenating under eye hollows with dermal fillers.
Algeness launch, London
Practitioners attended an information seminar by aesthetic distribution
company, Wigmore Medical to learn about the new natural dermal filler
derived from red algae, Algeness, at the Royal Society of Medicine on
February 9. The evening began with an introduction to Algeness from the
executive chairman at Advanced Aesthetic Technologies, which markets
the products, and Algeness Europe, Richard Brutt, who explained that
the product is the UK’s first natural dermal filler composed of agarose
(polysaccharide) gel. A presentation followed by Dr Giorgio Maullu from
Italy, who discussed the science and technology behind the product.
He explained that the product is composed of an agarose gel or sugar,
which is natural to the human body and does not contain the cross-linked
synthetic chemical, BDDE, associated with other hyaluronic acid (HA) fillers.
He explained that because of this, there is high patient tolerability and
biocompatibility, and the product is safer as it does not induce allergic or
foreign body reactions. “Since its debut, I have been using the agarose gel
with amazing results,” said Dr Maullu, adding, “its molecular characteristic of
three-dimensional mesh allows me to go deep, in order to gain a volumising
effect, as well as work on the surface where, besides giving a smoothing
effect on the epidermis, it has given proof of biostimulant properties on
fibroblasts, in regards to collagen and elastin production.” KOL Dr TaylorBarnes also presented, and said, “Algeness is attractive to my clinic patients.
They like the association with red algae and being naturally sourced. It is
versatile and suitable for smoothing and volumising with the three varieties
of Algeness HD (mid Dermis), VL (deep Dermis and sub cutaneous) and DF
(Deep Volumizer). I have had great results with lip enhancement using HD,
nasolabial with VL and cheek sculpting with DF,” she said.
Cosmetic Redress
Scheme inaugural
meeting, Hamilton
Fraser, Hertfordshire
On February 10, aesthetic practitioners and
representatives of aesthetic bodies attended a
roundtable meeting to discuss how new Alternative
Dispute Resolution (ADR) regulations could impact the
cosmetic and aesthetic industry. New legislation, the
Consumer Rights Act 2015, came into force on October
1, which brought into UK law the requirements from
a European Union ADR Directive. This means that all
traders are required to signpost their consumers to a
government authorised consumer redress scheme –
a set of rules under which a firm is required to take one
or more of the following steps: investigate whether, on or
after a specific date, it has failed to comply with particular
requirements that are applicable to an activity it has been
carrying on; determine whether the failure has caused,
or may cause, loss or damage to consumers; determine
what the redress should be in respect of the failure, and
make the redress to the consumers. If the trader operates
online then they must provide a link to the new Online
Dispute Resolution website, which provides information
about authorised consumer redress schemes; and if a
trader does not do either, they could be subject to an
unlimited fine or even a custodial sentence. The meeting
posed the question, ‘Is a Cosmetic Redress Scheme
something that should be introduced into the market and
if yes, how can we make this work?’ Tim Frome, associate
director of Hamilton Fraser, explained the Consumer
Rights Act 2015 to the group. For the health sector,
membership of the redress scheme is not compulsory,
however consumers must be signposted to a scheme
they feel is responsible for them.
According to the Department for Business Innovation and
Skills, ADR is quicker than a court and the costs are lower.
It is also less confrontational, but the outcome is taken
into consideration by courts if taken further.
The attendees agreed that incorporating ADR would be a
good way of ensuring traders had an internal complaints
procedure in place. Paul Burgess, CEO of the British
Association of Cosmetic Nurses (BACN), suggested there
should be a mandatory membership of a redress scheme
before anybody can join the BACN or other trade bodies.
The attendees agreed on the creation of a new scheme
and all agreed that Hamilton Fraser would be a good
industry player to start the new cosmetic redress scheme
and provide a valuable service. Everyone agreed on a
name: the Consumer Redress Scheme, as well as a logo,
and agreed that beauticians should also be able to join if
they wish to. Eddie Hooker, CEO of Hamilton Fraser, said,
“Raising standards and educating practitioners is a core
value of Hamilton Fraser Cosmetic Insurance and the
scheme would fit in well with what we do.”
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
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Aesthetics Journal
Aesthetics
18th International
Master Course on
Aging Skin, Paris
Aesthetics reports on the highlights from
Paris’ international aesthetics conference
More than 6,500 doctors, nurses, surgeons, manufacturers and aesthetic
professionals attended the 18th International Master Course on Aging Science
(IMCAS) in Paris between January 28 and 31. Professionals from 85 countries
around the world gathered at the Palais Des Congrès in Paris for four days of
learning, educating and networking.
The diverse agenda comprised 127 scientific sessions, 1,050 lectures, 520 expert
speakers and 180 exhibitors. Many delegates noticed the increase in attendees at
this year’s congress, as well as an upsurge in the amount of international sessions.
“The conference was busy on all four days,” said consultant plastic surgeon Mr Dalvi
Humzah. “IMCAS has grown considerably and you need to plan before you go to
ensure you don’t miss anything.” On the first day of the conference, the ‘Minimally
Invasive Cadaver Workshop’ proved to be popular with a packed-out audience. The
full-day workshop looked at facial anatomy and how to avoid vascular complications,
with live links streamed from Tokyo and Taipei.
On the same day, a new agenda, ‘Middle Eastern Masterclass’, organised in part
by dermatologist Dr Sahar Douad Ghannam, took place. The panel explored the
patient-doctor communication in consultation with Middle Eastern patients and how to
properly handle the cultural values of the region when dealing with patients.
Aesthetic business consultant Wendy Lewis, who was part of the ‘Middle Eastern
Masterclass’ and ‘Tips to Avoid Psychological Pitfalls in Aesthetic Procedures’
panels, was impressed by the versatility of this year’s congress, “As a veteran
of IMCAS, having been going for 15 out of 18 years in Paris, and one of the first
Americans to embrace the importance of this global congress, 2016 did not
disappoint! I participated in two important panels that generated a lot of interest.”
The ‘Tips to Avoid Psychological Pitfalls in Aesthetic Procedures’ panel discussion,
led by Dallas plastic surgeon Dr Rod Rohrich and Mayo Clinic facial plastic surgeon
Dr Eugene Kern, highlighted important signs for practitioners to look out for when
treating patients. The international panel, including Dr Jonathan Sykes, Dr Richard
Abs and Dr Milos Kovacevic, explored how to properly screen aesthetic patients, the
red flags to look out for and signs of body dysmorphia.
Cosmeceuticals took centre stage on Friday with a full-day programme covering
important topics for attendees, including the consumer interest in natural products,
probiotics, prebiotics, and nutraceuticals, as well as innovative delivery systems for
active ingredients. US dermatologist Dr Hema Sundaram delivered a particularly
helpful talk, ‘What’s New Concerning Cosmeceuticals Combined with Procedures:
A Literature Review of Recent Updates’, in which she talked about combing topical
products with procedures. Dr Sundaram argued that doing so can address signs of
ageing that singular procedures cannot easily treat, and advised delegates on how to
achieve improved post-procedure recovery time with
reduced side effects. Arguing that dysfunction of the
skin barrier is the ‘cardinal sin of the ageing process’,
she explained how it is essential to use ingredients
that improve transepidermal water loss (TEWL), and
increase the H2O content of the skin.
Independent nurse prescriber Lorna Bowes was
impressed by the one-day cosmeceutical agenda,
“These sessions were packed throughout most
of that day and it was very interesting. The main
theme running through these sessions was that
cosmeceuticals and nutraceuticals actually can be
evidence-based and it was interesting to see a
resurge of interest in skin peels.”
Friday also saw Dr Arthur Swift present a 3D
experience on facial restoring and enhancement,
drawing special attention to facial anatomy, product
placement and depth considerations. Mr Humzah said
the ‘audience reacted well to the novel experience’
and it was a ‘very engaging session’. To complete the
symposium, Dr Kuldeep Minocha looked at a ‘fresh
approach to skin rejuvenation’ using new techniques
and skin boosters.
Dr Swift also presented on ‘Combined Treatments
with Filler and Toxin for the Upper Face’ on Saturday.
Dr Tapan Patel followed Dr Swift on the agenda,
speaking on combination treatment for full-face
rejuvenation; combination treatment was a popular
theme throughout the whole weekend, particularly
non-surgical and minimally invasive options, and novel
drug delivery systems.
The IMCAS Industry Tribune highlighted some
interesting trends, including a desire for ‘instant
beauty’. A fairly new advancement also made its
way onto the agenda at IMCAS in the form of topical
botulinum toxin. A talk comparing two types of topical
toxins influenced an intriguing discussion led by
plastic surgeon, Dr Michael Kane.
Feedback from the weekend was particularly positive.
US dermatologist Dr Gary Monheit said, “This was the
most outstanding IMCAS, as well as multi-speciality
cosmetic meeting I have ever attended. The panels
were successful and all the talks I was involved with
were objective, relevant and unbiased.” Dr Benjamin Ascher, plastic surgeon and IMCAS
scientific director, said, “We are delighted with the
feedback that we have received from this year’s
congress. The Minimally Invasive Cadaver Workshop,
spread over an entire day, proved to be incredibly
popular, and we were delighted to see that the day
dedicated to cosmeceuticals also attracted a large
audience, confirming our belief that this sector is set
to explode in popularity over the coming years. The
exhibition, this year spread over two levels for the first
time, was also a great success, with exhibitors coming
from all four corners of the world to display their latest
products and devices. We are now looking at how we
can utilise the feedback that we have received to build
upon this year’s success and to develop an even more
comprehensive scientific programme in 2017.”
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
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Aesthetics Journal
Cosmetic surgery
on the rise
The latest figures from the British
Association of Aesthetic Plastic Surgeons’
annual audit indicated a significant rise
in the number of Britons having cosmetic
surgery. Aesthetics investigates why it
appears that more people are prepared to opt
for a surgical treatment
The rise in the number of people having non-invasive procedures over the past
few years has been well documented. Consumer media has been saturated with
headlines on the rise of treatments such as dermal fillers and botulinum toxin;1 news
of Kylie Jenner having lip fillers caused a surge of enquiries in some clinics, with one
London practice reporting a 70% rise in lip filler enquiries in the 24-hours following
the news.2 But now, according to the 2015 BAAPS annual audit, cosmetic surgery is
also accelerating, following a 9% dip in 2014.3
The data collected by the body of surgeons suggests 51,000 Britons underwent
cosmetic procedures last year and the amount of women having surgery increased
by 12.5%, whilst the amount of men going under the knife increased by 13.5%. So
why are more people looking to cosmetic surgery as a viable option to enhance their
body? And, does this spell the end to the stigma surrounding the specialty?
The facts
The most noteworthy increases in the published results include a 20% rise in
both men and women having liposuction, a 15% increase in otoplasty and a 12%
rise in breast augmentation – which remains the most popular procedure in
women. In men, eyelid surgery is the most common treatment, which rose by
15% last year, while a previously less common procedure in men, brow lifts, also
increased by 15.5%.
Mr Rajiv Grover, consultant plastic surgeon and former president of BAAPS, said,
“The double digit rise in surgical procedures suggests that the public are choosing
to spend on treatments with a proven track record such as facelifts and liposuction,
which remain the gold standard for facial rejuvenation and body contouring.
Aesthetics aestheticsjournal.com
The plethora of new non-invasive methods for skin
tightening and cellulite that are here today and gone
tomorrow, often appear too good to be true and fail to
make the cut.” Consultant oral and maxillofacial surgeon, Miss
Katherine George, also believes that alternative nonsurgical options don’t always deliver, “By the time I
see my patients for the first time, a lot of them have
already tried non-surgical treatments. Although these
types of treatments have minimal downsides, surgery
is still the benchmark and will deliver natural-looking
results.” Having non-surgical treatments can be a
long-term commitment for many patients. The average
duration of results for a treatment such as botulinum
toxin on facial lines ranges between three to six
months,4 meaning patients have to keep going back
for more to keep up their new appearance. This isn’t
an issue with a lot of surgical procedures. Consultant
maxillofacial and facial plastic surgeon, Miss Caroline
Mills, believes people are becoming more informed of
the potential downsides of treatments such as dermal
fillers, “Fillers aren’t the be all and end all and people
are starting to see the possible negative side effects
of having dermal filler. Surgery can be a nicer way of
doing things and will actually cost less money in the
long term. I also think people are finding surgery is
more acceptable than it used to be.”
On the other hand, aesthetic practitioner Dr Kuldeep
Minocha believes that non-invasive procedures still
very much have a place in antiageing treatments,
“Timely intervention on appropriate patients by
an experienced aesthetic practitioner can lead
to excellent, natural-looking results. Advances in
our understanding of the evidence-based use of
hyaluronic acid dermal fillers, collagen stimulators,
toxins, suspension threads, medical devices and
topical skincare over the last two decades has hugely
benefited our increasing patient base.”
The stigma
According to author Deborah Mitchell in the book
Botox: is it for you? People were more likely to
make up an elaborate excuse as to why they were
disappearing from work for a few weeks than admit
to having a facelift or eyelid surgery.5 Nowadays,
“Having nonsurgical procedures
can be a long-term
commitment for
many patients”
Miss Katherine George, consultant oral and
maxillofacial surgeon
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
aestheticsjournal.com
@aestheticsgroup
Aesthetics Journal
“The double digit rise
in surgical procedures
suggests that the public
are choosing to spend on
treatments with a proven
track record such as facelifts
and liposuction, which
remain the gold standard
for facial rejuvenation and
body contouring”
Mr Rajiv Grover, consultant plastic surgeon
more and more people are happy to admit to having cosmetic
procedures and this is reflected in celebrity culture. “Celebrities such
as Jane Fonda and Sharon Stone have admitted to having cosmetic
procedures and I think people notice how much better they look for
it,” said Mr Grover, adding, “There is definitely less stigma attached
now.” Mr Bryan Mayou, consultant plastic surgeon and founder of
Cadogan Cosmetics believes there is also less shame attached to
cosmetic surgery for men, “There’s much less of a taboo now for
men undergoing cosmetic surgery. They’ll all talk about it; it’s not a
secret and they don’t creep in to a clinic quietly hoping no one sees
them. Men are prepared to talk about it with their wives, friends and
even the men they work with.”
More men
Between 2011 and 2013, the number of men having botulinum toxin
treatments rose by 200% at Courthouse Clinics,6 and cosmetic
surgery also seems to be gaining popularity with men. “Having
non-invasive treatments is almost a gateway to surgical procedures,”
notes Miss George, adding, “The number of people who come to
me for surgery have already tried botulinum toxin and thread lifts,
and this includes men.”
The most popular cosmetic surgery procedures men are opting for
include rhinoplasty, ear correction, face/neck lifts and fat transfer,
according to BAAPS.7 Mr Grover said, “Media figures such as David
Beckham and David Gandy are seen all over men’s magazines
and they have this very chiseled, masculine appearance. Men are
looking to them, wanting to achieve that look.”
But Miss Mills believes men’s expectations need to be better
managed, “Men are a more difficult group to handle. Some men
are looking to surgery for lifestyle reasons; they think it’s a way
to get a girlfriend, and it’s not. Some men I treat say they like the
results to begin with, but later on, complain that it hasn’t made them
feel any better.”
Gynaecomastia has seen a 13% jump over the last ten years, rising
Aesthetics
to an average of 796 operations per annum.8 Consultant plastic
surgeon Mr Adrian Richards has seen an increase in men coming
to his clinic for the procedure, “Having gynaecomastia can be
very upsetting for some men and they don’t necessarily have this
condition because they’re overweight. These men tend to have
a low body mass index, but due to a hormonal imbalance, have
developed gynaecomastia. In the past, men might have been more
likely to try and cover it up and hide it under loose clothing, but now
they’re more open to having surgery.”
A change in trends for women
Although the amount of women having breast augmentation
continues to rise, patients are said to be requesting a more naturallook and Mr Richards has also noticed this change, “In France,
the trend has always been to have smaller, more natural-looking
breasts, whereas for a while in the UK, the trend was ‘bigger is
better’. That’s not the case anymore. I’d say women now want the
‘Parisian look’ and actually say to me ‘I don’t want to look big’.”
Mr Richards believes that women are also more willing to have
procedures they may have been too afraid to have previously,
“I treated a woman for an inverted nipple which she’d had for 15
years. It’d had a big impact on her life and she’d found it difficult
to have a relationship because of it. She came in to the clinic
and within 20 minutes I had corrected it. I think more people are
realising the potential with cosmetic surgery.”
The future
With BAAPS’s figures suggesting that cosmetic surgery is gaining
popularity, is there still room for non-invasive treatments to
grow alongside? “I think that non-surgical treatment is good at
prevention and slowing down ageing,” said Mr Grover, “Think about
a remote control; non-surgical treatments are like pressing the
slow-motion button or pressing pause, but surgery is the rewind.”
Mr Richards adds, “There has definitely been a swing back
to surgery. Whenever there is something new there is a hype
surrounding it, whether it’s the ‘vampire face-lift’, or the latest
dermal filler. But then the excitement dies down and people
eventually realise it’s not the answer to everything. But surgery
keeps getting better and achieves the greatest results.”
Dr Minocha concludes, “For some patients, surgery may be a
step too far with its potential downtime and complications, and an
injectable option is preferred. As aesthetic practitioners we must
also recognise our limitations and refer to our surgical colleagues
when the patient has reached their injectable threshold.”
REFERENCES
1. WhatClinic, (2015) Enquiries into non-surgical cosmetic treatments rise by more than half (55%) in
just six months, <http://www.whatclinic.com/about/press/pdfs/Medical%20Aesthetics%20UK%20
Roundup%20-%20June%202015.pdf>
2. Akbarein, E. (2015) Kylie Jenner lip filler confession leads to 70% increase in enquiries for the
procedure, The Independent, <http://www.independent.co.uk/life-style/fashion/news/kylie-jenner-lipfiller-confession-leads-to-70-rise-in-enquiries-for-the-procedure-10232716.html>
3. BAAPS, (2015) Annual Audit, <http://baaps.org.uk/about-us/audit/2040-auto-generate-from-title>
4. Rice, F. (2015) Botox Vs Fillers: Here’s Everything You Need To Know, Marie Claire, <http://www.
marieclaire.co.uk/blogs/548418/botox-vs-fillers-the-lowdown.html>
5. Mitchell, D. (2002) Botox: is it for you? The Botox Miracle, Gallery Books; USA, p.15
6. Aidin, B. (2014) Botox treatments for men grow in popularity, FT, <http://www.ft.com/cms/
s/2/25e82892-b69b-11e3-905b-00144feabdc0.html#axzz3zgEKnzFb>
7. BAAPS, (2016) SUPER CUTS ‘Daddy Makeovers’ and the Celeb Confessions: Cosmetic Surgery
Procedures Soar in Britain, <http://baaps.org.uk/about-us/press-releases/2202-super-cuts-daddymakeovers-and-celeb-confessions-cosmetic-surgery-procedures-soar-in-britain>
8. Wells, J. (2016) Rise of the ‘moob job’? UK men opting for plastic surgery doubles, The Telegraph,
<http://www.telegraph.co.uk/men/the-filter/rise-of-the-moob-job-uk-men-opting-for-plastic-surgerydoubles/>w
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
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Aesthetics Journal
Free Clinical Agenda
at ACE 2016
With free CPD points available and 2,000
delegates expected to attend ACE 2016, we look
at the comprehensive free clinical agenda and
describe what’s in store on April 15 and 16
Delegates will have access to a
comprehensive free clinical agenda
consisting of professional speakers and
high-quality content at the Aesthetics
Conference and Exhibition (ACE) 2016 on
April 15 and 16. Alongside the premium
Conference programme, which comprises
eight sessions on key anatomical areas, the
free clinical agenda will allow professionals
to enhance their practice clinical skills and
gain CPD accreditation within the Expert
Clinics, Masterclasses and Treatments on
Trial agendas. Expert Clinics
Two dedicated workshop areas in the
Exhibition hall will host the Expert Clinic
agenda, which will encompass free practical
sessions run by top aesthetic experts,
demonstrating their best techniques in
order to maximise treatment outcomes.
With a new layout and improved audio
system for an optimal learning experience,
the Expert Clinics are the perfect place
to strengthen clinical knowledge and
ensure you’re up-to-date with everything
that’s happening in the industry. Special
sponsored sessions will take place over
the two days and will include presentations
from industry specialists supported by
Rosmetics, Naturastudios, AestheticSource,
AesthetiCare, 3d-lipo, Fusion GT, BTL
Aesthetics, Healthxchange, Syneron Candela,
Medico Beauty, SkinCeuticals and Lynton
Lasers. AestheticSource will host cosmetic
and dermatology nurse practitioner, Anna
Baker and dermatologist Dr Sandeep Cliff,
who will be presenting on how to boost
sales of cosmeceutical products with multitasking, in-clinic techniques. AesthetiCare
will sponsor a unique session on how to get
natural results through non-surgical face and
eye lifts using radiofrequency by surgeon
and aesthetic practitioner Miss Sherina
Balaratnam. 3D-lipo Ltd will be sponsoring
a stimulating presentation by consultant
cosmetic surgeon, Mr Paul Banwell on
the benefits of the latest developments in
non-surgical facial rejuvenation and lifting
using high intensity focussed ultrasound
(HIFU) multi-technology devices. Fusion
GT will sponsor two sessions by aesthetic
surgeon Vanessa Patrizi, who will discuss
thought-provoking concepts on non-surgical
blepharoplasty and non-invasive face lifting.
Delegates will be able to hear from aesthetic
practitioner, Dr Galyna Selezneva, sponsored
by BTL Aesthetics, and SkinCeuticals will
support discussions by dermatologist, Dr
Firas Al-Niaimi. Healthxchange will also
sponsor an in-depth session by cosmetic
doctor, Dr Johanna Ward, on technology
for non-surgical face-lifts and collagen
remodeling. As well as this, Medico Beauty
will sponsor interesting discussions by its
managing director Aysha Awwad. Through
the Expert Clinics, delegates can benefit
from in-depth presentations and thoughtprovoking discussions from other leading
aesthetic professionals and experts. A talk on
facial lifting and slimming
with botulinum toxin will
be led by dental surgeon
and aesthetic practitioner
Dr Victoria Dobbie, who
will provide top tips for
patient selection and
technique, as well as
consent advice in her
facial beautification
and rejuvenation
dedicated session. A
discussion on optimising
facial harmony will be
Aesthetics aestheticsjournal.com
delivered by dental surgeon and aesthetic
practitioner, Dr Souphiyeh Samizadeh, who
will highlight different skeletal patterns and
explain how to treat the face, respecting
proportions and patterns to obtain a natural
effect. A presentation on surgical versus
non-surgical options for the face will be
delivered by consultant plastic surgeon, Mr
Adrian Richards, who explained delegates
will get an insight into facial ageing, how and
when this occurs and the possible treatment
options during his session, where he will be
supported by aesthetic nurse prescriber,
Mel Recchia. “I will be discussing the MACS
facelift procedure as a surgical solution to
facial ageing,” said Mr Richards, adding. “Most
notably who is suitable, the specifics of the
procedure and the expected results following
surgery. Mel Recchia will be discussing nonsurgical treatment options, specifically the use
of botulinum toxin and dermal fillers, as well
as discussing new techniques and effects
on the ageing face.” The session will also
include an unmissable live demonstration,
which Mr Richards said is extremely
important to aid learning and understanding
of the theory. “The demonstrations show
practice in action and enable delegates
to put questions to presenters as they are
administering treatments. It also allows
delegates to gain a greater understanding
of facial assessment which we consider an
important aspect of our own training courses,”
he said. “There is a wealth of experience,
knowledge and information available at
the Expert Clinics for delegates to pick and
choose which is most relevant to them. It is
also an excellent opportunity to network with
like-minded professionals and share learning
experiences,” he concluded. Delegates
will have the opportunity to gain in-depth
knowledge on non-surgical nose reshaping
from facial cosmetic surgeon Dr Julian
De Silva, who will demonstrate the latest
techniques and beautification treatments to
establish facial proportions and aesthetics.
How to optimise patient results using a
multidisciplinary approach will be examined in
an Expert Clinic session by Miss Balaratnam.
Attendees can expect to be presented with
a selection of clinical case studies to illustrate
the role of topical skincare, radiofrequency
technology, botulinum toxin injections and
full-face revolumising using dermal fillers,
followed by a live demonstration using the
Juvéderm Vycross range of dermal fillers.
“ACE 2016 is a valuable opportunity for
practitioners to gain knowledge and skills
about different aesthetic treatments and
techniques,” said Miss Balaratnam. “Our
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
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Aesthetics Journal
Aesthetics
“I come to ACE specifically to see doctors that I
respect, to see certain lecturers, and I’ve also come
here as an opportunity to network.”
Cosmetic doctor
profession is all about continued learning,
and I am looking forward to presenting and
sharing my approach to facial rejuvenation,
hopefully helping delegates to learn
something new.” Practitioners can attend aesthetic
practitioner Dr Lee Walker’s presentation
on lip augmentation, which will include
a demonstration and talk about the first
motorised cordless HA injection device.
Aesthetic practitioner Dr Sangita Singh,
who hopes to provide insight on how to
recognise the warning signs of patients not
to treat, will lead interesting discussions on
managing ‘red flag patients’. An overview
of the extensive range of laser treatments
available for the skin will be presented by
consultant dermatologist Dr Daron Seukeran,
who will discuss the use of lasers for hair and
tattoo removal, acne, scars, rosacea, skin
resurfacing and laser skin rejuvenation. Talks
on hair transplant techniques, anatomy and
physiology will be conducted by cosmetic
surgeon Dr Sotirios Foutsizoglou, who will
describe the hair cycle and follicular anatomy,
with a focus on common hair restoration
techniques, the traditional strip surgery
and the follicular unit extraction technique.
Senior researcher in skin biochemistry and
physiopathology, Dr Chiara de Luca, will
lead a presentation focusing the power of
non-aggressive ingredients to ignite the skin’s
natural immune system and Baker and Dr Cliff
will present a second Expert Clinic session
in collaboration with Dr Mustafa Varcin on
the future of cosmeceuticals. As well as this,
delegates can expect a comprehensive
presentation by Dr Sarah Tonks, Dr David
Jack and Dr Kishan Raichura on the multiple
approaches to lower face treatments. Masterclasses
The Masterclass presentations are to be
showcased in dedicated rooms in the gallery
and will demonstrate the best practice
methods with the latest products, providing
delegates with invaluable product guidance.
Galderma will host a Masterclass on periorbital rejuvenation with hyaluronic acid fillers.
During the session, consultant oculoplastic
surgeon, Mrs Sabrina Shah-Dasai, will
discuss the anatomical basis of peri-orbital
rejuvenation and will highlight the importance
of choosing appropriate fillers, correct
injection techniques and how to maximise
aesthetic outcomes. HA-Derma will also
be supporting a Masterclass session led
by plastic and aesthetic surgeon, Professor
Daniel Cassuto, along with dermatologist,
Professor Hema Sundaram and HA-Derma’s
UK lead trainer and aesthetic practitioner
and dental surgeon, Dr Irfan Mian. Sales and
marketing manager, Iveta Vinklerova, said
HA-Derma was delighted to be featuring a
Masterclass session at ACE for the first time.
“ACE is giving us a fantastic opportunity to
position our products amongst the leading
brands within the industry. We are equally
excited to sponsor our Masterclass, which
will complement the conference programme
and provide important educational content for
the delegates.” Other top medical aesthetic
companies, including Zeltiq, who will support
cosmetic practitioner, Dr Sach Mohan, will
host a number of other leading professionals
demonstrating how to use the most popular
products and treatments, while discussing
the best ways to incorporate them in to
daily practice. Each 90-minute Masterclass
will allow practitioners to build on their skills
and understanding through informative
and focused guidance. Practitioners are
encouraged to take advantage of this free,
innovative content. Treatments on Trial
Delegates are sure to benefit from attending
the Treatments on Trial on Saturday April
16 in the gallery, where engaging debates
and discussions on the latest products will
take place. The event, which is an exciting
new feature of ACE, is supported by BTL
Aesthetics, Lumenis and Syneron Candela,
and will focus on body contouring and
weight loss. Delegates will also have the
opportunity to learn how and when to use
the latest treatment offerings and directly
compare these to discover the best options
for their practice. “ACE is an important event
in our conference diary and gives us the ideal
opportunity to meet with medical practitioners
and showcase our technology,” said Syneron
Candela marketing manager, Dianne Burkhill.
“This year, we have chosen to sponsor the
Treatments on Trial session as we believe it’s
important that delegates attending the event
have the opportunity to hear about the latest
treatments available, so that they can make
informed decisions about what will best suit
their business needs,” she said. Director of
BTL Aesthetics, Lee Boulderstone, said he
is thrilled to be a part of this new agenda at
ACE 2016. “BTL Aesthetics are delighted
to sponsor Treatments on Trial at ACE this
year. With such a huge amount of products
available and the deregulation of some
aesthetic devices in 2010, it can be difficult
for practitioners and business owners
to make informed decisions as to what
devices to invest in. As a company, we are
committed to providing superior technology
to practitioners, and the introduction of
Treatments on Trial means that all companies
who are involved can provide their own
clinical data and results to the aesthetic
market, and delegates can be confident that
the products on show are proven to be both
safe and efficacious,” he said.
Free CPD accreditation Practitioners are urged to make
the most of the free, informative
clinical content offering at
ACE 2016, and utilise this opportunity to
gain more product and industry knowledge,
as well as CPD accreditation. To access
the free Expert Clinics, Masterclass and
Treatments on Trial agendas, practitioners
can register online. Once registered,
they can also choose to purchase the
premium Conference Pass for a full and
comprehensive learning experience.
Through this free registration, delegates can
also attend the Business Track, to learn the
latest in business industry knowledge. The
Aesthetics Conference and Exhibition 2016
is expected to attract 2,000 practitioners
and industry personnel from across all areas
of the aesthetics field. There are 50 CPD
points available over the two-days, so be
sure not to miss out on this key event in the
professional calendar.
To gain access to the free clinical
sessions, including the Expert Clinics,
Masterclasses and Treatments on Trial,
as well as the Business Track,
practitioners can register online for
free at www.aestheticsconference.com
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Aesthetics Journal
Aesthetics
Managing Hair Loss
There are numerous techniques and
procedures available to restore thinning
and declining hair. Allie Anderson speaks
to practitioners about some of the options
available and details how they work
Many people seek aesthetic treatment for hair loss that has
occurred either as a result of ageing or an underlying condition.
Various treatments are available, however unnatural-looking results
have made some of them unappealing. Even with the development
of more advanced technology, according to the practitioners
interviewed for this article, the market for male hair loss treatments
remained comparatively small until around five years ago, when
there came a steady rise in demand, particularly among younger
men. “I see a large proportion of men in their 20s, and that’s
doubled in the last few years. I put that down to celebrities,” explains
Dr Edward Ball, medical director of The Maitland Clinic. He is, of
course, alluding to the likes of Wayne Rooney, who at the age of 25
famously (and openly) underwent hair transplant surgery in 2011,1
demonstrating impressive results. Such well-publicised successful
treatments, revealing fuller-looking hair and restored hairlines,
have helped generate interest among the general public. In fact,
research conducted by The Maitland Clinic found that one fifth of
2,000 men polled think hair transplants are more acceptable thanks
to these high-profile endorsements.2 This is perhaps borne out in
the numbers of people – both men and women – having treatment,
with numbers of surgical treatments carried out in Europe increasing
by 45% between 2008 and 2014.3 Dr Ball adds that, in his opinion,
the rise of social media and ‘selfie’ culture is, in part, responsible for
society’s increasing preoccupation with hair.
Causes of hair loss
Anecdotal evidence from those interviews suggests that the
most common cause of hair loss in men who seek treatment
is androgenic alopecia (male pattern hair loss). It is caused by
oversensitivity of the hair follicles to dihydrotestosterone, a
converted form of the testosterone hormone.4 Male pattern
baldness also runs in families, most strongly in the mother’s side.4
This form of hair loss typically follows a predictable pattern, such
that patients’ hair usually begin to recede at the temples or notice
a thinning patch on the crown, followed by gradually increasing
thinning and sometimes complete loss of hair on the top of the
head.5 Women, too, can present with androgenic alopecia (female
pattern hair loss). “Some women have hair that thins more as they
age,” says Natasha Borciani, owner of Borciani London. “They tend
to get a strip (of thinning hair) down the centre along the parting,
which will widen over the years.” This diffuse thinning makes the
scalp more visible and worsens with time. Androgenic hair loss
in women is associated with the presence of testosterone, and,
post-menopause, with a reduction in oestrogen levels.5 The most
common problem in women with regards to hair loss is telogen
effluvium, which presents as widespread yet gradual diffuse
shedding or thinning of the hair, rather than in clumps or patches.6
Other types of hair loss include:5,6
• Alopecia areata – where coin-sized bald patches appear on the
scalp
• Scarring alopecia – also known as cicatricial alopecia,
usually caused by complications from another condition (and
consequently, hair won’t grow back)
• Anagen effluvium – commonly a side effect of chemotherapy and
other cancer treatments
• Trichotillomania – self-inflicted hair loss caused by obsessivecompulsive pulling of the hair
Forms of treatment
Medication
Medical interventions can be effective to slow or halt the progression
of androgenic hair loss in men and women, and is often the first line of
treatment. “There are two FDA-approved medications for hair loss, the
first of which is minoxidil,” says Dr Munir Somji, clinical director at Priors
Clinic. He adds, “Although we’re not completely sure of its mechanism
of action, it causes vasodilation, which could help hair growth.”7 The
vasodilatory effects of minoxidil could, it is suggested, open potassium
channels and thereby allow more oxygen, blood and nutrients to the
hair follicle.7 Indeed, topical minoxidil has been indicated to generate
‘superior’ results compared with placebo controls in trials among
both men and women, with 5% concentrations appearing to be more
effective than 2% and eliciting no significant adverse effects.8,9 The
second FDA-approved medication, says Dr Somji, is finasteride. “It is
prescribed in 1mg doses for male pattern hair loss, and we see that it
actually stops hair loss in about 65% of individuals,” he says. It works
by blocking the conversion of testosterone to dihydrotestosterone,
and it has been indicated to promote hair growth and prevent further
loss, with improvements noted in 66% of male recipients after two
years of treatment, with a good tolerability profile.10
Before
After
Figure 1: Patient with traumatic alopecia treated with minoxidil and
tailored, topical solutions over a period of seven months. Images
courtesy of Mandy Baldwin.
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
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Mesotherapy
Before
After
Six months after
Mesotherapy is used in aesthetics to combat a number
of concerns, including cellulite and signs of ageing skin,11
and its application in hair loss is gaining in popularity.
“The science is limited, but essentially, mesotherapy
Left side
Right side
Left side
Right side
is a term that describes a technique as opposed to a
specific treatment,” explains Pam Cushing, aesthetic
Figure 2: Images following treatment with the Athrex ACP PRP system from Biotherapy
nurse prescriber and vice president of the Society of
Services Ltd Windsor. Images courtesy of Pam Cushing.
Mesotherapy UK. “You can do mesotherapy with different
is different for everybody. People of Indian origin have longer hair
types of products; for example, we could use platelet-rich plasma
follicles than Caucasian people, for example,” he says. As a result,
(PRP), pure hyaluronic acid, or cocktails that combine natural products
injection depth should be determined by the length of the individual
that would stimulate the hair to thicken by feeding the bulb of the hair
patient’s hair follicle. “I surgically remove one follicle and look at
follicle.”
it under the microscope to measure how far it goes down to the
These ‘hair cocktails’ contain different pre-mixed ingredients that
papillary dermis, which is where the PRP is injected. That gives me
can be injected into the scalp. “Using very small, microinjections just
an accurate measurement of how deep to set the needle,” explains
underneath the scalp, small deposits of the product are delivered
Dr Somji, adding, that this is typically between 1.5 and 2.5mm, with
and evenly spaced out, to stimulate collagen production, but also
0.5ml of PRP injected per cm squared, but, crucially, the depth is
to feed, nourish and hydrate the hair bulb,” says Cushing. “If you
varied from patient to patient, where other practitioners may use the
increase the nutrients, vitamins, trace elements and amino acids that
same depth across the board. According to consultant trichologist
the hair requires for growth, it stands to reason that the bulb will grow
Mandy Baldwin from the Hair and Scalp Clinic, dormant hair follicles
thicker.” She points out that different manufacturers will use different
start to become fortified and reinvigorated almost immediately.
preparations, but an example cocktail might include:
“You can’t see anything straight away but there is lots happening
• Drugs – buflomedil, pentoxifylline, minoxidil, finasteride
underneath, just like when you plant a seed that eventually grows
• Vitamins – dexpanthenol (B5), biotin (vitamin H), L-ascorbic acid
into a flower,” she says. “Patients normally begin to see a change at
(vitamin C), vitamins A, E, B1, B2, B6, B complex, and D
around three to six months post treatment.” Moreover, Baldwin adds,
• Trace elements – cobalt, copper, ginkgo biloba, lithium,
PRP can be used in combination with hair transplantation to help
magnesium, manganese, phosphorous, selenium, sulphur, zinc
the implanted follicles to prosper, reduce inflammation, erythema,
• Nutritional drugs – Centella asiatica, silicon
trauma, and the formation of scabs, and to aid healing.
• Hormone – calcitonin
• Anaesthetic – procaine
Hair transplantation
When one thinks of hair loss treatments, transplantation might be the
This type of therapy has been the subject of comparatively few
first thing that springs to mind. Dr Ball explains, “Hair transplant surgery
scientific studies, but some have demonstrated that mesotherapy can
is based around a principle known as ‘donor dominance’. That means
elicit good results in the treatment of acute diffuse hair loss, such as
telogen effluvium, stress alopecia, androgenetic hair loss and alopecia the donor hair is dominant in its characteristics. So, you take hair from
a donor area – that usually being the back and sides of the head –
areata.14 Patients typically undergo one treatment per month over
and the hair will retain the characteristic from that area regardless of
three months, at which point Cushing would expect to see results.
where you put it.” Hair transplant surgery is said to produce ‘excellent’
“The greatest limitation is patient expectation,” she says. “You have
results in the treatment of many forms of male and female hair loss,
to be realistic, and some patients can be dissatisfied purely because
particularly androgenic alopecia.15
the change has not been as rapid as they anticipated. Managing
expectations is important.”
There are two methods of removing the donor hair: follicular unit
transplantation (FUT) and follicular unit extraction (FUE). The former
Platelet-rich plasma
involves taking a strip of skin from the back of the head, usually
Dr Somji offers PRP treatment, in which the patient’s own blood is
around 1- 2cm wide, with the length dependent on both how much
re-injected into the scalp via multiple, tiny injections around 1cm
hair you need and the density of the donor hair. “You have to
apart. This involves withdrawing blood – usually from the patient’s
carefully dissect in between each hair follicle to maximise the donor
arm – and processing it through a machine to centrifuge it and
yield, and the skin is then stitched up,” Dr Ball comments. “This can
separate out plasma containing a high concentration of platelets.
leave a scar, which although is usually barely noticeable and is easily
This PRP is rich in growth factors – naturally occurring substances
covered by hair, can be a concern for some patients, particularly
that stimulate cell growth and proliferation, and thereby promote
men who like to keep their hair short.” In such patients, the latter
tissue regeneration.12 Studies have demonstrated that injecting PRP
(and more advanced) technique – FUE – is advised. Dr Ball explains,
“Here, instead of taking the whole piece of skin and stitching it up,
preparations has a ‘positive therapeutic effect on male androgenic
you remove each hair individually using a device that makes tiny
alopecia without major side effects’.13 “First, we do a trichoscopy,
punches of around 0.8 to 1mm. From that point on, both techniques
looking at the scalp under a microscope for areas of miniaturised
are the same.”
follicles,” Dr Somji comments, adding, “We count the number
The donor hair is examined under the microscope and separated
of follicles per cm squared, so we have a quantitative analysis
into individual grafts of one or two hairs, which must be delicately
before treatment.” This gives both the patient and the practitioner
handled and placed in a preservative solution to maintain their
a measurable assessment of the success of the treatment. An
viability. The area of the scalp receiving the donor hair is then
important factor, according to Dr Somji, is the depth to which you
prepared: the practitioner makes a series of tiny incisions, into which
inject the scalp. “The length of the hair follicle underneath the skin
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
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Aesthetics Journal
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similar to a very fine tattoo pen,
which allows me to blend into
any remaining hair, and achieve
a natural-looking hairline.”
Patients normally undergo two
or three treatments, each four
Before
After
weeks apart, to get optimum
results, but the nature of the
technique – placing pigment
into the skin – means that you
can see a distinct difference
Figure 3: Patient in his 20s who underwent a single hair transplant surgery at The Maitland Clinic using the FUT method straight away. Borciani reports
to the frontal half, following seven months on oral finasteride (1mg daily). Images courtesy of Dr Edward Ball.
that anecdotally, the effect can
last up to two or three years, with a maintenance session often
the grafts will be positioned. “The placing of the hair takes a long
required around 15 months post procedure. “There are factors that
time. Each graft must be laid out to match the angle, direction, and
affect the longevity, such as sun exposure, lifestyle and general
the density of the hair you want to create,” says Dr Ball. “It has to be
skin condition – oily skin doesn’t retain the pigment as well – but if
natural-looking, in keeping with the patient’s age, face shape and
patients look after their scalp, they should be happy for more than
hair line, and the whole procedure can take up to 10 hours.” People
a year,” she says.
can, anecdotally, return to normal daily routine within one week, with
no evidence of having had surgery, Dr Ball adds. Post-treatment
care involves not touching the hair for the first six days, while the
Conclusion
skin heals over to root the follicles into place, then washing, styling
Hair loss for both sexes can be an emotional event and a source of
and treating the hair as normal thereafter. “The hair graft sits dormant great insecurity. The manifold treatments available can offer a solution,
waiting for new hair to grow, and that happens in stages very
and as techniques become more sophisticated, they will undoubtedly
gradually. It’s subtle, and it normally starts about four to six months
produce increasingly better results. Scientists have been researching
after surgery. Patients get most of the growth by 10 to 12 months.
the potential to grow human hair using stem cells, whereby stem
Beyond that, while they won’t get new hair growth, the quality,
cells can turn dead hair follicles into healthy ones, and consequently
calibre and thickness of the hair tends to get better and better.”
promote new hair growth.18 The point in time when not only human
hair can be grown in human tissue, but also when the science is
Hair follicle stimulation
routinely applied in clinics, may be closer than we think.
Most solutions are aimed at restoring hair, but an alternative
REFERENCES
option is to conceal instead of ‘treat’ hair loss, by way of scalp
1. Harley Street Hair Clinic, Wayne Rooney’s hair transplant, (London, 2013). <www.hshairclinic.co.uk/
patients-gallery/wayne-rooney/>
micropigmentation (SMP). Borciani offers this ‘follicle simulation’ for
2. The Maitland Clinic, Balding truth about hair loss in the UK, 2015. Data on file via The Maitland Clinic.
men and women experiencing all types of hair loss. She says, “We
3. International Society of Hair Restoration Surgery, 2015 Practice Census Results, (USA, 2015) <http://
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create micro dots of pigment underneath the skin in the dermal layer,
users/user3/report_2015_practice_census-final.pdf+&cd=1&hl=en&ct=clnk&gl=uk&client=safari>
which mimics the appearance of real hair follicles or strands. It’s a
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5. The Institute of Trichologists, Hair conditions (London) <www.trichologists.org.uk/index.php/
more affordable and natural alternative to hair restoration.” While
conditions/hair-conditions>
SMP can be an effective application for balding or thinning hair and
6. NHS Choices, Hair loss (London, 2015) <www.nhs.uk/Conditions/Hair-loss/Pages/Introduction.
aspx#telogen>
can yield extremely pleasing results,16
Figure 4
7. Rossi A, Cantisani C, Melis L, Iorio A, Scali E, Calvieri S., ‘Minoxidil use in dermatology, side effects and
this is largely reliant on the technical
recent patents’, Recent Pat Inflamm Allergy Drug Discov, 2 (2012), pp.130-6.
8. Lucky AW, Piacquadio DJ, Ditre CM, Dunlap F, Kantor I, Pandya AG, Savin RC, Tharp MD., ‘A
and artistic skills of the practitioner,
randomized, placebo-controlled trial of 5% and 2% topical minoxidil solutions in the treatment of
whose careful selection of pigments
female pattern hair loss’, J Am Acad Dermatol, 50 (2004), pp.541-53.
9. Olsen EA, Dunlap FE, Funicella T, Koperski JA, Swinehart JM, Tschen EH, Trancik RJ., ‘A randomized
and understanding of the hair loss
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process is crucial to the procedure’s
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10. McClellan KJ, Markham A., ‘Finasteride: a review of its use in male pattern hair loss’, Drugs, 57 (1999),
success.17 “I draw on a hairline
pp.111-26.
template with a liner to get an idea
11. Mesotherapy and Estetik, FAQ, testimonials, patient warning, (New York, 2006) <www.mesotherapy.
Before and after two sessions
com/faq/>
of hair follicle stimulation
of the shape we can work with and
12. El-Sharkawy H, Kantarci A, Deady J, Hasturk H, Liu H, Alshahat M, Van Dyke TE., ‘Platelet-rich plasma:
over four weeks. Images
what the likely result will be,” Borciani
growth factors and pro- and anti-inflammatory properties’, J Periodontol, 78 (2007), pp.661-9.
courtesy of Natasha Borciani.
13. Gentile, P et al, ‘The Effect of Platelet-Rich Plasma in Hair Regrowth: A Randomized Placeboexplains. “Then we do some colour
Controlled Trial’, Stem Cells Translational Medicine, 4 (2015), pp.1317–1323.
matching; we work with a large range of pigments that we blend
14. Kutlubay Z, Karakuş Ö, ‘Hair Mesotherapy’, Hair Ther Transplant (2012) 2:e102. <www.omicsgroup.org/
journals/2167-0951/2167-0951-2-e102.pdf>
together to find an exact match that’s as natural looking as possible.”
15. Paul T Rose, ‘Hair restoration surgery: challenges and solutions’, Clin Cosmet Investig Dermatol, 8
After numbing the scalp for 20 to 30 minutes, the treatment is
(2015), pp.361-370.
16. William R Rassman, Jae P Pak, Jino Kim, ‘Scalp Micropigmentation: A Useful Treatment for Hair Loss’,
performed using one of two systems – or a combination of both –
Facial Plastic Surgery Clinics of North America, 21 3 (2013), pp.497-503.
depending on the extent of the hair loss and the desired outcome.
17. William R Rassman, Jae P Pak, Jino Kim, Norman Estrin., ‘Scalp Micropigmentation – A Concealer for
Hair and Scalp Deformities’, J Clin Aesthet Dermatol, 8(3) (2015), pp. 35-42.
“The first is a roller system, which allows you to put in far more
18. Medic8, Future Treatment Hair Loss – Hair Loss treatments, <http://www.medic8.com/healthguide/
pigment far more quickly. It reduces the length of time the patient
hair-loss/treatments/future-treatment-hair-loss.html>
has to be in the chair, which, for a full head, could be from up to
five hours down to about 60 minutes.” This roller is applied to large
sections of the scalp, and around the front and sides the second
system will usually be used. “This is a manual dotting technique,
Before
After
Before
After
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Granuloma Management
Dr Beata Cybulska details the formation, pathophysiology and treatment of
granulomas following dermal filler injections
Abstract
Granulomas are a delayed, poorly understood and distressing
complication of dermal filler injections. Histologically, they represent
a foreign body type of reaction with giant cells and macrophages
infiltrating tissues. Granulomas are classified into three types: cystic,
nodular and sclerosing, which clinically present as red, firm papules,
nodules or plaques occurring months or years after filler injections.
Filler dependent factors such as volume and particle size, as well as
the presence of biofilm, have been suggested as possible causes.
Treatment is often empirical, hence good differential diagnosis is
essential in choosing the right treatment pathway. Overcorrection
using dermal fillers, hypersensitivity reaction and infections ought
to be considered before embarking on treatment, which consists
of antibiotics and hyaluronidase in the first instance, followed by
intralesional or systemic steroids. Surgical excision is recommended
as the last resort. Investigations that may be of assistance in making
the diagnosis and assist with the management include blood tests
such as: white blood count (WBC) and C-reactive protein (CRP). Out
of the imaging methods available, the use of ultrasound (USS) is most
useful. Biopsy and histology offer confirmatory diagnosis. Culture is
often unhelpful as a negative result does not exclude possibility of the
presence of biofilm. Counselling the patient and adopting preventative
measures such appropriate filler choice and prevention of infection
should be part of every case of dermal filler injections.
Introduction
Granulomas following dermal filler injections are challenging for
aesthetic practitioners to manage and can be distressing to the
individuals affected by them.1,2 Granulomas can develop months
or years after deposition of the dermal filler in the dermis and may
occur after both permanent and semi-permanent dermal filler use,
including hyaluronic acid (HA), bovine collagen, silicone, paraffin,
polyacrylamide gel, poly-lactic acid microspheres and calcium
hydroxyapatite.1-8 Frequency of granuloma occurrence has been
reported as 0.02-0.4% after HA and 0.04%-0.3% after bovine
collagen injections.3,4,5
Pathophysiology of granuloma
Granuloma formation is a non-allergic, chronic inflammatory
response, characterised by foreign body types of reaction in the
dermis following injection of dermal filler or other foreign material.3,4
A granuloma is defined as a tumour composed of immune cells such
as macrophages, activated and fused into multinucleated giant cells,
consisting of more than 20 nuclei and arranged in an irregular and
random way.9,10
Formation of granuloma occurs in stages involving:
1) Protein absorption
2) Macrophage adhesion
3) Macrophage fusion
4) Crosstalk
As the neutrophil infiltration and adsorption of host proteins to the
foreign material occur, monocytes circulating in the blood migrate
to the surrounding tissues and differentiate into macrophages.
Where the particle volume is greater than the macrophage volume,
macrophages aggregate, forming giant cells and secrete factors,
which activate fibroblasts, influencing the development of fibrous
capsule around the foreign body material and formation of the foreign
body giant cell (FBGC). 3,9,10
It is not fully understood why small filler particles or silicone fluid
trigger granuloma formation, both of which are easily phagocytosed
by macrophages.11 One hypothesis that was put forward by Lemperle
et al in 2006 suggests that macrophages act as memory cells and
remember small phagocytosed particles. Triggered by systemic
infection, they initiate FBGC formation and the development of
granuloma.12 The authors were of the opinion that volume, purity and
physical characteristics of the injected dermal filler such as particle
size, smoothness, charge and hydrophilicity play a role in this process.
Bentkover hypothesised that the main cause of FBGC reaction
is the size of the filler particles, which prevents them from being
phagocytosed.13 Granulomas have been linked to biofilms, which are
defined as a structured community of microorganisms encapsulated
within a self-developed, polymeric matrix, irreversibly adherent to a
living or inert surface.14 In 2007, Christiansen hypothesised that biofilms
form when bacteria is introduced during filler injections or are seeded
in the filler during bacteriaemic episodes.14 Once present, they remain
dormant for months or years on the surface of the filler and become
a target of a delayed immune response, resulting in granuloma
formulation. Many biofilms are almost impossible to culture using
current microbiology culture technology.15 They live in a quiescent
state, resulting in a low-grade infection associated with low-grade
host response. Activation of biofilms may be triggered by dental
manipulation, trauma or other factors, leading to local or systemic
infection, as well as granulomatous, inflammatory response. Biofilm
populations can shift from active to dormant depending on exogenous
threats. When bacterial proteins turn off cell metabolism and the cell
becomes dormant, it becomes antibiotic resistant, as well as difficult, if
not impossible, to culture.3,15,16,17
Patients with chronic sinusitis, chronic dental problems, or other
infections may have a greater tendency to develop an infection after
a filler is injected in the periorbital area or central face. These patients
may also be prone to formation of a biofilm around or in the implant,
caused by injection trauma around the site of a previous filler injection.
Many problems that were previously assumed to be foreign body
granulomas or allergic reactions, on the basis of negative bacterial
cultures, are now thought to be due to biofilms.3,15,16,17
Diagnosis and treatment of dermal filler granulomas
Diagnosis and management of dermal filler granulomas is complex. In
order to offer satisfactory treatment and resolution, it is very important
to take good medical and aesthetic history and thoroughly examine
the patient. Investigations may assist with making correct diagnosis
although, in reality, they are rarely carried out and treatment is
empirical. It is therefore essential to understand the pathophysiology
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
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Granuloma
Presentation
and symptoms
Causes
Onset
Aesthetics
Delayed
hypersensitivity
Filler nodule
Infection
Cystic, nodular, bluish, indurated
plaques with congested capillaries
that are bigger than the injected
volume of filler and develop
simultaneously at different sites.
Evenly sized, whiter in
colour and harder than
granulomatous nodules.
Erythema, oedema, indurated
papule, nodule with or
without itching.
Erythema, swelling,
oedema, induration and/or
tenderness.
Filler dependent: type and volume
of filler used.
Injector dependent:
poor injection technique
(overcorrection or too
superficial injection), lack of
massage.
Filler dependent: HA or
bovine type collagen.
Subject dependent: bacterial,
viral, fungal, parasitic
infections.
Subject dependent: infection and
biofilm.
Injector dependent: attention
to skin cleanliness and patient
selection.
Subject dependent: lack of
massage (L-polylactic acid).
Delayed by months or years after
filler injection.
Early – up to two weeks after
filler injection.
Injector dependent: poor
patient selection, poor skin
cleansing.
One month after filler
injection with spontaneous
resolution after one year.
Early or delayed.
Figure 1: Differential diagnosis of granuloma3,16
of granulomas and differentiate them from other causes of nodular
lesions caused by dermal fillers, as their management differs
depending on the presence or absence of inflammatory features.
abscesses, dermal fillers should not be injected. There is evidence
that these infections might invade the implanted filler and may result in
biofilm formation, which in turn may trigger hypersensitivity reaction.16
Patient history
Medical history should constitute part of every aesthetic consultation.
In cases of delayed complications such as suspected granuloma
formation, more specific questions about onset, presence of
inflammatory features such as pain and redness, history of dermal
filler injections, type and volume of injected filler and sites, presence
of skin infections, as well as skin conditions or immunocompromised
state should be enquired for. Pre-existing skin infection in or close to
the injected area may worsen and result in complications. Patients
with ongoing skin infections caused by bacteria like streptococci
and staphylococci resulting in impetigo; those with excessive
Propionibacterium acnes or parasitic mite infection such as demodex
folliculorum associated with rosacea; yeast infections; extensive
pityrosporum folliculitis; viral infections such as herpes virus simplex
(HSV) or perioral human papilloma virus infection (HPV); should not
have dermal filler injections until the infection is treated. In the presence
of sinusitis, periodontal disease, ear, nose or throat infections, or dental
Clinical and histological features of dermal filler
granulomas
Patients with chronic
sinusitis, chronic dental
problems, or other
infections may have a
greater tendency to develop
an infection after a filler is
injected in the periorbital
area or central face
Dermal filler granulomas have been classified into three types based
on their histological features: cystic (HA, bovine collagen), nodular
lipogranuloma with ‘Swiss cheese pattern’ (silicone, polyacrylamide)
and sclerosing.11 Mixed pattern granulomas have also been identified.1
Clinically, granulomas present as red, firm papules, nodules or
plaques, which may occur months or years after filler injection.16
Intralesional
injections
Corticosteroids
(triamcinolone acetate
– Kenalog)
Bleomycin
5-Fluorouracil
Systemic
treatment23,24,25
Antibiotics
Prednisolone
Allopurinol
Colchicine
Cyclosporine
Surgery
Melting with laser
Incision and drainage
Excision plus fat
grafting or flaps
Figure 2: Treatment options for granulomas
Differential diagnosis of granulomas
It is sometimes difficult to distinguish between granulomas and
nodules due to other causes or an abscess. Diagnosis of nodules
complicating dermal filler injections is complex and difficult in those
with no clear history of dermal filler injection. It is, however, very
important to get the correct diagnosis in order to achieve a successful
outcome. Granulomas ought to be differentiated from nodules caused
by poor injection technique, an infection or delayed hypersensitivity
reaction (Figure 1). Establishing possible causes of dermal filler nodules
impacts on treatment options and outcomes. Investigations which
may assist in diagnosis include: blood tests: C-reactive protein, white
blood count (WBC), erythrocyte sedimentation rate (ESR), microscopy
and culture, in situ hybridisation, computerised tomography (CT scan),
magnetic resonance imaging (MRI), skin biopsy and histology.11,18
Cassuto and Sundaram (2013) advocate the use of ultrasound (USS)
imaging in cases of persistent nodules to assist with location of the
implanted material.19
Treatment of granulomas
Treatment of dermal filler nodules is often empiric without full
evaluation of possible causes and variable satisfaction rates
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
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Non-inflammatory dermal filler nodules
Palpable, visible, nodules appearing two to four weeks after injection
Early onset
Delayed onset
HA filler
Non HA filler
Hyaluronidase
Massage
Lidocaine + Saline
Small amounts of intralesional steroids
5 FU 0.5ml of 50mg/ml + 0.3ml of 10 mg/ml triamcinolone +
0.2 ml of 2% lidocaine with adrenalin
Fractional laser (eyelids and lips)
Surgical excision
Prevention of non-inflammatory nodules formation
Avoid: overcorrection, superficial filler placement; use appropriate filler for tissue site, massage for even distribution
Figure 3: Management of non-inflammatory dermal filler nodules
due to a misunderstanding of the pathophysiology. A problemfocused approach in the diagnosis and treatment has been
recommended.17,19-21 Common causes such as infection, before
rare causes such as hypersensitivity to filler material, ought to
be considered, as should poor injection technique, before filler
dependent factors are blamed (Figure 1). Painful nodular lesions
with inflammatory features ought to be treated promptly with broad
spectrum antibiotics in spite of negative culture when biofilm
is suspected (Figure 2). If HA filler was injected, intralesional
hyaluronidase and extraction of the nodule content using a 16G
needle and negative pressure, followed by administration of
intralesional 5 fluorouracil (5 FU), laser lysis and, as a last resort,
surgical excision can be carried out. Antibiotic therapy is the first step
in the management of cases suspected of infection origin, in spite
of negative culture. Intralesional steroids used before antibiotics can
prolong the problem.
Intralesional injections
Painless granuloma with no inflammatory response can be treated
with intralesional steroids in the first instance, followed by 5 FU and
surgical excision21 (Figure 2). Such lesions are not urgent and the
patient can be reviewed in two weeks. Polymethylmethacrylate
fillers can be melted with laser energy first, before pouring them
out of the area as demonstrated by Cassuto et al.22 In some
cases it may be necessary to use intralesional steroids to reduce
the lump whilst continuing to administer antibiotics. Injections of
steroids ought to be performed carefully due to the risk of localised
atrophy. High dose triamcinolone (35-40mg) mixed with 2%
lidocaine is recommended using a 0.5mlto 1ml insulin syringe with
a 30G needle for intralesional injections. Smaller needle diameter
helps to avoid steroid-induced atrophy. As granulomas spread in
a finger-like pattern, best injection technique involves injecting
small amounts on the periphery, moving towards the centre. Other
agents include bleomycin, colchicine, cyclosporine, immiquimod or
etanercept, which is traditionally used to treat rheumatoid arthritis
and psoriasis.23-26 Isotretinon can be used alone or in combination
with steroids.27
Systemic treatment
Systemic treatment is recommended in recurrent granulomas when
localised treatment is not effective. Higher doses of steroids are
used in such cases, e.g. oral prednisolone 30mg/day starting dose
followed by 60mg/day of maintenance dose has been suggested
to prevent recurrence of granulomas.1 Oral antibiotic minocycline
alone or combined with oral or intralesional steroids has been
indicated as effective in the treatment of inflammatory granulomas
and silicone granulomas.20
Surgical treatment
Surgical excision offers a cure by removing the foreign body, as
well as biofilm, however it is not without complications. In particular,
scarring and deformities can occur because of potential invasive
growth of granulomas and irregular borders making their complete
removal impossible.4 In addition, in silicone-induced granulomas,
surgery carries a risk of abscess or a fistula. Localised sclerosing
granulomas can be excised with subsequent correction of
deformities using fat grafts or flaps.3 Incision and drainage of a sterile
abscess has been indicated as effective.6
Inflammatory nodules
Granuloma
Biofilm
Red, indurated area occurring any time after filler injection
Broad spectrum antibiotics:
Sterile abscess, red, indurated area occurring several months to years after filler
injection
Intralesional or systemic steroids: triamcinolone, betamethasone or
prednisolone.
Ciprofloxacin or clarithromycin 500mg bd PO + moxifloxacin 400mg od PO x
four weeks.
If poor response switch to clindamycin 600mg bd P.O. + tetracycline 500mg bd PO.
If no response add: 5 FU, bleomycin, colchicine, cyclosporine.
If still no response, consider surgical excision using flap technique or fat
grafting.
If good response, extract nodule material using 16G needle and negative
pressure. Consider: injections of 0.5 cc of 5FU monthly x 4; laser lysis, incision
and washing out cavity with antibiotics or surgical excision.
Prevention of inflammatory nodules formation
Clean skin thoroughly before injection, avoid injecting through oral or nasal
mucosa, use prophylactic antibiotics if facial infection present two weeks prior
to treatment.
Limit filler volume, avoid intramuscular injection, select microspheres with
smooth surfaces for use in patients with multiple filler injections.
Figure 4: Management of inflammatory dermal filler nodules28
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
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Clean surfaces
>> Clean surfaces with disinfectant
wipes
>> Discard contaminated material
>> Clean cold packs with antiseptic
wipes and wrap them in gauze
before procedure
Aesthetics Journal
Clean patient’s skin
>> Find out about history of local or
systemic infections
>> Remove makeup
>> Clean skin with an antiseptic
>> Tell patients not to touch cleaned
areas
>> Clean the skin after procedure
>> Consider topical antibiotic
treatment
Aesthetics
Clean hands
>> Disinfect hands prior to using
clean gloves
>> Do not touch surfaces, lights, nonclean areas before injecting
Clean instruments
>> Use single-use dressing pack per
patient
>> Keep syringes/ needles in clean
area before and during treatment
>> Use a ‘no touch’ technique at all
times, restricting any contact to
clean areas
Figure 5: Aseptic technique
Case study
Figures 6 and 7 show the before and after images of a
female patient who self-referred for treatment of a nodular,
inflammatory lesion which appeared several weeks after
hyaluronic acid injection to treat the tear trough. The lesion
was preceded by non-inflammatory, tender nodules. Culture
was positive for coagulase-negative Staphylococcus
aureous. The patient was treated with hyaluronidase
injections, antibiotic ciprofloxacin 500 bd for two weeks,
followed by surgical incision and drainage, as well as LED
lamp treatment.
Before
After
Prevention of dermal filler granulomas
Dermal filler related granulomas may be prevented by meticulous
cleansing and disinfecting the skin, sterile injection technique,
prophylactic antibiotics, as well as using smaller gauge needles
to minimise trauma and access for bacteria. Patients should be
advised to avoid makeup immediately before and after injection.
Overcorrection with dermal filler, injecting too large a volume of the
wrong type of filler for the tissue type, and lack of even redistribution
of the filler due to lack of massage, should be avoided. Correct
injection technique with placement of needle at the appropriate depth
before injecting and discontinuing injecting before retraction of the
needle is recommended.
Conclusion
Granulomas are rare, however they are complex and difficult
to manage delayed complications of dermal filler injections.
Understanding their pathophysiology is essential in differential
diagnosis and appropriate management. Use of a sterile and
correct injection technique, as well as high quality dermal filler that is
appropriate for the tissue type, are important factors in the prevention
of these challenging, and often distressing for the patient, filler
complications.
Figure 6
Figure 7
Images courtesy of Dr Ewa Kaniowska, MD, dermatologist, founder of
Derma Pulse – aesthetic dermatology and laser center in Wroclaw, Poland.
REFERENCES
1. Lemperle G, Gauthier-Hazan N, Wolters M, et al., ‘Foreign body granulomas after all injectable dermal
fillers: part1: Possible causes’, Plast Reconstr Surg, 123 (2009), pp.1842-63.
2. Requena C, Izquierdo MJ, Navarro M, et al., ‘Adverse reactions to injectable aesthetic microimplants’,
Am J Dermatopathol, 23 (2001), pp.197-202.
3. Lee JM, Kim YJ., ‘Foreign Body Granulomas after the use of dermal fillers: pathophysiology, clinical
appearance, histologic features, and treatment’, Arch of Plast Surg, 42 (2015), pp.232-239.
4. Alijotas-Reig J, Garcia-Gimenez V., ‘Delayed immune-mediated adverse effects related to hyaluronic
acid and acrylic hydrogel dermal fillers: clinical findings, long-term follow up and review of literature’, J
Eur Acad Dermatol Venerol, 22 (2008), pp.150-61.
5. Ko CJ, Glusac EJ, Shapiro PE., ‘Non-infectious granulomas’, In: Lever WF, Elder DE, editors. Lever’s
histopathology of the skin., Wolters Kluwer Health/Lippincott Williams & Wilkons, (2009), pp.373-87.
6. Lemperle G, Gauthier-Hazan N., ‘Foreign body granulomas after all injectable dermal fillers: part 2.
Treatment options’, Plast Reconstr Surg, 123 (2009), pp.1864-73.
7. Mukta Sachdev, YN Anantheswar, BC Ashok, Sunaina Hameed, and Sanjay A Pai, ‘Facial Granulomas
Secondary to Injection of Semi-Permanent Cosmetic Dermal Filler Containing Acrylic Hydrogel
Particles’, J Cutan Aesthet Surg, 3(3), (2010), pp.162-166.
8. Lowe NJ, Maxwell CA, Patnaik R., ‘Adverse reactions to dermal fillers: review’, Dermatol Surg, 31 (2005),
pp.1616-25.
9. Murphy KM, Traves P, Walport M, ‘Janeway’s immunology’, Garland Science (2008).
10. Rubin E, Faber JL., ‘Pathology’, Lippincott-Ra-ven, (1999).
11. Zimmermann US, Clerici TJ., ‘The histological aspects of filler complications’, Semin Cutan Med Surg,
23 (2004), pp.241-50.
12. Lemperle G, Rullan PP, Gauthier –Hazan N., ‘Avoiding and treating dermal filler complications’, Plast
Reconstr Surg, 118, (2006), 92S-107S.
13. Bentkover SH., ‘The biology of facial fillers’, Facial Plast Surg, 25 (2009), pp.73-85.
14. Christiansen L., ‘Normal and pathologic tissue reactions to soft tissue gel fillers’, Dermatol Surg, 33
(2007) pp.168-75.
15. Dayan SH, Arkins JP, Brindise R., ‘Soft tissue fillers and biofilm’, Fac Plast Surg, 27 (2011), pp.23-28.
16. De Boulle K, Heydenrych I., ‘Patient factors influencing dermal filler complications: prevention,
Dr Beata Cybulska is a board-registered dermatovenereologist (Poland) and an aesthetic practitioner with
more than 20 years of experience of working in teaching
hospitals in London and Bristol as an associate specialist.
She trained in aesthetic medicine in the UK and Poland,
graduating with distinction from Queen Mary University of London
and the International Foundation of Anti-ageing and Aesthetic
Medicine in Warsaw.
assessment and treatment’, Clin Cosm and Inestigat Dermatol, 8 (2015) pp.201-214.
17. Nairns RS, Coleman WP, Glogau RG., ‘Recommendations and treatment options for nodules and
other filler complications’, Dermatol Surg, 35 (2009), pp.1667-1671.
18. Lemperle G, Morhenn V, Charrier U., ‘Human histology and persistence of various injectable filler
substances for soft tissue augmentation’, Aesthetic Plast Surg 27 (2003), pp.354-66.
19. Cassuto D, Sundaram H., ‘A problem-oriented approach to nodular complications from hyaluronic
acid and calcium hydroxylapatite fillers: classification and recommendations for treatment’, Plast
Reconstr Surg. 132 (2013) 48S-58S.
20. Lemperle G, Duffy DM., ‘Treatment options for dermal filler complications’, J Am Acad Dermatol, 26
(2006), pp.356-64.
21. Conejo-Mir JS, Sanz Guirado S, Angel Munoz M., ‘Adverse granulomatous reaction to Artecall treated
by intralesional 5-Fluorouracil and triamcinolone injection’, Dermatol Surg. 32 (8) (2006), pp.1079-81.
22. Cassuto D, Marangoni O, De Santis G, Christiansen L., ‘Advanced laser techniques for filler – induced
complications’, Dermatol Surg, 35 (2009), pp.1689-16-95.
23. De Barros Silveira LK, de Oliveira FL, Alves T de B et al. ‘The therapeutic benefit of allopurinol in the
treatment of foreign body granulomas caused by Polymethylmethacrylate microspheres’, Case Rep
Dermatol Med, (2012) 945205.
24. Aivaliotis M, Kontochristopulos G, Hatziolu E et al. ‘Successful colchicine administration in facial
granulomas caused by cosmetic implants: report of a case’, J Dermatol Treat, 18 (2007), pp.112-4.
25. Bauman LS, Kerdel F., ‘The treatment of bovine collagen allergy with cyclosporine’, Dermatol Surg
25 (1999), pp.247-9.
26. Desai AM, Browning J, Rosen T., ‘Etanercept therapy for silicone granuloma’, J Drugs Dermatol, 5 (9)
(2006), pp.894-6.
27. Lloret P, España A, Leache A, Bauzá A, Fernández-Galar M et al. ‘Successful treatment of
granulomatous reactions secondary to injection of esthetic implants’, Dermatol Surg. 31(4) (2005),
pp.486-90.
28. Funt D, Pavicic T., ‘Dermal Fillers in aesthetics: an overview of adverse events and treatment
approaches’, Clin Cosm and Interven Dermatol, 6 (2013), pp.295-315.
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Cavitation is a natural phenomenon based on low frequency
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Treating the Postpregnancy Body
Mr Taimur Shoaib details the options
available to treat women’s aesthetic
concerns following childbirth
Pregnancy is a physiological process,
resulting in changes to a woman’s body
during and after the pregnancy. As the
NHS sees the condition as a normal
physiological process, rather than one
that leads to a medical condition, it does
not offer funded treatment. Many of the
changes that we see post-pregnancy
are related to hormonal changes and the
development in the body shape and size
that take place during pregnancy, as well
as subsequent breastfeeding. In this article
I will highlight some of the more common
conditions that affect women, and the
changes they see that are sometimes
considered unfavourable, which lead to a
consultation at a medical aesthetic clinic.
The article will specifically not discuss the
gynaecological changes that occur during
and following pregnancy.
Skin physiology and pathophysiology
In order to understand what happens after
pregnancy, it is important to understand
some of the inherent properties of the
skin. These properties change and are
affected during pregnancy, and so a level of
understanding of the normal anatomy and
physiology of the skin is vital to understand
what happens, and why it happens, when
pregnancy occurs. In the skin, the elastic and
collagen fibres are arranged in a springlike manner.1 When a spring is stretched to
a certain level, it springs back to its usual
configuration and returns to the same state
that it was in, prior to the stretching process. If
a spring is stretched beyond the point where
it has the ability to return to its pre-sprung
state, it remains permanently stretched,
which is a state known as hysteresis.
Accordingly, it will permanently enlarge
and become loose and stretched. For this
reason, we see loose skin around structures
that have stretched, such as the abdomen,
the breasts and any other areas where
weight gain has taken place. Permanent
loose skin after pregnancy appears because
the tightly-wound collagen and elastic fibres
have unwound beyond their ability to return
to their pre-sprung state, and they have thus
exhibited the characteristics of hysteresis.2
Collagen and elastic fibres can also tear
and split. Therefore, when these fibres are
stretched quickly, the collagen and elastic
fibres cannot only unwind but can also tear.
When they do so, the thickness of the dermis
is reduced, an injury response takes place
increasing blood supply to the area, and
the quantity of elastic fibres and collagen in
the skin decreases, forming stretch marks.
Stretch marks are initially purple and thin
due to the increased blood supply following
the injury response. Afterwards, when the
blood supply reduces, the stretch marks
become pale and wide. In skin prone to postinflammatory hyperpigmentation, the skin
may become hyperpigmented and thinned.3
Increased pigmentation is a normal part
of pregnancy. During pregnancy there are
increased levels of the adrenocorticotropic
Aesthetics aestheticsjournal.com
hormone (ACTH), which is very similar to
melanocyte-stimulating hormone (MSH).4
One of the hallmarks of pregnancy is the
linea nigricans, the dark line of skin that runs
from the umbilicus to the pubic region. This
area of skin becomes hyperpigmented and,
due to the increased levels of ACTH during
pregnancy, women are prone to melasma
and other disorders of hyperpigmentation.5
Lastly, the breasts increase in size in
preparation for lactating, and the abdomen
increases in size to accommodate the
growing foetus. During pregnancy there
is inevitable weight gain and an increase
in fat stores in areas that may be resistant
to subsequent diet and exercise, thereby
leading to permanent pockets of unwanted
fat. Now that we understand some of the
changes that occur during pregnancy, we
can appreciate some of the concerns that
women will have when they attend medical
aesthetic clinics.
Stretch marks
Stretch marks may be pale, purple or
pigmented, depending on the individual and
what stage the stretch mark is at. Examination
of an area of skin where there are stretch
marks should note the number, colour, length,
width and location of the marks. Accurate
records, including high-quality photographs
taken under standardised conditions, with
a ruler scale, will allow comparisons before
and after treatment. Purple stretch marks
manifest themselves as a result of increased
vascularity in the dermis of the stretch-marked
skin, and recommended treatment for this
would generally be a light-based procedure
that reduces vascularity, for example a green
or yellow intense pulsed light (IPL) or laser.
With these wavelengths of light, IPL will target
haemoglobin as a chromophore, thereby
reducing the prominence of blood vessels.
Stretch marks that are pale can have
treatment to increase pigmentation within the
skin. Treatments such as micropigmentation
can add colour to pale skin, as it is a
method by which skin-coloured tattoos are
carefully created in areas of pale skin, in
order to darken it to match the colour of the
surrounding skin.
Stretch marks are characterised by thinned
skin and, unfortunately, it is not possible to
completely eliminate the reduced depth
of the dermis. Since that is the case, it is
important to advise patients that the stretch
marks will still be present, but we should be
able to reduce their size and prominence.
There are several non-surgical treatments
that can thicken the skin: laser, microneedling,
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
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ACTH levels increase during
pregnancy and this results
in melanocyte stimulation,
melasma and darkening of the
skin in certain areas
platelet rich plasma (PRP) injections and
radiofrequency. All of these methods can
be used to help thicken the skin to a mild
degree. The laser treatment of choice for
thickening the skin is a fractionated ablative
laser, such as an Erbium:YAG laser, CO2 laser,
or YSGG laser.6 This technology drills small
holes into the skin and the injury elicits a
repair response. As a result, the skin thickens
to varying degrees, causing a reduction in
the prominence of the stretch mark. Multiple
treatments are required to reduce the stretch
marks and a suitable time period is required
to allow skin healing in between successive
treatments. Microneedling includes
treatments such as dermaroller, Dermapen,
and the Dermastamp. These devices create
needle-point entry micro-injuries in the
skin. The skin heals quickly, but the injury
elicits a repair and regeneration process,
which thickens the dermis and creates
a collagenesis response. Microneedling
devices are available in different needle
lengths, and the required length of the
needle is one that will penetrate through
the full thickness of the dermis, in view of
the full thickness depth of the actual stretch
mark. As with the laser, multiple treatments
are required to reduce, not eliminate, stretch
marks. PRP has been used to reduce stretch
marks and there is anecdotal evidence of its
efficacy. PRP involves taking a blood sample
from the patient, separating the blood into its
components in a centrifuge, extracting the
platelets from the centrifuge and injecting the
platelets into the dermis, using something
similar to the Nappage technique, in which
the injection is targeted at the junction
between the dermis and epidermis. Platelets
are involved in repair and regeneration of
injuries and release growth factors. The
release of these growth factors also elicits a
collagenesis response, hence reducing the
prominence of stretch marks.
As mentioned, radiofrequency energy can
also be used to treat stretch marks. The
technology works by passing an electric
current through the tissues. Those tissues
that have high resistance absorb the
energy converted to heat and again elicit a
collagenesis response. There are devices
available that combine microneedling with
radiofrequency and, as with all treatments that
have a mild to moderate effect, combination
treatments are often used to give the best
possible results.
Pigmentation
As we know, ACTH levels increase during
pregnancy and this results in melanocyte
stimulation, melasma and darkening of
the skin in certain areas. After pregnancy
and the normalisation of ACTH levels,
the melanocytes no longer undergo
hyperstimulation. Accordingly, the level
of melanin production normalises but,
sometimes, patchy pigmentation remains.5
In such cases, hyperpigmentation can be
treated with a number of different treatment
options. Melanocyte stimulation can be
downgraded with prescription and overthe-counter medicines such as kojic acid,
tretinoin and hydroquinone. Lasers, such
as the Alexandrite or Nd:YAG laser, can be
used to reduce pigmentation and on-going
use of cosmeceutical products also help in
suppressing the overproduction of melanin.
Body fat changes
During pregnancy, body fat distribution
changes. In some cases, the distribution of
fat remains altered even after parturition and
some women will have a desire to restore
their body shape back to the pre-pregnancy
state. For pockets of fat that are resistant
to diet and exercise there are non-surgical
and surgical treatment options available.
Non-surgical treatments include cryolipolysis,
contact radiofrequency and non-contact
radiofrequency devices. These give a mild
to moderate reduction in the fat that is
treated, for example cryolipolysis reduces
pinch thickness by approximately 15-28%
in the area treated.7 All treatment options
must always be discussed with patients,
even though the healthcare professional
Aesthetics aestheticsjournal.com
may not actually deliver those treatments.
In my opinion, liposuction remains the
gold standard for fat reduction and body
contouring. Liposuction consists of three main
phases: fluid infiltration, fat energy delivery
and fat extraction. Fluid infiltration can be
considered to be absent (in dry liposuction),
and with increasing volumes of fluid infiltrated
into the area treated. The terms used for the
amount of volume of fluid are: wet liposuction,
superwet liposuction and tumescent
liposuction. The next step, in which energy is
delivered to the fat, is one of three options:
laser, ultrasound or radiofrequency. Each
energy-based system has its advantages
and disadvantages (for example, some
RF systems can be bulky) and different
surgeons will have their preference based
on a number of criteria. The energy-based
delivery systems disrupt the fat cells, increase
the amount of fat removed in relation to
blood removal, tighten the overlying skin and
sometimes emulsify and target the fat cells.
Finally, the practitioner will remove the fat,
which may be performed through standard
liposuction or through a power-assisted
liposuction device. Power-assisted liposuction
transfers the repetitive mechanical force from
the surgeon to a surgical device, reducing
mechanical strain and stress for the surgeon.
Changes in the breast size and shape
One of the major changes that takes place
during pregnancy is the size and shape of
the breasts as they prepare for lactation. After
pregnancy and lactation, breast glandular
hypertrophy reduces and often women are
left with lost volume in the upper pole of the
breast, glandular ptosis, nipple ptosis and
excess skin. In such cases, breast surgery
for reshaping may be an option. In women
who have simply lost volume, particularly in
the upper pole of the breast, augmentation
with breast implants is the treatment of
choice for those looking to increase volume.
If there is concomitant ptosis of the nipple,
this may be combined with a mastopexy, in
which the breast tissue is elevated off the
pectoral fascia to secure it in a more cranial
position, while simultaneously elevating
the nipple-areolar-complex on a vascular
pedicle to raise its position. This will be
conducted either as a one-stage or twostage procedure, particularly when the skin of
the breast undergoes hysteresis. When this
happens the skin will not retract back to its
original state, leaving some redundant skin.
Sometimes the breast tissue enlarges and
remains enlarged, and a breast reduction
may be indicated.
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
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Overhanging skin in the abdomen
As a result of the developing foetus, the abdominal region stretches
to accommodate the growth. The skin may develop stretch marks and
these are often seen in the lower abdomen, between the umbilicus
and the pubic region. The skin will usually show signs of failing to
shrink back to its pre-pregnancy state, as a result of hysteresis, and
an abdominal apron of skin may ensue. Sometimes the patient may
have had a caesarean section, with a lower abdominal Pfannenstiel
incision. If the skin at the site of such an incision is tethered down
to the underlying tissues, an abdominal overhang develops. The
treatment of choice to reduce excess skin, particularly when there is
a significant abdominal pannus, is an abdominoplasty. As part of the
abdominoplasty procedure, any divarication of the rectus muscles may
also be addressed with muscle suturing. In such cases, a preoperative
assessment is made of the position of the rectus abdominus muscle. If
the surgeon determines there is an increased width of the muscles in
the midline, with reduced muscle function in this area, a decision with
the patient may be made to bring the muscles closer together. In these
cases, the lateralised anterior wall of the rectus fascia is medialised
with an appropriately strong suture. The excess skin is excised and the
abdomen is inevitably flatter.
Summary
In conclusion, there are several changes that happen as a result
of pregnancy, and many of these changes can be addressed in a
medical and surgical aesthetic clinic. These changes are normal and
physiological and are all to be expected during pregnancy. If the
Aesthetics
changes concern a woman, then there are procedures that we can
perform that may improve symptoms and improve their quality of life.
Mr Taimur Shoaib is a consultant plastic surgeon
with more than 20 years’ medical experience. He
qualified from the University of Glasgow in 1992, before
establishing his cosmetic surgery practice, La Belle
Forme, in 2009. Mr Shoaib is an honorary senior clinical
lecturer at the University of Glasgow and a faculty member of the
Allergan Medical Institute.
Mr Taimur Shoaib will discuss surgical and non-surgical methods for
fat reduction and enlargement at the Aesthetics Conference and
Exhibition 2016. Visit www.aestheticsconference.com/programme
to find out more.
REFERENCES
1. Tatsuo USHIKI., ‘Collagen Fibers, Reticular Fibers and Elastic Fibers. A Comprehensive Understanding
from a Morphological Viewpoint’, Archives of Histology and Cytology, 65 (2002), p.109-126.
2. Hussain, Sadaf Hashim, Boonyapat Limthongkul, and Tatyana R. Humphreys., ‘The biomechanical
properties of the skin’, Dermatologic Surgery, 39.2 (2013), pp.193-203.
3. Arem, Arnold J., and C. Ward Kischer., ‘Analysis of striae’, Plástic and reconstructive surgery, 65.1
(1980), pp.22-29.
4. Schwyzer, Robert., ‘ACTH: a short introductory review*’, Annals of the New York Academy of
Sciences, 297.1 (1977), pp.3-26.
5. Melmed et al., ‘Williams Textbook of Endocrinology’, 12th Edition, ISBN: 978-1-4377-0324-5.
6. Elsaie, Mohamed L., Leslie S. Baumann, and Lotfy T. Elsaaiee., ‘Striae distensae (stretch marks) and
different modalities of therapy: an update’, Dermatologic Surgery, 35.4 (2009), pp.563-573.
7. Ingargiola, Michael J., et al, ‘Cryolipolysis for Fat Reduction and Body Contouring: Safety and Efficacy
of Current Treatment Paradigms’, Plastic and reconstructive surgery, 135.6 (2015), pp.1581-1590.
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Aesthetics
• Radiotherapy or chemotherapy for cancer that has resulted in loss
of hair.
• Trichotillomania.
• Permanent damage to the eyelashes during a beauty routine –
possibly by accidentally ripping them out or by over-plucking.
Fashion dictates, to a large degree, the way people use their
eyelashes. There is a range of cosmetic aids that can help eyelashes
appear longer, thicker or of a different colour. In recent times, I have
witnessed more and more people looking to eyelash transplantation
in order to get the eyelashes they want. Such transplants are relatively
new developments, however they are becoming increasingly popular
as women covet the fuller eyelashes popular with celebrities.
Eyelash
Transplants
Mr Asim Shahmalak details the
history of eyelash transplants and
shares his technique for treatment
Eyelash transplants were originally developed to help victims of
accidents and traumas who had subsequently damaged their
lashes permanently. Burns victims, for instance, can often be left
with no eyelashes at all – damaging their facial symmetry and selfesteem. The first eyelash transplant was carried out 17 years ago
in Brazil,1 and once surgeons at a hospital in San Paulo first began
performing the procedure, word spread quickly around the world
about its possible life-changing benefits.
Over time, surgeons have begun to realise that eyelash transplants
can also be performed for aesthetic reasons; patients with
naturally thin eyelashes could benefit, particularly those who
have permanently damaged their eyelashes using glue-on false
eyelashes. Wearing these false lashes can sometimes rip out natural
follicles, leaving patients with virtually bald eyelids.
There are only a few surgeons in the world currently carrying
out eyelash transplants today. I performed the very first eyelash
transplant in the UK in 2009,2 on a young woman who suffered from
trichotillomania,3 a condition where a person feels compelled to pull
their hair out. It received a lot of publicity and was one of the most
fulfilling moments of my career; the patient told me afterwards that it
had changed her life.
In this article I shall explain how to assess patients for the procedure,
and detail the treatment process and expectant results.
Indications for an eyelash transplant
Eyelashes make an important contribution to facial symmetry and
presentation of oneself to others. A person without eyelashes may
feel very self-conscious about his/her appearance. Like general hair
transplant surgery, eyelash surgery can be required due to a number
of reasons:
• Physical trauma/facial injury and scarring, resulting from events
such as: road accidents, industrial accidents, thermal and chemical
burns, eyelid tattoos and the use of false eyelashes.
• Surgical treatment of an injury or tumour that resulted in removal of
eyelash follicles and tissue scarring.
The consultation
The key questions I consider from the outset of the consultation are:
does the patient really need an eyelash transplant, and are they
suitable for the procedure? It must be noted that eyelash transplants
can only be carried out on the upper eyelid, as the hair does not grow
as well on the lower lid. From my experience, hairs on the lower lid
grow very straight and are difficult to curl and trim.
During the consultation, I am looking for gaps in the eyelid where
hair, harvested from the scalp, can be transplanted. This is not
always possible with an accident victim as their eyelids can be badly
damaged. In these cases, I may have to wait for a plastic or ophthalmic
surgeon to rebuild the eyelid so there is an area where the transplant
can take place.
It is also important to make sure that the patient can close their eyes
completely. Some trauma victims cannot close the full lid and this
makes a transplant impossible because the new transplanted lashes
could damage the eye.
Many eyelash transplant patients have suffered from trichotillomania
and it is imperative you are satisfied that they have been cured of the
condition for at least two years before performing a procedure. In my
opinion, the risk of them relapsing and ripping out the transplanted hair
is too great prior to two years as trichotillomania can be a challenging
condition to treat.4
I often perform eyelash transplants on women who have damaged
their eyelids by gluing on false eyelashes. With these patients you
need to be sure that there is a healthy upper eyelid where new
eyelashes can be transplanted. If the procedure is being performed
for aesthetic reasons, you need to be sure that the patient genuinely
needs the operation; I tend not to treat patients who simply want
longer eyelashes. In these cases, I prefer to recommend an eyelash
conditioner such as RevitaLash or Latisse, which can help lashes to
grow longer.
I need to make sure there is a decent gap of approximately 1-2mm in
Wearing false lashes can
sometimes rip out natural
follicles, leaving patients
with virtually bald eyelids
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
@aestheticsgroup
Case study one: Patient A
One of my successful eyelash transplant patients was a 42-yearold woman who had an eyelash transplant at my clinic two years
ago.5 The patient had damaged her natural eyelashes from
becoming addicted to wearing false lashes for 20 years.
The patient was left with just three eyelashes on her upper right
lid and 19 on her upper left lid. The damage was made worse
when she got an eye infection which caused itching and she
rubbed off many of her already weakened natural lashes.
With almost completely bald upper lids, the patient was
too embarrassed to leave her house or even let her family,
boyfriend or friends see her without her false eyelashes.
Patient A’s eyelash transplant was carried out over a single
day at Crown Clinic. She had 70 eyelashes transplanted into
Before
Before
After
After
Aesthetics Journal
Aesthetics aestheticsjournal.com
her eyelids in a three-hour operation. A strip of hair was taken
from the back of her scalp and the individual hair follicles
removed. I then threaded each hair into the skin at the bottom
of her upper eyelids. Patient A felt some mild discomfort in the
harvesting area at the back of her head, however this passed
after a couple of days. She had swelling in both upper eyelids
for two or three days following the operation, which eventually
resided. It took around six months for the new eyelashes to fully
bed into her eyelids. I assessed the patient six months after the
operation and found that 95% of the transplanted follicles were
now growing healthily in her upper eyelids. Patient A reported
that she first noticed positive results two months after the
operation, however the new lashes did not look their best until
six months after the operation. After
Case Study Two: Patient B
I travelled to my home city of Karachi in January 2013 to perform hair, eyebrow
and eyelash transplants on seven women who had been horrifically scarred
in acid attacks.6 I helped a 24-year-old woman (Patient B) by giving her two
new eyebrows and eyelashes on her right eye with hair transplanted from the
back of her head in a series of intricate operations performed over three days.
As Patient B was the victim of an acid attack, it made the procedure slightly
more complicated because you have to assess the eyelid very carefully to
ensure that it is will be receptive to the transplanted hair. In this case, the
patient’s eyelids were receptive, despite extensive damage to the lids from
the attack. The operation had a success rate of around 85% when Patient B
was assessed a year after the procedure. Patient B had no complications,
however there was mild pain in the harvesting area for two days following the
operation. She felt no pain in her eyelids either during or after the operation,
though there was some gentle swelling which went down after two days.
the eyelid for me to insert the new follicles. Without sufficient gaps to
fill, I run the risk of damaging the existing healthy follicles in the lid.
Eyelash transplant procedure
The process starts by removing a section of hair from the patient,
typically from the back of the head where hairs tend to be longer,
making it easier to thread them through the upper eyelid. An area (1 x
1cm) of scalp is numbed with a local anaesthetic and a small strip of hair
is removed and the scalp sewn back with stitches. Harvesting is fairly
quick, usually taking no more than 10 minutes to surgically remove the
strip. As there would be from any mild surgical treatment, patients will
experience some mild discomfort from the harvesting area, however
they don’t tend to experience any pain at all in their upper eyelid
following the threading of the new lashes – either during or after the
procedure. There will be a small amount of scarring, though it only tends
to be visible on patients with very short hair.
Following the harvesting, the scalp strip is given to a technician
who separates the hair tissue into single hair follicular grafts under a
microscope. I will choose the hair grafts for the transplant individually –
I am always looking to use longer hair, about 3-4 inches long, so these
strands can be easily threaded into the donor area. Once I have the
donor grafts, the upper eyelid is anaesthetised and I insert the grafts by
threading with a curved needle. It is a long and painstaking job because
each graft has to be individually threaded. Surgical loupes are used
which are magnified to six times their normal size to assist with this
process and ensure the hairs are placed in exactly the right position
on the lid. A normal eyelid will have between 100 and 150 lashes per
eye. In an eyelash transplant, I look to add between 25 and 60 new
lashes to the upper lid. The operation normally takes around three to
four hours and the success rate is very good – between 80 and 90%.
To arrive at this success rate I assess patients from six months to a year
after their operation. I then count the number of follicles that have been
transplanted and check how many of these new hairs have survived.
Post-operative care and complications
The patient will need between three to five days to recover, while
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
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there will be bruising and swelling around the eyelid. We advise that
they do not wash their face for the first couple of days following the
operation to allow the new follicles to settle in. It takes around six
months for the new lashes to grow to their full length and be seen at
their best.
As with any surgery, there can occasionally be complications such
as an infection, which can usually be remedied with antibiotics. Also,
there is a chance the new follicles will grow into the eyelid – these
would need to be removed either by plucking them out or via
surgery if they become embedded inside the eyelid. There can also
be swelling at the base of the follicle, which again can be treated
with antibiotics. As the donor hair is taken from the scalp, it grows
just as hair on the head does. This means it will need trimming every
week and curling, too, so that the new lashes blend with the existing
natural lashes. At Crown Clinic we provide all patients with a cutting
and curling kit so they can do this at home, though some prefer to
get this done at a beauty salon.
We have found that with some patients, over several years, the
donor hair has taken some of the properties of the natural eyelashes
– growing more slowly than scalp hair and also curling naturally. In
these cases, the transplanted hair may only need trimming once
every three weeks.
Conclusion
Eyelash transplants are an increasingly common cosmetic
procedure, which are performed for both medical and aesthetic
reasons. In my experience the success rate of this treatment has
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Aesthetics
been very high and complications are rare. Patients who have lost
their eyelashes can suffer severe damage to their self-esteem. At
Crown Clinic we have treated patients who are so embarrassed
by their bald eyelids that they refuse to leave the house without
wearing false eyelashes. Eyelash transplants can, however, provide
profound benefits to patients, increasing their confidence and
allowing them to lead normal lives in the years after a procedure.
It must be noted that eyelash transplantation is an extremely
complicated procedure and only a handful of surgeons in the world
currently carry out this operation. Only a qualified surgeon should
carry out an eyelash transplant and thorough training is essential.
Dr Asim Shahmalak is a hair transplant surgeon
and gained his medical degree from the University of
Karachi, Pakistan in 1988. He founded the Crown Clinic
in Manchester eight years ago and also has consulting
rooms in Harley Street. He is a hair loss expert on
Channel 4 show Embarrassing Bodies.
REFERENCES
1. Eyelash transplant or surgery to solve alopecia (US: Hairtransplantsurgery.com, 2009) <http://www.
hairtransplantsurgery.co.uk/eyelash-hair-loss-alopecia-eyelashes-transplant.html>
2. Peter Bainbridge, (2013) Manchester Evening News, Salford woman spends £4,000 on EYELASH
transplant <http://www.manchestereveningnews.co.uk/news/greater-manchester-news/salfordwoman-spends-4000-eyelash-5840036>
3. ITV News, (2014), Manchester surgeon helps acid attack victims in Pakistan, <http://www.itv.com/
news/granada/2014-02-25/manchester-surgeon-helps-acid-attack-victims-in-pakistan/>
4. Trichotillomania – Treatment (UK, NHS Choices, 2015) <http://www.nhs.uk/Conditions/trichotillomania/
Pages/treatment.aspx>
5. Peter Bainbridge, (2013) Manchester Evening News, Salford woman spends £4,000 on EYELASH
transplant <http://www.manchestereveningnews.co.uk/news/greater-manchester-news/salfordwoman-spends-4000-eyelash-5840036>
6. ITV News, (2014), Manchester surgeon helps acid attack victims in Pakistan, <http://www.itv.com/
news/granada/2014-02-25/manchester-surgeon-helps-acid-attack-victims-in-pakistan/>
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Aesthetics
Peri-ocular Ageing
Mrs Sabrina Shah-Desai explains the variations
in ageing of the peri-ocular region in different
ethnicities and how to treat the area appropriately
In my research, I have found that world literature on cosmetic facial
rejuvenation is commonly centered on Caucasian aesthetic ideals
and tends to ignore the larger ethnic groups such as African, Asian
(Oriental and Indian) and Hispanic, despite darker skinned people
(tan, olive, brown and black) constituting the majority of the global
population.1 Of the 5,000 ethnic groups in the world, the largest are
the Chinese followed by the Indians.1
The obvious difference in individuals of varying ethnicities is the skin
colour, although there is a wide variation of the facial dimensions
between ethnicity, gender, and age. When assessing the anatomical
aspects, it is apparent that key angles and proportions do vary in
different ethnicities.2
Photoageing affects all skin types, regardless of ethnicity. As eyelid
skin is one of the thinnest in the human body, the periorbital area is the
first to demonstrate visible signs of ageing.3
Rawlings’ analysis of the effects of photoageing due to sun exposure4
concluded that although all ethnic groups are subject to the process of
photoageing, Caucasian skin usually ages faster than any other ethnic
group. The main reason is that this skin type contains low levels of
melanin and is thinner, making factors such as upper eyelid hooding,
eye bags and crow’s feet more visible (as early as the third decade),
whereas hyperpigmented macules and seborrhoeic keratosis are
more common with the darker skin types.4
Studies have confirmed that racial differences in skin physiology
are mainly related to the protective role of melanin present in races
with darker skin, differences in stratum corneum (SC) thickness,
water content, rate of transepidermal water loss (TEWL) and in skin
characteristics like extensibility, recovery and elastic modulus.4,5
Typically in the skull, the nose area, eye orbits, and brow ridges,
significant racial differences are apparent.6
Peri-orbital features of the African American, Asian and Hispanic patient
African American peri-orbital area:
Characteristics
• Brow ptosis
• Forehead and glabella furrows
• Upper eye lid > lower lid tissue laxity
with lateral upper lid fullness due to
lacrimal gland herniation
• Lower supra tarsal fold of skin – due to
shorter tarsus
• Lateral canthal (outer corner of eye)
rounding
• Malar hypoplasia causes increased
inferior scleral show, malar flattening,
submalar hollowing
• Proptosis (bulgy eye)
• Periorbital hyperpigmentation – progress to melanoma, papillomas and
keratoses
7
Not only does African American skin contain the most amount of
melanin, which protects its complexion from the ageing-affects of the
sun, 4,5 but the skin is also thicker, therefore wrinkles show up much
later in life (generally the sixth decade). However, African American
skin is much more likely to develop a scar after an incision and has
a higher risk of pigmentation.4,5 The eye orbits of African Americans
tend to be of a more rectangular shape, with small brow ridges, high
brows and lateral brow hair thinning. When it comes to the eye area,
the main concerns for African Americans are droopy eyelids (ptosis),
bulgy-looking eyes and rounding at the outer corner due to soft tissue
atrophy and bony remodelling of the eye socket.7
Asian peri-orbital area:8
Characteristics
• Weaker facial skeletal support
• Malar fat pad ptosis
• Tear trough deformity
• Descent of thick juxtabrow tissues of lower orbit
(oriental)
• Single eyelid (oriental)
• Epicanthic folds (oriental)
Asian skin is made up of higher levels of melanin, and, as a
result, signs of ageing around the eye zone show up much
later in life. However, melanin also makes skin more prone
to pigmentation and it is common to see hyperpigmented
macules and seborrhoeic keratosis. Nearly half of Oriental
Asians are born with no upper eyelid crease (single eyelid),
which can cause the lashes to droop in the visual axis (lash
ptosis) or give rise to a sleepy appearance.10 The eye orbits
of Asians tend to be of a more rounded shape, with small
brow ridges, high brows with a shorter tail. Weaker skeletal
support and loss of elasticity leads to under eye hollows
and cheek flattening.8
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
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Hispanic and Latino peri-orbital area:7
Characteristics
• Minimal skin elastosis
• Eyelid ptosis
• Infraorbital shadows
• Loss of soft tissue bulk in infra brow region, malar, submalar and infraorbital region
• In Hispanics, the brow tends to be set lower on the supraorbital rim than Caucasians
Hispanic and Latino skin tones can range from light to very dark. The skin of these ethnic groups contains a
fair amount of melanin, making them less likely to show signs of ageing until they hit their 40s.7 Like Oriental
and African American skin, it is more prone to developing skin discolorations. Hispanics tend to have a lower
brow position compared to Caucasians, which can sag relatively early and cause brow drooping. Dark circles
under the eyes are also common, which is due to volume loss along the eye socket (tear trough area).7
Treatment
Whilst the darker-skinned ethnic groups tend to have less
periorbital wrinkling, they are all prone to pigmentation issues
and practitioners should bear in mind that any skin rejuvenating
treatment may respond unpredictably to chemical peeling in
different ethnicities. Asian (Indian) skin may be more sensitive to
topical therapies and develop allergic reactions.9 An individual
patient history of post-inflammatory hyperpigmentation (PIH) is very
important to take into account. In this subpopulation, peels may be
considered as a second-line therapy after topical therapies fail.9
I use botulinum toxin in African Americans and Hispanic patients
to improve brow ptosis and glabellar furrows. African Americans
need dermal fillers to support their lateral canthus and cheek,
as these areas are prone to early ageing. I would normally inject
three points (similar to points 1,2 and 3 of the 8-point lift)11 to correct
the malar hypoplasia and the lateral canthal rounding. Surgical
correction is performed without cutting the skin, where possible, to
avoid keloid formation.
Asian (Oriental) patients require upper eyelid rejuvenation (double
eyelid blepharoplasty), which I perform surgically and non-surgically
(suture Asian blepharoplasty). From my experience, Asian (Indian)
and Hispanic patients tend to require tear trough rejuvenation
earlier than other ethnicities. Asian (Indian) dark circles often have
As eyelid skin is one of
the thinnest in the human
body, the periorbital area
is the first to demonstrate
visible signs of ageing
a hereditary pigmentation component, which make their dark
circles more challenging to treat. For dark circle rejuvenation in
Asian (Indian) ethnicities, I use a combination of topical creams that
contain vitamin C, Kojic acid and arbutin. I also use a skin plumping
filler in the lower eyelid skin, such as Restylane Vital Light, in
addition to a deep filler in the central and lateral trough.
Recognising ethnic differences in skeletal support and skin can
hugely impact our ability to better target rejuvenation efforts for
different ethnic groups.
Mrs Sabrina Shah-Desai is an oculoplastic surgeon
well known for cosmetic eyelid lifts, scar-less droopy
eyelid correction and revision eyelid surgery. She is
highly experienced in non-surgical aesthetic periorbital
rejuvenation with botulinum toxin and dermal fillers. Mrs
Shah-Desai is a keen educator and runs surgical training wet labs.
Mrs Sabrina Shah-Desai will discuss periorbital rejuvenation
with hyaluronic acid fillers at the Aesthetics Conference
and Exhibition 2016. Visit www.aestheticsconference.com/
programme to find out more.
REFERENCES
1. Levinson, D (1998), Ethnic Groups Worldwide: A Ready Reference Handbook, Greenwood Publishing
Group
2. Farkas LG, Katic MJ, Forrest CR et al, International anthropometric study of facial morphology in
various ethnic groups/races. J Craniofac Surg, 2005;16:615–46.
3. Chopra K, Calva D, Sosin M et al, (2015) A comprehensive examination of topographic thickness of
skin in the human face. Aesthet Surg J Nov;35(8):1007-13
4. Rawlings AV, (2006) Ethnic skin types: are there differences in skin structure and function? Int J
Cosmet Sci, Apr;28(2):79-93
5. Voegeli R, Rawlings AV, et al, (2015) A novel continuous colour mapping approach for visualization
of facial skin hydration and transepidermal water loss for four ethnic groups, Int J Cosmet Sci,
Dec;37(6):595-605
6. Jagadish Chandra H, Ravi MS, et al, (2012) Standards of facial esthetics: An anthropometric study. J
Maxillofac Oral Surg,11:384–9.
7. Grimes, P.E (eds), (2008) Aesthetics and Cosmetic Surgery for Darker Skin Types, Lippincott Williams
& Wilkins; Philadelphia
8. Liew S, (2015) Ethnic and Gender Considerations in the Use of Facial Injectables: Asian Patients.
Plast Reconstr Surg, Nov;136(5 Suppl):22S-27S.
9. Marta I. Rendon, Diane S. Berson et al, (2010) Evidence and Considerations in the Application of
Chemical Peels in Skin Disorders and Aesthetic Resurfacing, J Clin Aesthet Dermatol, 3(7): 32–43
10. Chen, W.P, (2015) Asian Blepharoplasty and the eyelid crease, Elsevier; China
11. De Maio, M, Treatment planning, Injectable fillers in aesthetic medicine, 2014: pp52-58
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
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Aesthetics
Treating Facial Thread
Veins with Lasers
Aesthetic nurse prescriber Mary White takes
an in-depth look at how lasers function and
explains how to use them to effectively treat
thread veins
The last decade has brought about big
advances in medical laser technology,
which have assisted aesthetic
practitioners in providing a more effective
treatment of thread veins. Broken veins,
telangiectasia or thread veins are the small
red or blue veins that can appear anywhere
on the body and are very common on the
face. Thread veins can appear as single
veins, widely dispersed, or as a collection
of broken veins close together. They can
also appear as a collection of vessels
arising from a single point, known as spider
naevi. Thread veins are caused by a variety
of factors including exposure to ultraviolet
light, wind and extreme temperatures.
Steroid creams and the hormonal changes
that occur during pregnancy can also cause
thread veins.8 In addition, there is a belief
generally amongst practitioners that some
individuals are genetically more prone
to develop thread veins than others, and
some people are more at risk because of
old injuries. To understand how to safely
and effectively treat facial thread veins
using lasers, it is necessary to go back to
some basic physics in order to appreciate
the principles of how laser light interacts
with tissue to achieve the desired result.
All lasers have unique characteristics,
which determine the outcome of treatment,
and what condition a specific laser can
effectively treat.
Back to basics: physics of lasers in
dermatology
All lasers have unique characteristics,
which determine the outcome of treatment,
and what condition a specific laser
can effectively treat. Laser light is nonionising, which means that unlike X-rays
or cosmic radiation, it does not affect
cellular DNA.1 Many lasers that are used
in dermatology fall within the visible part
of the electromagnetic spectrum, and
wavelengths of these lasers are typically
measured in nanometres (nm).
Lasers have certain characteristics
that make them unique. Laser light is
monochromatic (one colour, or one
wavelength), coherent (all the photons are
in phase) and collimated (it can be precisely
directed). For example, ordinary light from
a light bulb or a torch is polychromatic
(has several colours) with all wavelengths
of visible light present (remember splitting
sunlight using prisms in science lessons to
show the colours of the rainbow?) and is
not coherent or collimated, which means
it is scattered in many directions.1 When
standing in front of a wall with a torch, the
circular light from the torch would be small
whilst close to the wall and would get
dimmer and more scattered as it retreats
from the wall. Compare that with a laser
pointer being used at a conference in
a large auditorium; the laser spot does
not change size or get bigger as the
speaker moves around and it can travel
a long way around a room. Laser light
interacts with targets in many ways, such
as reflection, scattering and transmission.
However, from my experience when
using lasers in dermatology applications,
the tissue interaction that is most utilised
is absorption. Lasers have a variety of
indications, such as cutting, vaporising and
coagulation, and they can do this because
the target tissue absorbs the laser light.
The theory of selective photothermolysis2
states that in order to destroy a selected
target, while sparing the surrounding tissue,
three basic parameters are necessary. First
of all, the colour of the chosen laser light
(wavelength) must be one that is absorbed
by the target and poorly absorbed by
the surrounding tissue. This spares the
surrounding tissue from being damaged at
the same time by the laser. Secondly, the
length of time that the laser beam interacts
with the target, that is the pulse duration,
must be long enough to destroy the target
and is determined by the size of the target.
The pulse duration will vary depending
on the application you are using the laser
for. Finally, in order to destroy or alter the
target, it must be heated to a high enough
temperature to cause permanent damage
to that target.2 Therefore, enough energy
must be applied and absorbed for an
effective temperature rise.
When treating facial thread veins, the
target for absorbing the energy of the
laser is haemoglobin or oxyhaemaglobin.
A laser would be selected on the basis
that it would absorb well into these
chromophores (targets), while at the same
time not affecting surrounding structures
such as melanin or water. Haemoglobin
and oxyhaemaglobin are well absorbed by
wavelengths of 585-595nm,4 which are the
wavelengths of Pulsed Dye Lasers (PDL).
Another influencing factor when choosing
Another influencing factor when
choosing a laser to treat facial thread
veins is the depth of penetration of
the laser into tissue
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a laser to treat facial thread veins is the
depth of penetration of the laser into tissue.
This is dependent upon the wavelength
of the laser and also the spot size, with
larger spot sizes penetrating deeper than
smaller ones. Facial thread veins are fairly
superficial and will require smaller spot
sizes than, for example, a hair follicle for
laser hair removal, which will be more
deeply rooted.
Another important parameter to consider
when carrying out laser treatment is pulse
duration. Pulse duration is the amount of time
over which the laser pulse is delivered into
the target, in this case the haemoglobin in
the blood cells. In order for laser treatment
to be effective, the pulse duration must be
selected in consideration with the thermal
relaxation time (TRT) of the target. The pulse
duration must be shorter than the TRT of
haemoglobin, but not too short that it causes
unwanted side effects, such as hyper/hypo
pigmentation or scarring.2
TRT is defined as the time required for the
targeted chromophore/structure to cool
to half its peak temperature immediately
after the laser exposure. Simply put, smaller
objects cool faster than larger objects of the
same material and it is important to consider
how long the haemoglobin will take to cool
down, and then choose an appropriate
pulse duration.
Finally the energy density that is delivered
during laser treatment must be considered,
which would vary depending on a number
of factors including spot size, wave length
and laser manufacturer, and is referred to as
fluence and measured in joules/cm2. Fluence
takes into account the energy used as well as
the area being treated or spot size.
Lasers vs. Intense Pulsed Light (IPL)
Once the physics is understood, it is easier
to see the fundamental difference between
Aesthetics Journal
lasers and IPL sources. Both technologies
can reduce thread veins, but that’s where
the similarity ends.
Lasers have the properties described
earlier: monochromatic, collimated and
coherent light. Lasers target a single
chromophore; haemoglobin in the case of
thread vein removal and the surrounding
tissue is spared by the principle of Selective
Photothermolysis.1 IPL is simply a very bright
light or lamp and is polychromatic, not
collimated, and exposes the patient to a
broader spectrum of light energy defined by
cut-off filters, typically in the range of 6001200nm. The use of filters in front of the light
source can exclude certain wavelengths
by blocking them, but it is impossible to
filter every wavelength and be left with
just one.3 The multiple wavelengths IPL
produces target multiple chromophores and
can therefore be absorbed by surrounding
tissue that is an unintentional target, such
as melanin. This can increase the risk of
unwanted side effects of treatment and
limits the safe use of IPL to fairer skin types,
usually I-III on the Fitzpatrick Scale.3 I believe
IPL to be is far less effective than laser for
thread vein removal as it is more diffuse
and less powerful. Figure 1 demonstrates
how IPL diffuses into target tissues
more than laser light and how the many
colours or wavelengths affect competing
chromophores.
Treating facial thread veins with Nd:YAG
laser
The Nd:YAG laser delivers a burst of
energy using long pulse durations in the
remit of milliseconds. Using longer pulse
durations delivers the energy in a more
controlled and gentle manner than very
short durations, such as the acoustic type
nanosecond pulse durations delivered
during tattoo removal. Nd:Yag laser at
IPL vs LASER
IPL
• Polychromatic
(many colours)
• Diffuses and
scatters in tissue
• Poor depth of
penetration
LASER
• Nd:YAG laser
penetrates deeply
to reach target
• Is a single colour
to target the
structure
• Not diffusing or
scattering
• Is focused
Figure 1: IPL diffuses into target tissues more than laser light and how the many colours
or wavelengths affect competing chromophores
Aesthetics aestheticsjournal.com
1064nm is delivered deeply into the skin to
target vessels lying in the deeper dermis.
Energy from the laser is absorbed by the
vessels and the haemoglobin therein and
causes a reaction, usually either intravascular
coagulation or collapsing of the vessel wall by
damaging the endothelial lining.5
In either case, the damaged veins are
gradually dissolved and removed by
the body’s immune system over several
weeks after treatment, during a process
called phagocytosis.6 The Nd:YAG laser
in my clinic effectively treats facial
thread veins in one to three treatments
sessions, lasting approximately five to 15
minutes, with treatments spaced at six
to eight week intervals. The treatment
sensation is hot, however this is reduced
by epidermal cooling, delivered with a
cryogen device built into the laser I use.
Freezing cryogen gas is delivered onto
the treatment area and can be controlled
by three parameters: how long to freeze
for (in milliseconds), the delay between
the cryogen delivery and the laser beam
delivery (again milliseconds) and how long
to freeze after the laser beam delivery
(also in milliseconds). This effectively
cools and protects the epidermis and
reduces the risk of thermal damage and
scarring. With Nd:YAG laser therapy,
the thread veins are immediately less
visible than before treatment. There may
be some skin reaction in the form of
intravascular coagulation, which appears
as a grey-hued tiny bruise on some larger
vessels, particularly around the nose.
Other acceptable clinical end points
include vasospasm, vessel swelling and
‘sticky’ vessels, which are caused by the
microscopic damage to the endothelial
cells of the vessel walls, causing them
to collapse and then ‘stick’ together,
preventing further blood flow through the
vessels.7 The latter is probably the best
clinical endpoint in my opinion, and when
tested with a blanche test, these vessels
will not refill and an excellent outcome can
usually be predicted. From my extensive
experience in treating thread veins, normal
sequelae of treatment include erythema,
oedema and occasional micro-crusting.
These side effects usually disappear after
24-48 hours, but can occasionally last up
to seven days.
Complications of laser therapy using
Nd:YAG lasers
In general, and in experienced hands, laser
therapy is safe and effective. Complications
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
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Before
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After
Figure 2: Facial thread veins treated with Nd:YAG laser in my clinic and the results
after just one session. Treatment parameters were: 1064nm, 1.5mm spot size, 40ms
pulse duration and fluence of 360J/cm.2 Cryogen cooling was delivered at 10ms pre
spray, 20ms delivery delay and 10ms post spray.
Figure 3: Treating a patient for thread veins using Nd:YAG laser
do sometimes occur but the risk of
scarring is very low due to the sparing of
surrounding tissues.2
Overtreatment indicators are usually seen as:
•
•
•
•
•
Blistering
Pain
Whitening of skin or vessels
Indentations
‘Popping’ of blood vessels during
treatment
A common error when administering
laser treatment for facial thread veins
is the incorrect selection of which laser
parameter to alter first. It is often believed
that increasing the fluence is the best
approach when a clinical endpoint is not
achieved. Unfortunately, this usually leads
to thermal damage of the treated area and
non-selective damage to tissues and, thus,
increases the risk of scarring.2
When treating facial thread veins with
Nd:YAG laser, the first parameter to alter
when clinical endpoints are not achieved
is the pulse duration. Larger blood vessels
will require heating for longer than smaller
ones and when the correct pulse duration
is used, selective damage will occur.
Because larger objects and structures
take longer to cool down than smaller
ones with a smaller surface area, larger
blood vessels take longer to cool down
than smaller ones. Therefore, a longer
pulse duration would be selected for
wider vessels and a shorter pulse duration
for narrower ones.
Using pulse durations that are too short
can cause unwanted side effects and
carry more risk. A fixed fluence of energy
is being delivered over a fixed period of
time. If this energy is delivered over a
short period of time, e.g. pulse duration
3ms, it comes as a short, strong pulse.
However, if this energy is delivered over
a longer period such as 30-60ms, it is
more gently delivered. It can be confusing
to think of pulse duration as being
‘stronger’ when the number is higher but,
in fact, it should be considered as gently
‘simmering’ the target with the same
energy, just over a longer period of time,
rather than delivering a short burst of
energy in a short time. The safest way to
The damaged veins are gradually
dissolved and removed by the body’s
immune system over several weeks
after treatment, during a process
called phagocytosis
treat is to adjust the pulse duration first,
until a desired endpoint is seen. Only then
should the fluence be increased in stages
until either intravascular coagulation, or
‘sticky’ vessels are seen.
Conclusion
Facial thread veins can be safely and
effectively treated using Nd:YAG laser
therapy. The treatment is cost effective as, in
my experience, it usually takes under three
sessions to clear most unwanted veins.
The incidence of recurrence is low with this
treatment and side effects are minimal.
Mary White has been an
aesthetic nurse since 1993 and
specialises in dermatology
laser treatments and aesthetic
injectable treatments. Mary owns
and runs a busy full time CQC Registered
aesthetic clinic in Worcestershire and is
passionate about providing an environment
of clinical excellence for her patients.
REFERENCES
1. Lanigan, S.W, (2000) Lasers in Dermatology, Springer-Verlag
Ltd, pp.2-8
2. Anderson RR, Parrish JA, (1983) Selective Photothermolysis:
Precise microsurgery by selective absorption of pulse
irradiation, Science 220, pp.524-527
3. Randeberg L, Daae Hagen A., Svaasand L, (2002) ‘Optical
Properties of Human Blood as a function of temperature’,
Lasers in Surgery: Advanced Characterization, Therapeutics
and Systems XII, pp.20-28.
4. Kauvar, A. & Hruza G, (2005)
5. DermNet, (2014) Nd:YAG laser treatment http://www.dermnetnz.
org/procedures/nd-yag-laser.html
6. Britannica, (2015) Phagocytosis, http://www.britannica.com/
science/phagocytosis
7. Dover, J.S, Sadik, N.S, Goldman MP, (1999) The role of laser
and light sources in the treatment of leg veins, Dermatol Surg,
25:328-336
8. Stearn, M. Tread veins, Embarrassing Problems, <http://www.
embarrassingproblems.com/problem/thread-veins>
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
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@aestheticsgroup
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Cholesterol – the new
‘wonder’ ingredient
for mature skin?
Leading Washington DC-based
dermatologist and cosmetic surgeon,
Dr Hema Sundaram, unveils the latest
research insights for mature skincare, and
how this has underpinned the development
of Triple Lipid Restore 2:4:2 – the latest
addition to SkinCeuticals’ Correct range.
We know that older skin has different physiological needs versus young
skin, but what are these exactly?
When skin is young and healthy, it’s in perfect balance – there is a constant
turnover of the structural components. The rate of cellular breakdown is equal
to the rate of regeneration and, most importantly, the barrier function is intact.
However, as we age, the degradation cycle outweighs the skin’s ability to form
essential components - in particular, lipids such as ceramides and cholesterol leading to disrupted barrier function and increased trans-epidermal water loss
(TEWL). Research from dry skin conditions such as atopic dermatitis has shown that
ceramide deficiency is a core, underlying factor in these conditions and, as a result,
topical formulations for dry skin and ageing skin are primarily ceramide-dominant.
However, our latest research shows that it is in fact cholesterol deficiency that plays
the most significant role in ageing skin. Triple Lipid Restore 2:4:2 is the first product
to have a cholesterol-dominant formula specifically tailored to restore the exact
ratio of lipids that are deficient in chronologically aged skin. I believe this will be a
complete game-changer for skin specialists and their patients.
1
What is the connection between lipid loss and accelerated ageing? What
does this look like for the patient?
Aged skin is chronically water-deprived and unable to protect itself due to the
loss of lipid protection. Associated barrier abnormalities result in skin becoming
more vulnerable against external aggressors and irritants, causing effects such as
reduced desquamation. This results in uneven texture and dry patches; weakening
of the skin barrier integrity that is required for ongoing self-repair; and lower levels
of moisture, which is required for healthy skin fullness. Patients notice that their skin
is dull, rough, and uncomfortably tight, with a loss of firmness and radiance.
2
What is Triple Lipid 2:4:2 and how is it different to other mature skin
creams?
Triple Lipid is a unique anti-ageing lipid replenishment cream to address the
specific challenges of accelerated ageing and skin barrier repair. It is founded
on SkinCeuticals’ two-year research programme, in which I was honoured to be
directly involved, highlighting the role of cholesterol to accelerate barrier recovery.
Triple Lipid Restore 2:4:2 is the first and only cosmeceutical product to combine
a proprietary ratio of lipids in a maximised concentration of 2% ceramides, 4%
cholesterol and 2% omega-fatty acids. This specialised ingredient combination
is designed to restore healthy skin function and self-repair by replenishing the
essential skin lipid ratio, as well as restoring natural hydration and skin barrier
function. With its lightweight and fast-absorbing texture, this cosmetically elegant
3
56
Aesthetics | March 2016
SEE US AT
STAND 42
cream is scientifically proven to stimulate lipid
replenishment, barrier protection, hydration and repair
ageing or dry skin.
What have been the clinical results?
Our eight-week clinical study demonstrated
statistically significant improvements in the key signs
of accelerated ageing, such as skin clarity, evenness,
radiance, smoothness, laxity, and pore appearance
(p<0.05). Treatment with Triple Lipid Restore 2:4:2
more than doubled levels of ceramides (57%) and
cholesterol (52%) after eight weeks, refilling those
essential lipids in the skin. The skin barrier was
restored, with a 39% improvement in hydration after
just 24 hours, and eight times faster barrier recovery
following an external injury (tape stripping). Barrier
quality was also improved, shown by a doubling of
mature corneocytes, thus reducing susceptibility to
external aggressors.
4
How can Triple Lipid Restore 2:4:2 be
integrated within clinical practice?
As clinicians, we’re evolving towards patient-tailored
treatments – this is what we’re looking to deliver in
our practices through a combination of products,
treatments and procedures. Skin ageing is multifactorial and multi-level, so it makes sense to address
this with a variety of topical actives and procedures.
However, a pre-requisite for the most successful
outcomes from these procedures and from topical
treatments is a fully-functioning skin barrier. If the
barrier is compromised, we’re not going to get the
results we’re looking for– no matter the quality of the
other treatments we’re offering. Triple Lipid Restore
2:4:2 therefore forms the foundation or cornerstone of
our patients’ skincare. Once we’ve repaired the skin
barrier function, we can layer all the other treatment
benefits on top.
5
Triple Lipid Restore 2:4:2
from SkinCeuticals.
Available Nationwide.
• TRL242 Retail size 48ml | Trade Price: £51.25
• TRL242 PRO size 120ml | Trade Price: £65
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Aesthetics Journal
Aesthetics
A summary of the latest
clinical studies
Title: The long-term effect of 1550nm erbium:glass fractional
laser in acne vulgaris
Authors: Liu Y, Zeng W, Hu D, Jha S, Ge Q, Geng S, Xiao S, Hu
G, Wang X
Published: Lasers Medical Science, January 2016
Keywords: Fractional laser, acne, laser, lesions
Abstract: We evaluated the short-term and long-term effects of
the 1550nm erbium:glass (Er:glass) fractional laser in the treatment
of facial acne vulgaris. Forty-five (9 male and 36 female) acne
patients were treated 4 times at 4-week intervals with the following
parameters: 169 spot density and 15-30mJ/cm(2) fluence. There
was no control group. The laser spots were adjustable (maximum
overlap: 20 %) according to the treatment area, and delivered
in rows in order to cover all the face. The IGA scores and lesion
counts were performed for each treatment. Their current state was
obtained by phone call follow-up to determine the long-term effect
and photographs were offered by themselves or taken in hospital.
After four treatments, all patients had an obvious reduction of
lesion counts and IGA score and the peak lesion counts decreased
to 67.7% after the initial four treatment sessions. For long-term
effect, 8 patients lost follow-up, hence 37 patients were followed-up.
8 patients were 2-year follow up, 27 at the 1-year follow-up, and
all patients at the half-year follow-up. The mean percent reduction
was 72% at the half-year follow-up, 79% at the 1-year follow-up and
75% at the 2-year follow-up. All patients responded that their skin
was less prone to oiliness. In conclusion, acne can be successfully
treated by 1550nm Er:glass fractional laser, with few side effects and
prolonged acne clearing.
Title: Combined autologous platelet-rich plasma with
microneedling verses microneedling with distilled water in the
treatment of atrophic acne scars: a concurrent split-face study
Authors: Asif M, Kanodia S, Singh K
Published: Journal of Cosmetic Dermatology, January 2016
Keywords: Acne, scar, plasma, microneedling, injections,
distilled water
Abstract: Acne scarring causes cosmetic discomfort, depression,
low self-esteem and reduced quality of life. Microneedling is an
established treatment for scars, although the efficacy of plateletrich plasma (PRP) has not been explored much. The objective of
this study was to evaluate the efficacy and safety of platelet-rich
plasma (PRP) combined with microneedling for the treatment
of atrophic acne scars. Fifty patients of 17-32 years of age with
atrophic acne scars were enrolled. Microneedling was performed
on both halves of the face. Intradermal injections as well as topical
application of PRP was given on the right half of the face, while the
left half of the face was treated with intradermal administration of
distilled water. Right and left halves showed 62.20% and 45.84%
improvement, respectively, on Goodman’s Quantitative scale.
Goodman’s Qualitative scale showed excellent response in 20 (40%)
patients and good response in 30 (60%) patients over right half of
the face, while the left half of the face showed excellent response
in 5 (10%) patients, good response in 42 (6%) patients and poor
response in three patients. We conclude that PRP has efficacy in
the management of atrophic acne scars. It can be combined with
microneedling to enhance the final clinical outcomes in comparison
with microneedling alone.
Title: Perioral wrinkles are associated with female gender, aging,
and smoking: Development of a gender-specific photonumeric scale
Authors: Chien AL, Qi J, Cheng N, Do TT, Mesfin M, Egbers R,
Xie W, Chow C, Chubb H, Sachs D, Voorhees J, Kang S
Published: Journal of the American Academy of Dermatology,
January 2016
Keywords: Wrinkles, photonumeric scale, photoageing
Abstract: Perioral wrinkling is commonly reported among
older adults, but its objective evaluation and causes remain poorly
understood. We sought to develop a photonumeric scale for
perioral wrinkling and to elucidate contributory lifestyle factors.
In this cross-sectional study, we recruited participants for facial
photographs and a survey. A gender-specific photonumeric scale for
perioral wrinkling was developed and used by 3 graders to evaluate
participant photographs. Scores and survey responses were used
to create a multiple regression model to predict perioral wrinkling.
In all, 143 participants aged 21 to 91 years were enrolled. Intraclass
correlation coefficient values for interrater and intrarater reliability
were high (>0.8) across 2 trials and 3 graders. A multiple regression
model for prediction of perioral wrinkling severity included age,
gender, and years of smoking as variables. The study was limited by
sample size and a predominantly Caucasian study population. We
created a photonumeric scale that accounts for gender differences
in perioral wrinkling and highlighted contributory variables to
photoaging in this anatomical location.
Title: Target-oriented therapy: Emerging drugs for atopic dermatitis
Authors: Lauffer F, Ring J
Published: Expert Opinion on Emerging Drugs, January 2016
Keywords: Dermatitis, eczema, atopic dermatitis, skin disease
Abstract: Atopic dermatitis (AD) is a chronic inflammatory
skin disease with a life-time prevalence of 10-20% in western
countries. Patients suffer from stigmatizing eczematous skin
lesions, persisting itch and sleep disorders. Starting usually in
early childhood the course of AD is heterogeneous. While most
frequently AD disappears before adolescence, about 30% of
patients show a chronic persisting course. There is an urgent
need for new therapeutic options as until now, specific drugs are
missing. Areas covered: Over the last years research has made
enormous progress in understanding mechanisms involved in
AD pathogenesis. Th2 cells and their key cytokines IL-4 and IL-13
as well as TSLP, CRTH2 and IgE are targets for new compounds
currently being tested in clinical trials. This review highlights
new drugs for AD at all stages of development as well as current
promising scientific approaches. Expert opinion: After decades
of silence the market for AD drugs has recently become highly
active. Amongst all new compounds, dupilumab – an antibody
directed against IL-4 and IL-13 receptors – is the most advanced
candidate showing convincing efficacy in several phase III studies.
The availability of specific drugs for AD will open up a new era in
dermatological therapy.
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
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Aesthetics Journal
Aesthetics aestheticsjournal.com
blogger likes what you do, they could tell their 50,000
followers that your product or service is simply the best,
dramatically increasing the chance of a referral.
Often, mainstream media will follow these bloggers,
meaning your blogger may also be able to open an
Aladdin’s cave of opportunities. She or he may tell
all their followers about you, and then the high street
glossy magazines may pick it up, further building
the publicity trail. In my opinion, word-of-mouth
endorsement is far more powerful than advertising. An
endorsement from a blogger or the media is a third
party, without an agenda, vocalising that your business
is the best at what you do.
How do I find a blogger?
The Benefits
of Bloggers
PR consultant Mike Nolan shares advice
on how aesthetic professionals can build
successful relationships with bloggers
to improve their online marketing and
increase their customer base
A decade ago, barely anyone knew what a blogger was. Thanks to the great tidal
wave of digital communication in recent years, however, these ‘internet writers’,
for want of a better term, have become an integral part of modern communication.
Working in public relations (PR), I now recommend that most of my clients make
blogger outreach an essential part of their marketing plan. I also advise that for
certain industries, in particular aesthetics, clients do their utmost to look for what I call
the ‘professional bloggers’, and go out of their way to ‘make friends’ with them. In my
opinion, this might be the wisest marketing decision they will ever make.
Why use bloggers?
Certainly in the beauty and aesthetics industry, bloggers have a very loyal following,
so getting to know them could be hugely beneficial for increasing your patient base
and future business development.
The best bloggers can have millions of followers and be extremely influential people.
For example, 25-year-old Zoella has more than 10 million YouTube followers1 and,
while some adults may not have heard of her, my 11-year-old daughter will listen to
Zoella more than she will her mother.
Zoella is certainly one of the UK’s blogging stars and, while getting her on board
would now likely be a big ask, consider if you got hold of her four years ago – where
would someone with Zoella’s reach and influence have taken your business?
It used to be the case that magazines, newspapers and the rest of traditional media
held the key to the best PR opportunities, however bloggers are now considered
as valuable as some of the best beauty magazines in terms of sharing powerful
endorsements. I believe this is evident by the sheer number of followers they have.2
As most business owners know, the best way to find new customers is through
a recommendation. That recommendation could be from Patient A, who was so
delighted with her treatment results at your clinic that she tells her best friend, Patient
B, who in turn gets in touch with you and books an appointment. If a popular beauty
The savviest businesses are increasingly
recognising the important role that bloggers can
play in their marketing plan. But who are these
bloggers, and how do you reach them? Bloggers
are often a PR professional, journalist, photographer,
videographer, search engine expert and social
media specialist all rolled into one. Luckily for you,
finding bloggers is relatively easy. If your budget is
limited, then the first port of call should be Google.
It’s free and it’s easy to use. For example, put in your
search term, ‘beauty bloggers’ and see what comes
up. Generally, somebody will have pulled together
a list of the best beauty bloggers and, very helpfully,
will often rate them for you, so you can see instantly
which blogger would be most appropriate for your
business growth goals.
One such website, Blow Ltd, lists the 27 most
powerful beauty bloggers in the UK and, while the
stats presented are a year old, it gives you a good
idea of how many followers a blogger can reach.2
If you don’t have time to search through Google
listings, you can take some shortcuts. Two of my
favourite tools are Buzzsumo3 and Authority Spy.4
Buzzsumo is a great platform for discovering
interesting content and finding those influential
bloggers who are hopefully going to talk about your
clinic. You can search based on topics/keywords
or Twitter usernames, filter by type of user (e.g.
bloggers, influencers, journalists) and then sort your
results by various metrics. Usefully, it can also help
you identify which posts are getting the most shares
for your competitors. Buzzsumo allows a free trial,
but then depending on the amount of use, starts at
£55 per month.
Authority Spy is a simple and easy to use influencer
research tool that also has helpful features for those
starting out, and, if you are feeling creative, you can
also source guest blogging opportunities. Simply
enter a search term and the system does the rest,
pulling together hundreds of influential bloggers in
a matter of seconds. Once you have reviewed the
results, the platform provides a direct link to their
social media profiles, so it’s easy to access your
potential bloggers. This service starts at around £20
for a basic package.
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
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with any business clients, the most important thing is to treat them
with respect and this will likely be reciprocated.
If a popular beauty blogger
likes what you do, they
could tell their 50,000
followers that your product
or service is simply the best,
dramatically increasing the
chance of a referral
Working with bloggers
Once you find the kind of bloggers that you want to make contact
with, spend some time exploring the content of their blog posts
and make sure that their audience and your target market are in
harmony. Bear in mind, that when it comes to a blog audience,
bigger isn’t always better. It’s better to go where there’s a small
audience who may be your exact target market. For example,
if you’re trying to promote your post-pregnancy weight loss
treatment, telling an audience of teenage girls seeking acne
treatments won’t have much of an impact.
Some bloggers have a PR page, which means they are interested
in partnering with brands and will be open to you contacting them.
When making contact, the first thing to remember is that they are
human just like me and you, and most respond positively to the
personal bespoke approach, so no bulk emailing! Ensure you have
done your research and understand what your potential blogger is
interested in, then tell them a little bit about your business and how
you could work together.
It’s not easy capturing the attention of the right kind of bloggers,
and all blogs are not equal. Some blogs might look the part,
however they may not have a great following. This means that
even if the blogger agrees to talk about you, enough of, or even
the right people may not hear the messages they subsequently
share. Ensure you have thoroughly researched not only the
blogger’s blog, but also their social media accounts and the
responses from their followers to the content they share. Important
questions to ask include:
• How often do they post online?
• What social networks do they use?
• Can they present any audience data such as average age, sex
and location?
You should then consider whether the responses are in-line with
your needs and appropriate to the audience you are trying to
attract. If, for some reason, you don’t feel that a relationship will
work after you’ve approached a blogger, don’t be afraid to walk
away. Be aware, however, that if you treat bloggers with disregard,
there is a chance that they won’t be slow in telling their audience,
which could negatively impact on your business. Remember, as
Payment
It may also be advisable to offer bloggers some kind of compensation
for helping promote your product or service. Newer bloggers who
are hoping to make a name for themselves may be willing to help
promote your products or services in exchange for free products to
review, or a ‘shout out’ via your social media channels. While these
emerging bloggers do not necessarily rely on their blog as their main
income, it doesn’t mean they shouldn’t be compensated for the value
that they can offer your brand.
With established bloggers, who produce blogs for a living, you should
ensure that you offer them a fair rate of compensation. If the rates
aren’t clear from the blogger’s media kit, which is usually on their
website, ask about this. Many bloggers will have rates for working
with brands, but are usually open to negotiation depending on the
project. They may also be open to ‘payment’ in the form of products
or services – this is a case of common sense – only do something
that you feel is right and at all times bear in mind that this, like all
relationships is about nurturing and trust.
Content
Be specific about your campaign goals and let the blogger know what
these are. It is important, however, that you are not controlling what the
blogger can and can’t do. Bloggers are usually very creative people
and could dream up better promotional ideas than you would have
ever thought of. The promotional formats that bloggers are now using
are wide-ranging and may include, amongst others, written blogs,
videos, photography, graphic design and social media. Let the blogger
feel free to decide how they communicate with their audience.
Conclusion
Hopefully this article has equipped you with the knowledge to
approach bloggers with confidence and got you excited to explore
this particular form of digital marketing further. If you’re still a little
hesitant then talk to a media professional who should be able to
help point you in the right direction and find appropriate bloggers for
you. Remember, just as you would in other business arrangements, if
you like how the blogger has worked, show your appreciation. If you
nurture the relationship, the blogger will, in all likelihood, become
a brand advocate and keep promoting your business, even if you
aren’t passing money to them. And remember, bloggers are the new
stars of the digital age, so embrace them – they aren’t about to go
anywhere soon.
Mike Nolan has been involved in PR for more than
a decade and is the founder and director of Nolan PR.
Since he started his company in 2009 he has helped
a broad range of clients from many industries design
and implement successful social media marketing
campaigns. Nolan also has news editing and journalistic experience
at a daily newspaper. REFERENCES
1. Zoella, (UK, YouTube, 2016) <https://www.youtube.com/user/zoella280390?feature=mhee>
2. Emma Cooke, 27 Most Powerful Beauty Bloggers (UK, Blow Ltd, 2015) <http://www.blowltd.com/
magazine/magazine/27-most-powerful-uk-beauty-bloggers-weve-crunched-the-numbers.html#.
VqfP-PmLTIU>
3. Buzzsumo (2016) <http://buzzsumo.com/>
4. Authority Spy (2016) <http://authorityspy.com>
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
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Don’t miss the premier CPD event of the
year for sclerotherapy practitioners.
Taking place at The Ark Centre, Basingstoke, Hampshire, RG24 9NN
Thursday 28 April 2016
Eminent speakers include Mr Philip Coleridge Smith and Dr Stephen Tristram.
Provisional topics include:
•
•
•
•
•
Compressionaftersclerotherapy
Complicationsandhowtoavoidthem
Demonstrationsoffoamsclerotherapy,Dopplerultrasoundassessmentandmicrosclerotherapy
Effectivemarketingforyourbusiness
ShouldIbeworriedaboutDVTinmypatients?
What our delegates say...
“Lots of great up to date info, well
presented, varied and entertaining.
Learnt a lot. Great to meet other
professionals. More options for referral”
“Excellent meeting,
very useful information
for clinical practice”
Consultant Vascular Surgeon
Aesthetic Nurse Practitioner
Forfurtherinformation
www.bassclerotherapy.com | [email protected] | 01264 736500
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Aesthetics
The Big Brand Theory
Aesthetic business founder Roydon Cowley
discusses branding strategies and how you can
separate yourself from the competition
As small business owners, our expertise will often lie in only a few specific
areas of our business’s total operational requirements. As an aesthetic
practice/clinic owner, this is likely to be the hands-on element and day-to-day
running of the clinic and treatment application. The thought of accounting,
legal requirements and other peripheral duties can fill some business owners
with dread. These individuals may choose to delegate these responsibilities to
qualified third parties, however there is a risk they might totally neglect these
areas of running a business. From my experience of working with aesthetic
businesses, I have noticed that branding is one of the areas that is often
significantly lacking. Have you considered the importance and relevance of
branding when planning your business strategy?
When discussing my brand I am often told how lucky I am, as if it has in some way
stumbled into success. I generally answer, “Yes it’s strange, the harder I work the
luckier I seem to become!” In truth, using many years of experience, good and
bad, my brand was more likely to succeed from day one as I had a very specific
plan and branding strategy. It is this I would like to share with you, as I believe
it can be applied to significantly improve any company’s performance in the
increasingly competitive market of aesthetics.
What is branding?
Firstly, we need to appreciate what branding is and why it is so important to our
businesses. Branding goes way beyond just a logo or graphic element. When
you think about your brand, you really need to think about your entire customer
experience. This is everything from your logo, website, social media experiences
and treatments, to the way you answer the phone, and the way your customers
experience your staff. When you look at this broad definition of branding, it can
be overwhelming to think about. In short, however, your brand is the way that
your customer perceives you. It is critical to be aware of your brand experience
and have a plan to create the experience that you want to allow your customers/
patients to have – a good brand doesn’t just happen – it is a well thought out
and strategic plan. Many small organisations and startups neglect spending
necessary time thinking about their brand in this broad sense, as well as the
impact it has on their business.
10 reasons why focusing on your brand is important:
1. Promotes recognition 2. Sets you apart from the competition
3. Tells people about your business ‘DNA’
4. Provides motivation, structure and direction for your staff
5. Generates referrals as customers love to tell others about brands they like
6. Helps customers know what to expect
7. Represents you and your promise to your customer
8. Helps you to create clarity and stay focused
9. Helps you to connect with your customers emotionally
10. Provides your business with value
All of the above is relatively basic stuff when assessing
how important branding is and what I would regard
as the solid foundations of any strategy. The best
branding is built on a strong idea; one which you and
your staff can hold on to, commit to, and deliver upon.
More importantly, you need to be different if you want
to swim alone in the big blue ocean!
Blue Ocean vs. Red Ocean strategy
In business, we use the ‘Blue Ocean’ and ‘Red Ocean’
strategies, which are analogies that define what sort
of market you are in. The ‘Red Ocean’ represents
all of the industries in existence today – the known
market space. In this ocean, boundaries are defined
and accepted and the competitive rules of the game
are well known. Here, companies try to outperform
their rivals to achieve a greater share of the product
or service demand or, as this space becomes more
crowded, prospects for profits and growth are
reduced through price wars. A product becomes a
simple commodity, and cutthroat competition turns
the ocean bloody; hence, the term ‘Red Ocean’.1,2 Our
‘Red Ocean’ is the business of aesthetics, which we
all know is becoming a more crowded space with
plenty of sharks circling in the bloodied waters. ‘Blue
Ocean’ on the other hand, is defined in contrast of
the industries not in existence today – the unknown
market space, untainted by competition.1,2 In the ‘Blue
Ocean’, competition is irrelevant because the rules of
the game are yet to be set. ‘Blue Ocean’ is an analogy
to describe the wider, deeper potential of a market
space that is not yet explored and where you swim
alone (Figure 1).2
How to use the ‘Blue Ocean’ strategy
So what is the relevance of this strategy and how can
you benefit from it? As an aesthetic practice, you are
likely to have a price list of services that is accepted
as standard within the industry. This positions you
firmly in the ‘Red Ocean’, swimming with the rest of the
sharks and fighting for market share in an increasingly
competitive environment. I am making the assumption
that you are striving to be the best and have already
looked at some or all of the 10 reasons why focussing
on your brand is important; making a concerted effort
to implement these ideas in your practice. You might
also have stunning premises, excellent techniques
and treatments and other successful elements of
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
@aestheticsgroup
Aesthetics Journal
Aesthetics aestheticsjournal.com
means you are non-comparable to the high street and
seek to make the competition irrelevant. You need to
create and capture new demand and break the value
to cost trade off – meaning that differentiation AND
low cost should be persued simultaneously to create
a ‘Blue Ocean’ instead of differentiation OR low cost.
You too can create bespoke treatments that not only
Create uncontested market space
Compete in existing market space
improve your patient’s outcomes, but also make you
Beat the competition
Make the competition irrelevant
non-comparable to your direct competitors.
You are the expert in your field and through research of
Exploit existing demand
Create and capture new demand
the excellent devices and products now available, you
Make the value-cost trade off
Break the value-cost trade off
are best positioned to create the best treatments, for a
Align the whole system of a firm’s
Align the whole system of a firms
variety of indications.
activities with it’s startegic choice
activities in pursuit of differentiation
As an example, your antiageing facial might be
of differentitation or low cost
and low cost
microdermabrasion layered with radiofrequency
“Defend Current Position”
“Innovate & Pursue New Opportunities”
and LED, combined with peels following a course of
Perspective
Perspective
treatments. For a more curative approach your package
Figure 1: Blue Ocean vs. Red Ocean.2
may include dermal fillers and/or botulinum toxin.
You could create a programme/course and give it a name such as
your aesthetic practice, which puts you in good stead against your
the ‘Hollywood Bespoke Facial’ and, once you have decided upon
competition. However, I guarantee that your price list will be full of
a brand name and direction, market it effectively to demonstrate
services that can be compared to your competitors, and decisions to
how unique and ground-breaking it is. Alternatively, you might want
come to your clinic could be made purely on price before a patient
to brand it in your name to promote your innovation, such as ‘The
even comes through your door.
Dr Jones Age Defying Facial’. Like me, you will get a great deal of
enjoyment out of creating your treatments and a lot of pride whilst
Finding my ‘Blue Ocean’
selling them. No longer are you that clinic selling a generic treatment,
For many years I chased the next technology trend as a distributor.
but a passionate individual and bespoke organisation that spreads the
I had to fight for a sale based on why ours was better than
another’s and, in some instances, it wasn’t. I even instigated a huge word about their differences, not their similarities to others.
Some good examples of those who have adopted this strategy are,
PR campaign to support one of our brands, which worked well but
the ‘60 Minute Bespoke Facial’ by Antonia Burrell Holistic Skincare,
created a popular platform for others to jump onto. Not only will
the ‘Made To Measure Facial’ by Anne Semonin and the ‘Dr Leah
other companies follow your lead, they might actually do a better
job or sell the product or service at a better price. I didn’t realise it
Bespoke Facial’ by Dr Leah Totton. These are great examples of
at the time but I was drowning in the ‘Red Ocean’ with a group of
individuals who stand alone with their strategy and whose services
sharks circling in anticipation.
cannot be compared to others. Many create bespoke facials that are
Learning from these lessons, I set out to do something fundamentally
tailored to the individual patient’s needs. Not only does the patient feel
different. My passion is for the development of effective non-surgical
special – they cannot compare this service to any other provider.
technology for the face and body. Over the years, I realised that no
The final point is that you align the whole system of your company’s
one technology or trend treats all indications for the face or body.
activities in pursuit of promoting these differences. Ways to achieve
Therefore, I developed multi-technology affordable devices, aiming
this could include celebrity PR campaigns, local editorial coverage
to give the best possible patient outcomes on the face and body.
through editors and journalists experiencing your unique offering,
This philosophy was to treat the whole problem by adopting a threesocial media and advertising. Sometimes it is really effective if you
dimensional approach to treat fat removal, tighten skin and improve
seek individuals or personalities who have large social media or blog
cellulite, hence the name of the company. We strongly market this
following to spread the word. Diving into the ‘Blue Ocean’ is much
philosophy ensuring that only my company and clients benefit from
more rewarding than simply selling what everyone else is selling or
our specific treatments and services.
relying on short-lived trends to boost your income; I urge you to give
This approach has also worked for some of the most respected
it a try.
brands like Bloomberg Business, Canon, and Apple.2 Apple created
Roydon Cowley is the founder and managing
future profits and growth not by exploiting existing demand, but by
director of 3D-lipo Ltd and he has been involved in
reconstructing industry boundaries to create new market space
the beauty/aesthetics industry for the past 25 years.
After seeing a gap in the market, he established his
and unlock latent demand. As a result, the company’s value grew
own manufacturing company specialising in multiexponentially as the total market value of a firm reflects not only
technology platform devices and developed his company through
today’s performance but also its future profitability. Apple adopted
powerful branding and marketing campaigns.
a number of blue ocean strategic moves that transformed the
REFERENCES
company from a computer manufacturer into a consumer electronics
1. Chan Kim W & Mauborgne R, ‘Blue Ocean Strategy: How to Create Uncontested Market Space and
3
powerhouse. This philosophy can work for you too.
Make the Competition Irrelevant, (Harvard Business Review Press; Expanded edition 2015), <http://
How to find your own ‘Blue Ocean’
In this increasingly competitive environment, as a business, you now
have to be smart in order to win. As the saying goes, ‘work smarter
not harder’. You need to stand alone; create a business strategy that
thepersonalcoach.ca/userContent/documents/BookReport,BlueOceanStrategy.pdf>
2. What is Blue Ocean Strategy, (2015), <https://www.blueoceanstrategy.com/what-is-blue-ocean-strategy/>
3. Blue Ocean Strategic Moves, (2015), <https://www.blueoceanstrategy.com/bos-moves/>
4. Chan Kim W, Mauborgne R & Oh Young Ko, How Apple’s Corporate Strategy Drove High Growth,
(2015) <https://www.blueoceanstrategy.com/teaching-materials/apple/>
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
TIGHTEN
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Images courtesy of The Banwell Clinic
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@3Dskinmed
@aestheticsgroup
Aesthetics Journal
Aesthetics aestheticsjournal.com
reputation may significantly suffer now, as Google displays this bad
review and negative rating prominently in its search results.
Google, of course, is left unscathed. The fate of the clinic has no
bearing on Google’s success. Google is constantly looking for ways
to enhance the ‘user’ experience (that’s the ‘user’ experience and
not your clinic’s bottom line). Its mission is to understand exactly what
its users are searching for, and return exactly what they are looking
for. Today, when someone searches for a clinic, Google knows that
person probably wants to find the most trusted and reliable clinic in
their area. They want to know they will be in safe hands and they
want to feel confident that their results will be excellent. In most
cases, this matters even more than cost.
How Google influences
new patients
PR and reputation management
consultant Jay Cruiz discusses
Google’s impact on your clinic’s
reputation and offers advice on how to
successfully manage online reviews
For the better part of a decade, leveraging Google’s search engine
has been a very effective way to market a clinic and bring in a
wealth of new patients. Unfortunately, some of Google’s recent
innovations can hurt the reputation of many clinics. Google is now one
of the primary determinants of your clinic’s overall reputation – and the
way you manage your online reputation determines whether this is
good news, or bad news, for your clinic.
Your clients are likely to use Google
Google is the internet’s leading search engine and the world’s most
visited website, equating to around two fifths of the world’s internet
traffic, beyond sites like YouTube and even Facebook. In fact, in 2013
when Google went down for just two-to-five minutes; worldwide
internet traffic plummeted by approximately 40%.2 In the modern era,
when someone is considering an aesthetic treatment or procedure,
they will usually open their computer or tap on their smart phones,
searching for the best clinic in their area. Nine times out of 10 they
are using Google,3 because people TRUST Google.
Google doesn’t consider your business
Imagine a clinic that’s extremely well trusted and adored by its
patients. It has a gorgeous website, professionally created and
presented. The staff are efficient, friendly and great at what they do,
however, they never encouraged their patients to rate and review
the clinic online. Then one day, this stellar clinic treats a person who
is just having a bad day. A horrible day in fact, not to mention that
they are a rather ‘difficult’ patient at the best of times. The clinic may
have fallen temporarily short of their usual standard (perhaps through
no fault of their own). Regardless, the patient, in a rage, decides to
log in to their favourite review site and display their dissatisfaction
online. Consequently, this otherwise excellent clinic is now
represented entirely by that single negative review online. The clinic
now appears to be one of the worst rated in the region. The clinic’s
The effect of Google reviews
Google is often where your clinic makes its first impression online,
and with a competing clinic just pixels away, your first impression
really counts. To provide the user with a better experience and
‘return exactly what they are looking for,’ Google now gathers
reviews, star ratings and testimonials from past patients across
the web. In Google Maps and local results, for example, they will
prominently display reviews submitted by people via their own
Google accounts. Anyone can leave reviews this way and Google
prompts its users to do so. In regular Google Search results, Google
gives these reviews priority placement and it will then also show
the average rating, right there in the results, individually from other
sites that use rating schema. These sites include Yelp, Facebook
Pages, GlassDoor.com and many others. When people search for
your clinic, they may well also add the word ‘review’ to the search to
see what other people say about you as demonstrated by Google
Suggest. These eye-catching features draw the user’s attention and
often supersede the regular search results, in terms of user focus.
So it’s now the clinic with the ‘5-star reputation’ winning the business.
A clinic with no reviews also has no positive feedback to reassure
potential clients. Consequentially, if your online reputation is not
carefully managed, one bad review can destroy your chances of
bringing in new patients via the internet, since there is no buffer or
counterpoint. More than ever, people are looking to Google to help
them choose a clinic. That one star rating could mean all your other
investment in marketing and promotion, print ads, radio spots etc.
are severely hindered.
The 5-star reputation and your clinic
A 5-star reputation is the gold standard of trust and credibility online
and encourages new and potential patients to choose your clinic
over another. No matter how far technology develops, social proof is
likely to always be one of the primary deciding factors as to whether
a patient chooses one clinic over another. If enough people say Clinic
B is better than Clinic A, with all other factors being equal, Clinic B
gets the business. If your aim is to leverage the internet to attract new
patients, your focus should be on forging a 5-star reputation for them
to clearly see when searching online for aesthetic treatment.
Priming: the deciding factor you can control
There is a psychological concept known as ‘priming’, whereby a
person’s pre-conceived expectations ‘prime’ them either positively or
negatively, towards how they ultimately feel about a given experience.
One of the best examples of ‘perception dictating experience’ is
wine tasting – and how if a person expects a wine to taste better...
the wine tastes better to them.4 This explains why a bad review has
such a severe knock-on effect for the rest of your potential patients.
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
aestheticsjournal.com
@aestheticsgroup
Aesthetics Journal
Negative priming occurs when a person is influenced to expect bad
things.5 This tends to occur when reading a critical review online, for
example. A negatively primed patient is far more attuned to ‘nitpicking’.
They are on the lookout for things that bother them, inconvenience
them, or could be done better. Bad reviews online ‘negatively prime’
as much as 50-75% of potential patients.6 Conversely, positive priming
occurs when a person is influenced to expect good things. 7 When
a person expects good things, they pay more attention to the things
they like and enjoy. This is where their mind is focused, so any mild
negatives tend to be marginalised or ignored completely. For these
reasons, online reputation management should form a critical part
of your overall marketing strategy. Akin to ‘confirmation bias’, people
pay far more attention to evidence that confirms their perspective as
being correct, while more readily ignoring evidence that challenges
their perspective and proving them to be misguided or completely
wrong.8 As such, no matter how many reviews you may currently have,
managing your online reputation is critical for minimising damage
caused by bad reviews.
Of course, creating a 5-star reputation can actually have the reverse
effect, in that more patients will seek you out, tell their friends, be
primed to enjoy a more positive experience, leave better reviews
AND spend more with you in the future through follow up treatments
– not to mention referral business!
Putting your clinic on the map
Another innovation of Google’s has been the inclusion of ‘Google
Maps’ in the search results as well as the coinciding star ratings
and reviews. It takes up a lot of space on the results page too,
so your appearance here (or lack thereof) has an exponentially
greater impact. This is yet another instance where you can display
and benefit from a strong 5-star reputation, or suffer and become
crippled by a scathing one star review. The fact is, most people
nowadays find a clinic by using Google Maps9,10 and pay attention
to the reviews that appear alongside the map and location points.
This makes your presence in Google Maps and your clinic’s reviews
exponentially more important. There are three major factors to focus
on when improving your Google Maps presence:
• Address and telephone number citations
• Review generation and management
• Mobile friendly websites
These elements have the biggest impact11 and mobile optimisation
is especially important, because Google has actually gone as far to
tell its human website analysts to rate any web page, which is not
‘mobile-friendly’12 (i.e. a page that becomes unusable on a mobile
device) with the lowest rating. Simply having a mobile version of
your site does not make it mobile-friendly. A ‘mobile site’ allows
you to access the site on a smartphone without having to view it
like a normal website which helps usability as it prevents the need
of zooming in. A ‘mobile friendly’ site however, is designed to give
the best and easiest user experience while getting more people to
contact the business by providing a contact number, easy review
system and location map.
Never fake it ‘til you make it’
Most clinics already understand the gravity and opportunity that goes
with having a solid reputation. Unfortunately, some clinics (or the
marketing companies they employ) also opt to take shortcuts, which
only serve to hurt them in the long run. For some, the temptation is
Aesthetics
there to implement ‘fake’ reviews. Forget about the penalties your
site eventually receives from Google, this can land you in serious
legal trouble as well,13 and nothing hurts your reputation quite like
a court hearing. Amazon recently began a law suit against more
than 1,114 fake reviewers as it undermines consumer trust14 and
Yelp joined a series of law suits known as ‘Operation Green Turf’
in 2013 with damages being awarded $350,000 from 19 separate
companies.15 The funny thing here is; fake reviews all tend to sound
the same. The language used is often unconvincing, which inspires
a level of scepticism from potential patients, so those reviews could
have the opposite effect. Not to mention there are algorithms,
which effectively pick out these fake reviews due to the predictable
wording. My advice is to avoid this practice altogether.
The most cost-effective way to a 5-star reputation
If you run a good clinic, you should already have a plentiful supply of
patients willing to sing your praises. If you genuinely enhance their
lives and make an effort to help them feel good (with a healthy dose
of ‘positive priming’ working in your favour too), you should have no
trouble gathering positive reviews. You simply need to ask for them
to post on your chosen site (and be sure to direct them to various
top review sites, to get the most visibility in Google Search). Do not
underestimate the rising power of online reviews for your clinic’s
success. If you decide to work with a marketing company to handle
this side of your business, make sure they focus on real reviews,
strong branding, and appreciate the importance of a good patient
satisfaction strategy and the impact of online presence.
Jay Cruiz is the sales and research director at Fountain
PR, an online PR and reputation management company
set up to help aesthetic clinics develop their own 5-star
reputations. For several years before helping clinics with
their online reputation and visibility, Cruiz worked in
the field of sales and client acquisition, from event sales, to medical
equipment, to the aesthetics industry.
REFERENCES
1. Worstall Tim, Fascinating Number: Google Is Now 40% Of The Internet (Forbes, 2013) <http://www.
forbes.com/sites/timworstall/2013/08/17/fascinating-number-google-is-now-40-of-the-internet/>
2. Statista, Inc, Worldwide market share of leading search engines from January 2010 to October 2015,
(Statista.com, 2015) <http://www.statista.com/statistics/216573/worldwide-market-share-of-searchengines/>
3. Mayyasi A, The Price of Wine (Priceonomics.com, 2013) <http://blog.priceonomics.com/
post/46618070248/the-price-of-wine>
4. Plassmann et al, Marketing actions can modulate neural representations of experienced pleasantness,
(California Institute of Technology, 2007) <http://www.pnas.org/content/105/3/1050.full.pdf>
5. Anderson M, Study: 72% Of Consumers Trust Online Reviews As Much As Personal Recommendations,
(SearchEngineLand.com, 2012) <http://searchengineland.com/study-72-of-consumers-trust-onlinereviews-as-much-as-personal-recommendations-114152>
6. Plous S, The Psychology of Judgment and Decision Making (McGraw-Hill Higher Education, 1993)
p.233.
7. Ariely D et al, ‘Tom Sawyer and the Construction of Value,’ Journal of Economic Behavior and
Organization’, 2006 <https://www.bostonfed.org/economic/wp/wp2005/wp0510.pdf>
8. Smith CS, Google Trends: Yellow Pages Will Be Toast In Four Years (SearchEngineLand.com, 2007)
<http://searchengineland.com/google-trends-yellow-pages-will-be-toast-in-four-years-12256>
9. Smith, Chris Silver, Are Yellow Pages Toast? Four Years Later We Review Ad Value (SearchEngineLand.
com, 2012) <http://searchengineland.com/are-yellow-pages-toast-four-years-later-we-review-advalue-116199>
10. Moz.com, The 2015 Local Search Ranking Factors (SEOMoz, Inc, 2015) <https://moz.com/local-searchranking-factors>
11. Slegg J, 30+ Important Takeaways from Google’s Search Quality Rater’s Guidelines (SEOMoz, Inc,
2015) <https://moz.com/blog/google-search-quality-raters-guidelines>
12. Paresh D, Edmunds.com settles lawsuit against alleged fake reviewer Humankind (Los Angeles Times,
2013), <http://articles.latimes.com/2013/aug/29/business/la-fi-tn-edmunds-lawsuit-humankind-20130829>
13. Tuttle B, Amazon Lawsuit Shows That Fake Online Reviews Are a Big Problem (Time Inc, 2015) <http://
time.com/money/4078632/amazon-fake-online-reviews/>
14. Schneiderman, ET et al, Schneiderman Announces Agreement With 19 Companies To Stop Writing
Fake Online Reviews And Pay More Than $350,000 In Fines (New York State Office of the Attorney
General, 2013) <http://www.ag.ny.gov/press-release/ag-schneiderman-announces-agreement-19companies-stop-writing-fake-online-reviews-and>
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
EMERVEL – MORE CHOICE AND
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Tel: 01923 208950 Email: [email protected]
For more information visit www.galderma-alliance.co.uk
EME/030/0714 Date of prep: July 2014
You can sign up to receive email
& text message alerts through
Galderma (UK) Ltd’s A&C
subscription service for Healthcare
Professionals and Non-Medical
Aesthetic Clinic Staff. Scan here,
or visit www.galderma-mail.co.uk
complications “wet lab”
aestheticsjournal.com
@aestheticsgroup
Aesthetics Journal
Aesthetics
“All practitioners should take a step back
and say ‘how can I make myself proud
of what I do?’”
Dr Beatriz Molina details her route into aesthetics and
her constant strive to make it a recognised specialty
“Being part of the committee for BCAM, I was talking to nurses,
Coming to the UK was supposed to be a temporary move for
aesthetic practitioner Dr Beatriz Molina, who initially moved here to dermatologists and surgeons, trying to get everybody together to
work with HEE. At the time, we were at opposite ends of the table, but
train as a surgeon, gain some experience within the NHS and learn
having been in the industry for a very long time and knowing people
English. But after falling in love with her now-husband and the British
This one-day
simulation
“wet-lab”
provide
"Anatomical
basiscareer
of Facial
rejuvenation
quite
well personally,
it waswill
easier
for me to speak to people and say
way
of life, Dr Molina’s
took an
unexpected turn.
small group,
hands
on practical
training,
so that
‘look,
we have
a common
aim here,
we need to join forces’ and that
“Iwith
attended
medical
school
at the
University of Malaga
and then
Dermal
Fillers
and
management
of
delegates
will
be
confident
in
how
to
avoid
and
was
a
big
achievement.”
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Molina
advises
anyone looking to get
came
to
England
in
1994
to
start
my
surgical
training.
But
after
five
complications wet lab" on 11th April 2016
treat complications
from non-surgical
fillercourses extremely carefully. Work
into the industry
to, “Choose your
years of learning I woke up one morning and decided that I didn’t
treatments,with
based
on a thorough
anatomical
someone
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if you can, have a mentor and get properly
want
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Dr Molina.wet-lab
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trained. Do it very slowly, carefully and don’t take it as a side job. If
heart
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family and friends
in shock,
“I had a bit of a breakdown
internationally
recognized
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anatomical
you want to do it because you love it, go for it, but it is going to take
and
thought ‘what
am I goingclinical
to do with
life?’ and then some
Course Directors :
trainers,
with the that
aim Iof
aesthetic
a lot of your time.” Although Dr Molina is proud of her achievements,
friends
suggested
gopromoting
into generalsafe
practice
temporarily, whilst
Mrs. Sabrina Shah-Desai (MS, FRCS), one of
she continues to strive for better, “We need to stop people from
Ipractice
made myamongst
mind upmedical
on what professionals.
I wanted to do.” Becoming a general
UK’s leading Oculoplastic Surgeons specializing in
Delegates will
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doing
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then going out there thinking they can
practitioner
was get
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Molina and, as she explains,
surgical and
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of facial
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usingsurgeon,
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do
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Things
are
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a trainee
Dr. Beatriz Molina, one of the world’s leading but very slowly. Our next
prosections
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was,
she wasn’t
lovepractice
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wasn’t enough
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authoritiesbig
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opinion
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with
speciality.
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going
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everyday
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thenfrozen
I foundcadavers,
cosmetics.”
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Molina heard about
medicine and vice president of the Britishbut
College
emphasis
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we’ll
be
able
to
achieve
it.”
treating
hyperhidrosis
botulinum
toxin and wanted to learn
of Aesthetic Medicine.
anatomy in upper, mid and lower face.
more, “I did a course and found out you could also use botulinum
The “wet-lab” will cover basic, intermediate and
toxin to treat lines and wrinkles – it was like a wake-up call!” This course will
place at
Whattake
treatment
dothe
youWest
enjoyMidlands
giving the most?
advanced safe reproducible filler injection
Dr Molina had been practising medicine for 11 years when she Surgical
finally Training
Centre,
Coventry
on
11th
April
I
love
using
dermal
fillers
and
feel
like
an artist when I’m treating
techniques for the most clinically relevant facial
discovered her passion for aesthetics. “I got really excited and2016.
patients with them. I combine my medical knowledge with my
areas (forehead, temple, tear trough, superior
booked
myself onto
courses
in botulinum toxin for lines and wrinkles,
artistic flair and I love how you can transform someone’s face. You
sulcus, peri-oral
and
jawline).
Course Fee : £895 , includes lunch and all
and
then
for
dermal
fillers,
and
then
that’s when
see the
changesheadsets
straight away
Delegates will be confident in
thelasers;
management
of my journey
refreshments, can
teaching
materials,
& a and it’s just incredible.
really
started.”
Afterfiller
two years
of training(Tyndall
in aesthetic treatments,
common
dermal
complications
Certificate of attendance.
What technological tool do you think best compliments your
Dr
Molina
decided toand
open
own clinic,
and, in expert
2005, Medikas
effect,
overfilling)
beher
updated
on current
work?
in
Somerset
was
launched,
followed
by
her
Bristol
establishment
protocols for the management of vascular
To learn more
the courses
to book
Atabout
the moment,
it’s theor
cannulas
foryour
my dermal filler. I can achieve a
in
2014.
“In
those
days,
in
Somerset,
where
I
was
working
as
a
GP,
complications. The wet-lab includes practical
place, email lot and I think it’s enabled me to develop my own techniques and
there
wasn’t
really
anyone
offering
aesthetic
services
and
I
realised
sessions using Hyaluronidase.
infodermalfi[email protected]
give better results with fewer traumas.
there was a gap in the market.” Dr Molina wanted to make sure her
or [email protected]
clinic offered a variety of treatments and that she had the knowledge
and expertise she needed in order to deliver this. She explains, “If
you want to offer a service, you have to know everything about it.
Sometimes we think ‘we’re doctors and we know it all’ – but we don’t!
It is a very specialised industry; you have to study a lot, you have to
learn and I took it very seriously.” In 2015, Dr Molina was appointed
vice president of the British College of Aesthetic Medicine (BCAM),
by the committee board. As vice president, she is a firm believer in
keeping yourself as up-to-date as possible within the industry. “It’s
fast evolving and there are new techniques coming in everyday, a lot
more new products, and you need to have a solid understanding to
know what looks good and will work and what sounds a bit crazy. You
have to be very selective and that’s important for your patients.”
BCAM and the British Association of Cosmetic Nurses have been
working together with Health Education England (HEE) to establish a
new regulatory body for the cosmetic sector in England – the Joint
Council for Cosmetic Practitioners (JCCP); a venture Dr Molina is
particularly excited about and proud of.
Do you have an industry pet hate?
I don’t like how anybody in this country can perform aesthetic
treatments. You see a lot of people traumatised because they’ve
had a really bad experience or a bad result and that’s why we are
trying to change it. All practitioners should take a step back and say
‘how can I, from the heart, make myself proud of what I do?’
What aspects of the industry do you enjoy the most?
The conferences! It’s great to have these big meetings where you
get to see your colleagues and share experiences. You get to talk
to people and learn all about different treatments and procedures.
It’s nice because you can trust your colleagues and ask, ‘what
do you think about that product? What do you think about that
treatment?’ and they give you their honest opinion. It’s fantastic!
Dr Beatriz Molina will discuss treating the buttock and thigh area
at the Aesthetics Conference and Exhibition 2016. Visit
www.aestheticsconference.com/programme to find out more.
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
@aestheticsgroup
Aesthetics Journal
Aesthetics aestheticsjournal.com
the suggested financial benefits of the deal, as well as
being left with poor treatment results.
The Last Word
Dr Joney De Souza discusses the use of
voucher websites as a portal for selling
cosmetic treatments
From my professional standpoint, and many other practitioners I know, the
presence of e-commerce voucher sites within the cosmetic aesthetic arena is
a complex minefield. Whilst discount sites can highlight some attractive deals in
medical aesthetics, I believe it to be immensely important for both consumers and
practitioners to exercise severe caution before buying or selling through such portals.
The use and benefits of voucher sites
Voucher sites such as Groupon, LivingSocial and Wowcher have an incredibly
successful business model and a vast multi-national customer base. On entering
the discount site arena in 2008, Groupon became the second fastest online
company to reach a billion dollar valuation,1 thereby cementing itself as a popular
business model with proven credentials for potential businesses and consumers
alike. Selling invasive and non-invasive cosmetic treatments on these e-commerce
platforms could initially seem to have many advantages. First and foremost, they
can be an invaluable way to increase footfall and promotion of a brand, clinician
or establishment. Unlike classified advertising, the vendor doesn’t have to pay any
upfront costs to participate on these sites. This thereby, might make it an attractive
concept for retailers looking to build brand loyalty and promote themselves
on an internationally recognised platform, while, at the same time, potentially
gaining more customers and selling surplus inventory. The most common types of
treatments that clinics advertise through these sites tend to be laser treatments,
dermal filler treatment for lips and nose reshaping and microdermabrasion.
Disadvantages for patients
However, on deeper inspection, concerns arise over the financial viability for
businesses and, even more importantly, the sub-standard ethics for which some
businesses operate within this field. The aesthetics arena is an incredibly poorly
regulated industry and consumer desire for discounted treatments, matched with
the need for practitioners to ‘survive’ in such a competitive market, can lead to some
serious compromises being made. These not only include poor choice and cheaper
variations of products being used, but also the sub-standard investment a practitioner
might be tempted to make in their own and staff training, leading to a direct impact
on skills. Consumers may think that they are purchasing a great deal, whereas they
could have actually signed up for an aesthetic service carried out by an unqualified
and non-medically trained practitioner, in a field that already has very little regulation
in place to protect consumers. In addition, the majority of deals advertised on such
platforms offer limited product availability with a plethora of terms and conditions
that can confuse the consumer with complicated timing or redemption structures not
primarily visible in the original advert. As a result, the consumer may not experience
Disadvantages for practitioners
Businesses also have to understand that the use of
these sites is very rarely a means of generating profit,
with some sites taking more than 50% commission
of the total sale price,2,3 effectively making the deals
offered ‘loss leaders’. The promise of attracting loyal
and returning customers is also widely revoked due
to the nature of customers who purchase such deals
being classed as ‘price-sensitive deal-seekers’ who
are therefore unlikely to return to the practitioner in
the future, without similar substantial promotions and
discounts being applied to services. The popular
practice of compromising on treatment quality to
drive down price can mean an increase in the risk
of potential complications,4,5 which will have a direct
negative impact on treatment results and on the
practitioners’ reputation. This could therefore actually
drive business away from a practice and hinder your
primary goal for advertising on such sites in the first
place. One incredibly important question to factor in
is if the voucher deal will have a negative impact on
your business by damaging your brand, especially
if you have formerly marketed yourself within the
luxury sector. Once patients start to consider you as a
discount provider of treatments, you will probably never
be able to increase prices to their original state and,
unfortunately, that reputation will be difficult to regain.
Think long, not short term!
Regulation
Furthermore, an important point for any practitioner to
consider is the notable restrictions by regulatory bodies
like the General Medical Council (GMC), Nursing and
Midwifery Council (NMC) and General Dental Council
(GDC) on advertising treatments that use prescription
medications, such as botulinum toxin (or the generalised
use of Botox). As a prescription-only medicine, botulinum
toxin is banned from any promotion incentives or
marketing and this would be applicable to voucher
websites. These sites also need to be careful what they
are promoting botulinum toxin can treat. As stated on
the Advertising Standards Agency website: “The only
cosmetic use for which Botox is licensed is the ‘glabellar’
lines, which are the vertical lines on the forehead
between the eyes. This means that although Botox is
commonly used to treat other lines and wrinkles, it is
not licensed for that sort of use. Any claims, therefore,
that go beyond factual information representative of the
licence are likely to automatically breach the Advertising
Code.”6 The GMC advises against the use of botulinum
toxin advertising7 and I’ve known some practitioners
get around this by using the terms ‘muscle relaxing
treatments’ on promotional deal sites. Sites such as
Google also now bans ‘Adwords’ containing the use of
the word ‘Botox’ and also penalise users who openly
advertise it on websites.8
Although these sites are merely a purchasing platform
Reproduced from Aesthetics | Volume 3/Issue 4 - March 2016
aestheticsjournal.com
@aestheticsgroup
for prospective customers to browse deals, I
believe a significant percentage of clinics and
practitioners using these sites and carrying
out these discounted treatments are indeed
breaching their ethical and moral duty. Ethics
are breached if these procedures are carried
out by non-medically trained aestheticians
that may have had sub-standard training and
potentially use cheaper and poor variations
of the products, something I believe happens
through these sites.
The Keogh report – the Review of the
Regulation of Cosmetic Interventions –
considered time-limited deals to be ‘socially
irresponsible and should be prohibited by the
professional registers’ codes of practice’.9 It
also pointed out that financial inducements
and package deals were negligent. Patients
should have adequate time to consider the
information before agreeing to any cosmetic
procedure – something that time-limited
deals on voucher websites do not allow for,
meaning people aren’t properly consenting.
Conclusion
As a general ethos, I believe the use of
discount sites for promotion of aesthetic
Aesthetics Journal
Aesthetics
medicine has more negatives than
positives for a practitioner and clinic. From
a consumer’s standpoint, if you do some
detailed groundwork, you can attain a very
good deal with an astute practitioner, without
voucher websites, however this can be
hard to find. I would advise my peers that
we tell all potential consumers to approach
selected practitioners with caution, checking
practitioners’ credentials and registration with
leading bodies such as the GMC, NMC and
GDC, as well as direct customer reviews. I
would also advise practitioners to tell anyone
looking for cosmetic aesthetic treatments
in the UK to look beyond the financial
aspect of the deal and consider all risks
and implications, given the poorly regulated
sphere which these services are part of.
Usually, when patients come to me saying
they have found an ‘unbelievable’ low price
for a treatment, I tell them that more often
than not, there will be a distinct reason behind
this seemingly plausible offer and that, if they
choose to go ahead, they should do even
more to ensure all the prior points discussed
have been checked. As the old adage says,
you get what you pay for!
Dr Joney De Souza gained his
medical degree in Brazil and has
more than 15 years’ experience
in aesthetic and antiageing
medicine. A GMC-registered
aesthetic doctor and member of the British
College of Aesthetic Medicine, Dr De Souza
relocated to London in 2007 and has a skin
and laser clinic on Wigmore Street.
REFERENCES
1. Steiner, C. (2010) Meet The Fastest Growing Company Ever,
Forbes Magazine, August 30 issue
2. Christie, (2012) Online daily deals: good for the customer but
bad for business? Attacat Brain, http://www.attacat.co.uk/brain/
online-daily-deals-good-for-the-customer-but-bad-for-business>
3. Brignall, M. (2011) Groupon: cut-price deals… and customer
service, The Guardian <http://www.theguardian.com/
money/2011/nov/18/groupon-vouchers-readers-experiencessecond-class-service>
4. Casewell, L. (2013) Cut price cosmetic surgery: Why online
voucher sites aren’t offering you the best deal, Huffington
Post, <http://www.huffingtonpost.co.uk/laura-casewell/cut-pricecosmetic-surgery_b_3712075.html>
5. NHS, (2009) Cosmetic surgery ‘needs regulation’, <http://www.
nhs.uk/news/2009/11November/Pages/plastic-cosmetic-surgerybotox-filler-warning.aspx>
6. ASA, (2014) Taking a firm line – ASA rulings on Botox ads
<https://www.asa.org.uk/News-resources/Media-Centre/2014/
ASA-rulings-on-Botox.aspx#.Vqt7mFOLS34>
7. CAP, (2015) Marketing of cosmetic interventions, https://
www.cap.org.uk/~/media/Files/CAP/Help%20notes%20new/
CosmeticSurgeryMarketingHelpNote.ashx
8. Custwin, (2010) No more Botox in adwords – How will this affect
Google? <http://www.custwin.co.uk/custwin-blog/2010/06/nomore-botox-in-adwords-–-how-this-will-affect-google/>
9. Department of Health, (2013) Review of the Regulation of
Cosmetic Interventions, <https://www.gov.uk/government/
uploads/system/uploads/attachment_data/file/192028/Review_
of_the_Regulation_of_Cosmetic_Interventions.pdf>
Anatomical basis of Facial Rejuvenation
Anatomical Basis of Facial Rejuvenation with Dermal
with dermal fillers and management of
Fillers and Management
of Complications
complications
“wet lab”Wet-lab
This unique ‘hands-on’ fresh cadaver wet-lab is
a scientific, evidence-based course, aiming to
promote safe aesthetic practice amongst medical
professionals.
The course will cover basic, intermediate and
advanced safe filler injection techniques for the
forehead, temple, tear trough, superior sulcus, perioral
area and jawline. Delegates will be confident in the
management of filler complications (Tyndall effect and
overfilling) and be updated on expert protocols for
the management of vascular complications, based on
thorough anatomical knowledge.
This one-day simulation “wet-lab” will provide
small group, hands on practical training, so that
delegates will be confident in how to avoid and
complications wet lab" on 11th April 2016
complications
from non-surgical
filler
Mrs Sabrina Shah-Desai (MS, FRCS) – one treat
of the
UK’s leading
oculoplastic
treatments, based on a thorough anatomical
This uniquespecialising
"hands on" fresh
a
surgeons
in -cadaver
surgicalwet-lab
and isnon-surgical
peri-orbital rejuventation.
knowledge.
scientific, evidence-based course run by
"Anatomical basis of Facial rejuvenation
COURSE
with DermalDIRECTORS
Fillers and management of
recognized
clinical
Drinternationally
Beatriz Molina
– one
ofand
theanatomical
world’s leading
authorities
Course
Directors : and opinion leaders on
trainers, with the aim of promoting safe aesthetic
Sabrina
Shah-Desai
(MS, FRCS),
one of
aesthetic
medicine
and
vice president of theMrs.
British
College
of Aesthetic
Medicine.
practice amongst
medical
professionals.
Delegates will get a comprehensive understanding
of facial anatomical layers using cadaver
prosections and will practice anatomical surface
marking on fresh frozen cadavers, with an
emphasis on avoiding critical neurovascular
anatomy in upper, mid and lower face.
The “wet-lab” will cover basic, intermediate and
advanced safe reproducible filler injection
techniques for the most clinically relevant facial
areas (forehead, temple, tear trough, superior
sulcus, peri-oral and jawline).
Delegates will be confident in the management of
common dermal filler complications (Tyndall
effect, overfilling) and be updated on current expert
protocols for the management of vascular
complications. The wet-lab includes practical
sessions using Hyaluronidase.
UK’s leading Oculoplastic Surgeons specializing in
surgical and non surgical peri- orbital rejuvenation.
Dr. Beatriz Molina, one of the world’s leading
authorities and opinion leaders on aesthetics
medicine and vice president of the British College
of Aesthetic Medicine.
The course will take place at the West Midlands Surgical Training Centre
in Coventry on 11th April 2016
This course will take place at the West Midlands
Surgical Training Centre, Coventry on 11th April
2016. of attendance.
Course fee: £895 includes lunch, refreshments, teaching materials and a certificate
Email: [email protected]
Course Fee : £895 , includes lunch and all
refreshments, teaching materials, headsets & a
Certificate of attendance.
To learn more about the courses or to book your
place, email
Reproduced from Aesthetics | Volume 3/Issue 4 - Marchinfodermalfi[email protected]
2016
or [email protected]
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Date of Preparation: October 2015