As 2014 draws to a close, Aesthetics speaks to practitioners working across the UK to reflect on the developments, achievements, and problems faced by our ever-changing industry
Aesthetics is the most exciting medical field to be involved in at the moment, according to Dr Christopher Rowland Payne. He says, “Innovation, research and development are mirrored by growing public interest.” Dr Raj Acquilla agrees, claiming that medical education in aesthetics is the best he has seen in a decade. “Our understanding of facial anatomy, and therefore injection strategy, has never been better,” he says. “This further optimises aesthetic outcomes and reduces adverse events.”
One of the key developments that Dr Acquilla has noticed this year is the advancement in Hyaluronic Acid (HA) filler technology. This thought is echoed by Dr Britta Knoll, who says one of her favourite tools of 2014 is a filler delivery system, which she claims allows her to inject deep volumes of HA very comfortably. Dr Acquilla adds, “Low molecular weight products with high cohesivity allow for superior tissue integration and lifting capacity using low volume injection. This generates excellent results whilst minimising risks to the patients.” Dr Rowland Payne explains that this year, he has preferred administering filler with cannulas rather than needles. He says, “Flexible fine cannulas (e.g. 27 gauge) offer safety advantages over needles as they greatly reduce the risk of arterial embolization. They also offer improved possibilities for soft filling of the cheeks, as well as other sites.”
Dr Rowland Payne also notes that thread lifting, although not a substitute for a facelift, is a major advancement in the non-surgical domain and is becoming increasingly accessible. Dr Sarah Tonks agrees, explaining, “They are a great alternative to dermal fillers if there is more tissue descent than you would correct with filler alone.”
2014 has been the year of the “natural look”, according to Mr Adrian Richards. He says, “Our clients are asking us to help them look naturally fresher and we have noticed a trend towards more natural lip shapes.” He adds that the 8-point facelift has helped achieve this, as patients are focussing less on single areas and more on creating a balanced look and improving their skin overall.
The development of skin and subcutaneous tightening is also something that Dr Rowland Payne has recognised. He believes that the technology to treat this is continuing to improve. Dr Johanna Ward, however, believes that the technological issue of IPL and laser regulation has been completely ignored in 2014. “These powerful machines remain unregulated and are therefore potentially able to cause harm. Cheap machinery continues to flood the aesthetics market with few safety standards and little empirical evidence of efficacy,” she says.
Whilst there have been many positive developments this year, regulation is still a substantial issue amongst practitioners, with some agreeing with Dr Ward that not enough has been done since the Keogh Review took place last year. Dr Rita Rakus explains that, for her, the rise in certain discount websites is a problem for the safe regulation of the industry. She believes that the lack of consultation with an appropriate practitioner is not acceptable. “A consultation will ensure that the customer is booking in for the correct treatment that will address their concerns – otherwise the desired results will not always be achieved.” Dr Rakus explains that aftercare is also an important part of any procedure. “Due to the treatments being booked through a third party, if there is a problem, it can be hard for the customer to communicate this with the correct person.”
Dr Tonks believes that the Health Education England (HEE) proposed educational and training framework for their report: Non-surgical Cosmetic Interventions and Hair Restoration Surgery, has been a missed opportunity to implement tighter regulation. “Although we now have a training structure, in my opinion, we are going to be training the wrong people. The field has been opened up to anyone without a medical background to start performing procedures, which is pretty much where we are at the moment anyway.” Sharon Bennett, however, argues that the HEE framework is a step in the right direction. “It is hoped that some form of control will be put on those who are non-medically qualified when delivering non-surgical treatments,” she says.
In addition, Dr Ward argues that misadvertising has continued in 2014 and there is lot of consumer confusion as to what treatments are safe and effective. “Practitioners have a duty of care for patients and need to be offering neutral, unbiased advice about treatments that help guide patients to make sensible and educated decisions about aesthetic treatments,” she says. “There is still a lot that individual practitioners can do to raise standards in the industry. Most importantly, we can all insist on buying products, treatments and machines that are of the highest quality to ensure patients are receiving the best possible aesthetic care.”
Despite the negative aspects of the industry, Dr Sam Robson celebrated the fact that appraisal and revalidation will be extended to aesthetic nurses next year. She says, “Having been appraised every year since 2004 has really helped me focus my education and practice so that I remain safe, accountable and up-to-date.” She argues that introducing the regulation, set out by the Nursing and Midwifery Council (NMC) as mandatory practise, will ensure that the consequences for not engaging with its content cannot fail to improve standards.
Dr Knoll explains how, for her, the highlight of 2014 was the Monte Carlo Anti-Aging Medicine World Congress (AMWC). “There was a huge number of international visitors with plenty of new products and techniques for minimally-invasive aesthetic procedures available,” she says. “My wish for 2015 is that there is more practical training available in congresses; not only for selling activities but to offer practitioners good, scientific, clinical education. Economic success yes, of course, but safety comes first!”
“My wish for 2015 is that there is more practical training available in congresses; not only for selling activities but to offer practitioners good, scientific, clinical education. Economic success yes, of course, but safety comes first!”
Sharon Bennett agrees, saying, “The fantastic conferences and expos throughout the year are a constant source of education and networking, and our specialism is at last being recognised,” She adds, “The requirement and hunger for research and evidence – in all we do – has triggered the imagination of many and we are now starting to see a trickle of well researched, evidence-based papers, and consensus on areas such as complications, becoming available.” In regards to 2015, Bennett suggests that the biggest area of change will be a stronger focus on health and wellbeing. “Today’s men and women want to feel healthy as well as looking good. Our work won’t just be with fillers, toxins and lasers, I believe there will increased demand for supportive anti-ageing medicine, bio-rejuvenation and hormone management.”
It is clear that, despite its challenges, this year has been an educational, exciting, and enthralling year for everyone involved in medical aesthetics. As we look toward the new year, we hope that it will bring further success and happiness to both practitioners and patients. To conclude, Dr Ward expresses her hope that aesthetic practitioners continue to work tirelessly to deliver standards of clinical excellence for all patients. She says, “I hope that we can all come together and work towards a more ethical, regulated and clinically sound industry in 2015.”