We reflect on a decade of publishing the Aesthetics journal and discuss the development of the specialty over this time
As we move into our tenth year in 2023, we take the opportunity to look back at the changes we have seen and consider how medical aesthetics will evolve over the next 10 years.
Editor and content manager Shannon Kilgariff comments on the trends she has seen over the years and shares her unique insight from working closely with both the companies developing new products, and the practitioners seeing the results in clinics throughout the UK.
You’ll also be able to learn more about the latest products and treatments following our aesthetic conference CCR on October 13-14. Our annual Trends Report will be available to the community following the event.
According to research, the aesthetics injectable market has grown by more than 10% annually and could grow by 12-14% a year over the next five years. Forecasts suggest that this is largely expected due to the expanding portfolio of dermal fillers and biostimulators.1 Each year, we are seeing new products being introduced to the market and exciting new studies looking into ways to improve the skin from within.
Kilgariff says, “Focus has shifted from treating the symptoms of ageing and instead is aiming to address the cause. Over the past couple of years, it’s been fascinating to learn more about biostimulation products – each work in their unique way and provide practitioners with a new tool to tackle ageing. It’s going to be interesting to see which ones take off and become the most successful over the next few years. Some of the brands I’ve been keeping an eye on include HArmonyCA from Allergan, Juvenus from Croma-Pharma and Plenhyage XL from DermaFocus.
The toxin market has also been experiencing big changes. While not much progressed in the first half of the decade, new toxins have been under development for the past few years. Just last month, Daxxify from Revance Therapeutics was approved by the US Food and Drug Administration, with clinical studies suggesting that results can last up to nine months.2 We’ve also seen the introduction of Letybo from Croma-Pharma, Alluzience from Galderma and Nuceiva from Evolus.
“With topical toxins in the works as well, it’s going to be an interesting few years,” says Kilgariff, adding, “At the moment it seems practitioners are still unsure whether topical toxin will be as effective as the injectables we’re familiar with. I’ll be keen to see whether they stick to the brands that they know, and provide proven results, or try something new!” Threads have also grown in popularity. While they’ve been around since the 80s, better products and techniques have led to improved results with less pain and downtime. Serving a different purpose to that of dermal fillers, practitioners highlight that threads can offer a decent amount of lift to anchor and reposition tissues, while stimulating collagen production.3
Kilgariff says, “It was great to see the introduction of tighter regulations for thread lifts back in 2018. Any medical-led clinic performing a thread lift must be registered with the Care Quality Commission (CQC) or their nation’s equivalent, which enhances safety for patients, and is something I’m sure we’d like to see much more of over the coming years.”4
Whether you want to tighten, rejuvenate, contour, heat or freeze, in 2022, there is an energy device for you.
The global market size was worth US $2,661.6 million in 2021, with forecasts suggesting this will rise to US $6,326.2 million in 2030 – a growth rate of 10.1%.5 “While huge numbers are mentioned here, this is unsurprising news. For the last few years, we have seen new devices launching regularly thanks to the rapid development of new technology and consumer awareness of these products increasing. Patients appreciate the minimal downtime and fantastic results that they can offer,” says Kilgariff.
As of 2021, lasers were the most popular energy-based device, holding around 40% of the market share. According to reports, this is largely attributed to the widening capabilities of lasers – from rejuvenating skin, to removing hair.5
The last few years have also seen electromagnetic devices increase in popularity, with a number of new devices, such as EMSculpt Neo and truSculpt Flex, launched here in the UK. Research suggests that this market is anticipated to see the highest growth over the next few years.6
Additionally, increased availability of home-use devices is expected. Kilgariff comments, “We are starting to see this, particularly with at-home light-based devices becoming available over the past few years. Some brands include Dermalux Flex MD and Celluma HOME. I just hope that companies don’t comprise safety for money when it comes to adapting their technology. It’s also imperative that, if being sold through clinics, practitioners are investing in and recommending well-researched products, rather than selling cheaper counterfeit devices that do not meet safety and result standards.”
In 2013, the global skincare market was worth US $103 billion, while in 2023 it is set to bring in US $ 171.7 billion.7 More locally, anecdotal reports suggest that lockdown led skincare sales to boom in the UK.
Kilgariff explains, “Reports from practitioners suggested that the ‘Zoom Boom’ led to consumers becoming more aware of their skin quality as they spent so much time looking at their face through video calling. Interest in aesthetic procedures soared, but of course clinics weren’t open to address concerns. Instead, practitioners were recommending skincare so patients could take action at home, which helped users recognise the value of sticking to a good skincare routine and investing in products that work.”
Alongside this, online consultations began to grow – saving time for both practitioners and patients. Moving forward, Kilgariff has heard from many practitioners who say this digital communication has transformed their practice. “It means practitioners can see patients from further afield, as well as fitting in more appointments. But practitioners don’t have to utilise the extra free time it allows specifically for work – the pandemic helped lots of people reset and consider what a good work/life balance means to them. I’ve seen many practitioners move towards prioritising their own wellness, as well as their patients’, which surely can only be a good thing,” she says. The last 10 years have seen the growth of skin analysis devices too; a useful tool to demonstrate to patients the extent of their skin damage, get them on board with treatment and review progress. Having one of these devices, such as VISIA Skin Analysis, OBSERV or LifeViz, can make a clinic stand out from the crowd.
Kilgariff says, “As consumers, we don’t like to be sold to anymore! Instead, we want to conduct our own research, with the help of credible advice, and see the value of investing in something for ourselves. Skin analysis backs up a practitioner’s recommendations by showing us evidence and demonstrating results. I expect these devices to become more popular over the coming years.”
We all know that the most important part of everyone’s skincare routine should be SPF application. While this advice has not changed in the past 10 years, are consumers still getting the message? In 2012, a survey found that 13% of Brits regularly use tanning oils with SPF factors of 10 or less, while only one in four use SPF 30 or above.8 While we don’t have exact comparisons, research suggests that not much has changed – in 2022, 45% of over 50s said they rarely use sunscreen in the UK.9
Skin cancer rates continue to rise, according to Cancer Research UK, with a drop only seen in those aged 0-24. Since the early 90s, for those aged 25-49 rates have increased by 67%, in 50-59s they’ve increased by 102%, in 60-69s they’ve increased by 158%, in 70-79s they’ve increased by 236% and in 80+ skin cancer rates have increased by 218%.10
Kilgariff says, “Anecdotally, practitioners say that there is more appreciation for suncare, but these statistics suggest there’s more that needs to be done. Aesthetic practitioners are perfectly placed to educate patients on the importance of SPF, highlighting both the impact on ageing and, most importantly, the skin cancer risk.”
What were we doing to promote and champion diversity 10 years ago? Looking back, adverts, publications, events and marketing materials featured largely Caucasian faces and many noted that clinical research lacked representation of black, Asian and ethnic minority patients. The Black Lives Matter movement in 2020 had an impact. Along with the Black Aesthetics Advisory Board (BAAB) and the Black Skin Directory, we took matters into our own hands. We ran surveys to investigate the experiences of black practitioners and consumers, as well as practitioners from other ethnicities, to better understand their views on the representation and treatment of skin of colour in general.
Statistics were revealing. The majority of respondents (92%) said they felt comfortable approaching diversity in their clinics, despite the fact that comments suggested they were scared to say the wrong thing and felt they needed better training and guidance on treating skin of colour, and acknowledged that more literature on treating darker skin was needed.11
Sadly, 84% of black practitioners said they did not feel well represented when attending aesthetic conferences, 70% said they did not think they had a fair shot of becoming a key opinion leader, and seven out of 10 black patients said they had difficulties in finding practitioners confident in treating their skin.11
Kilgariff says, “Carrying out these surveys was absolutely necessary and really helped start an important conversation. To build further awareness, we published the results throughout the Aesthetics journal and website, turned the stats into serialised social media posts across our platforms, and hosted Instagram Lives discussing the outcome and actions with BAAB board members. Of course, we looked at changes we as an organisation could make, while providing guidance and training to our employees. Simple things like using stock images of patients of all races and ensuring clinical articles noted considerations for treating skin of colour were just small changes we made.”
She continues, “On a larger scale, we focused on reaching out and engaging with more diverse practitioners; ensuring we provide writing and speaking opportunities for all, while encouraging everyone to enter The Aesthetics Awards and gain the recognition they deserve. We endeavour to continue this work and hope that over the next 10 years, all practitioners feel represented, regardless of their skin colour!” Kilgariff adds that diversity is a key part of a wider conversation for parent company of Aesthetics & CCR, Easyfairs, which has initiated a huge focus on Environmental and Social Governance (ESG) and is treating this as a priority.
In our first issue in 2013, our Aesthetics journal headlines included ‘Stopping the Cosmetic Cowboys’ and ‘A Third of Brits Undergo Cosmetic Surgery Abroad’.12 You may read these and think, ‘Hey, not much has changed!’ But is that fair?
Of course, regulation isn’t where we want it, but the last 10 years have seen positive steps forward. Organisations such as the Joint Council for Cosmetic Practitioners, British College of Aesthetic Medicine and British Association of Cosmetic Nurses are working hard to provide guidance and support to enforce regulation, while Healthcare Improvement Scotland introduced regulation of private clinics in the country back in 2016.13
In 2021, the Botulinum Toxin and Cosmetic Fillers (Children) Act came into force,14 while earlier this year we saw the introduction of the Health and Care Bill 2022, which aims to apply a licensing scheme for practitioners working in England.15
Kilgariff comments, “For now, all this means is that the Government has the power to introduce a new licensing scheme to regulate premises and practitioners, but we have no timeline for when this will be developed and introduced. Regardless, it’s promising to see steps moving forward!”
Over the last 10 years and as we move forward into the next decade, we are seeing much greater focus on complication prevention and management from training providers, manufacturers, associations and organisations. There’s also now lots of discussion around using ultrasound to aid placement of injectables and support complication management. Although Kilgariff points out that the advice from experts in this area is that practitioners should not be relying on ultrasound to help them with their work, she says, “Sound knowledge of anatomy and complication management should always come first – this is what I’m hearing at conferences on the subject.”
Kilgariff adds, “In general, the work being done by all to prevent complications is incredible,” says Kilgariff, highlighting that her team has also been committed to enhancing understanding and knowledge. She says, “All of our articles provide safe practice advice, with a discussion of potential side effects and complications as standard. We also host the Aesthetics Complications Expert (ACE) Group World conference at CCR, as well as seeking evidence of complication protocols for all Aesthetics Awards entries.”
As evidenced over the past 10 years, medical aesthetics is an ever-growing market with hundreds of exciting technologies being developed, and thousands of new practitioners emerging every year.
While this brings opportunities for individual growth, Kilgariff emphasises that it is imperative we take the advice of the practitioners outlined earlier and be cautious before jumping into anything new too fast. She concludes, “The sentiment echoed by our Clinical Advisory Board is to do your research, focus on your area of expertise and always stay safe. You don’t have to have the biggest clinic, offering every treatment under the sun – do what you do well, build trust and you will naturally gain loyal customers who recommend your services and keep coming back for more.”
Mr Adrian Richards, consultant plastic surgeon (AR)
Dr Souphiyeh Samizadeh, dental surgeon (SS)
Dr Stefanie Williams, board-certified dermatologist (SW)
We chat to three of our long-standing Clinical Advisory Board members for their thoughts on our specialty’s development...
SS: Awareness of complication management was almost non-existent 10 years ago, whereas our knowledge now is outstanding. It’s great to see so many training companies prioritising this, as well as conferences and publications like the Aesthetics journal, educating attendees and readers on complication prevention, as well as management.
SW: Thankfully most good practitioners have come away from chasing isolated lines and wrinkles, as was the case 10 years ago, and are instead treating the face as a whole.
AR: This will sound a bit weird, but it was probably lockdown in 2020. I’ve been operating for 38 years and it’s been full on, all of the time. Lockdown gave me the opportunity to try new things and I spent a lot of time engaging with colleagues and sharing knowledge online – I did more than 150 Instagram Lives and started a podcast; it was a lot of fun and great to chat to practitioners from around the world in depth and learn new things.
SW: I’m glad to see us move away from trying to make our patients look younger at any cost, but instead try to make them look like the best version of themselves. Whatever their age, it’s good to embrace the changes that come with it, rather than fearing them. We still have a way to go though!
SS: The move towards regenerative medicine is really exciting. While it’s still in its infancy, it’s great to see new products coming to market using a combination of hyaluronic acid and various biostimulators, which move away from simply filling or correcting a concern, but instead focus on treating the cause.
SW: I’m excited about a more holistic approach to aesthetic medicine going forward. For example, the integration of mitochondria support treatments such as intermittent hypoxia/hyperoxia, rather than just treating the skin’s surface in isolation. Hopefully we will see many more systemic treatments appear that support both the skin and general health.
AR: For me as a breast surgeon, the advancements in imaging and ultrasound are getting so much better. I do a lot of 3D simulations, so it’s fantastic that people can see how they may look with different types of implants and I’m excited to continue working with this. It’s also great to see techniques continually improving and implants becoming safer.
AR: New trends and ensure they think analytically. Don’t just go for the first thing that comes along. I always say, think if you or your family were the patient, what would you do? Never do anything that you wouldn’t want done to you.
SS: Always go back to basics. People sometimes get super excited about new treatments, without properly understanding what they do. Think first about patient care, anatomy and pharmacology; this way you will gain the respect and trust of your patients.
SW: Don’t blindly jump on the next bandwagon. Closely look at the evidence behind treatments, before exposing your patients to them. We should also be more aware of the high incidence of BDD in our patients and should protect them from treatments that they don’t benefit from.
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