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Regulation in the Aesthetics Industry – Dr Aicken

Recently there has been a lot of media coverage, interest and speculation regarding the regulation of all those who practice non-surgical aesthetics. At Visage Academy, we train all individuals that meet the criteria for Aesthetic Insurance and ensure that they are trained and assessed  in line with Health Education England guidelines. Since 2014, we have also included comprehensive training in complications management; something I’m pleased to say that some other training academies have since included in their courses. Although our trainees come from a variety of professions and therefore have varying training requirements, we treat all of our students with the same level of respect and provide them with ongoing support. Our aim is to train all of our students to be safe practitioners who can recognise complications and manage them responsibly and effectively.   Myself and Visage Academy wholeheartedly support moves to regulate the non-surgical aesthetics industry, but believe this should incorporate an inclusive register that seeks to support all safe practitioners, regardless of their entry route into the specialty. Excluding one or more groups from such regulation can only undermine patient safety and cannot be justified with the logical fallacy that certain groups are ‘not well enough trained already to be trained now’.   There are bad practitioners in aesthetics on both sides of the fence and we need to have a robust system to deal with these practitioners medic or non-medic, swiftly and in a manner than enhances public confidence in our profession.   I will continue to work with colleagues and welcome engagement from any other interested parties who share my viewpoint to make aesthetics...

Hyaluronidase & Vascular Occlusion Update 2019

In April 2014 I wrote a blog post called ‘Holy Shit, It’s Filler Blindness!’. I felt at the time that the post was needed as there was a lot of fear in the industry about the newly infamous filler-related ischamia of the skin or retina, potentially resulting in the need for a skin graft or even worse, sudden, irreversible blindness. My post was based upon the ‘Expert Consensus…’ (see below) and we went on to use their proposed protocol, with some adaptation as the basis of our hyaluronidase / hyalase assessment station on our training courses. The blog post still gets more hits than anything else on our websites, BUT, ‘expert advice’ has changed regarding the management of dermal filler-related skin ischaemia and blindness since then, and also, we now have a peer-reviewed and evidence-based document. Here’s a quick update (skin ischaemia > blindness). QUICK LINKS: CONSENT FORM for hyaluronidase AFTERCARE SHEET for hyaluronidase February 2014 Aesthetics Complications Expert (ACE) Group. The Use of Hyaluronidase in Aesthetic Practice Summary: Use 1.5-30 units hyalase for skin ischaemia, depending on the size of the effected area. March 2014 Expert Consensus on Complications of Botulinum Toxin and Dermal Filler Treatment. Inglefield, Collins, Duckett, Goldie, Huss, Paun, Williams (March, 2014). Part funded through an unrestricted educational grant from Merz Aesthetics UK). Not available online. Summary: Use 30 units of hyalase for all incidences of skin ischaemia. 4 years ago (no date recorded). Facecoach: Dissolving Hyaluronic Fillers A video explanation March 2017 Aesthetic Surgery Journal, Volume 37, Issue 7, 1 July 2017, Pages 814–825 Summary:Use 500-1500 units hyalase for skin ischaemia, depending on the area of skin affected. Larger...
Can my Client on Immunosuppressants get Aesthetic Treatments?!

Can my Client on Immunosuppressants get Aesthetic Treatments?!

We have the general day-to-day Q&A’s as practitioners, prime example being “I’m pregnant, is it safe for me to have anti wrinkle treatment?” but then every so often we stumble upon clients in slightly more rare circumstances than the usual and it’s why we have a thriving practitioners group on Facebook where expert opinions, advice and knowledge is shared from practitioner to fellow practitioners. Recently someone posted the following question: Can a patient on immunosuppresants for a kidney transplant, receive anti-wrinkle injections and / or filler? We think this answer to this case, although rare, is something that is worth sharing outside of the group, so here it is! The issue with this clients situation is that they are on immunosuppressants to stop their body rejecting the transplanted kidney. From the outset we know anti wrinkle injections isn’t an issue – we don’t think many practitioners would disagree with that. However, Dermal Filler treatment is potentially an issue as it remains in the body for 6-18 months, depending on the product and the area injected. If an infection develops with filler, it can be tricky to treat, requiring several strong antibiotics for a long period. Filler infection is fairly rare, but I  have seen it twice and it can be difficult for the patient to cope with because of the side effects to the antibiotics and due to the fact that the face gets inflamed which can’t be covered up. Being on an immunosuppressant makes it more likely that they could get an infection. So in summary, we say – yes to anti-wrinkle injections and maybe to filler. As...
The Nefertiti Facelift & Working with Platysmal Bands

The Nefertiti Facelift & Working with Platysmal Bands

Did you know that you have four Platysmal Bands? You have two on each side. What are Platysmal bands? Wikipedia describes Platysmal muscle this way – “The platysma is a superficial muscle that overlaps the sternocleidomastoid”… The platysmal muscle covers the upper part of the chest and shoulders rising to the sides of the neck. So now that we’ve cleared that up… we can imagine the process of aging in this area which is situated below the jawline and along the neck area. Usually we picture the aging process as the skin ‘drooping’ and loosing elasticity. However the same is not to be said about the Platysmal Bands – these bands actually tighten over time which forms prominent lines at the front of our necks. Enter the Nefertiti Facelift. It is most common for only one or a couple of the bands to become more prominent, causing the tenting out at the neck which affects the cervico-mandibular angle (the angle of your chin to neck). So how do we treat this problem area for so many? We hear from Dr Michael Aicken, founder of as well as trainer and practitioner at Visage Aesthetics U.K. – First up:  “Ask your patient to tense up and relax from the sides and identify which one(s) are causing the issue…” Next:  “Inject Anti-wrinkle toxin down the muscle band, directly into it by grabbing it like a rope between your finger and thumb. No anaesthetic cream is best as then it isn’t slippy,  (this area is not usually tender anyway). 4 units Anti Wrinkle Toxin (Allergan) or 5 graduations of a 1ml insulin syringe if you trained with Visage Academy /...

Large Swelling Immediately After Dermal Filler Treatment

Imagine that you have just injected a patient’s lips or cheek. Suddenly, the area swells up like nothing you have ever seen before. It’s an unfamiliar sight… you panic… you vaguely remember about some of the rare but catastrophic complications of dermal filler. You reach for your emergency filler pack. Should you do that? Are you sure? Skin ischaemia is now a complication of dermal filler treatment that most practitioners are aware of but thankfully, few have experienced it first hand. With an estimated incidence of 1 in 1 million, in an industry still experiencing record growth rates, the occurrence of dermal filler related skin ischaemia and many other complications are bound to increase. Haematoma formation (a large, swollen bruise) is another, more common and less severe complication of dermal filler; one that differs from skin ischaemia is almost every possible way, is frequently being misidentified as skin ischaemia by aesthetic practitioners from various medical and non-medical disciplines. Whilst it is vitally important that aesthetic practitioners identify skin ischaemia and take action if they suspect this, it is also important that misdiagnosis is avoided so that perceived rates of skin ischaemia are not inflated and that unnecessary stress is not brought upon these practitioners and their patients. So, what’s the difference? Ischaemia would be white and painful and not associated with swelling. If you see swelling develop before your eyes, you may have hit a blood vessel, causing a haematoma / large bruise. It may not look discoloured like a bruise *YET*, but this may just be because the bruising is so deep that you can’t see it through...

Lipstick Lines (Smoker’s lines): A Quick Guide for Practitioners

Lipstick or ‘smoker’s’ lines can be tricky to treat. They are relatively difficult to access because the nose gets in the way, and it’s difficult to get yourself and the patient into a comfortable position so that you can concentrate on the treatment itself AND when you’re finished, initially, the lines may look worse than when you started! So how do you do it? Lipstick line filler gives ok results if done well. It’s tricky. I recommend using strong anaesthetic gel as it’s a tender area. It can also bruise; remember that each time you insert the needle, you cause more trauma. If the lines are below the nose, approach from below if the lines are lateral to the nose, approach from above. Use a max of 0.4 ml for top lip lipstick lines. If you try a treating a line twice and it still hasn’t lifted, it’s probably better to leave it rather than risk giving them a thickened top lip. Avoid injecting into the lip (i.e. Below the vermilion border), to save on causing unnecessary swelling. Mould the area afterwards to limit the lumps that you leave behind. Be aware, and advise the patient before you start, that initially the lines may look WORSE as they will be highlighted by pink / redness, from the injections themselves. Reassure the patient that on covering with their regular makeup regimen the following day, the true effect of treatment will be seen. I use Dermal Revolution (DERM) now for lipstick lines, but again, remember that no-matter what product you use, apply a strong anaesthetic gel liberally before...