UBT273 – PRINCIPLES AND PRACTICE OF NON- MEDICAL AESTHETIC THERAPIES

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<b>Developmentsofnon-medicalaesthetictherapies• Thedefinitionofnon-medicalaesthetictherapies</b>

• Chemicalskinpeeling• Cryolipolysis

• Laser/IPLhairremoval

• Laser/IPL/LEDforskinrejuvenation• Laserfortattooremoval

• Mesotherapytreatments• Microneedling

• Micropigmentation• RadioFrequency• Ultrasound

• Plateletrichplasmatreatments(PRP)

<b>• Thehistoryanddevelopmentsofnon-medicalaesthetictherapies</b>

There has been a substantial growth of non-medical therapies over the past years.Beautytherapistsandmedicalpractitionershaveextendedtheirskillsettoaddressskinconcernsofageing,acneandpigmentationwithadvancedmachinesandtherapiesthatgiveprovenresults.

Microneedling is a relatively minimally invasive procedure involving superficial andcontrolled puncturing of the skin by rolling with miniature fine needles. Over a shortperiodoftime,ithasgainedmasspopularityandacceptanceasitisasimple,cheap,safe,andeffectivetechniquerequiringminimaltraining.Traditionallyusedasacollageninductiontherapyforfacialscarsandskinrejuvenation,itisalsowidelyusednowasatransdermal delivery system for therapeutic drugs and vaccines. Pens and DermastampsbecametheclinicdeviceswithDermarollersbeingpurchasedforhomeuseasamaintenance treatment. Many new machines have recently been launched withadditionalnon-fractionalmicroneedlingdevicesdeliveringradiofrequency(RF)andhighintendedfocusedultrasound(HIFU)wavestothedeeperlayersoftheskin.

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The chemical skin peel, the concept of a topical solution to trigger the skin’s woundhealingprocesscanbetracedrightbacktoancientEgyptsomefourthousandyearsago.Forward-thinkingancientEgyptianswerereportedtouseanimaloils,saltandalabaster(a soft white mineral or rock, often used for carving) to regenerate skin for aestheticpurposes.Inanodtothedistantfutureofnon-surgicalaestheticsweknowtoday,theancientEgyptiansalsodependedonthelacticacidwithinsourmilkasanactivechemicalagentforexfoliation.

Today, popular peels usually involve either alphahydroxy or betahydroxy acid, withdeeper peeling agents used for specific conditions. While the science behind thesechemicalsissophisticateditssurprisinghowdirectthelinkistothepast.Alphahydroxyacid for instance forms the basis of many common treatments like the glycolic peel.AHAsincludelactic,citricandtartaricacids-allofwhichhavetheirrootsintheage-oldcosmeticuseofsourmilk,sourgrapesandcitrusjuices.Betahydroxyacidpeelslikethesalicylicpeelareusedtocontrolacne-harkingbacktotheancientIndianpracticeofapplyingwintergreen,anaromaticplanthighinBHA,tocontrolskinoil.

Skin peels today are highly refined - absorption rates, penetration and after effectscontinuetoimprove.Withongoingeffortstominimisetraumawhileenhancingresults,the skin peel is safer and more effective than ever. Many deeper and more complextreatments are the result of modern research - retinoic acid based peels and TCA forexampleare20thcenturydiscoveries-butthebasicsoftheskinpeelremainunchangedand our debt to the past, and to the long chain of trial and error which got us here,remains.

IPL and Laser Hair Removal Machines have been around since the 90's, theywereprimarilyusedforscientificpurposesandthenIPLevolvedandmadeitstransitionintotheAestheticIndustry.

After this transition the equipment was expensive and only the wealthy could affordwhat they thought was 'permanent' hair removal treatments; the treatments wereexceptionally painful and often were not successful.The technology evolved into lessexpensive technology, more refined and resulted in less expensive machines. Thisallowedforlaserhairremovalequipmenttomovefromhigh-end,high-browclinicsandclientsonly,tobeaffordableforthegeneralaestheticandbeautyclinics.Nextwasthede-regulationofIntensePulsedLightLaserHairRemovalTreatment,whichatthetimewasregulatedby the Health Care Commission (HCC) now called the Care QualityCommission.Thisde-regulationfacilitatedtheIPLTechnologytobeproducedandpricedmuch more affordable incomparison to previous years, along with cheap technologycame cheap companies who can supply equipment with only a Chinesetrainingmanual.Note: regulation by (RQIA)for laser and IPL equipment and clinics remainslegislationinNorthernIreland.

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<b>• Currentworkingenvironments:</b>

Treatmentsareperformedinsalons,aestheticclinic,medispa,medicalenvironmentsAesthetic therapies are now practised in skin clinics, beauty salons. Standards forworking environments rely on the professionalism of the practitioner. With newstandards being published from the Joint council of cosmetic practitioners (JCCP) thishasleadthewayforguidancetobeprovidedinordertoensurethatthecliniccomplieswith the best health and safety advice in order to promote professionalism and safepractice.

<b>• Therolesofspecialistpractitioners:medicalandnon-medical</b>

The roles of medial and non-medical practitioner can mix comfortably with oneanother.Medicalpractitionerscanhaveclinicaloversiteintheclinicandbeonhandifacomplicatedissuearisesaswellasgivingtreatingthemorecomplexskinissue.Non-medicalpractitionersarespecialisedintheirparticularareaandcandeliveroutstandingresults as they become more experienced in the modality that they are practicing inconstantly.

Medical Aesthetic Practitioners are qualified medical professionals and areregisteredwithagoverningbody.

v <b>MedicalTreatments</b>

The term “medical treatments” overlaps with nonsurgical treatment so can beinter-used when describing the use of injectables, deeper peels and moreinvasivetreatments.

v <b>Nonsurgical/Medicalaesthetics</b>

Non-surgical/Medicalaestheticproceduresdonotrequireasurgicalincisiontobe made and are usually considered minimally invasive. However, as with anymedical procedure, these treatments may have some side effects, especially ifthey’recarriedoutbypractitionerswhoarenotproperlyqualified.

Types of Non-Surgical Cosmetic Procedures: There are many types of

<b>non-surgicalcosmeticproceduresbutsomeofthemostpopulartreatmentsinclude:</b>

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• BotulinumToxinInjection• Dermalfillers

• DeepandmediumChemicalpeels

Everycouncilalsohastheirownstanceontheuseoftopicalanaesthetics.Someareokwithuspurchasingandusingtheproductonourclientsafterapatchtest,whilstothersprefertheclientstopurchaseandapplytheproductthemselves.TheMHRAalsostatethat it is down to individual councils and our insurers to use the product safely andlegally.However,theissueofusing'P'productsonlybecomesanissue,whenaclienthasareactionorsubsequentlydiesfromtheuseofsuch.

CanweuseOTC(overthecounter)topicalanaestheticslegally?Thelawaroundthisissimple, no we cannot. 'P' medicines should only be sold to the intended user. WhilstsomecouncilsandtheMHRAturnablindeye,itisarisknotworthtaking.Thebestandsafestsolutionistospeaktoyourclientaboutpaintoleranceanddiscomfortthatmaybe associated with your treatment. If you have a prescriber, then they can prescribecreamspecificallyforthemtouseortheclientcangoandpurchasethisdirectattheirlocalpharmacy.Theclientshouldapplythistothemselves20-30minutespriortotheirappointment.Theclientshouldalsosigntostatethattheypurchasedandappliedtheanaestheticthemselvesand/orarehappyforyoutoapplyit,ifitisforuseoneyelidsorotherareaswheretheymaystrugglewiththeapplication.

<b>• Theroleofclinicaloversightwithinnon-medicalaesthetictherapies</b>

Thisiswherearegisteredprescriberwilloverseeothertreatmentsintheclinic.Theywilltake accountability for the treatments delivered from the Non-prescriber. Thy mustunder their code of practice ensure that they are happy that the administratorisadequatelytrainedandisproficientinthemodalitythatareperforming.

<b>• TheKeoghReportandtheHEEQualificationStandards</b>

In2013thepreviousNHSEnglandnationalmedicaldirectorSirBruceKeogh'sreviewof

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the regulation of cosmetic practice was published (Department of Health and SocialCare(DHSC),2013).

The review stated that a person having a non-surgical procedure has ‘no moreprotection and redress than someone buying a ballpoint pen or a toothbrush’. It alsosurmisedthatdermalfillerswerea‘crisiswaitingtohappen’.

Keogh'sreportpresentedapictureofanareaofpracticewithoutdefinedstandardsoftraining, and without efficacy or safety data for the treatments and products beingprovided. It was clear that patients were rarely supplied with adequate informationabout the procedure(s) they were offered and, in the event of a complication; theyreceivedverylittleinthewayofsupport.

TheinitiativesproposedintheGovernment'sresponsetothereview(DHSC,2014)weredesigned to help develop and support ‘a high quality of care and an informed andempowered public’. In the first instance, Health Education England (HEE) was taskedwith developing ‘appropriate accredited qualifications for providers of non-surgicalinterventions’.

TheGovernment'sresponsestoppedshortofanagreementwiththeproposalthat‘allpractitionersmustberegisteredcentrallyonaregister,thatshouldbeindependentofaparticularprofessionalgrouporcommercialorganisation,andwhichshouldbefundedthroughfees’(DHSC,2014).Itdid,however,suggestthat‘clinicalinvolvementincertainnon-surgical procedures was key to improving standards of practitioners who are notmembersofaregulatedprofession’.

<b>• TheJointCouncilofCosmeticPractitioners(JCCP)</b>

ThisbodyistheJointCouncilofCosmeticPractitioners(JCCP)andisrepresentativeofallprofessionaldisciplinesincludingplasticsurgeons,dermatologists,aestheticdoctorsandnurses,dentistsandbeautytherapists.Assuchitmarksamilestoneinrecognisingandsecuringtheroleofbeautytherapistsandnon-medicalaestheticpractitionerswithinthemedispasectoraswellasinestablishingauniformityofqualificationandpracticeacrossall disciplines providing aesthetic treatment. One of the government’s stipulations incommissioningtheJCCPwasthatitmustestablishavoluntaryregisterofpractitioners,which all professionals working within aesthetics should join, irrespective of otherprofessional memberships. The resultant JCCP register is due to be ready foraccreditation by the Professional Standards Authority in June 2017 and officiallylaunchedinNovember2017.

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While at present this is not a legal or statutory requirement, it is intended thatmembership of this voluntary register will be implemented in the strongest sense bywayofindustryselfregulation.

These practitioners must be able to demonstrate that they meet Level 4 and aboveeducational and practice standards as described in the HEE Education and TrainingFramework as described below. To gain entry onto the register as an individualpractitioneryouwillneedaminimumqualificationatLevel4ineachtreatmentgenreyouwishtoprovideandyouwillonlyberegisteredforthelevelofpracticestipulatedwithin the qualification framework. For example, to provide superficial chemical skinpeelstotheStratumCorneum,aLevel4qualificationinchemicalskinpeelingwillberequired, while to peel down to the Dermal-Epidermal Junction will require a Level 6qualification.

<b>• TheCosmeticPracticeStandardsAuthority(CPSA)</b>

<b>• TheBritishAssociationforCosmeticNurses(BACN)</b>

The BACN is the largest Professional Association for nurses carrying out cosmetictreatments in the UK. It operates under a strictCode of Conductin order to ensurepatientsafetyacrossalltreatmentsundertakenbyitsmembers.

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v ToprovideservicesandsupporttoallofitsMembers

v TopromoteandsupportpatientsafetyintheareaofNon-SurgicalAestheticTreatments

The BACN is a ‘Not for Profit’ organisation owned by its Members and its Board iselectedonanAnnualCycle.

<b>• NationalInstituteforClinicalExcellence(NICE)</b>

NICE givesguidance, advice, quality standards and information services for health,public health and social care.they also provide resources to help maximise use ofevidenceandguidance.

Essential information for key groups including GPs, local government, public healthprofessionals,socialcareprofessionalsandmembersofthepublicisavailablefromheirwebsite.

<b>• BSIstandardsEN16844:2017</b>

This European Standard addresses the requirements for certain aesthetic non-surgicalmedical treatments:-treatments with resorbable injectables, botulinum toxin andmicro needling;-treatments with non-ablative fractional resurfacing and superficialpeels, lasers and comparable energy based devices;-treatments with fractionalablative lasers and comparable energy based devices and medium depth peels; andothertreatmentssuchasdeepchemicalpeels,fullablativelasersandthreadlifts.ThisEuropean Standard provides recommendations for aesthetic non-surgical medicaltreatments,includingtheethicalframeworkandgeneralprinciplesaccordingtowhichaesthetic medicine services are provided by all practitioners and stakeholders of theaesthetic medical field. These recommendations apply before, during and after thetreatment.Any aesthetic medical treatment that goes deeper than the stratumcorneum or which has, or claims to have, a biological effect beyond the stratumcorneum (with or without instrument or devices) is included in the scope of thisEuropeanStandard.AestheticsurgicalprocedurescoveredbyEN16372anddentistry)procedures are excluded from the scope of this European Standard.Aesthetic non-medicaltreatments(tattooingandanytreatmentnotaffectingtissuedeeperthanthestratum corneum) which can be legally performed by non-physicians (e.g. tattooist,beautytherapists)areexcludedfromthescopeofthisEuropeanStandard.

NOTE:Someoftheinformationsuppliedabovemayeitherbecomeobsoleteorchangedaccording to new reviews post Brexit. We will do our best to update you as soon aschangestakeplace.

Aaamed.org. (2021).Mission Vision and goals. [online] Available

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Brody, H., Monheit, G., Resnik, S. and Alt, T., 2000. A History of ChemicalPeeling.DermatologicSurgery,[online]26(5),pp.405-409.Availableat:

Aesthetic medicine has ahistory only of decades. The average person who requestsmedicaltreatmentisreferredtoasahealthyconsumer.Theirmainaimistoimprovetheirappearance.Thesepatientsarenottheconventionalpatientsfrombygoneyearsbutnowknownasa“consumerpatient”

Aesthetic medic e bridges the gap between beauty and health.A healthypsycho-physicalbalanceisimportantbutanypotentialpatientsmaysufferfromsomeformofpsychosomaticdisorder.Itisimportantthatthemedicalpractitionerrecognisesthisandinitiates the proper treatment plan. Aesthetic consideration encompasses bothnonsurgical and conventional medicine. Even sick patients want to look the best thatcanwhentheyaregettingbetter.

<b>Benefitsandlimitationsofcommonlyavailablenon-medicalaesthetictherapies• Blemishremoval(thermolysisandcryotherapy)</b>

AdvancedElectrolysisisminimallyinvasivesodoesn’tcauseanybleedingandonlyasmall amount of discomfort should be expected. The surrounding tissue is leftundamaged. Immediately after your treatment the targeted area may appear redandslightlyswollenandmayfeelwarm.Acrustmaythenappearonthesurfaceof

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theskinandweadviseallAdvancedElectrolysispatientsnottotouchthetreatedarea,butletthecrustsfalloffnaturally,whichshouldhappeninthenextweekorso.If there is a sensation of itching this is to be expected and is the body’s healingresponse.

Thread Veins are cosmetically disfiguring and can really affect our confidence.Thread veins are also often associated – usually incorrectly – with the stigma ofalcoholism. Although alcohol can be a contributory factor, as facial flushing cancausedamagetothecapillaries,(spicyfoodmayalsocausesimilareffects)itisnotthe cause. There are many reasons we get the tiny red capillaries seen on thesurfaceoftheskinthatwecallthreadveins.Mostofusaresusceptiblewithcausesranging from sun damage, ageing, hormones, hereditary and genetic causes,pregnancy, smoking, extreme sports and harsh weather exposure to name a few.Theyareverycommononamaturingfragile‘Englishrose’complexion.Rosacea(aswellasthemedicationforit)maybearelatedfactor,andthetwoconditionsoftenappearsimultaneously.

SpiderNaeviisacentraldilatedbloodvessel,withsmallercapillariesradiatingfromits’bodyresemblingthelegsofaspider.Foundasindividualblemishesorasgroupsthey will often appear as a result of a knock or minor accident to the area.Hormonesareanothercontributoryfactorandpregnancycanbeatimewhenmanyappearspontaneously.Sundamage,smokingandmanyotherfactorssuchasgeneticlinks can be a contributory factor. Usually, they do not appear until adult lifealthoughchildrencansufferfromthemaresultofaninjury.

SkinTagsarealoosefibroustissueskincomplaint,whichaffectssomanyofus.Theygrowinareasoffriction–underarm,underthebreastsoraroundtheneckwherenecklaces may irritate and even under any unwanted ‘rolls’. Once the first oneappears,otherswillfollowandsomesufferershaveover100varyinginsizefromagrain of rice to a kidney bean (or larger). Skin tags that cause irritation or arecosmetically unappealing may be removed safely, easily and effectively usingelectrolysis.

Miliaaresmall,white,oftenhardlumpsappearingonthesurfaceoftheskin.Aporebecomesblockedandthesebumwithinkeratinises.Electrolysisbreaksupthemilia,which then gradually become absorbed into the skin with no cutting or removal

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required. No definitive cause of milia is known although they are often related todiet with a high cholesterol count, excessive vitamin C, and too rich moisturisingcreamandarealsoassociatedwithdryskin,whichcanbeacidic.

Molesaresimplypigmentedgrowthsthatusuallyappearslightlyvelvety,butunlikefrecklestheyhaveadifferenceinappearanceandtexturetothesurroundingskin.‘Nanny McPhee’ moles are the typical growth that can be cosmetically disfiguringand can seriously damage an individual’s self-esteem and confidence. Usingelectrolysisandexpertknowledge,themolecanbeeasilytreatedandremoved.

Syringomaarefleshcolourcreamybumpsandlumpswhichappeararoundtheeyeareaandareoftenmistakenformiliabutdonotcontainahardkeratinisednoduleas milia do. They are benign noncontagious tumours of the eccrine gland and aresmall, generally oval shaped, often numerous in numbers, which can make themageingandunattractive.Exfoliationisunsuccessfulandelectrolysisisoneofthebesttreatmentsavailableforthiscondition.

SenileWarts/SeborrhoeicKeratosisarecalled‘SenileWarts’.Thesebrownmarksarecausedbynaturalaging,sundamageandhaveageneticlink.Theyareclassifiedwithinthewartfamilybutdifferinthefactthey’renotcontagious.Theycanstartlifeasjustatinydrypieceofskinonthesurfaceoftheskinwhichgrowslarger,crustierandugliergrowingasbigasuptotwoinchesacross.Theybecomeraisedandifyoufind one you are likely to get more. Sometimes they can almost cover the wholetrunkofthebody.Theycanalsobequitecommononthefaceinolderpeople.Theyare usually brown because of melanin and so can be mistaken for moles to theuntrainedeye.

<b>• Chemicalskinpeeling</b>

The type of chemical peel used depends on the nature of the skin problem to betreated. Skin problems that respond best to chemical peels are due to chronic sundamagefromultravioletlight.Sincemostskinpeelsdamagetheskin,thereisaperiodofrecuperationnecessary.Aswithanysurgicalprocedure,therearerisks,whichincludescarring,infection,andundesirablecolourchanges.Currently,dermatologistsoftenusechemical peels in conjunction with other destructive techniques like laser to diminishthesignsofsundamageoracnescarring.

Therisks,sideeffects,andcomplicationsofchemicalpeelsinclude:• Scarring

• Infection

• Reactivationofherpessimplexinfections

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• Substantialcontrastincolorationofthetreatedskin.

All patients will have a recuperation period, the length of which depends upon thedepthofthepeel.Deeppeelscanresultinsubstantialperiodsofhealingontheorderofweeks. Deep peels generally require extensive local anaesthesia, conscious sedation,andoccasionallygeneralanaesthesia,whichcarriesitsownrisks.

<b>• Cryolipolysis</b>

Cryolipolysis, commonly referred to as fat freezing, is a nonsurgical fat reductionprocedure that uses cold temperature to reduce fat deposits in certain areas of thebody.Theprocedureisdesignedtoreducelocalizedfatdepositsorbulgesthatdonotrespondtodietandexercise.Itisnotintendedforpeoplewhoareobeseorsignificantlyoverweight.

Whatsideeffectsaretobeexpectedimmediatelyaftercryolipolysis?• Painoraches

• Stingingortinglingoftheskin• Redness

• Swelling

• Skindiscolorationorbruising• Skinsensitivityornumbness

<b>• Injectabletreatments</b>

As Botox and fillers are different substances designed for different uses, they cansometimes be combined in one treatment. For instance, someone may use Botox tocorrectlinesbetweentheeyesandfillertocorrectsmilelinesaroundthemouth.

• Droopingoftheeyelidorbrowifinjectedneartheeye• Weaknessorparalysisofnearbymuscles

• Hives,rashes,oritching

• Pain,bleeding,bruising,swelling,numbness,orredness• Headache

• Drymouth

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• Flu-likesymptoms• Nausea

• Troubleswallowing,speaking,orbreathing• Gallbladderproblems

• Blurryvisionorvisionproblems

• Skinrash,itching,orpimple-likeeruptions• Redness,bruising,bleeding,orswelling

• Undesirable appearance, such as asymmetry, lumps, or overcorrection ofwrinkles

• Skindamagethatcausesawound,infection,orscarring• Abilitytofeelthefillersubstanceundertheskin

• Blindnessorothervisionproblems

• Deathofskincellsduetolossofbloodflowtothearea

<b>• Laser/IPLhairremoval</b>

<b>Advantages1. Legibility:</b>

<b>2. PreventIngrownHairs:</b>

<b>3. Savemoney:</b>

<b>4. Minimumside-effects:</b>

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<b>Disadvantages1. Takestime:</b>

<b>2. SkinBurning:</b>

<b>3. DoesNotSuitEveryone:</b>

As for the various skin types, this treatment is not suitable for everyone. Usuallydarkhairswithafairskinwillworkperfectlyinthisactionbutforfinepeachfuzzhair,thisisnotsoeffective.

<b>• Laser/IPLforSkinRejuvenation</b>

An IPL or Laser treatment uses the power of broadband light to minimize theappearance of age spots, sunspots, acne scars, rosacea, and more. IPL treatmentsgenerally take about 20 – 30 minutes. After the patient’s face is cleaned and dried,patientswillbegivenprotectiveeyeshieldstowearduringtheprocedure.Ahandhelddevicewillbepassedoverthetargetarea,deliveringpulsesofintenselighttopenetratethe layers of the skin. Most patients describe experiencing a fast, pinching sensationduringtreatment,withminimaldiscomfort.Thereisnoneedforinjectionsorincisions,givingpatientsthebonusofnodowntimerequired.

ImmediatelyafteryourIPLtreatment,thetreatedareaswillbeslightlypinkorredandswollen. These effects will begin to dissipate after 24 hours. You may noticediscoloration and sunspots turning somewhat darker or more noticeable, and otherblemishesmaybegintosurface.Thisisagoodsignthatthetreatmentisworking.Thesespotswilleventuallyflakeoffastheskinbeginstohealfromtheinsideout.

• Increasingcollagenproductionintheskin,whichgivestheskinitselasticity• Increasingfibroblastproduction,whichhelpsproducecollagenandothertissue

• Increasingcirculationbetweenbloodandtissuecells• Protectingcellsfromdamage

• IncreasingmRNAinthecells,whichhelpsstimulatethecell• Improvingfacialtexture

• Reducingfinelines

• ReducingwrinkleseverityLaserfortattooremoval

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