NEWS AND ANALYSIS

Evidence review suggests serious toxin complications widely under–reported

One in six botulinum-toxin patients suffer side effects or more serious complications, says a new study, with cases likely vastly under-reported.

Research findings from a review of global evidence undertaken by four doctors and academic researchers – three of whom are plastic surgeons – at the Royal Free and St Thomas’ hospitals in London, show a 16% complication rate with toxin injections, according to The Observer, with which the findings were exclusively shared.

Side effects including bruising, headaches, nausea and “frozen” facial features were most widely reported in the evidence reviewed by the researchers, with more severe complications such as muscle stiffness, pain, dizziness and heart attack also apparent.

The team analysed 30 studies involving 17,352 injections of botulinum toxin into the face. Localised skin reactions or bruising (5%), headache (3%) and facial paralysis (2%) were found to be the most common adverse reactions.

While medical aesthetic professionals are well aware of the possible side effects and complications of toxin treatment, the report’s authors were mostly concerned with the disparity between the high number of incidents that occurred and that which were actually reported to the MHRA (Medicines and Healthcare products Regulatory Agency). The researchers found that only 188 “adverse reactions” were reported.

Lead author of the study Dr David Zargaran told The Observer: “I was surprised to find such a low number of incidents reported to the MHRA. It was surprising as it equates to less than 10 adverse events a year across the UK. I believe the MHRA database of complications is a significant underestimate of the total number of complications.”

Of the adverse reaction reports submitted to the MHRA between 1991 and 2020, the 188 patients had experienced a total of 481 side effects between them, suggesting that frequently, more than one side effect is experienced at the same time. In 28% of the MHRA reports the patient had flu-like symptoms or a chill, while in 27% they had a headache or migraine.

25 reports – one in eight – recorded cardiovascular symptoms ranging from high blood pressure to an abnormally fast heart rate and heart attacks. Small numbers also suffered an anaphylactic reaction or wound infection such as cellulitis. These exact numbers are as yet unreported.

Brits don’t spend long enough researching aesthetic treatments

Brits considering aesthetic treatments don’t spend enough time researching them beforehand, suggests new research. The research comes from aesthetics pharmacy and supplier Primed Pharmacy, which says people should spend at least three hours researching the clinician, clinic, materials used and price of a treatment before even having a consultation.

The findings revealed how long Brits take to look into a range of treatments, from botulinum toxin to weight-loss injections, and also revealed that aesthetic treatment searches saw an increase from March 2021 to August 2021, with searches for “aesthetic treatments near me” rising by 60%.

According to the study, the more invasive aesthetic treatments are what Brits spend the most time researching before booking:

1. Botulinum toxin – 2.8 hours

2. Weight-loss injections – 2.7

3. Other fillers (cheek, under eye, nose) – 2.5

4. Lip filler – 2.4

Older age groups apparently spend over the average time looking into aesthetics treatments, with 55–64-year-olds spending on average 3.7 hours researching botulinum toxin, while over 65s spend three hours researching weight-loss injections.

Qadir Hussain, chief executive at Primed Pharmacy, said, “We have heard of many stories of aesthetic treatments ‘gone wrong’ over the last few months, and so it’s important to remind people of the risks involved with booking an aesthetic treatment without carefully researching the treatment itself and the clinic that delivers the treatment.”

Laser hair removal is most popular aesthetic treatment for PCOS sufferers and helps boost confidence

To mark PCOS (polycystic ovarian syndrome) Awareness Month in September, London clinic group Pulse Light Clinic conducted an exclusive survey for Aesthetic Medicine among its patient base who suffer with the condition.

Aiming to gain insight into the most common symptoms and how aesthetic treatments can help – and to spread this awareness to other sufferers – the survey was answered by 60 women.

Excess facial and body hair was identified as the most common symptom, with 78% of respondents giving this answer. Next was weight gain (55%), irregular periods (55%), thinning hair or hair loss (33%) and severe acne (20%). 65% said they had sought aesthetic treatments to help with their symptoms, with laser hair removal the most popular – 75% of respondents said they’d had the treatment.

Food intolerance tests and laser facials were among the other answers given. 72% of respondents said these treatments helped ease their symptoms, and 80% said they had helped with their confidence.

Laser hair removal can permanently remove excess hair caused by PCOS without the skin irritation of other hair-removal methods. Excess hair can often appear on the jawline, sides of the face, chin, neck, upper lip and bikini line in PCOS sufferers.

BCAM forms new regulatory committee focused on standards

The British College of Aesthetic Medicine (BCAM) has formed a new committee to spearhead its work in the areas of regulation and ethics in aesthetic medicine. The new committee will inform and advise BCAM’s board of trustees.

Chaired by Dr John Curran, who will support the College with his expertise and experience in this complex and challenging area, the BCAM Regulatory, Ethics and Professional Standards Committee comprises nine other BCAM members: Dr Paul Cronin, Dr Eithne Deignan, Dr Bhavjit Kaur, Dr Tahera Bhojani- Lynch, Prof Rhoda Mackenzie, Dr Rita Rakus, Dr Sam Robson, Dr Julia Sevi and Dr Richard Sibthorpe.

Most committee members are also BCAM appraisers and have many years’ experience in the field of aesthetic medicine. Dr Rakus and Dr Cronin, along with Dr Curran, are founding members of BCAM.

“I was honoured to be asked to lead this advisory group which will focus on all areas of regulation and ethics pertaining to aesthetic medicine,” commented Dr Curran.

“The committee members have great breadth of experience and are well placed to guide and advise BCAM’s board on these issues. Regulation is a prominent topic, with the success of the Bill banning toxin injections and fillers for under-18s and it is crucial to maintain momentum and raise awareness of the lack of regulation across the sector which puts the public at great risk.”

The committee has a remit to review stakeholder reports and statements, to inform BCAM decision-making on future campaigning and lobbying and to ensure that the College’s own code of conduct reflects the high professional standards expected of its members. Committee member Dr Tahera Bhojani-Lynch added: “Any group of professionals is only as good as the values it upholds. The Regulatory, Ethics and Professional Standards Committee will strive to ensure that the best standards of medical and surgical practice are at the heart of BCAM’s membership.”

Edinburgh best city for skin health worldwide, says study

UK cities have a less harmful impact on residents’ skin health than most, new research has shown.

The study by beauty retail site Lookfantastic scored cities across the world out of 10 after looking at four environmental influences: air pollution levels, average temperatures, annual sunshine hours and the estimate of smoking prevalence.

Pollution levels and UV exposure can impact the skin and cause serious medical issues, such as skin cancer. The UK took two of the three top spots in the list of “healthiest” cities for skin, with Edinburgh named the city where skin is least impacted by the environment, scoring 8.24/10, and Manchester placing third with a score of 7.88. Dublin and London also made the top 10:

1. Edinburgh, Scotland – 8.24/10

2. Helsinki, Finland – 7.92

3. Manchester, England – 7.88

4. Vancouver, Canada – 7.83

5. Dublin, Republic of Ireland – 7.78

6. Stockholm, Sweden – 7.77

7. Oslo, Norway – 7.75

8. Toronto, Canada – 7.60

9. Montreal, Canada – 7.58

10. London, England – 7.42

Edinburgh ranked so highly due to the low annual sunshine hours (1,895), meaning UV exposure is reduced. Manchester also has low sunshine hours (1,862), helping to prevent dryness, irritation, and other conditions. Both cities also ranked low for air pollution levels, averaging just 4.9µg/m³ (Edinburgh), and 11.1µg/m³ (Manchester).

While the UK capital scored higher than some for air pollution (12.9), its comparatively low sunshine hours (2,109) and smoking prevalence (17.8%) improved its overall score, putting it just ahead of Copenhagen in Denmark and Bogota, Colombia.

“Un–natural substances” biggest barrier for men considering aesthetic procedures, despite high treatment demand

Almost two million men in Britain are considering an aesthetic treatment but are put off by introducing “un-natural” substances into their body, according to new research by super-enriched tissue treatment company Uvence.

The research found that 11% of British men have been left feeling as though they look at least five years older following the pandemic, leading to a surge in interest for cosmetic intervention. Uvence says non-surgical treatments for the jawline, chin and neck are among the most in demand. However, concerns about introducing foreign-body substances such as dermal fillers and toxins are a bigger barrier for men than women.

“I personally have seen a huge increase in men who have never considered getting a treatment before getting in touch to organise consultations to learn more about their options,” said Dr Olivier Amar, founder of Uvence. “…The cryopreservation capability [of the Uvence treatment protocol] allows plastic and cosmetic surgeons alike to provide this treatment on a consistent basis to their patients without the need for synthetic, foreign substances or invasive treatments”.

UK could reverse ban on animal testing for cosmetic ingredients

The UK could allow animal tests for cosmetic ingredients for the first time since 1998 after the Home Office told animal protection organisation Cruelty Free International (CFI) that it had “reconsidered its policy” in a letter in August. This would be a huge turnaround on policy as animal testing on ingredients exclusively used in cosmetics has been banned in the UK for 23 years (since 1998).

The Government told CFI that it was aligning itself with a decision made last year by the appeals board of the European Chemicals Agency (ECHA) on cosmetics testing, which said that some ingredients used solely in cosmetics need to be tested on animals to ensure they are safe.

The ECHA ruled that German chemicals company Symrise had to carry out animal tests on two ingredients used in cosmetics to satisfy chemicals regulations, overruling EU restrictions on animal testing of cosmetic ingredients.

In 2004, the EU testing ban on finished cosmetic products was introduced, and the ban on such testing of cosmetic ingredients in 2009, but with the UK no longer a member of the EU due to Brexit, changes could come. The Home Office has insisted that UK law on animal testing had not changed and that the ban on using animals for the testing of finished cosmetic products remained in force, but accepting the ECHA’s ruling could lead to a much wider use of animal testing, which the CFI said would be “blowing a hole” in the UK’s leadership on animal testing.

The CFI is asking people to sign and share its #TargetZero petition, which is pushing for a “clear and ambitious action plan” to drive the phase-out of animal experiments. The petition had more than 75,710 signatures as Aesthetic Medicine went to print.

Less than half of “natural” skincare products are actually natural

The word “natural” is being misused to market non-natural skincare products, with only 42% of those marked up as “natural skincare” being truly natural, says a new study.

Research conducted by online skincare information resource The Derm Review analysed the ingredient lists of the top 100 best-selling natural skincare products and found that more than half (58%) contained synthetic ingredients, while all the “natural” serums in the study contained at least one synthetic ingredient. Nearly eight in 10 (78%) “natural” face masks in the study contained synthetic ingredients, the report found, with the average amount of synthetic ingredients coming out in these skincare products being 2.4.

Ethylhexylglycerin is the most used synthetic ingredient found in 24% of all the skincare products analysed in the study. “It is deemed safe and is generally used in low concentrations in skincare products, however, it can cause minor irritation to the skin and eyes if high concentrations are used,” said The Derm Review in its report. The second synthetic ingredient was phenoxyethanol, which was found in 22% of the products. Like ethylhexylglycerin, it is considered safe “but can cause irritation when high concentrations are used,” said The Derm Review. “It is used mainly as a preservative and antimicrobial agent used to help products last longer and prolong their safety and efficacy.” Sodium ascorbyl phosphate came in third as it was found in 13% of the natural products. “While being a synthetic agent, it is generally safe for all skin types, and is a type of vitamin C,” added The Derm Review.

Elle MacLeman, skincare biochemist at The Derm Review, commented: “I think one of the problems is that the industry is pretty much unregulated when it comes to making claims. For instance, it’s common to see ‘chemical-free’ products on the shelves, but that doesn’t make any sense, as even water is a chemical.”