NEWS AND ANALYSIS

Open letter to GMC demands changes to guidance on non–medic prescribing

Dr Steven Land, director of Novellus Aesthetics, along with some 300 UK aesthetic doctors and nurses, has sent an open letter to Charlie Massey, chief executive of the General Medical Council (GMC), sharing collective concern over the breaking of remote prescribing rules by some clinicians.

The letter follows an undercover investigation by The Sunday Times published on 31 October which revealed doctors and nurse prescribers agreeing to sign off prescriptions for botulinum toxin on behalf of nonmedics in exchange for money, without ever seeing or speaking to the would-be patients.

Dr Land told Aesthetic Medicine he felt compelled to write the letter “on behalf of aesthetics doctors, dentists and nurses, insisting [regulatory bodies] act to protect the public from rogue prescribers and protect the reputation of their members.”

An excerpt from the letter reads: “For too long, aesthetic medicine has been seen as a poor relative of ‘proper medicine’ and not taken seriously by the regulatory bodies. This has led to the situation we find ourselves in with little to no regulation and the proliferation of poor practice which goes unchecked. The regulatory bodies of medics involved in this highly skilled and rewarding branch of medicine owe it to their members and the general public to try and bring some sort of order to the chaos.

“…The press report highlighted shines a light on the poor practice of doctors and nurses providing remote prescriptions for non-medics to inject the world’s most dangerous neurotoxin. This practice is already against the guidance produced by the GMC, but this seems to be little deterrent (and we note, this guidance is already very old in terms of the speed of development in aesthetic medicine).

“…We believe that prescribing injectable aesthetic medicines to be given by non-medics should be against guidance completely. The field of aesthetic medicine in this country is awash with non-medics injecting prescription-only medicines and implantable class III medical devices – we are one of the only countries in the civilised world that allows this counterintuitive situation to continue and are the laughing stock of the wider aesthetic medicine community.

“…Of interest, we also note that you are in the process of updating the Good Medical Practice guidance and if you felt that this (fairly simple) change in guidance did require wider consultation then this would seem to be an ideal opportunity to do it. We firmly believe though that this guidance needs issuing now and being acted upon firmly and decisively when necessary, to prevent further patient harm and the damage to our collective reputation.”

BCAM audit reveals top treatments performed in 2020

The British College of Aesthetic Medicine (BCAM) has released its 2021 Annual Clinical Review, covering treatments performed by its members between January and December 2020. It found that the top five most performed treatments were botulinum toxin injections, HA dermal fillers, mesotherapy, PRP and laser/ IPL, respectively.

The audit covers just shy of 299,000 individual treatment sessions conducted by 340 clinicians. While the College didn’t release individual treatment numbers, it did reveal that 147,000 of these sessions were for toxin injections. The audit also found a 50/50 split between female and male member practitioners and a wide representation of nationalities from across the globe practising in Britain. Data from BCAM’s Annual Clinical Reviews is shared with the Department of Health and Social Care (DHSC) to help guide and inform government thinking around the field of aesthetic medicine.

BCAM president and Aesthetic Medicine editorial board member Dr Uliana Gout commented: “The College is pioneering data collection, sharing insights and trends with stakeholders including the DHSC to pursue its charitable aims of patient education and safety.

“BCAM is the only professional body that collects data on this scale and we are proud to be leading with facts, not opinions, making evidence-based decisions about BCAM’s strategies and informing the wider aesthetic medicine community about our members’ clinical activity.”

BAAPS develops mentorship programme for junior plastic surgeons

The first nationwide mentorship scheme for young plastic surgeons has been established by The British Association of Aesthetic Plastic Surgeons (BAAPS).

The BAAPS mentorship scheme will see senior, experienced BAAPS member surgeons establish long-term relationships with young plastic surgeons to support them on their training journey and into their early consultant careers.

The Association hopes the scheme will create mutually beneficial relationships that protect industry standards throughout future generations. BAAPS will support the development of a nationwide series of aesthetic mentorships aimed at post-FRCS(Plast) trainees to provide structure for mentors and their mentees, with BAAPS as the facilitator.

The mentorships are designed whereby the mentee gains a highly qualified assistant and colleague to participate in practice audit and research, and to help with improvements in operation room efficiency. They will also receive CPD through teaching, discussion and mentee involvement in the patient journey.

Meanwhile, mentees benefit from tailored teaching and observation in various key settings – the operating theatre, in clinic, and in the running of a private practice.

BAAPS vice president Marc Pacifico commented: “There are many threats to the future of plastic surgery in the UK and we need to act now to protect the future through training. There is little or no exposure to aesthetic training in the NHS and although aesthetic fellowships are available, they are independent of each other and unevenly spread around the UK.

“BAAPS is uniquely placed to deliver this training. We are the UK’s nationally recognised and official aesthetic plastic surgery association with links to the Royal College of Surgeons. It is our responsibility to ensure that aesthetic surgery remains a recognised and respected discipline and part of the plastic and reconstructive surgical training, ultimately for the benefit of our patients.”

FDA tightens rules for breast implants in bid to make patients better informed of procedure risks

In an effort to strengthen communication about the possible risks of undergoing breast augmentation surgery with implants, The US FDA (Food and Drug Administration) announced several new safety measures to help patients make informed decisions.

The agency issued orders restricting the sale and distribution of breast implants to only healthcare providers and facilities that provide information to patients using a Patient Decision Checklist which must be reviewed with the prospective patient to help ensure they understand the risks, benefits and other information about the breast implant device. The patient must be given the opportunity to initial and sign the Patient Decision Checklist and it must also be signed by the surgeon implanting the device.

In addition, the FDA has approved new labelling for all legally marketed breast implants that includes a boxed warning, the aforementioned Patient Decision Checklist, updated silicone gel-filled breast implant rupture screening recommendations, a device description with a list of specific materials used in the device, and a patient device card.

Also part of the new guidance is updated information on the status of breast implant manufacturer postapproval studies. These actions will help patients understand the risks and benefits of breast implants and make more informed decisions about their health.

“Protecting patients’ health when they are treated with a medical device is our most important priority,” said Dr Binita Ashar, director of the Office of Surgical and Infection Control Devices in the Center for Devices and Radiological Health. “In recent years, the FDA has sought more ways to increase patients’ access to clear and understandable information about the benefits and risks of breast implants.

“By strengthening the safety requirements for manufacturers, the FDA is working to close information gaps for anyone who may be considering breast implant surgery. As the FDA continues to evaluate the overall effects of breast implants in patients, today’s actions help ensure that all patients receive the information they need to make well-informed decisions affecting their long-term, personal health.”

Required toxin dosage linked to climate

A new study examining the effects of climate and sun exposure on patients’ required dosage of botulinum toxin A injections has shown that those living in sunnier climes may need increased doses achieve the same level of paralysis as those in colder countries.

The study, presented at The British Association of Aesthetic Plastic Surgeons (BAAPS) Annual Scientific Conference and titled, Does climate affect the dose requirements of Botulinum Toxin A in aesthetics?, investigated the effect of climate on real-world doses by comparing two groups of female patients (aged 35-60) who were injected with botulinum toxin in the vertical frown lines between the eyebrows and top of the nose (glabellar lines).

One set of patients was treated in the UK during the winter months, while the other was treated in Malta in the summer months, where sun exposure would be high.

Experienced clinicians performed the treatments from 2012-2019 following standard procedures. Smokers, those not seeking maximal paralysis, non-complaints, those with colds/fevers and broken cold supply chains were excluded. Univariable and multivariable analyses were undertaken.

Patients were followed up after three weeks and received top-up doses until full clinical paralysis was achieved. The authors found that the 292 patients in the higher-sun climate needed significantly increased dose requirements to achieve maximal paralysis than the 231 in the low sun group (mean total doses = 29.2U vs 27.3U, p=0.0031). Even when correcting for age in multivariable analysis, the low-sun group still had lower total dose requirements (p=0.00574).

This, they suggested, could be because of “chronic behavioural adjustments” leading to “functional musculature differences”. In short, they said, we frown more in the sun.

The study has the potential to affect the clinical practice of botulinum toxin injections globally, said BAAPS.

Galderma acquires American clinical skincare brand Alastin

Galderma is to add skincare brand Alastin to its portfolio of aesthetics brands.

The dermatology company has signed a definitive agreement to acquire Alastin Skincare. The medical-grade skincare brand is prescribed by cosmetic doctors and dermatologists in the US.

Founded in 2015, its products include patented TriHex technology, a proprietary blend of peptides and active botanicals to help rejuvenate skin.

Since inception, Alastin achieved a CAGR (compound annual growth rate) of 106% to 2020, while a report by Kline Group cited Alastin as the fastest growing brand in the US professional skincare market in 2020.

“… The addition of Alastin, with its synergistic portfolio and expertise in science-proven skincare, increases our ability to serve the needs of consumers and underscores our commitment to be the partner of choice for aesthetic professionals, said Flemming Ørnskov, chief executive of Galderma.

“This transaction will further enhance our premium product offering and provides a tremendous platform for future growth. We look forward to welcoming the Alastin team into Galderma and partnering with them to advance the science of dermatology together.”

Galderma plans to leverage Alastin’s “global reach and integrated dermatology platform” to push forward with the brand’s next growth phase to reach more consumers via more healthcare professionals. This will include further product development and skincare technology innovation.

Sofwave Medical plots UK growth with new country director

Non-invasive energy-based device manufacturer Sofwave Medical has appointed a UK and Ireland country director as it plots growth in the UK market. Matt Hubball brings seven years’ experience within aesthetics, having previously worked for brands including BTL Aesthetics and Aesthetic Technology.

Sofwave chief executive Louis Scafuri commented, “Matt will be focused on the UK and Ireland sales organisation and will assume international sales responsibilities. With this new appointment we are well positioned to bring best-in-class technology to meet our customer and their patients’ needs.”

Meanwhile, Sofwave’s platform, which uses synchronous ultrasound parallel beam technology, has received new FDA clearance for lifting the eyebrow, submental and neck areas for patients aged 22 and older. The device was originally cleared for the improvement of facial lines and wrinkles. According to a multisite clinical study conducted by the brand, 80% of 80 patients saw improvements in treated facial areas in 12 weeks.

Bristol named “baldest” city in the UK by hair transplant study

A study that set out to rank the top 20 UK cities that are home to the highest number of men suffering from hair loss has put Bristol at the top of the list. Medical tourism company Longevita took a sample of 5,000 of its most recent male patients and used internal data to analyse their postcodes, revealing how prevalent baldness is among UK cities.

Bristol had a “baldness” score of 81.1%, while Peterborough came in last at 48.8% – still a relatively high percentage of baldness.

While London ranks low on the list at 56%, interestingly, the largest number of patients in the sample live in the capital – 1,450 out of 5,000. However, only 812 of those needed 3,000 or more hair grafts for their hair restoration surgery. Comparing this figure to Bristol, 81% of patients needed 3,000 or more grafts, indicating extensive baldness.

Many Brits worsening their own inflammatory skin conditions

One in five adults who have a skin condition such as eczema, acne or psoriasis are using a potentially damaging product on their skin on purpose to try and alleviate the symptoms, according to new research conducted by skincare company Medovie.

Six in 10 admitted to turning to methods that they now regret to help cure or heal their skin condition, while only less than 20% have found the “perfect” routine for their skin despite all the trial and error.

Just under half (47%) admitted to scratching their skin, 33% have used a scrub that is too harsh, and 30% skip their moisturiser – all of which could cause further irritation to inflamed or irritated skin.

The poll of 2,000 adults with skin conditions found that Brits are using on average eight different products to combat their skin issue, while one in 10 have tried 16 or more different products to get themselves looking their best.

The research also found that three quarters have had a formal diagnosis of a skin complaint, with an average of four-anda-half months wait to find out what it was, and up to a third of people (29%) waiting more than six months to have their skin condition diagnosed. Unsurprisingly, six in 10 wish they had been able to get their diagnosis sooner, with the most common complaints being eczema (54%), acne (32%), and psoriasis (31%).