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TOPICALS AND SKINCARE September 2026 | VOLUME 14 - ISSUE 10

Your Trusted Voice in the Aesthetics Specialty

SOPHIE—RIO DE JANEIRO

WAKE UP READY Hyaluronic acid treatments for natural always-on beauty. 1-14 WAKE UP TO

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3 decades of unmatched safety*†15,16

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*Unmatched safety based on the 27 years of safety experience of Restylane®, the first non-animal-based HA injectable. Safety data has been published on nearly 407,000 patients treated with Restylane® products.15,16 †Always consult a healthcare professional for individualised treatment recommendations and to discuss important safety information and risks associated with the use of the products. References: 1. Philipp-Dormston WG, et al. Dermatol Surg. 2018;44(6):826-32. 2. Solish N, et al. J Cosmet Dermatol. 2019;18(3):738-46. 3. Lee BM, et al. Arch Plast Surg. 2015;42(3):282-7. 4. Gregorio C, et al. Clin Cosmet Investig Dermatol. 2022;15:681-90. 5. Nikolis A et al. Poster presented at: AMWC, Monte Carlo, Monaco. 2022. 6. Restylane® LYFT™. IFU. 7. Restylane®. IFU. 8. Restylane® EYELIGHT™. IFU. 9. Restylane® DEFYNE™. IFU. 10. Restylane® VOLYME™. IFU. 11. Restylane® KYSSE™. IFU. 12. Restylane® REFYNE™. IFU. 13. Restylane® SKINBOOSTERS VITAL LIDOCAINE™. IFU. 14. Restylane® SKINBOOSTERS VITAL LIGHT LIDOCAINE™. IFU. Restylane and Galderma are registered trademarks. GL-RES-2500113 11/25. 15. Galderma Data on file. MA-39680. Global 55 million Restylane® treatments, update 2022. 16. Galderma. Data on file. MA-55607. Restylane® 27 years data publication analysis, 202. UKI-RES-260014 DOP August 2026

CPD: Understanding Peptides 6104 Restylane front cover AJ_v1.1.indd 1

Dr Mayoni Gooneratne examines the use of systemic peptides within longevity

Special Feature: Showcasing the Use of Topical Peptides Understanding Rosacea in Skin of Colour

ALSO IN THIS ISSUE

10/08/2026 16:58

Nina Prisk discusses microneedling with topical therapy Órla Phelan reviews patient and staff journeys

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Contents • September 2026 08 News The latest product and specialty news

16 mesoestetic® Advances Regenerative Aesthetics with the Evolution of mesofiller® nexha Succinic acid and dual release™ technology plus active ingredients

17 News Special: New Analysis Indicates an Evolving Polynucleotide Market Aesthetics investigates how the integration of PNs is evolving

CLINICAL PRACTICE 18 Event Preview: Defining the Future of Medical Aesthetics CCR returns with education, networking and innovation

22 Special Feature: Showcasing the Use of Peptides in Skincare Practitioners discuss protocols for topical peptides

26 CPD: Understanding Peptides

News Special: New Analysis Indicatesan Evolving Polynucleotide Market Page 17

Dr Mayoni Gooneratne examines systemic peptide use

31 Combining Topical Therapy with Microneedling Nina Prisk explores outcomes after microneedling and topical therapy

37 More, More, More: Embedding Sun Safety into Everyday The British Skin Foundation promotes a simple, consistent approach to sun protection

38 Understanding Rosacea in Skin of Colour Dr Angela Tewari shares diagnostic challenges for rosacea in SOC patients

43 Treating Hyperpigmentation with Topicals Dr Jaymi Lad presents an overview of topicals for hyperpigmentation

47 One Patient Record. One Clearer Prescribing Workflow. Helping prescribing teams replace operational steps

49 Optimising Pre- and Post-Procedural Skincare Dr Sally Rayment explores pre- and post-procedural topicals

53 Abstracts

Special Feature: Showcasing the Use of Peptides in Skincare Page 22

The latest research highlights from Professor Sebastian Cotofana

Clinical Contributors

IN PRACTICE 56 Considering Strategy for Email Newsletters Ivan Lusica provides a framework for creating a newsletter

59 The Role of Team Clarity in Driving Clinic Performance Órla Phelan considers staff expectations and patient journeys

62 Integrating AI Scribes in Aesthetic Practice Aesthetics explores how AI notetaking could benefit aesthetic practices

65 In Profile: Dr Zainab Al-Mukhtar Dr Zainab Al-Mukhtar shares her journey from dentist to aesthetic practitioner and clinic owner

66 The Last Word: Is Medical-Grade Skincare Superior To Over-The-Counter Products? Dr Jenni Thain examines whether ‘medical-grade’ skincare offers clinical advantages as a marketing term

NEXT MONTH: MEDICAL LONGEVITY AND REGENERATIVE MEDICINE • Skin substrates • Hair restoration • PIH in menopausal patients

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Dr Mayoni Gooneratne is a former surgeon specialising in functional medicine, women’s health and longevity medicine. She is the founder and medical director of Human Health and the founder of Human Health Professionals. She is also vice president and co-founder of the British College of Functional Medicine. Nina Prisk is the founder and clinical director of Update Aesthetics, a CQC-registered medical and surgical aesthetics clinic with locations in Cornwall and London. She is an independent nurse prescriber with more than 20 years’ clinical experience. Prisk is an international key opinion leader for leading aesthetic brands. Dr Angela Tewari is a consultant dermatologist and founder of Dermatology Studios in Chelsea, London. She also works as a consultant dermatologist in the NHS sector leading in Paediatric dermatology, contact dermatitis and skin cancer screening clinics. Dr Jaymi Lad is an aesthetic practitioner in Manchester. She is the founder of Dr Jaymi Aesthetics, an independent clinic with a special interest in regenerative aesthetics, cosmetic dermatology and skin of colour. She spent six years as a clinical trainer at Harley Academy and currently works for Evolus. Dr Sally Rayment is a facial aesthetics practitioner, partowner of Facial Aesthetics Centre, as well as a restorative dentist based in Haywards Heath, West Sussex. She qualified at Guy’s, King’s and St Thomas’ Hospital in 2004 and holds a Master’s degree in Prosthodontic Dentistry from King’s College London.

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Editor’s letter This month, Aesthetics turns its attention to topicals; the products, ingredients and homecare protocols that continue to play a vital role in both everyday skin health and clinical outcomes. Our Special Feature on p.22 explores the growing interest in topical peptides and how they can be integrated into practice. While peptides are far from new, their place within professional skincare continues to evolve, with practitioners increasingly considering where they may add value within tailored treatment plans. Holly Carver Editor & Content Manager

This issue also includes clinical guidance on treating hyperpigmentation with topicals, as well as the importance of pre- and post-procedure care. Our Last Word analyses the differences between medical-grade and over-the-counter skincare on p.66. In our News Special, we examine specialty use of polynucleotides. With reports of a 5% drop in advertising activity since last year, we

consider what this may signal for the treatment category. As interest in regenerative treatments remains strong, we question whether this signals a changing market. With the Clinical Cosmetic Regenerative Congress (CCR) taking place next month on October 1-2, make sure you have registered to join the medical aesthetics community for two days of education, innovation and connection. CCR will bring together the breadth of the specialty, from injectables, regenerative medicine and devices to skincare, medical longevity and business strategy. Visitors can access CPD-verified education, hear from leading speakers, explore the latest launches from more than 150 brands and suppliers, as well as take advantage of dedicated networking opportunities. Read our final agenda preview on p.18 to start planning your visit and discover the sessions and experiences not to miss. Finally, entries for The Aesthetics Awards are now open. The Awards celebrate the people, practices and brands helping to move our specialty forward, so make sure the work, innovation and commitment within your clinic or business receives the recognition it deserves – turn to p.64 to find out how to enter.

Clinical Advisory Board

Leading figures from the medical aesthetic community have joined the Aesthetics Advisory Board to help steer the direction of our educational, clinical and business content

Sharon Bennett is the former chair of the British Association of Medical Aesthetic Nurses (BAMAN), UK lead of the BSI committee for aesthetic non-surgical standards and member of the Clinical Advisory Group for the JCCP. She is a trainer and a registered university mentor in cosmetic medical practice, and is finishing her MSc at Northumbria University. Bennett has won the Aesthetics Award for Nurse Practitioner of the Year and the Award for Outstanding Achievement.

If you are interested in contributing to the journal, get in touch... Email: editorial@aestheticsjournal.com

Sharon Bennett, Clinical Lead Mr Naveen Cavale has been a consultant plastic, reconstructive and aesthetic surgeon since 2009. He has his own private clinic and hospital, REAL, in London’s Battersea. Mr Cavale is the national secretary for the ISAPS, president of the Royal Society of Medicine, and vice-chair for the British Foundation for International Reconstructive Surgery.

Dr Mayoni Gooneratne (MBBS, BSc, MRCS, MBCAM, AFMCP) was an NHS surgeon before establishing The Clinic by Dr Mayoni and founding Human Health – an initiative combining lifestyle with traditional and functional medicine to provide a ‘cell-up’ regenerative approach to aesthetics. She is also the co-founder of The British College of Functional Medicine.

Dr Sophie Shotter is the founder & medical director of Illuminate Skin Clinic in Kent and Harley Street, London. Her passion is for natural treatments delivered with utmost attention to safety. She works closely with Allergan as part of their UK and International Faculty.

Miss Elizabeth Hawkes is a consultant ophthalmologist and oculoplastic surgeon. She is the lead oculoplastic surgeon at the Cadogan Clinic, specialising in blepharoplasty and advanced facial aesthetics. Miss Hawkes is a full member of the BOPSS and the ESOPRS, and is an examiner and fellow of the Royal College of Ophthalmologists.

Jackie Partridge is an independent nurse prescriber. She is the clinical director and owner of Dermal Clinic in Edinburgh and a KOL for Galderma. She holds an MSc in Non-surgical Aesthetic Practice and a BSc in Dermatology. Partridge is a stakeholder group member with Scottish Government/HIS, Honorary BACN member and JCCP Fitness to Practice Nurse.

Dr Anjali Mahto is one of the UK’s leading consultant dermatologists. She is a Fellow of the Royal College of Physicians, member of the Royal Society of Medicine and a spokesperson for The British Skin Foundation. In 2023 Dr Mahto opened Self London, a dermatology and lifestyle clinic aimed at managing skin conditions holistically.

Mr Adrian Richards is a plastic and cosmetic surgeon with over 30 years’ experience. He is the clinical director of the aesthetic training provider Cosmetic Courses and surgeon at The Private Clinic. He is also a member of the British Association of Plastic and Reconstructive and Aesthetic Surgeons and the British Association of Aesthetic Plastic Surgeons.

Dr Souphi Samizadeh is a dental surgeon with a Master’s degree in Aesthetic Medicine and a PGCert in Clinical Education. She is the founder of the Great British Academy of Medicine and Revivify London Clinic. Dr Samizadeh is a Visiting Teaching Fellow at University College London and King’s College London.

Dr Stefanie Williams is a dermatologist with a special interest in adult acne, rosacea and aesthetic medicine. She is the founder and medical director of multi-award winning EUDELO Dermatology & Skin Wellbeing in London, and creator of Delo Rx skincare. She is the author of three books and has published more than 100 scientific articles, book chapters and abstracts.

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Legal Protection

In the Spotlight... A monthly snapshot of the people, products and ideas generating real time buzz in aesthetics

Sector Developments Aesthetics Journal discusses regulation and AI on podcast Aesthetics Journal journalist Sophia-Fai Roche appears on PhorestFM hosted by Alex Bélisle-Springer. Roche says members of the medical aesthetics community are pushing for more detail on the proposed national licensing scheme. She adds, “These conversations are being driven by concern for patient safety and efforts to ensure medical aesthetics is recognised and treated as a medical field.” Roche also gave a broad assessment of artificial intelligence (AI)’s growing role in the sector, saying, “As much as I’m excited to see how AI is going to come into fruition, we have heard some concerning stories already of patients using AI-edited images to obtain weight-loss injections.” Regulatory and AI concerns aired by PhorestFM

Trends Dr Manav Bawa discusses dermal filler trends with ELLE magazine Aesthetic practitioner Dr Bawa features in ELLE magazine sharing his insights on the shift away from overfilled, unnatural results and towards treatments that are more subtle. He notes that he is witnessing filler reversals more frequently than before, adding, “While this reflects a welcome change in patient preferences, it also highlights the importance of choosing an experienced, medically qualified practitioner who understands facial anatomy, balance and long-term planning.” Dr Bawa adds that this trend is being influenced in part by high-profile celebrities. Aesthetic trends printed in ELLE magazine

TV Series ITV profiles the medical aesthetics specialty TV personality Olivia Attwood’s third series of The Price of Perfection explores the modern aesthetics field, investigating the lengths patients will go to in pursuit of idealised beauty standards. The series features a range of well-known faces and businesses, including aesthetic training provider Cosmetic Courses alongside aesthetic practitioners Dr Preema Vig and Dr Nina Bal – to name a few. Across the series, key themes include celebrities speaking openly about the benefits and drawbacks of undergoing cosmetic procedures in the public eye, the growing popularity of facelifts among patients under 50, and the latest innovative treatments shaping the aesthetics sector. Aesthetics community spotted in mainstream media

Government commits to protecting the title ‘nurse’ The UK Government has launched a Call for Evidence on how to implement legal protection for the professional title ‘nurse’. Currently, the titles ‘registered nurse,’ ‘midwife,’ ‘specialist community public health nurse’ and, in England, ‘nursing associate’ are protected by law. It is a criminal offence for anyone to falsely claim these titles or misrepresent themselves as being on the Nursing and Midwifery Council (NMC) register. However, the standalone title ‘nurse’ is not currently protected, allowing individuals who are not NMC-registered to use it in some job titles. Proposed reforms would make it a criminal offence for anyone who is not registered with the NMC to describe themselves as a nurse, including where the word forms part of a longer job title. The changes are expected to be subject to public consultation in 2027 before legislation is introduced. The British Association of Medical Aesthetic Nurses (BAMAN) shared it will submit an organisational response to the consultation and has encouraged members to provide individual evidence. The consultation is open to healthcare professionals, regulators, employers, educators, patients and members of the public from across the UK. Gareth Lewis, BAMAN chief executive officer, commented, “For nurses working in medical aesthetics, legal protection of the title would recognise the education, clinical expertise and professional accountability that define nursing practice. It would help safeguard the integrity of the profession and reinforce public confidence in those delivering aesthetic treatments.” Evidence can be submitted via an online survey until October 8, 2026. BAMAN will be exhibiting at CCR next month. Turn to p.18 to register now. Research

Tirzepatide reduces risk of cardiovascular events Weight-loss injection tirzepatide has been associated with cardioprotective effects according to new findings. The research published in The BMJ set out to estimate the magnitude of reduction in major adverse cardiovascular events that would be observed in clinical practice from adding tirzepatide to standard of care treatment. The study took place across two national US claims databases, between May 2022 to May 2025. Researchers looked at 52,971 adults aged 40 or older, with type 2 diabetes and existing heart and blood vessel disease. Some participants started taking tirzepatide (35,353 people), while others began sitagliptin (17,618 people). The research suggests that, in people with type 2 diabetes and existing cardiovascular disease, being prescribed tirzepatide lowers the risk of major cardiovascular events compared with the comparison treatment. The lower rates of infection and infection-related death also suggest that tirzepatide may have wider health benefits, as well as effects on heart and blood vessel disease. The study suggests tirzepatide may provide cardiovascular benefit in clinical practice, and the findings could help doctors and patients make more informed treatment decisions.

Aesthetics | September 2026

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Exhibition

Vital Statistics

CCR returns next month The Clinical Cosmetic Regenerative Congress (CCR), sponsored by pharmaceutical company Galderma, opens its doors next month on October 1&2, at Excel, London. The must-attend event will bring together the latest advancements in aesthetics, regenerative medicine and clinical practice, offering visitors two days of education, innovation and networking. This year’s edition will feature a strong line-up of CCR talks, alongside an Innovation Trial spotlighting new ideas and emerging solutions shaping the future of the sector. Dermapenworld will support the event as VIP Sponsor and will speak in the Aesthetics Mastery Theatre, while Nicoya Health will join as Headline Theatre Sponsor for the Medical Longevity Summit. Partners confirmed for this year include Hypo21 as Skin Prep Partner, International Beauty Industry Trade Association in partnership with the Korea Zone, Initial Medical as Clinical Waste Partner, Aesthetic Complications Expert (ACE) Group World as Complications Partner and Quantificare as Imaging Partner. CCR will also host Distributor Connect, linking emerging brands looking to enter the market with UK-based supplier partners. Participating companies include: BNV Biolab, GC Wellbeing, Libera, Pavist and Renaissance SRL. Shannon Kilgariff, publisher and event director at Aesthetics, commented, “CCR continues to provide an important platform for professionals across medical aesthetics to come together and engage with the latest clinical developments, emerging technologies and specialty perspectives. This year’s programme has been designed to support meaningful education, collaboration and discussion across the sector. We look forward to opening our doors next month!” Turn to p.18 to register now. Chin Augmentation

Galderma receives EU approval for Restylane Shaype

Insider News

Out of 261 UK aesthetic clinics, 31.4% do not appear in Google Maps results for their primary treatment in their local area (LTF Design & Marketing Ltd, 2026)

Among 3,500 men, 45% did not know prostate cancer can present without symptoms and 20% were unaware of PSA testing (Imperial College London, 2026)

37% of 500,000 adults who are on GLP-1 medication lost more than 20% of their body weight within 12 months (DiCE, 2026)

Nearly one in four Generation Z brides report considering injectable cosmetic treatments before their wedding (Zola, 2026)

Amid 1,000 UK individuals, 39% admit they don’t comprehend how cold therapy supports muscle and joint health

Pharmaceutical company Galderma has secured European Union (EU) approval under the Medical Device Regulation for Restylane Shaype for chin augmentation. Powered by NASHA HD technology, the injectable is indicated for deep injection to build and shape the bone. According to Galderma, it is the first bone-mimicking hyaluronic acid (HA) injectable for facial shaping, designed to provide natural-looking structural enhancement without surgery. The approval marks the latest addition to the company’s Restylane portfolio of HA injectables. Baldo Sforzolini, global head of research and development at Galderma, commented, “These approvals bring Restylane Shaype to practitioners across Europe – the first and only bone-mimicking HA injectable for chin augmentation. Powered by new NASHA HD technology, this firm gel enables natural-looking lower-face shaping without surgery, expanding clinicians’ ability to deliver structural facial balance.” Headline Sponsor Galderma will be exhibiting at CCR next month. Turn to p.18 to register now.

(Clariti, 2026)

Across 10,311 UK businesses, 29% reported using at least one form of artificial intelligence, with text generation labelled as the most widely adopted (Office for National Statistics, 2026)

Aesthetics | September 2026

Insider News

Events diary 24th-25th September 2026 BAMAN Autumn Aesthetic Conference 1st-2nd October 2026 Clinical Cosmetic Regenerative Congress (CCR) and Medical Longevity Summit (MLS) 7th November 2026 RAMCE 14th November 2026 IAAFA Aesthetics Conference 21st - 22nd November 2026 The Anatomy & Injection Experience, BAMAN 12th-13th March 2027 Aesthetics Conference & Exhibition (ACE) 13th March 2027 The Aesthetics Awards

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High-risk Procedures

Surgical bodies call for tighter regulation of cosmetic surgery A coalition of surgical, medical and patient safety organisations has renewed calls for tighter regulation of cosmetic surgery in England. In an open letter to the Secretary of State for Health and Social Care and Member of Parliament, Yvette Cooper, the group called on the Government to publish its consultation on high-risk cosmetic procedures. The coalition was led by the Royal College of Surgeons of England (RCS of England) and included royal colleges, specialist surgical associations and patient safety bodies. Currently, any doctor registered with the General Medical Council (GMC) may legally carry out cosmetic surgical procedures – including breast augmentation, rhinoplasty, facelifts and liposuction – regardless of whether they hold recognised specialist surgical qualifications or appear on the GMC Specialist Register. Professor Vivien Lees, spokesperson on Cosmetic Surgery, RSC England, said, “The Government should publish its consultation without further delay and take action to ensure that high-risk cosmetic surgery is only carried out by appropriately trained specialist surgeons, giving patients the confidence they deserve.”

Patient Safety

Skin Laxity

Pharmacists warn of potential counterfeit weight-loss pills Specialists have warned that the approval of a glucagon-like peptide (GLP-1) receptor agonist weight-loss tablet could make it a target for online fraud and counterfeit medicines. Following its introduction into the UK market, a snap survey by the National Pharmacy Association, who represent around 6,000 independent community pharmacies in the UK, found that 97% of pharmacies were concerned that the new form of treatment would increase fake or unlicensed weight loss pills being sold on the black market, causing a risk to patient safety. A spokesperson from the Medicines and Healthcare products Regulatory Agency said, “We have as yet not received any reports of counterfeit Wegovy or Foundayo in pill form. Authorised medicines, including those used for weight management, are subject to robust regulatory processes and ongoing oversight, including controls on how they are manufactured, supplied and monitored once on the market. We remain vigilant to emerging threats relating to unauthorised and falsified weight-loss products and, where necessary, will take appropriate enforcement action to protect public health.”

Ultherapy PRIME acquires FDA approval Pharmaceutical company Merz Aesthetics has received US Food and Drug Administration (FDA) approval for Ultherapy PRIME for skin laxity on the knees. According to Merz Aesthetics, Ultherapy PRIME treats multiple skin depths, allowing practitioners to tailor treatment to each patient’s unique anatomy. By stimulating the body’s natural collagen and elastin production, it aims to deliver a non-surgical lift with natural-looking results for the face and body. The company shares it typically requires a single session with no downtime and is safe for all skin tones. Dr Samantha Kerr, chief scientific officer at Merz Aesthetics, commented, “The new knees indication marks another monumental moment for Ultherapy PRIME. It underscores our commitment to advancing science-backed innovation and expanding non-invasive treatment possibilities for healthcare professionals and their patients.” Merz Aesthetics will be showcasing Radiesse at the Injectable Experience at CCR next month. Turn to p.18 to register now.

Tailored Technique

Teoxane unveils babyGLOW for HIM by Teoxane Aesthetic manufacturer Teoxane has announced the launch of male-adapted technique babyGLOW for HIM by Teoxane in the UK. The company explains that the technique is designed specifically for male facial anatomy, aiming to improve hydration, texture and radiance without changing facial structure. According to the company, the protocol uses an eight-point technique to administer TEOSYAL Puresense Redensity 1, with the treatment designed to support overall skin quality skin quality through hydration, collagen stimulation and dermal restructuring. Joanna Underhill, general manager at Teoxane UK, commented, “We’re incredibly excited to bring Teoxane babyGLOW for HIM to the UK market, giving our clinic partners a new opportunity to engage and grow their male patient base. We know that men are increasingly looking for aesthetic treatments that deliver visible, natural-looking results with minimal downtime, but the way we communicate and tailor those treatments needs to resonate with their specific needs.” Teoxane will be showcasing babyGLOW by Teoxane at the Injectable Experience at CCR next month. Turn to p.18 to register now. 10

Aesthetics | September 2026

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Accolades

The Aesthetics Awards 2027 opens for entries Entry submission has started for The Aesthetics Awards 2027, with clinics, practitioners and teams invited to submit their applications by October 21. Returning for another year, the Awards recognise achievement and innovation across the medical aesthetics sector. New categories for 2027 include Best Clinic Ireland and Aesthetic Dentist of the Year, alongside a range of existing awards spanning clinical practice, business performance and team achievement. Accredited with an Advanced Trust Mark from the Independent Awards Standards Council, the programme is subject to a rigorous judging process intended to ensure transparency and credibility. Widely regarded as a key date in the specialty calendar, the Awards bring together professionals from across the field to acknowledge progress and standards in practice. Finalists will be announced on January 4, with Winners revealed at the ceremony on March 13, 2027, at the Great Room in Grosvenor House, London. Shannon Kilgariff, publisher and event director at Aesthetics, said, “The Awards continue to provide an important opportunity to recognise the individuals, teams and clinics shaping our community. Each year, the standard of entries reflects the field’s commitment to high-quality practice, innovation and continued progress across all areas of the specialty. Join the medical aesthetics community in celebrating excellence and the people making a meaningful impact across the sector.” Turn to p.64 to enter.

BAMAN UPDATES A round-up of the latest news and events from the British Association of Medical Aesthetic Nurses

NEW EDUCATIONAL RESOURCES LAUNCHING SOON We’ll be launching the brand-new eLearning Platform alongside our long-awaited Career and Competency Framework. Together, they’ll provide members with a route for professional development, making it easier for members to demonstrate their skills and continue progressing throughout their careers. Our eLearning platform launches with an exclusive CPD-accredited course from BAMAN regional lead and nurse prescriber Tracey Dennison, focusing on hormonal health. Available through the BAMAN Members’ Area, the course comprises 10 interactive modules, each with a knowledge quiz, allowing you to learn at your own pace while earning valuable CPD towards your Nursing and Midwifery Council revalidation. The BAMAN Career and Competency Framework is also in its final stages ahead of launch. It has been developed to provide a structured pathway for career progression and competency across medical aesthetics while promoting safe, evidence-based practice and the highest standards of patient care.

UPCOMING FOR 2026

Skincare Safety

BAD advocates for skincare warnings The British Association of Dermatologists (BAD) has called for clearer labelling on skincare products containing ingredients unsuitable for children. BAD has urged for packaging to carry more explicit warnings, including information about the risks of irritation, allergy and possible long-term skin damage. This comes after an ITV News investigation prompted renewed calls for stronger warnings on products unsuitable for young skin. The report found children as young as four were using products designed to target wrinkles and other signs of ageing in social media skincare routines. Dermatologist and aesthetic practitioner Dr Derrick Phillips, said, “From a dermatology perspective, there is no need for children to be using antiageing skincare products. Retinol and other retinoids are slightly different because they do have an established role in the treatment of acne. They can therefore be appropriate for some teenagers when being used for this indication, ideally with suitable guidance or medical supervision. However, that is very different from children routinely using retinol as part of an antiageing skincare routine.”

We’re just a few weeks away from our 2026 BAMAN Autumn Aesthetic Conference, and we can’t wait to bring the BAMAN community together once again for two days of inspiring speakers, practical education, invaluable networking and our 2026 BAMAN Awards Ceremony. This November, in collaboration with Cotofana Anatomy, we’re bringing one of the world’s most sought-after anatomy programmes to the Royal College of Surgeons of Edinburgh. Led by Professor Sebastian Cotofana and his specialist faculty, doctors, dentists and nurses experience anatomy education and hands-on cadaveric dissection at the very highest level, right here in the UK. Find out more via the QR code below.

This column is written and supported by BAMAN

The Advertising Standards Authority commented, “At this point, we haven’t seen evidence of inappropriate advertising of skincare products to children, but it’s an area we’re continuing to explore. In terms of our rules, advertisers have a responsibility to ensure that their adverts are socially responsible.” Aesthetics | September 2026

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Patient Concerns

Survey reveals weight-loss perception shift

01 & 02 October 2026 Excel, London

Event Spotlight: The Conversations Worth Having Your guide to networking at CCR

For a lot of people, networking can feel like something they should be good at but secretly dread. The problem is that networking is often treated as something performative, when in reality most people are looking for something much simpler: a useful conversation. At the Clinical Cosmetic Regenerative Congress (CCR), the Networking Trail is there to make those moments easier to find. Three top tips for success: 1) Know what you want from it

Conducted by independent European data collector Norstat on behalf of Teoxane, the research surveyed 2,500 women in the UK. A key theme was heightened concern around facial fat loss, with 65% of women expressing worry that they may experience it in the future, according to the company. Among those who have experienced facial fat loss following weight loss, 84% are aged 18-24, compared to 53% are aged 35-44, Teoxane explains. In addition, 42% of people in the UK say they have addressed facial fat loss with dermal filler, with the leading demographic aged 35-55 (51%), followed by 18-34-year-olds (38%), shares the company. Among those who have lost weight rapidly, 60% felt they had experienced noticeable facial fat loss. The aesthetic manufacturer claims the most common visible changes were loss of temple volume (31%) and noticing a more prominent bone structure (37%). Teoxane key opinion leader and aesthetic practitioner Dr Raul Cetto, commented, “It is now one of the most frequent topics I encounter in clinic, and the data backs that up. Patients are no longer simply asking about lines and wrinkles – they are asking why their face looks ‘tired’ or ‘deflated,’ and they want to understand why.” Teoxane will be showcasing babyGLOW by Teoxane at the Injectable Experience at CCR next month. Turn to p.18 to register now. Event Agenda

Before the event, think about what would make networking feel worthwhile for you. That might be finding a potential supplier or collaborator, getting honest advice or simply widening your circle.

BAMAN Autumn conference returns

2) Lead with curiosity, not a script The easiest way into a good conversation is usually a good question. Ask people what has brought them to the event, what they are seeing in clinic or what has stood out to them so far. 3) Do the follow-up A short message saying it was good to meet them, or picking up on something you discussed, is often all it takes to turn a one-off chat into an ongoing contact. Key moments to remember · CCR Speaker and VIP Networking Hour – 14:30 daily – Dermapenworld VIP Lounge · Aesthetics Journal Networking Drinks – 15:30 day 1 – Aesthetics Lounge · Brands of Aesthetics Networking Drinks – 16:00 day 1 and 15:00 on day 2 – Aesthetics Lounge · Official CCR Networking Event & drinks reception – 17:00-19:00 day 1 – Galderma & CCR Networking Lounge

Scan the QR code to register now.

Research by aesthetic manufacturer Teoxane highlights growing concern around facial fat loss.

The British Association of Medical Aesthetic Nurses (BAMAN) has revealed the agenda for its Autumn Aesthetic Conference 2026. The two-day conference will be held at The Eastside Rooms, Birmingham, on September 24-25. The programme includes sessions covering commonly occurring skin lesions and referral pathways, injectables ahead of surgery, new university modules for medical aesthetic nursing, VAT in aesthetics, artificial intelligence and career planning, as well as live demonstrations. Joining the conference virtually, Professor Sebastian Cotofana is presenting ‘Anatomical Approach with Toxins: Update on Toxin Injection Strategies’. The organisation shares the speaker lineup will include founding director of the Complications in Medical Aesthetic Collaborative Gillian Murray, alongside BAMAN chair Amy Bird, director Julie Brackenbury and vice-chair Anna Baker. BAMAN head of brand, Bec Coleman, commented, “Clinical education will always sit at the forefront of this conference, but it’s important for us to also offer practical sessions on consent, licensing and what the future of this profession actually looks like. These are conversations our nurses are having every day, and they deserve a conference programme that reflects that.” BAMAN will be exhibiting at CCR next month. Turn to p.18 to register now.

Aesthetics | September 2026

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Partnership

Insider News

Radiofrequency

Zenoti reveals collaboration with PavilionFlow

XERF launches in the UK

Patient booking software company Zenoti and self-service platform PavilionFlow have announced a partnership. Zenoti explains that the collaboration will make PavilionFlow’s front-of-house technology available to Zenoti partners. PavilionFlow provides self-service kiosks and in-clinic tablets designed to reduce reception workloads and improve the patient journey, according to the company. The company says the technology is aimed at large-scale clinic operators looking to reduce front-of-house costs and improve site-level profitability. According to the partners, PavilionFlow connects directly to existing Zenoti accounts, with patient records, appointments, services and transaction data remaining within Zenoti. Venkata Sankaran, senior vice president of partnerships at Zenoti, said, “PavilionFlow addresses a real operational challenge for multi-site salon operators – how to manage front-office costs without compromising the patient experience. We’re pleased to welcome PavilionFlow to the Zenoti ecosystem, and we look forward to seeing our shared partners put this to work.” Zenoti will be exhibiting at CCR next month. Turn to p.18 to register now.

Non-invasive skin-tightening treatment XERF has officially debuted in the UK under the exclusive distribution of laser device company Seriderm. According to the company, XERF uses dual-frequency monopolar radiofrequency energy to heat the deeper layers of the skin. This controlled heat encourages collagen contraction and long term collagen remodelling, helping improve skin firmness and elasticity, shares Seriderm. The company adds that the treatment is designed to address early-to-moderate skin laxity, including sagging around the jawline, early jowls, loose neck skin, under-chin laxity and reduced facial firmness. Zabi Zaheer, South UK and Ireland business manager at Seriderm, commented, “Patients are already expressing strong interest, while practitioner demand and pre-orders have been exceptional. Its patented dual-frequency technology, designed to deliver controlled energy at multiple tissue depths, including deeper structures around the superficial musculoaponeurotic system, offers something genuinely distinctive to the UK market. With treatments commencing in September, I expect XERF’s momentum to build further. For Seriderm, this is just the beginning.” Seriderm will be exhibiting at CCR next month. Turn to p.18 to register now.

Topical Formulation

Caromed Italia debuts ElysiHA

Skin Health

Aesthetic manufacturer Caromed Italia has announced that ElysiHA will be officially launching at the Clinical Cosmetic Regenerative Congress (CCR) 2026. According to Caromed Italia, ElysiHA is a topical formulation, developed to support skin quality in individuals undergoing pharmacological weight loss. Its formulation combines polydeoxyribonucleotide (PDRN), dual molecular-weight hyaluronic acid (HA), recombinant collagen, ectoin and copper peptide GHK-Cu to support hydration, barrier function and collagen-related signalling. Massimiliano Candini, Caromed Italia brand and business development director commented, “Caromed Italia is proud to announce the global launch of ElysiHA, the next evolution of regenerative science, balancing key actives that target and enhance the PDRN regenerative compound for each area. ElysiHA face pairs recombinant collagen for structure with dual-molecular-weight HA for hydration; the eye formula refines the same core to target dark circles and under-eye bags – a natural approach to slowing ageing.” Caromed Italia will be exhibiting at CCR next month. Turn to p.18 to register now.

Revision Skincare unveils topical biostimulator Skincare company Revision Skincare has released its D·E·J BioStim Treatment Solution designed for in-clinic use. Available through aesthetic distributor AestheticSource, the treatment aims to stimulate the skin’s natural collagen and elastin production. AestheticSource notes that the treatment is a needle-free topical biostimulator, which uses a patent‑pending, dual‑action technology combining antioxidant phytoacids and a multi‑acid delivery system to stimulate the dermal‑epidermal junction, where skin firmness and elasticity originate. The company further shares that it aims to support long-term skin health across the face, neck and décolletage. Chief executive officer of AestheticSource, Lorna Bowes, commented, “Revision Skincare has built its reputation on combining cutting-edge science with clinically proven results, and this launch is another example of that commitment to innovation. It offers our clinic partners an exciting new way to deliver visible rejuvenation with minimal discomfort and downtime. We believe this treatment will become a valuable addition to any clinic looking to offer evidence-based solutions that support long-term skin health and skin longevity.”

Aesthetics | September 2026

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Further Education

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Individualised Treatment

Interface Aesthetics reveals training packages

New genomics-led platform to unveil at CCR

Training academy Interface Aesthetics has introduced a new range of enhanced Level 7 training packages for practitioners.

DNA and genetic testing platform BIOguided is officially launching at the Clinical Cosmetic Regenerative Congress (CCR) 2026.

The company explains that the packages include its Joint Council for Cosmetic Practitioners accredited Vocational Training Charitable Trust Level 7 Postgraduate Diploma in Aesthetics. In addition, the packages also feature specialist masterclasses covering advanced botulinum toxin techniques, cannula use, skin boosters, biostimulators, polynucleotides, lower-face contouring, periorbital and perioral rejuvenation and complications management. Interface Aesthetics shares that all three packages include a complications management masterclass and mentorship as well.

BIOguided explains the platform then generates an individualised treatment protocol for each patient, spanning in-clinic treatments, homecare, supplements and broader wellness and sleep considerations.

Oral and maxillofacial surgery registrar and founder and lead educator at Interface Aesthetics, Mr James Olding, commented, “We’re seeing patients arrive with far more complex, interconnected concerns than a single treatment can address. These packages exist so our delegates leave equipped to think about the whole face, not just one area of it – combining the rigour of a regulated postgraduate qualification with the breadth practitioners now need in real clinical practice.” Interface Aesthetics will be exhibiting at CCR next month. Turn to p.18 to register now. Injectable Kit

TSK Laboratory UK relaunches cannula kit Aesthetic manufacturer TSK Laboratory UK has reintroduced selected STERiGLIDE Cannulas in a new smaller four-pack format. According to the company, the new four pack features sizes 25G x 38mm, 25G x 50mm, 22G x 50mm and 22G x 70mm. TSK Laboratory UK shares that the launch has been designed to give medical aesthetic professionals an easier introduction to STERiGLIDE Cannulas, while being able to trial different sizes and build confidence with cannula treatments before progressing to larger pack quantities. Managing director at TSK Laboratory UK, Simon Poustie, commented, “Working closely with training academies and practitioners, we understand the challenges of starting a cannula journey or establishing a new clinic. This smaller pack format provides a more accessible way to experience STERiGLIDE and build confidence with cannula treatments.”

The company says its genomics-led platform uses an individual’s DNA and genetic test results to analyse 45 genetic markers across 10 biological pathways. These include skin barrier function and sensitivity, oxidative stress, inflammation and inflammaging, collagen and extracellular matrix, pigmentation, glycation and metabolic ageing and injectable readiness.

Claire Williams, CEO and founder of BIOguided, shares, “For years, aesthetics has treated skin from the outside in and hoped for the best. If you aren’t testing, you are guessing. When you can see which pathways are driving someone’s skin ageing, you stop prescribing by trend and start prescribing by evidence supporting your patients unique biological signature and working on their skin and health longevity.” BIOguided will be exhibiting at CCR next month. Turn to p.18 to register now. Firming Complex

IMAGE Skincare debuts VOL.U.LIFT Body Skincare company IMAGE Skincare has released topical formulation VOL.U.LIFT Body designed for weight-loss side effects. Available through aesthetic distributor Wigmore Medical, the new body formula is designed to address the visible signs of sagging, crepiness, dehydration and loss of tone, the company shares. According to IMAGE Skincare, ingredients include marine bioactives and blackberry extract, aiming to improve the appearance of contours and firmness, while heptapeptide-7 and bakuchiol support a firmer, smoother, more elastic-looking complexion. The company adds that hyaluronic acid combined with silanol delivers deep hydration and suppleness, while coffee arabica seed oil helps smooth skin and reduce the appearance of cellulite. Additionally, IMAGE Skincare’s XOSM Technology aims to enhance antioxidant delivery while supporting the skin barrier. Chief executive officer of IMAGE Skincare and plastic surgeon Mr Marc Ronert commented, “We are now expanding the category with VOL.U.LIFT Body, a clinically tested body skin treatment designed to complement glucagon-like peptide (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) agonist therapies and diminish visible signs of ageing. VOL.U.LIFT Body has undergone robust clinical studies with current GLP-1 and GIP patients, showing improvements in overall body skin firming, tightening and sculpting.”

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Aesthetics | September 2026

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Insider News

Cadaver Masterclass

Mr Dalvi Humzah hosts anatomy training The Anatomy and Complication Management Masterclass – Dalvi Humzah Aesthetic Training took place at the Surgical Skills Centre, Coventry. Led by consultant plastic surgeon and anatomist, Mr Dalvi Humzah, the masterclass was delivered with a ratio of two delegates per specimen, allowing for detailed exploration of anatomy and practical techniques. The programme examined the arrangement of facial fat, muscle, vessels and nerves, with a particular focus on anatomical danger areas relevant to both surgical and non-surgical procedures. Delegates explored age-related facial changes and their implications for treatment, as well as injection planes and intervention techniques. Practical dissection covered the forehead, temple, periorbital region, mid-cheek and buccal fat, lower jawline and masseter. Mr Humzah commented, “The cadaver masterclass enables practitioners to have an in-depth discussion with myself, and the small group session gives delegates the opportunity to develop their knowledge, skills and abilities that will enhance their clinical practice.” Mr Humzah is part of the expert judging panel, alongside nurse prescriber Sharon Bennett and Dr Catherine Fairris, for the Aesthetics Results Awards on Day 2 of CCR next month. Turn to p.18 to register now. Skin Concerns

Roseway Labs debuts tretinoin mask Compounding pharmacy Roseway Labs has launched its Tretinoin 5% Gold Peel Mask. According to Roseway Labs, the mask is developed for professional in-clinic application and home use, as the company shares it may be used as a standalone treatment or incorporated into an individualised treatment plan. The company shares that the mask creates a temporary occlusive environment that keeps the active ingredient in close contact with the skin for 20-30 minutes before being gently peeled away. Roseway Labs adds that the treatment has been developed to support skin concerns, including acne, photoageing, hyperpigmentation, melasma, uneven skin texture and early signs of ageing. Miriam Martinez Callejas, chief clinical pharmacist at Roseway Labs, commented, “The 5% Tretinoin Gold Peel Mask introduces an exciting new way for clinicians to incorporate tretinoin into professional treatment plans, offering a controlled, short-contact application that can be tailored to individual patient needs.” Roseway Labs will be exhibiting at CCR next month. Turn to p.18 to register now. Campaign

Healthxchange unveils new campaign Aesthetic distributor Healthxchange has launched Trust in Aesthetics. Designed to highlight standards and principles underpinning the field, Healthxchange shares the campaign will run across trade and digital communications throughout 2026. The company says the initiative highlights its 25-year focus on ethical practice, regulatory standards, product authenticity and patient safety. Jack Curran, chief executive officer at Healthxchange, commented, “Trust sits at the centre of those relationships, and this campaign is an opportunity to celebrate the partnerships we’ve built over the last 25 years with practitioners, manufacturers and specialty stakeholders alike.”

News in Brief OxygenRx debuts AI scribe Clinical operating system company OxygenRx has introduced an artificial intelligence (AI) assistant to its prescribing platform. The company shares the OxygenRx AI Scribe tool is designed to capture consultations by listening to the dialogue and automatically generating a written transcript of the appointment. According to OxygenRx, tasks that would traditionally require prescribers to manually re-enter information into consultation or assessment forms, such as weight management questionnaires, can now be completed automatically based on what is discussed during the consultation. LAB 31B debuts skincare range Skincare company LAB 31B has launched three new products that are designed to replicate microneedling benefits through topical application. According to the company, the products use peptide-infused hyaluronic acid (HA) crystals that gently massage into the skin. LAB 31B says the formula contains HA alongside PowerPeptide-5, which the company describes as an anti-wrinkle, collagen-supporting peptide complex. mesoestetic introduces new pre-filled syringe format Aesthetic manufacturer mesoestetic has debuted skin booster mesohyal argibenone in a new pre-filled syringe format. The company shares that mesohyal argibenone has been re-designed in a convenient 1 x 2ml pre-filled syringe, aiming to support precise delivery for practitioners. The targeted skin booster is formulated to enhance radiance, retexturise the skin and promote a more unified tone, addressing early signs of skin ageing including dehydration, dullness, uneven tone, fine wrinkles and changes in texture. New online community platform launches Independent nurse prescriber Kelly Saynor has founded the Practitioner Hub. Saynor shares that the platform is a new online membership, created to support practitioners throughout the realities of building a safe, credible and sustainable career in aesthetics. Saynor explains that she aims to bridge the gap between completing individual treatment courses and navigating clinical practice, providing practitioners with the ongoing guidance, context and mentorship needed to navigate clinical practice, regulation, prescribing, patient management and business ownership.

Healthxchange will be exhibiting at CCR next month. Turn to p.18 to register now. Aesthetics | September 2026

Advertorial mesoestetic

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mesoestetic® Advances Regenerative Aesthetics with the Evolution of mesofiller® nexha Succinic acid and dual release™ technology plus specific active ingredients: the mesofiller® nexha difference Medical aesthetics is entering a new era, one defined not just by correction, but by regeneration. As patient expectations evolve, there is a growing demand for treatments that deliver subtle, natural-looking results while actively improving skin quality over time. mesoestetic® continues to lead this shift with the evolution of mesofiller® nexha a next-generation injectable range designed to go beyond traditional fillers. Building on the success of its first generation, the portfolio has now expanded to include mesofiller® nexha aox, mesofiller® nexha lift, complementing mesofiller® nexha lips and mesofiller® nexha volume.1

· mesofiller® nexha aox: Targets moderate

signs of ageing while enhancing skin tone and luminosity. Formulated with potent antioxidants, including vitamin C and idebenone, it helps neutralise reactive oxygen species (ROS), reduce melanin synthesis by inhibiting tyrosinase activity, and support collagen production for improved overall skin quality.1 Together, these solutions enable practitioners to move beyond isolated treatments delivering a more holistic, regenerative approach across multiple indications.

restoring structure and definition in areas such as the jawline, chin and deeper facial folds, helping to rebalance facial proportions.1 · mesofiller® nexha lips: Designed to enhance and rejuvenate the lip and perioral area, creating soft, natural-looking definition and hydration.1 · mesofiller® nexha lift: Developed to support and reposition tissues, helping to restore facial structure and improve the appearance of skin laxity. Enriched with NCTC 109 to optimise skin metabolism supporting fibroblast viability, biosynthesis and repair and DMAE to promote cell membrane stability and collagen synthesis, contributing to firmer, more resilient skin.1 16

Since launch, mesofiller® nexha has gained strong endorsement from practitioners who value both performance and patient satisfaction.1-3 Dr Fab Equizi, Enhance Clinispa, says, “While there is an increasing trend towards regenerative treatments fillers are still a very necessary treatment modality in my practice. To have a product that can restore volume loss and have regenerative benefits to skin and subcutaneous tissue is both novel and exciting. I have gained some experience with this range now and I am impressed with the results.”

mesoestetic® supports practitioners with a comprehensive portfolio of over 300 products, spanning injectables, professional treatments and homecare. This is underpinned by the PATH framework:

From correction to regeneration: the nexha evolution

· mesofiller® nexha volume: Ideal for

mesofiller® nexha challenges the limits of conventional fillers going beyond superficial correction to actively improve skin quality over time. The pioneering range of hyaluronic acid – fillers combine visible correction and deep biostimulation through the synergistic action of succinic acid and exclusive ingredients that target the main signs of ageing.1

A complete, 360º treatment approach

The new additions to the range include the incorporation of active ingredients as well as cross-linked hyaluronic acid and succinic acid, making it truly unique and unlike anything else currently available on the market.1

The mesofiller® nexha range was developed to meet a clear clinical need: solutions that combine immediate aesthetic correction with long-term skin regeneration. With the introduction of new targeted formulations, the range has evolved into a comprehensive system for full-face and area-specific rejuvenation.

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· Profundity: in-depth

patient understanding

mesofiller® nexha: redefining injectable science Powered by dual release™ technology, mesofiller® nexha delivers immediate lifting with cross-linked hyaluronic acid while progressively releasing succinic acid and targeted active ingredients including peptides for up to seven months.1

· Action: personalised treatment plans · Time: structured treatment progression · Homecare: maintenance for long-term results

By integrating mesofiller® nexha into this approach, clinics can deliver results that are not only immediate, but progressive and sustainable.

Each formulation combines:

· Cross-linked hyaluronic acid

to restore volume and provide immediate correction2 · Succinic acid, a powerful biostimulator with antioxidant and regenerative action3 · Additional active ingredients: exclusive ingredients that target the main signs of ageing including peptides, NCTC 109, vitamin C3 This unique combination positions mesofiller® nexha as a pioneer in what mesoestetic® defines as neostimulation a synergistic approach that delivers both tissue volumisation and ongoing skin regeneration. Aesthetics | September 2026

This advertorial was written and supplied by

mesoestetic® UK & Ireland is the official authorised distributor in the region, ensuring clinics receive authentic products alongside expert training and ongoing support. For clinics interested in offering mesofiller® nexha, contact: contact@mesoestetic.co.uk

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News Special Polynucleotide Trends

What the shift means for the market With 15% of UK aesthetic clinics still advertising PNs, the category remains an established part of the regenerative market rather than a passing trend, Rare. explains.1 However, ranking behind skin boosters at 34% and only narrowly ahead of biostimulators at 14%, the figures suggest PNs are settling into a more selective role rather than emerging as a dominant treatment category.1

New Analysis Indicates an Evolving Polynucleotide Market Aesthetics investigates how the integration of polynucleotides is evolving According to research by consulting company Rare. the proportion of clinics advertising polynucleotides (PNs) has fallen by 5% in the last year. The research used a random sample of around 13,000 UK aesthetic clinic websites, comparing advertised treatments year on year.1 Rare. notes that this reflects advertised services rather than actual treatment volumes and describes the trend as a “modest softening” rather than evidence of a category in decline.1 Aesthetics spoke to independent nurse prescriber and PN trainer Anna Baker and aesthetic practitioner Dr Steven Harris about how the sector is responding in practice.

Why are clinics taking different approaches? From the same sample, Rare. shares that 13% of clinics had removed PNs from their websites, as opposed to only 8% adding them.1 Rare. notes that it cannot cleanly distinguish between a genuine market decline, clinics removing prescription-only products from their public pages in line with Medicines and Healthcare Regulatory Agency advertising guidance, and measurement drift on its side during the same period.2 However, Dr Harris believes some clinicians’ caution around PNs reflects broader concerns within the aesthetics sector, particularly as clinicians are asking more questions about mechanisms, definitions, long-term outcomes and complications. He notes, “We need reproducible clinical evidence, objective outcome measures, meaningful long-term follow-up, independent studies and a plausible biological mechanism that can be demonstrated rather than assumed.” Dr Harris does not offer PNs in his clinic, noting this is not due to ineffectiveness, but rather the current evidence base not meeting his threshold for adoption. However, despite these stats, many practitioners do offer these treatments in clinic. Notably Baker, who has provided them for more than three years, says both patient demand and a measured evaluation process drove her clinic’s decision to introduce PNs. “Our discerning patient database increasingly requested PNs,” she explains, adding, “The clinic initially trialled the treatment on a small number of patients in the periocular area before deciding whether to incorporate it more widely.”

For Dr Harris, the figures reflect the natural evolution of an emerging treatment category. “New treatments often experience an initial surge driven by marketing, education and social media. Over time, clinicians begin comparing outcomes with established treatments and become more selective about where a treatment genuinely adds value,” he says. Dr Harris also believes patient attitudes may be evolving. “Patients are becoming increasingly interested in evidence, not just novelty.” More broadly, he sees the trend as part of a wider shift within medical aesthetics. “I believe the specialty has become more cautious, and I see that as a positive development. There is growing recognition that innovation and evidence are not the same thing,” adds Dr Harris. However, Baker notes that the softening seen in the data is not necessarily being reflected at practice level. She says, “From our perspective, we have not witnessed a decline in requests or the number of PN that we offer.”

Navigating a more mature PN market Aesthetics Journal reached out to manufacturers for a comment, and Croma and DermaFocus said the decline in advertising should not be interpreted as a drop in practitioner confidence, but rather as a sign of a maturing market, with practitioners increasingly incorporating it into combination plans. As the category matures, practitioners believe greater attention is being paid to how PNs are selected, positioned and discussed with patients. Baker says, “Clinicians should ensure that products are appropriately licensed for use and that the brand has credible data to support the indications for use. They should also carefully consider the manufacturer process, including extraction and purification methods, and to source manufacturer approved training, which offers post-course support in the event of a potential complication.” For practitioners, Dr Harris advises ensuring that marketing and patient communications accurately reflect the available evidence. “I think it’s more accurate to talk about tissue remodelling rather than regeneration. From a marketing point of view, I would avoid making claims about ‘regenerating’ or ‘restoring’ tissue unless we have evidence showing that this is genuinely happening,” he notes. Dr Harris believes wider adoption will ultimately depend on the strength of the evidence base. “Training is particularly important here because practitioners need to understand the difference between a proposed mechanism and a proven clinical outcome, and between regeneration, repair and remodelling,” he explains.

Moving beyond initial implementation Overall, the interviewees suggest that PNs are not disappearing from the UK aesthetics market, but moving into a more selective and clearly defined role. While some clinics appear to be stepping back from actively promoting the treatment, others continue to see value in it where patient demand, training and product choice align. As the category evolves, the practitioners believe its longer-term place in the market may depend less on novelty and more on evidence, education and precise positioning. VIEW THE REFERENCES AT AESTHETICSJOURNAL.COM

Aesthetics | September 2026

Event Preview CCR

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Defining the Future of Medical Aesthetics CCR returns with education, networking and innovation shaped around the needs of today’s medical aesthetics professionals

Medical aesthetics is not short of innovation, but for most practitioners that is not the same as clarity. New products launch, treatment areas evolve, patient expectations shift and adjacent fields such as longevity and regenerative medicine continue to influence the conversation. At the same time, clinics are balancing practical concerns around growth, retention, differentiation and standards of care. What many professionals need now is not simply more information, but better context; what matters, what is changing and what may genuinely be useful in practice. 18

That is where a well-curated event can still prove value. Done well, it offers more than a diary of sessions or a busy show floor. It gives visitors the opportunity to compare ideas, pressure-test trends, explore technologies in person and hear how others are approaching the same clinical and business questions. This year’s Clinical Cosmetic Regenerative Congress (CCR) is built around exactly that mix of needs, with a programme spanning education, innovation, networking and practical clinic support. Aesthetics | September 2026

A programme that reflects the reality of practice Set across seven conference theatres and featuring more than 120 speakers, CCR’s educational programme is designed to cover the breadth of modern aesthetics practice, with free-to-attend, CPD-verified sessions spanning injectables, regenerative medicine, devices, skincare, longevity, business and more. Across the programme, attendees can expect a mix of evidence-led discussion, technique development and wider strategic thinking – useful not just for those looking

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to sharpen their clinical knowledge, but also for those wanting to understand where the specialty is heading more broadly. Practical learning for evolving patient needs As Headline Sponsor, Galderma is set to bring a strong educational focus to this year’s event, with two sessions closely aligned to some of the specialty’s most relevant conversations. On Day 1, Dr Jessica Halliley and Dr Yusra Al-Mukhtar will present ‘Menopause in the Mirror: Navigating the Patient Journey’ with the Galderma Portfolio. Combining education with a live half-face demonstration, the session will explore the science of the menopausal face, including collagen depletion, bone resorption and changes in skin quality. The programme is designed to move from theory into practice, showing how the Restylane portfolio can be combined with Sculptra and ALASTIN to address structural support, contour and skin vitality in a more multimodal way. For practitioners seeing increased demand from patients in perimenopause and menopause, this session will highlight practical treatment framework as much as the science behind it. Galderma’s Day 2 session, ‘Architectural Smile: Bridging Dental Assessment and Aesthetic Execution,’ will shift attention to

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the perioral region. Dr Nataile Ball and Mary Irving will bring together cosmetic dentistry and aesthetic nursing perspectives, focusing on diagnostic assessment, skeletal profiling, dynamic movement and product selection, followed by a live half-face demonstration. Metabolic health in focus One of the clearest signs of how aesthetics continues to broaden its scope is the return of the Medical Longevity Summit, sponsored by Nicoya Health, now in its fourth year at CCR. This year, the summit will focus on inside-out ageing and how optimising metabolic health can support longer, healthier lives. That reflects a wider shift already visible across the sector, as practitioners respond to growing patient interest in prevention, wellness and longer-term health outcomes. A key voice within this year’s summit is international keynote Dr Nasha Winters, who will deliver sessions on ‘Why Metabolism Matters: From Cell Biology to Global Disease, Metabolic Health and Cancer Risk – What the Evidence Shows, and The Future of Metabolic Health and Mitochondrial Medicine.’ The summit is not just about introducing longevity as a trend but grounding it in evidence and wider health context.

Aesthetics | September 2026

Event Preview CCR

Access the latest trends The aesthetics specialty is constantly evolving, and the Aesthetics annual Trends and Product Launches Report, brought to you by Aesthetics Journal and Rare., provides a curated overview of the most exciting products, treatments and innovations introduced to the UK aesthetics market in 2026. For ease of navigation, the report is divided into six key categories:

· Revitalising Injectable Treatments · Devices for Face and Body Rejuvenation · Advanced Skin Treatments · Professional Skincare · Longevity and Wellness · Practice Management and Clinic Growth The report will be distributed to CCR delegates at 9:45am on the In Practice Theatre, during the session ‘2026 Trends Outlook: Featuring the Launch of the annual Trends and Product Launches Report’.

Event Preview CCR

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Recognition rooted in clinical judgement A new addition for 2026 is the Aesthetics Results Awards, shining a spotlight on the clinical thinking behind strong patient outcomes. In a specialty where attention can often settle on the end result alone, the Results Awards are designed to celebrate something more complete; safe, ethical and exceptional outcomes, alongside the judgement, planning and standards of care that make them possible. The top Finalists from each category will be invited to speak on stage about their result, giving attendees the opportunity to hear more about the clinical reasoning behind standout case studies. Judged by Mr Dalvi Humzah, Sharon Bennett and Dr Catherine Fairris, the Awards will culminate in the Winners being announced at the Aesthetics Mastery Theatre on Day 2 of CCR. Support beyond the treatment room Clinical education is only part of what many delegates need from an event. Running a successful clinic also means understanding patient communication, marketing, finance and how to stand out in a competitive landscape. The In Practice Zone is designed with that reality in mind, offering a dedicated space for clinics to build business knowledge and explore ways to strengthen their proposition. For many attendees, that practical support may prove just as valuable as the more treatment-led sessions. ‘Behind the Selection: How Companies Choose KOLs’ brings together representatives from Galderma, IBSA and BTL Aesthetics to unpack a topic that is often discussed informally but less often explored openly; how key opinion leaders are identified, what brands are really looking for and how credibility is built in a crowded market. Media presence is also firmly on the agenda in ‘Building your Brand Presence Through Press Coverage.’ Dr Ahmed El Muntasar, Mr Ash Soni, Nina Prisk, Dr Preema Vig and Francesca Ogiermann-White explore how practitioners and brands can approach visibility more strategically. With demand continuing to evolve, ‘Understanding How to Integrate GLP-1s into Practice,’ presented by Miss Jennifer Doyle, will address one of the most current and commercially significant conversations in aesthetics and wellbeing. For clinics considering where these treatments may fit – and how to approach them responsibly – it is likely to be one of the more closely watched sessions. You can read the full CCR agenda on the website and app.

Aesthetics | September 2026

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A show floor built for discovery This year’s CCR Innovation Trail You can discover the latest in UK medical aesthetics by following the Innovation Trail, the go-to guide for discovering the most cutting-edge and transformative products in the market. Designed to streamline the experience, the trail highlights brands and innovations making waves in the specialty – from pioneering devices and injectables to advanced skincare and diagnostic tools. Aerolase – Neo Elite BIOguided – BIOguided BTL – EMFUSION Galderma – ALASTIN Restorative Skin Complex

CCR’s show floor brings together more than 150 brands and suppliers, covering devices, skincare, injectables and wider clinic solutions. The value of that lies not simply in scale; it lies in the opportunity to compare options properly, ask better questions and see where new technologies may fit within real practice needs. This year also sees the return of The Korea Zone, in partnership with the International Beauty Industry Trade Association (IBITA), which showcases cutting-edge technology that is new to the UK market. For visitors keen to understand where innovation is heading internationally, this is likely to be a particularly interesting stop on the floor.

Promoitalia – EXO-NAD Renaissance – X Blast

Key moments include:

Roseway Labs – Gold Peel Mask

· Speaker & VIP Networking Hour drinks

Medik8 – Exo-PDRN Prismatic+ Pro Concentrate Ninaveli London – NAD+ NMN

– 14:30 daily – Dermapenworld VIP Lounge

Headline Sponsor

01 & 02 October 2026

· Aesthetics Journal Networking Drinks

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Special Feature Topical Peptides

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Another study published in the Journal of Cosmetic Dermatology by Lintner et al. investigated the effects of a serum containing Palmitoyl Tripeptide-38 on visible facial ageing.13 35 women aged 40 years and older – with signs of ageing – applied the serum once daily for 56 days.13 After, skin roughness decreased by 8-9%, redness and pigmentation by 9% and 8%, while uniformity increased by 8% and clarity by 3%.13 Participants also reported improved radiance, complexion and wrinkles.13

Showcasing the Use of Peptides in Skincare Three practitioners discuss protocols for topical peptides within clinical management Topical peptides have been gaining momentum in evidence-led skincare, valued for their ability to support skin repair and address visible signs of ageing through targeted biological signalling.1-4 Unlike traditional active ingredients that primarily exfoliate or protect the skin, peptides act as cell-signalling molecules capable of influencing processes involved in collagen synthesis, barrier function and inflammation.1-5 While their clinical effects depend on peptide structure, formulation and skin penetration, growing evidence suggests that selected topical peptides can improve skin firmness, fine lines, hydration and overall skin quality.6-10 Topical peptide formulations encompass several functional classes, including signal peptides, carrier peptides, enzyme-inhibiting peptides and neurotransmitter-inhibiting peptides, each designed to target different aspects of skin ageing and homeostasis.1,2 As peptide technologies continue to evolve, they are increasingly incorporated into evidence-based skincare regimens, offering a complementary approach to established topical actives for both preventative and corrective skin rejuvenation.2-5 Aesthetics spoke with aesthetic practitioners Dr Jessica Halliley, Dr Tom Kamal and Dr Zunaid Alli on how to incorporate topical peptides into clinical protocol.

Exploring recent literature Recent clinical studies provide evidence supporting the efficacy of topical peptides for improving signs of skin ageing. Chang et al. conducted a randomised, double-blind, active- and vehicle-controlled trial involving 90 adults with ageing skin, with participants aged 30-55.11 Published in the Journal of Cosmetic Dermatology, participants applied either 0.002% cyclized hexapeptide-9 (CHP-9), 0.002% retinol or a vehicle serum twice daily for 56 days. CHP-9 significantly reduced crow’s feet, with wrinkle number decreasing by 2.2, wrinkle area by 3.95 and roughness by 1.95.11 Forehead wrinkle number decreased by 2.88, area by 4.90 and roughness by 3.96. The study also reported improvements in skin hydration, barrier function, epidermal thickness and density.11 Similarly, published in the Journal of Cosmetic Dermatology, Gold et al. evaluated a topical antiageing formulation containing TriHex peptide technology, octapeptide-45 and magnolol in a 12-week, multicentre open-label study involving 44 participants.12 At week 12, investigator assessments found a 20% improvement in elasticity, 17% reduction in wrinkles, 41% improvement in skin surface roughness, 23% improvement in pigmentation, 33% reduction in erythema and 25% reduction in pore size.12 22

While emerging evidence supports the use of peptides in skincare, efficacy should not be generalised across the category, as different peptides have distinct mechanisms, formulations and levels of supporting evidence.3-5 Efficacy may also be influenced by formulation and delivery characteristics, including peptide stability, concentration and skin penetration.3-5 As a result, evidence for one peptide or formulation should not necessarily be extrapolated to other peptide-containing products.3-5

Defining peptides Dr Kamal explains that peptides are short chains of amino acids that can act as signalling molecules or functional ingredients within the skin.1,2 He says, “Unlike traditional moisturisers, which primarily hydrate the skin, peptides send signals that can encourage processes such as collagen synthesis and wound repair.”1-5 Dr Kamal explains that their potential applications therefore extend beyond hydration, with different peptides being investigated for their role in supporting collagen and elastin production, skin repair and barrier function, as well as addressing visible signs of ageing and inflammation.1-5 All three practitioners interviewed outline that, in clinical practice, peptides can be broadly categorised according to their function, including signalling peptides, carrier peptides, enzyme-inhibiting peptides and antimicrobial peptides.14

“Peptides are not a quick fix, but if patients commit to it, the results can be amazing” Dr Tom Kamal The role of signalling peptides, explains Dr Kamal, is to stimulate fibroblasts. “The fibroblast is like the powerhouse within the skin tissue, and works to encourage collagen, elastin and other key proteins within the extracellular matrix (ECM),” he says.15 Dr Halliley explains the role of the other three peptide categories, outlining, “Carrier peptides support signalling and repair processes, whereas enzyme-inhibiting peptides influence pathways involved in collagen degradation.” She also describes antimicrobial peptides – known for eliminating harmful bacteria, therefore reducing inflammation – as a newer area of research, but one that is particularly interesting for the future treatment of inflammatory skin conditions.14,16,17 Considering peptide categories “Peptides can be described in two different ways; according to their function within the skin, and their structure,” explains Dr Kamal.1,2

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“As outlined above functional categories include signalling, carrier, enzyme-inhibiting and antimicrobial peptides; meanwhile structural terms such as tripeptide and hexapeptide, refer to the number of amino acids within the peptide chain,” he says.14 Dr Kamal explains that a tripeptide contains three amino acids, while a hexapeptide contains six, adding, “These terms therefore describe the peptide’s structure rather than its function or efficacy.”14

“I predict patients will become better informed and more discerning, particularly in the skincare market, paying closer attention to ingredient lists and actively looking for peptides” Dr Zunaid Alli One example is glycyl-L-histidyl-L-lysine (GHK), a naturally occurring tripeptide that can bind copper ions to form GHK-Cu, also known as copper tripeptide-1.18-20 Dr Alli highlights Copper Tripeptide-1 as a prominent peptide used in skincare, explaining, “It’s certainly finding its way into a lot of skincare formulations because of its potential to support skin regeneration at a cellular level, particularly within the epidermis and its upper layers.”18-20 Other specific peptides have been investigated for their potential effects on the appearance and function of ageing skin. Dr Halliley highlights, “Tripeptide-1 and Hexapeptide-12 are beneficial for improving the overall skin quality; they work by removing fragmented old collagen and elastin and accumulates with intrinsic ageing and UV damage.” She explains that these peptides may also support fibroblast activity and the production of structural proteins such as collagen and elastin.21,22 Dr Kamal highlights another specific peptide, Palmitoyl Tripeptide-38, commonly known by the trade name Matrixyl Synthe’6, in the context of antiageing skincare. He states, “It is one of the best studied peptides, with strong evidence behind it.”13,23 According to Dr Alli, Acetyl Hexapeptide-8 is used as an active skincare ingredient targeting the appearance of expression lines, making it a suitable adjunct to botulinum toxin, or as an alternative for patients who don’t want botulinum toxin.24,25

Analysing patient suitability Dr Halliley suggests that peptides may be broadly applicable across patient groups, with potential benefits for long-term skin health and quality. She specifies, “It is great for patients with signs of ageing. They are losing firmness in the skin, they’ve got an impaired skin barrier or they’re recovering from aesthetic procedures.”26,27

Special Feature Topical Peptides

Additionally, Dr Halliley notes that peptide-based skincare can be particularly beneficial for patients with sensitive skin but stresses the importance of setting realistic expectations. She explains, “It’s not a replacement for things like daily sunscreen, antioxidants, retinoids, but they work well when they’re incorporated into that kind of full skincare routine.”28-30 Considering suitability, Dr Kamal says, peptides may be particularly beneficial for patients showing earlier signs of maturing skin or reduced elasticity, as well as those looking to improve their skin barrier function. Broadly, he suggests this may include patients in their 30s and 40s. He explains, “Peptides are best suited to patients looking for a long-term plan rather than an immediate quick fix.”6-9 Dr Alli identifies patients seeking prejuvenation, rejuvenation, antiageing or hair restoration as ideal patient categories for topical peptides. He explains, “Peptides also are suitable for patients with acne, rosacea or eczema, provided the skin is not currently experiencing a flare-up or significant inflammation.” He adds that older patients can particularly benefit from topical peptides, especially when used alongside retinoids.14,16,31 “Beyond their longer-term benefits, peptides also support the skin’s natural healing and repair processes, making them a useful addition to post-treatment skincare,” Dr Alli says.26,27 Utilising assessment During the consultation, Dr Halliley explains, “I first evaluate the patient’s overall skin condition, including skin quality, hydration status and barrier function, while also assessing for active inflammation and signs of photodamage, using the Galderma Facial Assessment Scale.” She emphasises that treatment decisions should also be guided by lifestyle factors, individual concerns, treatment goals and skin sensitivity.32 Rather than using a scoring system, Dr Kamal says he assesses suitability for peptides through visual observation, stating, “I look for a degree of photoageing, pigmentation and any inflammatory conditions.”8,9 As part of the assessment, Dr Alli begins by reviewing the patient’s current skincare routine before examining the skin in detail, to gauge a greater idea into daily topical use. He shares, “Imaging devices can help assess areas of redness, deeper wrinkles, pore size, tone, texture and pigmentation that may not be visible to the naked eye.” Dr Alli details the use of Wood’s lamp imaging feature, which aims to reveal what’s happening underneath the skin, providing a useful baseline for treatment recommendations.33

Examining treatment protocol All three practitioners highlight that topical peptides can complement in-clinic aesthetic treatments, either as part of a regular morning and evening skincare regimen between treatment sessions or where the specific formulation and treatment protocol is appropriate, as part of post-procedure care. For example, clinical studies have investigated specific peptide-containing formulations applied immediately following procedures such as radiofrequency microneedling, with continued use over the following days or weeks.34,35 Used appropriately, peptide-containing skincare supports ECM remodelling, collagen synthesis and overall skin quality between treatment sessions, providing a synergistic, multimodal approach.2,3,34,35

Aesthetics | September 2026

Special Feature Topical Peptides

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Dr Kamal emphasises that peptides should be incorporated into a wider skincare routine, rather than used in isolation. He highlights the use of consistent SPF as essential, whilst recommending a combination of medical-grade SPF, with a retinoid and peptide serum, saying, “This is the absolute gold standard to enhance the skin quality, aiming to achieve greater injectable results down the line when the quality has been addressed.”28-30 Dr Alli highlights the importance of keeping a skincare routine simple, with cleanser and SPF forming the foundation. He says, “A serum and moisturiser can then be added depending on the formulation; some serums already contain moisturising ingredients, meaning there may be no need to use a separate moisturiser.”28-30 Before

After

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Dr Halliley shares that the patient used no other topical products on her arms, applying the peptide formulation morning and evening. The formula contains several peptides, including Palmitoyl Hexapeptide-12, Palmitoyl Tripeptide-1, Palmitoyl Tripeptide-5, Palmitoyl Dipeptide-5 Diaminobutyroyl Hydroxythreonine, Palmitoyl Dipeptide-5 Diaminohydroxybutyrate, Acetyl Hexapeptide-38 and Octapeptide-45, with the ALASTIN Restorative Skin Complex with TriHex+ being the chosen product for the treatment. 38 Detailing the treatment approach, Dr Halliley describes a combination of two Sofwave sessions, performed six weeks apart on the upper arms, alongside the use of the Restorative Skin Complex formulation. 37,38 To assess the individual contribution of the product, she conducted a split-arm comparison, applying her chosen peptide formulation to one arm for three months while leaving the other untreated. “The difference was quite dramatic,” she recalls, noting that she had not anticipated such a marked contrast between the two sides. Topical peptides with injectable treatments

Figure 1: A 68-year-old patient before and six months after two sessions of Sofwave, performed six weeks apart, and daily use of the ALASTIN Restorative Skin Complex with TriHex+. Images courtesy of Dr Jessica Halliley.

Dr Kamal explains that a 41-year-old female patient presented with concerns around fine lines, dullness and pigmentation, alongside a minimal skincare routine and no previous aesthetic treatments (Figure 2). As the patient expressed that she regularly ran outdoors and spent significant time in the sun without SPF, Dr Kamal focused first on improving her overall skin health and protecting it from further damage, by combining peptides with a range of skincare protocols.28-30

Before

After

He explains, “Peptides can generally be applied morning and evening, with products layered according to their ingredients. When combining peptides with a retinoid, I recommend cleansing in the evening, applying the retinoid first then following with the peptide product.” He also suggests patients should pat the peptide into the face instead of rubbing, to ensure a good level of absorption.3,36

Illustrating case studies The three practitioners interviewed shared a detailed protocol implementing topical peptides into treatment. Topical peptides with ultrasound Dr Halliley introduces her case study of a female patient, aged 68, who had been experiencing medicated weight loss from the use of a glucagon-like peptide (GLP-1) receptor agonist (Figure 1). She shares, “Following the weight loss, the patient was feeling conscious of her upper arms, due to crepiness and laxity. She was going on a cruise later that year and wanted to be able to wear strappy clothes comfortably.” Additionally, Dr Halliley notes that the patient had stopped taking GLP-1, as she had reached her goal weight. Describing the protocol, Dr Halliley shares it was a combination of ultrasound skin tightening with topical peptide use.37 Treatment sequencing and product selection Discussing the treatment combination, Dr Halliley explains that topical peptides can complement ultrasound skin tightening by supporting collagen and elastic-matrix signalling and improving hydration and skin quality, while ultrasound provides the deeper thermal stimulus for collagen remodelling.37 “Together, they may help the skin look firmer, smoother and more resilient over time,” she says.37 24

Figure 2: A 41-year-old female patient, before and 10 months after a combination of AlumierMD EverActive C&E Peptide Serum, AlumierMD Retinol Resurfacing Serum, Bocouture, Profhilo and microneedling. Images courtesy of Dr Tom Kamal.

He says, “The patient was a good candidate for a peptide-led approach, particularly because she was excited to commit to a longer-term plan.” To address pigmentation and improve radiance, Dr Kamal introduced vitamin C alongside a retinoid, which he says helped to brighten the skin.29,30 Dr Kamal combined peptides with botulinum toxin to address dynamic lines and later introduced hyaluronic acid (HA) injectables to enhance the skin’s radiance and hydration. Microneedling was introduced alongside her second botulinum toxin treatment to support collagen stimulation and, as Dr Kamal explains, “Microneedling helps drive the topical products deeper down into the tissues.” 39,40

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Special Feature Topical Peptides

As the patient’s skin became more accustomed to active ingredients, Dr Kamal gradually increased the strength of her retinoid, eventually introducing tretinoin. He says, “The combination of topical peptides and collagen-stimulating treatments allowed me to address both the visible concerns and the underlying quality of the skin, rather than relying on a single treatment or a quick fix.”13

He says, “The treatment combined microneedling with a peptide serum, which was used as the glide medium throughout the procedure.” Dr Alli details that around 2-2.5ml of serum was applied per session, explaining, “The microneedling creating thousands of microchannels that allow the product to penetrate the skin, while simultaneously stimulating collagen production.” 39,40

Treatment sequencing and product selection

The patient underwent three sessions, spaced one month apart, and continued with consistent skincare at home. Dr Alli shares, “A six-month homecare protocol comprises Toskani Anti-Ageing + HA Ampoules once daily in the morning, alongside Toskani Myotec Eye Lift twice daily.” He continues that Toskani Night Reverse Advanced Serum was applied nightly after cleansing.

Dr Kamal’s protocol combined daily skincare with regular in-clinic treatments. In the morning, the patient used SPF alongside a peptide serum containing Palmitoyl Tripeptide-38. Dr Kamal shares his product of choice is the AlumierMD EverActive C&E Peptide Serum, while AlumierMD Retinol Resurfacing Serum was introduced in the evening. Her retinol was gradually increased from 0.5% to 1%, before eventually transitioning to 0.025% tretinoin at her request.13,29,30 For in-clinic treatments, botulinum toxin type A was performed every four months, while HA injectable treatments were carried out every six months, with the first appointment combining both treatments. Dr Kamal notes that his chosen neuromodulator is Bocouture, whilst his preferred HA injectable is Profhilo.41,42 The patient completed three consecutive microneedling sessions, spaced one month apart, with an additional session incorporated between treatments, according to Dr Kamal. 39,40 Topical peptides with microneedling Introducing his case study, Dr Alli describes his patient as a 60-year-old female patient who was enthusiastic to improve her skin without using toxin (Figure 3). He shares, “As she continued to work in a demanding role, she wanted to avoid treatments that would cause significant redness or downtime.” Dr Alli explains that the patient opted for microneedling with a serum containing argireline to help soften fine lines and improve the overall tone and texture of her skin. She was then prescribed a hexapeptide for home use alongside a moisturiser containing a low concentration of retinol. “This meant she was getting the cellular turnover and repair, while nourishing the skin at the same time,” he says. 24,39,40 Before

After

Evaluating considerations and expectations Addressing the topic of maintenance, all three practitioners acknowledge that the advice for topical peptide use is relatively straightforward – consistency is key. Unlike some active ingredients, such as retinoids, which may require patients to adjust their use depending on tolerance, peptides can generally be incorporated into a skincare routine on an ongoing basis, without the need for regular breaks.1-4,6-9 “Peptides are not a quick fix,” Dr Kamal explains, “They’re something that takes months. But if patients commit to it, the results can be amazing.”6-9 Dr Halliley notes that topical peptides have very few contraindications, advising that they should be avoided on broken skin. In terms of managing expectations, she emphasises, “Peptides are best viewed as a supportive ingredient rather than a miracle solution. While dramatic results are possible, peptides tend to be most effective as part of a multimodal treatment plan, with product selection and realistic expectations key to achieving the best results.”1-4,9 Dr Kamal highlights the importance of considering the overall formulation when introducing peptides, particularly in patients with inflamed or compromised skin. He cautions, “Ingredients such as preservatives and fragrances can cause irritation, meaning that choosing a product should involve more than simply looking for a peptide on the label.” For patients with significant inflammation or barrier disruption, he recommends addressing the skin barrier first, as introducing active products too early could potentially exacerbate the condition.16,44 Addressing safety and potential reactions, Dr Alli emphasises that peptide products are often formulated to pharmaceutical standards, meaning they can be highly potent and are designed to deliver a noticeable effect. However, he stresses the importance of monitoring how the skin responds. “If a patient starts to develop unnecessary irritation, redness or inflammation, and the skin is becoming angry, then that particular peptide may not be suitable for them,” he explains.1-4,9

Considering the future landscape

Figure 3: A 60-year-old female patient before and six months after microneedling treatments, alongside use of Toskani Anti-Ageing + HA Ampoules, Toskani Myotec Eye Lift and Toskani Night Reverse Advanced Serum. Images courtesy of Dr Zunaid Alli.

Treatment sequencing and product selection Dr Alli highlights that the in-clinic peptide combination included Acetyl Hexapeptide-8, SH-Oligopeptide-2, SH-Polypeptide-1 and SH-Oligopeptide-1, with his product of choice being Toskani’s Anti-Ageing + HA and Myotec ampoules.43

Looking ahead, Dr Alli believes topical peptides are set to become a mainstay of modern skincare, if they are not already. “Patients will become better informed and more discerning, particularly in the skincare market, paying closer attention to ingredient lists and actively looking for peptides,” he says, adding that he sees this growing awareness as a positive development. All three practitioners agree that incorporating peptides into a tailored treatment plan can help enhance clinical outcomes while supporting patient satisfaction. VIEW THE REFERENCES AT AESTHETICSJOURNAL.COM

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CPD Peptides

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Understanding Peptides Dr Mayoni Gooneratne examines systemic peptide use in longevity and wellness practice Peptide-based drugs have moved rapidly from niche therapeutics to a major growth area across endocrine, metabolic, oncologic and rare disease medicine.1-4 At the same time, a parallel market has emerged in the wellness and longevity space, where intramuscular, subcutaneous (SC) and intravenous peptides are promoted for tissue repair, fat loss, performance and ‘antiageing,’ often outside established regulatory frameworks. This disconnect between robustly developed peptide therapeutics and loosely regulated ‘research peptides’ creates clinical, ethical and legal challenges for any medical professional practising in appearance medicine, metabolic health or general wellness. Systemic peptides act far beyond the skin, raising questions about long-term safety, off-target effects and professional scope that cannot be answered by aesthetic outcome data alone.2-5 This article will review the fundamentals of systemic peptide therapeutics, summarise current regulatory positions, outline commonly discussed agents and critically appraise potential benefits versus documented and theoretical dangers to support safer, evidence aligned decision-making.

Intravenous administration is reserved for rapid systemic exposure or investigational protocols, but carries higher risks of infection, infusion reactions and dosing error. Advances such as PEGylation, lipidation, stapled peptides and prodrug strategies have substantially extended half lives and improved stability but also alter tissue distribution and may introduce new immunogenicity or toxicity profiles.2-4,6 From a wellness or longevity perspective, the key point is that these agents act systemically, influencing endocrine, metabolic, vascular and immune pathways in ways that are often only partially characterised outside their licensed indications.2 This makes uncritical use in ‘health optimisation’ programmes particularly problematic when long term safety data are lacking. There is also a growing grey market around these drugs, making toxicity and uncertainty around the provenance of these medications hard to verify, certainly in the UK. For aesthetic practice this means that systemic peptide use falls beyond purely cosmetic intervention; prescribing decisions must take account of whole patient metabolic and cardiovascular risk, long term safety uncertainty, regulatory classification and whether the indication sits within the clinician’s usual scope of practice and indemnity cover, rather than being justified solely by skin level or appearance outcomes.

Systemic peptide therapeutics

Common systemic peptides

Therapeutic peptides are short chains of amino acids designed to modulate specific receptors, enzymes or signalling pathways, sitting between small molecules and biologic proteins in size and complexity.2-4 Because they are typically degraded in the gastrointestinal tract, systemic peptides are usually administered parenterally, most commonly via subcutaneous, intramuscular or intravenous routes.

Several systemic peptide categories are particularly relevant to clinicians working in aesthetics and wellness.

SC and intramuscular injections are favoured for chronic indications (such as type 2 diabetes and chronic hypoparathyroidism palopegteriparatide and related PTH analogues) that benefit from depot type or extended-release pharmacokinetics, such as glucagon-like peptide-1 receptor agonists (GLP-1 RA) or parathyroid hormone analogues.

“For clinicians, the key regulatory distinction is between peptide drugs that have progressed through formal licensing pathways and those that remain unlicensed ‘research’ products” 26

BPC-157 Body Protection Compound 157 (BPC-157) is a synthetic fragment of a gastric protective protein, promoted for tendon and ligament healing, gastrointestinal protection and neuroprotection.7-9, 10 A 2025 narrative review published in The Musculoskeletal Journal of Hospital for Special Surgery notes promising pre-clinical data for musculoskeletal repair across multiple animal models with apparently low acute toxicity.7 However, human evidence remains extremely limited. A recent pilot intravenous study in two healthy adults reported no acute adverse events or biomarker changes at single 10-20mg doses, but provides no insight into long term safety, cumulative dosing or rare events.8 A scoping review concludes that while animal studies suggest a favourable safety signal, there is no robust clinical safety data in humans and significant knowledge gaps regarding carcinogenesis, reproductive toxicity and immune effects.7-9 Regulatory commentaries emphasise that BPC-157 is not approved by the US Food and Drug Administration (FDA) and exists firmly in a regulatory grey area.9 In wellness practice, the key message is that its human safety profile is essentially unknown, despite aggressive marketing. GHK-Cu Glycyl-L-histidyl-L-lysine copper (GHK-Cu) is a naturally occurring tripeptide-copper complex with well described topical effects on wound healing, collagen synthesis and hair growth in pre-clinical and small cosmetic studies. Articles and safety reviews stress that topical use at cosmetic concentrations is generally well tolerated, with limited systemic absorption.11,12 For example, aesthetic and cosmetic peptide reviews describe small topical and mesotherapy studies in which GHK-Cu formulations improved clinical and histologic markers of skin quality and hair

Aesthetics | September 2026

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growth, with trial authors reporting good tolerability and mainly mild local irritation at cosmetic concentrations.11-15 By contrast, injectable GHK-Cu is largely experimental; there are no large controlled human trials evaluating systemic use for longevity, skin or hair outcomes. Risk summaries highlight potential local reactions (irritation, discolouration), rare hypersensitivity and theoretical concerns about copper overload in patients with hepatic disease or disorders of copper metabolism.13-15 Published GHK-Cu safety reviews emphasise that reassuring topical data at cosmetic doses do not equate to proven long term safety for systemic or injectable use, where higher copper loads and a lack of robust human trials leave important uncertainties, particularly in patients with hepatic or copper metabolism disorders.13-15 Similar concerns apply to injectable GHK-Cu, growth hormone secretagogues and other research peptides, where chronic dosing could theoretically exacerbate neoplastic growth, insulin resistance or immune dysregulation. Growth hormone secretagogues CJC-1295, Ipamorelin and related peptides are synthetic growth hormone releasing hormone (GHRH) analogues and ghrelin mimetics designed to stimulate endogenous GH and IGF-1 production.2-4,11 They are marketed in longevity circles for fat loss, muscle gain, sleep and ‘antiageing,’ often as nightly SC injections or combined ‘stacks’.2-4,6,16 However, much of the evidence for these compounds is extrapolated from older GH and GHRH work in deficiency states or specific catabolic conditions, rather than from robust trials in generally healthy adults seeking wellness benefits.2-4,6,16,17 Chronic GH axis activation carries recognised risks including insulin resistance, oedema, arthralgia, carpal tunnel syndrome and possible promotion of neoplasia in susceptible individuals. 2-4,6,16-18 Reviews of peptide therapeutics underscore that long term safety data for many secretagogue analogues at ‘wellness’ doses are sparse or absent.2-4,6,11,21 Regulatory agencies also note overlap with anti-doping rules, making non medical use particularly problematic for athletes. Melanotan II and related melanocortin peptides Melanotan II is a synthetic analogue of alpha melanocyte stimulating hormone used illicitly to darken skin, often via self-administered SC injections or nasal sprays purchased online. Safety warnings from agencies such as the Therapeutic Goods Administration (TGA), the Health Products Regulatory Authority (HPRA) and US dermatology specialists including Dr Anand Rajpara, Dr Faraz Ali et al. report associations with increased pigmentation, rapid darkening of naevi, gastrointestinal upset, flushing, libido changes, rhabdomyolysis, kidney infarction and suspected melanoma promotion.17-19 Safety notices from agencies such as the TGA and HPRA make clear that melanotan products are unregulated, unauthorised and may contain multiple unidentified contaminants in addition to the active peptide.17-19 By contrast, bremelanotide (PT-141) is a related melanocortin agonist approved by the US FDA for hypoactive sexual desire disorder in pre-menopausal women, administered by SC injection under medical supervision with a known, albeit non-trivial, side-effect profile.17 Any clinician encountering patient use of Melanotan II should strongly advise discontinuation, arrange dermatological assessment where appropriate and document counselling around serious health risks.17-19 Regulatory investigations into melanotan products reveal not only peptide related toxicity but also contamination with numerous unidentified substances, underscoring the quality risks inherent in grey market or internet purchased vials.17-19

CPD Peptides

“Therapeutic peptides are short chains of amino acids designed to modulate specific receptors, enzymes or signalling pathways, sitting between small molecules and biologic proteins in size and complexity” Tesamorelin and GLP-1 receptor agonists Tesamorelin is a GHRH analogue approved for human immunodeficiency virus (HIV)-associated lipodystrophy, with evidence for reduction of visceral adiposity and possible cognitive benefits in this narrow population.7,9,16-18 Reviews and trials show significant reductions in visceral adipose tissue, trunk fat and hepatic fat, alongside improved body image and quality of life scores in antiretroviral treated adults with central fat accumulation.7,9,20-22 Reviews of peptide therapeutics report generally favourable safety profiles for GLP-1 RAs, albeit with recognised gastrointestinal, gallbladder and rare pancreatitis risks that require monitoring and patient selection.1-4,6,16 These agents illustrate the difference between evidence based peptide therapy within guidelines and off label or unlicensed peptide use driven primarily by wellness marketing. Clinically approved agents such as GLP-1 RAs and palopegteriparatide deliver substantial improvements in glycaemic control, body weight, bone and mineral homeostasis and quality of life for defined patient groups. It is therefore reasonable to view peptides as an important and expanding therapeutic class with genuine opportunity for future longevity related indications, provided development follows rigorous scientific and regulatory standards.2-4,6,16

Regulatory landscape For clinicians, the key regulatory distinction is between peptide drugs that have progressed through formal licensing pathways and those that remain unlicensed ‘research’ products. From a UK and EU perspective, systemic peptide prescribing for metabolic, endocrine or antiageing indications generally falls within internal medicine or endocrinology rather than traditional cosmetic practice. Guidance documents on aesthetic prescribing emphasise that clinicians should work within their usual scope of practice and relevant specialty guidelines, and that extending into systemic peptide therapy without appropriate training, governance and multidisciplinary support may be considered outside standard aesthetic scope.5,7-9,10,11

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“From a wellness or longevity perspective, the key point is that these agents act systemically, influencing endocrine, metabolic, vascular and immune pathways in ways that are often only partially characterised outside their licensed indications” Licensed peptide drugs Over recent years, regulators have approved a growing number of peptide therapeutics for clearly defined indications, following standard phase I-III development and pharmacovigilance.1-4,6,16 The US FDA’s 2024 TIDES review describes new peptide approvals including palopegteriparatide for chronic hypoparathyroidism and peptide based therapies for rare neurogenetic conditions, each with documented efficacy, adverse event profiles and long term safety follow up. GLP-1 receptor agonists such as semaglutide and tirzepatide are now established treatments for type 2 diabetes and obesity, supported by large cardiovascular outcome trials and detailed guidance from diabetes and obesity societies.1,2,6,16,23-25 These drugs may intersect with lifestyle and wellness clinics, but they remain prescription medicines with specific indications and monitoring requirements. Unlicensed and research peptides In contrast, many peptides marketed in longevity and ‘biohacking’ circles – such as BPC-157, a thymosin β4 fragment (TB-500), CJC-1295, Ipamorelin and Melanotan II – are not licensed medicines for any indication in major jurisdictions.5,7-9,17-19,26,27 They are often sold as ‘research chemicals’ with disclaimers against human use, yet promoted via online clinics, social media and compounding pharmacies for tissue repair, fat loss, libido or tanning.5,7-9, 17-19,26,27 Regulatory agencies have issued repeated warnings; the HPRA and other bodies explicitly highlight that Melanotan II is unregulated, not authorised and associated with serious health risks including skin cancer and renal injury.17-19 Professional indemnity policies may exclude the use of such unlicensed peptides for elective wellbeing purposes, placing clinicians at significant personal risk.

Compounding and enforcement trends Regulators have also turned attention to compounded peptides. US analyses describe increasing FDA scrutiny of compounded CJC-1295, Thymosin alpha-1, AOD-9604 and related agents, including advisory committee reviews and legal challenges around compounding ‘essentially copies’ of approved drugs. Blogs and legal commentaries aimed at clinics emphasise that 28

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compounded peptides sit in a regulatory grey zone, and that upcoming reclassification and enforcement actions may further restrict access. Analyses of melanotan products and regulatory alerts have documented vials containing dozens of unidentified constituents, variable peptide content and no reliable labelling, batch testing or pharmacovigilance.17-19 Similar concerns are raised around online BPC-157 and GHRH analogue vendors, where manufacturing conditions, sterility and sequence integrity are often unknown.5,7-10 Compounded peptides prepared in regulated pharmacies may offer better quality control, but they are still unlicensed medicines with limited stability and safety data and are increasingly scrutinised by agencies seeking to avoid duplication of licensed products. While UK and EU frameworks differ, the overarching trend is clear; authorities are tightening control of unlicensed peptide supply and marketing, particularly where patient harm has been reported. From a clinical risk perspective, injecting any systemically active peptide of uncertain provenance into a patient for non-essential indications carries the combined hazards of contamination, mislabelling, dosing error and unpredictable pharmacology.5,7-11,20 For clinicians, a practical rule of thumb is to treat unlicensed systemic peptides as experimental interventions whose routine use in wellness or aesthetic practice is very difficult to justify on current evidence.5,7-11,20

Practical and ethical guidance for clinicians For aesthetic and wellness clinicians confronted with patient interest in peptides, a pragmatic approach is needed. First, it is important to clearly differentiate evidence based, licensed peptide therapies (e.g. GLP-1 RAs for obesity) from unlicensed ‘research’ peptides, and to align any prescribing with national and specialty specific guidelines. Second, clinicians should avoid promoting or advertising systemic peptide stacks for vaguely defined antiageing or performance goals, as this risks breaching medicines advertising rules and professional codes. In the UK, Advertising Standards Authority (ASA) and Committee of Advertising Practice (CAP) guidance states that medicinal claims require Medicines and Healthcare products Regulatory Agency (MHRA) authorisation, and prescription-only injectable weight-loss medicines and similar POMs must not be advertised to the public.11,20,28-30 When patients disclose self-directed peptide use, the clinician’s role is to provide balanced information about known and unknown risks, discourage continued unsupervised use, and screen for complications such as new pigmented lesions, unexplained systemic symptoms or metabolic derangement.7–10,12,16,19,21-23 Where licensed peptide therapy may be appropriate – for example, GLP-1 RA in a patient with obesity and metabolic syndrome – referral to or collaboration with endocrinology, diabetology or obesity services ensures that prescribing occurs within an appropriate monitoring framework, in line with national and international obesity and GLP-1 guidelines.1,2,6,16,23-25,31-33 Finally, clinicians should maintain a high standard of documentation and informed consent and recognise that participation in formal research, rather than informal experimentation, is the ethical route for exploring new peptide applications.

Safety in peptide practice Peptide therapeutics represent one of the most dynamic areas of modern pharmacology, with a growing portfolio of licensed drugs transforming outcomes in endocrine, metabolic and rare diseases.1-4 At the same time, unlicensed systemic peptides have been rapidly adopted in wellness and longevity circles

Aesthetics | September 2026

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CPD Peptides

based on preclinical promise and anecdote rather than robust clinical data.5,7-9 For clinicians working at the interface of medical aesthetics, metabolic health and antiageing medicine, it is essential to distinguish between these two worlds, prioritising patient safety, regulatory compliance and honest communication about what is currently known – and unknown. Until high-quality human trials clarify the long term benefits and risks of research peptides such as BPC-157 or injectable GHK-Cu, their routine use in wellness protocols should be regarded as experimental and approached with extreme caution.7-9,10

Where science meets longevity

Test your knowledge! Complete the multiple-choice questions and email contact@aestheticsjournal.com to receive your CPD certificate!

Questions

Possible answers a. Fully licensed for tendon injury and IBS

1. Which statement best describes the regulatory status of BPC-157 in major jurisdictions?

b. Licensed for HIV-associated lipodystrophy only c. Not approved as a medicine; marketed as a research chemical d. Approved over the counter supplement

Dr Mayoni Gooneratne will speak and chair sessions at the Medical Longevity Summit (MLS) at the Clinical Cosmetic Regenerative Congress next month. Taking place at the Excel London on October 1-2, this year’s MLS will explore inside-out ageing and optimising metabolic health for longer, healthier lives. Scan the QR code to register.

a. Predictable, dose-dependent mild anaemia only 2. What is the main safety concern with Melanotan II tanning injections?

b. Increased risk of serious adverse effects including skin cancer and kidney injury c. Exclusively local bruising without systemic effects d. Pure cosmetic effect with no documented risks a. Licensed drugs are always given orally

3. Which of the following best distinguishes licensed peptide therapeutics from most “research peptides” used in wellness clinics?

b. Licensed drugs have undergone controlled human trials and regulatory review c. Research peptides cannot be synthesised chemically d. Licensed drugs do not require monitoring

a. Only case reports in elite athletes 4. What is a key limitation of current evidence for systemic use of BPC-157?

b. Numerous phase III trials but no animal data c. Limited human clinical data and unknown long term safety d. HA fillers with high molecular weight a. Continue the regimen and add more peptides b. Refuse to discuss and discharge the patient c. Provide balanced risk information, advise against further unsupervised use and document the discussion d. Report to law enforcement without informing the patient Answers: C,B,B,C,C

5. When a patient presents using online purchased peptide injections, what is the most appropriate first step?

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Aesthetics | September 2026

Boost your patients’ collagen production to work against skin ageing from within RADIESSE is an injectable dermal ﬁller used to enhance the facial area and back of the hands. RADIESSE is available for smoothing moderate and severe wrinkles of the décolleté.

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Adverse events should be reported. Reporting forms and information for United Kingdom can be found at https://yellowcard.mhra.gov.uk. Reporting forms and information for Republic of Ireland can be found at https://www.hpra.ie/homepage/about-us/report-an-issue. Adverse events should also be reported to Merz Aesthetics UK Ltd by emailing UKdrugsafety@merz.com or calling +44 (0) 333 200 4143.

©2026 Merz Aesthetics UK Ltd – All rights reserved. MERZ AESTHETICS and RADIESSE logos are trademarks and/or registered trademarks of Merz Aesthetics UK Ltd in the United Kingdom. Registered in England No. 14506945. Merz Aesthetics UK Ltd. Ground Floor Suite B, Breakspear Park, Breakspear Way, Hemel Hempstead, Hertfordshire, HP2 4TZ. www.merz-aesthetics.co.uk.

M-RAD-UKI-0570 Date of Preparation: February 2026

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Topical Therapies Microneedling

Although this inflammatory response is essential for effective repair, excessive or prolonged inflammation may contribute to increased erythema, discomfort and delayed recovery, potentially affecting patient satisfaction and adherence to treatment programmes.5,13 Consequently, interest has grown in approaches using topical therapies that support normal tissue repair while complementing, rather than disrupting, the skin’s intrinsic healing mechanisms.7-10 Many regenerative technologies in clinical aesthetics are still relatively new, but their rationale can be consistent with current wound-healing biology.11,12 While microneedling is well supported by evidence for collagen induction, acne scarring and skin rejuvenation, adjunctive topical technologies such as PDRN, exosome-derived ingredients and biomimetic peptides are at an earlier stage of clinical development.7,10,14 Although early findings are promising, evidence varies widely between formulations due to differences in sourcing, manufacturing, regulation and study design.15,16 Clinicians should therefore assess products critically and distinguish between the established evidence for microneedling and the emerging evidence for adjunctive topicals.

Combining Topical Regenerative Therapy with Microneedling Independent nurse prescriber Nina Prisk demonstrates skin recovery and patient outcomes following microneedling with adjunctive topical therapy Microneedling is a well-established regenerative procedure that improves skin quality through controlled dermal injury, stimulating collagen synthesis, elastin remodelling and extracellular matrix (ECM) renewal.1-4 Although its efficacy is well supported, the acute inflammatory response associated with treatment frequently results in transient erythema, oedema and discomfort, which may influence patient satisfaction and adherence to treatment programmes.5,6 Growing interest has focused on topical regenerative therapies designed to complement physiological wound healing during the immediate post-procedure period. Topical ingredients, including polydeoxyribonucleotide (PDRN), exosome-derived technologies, biomimetic peptides, and low molecular-weight hyaluronic acid (HA), have been investigated for their potential to support barrier recovery, cellular signalling and tissue regeneration.7-10 This article reviews the biological rationale for incorporating regenerative topical formulations following microneedling and presents findings from a small observational case series using standardised skin imaging to evaluate early post-treatment recovery.

The context of topical regenerative therapies Microneedling initiates a well-characterised wound-healing response involving three overlapping phases – inflammation, proliferation and remodelling.11 During inflammation, platelet activation and cytokine release establish haemostasis and recruit immune cells to remove damaged tissue. The proliferative phase then supports re-epithelialisation, angiogenesis, fibroblast activity and deposition of new ECM. During remodelling, newly formed collagen is reorganised and strengthened over subsequent weeks to months.11,12

Improving early recovery may influence more than patient comfort. Perceived downtime can deter patients, particularly those balancing work and personal commitments or with prior experience of prolonged erythema.6 Supporting early recovery may therefore improve treatment acceptance, adherence and completion.

Biological rationale for topical formulations The ingredient classes listed below have attracted increasing interest because of their potential role in supporting tissue repair following aesthetic procedures.7-10 Whilst many are also available within homecare skincare products, professional formulations designed for use alongside microneedling are typically applied immediately following treatment, when the temporary microchannels created within the epidermis may enhance topical delivery.17 In some protocols, patients continue application at home during the first 24-72 hours to support early recovery, although this should always be undertaken in accordance with the manufacturer’s instructions and clinical judgement.7,8 It should be avoided in anyone with a known hypersensitivity to the finished formulation or any of its components. Treatment should also be deferred where microneedling itself is unsuitable – for example, active infection, active inflammatory dermatosis, impaired wound healing or significant immunosuppression – and product-specific contraindications and manufacturer instructions should always be followed.

Interest has grown in approaches using topical therapies that support normal tissue repair while complementing, rather than disrupting, the skin’s intrinsic healing mechanisms

Aesthetics | September 2026

Topical Therapies Microneedling

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Polydeoxyribonucleotide

Selection and assessment for microneedling

PDRN has been investigated for its ability to activate adenosine A2A receptors, modulate inflammatory signalling and support fibroblast activity.18,19 Experimental and early clinical studies suggest potential benefits for wound healing, angiogenesis and collagen synthesis, although evidence within medical aesthetics continues to evolve.18-20 As a topical adjunct following microneedling, PDRN may be considered when supporting early tissue repair and reducing prolonged post-procedure inflammation are clinical priorities, including in patients with compromised skin quality, acne scarring or a history of prolonged erythema.18-20

Careful patient selection is fundamental to achieving safe, predictable outcomes with microneedling.1,4,14 It is well suited to patients seeking improvement in skin quality, fine lines, enlarged pores, mild-to-moderate photodamage, acne scarring and overall skin rejuvenation, particularly those with early signs of ageing.2,4,14 Before

After

Exosome-derived technologies Exosome-derived technologies have attracted considerable attention because extracellular vesicles can carry signalling molecules, proteins and lipids that may influence cellular behaviour and tissue repair.9,21 Topical formulations may be particularly relevant for patients whose priorities include barrier support, hydration and a calmer early recovery after microneedling, especially those with a previous history of prolonged erythema or discomfort.21 However, evidence is product-specific and remains emerging. Significant variation exists between products in biological source, manufacturing process and regulatory classification. Human-derived extracellular-vesicle ingredients raise substantial regulatory and safety concerns in cosmetic use; plant-derived vesicle products may be marketed for topical cosmetic use where they comply with applicable cosmetic regulations. No exosome product should be injected unless it has the appropriate medicines authorisation for that route and indication.22,23 Clinicians should therefore verify the source, quality documentation, intended route of use and regulatory status of each product, interpret claims cautiously and regard topical exosome-derived products as an emerging adjunct rather than an established standard of care. Biomimetic peptides Biomimetic peptides are short chains of amino acids designed to mimic naturally occurring signalling molecules involved in wound healing and ECM production.24 When incorporated into topical formulations, they aim to support fibroblast activity and collagen remodelling while complementing the regenerative response initiated by microneedling.24,25 They may be particularly appropriate for patients seeking improvements in skin quality, fine lines and age-related changes. Low molecular-weight hyaluronic acid In general aesthetic use, low molecular-weight HA provides additional support by improving hydration, facilitating keratinocyte migration and contributing to epidermal barrier recovery during the early stages of healing.10,26,27 It is particularly useful for patients with dry, dehydrated or barrier-compromised skin and for those who experience post-procedure tightness. Its broad suitability also makes it a practical adjunct where comfort and hydration are primary priorities, although patients with known sensitivity to the finished formulation should not use it. Maintaining adequate hydration immediately following microneedling may improve comfort during the first few days after treatment.27 Although each ingredient has distinct biological properties, it is likely that their greatest potential lies in multimodal formulations that combine complementary mechanisms of action.7-10 Nevertheless, whilst early laboratory and clinical evidence is encouraging, further independent studies are required to establish the relative contribution of individual ingredients and determine which patients are most likely to benefit from specific regenerative topical protocols. 32

Figure 1: The 60-year-old patient from the case series, with images showcasing baseline, immediately after and 24 hours after treatment.

A comprehensive consultation should include a detailed medical history and review of previous aesthetic treatments.28 For patients who have undergone microneedling, clinicians should assess the duration of post-treatment erythema, healing time, history of post-inflammatory hyperpigmentation, prolonged swelling or discomfort and overall satisfaction with recovery. This helps identify patients who may benefit from strategies that support early post-procedure healing.28 Microneedling should be considered within a personalised treatment plan rather than as a universal solution due to individual patient needs.28 Patients with advanced skin laxity, deep static rhytides or severe photodamage may achieve better outcomes with combination approaches incorporating energy-based devices, injectables or resurfacing procedures, dependent on the case.29 It also remains an effective treatment for acne scarring, where adjunctive regenerative topical therapies may improve the early healing experience, although larger studies are needed to determine their impact on long-term scar remodelling.2,30 Assessment should also identify factors that may impair wound healing or increase complication risk, including active skin infection, inflammatory dermatoses, impaired barrier function, uncontrolled diabetes, immunosuppression, medications affecting wound repair, and a history of keloid or hypertrophic scarring.31,32 Treatment should be deferred until modifiable conditions are appropriately managed, with realistic expectations discussed during consent.28 The case series presented below focuses on patients who consistently experienced prolonged erythema following microneedling. Although transient erythema is expected, persistent redness and skin tightness can negatively affect recovery and reduce willingness to continue treatment.5,6 Optimising early post-procedure recovery may therefore improve both patient satisfaction and adherence to recommended treatment programmes.

Protocol and case series This small observational case series involved three patients aged 32, 45 and 60 who had previously experienced moderate, prolonged erythema after with the same device, settings and practitioner (Figure 1). Each received the same microneedling protocol with a topical formulation containing PDRN and exosome-derived

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technologies. The series assessed early post-procedure recovery at 24 hours; it did not evaluate comparative efficacy or long-term collagen remodelling.33,34

Topical Therapies Microneedling

Immediately after microneedling, patients showed the expected erythema and increased superficial vascular activity. By 24 hours, both had visibly reduced. PDRN and exosome-derived signalling ingredients may support inflammatory regulation, fibroblast activity and barrier recovery, potentially contributing to a calmer recovery. However, as this was an uncontrolled series, the individual contribution of each ingredient cannot be determined. These objective findings closely aligned with patient-reported outcomes. Participants consistently described less skin tightness and discomfort during the first 24 hours and reported feeling sufficiently comfortable to return to work and normal social activities sooner than after previous treatments. Reduced perceived downtime emerged as a consistent benefit across the case series. These findings should be interpreted within the limitations of a small, uncontrolled observational case series assessing early recovery only at 24 hours. Sessions and maintenance

Figure 2: Patient through Vascularity Mode, immediately after treatment and 24 hours after treatment.

Clinical protocol Microneedling was performed using the SkinPen Precision at a needle depth of 1.5mm, with three complete passes over the full face using horizontal, vertical and circular motions, avoiding the periorbital region. No additional depth scaling was used in this series. The endpoint was uniform erythema without excessive pinpoint bleeding, providing consistent coverage while limiting unnecessary trauma. Medik8 Exo-PDRN Prismatic+ Pro Concentrate – containing Prismatic PDRN, Triple Exosome Complex, GF MiniProtein and low molecular-weight HA – was applied throughout the procedure to provide glide and was reapplied immediately afterwards. Patients then used the take-home concentrate for the first 24 hours. It was applied after gentle cleansing, morning and evening, before moisturiser and sunscreen; potentially irritating actives were withheld during the early recovery period. Product use should remain consistent with the manufacturer’s instructions and the treating practitioner’s assessment. Standardised aftercare advice included avoiding potentially irritating active skincare ingredients – including retinoids and exfoliating acids – for at least the first 48 hours, maintaining gentle hydration, using daily broad-spectrum sunscreen, and avoiding excessive heat, strenuous exercise, swimming and unnecessary touching of the treated area during the initial healing period.35 Patients were advised to use a gentle, non-active cleanser rather than cleansing brushes, scrubs or exfoliating products. To minimise variability when evaluating clinical outcomes, treatment parameters, imaging conditions and follow-up assessments were standardised across all patients included in this case series.36-38 Objective assessment of early recovery Assessing post-procedure recovery can be challenging, as improvements are often described subjectively by both clinicians and patients. Whilst patient-reported outcomes provide valuable insight into comfort and downtime, they may be influenced by individual perception, previous treatment experiences and expectations.39 Incorporating objective imaging therefore offers an additional means of evaluating early healing.40 All three patients underwent standardised imaging using the OBSERV 520x immediately before treatment, immediately afterwards and at 24 hours, using both Daylight and Vascular imaging modes. Patients were selected because they had previously experienced moderate post-microneedling erythema and identified prolonged redness as the principal barrier to continuing treatment despite recognising its long-term aesthetic benefits (Figure 2).

From general clinical experience, most patients benefit from an initial course of three treatments performed four weeks apart. Patients presenting with acne scarring or more advanced photodamage may require four to six sessions, depending on clinical response.2,30 Maintenance treatments, typically every four to six months, can then be considered to support ongoing collagen remodelling and skin quality.41 Contraindications, safety and limitations Contraindications to microneedling include active skin infection, active inflammatory dermatosis in the treatment area, pregnancy where local policy or device guidance advises deferral, a history of keloid or hypertrophic scarring, uncontrolled diabetes, significant immunosuppression and current or recent isotretinoin use in accordance with contemporary guidance.28,31,42 Treatment should also be postponed when baseline oedema or unexplained skin sensitivity suggests active inflammation, allergy, barrier disruption or infection, until the cause has been assessed and resolved.42 Safety depends on meticulous aseptic technique, sterile single-use needle cartridges, comprehensive informed consent and clear aftercare, including daily broad-spectrum sunscreen to minimise post-inflammatory hyperpigmentation risk.28,44 Transient erythema, mild oedema, warmth, tightness and sensitivity are expected early effects. Patients should be advised to contact the clinic if redness, swelling, pain or heat worsens rather than improves; if symptoms persist beyond the expected recovery window; or if blistering, pustules, discharge, spreading rash, marked tenderness or systemic symptoms develop, as these may indicate infection, contact dermatitis or another adverse response requiring assessment.28,43

Combining microneedling with topicals Microneedling continues to represent one of the most versatile regenerative procedures available within aesthetic practice. Although further independent clinical research is required, these observations suggest that regenerative topical therapies may become an increasingly valuable component of comprehensive microneedling protocols.7-10 Nina Prisk is the founder and clinical director of Update Aesthetics, a CQC-registered medical and surgical aesthetics clinic with locations in Cornwall and London. An independent nurse prescriber with more than 20 years’ clinical experience, Prisk is an international key opinion leader for leading aesthetic brands, a faculty trainer, medical affairs advisor and media advisor. Qual: INP, BSc, MSc, MBA

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Aesthetics | September 2026

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Advertorial British Skin Foundation

The new British Skin Foundation website has been designed to provide a reliable source of independent, evidence-based information that patients and professionals can access with confidence. Visitors can explore our comprehensive A to Z of skin conditions, learn about skin cancer and sun protection, discover the latest research and awareness campaigns, read patient stories and locate dermatologist-led clinics. For aesthetic practitioners, trusted resources can play an important role in supporting patient care. Although many patients seek treatment for cosmetic concerns, practitioners are often asked wider questions about skin health. They may be the first healthcare professional to notice a suspicious lesion, reassure someone about a common skin condition or encourage a patient to seek further medical assessment. Having access to clear, evidence-based information allows practitioners to reinforce good skin health advice and confidently signpost patients to trusted resources when appropriate.

Helping people find answers more quickly

30 Years of Progress in Skin Research As the British Skin Foundation celebrates its 30th anniversary, a new website and AI-powered search are making expert skin health information more accessible for patients and healthcare professionals alike For 30 years, the British Skin Foundation has been working towards one clear goal. To improve skin health through research, education and trusted information. Since the charity was founded in 1996, that mission has remained at the heart of everything we do. We fund pioneering research into all skin diseases and skin cancer, while helping people access accurate, evidence-based information about their skin. Today, we are proud to be the UK’s leading charity dedicated to skin research, having invested more than £22 million into dermatology research and funded over 500 research projects.

A key feature of the new website is its AI-powered search function, developed to help users find relevant information more efficiently. Rather than replacing expert advice, the AI search helps people navigate the British Skin Foundation’s extensive library of trusted content. Every article and resource continues to be informed by dermatological expertise and reflects our commitment to providing accurate, independent information. Whether someone is looking for information about eczema, acne, psoriasis, skin cancer or sun safety, the new search function makes it easier to find reliable answers quickly.

Looking to the future 30 years after the British Skin Foundation was established, our purpose remains as important as ever. Skin disease affects millions of people across the UK and demand for reliable health information continues to grow. Research remains central to everything we do, but education and accessibility are equally important. By investing in both scientific discovery and trusted public information, we hope to improve outcomes for people living with skin conditions today while helping shape the treatments of tomorrow. We are grateful to the researchers, healthcare professionals, partners, fundraisers, volunteers and supporters who have helped us reach this milestone. Together, we have made significant progress over the past three decades. Together, we will continue working towards a future where everyone can benefit from healthier skin. This advertorial was written and supplied by

Every breakthrough brings us closer to better prevention, earlier diagnosis and more effective treatment outcomes for the millions of people affected by skin disease. Alongside research, we believe that access to trusted information empowers people to better understand their skin and seek the right care when they need it. As we celebrate our 30th anniversary, we are also looking ahead. Our newly redesigned website reflects how people search for health information today, making it easier than ever to access expert advice, educational resources and the latest research.

For more information, resources & to get involved in our mission of funding vital skin disease research, visit www.britishskinfoundation.org.uk

Supporting informed conversations Patients are increasingly seeking information online before or after visiting a healthcare professional. While access to information has never been easier, knowing what to trust can be challenging.

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Aesthetics | September 2026

Rosacea Skin of Colour

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Demodex density correlates with disease severity and is thought to amplify inflammation via TLR2 mediated pathways.8 Interestingly, in patients with small intestinal bacterial overgrowth (SIBO), papulopustular rosacea was more likely to clear after treatment of the SIBO, suggesting a significant gut-skin axis.⁹ Neurovascular hyperreactivity

Understanding Rosacea in Skin of Colour Dr Angela Tewari highlights diagnostic challenges and treatment strategies for rosacea in patients with SOC Rosacea is a chronic inflammatory dermatosis with a relapsing–remitting course, characterised by facial flushing, persistent papules and pustules, telangiectasia and, in many cases, ocular involvement affecting both the eyelids and ocular surface.1 A 2020 expert review involving 19 dermatologists first identified a lack of robust clinical guidance on the assessment of patient satisfaction with rosacea therapies and how we should focus on treatment of those nonvisible symptoms: burning, stinging and dryness.¹ Together with the diagnostic challenges in patients with darker skin, this probably contributes to the lower incidence reported in the literature.² The estimated global prevalence of rosacea is 5.46%, of which only 0.8% occurs in patients with skin of colour (SOC).³ In SOC, subtle erythema may be difficult to appreciate and is frequently misdiagnosed as eczema (dermatitis) or acne in the presence of inflammation. Persistent low-grade inflammation commonly leads to post-inflammatory hyperpigmentation (PIH), which is equally important to recognise and manage.4 PIH can be particularly distressing for patients with SOC, as their basal epidermal melanocytes are more reactive to cutaneous stressors.5

Pathogenesis of rosacea The underlying pathogenesis of rosacea is consistent across all skin types. However, the visibility of cutaneous inflammation is reduced in SOC, as erythema will be masked by higher concentrations of epidermal eumelanin.6 Increased inflammation There is overexpression of toll like receptor 2 (TLR2) on keratinocytes, leading to excess production of the protease kallikrein 5. Under normal conditions, kallikrein 5 helps protect the skin barrier by activating antimicrobial peptides and supporting epidermal barrier maintenance. In rosacea, however, it excessively cleaves inactive cathelicidin precursors into the active peptide LL-37. This peptide then drives recruitment and activation of mast cells, macrophages, neutrophils and Th1/Th17 lymphocytes, resulting in the erythema and surface inflammation that we see clinically.7 Microbiome imbalance There is dysbiosis involving increased Demodex folliculorum (which has been shown to upregulate IL-8, IL-12 and IL-10 and persist within sebaceous glands), as well as overgrowth of Staphylococcus epidermidis and Bacillus oleronius, with a concomitant reduction in protective Cutibacterium species.8 38

Transient receptor potential (TRP) channels, particularly TRPV1, TRPV4 and TRPA1, are upregulated and activated on sensory nerve endings in facial skin.7 Their activation contributes to neurogenic inflammation, vasodilation and the characteristic flushing and burning symptoms associated with rosacea. These are environmental sensors that respond to thermal, chemical and mechanical stimuli (for example heat such as saunas, ultraviolet radiation, capsaicin in chilli peppers, cayenne pepper, alcohol and emotional stress). Their activation triggers the release of calcitonin gene related peptide (CGRP), substance P, pituitary adenylate cyclase activating polypeptide (PACAP) and vasoactive intestinal peptide (VIP), which act on nearby blood vessels to increase blood flow. Clinically, this manifests as flushing and erythema.7 There are no reported differences between skin phototypes.5 Epidermal barrier dysfunction As a consequence of the mechanisms above, there is increased transepidermal water loss, due to reduced expression of tight junction proteins (claudins) in the granular layer of the epidermis. This impaired barrier further perpetuates inflammation, sensitivity and the clinical signs of rosacea.7

Clinical presentation and diagnostic challenges The classical categorisation of rosacea into four subtypes – papulopustular, erythematotelangiectatic, phymatous (rhinophyma) and ocular rosacea – has largely been superseded.10 Current diagnostic approaches focus on features such as persistent centrofacial erythema or phymatous changes (thickening and swelling of the nose), with major criteria including papules, pustules and flushing in the absence of comedones, and minor features such as burning or stinging, dryness and oedema.1 In patients with SOC, erythema may present less obviously and can appear as a subtle violaceous or dusky hue on the cheeks, often without scale or pruritus but with reports of burning or stinging sensations. A detailed history of trigger factors can be particularly helpful in supporting the diagnosis.7 Common triggers include alcohol, heat and emotional stress; in flushing predominant rosacea, activation of neurovascular receptors such as TRPV channels can lead to exaggerated vasodilation and more pronounced flushing.7 Skin sensitivity syndrome should also be considered in the differential diagnosis, particularly where there is a history of aggressive skincare routines or excessive use of active topical agents. This includes leave-on products such as glycolic acid at concentrations above 5% or lactic acid above 10%.11 In such cases, simplifying topical regimens may be required to reduce barrier disruption and improve tolerance.11 This differs from rosacea, which is typically associated with photosensitivity and the presence of papules and pustules, features not seen in skin sensitivity syndrome.1 Difficulty assessing erythema and inflammation A central challenge in diagnosing rosacea in SOC is the assessment of erythema. Traditional diagnostic frameworks rely heavily on visible redness as a marker of skin inflammation in a number of skin conditions, a feature that will be subtle or absent in darker skin tones.6 Inflammation can present as violaceous, grey, brown or darkened patches, which will be PIH and a marker of previous skin inflammation. Finlay et al. highlights

Aesthetics | September 2026

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that inflammation should instead be assessed using additional markers such as heat, swelling, tenderness and patient-reported symptoms, including burning or stinging.6 This is particularly important for SOC patients with rosacea, where practitioners now need to reconsider how to assess severity when the usual marker, erythema, is difficult to delineate.6 Ocular involvement Recognition of associated rosacea features may facilitate earlier diagnosis. Approximately 40% of more than 1,700 patients with cutaneous rosacea were reported to have concurrent ocular rosacea, with dry eyes, pruritus, burning and stinging among the most common presenting symptoms.12

Treatment of rosacea in SOC Management of rosacea in SOC should be phenotype directed, with treatment tailored to the specific clinical features present. Evidence-based dermatology care Given the characteristic features of rosacea, a gentle, non-irritating skincare regimen is recommended. A mild cleanser containing glycerin, or alternatively a micellar water formulated with mild surfactants, may be used to remove impurities while minimising barrier disruption. This may be followed by a topical antioxidant containing a stable form of L-ascorbic acid, which may help to reduce inflammation and oxidative stress. A hyaluronic acid- or ceramide-based moisturiser should then be applied to support barrier repair and maintain hydration. This can be complemented by a tinted CC cream or a tinted sunscreen containing iron oxide pigments, which provides both photoprotection and camouflage of erythema or dyspigmentation.13 In clinical practice, regular use of a ceramide- or glycerin-based moisturiser as part of a maintenance regimen may be beneficial given the disrupted skin barrier that is present in rosacea, and niacinamide at concentrations of around 2% may also be helpful.14 A growing range of anti-inflammatory ingredients are available in skincare formulations. Azelaic acid (15%) offers the strongest evidence for reducing redness and improving skin quality, while early studies suggest that licorice extract may provide additional anti-inflammatory support.15,16 Early intervention remains important in minimising PIH and optimising both clinical and aesthetic outcomes.17 Standard dermatology guidelines show that evidence supported therapeutic options include topical ivermectin, topical azelaic acid and oral tetracycline class antibiotics.13 In selected cases of recalcitrant papulopustular disease or painful, rapidly progressive facial rosacea, low dose oral isotretinoin is highly efficacious as prescribed in accordance with standard dermatology guidelines as issued by the British Association of Dermatology and by a consultant dermatologist.18 Azelaic acid is particularly valuable in SOC, as it addresses both inflammatory lesions and dyschromia, providing dual benefit where PIH is a concern. Tolerability is critical in this context; treatments should be introduced gradually to minimise irritant dermatitis, which itself may precipitate or worsen PIH.4,13 Alpha-adrenergic agonists Alpha-adrenergic agonists such as brimonidine and oxymetazoline can reduce flushing and persistent erythema in those with erythrotelangictatic form of rosacea. However, rebound or compensatory erythema may occur and can be clinically significant, as patients may perceive a return to baseline or worsening redness within a few hours of application. If this occurs, it would be appropriate to move to the next level of management– using devices.1,10

Rosacea Skin of Colour

Energy-based devices Laser-based therapies, including pulsed dye laser (PDL) and light-based modalities such as intense pulsed light (IPL), together with accumulating evidence supporting red-light therapy, have demonstrated clinical benefit in reducing vascular manifestations and, in some cases, inflammatory papular lesions in rosacea.19 However, in patients with SOC, increased epidermal melanin content results in greater absorption of light energy and its subsequent conversion to heat, thereby increasing the risk of localised epidermal and dermal injury.20 Where such injury involves the basal melanocyte layer and results in melanin dispersion, this may lead to PIH, a complication that can be particularly challenging to manage.20 For rosacea in SOC, the 1064 nm Nd:YAG laser is generally the safest choice, as its longer wavelength largely bypasses epidermal melanin and likely carries the lowest risk of PIH amongst the vascular lasers – provided it’s performed by an experienced practitioner using conservative settings, ideally with a lower fluence, longer pulse duration and appropriate cooling.20

Post-inflammatory hyperpigmentation in SOC SOC is characterised by increased melanocytic reactivity in response to cutaneous inflammation. In rosacea, PIH may occur following papulopustular lesions when inflammation extends to the basal epidermis. PIH may also arise secondary to irritant dermatitis caused by inappropriate topical or procedural treatments, as well as from excessive absorption of device-delivered energy by epidermal melanin, with subsequent conversion to heat and resultant injury to surrounding tissue.13 Prevention Prevention of PIH centres on minimising cutaneous inflammation and erythema, avoiding known irritants such as menthol, camphor, eucalyptus and isopropyl alcohol and implementing strict photoprotection.13 Rigorous sunscreen use is critical and should be emphasised at the initiation of treatment and reinforced at each consultation.4 Treatment strategies PIH treatment should be initiated once rosacea is stable. Azelaic acid remains a first-line option due to its favourable tolerability profile.13 A recent global consensus on hyperpigmentation disorders published in the Journal of the European Academy of Dermatology and Venereology highlights the need for structured, long-term management approaches, including maintenance therapy and relapse prevention.4 A randomised control trial shows that the use of Thiamidol (isobutylamido thiazolyl resorcinol) as a dermocosmetic option is useful for facial hyperpigmentation. However there are recent reports of a facial contact dermatitis to the active ingredient, so practitioners should be mindful to counsel for symptoms of irritation and to reduce down or stop treatment.21

Optimising management in SOC Rosacea in SOC is often underdiagnosed because erythema is less visible and awareness remains limited among both patients and clinicians. This highlights the need for careful history-taking, targeted questions on triggers and symptoms, and close examination for subtler signs as explained earlier. Dr Angela Tewari is a consultant dermatologist and founder of Dermatology Studios in Chelsea, London. She works as a consultant dermatologist in the NHS sector and holds a Doctor of Philosophy in ultraviolet radiation. Qual: MBBS, BSc, FRCP(derm), PhD(London)

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FOR UK HEALTHCARE PROFESSIONALS ONLY

FOOTNOTES AND REFERENCES *Per licensed glabellar lines dose in comparison with OnaBoNT-A and IncoBoNT-A.1 † Dose for glabellar lines: Azzalure®: 50 U; OnaBoNT-A: 20 U; LetiBoNT-A: 20 U; PraBoNT-A: 20 U; IncoBoNT-A: 20 U. § Azzalure®, OnaBoNT-A, and IncoBoNT-A have equivalent light chain activity per single neurotoxin molecule. The light chain activity of LetiBoNT-A and PraBoNT-A is not known but is assumed to be equivalent to the other products. || Direct correlation between the amount of active neurotoxin and clinical outcomes has not been established.

SCAN FOR PRESCRIBING INFORMATION

1. Galderma (UK) Ltd. Azzalure® Summary of Product Characteristics. February 2026; 2. Galderma. Data on file. MA-52573. More than 100 million Azzalure®/Dysport® treatments delivered in aesthetics indications. June 2022; 3. AbbVie Ltd. Botox® Summary of Product Characteristics. May 2025; 4. Merz Aesthetics Ltd. Bocouture Summary of Product Characteristics. January 2026; 5. Field M, et al. Toxins. 2018;10:535. 6. Frevert J, et al. Clin Cosmet Invest Dermatol. 2018;11:327–31. 7. Croma Pharma UK. Letybo® Summary of Product Characteristics. July 2023. 8. Allcock D, et al. Poster presented at: TOXINS 2021 Virtual Conference; January 16–17, 2021. 9. Evolus International Ltd. Nuceiva® Summary of Product Characteristics. July 2023. 10. Nestor MS, et al. J Cosmet Dermatol. 2020;19:278

Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard or search for Yellow Card in the Google Play or Apple App Store. Adverse events should also be reported to Galderma (UK) Ltd, E-mail: medinfo.uk@galderma.com Tel: +44 (0) 300 3035674

Botulinum toxin type A

Uniquely You. Naturally Azzalure. Azzalure® is a powder injectable wrinkle treatment indicated for glabellar lines and lateral canthal lines, offering two simple reconstitution methods to best suit your preferences1,2

The standard 0.63 mL dilution offers a lower dosing option, with a volume per injection point of 0.05 mL You may prefer the 1.25 mL option if you are more familiar with injecting 0.1 mL per injection point, as per standard reconstitution of other botulinum toxins3,4 Based on placebo-controlled clinical trials, the most frequent adverse reactions were headache and injection site reactions for glabellar lines, and headache, injection site reactions, and eyelid oedema for lateral canthal lines1

Azzalure delivers more active neurotoxin per dose than OnaBoNT-A or IncoBoNT-A*†, which may contribute to its fast onset of action and lasting duration§||1,3-10

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Hyperpigmentation Topicals

Melanin deposition may be epidermal, dermal or mixed, influencing both clinical presentation and treatment response.8 Melasma predominantly affects women and individuals with darker Fitzpatrick skin types (FST).7 Its pathogenesis is multifactorial, with ultraviolet (UV) and visible light exposure, hormonal influences and genetic predisposition recognised as major contributors.9 Post-inflammatory hyperpigmentation PIH develops following cutaneous inflammation or injury and is particularly common in FST III-VI.10 Common triggers include acne, atopic dermatitis, insect bites, trauma and iatrogenic procedures such as chemical peels and laser treatments.11 Clinically, PIH presents as excess melanin deposition at sites of previous inflammation or injury, and may persist long after the initial insult has resolved.11

Treating Hyperpigmentation with Topicals

Solar lentigines

Dr Jaymi Lad presents an overview of topical tyrosinase inhibitors and topical adjuncts for hyperpigmentation treatment Hyperpigmentation encompasses a heterogeneous group of acquired and inherited pigmentary disorders characterised by excess melanin production, abnormal melanin distribution or impaired melanin transfer.1 It is one of the most common reasons for dermatology and aesthetic consultations, particularly among patients with darker Fitzpatrick skin phototypes, where it can have a significant psychosocial impact.1,2 Topical therapy, combined with photoprotection, remains the first-line treatment for predominantly epidermal hyperpigmentation and may also be used to prime the skin before procedural treatments, reducing the risk of post-inflammatory hyperpigmentation (PIH) in susceptible patients.1,3,4

Diagnosis and assessment Clinical examination plays a key role in establishing the diagnosis by identifying the pattern and distribution of pigmentation, the anatomical sites affected which can include sun-exposed areas such as the face, neck, decolletage and backs of the hands, and the depth of pigment deposition.5 Blue-grey pigmentation suggests dermal involvement, whereas lighter brown pigmentation is more indicative of epidermal pigmentation. Wood’s lamp examination enhances epidermal pigmentation but not dermal pigmentation.5 Where available, skin imaging devices provide an objective assessment of pigmentation and inflammation.6 A range of skin imaging devices are available in the UK, including Obersv, Aura 3D and VISIA. Identifying the underlying pathogenesis and pigment depth guides management, with topical therapy generally producing the best outcomes in epidermal pigmentation.3

Hyperpigmentation disorders Hyperpigmentation presents in several forms, including melasma, PIH and solar lentigines. Accurate identification requires a thorough clinical assessment to determine the underlying cause and appropriate management approach. Melasma Melasma is an acquired hypermelanosis characterised by symmetrical, reticulated hyperpigmented macules, typically affecting the centrofacial, malar or mandibular regions.7 The forehead, cheeks, nose, upper lip (usually sparing the philtrum) and chin are most involved.

Solar lentigines are benign hyperpigmented macules resulting from chronic UV exposure, most frequently occurring on sun-exposed areas including the face, neck, hands and forearms.12 Their prevalence increases with age, although genetic predisposition and skin phototype also influence development. Beyond their cosmetic impact, solar lentigines are recognised markers of cumulative photodamage and are associated with an increased risk of cutaneous malignancy.12 Before initiating topical or procedural lightening treatment, lesions should be assessed clinically and, where appropriate, with dermoscopy to exclude atypical lesions, particularly lentigo maligna and pigmented actinic keratosis. Any lesion with suspicious features should be referred for dermatological assessment and biopsy rather than treated cosmetically.12

Topical tyrosinase inhibitors Although hyperpigmentation disorders differ in cause and presentation, they share overlapping biological pathways that drive excess pigment production and retention.13,14 Understanding these pathways helps explain how topical therapies work and why combination treatment is often required for optimal outcomes.15,16 The mainstay of topical treatments for hyperpigmentation are aimed at targeting this rate-limiting step in the melanogenesis pathway by use of tyrosinase inhibitors.18 For most topical tyrosinase inhibitors, contraindications are limited, with known hypersensitivity to the active ingredient or formulation components being the most consistently recognised.19-21 Additional agent-specific contraindications and precautions are outlined below. Hydroquinone Hydroquinone (HQ), either as a monotherapy or in triple combination creams with a retinoid and corticosteroid, remains the gold standard depigmenting agent in the literature for many hyperpigmentary disorders, such as ephelides, solar lentigines, PIH – but especially melasma.11,22,23 HQ was one of the first topical depigmenting agents able to demonstrate consistent clinical efficacy.24,25 It is a prescription-only topical preparation in the UK and is typically prescribed at concentrations of 4%. HQ inhibits melanogenesis primarily through the reversible inhibition of tyrosinase and selective melanocyte toxicity, thereby reducing new melanin synthesis.22 A multitude of clinical studies have evaluated HQ in the treatment of melasma and the availability of validated assessment tools, such as the Melasma Area and Severity Index (MASI), has also facilitated robust clinical evaluation. As a result, melasma has become the principal disease model for assessing the efficacy of topical depigmenting therapies.7,26,27 Consequently, HQ has become the benchmark comparator in subsequent clinical trials evaluating new and combination depigmenting agents.26 Effective treatment for melasma requires a multimodal approach targeting melanogenesis, inflammation and photodamage, with

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Hyperpigmentation Topicals

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topical agents such as HQ forming the cornerstone of therapy alongside rigorous photoprotection.7 A double-blind, split-face, randomised control trial (RCT) comparing HQ 4% and niacinamide 4% in 27 patients with melasma demonstrated HQ improved hyperpigmentation in 55% of patients.28 HQ is typically applied once daily and prescribed in cyclical courses (e.g. six months on, followed by a treatment break) to minimise the risk of adverse effects.9 Patient counselling and regular review are essential throughout treatment to monitor for complications, including irritant contact dermatitis (and subsequent PIH), leukoderma and nail hyperpigmentation.9 Although rare, exogenous ochronosis – characterised by grey-blue to black macular pigmentation – has been associated with prolonged or unsupervised use, higher HQ concentrations and individuals with FST IV-VI.23 Hydroquinone is contraindicated during pregnancy and breastfeeding because of systemic absorption.29 Concomitant use with photosensitising medications and excessive UV exposure should also be avoided.23 Concerns surrounding HQ side effects have led to restrictions on the availability and concentration. In the UK, HQ use is not permitted in cosmetic products but remains available on prescription with medical supervision.30-32 Alpha arbutin Alpha arbutin is a HQ derivative, available in topical over-the-counter formulations ranging from 1-5% and is typically applied once or twice daily. It is a synthetic and more potent version of the natural compound arbutin, extracted from bearberry leaves.23 Alpha arbutin interrupts melanogenesis by competitively inhibiting tyrosinase, delaying melanocytes maturation and it has antioxidant action.21,33 A split-face, blinded RCT comparing 5% alpha arbutin and 2% kojic acid to triple combination cream (HQ 4%, tretinoin 0.05% and fluocinolone acetonide 0.01%) in 30 participants demonstrated comparable improvement in melanin index and MASI scores and fewer adverse effects for the treatment of melasma over 12 weeks.34 Adverse effects such as stinging, erythema, pruritus and dryness were apparent in both groups, but significantly higher with use of the triple combination cream.34 Use of alpha arbutin during pregnancy and breast-feeding is generally avoided because of insufficient safety data and few well-designed clinical trials.21,34 Azelaic acid Azelaic acid (AZA) is another topical depigmenting agent that works by competitively inhibiting tyrosinase and reducing oxidative stress. In addition to its depigmenting effects, AZA demonstrates antibacterial, anti-keratolytic, antioxidant and anti-inflammatory properties. AZA is available as prescription-only formulations at concentrations of 15% and 20%, as well as cosmeceutical products, and is typically applied once or twice daily.9 A randomised, double-blind study comparing the therapeutic effects of 20% AZA to 4% HQ in 329 participants with melasma over a 24-week period found comparable clinical efficacy, with no significant differences in overall clinical improvement, lesion size or pigment intensity.35 In PIH, management focuses on treating the underlying inflammatory condition while reducing pigmentation, as further irritation may exacerbate the condition, particularly in skin of colour.3,10,11 This makes AZA a suitable option for the dual treatment of PIH driven by inflammatory skin conditions such as in acne vulgaris and rosacea.36 Its tolerability and anti-inflammatory properties make it particularly suitable choice for long-term maintenance therapy, especially in patients with acne and rosacea. It is also considered one of the preferred topical treatments for hyperpigmentation during pregnancy 44

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because of its favourable safety profile.37 The most frequent adverse effects with AZA include mild transient erythema and cutaneous irritation, however, does not include allergic sensitisation and photodynamic skin reactions.38 Very rarely, exacerbation in asthma has been reported with use of AZA.19,38 Tranexamic acid Both topical and oral forms of tranexamic acid (TXA) are utilised for hyperpigmentation – oral treatment has more clinical backing, but emerging research also highlights the use of topical TXA.39 TXA inhibits the production of plasmin, reducing inflammation-driven melanogenesis and decreasing tyrosinase levels and tyrosinase related proteins.37,38 Topical preparations ranging from 2-5%, with up to twice-daily application are most studied.39 In a prospective split-face comparative study of 100 women with melasma, topical 5% TXA demonstrated comparative clinical efficacy to topical 4% HQ when applied over 12 weeks, using objective measures such as histopathology and Antera 3D imaging.40 Topical TXA is generally well tolerated, with only mild irritation, dryness and erythema noted.41 Use in pregnancy, substantial barrier disruption and significant thrombotic history warrant caution due to insufficient evidence with topical prepartions.39,42 Cysteamine Cysteamine reduces existing epidermal melanin and prevents new melanin formation by targeting multiple stages in the melanogenesis pathway.11 The proposed mechanism of action includes tyrosinase and peroxidase enzyme inhibition, preventing the conversion of dopaquinone into melanin polymers and increasing intracellular glutathione.40 Stabilised 5% cysteamine cream has demonstrated efficacy in melasma, with emerging evidence for PIH and solar lentigines. It is typically applied once daily in the evening as 15-minute short-contact therapy.41 Kojic acid Kojic acid is a naturally occurring agent derived from certain fungal species typically found at a concentration of 1-4% in cosmeceutical formations and is usually applied once or twice a day.20,33 As well as being a potent antioxidant, kojic acid is an effective tyrosinase inhibitor, mainly due chelation of its copper at the enzyme active site.33 Kojic acid is frequently combined with other depigmenting agents, such as HQ and glycolic acid, mostly for the treatment of melasma.34 Adverse effects such as irritation, contact dermatitis and pruritus have been observed with kojic acid, with the risk of cutaneous irritation increasing at concentrations above 1%.34 Thiamidol Thiamidol (isobutylamido-thiazolyl-resorcinol) is a resorcinol derivative developed as an alternative to HQ. Thiamidol is a selective tyrosinase inhibitor that has demonstrated promising results in multiple in vitro and in vivo research showing comparable efficacy but reduced side effects than HQ.42 It has been used in the management of melasma, PIH and solar lentigines, as well as the prevention of UVB-induced hyperpigmentation at a concentration of 0.2% and when applied twice daily.17,40,42

Topical adjuncts Topical adjuncts are designed to clear existing pigment, prevent its transfer or manage the underlying inflammation causing hyperpigmentation.1

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Niacinamide Niacinamide, a water-soluble form of vitamin B3, has multiple biological effects that are relevant to dermatological practice. It exerts its anti-melanogenic effect independently of melanin synthesis by reversibly inhibiting the transfer of melanosomes from melanocytes to surrounding keratinocytes.43 Skin lightening effects have been observed with topical cosmetic formulations containing 5% niacinamide, when used twice daily.43 In a small eight week, double-blind, split-face RCT involving 27 women with melasma, topical 4% niacinamide produced good-to-excellent improvement in 44% of participants compared to 55% for topical 4% HQ.28 It also possesses anti-inflammatory, antimicrobial, sebostatic, barrier-protective effects through synthesis of ceramides and photoprotective effects, suggesting it may be useful when treating pigmentation with underlying inflammatory skin conditions such as atopic dermatitis, acne and rosacea.11 Adverse effects to topical niacinamide are uncommon and typically include mild transient irritation, erythema or pruritus.28 Retinoids Retinoids are commonly used adjuncts in the management of hyperpigmentation because they accelerate epidermal turnover, promote the dispersion of melanin granules and reduce inflammation.11 Retinoids also directly affect melanin synthesis, as they also reduce tyrosinase production.44 In addition to treating acne vulgaris, prescription topical retinoids such as tretinoin have demonstrated improved outcomes in melasma when combined with hydroquinone and corticosteroids.11 The effectiveness of other prescription retinoids for the treatment of PIH and acne has been demonstrated with adapalene, tretinoin and tazarotene.44 Side effects of retinoids can include erythema, pruritus, scaling, irritant dermatitis and rarely paradoxical PIH, so caution is advised particularly in individuals with darker skin types.10,11 To minimise irritation, topical retinoids should be introduced gradually, applied at night, two to three times per week and increased to more frequent use as tolerated.46 Patients undergoing procedures such as chemical peels, laser treatments or waxing should discontinue retinoids several days beforehand to reduce the risk of post-procedural complications.44-46 Retinoids should be avoided during pregnancy because of the established teratogenicity of oral retinoids, particularly isotretinoin. Although systemic absorption from topical retinoids is low, their use is generally contraindicated during pregnancy as a precaution.47 Vitamin C and other antioxidant formulations Vitamin C is a well-recognised antioxidant that inhibits melanogenesis through multiple mechanisms. It is most biologically active and best-studied in the form L-ascorbic acid.48 In addition to its antioxidant activity, it interacts with copper ions at the active site of tyrosinase and acts as a reducing agent during the oxidative steps of melanin synthesis, resulting in reduced pigmentation.24 Concentrations between 8-20% are commonly recommended. Concentrations below 8% are unlikely to achieve clinical efficacy and higher concentrations above 20% do not improve product absorption or clinical outcomes and are associated with an increased risk of irritation.24,48 Starting treatment with a lower concentration or a vitamin C derivative may improve tolerability and reduce the risk of adverse effects.24,48 Topical therapies including combinations of ascorbic acid and its derivatives, as well as HQ, retinoids, triple combination cream and arbutin have all demonstrated effectiveness in the management of solar lentigines.12,29,44 However, combining these

Hyperpigmentation Topicals

topical depigmenting agents with procedural treatments, including cryotherapy, chemical peels and laser – or other energy-based devices (EBDs) – appears to be more effective than topical management alone.12 Although comparative studies evaluating application frequency are lacking, vitamin C is generally recommended for once daily, morning use in combination with sunscreen because of its antioxidant and photoprotective properties.48 To improve stability and enhance photoprotective efficacy, vitamin C is frequently formulated in combination with vitamin E and ferulic acid and stored in an air-tight, opaque container.48,49 Reported adverse effects are generally mild and can include erythema, stinging, dryness and irritation with reactions occurring at higher concentrations and low-pH, L-ascorbic acid formulations.48 It should be used with caution in patients with skin barrier dysfunction and heighted cutaneous sensitivity, as they are more susceptible to adverse effects.24,48

Glutathione Glutathione’s proposed mechanism of action is related to its potent antioxidant properties, reducing oxidative stress-induced melanocyte activation, inhibiting tyrosinase activity and promoting pheomelanin over eumelanin synthesis.24,45 The skin lightening properties of glutathione were studied in 30 healthy women in a randomised, split-face study. Topical 2% oxidised glutathione used twice daily for 10 weeks, showed significantly lower melanin index, improve skin firmness and hydration compared to the placebo cream.50 Either no adverse effects or mild transient erythema were reported with use of topical glutathione.45,50 However, the current evidence is limited by a small number of clinical studies, and further quality randomised controlled trials are required before its routine use can be recommended. Sun protection factor The use of sunscreen is paramount in the management of hyperpigmentation due to the well-known link of UV and visible light stimulating melanin production and contributing to symptom recurrence. FST IV-VI are particularly susceptible to UVA, UVB and visible light-induced hyperpigmentation.40,51 Two hourly reapplication of a broad-spectrum sunscreen with a sun protection factor of at least 50 should be combined with additional photoprotective measures, including protective clothing and sun avoidance during peak UV hours.52 Tinted sunscreens containing iron oxides are preferred, as they provide enhanced protection against visible light and long-wave UVA.13

Managing hyperpigmentation topically The successful management of hyperpigmentation requires an accurate diagnosis and an individualised treatment approach. Management should address the underlying cause of pigmentation while including evidence-based topical depigmenting agents, photoprotection and, where appropriate, adjunctive procedural therapies. Dr Jaymi Lad is an aesthetic practitioner based in Manchester. She is the founder of Dr Jaymi Aesthetics, an independent clinic with a special interest in regenerative aesthetics, cosmetic dermatology and skin of colour. She spent six years as a clinical trainer at Harley Academy and currently works for Evolus as a medical affairs clinician. Qual: BMBS, BSc Hons, L7 Certificate (Injectables), MSc Derm

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One patient record. One clearer prescribing workflow. Helping UK private prescribing teams replace disconnected operational steps with a clearer way of working

Advertorial OxygenRx

responsible for appropriate configuration, policies, staff training, lawful data handling and professional oversight. For independent prescribers, the result is a simpler operational model around patient context and follow-up. For multi-user clinics, it creates a shared view across clinicians, administrators and managers. For growing or enterprise teams, it standardises workflows across services, users and locations. “Before OxygenRx our information sat in different places. Now the whole team works from the same view, so we can see what is due and who is responsible without chasing spreadsheets.” – Chloe Goodman, nurse and director, Opiah Aesthetics, Hove, Brighton

OxygenRx brings patient intake, consultations, prescribing activity, repeat care and Mediva Pharmacy fulfilment visibility together around the patient record. OxygenRx is built by Brown’s Pharma Limited, the operator of Malta’s largest pharmacy chain, with 30 pharmacies over 28 years.1 We created the first version to run our own business, and we are now bringing it to UK private prescribing teams. Private prescribing rarely begins and ends with issuing a prescription. Before a clinical decision, a team may collect patient information, review medical context, arrange a consultation and document it, then handle follow-up, repeat care and communication with the pharmacy. When each stage sits in a different system, teams spend time searching for context and checking what happens next. Clear, accurate records are not an administrative preference. They are a professional expectation: the General Medical Council, the Nursing and Midwifery Council and the General Dental Council all require patient records to be clear, accurate, contemporaneous and complete.2,3,4 Rather than treating the patient record as an isolated database, OxygenRx places it at the centre of the private prescribing workflow. Patient information, questionnaires, consultation context, prescribing activity, repeat care and fulfilment updates stay connected, giving authorised users a coherent view of the patient journey.

What this means in practice Information supplied once through structured forms stays attached to the record, so teams prepare from what the patient already provided rather than re-collecting it. Active prescribing work, history and follow-up sit in one place, reducing time lost switching between systems. Repeat workflows show what is due without separate spreadsheets or manual reminders, helping teams stay ahead of care. Appointment and online consultation workflows connect to that same context, so the reason for the visit and any required follow-up are easy to review together. The platform supports the workflow; it does not replace the prescriber’s professional judgement, clinical assessment or responsibility to work within their competence and scope of practice. The Royal Pharmaceutical Society’s Competency Framework for All Prescribers remains an important reference for safe and effective prescribing.5

Figure 1: OxygenRx connects private prescribing activity around the patient record.

From prescribing to pharmacy fulfilment Where prescriptions are fulfilled through Mediva Pharmacy, OxygenRx connects fulfilment visibility back to the prescribing workflow. Mediva Pharmacy is responsible for dispensing, patient payment and delivery; OxygenRx provides the connected operational view where that information is relevant to the patient record. This clear separation of responsibilities helps teams understand the status of approved prescriptions, without implying that the software itself dispenses medicines. “The connection through to Mediva Pharmacy fulfilment gives us a clear view of where an approved prescription is, which makes follow-up and continuity of care far more straightforward.” – Dr Kyrollos Hanna, Medical Doctor, Lyv Pharmacy (www.lyvpharmacy.com) Private prescribing will always require careful professional judgement. The supporting operations should make that judgement easier to document, review and follow through. OxygenRx gives authorised teams a clearer, faster environment for doing exactly that.

See the workflow at CCR Meet the OxygenRx and Mediva Pharmacy teams at the Clinical Cosmetic Regenerative Congress (CCR), Stand D20, for a guided demonstration using a realistic prescribing workflow. Visitors can explore the full workflow and discuss how it could fit their operating model.

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A clearer workspace for the whole team Within OxygenRx, prescribing activity is managed against the patient record. Teams can see active work and keep forms, notes, prescription history and follow-up connected. Role-aware access means a prescriber, clinic administrator and fulfilment partner each work with the context relevant to their role, while a reviewable activity history shows who was involved and what happened. This supports clearer internal governance and ownership without splitting the patient journey. Technology alone does not guarantee regulatory or data-protection compliance: each organisation remains

Request a 30-minute tailored demo: oxygenrx.co.uk/request-demo Meet us at CCR: Stand D20 - Mediva Pharmacy Email: info@oxygenrx.co.uk or lara@oxygenrx.co.uk Telephone: +44 (0)7960 899614 Website: oxygenrx.co.uk

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Optimising Pre- and Post-Procedural Skincare Dr Sally Rayment explores pre- and post-procedural topical skincare protocols designed to optimise clinical outcomes The skin barrier is fundamental to cutaneous homeostasis, regulating transepidermal water loss (TEWL), modulating the immune response and resisting microbial colonisation.1 When aesthetic procedures disrupt this barrier – through mechanical trauma, thermal injury or chemical exfoliation – the trajectory of healing is profoundly influenced by the pre-procedural condition of the skin and by the topical agents deployed afterwards. Across the full spectrum of aesthetic practice, from injectable neuromodulators and dermal fillers to fractional laser resurfacing, intense pulsed light (IPL), chemical peels and microneedling, pre- and post-procedural skincare protocols represent an underutilised lever for optimising outcomes. A growing body of evidence from randomised controlled trials (RCTs) and meta-analyses now supports structured topical regimens that reduce post-inflammatory hyperpigmentation (PIH), accelerate barrier reconstitution, decrease infection risk and improve the patient experience.2 This article provides a clinically grounded framework for pre-procedural skin preparation and post-procedural care (Table 1), for aesthetics procedures including semi-ablative and ablative laser, chemical peels and microneedling. Guidance on the phased reintroduction of active agents during the maintenance phase, with particular attention to Fitzpatrick phototype risk stratification is also discussed.

Pre-procedural skin preparation

RCTs by Dr Kono et al. confirmed that ceramide-containing formulations consistently produced equivalent or superior outcomes to similar moisturisers across all trials assessing barrier function and TEWL in patients with barrier-compromised skin. 3 More recently, a 2025 review reinforced that ceramide replenishment attenuates inflammation and supports epidermal differentiation, providing a rationale for a two- to four-week ceramide-dominant priming period prior to aesthetic procedures in this population.4 Preventing post-inflammatory hyperpigmentation For patients at risk of PIH – particularly Fitzpatrick phototypes IV-VI or those with a personal history of post-inflammatory dyspigmentation – pre-treatment with a melanogenesis-modulating agent for four to six weeks before ablative or semi-ablative procedures is supported by robust evidence. A systematic review and meta-analysis of seven RCTs concluded that tranexamic acid (TXA) used adjunctively with laser significantly reduced the melanin index compared with laser alone, with a favourable safety profile, establishing it as a first-line adjunct for PIH prevention in laser patients.5 Where hydroquinone is used, 4% concentration remains the standard; however, the same evidence base supports niacinamide (5-10%) as both a pigmentation-modulating and barrier-supporting agent.6

The goals of pre-procedural conditioning are fourfold; to optimise barrier integrity, attenuate baseline inflammation, modulate melanogenesis in susceptible patients and reduce cutaneous microbial load.

A 2021 mechanistic review confirmed niacinamide inhibits melanosome transfer, reduces oxidative stress and enhances ceramide production, making it particularly suited to the pre-procedural phase in phototypes where irritation risk is a concern.6

Barrier support in compromised skin

Retinoids in skin priming

Patients with atopic dermatitis, rosacea or seborrhoeic dermatitis have impaired lamellar body secretion and reduced ceramide levels in the stratum corneum, rendering them more vulnerable to procedure-related irritation and delayed healing. A 2021 qualitative review of

Retinoids are a well-established component of pre-procedural priming for ablative procedures. A 2022 systematic review of RCTs confirmed that topical tretinoin produces significant improvements in photoaged skin, with evidence across both fine wrinkling and Aesthetics | September 2026

Topical Skincare Procedural pigmentation endpoints. It was found that 0.1% tretinoin applied for three months before ablative laser was the most commonly evaluated priming regimen, and that it should be discontinued a day before ablative procedures, and at a lower dose (of 0.05%) for non-ablative approaches.7 The rationale is that active retinisation (erythema, increased cell turnover, reduced barrier tolerance) can heighten irritation and delay re-epithelialisation when combined with an ablative injury. Clinicians should counsel patients on the expected retinisation response – erythema, scaling and sensitivity – which often peaks in the first two to four weeks, and typically resolves with continued use. The management of patients on systemic isotretinoin has historically required the postponement of all aesthetic procedures for six to 12 months following cessation. This guidance is now subject to revision. A comprehensive 2025 systematic review, encompassing 34 eligible studies and 1,563 patients, found insufficient evidence to support mandatory delays before fractional ablative lasers, non-ablative lasers, chemical peels or microneedling in patients receiving or recently completing isotretinoin.8 A parallel 2024 systematic review of six RCTs and additional case series reached the same conclusion for energy-based devices used adjunctively.9 The exception remains fully ablative laser and mechanical dermabrasion, where the evidence base does not yet permit the same reassurance. Clinical judgement and informed consent remain essential in all cases.

Immediate post-procedural care The immediate post-procedural window for ablative, semi-ablative, chemical peel and microneedling procedures, is characterised by disrupted barrier integrity, acute inflammation and heightened susceptibility to secondary infection and sensitisation.10 Topical management during this phase must prioritise barrier repair above all other objectives. Barrier repair and emollient support A 2022 multicentre, randomised, double-blind, split-body clinical trial by Dr Casas et al. evaluated a topical priming and post-procedural product across 29 patients undergoing 38 aesthetic surgical body procedures, in particular, abdominoplasties. Statistically significant improvements versus the comparator side were observed for ecchymosis by post-operative days 10-14, with benefits extending to skin discolouration, oedema, 49

Topical Skincare Procedural

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Phase

Recommended topical approach

Key caution

Pre-procedural: barrier-compromised skin

Ceramide-dominant moisturiser, two-to-four-week priming period

Avoid starting on actively inflamed or broken skin3,4

Pre-procedural: PIH risk (phototype IV–VI)

Topical/oral TXA adjunct ± niacinamide 5-10% ± hydroquinone 4%

Allow adequate lead-in time; monitor for irritation5,6

Pre-procedural: retinoid priming

Tretinoin 0.1% for three months (0.05% for nonablative); stop one day before ablative procedures

Discontinue before ablative treatment; counsel on retinisation response7

Pre-procedural: isotretinoin history

Individualised timing; no blanket six-to-12-month delay

Exception: fully ablative laser and mechanical dermabrasion8,9

Immediate post-procedural: barrier repair (0-72 hours)

Petroleum-based ointment or ceramide barrier cream, fragrance/preservative-free

Avoid known sensitisers on compromised skin10

Immediate post-procedural: antioxidant support

Vitamin C/E + ferulic acid serum from re-epithelialisation, daily for seven days

Confirm re-epithelialisation has begun before starting11-13

Immediate post-procedural: photoprotection

Mineral SPF50+ (zinc oxide/titanium dioxide), reapplied two-hourly

Avoid organic UV filters on inflamed skin14,15

Immediate post-procedural: cleansing/antiviral

pH-balanced, low-surfactant cleanser or micellar water; aciclovir prophylaxis for perioral ablative laser

Avoid sodium lauryl sulphate, high-foam products and physical exfoliants for 48 hours16

Maintenance: active reintroduction (two to four+ weeks)

Vitamin C from day 10-14; retinol 0.1-0.3% alternate nights, titrated over four to six weeks

Six-to-eight-week interval before retinoids after ablative/deep peel treatment10

Maintenance: PIH-prone patients

Continue depigmenting agent ± retinoid ± shortcourse mild topical corticosteroid

Bridge pre- and post-procedural phases continuously; extra caution in phototype IV-VI19

Table 1: Recommended topical skincare approaches before and after aesthetic procedures, with key cautions by treatment phase and patient risk profile.

induration and fibrous banding at weeks three, four, six and 12. These findings highlight the clinical value of formulated post-procedural products beyond simple emollient therapy.10 A smaller, more recent study published in the Journal of Cosmetic Dermatology involving five patients reported similar findings.11 Petroleum-based ointments and ceramide-dominant barrier creams remain the most evidence-supported emollients for acutely compromised skin. 3,4 Formulations should be free of fragrance, ethanol, and preservatives with known sensitisation risk in compromised skin. 3,4 Antioxidant support For post-laser patients specifically, a 2025 randomised split-face trial by Qin et al. looked at a cohort of 50 patients and found that a topical serum containing vitamin C, vitamin E and ferulic acid, applied immediately after non-ablative fractional laser and daily for seven days, significantly reduced erythema scores and melanin index at day seven compared with saline control, with improved skin hydration and reduced TEWL.12 This is consistent with a 2023 systematic review of RCTs confirming that topical vitamin C formulations improve photoaged skin and reduce pigmentation indices when applied following laser treatment, with the caveat that most clinical evidence uses concentrations below 10%.12 A further 2026 RCT of ablative fractional CO2 laser for acne scars found that the same antioxidant 50

combination produced a significantly higher complete scab detachment rate at day seven and lower melanin index, supporting its use from the day of re-epithelialisation.13 Photoprotection after procedures Photoprotection must be instituted from the first day of re-epithelialisation. Mineral sunscreens (zinc oxide and/or titanium dioxide) are the preferred formulation for acutely inflamed post-procedural skin, given their physical mechanism, minimal sensitisation potential and absence of systemic absorption concerns raised with several organic UV filters.14,15 A 2021 expert panel consensus published in the Journal of the European Academy of Dermatology and Venereology recommended mineral-based, broad-spectrum SPF 50+ photoprotection as standard of care following laser and energy-based procedures, with reapplication every two hours under UV exposure.14 A 2020 systematic review of banned chemical sunscreen ingredients further supports the preference for mineral formulations in post-procedural and sensitive-skin contexts.15 Cleansing and antiviral prophylaxis Cleansing in the immediate post-procedural period should use a gentle, pH-balanced, low-surfactant formulation. Sodium lauryl sulphate-containing cleansers, high-foam products and physical exfoliants must be avoided. Micellar water applied with Aesthetics | September 2026

soft gauze is appropriate for the first 48 hours following ablative procedures. Oral antiviral prophylaxis – such as aciclovir – should be given for perioral ablative laser resurfacing, commencing the day prior and continuing for five to seven days. Commonly cited protocols use aciclovir 400mg twice daily starting the day before ablative laser resurfacing and continuing five to 10 days.16

Longer-term maintenance and optimisation The remodelling phase – typically one to four weeks post procedure depending on treatment depth–marks the appropriate window for the phased reintroduction of active topical agents. This applies, for example, to superficial, medium and deep chemical peels, as well as non-ablative and ablative laser treatments. Premature resumption of aggressive actives is one of the most common iatrogenic drivers of post-procedural complications, including contact dermatitis and exacerbation of PIH.17 Reintroducing active ingredients Topical vitamin C may be reintroduced as early as 10-14 days post procedure in patients tolerating it, given its antioxidant and anti-pigmentation properties. A 2023 review of ascorbic acid as a cosmeceutical confirmed its dual role in inhibiting melanin synthesis and stimulating collagen, supporting its early reintroduction in the post-procedural maintenance phase.18

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Retinoids should be reintroduced cautiously at two to four weeks following superficial-to-medium depth procedures, starting with retinol 0.1-0.3% on alternate evenings, titrating over four to six weeks. Following ablative resurfacing or deep chemical peels, a six- to eight-week interval is advisable before any retinoid use.7 The 2022 RCT systematic review supports the efficacy and tolerability of this graduated approach, noting that adverse events – primarily erythema and peeling – are concentration and frequency-dependent and manageable through titration.7

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Topical Skincare Procedural

The skin barrier is fundamental to cutaneous homeostasis, regulating transepidermal water loss, modulating the immune response and resisting microbial colonisation

Managing PIH In patients predisposed to PIH, depigmenting agents should bridge the pre- and post-procedural phases continuously. A 2024 systematic review of PIH management in skin of colour confirmed that TXA across topical, oral and intradermal routes significantly reduced pigmentation indices, with a more favourable tolerability profile than hydroquinone, particularly in Fitzpatrick phototypes IV-VI.19 Where post-procedural PIH develops despite prophylactic measures, early institution of a combination regimen – typically a depigmenting agent, a retinoid and a short-course mild topical corticosteroid – accelerates resolution.19 Condition-specific maintenance and barrier support For rosacea-prone patients, avoidance of vasodilatory ingredients (high-concentration niacin, menthol, capsaicin) and reintroduction of anti-inflammatory actives such as azelaic acid (AZA) should guide the maintenance phase. For acne scarring, comedolytic and sebum-modulating agents (niacinamide, salicylic acid, AZA) take precedence. Across all phototypes, hydration and barrier support should remain the primary objective for the first four weeks.20

Risk management and special populations The most consistent iatrogenic pitfall in post-procedural skincare is premature reintroduction of actives. Providing written aftercare protocols at the point of treatment substantially reduces this risk and improves compliance. Protocol content should specify which products to use, when to introduce each one, and which ingredients to avoid during each recovery phase. Patients with signs of increasing pain, spreading erythema, pustules, fever or unexpected changes in pigmentation should be reviewed in-person as soon as possible.

Patients with pre-existing barrier disorders including atopic dermatitis, ichthyosis and psoriasis require enhanced emollient regimens and avoidance of potential sensitisers. In these patients, the evidence base supports ceramide-containing formulations as the preferred class of post-procedural emollient, with a 2021 review of 12 RCTs confirming consistent benefit across barrier-compromised skin types.1 Darker phototypes (Fitzpatrick IV-VI) carry the greatest risk of PIH and, in rare cases, PIH following energy-based procedures. The 2024 systematic review by Mar et al. reviewing all published evidence for PIH management in skin of colour, identified TXA (topical 2-5%, oral 250mg twice daily, or intradermal) as the intervention with the most favourable evidence-to-tolerability ratio for this population, with a minimum of four weeks of pre-treatment and three months of post-procedural maintenance recommended.19 Caution should be exercised with ablative fractional lasers at higher fluences, non-cooled IPL settings and deep chemical peels in this group.19 Conservative fluences and extended intervals between sessions are advisable. For patients receiving or recently completing isotretinoin therapy, the clinical consensus has shifted. Based on the 2025 systematic review, there is insufficient evidence to mandate a waiting period before most aesthetic procedures, with the important exceptions of fully ablative laser and mechanical dermabrasion.8 An individualised approach – incorporating dose, duration of therapy and procedure type – is the recommended standard, with informed consent and thorough documentation essential. A practical risk stratification approach for topical protocol design is to consider three variables together; procedure depth, Fitzpatrick phototype and baseline skin condition. Low-risk patients (superficial procedures, phototype I-III, Aesthetics | September 2026

intact barrier) may be managed with a streamlined regimen. Moderate-risk patients (medium-depth procedures, phototype IV, mild pre-existing condition) benefit from the full priming and post-procedural protocol described above. High-risk patients (ablative or deep procedures, phototype V-VI or significant barrier disorder) require individualised protocol design and enhanced post-procedural review.

Individualising patient protocols Structured topical skincare protocols, applied systematically in the pre- and post-procedural phases, represent one of the highest-yield, lowest-risk interventions available to the aesthetic clinician. Barrier preparation reduces procedural complications, melanogenesis suppression mitigates PIH risk in susceptible patients and phased reintroduction of actives optimises and prolongs treatment outcomes. Incorporating a protocol-driven approach into standard practice requires a clear risk stratification framework, a curated formulary of evidence-based agents and written patient guidance. As the evidence base continues to evolve and develop, the integration of contemporary skincare science with procedural expertise will define the highest standard of aesthetic clinical practice. Dr Sally Rayment is an aesthetic practitioner, part-owner of Facial Aesthetics Centre, and a restorative dentist based in Haywards Heath, West Sussex. She qualified at Guy’s, King’s and St Thomas’ Hospital in 2004 and holds a Master’s degree in Prosthodontic Dentistry from King’s College London. Qual: BDS MClinDent FRP

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Clinical Papers Abstracts

A Summary of the Latest Clinical Studies The latest research highlights from Professor Sebastian Cotofana Key Takeaways

· Topical treatments affect the various layers of the skin · Improvement of the skin can be achieved with dermal, intradermal, and subdermal treatments

· Subdermal treatments affect the superficial fascial system, which will influence skin appearance

Title: Understanding the Interplay Between Skin, Fascia, and Muscles of the Midface in Facial Ageing

Authors: Konstantin Frank et al. Published: Aesthetic Plastic Surgery Journal Keywords: 3D imaging; Aesthetic facial treatments; Cutometry;

Electromyography; Facial aging

The skin is the largest organ of the human body (if the interstitium is neglected) and is composed of various layers. The layers are from superficial to deep: epidermis, dermis and hypodermis. The epidermis consists of six different layers, which decrease in viability from deep to superficial, indicating that the most superficial layer, the stratum corneum, is composed of dead cells only. On the contrary, the stratum basale, the deepest layer of the epidermis and the layer adjacent to the dermis, contains keratinocyte stem cells, melanocytes and Merkel cells. No arteries, no veins, no lymphatic tissues can be identified in the epidermis, implying that the human epidermal envelope is reliant on diffusion of nutrients and oxygen from adjacent dermis. The dermis, on the contrary, contains an abundance of arteries, veins, nerves and lymphatic tissues which provide nutrients and oxygen to all dermal and epidermal layers. The dermis can be subdivided into a papillary layer, which is located superficially and therefore closest to the epidermis and into a reticular layer, which is deep and therefore closest to the subcutaneous fat. The dermis allows for thermal regulation via arterio-venous shunt vessels and, in addition, allows for the uptake of creams and topical products

into the respective layers as well as into the central circulation via the lymphatic and venous systems. The latter indicates that topical or dermal injectable treatments need to allow for diffusion into the dermal layer or be designed for direct intradermal product application. Intradermal product application is challenging when considering that the epidermis and dermis together have an average thickness of 1-4 mm. In the periorbital region, where the skin displays the smallest thickness values of the entire human body, products can diffuse easily to reach deeper layers. Intradermal treatments, however, are almost impossible because the skin is as thick as the needle itself. It is therefore plausible that sometimes injectable treatments are deployed into the subdermal layer (instead of the intradermal layer). Administering products into the subdermal layer can have two different consequences which need to be mentioned here: Consequence one: Injecting product into the subdermal plane can cause adverse vascular events when the product inadvertently is injected into the arterial vascular system. There, the product can obstruct arterial vascular flow, and the consecutive dermal tissue receives less oxygen and nutrients, resulting in hypoperfusion and even in tissue loss. Consequence two: Products intended for intradermal deployment most often target fibroblasts and the nutritional homeostasis of the skin. When fibroblasts are targeted, new collagens and proteins are produced (in the most optimal of cases), which then influence the superficial fascial system (= SFS). This system is a newly discovered biomechanical unit which has been shown to connect deeper structures of the face to the dermal undersurface. These connections – like stabilizing pillars during construction – are made of collagens and anchor into the subdermal interface. Stimulating fibroblasts with topicals, or with intradermal or subdermal treatments, will influence the SFS and will ultimately influence the appearance of skin. Understanding that the SFS is made of vertical pillars will reduce the fear of potentially misplaced intradermal products when targeting the subdermal plane. This abstract was supplied in partnership with Cotofana Academy.

Aesthetics top picks · Title: Anti-Obesity Medications in Longevity and Aesthetic Medicine. Authors: Julia Bijoch. Published: Journal of Clinical Medicine, August 2026. · Title: Safety Considerations in Hair Restoration Procedures: A Comprehensive Review. Authors: Savanah R Sturm, et al. Published: The Journal of Craniofacial Surgery, August 2026.

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Marketing Newsletters

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Considering Strategy for Email Newsletters Marketing and copywriting specialist Ivan Lusica provides a framework for creating newsletters that simultaneously attracts and retains patients The greatest challenge in marketing is earning your audience’s trust. With an established email list, you have already taken that crucial first step by building a trusted connection with your subscribers. Every person on that list has chosen your clinic, yet many newsletters are written as though the recipient has never heard of you. That disconnect is the difference between an email that gets opened and one that gets ignored. The clinics that achieve the greatest success treat email as a continuation of patient care, using education to build confidence in ways that discounts never can. A patient who understands what a treatment can and cannot achieve arrives with better questions, more realistic expectations and greater confidence in your recommendations. Over time, that is far more valuable than the temporary uplift of a price-led campaign. This article explores the key principles of an effective clinic newsletter, including the types of content patients genuinely engage with while remaining compliant with regulatory requirements.

Writing emails patients will read A patient newsletter needs to do more than contain accurate information; it needs to give the patient a reason to open and read it. Subject lines should be clear, specific and relevant rather than relying on exaggerated promotional language. ‘What to expect after your treatment,’ is more useful than ‘Everything you need to know about your transformation!’ The opening lines matter too. Patients should quickly understand why the email is relevant to them and what they will gain from reading it. Short paragraphs, informative subheadings and straightforward language make clinical information easier to scan, particularly on mobile. Practitioners should also subject every piece of patient-facing copy to a simple question – ‘Would I say this, in these words, to the patient sitting in front of me?’ Think of it as a ‘consultation continuity test’ – a simple way to identify where clinical communication begins to lose authenticity. The patient should recognise the same tone of voice and professional persona in a newsletter or follow-up email as they encountered during the consultation. Measured, precise writing reinforces the impression that the communication comes from the treating clinician. For example, ‘After this treatment, swelling can occur. Follow the aftercare plan provided and contact the clinic if symptoms worsen or fall outside the timeframe discussed with you.’ By contrast, generic marketing language, such as ‘Wave goodbye to tired skin and hello to a brand-new you!’ can make the email feel detached from the clinical conversation. A newsletter does not need to sound like an advertisement to be engaging; relevance, clarity and a recognisable clinical voice can be more effective. 56

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The solution is not necessarily to bring all content production in-house or outsource it entirely. The most effective approach depends on a clinic’s size, resources and expertise. Regardless of who drafts the content, responsibilities should be clearly defined. The writer or content producer is responsible for structure, readability and compliance considerations, while the clinician retains ownership of the clinical accuracy, professional voice and final approval. When treatment explanations reflect the clinician’s own expertise and experience, they are more likely to feel authentic and useful to the patient. Regulatory compliance amongst tone Patient newsletters are marketing communications and must comply with the same rules as a clinic’s website, including the Advertising Standards Authority and Committee of Advertising Practice Codes, Medicines and Healthcare products Regulatory Agency requirements for prescription-only medicines (POMs), General Medical Council guidance and Information Commissioner’s Office rules on consent and patient data.1-8 Clear, accurate information should do the persuasive work. Pressure, exaggerated outcomes, exploitation of insecurity and minimisation of risk should be removed. Avoid promotional language, pressure tactics, exaggerated claims or messaging that exploits insecurity. Do not advertise POMs directly or indirectly, including through pricing, brand references or before-and-after images. Testimonials must be genuine and not misleading; marketing must not target under-18s and email communications require appropriate consent. Outsourcing production does not remove accountability. The clinician must verify the clinical claims and information published about their services, while the clinic or marketer retains its advertising and data-protection obligations.9,10

Segmentation and automation Many clinics send the same newsletter to their entire mailing list and judge email marketing effectiveness on that basis. It is the equivalent of giving every patient the same consultation, regardless of why they attended. Segmentation and automation allow clinics to make communication more relevant and timely. For most practices, the information needed to begin already exists within the practice management system. Segmentation Segmentation involves dividing an eligible mailing list into smaller groups so that communications better reflect the recipient’s circumstances. A simple starting point is to segment using reliable non-clinical information, such as when someone joined the mailing list, the type of updates they requested or whether they have engaged with previous educational content. A recent subscriber may receive a welcome sequence, while someone interested in general education may receive relevant treatment information. As segmentation becomes more advanced, clinics may consider treatment-related criteria. However, treatment history is special category health data. Using it to personalise marketing communications requires an appropriate lawful basis and, in many circumstances, explicit consent in addition to marketing consent. The appropriate approach should always be confirmed with a data protection adviser. Automation Automation allows clinics to provide timely communication based on a patient’s stage in the journey, rather than relying solely on a monthly newsletter.

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Examples include welcome emails for new subscribers, educational content following an enquiry or clinician-approved aftercare information after treatment. These communications can support the patient experience by providing relevant information at the right time. The difference in performance between broadcast emails and automated sequences is significant (Table 1). In the health and beauty sector, automated email flows achieve click-through rates approaching four times those of standard broadcast campaigns.11 However, no published benchmark isolates medical aesthetics, so these figures should be viewed as directional rather than clinic-specific. Examples include welcome emails for new subscribers, educational content following an enquiry or clinician-approved aftercare information after treatment. For example, a new consultation booking could trigger an automated sequence explaining what to expect, how to prepare and what questions to consider before attending. These communications provide useful information at the right time. Broadcast campaign

Automated flow

Health and beauty (closest published category)

1.24%

4.8%

All specialties

1.69%

5.58%

Benchmark

Marketing Newsletters

This is a lower-risk, consultation-led formulation compared to higher-risk promotional wording such as – ‘It has been around three months since your last anti-wrinkle treatment. Book your next appointment now to maintain your results.’ Reactivation sequence Re-engages subscribers who have not clicked, replied to or otherwise interacted with clinic emails for a defined period. A first message might offer a useful educational resource and allow the reader to reset their preferences; ‘We have published a short guide to preparing for an aesthetics consultation, including questions to ask about suitability, risks and recovery. You can read it here.’ Promotions for non-surgical procedures are not automatically prohibited, but they must not pressure patients into booking or trivialise the decision, and should avoid short deadlines, limited-availability claims, countdowns or discounts presented in a way that pressures the reader to make a rapid decision.1,7 Once established, automated sequences reduce repeated manual work, but may still require scheduled clinical, regulatory and performance review. Unlike a monthly newsletter, which must generate new relevance each time, well-designed automation can support long-term patient relationships and continuity of care.

What to measure

Table 1: Average click-through rate.11

General newsletters still have a role, but they should not be expected to carry the entire responsibility for patient engagement. A small number of well-designed automated journeys can make communication more useful, timely and aligned with the patient’s needs.

Approaches to patient email communication A newsletter is only one form of patient email communication. Clinics can also use targeted email approaches to support different stages of the patient relationship, from introducing new patients to providing aftercare and maintaining continuity of care. Welcome series Introduces new patients to the clinic during their first few weeks, building familiarity and trust before further care is required. A typical sequence includes three emails: week one, an introduction to the clinic and its approach; weeks two to three, education tailored to the area of enquiry; and week four, guidance on what to expect from a consultation. Post-treatment follow-up Provides timely aftercare support, addressing common questions that arise after treatment and reducing avoidable enquiries. This may include a 24-48-hour check-in, recovery guidance at day seven and a review invitation at the clinically appropriate interval. The focus should remain on patient care rather than promotion. Recall sequence Re-engages existing patients when a previous course of care may warrant review. Where POMs are involved, communications should avoid naming the medicine or implying that treatment is overdue, as this may be interpreted as promotion of a prescription medicine.12-14 For example, ‘It has been some time since your last skin review. If you would like to discuss how things have settled and whether any further care is appropriate, we would be happy to arrange a consultation.’

Consultation bookings are just one metric by which to judge a newsletter. Open rates are no longer clear-cut either, as Apple’s Mail Privacy Protection marks messages opened automatically and can inflate the figure.15,16 First-party data puts true average opens near 21% once those automatic opens are stripped out, against dashboard figures ranging from the mid-30s to the low 40s, depending on platform.15,16 So read ‘opens’ as a direction, not an absolute. More meaningful indicators include click-through rates on educational content, reply rates to conversational emails and unsubscribe rates, which are typically low for healthcare mailing lists, consistent with content that remains relevant to readers.14 The most valuable indicator is also the hardest to measure: the quality of questions patients bring to consultations. A practical proxy is to ask, “What prompted your visit today?” at the start of each consultation, record when patients mention newsletter content, review these figures monthly and interpret them alongside reply rates. This should be treated as an indicator of engagement rather than a performance metric.

The newsletter as continuity of care Your email list is the most valuable audience you will ever own – people who have already chosen to trust you. Treating your newsletter purely as a sales channel may generate occasional bookings, whereas treating it as a continuation of the consultation builds stronger relationships, better-informed patients and greater long-term loyalty. Ivan Lusica is co-founder and managing director of ContentClicks, a global content marketing and copywriting agency serving regulated fields including medical aesthetics, healthcare, legal and finance. Lusica is an Australian-qualified lawyer with regulatory affairs experience spanning global consulting firms and large institutions. His work focuses on protecting clinical voice in patient-facing communications and building creative and compliant marketing systems for clinics in the UK and internationally.

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Business Strategy Team Performance

Improvements in these metrics are more likely to be sustained when clinics recognise contribution in ways that matter to the individual, whether through greater responsibility, professional development, increased autonomy or team-based rewards. The reward itself matters less than making each person’s contribution visible and meaningful. In order to track performance, different software can offer team members the option to track their performance, with real-time push notifications to update progress and offer motivation. This can also be achieved manually, as long as a manager tracks the relevant KPIs per role for weekly or monthly progress and makes the performance visible to the individual team member it relates to. Each stage of the patient journey should therefore have three aspects attached to it; clear role ownership, expected behaviours and measurable outcomes. That is what turns team performance from a broad ambition into something visible, coachable and repeatable across the clinic. That is where the patient journey blueprint comes in.

The Role of Team Clarity in Driving Clinic Performance

Turning expectations into repeatable behaviour

Operations director Órla Phelan explains how clear staff expectations and a structured patient journey can increase clinic growth As the specialty continues to grow as close to 10% annually, owners can no longer personally oversee every interaction.1 The challenge is not simply setting team goals but translating those goals into consistent behaviours at each stage of the patient journey so performance can be measured, coached and improved. Clinic growth comes from turning role clarity into consistent actions across the patient journey, then tracking whether those actions are happening.

Why role clarity is the foundation Just as patients benefit from clear treatment plans, teams perform best when they have clear expectations. Before a clinic can build a team that delivers consistently, each team member needs to understand exactly what great looks like in their role. The single strongest driver of employee engagement is role clarity – employees knowing exactly what is expected of them.2 Your team may include providers such as aesthetic practitioners and therapists, alongside front-of-house staff, a patient coordinator and a manager. Each role shapes the patient experience differently and should be accountable for the outcomes it influences. That clarity becomes more powerful when it is tied to measurable goals. By linking each team member’s key performance indicators (KPIs) to the outcomes they influence, clinics make expectations visible, practical and easier to act on. At a business level, the aim is rebooking above 70%, strong, new and existing patient retention (top clinics exceed 70%), and a retail-to-service percentage greater than 15%.3 The number of visits per patient each year will vary depending on the treatments a clinic offers. However, for injectable treatments such as neuromodulators and dermal fillers, there are more established maintenance intervals that can help guide rebooking expectations.

Ultimately, patient retention is one of the clearest indicators that these standards are being upheld. Research from Harvard Business Review shows that a 5% improvement in patient retention can increase profitability by 25% or more.4 These metrics are more than performance indicators. They show whether the standards you have set are being delivered consistently across the patient journey and whether those behaviours are translating into stronger retention, greater lifetime value and sustainable clinic growth. To achieve this, begin by mapping your ideal patient journey. What does excellence in your clinic look like at every touchpoint, from first enquiry to final follow-up? The clearer your vision for team behaviours and clinic values, the easier it becomes to translate that vision into daily behaviour from front-of-house through to the treating clinician. If every team member prepares differently, every patient experience becomes different too. Before the appointment At this stage, front-of-house, coordinators and clinicians all contribute. One ensures the right information is captured, another flags relevant history and the treating practitioner prepares to lead a more relevant consultation. Standardising the preparation stage ensures your expectations are delivered, regardless of who is treating the patient. One of the best ways to standardise preparation is to set up your forms with pre-loaded questions to help plan relevant education and care. Include fields like current at-home skincare routine and the outcome they are hoping to achieve. This equips the practitioner to deliver a strong consultation and to present a tiered proposal, tailored to the patient’s goals and budget. Patients rely on clinicians to guide them confidently through their treatment journey. When delivered consistently across the team, this is reflected in stronger new patient retention. Strong preparation should be an expected standard, not an individual habit. High-performing clinicians build a short preparation window into the start of every day, allocating time to review the diary, identify new patients and revisit the history of previous treatments and stated goals of returning patients. Arriving prepared signals care. Greeting a returning patient by name, referencing their last treatment and picking up the conversation where it left off helps create continuity and builds trust. For new patients, reviewing the consultation form in advance gives clinicians useful context about their concerns, treatment interests and desired outcomes, allowing the conversation to begin at a deeper level.

Aesthetics | September 2026

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References: 1. Sculptra. IFU. 2. Widgerow A, et al. Poster presented at IMCAS World Congress. 01-03 February 2024. Paris, France. 3. Huth S, et al. J Drugs Dermatol. 2024 Apr 1;23(4):285-288. 4. Galderma. Date on File (MA-60875). 5. Zhang Y, et al. Regen Biomater 2021;8(5):rbab042.

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This kind of preparation turns expectations into a more consistent patient experience. Rather than spending valuable appointment time gathering basic information, clinicians can focus on listening, educating and guiding patients towards the most appropriate treatment plan. In turn, that supports stronger patient trust, more consistent recommendations, better rebooking and improved long-term retention. Retention KPIs can also help indicate which practitioners are delivering these standard consistently. During the consultation or visit Preparation creates the opportunity; but the consultation is where consistency is delivered. Clinicians are not salespeople, and they should not be treated as such. A consultation is where the clinician has the greatest influence, but the quality of the interaction still depends on the standards the wider team has set around preparation, documentation and handover. Patients come looking for expert guidance and they want to be educated, advised and pointed in the right direction. The discomfort around follow-up conversations usually comes from confusing recommendation with selling. They are not the same thing. Where treatment interests have been captured in advance, recommendations become a natural continuation of the conversation; “When we completed your consultation, you mentioned you were also considering [X]. Is that still something you’d like to explore?” If no prior information has been recorded, build a brief results review into every appointment to create the same opportunity; “Are there any other areas you’d like to address, or treatments you’d like to know more about?” When these conversations are built into every consultation, recommendations feel like professional guidance rather than selling. When they become an expected part of every consultation, they shift from individual communication styles to a repeatable clinical standard that can be coached, measured and reinforced. The difference between teams that do this by default and those that do not usually comes down to whether the owner has made these behaviours an explicit expectation. Throughout the appointment, team members should be encouraged to look for opportunities to educate patients about other treatments that align with their goals, whether that’s a new device, a seasonal treatment or a future service to consider. Record any future treatment interests in the clinical notes so the next consultation can continue the conversation naturally. When done effectively, these conversations naturally increase retail sales and add services by layering modalities to address patient concerns. After the appointment Every appointment should finish with a clear recommendation for ongoing care; “To achieve the best result from today’s treatment, we’d normally recommend seeing you again in [X weeks]. Shall we get that booked in before you leave?” It is important to be clear on which team member is responsible for rebooking but often it sits with the front-of-house team. If the patient prefers not to book on the day, ensure there’s a clear follow-up pathway including rebooking reminders and online booking, so it is easy for them to book when they’re ready. For any patients who do not return, the patient coordinator can work to re-engage lost patients with outreach, education and follow-up by tracking those who have not had an appointment in over six months.

Business Strategy Team Performance

How clinic owners can track and coach performance Once expectations have been defined across the patient journey, tracking performance shows whether those standards are actually being delivered. This is what allows clinic owners to move from assumptions about team performance to evidence-based coaching. Across clinics that introduced clear, tracked staff goals, data shows average ticket size increased by 18%, retail sales by 41% and rebooking rates by 9%.5 Great might look slightly different for each practice. As a starting point, we assume the majority (73%) of patients are repeat patients.6 Typically the clinician or practitioner is responsible for reviewing patient concerns and recommending a holistic approach including appropriate treatment layering for optimal results. At-home skincare education to support clinical treatment typically also sits with that practitioner. Front-of-house tasks include rebooking and reviewing retail skincare purchases for refill. A patient coordinator might hold responsibility for re-engaging patients who last visited more than six months ago. Managers review KPIs, including those above, like retail, retention and rebooking per role, to highlight the impact they have on the business. Setting expectations is only valuable if you or your manager measures whether they are being delivered. Having the performance tracked closes the loop, allowing clinic owners to reinforce behaviours that create a consistently excellent patient journey. Managers can also be targeted to focus on one key metric, or a single, all-encompassing measure such as year-on-year revenue growth. Start with the metrics that matter most; retail conversion, service revenue per visit and rebooking rate. Most clinic management software will have a staff performance report that surfaces these by provider that can be run on a weekly basis to see progress and trends. This data shows not only who is performing well, but which behaviours are driving those results. A clinician with strong rebooking rates, may be consistently setting expectations for follow-up care, recommending treatment plans confidently and making rebooking a routine part of the consultation. When high-performing team members share those habits, behaviours that once felt individual can become repeatable across the clinic. Retention data can also help guide patient allocation, directing new patients towards clinicians with strong retention and rebooking rates while giving others the opportunity to learn from their approach.

Why this improves retention and growth Ultimately, clinic performance is less about having exceptional individuals and more about creating exceptional consistency. When clear expectations, a structured patient journey and meaningful performance measurement work together, consistency stops being dependent on individual personalities and becomes part of the way your clinic operates. That’s what drives stronger rebooking, higher retention and sustainable clinic growth. Órla Phelan is director of MedSpa Operations at Phorest, a clinic management platform operating across the UK, Ireland and North America. She works with medical aesthetic clinics on growth strategy, patient journey design and team performance, helping practices translate clinical excellence into consistent business results.

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Aesthetics | September 2026

Artificial Intelligence Note Taking

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that outputs must be checked for accuracy.³ Within medical aesthetic clinics, this could translate into support with documenting consultations, treatment plans, aftercare instructions, follow-up requirements and relevant medical history. For clinics where patients may return for multiple treatments over time, structured and consistent documentation helps practitioners maintain a clear record of previous consultations and treatment decisions, thus ensuring a smooth consultation process. Used appropriately, AI-generated documentation could help clinics create more consistent records by structuring information according to predefined templates, while reducing some of the manual work involved in producing them. There may also be wider operational benefits. For clinic owners, reducing routine documentation could free up practitioner time for patient care and other revenue-generating activity. The financial impact will vary depending on the practice, the technology used and how well it fits existing workflows.

Integrating AI Scribes in Aesthetic Practice Aesthetics explores how AI notetaking could benefit aesthetic practices and what to consider before adopting it Artificial intelligence (AI) notetaking is changing how healthcare professionals manage consultations. An NHS England evaluation published last year found that AI-scribing technology could reduce administrative burden and increase direct patient interaction.1 Out of 17,000 patient encounters that were evaluated, results portrayed a 23.5% increase in direct patient interaction time during appointments, alongside an 8.2% reduction in overall appointment length when AI-scribes were used.1 With the NHS now accelerating the rollout of AI note-taking tools across England, the technology is moving away from an emerging innovation to mainstream healthcare infrastructure.2 However, what does this mean for aesthetic practices – should clinics that haven’t yet adopted AI tools in consultations be considering it?

What are the potential benefits for an aesthetic business? An important caveat of this discussion is that the NHS rollout does not automatically mean a tool is suitable for private aesthetic practice. Private clinics will still need to assess legal, governance and workflow implications in their own setting. However, if AI can reduce the amount of time a practitioner spends looking at a screen or manually writing notes, the potential isn’t simply administrative efficiency – it could also allow practitioners to be more present during the consultation. This is particularly relevant in medical aesthetics, where the consultation is an important opportunity to understand a patient’s treatment goals, expectations and suitability for treatment, as well as discussing potential risks, outcomes and the proposed treatment plan. NHS England explains that these tools can convert speech interaction into transcripts, generate summaries of appointments, structure outputs according to templates, extract clinical codes, populate health records and generate letters and other documentation.³ In addition, standardisation of documentation is one potential benefit of ambient scribing, while also emphasising 62

Clinical advisory board perspectives Aesthetic practitioner Dr Mayoni Gooneratne notes that using AI in clinic streamlines her time, allowing her to be as patient-facing as possible. Rather than treating AI as a bolt-on addition, Dr Gooneratne believes it must be supervised by clinicians and not left to operate independently. Creating clear guidelines around its use in practice is essential. For those who are considering AI adoption, Dr Gooneratne advises using solutions that are already trusted and implemented by organisations such as the NHS. She also emphasises that it is important to declare the use of AI to patients, while also having clear AI policies that the clinic follows. Conversely, aesthetic practitioner Dr Sophie Shotter adds that she has trialled AI note-taking systems but has not yet fully adopted them into her practice. She notes that there are often nuances in what practitioners say, write and do that AI note-taking tools may not fully capture. At present, she feels the technology can be somewhat inconsistent in accurately reflecting the key points and context she wishes to document. However, Dr Shotter acknowledges that AI note takers can be highly beneficial from a medico-legal perspective, particularly during the consent process. By producing a comprehensive transcript of discussions, these tools can capture everything that is said, providing an additional layer of reassurance and supporting thorough record-keeping. She believes this can be particularly valuable in demonstrating that informed consent discussions have taken place in full.

What aesthetic clinics should look for Organisations looking to develop or implement an ambient scribe should ensure they are familiar with the wider regulatory framework.4 It is therefore beneficial to familiarise yourself with the AI and Digital Regulations Service (AIDRS) guidance on regulations and NHS England guidance on adopting ambient scribing products.4 A key question aesthetic practitioners should consider when looking to implement AI into clinic operations is whether it is designed for the aesthetic sector. Practitioners should look beyond whether a system can ‘write notes’ and consider whether it can capture the information relevant to their aesthetic consultations, such as medical history, treatment goals, treatment areas, products, aftercare and follow-up. Another important consideration is whether the technology fits your existing patient record, as some platforms are standalone AI scribes; others have the AI built directly into an aesthetic practice-management system. The best AI tool isn’t necessarily the

Aesthetics | September 2026

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one with the most impressive AI – it may be the one that removes the most administration from your existing workflow. It is also important to recognise whether there is a human review stage before notes become part of the patient’s clinical record. Some aesthetic platforms explicitly build practitioner review into the workflow. The key principle is that AI should assist with documentation, not replace the practitioner’s responsibility for reviewing the clinical record. An important caveat when adopting any AI tool within clinic workflow is that the output from the ambient scribe will not always be accurate for several different reasons.4 The technology may misinterpret a word or misunderstand the context of a discussion. Therefore, the output must always be checked and verified by the clinician to ensure that any inaccurate output is corrected before it may impact the patient or service user.4

Considering patient data AI consultation tools are not simply processing generic conversations. Consultations are likely to contain health information and personal data, including medical history, medication use, allergies and previous treatments. Under UK General Data Protection Regulation (GDPR), data concerning health is classed as special category data and receives additional protection, according to the Information Commissioner’s Office (ICO).⁵ For clinics considering AI notetaking, understanding what happens to this information once it enters the system is therefore an important part of assessing the technology. Audio recording Clinics should establish where inputs and outputs from an AI notetaking tool are stored at each stage of processing and who has access to them.4 Where an audio recording and transcript are used to create a summary that is checked and signed off, the original recording and transcript could be deleted and the summary of the audio only retained as part of the health care record, unless there is a further reason to retain it.4 In addition, you should ensure that your chosen tool has functionality to comply with retention periods, using automatic deletion where appropriate.4 Patient information

Artificial Intelligence Note Taking

Data Protection Impact Assessment Clinics should consider whether a Data Protection Impact Assessment (DPIA) is required before implementing the technology. The ICO states that a DPIA must be carried out where processing is likely to result in a high risk to individuals’ rights and freedoms, including certain circumstances involving large-scale processing of special category data, and recommends DPIAs as good practice for major projects involving personal data.4 NHS England’s specific guidance on ambient scribes goes further, stating that a DPIA is highly likely to be a legal requirement for their use in health and care settings.4

Support and maintenance When a new AI note-taking tool is implemented within clinic activities, it can be beneficial for staff if there are ongoing training and guidance available. By ensuring these steps are followed, it allows the those using the tool to be aware of their obligations and requirements associated with using an ambient scribe. As part of this ongoing training, team members should be aware of how to undertake appropriate checks of the software, such as the accuracy of the transcripts, and the ease of adapting templates for personalised use. Also included in the training can be the reinforcement of practitioners’ responsibility to review and amend AI generated content as a mandatory step when using such tools.

Questions to ask a supplier · Where is patient information processed and stored? · What information does the system retain, including audio, transcripts and generated notes, and for how long? · Is patient information used for any purpose beyond providing the service, including developing or improving the technology? · Who else has access to or processes the patient data, including any third parties or sub-processors? · What security measures are in place to protect patient information? · Can practitioners review and amend AI-generated notes before they become part of the patient record? · How does the system integrate with your existing patient-record system and consultation workflow?

Clinics should establish what the technology provider is permitted to do with patient information. NHS England says that, where an ambient scribe is used for individual care, organisations should ensure patient data is not used by the technology provider for purposes beyond the care of the individual.4 It also states that arrangements with parties involved in processing the data should be appropriately documented, including the roles and responsibilities of each party.4

AI as a tool for support

Security is another important consideration. Ambient scribes can introduce security vulnerabilities through their own processing and through integration with existing systems. Clinics should therefore assess the security risks associated with their chosen technology before implementation.4

The NHS’s move towards AI-assisted documentation signals a wider shift in how healthcare businesses approach administrative work. For aesthetic practices, AI notetaking could offer similar opportunities to reduce the time practitioners spend documenting consultations and allow more of their attention to remain on the patient.

Disclosing AI during a consultation There is a responsibility to be transparent with patients about how the technology is being used. Patients should be told at the beginning of a session when an ambient scribe is being used, while privacy information should explain how the data is processed and how individuals can request that ambient scribing is not used.4 The guidance distinguishes this from explicit consent, stating that explicit consent is not required for individual care under the lawful bases it sets out, although individuals must have an opportunity to object or dissent.4 Private aesthetic clinics should not, however, assume that the NHS position automatically applies to their own business. They should establish the appropriate lawful basis for their specific processing activities.

But adopting the technology should not be a decision based on speed alone. For aesthetic clinics, the quality and accuracy of the clinical record, patient privacy, data security and the practitioner’s ability to review and approve documentation are equally important. The right system will therefore be one that fits naturally into the clinic’s existing workflow, supports the way practitioners document consultations and meets the necessary data-protection and regulatory requirements. AI may be able to take more of the administration out of the consultation, but responsibility for the patient relationship and the clinical record remains firmly with the practitioner. VIEW THE REFERENCES AT AESTHETICSJOURNAL.COM

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“There is no room for complacency when you really want something” Dr Zainab Al-Mukhtar illustrates her journey from dentist to aesthetic practitioner and clinic owner Born in Scotland and the eldest of four daughters, Dr Zainab Al-Mukhtar grew up in a family steeped in medicine, inspired by her surgeon father and dentist mother. As a child, her family frequently relocated because of her parents’ work. When Dr Al-Mukhtar was seven, they moved to London, before relocating again to Oman when she was 11. She says, “Going to international school in Oman was an amazing experience. The school had extremely high standards around exams, which ingrained that culture in me and helped me later in my dental career.” When her family returned to London five years later, her mother opened a dental practice, which ignited Dr Al-Mukhtar’s interest in dentistry as she became fascinated by the way it combined science, artistry and patient care. However, her path into the profession was not straightforward. A fire at their family home disrupted her A-level education, and she narrowly missed the grades needed to secure a place at King’s College London. Refusing to give up, she retook her exams and successfully challenged one of her results, earning her a place on the dentistry course at the university. “The whole experience taught me there’s no room for complacency when you really want something,” she reflects. Dr Al-Mukhtar went on to graduate with distinction in Bachelor of Dental Surgery in 2010. After university, she worked within the NHS as a dentist for five years in addition to undertaking further training. Between 2012 to 2014, Dr Al-Mukhtar completed a Certificate in Aesthetic Dentistry with Tipton Training in Manchester, as well as the Royal College Membership examinations (Membership of the Faculty of Dental Surgery and Membership of the Joint Dental Faculties), eventually transitioning into private practice in 2015. “I began with cosmetic dentistry – sculpting teeth and carrying out composite bonding,” she explains. Dr Al-Mukhtar continued her aesthetic training with training provider Oris Medical in 2013, followed by a further five years of advanced education through the Allergan Medical Institute MD Codes curriculum, alongside numerous advanced masterclasses. In 2018, Dr Al-Mukhtar became the co-owner – in partnership with her husband who is a fellow dentist and educator – of her mother’s practice, Harrow on the Hill Dental and Facial Aesthetics, after managing it in her mother’s absence for more than a year. By 2022, after navigating the challenges of the COVID-19 pandemic and spending years working 10- to 11-hour days in clinic, it became clear to Dr Al-Mukhtar that the pace was no longer sustainable. In 2023, she made the difficult, pragmatic decision to step away from dentistry, not out of lost love for the craft, but to protect her energy, her family life and the future of the clinic. “I had realised that the specialty was evolving very fast, and if I was to be at the forefront of it, I needed to fully commit,” she reflects.

In Profile Dr Zainab Al-Mukhtar

Today Dr Al-Mukhtar still runs the clinic alongside her husband, as well as a dedicated team of both aesthetic practitioners and dental professionals serving her patients. Outside the clinic, Dr Al-Mukhtar has evolved from a clinical educator into a holistic mentor. Her speaking engagements include the Aesthetics Conference & Exhibition (ACE) in 2023, as well as participating in Meet the Mentor programme at the Clinical Cosmetic Regenerative Congress (CCR) for three consecutive years. Her teaching journey began in 2014, she explains, when Oris Medical invited her to join its faculty. Dr Al-Mukhtar subsequently became course creator and clinical lead for the Facial Contouring programme at training provider Acquisition Aesthetics. “In recent years, I decided to further develop my role as an educator by pursuing a Postgraduate Diploma in Clinical Education, Mentoring and Coaching with Smile Academy. The programme assessed everything from lecture design and feedback skills to leadership and one-to-one coaching,” she explains. Dr Al-Mukhtar adds that she is also due to complete separate continuing professional development certifications in Feminine Edge Coaching and Breathwork Coaching, with a focus on conscious connected breathing. She notes, “I have invested deeply not only through clinical education, but also through studying leadership, mindset, psychology, communication and human behaviour. Technical excellence matters hugely, but how we lead, connect, communicate and understand ourselves is equally fundamental to our profession.” In addition to her further education, she has launched Evolve with Dr Zainab, a private one-to-one clinical mentoring and holistic coaching space, supporting colleagues as they navigate burnout, perfectionism and the pressures of demanding professional and personal lives. She is also a key opinion leader for Clarius Health, a portable ultrasound provider, for whom she is an international speaker and online educator in facial ultrasound. Most recently, Dr Al-Mukhtar has been invited to join pharmaceutical company Galderma’s Relfydess Training Faculty, commencing in September 2026. Dr Al-Mukhtar believes to stay at the forefront of a specialty that is constantly evolving, practitioners must remain committed to continuous learning and keep up-to-date with the latest research. “I make sure I stay informed about emerging data, particularly in the field of biostimulators. Recent investment in artificial intelligence-supported facial analysis technology is another area that is important to monitor closely, alongside keeping an eye on global trends and developments in international markets,” she notes. Next month at CCR, Dr Al-Mukhtar will be presenting a lecture on ‘Integrating Dentistry, Facial Aesthetics & the Art of Connection’ She shares that this will introduce a unique hybrid approach that combines the precision of dentistry with the artistry of facial aesthetics. Do you have a mantra that you stick to? Be the change that you wish to see in the world! What is your favourite holiday destination that you’ve been to? Mauritius was the most memorable holiday we experienced as a family. What is the biggest lesson you’ve learned through the mistakes you’ve made? No mistake is wasted if you reflect and learn from it.

Aesthetics | September 2026

The Last Word Medical-Grade Skincare

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product formulation is only part of the picture. Clinician Is Medical-Grade Skincare However, involvement may also improve outcomes by helping patients use skincare more consistently, safely and appropriately. Patient education and ongoing support are important components of Superior To Over-Thesuccessful skincare management, particularly when topical regimens form part of a broader treatment plan. In my view, the practitioner’s Counter Products? role is not simply to recommend a product, but to translate evidence 7

Nurse practitioner Dr Jenni Thain examines whether ‘medical-grade’ skincare offers distinct clinical advantages Skincare has evolved from an adjunct to aesthetic treatments into an integral part of patient management. Whether preparing the skin before procedures, optimising healing or maintaining long-term outcomes, topical skincare is now widely recognised as an important component of evidence-based aesthetic practice.1,2 Alongside this shift has come growing popularity of products marketed as ‘medical-grade’ or ‘professional-grade,’ often available exclusively through healthcare professionals. However, these terms have also become increasingly controversial because unlike medicines, cosmetics in the UK are regulated under the UK Cosmetics Regulation, which does not recognise ‘medical-grade’ as a legal or regulatory classification.³ In my opinion, this is where much of the confusion and debate begins over whether these products genuinely offer clinical advantages or whether terminology has become a sophisticated marketing tool. For clinicians, the absence of a recognised definition complicates patient education and reinforces the need to base product recommendations on evidence.

Medical-grade skincare vs. over-the-counter skincare Although the term ‘medical-grade’ skincare is widely used in practice, it is not a formally recognised legal or regulatory category in the UK. Unlike medicines, skincare products are not classified as ‘medical-grade’ under UK cosmetics legislation, so the phrase has no standardised definition and can be used inconsistently.3 In practice, it is commonly applied to products that are sold, recommended or dispensed through clinicians, and which are often marketed on the basis of stronger formulations, supporting evidence or professional oversight. By contrast, over-the-counter skincare refers to products that consumers can buy directly, either in shops or online, without any clinical consultation or personalised advice. Some supporters of medical or professional skincare argue that these products may offer advantages beyond simply containing active ingredients. Rather than relying on marketing claims alone, many clinician-dispensed brands invest heavily in research and development, formulation stability and clinical testing, allowing practitioners to recommend them with greater confidence.⁴ In clinic, this may be particularly relevant for concerns such as hyperpigmentation or photoageing, where published evidence supporting a formulation’s performance can be more meaningful than labels such as ‘medical-grade’ or ‘professional strength’. A key distinction often lies not in the ingredient itself, but in how it is formulated. Retinoids, vitamin C and alpha hydroxy acids are inherently unstable and require carefully designed delivery systems to maximise efficacy while limiting irritation.⁵ Formulation factors such as vehicle composition, pH, encapsulation and ingredient combinations can affect both bioavailability and tolerability, meaning products with the same active ingredient may perform differently.⁶ 66

and formulation science into a personalised treatment strategy, while providing reassurance, accountability and continuity of care.

Separating value from marketing Despite these advantages, some critics argue that ‘medical-grade’ has become one of the most misunderstood terms in medical aesthetics. Importantly, there is currently no universally accepted scientific or regulatory definition distinguishing medical-grade skincare from over-the-counter cosmetics.³ That criticism, I believe, is entirely valid. Many over-the-counter skincare brands now formulate products containing evidence-based ingredients such as retinol, niacinamide, azelaic acid, ceramides and vitamin C. The increasing accessibility of scientifically developed skincare has narrowed the gap between professional and consumer markets. Ingredient concentration alone is rarely the determining factor in efficacy. Higher concentrations do not automatically produce superior clinical outcomes and may instead increase irritation, reduce adherence or compromise skin barrier function.8 In consultation, practitioners should therefore focus less on positioning clinic products as inherently superior, and instead help patients understand the rationale behind a recommendation. This might include factors such as formulation, evidence, suitability for their skin concerns and the support provided alongside its use. Cost is also an important consideration. Clinician-dispensed skincare often comes at a premium, which may be a barrier for some patients. Where similar outcomes can be achieved with less expensive options, recommending higher-priced products without clear evidence may undermine trust. Clinicians therefore have an ethical responsibility to ensure recommendations are transparent, proportionate and focused on patient benefit rather than commercial interests. This means explaining the clinical rationale, discussing appropriate alternatives and making clear that value depends on suitability and evidence, not price alone. In my view, preserving that trust matters more than defending any one product category.

Separating commercial language from clinical value I believe that the true value of clinician-recommended skincare lies not in the phrase ‘medical-grade,’ but in the expertise used to select, prescribe and optimise it for each individual patient. The clinician’s role is not to defend a marketing category, but to evaluate the evidence, understand formulation science and recommend products according to individual need, while being transparent about cost, expected results and limitations. Jennifer Thain is a registered nurse and owner of SkinFirst clinic in Warrington. She has trained as a paediatric nurse and holds V300 Independent Prescribing qualification and Clinical Diagnostics, Adult Clinical Examination and Paediatric Clinical Examination. Thain has a postgraduate diploma in Dermatology and Level 7 Diploma in Clinical Aesthetic Injectable Therapies. Qual: BNURS Child, INP, PgDip Derm, PgDip Aes

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Aesthetics | September 2026

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Exocobio Fermented Green Papaya Enzyme Fotona UK Galderma (UK) Ltd GC Wellbeing Genefill UK GLANZEN Halo Health Technologies Ltd - T/A Halo IV Hanun Medical Harley Academy Hawksley & Sons HE Interiors Healthxchange Human Health Professionals Hydrafacial HYPO21 HYUNDAE MEDITECH CO., LTD. Ibita (Korea-International Beauty Industry Trade Association) IBSA UK iiaa Initial Medical InMode INTENTIQ Interface Aesthetics IVANMED JJ Meditec Joint Council Cosmetic Practitioners (JCCP) JY Medicine Co,. Ltd Klira K-Laser UK Lavderma Limited Libera LINKUS GLOBAL LOOKUPMEDICAL CO., LTD LW Aesthetic Solutions Ltd Lynton Lasers Ltd MAP Health Ltd Map My Mole Maypharm Co., Ltd. Med&Skin SRL Medicines & Healthcare products Regulatory Agency (MHRA) MedivaPharma Menopause in Practice Merz Aesthetics MIDEQ Million Dollar Facial Moore Scarrott Medical & Dental My Compliance Clinic My Vital Metrics NEEDLE CONCEPT Nicoya Ninaveli London Novaderm Medical Ltd Novasonix Medical

Directory is correct as of time of print. Updates may be made before the event.

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Novus Medical UK Nuchido One Planet & Biolitec Opatra Pabau Pavist. Co., Ltd Phorest Primoris International Co.,Ltd PromoItalia UK PPR & HAIR RESTORATION EXPERT Pure Tone Aesthetics QUAD UK Quartier Latin Rebecca Mackay Aesthetics Academy REGEN LAB SA Rein PRP / Nuemed RELIFE Renaissance Revance Roseway Labs Sciton, Inc. Seriderm UK Share Fermented UK LTD Shire Leasing PLC Skin on You Ltd Skymedic Sofwave Medical Sons SOOVIA CARE LTD STEG Laboratories Teoxane The British Association for Nutrition and Lifestyle Medicine (BANT) The Cosmetic Consultant Totally Derma Twiqk® Uberlube UNTIL Upnovia VF PHOTONIX UK LTD Vida Glow Visionmed Ltd WEDERM Co., Ltd. WeRX Health Wild Nutrition Xyon Health Zemits UK Ltd Zenoti ZO Skin Health

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