HArmonyCa is a first-in-class, dual-action, synthetic non-pyrogenic biodegradable hybrid dermal filler composed of calcium hydroxyapatite (CAHa) (55.5%) and cross-linked hyaluronic acid (44.5%) that is clinically indicated to enhance volume as well as lift and rejuvenate the mid and lower face and overlying skin. Its effects are illustrated in three case studies. Significant and immediate improvements in cheek projection, lifting of the midface, reduction of the pre-jowl sulcus and in the depth of the nasojugal groove were observed in these cases. The hybrid injectable is effective with a good tolerability profile, with the patients reporting a high level of satisfaction. The early clinical changes that were seen resulted mainly from the cross-linked hyaluronic acid filler and, secondly, from the CAHa. CAHa microspheres have been demonstrated to provide long-term efficacy through regional collagen synthesis. Effects will be monitored in the treated cases at 6, 12 and 18 months.

The facial ageing process is multifactorial, resulting in a combination of changes that affect the face layer by layer. Superficially, skin atrophy with thinning of the epidermis and the deeper dermis together with redistribution and loss of subcutaneous fat, coupled with bone remodelling and resorption, converge to different extents in any individual (Coleman et al, 2006; Swift et al, 2020). The underlying genetics, age, bone structure, ethnicity, degree of exposure to both UVA and UVB light, coexisting comorbid states and dietary habits are all key to how an individual ultimately ages, resulting in the tell-tale signs of volume loss and increased skin laxity (Gonzaga da Cunha et al, 2020; Lipko-Godlewska et al, 2021).

Increased demand for biostimulators has been fuelled by the need for dermal fillers that trigger biostimulation and collagen synthesis which have longer-lasting results. Recommendations of serial dilution 1:1 and hyperdilution 1:3–1:4 of calcium hydroxyapatite (CAHa) have emerged from 2018 and were reviewed in a consensus recommendation peer- reviewed article (de Almeida et al, 2019). This allowed for a more universal approach to treatment that appeared to be highly effective, versatile and with a good tolerability profile.

Early studies showed the versatile nature of the rejuvenating capacity of CAHa beyond the face with indications extended to the hand (Haq et al, 2010; de Almeida et al, 2019). The European Dermatologic Consortium on Hand Augmentation, headed by Haq et al (2010), carried out the first hand rejuvenation study using CAHa as part of a large, multinational, multicentre hand rejuvenation clinical trial. These combined findings underscore and validate the approach taken by Allergan, an AbbVie company, with its investment into innovative hybrid injectable HArmonyCa following acquisition of Luminera’s dermal filler portfolio.

HArmonyCa is a first-in-class, hybrid dermal filler. Technologically advanced, it has a unique dual impact on the dermis, particularly when used by a practitioner in the indication of aesthetic facial augmentation. The product is the latest addition to the advanced portfolio of hyaluronic dermal based fillers in Allergan’s Juvéderm range (Allergan, 2019; Allergan Aesthetics, 2021a; 2021b; 2021c; 2021d).

HArmonyCa was originally developed in Israel and made available commercially in Brazil, Israel and Ukraine. Having now secured a CE mark, it is being launched across Europe and in selected Middle Eastern and African countries. Allergan Aesthetics will continue to explore and work with regulatory authorities around the world to make HArmonyCa more widely available in the future.

The concept and effects of HArmonyCa are based on two key factors: first, the use of a cross-linked hyaluronic acid dermal filler (De Boulle et al, 2013); and, second, the key ingredient of CAHa (Gonzaga de Cunha et al, 2020; Allergan Aesthetics, 2021a). This is provided in the form of microspheres which, when combined, provide for a filler whose performance exceeds any product currently available in the aesthetic arena. From a tolerabilty profile perspective, CAHa microspheres are porous and are naturally degraded and eliminated from the body over 6 months after injection.

Decades of use of cross-linked hyaluronic acid dermal fillers such as Juvéderm (Coleman et al, 2006; Kahn et al, 2010; Lipko-Godlewska et al, 2021) and CAHa have led to a substantial accumulation of evidenced-based data relating to both types of dermal fillers in terms of their excellent tolerability profile and efficacy. The combination of these two distinct technologies may be a true game changer in non- surgical injectable facial augmentation, allowing for a more multidimensional approach to the ageing face (Zerbinati et al, 2018; Lipko-Godlewska et al, 2021).

Cross-linked hyaluronic acid fillers lead to immediate changes with hydration, lift and volume depending on their specific rheology (De Boulle et al, 2013; Allergan Aesthetics, 2021b). CAHa is provided in the form of smooth microspheres 25–45 microns in diameter, providing a more sustained and longer- term result in terms of lifting impact and duration of effect (Allergan, 2021a). The reason for this is the increased synthesis of collagen from the hydroxyapatite microspheres, which directly activate regional fibroblasts in the dermis. The biological advantage conferred by the microspheres is that they have a high surface:volume ratio because of their sheer number so more collagen can be synthesized in any one area (Allergan Aesthetics, 2021c).

HArmonyCa: product and indications

HArmonyCa is indicated in patients looking for a multidimensional approach to the ageing face. It can be used to treat men and women in middle age who are looking for lift, volume or rejuvenated skin. All information in this section is taken from the product leaflet (available from the authors on request by email).

The product is an injectable implant that is approved for subdermal administration for the correction of moderate-to-severe facial wrinkles and folds in the face and to treat the dorsum of the hand. It is also indicated for deep injection (subdermal, deep dermal and/or supraperiosteal) for soft tissue augmentation to improve moderate-to-severe loss of midface volume and jawline contour.

HArmonyCa, which contains lidocaine, is a sterile, apyrogenic, viscous, opaque, injectable, semisolid, latex-free and biodegradable dermal implant. It consists of synthetic CAHa microspheres 25–45 microns in diameter, formulated to a concentration of 55.7%, suspended in a cross-linked sodium hyaluronate gel from a non-animal source, and is provided in a 1.25m l prefilled syringe. The product contains 0.3% (w/v) lidocaine hydrochloride to minimise pain during treatment. The implant is intended for subdermal and deep dermal use in specific facial regions to rejuvenate, volumise and lift. The hybrid filler can be extended to use in the dorsum of the hand to rejuvenate target zones.

HArmonyCa is contraindicated in patients with severe allergies with a history of anaphylaxis, and multiple severe allergies (hypersensitivity) to any of the components: lidocaine; amides; hyaluronic acid; and/or CAHa. It is also contraindicated in patients with bleeding disorders and autoimmune disorders (e.g. connective tissue disease). These products should not be used in anyone with active skin inflammation or an infection. Pregnant and breastfeeding mothers should not be treated, nor anyone aged <18 years. The tolerability profile and effectiveness for use in the lips has not been established so, at present, treatment of the lips and tear trough should be avoided (Allergan Aesthetics, 2021d).

Health professionals such as nurses, doctors and dentists should have training, experience and knowledge about the anatomy in and around the injection site and should be familiar with the product’s properties and educational material.

Process and effects

HArmonyCa can be used to target the ageing face when injected into the sub- or deep dermal plane. The dual-acting dermal filler redresses the volume loss and soft tissue structural changes that occur as part of the ageing process.

Using a cross-linked hyaluronic acid dermal filler mixed with CAHa has a synergistic effect, both immediately and in the long term. This synergism is demonstrated by the fact that the overall impact of HArmonyCa’s properties exceeds the sum of each of the two constituents alone (Allergan Aesthetics, 2021d).

In terms of understanding what this means in the context of the cellular level, the dermal filler acts as a foreign body implant that triggers a sequence of events from regional inflammation followed by macrophage infiltration and antigen presentation. This occurs within a 2–3 week period; this is often described clinically as a time when the filler is settling (Jennen et al, 2022).

Cellular senescence is the process by which cells over time undergo mitosis and eventually become no longer able to divide any further and, ultimately, die. This occurs with the epithelial cells of the epidermis, fibroblasts in the dermis, adipocytes in the superficial and deep fat compartments of the face and osteoblasts/osteoclasts of the skeleton. The effect of senescence are diminished elastin, collagen and glycosaminoglycans (including hyaluronic acid) and bone resorption.

HArmonyCa addresses several of these changes post injection with the cross-linked hyaluronic acid component of the injectable targeting hydration the loss of glycosaminoglycans (impacting lost volume) and later stimulation of fibroblasts to restore loss of collagen type III (early response) and later with type I collagen typically surrounding the CAHa microspheres. The individual microspheres are too large to be phagocytosed by macrophages. This maintains their longevity of 12–18 months.

Extracellular matrix remodelling occurs as a result of both components of HArmonyCa. Subcellular changes occur, leading to the suppression of several pro-ageing metallomatrixproteinases (MMP1 and MMP9) and upregulation of the anti-apoptotic tissue metallopeptidase 1 (TIMP1), which inhibits cellular senescence (Gonzaga et al, 2020; Laquerriere et al, 2004).

Administration, tolerability profile and aftercare

The treatment takes less than 20 minutes to perform depending on the complexity of the treatment plan. The procedure can be carried out in a clinic or outpatient setting. Before HArmonyCa is injected, an initial patient assessment and consultation is carried out, and informed consent is given. The area to be injected is marked and photographed. With the patient in an upright position, the area to be injected is cleaned with Clinisept (a solution containing phosphoric acid and sodium hypochlorite) followed by the application of topical lidocaine or tetracaine. The practitioner should consider the technique to use (linear retrograde injections or bolus administration), the area to be treated, the depth of the injection (intradermal/deep dermal/subdermal) and the volume to be used. In the authors’ view, either a 25G cannula or 27G needle, the retrograde linear thread, serial puncture, fanning, cross-hatching or bolus injection should be performed slowly using 0.05m l–0.2m l threads or a bolus volume of 0.2m l–0.4m l if indicated. An initial volume of

0.5m l–1.5m l on both sides would be the initial aim. When withdrawing the cannula/needle, the practitioner should not inject material into the superficial dermis to avoid creating white nodules of hyaluronic acid/CAHa material at the exit point. After the product has been placed, it can be massaged and moulded to increase homogeneity with the tissue plane. If further augmentation is required and indicated, the patient can be advised to have an additional treatment on or after 3 months to ensure that the product is integrated and there is plateauin of any ongoing neocollagenesis.

In the event of a vascular occlusion, standard emergency management following the ACE guidelines (Murray et al, 2021) should be followed as for any other hyaluronic acid filler. Hyalase can and should be used in such a case with practitioners following the step-by-step management protocol set out by Murray et al (2021).

Common complications are bruising, swelling, pain, tenderness and itching. Advise patients to avoid exercise for 24 hours and any sunbeds, saunas and UV light therapy for a week. Aftercare and reassurance should be given with a follow-up review.

The decision on whether use of a needle or cannula will depend on what one is trying to achieve. In general, a deeper injection where lift and volume are the main objectives would be best served with a needle, while a cannula would allow the practitioner to rejuvenate a large target area better. In both scenarios, multilayering of the filler can be done, although less trauma is observed using a standard 25G or 23G cannula than a 27G needle. Use of cannulas results in better product confinement to the deep anatomical layers, whereas a sharp needle technique results in material placement in the deepest layer from the periosteum to more superficial layers.

The authors are of the analytical opinion that retrograde injection technique delivering 0.05–0.1m l per thread and or a bolus administration of 0.1–0.2m l are both suitable methods of administration, depending on the clinical end goal: retrograde linear threading delivers improved rejuvenation while a bolus-type injection creates greater volumisation and lift (Braz et al, 2020; Kahn et al, 2010; Hee et al, 2015; Lipko-Godlewska et al, 2021).

The tolerability profile of HArmonyCa is exemplary. As with any dermal filler, one must be clear about the depth and volume to be injected to avoid potential nodules from product that has not integrated with the surrounding tissue.

Vascular occlusion can occur with any dermal filler and is best avoided by understanding key anatomical structures as well as checking for flashback on withdrawal of the plunger in the syringe for at least 10–20 seconds. The downtime after injection is minimal, with minor swelling, redness and bruising always possible. Simple advice on standard aftercare using HArmonyCa post-treatment guidance as with any dermal filler injectable should be followed. Patients should avoid strenuous exercise and exposure to sun or heat for 24 hours after treatment or until any initial swelling, significant bruising and redness have resolved.

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Alexandra Mills and Professor Syed Haq provide an overview of lip augmentation procedures using hyaluronic acid-based dermal filler, injection technique and the role of the ageing process.

Medical aesthetic treatments, in particular, when using a hyaluronic acid-based dermal filler, focus around delivering a comprehensive outcome when addressing the face, especially

for more advanced treatments. In this regard, paying attention to the mouth and lip area is critical. Profiling of the jaw, chin, cheeks, pre-auricular area and orbital troughs, together with the temporal zones, falls foul when not achieving a balanced, natural and symmetrical lip augmentation (Figure 1) (Mandy, 2007).

Defining and assessing perioral ageing should be carried out as part of any general aesthetic clinical assessment. Perioral ageing is a highly individual process that takes place over a period of time and affects multiple structures. It can be influenced by lifestyle choices, genetics, ultraviolet B (UVB) light exposure and anatomy. At the time of writing, there is no consistent consensus as to how to best to approach this complex area in a manner that is both reproducible and natural in regard to rejuvenation and augmentation.

One of the most important skills of any clinician is to be able to reliably and consistently identify the key landmarks of the ongoing process of perioral ageing. It is not acceptable to focus merely on the lip’s shape and volume. The injector has to take into consideration the lip surface and degree of hydration to achieve an optimal outcome.

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Sciton Moxi utilises laser technology with a wavelength of 1927nm. This wavelength is designed to target the superficial layers of the skin, specifically the epidermis. The laser energy

is absorbed by the water content in the skin, causing controlled heating of the targeted cells. This heating stimulates collagen production and initiates a wound- healing response, leading to skin rejuvenation. It can be used to treat visible signs of aging such as wrinkles, fine lines, acne scars, improve loss of skin tone, correct initial signs of sun damage and more. It treats all of these with minimal downtime required. Additionally, Moxi uses a fractional scanning technique, where microbeams of laser energy are delivered in a pattern, leaving small areas of untreated skin between these microbeams. This enables faster healing and minimises downtime compared to fully ablative laser treatments.

Sciton BBL: Broadband Light therapy, or BBL, uses intense pulsed light (IPL) technology. The BBL system emits a range of wavelengths that can be customised to target specific chromophores (colour molecules) in the skin, such as melanin or hemoglobin. By delivering precise amounts of light energy, BBL heats the targeted chromophores, effectively reducing pigmented lesions, vascular lesions, and other blemishes. Additionally, BBL stimulates the production of collagen, which helps improve skin texture, elasticity, and overall appearance.

In both Moxi and BBL, the controlled heating of the skin triggers the body’s natural healing response, prompting the production of new collagen and elastin, leading to improved skin tone, texture, and youthfulness over time. These treatments are non- surgical and non-invasive, with minimal downtime, making them popular options for skin rejuvenation.

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As aesthetic nurses, we find ourselves at the forefront of an ever-evolving field, where innovation and patient-centered care intersect. The landscape of aesthetic nursing is continuously shaped by advancements in technology, shifts in patient preferences, and the growing emphasis on holistic well-being.

The past decade has witnessed a remarkable surge in technological advancements and treatment modalities within aesthetic nursing. From minimally invasive procedures to the utilisation of cutting-edge laser therapies and injectables, the aesthetic nursing profession has undergone a paradigm shift. Embracing these innovations, accompanied by ongoing professional development and education, enables us to deliver safe, evidence-based care while staying attuned to the evolving needs of our patients.

In today’s healthcare landscape, patient empowerment and individualised care have become central tenets of clinical practice. Aesthetic nursing is uniquely positioned to provide personalised experiences that prioritise patient education, informed consent, and comprehensive consultations. By fostering open communication and a collaborative approach, we empower our patients to make well-informed decisions about their aesthetic journeys while promoting realistic expectations and outcomes.

As stewards of patient safety and well-being, aesthetic nurses uphold the highest standards of ethical practice. This extends beyond clinical competencies to encompass advocacy for regulatory initiatives, patient rights and industry transparency. By engaging in ethical dialogue and practising within the scope of evidence-based guidelines, aesthetic nurses play an integral role in shaping the ethical landscape of our profession, instilling trust and confidence in the care we provide.

The dynamic nature of aesthetic nursing presents both challenges and opportunities. Rising to the occasion involves addressing issues such as industry regulations, ethical dilemmas, and the intersection of aesthetics with mental health and body image. By embracing these challenges as catalysts for improvement, aesthetics nurses can advocate for inclusive, ethical practices and contribute to the broader conversation surrounding patient wellbeing and safety. As we gaze towards the future, the trajectory of aesthetic nursing is teeming with possibilities. The synthesis of medical advancements, patient-centred care, and ethical practice heralds a promising era for our profession. By championing innovation, embracing diversity, and upholding the principles of integrity and compassion, aesthetic nurses can continue to lead the charge in shaping the dynamic landscape of aesthetic medicine.

In conclusion, the evolution of aesthetic nursing is a testament to our profession’s adaptability, compassion and dedication to promoting patient well-being. As we navigate the ever-changing currents of healthcare, let us stand united in our commitment to delivering exceptional care, driving positive change and advocating for the highest standards of ethical practice.

Together, we embark on this transformative journey, charting a course that transcends boundaries and encompasses the essence of aesthetic nursing — the artistry of healing.

Since the theory of ageing as a process in which oxidative stress led to accumulation of damage of the cellular environment over time, first proposed by Harman (1956), we have seen an exponential expansion in our understanding of the ageing process.

Many advances have contributed to our understanding of the ageing process and how to mitigate its effects. Some important milestones have led to a leap in our understanding and these are briefly discussed below. A more expansive explanation of an area that will no doubt lead to the bench-to-bedside transition that we seek as clinicians is provided by Kirkwood and Austad (2000) and by López-Otín et al. (2013).

Anti-ageing medicine will be a defining area both in mainstream medicine and medical aesthetics as we see more developments over the coming decade, with an estimated doubling of the valuation of this area in terms of revenue from $22.5 to $44.5 billion USD.

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Source – https://www.aestheticnursing.co.uk/content/editorial/anti-ageing-drugs

Botulinum toxin and hyaluronic acid (HA) dermal fillers and their use in medical aesthetics have seen exponential growth patterns over the past three decades. They are the foundation of treatment in medical aesthetic practices today. Following the COVID-19 pandemic, there has been an increasing emergence of both post COVID-19 infection- and vaccination-related adverse events issues following their use.

Several cases of acute and subacute hypersensitivity reactions that have developed complications following botulinum toxin type A treatment have been reported in patients who have had previous COVID-19 vaccinations or a recent COVID-19 infection. The subacute progressive nature of the allergic reaction post botulinum toxin type A has been seen to be variable in severity, with the most severe form being anaphylaxis in one case.

Zhang et al (2020) described a number of cases, including facial swelling and lip angioedema, occurring several days post-vaccination. Similar results were observed by Shome et al (2021), with perioral swelling developing 4 weeks post COVID-19 infection. Importantly, in the aforementioned case, the patient had been treated with HA fillers to the face. Additional examples of regional oedema, nodules, induration, facial erythema and tenderness have been observed in patients who have had previous HA injectables to the nose and face. In several case reports, the impact of the dermal filler has not been restricted to regional changes, but more widespread changes. These include swelling and burning in the lip, cheek and tear

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Source – https://www.aestheticnursing.co.uk/content/editorial/the-impact-of-covid-19-on-aesthetic-practice-now-and-in-the-future

At what age can you start botulinum toxin type A treatment? This is a question that many of my patients ask me on a day-to-day basis. When defining age boundaries, safety should be considered first, followed by an evidenced-based approach. Additionally, the question of ethics is something that cannot be underestimated during the pre-treatment assessment. In 2017, the Nuffield Council on Bioethics produced a report in on cosmetic procedures. It found that pressure from social media platforms, celebrities and influencers, postproduction techniques and anatomical changes in adolescence all had a significant impact on the decision-making process of young people. Furthermore, in a statement from the Youth Select Committee, they highlighted issues of ‘body dissatisfaction by women, and the increasing danger and challenges faced by young men, LGBT and youth, ethnic minorities and those with disabilities or serious illnesses, which were overlooked in the Nuffield Council report’ (UK Parliament, 2017). When carrying out assessments in these groups, we, as clinicians, must take on board even greater responsibility when using clinical judgement.

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Source – https://www.aestheticnursing.co.uk/content/editorial/the-age-issue

Going back to basics and visiting one of the backbones of the medical aesthetics sector, Alexandra Mills Haq details important information on dermal fillers

The G’ prime of a filler is extremely important when assessing its physical property in terms of projection and lifting capacity

Since the emergence of ageing baby boomers, the influx of dermal fillers has been an exponential one. Differing types of technology have provided the aesthetic practitioner with the ability to provide natural, long-lasting and reproducible results, with minimal downtime, safely and at an affordable price. The use of dermal fillers for soft tissue augmentation with the synergistic use of botulinum toxin and a variety of complementary procedures has become the mantra for rejuvenation. Despite the various economic woes of the past decade, the non-surgical aesthetic industry has only seen stepwise growth (Klein and Elson, 2000).

In this summary, the types of fillers that are readily available will be outlined, as well as some practical tips that the practitioner should adhere to so as to ensure a higher chance of achieving optimal results.

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Source – https://www.aestheticnursing.co.uk/content/comment/dermal-fillers-a-brief-background-and-overview-for-injectors

With polynucleotides being brought to the forefront in the aesthetics sector, editorial board member Alexandra Mills talks about their mechanisms, impact and versatility.

With its efficacy, ease of use, safety profile and patient orientated-treatment, it isn’t difficult to see why polynucleotides are now becoming increasingly popular in aesthetic medicine
The introduction of polynucleotide-based therapy into the cosmetic/aesthetic arena heralds a significant step in the way in which practitioners are now able to bio-revitalise and bio-rejuvenate a patient’s skin in a significant and longer-lasting manner.

How it works

The basic unit of the polynucleotide-based injectable relies on long chains of highly purified nucleotides which form a series of highly stable alpha helixes. The hypoallergenic polynucleotides are contained within a non-hyaluronic acid clear gel carrier.

What about its mechanisms? Once injected intra-dermally, the high-purity polynucleotides target the dermal fibroblast to reduce levels of local free radicals, increase the synthesis of collagen and elastin appreciably, increase hydration through attracting water molecules local to the injection site and increase the viability of the targeted fibroblasts (Colangelo et al, 2021).

The impact

The overall impact clinically of high-purity polynucleotides when administered in skin is an improvement in intrinsic skin quality, with increased skin glow, reduction in pore size, improved smoothness, greater elasticity, improved humectant capacity and skin turgor. The treatment can be applied to patients who require skin maintenance, skin rescue and repair, wound healing, scar improvement and revision, reduced inflammation and importantly, skin ageing. Whether a patient has normal or sensitive skin, protocols have been devised through extensive research and peer-review that allow polynucleotides to be effective and well tolerated in either clinical situation (Cavallini et al, 2021; Cavallini et al, 2022).

» The overall impact clinically of high-purity polynucleotides when administered in skin is an improvement in intrinsic skin quality, with increased skin glow, reduction in pore size, improved smoothness, greater elasticity, improved humectant capacity and skin turgor «

The versatility

The versatility of the high purity polynucleotide is defined by a well formulated portfolio which allows the face, neck, décolleté, hands, abdomen, thighs and under-eye area to be treated effectively as part of evidenced-based consensus recommended clinical protocols. This can be tailored for each individual patient through a consultation and comprehensive assessment of the patient by their treating clinician (Cavallini et al, 2021).

‘Polynucleotides—what’s the fuss?’ It’s easy to see why from its efficacy, ease of use, safety profile and bespoke patient-orientated treatment. It now allows clinicians to do more for their patients than ever before.

Cleansing your face is the first step to any good skincare routine. But these days, everyone’s double cleansing, because once doesn’t seem enough. Hailey Bieber apparently does it on the daily. Kim Kardashian, too. And in a recent interview with The Zoe Report, Sydney Sweeney said: “At night, I always double cleanse because all of the elements of the environment are on your skin [and] you touch your face during the day… I’ve been really loving it.”

Of course, it’s a trend that’s gone viral on TikTok. The #DoubleCleansing hashtag currently has millions of views, with some users calling it the “greatest skincare hack of all-time”. Some users have even gone as far to say it’s “life-changing.”

But, as with all things faddy like face icing and detoxing, it doesn’t automatically mean that it works. So, we sat down with some of London’s leading skincare experts to find out if double cleansing is truly as miraculous as TikTok would have you believe, or if the benefits are just skin deep.

What is double cleansing?

Double cleansing has been a thing in South Korea for many years now, and it’s one of the most important steps in any K-beauty routine. While it sounds like you’re just washing your face two times in a row, there’s actually a lot more to it than just that.

Most methods consist of two main steps (duh). Firstly, you remove anything that’s on the skin like sun cream, dirt, and oil. Afterwards, you wash the actual skin itself so that it’s all nice and clean. On paper, it makes a lot of sense, but recently, some TikTokers have suggested that it can get rid of acne altogether and even prevent wrinkles, which almost sounds a bit too good to be true…

What are the benefits?

“Generally speaking, substances are either oil or water soluble,” says Dr Christine Hall, NHS general practitioner and aesthetics doctor. “Sebum, makeup, and SPF are lipophilic, which means that they dissolve in oil. Whilst sweat, pollutants, and other impurities dissolve in water. So, the only way to get a really deep clean and completely remove all of the build-up from the day is to double cleanse using an oil cleanser, followed by a water-based one.”

Even though you might not be able to see it with a naked eye, it’s important to properly remove all of these things. That’s because when impurities and debris begin to pile up, it can cause your skin to become inflamed. This build-up also prevents your skin from “breathing,” which it needs to fully rest and recover.

“Double cleansing is also extremely effective for those who have oily skin types and acne prone skin,” says Dr Leah Totton, cosmetic doctor and medical director at Dr Leah Clinic. “It can help to remove bacteria and excess oil from the skin, and also unclog your pores.”

“However, while double cleansing can prevent breakouts caused by impurities, it’s worth noting that acne has various causes including hormones and genetics that double cleansing can’t fully address,” says Alexandra Mills, skincare expert at AM Aesthetics. “Some claims also suggest that it can reduce signs of ageing, but its benefits in this area are more about creating a clean base for anti-ageing products rather than a direct effect.”

On top of that, many TikTokers have started doing double cleansing in place of exfoliating. In ways, it does make sense. But while double cleansing cleans the surface of the skin, exfoliation is still an essential step to any grooming regimen if you want to really get rid of all the bad stuff.

What’s the best way to do it?

“Double cleansing involves the use of an oil-based cleanser followed by a water-based one,” says Hall. “The first thing to consider is the oil-based cleanser and whether you would prefer a liquid, a balm or a gel formulation. Take a small amount of product and warm it in the palm of your hand before applying to your dry face. Massage the product into the skin for 30 to 60 seconds before removing it with lukewarm water.”

“As you do this, you should see the product ‘emulsify’ as it turns to a white colour on contact with water. With your skin still damp, you then apply your water-based cleanser, massaging it into the skin before washing it all away.”

Once you’ve done all of this, get yourself a soft, clean towel (preferably dry) and gently pat your face to rinse off any excess water. Afterwards, apply your eye cream, moisturiser, toner, and all that good, good stuff, and you’ll be sweet.

How often should you do it?

“Double cleansing is typically recommended in the evening to remove the day’s build-up of sunscreen, makeup, and pollutants,” says Mills. “Doing it once a day is sufficient for most skin types. Over-cleansing can lead to irritation, so it’s essential to listen to your skin and adjust as needed.”

Who should avoid double cleansing?

“Those with rosacea, eczema, or sensitive skin should probably avoid double cleansing as it may remove the skin’s natural moisture, leaving it flakey, tight, and irritated,” says Totton. “You may also look to avoid double cleansing if you have dry skin. However, if you find your skin is becoming dry due to double cleansing, you may be using a cleanser that is far too harsh.”

As with all new skincare techniques and products, introduce it slowly and see how your skin reacts to it. If you’re not entirely sure if it’s suitable for you and you need some further advice, contact your GP or a healthcare professional.

Are there any side effects?

“Generally speaking, double cleansing is a very safe and risk-free skincare technique, but it’s important that you are using the right products,” says Hall. “Those with drier or more sensitive skin should avoid lighter oils or stronger water-based cleansers to avoid stripping the skin of moisture and compromising the skin barrier.”

Source – https://www.gq-magazine.co.uk/article/double-cleansing-skin-benefits

Excessive sweating, also known as hyperhidrosis, is a big problem. According to the International Hyperhidrosis Society (or IHS, for short), it affects around 5 per cent of the world’s population, which is about 385 million people. It’s annoying, it’s uncomfortable, and at times, it’s embarrassing, especially if it’s the middle of summer and you’re wearing lighter colours. That’s where Driclor antiperspirant comes in.

The #Driclor tag currently has almost 16 million view on TikTok, and most of the videos are by people who are desperately wondering if Driclor antiperspirant actually works or not. One TikToker even called it their “last resort” after suffering from hyperhidrosis for almost their entire life. However, like other health and wellness trends such as dry brushing and face icing, there are plenty of pros and plenty of cons to speak of. So, we caught up with some of London’s leading dermatologists to find out if Driclor antiperspirant is actually as beneficial as some say it is – or if it’s just another thing that’ll make you sweat.

What is Driclor antiperspirant?

Driclor antiperspirant is manufactured by Stiefel Laboratories and was specifically designed to treat heavy sweating or hyperhidrosis. It works by forming a gel matrix in the effected sweat glands, and is meant to reduce and eventually stop the flow of sweat on your body. While most people tend to use it for their armpits, you can apply it on other areas such as your back, hands, and your feet too.

According to research by the brand itself, the product can apparently reduce sweating by up to 65 per cent. But it’s worth noting that it doesn’t work for absolutely everyone. It’s also not a long-term solution, and can cause some potential side effects that you should be aware of.

What are the benefits?

“Driclor antiperspirant contains aluminium chloride that reacts with molecules within the skin and sweat ducts to reduce sweat secretion,” says consultant dermatologist Dr Mia Jing Gao. “It’s used to treat hyperhidrosis, which can affect any part of the body, but commonly affects the axilla, palms, and soles.”

“As well as hyperhidrosis, hormonal changes such as the menopause can also affect how much we sweat,” says Dr Leah Totton, cosmetic doctor and medical director at Dr Leah Clinic. “Driclor antiperspirant may help with this as it contains active ingredients that can block sweat glands.”

“There is a myth that using Driclor excessively can completely stop sweating, but this is not true.”
However, while it has been scientifically proven, it doesn’t always work as advertised. “There is a myth that using Driclor excessively can completely stop sweating, but this is not true,” says Alexandra Mills, skincare expert and founder of AM Aesthetics. “It’s important to follow the usage instructions to achieve the best results and avoid potential any side effects.”

“If you have body odour, Driclor antiperspirant is not a cure,” says Dr Magnus Lynch, consultant dermatologist and laser surgeon. “Furthermore, it may not work for everyone, and it’s not always sufficient to control sweating.”

What’s the best way to use Driclor antiperspirant?

“The best way to use Driclor antiperspirant is to apply it to clean, dry skin before bedtime,” says Mills. “This allows the product to work effectively overnight. Before application, make sure the skin is completely dry, and avoid applying it right after shaving as it may cause irritation. Using a small amount of Driclor on the affected areas and allowing it to dry completely before putting on clothing is important.”

How often should you use it?

“Driclor should be applied nightly every one to two days,” says Lynch. “If it is effective, then you can reduce the frequency of usage to a couple of times a week.”

“Before trying it, it’s essential that you consult your GP or a healthcare professional first to examine your causes of excess sweating.”

“Some may notice a slight improvement straight away, however, the significant changes won’t be noticed until the two week mark,” says Totton. “Before trying it, it’s essential that you consult your GP or a healthcare professional first to examine your causes of excess sweating.”

Who should avoid using Driclor antiperspirant?

“There are a few groups of people who should avoid using Driclor antiperspirant,” says Gao. “If you have an open cut or an active infection in the skin, I would stay away from it. People with the skin conditions like eczema and hidradenitis suppurativa should use it with caution.”

“Individuals with sensitive skin or a history of allergic reactions to similar products should avoid using Driclor too,” says Mills. “Furthermore, it is not recommended for use on children under the age of 12 unless prescribed by a healthcare professional. Pregnant or breastfeeding women should consult with their healthcare provider before using it to ensure it is safe for them and their baby.”

Are there any side effects?

“Some people may experience a rash, swelling, irritation, burning sensation, stinging, and redness on the areas where Driclor antiperspirant has been applied,” says Totton. “If this happens, do not continue using it. Initial itching or a warm stinging sensation is often present when the deodorant is first applied, however, this should only be short-term.”

“Some people may experience a rash, swelling, irritation, burning sensation, stinging, and redness on the areas where Driclor antiperspirant has been applied. If this happens, do not continue using it.”
“It is always worth speaking to your GP before trying treatments for excessive sweating. If Driclor doesn’t work for you, alternatives such as botox can also be considered. At Dr Leah Clinic, our hyperhidrosis treatment involves injecting Botulinum Toxin to target heavy sweating. This method blocks the signals for perspiration at the sweat glands, and can be used to treat underarms and other areas.”

Source – https://www.gq-magazine.co.uk/article/driclor-antiperspirant-benefits

Believe it or not, adult acne is a very real problem. In fact, according to a 2022 study, 34 per cent of British adults have suffered from acne at some point in their life. And while it tends to go away as you age, around 12 per cent of people still have to deal with it every single day. It can be annoying, frustrating, and at times, kind’ve embarrassing.

But, unlike in your youth when it was all sorts of unpredictable, some techniques can reduce adult acne once and for all. So, we caught up with Alexandra Mills, award-winning skincare expert and founder of AM Aesthetics, to impart some of her knowledge on what to do and what not to do.

What causes adult acne?

“Acne is a common skin condition that affects millions of people worldwide,” says Mills. “It occurs when the hair follicles in your skin become clogged with dead skin cells, excess oil, and dirt. This blockage leads to the formation of pimples, blackheads, whiteheads, and sometimes even cysts or nodules. Acne typically appears on areas of the body that have a higher concentration of oil glands, such as the face, neck, chest, shoulders, and back. It’s most common during adolescence, but can affect people of all ages, including adults.”

Stress is one of the main contributors to it, as it can cause a rise in hormones which stimulate the glands in your skin that secrete oily matter (known as sebum). However, while greasiness can trigger acne, you also have to be careful that you don’t remove too much oil to the point that your skin gets way too dry. It’s a vicious cycle, but stripping it of essential oils will send your glands into overdrive just to bring your skin’s oil levels back into balance.

External elements can also cause adult acne. Chemical-based ingredients found in some grooming products can irritate the skin, and if you’re one of those people who just refuse to apply any sort of sunscreen and you get burnt (which is bound to happen), your body can react with acne in the two weeks following exposure, so stop being silly and slather on that SPF ASAP.

Late nights full of wine and takeaways can also negatively affect your skin, and even if you decide to finally hit the gym, you need to make sure that you stay nice and clean, as sweat can clog your pores and provoke breakouts. And, for those of you out there using steroids to get swole, the unnatural levels of hormones entering your body can have a long-lasting effect, and can increase the difficulty of clearing up your adult acne.

How to get rid of your adult acne

#1: Stop touching your face

In a 2015 paper by the University of New South Wales, it found that, on average, people touch their face around 23 times per hour. It’s something that we all do without even realising (you’re probably doing it right now), and if you suffer from adult acne, it’s a habit that you should probably try and avoid as much as possible.

“Touching your face transfers dirt, oil, and bacteria onto your skin, which can worsen acne,” says Mills. “It can be difficult, but it’s definitely something to bear in mind especially if you want to get rid of it. While we’re on this topic, you should also try to resist the temptation to pick at or pop your pimples, as this can lead to inflammation and scarring, which, in some cases, can be permanent.”

#2: Stick to a routine

We all know how important it is to come up with a solid skincare routine. However, even if you’ve got all of the best cleansers and all the best moisturisers, you need to make sure that you’re actually using them every day. Inconsistencies in your daily regime can make your skin a little confused, which can result in acne.

“Start by cleaning your face twice a day using a gentle cleanser that is suitable for your skin type,” says Mills. “Avoid harsh products that can strip away natural oils and irritate your skin. Follow up with a non-comedogenic moisturiser to keep your skin nice and hydrated.”

#3: Use acne-fighting ingredients

If your skin is prone to adult acne, you probably shouldn’t be using the same skincare products that everyone else is using. Instead, check out some that are infused with acne-fighting ingredients. They may be a little more expensive, but they’re definitely worth it in the long run.

“Look for skincare products that contain effective acne-fighting ingredients such as salicylic acid, benzoyl peroxide, or retinoids,” says Mills. “Salicylic acid helps unclog pores, benzoyl peroxide kills bacteria, and retinoids promote skin cell turnover. However, it’s important that you introduce these products gradually and monitor your skin for any signs of irritation.”

#4: Manage your stress levels

According to a 2018 report by the Mental Health Foundation, of the 4,619 people who were surveyed, 74 per cent have felt so stressed they have been overwhelmed or unable to cope. Whether it’s your demanding job or something personal, we’ve all been under pressure at some point or another, and this can have detrimental effects on your adult acne.

“As mentioned previously, stress can contribute to hormonal imbalances that exacerbate acne,” says Mills. “Finding healthy ways to manage stress, such as exercise, meditation, or engaging in hobbies, can help minimise its impact on your skin.”

#5: Be mindful of your diet

While the direct relationship between diet and acne is still being researched, some individuals find that certain foods can actually trigger breakouts. If you’re someone who suffers from adult acne, it’s worth paying attention to your own skin and seeing if there is any correlation between what’s on your plate and what’s on your face.

“Consider reducing your intake of processed foods, sugary treats, and excessive dairy, and incorporate more whole grains, fresh fruits, and vegetables, into your diet,” says Mills. “As this 2021 analysis from Harvard Medical School suggests, you should get a total of five servings per day, at least.”

#6: Get professional help

If your acne persists despite your best efforts, consider consulting your GP or a dermatologist. They can assess your specific situation and recommend appropriate prescription medications or treatments tailored to your needs.

“All of this takes a lot of time and a lot patience,” says Mills. “It may take a few weeks or even months to see significant improvements. Be consistent with your routine and give your skin time to adjust to new products or treatments. With the right approach and professional guidance, it’s possible to manage and improve adult acne.”

Source – https://www.gq-magazine.co.uk/article/adult-acne-causes-treatments

What makes natural deodorant different?

“The main differences between natural and normal deodorant lies in their composition,” says Alexandra Mills, skincare expert at AM Aesthetics. “Natural deodorants are typically made from plant-based ingredients such as essential oils, baking soda, and mineral salts, and they do not contain artificial additives like parabens, phthalates, or synthetic fragrances.”

“Some natural deodorant brands have also started distinguishing themselves by utilising skin-friendly ingredients such as coconut oil and shea butter,” says Charlie Bowes-Lyon, co-founder of Wild. “Not only can these ingredients make your skin softer, they also have natural antibacterial properties to counteract odour-causing bacteria.”

What are the benefits?

“In most cases, natural deodorant means fewer chemicals and more natural ingredients,” says Dr Dev Patel, doctor in aesthetic and regenerative medicine and founder of CellDerma. “This is believed to create a happier and healthier underarm microbiome.”

“Most normal deodorants and antiperspirants contain aluminium salts that work to stop sweat by completely blocking skin pores,” says Melissa Christenson, chemist at Hume Supernatural. “Alternatively, modern, clean natural deodorants use alternate renewable, non-petrochemical ingredients to reduce odour.”

However, it’s worth noting that the word “natural” is primarily a marketing claim and the term is not regulated. “Compared to conventional deodorants, those that claim to be natural tend to contain fragrances, baking soda, and essential oils,” says consultant dermatologist Dr Mia Jing Gao. “Conventional deodorants contain ingredients that reduce sweating and are more effective at it. Natural deodorants, on the other hand, tend to soak up sweat and mask the odour.”

Who should avoid using natural deodorant?

“Individuals with sensitive skin or allergies to certain natural ingredients should avoid using natural deodorants,” says Mills. “As mentioned previously, those who require stronger odour control may find that they’re not as effective for their needs.”

“Those who suffer with excessive sweating, or hyperhidrosis for instance, are better to select a regular deodorant to control their symptoms as they will achieve a better and longer lasting result,” says Emma Coleman, aesthetic and dermatology RGN. “Natural products may also require repeat application throughout the day, which is something to bear in mind.”

Are there any side effects?

“Individuals with certain skin conditions or allergies should exercise caution and should consult their GP or a dermatologist before using natural deodorants,” says Gao. “Some users may experience skin irritation, especially if they have sensitive skin or are allergic to specific natural ingredients like baking soda or essential oils.”

“Your pores can be blocked by regular deodorant, so your body may sweat more for the first few weeks before adjusting to natural deodorant says,” Patel. “It takes time to adjust because our bodies are used to the harsher chemicals on our underarms. After around seven days, your body should have adjusted to the change, but it could take a little more time for some. In reality, no natural product is likely to keep you as sweat free as a regular antiperspirant, but you may smell as good with natural ingredients.”

What should you look for when buying natural deodorant?

“When you’re buying your first natural deodorant, be sure to check out the back of the pack,” says Coleman. “Try and look out for antibacterial ingredients such as tea tree and grapefruit and high concentration of baking soda and natural alcohols to preserve the product.”

“You should also consider the effectiveness of the product for your specific needs, whether it’s controlling odour or providing long-lasting protection,” says Bowes-Lyon. “Additionally, factor in your skin type and potential sensitivity, opting for formulations that align with your preferences. Finally, prioritise brands that focus on eco-friendly packaging if sustainability is a concern.”

Some brands are now developing products that have been especially formulated for other parts of your body. “These are unlike anything even in the clean deodorant category,” says Christenson. “The microbiome-approved formula is powered by antioxidant-rich plant oils plus anti-inflammatory plant extracts and prebiotics to nourish and sustain the skin barrier, while castor-oil derived zinc ricinoleate neutralises odours, not just under your arms, but also on your feet, down there, and everywhere.”

Source: https://www.gq-magazine.co.uk/article/natural-deodorant-benefits

So, you’re in your 30s. You know what clothes look good on you, and what clothes don’t. That’s great! Now, it’s time to give your skincare routine a bit of an upgrade, too. In your fourth decade on Planet Earth, your face is going to go through a lot of changes. You might start getting some fine lines across your forehead, a duller complexion, and maybe even dark circles around your eyes.

And unlike in your 20s, it’s going to take a lot more than just a splash of H2O and a dab of moisturiser every now and again to keep looking your best. But it doesn’t have to be that complicated, either. We sat down with some of London’s leading dermatologists and skincare experts to work out the best skincare routine to follow in your 30s.

“As the body ages, your skin also undergoes various changes at both visible and cellular levels,” says Alexandra Mills, skincare expert at AM Aesthetics. “The epidermis and dermis, the outermost and middle layers of the skin, respectively, become thinner over time. This is due to a decrease in cell production and a slower turnover rate, making the skin more fragile. Older skin tends to be drier too due to a decrease in sebaceous gland activity, so you’ll need to begin moisturising more.”

These changes will be most noticeable around your neck, on your hands, and of course, your face. It’s not all doom and gloom though, because there are some things that you can start doing (or continue to do) that can effectively tone down these effects, maintain your skin’s health and appearance, and minimise signs of ageing.

Source – https://www.gq-magazine.co.uk/article/skincare-routine-for-your-30s-men

What are stretch marks?

“Stretch marks, or striae, occur when the skin is stretched beyond its natural elasticity,” says Alexandra Mills, cosmetic nurse and owner of AM Aesthetics. “When this happens, the collagen and elastin fibres in the dermis can break, leading to visible marks.”

Stretch marks are essentially a form of skin scarring, which can occur anywhere on the body, although they tend to affect areas that have endured a growth spurt. These include the stomach during pregnancy, breasts during puberty, upper arms, thighs and buttocks.

They can be identified by their distinct stripe-like appearance, which some liken to claw marks. “When stretch marks first appear, they tend to be red, purple, pink, reddish-brown, or dark brown, depending on your skin colour,” says Dr Anastasia Therianou, consultant dermatologist. “With time, the colour fades and the narrow bands sink beneath your skin.”

Why causes stretch marks?

“When the skin is stretched during periods of rapid growth, such as puberty or pregnancy, or due to rapid weight gain or loss, you can be left with stretch marks,” says Alexandra.

• Pregnancy: Your skin stretches to accommodate your growing baby.
• Hormones: This is especially relevant if there is a sudden change in certain thyroid and adrenal disorders, or for those taking anabolic steroids with excessive levels of testosterone. “Puberty, pregnancy and polycystic ovarian syndrome are states that also predispose to the development of striae, all because of the stretch on tissue combined with the hormonal changes,” says Dr David Jack, aesthetic doctor and founder of Dr David Jack Clinic.
• Puberty:“Stretch marks occur where the child experiences a sudden growth spurt,” says Dr Therianou.
• Weight training: Rapid muscle growth can cause stretch marks on the arms and legs.
• Rapid weight loss or gain: Stretch marks occur when the skin rapidly shrinks or stretches.

Source – https://www.glamourmagazine.co.uk/article/stretch-marks

From stress and breakouts, to pollution and second-hand Lost Mary smoke, a skin detox is necessary from time to time. Listen, it puts up with a lot of shit every single day. But considering the fact that it’s the largest organ of the human body, it makes sense to keep it nice and healthy.

While the term “skin detox” isn’t entirely accurate because it’s physically impossible to remove toxins through the skin (science, baby!), there are a few things that you can do to look better and brighter. Which is why Alexandra Haq, skincare expert and founder of AM Aesthetics, and Dr Theodora Mantzourani, senior GP and founder of Precision Skin, are here to share six simple steps on how to give your skin the detox that it deserves.

Source: https://www.gq-magazine.co.uk/article/skin-detox

Brilliant beauty (but on a budget).

Cerave CeraVe Hydrating Hyaluronic Acid Serum

‘CeraVe Hydrating Hyaluronic Acid Serum is a favourite of mine. It is formulated to provide long-lasting hydration and help improve the skin’s moisture barrier. It contains three essential ceramides to help restore and maintain the skin’s natural protective barrier which is perfect for this time of year.’

Alexandra Mills Haq, medical aesthetician and skincare expert at AM Aesthetics

https://www.womenshealthmag.com/uk/beauty/skin/g45048701/best-serums-for-under-30-pounds/?slide=8

“Probiotics can help to reinforce the skin’s natural barrier function,” says Alexandra Mills, skincare expert at AM Aesthetics. “This helps to protect the skin against harmful pathogens, pollutants, and environmental damage. Some probiotics can increase the skin’s production of ceramides too, which are basically lipids that help keep the skin hydrated and plump.”

https://www.gq-magazine.co.uk/article/probiotics-benefits