General Articles

How did you come to make the shift from ophthalmology to aesthetics?  

When my youngest child underwent treatment for leukaemia, I took a career break to look after him as it wasn’t possible to combine my role as a NHS surgeon with the heavy demands of his treatment. Fortunately, once he was cured, I decided to follow a more flexible clinical role. Leveraging my extensive experience of over 20 years with botulinum toxin and my knowledge of light and laser technology, aesthetics provides a better work-life balance after more than two decades in the NHS. 

Lots of people are unaware of the applications of Botox in the medical setting, what are some of the key ways it is used in hospitals?  

The first medical application of botulinum toxin was in the treatment of eye movement disorders, exactly my area of specialist practice within ophthalmology. It is used to help straighten the eyes of babies, young children and adults, both as an alternative to more invasive surgery or when surgery cannot help. It is used extensively to treat muscular spasms and tics around the face, or even in conditions like cerebral palsy, bladder instability, sports injuries and cleft palate repair surgery. It is also transformative for those with excessive sweating and can also treat headaches and depression. The list is pretty extensive! 

Aesthetic treatments can be used to treat lots of skin conditions that are non-cosmetic. What are they? 

Personally, I treat a lot of rosacea and acne, but also pre-cancerous skin lesions like actinic keratoses, hyperpigmentation, moles, birth marks and scarring. These are some of the more medical conditions that can be treated effectively with phototherapy.  

Can you define regenerative aesthetics? 

Regenerative aesthetics encompasses exciting new technologies, injectables, topicals and supplements that can assist and boost the body's own repair mechanisms. Specifically in the skin, these treatments can rejuvenate and actually turn back the clock. Sciton BBL phototherapy is the only technology with evidence to show it alters the gene expression of aged skin. The landmark Stanford study showed that of the 2265 genes whose expression was altered in aged skin, 1293 were fully restored to the expression seen in younger people. 

Have you seen increased interest in this area of treatment throughout your career, why?  

I think there is genuine interest in improving the health and longevity of skin and a move away from treatments that are more centred on cosmetic or superficial improvements. 

With impending regulation incoming, what would you say to a person seeking out aesthetic treatments? 

Like many other responsible practitioners, I very much welcome the plans for the forthcoming regulation and look forward to hearing the outcomes of the consultation process currently underway. Hopefully, some kind of formal certification or kitemark will become established which will help people identify regulated clinics. In any case, it is essential for anyone considering treatment to thoroughly research the treatment itself and the actual clinician who will be providing you with your treatment.  

Ideally, you should be seen by a doctor, who should undertake a proper medical consultation, and clearly demonstrate their GMC registration number online. Also do not be afraid to ask a clinic about the provenance of any injectable products. Labelling on products outside EU/US markets cannot necessarily be relied upon and so having any injectable in a spa/beauty clinic without a formally trained practitioner can potentially be hazardous. 

How do aesthetic treatments work when it comes to controlled injury? 

Energy-based treatments such as phototherapy, radiotherapy and ultrasound create controlled thermal injury in the skin which in turn activates the body’s own healing and repair mechanisms, this is how they exert some of their rejuvenating effects. Some of the newer injectables such as polynucleotides also stimulate repair and restoration but through different mechanisms. They are considered to have an anti-inflammatory effect. Many people may not be aware that in addition to its muscle relaxing properties botulinum toxin also acts as an anti-inflammatory agent within the skin. The physical micro-trauma of a needle puncture whether for the delivery of an injectable or a microneedling procedure also stimulates repair mechanisms and healing. 

 In terms of cosmetic treatments, trends are moving towards the 'stacking' of treatments. Is this the same for regenerative care?  

It is really important to remember that many trends in the aesthetic industry are commercially driven. Stacking potentially gives practitioner carte blanche to recommend/sell several different treatments at the same time. Whilst there can be genuine value in combining certain treatments – such as microneedling and PRP – it can be an expensive trap. It may appear to be a time-saving or synergistic solution, but it potentially muddies the waters. It will not be clear from which therapy the greatest benefit is being gleaned.