Kỹ Thuật - Công Nghệ - Kinh tế - Quản lý - Tài chính thuế UBT273 – Principles and practice of non- medical aesthetic therapies Learning outcomes On completion of this unit, learners will: 1. Understand the developments of non-medical aesthetic therapies 2. Know the benefits and limitations of commonly available non-medical aesthetic therapies 3. Understand the importance of professional conduct in non-medical aesthetic therapies 4. Know the key regulations, legislative influences and responsibilities relating to non-medical aesthetic therapies 5. Understand advanced contra-actions, hygiene issues and medical emergencies of specific concern to non-medical aesthetic therapies 2 Learning Outcome 1: Understand the developments of non-medical aesthetic therapies Developments of non-medical aesthetic therapies The definition of non-medical aesthetic therapies The term “non-medical” refers to therapies that are not involving, relating to, used in, or concerned with medical care or the field of medicine. So in this case refers to minimally invasive aesthetic therapies carried out by therapists who are not registered healthcare practitioners but are professionally trained in the specific modalities of: Chemical skin peeling Cryolipolysis LaserIPL hair removal LaserIPLLED for skin rejuvenation Laser for tattoo removal Mesotherapy treatments Microneedling Micropigmentation Radio Frequency Ultrasound Platelet rich plasma treatments (PRP) These therapies can become medical in their own sense if used in a manner as to create higher risks and must be used by medical practitioners i.e. medium to deep chemical peel, medical microneedling to a depth of 2.5mm, IPL for lesions etc. The history and developments of non-medical aesthetic therapies There has been a substantial growth of non-medical therapies over the past years. Beauty therapists and medical practitioners have extended their skill set to address skin concerns of ageing, acne and pigmentation with advanced machines and therapies that give proven results. Microneedling is a relatively minimally invasive procedure involving superficial and controlled puncturing of the skin by rolling with miniature fine needles. Over a short period of time, it has gained mass popularity and acceptance as it is a simple, cheap, safe, and effective technique requiring minimal training. Traditionally used as a collagen induction therapy for facial scars and skin rejuvenation, it is also widely used now as a transdermal delivery system for therapeutic drugs and vaccines. Pens and Derma stamps became the clinic devices with Derma rollers being purchased for home use as a maintenance treatment. Many new machines have recently been launched with additional non-fractional microneedling devices delivering radio frequency (RF) and high intended focused ultrasound (HIFU) waves to the deeper layers of the skin. 3 Chemical peels The chemical skin peel, the concept of a topical solution to trigger the skin’s wound healing process can be traced right back to ancient Egypt some four thousand years ago. Forward-thinking ancient Egyptians were reported to use animal oils, salt and alabaster (a soft white mineral or rock, often used for carving) to regenerate skin for aesthetic purposes. In a nod to the distant future of non-surgical aesthetics we know today, the ancient Egyptians also depended on the lactic acid within sour milk as an active chemical agent for exfoliation. Today, popular peels usually involve either alphahydroxy or betahydroxy acid, with deeper peeling agents used for specific conditions. While the science behind these chemicals is sophisticated its surprising how direct the link is to the past. Alphahydroxy acid for instance forms the basis of many common treatments like the glycolic peel. AHAs include lactic, citric and tartaric acids - all of which have their roots in the age-old cosmetic use of sour milk, sour grapes and citrus juices. Betahydroxy acid peels like the salicylic peel are used to control acne - harking back to the ancient Indian practice of applying wintergreen, an aromatic plant high in BHA, to control skin oil. Skin peels today are highly refined - absorption rates, penetration and after effects continue to improve. With ongoing efforts to minimise trauma while enhancing results, the skin peel is safer and more effective than ever. Many deeper and more complex treatments are the result of modern research - retinoic acid based peels and TCA for example are 20th century discoveries - but the basics of the skin peel remain unchanged and our debt to the past, and to the long chain of trial and error which got us here, remains. Intense Pulsed Light IPL and Laser Hair Removal Machines have been around since the 90''''s, they were primarily used for scientific purposes and then IPL evolved and made its transition into the Aesthetic Industry. After this transition the equipment was expensive and only the wealthy could afford what they thought was ''''permanent'''' hair removal treatments; the treatments were exceptionally painful and often were not successful. The technology evolved into less expensive technology, more refined and resulted in less expensive machines. This allowed for laser hair removal equipment to move from high-end, high-brow clinics and clients only, to be affordable for the general aesthetic and beauty clinics. Next was the de-regulation of Intense Pulsed Light Laser Hair Removal Treatment, which at the time was regulated by the Health Care Commission (HCC) now called the Care Quality Commission. This de-regulation facilitated the IPL Technology to be produced and priced much more affordable in comparison to previous years, along with cheap technology came cheap companies who can supply equipment with only a Chinese training manual. Note: regulation by (RQIA) for laser and IPL equipment and clinics remains legislation in Northern Ireland. 4 Current working environments: Treatments are performed in salons, aesthetic clinic, medispa, medical environments Aesthetic therapies are now practised in skin clinics, beauty salons. Standards for working environments rely on the professionalism of the practitioner. With new standards being published from the Joint council of cosmetic practitioners (JCCP) this has lead the way for guidance to be provided in order to ensure that the clinic complies with the best health and safety advice in order to promote professionalism and safe practice. The roles of specialist practitioners: medical and non-medical The roles of medial and non-medical practitioner can mix comfortably with one another. Medical practitioners can have clinical over site in the clinic and be on hand if a complicated issue arises as well as giving treating the more complex skin issue. Non- medical practitioners are specialised in their particular area and can deliver outstanding results as they become more experienced in the modality that they are practicing in constantly. The difference between medical and non-medical treatments, surgical and non-surgical treatments v Non medical treatments These are treatments that can be carried out by non-registered health practitioners. They cause minimum risk to the skin however specific training in their use is still needed to avoid more serious injury. In essence, the difference between a ‘non-medical Practitioner’ and a ‘Medical Aesthetic Practitioner’ is accountability. Medical Aesthetic Practitioners are qualified medical professionals and are registered with a governing body. v Medical Treatments The term “medical treatments” overlaps with nonsurgical treatment so can be inter-used when describing the use of injectables, deeper peels and more invasive treatments. v Non surgical Medical aesthetics Non-surgical Medical aesthetic procedures do not require a surgical incision to be made and are usually considered minimally invasive. However, as with any medical procedure, these treatments may have some side effects, especially if they’re carried out by practitioners who are not properly qualified. Types of Non-Surgical Cosmetic Procedures: There are many types of non- surgical cosmetic procedures but some of the most popular treatments include: 5 Botulinum Toxin Injection Dermal fillers Deep and medium Chemical peels v Surgical treatments Surgical treatments require an anaesthetic and are carried out by specialised doctors and include face-lifts, breast augmentation or liposuction. Current dispensing models and regulation for the use of topical anaesthetic products There are only a few topical anaesthetics available over the counter in a pharmacy, these include, EMLA, LMX-4 and Ametop. These products are ''''P'''' medicines, which mean Pharmacy Only Medicine, and should be given under direction of the pharmacist direct to the user (client). It was always believed that professionals could purchase topical anaesthetic for application on their clients prior to any invasive procedure. Every council also has their own stance on the use of topical anaesthetics. Some are ok with us purchasing and using the product on our clients after a patch test, whilst others prefer the clients to purchase and apply the product themselves. The MHRA also state that it is down to individual councils and our insurers to use the product safely and legally. However, the issue of using ''''P'''' products only becomes an issue, when a client has a reaction or subsequently dies from the use of such. Can we use OTC (over the counter) topical anaesthetics legally? The law around this is simple, no we cannot. ''''P'''' medicines should only be sold to the intended user. Whilst some councils and the MHRA turn a blind eye, it is a risk not worth taking. The best and safest solution is to speak to your client about pain tolerance and discomfort that may be associated with your treatment. If you have a prescriber, then they can prescribe cream specifically for them to use or the client can go and purchase this direct at their local pharmacy. The client should apply this to themselves 20-30 minutes prior to their appointment. The client should also sign to state that they purchased and applied the anaesthetic themselves andor are happy for you to apply it, if it is for use on eyelids or other areas where they may struggle with the application. The role of clinical oversight within non-medical aesthetic therapies This is where a registered prescriber will oversee other treatments in the clinic. They will take accountability for the treatments delivered from the Non-prescriber. Thy must under their code of practice ensure that they are happy that the administrator is adequately trained and is proficient in the modality that are performing. The Keogh Report and the HEE Qualification Standards In 2013 the previous NHS England national medical director Sir Bruce Keogh''''s review of 6 the regulation of cosmetic practice was published (Department of Health and Social Care (DHSC), 2013). The review was requested by Andrew Lansley, the then Secretary of State for Health, following an insight into some of the problems and challenges within the sector, gained at the time of the Poly Implant Prothèse (PIP) implant crisis. Some well-crafted phrases, with powerful imagery, were introduced into the report that highlighted the impact of failings in non-surgical practice. The review stated that a person having a non-surgical procedure has ‘no more protection and redress than someone buying a ballpoint pen or a toothbrush’. It also surmised that dermal fillers were a ‘crisis waiting to happen’. Keogh''''s report presented a picture of an area of practice without defined standards of training, and without efficacy or safety data for the treatments and products being provided. It was clear that patients were rarely supplied with adequate information about the procedure(s) they were offered and, in the event of a complication; they received very little in the way of support. The initiatives proposed in the Government''''s response to the review (DHSC, 2014) were designed to help develop and support ‘a high quality of care and an informed and empowered public’. In the first instance, Health Education England (HEE) was tasked with developing ‘appropriate accredited qualifications for providers of non-surgical interventions’. The Government''''s response stopped short of an agreement with the proposal that ‘all practitioners must be registered centrally on a register, that should be independent of a particular professional group or commercial organisation, and which should be funded through fees’ (DHSC, 2014). It did, however, suggest that ‘clinical involvement in certain non-surgical procedures was key to improving standards of practitioners who are not members of a regulated profession’. The Joint Council of Cosmetic Practitioners (JCCP) This body is the Joint Council of Cosmetic Practitioners (JCCP) and is representative of all professional disciplines including plastic surgeons, dermatologists, aesthetic doctors and nurses, dentists and beauty therapists. As such it marks a milestone in recognising and securing the role of beauty therapists and non-medical aesthetic practitioners within the medispa sector as well as in establishing a uniformity of qualification and practice across all disciplines providing aesthetic treatment. One of the government’s stipulations in commissioning the JCCP was that it must establish a voluntary register of practitioners, which all professionals working within aesthetics should join, irrespective of other professional memberships. The resultant JCCP register is due to be ready for accreditation by the Professional Standards Authority in June 2017 and officially launched in November 2017. Practitioners and training organisations will then most likely have 5 years to comply (this term is subject to final JCCP agreement). 7 Legislation While at present this is not a legal or statutory requirement, it is intended that membership of this voluntary register will be implemented in the strongest sense by way of industry selfregulation. Membership of the register will not only represent a ‘kite mark’ for the public to source appropriately qualified practitioners and compliant clinical facilities but will also register courses and training providers for the guidance of practitioners looking for accredited education and training. Supplier driven training, and that without the accreditation of an Ofqual awarding body, university or other accrediting organisation endorsed by the JCCP, will not be acceptable for entry onto the register. Practitioner Registration The Register for practitioners will be for: Practitioners already registered with their professional statutory bodies ( Eg: GMC, NMC, GDC etc) Practitioners not registered with a statutory body – this includes ALL beauty therapists as no national statutory body exists. These practitioners must be able to demonstrate that they meet Level 4 and above educational and practice standards as described in the HEE Education and Training Framework as described below. To gain entry onto the register as an individual practitioner you will need a minimum qualification at Level 4 in each treatment genre you wish to provide and you will only be registered for the level of practice stipulated within the qualification framework. For example, to provide superficial chemical skin peels to the Stratum Corneum, a Level 4 qualification in chemical skin peeling will be required, while to peel down to the Dermal-Epidermal Junction will require a Level 6 qualification. The Cosmetic Practice Standards Authority (CPSA) The CPSa has been established to standardise protocols for best clinical practice across the aesthetics industry. It will work in conjunction with the JCCP in order that the clinical and practice standards are integrated fully into the qualification standards. The British Association for Cosmetic Nurses (BACN) The BACN is the largest Professional Association for nurses carrying out cosmetic treatments in the UK. It operates under a strict Code of Conduct in order to ensure patient safety across all treatments undertaken by its members. 8 The BACN has a dual role: v To provide services and support to all of its Members v To promote and support patient safety in the area of Non-Surgical Aesthetic Treatments The BACN is a ‘Not for Profit’ organisation owned by its Members and its Board is elected on an Annual Cycle. National Institute for Clinical Excellence (NICE) NICE gives guidance, advice, quality standards and information services for health, public health and social care.they also provide resources to help maximise use of evidence and guidance. Essential information for key groups including GPs, local government, public health professionals, social care professionals and members of the public is available from heir website. BSI standards EN 16844:2017 This European Standard addresses the requirements for certain aesthetic non-surgical medical treatments: - treatments with resorbable injectables, botulinum toxin and micro needling; - treatments with non-ablative fractional resurfacing and superficial peels, lasers and comparable energy based devices; - treatments with fractional ablative lasers and comparable energy based devices and medium depth peels; and other treatments such as deep chemical peels, full ablative lasers and thread lifts. This European Standard provides recommendations for aesthetic non-surgical medical treatments, including the ethical framework and general principles according to which aesthetic medicine services are provided by all practitioners and stakeholders of the aesthetic medical field. These recommendations apply before, during and after the treatment. Any aesthetic medical treatment that goes deeper than the stratum corneum or which has, or claims to have, a biological effect beyond the stratum corneum (with or without instrument or devices) is included in the scope of this European Standard. Aesthetic surgical procedures covered by EN 16372 and dentistry ) procedures are excluded from the scope of this European Standard. Aesthetic non- medical treatments (tattooing and any treatment not affecting tissue deeper than the stratum corneum) which can be legally performed by non-physicians (e.g. tattooist, beauty therapists) are excluded from the scope of this European Standard. NOTE: Some of the information supplied above may either become obsolete or changed according to new reviews post Brexit. We will do our best to update you as soon as changes take place. References Aaamed.org. (2021). Mission Vision and goals. online Available 9 at: https:www.aaamed.orgpastpresentfuture.php Brody, H., Monheit, G., Resnik, S. and Alt, T., 2000. A History of Chemical Peeling. Dermatologic Surgery, online 26(5), pp.405-409. Available at: https:onlinelibrary.wiley.comdoiabs10.1046j.1524-4725.2000.00505.x http:iplmachines.blogspot.com201307ipl-history-and-evolution.html https:www.hee.nhs.uk https:www.rcseng.ac.uk https:www.gmc-uk.org https:www.nice.org.uk Aesthetic medicine has a history only of decades. The average person who requests medical treatment is referred to as a healthy consumer. Their main aim is to improve their appearance. These patients are not the conventional patients from bygone years but now known as a “consumer patient” Aesthetic medicine is minimally invasive compared to cosmetic surgery, which requires an aesthetic and includes face-lifts, breast augmentation or liposuction. The dilemma exists in that no matter how minimally invasive, the treatment still carries some risks. As a result some would say it is ethically more challenging when carrying out nonsurgical treatments than with conventional medicine. Aesthetic medic e bridges the gap between beauty and health. A healthy psycho- physical balance is important but any potential patients may suffer from some form of psychosomatic disorder. It is important that the medical practitioner recognises this and initiates the proper treatment plan. Aesthetic consideration encompasses both nonsurgical and conventional medicine. Even sick patients want to look the best that can when they are getting better. Learning Outcome 2: Know the benefits and limitations of commonly available non- medical aesthetic therapies Benefits and limitations of commonly available non-medical aesthetic therapies Blemish removal (thermolysis and cryotherapy) Advanced Electrolysis Advanced Electrolysis is minimally invasive so doesn’t cause any bleeding and only a small amount of discomfort should be expected. The surrounding tissue is left undamaged. Immediately after your treatment the targeted area may appear red and slightly swollen and may feel warm. A crust may then appear on the surface of 10 the skin and we advise all Advanced Electrolysis patients not to touch the treated area, but let the crusts fall off naturally, which should happen in the next week or so. If there is a sensation of itching this is to be expected and is the body’s healing response. Thread Veins Thread Veins are cosmetically disfiguring and can really affect our confidence. Thread veins are also often associated – usually incorrectly – with the stigma of alcoholism. Although alcohol can be a contributory factor, as facial flushing can cause damage to the capillaries, (spicy food may also cause similar effects) it is not the cause. There are many reasons we get the tiny red capillaries seen on the surface of the skin that we call thread veins. Most of us are susceptible with causes ranging from sun damage, ageing, hormones, hereditary and genetic causes, pregnancy, smoking, extreme sports and harsh weather exposure to name a few. They are very common on a maturing fragile ‘English rose’ complexion. Rosacea (as well as the medication for it) may be a related factor, and the two conditions often appear simultaneously. Blood Spots Blood Spots or Cherry spots are bright red dots on the surface of the skin. They can be tiny and flat to the skin or the size of a 50 pence piece and domed shaped and raised from the surface of the skin. Whatever the size, they all start to appear as we age. They usually appear on the trunk but are also seen on the face and other areas of the body and limbs. Sun damage is the main culprit but they are also genetic and tend to run in families. Sun beds are a definite no-no and sunscreen is a help, but they are easily removed with this procedure. Spider Naevi Spider Naevi is a central dilated blood vessel, with smaller capillaries radiating from its’ body resembling the legs of a spider. Found as individual blemishes or as groups they will often appear as a result of a knock or minor accident to the area. Hormones are another contributory factor and pregnancy can be a time when many appear spontaneously. Sun damage, smoking and many other factors such as genetic links can be a contributory factor. Usually, they do not appear until adult life although children can suffer from them a result of an injury. Skin Tags Skin Tags are a loose fibrous tissue skin complaint, which affects so many of us. They grow in areas of friction – underarm, under the breasts or around the neck where necklaces may irritate and even under any unwanted ‘rolls’. Once the first one appears, others will follow and some sufferers have over 100 varying in size from a grain of rice to a kidney bean (or larger). Skin tags that cause irritation or are cosmetically unappealing may be removed safely, easily and effectively using electrolysis. Milia Milia are small, white, often hard lumps appearing on the surface of the skin. A pore becomes blocked and the sebum within keratinises. Electrolysis breaks up the milia, which then gradually become absorbed into the skin with no cutting or removal 11 required. No definitive cause of milia is known although they are often related to diet with a high cholesterol count, excessive vitamin C, and too rich moisturising cream and are also associated with dry skin, which can be acidic. Mole Removal Moles are simply pigmented growths that usually appear slightly velvety, but unlike freckles they have a difference in appearance and texture to the surrounding skin. ‘Nanny McPhee’ moles are the typical growth that can be cosmetically disfiguring and can seriously damage an individual’s self-esteem and confidence. Using electrolysis and expert knowledge, the mole can be easily treated and removed. Common Warts Common warts are the same as the warts on the sole of the foot called Verrucas or Plantar Warts and electrolysis has a great deal of success treating both. Electrolysis is definitely successful even on the most stubborn warts. Syringoma Syringoma are flesh colour creamy bumps and lumps which appear around the eye area and are often mistaken for milia but do not contain a hard keratinised nodule as milia do. They are benign noncontagious tumours of the eccrine gland and are small, generally oval shaped, often numerous in numbers, which can make them ageing and unattractive. Exfoliation is unsuccessful and electrolysis is one of the best treatments available for this condition. Senile Warts Seborrhoeic Keratosis Senile Warts Seborrhoeic Keratosis are called ‘Senile Warts’. These brown marks are caused by natural aging, sun damage and have a genetic link. They are classified within the wart family but differ in the fact they’re not contagious. They can start life as just a tiny dry piece of skin on the surface of the skin which grows larger, crustier and uglier growing as big as up to two inches across. They become raised and if you find one you are likely to get more. Sometimes they can almost cover the whole trunk of the body. They can also be quite common on the face in older people. They are usually brown because of melanin and so can be mistaken for moles to the untrained eye. Chemical skin peeling The type of chemical peel used depends on the nature of the skin problem to be treated. Skin problems that respond best to chemical peels are due to chronic sun damage from ultraviolet light. Since most skin peels damage the skin, there is a period of recuperation necessary. As with any surgical procedure, there are risks, which include scarring, infection, and undesirable colour changes. Currently, dermatologists often use chemical peels in conjunction with other destructive techniques like laser to diminish the signs of sun damage or acne scarring. The risks, side effects, and complications of chemical peels include: Scarring Infection Reactivation of herpes simplex infections 12 Substantial contrast in coloration of the treated skin. All patients will have a recuperation period, the length of which depends upon the depth of the peel. Deep peels can result in substantial periods of healing on the order of weeks. Deep peels generally require extensive local anaesthesia, conscious sedation, and occasionally general anaesthesia, which carries its own risks. Cryolipolysis Cryolipolysis, commonly referred to as fat freezing, is a nonsurgical fat reduction procedure that uses cold temperature to reduce fat deposits in certain areas of the body. The procedure is designed to reduce localized fat deposits or bulges that do not respond to diet and exercise. It is not intended for people who are obese or significantly overweight. What side effects are to be expected immediately after cryolipolysis? Pain or aches Stinging or tingling of the skin Redness Swelling Skin discoloration or bruising Skin sensitivity or numbness Injectable treatments Botox: This freezes muscles to stop creases and wrinkles caused by facial expressions. These are typically found in the upper face, such as the forehead and around the eyes. Dermal fillers: These use hyaluronic acid and similar substances to “fill in” or plump areas that have lost volume and smoothness. This includes wrinkles around the mouth, thin lips, and cheeks that have lost fullness. They may also be used on forehead wrinkles, scars, and other areas that need extra volume for a smoother look. Botox results last 3 to 4 months. Dermal filler results vary, depending on which filler is used. As Botox and fillers are different substances designed for different uses, they can sometimes be combined in one treatment. For instance, someone may use Botox to correct lines between the eyes and filler to correct smile lines around the mouth. Possible side effects of Botox include: Drooping of the eyelid or brow if injected near the eye Weakness or paralysis of nearby muscles Hives, rashes, or itching Pain, bleeding, bruising, swelling, numbness, or redness Headache Dry mouth 13 Flu-like symptoms Nausea Trouble swallowing, speaking, or breathing Gallbladder problems Blurry vision or vision problems Dermal fillers are considered to be safe but side effects can occur. The most common problems include: Skin rash, itching, or pimple-like eruptions Redness, bruising, bleeding, or swelling Undesirable appearance, such as asymmetry, lumps, or overcorrection of wrinkles Skin damage that causes a wound, infection, or scarring Ability to feel the filler substance under the skin Blindness or other vision problems Death of skin cells due to loss of blood flow to the area LaserIPL hair removal Advantages 1. Legibility: This is the main reason to go for a laser treatment. As the laser directly targets on the hair follicles and destroy them, it gives a clear skin with no hair on your body. People, mostly, look for faster result and precision while going for this method. 2. Prevent Ingrown Hairs: This is another significant advantage of laser treatment. In this process there is no chance of irritation like threading or waxing. This is purely painless and easily works on finer and ingrown hairs that give you super satisfaction. 3. Save money: The process is very effective to remove your body hair completely. Therefore, there is no need of going to the parlour every time to get your waxing or threading done and you can save a huge amount of money. It is true that you need to spend well for this treatment, but that is for once in lifetime. 4. Minimum side-effects: Another ideal benefit of laser treatment is it has the minimum side effects. It can cause for temporary uneasiness, redness, few rashes or some irritations for a very short time and will not last more than a few days. 14 Disadvantages 1. Takes time: Results won’t come overnight. The process takes time because the hair will fall in a gradual process. You need to go for some treatment sessions and wait to see the results. 2. Skin Burning: As the heat does the process i...
Trang 2• The history and developments of non-medical aesthetic therapies
There has been a substantial growth of non-medical therapies over the past years Beauty therapists and medical practitioners have extended their skill set to address skin concerns of ageing, acne and pigmentation with advanced machines and therapies that give proven results
Microneedling is a relatively minimally invasive procedure involving superficial and controlled puncturing of the skin by rolling with miniature fine needles Over a short period of time, it has gained mass popularity and acceptance as it is a simple, cheap, safe, and effective technique requiring minimal training Traditionally used as a collagen induction therapy for facial scars and skin rejuvenation, it is also widely used now as a transdermal delivery system for therapeutic drugs and vaccines Pens and Derma stamps became the clinic devices with Derma rollers being purchased for home use as a maintenance treatment Many new machines have recently been launched with additional non-fractional microneedling devices delivering radio frequency (RF) and high intended focused ultrasound (HIFU) waves to the deeper layers of the skin
Trang 3Today, popular peels usually involve either alphahydroxy or betahydroxy acid, with deeper peeling agents used for specific conditions While the science behind these chemicals is sophisticated its surprising how direct the link is to the past Alphahydroxy acid for instance forms the basis of many common treatments like the glycolic peel AHAs include lactic, citric and tartaric acids - all of which have their roots in the age-old cosmetic use of sour milk, sour grapes and citrus juices Betahydroxy acid peels like the salicylic peel are used to control acne - harking back to the ancient Indian practice of applying wintergreen, an aromatic plant high in BHA, to control skin oil
Skin peels today are highly refined - absorption rates, penetration and after effects continue to improve With ongoing efforts to minimise trauma while enhancing results, the skin peel is safer and more effective than ever Many deeper and more complex treatments are the result of modern research - retinoic acid based peels and TCA for example are 20th century discoveries - but the basics of the skin peel remain unchanged and our debt to the past, and to the long chain of trial and error which got us here, remains
Intense Pulsed Light
IPL and Laser Hair Removal Machines have been around since the 90's, they were primarily used for scientific purposes and then IPL evolved and made its transition into the Aesthetic Industry
After this transition the equipment was expensive and only the wealthy could afford what they thought was 'permanent' hair removal treatments; the treatments were exceptionally painful and often were not successful The technology evolved into less expensive technology, more refined and resulted in less expensive machines This allowed for laser hair removal equipment to move from high-end, high-brow clinics and clients only, to be affordable for the general aesthetic and beauty clinics Next was the de-regulation of Intense Pulsed Light Laser Hair Removal Treatment, which at the time was regulated by the Health Care Commission (HCC) now called the Care Quality Commission This de-regulation facilitated the IPL Technology to be produced and priced much more affordable in comparison to previous years, along with cheap technology came cheap companies who can supply equipment with only a Chinese training manual Note: regulation by (RQIA) for laser and IPL equipment and clinics remains legislation in Northern Ireland
Trang 4
• Current working environments:
Treatments are performed in salons, aesthetic clinic, medispa, medical environments Aesthetic therapies are now practised in skin clinics, beauty salons Standards for working environments rely on the professionalism of the practitioner With new standards being published from the Joint council of cosmetic practitioners (JCCP) this has lead the way for guidance to be provided in order to ensure that the clinic complies with the best health and safety advice in order to promote professionalism and safe practice
In essence, the difference between a ‘non-medical Practitioner’ and a ‘Medical Aesthetic Practitioner’ is accountability
Medical Aesthetic Practitioners are qualified medical professionals and are registered with a governing body
v Medical Treatments
The term “medical treatments” overlaps with nonsurgical treatment so can be inter-used when describing the use of injectables, deeper peels and more invasive treatments
Types of Non-Surgical Cosmetic Procedures: There are many types of
non-surgical cosmetic procedures but some of the most popular treatments include:
Trang 5to the user (client) It was always believed that professionals could purchase topical
anaesthetic for application on their clients prior to any invasive procedure
Every council also has their own stance on the use of topical anaesthetics Some are ok with us purchasing and using the product on our clients after a patch test, whilst others prefer the clients to purchase and apply the product themselves The MHRA also state that it is down to individual councils and our insurers to use the product safely and legally However, the issue of using 'P' products only becomes an issue, when a client has a reaction or subsequently dies from the use of such
Can we use OTC (over the counter) topical anaesthetics legally? The law around this is simple, no we cannot 'P' medicines should only be sold to the intended user Whilst some councils and the MHRA turn a blind eye, it is a risk not worth taking The best and safest solution is to speak to your client about pain tolerance and discomfort that may
be associated with your treatment If you have a prescriber, then they can prescribe cream specifically for them to use or the client can go and purchase this direct at their local pharmacy The client should apply this to themselves 20-30 minutes prior to their appointment The client should also sign to state that they purchased and applied the anaesthetic themselves and/or are happy for you to apply it, if it is for use on eyelids or other areas where they may struggle with the application
• The role of clinical oversight within non-medical aesthetic therapies
This is where a registered prescriber will oversee other treatments in the clinic They will take accountability for the treatments delivered from the Non-prescriber Thy must under their code of practice ensure that they are happy that the administrator is adequately trained and is proficient in the modality that are performing
• The Keogh Report and the HEE Qualification Standards
In 2013 the previous NHS England national medical director Sir Bruce Keogh's review of
Trang 6the regulation of cosmetic practice was published (Department of Health and Social Care (DHSC), 2013)
The review was requested by Andrew Lansley, the then Secretary of State for Health, following an insight into some of the problems and challenges within the sector, gained
at the time of the Poly Implant Prothèse (PIP) implant crisis Some well-crafted phrases, with powerful imagery, were introduced into the report that highlighted the impact of failings in non-surgical practice
The review stated that a person having a non-surgical procedure has ‘no more protection and redress than someone buying a ballpoint pen or a toothbrush’ It also surmised that dermal fillers were a ‘crisis waiting to happen’
Keogh's report presented a picture of an area of practice without defined standards of training, and without efficacy or safety data for the treatments and products being provided It was clear that patients were rarely supplied with adequate information about the procedure(s) they were offered and, in the event of a complication; they received very little in the way of support
The initiatives proposed in the Government's response to the review (DHSC, 2014) were designed to help develop and support ‘a high quality of care and an informed and empowered public’ In the first instance, Health Education England (HEE) was tasked with developing ‘appropriate accredited qualifications for providers of non-surgical interventions’
The Government's response stopped short of an agreement with the proposal that ‘all practitioners must be registered centrally on a register, that should be independent of a particular professional group or commercial organisation, and which should be funded through fees’ (DHSC, 2014) It did, however, suggest that ‘clinical involvement in certain non-surgical procedures was key to improving standards of practitioners who are not members of a regulated profession’
• The Joint Council of Cosmetic Practitioners (JCCP)
This body is the Joint Council of Cosmetic Practitioners (JCCP) and is representative of all professional disciplines including plastic surgeons, dermatologists, aesthetic doctors and nurses, dentists and beauty therapists As such it marks a milestone in recognising and securing the role of beauty therapists and non-medical aesthetic practitioners within the medispa sector as well as in establishing a uniformity of qualification and practice across all disciplines providing aesthetic treatment One of the government’s stipulations in commissioning the JCCP was that it must establish a voluntary register of practitioners, which all professionals working within aesthetics should join, irrespective of other professional memberships The resultant JCCP register is due to be ready for accreditation by the Professional Standards Authority in June 2017 and officially launched in November 2017
Practitioners and training organisations will then most likely have 5 years to comply (this term is subject to final JCCP agreement)
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While at present this is not a legal or statutory requirement, it is intended that membership of this voluntary register will be implemented in the strongest sense by way of industry selfregulation
Membership of the register will not only represent a ‘kite mark’ for the public to source appropriately qualified practitioners and compliant clinical facilities but will also register courses and training providers for the guidance of practitioners looking for accredited education and training
Supplier driven training, and that without the accreditation of an Ofqual awarding body, university or other accrediting organisation endorsed by the JCCP, will not be acceptable for entry onto the register
• The Cosmetic Practice Standards Authority (CPSA)
The CPSa has been established to standardise protocols for best clinical practice across the aesthetics industry
It will work in conjunction with the JCCP in order that the clinical and practice standards are integrated fully into the qualification standards
• The British Association for Cosmetic Nurses (BACN)
The BACN is the largest Professional Association for nurses carrying out cosmetic treatments in the UK It operates under a strict Code of Conduct in order to ensure patient safety across all treatments undertaken by its members
Trang 8v To provide services and support to all of its Members
v To promote and support patient safety in the area of Non-Surgical Aesthetic Treatments
The BACN is a ‘Not for Profit’ organisation owned by its Members and its Board is elected on an Annual Cycle
• National Institute for Clinical Excellence (NICE)
NICE gives guidance, advice, quality standards and information services for health, public health and social care.they also provide resources to help maximise use of evidence and guidance
Essential information for key groups including GPs, local government, public health professionals, social care professionals and members of the public is available from heir website
• BSI standards EN 16844:2017
This European Standard addresses the requirements for certain aesthetic non-surgical medical treatments: - treatments with resorbable injectables, botulinum toxin and micro needling; - treatments with non-ablative fractional resurfacing and superficial peels, lasers and comparable energy based devices; - treatments with fractional ablative lasers and comparable energy based devices and medium depth peels; and other treatments such as deep chemical peels, full ablative lasers and thread lifts This European Standard provides recommendations for aesthetic non-surgical medical treatments, including the ethical framework and general principles according to which aesthetic medicine services are provided by all practitioners and stakeholders of the aesthetic medical field These recommendations apply before, during and after the treatment Any aesthetic medical treatment that goes deeper than the stratum corneum or which has, or claims to have, a biological effect beyond the stratum corneum (with or without instrument or devices) is included in the scope of this European Standard Aesthetic surgical procedures covered by EN 16372 and dentistry ) procedures are excluded from the scope of this European Standard Aesthetic non-medical treatments (tattooing and any treatment not affecting tissue deeper than the stratum corneum) which can be legally performed by non-physicians (e.g tattooist, beauty therapists) are excluded from the scope of this European Standard
NOTE: Some of the information supplied above may either become obsolete or changed according to new reviews post Brexit We will do our best to update you as soon as changes take place
References
Aaamed.org (2021) Mission Vision and goals [online] Available
Trang 9an aesthetic and includes face-lifts, breast augmentation or liposuction
The dilemma exists in that no matter how minimally invasive, the treatment still carries some risks As a result some would say it is ethically more challenging when carrying out nonsurgical treatments than with conventional medicine
Aesthetic medic e bridges the gap between beauty and health A healthy psycho- physical balance is important but any potential patients may suffer from some form of psychosomatic disorder It is important that the medical practitioner recognises this and initiates the proper treatment plan Aesthetic consideration encompasses both nonsurgical and conventional medicine Even sick patients want to look the best that can when they are getting better
medical aesthetic therapies
Trang 10If there is a sensation of itching this is to be expected and is the body’s healing response
Thread Veins
Thread Veins are cosmetically disfiguring and can really affect our confidence Thread veins are also often associated – usually incorrectly – with the stigma of alcoholism Although alcohol can be a contributory factor, as facial flushing can cause damage to the capillaries, (spicy food may also cause similar effects) it is not the cause There are many reasons we get the tiny red capillaries seen on the surface of the skin that we call thread veins Most of us are susceptible with causes ranging from sun damage, ageing, hormones, hereditary and genetic causes, pregnancy, smoking, extreme sports and harsh weather exposure to name a few They are very common on a maturing fragile ‘English rose’ complexion Rosacea (as well as the medication for it) may be a related factor, and the two conditions often appear simultaneously
Blood Spots
Blood Spots or Cherry spots are bright red dots on the surface of the skin They can
be tiny and flat to the skin or the size of a 50 pence piece and domed shaped and raised from the surface of the skin Whatever the size, they all start to appear as we age They usually appear on the trunk but are also seen on the face and other areas
of the body and limbs Sun damage is the main culprit but they are also genetic and tend to run in families Sun beds are a definite no-no and sunscreen is a help, but they are easily removed with this procedure
Spider Naevi
Spider Naevi is a central dilated blood vessel, with smaller capillaries radiating from its’ body resembling the legs of a spider Found as individual blemishes or as groups they will often appear as a result of a knock or minor accident to the area Hormones are another contributory factor and pregnancy can be a time when many appear spontaneously Sun damage, smoking and many other factors such as genetic links can be a contributory factor Usually, they do not appear until adult life although children can suffer from them a result of an injury
Skin Tags
Skin Tags are a loose fibrous tissue skin complaint, which affects so many of us They grow in areas of friction – underarm, under the breasts or around the neck where necklaces may irritate and even under any unwanted ‘rolls’ Once the first one appears, others will follow and some sufferers have over 100 varying in size from a grain of rice to a kidney bean (or larger) Skin tags that cause irritation or are cosmetically unappealing may be removed safely, easily and effectively using electrolysis
Milia
Milia are small, white, often hard lumps appearing on the surface of the skin A pore becomes blocked and the sebum within keratinises Electrolysis breaks up the milia, which then gradually become absorbed into the skin with no cutting or removal
Trang 11required No definitive cause of milia is known although they are often related to diet with a high cholesterol count, excessive vitamin C, and too rich moisturising cream and are also associated with dry skin, which can be acidic
Mole Removal
Moles are simply pigmented growths that usually appear slightly velvety, but unlike freckles they have a difference in appearance and texture to the surrounding skin
‘Nanny McPhee’ moles are the typical growth that can be cosmetically disfiguring and can seriously damage an individual’s self-esteem and confidence Using electrolysis and expert knowledge, the mole can be easily treated and removed
Common Warts
Common warts are the same as the warts on the sole of the foot called Verrucas or Plantar Warts and electrolysis has a great deal of success treating both Electrolysis
is definitely successful even on the most stubborn warts
Syringoma
Syringoma are flesh colour creamy bumps and lumps which appear around the eye area and are often mistaken for milia but do not contain a hard keratinised nodule
as milia do They are benign noncontagious tumours of the eccrine gland and are small, generally oval shaped, often numerous in numbers, which can make them ageing and unattractive Exfoliation is unsuccessful and electrolysis is one of the best treatments available for this condition
Senile Warts / Seborrhoeic Keratosis
Senile Warts / Seborrhoeic Keratosis are called ‘Senile Warts’ These brown marks are caused by natural aging, sun damage and have a genetic link They are classified within the wart family but differ in the fact they’re not contagious They can start life
as just a tiny dry piece of skin on the surface of the skin which grows larger, crustier and uglier growing as big as up to two inches across They become raised and if you find one you are likely to get more Sometimes they can almost cover the whole trunk of the body They can also be quite common on the face in older people They are usually brown because of melanin and so can be mistaken for moles to the untrained eye
• Chemical skin peeling
The type of chemical peel used depends on the nature of the skin problem to be treated Skin problems that respond best to chemical peels are due to chronic sun damage from ultraviolet light Since most skin peels damage the skin, there is a period
of recuperation necessary As with any surgical procedure, there are risks, which include scarring, infection, and undesirable colour changes Currently, dermatologists often use chemical peels in conjunction with other destructive techniques like laser to diminish the signs of sun damage or acne scarring
The risks, side effects, and complications of chemical peels include:
• Scarring
• Infection
• Reactivation of herpes simplex infections
Trang 12• Substantial contrast in coloration of the treated skin
All patients will have a recuperation period, the length of which depends upon the depth of the peel Deep peels can result in substantial periods of healing on the order of weeks Deep peels generally require extensive local anaesthesia, conscious sedation, and occasionally general anaesthesia, which carries its own risks
• Cryolipolysis
Cryolipolysis, commonly referred to as fat freezing, is a nonsurgical fat reduction procedure that uses cold temperature to reduce fat deposits in certain areas of the body The procedure is designed to reduce localized fat deposits or bulges that do not respond to diet and exercise It is not intended for people who are obese or significantly overweight
Botox results last 3 to 4 months Dermal filler results vary, depending on which filler is used
As Botox and fillers are different substances designed for different uses, they can sometimes be combined in one treatment For instance, someone may use Botox to correct lines between the eyes and filler to correct smile lines around the mouth
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This is another significant advantage of laser treatment In this process there is no chance of irritation like threading or waxing This is purely painless and easily works
on finer and ingrown hairs that give you super satisfaction
3 Save money:
The process is very effective to remove your body hair completely Therefore, there
is no need of going to the parlour every time to get your waxing or threading done and you can save a huge amount of money It is true that you need to spend well for this treatment, but that is for once in lifetime
4 Minimum side-effects:
Another ideal benefit of laser treatment is it has the minimum side effects It can cause for temporary uneasiness, redness, few rashes or some irritations for a very short time and will not last more than a few days
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1 Takes time:
Results won’t come overnight The process takes time because the hair will fall in a gradual process You need to go for some treatment sessions and wait to see the results
2 Skin Burning:
As the heat does the process in several sessions, it may cause hair burning or skin burning sometimes Although the burns are minimal but there are also intense cases
of skin burning has been reported
3 Does Not Suit Everyone:
As for the various skin types, this treatment is not suitable for everyone Usually dark hairs with a fair skin will work perfectly in this action but for fine peach fuzz hair, this is not so effective
• Laser/IPL for Skin Rejuvenation
An IPL or Laser treatment uses the power of broadband light to minimize the appearance of age spots, sunspots, acne scars, rosacea, and more IPL treatments generally take about 20 – 30 minutes After the patient’s face is cleaned and dried, patients will be given protective eye shields to wear during the procedure A handheld device will be passed over the target area, delivering pulses of intense light to penetrate the layers of the skin Most patients describe experiencing a fast, pinching sensation during treatment, with minimal discomfort There is no need for injections or incisions, giving patients the bonus of no downtime required
What can I expect after a photo facial?
Immediately after your IPL treatment, the treated areas will be slightly pink or red and swollen These effects will begin to dissipate after 24 hours You may notice discoloration and sunspots turning somewhat darker or more noticeable, and other blemishes may begin to surface This is a good sign that the treatment is working These spots will eventually flake off as the skin begins to heal from the inside out
LED for Skin Rejuvenation
• Increasing collagen production in the skin, which gives the skin its elasticity
• Increasing fibroblast production, which helps produce collagen and other tissue fibres