Sparing the knife to face the needle

As little as 15 years ago the only real alternatives to surgery were aggressive chemical peels, CO2 laser resurfacing, collagen injections and Botox. Fast forward to today and we have a plethora of safe and effective non-surgical solutions designed to reverse ageing, banish cellulite, and shape and tone the body.

What’s more these treatments have far less downtime and associated side effects than the procedures of the past, which makes them an attractive option for busy men and women who can’t afford or don’t want to take time off work to have a cosmetic procedure.

By opening the door to those who want to dip their toe in the anti-ageing pool, but don’t want to go under the knife, the non-surgical market has broadened the potential patient scope and seen aesthetic clinics popping up in every corner of the country.

Aesthetic nurse Lou Sommereux, who runs the Cosmex Clinic in Cambridge, says: “People want subtlety and the natural look, and we now have more sophisticated treatments than ten years ago.”

Cosmetic injectables, such as botulinum toxin and dermal fillers, remain among the most popular treatments in this category, but the products available and techniques for injecting them have evolved dramatically in recent years.

Permanent fillers, which critics claim “cause permanent problems”, have virtually been ousted in favour of safer and reversible products, namely hyaluronic acids (HAs). As our understanding of how we age has changed, practitioners have stopped simply “chasing the line” and filling wrinkles, and are now volumising and contouring the face to create a more natural look.


Dr Juan Sopena, a key opinion leader for Allergan, the maker of the Juvederm VYCROSS and Botox range of HA fillers, says: “For me VYCROSS has completely changed the world of facial aesthetics because I can treat the cause of ageing and not just the sign. We have products that have enough lift capacity to restore proportions, contour and add volume, and that has changed completely from just treating a wrinkle.”

The market has had some bad press mainly due to the lack of regulation surrounding the products available and who can inject them. Dr Patrick Treacy, of the Ailesbury Clinic in Dublin, recommends looking for fillers and toxins that are approved by the US Food and Drug Administration (FDA), as the United States has much tougher regulation on fillers.

“One of the problems is there are a lot of false fillers and ‘fau-tox’ going around, so make sure you know what product your practitioner is using,” he says. “There are two different types of filler: reversible and non-reversible. It is always preferable to opt for the reversible one so that, in the rare instance that something does go wrong, it can be reversed.

“It is interesting that over the years the products which have ended up having the least complications are those that have passed the FDA test, so if patients want to know what is safe, they should ask their practitioner if the product being used is FDA approved and only have treatment done by a doctor, dentist or nurse.”


While toxins and fillers are the bread-and-butter treatments of most clinics, the Holy Grail is, of course, finding effective no-needle alternatives. As yet nothing has been able to steal the injectables’ wrinkle-busting crown. In 2013, Myoscience launched iovera, a no-toxin alternative known colloquially as “frotox” because it uses cold technology to freeze the nerves that control muscle movement, but this still involves needles and does not have the longevity of toxin.

Phase-III clinical trials are currently underway in the States for a delivery system that would allow botulinum toxin to be used topically and this has been predicted to be a game-changer.

Practitioners are now taking more of a comprehensive approach to facial rejuvenation, and combining injectable treatments to restore volume and erase wrinkles with those that address skin texture and tone

Aesthetic nurse and market analyst Constance Campion explains: “Investors are pouring money into this area. There is a phase-III clinical development programme in the United States for the treatment of crow’s-feet lines, based on a peptide technology to enable delivery of botulinum toxin across the skin, eliminating the need for injections.

“Market research and analysts’ reports suggest that the only current barriers to more people using injectable botulinum toxins include the fear of frozen face and needle aversion.”

But the anti-ageing market is about more than just lines and wrinkles. Practitioners are now taking more of a comprehensive approach to facial rejuvenation, and combining injectable treatments to restore volume and erase wrinkles with those that address skin texture and tone.

As plastic surgeon Rajiv Grover once said, “You can give a prune a face lift, but it doesn’t make it a plum”, which demonstrates the need for treatments that are geared towards skin health, alongside the needle and the knife.

Leading dermatologist Dr Stefanie Williams, of European Dermatology London, has noticed a real shift to what she calls “regenerative aesthetic dermatology”. “We are moving away from just plumping up wrinkles,” she says. “Of course, we still do the Botoxand fillers, they are still important; however, we are now much more aware of regeneration and biostimulation.”

Treatments that fall in this category include dermal rollering, PRP or platelet-rich plasma, Sculptra and mesotherapy. Dr Williams adds: “These treatments are all aimed at improving skin quality, rather than having that immediate before-and-after effect.”


Another big trend is targeting skin health from within with nutrition, supplementation and skin drinks being added into the mix. This inside-out approach to ageing recognises the need for good skin health in order to enhance and maintain the results of treatments.

Jawline, chin and neck treatments are also high up on the trends list with new treatments emerging to treat these areas. Ulthera has recently launched Ultherapy in the UK market, the first and only ultrasound platform device to receive FDA clearance for lifting skin on the eyebrow, the neck and under the chin. Other treatments launched in this category include the VelaFace from Syneron Candela, which uses radio-frequency to target jowls and crepey necks.

Ms Sommereux has also noticed a real shift towards skin tightening and finds combination treatments most effective for the eyes. “I use the ENDYMed 3Deep and am getting really good results around the eyes by using a combination of toxin, skin tightening, resurfacing and, if needs be, some skin boosters in that area. It is a treatment plan rather than just a one-size-fits-all approach,” she says.

Skin tightening is a popular treatment for the body. The makers of Pellevé have recently launched their body-tightening treatment PelleFirm. Dr Hugo Kitchen, of the Stratford Dermatology Centre, comments: “At last we have a device that targets cellulite and loose skin on the body, and a great adjunct to the already internationally established Pellevé facial tightening system.”

Demand for non-invasive, fat-busting treatments with little or no downtime has spiralled in recent years and the body-shaping market has boomed. Cryolipolysis is undoubtedly one of the biggest recent trends in this area and is ideal for removing pockets of body fat, particularly in the stomach area, flanks, thighs and back.

With new treatments and technologies emerging all the time, the non-surgical sector looks set to continue to grow giving the beauty-seeking public additional less-invasive, yet effective, options to turn back the clock, combat ageing and address body hang-ups.