I had the opportunity to visit the Polytech manufacturing plant in Germany. Despite having used breast implants for many years I was not aware how they were actually made.

The process of manufacturing was a lot more complicated than I had thought. Did you know that most of the process for making them is done by hand. It takes about 2 weeks to make each one. This factory was also able to make custom sizes for those that would like larger than the standard implants available.

There are multiple steps in making breast implants. The initial step involves production of a mold of the breast implant. The mold is then covered with silicone to form the shell of the breast implant. The shell can be covered with a variety of coatings or textures.

The sterile breast implants are then packaged into their boxes and prepared for delivery to users across the world. Some hospitals will store a bank of them for use when required whilst others will order in specifically for each case.

So this briefly summarizes the manufacturing process of implants. It is a lot more intricate and complex than I had ever imagined. It was surprising how much was undertaken by hand rather than machinery. It is important to know how these products are made and to see what measures are taken by manufacturers to ensure their products are of the highest quality. Patients should also know how much care and attention goes into making their implants. It was a very informative visit and to understand the technology and research that goes into the manufacturing process. There are regulatory controls that will hopefully prevent another PIP scandal.

The Times cover story highlights patients being put at risk over Botox jabs. Botox ® is a prescription only medicine and should only be prescribed by a registered doctor after a face-to-face consultation. The General Medical Council (GMC) had previously issued guidance on remote prescribing. This was a method where doctors could prescribe medications such as Botox ® to be administered by someone, such as a beautician, without seeing the patient. This practice of remote prescribing should have stopped. The Times article reports that many patients are still being treated by unqualified practitioners often using black market products.

Mr Nassab presented findings of a research article at a previous BAAPS meeting. The aim of his article was to explore who was actually providing non-surgical treatments, such as Botox ® and fillers, and what qualifications they had. The paper was entitled ‘Non-surgical aesthetic treatments: Who’s offering treatments and how qualified are they?’ and is attached below. The research looked at the top 50 websites of providers for ‘anti-wrinkle injections in London.’ We showed that two thirds of treatments were by doctors but 14% of sites did not mention who was administering the treatments. There are a number of recognized associations such as BAAPS and BAPRAS that require members to be fully accredited and follow strict codes of conduct. Our paper found that over half of providers did not mention any association memberships. It was interesting that there were some associations mentioned by some providers that were not well known, had very small memberships or non-existent. The paper also highlighted that only 22% of treatment providers had premises registered with the Care Quality Commission (CQC). The provision of treatments was undertaken in beauty salons and spas in 12% of cases. There were also mobile providers offering home visits and Botox ® parties.

The Times article and our research highlights the lack of regulation in the provision of non-surgical aesthetic treatments such as Botox ® and fillers. If you are considering Botox or filler treatments, always ask about your providers qualifications and make sure they are a member of a well known association such as BAAPS or BAPRAS.

Mr. Nassab has been awarded the Best International Journal Article in the Aesthetic Surgery Journal at the annual American Society of Aesthetic Plastic Surgery (ASAPS) meeting. The article entitled ‘The evidence behind noninvasive body contouring devices’ was published in the Gold journal in March 2015. The paper presents the latest evidence for numerous noninvasive body contouring devices including Coolsculpting, Velashape, Thermage, Exilis and Ultrashape.

A blog post about the article was posted here and the full paper can be found at the Aesthetic Surgery Journal website here. The article concludes that there is very little high-level evidence to support the benefits of a number of these devices. There is need to for better studies into these devices to support their effectiveness.

Halloween is fasting approaching and the latest trend making headlines is the Vampire Breast Lift ®. Dr Runels who coined the Vampire Face Lift ® has applied the use of PRP to the breasts. Platelet Rich Plasma (PRP) is a technique of taking blood from the patient’s arm and using a machine to separate the various components of the blood. When the separated platelets are mixed with plasma this produces PRP. The higher levels of platelets contain higher concentrations of numerous growth factors. These are thought to be the secret behind the effects of PRP.

The numerous media reports of this application of PRP to the breasts have included images of a patient who had her cleavage area injected with PRP. Although some beneficial effects can be seen the evidence for the procedure remains sparse. There are no scientific publications currently available to show the long-term outcomes of this treatment. There are, however, numerous publications exploring the use of PRP in medicine from cosmetic surgery to orthopaedics. These studies support the potential benefits of PRP for wound and bone healing.

Mr Nassab was involved in research exploring the use of PRP for facial rejuvenation. This research was highlighted in a number of national newspapers in the UK including the Daily Mail. This study showed that 61.5% of patients were satisfied with the results of the PRP treatment. We, like Dr Runels, also found that it takes time for the results of treatment to become evident. The most important factor was selecting the right patient for the procedure, also highlighted by Dr Runels. The quality of the skin before treatment is important as well as how the PRP is prepared.

There is a growing body of evidence supporting the use of PRP in medicine and its use in aesthetics is becoming more popular. There are likely to be some beneficial effects from PRP in skin rejuvenation but more evidence is required to support this.

Mr Nassab reviews the latest technologies for non-surgical body contouring in the Aesthetic Surgery Journal. This article was featured as the Editor’s Choice in the gold journal in March 2015. The demand for body contouring is rapidly increasing, and interest in noninvasive approaches has also grown. According to the statistics from the American Society for Aesthetic Plastic Surgery, 9.5 million nonsurgical procedures were performed in 2013, compared with only 1.8 million surgical procedures. In 2013, almost 95,000 nonsurgical fat reduction procedures and 294,000 nonsurgical skin-tightening procedures were performed in the United States.

We reviewed the published scientific literature for evidence supporting the benefits of these devices. The general mechanism of these devices relies on the use of an externally applied energy to cause adipocyte disruption or apoptosis. This study explored fat reduction using mechanical suction, radiofrequency, ultrasound, cryolipolysis and laser devices.

There is generally not much in the way of high-level evidence to support the use of any of the noninvasive body contouring devices. The research papers that have been published are often supported by the companies that manufacture the machines or are authored by investigators who have financial interests in the companies. The majority of studies also had very short-term follow-up periods with no long-term evaluation of the duration of the treatment results. The majority of studies failed to account for patient variables, such as generalized weight loss from lifestyle changes, that can contribute to reductions in measurements and affect outcomes. There are some small studies supporting positive outcomes with some devices with short-term follow-up.

The noninvasive device market needs further studies to evaluate these devices. There is a need for larger studies with much longer follow-up to fully evaluate the benefits of these devices for fat reduction. Studies are also needed to compare and contrast devices to identify which technology provides the most benefit in terms of outcomes for patients.

Watch Mr Nassab discuss this paper on YouTube here.

The demand for non-surgical procedures is rapidly increasing. The ASAPS statistics revealed that 9.5 million non-surgical procedures were performed in 2013 compared to only 1.8 million surgical procedures. This has fuelled development for numerous non-surgical devices with varying technologies to combat ageing and body contouring. A number of these devices have had strong marketing campaigns and media coverage. We explored a number of these devices comparing marketing claims in the media with results in peer reviewed scientific publications.

The press and media feature significantly more articles than the scientific literature on novel non-surgical devices (583 vs 63 articles).

The majority (73.4%) of press articles feature a specific provider or clinic, often promoting provision of services related to the device. Over a third (36%) of the scientific literature also declare some financial interest or conflict of interest declaration by their authors. This highlights some of these devices are driven by marketing either by the manufacturer or provider.

The evidence supporting these devices is of low level consisting of only case series. The results are also variable and there is variation of findings between studies. There is much need for higher level evidence studies in the medical literature exploring novel devices. The present published studies are all case series with short follow-ups.

There is a ‘evidence-marketing gap’ for novel aesthetic procedures and devices. The aim should be to provide more evidence to support the marketing claims of such procedures and reduce this gap.

We present the findings from our recent study at the Annual British Association of Aesthetic Plastic Surgeons meeting at the CCR Expo, London.

The NHS is facing significant financial pressures. There exists a ‘postcode lottery’ for many procedures and treatments within the NHS. A previous study explored the provision of cosmetic surgery procedures on the NHS at the time of the primary care trusts (PCTs). The PCTs have now become Commissioning Care Groups (CCGs).
The aim of this study was to review the provision of cosmetic surgery in the NHS according to different CCGs in England.
There are just over 200 CCGs in England. There was widespread variation in which cosmetic surgery procedures were funded. This again shows there exists a ‘postcode lottery’ when it comes to cosmetic procedures within the NHS.
When compared to the previous study, there are tighter restrictions on who is eligible to have these procedures on the NHS.

‘Our paper shows that there is great variation in the provision of aesthetic procedures in the NHS. There has been reduction in funding for these procedures and eligibility criteria are becoming tougher. This is likely to fuel the demand for private procedures. There is also an impact on the training of future plastic surgeons’ says Mr Nassab, Consultant Plastic Surgeon in Chester.