Cosmetic Courses: The Budget 2015 - How to run your business...

The Chancellor has just delivered his first Budget of this government – and as usual, some will benefit and others lose out. But if you run your own business, how will you be affected by his red box revelations?

Essentially, how the Budget is likely to affect you depends on how your business is structured, and how established you are.

By and large, this Budget focused on two kinds of business – very large companies and successful smaller businesses that are ready to grow.

Some commentators were disappointed by the lack of new incentives for entrepreneurs looking to launch solo start-up businesses. But if you already run your own business and are doing well, there are measures that may help you. 

Let’s take a look at some of the major announcements and what they could mean for you.

Tax

The Chancellor announced the rate of corporation tax would fall from its current 20% to 19% in 2017, and then further still to 18% in 2020 – giving the UK the lowest corporation tax rate in the G20.

Great news if you run your own business – but only under certain circumstances.

If you’re a limited company making significant profits, you’re likely to benefit from the drop in corporation tax. But if you’re a sole trader or partnership, a start-up or small limited company that only generates a marginal profit, the change probably won’t affect you.

Other new tax measures may make life easier, and save you time – if not money!  

The Office for Tax Simplification has been given more powers to cut red tape, and will be putting forward its recommendations for a reformed tax system as part of the 2016 Finance Bill.

And the dreaded tax return, having already been moved online, will see further digitisation over the next few years. 

Employees

If you run your own business, you may already have, or be looking to take on, members of staff.

The National Living Wage will come into effect in April 2016, requiring all employees to be paid a new minimum wage of £7.20 per hour, rising to £9 per hour by 2020. 

This will mainly impact small businesses with a significant number of employees earning the minimum wage. But if that applies to you, there’s also a measure that will help offset your increased wage bill. 

The national insurance employment allowance will be raised by 50%, from £2,000 to £3,000. Only you and your accountant will know whether this completely offsets the impact of the increased minimum wage on your business, but every little helps.

Investment

One of the most crucial allowances when you run your own business and are looking to grow is the Annual Investment Allowance – and there’s good and bad news on that front.

The allowance lets small and medium-sized firms make tax-deductible investments in equipment and machinery to help fuel their growth.

It currently stands at £500,000, but was set to be cut to just £25,000 from 1st January 2016 – though many were calling for an increase on the £500,000.

Mr Osborne has decided the new allowance will be £200,000. So, not cut as much as it was going to be, but still by a significant amount.

Finance

Another important area if you run your own business and are looking to grow is access to finance. And two new measures announced by the Chancellor will make it much easier to secure business loans.

First, the UK’s major banks will have to share credit information on small businesses with other lenders, and must share details of firms they reject for finance with online platforms that can pair them up with other finance providers.

In addition, the British Business Bank will look to increase and diversify the supply of finance available – with plans to make £10bn available by 2019.

So there you have it. Not quite as exciting for business as it could have been, but some incentives nonetheless. Perhaps the biggest incentive of all being that to benefit from many of the measures, your business needs to grow! 

Looking to run your own business?

Cosmetic Courses offer expert training for medical professionals looking to enter the aesthetics industry. Our ongoing support network provides comprehensive advice and resources to help you set up and run your own business. For information on our aesthetic training courses, please contact the team on 01844 318317 or email [email protected].

ISAPS cosmetic procedures statsGlobal plastic surgery body ISAPS (International Society of Aesthetic Plastic Surgery) have released some interesting stats on the number of cosmetic procedures performed in 2014.

And they make compelling reading for those looking to offer non-surgical treatments.

The figures, published on ISAP’s website on Wednesday, show a drop in the total number of cosmetic procedures performed in 2014 compared to the previous year (20,236,901 vs 23,474,273).

Breaking that down by area, surgical procedures fell from 11,599,336 to 9,645,395, while non-surgical procedures dropped from 11,874,937 to 10,591,506.

But while they both saw decreases, the non-surgical side held up markedly better – and increased its percentage of the total market.

Cosmetic procedures – a shift taking place?

The figures suggest a shift is under way, with non-surgical treatments continuing to gain ground at the expense of surgery.

Though non-surgical procedures already accounted for the majority of total procedures by a slim margin, the scales have tipped even further in their favour.

Looking at the stats in percentage terms, non-surgical procedures accounted for 50.6% of the total in 2013, but an increased percentage of 52.3% in 2014.

We can speculate on the reasons why people are increasingly choosing non-surgical options. It may be that cost is a factor in a still-shaky global economy – non-surgical procedures being generally far less expensive than surgery.

Or it could be part of the shift we’re seeing towards a less-is-more approach. Subtle and natural are fast becoming watchwords in the aesthetic industry. Nobody wants to look ‘done’, and non-surgical treatments are seen by many patients as less invasive than surgery, with results that are less likely to be apparent to others.

Whatever their motivations, patients are speaking. And for aesthetic professionals, this brave new world represents a very exciting opportunity.

Non-surgical treatments – a great time to train

The table below shows the ISAPS data for non-surgical procedures:

Non-surgical cosmetic procedures

As you can see, Botulinum Toxin (including BOTOX® Dysport and Xeomin) holds on to its position at the top of the non-surgical tree. In fact, it remains the world’s most popular procedure overall – both non-surgical and surgical.

And again, though the numbers have dropped, it has actually increased its share of the total cosmetic market – from 21.9% to 23.9%.

So if you’re a medical professional thinking about a move into aesthetics, Botox training still represents the best investment you can make for your future career.

But the stats are also impressive for chemical peel and laser resurfacing. In 2013, between them – and combined with dermabrasion – there were only 773,442 procedures in total. In 2014, chemical peel and laser skin resurfacing alone racked up a combined total of 973,314 procedures.

So it may be worth your while to add chemical peel training to your repertoire too.

Though the ISAPS data is based solely on countries from which they obtained sufficient survey responses (USA, Brazil, Japan, South Korea, Mexico, Germany, France & Colombia), the scale of the survey lends weight to the findings.

And ISAPS themselves say they consider the data to be representative of the industry globally.

“We have improved our survey methodology to reflect a detailed profile of our field,” said Susumu Takayanagi, MD, ISAPS president. “Our society is committed to following sound analytical practices in creating this valuable report.”

Cosmetic Courses offer medical professionals expert training in a wide range of cosmetic procedures. If you would like information on our aesthetic training courses, or would like to book a place, please contact the team on 01844 318712.

Kybella fat dissolving injectionsThe aesthetic industry doesn’t stand still for long. With increasing regularity, new treatments come along and grab the public imagination. 

And we could be on the threshold of another.

Botox and fillers may be sharing headlines with a brand new injectable treatment soon. Aesthetic giant Allergan have just bought the company behind fat dissolving injectable Kybella.

What is Kybella?

The deoxycholic acid based drug was approved by the US Food and Drug Administration in April this year.

It is designed specifically to treat submental fat – the dreaded double chin. While traditionally this area has been treated surgically, the goal is for Kybella to position itself as a viable non-surgical alternative to chin liposuction.

Though non-surgical options are available for the double chin, none are effective at reducing the submental fat. So if the treatment works well, it could be in huge demand from both practitioners and patients.

As New York dermatologist Dr Heidi Waldorf explains:

“We could lift from above with a facial filler, tighten from outside with an ultrasound laser, and smooth with a toxin — but we could not get rid of the underlying fat without something more invasive like liposuction”.

Unlike liposuction, the results won’t be instant with Kybella. Patients will need a course of the fat-dissolving injections over several months to achieve the best outcome.

But with no general anaesthetic or surgery needed, the treatment is bound to appeal to patients who are looking for improvement but nervous about the knife.

Allergan’s investment in Kybella

It’s clear Allergan has faith in the treatment’s potential, having paid a staggering $2.1bn to acquire Kythera, the biotech group behind Kybella, to stop it being snapped up by rivals.

The cosmetic treatments market is huge in the US. More than 6m treatments were performed last year, including 1.6m anti-wrinkle injections and more than 1m facial fillers.

Acquiring Kybella is Allergan’s latest move to diversify its product portfolio as it looks to capitalise on the growing demand for non-surgical treatments.

Other recent new products have included facial filler Juvéderm Voluma and Latisse, a serum for growing longer, thicker eyelashes.

Pricing for Kybella has yet to be announced, but the company are currently rolling out a training programme for the treatment.

As we know in the UK aesthetic industry, what happens ‘over there’ inevitably happens over here too. So we’ll be watching with interest to see how Kybella takes off. Who knows, perhaps we’ll see Kybella training sitting alongside our regular Botox and filler courses soon.

Cosmetic Courses offer a varied programme of aesthetic training courses for medical professionals, including Botox and filler training. For information on our courses, or to book a place, please contact the team on 01844 318317 or email [email protected].

 

While the UK has traditionally lagged behind the US when it comes to medical litigation, this appears to be changing. Litigation rates in the NHS and Private Practice are now reported to be rising by 20% every year.

Needless to say, this affects all of us working in the aesthetics industry. If you’ve been practising for a while, you’ve probably noticed the gradual increase in your indemnity costs year on year.

So in this climate of increasing litigation, what can you do to protect yourself?

Improving the patient consent process

A substantial proportion of medical litigation cases hinge on the issue of patient consent. So examining and, if necessary, improving the way you manage this crucial part of your practice is essential to safeguard yourself against future problems. 

Broadly speaking, in medical litigation cases the proceedings will focus on two questions:  

  • Were the risks of the procedure fully explained to, and understood by, the patient?
  • Were the risks, and the patient’s understanding of the risks, recorded accurately in the patient’s notes?

So it’s important that your approach to both these parts of the process is as efficient as possible.

Approaching patient consent for non-surgical procedures 

Taking a sufficiently thorough approach to patient consent will benefit both you and your patients.

For your patients, a better understanding of the benefits and risks of a treatment will help them to make a more informed decision. And for you, detailed, accurate and – importantly – legible consent will reduce any risk of litigation.

Here are five steps you can take to protect yourself and your business:

1. Information packs

Send out an information pack when patients enquire about a particular treatment. This should outline the treatment process, recovery period any possible complications, and include contact details they can refer back to should they have any concerns after treatment.

2. Discuss and document

During a consultation, take time to discuss all the pros, cons and potential risks of the treatment, and crucially, make sure you document this in the patient’s notes.

3. Seek specific consent for photos

Under standard medical practice guidelines, practitioners must not show before and after photographs to other patients or publish them without specific written consent from the patient. If photographs are taken, obtain specific consent from your patient to use them – ideally on a dedicated form.

4. Detailed patient consent form

Make reference to your information pack in your general patient consent form. On the form, specifically ask the patient to confirm they have read and understood the information pack. And make sure you ask patients to sign a new consent form before each and every treatment. 

5. Detailed patient notes

A patient’s notes should reflect the detailed discussion that took place before their treatment, so be as thorough as is practical. Patient notes should also be used to document the completion of each stage of the consent process.

As aesthetic professionals, we need to ensure we spend sufficient time educating patients about the risks and benefits of treatment before going ahead – and documenting everything we’ve discussed.

Rushed and incomplete consultation notes leave us vulnerable to litigation (warranted or not), so it’s impossible to be too thorough when it comes to keeping patient records. New technology (apps, tablets) has allowed many of us to streamline the process, and this may be a good investment for your practice. But whichever tools and methods you choose, diligence and detail are key.

Cosmetic Courses provides all delegates with access to downloadable consent form templates and other useful documentation. For information on training with us, give the team a call on 01844 390110 or email [email protected].

Our Clinical Director Adrian Richards recently joined the editorial board of Aesthetics Journal, the specialist monthly publication for medical aesthetics professionals.

As part of his work with the magazine, he’ll regularly be contributing expert articles on a variety of subjects. If you don’t subscribe to the magazine, or didn’t catch the latest couple of issues, you can read Adrian’s latest contributions here.

In this article, Adrian offers advice on the most appropriate treatments for each area of the face, based on what your patients are looking to achieve. He covers each area of the face in turn, from the forehead down to the neck, giving his thoughts on whether surgical or non-surgical treatments would produce the best aesthetic results. Click on the link above to read the full article.

Adrian wrote this article in collaboration with Cosmetic Courses trainer and Aurora Skin Clinics Clinical Lead Mel Recchia. They discuss two recent cases treated at Aurora. Both female patients had received dermal fillers to the upper face region at other clinics, and experienced significant late-onset peri-orbital swelling some time afterwards. Both were successfully treated with Hyaluronidase. The article looks at both the causes of Hyaluronic Acid dermal filler associated peri-orbital swelling, and its management. Click on the link above to read the full article.

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Are you a medical professional considering a move into the aesthetics industry? Or do you already have an aesthetic practice and would like to broaden your repertoire of treatments?

Cosmetic Courses offer a wide range of medical aesthetic training courses to help equip you with all the skills you need to build a successful aesthetic business. As the industry develops and new treatments become available, we are regularly adding new training courses to our programme.

Our newly launched Cosmetic Courses website includes plenty of support to help you carve out your new career, from podcasts and videos to downloadable materials and a jobs board.

For more information on any of our aesthetic training courses, our trainers or our training venues, please contact the team on 01844 390110 or email [email protected]

Anyone interested in better time management would do well to have a chat with Adrian Richards. As well as being a busy surgeon, aesthetic trainer, bass player, father of four, sometime marathon runner and Clinical Director of both Aurora Clinics and Cosmetic Courses, Adrian has also found time to write a book.

He has just finished the second edition of his best-selling textbook, ‘Key Notes on Plastic Surgery’, a concise reference guide for surgeons in training, along with co-author Hywel Dafydd. We sat down with Adrian for five minutes to talk about the book.

Hi Adrian, why did you write the first edition of Key Notes?

When I was doing my final exams in Plastic Surgery, I really felt a need for this type of book. As it didn’t exist, I decided to write it myself. I’m delighted that most Plastic Surgeons doing their final exams now have a copy with them.

How would you describe the style of the book?

George Orwell felt that sparse writing was the best. While I can’t claim to write like him, I tried to live by this principle – using the shortest word that would convey meaning and keeping the text and sentences as concise as possible.

Who do you think will read the book?

Anyone who buys it I suppose! But most people who have it are either junior Plastic Surgeons preparing for their major Plastic Surgery exam or experienced surgeons who want to keep up with the latest information.

Is Key Notes in Plastic Surgery suitable for members of the general public?

The book is quite technical but it’s designed to be easily understood. We’ve broken up the information using bullet points, so anyone with an interest in Plastic Surgery will be able to dip into it.

Why might a member of the general public read the book?

Perhaps if they were researching a particular aspect of Plastic Surgery the book might be a good reference for them.

Why have you published a second edition of Key Notes in Plastic Surgery?

The first edition was really popular but times and techniques change. Plastic Surgery is a rapidly evolving speciality and the book has been updated to reflect this.

What are the differences between the 1st and 2nd Editions?

The second edition is slightly longer and has many more diagrams to bring it to life and help the reader understand what is a very visual speciality.

Why have you recruited a co-author?

When I wrote the first edition back in 1999 I was a young Plastic Surgeon with an up-to-date knowledge of the breadth of Plastic Surgery. Like all Plastic Surgeons, I now focus on specific types of surgery. For this reason, Hywel Dafydd has been responsible for the majority of the updated content in the 2nd edition.

What is Mr Dafydd’s background?

Hywel reminds me of a younger version of myself. He has just passed his final Plastic Surgical exams and is travelling the world learning the latest Plastic Surgical techniques before starting his Consultant post in Swansea. Having studied for the exams for the last 3 years Hywel has an excellent and broad understanding of the current state of Plastic Surgery.

Will there be a 3rd edition of Key Notes?

I would like to see a new edition of Key Notes published every 10 years – ideally updated and improved by a new generation of Plastic Surgeons finishing their training and at their peak of understanding the wide scope of Plastic Surgery.

‘Key Notes on Plastic Surgery (Second Edition)’ is published on 21 November 2014 and available to pre-order now from all good book shops, including Amazon.

 

As the law stands, newly qualified consultants can walk straight into the operating theatre and perform the full repertoire of cosmetic surgery procedures for anyone who asks.  But in a recent survey, both doctors and patients have expressed their dissatisfaction with the status quo – and called for more specialist training for cosmetic surgeons to be made a legal requirement. The poll was conducted on 2,000 women and 500 doctors to coincide with the Clinical Cosmetic and Reconstructive Expo (the UK’s biggest plastic surgery conference), which takes place next month. 93% of the doctors surveyed said that they didn’t feel newly qualified surgeons were of the required standard to provide complex specialist surgeries like facelift and breast enlargement. Even though the law says otherwise, and NHS training is deemed to be sufficient.

Which leaves a vanishingly small one in 14 clinicians who felt things were fine the way they are, and no accredited training was necessary. Three-quarters of the patients surveyed also said they would feel more confident having cosmetic surgery if they knew their surgeon had undertaken further specialist training.

When asked about non-surgical cosmetic treatments, including injectables and laser treatment, both doctors and patients agreed that comprehensive specialist training was necessary. A minority of the doctors surveyed (around a third) thought medical professionals should have a minimum of three months’ training before being allowed to perform laser treatment.

Calls and campaigns to improve standards in the industry seem to be gathering momentum. This poll comes only days after Health Education England (HEE) released the first part of their review into training for non-surgical procedures.

And the organisation Save Face is currently creating a voluntary register of non-surgical cosmetic practitioners who have been thoroughly vetted by doctors before accreditation.

We will keep a close eye on any outcomes arising from this new scrutiny on what has hitherto been a largely unregulated industry. From our point of view as medical professionals, anything that improves patient safety and raises the standard for those entering the cosmetic arena can only be healthy for the industry – and improve its reputation beyond measure.

 

As an aesthetic practitioner it goes without saying that you want to deliver the best possible service to your clients. However there may be occasions when things go wrong and a claim is made against you. We know how distressing this can be for not only the patient but also the practitioner.

Eddie Hooker, CEO of Hamilton Fraser Cosmetic Insurance, recommends the following five steps that will help in the event of a claim being made against you:

1. Obtain full consent

Always ensure you obtain full consent from your client before the start of any treatment. Set out all the risks and benefits as well as any potential side effects and ensure your client has read and absorbed all of the information before they consent to the treatment they will be undergoing.

2. Keep detailed records

Always make sure you maintain a written record of all of the treatments you have provided, on the date you provided it. This should include machine settings together (where appropriate) with before and after photographs. You will need to keep your notes for 10 years in case a claim may arise in the future. You will also need to keep your equipment in good working order and up to date in accordance with manufacturers’ guidelines.

3. Stay up to date with your training

Ensure you can demonstrate you are fully trained and competent by undergoing initial training and also regular re-training throughout your career and retain all certificates.

4. Manage expectations

It is important to ensure the client has realistic expectations of the outcome of the treatment and whether (and when) any top up treatments may be necessary. Ensure that you allow sufficient time at consultation to cover this.

5. Medical due diligence

Make sure you get a full medical history from the client and explain full aftercare treatment and what they need to carry out themselves.

It is important to ensure that you have adequate insurance protection in case the worst happens. At Hamilton Fraser Cosmetic Insurance we have been insuring aesthetic practitioners for many years and understand the aesthetic industry, so please contact us on 0800 63 43 881 or email [email protected] for insurance advice and a free quotation.

Who knew a takeover bid in the pharma industry would be so thrilling? The battle between Allergan Vs Valeant is shaping up like an epic tennis match, with shot after shot screaming back over the net.

The last was from Valeant, who announced they were seeking to bypass Allergan’s board of Directors and take their hostile bid directly to shareholders.

But now Botox maker Allergan have hit a blistering return. To head off the $53 billion hostile takeover bid, the board are preparing a slew of measures – including taking on debt to buy back their own shares.

Also on the table is a plan to make acquisitions of its own (anything Valeant can do…), as well as a round of spending cuts to increase shareholder value, according to Chief Executive David Pyott.

The hope is that these measures will be enough to persuade shareholders that Allergan is better off going it alone.

It’s thought that Allergan will officially reveal their masterplan when they release their second-quarter results later this month. But even then it seems the battle won’t be over.

Valeant have hit back, saying they already have enough shareholders on side to call a meeting to try and replace Allergan board members with nominees who support their takeover bid. They need the support of shareholders who hold at least 25% of the company’s shares.

Financial Analyst Ronny Gal says that while it’s possible for Allergan to swing things in their favour, they will find it challenging.

“When I run my numbers, a buyback alone doesn’t quite cut it. A buyback plus another round of cost cuts, or the acceleration of the discussed cost savings, does.”

An acquisition could help them, according to Gal, but only if it increases their profits – and quickly. To win round short-term investors, he says, Allergan needs to deliver another $10 per share in 2015 or $11 per share in 2016.

Get comfortable. Allergan Vs Valeant is going to run and run…

This is the story that just won’t go away. We recently wrote about Botox maker Allergan rejecting a takeover bid by Canadian pharmaceutical company Valeant. But it seems Valeant have rhino hide, and won’t be letting rejection put them off.

It’s been reported that the conglomerate will this week launch an exchange offer for Allergan Inc, which will allow them to bypass the board of Directors and take their hostile bid directly to shareholders.

Allergan has already rejected Valeant’s $53 billion offer, but the company’s largest shareholder, Pershing Square Capital Management, has indicated it will be seeking a special meeting later this year to change most of Allergan’s board.

To trigger the meeting, Pershing needs to ensure the support of 25% of Allergan’s shareholders – an increase of 15.3% on its own holding of 9.7%.

Despite the challenge ahead, Valeant’s Chief Financial Officer Howard Schiller is bullish about their chances of shoring up the support. He pointed out that more than 50% of Allergan’s shares have traded since news of Valeant’s offer first leaked out on 21st April.

Talking about the controversy surrounding their approach to Allergan, Valeant’s Chief Executive Officer Mike Pearson, said:

“Hostile is not our preferred approach. But this deal was so strategic and financially compelling that it really makes sense.”

It increasingly seems that it’s a question of when, not if, this deal will finally go ahead.