Dr David Eccleston is one of the UK’s longest-standing aesthetic practitioners. Having spent almost three decades in the sector, he’s seen it evolve from something GPs and dermatologists did on the side to the booming industry it is today. He is also regarded as one of the UK’s foremost experts on botulinum toxin not only as a trainer and practitioner but also because his passion for the scientific side of things has seen him involved in a significant number of toxin studies.
“I feel like the granddaddy of UK aesthetics”, he jokes. “I’ve been injecting since about 1995. I first started using medical lasers in a tattoo removal clinic based in Birmingham, which, at the time, was called Laser Care. That then multiplied its clinics and finally became rebranded as sk:n.
“While I was working with that clinic, having done some work in dermatology before that as a junior doctor, I was approached by a product specialist for a company called Allergan who were selling chemical peels. His name was Ron Myers. He told me that these crazy Americans were injecting botulism into people’s faces. That was the first I’d heard of it. I thought ‘this cannot be true’, but three months later, I went down to London with the great Dr Patrick Bowler – he was one of the very first trainers in the UK – and he taught me how to do Botox. This was long before it had a cosmetic license, so then, all treatments were unlicensed.”
Dr Eccleston fell in love with botulinum toxin there and then, and it has since been an integral part of his practice. But for his scientific mind, simply carrying out the treatments wasn’t enough. He wanted to delve deeper and has since gone on to be the chief investigator in many of the pre-marketing and pre-licensing trials for toxin brands.
“I’ve always had an inquiring mind, so I’m very, very big on research”, he says. “The first trial I did was back in about 1997 when we were looking at getting a cosmetic license for glabellar use of Botox. Since then, I’ve been involved in 15 or 16 different toxin trials plus other trials involving fillers, medical devices, etc.
“It does require a lot of painstaking detail, lots of note-taking, lots of measurements, blood tests, frozen blood samples, ECGs in some circumstances, so it is a lot of work. Thankfully, I’ve got a team behind me. I’ve got a clinical trials monitor in the clinic and a clinical trials nurse and phlebotomist.
“I did the three pre-license trials for Botox for glabellar, crow’s feet and frontalis. I also did those three same trials for Merz, for their Xeomin product, which then became marketed as Bocouture, and once again, also for the three cosmetic licenses for Azzalure. I’ve also been involved in Azzalure in Galderma’s new next-generation liquid toxin, which has recently been launched, and also Medytox. I’m about to start trials of a type E toxin as well, which is proving to be quite interesting.”
In 2022, for the first time in 14 years, the UK will see a number of new toxins enter the market but does Dr Eccleston think these will disrupt the marketplace and its dominant players?
“I think the next 18 months are going to be a game-changer when it comes to new toxins on the market, coming in at different price points and different claims of various durations”, says Dr Eccleston. “I’m a firm believer in that if you have only got one tool in your box, you have to treat everything like it’s a nail and hit it with a hammer. My go-to toxin has always been Botox. That is the toxin I was initially trained on, most of the trials I have done have been with Botox, and I’m a key opinion leader and faculty member for Allergan, so a lot of the work I do is with them. However, I still do have other toxins in my armoury because they all do behave slightly differently.
“You could argue that Botox and Bocouture have relatively similar behaviours, whereas I think the Galderma toxin has different characteristics when it’s injected in terms of its spread and speed of onset. It’s a very useful toxin to have as an alternative when you want to achieve different therapeutic effects. It’s really nice to just have those different tools in the box, and I’m looking forward to adding a few more gauges of Allen key to add to my own.”
With talk about longer-lasting toxins being among those coming to market in the future, what does Dr Eccleston think about this? “One of the toxins is making fairly well-substantiated claims for duration of action”, he says. “We are looking at a toxin which arguably could last for up to six months which is a double-edged sword. Arguably, in less expert hands, if you do get one of the uncommon but well-described side effects, such as ptosis, a Spock brow, or periorbital oedema, then you have got stuck with that side effect for longer.
“I think there are pros and cons for longer-lasting toxins. To be honest, for me, I think I would rather have a patient coming to my clinic more regularly to stock up on their skincare and have their repeat HydraFacial treatment. So I think longevity is not necessarily totally a good thing, although it does have advantages.”
In his almost 30 years of injecting, Dr Eccleston has also witnessed changing demands from patients and advances in techniques that have shaped trends.
He explains, “I think if you asked me what I was doing 20 years ago, we were trying to freeze faces. Patients wanted a smooth forehead. They did not want any movement. They would come back for their review and occasionally would say, ‘Look, doctor. I can still move.’ I’d go, “I’m really sorry. That should not be happening. Let’s put some more in.’ Whereas I think now, particularly in the area where I practice, in the Midlands, people appreciate subtlety. They want a more natural look. They want some subtle residual movement.
“I think the frozen face, certainly in my population, which is probably the 30s to 55s, is the majority of my workload, does not want to look done. The same with fillers. They do not want the overstuffed pillow face. They do not want the big lips. So it is calling for a lot more fineness, a lot more subtlety and a lot more artistry.
“That is one of the reasons why I have changed the way I use toxins, in terms of dilutions and dose, to make it more bespoke, rather than just sticking to thou shalt have 20 units in the glabellar and 12 units in each side in the crow’s feet. I will sometimes use eight units in a glabellar, or sometimes 35 or 40, depending on what I’m trying to achieve. Although it’s off-license in terms of dose, me being an experienced physician, and knowing the safety and longevity of the product, I am very, very confident that I can provide individually personalised results to the patients that are seeking my advice and help.”
As well as running his award-winning clinic, MediZen,
Dr Eccleston has always been a keen speaker and trainer and travelling the world in pursuit of this has been one of the highlights of his career.
“It has given me a huge opportunity to travel and meet colleagues and experts from all over the world”, he says. “I’ve been very privileged to travel to America, Canada, South Africa, Australia, all over the Middle East. I’ve visited cultures that I probably wouldn’t have done on a family holiday. Going to Saudi Arabia was a real eye-opener, and visiting places like Lebanon and Jordan, which nowadays are probably not top of the holiday maker’s destination list, but the people and the culture and the food and the enthusiasm for the industry are unparalleled.
“I think the most memorable one was probably flying to Australia for two days to give some lectures in Sydney and then flying back again. That was somewhat tiring. I had to write off a week after that.
“But it’s nice that people actually want to listen to me after 27 years. You would have thought I’d be sounding like a scratched record by now. I really do enjoy being on stage and sharing my passions for the products that I choose.”
“What I love is I have got the variety. I’ve got the travel (well, I had until two years ago). I have got the teaching, the training, sharing my knowledge, supporting colleagues, treating patients, doing the trial work, writing articles, having interviews, going to conferences. So it’s never, ever boring. Probably at my age, I should be thinking about slowing down a bit, but I just love it. It’s great. The industry’s been great to me. I just love that I can give something back to it.”