Dr Steven Land

I have written for Aesthetics Journal this month - on the driver of facial ageing that we don't talk about enough: bone.

My article, 'Understanding Facial Bone Resorption', is out in the July issue.
The premise: we obsess over what we can see - lines, laxity, volume loss - and largely ignore the foundation it all sits on. The facial skeleton starts remodelling in the late 20s, decades before anyone books a consultation, and it reshapes everything above it.
In the piece I work through the bony story behind the concerns patients actually walk in with: why the orbit widening explains tear troughs, why the maxilla shrinking explains nasolabial folds, and why resorption at the jaw explains a softening jawline and jowls. I cover why women lose bone earlier and faster around the menopause, and why filling the surface without addressing the foundation is how you end up with faces that look 'off' rather than refreshed.
It is written for practitioners who want to think one layer deeper than the skin - and to plan treatment around the scaffold, not just the surface.
The line I keep coming back to, and the one I will stand behind: the face is not just skin deep, and neither should our treatments be.

Link in bio to read the full article. Tell me what you make of it - especially if you disagree.

The Lip Masterclass is not for practitioners starting out, it's for those of you ready to question why they reach for the product they reach for.

This is the course I find most satisfying to deliver. Small group, 3:1, discussion-led, evidence-focused.

It is built around a questions most lip training never asks: are we selecting the right product and techniques for the right lip? I will make the case - openly, and happy to be argued with - that the conventional age-based approach to lip product selection is largely backwards, and we will work through the rheology and the anatomy that supports a better way.

Sessions cover: filler characterisation and evidence-based product selection for the lip and peri-oral area, the rheology that actually matters in a high-movement zone, anatomical risk and vascular safety, and how to build a treatment plan around the face in front of you rather than a fixed pattern.

What makes it different: no manufacturer sponsorship, no product placement, no sales agenda. Where I reference specific products I disclose my interests. The evidence is presented as it stands.

Who it is for: practitioners with a minimum of one - two years of active aesthetic practice who already inject lips and want a rigorous, evidence-led rethink rather than another technique demo.

£ 1,000. Small group, 3:1. Full day of teaching. Newcastle.

Lip Masterclass - 15th September. Places available now.

DM to discuss whether this is the right stage for you, and to check availability.

The lip is one of the most vascular areas of the face, and a major new meta-analysis has just consolidated what we know. Ostrowski, Cotofana and colleagues pooled 23 studies on the blood supply of the lips (Aesthetic Plast Surg, June 2026), and the take-home is more uncomfortable than the old teaching.

Both labial arteries most commonly run in the submucosal plane - the superior labial artery in up to 84.8% of cases, the inferior in up to 81.25% - at a mean depth of around 5.2mm. Shallower than many of us inject, and not where 'stay deep and you are safe' would have you believe.

The vessels are inconsistent in whether they are even present: the SLA was absent in 3.55% of cases, the ILA in 13.45%. And the single most important line in the paper - no lip plane can be regarded as entirely free of vascular structures. There is no safe plane, only individualised, anatomically-guided technique, supported by ultrasound where you have it.

The novel part, and the one worth sitting with, is what the authors call the 'steal phenomenon': a proposed redistribution of perfusion - or filler - from the upper lip toward the nasal and ophthalmic territories through pre-existing anastomoses. It offers a theoretical explanation for why the upper lip carries greater risk, and why a lip complication can present far from the lip.

For what it is worth, from my own practice: vascular occlusion has been the single most common serious complication among the 26 I have helped manage. This paper explains a lot of why.

What I take from it for technique - my interpretation, not the paper's conclusion: layered safety is the only defensible standard. Anatomical knowledge, careful plane and product selection, real-time monitoring, and a rehearsed management protocol. Aspiration alone is not a safety net - and aspiration with a moving needle tells you nothing.

Reference: Ostrowski, Cotofana et al. Aesthetic Plast Surg 2026. PMID 42329443.

If you want to go deeper on lip and peri-oral work specifically, my Lip Masterclass is 15 September - small group, 3:1, evidence-led, £1,000. DM for a place.

I mean this clinically, not metaphorically.

The practitioners who manage adverse events best are not always the most technically skilled or the most experienced. They are the ones who carry a productive level of clinical anxiety into every treatment session.

Productive anxiety is not the same as paralysing anxiety. It is the background awareness that this treatment involves a real biological system, that outcomes are not fully predictable, that the anatomy of the person in front of you is not identical to the textbook. It is the disposition that keeps you checking, monitoring, asking the next question, staying alert for problems.

The practitioners who concern me most are the ones who have stopped feeling it. Whose confidence has settled into automatic routine. Whose pre-treatment assessment has shortened because they have done this a thousand times and nothing has gone wrong yet.

"Nothing has gone wrong, yet" is not a safety record, it is a run of good fortune that has not run out, yet.

The anxiety is not a flaw to train away. It is the clinical instinct working exactly as it should.

If you feel it - good. Learn from it. Build around it. Do not mistake its absence for mastery.

Share this with a colleague who needs to hear it today!

Midsummer's day - a time for reflection. The day novellus was officially started - 13 years ago.

We are halfway through 2026 and it's a nice moment to pause and take stock. People often mention all the stuff I get up to and how busy I keep myself - so here's the recap:

Conferences: I have spoken at several national and international meetings already - regenerative medicine, supplements, GLP-1 patients, and the product-selection dogma that gets repeated without evidence. Standing on those stages and fielding questions afterwards is still the part of this job I learn the most from.

The Neauvia UK clinical pathway: I rewrote the entire thing - five modules so far. Built around the science of the technology rather than a product tour. It is now live and the early delegate feedback has been better than we dared hope. Rebuilding it taught me more about how we train injectors in this country than any course I have sat.

Training and mentoring: foundation days, one-to-one mentoring, masterclasses. The mentoring days remain my favourite - one practitioner, a full day, working on the clinical reasoning behind the decisions they are already making well.

The thread running through all of it: this speciality gets better when we train people to think, not just to inject. That is what I am trying to do in all my teaching - not just spoon-feeding the answers, but teaching people to engage their brains and think about the evidence, the techniques they use, and the products they choose.

Thank you to everyone who has been part of it so far - the delegates, the mentees, and the colleagues on the end of a Friday-evening message.

The second half of the year is going to be even busier... see you at the next conference or training session?

If any of this resonates - or if you want to be in one of the rooms in the second half of the year - DM me. And if you know a practitioner who is trying to train properly rather than just collect certificates, send this their way.

The conventional teaching on lip filler product selection is, I think, backwards - and rheology and anatomy are the reason why.

Start with anatomy and ageing. The area around the mouth is one of the highest-movement zones in the face. That single fact should drive product selection more than the patient's age does.
Why movement matters: a filler with high elasticity but low cohesivity, when deformed by strong pressure, may not return to its original shape once the pressure is removed - which shows up as an altered appearance after treatment. Cohesivity - the force that lets a gel restore its structure after being deformed - is what resists that. In a high-movement area, cohesivity matters more than firmness.
The conventional teaching: higher G' (firmer) filler in younger lips for projection, softer filler in mature lips for subtlety. I think that is the wrong way round.
The younger lip already has good volume and a defined border. It does not need structure - it needs hydration and a small amount of soft, cohesive product. The mature face is the opposite: the real changes are peri-oral as well as in the lip itself - volume loss, loss of border definition, dropping oral commissures, deepening nasolabial & marionette lines. That is where structure is needed - placed peri-orally, with only a small amount of firmer product in the lip itself.
There is published precedent for selecting against convention. A 2025 systematic review put it directly: contrary to conventional assumptions, choosing filler properties according to the specific characteristics of each facial region is what matters - not a blanket rule.
This is an argument for actually thinking about the anatomy & the movement in front of you, rather than doing the same thing for every patient regardless of age. This is what makes you a better injector
Argue with me. I do not always think I am right - but I do think we should be thinking harder about why we reach for the product we reach for. If you want to go deeper, my Lip Masterclass (15 September, 3:1, £1,000) is built around exactly this.

DOI: Neauvia KOL - your brand rheology may vary

The regulatory landscape for UK aesthetic medicine is changing faster than most of us realise. Here is where we currently stand:

The Botulinum Toxin and Cosmetic Fillers (Children) Act 2021 and the Health and Care Act 2022 moved the legislative framework forward, but the picture is still fragmented - and it is this patchwork legislation, licensing and enforcement that puts our patients at risk.

Three things every practitioner needs to understand right now:

Botulinum toxin is a prescription-only medicine. Administration requires a valid prescription from an appropriately qualified prescriber. This is law, not guidance. What also matters is the need for face to face consultations mandated by our regulatory bodies - they hold doctors, dentists, pharmacists and nurses to a higher standard than the law. They have seen that these procedures are entirely elective and the prescribing process is open to abuse. They have therefore mandated that consultations need to be in person - every time.

Dermal fillers remain almost unregulated at product level in the UK. CE marks for safety are needed, but other than that it is the wild west. The onus therefore falls on the practitioner to ensure you are keeping your patients safe and using quality products. Your clinical decision-making about product selection is incredibly important - see my other posts for more on this...

The JCCP and Save Face voluntary registers are a positive development, but they are not mandatory. The implications for how you present your qualifications, background and memberships to patients are worth understanding clearly.

If you have not reviewed your practice against the current legislative framework recently, now is a good time.

I get a lot of messages from practitioners in difficult clinical moments. Local colleagues, people from further afield, practitioners I have never met who got my details through a colleague.

It always starts the same way: hesitant, apologetic, slightly embarrassed that they are asking. As though needing a second opinion is a sign of inadequacy rather than professional diligence. It's the exact opposite - it is a sign of good clinical care.

What I have noticed over years of being on the end of those calls: the practitioners who reach out early, while the clinical picture is still developing and the options are still open, consistently get better outcomes than those who wait until they are certain something is wrong. By then, some of the damage may already be done

The reluctance to ask for help in aesthetic medicine runs deep. We are trained to project confidence. The culture does not reward uncertainty. There is a professional cost to saying "I am not sure and I need a second opinion" that does not exist in most other medical specialities.

At the end of the day it is the patient that ends up paying the price for this culture we have allowed to develop...

If you are ever in a difficult clinical moment and you need a second pair of eyes or ears - call. That is what I am here for, it's what we should all be here for - our patients.

I run two separate foundation courses - Foundation Filler and Foundation Toxin. They are distinct days, booked individually, and I teach both of them one-to-one.

One-to-one is a deliberate choice. Foundation training is where your habits are set. I would rather spend a full day with one trainee, building the reasoning properly, than split my attention across a group of six on the day their technique is being formed.

After a foundation day with me, you leave ready to start treating patients independently - with a clinical decision-making framework, not just a technique portfolio.

You leave able to recognise when a treatment is inappropriate for a specific patient, explain why clearly, and manage that conversation professionally.

You leave able to spot the early signs of an adverse event, start management without delay, and know when and how to escalate.

And you leave documenting your clinical reasoning in a way that is defensible to your insurer and transparent to your patient.

What I do not promise: that you will leave commercially successful, fully confident, or finished with your training. Those come with time and support - which is exactly why every foundation practitioner I train has access to the wider network afterwards.

Foundation Filler and Foundation Toxin: one-to-one, in person, Newcastle, arranged at your convenience. Investment: 1,500 each.

Link in Bio, or DM me if you want to discuss it further

The anatomical knowledge that underpins injection safety has been built mostly on cadaveric studies. These studies are invaluable. They are also not enough on their own for clinical decision-making.

The limitations:

First, cadaveric tissue does not behave the way living tissue behaves under injection pressure. Dissection findings do not translate directly to the treatment room.

Second, anatomical variation in the face is significant and well-documented. Cadaveric studies report mean positions and ranges. The individual in front of you may sit outside those ranges in ways that matter clinically. The individual that the anatomist was studying to write the textbook may have been outside the norm.

Third, vessel wall compliance and the behaviour of filler under pressure in living tissue differs from cadaveric models.

What does this mean for us as injectors? Cadaveric anatomy gives you a framework and a probability distribution. It does not give you certainty about the individual. This is not a criticism of the cadaveric literature - it is an argument for reading it critically and understanding what it can and cannot tell you.

References: Cotofana et al. (2017) on facial vascular anatomy. Sattler et al. on injection safety anatomical frameworks.