Introducing GEM: The Global Evidence Matrix for Aesthetic Practitioners

Harley Academy has today announced its launch of GEM: The Global Evidence Matrix for aesthetic practitioners, at IMCAS Paris.

If you’ve ever been concerned by the lack of standardisation and evidence-based protocols in aesthetic medicine, then worry no more!  

GEM by Harley Academy is a groundbreaking innovation that standardises the administration of cosmetic injectables, evidenced by regularly updated clinical safety data. It provides all the details clinicians require to complete aesthetic treatments in the safest possible way, based on their skill level.

GEM, reinforced through an accessible interactive tool: 

• Aligns aesthetic medicine with other medical specialties
• Elevates practitioner outcomes
• Enhances patient safety standards
• Provides a roadmap for clinician development, from novice through to expert
• Creates a framework for robust aesthetics regulation.

More than that, it offers every user the chance to help shape the evolution of safe aesthetic practice.

So what is GEM and how does it work? Let us explain - and read on for our interview with its creator, Dr Tristan Mehta, for the full insights…

What is GEM?

We’ll start by detailing exactly what GEM is and how it came about with input from its key players, Harley Academy Founder and CEO, Dr Tristan Mehta and our Academic Director, the renowned anatomist and researcher, Professor Sebastian Cotofana.

Explaining the Global Evidence Matrix

GEM is a set of principles developed to standardise our industry’s approach to delivering injectable treatments. 

Split by skill level - developmental stage 1 (novice), 2 (intermediate), and 3 (expert) - GEM is a roadmap for the safe administration of every injectable treatment. 

GEM is delivered via what’s essentially an interactive online textbook like nothing you’ve seen before in aesthetic medicine. At its heart is what Dr Tristan calls “the periodic table of injectables” - a universal framework applicable to any product range.

This walks you through every aspect of how to administer injectable treatments based on your experience level, using up-to-date, evidence-based information. The online GEM platform offers both ‘at-a-glance’ checklists and exquisite detail on how every treatment should be administered across all areas of the face, alongside animations and video demonstrations.

These experience levels are based on published research undertaken by Professor Sebastian Cotofana, and a team including Dr Tristan Mehta and industry luminary, Dr Arthur Swift.

Breaking down injectable treatments

GEM uses exclusive video demonstrations, animations and online guides to cover how to administer injectable treatments, such as dermal fillers and biostimulators. 

It breaks treatments down into facial zones and describes the ‘Key Concepts’ for each.

The individual guides that make up the matrix include the following information for each treatment within that zone, all evidenced with sources made available:

• Vascular Risk
• Technical Difficulty
• Injection Technique
• Clinical Indications
• Device (optimal tool to be used, including size information)
• Aspiration (yes or no)
• Injection Depth
• Anatomical Placement (where the product ends up)
• Product Category (eg. optimal GPrime for filler products)
• Recommended Total Product Volume (per hemi-face treatment).

A high-definition, narrated video demonstration is available for every treatment, in every facial zone.

From lip filler to non-surgical rhinoplasty, every filler treatment is clearly set out in a standardised, evidence-based framework for the very first time. The fact that every aspect of GEM is based on real-world evidence which is regularly reviewed and tailored to your specific aesthetics experience level is what makes it so special and so unique.

If you’ve ever considered trying a new filler treatment but weren’t sure if it was ‘too advanced’, this will instantly provide the answer. It’ll also act as the perfect companion to your practical aesthetics training.

GEM is further bolstered by a series of live webinars with Harley Academy and Professor Sebastian Cotofana. These provide cadaveric insights into facial anatomy and delve further into the latest aesthetic medicine research, as well as their matrix applications.

How did GEM come about?

GEM is the brainchild of Dr Tristan Mehta, the original innovator of the Level 7 qualification in injectables. 

As a leader compelled to drive up safety standards through education, Dr Tristan wanted to create a tailored roadmap for each injectable treatment. Something that relied on up-to-date evidence, just as you’d find in any other area of medicine, rather than simply opinion.

“It’s a very interesting time right now because we are quite divisive in medical aesthetics, in terms of how practitioners treat patients,” shares Dr Tristan. “Particularly when it comes to injectables.

“There are a lot of opinions and a lot of pharmaceutical companies wanting to push their own product and their own techniques. In reality - especially over the last 10 years - there’s been a huge amount of published research and data that suggest there are specific ways to inject that do lead to increased safety and offer better outcomes. This comes from both research insights and anatomical insights.”

“A right way and a wrong way to inject”

He highlights, “There is increasingly a right way and a wrong way to inject.

“Even within our Harley Academy faculty of 20 to 30 injectors, we each have our own ways of doing things and our own techniques. Whilst there is room for individual preference, the fundamental ideas of which anatomical target is being injected and how to get the needle or cannula into that target is the thing that needs to be standardised. 

“It makes total sense that for injectables, which are medical procedures, we have guidelines much as we have guidelines for other medical procedures. I think it’s only a matter of time before aesthetics becomes much more like this. So what we wanted to build was the first set of evidence-based guidelines for injectables that are transferrable across different product ranges in any category of patient.”

Partnering with Professor Sebastian Cotofana

When asked how he went about creating the Global Evidence Matrix, Dr Tristan explains, “I needed to have an authority on the anatomy of the face and the current status of the research-base. For that, the obvious choice - the only choice - was Professor Sebastian Cotofana.”

This alignment was obvious given Prof. Cotofana’s well-known mantra, “evidence-based not eminence-based”.

Dr Tristan notes, “GEM is built on first thinking about where the product needs to go - and stay - and working backwards. We could have built GEM on multiple things - did we focus on products? Did we focus on danger zones? On the technique and how you hold the cannula or how we aspirate? 

“The main thing that ties all the GEM ideology together is focusing on where you want that gel to go and then thinking about the safest way to get it there and the most effective way to get it in there, based on your experience and based on your development stage.

“If we then have this framework focusing on where the products need to go, then it doesn’t matter which product you’re using or why you’re injecting it into that zone. The reason why you’re injecting is down to your assessment and your treatment plan. But when it comes to doing the actual injections, this comes down to what I call a ‘periodic table of injectables’. This is every single possible injection broken down into its fundamental elements and that was the idea behind GEM.

“I approached Sebastian Cotofana three years ago, I pitched him this idea and told him I needed him to make it work.  So we started with the research that we did on determining which injection zones were considered ‘high-risk’ and which were considered ‘difficult’.  And this was the research paper Identifying Levels of Competency in Aesthetic Medicine. 

Developing the Global Evidence Matrix

Talking about their research project, Dr Tristan says, “It was critical that we identified, for the first time ever, what constitutes someone who is a novice, competent or expert injector. We’ve called these developmental stages 1, 2 and 3. 

“It was really important to do that because people need guidance on this. I think a lot of people want to call themselves a ‘master injector’ after practising for six months. Actually, for true expertise, our research shows that it’s more like completing 2,000 fillers to get to what the consensus would consider an expert. 

“So the volume of cases is definitely correlated with expertise, but we know that’s not perfect because you can also be doing things wrongly thousands of times. So we also need to look at that in the context of how they’re actually practising. 

“The competency research paper, which I was the second author on after Sebastian, was the framework upon which we built the development stages and started to map all these different injectable targets across the face. That was the backbone,” he tells us.

“Once we had that, we needed to bring it to life and to do that, we’re working with a 3D artist who’s creating these beautiful visuals. I think, even if you’re looking at dissection videos or are in the cadaver lab, a really nice 3D visual and animation is the best way to think about where that needle or cannula is going to go.”

Making GEM accessible 

“In addition to the 3D visuals, we also needed to tie GEM together into more of a narrative,” notes Dr Tristan. 

“We took all of the hardcore science and research evidence principles and gave them more of a conversational tone. GEM’s language, which we’re very intentional about, makes it more accessible. 

“We guide injectors through the different facial zones, talking about ‘Key Concepts’ that they need to understand as they move between them. We also give practitioners an idea of which treatments are suitable for them to practice, and which ones aren’t, based on their experience.

“Hopefully GEM is useful for any injector whether they’re a beginner or whether they’re an expert, to see if they’re injecting in line with what the current understanding of anatomy and injection techniques suggests. 

“The text that accompanies GEM and its videos, is intended to be an ideal reference for how to safely get the gel into the anatomical target of choice. As close as you can be to that, should be the best way to inject in any given year that GEM is teaching.”

Professor Sebastian Cotofana confirms, “Based on our recent research findings, this innovative curriculum integrates injector competencies, anatomic knowledge, and scientific evidence. I am confident this system will empower injectors globally to enhance their practice, ensuring safety and excellence in patient care.”

How GEM fits with Harley Academy aesthetics courses and approach to education

“With aesthetics regulation coming, people need to have standards and those standards are still up in the air in terms of higher education. 

“Harley Academy is leading a vision for what higher education should look like in aesthetic medicine. But the way I describe GEM is that it’s like the other side of the coin. On one side of the coin, you’ve got the qualification - the broad understanding of how to practise aesthetic medicine. You cover things like ethics, psychology, anatomy and product science. Whereas GEM is the very specific directive teaching on how to inject. And you need both,” he confirms.

“You need the broad understanding of the field to become a specialist, but you also need to know how to practise and that GEM component - how to inject and why you inject in certain ways - that will change every year.”

“The Harley Academy curriculum, with the Level 7, doesn’t change much as that’s the field of aesthetic medicine and the fundamental concepts that will stay there forever. When it comes to GEM, it needs to be updated every year because practice changes every year. It’s a much more agile framework and standard that we’ve built that I’m super excited to get out there and start to iterate.”

GEM principles are embedded into all Harley Academy’s filler courses

“All our Harley Academy aesthetics courses are now taught using GEM principles,” notes Dr Tristan. “Whether you’re learning the basics or mastering advanced techniques, GEM provides a structured, evidence-based roadmap for safe and effective practice. All filler treatments carried out at The Academy Clinic - our training clinic - are conducted using GEM approaches.

“By embedding GEM principles into every stage of our training, we’re not just preparing our students for today’s challenges. We’re equipping them to meet the future requirements of regulation head on.”

Dr Tristan rounds off, “Harley Academy is all about driving up standards, promoting patient safety and creating structure for people to progress as they learn. GEM is going to be a new focus for Harley Academy as we start to propagate this exciting new standard. I’m really looking forward to seeing how it’s received. I’m even looking forward to the criticism and negative feedback as it can all roll into continuous updates - that’s the whole idea.”

Who can use GEM and how do we access it?

Access to GEM via its online platform, hosted on Harley Academy’s Comma network, will be made available via a subscription. 

As part of a phased rollout, this will initially be made available to the following cohorts:

• Harley Academy current trainees undertaking any of our Level 7 courses
• Recent Harley Academy Level 7 graduates who still have an active eLearning platform account.

Free for Harley Academy Level 7 trainees and recent graduates

GEM is included free of charge for our Harley Academy Level 7 trainees for one year. It’s also available to our Level 7 graduates with live eLearning platform accounts, for as long as their accounts remain active. This will provide exclusive, private access to the full Global Evidence Matrix tool.

This free one-year subscription forms part of our Level 7 Diploma in Cosmetic Injectables course package. This applies to all our Level 7 courses, including our Level 7+ and Fast Track Level 7 options.

GEM access for these groups will go live on 10th February 2025. Student Support will contact you with all the details nearer the time so you can utilise this valuable asset.

How to purchase a GEM subscription

Once the initial Level 7 rollouts are completed, we’ll start to make GEM available to other Harley Academy trainees, graduates and other industry professionals. 

This will be via a paid annual subscription.

We’ll announce these details in due course but, in the meantime, look out for updates and insights from GEM to show you what you’ll be able to add to your toolkit. You’ll find these here and on our social media channels.

It is truly an immense asset that every clinician interested in improving their skills, safety levels and standards of patient care should invest in.

As Dr Tristan says, “With GEM, you’re not just improving your own practice, you’re contributing to the transformation of the aesthetics industry. Together we can create a safer, more evidence-driven future for practitioners and patients alike.” 

We look forward to revealing more about GEM in the coming weeks and can’t wait for you to experience it!

All information correct at time of publication