ADvERtISING · Intense pulsed light (IPL) entered the market ... Florida. The treatments can be used both on and off the face, says Patrick Bitter Jr., MD, of Advanced Aesthetic Dermatology,

vo

lum

e 2

Nu

mb

er

3sp

rin

g e

dit

ion

2009

Endo

rsed

by

SKINCARE & SKIN NEEDLINGby Dr Des Fernandes

ADvERtISING

ACCREDItED FOR

1 EtHICS CPD POINt

PER ISSUE*

SHAPEof things to come

Practitioner Services *

Scientif techologies ad.indd 1 21/2/08 5:19:40 PM

MedEsthetics | Southern Africa

‘Tis ThE sEason To bE bEauTiful!

note from the editor

In South Africa, despite the still chilly weather, patients are again starting to stream towards aesthetic medical practices to enhance their appearance in due time for the season of all seasons.In a very interesting philosophical book by Yuriko Saito called ‘Everyday Aesthetics’ the author comments on the appreciation of the atmosphere of the summer season and how it is considered by most: “…the aesthetic appreciation of the unified atmosphere expressive of a particular season sometimes supercedes peoples concern with comfort”. It’s an inspiring book commenting on how we take everyday aesthetically pleasing aspects and objects for granted.

The period from September through to December is filled with more than just an improvement in climatic conditions and reduced layers of clothing. This is also the time of the year filled with year-end parties, matric farewells, reunions, weddings, getting into your swimwear at the beach and all those very important events where one has to show how you did not let go of yourself during winter (and the past few years)! This is the time of the year where patients start reallocating their budgets towards improving their appearance. One cannot hide under layers of clothing anymore and the atmosphere of renewal in nature brings similarities forth in the human race.

The annual Aesthetic Medicine Congress of South Africa, where most of you would have received this issue from, is ideally placed

in the beginning of our season to bring all the new ideas and innovations from all over the world to be used on our patients. This issue brings some updated news on various aspects that you will find useful. We have the honor of featuring one of our Proudly South African medical experts, Dr Des Fernandes. Dr Fernandes has not only gained respect from local peers but also internationally. He has done a lot for the growth of both plastic surgery and aesthetic medicine in South Africa.

This issue features some updates on two dermatological conditions, Acne and Rosacea. You will find a variety of updated information and newly launched innovations that will appeal to all tastes. Two major announcements in Aesthetic Medicine in South Africa is the introduction of a Post Graduate Diploma in Aesthetic Medicine and very importantly, the fact that South Africa has won the bid to host the 19th World Congress of Aesthetic Medicine in 2013 in Cape Town. This will be a major stepping stone for the industry, our doctors and our country. We are very proud of this achievement. This event will be held at the Cape Town International Convention Centre. Organizing and marketing has already commenced to make sure that this will be the best of the past 19 events ever and to show what South Africans are capable of. This will be the first international event on aesthetic medicine to be held in Africa.

Happy reading and we hope that this issue of MedEsthetics will help to prepare you for this season!

Dr Riekie smitMedEsthetics southern africa Editor

MedEsthetics | Southern Africa � MedEsthetics | Southern Africa

bad Debt - sign of the Times?

note from the publisher

With our foray into the new field of medical aesthetics with the journal that you are now reading we have certainly seen a different side of the coin. Most of the companies in this field are smaller companies or agents and cash flow might therefore more often be a problem. We as the publisher of MedEsthetics Southern Africa survive purely on advertising revenue and the equation therefore is simple – no advertising no journal! Sadly it seems that some companies run advertising and draw the benefit of this exposure with no intention of paying for this service. These companies are missing the boat when it comes to all building long term relationships and establishing a winning paradigm for all – reader, advertiser & publisher as a break in this link puts the publication at risk. What further amazes me is that no one ever responds to any queries but seem to have the ostrich syndrome, ignore it and it will go away! You would think that companies like Ikosoft, Morningstar Surgical, Squabb Technologies and Ergon Medical would have professional systems in place and would pay what is due, certainly not delay payment for more than six months!

Enough on the negative side.We have had very good feedback to this publication and believe that as a journal that features both international and local articles we are adding value to your professional business/practice reading. With this in mind we have inserted a loose leaf questionnaire for you to please complete and fax back as this will ensure that you continue to receive the journal. Any suggestions to improve will also be most welcome and can be sent to me or our editor Dr.Riekie Smit.

Enjoy our latest offering!

Reni RouncivellMedEsthetics southern africa Publisher

It would be interesting to note whether you as a practitioner are seeing more bad debt from your private patients, it seems that no one is immune from the current recession? We as medical publishers with nine titles in our range have been fortunate enough to escape this unfortunate scenario until now as most of our advertisers have always been the big pharmaceutical companies and they are eminently trustworthy.

MedEsthetics | Southern Africa �

MedEstheticssouthern africa

PublishER

Reni RouncilvellMedSpec Publishing

PO Box 12973 · Clubview · 0014South Africa

T +27 (0) 12 661 3294Mobile +27 (0) 82 441 6904e-mail [email protected]

salEs & aDvERTising

Lelani WearingT +27 (0) 12 661 3294

Mobile +27 (0) 79 512 6990e-mail [email protected]

Johan SmookT +27 (0) 12 661 3294

Mobile +27 (0) 83 653 8411e-mail [email protected]

subsCRiPTion & aCCounTs

Elizabeth VersteegMobile +27 (0) 72 189 8499

e-mail [email protected]

DEsign & laYouT

Sonja van NiekerkMedSpec Publishing

T +27 (0) 12 661 3294Mobile +27 (0) 82 444 0231e-mail [email protected]

DisClaiMER This publication contains selected items originally published under license from

Creative Age Publications in the USA.

This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights for translation, reprinting reuse of illustrations, broadcasting, reproduction of CD-Rom, microfilm, online publication, or in

any other way, and storage in data banks.

The use of registered names trademarks etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt for the relevant laws and regulations and therefore free for general

use.

Product liability: the publishers cannot guarantee the accuracy of any information about the publication of medications contained in this publication. In every individual case, the user must check such information by

consulting the relevant literature.

contents...

1 note from the editor

2 note from the publisher

ColuMns 34 BUSINESS CONSULTANT a model for success

38 NEWS MAKERS new wrinkle relaxer approved in SA

40 DETAILS laser assisted lipolysis

52 BEST PRACTICES 54 INTRODUCTIONS 58 PRODUCT REVIEWS 60 NEWS & EVENTS

fEaTuREs 6 ray of light

12 the difference is clear

18 skincare & skin needling

20 advertising practitioner services

26 shape of things to come

34 a model for success

42 get the red out

48 keep it simple

6

spring edition �009

MedEsthetics | Southern Africa�

20

Intense pulsed light (IPL) entered the market as an alternative to laser treatments for indications including permanent hair reduction and skin rejuvenation. In the past 12 years, IPL devices have become a mainstay in many medical aesthetic practices thanks to their ability to offer immediate results with minimal pain and short recovery times. Some of the latest advances in IPL technologies include increased energy, better cooling and new handpieces that filter specific wavelengths to offer optimal results for some of IPL’s most notable indications.

RAY OF

LIGHT

ray of light KEY FEATURE

RAY OF

LIGHT

ToP inDiCaTions IPL was first touted as an alternative to laser treatments for permanent hair reduction but has since become the device of choice for many practitioners as they address dyschromia and facial telangiectasias. “IPL is excellent at treating photodamaged pigmented lesions and generalized dyschromia,” says Jill S. Waibel, MD, of Palm Beach Esthetic Dermatology & Laser Center, West Palm Beach, Florida.

The treatments can be used both on and off the face, says Patrick Bitter Jr., MD, of Advanced Aesthetic Dermatology, Los Gatos, California, who uses the

Sciton BBL and Syneron eLight. “I get really spectacular results in the treatment of sun spots and freckles on nonfacial areas including the neck, hands and chest,” he says. “I prescribe five treatments with the BBL, but patients see results after the second treatment.”

For patients with significant dyschromia or hyperpigmentation, Vic Narurkar, MD, of the Bay Area Laser Institute in San Francisco, pretreats the skin with hydroquinone for three to four weeks before beginning IPL therapy.

Although some gradual collagen remodeling has been reported with IPLs, the extent of wrinkle correction is generally limited to improvement in the appearance of fine, surface wrinkles. “You see color improvement and improvement in texture because of novo collagen deposition,” says Dr. Narurkar,.

A 2000 study by Dr. Bitter (Dermatolog Surg) showed a 28% reduction in wrinkles following IPL treatment. A 2005 study by Neil Sadick, MD, et al (J Drugs Dermatol), using a combination IPL plus radiofrequency device showed that “overall average wrinkle improvement was 41.2%.” The most significant improvement was seen in Class 1 wrinkles.

In addition to improving skin tone and texture, Dr. Bitter notes that IPL is

bEfoRE afTER

Phot

o co

urte

sy o

f sci

ton

facial dyschromia and photodamage-related hyperpigmentation remain top indications for iPl and broadband light treatments.

Phot

o co

urte

sy o

f sci

ton

in addition to facial treatments, iPls are becoming increasingly popular for off-the-face indications. The sciton bbl was used to reduce freckling and improve skin tone on this patient’s hands.

bEfoRE afTER

Volume 2 Number 3 Spring Edition 2009 | MedEsthetics �

MedEsthetics | Southern Africa �

unsurpassed in the treatment of rosacea. “IPL and Sciton BBL are the best treatments in the world for redness and telangiectasias associated with rosacea,” he says. “No other laser or medical treatment will work like a series of IPL for this indication.”

When it comes to permanent hair reduction, opinions are mixed. Mitchel Goldman, MD, of La Jolla Spa MD, La Jolla, California, does not use an IPL for hair removal, preferring the targeted wavelengths of a laser, while Dr. Bitter reports that he achieves “the best results with my Sciton BBL. It works as well or better that any of my lasers for hair removal,” he says.

Dr. Bitter uses a three pass technique, “with fairly conservative settings,” he says. “After one treatment, patients experience a 50% to 75% reduction with 25% to 50% regrowth. Following multiple treatments, we see a permanent reduction of 50% to 75%.”

Oculoplastic surgeon Wendy Lee, MD, and husband Michael Lee, MD, a plastic surgeon, chose the Palomar StarLux 500 for their Kendall, Florida-based practice, thanks to its multiple handpieces that offer large spot sizes, designed specifically for permanent hair reduction. “The StarLux is faster than a large spot size Nd:YAG laser, and it is generally safer for patients,” says Dr. Wendy Lee. In addition, IPL equipment tends to be less expensive than a laser device, making it a popular choice for patients and physicians.

“I can treat both arms in 16 minutes, and I charge $500,” says Dr. Bitter. “It’s a reasonable fee for my patients and still quite profitable for me.”

IPL treatments have also found a place as a viable option for port wine stains, particularly in patients who have experienced poor results with the more commonly used pulsed dye lasers (Bjerring, et al, J Cosmet Laser Ther, April 2003).

“The appearance of red and purple scars and stretch marks can be reduced with IPL or BBL,” says Dr. Bitter. “But the results are limited for white scars.”

For actinic keratoses, Joely Kaufman, MD, of the University of Miami Cosmetic Center, Miami, recommends photodynamic therapy (PDT) with aminolevulinic acid and IPL. “Several studies show use of these photosensitizers with IPL provides better efficacy and greater results than IPL alone,” she says.

CoMbinaTion TREaTMEnTs Several physicians are achieving high patient satisfaction

rates by combining IPL treatments with other procedures. “For patients who don’t want surgery or downtime, but desire more correction than IPL alone can provide, combining IPL with Botox and dermal fillers for volume enhancement is a patient-pleasing combination,” says Dr. Bitter.

Hema Sundaram, MD, founder and director of Dermatology, Cosmetic & Laser Surgery in Rockville, Maryland and Fairfax, Virginia, is investigating the use of pre- and post-procedure

Phot

o co

urte

sy o

f Dr.

stev

en P

atte

rson

iPls are effective at targeting

visible blood vessels. These

results were obtained using

the Palomar starlux.

bEfoRE afTER

skincare to improve results. “I’m working with ceramide-based skincare products developed for atopic dermatitis to improve skin barrier function,” she says. “It reduces inflammation of the skin following the IPL treatment and appears to improve the results of the treatment.”

Dr. Bitter recently launched a research project to study the effect of ongoing IPL treatments on skin aging. “This is potentially a huge area,” he says. “I’ve treated patients with 10 to 11 IPL sessions, and the observation is that their skin is aging more slowly.”

aDvanCEs in TEChnologY IPL technology has greatly improved since its inception. According to Dr. Goldman, early devices were not popular, since operators had to pass through layers of gel to reach the target. The cooling devices and sapphire windows on today’s IPL devices eliminate the need for gel and have increased efficacy. Milan Shah, MD, of Dr. Shah & Associates, Bakersfield and Malibu, California, notes that the treatment time of his original IPL device was seven times longer than his current device. “And I didn’t have as much control in terms of pulse duration and thermal cooling times as I do now,” he says.

Contact cooling is the most significant advance in the safety of IPLs, according to Dr. Narurkar. “The newer generation of IPLs with contact cooling and a better selection of filters allows me to safely treat all skin types,” he says. “With the Palomar Starlux, for example, I treat fair skin for 10ms to 20ms at 36 J, and Asian skin for 40ms at 20 J to 26 J. For darker skin types, I reduce the energy and increase the pulse duration.” Dichroic filters are another notable advancement. “They offer a more specific range of wavelengths to affect the target you’re after,” says Dr. Narurkar. “They allow the IPL to behave more like a laser than the original, nonspecific IPL.”

The range of filters on the Ellipse I2PL impressed Dr. Waibel. “They have so many filters that you can block everything down to 500nm if needed with an upper range cut-off limit of about 900nm,” she says.

Dr. Shah also appreciates the filters on his Lumenis One. “They allow for more treatment applications and better safety in all skin types,” he says.

KEY FEATURE ray of light

5390 cetaphil med ad A4.fh11 4/23/09 5:48 PM Page 1

Composite

C M Y CM MY CY CMY K

MedEsthetics | Southern Africa 10

The Sciton BBL offers interchangeable filters for specific indications while systems including the Lumenis One, Ellipse MultiFlex, and Cutera Limelight and Solera Opus, offer a combination of IPL handpieces plus laser modules that allow you to use a variety of technologies in one treatment room for permanent hair reduction, vascular concerns, acne and more. New handpieces—such as the Lumenis One Universal IPL handpiece—also feature ergonomic designs for both right- and left-handed doctors to reduce fatigue.

The Palomar Starlux offers several handpieces for the treatment of rosacea and acne; pigmented and vascular lesions; photorejuvenation; and permanent hair reduction. “The Palomar is also advantageous because the handpiece can be changed to a fractional laser,” says Dr. Wendy Lee.

Dr. Sundaram works with the Syneron eLight system, which allows her to offer the FotoFacial RF for superficial vasculature and telangiectasia as well as Refirme noninvasive skin tightening. “These next generation IPL/radiofrequency devices offer an immediate effect on skin appearance, followed by progressive skin tightening due to collagen remodeling,” she says.

Preset parameters have also made today’s systems easier to operate and safer than earlier units.

CoMPliCaTions anD ConTRainDiCaTionsAlthough IPLs are often marketed as easier to use, less painful and safer than lasers, they are not without risk. “IPLs are effective, but they can cause burning, especially when used by those who are not familiar with the device and its settings,” says Dr. Wendy Lee.

Mild redness is to be expected after IPL treatment. Some transient erythema and darkening of age spots can occur as well, says Dr. Shah. If a patient is burned during the procedure, Dr. Wendy Lee recommends the application of Humatrix (Care-Tech Labs, caretechlabs.com), which cools the skin by about 10°F in 3 minutes, as well as ice packs.

Because topical numbing cream can cause vessel constriction, it is discouraged during the treatment of pigmented and vascular lesions, says Dr. Wendy Lee. Pain will be greater in patients undergoing hair removal in areas with coarse hair. For these patients, Dr. Waibel does use a topical numbing cream to improve comfort.

Zebra striping can also occur in some patients. “We tend to see striping in patients who have an active tan,” says Dr. Goldman.

Choosing an iPlThe effectiveness and resulting popularity of IPL treatments has led to an influx of these systems in the medical aesthetics market. When choosing a system for your practice, cost is certainly a primary concern. In addition to the initial investment, be sure to factor in the cost of consumables, if applicable.

Your training and the experience of the technicians who will be using the device in your practice may also play into your device choice. If you have little experience with these procedures, a device with preset treatment parameters may be preferred. However, as one gains experience with IPLs and acquires more patients, other factors come into play. The size of your treatment room and the footprint of the unit should be considered as well as the indications you plan to treat.

If you plan to treat multiple indications, an upgradeable unit with multiple handpieces offering a variety of filters and spot sizes may be a good option. “Most physicians choose one IPL device and then attach multiple handpieces to it,” says Dr. Kaufman. “They’re all different, so you do want to think about your patient demographics and what you plan to do with the device.”

The perception of IPLs has improved significantly since their introduction more than a decade ago, and their role has become firmly entrenched in many practices. “The IPL is the workhorse of our practice, and is used 5 to 10 times a day for so many applications,” says Dr. Narurkar. “The newer generation of IPLs are safer, more ergonomic and offer enhanced patient care.”

Ingrid Schaefer Sprague, a Broadview Heights, Ohio-based freelance writer, specializes in medical journalism.

REsouRCEsALMA LASERS - SqUABB TECHNOLOGIES,

[email protected], 012 667 5304

CUTERA - ERGON MEDICAL, [email protected], 011 454 1876

CYNOSURE - [email protected], 0800 110 679

ELLIPSE - [email protected], 012 349 1750

LUMENIS - [email protected], 012 349 1250

PALOMAR - GENOP [email protected], 011 545 6600

SCITON - [email protected], 0800 110 679

SYNERON - RADIANT [email protected], 011 794 8253

KEY FEATURE ray of light

Volume 2 Number 3 Spring Edition 2009 | MedEsthetics 11

safe technologyGreat was the excitement when in the laser era not so long ago, many technologies promised permanent hair removal and even took advance payments. We have seen several of these clinics and institutions ending up in disrepute and serious legalities.

A better understanding of hair growth mechanics has now reduced permanent hair removal to hair reduction to various degree and permanent hair removal only in some cases.

The Alexandrite laser (755 nm) was a good laser choice for hair reduction due to the optimal absorption of melanin at this wavelength – the only limitation being cost and maintenance of the laser. With the advent of the IPL technology it was found that some IPL devices rendered similar results. In a bench mark study the Ellipse I2PL advanced technology was found to give a similar result and only slightly better with the added advantage of including all skin types and requiring far less energy, heat and pain (dual technology) entering the “safe technology” compared to other IPL & laser systems.

When some IPL systems failed to equal the Ellipse efficiency and safety standards, they resorted to additional means to achieve similar efficiency. One example was adding radio frequency to the IPL system to compensate for the inadequacy of the IPL system alone.

The combination delivered more heat to the melanin in the follicle affording the required 70ºC at 1 ms for permanent damage without relying on the light source alone and without compromising the skin and safety. As much as 25 J/cm² is reached by bipolar radio frequency compared to only 13 J/m² with the Ellipse I2PL required for efficient hair removal.

This is probably the reason why an increasingly number of doctors are wary of RF due to consequences seen e.g. plastic surgeons wanting to do conventional face lift see that after RF procedures, collagen has become integrated (melted) into lower tissue structures. The risk of fibrosis and bone necrosis under the skin has also been mentioned with the application of RF. Radio frequency is an easy and rapid way to achieve skin shrinkage even body contouring but with the risks mentioned above.

In the hay-day of RF some years ago the Ellipse stable investigated the addition of RF to their already well-known I2PL results only to find that the RF in the case of the Ellipse I2PL made very little difference attesting the high level of efficiency and safety. Even in the case of light hair, blond or aging hair, hair reduction is found especially if the follicles contain melanin. But clinics are encouraged to inform their clients that the results can be mixed depending on melanin content of follicles.

ThE CaRTE blanChE DEbaTERecently a Carte Blanche programme exposed serious damage to patients subject to IPL or laser treatments. On investigation it was revealed that the main cause was inadequate training of users and the technology of some devices. Dark skin or compromised skin as a high risk. For this reason Ellipse with the automatic and built-in safety technology has so-far avoided damage or permanent lesion world wide despite more than 3000 machines in more than 60 countries.

HAIR REMOVALADVERTORIAL

THE DIFFERENCE IS

CLEAR by

Dia

ne

Do

no

frio

ang

elucc

i©

isto

ckph

oto.

com

OPTIMIZING ACNE TREATMENTS

By the time an acne patient arrives at your doorstep, she has likely tried, and been disappointed by, an array of over-the-

counter lotions and potions. Fortunately,

today’s acne treatment armamentarium features a wide range of tools - from topicals and oral medications to laser- and

light-based treatments - that you can use to design a

customized regimen to help your patients achieve the clearer skin

they seek.


Young asian male with inflammatory papulopustular acne following treatment with isolaz (aesthera).

Photo courtesy of girish Munavalli, MD

bEfoRE afTER

nEw oPTions foR MilD To MoDERaTE aCnE“The most effective acne treatments rely on a combination of medications to target the four causes of acne: follicular plugging, sebum, P. acnes and inflammation,” says Julie C. Harper, MD, of the Dermatology and Skin Care Center of Birmingham, Alabama, and clinical associate professor at the University of Alabama-Birmingham. Mild acne can often be successfully controlled with topical retinoids used alone or in conjunction with a benzoyl peroxide/antibiotic combination product, says Dr. Harper.

Amy Forman Taub, MD, medical director of Advanced Dermatology in Lincolnshire, Illinois, and assistant clinical professor, Northwestern University Medical School department of dermatology, uses a retinoid and antibacterial for mild acne. For moderate cases, she adds oral antibiotics or laser treatment with the Isolaz (Aesthera, isolaz.com).

To achieve the best results, Dr. Taub suggests combining topical agents formulated to unblock pores and reduce oiliness (i.e., salicylic acid, alpha hydroxy acids, retinoids or retinol) with products that kill bacteria (i.e., benzoyl peroxide or topical antibacterials). She also has found a new topical cosmeceutical—SebRx analgesic gel (Revision Skin Care, sebrx.com), which provides significant pore reduction and oil control without drying—for retinoid-sensitive patients.

“We’re fortunate,” says Michael H. Gold, MD, owner of Gold Skin Care Center, medical director of Tennessee Clinical Research Center, Nashville, and clinical assistant professor, Vanderbilt University School of Medicine. “We went through a dry spell over the last couple of years with acne medicines, but in the past six months, we have had several new acne medications come on the market,” he says.

“The two standard combination topicals are BenzaClin and Duac, and I use them both frequently,” says Dr. Gold. In addition, he is prescribing a new lower concentration benzoyl peroxide/

clindamycin c o m b i n a t i o n ,

Acanya, which shows similar clinical efficacy to Duac and BenzaClin. Dr. Gold advises his

patients to care for their skin at home with the Clarisonic Skin Care Brush (Pacific Bioscience, clarisonic.com) and Tända Clear Acne Light Therapy (Pharos Life Corporation, tandaskincare.com), an LED home device that emits both blue and red light.

For noninflammatory mild to moderate acne with blackheads and whiteheads, Hilary E. Baldwin, MD, associate professor of the SUNY Downstate Medical Center department of dermatology in Brooklyn, New York, generally recommends a topical retinoid alone. In more moderate cases, she prescribes a combination retinoid with benzoyl peroxide, and for primarily inflammatory acne, a combination topical antibiotic with benzoyl peroxide, in addition to the topical retinoid.

“If the patient is a woman with a significant hormonal component to her acne, I’ll also add either birth control pills or spironolactone to calm those monthly breakouts,” says Elizabeth L. Tanzi, MD, co-director of the Washington Institute of Dermatologic Laser Surgery in Washington, D.C., and clinical instructor of dermatology at Johns Hopkins Medical Center in Baltimore.

For inflammatory acne or in cases where topical remedies have proven ineffective, patients may benefit from the addition of a systemic antibiotic. Due to the the risk of bacterial resistance, it’s important to exhaust other nonantibiotic remedies and discontinue antibiotics as soon as possible, says Dr. Baldwin. She recommends planning an exit strategy the day a patient begins antibiotics and beginning alternative therapies early in the treatment plan that will be effective by the time the antibiotics are discontinued.

Newer once-daily antibiotics, such as Doxyhexal, an extended-release minocycline that can be taken with or without food; and Minotabs, a delayed-release doxycycline, may turn out to be more effective than previous options because they improve patient compliance, says Dr. Baldwin.

TREaTing sEvERE aCnEWhen addressing more severe cases of inflammatory or cystic acne, isotretinoin (Roaccutane) remains the gold standard. It addresses all four factors of acne, says Dr. Baldwin, and remains the only standalone medication capable of actually curing acne.

the difference is clear KEY FEATURE

MedEsthetics | Southern Africa 1�

“Eighty percent of people who take a full course of isotretinoin never have acne again,” says Dr. Baldwin.

For patients with severe acne, Dr. Taub recommends isotretinoin or photodynamic therapy (PDT) with intense pulsed light.

EvaluaTing lasER anD lighT oPTionsLaser- and light-based treatments for acne have become increasingly popular for patients who have acne scarring, those who desire a quick result, and in cases where topical and systemic approaches have either failed or are deemed inappropriate. But these treatments are not reimbursed by insurance and they are not curative. Light-based devices are still trying to achieve the long-term results demonstrated by isotretinoin, says Emil A. Tanghetti, MD, who operates the Center for Dermatology and Laser Surgery in Sacramento, California, and is clinical professor of dermatology at the University of California, Davis. He has performed clinical studies for a variety of companies. “The only drug and device that has come in any way close to the efficacy of isotretinoin in very preliminary clinical trials is PDT using aminolevulinic acid (Levulan) and red light,” he says. “The blue light data where we use a photosensitizing drug and blue light is not as robust because the long-term studies are not there,” he says. “Blue light, as it’s used today, doesn’t penetrate deep enough to significantly damage the sebaceous glands for long-term results.”

Girish (Gilly) Munavalli, MD, MHS, Charlotte, North Carolina, and assistant professor, John Hopkins University department of dermatology, Baltimore, receives many referrals for device procedures. For acne, he uses the Isolaz 90% of the time. “It can handle pretty much any type of acne that you have, including mild nonscarring nodulocystic,” says Dr. Munavalli. For mild to moderate inflammatory acne, he considers blue light alone, Levulan and blue light, or he combines Levulan with the Isolaz, which contains light in both the blue and red spectra.

Dr. Gold introduces the concept of lasers and light sources to his acne patients at the beginning of treatment and combines these therapies with other medications. “We do a consult and I explain to the patient that if we can add the light at the beginning, clinical studies show that we can improve her acne in as little as two to three days,” he says. “While the topical and oral medicines take several weeks to kick in.”

Based on her experience and her review of the literature on laser and light therapies, Macrene Alexiades-Armenakas, MD, PhD, assistant clinical professor and director of dermatology and laser surgery at the Yale University School of Medicine, New York, has found that PDT with a pulsed dye laser is the most effective laser treatment thus far. “I ranked laser and light-based sources as low, moderate, advanced and marked efficacy, such that we now have an evidence-based approach to evaluating these various

laser and light based systems,” she says. Although this data guides her device choices, she also factors in

other considerations. For example, she regularly uses the Candela Smoothbeam diode laser (candelalaser.com) because it is FDA-approved for the treatment of acne scars. “If I have a patient who has a mild case of acne with scarring, I may treat with the diode as opposed to PDT,” she says. “On the other hand, most patients who have resistant cystic acne or inflammatory acne are better treated with PDT using the pulsed dye laser, which also addresses red scars.” In patients with recalcitrant erythematous inflammatory cystic acne and a variety of acne scars, Dr. Alexiades-Armenakas combines treatment with the Smoothbeam and the V beam plus Levulan. “It augments the efficacy of either of the two devices used alone,” she says.

When topical and oral protocols fail, Dr. Tanzi also turns to laser and light-based treatments. “My favorite treatments for difficult acne cases include PDT for active acne and a pulsed dye laser to soften red, firm acne nodules that persist for months,” she says.

DEvEloPing a TREaTMEnT sTRaTEgYIn designing a treatment regimen, a thorough clinical examination and patient history are key. questions to determine include:• How long has the patient had acne? • What type of acne is it, and is there a hormonal component? • What treatments have already been tried, and what was

the response? • Is the patient pregnant or might she become pregnant?• What is the patient’s skin sensitivity?

“All of these factors will help me decide which treatment option is best for the patient,” says Dr. Tanzi. “There is no cookie cutter approach to curing acne.”

“We have to be very careful to make sure we get the right history, especially regarding what the patient has been using for

Reduction in acne lesions following two treatments with a photopneumatic laser (isolaz PPx).

Photo courtesy of Michael gold, MD

bEfoRE afTER

KEY FEATURE the difference is clear


her acne and for how long,” says Dr. Gold. “A lot of people use acne medications for a week or two, and when they don’t see improvement, they stop.”

Furthermore, treatment choices should be based on objective data, says Dr. Alexiades-Armenakas. “There needs to be, in my view, a logical algorithm in the way acne is approached. I will sometimes have a patient come into my office and they’re on spironolactone, yet they have no topical regimen nor have they had blood tests to assess whether they’re in androgen excess or not. We have sufficient data such that our treatment of acne should be evidence-based.”

boosTing PaTiEnT CoMPlianCEIn designing an effective treatment regimen, patient compliance is essential. Here are some tips to help patients achieve the results they desire.

Set Reasonable Expectations. “I tell patients to expect a 40% to 50% improvement at two months and 80% to 90% improvement at four months,” says Dr. Harper.

See Patients as Often as You Can. “If you’re only seeing your patients every three months, you have no control,” says Dr. Gold. Dr. Harper schedules two-month followup appointments to monitor progress and to encourage continued treatment.

Tailor Treatment to the Patient’s Lifestyle. “I ask patients very honestly while I’m putting together their treatment regimen: ‘How much time do you have to put things on in the morning? Will you regularly put things on at night?’” says Dr. Alexiades-Armenakas.

Dr. Tanghetti agrees with this approach. “The treatment will not be effective if the patient wants to do a monthly therapy, and you’ve designed a program she’s required to follow twice daily,” he says.

Educate Patients. “A detailed explanation at the first visit pays off,” says Dr. Harper. “Take control of what skincare products the patient is using and eliminate the rest. Remind patients to use small amounts of topical medications on the entire affected area, schedule short intervals of non-use, and teach the patient how to minimize side effects like drying and peeling.”

Provide Skincare Guidance. Dr. Munavalli counsels patients extensively on skin care. “Overcleaning your skin can make acne worse,” he says. He also reminds patients that occlusive makeup, ointments and concealers can aggravate acne. With light device treatments, he stresses that these are best used to control symptoms and won’t cure acne. He strongly encourages sunscreen use for at least three to five days after light-based treatments.

To improve compliance, provide instructions in writing. “If you don’t give the protocol to the patient in writing, it’s like it was never said,” says Dr. Alexiades-Armenakas.

Understand the Teen Psyche. Teens tend to expect instant results, so Dr. Baldwin reminds them that their acne won’t disappear overnight and that success depends on their willingness

to keep up with their medications. To improve compliance, she prescribes simple and nonirritating regimens. To help teens remember to take twice-daily oral medications, she recommends they place one bottle on the breakfast table and another near their computer monitor for evening use.

To achieve the best results for your patients with acne, understand the strengths of current treatments in targeting various aspects of the condition and include your patients when designing their treatment plan. “Have a wide range of options and be willing to use them in combination for the best results,” says Dr. Taub.

Diane Donofrio Angelucci is a Clarksboro, New Jersey-based freelance writer who has covered a variety of medical- and healthcare-related topics for both professionals and consumers.

The past year has seen an influx of new physician-prescribed medications to combat acne. Some of the offerings now available to your practice include:

TOPICAL RETINOIDSDifferen (Galderma, differin.com)Retin A (Janssen-Cilag)Zorak (Allergan, tazorac.com)Isotrex (Stiefel)Ilotycin-A (Aspen)Airol (Pharmaco)

TOPICAL ANTIBACTERIALSDalacin-T (Pfizer (Pharmacia))Ilotycin TS (Aspen)Stiemycin (Stiefel)Zineryt (Astellas)

COMBINATION TOPICALS WITH BENZOYL PEROxIDEAcneclear - miconazole and benzoyl peroxide (Jannsen Cilag)Acnidazil (Jannsen Cilag)Brevoxyl - benzoyl peroxide and benzoic acid (Stiefel)quinoderm - k-hydroxyquinoline and benzoyl peroxide (Winthrop)

KEY FEATURE the difference is clear

Face to Face AD_MEDes\p 5/22/09 1:34 PM Page 1

When I first showed my two year experience of skin needling in 1998, as a method to tighten and smoothen skin, I was regarded as being a bit freaky by many people. They could not understand why a process that broke down scar collagen should paradoxically also tighten skin by making more collagen. At that time I pointed out that concomitant skin care was vital in order to get a good result but because I had formulated cosmeceuticals many years prior to this, people thought that my suggestions of using vitamin A, C and other anti-oxidants was just a ploy to induce people to buy more of these cosmeceuticals. When I later introduced micro-needling of the skin to enhance penetration by piercing holes only into the stratum corneum, people thought this idea was also crazy and they doubted the results that I showed from enhancing the penetration of vitamin A as retinyl palmitate (the so-called “ineffective vitamin A”) and antioxidants. I was told at one stage by an experienced American dermatologist that there was no way that he could believe that my photographs were honest and untouched because he used machines costing about

$100,000 to get results such as I showed. On the other hand I was told by others that the results that I showed were from the skin care alone and not from the advanced penetration!

My philosophy is that needling induces changes that by themselves are not be as dramatic as we would like them to be, but that if we use a scientific skin care based on vitamin A and antioxidants that by itself produces impressive changes, then we would get better results. For me needling is either to enhance penetration or to induce regeneration of collagen and elastin etc... They should not be regarded as separate systems but should be seen as integrated ways to get the healthiest, smoothest, tightest skin

Needling and skin care both demonstrate, in differening degrees, Schopenhauers Principle that initially a revolutionary idea is mocked and then later grudgingly investigated and then finally recognised as true and of course it makes sense!

SKINCARE& SKIN NEEDLING


Today there is a plethora of companies offering needling instruments and various concepts for the best skin care regime to accompany. Many people mistakenly still place value on alpha hydroxyacids but I believe we have to get a scientific understanding of what is needed by the skin when one does any sort of needling.

My attitude towards skin care has been moulded by the research which shows that a localised deficiency of vitamin A antioxidants as one of the most important features of photoageing so therefore every patient with any signs of photoageing should be using topical vitamin A.

We all have signs of photoageing and I believe every single person who ventures out into the sun should be dosing their skin with topical vitamin A and antioxidants every day. Vitamin A stimulates epidermal growth , activates fibroblasts to produce more GAGs, more lattice layered collagen I and improves blood supply. Because one cannot make healthy collagen I without vitamin C it makes scientific sense to increase vitamin C whenever one induces greater collagen production. I can give you illustrations that show the effects of vitamin A nutrition of skin. If one enhances penetration of vitamin A and C etc, by skin needling, then even better results can be achieved. However, we need to stress that the micro-needling (cosmetic) roller or stamping device has to be used thoroughly enough to make thousands of holes in the stratum corneum so that the topical agents can reach the important cells in the skin. Idf the needles are ideal length then one will not feel any pricking at all. I can give you pictures to show the results of enhanced penetration from needling. There is a limit to the tightening that topical products can achieve with cosmetic needling and if we want more then we have to use needling that penetrates about 1 – 3 mm into the dermis.

Deeper needling is also a penetrant enhancer, there is no doubt about that, but it’s real effects come from other processes. I believe that the major reason why deeper dermal needling works is because the needles fracture tiny blood vessels in the papillary dermis and the platelets that are relaeased induce a cascade of growth factors that are responsible for thickening of the dermis and epidermis, increased collagen, GAGs and even elastin that tighten and smoothen skin. Studies at Hannover University in Germany have confirmed that elastin is produced and as far as

is known, this is the first time that a medical process has induced elastin. This signals that in fact needling causes regeneration of tissue. There is no scar formation at all and it can be safely repeated as many times as necessary to get the desired result.

I believe that is where we also need the power of vitamin A and C in order to maximise the results. Vitamin A (all forms are metabolised to retinoic acid) controls growth, differentiation and maturation of skin cells and so it has a natural role in recovery after needling. We need all the skin cells to be highly organised with the restoration of normal physiology. That is exactly what vitamin A normally does and why I believe the skin should be primed and enriched with vitamin A before and after needling. Aust also showed in a paper to be published that if one used high doses of retinyl esters with ascorbyl tetra-isopalmitate and other antioxidants then one could achieve a 22% thickening of mouse skin. If one needled the skin then one could achieve about 110 % thickening, whereas if one treated the skin with vitamin A, C etc and needled the skin then one achieved a 140% increase in thickness. That’s almost a third better just from using a scientific cosmeceutic with needling. Those results speak volumes about the scientific approach to skin care and the use of these products in skin needling. I tell my patients to use Vitmain A and C products immediately after the needling session. I do avoid retinoic acid products at this stage because they can be irritant in higher doses and immediately after effective needling penetration through the epidermis is enhanced about 10,000 fold and patients may easily develop a severe retinoid reaction. I advise them never to stop using topical vitamin A and C and antioxidants so that they can maintain and even improve on the results.

I should answer the question posed so often: why does needling work for scars with excess collagen and for lax skin that is deficient in collagen? The answer lies in understanding the release of the growth factors from the platelets. Some growth factors promote the breakdown of damaged scar collagen whereas others e.g. TGF-beta-3 promote the regeneration of tissue with laying down of normal lattice-work collagen and elastin.

Dr Des Fernandes

Renaissance Body Science Institute183 Bree Street Cape TownEmail: [email protected]

local article KEY FEATURE


Medical practitioners in South Africa have long accepted the convention that medical practitioners should refrain from self-promotion. The reason has been that the medical practitioner who is most successful at getting publicity may not necessarily be the most appropriate one to treat a patient. Furthermore, patients (and their families) are often particularly vulnerable to persuasive influence such as unprofessional advertising.

CPD ARTICLE

SUBSCRIBE & EARN

1 ETHICS CPD POINTPER ISSUE

pRACTITIONER SERVICESADVERTISING

MedEsthetics | Southern Africa �0

Volume 2 Number 3 Spring Edition 2009 | MedEsthetics �1

There are within all economies forces causing persons to reconsider their practices. These forces apply as much to medicine as to any other discipline. Forces driving change in the medical profession are:

• Increased patient knowledge;• Competition;• Governmental and societal pressures;• Changing technology; and• Cost

The language of business and management is very different from that of the medical profession – consulting rooms not offices, patients not consumers. This has contributed to the reluctance by the medical profession to adopt a more structured approach to the running of practices and a tendency to reject management techniques, which are as applicable and valuable in professional services as they are in commercial activities. Medicine is not directly comparable to other professions. Normal financial and commercial considerations do not always apply between doctors and patients, since often services are paid for by government or other insurers such as medical schemes. However, this does not remove the need for medical practitioners to communicate more effectively with patients about their skills, services and resources. There is consequently a place for marketing or at least advertising of services.

The business world boasts a variety of techniques and mechanisms for creating an effective marketing and advertising strategy. However, medical practitioners are bound by the Ethical Code and related policies of the Health Professions Council of SA (HPCSA). Therefore for purposes of this article, the rules and guidelines in respect of advertising and marketing that are applicable to medical practitioners will be reviewed.

EThiCal RulEsEthical Rule 3 provides as follows in respect of advertising, canvassing and touting:

(1) A practitioner shall be allowed to advertise his or her services or permit, sanction or acquiesce to such advertisement: Provided that the advertisement is not unprofessional, untruthful, deceptive or misleading or causes consumers unwarranted anxiety that they may be suffering from any health condition.

(2) A practitioner shall not canvass or tout or allow canvassing or touting to be done for patients on his or her behalf.

Touting is defined as “conduct, which draws attention either verbally or by means of printed or electronic media, to one’s offers, guarantees or material benefits that do not fall in the categories of practitioner services or items, but are linked to the rendering of a professional service or designed to entice the public to the professional practice”.

guiDing PRinCiPlEsPatients are entitled to protection from misleading promotional advertising or improper competitive activities among medical practitioners. Publications that improperly draw attention to the titles, professional attainments, personal qualities, superior knowledge or quality of service of a particular medical practitioner, his/her practice or best prices offered, may be construed as unprofessional conduct.

In such cases the HPCSA will consider:

• The motive of the practitioner concerned in arranging for or agreeing to such publication;

• The nature, content and presentation of the material;• Whether the material• Suggests the medical practitioner has particular abilities

compared to other practitioners;• Is published in a manner likely to attract patients to the

practitioner; or• Is likely to encourage patients to refer themselves directly to

a particular doctor or organisation.

noTifiCaTionsMedical practitioners may disseminate information about their practices by publishing notices in any printed or electronic medium, including on the Internet and television. The aim of such notices must be to inform patients of the whereabouts of practitioners and not to promote individual practices.

The following guidelines apply to such notifications:

• No limitations exist on the size or number of times a notice may be published;

• Direct mailing of pamphlets to post boxes or delivery to homes is permissible;

• Bulk distribution of pamphlets, for example at shopping malls is not permissible;

• Pamphlets may be made available to patients at consulting rooms and at local information centres, such as libraries; and

• The use of photographs on notifications is not permissible.

CPD article KEY FEATURE

MedEsthetics | Southern Africa ��

KEY FEATURE CPD article

nEwslETTERs To PaTiEnTsMedical practitioners may communicate with their bona fide patients via practice notices. These notices may include information about the practitioner’s own practice arrangements (e.g. new partners), health care information (e.g. flu vaccinations) and changes in tariff structures.

CoMMuniCaTion wiTh CollEaguEsMedical practitioners are encouraged to communicate the setting up of a practice or changes in practice address to colleagues. Communications to colleagues may include information on field of practice such as “treatment of AIDS patients”.

DiRECToRiEs anD PubliC lisTsProspective patients and other health care practitioners should have ready access to accurate, comprehensive and well-presented information about the medical practitioners practising in their area in order to make informed choices. Directories and public lists with the names of medical practitioners and their practice details may therefore be distributed for the benefit of members of the public and peers. All medical practitioners in a specific area should be eligible for inclusion in such publications. The names and particulars of practitioners listed in such directories and public lists should be of the same size and format.

• Signs and nameplates may not be larger than 1m x 0.5m and may contain the following information:• Names (initials) and surname of the medical doctor;• Profession;• Indication of the location of the practice (e.g. room number, street number, name of the building);• Telephone number(s); and• Consulting hours• Although logos may be used on practitioner stationery , they may not be used on outside signs;• The “red cross” symbol may not be used by medical practitioners;• Only one outside sign may be used. In the case of a large complex with more than one entrance, a sign may be placed at

each entrance. The sign should be placed on the premises where the practice is situated or at the street corner closest to the premises;

• A nameplate may be used on the door of the consulting room;• Where special provision is made in the entrance hall and on the various floors of large complexes to indicate the tenants, doctors

may use such a facility;

The following information may appear on notifications:

• Name(s) and surname;• Profession;• Registered qualifications;• HPCSA registration number and registration category;• Professional category registered at the HPCSA;• Practice address and directional map;• Consulting hours;• Telephone number(s);• Field(s) of practice: If a medical practitioner wishes to include a field of practice (which is different from “field of interest”),

he/she assumes a legal and ethical responsibility for having acquired a level of professional competence within that field of expertise which must be demonstrable and acceptable to his/her peers. “Field of practice” is not the same as “field of interest”. A field of practice is only permissible if a practitioner limits his/her practice entirely or for the most part to that field e.g. aesthetic medicine; and

• Information on financial arrangements: Such information must be limited to statements relating to formal arrangements, e.g. “credit cards acceptable” or “cash only”. Reference may not be made to discounts or quantum of fees.

lidocaine 25mg & prilocaine 25mg

www.emla.co.za

©iS

tockp

ho

to

Applied an hour beforehand, emla helps reduce the pain and discomfort of many cosmetic procedures, including, lasertreatment, botox, fillers, dermabrasion, mesotherapy etc. In cream or patch, emla is a local anaesthetic that’s also ablessing for injections, wart removal, dialysis and more.

Keep emla handy in your practice or let patients apply it at home – and see why more than 220 million people worldwideare smiling.

Availablefrom pharmacies without a prescription. Visit www.emla.co.za for more information.

why should looking goodbe a painful experience?

AstraZeneca Pharmaceuticals (Pty) Ltd, 5 Leeuwkop Road, Sunninghill 2157, South Africa. Private Bag X30, Sunninghill 2157, South Africa. Tel: (011) 797-6000. Fax: (011) 797-6001. www.astrazeneca.co.za. Reg.No.1992/005854/07. S1 Emla Patch (Transdermal Therapeutic System). Reg No.: 30/4/0478. EPI date: 21/04/2004. each patch contains 25mg Lidocaine and 25mg Prilocaine. INDICATIONS: Topical anaesthesia ofintact skin for minor procedures, such as needle insertion and superficial surgical treatment of localised lesions, where application of EMLA one hour before the procedure is feasible. S1 Emla 5% (Cream). Reg No.:Z/4/51. EPI date: 16/11/2005. 1g of emla 5% cream contains 25mg of lidocaine and 25mg of prilocaine. INDICATIONS: Topical anaesthesia of the skin in connection with needle insertion, e.g. i.v. catheters or prior to bloodsampling where application of EMLA 5% cream 1 hour before the procedure is feasible. Topical anaesthesia of the genital mucosa prior to superficial surgical procedures lasting not longer than 10 minutes on smallsuperficial localised lesions e.g. removal of condylomata by laser or cautery, and biopsies. Topical anaesthesia of leg ulcers to facilitate mechanical cleansing/debridement. For full prescribing information, refer to thepackage inserts. Emla is a registered trademark of the AstraZeneca group of companies. Compiled: October 2008.

®

®

®


Esmé PrinsREgisTRaTion insTRuCTions foR YouR fREE EThiCs CPD PoinT1. Go to www.medspecpublishing.co.za 2. Click on the MedEsthetics CPD programme button. 3. Complete the registration form and click the submit button. 4. You will be directed to your landing page, where the questionnaires will be displayed. 5. Click on the questionnaire which you would like to complete, once completed click submit.

KEY FEATURE CPD article

• A nameplate with the name of practitioner only, may be used in the corridor of large complexes for the direction of the patients;

• An outside sign indicating parking is permissible. It may only refer to the street name and number;• In the event of a change in the membership of a company, partnership, or association, the original

nameplate may be displayed for a period of six months at the premises. Should a practice move to other premises, the name of the practice and the new address may also be displayed at the vacated address for six months;

• If an illuminated sign is used, the only sources of illumination may be a constant white light; and• Only two colours of own choice may be used on outside signs, one for background and one for

lettering.

MEDia aPPEaRanCEs • Practitioners with the necessary knowledge and skills may participate in the presentation and discussion

of health topics by means of public address or through the printed or electronic media to lay audiences. However, no information about their standing should be given that may imply that a practitioner is the only, the best or the most experienced in his/her particular field;

• Practitioners should not disclose details of their practices when participating in public presentations or discussions as this may be construed as touting or canvassing for patients. They should preferably remain anonymous or use a pseudonym when participating in radio, television or Internet programmes. Practitioners acting as spokespersons for institutions may be named. It should be stated explicitly that these practitioners could not offer individual advice or consultations to members of the audience; and

• A medical practitioner who is the author or co-author of books or articles may mention his/her own name as author or co-author and indicate his/her practitioner standing. This promotes the profession’s duty to disseminate information about advances in medical science.

ConClusionIn deciding on an appropriate advertising strategy, the strengths and weaknesses of different methods and media as well as practice variables such as location of the practice, target audience and speciality should be considered. The strategy should comply with the guidelines of the HPCSA. Medical practitioners remain at all times responsible for their professional conduct.

1. GNR. 717 of 4 August 2006: Ethical Rules of Conduct for Practitioners registered under the Health Professions Act, 1974 as amended by No. R. 68 of 2 February 2009;

2. Medical and Dental Professions Board of the HPCSA. Guidelines for Making Professional Services Known. Booklet 5. July 2001.

Compiled by Esmé Prins

Director: benguela health (Pty) ltd

[email protected]

august 2009

attorney, notary and Conveyancer of the high Court of sa, healthcare Consultant.

blC (Cum laude) (1986), llb (Cum laude) (1988) and llM (Cum laude) (1997) (university of Pretoria) attorney,

notary and Conveyancer of the high Court of sa healthcare Consultant.

CPD MoDulE sPonsoRED bY asTRaZEnECa

rebuilding skin, rebuilding liveswww.dannemking.com

For more information about DMK treatments contact DANNÉ Montague-King

Tel: +27 (0)11 2626 120 l Fax: +27 (0)11 2626 125 l Cell: 079 697 2122 l Email: [email protected]

Address: Georgian Place, Block C, First floor, 18 Southway Rd, Kelvin, Sandton Johannesburg

DANNÉ Montague-King (DMK) can enhance and prolong the result of fillers and injectables and minimise post surgery downtime, to days not months.

DMK Pre and Post Operative Treatments work on the premise that the healthier skin functions prior to surgery, the faster it heals, and the better the result.

DMK Skin Revision Protocols can offer you: New clientele with high levels of client retention and satisfaction

A competitive advantage in an ever-changing marketPre and Post Operative Treatments protocols for medical proceduresAlignment with medical practicesThe benefits of high retail marginsInternational education and marketing support

five days post surgery during enzyme therapy nine days post surgery

Stitching theaesthetic and medical worlds together.

SA_AAA_DMK_stitch_09_v3.indd 1 7/29/2009 4:42:21 PM


Whether they pine for Brad Pitt’s six-pack abs, the perfectly contoured curves of Heidi Klum

or the smoothing of unsightly cellulite, today’s body contouring patients have high expectations

when they enter your practice. Fortunately, your ability to meet

those expectations is getting easier, thanks to 30-plus years of improving technologies and

techniques. From ultrasound-assisted liposuction to laser-

assisted cellulite treatments and new high-definition body sculpting techniques, you have more options than ever when it comes to helping

clients perfect their physiques.

bY inga hansEn

KEY FEATURE

MedEsthetics | Southern Africa�6

of things Shape

to come

Volume 2 Number 3 Spring Edition 2009 | MedEsthetics ��

boDY ConTouRingInvented in 1974, liposuction remains the most requested cosmetic procedure in the United States. The physical removal of fat allows for dramatic results in both circumference reduction and body contouring. In 1985, Jeffrey Klein, MD, revolutionized the procedure with the tumescent technique in which a mixture of lidocaine, saline and epinephrine is injected to reduce bleeding and minimize nerve and muscle damage while removing the need for general anesthesia.

Today liposuction has taken another leap forward with the addition of ultrasound and laser technologies. “Infusing the tissue with an anesthesia solution prior to removal numbs the area and makes the fat very soft and mushy so it’s easier to suction out through the cannula,” says David E. Bank, MD, director, The Center for Dermatology, Cosmetic & Laser Surgery, Mt. Kisco, New York. “New systems include cannulas that emit either ultrasound waves or laser wavelengths in an attempt to further liquefy fat prior to removal and thus improve outcomes.”

The purported benefits to patients are twofold. When the fat is easier to remove it can be suctioned out with less trauma to surrounding tissues so the patient experiences less postprocedure swelling, bruising and pain. The second benefit is that these technologies help increase skin tightening by maintaining more connective tissue in the area, while the heat stimulates collagen production.

ulTRasounD-assisTED liPosuCTionTwo of the latest ultrasound-assisted systems include UltraSculpt (Mentor Corporation) and Vaser Lipo System (Sound Surgical Technologies). Both systems use a two-step method in which pulsed ultrasonic waves are delivered through a special cannula to liquefy fat before it’s suctioned out. The benefits include better preservation of surrounding tissues and a smoother end result. While early attempts at ultrasound- assisted liposuction led to side effects such as nerve damage and skin burns, the Vaser, a third-generation lipoplasty device, addressed these concerns by creating a grooved cannula that delivers ultrasonic waves at significantly lower energy levels than earlier systems to loosen and emulsify fat cells. “The nerve plexus, the vascular bed and the connective tissue are left intact so you have dramatically reduced bruising and a faster recovery,” says Dan Goldberger, CEO, Sound Surgical Technologies. “The connective tissue, which remains intact, tightens up to fill in the areas previously filled with fat following the procedure so you also see better skin tightening.”

Stacey Hedlund, MD, of Epiphanea, an affiliate of Face & Body Medical Aesthetics in Oklahoma City uses the Vaser Lipo System for contouring thighs, abdomen, back and arms. “Because the fat is emulsified, the Vaser offers a smoother

finished result,” she says. “You don’t get the tracks or dimpling that you sometimes see with traditional liposuction, and the heat stimulates collagen production so you get quite a bit of skin tightening as well.”

Dr. Hedlund gives patients a mild sedative during the procedure and reports that most of her patients are back at work within three days.

“The amount of fat we can remove is dependent on the amount of lidocaine we can use, which is based on the patient’s body weight,” says Dr. Hedlund. “If you have a fairly large patient who wants to come down multiple sizes, you can perform the procedure in stages by doing multiple treatments spaced at least two months apart.”

lasER-assisTED liPosuCTionThe SmartLipo (Cynosure), the Pro-Lipo (Sciton) and the Syneron LipoLite use small cannulas, between 1mm and 2mm, with a 1064nm laser fiber to melt fat prior to suction. CoolTouch has adapted its 1320nm CoolTouch laser to deliver CoolLipo. “The advantage of adding the laser is that you disrupt the fat prior to removal for more even suctioning and less contouring irregularities,” says Charles Mok, MD, Allure Medical Spa, Shelby Township, Michigan. “You also get more skin tightening, so the areas most commonly treated with the CoolLipo are the ones where we’re most concerned with skin retraction—the neck, the chin and the upper arms.”

The SmartLipo with its smaller cannulas is also a popular choice for the chin, neck and upper arm areas. “The Vaser Lipo System is for patients who have higher BMIs and want a more shapely body, while the SmartLipo can contour smaller areas for patients who are in relatively good shape,” says Jeffrey Adelglass, MD, The Skintastic Medical & Surgical Rejuvenation Center, Plano, Texas.

The added heat of the laser is leading some physicians to

Summer Edition | MedEsthetics ��

shape of things to come KEY FEATURE

Marc winter, MD, noted these results after using the velashape on two different patients.

Phot

o co

urte

sy M

arc

win

ter,

MD

bEfoRE afTER

bEfoRE afTER


bEfoRE afTER

combine ultrasound-assisted and laser-assisted liposuction procedures. “The SmartLipo is a much smaller instrument but it heats to a higher temperature,” says Dr. Hedlund. “So we melt the fat in larger areas with the Vaser and then follow with the SmartLipo to stimulate collagen production right under the skin. This gives you a lot of skin tightening following the liposuction.”

Another option is the SlimLipo (Palomar), which features a unique and patented 924nm wavelength that’s designed for selective heating and liberating lipids in the tissue while leaving other structures intact.

boDY sCulPTingFor patients with good muscle tone and low BMIs, a new procedure known as Vaser-assisted High Definition Liposculpture, or Vaser Hi Def, is gaining in popularity. Built on the Mentz technique used in the 1990s to create washboard abs for body builders, it allows surgeons to sculpt the appearance of muscle into patients who are already shapely.

“High Definition Liposculpture is for patients with good muscle tone and a BMI less than 30,” says Dr. Adelglass. “We use the Vaser to achieve a gym rat body. This is not simple contouring; we sculpt the body to create six-pack abs and muscle definition to match months of gym time.”

According to Alfredo Hoyos, et al. whose work with Vaser Hi Def appeared in the November/December 2007 Aesthetic Surgery Journal, the technique is both “more difficult and more time consuming than traditional lipoplasty...requiring selective fat retention and fat removal from both the superficial and deep fat layers to achieve a natural three-dimensional muscular appearance.” The addition of ultrasound technologies has helped improve outcomes, according to Dr. Hoyos. He says, “The Vaser Hi Def allows the fat to be prepared like an artist’s clay through emulsification, so the surgeon can ‘sculpt’ muscle anatomy in great detail through gentle extraction aspirations that minimize the trauma normally associated with traditional lipoplasty.”

Although the procedure is performed with the Vaser, Dr. Adelglass is quick to point out that this is not traditional lipoplasty. “It requires special cannulas, a different technique and a different

philosophy,” he says. “It is truly a sculpting of the body.”Though the addition of laser and ultrasound technologies is

helping to improve outcomes in terms of both results and recovery times, the one thing these technologies have not been able to do is increase the number of candidate profiles for liposuction. “These technologies can offer superior results but they do not expand the indications for liposuction among patients who were not good candidates in the past,” says Dr. Mok. “Patients who are obese require lifestyle changes, not liposuction, and patients with excessively loose skin will still require incisions even with the laser- and ultrasound-assisted systems.” Dr. Mok himself often works with the CombiTuck, a technique that combines liposuction and abdominoplasty. “We liposuction the stomach first and then do an incision and a tummy tuck without cutting the blood vessels or nerves,” he says. “It’s like a face-lift for the abdomen following fat removal.”

Liposuction also remains limited in terms of its ability to improve skin dimpling. “Body contouring options are expanding but these technologies do not address the cellulite that plagues 85% of women,” says Dr. Adelglass.

boDY sMooThingLike lipoplasty, new systems that reduce the appearance of cellulite and the circumferences of abdomens, thighs and arms are harnessing the powers of heat and light to improve outcomes. Both the VelaShape (Syneron) and the SmoothShapes (Elemé Medical) offer the vacuum and roller massage components of the original Endermologie system but with a few additions. The VelaShape incorporates infrared light and radiofrequency to help shrink fat cells and stimulate collagen production for improved skin smoothing and tightening. Marc Winter, MD, of the Orange Coast Women’s Medical Group in Laguna Hills, California, recently completed “Body After Baby,” a study of 20 postpregnancy women. Dr. Winter performed five VelaShape sessions each, spaced one week apart, on postpregnancy women. He waited at least six weeks after the birth to start the sessions. Patients lost an average of 2.33 inches on the buttocks, 1 inch on the thighs and 2.9 inches on the abdomen.

“I was skeptical at first but every patient saw a reduction of at

KEY FEATURE shape of things to come

The smartlipo’s

smaller cannula is a

popular choice for contouring

chins and necks, as

seen in these photos.

Phot

o co

urte

sy s

herw

ood

baxt

, MD

Feel full with less food.

P53300 RED Medaesthetics Cons Ad RP.indd 1 6/19/09 11:18:11 AM


2-3 SEPTEMBERAMCSAPre-congress beginners & advanced training workshops [email protected] 6374

4-5 SEPTEMBER AMCSA 2009www.aestheticcongress.co.zaCSIR ICC, Pretoria [email protected] 0125486374

8 SEPTEMBER Basic Botox (Upper face) [email protected]

7-8 SEPTEMBERI²PL Training Technolase CSIR Pretoria [email protected]

9 SEPTEMBERAdvanced Botox / Fillers (lower face)[email protected]

14 SEPTEMBER Restylane Advanced Course Johannesburg [email protected]

16-18 SEPTEMBER Endermologie training Cape [email protected]

17 SEPTEMBERBotox by Dr Alek Nikolic Cape [email protected]

18 SEPTEMBERDermal Fillers by Dr A NikolicCape [email protected]

25 –26 SEPTEMBERSFME – French Society of Esthetic Medicine Annual congress Paris, France [email protected]

26 – 27 SEPTEMBER Poland Aesthetic medicine Congress Warsawwww.congress.psme.waw.pl

30 – 2 OCTOBER Endermologie training [email protected]

7 OCTOBERBasic Botox (Upper face)[email protected]

8 OCTOBERAdvanced Botox / Fillers (lower face)[email protected]

10 – 11 OCTOBERSouth Korea Aesthetic Medicine Congress - Seoul [email protected]

12 OCTOBER Restylane Full Facial Balance Johannesburg [email protected]

14-16 OCTOBER Endermologie training Cape [email protected]

15 OCTOBERBotox by Dr Alek Nikolic Cape [email protected]

16 OCTOBERDermal Fillers by Dr A NikolicCape [email protected]

0217970960

24 – 25 OCTOBER 7th Congress of Aesthetic Medicine USA - Miamiwww.aaamed.org

27 OCTOBER Basic Botox (Upper face) [email protected]

28 OCTOBERAdvanced Botox / Fillers(lower face)[email protected]

18-30 OCTOBER Endermologie training [email protected]

28 - 31 OCTOBERChina Aesthetic Medicine Congress - Beijing www.caamed.com

30 – 31 OCTOBERChile Aesthetic Medicine congress - Santiago 2 NOVEMBERRestylane Introductory CourseJohannesburg [email protected]

9-10 NOVEMBERI²PL Training - Technolase CSIR Pretoria [email protected] 1750

10 NOVEMBERBasic Botox (Upper face)Cape [email protected]

11 NOVEMBERAdvanced Botox / Fillers(lower face)Cape [email protected]

14 – 15 NOVEMBERUruguay Aesthetic Medicine Congress Montevideo [email protected]

14 NOVEMBERSwitzerland Aesthetic Medicine CongressLucernewww.ssme.ch 17 NOVEMBER Basic Botox (Upper face) [email protected]

18 NOVEMBERAdvanced Botox / Fillers(lower face) [email protected]

19 NOVEMBERBotox by Dr Alek Nikolic Cape [email protected]

20 NOVEMBERDermal Fillers by Dr A NikolicCape [email protected]

18-20 NOVEMBER Endermologie training Cape [email protected]

25-27 NOVEMBER Endermologie training [email protected]

17 DECEMBERBotox by Dr Alek Nikolic Cape [email protected]

0217970960

18 DECEMBERDermal Fillers by Dr A NikolicCape Town

[email protected]

0217970960

18 -19 JANUARY 2010 Beginners and Advanced Botox and Filler coursesDr Renier van AardtCape [email protected]

CALENDAR OF EVENTS

Calendar of aesthetic/ anti-aging Medical Events Supplied as a service by the Aesthetic and Anti-aging Medicine Society of South Africa

(AAMSSA) [email protected]


TRAINING

aEsThETiC MEDiCinE TRaining TaKEn To a DiffEREnT lEvEl

The Aesthetic and anti-aging Medicine Society of South Africa (AAMSSA) organizes bimonthly educational events on aesthetic medical topics.

This year, the AAMSSA offered CPD accredited training courses or meetings in Practice Management and Ethics, Vein Treatments, Advanced

mesotherapy with an international guest speaker, developing dermal fillers in your practice and now at the AMCSA 2009 also pre-congress

symposiums covering aesthetic business development, aesthetic pharmacology and the beginners and advanced botulinum toxin and filler

courses.

The AAMSSA events have always been of high scientific standards with quality speakers or demonstrators. Now, to take the standards even

higher, the AAMSSA has partnered with Foundation for Professional Development (FPD) to develop training courses and qualification for

practitioners involved in aesthetic medicine. Many healthcare practitioners are already familiar with FPD and its high standards of education.

Nonetheless, before introducing the new postgraduate training program in aesthetic medicine, we would like to first introduce you to the FPD.

abouT ThE fPD

Foundation for Professional Development (FPD) is a South African Private Institution of Higher Education established in October 1997 by the

South African Medical Association. FPD works predominantly in Africa. The vision of FPD is to build a better society through education. The

mission of FPD is to ensure the availability of skilled professionals and managers who will be able to deliver a service to the public that is

affordable, evidence based and congruent with international best practice.

fPD foCus aREas aRE:

• Teaching and Learning – FPD provides a comprehensive curriculum of development courses in management and professional skills

that are customised to the needs of managers and practitioners. Educational products are presented through formal postgraduate

qualifications, short courses, in-house courses and conferences.

• Research – FPD’s research priorities focus on promoting action research, clinical research and research on educational practice.

• Community Engagement – This is a critical component of our work and targets areas such as: the development of grassroots NGOs; AIDS

and TB treatment and care; and developing institutional capacity within the public sector, utilising a public-private-initiative model.

FPD is currently the largest self-funding educational provider in the health sector in South Africa. FPD provides training to 20 000 healthcare

professionals and managers every year across Southern Africa. FPD offers training programmes in most English speaking countries in Africa on

clinical and management subjects.

inTRoDuCTion To ThE PosT gRaDuaTE DiPloMa in aEsThETiC MEDiCinE

This educational programme has been specifically developed for health care practitioners working in the Aesthetic and Anti-aging medical field.

The course is tailored to take into account the time and financial constraint of practitioners working full-time in a practice. The range of course

modules has been designed to develop and expand the participants’ comprehensive knowledge and advanced skills in this rapidly evolving and

sophisticated field of medicine.

Any healthcare practitioner involved or wanting to be involved in the field of aesthetic or anti-aging medicine may enroll for the course. The

programme is designed to give participants advanced comprehension and skills so that they can manage and treat various pathological and

non-pathological indications pertaining to aesthetics at a high level of competency and confidence. In order to achieve this, FPD incorporates

the following learning methodologies: Modular format supported with pre-course learning materials; Full time workshops; Learning through

action and assignments. The faculty who present this programme are leading-edge and acknowledged international and national experts in their

particular fields.

Four modules will each be presented over a 6 month period and totaling 2 years. The first year will focus on revising basic medical sciences

applied and integrated into aesthetic medicine. The second year integrates the knowledge and encompasses advanced knowledge and skills

pertaining to aesthetic medicine. Participants will be assessed by a battery of assessment including multiple choice questionnaires and work-

related projects. The admission requirement is a MBChB degree. The course will also be CPD accredited.

Other short course trainings will also be offered in specific field of aesthetic medicine.

For more information contact Dr Allan Thomas ([email protected]) at FPD or [email protected] at the AAMSSA


least one inch or more in the areas we treated,” says Dr. Winter, who identifies two ideal patient groups for the VelaShape system. “One is the patient who is in fairly good shape but has an area or two that she wants to tone and/or decrease the appearance of cellulite. The other group includes patients who want to lose more than a couple of inches but need a jump start.” According to Dr. Winter, larger patients who experience smoothing and inch loss with the VelaShape often view it as a springboard to a diet and exercise program.

It’s something that Sheri Rowen, MD, experienced firsthand when she introduced SmoothShapes to her patients at the Eye Cosmetic Surgery Center in Baltimore, Maryland. “I’d been trying to lose 10 pounds for years, and I’ve lost 6 pounds since I started undergoing the SmoothShapes myself,” she says. “I can definitely see a difference after the sessions; my pants feel looser and it’s encouraged me to eat better.”

Dr. Rowen, who performs the sessions either twice weekly or once a week depending on patients’ schedules, has also seen dramatic results in reducing the appearance of cellulite. The SmoothShapes uses two light sources—a 650nm wavelength and 950nm wavelength—to liquefy lipids and increase the permeability of fat cells. The vacuum improves penetration of the light while rollers help move the liquefied fat into the lymphatic system for drainage. “I have a patient who is not overweight but has quite a bit of cellulite,” says Dr. Rowen. “She started to see improvement in her cellulite at about the fifth session and today she’s wearing shorts and skirts for the first time in her adult life.”

The cellulite and skin smoothing results of VelaShape and SmoothShapes make them a popular adjunct for liposuction as well. “We perform a session within a week of liposuction, and it helps reduce patient discomfort and smooth some of the irregularities that can be seen following liposuction,” says Dr. Adelglass.

on ThE hoRiZonWhile the gap between the dramatic results of liposuction and the subtler results of noninvasive skin smoothing can be frustrating to patients who want big results with small risks, there is hope on the horizon. Two new systems utilizing ultrasound technologies for noninvasive body contouring are currently in use outside the United States but have not yet gained U.S. Food & Drug Administration approval. The LipoSonix (Medicis) and UltraShape Contour Plus both use high-intensity ultrasound to melt fat in the subcutaneous layer without incisions. They do this through the use of a transducer that emits multiple low-energy ultrasound waves that meet in the subcutaneous layer to destroy fat cells. The body then flushes out the debris. “The biggest issue the FDA would like to see safety data on is what effect this has on the patient’s triglyceride and cholesterol levels?” says Dr. Bank. “When you shatter large amounts of fatty cells but don’t physically remove them, like in liposuction, the body absorbs and then excretes them; the question is what happens within the body as a result of this mechanism.” The likely answer, according to Dr. Bank, is nothing bad. “There have been no negative reports from countries where these technologies are currently in use,” he says. “And I think they will be enormously popular here in the United States because they appear to offer real, noninvasive contouring results.”Double-blind studies on the Ultrashape Contour I, the predecessor to the Contour Plus, conducted by Dr. Moreno-Moraga, et al., showed a 100% response rate with a mean reduction in fat thickness of 2.28cm and a mean reduction in circumference of 3.95cm. A six-center study on the Contour Plus commenced in June 2008. Results will be submitted to the FDA as part of the company’s submission for premarket approval.

When it comes to meeting patient expectations for body contouring, honesty is the best policy. “You want to under-promise and over-deliver on results,” says Dr. Bank, who notes that the best candidates for liposuction and body smoothing are those with well-defined localized areas of fat or cellulite who’ve been able to maintain their body weight for a significant period of time. “Patients who undergo body treatments, especially liposuction, do lose a significant amount of weight, and it can be an invitation to be less careful with diet and exercise,” says Dr. Bank. “There’s no physical danger in gaining a little weight but it will reduce the aesthetic of the procedure. The patient needs to understand her role in maintaining the best post-op results.”

Inga Hansen is a Los Angeles-based freelance writer.

Charles Mok, MD, captured these

results one week after a Coollipo

procedure.Photo courtesy

Charles Mok, MD afTER

bEfoRE

KEY FEATURE shape of things to come


inTRoDuCTionRecently, LAL, specifically SmartlipoTM has gained a great deal of attention based on expectations of skin tightening caused by laser thermal effect on collagen and connective tissue. LAL is based on manual scanning of the adipose tissue treatment volume with a cannula delivering laser radiation through a very small fiber with a 600 micron diameter. Due to the manual delivery during LAL and the relatively small size of the laser radiation source questions are raised about treatment uniformity. Hot spots in the treatment area many lead to a dermal injury while undertreated areas reduce uniformity of the treatment, potentially compromising the overall result including soft-tissue contraction.

The development of a Radiofrequency Assisted Liposuction system (BodyTiteTM, Invasix Ltd.), which delivers high power radiofrequency to adipose and connective tissue while continuously monitoring all parameters including temperature allowed an opportunity to compare RFAL heating characteristics with LAL.

MaTERials anD METhoDsWe use the most advanced LAL device – SmartLipo MPx (ynosure Inc.) combining 20W of 1064nm and 12W of 1320nm laser radiation. A motion sensor (SmartsenseTM) was assembled to the hand piece to avoid over delivery of laser energy. A Ryatek IR thermometer was used to monitor the skin surface temperature. Treatment of thermal zone was stopped when measured temperature reached 40°C.

The RFAL procedure was performed with the BodyTiteTM system (Invasix Ltd.). The BodyTite device uses a bipolar RF hand piece to deliver RF current and heat internally to the adipose tissue. BodyTiteTM also provides online, continuous skin temperature measurements with a negative feedback loop control of power. During the treatment the parameters of the BodyTite device were set so the system would reach 40°C and maintain the target

temperature consistently for a prolonged period of time.

ConClusionThe presumption in energy assisted liposuction technologies (laser, RF) is that heat will result in adipose and vascular coagulation leading to more gentle aspiration and less bruising, swelling and pain. The advantage of LAL has been demonstrated in a randomized, double blinded trail. The second and perhaps most clinically significant advantage of heat generating energy assisted liposuction, in the enhanced skin contraction that should theoretically occur when the thermal energy is applied to the collagen of dermis and connctive tissue. Therefore, it would be an advantage and essential that the ideal heat generating energy assisted liposuction device, be able to do so quickly and uniformly and be able to do so safely by continuously monitoring temperature and regulating power output to maintain the desired thermal environment.

In this study we witnessed some significant advantages using RFAL technology in comparison to LA including its ability to heat uniformly in both small and lager thermal areas. LAL, without continuous temperature monitoring is at high risk of focal “hot spots” and subsequent focal dermal necrosis. The relatively small thermal surface areas of a laser fiber, regardless of their specific adipose, water or vascular absorption spectra, heat relatively minimal volume of fat and do so quite slowly. By contrast, RFAL demonstrated higher heating speed with greater uniformity and ability, through feedback monitoring to maintain the desired thermal level for a prolonged period of time. As skin contraction will be dependent upon not just a critical temperature, but maintaining that temperature for a critical duration and applying this heat uniformly throughout the tissue, the new BodyTiteTM RFAL device displays some critical safety and efficacy features the position this device as the most valuable energy assisted liposuction system on the market today.

reportSCIENTIFICComparison of Treatment Uniformity of Laser Assisted Liposuction (LAL) and Radiofrequency Assisted Liposuction (RFAL)Amir Waldman Ph.D., Israel

ADVERTORIAL


Developing the right employee incentive plan can help you to attract and retain high performing staff within your aesthetic practice without overshooting your budget.

The core components of your aesthetic practice are your employees, and instrumental in keeping them happy, motivated and performing at their best will be how you choose to address their compensation plan. By incorporating a good mix of income opportunities, you can create a compensation plan that addresses both their needs, as well as yours.

A MODELFOR SUCCESS

CoMPEnsaTion oPTionsAside from a competitive salary or wage structure it is vital that you consider additional factors. Employees are more mobile and certainly more motivated than ever which means employers need to work overtime in order to attract, satisfy and retain employees while laboring to run a successful and profitable business.

Establishing a work-life balance is in vogue, but it generally entails much more than providing employees with greater financial packages, flexible working hours or time off to keep them around, particularly for small businesses.

Practice owners’ intent on trimming turnover should not underestimate the value of training and performance evaluation. An educated workforce that actively seeks additional skills development opportunities is a key element in strengthening your business.

Often the choice to work for one employer over another will come down to the question of who offers the best benefits. The following list is by no means exhaustive and offers potential types of payments as you review and create your employee incentive plan:• Base Salary• Commissions• Bonuses• Medical Insurance• Annual Vacation Allowance• Paid Holidays• Sick Leave

sTRuCTuRing YouR PlanBefore you determine what types of benefits you can offer, you need to develop a base pay structure. There are multiple options, each with its own pros and cons. It’s important to explore these options and then decide which will work best for your practice.

CoMMission:Commissions should range from 25% to 40% of your total treatment cost. Total compensation, including set wages and commission, should not be more than 50% of the total treatment cost. Most employers who offer commission will


BUSINESS CONSULTANT

start new employees outright at the lower end of the payment scale and then increase their commission upon completing or passing a probation period. It is imperative that your staff are appropriately informed and abreast of recent trends in your business environment. Commissions can then be implemented much more effectively. Remember that an effective repeat and referral system at your practice with drive your business growth and as such is an instrumental component of your commission structure.

fEE-foR-sERviCEAn interesting term, which refers to a more traditional payment scheme, in my humble opinion. As a concept this is simple: In essence for the amount of effort, skill and knowledge required to perform a specific service, the employee is paid a predetermined amount of money as opposed to a percentage-based commission. One option is to employ several treatment levels. Exploring this concept in further detail means that any treatment which requires greater ‘wear and tear’ or experience for the provider will carry higher service payment rate as a higher overall treatment price. Many service industries use a seniority model concept which allows for your more experienced employees to command a larger treatment rate. It’s important to ensure however that these employees meet established performance measures on retail sales as well as patient retention and satisfaction evaluations. Although gross profit decreases as compensation moves into these higher seniority levels, net profit actually increases because these employees are naturally more profitable. If you choose a commission-only compensation model, employees must earn an amount equal to or above the minimum wage for each hour they are in your practice.

sET wagEDepending on the size of your aesthetic practice as well as your turnover, you can employ your team on an hourly rate basis. Your hourly wage should be based on education, qualifications, and work experience and as an absolute essential, the ability to build and maintain strong rapport with your clients. Fixed rates will not vary and should reflect accepted rates for that position in your locality. One of the main benefits of using a set wage system is that it allows both you and your employees to budget long term.

CoMbinaTionMix it up! You have the option of offering an hourly rate of pay, as well as a commission structure for treatments performed and /or products sold. This is a popular option because it factors staff loyalty and long-term budgeting benefits of fixed wages, whilst rewarding individual performance, via a robust commission structure.

sPaCE REnTalAn additional type of pay structure is space rental or an independent contractor arrangement. So for example an aesthetic practice has the ability to charge a monthly or weekly charge for a physician to rent space within the practice where he or she can perform treatments. The advantage of this structure is that you are not responsible for recruiting potential clients, nor are you responsible for motivating and managing the practitioner. Additionally, it allows you to bring in surplus income versus paying out in wages, commissions and benefits. The disadvantage is that you have no control over your renter, the treatments being offered, or the standards and protocols being followed. Ensure that you have knowledge of the code of ethics determining what contracts are considered appropriate for Medical Paractitioners.

RETail CoMMissionIn my experience the retail portion of an aesthetic business is generally under developed. Product sales provide a fantastic opportunity for revenue growth. No matter what fee structure you choose to implement, you will want to pay a commission to all your employees for contribution to retail sales profits. It is generally accepted that an average commission range for retail sales is between 5% and 15%. It’s vital however that you create a commission plan which will avoid tension amongst your employees. For example, if front line staff members and treatment staff are completing against each other for the same sale, you run the risk of employee anti-competitive behavior, which comes across loud and clear to your clients. Your plan needs to offer an opportunity for all employees to participate in retail commissions with clear boundaries.

Whichever compensation plan you choose to offer, it is imperative that clear targets are instrumental in driving and motivating your staff and increasing loyalty. Some examples of goal-orientated plans include rewards programs, sales goals and rebooking rewards.

REbooKing REwaRDsRebooking rewards, or loyalty incentives as I call them, enable you to set a goal of a certain amount of predetermined bookings per week. Employees who achieve or surpass this goal will receive a pre-determined award.

RETail salEs goalsA sliding sales commission structure is another option available to your aesthetic practice. To motivate your team member to reach his or her goal you can set a specific reward, which the individual can receive when that sales target is met.

RECogniTion sChEMEsReward and recognition go hand in hand and all too often we tend to forget the motivational benefits of recognition. Having a clear and structured internal recognition scheme can add immense value to staff performance without creating an unhealthy competitive environment. Tokens of appreciation, such as overnight stays at a local five star hotel for the best team player, and dinner for two at a local up market restaurant for the most improved team member, are some of the options which can be considered.

whaT’s aPPRoPRiaTE?Part of the problem is that business owners are still not recognizing the true cost of employment to their practice, and not placing thorough emphasis on what is popularly termed human capital management, which is routinely described as a strategic approach to people management. It is about managing people effectively and efficiently, understanding their skills sets, attracting and retaining their talent and exploring your future recruitment needs.

Payroll is your most costly operating expense. You must balance competitive pay with an acceptable return on investment. Based on industry averages your total employee compensation numbers should not be higher than 25% to 35% of your annual revenue.

ToTal CoMPEnsaTion inCluDEs:• Base pay• Commission pay and other variable pay plans• Benefits

Because the cost of living will shift over time, it is wise to keep a pulse on the market so you can make changes to your compensation plan as needed. In addition, as your practice grows and becomes more successful, you will also want to make changes to reflect that increase in revenue.

By offering a strong compensation package, you not only show your employees how valuable they are to your success, but also provide the incentive for them to work even more productively for higher compensation, and that translates into more business leverage for you.

Jem Patel


Physicians waiting to add Reloxin to their medical aesthetics practices will have to get used to calling this newly approved neurotoxin for glabellar lines by the name Dysport instead. “We originally filed for FDA approval under the name Reloxin,” explains Mitchell Wortzman, PhD, chief scientist for Medicis (medicis.com). “However, since Ipsen also filed under the name Dysport for use of the same drug for therapeutic indications, the FDA made the decision to grant approval for both aesthetic use and therapeutic use under the single name Dysport.” Ipsen will market Dysport in the United States for therapeutic indications (cervical dystonia), and Medicis will market it in the U.S. for aesthetic indications (glabellar lines). Additionally, Dysport is differentiated from other marketed botulinum toxin products with the unique established name abobotulinumtoxinA.

U.S. clinical trails of Dysport were conducted at 80 study sites and involved approximately 2,900 patients. “The trials showed no diminution of efficacy over four cycles and no safety concerns over 12 cycles,” reports Wortzman. “We are pleased to be able to claim up to four months’ efficacy on the label.” Dysport has been used in the United Kingdom since 1991 with an outstanding safety record and has marketing authorizations in 76 countries for therapeutic use and in 27 countries for aesthetic use. Patient exposure

is estimated to be above 2 million single-treatment cycles, representing more than 600,000 patient years of treatment.

“For the past three years, my colleagues and I at the University of Miami have been involved in the clinical trials that led to Dysport’s approval by the

FDA; I also participated in research trials

that led to the approval of Botox in 2000,” says Leslie Baumann, MD, professor and director of cosmetic dermatology at the Miller School of Medicine, University of Miami. “I’m a huge fan of both products, but each has its strengths and weaknesses. Though there hasn’t yet been a significant study that directly compares the effects of Botox Cosmetic and Dysport, Dysport seems to work faster, diminishing creases in just two days instead of the three to seven days it takes for Botox to kick in. Many Brazilian doctors also report that the effects of Dysport last a bit longer—five to six months compared to four months for Botox. I’ve also heard colleagues say that Dysport has more ‘spread’ than Botox, meaning it breaks the SNAP-25 protein in a larger radius from the point of injection.”

Even doctors proficient at injecting Botox Cosmetic (Allergan, botoxcosmetic.com) will need training to work with Dysport. “Dysport will be supplied in a 300 unit vial; treatment is 50 unit doses divided into five treatment areas at 10 units apiece,” reports Wortzman. “This is not comparable to any other toxin product.”

Ipsen and Medicis worked closely with the FDA to develop a Risk Evaluation and Mitigation Strategy designed to help prevent errors related to the lack of interchangeability of Dysport with other botulinum toxin products and to ensure that the potential benefits of treatment outweigh any potential risk of the spread of the toxin effect beyond the injection site. The labeling for Dysport contains a boxed warning about the potential distant spread of all botulinum toxin products.

At press time, Medicis was not ready to reveal pricing information. Interested physicians can learn more by visiting medicis.com or calling 877.520.0500.

Linda W. Lewis is a MedEsthetics contributing editor.

With FDA approval of Dysport, Medicis gears up to compete in the $300 to $400 million market for expression-line relief.

by linda w. lewis

Dysport has been used in the United Kingdom since 1991 and has marketing authorizations in 76 countries.

NEW WRINKLE RELAXER APPROVED

NEWS MAKERS

IN THE USA


Laser lipolysis systems are expanding treatment options for fat removal and skin tightening

Patient acceptance of body-shaping treatments has created a huge demand for fat removal and skin tightening procedures thanks in part to positive media coverage. When I first began performing liposuction procedures 11 years ago, patients would hide for several weeks post surgery so no one would know they had opted for fat reduction rather than diet and exercise. But today, magazine and television coverage have helped women understand that localized fat deposits and cellulite are not their fault and often can’t be eliminated with changes in diet and exercise alone. In the last few years, we’ve seen a proliferation of fat removal and skin tightening devices that allow physicians to customize procedures to meet very specific patient concerns. These new procedures and combined treatment protocols have enhanced results and improved safety profiles while optimizing patient comfort and reducing recovery time.

a nEw TREaTMEnT PaRaDigMLaser lipolysis systems, introduced to complement traditional lipolysis methods, offer patients more treatment options to combat fat and cellulite than ever before. I have significant experience with SmoothLipo (Elemé Medical, smoothshapes.com), SmartLipo (Cynosure, cynosure.com), and CoolLipo (CoolTouch, cooltouch.com). There is a very important paradigm shift happening with protocols developed for these systems: Laser lipolysis isn’t just for bulk fat reduction anymore. These new systems help physicians achieve skin tightening and contouring in areas that we previously were unable to treat with traditional liposuction alone. These include the knees, thighs, arms, ankles and neck extending up into the jaw and pre-jowl regions. I’ve achieved very successful patient outcomes with the SmoothLipo system, for example, in areas where results need to reflect as much skin contraction as possible. The device uses a 980nm wavelength in a continuous wave output, which allows for faster homogenous heating of targeted areas. The 980nm wavelength has high absorption in tumesced fat, and the continuous wave laser energy uniformly raises the temperature

LASER-ASSISTED

LIpOLYSIS

DETAILS

by Cheryl Karcher, MD

New systems help physicians achieve skin tightening and contouring in areas that we previously were unable to treat.

These results illus-trate skin tightening in the neck area at 2 1/2 months follow-ing treatment with a 980nm laser-assisted lipolysis device.bEfoRE afTER


DETAILS

of the treatment area to between 45° C and 55° C. This uniform rise in temperature allows for a high safety profile and consistently smooth results that can be duplicated. Apoptosis from SmoothLipo continues for several months following treatment, which can be performed under local anesthesia.

CasE sTuDYOne of my female patients recently came in with an increasingly common concern. She is an executive who has taken good care of her health and appearance; her skin and facial features appear at least 10 years younger than her 54 years of age. Unfortunately, loss of definition between the lower part of her face and neck with a small amount of excess fat caused her to be unhappy with her profile. This patient was so concerned about the aging process in her jaw and neck area that she was limiting her clothing choices to camouflage the area. I chose to treat her with SmoothLipo because my goal was to create skin tightening and definition in addition to removing the excess fat.

We executed a standard pre-op visit including a basic physical, pretreatment photographs, blood work and antibiotics. On the day of the procedure, I involved the patient in the marking process as a way to reassure and encourage her. We discussed the use of a technique that exposes tissue as high as the jaw line to laser energy to promote as much apoptosis and contraction as possible.

After administering tumescent anesthesia, I let it sit for 15 minutes; I then used a #11 blade to make three entry points for inserting the 1mm microcannula, which houses a 600µm optical fiber. At each insertion point, I moved the cannula in a back-and-forth fanning motion with one hand (see diagram on this page), while constantly monitoring the skin in the treated area with the other. It is important to keep the cannula in motion to get a homogeneous distribution of energy at the treated area.

During the procedure, the positioning of the 1mm cannula is highlighted via transillumination from a red guiding beam. The laser energy is transmitted to the adipocytes, which absorb the energy, expand in volume and rupture. I use my monitoring hand to gauge the gradual rise in temperature. A good clinical end point for SmoothLipo is an external skin temperature between 38° C and 40° C, which generally indicates an internal temperature of 48° C to 50° C.

For this procedure area, we used 8 watts of power, but the SmoothLipo will go as high as 25 watts. In 20 minutes I had delivered 7,000 joules of energy and noticed the shrinkage of skin in the patient’s neck area. I sent the patient home with Tylenol and a tight wrap on her neck that remained for 24 hours. She came in the next morning for a standard post-op visit, and I reminded her that small amounts of drainage and bruising are normal. The drainage lasts about 24 hours. Bruising can last for up to 10 days but can be easily covered with makeup at 48 hours

after the procedure.The patient reported visible improvement in the appearance of

the treated area every week, and her friends and family noticed as well. Today her neck and jaw line are a complement to her young-looking skin, and she is thrilled to have plenty of new wardrobe choices because she isn’t self-conscious about covering her neck area anymore.

ConTRainDiCaTionsAlthough SmoothLipo and other laser-assisted lipolysis systems are an attractive, minimally invasive alternative for many patients who don’t want to undergo invasive surgery, there are still some contraindications. These include, but are not limited to: pregnancy; bleeding disorders; immune, heart, liver or kidney insufficiency; allergies to local anesthetics; pacemakers and serious heart rhythm disorders; large fat volumes; obesity; and patients presenting with psychiatric disorders or unstable motivations.

While it is not the best option for patients with large volumes of deep reserve fat, laser-assisted lipolysis is ideal on most areas of localized fat and skin laxity. The wide array of available technologies allows physicians to customize protocols based on individual patient need. For example, some patients present with both localized fat deposits and cellulite. In these cases, I prescribe a series of SmoothShapes treatments to begin one week after surgery. This is a noninvasive technology for cellulite improvement that works with a laser and light source plus suction and massage to treat the enlarged adipose cells and inflexible collagen that contribute to the formation of cellulite. The SmoothShapes treatment dramatically reduces postoperative bruising and swelling. It smooths out bumps that can be part of the healing process and works to improve cellulite that can’t be corrected with laser-assisted lipolysis alone.

Cheryl Karcher, MD, is a board-certified dermatologist practicing at Sadick Dermatology in New York City and a nationally recognized expert in aesthetic medicine.

for smooth results and to prevent burning, the cannula is moved in a back-and-forth fanning motion during treatment.


Rosacea is a common and somewhat m

ysterious co

ndition that affects an estim

ated 14 million

Americans. Th

e condition presents with a variety o

f symptoms fro

m redness and flushing

to papulopustular eruptions and, in the most s

evere cases, rh

inophyma, an

overgrowth of tissue that disfigures th

e nose.

GET THE

REDOUT


ThE laTEsT in

RosaCEa CaRE

© www.isToCKPhoTo.CoM

by inga hansen

“Despite its prevalence, there’s still so much that we don’t know about rosacea—why does one person get it while others don’t? Why do some people have minor symptoms while others see a steady progression? Why does one patient maintain the structure of her skin while another develops rhinophyma?” says Thomas Sult, MD, of Aesthetics in Willmar, Minnesota.

A recent study, “A New Perspective on Rosacea—The Role of Innate Immunity,” conducted by Richard Gallo, MD, et al, at the University of California, San Diego, suggests that a dysregulation of the innate immune system in rosacea patients, resulting in abnormal production of a vasoactive and pro-inflammatory peptide called cathelicidin, may be responsible for many of the symptoms associated with rosacea.

“This research shows that there are antimicrobial peptides that can cause the redness and papules that we see in rosacea,” says Hema Sundaram, MD, founder and director of Dermatology, Cosmetic & Laser Surgery in Rockville, Maryland. “It paves the way to a better understanding of what rosacea is and the development of new strategies to address it.”

Current treatment strategies focus on lifestyle changes to help patients avoid triggers that can exacerbate symptoms and combination topical, oral, and laser- and light-based treatments to address the various components of rosacea.


aDDREssing ERYThEMa anD TElangiECTasiasErythema, particularly in the mid-face region, and facial telangiectasias are two of the earliest and most common symptoms of rosacea. A combination of prescription topicals, home-use products and intense pulsed light treatments are commonly used to address these components. Mitchel Goldman, MD, of La Jolla SpaMD in La Jolla, California, performs one to two intense pulsed light (IPL) treatments per year to address redness and visible facial vessels and prescribes an ongoing home skincare regimen with the Rosaclear system (Obagi Medical, obagi.com). “The Rosaclear system is a skincare line with a gentle cleanser and a metronidazole gel,” says Dr. Goldman. “IPL works well for the visible blood vessels and telangiectasias, it also barbeques the demodex mites. All people have these mites but rosacea sufferers seem to have higher populations of them, and their skin is more sensitive to the mites and their byproducts.”

Dr. Sundaram estimates that she treats 75% to 80% of her rosacea patients with the Syneron eLight (radianthealth.co.za) system, which incorporates both IPL and radiofrequency. “These treatments address components of rosacea—namely redness and telangiectasia—that cannot be addressed by oral or topical medications,” she says. “I use the eLight because with rosacea patients, we are limited by how high we can push the fluence of the IPL device. At high fluences, patients will experience both pain and redness. This is magnified in rosacea sufferers already prone to redness and flushing. The radiofrequency boosts the results of the IPL so I can use a lower fluence and provide very good results with a comfortable treatment and minimal downtime.”

Topicals, including azelaic acid, metronidazole and sodium sulfacetamide are commonly prescribed to soothe the symptoms of rosacea, particularly when the condition progresses to the papulopustular phase.

REDuCing ERuPTions

For patients who have developed a papulopustular component to their rosacea, prescriptive topicals and oral therapy can be combined with new laser- and light-based protocols to help reduce and slow the progression of symptoms. “For inflammatory rosacea, in some cases, you can combine a short course of either a prescription topical or a prescription antibiotic concomitantly with IPL treatment,” says Patrick Bitter, Jr., MD, of Advanced Aesthetic Dermatology, Los Gatos, California. “As the patient progresses with IPL, she can be treated without topicals or pills.”

For patients with erythema, telangiectasias and mild papules, Dr. Sundaram uses topical Pyratine xR (Senetek, senetekplc.com), whose active ingredient is cytokinin 0.125%. For grade I and

grade II papules, she prescribes Oracea (Galderma, oracea.com). For patients with grade II or above papules, she prescribes Solodyn (Medicis, solodyn.com). “Both Oracea and Solodyn are oral, extended-release tetracycline-family antibiotics that offer anti-inflammatory benefits,” says Dr. Sundaram.

“Rosacea requires a combination of products—light treatments, skin care, and topical and oral prescription meds,” says Janice Lima-Mirabona, MD, Miami, who prescribes Oracea and sodium sulfacetamide in conjunction with a full home care regimen of gentle cleansers and topical metronidazole. “Oracea works extremely well for papules and pustules,” she says. “And both the doxycycline and sodium sulfacetamide decrease inflammation. I also recommend antioxidant-based skin care products to diminish redness long term.”

Jennifer Linder, MD, Scottsdale, Arizona, uses both prescription and nonprescription-strength azelaic acid products for her rosacea patients. She also prescribes Elidel (Novartis, elidel.com). “Elidel was originally developed for atopic dermatitis, but

“This research shows that there are antimicrobial

peptides that can cause the redness and papules that

we see in rosacea.”

KEY FEATURE get the red out

Thomas sult, MD, obtained these results using an nd:Yag laser for a patient who was unresponsive to

traditional treatments.

Photo courtesy of Thomas sult, MD

bEfoRE

afTER

Cipla Medpro (Pty) Ltd. Reg. No. 1995/004182/07, Rosen Heights, Pasita Street, Rosen Park, Bellville, 7530. Tel (021) 943 4200, Fax (021) 914 4699.E-mail: [email protected] Website: www.cipla.co.za

Specif ic skincare for hyperpigmentationand photo-ageing.

Contains Rucinol and Sophora-- unique ingredients to effectively managehyperpigmentation.

Dermatologically tested & Fragrance free.

®

LAMAR franceT H E T R U S T E D S K I N C A R E C O M P A N Y


it’s a nonsteroidal topical that helps to reduce inflammation,” she says.

For redness and telangiectasias, she prefers to use either a pulsed dye laser or long-pulsed Nd:YAG. “These are true vascular lasers so I get very good, long-term results,” she says. “My second choice is an IPL, but IPLs tend to require more treatments to achieve the same results.”

P h o t o d y n a m i c therapies and laser treatments offer a relatively new approach to rosacea, particularly for patients who have a significant p a p u l o p u s t u l a r component. “This is not a first-line treatment, but if you have patients for whom traditional treatment regimens have failed, laser- and light-based treatments can provide successful results that last for years,” says Dr. Sult. According to Dr. Sult, photodynamic therapy with IPL works well in the treatment of rosacea, but “it’s similar to a chemical peel in that there’s significant downtime for the patient, and most patients want results with minimal downtime,” he says.

Dr. Sult uses an Nd:YAG laser to reduce redness and papules in patients whose rosacea has proven resistant to more traditional methods of treatment. “I use a combination of pulse durations—short to heat small structures and sterilize the pustules, and long for collagen remodeling, if needed,” he says. “I start at 14ms, using a Zimmer Chiller and a device with a scanner that allows for cooling between spot placements to prevent burning. I do one treatment and have the patient come back in six weeks.”

If needed, the patient may undergo a second Nd:YAG

procedure. “For the second treatment I reduce the pulse duration, but you need to be very careful. If you push it down too far, you can overheat the dermis and burn the patient at these parameters,” says Dr. Sult. “Patients see improvement in the papules within 24 to 48 hours, you also see a reduction in redness within 3 to 5 days.”

Laser treatment is the best option for patients who develop rhinophyma, according to Dr. Goldman. “Rhinophyma is extremely rare,” he says. “Fewer than 1% of patients experience this, and the only treatment is surgical. I would use an

ultra pulse CO2 laser to sculpt the nose. The key is to sculpt the area without causing scarring, and the ultrapulse CO2 lasers allow us to do this.”

Improving ComplianceThe chronic and progressive nature of rosacea requires a commitment from both physician and patient to maintain long-term control of the condition. In addition to in-office light treatments and prescriptive topical and oral medications, patients need

to adopt a variety of lifestyle changes and self-care strategies to keep inflammation and irritation at bay.

“Proper skincare is essential to rosacea care,” says Dr. Linder. “These patients have skin barrier dysfunction. The decreased lipids can cause tiny cracks in the skin, which allow pollutants and products with strong fragrances, dyes or active ingredients to inflame and irritate the skin, exacerbating the condition.”

Dr. Linder counsels her patients to avoid traditional soaps, which can strip the skin of its natural oils. In place of soap, she

“If you have patients for whom traditional treatment regimens have failed, laser- and light-based treatments

can provide successful results.”


Volume 2 Number 3 Spring Edition 2009 | MedEsthetics ��

recommends creamy cleansers and moisturizers that help heal the barrier function. “With these patients we want to maintain as much of their natural oils as possible and add moisture to the skin,” she says.

Dr. Sundaram recommends home care products, including TNS Cleanser and TNS Essential Serum (SkinMedica, skinmedica.com), that incorporate growth factors and antioxidants. “The growth factors aid in repairing skin barrier function and also offer an antioxidant effect, which is helpful in rosacea.”

Drs. Sundaram and Linder also recommend mineral cosmetics and sunblocks for their rosacea patients. “Some cosmetics can irritate the skin, but mineral cosmetics provide multiple benefits,” says Dr. Linder. “They cover the redness so the patient feels less self-conscious, they are anti-inflammatory so they soothe the inflamed skin, and they offer sun protection. In addition to my female patients, I have male patients who use a mineral bronzer to cover their redness and protect their skin.”

In addition to harsh and abrasive ingredients rosacea symptoms can be triggered by a variety of environmental factors—stress, hot

weather, exercise, caffeine and spicy foods are some of the most common. The National Rosacea Society (rosacea.org) offers a downloadable diary to help patients track their own triggers.

“I also work with my patients on stress reduction, because this is such a common trigger,” says Dr. Sundaram. “I recommend yoga or meditation and encourage them to take ‘chill breaks’ during the day to relax and destress.”

For patients, changing their lifestyles and diet can be challenging. To help improve compliance, Dr. Sundaram recommends regular office visits, especially early in treatment and developing a good rapport with patients. “Rosacea is a very challenging condition because it is chronic,” she says. “These patients need a lot of support and handholding. You can’t just prescribe a treatment regimen and send them home. The physician/patient relationship is always important, but in the case of chronic conditions, like rosacea, it becomes extremely important.”

Inga Hansen is the executive editor of MedEsthetics.

GET THE

REDOUT



simplekeep itForget the fancy graphics. When it comes to online

advertising, text ads top all.by Joe Dysart

Developing a web presence has become an essential part

of growing a medical aesthet-ics practice. In the past, consum-

ers would look to their local Yellow Pages to find businesses, but today they

log onto the Internet and search under spe-cific key terms to find providers. Once your practice

is online, the question becomes, how do I help patients find my site? According an October 2008 survey by iPerceptions (iperceptions.com), de-spite the buzz about rich media, the simple text ad—a three to five line ad that runs to the right of search pages and in the left or right hand columns of many websites— remains the most effective form of online advertising. The market research company found that 25% of web users will click on a text ad when they visit a website—a preference that beat out every other ad format. The study is especially intriguing given the substantial number of subjects surveyed—14,000.

Similar results on text ad dominance also surfaced in an earlier study released in July 2006 by Y2M (y2m.com). The market research firm, which specializes in the youth market, found that 52% of college community members who read college newspapers online responded most favorably to text ads. The study, which featured input from 7,500 readers of online college newspapers, and included undergrads, graduates, alumni, faculty and parents, also found that pop-up ads were the most unpopular form of advertising with only 5% of subjects responding to them.

Banner ads—those ubiquitous rectangles that pop up next to articles and other web

content—proved nearly as popular as text ads in the iPerceptions study. A full 20% of respondents said they are likely to click on banner ads, which often include pictures of product, just to the right of web content. Another 12% said they are likely to click on banner ads that run across the top of web pages.

Online advertising preferences vary not only by age—with younger browsers more likely to click on advertising messages than those who are older—but also by income. Lower income website visitors are more likely to click on ads overall when compared to upper income web users. A full 40% of consumers who make less than $50,000 annually said they are likely to click on some kind of advertising when they visit a site, while visitors who make $150,000 or more annually said they are likely to click on ads only 15% of the time.

Another major predictor of ad efficacy: repeat visitors. A full 65% of people who frequented the same website on a daily or weekly basis said they were likely to click on ads there, according to iPerceptions, while only 15% of respondents would click on an ad on a site they were visiting for the first time.

gETTing sTaRTED wiTh TExT aDsIf you’re interested in trying online text advertising, three big ad networks can help you get started. Google (https://adwords.google.com), Yahoo! (http://searchmarketing.yahoo.com/as/) and MSN (http://advertising.microsoft.com/home/home) all have highly evolved ad networks that have been painstakingly designed for non-techie use. Any of these domains is a good place to learn the basics of online text advertising.

A fourth ad network, the new MySpace Ads ((https://adver tise.myspace.com) is also worth a look-see for companies just getting into text advertising.

Once you’re acquainted with the medium, you can begin to take advantage of the ad analytics these companies offer as part of their services, free-of-charge. These tools will help you hone your text ad message and ensure that you’re getting the best return on investment (ROI) for your advertising dollar.

Sheara Wilensky, president of Promediacorp (promedia corp.com), a New York City-based search marketing firm, believes text ads on search engines like Google are a no-brainer for business owners because the advertising is affordable and the costs are controllable. Businesses can get started in text advertising on the service for as little as $50. But perhaps the most compelling facet of the service is that “the entire advertising process is measurable,” says Wilensky. “You can see which ad creatives are attracting clicks, which keywords are leading to sales, and how much each lead is worth based on the dollars you spend.”

sPonsoRED linKs on ThE big ThREESearch engine text ad networks generally operate by matching the content of an ad with a specific search query entered by visitors to sites like Google, Yahoo! and MSN. A query for “medical peel” on Google, for example, recently brought up a link to the Natural Skin Shop, and queries for “medical spa” returned Ayuerveda Health Spa and Vita Ageless Medical Spa.

Natural Skin Shop (naturalskinshop.net) regularly uses text ads on Google to bring in Web traffic, as does Juvenex Spa (juvenexspa.com). Other users of web text ads in the industry include The Aesthetic & Laser Suite (medicalsparaleigh.com); Vita Ageless Medical Spa (vitamedspa.com) and Platinum Skin Care (platinumskincare.com).

Tel: 011 444 0404 Fax: 086 670 0063 E-Mail: [email protected]

www.intamed.co.za

Intamed has been selected as dIstrIbutor of choIceby the followIng hIghly respected companIes:

Apollo, Regen, TopJen Face and Body. The most advanced RF Systems.

Anti-Ageing Cooling Mask for Face and Hands. Also used Pre or Post Injectables, Microdermabrasion, PDT, Peels and Laser.

Eyelash Conditioner for longer, thicker, fuller lashes.

Airgent - The next generation of Skin Remodelling with immediate results that last.

Pharaon Laser Lipo, Lipo Control, Pharaon Exo, Pharaon Endo.

Revolite, Medlite C6, Medlite C3, V-Razor.

SmartLipo, CO2 Fractional.

308 Excimer, LEDA Epilation, Exelo 2 Fractional.

ProFractional XC, ProLipo, Contour TRL, Clearscan, BBL, Skin Tyte.

Laser and Light Based Systems:

Skin Remodelling and Body Contouring Systems:

General:

Dermatology, Plastic Surgery and General Surgical Instruments.

An Unmatched Aesthetic Medicine Portfolio...


Each of these companies participates in the network by placing bids on search terms like “medical peel” and “medical spa.” The highest bidding companies show up highest in returns in Google’s “sponsored links” section, located just to the right of the actual search returns. Each participating business sets a daily budget for the amount of bidding it wants to do for each keyword to ensure costs don’t get out of hand. One company may set a $10,000 daily budget for a particular search term; another may only want to part with up to $1,000. Bidding can focus on general search terms, like “medical peel,” or be fine-tuned by location with terms such as “medical peel Los Angeles.”

Some of the ad networks, including Google, will even create a free web page for your company if you’d like to try their text ad service, but don’t yet have a website.

bEYonD sEaRCh EnginEsBesides placing text ads on the search engines, you may want to experiment with placing your own text ads on consumer sites, like realself.com, that your patient base is likely to visit. You can also generate some extra income by running text ads from non-competitors on your own website. Chances are your site already offers pages of background information on the procedures you offer and the industry, in general. These pages can naturally accommodate outside advertisers. You can obtain more information on offering this type of advertising on your site from the ad networks mentioned above.

If you’re looking to give text ads a try, now is the perfect time. Given the intense competition for text advertising dollars among the major search engines, getting into the online text ad market is easier and more cost effective than ever.

Joe Dysart is an Internet speaker and business consultant based in Manhattan. Contact him at [email protected], joedysart.com.

Two recent studies have shown that text ads are the most effective form of online advertising. You can get the best results from your online text advertising by incorporating some of these copywriting tips.

EMbED KEYwoRDsWhile it’s not always possible, embedding the primary keyword for your product or service in the ad headline and copy will deliver the best results.

offER a fREE TRial oR DisCounT As with conventional advertising, words like ‘free’ and ‘discount’ are extremely effective in online text ads

EsChEw JaRgonThis should be a no-brainer, but it never hurts to run your ad by your 73-year-old grandmother to make sure it’s clear and easy to understand before it goes live.

inCluDE a Call To aCTionSometimes people get so entranced in the ad writing process that they forget this simple requirement. Always include an explicit request to buy, purchase, order or perform some similar action.

CREaTE a CusToM lanDing PagE You’ll get more sales if your text ad link leads directly to a specific product/service page for your offer. Ideally, that page will include images and copy designed to help complete the sale, as well as a button visitors can click on to initiate a purchase. Conversely, you’ll have fewer sales if your text ad link simply leads to your home page, and consumers are forced to “hunt” for the offer you’re advertising.

RoTaTE YouR aDsIf you’re running more than one version of your text ad to see which performs best (a good idea), be sure to set your ad distribution on rotate when advertising with the ad networks. Some of the bigger networks are programmed to analyze which text ad performs best for you, and then automati-cally run that ad for you to the exclusion of the others.

This is fine for advertisers who would rather not get involved in the selection process. However, if you prefer to maintain control of what is seen by your potential patients, make sure all your test ads are evenly rotated.

TEsTing, TEsTingEach of the big three ad networks - Google, Yahoo! and MSN - offer varying analytics programs that will help you determine which text ad is working best for you, and why. It pays to invest a little time mastering these analytics.

KEY FEATURE - keep it simple


Pilot Evaluation of Radio-Frequency Assisted Liposuction (RFALTM)

Malcolm Paul, MD, R Stephen Mulholland, MD. Newport Beach, CA, and Toronto Canada

absTRaCT: This pilot study was conducted to evaluate the thermal effect and immediate response of human adipose tissue to RF energy applied during minimally invasive liposuction. The preliminary investigation showed efficiency of RF energy in creating the desired thermal effect, specifically effective pre-aspiration thermal coagulation of adipose and vascular tissue with uniform heating of the skin during a liposuction procedure.

inTRoDuCTionRecently, LAL (Laser assisted lipolysis), specifically SmartlipoTM has received a lot of media attention and gained strong physician popularity in cosmetic surgery. The main reported limitation of the LAL is relatively long treatment time (5) and focal burns. In this current report, we summarize our preliminary data on the use of RF energy for simultaneous lipolysis, vascular coagulation and skin heating. The underlying concept of the treatment is based upon accurate, monitored and controlled pre-aspiration thermal destruction and coagulation of the adipose and vascular tissue with sub-necrotic heating of the dermis using RF energy.

MaTERials anD METhoDsThe RFALTM procedure was performed on 4 patients during the BodyTiteTM system (Invasix Ltd.)The internal electrode was inserted into the adipose tissue at the desired depth.

Figure 1 Bopolar RF hand piece inserted into the body.

ConClusionIn this study we witnessed some significant advantages using RFAL technology including its ability to heat uniformly both small and lager thermal areas. RFAL demonstrated a very rapid adipose heating speed with excellent uniformity. Our early clinical experience suggests signification skin contraction, but more quantitative and objective measurements of the effect of tissue heating on skin tightening and the healing process will be reported in further investigations. Skin contraction aside, we believe that a more uniform thermal adipose tissue and blood vessel coagulation allows for a less traumatic fat aspiration with less bleeding and less post operative bruising, edema and pain. The FFAL technology demonstrated a tremendous ability to heat skin and sub-dermal fat to the desired temperature and then, with a feedback control loop, maintain that temperature for prolonged periods of time. It is both the absolute temperature and the duration of exposure that will determine skin contraction after heating based liposuction procedures.

We believe that the safe, affective and rapid RF thermal component incorporated in RFALTM, minimally invasive body contour procedures represents a significant advance in less morbid liposuction procedures and affords optimal skin contraction for those patients with questionable skin laxity.

1. goldman a. submental nd:Yag laser- assisted liposuction. lasers in sug and Medicine. 38:181, 2006.2. ichikawa, K., et al. histological Evaluation of Pulased nd:Yag laser for lipolysis. lasers in surg and Medicine. 36:43, 2005.3. Zulmira, a, badin D. laser lipolysis:flaccidity under control. aesthetic Plast surg 6:335,2002.4. Prado a, andrades P, Danilla s, leniz P, Castillo P, geate f. a prospective, randomized, double-blind, controlled clinical trial comparing laser-assisted lipoplasty with suction-assisted lipoplasty. Plast Reconstr surg. 2006 sep 15;118(4):1032-45.5. laser assisted lipolysis evolves body Contouring arena, by bob Kronemyer, aesthetic guide Primary Care Edition, volume 4, number 2, p.61.

RADIOfrequency

FatSkin

ADVERTORIAL


02

0101 ChaRTing ThE aging PRoCEssVisual aids, including before-and-after photographs and skin imaging technologies, are highly effective patient communication tools for aesthetic practices. Now Merz Pharmaceuticals is offering a new visual aid to practitioners—the Merz Scales. These standardized rating systems, which can be used to educate patients about the aging process, utilize computer-morphed photography to show the process of aging in five areas. The scales include a validated brow positioning grading scale; a validated grading scale for forehead lines; a validated lip fullness scale; a validated grading scale for marionette lines; a validated hand grading scale; and a validated grading scale for crow’s feet. The ratings range from 0 for “no wrinkles” to 4 for “deeper wrinkles at rest” and “deeper furrows with facial expression.” To obtain a free copy of the scales, visit merzaesthetics.com.

02 a CoMPREhEnsivE CosMETiC REsouRCEThe second edition of Cosmetic Dermatology (McGraw-Hill) by Leslie Baumann, MD, is now available. The comprehensive resource, written for both beginning and experienced dermatologists and estheticians, offers:

• A step-by-step review of cosmetic procedures and how to perform them• An in-depth comparison of the various hyaluronic filler brands• A review of frequent allergens found in skincare products• Guidance on the efficacy of over-the-counter and prescription skincare products• Guidance on which ingredients to use on various skin types• Update on diets and supplements, and their role in skin appearance

The new edition also offers 30% more content than the first edition, including expanded coverage of laser treatments, varicose veins, dermal fillers and botulinum toxins; new chapters on antioxidant and anti-inflammatory cosmeceuticals; plus a thorough explanation of Dr. Baumann’s 16 skin types and how to treat them. Available at mhprofessional.com.

03 suPPlEMEnTs & suRgERYFor many patients the words “natural” and “herbal” are synonymous with safety, but when it comes to mixing herbal supplements with surgical procedures the results can be anything but. Dangers include alteration of coagulation, increased sedative effects, cardiovascular complications and adverse interactions with other medications, says researcher David J. Rowe, MD, assistant professor of plastic surgery at University Hospitals Case Medical Center in Lyndhurst, Ohio. In his recently published study (Aesthetic Surgery Journal, March/April 2009), Rowe found that more than 40% of plastic surgery patients use herbal supplements within two weeks of their surgical procedures. To reduce risks, he recommends that all physicians provide a list of supplements that must be avoided in the perioperative period to minimize surgical complications. They include:

Dong quai · Echinacea · Ephedra · Feverfew · Fish oils · Garlic · Gingko Biloba · Ginseng · Goldenseal · Kava · Licorice · St. John’s Wort · Valerian Root

03

BEST PRACTICES


05

04

06

04 ExTRa! ExTRa! REaD all abouT You!Local and national press coverage can help establish your reputation as an expert in the field of medical aesthetics, build brand name awareness and help drive new patients through your practice doors. To help increase your chances of getting coverage, publicist Marsha Friedman of EMS Incorporated offers the following tips to pitching the press.

If you want to be in the paper, read the paper. If you want a particular newspaper or magazine to cover you, get several copies to see what types of stories they feature. Once you understand what they’re covering, it will be easier for you to see where you might fit in.

Analyze if you’re newsworthy. If certain procedures or issues relating to your specialty are getting a lot of press coverage, you can piggyback on the headlines by letting editors know that you’re an expert on the topic. Has your business overcome adversity? Do you have an inspirational story to share? These angles are universal and appeal to all audiences.

Would you read the story you’re pitching. Before you send out a news release, be objective and ask yourself if you would stop and read a story like the one you’re pitching. If you visualize the headline and think, “Who cares?” it’s time to come up with another idea.

05 bECoME a M.a.D. lEaDERPractice leaders face numerous challenges. Doctors and staff may excel in clinical care, but patients don’t always follow recommendations. Managers strive to boost revenue and referrals, but office gossip, conflicts and inefficiency undermine the patient experience and practice growth. The bottom line is that success depends on your ability to address the people factor, says practice management expert Wendy Lipton-Dibner, MA. In M.A.D. Leadership for Healthcare: Proven Strategies To Get People To Do What You Want Them To Do, Lipton-Dibner outlines her Motivate-Align-Differentiate (M.A.D.) formula to help boost patient satisfaction; staff efficiency and morale; partner collegiality and effectiveness; and practice referrals and revenue. The combination textbook, workbook and CD provides step-by-step instruction plus real world examples to help practice leaders apply M.A.D. strategies. “The M.A.D. formula enables doctors and administrators to get people to do what they want them to do by motivating partners, colleagues, staff and patients to action; aligning all stakeholders by maximizing individual strengths; and differentiating the practice in the community,” says Lipton-Dibner. For more information, call 800.704.6722 or visit pro-impact.com.

06 sTaff sCRiPTing suPPoRTProspective patients have multiple contacts with your practice before they commit to a procedure. At each point of contact you and your staff have the ability to turn that prospective patient into a loyal patron or watch her walk away to another practice. Catherine Maley, MBA, of Cosmetic Image Marketing, offers two new scripting tools to help you welcome new patients into your practice from the very first phone call. Exceptional Receptionist, a guidebook and flip chart, gives your receptionist a clear script to bond with the caller, qualify the caller to see where she is in her decision-making process, answer inquiries effectively and close the appointment. Staff Scripting for Success, a guidebook with accompanying audio CD, teaches physicians and staff how to build rapport with prospective patients, address patient concerns, promote your practice’s unique identity and close the procedure booking. For more information, visit the online store at asps.org or cosmeticimagemarketing.com.

BEST PRACTICES


02

01

01 Two-in-onE haiR REDuCTionThe new Lumenis LightSheer Duet 800nm diode laser system for high-speed permanent hair reduction features two hair removal systems in one platform. The platform includes the LightSheer ET for smaller, difficult-to-navigate areas, such as the upper lip, chin and ankles while the LightSheer HT treats large areas such as the legs, arms, chest, abdomen, shoul-ders and back. The HT features a 22mm x 35mm diode array plus fully integrated vacuum assist technology to gently lift skin and pull the hair follicle closer to the surface prior to applying laser energy. “The LightSheer Duet reduces hair re-moval treatment times by up to 75% and vastly improves pa-tient comfort, eliminating the need for topical anesthetics,” says Robert Mann, general manager of Lumenis. Contact: [email protected]

02 fasTER sMooThing & shaPingSyneron introduces the VelaShape II for circumferential and cellulite reduction. The VelaShape II uses bipolar radiofre-quency, infrared light, vacuum and mechanical massage to shrink fat cells, increase lymphatic drainage and smooth the lumps and bumps associated with cellulite. The system fea-tures greater radiofrequency energy than its predecessor, the VelaShape, allowing for treatment of the same indications - cellulite, body contouring and post-liposuction smoothing - with shorter treatment times and fewer sessions. The de-vice includes two applicators - large and small - and Clever terminal technology, a digital user interface that improves consistency in treatment delivery. Contact: [email protected], 011 794 8253

INTRODUCTIONS


04

INTRODUCTIONS

03 sMaRT anD PowERfulCynosure has increased the energy and temperature sensing capabilities of the orig-inal SmartLipo laser lipolysis system to create the new SmartLipo MPx Laser Lipoly-sis Workstation. The 46-watt workstation allows physicians to liquefy and remove larger volumes of fat in about half the time of the original 32-watt system. The de-vice features ThermaGuide, which continually monitors the temperature under the skin and controls the output of energy to maintain optimal temperatures for tissue coagulation and skin tightening while reducing the risk of burns. “The nearly 50% increase in power allows me to treat larger areas, and multiple areas, with a faster response,” said John W. Decorato, MD, Staten Island, New York. The SmartLipo MPx features both 1064nm and 1320nm wavelengths. Contact: 800.886.2966, cynosure.com.

04 ThE aDvanTagEs of TRios• Trios™ is an advanced IPL phototherapy system, based on world renowned

technology• Offers the top 3 most popular applications: Hair removal, Skin rejuvenation and

Acne• Superior parameters available: spot size, energy, treatment area• Reliable: designed, FDA & CE mark approved• Target audience: the untapped mid-to-high level cosmeticians and salons• Very attractive & profitable business model• Powerful energy – 22J/cm2 at skin level * As opposed to lamp level energy• Fast treatment time * Large spot size – 7.5 cm2

* Short interval between pulses – up to 0.3 Hz.• Safe treatments with minimal discomfort * Unique air cooling system.• User-friendly device * Easy to operate * 15 computerized program settings to ensure maximum results• Modular system with multiple applications: * Hair removal & Skin rejuvenation & Acne clearance• Reliable * Minimal maintenance required.• Clinically proven• Portable desktop device Contact: [email protected], 011 794 8253

03


INTRODUCTIONS

CLEAN START by Dermalogica®:Forming Healthy Skin Habits Early

As a demographic, teens are obsessed with their appearance, especially their skin. Oiliness, a flurry of acne lesions, or even a single prominent blemish can contribute to slamming doors and days of sullen withdrawal beneath blasting music. To help calm the notoriously stormy moods of adolescence by setting an early foundation for intelligent skin care, Dermalogica introduces Clean Start, a skin care brand formulated specifically for teens.

CLEAN START CUTS THROUGH THE HYPE!The system of 8 retail products present a regimen which is simple to follow, easy to self speak directly to the Generation Me audience;

• Wash Off - a forming skin wash designed to clear away dead skin cells and extra oil from the face and body.

• All Over Clear - a refreshing mist that controls shine as it hydrates.

• Ready, Set, Scrub! - a dual-action masque/scrub that purifies and gently polishes skin.

• Welcome Matte SPF15 - a lightweight lotion that reduces shine and offers sun protection without drying skin.

• Brighten Up SPF15 - a multi-tasking lotion with UV protection that offers a natural tint and shimmer.

• Bedtime for Breakouts - an overnight clearing treatment.

• Hit the Spot - a concentrated, easily absorbed spot treatment for breakouts.

• Smart Mouth Lip Shine - a super-smoothing lip shield that moisturises and conditions.

The motivational message behind the Clean Start product line is health, not beauty, placing the regimen into the same category as flossing teeth daily or refraining from cigarettes. However, healthy skin also presents a strong social factor. Acne, for instance, plays a major role in tween and teen depression according to Debi Byrnes, founder of the non-profit www.clearupskincare.org. Likewise, according to the American Academy of Dermatologists, 80 percent of UV-related skin damage occurs before an individual’s 18th birthday - essentially setting the stage for what someone will look like at retirement age. Early damage may have immediate as well as long-term effects. “This generation is highly social, making healthy skin an absolute priority,” said Wurwand.

Teens are the savviest consumer group in history - and they demand authenticity and relevancy to their lifestyles and life goals. With this in mind, Dermalogica enlisted the cultural credibility of teens themselves for brand positioning and marketing. During the development stages, Dermalogica worked with teens and young adults to assist with the naming, labeling and packaging copy, and product testing to tell Dermalogica what worked – and what didn’t. This gives the line a unique “created by us, for us” feel. Wurwand calls the experience “eye-opening, and the only way to authentically connect with this very savvy and somewhat cynical market. Teens really resist conventional teaching and any sort of preaching. Word-of-mouth from peers, even if it’s being sent via email from the other side of the world, will be the way Clean Start finds its intended audience.”

ClEan sTaRT is sChEDulED To launCh in sEPTEMbER 2009

RECOMMENDED RETAIL SELLING PRICES AS FOLLOWS

Wash Off R230All Over Clear Rl90Ready Set Scrub R260Welcome Matte SPF15 R290Brighten Up SPF15 R290Bedtime for Breakouts R290Hit the Spot R230Smart Mouth Lip Shine R190Clean Start Kit R490

Volume 2 Number 3 Spring Edition 2009 | MedEsthetics 5�

technologyELOS

iPl. anD RaDio fREQuEnCY sTill ThE safEsT?Elos Technology (Syneron Medical) –IPL. (and Laser) based treatments for hair removal, skin rejuvenation, skin tightening ( Refirme ) , wrinkle reduction, acne and leg/facial veins is now available in South Africa at more than 80 selected treatment centers.

Traditional IPL. devices uses broad spectrum light to achieve results. Due to the shortcomings of these older technology based devises, –ELOS technology was born. This technology uses less light combined with conductive radio frequency to treat the area more safely and effectively.

The founder and creator of this technology and also the father of IPL .technology – Dr Simon Echhouse had several things in mind whilst developing ELOS.1) Patient safety2) Treatment effectiveness3) Treatment of all hair colours. ( even blond, grey, red )4) Treatment of all skin types ( even tanned skins )

whaT MaKEs Elos –TEChnologY DiffEREnT anD how DoEs iT woRK?Optical energy selectively preheats the target while radio frequency, drawn to the initial heat source, further increases the heat in the target zone – creating a vortex of energy inside and around the target, and leaving the surrounding tissue unharmed. These two energies working in synergy, enables a reduction in optical (light) energy output, allowing the treatment of the widest range of clinical treatments ( hair removal, skin rejuvenation, skin tightening, wrinkle reduction, age/sun spots, pigmentation, vascular lesions, fine lines and wrinkles, and even active acne.) Treatments can also be done on all skin types and all hair colours.

nEw TREaTMEnT MoDaliTY:Due to the safety of ELOS technology, combination treatments as skin rejuvenation and skin tightening treatments in one treatment session gives safe and excellent clinical results. Normal and older light based IPL. Systems can not do these two applications in one treatment. Synerons E Style system offers hair removal, skin rejuvenation, skin tightening and acne in one cost effective system.

More information can be obtained from Radiant Healthcare at Tel: 086 727 2200e mail: [email protected]: www.syneron.com

ADVERTORIAL


01 sounD suRgiCal TEChnologiEs

Vaser Lipo System utilizes third-generation ultrasound technology to remove fat and tighten skin with minimal postprocedure pain and bruising. Small diameter, solid, grooved probes deliver pulsed ultrasound to liquefy fat for easy removal, allowing you to pre-cisely sculpt problem areas. Contact: 888.471.4777, vaser.com.

02 Roll awaY DaMagE Designed to stimulate collagen and

elastin, and improve product penetration, MTS Rollers from Clinical Resolution Labs subtly injure the skin with 200 microneedle bristles. The rollers create microchannels in the skin to address indications including wrinkles, hyperpigmentation and scarring. Contact: 877.566.9687, microneedle.com.

03 hElP foR Thinning haiR Athena Cosmetics’ Hair by Revitalash

daily conditioner was developed for women with fine, thinning hair and those who want more volume. The easy-to-use foam formulation is massaged daily into areas of the scalp where users want their hair to appear thicker and fuller. Contact: 877.909.5274, athenacosmetics.com.

02

01

03

PRODUCT REVIEWS


ADVERTORIAL

MissionEnsure moisturisation, anti-oxidant and toning action on the epidermis in a single process.

Genuine ‘fountain of youth’ treatment alongside complete cellular renewal cycle, this pinpoint treatment from Laboratoires Filorga is the solution to recover a luminous complexion, a supple and elastic skin and rested facial features in 21 days. Pure vitamin C is delivered in the most active form existing, achieved by mixing just before use, thus preserving all its efficiency – intense toning and revitalising of the tissues, brightness by melanin regulation, anti-wrinkle and anti-oxidant activity. Hydrating polysaccharides* combine to its action to offer an immediate and long-lasting result. In less than three weeks the skin appears transformed.

• Truly rejuvenating treatment in accordance with a complete cycle of cell renewal

• Offers instant and lasting results. In barely three weeks, the skin is transformed.

• Pure vitamin C is delivered in its most active version thanks to its ingenious packaging.

PRofEssional usEA small flask allows a week’s worth of use for an application every morning instead of the usual serum. For 21 days, apply in a gentle massage a few drops before the day cream.

Frequency of use depends on the skin’s needs and on the protocol recommended by your beautician.

aCTivE ingREDiEnTsVitamin C in powder + serum with moisturising polysaccharides

Volume // 3 x 7 mlCutaneous innocuousness // non irritatingOcular innocuousness // non irritatingTexture // fluid, without crystalsVisible results //A radiant skin, a luminous, even complexion.

availablE fRoM g.a. aCTivE wholEsalERsTel 012 548 [email protected]

DERMA C

NEWS & EVENTS

PaloMaR To DisTRibuTE QuanTEl DEviCEPalomar Medical Technologies, a leading researcher and developer of light-based devices, will distribute quantel’s SINON q-switched ruby laser for tattoo removal in the United States and Canada. Palomar entered into a distribution agreement with Eriangen, Germany-based quantel Derma, a manufacturer of solid state lasers, in May 2009. As part of the agreement, the SINON will be exclusively marketed in the U.S. and Canada by Palomar. Installation and technical support will be provided by quantel USA, based in Bozeman, Montana. “We are pleased to become the exclusive distributor for quantel Derma’s SINON,” said Joseph Caruso, CEO, Palomar. “With the shortest pulse and highest peak power of all ruby lasers available, the SINON is optimized to treat the more complex and difficult to remove tattoos you see today.”

bETa-bloCKERs anD hEMangioMa TRials sET Pierre Fabre Dermatologie has announced the launch of a set of clinical trials to ascertain the efficacy of beta-blockers in the treatment of hemangioma. The launch of the clinical trials follows the signing of an exclusive, worldwide license agreement between Pierre Fabre and the University of Bordeaux. The agreement covers the development, production and marketing of a pediatric beta-blocker for the treatment of severe infantile hemangioma. “This is a major discovery that will bring true therapeutic advances to patients affected by this highly apparent disease, which can be very severe and can have a strong impact on the child’s quality of life and that of the parents,” said Jacques Fabre, general manager of Pierre Fabre Dermocosmétique.

uv PhoTogRaPhs iMPRovE sun PRoTECTion CoMPlianCEResearch shows that teens who see UV photographs illustrating their existing sun damage and pigment changes, not visible to the naked eye, are more likely to follow proper sun protection protocol. The study, performed by the Boston University School of Medicine and partially funded by the LaRoche-Posay North American Foundation, followed 111 students between the ages of 11 and 13 years old for six months. All students were informed of proper sun protection protocol, 83 of the subjects received an additional intervention, consisting of their own UV photographs. According to researchers, the intervention group reported 36% fewer sunburns at two months and 51% fewer sunburns than the control group at six months. “The UV photographs represent an immediate picture of sun damage

news&EVENTS

that can impact impressionable teens,” said Marie-France Demierre, MD, lead researcher.

sKinMEDiCa Joins foRCEs wiTh allERganSkinMedica has entered into an agreement with Allergan to exclusively promote Allergan’s ACZONE Gel 5% to pediatricians in the United States. ACZONE Gel 5%, a topical treatment for acne in patients 12 years of age and older, combines dapsone in a Solvent Microparticulate gel, enabling dapsone to be topically applied in a well-tolerated formulation. It is the first new molecule approved by the U.S. Food and Drug Administration for the topical treatment of acne in a decade. “We are delighted to add ACZONE Gel 5% to our dermatology consultations with pediatricians, as it provides us with a pivotal opportunity to further educate pediatricians on the latest advances in acne treatments,” said Mary Fisher, president/CEO of SkinMedica.

vasER REsEaRCh shows sKin TighTEning REsulTsPreliminary findings from a multi-center clinical study measuring postoperative skin retraction in Vaser Lipo Patients showed 40% to 60% improved skin tightening following treatment with the ultrasound-assisted liposuction device. Subjects had skin markings placed on areas to be treated and measurements of the areas were taken over a six month period following treatment.

sliMliPo EaRns high saTisfaCTion RaTingsA clinical study, led by Robert Weiss, MD, of the Maryland Laser, Skin and Vein Institute, showed 100% patient satisfaction among subjects who underwent laser lipolysis with the Palomar SlimLipo. The SlimLipo uses the 924nm and 975 nm wavelengths for preferential absorption by fat and dermal tissue. Immediately following treatments, 83% of subjects reported a difference in smoothness in the treated area and 67% reported skin tightening. At three months, 100% of subjects saw an improvement in skin tightening and smoothness in treated areas.


›› Image processing via normal light image, polarised light and UV light images.

›› 3D display of each area ›› History and comparisson analysis›› Printed output of above

FACIAL ANALYSIS SYStEM -Janus

Observation & Measurement of› Pores› Wrinkles› Spots› Sebum› Porphyrin› SkinColour&Tone

Documents

ADvERtISING · Intense pulsed light (IPL) entered the market ... Florida. The treatments can be used both on and off the face, says Patrick Bitter Jr., MD, of Advanced Aesthetic Dermatology,