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Sunday
Sep042016

Facial Injections: Does the size of the needle matter?

For Botox injections, is there any benefit with using smaller needles?

The current standard seems to be 30-gauge needles for Botox, buta recent study shows that 33-gauge needles caused less pain.

(Investigations related to clinical needle derived pain also demonstrate that needle size is not the only factor affecting patient comfort level. In addition, the mechanics of needle insertion has been found to significantly affect pain. Both the force and the mechanical workload (i.e., area under the force-displacement curve) of hypodermic needle insertion have been found to positively correlate with the frequency of pain. Thus, needle tip sharpness and other factors, such as lubrication, which can reduce the force of insertion and mechanical workload, and pre-treatment with a topical anesthetic are important parameters that can be optimized to reduce pain from needle insertions.)

From the study:

The highest level of pain was in the malar region, and the lowest level was in the glabella. Although all pain scores were lower for the 33-G microneedle, the difference was significant only for the forehead. Because most minimally invasive procedures require multiple injections during the same sitting, the overall procedure was evaluated as well. Assessment of the multiple-injection process demonstrated a significant difference in pain level, favoring the 33-G needle. Although the difference in bruising was not statistically significant between the two needles, the degree of bruising was lower with the 33-G needle.

Conclusions: For procedures that involve multiple injections to the face (such as mesotherapy and injection of botulinum toxin A), thinner needles result in less pain, making the overall experience more comfortable for the patient and the physician.

There are a few other studies that show similar results and there are some contradictory findings from a study in 2010.

References:

1. The Effect of Microneedle Thickness on Pain During Minimally Invasive Facial Procedures: A Clinical Study. . Aesthetic Surgery Journal. 1 July 2014 Billur Sezgin MD, Bora Ozel MD, Hakan Bulam MD, Kirdar Guney MD, Serhan Tuncer MD, Seyhan Cenetoglu MD

2. Effect of Needle Size on Pain Perception in Patients Treated With Botulinum Toxin Type A Injections: A Randomized Clinical Trial. JAMA Dermatol. 2015 Nov;151(11):1194-9

3. Dermatol Surg. 2010;36(1):109-12. Needle preference in patients receiving cosmetic botulinum toxin type A. Price KM1, Williams ZYWoodward JA.

4. Egekvist H, Bjerring P, Arendt-Nielsen L. Pain and mechanical injury of human skin following needle insertions. Eur J Pain. 1999 Mar;3(1):41-49.

5. Egekvist H, Bjerring P, Arendt-Nielsen L. Regional variations in pain to controlled mechanical skin traumas from automatic needle insertions and relations to ultrasonography. Skin Res Technol. 1999;247-54.

6. Schneider LW, Peck LS, Melvin JW. Penetration characteristics of hypodermic needles in skin and muscle tissue. Phase I (Appendices B-E). Final report. Highway Safety Research Institute, Ann Arbor, MI; 1978

7. Dermatol Surg. 2005 Dec;31(12):1655-9. Single-center, double-blind, randomized study to evaluate the efficacy of 4% lidocaine cream versus vehicle cream during botulinum toxin type A treatments. Carruthers A1, Carruthers J.

Originally published on LinkedIn by Michael Greenspan. Link

Tuesday
Aug092016

Know what patients (or competitors) are saying about your clinic.

The very best way to stay informed of any new post or comment about you or your clinic is to create a few Google Alerts. It takes just a few seconds and will email you a link whenever one of your alerts is triggered.

To create an alert:

  1. Visit Google Alerts
  2. In the "Create an alert about" box, enter the words you want to get email notifications for.
  3. Click Show options to say how often you get alerts, what types of results you want to get, and more.
  4. Click Create Alert.
  5. Once your alert is set up, you'll start getting emails any time Google finds new search results for your keywords.

You'll want to set up alerts for you name (with any common spellings), your medical spa or clinic's name, and possibly even your competitors to instantly be notified when something you're interested in gets mentioned.

Tuesday
Aug092016

Want to make more money in your medspa? Work on your personality.

85% of your financial success is due to your personality and ability to communicate, negotiate, and lead. Shockingly, only 15% is due to your technical knowledge - Carnegie Instistute of Technology

The above seems about right. The money gets made in the consultation room, not the treatment room.

Thursday
May052016

Medical Spa Report: $3.6 billion US Market in 2016?

According to an independent study: the US medical spa market will hit $3.6 billion in 2016, it's expected to grow 18% yearly, and average net medspa profits are 14%.

Medical Spa ReportThe rest of the world is not covered but if you're outside the US this is still interesting. The study is 127 pages in length, has 32 tables, and costs $1,495 so get ready to open your wallet if you want to read the entire report (or just read the findings here).

Approximately 2,100 “medical spas” or “med spas” are now operating in the United States. Medical spas only emerged ten years ago and exploded in number between 2007 and 2009. However, a major shake-out took place as franchises failed and the recession hit—exposing overoptimistic revenue assumptions and poor management. As primary care MDs seek to replace lost income, and as baby boomers age, demand should grow for minimally or non-invasive cosmetic procedures made possible by new laser equipment.

Intersting Findings:

  • Marketdata estimates that revenues of the 2,100 U.S. medical spas reached $1.94 billion in 2012, and will hit $3.6 billion by 2016.
  • Average revenues per facility are $924,000—with about 80% coming from procedures and 20% form retail product sales.
  • The market is forecast to grow 18% per year. Fully 58% of med spas expected sales to grow more than 5% last year.

Click to read more ...

Tuesday
May032016

Robot Surgeon Outperforms Humans Performing The Same Procedure

Score another victory for machines: a surgical robot outperformed humans and robot-assisted human operators in a soft-tissue procedure, bringing us one step closer to automated care...

We're not quite at the cosmetic surgery carwash yet, but we're headed in that direction. Could we be a few years away from robotic liposuction?

The Smart Tissue Autonomous Robot (STAR) was designed at the Children's National Medical Center in order to bring some automation into soft-tissue surgery, a field where soft-and-squishy makes it more difficult to apply robotics due to the complexity of spatial relationships.

“As surgeons, we usually do three things,” said lead researcher Peter Kim, of the Sheikh Zayed Institute in a press call, “we use our vision and we use our hands for dexterity and then we use our mind as cognition to make judgment and then carry it out. We improved on all these things.”

Click to read more ...

Saturday
Apr232016

UVLrx Intravenous Light Therapy

New light thereapies are coming to market that are designed to operate inside the bloodstream. Will they find their way into cosmetic medicine?

One example of this is UVLrx Intravenous Light Therapy, a treatment that uses light delivered directly into the bloodstream intravenously. UVLrx is currently being tested for treatments ranging from a myriad of diseases; Lyne desease, Epstien Barr Virus, Hepatitis C, HIV, Dengue Fever, and even pain and general inflammation.

There are of course other light based blood therapies, but many of those involve drawing blood (roughly 5% of blood volume) that is then treated outside the body and injected back in the patient. These new therapies look to treat the full blood volume with less energy delivery. And, since the LED stays inside the peripheral intravascular catheter during the treatment, UVLrx says that they are in a "non-significant risk" status according to FDA guidelines.

Currently, the UVLrx device is not available for sale in the U.S. but according to their website they have already recieved ISO 13485 certification. 

Here's some more from their press release:

After a successful North American debut last month at the American Academy of Anti-Aging Medicine (A4M) in Las Vegas, UVLrx Therapeutics™ is pleased to announce the official European launch of its intravenous light therapy treatment system, the model UVL1500, at this year’s 14th Aesthetic & Anti-Aging Medicine World Congress (AMWC) from March 31st to April 2nd. Under the scientific supervision of the World Society of Interdisciplinary Anti-Aging Medicine (WOSIAM), the conference will attract over 10,000 physicians and researchers from more than 120 countries who are interested in the role of prevention in global aesthetic and anti-aging management. At the Congress, UVLrx Therapeutics™ will highlight the clinically proven benefits of light wavelengths utilized by its UVLrx™ Treatment System* for reducing inflammation, a key issue facing the entire $300 billion global industry today.

“We are especially excited that the theme of the Congress this year is prevention, given the clinically proven ability of the wavelengths utilized by the UVLrx Station™ to immediately reduce inflammation caused by such things as pathogens in the bloodstream, stress and a wide range of aesthetic surgical procedures.”

“Inflammation is a common side effect of all aesthetic procedures, whether they be facial laser treatments, injections or surgery,” said Michael Harter, CEO and president of UVLrx. “By immediately reducing inflammation caused by an aesthetic procedure, our technology will minimize pain and accelerate healing, which in turn will lead to better results and a more satisfied post-op patient.”

“Beyond aesthetic procedures, chronic inflammation can occur due to pathogens in the bloodstream and just everyday stress,” commented Rowland Hanson, chairman of UVLrx. “Left untreated, chronic inflammation accelerates the aging process and has been linked to heart disease, cancer and Alzheimer’s disease. This is why UVLrx is an essential adjunct therapy for physicians practicing both aesthetic and anti-aging medicine.”

In addition to its exhibitor booth at the Congress, UVLrx has secured an adjacent private salon for physician and distributor on-site demonstrations of its CE-marked UVLrx Station™ Model UVL1500. Moreover, UVLrx Chief Science Officer, Ryan Maloney, has been asked to speak at a special session at noon on Friday, April 1st, about the efficacy of ultraviolet light and UVLrx technology for both anti-aging and aesthetics purposes. To ensure that Congress attendees are aware of UVLrx Therapeutics’ participation at AMWC, the company has secured inside front cover advertising, as well as a two-page promotional article, in the March/April issue of PRIME Journal, which will be distributed to all Congress attendees as well as the publication’s nearly 100,000 additional print and online subscribers.

“We look forward to sharing our technology with the global aesthetics and anti-aging community at AMWC 2016 and demonstrating, in person, how the UVLrx Treatment System will benefit all physicians practicing in this field,” added UVLrx CSO Ryan Maloney. “We are especially excited that the theme of the Congress this year is prevention, given the clinically proven ability of the wavelengths utilized by the UVLrx Station™ to immediately reduce inflammation caused by such things as pathogens in the bloodstream, stress and a wide range of aesthetic surgical procedures.”

Ultraviolet blood irradiation (UBI) has been used for over a century to treat bacterial and viral infections and was awarded a Nobel Prize for treating lupus in 1903. Routinely used in hospitals around the world, this form of light therapy fell out of prominence in the U.S. with the advent of antibiotics in the 1950s. With the recent expansion of drug-resistant infections, blood irradiation offers significant advantages to pharmaceutical therapies. Furthermore, UVLrx’s intravenous system is superior to existing ultraviolet blood irradiation (UBI) in that it does not require removal of blood from the body.

About UVLrx Therapeutics

Based in Oldsmar, Florida, UVLrx Therapeutics is dedicated to evidence-based medicine in the field of light therapy and offers the first intravenous, concurrent delivery of ultraviolet-A (UVA) and multiple visible light wavelengths for treating a variety of medical indications. In addition to two Nobel Prizes and NASA-backed research, hundreds of international clinical trials have verified the health benefits of UV and other wavelengths of light utilized in the UVLrx™ Treatment System. 

Here's their website: http://uvlrx.com/

Friday
Apr082016

Soft Tissue Fillers May Be Causing Blindness in Patients?

The rising popularity of soft tissue fillers has led to a rise in reports of side effects such as blindess.

The FDA approved the use of soft tissue fillers for the correction of moderate to severe facial wrinkles and skin folds (like the nasolabial folds). Some soft tissue fillers are approved for the restoration or correction of facial fat loss in people with HIV.

But according to the Food and Drug Administration, there are risks associated with the use of these fillers.

 Any soft tissue filler can cause long-term side effects, permanent side effects, or both. However, most side effects associated with soft tissue fillers happen shortly after injection and most go away in less than two weeks.

Swelling and pain after hand treatment may last a month or more. In some cases, side effects may appear weeks, months, or years after injection.

Among the rare side effects reported to the FDA are severe allergic reactions which require immediate emergency medical assistance, migration or movement of filler material from the site of injection, leakage, or rupture of the filler material at the injection site or through the skin (which may result from tissue reaction or infection).

There were also rare reports of formation of permanent hard nodules in the face or hand, vision abnormalities, including blindness, stroke, injury to the blood supply, and damage to the skin or the lips.

Recent reports by the American Society for Dermatologic Surgery, Inc. and published by Wolters Kluwer Health, Inc. showed that with the rising popularity of soft tissue fillers has led to a rise in reports of adverse events.

The study conducted a literature review of the reported cases of blindness after the filler injection. The study also examined some prevention and management strategies that may be done.

The results were as follows:

  • 98 cases of vision changes from filler were identified.
  • The sites that were high risk for complications were the glabella (38.8%), nasal region (25.5%), nasolabial fold (13.3%), and forehead (12.2%).
  • Autologous fat (47.9%) was the most common filler type to cause this complication, followed by hyaluronic acid (23.5%).
  • The most common symptoms were immediate vision loss and pain and most of the cases of vision loss did not recover.
  • Central nervous system complications were seen in 23.5% of the cases. No treatments were found to be consistently successful in treating blindness. 

Even though the risk of blindness from fillers is rare, researchers concluded that it is critical for injecting physicians to have a firm knowledge of the vascular anatomy and to understand key prevention and management strategies.

For more information: http://journals.lww.com/dermatologicsurgery/Abstract/2015/10000/Avoiding_and_Treating_Blindness_From_Fillers___A.1.aspx

Thursday
Apr072016

Pfizer's Inversion Of $160 Billion Allergan Deal Called Off

Pfizer terminated it's $160 billion agreement to aquire Botox marker Allergan.

It's something of a victory for lawmakers looking to stop corporate mergers designed to reduce taxes in the US. It would have cut Pfizer's tax bill by 'relocating' the company to Ireland where Allergan is registered.

In backing out of the deal Phiser will have to pay Allergan up to $400 million for it's expenses according to the merger aggrement. (Who negotiated that?)

The Treasury Dept. also implement a new rule that does not allow stock accumulated through a foreign company's U.S. deals in the last 3 years to count towards the "book value" needed to meet this new inversion threshold.


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