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New Advancements In Cosmetic Lasers (2017)

Cosmetic laser technology has continuously advanced over the years, and many physicians have noted the progress in the past few years.

The American Association of Dermatology (AAD) Annual Meeting was held in March. One common topic according to the AAD articles is the advancement and improvement of aesthetic laser devices. Aesthetic laser devices can target skin and facial conditions, even allowing multiple treatments on one device.

Dr. Michael Gold, a renowned dermatologist, spoke in a symposium, noting the significant changes of the current aesthetic devices.

Aesthetic companies like Syneron, is gearing up to release new devices and make improvements with their current devices. In addition, Cutera introduced PICO Genesis last December that treats skin pigmentation, which also enhances the patient’s skin complexion.

Two doctors from the AAD conference has noted that laser will improve further in the future. Dr. Chapas said that there are studies being conducted over the use of a picolaser for other cosmetic purposes other than laser hair removal. Additionally, Dr. Waibel mentioned that research is also done to examine other laser uses.

The dermatologist added she is aware that new technology are being developed such as the free electron laser, which has promising uses for the medical sector.

It is expected that lasers will continue to develop in aesthetic medicine. What are your expectations for aesthetic or cosmetic lasers in the future?


Thinking of a Picosecond Laser? Do I need one and which one to buy.


6 Keys to Medical Spa Success


Overlooked Anti-Aging Procedures

Many fillers and injectables are marketed for the face and skin. According to the 2016 ASPS statistics, there were 2,600,000 procedures for dermal or soft tissue fillers alone. However, dermal fillers are also used for other purposes, like on the hand and neck.

Overlooked Anti-Aging ProceduresNumbers are scarce regarding treatments for those areas, however some patients seek hand or neck rejuvenation, which are overlooked procedures.

There have been studies about using neck and hand rejuvenation, mostly showing promising results to the patients. Few studies have only shown complications about rejuvenation and resurfacing. Frequent modalities used in treating these areas are dermal fillers (used for off label use) and lasers or IPL.

In the official statistics provided by the ASPS, only hand surgery is listed as a surgical procedure and so far, hand and neck rejuvenation is not listed as a non-surgical procedure. It is probable that it is part of the filler statistics.


Common injectables used for hand rejuvenation are Collagen, Hyaluronic Acid (HA), Calcium Hydroxlypatite (CaHA), and Poly-L-Lactic Acid (PLLA) (Kühne and Imhof, 2012). According to the authors, side effects of the fillers on the hands are swelling and bruising. In addition, they suggested that dermal fillers for better effectiveness is CaHA due to collagen stimulation. Furthermore, according to Butterwick and Sadick (2016), hand rejuvenation procedures are more effective when treated with multiple modalities such as IPL, RF, and CaHA and PLLA.

In Maruyama’s (2016) study, it focused on the hand rejuvenation for 128 Japanese patients. The researcher took into consideration some skin differences and side effects. The researcher used IPL by using two wavebands, one using 560nm and another 515nm.

Immediate downtime results for wrinkles showed that most of the patients were mostly unpleased, effects improved after two or more treatments. Meanwhile, many patients were satisfied by the results with the dorsal lentigines. One of the prominent side effects presented in the author’s study was erythema, followed by hyperpigmentation and itching.

Despite such, most patient satisfaction for hand rejuvenation is usually high and there is an expected patient return or retention for a treatment of hand rejuvenation (Rivkin, 2016).

After administering an injection related hand rejuvenation procedure, massaging is recommended as it helps in the longevity of the treatment on the hands.


With surgery, come the complication and risks. Batniji (2014) enumerates the possible risks of surgical neck lifts, such as induration, neck injury, and skin contour irregularities. Despite such complications, neck lifts is slowly on the rise.

As an alternative, some cosmetic physicians offer non-surgical neck rejuvenation.

However, recent literature is still little for non-surgical neck rejuvenation.

de Oliviera et al.’s (2017) study presented a 100% improvement rate upon treatment. A combined RF and PEMF treatment shows significant positive results when used to treat the neck. Additionally, the researchers note that RF alone may not be as effective. It is suggested these combined treatment be used in observing shorter downtime and lesser complications.

Their main limitation was no follow-up was done after their initial study. Any observed complication was quickly resolved.

In another study, di Bernardo (2016) used two modalities for the neck: a laser and RF for different purposes. Their study focused on the procedure of using the modalities for the neck. The researchers marked the areas to laser and used tumescent anesthesia for this treatment. As for the RF treatment, they plotted the areas to treat the neck to avoid neuropraxia.

Finally, Oram and Akkaya (2014) uses CO2 as another option in treating the neck as it showed improvement with Skin Laxity, Jowling, Fat Disposition, and Horizontal Neck Lines. Their study, however, presented complications, however it was only short lived. Despite such results, most of the patients returned for further treatments in the long-term. Their main takeaway in the study was the skin tightening due to the bettering of the skin laxity and in turn causing good effects with the jowling and fat disposition.

These two procedures, while, not popular, are also sought by patients. These elective procedures are befitting

In another post, we discuss injection techniques for hand and neck rejuvenation.


Patient Retention through Better Customer Service

Even medical practices need to brush up on customer service. Some patients complain about the poor services provided by staff. Online reviews for some practices have patients talking about how poorly they were treated by the staff and may need to find a new doctor. This could hurt your practice, as your leads could decrease because of your staff members.

If you received poor reviews about the staff, then it might be time to reconsider getting friendlier staff or training them for better customer service.

Manage staff well

Customer service starts within the practice. How you deal with staff could translate to their behavior towards patients. Aside from better treatment towards staff, provide them with appropriate training such as customer service and procedures.

In a medical aesthetic practice, allow staff to have training and delegate tasks for them so they could also take part in your practice and learn more about how to deal with patients in different situations.

Survey Patients

One of the many ways you can connect with your patients is to give them a say in what you are offering. Many experts suggest this method as a way to put your patients first. While you cannot offer every treatment out there, at least consider the idea of having that non-surgical treatment or an alternative.

For your reference, the most common procedures in 2016 (according to the ISAPS) were Botox or dermal filler related procedures, chemical peels, microdermabrasion, and laser hair removals.

Hold Offers, Discounts, and Specials

All patients love to hear the words discount and special. If you have found footing Advertise it on social media or conduct an email blast. Either way, build a relationship with all your returning patients, and hook them up with your offers and specials so they could refer your practice to their other friends.

Invest in Social Media

A large number of practices are on social media, not to keep up with trends, but to connect with customers digitally. Social media is one of the most recommended marketing strategies, and this is how you can pick up potential patients for the practice.

Twitter and Facebook are among two social media outlets that have improved on the business side of customer service. Businesses on Twitter have been given a feature to accept or decline a Direct Message (DM) from an individual. Facebook has also that option on Messenger to set up chatbots for your business. Further discussion about this concept will come at a later time.


What Your Medical Spa Staff Should Understand About Body Dysmorphic Disorder

Are you at risk of treating patients with Body Dysmorphic Disorder (BDD)? What should your staff be doing to screen and communicate with risky patients.

Understanding Body Dysmorphic DisorderEveryone who's in the industry has delt with peatients who have unrealistic expecations and who make you think that there's not something quite right with their perception of themselves.

Most physicians avoid these patients after dealing with one or two of them that go from big cheerleaders before the treatment, to keying cars in the parking lot after the results don't live up to their unrealistic expectations.

It's something that everyone experiences and the more ethical providers aim to steer clear of these patients, but the result is that they'll go elsewhere.

Whill BDD seems to be underdiagnosed, there are some things we've learned that you might want to pass along to your clinic staff.

What have studies found out so far?

Many patients are faced with this concern that going under the knife would appease them, however symptoms of BDD can still linger. Many studies have shown that patients who have undergone cosmetic surgery still exhibit symptoms of BDD.

In a study conducted by Bouman, Mulkens, van der Lei (2017), a sizeable number of physicians are still unaware about body dysmorphic diagnostic disorder and what it entails both for the patient and the provider. In their study, they found when plastic surgeons refused patients to cosmetic treatment and had them referred to a psychologist, some of these patients attempted to sue the physicians. Additionally, their plastic surgeon sample considered surgery as a contraindication of BDD. Their sample also mentioned that they will not pursue with a procedure, provided the patient exhibited symptoms of BDD.

In the end, the researchers stressed the importance for cosmetic physicians to educate themselves further about recognizing the disorder, diagnosing the patient, and treating it.

Despite such events, there was research about the positive effects of cosmetic procedures with BDD also (Bowyer, Krebs, Mataix-Cols, Veale, and Monzani, 2016). One study was conducted that some patients manifested some BDD symptoms pre-surgery and the patient group reported satisfaction one year after the surgery (Felix et al., 2014).

What should you tell your staff to look for? (Note: This is not medical or legal advice, just an opinion.)

Patients may exhibit a number of symptoms and attitudes that staff can identify as potential problems including:

  • If a patient thinks that a treatment is going to change their life in some kind of unrealistic way.
  • Odd confidence that a physician is going to 'fix' them. These patients often are your most ardent supporters before the treatment.
  • Wanting to 'stack' treatments together and build a pipeline of problems that they want fixed.

What can your clinic staff do?

  • Understand that this is not really a vanity issue, even though it appears to be. BDD patients feel bad about this and their perceived as vain and shallow, but they're not able to stop obsessing. This is as real as depression, anxiety or other mental disorders.
  • Understand that they have poor insight regarding their treatment and their body perception. You won't be able to 'talk them out of it'.
  • Don't encourage BDD if you see symptoms. (I've seen a number of unethical clinics do just this.)

This isn't something that you want your staff to be in the dark about since there can be serious consequences if you don't take it seriously.


Website Optimization and How It Could Help Your Practice

Websites are a digital version of your practice’s information. You’re putting yourself out there, and of course you would want to impress potential patients. However, the content inside your website could contribute in helping you lose leads, if you are not involved in the website building process.

Here are three main blunders could drive your potential patients away to your competition.

Created a disorganized and outdated website

This is a complete turn-off for your prospective patients. Remember, patients have gone digital, and would prefer to look for their doctors on the internet. These people stay for a few seconds on pages so make their visit count. You wouldn’t want to show cluttered pages that would immediately have them searching for another doctor or repeatedly...

Click to read more ...


Dr. Gregory Buford - Beauty by Buford, Englewood, CO

Dr. Gregory Buford of Beauty by Buford gave us insight of how he started practicing medicine and how he runs his clinic in our interview with the author and plastic surgeon.

Name: Dr. Gregory Buford
Clinic:Beauty by Buford
Location: Englewood, CO

Brief Bio:

Dr. Gregory A. Buford is Board Certified in Plastic Surgery with additional Fellowship training in Anti-Aging/Restorative Medicine. He is a nationally recognized expert on minimally invasive facial rejuvenation and author of “Beauty and the Business” and has performed over 6000 procedures with liquid facelift products including BOTOX® and advanced dermal fillers, such as Juvederm®, Voluma®, Sculptra®, Radiesse®, Vollure®, and Volbella®. Dr. Buford is recognized by Allergan as a Diamond BOTOX® /Juvederm® Provider, signifying that he is ranked among the TOP 1% of BOTOX® injectors in the nation. In addition, he is a nationally recognized trainer for the Allergan Facial Portfolio and trains other medical practitioners in advanced injection techniques. Dr. Buford has been consistently recognized in the media for his Plastic Surgery expertise and has participated with resources including Vogue, E Online, ABC News, FOX News, EMedicine, and many others. In addition, he was selected twice as a finalist...

Click to read more ...


Picosecond Lasers – Do I need one, and which one to buy?

Guest post by Dr. Steven Ang

This article is a personal review of some of the Picosecond lasers currently available in the market. The relevant distributors in Singapore had provided information on these lasers, when the machines were tested in November and December 2016.

The first commercially available Picosecond laser was the Picosure, introduced by Cynosure Inc about four years ago. Since then, more of such lasers have entered the market. When launched, the Picosure was a 755 nm Alexandrite laser, but Cynosure has since taken measures to introduce two other wavelengths, 1064 nm and 532 nm. All the other companies primarily used the 1064 nm and 532 nm wavelengths, in addition to other wavelengths. These wavelengths are usually introduced to tackle the problem of removing stubborn green and blue inks in tattoos.

For anyone contemplating to purchase a Picosecond laser, the first question that naturally comes to mind is: Is there a need? Is the Picosecond laser really superior to the more commonly available and much less expensive Nanosecond Laser?

According to a systematic review article in the journal, Lasers in Medical Science, in September 2016, the Picosecond laser had not proven its superiority over the Nanosecond laser in the removal of blue and black tattoos. However, in the same journal in February 2017, Forbat, Ali and Al-Niaimi posited in a letter that the applications of the Picosecond laser could extend beyond tattoos to pigmentation reduction and tissue remodeling.

On deeper analysis, the Picosecond technology is rather persuasive. The idea seems logical that when the pulse width is narrowed, laser energy can be more efficiently converted into the mechanical stress needed to fracture particles into smaller fragments, which are easier for the body to remove, and there is less risk for side effects. When used in the removal of tattoos, for example, the notion that the laser exerts a photoaccoustic effect and not a photothermal effect, appears reasonable. Therefore, this can shorten the number of treatments needed.

In evaluating which laser to purchase, I believe you need to consider the following factors:

Is it effective? For this, you can look for published studies and also news about the lasers. One limiting factor is that since Picosecond lasers are relatively new, there may a paucity of studies, and even if available, the sample size is usually small. You should try out each laser for yourself to determine the relative efficacy.

What are the technical specifications? 1000 picoseconds equal 1 nanosecond. To me, in a simplistic way, the lower the wavelength is in picoseconds, the more potential it has. If a greater range of power and fluence is available, the more flexible it is. It is arguable whether you still need a Nanosecond mode, but it is always reassuring if the mode is present.

What is your primary reason to purchase the equipment? I believe that in Western countries, the primary reason is to remove tattoos. In Asia, the main reason may be to treat hyperpigmentation like melasma.

What is your budget? The Picosecond laser doesn’t come cheap and you need to set aside a budget of about USD$200,000 or more. You need to plan carefully to optimize your return of investment.

Are there any local factors that may influence your purchase? For example, the strength of representation of the distributor/agent in your state/country is important. The major manufacturers usually have their appointees in each state/country. The track record of the distributor/agent in servicing and repairing machines is important. Another local factor to consider is whether the machine can be used on your local electricity grid or whether you need to make special adaptation.

Should you buy a new machine or a used one? Because of the short history of the Picosecond lasers, there may not be many used units in the market. Check the usage clocked, the ease to service the machine and the potential costs to service and if need be, repair the equipment.

I have reviewed the following Picosecond lasers: The Discovery Plus from Quanta, the Pico Plus from Lutronic, the Picoway from Syneron-Candela and the Enlighten from Cutera.

A comparison is given at Table 1.

Name of Laser


Discovery Pico Plus

Pico Plus





Quanta System S.p.A

Lutronic Corporation



Wavelength 1


Nd: YAG 1064 nm

Nd:YAG 1064 nm

Nd:YAG 1064 nm

Nd:YAG 1064 nm


PICO, pulse duration

Maximum energy

450 ps

800 mJ

750 ps

600 mJ

450 ps

400 mJ

750 ps

600 mJ


Q-switched, pulse duration

Maximum energy


800 mJ


800 mJ

Not applicable

2 ns

600 mJ


Opti-pulse, pulse duration

Maximum energy

6ns + 6ns

1.2 J

Not applicable

Not applicable

Not applicable


Photo-thermal, pulse duration

Maximum energy

300 ms


2 J


Not applicable

Not applicable

Wavelength 2


FD Nd:YAG 532 nm

FD Nd:YAG 532 nm

FD Nd:YAG 532 nm

FD Nd:YAG 532 nm


PICO, pulse duration

Maximum energy

370 ps

300 mJ


375 ps


750 ps

300 mJ


Q-switched, pulse duration

Maximum energy

6 ns



Not applicable

2 ns

300 mJ

Wavelength 3


Ruby 694 nm, QS, 30 ns, 1200 mJ

595 nm Gold Toning

785 nm

Not applicable. In the process of introducing 670 nm


PICO, pulse duration

Maximum energy

Not applicable


Will be in picoseconds, not available in Singapore yet



Q-switched, pulse duration

Maximum energy

30 NS

1200 mJ


Not applicable

Not applicable


Photo-thermal, pulse duration

Maximum energy

2 ms




Not applicable

Not applicable

Wavelength 4


Not applicable

660 nm RuVY Touch

Not applicable

Not applicable

Fractional laser or equivalent


Yes, 8 mm fractional round hand piece

Yes, Focused Dots 1064 nm

Yes, Resolve hand pieces

Yes, Micro Lens Array Fractionated System









Versatile. High energy.

Many types of hand pieces with different wavelengths.

Easy to use and ergonomic. Size fits in any office.

Known for PICO Genesis in skin toning.


In conclusion, whichever machine you purchase, there is bound to be some element of regret as each machine has its relative strengths and weaknesses. It is only human to always think that the grass is greener on the other side. Just make a decision and move on.

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