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Entries by Medical Spa MD (1198)

Tuesday
Feb072017

The State of Aesthetic IPLs & Lasers

In the last few years there's been an explosion of new IPLs and cosmetic lasers.

While that's generally good for clinics - inducing some competition and pricing/sales pressure - it can be a problem trying to find the right system to invest in.

READ: Cosmetic IPL & Laser Reviews & Comparisons Forums

In 2011, Dermatologist Dr. Goldman wrote a journal article about using what kind of laser should be used for the practice. In the present, there are devices that have multiple modalities and treatment options, you can have a single laser device instead of two or more. These devices are now made convenient for physicians and practitioners.

Lasers are steadily gaining traction in the aesthetic field. Many aesthetic devices have been launched, and various companies continue to upgrade their devices or create breakthroughs. Physicians are able to choose devices, which is suitable for their practice, as there are many ranging from skin rejuvenation to fat melting to even vaginal rejuvenation. At the same time, not everything has been met with praise, as lasers have its downsides for the patients or the physicians or practice itself. Thus, it is best that physicians and practitoners practice laser treatments with care.

Multiple treatments are common in many practices. More and more aesthetic companies are making more integrated systems with multiple modalities. Alma, Sciton, and Cutera are some of the aesthetic laser companies that have begun or launched a multiple modality device for one’s practice. No studies have been made about the efficacy of using multi-modality systems, but the technology is promising.

Having multiple modalities could mean multiple or combination treatment options. Effectiveness has been proven in several studies. Prior to multiple modality in a single device, physicians have been combining treatments.

Findings:

  • In a dermatologic setting, treatment of non-melamona skin cancer with laser and photodynamic therapy was proven successful and effective. Er:YAG and ALA-PDT had the most efficacy rate with 98.97%
  • Goldberg, 2012 suggests that IPL is better at removing hair considering it will be done with multiple sessions
  • As for skin rejuvenation, an alternative to fillers would be repeated Erbium:YAG laser mini-peels (El-Domyati et al., 2013), leaving patients with an average of 88% satisfaction rate after the treatment.

Lasers remain to have some controversy over lawsuits filed by patients and complications brought about by its usage. One common issue faced by practices is negligence or mishandling by a non-physician administering the laser procedure. Several state laws allow non-physician practitioners, so long as the doctor is present in the practice. However, unhappy patients experieince some adverse side effects possibly due to poor handling and patient screening.

Training is important to avoid any of this concerns to rise and be the cause of lawsuits. According to E. Victor Ross, dermatologist, vigilance is key when administering laser treatment.

In 2016, a study was published by Dr. Gary Chuang, noting that fumes were present in a laser hair removal system. There are 13 carcinogenic compounds present in the laser hair removal plume. It is a cause for alarm as it could affect the respiratory systems of those performing the procedure and those receiving it. The researchers suggest that better ventilation systems and protection would help prevent any further issues.

Aside from this finding, Laser Service Solutions provides us with a list of common issues with laser devices. Technical issues like LCD screens and circuit boards should not be taken lightly. Other problems include: water issues, calibration, and handpieces.

It is expected that despite issues and problems, aesthetic laser procedures will still rise according to several market research reports.

REFERENCES:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3390232/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3376014/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4632833/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3100114/
http://dermatologytimes.modernmedicine.com/dermatology-times/news/laser-fundamentals?page=0%2C1
http://jamanetwork.com/journals/jamadermatology/article-abstract/2532614
https://www.laserservicesolutions.com/most-common-aesthetic-laser-issues/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3390232/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3376014/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4632833/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3100114/http://dermatologytimes.modernmedicine.com/dermatology-times/news/laser-fundamentals?page=0%2C1http://jamanetwork.com/journals/jamadermatology/article-abstract/2532614https://www.laserservicesolutions.com/most-common-aesthetic-laser-issues/

Tuesday
Feb072017

Dr. Michael Law - Michael Law MD and Blue Water Spa, NC

Dr. Michael Law shares about his experience in aesthetic medicine, and how he runs his clinics with wife Kile in our interview with the Plastic Surgeon.

Dr. Michael Law - Michael Law MD and Blue Water Spa, NC

Name: Michael Law MD
Clinics: Michael Law MD/Aesthetic Plastic Surgery and Blue Water Spa
Location: Raleigh, North Carolina
Website: www.bluewaterspa.com, www.michaellawmd.com

Brief Bio:

Michael Law MD is a plastic surgeon certified by the American Board of Plastic Surgery. He received his M.D. degree at Emory University, where he graduated magna cum laude, second in his class of over 100 graduating physicians, and was inducted into Alpha Omega Alpha. He elected to pursue a rigorous ten-year training program that includes general surgery residency at the University of California Los Angeles (UCLA), plastic surgery residency at the University of Southern California (USC), and a plastic surgery fellowship at USC. His ten years of formal training following medical school amount to twice that of some plastic surgeons.

How did you get started with plastic surgery?

I knew I wanted to be a surgeon since childhood. I elected to become a plastic surgeon for several reasons: for the creativity required for practice of reconstructive surgery, for the procedural and anatomic variety of surgeries performed, and perhaps most of all for the opportunity to be artistic in my life’s work.

I practiced plastic surgery in Beverly Hills for several years after completing my surgical residency and fellowship. While there, I started working with aestheticians. I realized early in my practice that good skin care was a great compliment to aesthetic plastic surgery. When I made the decision to move to...

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Monday
Jan302017

Why You Should Review Injecting Techniques

Injectables are one of the many popular non-cosmetic procedures. Around 45% of the aesthetic/cosmetic procedures done in 2015 in the US was injectable procedures. It ranks high as an alternative to cosmetic surgery, and it is expected to rise in the coming years. These procedures have received praise by many patients. However, there is a constant need for reminder on injecting dermal fillers and botulinum toxin on patients. It is all in the [method of] injection, declares all practitioners. Additionally, some studies and researchers have emphasized the importance of administering procedures.

Some patients have reported that they have issues with fillers, which have caused adverse side effects like disfiguration of the face and vision loss. These side effects should serve as reminders to practitioners.

In the latest study by Scheuer, Sieber, Pezeshk, Campbell, Gassman, and Rohrich (2017) the authors present how to minimize problems in administering soft tissue filler injections. The authors suggest to inject slowly with small doses. In addition, a serial puncture technique is best in high risk areas. They cover six regions, which are considered danger zones.

Even with experience, physicians and certified injectors could still make mistakes in administering these injections. Thus, physicians must remember these safety concerns and administering of injections.

 Brow and Glabellar Region

  • Digital injection must be applied.
  • The authors recommend that intradermal injections must be done for this area.
  • Blindness and tissue loss are common serious side effects in this region.

Temporal

  • The measures of the danger zones in this area are 2.5 mm lateral and 3.0 mm superior to the peak of the brow (Scheuer, Sieber, Pezeshk, et al., 2017).
  • Deep and superficial injections can be done in this area,
  • The adverse side effect when injecting in this area is blindness.

Infraorbital

  • Practitioners should refrain from injecting deeply
  • Authors suggest to inject laterally and pushed medially
  • Tissue necrosis is an adverse side effect in this region

Lips/Commissure

  • On the commissure, the linear crosshatching method in injecting is safe.
  • Injections done in either lips must be done superficially with around 3mm deep.
  • Tissue necrosis is a serious side effect in these regions.

Nasolabial Fold

  • Intradermal injections can be administered as well injected in the preperiosteal plane.
  • Injections on the deep and superficial subcutaneous and dermal areas in the nasolabial fold are safe
  • On the alar base, only intradermal injections should be administered.

Nose

  • Fillers should be injected deeply and greater than 3mm.
  • As suggested by the authors, any injections done on the tip and dorsum should be in the preperichondrial and preperiosteal planes.
  • Tissue necrosis and visual loss are some of the adverse side effects.

To learn more about the injection techniques, you can watch the video provided by the authors here: http://journals.lww.com/plasreconsurg/Pages/videogallery.aspx?videoId=972&autoPlay=true

Monday
Jan232017

New Botulinum Toxin Undergoing Clinic Trials: Daxibotulinumtoxina

More competition might be coming for Botox, Dysport and Xeomin.

Three cosmetic injectables are currently available in the market (Botox, Dysport, and Xeomin). A fourth one is shaping up as the next competitor against the botulinum toxins. Revance Therapeutics Inc. is gearing up to produce the newest in the botulinum toxin market. The daxibotulinumtoxina is the newest to gain interest.

The neurotoxin is currently undergoing trials since early 2016. It claims that it will have a longer effect on the face against those available in the market. A 2011 study have found the effects of daxibotulinumtoxina for injection (RT002), which shows its efficacy and longevity.

How would this affect the three existing neurotoxins?

So far, Botox is the popular choice of neurotoxin, it being the first and proven effective for treatment of glabellar and lateral canthal lines. Xeomin and Dysport treats Cervical Dystonia and the glabellar lines. Many have expressed their concerns with the existing neurotoxins, most specifically with the possible side effects (e.g. ptosis).

Why does it matter?

Revance will include a peptide technology called: TRANSMTS in their (what they claim) a highly purified botulinum toxin to produce a longer-lasting effect. Aside from treating any aesthetic concern, daxibotulinumtoxina will also treat plantar fasciitis--- which is also undergoing study— and cervical dystonia. The neurotoxin will also come in a topical form.

Peptides have been used also for some cosmetics, with some calling it as an alternative to Botox having anti-aging effects for the face. Most studies regarding peptides are focused mostly on cosmetic products (i.e. make-up).

Botox, Dysport, and Xeomin have been met with their own criticisms from patients and physicians. The daxibotulinumtoxina could be a game changer in the market. Trials are underway for the daxibotulinumtoxina. Not much can be said about the trials but so far, the sample has not experienced any serious or adverse effects. According to clinicaltrials.gov, the study for the efficacy of daxibotulinumtoxina will be released on 2018 at the latest.

References:

http://www.revance.com/pdfs/diffusion-and-duration-of-new-type-a.pdf
https://clinicaltrials.gov/ct2/show/NCT03014622?term=DaxibotulinumtoxinA&rank=4
https://clinicaltrials.gov/ct2/show/NCT02973269?term=DaxibotulinumtoxinA&rank=2

Friday
Jan202017

Dr. Peter Jenkin - Dermatology Associates of Seattle, WA

With more than 30 years of experience in Dermatology, Dr. Peter Jenkin shares how he got into cosmetic medicine and his approach to staffing and marketing.

Dr. Peter Jenkin - Dermatology Associates of Seattle, WAName: Dr. Peter Jenkin
Clinic: Dermatology Associates of Seattle
Location: Seattle, WA
Website: https://www.daseattle.com

Brief Bio:

Dr. Jenkin completed his dermatology training at McGill University in Montreal in 1980. He was in private practice for 20 years in Canada before moving to Seattle and worked for PacMed and Virginia Mason until he purchased Dermatology Associates in January 2010. Dr. Jenkin is an outdoor enthusiast, loves skiing, hiking and racing cars. When he is not treating patients he can often be found speaking about skin diseases at local seminars or visiting his grandchildren.

How did you first get into cosmetic medicine?

My interest was piqued in cosmetic medicine back in the mid-1980s when I started to use a CO2 laser which was followed in 1987 by the development of the first pulsed dye laser. I was always fascinated by the new advances which extended the range of things we could do to help patients with their cosmetic concerns. That trend has been followed by making those treatments less invasive and safer.

None of these treatments were available when I did my dermatology residency...

Click to read more ...

Friday
Jan062017

Dr. Jenny Weyler - Aponi Aesthetics, Massachusetts

Starting out as a Primary Care Physician, Dr. Jenny Weyler branched out to aesthetics, exclusively practicing the field since 2010 in our interview with the Physician.

Dr. Jenny Weyler - Aponi Aesthetics, Massachusetts

Name: Dr. Jenny Weyler
Clinic: Aponi Aesthetics
Location: Worcester, MA
Website: http://aponiaesthetics.com/

Brief Bio:

I am a Board Certified family practice doctor, who graduated in 1992 from the Medical College of Pennsylvania (now part of Drexel University) in Philadelphia, PA. I completed my family practice residency in 1995 at the University of Massachusetts in Worcester, MA. I practiced as a primary care physician from 1994-2004, and then worked in an Urgent Care clinic from 2004-2010. In 2010 I started taking classes to learn aesthetic injections, and I opened my own business in December 2010. Initially we did some primary care here, but I loved doing aesthetics so much, and that part of the practice grew so quickly that we became exclusively aesthetic providers in 2014 and changed our name to Aponi Aesthetics.

How did Aesthetics interest you and it influence your practice?

When I was doing primary care I always loved doing procedures: stitches, mole removals, biopsies and any minor surgical procedure. Learning aesthetic injections was a great way to incorporate my love of procedures with the excitement of learning a whole new field of medicine. The results are so obvious, amazing and gratifying. People love the results, so the clients are enthusiastic and how could I not love making people look and feel better? As I honed my skills in injections, I started to learn more about lasers and skin care products and we added that to our repertoire as we went along. I have logged well over 100 hours of direct hands-on training in injectables and laser safety and use, as well as many more hours of lectures on the same subjects. Aesthetics is constantly evolving and advancing, and I love...

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Friday
Jan062017

Dr. Jennifer Trent - American Dermatology Associates, Florida

With more than 10 years of experience under her belt, Dr. Jennifer Trent practices medicine and writes journal articles and text books in Dermatology, in our interview with the Florida-based Dermatologist.

Dr. Jennifer Trent - American Dermatology Associates, Inc., FloridaName: Dr. Jennifer Trent
Clinic: American Dermatology Associates, Inc.
Location: Sarasota, FL
Website: http://www.americandermatology.net/

Brief Bio:

Jennifer Trent, MD FAAD completed a 6 year combined BS-MD at the University of Miami with an undergraduate major in biology and a minor in chemistry. While in medical school, she interrupted her formal course to participate in a 2 year research fellowship in Dermatology at the University of Miami. The focus of her work was hos-pital care of dermatology patients, toxic epidermal necrolysis, and wound care. Dr. Trent graduated from Medical School with research distinction as well as the Univer-sity of Miami Department of Dermatology’s medical student of the year award.

She completed her internship in internal medicine and her residency in Dermatology and Cutaneous Surgery at the University of Miami/Jackson Memorial Hospital. Dr. Trent has presented her research on toxic epidermal necrolysis and methicillin re-sistance staphylococcus aureus several times at the Society of Investigative Dermatol-ogy and the annual American Academy of Dermatology meetings. She was recipient of the Celia and Samuel Resnik Award for dermatology research from the University of Miami Department of Dermatology and the prestigious Young Investigators award for research from the American Academy of Dermatology for her work on toxic epider-mal necrolysis. Dr. Trent has also received several awards for teaching from the Uni-versity of Miami Department of Dermatology.

At what point in your life did you discover your interest in cosmetic medicine?

Ever since I started medical school, I was also fascinated by the skin. How it exists as this beautiful intermediary between the harsh environment and our delicate bodies. It is a strong but vulnerable gatekeeper. During my residency at the prestigious University of Miami Department of Dermatology, I learned that dermatologists are artists. We can “re-sculpt”...

Dr. Jennifer Trent - American Dermatology Associates, Inc., Florida

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Thursday
Jan052017

Labioplasty, Vaginoplasty... Where's The Line Around Genital Cosmetic Surgery

What's going on with the growing trend of labiaplasty and genital surgery?

aesthetic labioplasty

There's been a pretty dramatic increase in genital aesthetics in the last decade. What's up with that? Is it market demand or are aesthetic clinic just getting better at marketing to a deeply personal fear.

In the United States, it's being circulated that a labiaplasty surgeon can earn up to $250,000 a month (which seems unrealisticly high). Simone Weil Davis, professor of American studies, told Shameless magazine in 2005 that surgeons are perpetuating the idea that there is a right way for women's genitalia to look; because most women see only their own vaginas or pornographic images, it is easy to make them doubt themselves, and for cosmetic surgeons to provide an answer.

But not everyone is on the hooha beautification bandwagon...

Click to read more ...

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