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Entries by Pramit Malhotra MD, MS (3)


Breast Fat Grafting Comes Of Age

The search for the ideal breast implant material has spanned everything from soy oil to paraffin. 

The current generation of silicone implants are one of the most studied medical implants in the world.  Despite the favorable safety profile, a sizeable percentage of women interested in augmentation surgery have sat on the sidelines.  There most cited concern is having something they consider unnatural in their body. 

At the recent American of Society Plastic Surgeons meeting in New Orleans,  fat grafting to the breast seems to have come of age.  Plastic surgeons have been using fat grafting to the breast for patients undergoing reconstructive breast surgery for several years now.  The original hesitations of using fat grafts for breast augmentation purposes have to do with the number of procedures necessary and the ability to read subsequent mammograms.  Both these issues are slowly being resolved.

Who is a candidate?

Most patients would prefer to have this procedure in one surgical procedure with one recovery.  Ideally, a perfect patient would want to increase their breast size from 1 to 1 1/2 cup sizes larger.  They would need to have a sufficient fat volume to be liposuctioned to provide enough material to graft.  People that are very athletic often would not have enough donor fat to be used. 

Who is not an ideal candidate?

Traditional augmentation is still best utilized for the very slim patient who wants to increase her breast size 1 1/2 to 2 cup sizes or more.  A breast implant would allow more shaping options to the breast particularly giving a patient more fullness in the superior portions of the breast.

There are still are remaining issues of the effectiveness of mammograms in patients that have had fat grafting to the breast.  Newer imaging technologies, or CT/MRI, may help resolve these issues.


Botox & The "Spock" Look

Botox + fillers that make your patients look like Vulcans?

The clinical and cosmetic uses of neurotoxins continue to grow. Botox, perhaps after aesthetician visits, are often the first procedure consumers consider. It is very common for patients to tell me that they have been considering Botox treatments for 3 to 5 years. We frequently see these patients pleased with there Botox treatments and then very interested in fillers, non-invasive body contouring, and often surgical procedures. However, what quickly interrupts this transition to other services is a result from neurotoxins that looks unnatural.

In our practice, we have increased patient retention and satisfaction after their initial Botox treatment by reviewing with them possible outcomes. Patients will often complain about a quizzical or "Spock" look after glabellar and sometimes forehead injections. I am still surprised that patients are not told of this and that there is a simple remedy. As most practioners know, 2-4 units additional neurotoxin at or just above the over arched area will soften the arch of the eyebrow.  A follow-up call/visit or just good instructions to the patient can turn a dissatisfied patient into a lifelong member and proponent of your practice.


Medical Spa Marketing: The Rise Of The "Social Shoppers"

How active are you in attracting new patients through your social networks?

The growth in the online ad market is undeniable. Double digit gains of over 20% for 2011 were seen and 2012 will likely follow suit. This mega trend in marketing has changed our marketing strategies in our practice as well as how consumers are choosing their cosmetic provider. I have seen many mature practices where 60% or more of their patients come from internet sources. I have several colleagues who currently grow their practice through web related activities or word of mouth referrals exclusively.

Patients seeking cosmetic services have evolved their research methodology considerably from simple web site searches a few years ago to a search that is much more comprehensive. Patients want much more information about their providers outside of a curriculum vitae and a smiling photo. Three years ago, outstanding patient result photos were enough (btw, most practitioners fail to remove outdated photos or marginal results). In the age of social media, I refer to a certain group of internet savvy patients as “Social Shoppers”. This means that essentially if they don't have a best friend that has personally experienced your practice, then they need to perform enough research to feel like they know your practice personally. An outstanding website with great results is a large portion of the picture, but patients want unbiased affirmation that you have the expertise and track record of results for their particular procedure of interest. In our practice, we have always emphasized specialization and core expertise. By only performing certain types of procedures and literally refusing potential patients, we have grown our practice in core areas and augmented our expertise. There are reams of data to support better outcomes when people focus on certain tasks repetitively. Variety is the spice of life but repetition is the sugar!

A task list to satisfy “social shoppers” 

  1. Encourage your patients to review you online. You have great results and there should be evidence of this online for your patients to see.
  2. Actively blog about topics relevant to your core expertise and interest area. Focus on being an expert in your community and region.
  3. Become involved in social media cosmetic services forums
  4. Find your voice. As your writing volume increases, you will find a voice that demonstrates your expertise, attention to detail, and empathy. 

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