The Beauty and the Buzz at ASLMS

Just like many of you, my day is scheduled from morning to night and I am lucky if I can grab a bite to eat in between patients. It’s a real challenge to carve out time for professional development (and lunch). That’s why I appreciate the annual conferences hosted by the professional organizations. I can block out that time months in advance knowing that I will come back with new ideas.  

The American Society for Laser Medicine & Surgery (ASLMS) is on my must attend list year after year. It’s probably the best in the world for exchanging ideas and real science in the world of aesthetics, and not just marketing hype.

This year was no different. The 2014 meeting held in Phoenix, AZ was full of ideas. So many ideas that I wish I had a longer flight home to research them all.

When I returned my staff asked “What was the highlight”? The truth is there were so many highlights. I came home with so many pearls of wisdom about so many different areas of practice. I’d like to share a few of them with you.

Privacy Laws    
This year brings changes in HIPAA privacy and security rules. There are new rules addressing the sale of protected health information for marketing and fund raising purposes. There are new rules surrounding business associates that you contract with. There are also new waves of audits to ensure compliance. The meeting was a call to action to get my staff prepared for the new guidelines.
Under Eye Bags
For those of you not familiar with Neotensil, I suggest you take a look. It is a new film-like substance, made by a hair care line Living Proof, which reduces the appearance of undereye bags. It’s sold through physicians’ offices, but applied by the patient at home.  
Injectable Filler Technique
Take that extra care, that extra wipe step, with Voluma and other facial fillers. When injecting fillers in the hollows of the lateral orbit, think microcannulas with a lateral point temple zygomatic point of entry.  And on those crow’s feet, think of almost individual dosing per severity of lines at those two to three lateral orbit injection points. I also learned about pre-injection disinfecting wipe pads that combine clorhexidine with isopropyl alcohol.
Acne Suppression
There was a lot of buzz about keeping acne at bay using combinations of both short pulsed and long pulsed YAG lasers. It seems a paradox, but patients did better long term when they did laser acne treatments after finishing a course of antibiotics.  For patients with unresponsive rosacea pustular acne, think SIBO or small intestinal bacterial overgrowth and order a lactulose breath test screen.  
Bruising
For that post treatment unintended or inconvenient bruise, think of speeding up its disappearing act with an IPL treatment about 2 days after.  
Tattoo Removal
Here is a tip for tattoo removal for those of you not yet into Picosecond lasers. Treat the area through a hydrocolloid dressing, such as Second Skin.  
Noninvasive Fat Removal
There was a ton of chatter, all of it exciting, about noninvasive fat removal. The players are CoolSculpting,  Liposonix and the newest kid on the block, Vanquish.

Some of the above ideas are reality for me. We added Vanquish to our list of noninvasive fat removal a few months back. It’s a great fit for our practice and patients. Other ideas may not be a fit. But that’s the beauty of the meeting. With so many new products and protocols shared in one space, you are bound to come back with ideas to push your practice forward.  

Medical Devices & Estheticians

It's true, medical devices are used by Estheticians.

In most clinics in the US, esteticians are often used to perform treatments... but outside the US not so much. Here's an email I received from Susanne Warfield, Executive Director of NCEA, taking us to task for 'misinformation'.

Susanne Warfield - Executive Director NCEA

I received a call from one of our members regarding your website and the statement about estheticians using medical devices.

Estheticians are using medical devices every day...- even an electric tooth brush is a medical device as defined by the FDA. It is very important that we understand that any device sold and marketed in the United States must be registered with the FDA and laser and light therapy devices are just another medical device that have "Indications for Use" and "Intended Use".

Please update your misinformation on your website as it it incorrect. Thank you

Anyone have thoughts on what an esthetician in the US (or each state) can or can not perform? Where's the line?

Richard D. Gentile, MD MBA, A Plastic Surgeon In Ohio

Our interview with Dr. Richard Gentile of Gentile Facial Plastic & Aesthetic Laser Center with three locations in Ohio.

Name:  Richard D. Gentile, M.D., M.B.A.
Location: Youngstown, Akron, and Cleveland, OH
Website: www.facialplastics.org

That’s interesting: Dr. Gentile is deemed as one of America’s Top Facial Plastic Surgeons by the Consumer’s Research Council of America. 

Profile: Graduate of Ohio State University, The University of Cincinnati College of Medicine and Baylor College of Medicine Residency Program. International lecturer and author of many publications including the 2011 Textbook “Neck Rejuvenation” published by Thieme. Dr. Gentile is a past member of the Executive Committee of the American Academy of Facial Plastic & Reconstructive Surgery and served as its Treasurer from 2004-2007.

How did you realize you were meant to practice cosmetic medicine?

As an undergraduate student I had the privilege of spending a week externship with a Plastic Surgeon in Columbus Ohio. It was really my first exposure to medicine and I was significantly influenced by the mentoring that occurred. During medical school I was equally influenced by head and neck cancer procedures and elected to pursue postgraduate residency studies encompassing both cosmetic head and neck and reconstructive surgery.

With three different locations in Ohio you must be busy. Can you describe how your clinics operate and how you staff them?

The Facial Plastic & Aesthetic Laser Center is a fully integrated aesthetic practice with a free standing state licensed and nationally accredited surgery center adjacent to it. There are satellite offices in Akron and Cleveland Ohio where consultation and minor surgery is offered. We are privileged to see patients from all regions of Ohio, Western New York, Western Pennsylvania and West Virginia. We also see patients from other states and foreign countries as well. A full service medical spa is located in the Boardman office and one of the largest private laser clinics with 20 different aesthetic lasers.

Our main office is not located in a large metropolitan area so staffing is sometimes a challenge. (Larger metro areas feature more cosmetic practices training staff who then have experience in medical spas or pastic surgery centers when they interview for new positions.)

Unless someone moves into our area we usually do not have the opportunity to hire experienced personnel so we have to train them on site. Another disadvantage is the smaller surgery centers need per diem or part time staffing patterns unless they operate five days a week and frequently it is difficult to find personnel who are interested in more limited schedules. Understanding these special needs allows us to zero in on those candidates who are interested in the employment opportunities we offer. We have several aestheticians, a cosmetic surgery coordinator who also assists our marketing efforts, two RN’s one exclusively dedicated to the surgery center and anesthesia staff who are retained from a national staffing firm. Our front office has a billing director and a receptionist.

What IPL or laser technologies are you using? What are your thoughts about the technologies you’re using now?

We have two Lumenis One platforms one in Boardman and one in Cleveland. They are equipped with IPL, Light Sheer laser hair removal diode laser and Nd:Yag. We also utilize three fractional lasers the Lumenis Ultra Pulse with deep FX , the Cynosure SmartSkin laser, and the Sciton Contour with ProFractional capabilities. We also utilize radiofreqency units for skin tightening with LumenisAluma and Pelleve. We frequently combine these modalities in multi-modality laser skin rejuvenation. The Cynosure Med Lite is one of our most frequently utilized lasers and is used for Tatoo removal, non ablative skin rejuvenation and dermal toning. A 532 nm diode laser is used for non-ablative treatment of vascular and pigmented lesions. Laser Lipolyis is a big part of our practice particularly in the head and neck and we developed many of the facial surgery protocols for laser assisted facelifting procedures or Smartlifting™ procedures.

Have your marketing efforts successfully increased the volume of patients coming in your clinic?

We use or have used virtually all media to market our practice and find particular success with internet based, social media, and seminars to educate the public about the procedures we offer. Being features on the websites of our technology partners also helps to let patients know about the services we offer.

Our favorite referral are those that come from a satisfied and happy patient sending their friends and family members to us and those make up about 50% of our new patients.

Are there particular treatments that have increased your profits dramatically?

Our services are divided about 50-50 between surgical services and the other office based non surgical services including neurotoxins (Botox), dermal fillers and laser procedures. Among our surgical procedures 90% are facial plastic & reconstructive in nature but primarily cosmetic and not as much reconstructive surgery as previously.

A small percentage of our practice revenue comes from skin care products and related sales.

What lessons have you learned in your practice that you can pass on to those who have just started their medical spa?

Listen to your patients. I think it is important that they are not always in your office so that you can give them the result you think they should have. They are there to hear about how you can best help them achieve the result they are interested in. The closer you come to achieving their goals the more satisfied and happy they will be. Learn from the unhappy patients so that it can help you to either modify your approach or better select patients so as to not try to please the difficult to please patients.

It has been a great privilege to practice Facial Plastic & Reconstructive surgery for nearly 25 years and the greatest development from early practice to later practice is the accumulation of wisdom from the early years of practice. When first starting in practice you sometimes carefully walk into the exam rooms of post op patients not quite sure what the result is going to be like or whether there will be complications. 25 years later you pretty much know what to expect and the kinds of results that will be achieved. We are always innovating and trying to add modifications to our techniques that will enhance our patients post- operative results. So while we are getting closer all the time our practice continually strives to obtain the best surgical and non surgical results available anywhere.

This interview is part of a series of interviews of physicians running medical spas, laser clinics and cosmetic surgery centers. If you'd like to be interviewed, just contact us.