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Entries in Botox (110)

Wednesday
Apr182012

An Interview With Dr. Mary Lupo Of Lupo Center For Aesthetic Dermatology

Mary Lupo MD, FAAD Board Certified Dermatologist New OrleansSince 1983, Dr. Mary Lupo has been at the forefront of non-surgical skin rejuvenation.

As the founder of Tulane University's resident's cosmetic clinic, a Platinum plus Botox and Juvederm provider, and a clinical instructor for Allergan, Dr. Mary Lupo knows her way around injectables. In fact, she launched Botox to physicians in Austrailia in 2007. We wanted to hear what Dr. Lupo has to say about how she manages her dermatology clinic and her lifestyle as a physician.

Name: Mary P. Lupo MD FAAD
Location: New Orleans, LA
Website: drmarylupo.com/index.html

That's interesting: Dr. Lupo received the Peterkin Award for original research in skin lipids and inflammation in patients with atopic dermatitis. Author of over 50 publications and presentor of over 230 presentations. Researcher, author, lecturer, teacher. Founding co-director of the Cosmetic Boot Camp in 2005. Past-president of the Women’s Dermatological Society and former member of the board of directors of the American Society for Dermatologic Surgery.

Click to read more ...

Monday
Apr092012

Warren Seiler MD, A Laser Center & Medical Spa In Alabama

Warren B. Seiler III, MD, A Board Certified Cosmetic Laser Surgeon in Alabama

Dr. Seiler is a speaker, preceptor and physician trainer for Lumenis Laser Company and injection trainer for Allergan (manufacturer of Botox & Juvederm).

Birmingham Alabama is home to Seiler Skin, Cosmetic Laser Center & Medical Spa, a single-physician clinic run by Dr. Warren Seiler and his wife. We sat down with Dr. Seiler to find out what he thinks of the current crop of cosmetic lasers, how he runs his clinic, and hear what advice he has for other physcians.

Name: Dr. Warren B. Seiler III
Location: Homewood, AL
Website: seilerskin.com

That's interesting: Dr. Seiler is a Board Examiner and the Executive Director of the American Board of Laser Surgery and co-author of the ABLS examination text book and board certification exam.

As a single physician owner, how does your clinic operate?

My practice, Seiler Skin Cosmetic Laser Center, is a single physician driven cosmetic practice. I personally perform the laser and injectable procedures. I have a very good medical aesthetician working directly under me who helps patients with skincare programs, Hydrafacial, chemical peels, and laser hair removal. My wife is our marketing and website director and she is co-owner with me in the practice. We run the practice together, but we have an office manager that helps.  I perform fractional CO2, Fraxel, Thermage, Laser Hair Removal, Laser Spider Vein treatments, IPL, and others. Botox and Juvederm are the only injectables, although I have tried many others, I feel they are the best. Our practice is really the only one in Birmingham in which the physician specializes entirely in cosmetic laser procedures and nothing else, which really helps to offer the experience that I provide.  

Click to read more ...

Saturday
Apr072012

Alex Denes, MD, FACP, A Medical Spa In California

Dr. Alex Denes CaliforniaFrom a start in internal medicine, Dr. Alex Denes has moved to an entirely cosmetic medical spa and practice.

Dr. Denes worked as an assistant surgeon for 30 years before entering the cosmetic field in 2000. We sat down with Dr. Denes to find out what he's learned, and what lessons he has to pass on.

Name: Dr. Alex Denes
Location: Hemet, CA
Website: HiGorgeous.net

That's interesting: Dr. Denes is qualified as an expert witness for the US Department of Justice and the California Medical Board. He's appeared as an expert witness for the defense in hundreds of medical malpractice cases.

He is Medical Director and VP of Medical Affairs of Hemet Community Medical Group, a multispecialty group consisting of 155 physicians, and Corporate Medical Director for KM Strategic Management Group.

How did you transition from Internal Medicine to Cosmetic Medicine?

Click to read more ...

Saturday
Mar312012

Plastic Surgeon Herluf G. Lund Jr., MD, FACS From St. Louis Cosmetic Surgery

With four plastic surgeons and a medical spa, St. Louis Cosmetic Surgery has been around for more than 35 years.

Name: Dr. Herluf Gyde Lund, Jr.
Location: Chesterfield, MO
Website: stlcosmeticsurgery.com

As part of a large cosmetic practice in St. Louis that is one of the largest cosmetic breast surgery practices in the country, Dr. Lund has undoubtedly seen his share of patients and has stories to tell. In this inteview, Dr. Lund shares his clinics compensation structures for staff members, details different types of medical spa business models, and shares his thoughts on building a successful practice.

That's interesting: Dr. Lund chairs and serves on numerous committees for both the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery and is a principle investigator in studies using the next generation, Cohesive Gel Implant. Every summer, Dr. Lund volunteers as the "camp doctor" for Camp Chippewa for Boys in Cass Lake, Minnesota.

What do you think physicians need to know about starting or running a medical spa?

Determine first if you really need a medical spa. If you just want to provide some products and skin care, then you may not need to add a great deal of staffing and services. You may be able to train your nursing staff to provide many of the treatments and the product manufacturers are usually very willing to help train you staff on how to market and sell their product lines. This does not require a big investment in inventory and office space and also lets you “try the water” first. Once you have made the decision to open a medical spa, then you need to decide what you want your medical spa to do. Once you have decided what you want to do, then you need to examine your patient practice mix and the surrounding competition to determine if the goals you have set are achievable given the environment you practice in. For example, there are essentially four types of medical spa models to choose from when setting up a medical spa...

Click to read more ...

Wednesday
Mar282012

Interview: Brian K. Sidella, Founder Of Forever Young Medspa In South Florida

Brian K. Sidella, Owner and President Forever Young Medspa

Surviving and thriving in the cut-throat cosmetic industry of South Florida.

Brian Sidella, founder of Forever Young Medspa sat down with us to discuss how a non-physician running a medical spa competes with a host of physician run clinics in South Florida.

Name: Brian K. Sidella
Location: Cooper City, FL
Website: foreveryoungmedspa.us

Having now been in this business for almost 7 years, I’m still amazed at how this industry operates. Most of the players have a planned obsolescence strategy of about a 4 year life cycle and then most force you into a fork lift upgrade. As an example you could have begun 2004 with a Palomar Medilux, bought a Starlux 300 in 2005, a Starlux 500 in 2009 and now an Icon in 2012. Each of these systems represents a six figure investment. Whoever brings to market a field upgradable platform that will last a decade is going to dominate… as for the technology itself we have a pretty extensive suite from Palomar, Cynosure, Syneron, Edge & BTL. We use Palomar for IPL services and 1540 Fractional, Syneron for the Matrix, Cynosure for laser hair removal, Edge for HydraFacial M.D., Syneron for VelaShape & BTL for the Exilis...

Click to read more ...

Friday
Mar162012

Dr. Daniel Kaufman, Discreet Plastic Surgery In Manhattan & Brooklyn

Daniel Kaufman MD stays busy with clinics in Manhattan's Upper East Side, the East Village, Brooklyn, and a location in Garden City, Long Island. 

Dr. Daniel Kaufman Plastic and Reconstructive Surgeon

Name: Daniel Kaufman, MD
Location: New York, NY
Website: DiscreetPlasticSurgery.com

Thats interesting:  He holds a Master of Science degree in Biomedical Engineering from the Polytechnic Institute of New York University. In fact, he helped create the program, just after completing his medical degree.

What is your professional approach to cosmetic medicine?

Training in plastic surgery, you learn about a wide variety of surgical procedures, cosmetic and reconstructive, that can be utilized in a multitude of medical situations. As a plastic surgeon facing difficult medical problems, I always

Click to read more ...

Friday
Mar092012

Jeffrey W. Kronson, MD, of Gia Laser Aesthetic Center in Claremont CA

Dr. Jeffrey W. Kronson California Board Certified SurgeonTalking medical spas with Dr. Jeffrey Kronson of Gia Laser Aesthetic Center in Claremont, California.

Physician: Jeffrey W. Kronson, MD, FACS
Location: Claremont, CA
Website: http://www.gialaser.com

Profile:  Jeffrey W. Kronson, M.D., F.A.C.S. is the founder of both the Whittier Vascular Surgery Center and Gia Laser Aesthetic Center and a Past-Chair of the Department of Surgery at Presbyterian Intercommunity Hospital in Whittier, California. He currently practices at Methodist Hospital in Arcadia and Huntington Memorial Hospital in Pasadena. Dr. Kronson is Board-Certified by the American Board of Surgery in both general and vascular surgery and is a Fellow of The American College of Surgeons.

He currently serves as Medical Director at Gia Laser Aesthetic Center, which he founded in 2007.

How did you get started in cosmetic medicine?  

I had a large varicose vein practice where I was treating literally thousands of legs that were pathological but I had a real hard time with the cosmetic needs of the patients, usually for an insurance or financial reason. I opened the Medical Spa as a way to engage these clients in services that they requested, giving them different options and avenues. From there, it grew into the full complement of injectables (Botox and dermal fillers) IPL, body contouring, medical aesthetics and cosmeceuticals.

Now we have a full service Medical Spa. It is run by 5 full time employees, as I am there 2 days a week or by appointment. Our average patient is 30-65, educated, upper-middle class and often executive. Being just outside LA proper, we see our fair share of A-list celebs who don’t want the paparazzi chasing them. We offer complete privacy, complementary car service and a discreet, professional standard that is difficult to find elsewhere.

How do you select and manage your staff? Did you encounter any problems?

I have a full-time manager who screens candidates, we interview them then together and make a decision. We are part commission and part salary. Before I had the excellent woman that is currently working with me now, I had DISASTERS in finding supervisory personnel. I unfortunately ran into theft, deceit and dishonesty. Right now, that is a thing of the past.

It is also very difficult to find an RN who is as good clinically as she is selling retail. We also have finally found such a person but we need one more.

What laser technologies are you currently using?

We use Syneron EMax, Velashape and Lipolite. I bought these systems from the end of 2007 to the middle of 2009. The non-invasive Elos technology continues to give us superb results with no down time.

The new systems are interesting, less expensive as the economy has fallen, but all seem to require less individual treatments and fewer patient visits. It stands to follow that most are more invasive or ablative, though there is no long-term data that I am aware of on all these new ones out there.

If there was such a product that clearly was faster, non-invasive and gave outstanding results, we would certainly entertain the idea of purchasing it.

What marketing strategies have you found effective for your clinic? 

  • Social media (FB), the internet, many marketing sites.
  • Clipper coupon ads
  • Some print
  • Glossy postcards
  • Word of mouth, specials and invertising still the best.

What treatment/s generate the most revenue?

Lipolite and laser in general are most profitable as there are no disposables.

Any parting advice for other docs starting or running medical spas?

 Know everything. If there is a “rogue” RN operating outside the boundaries of your practices and policies, you will be meeting an attorney sooner rather than later;.

Doing this job well is a FULL-TIME commitment. It is far different to add a laser to an MD’s practice than to open a free-standing Medical Spa in addition to a busy practice. Learn finance. Hire people you trust. Know what you don’t know and hire someone to know it.

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.

Sunday
Mar042012

Interview: Stephen Weber MD, PhD of Lone Tree Plastic Surgery

Sitting down with Dr. Stephen Weber of Lone Tree Facial Plastic & Cosmetic Surgery Center outside of Denver, Colorado.

Physician: Stephen Weber MD, PhD
Location: Lone Tree, CO
Website: http://www.lonetreefacial.com

That's interesting: Dr. Weber has participated in the "Face to Face" program where local plastic surgeons donate their services to the victims of domestic violence and has participated in the annual humanitarian mission surgical trips providing free care to medically isolated, indigent patients.

Profile: I am a double board-certified Facial Plastic and Reconstructive Surgeon practicing at Lone Tree Facial Plastic & Cosmetic Surgery Center in the Denver metro area. My practice involves all aspects of facial cosmetic surgery including facelift, browlift, blepharoplasty, rhinoplasty, otoplasty, facial implants, facial resurfacing and scar revision. Our office also provides comprehensive treatments for facial aging including Botox and Dysport to reduce facial wrinkles, dermal fillers to minimize facial lines and folds as well as fractional laser (Fraxel and MiXto) resurfacing.

Can you tell us a little bit about you and how you got started in cosmetic medicine?

I became a Facial Plastic & Reconstructive Surgeon by a very circuitous route. In medical school, I planned to become an Infectious Disease specialist and even obtained a Ph.D. in Immunology and Microbiology in pursuit of that goal. However, my first rotation after successfully defending my thesis was in head and neck surgery. I knew that first day that I wanted to become an Otolaryngologist (Head & Neck Surgeon, ENT). During my residency training in Otolaryngology and Head & Neck Surgery I realized that my goals of performing a diversity of procedures in a technically demanding sub-specialty made Facial Plastic Surgery a very well suited specialty. I trained as Dr. Shan Baker’s fellow in Facial Plastic Surgery at the University of Michigan and then entered practice.

Can you tell us more about your clinic and the services available? 

My practice is a single specialty clinic. We have two plastic surgeons here at the practice, myself and Dr. Rick Schaler who is my partner and practice owner. We have eight other staff including one nurse, five estheticians, one front desk staff member and a billing manager. We offer the full range of facial reconstructive and cosmetic surgery. Our office has a fully functional operating room in which we perform all of our cosmetic procedures under IV sedation. On the medical spa side, we offer all of the available injectable treatments including Botox, Dysport, Xeomin, Restylane, Perlane, Juvederm, Radiesse and Sculptra. We perform laser services including Fraxel and MiXto (fractional CO2) resurfacing, vascular laser and laser hair removal treatments. We also perform a full complement of facial peels and facial treatments. Our patient population comes from the surrounding suburbs of Lone Tree, Highlands Ranch, Littleton, Parker as well as Denver proper.

How are you dealing with staff in your clinic?

Fortunately, we have not had the need to fire staff. The reason for this is that we’re very careful with the hiring process. The communication between members of our office is very clear. When we set out to hire a new member of the office we have a clear, articulated goal regarding our needs and the type of person we want to hire. Everybody in the office has a chance to veto a potential new member of the office staff. Each member of the office also has the opportunity to veto that potential candidate. We tend to hire from a pool of people already familiar to the office or from strong referrals from friends of the practice. We have avoided print advertising of open positions of late as this always leads to a huge response with relatively low yield of the type of candidate that we need.

For the front desk staff, compensation is hourly. For procedure or treatment oriented members of the office, including physicians, compensation is heavily weighted toward production. This is the most fair compensation method and encourages productivity. The formula is simple, clearly articulated and fair. Employees are paid a percentage of net collections. An employee can review their production at the end of each month, if requested. I review my own production at the end of every pay period and encourage the rest of our staff to do the same.

What laser technologies are you using now? How do you decide on new purchases?

We perform laser treatments including Fraxel and MiXto (fractional CO2) resurfacing, vascular laser and laser hair removal treatment. In terms of new purchases, laser companies really need to show us a substantial improvement in results before we will purchase new technology. We are marketed to by phone, mail, email and at conferences. I am interested in new radiofrequency technologies but I think the jury is still out and we’re holding out on making that purchase.

How do you market your clinic?

In terms of social media, we market on Facebook , Twitter, as well as LinkedIn. We’re trying to determine whether Pinterest can be leveraged with pre- and post-op photos and other images. We use social media to communicate with current and prospective patients with informational posts and product samples/ give-aways. Our email list of current patients is our most valuable marketing tool. Providing current patients with updates that they can forward to friends is invaluable. We also put on open houses and seminars that allow us to provide education, meet new patients and learn more about our current clients.

In the pay-per-click arena, we use Google AdWords with a relatively conservative budget. That has drawn a lot of traffic to our website and helped generate surgical cases. We have been testing the waters of direct mail and print advertising. Direct mail has had moderate result. Print advertising has been disappointing. We do not currently take part in Groupon, Living Social or any other daily deal sites. The main reason for this is cost and questionable ability to develop lasting relationships with users of these services.

What are the most coveted treatments/services in your practice? Have you tried removing some of your services?

The sun and dry air in Denver are the reason why people flock to this area. However, they wreak havoc on facial skin. As a result the demand for lasers and peels here is tremendous. On a volume basis, Fraxel skin resurfacing and Botox are the most common services in our office. However, the fixed cost associated with these services is significant. From a revenue perspective, surgery provides the greatest revenue and greatest profit for the practice. About 75% of our cases are elective in nature. We have not dropped any procedures recently. When I joined the practice, I introduced Sculptra facial injections and Radiesse hand rejuvenation and we’ve seen high demand for these treatments. 

What have you learned about practicing cosmetic medicine?

I’ve developed a thicker skin and learned not to take things personally. In the past, when a patient booked surgery with a competitor I assumed that I had erred in some way or not provided excellent photos of patient results or …. I’m noticing today more and more patients that will meet multiple surgeons and come back to book surgery with me. When I’ve asked why, the answers that patients provide are incredibly vague. It really is a gut feeling that people have that you are or are not the surgeon that will provide what they’re looking for. All we can do is provide as much information and education, quality photos of surgery results, a top notch facility and a warm, caring environment to convince patients that we’re the right team for them.

Any last thoughts on advice for your physician colleagues in the cosmetic industry?

I would urge physicians, especially in the plastic surgery realm, to compete by providing exceptional service. With Groupon and other daily deal sites, there is increasing pressure to compete on cost. Some of these deals will temporarily drive patients into the practice. However, few are likely to be loyal patients when the practice down the road runs an even cheaper deal. The daily deal trend has provided consumers with cheap (not necessarily quality) services. However, this has come at the expense of sustainability for practices that jumped in without doing enough research. The bottom line is that daily deals will lead to a spike in volume composed of largely price-oriented patients. Further, the deal seeking crowd is unlikely to see the value in your services. Continuing to drive down prices when our costs are fixed is not only unsustainable but diverts your attention from providing services, such as surgery, that are the profit engine for the practice. When you offer services at cost, you CANNOT "make it up on volume."

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.

Wednesday
Feb292012

Interview: Anthony Youn, MD, FACS

Medspa MD's interview with Dr. Anthony Youn, MD, FACS, a plastic surgeon and author practicing in Michigan.

Physician: Dr. Anthony Youn, MD, FACS
Location:
Troy, Michigan
Website:
www.dryoun.com
That's interesting: Dr. Youn has been named one of the top three plastic surgeons in the United States by askmen.com and the only Michigan plastic surgeon named as a Top Doctor by U.S. News and World Report.

Profile: I am a board-certified plastic surgeon in private practice in Troy, Michigan. I am a member of the American Society of Plastic Surgeons, the American Society for Aesthetic Plastic Surgery, and an Assistant Professor of Surgery at Oakland University / William Beaumont School of Medicine.

Can you tell us a little bit about your background and how you got started as a plastic surgeon?

My first taste of plastic surgery was when I underwent major reconstructive surgery to my jaw in the summer between high school and college.  Prior to this surgery, my mandible was so large it was twice the size of Jay Leno’s and dubbed “Jawzilla.” At the time I hoped that this surgery would transform me, a skinny Asian American nerd with no nerve, no game, and no clue, into an Adonis: A ladies’ man.  Unfortunately, this surgery started a four-year dating drought, and didn’t really teach me that changing your appearance could change your life until much, much later.

My real introduction to plastic surgery came in the form of an eight-month-old boy who was mauled by a raccoon. His face was literally eaten off. The moment I saw the plastic surgeon make plans to reconstruct this poor child’s face, I was hooked. I describe this scene in great detail in my book.

I completed my plastic surgery residency at Michigan State University in Grand Rapids, a fellowship in aesthetic plastic surgery in Beverly Hills, and stared my private practice in Metro Detroit.

Can you tell us more about your practice and how it's organized?

Youn Plastic Surgery, PLLC is a private practice plastic surgery clinic. I have six employees: a receptionist, a patient coordinator/scheduler, a medical assistant, two aestheticians, a nurse injector, and myself. The office inhabits 4000 sq feet on the 12th floor of the tallest high rise building in Metro Detroit. We offer a full range of surgical and non-surgical plastic surgery treatments, including laser treatments, injections, cosmetic and reconstructive plastic surgery.

Staff compensation is often a question for docs. How do you handle that?

All of my employees are paid hourly, with no pre-set incentives or commission. Full time employees get full benefits, including health insurance, 401K, and profit-sharing. I work with a practice management company to help with payroll and other employment issues.

What are your thoughts about the IPL and cosmetic lasers that youre using in your clinic?

Due to my frequent media appearances, I often have new technology come through my office, usually for limited periods of time. I frequently present the newest laser and light-based technology for several television programs, and have partnered with various companies who supply them to me on a trial basis. That being said, I also own several ‘workhorse’ devices that are used on a daily basis.  I have the Cynosure Cynergy laser, which combines pulse dye and Nd-YAG lasers in one, and the Syneron eLight with Refirme, hair removal, and skin rejuvenation treatment heads. My office also uses the Dermosonic device for the temporary reduction of cellulite and a microdermabrasion machine as well.

Sound's like you're fortunate in that you're really busy which leads to the next question: How are you marketing your practice?

I’m fortunate that the only advertising I purchase is the maintenance of my three websites:dryoun.com, celebcosmeticsurgery.com, and institchesbook.com.  I’m often featured in local and national media, which has given me a significant amount of exposure. In the past I’ve used many sources of advertising, including newspapers, local magazines, internet SEO, local TV and radio, all with varying results. I find that internal advertising using Constant Contact (email software) has been our most effective means of getting the word out. The yellow pages is the one media source I recommend other providers not waste their money on.

I recently went on a book tour to promote my book which included articles in several magazines and newspapers, including Plastic Surgery Practice and Plastic Surgery News.  This exposure has been really valuable for my practice.

What treatments or services are most profitable for you?

No question, Surgery. The vast majority of the profits of my practice come from surgery. Although approximately 25-30% of the gross practice revenue stems from non-surgical treatments, approximately 60-70% of this revenue goes to supply costs, like Botox vials, Restylane syringes, and laser maintenance costs. 

Plastic surgeons, like all doctors in cosmetic medicine, usually have some interesting patient stories to tell. Do you have one that really stands out?

As a plastic surgeon, I often encounter patients whom I suspect suffer from Body Dymorphic Disorder, or BDD. Typically, I encourage them to seek counseling and avoid plastic surgery. Unfortunately, most BDD patients don’t believe they have the disorder and refuse to see a therapist. I remember a patient I’ll call “Jane.”

Jane was a librarian in her mid-forties who consulted me for eyelid surgery. It didn’t take long for me to diagnose her with BDD.

“So what would you like to talk about today?” I asked her.

“Don’t act like you don’t know, Dr. Youn. I see you staring at my eyes.  Just like everyone who comes into the library. They pretend to read books or go through the card catalogue, but the moment I look away they stare at me. I catch them doing it all the time. I need you to fix my hideous eyes.”

“What’s wrong with them?  I think they look fine.”

“Don’t patronize me. You know what’s wrong with them! I’ll pay you five thousand dollar cash to fix them. I hear you’re the best. I want you to make them perfect.”

I spent an hour trying to convince Jane that she didn’t need surgery and that she should seek professional counseling instead. She wouldn’t listen.  She became increasingly agitated. Finally she said if I didn’t operate on her, she would take a scalpel and perform the surgery on herself in my office right then! 

Cue creepy horror film music here.

I would never operate on Jane, who clearly seemed mentally imbalanced. But I wanted to say no to her as tactfully as possible. I pulled out my trump card. When things get ugly, I go to the one excuse that always defuses a situation, guaranteed to reject a patient for surgery without making her upset. 

Sadly, it’s the same excuse countless women used on me during high school and college.

“Jane, it’s not you, it’s me. I’m not ready to do your surgery. I don’t think I’m a skilled enough surgeon to make you happy.

“Really?”

“Yes. Jane, I’m not good enough for you.”

Don’t laugh. She bought it.    

Any final words of advice for other physicians running their own clinic?

I think the best advice I can give is this: When you are done with work, do things you enjoy.  As physicians, we are accustomed to delayed gratification. It’s always a challenge for us to find balance in our lives. I currently split my time between my family, my work, and writing. We’ve each undergone over 23 years of schooling to become practicing physicians, and now is the time to enjoy the fruits of our labor. Find moments of happiness in your work and at home. I think the turtle in Kung Fu Panda said it best, “Today is the present, and that’s why it’s a gift.”

About: Dr. Youn is the author of a plastic surgery tell-all, In Stitches, recently published by Simon and Schuster and  a regular contributor to CNN.com, MSNBC.com, and USA Today.  Dr. Youn has been featured on the Rachael Ray Show, Good Morning America, the Dr. Oz Show, the CBS Early Show, and many others.

Dr. Youn has authored or co-authored several papers and scientific manuscripts on plastic surgery, including such procedures as the Volumetric Facelift and Facial Reshaping. In addition, throughout his career he has conducted scientific research on a variety of topics, extending from cosmetic surgery, to laser treatments, to reconstructive trauma surgery, to HIV medications.  He is a member of the Editorial Advisory Board for Plastic Surgery Practice Magazine and has lectured throughout the country.

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.

Wednesday
Sep212011

Can Nurse Practitioners Offer Botox?

By Carolyn Buppert, NP, JD

Can Nurse Practitioners offer Botox, Restylane, Juvederm and other cosmetic treatments on their own?

The answer to this question is going to be state-specific. Here are the steps to follow:

  1. Read your state's Nurse Practice Act section on scope of practice for nurse practitioners to answer these questions: What acts require physician collaboration or supervision? How is collaboration or supervision defined? (Boards of Nursing in the United States: State-by-State Web Links)
  2. Go to your state's Board of Medicine Websites and search for any policies on provision of botulinum toxin (Botox®). Note that botulinum toxin is a prescription medication, so a prescription or order for the medication must be written and someone must administer the drug. If your state has policies on botulinum toxin, note the requirements for prescription and administration. Some states consider administration of botulinum toxin a medical act, and some states consider it to be within the scope of a registered nurse. Prescribing is always a medical act.

    If you live in a state that requires no physician collaboration when nurse practitioners prescribe, then as long as the Board of Medicine has no requirements with respect to botulinum toxin, you are free to proceed with your practice idea. If your state requires physician collaboration in order for nurse practitioners to prescribe, then you'll need to line up a collaborator. In most states, the collaborator does not need be on site, but in some states, the collaborator must practice at the site with specified frequency. Follow the rules as they relate to any prescribing.

About: Carolyn Buppert, NP, JD is an attorney practicing in Bethesda, Maryland.

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Tuesday
Aug022011

Xeomin vs. Botox vs. Dysport

Botox & Dysport now have a new contender in the cosmetic space... Xeomin.

About Xeomin: (pronouced ZEE-oh-min) from Merz Pharma GmbH & Co KGaA

Download the Xeomin Report PDF

Botox, Dysport and Xeomin have a lot in common, but they also have some important differences. Unlike both Botox and Dysport, Xeomin does not need to be refrigerated before it's reconstituted (see below). This should be an advantage during distribution. What's more, Xeomin has no additives — just botulinum toxin type A. This may lessen a patient's likelihood of developing antibodies.

Supposedly, Xeomin is more like Botox than Dysport. It takes about one week for the full effects of Xeomin injections to be realized, and once this occurs the results last from three to six months. Dysport, Xeomin and Botox should not be used interchangeably.

Also, since Xeomin is approved only for cervical dystonia and blepharospasm in adults who have had previous treatments with onabotulinumtoxinA (Botox), any use for wrinkles and crows feet is going to be off label. This, along with the fact that Botox pretty much owns this space will probably mean that Xeomin will have a hard slog finding a huge audience. It may be worth trying thought to see if you just like it that much better. (Anyone who's already tried it, please leave a comment and let us know what you think.)

Storage

Unopened vials of XEOMIN® (incobotulinumtoxinA) can be stored at room temperature 20 to 25°C (68 to 77° F), in a refrigerator at 2 to 8°C (36 to 46°F), or a freezer at -20 to -10°C ( 4 to 14°F) for up to 36 months. Do not use after the expiration date on the vial. Reconstituted XEOMIN® (incobotulinumtoxinA) should be stored in a refrigerator at 2 to 8°C (36 to 46°F) and administered within 24 hours.

Indications & Usage

Cervical Dystonia: XEOMIN (incobotulinumtoxinA) is indicated for the treatment of adults with cervical dystonia to decrease the severity of abnormal head position and neck pain in both botulinum toxin-naïve and previously treated patients.

Blepharospasm: XEOMIN (incobotulinumtoxinA) is indicated for the treatment of adults with blepharospasm who were previously treated with onabotulinumtoxinA (Botox).

Complications

Like other botulinum products, Xeomin must carry a black box warning regarding a rare risk for spreading outside of the injection site. If this occurs, life-threatening swallowing and breathing problems may result. This has not been seen in people receiving neurotoxins for cosmetic reasons or to treat blepharospams. It has mainly occurred among children treated off-label for cerebral palsy-related muscle spasms.

Adverse Reactions

Cervical Dystonia: The most commonly observed adverse reactions (incidence ≥10% of patients and twice the rate of placebo) for XEOMIN 120 Units and XEOMIN 240 Units, respectively, were: dysphagia (13%, 18%), neck pain (7%, 15%), muscle weakness (7%, 11%), and musculoskeletal pain (7%, 4%).

Blepharospasm: The most common adverse reactions (incidence ≥10% of patients and twice the rate of placebo) for XEOMIN were eyelid ptosis (19%), dry mouth (16%), visual impairment (12%), diarrhea (8%), and headache (7%).

Drug Interactions

Concomitant treatment of XEOMIN and aminoglycoside antibiotics, spectinomycin, or other agents that interfere with neuromuscular transmission (e.g., tubocurarine-like agents), or muscle relaxants, should be observed closely because the effect of XEOMIN may be potentiated.

Pregnancy

Pregnancy Category C: There are no adequate and well-controlled studies in pregnant women. XEOMIN should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Cost

The costs are expected to be similar to Botox. I checked over on Medical Spa RX and they don't seem to be carrying it as of now so you won't be able get a deal on it the way you can with Rx's Botox Group Buy Program.

Have you got any intention of trying something besides Botox or Dysport? Does Xeomin have a chance in your clinic? Would you try it on a few patients to see if you like it?

Thursday
Jun162011

Texas Law & Botox Regulation

Eveidently, and this surprises me, if you're in Texas, anyone can inject Botox, Restylane, orJuvederm if they're 'delegated to' by a clincian.

Is this why the individuals and websites that were leading the do-it-yourself Botox injections hailed from Texas?

Hopefully, Texas will get it's act together and finally pass some sensible regulation around Botox and injectables. Undoubtedly there are individuals who have been injecting safely and will be affected by this but it's just not a good idea to have anyone able to inject.

via WFAA.com

Last year, actress Dana Delaney opened up publicly in Prevention magazine about getting a botched Botox job that caused one eye to droop. She said the wrinkle fighting toxin was improperly injected into a nerve.

Botox and other injectable treatments are controlled substances. Only someone with a medical license can order them. That has many surprised to hear there are no rules about who can inject them. In medical spas across Texas, just about anyone can wield the needle.

“As long as I’m the one purchasing it, right now I can delegate to whoever I want to,” said Dr. Lori Stetler, a Dallas dermatologist.

Stetler applauds efforts to make the lucrative anti-aging industry safer for patients.

Friday, the Texas Medical Board will consider changing who can be delegated to perform “cosmetic procedures” that use “prescription medications.” That includes Botox and a host of other wrinkle fillers, including Restylane and Perlane.

Among the considerations is limiting who can give injections to doctors, nurses or physician assistants. Training is also an issue. Currently, no experience is required.

“There’s no set or approved curriculum or licensure or anything for that,” said Stetler, who says patients can unknowingly find themselves in unqualified and inexperienced hands.

She hopes potential state-wide changes will improve the safety profile of all anti-aging clinics.

“I like the idea that they are looking into and hopefully will get rid of some of those people who are harming the public,” she said.

Friday will be the medical board’s first discussion. Action is unlikely. If the board eventually changes the regulations, anyone who breaks the rules could face punishment or potentially lose their medical license.

"Action is unlikely?" What is going on in Texas? Why would the Texas Medical Board be unlikely to take action and follow almost every other state on this issue? Who are the doctors arguing against this?

By this reasoning it should be possible for Texas physicians to run 'Do It Yourself Botox Course' and teach patients how to inject themselves...

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