Vibration Anesthesia + Insulin Syringes: Does it make a difference?

Having some yahoo stick needles in your lips hurts. We try to mitigate that using everything from topical anesthetics (the most common), ice, and even nerve blocks, but should we be using vibration anesthesia and/or insulin syringes?

Vibration Anesthesia has been explored since 2004, but it hasn't reached mainstream adoption.

The study also applied topical anesthetic cream to lessen the incidence of pain as well.

Findings:

• 25 patients underwent the procedure
• 92% of patients were comfortable with vibration anesthesia
• The 8% of unsatisfied patients felt more pain and anxiety from the vibrations

Previous studies are also on the positive side of vibration anesthesia.

In conclusion, vibration anesthesia is deemed effective from some other studies. Smith et al. (2004) conducted one of the earlier studies of vibration anesthesia with regard to dermal fillers. The researchers recommended the use of vibration anesthesia for several procedures to help alleviate pain, but it is also suggested to use other methods in producing less pain to the patient.

Another study also explored vibration anesthesia, Mally et al. (2014) showed the efficacy of vibration anesthesia, with around 95% of their participants preferring vibration anesthesia.

What anesthesia works in your practice and for your patients?

In another article, an insulin syringe was used to inject dermal filler on the lips. More and more studies emerge in terms of injection techniques. What about what the needles used for injecting dermal fillers, do they matter as well? 

It is best to consider the consistency of the filler (Urdiales-Gálvez et al., 2017) before going through what needle or cannula to use. Many physicians made the switch from needles to cannulas, simply because of its ability to reduce pain and cause less discomfort to the patient. There is collagen stimulation when a cannula is administered (Brackenbury, 2015). On the other hand, needles are more precise, and a few injection sites would suffice. Bruising is the most common complaint when using needles.
 
Both modes have their pros and cons, but eventually the physician will need to discern, which is much better for dermal fillers.

In one journal article, the researchers found that an insulin syringe is also an effective way to deliver dermal filler injections. Kechichian et al. (2017) used an insulin syringe for lip augmentation. It is a novel method, but the idea is to give the patient more comfort as the injection is administered. Their findings leaned towards the preference of using insulin syringe due to its fine needle.

In the end, it all boils down to the administering of the injection and the comfort of the patient, and the experience of the provider.

Would patches really replace injectables and laser or light based devices?

Microneedle patches seem to have beneficial implications based on the current studies presented by researchers. It could then give another alternative for patients, for those who would need short term solutions or quick fixes maybe. Since the patches were made for the studies, it may be too early to say if it would be produced for the public. 

A few months ago, a microneedling patch to reduce fat was tested on mice, having good effects after the application of patches. In another study, a patch was also developed to brighten the skin, additionally there was another study which examined the use of hyaluronic acid on the microneedle patch. In this new study, a microneedle patch was used to reduce the appearance of wrinkles.

The question then is, would patches be the future of cosmetic medicine?

The latest study in microneedle patches was conducted by Hong and colleagues. The researchers divided the 84 participants into groups of 3, group 1 had the patch applied solely, group 2 had the wrinkle cream and patch, while group 3 had the wrinkle cream only.

Findings:

• The researchers examined skin conditions before patch application, and 4, 8, and 12 weeks after application, with group 2 having improvement by 8 weeks, whereas groups 1 and 3 had eventual improve by the 12th week.
• There were no adverse effects reported in the study.
• Microneedle patch coupled with wrinkled cream was more effective as standalone patch or cream.

Would these patches have better efficacy than the current treatment options?

Based on the studies presented by the researchers, it would be good to examine the long term effects of using the patch. In the current studies about microneedling patches, there are no signs of adverse effects or symptoms on the subjects. It may be difficult to say regarding the use of patches as the literature is scant regarding it as these are nascent in the field. It does have its benefits, but a long term solution and efficacy are of utmost importance regarding treatments. So far, patches do offer short term solutions according to the studies.

Many things remain unclear regarding the use of patches, such as the long-term efficacy rate, number of treatments done to alleviate wrinkles or brighten skin, but the future of cosmetic medicine holds many possibilities, and patches could help advance the field for many providers and patients to come, considering it holds promise in the field to understand medical aesthetic in microneedling.

Neuromodulators Introduced in 2017

Neuromodulators or botulinum toxins continue to gain popularity considering its effects on patients. Botox remains one of the most trusted brands in the market, and it does not seem to slow down along with the other two brands, Xeomin and Dysport. Of course, not everyone approves of having the botulinum toxins injected on them because of the effects that it has brought.

Revance Aesthetics is currently testing its RT002, and has had studies published regarding the efficacy of their neuromodulator, meanwhile EB-001 is fairly new but according to the company, their botulinum toxin seems to take effect much quicker than the current ones in the market. In that light, will the big neuromodulators brands be replaced by those still in testing phase?

In a previous article we published, we also wrote about Nabota, which has already been in use by some countries. Revance’s RT002 and Bonti’s EB-001 are currently undergoing trials, but both show potential.

According to Bonti, around 32% of patients show interest in having EB-001 injected on them. In a press release, the company mentioned they have conducted a clinical study, and it supports their claims about the product’s safety and efficacy. The product aims to be an introductory neuromodulator for those who have not tried and for time sensitive events.

As of December 2017, RT002 has reached Phase 3, which is showing better results than Botox. According to press releases, RT002 will have a six month duration period. If approved by the FDA, it’s the only neuromodulator that could ever receive that approval. Like the other neuromodulators, it has adverse effects like ptosis and headaches. Phase 3 will end its testing by February 2018.

These new brands will definitely shake the aesthetic market, since providers will have different options to choose. However, would these brands be able to replace the current ones?

These products will continue to compete regarding which one botulinum toxin would be enough to treat glabellar lines and crow’s feet, it is still unknown which among these treat these concern areas better. It is highly unlikely that the current three neuromodulators will be replaced, but possibly their market might change as there are other patients. Currently, patients can enjoy the present neuromodulators provided in your medical spa or practice.

Improving Your Systems Will Increase Your Clinic's Revenue?

Yes, improving your operations will increase the total revenue of your medical practice.

One of the best ways you can do is make it more efficient. Efficiency is key in any business, so your medical spa should make sure to be it for your patients and to get good reviews. Make your medical spa or aesthetic practice more efficient with software, staff training, and an operations and management overhaul for 2018. 

Software

There are different software applications you can use for your medical spa, which could make any procedures or processes faster and more efficiently. Which software applications would you need for your medical spa?

A practice management software should cover all scheduling and EHR. It should be something that will keep your records secure, and many experts suggest you should have an all-in-one type of EMR software; there are some EMR software that also includes marketing, which you should consider as well.

A cloud computing service would definitely help you store all the files you will need to protect, as an unprotected computer is vulnerable to viruses and hacking. While some EMRs have a cloud software, it would be better to have a backup from your EMR as well. You can use your Google Drive and even sign up for Dropbox.

A reputation management software seems necessary considering its impact on companies; some medical practices are even purchasing a software that would definitely help them. If you are looking for one you can check out Podium where that application would help attract more patients and get you more reviews.

Training

There are different training programs available for non-medical staff. HIPAA and customer service are the two most important things you should consider when it comes to staff training. 

You must have your staff trained with HIPAA periodically. Aside from HIPAA, find them training with marketing or management. If staff is trained with marketing, they could help with selling your products and services. When it comes to staff training, you will need to train them with customer service as well, most especially considering you are dealing with patients almost daily.

Customer service play a huge impact on reviews as well, and if in some reviews some patients have noted your bedside manner, you may need to improve on it as well.

Management

Managing staff and operations could be a lot of work. To manage your medical spa staff and your operations, you will have to identify factors that are currently causing your productivity. Learn to motivate your staff, as part of your management efforts. 

As the physician and their leader, you will need to juggle these two roles well. Always communicate with them and make sure you engage with your employees regularly. You need to find strategies to retain your employees and monitor their performance often as you can.

How 2017 Data Will Help Your Medical Spa 2018

Reviews will remain a paramount factor in Google rankings, and that holds true thanks to a study conducted by different SEO websites, Moz and Local SEO Guide. It should remain as your priority in gaining a new audience, since reputation management is also important for any business, and Google My Business is one of the methods that will help put you on the map. Your medical spa will greatly benefit from reviews, if you and your staff know how to utilize reviews well for ranking and visibility.

Google My Business

Google My Business (GMB) holds a huge weight in the ranking of you medical spa. Original, authentic, and legitimate content, such as reviews could help raise your ranking better and would give you better visibility. Google is the most used search engine, and while you have many competitors, it still is your best chance of being discovered by potential patients.

What if you do not have a Google My Business

In ‘claiming’ your GMB, you need to remember these things, one you must update all the relevant information regarding your medical spa or aesthetic practice. These include: times and days open, a link to your website and your appointment page, the exact location of your medical spa or practice based on Google maps, and photos.

Reputation management should be a necessity for all medical practices if physicians aim to be searchable and seen by prospective patients in their area. It will take time to rank in Google, especially in the first year. This is why alongside a reputation management strategy, you need a consistent SEO strategy for your medical spa or aesthetic practice, to ensure that you will remain on Google’s rankings.

It is much better to rank in Google organically, because apparently according to experts choosing to go for paid will not help as much. This is why you will need to ask for reviews from patients regularly. You can give them a piece of paper or card, you may email them (making sure that no PHI is in the email), or you may send them a text.

What if it’s a multi-practice or a part of it?

If you are in or part of a multi-practice, create pages for all locations. Make sure it’s not duplicate content, as such, indicate the different locations for other pages. For example, Aesthetic Practice New York, Aesthetic Practice Los Angeles. Make sure to have complete information across all locations.

Should I have a personal Google My Business page?

What you are referring to is a Google+. Your medical spa or aesthetic practice could have your own Google+ also, but your individual Google+ should only be meant for social media. You will need the Location Page for your Google My Business, so that it would help you be recognized when patients search your area. A Brand Page of a Google My Business acts more as a page for patients to follow and like posts for.

It is important to discover the importance of having a Google My Business. In this sense, you will be more known by patients. As part of your Local SEO strategy, be listed. Experts recommend you start ranking or focusing locally, so it could be easier for you to be recognized by new patients. Always have a consistent strategy all throughout.

Physician Lifestyle Design

Guest post by Greg Bledsoe MD, MPH

I've posted a couple of articles about taking responsibility for yourself and "building your own ship" , and we've also gone through a few common reasons why physicians aren't the best at career modification.

In this post, I'd like to spend a little time introducing you to the idea of "lifestyle design," something that has become a bit of a buzz-phrase in the business world but as far as I can tell hasn't penetrated the world of medicine just yet (for a lot of reasons).

I'll begin with a personal story...

When I jumped off the academic track in 2006, I wasn't exactly sure what I wanted to do as a career but I knew I wanted something unique.  My idea was to design a career that was flexible, fun, adventurous, and meaningful, all the while paying my bills and being a responsible spouse and parent.  Simple, huh?

I spent months thinking about how to do this as a physician.  I searched websites and blogs.  I spoke with mentors and colleagues.  I read the literature, all to no avail.  There seemed to be no conversation about a career like this in medicine.  I mean, there were a few articles about volunteer opportunities or non-traditional careers, but nothing really like what I was trying to create.  

What I found, though, was that while the medical community was silent about how to develop a very non-traditional and interesting career, the business world had already awakened to the idea.  Within the world of business, the idea of becoming a "free agent" and overhauling your career through "lifestyle design" was beginning to pick up steam. 

Around this time I picked up a copy of the book Free Agent Nation by Daniel Pink.  I'm not sure how I found this book, but it became a sort of manifesto for me.  In this book, Dan explains how more and more individuals were escaping their cubicles to become independent free-lancers and living their lives with increasing flexibility and empowerment.  It was a great read and it hit me at a very important time.  Through this book I realized that I was not alone in my desire for more autonomy, and that a lot of workers who had already yanked themselves off the grid were thriving.  I was hooked.

The second book I read was a book that has become a bit of a cult classic already, Timothy Ferriss' text, The 4-Hour Workweek .  This book is a basic introduction to how Tim built a stream of residual income and then used his extra time and money to explore his interests and live a more interesting life.  It was Tim's book that introduced me to the term "lifestyle design," and while the phrase might seem a bit hokey, it's a very powerful concept.  Basically, what Tim discusses in his book is the idea that it is possible to live an incredible life if you prioritize correctly, live frugally, and develop your entrepreneurial side.  Some have criticized the book recently, explaining that no productive person-- not even Tim Ferriss himself-- really only works four hours a week-- but I would argue that that's not really the point.  The catchy title sells books, but it's the mindset Tim describes that is the reason why the book is an important introduction for individuals who feel helplessly caught in a hamster wheel at work.  Tim's point is that you can-- through ingenuity and hard work-- leap off the hamster wheel and into something much better.

So how does all this apply to physicians?

Well, when you have a career discussion with most physicians, it often boils down to whether or not that individual wants to continue practicing clinical medicine or go into a nonclinical job.  There's nothing wrong with either, mind you, and I have friends who have great careers in each; however, for me and for many other physicians, I suspect, this approach is just too simplistic.

The fact is, I like clinical medicine.  I've spent a of of time getting good at what I do and I'd like to continue to be able to help people by providing good clinical care to patients who need it.  I also like many aspects of the nonclinical opportunities available to physicians-- things like consulting, writing, medical device development, and many other niches really appeal to me.

My main question is not whether I want to practice clinical medicine or jump into a nonclinical career, it's how do I design my life to be able to practice medicine, participate in the nonclinical activities I enjoy, and still have the flexibility to pursue life outside of medicine?  Discussions about clinical versus nonclinical are at their core too reductionistic for most modern physicians.  What most modern physicians really need to be having are overarching discussions about how to design a lifestyle that incorporates the multiple facets of their career interests and also does not overlook the ultimate (and most likely unspoken) goals they have for their lives. This is a much deeper conversation, but one that is desperately needed today in this time of significant upheaval in our healthcare system.

So where do you begin if you're a physician and you are interested in exploring this idea of "lifestyle design?"

Well, don't go to the career advice section of your specialty journal and certainly don't go to the HR person at your hospital or academic institution.  

In my opinion, you should begin by checking out the conversations going on in other fields.  There are some incredible websites built around some really creative and interesting people who are living fascinating lives and teaching others how to do the same.  Check out the following as a starting point:

• The Blog of Tim Ferriss: Experiments in Lifestyle Design
• The Art of Non-Conformity Blog
• Thrilling Heroics with Cody McKibben
• The Blog of Corbett Barr

Once you immerse yourself in this culture you begin to see possibilities that you never would have realized before.  What's more, as a physician there are even more possibilities available to you than for the typical person, if only you'll step out and take a little risk.

Over the last few years this idea of lifestyle design has been a focal point of my thinking when it comes to career moves and ultimate goals.  I've invested a lot of time, cash, and sweat into learning how to build a unique career, and my hope with ExpedMed is that we can use this website as a vehicle to help other physicians, just like you, succeed in designing a lifestyle and career they truly enjoy. 

The Newest In Dermal Fillers

Dermal fillers remain one of the most known methods of non-surgical rejuvenation, due to its popularity and effects, many patients have preferred dermal fillers. However, not everything ends well because of the possible adverse effects of dermal fillers. Thus there have been studies to ensure the safety of administering inejctables.

A couple of studies.

Double Injection Technique

Novel techniques are developed and presented to ensure the delivery and safety of the filler. Injecting requires skill and precision, thus it is crucial to learn safer techniques in injecting dermal fillers especially in the danger zones. One dermatologist mentioned that during a demo, the subject had become blind also.

Intravascular injection is something that all providers avoid due to disastrous side effects it causes on patients, and due to this delivery of injection, there have been cases of blindness and providers must always practice care and precision in administering the injection. 

The technique was double injection, as presented by the researchers, Huang and Lin, which could help prevent intravascular injection. Their method aims to thwart the possibility of intravascular injection, basically there would be an inner and outer needle in performing the procedure. In the event of drawn blood, the inner needle would move the blood out.

The researchers do admit limitations to their method and there could be more research that may be done in order to use this method.

Regeneration is the new Rejuvenation?

Dermal fillers could also demonstrate its efficacy in regeneration. Only two studies have examined dermal filler use for regeneration, it seems likely that in the near future, physicians could use dermal fillers for soft tissue regeneration. There are two studies regarding tissue regeneration and filler or fat injection, which have regenerative properties.

Fallacara et al. (2017) suggest that Urea could be cross-linked with HA considering its properties. According to the researchers, this could be the future of dermal fillers, and that could treat cosmetic issues other than its usual common dermatological concerns (e.g. psoriasis, calluses)

Additionally, there is another alternative to filler for tissue regeneration, which was discussed in detail by Dr. Cohen through Medscape that fat was also helpful in rejuvenating and regenerating  the reason he used fat was it made for a more natural look and that it lasted longer as compared to using fillers. Additionally, it adds more volume.

CaHA with Ascorbic Acid?

The study examined the efficacy of CaHA with Ascorbic acid to treat stretch marks. The researchers tested it on 35 patients, and on areas where stretch marks commonly appear such as: thighs, knees, buttocks, abdomen, and breasts. 

Findings:

• 63% of patients in the study were satisfied with the treatment; while only 1 was unsatisfied.
• Most patients were more satisfied in areas like abdomen, buttocks, and breasts.

Dermal fillers would have more potential uses in the future, and that it could have other uses in the future. For now, dermal fillers remain as one of the most popular treatment for cosmetic concerns, leaning towards rejuvenation.

A list of cosmetic dermal fillers here.

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5426873/
https://www.researchgate.net/publication/315818101_Hyaluronic_Acid_Fillers_in_Soft_Tissue_Regeneration
https://journals.lww.com/prsgo/Fulltext/2017/09000/Calcium_Hydroxylapatite_Combined_with.17.aspx

Here's Why Podium Should Be Your Reputation Management Software

Getting positive patient reviews that give an accurate representation of your medical spa's reputation used to be hard. Now it's easy.

Receiving negative patient reviews is a bummer, especially when one of your unhappy patients - perhaps with unrealistic expectations - looks to wreck your reputation online. And it's the angry, unhappy patients who can really damage your reputation because their voice or 'comment' is abnormally enlarged since your happy, satisfied patents are not the ones who most often leave you reviews.

It seems that patient reviews fall in to two camps; friends and family who you beg to give you reviews, and unhappy patients who seem bent on destroying your reputation.

No more.

Podium gives you a super simple way to to gather patient reviews from almost all of your patients and build your reputation on Google, Facebook and other review and reputation sites. (Watch the video above to see how easy it is to request a review.)

There are a myriad of benefits for a continual stream of reviews including:

1. Increasing your SEO rankings and visibility of your clinic for more patient traffic.
2. Increasing the number of inbound contacts you're front desk is fielding.
3. Outbound contacts to your existing patients via text message (a 99% open rate)
4. Control of your online reputation by gaining a massive influx of patient reviews that more accurately show your actual reputation and lessen the effect of a few unhappy patients.

Check out the Podium special offer for Medical Spa MD Members.

Facebook, Google, word-of-mouth all expand your reach - note that Podium handles this use case as well - but reviews can make or break your reputation and either lead to long term success, or abbreviate your opportunities.

You'll notice on this chart that online reputation is critical for  "Medical / Healthcare" businesses. The reviews that you now have are setting the tone for your new patients since a whopping 87% of consumers - including consumers of cosmetic medicine - now search for even local businesses before they contact them. 

It's often the case that successful clinics are competing in ways that the rank and file don't appreciate, or don't have access to (Asymmetrical Competition), using tools and spending smart money in areas that actually benefit them in the long term rather than just saying yest to the salespeople who walk through the door.

Take a look at the special offer and free setup that Podium is offering to Members.

Sentient Lasers Joins Medical Spa MD As A Certified Partner

Sentient Lasers is joining Medical Spa MD as a Certified Partner - providing Members access to the highest quality used aesthetic lasers and promising to keep our Certified Partner 7 Point Guarantee.

The highly prohibitive costs of new aesthetic lasers can make the profitability of your clinic or practice challenging. Fortunately, the advancements in medical laser technology over the last few years, as well as changes in the economy, now offer you the ability to buy medical lasers of almost any type at a significant savings – often up to 75% off of manufacturer prices.

Every cosmetic laser Sentient lists on Medical Spa MD is inspected, tested and refurbished to manufacturer’s specifications at our warehouse before it is ever available for resale. This ensures that our certified pre-owned lasers are the best on the secondary market.

"We're excited to join Medical Spa MD's Certified Partner Program", says Chris Cella, CEO of Sentient Lasers. "It's fits with our own Blue Dot Certification and gives Member of access to the very best quality lasers while providing the best, ethical service in the industry - and let's them save 70% off of buying a new aesthetic laser."

You can always see Sentient Laser's current offer to Members here.

(At the time of this posting it's a free upgrade from a standard 30 day warranty to a "Gold" 90 day warranty on any used aesthetic aser, IPL or RF device for free if you mention Medical Spa MD - a $2,500 value.)

To get this deal from any Certified Partner, just mention that you're a Medical Spa MD Member. No need to do anything else, just mention Medical Spa MD for ANY purchase and Sentient Lasers will take care of you.

Sentient is the third used aesthetic seller to join our Certified Partner Program and not the last. Our program gives our Members access to our 7 Point Guarantee and provides the largest single marketplace of used cosmetic lasers where you're guaranteed to get the lowest possible price and additional benefits.

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Learn more about Certified Partners

Remote Patient Monitoring Research

Remote Patient Monitoring via Smartphone

Telehealth is finally beginning to show real adoption with the move to outcome based care.

Any number of virtual care platforms have now thrown their hat in the ring to attempt to make patient communications as easy as regular calls. 

Smartphone monitoring seems like a good option for physicians and patients alike. The literature on smartphone monitoring is limited, but it shows potential for clinical use.

In a recent study by Dalla Pozza et al. (2017), the researchers explored patient monitoring after treatment, which asked their patients to take photos of post-op procedure as they were instructed by their surgeons. Patients were asked to send photos of the front and side views of their face to send to the surgeons.

Out of the original 57 in the sample, only fifty followed-up with post-operative photos.

The following procedures performed were:

• (32) Facelifts, platysmaplasty, submental lipectomy;
• (14) Upper and lower blerophaplasty;
• (11) Fat injections

After treatment, three patients experienced complications early on. The patient in the study still preferred the usual face to face consultation, but the researchers mention that most of their sample were older patients, and were not able to adapt to some applications used for the study.

A similar study also examined the use of patient monitoring via smartphone. Chee et al. (2016) focused more on laser resurfacing on the dermatological aspect of it. Their study provided insight on the patient’s use of smartphone monitoring. There were 123 patients in the study, and having done the procedure around 12% had adverse events after it. Due to the complications, the dermatologist treated them the day after. Numbers dwindled as only a few answered the follow-up survey leaving only a few to report the smartphone review had good effects on them.

According to the authors, 95% out of the 24 who completed their survey felt at ease with the teledermatology process.

There is the risk of violating HIPAA and HITECH. In the first study, the researchers mention that limitation as patients may not have a HIPAA-compliant smartphone to send images or details of their condition. In this case, physicians have the responsibility to make sure their images are secure. In the second study, patients were wary with sharing their photos as well.

To learn more you might take a look at the scores from the KLAS 2017 Virtual Care Platform Report in which a dozen or so telehealth platforms (TruClinic, American Wellness, InTouch, etc.) were scored across a number of criteria.