2016 Trends: Classic and Elegant Beauty

The year 2016 is predicted to be a time for putting forward a classy, elegant, and modern yet effortless look.

Beauty experts reveal that  the trend is leaning more on the "natural" look as complexions are expected to be taking a softer turn with a subtle quality.

Glowing and luminous skin will be a trend. According to Vogue, the recent call to natural beauty was given a windswept polish this season, with healthy washes of sun-kissed blush at Gucci and Michael Kors Collection meeting the breeze-tousled waves of Versace, Alexander McQueen.

Its all about bright and pouty lips this 2016, with classic reds and browns as "in" lip colors as they balance against a backdrop of a bare skin.

Hairstyles are expected to be going back to basics as natural and effortless look will be in style and buns and ponytails will be given a fresh twist. As they say, less is more.

With these trends, minimally invasive aesthetic procedures are expected to be popular among medspa patients to achieve a more enhanced yet effortless and youthful look.

Non-surgical facelifts, use of autologous fat grafting, botox injections, and fillers are among the procedures that are expected to be a trend in 2016.

Non-invasive procedures which offer less pain and quick recovery are also seen to be popular among patients. 

For more beauty trends in 2016, you may browse: http://www.vogue.com/13359453/top-beauty-trends-spring-2016-fashion-week/.

The New "Natural" Breast - Ideal Proportion is Key

A recent study in the Journal of Plastic and Reconstructive Surgery reveals the ideal proportions that may be used as a basis for helping your patients define the perfect breast.

You've all seen it happen; every woman wants perfects breasts and is convinced she knows what that means. Why then, is she dissatisfied when you deliver the modifications she's asked for? It turns out there's a new standard of beauty and a new study to help you, and your clients, achieve it.

In a recent survey, 1,315 men and women were asked to rate the attractiveness of breasts shown to them in three-quarter profile.  The results showed a clear pattern; the best chests have 45% fullness above the nipple line and 55% fullness below in a slightly teardrop shape.  Upward pointing nipples, a mildly concave upperslope and a convex and smooth lower slope were also key. Ironically, the traditional emphasis on upper pole fullness is not what patients now want. Round is out, natural is in!

So, how do you transfer the old ideal to the new real? Use these tips to guide your consultation:

• Educate - find out what she already knows about the procedure and use this  knowledge as a basis to discuss the safest and healthiest way to achieve the result. Augment what they "know" with your expert medical opinion.
• Communicate - Eveyone woamn has her own opinions about ideal shape and size. It is also critical to know whether a natural or augmented look is desired. Also useful is a  discussion of implant location, fill material and resulting profile in addition to size. It is also key to help her understand that a naked breast will have a shape that differs from a clothed breast.
• Be specific - Size and proportion alone isn't enough.  Discuss frame size, body shape and activity level with your patient.
• Use images - Pictures, drawings and 3D imaging are all excellent tools to guide the process.

In the end, a common standard of beauty may be ideal, but your goal is to also help a woman be beautifully real.  If beauty is in the eye of the beholder, use her as a collaborator to achieve both of your goals.

Read more about the survey discussed above at: http://journals.lww.com/plasreconsurg/Fulltext/2014/09000/Population_Analysis_of_the_Perfect_Breast___A.8.aspx?WT.mc_id=HPxADx20100319xMP

Search for the Best Hyaluronic Acid Filler

The October issue of the official medical journal of the American Society of Plastic Surgeons (ASPS) reports a new and validated method for providing standard cohesivity ratings for hyaluronic acid dermal fillers.

The search for the best hyaluronic filler comes after the surge of interest in the use of dermal fillers to enhance shallow contours, soften facial creases and wrinkles and improve the appearance of recessed scars.

Dermal fillers can be very helpful in those with early signs of aging, or as a value-added part of facial rejuvenation surgery. These fillers are often injected in medspas or a surgeon's office and are predictable, with relatively minimal risks and side effects.

In 2014, ASPS data revealed that around 2.3 million dermal filler injections were done. Statistics from the Cosmetic Surgery National Data Bank and other market research show that dermal filler market in the United States is valued at a whooping $1 billion.

Hyaluronic acid dermal fillers are natural, gel-based products which are highly compatible with the body, making them the most commonly used dermal filler in the industry. Plastic surgeons are now looking for evidences that will aid them in selecting the product that will give the best result for their patients.

Though there is a wide range of available products, there still exists a lack of scientific data to support the rheologic or the flow-related properties of the available dermal fillers in the market.

Dr. Hema Sundaram, a dermatologist in Rockville, MD, Samuel Gavard Molliard, a scientist in Geneva, Switzerland, and colleagues used the ratings of cohesivity and other biophysical properties to identify the dermal filler that is suited to each procedure being done.

The biophysical characteristics of hyaluronic acid gel fillers reflect individual manufacturing processes. They confer rheologic properties that provide scientific rationale with Evidence Level II clinical correlation for selection of appropriate fillers for specific clinical applications.

Cohesivity measures the capacity of a material to "stick together" and not dissociate. It is a key property that maintains gel integrity, contributes to tissue support with natural contours, and diminishes surface irregularities.

Researchers point out that products with higher cohesivity scores are not always the best. The ranking system aims to ‘provide a scientific rationale for the intuitive selection of different products for specific clinical objectives.’

According to Dr. Sundaram and colleagues, fillers with higher cohesivity may be better used for more superficial placement, or placement in mobile areas such as around the mouth or eyes while products with lower cohesivity may be effective for use as ‘deep volumizers’.

The researchers developed a standard test for comparing the cohesivity of hyaluronic acid dermal fillers. Samples of each filler gel were dyed, then squeezed into water and stirred using automated technology.

A panel of plastic surgeon and dermatologist specialists experienced in using HA fillers then rated each sample’s cohesivity on an original five-point scale, known as the Gavard-Sundaram scale.

Cohesivity scores of the FDA-approved fillers varied across the full range of the scale: from ‘fully dispersed’ to ‘fully cohesive’. Cohesivity was rated high for one product, medium to high for three, low to medium for one, and low for one.

Aside from the data on cohesivity, researchers believe that comparative data on other rheologic properties (such as elasticity and viscosity) can make dermal filler procedures more sophisticated and successful.

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Results of the study "Cohesivity of Hyaluronic Acid Fillers: Development and Clinical Implications of a Novel Assay, Pilot Validation with a Five-Point Grading Scale, and Evaluation of Six U.S. Food and Drug Administration–Approved Fillers" may be read on: http://journals.lww.com/plasreconsurg/Fulltext/2015/10000/Cohesivity_of_Hyaluronic_Acid_Fillers__.11.aspx

Fear of the Unknown in Cosmetic Surgery

A study commissioned by CCR Expo reveals that only half of the women who are interested in cosmetic surgery actually undergo the procedure.

Aside from cost, CCR Expo research reveals that there is actually fear of botched treatment as seen in media, wariness in the results (patients fear that they might not like what they will see in the mirror), and not knowing if the practitioners themselves are qualified to perform the procedure.

The annual CCR Expo, or the Clinical Cosmetic and Reconstructive Expo 2015, will be held on October 8-9, 2015 at the Olympia National Hall, London, United Kingdom. Prior to the event, three surveys were conducted among to know the opinion of various individuals including aesthetic practitioners, medics such as general practitioners and dentists, and the women patients who constitute majority of the patients undergoing such treatments.

Notwithstanding the governments efforts to regulate and "clean up" the cosmetic surgery arena, research revealed that patients and practitioners alike have a lot of fears. This is attributed to the fact that the aesthetic sector is largely unregulated.

Practitioner's View 

•  There are too many untrained cosmetic providers who perform procedures that damage the reputation of credible and qualified practitioners.
•  There is a lack of training and expertise in the following: facial anatomy, diagnosing and coping with complications, wrong treatments, and the use of unproven products.
• Medical colleagues see that there is a strong prejudice for practicing aestheticians and the later are regardes as "beneath them". On the other hand, the survey also revealed that colleagues saw the field as lucrative but they got scared to enter because of lack of knowledge.
• 90% of the surveyed GPs and dentists had considered providing aesthetic treatments, yet they did not push through because of: lack of specialized training, concerns in tax regulations and botched jobs, not understanding its legal frameworks, and the marketing involved.

According to CCR Expo organizer Peter Jones:

We don’t necessarily encourage more clinicians to join the aesthetics arena, but our research clearly shows there is a strong desire for more clarity in the sector, alongside some understandable concerns. At CCR Expo our logic is, if you’re going to do it, then do it right! This is why we have put together a full programme and roster of experts who can offer support and guidance to those who do wish to enter this field, so they have the tools enabling them to practise ethically and safely.

Clinicians have honed their careers over many years – sometimes decades, and being protective of their reputation is entirely natural. We are here to help them train andmaintain their hard-earned standing, whilst also helping keep the public safe. They certainly deserve no less.

More on: https://www.prime-journal.com/fears-continue-to-grow-around-aesthetics-sector/

Filler Injections: Achieving the Ideal Lip Shape

Our lips provide competence to the oral cavity when we chew our food. They may also affect sounds and facilitate facial expression which help us communicate what we feel. Lips also have their own aesthetic value.

Earlier this year, the Kylie Jenner Lip Challenge went viral on the internet. People who took the challenge sucked the air out of a glass to create fuller lips that is said to be more attractive. Of course, everything did not go well for others because many attempts ended in painful bruisings and trips to hospitals.

Sucking glass cyclinders did not make Kylie's lips look plump - it was cosmetic enhancement that did it. In an interview with Cosmopolitan magazine, she admitted using a filler and advised others who want a similar look to try a filler that lasts about two to four months, in case they change their mind and want to give it up.

For dermatologists and Medspa owners who work with patients desiring for plump lips, giving advice to patients during patient consultation may boost patient satisfaction rate.

A study in Germany was conducted "to clarify what it is that makes lips attractive - and whether there are gender-related differences of an attractive lip and lower third of the face".

After patients' lip and chin regions were photographed and evaluated by voluntary judges through a Likert scaling system, the results showed that there were certain parameters of the lips that add attractivity of both male and female individuals. Further, gender-related differences were manifested in the form and shape of an attractive lower third of the face.

• There is a significant higher ratio of upper vermillion height/mouth-nose distance in frontal-view images of attractive compared to unattractive female (p < 0.001) and male (p < 0.05) perioral regions.
• Furthermore, the ratio of upper vermillion height/chin-nose distance was significantly higher in attractive than in unattractive female (p < 0.005) and male (p < 0.05) lip and chin regions.
• The nasolabial angle was significantly sharper in attractive compared to unattractive female perioral regions (p < 0.001).
• Attractive female lip and chin regions showed a wider mentolabial angle compared to unattractive female lip and chin regions (p < 0.05).
•  Comparing men and women, we found that attractive female perioral regions showed a higher ratio of lower vermillion height/chin-mouth distance (p < 0.05) and lower vermillion height/chin-nose distance than attractive male perioral regions (p < 0.05).

Read more on: http://www.jprasurg.com/article/S1748-6815(15)00137-0/abstract

I Want To Be A Fibroblast!

What criteria is most important when choosing a treatment or technology to stimulate fibroblasts for skin rejuvenation?

Being a dermatologist focused on aesthetic treatment options for improving skin's condition  it's quality and overall appearance – I clinically and scientifically overlook tons of different approaches.

Basically, and I think we can agree on this, many treatments try to target the fibroblast. Its about the stimulation of this branched tissue cell who's function is to maintain the structural integrity of connective tissues by continously secreting precursors of the extracellular matrix such as ground substance, a variety of fibers notably the reticular and elastic ones and cytokines.

The goal in many skin rejuvenation treatments is to activate and stimulate the fibroblasts... and there are countless strategies to do this: You might choose chemical peels, energy based devices such as non-fractionated or fractionated resurfacing lasers, intense pulsed light (IPL), infrared light or radiofrequency. One might think of dermal filler substances such as hyaluronic acid or – better – calciumhydroxylapatite (there are even publications on a stimulating effect botulinum toxin type a...). Further one might consider microneedling, dermabrasion, etc..

Or think about "newer" technologies such as platelet rich plasma, carboxytherapy, nitrogen plasma energy, kinetic HA (kinetic Hyaluronic Acid). And last but not least cosmeceuticals (this list is not exhaustive!!).

Which strategy to choose? It's actually very difficult to find way through this jungle!

I would like to encourage and activate the discussion here and ask for your opinion: What are the most important criteria for you when you do your choice? Is it about mangeability, about downtime, about scientific proof, about safety, about treatment protocols (such as e.g. multiple treatments), about clinical experience of other physicians, about availability, about the learning curve, about the deligability, about the costs?

What's your decision maker here?

Peeling Melasma

Treating melasma is one of the most challenging indications in aesthetic dermatology.

In my hands and over the years, chemical peels in combination with bleaching agents still work the best. Most recently, very interesting and promising new bleaching cosmeceuticals are coming up, matching both, efficacy and safety compared to the gold standard substances such as low dose hydroquinone and or kojic acid.

Anyhow, I do strongly believe in the fact, that -for a therapeutic effect- we still need highly efficacious treatments to resolve and manage these hyperpigmentation conditions: Chemical Peels in combination with bleaching substances are a very potent way to treat melasma. It`s either about raising the concentration of the working agents or about performing multiple treatments.

Overall, the physician has to have a broad experience in combining those agents and secondly, the patient needs to be educated on following a life-long "skin-diet"-program.

Allergan Shifting Headache Sales Reps to Botox

Allergan sales forces previously working on GlaxoSmithKline headache drugs Imitrex and Amerge as part of a co-promotion will be reassigned to Botox, in support of the drug's new headache indication.

The move,  confirmed by a company spokesperson,  gives Allergan a jump start with headache specialists, since the GSK co-promotion deal was “a very good way for Allergan to learn the headache market,” Allergan CEO David Pyott told the Journal. Crystal Muilenburg, a spokesperson for Allergan, says that sales forces will initially target neurologists, pain, and headache specialists, to train them on Botox's “injection protocol and dosing regimen.” Muilenburg declined to estimate the number of reps that will support the headache indication, which received an FDA green light on October 15. GSK drugs Imitrex and Amerge have lost patent protection.

A key challenge that we started addressing immediately upon FDA approval is reimbursement,” said Muilenburg. “As with many new drugs, reimbursement is not widely established for Botox in this new therapeutic category.”

Physicians or patients looking for information on reimbursement can visit a dedicated website, call 1-800-44-BOTOX (option 4), or locate a Botox reimbursement business manager for “on-site education, training, and support,” according to the website. Physicians can also sign up to receive forthcoming treatment records and case studies on the headache indication, as they become available.

Allergan paid $600 million to settle Justice Department charges of off-label marketing in September, and pled guilty to marketing Botox off-label for conditions including headache. As part of the settlement, Allergan was forced to drop a First Amendment lawsuit challenging FDA policy on the exchange of “truthful scientific and medical information,” a spokesperson reported at the time. The pending approval in September of Botox for an ailment that previously existed as an off-label use sparked rumors about a relationship between Allergan's lawsuit and FDA's approval of the headache indication, rumors which Muilenburg quelled: “The FDA granted approval of Botox for the treatment of chronic migraine patients based on two phase III pivotal trials, and on its own merit,” she said. “The two actions are completely separate matters.”

Botox's headache indication, specifically, is for the prophylaxis of headaches in adult patients with chronic migraines. GCI Health has been awarded the PR account for the indication. Muilenburg declined to reveal other agency partners for the headache indication launch.

Cosmetic Dermatology from the Point of View of a Full-Time, Non-Core Cosmetic Physician

I receive the occasional email from a derm or plastic asking me to post an article that they're not willing to post under their real name. Here's an email I got from a non-core doc practicing cosmetic medicine. It came with this introduction:

"I wrote this and would like you to post this. I don't want it posted under my name because I don't want to take the heat and wrath of the Plastics and Derms. I need to choose my battles. Please post this as if you got this forwarded from me and I received it from an unknown writer. The post should be from "A Full-Time, Non-Core Cosmetic Physician". Can you do this?"

In general I dislike ananymous posts or comments. While there can be genuine concerns and I protect the identities of all Members, the anonymous nature detracts from the legitimacy of the content and just isnt' as credible as identified authors. With that said, here's the post:

Cosmetic Dermatology from the Point of View of a Full-Time, Non-Core Cosmetic Physician

A physician’s clinical results are directly related to their clinical skills. These skills come from their ability, their training, their dedication to learning and their clinical experience. Gifted mentors along with a high volume clinical practice are also important ingredients.

Many of the best non-invasive cosmetic physicians are non-core physicians who have dedicated 100% of their professional activity to cosmetic dermatology.

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1. What is Cosmetic Dermatology?
2. Can Non-Core Physicians Practice Cosmetic Dermatology?
3. What is a Cosmetic Dermatologist? What is a Non-Core Cosmetic Physician?
4. Is a Cosmetic Dermatologist better than a Non-Core Cosmetic Physician?
5. How many Dermatologists are Fellowship Trained in Cosmetic Dermatology?
6. How many Cosmetic Dermatology Fellowship Training Programs are there in the United States? How many Fellows graduate every year from these programs?
7. Why do we need Experienced, Expert, Full-Time Non-Core Cosmetic Physicians Practicing and Teaching Cosmetic Dermatology?

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1. What is Cosmetic Dermatology?

Dermatology that concerns cosmetic issues. Anything that is not Medical Dermatology, like skin cancer and other serious medical conditions. Wrinkles, Age Spots and Skin Tightening are cosmetic concerns.Cosmetic Dermatology also includes some medical conditions like Acne, Rosacea and Melasma. It also includes Acne Scars, other types of Scars, Unwanted Hair and Unwanted Veins.

2. Can Non-Core Physicians Practice Cosmetic Dermatology?

YES. Cosmetic Dermatology involves treating cosmetic conditions. Non-Core Physicians practice Cosmetic Dermatology when they treat cosmetic conditions of the skin. Non-Core Cosmetic Physicians are NOT Cosmetic Dermatologists. They are Non-Core Cosmetic Physicians.

3. What is a Cosmetic Dermatologist? What is a Cosmetic Physician?

A Cosmetic Dermatologist is a Board Certified Dermatologist who does Cosmetic Dermatology. A Cosmetic Physician is a Board Certified Physician who practices Cosmetic Dermatology. Cosmetic Dermatologists and Cosmetic Physicians can be full-time or part-time. Most Cosmetic Dermatologists are NOT Fellowship Trained in Cosmetic Dermatology.

4. Is a Cosmetic Dermatologist better than a Non-Core Cosmetic Physician?

Not necessarily. It depends on each doctor’s training and the experience. A full-time Non-Core Cosmetic Physician can be better than a Cosmetic Dermatologist who only practices Cosmetic Dermatology as a small adjunct to their Medical Dermatology Practice and has not been Fellowship Trained. A Non-Core Cosmetic Physician in a state like New Jersey is probably a better Laser Physician than a Dermatologist or a Plastic Surgeon who does not do the actual treatments but instead supervises Physician Extenders in their practice.

5. How many Dermatologists are Fellowship Trained in Cosmetic Dermatology?

Not very many. I am not sure of the exact number, but not very many. There is a big difference between a Cosmetic Dermatologist who has been Fellowship Trained and a Cosmetic Dermatologist who has NOT been Fellowship Trained.

6. How many Cosmetic Dermatology Fellowship Training Programs are there in the United States? How many Fellows graduate every year from these programs?

Not very many. I don’t know the exact numbers, but it is not very many.

7. Why do we need Experienced, Expert, Full-Time Non-Core Cosmetic Physicians Practicing and Teaching Cosmetic Dermatology?

Full-Time, Expert Non-Core Cosmetic Physicians are needed because there is an inadequate number of Fellowship Trained Cosmetic Dermatologists and an inadequate number of Cosmetic Dermatology Fellowship Training Programs. A physician’s clinical results are directly related to their clinical skills.These skills come from their ability, their training, their dedication to learning and their clinical experience. Gifted mentors along with a high volume clinical practice are also important ingredients.Plastic Surgeons, Dermatologists and Non-Core Cosmetic Physicians all start from the same point.Dermatologists are expert in skin physiology and pathology. The Plastic Surgeons and the Non-Core Cosmetic Physicians must become experts in skin physiology. The Fellowship Trained Dermatologists are the future of Cosmetic Dermatology, but until there are more training programs and more Fellowship Trained Dermatologists, they will not be the primary providers of Cosmetic Services to the general population. Many of the best non-invasive cosmetic physicians are non-core physicians who have dedicated 100% of their professional activity to cosmetic dermatology.

Signed, A Full-Time, Non-Core Cosmetic Physician

Are a dermatologists medical patients second class citizens?

There's been some debate about whether it's ethical for dermatologists to be focusing on treating cosmetic patients at the expense of skin cancer and other 'real medical' patients.

Here's an example via WPS:

NY Times Article: As Doctors Cater to Looks, Skin Patients Wait

“Cosmetic patients have a much more private environment than general medical patients because they expect that,” said Dr. Richey, who estimated that he spent about 40 percent of his time treating cosmetic patients. “We are a little bit more sensitive to their needs.”

Like airlines that offer first-class and coach sections, dermatology is fast becoming a two-tier business in which higher-paying customers often receive greater pampering. In some dermatologists’ offices, freer-spending cosmetic patients are given appointments more quickly than medical patients for whom health insurance pays fixed reimbursement fees.

In other offices, cosmetic patients spend more time with a doctor. And in still others, doctors employ a special receptionist, called a cosmetic concierge, for their beauty patients.

...According to a presentation for doctors from Allergan, the makers of Botox, a medical dermatology practice might have a net income of $387,198 annually, but a dermatologist who decreased focus on skin diseases while adding cosmetic medical procedures to a practice could net $695,850 annually. The same material advises doctors to “identify and segment high priority customers.”

Skin Cancer & Photodynamic Therapy

Via Wired: Making Skin Cancer Therapy As Convienient As A Band-Aid

A new light-activated therapy could make skin cancer treatment painless, inexpensive and portable.

Scottish company Lumicure has developed a portable device that combines a tiny light, a photosensitizing cream and a bandage that, if approved by the Food and Drug Administration, could treat skin cancer conveniently with molecular precision.

"It can be worn by the patient in a (Band-Aid), while the battery is carried like an iPod," said professor Ifor Samuel of the Organic Semiconductor Centre at Scotland's University of St. Andrews, who helped develop the technology, in a statement.

Skin cancer, which typically requires painful or invasive treatments, affects 40 percent of all Americans at some point during their lives. The Lumicure treatment would cost between $200 and $300, compared with roughly $15,000 to $20,000 for the standard therapy. It could also eliminate the need for chemotherapy in some cases.

Lumicure's treatment is a new twist on an existing treatment called photodynamic therapy. It starts with a cream containing aminolevulinic acid, which becomes photosensitive when it comes in contact with a cancer lesion. When exposed to light, the cream interacts with only the cancerous cells, making it a very selective skin treatment.

Lumicure's light source is a low-powered organic light-emitting diode embedded in a small adhesive device. Its battery module -- roughly the size of an MP3 player -- fits easily in a pocket.

Photodynamic therapy available today requires treatment at a hospital using heavy equipment. It's also uncomfortable for patients because they must stay very still under extremely intense light; the treatment also can leave painful skin lesions. The new treatment takes longer than the standard therapy, but there's almost no discomfort and no scarring.

"As traditional photodynamic therapy is delivered in a physician's office, this new technology, if proven effective in clinical trials, may offer the possibility of increased access and ease of use for many patients," said Dr. Isaac Neuhaus, assistant professor at University of California at San Francisco Dermatologic Surgery and Laser Center.

Early human trial results are promising, and Lumicure hopes the light therapy will be available in about two years. Future iterations could target other skin problems including warts, acne and even wrinkles.

Hmmm. This sounds promising. We do a fair number of photodynamic treatments and I've had a few myself to get rid of some ACs and Rosacea. I'd wear another iPod for a while. 

LS, a Derm that's pissed at Medspa FP's and OB's.

The war to control cosmetic medicine that's been raging between plastic surgeons and dermatologists has a new additon, aesthetic physicians. And here's one derm that doesn't like it.

LS posted this comment on: Botox certification for family Practitioners

"When I graduated from med school, only me and another guy got into a derm residency - and he had a PhD in Immunology before getting into med school. The OB's and FP's were at the bottom of the class. Now they want to get into cosmetic dermatology for the money - but they are NOT TRAINED to do anything with skin. Derm is a 3 year residency - these people know so little they don't have a clue how little they know. Studies have shown that when primary care physicians get minimal (like 4-6 weeks) of Derm training, they begin to see that it's an incredibly complex field of which they know not, and the number of referrals to derms INCREASES - the more training they receive, the more they refer.

The Cosmetic companies and laser companies are all in it for the money so they don't care WHO they sell to. This is all going to change - the policy makers are already working on it so these FP's etc who are going into it better have their own practice of sore throats and earaches to fall back on since the balloon is about to bust."

LS has a point. Dermatology is a specialty.

It's also the study of 'diseases of the skin', not Botox and laser hair removal. Although some medical schools are geting into this, Dermatologists generally get training in cosmetic procedures the same as other doctors... see one, do one, teach one.

Dermatologists are physicians (medical doctors) specializing in the diagnosis and treatment of diseases and tumors of the skin and its appendages...

Pediatric dermatologists specialize in the diagnoses and treatment of skin disease in children. Immunodermatologists specialize in the diagnosis and management of skin diseases driven by an altered immune system including blistering (bullous) diseases like pemphigus. In addition, there are a wide range of congenital syndromes managed by dermatologists.

 LS is right that Florida has passed legislation, but it's going to be harder to enforce than keeping Paris Hilton at home.

There's also something of a conflict in that dermatologists are trained to treat medical problems like skin cancer. With skin cancer the fastest growing cancer in the US, there's a train or thought that says dermatologists should focus on where they can do the most good, not where they can make the most money. Of course that's not the real world either.

Comments? 

Laura Bush & her squamous cell carcinoma.

Dr. Charles: Laura Bush & skin cancer screenings.

I have definitely seen an increase in the number of people coming into my office for mole checks and skin exams this week. Some directly mention Laura Bush. "Well, I just thought I should get it looked at, with Laura Bush and all, you never know." She certainly did pass on an opportunity to encourage screening and prevention of skin cancer.

The New York Times does note the service Laura performed on behalf of breast cancer awareness when she too was diagnosed:

Mrs. Bush has advocated the public discussion of cancer. Speaking in St. Louis in October for Breast Cancer Awareness Month, she lamented how decades ago, "because everyone kept breast cancer a secret, women didn't have regular mammograms or perform breast self-exams, because no one told them to."