The Physicians path To Effective Leadership: Humility and Will

Most physicians think that they're effective leaders but there are plenty of clinics that rely more on authority than leadership.

So what do you need to be an effective leader? Personal humility and the will to be a great leader.

Studies shows that CEO humility is positively associated with empowering leadership behaviors. They tend to connect more effectively with both top and middle management, creating a collective empowerment for the organization.

This was the result of the study examining the concept of humility among CEOs in 63 companies from China. A More than 300 top management team members and 600 middle managers were surveyed in the study.

In 2001, the research done by Jim Collins about how a CEO's humility can impact a company has been shown in his book, From Good to Great. Here, Collins shattered the concept of a supposed CEO image: charismatic, authoritative, convincing, and larger-than-life.

Collins described leaders who have both personal humility and intense will to be "Level 5 Leaders".

According to our five-year research study, executives who possess this paradoxical combination of traits are catalysts for the statistically rare event of transforming a good company into a great one.

The other types of leaders, according to Collins, possess skills to transform companies but not sustain the level of excellence. This type is not the only one that can effectively lead a company, but it is essential. An interesting question would be: Can this type of leadership be learned? In an answer, Collins shares his hypothesis about two categories of people: those who don’t have the Level 5 seed within them and those who do.

My best advice, based on the research, is to practice the other good-to-great disciplines that we discovered. Since we found a tight symbiotic relationship between each of the other findings and Level 5, we suspect that conscientiously trying to lead using the other disciplines can help you move in the right direction. There is no guarantee that doing so will turn executives into full-fledged Level 5 leaders, but it gives them a tangible place to begin, especially if they have the seed within.

Read more:

• https://hbr.org/2005/07/level-5-leadership-the-triumph-of-humility-and-fierce-resolve
• http://asq.sagepub.com/content/59/1/34

8 Rules in Finding Patients (and Saying No!) in 2017

With 2017 coming up, more and new challenges are afoot in managing practice and performing cosmetic procedures. You may encounter new patients who have no idea about cosmetic procedures or get quirky ones who have jumped from one physician to another.

Before all that, here are three things to evaluate in the upcoming year.

Practice ways you can market

Marketing will always stay a crucial factor in getting patients. Whether you are marketing through word-of-mouth or social media (SEO), strengthen that further.

Not getting your desired results? Try a different approach. There are other marketing approaches other than basic marketing in social media. You could mix it up in other social media platforms. Read more about our Marketing Strategies in 2017 here.

Set your current policies and rules

This one deals with mostly updating your current guidelines to staff and patients; this is in dealing with new patients and caring for them. It could act as a refresher to old staff or new information for your new staff as well.

Organize a list

For what, you ask. Everything you do and will do in your practice, and now that you have probably figured out which services you want to keep, it’s best to know which new procedures you could do with existing ones. That includes updating your menu of services.

Promote services that keep your practice alive. Don’t let your old devices collect dust in the corner. Sell them while you still can or probably re-use them.

Considering having your staff undergo training? Enumerate it there. Do not only expand your experience, give them opportunities to make them grow.

Now that you have set-up, what about the new patients that would come in your office come 2017. The holidays are finally over, and they would need a new look over the new year. Some would come with the weirdest requests while others would come in without knowing anything. This is where you come in and educate them about what you offer and how you manage your practice.

Have a sit down with the patient and assess the situation objectively

Allow them to come to your office and listen to them. Ask them where they got the idea to get the new treatment. Once you have heard their story, discuss what options they have or recommend what other alternatives for their desired treatment.

Explain the expected outcomes (for their preference and of your assessment)

Many patients come in the clinic without expecting risk at all; most would think it would only enhance them. As their physician, it’s your responsibility to inform them of everything involved around their favored procedure.

For example, if their desired procedure or treatment is attainable in another way, offer that one instead. Spare no details of the risks and costs involved. This way, your patient knows the effects of undergoing the procedure, rather than leaving you with a bad review. Yikes!

Stand your ground

This comes hand-in-hand with the policies and rules you have prepared, and later we will briefly elaborate on saying no to your patient. Don’t be a pushover to your patient, and approach them as to how you will be performing the procedure without being aggressive either.

Remember to ask about their history

Patients may forget to disclose their past surgeries or physicians they have gone to, and from there you can determine how you could work out your process in treating them.

Get insight from past patients

Learn from your past and apply it in your present. You might think that this one patient was similar to someone you have encountered before, tell a background about how some patients reacted to the treatment.

Saying no can be a daunting task. Most aim to please their patients, which could be a factor to getting good reviews, but not all procedures and treatments are plausible or doable, as they pose risks to your patient and to your practice. In order to avoid that, politely apologize to avoid any misunderstanding from the patient; the prospective patient may not appreciate your initial turning down. Thus, elaborate why you will not perform the procedure, and how risky and costly it could be.

In doing so (and saying no), remember three things in mind.

Empathize first

Many patients would undergo a procedure just to enhance a specific area of concern, and this could be a valid reason. Some others would do it for other people, and not for themselves. Let them know that surgery would not be the immediate answer to their concerns. Instead, offer them an alternative.

Offer other options

Their procedure may not be attainable, offer alternatives as to how to achieve similar results or that would greatly benefit them. Another scenario is after you have assessed them, and recommend the treatment that would suit them best.

Stay firm

In the case where the patient is insistent on getting their wanted procedure, assert and assure that the options you laid out would be the safest. Emphasize how the treatment won’t be achievable. Remind them as a physician all you want to offer your patient is better care and services.

Soft Tissue Fillers May Be Causing Blindness in Patients?

The rising popularity of soft tissue fillers has led to a rise in reports of side effects such as blindess.

The FDA approved the use of soft tissue fillers for the correction of moderate to severe facial wrinkles and skin folds (like the nasolabial folds). Some soft tissue fillers are approved for the restoration or correction of facial fat loss in people with HIV.

But according to the Food and Drug Administration, there are risks associated with the use of these fillers.

 Any soft tissue filler can cause long-term side effects, permanent side effects, or both. However, most side effects associated with soft tissue fillers happen shortly after injection and most go away in less than two weeks.

Swelling and pain after hand treatment may last a month or more. In some cases, side effects may appear weeks, months, or years after injection.

Among the rare side effects reported to the FDA are severe allergic reactions which require immediate emergency medical assistance, migration or movement of filler material from the site of injection, leakage, or rupture of the filler material at the injection site or through the skin (which may result from tissue reaction or infection).

There were also rare reports of formation of permanent hard nodules in the face or hand, vision abnormalities, including blindness, stroke, injury to the blood supply, and damage to the skin or the lips.

Recent reports by the American Society for Dermatologic Surgery, Inc. and published by Wolters Kluwer Health, Inc. showed that with the rising popularity of soft tissue fillers has led to a rise in reports of adverse events.

The study conducted a literature review of the reported cases of blindness after the filler injection. The study also examined some prevention and management strategies that may be done.

The results were as follows:

• 98 cases of vision changes from filler were identified.
• The sites that were high risk for complications were the glabella (38.8%), nasal region (25.5%), nasolabial fold (13.3%), and forehead (12.2%).
• Autologous fat (47.9%) was the most common filler type to cause this complication, followed by hyaluronic acid (23.5%).
• The most common symptoms were immediate vision loss and pain and most of the cases of vision loss did not recover.
• Central nervous system complications were seen in 23.5% of the cases. No treatments were found to be consistently successful in treating blindness. 

Even though the risk of blindness from fillers is rare, researchers concluded that it is critical for injecting physicians to have a firm knowledge of the vascular anatomy and to understand key prevention and management strategies.

For more information: http://journals.lww.com/dermatologicsurgery/Abstract/2015/10000/Avoiding_and_Treating_Blindness_From_Fillers___A.1.aspx

Powerful Marketing For Your Medical Spa: Social Proofing

Increase conversion rates of cold sales emails through social proofing!

Social proofing is a psychological phenomenon which influences someone to think that you are great after knowing that other people think you are great. It is informational social influence where people assume or conform to other's actions in an attempt to reflect the correct behavior for a given situation.

This is useful especially when you are communicating to your potential customers for the first time, as when you are cold emailing them.

Social proof is also notable on social networking sites such as Facebook, Twitter, and Instagram. The more followers you have, the more trustworthy and reputable you appear to be.

Product reviews and ratings are relevant for American consumers. Statistics says that more than 70% of them look at product's site and its reviews and ratings before deciding to purchase a product.

Several techniques of social proofing can be utilized, including mentioning in your email the patrons of your product, perhaps a famous company which is also your client, a famous investor, or the person you know in common in the mail.

It shows your potential customer that others have also taken the action that your company wanted them to take, whether purchasing or subscribing. Research shows that when a famous customer is mentioned at the bottom of the email, replies in the cold email doubled.

In a study of 10,000 accounts at a German bank, it was shown that customers who came from customer referrals had 16% higher lifetime value than those who came from other acquisition sources. Social media has sparked dozens of different ways to provide this kind of social proof.

Facebook widgets that show other Facebook friends that “like” a brand, Twitter’s display of people you follow that also follow another person, and the various ways that company offer rewards for referring others to the brand are all examples of this. Perhaps you might also want to mention present customers with established positive reputations.

These influencers are seen more positively with association. A shared LinkeIn Connection may also be mentioned. It was found that when you point out a shared connection with someone in common, 25.5% of the people who received the email opted in to have a further conversation about the product compared to the 4 % who received the basic mail.

Testimonials, accompanied with corresponding faces, are one of the most persuasive forms of social proof out there. Compared to statistics, stories and real-life experiences by other people are more trustworthy and persuasive because these examples touch our hearts and mind.

Optimizing Your Clinics Email Marketing

Email marketing is a good way for businesses to engage both potential and existing customers. In 2015, email users are nearly around 2.6 billion and this is expected to exponentially increase to over 2.9 billion in the year 2019.

Emails are very useful in the business world and as well as consumers - mainly due to its use for notification consisting of online sales.

Further, survey says that 91% of consumers check their email at least daily and 55% of companies surveyed say they generate more than 10% of sales from email.

Data from the Direct Marketing Association reveal that 66% of online consumers made transactions out of an email marketing message.

Email marketing allows you to be efficient. You can save a lot of your precious time after optimizing your autoresponder sequence or your sales funnel. Automation takes over and does most of the work for you.

But first, you have to plan about the results you want to achieve when hatching plans to grow your list. Map out how email marketing can be incorporated in your overall marketing scheme.

So, how do you improve your patient interaction through email marketing?

Start with what you write as a keyword in your subject line. A study shows that those with keywords confirm, features, upgrade, magic and raffle are likely to be reported as spam so it is best to avoid them unless you were able to built up a list that really trusts you and your brand.

Make a great first impression on your new subscriber through the welcome email or the autoresponder sequence.

When do you send them?

Try sending them on days other than Tuesday and Thursday and email your customers between the hours of 2 PM and 5 PM.

MailChimp’s Email Genome Project reveals that more mails are sent on Tuesday and Thursday than any other day of the week so you might want to test sending emails on other days so you will have less competition. This will pave the way for increased inbox space and click through rates.

People are more likely to open their email between 2 PM to 5 PM, regardless of time zone, according to the Email Genome Project.

Where do you link your email?

Try sending your email traffic to a dedicated landing page because this is usually the one that has a higher conversion rate. Also, you might want to include social share buttons in your emails as this can also generate higher click through rates.

Got other email marketing advices? Share them by posting your comments below. =)

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/.

Antidepressant Use in Plastic Surgery

"Stopping antidepressants before plastic and reconstructive surgery is unlikely to reduce complications--and might increase the risk of postoperative problems related to the patient's underlying depression."

This was reported by Dr. Isabel Teo of Ninewells Hospital, Dundee, and medical student Christopher Tam Song of University of Edinburgh after making a comprehensive literature review of the PubMed and Cochrane databases.

A total of 26 studies which assessed the effects of antidepressants on different plastic surgery risks were included for comparison including: risk of bleeding, risk of breast cancer, risk of breast cancer recurrence, breast enlargement, and other uique complications.

Evidences gathered has not debarred the increase in bleeding risk, breast cancer, or other adverse outcomes, according to the research review found in the issue of the Plastic and Reconstructive Surgery Journal.

Researchers Dr. Teo and Mr. Song stated that their review did not find consistent evidence of increased complications related to antidepressants. They said that risks associated with the stopping of prescribed antidepressant therapy in "psychologically vulnerable" patients likely outweigh any increase in complications.

According to them, discontinuation of antidepressants before surgery in the absence of a careful evaluation should be avoided. "Discontinuation syndrome" may happen to patients whose use of antidepressants - particularly the widely used selective serotonin reuptake inhibitors (SSRIs) - is stopped before surgery.

In conclusion, they said that:

This review does not support the cessation of antidepressants in patients before plastic surgery, as the numbers needed to harm are low and the implications of withdrawal may prove to be detrimental to postoperative management. 

However, the use of antidepressants for mental disorders may also implicate key patient risk factors for surgical complications, and sufficient exploration into the patient’s indications for the prescription is crucial. Evidence so far does not suggest that antidepressants increase the risk of breast cancer or recurrence in general, but caution should be exercised for those specifically on concurrent tamoxifen and paroxetine treatment.

Read more on: http://journals.lww.com/plasreconsurg/Fulltext/2015/11000/Assessing_the_Risks_Associated_with_Antidepressant.32.aspx

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

Pfizer + Allergan Mega-merger?

In a move driven by Pfizer Inc's desire to slash its tax bills its meregr with allergan will make it one of the worlds biggest market caps.

In a deal is expected to close in second half of 2016 The Pfizer/Allergan merger is likley the largest merger in the health care sector.

As part of an effort to reduce its corporate tax rate from 40 percent to 12.5 percent, Pfizer is negotiating to buy Allergan Plc. in a $160 billion dollar deal.  Operating under the new name of Pfizer Plc Ian Read will remain Chief Executive Officer, while Allergan's CEO Brent Saunders remain in a senior role focused on operations and the integration. Current Pfizer shareholders will receive one share of the new company for each share they own.

Beyond the issue of tax rate reduction, Read also cites greater financial flexibility that will facilitate continued discovery and development of new drugs, direct return of capital to shareholders, and continued investment of about $9 billion dollars in the United States; all of which would make Pfizer more secure in an increasing competitive market.

It all sounds great, so why the discussions and debates?  The acquisition, shifts Pfizer's headquarters to Ireland, resulting in the largest relocation of a U.S. company re-locating production overseas. This relocation explains, in part, the expected tax benefit.

As you can imagine, in an election year, this has added fuel to a roaring fire. President Obama called the move unpatriotic while Democrat presidential candidate Hillary Clinton vowed to push for measures to prevent such deals. The move was also slammed by Republican Presidential candidate Donald Trump, saying that such move was disgusting considering the potential job losses.

Job losses aren’t the only issue however; investors had hoped Pfizer would sell off the lower-margin business in 2017, a move now put off by the time required to integrate Allergan. However, after completion, Pfizer will be the fourth largest market cap company in the world. No wonder everyone’s talking.

Read more at Reutershttp://www.reuters.com/article/2015/11/24/us-allergan-m-a-pfizer-idUSKBN0TB0UT20151124#yS4ozV636BhWJ42T.99

Improved Method for Treatment of Burns

The use of meshed split skin autographs (SSGs) combined with autologous cultured proliferating epidermal cells provided better wound healing and less scarring compared to using SSGs alone.

In a 40-patient clinical trial, researchers from The Netherlands found that such technique provided better results for patients who suffered serious and deep burns. The usual method of treating burns was the use of split skin autographs.

The new technique developed by the researchers used autologous (self-donated), cultured proliferating epidermal cells that were “harvested” from a small donor site, and “seeded” in a collagen carrier that could, in theory, enhance the wound healing rate and improve scar quality.

Dr. Shinn-Zong Lin, Vice-Superintendent for the Center of Neuropsychiatry, professor of Neurosurgery at China Medical University Hospital, and coeditor-in-chief for Cell Transplantationwas quoted saying that this study offers a promising, improved therapeutic method for treating severe burns.

According to Dr. Esther Middelkoop of the VU University Medical Center in Amsterdam, a co-author of the study,

The rate of epithelialization in the experimental treatment was statistically significantly better when compared to the standard treatment. We also established improved pigmentation for the wounds treated with cultured ECs. Scar quality impacts patients’ lives in many ways due to cosmetic and functional concerns.

Additionally, there is a high economic burden on patients due to extended hospital stays and the cost of rehabilitation and reconstructive therapies. Because of this, additional research in burn wound treatment and the improvement of scar quality will always be of the highest priority.

It was revealed that epithelial cells applied to a carrier system could, in fact, reduce wound healing time and improve both short-term and long-term functional as well as cosmetic scar quality.

It was observed that the primary outcome was wound closure after five to seven days, said the researchers. Secondary outcomes were safety and scar quality, which were measured at three and 12 months.

Read more on: http://ingentaconnect.com/content/cog/ct/pre-prints/content-CT-1380_Gardien_et_al

Newly Identified Genes Linked to Aging

In the largest human molecular aging study to date, researchers discovered some 1,450 genes newly identified aging genes. These, together with factors such as diet, smoking, and exercise are linked to aging.

The underlying causes of human aging are largely unknown. However, growing old has been linked to the increased risk of diseases such as cancer, heart disease, and stroke - three of the leading causes of death.

According to the authors of the study, this large amount of newly identified genes provides a key breakthrough to better understand the molecular changes during aging.

Dr Marjolein Peters and Dr Andrew Johnson, from the Erasmus Medical Center and the Framingham Heart Study, respectively led this extensive study of the aging process.

Professor David Melzer from the University of Exeter oversaw the Exeter contribution.

Dr Luke Pilling, Associate Research Fellow in Genomic Epidemiology at the University of Exeter and part of the research team said:

This study has discovered many genes that change in their patterns of expression with age. This study has not only given insights into aging mechanisms – such as mitochondrial function – but these techniques have potential use in prediction and treatment.

Large, observational, and collaborative projects such as these provide a great platform to focus aging research in the future, with the hope that predictive tests can be developed, and treatment strategies for age-related conditions improved.

Researchers looked into the changes in gene expressions in blood samples of some 15,000 people from all over the world to find easy to measure markers of human aging. Information in the genes were analyzed by reading the DNA sequence and creating RNA, and then proteins.

The study showed that many of these genes work are responsible for generating the energy supply of the cells (mitochondrial function), metabolic processes, and the stability and flexibility of the cells.

By using the gene expression profiles, authors said that it allowed them to calculate the ‘transcriptomic age’ of an individual, and show that differences between transcriptomic age and chronological age are associated with biological features linked to aging, such as blood pressure, cholesterol levels, fasting glucose, and body mass index.

A potential limitation of their study, according to the authors, is that they relied on a linear regression model to identify age-associated genes. A linear model assumes constant change over age, which may not be always correct in biological processes that stretch over several decades (adulthood).

The research is published in the online edition of respected scientific journal, Nature Communications. http://www.nature.com/ncomms/2015/151022/ncomms9570/full/ncomms9570.html

OTC Vitamin Lowers Non-Melanoma Skin Cancer Risk

Can a simple vitamin taken in conjunction with sensible sun protection significantly lower the risk of common, non-melanoma skin cancer in high-risk patients?

A recent study completed at the University of Sydney and Royal Prince Alfred Hospital in Australia supports this claim. Senior author and professor of dermatology Dr. Diona Damian found evidence that skin cancers may be reduced with a year of treatment of nicotinamide.

A type of vitamin B3, nicotinamide is considered to be safe and affordable and is available in most countries as an over-the-counter drug. The study showed that nicotinamide was very well tolerated with no difference in adverse events, blood results, or blood pressure.

Nicotinamide differs from nicotinic acid and niacin, two other forms of vitamin B3. Nicotonic acid commonly causes headaches, flushing, and low blood pressure, but these side effects are not seen with nicotinamide.

Previous studies suggest that nicotinamide enhances the repair of DNA in skin cells damaged by sunlight. Additionally, nicotinamide appears to protect the skin's immune system from UV radiation by providing skin cells an extra energy boost when they are in repair-mode after sun exposure.

Skin cancer is known to be the most common form of cancer in fair-skinned populations in the world and it is considered to be four times as common as all other cancers combined. More than half of the population of Australia is affected by non-melanoma skin cancer.

Non-melanoma skin cancer is caused by sun exposure. The 386 participants involved in Dr. Damian’s study had a history of skin cancer, increasing their risk for additional skin cancers.

The patients were asked to take the pill twice-daily pill for a period of 12 months. Nicotinamide reduced the incidence of new non-melanoma skin cancers by 23%, relative to placebo controls, and cut the incidence of pre-cancerous sun spots by around 15%.

The average number of actinic keratoses (pre-cancerous sun spots) in the nicotinamide group was consistently lower during treatment, ranging from an 11% reduction at three months, to a 20% reduction at nine months.

Dr. Damian hopes that these findings can be immediately translated into clinical practice. However, she adds that people who are at high risk of skin cancer still need to practice sun safe behavior, use sunscreens, and have regular check-ups with their doctors.

More about this on: http://www.sciencedaily.com/releases/2015/10/151021185104.htm

Revolutionary Single-stage Breast Reconstruction Procedure

This new procedure preserves the nipple, areola and surrounding skin by using a vertical mastectomy incision, a dermal flap for coverage, and a definitive adjustable smooth saline implant.

Hilton Becker, M.D., a local plastic and reconstructive surgeon and an affiliate professor in FAU's Charles E. Schmidt College of Medicine, studied and developed this procedure as an alternative to radical mastectomy. His findings were published in the Plastic and Reconstructive Surgery Journal, co-authored by Jeffrey Lind II, M.D.

According to Dr. Becker,

There are numerous advantages to using a vertical incision over a horizontal incision. From the surgical perspective, it allows for ease of access, and from an aesthetic perspective this incision leads to a better cosmetic result with a scar that resembles that of a breast lift procedure. The procedure is minimally invasive as no new tissue planes are opened after the general surgeon has completed the mastectomy.

Procedures that spare the nipple and skin have been shown to be oncologically safe and allow for much more flexibility in implant-based breast reconstruction. Single-stage breast reconstruction will become more important as there continues to be increasing financial strains on our healthcare system.

Elizabeth Hopkins is an aspiring physician and pre-med student who has been mentored by Dr. Becker. She is also a patient of his and shared her personal feedback after undergoing this new procedure.

This blessing in disguise introduced me to a brilliant surgeon whose unique procedure enabled me to have a skin and nipple sparing mastectomy free from animation deformity, which happens when implants are placed beneath the pectoral muscle – mine were placed over the muscle. Being his patient and working side-by-side with Dr. Becker has changed my life and will hopefully change the lives of many others.”

During the preliminary stage of the study, 31 patients with a median age of 51 underwent the single-stage breast reconstruction procedure. They were followed over the course of four and a half years.

Both a low complication rate and implant loss were shown and reported as part of the results of the procedure. Other benefits according to the authors of the study include: elimination of animation deformities or movement of the implants, elimination of asymmetry, less postoperative pain and discomfort, and a faster recovery.

In addition, the natural position of the implant above the muscle leads to a more natural feel.

Currently, both a one-stage and a two-stage reconstruction are available for patients.

In an immediate breast reconstruction, the plastic surgeon places the implant beneath the muscle of the patient's chest after the removal of the breast tissue. A special type of graft or an absorbable mesh is used to hold the implant in place, much like a hammock or sling.

In a two-stage reconstruction (also called delayed-immediate reconstruction), a short-term tissue expander is used wherein a saline-water solution is injected by the surgeon over a period of 2 to 3 months. When the skin over the breast has stretched enough, a permanent implant will be surgically done to replace the expander. This kind of reconstruction allows time for other treatment options such as radiation therapy to be done when it is needed by the patients.

For more info, you may visit:

http://www.fau.edu/newsdesk/articles/Mastectomy%20Alternative-study.php

What's The Best Music For Face Lifts?

The next time you're performing a face lift, consider what music you're listening to.

A survey of surgeons in the UK revealed that a whooping 90% listen to music while they are operating on their patients; with half of respondents favoring up-tempo rock, 17% pop music and 11% classical.

In fact, an article written by Henley J, “Music for surgery,” published in The Guardian (2011) revealed that plastic surgeons play the most music. When asked, the surgeons revealed that music contributed to creating a "harmonious and calm atmosphere."

According to a 1994 publication of the Journal of the American Medical Association,

Surgeon-selected music was associated with reduced autonomic reactivity and improved performance of a stressful nonsurgical laboratory task in study participants.

Further, researchers from the psychology department at the State University of New York at Buffalo, found that listening to Pachelbel was better than not listening to any music at all. There was a decreased stress and increased performance after surgeons listened to music, especially when it was their own choice.

A recent study reveals that listening to music may reduce the time spent on surgical closures. The study was conducted with 15 residents performing layered closures on a simulated wound model on a pig's feet. These were done with and without their preferred music.

Twelve residents (five lower level and seven upper level residents) completed both sessions, performing 48 repairs. Blinded faculty completed 144 repair ratings.

These were the results of the pig's feet study:

• There was an 8% overall reduction of operative time among all residents.
•  There was a 10% decrease in the operative time of surgical closure for upper-level residents who were listening to their music of choice.
•  A resident took an average of 11.5 minutes to complete the surgery without music. On the other hand, it only took 10.6 minutes to complete the repairs with music. 

The study further revealed that there was also an improved efficiency and repair quality for those who listened to music.

For patients, music reduces anxiety before surgery. A research done by Yale University anaesthetist Zeev Kain reveals that music decreases the amount of pain or the patient's needs for anxiety medication. A study by the department of anaesthesia at Glasgow's Western Infirmary surveyed 200 anaesthetists; it found 72% worked in theatres where music was played regularly, and around 63% generally enjoyed it.

Some 26%, though, said they thought music, especially music they didn't know and like, could at times "reduce vigilance and impair communication".

On the other side...

It's a distraction. Junior surgeons who are performing new tasks may be distracted by operating room music. This was reported in a November 2008 issue of Surgical Endoscopy.

For patients, it may also be a cause for discord and anxiety, especially when the music is not to their liking. The results are ultimately related to the surgeon's preferences as to the kind of music and its volume.

It is important that both create a harmony in the operating room between and among the surgeons and the patients. The reduction in the amount of time to perform a surgery finds a positive welcome in the healthcare environment.

The September 2015 issue of the Aesthetic Surgery Journal says that

In the current health care environment, where cost reduction is center stage and operative time is money, every second counts.

Read more on:

http://www.theguardian.com/lifeandstyle/2011/sep/26/music-for-surgery http://cosmeticsurgerytimes.modernmedicine.com/cosmetic-surgery-times/news/music-improves-surgical-closures

Juvederm Ultra XC: Year-Long Lip Fillers

The US FDA has approved Allergan's JUVEDERM® ULTRA XC for the injection into the lips and perioral area for lip augmentation in adults over the age of 21.

Allergan's trials show that results last up to a year in the lips, but as always, there are two sides to the coin.

Since 2006, Juvederm formulations were already FDA approved for correction of moderation to severe facial wrinkles and folds such as parentheses lines around the nose and mouth. Then in 2013, the Juvederm XC for age-related mid-face volume loss was introduced.

Clinical trials for Juvederm revealed that 79% of subjects showed an improvement in lip fullness three months following the treatment. More than 78% of the subjects reported an improvement in their overall satisfaction with the smooth and natural look and feel of their lips at one year after treatment.

Executive Vice President & President, Allergan Medical Philippe Schaison said that:

As the leader in medical aesthetics, Allergan is committed to continued research and development in this area. Providing physicians and patients with premium products that allow them to achieve the aesthetic results they want is always our goal. Understanding that the desire with lip augmentation is to achieve a natural-looking and lasting result, we continued our research of JUVEDERM® ULTRA XC for the lips. With this approval, JUVEDERM®ULTRA XC is now the only filler that is approved to last up to one year in the lips while providing natural-looking results.

Juvederm Ultra XC contains a smooth gel formulation of modified form of hyaluronic acid (HA) and a small amount of lidocaine. The hyaluronic acid helps the skin to maintain its moisture and softness and the lidocaine acts as a local anesthetic to improve the comfort of the injection.

While the increase in the time between injections is going to be welcomed by patients, there are some physicians and clinics that might lose income since patients are not coming in as frequently. Additionally, these longer fillers might not be appropriate as a "first-time" filler for patients who are unsure if thy're going to love the effect. There's a big psychological difference between living with a change for a few months and an entire year. Still, the general increase in lenght is a good thing for clincs and patients who are familiar with the effects.

Scar Management Techniques for Surgeons

Each year, it is estimated that around 100 million people in developed countries acquire scars after undergoing elective surgery and surgery for trauma. In a purely cosmetic surgical procedure such as an aesthetic breast surgery, scarring is viewed as a source of dissatisfaction among patients.

Prevention and treatment of unaesthetic scar formation after an operation greatly rests on plastic surgeons who perform these operations. Scarring may have several unpleasant aesthetic and psychological consequences to the patients including diminished self esteem, stigmatization, anxiety and depression.

In a study published at Journal of Plastic, Reconstructive & Aesthetic Surgery, an international, multidisciplinary group of 24 experts developed a set of practical, evidence-based guidelines for the management of linear, hypertrophic and keloid scars which could be useful for surgeons, dermatologists, general practitioners and other physicians involved in the prevention and the treatment of scars.

Here are some of the results:

1. After a surgery, prevention of abnormal scar formation should be a priority. In an elective surgery, the position and length of scar is to be greatly considered. As much as possible, the incision should be parallel to the relaxed skin tension lines. During the operation, the surgeon should ensure that excessive tension on the wound edges is avoided. Several measures may also be done to reduce inflammation, provide rapid wound closure, reduce the risk of infection, and provide an early surgical wound coverage.

2. Following a wound closure, scar prevention consists of three phases: tension relief, hydration/taping/occlusion, and pressure garments. Recent studies show that offloading mechanical forces using a stress-shielding device made from silicone polymer sheets and pressure-sensitive adhesive significantly reduced scar formation. Also, the use of botulinum toxin A decreases tensile forces on post-surgical scars and results in significant improvements in the cosmetic appearances of scars compared with placebo injections.

3. Silicone products may help to prevent excessive scar formation by restoring the water barrier through occlusion and hydration of the stratum corneum and need to be used as soon as the wound/suture is healed. Moisturizing emollient and humectant creams and moisture-retentive dressings such as silicone sheets and fluid silicone gel have been shown to be beneficial for itching scars, and can also reduce the size and pain or discomfort associated with scars as well as improving their appearance.

4. Randomized studies in animals and humans have shown that ultraviolet radiation increases scar pigmentation and worsens their clinical appearance. A preventive measure of avoiding exposure to sunlight and the continued use of sunscreens with a high to maximum sun protection factor (>50) until the scar has matured is recommended.

5. For patients with linear hypertrophic scars who have further scar maturation after 6 months, silicone therapy should be continued for as long as necessary. For those with an ongoing hypertrophy, more invasive measures are indicated such as the use of intralesional corticosteroids. This is the only invasive management option which currently has enough supporting evidence to be recommended in evidence-based guidelines.

Additional injectable treatment options which may help to treat hypertrophic scars (and keloids) include bleomycin, 5-fluorouracil and verapamil, although the evidence to support these is currently more limited than for intralesional corticosteroids. If the patient develops a permanent (>1 year) hypertrophic scar, surgical scar revision may be considered.

Pressure therapy has recently been considered as an ‘evidence-based’ modality for the treatment of scars. The mechanism of its action remains poorly understood despite its widespread use around the world. Part of the effect of pressure could involve reduction of oxygen tension in the wound through occlusion of small blood vessels resulting in a decrease of (myo)fibroblast proliferation and collagen synthesis. Pressure therapy can also provide symptomatic treatment benefits such as the alleviation of oedema, itchiness and pain which may contribute to the patient's well-being.

Laser therapy is another invasive option which can be used to treat the surface texture of abnormal scars and may also be suitable for the treatment of residual redness, telangiectasias or hyperpigmentation. This has also been advocated for the prevention or minimization of both post-surgical and traumatic scars, and even in combination with botulinum toxin. An increasing number of articles being published on the successful management of hypertrophic scars with lasers is increasing the interest in this therapeutic modality.

6. Keloids are also best treated in centres with specialized expertise. Patients with growing minor or major keloids should first be treated with silicones in combination with pressure therapy and intralesional injections of corticosteroids. Some experts recommend that the lateral parts of keloids should not be excised, but should be joined together and left in situ. However, others have objected to this proposal and consider that the cells from these lateral parts of the keloid are more active in terms of collagen production.

Both electron beam irradiation and brachytherapy with iridium 192 can be used after surgical removal of the keloid to reduce recurrence rates. Objections were raised because of the potential risk of inducing malignancy but a study conducted has concluded that the risk of malignancy attributable to keloid radiation therapy is minimal.

Cryotherapy may also be used as an invasive treatment modality for keloids. In a study of 10 patients, scar volume was significantly reduced by 54% after one intralesional treatment with no recurrence over an 18-month follow-up period.

7. Silicone therapy is advocated as a non-invasive first-line prophylactic and treatment option for both hypertrophic scars and keloids. For non-invasive scar management options. silicone sheets and silicone gels are universally considered as the gold standard in scar management and the only non-invasive preventive and therapeutic measure for which there is enough supporting data to make evidence-based recommendations.

Silicone therapy is easy to use and is associated with only minimal side effects such as pruritus, contact dermatitis and dry skin. This therapy is believed to prevent and treat scars through occlusion and subsequent hydration of the scar tissue. Several clinical studies have indicated the beneficial effects of silicone gels in the prevention and treatment of scars. Several comparative studies with silicone sheets have shown that fluid silicone gels have at least equivalent efficacy although patients may find the gel formulations easier to use.

Scars may leave several psychological impacts on patients after their surgery. It is important that appropriate scar management measures are done and tailored to the needs of the individual patient and wound requirement. Preventive measures should be prioritized and applied before, during, and after wound closure.

For more details, you may visit:

http://www.jprasurg.com/article/S1748-6815(14)00173-9/fulltext