Integrating Aesthetics in Your Practice

Non-surgical cosmetic procedures continue to rise steadily, and it is expected to so in the coming years. The market, however saturated, is still competitive with the increasing demand of patients seeking these procedures. Thus, many physicians venture to aesthetics either through ancillary services or as the focus of their practice.

Admittedly, adding aesthetic treatments and procedures is more profitable and bring in more patients in the practice. Based on the statistics published by the American Society for Aesthetic Plastic Surgery (ASAPS), non-surgical procedures have steadily every year with statistics only limited to plastic surgeons, what more for dermatologists and general practice physicians. Many expect the number of procedures to...

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Allergan Starts Trials for Hair-Growth Treatment

Botox maker Allergan is about to launch clinical trials of a hair-growth treatment similar to its drug Latisse, which stimulates the growth of eyelashes.

The Phase 1 trial, scheduled to start this month, will focus on the safety of two formulations of bimatoprost, which is the active ingredient in Latisse.

This phase of the trials will include a total of about 28 patients — men with moderate male-pattern baldness and women with moderate female-pattern hair loss.

The FDA approved Latisse as a treatment for eyelashes, with a warning that it can cause hair growth on other parts of the body that come in contact with the drug.  Some doctors have already tried using Latisse as an “off-label” treatment for hair loss.

Hair-restoration expert Dr. Alan Bauman of Boca Raton, Fla., reported “modest hair growth” among patients who have been applying Latisse daily to their scalp.

Irvine-based Allergan might want more impressive results than that in order to make its hoped-for baldness remedy more commercially successful.

Bauman predicted that “Allergan will likely test a stronger concentration for the use on the scalp than the 0.03% bimatoprost found in Latisse.”

If Phase One (safety) trials are successful and Phase Two and Three trials (efficacy) are eventually completed, bimatoprost could become the third FDA-approved drug for the treatment of baldness in men and only the second FDA-approved drug for women with hereditary hair thinning or female pattern baldness,” Bauman said. Those conditions affect an estimated 60 million-100 million Americans, he said.

The clinical trial will be run out of Tempe, Ariz.  It is scheduled to be completed in February.

The Beauty Brains: Answers about cosmetics.

beautybrains.gifThe Beauty Brains blog.

The Brains are both professional cosmetic chemists with over 30 years experience creating cosmetics and personal care products and answer questions about cosmetic products.

From Beauty Brains:

How Does This Blog Work?
You can ask us questions two ways. Use our Ask The Beauty Brains link or email us at Check back for your answer in a few days; depending on our traffic and how much research we have to do it may take a little longer.

What Products Do We Discuss?
It depends on what you ask about, but pretty much anything you put on your body is fair game.

  • What you can really expect the product to do (or not do)
  • How the product does what it does.
  • How the product is made.
  • How the product is (or isn't) different from similar products.
  • What the advertising behind the products really mean. 

Lips and Silikon 1000...a good combination? that you?

A good friend of mine recently confessed to me that she had seen one of my competitors and gotten Silikon 1000 in her lips.  I usually treat her for Restylane that we use judiciously in her nasolabial folds and her lips.  We also use a little Botox around her eyes.  She is 31 years old and has a beautiful face.  Her lips are full, but she wants "luscious!"  Her assistant had had it done with Dr. T and "she looked amazing."  And when my friend went to his office, his entire staff of young women all had gorgeous bee-stung lips. 

Now, for a moment, just forget all the stories of granuloma risk and inflammation.  Let us pretend that Silikon 1000 in the lips is 100% safe.  I actually do have Silikon 1000 in my office.  But I've only used it in a handful is situations.  One woman had been "butchered" (her term, not mine) by a oral surgeon and felt it left 2 divots in her lower lip.  I carefully filled these in.  Another woman's right upper lip dropped lower than her left from lingering Bell's palsy.  I used it to even out her lips. 

I have two patients who want to look like Angelina Jolie. I can't seem to put enough Restylane into their lips. One of them is from Texas and she said to me, "Honey, bigger is ALWAYS better!"  But the vast majority of my patients who want lip augmentation want only a slightly fuller look.  And so what happens when Angelina is no longer the superstar?  What happens when thin, straight, bead-like lips are in style?  Or what happens when all these young, beautiful woman with these mammoth sized lips get old and are grandmothers?  Their faces will continue to age in the normal, dynamic manner.  But those Silikon lips will be permanent!  I keep getting the visual of a faded tattoo on the side of  a wrinkled, sagging breast.   

Cosmetic Medicine: Aesthetics & the perception of beauty.

The current standards for human beauty are not only impossible to reach for the average person, they're impossible for anyone. It appears that we humans are 'hardwired' with what we consider attractive traits. Now technology is allowing us to realize those standards in visual form through digital aids. You can imagine in the not to distant future that computer programs and motion picture digital aids will be able to: Make Tom Cruize taller, take 15 pounds off the female lead, and create hyper exaggerated sexiness. (Perhaps the real life Jessica Rabbit.) But these manifestations of beauty will be confined to the digital and motion picture worlds... At first.

It may be that these hyperbeauty standards will accelerate the move to genetically engineering of human beings. (This is inevitable for many reasons.) With society setting the bar impossibly high, I can imagine that it will increase both the speed and pressure. Gattiaca is not far off.

What we perceive as the perfection of beauty. 

Take a look at the picture to the left, you will 'know' that this is a very beautiful face. But why? Finding answers to why we regard one face as being more beautiful than another is actually not as easy as it seems. 

Nevertheless, at least in the case of this photograph, it's not a big surprise that you think this is an attractive face. Each pixel of that face has been calculated by scientists using a specialized software program, altered in a special way to ensure that you think this is an attractive face. 

The Universities of Regensburg and Rostock in Germany have created a remarkable study on attractiveness and how humans interpret Beauty.

From the study: A remarkable result of our research project is that faces which have been rated as highly attractive do not exist in reality. This became particularly obvious when test subjects (independently of their sex!) favoured women with facial shapes of about 14 year old girls. There is no such woman existing in reality! They are artificial products - results of modern computer technology.

The same applies to the morphed average faces: Faces with such a smooth, pure skin, without any irregularities do not and cannot exist. But it is this kind of perfection that obviously overwhelmed our test subjects. Taking everything together it can be said that the most attractive face does not exist in reality - they are computed according to certain principles by machines. 

Having these results in mind it is also not surprising that a model agency from Munich chose 88% artificial faces (14 out of 16 selected faces) for potentially being interesting as a model for the category “beauty”. Only two natural male faces could keep up with the computer generated ones, within the group of female faces no natural faces have been selected! We also asked test subjects to indicate the most attractive faces found the same pattern: 81% (13 out of 16) of the selected faces had been generated by the computer.

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virtuelles Model

virtuelles Model

virtuelles Model

A selection of faces which have been judged by the model agency as being suitable as a model. All six faces were produced by the computer and don not exist in reality.

Natural faces cannot keep up with their artificial “competitors”. This becomes even clearer when you look at the labels of the rating scale that has been used for the evaluation: Just 3% (!) of the natural faces were rated as "rather attractive" - the judgements "quite attractive" and "very attractive" were never applied to natural faces. However, within the group of morphed faces 30% of all female and 23% of all male faces were perceived as being at least "rather attractive". 
Looking at the negative pole of the judgements is even more worrying: 70% of all natural female faces and 79% of all natural male faces were judged as being "rather unattractive", "quite unattractive" or even "very unattractive". Keep in mind that the average age of the subjects that were depicted on the images was just about 24 years! 

What is it that makes a face look beautiful? What are the differences between very attractive and less appealing faces?

For every historical period and every human culture, people have always had their own ideal of beauty. But this ideal has never been constant and is still subject to changes. In our research project we adopted an empirical approach and created prototypes for unattractive and attractive faces for each sex by using the morphing technique. For example, the prototype for an unattractive face ("unsexy face") was created by blending together four faces that had previously been rated as very unattractive. The "sexy face" was created by blending together four of the most attractive faces, respectively (see report). 

In order to find out the characteristic differences between attractive and unattractive faces, we presented pairs of one  "sexy" and one  "unsexy" image for both sexes to test subjects. The task was to report which facial features were perceived to be different between the two faces. For the results see the list below. 

Female faces:

Prototypic female face of high attractiveness
("sexy face")
   Prototypic female face of low attractiveness
("unsexy face")

Characteristic features of the female "sexy face" in comparison to the "unsexy face":

    • Suntanned skin 
    • Narrower facial shape 
    • Less fat 
    • Fuller lips 
    • Slightly bigger distance of eyes 
    • Darker, narrower eye brows 
    • More, longer and darker lashes 
    • Higher cheek bones 
    • Narrower nose 
    • No eye rings 
    • Thinner lids 

Male faces: 

The prototypic male face of high attractiveness
("sexy face")
    The prototypic male face of low attractiveness
("unsexy face")

Characteristics of the male "Sexy face" in the comparison to the "unsexy face": 

    • Browner skin 
    • Narrower facial shape 
    • Less fat 
    • Fuller and more symmetrical lips 
    • Darker eye brows 
    • More and darker lashes 
    • Upper half of the face broader in relation to the lower 
    • Higher cheek bones 
    • Prominent lower jaw 
    • More prominent chin 
    • No receding brows 
    • Thinner lids 
    • No wrinkles between nose and corner of the mouth

Beauty and pixel pushing

Who is the most beautiful woman in Germany? An official jury tries to answer this question each year. In January 2002 it chose Miss Berlin to be the most attractive woman (left picture). But is she really the most beautiful one? The results of our study suggest - at least in theory - to be far from the ideal. 

For this reason we cooperated with Pro7 (a German television channel) and managed to get portrait photos of all contestants of the final round of this national beauty contest. In contrast to their live evaluation on the catwalk, the beautiful women could not show a particular sexy way of walking or put on a charming smile but had to comply with our scientific requirements: Frontally photographed face, hair tied to the back, neutral facial expression - and especially: no make-up! 

A selection of the 22 contestants of the final round of the contest

Miss North-Rhine/Westphalia 


 Miss Thuringia


 Miss Bavaria


Miss Bremen

Miss South Germany

Miss Baden-Wuerttemberg

Based on our previous research results we computed a new face out of all original faces by using the described morphing software. The resulting “virtual” beauty as well as all other original faces were evaluated with respect to their attractiveness by a representative sample of people in a local shopping center. 

More beautiful than Miss Germany 

The results are clear. The virtual face was rated by far as being most attractive. On a scale reaching from 1 (= very unattractive) to 7 (= very attractive) it obtained the highest score with an average of 6.2 and let Miss Germany lie far behind having an average score of just 2.8. None of the 47 asked test subjects rated the real Miss Germany as being more or at least evenly attractive than the virtual one. The highest score of the real faces obtained Miss Bremen (4.9 points), but also Miss Bremen lies clearly and statistically most significantly behind the computer beauty. 

"Real" and "virtual" Miss Germany in comparison:

On the left: the “real” Miss Germany 2002 (= Miss Berlin) and on the right: the “virtual” Miss Germany, which was computed by blending together all contestants of the final round and was rated as being much more attractive. 

Read the entire study here.

How do you define "beauty"?

Beauty is in the eye of the beholder, right? 

To some degree that is true.  Beauty is subjective.  When a patient says to me, "Doc, you just do what you think I need" I quickly remind them that very little of the procedures I perform are things that people "need."  Rather I try to do what people want.  So what if somebody doesn't know what they want?  Well that's were your experience can really make the difference.

Most of the time people have a fairly good idea of what bothers them when they look in the mirror.  If they need some prodding, then I try to steer them into one of two categories:  color or contour.  Some people would like their skin tone to be more even by removing pigment from broken blood vessels or sun damage.  Others tend to be more focused on their wrinkles or the texture of their skin.  So one woman may love her crow's feet, but hate her freckles and it's the exact opposite for the next woman. 

Why is all of this important?  Have you ever read one of those magazines (Allure, Glamour, etc) where they send in the undercover journalist to have a consultation with the plastic surgeon?  She goes to see about 5 different physicians and requests information on a nose job, for example.  And she leaves with a laundry list of procedures she "needs" and the nose job has now morphed into the chin implant, eye lift, laser skin resurfacing, etc.   Now she may have left the door wide open for the surgeon to recommend all the things that he thinks would be in her best interest.  But, in general, the tone the author takes in the magazine article is as if she's just been to the auto mechanic and they have tried to replace everything under the hood.  And the reader gets the impression that all plastic surgeons are out to up-sell every vulnerable, naive woman who walks in their door.

Now some patients may want to hear all the recommendations and then make an informed decision on their options.  But a great many of them will be so overwhelmed that they leave your office running as fast as they can and feel grateful to still have their features intact.   My practice involves no surgery.  We specialize in all non-invasive or minimally invasive technologies and so we tend to attract patients who favor doing less over doing more.  So it is important to read from them what they are interested in doing and what they could do without.  And much of the time, my patients who start out only wanting to know more about sunscreen end up doing fotofacials, Thermage, or Botox as we develop a relationship and they learn to trust me and our practice.

The surest way to have an unhappy patient is to recommend or talk her into doing things that she's not intersted in or could care less about.  She'll never really be thrilled with her results if that particular area didn't even bother her in the first place.  If you stick to what is of value to them and give them all their options (including services you might not even offer), then she will feel most confident about moving forward in whatever she decides to do.  And she'll trust you which is truly the cornerstone of the doctor-patient relationship.

Read about one woman's experience visiting 4 different plastic surgeons.