Remote Patient Monitoring Research

Remote Patient Monitoring via Smartphone

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

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

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

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

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

The following procedures performed were:

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

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

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

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

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

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

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

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

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

Plastic Surgery & Body Enhancement Infographic

The business of plastic surgery and body enhancement.

How much are people really spending on body enhancing procedures? The infographic below answers these questions in interesting detail.

Men & Their Path To Plastic Surgery

Men may not be as open to their bodies as women, but they have their own insecurities about appearance, especially when entering middle age.

At the last couple of years, plastic surgeons noticed an increase in the number of guys seeking their skills to improve their bodies.

What are the most common complaints among men when it comes to body image and the available surgeries to treat them?

Man boobs – Gynecomastia

Men as they age can develop fat around their chest, which results in the appearance of male breasts-known in the medical language as gynecomastia.

According to the American Society of Aesthetic Plastic Surgery (ASAPS), 40 to 60 percent of men suffer about this issue. Liposuction or cutting the excess glandular tissue is the key.

The Beer Belly

This condition can be caused by an intake of too many calories from alcohol or simply of genetics. When diet and / or exercise aren’t working to shrink the belly may liposuction will be the way to remove the excess fat.

ASAPS reports, liposuction was the most common procedure for men last year. It can be combined with a tummy tuck to remove any excess skin left over, following liposuction.

The Male Face

This area is another place of concern for men, as wrinkles and lines are impossible to hide. The most popular options to get rid of them are Botox® injections and facelifts.

Source: ASAPS

Plastic Surgery & Medical Tourism

Medical tourism just doesn’t make a whole lot of sense.

In recent years medical tourism has become an option increasingly available to potential plastic and cosmetic surgery patients. These potential patients often imagine that inexpensive, high-quality surgical care can be obtained by traveling to such countries as India, Mexico, Costa-Rica, Thailand, and the Dominican Republic. Add to that the price-conscious “savvyness” of the internet coupon generation, and the options increase exponentially. The guiding principles often celebrated by proponents of medical and cosmetic surgery tourism are the promotion of patient consumerism and, most notably, cost savings.

In the age of global digitalization, outsourcing of various business practices has become commonplace. Beginning with the export of information technology and call center jobs, outsourcing has now extended its reach to include medicine, surgery, and even plastic surgery. Several developments have facilitated this trend. Prohibitive health care costs at home, increasing denials of insurance claims and decreasing provider reimbursement rates, increasing overall demand for plastic surgery, long waiting times, and lastly, and perhaps most importantly, cost savings, have all contributed.

Medical tourism is marketed on the basis that health care can be off-shored much like the production of computers and cell phones or the provision of professional services such as bookkeeping and accounting. Good surgical care, however, involves more than just the technical act of surgery itself. It requires extensive and careful preoperative consultation, deliberate formulation of reasonable treatment plans, and implementation of proper postoperative care. Yet, such goals are unlikely to be achieved when patients fly to a foreign country, undergo surgery, recuperate oftentimes for less than a week, and return home with no plan for follow-up care. Furthermore, with increasing numbers of reports about patients traveling abroad and returning home with serious complications, the merits of “globalizing” health care must be questioned.

All too often I consult with patients who tell me of lamentable stories of “plastic surgery gone wrong” abroad. The informed consent process, a standard component of patient-physician communication in the United States, involving full disclosure of risks and benefits of treatment, risks and benefits of alternative forms of treatment, and consequences of not undergoing treatment, is virtually non-existent. Most of the time, the patient cannot even recall the name of the surgeon, or even identify him/her in person preoperatively. In all of medicine, but especially in elective plastic surgery, in order for choices to be made in a meaningful and appropriate manner, patients need to receive accurate and comprehensive information. Inadequate communication before surgery and the seemingly non-existent culpability lead some patients to have procedures that in health care settings with higher standards would never be deemed as falling within the professional realm of care.

When considering the cost savings purported to be an attractive feature of medical tourism, one must always consider the added costs of revisional surgery and medical care incurred with the potential for adverse outcomes. These costs increase on the whole when one considers the increasing frequency of surgical complications incurred with surgery in health care settings that do not meet the standard of care. Medical travelers often purchase cosmetic surgery packages without physician consultation and without knowledge of the medical implications to their health and well-being. Medical tourism companies and destination health care facilities, often owned and operated by non-physicians, benefit from maximizing profits without the necessary medical knowledge, legal responsibilities, and unfortunately, moral compunctions either.

All in all, elective plastic surgery is a drastic measure to undergo in order to change your appearance. So if you do it, you should have all the support from family and friends that you can get to help you get through it. Being home in a comfortable and familiar environment is also instrumental in proper healing. Going away to a foreign country to get this done just doesn’t make a whole lot of sense. And that’s the bottom line.

SIMON Says: “Run Forrest Run!”

Saying ‘No’ to Prospective Cosmetic Medical Patients

Certainly, everyone is entitled and should have access to cosmetic medical and surgical services. However, depending on your particular risk tolerance, there are certain times when you might want to just 'pass' on treating a patient.  Knowing which patients to sidestep is a gray art and is frequently based on hunches and ‘gut’ feelings.  This subtle impression, as described in Malcolm Gladwell’s book 'Blink: The Power of Thinking Without Thinking', is correct more often than not.  However, there are more objective guidelines available to help decide whether or not to dance with a particular patient. Several of these tips have been developed and expounded upon in numerous papers by Dr. Mark Gorney and in the book 'The Patient and the Plastic Surgeon' by Dr. Robert Goldwyn.  Consider running for the hills if:

• The patient is a SIMON – single,immature, male, overly expectant, and narcissistic.  Even worse if they answer to SIMON-SLAP (SIMON + still lives at parents). 
• You don’t click with the patient – or just plain dislike them
• The patient is critical of previous physicians but thinks you hung the moon.
• The patient is rude to your staff.
• The patient demands a guarantee.
• You are asked to do something you can’t deliver.
• Anyone in a hurry to have surgery – gotta do it now!
• The surgiholic patient.
• Patients wanting procedures because they are prodded by friends or family members.
• The out-of-town patient who has to bolt before you are comfortable with them leaving.
• The patient who is vague, indecisive and leaves the driving to you.

Unfortunately, patients don’t walk into your office with a label on their shirt saying ‘I’m going to be a real problem’.  Listen to the voices in your head and apply the above principles.  Cosmetic medicine is supposed to be fun – don’t let a rogue patient slip through the cracks and haunt you.  It just isn’t worth it!

Top 10 Countries For Cosmetic Procedures

According to the International Society of Aesthetic Plastic Surgery, here are the top 10 countries ranked by number of cosmetic procedures.

Some interesting facts according to the report:

• Japan moved from #6 in 2009 to #4 in 2011.
• France moved from #14 to #9 in the same period.
• The US dominates with just under 18% of procedures worldwide.
• Asia performs the most treatments by continent with 28.8% of plastic surgeons and 31.7% of total procedures. North America is second with 24.3% of the worlds plastic surgeons and 24.6% of the total procedures.

American Cosmetic Surgery Numbers By Region

American cosmetic surgical procedures in the U.S. by region.

North East: 302,000 cosmetic surgeries

• 29% Nose Reshaping
• 20% Facelift
• 18% Eyelid Surgeries
• 17% Liposuction
• 15% Breast Augmentation

South East: 289,000 cosmetic surgeries

• 23% Liposuction
• 23% Facelift
• 22% Eyelid Surgeries
• 16% Breast Augmentation

South: 258,000 cosmetic surgeries

• 17% Breast Augmentation
• 17% Nose Reshaping
• 16% Tummy Tuck
• 15% Liposuction

Midwest: 242,000 cosmetic surgeries

• 31% Dermabrasion
• 17% Breast Augmentation
• 14% Nose Reshaping
• 13% Eyelid Surgeries
• 13% Liposuction

West: 485,000 cosmetic surgeries

• 36% Breast Augmentation
• 34% Eyelid Surgery
• 32% Liposuction
• 31% Facelift
• 27% Nose Reshaping

* Percentages may aggregate to more than 100% do to the same patient having multiple types of treatments.

Dealing With Anonymous Patient Reviews As A Physician

The internet is a double edged sword to the Plastic Surgeon.

Patients from near and far can read about and research our skill and services but at the same time a handful of malicious people can significantly tarnish a great reputation which we have strived to achieve and maintain.

As a surgeon and as a human I have always strived to maintain the highest ethical and moral pathway. Most of us went into medicine to help people. What we do as cosmetic surgeons may not save lives but it does save quality of life and that is evident in our patients' smiles and behavior after successful cosmetic surgery. As doctors we strive to achieve and maintain a pristine reputation but as in anything else in life, it is impossible to please all the people all the time.

The internet has given a voice to everyone but it seems like angry, bitter, malicious people take advantage of this soap box and platform much more often than normal happy folks. You can see this on comments on YouTube or blogs or chat rooms of all kinds - not just medical or plastic surgery related.

But in our field, we depend on our reputation and while you may have thousands of happy patients, a small handful of unhappy ones can affect your reputation. Personally I have seen that the vast majority of my negative online anonymous patient reviews or ratings are from people who I have either never seen in my office or have seen but refused to operate on as patients. I recently had a "1 star negative review" on YELP from a person who has never even come to my office nor met me but decided that she did not want to pay $100 for an hour of my time for a consult and felt obligated to give me a negative rating for not offering free consults! We have all had such occurrences. But how do you deal with it?

My method has always been dealing straight forward with any and all comments.  If it is out there then it begs clarification and a reply from my staff or office managers or even myself.  There has to be accountability.  In the restaurant industry, restaurants can actually review and rate their patrons, not just vice versa! As physicians, we have to respect patient confidentiality and HIPAA but that does not mean we must be silent and let any anonymous person's comments go without a reply or clarification especially when most of us work so hard to do the right thing and practice with skill, ethics and integrity.

Resources for physicians:

• Read: Reputation Management Part 1: Understanding what not to do online.
• Podium Special Offer for Members

Top 5 Cosmetic Surgery Treatments In 2011

According to the American Society of Plastic Surgeons cosmetic surgical procedures increased 2 percent, with nearly 1.6 million procedures in 2011. The top five surgical procedures were:

• Breast augmentation (307,000 procedures, up 4 percent) 
• Nose reshaping (244,000 procedures, down 3 percent)
• Liposuction (205,000 procedures, up 1 percent)
• Eyelid surgery (196,000 procedures, down 6 percent)
• Facelift (119,000 procedures, up 5 percent)

Richard D. Gentile, MD MBA, A Plastic Surgeon In Ohio

Our interview with Dr. Richard Gentile of Gentile Facial Plastic & Aesthetic Laser Center with three locations in Ohio.

Name:  Richard D. Gentile, M.D., M.B.A.
Location: Youngstown, Akron, and Cleveland, OH
Website: www.facialplastics.org

That’s interesting: Dr. Gentile is deemed as one of America’s Top Facial Plastic Surgeons by the Consumer’s Research Council of America. 

Profile: Graduate of Ohio State University, The University of Cincinnati College of Medicine and Baylor College of Medicine Residency Program. International lecturer and author of many publications including the 2011 Textbook “Neck Rejuvenation” published by Thieme. Dr. Gentile is a past member of the Executive Committee of the American Academy of Facial Plastic & Reconstructive Surgery and served as its Treasurer from 2004-2007.

How did you realize you were meant to practice cosmetic medicine?

As an undergraduate student I had the privilege of spending a week externship with a Plastic Surgeon in Columbus Ohio. It was really my first exposure to medicine and I was significantly influenced by the mentoring that occurred. During medical school I was equally influenced by head and neck cancer procedures and elected to pursue postgraduate residency studies encompassing both cosmetic head and neck and reconstructive surgery.

With three different locations in Ohio you must be busy. Can you describe how your clinics operate and how you staff them?

The Facial Plastic & Aesthetic Laser Center is a fully integrated aesthetic practice with a free standing state licensed and nationally accredited surgery center adjacent to it. There are satellite offices in Akron and Cleveland Ohio where consultation and minor surgery is offered. We are privileged to see patients from all regions of Ohio, Western New York, Western Pennsylvania and West Virginia. We also see patients from other states and foreign countries as well. A full service medical spa is located in the Boardman office and one of the largest private laser clinics with 20 different aesthetic lasers.

Our main office is not located in a large metropolitan area so staffing is sometimes a challenge. (Larger metro areas feature more cosmetic practices training staff who then have experience in medical spas or pastic surgery centers when they interview for new positions.)

Unless someone moves into our area we usually do not have the opportunity to hire experienced personnel so we have to train them on site. Another disadvantage is the smaller surgery centers need per diem or part time staffing patterns unless they operate five days a week and frequently it is difficult to find personnel who are interested in more limited schedules. Understanding these special needs allows us to zero in on those candidates who are interested in the employment opportunities we offer. We have several aestheticians, a cosmetic surgery coordinator who also assists our marketing efforts, two RN’s one exclusively dedicated to the surgery center and anesthesia staff who are retained from a national staffing firm. Our front office has a billing director and a receptionist.

What IPL or laser technologies are you using? What are your thoughts about the technologies you’re using now?

We have two Lumenis One platforms one in Boardman and one in Cleveland. They are equipped with IPL, Light Sheer laser hair removal diode laser and Nd:Yag. We also utilize three fractional lasers the Lumenis Ultra Pulse with deep FX , the Cynosure SmartSkin laser, and the Sciton Contour with ProFractional capabilities. We also utilize radiofreqency units for skin tightening with LumenisAluma and Pelleve. We frequently combine these modalities in multi-modality laser skin rejuvenation. The Cynosure Med Lite is one of our most frequently utilized lasers and is used for Tatoo removal, non ablative skin rejuvenation and dermal toning. A 532 nm diode laser is used for non-ablative treatment of vascular and pigmented lesions. Laser Lipolyis is a big part of our practice particularly in the head and neck and we developed many of the facial surgery protocols for laser assisted facelifting procedures or Smartlifting™ procedures.

Have your marketing efforts successfully increased the volume of patients coming in your clinic?

We use or have used virtually all media to market our practice and find particular success with internet based, social media, and seminars to educate the public about the procedures we offer. Being features on the websites of our technology partners also helps to let patients know about the services we offer.

Our favorite referral are those that come from a satisfied and happy patient sending their friends and family members to us and those make up about 50% of our new patients.

Are there particular treatments that have increased your profits dramatically?

Our services are divided about 50-50 between surgical services and the other office based non surgical services including neurotoxins (Botox), dermal fillers and laser procedures. Among our surgical procedures 90% are facial plastic & reconstructive in nature but primarily cosmetic and not as much reconstructive surgery as previously.

A small percentage of our practice revenue comes from skin care products and related sales.

What lessons have you learned in your practice that you can pass on to those who have just started their medical spa?

Listen to your patients. I think it is important that they are not always in your office so that you can give them the result you think they should have. They are there to hear about how you can best help them achieve the result they are interested in. The closer you come to achieving their goals the more satisfied and happy they will be. Learn from the unhappy patients so that it can help you to either modify your approach or better select patients so as to not try to please the difficult to please patients.

It has been a great privilege to practice Facial Plastic & Reconstructive surgery for nearly 25 years and the greatest development from early practice to later practice is the accumulation of wisdom from the early years of practice. When first starting in practice you sometimes carefully walk into the exam rooms of post op patients not quite sure what the result is going to be like or whether there will be complications. 25 years later you pretty much know what to expect and the kinds of results that will be achieved. We are always innovating and trying to add modifications to our techniques that will enhance our patients post- operative results. So while we are getting closer all the time our practice continually strives to obtain the best surgical and non surgical results available anywhere.

This interview is part of a series of interviews of physicians running medical spas, laser clinics and cosmetic surgery centers. If you'd like to be interviewed, just contact us.

Symbol of Excess: Is Any Publicity Good Publicity In Medicine?

By Patricia Walling

Once upon a time, cosmetic surgery was talked about in hushed tones.

Hollywood starlets were whisked through back doors into surgical suites, swathed in scarves and sunglasses to protect even the whisper of an identity. Then celebrities began talking, and soon Americans were seemingly obsessed with the transformative promises of cosmetic surgery. From requests for Nicole Kidman’s nose to Angelina Jolie’s lips, cosmetic surgeons were soon being asked to transform patients into lesser versions of their favorite stars. Larger breasts, higher cheekbones and a smaller chin soon became normal requests. Yet some may wonder, has this quest for perfection taken a toll on the American psyche? When is cosmetic surgery a beneficial procedure, and when is it simply one more symbol of excess and vanity in an increasingly image-oriented society? There are no easy answers.

When reality TV starlet Heidi Montag announced in January of 2010 that she had undergone a marathon of cosmetic surgery, racking up 10 procedures in a single day, many wondered if her dreams of the perfect body and face hadn’t become an obsession. However others in the medical community, such as those in medical transcription, saw in the 10 surgical procedures something more terrifying, addiction.

By all accounts, Montag was beautiful, a blonde-haired, blue-eyed young woman with a natural smile, but when discussing the plastic surgery procedures with People Magazine, she referred to herself as “an ugly duckling.” From a mini brow-lift to Botox to liposuction to breast and buttock augmentations, the procedures nearly killed Montag, but she stood firm behind her decision, saying Hollywood’s visions of beauty had pressured her into it. However, apparently 10 surgeries were still not enough. When the hoopla died down around the reality star’s new look, her husband announced later that year that she wanted to augment her breasts again. The surgery was to be filmed for a new reality show they were shopping. Was her subsequent admission to a plastic surgery addiction just another reality show ploy or did the superficial nature of Hollywood push her to a true addiction?

These days, it seems that more and more women feel the need to get some type of plastic surgery to order to achieve the Hollywood beauty ideal. According to an article in Medical News Today cosmetic surgery procedures increased an astonishing 700 percent between 1995 and 2005. Similarly, in an in an article discussing the psychological ramifications of Montag’s procedures, Fox News noted that 91 percent of all patients opting to have elective cosmetic surgery were women. While the average age of a patient wanting plastic surgery has not skewed younger, it has become far more socially acceptable for individuals, generally women, in their teens and 20s to have plastic surgery procedures.

A teenager going under the knife is hardly news anymore, but even children are getting in on the act. One mother recently made headlines when her seven-year old daughter had her ears pinned back and a fold on one ear corrected. An article in the New York Daily News details the mother’s decision, which she said was made to prevent bullying. She recounts adults making comments about her daughter’s ears, in front of her daughter. Oftentimes other children would refer to the girl’s ears as “gross” and wonder what had caused them to look strange. The plastic surgeon that performed the procedure, Dr. Steven Pearlman, agreed that children born with seemingly minor differences can face major harm in terms of the “development of their self-identity” if such deformities are not corrected. All of this raises the specter of a major ethical conundrum. At what point is it appropriate to refuse a patient’s cosmetic surgery procedure? What problems can be fixed through therapy or friendships rather than rhinoplasty and brow lifts? There is no easy answer.

A list of guidelines published by Mayo Clinic notes a number of things that individuals considering cosmetic surgery should keep in mind. Beyond considerations about expense and risk, individuals should think about what they expect the procedure will accomplish. If a woman believes that having Angelina Jolie’s lips will make her look like Angelina Jolie, she will be disappointed with the results. Likewise, if she believes that the procedure will make her happier, she is likely to be equally as disappointed.

While it is possible that a patient with reasonable expectations will experience a boost in self-esteem, cosmetic surgery is not the panacea of the average and aging as portrayed by popular culture. A patient’s depression won’t improve just because her chin no longer juts out. Plastic surgery won’t turn a patient into the epitome of female beauty, nor will it save a marriage or improve a social life. It short, no amount of plastic surgery can buy happiness.

A Fox News article discussed the specific implications of Heidi Montag’s surgery shortly she revealed her totally remodeled body. Among those who weighed in on the pros and cons of plastic surgery was Debbie Then, a psychologist who specializes in women and appearance. She fears that many people who go under the knife, especially at a young age, want to change who they are as individuals, something that is simply not possible to do through cosmetic procedures. A new nose might give an individual confidence, but it will not suddenly transform her from a wallflower into a social butterfly. Yet, that’s just what popular culture seems to teach.

From teasing about big ears to beliefs that women lose something of themselves as they age, the reasons individuals opt for cosmetic surgery are numerous. Yes, there is an element of vanity to their decisions, and certainly plastic surgery is more common in cultures with significant disposable incomes, but the heart of the matter is in the values that are placed on beauty above personal substance. If a woman wants to fix her nose or plump her lips, she should not be reviled for doing so, no more than a man should be reviled for getting hair plugs. Improving one’s appearance in an effort to feel better about oneself is perfectly acceptable. However when that need to better oneself physically surpasses any belief in the intrinsic values of each individual’s personality, it is time to question the role cosmetic surgery has assumed in the popular conscience.

About: Patricia Walling is a contributor for several healthcare related blogs, including http://MedicalTranscription.net. She self-identifies as a perpetual student of health care, and is based in Washington state.

Healthy Aging's Annual "Top of Class" Survey

Our friends over at Healthy Aging are gathering their annual "Top of Class" votes for our industry.  Cast your votes and we will publish their results in January.

Physicians must stay on the cutting-edge of technology. Your knowledge of leading industry reps, manufacturers and distributors can assist your colleagues during crucial equipment selection and purchasing decisions. Share your experience with colleagues in our annual "Top of the Class" survey, which allows dermatologists, estheticians and plastic surgeons to identify companies they feel are "among the elite."

Review the categories listed below, then cast your vote for your favorite vendors* by Dec. 30, 2010. We’ll tabulate the results and share the "Top of the Class" vendors online in January 2011. 

Click here for the survey.