Robert Alan Shumway MD FACS: Cosmetic Surgeon In La Jolla

Dr. Robert Shumway is a cosmetic surgeon in La Jolla California.

Name: Robert Alan Shumway, MD, FACS, FAACS
Location: La Jolla, CA

That's interesting: Dr. Shumway has personally performed well over 3,500 TransUmbilical Breast Augmentation (TUBA) procedures and has taught Cosmetic Surgery at UCSD, UCLA and Duke.

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Injecting Botox As A 'Medical Esthetician'

It seems that there are medical spas that are having non-medical staff performing medical treatments... In this case, Botox injections.

Here's a comment that someone posted on the comment thread from the post: Medical Assistants Can Not Inject Botox.

As a medical aesthetician I have injected under a physician's supervision for nearly eight years. That is the concept of a med spa? Medical Aesthetic procedures delivered under a physician's supervision. I have more often seen patients injured by laser treatments. In fact, in a decade of working in spas that offered Botox, I've never seen serious side effect. I've seen one temporarily droopy brow, once, injected by a "diamond" injector physician.

@Aesthetic Injector
You may have been doing this. Your supervising physician may know that you're doing this... but this is not legal in the US (or Canada or Euroope as far as I know).

First: There is no such licensee as a 'Medical Aesthetician'. If you're an esthetician working in a medical spa, you're an esthetician working in a medical spa. You have no expanded scope of practice or licensure about what medical treatments you can perform. Your esthetican license allows you to perform certain treatments... none of which allow you to break the dermis. You have no licensure that allows you  to perform injections. In this case there is no difference between an esthetician and the front desk staff (or anyone off the street).

Second; you equate what you're doing directly with a physician. In this you're correct. You are indeed performing medicine.

However, your supervising physician can not extend his or her license to allow you to perform Botox injections. It does not matter if the physician knows about it. It does not matter if the physician trained you to do it. It does not matter if the physician tells you to do it. The fact that it's relatively easy and that you've been doing it (even successfully) is irrelevent. Your physician can not 'expand' the treatments that you're licensed to perform. Injecting Botox is not one of them. There is no legal difference between what you're doing inside of this 'medical spa' and what you would be doing if you were injecting Botox in a motel room somewhere, other than the physician that's allowing you to do this is on the chopping block too.

Third; If you have any issue at all, you are not going to be covered by any malpractice carrier. You (and your supervising physician) are performing entirely without any net or recourse. Your supervising physician is probably in deeper water since his or her medical license is also at risk.

You mention that you've seen 'diamond' injectors who's Botox treatments have resulted in drooping around the eye. This is a known potential complication with Botox. So, if a diamond level physician who's squirting Botox day and night can have a complication, what are the odd that you could run into any sort of complication?

If you ever perform a treatment with a negative outcome that results in any investigation, you'll be found to be performing medicine without a license, without malpractice coverage, and without a chance of any good outcome.

So, what's going to happen?

Truthfully, I don't know, but here's a probable outcome based on experience.

Something is going to go wrong; you're going to have a complication, a patient is going to be unhappy, a staff member is going to be fired but has a grudge... something will happen. It always does at some point. It may even be unrelated.

Someone is going to point out that this clinic is operating outside of both legal and ethical guidelines, and then it's going to get ugly. If it involves a patient or civil suit it's going to be even uglier. These things have a way of cascading out of control.

If you disagree, I'd truly love to hear your arguments.

Anyone else want to weigh in on this?

Your Medical Spa & Laser Clinic Advertising Sucks

I hate to tell you this, but your advertising sucks.

That's alright. Your competitors advertising sucks too.

In the last ten years that I've been around medical spas, laser clincs, dermatologist practices and plastic surgery centers, I've seen a lot of sucky advertising.

In the kingdom of the blind, the one-eyed man is king. It's more than just a little appropriate if you apply it to the marketing and advertisng of cosmetic practices. After all, the're generally small businesses in which the owner is in there working all day making the payments. It's no wonder that with; no training, no resources, no access, and no working knowlegde of how to really market and advertise... the typical medspa or plastic surgeon relies mostly on the 'vendors' to try to get some littel bit of name recognition.

And the vendors love to help you (if you're producing for them) by giving you a hundred brochures or postcards that tout 'their' product.

And docs are tripping all over themselves to try to get this stuff.

So, we're going to be doing something about that. We're going to to offer some actual advertising and marketing umph that a few of the smarter docs on the site will be able to take advantage of.

We're going to be launching a marketing and advertising portal for plastic surgeons, dermatologists, medical spa and laser clinics.

We've been working on it for the last six months already.

It's still about a month away but I've been pretty excited about it and thought it about time to show a little leg.

This new portal will be designed specifically around providing the highest quality marketing and advertising for cosmetic medical practices. The idea will be to provide entire, integrated campaigns that will give you the ability to have the same look and feel across your entire presence; business cards, postcards, brochures, flyers, posters, emails... all of it.

Sure, there might be another clinic somewhere that's using the same theme, but what will you care? You'll be paying pennies on the dollar for what you'd pay to have this work done exclusively for you and you'll be able to look a lot bigger than you are.

I may be jumping the gun just a little in this but, damn, I've seen the stuff and it rocks!

Oh, and by the way, this stuff wasn't put together by some teenagers or housewives with photoshop. We've scored some fantastic talent, from art directors to writers who have worked on huge accounts.

So, there are a few things left to do, but it's all coming together. Stay tuned.

Medical Spa MD Members get a Podium patient review marketing account and save $1,257

Protect your reputation. Get new patients. Medical Spa MD Members receive a special, full service Podium account that includes: no setup fee (save $300), a 10% discount forever (save $330/year) and on-demand patient review marketing training for your entire staff ($597 value).  This offer is not available anywhere else.

Frontdesk SEO: Medical Spa Marketing & Keyword Selection

Frontdesk has a growing number of full-service website SEO accounts from Medical Spa MD Members and additional do-it-yourself accounts popping in all the time.

Read this review of our SEO software by a Medical Spa MD Member.

Since we've had so many Medical Spa MD Members sign up and begin using our SEO software or outsourcing their SEO to us, I though I'd comment on one of the most common questions that we get from plastic surgeons and medical spas that are just starting; keyword selection.

What are keywords?

Keywords (or key phrases) are what someone who is looking for your clinic types in to the search engine. For many, selecting the right keywords can be of the utmost importance. If you select the right keywords your marketing efforts should see some pretty significant results after just a short time, but select the wrong keywords and you're going to be banging your head against the wall with little to show for it. So, let's talk keywords that are going to be most useful for Medical Spa MD Members.

Most Medspa MD Members are individual physicians who have a single clinic location. As such, you're targeting potential clients based on geographical location; a certain 'radius' around your practice that you typically pull new patients from.

This one single piece of info gives you the ability to be especially effective by using your geography in your SEO efforts. And since 85%+ of your potential clients are now using the web to find local businesses it's more than just a 'nice to have', it's imperative for success if you're looking to grow.

Selecting Your Medical Spas Best Keywords

There's some good news here. If you're offering Botox, Dysport, laser hair removal, or photofacials, or you're using technology that clients might be searching for like Fraxel, Thermage, or IPL treatments, you can just stick your area code or location on the end (which is how people commonly search) and you're set; so 'Fraxel' now becomes 'Fraxel Manhattan', 'Thermage' becomes 'Thermage NYC', and 'laser hair removal' is now 'laser hair removal 90210'.

Of course there's a hitch. Just because you're being ranked for 'Fraxel NYC' doesn't mean that you'll rank for anything else. So, you'll need to keep up your marketing efforts on all the keywords that you're targeting at the same time. (This can be pretty difficult if you don't have a system in place.)

If you've got any website SEO efforts in place, you'll do better with just adding your local city or zip code to your normal process.

Where to start

OK, here's the plug; you should run a free SEO website report on your domain name. We offer this service (and it's a valuable one) so that you can see exactly how your site's performing at any given time.

Sciton BBLs Partnership Launch Is Coming

Sciton and Medical Spa MD will be announcing a group buy offering for our Members next week.

This is just a heads-up, but if you're even thinking about adding a cosmetic laser or IPL to your medical center you'll want to take a look at this new program.

Sciton's not sitting on their thumbs. They're a motiviated and hungry company that's watched the success that some of our other Select Partners like Shine and Frontdesk SEO have had and decided to craft an offer that pushes the limits of what a cosmetic laser manufacturer has done before.

This could fizzle of course, but I think there's an equal possiblity that it could just change the way that cosmetic medical technologies like laser and IPLs are sold and marketed... at least by those companies who have good reputations and understand that their physician customers are their greatest asset.

For Medical Spa MD's community this could be something of an inflection point, with one of the major technology companies now looking to actually become a member of the community we've built and allowing Members to pool their collective buying power and benfit from others who are using the same technology without trying to wall them off from all other information and messaging – which never really worked anyway. We'll be discussing the details of the offer and how it came about when it launches now but I wanted to mention that it's coming.

To bone up beforehand, read the latest cosmetic laser & IPL reviews and get a sense of what the medical spa community's thinking about Scition, Palomar, Cutera, Solta and the rest of the cosmetic laser & IPL technologies or visit some of the physician user groups.

If you're in the market for any type of cosmetic laser or IPL my advice is this; wait a week. Even if you're about to buy a Palomar Starlux, Candela Smoothbeam, or even a used cosmetic IPL, you'll be able to beat up your sales rep on price a little.

Allergan Q1 Profits: Botox, Dysport, Juvederm Ultra XC

Allergan's Q1 Earnings Call: Allergan's thoughts on it's Botox and Juvederm Ultra XC growth.


First quarter sales increased year-over-year 11.2% in dollars and 6.9% in local currencies, boosted by the strong pickup in the sales of medical devices, which grew 18.4% in dollars and 13.4% in local currencies. The growth in the Medical Aesthetics businesses was even stronger outside the U.S. in all regions and across a wide range of countries, with surprisingly strong performance in Europe.

Operating performance was strong, with non-GAAP earnings per share at $0.65, marking an increase of 18.2% versus the result for Q1 of 2009, and comfortably exceeding the Q1 expectations shared with you, the investment community, of $0.57 to $0.59.

Earnings growth was driven by strong gross margin expansion, especially in the Medical Device segment. Careful spending in the selling, general administrative area, whilst we increased investment in R&D by 11.1% on a non-GAAP.

Within SG&A, we however doubled our DTC expenditures versus Q1 of 2009, which of course was the low watermark for spending when the world economy was in crisis. Our plan is to continue to invest in 2010 across our brands and into the recovery of our markets.

During the quarter, we were pleased that we continued to strengthen our R&D pipeline, supplementing our internally development programs with acquisitions and licenses. In January, we acquired Serica, a company with proprietary technology for use in tissue regeneration especially applicable to breast reconstruction, as well as the license for Ser-120 in Phase III clinical development for nocturia. Strategically, we have made good progress in building up a portfolio of urology assets.

We also furthered our aspirations to be the leader in medical aesthetics also in Asia, by reacquiring the rights to BOTOX Cosmetic in Japan and China and expanded our footprint in fast-growing emerging markets by establishing direct operations for all of our businesses in Turkey, effective from the second quarter.

After the out-licensing transaction with Bristol-Myers for neuropathic pain, we've increased our degree of R&D focus on our core specialty areas.

Now I’d like to comment on our expectations for 2010. For the full year earnings outlook, we have brought up the bottom of the EPS range by $0.02 to $3.11 and have left the top end of the range at $3.15 which at the time of the last earnings call expressly excluded the costs of any healthcare reform bill in the United States. With the increase of the Medicaid rebate, extension to managed Medicaid and expansion of eligible hospitals in the so-called 340B program, we estimate that the cost of healthcare reform in 2010 will be approximately $12 million. This is now included in our outlook.

Turning to BOTOX

Sales growth has picked up relative to trends seen across 2009, with growth versus the first quarter of 2009 at 11.3% in dollars and at 6.6% in local currencies. Sales of $331 million were only modestly lower sequentially than Q4, which is always seasonally the highest quarter of the year. Most of this increase was due to the more economically sensitive aesthetic side of the business, as the benefits of the upper-limb spasticity FDA approval in March occurred too late in the quarter to contribute to our sales results.

Outside the U.S., we enjoyed very strong double-digit increases across a wide range of countries, with surprisingly strong growth in several of the main European markets. These global markets are precisely where we are successfully dealing with multiple competitors.

It would therefore seem that the market is recovering as we can measure our market share with only a short time lag. In Europe, on the aesthetic side, we’re holding share at just under 80%, as we deal with the incursions of both Merck’s, with their Zymine and Bocatua [ph] brands and Galderma with Azzalure.

On the therapeutic side, it seems that most of ZMM’s market share gains have been at the expense of Dysport. In the U.S., BOTOX sales growth is less buoyant, as there was no base of Dysport sales in the prior year, but it is clear that the market is growing again.

We estimate that in the aesthetic market, Dysport had somewhere between 13% and 14% share in the first quarter. We'll be curious to see the lasting impact of the Dysport Love It or Leave It promotion after it terminates at the end of May.

In the therapeutic market, Dysport’s share is so far negligible, given the long history and experience of BOTOX use. In Europe and the U.S., we have recently introduced a 200-unit vial, which is useful for injectors treating large muscle groups, as well as for differentiation from competition. Regarding global market share for the fourth quarter, the last quarter for which data is available, we estimate that BOTOX held 79% share in a market growing 13% year-over-year.

Regarding the clinical program for BOTOX for chronic migraine, the clinical trial results of our PREEMPT program were published in Cephalalgia, the journal of the International Headache Society. Regarding facial aesthetics, we've experienced an even stronger rebound in sales than observed with BOTOX. Dermal filler sales grew year-over-year, a very strong 42.4% in dollars, and 34.5% in local currencies, with great growth in all operating regions of the world, with Europe again surprising on the upside.

Juvederm & Juvederm Ultra XC

In the U.S., we've seen huge growth in the JUVÉDERM line since the launch of JUVÉDERM Ultra XC, this is the lidocaine-containing product, in early February. Although we have gained some market share, it would seem that the market is responding strongly to the reduction in treatment pain experienced with this lidocaine-containing product and already a substantial share of the mix is attributable to JUVÉDERM Ultra XC.

We have just initiated print advertising for JUVÉDERM XC and have a PR campaign with TV host Dayna Devon, as our spokesperson to further drive growth. In Europe, we launched new additions to the JUVÉDERM product line, JUVÉDERM Smile at the IMCAS Conference in Paris in January and JUVÉDERM Hydrate at the Anti-Aging Conference in Monaco in March. JUVÉDERM Smile was also approved in South Africa, JUVÉDERM XC in Korea and JUVÉDERM Ultra Plus in Taiwan.

Voluma was recently launched in Brazil and also approved in Taiwan.

Based on our analysis of the world market in Q4, which we estimate grew 12%, it is clear that global market growth has accelerated since then. Our analysis also points to JUVÉDERM market share gains in all regions of the world. Beyond superior product performance characteristics, Allergan also benefits from having full product line.

At the end of the first quarter, Allergan's cash and cash net of debt positions totaled approximately $2 billion and $471 million, respectively. Allergan continued to maintain exceptional cash flow generation capabilities in the first quarter, with operating cash flow after capital expenditures of approximately $161 million, an increase of approximately $56 million over the first quarter of 2009.

Effective Link Building Strategies to Increase Your Medical Spa's SEO

If you are new to "link building", it really isn't as hard as it seems.

Basically, link building is just a link from another website back to your own medical spa or laser clinic. The more back links your site has, the higher it will rank on the major search engines.

Link building can be very time consuming, but the FrontDesk SEO tool can really help you go out there and find the sites you should be listed on. This saves you a tremendous amount of time.

Because you will be resubmitting the same text over and over again, make yourself a document that you can keep all of your submission text on. This should include your Page Title, your website's URL address, a brief description of your practice, and important keywords. Website submissions also ask for a name of the submitter and email address. I would suggest setting up a email address with Google or Yahoo, one that you only use for submissions, this way your personal email won't become inundated with confirmation and/or spam emails as a result of your submissions.

View: 5 minute video introduction to linkbuilding and SEO

There are several types of link building methods you can do. Some are just basic data submissions, and some are blog and article submissions. I will describe the differences amongst the major link building methods:

Article Submission

There are directories on the web designed just for submitting articles and some for writing blogs. When you submit something you wrote about your practice or even a particular therapy you offer, you can attach hyperlinks to keywords in your article that direct the reader back to your website. Some quality sites are Squidoo, Hubpages, Blogger, and Let me show you how this works with just one line taken from a blog I wrote on my own blogpost:

"It's your body and you do have to be careful of who you choose to perform your laser lipo procedure. While no physician can have a 100% satisfaction rate, don't be afraid to ask questions about how long a physician has been performing these procedures, who they trained with, how many procedures do they perform a month, and also if they have any satisfied patients you can chat with. Also, it's important to ask to see a before and after photo book with their patients, and not someone else's."

By choosing a keyword you think your reader would be interested in, you can immediately direct them right to that page on your website with the hyperlinks.

Google considers a "Yahoo Directory" link as a quality back link. Unfortunately, they charge an annual fee of $300. It may be worth submitting to; however, there is no guarantee from Yahoo Directory that your site will be accepted.

Directory Submission

DMOZ is a directory worth submitting your site to. DMOZ is an Open Directory Project (ODP) mainly known as DMOZ which stands for "" and is owned by Netscape. While DMOZ can substantially increase your SEO ranking, it's tough to receive their approval and the entire process could take months. If you are fortunate enough to receive their approval, many smaller directories use the DMOZ directory categories so if you can become listed with DMOZ this would mean you would also become listed on many other web directories as well.
There are other major directories you can submit to such as the BOTW (Best Of The Web) directory ($99/year or $299/permanent).

Social Bookmarking

Social bookmarking is changing in it's effectiveness all the time. In social bookmarking websites, users save links publicly (not personally on their own computers) to web pages that they want to store and/or share with others. Usually, these bookmarks are shared within an individual "group" someone may subscribe to (such as "Laser Hair Removal"). You can add descriptions to your bookmarks in the form of metadata, or meta tags, so that other users can understand what the content is of your bookmark without having to download it beforehand. Different types of "descriptions" can include comments or even reader's votes (favorable or not - like on YouTube or Digg). Again, FrontDesk SEO makes this process relatively easy.

Blog Commenting

MedicalSpaMD is a blog and, like most blogs, it is highly susceptible to spammers like we have all seen and Jeff so diligently tries to eliminate on a daily basis as it can be a true nuisance for people like us who use this site as a valuable tool for your practices.

If you want to find blogs to participate in and comment on, try to find quality blogs that are related to what you do as a profession. Again, FrontDesk SEO can help with this. And when you add your comments, try to make them content-relative because not only do your comments add value to the blogpost in general, they also have greater chance of staying on the blogpost with a link back to your website.

Press Releases

Press Releases have worked well for me, and I'm not too proud to say that I didn't write the ones that really worked. There are a lot of good and bad example press releases out there and I am no exception. Writing a quality press release is an art and, frankly, I don't have the talent for them and pay someone else to do it. Let me give you an example of my own good and bad press release experiences.

While this press release still continues to give my website hits, all it is is words: Paula's Bad Example

Now look at the one I paid Fran Acunzo from Acara Partners to do for us. It includes a photo, links and even video: Paula's Good Example

If writing a good press release including videos and back links is not your forte, then it's worth it to farm it out. Just writing a good press release is half the battle. Submitting it to the right press release agencies that will index it effectively for you is the other half.

Social Media Sites

Social Media sites such as Facebook, Twitter, Flickr and YouTube work very well by providing quality and relevant back links to your site that all the major search engines love.

So, this is back linking in a nutshell and we can really go deeper into the categories, but I fear you will become bored or even glassy-eyed if you're not a geek like me. So if you don't have someone out there performing these activities for you and you really are serious about your web presence, you really might want to take a look at FrontDesk SEO and see what it can do for you. Just remember, building links doesn't increase your website's internet presence overnight. It does take some time, like my good friend Jeff keeps reminding me! In a world of available "instant results", it's hard to be patient sometimes! 

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course, Study Guide, and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

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FDA Warns 6 Medical Spas About Lipodissolve Marketing

Lipodissolve (or liposolve or mesotherapy) is a staple in any number of medical spas, but the FDA has just issued a warning letter to 6 clinics that they've crossed the line in marketing lipodisolve to patients.

My own experience with lipodissolve mesotherapy is something of a mixed bag. Clinics that I've been associated with have offered liposolve in the past and I'm aware of one really scary incident where a woman had been treated in Park City over a large area (thights and stomach as I remember) and then went golfing. She colapsed at the golf course and was rushed to the ER at the University of Utah.

She recovered but the administering physician faced some pointed questions from the ER docs about what he'd injected and why.

(The lipodissolve treatment causes fluid accumulation and swelling temporarly. That fluid comes from the blood stream and when there's a large treatment area, that can be a lot of fluid. This can affect the patient's blood pressure and volume, in some cases dramatically. This patient's recent treatment combined with golfing in the sun, walking, and dehydration was enough that she tipped over and (I think) lost conciousness for a few moments.)

If you're offering lipodissolve, leave a comment below and detail your experiences, results and thoughts... especially if you're from one of the 6 medial spas named below.

Anyway, here's the FDA story via

FDA Issues Warning on 'Fat-Melting' Spa Injections

There's no proof the procedures work and serious side effects can occur, agency says

Claims by spas that "lipodissolve" injections can melt away fat are unsubstantiated and the procedures' safety also remains in question, according to warning letters issued Wednesday by the U.S. Food and Drug Administration.

The FDA warned six U.S. based medical spas and a Brazilian company to stop making false claims about the drugs used in these procedures.

Sold on the Internet and used by some spas, lipodissolve is a procedure that its proponents claim will eliminate fat. U.S. companies claim that the drugs used in the procedure are safe and effective, but these products have never been approved by the FDA, the agency said.

"We are concerned that these companies are misleading consumers," Dr. Janet Woodcock, director of the FDA's Center for Drug Evaluation and Research, said in a prepared statement. "It is important for anyone who is considering this voluntary procedure to understand that the products used to perform lipodissolve procedures are not approved by the FDA for fat removal."

Lipodissolve involves several injections that supposedly dissolve and remove small pockets of fat from areas of the body.

Lipodissolve is also known as mesotherapy, lipozap, lipotherapy, or injection lipolysis. The drugs most often used are combinations of phosphatidylcholine and deoxycholate.

Sometimes other ingredients such as vitamins, minerals and herbal extracts are added into the mix, the agency said.

However, there is no "credible scientific evidence that supports the effectiveness of any of these substances for fat elimination, and their safety when used alone or in combination is unknown," the FDA said.

The FDA has asked for a written response from the U.S. companies within 15 days outlining how they plan to correct the violations and prevent future violations. Failure to correct the violations could result in legal action, the agency said.

Each company has been cited for a variety of violations, including making "unsupported claims that the products have an outstanding safety record and are superior to other fat loss procedures, including liposuction," the FDA said.

Also, some of these companies have claimed that lipodissolve can treat certain medical conditions, such as male breast enlargement, benign fatty growths called lipomas, excess fat deposits and surgical deformities.

"The FDA is not aware of clinical evidence to support any of these claims," the agency said.

FDA officials have received reports of negative side effects from people who have tried the procedure, including permanent scarring, skin deformation, and deep painful knots under the skin in areas where lipodissolve drugs were injected.

Warning letters were sent to: Monarch Medspa, King of Prussia, Penn.; Spa 35, Boise, Idaho; Medical Cosmetic Enhancements, Chevy Chase, Md.; Innovative Directions in Health, Edina, Minn.; PURE Med Spa, Boca Raton, Fla.; and All About You Med Spa, Madison, Ind.

The Brazilian company receiving the warning letter sells lipodissolve products on two Web Sites: and, the FDA said.

The FDA also has issued an import alert against these Internet sites to prevent the drugs from being imported and distributed in the United States.

Well, the zipmed and mesoone sites are both down and have this simple statement.

Due to the current facts, and do not sell Lipodissolve vials anymore. Thank you. For more information access

Leave a comment below.

Dysport Reviews

Evidently Dysport is very friendly with some docs. Too friendly for the FDA when it comes to promoting Dysport before it's been approved.

From Pierce Mattie PR:

It appears it is not only bloggers that are feeling the heat from the government in regards to their relationships with the brands they write about, but cosmetic dermatologists as well. Recently the FDA made an example of Dr. Leslie Baumann by sending her a warning when she was sourced for several beauty magazine articles regarding her positive praise of Dysport, the newly approved Botox competitor created by Medicis prior to such approval. The warning appears to have more to do with disclosure than anything else, which, mark my words, will be the buzzword of 2010 due in part to both the FTC and FDA.

Dr. Baumann was given 10 days to "clean up her act;" I wonder how her publicists will handle that.

It is a publicist's job to land their client in A+ publications and in this fierce competitive world of Beauty PR, everyone wants to be first to be sourced for being in the know about the latest and greatest beauty treatment.

However, Dr. Baumann's publicists should've been more careful considering her relationship with Medicis as an "investigator" for Dysport. In all of the articles she was quoted in, not once did she disclose this relationship, but merely indicated her praise that the neurotoxin was more effective than Botox.

Aesthetic Predictions for 2010

I think everyone staring out in the aesthetic industry, especially if you are a non-core practice, needs some sort of a guru. Someone to guide you along the way in your decisions on equipment, procedures, pricing, staffing, standard operating procedures, menu of services, etc. Our guru many years ago was Fran Acunzo from Acara Partners. Perhaps Fran's most famous, or successful client, is Dr. Bruce Katz of Juva MediSpa in New York City.

I remember listening to some of his suggestions he had for us at the time and saying "Is he serious? I have no idea what this SmartLipo thing is, but if he thinks it is going to be the next big thing, then we had better trust him as our consultant". Needless to say, Fran was right. And not only about adding SmartLipo to our practice when it was first approved by the FDA, but other procedures and services as well. So, to me, when Fran speaks... I listen.

Fran blogged his predictions for aesthetic procedures for the year 2010 and it's already making it's way across the internet cited and adapted into blogs by (Read Susie's comments on such predictions) and many, many others. If you have not yet read his predictions, I'd like to post them here in their entirety:

Here are my 2010 top 10 predictions in the world of Aesthetic Medicine

1. Dysport will become a strong competitor to Botox.  Dysport, Medicis’ new entry into the world of botulinum toxin, was launched in the spring of 2009 and has begun to see increased demand as market awareness grows.

2. Non-invasive body contouring will continue to grow in popularity lead by Erchonia’s Zerona.

3. Face lifts will continue to drop in demand while liquid face-lifts grow in popularity, especially with the younger market (40 -54 year olds)

4. Fat transfer, specifically for natural breast enhancement, will become sought after by women who were previously uncomfortable with implants.

5. Laser Lipolysis will continue to be one of the most in-demand medical aesthetic procedures due to its minimal downtime and great results.

6. The younger audience (24 – 40 year olds) will continue to discover aesthetic medical services for preventive aging.

7. There will be an increase in the number of men having aesthetic medical procedures starting with facial fillers and injectables (i.e. Botox, Restylane, Radiesse, etc.)

8. The tipping point of when men and women want to have their tattoos removed will arrive and the demand will grow exponentially.

9. Facial Rejuvenation will come of age as medical practitioners perfect their skill combining aesthetic medical facial procedures for a complete Medical Makeover including the combination of fractional resurfacing, ablative resurfacing, chemical peels, photofacials, skin tightening, injectables and facial fillers, etc.

10. What was an Extreme Makeover in 2003 when the then popular TV show hit the airwaves will now become the Everyday Makeover.

It is entirely up to you whether or not you place your trust in Fran's predictions. I would guess to say there would be some discepancies amongst professions, but I can tell you I am already beginning to see many of these prove true in our own practice. It's also interesting to me that, upon research, I could find no other person or entity posting such predictions.

So, unless you have a crystal ball somewhere that has worked for you, I'm sticking to what has worked for us!

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course, Study Guide, and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

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Medical Spa Estheticians: Learning how to perform laser hair removal

It's the number 1 laser procedure performed by aestheticians in medical spas across the U.S. - Laser Hair Removal. If you're old schooled, 10 to 1 no one ever taught you about laser hair removal procedures.

With facial and chemical peel services on the downfall these days, I've received many emails from aestheticians wondering where to get trained in laser hair reduction so they can secure a position within a medical spa, or just advance their career. Aestheticians are lucky in my area, they have a wonderful beauty academy right at their fingertips where they can get an advanced education in aesthetic services (if they want to go back to school). Their training manual is the Medical Spa Advanced IPL & Training Course, available through Medical Spa MD.

In the Laser Hair Reduction Chapter, you will learn about the anatomy and growth phases of a hair follicle from the anagen phase to the telogen phase and what the significance is of those stages during treatments. You will also learn the differences between and Nd:YAG, Alexandrite, IPL and diode lasers for hair reduction. Other important pearls are skin typing, ethnicity responses to therapy, topical anesthetics and using them safely, patch testing, and information about how various body areas respond to treatment.

If you're looking for a way to get the theory behind laser treatments, then take a look at the Medical Spa Advanced IPL & Training Course.

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course, Study Guide, and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

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Plastic Surgery Trends For 2010

The Consumer Guide to Plastic Surgery thinks they know what’s in store for cosmetic medicine in 2010, from how the newly proposed “Botax” could affect your self-improvement plans to which new products will come to market. Here's what you might see in 2010:

Even More Botox-Like Products Will Come to Market

First there was Botox Cosmetic; then 2009 brought the Botox alternative Dysport. In 2010, expect to see a few more Botox rivals, including a topical form of the popular wrinkle relaxer and at least one more injectable. A couple of injectable Botox cousins are in development, but PurTox will likely be the next to get a nod from the Food and Drug Administration (FDA). The main difference in these injectables seems to be how long the results last and how quickly the products start to work on your crow’s feet.

Fat Injections to the Breast Will Be Used Cosmetically
After being condemned by plastic surgery associations, fat injections to the breast were deemed OK for "touch-ups" after breast reconstruction in 2008. But these once controversial injections may soon play a role in cosmetic breast augmentation. Taking fat from a part of the body where there is too much (your thighs or butt, for example) and injecting it into your breasts where there is too little, may replace the need for breast implants when done in conjunction with a breast lift. Some kinks still need to be worked out, but fat injections to the breast are likely here to stay.

Surgeons Will Invent – and Perfect – Body Contouring Surgeries to Follow Massive Weight Loss

More and more people are undergoing bariatric surgery to lose weight, only to be left with hanging fat and flab in highly visible areas. As plastic surgeons put on their thinking caps to better address these issues, expect to hear about many new procedures, including the corset trunkplasty. This new surgery targets above-the-belly-button flab, to recreate an hourglass silhouette in formerly obese women and get rid of love handles in men who have lost massive amounts of weight. This area has been ignored by many traditional body contouring procedures that target the lower abs, buttocks and/or thighs. We will hear more about corset trunkplasty and other innovative body contouring procedures in 2010.

Fat Freezing Heats Up in 2010

Fat freezing (or cryolipolysis) may give liposuction a run for its money in the coming years. This technology works by freezing fat cells and breaking them down. Zeltiq is in clinical trials now, and results look promising. Stay tuned.

Cohesive Gel Breast Implants Receive FDA Approval

These so-called "gummy bear implants" have been making their way down the pike for some time, and they just may get the long-awaited FDA nod in 2010. Filled with cohesive silicone gel, these leak-resistant implants – used in Europe and Brazil – are being studied in the United States. Gummy bear implants have the positive attributes of silicone gel, but the gel doesn't migrate. This is a good thing, because if the shell should fail, the gel wouldn’t leak into surrounding tissue.

Lipodissolve Study Results Stun Skeptics

Lipodissolve, an experimental "fat-melting" technology, is being billed as a non-surgical alternative to liposuction. Also called mesotherapy, lipodissolve is performed via injection of a cocktail of chemicals into muffin tops, saddlebags, love handles and other trouble spots to dissolve fat cells. Critics were outspoken, which is why the American Society for Aesthetic Plastic Surgery started a rigorous scientific study of lipodissolve, using standardized ingredients. And while even the trialists were skeptical at first, and the final results have not been tallied, it works. The study results – to be released in 2010 – may encourage many doctors to offer lipodissolve. Still, lipodissolve is only for small areas of localized fat and will never replace liposuction.

“Botax” Will Raise Eyebrows

A health care reform bill will be passed in 2010, and it just may include a five percent tax on all cosmetic surgery procedures (except those deemed medically necessary). Let’s say that breast augmentation with implants costs $10,000 in 2008; add a five percent levy, and the total becomes $10,500 in 2010. With business already down, most plastic surgeons are up in arms about the Botax. There is also fear that taxing cosmetic surgery in the U.S. will encourage many to seek out services abroad or through unskilled providers who offer procedures at cut rates in America, compromising their safety.

Surgery-Free Tummy Tucks Trim Waistlines

Non-invasive body contouring procedures such as Thermage, VelaShape, UltraShape, LipoSonix and Zerona will continue to grow in popularity in 2010. Once reserved for the face,

Thermage also uses radio waves to lift and firm skin on your stomach, knees, arms, legs, hands or butt.
VelaShape employs bipolar radiofrequency energy to reduce the size of the fat cells, along with infrared heat to tighten the skin. And Zerona uses a “cold” laser to painlessly zap the fat cells beneath your skin. These technologies (and more) may give tummy tucks and lower body lifts a run for their money in 2010.

Face Transplants Face Upsurge

Face transplant surgery was once nothing more than fodder for sci-fi thrillers like the movie Face/Off, but they are now becoming a reality. Eight have been performed so far in the United States and abroad, but there will likely be many more as reconstructive facial surgeons further hone their skills and work toward perfecting their highly complicated techniques.

Minimally Invasive Cosmetic Procedures Experience Rebirth

As our economy starts to show signs of life again, more people may opt for cosmetic surgery procedures, reversing the steep decline of the last two years. Don't expect the numbers to reach their record highs anytime soon, though. There will likely be a slight increase in plastic surgery procedures – especially minimally invasive ones such as injectables that allow people to put off more invasive (and expensive) procedures like face lifts until they really need them (and can better afford them).

Consumer Guide to Plastic Surgery is published by Ceatus Media Group LLC, an online provider of health information and physician directories. Consumer Guide to Plastic Surgery is a registered trademark of Ceatus Media Group LLC.

Career Advancement for Medical Estheticians

Awhile back I posted an aesthetician position on a local job search website. In my requirements, I had stated that only those aestheticians who have been trained in the proper use of laser technology should apply. I must have received over 100 resumes with barely a few who have ever laid their hands on a laser or even observed any procedures.

I selected a few resumes who I felt had years of experience and; therefore, would know the basic concepts of how skin reacts to laser light, Fitzpatick Skin Typing Scale, etc. I was surprised at how many of them had no idea how to answer what I was asking them.

It's obvious there are many skilled aestheticians out there seeking employment, or desiring to advance their career. I would highly suggest the Advanced IPL & Laser Training Course for Estheticians & Medical Spa Laser Technicians.

Advanced IPL & Laser Training Course is much more than knowing what the difference is between 532nm and 2940nm of light; or how different wavelengths affect blood, pigment and water; or even how laser light affects the stem cells of a hair shaft during the anagen growth phase. It's about broadening your knowledge of the aesthetic field, becoming a more valuable member to a medical aesthetic team, increasing your revenue by commission and upselling with your knowledge, and benefiting your patient by being able to explain various treatment options for them (some performed by you and other treatments by the physician). Even though you may not perform every treatment in a medical spa, such as injectable procedures or laser skin resurfacing, your knowledge of those procedures is very important in the patient advocate and educational process.

Even if you have no hands on training at this point, the Advanced IPL & Laser Training Course for Estheticians & Medical Spa Laser Technicians will lay down the foundation you need to secure a position in a medical spa. If one of the candidates had any understanding of some of the principles of laser technology, I would have brought them in for a personal interview with the physician. Hands on training is the easy part, the hard part is the theory behind laser technology.

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course, Study Guide, and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

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Single use Botox?

Is your medical spa using a new vial of Botox for every patient?

If your medical spa is using a new vial of Botox for every patient, yours will be the first medical spa or cosmetic practice of any kind that I've ever know to do so.

Here's a story from the Las Vegas Review Journal that specifically points out Botox as a 'contributor' to an outbreak of hepatitis C. Of course, if you read the story you'll see that some nurses were observerd 'reusing needles' that contaminated vials of Botox. A very different cause indeed from just using the Botox on multiple patients.

And of course, there's the cost, which almost every medical spa meantioned in the story. (You'd have to get all of your Botox from Canada to afford that.)

Here's the story.

Single-use Botox vials used on more than one patient.

That practice at the Endoscopy Center of Southern Nevada, public health officials have repeatedly said, contributed to the hepatitis C outbreak in the Las Vegas Valley.

A phone call to inquire about the cost of a Botox party was greeted with this information: "It will be cheaper if all the partiers use the same vial."

One business that seems to be going well in Las Vegas is known for throwing Botox parties. That's an ongoing phenomenon across the country where friends get together and drink champagne while their wrinkles are needled away.

"We just couldn't handle it financially," said one medical assistant who asked to remain anonymous. "We would have gone out of business."

Medical assistants at two different spas said their owners only stopped multipatient use of single-use vials of Botox "until things quieted down" after the hepatitis outbreak was announced.

The Review-Journal had little trouble finding medical providers who said they and their companies knowingly broke state and federal regulations.

"You can't have doctors worrying about breaking the law or guidelines or whatever," Niamtu said.

A new company called Dysport is manufacturing a similar product, and the competition could force Allergan to provide smaller dosage vials to physicians who want them, he said.

Now a federal lawsuit filed in California by Las Vegas physician Ivan Goldsmith argues that sales representatives for Allergan Inc., maker of the popular anti-wrinkle drug Botox, promote multipatient use of its 50-unit or 100-unit single-use vials.

Goldsmith's lawsuit alleges that doctors can only make a profit using Botox if they reuse the single-use vials that the drug comes in.

But the complaint also raises issues that go beyond dollars and cents, ones that the community has been acutely aware of since the hepatitis C outbreak became public in February of last year.

The Botox business model "created an unacceptable and unreasonable risk of serious and debilitating injuries and illnesses, including HIV and Hepatitis B and C," states the lawsuit, filed Sept. 29 in U.S. District Court for the Central District of California.

Allergan spokeswoman Kellie Reagan said the product's (Botox) prescribing label has always been clear: single use only.

She wouldn't comment, however, on how Allergan's sales representatives promote the drug's use.

Goldsmith said in the lawsuit that Allergan misrepresented to him "the true and permissible use of the product."

Most patients need far less Botox than is provided by Allergan in either its 50-unit or 100-unit vials, the lawsuit said.

And, according to the suit, the medication can't be saved for later use on the same patient because, once a vial is opened, it must be thrown away within four hours of first use.

Physicians and medical spa providers of Botox contacted by the Review-Journal said Allergan's sales representatives have consistently said vials of Botox could be used for multiple patients.

"No matter what training seminar or continuing medical education course I went to, the Allergan people always said a vial was for multiuse," said Sandra Bledsoe, who operates Focus Medical Weight Loss & Spa. "Many patients only need 15 or 20 units at a time."

"Allergan seminars have demonstrated multiple patient use of the product for years," said Las Vegas plastic surgeon Dr. Julio Garcia, who said he has attended the company's seminars.

Garcia said doctors felt they could be safe if they used a new syringe and needle for each injection, which, even if against the rules, would result in sterile treatments.

The problem comes when mistakes happen, said Dr. Joseph Niamtu, a Richmond, Va.-based cosmetic facial surgeon long active with the American Academy of Cosmetic Surgeons and the Cosmetic Surgery Foundation.

"Someone inadvertently picks up a contaminated syringe and inoculates the entire vial," he said.

That may sound familiar.

Last year, health officials revealed that authorities investigating a cluster of hepatitis C cases had observed nurses at the Endoscopy Center's Shadow Lane clinic reusing syringes in a manner that contaminated single-use vials of medication.

Nine hepatitis cases were linked to the practice, and more than 50,000 people were urged to get tested for blood-borne diseases.

Medical officials say no cases of hepatitis C have been connected to Botox injections.

Still, Dr. Ihsan Azzam, state epidemiologist for the Nevada State Health Division, said concerns about blood-borne diseases in relation to the administration of Botox can't be dismissed.

He said discussions with some of the state's medical providers have made it clear to him that multipatient use of single-use Botox vials continues in Nevada.

The Review-Journal also contacted providers who say the practice is ongoing.

"I think we need to include use of Botox as a risk factor when we talk about hepatitis," Azzam said.

He noted that after he sent a bulletin to physicians and other medical providers about injection safety in the wake of the hepatitis C crisis in Las Vegas, some providers who administered Botox in their practices were not supportive.

In his directive, which echoes the position of the Centers for Disease Control and Prevention, he wrote: "Do not administer medications from single-dose vials to multiple patients or combine leftover contents for later use."

He said a number of providers called him to say that they wouldn't follow the regulations because they knew how to safely administer Botox to multiple patients from a single-dose vial.

"I was very surprised," Azzam said Thursday, adding he hopes state inspectors will catch those who refuse to abide by medical regulations. "Some seemed to be daring me to come after them."

If caught, physicians' licenses would be at risk.

Azzam said Botox providers told him it would not be possible to make a profit if the injection practices he supported were followed.

"I followed the rules," Goldsmith said last week. "And it killed me financially."

Goldsmith is asking the court that his lawsuit be certified as a class action, arguing that more than 100 doctors who invested in the product are affected nationwide, with their economic losses exceeding more than $5 million.

In his lawsuit, Goldsmith said a 100-unit vial of Botox could cost him $1,000, but a patient treatment might only be $500. Because it is a single-use drug, the rest would then have to be thrown away.

"You were losing money that way, not making it," Goldsmith said. "The patient didn't want to eat the cost."

Goldsmith has had a run-in with the Nevada State Board of Medical Examiners, which last year subpoenaed some of his patient records.

The board said it had received information that Goldsmith illegally dispensed compounded medications, dispensed medications without having a pharmacist on site, allowed clerks to dispense medications, and used human growth hormone on patients without meeting Food and Drug Administration criteria.

Goldsmith has denied the allegations and, more than a year after the board's subpoena, no action has been taken.

Garcia said he is following the rules regarding Botox injections, but knows that many in the medical community aren't doing so.

Last year he wrote a letter to the state medical board saying patient safety could be compromised because spa personnel continue to inject Botox "with the doctor not present."

That issue has been in the news lately, the result of recent attempts by the medical board to keep medical assistants from injecting Botox. That effort failed.

"The possibilities of infection, given what is going on when it comes to injecting Botox by whomever, are terrifying," Garcia said.

"We're not talking about 40,000 or 50,000 people. We're talking about hundreds of thousands of injections" in Southern Nevada.

Tracy Jones, a Las Vegas saleswoman, said while she has been a frequent user of Botox, she generally doesn't know if she is the only one receiving Botox from a vial.

"It's not something people ask," she said.

Most medical providers are well aware that Botox, like any injectable medication, can be contaminated when drawn up into a syringe.

To prevent contamination in his Botox injections, Niamtu, the Virginia facial surgeon, said he and his staff every day will draw up five sterile 20-unit syringes of Botox from a 100-unit vial.

Though he said that may not be in accordance with CDC guidelines that say single-use vials cannot be used for more than one patient, Niamtu said he must walk a tightrope between the "practical and the optimal."

He said "something will have to be done," if medical officials in other states become as aggressive in enforcing regulations as he believes they are in Nevada.

"Doctors can't throw away that much medication, and patients aren't going to pay for the extra," Niamtu said. "Allergan will have to step up to the plate and make different quantities of the drug. It may cost them a little more."

Advanced Aesthetics Course: Understanding Injectables

Injectable products are an important contributing factor to your clinic's financial success. With new products entering the market like Dysport and Evolence, and other exiting like ArteFill, it is important that your staff be knowledgeable of the products used in injectable procedures.

Although this chapter from the Advanced Medical Aesthetics Training Manual wasn’t actually requested in the training manual I wrote for the academy students, I felt it was extremely important for , especially for medical estheticians, to know the difference amongst the various treatments used to alleviate the appearance of wrinkles and folds, and the difference between dynamic and static lines.

Medical estheticians have the most “face time” with clients, examining it with magnifying lenses, treating it with exfolliants, moisturizers, galvanic current, high frequency, various acids, etc. They understand the realm of fine lines and wrinkles and know what can be alleviated with topical treatments such as facials, peels, microdermabrasion and laser resurfacing, and what cannot.

I cannot tell you how many patients call or come into our office with no knowledge of the difference between paralyzing agents such as Botox and Dysport, and dermal fillers. We take it for granted that we know the difference, but injectable products can be very confusing to the lay person. Because the aesthetician works with the client’s skin, they should be well versed in the differences in the two categories of injectables and the products that lie within. Estheticians become your most powerful education source for your clients which ultimately leads to an upsell for them (with possible commission).

Many people think all fillers products are the same, nor do they care to understand the difference between hyaluronic acid or calcium hydroxylapetite. All they truly care about is “how long will it last” and will the “results look fake”. Only with proper education can the medical esthetician effectively and intelligently discuss the differences in the filler products, educate the patient about the effects and lasting results, and help lead the patient to the right product, or combination of products, for their expected outcome.

This information in this chapter is very important for your front desk/phone people as well!

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course & Study Guide, and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

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Medical Spa Training Manuals Launched!

We've successfully launched the Medical Spa Training Manuals... finally.

It was something of a struggle for the last few weeks trying to get everything edited and designed but the result is extrordinary. I'd like to congratulate Paula for excellent work and Melissa for the final editing and the very long days getting everything together. We couldn't be happier being given the opportunity to publish them.

If you haven't yet taken a look you can download the tables of content for both the Advanced IPL & Laser Training for Non-Physicians and the Advanced Medical Spa Aesthetics Training Manual & Study Guide.

If there are cudos, and there are certainly going to be, the're most correcty directed at Paula, who has done a fantastic job on the content, from differences in technology to a fantastic sense of what's the needed amount of information in each areas.

Of note: a number of our first orders have been made by medical spa consultants and trainers who know how important training your laser clinc or med spa staff actually is.