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Colour Cosmetics HIPAA Compliance ISAPS-LEAP Foundation Facial Rejuvenation
May/June 2014 ❙ Volume 2 ❙ Issue 3
May/June 2014
Volume 2 Issue 3
❙
INTERNATIONAL JOURNAL OF AESTHETIC AND ANTI-AGEING MEDICINE
INTERNATIONAL JOURNAL OF AESTHETIC AND ANTI-AGEING MEDICINE
ROBOTIC
TECHNOLOGY
AND AESTHETIC MEDICINE
TELOMERES
AGEING AND LONGEVITY
prime-journal.com
HAIR
UPPER
BLEPHAROPLASTY
AND BROWPEXY
TREATMENT OPTIONS
RESTORATION
Surgical and non-surgical options
| GUEST EDITORIAL
®
International Journal of Aesthetic
and Anti-Ageing Medicine
Informa, Christchurch Court,
10–15 Newgate Street, London,
EC1A 7AZ, UK
www.prime-journal.com
ISSN 2325-9817 (print)
ISSN 2325-9825 (online)
Managing Editor Rosalind Hill
[email protected]
Sub-Editor Balraj Juttla
[email protected]
Art Director David ‘Spike’ McCormack
[email protected]
Publisher Mark Eaton
[email protected] / +44(0)20 7017 4060
Business Development Manager NA Meg McNeel
[email protected] / +1 (212) 520 2745
EMEA Sales Manager Sabrina Nawaz
[email protected] / +44(0)20 3377 3676
Marketing Director Justin Bambridge
[email protected]
Production Manager Jonathan Collard
[email protected]
Graphic Designer Snehal Sanghani
[email protected]
Director of Audience Development Nora Pastenkos
[email protected]
Production & Ads Department [email protected]
Please send your manuscripts and press releases to:
[email protected]
All submitted manuscripts are evaluated on the basis
of scientific quality, originality, appropriateness,
contribution to the field and style. Suitable
manuscripts are subject to peer-review. Manuscripts
and accompanying files should be prepared in
accordance with our Author Guidelines, which are
available via www.prime-journal.com.
All content © 2014 Informa UK Ltd
Images © Shutterstock.com, unless otherwise stated
PRIME® (ISSN 2325-9817) is published bi-monthly by
Informa, 52 Vanderbilt Avenue, New York, NY 10017.
Application to mail Periodicals postage rate is
pending at New York, NY, and additional mailing
offices. POSTMASTER: Send address changes to
PRIME, PO Box 1170, Skokie, IL 60076
M
ULTI-SPECIALTY EDUCATION SEEMS TO BE A NEW BUZZWORD ASSOCIATED
with many conferences around the world. As the original multi‑specialty
symposium in the aesthetic market, those of us responsible for the Vegas
Cosmetic Surgery Symposium are very proud to have had a role in changing
the educational paradigm within our specialty. As evidence of this changing
paradigm, this event has quickly grown to be the largest ‘independent’ aesthetic
conference in North America, annually attracting well over 1500 attendees and proving that there is
a place for independent meetings that offer a high-end educational product devoid of excessive
industry influence.
Our goal from the very beginning has been to build educational bridges between what many
consider the four core specialties associated with aesthetic surgery and medicine — aesthetic
dermatology, facial plastic surgery, plastic surgery, and oculoplastic surgery. No other meeting has at
its core a mission to gather the world’s leading experts from each of these fields and allow them to
exchange ideas with one another.
The thing that I am most proud of when I reflect on the past 10 years is that we have encouraged
other meetings to look at our model and many have even adopted some of the things we have tried
to do over the past decade, including the recognition of the importance of the business aspects of
our specialty. Vegas Cosmetic Surgery continues to feature a 4-day track on the management and
marketing aspects of aesthetic medicine and surgery. The word ‘trade show’ has never defined
Vegas Cosmetic Surgery. This is an educational symposium in every sense of the word.
So what does all of this mean for our specialty and our patients? In my mind, our patients are the
real beneficiaries of this level of cooperation among the core specialists. Our specialties also benefit
from this cooperation as more and more barriers are broken down and cooperation among the
societies continues to increase and strengthen. In fact, the Physicians Aesthetic Coalition was
organised by Dr Renato Saltz and some of his courageous colleagues as a means of communication
among the leaders of the four core specialties. This group has been meeting each year at the Las
Vegas meeting in an attempt to enhance communication and cooperation on a myriad of issues
that affect our specialties, our practices, and our patients.
A number of years ago I was asked to join the editorial board of PRIME as they launched the
premier North American edition of this peer-reviewed journal. I took a look at what they were
already doing in Europe and commented on the quality of the publication in both content and style.
It also did not escape my attention that the world’s leading publisher was behind this endeavour. So
accepting this invitation was easy, as this journal was a reflection of all of the things that we were in
fact doing in Las Vegas.
Clearly after 10 years some of our goals have been achieved and others are within reach, but there
is still much left to accomplish. As we consider our next 10 years it is my hope that we can expand
and become more of an advocate for our patients and the public in general. The confusion they
now face when trying to decide on the legitimacy of a procedure and a provider for this procedure
is well known, and we as the providers can no longer rely on the medical boards and the regulatory
agencies to sort all of this out for them. We must develop close ties with our media partners,
industry supporters and the lay media, and continue to find additional ways for our societies to
work together to maintain our high ethical standards and help educate a very confused public.
Dr S. Randolph Waldman
Facial Plastic Surgeon, Kentucky
PRIME JOURNAL NORTH AMERICA EDITORIAL BOARD
BOARD MEMBER
Dr Ashraf Badawi
Dr William H. Beeson
Dr Anthony Benedetto
Dr Valerie Callender
Dr Andrew Campbell
Prof Wayne Carey
Dr Anoop Chaturvedi
Dr Joel Cohen
Dr Lisa M. Donofrio
Dr Joseph Eviatar
Dr Michael H. Gold
Dr Steven B. Hopping
SPECIALISM
Dermatologist
Plastic Surgeon
Cosmetic Dermatologist
Dermatologist
Facial Plastic Surgeon
Dermatologist
Anti-ageing Practitioner
Dermatologic Surgeon
Cosmetic Dermatologist
Oculofacial Plastic Surgeon
Dermatologist
Plastic Surgeon
STATE
Ontario
Indiana
Pennsylvania
Maryland
Wisconsin
Quebec
Texas
Colorado
New York
New York
Tennessee
Washington, DC
BOARD MEMBER
Dr Gustavo H. Leibaschoff
Wendy Lewis
Dr Z. Paul Lorenc
Dr Ronald Mancini
Dr Neil Sadick
Dr Joel Schlessinger Dr Nazanin Saedi
Dr Hema Sundaram
Dr Amy Taub
Dr S. Randolph Waldman
Dr Heidi A. Waldorf
Dr Susan Weinkle
SPECIALISM
Cosmetic Surgeon
Industry Expert
Aesthetic Plastic Surgeon
Oculoplastic and Orbital Surgeon
Dermatologist
Cosmetic Dermatologic Surgeon Dermatologist
Dermatologist
Dermatologist
Facial Plastic Surgeon
Dermatologist
Dermatologist
STATE
Texas
New York
New York
Texas
New York
Nebraska
Pennsylvania
Maryland/Virginia
Illinois
Kentucky
New York
Florida
For the full list of our international board members, visit www.prime-journal.com/editorial-board
prime-journal.com | May/June 2014 5
MEETING PREVIEW
|
VEGAS COSMETIC
SURGERY AND AESTHETIC
DERMATOLOGY
IS TURNING 10
Wendy Lewis previews the 10th Vegas Cosmetic Surgery and Aesthetics
Dermatology Symposium, held in Las Vegas from 18–22 June 2014
V
EGAS
COSMETIC
Surgery and Aesthetic
Dermatology
is
celebrating
a
big
milestone. 2014 marks
its 10th anniversary in
Las Vegas under the leadership and
coordination of its founder, Kentucky
facial plastic surgeon S. Randolph
Waldman, MD.
According to Dr Waldman, 'We are
extremely proud to host the leading
educators and teachers in the fields of
facial plastic surgery, plastic surgery,
dermatology, and oculoplastic surgery.
Vegas Cosmetic Surgery and Aesthetic
Dermatology was not only the first truly
multispecialty forum in the aesthetic field,
but by listening to our faculty and
attendees, it has grown to be the largest
event of its kind in North America.'
The goal of Vegas Cosmetic Surgery
(VCS) was to foster a spirit of cooperation
and understanding among the medical
specialties that are primarily involved in
the science, practice, and teaching of
aesthetic surgery and medicine. 'We try to
have at least 25 members of each specialty
represented so it is a true multi-specialty
meeting. We go out of our way to make sure
any interspecialty conflicts are left out of
this meeting. It’s not about politics; it’s about
education. We believe we are inviting the
best people in their respective fields to join
our faculty, and we try to find the leaders
on each subject within their fields as well,'
said Dr Waldman.
According to Kentucky facial plastic
surgeon Donn Chatham, 'VCS is an
12
equal‑opportunity symposium; regardless
of specialty, we all have much to share and
much to learn. And there is really no
political agenda but to listen and improve
one's game.'
'VCS 2014 is an opportunity to network
and learn alongside your peers as well as
mingle with many of the leading experts in
the industry,' said plastic surgeon Renato
Saltz, MD, FACS. 'This multi-specialty
conference provides plastic surgeons,
facial plastic surgeons, dermatologists,
oculoplastic surgeons, physician extenders,
and practice managers with a great
educational experience. It is also the only
meeting where one can bring the entire
office staff and everyone will take new
information home!'
Under Dr Waldman’s experienced
tutelage, the VCS team devotes their
concerted efforts all year round to keep the
programme relevant to their registrants. 'I’m
always looking towards what I want to hear,
who would I be interested in listening to,
and what are the trends and hot topics,'
said Dr Waldman. 'The courses and
May/June 2014 | prime-journal.com
L–R: Donn
Chatham,
Renato Saltz,
Foad Nahai,
and S.
Randolph
Waldman
workshops are where registrants really
learn pearls they can take away and use in
clinical practice.'
Executive Director Delphine Hepp has
her work cut out for her. She and her team
of three go to task on the next year’s event
as soon as the annual meeting concludes.
It’s a full time job and then some. Along
with Executive Assistant, Sheridan Likoy,
and Meeting Coordinators, Laura Beth
Harris and Matthew Waldman, the VCS
staff has a full plate. 'We believe that Vegas
Cosmetic
Surgery
and
Aesthetic
Dermatology brings together the best of the
best in the cosmetics and aesthetics world,
and it has been very exciting to see it grow
over the years,' said Hepp.
And their hard work has certainly paid
off, with a loyal following of faculty and
attendees. 'The Vegas Meeting has such
great appeal because it brings together
thought leaders in the core subspecialties
so that ideas are exchanged and
developments within each subspecialty
are shared. Dr Waldman and the steering
committee develop the programme by
inviting speakers who are innovators, so
the meeting is different each year and the
attendee can acquire new ideas and
techniques that can help the practitioner
better serve their patients. It has become a
must attend for top physicians across the
country,' said New York facial plastic
surgeon Andrew Jacono.
2014 multispecialty
programme
With such a diverse 5-day programme,
there is a wealth of topics to choose from.
| MEETING PREVIEW
New
There is a roster of 15-minute clinical
products
presentations that focus on industry
from skin
trends and hot topics across all core
care to
specialties, including blepharoplasty,
injectables
and devices
rhinoplasty, facelifting, dermal fillers,
are featured
neurotoxins, fat grafting, skin resurfacing,
in the
and topical agents. If you want to take a
exhibition
deeper dive into the art of aesthetics, you
hall so
can check out the 45 minute Masters attendees are
able to gain
Seminars that explore innovative
an overview
techniques. Expert roundtables that
of what is
feature leaders in their field also showcase
new and
the latest tools and technologies available.
exciting
The meeting’s rhinoplasty programme is
a labour of love for New York facial plastic
surgeon Steven Pearlman. 'Bringing an
illustrious faculty of leaders together in one
location every year seems like a
monumental task, but the Vegas Cosmetic
Surgery meeting is considered one of the
top meetings in the field internationally.
care range? The VCS practice management
track features a roster of specialists who
This year we are exploring some innovative
techniques and complex cases to stimulate
will be speaking on a wide range of critical
issues in online marketing, social media,
an open debate and evidence-based
discussion.'
staff training, managing difficult patients,
Brian Biesman, an oculoplastic
SEO, SEM, coding, medical
liability,
public
relations,
surgeon from Nashville, TN, said,
This is a meeting reputation management, and
'The faculty is world-class, the
with a high yield of much more.
meeting is long enough so that
there is sufficient time to cover knowledge acquisition
The
marketing
and
topics in detail. There are some
management
workshops
and opportunity.
very frank and open discussions
present the tools you need to
about complications, alternative
Andrew Jacono, help your aesthetic practice
approaches to certain clinical
MD, FACS thrive and grow. 'We were the
problems are discussed, and the fact that it
first people who put the
emphasis on the idea of practice
is a multispecialty forum ensures that some
management and marketing. Because of
of the same issues will be examined from
multiple viewpoints. It is so helpful to hear
that, we have recognised the importance of
the office staff in aesthetic practices. We
how surgical and non-surgical options are
integrated into an overall approach to facial
encourage physicians to participate in
aesthetics, and I always come away feeling
meetings with their staff because they are
as if I have learned more than I taught.'
as important, if not more so, than the
New York dermatologist Heidi Waldorf
physicians. We were the first meeting to put
the practice marketing track on the same
agrees. 'The strength of VCS is twofold: a
strong multidisciplinary faculty and the
level with the clinical sessions,' said Dr
array of topics presented. Each core
Waldman.
According to Jeffrey Spiegel, MD, FACS, a
cosmetic specialty has its own unique
approach; however, over recent years we've
facial plastic surgeon in Boston, 'I find this
conference to be very focused on areas of
realised that by exchanging ideas and
learning from each other, our fields improve
interest for those who run busy aesthetic
exponentially. The mix of lectures, panels,
practices. The different concurrent
programmes (e.g. surgery, non-invasive,
and live demonstrations makes the meeting
a busy one and very worth attending,' she
practice management) allows for an
said.
intensive learning experience.'
Emphasis on practice
management
Want to learn how to use Facebook?
Confused about the new EHR regulations?
Interested in starting a medispa or skin
Over 100 exhibitors
The aesthetic industry is also an important
component of the decade-long VCS
success story. There are over 100
exhibitors registered this year. New
products from skin care to injectables and
devices are featured in the exhibition hall
so attendees are able to gain an overview
of what is new and exciting.
'The meeting attracts a wealth of key
opinion leaders under one roof that draws
industry to participate year after year,' said
Dr Waldman. 'Along with a packed
programme of workshops and special
events, many sponsors will have receptions
going on to meet and greet your colleagues
and peers from all over the country and the
world.'
Las Vegas
Vegas Cosmetic Surgery and Aesthetic
Dermatology will be held on 18–22 June
2014 at The Bellagio in the heart of the Las
Vegas strip. Las Vegas is known as a
playground for adults and world-class
restaurants, shows and concerts, and
designer shops abound. The immensely
popular O from Cirque du Soleil® features
an international cast of acrobats,
synchronised swimmers, divers, and
characters who perform in, on, and above
the water for a truly memorable evening.
Enjoy some unique dining experiences at
Petrossian, Le Cirque, Michael Mina,
Picasso, and Prime Steakhouse, or shop-'tilyou-drop on the strip in between courses.
Further information
Physicians can earn as many as 46+ hours of
CME credit. To register, call Vegas Cosmetic
Surgery at +877-673-3273 or visit
vegascosmeticsurgery.info/
prime-journal.com | May/June 2014
13
thursday june 19, 2014
YOUR DAILY GUIDE TO THE Vegas Cosmetic Surgery and Aesthetic Dermatology Symposium
z
celebrating of the day
10 years
Highlights
M
ulti-Specialty Education seems to be
a new buzzword associated with
many conferences around the
world. As the original
multi‑specialty symposium in the
aesthetic market, those of us responsible for the Vegas
Cosmetic Surgery (VCS) Symposium are very proud to
have had a role in changing the educational paradigm
within our specialty. As evidence of this changing
paradigm, this event has quickly grown to be the
largest ‘independent’ aesthetic conference in North
America, annually attracting well over 1500 attendees
and proving that there is a place for independent
meetings that offer a high-end educational product
devoid of excessive industry influence.
Our goal from the very beginning has been to build
educational bridges between what many consider the
four core specialties associated with aesthetic surgery
and medicine — aesthetic dermatology, facial plastic
surgery, plastic surgery, and oculoplastic surgery. No
other meeting has at its core a mission to gather the
world’s leading experts from each of these fields and
allow them to exchange ideas with one another.
The thing that I am most proud of when I reflect on
the past 10 years is that we have encouraged other
meetings to look at our model and many have even
adopted some of the things we have tried to do over
the past decade, including the recognition of the
importance of the business aspects of our specialty.
VCS continues to feature a 4-day track on the
management and marketing aspects of aesthetic
medicine and surgery. The words ‘trade show’ have
never defined VCS. This is an educational symposium
in every sense.
So what does all of this mean for our specialty and
our patients? In my mind, our patients are the real
beneficiaries of this level of cooperation among the
core specialists. Our specialties also benefit from this
cooperation as more and more barriers are broken
down and cooperation among the societies continues
to increase and strengthen. In fact, the Physicians
Aesthetic Coalition was organised by Dr Renato Saltz
and some of his courageous colleagues as a means of
communication among the leaders of the four core
specialties. This group has been meeting each year at
the Las Vegas meeting in an attempt to enhance
communication and cooperation on a myriad of
issues that affect our specialties, our practices, and
our patients.
Clearly after 10 years some of our goals have been
achieved and others are within reach, but there is still
much left to accomplish. As we consider our next
10 years, it is my hope that we can expand and
become more of an advocate for our patients and the
public in general. The confusion they now face when
trying to decide on the legitimacy of a procedure and
a provider for a procedure is well known, and we as
the providers can no longer rely on medical boards
and regulatory agencies to sort all of this out for them.
We must develop close ties with our media partners,
industry supporters and the lay media, and continue
to find additional ways for our societies to work
together to maintain our high ethical standards and
help educate a very confused public.
The consult to the treatment and
everything in between
Time 08:45
E. Gaylon McCollough, MD
Combining upper blepharoplasty with
brow lifting using a single incision
Time 12.00
Julius Few, MD
Is it ethical to name or trademark a
surgical procedure?
Time 15.00
Harold Kaplan, MD
Integrating bioidentical hormone
replacement therapy into an aesthetic
practice
Time 17.00
Sharon Giese, MD, Greg Buford, MD,
Brian Kinney, MD
Panel: Dealing with the challenging
patient
Time 17.30
Moderator: Donn Chatham, MD. Panel:
MK Maloney, RN, Laurie Mercier, Brent
Kock, MD, Todd Schlesinger, MD,
Theresa Schultz, PhD
 S. Randolph Waldman
Founder and Chair, Vegas Cosmetic
Surgery
Register to PRIME online for
FREE at prime-journal.com
Online first
Article Archive
Video
Interact
Available on-the-go
What Twitter said…
“Great day at the meeting serving as
a moderator with Dr. Steve Yoelin at
the Master’s Session!” @DrRyanGreene
“How to create a youthful upper
eyelid? Dr. Nancy Swartz revealed
her “youthful triad” strategy today at
#VCS2014! Written details tomorrow!”
@DermTimesNow
“Best multi-specialty conference
hands down. Great space to share
and exchange ideas on
#cosmeticsurgery #VCS2014”
@PhoenixSkin
“Does the aging nose droop or is it all
an illusion, asked Dr. Val Lambros in
his presentation today at #VCS2014? Stay
tuned for details!” @CSTNow
“Learn more about our “Game
Changing” Subscription Program for
Aesthetic Technology at Booth #113.
#VCS2014 #Bellagio” @VenusConcept
“Get your tweet on @VCS2014 using
the hashtag #VCS2014 and see
whether you’re featured in our daily
news on Thursday, Friday and
Saturday!” @PrimeJournal
“Team Davis goes to Vegas! Follow
along with the Aesthetics meeting
on Instagram using #vcs2014”
@DrDavisPlastic
“Attending #VCS2014? Contact your
Realself Advisor to schedule a
complimentary video session in the
Realself TV studio” @DrCommunity
Share your thoughts on the 10th Annual
Vegas Cosmetic Surgery Congress using
Twitter and the hashtag #VCS2014 and
have your Tweets featured in this
column!
In Friday’s
edition...
 Trending: EU vs US
 The power of PR and earned
media for physicians
 Fillers in the United States: what’s
coming?
 HIPAA: what you need to know
Women for Women
The International Confederation for Plastic
Reconstructive and Aesthetic Surgery (IPRAS) is a
huge organisation, with over 37 000 aesthetic and
plastic surgeon members and 35 000 residents in
training across 99 nations. With their size and
resources they recognize they have the capabilities to
do great humanitarian work and are continuously
developing new initiatives to make use of their skills
for the benefit of others. One such initiative is the
Women for Women program. I spoke to one its
founders and now Managing Director, Dr Constance
Neuhann-Lorenz, to find out more.
Women for Women aims to provide reconstructive
plastic surgery and medical care to women in
developing countries who have suffered the effects of
an injury. These women would have little to no access
to health care, and the program works to help alleviate
their suffering through reconstructive surgery.
Itwas developed in 2006 by the current President of
IPRAS, Dr Marita Eisenmann-Klein, and Dr NeuhannLorenz. The two were good friends and shared the
belief that there was a need for a program that
dedicated its efforts to helping women in developing
countries, who they felt were under-represented in
humanitarian medical missions. They took their
vision to the 2007 IPRAS delegate meeting and
convinced the board of directors and executive
committee to green-light the program.
Since it was founded, the program has travelled to
many countries helping women who had been the
victims of domestic violence, accidents, war or natural
disasters. Their work has not only restored physical
function and external appearance to many women,
but also increased the educational or employment
options for these women who were often
marginalised in society because of their injuries.
Women for Women
A key difference between the Women for Women
program and other volunteer schemes is that all the
plastic surgeons who volunteer for the program are
women. To understand why they made such a
decision, Dr Neuhann-Lorenz tells me you have to
understand the society in which these women live.
‘Many women from certain socio-cultural
backgrounds in the Third World would have more
confidence to be treated by a woman or would only
be allowed to be treated by a woman,’ she explains.
‘In the past, if these humanitarian efforts arrived in
these countries the women would normally send
their husbands or their children before they came for
treatment. They would send their husbands because
they would be the ones who go out to work and the
children are the future, so the women tended to put
themselves in the background. When we come as
women they understood it is for them,’ she continued.
 Balraj Juttla is Subeditor of PRIME. Read the full
article online at www.prime-journal.com
DOES FACEBOOK GENERATE
FACELIFTS?
Social media is changing the way your patients
see themselves, and it also provides another way
for you to reach them and brand your practice.
With 1.31 billion monthly users, Facebook remains
the biggest social platform out there, but it’s not the
only game in town. Other social platforms of
importance to all service businesses include Twitter,
LinkedIn, Pinterest, Instagram, Google+,
and YouTube.
When it comes to your practice’s Facebook page,
post once or twice daily about any specials at your
practice, upcoming speaking engagements or
publications, as well as any trending plastic surgery
stories. Remember the goal is not quantity; rather it
should be quality and engagement. These elements
are more important than merely the number of
Facebook fans you have. To gauge engagement, look
at whether your Facebook posts are being liked,
commented on and shared. At its core, social
media is all about building relationships with
your audience.
Sharing photos and video content is key. Research
suggests that people are 44% more likely to engage
with content that has images. Make your business
page look like a magazine — with attractive and
appealing images, customized content, and a
beautifully designed cover photo. Your page is like
real estate so don’t waste that space.
Social media is not free or something you can just
dabble in. It involves an investment of your staff’s
Social media is not free
or something you can just dabble
in. It involves an investment
of your staff’s time and/or the
possibility of outsourcing your
social media accounts to an
experienced vendor.
time and/or the possibility of outsourcing your social
media accounts to an experienced vendor. Facebook
ads are also needed to grow your fan base. Without
ads, it will take a long time to build a respectable
sized community. It also helps if you boost Facebook
posts for as little as $15 using targeting features. Don’t
forget to use ‘Like us on Facebook, Follow us on
Twitter’ signage in your practice and on all materials
to help build your online community.
Your practice’s social media presence is a big factor
in the search engine-ranking algorithm, and
enhances branding and word-of-mouth exposure.
Take it seriously and have fun! Social media is here
to stay.
 Wendy Lewis is President of Wendy Lewis & Co Ltd
I
N
T
E
R
V
I
E
W
Fillers in the United
States: where we stand
D
rs Heidi Waldorf and
Doris Day discuss the
dermal filler market
in the US. In part 1 of
3, they discuss what
is currently available, in part 2 what
we are likely to see in the next
5 years, and in part 3, the properties
of a hypothetically ‘ideal’ filler.
HW: In the US, obviously we’ve
been a lot slower to get to market on
a lot of the fillers. However, it’s not as
though we need hundreds of
options. The biggest change for our
market was when Voluma was
brought in, because that was the first
larger HA that could give us the kind
of lift that previously we needed to
use a significant amount of HA to
increase volume, or we had to use
CaHA. Now we have a longer-lasting
filler that gives lift, but can also be
erased.
DD: I totally agree, Voluma is one
of the most natural, softest-looking
products I’ve seen.
HW: In my practice we still use a
lot of the other fillers. I still use PLLA,
I use CaHA, and I use some of the
smaller HAs, but for certain patients
I do find that Voluma is more
helpful.
DD: Part of it is getting comfortable
with the new fillers as they come on
the market, knowing the best places
to use them, and also the risks. With
Voluma I’m finding that it’s my go-to
product more and more, as I learn all
that it can do, and as I’m seeing
patients back looking beautiful,
natural and so happy with their
results. But I have my favorites for
different places, so I still prefer
Restylane or Belotero under the
eyes, and Juvéderm for the lips. The
only product I use in the hands is
Radiesse. If I need a volumizer for
someone who’s a fitness trainer or
someone who has a lot of
lipoatrophy, sometimes I’ll use
Sculptra for a few sessions just to
build them up a little bit locally or
pan-facially, and then I’ll start
building with an HA. So, Voluma is
starting to eat a little bit into my
Perlane and Juvéderm Ultra Plus
types of volume, and starting to
cannibalize that just a little bit, but
otherwise we have a very nice mix.
HW: I think we have similar
approaches. We both have some
patients who go to SoulCycle twice
per day, who are very tiny and will
often require pan-volume. If their
skin is not too terribly sun damaged,
and if it’s less of an age thing and
more to do with the health of their
skin, then I like pan-volumizing with
Sculptra. I also find that it’s great for
the temple area because we can
reflux from the plunger, we can feel
safer in certain areas, but it also does
take a certain kind of patient who is
willing to do the homework of
massaging, but is also willing to wait
to see the results.
DD: Some people like the initial
subtlety and that gradual result, and
that’s another area where Sculptra
really excels.
HW: I agree, and I think that that is
one of the decisions that as
physicians we make. We have to
find out, we look at the patient, we
evaluate the patient, we decide what
our recommendations are, and our
recommendations may come down
to a choice of two different products
for one area, another product for a
different area, and then we present it
to the patient and see what fits with
the patient’s lifestyle and needs — do
they have an event they have to
look good for, or are they looking at
just looking better gradually for life?
And like Doris, I will also layer these
fillers, so I may use Sculptra for
pan-volumizing or use Radiesse as
scaffolding for the jaw line. For the
lower lids and tear trough I like a
combination of Restylane and
Belotero.
DD: Me too.
HW: And I do a lot in the lateral
forehead now, as well as the
mid-forehead and the temple.
DD: Me too. What do you do
there?
HW: If I’m not using Sculptra, with
a cannula I will use Radiesse or
dilute Voluma in the temples,
otherwise I use Restylane. As with
Doris, as we’ve been using Voluma
more and more, and seeing our
patients back, I’m now extending it
and using it as some of my Canadian
colleagues have recommended, in a
more dilute manner to spread it like
a layer in the temple area, and even
into the lateral forehead. In the
forehead generally though, I’m
layering Restylane and then for
some fine lines above, Belotero. I
think for those of us who do a lot of
fillers, we have this armamentarium
of tools, and we’re figuring out and
constantly changing our ideas,
adjusting and tailoring them to our
patients.
DD: And we’re using devices as
well. We’re using Ulthera, Thermage,
Fraxel and fractional CO2 to
complement and enhance
treatments. These are all very
effective on every layer of the skin,
using more than just one tool. Fillers,
lasers, and other devices — it’s really
a global combination approach.
HW: It’s very different to when
we started in practice. If you think
of 20 years ago, we had collagen
and you could fill a line for about
4 months and you were always
starting from scratch. Now we are
looking at growing old while
staying youthful-looking and
natural because our patients are
coming in earlier. Someone might
visit in their late 20s or early 30s
because they’re starting to notice
the brow and frown lines, or are
concerned about dark circles under
the eyes that make them look tired.
So we might start tweaking, put a
little bit of an HA for example, a
little toxin.
DD: I’ve started asking patients to
bring in pictures from when they
were in their late 20s or 30s,
sometimes mothers and daughters
come together, and I’m even going
one step further. Instead of looking
at someone and saying ‘here’s
where you’re deflated, here’s where
you’ve lost’, I can look at someone
now who is 30 who is just in the
very early stages of deflation, I can
just see the signs of it coming and I
think the commonality of the
ageing experience is intrinsic. You
can actually start adding in volume
very gently, just a little bit in part of
their face, in their early 30s and
perhaps before they really notice
that they’re ageing, and you can
actually not have to catch up later. It
lasts longer, it looks better instantly,
but they also stay looking better for
years to come.
HW: I agree. I would say that even
if I look back at some of my patients
over the last 15 years or so, we may
have started doing a little Restylane
here, a little there, and tweaking.
Then as the patient has aged and as
our tools have increased, we
adjusted as we need and you can
pretty much keep them at a very
good baseline.
DD: And then we need less
product, less often. So
people we’ve been
treating for over
15 years, they’re
15 years older but
they look better and
they don’t need as
much as often to
maintain that look.
Just as we have
preventive
neuromodulators, now we’re
starting to have a preventive
filler. And it’s not to
change how you look,
but to keep you at a
great place and to
keep that balance. It
also links to
education — you
don’t want someone
coming in asking for
‘more more more’; it’s a
matter of putting in just
enough and in the right way to keep
them in a good place.
HW: I do think that as we get
some of the newer products like
Voluma, even with the products
that we’ve had, there’s always been
this risk of practitioners who are
not looking at the patient as a
whole, not looking at the face from
all angles. I think for Drs like Doris
and I, we’re spending our time
telling patients what not to do;
we’re saying no and we’re spending
the time to educate. We would
move a lot quicker if all we did, for
example, in the US was treat what’s
on-label, because unlike other
countries, in the US when
something has an on label
indication, that’s all that the
direct-to-consumer advertising can
cover. So in the past, with the
nasolabial folds, we had to spend a
lot of time discussing with patients
that if you just fill the nasolabial
folds you’re going to look very
strange. Now for our patients and
staff, the concept of doing the
cheek is very natural, but now that
Voluma has that indication we’re
talking more about that and that’s
very helpful for us and again, it
doesn’t mean that it’s taken away
our use of Radiesse, Sculptra,
Belotero or Restylane. I think that,
as Doris said, there are some of
the mid-level fillers that it’s going
to change.