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Specialty
Official Publication of the
S O C I E T Y
O F
SkinCare
Pamela Hill, RN, Editor
P L A ST I C
S U RG I C A L
S K I N
Spring 2016
C A R E
S P E C I A L I STS
Inflammation and Skin Renewal:
Exploring the Connection
S
From the Editor’s Desk
Pamela Hill, RN
F
or those of you that own your
businesses, you may find this newsletter
interesting. One article in particular
talks about websites for your business
and is very helpful. The article, by
Judy Culp, talks of websites and
reminded me that all of us use social
media these days—sometimes, more
than we should. As a medi-spa owner,
I can share with you that I use social
media in the interview process. I always
look to see what is being posted by an
applicant. Is it appropriate? If not,
what does it look like? What are the
pictures and posts about? This helps
me as a business owner get an idea of
the individual that I am interviewing.
On the other hand, we use social
Continued on page 10
By Dr. Annette Tobia and Dr. Alice Marcy
kin provides
a remarkable barrier
to physical,
environmental,
chemical, and
infectious assaults,
and yet undergoes
continuous renewal.
We will explore how
selected anti-aging techniques use acute
inflammation along with skin’s natural
renewal process to encourage the formation
of new, younger-looking skin. We will also
briefly review the role of inflammation in
skin aging and disease.
SKIN RENEWAL DEPENDS ON CELL
COMMUNICATION
The outer visible layer of the epidermis
is the final product of a cell differentiation
process that starts with proliferating basal
keratinocytes, and ends with a tight
formation of dead corneocytes that form
the physical barrier. Protein signaling
molecules such as cytokines and growth
factors are essential to coordinate the
differentiation process and the resulting
integrity of the cornified layer.1 Some of
these same biochemical messengers are
also the master regulators of the skin’s
Specialists is a voluntary, non-profit organization
dedicated to the promotion of education,
enhancement of clinical skills and the delivery
of safe, quality skin care provided to patients.
INFLAMMATION IS PART OF
WOUND HEALING
Inflammatory cytokines also have a
central role in the wound healing process,
and managing inflammation is a critical
component for success in many dermatological
procedures that treat aging skin. Wound
healing is a carefully orchestrated cellular
process and any dysregulation can result in
fibrosis, scarring or pigmentation abnormalities.
Clients with impaired immune systems or
impaired wound healing (e.g. smokers,
uncontrolled diabetics) are not suitable
candidates for cosmetic procedures that
damage skin.
Continued on page 10
SPSSCS Board of Directors 2015–2016
SPSSCS Mission
The Society of Plastic Surgical Skin Care
inflammatory
response to injury
and stress. Skin
keratinocytes,
fibroblasts and
recruited cells such
as macrophages
all have a role
in inflammation
as producers of cytokines and growth
factors, responders to these signals or
sometimes both.
Nina Spadaccino
Donna Erb
Shay Moinuddin, MHA, RN, CANS
Craig W. Colville, MD
President
Secretary/Treasurer
Member-At-Large
ASAPS Advisor
Lizabeth Clouse, RN, CPSN
Susan Eldridge
Karen Menard, RN
Renato Saltz, MD
President-Elect
Member-At-Large
Parliamentarian
ASAPS Advisor
Cindy Steele, LA, NCEA
Pamela Hill, RN
Elena Reyes-Nelson, C-RMA, RST
Vice President
Member-At-Large
Immediate Past President
SPSSCS Central Office • 11262 Monarch Street, Garden Grove, CA 92841 • www.spsscs.org
562-799-0466 or 800-486-0611 • Fax 562-799-1098 • email: [email protected]
1
THE PRESIDENT’S MESSAGE
Nina Spadaccino
Attracting New SPSSCS Members
W
e
need your help.
The SPSSCS is
always looking for
ways to grow and
recruit new members. Growth is vital for
the survival of our Society. There are many
things that we as SPSSCS members can do
to assist in these efforts. Here are just a few
practical approaches that I have used
personally to recruit new membership:
• Networking is most important. Maintain
contact with past members. Do this
whether they have retired, resigned or
relocated. These members have been
there and done it, they can often be the
best advertising for our Society. They are
also an invaluable resource—they are
experienced and they have contacts.
• Build working relationships with other
groups that pertain to our field. Share
contacts, knowledge and possible
resources. Build partnerships that allow
you to enhance each other’s skills and
resources and thus take advantage of
each other’s strengths, as well as find
ways we can comingle the groups so that
both memberships would benefit through
shared education and knowledge.
• Recruit from within your practice. Please
do not assume that everyone is already a
member. Ask questions! Tell your staff
Are You Interested in
Advertising in
Specialty
Skin Care?
PLEASE CONTACT THE
SPSSCS CENTRAL OFFICE
FOR COMPLETE INFORMATION
562-799-0466
OR VIA E-MAIL
[email protected].
2
about all the amazing membership
benefits that we offer. We are a special
group of professionals. We are a
nationally recognized plastic surgical
skin care society. We have bragging
rights!
More members will give us the
opportunity to provide additional educational
offerings at our annual meetings, which will
enhance our professional skills. Let’s pull
together and build our Society. Please feel
free to call or email me with any questions
regarding the Society and what we offer to
our members. ▲
World Burn Congress
2016
Jeannine Dabb
W E CAN GO THROUGH LIFE AS A VICTIM
OR A VICTOR. IT’S A CHOICE.”
—JOHN O’LEARY
I
t’s a simple statement with profound
impact. It was the most valuable lesson I
took home from this year’s World Burn
Congress. There are a few things in my life
that have changed me as a person. Every
time I attend this congress, I come back
with something new. Ten years ago in
North Carolina, I never knew my passion
about medical skin care and makeup would
continue this far. It just goes to prove that a
little vision and thinking outside the box
can move mountains. World Burn Congress
and the BEST program do so much for me.
I am so proud of our organization for
helping sponsor the initial volunteer fee
for our SPSSCS members to attend. This
year, we were given an added surprise
bonus of assistance from the Phoenix
Society, as well. And Indianapolis was an
amazing venue.
This experience has, once again, given
me the tools to grow as a person by giving
back to others. It reminds me of the impact
that our energy can have on others. It
reminds me that my makeup artistry skills,
that are second nature for me, can be life
altering to others. The simple act of a smile
can change someone’s life forever. We, as
SPSSCS members, are capable of sharing
our specialized knowledge with burn
survivors. It is a special and unique
opportunity to give back. Barbara Quayle
has formed the most amazing program and
I am forever grateful to be a part of
something so special. If you ever think
about charitable donations for an amazing
cause, this group is beyond worthy, and I
hope to see ASAPS and SPSSCS continue
their involvement in coming years.
Thank you again for all the years of past
assistance—it brings my heart happiness to
see our support efforts continue with Barbara
Quayle’s Best Program. As we left, I posed a
question to the other volunteers, who, like
myself, have attended past World Burn
Congresses. These are their answers:
spirit that World Burn Congress and the
Phoenix Society bring out in the host
community, fire fighters, family and
volunteers that make it all happen. Thank
you SPSSCS and the Phoenix Society for
allowing me the opportunity to be of
service.
ALICIA BARRERA
SUSAN TOGNAZZINI
I have thought over writing this for the
last several days. The question posed was
how do I (we) feel about the World Burn
Congress... such a loaded and complicated
question. The word ‘feel’ is appropriate—
not ‘think’ however—much more difficult
to put into words. I am so fortunate to have
the opportunity to work along-side some
amazing givers from the SPSSCS and then
there is, of course, our mentor, the amazing
Barbara Quayle. She is, herself, a burn
survivor and has taught each of us how to
be among those who need our help, as well
as the skills to be of help. I am able to
witness people from all walks of life that
have taught me what strength, courage and
perseverance are. I believe that if we are
given a skill, then we need to give of that
skill. It is not about the financial gain, it is
about giving of ourselves. Each year, I come
away humbled and awestruck at the
courage that I witness and the generous
3
My experience at the 2016 World Burn
Congress was such a pleasure! I was able
to connect and network with my fellow
SPSSCS team members, and provide what
I love to do most—help with image
enhancement through make up application.
The smiles and the learning experience on
both ends was priceless. The amount of
energy, zest, and inspiration filled the air, as
it has before. I feel thankful and humbled
to have been a part of this year’s World
Burn Congress Image Enhancement team!
A special “thank you” to Barbara Quayle for
always being a great leader and mentor.
To Susan, Jeannine, and Elena: you are all
amazing and magical! Looking ahead, I
would encourage others who have an
interest in helping others feel great, by
utilizing specialty makeup application for
image enhancement, to participate! World
Burn Congress offers an outlet for all of us
to learn, share, and grow! ▲
The Laws of Aesthetics
Ignorance Is Not An Excuse
Alex R. Thiersch, JD,
Founder, American Med Spa Association (AmSpa)
A
s a specialist working for, or with,
a plastic surgeon, the investment
you’ve made in your career has been
immeasurable. Considering the money,
time, blood, sweat and tears you’ve
put into getting where you are, it is
crucial that you do everything you
can to protect yourself. Perhaps
more importantly, your actions
reflect upon the practice you work
for, and any mistakes you make—
even if unwittingly—can have
an impact on those
around you.
When it comes to
operating legally and
compliantly, many
physicians and surgeons
don’t pay nearly enough
attention to the laws and
regulations that govern
their practices. This also
holds true for their staff
—it is rare for any
surgery office to
have training on the
laws and regulations
that govern what they can
and cannot do on a daily basis. For
instance, how many of you have been
trained on proper supervision and delegation
procedures? What about the laws related to
fee-splitting, gift cards, or referrals? What
about patient privacy? While these issues
may seem to only apply to the physicians,
that is not the case. All staff at a plastic
surgery office are subject to healthcare law,
and violation of those laws can subject the
entire practice to fines or lawsuits.
44
Here are 4 pieces of advice I give to all
my clients:
1. KNOW THE LAW
I am continually surprised at how
uninformed aesthetic physicians and their
staff are about the laws that govern them.
This is not a critique of anyone personally;
instead, it is an observation of the state of
the aesthetic industry in general. There are
literally hundreds of laws and regulations
that you are required to follow, such as
state-based laws, medical-board regulation,
and federal compliance regulations; so
many, in fact, that an entire legal industry
has developed around interpreting them.
And despite the byzantine environment
in which the industry exists, there has
been very little attempt by esthetic schools,
nursing schools and medical schools to
train the industry on what the laws allow
them to do—and don’t allow them to do.
I speak to aesthetic groups throughout the
United States and one thing I always ask
is: “Have you ever read or been taught your
state’s medical practice act.” (Every state has
a medical practice act that lays out, in
detail, the rules that doctors must follow.)
To my continued amazement, fully 95% of
every group I ask‚whether its physicians,
nurses, aestheticians, or staff—has never
even attempted to read their state’s medical
practice act.
This is a glaring deficiency and is, in
fact, the reason I formed my company,
the American Med Spa Association (AmSpa
provides online legal guidance for the
aesthetic medical industry). Unfortunately,
most of the time, laws are written in
difficult-to-understand “legalese,” and
states do absolutely nothing to disseminate
this information to its constituents.
However, ignorance of the law is never
an excuse, and, in my 15 years of practice,
I have yet to convince a medical board
that a practitioner should be forgiven for
a mistake because he or she didn’t know
the law.
A great example of this relates to the
laws regarding lasers. In most states, for
instance, estheticians are expressly forbidden
by their practice acts from operating lasers.
Estheticians have no medical training and
are limited to practicing on the outer layers
of the skin. There are exceptions, of course
(some states, like New York, have carved out
laser hair removal from this prohibition),
but as a general rule estheticians should not
be firing lasers of any kind. And yet when
I mention this at conferences—and when I
point out that estheticians have actually
been disciplined by their state boards for
doing so—I am generally met with shock,
disbelief, and sometimes panic. But that’s
the law.
The bottom line is that a greater attempt
should be made to educate the aesthetic
community. In the meantime, however, it is
up to the physicians themselves to learn the
law and ensure their staff knows the law as
well. Read your practice act. Search online.
Build a relationship with a healthcare
attorney. Do whatever you can to become
educated on the laws that govern your
practice, because I promise the medical
board expects you to do so.
2. BE MINDFUL OF LAWS DEALING
WITH MODERN MARKETING.
Aesthetic medicine is different from
other areas of medicine. Attend any
conference, and you’ll quickly realize that
more and more time is devoted to marketing,
social media, and patient acquisition.
Whether you like it or not, because aesthetic
treatments are voluntary, all aesthetic
practices must engage in some sort of
marketing effort to bring in patients. In this
industry, patients must be convinced to
come to your practice and must be sold on
your practice.
But be careful. What works in traditional
retail outlets and other industries is often
illegal in medicine. Even though aesthetic
practices are offering and selling voluntary
treatments, it is still the practice of
medicine. And that means that medical
boards hold aesthetic practices to the same
standard as every other medical facility.
What does this mean? It means that the
practice—including the staff—must be
honest and truthful with advertising. It means
you must guard patient confidentiality
zealously. It means you must not receive any
payment for referrals or, in most states, get
paid a commission for medical treatment
(and yes, laser treatments are considered
medical treatments).
I teach entire courses on the laws
surrounding physician marketing, but many
aesthetic physicians are unaware these
laws even exist, and most make little or
no attempt to inform their staff of the
requirements imposed by the law. And
with a premium being placed on practice
management sessions at conferences, many
marketing experts during these sessions are
increasingly encouraging staff to engage in
practices that violate the law. Be mindful
of consultants in this area and check with
a qualified healthcare attorney before
implementing any tips learned from
marketing consultants to ensure they are
legal in your state.
3. INVEST IN YOUR LEGAL FUTURE.
Benjamin Franklin once said, “An ounce
of prevention is worth a pound of cure.”
This couldn’t be truer in this industry. I
have literally made it my life’s work to
encourage health care professionals to use
lawyers more efficiently. This means having
employment contracts reviewed, ensuring
proper standard operating procedures
and forms are in place, and completing
adequate training. You, as a member of the
practice, have just as much right to review
the contracts and protocols that affect you
as the physician. And I’ll be honest—most
of the time the physicians you work for
have little knowledge of the law, so it is
incumbent upon you to educate yourself
so you are never put in a compromised
position.
I always bring up a real-life example
to demonstrate this point. Oftentimes
physicians will pay their staff commissions
for laser treatments or allow “laser
technicians” to treat clients without a
physician ever seeing the patient. In many
states this is absolutely illegal (trust me, it
is). If are caught engaging in these
practices, your license—and your wallet—
55
will suffer. It doesn’t matter if you were
simply following instructions—states
demand that you know the law and follow
it, regardless of what your supervisor
told you. So learn the law. Learn what
is required of you and learn what you
are prohibited from doing. Educate the
physician yourself, if necessary.
I understand that lawyers are expensive;
however, I promise that whatever you
spend now will pale in comparison to what
you’ll need to spend to fix the situation
once a problem arises.
4. GET TO KNOW A GOOD
HEALTHCARE ATTORNEY.
This is really the whole point of this
article. You need a healthcare attorney—a
general counsel or a “consigliore” for your
career. And please don’t use a real estate
attorney or general corporate attorney, and
please do not rely solely on online forms. I
cringe every time a client tells me that they
had their employees sign non-competition
agreements downloaded from Google, or
that their neighborhood attorney set up
their corporate structure. I spend as much
time fixing those situations as I do building
a practice from the ground up.
As mentioned at the beginning of this
article, healthcare law is complicated.
There are multiple practice acts and
multiple jurisdictions to know. Just as you
would not recommend that a patient
receive Botox from a family practice
physician, do not rely on general practice
attorneys to set up your aesthetic practice.
There are nuances and exceptions that
general lawyers would never know or fully
understand.
Alex R. Thiersch is the founder and director of
the American Med Spa Association (AmSpa) and
AmSpaMD, which were created for the express
purpose of providing comprehensive, relevant and
timely legal and business resources for medical spas
and medical aesthetic physicians throughout the
United States. For more information about becoming
a member or to learn about AmSpa’s upcoming
events, log on to www.americanmedspa.org. Alex can
be contacted at [email protected]. ▲
S P S S C S 2 0 1 6 – 2 0 17
Nominating Slate
T
he Nominating Committee and the Board of Directors are pleased to recommend the following
nominations for the 2016–2017 Board of Directors. The Nominating Committee consists of
two SPSSCS members elected at the Annual Business Meeting, the two Board Representatives
from The Aesthetic Society (ASAPS) and the SPSSCS Immediate Past President. Elections will
be held during the Member Business Meeting on Friday, April 1 at our 22nd Annual Meeting in
Las Vegas, NV.
PRESIDENT—
AUTOMATIC FROM
PRESIDENT-ELECT
Lizabeth Clouse,
RN, CPSN—Little Rock,
AR, has been in nursing
as an RN since 1980. Her
experience has been in the operating room,
intensive care, and in a plastic surgeon’s
office. She received her CPSN certification
in 1991. She worked as office nurse, operating
room assistant, skin care specialist and
nurse injector for Dr. Robert Lehmberg
(1989–2004). Liz has been member of
SPSSCS since its inception. She served on
the SPSSCS Board of Directors as Treasurer
in 1997. Liz has had her own business
within the office of plastic surgeon Dr. Ed
Love for the past eleven years. Her duties
include: injection of neuromodulators and
fillers; laser treatments and skin care including
chemical peels and microdermabrasion.
PRESIDENT-ELECT—
ONE-YEAR TERM
Cindy Steele, LA
NCEA—Little Rock, AR, is
a licensed aesthetician
and is a certified national
esthetician set forth by the
National Coalition of Estheticians, NCEA.
She has been in the skin care industry for
20 plus years and works at Advanced
Aesthetics of Arkansas in association with
Arkansas Plastic Surgery. The business
specializes in body treatments, skin tightening
therapy and a multitude of specialty lasers.
A strong retail business is an integral part to
her success. She has served on the SPSSCS
Board of Directors as Parliamentarian,
Secretary/Treasurer and Vice President, as
well as the Scholarship and Program
Committees. She co-chaired the “Master
Aesthetician” pre-meeting course at the
Annual Meeting in Boston, lead a networking
roundtable discussion at the Vancouver
meeting, moderated the Micro Needling
Panel and presented on Open House and
Special Events Marketing in Montreal.
Cindy served on the Cosmetology Technical
Advisory Committee Board as Vice President
for a 2-year term, appointed by Governor
Beebee.
VICE PRESIDENT—
ONE-YEAR TERM
Donna Erb—
Wyomissing, PA, has been
employed at Berks Plastic
Surgery since 2005 as a
licensed aesthetician and
skin care counselor. With over 20 years of
experience in the field of aesthetics, she
finds great pleasure in educating her clients
with information regarding non-surgical
services such as microneedling, laser hair
removal and treatment for rosacea. She has
completed training in Obagi systems and
specializes in advanced laser techniques.
Donna has been a member of the SPSSCS
for the last 11 years, has been an SPSSCS
Board member for the last 4 years and is
also a member of the Aesthetics Leadership
Community.
SECRETARY/TREASURER
—ONE-YEAR TERM
Susan Eldridge—
Portland, OR, has been
a licensed aesthetician
since 1980, after
graduating from the
First National School of Aesthetics in
Boston, Massachusetts. She moved to
Portland, Oregon in 1990 with her husband
and three sons. Susan has been practicing
6
aesthetic skin care in a medical environment
for 21 years. She is currently working for
Dr. Kathleen Waldorf at the Waldorf
Center for Plastic Surgery, specializing in
the use of modalities such as ultrasound
and microneedling, along with pre and
post-op treatments and clinical skin care
consultations. A member of the SPSSCS for
20 years, she has volunteered with the
World Burn Congress and as a Mentor to
new SPSSCS members. Last year, she
served on the SPSSCS Board of Directors
as a Member at Large. Susan is an advocate
of education and advancing her knowledge
in the science of skin care.
MEMBER-AT-LARGE—
ONE-YEAR TERM
Charlott Chotsie
Adney, LA—Little Rock
AR, SPSSCS member
since 1995, is president
and owner of Advanced
Aesthetics of Arkansas at Baptist Hospital
in Little Rock. Chotsie is a highly
experienced aesthetician, laser specialist
and skincare expert. Licensed in Oklahoma
City in 1985, she began post-op facial
treatments and make-up for a plastic
surgeon and practiced in Boston, MA
from 1987 until 1989. Her medical skin
care practice in Little Rock started in 1992.
She offers an extensive array of treatment
modalities, specializing in lasers &
Coolsculpting. Chotsie was voted Woman
to Watch in 2012 and in 2013 voted
Arkansas Small Business Person of the Year.
MEMBER-AT-LARGE—
ONE-YEAR TERM
Alicia Barrera—
Yakima, WA, is the
creator of Pretty~N~Ink
Image Enhancement. She
holds a triple Washington
State license in Master Esthetics, Permanent
Cosmetics, and Cosmetology. She is an
NCEA Nationally Certified Skin Care
Specialist, and an Allied Health Care
Professional, with a dual degree in Surgical
Technology and Medical Assisting (certified
by the America Medical TechnologistAMT). She has been practicing since 2000
and has dedicated the last decade mastering
the field of medical aesthetics and clinical
beauty skin care therapies. She has specialized
in the art of medical micro-pigmentation
for post-mastectomy patients, also offering
services in permanent cosmetics since 2005,
in the office of Dr. Christopher Hauge and
Dr. James Hoyt, board-certified plastic
surgeons. She has had training in the Look
Good Feel Better program, and volunteered
at World Burn Congress. She has been a
member of the SPSSCS since 2008.
MEMBER-AT-LARGE—
ONE-YEAR TERM
Shay Moinuddin,
MHA, RN, CANS—
Chicago, IL, is the Practice
Manager and an Aesthetic
Nurse Specialist at The
Few Institute for Aesthetic Plastic Surgery,
with offices in Chicago and New York.
Shay manages the daily operations of the
clinical practice, AAAASF accredited
surgical suite, and The Few Institute Skin
Clinic. In addition to her managerial
responsibilities, Shay is also a highly
experienced nurse injector, laser specialist
and skin care clinician. She has received the
elite Physician Extender and Certified
Aesthetic Nurse Specialist certifications,
which credential her expertise in minimally
invasive cosmetic procedures.
All nominees meet the
qualifications required by the
SPSSCS and are willing to serve in the
designated capacity, if elected.
NOMINEES FOR THE 2016
NOMINATING COMMITTEE ARE:
Abbey Helton, BSN,
RN, CPSN, CANS—
Louisville, KY, holds dual
certification in plastic
surgery nursing and
aesthetic nurse specialist
with over 24 years of
experience in the medical field, the last 17
years as Clinical Director for Joseph Banis
Plastic Surgery. Her background includes
Legal Nurse Consultant, reviewing and
preparing legal documentation for expert
witnessing, development of Skin Care
Solutions,™ as well as aiding in the research
of a Nutricosmetic and Genetic Skin Aging
Project with Dr. Joseph Banis. She has
been a member of the SPSSCS since 2005,
serving on the Board of Directors from
2009–2015.
Debra Yates—Camp
Hill, PA, is a licensed
esthetician and practice
administrator for Skin
Rejuvenation & Laser
Center at Plastic surgery
Center, Ltd in Camp Hill,
PA. She is Past President of the Society of
Plastic Surgical Skin Care Specialists and
honoree of the SPSSCS Presidential Award
for Distinguished Service. She is a past
Editor of the Specialty Skin Care newsletter.
Debra is on the Board of Directors for the
American Business Women’s Association.
She is President-Elect of the Harrisburg
Symphony Society Board and on the Board
of Directors. She is also Past President of
the Harrisburg Area YWCA Friend’s board.
POSITIONS NOT REQUIRING A VOTE:
PARLIAMENTARIAN—
ONE-YEAR TERM
APPOINTED BY THE
PRESIDENT
Belinda
Hammergren, RN,
BSN,—Stillwater, OK,
is a Nurse Injector, Aesthetic Nurse
Specialist and a Certified Medical
Micropigmentologist. Belinda graduated
from nursing school in 1977 and later
received a Bachelors of Science in Nursing
from Oklahoma University. Belinda worked
in the hospital setting for over 25 years in
7
the areas of Emergency Department, Labor
and Delivery, Surgical Intensive Care,
Endoscopy lab and anesthesia. Belinda was
named Nurse of the Year at all three hospitals
where she has been employed, those being
Wesley Medical Center, Wichita, Kansas;
Mercy Hospital, Oklahoma City, Ok.
And Stillwater Medical Center, Stillwater,
Oklahoma. Belinda served as Director
of Community Education and Staff
Development at Stillwater Medical Center
before beginning her cosmetic nursing
career 8 years ago. Belinda is an expert
instructor having conducted recertification
courses in CPR and ACLS, and conducted
dozens of community education programs.
Belinda is highly trained to perform
permanent makeup of the eyebrow, eyeliner
and lips, and has performed over 600
procedures. She was named “Top Achiever
in Permanent Cosmetics” at the Florida
Institute of Permanent Makeup. She also
performs camouflage for vertiligo patients,
scar revisions and areola restorations.
Creating a service ministry, “Belinda’s
Butterflies,” she works with cancer clinics to
provide complimentary permanent eyebrow
color to women diagnosed with cancer
prior to beginning chemotherapy treatment.
IMMEDIATE PASTPRESIDENT—
AUTOMATIC FROM
PRESIDENT
Nina Spadaccino—
Dallas, TX, is a clinical
aesthetician and laser
specialist with over 18 years’ experience in
the field of cosmetic and plastic surgery. In
2015, she joined EpiCentre, Directed by
the Dallas Plastic Surgery Institute as the
Regional Director, managing multiple
locations. For nine years prior to 2015, she
served as Practice Director for Town &
Country Plastic Surgery and Medical Spa in
Houston, TX. Nina is a General Partner of
EventsRx, LP, a physicians’ marketing and
consulting firm based out of Houston, TX.
She attended the World Burn Congress in
October, 2010 and September, 2012, as
part of the SPSSCS Image Enhancement
Team. In addition to being a member of
SPSSCS since 2007, she looks forward to
serving a fifth term on the Board of
Directors as Immediate Past President. ▲
8
Y
Is Your Website Working for You?
our website is the customer’s first
impression of your business. It tells who
you are, the personality of your business
and how you can benefit them. It invites
them to explore your webpages. Getting
this to happen can be challenging, technical
and crucial for success.
The services you offer dictate what
pages you need. Do you specialize in
microdermabrasion, chemical peels, light
energy therapies, injectables, neurotoxins?
Tracking treatments tells you which ones
are the most popular and bring in the most
revenue. Those services must be easy for
the client to find. It’s both page content
and page arrangement that generates
successful interaction.
Your home page should be a snapshot
of your business. Who you are and what
you do. All of the information in your
brochure should be included on your web
pages. Introduce your team and their
strengths—profiles and pictures and give
details about the types of services offered.
In addition to good head shots, add
pictures of staff working with clients.
There is nothing like a happy client to
attract another.
Viewers need the basics. Where you are
located and when you open. How do they
make an appointment? Who do they call
with questions?
Include your service menu and the
benefits of each service. They want to
know what it will do for them. Tell them
about the products you offer and their
benefits. A policies page helps establish
expectations. Informational or educational
articles can also be helpful. The inclusion of
a You-Tube video is another great way to
engage the viewer.
Judith Culp, CIDESCO Diplomat
Have a way to collect information
about the person that looks at your page.
It might be as simple as a sign up spot on
your home page that offers a coupon if the
viewer provides their name and email.
Or it might sign them up to receive an
e-newsletter. Their contact information
gives you a way to add them to your
mailing list or to follow up with them
perhaps with an email note thanking them
for visiting and invite them to your spa.
Logical arrangement of pages is
important to lead the potential customer
through to desired action. In our business,
that action is scheduling an appointment.
Review the pages you have listed on your
webpage and evaluate: are they in the best
order to accomplish the goal and get the
appointment?
Content on your website is only as
good as the information you provide to the
person building your page. If the web
person doesn’t understand our industry, it
can come through in the presentation.
Unless you are comfortable writing
promotional material, and many of us find
it awkward to brag about ourselves, you
might want to make your life a lot easier
and develop a team. Sometimes, we try to
do it all, when often we would be more
productive focusing on our strengths and
delegate other tasks out.
We know that the right team is critical
to our in clinic success. So it is also critical
for on-line and marketing presence.
In addition to a reliable webmaster, a
copywriter is a great person to have on
your team. As a freelancer, you only pay
them for the work they provide so this
keeps your overhead down. It is important
that the person you choose has a good
9
knowledge of your business and the clients
you want to attract. You can work with
them in person or via phone so they can
get to know you, your needs and your
goals. They will work with you to develop
what kind of content you need and then
write it for you. They can also provide a list
of key search words that your webmaster
can include, so the search engines better
connect you with potential clients. They
can handle your e-newsletter based on
the information, specials and promotions
you want to feature. They can prepare
automated emails, so when a client signs up
for your newsletter, they get a nice thank
you and an invitation into your business.
Just getting started? Someone with
insider experience can jumpstart your
career. A single packet of information can
be used to create a google business page, a
Facebook page, a Yelp page or any other
web presence that focuses on businesses in
your local area.
Periodically, all businesses need to give
themselves a bit of a face lift to keep a fresh
look. Web pages are no exception. They
don’t have to be completely redone, but
revisions trigger more activity with the
search engines and can elevate your
rankings so you become more visible.
Judith Culp has worked in the spa industry for
over 30 years. She has written extensively for trade
publications, a newspaper column in the Stylist
and her own websites. For Milady Publishing she
was the Contributing Editor for Milady Standard
Esthetics Advanced first and second additions.
As Judith Culp Creative Copy she is a copywriter
providing that extra set of hands to busy business
owners with a focus of helping your business grow.
If you or someone you know needs writing assistance
visit www.jculpcreativecopy.com. ▲
INFLAMMATION AND SKIN RENEWAL: EXPLORING THE CONNECTION
Continued from Cover
Procedures that stress or damage the
skin such as medium-to-deep chemical peels,
dermabrasion, or laser treatments will provoke
a desired inflammatory response that is
essential for skin regeneration and healing.
The wound healing process follows a
sequential and overlapping pattern of events.
Following trauma, platelets are recruited to
stop blood flow and immune cells are
recruited to remove damaged cells and
bacteria. The typical signs of inflammation
such as pain, warmth, redness and swelling
are due to increased blood flow and increased
small vessel permeability that allows more
plasma to move into the damaged tissue.
Although this is an anticipated response,
an extended period of inflammation is
undesirable and may not produce optimal
healing. Inflammation beyond a typical
time may also be a sign of infection.
Oral agents such as non-steroidal antiinflammatory drugs may be used to
minimize the inflammatory period and
decrease pain. After the inflammatory
period, fibroblasts, endothelial and
epithelial cells are recruited to the wound,
undergo proliferation, and new extracellular
matrix is deposited. This healing process
allows for new collagen to be organized
and can continue for several months.
Although not completely understood, skin
rejuvenation with milder non-ablative
procedures such as IPL and dermal needling
can be considered to be less harsh examples
of controlled wound healing.2,3
INFLAMMATION AND SKIN AGING
The inflammatory response of skin to
chronic stressors is thought to be central to
skin aging, as it results in decreased collagen
production, increased collagen degradation
and oxidative stress. Inflammation can be
due to environmental stressors as well as
intrinsic aging. The most important
environmental cause of skin aging, UV
exposure from the sun, causes the production
of free radicals that damage DNA and
produce a resulting inflammatory response
visualized as sunburn. Repeated UV
exposure of skin leads to photoaging
characterized by thickened, inelastic, and
wrinkled skin. Although less visible than
sunburn, exposure of skin to environmental
stressors such as pollutants, particulates and
cigarette smoke result in increased
production of inflammatory cytokines.
Glycation, the process where sugar
molecules modify protein, DNA or lipid
molecules results in oxidative stress and
a corresponding inflammatory response. A
good anti-aging skin care regimen should
include use of a sunscreen, along with antiglycation and anti-oxidant ingredients to
mitigate the effects of inflammation.
INFLAMMATION AND SKIN CONDITIONS
Cytokines are important for maintaining
the essential physical barrier of skin, and
their dysregulation leads to pathologies
such as psoriasis and atopic dermatitis.
Acne has an inflammatory component as
well due to the presence of cytokines and
P. acnes bacteria. Rosacea is an immune
mediated syndrome characterized by redness,
flushing and inflamed areas of the face.
Post-inflammatory hyperpigmentation
is a condition that occurs more often in
brown skinned individuals of African, Asian,
Indian, Latin, or Native American background.
Dark skin spots or patches are due to the
excess melanin produced by melanocytes in
response to inflammation from a wound or
infection site. Similarly, post–inflammatory
hypopigmentation can occur in these same
individuals and produce lighter skin spots
from the absence of melanin.
SUMMARY
Inflammatory mediators are abundant in
skin and are required to maintain its barrier
function. Techniques to induce an acute
inflammatory response followed by wound
healing encourage skin renewal. Anti-aging
topical treatments should address the
effects of chronic inflammation.
REFERENCES
1. Hänel, K.H.; C. Cornelissen; B. Lüscher,
and J.M. Baron. Cytokines and the Skin
Barrier. Int. J. Mol. Sci 14:6720-6745
(2013).
2. Ganceviciene, R.; A.I. Liakou; A.
Theodoridis; E. Makrantonaki; and C. C.
Zouboulis. Skin anti-aging strategies.
Dermato-Endocrinology 4:3, 308-319
(2012).
3. Setterfield, L. Concise Guide to Dermal
Needling. Acacia Dermacare, Canada.
(2013).
10
Annette Tobia, PhD, is founder of Dynamis
Skin Science, which carries the MEG 21 product
line, formulated with Supplamine,® an anti-glycation
ingredient that Dr. Tobia invented, which removes
age-causing toxic sugar from skin. Dr. Tobia earned
her PhD from New York University, completed. post
doctoral work at Rockefeller University, and received
her law degree from Rutgers School of Law.
Alice Marcy, PhD, is vice president of
Dynamis Pharmaceuticals, a pharmaceutical
company developing a drug to treat diabetic
complications. Dr. Marcy earned her PhD from
Johns Hopkins University School of Medicine, and
completed her post doctoral work at Harvard
University. ▲
FROM THE EDITOR’S DESK
Continued from Cover
media to grow our business and
communicate with our clients and those
that might be interested in becoming a
client. We have to be appropriate, too. We
try to make sure our posts are fun and help
us to communicate a point. Social media
is everywhere, it is how we communicate
now and it is here to stay. I recommend
that you take a moment and look at your
social media posts. Make sure you are being
professional and “doing the right thing”
for yourself and your business.
In addition to the articles in the
newsletter, there is also information
regarding the Nominating Slate of officers
to be voted on for our 2016-2017 Board
of Directors. I hope that you will take a
few moments to review the slate. This is
your organization, get involved. Choose
to serve on a committee, or submit an
abstract for our next annual meeting. I
know that there is a lot of knowledge out
there—let’s share it!
Finally, it is beginning to be that time
of the year when changing your client’s skin
care routine is important. As we approach
spring and summer, the skin changes and so
should the products that the client uses.
Take a look at the home care routine of all
of your clients and make sure it will be
right for the upcoming months. ▲
You Are the Office Police
Bob Aicher, Esq.
A
s Skin
Care Society
members, all of you help Aesthetic Society
plastic surgeons provide exceptional
medically-necessary as well as aesthetic
care. If you pay attention, you can also help
keep your bosses out of trouble. ASAPS
members regularly call me for guidance.
Many times you, their staff, could have
helped with the very issues they are calling
about. Here are a few examples.
ACCEPTING QUESTIONABLE
PROSPECTS.
I once asked a few of our members how
they know when to reject a patient. Some
said, “When the patient flatters me,” or,
“When the patient says, ‘Tell me what you
would fix.” The few doctors I polled said, “I
ask my staff.” If only all our ASAPS members
asked their staff, because I routinely receive
phone calls where the member says, “I just
knew this patient was going to be trouble.”
Do your boss a favor. If you have any
misgivings about a prospective patient,
don’t keep them to yourself. As the police
say, “If you see something, say something.”
You are the office police.
FIRING A PATIENT.
It’s not that hard, as long as the patient
is fully healed, and if the procedure was
aesthetic, you don’t even have to provide
a referral as you would if you were the
patient’s primary care physician. It isn’t
patient abandonment when the patient
simply isn’t happy with the aesthetic result
and is trying to get more procedures free
by threatening to Yelp. Many surgeons,
nevertheless, wait too long to fire patients.
A common situation is the “impossible to
please” patient who keeps wanting more,
usually for free, and doesn’t mind making a
scene. When I asked one ASAPS member
how his staff felt about this particularly
bullying patient, he said, “They hate her!”
to which I replied, “Then you’ll be a hero.”
It’s easier for surgeons to take action when
they know what their staff thinks. You are the
office police.
TRUSTING COLLEGIAL FLATTERY.
One of our ASAPS members was
flattered to be asked to do live surgery at a
hospital in Germany. He called to ask if I
saw any problems with that. I pointed out,
for starters, that it is illegal since he wasn’t
licensed in Germany. I also pointed out that
his med mal insurance might defend him if
a lawsuit were brought in the United States,
but not if it were brought in Germany.
Another member called about volunteering
to teach surgical techniques at a hospital
in Dubai. Such opportunities come with
three issues: licensing, insurance, and cost
reimbursement, all of which these surgeons
hadn’t thought about. Don’t we frown
upon doctors who come here and practice
medicine without a license? As staff, you
can help your boss think about such matters
the same way. Germany offers temporary
medical licenses, and hospitals will offer
insurance. So when you hear your boss
being flattered into leaving the country,
speak up. You are the office police.
ACCEPTING CREDIT CARD PAYMENTS.
Staff noticed on the day of surgery a
prepped patient hadn’t fully pre-paid, as
office policy required. The patient said to
call her boyfriend, which staff did, and
obtained his Visa number and phone
authorization. The procedure went fine, but
by the time the boyfriend’s Visa statement
arrived, he and the patient had broken
up. The boyfriend initiated a chargeback,
and since the practice didn’t have a valid
signature, the boyfriend won. The doctor
took both of them to small claims court
and won, but the surgeon’s staff could have
averted the situation by either following
office procedure, or, when the error was
discovered, by insisting on getting the
boyfriend’s signature. Don’t let things
like this happen to your boss. You are the
office police.
BUYING IRISH BOTOX OR CHINESE
IMPLANTS.
Sure, they look identical to the product
in your refrigerator, they’re significantly less
expensive, and you can buy them online,
so what’s the problem? They are illegal,
and even nurses have gone to jail for
buying illegal product. Furthermore, you
11
can’t obtain the patient’s consent to use
illegal products, and this won’t escape the
notice of a plaintiff’s attorney. So maybe
you’re asking, Why are these products
illegal? To be legal in this country, devices
must have an FDA label. Doctors can then
use devices for any purpose that is not on
the label (off-label), but first, the device
must be labeled. Chinese implants carry no
FDA label.
As for Irish Botox, I call it that because
Allergan manufactures it in Ireland. Since
some of the Botox will be shipped to the
United States, the facility is FDA inspected,
and that product will be FDA labeled. The
good news is that the product is genuine,
so patient safety shouldn’t be an issue. The
bad news is that a lot of the product is
being shipped to Canada or the European
Union, both of which have different doctor
and consumer labeling requirements. The
temptation, of course, is that product sold
outside the United States is often far
cheaper than the same product sold within
the United States.
Unfortunately, when a product doesn’t
have the right FDA label or package inserts,
it’s called misbranded. If the supply chain
isn’t under FDA oversight, FDA can’t
guarantee freshness, so FDA assumes the
product is adulterated. Either way, buying
product that is misbranded or adulterated
is illegal, a federal crime, and thus grounds
for state medical board discipline. Internet
suppliers hype their low prices, but they
don’t mention somebody might lose his
or her license. Don’t buy illegal product.
You are the office police.
YOU ARE THE OFFICE POLICE.
I’m going to keep saying it. Your boss
spends every minute minimizing risks for
patients. Don’t let those good efforts be
undermined by difficult patients, unlicensed
and uninsured medical practice abroad,
avoidable chargebacks, or Irish Botox.
You are the office police.
Robert H. (Bob) Aicher, Esq. has served as
ASAPS’s General Counsel since 1998. For the 10
previous years he represented ASAPS, The Doctors’
Company, and the California Society of Plastic
Surgeons. Mr. Aicher resides with his wife in
Pasadena, California. ▲
SpecialtySkinCare
SOCIETY OF PLASTIC SURGICAL SKIN CARE SPECIALISTS
11262 Monarch Street, Garden Grove, CA 92841-1441 • www.spsscs.org
Welcome
NewMembers
Karen Menard, RN
Chair, Membership/Mentor Committee
Liliana Aguilar, LMT, MA—Houston, TX
Sharon Amato—Hummelstown, PA
Brittany Baldwin—Kaufman, TX
Grace Barber, PAC—Modesto, CA
Michelle Bohlman—Duluth, MN
Debbie Boyte, MEP-C, RN—Dallas, TX
Paula Brezavscek, PAC—Miami, FL
Jenny Burnley—Austin, TX
Mischell Marie Christmas, RN, BSN—
Charlotte, NC
Janice Cunningham—Portland, OR
Alicia Czernia—Grand Rapids, MI
Aiping Dai, RN—Anaheim, CA
Melissa Giordano, RN, CANS—Paramus, NJ
Stephanie Harshbarger, MSN, CRNP—
Camp Hill, PA
Tanya Haug, RN—Kelowna, BC, Canada
Alyssa Hoerl—Edina, MN
Melissa Hoogland—Grand Rapids, MI
DeAnna M. Huizinga—Grand Rapids, MI
Heather Lantz, RN—Eden Prairie, MI
Samantha Le Blanc—Austin, TX
Virginia Lowther—Little Rock, AR
Malinda Luke—Salt Lake City, UT
Marli Maloney—Salt Lake City, UT
Trisha Meinert—Grand Rapids, MI
Ashton Meyer, RN, BSN—Lake Oswego, OR
Kelly Porter—Greenwood Village, CO
Sarah Proulx, RPA-C—Stratham, NH
Tammy Raffkind—Dallas, TX
Ashley Reuter—Carson City, NV
Eva Rodgers—Oakmont, PA
Kayla Rudolph, RN—Austin, TX
Katelyn Scalabrini—Austin, TX
Megan Schmitz—Edina, MN
Angela Scott—Lambertville, MI
Rachel Sims, RN—Little Rock, AR
Rachel Six—Grand Rapids, MI
Kristie Sutton—Hailey, ID
Jacquie Tribble—Houston, TX
Meilyn Urling—Anchorage, AK
Karen M. Van Dyk, RN—Knoxville, TN