2009 Winter - Aesthetic and Anti-Aging Medicine Society of South

Transcription

CHEMICAL peels
HPCSA issues notice
on Scopes of Practice in Aesthetic Medicine *
DIY
Devices
Endorsed by
volume 2 Number 4
summer edition 2009
1 ACC
ET R
HI ED
PE CS ITE
R CP D
IS D FO
SU P R
E* OIN
T
note from the editor
Guest Editor: Dr Nerina Wilkinson
This issue is in keeping with the economic
climate. Where champagne shopping has been
replaced by essential shopping and many people
are resorting to their own DIY at home. This
could also be true in the aesthetic world where
there seems to be a new potential growth area
and smart money in physician-dispensed home
use devices for common conditions like acne
and excessive hair growth.
If your patients are not already asking about home use devices,
they will be. According to market research in the USA, today’s
$226 million home use device market is expected to quadruple
to $1 billion by 2012.
with tattoos will consider having one or more of them removed.
For patient satisfaction during the removal process, it is extremely
important to correctly asses these tattoos to give patients realistic
expectations on the time required to remove the tattoos and to be
able to offer a variety of treatment options which are reviewed in
detail in this article. An interesting new option to tattoo removal
is a product called Elimin Ink which is placed in the tattoo, and
leads to scab formation. The scab actually changes color as the
different inks in the tattoo are absorbed by Elimin Ink and pulled
to the surface.
So whether you are improving your DIY skills or removing that
embarrassing tattoo, the end of the year is upon us and is time
to plan how we are going to optimize 2010 before taking a well
deserved break!
Enjoy and happy holidays.
Another cost effective treatment that enhances the results of most
aesthetic treatments are chemical peels, which offer visible skin
improvements. Today the move forward, is more towards regular
superficial peels. Blended peels are also gaining favor due to the
visible results that can be achieved without the downtime typicaly
associated with single acid peels.
DR NERINA WILKINSON
The Chemical Peels article, shows us the exciting advances that
have been made over the past five years in the new ingredients
for acid peels and the improved uses in pigmented skin types.
She has a major interest in aesthetic surgery of the face, breast and body, closely
integrating surgical with other non-invasive procedures.
December is the time to start showing some skin after an extended
cold winter. However, some are still covering up to hide a visible
tattoo that was once shown with pride. Seasons change, but so
do some peoples lives, sadly some more permanent options ie.
tattoos which are not easily removed.
In the article Invisible Ink, it is clear that seventeen percent of those
MedEsthetics | Southern Africa
MBChB(Stell) FCS(SA)Plast
(Plastic and Reconstructive surgeon,Dr Nerina Wilkinson has a full time private
practice at the holistic anti-aging Renaissance Body Science Institute in Cape
Town. She is a member of the Association of Plastic and Reconstructive Surgery
and has presented scientific papers at congresses and publishes in health related
magazines.
She started her private practice in 2000 at the Mayo clinic in Johannesburg and
concentrated on cosmetic surgery of the face, breast, abdomen and thighs. She
also had a large non-invasive practice working closely with the Global Aesthetic
Centre. Here minimally invasive procedures including botox and fillers were
combined with skin resurfacing techniques like chemical peels and skin lasers.
In February 2006 she relocated to Cape Town to concentrate on cosmetic surgery:
invasive and non-invasive at Rennaisance Body Science Institute.)
contents...
MedEsthetics
Southern Africa
PUBLISHER
Reni Rouncilvell
MedSpec Publishing
PO Box 12973 · Clubview · 0014
South Africa
T +27 (0) 12 661 3294
Mobile +27 (0) 82 441 6904
e-mail [email protected]
Sales & Advertising
18
summer edition 2009
COLUMNS
30 BUSINESS CONSULTANT
patient consult
40 BEST PRACTICES
42 INTRODUCTIONS
44 PRODUCT REVIEWS
46 NEWS & EVENTS
48 IN THE LIMELIGHT
FEATURES
4 chemical peels
10 DIY devices
18 CPD Article
HPCSA issue notice on scopes of practice in aesthetic medicine
20 ultrapulse CO2 fractional laser treatments for aging skin
24
26
34
38
invisible ink
the right mix
case study
fat profits in lean times
Lelani Wearing
T +27 (0) 12 661 3294
Mobile +27 (0) 79 512 6990
Johan Smook
T +27 (0) 12 661 3294
Mobile +27 (0) 83 653 8411
SUBSCRIPTION & ACCOUNTS
Elizabeth Versteeg
Mobile +27 (0) 72 189 8499
DESIGN & LAYOUT
Sonja van Niekerk
MedSpec Publishing
T +27 (0) 12 661 3294
Mobile +27 (0) 82 444 0231
DISCLAIMER
This publication contains selected items
originally published under license from
Creative Age Publications in the USA.
This work is subject to copyright. All rights
are reserved, whether the whole or part of
the material is concerned, specifically the
rights for translation, reprinting reuse of
illustrations, broadcasting, reproduction of
CD-Rom, microfilm, online publication, or in
any other way, and storage in data banks.
The use of registered names trademarks
etc. in this publication does not imply, even
in the absence of a specific statement, that
such names are exempt for the relevant laws
and regulations and therefore free for general
use.
Product liability: the publishers cannot
guarantee the accuracy of any information
about the publication of medications contained
in this publication. In every individual case,
the user must check such information by
consulting the relevant literature.
4
LOCAL ARTICLE
Chemical
Peels
Chemical Peels remains in the top
5 most performed non-surgical
cosmetic procedures worldwide
for over a decade already. For
aesthetic doctors, chemical peels
are a cost effective method for facial
rejuvenation that have successful
results and complements al the newer
technologies and devices. Chemical
peels offers results in most of the skin
indications that worry our patients
including wrinkles, pigmentation,
dull skin, acne, acne scars and even
stretch marks.
For over a decade, chemical peels have remained in the top 5
most performed non-surgical cosmetic procedures worldwide.
For aesthetic doctors, chemical peels are a cost effective
method for facial rejuvenation. They complement the newer
technologies and devices and offer successful results in most of
the skin indications that worry our patients, including wrinkles,
pigmentation, dull skin, acne, acne scars and even stretch marks.
Peel depth & the duration of skin changes
Level of Peel/ Chemical destruction
Upper Stratum corneum
Intra-epidermal
Basal layer Grenz Zone Papillary dermis Upper Reticular dermis
Deep Reticular dermis Hypodermis Duration of change
Very temporary
Very temporary
Temporary
Medium duration
Long lasting
Permanent
Permanent, risk of scarring
Permanent, scarring
local article KEY FEATURE
Though the various depths of peels determines the duration of change seen in the skin, the various chemicals have different benefits
on the skin. Using different chemicals, the same depth of peel can be tailor-made to suit the individual needs of your patient.
Chemical Peeling Agents and their Actions
Peeling agent
Depth of peel
Glycolic acid
Superficial
Kojic acid
Superficial
Azelaic acid
Superficial
Phytic acid
Superficial
Lactic acid
Superficial
Salicylic acid
Superficial
Retinoic acid
Superficial
Trichloracetic acid
<15% Superficial
>20% Medium
Phenol
Deep
Actions
Benefits
Keratinocyte discohesion
Reduces wrinkles, photoageing,
Epidermolysis
acne & dull skin,
Increases type 1 collagen & skin renewal, depigmenting action also
hyaluronic acid in skin
Comedolytic
Depigmenting action: reduces Reduces pigmentation & melasma
synthesis of melanin by inhibiting
activity & synthesis of tyrosinase,
regulates melanin production
Tyrosinase inhibition, regulates melanin Reduces pigmentation & melasma
production, keratinisation normalization,
anti-bacterial action, anti-oxidant action
Anti-oxidant
Reduces pigmentation & inflammation
Chelating action on iron, copper & calcium
Lightening action by blocking entrance of
iron and copper in the formation of melanin
Keratolysis, metabolic stimulation by Skin renewal, skin hydrator and exfoliant
interfering with enzymes to decrease
corneocyte cohesion, renewal of epidermal
cells, skin hydrator, collagen deposition
Keratolysis, comedolytic, antibacterial action
Improvement of acne and blocked pores
Corneous cells desquamation, keratoregulating, Wrinkles, active acne , pigmentation &
comedolytic, keratinisation normalization, photoageing reduction
protects collagen fibres, regulates melanin
production
Protein precipitation, dissolves keratin,
Wrinkles and photoageing reduction,
coagulates skin proteins, augments collagen improvement in acne scars and stretch
production
marks
Keratin protein coagulation, augments Photo-ageing reduction, depigmenting,
collagen production, antiseptic, antifungal, antiwrinkle (medium to deep wrinkles),
anaesthetic properties
reduces acne scarring, skin tightening
There are a number of high quality peel formulations available
in South Africa. Most of these formulations have gone through
various types of research, testing and changes to make them ideal
for specific indications. Although some doctors might find that
pharmacy-compounded formulations are more affordable, results
are certainly not comparable to the laboratory manufactured
formulations that are backed by scientific research. The following
formulations are available on the market in South Africa.
Filorga GlyKopeel
A dermatological, chemical, superficial and complete peeling
solution specific for cutaneous ageing and photo-damage. The
formulation combines 18 active ingredients to ensure results for
various indications ranging from
photo-ageing, wrinkles, loss of elasticity, overall skin appearance, acne and especially for various types of pigmentation due
to its multiple depigmenting ingredients, which have been added
to the glycolic acid.
The GlyKopeel is formulated at a concentration proven to provide maximum delivery of the active ingredients. The 18 active
ingredients rapidly improve skin radiance & smoothness and have
a progressive action on wrinkles and uneven pigmentation.
This unique and complete formulation has 4 mechanisms of
action:
A IMMEDIATE EFFECTS
1 Exfoliation by means of the Glycolic acid
2 Protection due to the action of white mulberry, brown algae
and glycerin
B PROGRESSIVE EFFECTS
3 Stimulation with vitamins A, C and E
4 Correction of pigmentation due to the depigmenting
actions of Kojic acid and bearberry extracts. Kojic acid and
bearberry extract, which produces arbutin, reduce melanin
synthesis by inhibiting tyrosinase activity.
GlyKopeel is available in 20%, 50%, 70% and also 70% MAX
peels. It can be applied anytime of the year.
Volume 2 Number 4 Summer Edition 2009 | MedEsthetics
KEY FEATURE local article
of four concentrations including 20%, 35%, 50% and 70% free
glycolic acid. In addition, for those patients desiring a stronger
clinical effect after successfully completing a series of peels ending
at 70%, there is a High Potency Peel with 70% glycolic acid and
the added peeling agents ethyl pyruvate/pyruvic acid and acetic
acid. This range of formulation strengths enables the physician to
safely design a treatment program around the
skin care needs and tolerances of a particular patient. To enhance
the peel procedure, the NeoStrata Citriate SRS Peel Booster
pads can be used in conjunction with the glycolic acid solutions.
There is a choice of two different Citriate Booster pads to help
target treatment - the Clarifying Booster pad and the Brightening
Booster pad. Each can be easily incorporated into the procedure to
help improve specific skin conditions such as acne, pigmentation
and photodamage. For improving acne and acne scarring, the
Clarifying Booster pad should be used, which contains 20% citric
acid and 10% mandelic acid. Mandelic acid is lipid soluble AHA
This superficial peel has been on the market for over 20 years
and has been improved numerous times to become one of the
most popular superficial peels for both patients and physicians.
GlyKopeel is available in 20%, 50%, 70% and also 70% MAX
peels. It is unique that it offers superior benefits without recovery
time and can be done anytime of the year.
NeoStrata Peels
NeoStrata’s peeling solutions were developed by renowned
dermatologist Dr Eugen J Van Scott and dermatopharmacologist
Dr Ruey J Yu, to provide physicians with a highly effective,
superficial peeling system. NeoStrata peels offer maximum
bioavailability and free acid, along with a comprehensive range
of acid concentrations for optimum strength and flexibility in
treating patients of all skin types and conditions. NeoStrata’s peels
can easily be combined with other treatments and procedures
within the office to maximize skin benefits. The NeoStrata Skin
Rejuvenation System of glycolic acid peels offers the flexibility
Before
After
FILORGA
which is effective in penetrating the skin and helping to control
oil and sebum on the skin. For improving various pigmentation
irregularities, the Clarifying Booster pad should be used. This
booster pad contains 30% citric acid along with kojic acid and
arbutin, which are widely used lightening agents.
Before
After
DERMACEUTIC
NeoStrata superficial peels, in conjunction with a maintenance
regimen of the NeoStrata AHA, PHA and Bionic acid home-use
skin care products, can be used to improve skin imperfections
including fine lines and wrinkles, pigmentation irregularities,
mild to moderate acne, superficial acne scarring, keratosis pilaris,
pseudofolliculitis barbae, keratoses and/or benign lentigines. Some
physicians use light peels to improve sensitive skin conditions
such as rosacea or combine them with other cosmetic procedures
such as microdermabrasion, IPL and non ablative laser to provide
enhanced rejuvenation. Because this range of products makes the
skin more sensitive to the sun, a broad spectrum sunscreen of at
least SPF 15 must be applied while using these products and for
a week after use is discontinued.
and transdermal nutrition infusions. These work on the internal
function and structure of the skin, as well as by restoring essential
amino acids, proteins, water, vitamins and antioxidants to support
the skin, and enable the cells to stay alive longer and perform at
their healthiest. A Six-Layer Peel is safe for almost all skin types
and races. Excellent results can be achieved on thick, uneven
textured skin, wrinkles, fine lines, pigmentation, sun damage and
acne scarring. It is not recommended for people with very fine
fragile skin, excessively oily skin, certain forms of acne or those of
Indian extraction. In some cases to achieve optimum results, there
may need more than one application of Six-Layer Peel.
The Dermaceutic peeling range
This range of products includes a range of applications from
very superficial to deep in an easy-to-use format. The use of
combination peels affords the opportunity to generate highly
effective results with very little discomfort to the client and with a
low side effect profile. The range is made up of a very superficial
Mask peel (Glycolic acid 30%), a superficial Milk peel ( Glycolic
acid 50%, salicilic acid 4% and lactic acid 10%), two medium
depth peels in Cosmo and Spot peel as well as a very deep Exo
peel (Phenol). Both the Cosmo and Spot peels utilise a two step
peeling procedure. The Cosmo peel is based on a 15 or 18% TCA
followed by a mask containing lactic, salicylic, citric acids, retinyl
palmitate andascorbic acid. Spot peel starts with a milk peel
followed by a potent depigmenting mask containing mandelic
acid, idebinone, emblica, retinol and salicylic acid.
Danne Six layer peel
The six-layer peel is a resurfacing and regenerating procedure,
which removes and rebuilds at the same time. It removes dead
skin cells and stimulates collagen development. Six Layer peel
diminishes imperfections, reduces deep lines and wrinkles, refining
and smoothing thickened and rough textured skin. It eliminates
sun-damaged, pigmented discoloration and restores skin back to
a healthy fresh more youthful appearance.
The Six-Layer Peel is a unique blend of natural plant
and fruit sugar acids, applied systematically in layers. The number
of layers required is adjusted for the specific needs of the patient
and the desired result. The strength of the formulation is tailored
by the clinician or therapist to suit the skin colour, texture,
sensitivity and condition. The procedure takes either five, seven or
ten days depending on the individual.
The skin is prepared by using a formulation called Retosin,
a derivative of vitamin A, which strengthens new cells coming
through and regulates and normalizes skin functioning. The sixlayer peel is finished with a set of enzyme lift off treatments
Environ
Environ have a variety of peeling systems, using acidic creams
and gels instead of using acid solutions. These peels preserve as
much epidermis as possible while at the same time, achieving
the safest effective concentration of hydroniumions in the dermis.
These peels are designed to preserve the architecture of the skin
while simultaneously stimulating the fibroblasts in the dermis to
increase the quantity of collagen.
LIST OF SUPPLIERS
Filorga
www.filorgasouthafrica.co.za
012 548 3945
[email protected]
Neostrata Genop Healthcare
www.genophealthcare.co.za
011 545 6620
Danne Montague King
www.dannemking.com
011 262 6120
[email protected]
Environ
www.environ.co.za
0800 114 402
[email protected]
Can you achieve these
results?
With a large portion of aging caused by environmental damage, it is
essential to provide clients with treatments that effectively revise the skin.
The Pro Alpha Six-layer Peel is an in-salon treatment that is considered to have
effects similar to laser treatments or medical peels without the risk of trauma, long
convalescence or possible contra-indications.
Imitating nature for natural results has always
been the basis of the DMK concept. By
combining state-of-the-art botanical science
with innovative technology, DMK has created
one of the most advanced skin care systems
available.
The DMK concept is based on the principle
that cells of human skin do not positively react
to any chemical(s) they do not recognise. The
cells of the skin will react in a positive and
correct manner when confronted with similar
chemistry to that which they manufacture on
their own.
Excellent results can
be achieved on thick,
uneven textured skin,
wrinkles, fine lines,
pigmentation, sun
damage and scarring.
For more information about the
Pro Alpha Six-layer Peel or other
DANNÉ treatments contact your
nearest DANNÉ distributor.
Head Office: 011 262 6120
BEFORE
DURING
AFTER
Eastern Cape, Garden Route,
KwaZulu-Natal
Gauteng, Limpopo, Mpumalanga
Western Cape, Northern Cape
083 280 8633
079 697 2130
079 697 2122
[email protected]
[email protected]
[email protected]
rebuilding skin, rebuilding lives
www.dannemking.com
DIY
S
E
C
I
V
DE
When it comes to potential
growth areas for aesthetic practices, the smart
money is on physician-dispensed home use devices for
common conditions like acne and excessive hair growth. Two
compelling reasons are in play: First, today’s devices generally
offer better performance than devices of the past - their FDA
clearances guarantee low risk and a certain level of efficacy. Second,
consumers are demanding the ease, affordability and flexibility that
home use devices provide.
By Darcy Lewis
If your patients are not already asking about home use devices,
they will be. According to market research firm Medical Insight,
today’s $225 million home use device market is expected to
quadruple to $1 billion by 2012.
10
The
home use
market is exploding,”
says Robb Akridge, PhD, vice president
of clinical affairs at Clarisonic (clarisonic.com) and
creator of the Clarisonic skincare system. “The clear trend today
is taking what the professional has in the office and adapting it
for use at home.”
According to Fred Carr, vice president of marketing and business
development for Photomedex/ProCyte (photomedex.com), savvy
physicians have multiple reasons to retail home use devices to
their patients. “From a therapeutic standpoint, physicians are
DIY devices KEY FEATURE
finding that many of these devices really do offer the
benefits they claim, so they want their patients to
receive these benefits. And they want to be the ones
to educate their patients on which devices work and
why,” he says. “From a commercial standpoint, retailing
devices clearly enhances revenue.”
“Consumers who invest in home use
beauty products still go to the salon to
get their hair cut and colored or their
nails done because the professionals
do a better job.”
But it’s not just manufacturers who see home use
devices as an important trend, many clinicians do too. “I
believe this is where the future of medicine lies—we’re
currently seeing only a small portion of the total pool
of people who are medically good candidates for the
procedures we offer in the office,” says Tina Alster, MD,
director of the Washington Institute of Dermatologic
Laser Surgery in Washington, DC. “There’s a large
market out there that’s relatively untapped due to
finances, discomfort with in-office procedures or a lack
of awareness regarding these treatments. I think the
only patients we’re ‘losing’ to the home use device
market are the ones who are unlikely to come into our
offices, anyway.”
Eric Bernstein, MD, director of The Mainline Center
For Laser Surgery in Bryn Mawr, Pennsylvania, is
one physician who is embracing home use devices.
“You can’t put your finger in the dyke and hold back
technology. I see home devices as an adjunct to what
I do,” he says. “As people become more familiar with
home lasers, for example, I think that will stimulate
their interest in office-based laser procedures. After all,
consumers who invest in home use beauty products
still go to salons to get their hair cut and colored or
their nails done—all things they can do themselves at
home—because the professionals do a better job.”
Which Devices Are
Right for Your Office?
With the explosion of new home use devices hitting
the market, physicians often struggle with the question
of which devices to offer their patients. “If a device
catches my attention, I have to get excited about it. I
read all the clinical trials and test the device myself to
Antiaging Options
In keeping with a key demand of medical aesthetic patients,
manufacturers are developing home use devices to slow and
reverse the signs of aging.
FaceTrainer by no!no!
Launched in summer 2009, the FaceTrainer applies the principles of resistance
training to delicate facial muscles in a 10minute daily routine. “Professional solutions for wrinkles and sagging skin all use
very high levels of energy - we couldn’t
do that for home use,” says Dolev Rafaeli,
president/CEO, Radiancy. “We also know
that consumers want immediate effects.
Resistance training for the face has been
used in therapy for facial paralysis, but
no one had looked at it as a home-based
cosmetic solution before.” According to
Rafaeli, the FaceTrainer’s clinical studies
show that using the device for 30 days
resulted in an average 71% reduction in
sagging and 42% reduction in wrinkles.
Handheld Omnilux
Clear-U and New-U light therapy systems – an innovation for
convenience.
The light therapy treatment of acne and skin rejuvenation has
recently been simplified with the introduction of two FDA approved
small handheld LED systems.
• Omnilux Clear-U for the improvement of mild to moderate
acne utilizes switchable blue (415nm) and red (633nm) light
emitting diodes to destroy Propionibacterium acnes – the
bacteria responsible for acne. 70% of lesions cleared up after
4 weeks of alternating blue and red light therapy.
• For skin rejuvenation, Omnilux New-U utilizes alternating red
(633nm) and near infrared (830nm) light which targets cells
responsible for the synthesis and repair of the skin’s supportive
structures and stimulates the natural anti-aging process. A
significant reduction in periorbital wrinkles, an improvement
in skin tone, clarity, smoothness and elasticity is experienced.
Omnilux light therapy stimulates the body’s own cellular
mechanism by photo-modulation and therefore it is noninvasive and safe with no damage to the dermal tissue.
Clear-U R2000 excl VAT
New-U R2250 excl VAT
Genop Healthcare
Tel 011 545 6600, Fax 011 315 6008
www.genophealthcare.co.za
11
KEY FEATURE DIY devices
see how well it works,” says Dr. Bernstein. “I currently retail the TRIA
and the Clarisonic, but I have patients asking about several other
devices. If it’s something I’ve tested and was not impressed with, I
tell my patients that. If I haven’t read the studies or tested the device,
I tell them I’ll get back to them.”
This cautious approach makes sense to Clarisonic’s professional
marketing manager Heather Dazell. “Practitioners are understandably
leery of recommending a product if they haven’t tried it or seen
compelling evidence of efficacy,” she says. “Physicians’ livelihoods
are dependent on their credibility, so we absolutely encourage them
to carry a device only if it impresses them.”
Clarisonic has found success in the aesthetics market by adopting
a marketing strategy that supports the clinicians’ sales efforts. “We
sell two versions of the product, one for physicians and one direct to
consumer,” says Akridge. “Our professionals are very important to
us, so we always add additional features to the professional model,
which means they’re offering a better version of the product for the
same price.”
In addition, the company offers a professional trial program. “We
encourage physicians and skincare professionals to try the Clarisonic
in two ways: We offer it to them at a reduced price,” says Dazell,
“and our reps are trained to have the doctor try the system himself
before making a purchasing decision.”
But it’s not enough to win over just the doctor. “We suggest that
physicians only carry products that the whole office staff supports,”
says Dazell. “Occasionally the doctor likes the product but his
esthetician doesn’t, and that’s asking for trouble. Estheticians don’t
like having to sell things they don’t believe in.”
CLRS Technology hopes to emulate Clarisonic’s success with its
CLARO Home Intense Pulsed Light hair removal device. “We’re going
with physician-only distribution because we really want to build
off dermatologists’ high regard,” says James Pereyra, CLRS chief
marketing officer. “Consumers don’t know IPL technology yet, but
the physicians are very comfortable with it. We think they’ll be our
best advocates.”
Ensuring Patient Satisfaction
Physicians, as the retailers of these devices also need to help patients
set realistic expectations about the devices’ limitations and results.
“When something has been cleared by the FDA, it will be low risk
and reasonably effective,” says Dr. Bernstein. “It will not be as
effective and/or as fast at providing results as the treatments I offer
in the office, and I make sure all my patients understand that. Those
who do tend to be very happy with their home use devices,and they
appreciate being able to get them from a trusted source.”
Darcy Lewis is an award-winning Chicago journalist specializing in
healthcare and business topics.
12
Hair RemovaL Options
Some of the greatest demand for home use devices is
in the arena of hair removal, and this interest extends
beyond aesthetic patients. Many clinicians report
that their patients are anxious to introduce friends,
family and the men in their lives to light-based hair
removal.
TRIA Laser Hair Removal System
($795 retail, TRIA Beauty, triabeauty.com)
Dr. Eric Bernstein, who consults for TRIA,
is impressed with the TRIA Laser Hair
Removal System. The system uses
diode laser technology to destroy
hair follicles. “In my opinion, the TRIA
is the best home use hair removal device
currently on the market. It works, its studies
are compelling, and people love it,” he says.
The Tria is indicated for light to medium skin
tones with medium to dark hair. Prior to the
initial use, the purchaser needs to confirm
her skin tone’s suitability and activate the
unit. When applied to the skin, the laser
automatically emits a single laser pulse,
targeting multiple hair follicles in secondlong intervals.
HairMax Laser Comb
The HairMax Laser Comb delivers light in the visible
red wavelengths to target hair follicles of patients
with thinning hair, including male and female pattern
baldness. “In January 2007, we also became the
only device in America cleared by the FDA for hair
regrowth in patients with androgenetic alopecia,”
says David Michaels, managing director and founder
of HairMax. “After using the brush for 10 minutes
three times per week most users see a quantifiable
regrowth in hair.”
According to sales
director Randy Veliky,
the HairMax can be
used in conjunction with
Rogaine or Propecia
to enhance results.
“HairMax addresses
hair loss differently,
so the multitherapy
approach often gets
better results than either
independently,”
he says.
Silk’n SensEpil
($499 retail, Home Skinovations, silkn.com)
The SensEpil uses what the company terms Home Pulsed Light. It is the next
iteration of the Silk’n physician-dispensed hair removal device. “We have received
new FDA clearance for OTC sales,” notes Tom Goslau, vice president of marketing.
Safety features include a proprietary skin-sensing device that ensures that only
users with appropriate skin tones can activate the light pulse. The unit comes
with one disposable lamp cartridge, good for 750
light flashes or the equivalent of one full body
treatment from the neck down. “It’s a nice
addition to what I offer,” says Dr. Tina
Alster, who consulted in the new device’s
design. “A patient may come to me for her
bikini hair, but would find doing her legs inoffice to be cost prohibitive, so she purchases
a device to do them at home herself.”
Acne Treatment Options
Devices in this category are more readily seen as a continuation of a physician’s
in-office care and have been well-received in the profession. They are most often
recommended for use in conjunction with prescription-strength topical and oral
medications to control acne.
Omnilux Clear-U (R2000 excl
VAT retail, Photomedex/
Phototherapeutics,
phototherapeutics.com)
The Omnilux Clear-U has seven FDA clearances,
including acne, pain and photoaging. It combines
blue and red LED light to kill propionibacterium
acnes (P.acnes) and ease inflammation. “We’re also
currently seeking FDA approval for wound healing,
hair growth and scar reduction. We know we’ve got
the science on our side and physicians are supporting
us accordingly,” says Fred Carr, vice president of
marketing and business development. “The Clear-U
has the same intensity and output as our in-office
devices—it just covers a smaller area for safety
reasons.” The acne treatment course consists of two
20-minute treatments per week for four weeks with
alternating blue and red light.
KEY FEATURE DIY devices
Acne Treatment Options
Tända Professional Skincare
System ($250-$275 retail, Pharos Life,
tandaskincare.com)
The Tända Professional Clear features 414nm blue LED light to
destroy P.acnes. “In the clinical trial we conducted with the Tanda
Professional Clear, we found that daily self treatments using the device
reduced the number of acne lesions significantly. Moreover the study
demonstrated significant improvement of the subjects’ skin condition,”
says Michael H. Gold, MD of the Tennessee Clinical Research Centre
in Nashville. The company also offers the Tända Regenerate with
660nm red light to speed healing and stimulate collagen production.
Both devices are available in a professional model for dermatologists
and medspas and an over-the-counter model sold direct to
consumers.
CLARO ($250 retail, CLRS Technology,
myclaro.com)
Launched in August 2009, the CLARO is the first hand-held device to use IPL
technology for at-home, acne spot treatments. “Other home use devices for
acne have used LED or thermal energy, but if you ask dermatologists how they
treat acne in the office, they’ll tell you that IPL is the recommended standard,”
says James Pereyra, CLRS chief marketing officer. “Our combination of heat and
light drastically reduces treatment time down to 12 seconds per blemish.” The
rechargeable CLARO treats 50 to 60 blemishes per charge and has no disposable
elements or parts.
Clarisonic Skin Care System ($195 retail,
Clarisonic, clarisonic.com)
The Clarisonic skincare brush uses sonic frequency to gently and
effectively remove debris and cleanse pores. It also helps to reduce
dry patches, blemishes, and the appearance of fine lines and wrinkles.
“The Clarisonic is different from other home use devices in that
they tend to differ significantly from their high-grade, professional
counterparts,” says Robb Akridge, PhD, an immunologist and lead
inventor of the Sonicare toothbrush and Clarisonic. “The Clarisonic
Professional is used in-office by the clinician to cleanse skin prior to
procedures like chemical peels and microdermabrasion, and the same
device can be used safely at home by the patient.”
14
Specific skincare for hyperpigmentation
and photo-ageing.
®
Contains Rucinol and Sophora-_
- unique ingredients to effectively manage
hyperpigmentation.
Dermatologically tested & Fragrance free.
LAMAR france
THE TRUSTED SKINCARE COMPANY
Cipla Medpro (Pty) Ltd. Reg. No. 1995/004182/07, Rosen Heights, Pasita Street, Rosen Park, Bellville, 7530. Tel (021) 943 4200, Fax (021) 914 4699.
E-mail: [email protected] Website: www.cipla.co.za
LE RN
C
I
RT EA INT
A
& O
D
CP RIBE PD P
SC S C UE
B
SU THIC R ISS
1 E PE
scopes
HPCSA issues notice on
of practice in aesthetic medicine
On 13 October 2009, the HPCSA, by media release clarified various issues relating to cosmetic
medicine.
The HPCSA appears to differentiate between:
•
•
•
•
16
“cosmetic medicine procedures resulting in permanent changes”,
“cosmetic medicine procedures not resulting in permanent changes”,
“cosmetic surgery” and
“reconstructive surgery”.
CPD article KEY FEATURE
It defines “cosmetic surgery” as “an operative
procedure in which the principal purpose
is to improve the appearance, usually with
the connation that the improvement sought
is beyond the normal appearance, and its
acceptable variations, for the age and the
ethnic origin of the patient.” It furthermore
explains that cosmetic surgery was always an
elective procedure.
It also stated that cosmetic surgery could only be performed “in the
main” by specialists in plastic and reconstructive surgery. It does,
however, allow “other specialists” which have formal structured
training, assessment and ongoing professional development in
certain aspects of cosmetic surgery relevant to those particular
specialties to perform cosmetic surgery. Such training has to be,
if not part of normal specialist training, conducted by a training/
examination body accredited by the Board for such training”.
In general “cosmetic medicine” is defined as “the field that
dealt with any non-surgical cosmetic procedures”. It confirmed
that “cosmetic medicine” was not confined to any specialty or
discipline and could therefore, potentially, be performed by any
person registered at the HPCSA.
The HPCSA however, also stated that “any practitioner performing
cosmetic medicine procedures which result in permanent
anatomical and/or physiological changes shall be appropriately
trained as for cosmetic surgery.” The use of the phrase “any
practitioner” seems to indicate that general practitioners, dentists,
etc could all potentially perform cosmetic medicine procedures,
provided that they are appropriately trained.
It is not clear whether the implication of the above is that cosmetic
procedures that do not result in permanent anatomical and/or
physiological changes do not require “appropriate training” and
what exactly the definition of “permanent anatomical and/or
physiological changes”. For example, the use of fillers for wrinkles
is often regarded as not being “permanent” (it lasts for a couple
of months), as with certain other procedures.
It is, however, submitted that Rule 19 of the HPCSA’s Ethical Rules,
as amended in February 2009, dictate compliance with the “scope
of … practice”, and within that, only use “a form of treatment,
apparatus or health technology which is not secret and which is
not claimed to be secret; and an apparatus or health technology
which proves upon investigation to be capable of fulfilling the
claims made in regard to it”.
The use of equipment is regulated by other HPCSA policies,
and will, in future, also be subject to regulation by a new
South African Health Products Regulatory Authority (i.e. the
old Medicines Control Council (“MCC”). As far as to use of
equipment is concerned, the HPCSA Policy on Perverse Incentives,
as revised in 2007, states the following in connection with the
use of equipment, which is prevalent in the practice of cosmetic
medicine and surgery (emphases provided):
3.6.1 Health care practitioners shall only own and use
technological equipment if it forms an integral part of
their scope of practice and on condition that the health
care practitioner concerned has received appropriate
training in using and managing such equipment.
3.6.2 Health care practitioners shall not over-use equipment
for procedures, tests and other applications that are not
indicated, scientific or based on evidence. This constitutes
over-servicing and is prohibited.
3.6.3 Health care professionals shall not use technological
equipment, health care products or devices for profiteering
and must refrain from charging patients fees for the use of
such products or devices that are not market related.
As far as billing for equipment use is concerned, practitioners
should take heed of the rules in relation to fee-sharing, i.e. a
practitioner would not be allowed to share a proportion of the
equipment-use part of a bill with a person not registered at the
HPCSA, and who has not undertaken work with the practitioner.
If a piece of equipment is, therefore, owned by an outsider, the
practitioner may rent (at fair market value) the equipment from
that person, but may not share a percentage of patient income
with such a person. Care should also be taken that the amount
that is billed for equipment use does not amount to a violation of
competition law, and does not exploit patients.
The clarification issued by the HPCSA states that the practice of
cosmetic medicine should be in line with the “guidelines” issued
by the MCC. What is described as “guidelines” are in many
instances, legal requirements found in the Medicines and Related
Substances Act of 1965. It currently includes, amongst others that
medicines may only be used in line with its registered indications
and may only be administered and dispensed in line with the
applicable rules, i.e. schedules 2 and above must be prescribed
by an authorized prescriber and may only be administered and/or
dispensed by a person with the necessary qualification and license
to do so. This also means that practitioners should be careful when
17
KEY FEATURE CPD article
using medicines off-label (i.e. for indication for which it is not
registered). It should be noted that, unless a very clear informed
consent is obtained from the patient after being informed of- and
declaring that s/he understood- the available treatment options,
risks, benefits and costs of each, both practitioner and product
manufacturer may be liable, should anything negative happens to
the patient. Patients should be informed that the product to be
used is being used off-label.
It should also be noted that some devices are being registered
as medicines, as no device regulatory framework existed in the
past. A medicine is distinguished from a device in that, in terms
of section 1 of the Medicines Act, it “does not achieve its purpose
through chemical, pharmacological, immunological or metabolic
means in or on the human body.” It is clear that some products
are, therefore, erroneously registered as medicines, and would
have to be removed from the medicines register in future, and
could, potentially, be subject to call-up for device registration.
The envisaged regulatory framework for devices will authorize that
a device is, actually, “able to fulfill
the claims made with regard to it”.
It will also investigate the safety
and performance of the device.
Rule 23 of the HPCSA Ethical rules have also been amended,
in order to prevent practitioners from engaging in advocating
preferential usage of any medicine or device, where such
preferential use would lead to the practitioner receiving some
reward other than that lawfully payable in terms of the service
he or she renders. The agreements, whether in writing or verbal,
associated with equipment and medicines used in aesthetic
medicine should not provide for any such “other” remuneration,
and should contain clauses that protect the practitioner and
supplier from such allegations or enticements.
Practitioners should take care to ensure that patients, even
in esthetic medicine, receive what is clinically appropriate or
the most cost-effective, and not what would provide a “better
return on investment”, or in line with some reward or incentive
scheme.
In conclusion, practitioners in the field of aesthetic medicine
should obtain expert advice on, amongst others:
• their scope of practice in view of the latest HPCSA rulings on
cosmetic medicine and surgery;
• the use of equipment and the agreements associated with it,
in view of future medical device regulation;
• the use of registered medicines within their scope of
practice;
• all agreements with equipment and facility owners, as well as
agreements relating to equipment and medicine use, checked
from both an ethics and legal perspective; and
• the fees charged for medicines, devices and professional
fees.
Due to the voluntary nature of cosmetic medicine and surgery,
practitioners may feel that issues of fees may not be as pertinent
as where treatment is not voluntary. It is, however, important to
also ensure compliance with competition law, and to bear the
new Consumer Protection Act, 2009 (on terms and conditions,
value for money and quality), which is due to come into operation
in 2010, in mind.
Elsabe Klinck
Benguela Health Group
www.benguelahealth.com
registration instructions for your
free ethics cpd point
1. Go to www.medspecpublishing.co.za 2. Click on the
MedEsthetics CPD programme button. 3. Complete
the registration form and click the submit button.
4. You will be directed to your landing page, where
the questionnaires will be displayed. 5. Click on the
questionnaire which you would like to complete, once
completed click submit.
CPD MODULE SPONSORED BY ASTRAZENECA
18
©iStockphoto
www.emla.co.za
why should looking good
be a painful experience?
Applied an hour beforehand, emla helps reduce the pain and discomfort of many cosmetic procedures, including, laser
treatment, botox, fillers, dermabrasion, mesotherapy etc. In cream or patch, emla is a local anaesthetic that’s also a
blessing for injections, wart removal, dialysis and more.
Keep emla handy in your practice or let patients apply it at home – and see why more than 220 million people worldwide
are smiling.
Available from pharmacies without a prescription. Visit www.emla.co.za for more information.
lidocaine 25mg & prilocaine 25mg
AstraZeneca Pharmaceuticals (Pty) Ltd, 5 Leeuwkop Road, Sunninghill 2157, South Africa. Private Bag X30, Sunninghill 2157, South Africa. Tel: (011) 797-6000. Fax: (011) 797-6001. www.astrazeneca.co.za. Reg.
No.1992/005854/07. S1 Emla® Patch (Transdermal Therapeutic System). Reg No.: 30/4/0478. EPI date: 21/04/2004. each patch contains 25mg Lidocaine and 25mg Prilocaine. INDICATIONS: Topical anaesthesia of
intact skin for minor procedures, such as needle insertion and superficial surgical treatment of localised lesions, where application of EMLA one hour before the procedure is feasible. S1 Emla® 5% (Cream). Reg No.:
Z/4/51. EPI date: 16/11/2005. 1g of emla 5% cream contains 25mg of lidocaine and 25mg of prilocaine. INDICATIONS: Topical anaesthesia of the skin in connection with needle insertion, e.g. i.v. catheters or prior to blood
sampling where application of EMLA 5% cream 1 hour before the procedure is feasible. Topical anaesthesia of the genital mucosa prior to superficial surgical procedures lasting not longer than 10 minutes on small
superficial localised lesions e.g. removal of condylomata by laser or cautery, and biopsies. Topical anaesthesia of leg ulcers to facilitate mechanical cleansing/debridement. For full prescribing information, refer to the
®
package inserts. Emla is a registered trademark of the AstraZeneca group of companies. Compiled: October 2008.
LOCAL ARTICLE
UltraPulse
®
CO2 Fractional
Laser Treatments
for Aging Skin
UltraPulse technology was introduced more than 18 years ago, and has
proven itself with over 34 FDA cleared indications. Considered the gold standard of CO2 lasers,
UltraPulse has been referenced in over 90 peer-reviewed publications. With its long history of
fractional capabilities, UltraPulse has led the way in factional resurfacing.
UltraPulse
20
CW
Super-Pulse
UltraPulse high-energy short pulse
Ablates tissue quickly and provides hemostasis. Delivers four times more energy per
pulse than the super-pulse laser. Results in more new collagen formation than the
super-pulse laser
local article KEY FEATURE
CONTINUOUS
WAVE
Wide zone of
thermal damage
Increased
Char Downtime
Discomfort
ULTRAPULSE
Char caused by
overheating
Zone of ablation
Narrow zone of
thermal damage
Decreased
- Downtime
- Discomfort
Zone of thermal
damage
UltraPulse fractional laser treatments were introduced to
optimise outcomes and minimise downtime. The introduction
of ActiveFX and DeepFX, the first fractional CO2 treatments
available, reduces downtime and provides dramatic results. Both
procedures require only one system, one pass and one treatment.
The UltraPulse is the most versatile CO2 laser system available. It
is capable of offering the full range of fractional resurfacing.
DeepFX offers a small, deep spot microablative treatment for
deep wrinkles and scars and ActiveFX offers a large, superficial
spot treatment for fine lines, texture and dyschromia. DeepX and
ActiveFX can be combined to form TotalFX, for total outcomes in
the treatment of scars, fine lines, texture, dyschromia and deep
wrinkles.
Deep FX
for deep wrinkles & scars
Active FX
for fine lines, dyschromia & texture
Total FX
combined treatment for TOTAL outcomes
and new collagen formation throughout the entire treatment
area. Because only a fraction of the skin is actually touched by
the laser, healing time can be limited to just a few days.
ActiveFX/DeepFX procedures involve treating only a fraction of
the skin’s surface, leaving bridges of untouched skin to aid in the
regeneration process. Each laser pulse removes a narrow column
of tissue while simultaneously treating surrounding skin. The
deep heating causes immediate collagen contraction and longterm collagen remodelling. The result is softening and smoothing
of wrinkles and scars, and improved skin texture.
DeepFX/ActiveFX is typically performed in a physician’s office
and lasts for about 20 minutes. I make use of an application of
Emla cream with occlusion prior to treatment to aid in comfort.
As the micro beams are applied, the patient will experience a very
warm sensation and the appearance of the skin will be similar to
deep sunburn.
During the 5 days post treatment the patient will follow a
gentle washing and moisturizing regime, and avoid direct exposure
to sunlight. It has become evident with all or my patients that
Overview
Our skin changes over time, losing its youthful look and giving
way to brown spots, wrinkles and laxity. In recent years there
have been a growing number of aesthetic procedures available to
treat the skin. ActiveFX/DeepFX the result of the latest advances
in laser technology is a new procedure that yields remarkable,
long-lasting results with just one treatment. A fast, office-based
procedure with minimal patient downtime, this is your patient’s
single treatment solution for beautiful, younger looking skin.
Active FX/DeepFX is a revolutionary fractional laser technology
for aged, sun-damaged or scarred skin. The low-downtime
procedure uses fractional C02 laser micro beams to precisely
target the deep dermal layers of the skin. This stimulates a
cascade of healing responses that leads to tissue regeneration
Before
After
Before
After
21
Before
After
Before
After
Before
After
UltraPulse®
CO2 Fractional
Laser Treatments
for Aging Skin
as the skin heals, it will begin to flake and the patient will
notice improvement in texture, wrinkles, fine lines and scars.
In addition, the skin responds by stimulating organic growth
of new collagen that continues for up to 12 months. Results
of the treatment are long lasting and with proper skin care
and sun protection, can last for many years.
I have successfully treated and recommend the use of
ActiveFX/DeepFX for areas such as the full face, around the
mouth, crows feet, the neck, upper chest, hands and arms as
well as scarring.
Due to the ability of the “feathing” technique of this device, the practitioner is able to treat isolated areas without any
distinct demarcation. This I believe, is a very convenient advantage over the conventional CO2 ablative lasers previously
used. This benefit results in patient’s being able to select this
treatment as a cost effective option.
DeepFX is safe for most patients, however, it should not be
used in patients undergoing treatment with Accutane in the
past 12 months, have a history of keloid formation, have a
history of poor wound healing, or demonstrate excessive or
unusually prolonged erythema, hyper pigmentation or hypo
pigmentation upon laser test patching.
From experience the combination of ActiveFX for resurfacing
combined with DeepFX (for deep lines and wrinkles) delivers
optimal results.
Conclusion
Having treated patients with ActiveFX for the
past 2 years and now combining ActiveFX
with DeepFX, resulting in TotalFX the results
of these fractional laser treatments are longterm and with proper sun protection, can
persist for many years.
The reduction of rhytides and pigmentation with significant skin
tightening gives the ultimate result with a limited downtime
and superior remodelling of skin for up to 12 months.
Therefore the result with one system, one treatment and one
pass with practically no side effects and minimal downtime is
presently the most profitable treatment available.
By Dr Albert Niemann
MBChB, MPraxMed, MPharmMed, FCFP(SA),
Senior AME, Director of AAMSSA. Owner of Renew
Time Restoration™
22
KEY FEATURE acid test
Invisible
Ink
During the NBA Playoffs in May and June
2009, millions of basketball fans thrilled to the
athleticism of top players like Carmelo Anthony, Kobe Bryant and LeBron James.
They also marveled at the gallery of tattoos adorning the players’ arms, necks and backs. Young people are increasingly emulating their sports and entertainment idols by getting their own
tattoos. In January 2007 the PEW Research Center reported that
36% of U.S. citizens between the ages of 18 and 35 have at least
one tattoo—that’s more than 2.5 million tattooed citizens in that
age category alone. Earlier research published in the Journal of
the American Academy of Dermatology in 2005 suggested that
17% of those with tattoos will consider having one or more of
them removed.
“People tire of their tattoos—they become boring or outdated,
or the person’s life changes,” remarks Suzanne Linsmeier Kilmer,
MD, of the Laser and Skin Surgery Center of Northern California.
The current gold standard for tattoo removal is Q-switched lasers,
which deliver high energy in short (nanosecond) pulses at large
spot sizes. Our panel of experts explores some of the latest laser
introductions and refinements in practice parameters that allow
them to offer more effective tattoo treatments, plus a surprising
new technology developed to remove tattoos.
“Our ability to remove tattoos improved dramatically with the
introduction of the Q-switched laser about 10 years ago,” says
Eric Bernstein, MD, director of the Mainline Center for Laser Surgery in Bryn Mawr, Pennsylvania, and clinical associate professor
of dermatology at the University of Pennsylvania. “Q-switched
just means the laser energy is delivered in really short pulses
(nanoseconds not microseconds). To remove tattoos effectively,
24
you need a large spot size (3mm to 5mm or more), which necessitates high laser energies to penetrate deeply into the skin,
with sufficient fluences to fracture tattoo particles. Problems occur when you try to use a Q-switched laser that is underpowered,
forcing one to use a smaller spot size, which deposits the energy
superficially, hurting the epidermis but delivering very little energy
to where the tattoo pigment lies.”
Because laser wavelengths are absorbed by different colors,
you will need more than one laser to remove a wide range of
tattoos. “I use an alexandrite (755nm) or ruby (694nm) laser for
black, blue or green inks and an Nd:YAG (1064nm or 532nm) for
black or red/orange ink,” Dr. Bernstein explains.
Many companies offer Q-switched Nd:YAG lasers, which can
effectively remove most black, dark blue and red tattoo inks; for
other colors, you will need a Q-switched alexandrite or ruby laser.
Fortunately, manufacturers are now creating platform systems
that give you all of the necessary wavelengths in a single box.
“The HOYA Conbio Revlite delivers a lot of power at 1064nm,
enabling the use of large spot sizes for treating black and red
inks, especially in darkly pigmented patients,” says Dr. Bernstein.
The RevLite and MedLite C Series Q-switched Nd:YAG lasers
(HOYA ConBio, conbio.com) have been widely used for tattoo
removal for several years. They produce powerful 1064nm and
532nm wavelengths and include MultiLite Dye Laser Handpieces
that deliver 585nm and 650nm wavelengths for virtually full-color
spectrum tattoo removal.
Candela (candelalaser.com) introduced its Alex TriVantage in
2007, featuring a lightweight, flexible fiber optic delivery system.
Using its popular AlexLAZR, a Q-switched alexandrite laser as a
base, the company built in laser resonators to create Q-switched
532nm and 1064nm wavelengths.
“The Alex TriVantage offers the first-ever laser-pumped laser
invisible ink KEY FEATURE
handpieces,” says Dr. Bernstein. “This new technology lets the
Removing tattoos from dark skin can be especially difficult. MelAfter
Before
Alex TriVantage reliably deliver
powerful 532nm and 1064nm anin absorbs laser light so special
caution is the rule. Dr. Bernstein
wavelengths as well as the 755nm alexandrite wavelength. It insists on a test spot before offering the treatment to some patients.
treats a wide variety of tattoo ink colors because it can deliver “When treating black tattoos in dark skin, I always start with the
three different wavelengths of light. It’s also great at treating 1064nm wavelength, which will ‘see’ the tattoo pigment but have
pigmented lesions, especially in darker skin types, because of its less melanin absorption than other Q-switched wavelengths,” he
longer duration Q-switched pulse and microsecond domain alex- says. “For some patients I recommend Triluma, a retinoid, pulse
andrite laser pulses.
hydroquinone, and a steroid bleaching cream or other bleaching
“I am also impressed with the new Sinon Q-switched ruby laser agents to lighten the skin above the tattoo before laser treatments
(Quantel),” says Dr. Bernstein. “Ruby lasers used to be very difficult and I advise patients to stay out of the sun. I don’t treat tanned
to build reliably and efficiently. The Sinon offers a 20ns pulse length skin. After the treatment I cover the skin with Aquaphor tape for 6
and a 2hz repetition rate with high fluences and reliability, a break- to 10 days to protect it and help it heal.”
through in ruby laser technology in my opinion.” The ruby waveContraindications to laser tattoo removal include immunosuplength offers good to excellent
clearance
for
black,
blue,
green,
pression,
pregnancy,
Bruce Saal, MD, obtained these results following multiple
sessionscollagen
with thevascular disease, plaque psoriasis,
Medlite
C6
at
1064nm
magenta, gray and brown tattoo colors. The Sinon laser beam is malignancy, use of Accutane within six months and any history
divergent and spreads with distance, an important safety consider- of keloid scarring. “I won’t treat tattoos if there is any sign of an
“To remove tattoos effectively, you need a large spot
ation. In May 2009 Palomar Medical (palomarmedical.com) signed allergic reaction to the tattoo ink because the treatment can lead
which
necessitates
hightolaser
toallergic
pen- reaction,” adds Dr. Bernstein.
a distribution agreement withsize,
Quantel
SA (formerly
WaveLight and
a moreenergies
systematized
the Quantel Group) to distribute
Sinon ininto
the United
States with “Pain
management
depends
etratethedeeply
the skin,
sufficient
fluences
toon the type, size and location of
and Canada.
the tattoo; we use topical lidocaine for some, and local injections
fracture tattoo particles.”
or even nerve blocks for others. We offer patients these options for
Practical Considerations
pain control and charge just enough to cover costs. In some cases,
“When investigating devices for tattoo removal I ask ques- we sell patients topical anesthetic creams so they can come in for
tions like: How many photons can your device deliver at the larg- treatment with the cream already in effect,” notes Dr. Kilmer.
est spot size? You don’t want to have to decrease the spot size to
Patients at Dr. Kilmer’s Laser and Skin Surgery Center of Northget the energy you need as larger spot sizes penetrate deeper into ern California sign a consent form that clearly states the possibilthe dermis where the ink is located. What is the pulse duration? ity that clearance can take 20 treatments or more, that some tatThe pulse must be really short—nanoseconds—to best target the toos will never clear completely and that some may even darken
ink particle size and for safety,” says Dr. Kilmer.
in color.
Purchasing lasers that will allow you to offer effective tattoo
“Bottom line, these devices are expensive to use,” says Dr.
removal to a wide range of patients can cost $100,000 or more. Kilmer. “You have to charge accordingly. Our nurses have become
“If you are unsure whether your practice can support this equip- quite adept at estimating the number of treatments based on the
ment purchase, consider renting a laser to get started or buy one size, ink density and ink colors, which determine how many differlaser that can be used for additional procedures like treating pig- ent lasers are needed. The alexandrite laser is more expensive to
mented lesions and rent any additional lasers you may need,” Dr. maintain so if the tattoo includes green and blue inks, we add a
Kilmer suggests.
bit more. Our cost for a first treatment is $200 and increases with
Some inks will not clear completely even if you have a com- tattoo size. The fee drops at each subsequent treatment, but we
plete arsenal of lasers. “Aquas, yellows and fluorescents are tell patients the minimum cost will be $100/treatment.” Prices
particularly difficult to remove,” says Dr. Kilmer. “The number of listed on a variety of websites ranged from $50 to $500 per sestreatments required will also depend on the type of application sion, depending on the type of tattoo. Most fell into the $150 to
and what’s in the ink. Tattoos applied by professionals with ink $300 per session range. A few doctors offer flat, up-front rates
guns can take up to 15 treatments and some may never clear if of $1,000 to $1,200 for tattoos that can generally be cleared in
the inks contain certain compounds.”
10 to 12 treatments, noting that the set price allows patients to
Dr. Bernstein adds, “We never know what kind of ink we’re better manage their budgets and feel more secure that they can
working with. Removing black ink from light skin is not a prob- afford the procedure.
lem, but the iron oxide in white tattoo pigment can turn black as
a result of a laser treatment and that discolored pigment can be
Something New
impossible to remove. Be sure to include this possibility in your
Until a few months ago, the only alternatives to laser tattoo
consent form because some tattoos may even have a base layer removal were dermabrasion and chemical peels that faded but
of white pigment underlying the entire tattoo.”
could not reliably remove any but the most superficial tattoos.
25
KEY FEATURE invisible ink
Now there’s an interline tattoo pigments of
esting third option: “When treating black tattoos in dark skin, I always start all colors. We have even
with the 1064nm wavelength, which will ‘see’ the tat- used it successfully
EliminInk. Introduced
by Cynergy Products too pigment but have less melanin absorption than other on multicolor tattoos
(cynergyproducts.com)
that failed to respond
wavelengths.”
in November 2008,
to multiple laser treatEliminInk is placed into tissue using a technique similar to that ments. That’s why this is so exciting,” says Murata.
used by the original tattoo or permanent makeup artist. It con“We have had no complications of any kind from doing the
tains magnesium oxides and other ingredients that bind to the procedure,” says Dr. Murata, “but patient compliance is a big isiron oxides in the tattoo inks or the color pigments in permanent sue in determining the outcome. Patients must follow postprocemakeup and safely lift them to the surface through oxidation. A dure care instructions. It is vital that they do nothing to soften the
scab forms over the treated area that must be kept dry until it scab prematurely.”
falls off naturally.
“We charge $280 to $500 per treatment, depending on the
Because EliminInk is classified as a cosmetic rather than a size and density of the tattoo,” says Murata. “Each session takes
medical procedure, it does not need FDA approval. Unfortunately, approximately one hour, and we generally achieve complete clearthat also means there are no long-term safety and efficacy stud- ance of a tattoo within three to six sessions.”
ies of the product. The company did provide us with the name of
a physician who is offering the procedure in his practice, James
On the Horizon
J. Murata, MD, FACS, Ear, Nose and Throat Associates of South
“I think current lasers are fast and effective tools for removing
Florida in Boca Raton, Florida. We spoke with Caroline Murata, tattoos,” states Dr. Bernstein. “Of course, doctors always want
RN, who performs the EliminInk procedures in Dr. Murata’s prac- more power and a larger spot size at a more reasonable price.
tice, and heads the Harmonix Institute in Boca Raton, Florida, What would really improve our ability to remove tattoos is if evwhich provides training on the procedure.
eryone used an ink like the Freedom2 ink recently developed by R.
“Dr. Murata initially investigated the product because he had Rox Anderson and Kim Koger,” suggests Dr. Bernstein. “Freedom2
seen many patients treated with lasers who had scarring and min- Ink contains known ingredients and should be easier to remove
imal improvement even after multiple sessions,” reports Murata. by laser than other inks.” Candela has exclusive rights to develop
“In our experience, EliminInk offers better removal of permanent a laser device that works specifically with Freedom2 Ink, but it
makeup and tattoo ink with less discomfort during the procedure will undoubtedly be many years before a substantial number of
and with a better outcome.
tattoos use the ink.
“We use a German-made digital machine designed for perMeantime, doctors continue to work with existing equipment
manent makeup application that precisely places EliminInk at in an effort to fine tune laser tattoo removal. Sciton is working
the correct level of the tattoo ink or makeup pigment,” Murata with several doctors, including Todd Bessinger, MD, PhD, Aesthetic
explains. “After the procedure, a scab forms and must remain in & Dermatology Center, Honolulu, Hawaii, to investigate the use
place for several weeks until it comes off naturally. The scab actu- of the ProFractional (Sciton, sciton.com) laser for tattoo removal.
ally changes color as the different inks in the tattoo are absorbed “We have found that the ProFractional lightens tattoos indepenby the EliminInk and pulled to the surface. For permanent makeup, dent of the color of the tattoo, although it takes multiple treattwo to three treatments will usually do the job. For more complex ments just like Q-switched lasers. Ultimately, I think that tattoo
tattoos, we may need to repeat the application of EliminInk sev- removal will involve both Q-switched Nd:YAG and alexandrite laeral times. When the scab comes off, the patient applies Cynergy sers combined with fractional resurfacing,” says Dr. Bessinger. z
DermRenu, a scar inhibitor, two to three times per day for up to
eight weeks.
Linda W. Lewis, a MedEsthetics contributing editor, is based in
“It works for everything from jailhouse tattoos to top of the Orange County, California.
Local Suppliers
26
Hitech Lasers
Tel (012) 349 1250
Email: [email protected]
Genop Healthcare
Tel (011) 545 6600
Technolase
Tel (012) 349 1750
Intamed
Tel (011) 444 0404
Radiant Healthcare
Tel (011) 794 8253/2
Sternlasers
Tel (086) 117 8376
the
KEY FEATURE
By Lesley Ranft
The goal of marketing is to develop a series of strategies that will leverage
patient acquisition, strengthen patient loyalty and produce a strong return on
investment. The mainstay in traditional marketing has been word of mouth
referrals. However, with increased competition and a tight economy, many
practices are diversifying their marketing strategies in an effort to keep their
appointment books full.
mix
RIGHT
Where Patients Find New Providers
A successful marketing campaign combines internal marketing efforts to increase bookings among existing
patients and encourage word of mouth referrals, with external marketing efforts to attract new patients.
Consumers interested in aesthetic medicine typically research providers through a variety of means before
selecting a physician. They talk to friends, family members and co-workers; investigate doctors they’ve seen
in paid advertisements, on television or in print publications; and search the Internet before contacting the
practices that pique their interest. According to Jupiter Research, 63% of healthcare information seekers on
the Internet indicated that they would switch doctors if they found credible content online.
Whichever media you choose to reach out to patients, your message should be geared toward building trust
and credibility.
“In today’s day and age, internal marketing is still the most effective means to generate trust between patients
and the practice,” says Richard Greco, MD, of the Georgia Institute for Plastic Surgery in Savannah, Georgia.
“Successful internal marketing programs may include: quarterly newsletters, educational seminars, patient
testimonials, and before-and-after patient photos. But the Internet remains a critical component in practice
building. “
Online Marketing
There is no doubt that most consumers who are interested in aesthetic medicine search the Internet for
27
KEY FEATURE right mix
Before-and-after portfolios, manufacturer-supplied brochures
and posters, and email newsletters, all help to trigger interest
in new aesthetic
procedures
among
your
existing patient
base. In 2008, The
American Society
of Plastic Surgeons
found that 44% of
cosmetic patients
are repeat patients.
Are 44% of your
patients returning
for
additional
procedures?
If
not, you may want
to reexamine your
current efforts to
Crutchfield Dermatology includes a wealth of indication-specific
information plus patient testimonials on its website to build
credibility with prospective patients.
28
rebook existing patients.
One of the latest tools used to foster patient loyalty and increase
rebookings is text messaging. When offered by providers like Smile
Reminder (smilereminder.com), a simple software component is
added to the practice management software system that allows
you to create customizable email and text messages for members
of your database.
The messages can be used to remind patients of upcoming
scheduled appointments or to advise patients if the office is
closed or running late. Many practitioners are finding that it helps
to increase rebookings when used to notify patients that it’s time
to schedule their next Botox or dermal filler injection.
Practices can set parameters for specific demographics,appointment
confirmations or reminders, and cancellations. Imagine the extent
of improved productivity with a software component that can
pull cancellation and reminder lists off the practice desktop and
automatically send an appropriate message to targeted contacts.
“Electronic communication is low cost and high return,” says
Mitchell Chasin, MD, medical director of Reflections Center
for Skin and Body of Livingston and Bridgewater, New Jersey.
“The software for text messages integrates easily with our
software system, improves quality of care, and leverages office
efficiency.”
Reaching Prospective Patients
In addition to building word of mouth and increasing multiple
bookings among existing patients, you want to create a marketing
strategy that will consistently bring new patients through your
doors. External marketing campaigns, including direct mail, paid
media advertising and PR campaigns can help keep your name
front and center in your community.
Direct Mail. Direct mail campaigns are most effective when sent
to: current and past patients; referring doctors; and a purchased,
targeted list of prospective patients. Direct mail traditionally
provides a response of 1% to 2%. But as mailing lists have
become increasingly targeted those response rates have grown
to between 14% to 24%. An online search of “direct mail lists”
will bring you a variety of companies that can help you create a
targeted list based on gender, age, income and proximity to your
practice.
Direct mail messages may include newsletters, practice
announcements on new procedures, seasonal specials, or more
expansive custom-designed magazines that provide a wealth of
e
Internal Marketing
According to Jupiter Research, 63% of
healthcare information seekers on the
Internet indicated that they would switch
doctors if they found credible content online.
Lif
iant
Rad
information. Accordingly, developing some form of web presence
has become a must for practitioners. Building a website for your
practice is a great start. But with so many practices online, today’s
practitioners must also formulate a strategy to bring visitors to
their sites. Free and paid directories, like locteadoc.com, docshop.
com or those offered through professional associations are
valuable patient acquisition tools.
Search engine optimization (SEO), the practice of adding content
that will push your site to the top of search engines, has also
become more popular in recent years. One of the keys to
optimizing your standing on search engines relates to how often
new content is published to your site. The more often you update
your content through blogs, newsletters and postings, the higher
your standing.
The use of “pay per click” text advertising is also growing in
popularity. Pay per click campaigns give your website immediate
prominent positioning on Internet search engines when consumers
search select key words that relate to your offerings. As Charles E.
Crutchfield, MD, of Crutchfield Dermatology in Eagan, Minnesota,
explains, “I like the concept of Google Adwords, because you only
pay when a patient actually clicks through to visit your site, as
opposed to other marketing efforts where you pay regardless of
whether patients are calling or not.” But he notes, “The most
important thing in marketing is to take a multifaceted approach
and track the results.” Dr. Crutchfield uses print, radio and
direct mail advertising in conjunction with his Google Adword
advertising campaign.
Text messaging and custom publications are some of the latest marketing vehicles
designed to increase rebookings and new patient acquisitions.
right mix KEY FEATURE
information on medical aesthetics and your specific practice.
Custom designed publications, like newsstand magazines, offer
diverse content to reach broad a consumer base. The difference
is that these magazines also provide content that is customized
to your practice including a profile of the treating physician and
content outlining the procedures you perform plus special offers
currently available to patients. The magazine is sent to current
and prospective patients, and can also be placed in the waiting
room of your medical practice and the reception area of local
businesses you cross-promote with, including spas, beauty salons
and highend retailers. Sherry Simmons, MD, of Body Perfect
Medical Spa in Springfield, Illinois, successfully uses multiple
platforms to leverage patient acquisition, including Radiant Life
magazine (radiantlifemagazine.com). “Radiant Life contains
pertinent information about the treatments offered in my
practice,” she says. “It also offers me the ability to add content
about special offers, products and procedures. It helps to position
me as the expert in my community, which I find is essential in
today’s competitive environment. Combined with my weekly
cable and call-in radio shows, my practice has grown by 30%
through these marketing methods.”
P
c
hoto
e
ourt
sy o
Photo courtesy of Smile Remonder
Public Relations. Media coverage, whether
in print, radio, television or online, can help
you reach a large audience and establish
yourself as an expert in the field. But you
need to let the media know that you’re
available. This is where pubic relations
comes into play. A PR campaign may
include offering opinion editorial
(Op-ed) pieces to local or national
newspapers, providing educational
content to editors and producers, offering yourself
as an interviewee versed in a specialized area of cosmetic
medicine, or sharing in-depth information on new procedures
Repeat appearances on television, radio
and/or in print help to foster patient trust,
build your brand and create a call to
response.
coming to your community through your practice.
Although there is no guarantee that all of your public relations
efforts will result in coverage, PR campaigns tend to be low cost
and can help you develop an ongoing relationship with the press,
which can be beneficial in the long run. You can distribute press
releases to local and national media contacts by email, which
keeps costs low. Each release should include the following:
• The five Ws. “Who are you?” “What are you promoting?”
“Where is this taking place?” “When is this happening?”
and “Why do our readers/viewers need to know this now?”
• Your credentials to establish your expertise
• Visual aids. These may include photographs,
including before-and-after images, or video
As Marilyn Sardo, MD, San Diego, explains, “The numerous
press releases we’ve sent out have resulted in both local and
national exposure for my practice, and that exposure has
brought many new patients into my practice.”
Paid advertising. Paid advertising efforts are most effective
when they are repetitive. Repeat appearances on television,
radio and/or in print help to foster patient trust, build your
brand and create a call to response. Getting the best return
on your advertising dollars starts by choosing advertising
media that hits your target market and then tracking the
response you receive from each advertising effort. Daily
or weekly regional newspapers and local cable television
advertising spots ensure that you’re hitting your target
market in terms of proximity. You can also investigate
markets that speak to more affluent community members
including local symphony or theater programs. Metropolitan
and beauty-oriented magazines offer a longer shelf life than
television or radio TV ads, as they are often reviewed multiple
times by more than one person in a household, but they may not
be as targeted in terms of physical distribution.
The best means of developing an effective marketing strategy is to
identify your niche in the community, identify your target market
and design a multifaceted marketing program that speaks to both
potential and existing patients. It may be helpful to assign a staff
member in the office to monitor advertising and public relations
appearances in order to ensure that they run as scheduled, and to
track the efforts that are inviting the strongest response.
Lesley Ranft is a San Diego, California-based freelance writer.
29
BUSINESS CONSULTANT
Patient
Consult
Increase conversions by understanding what prospective patients need
to hear from you. The more you can reassure the patient that she is in the right place for the
right procedure, the more likely she is to book the treatment.
Once you’ve developed and implemented a successful marketing
program to attract new patients, it’s time to turn those leads into
bookings. Patients tend to base their decision on whether or not
to move forward with an aesthetic procedure on two factors: their
comfort level with the treating physician and their comfort level
with the risks and benefits of the given procedure. Addressing
these fundamentals in your patient consult can pay dividends in
increased conversion rates.
by fixing, repairing or enhancing it, she will feel better.
She’s also heard negative stories about cosmetic procedures
and wants to avoid making a bad choice that she will regret. The
more you can reassure the patient that she is in the right place for
the right procedure, the more likely she is to book the treatment
with you.
The Patient’s Perspective
The aesthetic patient needs two things: She needs to feel
comfortable with you and she needs time to ease into a decision.
The amount of time can vary depending on the scope of the
procedures recommended. So several things need to take place
at the front end before the prospective patient meets with you in
her consultation.
If you set the stage correctly, 80% of the selling will be done
by your staff leaving you to focus on bonding with the patient,
reiterating the information she already has and addressing any
questions. There are a few ways for you and your staff to do this.
Every prospective patient who contacts your practice is performing
a cost/benefit analysis in her head in an attempt to determine
whether what you are offering is worth the time, money, effort
and risks associated with the desired treatment. And despite—or
perhaps because of—the abundance of information available on
medical cosmetic procedures, today’s aesthetic patient is more
confused than ever. She’s facing multiple options for physicians,
treatments and products and often ends up overwhelmed.
Consider how difficult this process can be for your patient.
At the initial consultation she will likely feel awkward and
uncomfortable. She wants to change something about her
appearance that is making her feel insecure, and she hopes that
30
The “Pre” Consultation
Create a Practice Welcome Package. Welcome packages allow
you to quickly and effectively provide information about your
practice and procedures to prospective patients who contact you
by email or phone. Think of this as a “shock and awe” package of
high-quality materials including:
• A welcome letter with a handwritten note from you telling the
prospective patient that you look forward to meeting her
• S pecific information on the procedure she has expressed
interested in
• Patient testimonials with before-and-after photos
• Your career highlights, including education, media coverage,
experience, areas of expertise
a nd medical association memberships
• A practice brochure outlining your philosophy and procedures
• A DVD of you, your staff, your office and patient testimonials
(optional but impressive)
Continue the Education In-Office. When the patient arrives at
your office for her consultation, there are a number of steps your
staff can take to put her at ease and assist in the consultation. They
include: offering her a beverage and inviting her to peruse an album
with patient testimonials and before-and-after pictures. If you have a
television and DVD player, they can put in a patient education video
of the procedure she has expressed interest in and/or a welcome
video introducing her to your practice and staff.
The Consultation
A successful consultation is one in which the patient sees a solution
to her problem, likes and trusts you and then books the procedure.
There are some fundamental steps you can take to ensure that you’re
providing all the information a patient needs to book a procedure at
your practice.
Step 1
Introduce Yourself. Knock on the door gently before opening and
greet the patient by name. Introduce yourself while you look her in
the eye, smile and shake her hand.
Step 2
Build Rapport. Think of the prospective patient as a person
first and a patient second. Spend a couple of minutes discussing
nonmedical topics with her before you launch into the reason for
her visit. The patient will share more information with you about her
expectations and concerns if she feels like you are interested in her
as a person. The goal is to make the patient comfortable enough to
open up to you.
Step 3
Uncover the Problem. You can uncover the patient’s concerns
and motivations for seeking treatment by asking an open-ended
question such as, "What can I help you with today?”Or, by simply
confirming what you already know based on her initial inquiry and
staff communication, "Sara tells me you have a wedding coming
up?” and then let her elaborate.
Listening is a skill. The amount of attention you provide in actively
BUSINESS CONSULTANT
listening to the patient
at this point will directly
correlate to how much
information she is willing
provide. To maintain your
focus on the patient, it may
help to nod, look at her
and take notes while she is
talking so she knows that
you are listening carefully.
Step 4
Attach Emotions
to the Problem and
Solution. Be sure to get
the prospective patient
emotionally involved. Ask
her additional qualifying
questions that speak to
her emotions such as, ”How long has this bothered you?” or
”Why did you not seek help sooner?”
You want the patient to feel the need and benefits of your
treatments. Find out how big the problem is, and how it affects
her life.
Please remember to show respect for the patient. Even though
you are the expert, arrogance does not sell. If you come across
as demeaning, condescending or intimidating, you’ll drive the
prospective patient away. Use words she will understand, be
concise and keep it simple. Then briefly reiterate the main points
touched on by the patient. Ask if you have left anything out, then
wait for her answer.
Step 5
Know Where You Stand. Following the reiteration of your
conversation, ask additional probing questions to determine
where the patient is in her decision-making process. For example,
”Have you seen any other doctors and, if so, do you have any
questions they have not addressed?”
Step 6
Manage Expectations. The golden rule of the successful
aesthetics practice is: Under promise and over deliver. It is your
job to ensure the patient has an experience equal to what was
promised to her. The following tools will help you communicate
realistic expectations that the patient can see, feel and touch:
• Use a mirror and your hands to show her what you
recommend and how it will change her current appearance
• Draw a picture if you’re artistic
• Show photos of previous patients and tell their stories
• Perform computer imaging
• Have the patient speak to other patients and/or staff
members who’ve undergone similar procedures
• Show her videos of the procedure
32
• Let her touch the
breast implants, skin
care products, etc.
• Use metaphors,
analogies and
anecdotal experiences
of other patients to
relay information
A great way to set
expectations is to use the
best case/worst case scenario.
For example, if the patient is
asking you how long the
recovery will take, you can
respond by saying, "The best
case scenario is that you will
be back at work the next day;
however, some patients need an extra 24 to 48 hours.” Or, let her
know that four out of five patients go back to work the next day.
This way, if she is not the “best case” or the “four out of five,” she
will recall that you did mention this could happen.
Step 7:
Qualify/Differentiate Yourself. The prospective patient wants
to know that you are confident that she will get a good result so it
helps to: look the patient in the eye and let her know that you are
confident in your ability to give her a good result; inform her that
you have done many of these procedures with excellent results;
and let her know that you understand her concerns and fears.
Step 8
Reassure the Patient. The patient needs to be confident about
your skills. She also wants a little prodding from you so that she
feels you are competent and will deliver. Simple phrases like
"You are the perfect candidate for this procedure,” or "We have
something to work with here, and I’m sure you will be pleased
with the outcome,” can help.
Step 9: Close the Consultation. Prepare a closing statement
before you hand the prospective patient back to your front desk
staff or patient care coordinator to discuss financing particulars
and schedule the procedure. Something simple like, ”I look
forward to working with you.”
Perfecting these fundamental steps of the
patient consultation process will help ensure the
highest closing ratio possible.
Catherine Maley, MBA, is an industry consultant and the author
of Your Aesthetic Practice: What Your Patients Are Saying. You can
contact her at cosmeticimagemarketing.com.
ADVERTORIAL
IMCAS NEWS AUTUMN 2009 –
ADVANCES IN CELLULITE TREATMENT
by Diane I Duncan, M.D. Plastic Surgeon
Recent histologic evaluation of the dermal/fat
inaccurate;
junction in patients with cellulite disputes the
or changing the lighting
cavantional thought that tight dermatofibrils cause
can
bulging of fat under the skin. Cellulite has been
improvement that is not
classified into grades I-IV, based on this theory.
real.
The idea that cellulite is a result of a vertically oriented
see even a 50% improvement
pathophysiologic process is no longer valid.
as a failure; if “hail damage”
In 2008, Golitz and Duncan looked at serial
create
overexposure
an
apparent
Patients with cellulite
is still evident, they will not be
biopsies of cellulite at the junction of the deep
satisfied. The date, no objective
dermis and fat in patients with normal appearing
measurements device for cellulite
skin and those with cellulite. They noted that in the
has been available.
normal patients, “peninsulas” of fat protrude into
In 2008 and early 2009, the BotyTiteTM
the deep dermis, and fingers of dermis extend into
radiofrequency
the fatty layer. The coastline is irregular, and a good
machine was used to treat cellulite and
assisted liposuction
target for correcting skin contour irregularities in this
lipodystrophy in six women under IRB
junction.
auspices. The device uses a bipolar signal, and
In cellulite patients, the peninsulas were found to
has a clothespin type handpiece. The cannula,
be exaggerated, with some measurable thinning of
inserted into the subcutaneous fat, has a RF tip
skin thickness at the apex of the invaginated fat. The
on the small suction cannula. The external part
subcutaneous fat layer was carefully examined for
of the device has a board round thermistor
“dermatofibrils”. Other than the normal extensions
that heats the sin overlying the cannula tip.
of dermis into the fatty layer, there were no thickened
The “sandwich “ approach is novel, and is
strands of collagen tying the dermis to underlying fat
very effective for treating the dermis/fat
or fascia present.
junction.
Gross specimen evaluation showed a “honeycomb”
Safe settings are essential for good
appearance of fat globules in both normal skin/
results. The heating modality is effective
fat specimens and those of patients with cellulite.
for reducing the size of bulging fat
The skin in the cellulite patients appeared thinner,
globules, and for causing a reduction in
especially at the most protuberant point in the “hill”
surface area of the skin. The combination
of the irregularity.
is very effective for treating cellulite,
Given the absence of a tethering force, it appears as
patients with mild skin laxity, and those
if the pathology is located at the dermal/fat junction.
with skin contour irregularities following
The irregular topography is the real problem, and
liposuction.
has three components: too much surface area,
The advent of radiofrequency assisted
depressions that dip below the ideal, and protrusions
liposuction using an internal and
that extend above the ideal.
external heating device has mad
Once the pathologic process is viewed as a
it possible to target the location of
horizontally oriented surface irregularity problem, a
the problem region in patients with
better and more permanent solution for cellulite can
cellulite. Ongoing studies will show
be created.
the degree of improvement using the
Another problem in the treatment of cellulite
interpolated surface measurements,
has been the difficulty in measuring improvement.
and the longevity of improvement in
Photographs are notoriously
skin quality
33
LOCAL CASE STUDY
CASE
STUDY
Evaluation of the enhancement of efficacy with injection of a
hypo-osmolar solution prior to localized on-invasive ultrasound
treatment for the reduction of localized fat deposits.
Body contouring and fat reduction treatments are highly
requested by patients. Because invasive methods carry high
risks for side effects and complications, the development of noninvasive technologies for body contouring has opened numerous
doors in this field of medicine. Non-invasive ultrasound devices
offer patients safe and effective results for reducing localized fat
deposits.
The device used for this case study was the NovaShape
(Ultramed), which was selected due to its advanced technology
which, unlike the focused beam, fixed frequency and heat
generation of other known devices, has a seemingly variable
frequency, non-focused beam and chilled transmitter, with no-heat
generation and a mechanical cell wall destruction mechanism. The
efficacy and safety of this device has been confirmed in a number
of research studies, which have demonstrated superior efficacy
compared with other similar ultrasound devices.
Safety has been well researched in studies evaluating urinary
and blood levels before, during and after treatment, showing
the normalizing of triglycerides, liver transaminases and urinary
density within 48 hours after the treatment. After treatment,
LaPente found a significant reduction in circumferential
measurement of the abdomen (12 cm) and lower limbs (5 cm).
Abdominal volume was reduced to 9.27% and lower limbs to
11.2%. Shortly after treatment, blood triglycerides rose by 77.7%
and liver transaminase rose by 11.3%. Total cholesterol, mean
gamma glutamyl transpeptidase, and ketonic bodies in the urine
showed slight changes. Mean urinary density was also slightly
raised.
Studies published on the use of adipocytolysis using hypoosmolar solutions combined with the weakening of the cellular
34
Dr Riekie Smit
MBChB (UOFS)
MSc Sports Medicine(Pret)
membrane using specific ultrasound energy designed for the
destruction of adipocytes have shown the efficacy of combination
therapy. These studies will be briefly outlined in the case study
report.
The purpose of this case study was to evaluate the efficacy of
adding an injectable solution prior to treatment with the focused
ultrasound.
Case Study Group
-
-
1 male and 4 females
Age between 20 – 50 years
Exclusion criteria
-
-
-
-
-
Diabetes
Other weight loss medication or treatments
Use of corticosteroids
BMI > 35 or < 20 kg/m2
Liver or kidney disease or abnormality
Area of treatment
-
Thighs or abdomen
Treatment
- One side of treatment area: focused ultrasound with
NovaShape only
- Other side: injection of Solution A plus focused ultrasound
with Novashape
- Areas of 80 cm2 were marked out in a standing position
Areas of 80cm2 was marked out in a standing position.
Solution A: hypo-osmolar solution containing injectable water, lidocaine and ascorbic acid.
10 ml of the solution per treatment area was
injected with 27G 13 mm needles using a multipuncture technique - 0.5 ml of solution is injected over the marked area in points 1cm apart.
The patients were evaluated before and 3 weeks
after treatment by means of the following measures:
- Weight
- Bio-electrical impedance
- Measurements of the areas treated
- Photographs
- Sonar evaluation for measuring sub
cutaneous fat
.ONINVASIVE"ODY#ONTOURING
#ELLULITE2EDUCTION
5NIQUEULTRASOUND
TECHNOLOGY
,OWFREQUENCY
.OHEATING
.ONINVASIVE
-OST!FFORDABLE
Results
After one session of treatment, with NovaShape alone, sonar evaluation showed an average of 11.2 mm reduction of subcutaneous fat
per patient. The contra lateral areas treated with
the hypo-osmolar injection solution combined
with NovaShape showed an average reduction
of 14.2 mm subcutaneous fat per patient. The
patients’ weight remained stable, the bioelectrical impedence remained the same, and centimetre loss over the treated area (including both
treatment groups) averaged 4.6 cm.
The sonar evaluations (figure 1 and 2)
showed clear resolving of fat cells and reduction
of the subcutaneous fat layer in all the treated
areas. The measurements showed the improved
efficacy obtained by combining Novashape with
prior treatment with a hypo-osmolar solution
over the area to be treated.
Adipose layer measurement (mm)
40
35.2
CMREDUCTION
AFTERTREATMENTS
&ULLY
PORTABLE
36.1
35
30
3CIENTIlCALLY
PROVEN
Pre-treatment
24
25
21.9
1 Week
Post-treatment
20
15
&INANCINGAVAILABLE
4ECHNOLASE CC
10
4ELs&AX
5
%MAILTECHNOLA MWEBCOZA
WWWTECHNOLASECOZA
0
WWWULTRAMEDCH
Novashape
Alone
Novashape combined with
hypo-osmolar injections
LOCAL CASE STUDY
Figure 1. This first case shows the sonar evaluation of both treatment areas
before (image on the left) and 1 week after (image on the right) treatment
with the Novashape device. The treatment was performed over the abdominal
area. The right side of the abdominal area was treated with the Novashape
only and the left side with the hypo-osmolar solution combined with the
Novashape. The measurements of the adipose layer were: right side, 38.4
mm before treatment and 21.7 mm after treatment; left side, 39.6 mm before
treatment and 19.1 mm after treatment.
Discussion
Lipolysis by means of focused resonant ultrasound through
ultracavitation is a new and effective non-invasive method
to reduce localized fat deposits. The efficacy and safety of this
treatment has been confirmed by previous studies. The treatment
on its own is very effective and deserves a significant place
in treating fat deposits, though this study has shown that the
results can be enhanced by combining the treatment with prior
injection of a hypo-osmolar solution in the area to be treated. This
combination treatment may be indicated in the small amount of
resistant cases and in patients wanting faster results. However, not
all patients will feel comfortable with the addition of an injectable
procedure and sufficient scientific support shows that treatment
with the Novashape device alone will be effective enough. This
specific study also showed the efficacy of the treatment on the
side that received ultrasound treatment alone.
Therefore, the study demonstrates not only the visible efficacy
36
Figure 2. This sonar evaluation was performed on a patient receiving
treatment over her waist area. The patient received Novashape alone on the
left side and Novashape combined with the hypo-osmolar solution on the
right side. On sonar, the adipose layer on the right side measured 19.8 mm
before treatment and 15.6 mm after treatment. The left side measured 19.1
mm before and 16.5 mm after the treatment.
of treatment of localized fat pads utilizing the NovaShape device,
but also demonstrates the enhancement of results by prior
injection of a hypo-osmolar solution into the area to be treated.
In conclusion, including prior injection of hypo-osmolar
solution over an area to be treated with the Novashape provides
a valuable treatment option for patients who are comfortable
with receiving injections.
References
1. Crassas Y, Blache D. Adipocytolysis using the Novashape Ultrasound
Machine, alternative to liposuction 2 years follow up.
2.Kubota J. Matsuda H. A Clinical Trial of Multi-frequency Ultrasound
Device for Non-invasive Body Contouring.
3. Haviarova Z, Haviar M. Body Contouring – comparison of various
ultrasound techniques.
4. Fernandes JPL. Results of treatment of the edematous fibrosclerotic
panniculopathe grades II- III in 50 patients with the Novashape
device for selective fat ultracavitation. Int Journal Cosm Med &
Surg.
5. Michel A, Blache D Adipocytolysis: alternative treatment 6 years
behind liposuction, limitations and research perspectives. PACAAM
Sept 2008.
ADVERTORIAL
Radio Frequency Assisted Lipolysis
Comes of age
By Malcolm Paul, MD. FACS
Liposuction is expected to escalate word wide
in years to come. The evolution of this surgical
technique includes the following approaches
to remove unwanted amounts of fat in various
locations.
1. Simultaneous skin tightening
1. Dry technique (SAL)
2. Wet tumescent techniques
3. Ultrasonic assisted liposuction (UAL)
4. Power assisted liposuction (PAL)
5. Laser assisted liposuction (LAL)
6. Externally applied ultrasonic energy.
All of these techniques are not precise, as there is no closedloop system to monitor power delivered, skin temperature,
impendence of energy delivered to allow fat removal and
significant soft tissue retraction are not consistent treatments of
these devices.
7. Radio frequency assisted liposuction (RFAL)
THE DEVICE
The InvasixTM BodyTite system is composed of the following:
1. A bipolar radio frequency hand piece; and
2. A RFAL computer device.
The hand piece has an internal and an external electrode. The
internal electrode is coated with Teflon for the entire length of the
probe. The energy is delivered at the end of the probe, which is
not coated. The external electrode delivers a focused amount of
energy through the skin and measures the skin temperature.
The amount of energy delivered to the fat is watts, the limit of skin
temperature in degrees, and high and low limits of impendance
are determined by the surgeon on a user-friendly touch screen.
All parameters are controlled in a close-loop system to prevent
excessive heating of fat and/or dermis.
The delivery of bipolar radiofrequency energy has the enormous
benefit of being able to quickly and precisely control the depth
and direction of energy to the fat, blood vessels, and dermis.
This device allows for the following; :
• Reduced tissue trauma;
• Coagulation of blood vessels;
• Safe, controlled application of energy and skin temperature monitoring; and,
• Uniform heating of skin and subcutaneous layer.
CLINICAL OBSERVATIONS
The evolving technology that uses radiofrequency energy to dissolve
fat has produced favorable responses for patients and interesting
observations with regard to postoperative findings.
For example, patients report minimal discomfort, particularly in areas
that traditionally are quite uncomfortable – such as the epigastrium
and areas that have been treated secondarily.
Reduced ecchymosis provides for less discomfort due to the
simultaneous coagulation of blood vessels.
You can expect tissue contraction with improved contour, even
in patients in whom retraction was expected to be minimal (for
example, avoiding an abdominoplasty in patients with skin laxity and
lipodystrophy). In addition, the patient experiences a faster return t
daily activities due to minimal discomfort.
There is a minimal risk of sequelae and complications due to the
closed-loop feedback fetatures of the device – less risk of thermal
burns as the energy delivered in watts, soft-tissue impedance, and
skin-temperature limit are preset.
CONCLUSION
RF-assisted liposuction is a promising technology for body contouring
with the following main advantages :
• The ability to heat quickly and uniformly as significant volume of
tissues with the effects of coagulation of blood vessels, dissolving
of fat (lypolysis) and tightening of the skin by controlled subdermal
heating; and,
• The ability to control tissue heating via the direct monitoring of
temperature and tissue impedance on a user-friendly, touch screebased, narrow-footprint computer device.
The correlation between tissue heating temperature, time of application
of the energy, and the skin tightening requires additional investigation
– which is in progress.
The emerging technology is the latest chapter in invasive body
contouring, and appears to offer and exciting new vista in
noneexcisional body contouring.
• High speed of treatment;
37
KEY FEATURE
profits in
times
FAT LEAN
According to a recently released study, new offerings in fat reduction may help fuel sales in the
aesthetics market. American Health and Beauty reported a surge in traffic from patients looking
for nonsurgical, noninvasive alternatives to liposuction.
The market for fat reduction devices will grow more rapidly
than the market for other body contouring devices for the
next five years—at least in Europe, says Toronto-based
Millennium Research Group, a global authority on medical
technology market intelligence. Whether the United States
keeps pace may depend on the FDA.
Fat reduction devices include laser-assisted lipolysis,
low-level laser-assisted lipoplasty (LLL) and transdermal
ultrasound. According to MRG’s “Body Contouring 2009”
report on the European market, physicians adopting
newer modalities like transdermal ultrasound and laser,
light and energy-based fat reduction devices will fuel
the upsurge as they continue to meet the public’s
demand for less invasive fat reduction solutions. The
report, available at decisionresourcesinc.com covers
markets in France, Germany, Italy, Spain and the United
Kingdom.
The U.S. market has already seen substantial growth
in laser-assisted lipolysis devices since Smartlipo
(Cynosure, cynosure.com) was introduced in 2006. “We
now have nine companies offering these devices,” says
Bruce E. Katz, MD, clinical professor of dermatology at
The Mount Sinai School of Medicine and director of
Juva Skin & Laser Center in New York. Dr. Katz has been
working with liposuction for 25 years and conducted
some of the early clinical trials on Smartlipo. “Laser lipo
is now more popular than traditional liposuction, and
with the increased power of these devices, we are able
to use them for large as well as small areas of fat all over
the body,” he says. “Laser lipo is minimally invasive, can
be done using local anesthetic and the lmm laser fibers
give you the ability to remove fat precisely, sculpt the body
aesthetically and tighten the skin at the same time.”
When it comes to other fat reduction solutions, such
as transdermal ultrasound, the U.S. market lags well
behind Europe as it awaits FDA approval for UltraShape and
LipoSonix. Both devices are currently available in Europe and
Canada. Dr. Katz says focused ultrasound does remove fat in
small amounts but current devices are slow and offer no way
to sculpt the body. He suggests that the devices may be refined
38
in time to include smaller transducers that would give the
physician more control over fat removal.
Hot Topic
In June the online magazine American Health and Beauty
(americanhealthandbeauty.com), which has one of the
largest directories of aesthetic providers, reported a
surge in traffic from patients looking for nonsurgical,
noninvasive alternatives to liposuction. Two LLL devices,
Zerona (Erchonia, erchonia.com) and Lipo-Ex (Advanced
Aesthetic Concepts, fromstarttoperfection.com),
are attracting the most attention. Like transdermal
ultrasound devices, they claim to break down fat
cells, allowing the lymphatic system to clear away the
debris naturally—no invasive extraction cannulae
required.
Erchonia reports that early clinical studies of
the Zerona verify an average of 3.65 inches of
circumference loss after six 40-minute treatments.
Rodrigo Neira, MD, Alan Bauman, MD, and James
Chan, MD, have all presented positive reports on
laser emulsification using the Zerona. Frank Ryan,
MD, a board-certified plastic surgeon in Beverly
Hills, California, raves about the Zerona in his blog
(drfrankryanblog.com), saying it “revolutionizes the
field.”
While Dr. Katz has not worked with LLL devices,
he points out that they have not yet received FDA
approval and says there are no published clinical
trials that show their effectiveness. His experience
makes him skeptical that these low power devices
could produce more than minimal results.
Like UltraShape and Lipo-Ex, Zerona is hoping for
FDA approval this summer. Perhaps the addition of these
new technologies with some compelling clinical studies
would generate enough excitement to drive more patients
into U.S. medical aesthetic businesses by year’s end and fuel
the kind of growth the MRG report predicts in Europe. z
Linda W. Lewis is a MedEsthetics contributing editor.
BEST PRACTICES
01 Advanced Skin Typing
01
Skin type plays an important role in prescribing treatments and determining treatment
parameters. But current strategies used to determine Fitzpatrick skin types—based on skin
tone, eye color and susceptibility to sunburn—may not be thorough enough for today’s
patient base, warns Marcy Street, MD, of Doctors Approach MedSpa & Laser Center in East
Lansing, Michigan. The reason: There are patients with fair skin tones and blue or green eyes
whose skin behaves similar to a skin type IV or V in terms of hyper- and hypopigmentation
risks and the risk of keloid scarring.
“It’s important to discuss how a person reacts to sun exposure, but I also want to learn
about her inflammatory response,” says Dr. Street. “How does she heal?” Additional questions
that Dr. Street asks patients include:
• How does your skin behave following an acne breakout? Does it turn red or darken? How
long does this last?
• How does your skin react to insect bites?
• How have you responded to previous surgeries? Did your incision heal quickly? Did you
experience keloid or hypertrophic scarring?
“If you’re performing laser treatments; microdermabrasion; or chemical peels, you want to
know if the patient has an overzealous inflammatory response so you can lower the settings
and reduce the risk of adverse reactions,” says Dr. Street.
02 New Technologies Offer New Opportunities
02
40
There’s good news if your practice is in the market for new equipment. Manufacturers are
offering a varitety of programs to spur new sales including:
New Financing Options. The Syneron Advantage program (syneron.com) offers a tradein option, which provides credit toward new purchases when you trade-in your older
technologies. The company is also offering a number of customizable financing options
including low interest rates and flexible terms.
Lasering USA (laseringusa.com) and Genesis Biosystems (genesisbiosystems.com) have
introduced “pay-as-you-go” programs that allow you to purchase equipment for a low down
payment and then pay off the remainder of the balance based on usage. Genesis Biosystems
has also introduced “rent to own” and “loan to own” programs that allow you to introduce
its AccelaWave system for as little as $2,495 down.
Marketing Support. Lasering USA and Syneron are among the manufacturers offering co-op
marketing and advertising to help defray the costs of booking new procedures. Customizable
marketing kits; web-based referrals; personalized direct mail pieces, posters and ad slicks are
among the extras available with new purchases.
Clinical Support & Training. To help you obtain the best possible results, companies are
also including upfront and ongoing training for you and your staff. The Syneron Advantage
program includes on-demand clinical training from Syneron’s medical director and clinical
manager plus access to the company’s Online Learning Management System, which offers 8
to 10 minute interactive online learning modules for practitioners and staff members.
BEST PRACTICES
03
03 inspiring Employee Greatness
It’s often said that employees are a business’ most valuable
resource, but are you using this resource to its full potential?
According to Pam Bilbrey and Brian Jones, authors of Ordinary
Greatness: It’s Where You Least Expect It...Everywhere (John
Wiley & Sons, 2009), there are a few steps you can take to open
the storehouse of passion, energy, skills and commitment that
exists in each of your employees.
Make sure staff members are clear on where your
organization is headed. If you, like many business owners, are
redefining and/or re-evaluating your business plan, be sure to
communicate your goals to your staff.
Inspire ownership by involving employees in major decisions.
Are your employees renters or owners? If they’re the former, says
Jones, they may be treating your company like a hotel room,
expecting others to pick up after them. If they’re the latter,
they’re actively looking out for the company’s best interest. You
can inspire ownership by inviting employee input as you seek to
resolve problems and pinpoint opportunities.
Don’t hide the (scary) truth. Transparency is the hallmark
of good leadership, especially in times of uncertainty. “Open,
frequent communication will generate the commitment and
energy needed to rally your staff with a sense of ownership that
says, ‘We can do this!’” says Jones.
04 Science log
Sculptra Aesthetic (injectable poly-L-lactic acid) has received
U.S. Food & Drug Administration approval for the correction of
shallow to deep nasolabial fold contour deficiencies and facial
wrinkles. The approval was based on a randomized, evaluatorblinded, multi-center study of 233 patients with nasolabial fold
contour deficiencies. Sculptra Aesthetic was administered at
three week intervals for up to four treatment sessions using a
cross hatch injection technique. Results were maintained up to
25 months after the last treatment session.
...Research published in the July 2009 journal Plastic
Reconstructive Surgery shows that Botox may be an effective
treatment for Reynaud’s phenomenon. George J. Hruza, MD,
injected 19 patients who suffered from Reynauds-related
ischemic pain (14 of whom also had ulcerations of the fingertip)
with 50 to 100 units of Botox. Pain relief was immediate in
13 patients and gradual—in one to two months—for thee
additional subjects. Within two months of injection, all fingertip
ulcerations had healed.
05 Do-It-Yourself PR
Press coverage is an effective way to build your brand name
and attract prospective patients but hiring a PR firm can be cost
prohibitive to small or fledgling practices. To help you launch your
own PR campaign, Susan Hartzler of Alpha Dog PR is offering
The Zen of Public Relations a DIY eBook for spas, medical spas
and resorts. “Many of my customers could no longer afford to
pay for my services when the recession hit,” says Hartzler. “So
I decided to help them out by taking my 30 years of experience
and writing it down for them. That’s how this ebook was born.
In it, I share my secrets of generating thousands of dollars of
free media placement.”
The book includes:
• Sample press releases
• Information on social media
• How to build a press list
• And more
The ebook can be downloaded for $5.95 at alphadogpr.
com/shop-online.
41
INTRODUCTIONS
01
01 Reverse Sun Damage
02
The three-step Kinerase PhotoFacials Sun Damage Reversal System
was designed to offer patients similar benefits to an in-office
photofacial through the use of a topical homecare regimen. The
system addresses mottled pigmentation, rough texture, and fine
lines and wrinkles with three products: Daily Exfoliating Cleanser,
Day Moisturizer with SPF 50, and Night Moisturizer. Ingredients
include kinetin, antioxidants, fruit enzymes, natural skin lighteners
and a patent-pending ozone protector to repair environmental
damage. Contact: 800.321.4576, kinerase.com.
02 Improved Temperature Monitoring
Sciton introduces TempAssure, a temperature sensory accessory
for laser-based treatments that accurately measures tissue
temperature in real time. TempAssure monitors changes in tissue
and body temperature and indicates fluctuations through light
and sound. “TempAssure is the state-of-the-art in temperature
monitoring for the higher power laser lipolysis procedures,” says
Marc Salzman, MD, Louisville, Kentucky. “It allows for direct
feedback of temperatures at all levels of the laser application for
increased safety and efficacy.” Contact: 888.646.6999, sciton.
com.
03
03 The New Elite
The new Elite MPX aesthetic laser workstation from Cynosure offers
three new features to speed treatment times and improve ease of
use. The dual wavelength platform combines a 755nm alexandrite
laser and 1064nm Nd:YAG laser for vascular treatments, hair
removal and skin rejuvenation. New features include a built-in
Zimmer SmartCool skin cooling system to save valuable practice
space while reducing treatments times; Xenon Pulsed Light
(XPL2) technology with interchangeable filters that allow you to
treat sun damaged skin, dyschromia and rosacea; and Graphic
User Interface, a new graphically enhanced software system that
makes the station easier to learn and operate. In addition, the
Elite MPX offers eight different spot sizes with adjustable pulse
durations. Contact: 800.886.2966, cynosure.com.
42
INTRODUCTIONS
04 TECHNOLASE
04
The Invasix TM BodyTite system is composed of the following :
1 A bipolar radiofrequency handpiece; and
2 A RFAL computer device.
The amount of energy delivered to the fat in watts, the limit of skin
temperature in degrees, and high and low limits of impedance
are determined by the surgeon on a user-friendly touch screen.
All parameters are controlled in a closed-loop system to prevent
excessive heating fat and / or dermis.
The delivery of bipolar radiofrequency energy has the enormous
benefit of being able to quickly and precisely control the depth
and direction of energy to the fat, blood vessels and dermis.
The device allows for the following :
• Simultaneous skin tightening
• High speed of treatment
• Reduced tissue trauma
• Coagulation of vessels
• Safe, controlled application of energy and skin temperature monitoring
• Uniform heating of skin and subcutaneous layer
Contact : [email protected], 012 349 1750
05 Danné - Trans dermal sunblock
A double strength sun block that totally protects skin from
damaging ultraviolet A + B rays, Transdermal sub block SPF30 is
formulated with a water resistant transdermal base that is never
greasy.
05
Along with sun protection, many fear that their sunscreen will
make their skin clogged and oily. This is no longer the case, as
DannÈ Montague-Kingís Transdermal Sunblock protects the skin
from the sun without clogging your skin.
This non-greasy sunblock was originally formulated for acne
sufferers which means it is safe and non invasive for all skin
types.
Sunblock should do one job and that is effectively protect the skin
from the sun, without clogging the skin.
Danne Montague King
www.dannemking.com, 011 262 6120, [email protected]
43
PRODUCT REVIEWS
01
02
01
Controlled Destruction
The FDA-approved, handheld Cryoprobe X cryofreeze instrument from Cryosurgical Concepts
destroys a wide variety of epidermal lesions, including seborrheic keratosis, skin tags and age
spots with a fine pinpoint spray of nitrous oxide. Treatment is virtually pain-free and is safe for
any part of the body. Contact: Sere-Med, 011 262 2220, [email protected]
02
3-D Imaging Support
Face Sculptor three-dimensional software from Canfield Imaging allows your patients to see
potential outcomes of rhinoplasty, chin augmentation and more. The easy-to-learn software
features pictorial icons and slide bars that allow you to sculpt facial images to the desired
appearance. The high resolution images can then be rotated and viewed from any angle.
Contact: Genop Healthcare, 011 545 6600, [email protected]
03 First OTC Laser Approved
Palomar Medical Technologies, a researcher and developer of light-based systems for cosmetic
treatments, has received 510(k) over-the-counter FDA clearance for a new, patented, home use
laser device for the treatment of periorbital wrinkles. The OTC clearance allows the device to
be marketed and sold directly to consumers without a prescription. “Years ago, we believed
that light-based antiaging applications could be brought to the home,” said Joseph P. Caruso,
CEO of Palomar. “We invested significant resources in research, development, clinical testing
and patent protection to make this a reality and ensure that Palomar would be the leader with
this innovative technology. We envision a strong market for this OTC device and an increase
in consumer awareness to help drive growth in our professional business.” The device was
developed by Palomar in conjunction with Johnson and Johnson Consumer Companies.
04 GSK Acquires Stiefel
GlaxoSmithKline (GSK) and Stiefel have signed an agreement under which GSK will acquire the
total share capital of Stiefel for $2.9 billion. GSK’s existing prescription dermatological products
will be combined with Stiefel’s and the new specialist global business will operate under the
Stiefel identity. Charles Stiefel, CEO and chairman of Stiefel, will lead the new business group.
“As part of our strategy to grow and diversify GSK’s business, we are continuing to make new
investments through targeted acquisitions,” said Andrew Witty, CEO of GSK. “This transaction
will create a new world-leading, specialist dermatology business and re-energize our existing
dermatology products...We look forward to working with Stiefel to develop this exciting
opportunity.”
44
ADVERTORIAL
MESO WHITE
Flash whitening treatment for pigmentation
Mission: Softens pigmentation lesions, smoothes and lifts skin complexion. Can
be used as a daily treatment or following on from depigmenting laser treatments
and peels.
WHITENING ACTION OF DEPIGMENTING DUO
Alpha Arbutin fast and efficient depigmentation
Azelaic acid depigmentation and keratolytic actions
Inhibition of tyrosinase
•
Prevents melanin synthesis
• Prevents further pigmentation lesions
Acceleration of cell renewal removes existing
pigmentation lesions.
GLOW ACTION
Vitamin C lightens, smoothes cutaneous contours to increase light reflection.
NCTF chronospheres scientifically proven effectiveness on skin brightness skin
brightness improvement : + 144% in 88% of cases.
IMMEDIATE SMOOTHING ACTION
Soft focus agents with opal effect smoothes skin complexion by diffusing the
light and softening pigmentation lesion contours by adapting to the skin colour.
Rhamnose Polysaccharides softens redness caused by UV exposure and eases
inflammation.
USE
Apply morning and evening, on its own or before the day or night cream. Locally
on the lesions or on all the face. As a daily treatment following peelings or
depigmenting laser treatments. As sunburn treatment for all skin types. For an
intense and fast result use for 12 weeks minimum with sleep and peel.
45
NEWS & EVENTS
CALENDAR OF EVENTS
Medical CME utilizes
Video Streaming
via the Internet
Calendar of Aesthetic / Anti-Aging
Medical Events
Video Streaming brings CME, via the
Internet, directly to you in the comfort
of your own home.
Video streaming for CMEs has been
used globally since 2003, with over
40% of all CMEs, being conducted in
this format. 1
A trial conducted at a medical school
showed no statistically significant
difference in academic performance
between students attending lectures
and those utilizing video streaming. 2
The success of the first Video Streaming
CME in South Africa, managed by
VideoLive on behalf of Galderma,
has been overwhelming, from both
Galderma and the doctors perspective.
VideoLive
has
spent
years
conceptualising and building a product
with the African environment in mind,
mainly the limited bandwidth, while
considering the elements that will allow
our clients to function optimally in the
global arena. This product will assist
companies in taking CMEs to outlying
areas and densely congested cities.
For further information kindly contact
Susan van Driel 082 441 9235 or visit
our website www.videolive.co.za
Ref: 1. Frost and Sullivan Broadcast. 2.
The Effectiveness of Streaming Video
on Medical Students Learning: A Case
Study. Bridge PD, Jackson M, Robinson
L. Med Educ Online 2009;14:11.
Supplied as a service by the Aesthetic and Anti-aging Medicine
Society of South Africa (AAMSSA) [email protected]
10 December 2009
AAMSSA GOLF DAY
Pretoria
[email protected]
012 548 6374
12 December 2009
Lipolysis Training
Paris
[email protected]
011 444 0404
17 December 2009
Botox by Dr Alek Nikolic
Cape Town
[email protected]
0217970960
11 January 2010
Natural Method of Pharmacology
Sandton
[email protected] · 082 737 9300
18 December 2009
Dermal Fillers by Dr A Nikolic
Cape Town
[email protected]
0217970960
18 -19 January 2010
Beginners and Advanced Botox
and Filler courses
Dr Renier van Aardt
Cape Town
[email protected]
www.nslaser.com
8 February 2010
Sandton
9 February 2010
Filorga Product & Glykopeel training Pretoria
10 February 2010
Filorga Physician Training – Advanced
Facial Mesotherapy & Dermal Fillers
Pretoria
11 February 2010
NeoStrata Training
011 545 6643 · [email protected]
Genop Healthcare 30 New Road, Midrand
25 February 2010
IPL/LED Phototherapy Training
8 March 2010
Sandton
11 March 2010
Neostrata Training
15 April 2010
NeoStrata Training
46
22 April 2010
27 May 2010
NeoStrata Training
3 June 2010
NeoStrata Training
24 June 2010
8 July 2010
NeoStrata Training
29 July 2010
NeoStrata Training
5 August 2010
NeoStrata Training
19 August 2010
1-2 September 2010
AMCSA
Pre-congress beginners & advanced
training workshops
Pretoria
[email protected] · 0125486374
2-4 September 2010
AMCSA
CSIR ICC, Pretoria
[email protected] · 0125486374
9 September 2010
NeoStrata Training
23 September 2010
7 October 2010
NeoStrata Training
4 November 2010
NeoStrata Training
18 November 2010
IN THE LIMELIGHT
4th ANNUAL
Some of the exhibitors seen at the congress which was held at the CSIR
International Convention Centre, Pretoria, South Africa
2009
Aethetic Medicine Congress
01
02
03
04
05
06
07
08
09
10
11
01
Filorga; Tanya Hoffman; René de Oliviera; Willemien van Rooyen; Colette de Wet &
Ansy du Toit
AstraZeneca; Pavani Pather; Lesego Parkies & Matshediso Mokhobo
Best Lasers; Andrew Best & Sharon Best
Hitech Lasers; Wicus Olivier & Johannes Cloete
Genop Healthcare; Dianne Rix; Jessica Meyer; Glynis Watkins; Lynette Schlebush-Mok; Helena Westwood & Grant Russel
Bester Medical; Jill Bester & Hendrik Bester
DR & Mr Smith
Danné Montegue King; Marieta Meyer & Dinette Snyman
Galderma; Peter McGill & Hilda Lamprecht
Intamarket; Anna Olsen; Sean Parker & John Lenihan
Radiant Healthcare; Jacques Pretorius, Melissa Eksteen, Dr. Sly Nedic, Pieter van Greunin
02 06
03
07
08
09
04
10
05
48
11
www.aestheticcongress.co.za
FACIAL ANALYSIS SYSTEM -Janus
Observation
& Measurement of
› Pores
› Wrinkles
› Spots
› Sebum
› Porphyrin
› Skin Colour & Tone
›› Image processing via normal light
image, polarised light and UV light
images.
›› 3D display of each area
›› History and comparisson analysis
›› Printed output of above

2009 Winter - Aesthetic and Anti-Aging Medicine Society of South

Transcription

Similar documents

InFeature Profile - Kirby Dermatology

TRINA BROCHURE v10 - English Dermatology Centers

articles - Absolute Laser Tattoo Removal

Nanocomp Pattern generators, PDF

Click here to view our Smoothbeam Lasers

Name: RAYMOND CRUZ

Laser Engraving - Source International

laser pointer pen sale

Temporary Tattoos

Body - The Skin Center