Healthy Aging Magazine Articles

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Healthy Aging Magazine is now a Select Partner. Welcome!

Healthy Aging has a pretty well-stocked store choc-a-block full of the kinds of stuff that makes my eyes glaze over, but is a veritable playground for whoever does the ordering in your clinic.

If you go to the Healthy Aging Magazine page, you'll find a code that will give you an additional 10% off of any purchase you make.

Healthy Aging also has a number of sites and blogs as well as their general publication online. Here are a couple of tidbits from their site.

Evidence-Based Practice Medical Spa

Implementing an evidence-based practice (EBP) change with health care professionals in a medical setting can be daunting, but implementing it in a practice where some staff members are not medical clinicians presents unique challenges. This article discusses an EBP change for the treatment of acne in adult women by nonmedical clinicians in a medical spa setting.
 
With organized team processes, documented plans for intervention and ongoing evaluation, evidence-based practice intervention should be sustainable. Nonmedical clinicians can learn that not all studies are scientifically strong. They can learn to carefully consider study details to determine scientific validity. And they can follow and use evidence-based treatment protocols. Read more.

HGH: Safe or Not

A recent editorial in the journal Aging Healthy (not to be confused with Healthy Aging www.advanceweb.com/healthyaging) reignited the debate of Human Growth Hormone as an anti-aging supplement. Last year the AMA came out against HGH, citing a lack of clinical evidence, yet physicians argue with that claim and continue to endorse its use.  Read more.

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Medical Spa MD Select Partners

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Medical Spa MD Select PartnerAs the world’s #1 physician community around non-surgical cosmetic medicine, Medical Spa MD's Select Partners offer discounted products and services as well as special customer service to our more than 4000 physician members worldwide.

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IPL & laser technology companies, service providers, publications, content providers and other businesses that sell to cosmetic medical practices and medical spas are partnering with Medical Spa MD to gain access to the tremendous buying power of our physician community. And our Members get special pricing and the trust that comes from the fact that Medical Spa MD stands behind every Select Member.

What makes a Medical Spa MD Select Partner?

  • Amazing Products & Services our Members want: To be included as a Medical Spa MD Select Partner, there has to be real value available to our world-wide community.
  • Exclusive Member Pricing: All Select Partners offer reduced, exclusive pricing to Members. In some cases our Select Members will build out entire new websites to keep this pricing from their existing clients.
  • Fantastic Customer Service: Select Partners must provide exceptional customer service to Members. Medical Spa MD is an active community and Members can complain directly to us.
  • Transparency: While we consider our Select Partners as just that, partners, our reputation comes first. When our Members buy from a Select Partner they know that we're standing behind that business.

Become a Medical Spa MD Select Partner.

If you meet the above criteria, let Medical Spa MD help you make the most of your marketing efforts. Consider joining the Medical Spa MD Select Partner Program — a way for you to access our incredible physician community. Or propose your own creative plan for partnering with Medical Spa MD. Apply here.

Medical Spa MD: New Partners & Services in 2010.

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We've had some significant growth over the last while and that's enabled (and motiviated) us to look at how we can provide the most opportunity to our physician community.

We're currently buiding out relationships and adding additional offerings that include: strategic partnerships with other content providers, SEO +SEM, marketing & advertising outsourcing, training products, IPL & cosmetic laser classifieds, additional medspa MD guest post authors and more. The power behind this is the strength of our independant physician community aggregated in one place. Because we have so many physicians, we can harness the buying power of the entire group and businesses can provide pricing and services that they just can't afford when selling individually.

I'll be posting on these individually but here's an overview of some of the partnerships and additional services in the works.

Medical Spa MD Select Partners

We have a number of relationships with other cosmetic medical resources that we're working that include websites, magazines, and other vendors that meet our criteria for inclusion as a Medical Spa MD Partner. What's the criteria to be a Select Partner?

Medspa MDs Select Partners must offer significant value exclusivley to Medical Spa MD Members as a group and provide fantastic service and responsiveness to Members.

If you're a business you can apply to become a Medical Spa Select Partner here.

A New Site For Medical Marketing & Outsourcing

This new site will be all about outsourcing for cosmetic medical practices. Outsource your marketing, your advertising, your SEM (Search Engine Marketing), article writing, direct mail and postcards... all that stuff.

  • Outsourcing
  • SEO & SEM: Directoy submissions, local search, backlinking.
  • Marketing & Advertising
  • Article Writing & Submission
  • Direct Mail: Postcards & Mailers

You'll be able to get whatever you need oursourced at a fraction of the time and expense that you'd be expending to source and and manage it. We'll probably start out fairly small and focus on a couple of services that we can already deliver exceptionally well and use ourselves.

Medical Spa Writers + Guest Posts

One of the easiest ways for you to get some exposure for your practice or company is simply to write a guest post here on Medspa MD. We're actively looking for physicians and providers who can offer real value to our community. You'll recieve a valuable link to your practice or business and some welcom traffic.

Submit a guest post onMedical Spa MD.

Medical Spa Products

The Advanced IPL & Laser Training Manual and Advanced Medical Spa Aesthetics Training Manual & Study Course are fantastic resources to train and educate your existing staff, and new hires. Paula's done an absolutely amazing job of getting everything your staff needs in one place. I only wish I had this way back when. If you'r training process consists of having new hires follow you around... your life just got a lot easier.

Used IPL & Laser Classified Ads

Looking to sell your cosmetic laser or IPL? Looking to get a killer deal on one? Medical Spa MDs classified listings are where you'll want to start. (It's anticdotal but I think we've passed the $1m mark.)

Teeth Whitening

We were approched by a company providing custom teeth whitening services for companies and organizations as fund-raisers and asked if we'd allow them to sell whosale teeth whitening kits, pens and services to our Members. We've tentatively said yes and are trying out their services ourselves to see what we think.

These are exacly the same services that dentists offer and include taking impressions, making custom whitening trays and delivering them back to the clinic. Clinics would buy these wholesale. The markup would be in the 100%-300% range I'm guessing.

This could be a fantasic add-on since the #1 cosmetic service that people want is actually teeth whitening.

Laser Repair, Parts, & Service

Another interesting deal that I'm not at liberty to discuss quite yet but we're looking to take on some reilable partners to provide IPL & laser repair services for Members. If you've every had an IPL hand peice rebuilt by the manufacturer you'll know what I mean here. (Of course we'd love to have good technology providers as a partner too.)

Anyway, that's just a few of the directions we're moving in. I'll update this post as we get some of these services up and running. If you want to make sure you're aware of your options and our Partners offerings, make sure you're a Medical Spa MD Member.

Medical Spas are still growing.

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Spa trends as reported by the International Spa Associations Members show that Medical Spas are still growing.

Medical spas: Is there a doctor in the spa? The number of medical spas continues to grow at the fastest rate of all the spa types, according to ISPA. The figure is 85 percent growth since July 2007.

While most people aren't going for a pedicure, people are using them for Botox, filler treatments and even a prescription for the new eyelash-lengthening drug, Ellis said.

Eyelash lengthing drug?

Plastic Surgery Trends For 2010

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

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

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

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

Fat Freezing Heats Up in 2010
Fat freezing (or cryolipolysis) may give liposuction a run for its money in the coming years. This technology works by freezing fat cells and breaking them down. Zeltiq is in clinical trials now, and results look promising. Stay tuned.

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

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

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

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

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

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

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

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

Nu U Medical Spas Sued By Illinois State Attorney General

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Attorney General Lisa Madigan has filed a lawsuit against the Chicago-area medical spas, Nu U Med Spas, for performing unapproved procedures without a physician's supervision and luring patients through deceptive marketing.

This looks like it started with an expose by local Chicago television news.

The seven NuU Medspas in the Chicago area aggressively promote Lipodissolve, a series of injections that supposedly will melt your fat away.

The ads talk about reduced inches with no knives, no tubes, and no pain -- a deceptive ad, patients say.

NuU does not tell clients that Lipodissolve is not approved by the Food and Drug Administration.

"There is no study out there that shows clearly whether it works and what specifically are the risks of it," said Northwestern Memorial Hospital's Dr. Michael Lee.

That's not a problem, said NuU district supervisor Laura Rowsey, formerly a modeling school sales manager.

"This is a soy-based mineral with amino acids," Rowsey said. "Bruising and swelling is like your worst case scenario with this treatment."

But doctors have seen a number of Lipodissolve complications.

Cynthia Sacramento, who went to the Lincoln Park spa, suffered painful scar tissue buildup around her injection site that will require surgery.

Dr. David Song of University of Chicago Hospital said the entire injection area will have to be excised.

Sacramento said she's devastated.

Even proponents say Lipodissolve is for treating pockets of fat, not for bigger weight problems.

NuU in Lincoln Park signed another former client, who preferred to remain anonymous, up for $2,400 in treatments on his belly.

"I think it's a big scam, a waste of money," he said. "The only thing that got thin on me was my wallet."

NuU sales people are pressured to meet sales goals and arrange for many clients to finance their treatments. The money is collected up front and NuU claims it's not refundable.

"Our goal was to get $15,000 a day," said former NuU spa manager Patti Feinstein.

Feinstein recalled how Rowsey scolded her for turning away a skin cancer patient saying, "You are not going to make quota if you don't sell," Feinstein said.

Records show her spa sold made more than $200,000 a month.

Ouch. You have to love how a reporter makes a point of stating that the Nu U spokesperson was fromerly a sales manager for a modeling school. Looks like another slap-down for Nu U Medspas. Madigan's complaint claims that Nu U Med Spas try to lure customers into buying "Lipodissolve, which is an injected therapy used to dissolve fat cells." Here's the full press release:

MADIGAN FILES LAWSUIT AGAINST CHICAGO AREA Nu U MEDICAL SPAS

Attorney General Alleges Nu U Performed Unapproved Procedures Without Physician Supervision And Used Deceptive Marketing to Lure Patients

Chicago — Attorney General Lisa Madigan today filed a lawsuit in Cook County Circuit Court against Nu U Med Spas for deceptively marketing and performing unapproved, unsupervised cosmetic treatments that caused some patients to experience extreme pain and lasting injuries.

“These procedures have yet to be thoroughly researched and sanctioned by the proper medical authorities,” Madigan said. “Despite lacking concrete scientific evidence, Nu U purposefully misleads consumers into believing that their medical spa treatments are safe and effective. I’m very concerned that the health and safety of Illinois consumers who visit Nu U Med Spas are at risk.”

The Chicago-based medical spa chain allegedly uses high-pressure sales tactics based on deceptive marketing claims to induce consumers into purchasing a series of medical and beauty treatments, including Lipodissolve, which is an injected therapy used to dissolve fat cells, according to Madigan’s complaint. Nu U allegedly claims its treatments will “liquefy fat quicker” and can “rid your system of that life long battle of the bulge,” but Nu U fails to inform consumers that its treatments haven’t been approved by the U.S. Food and Drug Administration (FDA) as safe and effective treatments. Both the American Society for Aesthetic Plastic Surgery and the American Society of Plastic Surgeons do not recommend using Lipodissolve for fat reduction due to the lack of research that shows its effectiveness.

Further, because Lipodissolve is an injected treatment, it requires a physician’s order, but Nu U allegedly administers the fat-reducing treatment without a doctor’s order. In fact, despite its outward claims, Nu U allegedly fails altogether to monitor and evaluate patients by licensed physicians at all seven of its Chicago area locations.

Madigan’s complaint further alleges that the Nu U personnel rush consumers into signing contracts, medical consent forms and financing documentation for treatments but fail to review the documents with consumers. The defendants allegedly pressure consumers to sign up for health care financing but fail to inform consumers that by signing the financial documentation they are authorizing an automatic credit card charge. Nu U allegedly refuses to provide refunds when requested, even in the event that a consumer has not received all of the contracted treatments.

Madigan’s lawsuit charges Nu U with violating the Illinois Food, Drug and Cosmetic Act, the Illinois Medical Practice Act and the Illinois Consumer Fraud and Deceptive Business Practices Act. It asks the court to permanently enjoin the defendants from owning or operating medical or beauty clinics in Illinois and to order the company to pay civil penalties of $50,000, an additional $50,000 penalty for each violation committed with the intent to defraud, an additional $10,000 penalty for each violation committed against a senior citizen 65 years of age or older, and the costs associated with the investigation and prosecution of the lawsuit.

To be honest, this looks like some grandstanding on the part of the Attorney General. Lipodissolve is used in perhaps thousands of medical spas and cosmetic practices around the country without 'painfull scar tissue build up' and complications.

And what does it actually mean when. "Dr. David Song of University of Chicago Hospital said the entire injection area will have to be excised."? An entire treatment area excised from needle sticks? Seems fishy to me. Might well be something of a hatchet-job.

Anyone have thoughts on this?

Discount Medspa Do-it-yourself-Botox website shut down.

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When we first discovered the videos promoting do-it-yourself Botox and filler injections being promoted on Youtube, I posted this article on Fake Botox or not, Discount Medspa is going to jail. Since then the websites have been shut down and the womant in the video's been charged with illegally offering prescription drugs without a license.

Via the Examiner

Even before a December 2009 ABC 20/20 report on self-injectable facial drugs including Botox, Restylin and Dysport, the company Discount Medspa had been shut down for selling these types of products to consumers without prescriptions for them.

Texas Attorney General Greg Abbott charged Laurie D’Alleva of Tarrant County, TX of illegally offering prescription drugs without a license on November 24, 2009 and gained a temporary restraining order barring her company from continuing to sell the drugs online. She is also charged with fraudulently claiming membership in Texas Medical Council, which doesn't even exist, and using this claim as a basis to say she can legitimately sell these products online.

The real surprise is not that this was shut down, it was the number of coments (98) from individuals proporting to be Discount Medspa patients who were defending the site and Ms D'Alleva. Shocking in some cases. Here are some of the comments.

"If smoking dope is okay with the moron than leave our botox self injection alone, no one is having a problem with it except the money grubbing doctors and pharmacys that sell the stuff. Bug off!"

"Funny we can inject ourselves with insulin and yet because of the greed of physicians, someone like Laurie is put out of business because why? She put the choices into the hands of the people."

"The FDA does not regulate how doctors use it. They go through a 3 hours class to inject it. What is the best way to learn?(DO IT YOURSELF)"

"I did purchase from Discount MedSpa and injected myself with Freeze (crows feet and forehead). I am extremely happy with the results. I will definatley do it again. I also have a college education and run my own business, so don't call me stupid."

"I have used the Freeze product from Discount Medspa with great results. The over priced Doc I received injections from did not do any better job than I did myself. It took 10 minutes and study on facial muscles. If the product is pure I see no problem with being able to inject at home."

"If I want to Freeze my face then let me and stay out of my business. It's not like I am harming anyone else. It's not like I am unfamiliar of the risks. It's not like I am jumping off a bridge and acting irritational, it's Cosmetic!"

"all these other money hungry Doctors thinks $320 every 4 to 6 months is reasonable thats crazy!!! I was purchasing 100 units of Freeze for $149.00 and was doing it myself do you think I am going to spend $320.00 for 40 units and have someone else do it,"

"Once I did the injections I realized how much of the "you will hurt yourself" is hype. This is the mantra that will brainwash us into being dependent and financially strapped to our medical treatments,"

"Yes, it is crazy...I have done it myself, I had great results with the fillers but always wondered what was really in them, what was I injecting into my face?"

You can read the entire thread here.

Are the best medical spas making the most money?

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Is you're medical spa providing the best medical care or just making the most money? Are they mutually exclusive?

There's a New Yorker article detailing the commencement address Atul Gawande Atul Gawande delivered this commencement address, titled “Money,” to the graduates of the University of Chicago Pritzker School of Medicine. It expands on the themes he touched on in his recent article about health-care costs in McAllen, Texas, which figured in President Obama’s speech on health care.

The text of this speech is available in this article in the New Yorker:

No one talks to you about money in medical school, or how decisions are really made. That may be because we’ve not thought carefully about what we really believe about money and how decisions should be made. But as you look across the spectrum of health care in the United States—across the almost threefold difference in the costs of care—you come to realize that we are witnessing a battle for the soul of American medicine. And as you become doctors today, I want you to know that you are our hope for how this battle will play out.

Kevin MD has this on: Can doctors resist the lure of money?

That’s a tall order for many American physicians.

In his speech, which is an extension of his celebrated New Yorker piece, he looks at so-called “positive deviants,” or doctors who practice higher value, higher quality care, than everyone else.

What makes these doctors so special? In essence, they have to “resist the tendency built into every financial incentive in our system to see patients as a revenue stream.”

Indeed, “These are not the doctors who instruct their secretary to have patients calling with follow-up questions schedule an office visit because insurers don’t pay for phone calls. These are not the doctors who direct patients to their side-business doing Botox injections for cash or to the imaging center that they own. They do not focus, the way business people do, on maximizing their high-margin work and minimizing their low-margin work.”

Unfortunately, most American doctors fail to resist the allure of money. In some cases, it’s greed. But in many others, patients and business have to be intertwined simply to keep the doors open. Doctors cannot practice quality medicine while bankrupt.

Changing physician behavior needs to be accompanied by fundamentally modifying the incentives that influence doctors. Without radical physician payment reform, Dr. Gawande can implore future doctors to fight the financial incentives all he wants, but most will realize that resistance alone will be futile.

So where does that leave us? Are plastic surgeons and medical spas practicing medicine first, or business? How, if ever, does cosmetic medicine differ from 'real' medicine? Is there any ethical guideline that applies or is cosmetic medicine fundimentally different?

Share Medical Spa MD on Twitter or Facebook.

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Medical Spa MD is foremost a community of more than 4,000 physicians around the world practicing cosmetic medicine. If you find something you like on Medical Spa MD, please share it.

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You can find Medical Spa MD on Twitter here.

Do it yourself Botox, Restylane, & Juvederm Disasters.

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So while there are still a number of people posting on how much the love Laurie D'Alleva and her videos touting the benefits of do it yourself Botox, there are a growing number of people who still have a non-paralyzed thought or two that are coming forward to talk about the problems you might have pumping fillers into your face. Perhaps the do it yourself Botox crew are also attracted to Trepanation.

Here's a story from ABC News: Watch the video on "20/20"here.

Some consumers are ordering prescription-only cosmetic products online and injecting themselves at home. One woman who self-injected her face with filler said it caused bags and lumps under her eyes, and a hard, infected pustule on her cheek.

For millions of Americans, the solution to crow's feet, thin lips, and frown lines is at the end of a syringe, or in a bottle. A quick trip to a medical spa, dermatologist or plastic surgeon for a Botox injection, lip augmentation or chemical peel offers the promise of a youthful look.

But these cosmetic procedures -- and the medical expertise that comes with them -- don't come cheap. For a single treatment of Botox, doctors charge about $380; for lip-plumping injections, over $500; and for a chemical peel, a whopping $700.

These high prices are enough for some consumers to take their business away from medical professionals, and go instead to the Web. They are "doing it themselves," ordering prescription-only products online, and injecting themselves at home.

Laurie D'Alleva, of Mansfield, Texas, is a big fan of "DIY" beauty injections and treatments. She is the face of a DiscountMedSpa.com, a website stocked with what she claims are pharmaceutical-grade cosmetics, similar to Botox, Restylane, and Retin-A. 

Self-injecting botulinum toxin might sound dangerous, but D'Alleva, 39, tries to put her customers at ease with informational videos, complete with tips and pointers on how, and where, to inject. "It doesn't hurt... It's easy," D'Alleva claims in one video, as she stands in front of a mirror and injects her face repeatedly.

Disaster isn't what "Alex," a paramedic, had in mind when she visited DiscountMedSpa.com a few months ago. In her 40s and dating, she just wanted to improve her look, and save some money. She asked ABC News not to disclose her identity.

After viewing "every one" of the instructional self-injection videos on D'Alleva's site, Alex was convinced she could do it herself, since using needles was part of her job.

"Why should I pay somebody else that got a few hours of training to do something I think I can do pretty easily?" she said she thought at the time.

Alex paid $450 for a DiscountMedSpa.com products including an injectable facial filler. She says she injected the products under her eyes and alongside her mouth.

But "the next morning, I woke up horrified by what I saw," she said. "Literally, my heart started pounding, and I thought, 'What have I done, what am I going to do?'"

Career Advancement for Medical Estheticians

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

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

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

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

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

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

Submit a guest post and be heard.

Cosmetic Surgeons enlist patients to fight the Botox Botax.

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Cosmetic surgeons are asking for patient help to fight the Botox Botax. Here's what the ASDS (American Society for Dermatologic Surgery) is giving it's members to solicit the support of Botox consumers: Here's the form.
The U.S. Senate health care reform bill  (Patient Protection and Affordable Care Act) contains a proposed 5 percent tax on "elective cosmetic medical procedures."  While this may look like an attractive option to Senators looking for ways to pay for health care reform, we know that:
  • Cosmetic medical procedures taxes are an unreliable and risky revenue source, which has proved to be a failure at the state level;
  • A tax on cosmetic surgery discriminates against working women;
  • The definition of cosmetic procedures is arbitrary and almost impossible to administer; and
  • enforcement would necessitate review of patient medical records by tax collectors, a clear invasion of privacy.

Please enter your zip code below to be connected to an automatic email system which allows you to send a quick message to your Senator asking him/her to vote against this tax.

I've received an number of emails about this over the last 48 hours. Is anyone worried that this 'Botax' will hurt your medical spa, skin clinic or cosmetic practice?

Medical Spa MD: Filler Injection Tips (Restylane, Juvederm)

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Restylane, Juvederm and filler injections tips for physicians running medical spas and laser clinics.

The following is from a string of emails that were circulating among some of Medical Spa MDs Members. I've edited this somewhat to make it readable and get rid of all the extraneous copies. I'm also not displaying the identity or email addresses of the physicians in this thread.

Please leave your thoughts below as a comment.

Note: Some of the comments below might be out of order from the original thread. Emails' somewhat difficult to follow as a thread but you'll get the gist.

Filler Injection Discussion & Tips: Restylane | Juevederm | Evolence

1.  When I use the "push ahead" technique, I feel that I get better "plumping" per cc of filler.  I learned this from Kevin (thanks Kevin).
 
2.  When I use the "push ahead" technique, the filler fills a few millimeters in front of the needle tip.  You need to realize this to be able to put the material exactly where you want it.  Sometimes you have to "feel" the injection because you can't "see" the plumping.
 
3.  I mix 0.1 cc of lidocaine with epinephrine with my Juvederm.  This helps with bruising (epinephrine) and when the lidocaine goes away and the Juvederm attracts water, the two effects cancel each other and there is not as much enhancement after the injection due to the hydrophilic nature of the Juvederm.
 
4.  I use Juvederm Ultra under the eye and above the lip.  I use Juvederm UltraPlus everywhere else.
 
5.  I constantly complain to my Juvederm Rep about the 0.8 cc syringes.  I use lots of Radiesse because you get almost twice as much material for the same price.  Volume, volume, volume.  Please complain to your rep, maybe we can get them to change. 
 
6.  I hear the Evolence is very good.  We will be getting trained and start using it next month.

 

Thanks for the filler tips.Can you explain how you get the Lido with epi mixed into the Juvederm syringe? --PD

 

BD 1 ml Luer-Lok Syringe
 
This syringe allows you to get very precise amount of lidocaine (swish back and forth 20 times).
 
I use this syringe to put exaclty 1 cc of saline in my Botox Bottle. When I reconstitute the Botox (this gives it full strength per unit). The chances of intravascular injection might be lower with push ahead because the material will push the vessels out of the way as you advance --  Jeff

 

Hi Jeff,--I agree w/ #6.  I seem to get good augmentation, less redness, swelling and bruising with Evolence.  I use it for deeper fills in cheeks, NLF, etc.  Don't use it for lips or under eyes.  I do same with Lido w/ epi.  I tend to use Juvederm in lips.  Perlane / Restylane for other areas.  I agree w/ why Allergan uses 0.8 cc syringes. I've moved away from Radiesse.  I feel that the duration is not that much longer than a good correction with the HA's.  Besides, I believe a fair amount of the volume of Radiesse is a gel carrier, thus needing touch-ups at 2-3 months.  Perhaps that's why the went to the larger syringes? -- Don

 

The push ahead technique also moves small blood vessels out of the way, so you may notice less ecchymosis is overall pts. -- Greg

 

Jeff: --"Push ahead" has a higher risk of vessel cannulation & potential for vascular effects - skin necrosis in glabella, even potential for retro-grade flow to eye (causing visual loss).  I wouldn't recommend that technique for the periorbital area.

Restylane is recommended for the tear troughs;  it's less hydrophilic than juvederm - which means less post-treatment swelling.--Tom  --  [note from Jeff:  Tom is a plastic surgeon]

 

I would not use push ahead around the eye, I agree with Tom's comments. It works great for NLF. I was actually taught this by a PS -- Greg

 

Thanks Jeff for your kind comments. However I must make a few points in regards to fillers:
1) There are some areas that one has to still do the retrograde injection either b/c the purpose was to make a straight line (eyebrow lift and vermillion border and the bow-tie (the vertical lines connecting the base of nose and the upper lip border) AND when injecting the most inner 1/3 of the tear-trough to avoid risk of filler getting into the orbital space due to its close proximity to the orbital rim.
2) On the glabellar injection, it is best to first push and pull the needle thru the space underneath to break up the tissue before actually injecting the filler both in an anterograde and retrograde pattern
3) I ONLY use the 1/2 inch needles in all my injections
4) One can inject even Radiesse and/or Perlane via an 1/2 inch 30 gage needle. Why is this noteworthy to mention?? When I work on the lips and Marrionette's lines, I ususally first build the Vermillion border with Radiesse or Perlane (I get the best "lifting outcome" with heavier filler). I push the 1/2inch needle all the way forward then slowly and steadily inject while withdrawing (retrograde method). Then I re-evaluate how much of a correction I already get of the Marrionette' line and lifting up of the lip body. My next step is to inject into the most lateral lip section (about 1 cm distance) starting at the corner (using Perlane or Restylane or Juverderm). This time I inject slowly as I push forward (anterograde). Often I ended up correcting about 50% of the marrionette's line by going after the lip's border and most lateral body. Besides, the patient loveto see that they now could see their lip body all the way to the corner and more "smiley shape". The last step is the trickiest one, I use either Radiesse or Perlane on an 1/2 inch 27 gage needle. First placing my left thumb at the patient's lower half NLF's I retract the skin upward (about 2-3cm upward) then I approach my needle in an upward (vertical) position at about one centimeter lateral and one cm below the mouth corner of that same side. Then I aim diagonally toward the corner and start injecting anterograde just 1-2 mm below the imaginary horizontal line of the mouth corner (about 0.2 cc), then I withdraw the needle and reaim straight up and inject just below the horizonal line (0.2cc) then I do it one more time aiming diagonally outward (0.2cc). What was I attempting to do?? I was laying down a new flooring along the imaginary horizontal line. After the injection, release the left thumb. You will be surprised to see the retracted portion just rest right along this new floor, thus the Marrionette'line has been corrected. This is different from the common fanning technique of using the filler to "blow up" around the Marrionette's line. If you look carefully at those company's issued photos, the area around the Marrionette's line now appeared very swollen and puffed up. It is aesthetically unpleasant. It looked like the patient was beat up below the mouth. It reduced the profile of the chin.
5) For those of you that use fillers on the highly vascularized and shallow areas such as the temporal, crow's feet, undereye area lateral to the submalar area and along the lateral border of the cheek prominence (especially in those older skinny Caucasian ladies with much excessive very thin skin) I now emulate the same technique used in the hand. I would pinch to levitate the skin itself above the bony structure, then I bolus Restylane into the empty space. Then I massage it down. This elimates the risks of injecting into the vessels and nodules.

 

Interesting discussion.  So Kevin, how do you account for the difference in that anterograde injection you need less filler than in retrograde injections, assuming all else being equal?

Second, I am understanding one group claims anterograde injection carries a higher risk of vessel cannulation and possible intravascular injection, while another group claims that anterograde injection "pushes away" blood vessels, thus decreasing the risk. Not sure how anterograde increases risk of intravascular injection any more than retrograde.  If you push the needle ahead, transfixing a vessel, then begin injection, you can still conceivably deposit some material intravascularly, can you not?  Am I missing something here?

I also found an interesting idea of sub q bolus technique in areas of thin skin, ie crowsfeet, etc.  Anyone else try this method? ~ Don

 

Tom:

I do agree with you about those risks with anterograde injection. The key is always the skills in doing it, be it retrograde or anterograde. One always has to be very carefully doing anything around the eyes. However, the anterograde techinique has been advocated some of the best known experts such as Arnold Klein, MD and Kent Remington, MD. I also believed that the filler amount used was critical. It takes much more amount to get the same result with the often taught retrograde technique compared with the anterograde one. For example, I almost never required more than one full syringe in correcting bilateral NLF's vs what was typically used ( 2 syringes) by most others. I attached the before and after of a case wherein I used Readiesse to correct her NLF's and Marrionette's lines with anterograde technique. The after photo was taken right after. You can still see some of needle marks. I used one full 1.3 cc syringe, 1/2inch 30g for the Vermillion border and 1/2inch for NLF's and Marrionette's line. Notice also there was no "puffy/swollen look" medial to the Marrionette's line often seen with retrograde and fanning technique used by most others. ~ Kevin

 

All interesting comments.  The only place, I use “push ahead” is in the cheeks when doing them via the intra-oral route. (Apparently Radiesse is no longer teaching this method because may practitioners couldn’t get the hang of it but it works for me.)  I might try it in the “safe” areas such as NL folds.  We use only Radiesse and Juvederm and  I find that neither filler lasts as long as advertised in “first-timers”.  I’ve also had disappointing longevity in my older patients (>65) with both types fillers despite using numerous syringes.  I’m sure this has to do with their inability to generate collagen around the filler once the carrier gel is gone.  Does anyone know the age range of patients done in the filler studies? ~ SD

 

I came across this old thread way down in my inbox and read it again.  I’m not sure who wrote #4 below.  It sounds interesting but I’m having a hard time visualizing it.  Do you steadily move the needle forward  toward the lip edge as you are injecting or do you hold it in place while the area fills?  I’d love to see a drawing on where you start.  ~ SD

 

SD: I wrote those threads. The techniques that I described were similar to what you could see watching the video instruction on www.thederm.org by Kent Remington and his colleagues (lower face injection portion) THe only thing new from my thread was when fixing the Marrionette's line, his doctor (Nowell Solish) injection upward and anterograde from the lower part toward the lip corner only one time vs what I now do is I do the same thing but with a fanning pattern where (with the skin lifted about 1-2cm upward with the other thumb) I laid down "three such "anchoring points" along an imaginary horizontal floor starting from the lip corner going laterally for about 3-5cm long. Here I used something firmer such as Radiesse or Perlane. Having done this, you would release the thumb letting the skin go back down. Often you will see the Marrionetter's line is much improved because "part of that Marrionette's line" now is positioned along the horizontal flooring that you just created. ~ Kevin

PS: It is hard for me to send over some graphic illustration but I will attempt to do this in the future

Medical Spa MD: Burned out & depressed plastic surgeons more likely to commit medical errors?

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Surgeons who are burned out or depressed are more likely to say they had recently committed a major error on the job, according to the largest study to date on physician burnout.

The new findings suggest that the mental well-being of the plastic surgeon is associated with a higher rate of self-reported medical errors, something that may undermine patient safety more than the fatigue that is often blamed for many of the medical mistakes.

Although surgeons do not appear more likely to make mistakes than physicians in other disciplines, surgery errors may have more severe consequences for patients due to the interventional nature of the work. Some estimate that as many as 10 percent of hospitalized patients are impacted by medical errors.

"People have talked about fatigue and long working hours, but our results indicate that the dominant contributors to self-reported medical errors are burnout and depression," said Charles M. Balch, M.D., a professor of surgery at the Johns Hopkins University School of Medicine and one of the study's leaders. "All of us need to take this into account to a greater degree than in the past. Frankly, burnout and depression hadn't been on everybody's radar screen."

Nine percent of the 7,905 surgeons who responded to a June 2008 survey commissioned by the American College of Surgeons for a study led by researchers from Johns Hopkins University School of Medicine and the Mayo Clinic reported having made a major medical mistake in the previous three months. Overall, 40 percent of the surgeons who responded to the survey said they were burned out.

Researchers asked a variety of questions, including queries that rated three elements of burnout -- emotional exhaustion, depersonalization and personal accomplishment -- and others that screened for depression.

Each one-point increase on a scale that measured depersonalization -- a feeling of withdrawal or of treating patients as objects rather than as human beings -- was associated with an 11 percent increase in the likelihood of reporting an error. Each one-point increase on a scale measuring emotional exhaustion was associated with a 5 percent increase.

Mistakes also varied by specialty.  

Surgeons practicing obstetrics/gynecology and plastic surgery were much less likely to report errors than general surgeons.

Researchers acknowledged the limitations of self-reporting surveys, saying they couldn't tell from their research whether burnout and depression led to more medical errors or whether medical errors triggered burnout and depression among the surgeons who made the mistakes.

The results are being published online on November 23 in the Annals of Surgery and will be published in the printed journal in an upcoming issue.

Notably, the research shows that the number of nights on call per week and the number of hours worked were not associated with reported errors after controlling for other factors.

"The most important thing for those of us who work with other surgeons who do not appear well is to address it with them so that they can get the help they need," says Julie A. Freischlag, M.D., chair of the Department of Surgery at the Johns Hopkins University School of Medicine and another of the study's authors.

via sciencedaily.com

Perhaps the most relevant items here are the decreased reporting of problems by plastic surgeons and the fact that 'depersonalization' has entered the discussion.

I'm really curious about what plastic surgeons think of this study.

Medical Spa MD: How to operate effectively in turbulent times.

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If you’re involved with or own a medical spa, this question is no doubt on your mind.

In this article, I will give you several tips and tools to evaluate your laser centers culture and operations, so you can successfully navigate any economic downturn… And live to sell another day when the inevitable upturn comes around.

What is the Passion and Purpose of Your Medical Spa?

You reap what you sew. When you engage proactively and passionately in your business you will undoubtedly be successful and see your practice expand. It helps to articulate your passion for your medical spa.

At Assara Laser, our passion is to “help clients look and feel great, not fake.”

Why the Recession Drastically Affects Your Laser Clinics Bottom Line

You’ve probably noticed that generating revenue is not as easy as it once was. There are myriad reasons for this; from the decline in disposable income, to unemployment hitting record highs and tanking real estate valuations. As if these facts were not bleak enough, credit markets are virtually frozen so business owners are finding it nearly impossible to obtain small business loans and lines of credit. Refinancing current loans has become difficult for small businesses.

In short, we're operating in the perfect storm.

Accepting Reality and Responsibility Today

The easy way out is to close up shop and blame the recession. This will not help you going forward, it will not pay your devoted employees their wages, and most of all, it will not help your clients “look and feel great, not fake.”

So, accept responsibility. 

The hardships of the recession create a fact-pattern, problem to be solved; not a reason for failure. To paraphrase Michael Jackson, start, first, with the man in the mirror. Think about the following questions. And pay attention - there will be homework at the end of this article!

Finding Your Medspas Winning Competitive Difference?

Let’s be honest. The quality of your laser clinc's treatments are probably not drastically better than that of your competitors. The proprietary equipment and IPL or laser systems (Thermage, Fraxel, Titan) that you use are, for the most part, available to the competitive skin clinic market at large.

You may believe (and tell clients) that your microdermabrasion treatments are better because you use a diamond-tipped wand or aluminum oxide crystals. You may think that your IPLs or laser hair removal treatments are better because you use cryo-cooling or because you use chilled air cooling, or because you use a diode laser or because you use alexandrite lasers . . .

BUT . . .

Step in to your clients' shoes. To them, the bells and whistles of your Thermage or Fraxel device don't matter. Your clients already expect expert advice and cutting edge cosmetic lasers, IPLs and skin tighening equipment, so merely meeting this fundamental requirement is not a winning competitive difference.

What does matter to your clients are presentation, client interaction, customer service, reliability and consistency. Consider this carefully.

What is each of your medspas clients worth? 

At Assara Laser, one of the most popular packages is our $449 per month Unlimited Laser Hair Removal Program. On average, a client that signs up for this program will remain a member of the Program for 7 months, depending on the results they wish to achieve. How much is a single unlimited client worth to us?  A client in the program for 7 months, making a monthly payment of $449 is worth $3,143. For many laser clinic owners, a single laser hair removal client is worth more than a home mortgage payment!

Do you treat every single potential laser treatment client that contacts your laser clinic as if they’re worth $3,000?

What is your time and effort worth?

Before my partners and I built Assara Laser, I was an attorney. I still practice corporate law as a labor of love, when a friend or business contact has an exciting deal. I normally discount my rate to about $400 per hour, as law isn’t my primary source of income. 

Assume an hour of your time is worth $400.  Assume further that, every time your customers complain, you are willing to give a discount, or a free treatment and that, collectively, free and discounted treatments account for a 20% loss in your revenue. To make up for this lost revenue, how much more work do you have to do? 

Well, let’s add 20% to your 10 hour day, which now makes it a 12 hour day. If your annual sales are say $1,000,000 per year, you’ve lost $200,000. This translates into 500 hours more of work you must do to bring your revenue back to status quo!

Is there a big difference between a day that starts at 9:00 a.m. and ends at 7:00 p.m. versus ending at 9:00 p.m.  You betcha there is!  Is there a big difference between a loss of $200,000 and a loss of zero. You betcha there is!  And these differences drastically affect your quality of life.

How Do You Avoid Mistakes?

Mistakes are costly. A happy client is worth more than $3,000, and will likely refer business, the best and cheapest form of marketing. A single angry client will result in you working 2 hours more per day for the following seven work days, and will possibly diminish your reputation by badmouthing your medspa. 

A lot of people think excellent customer service means free treatments. It doesn’t. Excellent customer service means delivering what you promise. You know the limitations and effectiveness of your treatments so promise only what you can deliver and do it consistently, with a smile on your face!

Your Homework

Write an email to one close friend or business partner (or to me, if you would like to engage in this project with me: wshuman@assaralaser.com), in which you answer the following questions.  Cut and paste the text below into your email, and fill in the blanks with no more than three sentences: 

I wanted to pick your brain for a moment. I’m working on a plan to really blast my medical spa practice off the ground, and I wanted you to use your intuition to judge the quality my sentences below.  What do you think? 

The best way to succeed in business while I make clients feel great is:

The recession has made it harder for my medical spa to operate because:

My medical spa’s winning competitive difference is:

Each of my laser center's potential clients is worth:

I will earn every cent paid to me from a client’s hard earned money by:

The biggest recurring (or systemic failure) affecting my customer service is:

Please let me know your thoughts.

Note: The above is a guest post from Will S. of Assara Laser Centers.  You can find Assara on the web at the following links: Assara Homepage and Assara Blog.

If you would like to write or guest post for Medical Spa MD please contact Medical Spa MD here.