Is Productivity Evading Your Medical Spa?

Does your medical spa or office run like a hamster on a wheel?  Is your payroll increasing but your revenues are declining?

The definition of "Productive" according to Webster’s is:

1: having the quality or power of producing, especially in abundance

2: effective in bringing about

3: yielding or furnishing results, benefits or profits

To expand a bit on Webster, we can define "productivity" as using the energy of people to create better ideas, better products and better working conditions - all leading to abundance for the people involved.

To improve existing productivity means removing existing barriers and energy-wasters that drain valuable resources (like people, money, focus) away from the production of better ideas, products and work environment.

Increasing productivity in your medical spa, clinic or office means being able to get better results without more staff, more resources, more cost, or more energy. So this means learning how to do the work so that less energy is required to produce the same results, producing higher results using the same amount of energy. The result is abundance for the whole team, happier patients and less staff turnover.

The start of every workday can often be overwhelming. You are likely to come into an office with an overflowing email inbox, endless lists of messages on the voicemail, messages from coworkers, to-do lists from your last meeting, as well as the every day tasks that were not completed from previous day or week.  Lastly, you are likely to have a line of impatient people waiting to speak with you throughout the day.

Using a set of disciplined skills can help you get the “stuff that matters most” done first. 

1. Communication

One of the most important skills in any business is effective communication. When you are communicating with staff and clients, make sure that all your instructions and information is crystal clear. Simply repeating the same request in different words at the end of a conversation can mean the difference between getting the report you want and the one that your staff thought you wanted.  Always check for understanding.

With communication, clarity is the number one objective. You may have a degree in English, but the person you are communicating probably doesn’t.  Keep the language you use simple and you increase your chances of being understood.

2. Planning

With larger projects, plan the entire project at the beginning. Let’s say you are remodeling your office to add space for 2 more cosmetic dermatologists – a daunting task for sure.  Break it down into smaller steps and assign a date by which each step should be completed. Delegate any of the project that can be done by someone else, but keep it closely supervised as to who is doing what and when you need it completed by. Once you have planned how you will do the project, you will find it much easier to dive in and get started.  Ask for frequent updates from anyone working on the project.

3. Procrastination

For many people, this is the biggest time thief of all! The most vital thing you need to do is to acknowledge that you are guilty of procrastination, and then identify the tasks you tend to put off as long as possible. Once you know which things you are likely to procrastinate about, consider why it is you don’t want to do them. Perhaps they are too large, too boring, or just seem like a waste of your time. By identifying the reasoning behind your procrastination issues, you can find solutions, such as breaking larger projects down into smaller pieces (see planning above), scheduling the boring tasks for first thing in the morning so they are done, and delegating (see delegation below) any tasks that are so routine they feel like a waste of your time. Eliminate procrastination from your working day and see how much more you can accomplish in your day.

4. Prioritizing

Jumping around from one project to another, not feeling as if you have accomplished anything each day or constantly rushing to finish on deadlines is a sign that you need to reorganize how you approach your task scheduling and work prioritizing strategy.

Each morning go through your in box and prioritize its contents. Once you know what has to be done, how urgently it is needed, and how long it is likely to take to complete, add the tasks in order of importance to your work schedule for the day. 

At the end of each month take a look at the projects that are known for the month ahead and start to schedule when you might start working on these so that you start the month already thinking about what needs to be done.

5. Delegation

If you have a staff or team, delegate some of your routine tasks right away.  Every front desk receptionist has slow times; a perfect time for you to delegate.  This will leave you open to handle the more high-level tasks.  We can tend to gravitate to “what is easy or comfortable”, but it’s important to push as much down to your team as possible. It let’s them grow in their jobs and allow you the freedom and time to be creative, grow your client base and earn more money.

Making these changes won’t happen overnight, but whether you are running an office or a med spa – increasing productivity will typically lead to decreasing cost and a happier bottom line.

Using The Art Of Persuasion On Your Website

Is your medical spa's website causing potential patients to make the kind of decisions you want them to make?

Think about the last 10 decisions you have made.  How did you come to your decisions? 

You probably made a mental note of the pros and cons, factored in your intuition along with some sound logic and came up with an intelligent decision. You probably understand that most people aren’t as strong and smart as you and therefore are easy targets to sway. But, that never happens to you. You are just too smart.

You just made your first mistake. You experienced something called the “fundamental attribution error”.  This is the belief that other people’s behavior is solely based on their personality, rather than external factors. For example, “Mary is late because she doesn’t care if others have to wait for her” verses “Mary is late because she must have had car trouble”.

These types of biases are very common and play a big role in the way decisions are made. So of course web designers are using this information to influence the behavior of users.  Some designers intuitively know what techniques to use to achieve this, but they may not be able to tell you exactly “why” it works. However, there are some very skilled “decision architects” that understand the psychological behavior and intentionally design web sites with the goal of shaping a visitors decision process and guiding them into a specific action.

There are 7 main components in the decision architect’s toolbox:  Authority, Commitment, Scarcity, Salience, Reciprocation, Framing and Social Proof.

#1 Authority: 

This principle is about influencing behavior via credibility. This is why you will see a lot of name-dropping, used to give the reader confidence that this information is valuable and credible. The MD or DO afer your name is a prime example.

Readers are more likely to believe information if it is written by an “expert” in the field.  In turn, they are more likely to act (buy) as a result of this information.

Decision architects exploit this principle by listing rave reviews and testimonials on their site. Patient testimonials are a common example that a lot of medical spas use. E-commerce sites show highly visible icons assuring the user that the site is secure.  Forums are another way to use authority.  People have the opportunity to rate their peers and users might rely on those ratings as if they were from an expert.

#2 Commitment:

This principle is about taking a stand on an issue that is consistent with our own beliefs. When you take a stand on something that is visible to other people, you usually feel a drive to maintain that point of view to appear credible and consistent.

Designers use this principle by asking for a small, but visible, commitment from you. If they can get you to behave in a certain way, you’ll soon start believing it. An example of this is Facebook.  If a group page can get you to “like” their page and it appears on your newsfeed, you are basically recommending this to all your friends.  If you can get a patient to “like” your medical spa fan page, you have “publicly committed” to being your fan.

#3 Scarcity:

This principle takes me back to some of the manufactured product scarcity around Botox and filler injections. The newspapers or press (or even a local doc) runs the headline “Botox shortage” and there are immediately lines around every block of people wanting to be seen. (Of course there is no Botox shortage and never will be.)

People are more likely to want something if they think it is in short supply or more valuable than it actually is. For example, psychologists have reported that if you give people a cookie from a jar, they rate the cookie as more delicious if it comes from a jar with only 3 cookies list verses a jar with 10 cookies. A nice fact and part of the reason that Fifth Avenue shoe stores put their shoes on pedistals in almost empty stores.

Decision architects exploit this by showing scarcity of a product. This could include limited treatment times or any number of 'act now' specials in your clinic. Smart medical spas understand that perceived scarcity will generate demand.

Another example of this might be a Grand Opening sale. How many medical spas keep that sign up for months and months, hoping that new customers will take advantage of the “special” price?

#4 Salience:

People are more likely to pay attention to details in your user interface that are unique such as a colored “continue shopping” button.  For example, there are certain times during a purchase when consumers are more likely to investigate a special offer. Being able to understand this gives you an opportunity to sell more products or services by offering them at just the right time in the buying cycle.

#5 Reciprocation:

Do you like to return favors?  Most people do and it’s this psychology that is the basis for this principle.  If someone helps you paint your house or babysit your kids, you feel obligated to help them at a future date.

Decision architects know that if they offer you a small gift – a free newsletter, consultation, seminar, or a sample chapter from a book – you are very likely to do something for them in return, even if it's only positive word of mouth. At first they may not ask you to buy something. They may start by asking you to comment on their blog or link to a website.  They know that it usually take several contacts with a user to make them an actual “customer”. 

#6 Framing:

Savvy decision architects know that we like making choices. It makes up feel in control of our destiny.  So, if we are given a choice of 3 tiers of products, you can be assured that there is one of them that they are pointing you towards whether you realize it or not. Another example of framing is the medical spa doc who shows you the most expensive 'total makeover' package knowing you can’t afford it.  Then the next 'best bang for the buck treatments' seem like a real bargain in comparison!

#7 Social Proof:

Have you ever gone to lunch with a group of friends?  Have you ever watched as everyone orders and then base your decision on their choices? 

A great example of Social Proof is shopping on Amazon. When you buy a certain product, say a digital camera, Amazon will then post a note to you saying “other people who bought this camera bought this case and memory card”. Well, if other people bought them, you certainly should as well!

A medical spa example is a 'recommended treatment' for a patients age issue or skin type. A good decision architect will have the 'most patients like' add-on already checked. The client thinks, “I guess everyone buys this so I should too”. 

So back to my original question: How do your medical spas patients come to their decisions?  Maybe now you can see that their decisions can be 'helped along'! Smart medical spas help patients make the 'right' decision.

Making Things Happen in 2011

How many New Year’s resolutions do you actually keep past the month of January?

How many ideas do you dismiss because there isn’t enough time.  If you are like most of us, “getting more done” is on your list of things to improve in the New Year.  Here are great tips from some of the top idea executors out there to help you transform that idea in your head into a reality.

1. Walk before you run.  Great ideas usually start as big, blue- sky concepts in our head.  The downside to this is that you may not know how or where to start executing.  Break your big idea into small, actionable chunks that will move you past the “dreaming” stage.  Once you get some initial feedback on your “small” steps, you will feel more confident taking the bigger steps.

2. Find the courage to move.  What separates the entrepreneurs and creative professionals from the rest is an innate desire to move forward.  Yes, planning is crucial, but don’t fall into analysis paralysis.  As soon as you take that first step (applying for a patent, designing a prototype), your momentum will grow.  You must challenge yourself to take action sooner rather than later.   

3. Try, try and try again.  Even the best idea can suck the first time it’s prototyped.  Trial and error is a must in the creative process.  The important thing is to learn, refine, study and create a new-and-improved version. Rather than getting discouraged by your “failures,” just keep moving.  Then build a new prototype. Then do it again. And then one more time if needed until you get it right. 

4. Create a routine and stick to it. Part of being able to work on your project a little bit each day is carving out the time to do so. Routines can seem monotonous and uninspiring, but they actually form a strong foundation for creating true insight. 

5. Create simple objectives and review them frequently.  Working on complicated projects can make it difficult to remain focused on the goal.  Lots of new ideas enter the scene and the project’s scope can grow out of control.  This phenomenon, called “scope creep” can make it impossible to ever complete anything. The best way to avoid it is to write down a simple goals that summarize your objective at the start of each project. Read it regularly and ask yourself if you are still focused on the original goal.

6. Avoid “out of sight, out of mind”.  Whether you are writing a book, developing a new medical instrument or just learning a new skill, it is imperative that you maintain momentum.  It’s like exercise; the more you do it, the easier it becomes.  The same thing applies to your brain.  Just as when you run everyday, the exercise gets easier and easier, the same thing happens with your brain. As Jack Cheng argues in a great blog post, “Thirty Minutes A Day”: “the important thing isn’t how much you do; it’s how often you do it.”                                               

7. Say “no” more often. Be selfish with your energy. 

Creative energy is not infinite. Seasoned idea-makers know that they must guard their energy – and their focus – closely. Take author Jim Collins for example. His books Built to Last and Good to Great have sold millions of copies. His business acumen and insights are in demand. Yet, “even though Collins demands over $60,000 per speech, he gives fewer than 18 per year.” More than that and Collins wouldn’t have enough time to focus on the research and writing that yield those bestselling books. The ability to say “no” is an essential part of the productivity process.

The tips here should only be followed as long as they are actually working. If moving forward seems impossible, then take a walk, call a friend, visit a museum. Make sure you occasionally shake up your established routine. New perspective is gained and helps recharge us to keep moving forward.

Chicago Doctor Sues Over Yelp & Citysearch Reviews

The next time three of Dr. Jay Pensler's patients could be seeing him will be in a court of law. But it's probably not what you're thinking. Pensler's patients aren't suing him -- he's suing them.

Pensler is upset about negative remarks they made about him on Yelp and Citysearch , two websites where customers can anonymously post reviews about almost anything and everything.

I was trying to prevent what happened to me from happening to other women," one of his former patients told FOX Chicago News. "I didn't want people to go through the same thing I went through."

If you want to know exactly what the women who posted reviews went through, they said the pictures speak for themselves. One woman's breasts are clearly uneven and the nipples point in different directions. The X-ray from another woman who received a tummy tuck showed an object that looks like a staple. She said it is actually the head of a needle Pensler left in her body, but Pensler says was left by another doctor in a previous procedure.

Some people call him a butcher, which I agree with," another woman who went to Pensler told us.

Like the other patients we interviewed, she asked we don't identity her because she's embarrassed and scared what she says can be used against her in a trial. Since seeing Pensler, she said she's been operated on twice by another surgeon to correct Pensler's work.

Pretty harsh stuff. Click here for the rest of the article.

Dr. Pensler is in way over his head of course since he's got no recourse if either the patient's claims are true or they're the patients opinions. The law suit that Dr. Pensler was hoping would keep negative reviews of his practice off of the internet are having exactly the oposite effect. His lawyer should have told him as much.

Allergan Shifting Headache Sales Reps to Botox

Allergan sales forces previously working on GlaxoSmithKline headache drugs Imitrex and Amerge as part of a co-promotion will be reassigned to Botox, in support of the drug's new headache indication.

The move,  confirmed by a company spokesperson,  gives Allergan a jump start with headache specialists, since the GSK co-promotion deal was “a very good way for Allergan to learn the headache market,” Allergan CEO David Pyott told the Journal. Crystal Muilenburg, a spokesperson for Allergan, says that sales forces will initially target neurologists, pain, and headache specialists, to train them on Botox's “injection protocol and dosing regimen.” Muilenburg declined to estimate the number of reps that will support the headache indication, which received an FDA green light on October 15. GSK drugs Imitrex and Amerge have lost patent protection.

A key challenge that we started addressing immediately upon FDA approval is reimbursement,” said Muilenburg. “As with many new drugs, reimbursement is not widely established for Botox in this new therapeutic category.”

Physicians or patients looking for information on reimbursement can visit a dedicated website, call 1-800-44-BOTOX (option 4), or locate a Botox reimbursement business manager for “on-site education, training, and support,” according to the website. Physicians can also sign up to receive forthcoming treatment records and case studies on the headache indication, as they become available.

Allergan paid $600 million to settle Justice Department charges of off-label marketing in September, and pled guilty to marketing Botox off-label for conditions including headache. As part of the settlement, Allergan was forced to drop a First Amendment lawsuit challenging FDA policy on the exchange of “truthful scientific and medical information,” a spokesperson reported at the time. The pending approval in September of Botox for an ailment that previously existed as an off-label use sparked rumors about a relationship between Allergan's lawsuit and FDA's approval of the headache indication, rumors which Muilenburg quelled: “The FDA granted approval of Botox for the treatment of chronic migraine patients based on two phase III pivotal trials, and on its own merit,” she said. “The two actions are completely separate matters.”

Botox's headache indication, specifically, is for the prophylaxis of headaches in adult patients with chronic migraines. GCI Health has been awarded the PR account for the indication. Muilenburg declined to reveal other agency partners for the headache indication launch.

Allergan Starts Trials for Hair-Growth Treatment

Botox maker Allergan is about to launch clinical trials of a hair-growth treatment similar to its drug Latisse, which stimulates the growth of eyelashes.

The Phase 1 trial, scheduled to start this month, will focus on the safety of two formulations of bimatoprost, which is the active ingredient in Latisse.

This phase of the trials will include a total of about 28 patients — men with moderate male-pattern baldness and women with moderate female-pattern hair loss.

The FDA approved Latisse as a treatment for eyelashes, with a warning that it can cause hair growth on other parts of the body that come in contact with the drug.  Some doctors have already tried using Latisse as an “off-label” treatment for hair loss.

Hair-restoration expert Dr. Alan Bauman of Boca Raton, Fla., reported “modest hair growth” among patients who have been applying Latisse daily to their scalp.

Irvine-based Allergan might want more impressive results than that in order to make its hoped-for baldness remedy more commercially successful.

Bauman predicted that “Allergan will likely test a stronger concentration for the use on the scalp than the 0.03% bimatoprost found in Latisse.”

If Phase One (safety) trials are successful and Phase Two and Three trials (efficacy) are eventually completed, bimatoprost could become the third FDA-approved drug for the treatment of baldness in men and only the second FDA-approved drug for women with hereditary hair thinning or female pattern baldness,” Bauman said. Those conditions affect an estimated 60 million-100 million Americans, he said.

The clinical trial will be run out of Tempe, Ariz.  It is scheduled to be completed in February.

Allergan: $600 Million Poorer, but Closer to New Botox Uses

Sounds like Allergan may have been getting a little greedy and got busted....

Allergan, the maker of Botox, will pay $600 million in fines and civil settlements after pleading guilty to marketing their product for uses for which it hasn't been FDA approved.

The Justice Department accused Allergan of encouraging doctors to use the powerful neurotoxin through kickbacks and by teaching them how to forge drug reports.

"The FDA had approved therapeutic uses of Botox for only four rare conditions, yet Allergan made it a top corporate priority to maximize sales of far more lucrative off-label uses that were not approved by the FDA," U.S. Attorney Sally Yates explained.

Botox is most famous for its use by dermatologists to temporarily diminish the appearance of facial wrinkles, but the drug, which is scientifically known as Botulinum toxin and works by temporarily paralyzing nerves, has been approved for rare conditions like eye muscle spasms since 1989.  In March, the FDA approved Botox use to treat muscle spasms in elbow, wrist and finger injuries among adults.

According to the suit, Allergan paid doctors millions and taught them how to miscode the drug to avoid being caught, all so that they would use Botox for "off-label" treatments – uses for which it has never been approved, though it may be effective. Botox was promoted for migraine relief and juvenile cerebral palsy, for which observational data suggests it is effective.

When a drug has been approved for a certain medical use, it cannot be marketed to treat other uses, even if patients report those other uses as a side benefit. Still, marketing drugs for side benefits is common. In 2008, Bayer ran afoul of the FDA when it over-emphasized the acne reducing benefits of its popular birth control pill, Yaz.

Though off-label usage is legal and often beneficial for patients, it can be dangerous. In April 2009, after repeated reports of side effects among children with cerebral palsy that mimicked botulism poisoning, the FDA ordered Botox to carry "black box labeling," the strictest possible warning for a product.  Doctors reported respiratory problems, muscle weakness, loss of bladder control and double vision among their young patients, along with hospitalizations.

Currently, the FDA is reviewing Allergan's application to approve Botox for migraine headaches. The agency is not reviewing information on juvenile cerebral palsy and no known tests are in the works, though CBS is reporting that Botox is being tested in countries like India, Poland, Serbia and Turkey for a host of ailments, including Parkinson's disease, spinal cord injuries, excessive perspiration, depression and something called "curvature of the penis."

If any of these studies abroad provide conclusive data, they could potentially spur bids for approval of new uses of Botox in the United States.

Breast Reduction Surgeries on the Rise.......for Men

Men feeling self-conscious about the size of their breasts is nothing new—as members of the Seinfeld generation will recall, the episode in which Kramer invents "the Bro," or the "Mansierre" to tame oversized "man boobs" first aired in 1995.

This can't be good.

According to the BBC, in recent years discomfort over what are colloquially known as "moobs," is prompting increasing numbers of men to go under the knife. According to the British Association of Aesthetic Plastic Surgeons, the number of men who underwent breast reduction surgery in the U.K. increased from 323 in 2008 to 581 in 2009, a jump of 80%. Yet, instead of reflecting a surge in gynecomastia, the medical condition in which hormonal changes result in abnormal enlargement, swelling and discomfort in men's breasts, experts suggest that the uptick in cosmetic surgeries is more likely a reflection of both obesity, and increased media scrutiny of "man boobs." (Case and point, several gossip sites have entire photo galleries dedicated to male celebrities' fleshy breasts.)

Of course, for some men, surgery may provide relief from what can be an embarrassing and uncomfortable condition. Yet, as plastic surgeon Rajiv Grover points out to the BBC, for many men, it's not a hormonal imbalance, but simply being overweight, that is the root cause of bigger breasts. "Quite a few cases are caused by obesity, and we often say to men to look at their lifestyles before thinking about the scalpel," Grover said.

Is Taiwan Asia's Next One-Stop Plastic Surgery Shop?

Tourists who frequently return to Taiwan might recommend savoring succulent street food or exploring Taipei's boisterous night markets. Or they may pass along the business card of a favorite plastic surgeon or dermatologist....

And why not? Taiwan has long been popular with its expatriate population as a medical-travel destination. At Taipei's abundant health care facilities, the equipment is modern and sophisticated, and most importantly, prices are considered a steal. Some of the biggest savings are in liver-transplant surgery, which runs to around $91,000, compared with some $300,000 in the U.S.

Price tags like that have built a small but devoted following for Taiwan's niche medical-tourism market, and it's about to get a lot more customers. Taiwan's neighbors across the strait have been making their way to the island for a nip or a tuck since travel restrictions for Chinese tourists were lifted in mid-2008. Now, in the latest of a series of agreements and concessions between China and Taiwan, Taipei announced last week that Chinese tourists will soon be allowed to travel individually to the island — a development that many medical-tourism proponents are hoping will be a boon to their industry - especially the plastic surgeons.

Taiwan's current policy only permits controlled tour groups from the mainland, which limits options for Chinese who seek varied medical services.

Under group-travel restrictions, tourists are told where they can go and when. They can't deviate from the set itinerary," says David Wang, a plastic surgeon and chairman of the Taiwan Medical Tourism Development Association. "I've heard of a few people who will secretly come [for plastic surgery], perhaps under a fake name or by claiming they are here on business."

Now, Chinese patients seeking operations can plan ahead and book Botox treatments and eye-bag or double-eyelid surgery at Wang's offices on their own schedule.

Mainland tourists could be a huge boost. According to Taiwan government statistics, just over 972,000 tourists from China journeyed to the tear-shaped island in 2009 — a 195% jump from the figure in the previous year, when the two sides made transit and tourism agreements. Further encouraging cross-strait exchanges, last month Chinese aviation officials announced a 10% to 15% reduction in airfares for flights between the two sides. With over a million projected to visit this year, even more mainlanders will be emptying their wallets into Taiwan's service sector.

Wang, the plastic surgeon, already travels to China about once a month to promote his practice, and he isn't the only one. Many enterprising proponents of Taiwan's medical tourism have been making the cross-strait journey in the hopes that they, too, might entice more mainlanders to seek medical care on the island.

Not many people know about the quality of Taiwan's health care system," says Richard Wu, CEO of Taiwan Task Force for Medical Travel. "It's our priority to first put out Taiwan as a brand name and then promote individual hospitals for services."

The fact that these customers will now be able to travel to Taiwan solo will only help. "No one would join a group tour that lets everyone else know they are going for plastic surgery or other medical reasons," Yen says. "With individual travel, you can just tell your neighbor you are going to Taiwan for vacation."

Twilight Craze Brings The 'Vampire Facelift'; Selphyl

A new cosmetic procedure may just "eclipse" its competition. They're calling it the "Vampire Facelift", and it's increasingly available at medical spas.

It's not really a facelift, though, it's an injectable filler called Selphyl (get it? Sounds like cell-fill). It's generating lots of buzz.

It works by temporarily plumping up lines, much like its older cousins Juvederm and Restylane. But unlike the competition, Selphyl uses the patient's own blood to do the plumping.

Twilight enough for ya?

First, an amount of the patient's blood is extracted. Then, according to the maker, the platelets are separated from the red blood cells. The platelets are blended with a proprietary synthetic mixture and injected into your frown line.

This happens to coincide with all this fascination people have right now with blood - the whole vampire craze," says Dr. Tabasum Mir, who specializes in cosmetic dermatology and cosmetic laser surgery in Manhattan. Her patients are not requesting it, she ads, but inquiring out of curiosity. "I don't think my patients are interested in a two-step procedure when there are a lot of other fillers around that have been tried and tested."

Besides, one can't help but thinking that a real vampire wouldn't need Sephyl or any other wrinkle filler, because the undead stay out of the sun and never age. Anyway, is it safe for humans?

We certainly looked into it, but I think there probably isn't much of a problem when it comes to safety," says Dr. David Bank, President of the New York State Society for Dermatology and Dermatologic Surgery. "And by now, if any of our members were coming in with problems or complaints they would be reported to the society and those reports would be then shuttled to me. I haven't heard anything bad. But that's not a guarantee. The jury is still out."

Botox Effects Beyond the Obvious

US researchers suggest that people who have undergone Botox treatments not only change their appearance but may also have a weakened ability to experience emotions.

Joshua Davis from Columbia University in New York wrote about their findings in a paper published online in the journal Emotions this month.  Although it has been over a century since William James, an American pioneer of psychology proposed a theory of emotion that stated unless it can be expressed physically in the body it doesn't really exist, nowadays referred to as the facial feedback hypothesis (FFH), attempts to test it have been inconclusive.

That is until Botox (and presumably Dysport) came along, because it paralyzes face muscles used to express emotion (thus reducing wrinkles) and so you can use it to test FFH by comparing its effect with that of a cosmetic filler that does not affect facial muscles: this is essentially what the researchers did.

With the advent of Botox, it is now possible to work with people who have a temporary, reversible paralysis in muscles that are involved in facial expressions," Davis reports. 

A person who has received treatment with Botox can respond to an emotional event, for instance a sad scene in a movie, but their facial muscles will be less active, and this sends less feedback to the brain about what the face is expressing.

It thus allows for a test of whether facial expressions and the sensory feedback from them to the brain can influence our emotions," explained Davis who said Botox enabled them to design a study where they could "isolate the effects of facial expression and the subsequent sensory feedback to the brain that would follow from other factors, such as intentions relating to one's expressions and motor commands to make an expression".

For the study, Davis examined two groups of participants: one received Botox treatment and the other, the control group, received Restylane, a cosmetic filler that does not paralyze facial muscles.The participants filled in questionnaires about their emotional experiences to watching positive and negative video clips before and after treatment.

The researchers wrote that results from the Botox group showed no changes between the pre- and post-treatment emotional responses to the most positive and negative video clips, but when they compared the two groups they found that the Botox group showed an overall "significant decrease" in the strength of emotional experience.

This seems like pretty bogus info to me but you never know. It always makes me leary when there's press around terms like 'significant decrease'.

Of course, there's also this; 

A new study by the US Association for Psychological Science has found that the anti-wrinkle treatment, which works to smooth fine lines by paralyzing muscles in the face, actually has an effect on the brain as well, reports London’s Telegraph.

40 volunteers in the study, done by researchers from the University of Wisconsin, were evaluated both before and after having Botox injections. Their response time was recorded as they read a series of statements out loud, with content ranging from "angry" to "sad" to "happy."

The study found that the subjects took longer to read the more "negative" passages after the injections than before. Researcher David Havas told the Telegraph this delay was small but critical because it implies that the brain was processing the negative emotion more slowly after the drug's injection.

"Normally, the brain would be sending signals to the periphery to frown, and the extent of the frown would be sent back to the brain," explained research leader Professor Arthur Glenberg. "But here, that loop is disrupted, and the intensity of the emotion and of our ability to understand it when embodied in language is disrupted."

In other words, when your face stops frowning, your brain gets the message that you've decided there's less to frown about.

"There is a long-standing idea in psychology called the facial feedback hypothesis," Havas told the Telegraph, who believes the new study shows that, "When you're not frowning, the world seems less angry and less sad."

So does this mean that those getting Botox not only have smoother faces than their Botox-free friends but are happier too?

Not necessarily. A study published earlier this year in the Journal of Cosmetic Dermatology found that when injections of Botox are used to paralyze some facial muscles, other nearby muscles have to work overtime to compensate, creating even more lines in the face.

Sciton Launches New Site For Japan Market

Sciton reaches out to their Japanese customers via a new Japanese-language site.

Sciton recently offered our members a great deal on their BBLs IPL and they just sent over a bit of news I thought I would share with our international physicians and med spas.

Sciton is making a committed effort to support the Japanese aesthetic market (the second largest in the world) and has launched a new site for their Japanese-speaking customers.  Their hope is that Japanese customers will get better, more accurate info, in their native-language.

We’re excited to have the ability to provide information about our lasers in the Japanese language,” said Mr. Hiroyuki Takase, General Manager of Sciton Japan. “Since the establishment of Sciton Japan in April 2010, inquiries about Sciton laser systems have been coming in every day.  Now, with the translated website, we can serve our customers in a convenient and real-time fashion to provide the materials and references that they need.

For our Japanese doctors, you can check out their new website at: www.Sciton.jp

Are the best medical spas making the most money?

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?