Botox Patient » Medical Spa

Spreading The Love

Botox Patient — Thu, 18 Nov 2010 20:14:03 +0000

What the world needs now, is love, sweet love… and so the song goes.

Remembering this little line even in your online dealings will definitely get you a thumbs up from your web friends.

The question now is this: how can you spread the love when all you’ve got in front of you is your computer?

The answer is simple: let your fingers do the talking.

The easiest way to do this is by commenting, whether it’s on your friends’ blogs, facebook profiles, myspace accounts or youtube videos. Let them know that you’ve seen their posts… and that you appreciate their efforts at sharing a part of themselves with you.

Another thing you could do is to engage your online friends in conversations. They don’t have to be about deep topics like philosophy or the woes of life… even a simple discussion about music, your favorite vacation spots or even just your favorite Thanksgiving food will pave the way for creating relationships. And at the end of it all, that’s what you want: to be able to connect with people and form relationships.

A word of caution, though. There’s a thin line between being friendly and being annoying. You’d want to be careful that you’re the former rather than the latter. Here are a few things that you may want to remember:

Make sure that your comments are relevant to that which you are commenting on.
Exert the effort to follow through with conversations that you initiate (Don’t you hate it when a friend starts a conversation and leaves you in mid-air after you reply? Well, the same principle applies online.)
Moderate the number of comments and posts that you make in other people’s sites. (You don’t want to be “un-friended,” do you?)
Always be polite. There’s no need to cuss or be rude.

Commenting may be something that’s taken for granted but it’s a simple way to appeal to people’s desire to be appreciated. And doesn’t everybody like to feel appreciated? We know we do so, feel free to send some love our way.

Spreading The Love is a post from: Botox Patient

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Botox Mistakes You Should Avoid

Botox Patient — Tue, 07 Sep 2010 12:40:35 +0000

Here’s an update to The Insider’s Guide that we are creating.

We just decided to include a discussion of issues that should be considered as Botox no-no’s. A common denominator among these types of issues is the desire to avoid paying the high cost of Botox treatments. Sadly, money, or a feeling of lack thereof, can really drive people to make unwise decisions. We’re hoping that this Guide will protect women from unscrupulous individuals and, maybe, even from themselves, by giving them the information needed to make smart choices.

Here are a couple of issues that we might tackle in The Guide.

Do-It-Yourself Botox treatments

A lot of controversy was stirred by the arrest of Laurie D’Alleva. Suddenly, the issue of Do-It-Yourself Botox treatments was shoved into the spotlight. I know that there are individuals out there who believe that Laurie was doing the common person a great service by giving them access to cheaper cosmetic medicine. But, please be wary of distributors, online or otherwise, who allow you to purchase prescription medicine, such as Botox, without a prescription. The FDA has regulated these drugs for several reasons – most important of which is your safety. A lot of people seem to overlook the matter of health just to be able to save some money but, as some of the victims of Discount MedSpa admit, reversing the effects of their DIY treatments are causing a much bigger dent on their bank accounts.

Fake Botox

Most of the bad press associated with Botox actually pertain to instances where Fake Botox was used irresponsibly. You may have heard of the Houston physician who was sentenced to prison for using industrial strength Botox on her patients. The drug she used was labeled “FOR RESEARCH PURPOSES ONLY, NOT FOR HUMAN USE” and yet she still injected some 170 of her patients with it. Botox, despite being derived from a neurotoxin, is really a safe drug – but this comes with several precautions such as using only the FDA approved version produced by Allergan and proper administration by experienced medical practitioners. When a person chooses to cut corners and find cheaper alternatives without regard to possible repercussions, you just know that things are bound to get ugly – and with Botox in the equation, ugly might just be right on the money.

I know that deciding to undergo any medical procedure requires giving your physician a little bit of faith but that doesn’t mean that you have to go through the process blindfolded.

The inclusion of a section that discusses these issues in The Guide is made with the hope that we will be making more women think twice about latching on to super-saver deals like these. We’ll also give you some tips on avoiding Botox pitfalls such as how to choose your physician, what to ask during your consultation and even how to check if the Botox that will be used is the real deal.

I hope this is getting to be as exciting for you as it is for us!

Botox Mistakes You Should Avoid is a post from: Botox Patient

Debunking Botox Myths

Botox Patient — Thu, 02 Sep 2010 19:27:10 +0000

We’ve started writing the Insider’s Guide To Botox and are keeping you in mind the whole time — as much as possible, we’d like to address your Botox concerns from the moment you start deliberating if you’re a good candidate for the procedure until the time you schedule your next treatment.

One of the things that we decided to do is address the myths surrounding Botox and give you the correct information.

We came across several erroneous and misleading articles and commentaries online while conducting our initial research and this propelled our efforts into separating Botox myths from facts. We also took note of common misconceptions and will distinguish which ones are true and which are not.

We figured that if we were to put ourselves in the shoes of someone searching around online for information that will help them decide if they’re going to go through with the procedure, we’d end up having to wrestle with confusing literature especially with topics relating to when you should schedule your next treatment, who are authorized to administer the drug and something as basic as how the drug works.

All this is geared towards creating the ultimate guide for the smart Botox patient.

Here are the general headlines of the Guide:

Botox Basics: Everything you need to know even before your first consult
Botox Treatment: Overcoming Botox Jitters
Botox Aftermath: Making the effects of Botox last

Debunking Botox Myths is a post from: Botox Patient

CO2 Cosmetic Laser Resurfacing

Botox Patient — Sun, 06 Jun 2010 18:09:17 +0000

How Come Fractional CO2 Aesthetic Lasers Are Now The Top Fractional Procedure For Skin-Tightening?

CO2 laser skin resurfacing is not really a new principle. Co2 laser resurfacing has been around for 25 years. While conventional laser ablation had been fantastic for facial lines and wrinkles, scarring, sun damage or elastosis, there were substantive threat of infections, scarring and pigmentary differences. All those negative effects made this complete ablation to drop in favor with laser surgeons and subjects as well.

The concept of fractional laser treatments has been around since 04. Basically, fractional treatments provides for a small fraction of the epidermis is treated even though the all of the intervening areas are not ablated. These untouched areas of dermis all around the treated zones provides for swift healing.

As this methods was combined with with a CO2 laser, exhilaration within the laser clinic community catapulted. There are specific reasons for the medical spa community’s excitement:

First, there’s a smaller amount of downtime.

Conventional full laser ablation methods took extended down times of as many as 6 weeks. A handful of clients might have erythema (redness) for nearly eight months. By using Fraxel remedies, the down-time is from 3 to 6 days depending on the energy levels used. Such fast recuperation gives a much higher degree of expediency for your usual individual.

2. Much less danger of secondary complications.

Utilizing old-school total ablation laser procedures the chance of contamination, scarring like hypertrophic scarring and color alterations like hypopigmentation were much more frequent even with the most practiced laser surgeons. Considering the fact that Fraxel CO2 solutions leaves behind the majority of the dermis intact, the pitfalls linked with the approach are reduced.

3. Improvement.

Though much less of a dramatic end result when compared to old school CO2 laser solutions, the lowered risk and fine effects help make newer fractional laser treatments an alluring laser. In contrast to non-ablative fractional lasers, fractional CO2 lasers allow for significantly greater skin tightening. Fractional CO2 laser treatments are frequently performed again too. For scarring damage, it ordinarily involves 3 procedures in order to lessen the the scars. There are several fraxel CO2 lasers that you can purchase:

1. Smart Skin by Cynosure. This particular laser goes to thirty W in a two millisecond length. There are plenty of various parameters which may be selected so the procedure is personalized to every single customer.

2. Active FX & Deep FX by Lumenis: This fractional skin is also well-known, having said that you will find a couple of spot sizes which end up being switched out through a procedure.

3. Fraxel Repair from Solta: This laser skin penetrates really deeply. Be certain you look at a seasoned MD, since the highest rate of problems have been involved with this particular laser do to the level of penetration.

4. eCO by Lutronics. This fractionated laser is certainly attaining footing inside quite a few skin clinics and has a chaos technology which is good.

Those might be all the main fractional CO2 lasers which are typically though of as lasers which are generally easy to apply and show results. Certainly, there are different lasers, yet, some can be low powered and / or studies are lacking.

CO2 Cosmetic Laser Resurfacing is a post from: Botox Patient

Medical Spas & Plastic Surgeons On Twitter

Botox Patient — Sat, 09 Jan 2010 17:55:09 +0000

Via KevinMD: This issue has come up before, most recently when the New England Journal of Medicine asked whether doctors should friend their patients on Facebook.

Pediatrician Bryan Vartabedian looks further at the issue, and sees it fraught with potential risk.

He points out that sharing privileged information requires written consent. But what if the patient initiates the conversation? Some attorneys say that can imply consent, but the laws in this area are not yet clear.

Also, every communication between doctor and patient needs to be documented. Dr. Vartabedian notes that “the documentation on most social platforms isn’t detailed enough for other medical professionals or auditors to follow what’s gone on between you and your caregiver [and] let’s not forget that Twitter has a habit of disappearing after a couple of weeks.”

And perhaps most concerning is the privacy issue. When someone shares personal medical information in a public forum, like Twitter or a Facebook page, it has to potential to get indexed by search engines, making it permanent on the web.

There’s tremendous potential for doctors to better use Twitter and Facebook to interact with patients. By guiding patients to reputable sources of medical information, for instance.

But social media isn’t mature enough for doctors to provide personal medical advice to patients. Yet.

Medical Spas & Plastic Surgeons On Twitter is a post from: Botox Patient

Botox Patient: What to get your man for Christmas

Botox Patient — Mon, 21 Dec 2009 04:04:04 +0000

For the man who has everything...

According to the American Society of Plastic Surgeons (ASPS), men accounted for 13% of all cosmetic surgical procedures performed in the United States in 2008, and 9% of the cosmetic minimally invasive procedures. And these numbers are only going to rise as “getting work done” is no longer considered taboo and men realize that in today’s competitive environment, looking their best is advantageous to their careers and life.

While plastic surgery procedures are still predominantly performed on women, here are the top five surgical and top five minimally invasive procedures that are on men’s wish lists:

Top Five Surgical Male Procedures

1. Rhinoplasty: What man hasn’t broken his nose in a childhood injury and secretly wishes they had a straight nose again?

2. Eyelid surgery: Droopy eyelids make your man look old – open his eyes up to a more youthful appearance.

3. Liposuction: Love handles are called that for a reason, but do you really love them? Does he? That stubborn fat that won’t budge regardless of diet or exercise can now be removed through a myriad of new liposuction options.

4. Breast reduction: It’s never good when your man has bigger breasts than you. Enough said.

5. Hair transplant: Women want to move their fat around to different parts of their bodies. Men want the hair of their youth – on their heads, not their backs.

Top Five Minimally Invasive Male Procedures

1. Botox: Maybe he won’t look so angry anymore.

2. Chemical peel: Years of no sunblock plus sun exposure equals leather face. A chemical peel could turn back the clock by smoothing out the skin.

3. Laser hair removal: Sweaters should come off at some point – and aren’t you tired of shaving his back because he can’t reach? Laser hair removal is a permanent option.

4. Laser skin tightening: Using a carbon dioxide laser, skin is tightened and since it penetrates the deep layers of skin, it promotes collagen growth. And what guy doesn’t like lasers?

5. Microdermabrasion: It’s like sandblasting for your face. That’s all you need to tell him.

Botox Patient: What to get your man for Christmas is a post from: Botox Patient

Botox Patient: Botox brings relief to migraine sufferers

Botox Patient — Mon, 14 Dec 2009 16:09:45 +0000

Those who suffer from chronic migraines know the intense pain and discomfort they cause. Now there is new hope in Botox.

Migraines are extremely painful and can be debilitating to those who suffer from them. There are many different treatments available, the most popular being prescription medications. Many swear by acupuncture or hypnotherapy as a relief from pain and some even undergo surgery to make the headaches stop. There is another option available that is a new use of a well-established medicine – Botox.

Migraines are thought to be caused by the dilation of blood vessels in the head. When dilated, these blood vessels tug at the nearby nerve receptors causing incredible pain. Migraines tend to involve not only a headache but result in sensitivity to light and colors, nausea, dizziness and more.

According to Dr. Drew Ordon, Botox is an increasingly popular treatment because it can be targeted to treat the specific muscles that are overused. Botox is injected into the muscles, not the nerves, and it works by impairing the muscle’s ability to flex. The patient is able to work with the doctor, specifically identifying the areas that they believe are the origin of the migraines. The Botox may be slightly dilated and is then injected into the muscle. The physician will often massage the injection site to ensure proper dispersion of the medication.

Dr. Ordon also says that it only takes about 20 minutes for a treatment and it usually takes effect in a few days. Patients report relief for about 4 months and are generally pleased with the results.

As with any procedure, speak to your doctor about its safety and whether or not it is right for you. Also, use of Botox for headaches is currently an off-label use of the drug and has not been approved by the FDA. When seeking a physician regarding Botox treatment for your migraines, make sure to ask not only if they’re familiar with Botox injections, but if they’re familiar with Botox for migraines specifically.

Botox Patient: Botox brings relief to migraine sufferers is a post from: Botox Patient

Botox Patient: Latisse fans and detractors

Botox Patient — Thu, 10 Dec 2009 18:39:32 +0000

Taking a prescription drug for a cosmetic side effect — at the risk of other side effects — may seem risky. But it’s a risk that many Americans, mostly women, have shown themselves happy to take.

Latisse, originally a glaucoma drug marketed under the name Lumigan, was approved separately at the end of last year for its
eyelash-enhancing purposes, and its maker, Allergan, has reported sales of $47.7 million thus far. The company says 2009 sales could reach $70 million, exceeding projections of $30 million to $50 million. The national advertising campaign featuring model and actress Brooke Shields hasn’t hurt.

The success of Latisse, however, concerns some ophthalmologists –
albeit medically conservative ones, who say it’s important to see an
eye doctor before taking any eye medication, especially if you’ve never
had a full eye exam. As increasing numbers of dermatologists, plastic
surgeons and medical-spa physicians prescribe the drug, the desire for
pretty eyelashes seems to be taking precedence over eye health, they
say.

Besides stimulating lash growth, the drug can cause eye redness,
itchiness, irritation, infection, darkening of the skin around the
application area. It may even cause a change in eye color, especially
in people who have any amount of brown pigment in their eyes.

“As it is, most Americans don’t get basic routine eye exams, and it’s
really important that people get a baseline eye exam before they
consider using a drug like Latisse,” says Andrew Iwach, the executive
director of the Glaucoma Center in San Francisco and a spokesman for
the American Academy of Ophthalmology. “The eyes are a delicate tissue.
And if someone is thinking about Latisse, they need to see if there are
any contraindications or underlying problems they aren’t aware of.”

Such contraindications, or conditions precluding the use of the drug,
include pregnancy, breast feeding, cataract surgery and ocular
inflammation. “Use Latisse as an opportunity to look good but to see
well too,” Iwach said.

There simply is no long-term data on Latisse, he points out. The
original version, Lumigan, wasn’t even approved for glaucoma until
2001. “We have data for using this type of medication as an eye drop,”
he said. “But we don’t know if this will have a cumulative risk with
topical application over time.”

To many, the gamble is a small one — and well worth taking.

Continue article

Botox Patient: Latisse fans and detractors is a post from: Botox Patient

Botox Patient: Recycling your Fat

Botox Patient — Wed, 09 Dec 2009 21:23:50 +0000

The latest kind of recycling has nothing to do with soda bottles. It entails liposuctioning fat from thighs or buttocks and injecting it into breasts to augment them. After being condemned in the early ’90s, this procedure is generating newfound excitement among the handful of doctors nationwide who offer it and patients keen to enlarge their breasts without resorting to implants.

Almost 20 years ago, the association now known as the American Society of Plastic Surgeons issued a warning to its member doctors to not inject suctioned fat into patients’ breasts, for fear that mammograms would be misread. Since some injected fat dies and calcifies, the thinking was that radiologists would not be able to distinguish between those calcifications (or calcium deposits) and suspicious ones that may indicate breast cancer.

A second concern was that too little injected fat survived being transplanted, because techniques for harvesting, refining and placing fat were not advanced enough. Even today, the success of fat grafting to the breast, as the procedure is also known, depends on the physician.

But this year, the plastic surgery society reversed its former position. A report from its task force reviewed the limited research on fat grafting to the breast and concluded that it “can be considered a safe method of augmentation.” On the issue of mammography, the report said fat grafting “could potentially interfere with breast cancer detection; however no evidence was found that strongly suggests this interference.” Thus, the task force’s statement turned a red stoplight into a yellow one, signaling to plastic surgeons: Proceed with caution.

Botox Patient: Recycling your Fat is a post from: Botox Patient

Discount Medspa shut down for selling Botox style self-injection kits.

Botox Patient — Wed, 09 Dec 2009 00:48:08 +0000

Discount Medspa shut down for selling beauty drugs without a prescription.

stevendepolo

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.

DiscountMedSpa.com and OntarioMedSpa.com, which is also affiliated with the company, are both currently offline. A temporary injunction hearing for Ms. D’Alleva is set for Dec. 7

via examiner.com

What are people thinking? Injecting yourself with a neurotoxin is idiotic.

Botox Patient: Posted from Medical Spa RX: Wholesale Botox

Discount Medspa shut down for selling Botox style self-injection kits. is a post from: Botox Patient

How to Tell if Your Doctor Knows Jack.

Botox Patient — Mon, 07 Dec 2009 13:32:02 +0000

Istockphoto

From Health magazine

Watch for these red-flag phrases that suggest your “skin-care specialist” is subpar, says San Francisco ophthalmologist Krista Ramonas, MD, who has treated medical and aesthetic patients for six years.

“You’ll look 20 years younger.”
Beware the cosmetic doctor who overpromises, Ramonas says. Instead of flattering you, he should be discussing what you can reasonably expect from the procedure and addressing possible side effects.

“I’m an artist.”
The prima donna who tosses this phrase around may value her vision over standard operating procedures. “There is a little bit of art to it,” Ramonas points out, “but there’s a lot more science. We have certain parameters we all have to follow.”

“I’m so good, I’ve never seen complications.”
That may be code for “not very experienced,” Ramonas says. “Medicine is always about being prepared for complications.” You need a doctor who can handle the unexpected.

Of these, the greatest is the ‘Artist’.

Botox Patient: Posted from Laser Treatment MD

How to Tell if Your Doctor Knows Jack. is a post from: Botox Patient

How much does Botox cost your local doctor?

Cosmetic Surgeons enlist patients to fight Botox Botax.

Botox Patient — Fri, 04 Dec 2009 00:32:23 +0000

Your plastic surgeon of dermatologist may be asking for your help to fight the Botox Botax shortly. Here’s what the ASDS (American Society for Dermatologic Surgery) is giving it’s members to solicit the support of Botox consumers:

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.

Cosmetic Surgeons enlist patients to fight Botox Botax. is a post from: Botox Patient

Medical Spa eBook: IPL & Laser Training Course for Estheticians

Botox Patient — Thu, 03 Dec 2009 20:43:14 +0000

Awhile back I posted an esthetician position on a local job search website. In my requirements, I had stated that only those estheticians 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 estheticians out there seeking employment, or desiring to advance their career. I would highly suggest the Advanced IPL & Laser Training Course for Estheticians & Laser Technicians.

The 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 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.

Via Medical Spa MD

Medical Spa eBook: IPL & Laser Training Course for Estheticians is a post from: Botox Patient

Resylane + Juvederm + Filler Injection Tips for Medical Spa Physicians.

Botox Patient — Fri, 27 Nov 2009 18:50:03 +0000

Restylane, Juverderm 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.

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

Fluid Dispensing Connector from Braun Medical Inc (you can get from PSS)

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

via Medical Spa MD: Juvederma, Restylane, & Filler Injection Tips for Physicians.

Something worth knowing. How is your plastic surgeon or dermatologist communicating with other physicians to keep abreast of the latest information about treatments?

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Active FX: Laser Skin Resurfacing

Botox Patient — Wed, 25 Nov 2009 15:12:27 +0000

Active FX laser skin resurfacing is gaining popularity at medical spas, laser clinics and plastic surgery centers. It’s main competitors are Thermage, Fraxel, and other skin tightening or laser skin resurfacing treatments.

Here’s an overview of Active FX and some links to more information.

The goal of laser skin resurfacing is simple: replace damaged skin with new, fresh skin. Techniques for skin resurfacing have made enormous advances, allowing nearly everyone to achieve close to flawless complexions. Many systems allow for light, moderate or deep laser resurfacing. The primary targets of laser skin resurfacing include:

Fine lines and wrinkles of the face, especially around the upper lip, cheeks and forehead
Loose eyelid skin
Crow’s feet around the eyes
Pucker marks (smoker’s lines) and frown lines
Brown spots and splotchy, uneven skin tone
Scars, especially acne scars
Loose skin around the neck and jowls

How it Works

The gold standard of laser resurfacing systems, the UltraPulse® CO2 laser delivers thousands of tiny laser pulses in a pattern over the skin. Each pulse heats a column of tissue eliminating pigment discolorations at the surface and creating a zone of heating deep in the tissue. Unique to the UltraPulse Encore, these zones of heating shrink collagen and tighten the skin immediately*. The CO2 laser also offers the benefits of heating deeper layers of skin tissue, thereby stimulating collagen remodeling, tightening* the skin further. Patients can select from a range of treatments depending on the needs of your skin and lifestyle.

What is ActiveFX “fractional” laser resurfacing?

ActiveFX is a fractional laser procedure performed in a single treatment with minimal patient downtime. During the procedure, a high-energy beam of laser light is used to smooth out lines, wrinkles and scars, remove brown spots and other irregularities, and tighten the skin. It also stimulates formation of new underlying collagen to continue improvement over time. With fractional laser treatment, only a fraction of the skin’s surface is treated by the laser, leaving small “bridges” of untouched skin. This technique makes the healing process much faster and enables you to get back to normal activities sooner.

Is ActiveFX right for you?

Treated areas should be washed twice a day with cool water and a mild soap. Use our lotion twice daily to treated areas for 3 to 5 days or until healing is complete. Treated areas should be protected from direct exposure to sunlight. Sunscreen with SPF greater than 15 should be used at all times on the treated areas.

ActiveFX is ideal for you if you:

Have a busy lifestyle or cannot be away from work for a long time
Want noticeable results with minimal downtime
Want to treat dyschromia, fine lines, wrinkles and skin laxity*

What you can expect from ActiveFX

Most physicians perform the procedure in the office with a topical anesthetic cream that is applied 30-40 minutes before the ActiveFX procedure begins. There is little to no pain associated with the procedure – most patients say they feel warmth similar to sunburn. You can drive yourself home after the procedure. With a gentle washing and moisturizing regimen, your photodamaged skin will begin to flake off within 2 days. After about 3-5 days, your doctor will probably let you wear make-up. Pinkness should be gone in about a week.

ActiveFX benefits

ActiveFX treatment produces a dramatic effect on the skin:

Causes immediate skin tightening*
Reduces wrinkles and fine lines, and softens deeper frown lines
Noticeably improves skin tone and texture
Stimulates new collagen formation and plumps the skin

The results of ActiveFX laser treatment are long-term and, with proper sun protection, can persist for many years. Most effects of treatment become visible right away, whereas others – such as new collagen formation, which leads to continued inner tightening – build up gradually and become more evident over time. Therefore, most people look even better 3-5 months after the procedure.

Additional Information on ActiveFX

http://www.aesthetic.lumenis.com/wt/page/activefx

http://www.lumenis.com/wt/page/pr_1170434066

http://www.skinandhealth.com/details/wrinkles_treatment#wrinkles_co2

Redness after IPL & Laser Treatments: DeepFX & ActiveFX

Reliant UltraPulse Fractional CO2 Laser

Active FX: Physician User Group ~ Medical Spa MD

Active FX: Laser Skin Resurfacing is a post from: Botox Patient

Botax: New Taxes on Botox + Plastic Surgery?

Botox Patient — Sat, 21 Nov 2009 20:38:01 +0000

The medical spa and plastic surgery community is in an uproar over some proposed legislation that could make a trip to the plastic surgeon or a Botox injection at the medical spa more expensive.

People are calling it the Botax. It’s a 5 percent tax on elective procedures such as Botox, Juvederm, Restylane, laser hair removal, facelifts, breast augmentation and other nips and tucks that lawmakers are hoping will help fund the nearly $1 trillion health care plan.

The bill says the tax would not apply to cosmetic surgery to fix a deformity either from birth, accident, or disease. It would apply to procedures like face lifts, liposuction, cosmetic implants and teeth whitening.

But as Dr. Paula Hicks points out sometimes cosmetic surgeries have very medical purposes.

“Certainly breast reduction surgery is a very good surgery for a lot of women and a lot of them will get denied by the insurance company as cosmetic surgery,” said Dr. Hicks of the Ave Medical Laser Spa and Laser Clinic.

Under the proposal, Dr. Hicks says an eyelid tuck, which can help with vision, would cost an extra $100 in taxes on top of the $2,000 price tag for the procedure.

She says that could be a big hit to her business since most of her clients are not wealthy.

“Most of these procedures are not done on people that are rich and have endless amounts of money, it’s middle class working women that would be targeted with this tax and it’s really not fair.”

According to the American Society of Plastic Surgeons 86 percent of cosmetic surgery patients are women. Sixty percent of them have annual incomes between $30,000 and $90,000.

The tax, if approved, would raise $6 billion over 10 years.

Allergan, which sells Botox, took a civil rights angle: The tax “discriminates against women,” the company said in a statement. Some 86% of cosmetic surgery patients are working women ages 35-50, with an average annual income of $55,000 per year, according to Allergan.

“What’s next? Are we going to tax people who color their hair?” the CEO of Medicis, a drug company that sells fillers, told Dow Jones Newswires.

The American Academy of Cosmetic Surgery, which is fighting the provision, says “a large portion of those being taxed would be the baby-boomer generation. And as this age group continues to age, the more interest will be generated in cosmetic procedures.”

A spokesman for the 2,500-member group said they were surprised to see the provision in the Senate bill this week, because it had already surfaced and sank in July. The tax is not in the House bill.

The tax is on elective procedures, and would not apply to any procedure to correct birth defects or issues arising from disease, accidents or trauma. The CBO says it would raise about $5 billion over the next decade.

via medicalspamd.com Follow Medical Spa MD on Twitter

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Never a wait for Botox or Photofacials.

Botox Patient — Mon, 16 Nov 2009 05:09:10 +0000

A study in the Journal of the American Academy of Dermatology says if you want to see a skin doctor about a changing mole, get ready to wait. The average wait time is 26 days. But if you want a Botox shot, it’s just eight days, two-and-half weeks shorter. Here in mid-Missouri, two dermatologists say that’s not true.

“There’s a shortage of dermatologists nationally,” dermatologist John Despain said. ”Also, patients have direct access to dermatologists for skin care.”

Dr. John Despain owns Despain Dermatology Center and Skintuition Medical Spa in Columbia, focusing on cosmetic dermatology like Botox. He says at his practice, clinical appointments always come before cosmetics.

“They are seen on a priority basis within a few days,” Despain said. ”If they’re a new patient, if there’s the ability to put them in a new patient slot, they priority over anyone calling for cosmetic concerns, of course.”

At Dr. Lindall Perry’s practice in Columbia, they treat all appointment requests the same.

“We don’t have, quote, ‘cosmetic appointments,’” he said.

Although Perry is booked through January, he says patients with skin problems can get appointments.

“We have open appointments in two weeks with our newer staff and they would take both a cosmetic patient, an acne patient, a wart patient,” Perry said.

Perry says it can be a challenge juggling business and patient care.

“I like to think I have sound business practices,” she said. ”I do schedule myself very fully. My staff would say too full. My patients would say too full. We pay attention though to the frustration of long waits.”

With a heavy focus on clinical treatments, Perry says he tries to see as many patients as possible. Often leaving the Botox appointments for after hours. He says money is a benefit of his practice, not the motivator.

“My desire everyday is to find every melanoma that’s in front of me and not to miss that,” he said.

As for Despain, he likes biopsies just as much as Botox.

“I view them as a compliment to each other,” he said. ”If I had to choose how to spend my time out of enjoyment or profitability, they’re probably equal.”

Both doctors say there’s certainly a demand in mid-Missouri for cosmetic dermatology, but most of their patients and profits stem from clinical work. In the meantime, if you want to see a dermatologist, the best idea is to plan ahead.

via komu.com

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Cosmetic surgeons ban advertising… cosmetic surgery!

Botox Patient — Mon, 16 Nov 2009 05:05:55 +0000

An estimated 100,000 cosmetic surgical procedures are performed in Britain each year, many by doctors who have had no specialist training in cosmetic surgery. In addition, hundreds of thousands of non-surgical procedures are done, including Botox for wrinkles and laser treatments to rejuvenate skin, many by non-medical staff with little or no training.

The 200-member Baaps represents the top surgeons in the business who performed 34,187 surgical procedures in 2008, twice the number in 2004. More than 90 per cent of them were on women. The most popular procedure was breast augmentation, demand for which rose 30 per cent last year.

But Mr Mercer, who combines private practice as a cosmetic surgeon specialising in facelifts with his work as an NHS consultant in reconstructive surgery for cancer patients, said the market for cosmetic surgery, of which Baaps surgeons account for less than one third, was an “unregulated mess”.

He added: “There has been a massive increase in marketing, including discount vouchers, two-for-one offers and holidays with surgery. In no other area of medicine is there such an unregulated mess. What is worse is that national governments would not allow it to happen in other areas of medicine. Imagine a two-for-one advert for general surgery. That way lies madness.”

Mr Mercer, in the journal Clinical Risk, which publishes articles on cosmetic surgery today, he warns that “the doctor’s first duty to protect the patient” has been forgotten in the headlong rush to cash in. “The motive for performing any procedure must never be financial gain … if we cannot self-regulate then regulation will eventually be imposed.”

Citing experience in France, where all advertising of cosmetic procedures is banned, he says: “Perhaps, like tobacco, there should be a Europe-wide ban on advertising all cosmetic surgical procedures, including on the internet search engines.”

Among those who can testify to the dangers is Jill Saward, the former lead singer of 1980s group Shakatak, who last year agreed to a facelift in the hope of reviving her career after her divorce. But she suffered complications aggravated by her high blood pressure and bitterly regretted the decision. Three months after the operation she still did not have full feeling and was warned full recovery could take a year.

“Surgery is not a quick-fix solution,” she said. “The simple truth is that I could have died. I was an idiot, I should have thought much more carefully about the operation and its dangers. It was pure vanity.”

Foad Nahai, president of the International Society of Aesthetic Plastic Surgeons, backed Mr Mercer’s warning, and called for tougher regulations to prevent doctors practising without specialist training. A code of practice backed by self-regulation of cosmetic clinics was announced by the Government in 2007. Clinics are also subject to inspection by the Care Quality Commission. But Baaps says the measures do not go far enough.

via independent.co.uk

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Radiesse Filler Injections Tips

Botox Patient — Fri, 13 Nov 2009 19:15:11 +0000

Radiesse & Your Local Laser Clinic or Med Spa

Radiesse is a filler injection composed of very small and smooth calcium hydroxylapitite microspheres which are suspended in a water-based gel carrier. Calcium Hydroxylapitite is a biocompatible, biodegradable material identical in composition to the mineral portion of teeth and bone. Radiesse is used to fill moderate to severe facial wrinkles and folds such as nasolabial folds. Radiesse is generally not used to enhance the lips or lip line.

The Radiesse gel and microspheres form a “scaffold” that stimulates natural collagen production and encourages tissue growth in and around the injection area. The body absorbs the gel carrier as collagen has begun to infiltrate the area thus replacing the gel with natural tissue. The microspheres continue to provide support while the body completes this process. Eventually, the microspheres are safely absorbed by the body. This entire reconstruction process can take anywhere up to 3 years providing additional injections are administered to maintain even results.

Radiesse injections are very similar other Hyaluronic Acid fillers.

After the injection the medical provider should provide the patient with specific post-care instructions which may include:

Avoiding rubbing, movement or massaging of the area that could cause the Radiesse to migrate.

Don’t apply makeup for the next 24 hours.

No sun and heat exposure.

Injections for Radiesse can typically last from 6 to 18 months with an average of 11 months for nasolabial folds.

Pain? Physicians use a variety of pain management techniques during treatment to ensure patient comfort. Ask your physician about which techniques are right for you.

Are there any side effects? There have been very few side effects reported in clinical trials and actual usage. However, you may experience some common injection-related reactions, such as mild irritation, edema, swelling, itching, discoloration, or tenderness at the injection site. These conditions typically resolve themselves within one to two days.

Botox, Restylane, Juvederm and other filler injections with less pain.

Botox Patient — Fri, 13 Nov 2009 19:05:27 +0000

Botox, Restylane and Juvederm filler injections with far less pain.

A team at UT Southwestern has been combining 2% lidocaine with Radiesse, Restylane and other hyaluronic acid fillers. Tissue is immediately numbed and immediately treated—simultaneously—giving the patient a faster and more comfortable wrinkle-filling experience.

“There is significant time savings in not having to wait for traditional dental block anesthesia to take hold,” explains UT Southwestern plastic surgery chairman Dr. Rod Rohrich, “and the procedure is more pain-free with shorter recovery time.” His team’s findings appear in the journal Plastic and Reconstructive Surgery.

Although the aforementioned formulas require manual mixing, manufacturers have begun offering fillers with lidocaine already built in, like Hydrelle and Prevelle.

This couldn’t come soon enough for most of the medical spas and plastic surgery offices I know. And if you’ve ever had Botox or Restylane injections you know what I mean.

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Medical Spa MD selects Sendside Networks as it’s exclusive member communication platform.

Botox Patient — Wed, 11 Nov 2009 04:31:45 +0000

Medical Spa MD today announced that it has selected Sendside Networks as it’s exclusive member communication and customer retention platform. A secure replacement to email, Sendside offers a 1:1 secure sales communication platform that offers high touch interactive messaging and real-time reporting and control for mission-critical communications in a secure environment.

“Sendside is the only solution that addresses our need to communicate easily but still allows us to protect confidential information,” said Jeff Barson, Editor of Medical Spa MD.

“Unlike any other technology, Sendside gives us the ability to send interactive tabbed messages that allow recipients to fill out forms and actually make purchases ‘inside’ the message, without being redirected to an external link from an email. This gives us the ability to actually send the entire Medical Spa MD site directly through a message while retaining control and accessing all of Sendside’s analytics and real time reporting.

For the first time we can see exactly who has read a message, downloaded and attachment, or forwarded a message to a collegue, providing us with an inside look at what a recipient is doing and offering a perfect opportunity of knowing when to send follow-up information.

The cost to create and send this type of content would be cost prohibitive using any other solution.

Best of all, it’s free for the recipient and as easy to use as web based email.”

Medical Spa MD is currently using Sendside to communicate with thousands of plastic surgeons, dermatologist, and cosmetic physician members around the world.

* * *

ABOUT SENDSIDE NETWORKS, INC.
Utah-based Sendside® Networks, Inc. has developed Sendside—the 1 to 1 Sales Communication Platform that provides organizations a secure, interactive communications channel directly to their customers, prospective customers, clients and investors. Sendside combines secure, interactive messaging with file delivery, interactive forms, e-signatures, payments, and secure storage into a comprehensive communication and interaction platform unlike anything on the market today. Sendside currently has fifteen U.S. Patents pending including Sendside Markup Language (SML), Behavior-based Messaging (BBM), Multi-dimensional Messaging (MDM), Sendside eSign, on demand messaging, embedded payments and acknowledgement. Sendside.com

ABOUT MEDICAL SPA MD
Medical Spa MD is a community of Plastic Surgeons, Dermatologists, Aesthetic Physicians, and Medical Spa Professionals. Medspa MD has Blogs, Forums, and Classified advertising. Members include 4,000+ members worldwide and medicalspa.com recieves more than 100,000 page views each month from physicians and individulals looking for informaton about cosmetic medicine and the lates advances in non-surgical technology.

via medicalspamd.com

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The Medical Aesthetic Practice Assocation (MAPA) chooses Medical Spa MD as it’s exclusive technology platform.

Botox Patient — Wed, 11 Nov 2009 04:29:12 +0000

Medical Spa MD has been chosen by MAPA – The Medical Aesthetic Practice Association as the exclusive technology platform for MAPA Members.

“This is a great day for MAPA”, explained Dr. Epstein. “Medical Spa MD has been a pioneer in information exchange within the cosmetic medical field for years now. His MedicalSpaMD.com Internet Website & Blog has already advance our knowledge by quantum leaps. Combining our manpower, our experience and our content with his robust internet platform will take us even further.”

The Medical Aesthetic Practice Association was formed in response to a need for information sharing in the Medical Aesthetic Practice area. The Medical Aesthetic Practice Association (MAPA) is THE Clinical and Business Information Exchange Forum for Aesthetic Medical Practices and their business and clinical staff.

Jeffrey E. Epstein, MD, MAPA’s founder and Executive Director explained the need and the purpose of MAPA, “the Medical Aesthetic Practice Association’s purpose is to promote and facilitate information exchange among Medical Aesthetic Practices. By sharing our ideas, experiences, opinions and insights, we can learn faster and benefit from each other’s successes and failures. In order to facilitate the convenient and high volume exchange of advanced business and clinical information, MAPA provides Internet Based Platforms for Medical Aesthetic Practice Owners and their Clinical Staff. MAPA also hosts live discussions in their Chat Rooms on a regular basis to promote real-time discussion about important, topical issues.”

MAPA & MSMD will soon have in excess of 2000 (two thousand) members. MAPA currently has Fifty Diamond Club Members who produce content and manage daily activities.

MAPA is planning on hosting their third clinical exchange meeting this Spring at the Cherry Hill Physician Training and Research Center. The meeting held in November 2008 was a huge success. There is no cost to attend these meetings. MAPA will also be meeting at this years ASLMS Conference in Baltimore, MD the first week in April.

* * *

ABOUT MAPA
The Medical Aesthetic Practice Association’s purpose is to promote and facilitate information exchange among Medical Aesthetic Practices. By sharing our ideas, experiences, opinions and insights, we can learn faster and benefit from each other’s successes and failures. In order to facilitate the convenient and high volume exchange of advanced business and clinical information, MAPA provides Internet Based Platforms for Medical Aesthetic Practice Owners and their Clinical Staff. MAPA hosts live discussions in their Chat Rooms on a regular basis to promote real-time discussion about important, topical issues.

ABOUT MEDICAL SPA MD
Medical Spa MD is a community of Plastic Surgeons, Dermatologists, Aesthetic Physicians, and Medical Spa Professionals. Medspa MD has Blogs, Forums, and Classified advertising. Members include 2,000+ members worldwide and medicalspa.com recieves more than 100,000 page views each month from physicians and individulals looking for informaton about cosmetic medicine and the lates advances in non-surgical technology.

via medicalspamd.com

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Paula D. Young RN joins Medical Spa MD

Botox Patient — Wed, 11 Nov 2009 04:27:00 +0000

Medica lSpa MD is proud to announce the addition of Paula D. Young RN to it’s editorial board.

“It’s a fantastic addition to Medical Spa MDs ability to provide expert viewpoints from a diverse group of expert medical providers and business people”, says Jeff Barson, Medical Spa MDs founder and publisher. “Paulas experience will give Medical Spa MD voice for mid-level medical providers an an invaluable resource for the growing number of medical estheticians and laser techinics who are visiting Medical Spa MD to learn.”

“To really know what’s going on in the aesthetic business you must join Medical Spa MD!”, says Young. “Nowhere else can you find the information crucial to your success in this ever changing arena. From the classified ads section, to the professional community forum discussion threads, to real equipment reviews by aesthetic professionals. I especially value the articles on marketing and the community forum discussions on therapy management like melasma, fillers, laser lipolysis, and skin resurfacing. Medical Spa MD keeps me on my toes as a medical spa owner, marketer, and nurse!”

* * *

ABOUT Paula D. Young RN

Paula is the staff nurse and co-owner of Young Medical Spa in the Lehigh Valley area of Pennsylvania along with her husband Thomas E. Young, MD. Prior to establishing Young Medical Spa, Paula previously owned a Merle Norman Cosmetics national franchise, a full-service beauty salon and spa, and a chain of tanning salons. Most recently, Paula worked for Johnson & Johnson for over 10 years and held senior management positions in the medical and sales education, and customer relationship management departments. Her associations include:

Dermatology Nurses Association
American Academy of Medical Esthetic Professionals
Association of periOperative Registered Nurses
American Nurses Association
The Aesthetic Practice Association

Paula also holds a current license with the Cosmetology Board in the State of Pennsylvania. She has written for Medical Spa Report Magazine and authored a textbook on Advanced Aesthetic Practices.

ABOUT MEDICAL SPA MD
Medical Spa MD is a community of Plastic Surgeons, Dermatologists, Aesthetic Physicians, and Medical Spa Professionals. Medspa MD has Blogs, Forums, and Classified advertising. Members include 2,000+ members worldwide and medicalspa.com recieves more than 100,000 page views each month from physicians and individulals looking for informaton about cosmetic medicine and the lates advances in non-surgical technology.

via medicalspamd.com

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9 Top Tips For Medical Spa Success

Botox Patient — Wed, 11 Nov 2009 04:15:11 +0000

If you’re a plastic surgeon or dermatologist starting a medical spa, skin clinic, or laser center, you’ll need to have all of your ducks in a row.

Here are 9 tips to keep your medspa in the black, and your laser treatments and Botox appointments full.

1. Have sufficient funds to kee your Medical Spa open for months.
Don’t even think about opening a Medical Spa unless you have the capital needed to bring it through the startup and first year of operation. Invariably, your planning will not deal with all of the unforeseen issues that can occur in the MedSpa industry. From regulatory compliance changes and training costs, to increased marketing costs. Under-capitalization is a leading indicator of business failure. You should considering a combination of various financing strategies from leasing to working capital.

2. Talk with other doctors who have successful, operating Medical Spas
Ask them what they would do the same, and what they would do differently. We are starting to see some established Medical Spas out there, try and learn from their experiences and best practices.

3. Join associations that help new Medical Spas succeed
They are a great source of experienced MedSpa owners, who have already gone through what you will. In addition, they often have members who have specialized in the MedSpa industry, including: business planning, marketing, design, dealing with regulatory issues, insurance and finance. The International Medical Spa Association even has a mentorship program that is available for new MedSpa owners. It is invaluable to chat with someone across the country who has had the same problems you may have, especially if you know they are not a local competitor!

4. Know your strengths and weaknesses
No one is strong in all areas, you may be an expert in age management medicine, but you may be weak on the business and marketing side. That’s fine, but you are going to need to identify the areas where you are weak and compensate. Not all areas require a permanent, full-time employee, you may consider hiring a consultant who has the necessary experience.

5. Watch your medical spa’s monthly expenses
Especially during the startup phase of a MedSpa, it can be easy to see the glamour of having marble flooring, but is it really necessary? You may be better off adding another hair removal treatment room, which will generate income. Remember the old adage: “it will take twice as long and cost twice as much as you anticipated.”

6. Determine what need your Medical Spa meets.
As with any successful business, you need to meet a consumer demand. With 11,500 people joining the over 50 crowd every day, you have a great potential market. But you need to make sure you are where they can be found (i.e. medical centers, shopping centers, established communities).

7. Know your laser clinic’s monthly cash flow.
You may think financial statements are only for accountants to understand, but you need to be able to read some key financial statements. Including the cash flow statement, this lets you know where the money is coming from and where it is going. You must always know your current cash flow situation, if you cannot pay your bills, you are effectively out of business. Botox, Restylane, Juvederm, IPL, cosmetic lasers… they’re all expensive.

8. Open your medical spa because you want to.
Starting a MedSpa is going to consume two things: time and money. The profit potential of a MedSpa is huge, but if you are not doing what you really enjoy, it will show on your bottom-line! As you will probably be spending more time and money than you originally planned, you need to make sure operating a Medical Spa is what you really want to do.

9. Don’t hire family and friends
They may be able to provide you with valuable assistance during the startup phase, but they most likely will not be able to get you to that next level. This is where having an experienced MedSpa director is very important. Not only are they going to hire and train your employees, but they also will be responsible for the day-to-day operations of the MedSpa. Hiring a competent MedSpa Director can allow you to run your MedSpa as a stand alone profit center; one that makes money whether you are there or not.

Botox Patient: Posted from Laser Treatment MD

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How much does Botox cost your local doctor?

Botox Patient — Tue, 10 Nov 2009 20:55:20 +0000

What do doctors pay for Botox? Botox pricing

Prior to the slowing economy and rise of new competition (i.e. Dysport, Allergan has exercised incredible pricing power with Botox.

Based on data furnished to RealSelf, from 1998 to 2008 Allergan price increases for Botox exceeded the rate of inflation 9 out of 11 years.

Since 1997, the cost of Botox moved up $190 to $525 per vial, or 57%. If Botox prices were only adjusted with inflation, the same vial would price out at $447. The price per unit (paid by the doctor) has climbed from $3.35 to $5.25. Botox vials hold 100 units.

Here’s a table showing the historical cost of Botox to doctors (most doctors markup about 2X):

	vial cost	unit cost	% change	Inflation
1997	$335	$3.35	-	2.34%
1998	$352	$3.52	5.1%	1.55%
1999	$369	$3.69	4.8%	2.19%
2000	$370	$3.70	0.3%	3.38%
2001	$392	$3.92	5.9%	2.83%
2002	$392	$3.92	0%	1.59%
2003	$417	$4.17	6.4%	2.27%
2004	$448	$4.48	7.4%	2.68%
2005	$466	$4.66	4.0%	3.39%
2006	$485	$4.85	4.1%	3.24%
2007	$505	$5.05	4.1%	2.85%
2008	$525	$5.25	4.0%	3.85%
2009	$525	$5.25	0%

Botox Patient: Posted from Medical Spa RX: Wholesale Botox

How much does Botox cost your local doctor? is a post from: Botox Patient

Do it yourself home Botox injections? ABC News want’s to talk.

Botox Patient — Tue, 10 Nov 2009 19:22:19 +0000

Have you tried do-it yourself plastic surgery? In tough economic times, many try to cut costs, including in their beauty regimen. Despite the risks, some people have decided to skip the doctor — and obtain and self-administer cosmetic treatments.

If you have self-injected products like Botox, Restylane, Juvederm, silicone, and other substances, 20/20 would like to hear your story.

Please fill out the form below, including information about your experience, and a producer may be in contact with you.

You can tell ABC all about it here.

via medicalspamd.com

Amazing that anyone would give themselves Botox or Restylane injections at home.

Botox Patient: Posted from Laser Treatment MD

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Medical Spa MD: The dangers of makeup.

Botox Patient — Tue, 10 Nov 2009 19:19:22 +0000

Normally, I barely listen to the radio when driving in my car, but today on the John Tesh Radio Show (Sunday) my ears perked up when he started to discuss the hidden “dangers” of young girls using makeup too early. Dangers in makeup? Really?

The broadcast was entitled “The Ugly Truth About Young Girls Wearing Makeup”. The line that grabbed my attention was “the sooner your daughter starts wearing makeup, the sooner it might kill her!” This was a quote coming from Stacy Malkan, a cosmetic expert who wrote the book Not Just A Pretty Face: The Ugly Side of the Beauty Industry. According to the John Tesh website, Malkan states “by the time most North American girls become teenagers, many have a daily make-up ritual that includes lipstick, mascara, eyeliner, nail polish and perfume, not to mention skin lotion, shampoo, conditioner, and hair color treatments.” She goes on to say “in fact, experts estimate that a typical young girl now walks around with at least a dozen layers of beauty products on her body! As the makeup layers add up, so does her exposure to dangerous chemicals, and that’s very bad news for a young girl’s health.”

Apparently the culprits are chronic exposure to parabens and phthalates which have been found to disrupt hormone levels during adolescent years which may result in early puberty. Malkin continues to state “one study found that HALF [sic] of all North American girls now begin to show signs of breast development by the age of 10 – which is more than two years sooner than females from our grandmother’s generation. Other studies link those unusual hormone levels to a higher depression rate among young girls, and a higher risk for breast cancer! That’s why experts recommend women of all ages find out exactly what chemicals go into their makeup.”

There is a website suggested for reference to verify the ingredients in certain beauty products and cosmetics and it is called the Skin Deep Cosmetic Safety Database. I was instantly intrigued and raced to my Mac when I got home to give it a try! Here’s how my products scored:

(Scale: 0-2=Low hazard; 3-6 Moderate Hazard; 7-10 High Hazard).

Cleanser: 3 (moderate hazard)
Toner: 7 (high hazard)
Moisturizer: 5 (moderate hazard)
Eye Cream: 6 (moderate hazard)
Lip Cream: 7 (high hazard)
SPF 30: 7 (high hazard)
Concealer: 4 (moderate hazard)
Foundation Primer: 5 (moderate hazard)
Foundation: 9 (high hazard)
Loose Powder: 5 (moderate hazard)
Blush: 7 (high hazard)
Bronzing Powder: 8 (high hazard)
Eyeshadow: 7 (high hazard)
Mascara: 8 (high hazard)
Lipstick 6: (moderate hazard)

My gosh, I’m a walking carcinogen!!! Like most women, I use an array of products, from medical grade like Obagi, spa grade like SkinCeuticals, high end department stores like Merle Norman, Estee’ Lauder and Laura Mercier, right down to drug store brands like Maybelline. It seems no company’s products were completely safe. And, makeup is just the beginning for young girls!

More and more young girls are taking their skin care regimens to the next level by having microdermabrasion treatments and chemical peels, with some escalating to laser and injectable therapies. Putting aside the various protocols for acneic adolescents, there has actually been a rise in the U.S. of young girls undergoing laser hair removal, photo facials, dermal filler procedures, even laser lipolysis. Where do we draw the line as clinicians? 21? 18? 16 with parental consent? I know in our medical spa we have been approached by parents inquiring as to what our policy is for treating adolescents for non-medical related conditions. The number one request is laser hair removal for ethic skin types predominately for excess facial hair. Many clinicians feel it is a low-risk procedure which can lift a child’s self-esteem. Some clinicians disagree and feel a child is much too young to be exposed to laser therapies.

I’m not a laser expert and am uncertain as to if many aesthetic equipment manufacturers have performed clinical trials on adolescents for laser procedures (other than port wine stains). I’m more apt to believe the answer to this questions will become clearer as the years go on and by remembering the first rule is to “do no harm”.

That, and to throw away your teenager’s makeup!

via medicalspamd.com

Botox Patient: Posted from Laser Treatment MD

Medical Spa MD: The dangers of makeup. is a post from: Botox Patient

Do it yourself laser hair removal at home.

Botox Patient — Mon, 09 Nov 2009 17:17:21 +0000

They’re are a growing number of ‘home laser hair removal‘ devices appearing on the market. This article on do it yourself laser hair removal supposes that medical spas and laser clinics are feeling the heat.

Want to get rid of some unsightly hair, but don’t want to spend the big bucks for electrolysis or a laser clinic? Now, you can buy your own laser and do it yourself.

And people are.

The growth of the at-home cosmetic-device market, which includes personal lasers, has some professionals buzzing. At an annual conference hosted by the American Society of Plastic Surgeons, Barry DiBernardo, a New Jersey plastic surgeon, delivered a talk in Seattle about the pros and cons of the DIY market on the ASPS’s “Hot Topics” panel.

“We have to make sure that the patients are getting good, safe treatments. If they are getting good, safe treatments, then whether they are doing it at home or not, I’m not as worried,” DiBernardo told Wired.com by phone. “What I’m worried about is that they are seeing things in the Skymall on the airplane and spending hundreds of dollars, thousands of dollars on something that is not going to work or is unproven.”

New cosmetic lasers and medical devices including DIY lasers (do it yourself cosmetic lasers) are expected to explode into a $1.3 billion market 2013, up from just $296 million in 2008, according to the analyst group Medical Insights.

The growth in the market appears to be coming from light-based products that claim to either remove or grow hair on the human body. The Silk’n Hair was the first at-home laser device to be approved by the FDA, in 2006, although it didn’t come on the market until early 2008.

The laser hair removers damage the hair follicles that are in their growth phase, generally leading to some permanent reductions of body hair. DiBernardo questioned whether the lasers used in the home devices were powerful enough to get the kind of results that clinics achieve.

“In general, these devices are low-powered versions of the doctor versions. We’ve been doing laser hair removal since 1998, so we know that they work and how well they do,” he said. “I think these home devices have some effect, but they legally can’t have the power of what we fire at people.”

From nother nice post from Wired:

Technorati Tags: laser hair removal, laser treatment, do it yourself laser hair removal, laser clinic, medical spa, cosmetic laser, home laser hair removal, diy laser hair removal

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Laser Center Marketing

Botox Patient — Sun, 08 Nov 2009 21:56:53 +0000

What is medical spa & laser center click fraud costing you?

Is click fraud costing your laser center or medical spa and driving up your prices? If you’re one of the tens of thousands of cosmetic medical practices, laser clinics and med spas advertising online with Google Adwords or Yahoo, don’t be surprised to find that at least some of the money you’re paying every month is sucked out of your marketing fund by click fraud.

The practice of “click fraud” began in the early days of the Internet’s popularity with software programs that automatically surfed Web sites to increase traffic figures. This led companies to develop policing technologies touted as antidotes to the problem. (Some marketing executives estimate that up to 20 percent of fees in certain advertising categories continue to be based on nonexistent consumers in today’s search industry.)

Don’t think it’s already happening to your skin clinic, med spa or laser clinic? Here’s a recent quote from Michael Caruso, CEO of click fraud services vendor ClickFacts in an interview:

“In particularly fraud prone verticals such as finance, class action lawsuits and medical, we see click fraud rates in the 30-45 percent range. These are all categories that see high keyword pricing in the auction model. That makes them particularly tasty for click fraud artists. “If you can make more money from the dark side than the light side of search, there are plenty of people who will take advantage. Plus, it’s not even technically illegal yet.”

There are two main ways that your skin clinics and medical spas marketing budget is being drained by click fraud:

First, your medical spas and laser clinics competitors who see your ad are simply clicking on it, draining your marketing budget and costing you advertising dollars. Second, fraudsters set up ‘affiliate sites’ that run skin clinics ads where they are clicked on by bots or employees. (These sites are the most damaging since you’re paying for every click without any return at all. Click fraud around skin clinics, med spas or laser clinics can be very lucrative since dermatology or plastic surgery clinics are becoming such a competitive market and the payment per click can be as high as $4-6.)

Unfortunately, to keep your laser centers budget safe you have very few tools. (Google just gave advertisers $90 million to compensate for click fraud as the result of a class action suit but you can bet they’re not that Google’s not interested in your individual account. Especially since they’re making money from click fraud when your ads are clicked on.)

Start by limiting your laser centers exposure. If your dermatology or plastic surgery clinic is still running an Adwords or Yahoo campaign, they allow you to limit the maximum amount you spend in a day. Take advantage of this feature by limiting your maximum cost to what you can afford to spend. You can also look for the tracks of click fraud by examining the reports you might have available to you. Multiple clicks coming from the same IP address are a sure sign of fraud. (Malaysia has become such a haven for click fraud around medspas and IPL laser treatments.)

If you’re going to run ppc ads, protect your laser center, med spa or laser clinic. You can be sure that you’re the only one trying to.

Medical Spa MD is a physician community of Plastic Surgeons & Cosmetic Dermatologists with more than 4,000 physician members. Visit MedicalSpaMD.com for plastic surgeon and cosmetic dermatologist forums and provides patient and physician information on IPL & cosmetic laser medical technologies and treatments.

Botox Patient: Posted from Laser Center

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Medical Spa Botox

Botox Patient — Sat, 07 Nov 2009 17:23:45 +0000

From Medical Spa MD: Understanding Botox & Injectables. Injectable products are an important contributing factor to your clinic’s financial success. With new products entering the market like Dysport and Evolence, and other exiting like ArteFill, it is important that your staff be knowledgeable of the products used in injectable procedures.

Although this chapter from the Advanced Medical Aesthetics Training Manual wasn’t actually requested in the training manual I wrote for the academy students, I felt it was extremely important for , especially for medical estheticians, to know the difference amongst the various treatments used to alleviate the appearance of wrinkles and folds, and the difference between dynamic and static lines.

Medical estheticians have the most “face time” with clients, examining it with magnifying lenses, treating it with exfolliants, moisturizers, galvanic current, high frequency, various acids, etc. They understand the realm of fine lines and wrinkles and know what can be alleviated with topical treatments such as facials, peels, microdermabrasion and laser resurfacing, and what cannot.

I cannot tell you how many patients call or come into our office with no knowledge of the difference between paralyzing agents such as Botox and Dysport, and dermal fillers. We take it for granted that we know the difference, but injectable products can be very confusing to the lay person. Because the aesthetician works with the client’s skin, they should be well versed in the differences in the two categories of injectables and the products that lie within. Estheticians become your most powerful education source for your clients which ultimately leads to an upsell for them (with possible commission).

Many people think all fillers products are the same, nor do they care to understand the difference between hyaluronic acid or calcium hydroxylapetite. All they truly care about is “how long will it last” and will the “results look fake”. Only with proper education can the medical esthetician effectively and intelligently discuss the differences in the filler products, educate the patient about the effects and lasting results, and help lead the patient to the right product, or combination of products, for their expected outcome.

This information in this chapter is very important for your front desk/phone people as well!

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Medical Spa RX: Botox from Canada

Botox Patient — Sat, 07 Nov 2009 17:23:29 +0000

From Medical Spa MD: Medical Spa RX has had it’s first physician who has reordered Botox 5 times. In fact, there are a number of them. Woot!

Oddly enough, I consider 5 reoders of Botox significantly significanly more impressive than only 4. (I don’t know why. Perhaps because Medical Spa RX has only been offering Botox for the last 4 months so 5 orders would be more than monthly.)

Medical Spa RX has been shipping orders for something on the order of 4 months now so 5 orders is telling me that we’ve got a number of physicians who switched to Medical Spa RX very shortly after we launched it and have been using it exclusively. (My clincs usually orded Botox or Restyland monthly so that’s where my logic lies.)

We’ve been extremely diligent in makeing sure that Medical Spa MD Members are being taken care of by Medical Spa RX and as far as I’m aware we’ve never yet had a single complaint about the service or product.

I should note here that Medical Spa RX and Medical Spa MD are completely different. Medical Spa RX is Select Partner who offers exclusive services to our Members. (Any technology provider or service company who can provide meaningfull value to our Members is welcome to apply.)

For those physician or medical spa Members who have not yet ordered your Botox through Medical Spa RX and are in a position to do so, I’d highly recommend giving them a chance by placing a small test order of whatever you use most, Botox, Restylane, Juvederm of Dysport.

Also, if you haven’t heard about the group buy option, there’s nothing like it to harness buying power.

Botox Patient: Posted from Laser Treatment MD

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Medicals Spas & Laser Clinics in 2009

Botox Patient — Sat, 07 Nov 2009 17:23:19 +0000

What happened in medical spas, skin clinics and laser treatment centers in 2009?

Cosmetic enhancements circa 2009 can be divided into three basic categories. Non Invasive includes wash and wear injections and resurfacing treatments such as IPL & laser treatments and chemical peels, and clinical skin care. Minimally invasive falls somewhere in between surgery with visible scars, and the non invasive category, and can be performed in a doctor’s office. Invasive procedures involve surgery done to reshape or refine parts of the face and body, typically involving an office or hospital setting and anesthesia. Most common are breast augmentation, liposuction, mini face lifts and pretty much anything that involves a scalpel.

In the overall scheme of things, there is no ideal time frame to jump on the Botox® bandwagon, although the trend is certainly towards doing things earlier as a preemptive strike for maintenance and to forestall the day when everything goes south. But there will come a time when creams stop doing enough to make you content with the way you are aging, and you start to wonder what else is out there. You don’t have to take it lying down (although lying down does make sagging disappear – try holding a mirror above your head).

The next logical step from wrinkle creams and sunscreen are chemical peels, laser treatments, and intense pulsed light treatments (IPL) that can even out skin tone and improve texture.

Botox is brilliant for lines around the eyes, forehead and mouth. Dermal fillers such as Restylane, Evolence and Radiesse are de rigeur for plumping furrows, creases and deeper folds. Brown spots and sun damage can be helped with a course of Fraxel or Pearl. For slack skin, tightening devices such as Thermage and Titan can deliver a subtle lifting effect on droopy brows and necks. The final stage before considering surgery tends to be a combination of several of these to maximize the anti-aging results.

Of course, when the non invasive treatments stop delivering what you really want in terms of sagging, sinking and bulges, you might consider a short scar face or neck lift and some minor eye rejuvenation surgery to reduce excess skin and fat deposits.

Botox Patient: Posted from Laser Treatment MD

Medicals Spas & Laser Clinics in 2009 is a post from: Botox Patient

Bootox? Botox & Restylane injections for women’s high heels.

Botox Patient — Sat, 07 Nov 2009 17:22:46 +0000

I came across this article from Australia on Botox and Restylane being injected in womens feet.

IT'S the subject of whispered conversations over cocktails deep within Flemington's Birdcage. The secret weapon a flock of fashionistas rely upon to teeter upon 10cm stilettos all day long at the races.

Botox and filler injections for the feet are the latest crazes in cosmetic surgery to make their way to Flemington – and the solution, according those with cash to splash, to the old racing conundrum of how to wear those towering pumps and not end up carrying them home after the final race has been run.

For about $1500, some doctors, such as Bondi-based cosmetic surgeon Michael Zacharia, will inject hyaluronic acid (Restylane) into the balls of the feet.

The fluid, commonly injected into joints to treat osteoarthritis, numbs the parts of the foot that become strained by wearing sky-high heels.

And judging by the height of the footwear that was racing out the door of Melbourne boutique Miss Louise yesterday, 10cm heels will indeed be spotted around the Birdcage today.

Dr Zacharia, who has been doing the procedure for just over a year, said the foot filling provided "internal padding for the feel at that point of pressure underneath the balls of the feet. Instead of using those silicon pads inside your shoes, this is an internal way of doing it."

The procedure, however, is a lot more expensive than purchasing a pair of silicon inner-soles. At $750 per foot, the fillers will last for about six months.

Dr Zacharia said three or four people this week had told him they wanted the foot fillers for the Spring Racing Carnival, but he warned those considering the treatment that the sensation immediately following the injections could be uncomfortable.

"I've been told that for about 10 minutes afterwards it feels like you are walking with marbles in your feet, or it's like there is something in your shoe," he said.

The other procedure women are turning to is "bootox" – having Botox injected into the balls, arches and soles of the feet to paralyse the sweat glands, which Dr Zacharia said would also set you back about $1500.

Australasian College of Podiatric Surgeons president Mark Gilheany said while women might think the procedures were magic solutions to stiletto-fatigue, foot fillers could be masking symptoms of more serious problems.

He warned that for people experiencing a significant amount of pain standing in heels it could be a sign of partially dislocated bones or torn ligaments.

"If you require something of that (surgical) nature then you could have an underlying problem," he said.

"It's not something that is routinely done and I haven't seen any clinical trials to say whether the injection of a biological cushion into the foot is effective.

"If there was anything that really worked I'm sure I would know about it. It seems like a waste of time when you can stick a cushion in your shoes and take some paracetamol."

Botox Patient: Posted from Laser Treatment MD

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Bad Botox

Botox Patient — Sat, 07 Nov 2009 17:22:35 +0000

Federal officials in Washington State indicted three beauty salon proprietors this week for administering phony Botox and for trying to bribe an officer to overlook an unauthorized laser device.

In the first instance, Xin “Faith” He of Natural Beauty in Bellvue, WA told clients she was injecting Botox and the hyaluronic acid dermal filler Restylane when in fact she was injecting counterfeit substances. Her actions led to at least two reported negative reactions since 2004 that required a dermatologist’s or plastic surgeon’s care. One victim (pictured above), who wished to remain anonymous, remarked, “My face looked like Frankenstein’s.”

In the second case, the two owners of Crystal Nails in Burien are charged with offering an official an $800 bribe to overlook a dangerous and unapproved radiation-emitting laser treatment they had imported.

Of course, neither of these Botox injectors were running a real medical spa, skin clinic or laser treatment center. They were just injecting Botox on their own.

Botox Patient: Posted from Laser Treatment MD

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Medical Esthetician Training from Medical Spa MD

Botox Patient — Sat, 07 Nov 2009 17:22:24 +0000

Injectable products are an important contributing factor to your medical spa, plastic surgery center or laser clinic's financial success. With new products entering the market like Dysport and Evolence, and other exiting like ArteFill, it is important that your staff be knowledgeable of the products used in injectable procedures.

Although this chapter from the Advanced Medical Aesthetics Training Manual wasn’t actually requested in the training manual I wrote for the academy students, I felt it was extremely important for the entire medical spa staff, especially for medical estheticians, to know the difference amongst the various treatments used to alleviate the appearance of wrinkles and folds, and the difference between dynamic and static lines.

This information in this chapter is very important for your front desk/phone people as well!

Botox Patient: Posted from Laser Treatment MD

Medical Esthetician Training from Medical Spa MD is a post from: Botox Patient

Thermage Skin Tighening

Botox Patient — Sat, 07 Nov 2009 17:20:08 +0000

Thermage is FDA approved for tightening and thickening skin without surgery. This non-invasive choice is particularly attractive for patients who don’t want to undergo the more drastic effects of a traditional surgical facelift and its associated recovery period.

Thermage uses a radiofrequency (RF) technology to heat the deep layers of the skin while protecting the skin’s outer layers with a cooling cryogen spray. This deep heating promotes immediate collagen contraction beneath the skins surface and generates new collagen growth over time.

Thermage: Key Points

• Thermage is approved by the FDA for skin tightening and collagen growth.
• Thermage provides an alternative to traditional surgical face lifts.
• Thermage not only treats existing conditions, but is also a preventative treatment for future problems including wrinkles, loose skin and collagen loss.
• Thermage can treat any area of the body but is most commonly used on the face, around the eyes and forehead, cheeks and jowls, and the neck. Results actually increase over time. With maximum results usually achieved up to 6 months after the treatment.
• Thermage “Vectoring” can be used for more specific results. Vectoring uses a second, double row of pulses to tighten skin along specific lines or “vectors”. In this way we can perform eyelifts, neck lifts, bags around the eyes, crows feet, or any part of the face where loose skin is unwanted.

Thermage: Key Benefits

• Thermage tightens skin and stimulates new collagen growth.
• Thermage can be performed in 2-3 hours under local anesthetic.
• Thermage actually “tightens” skin rather than stretching skin.
• The results look completely natural
• The cost is less than traditional, surgical facelifts
• The results are very long lasting or permanent.
• Additional treatments can maximize the effects or just maintain results.

Thermage: Benefits in comparison to traditional surgical face lifts

• No cutting. No stretching. No stitches. No scars.
• Thermage requires no physical recovery time.
• The skin is tightened rather than stretched, eliminating the pulled look that can happen with traditional face lifts.
• The chance of complications or infection is almost nil.
• Thermage can be combined with other treatments like filler injections and Pointé Lifts for more dramatic effects.

Possible Complications with Thermage Treatments:

Thermage complications are very rare. The device contains three computers that constantly monitor the amount of energy being delivered. However, as with any medical treatment there exists the possibility of other results, including:

• Burns; in clinical trials for Thermage less than 1% of patients received any burns. (There were only two that healed completely and without complication). At Surface, we have never seen a burn.
• The effect is less dramatic than the client wants: However, Thermage can be used as a treatment more than once. Results can be improved or enhanced with additional treatments like Botox or Surface Pointé Lifts.

NOTE: Thermage has received mixed reviews from both patients and physicians. In our opinion this is because of the way that Thermage has been marketed to physicians as an "add-on" to their practice. Thermage results are highly dependant upon the treatment you receive. While Thermage is now widely available, our recommendation is that you only have a Thermage treatment from a physician who specializes in non-surgical cosmetic medicine and has a laser clinic, skin clinic, or laser treatment center with experience with this treatment.

Botox Patient: Posted from Laser Treatment MD

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Clinical Exchange of Laser Treatments for Medical Spas, Laser Clinics, & Skin Clinics

Botox Patient — Sat, 07 Nov 2009 17:17:17 +0000

When it comes to the cosmetic laser field, we can sometimes feel adrift at sea with little more than a compass and the stars to guide us. We're either doing laser treatments according to our laser manufacturers' guidelines, which are conservative and often inadequate to produce excellent clinical results. Or we're trying new laser treatment settings without the benefit of knowing what other doctors have tried.

If we discover something important, we have no forum to discuss this information with our colleagues. Many of us experiment in our clinics, but we don't share our problems, successes, failures and thought processes with anyone. As a result, we make little progress because we don't benefit from others' advances and insights.

This has flattened our learning curves. Innovation-if and when it comes-is slow. This needs to change. And it begins with doctors simply talking to each other. Participating in Internet-based user groups is one of the easiest ways to do this. Such a forum allows us to share our ideas, experiences and opinions so that we can learn from each other.

The collective intellectual capacity among us, as cosmetic laser providers, is tremendous. If we all worked together, we would discover and share treatment protocols that are more effective and less painful, and produce fewer complications. We would discover better ways to reduce and treat complications when they do arise. Our field would become stronger, and we'd become better practitioners.

Unfortunately, cosmetic laser practitioners have little clinical exchange compared to other specialists, such as cardiologists. These physicians have thorough initial training with a three-year residency and a one- to three-year fellowship. They have mentors, classmates and large practice groups so colleagues can talk to one another. Publications and newsletters keep cardiologists abreast of developments in the field. They stay in touch with their academic training centers, attend meetings and are members of professional associations. In short, they communicate and connect.

What Do We As Cosmetic Physicians Have?

Contrast this to cosmetic laser medicine. Unlike cardiologists, we don't have highly developed professional networks. Nor do we have the formal advanced training. Our main professional association is the American Society for Laser Medicine and Surgery (ASLMS), which hosts a yearly meeting and produces a monthly journal. The ASLMS is a great professional society, but it doesn't serve all of our needs.

Another source of education is the laser companies, which provide clinical training, Webinars and Web sites. The trainers teach the basics, but they're limited by company protocols, which are reviewed by corporate attorneys, and designed to prevent problems rather than to get excellent clinical results.

The laser companies' Webinars are lectures designed to sell lasers, not provide advanced training. Luminaries are paid to do the Webinars, but there's no access to them for detailed follow-up questioning.

What's more, we have to sit at our computers for two hours listening to basic, redundant information to glean one useful, advanced clinical tip. The content of the Webinars are not made available in any other format?-written summary, cassette tapes or CDs-so it's not widely accessed.

If we go to aesthetic laser manufacturers company Web sites for resources, the information is basic and limited. The marketing material, of course, is fresh and current, but the clinical material is dated and sparse.

Other resources are trade publications that keep us abreast of issues in aesthetic medicine. But these magazines don't get into the details of treatment protocols and how to get the best results.

Finally, we have independent blogs, such as MedicalSpaMD.com. This blog, in my opinion, is one of the best ways to get information and find out what other providers are thinking and doing. Some doctors who blog on MedicalSpaMD are experienced users who share their expertise and opinions?, all of which are extremely helpful. But the drawback is too few physicians blog about specific topics.

Several Solutions

Working with laser companies is one way to combat this problem. Laser companies can be particularly valuable in the clinical exchange arena. These companies have the resources to start, support and nurture this activity. They know who their users are, they can enlist the knowledge of luminaries, and they have company doctors and scientists who understand the clinical applications of their laser devices. It's important to mix all of these elements in the proper environment to spur the best advances and innovations from these groups.

M. Christine Lee, MD, MPH, writes that upstanding laser companies "put more money and resources into product development than in marketing and advertising. They have a corporate philosophy that's based on building relationships.investing in new technology and research.[and] nurturing forward vision."¹

It seems almost foolish not to work with cosmetic laser companies, especially since many providers are getting clinical results that are suboptimal. Furthermore, many patients are experiencing complications that can be avoided. (See RealSelf.com for patient complaints and see MedicalSpaMD.com for physician complaints.)

Although aesthetic laser companies don't provide the clinical exchange we need, we can find useful models to emulate outside our field. For example, a medical device company produces Philips NetForum. This community connects Philips users from around the globe in a virtual users meeting so they can share clinical experiences, learn from peers and optimize results.

I'm sure many innovations have occurred when users simply share ideas and explore insights with each other via this Internet clinical forum. If we had this resource, our field would advance dramatically.

What We're Doing As Medical Spa Physicians

As a physician, I have a responsibility to take my part in this call to action. As a result, we're now forming clinical exchange meetings at our Cherry Hill, N.J., clinic. We get together twice yearly with doctors from 20 to 30 other clinics to discuss what works and what doesn't. Part of our meeting focuses on business and marketing, and the other part addresses clinical issues.

We also work closely with MedicalSpaMD.com. We are active visitors to this site and frequent contributors. This Web site is so important that we've actually bought an intense pulsed light (IPL) system based largely on the opinions of the Web site's bloggers, many of whom have had experience with several IPL systems.

We're also forming Internet-based user groups on our own. These groups discuss everything from fractionated CO2 systems to injectables to treating patients with skin of color. Doctors from around the country and the world, including Greece, Australia, France, England and India, share their opinions and experiences.

In addition, we're setting up systems in which providers who attend conferences or listen to Webinars write summaries of what they've heard. These summaries can be posted on Medical Spa MD for others to learn from. Once these summaries are posted, other providers can read them and comment on the issues they're discussing. Of course, we cannot overlook traditional methods of clinical exchange. These are still important and should be developed further. Conferences, publications, newsletters and professional associations are excellent ways to communicate and exchange opinions and experiences.

Cosmetic laser medicine is still in its infancy. We haven't yet worked out the best protocols and new technology is continually emerging.

We have to quickly learn the best ways to use all of our technology for optimal clinical results. The best way to do this is to communicate with each other so we can learn what others are thinking, doing and experiencing. When we actively participate in this learning, our field will advance more rapidly and dramatically. This will benefit all of us. True to the Chinese maxim, when the tide rises, all boats indeed rise higher.

Reference

1. Lee CM. Lasers: what every patient should know, and what your doctor probably doesn't. The ultimate guide for the best skin ever. Bloomington, IN: AuthorHouse; 2006; 163.

Botox Patient: Posted from Laser Treatment MD

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Botox around the world

Botox Patient — Sat, 07 Nov 2009 17:16:41 +0000

There's a lot of Botox used around the world from sweating to headaches to wrinkles.

Here's a graphic from a Botox story on CNN.

In the hunt to discover the next blockbuster medical use for Botox, doctors have injected it experimentally into muscles and glands all over the body, making it medicine’s answer to duct tape. According to recent medical journals, physicians have used it to treat chewing problems, swallowing problems, pelvic muscle spasms, drooling, hair loss, anal fissures and pain from missing limbs.

“We see it as a molecule that keeps on giving. As we understand it more, it gives us new ideas of how to use it,” says Dr. Mitchell F. Brin, a neurologist who is the chief scientific officer for Botox at Allergan, the drug’s maker.

No other therapeutic agent “has so many demonstrated uses,” he says.

But some health advocates worry that doctors are widely adopting novel uses for Botox before federal guidance and rigorous clinical studies have established safe and effective dosages for the new treatments.

“It’s trial and error with a nerve poison,” says Dr. Sidney M. Wolfe, the director of the health research group at Public Citizen, a consumer advocacy group. Last year, the group petitioned the Food and Drug Administration to require a warning label for injectable toxins.

Botox Patient: Posted from Laser Treatment MD

Botox around the world is a post from: Botox Patient

Avoid A Facelift: Medical Spas, Laser Clinics, Skin Clinics & Laser Treatments.

Botox Patient — Sat, 07 Nov 2009 17:16:19 +0000

Facelifts have become a common cosmetic surgery for men and women. But surgery patients face a number of unwanted effects. Scarring, extensive recovery time, that artificial "stretched" look, and a permanent result that may be unwanted.

Fortunately, newly developed medical alternatives offer results to people wanting look younger without going under the knife.

As a leader in non-invasive cosmetic medicine, many medical spas, laser clinics and skin clinics now specialize in innovative new medical treatments for a youthful lift without the messy and painful recovery. Some medical spas have developed a unique non-surgical facelift for patients looking to gain the dramatic results of a surgical facelift but avoid a surgical facelift. Non-surgical facelifts include Thermage or Fraxel Skin Tightening followed by their signature Surface Point Lift as the non-invasive, yet exceptionally effective substitute for any surgical facelift. (Botox is also used.)

Thermage is an FDA approved radio-frequency technology that has been proven to tighten and contour the skin and its many underlying tissues without surgery. The treatment has the added benefit of stimulating the growth of new collagen throughout the skin. But there's a caveat. Thermage results are highly dependant upon the way the treatment is administered. Surface has developed specialized protocols that produce results that attract patients from other areas of the country who are looking to achieve maxim results.

Nonsurgical facelifts can be just as spectacular.

Point Lifts were created by specialists in non-surgical cosmetic medicine to replace the traditional invasive facelift. It can also be used for brows, jaw lines, necks, breasts, and even the derriere. They're perfect for the patient who does not want to undergo the harsh effects of a traditional surgical facelift including the associated, frustrating recovery period. Point Lifts are a physician procedure that "lifts" the treatment area in exactly the same was as surgical lifts, only there's no surgery.

The procedure involves placing a small, special suture under the skin through a tiny needle hole, leaving the skin to smooth with its own tension. The theme here is "No cutting. No stretching. No Stitches. No scars!" Most importantly, Point Lifts will not leave the face with that "stretched look" of traditional surgical lifts. Patients can resume their normal activities immediately with only minimal discomfort. Best of all, Point Lifts are completely reversible. Most people never knew they could have a fresh, younger lift without the troubles of surgery.

Botox Patient: Posted from Laser Treatment MD

Avoid A Facelift: Medical Spas, Laser Clinics, Skin Clinics & Laser Treatments. is a post from: Botox Patient

Medical Spa Training Manuals & Books for Medical Estheticians & Laser Clinic Staff

Botox Patient — Sat, 07 Nov 2009 17:16:01 +0000

Medical Spa MD is now publishing training manuals and books for laser clinics, plastic surgery centers and dermatology clinics.

These medical spa training eBooks are designed specifically for medical estheticians, cosmetic laser and IPL technicians and front desk staff, to provide a consistent environment for new hires and keep the staff informed the latest cosmetic treatments.

It’s part of an evolving plan to be able to monetize the huge community of plastic surgeons, dermatologists, laser clinics and medical spas that are part of the community at Medical Spa MD. There are more than 4,000 physician members running laser clinics, medical spas, and skin clinics, and around a million and a half targeted page views, most of which are from physicians (although non-physician numbers are growing).

Medical Spa MD is a community that was started a few years ago and I think it demonstrates how effective you can be if you have information that is not generally available, and know how to build and motivate an online community. Medical Spa MD will never make me rich, but it’s an asset that accrues increasing value over time and more than pays for itself with new opportunities.

Medical Spa RX is the sister site to Medical Spa MD and allows these same dermatologists, plastic surgeons and laser clinics to buy wholesale Botox, Juvederm, Restylane and Dysport from Canada and distribute it world wide.

But perhaps the greatest value of Medical Spa MD is simply the trust and goodwill we’ve grown among physicians. Medical Spa MD’s influence and reach is very long, as attested to the numerous leagal threats, phone calls from lawyers, and cease and desist letters we’ve received.

Botox Patient: Posted from Laser Treatment MD

Medical Spa Training Manuals & Books for Medical Estheticians & Laser Clinic Staff is a post from: Botox Patient

Do it yourself Botox: People are injecting themselves with fake Botox.

Botox Patient — Sat, 07 Nov 2009 17:15:12 +0000

People are risking death or serious injury by using an illegal Botox equivalent without prescription, a CBD cosmetic doctor warns.

Dr Mario Soteriou, of Cosmetic Image Clinics, said self-administering the goods obtained at a new US-based online store was equivalent to playing “Russian roulette”.

He said neither the Botox equivalent nor the dermal filler sold on the website was approved by the Australian Therapeutic Goods Administration, which also decrees the products must only be administered under medical prescription.

The website also sells needles and an instructional DVD to enable buyers to self-administer the do-it-yourself Botox equivalent, with the promise of wrinkle free skin.

The dermal filler is also being marketed with a DIY guide for plump lips.

Dr Soteriou, who has specialised in cosmetic medicine since 2000, said he was “severely shocked” by the shonky website.

He said injectable treatments such as Botox and dermal filler should only be administered by qualified practitioners.

“The big problem with these drugs is that we don’t know what they are made of and they can’t guarantee you safety or results,” Dr Soteriou said. “Self-administering them is essentially like making a life decision without putting any thought into it.

“I wouldn’t even advocate for doctors and nurses to be injecting themselves.

“You are also risking your own death if you have an adverse or severe allergic reaction to the drugs.”

Dr Soteriou believes the website is a “money grab” and fuels people’s desperate desires for quick-fix anti-ageing products.

“I’ve never heard of these products before and I attend a lot of medical conferences to ensure I’m up-to-date with the latest in facial rejuvenation techniques,” he said.

via Medical Spa MD: Fake Botox or not, Discount Medspa is going to jail!

Botox Patient: Posted from Laser Treatment MD

Do it yourself Botox: People are injecting themselves with fake Botox. is a post from: Botox Patient

Dysport: The New Botox?

Botox Patient — Sat, 07 Nov 2009 17:13:54 +0000

Dysport is often called the “New Botox.” However, Dypsort has actually been available in Europe for therapeutic indications since 1991 and for cosmetic applications since 2001. In April 2009, Dysport (officially known as BoNT-A/D) was approved in the United States for the “temporary improvement in the appearance of moderate to severe glabellar lines.” These are the lines between your eyebrows. However, just like Botox Cosmetic, Dysport can be used “off-lable” for treatment of crow’s feet (squinting lines around your eyes), forehead wrinkles, chemical brow lifts, platysmal bands (neck bands) and sweaty palms and armpits.

The molecule in Dysport is exactly like Botox Cosmetic but is covered by a different coating, which dissociates (dissolves) at a different rate. That is why the onset of action of Dysport is thought to be faster than Botox Cosmetic since the coating comes off faster. In Botox Cosmetic Treatment the usual onset of action is 3 to 7 days where the Dysport onset of action seems to be a few days faster. The dosing is different with Dysport, so there may be some confusion when translating Botox “units” with Dysport “units.” This is why you need to see an injector who has experience specifically in Dysport injections. Also, there is a learning curve with Dysport injections, so you may not initially achieve the same results as you are used to receiving with Botox Cosmetic.

There is also some confusion about the pricing of Dysport with many reports on the Internet and advertising claiming that it is cheaper than Botox Cosmetic. There is a discrepancy in the potency of units. A “unit” of Botox is not equivalent to a “unit” of Dysport, so unit pricing is not comparable. There is a slight savings with Dysport, but it is about 5% – nothing substantial. So, do not expect to go to your plastic surgeon to achieve the same results as Botox Cosmetic for half the price. However, with competition, hopefully prices will come down. Allergan (Botox Cosmetic) is currently offering a $50 mail-in rebate for Botox Cosmetic customers and Medicis Aesthetics (Dysport) is offering a $75 mail-in rebate. With these rebates and introductory pricing, you may be able to get a better deal than your last injection.

In the end, it is great to have another minimally invasive product approved on the market which can give consistent and noticeable results with virtually no downtime and minimal risks.

via Medical Spa RX: Dysport

Botox Patient: Posted from Laser Treatment MD

Dysport: The New Botox? is a post from: Botox Patient

Botox Injections by medical assistants?

Botox Patient — Sat, 07 Nov 2009 17:12:07 +0000

I’ve seen and head about medical estheticians, medical assistants and even front desk staff administering Botox injections.

It’s not legal, as this story on the prosicution of a medical assistant clearly shows.

Betty Guerra’s monthslong nightmare is over.

The 45-year-old former medical assistant learned today from her attorney that the 10 felony counts against her on allegations of “unlawful practice of medicine” will be dismissed, she said.

“I always believed things would work out the right way,” she said tearfully. “I cannot be punished for something I didn’t do.”

Guerra’s July arrest sparked controversy over what medical assistants can and cannot do. Specifically, there was confusion over whether they are able to give shots.

Guerra was accused of unlawfully administering cosmetic injections, an act commonly performed by medical assistants throughout Nevada.

The state attorney general’s office did not specifically say charges against Guerra would be dropped but indicated it won’t be pursuing the case.

“The complaint against Betty Guerra submitted to the Attorney General’s Office by the Board of Medical Examiners has been contradicted by the subsequent actions by the Board,” Attorney General Catherine Cortez Masto said in a statement. “Therefore, it is fair for us to conclude that it would be difficult to prosecute this case beyond a reasonable doubt.”

Guerra’s attorney, Jason Weiner, said this evening that the attorney general’s office had sent him a copy of an unfiled motion dismissing the case earlier in the day. He would not be able to provide the Review-Journal with a copy of that motion until Wednesday, he said.

After Guerra’s arrest, physicians became concerned about what duties their medical assistants could perform.

Former medical board director Louis Ling said that upon reading a 30-year-old law, he concluded that the assistants could not give shots. With flu season coming on, he then attempted to draft emergency regulations that would allow them to give flu shots, but not Botox or other cosmetic injections.

However, that effort was shot down when a judge recently ruled that the board, in considering the regulations, had violated the open meeting law.

via medicalspamd.com

The board later reversed its position, determining that state law allows medical assistants to administer everything from flu shots to Botox. Medical assistants could give shots as long as they are under the “direct supervision” of a physician. Most health officials and doctors take that to mean the physician is on premises.

If you’re a plastic surgeon or dermatologist running a skin clinic, laser clinic or medical spa you might want make sure that your medical estheticans and medical assistants are well within the guidelines for their individual scope of practice.

Botox Patient: Posted from Laser Treatment MD

Botox Injections by medical assistants? is a post from: Botox Patient

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Clinical Exchange of Laser Treatments for Medical Spas, Laser Clinics, & Skin Clinics

Botox around the world

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Medical Spa Training Manuals & Books for Medical Estheticians & Laser Clinic Staff

Do it yourself Botox: People are injecting themselves with fake Botox.

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Botox Injections by medical assistants?