I’ve been thinking about what we’ll need to answer in the Insiders’ Guide To Botox

Here are some of my thoughts about what we’ll reveal.

The Insiders Guide To Botox will be a tell-all revelation that will put you on the inside of one of the most sought-after and talked about cosmetic treatments around. This is information that no one else will give you and your friends and family don’t know.

Find out what your Doctor doesn’t want you to know about your Botox treatments
Learn how your doctor decides how much to charge you
Discover why some women are injecting themselves with Botox at home
Know what to ask your doctor in your consultation
Understand how Botox works, and if it will work for you.
Find out why some Doctors are administering fake Botox.

This guide gives you the inside scoop on the most popular cosmetic treatment for crows feet and foreheads. Botox has been around for a long time. You may have even had it. But did you know that.

Some doctors have lost their licenses for giving their patients fake Botox.
Websites are hawking ‘do it yourself Botox treatments’, and states are shutting them down.
China is pushing fake Botox into the US market, with disastrous results.
Some doctors are ‘watering down’ their Botox to save money.
There are new competitors coming on to the market.
Doctors get kickbacks for pushing more Botox.
Botox has a bottom price.

Where to get real information about Botox.

The Insiders Guide To Botox is a post from: Botox Patient

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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

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1. Active FX: Laser Skin Resurfacing
2. Avoid A Facelift: Medical Spas, Laser Clinics, Skin Clinics & Laser Treatments.
3. Clinical Exchange of Laser Treatments for Medical Spas, Laser Clinics, & Skin Clinics

New news on Botox without needles or injections.

Botox Without Needles is a post from: Botox Patient

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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

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

Botox Patient: Posted from Medical Spa RX: Wholesale Botox

Resylane + Juvederm + Filler Injection Tips for Medical Spa Physicians. is a post from: Botox Patient

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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

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2. Avoid A Facelift: Medical Spas, Laser Clinics, Skin Clinics & Laser Treatments.
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Botox Patient: Posted from Laser Treatment MD

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

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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.

Botox Patient: Posted from Laser Center

Laser Center Marketing is a post from: Botox Patient

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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!

Botox Patient: Posted from Laser Treatment MD

Medical Spa Botox is a post from: Botox Patient

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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

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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

Bad Botox is a post from: Botox Patient

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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.

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!

Botox Patient: Posted from Laser Treatment MD

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

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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

Thermage Skin Tighening is a post from: Botox Patient

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1. Avoid A Facelift: Medical Spas, Laser Clinics, Skin Clinics & Laser Treatments.
2. Active FX: Laser Skin Resurfacing
3. Top Medical Spa MD Blog Posts

Botox Patient: Posted from Laser Treatment MD

Top Medical Spa MD Blog Posts is a post from: Botox Patient

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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

Clinical Exchange of Laser Treatments for Medical Spas, Laser Clinics, & Skin Clinics is a post from: Botox Patient

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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

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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

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