Botox and dermal fillers are household terms these days and people are no longer shy to talk about it. In fact, according to survey statistics released today by the American Society for Aesthetic Plastic Surgery (ASAPS), nearly 9 out of 10 respondents (87 percent) openly discuss their dermal filler treatments with others, and 7 out of 10 (70 percent) receive support from the people they told.

This trend shows that aesthetic injectable treatments continue to evolve into mainstream and widely accepted options for the everyday use. Survey results found that the typical aesthetic injectable patient is a married, working mother between 41-55 years of age with a household income of under $100,000. The survey also found that women receiving aesthetic injectable treatments are health-conscious and philanthropy minded, with the majority incorporating exercise (95 percent) and healthy eating habits (78 percent) into their lives, and many volunteering with charitable organizations that matter to them (32 percent).

In addition, nearly seven out of 10 respondents believe that BOTOX® Cosmetic (72 percent) and hyaluronic acid dermal fillers (65 percent) are important parts of their aesthetic routine. “Most people have great success with BOTOX® Cosmetic and dermal fillers; however, we need to make patients aware that even though injectables are not ’surgery,’ their administration is a medical procedure with risks that depend on the training and experience of the clinician, the clinical setting and the technique used,” says Laurie Casas, MD involved in the survey.

Hyaluronic acid dermal fillers ranked as the third most popular procedure performed last year. The most common injectable dermal fillers are Restylane, Juvederm, Sculptra, Zyderm and Zyplast, and Bio-Alcamid.

Dermal fillers are being used to reduce or eliminate wrinkles, raise scar depressions, enhance lips, and replace soft-tissue volume loss.

Types of Dermal Fillers

Several classes of dermal fillers are marketed in the United States today. They include:

• collagen based fillers (i.e. Zyplast and Cosmoderm),
• hyaluronic acid based fillers (i.e. Restylane and Hylaform), and
• calcium hydroxyl apatite fillers such as Radiesse.

New promising dermal fillers are in development that will offer superior capabilities in the future.

Autologous (your own) fat is also used as a dermal filler. Your surgeon can take fat from one area (where you do not want it) and inject it into another (where you want it, such as facial wrinkles, or any other area with a loss of volume). This procedure is called lipoinjection or lipografting.

Injection of fillers usually requires the use of either a topical numbing cream or a local injection of numbing medication. Then, using a small needle, the dermal filler is injected into each wrinkle or scar that requires treatment. Some mild burning and stinging is normal and quickly resolves.

The results can last from three months to five years, depending on the filler being used. Collagen provides the shortest duration with effects lasting anywhere from three to six months. Restylane tends to last a bit longer with effects lasting from six months to one year. Radiesse can provide results that last greater than 3 years.

Dermal Fillers and Lasers

These two are very compatible. In fact, if your aesthetic physician is trained and has lasers, he or she can enhance your results dramatically by doing a combination treatment, which may stimulate the growth of new collagen and improve the skin texture. Typically IPL or laser photo rejuvenation (photo facial) is done as a separate procedure. An advanced aesthetic clinic will be able to offer a dermal filler-laser treatment combination in one seating.

IPL, photo-facial, light treatment, laser treatment – whichever name you use, intense pulsed light systems have become the single most popular and affordable light-based device for many aesthetic practices. Their sales are largely unregulated, with most of the devices being used in spas, “medi-spas” and “rejuvenation facilities.” Though universally offered, can IPL treatments differ at these “non-physician facilities” and physicians’ offices?

IPLs are not lasers, and they use a flash lamp to emit noncoherent, nonmonochromatic light. However, if used properly, IPLs can deliver good results for many indications. Understanding how to manipulate your IPL system via pulse numbers, pulse widths, filters, cooling and proper patient selection can let you completely reinvent your laser practice.

Wavelength

The range of wavelengths will depend on the system and on which handpiece or filter you use. There are two types of filters: cut-off and cut-on.

Cut-off filters are the most common and block all wavelengths below that filter number. For example, a 560 nm filter would allow all wavelengths above 560 nm and less than 1,200 nm to be emitted.

Cut-on filters block all wavelengths except for a small range right around the filter number. For example, a 1,064 nm filter might emit light from 1,060 nm to 1,066 nm.

Note that these are not lasers, as they are not mono-chromatic or coherent.

Choosing the right filter is one important parameter in a successful treatment. When thinking about which wavelengths to use, you must consider both the condition being treated and the patient’s skin color.

Since the highest absorption of melanin is at lower wavelengths, higher-wavelength filters — which are less absorbed by melanin — offer protection for darker skin types.

Higher-wavelength filters may also be used for better penetration when doing procedures such as hair removal, when penetration to the dividing cells is crucial for permanent removal. Lower-wavelength filters offer more absorption by melanin and are safe to use on lighter skin types.

Adjust for skin type

The darker the lesion, the easier it is to remove, even with longer wavelengths. When treating lighter lesions, you may need to adjust to a more pigment-absorbing, shorter wavelength. The lower limit will be determined by the patient’s skin type.

In addition to filters, IPL systems can also be adjusted, just as lasers are adjusted, using fluence and pulse widths. The pulse width adjustment parameters and the number of pulses in a row are two of the variables that set IPLs apart from other laser and light systems.

Thousands of pulse sequence variations can be formed by adjusting number of pulses, pulse width and the delay between each pulse. This is one thing that makes IPL systems so user-dependent. One operator may obtain great results using a system, while another may have no success.

Pulse widths

Pulse widths, the length of time of each pulse — milliseconds for IPLs — can be increased or decreased depending on the indication. For darker skin types, longer pulse widths offer additional epidermal protection, as the peak heat is lower than with short pulses of the same fluence, avoiding permanent damage to melanocytes. Longer pulse widths can also be helpful when treating larger vascular lesions. On the other hand, shorter pulse widths are preferred when treating pigmented lesions.

Remember, melanosomes are tiny and have a short thermal relaxation time; the desired pulse width should be as close to the thermal relaxation time as possible.

Small telangiectasias also respond well to short pulse width treatments. By programming a system to string pulses together, the operator is able to deliver more energy while keeping the peak temperatures below the point of epidermal burning. This can be important when treating vascular lesions, which are deeper in the skin.

Cooling

Cooling is another important variable in the proper use of an IPL. The mechanism for cooling the epidermis during treatment will vary depending on the device. Some use contact cooling, while others rely on air cooling. Proper cooling can increase the treatment possibilities and versatility of your device.

It’s important to note that more epidermal cooling is required when treating lesions below the epidermis, while little epidermal cooling is needed when treating epidermal lesions, such as solar lentigines.

Most cooling is operator-controlled, solely by how long the cooling apparatus is exposed to the skin. A few systems have temperature adjustments on the IPL itself. When using a contact dynamic cooling device, the cooling window will heat up as shots are fired through it.

The temperature of the cooling tip will be much warmer at the end of the session than it was at the beginning. Be sure to give the cooling apparatus time to cool itself down again. Inappropriate cooling due to rapid pulsing can lead to complications.

Applications

The clinical applications of IPLs are virtually endless. The classic indications for IPL treatment are the clinical signs of photoaging, including hyperpigmentation, telangiectasias and rhytids.

However, IPL devices have also shown success in treatment of rosacea, acne, melasma, port wine stains, hemangiomas, hair removal, angiokeratomas, hypertrophic scars, poikiloderma of Civatte and lesions of pigmented purpura.

In addition, IPL devices can be used as the activation source for photodynamic therapy. PDT can be used to treat actinic keratoses as well as verrucae.

Studies have also shown that when compared to IPL alone, the addition of aminolevulinic acid to an IPL regimen increases the production of collagen and the improvement of the signs of photoaging. (Marmur et al.) (Gold et al, Dermatol Surg. 2006.)

Safety

Two separate groups have examined the use of IPL after filler injections and found that there was no sign of interaction between the light and the fillers. IPL has also been shown to be safely administered immediately after botulinum toxin injections. (Farkas et al. Aesthetic Surg J. 2008.) (Goldman et al, Dermatol Surg. 2007.) (Semchyshyn, Kilmer, Dermatol Surg. 2005.)

Varieties

IPL systems come in many varieties. Most now come with other attachments, such as hair removal, ablative and nonablative fractional resurfacing handpieces, acne treatment, radiofrequency (RF), infrared tightening attachments and even IPL paired with RF. Choosing the IPL that is right for your practice will depend not only on the IPL portion of the device, but also on what other laser and light procedures you want to offer your patients.

As our understanding of these broadband light sources expands, we are able to offer our patients more tailored treatments. If you aren’t getting the results you are looking for, think about adjusting parameters other than fluence. Lighter skin types can tolerate shorter pulse widths, which may better target pigmentation. More cooling can further protect the epidermis when treating dermal targets using higher fluences.

With more applications than ever, these multipurpose, tunable light devices are likely to remain the workhorse of the aesthetic industry.

More about laser skin treatments on LaserOffers.com

---

Based on an article published by Joely Kaufman, M.D. in Dermatology Times, May 1, 2009.

Joely Kaufman, M.D., is assistant professor of clinical dermatology at the University of Miami Miller School of Medicine and director of lasers for the University of Miami Cosmetic Group. The Cosmetic Group is involved in research and development of lasers and light devices as well as other aesthetic procedures, such as fillers and toxins.

There is no denial that the demand for high ticket cosmetic surgery is on the decline but non-invasive aesthetic treatments, such as dermal fillers, injections of botulinum toxin, laser hair removal, photorejuvenation, vascular and pigmented lesion treatments are actually on the rise.

Most of these cosmetic interventions became widely available just a few years ago, but they are still holding the demand that has established aesthetic medicine as an endless frontier for fee-for-service business. In today’s economic recession, it is clear that even this business is affected, as many consumers are re-evaluating their cosmetic surgery plans and the money they will spend on them, in addition to applying higher scrutiny upon the services they purchase.

According to a recent poll by the American Society of Plastic Surgeons (ASPS), 27 percent of patient respondents were considering less expensive cosmetic options, compared with 20 percent six months ago. And while their planned expenditure may be less, the expectations of the consumer have not diminished. It is the promise of turning back the hands of time that continue to lure the consumer. But when cold hard cash is involved — especially during pressing financial times — practitioners have to deliver and their aesthetic outcomes must live up to the consumer’s expectations.

One of the ways to cope with the pressure of the consumer expectations is to focus on a few treatments, which you know the best and actually like to do. It is hard to be a master of all arts in aesthetic medicine and there are lots of jacks in the art of litigation who are also hungry for your patient’s cold cash.

Final Inches Medical Body Shaping Center in California just announced a new marketing idea. That is in addition to picking a cool name. This practice has two locations specializing solely in Laser Liposculpture, a minimally-invasive procedure that permanently eliminates frustrating fat. This lipo sculpture practice recently announced that they are helping their patients get ready for summer with their custom swimsuit giveaway.

“Certain areas of the body are genetically predisposed to store fat, including the waist, stomach, hips, thighs, and arms. This fat can be very difficult to reduce or eliminate through diet and exercise but at FINAL INCHES we remove this stubborn fat permanently, in about an hour,” states Anh Ngo, MD, Board Certified Surgeon and Medical Director of FINAL INCHES. “With our Laser Liposculpture procedure, we permanently remove stubborn fat, reshaping our patients’ bodies to create a slimmer, sleeker swimsuit-ready body.” This lipo practice performs more Laser Liposculpture procedures than any other Southern California practice.

“We couldn’t be happier designing custom swimsuits for the lipo sculpture patients,” states Jessica Neeper, National Sales Manager of Ginger’s Island, one of the swimsuit companies partnered with the practice in this promotion. “Lipo sculpture patients are some of our most enthusiastic customers because they come to us ready to show off their slimmer bodies. It’s a real thrill working with them to design custom swimsuits that accentuate their curves and get them ready for the beach.”

Qualifying for the free custom swimsuit is simple; patients only need to come in for a consult and have their slimming Laser Liposculpture procedure done before August 31, 2009. After the procedure, patients are then fitted for their free custom swimsuit to show off their new beach-ready body.

Non-invasive medical aesthetics is a booming discipline, which comprises all medical procedures in the field of Aesthetics excluding all surgical procedures which require an operating table and general anesthesia (such as breast implants, liposuction, surgery for obesity, facelifts, rhinoplasty, blepharoplasty and other cosmetic surgeries).

The exciting field of Aesthetic Medicine is a new trend in modern medicine. Patients not only want to be in good health, they also want to enjoy life to the fullest, be fit and minimize the effects of normal aging. Indeed, patients are now requesting quick, non-invasive procedures with minor downtime and very little risk. As a general rule, the needle is increasingly replacing the scalpel…

This recent trend explains the current success of Aesthetic Medicine around the globe. These risk-free, non-surgical aesthetic procedures consist of:

• Injections of Facial Implants and Botulinium Toxin
• Hair Removal
• Skin Laser Therapy
• Aesthetic Venous Treatment
• Chemical Peels
• Medical Cosmetology
• Aesthetic Mesotherapy
• Shapes and Cellulite Control
• Nutrition
• Hair Transplant
• Aptos/Contour Threads
• Curl Lifting

The real benefit of practicing Aesthetic Medicine is the type of care that practitioners are offering to their patients. These procedures are elective and are performed on patients who do not suffer from illness. They are usually happy and in excellent health. They simply want a quick fix or a preventative procedure to help manage the normal effects of aging.

This, along with the very lucrative business it represents, are the benefits any doctor should expect by expanding his/her own practice to an Aesthetic practice.

Aesthetic modalities

One of the most valuable resources in your practice: your staff. Their satisfaction at work has a direct effect on the feelings both you and your patients have toward your aesthetic practice.

Tags: cosmetic cosmetic surgery cstradio management practice surgery

Multiple studies have shown that the interior design of a medical office matters to reducing patient stress and is conducive for a return for additional treatments.

A patient at an aesthetic medical practice does not have the equivalent stress levels of a cancer patient (cosmetic treatments are by-and-large elective decisions), but the aesthetic setting is very important.

Medical spas were the catalyst to the expansion of slick, non-medical feeling aesthetic offices. But rather than slipping into a sense of peace and tranquility, the consumer should remain focused on what really counts.

Some medical spas, for instance, operate without a doctor on the premise or a doctor with deep expertise in delivering cosmetic services. Most of medical spa complications occur when a doctor is not present. Patients should be sure to ask the right questions before undergoing any type of procedure to ensure they are in good hands: who will be providing the medical service, what are their credentials, training and track record, how many days a week does the person perform these procedures?

Cosmetic treatments to avoid at a doctor-free medspa:

• Laser or injection treatments for spider veins
• Strong chemical peels
• Tattoo removal
• Fraxel for broken blood vessels, redness, or scars