Imagine the astonishment as Ponce de Leon, the Spanish explorer credited with discovering the legendary Fountain of Youth in 1513, teleports to present time. He would the manifestation of disappearing wrinkles, shaving bumps, spider veins, tattoos, scars, acne, hair removal and the effects of similar aesthetic rejuvenations, not with an elixir but with light.
Nearly 500 years later, people still clamor to be ever-young, ever-beautiful and ever-healthy, and aesthetic and surgical lasers help enhance their appearance, self-esteem, personal comfort and quality of life. And thus, they are willing to pay for the benefits of LASER treatment.
We have over 25,000 medical spas on the U.S., and more physicians are adding aesthetic services to their practice every month. Many surveys indicate that patients prefer a medical rather than a spa environment to receive laser procedures, and therefore doctors of many specialties will offer various non-invasive light-based treatments to their own patients in years to come. Lasers are main stream of aesthetic medicine.
Laser hair removal and laser resurfacing are household terms now. Laser lipolysis is still somewhat new and intriguing.
Unlike traditional liposuction, laser lipolysis does not do the suction part. Instead, the cannula housing the laser is inserted into the area and used to liquefy the fat. Then the liquefied fat is drained from the body through very tiny incisions (1-2mm) with less suctioning than that used in a traditional liposuction techniques.
During this harsh economic time, it is important to realize all the great things cosmetic surgeons can offer their patients. There are three main points that I believe are the keys to driving the cosmetic surgery industry throughout 2010.
First is the new, emerging technologies and applications. The advancement of lasers and the prolific results they can provide to the patients continues to impress practitioners. Some of the most significant changes have occurred in the use of fractionated lasers, automated lipolysis and a few specialty areas such as the use of lasers in the treatment of nail fungus.
Second is the great push with gynecologists pursuing cosmetic surgery. The scientific research incorporating the two has created the cosmetogynecology specialty. This specialty is fast growing and includes some of the best OB/GYNs practicing and continuing the education of cosmetic surgery.
Third is the field of the less costly but highly effective cosmetic procedures. For example, there has been a high demand for fillers and laser oriented procedures that require less money and less downtime for recovery. As a result, the patient is saving some money and is able to return to work quicker. It is a win-win situation as long as patient safety is still being practiced.
Hypatia Aesthetic & Laser center in Woodinville, WA was selected for the 2008 Best of Woodinville Award in the Physicians and Surgeons category by the Washington D.C. based U.S. Local Business Association (USLBA).
The USLBA “Best of Local Business” Award Program recognizes outstanding local businesses throughout the country. Each year, the USLBA identifies companies that they believe have achieved exceptional marketing success in their local community and business category. These are local companies that enhance the positive image of small business through service to their customers and community.
Why Hypatia Clinic?
Hypatia Aesthetics & Laser Treatment Clinic is a small aesthetic laser center located 25 miles northeast of Seattle. Based on a review of their website and other available info, here is what LaserOffers can offer:
1. Simple but smartly built website:
2. Optimal choice of popular aesthetic treatments:
Seems like a very good anti-aging package for any baby boomer in greater Seattle area.
Medical spas (medspa) is the most popular word in the names of practices owned and operated by aesthetic physicians. The field of aesthetic medicine is growing rapidly as more and more people want rejuvenating treatments and procedures that require minimal downtime.
Medical aesthetic treatments go far beyond the mud baths, fruit peels and therapeutic massages found at most day spas. Treatments at many medical spas, health and wellness clinics and plastic surgery offices are more intense and offer much more noticeable results.
Aesthetic medicine includes all procedures in the field of aesthetics except surgical procedures requiring an operating table and general anesthesia. Aesthetic procedures include dermal fillers such as Botox, Juvederm and Restalyne, laser resurfacing with skin tightening, permanent hair reduction, photorejuvenation, light-based acne treatments, pigment and vascular skin conditions improvement, body contouring and many more.
Medspas fill the niche, that has been largely ignored by plastic and cosmetic surgeons, who have until recently focused on high ticket plastic surgeries. In most medspas people can walk in and get Botox done, or get an appointment for a photorejuvenation session within the next couple of days. Medspas are convenient and much more accessible than a typical plastic surgeon’s or dermatologist’s office.
Aesthetic medicine is a nationwide trend and a growing field for physicians. A lot of family practice doctors and internists, fatigued by the U.S. managed care system, are opting into this field, which offers professional satisfaction and a much better pay. Patients like the noninvasive aspect of the treatments. Recent advances in laser technologies offer aesthetic physicians affordable tools to achieve very good results with minimal downtime.
GeneSphere, with patented QuSomes, is a cosmetic in-home use alternative to Botox®. Microscopic QuSomes carry super absorbent spheres of Hyaluronic Acid deep into the epidermis where they nestle beneath each wrinkle. The spheres absorb the body’s natural moisture and expand, gently lifting wrinkles from beneath.
A review of an article published in Houston Business Journal – by C. Richard Cotton
Originally trained in internal medicine, Dr. Kim Vo shares her new field of medicine — aesthetics — with other Houston doctors like Jim Cain, whose original specialty was interventional radiology.
Both physicians eventually ended up in the field of aesthetics, which, quite simply, is where many people turn to look better and younger.
Laser treatments, Botox injections and wrinkle fillers are the new Fountain of Youth — a step up from over-the-counter potions, but less expensive and intense than cosmetic surgery. And, weary of chasing insurance and Medicaid payments, physicians nationwide are capitalizing on the trend.
Cain compares the influx of physicians into aesthetics with a similar rush into pain management a decade ago: “It was mainly an economic thing — and this is the same thing.
“Doctors are looking for a way to get cash into their businesses,” he says, “and aesthetics is a cash business.”
Few insurance policies cover aesthetics procedures since they are primarily cosmetic and elective. But the economic times, Cain admits with a laugh, are not optimal for entrepreneurial endeavor: “There probably isn’t a worse time in history to start this.”
Vo says the typical patient at her Dermagenix Medical Spa, which she opened in the spring of 2007, falls into two main categories; younger patients seeking hair removal and treatment for acne and older patients in their forties or fifties.
“They want to continue looking good for jobs or their social lives,” Vo says of the latter group. “They want something more than the moisturizers found at the mall.”
Of the younger set, she says, “By the time they come here, they’ve been to the dermatologist and through over-the-counter products.”
Vo came to aesthetics through “personal interest” in the field, wanting to explore her own anti-aging options: “I’m getting older and wanted to know what’s out there.”
Through Continuing Medical Education, she studied the procedures for two years, “until I was comfortable with them.”
Her choice of names for her clinic describes its perceived duality of purpose, as much spa as sterile clinic; expect, as Vo describes it, “a combination medical facility in a spa environment with music and ambiance.”
Dermagenix offers the full range of aesthetics, from laser to injections. Vo says Botox injections run $200-$300; fillers of hyaluronic acid, $500-$800; and lasers, $300-$2,000.
Vo notes that lasers, in particular, are coming into more and more applications, including tightening skin, hair removal, vein treatment and skin resurfacing.
She says that in Texas, lasers are in something of a regulating gray area; a physician must purchase them but, beyond that, there is little regulation. Employing them in treatment, for example, is not restricted to a physician. Texas law, in fact, doesn’t mandate the purchasing physician even be on the property — or in the state, for that matter — where the laser is operated.
“Since it is my responsibility, I operate the laser,” Vo says.
“I have lasers that can burn a hole through the wall,” says Cain, co-owner of Innovative Aesthetics. With his initial training in interventional radiology, Cain already had experience in the laser arena.
Cain opened his clinic six months ago but still also practices radiology. Through his explorations of other specialties, particularly anesthesiology and pain management, Cain says he became fascinated with anti-aging medicines.
“I’ve just got to get into it,” he recalls thinking before becoming a fellow in aesthetics medicine through a program established by the American Academy of Anti-Aging Medicine.
Cain and his partners opened Innovative Aesthetics in extra space on Audley Street at one of their two imaging centers.
Dr. German Newall offers both aesthetic treatments and cosmetic surgery through Aesthetic Center for Plastic Surgery, of which he is a co-owner. The group maintains two offices and a surgery center.
“While I’m interested in aesthetic surgery,” says Newall, “these (aesthetic treatments) are part of the practice.” He adds that not all plastic surgeons delve into the aesthetics arena.
Newall, who is certified by the American Society of Plastic Surgery, says as a surgeon he’s “more readily available to deal with complications if they arise.” He adds this caveat: “If you do enough through the years, you’re going to have complications.”
And he says he’s dealt with patients who received less-than-ideal results from physicians who have gotten into aesthetics as a way to increase the bottom line.
“I do understand because of economic situations doctors want to subsidize their salaries through aesthetic procedures,” says Newall, “but I do think that making it readily available to MDs is maybe not such a good idea.”
He notes that those times when botched aesthetic and cosmetic procedures and surgeries get the media’s attention, which they periodically do, “it takes all the good guys with the bad guys.
“I think we need stricter regulations. We’re working toward that but it’s not easy.”
He points out that filler and laser manufacturers, naturally, want to be able to sell as much of their product as possible so tighter regulation is not necessarily in their best economic interests. There is, however, one regulator that works to keep the field of aesthetics from being even more flooded. Newall reports that laser machines can cost hundreds of thousands of dollars each.
“Easily,” says Newall, “the investment for a clinic start-up can run $700,000 to $1.5 million for equipment.”
S. Brown, PhD et al
Characterization of Non-thermal Focused Ultrasound for Non-invasive Selective Fat Cell Disruption (lysis): Technical and Pre-clinical Assessment
currently available on PRS Advance Online at http://www.plasreconsurg.com
In this new paper, Spencer Brown MD et. al. performs four pre-clinical experiments to elucidate the acute biological effects of the Ultrashape device for non-invasive fat cell disruption. Brown’s five co-authors are Ultrashape employees. In general, the presented work appears to be careful and the results accurate. Unlike the previously reviewed Zeltiq pre-clinical study, however, several important pre-clinical experiments were not performed, so we still do not know how the acute biological effects of the Ultrashape device are related to ultimate clinical outcomes.
In the first two experiments, the authors characterize the energy delivery of the UltraShape probe in water, which is a standard method for characterizing ultrasound energy fields. Brown shows that the device focuses the ultrasound energy in a volume that has a diameter of about 8mm, and a depth that ranges from about 5mm to about 25mm from the probe. Brown shows that the energy density (power per cm2) at the probe-water interface is very small, as desired. Further, the authors showed that the ultrasonic energy created air bubbles in the focal region, consistent with a non-thermal cavitation effect. Quantitative measures of ultrasonic power density were performed at 0mm and 14mm depth, and showed an absence of “hot spots.” An improvement to the study would have included power density measurements at 1.5-2mm (approximately the depth of the dermal-fat junction) and 25mm (to characterize the extent of the ultrasonic energy transmission).
In the third experiment, the UltraShape probe was characterized in a gel phantom intended to simulate the ultrasound transmission properties of skin and fat. In this case the focal volume was 9mm in diameter (slightly less focused than in water) and extended about 18mm in depth (the distance from the surface was not reported, but appears to extend from about 4mm to 22mm from the probe according to the figure). Again, bubbles were seen in the focal region in this model, consistent with a non-thermal cavitation effect.
In the fourth experiment, porcine skin was treated and then immediately evaluated with both frozen sections and histologically stained sections. Untreated control skin was also evaluated to ensure that results were not due to processing artifact. Importantly, no effect on skin color or skin appearance was seen on the animals receiving this treatment, and histology showed that the dermis and epidermis appeared to be completely unaffected by the treatment. The subcutaneous fat, however, showed evidence of tissue injury in both the frozen sections and the histology. Histological staining for LDH activity using NTBC (elevated levels of LDH indicate tissue breakdown) demonstrated a layer of adipocyte cell breakdown extending from about 15mm to 25mm of tissue depth. In the treated tissue, but not the control tissue, frozen sections and two other histological stains (H&E and Masson’s Trichrome) indicated a “defined area of tissue destruction” extending from approximately 8mm to 18mm of tissue depth. This region showed clear disruption of fat cells, while connective tissue, blood vessels and nerves remained intact. No evidence of any thermal damage was seen in any treated tissue, again “consistent with initial cavitation followed by the mechanical destruction of cells.” The authors state that fourteen animals were treated in this study, and the results were “consistent over time” despite the use of “multiple devices, [and] multiple transducers [by] numerous users.” No quantification of subject-to-subject variability was provided. For example, the authors should have measured the zone of tissue damage in each animal, and presented the results as averages with 95% confidence intervals.
So far, the results are promising, with clear evidence of non-invasive damage to subcutaneous fat and no apparent impact to the dermis. Unfortunately, the analysis stops there. For example, it is clear from the presented images that not all fat cells in the treated region were disrupted, but the authors do not quantify the percentage of the treatment volume that was disrupted. Further, the response of the animal to this treatment was not studied. Biopsies of treated and control areas were not performed at meaningful time durations subsequent to treatment (such a 1 day, 1 week, 1 month and 3 months post-treatment). Unlike the recent Zeltiq study, we have no idea how the skin and subcutaneous fat respond to these injuries. Does inflammation occur? While no changes to the histology of the dermis were seen immediately post-treatment, could an inflammatory response occur over time? Are non-viable cells removed or replaced? Does this treatment cause meaningful changes in fat thickness compared to control volumes over time, and if so, when do these changes occur? Lastly, blood lipid profiles were not analyzed in this study. We cannot know if release of lipids from the disrupted adipocytes has any systemic effect, either on blood lipids or the liver.
The authors state that these study “observations do not directly lead to predict clinical results,” and they recommend further clinical evaluation. However, the real need is for further pre-clinical evaluation. Perhaps this partly explains why this device, widely available in Europe and Canada, is not yet cleared by the FDA.