Dark skin is always a challenge for skin practitioners, and yet a wide variety of complicated skin conditions such as pigmentation disorders including post-inflammatory hyperpigmentation and melasma, keloid and hypertrophic scars, as well as pseudo folliculitis barbae (PFB), occur more frequently in people-of-color than Caucasian skin types.
Maritza Perez, MD in New York is among a small number of well-known physicians who specialize in treatments for patients of color. With over 15 years of experience, she is also recognized as one of the top authorities on how lasers and other cosmetic treatments can be best performed on skin of color patients. Like most other aesthetic physicians Dr. Perez prefers using Nd:YAG 1064 nm lasers on darker skin. YAG is the most widely recognized modality for safe and efficacious treatment of Fitzpatrick IV-VI in any laser clinic or medspa.
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.
Primary care providers chose their profession out of a desire to help patients live better and longer lives according to the Hippocratic Oath. But the winds of change are blowing stronger across the landscape of medical practices throughout America. Now, more than ever, practitioners wishing to fulfill their calling are increasingly challenged on all sides by the pressures of time, patient demands, and complexity in the health insurance industry, government involvement and economics.
Many primary care providers (PCPs) find themselves on a treadmill, trying to maintain the highest standards of care while also endeavoring to achieve the rewards they and their families deserve to compensate the years and high cost of medical training and the long hours devoted to this most noble profession. There are several strategies to bring the economics of medical practice back into balance: work more hours and see more patients (not usually possible); raise fees (not practical given insurance industry dynamics); cut costs further (many practices are already close to a point of diminishing returns); or offer new, cash-based medical services.
Several lasers are used for lipolysis – a recognized technique for fat reduction. It has been demonstrated that (i) fat liquefaction is induced through a temperature elevation of the adipocyte cells, and (ii) fat volume reduction depends on total cumulative energy delivered at the treatment site. Which wavelength (920nm, 980nm, 1064nm, 1320nm, and 1440nm) is the best?
Studies and substantial anecdotal evidence show that the penetration depth of wavelengths between 900 and 1320nm is very similar – around 1.5mm. The only minor difference is at 1440nm, which is more absorbed by subcutaneous fat. The irreversibly damaged volume of tissue is also similar for wavelengths between 920 and 1320nm. Practitioners obtain the total of about 4cm3 with 3750J delivered to the tissue.
With laser lipolysis, thermal elevation of a given volume can be obtained provided that the penetration depth remains in this nominal range. This explains why similar end results can be obtained using 920nm, 980nm, 1064nm, and 1320nm. Thermal build-up is the main factor behind adipocytolysis and skin contraction. Successful outcomes are dependent primarily on the movement of the optical fiber inside the tissue and even and stable delivery of the laser energy. It’s the hands of the surgeon that truly make a difference!
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.
Warts are ugly but they are common, and there are many ways and means to remove them. I prefer to use a YAG laser to remove warts.
Surprisingly, this simple technique is not very common among dermatologists who typically freeze warts with nitrogen. That is painful and not very effective as in many cases more than one treatment is required.
Digging into the body of research on the subject I found a report on a study published in September 2009 by the Korean Academy of Medical Sciences.
This study was designed to evaluate the efficacy of long-pulsed Nd:YAG laser in the treatment of warts. Over the course of 1 yr, 369 patients with recalcitrant or untreated warts were exposed to a long-pulsed Nd:YAG laser. The following parameters were used:
Patients can have bigger dreams when you break costs into smaller pieces.
When the economy is down, people tend to cut cosmetic procedures from their budgets, as they see it as a “want” instead of a “need.” For doctors this can mean fewer procedures in their practices. There are many credit card based financial products that can help patients realize that the procedures they have been wanting are affordable – even in today’s economy. Plans are available for 18 and 24 month no interest plans as well as 48 month extended payment plans that help break total costs into more manageable monthly payments. In addition, there are no down payments, so patients can get their treatments started faster.
Practices can save valuable time with the online reporting system that lets them submit applications electronically, view application statuses, track patient financing performance and even set goals for the upcoming year.
Practitioners should not provide links to these financing offers on their websites. Instead, publish a statement, which clearly says that financing is available and have your patients come to the office, where your staff will help them submit the application, explain all benefits and schedule the procedure.