Endorsed by - AAMSSA · and smart money in physician-dispensed home use devices for common conditions like acne and excessive hair growth. If your patients are not already asking

vo

lum

e 2

Nu

mb

er

4su

mm

er

ed

itio

n 2

009

Endo

rsed

by

ACCREDITED FOR

1 ETHICS CPD POINT

PER ISSUE*

HPCSA issues noticeon Scopes of Practice in Aesthetic Medicine *

DIY

CHEMICAL PEELS

Devices

MedEsthetics | Southern Africa

GuEst Editor: dr NEriNa WilkiNsoN

note from the editor

This issue is in keeping with the economic climate. Where champagne shopping has been replaced by essential shopping and many people are resorting to their own DIY at home. This could also be true in the aesthetic world where there seems to be a new potential growth area and smart money in physician-dispensed home use devices for common conditions like acne and excessive hair growth.

If your patients are not already asking about home use devices, they will be. According to market research in the USA, today’s $226 million home use device market is expected to quadruple to $1 billion by 2012.

Another cost effective treatment that enhances the results of most aesthetic treatments are chemical peels, which offer visible skin improvements. Today the move forward, is more towards regular superficial peels. Blended peels are also gaining favor due to the visible results that can be achieved without the downtime typicaly associated with single acid peels.

The Chemical Peels article, shows us the exciting advances that have been made over the past five years in the new ingredients for acid peels and the improved uses in pigmented skin types.

December is the time to start showing some skin after an extended cold winter. However, some are still covering up to hide a visible tattoo that was once shown with pride. Seasons change, but so do some peoples lives, sadly some more permanent options ie. tattoos which are not easily removed.

In the article Invisible Ink, it is clear that seventeen percent of those

with tattoos will consider having one or more of them removed. For patient satisfaction during the removal process, it is extremely important to correctly asses these tattoos to give patients realistic expectations on the time required to remove the tattoos and to be able to offer a variety of treatment options which are reviewed in detail in this article. An interesting new option to tattoo removal is a product called Elimin Ink which is placed in the tattoo, and leads to scab formation. The scab actually changes color as the different inks in the tattoo are absorbed by Elimin Ink and pulled to the surface.

So whether you are improving your DIY skills or removing that embarrassing tattoo, the end of the year is upon us and is time to plan how we are going to optimize 2010 before taking a well deserved break!

Enjoy and happy holidays.

DR NERINA WILKINSONMBChB(stell) FCs(sa)Plast

(Plastic and Reconstructive surgeon,Dr Nerina Wilkinson has a full time private practice at the holistic anti-aging Renaissance Body Science Institute in Cape Town. She is a member of the Association of Plastic and Reconstructive Surgery and has presented scientific papers at congresses and publishes in health related magazines.

She has a major interest in aesthetic surgery of the face, breast and body, closely integrating surgical with other non-invasive procedures.

She started her private practice in 2000 at the Mayo clinic in Johannesburg and concentrated on cosmetic surgery of the face, breast, abdomen and thighs. She also had a large non-invasive practice working closely with the Global Aesthetic Centre. Here minimally invasive procedures including botox and fillers were combined with skin resurfacing techniques like chemical peels and skin lasers.

In February 2006 she relocated to Cape Town to concentrate on cosmetic surgery: invasive and non-invasive at Rennaisance Body Science Institute.)

MedEsthetics | Southern Africa �

MedEstheticssouthern africa

PuBlisHEr

Reni RouncilvellMedSpec Publishing

PO Box 12973 · Clubview · 0014South Africa

T +27 (0) 12 661 3294Mobile +27 (0) 82 441 6904e-mail [email protected]

salEs & advErtisiNG

Lelani WearingT +27 (0) 12 661 3294

Mobile +27 (0) 79 512 6990e-mail [email protected]

Johan SmookT +27 (0) 12 661 3294

Mobile +27 (0) 83 653 8411e-mail [email protected]

suBsCriPtioN & aCCouNts

Elizabeth VersteegMobile +27 (0) 72 189 8499

e-mail [email protected]

dEsiGN & laYout

Sonja van NiekerkMedSpec Publishing

T +27 (0) 12 661 3294Mobile +27 (0) 82 444 0231e-mail [email protected]

disClaiMEr This publication contains selected items originally published under license from

Creative Age Publications in the USA.

This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights for translation, reprinting reuse of illustrations, broadcasting, reproduction of CD-Rom, microfilm, online publication, or in

any other way, and storage in data banks.

The use of registered names trademarks etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt for the relevant laws and regulations and therefore free for general

use.

Product liability: the publishers cannot guarantee the accuracy of any information about the publication of medications contained in this publication. In every individual case, the user must check such information by

consulting the relevant literature.

contents...

ColuMNs 30 BUSINESS CONSULTANT patient consult

40 BEST PRACTICES 42 INTRODUCTIONS 44 PRODUCT REVIEWS 46 NEWS & EVENTS 48 IN THE LIMELIGHT

4

summer edition �009

18

Natrelle A4 full pg ad paths 11/17/09 11:47 AM Page 1

Composite

C M Y CM MY CY CMY K

FEaturEs 4 chemical peels

10 DIY devices

18 CPD ARTICLE HPCSA issue notice on scopes of practice in aesthetic medicine

20 ultrapulse CO2 fractional laser treatments for aging skin

24 invisible ink

26 the right mix

34 case study

38 fat profits in lean times

Natrelle A4 full pg ad paths 11/17/09 11:47 AM Page 1

Composite



For over a decade, chemical peels have remained in the top 5 most performed non-surgical cosmetic procedures worldwide. For aesthetic doctors, chemical peels are a cost effective method for facial rejuvenation. They complement the newer technologies and devices and offer successful results in most of the skin indications that worry our patients, including wrinkles, pigmentation, dull skin, acne, acne scars and even stretch marks.

PEEl dEPtH & tHE duratioN oF skiN CHaNGEs

Level of Peel/ Chemical destruction Duration of changeUpper Stratum corneum Very temporaryIntra-epidermal Very temporaryBasal layer TemporaryGrenz Zone Medium durationPapillary dermis Long lastingUpper Reticular dermis PermanentDeep Reticular dermis Permanent, risk of scarringHypodermis Permanent, scarring

ChemiCal PEELS

Chemical Peels remains in the top 5 most performed non-surgical cosmetic procedures worldwide for over a decade already. For aesthetic doctors, chemical peels are a cost effective method for facial rejuvenation that have successful results and complements al the newer technologies and devices. Chemical peels offers results in most of the skin indications that worry our patients including wrinkles, pigmentation, dull skin, acne, acne scars and even stretch marks.

LOCAL ARTICLE

Volume 2 Number 4 Summer Edition 2009 | MedEsthetics �

Though the various depths of peels determines the duration of change seen in the skin, the various chemicals have different benefits on the skin. Using different chemicals, the same depth of peel can be tailor-made to suit the individual needs of your patient.

CHEMiCal PEEliNG aGENts aNd tHEir aCtioNs

PEELING AGENT DEPTH OF PEEL ACTIONS BENEFITSGlycolic acid Superficial Keratinocyte discohesion Reduces wrinkles, photoageing, Epidermolysis acne & dull skin, Increases type 1 collagen & skin renewal, depigmenting action also hyaluronic acid in skin ComedolyticKojic acid Superficial Depigmenting action: reduces Reduces pigmentation & melasma synthesis of melanin by inhibiting activity & synthesis of tyrosinase, regulates melanin productionAzelaic acid Superficial Tyrosinase inhibition, regulates melanin Reduces pigmentation & melasma production, keratinisation normalization, anti-bacterial action, anti-oxidant actionPhytic acid Superficial Anti-oxidant Reduces pigmentation & inflammation Chelating action on iron, copper & calcium Lightening action by blocking entrance of iron and copper in the formation of melanin Lactic acid Superficial Keratolysis, metabolic stimulation by Skin renewal, skin hydrator and exfoliant interfering with enzymes to decrease corneocyte cohesion, renewal of epidermal cells, skin hydrator, collagen deposition Salicylic acid Superficial Keratolysis, comedolytic, antibacterial action Improvement of acne and blocked poresRetinoic acid Superficial Corneous cells desquamation, keratoregulating, Wrinkles, active acne , pigmentation & comedolytic, keratinisation normalization, photoageing reduction protects collagen fibres, regulates melanin production Trichloracetic acid <15% Superficial Protein precipitation, dissolves keratin, Wrinkles and photoageing reduction, >20% Medium coagulates skin proteins, augments collagen improvement in acne scars and stretch production marksPhenol Deep Keratin protein coagulation, augments Photo-ageing reduction, depigmenting, collagen production, antiseptic, antifungal, antiwrinkle (medium to deep wrinkles), anaesthetic properties reduces acne scarring, skin tightening

There are a number of high quality peel formulations available in South Africa. Most of these formulations have gone through various types of research, testing and changes to make them ideal for specific indications. Although some doctors might find that pharmacy-compounded formulations are more affordable, results

are certainly not comparable to the laboratory manufactured formulations that are backed by scientific research. The following formulations are available on the market in South Africa.

FilorGa GlYkoPEElA dermatological, chemical, superficial and complete peeling

solution specific for cutaneous ageing and photo-damage. The formulation combines 18 active ingredients to ensure results for various indications ranging from

photo-ageing, wrinkles, loss of elasticity, overall skin appear-ance, acne and especially for various types of pigmentation due to its multiple depigmenting ingredients, which have been added to the glycolic acid.

The GlyKopeel is formulated at a concentration proven to pro-vide maximum delivery of the active ingredients. The 18 active ingredients rapidly improve skin radiance & smoothness and have a progressive action on wrinkles and uneven pigmentation.

This unique and complete formulation has 4 mechanisms of action:A IMMEDIATE EFFECTS1 Exfoliation by means of the Glycolic acid2 Protection due to the action of white mulberry, brown algae

and glycerinB PROGRESSIVE EFFECTS3 Stimulation with vitamins A, C and E 4 Correction of pigmentation due to the depigmenting

actions of Kojic acid and bearberry extracts. Kojic acid and bearberry extract, which produces arbutin, reduce melanin synthesis by inhibiting tyrosinase activity.

GlyKopeel is available in 20%, 50%, 70% and also 70% MAXpeels. It can be applied anytime of the year.

local article KEY FEATURE


This superficial peel has been on the market for over 20 years and has been improved numerous times to become one of the most popular superficial peels for both patients and physicians. GlyKopeel is available in 20%, 50%, 70% and also 70% MAX peels. It is unique that it offers superior benefits without recovery time and can be done anytime of the year.

NEostrata PEElsNeoStrata’s peeling solutions were developed by renowned dermatologist Dr Eugen J Van Scott and dermatopharmacologist Dr Ruey J Yu, to provide physicians with a highly effective, superficial peeling system. NeoStrata peels offer maximum bioavailability and free acid, along with a comprehensive range of acid concentrations for optimum strength and flexibility in treating patients of all skin types and conditions. NeoStrata’s peels can easily be combined with other treatments and procedures within the office to maximize skin benefits. The NeoStrata Skin Rejuvenation System of glycolic acid peels offers the flexibility

of four concentrations including 20%, 35%, 50% and 70% free glycolic acid. In addition, for those patients desiring a stronger clinical effect after successfully completing a series of peels ending at 70%, there is a High Potency Peel with 70% glycolic acid and the added peeling agents ethyl pyruvate/pyruvic acid and acetic acid. This range of formulation strengths enables the physician to safely design a treatment program around theskin care needs and tolerances of a particular patient. To enhance the peel procedure, the NeoStrata Citriate SRS Peel Booster pads can be used in conjunction with the glycolic acid solutions. There is a choice of two different Citriate Booster pads to help target treatment - the Clarifying Booster pad and the Brightening Booster pad. Each can be easily incorporated into the procedure to help improve specific skin conditions such as acne, pigmentation and photodamage. For improving acne and acne scarring, the Clarifying Booster pad should be used, which contains 20% citric acid and 10% mandelic acid. Mandelic acid is lipid soluble AHA

which is effective in penetrating the skin and helping to control oil and sebum on the skin. For improving various pigmentation irregularities, the Clarifying Booster pad should be used. This booster pad contains 30% citric acid along with kojic acid and arbutin, which are widely used lightening agents.

BEForE aFtEr BEForE aFtEr

FilorGa dErMaCEutiC

KEY FEATURE local article

Face to Face AD_MEDes\p 5/22/09 1:34 PM Page 1



NeoStrata superficial peels, in conjunction with a maintenance regimen of the NeoStrata AHA, PHA and Bionic acid home-use skin care products, can be used to improve skin imperfections including fine lines and wrinkles, pigmentation irregularities, mild to moderate acne, superficial acne scarring, keratosis pilaris, pseudofolliculitis barbae, keratoses and/or benign lentigines. Some physicians use light peels to improve sensitive skin conditions such as rosacea or combine them with other cosmetic procedures such as microdermabrasion, IPL and non ablative laser to provide enhanced rejuvenation. Because this range of products makes the skin more sensitive to the sun, a broad spectrum sunscreen of at least SPF 15 must be applied while using these products and for a week after use is discontinued.

tHE dErMaCEutiC PEEliNG raNGE This range of products includes a range of applications from

very superficial to deep in an easy-to-use format. The use of combination peels affords the opportunity to generate highly effective results with very little discomfort to the client and with a low side effect profile. The range is made up of a very superficial Mask peel (Glycolic acid 30%), a superficial Milk peel ( Glycolic acid 50%, salicilic acid 4% and lactic acid 10%), two medium depth peels in Cosmo and Spot peel as well as a very deep Exo peel (Phenol). Both the Cosmo and Spot peels utilise a two step peeling procedure. The Cosmo peel is based on a 15 or 18% TCA followed by a mask containing lactic, salicylic, citric acids, retinyl palmitate andascorbic acid. Spot peel starts with a milk peel followed by a potent depigmenting mask containing mandelic acid, idebinone, emblica, retinol and salicylic acid.

daNNE six laYEr PEElThe six-layer peel is a resurfacing and regenerating procedure,

which removes and rebuilds at the same time. It removes dead skin cells and stimulates collagen development. Six Layer peel diminishes imperfections, reduces deep lines and wrinkles, refining and smoothing thickened and rough textured skin. It eliminates sun-damaged, pigmented discoloration and restores skin back to a healthy fresh more youthful appearance.

The six-laYEr PEEl is a unique blend of natural plant and fruit sugar acids, applied systematically in layers. The number of layers required is adjusted for the specific needs of the patient and the desired result. The strength of the formulation is tailored by the clinician or therapist to suit the skin colour, texture, sensitivity and condition. The procedure takes either five, seven or ten days depending on the individual.

The skin is prepared by using a formulation called Retosin, a derivative of vitamin A, which strengthens new cells coming through and regulates and normalizes skin functioning. The six-layer peel is finished with a set of enzyme lift off treatments

and transdermal nutrition infusions. These work on the internal function and structure of the skin, as well as by restoring essential amino acids, proteins, water, vitamins and antioxidants to support the skin, and enable the cells to stay alive longer and perform at their healthiest. A Six-Layer Peel is safe for almost all skin types and races. Excellent results can be achieved on thick, uneven textured skin, wrinkles, fine lines, pigmentation, sun damage and acne scarring. It is not recommended for people with very fine fragile skin, excessively oily skin, certain forms of acne or those of Indian extraction. In some cases to achieve optimum results, there may need more than one application of Six-Layer Peel.

ENviroN Environ have a variety of peeling systems, using acidic creams

and gels instead of using acid solutions. These peels preserve as much epidermis as possible while at the same time, achieving the safest effective concentration of hydroniumions in the dermis. These peels are designed to preserve the architecture of the skin while simultaneously stimulating the fibroblasts in the dermis to increase the quantity of collagen.

list oF suPPliErsFILORGA www.filorgasouthafrica.co.za

012 548 3945

[email protected]

NEOSTRATA Genop Healthcare

www.genophealthcare.co.za

011 545 6620

DANNE MONTAGUE KING

www.dannemking.com

011 262 6120

[email protected]

ENVIRON www.environ.co.za

0800 114 402

[email protected]

rebuilding skin, rebuilding lives www.dannemking.com

The Pro Alpha Six-layer Peel is an in-salon treatment that is considered to have effects similar to laser treatments or medical peels without the risk of trauma, long convalescence or possible contra-indications.

With a large portion of aging caused by environmental damage, it is essential to provide clients with treatments that effectively revise the skin.

results?Can you achieve these

Imitating nature for natural results has always been the basis of the DMK concept. By combining state-of-the-art botanical science with innovative technology, DMK has created one of the most advanced skin care systems available.

Excellent results can be achieved on thick, uneven textured skin,

wrinkles, fine lines, pigmentation, sun

damage and scarring.

The DMK concept is based on the principle that cells of human skin do not positively react to any chemical(s) they do not recognise. The cells of the skin will react in a positive and correct manner when confronted with similar chemistry to that which they manufacture on their own.

BEFORE AFTERDURING

For more information about the Pro Alpha Six-layer Peel or other DANNÉ treatments contact your nearest DANNÉ distributor.Head Office: 011 262 6120

Eastern Cape, Garden Route, KwaZulu-Natal

079 697 2122

[email protected]

Gauteng, Limpopo, Mpumalanga

083 280 8633

[email protected]

Western Cape, Northern Cape

079 697 2130

[email protected]

DEVICES DiY

When it comes to potential growth areas for aesthetic practices, the smart

money is on physician-dispensed home use devices for common conditions like acne and excessive hair growth. Two compelling reasons are in play: First, today’s devices generally offer better performance than devices of the past - their FDA clearances guarantee low risk and a certain level of efficacy. Second, consumers are demanding the ease, affordability and flexibility that home use devices provide.

By darcy lewis

If your patients are not already asking about home use devices, they will be. According to market research firm Medical Insight, today’s $225 million home use device market is expected to quadruple to $1 billion by 2012.

The home use

market is exploding,” says Robb Akridge, PhD, vice president

of clinical affairs at Clarisonic (clarisonic.com) and creator of the Clarisonic skincare system. “The clear trend today is taking what the professional has in the office and adapting it for use at home.”

According to Fred Carr, vice president of marketing and business development for Photomedex/ProCyte (photomedex.com), savvy physicians have multiple reasons to retail home use devices to their patients. “From a therapeutic standpoint, physicians are

MedEsthetics | Southern Africa 10

Volume 2 Number 4 Summer Edition 2009 | MedEsthetics 11

aNtiaGiNG oPtioNs

In keeping with a key demand of medical aesthetic patients, manufacturers are developing home use devices to slow and reverse the signs of aging.

FaCEtraiNEr BY No!No! Launched in summer 2009, the Face-Trainer applies the principles of resistance training to delicate facial muscles in a 10-minute daily routine. “Professional solu-tions for wrinkles and sagging skin all use very high levels of energy - we couldn’t do that for home use,” says Dolev Rafaeli, president/CEO, Radiancy. “We also know that consumers want immediate effects. Resistance training for the face has been used in therapy for facial paralysis, but no one had looked at it as a home-based cosmetic solution before.” According to Rafaeli, the FaceTrainer’s clinical studies show that using the device for 30 days resulted in an average 71% reduction in sagging and 42% reduction in wrinkles.

finding that many of these devices really do offer the benefits they claim, so they want their patients to receive these benefits. And they want to be the ones to educate their patients on which devices work and why,” he says. “From a commercial standpoint, retailing devices clearly enhances revenue.”

“Consumers who invest in home use beauty products still go to the salon to get their hair cut and colored or their nails done because the professionals do a better job.”

But it’s not just manufacturers who see home use devices as an important trend, many clinicians do too. “I believe this is where the future of medicine lies—we’re currently seeing only a small portion of the total pool of people who are medically good candidates for the procedures we offer in the office,” says Tina Alster, MD, director of the Washington Institute of Dermatologic Laser Surgery in Washington, DC. “There’s a large market out there that’s relatively untapped due to finances, discomfort with in-office procedures or a lack of awareness regarding these treatments. I think the only patients we’re ‘losing’ to the home use device market are the ones who are unlikely to come into our offices, anyway.”

Eric Bernstein, MD, director of The Mainline Center For Laser Surgery in Bryn Mawr, Pennsylvania, is one physician who is embracing home use devices. “You can’t put your finger in the dyke and hold back technology. I see home devices as an adjunct to what I do,” he says. “As people become more familiar with home lasers, for example, I think that will stimulate their interest in office-based laser procedures. After all, consumers who invest in home use beauty products still go to salons to get their hair cut and colored or their nails done—all things they can do themselves at home—because the professionals do a better job.”

WHiCH dEviCEs arE riGHt For Your oFFiCE?

With the explosion of new home use devices hitting the market, physicians often struggle with the question of which devices to offer their patients. “If a device catches my attention, I have to get excited about it. I read all the clinical trials and test the device myself to

HaNdHEld oMNiluxClear-U and New-U light therapy systems – an innovation for convenience.The light therapy treatment of acne and skin rejuvenation has recently been simplified with the introduction of two FDA approved small handheld LED systems. • Omnilux Clear-U for the improvement of mild to moderate

acne utilizes switchable blue (415nm) and red (633nm) light emitting diodes to destroy Propionibacterium acnes – the bacteria responsible for acne. 70% of lesions cleared up after 4 weeks of alternating blue and red light therapy.

• For skin rejuvenation, Omnilux New-U utilizes alternating red (633nm) and near infrared (830nm) light which targets cells responsible for the synthesis and repair of the skin’s supportive structures and stimulates the natural anti-aging process. A significant reduction in periorbital wrinkles, an improvement in skin tone, clarity, smoothness and elasticity is experienced.

Omnilux light therapy stimulates the body’s own cellular mechanism by photo-modulation and therefore it is non-invasive and safe with no damage to the dermal tissue.

Clear-U R2000 excl VAT New-U R2250 excl VAT Genop Healthcare Tel 011 545 6600, Fax 011 315 6008 www.genophealthcare.co.za

DIY devices KEY FEATURE

MedEsthetics | Southern Africa 1�

Hair rEMoval oPtioNs

Some of the greatest demand for home use devices is in the arena of hair removal, and this interest extends beyond aesthetic patients. Many clinicians report that their patients are anxious to introduce friends, family and the men in their lives to light-based hair removal.

tria lasEr Hair rEMoval sYstEM ($795 retail, TRIA Beauty, triabeauty.com) Dr. Eric Bernstein, who consults for TRIA, is impressed with the TRIA Laser Hair Removal System. The system uses diode laser technology to destroy hair follicles. “In my opinion, the TRIA is the best home use hair removal device currently on the market. It works, its studies are compelling, and people love it,” he says. The Tria is indicated for light to medium skin tones with medium to dark hair. Prior to the initial use, the purchaser needs to confirm her skin tone’s suitability and activate the unit. When applied to the skin, the laser automatically emits a single laser pulse, targeting multiple hair follicles in second-long intervals.

HairMax lasEr CoMB The HairMax Laser Comb delivers light in the visible red wavelengths to target hair follicles of patients with thinning hair, including male and female pattern baldness. “In January 2007, we also became the only device in America cleared by the FDA for hair regrowth in patients with androgenetic alopecia,” says David Michaels, managing director and founder of HairMax. “After using the brush for 10 minutes three times per week most users see a quantifiable regrowth in hair.”

According to sales director Randy Veliky, the HairMax can be used in conjunction with Rogaine or Propecia to enhance results. “HairMax addresses hair loss differently, so the multitherapy approach often gets better results than either independently,” he says.

see how well it works,” says Dr. Bernstein. “I currently retail the TRIA and the Clarisonic, but I have patients asking about several other devices. If it’s something I’ve tested and was not impressed with, I tell my patients that. If I haven’t read the studies or tested the device, I tell them I’ll get back to them.”

This cautious approach makes sense to Clarisonic’s professional marketing manager Heather Dazell. “Practitioners are understandably leery of recommending a product if they haven’t tried it or seen compelling evidence of efficacy,” she says. “Physicians’ livelihoods are dependent on their credibility, so we absolutely encourage them to carry a device only if it impresses them.”

Clarisonic has found success in the aesthetics market by adopting a marketing strategy that supports the clinicians’ sales efforts. “We sell two versions of the product, one for physicians and one direct to consumer,” says Akridge. “Our professionals are very important to us, so we always add additional features to the professional model, which means they’re offering a better version of the product for the same price.”

In addition, the company offers a professional trial program. “We encourage physicians and skincare professionals to try the Clarisonic in two ways: We offer it to them at a reduced price,” says Dazell, “and our reps are trained to have the doctor try the system himself before making a purchasing decision.”

But it’s not enough to win over just the doctor. “We suggest that physicians only carry products that the whole office staff supports,” says Dazell. “Occasionally the doctor likes the product but his esthetician doesn’t, and that’s asking for trouble. Estheticians don’t like having to sell things they don’t believe in.”

CLRS Technology hopes to emulate Clarisonic’s success with its CLARO Home Intense Pulsed Light hair removal device. “We’re going with physician-only distribution because we really want to build off dermatologists’ high regard,” says James Pereyra, CLRS chief marketing officer. “Consumers don’t know IPL technology yet, but the physicians are very comfortable with it. We think they’ll be our best advocates.”

ENsuriNG PatiENt satisFaCtioN

Physicians, as the retailers of these devices also need to help patients set realistic expectations about the devices’ limitations and results. “When something has been cleared by the FDA, it will be low risk and reasonably effective,” says Dr. Bernstein. “It will not be as effective and/or as fast at providing results as the treatments I offer in the office, and I make sure all my patients understand that. Those who do tend to be very happy with their home use devices,and they appreciate being able to get them from a trusted source.”

Darcy Lewis is an award-winning Chicago journalist specializing in healthcare and business topics.

KEY FEATURE DIY devices

silk’N sENsEPil

($499 retail, Home Skinovations, silkn.com)

The SensEpil uses what the company terms Home Pulsed Light. It is the next iteration of the Silk’n physician-dispensed hair removal device. “We have received new FDA clearance for OTC sales,” notes Tom Goslau, vice president of marketing. Safety features include a proprietary skin-sensing device that ensures that only users with appropriate skin tones can activate the light pulse. The unit comes with one disposable lamp cartridge, good for 750 light flashes or the equivalent of one full body treatment from the neck down. “It’s a nice addition to what I offer,” says Dr. Tina Alster, who consulted in the new device’s design. “A patient may come to me for her bikini hair, but would find doing her legs in-office to be cost prohibitive, so she purchases a device to do them at home herself.”

7285 Omnilux strip ad pRR 11/15/09 9:05 PM Page 1

Composite


aCNE trEatMENt oPtioNs

Devices in this category are more readily seen as a continuation of a physician’s in-office care and have been well-received in the profession. They are most often recommended for use in conjunction with prescription-strength topical and oral medications to control acne.

oMNilux ClEar-u (r2000 ExCl vat rEtail, PHotoMEdEx/PHototHEraPEutiCs, PHototHEraPEutiCs.CoM)The Omnilux Clear-U has seven FDA clearances, including acne, pain and photoaging. It combines blue and red LED light to kill propionibacterium acnes (P.acnes) and ease inflammation. “We’re also currently seeking FDA approval for wound healing, hair growth and scar reduction. We know we’ve got the science on our side and physicians are supporting us accordingly,” says Fred Carr, vice president of marketing and business development. “The Clear-U has the same intensity and output as our in-office devices—it just covers a smaller area for safety reasons.” The acne treatment course consists of two 20-minute treatments per week for four weeks with alternating blue and red light.


täNda ProFEssioNal skiNCarE sYstEM ($250-$275 rEtail, PHaros liFE, taNdaskiNCarE.CoM)The Tända Professional Clear features 414nm blue LED light to destroy P.acnes. “In the clinical trial we conducted with the Tanda Professional Clear, we found that daily self treatments using the device reduced the number of acne lesions significantly. Moreover the study demonstrated significant improvement of the subjects’ skin condition,” says Michael H. Gold, MD of the Tennessee Clinical Research Centre in Nashville. The company also offers the Tända Regenerate with 660nm red light to speed healing and stimulate collagen production. Both devices are available in a professional model for dermatologists and medspas and an over-the-counter model sold direct to consumers.

Claro ($250 rEtail, Clrs tECHNoloGY, MYClaro.CoM) Launched in August 2009, the CLARO is the first hand-held device to use IPL technology for at-home, acne spot treatments. “Other home use devices for acne have used LED or thermal energy, but if you ask dermatologists how they treat acne in the office, they’ll tell you that IPL is the recommended standard,” says James Pereyra, CLRS chief marketing officer. “Our combination of heat and light drastically reduces treatment time down to 12 seconds per blemish.” The rechargeable CLARO treats 50 to 60 blemishes per charge and has no disposable elements or parts.

ClarisoNiC skiN CarE sYstEM ($195 rEtail, ClarisoNiC, ClarisoNiC.CoM) The Clarisonic skincare brush uses sonic frequency to gently and effectively remove debris and cleanse pores. It also helps to reduce dry patches, blemishes, and the appearance of fine lines and wrinkles. “The Clarisonic is different from other home use devices in that they tend to differ significantly from their high-grade, professional counterparts,” says Robb Akridge, PhD, an immunologist and lead inventor of the Sonicare toothbrush and Clarisonic. “The Clarisonic Professional is used in-office by the clinician to cleanse skin prior to procedures like chemical peels and microdermabrasion, and the same device can be used safely at home by the patient.”

aCNE trEatMENt oPtioNs

KEY FEATURE DIY devices

Cipla Medpro (Pty) Ltd. Reg. No. 1995/004182/07, Rosen Heights, Pasita Street, Rosen Park, Bellville, 7530. Tel (021) 943 4200, Fax (021) 914 4699.E-mail: [email protected] Website: www.cipla.co.za

Specif ic skincare for hyperpigmentationand photo-ageing.

Contains Rucinol and Sophora-- unique ingredients to effectively managehyperpigmentation.

Dermatologically tested & Fragrance free.

®

LAMAR franceT H E T R U S T E D S K I N C A R E C O M P A N Y

CPD ARTICLE

SUBSCRIBE & EARN

1 ETHICS CPD POINT

PER ISSUE

On 13 October 2009, the HPCSA, by media release clarified various issues relating to cosmetic medicine.The HPCSA appears to differentiate between:

• “cosmetic medicine procedures resulting in permanent changes”, • “cosmetic medicine procedures not resulting in permanent changes”, • “cosmetic surgery” and • “reconstructive surgery”.

HPCSA issues notice on

scopes

of practice in aesthetic medicine


CPD article KEY FEATURE

It defines “cosmetic surgery” as “an operative procedure in which the principal purpose is to improve the appearance, usually with the connation that the improvement sought is beyond the normal appearance, and its acceptable variations, for the age and the ethnic origin of the patient.” It furthermore explains that cosmetic surgery was always an elective procedure.

It also stated that cosmetic surgery could only be performed “in the main” by specialists in plastic and reconstructive surgery. It does, however, allow “other specialists” which have formal structured training, assessment and ongoing professional development in certain aspects of cosmetic surgery relevant to those particular specialties to perform cosmetic surgery. Such training has to be, if not part of normal specialist training, conducted by a training/examination body accredited by the Board for such training”.

In general “cosmetic medicine” is defined as “the field that dealt with any non-surgical cosmetic procedures”. It confirmed that “cosmetic medicine” was not confined to any specialty or discipline and could therefore, potentially, be performed by any person registered at the HPCSA.

The HPCSA however, also stated that “any practitioner performing cosmetic medicine procedures which result in permanent anatomical and/or physiological changes shall be appropriately trained as for cosmetic surgery.” The use of the phrase “any practitioner” seems to indicate that general practitioners, dentists, etc could all potentially perform cosmetic medicine procedures, provided that they are appropriately trained.

It is not clear whether the implication of the above is that cosmetic procedures that do not result in permanent anatomical and/or physiological changes do not require “appropriate training” and what exactly the definition of “permanent anatomical and/or physiological changes”. For example, the use of fillers for wrinkles is often regarded as not being “permanent” (it lasts for a couple of months), as with certain other procedures.

It is, however, submitted that Rule 19 of the HPCSA’s Ethical Rules, as amended in February 2009, dictate compliance with the “scope of … practice”, and within that, only use “a form of treatment, apparatus or health technology which is not secret and which is not claimed to be secret; and an apparatus or health technology which proves upon investigation to be capable of fulfilling the

claims made in regard to it”.

The use of equipment is regulated by other HPCSA policies, and will, in future, also be subject to regulation by a new South African Health Products Regulatory Authority (i.e. the old Medicines Control Council (“MCC”). As far as to use of equipment is concerned, the HPCSA Policy on Perverse Incentives, as revised in 2007, states the following in connection with the use of equipment, which is prevalent in the practice of cosmetic medicine and surgery (emphases provided):

3.6.1 Health care practitioners shall only own and use technological equipment if it forms an integral part of their scope of practice and on condition that the health care practitioner concerned has received appropriate training in using and managing such equipment.

3.6.2 Health care practitioners shall not over-use equipment for procedures, tests and other applications that are not indicated, scientific or based on evidence. This constitutes over-servicing and is prohibited.

3.6.3 Health care professionals shall not use technological equipment, health care products or devices for profiteering and must refrain from charging patients fees for the use of such products or devices that are not market related.

As far as billing for equipment use is concerned, practitioners should take heed of the rules in relation to fee-sharing, i.e. a practitioner would not be allowed to share a proportion of the equipment-use part of a bill with a person not registered at the HPCSA, and who has not undertaken work with the practitioner. If a piece of equipment is, therefore, owned by an outsider, the practitioner may rent (at fair market value) the equipment from that person, but may not share a percentage of patient income with such a person. Care should also be taken that the amount that is billed for equipment use does not amount to a violation of competition law, and does not exploit patients.

The clarification issued by the HPCSA states that the practice of cosmetic medicine should be in line with the “guidelines” issued by the MCC. What is described as “guidelines” are in many instances, legal requirements found in the Medicines and Related Substances Act of 1965. It currently includes, amongst others that medicines may only be used in line with its registered indications and may only be administered and dispensed in line with the applicable rules, i.e. schedules 2 and above must be prescribed by an authorized prescriber and may only be administered and/or dispensed by a person with the necessary qualification and license to do so. This also means that practitioners should be careful when



KEY FEATURE CPD article

using medicines off-label (i.e. for indication for which it is not registered). It should be noted that, unless a very clear informed consent is obtained from the patient after being informed of- and declaring that s/he understood- the available treatment options, risks, benefits and costs of each, both practitioner and product manufacturer may be liable, should anything negative happens to the patient. Patients should be informed that the product to be used is being used off-label.

It should also be noted that some devices are being registered as medicines, as no device regulatory framework existed in the past. A medicine is distinguished from a device in that, in terms of section 1 of the Medicines Act, it “does not achieve its purpose through chemical, pharmacological, immunological or metabolic means in or on the human body.” It is clear that some products are, therefore, erroneously registered as medicines, and would have to be removed from the medicines register in future, and could, potentially, be subject to call-up for device registration.

The envisaged regulatory frame-work for devices will authorize that a device is, actually, “able to fulfill the claims made with regard to it”. It will also investigate the safety

and performance of the device.

Rule 23 of the HPCSA Ethical rules have also been amended, in order to prevent practitioners from engaging in advocating preferential usage of any medicine or device, where such preferential use would lead to the practitioner receiving some reward other than that lawfully payable in terms of the service he or she renders. The agreements, whether in writing or verbal, associated with equipment and medicines used in aesthetic medicine should not provide for any such “other” remuneration, and should contain clauses that protect the practitioner and supplier from such allegations or enticements.

Practitioners should take care to ensure that patients, even in esthetic medicine, receive what is clinically appropriate or the most cost-effective, and not what would provide a “better return on investment”, or in line with some reward or incentive scheme.

In conclusion, practitioners in the field of aesthetic medicine should obtain expert advice on, amongst others:

• their scope of practice in view of the latest HPCSA rulings on cosmetic medicine and surgery;

• the use of equipment and the agreements associated with it, in view of future medical device regulation;

• the use of registered medicines within their scope of practice;

• all agreements with equipment and facility owners, as well as agreements relating to equipment and medicine use, checked from both an ethics and legal perspective; and

• the fees charged for medicines, devices and professional fees.

Due to the voluntary nature of cosmetic medicine and surgery, practitioners may feel that issues of fees may not be as pertinent as where treatment is not voluntary. It is, however, important to also ensure compliance with competition law, and to bear the new Consumer Protection Act, 2009 (on terms and conditions, value for money and quality), which is due to come into operation in 2010, in mind.

Elsabe klinck

Benguela Health Group

www.benguelahealth.com

rEGistratioN iNstruCtioNs For Your FrEE EtHiCs CPd PoiNt1. Go to www.medspecpublishing.co.za 2. Click on the MedEsthetics CPd programme button. 3. Complete the registration form and click the submit button. 4. You will be directed to your landing page, where the questionnaires will be displayed. 5. Click on the questionnaire which you would like to complete, once completed click submit.

CPd ModulE sPoNsorEd BY astraZENECa

lidocaine 25mg & prilocaine 25mg

www.emla.co.za

©iS

tockp

ho

to

Applied an hour beforehand, emla helps reduce the pain and discomfort of many cosmetic procedures, including, lasertreatment, botox, fillers, dermabrasion, mesotherapy etc. In cream or patch, emla is a local anaesthetic that’s also ablessing for injections, wart removal, dialysis and more.

Keep emla handy in your practice or let patients apply it at home – and see why more than 220 million people worldwideare smiling.

Availablefrom pharmacies without a prescription. Visit www.emla.co.za for more information.

why should looking goodbe a painful experience?

AstraZeneca Pharmaceuticals (Pty) Ltd, 5 Leeuwkop Road, Sunninghill 2157, South Africa. Private Bag X30, Sunninghill 2157, South Africa. Tel: (011) 797-6000. Fax: (011) 797-6001. www.astrazeneca.co.za. Reg.No.1992/005854/07. S1 Emla Patch (Transdermal Therapeutic System). Reg No.: 30/4/0478. EPI date: 21/04/2004. each patch contains 25mg Lidocaine and 25mg Prilocaine. INDICATIONS: Topical anaesthesia ofintact skin for minor procedures, such as needle insertion and superficial surgical treatment of localised lesions, where application of EMLA one hour before the procedure is feasible. S1 Emla 5% (Cream). Reg No.:Z/4/51. EPI date: 16/11/2005. 1g of emla 5% cream contains 25mg of lidocaine and 25mg of prilocaine. INDICATIONS: Topical anaesthesia of the skin in connection with needle insertion, e.g. i.v. catheters or prior to bloodsampling where application of EMLA 5% cream 1 hour before the procedure is feasible. Topical anaesthesia of the genital mucosa prior to superficial surgical procedures lasting not longer than 10 minutes on smallsuperficial localised lesions e.g. removal of condylomata by laser or cautery, and biopsies. Topical anaesthesia of leg ulcers to facilitate mechanical cleansing/debridement. For full prescribing information, refer to thepackage inserts. Emla is a registered trademark of the AstraZeneca group of companies. Compiled: October 2008.

®

®

®

UltraPulse technology was introduced more than 18 years ago, and has proven itself with over 34 FDA cleared indications. Considered the gold standard of CO2 lasers, UltraPulse has been referenced in over 90 peer-reviewed publications. With its long history of fractional capabilities, UltraPulse has led the way in factional resurfacing.

UltraPUlse®

CO2 FRACTIONAL LASER TREATMENTS

FOR AGING SKIN

UltraPulse CW Super-Pulse

ultraPulsE HiGH-ENErGY sHort PulsEAblates tissue quickly and provides hemostasis. Delivers four times more energy per pulse than the super-pulse laser. Results in more new collagen formation than the super-pulse laser

LOCAL ARTICLE

MedEsthetics | Southern Africa �0

Volume 2 Number 4 Summer Edition 2009 | MedEsthetics �1

UltraPulse fractional laser treatments were introduced to optimise outcomes and minimise downtime. The introduction of ActiveFX and DeepFX, the first fractional CO2 treatments available, reduces downtime and provides dramatic results. Both procedures require only one system, one pass and one treatment. The UltraPulse is the most versatile CO2 laser system available. It is capable of offering the full range of fractional resurfacing.

DeepFX offers a small, deep spot microablative treatment for deep wrinkles and scars and ActiveFX offers a large, superficial spot treatment for fine lines, texture and dyschromia. DeepX and ActiveFX can be combined to form TotalFX, for total outcomes in the treatment of scars, fine lines, texture, dyschromia and deep wrinkles.

ovErviEW

Our skin changes over time, losing its youthful look and giving way to brown spots, wrinkles and laxity. In recent years there have been a growing number of aesthetic procedures available to treat the skin. ActiveFX/DeepFX the result of the latest advances in laser technology is a new procedure that yields remarkable, long-lasting results with just one treatment. A fast, office-based procedure with minimal patient downtime, this is your patient’s single treatment solution for beautiful, younger looking skin.

Active FX/DeepFX is a revolutionary fractional laser technology for aged, sun-damaged or scarred skin. The low-downtime procedure uses fractional C02 laser micro beams to precisely target the deep dermal layers of the skin. This stimulates a cascade of healing responses that leads to tissue regeneration

and new collagen formation throughout the entire treatment area. Because only a fraction of the skin is actually touched by the laser, healing time can be limited to just a few days.

ActiveFX/DeepFX procedures involve treating only a fraction of the skin’s surface, leaving bridges of untouched skin to aid in the regeneration process. Each laser pulse removes a narrow column of tissue while simultaneously treating surrounding skin. The deep heating causes immediate collagen contraction and long-term collagen remodelling. The result is softening and smoothing of wrinkles and scars, and improved skin texture.

DeepFX/ActiveFX is typically performed in a physician’s office and lasts for about 20 minutes. I make use of an application of Emla cream with occlusion prior to treatment to aid in comfort. As the micro beams are applied, the patient will experience a very warm sensation and the appearance of the skin will be similar to deep sunburn.

During the 5 days post treatment the patient will follow a gentle washing and moisturizing regime, and avoid direct exposure to sunlight. It has become evident with all or my patients that

Wide zone of thermal damage

Increased Char Downtime

Discomfort

CONTINUOUSWAVE

ULTRAPULSE

Char caused by overheating

Zone of ablation

Zone of thermaldamage

Narrow zone of thermal damage Decreased- Downtime- Discomfort

dEEP Fxfor deep wrinkles & scars

aCtivE Fxfor fine lines, dyschromia & texture

total Fxcombined treatment for TOTAL outcomes

local article KEY FEATURE

BEForE aFtEr

BEForE aFtEr

MedEsthetics | Southern Africa ��

as the skin heals, it will begin to flake and the patient will notice improvement in texture, wrinkles, fine lines and scars. In addition, the skin responds by stimulating organic growth of new collagen that continues for up to 12 months. Results of the treatment are long lasting and with proper skin care and sun protection, can last for many years.

I have successfully treated and recommend the use of ActiveFX/DeepFX for areas such as the full face, around the mouth, crows feet, the neck, upper chest, hands and arms as well as scarring.

Due to the ability of the “feathing” technique of this de-vice, the practitioner is able to treat isolated areas without any distinct demarcation. This I believe, is a very convenient ad-vantage over the conventional CO2 ablative lasers previously used. This benefit results in patient’s being able to select this treatment as a cost effective option.DeepFX is safe for most patients, however, it should not be used in patients undergoing treatment with Accutane in the past 12 months, have a history of keloid formation, have a history of poor wound healing, or demonstrate excessive or unusually prolonged erythema, hyper pigmentation or hypo pigmentation upon laser test patching.From experience the combination of ActiveFX for resurfacing combined with DeepFX (for deep lines and wrinkles) delivers optimal results.

CoNClusioN

Having treated patients with ActiveFX for the past 2 years and now combining ActiveFX with DeepFX, resulting in TotalFX the results of these fractional laser treatments are long-term and with proper sun protection, can persist for many years.

The reduction of rhytides and pigmentation with significant skin tightening gives the ultimate result with a limited downtime and superior remodelling of skin for up to 12 months.

Therefore the result with one system, one treatment and one pass with practically no side effects and minimal downtime is presently the most profitable treatment available.

By Dr Albert Niemann MBChB, MPraxMed, MPharmMed, FCFP(SA), Senior AME, Director of AAMSSA. Owner of Renew Time Restoration™


BEForE aFtEr

BEForE aFtEr

BEForE aFtEr

ULTRAPULSE® CO2 FRACTIONAL

LASER TREATMENTS FOR AGING SKIN

5576 /Med Cetaphil A4.fh11 6/3/09 2:06 PM Page 1

Composite



KEY FEATURE acid test

invisibleink

During the NBA Playoffs in May and June 2009, millions of basketball fans thrilled to the athleticism of top players like Carmelo Antho-ny, Kobe Bryant and LeBron James.

They also marveled at the gallery of tattoos adorning the play-ers’ arms, necks and backs. Young people are increasingly emu-lating their sports and entertainment idols by getting their own tattoos. In January 2007 the PEW Research Center reported that 36% of U.S. citizens between the ages of 18 and 35 have at least one tattoo—that’s more than 2.5 million tattooed citizens in that age category alone. Earlier research published in the Journal of the American Academy of Dermatology in 2005 suggested that 17% of those with tattoos will consider having one or more of them removed.

“People tire of their tattoos—they become boring or outdated, or the person’s life changes,” remarks Suzanne Linsmeier Kilmer, MD, of the Laser and Skin Surgery Center of Northern California. The current gold standard for tattoo removal is Q-switched lasers, which deliver high energy in short (nanosecond) pulses at large spot sizes. Our panel of experts explores some of the latest laser introductions and refinements in practice parameters that allow them to offer more effective tattoo treatments, plus a surprising new technology developed to remove tattoos.

“Our ability to remove tattoos improved dramatically with the introduction of the Q-switched laser about 10 years ago,” says Eric Bernstein, MD, director of the Mainline Center for Laser Sur-gery in Bryn Mawr, Pennsylvania, and clinical associate professor of dermatology at the University of Pennsylvania. “Q-switched just means the laser energy is delivered in really short pulses (nanoseconds not microseconds). To remove tattoos effectively,

you need a large spot size (3mm to 5mm or more), which ne-cessitates high laser energies to penetrate deeply into the skin, with sufficient fluences to fracture tattoo particles. Problems oc-cur when you try to use a Q-switched laser that is underpowered, forcing one to use a smaller spot size, which deposits the energy superficially, hurting the epidermis but delivering very little energy to where the tattoo pigment lies.”

Because laser wavelengths are absorbed by different colors, you will need more than one laser to remove a wide range of tattoos. “I use an alexandrite (755nm) or ruby (694nm) laser for black, blue or green inks and an Nd:YAG (1064nm or 532nm) for black or red/orange ink,” Dr. Bernstein explains.

Many companies offer Q-switched Nd:YAG lasers, which can effectively remove most black, dark blue and red tattoo inks; for other colors, you will need a Q-switched alexandrite or ruby laser. Fortunately, manufacturers are now creating platform systems that give you all of the necessary wavelengths in a single box.

“The HOYA Conbio Revlite delivers a lot of power at 1064nm, enabling the use of large spot sizes for treating black and red inks, especially in darkly pigmented patients,” says Dr. Bernstein.

The RevLite and MedLite C Series Q-switched Nd:YAG lasers (HOYA ConBio, conbio.com) have been widely used for tattoo removal for several years. They produce powerful 1064nm and 532nm wavelengths and include MultiLite Dye Laser Handpieces that deliver 585nm and 650nm wavelengths for virtually full-color spectrum tattoo removal.

Candela (candelalaser.com) introduced its Alex TriVantage in 2007, featuring a lightweight, flexible fiber optic delivery system. Using its popular AlexLAZR, a Q-switched alexandrite laser as a base, the company built in laser resonators to create Q-switched 532nm and 1064nm wavelengths.

“The Alex TriVantage offers the first-ever laser-pumped laser

Volume 2 Number 4 Summer Edition 2009 | MedEsthetics ��

invisibleink

handpieces,” says Dr. Bernstein. “This new technology lets the Alex TriVantage reliably deliver powerful 532nm and 1064nm wavelengths as well as the 755nm alexandrite wavelength. It treats a wide variety of tattoo ink colors because it can deliver three different wavelengths of light. It’s also great at treating pigmented lesions, especially in darker skin types, because of its longer duration Q-switched pulse and microsecond domain alex-andrite laser pulses.

“I am also impressed with the new Sinon Q-switched ruby laser (Quantel),” says Dr. Bernstein. “Ruby lasers used to be very difficult to build reliably and efficiently. The Sinon offers a 20ns pulse length and a 2hz repetition rate with high fluences and reliability, a break-through in ruby laser technology in my opinion.” The ruby wave-length offers good to excellent clearance for black, blue, green, magenta, gray and brown tattoo colors. The Sinon laser beam is divergent and spreads with distance, an important safety consider-ation. In May 2009 Palomar Medical (palomarmedical.com) signed a distribution agreement with Quantel SA (formerly WaveLight and the Quantel Group) to distribute the Sinon in the United States and Canada.

PraCtiCal CoNsidEratioNs“When investigating devices for tattoo removal I ask ques-

tions like: How many photons can your device deliver at the larg-est spot size? You don’t want to have to decrease the spot size to get the energy you need as larger spot sizes penetrate deeper into the dermis where the ink is located. What is the pulse duration? The pulse must be really short—nanoseconds—to best target the ink particle size and for safety,” says Dr. Kilmer.

Purchasing lasers that will allow you to offer effective tattoo removal to a wide range of patients can cost $100,000 or more. “If you are unsure whether your practice can support this equip-ment purchase, consider renting a laser to get started or buy one laser that can be used for additional procedures like treating pig-mented lesions and rent any additional lasers you may need,” Dr. Kilmer suggests.

Some inks will not clear completely even if you have a com-plete arsenal of lasers. “Aquas, yellows and fluorescents are particularly difficult to remove,” says Dr. Kilmer. “The number of treatments required will also depend on the type of application and what’s in the ink. Tattoos applied by professionals with ink guns can take up to 15 treatments and some may never clear if the inks contain certain compounds.”

Dr. Bernstein adds, “We never know what kind of ink we’re working with. Removing black ink from light skin is not a prob-lem, but the iron oxide in white tattoo pigment can turn black as a result of a laser treatment and that discolored pigment can be impossible to remove. Be sure to include this possibility in your consent form because some tattoos may even have a base layer of white pigment underlying the entire tattoo.”

Removing tattoos from dark skin can be especially difficult. Mel-anin absorbs laser light so special caution is the rule. Dr. Bernstein insists on a test spot before offering the treatment to some patients. “When treating black tattoos in dark skin, I always start with the 1064nm wavelength, which will ‘see’ the tattoo pigment but have less melanin absorption than other Q-switched wavelengths,” he says. “For some patients I recommend Triluma, a retinoid, pulse hydroquinone, and a steroid bleaching cream or other bleaching agents to lighten the skin above the tattoo before laser treatments and I advise patients to stay out of the sun. I don’t treat tanned skin. After the treatment I cover the skin with Aquaphor tape for 6 to 10 days to protect it and help it heal.”

Contraindications to laser tattoo removal include immunosup-pression, pregnancy, collagen vascular disease, plaque psoriasis, malignancy, use of Accutane within six months and any history of keloid scarring. “I won’t treat tattoos if there is any sign of an allergic reaction to the tattoo ink because the treatment can lead to a more systematized allergic reaction,” adds Dr. Bernstein.

“Pain management depends on the type, size and location of the tattoo; we use topical lidocaine for some, and local injections or even nerve blocks for others. We offer patients these options for pain control and charge just enough to cover costs. In some cases, we sell patients topical anesthetic creams so they can come in for treatment with the cream already in effect,” notes Dr. Kilmer.

Patients at Dr. Kilmer’s Laser and Skin Surgery Center of North-ern California sign a consent form that clearly states the possibil-ity that clearance can take 20 treatments or more, that some tat-toos will never clear completely and that some may even darken in color.

“Bottom line, these devices are expensive to use,” says Dr. Kilmer. “You have to charge accordingly. Our nurses have become quite adept at estimating the number of treatments based on the size, ink density and ink colors, which determine how many differ-ent lasers are needed. The alexandrite laser is more expensive to maintain so if the tattoo includes green and blue inks, we add a bit more. Our cost for a first treatment is $200 and increases with tattoo size. The fee drops at each subsequent treatment, but we tell patients the minimum cost will be $100/treatment.” Prices listed on a variety of websites ranged from $50 to $500 per ses-sion, depending on the type of tattoo. Most fell into the $150 to $300 per session range. A few doctors offer flat, up-front rates of $1,000 to $1,200 for tattoos that can generally be cleared in 10 to 12 treatments, noting that the set price allows patients to better manage their budgets and feel more secure that they can afford the procedure.

soMEtHiNG NEWUntil a few months ago, the only alternatives to laser tattoo

removal were dermabrasion and chemical peels that faded but could not reliably remove any but the most superficial tattoos.

Bruce saal, Md, obtained these results following multiple sessions with the Medlite C6 at 1064nm

BEForE aFtEr

“To remove tattoos effectively, you need a large spot size, which necessitates high laser energies to pen-

etrate deeply into the skin, with sufficient fluences to fracture tattoo particles.”

invisible ink KEY FEATURE


Now there’s an inter-esting third option: EliminInk. Introduced by Cynergy Products (cynergyproducts.com) in November 2008, EliminInk is placed into tissue using a technique similar to that used by the original tattoo or permanent makeup artist. It con-tains magnesium oxides and other ingredients that bind to the iron oxides in the tattoo inks or the color pigments in permanent makeup and safely lift them to the surface through oxidation. A scab forms over the treated area that must be kept dry until it falls off naturally.

Because EliminInk is classified as a cosmetic rather than a medical procedure, it does not need FDA approval. Unfortunately, that also means there are no long-term safety and efficacy stud-ies of the product. The company did provide us with the name of a physician who is offering the procedure in his practice, James J. Murata, MD, FACS, Ear, Nose and Throat Associates of South Florida in Boca Raton, Florida. We spoke with Caroline Murata, RN, who performs the EliminInk procedures in Dr. Murata’s prac-tice, and heads the Harmonix Institute in Boca Raton, Florida, which provides training on the procedure.

“Dr. Murata initially investigated the product because he had seen many patients treated with lasers who had scarring and min-imal improvement even after multiple sessions,” reports Murata. “In our experience, EliminInk offers better removal of permanent makeup and tattoo ink with less discomfort during the procedure and with a better outcome.

“We use a German-made digital machine designed for per-manent makeup application that precisely places EliminInk at the correct level of the tattoo ink or makeup pigment,” Murata explains. “After the procedure, a scab forms and must remain in place for several weeks until it comes off naturally. The scab actu-ally changes color as the different inks in the tattoo are absorbed by the EliminInk and pulled to the surface. For permanent makeup, two to three treatments will usually do the job. For more complex tattoos, we may need to repeat the application of EliminInk sev-eral times. When the scab comes off, the patient applies Cynergy DermRenu, a scar inhibitor, two to three times per day for up to eight weeks.

“It works for everything from jailhouse tattoos to top of the

line tattoo pigments of all colors. We have even used it successfully on multicolor tattoos that failed to respond to multiple laser treat-

ments. That’s why this is so exciting,” says Murata.“We have had no complications of any kind from doing the

procedure,” says Dr. Murata, “but patient compliance is a big is-sue in determining the outcome. Patients must follow postproce-dure care instructions. It is vital that they do nothing to soften the scab prematurely.”

“We charge $280 to $500 per treatment, depending on the size and density of the tattoo,” says Murata. “Each session takes approximately one hour, and we generally achieve complete clear-ance of a tattoo within three to six sessions.”

oN tHE HoriZoN“I think current lasers are fast and effective tools for removing

tattoos,” states Dr. Bernstein. “Of course, doctors always want more power and a larger spot size at a more reasonable price. What would really improve our ability to remove tattoos is if ev-eryone used an ink like the Freedom2 ink recently developed by R. Rox Anderson and Kim Koger,” suggests Dr. Bernstein. “Freedom2 Ink contains known ingredients and should be easier to remove by laser than other inks.” Candela has exclusive rights to develop a laser device that works specifically with Freedom2 Ink, but it will undoubtedly be many years before a substantial number of tattoos use the ink.

Meantime, doctors continue to work with existing equipment in an effort to fine tune laser tattoo removal. Sciton is working with several doctors, including Todd Bessinger, MD, PhD, Aesthetic & Dermatology Center, Honolulu, Hawaii, to investigate the use of the ProFractional (Sciton, sciton.com) laser for tattoo removal. “We have found that the ProFractional lightens tattoos indepen-dent of the color of the tattoo, although it takes multiple treat-ments just like Q-switched lasers. Ultimately, I think that tattoo removal will involve both Q-switched Nd:YAG and alexandrite la-sers combined with fractional resurfacing,” says Dr. Bessinger. z

Linda W. Lewis, a MedEsthetics contributing editor, is based in Orange County, California.

“When treating black tattoos in dark skin, I always start with the 1064nm wavelength, which will ‘see’ the tat-

too pigment but have less melanin absorption than other wavelengths.”

loCal suPPliErs

HITECH LASERSTel (012) 349 1250Email: [email protected]

INTAMEDTel (011) 444 0404Email: [email protected]

GENOP HEALTHCARETel (011) 545 6600Email: [email protected]

RADIANT HEALTHCARETel (011) 794 8253/2Email: [email protected]

TECHNOLASETel (012) 349 1750Email: [email protected]

STERNLASERSTel (086) 117 8376Email: [email protected]

KEY FEATURE invisible ink


By

lesl

ey r

anft

The goal of marketing is to develop a series of strategies that will leverage patient acquisition, strengthen patient loyalty and produce a strong return on investment. The mainstay in traditional marketing has been word of mouth referrals. However, with increased competition and a tight economy, many practices are diversifying their marketing strategies in an effort to keep their appointment books full.

WHErE PatiENts FiNd NEW ProvidErsA successful marketing campaign combines internal marketing efforts to increase bookings among existing patients and encourage word of mouth referrals, with external marketing efforts to attract new patients.Consumers interested in aesthetic medicine typically research providers through a variety of means before selecting a physician. They talk to friends, family members and co-workers; investigate doctors they’ve seen in paid advertisements, on television or in print publications; and search the Internet before contacting the practices that pique their interest. According to Jupiter Research, 63% of healthcare information seekers on the Internet indicated that they would switch doctors if they found credible content online. Whichever media you choose to reach out to patients, your message should be geared toward building trust and credibility. “In today’s day and age, internal marketing is still the most effective means to generate trust between patients and the practice,” says Richard Greco, MD, of the Georgia Institute for Plastic Surgery in Savannah, Georgia. “Successful internal marketing programs may include: quarterly newsletters, educational seminars, patient testimonials, and before-and-after patient photos. But the Internet remains a critical component in practice building. “

oNliNE MarkEtiNGThere is no doubt that most consumers who are interested in aesthetic medicine search the Internet for

RIGHTm

ixth

e

KEY FEATURE


information. Accordingly, developing some form of web presence has become a must for practitioners. Building a website for your practice is a great start. But with so many practices online, today’s practitioners must also formulate a strategy to bring visitors to their sites. Free and paid directories, like locteadoc.com, docshop.com or those offered through professional associations are valuable patient acquisition tools.Search engine optimization (SEO), the practice of adding content that will push your site to the top of search engines, has also become more popular in recent years. One of the keys to optimizing your standing on search engines relates to how often new content is published to your site. The more often you update your content through blogs, newsletters and postings, the higher your standing.The use of “pay per click” text advertising is also growing in popularity. Pay per click campaigns give your website immediate prominent positioning on Internet search engines when consumers search select key words that relate to your offerings. As Charles E. Crutchfield, MD, of Crutchfield Dermatology in Eagan, Minnesota, explains, “I like the concept of Google Adwords, because you only pay when a patient actually clicks through to visit your site, as opposed to other marketing efforts where you pay regardless of whether patients are calling or not.” But he notes, “The most important thing in marketing is to take a multifaceted approach and track the results.” Dr. Crutchfield uses print, radio and direct mail advertising in conjunction with his Google Adword advertising campaign.

iNtErNal MarkEtiNGBefore-and-after portfolios, manufacturer-supplied brochures and posters, and email newsletters, all help to trigger interest

in new aesthetic p r o c e d u r e s among your existing patient base. In 2008, The American Society of Plastic Surgeons found that 44% of cosmetic patients are repeat patients. Are 44% of your patients returning for additional procedures? If not, you may want to reexamine your current efforts to

rebook existing patients. One of the latest tools used to foster patient loyalty and increase rebookings is text messaging. When offered by providers like Smile Reminder (smilereminder.com), a simple software component is added to the practice management software system that allows you to create customizable email and text messages for members of your database. The messages can be used to remind patients of upcoming scheduled appointments or to advise patients if the office is closed or running late. Many practitioners are finding that it helps to increase rebookings when used to notify patients that it’s time to schedule their next Botox or dermal filler injection.Practices can set parameters for specific demographics, appointment confirmations or reminders, and cancellations. Imagine the extent of improved productivity with a software component that can pull cancellation and reminder lists off the practice desktop and automatically send an appropriate message to targeted contacts. “Electronic communication is low cost and high return,” says Mitchell Chasin, MD, medical director of Reflections Center for Skin and Body of Livingston and Bridgewater, New Jersey. “The software for text messages integrates easily with our software system, improves quality of care, and leverages office efficiency.”

rEaCHiNG ProsPECtivE PatiENtsIn addition to building word of mouth and increasing multiple bookings among existing patients, you want to create a marketing strategy that will consistently bring new patients through your doors. External marketing campaigns, including direct mail, paid media advertising and PR campaigns can help keep your name front and center in your community.Direct Mail. Direct mail campaigns are most effective when sent to: current and past patients; referring doctors; and a purchased, targeted list of prospective patients. Direct mail traditionally provides a response of 1% to 2%. But as mailing lists have become increasingly targeted those response rates have grown to between 14% to 24%. An online search of “direct mail lists” will bring you a variety of companies that can help you create a targeted list based on gender, age, income and proximity to your practice.Direct mail messages may include newsletters, practice announcements on new procedures, seasonal specials, or more expansive custom-designed magazines that provide a wealth of

Crutchfield dermatology includes a wealth of indication-specific information plus patient testimonials on its website to build credibility with prospective patients.

According to Jupiter Research, 63% of healthcare information seekers on the

Internet indicated that they would switch doctors if they found credible content online.

Phot

o co

urte

sy o

f rad

iant

life

KEY FEATURE right mix


information on medical aesthetics and your specific practice.Custom designed publications, like newsstand magazines, offer diverse content to reach broad a consumer base. The difference is that these magazines also provide content that is customized to your practice including a profile of the treating physician and content outlining the procedures you perform plus special offers currently available to patients. The magazine is sent to current and prospective patients, and can also be placed in the waiting room of your medical practice and the reception area of local businesses you cross-promote with, including spas, beauty salons and highend retailers. Sherry Simmons, MD, of Body Perfect Medical Spa in Springfield, Illinois, successfully uses multiple platforms to leverage patient acquisition, including Radiant Life magazine (radiantlifemagazine.com). “Radiant Life contains pertinent information about the treatments offered in my practice,” she says. “It also offers me the ability to add content about special offers, products and procedures. It helps to position me as the expert in my community, which I find is essential in today’s competitive environment. Combined with my weekly cable and call-in radio shows, my practice has grown by 30% through these marketing methods.”

Public Relations. Media coverage, whether in print, radio, television or online, can help

you reach a large audience and establish yourself as an expert in the field. But you

need to let the media know that you’re available. This is where pubic relations

comes into play. A PR campaign may include offering opinion editorial (Op-ed) pieces to local or national

newspapers, providing educational content to editors and producers, offering yourself

as an interviewee versed in a specialized area of cosmetic medicine, or sharing in-depth information on new procedures

coming to your community through your practice. Although there is no guarantee that all of your public relations efforts will result in coverage, PR campaigns tend to be low cost and can help you develop an ongoing relationship with the press, which can be beneficial in the long run. You can distribute press releases to local and national media contacts by email, which keeps costs low. Each release should include the following:

• The five Ws. “Who are you?” “What are you promoting?” “Where is this taking place?” “When is this happening?” and “Why do our readers/viewers need to know this now?”

• Your credentials to establish your expertise• Visual aids. These may include photographs,

including before-and-after images, or video

As Marilyn Sardo, MD, San Diego, explains, “The numerous press releases we’ve sent out have resulted in both local and national exposure for my practice, and that exposure has brought many new patients into my practice.” Paid advertising. Paid advertising efforts are most effective when they are repetitive. Repeat appearances on television, radio and/or in print help to foster patient trust, build your brand and create a call to response. Getting the best return on your advertising dollars starts by choosing advertising media that hits your target market and then tracking the response you receive from each advertising effort. Daily or weekly regional newspapers and local cable television advertising spots ensure that you’re hitting your target market in terms of proximity. You can also investigate markets that speak to more affluent community members including local symphony or theater programs. Metropolitan

and beauty-oriented magazines offer a longer shelf life than television or radio TV ads, as they are often reviewed multiple times by more than one person in a household, but they may not be as targeted in terms of physical distribution. The best means of developing an effective marketing strategy is to identify your niche in the community, identify your target market and design a multifaceted marketing program that speaks to both potential and existing patients. It may be helpful to assign a staff member in the office to monitor advertising and public relations appearances in order to ensure that they run as scheduled, and to track the efforts that are inviting the strongest response.

Lesley Ranft is a San Diego, California-based freelance writer.

text

mes

sagi

ng a

nd c

usto

m p

ublic

atio

ns a

re s

ome

of t

he la

test

mar

keti

ng v

ehic

les

desi

gned

to

incr

ease

reb

ooki

ngs

and

new

pat

ient

acq

uisi

tion

s.

Photo courtesy of smile remonder

Phot

o co

urte

sy o

f rad

iant

life

Repeat appearances on television, radio and/or in print help to foster patient trust,

build your brand and create a call to response.

right mix KEY FEATURE

MedEsthetics | Southern Africa 30

Once you’ve developed and implemented a successful marketing program to attract new patients, it’s time to turn those leads into bookings. Patients tend to base their decision on whether or not to move forward with an aesthetic procedure on two factors: their comfort level with the treating physician and their comfort level with the risks and benefits of the given procedure. Addressing these fundamentals in your patient consult can pay dividends in increased conversion rates.

tHE PatiENt’s PErsPECtivE

Every prospective patient who contacts your practice is performing a cost/benefit analysis in her head in an attempt to determine whether what you are offering is worth the time, money, effort and risks associated with the desired treatment. And despite—or perhaps because of—the abundance of information available on medical cosmetic procedures, today’s aesthetic patient is more confused than ever. She’s facing multiple options for physicians, treatments and products and often ends up overwhelmed.

Consider how difficult this process can be for your patient. At the initial consultation she will likely feel awkward and uncomfortable. She wants to change something about her appearance that is making her feel insecure, and she hopes that

by fixing, repairing or enhancing it, she will feel better. She’s also heard negative stories about cosmetic procedures

and wants to avoid making a bad choice that she will regret. The more you can reassure the patient that she is in the right place for the right procedure, the more likely she is to book the treatment with you.

tHE “PrE” CoNsultatioN

The aesthetic patient needs two things: She needs to feel comfortable with you and she needs time to ease into a decision. The amount of time can vary depending on the scope of the procedures recommended. So several things need to take place at the front end before the prospective patient meets with you in her consultation.

If you set the stage correctly, 80% of the selling will be done by your staff leaving you to focus on bonding with the patient, reiterating the information she already has and addressing any questions. There are a few ways for you and your staff to do this.

Create a Practice Welcome Package. Welcome packages allow you to quickly and effectively provide information about your practice and procedures to prospective patients who contact you

Patient Consult

BUSINESS CONSULTANT

Increase conversions by understanding what prospective patients need to hear from you. The more you can reassure the patient that she is in the right place for the right procedure, the more likely she is to book the treatment.

by email or phone. Think of this as a “shock and awe” package of high-quality materials including:

• A welcome letter with a handwritten note from you telling the prospective patient that you look forward to meeting her

• Specific information on the procedure she has expressed interested in

• Patient testimonials with before-and-after photos• Your career highlights, including education, media coverage,

experience, areas of expertise and medical association memberships• A practice brochure outlining your philosophy and procedures• A DVD of you, your staff, your office and patient testimonials

(optional but impressive)

Continue the Education In-Office. When the patient arrives at your office for her consultation, there are a number of steps your staff can take to put her at ease and assist in the consultation. They include: offering her a beverage and inviting her to peruse an album with patient testimonials and before-and-after pictures. If you have a television and DVD player, they can put in a patient education video of the procedure she has expressed interest in and/or a welcome video introducing her to your practice and staff.

tHE CoNsultatioN

A successful consultation is one in which the patient sees a solution to her problem, likes and trusts you and then books the procedure. There are some fundamental steps you can take to ensure that you’re providing all the information a patient needs to book a procedure at your practice.

Step 1Introduce Yourself. Knock on the door gently before opening and

greet the patient by name. Introduce yourself while you look her in the eye, smile and shake her hand.

Step 2Build Rapport. Think of the prospective patient as a person

first and a patient second. Spend a couple of minutes discussing nonmedical topics with her before you launch into the reason for her visit. The patient will share more information with you about her expectations and concerns if she feels like you are interested in her as a person. The goal is to make the patient comfortable enough to open up to you.

Step 3Uncover the Problem. You can uncover the patient’s concerns

and motivations for seeking treatment by asking an open-ended question such as, "What can I help you with today?”Or, by simply confirming what you already know based on her initial inquiry and staff communication, "Sara tells me you have a wedding coming up?” and then let her elaborate.

Listening is a skill. The amount of attention you provide in actively


listening to the patient at this point will directly correlate to how much information she is willing provide. To maintain your focus on the patient, it may help to nod, look at her and take notes while she is talking so she knows that you are listening carefully.

Step 4 Attach Emotions

to the Problem and Solution. Be sure to get the prospective patient emotionally involved. Ask her additional qualifying questions that speak to her emotions such as, ”How long has this bothered you?” or ”Why did you not seek help sooner?”

You want the patient to feel the need and benefits of your treatments. Find out how big the problem is, and how it affects her life.

Please remember to show respect for the patient. Even though you are the expert, arrogance does not sell. If you come across as demeaning, condescending or intimidating, you’ll drive the prospective patient away. Use words she will understand, be concise and keep it simple. Then briefly reiterate the main points touched on by the patient. Ask if you have left anything out, then wait for her answer.

Step 5Know Where You Stand. Following the reiteration of your

conversation, ask additional probing questions to determine where the patient is in her decision-making process. For example, ”Have you seen any other doctors and, if so, do you have any questions they have not addressed?”

Step 6Manage Expectations. The golden rule of the successful

aesthetics practice is: Under promise and over deliver. It is your job to ensure the patient has an experience equal to what was promised to her. The following tools will help you communicate realistic expectations that the patient can see, feel and touch:

• Use a mirror and your hands to show her what you recommend and how it will change her current appearance

• Draw a picture if you’re artistic• Show photos of previous patients and tell their stories• Perform computer imaging• Have the patient speak to other patients and/or staff

members who’ve undergone similar procedures • Show her videos of the procedure

• Let her touch the breast implants, skin care products, etc.

• Use metaphors, analogies and anecdotal experiences of other patients to relay information

A great way to set expectations is to use the best case/worst case scenario. For example, if the patient is asking you how long the recovery will take, you can respond by saying, "The best case scenario is that you will be back at work the next day;

however, some patients need an extra 24 to 48 hours.” Or, let her know that four out of five patients go back to work the next day. This way, if she is not the “best case” or the “four out of five,” she will recall that you did mention this could happen.

Step 7: Qualify/Differentiate Yourself. The prospective patient wants

to know that you are confident that she will get a good result so it helps to: look the patient in the eye and let her know that you are confident in your ability to give her a good result; inform her that you have done many of these procedures with excellent results; and let her know that you understand her concerns and fears.

Step 8Reassure the Patient. The patient needs to be confident about

your skills. She also wants a little prodding from you so that she feels you are competent and will deliver. Simple phrases like "You are the perfect candidate for this procedure,” or "We have something to work with here, and I’m sure you will be pleased with the outcome,” can help.

Step 9: Close the Consultation. Prepare a closing statement before you hand the prospective patient back to your front desk staff or patient care coordinator to discuss financing particulars and schedule the procedure. Something simple like, ”I look forward to working with you.”

Perfecting these fundamental steps of the patient consultation process will help ensure the highest closing ratio possible.

Catherine Maley, MBA, is an industry consultant and the author of Your Aesthetic Practice: What Your Patients Are Saying. You can contact her at cosmeticimagemarketing.com.

BUSINESS CONSULTANT


ADVERTORIAL

IMCAS NEWS AUTUMN 2009 – ADVANCES IN CELLULITE TREATMENTby Diane I Duncan, M.D. Plastic Surgeon

Recent histologic evaluation of the dermal/fat

junction in patients with cellulite disputes the

cavantional thought that tight dermatofibrils cause

bulging of fat under the skin. Cellulite has been

classified into grades I-IV, based on this theory.

The idea that cellulite is a result of a vertically oriented

pathophysiologic process is no longer valid.

In 2008, Golitz and Duncan looked at serial

biopsies of cellulite at the junction of the deep

dermis and fat in patients with normal appearing

skin and those with cellulite. They noted that in the

normal patients, “peninsulas” of fat protrude into

the deep dermis, and fingers of dermis extend into

the fatty layer. The coastline is irregular, and a good

target for correcting skin contour irregularities in this

junction.

In cellulite patients, the peninsulas were found to

be exaggerated, with some measurable thinning of

skin thickness at the apex of the invaginated fat. The

subcutaneous fat layer was carefully examined for

“dermatofibrils”. Other than the normal extensions

of dermis into the fatty layer, there were no thickened

strands of collagen tying the dermis to underlying fat

or fascia present.

Gross specimen evaluation showed a “honeycomb”

appearance of fat globules in both normal skin/

fat specimens and those of patients with cellulite.

The skin in the cellulite patients appeared thinner,

especially at the most protuberant point in the “hill”

of the irregularity.

Given the absence of a tethering force, it appears as

if the pathology is located at the dermal/fat junction.

The irregular topography is the real problem, and

has three components: too much surface area,

depressions that dip below the ideal, and protrusions

that extend above the ideal.

Once the pathologic process is viewed as a

horizontally oriented surface irregularity problem, a

better and more permanent solution for cellulite can

be created.

Another problem in the treatment of cellulite

has been the difficulty in measuring improvement.

Photographs are notoriously

inaccurate; overexposure

or changing the lighting

can create an apparent

improvement that is not

real. Patients with cellulite

see even a 50% improvement

as a failure; if “hail damage”

is still evident, they will not be

satisfied. The date, no objective

measurements device for cellulite

has been available.

In 2008 and early 2009, the BotyTiteTM

radiofrequency assisted liposuction

machine was used to treat cellulite and

lipodystrophy in six women under IRB

auspices. The device uses a bipolar signal, and

has a clothespin type handpiece. The cannula,

inserted into the subcutaneous fat, has a RF tip

on the small suction cannula. The external part

of the device has a board round thermistor

that heats the sin overlying the cannula tip.

The “sandwich “ approach is novel, and is

very effective for treating the dermis/fat

junction.

Safe settings are essential for good

results. The heating modality is effective

for reducing the size of bulging fat

globules, and for causing a reduction in

surface area of the skin. The combination

is very effective for treating cellulite,

patients with mild skin laxity, and those

with skin contour irregularities following

liposuction.

The advent of radiofrequency assisted

liposuction using an internal and

external heating device has mad

it possible to target the location of

the problem region in patients with

cellulite. Ongoing studies will show

the degree of improvement using the

interpolated surface measurements,

and the longevity of improvement in

skin quality


Case stUDYEvaluation of the enhancement of efficacy with injection of ahypo-osmolar solution prior to localized on-invasive ultrasoundtreatment for the reduction of localized fat deposits.

LOCAL CASE STUDY

dr riekie smitMBChB (uoFs)

Msc sports Medicine(Pret)

Body contouring and fat reduction treatments are highly requested by patients. Because invasive methods carry high risks for side effects and complications, the development of non-invasive technologies for body contouring has opened numerous doors in this field of medicine. Non-invasive ultrasound devices offer patients safe and effective results for reducing localized fat deposits.

The device used for this case study was the NovaShape (Ultramed), which was selected due to its advanced technology which, unlike the focused beam, fixed frequency and heat generation of other known devices, has a seemingly variable frequency, non-focused beam and chilled transmitter, with no-heat generation and a mechanical cell wall destruction mechanism. The efficacy and safety of this device has been confirmed in a number of research studies, which have demonstrated superior efficacy compared with other similar ultrasound devices.

Safety has been well researched in studies evaluating urinary and blood levels before, during and after treatment, showing the normalizing of triglycerides, liver transaminases and urinary density within 48 hours after the treatment. After treatment, LaPente found a significant reduction in circumferential measurement of the abdomen (12 cm) and lower limbs (5 cm). Abdominal volume was reduced to 9.27% and lower limbs to 11.2%. Shortly after treatment, blood triglycerides rose by 77.7% and liver transaminase rose by 11.3%. Total cholesterol, mean gamma glutamyl transpeptidase, and ketonic bodies in the urine showed slight changes. Mean urinary density was also slightly raised.

Studies published on the use of adipocytolysis using hypo-osmolar solutions combined with the weakening of the cellular

membrane using specific ultrasound energy designed for the destruction of adipocytes have shown the efficacy of combination therapy. These studies will be briefly outlined in the case study report.

The purpose of this case study was to evaluate the efficacy of adding an injectable solution prior to treatment with the focused ultrasound.

CasE studY GrouP- 1 male and 4 females- Age between 20 – 50 years

ExClusioN CritEria- Diabetes- Other weight loss medication or treatments- Use of corticosteroids- BMI > 35 or < 20 kg/m2- Liver or kidney disease or abnormality

arEa oF trEatMENt- Thighs or abdomen

trEatMENt- One side of treatment area: focused ultrasound with NovaShape only- Other side: injection of Solution A plus focused ultrasound

with Novashape- Areas of 80 cm2 were marked out in a standing position

Areas of 80cm2 was marked out in a standing position.

Solution A: hypo-osmolar solution containing in-jectable water, lidocaine and ascorbic acid.10 ml of the solution per treatment area was injected with 27G 13 mm needles using a mul-tipuncture technique - 0.5 ml of solution is in-jected over the marked area in points 1cm apart. The patients were evaluated before and 3 weeks after treatment by means of the following mea-sures:- Weight- Bio-electrical impedance- Measurements of the areas treated- Photographs- Sonar evaluation for measuring sub cutaneous fat rEsults

After one session of treatment, with No-vaShape alone, sonar evaluation showed an av-erage of 11.2 mm reduction of subcutaneous fat per patient. The contra lateral areas treated with the hypo-osmolar injection solution combined with NovaShape showed an average reduction of 14.2 mm subcutaneous fat per patient. The patients’ weight remained stable, the bioelectri-cal impedence remained the same, and centi-metre loss over the treated area (including both treatment groups) averaged 4.6 cm.

The sonar evaluations (figure 1 and 2) showed clear resolving of fat cells and reduction of the subcutaneous fat layer in all the treated areas. The measurements showed the improved efficacy obtained by combining Novashape with prior treatment with a hypo-osmolar solution over the area to be treated.

40

35

30

25

20

15

10

5

0

Adip

ose

laye

r mea

sure

men

t (m

m)

35.2

24

36.1

21.9

NovashapeAlone

Novashape combined with hypo-osmolar injections

Pre-treatment

1 WeekPost-treatment


LOCAL CASE STUDY

disCussioNLipolysis by means of focused resonant ultrasound through

ultracavitation is a new and effective non-invasive method to reduce localized fat deposits. The efficacy and safety of this treatment has been confirmed by previous studies. The treatment on its own is very effective and deserves a significant place in treating fat deposits, though this study has shown that the results can be enhanced by combining the treatment with prior injection of a hypo-osmolar solution in the area to be treated. This combination treatment may be indicated in the small amount of resistant cases and in patients wanting faster results. However, not all patients will feel comfortable with the addition of an injectable procedure and sufficient scientific support shows that treatment with the Novashape device alone will be effective enough. This specific study also showed the efficacy of the treatment on the side that received ultrasound treatment alone.

Therefore, the study demonstrates not only the visible efficacy

of treatment of localized fat pads utilizing the NovaShape device, but also demonstrates the enhancement of results by prior injection of a hypo-osmolar solution into the area to be treated.

In conclusion, including prior injection of hypo-osmolar solution over an area to be treated with the Novashape provides a valuable treatment option for patients who are comfortable with receiving injections.

rEFErENCEs1. Crassas Y, Blache d. adipocytolysis using the Novashape ultrasound

Machine, alternative to liposuction 2 years follow up.2. kubota J. Matsuda H. a Clinical trial of Multi-frequency ultrasound

device for Non-invasive Body Contouring.3. Haviarova Z, Haviar M. Body Contouring – comparison of various

ultrasound techniques.4. Fernandes JPl. results of treatment of the edematous fibrosclerotic

panniculopathe grades ii- iii in 50 patients with the Novashape device for selective fat ultracavitation. int Journal Cosm Med & surg.

5. Michel a, Blache d adipocytolysis: alternative treatment 6 years behind liposuction, limitations and research perspectives. PaCaaM sept 2008.

Figure 2. This sonar evaluation was performed on a patient receiving treatment over her waist area. The patient received Novashape alone on the left side and Novashape combined with the hypo-osmolar solution on the right side. On sonar, the adipose layer on the right side measured 19.8 mm before treatment and 15.6 mm after treatment. The left side measured 19.1 mm before and 16.5 mm after the treatment.

Figure 1. This first case shows the sonar evaluation of both treatment areas before (image on the left) and 1 week after (image on the right) treatment with the Novashape device. The treatment was performed over the abdominal area. The right side of the abdominal area was treated with the Novashape only and the left side with the hypo-osmolar solution combined with the Novashape. The measurements of the adipose layer were: right side, 38.4 mm before treatment and 21.7 mm after treatment; left side, 39.6 mm before treatment and 19.1 mm after treatment.


Liposuction is expected to escalate word wide in years to come. The evolution of this surgical technique includes the following approaches to remove unwanted amounts of fat in various locations.

1. Simultaneous skin tightening

1. Dry technique (SAL)

2. Wet tumescent techniques

3. Ultrasonic assisted liposuction (UAL)

4. Power assisted liposuction (PAL)

5. Laser assisted liposuction (LAL)

6. Externally applied ultrasonic energy.

All of these techniques are not precise, as there is no closed-

loop system to monitor power delivered, skin temperature,

impendence of energy delivered to allow fat removal and

significant soft tissue retraction are not consistent treatments of

these devices.

7. Radio frequency assisted liposuction (RFAL)

tHE dEviCE The InvasixTM BodyTite system is composed of the following:

1. A bipolar radio frequency hand piece; and

2. A RFAL computer device.

The hand piece has an internal and an external electrode. The

internal electrode is coated with Teflon for the entire length of the

probe. The energy is delivered at the end of the probe, which is

not coated. The external electrode delivers a focused amount of

energy through the skin and measures the skin temperature.

The amount of energy delivered to the fat is watts, the limit of skin

temperature in degrees, and high and low limits of impendance

are determined by the surgeon on a user-friendly touch screen.

All parameters are controlled in a close-loop system to prevent

excessive heating of fat and/or dermis.

The delivery of bipolar radiofrequency energy has the enormous

benefit of being able to quickly and precisely control the depth

and direction of energy to the fat, blood vessels, and dermis.

This device allows for the following; :

• High speed of treatment;

• Reduced tissue trauma;

• Coagulation of blood vessels;

• Safe, controlled application of energy and skin temperature

monitoring; and,

• Uniform heating of skin and subcutaneous layer.

CliNiCal oBsErvatioNs The evolving technology that uses radiofrequency energy to dissolve

fat has produced favorable responses for patients and interesting

observations with regard to postoperative findings.

For example, patients report minimal discomfort, particularly in areas

that traditionally are quite uncomfortable – such as the epigastrium

and areas that have been treated secondarily.

Reduced ecchymosis provides for less discomfort due to the

simultaneous coagulation of blood vessels.

You can expect tissue contraction with improved contour, even

in patients in whom retraction was expected to be minimal (for

example, avoiding an abdominoplasty in patients with skin laxity and

lipodystrophy). In addition, the patient experiences a faster return t

daily activities due to minimal discomfort.

There is a minimal risk of sequelae and complications due to the

closed-loop feedback fetatures of the device – less risk of thermal

burns as the energy delivered in watts, soft-tissue impedance, and

skin-temperature limit are preset.

CoNClusioNRF-assisted liposuction is a promising technology for body contouring

with the following main advantages :

• The ability to heat quickly and uniformly as significant volume of

tissues with the effects of coagulation of blood vessels, dissolving

of fat (lypolysis) and tightening of the skin by controlled subdermal

heating; and,

• The ability to control tissue heating via the direct monitoring of

temperature and tissue impedance on a user-friendly, touch scree-

based, narrow-footprint computer device.

The correlation between tissue heating temperature, time of application

of the energy, and the skin tightening requires additional investigation

– which is in progress.

The emerging technology is the latest chapter in invasive body

contouring, and appears to offer and exciting new vista in

noneexcisional body contouring.

RADIO FREQUENCY ASSISTED LIPOLYSIS COMES OF AGEBy Malcolm Paul, MD. FACS

ADVERTORIAL


Fat LEAN The market for fat reduction devices will grow more rapidly than the market for other body contouring devices for the next five years—at least in Europe, says Toronto-based Millennium Research Group, a global authority on medical technology market intelligence. Whether the United States keeps pace may depend on the FDA.

Fat reduction devices include laser-assisted lipolysis, low-level laser-assisted lipoplasty (LLL) and transdermal ultrasound. According to MRG’s “Body Contouring 2009” report on the European market, physicians adopting newer modalities like transdermal ultrasound and laser, light and energy-based fat reduction devices will fuel the upsurge as they continue to meet the public’s demand for less invasive fat reduction solutions. The report, available at decisionresourcesinc.com covers markets in France, Germany, Italy, Spain and the United Kingdom.

The U.S. market has already seen substantial growth in laser-assisted lipolysis devices since Smartlipo (Cynosure, cynosure.com) was introduced in 2006. “We now have nine companies offering these devices,” says Bruce E. Katz, MD, clinical professor of dermatology at The Mount Sinai School of Medicine and director of Juva Skin & Laser Center in New York. Dr. Katz has been working with liposuction for 25 years and conducted some of the early clinical trials on Smartlipo. “Laser lipo is now more popular than traditional liposuction, and with the increased power of these devices, we are able to use them for large as well as small areas of fat all over the body,” he says. “Laser lipo is minimally invasive, can be done using local anesthetic and the lmm laser fibers give you the ability to remove fat precisely, sculpt the body aesthetically and tighten the skin at the same time.”

When it comes to other fat reduction solutions, such as transdermal ultrasound, the U.S. market lags well

behind Europe as it awaits FDA approval for UltraShape and LipoSonix. Both devices are currently available in Europe and

Canada. Dr. Katz says focused ultrasound does remove fat in small amounts but current devices are slow and offer no way

to sculpt the body. He suggests that the devices may be refined

in time to include smaller transducers that would give the physician more control over fat removal.

Hot toPiCIn June the online magazine American Health and Beauty (americanhealthandbeauty.com), which has one of the largest directories of aesthetic providers, reported a surge in traffic from patients looking for nonsurgical, noninvasive alternatives to liposuction. Two LLL devices, Zerona (Erchonia, erchonia.com) and Lipo-Ex (Advanced Aesthetic Concepts, fromstarttoperfection.com), are attracting the most attention. Like transdermal ultrasound devices, they claim to break down fat cells, allowing the lymphatic system to clear away the debris naturally—no invasive extraction cannulae required.

Erchonia reports that early clinical studies of the Zerona verify an average of 3.65 inches of circumference loss after six 40-minute treatments. Rodrigo Neira, MD, Alan Bauman, MD, and James Chan, MD, have all presented positive reports on laser emulsification using the Zerona. Frank Ryan, MD, a board-certified plastic surgeon in Beverly Hills, California, raves about the Zerona in his blog (drfrankryanblog.com), saying it “revolutionizes the field.”

While Dr. Katz has not worked with LLL devices, he points out that they have not yet received FDA approval and says there are no published clinical trials that show their effectiveness. His experience makes him skeptical that these low power devices could produce more than minimal results.

Like UltraShape and Lipo-Ex, Zerona is hoping for FDA approval this summer. Perhaps the addition of these new technologies with some compelling clinical studies would generate enough excitement to drive more patients into U.S. medical aesthetic businesses by year’s end and fuel the kind of growth the MRG report predicts in Europe. z

Linda W. Lewis is a MedEsthetics contributing editor.

According to a recently released study, new offerings in fat reduction may help fuel sales in the aesthetics market. American Health and Beauty reported a surge in traffic from patients looking

for nonsurgical, noninvasive alternatives to liposuction.

profi

ts in

tim

es

KEY FEATURE

Natrelle full pg adv 210x297 p 11/16/09 1:22 PM Page 1

Composite


MedEsthetics | Southern Africa �0

02

01

01 advaNCEd skiN tYPiNGSkin type plays an important role in prescribing treatments and determining treatment parameters. But current strategies used to determine Fitzpatrick skin types—based on skin tone, eye color and susceptibility to sunburn—may not be thorough enough for today’s patient base, warns Marcy Street, MD, of Doctors Approach MedSpa & Laser Center in East Lansing, Michigan. The reason: There are patients with fair skin tones and blue or green eyes whose skin behaves similar to a skin type IV or V in terms of hyper- and hypopigmentation risks and the risk of keloid scarring.

“It’s important to discuss how a person reacts to sun exposure, but I also want to learn about her inflammatory response,” says Dr. Street. “How does she heal?” Additional questions that Dr. Street asks patients include:• How does your skin behave following an acne breakout? Does it turn red or darken? How

long does this last?• How does your skin react to insect bites?• How have you responded to previous surgeries? Did your incision heal quickly? Did you

experience keloid or hypertrophic scarring?“If you’re performing laser treatments; microdermabrasion; or chemical peels, you want to

know if the patient has an overzealous inflammatory response so you can lower the settings and reduce the risk of adverse reactions,” says Dr. Street.

02 NEW tECHNoloGiEs oFFEr NEW oPPortuNitiEsThere’s good news if your practice is in the market for new equipment. Manufacturers are offering a varitety of programs to spur new sales including:

New Financing Options. The Syneron Advantage program (syneron.com) offers a trade-in option, which provides credit toward new purchases when you trade-in your older technologies. The company is also offering a number of customizable financing options including low interest rates and flexible terms.

Lasering USA (laseringusa.com) and Genesis Biosystems (genesisbiosystems.com) have introduced “pay-as-you-go” programs that allow you to purchase equipment for a low down payment and then pay off the remainder of the balance based on usage. Genesis Biosystems has also introduced “rent to own” and “loan to own” programs that allow you to introduce its AccelaWave system for as little as $2,495 down.

Marketing Support. Lasering USA and Syneron are among the manufacturers offering co-op marketing and advertising to help defray the costs of booking new procedures. Customizable marketing kits; web-based referrals; personalized direct mail pieces, posters and ad slicks are among the extras available with new purchases.

Clinical Support & Training. To help you obtain the best possible results, companies are also including upfront and ongoing training for you and your staff. The Syneron Advantage program includes on-demand clinical training from Syneron’s medical director and clinical manager plus access to the company’s Online Learning Management System, which offers 8 to 10 minute interactive online learning modules for practitioners and staff members.

BEST PRACTICES


BEST PRACTICES

03

03 iNsPiriNG EMPloYEE GrEatNEssIt’s often said that employees are a business’ most valuable resource, but are you using this resource to its full potential? According to Pam Bilbrey and Brian Jones, authors of Ordinary Greatness: It’s Where You Least Expect It...Everywhere (John Wiley & Sons, 2009), there are a few steps you can take to open the storehouse of passion, energy, skills and commitment that exists in each of your employees.

Make sure staff members are clear on where your organization is headed. If you, like many business owners, are redefining and/or re-evaluating your business plan, be sure to communicate your goals to your staff.

Inspire ownership by involving employees in major decisions. Are your employees renters or owners? If they’re the former, says Jones, they may be treating your company like a hotel room, expecting others to pick up after them. If they’re the latter, they’re actively looking out for the company’s best interest. You can inspire ownership by inviting employee input as you seek to resolve problems and pinpoint opportunities.

Don’t hide the (scary) truth. Transparency is the hallmark of good leadership, especially in times of uncertainty. “Open, frequent communication will generate the commitment and energy needed to rally your staff with a sense of ownership that says, ‘We can do this!’” says Jones.

04 sCiENCE loGSculptra Aesthetic (injectable poly-L-lactic acid) has received U.S. Food & Drug Administration approval for the correction of shallow to deep nasolabial fold contour deficiencies and facial wrinkles. The approval was based on a randomized, evaluator-blinded, multi-center study of 233 patients with nasolabial fold contour deficiencies. Sculptra Aesthetic was administered at

three week intervals for up to four treatment sessions using a cross hatch injection technique. Results were maintained up to 25 months after the last treatment session.

...Research published in the July 2009 journal Plastic Reconstructive Surgery shows that Botox may be an effective treatment for Reynaud’s phenomenon. George J. Hruza, MD, injected 19 patients who suffered from Reynauds-related ischemic pain (14 of whom also had ulcerations of the fingertip) with 50 to 100 units of Botox. Pain relief was immediate in 13 patients and gradual—in one to two months—for thee additional subjects. Within two months of injection, all fingertip ulcerations had healed.

05 do-it-YoursElF PrPress coverage is an effective way to build your brand name and attract prospective patients but hiring a PR firm can be cost prohibitive to small or fledgling practices. To help you launch your own PR campaign, Susan Hartzler of Alpha Dog PR is offering The Zen of Public Relations a DIY eBook for spas, medical spas and resorts. “Many of my customers could no longer afford to pay for my services when the recession hit,” says Hartzler. “So I decided to help them out by taking my 30 years of experience and writing it down for them. That’s how this ebook was born. In it, I share my secrets of generating thousands of dollars of free media placement.” The book includes:

• Sample press releases• Information on social media• How to build a press list• And moreThe ebook can be downloaded for $5.95 at alphadogpr.

com/shop-online.


02

01

01 rEvErsE suN daMaGEThe three-step Kinerase PhotoFacials Sun Damage Reversal System was designed to offer patients similar benefits to an in-office photofacial through the use of a topical homecare regimen. The system addresses mottled pigmentation, rough texture, and fine lines and wrinkles with three products: Daily Exfoliating Cleanser, Day Moisturizer with SPF 50, and Night Moisturizer. Ingredients include kinetin, antioxidants, fruit enzymes, natural skin lighteners and a patent-pending ozone protector to repair environmental damage. Contact: 800.321.4576, kinerase.com.

02 iMProvEd tEMPEraturE MoNitoriNGSciton introduces tempassure, a temperature sensory accessory for laser-based treatments that accurately measures tissue temperature in real time. TempAssure monitors changes in tissue and body temperature and indicates fluctuations through light and sound. “TempAssure is the state-of-the-art in temperature monitoring for the higher power laser lipolysis procedures,” says Marc Salzman, MD, Louisville, Kentucky. “It allows for direct feedback of temperatures at all levels of the laser application for increased safety and efficacy.” Contact: 888.646.6999, sciton.com.

03 tHE NEW ElitEThe new Elite MPX aesthetic laser workstation from Cynosure offers three new features to speed treatment times and improve ease of use. The dual wavelength platform combines a 755nm alexandrite laser and 1064nm Nd:YAG laser for vascular treatments, hair removal and skin rejuvenation. New features include a built-in Zimmer SmartCool skin cooling system to save valuable practice space while reducing treatments times; Xenon Pulsed Light (XPL2) technology with interchangeable filters that allow you to treat sun damaged skin, dyschromia and rosacea; and Graphic User Interface, a new graphically enhanced software system that makes the station easier to learn and operate. In addition, the Elite MPX offers eight different spot sizes with adjustable pulse durations. Contact: 800.886.2966, cynosure.com.

03

INTRODUCTIONS


05

04

04 tECHNolasEThe Invasix TM BodyTite system is composed of the following :1 A bipolar radiofrequency handpiece; and2 A RFAL computer device.The amount of energy delivered to the fat in watts, the limit of skin temperature in degrees, and high and low limits of impedance are determined by the surgeon on a user-friendly touch screen. All parameters are controlled in a closed-loop system to prevent excessive heating fat and / or dermis.The delivery of bipolar radiofrequency energy has the enormous benefit of being able to quickly and precisely control the depth and direction of energy to the fat, blood vessels and dermis.The device allows for the following :• Simultaneous skin tightening• High speed of treatment• Reduced tissue trauma• Coagulation of vessels• Safe, controlled application of energy and skin temperature monitoring• Uniform heating of skin and subcutaneous layer Contact : [email protected], 012 349 1750

05 daNNé - traNs dErMal suNBloCk A double strength sun block that totally protects skin from damaging ultraviolet A + B rays, Transdermal sub block SPF30 is formulated with a water resistant transdermal base that is never greasy.

Along with sun protection, many fear that their sunscreen will make their skin clogged and oily. This is no longer the case, as DannÈ Montague-Kingís Transdermal Sunblock protects the skin from the sun without clogging your skin.

This non-greasy sunblock was originally formulated for acne sufferers which means it is safe and non invasive for all skin types.

Sunblock should do one job and that is effectively protect the skin from the sun, without clogging the skin.

DANNE MONTAGUE KING

www.dannemking.com, 011 262 6120, [email protected]

INTRODUCTIONS


01 CoNtrollEd dEstruCtioNThe FDA-approved, handheld Cryoprobe X cryofreeze instrument from Cryosurgical Concepts destroys a wide variety of epidermal lesions, including seborrheic keratosis, skin tags and age spots with a fine pinpoint spray of nitrous oxide. Treatment is virtually pain-free and is safe for any part of the body. Contact: Sere-Med, 011 262 2220, [email protected]

02 3-d iMaGiNG suPPortFace Sculptor three-dimensional software from Canfield Imaging allows your patients to see potential outcomes of rhinoplasty, chin augmentation and more. The easy-to-learn software features pictorial icons and slide bars that allow you to sculpt facial images to the desired appearance. The high resolution images can then be rotated and viewed from any angle. Contact: Genop Healthcare, 011 545 6600, [email protected]

03 First otC lasEr aPProvEdPalomar Medical Technologies, a researcher and developer of light-based systems for cosmetic treatments, has received 510(k) over-the-counter FDA clearance for a new, patented, home use laser device for the treatment of periorbital wrinkles. The OTC clearance allows the device to be marketed and sold directly to consumers without a prescription. “Years ago, we believed that light-based antiaging applications could be brought to the home,” said Joseph P. Caruso, CEO of Palomar. “We invested significant resources in research, development, clinical testing and patent protection to make this a reality and ensure that Palomar would be the leader with this innovative technology. We envision a strong market for this OTC device and an increase in consumer awareness to help drive growth in our professional business.” The device was developed by Palomar in conjunction with Johnson and Johnson Consumer Companies.

04 Gsk aCquirEs stiEFElGlaxoSmithKline (GSK) and Stiefel have signed an agreement under which GSK will acquire the total share capital of Stiefel for $2.9 billion. GSK’s existing prescription dermatological products will be combined with Stiefel’s and the new specialist global business will operate under the Stiefel identity. Charles Stiefel, CEO and chairman of Stiefel, will lead the new business group.“As part of our strategy to grow and diversify GSK’s business, we are continuing to make new investments through targeted acquisitions,” said Andrew Witty, CEO of GSK. “This transaction will create a new world-leading, specialist dermatology business and re-energize our existing dermatology products...We look forward to working with Stiefel to develop this exciting opportunity.”

02

01

PRODUCT REVIEWS

Volume 2 Number 4 Summer Edition 2009 | MedEsthetics ��

MESO WHITE Flash whitening treatment for pigmentation

Mission: Softens pigmentation lesions, smoothes and lifts skin complexion. Can be used as a daily treatment or following on from depigmenting laser treatments and peels.

WHitENiNG aCtioN oF dEPiGMENtiNG duo

Alpha Arbutin fast and efficient depigmentation

Azelaic acid depigmentation and keratolytic actions

Inhibition of tyrosinase

• Prevents melanin synthesis• Prevents further pigmentation lesions

Acceleration of cell renewal removes existing pigmentation lesions.

GloW aCtioN

Vitamin C lightens, smoothes cutaneous contours to increase light reflection. NCTF chronospheres scientifically proven effectiveness on skin brightness skin brightness improvement : + 144% in 88% of cases.

iMMEdiatE sMootHiNG aCtioN

Soft focus agents with opal effect smoothes skin complexion by diffusing the light and softening pigmentation lesion contours by adapting to the skin colour. Rhamnose Polysaccharides softens redness caused by UV exposure and eases inflammation.

usE

Apply morning and evening, on its own or before the day or night cream. Locally on the lesions or on all the face. As a daily treatment following peelings or depigmenting laser treatments. As sunburn treatment for all skin types. For an intense and fast result use for 12 weeks minimum with sleep and peel.

ADVERTORIAL


NEWS & EVENTS

MEdiCal CME utiliZEs vidEo strEaMiNG via tHE iNtErNEt

Video Streaming brings CME, via the Internet, directly to you in the comfort of your own home.

Video streaming for CMEs has been used globally since 2003, with over 40% of all CMEs, being conducted in this format. 1

A trial conducted at a medical school showed no statistically significant difference in academic performance between students attending lectures and those utilizing video streaming. 2

The success of the first Video Streaming CME in South Africa, managed by VideoLive on behalf of Galderma, has been overwhelming, from both Galderma and the doctors perspective.

VideoLive has spent years conceptualising and building a product with the African environment in mind, mainly the limited bandwidth, while considering the elements that will allow our clients to function optimally in the global arena. This product will assist companies in taking CMEs to outlying areas and densely congested cities.

For further information kindly contact Susan van Driel 082 441 9235 or visit our website www.videolive.co.za

Ref: 1. Frost and Sullivan Broadcast. 2. The Effectiveness of Streaming Video on Medical Students Learning: A Case Study. Bridge PD, Jackson M, Robinson L. Med Educ Online 2009;14:11.

10 DECEMBER 2009AAMSSA GOLF [email protected] 548 6374

12 DECEMBER 2009Lipolysis [email protected] 444 0404

17 DECEMBER 2009Botox by Dr Alek NikolicCape [email protected]

11 JANUARY 2010Natural Method of [email protected] · 082 737 9300

18 DECEMBER 2009Dermal Fillers by Dr A NikolicCape Town [email protected]

18 -19 JANUARY 2010Beginners and Advanced Botox and Filler coursesDr Renier van AardtCape [email protected]

8 FEBRUARY 2010Natural Method of [email protected] · 082 737 9300

9 FEBRUARY 2010Filorga Product & Glykopeel training [email protected] · 012 548 6374

10 FEBRUARY 2010Filorga Physician Training – Advanced Facial Mesotherapy & Dermal [email protected] · 012 548 6374

11 FEBRUARY 2010NeoStrata Training011 545 6643 · [email protected] Healthcare 30 New Road, Midrand

25 FEBRUARY 2010IPL/LED Phototherapy Training011 545 6643 · [email protected] Healthcare 30 New Road, Midrand

8 MARCH 2010Natural Method of [email protected] · 082 737 9300

11 MARCH 2010 Neostrata Training011 545 6643 · [email protected] Healthcare 30 New Road, Midrand

15 APRIL 2010NeoStrata Training011 545 6643 · [email protected] Healthcare 30 New Road, Midrand

22 APRIL 2010IPL/LED Phototherapy Training011 545 6643 · [email protected] Healthcare 30 New Road, Midrand

27 MAY 2010NeoStrata Training011 545 6643 · [email protected] Healthcare 30 New Road, Midrand

3 JUNE 2010NeoStrata Training011 545 6643 · [email protected] Healthcare 30 New Road, Midrand

24 JUNE 2010IPL/LED Phototherapy Training011 545 6643 · [email protected] Healthcare 30 New Road, Midrand

8 JULY 2010NeoStrata Training011 545 6643 · [email protected] Healthcare 30 New Road, Midrand

29 JULY 2010NeoStrata Training011 545 6643 · [email protected] Healthcare 30 New Road, Midrand

5 AUGUST 2010NeoStrata Training011 545 6643 · [email protected] Healthcare 30 New Road, Midrand

19 AUGUST 2010IPL/LED Phototherapy Training011 545 6643 · [email protected] Healthcare 30 New Road, Midrand

1-2 SEPTEMBER 2010AMCSAPre-congress beginners & advanced training [email protected] · 0125486374

2-4 SEPTEMBER 2010AMCSACSIR ICC, [email protected] · 0125486374

9 SEPTEMBER 2010NeoStrata Training011 545 6643 · [email protected] Healthcare 30 New Road, Midrand

23 SEPTEMBER 2010IPL/LED Phototherapy Training011 545 6643 · [email protected] Healthcare 30 New Road, Midrand

7 OCTOBER 2010NeoStrata Training011 545 6643 · [email protected] Healthcare 30 New Road, Midrand

4 NOVEMBER 2010NeoStrata Training011 545 6643 · [email protected] Healthcare 30 New Road, Midrand

18 NOVEMBER 2010IPL/LED Phototherapy Training011 545 6643 · [email protected] Healthcare 30 New Road, Midrand

CALENDAR OF EVENTS

Calendar of aesthetic / anti-aging Medical Events Supplied as a service by the Aesthetic and Anti-aging Medicine Society of South Africa (AAMSSA) [email protected]


06

07 08

10

09

11

4th ANNUALAETHETIC MEDICINE CONGRESS

2009

IN THE LIMELIGHT

01

02

03

04

05

Some of the exhibitors seen at the congress which was held at the CSIR International Convention Centre, Pretoria, South Africa

01 Filorga; Tanya Hoffman; René de Oliviera; Willemien van Rooyen; Colette de Wet & Ansy du Toit02 AstraZeneca; Pavani Pather; Lesego Parkies & Matshediso Mokhobo03 Best Lasers; Andrew Best & Sharon Best04 Hitech Lasers; Wicus Olivier & Johannes Cloete05 Genop Healthcare; Dianne Rix; Jessica Meyer; Glynis Watkins; Lynette Schlebush-Mok;

Helena Westwood & Grant Russel06 Bester Medical; Jill Bester & Hendrik Bester07 DR & Mr Smith08 Danné Montegue King; Marieta Meyer & Dinette Snyman 09 Galderma; Peter McGill & Hilda Lamprecht10 Intamarket; Anna Olsen; Sean Parker & John Lenihan11 Radiant Healthcare; Jacques Pretorius, Melissa Eksteen, Dr. Sly Nedic, Pieter van Greunin

www.aestheticcongress.co.za

›› Image processing via normal light image, polarised light and UV light images.

›› 3D display of each area ›› History and comparisson analysis›› Printed output of above

FACIAL ANALYSIS SYSTEM -Janus

Observation & Measurement of› Pores› Wrinkles› Spots› Sebum› Porphyrin› SkinColour&Tone

Documents

Endorsed by - AAMSSA · and smart money in physician-dispensed home use devices for common conditions like acne and excessive hair growth. If your patients are not already asking