Making WAVES - AAMSSA · The LightSheer DUET enables you to treat backs and legs comfortably in only 15 minutes without any anaesthetics or gels. LightSheer DUET is CE marked and

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MedEsthetics Volume 4 Number 4 Summer Edition 2011 1

The industry focuses on improving patient compliance and researching new formulations as the FDA final sunscreen monograph remains in limbo. By Linda W. Lewis

editorsnote

A time for quick fixes…

Its that time of the year when aesthetic treatments are booming. The hot summer days require less clothing, exposing those areas easily hidden by winter clothes. Therefore patients are rushing for instant fixes for their skin, body, cellulite issues, weight problems and more.

Their need for instant fixes can sometimes lure one to perform too aggressive treatments in order to assist them reaching quicker results. These patients should be made fully aware of the risk of aggressive treatment protocols that are pushed into a shorter time period. The risk for less optimal results also increases when protocols are rushed.

As doctors we should be confident in the type of treatments that are safe and effective for instant results, but also ensure we know how to manage other treatment options when protocols are changed. Management of complications should be well mastered before attempting to stray from standard protocols.

Botulinum Toxin and Dermal fillers are popular treatment options this time of the year as the results are quick, visible and it remains a safe procedure. But rushing into laser resurfacing or deeper peels during summer requires intensive knowledge, skill and experience. Patients can often pressurize doctors into performing these treatments in their holidays in order to recover before returning to work. In our country our major holidays fall over the hottest time of the year, unlike in Europe where December is an ideal time to perform deeper treatments in the winter holidays. The risk for post-inflammatory hyperpigmentation is substantially higher when performing resurfacing procedures during summer time. This risk could possibly be overcome in Fitzpatrick Skin type I – III

patients, but you are very brave practitioner when performing resurfacing in darker skin types in summer.

Other popular treatments that are attractive to patients due to its safety, efficacy and the fact that it can be done any time of the year is radiofrequency treatments for face or body.The article in this issue, Making Waves, on radiofrequency treatments will give some insight into this amazing technology for aesthetic practices.

The articles on Volume Matters and Peri-orbital rejuvenation will further educate you on these increasingly popular demands for rejuvenating these areas of the face. Both volumizing and peri-orbital rejuvenation may not have been the major concern of patients in the past, but it has become one of the major concerns of patients since realizing that there are effective treatment solutions for these interesting indications.

Lastly, I think the importance of the information in the article, The Great Equipment Turnaround, is much underestimated. Electronic devices can be a major attribute in an aesthetic practice but can also be under utilized causing a loss of potential earnings. This article offers very useful tips to maximize the potential of your electronic equipment and complement your practice effectively.

Enjoy the articles in this issue. May you have a profitable summer and a blessed festive season!

Riekie SmitMedEsthetics Southern Africa Editor

President Aesthetic & Anti-aging Medicine Society of South Africa

Med Esthetics Southern Africa Editor: Dr Riekie Smit

MedEsthetics Southern Africa2

Volume 4 Number 4 Summer Edition 2011

contents

PUBLISHERReni Rouncivell

MedSpec Publishing

PO Box 12973Clubview · 0014

South AfricaTel +27 (0) 12 661 3294

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

SALES & ADVERTISINGLelani Adendorff

Tel +27 (0) 12 661 3294Mobile +27 (0) 79 512 6990

e-mail [email protected]

SUBSCRIPTION & ACCOUNTSElizabeth Versteeg

Mobile +27 (0) 72 189 8499e-mail [email protected]

DESIGN & LAYOUTSonja van Niekerk

MedSpec PublishingMobile +27 (0) 82 444 0231

e-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, specifi cally 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 specifi c 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.

ARTICLES page

At what Costs? 4

Making Waves 6

Volume Matters 12

Target Growth 16

Periorbital Revolution 22

The Great Equipment Turnaround 27

AESThETICS CALENDAR 20

PRESS RELEASE: CYTORI 31

PRODUCT REVIEW 32

BEST PRACTICES 37

ADVERTORIALS

Danné Montague-King 35

Best Lasers 36

Technolase 38

Intamed 40

Radiant healthcare 42

Intamed 44

Alpha-h 46

Radiant healtcare 48

12 22

For information on our full range of aesthetic systems please visit www.hitechlasers.co.za Tel: 012 349 1250 · Fax 012 349 1140 · email- [email protected]

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With six times the power of most CO2 lasers, the UltraPulse system is the laser for advanced applications. Delivering speed, versatility, performance and precision, UltraPulse easily supports a full spectrum of aesthetic and surgical capabilities.Single treatment, single pass, results in fast recovery. Active FX and Deep FX treatments ensure the deepest ablative capability with hemostasis.34 FDA-cleared dermatology and plastic surgery indications.

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Since 1974 Hitech Lasers has been a provider of safe, cost-effective and high-performance laser, light-based, radiofrequency and focused ultrasound devices for aesthetic and medical applications.

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Though consumers want to be smart patients—seeking out doctors with good credentials, asking for referrals and understanding that prices vary based on desired outcomes—what they really want to know is: “how much will this cost?” Cost is of the utmost importance to buyers and providers. Your fee schedule helps to determine your target demographic and whether you will see red, break even or prosper in your cosmetic practice. Thus, it is important to include fee-positioning in your strategic planning process.

There are two key factors that must be established before you set your fee schedule: What are your competitors charging and what are your costs? When determining your costs, look at how long it takes to perform the procedure and how many staff members will need to be in the office. You’ll also need to factor in the cost of facility maintenance, procedure marketing, consumables, equipment lease payments, back bar products and ancillary products—such as cotton swabs, eyeshields and towels. Last, but not least, you’ll need to consider your own compensation. Basing your prices on expenses-plus-income is a much safer business strategy than just choosing a figure that sounds fair based on local trends.

Your fee schedule also needs to match your practice’s niche. For example, seeing a $20,000 Rolex watch for sale at Kmart or Sears is as psychologically disconcerting to the customer as seeing a $20 Timex watch for sale at Tiffany & Co. In both cases,

the mismatch of prices within the established setting results in fewer sales, even if the $20,000 Rolex is priced lower than at other jewelry stores. The same applies to your office and your fees.An Evidence-Based ApproachTo a certain extent, you can take an evidence-based approach

to your fee setting, just as you apply evidence-based medicine to your procedures. In one four-month study, the aesthetics clinic at the UCLA Division of Plastic Surgery radically reduced its pricing and tracked the effects on demand for services. The result: “Average total fees per procedure were reduced by 40%, resulting in a 250% increase in procedures performed, but net revenues (collections) increased by only 52%”.1 Net profits and procedure mix variables—such as the number of neurotoxin units administered and whether the treatments were offered a la carte or in combination—were not reported and probably couldn’t be addressed given the residency location. Still, we can see what happened in terms of the top line charges.

A 2002 survey found that “93% of plastic surgeons categorized the majority of their patients as very or moderately price-sensitive. Fully 98% described their business climate as very or moderately competitive and most plastic surgeons thought they lost a sizable number of cosmetic patients within the last year for reasons of price. In this environment, business strategy dictates there are three protocols for success: discounting, differentiation and focus. Discounting joins the trend toward cutting fees. Success comes from increasing volume and efficiency and thus preserving profits. Differentiation creates a perception of uniqueness. Plastic surgeons that buck the trend toward discount cosmetic surgery must take concrete and potentially costly steps

to implement a plausible strategy for distinguishing their practices within the crowded cosmetic surgery market.”2

Fee-Setting StrategiesThere are several ways to obtain information on fees in your area. Some practices post their fees online. You can search

A little research can help you set a fee schedule that will keep your practice in the black.

Your fee schedule also needs to match your target patient demographic and the types of procedures you offer.

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BUSINESS CONSULTANT

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terms such as “Botox fees NYC” or “cosmetic surgery fee schedule” online. You can even find international fees by doing an Internet search for “medical tourism.” (ed note: On page 34 you can see fee ranges from our nationwide reader survey.) Another alternative is to have an employee, friend or family member mystery shop the competition in person or by phone. Then, set your own fees based on your costs and the current pricing in your market.

Be aware that the strategy of pricing at $499.99 instead of $500 can backfire. Some patients will react with distrust that you are trying to “game” them. Conversely, consumers do respond well to odd numbers, like $465, as it seems the practice must have a reason to price the procedure so specifically, especially in practices that market themselves as offering competitive pricing.

When changing your fees, it is better to do so incrementally (i.e., a smaller change every three months versus a big change every couple of years). The same goes for expressing fees: “$75 for the visit and $17/unit” for neurotoxins, sounds like less than “$500.”

A common question when determining practice fees is whether a physician’s consult fee should be complimentary, separate or credited toward a booked procedure. The answer will differ from practice to practice and is often based on how long the practice has been in business—a new practice will benefit more from a free consult than an established practice. What we do know is that “free” is a more effective term than “credited,” which is stronger than “separate” in creating a higher number of initial consults, though the quality of the respondents may vary significantly. When you advertise “free,” you attract more people who actually can’t afford the procedure.

Offering discounts—such as periodic specials or lower costs when procedures are booked on specific days—is a common marketing technique that works for some practices. Be careful, though, of the popular new Internet services like Groupon, wherein an outside provider markets a discount, limited to its membership, then retains a percentage—however small—of the revenues. This may violate your states’ fee-splitting regulations, so check with a healthcare business attorney first. Your state professional association is usually a good source of referrals for attorneys. You also can try healthLawyers.org.

In answer to the question, how high should I set my fee schedule? It depends on several factors—including location, costs and longevity of the practice—but a little research can go a long way in helping you to develop a competitive and profitable pricing schedule.

1. Krieger LM, et al, “Pricing strategy for Aesthetic surgery,” Plastic &

Reconstructive surgery, Feb. 1999, Vol. 103, issue 2.

2. Krieger LM, “Discount cosmetic surgey,” Plastic & Reconstructive

surgery, Aug. 2002, Vol. 110, issue 2.

Keith Borglum is a certified healthcare business consultant (cHBc), certified business broker and certified business appraiser. contact him at medicalpracticeappraisal.com.


WAVesMaking

Radiofrequency devices are gaining prominence with new generation technologies and expanding indications.

By Linda W. Lewis

KEY FEATURE

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n less than a decade, radiofrequency-based devices have carved out a niche in the medical aesthetic industry as a noninvasive option to treat skin laxity on the face, neck and upper arms. More recently, that niche has widened to include body contouring and fractional skin resurfacing.

The Thermage (Solta Medical, thermage.com) was the first RF-based device to garner FDA marketing clearance in 2002 for the treatment of periorbital wrinkles. This technology is based on the work of plastic surgeon Edward Knowlton, MD, who believed that RF exhibited properties that could be harnassed to tighten the skin noninvasively. “RF has been used for years for cautery where you actually see a wound or vein shrink. So it was from Dr. Knowlton’s roots in surgery that RF skin-tightening technology grew,” says Stephen J. Fanning, CEO and president of Solta Medical.

The original monopolar Thermage ThermaCool was soon followed by bipolar devices, including the Alma Accent (almalasers.com) and Syneron’s elos technology (syneron.

com), which combines RF and light. More recently we have seen the introduction of so-called multipolar RF devices, such as the EndyMed PRO (endymed.com) and Venus Freeze (venus-concept.com), and a new entry in monopolar technology with the BTL Exilis (btlaesthetics.com).

Growing PainsThough the early promise of RF was visible to many—”I still remember the first time I witnessed a Thermage treatment. It caused some forehead indents, and I thought, if it can do that, then a more advanced RF device could do even better,” says Daniel Man, a plastic surgeon in Boca Raton, Florida—early devices did present some difficulties, including intense pain, lipoatrophy and inconsistent results.

“Thermage did experience some difficulties, as do many early devices,” says Fanning. “First, there was a significant amount of pain associated with the procedure. As a result of the pain, it took longer to do the procedures.” With the second

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generation Thermage NXT, the company reduced the amount of energy. “So obviously you then suffered from lack of efficacy,” says Fanning.

The current, third generation Thermage called the Thermage CPT—which stands for Comfort Pulse Technology—sought to address these concerns by adapting the treatment handpiece. The CPT has a vibrating handpiece that allows practitioners to increase energy based on the Gate control theory of pain. It also offers what the company calls a “framed” tip.

“The earlier tip is a 3cm tip, and the face of it has little squares all over it—similar to a checkerboard,” says Fanning. “If you look at our newer tip, it has that same configuration but around that there is a square. This forces the energy more into the center of the tip. Some of the pain that was associated with the original Thermage was what we call the ‘edge effect,’ where it had a little bit of a sting to it as a result of the edge. This framed tip eliminates that.”

According to Inna Belenky, PhD, clinical trainer at Viora (vioramed.com), for the past 10 years “the development of RF devices has been focused on producing safer systems and treatment protocols, and reducing the occurrence of adverse effects and complications, such as burns and bruising,” she says. “These developments include using appropriate materials, such as ultrasound gel and glycerin oil, cooling the applicators, choosing patients according to their medical history (avoiding the treatment of patients with contraindications for exposure to electromagnetic energy) and monitoring of skin temperature and skin’s response during the treatment.”

While RF energy has been proven to tighten skin for more than a decade now, the problem has always been the unpredictability of results. Some scientists believe the variable results with RF are due to differences in skin impedance. “Impedance dictates where most of the current will flow. Lower impedance equals higher conductivity. It also dictates how much heat a specific amount of energy will deliver into that

impedance,” explains James Muze, vice president of development at Syneron Candela. “This is where impedance feedback systems are critical. They let you know how much energy was delivered and how much heat was created.”

“Newer devices allow us to better control the energy we deliver into the skin and direct it more precisely,” says Bruce Katz, MD, clinical professor of dermatology, The Mount Sinai School of Medicine, and director of Juva Skin & Laser Center, New York.

Expanding IndicationsLate in 2009, the FDA approved three new RF devices: the EndyMed PRO, the Exilis and the Viora Reaction. While the primary focus of all of these devices is body contouring, each also has a skin-tightening component appropriate for the face, neck and upper arms. The EndyMed PRO 3DEEP RF technology uses six independent, individually controlled RF poles to create focused heat deep in the treatment area. Because there is

less heat at the surface, the treatment is less painful. Patients typically receive two to three treatments for the face and four to six for the body at two-week intervals.

A clinical trial published in the December 2010 issue of the Journal of Cosmetic and Laser Therapy concluded that the device provides 85% to 90% predictability of good results, noting that the predictability is enhanced by the device’s ability to compensate for impedance on a real-time basis.

The BTL Exilis features a monopolar RF delivery system and the company’s embedded Energy Flow Control (EFC) technology to uniformly heat tissue at therapeutic skin levels. It also offers built-in temperature sensors in an attempt to reduce the energy to levels that will effect therapeutic heating without causing excess pain. “The Exilis is the most promising of the new RF devices,” says Dr Katz. “We’ve been using it for about six months now. Patients love the results and there is no pain. The Exilis gives the best tightening results after five or six sessions.”

The Reaction by Viora utilizes bipolar RF and includes

Results following four sessions with the Refit RF protocol for patients who have undergone extreme weight loss.

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Monopolar vs. Bipolar RFRF devices tend to market themselves as monopolar, bipolar or multipolar RF devices. Monopolar energy travels from the handpiece to a distant pole and requires a large ground electrode that is applied to the body. It penetrates up to 20mm, affecting both skin and subcutaneous fat. Bipolar energy travels from one pole on a handpiece to another, penetrating only 2mm to 4mm into the skin.

“Both work by causing bulk heating of the deep dermis,” says James Muze, vice president of development at Syneron Candela. “Bipolar uses symmetrical electrodes that can control the distribution of energy between the two and, more specifically, confine it to dermal structures when appropriate. Tripolar is a marketing term, not a scientific term. Devices with three or more poles use bipolar electrodes that switch between active pairs and inactive pairs.”

“There is only monopolar or bipolar current delivery,” says Inna Belenky, PhD, clinical director at Viora. “A multipolar system is actually a derivative of a bipolar system or a combination of two systems: bipolar and monopolar. For example, the octipolar system is an applicator that comprises four pairs of bipolar electrodes. The tripolar system has three electrodes: one acts as a positive electrode while the other two act as negative electrodes creating two pairs of a bipolar system.” Whether monopolar, biopolar or some combination of the two provides the best option for skin tightening has not been established by scientific studies.

“The tip for the face goes twice as deep as

the tip for the eye area. For the body tip,

we go 79% deeper.”

patented CORE (Channeling Optimized RF Energy) technology, which allows the operator to deliver heat to the skin using three different treatment modes. This allows users to target tissue at varying depths. The Reaction also employs vacuum therapy to help break down adipocytes and maximize the RF energy. A built-in cooling mechanism keeps the treatment comfortable. The Reaction can be used for body contouring and to rejuvenate the periorbital region, cheeks and neck.

This year, the company also introduced the new Refit protocol for extreme skin laxity in patients who have undergone rapid and excessive weight loss. “The ability of the CORE technology to supply RF energy in three different RF frequencies simultaneously allows for more concentrated heat delivery to the dermal skin layer,” says Belenky. The protocol combines applicators that are indicated for cellulite and circumferential reduction with a skin-tightening applicator used over the stretch marks to improve skin laxity and minimize the appearance of striae.

Similar to the evolution of laser technologies, the creation of new handpieces and treatment tips is expanding the indications for existing RF devices. Thermage, for example, has multiple tips that control the depth of penetration so practitioners can treat the eye area, the face and the body. “The tip for the face goes twice as deep as the tip for the eye area,” says Fanning. “For the body tip, we go 79% deeper than the face tip.”

The Venus Freeze debuted in early 2011. This device combines RF current and pulsed magnetic fields, which have been shown to increase collagen production by nonthermal membrane stimulation. The energy is delivered through two handpieces: an octipolar applicator with eight electrodes arranged in a circle for larger treatment areas and a handpiece with four electrodes for the face and smaller body areas. Each electrode emits both RF and a pulsed magnetic field. “On its own, multipolar RF is exciting, but when you pair it with magnetic pulsed technology, you get a device that not only stimulates collagen and elastin fibers but also causes the proliferation of fibroblasts and blood vessels,” says Tess Mauricio, MD, dermatologist and founder of Scripps Ranch Dermatology & Cosmetic Center, La Jolla, California.

Fractional RF Takes OffFractional skin resurfacing became all the rage with the introduction of the Fraxel laser in 2005 (Solta Medical, fraxel.com). In September 2008, the Syneron Matrix RF became the first FDA-approved bipolar RF-based device to offer skin resurfacing similar to fractional lasers. Part of the company’s eMatrix System, the Matrix RF fractionated handpiece consists of a matrix of 64 electrodes in a disposable applicator tip. In a process called sublative rejuvenation, the electrodes place heat energy directly into the dermis where it can produce dermal impact with minimal epidermal disruption. A study in the March 2009 issue of Journal of Drugs and Dermatology concluded that most patients showed improvement in skin brightness (83%) and skin smoothness/wrinkle reduction (90%).

Syneron introduced the ePrime system in December 2010. It delivers bipolar RF energy directly into the deep reticular dermis via a minimally invasive microneedle electrode array. The controlled, high-volume fractional injury creates new collagen, elastin and hyaluronic

MAKING WAVES


acid with minimal injury to the epidermis. The ePrime measures impedance and monitors real-time temperature, allowing the practitioner to achieve and maintain a specified treatment temperature. The FDA-approved ePrime was used in a study conducted by Andrea Willey, MD, et al., and published in the April 2010 Archives of Dermatology. The researchers compared elastometry measurements at baseline and three months post-treatment with physician assessments of wrinkles and skin laxity and patient rating. Elastometry showed statistically significant improvement (a 5% to 12% decrease in Young’s Modulus and a 10% to 16% decrease in retraction time). The average improvement correlated to a 2.6-year improvement in skin property. Physician scores showed an improvement of 1.42 grades on the Fitzpatrick scale for wrinkles, and 89% of patients were satisfied or very satisfied at three months. “The ePrime seems to give a volumetric change as well as tissue tightening,” says dermatologist Suzanne L. Kilmer, associate clinical professor at the University of California, Davis, and founder of Laser and Skin Surgery Center of Northern California, Sacramento, “but it does require local anesthesia and some downtime.”

The multipolar EndyMed PRO Fractional Skin Resurfacing Applicator received FDA clearance for skin resurfacing in February 2011. In May 2011, Li-Lin Liu, MD, of the Department of Dermatology in Taiwan presented a study of the device at the 22nd World Congress of Dermatology in Seoul, Korea. For the study he treated the dorsal

hand area, the neck and other off-the-face areas. Dr. Liu concluded that, while further studies need to be done, this combination RF device may become one of the most effective noninvasive therapies for wrinkle reduction, skin tightening and body contouring.

Waves of the FutureAt press time, the Alma (almalasers.com) iPixelRF handpiece was still awaiting FDA approval. The handpiece uses an array of pyramid-shaped RF electrodes arranged in rows of six to create skin ablation, deep thermal heating and controlled mechanical damage to the skin. The iPixelRF is indicated for skin resurfacing, skin tightening, acne scars, stretch marks, skin discoloration and skin rejuvenation.

“RF devices are only going to get more advanced: easier

to use, more reliable, and more consistent and predictable,” says Marcy Street, MD, dermatologist and director of Doctor’s Approach Dermatology and Laser Center, East Lansing, Michigan.

Dr. Man goes even further with his predictions, saying, “In a short time, we will see devices that offer physicians the ability to treat patients of many skin types and colors safely and effectively. Treatment protocols will address

various body areas not just the face and neck, including: [loose skin from] post-liposuction, post-bariatric surgery and post-childbirth, as well as skin laxity on the elbows, hands, arms and inner thighs.”

Linda W. Lewis is a Medesthetics contributing editor.

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Results shown three months post treatment with the thermage cPt.

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volume

How dermal fillers are reshaping cosmetic medicine.By Wendy Lewis

MAtteRsDermal fillers have become a popular tool to address contour defects

that are the inevitable result of aging. The effectiveness, low morbidity and predictable, reproducible results of these treatments have made dermal fillers

the bread and butter of most cosmetic practices. Additionally, “We now have a range of dermal fillers that are useful to fill an isolated wrinkle,

and fillers that can be injected into multiple tissue planes to create a change in facial shape and restore volume,” says New York City-based plastic surgeon Bryan G. Forley, MD, FACS.

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Biostimulators—A Fast-Growing Subset of Fillershyaluronic acid fillers represent the largest and most widely used group of dermal fillers. “Juvederm (Allergan, juvederm.com) flows smoothly into the skin, and lifts and fills wrinkles nicely. It feels soft and natural and smooths lines and folds, restoring lip borders and lip volume loss,” says Dr. Forley. “Whereas, with Sculptra Aesthetic (Sanofi Aventis, sculptraaesthetic.com) we can customize the treatment to the individual patient to fill volume deficiencies in a way that restores broad areas of lost facial volume, enhances the cheek area, and eliminates depressions around the mouth.”

Sculptra Aesthetic works differently than traditional dermal fillers. The particles of poly-L-lactic acid (PLLA) stimulate the formation of new collagen in the skin, adding volume over time. Results are not immediate and a series of treatments is usually recommended. “Sculptra may be injected either into the superficial dermis for the treatment of wrinkles and acne scars or subdermally to add volume to the cheeks, temples and hands, and to correct contour deformities,” says Dr. Forley.

“In patients who are not surgical candidates, Sculptra Aesthetic provides a means to achieve a rejuvenating effect on facial appearance without using the scalpel,” he continues. “It is a particularly effective technique in patients who want a longer-term result than we can offer them with traditional dermal fillers. In my practice, I have found that the improvement in facial appearance lasts up to three years.”

The downside to Sculptra Aesthetic is that the PLLA-stimulated collagen synthesis is gradual in onset. “For patients who want an immediate benefit, Sculptra Aesthetic can be layered with use of a hyaluronic acid filler, such as Juvederm or Restylane, at a more superficial level,” says Dr. Forley. “This approach addresses the instant versus delayed gratification mindset that must be managed in the patient who is injected with Sculptra Aesthetic alone and must wait several months to see the outcome of the treatment.”

Jonathan Sykes, MD, FACS, facial plastic surgeon at the University of California Davis Medical Center, and past president of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), adds his own twist to using Sculptra, “I dilute it more, reconstitute it early (two days before treatment), and I inject deeply—just above midfacial muscles and supraperiosteal in the prejowl sulcus. I massage it aggressively. I now put a lot more volume in the temples and in front of the ears to get the desired effect.”

Radiesse’s (Merz Aesthetic, radiesse.com) ability to create structural collagen support and stimulate the skin’s foundation makes it another favorable option for volumetric lifting and contouring. For Richmond, Virginia-based facial plastic surgeon Michael Godin, MD, FACS, Radiesse is the filler of choice, “I use Radiesse extensively in my practice. Its longevity and lifting capacity make it my go-to filler for facial contouring. I tell patients that Radiesse is the cake and hyaluronic acids—such as Juvederm and Restylane (Medicis Aesthetics, restylaneusa.com)—are the icing. I often use multiple filler types in combination, placing the Radiesse deep to the hyaluronic acid, to provide a foundation.”

According to Dr. Godin, “I see so many patients with sagging in the midface which can begin as early as the 30s and is almost universal by [the age of ] 50. As the midface descends, the bony rim of the orbit

“Mixing a little Radiesse into a hyaluronic acid filler

can alleviate the tendency for ‘blueing.’”


is exposed and any prominent lower eyelid fat is displayed in sometimes dramatic relief. The sagging tissue gathers just above the nasolabial fold, creating a triangular valley between the lower lid and lower cheek. Radiesse is the ideal material to correct this deformity. It is a sculptural process—one I enjoy. I prefer to place Radiesse in the subcutaneous plane. I imagine myself layering just beneath the fat. I don’t like to go deeper with it as it can track to the infraorbital nerve in this location and cause problems. After injecting I spend quite a bit of time positioning the Radiesse with my hands—feathering the edges of it for the most natural-looking effect.”

With advanced facial contouring techniques, practitioners are able to produce more facelift-like results to meet patients’ demands for long-lasting, non-surgical treatment options. “Years ago, I would have had to take these patients to the OR under anesthesia, make a cut and dissect through their cheek tissue to the bone, and place a synthetic implant that could move, get infected or become terribly obvious-looking with the passage of time and thinning of tissue,” says Dr. Godin. “With my Radiesse technique, [patients] are in the office for 30 minutes and walk out with great-looking cheeks that will last them a year.”

A Filler For Every NicheThere are nuances for every dermal filler, including ease of use, injection technique, versatility, duration of results, as well as potential risks and the management of adverse events. “Patient assessment is critical to achieving optimal outcomes with soft tissue fillers. You have to determine exactly the problem you are trying to correct, how deep is the fold or wrinkle to be filled and what the ideal options are for each situation, considering the patient’s expectations, budget and history,” says Steven Fagien, MD, an oculoplastic surgeon in Boca Raton, Florida. “Some of the new injectable sites include the dorsal hands, cheekbones, traumatic scars, eyebrows, temples, jawline, nasal dorsum and fine lines.”

Like many experienced practitioners, Lorrie Klein, MD, a dermatologist in Laguna Nigel, California, numbers three different fillers among her favorites: Radiesse, Juvederm and Artefill (Suneva Medical, artefill.com). “Each has its own niche in my practice. To me, using fillers is so much more than just filling in lines and plumping lips; it is an art akin

to sculpting. I do a lot of volume restoration for which I prefer Radiesse, due to its robustness and large volume syringe size. I use 3.0 ccs to 7.5 ccs per treatment s e s s i o n , especially when restoring volume to cheeks and

temples.“Juvederm Ultra XC is my first choice for lip enhancement.

It molds easily. I especially like how nicely it can be used to redefine the vermillion border and philtrum. Artefill has a smaller niche in my practice but nevertheless an important one. There is a definite subset of patients who want a longer-lasting filler that does not require continual visits to maintain. Men especially like the idea of treatments that do not require much maintenance,” she says. “I also like Restylane-L for the tear trough area. Because it is not as hydrophilic as Juvederm, it has a lower risk of the Tyndall effect in this area.”

New York City and New haven, Connecticut-based dermatologist Lisa Donofrio, MD, explains how her filler techniques have evolved. “I’ve migrated away from fat and more towards ‘off the shelf’ fillers, especially around the eyes. I have found that Restylane lasts a long time and, if a

bump occurs, it can be dissolved easily. I also love the textural changes that I can achieve when I ‘airbrush’ hyaluronic acid just under the skin of the cheek.”

Combination Therapies With FillersIn the United States, many of the advanced applications that practitioners use for FDA-approved dermal fillers are

considered off-label. “I often combine fillers in the same syringe,” says Dr. Donofrio. “For instance, mixing a little Radiesse into a hyaluronic acid filler can alleviate the

tendency for ‘blueing’ or the Tyndall effect, especially around the eyelids. I also thin out fillers at times to make them more appropriate for injecting into fine

lines. Lastly, the combination of fat for cheek volumization and hyaluronic acid for textural improvements is stellar.”

According to Great Neck, New York-based dermatologist Jeanette Graf, MD, “Currently I am quite pleased with the selection of fillers available. The filler I use is based on the area being treated as well as the particular patient’s

Radiesse is becoming increasingly popular for both filling and facial contouring.

Before After

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“For patients who want an immediate benefit, Sculptra

Aesthetic can be layered with a hyaluronic acid filler.”

VOLUME MATTERS


VOLUME MATTERS

needs. For hands and overall volumization of the face, including the mid and lower face, nasolabial folds and marionette lines, I like Radiesse. I dilute it with 0.3 cc of 1% Lidocaine (without epinephrine), however I may increase the dilution factor depending on the area of correction. Sculptra Aesthetic is a great volumizer and I love it for volumizing the face—both upper (temples well into the hairline), mid and lower face—and it is great for jawline enhancement. I don’t use Sculptra in the eye area at all.”

Although every practitioner has his filler of choice, most experienced injectors use several variations of hyaluronic acid fillers in their practices. As Dr. Graf says, “I like Perlane as a filler for the lower face, and I like both Restylane and Juvederm for filling in lips, nasolabial folds and marionette lines, as well as the upper and lower lip area. When correcting a nasal deformity I usually use Restylane and I also prefer Restylane in the tear trough area.”

Adding EnergyAmy Forman Taub, MD, medical director of Advanced Dermatology in Lincolnshire, Illinois performs energy-based procedures prior to filling for patients who are undergoing both. “If a patient recently had fillers injected, I will usually wait one month after a filler treatment to use an energy-based device, because the heat could potentially stir up some of the inflammation around the filler while it settles in,” she says. “If you are going to do something that could potentially allow you to use less filler material, like radiofrequency skin tightening, I suggest that the patient wait.”

The Future of Fillers There are several fillers in use in Europe and Canada awaiting United States Food & Drug Administration approval.

hyaluronic acid fillers on the horizon include:• Belotero, Merz Aesthetic• Emervel, Galderma (Galderma.com) • Prevelle Lift, Mentor/Ethicon

(ethicon.com)• Juvederm Voluma, Allergan

“Juvederm Voluma injects like fat, which is my first love,” says Dr. Donofrio. “It is highly cohesive so it sticks together and has a high G prime, which makes it ideal for lifting tissues.

Voluma can be injected with a cannula, with which I am c o m f o r t a b l e based on my experience using fat”

Dr. Graf is looking forward to the FDA approval of Belotero from Merz, which is

cross-linked with a CPM (cohesive polydensified matrix technology). “It will be helpful in

treating the extremely superficial lines as well as tear trough area since there is no Tyndall effect so far, based on how it integrates into the skin,” she says.

At the 2011 Annual Meeting of the American Society of Plastic Surgeons in Denver, Geoffrey Gurtner, MD, presented research on a new solid-state hyaluronic acid filler he has created. The cylindrical thread of filler can be placed below lines and wrinkles to “buttress” them. The potential benefits include: the filler will not migrate from the placement site; it can be quickly extracted in the case of an adverse event; it removes the risk of embolus; and there is no risk of lumps or bumps. The strands of filler are pulled into place using a Keith guiding needle. Dr. Gunter and Michael Longaker, MD, recently completed a short-term, 31-patient study of the filler and found that it was effective in reducing lines in the forehead, nasolabial folds and glabellar creases, and in filling lips and tear troughs. The filler is currently in development and working toward FDA review.

Technology will also play a growing role in how fillers are used, according to Dr. Graf. “The use of cannulas, especially 30 gauge, will expand our ability to fill vascularly challenging areas such as the forehead,” she says.

Dr. Klein has added a novel injection system to her tool kit. “I have recently begun using a new device, the Artiste Assisted Injection System (Nordson Micromedics, nordson.com), with my hyaluronic acid injections. This device utilizes a CO

2 pump and foot control to allow for more precise control of injection flow. I find it especially useful for lip injections.”

“Voluma, the latest advance in larger volume hyaluronic acid gel fillers, is poised to be the next game changer in facial rejuvenation,” says Dr. Fagien. “With the expanding menu of fillers now available and more products currently under clinical investigation, we are learning to treat the whole face with unprecedented results.”

Wendy Lewis is president of Wendy Lewis & co. Global Aesthetics consultancy, founder/editor in chief of beautyinthebag.com since 2008, and author of 11 books. contact her at wendylewisco.com.to

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sculptra Aesthetic offers a very natural contour, though the onset is slow and gradual.

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“Patient assessment is critical

to achieving optimal outcomes with soft tissue fillers.”


TargetFall is the perfect time to review your annual marketing

plan to make sure you’re spending your practice-building

dollars effectively.

growthYou can’t achieve a goal until you set one. It may

sound obvious, yet all too often, practice owners

implement marketing ventures on a whim without a

clear picture of a desired return. With a few months

to spare before the start of 2012, this is the perfect

time to develop an annual marketing strategy and

budget for the coming year that spells out your

practice-building goals, what you’re willing to spend

to achieve them and how you’ll track the results.

In this column, we’ll look at the various

components of an effective practice-marketing

program, offer advice on how to budget your

resources and show you how to track your

investments so you can make sure your getting the

best bang for your marketing buck.

A well-rounded marketing plan encompasses a

wide variety of marketing, PR and paid advertising

ventures, including:

A Practice Website. Your website is a virtual

brochure for your practice that also functions

as a virtual yellow pages advertisement. It is the

key element in a consumer’s decision to try your

practice. Therefore, you want your listing to be easy

to find and you want your site to be a dynamic,

evolving representation of the best your practice has

to offer. To make the most of this practice-building

tool, aim to update and refresh your site’s content on

a monthly basis.

A well-rounded marketing plan encompasses a wide variety of marketing, PR and paid

advertising ventures.

KEY FEATURE

Search Engine Optimization (SEO). If your practice website doesn’t

appear within the first five to 10 search engine listings, it likely won’t

be found. Consumers generally accept first-page listings as sufficient

to their needs. You cannot effectively grow your practice without an

effective SEO program.

Keyword Advertising, also known as Search Engine Marketing

(SEM). Keyword advertising, including Google Ad Words and Facebook

advertising, is the most common and effective form of SEM, because

it is so easy to track. It is the single most measurable marketing tool

available. You will know at a glance if your keyword investment is

generating a positive ROI.

here’s how it works: You purchase a specific search term for a

specific geographic area. Then, when someone in your market area

uses that term for a search, your link will appear. If the user clicks

though to your site, you are charged a fixed and specified fee. If you

have chosen your key words well, your click-through users will be

well-qualified prospects, leading to new patients and new business.

Online Social Networking. Social networking sites—such as

Twitter, Facebook and YouTube—require two elements

in shared priority: content (reasons for people to

come to your social media page) and conversation

(reasons for people to become and stay connected).

These take time and effort to hone, but social

networking will not succeed without a generous measure of both content

and conversation. One of the best things about social networking is that,

unlike advertising or other types of print marketing, it does not require

a significant monetary investment. however, it does require a time

commitment.

Open houses. Special events or open houses that bring individuals

into the practice environment are exceptionally effective at generating

new patient prospects. Optimally, you should hold events at your medical

aesthetics facility on a monthly basis or quarterly, at a minimum.

Public Relations. Done right, public relations—or PR—is remarkably

effective in generating awareness and interest in your practice. PR is most

often seen in terms of press releases: short, informative news articles that

are written for easy use by editors. These releases also have a dual purpose

of intriguing editors enough that they’ll want to create their own articles

or stories about treatments or trends at your medical aesthetic practice.

When press releases are issued via a professional placement service, such

as BusinessWire, PRNewswire or Newswise, they not only reach targeted

editors, they also “live” on the Internet where they can be found by

prospective patients and enhance SEO services. In order to obtain the best

results from a PR campaign, aim to send out monthly press releases.

Direct Marketing. Once considered a critical promotional tool, direct

mail marketing has been almost entirely replaced by direct email marketing.

The key to a successful direct email marketing campaign is to start with an

effective list of people who have agreed or “opted in” to receive emails from

your practice on specific topics. This list of existing patients and prospects

should be the core of any direct marketing campaign; however, there are

refined and focused lists of people in the target demographics that can

be rented or purchased to help your practice reach out beyond current

patients and recent prospects. Practices should aim to send out a direct

mail (or email) piece at least quarterly.

Advertising. The days when paid advertising was the most important

marketing tool are long past, but for some services and products, nothing

is more effective than a targeted media advertising campaign. The key

to choosing the most cost-effective advertising avenues (ie. newspaper,

magazine, radio and television) depends on careful tracking of results

(more on that below).

Grass Roots Marketing, aka Professional Networking. Grass roots

marketing—what others call networking—involves the physician, the

practice manager and key staff members attending third party events, such

as Fashion Week soirées or local society events, and becoming involved

with civic, social and professional organizations. For instance, in a college

After the intial launch, you can begin to step down your

marketing budget allocation to 12% to 15% of targeted

revenue.


town, approaching sororities with

offers of makeover parties can

be a big winner; while in other

communities, attending charity

events and offering service or

product raffle items can give

your practice name a big boost

in notoriety. The specifics aren’t

as important as the fact that you

and your staff are “out there” on a

regular basis, visible and involved

in your community.

Referral Development.

Perhaps the most cost-effective

kind of medical aesthetic

practice marketing is referral

development—a fancy term for

asking and motivating patients

to refer others to your practice.

The difference between referral

development and just asking for

referrals can be the difference

between night and day. Without

an incentive, relatively few

people will make the effort to

make a referral. If someone

asks, “where do you go for ___,”

patients—and especially satisfied

patients—will make the referral.

however, to get people to take

the initiative requires motivation.

And motivation needs to be

something tangible. It can involve

a significant discount—20%

off your next service—or a free

service. The ideal motivator is

one that:

• Incentivizes a patient to make

a qualified referral at a cost to

the practice that is less than the

value of the new patient

• Brings the patient who made the

referral back to the practice for a

return visit service

• Creates goodwill among existing

patients and newly referred

patients

Setting a Budget

Once you have created a well-

rounded marketing plan, it’s

time to apply your budget and

implement tracking protocols

to measure your marketing ROI.

Marketing is an investment.

Investing enough money to

properly launch, grow or sustain

your medical aesthetic practice

will pay handsome returns on the

bottom line. As a rule of thumb,

marketing and sales support

should be budgeted at 20% of

anticipated (target) revenue for

the first 18 months for a startup

business or service. This level of

marketing investment should

continue until practice growth

has reached your initial revenue

target, ideally within 12 to 24

months.

After the initial launch, you

can begin to step down your

marketing budget allocation

to 12% to 15% of targeted

revenue per year. Once growth

targets are reached, a marketing

budget of 7.5% to 10% of target

annual revenue will help your

practice maintain its market

position against competitors and

continue incremental growth.

This generally occurs three to

five years into the life cycle of the

practice.

TARGET GROWTH

To track effectively, ask every caller and every patient how she first heard about your practice. This is just a start. You’ll also want to ask some followup questions to fine-tune your efforts. here is what to ask:

• How did you first hear about us?

• Did you also hear about us from ____? (list all of the marketing initiatives that could have reached her)

• Did you see our new ad? (print, radio, TV, online)

• Did you read about us in the recent newspaper article (or radio or TV news coverage)?

• Have you read our blog or visited our website?

• Did a friend discuss our practice with you? If so, can you remember who (if yes, tell her that you like to say “thanks” to patients who make referrals so she won’t feel like she’s betraying a confidence)

In some cases, after five to seven years in business, your practice will

reach what’s called in marketing the maturity phase, where rapid growth

has slowed and sales are steady. At this point, a marketing investment of

3.5% to 5% should prove sufficient.

Tracking Results

There’s an old saying, “If you’re lost, it doesn’t matter if you’re making good

time or getting great mileage.” In the medical aesthetics field, when it comes

to marketing, if you don’t take the time to track where your new business

is coming from, it doesn’t matter how much you invest in marketing. In

order to truly enhance your bottom line, you need to know where each

patient is coming from so you can concentrate your efforts in those areas

and decrease—or discontinue—efforts in less effective programs.

A few quick questions like these will give you a much more complete

picture of your marketing efforts from the user’s perspective. Once you

know what’s bringing prospects or patients in, it is helpful (though a bit of

a challenge) to compare each referral with dollars-and-cents procedures.

For instance, a press release on a new procedure might only bring in three

patients, but if those three patients are big-ticket service purchasers, then

the release paid off. Conversely, if a paid television advertisement brings in

dozens of patients for a deeply discounted service but those patients never

return, then although volume was high, the profit tied to that ad was low.

So track carefully, and compare your tracking information to bottom-line

revenue. It may seem like a lot of work, but done properly it can be one of

the most advantageous projects assigned to your staff.

When it comes to marketing in the long term, nothing beats word-of-

mouth, but at the same time nothing is harder to deliver, especially on

schedule. Whether you are operating a relatively new practice, looking to

boost bookings for specific procedures or simply concerned about keeping

a low-key but consistent message out there in your community, your

practice can benefit by making use of these marketing tools. The first step

is to set a goal, then create the plan, apply the budget and—over time—

pare down and adapt your marketing program to those efforts most likely

to generate measurable results. Then stand back and watch your practice

grow.

cheryl Whitman is the founder and ceo of Beautiful Forever, a medical spa consulting firm, and creator of the Aesthetic Medical success system: A complete educational Guide to Building, Managing, and Marketing Your cosmetic Practice or Medical spa. contact cheryl at 877.sPA.MeDI, beautifulforever.com, aestheticmedicalsuccess.com.

There’s an old saying,

“If you’re lost, it doesn’t

matter if you’re making good

time or getting great mileage.”


26–29 JANUARY IMCAS 2012 – Paris, [email protected], www.imcas.com+33(0)1 4073 8282

23 FEBRUARY Filler & Mesotherapy workshop by Dr Riekie SmitPretoria Filorga [email protected] 548 3943 / 082 494 7670

11 FEBRUARY AAMSSA Ethic function with AGM Speaker: Ulundi BehrtelGauteng [email protected] / 012 548 7152www.aestheticdoctors.co.za

6 – 7 FEBRUARYI2PL Training CSIR, PretoriaTechnolase – Louise, [email protected] 349 1750 / 083 379 3988

17-19 MARCH ISAPSLord Charles hotel, Cape [email protected], 011 784 4537

2 – 3 APRILI2PL Training CSIR, PretoriaTechnolase – Louise, [email protected] 349 1750 / 083 379 3988

18 – 22 APRILAmerican Academy of Aesthetic Medicine (AAAM):Level 2 – DIPLOMA in Aesthetic Medicine Protea hotel, Midrand, JhBMareli J v Rensburg, [email protected] / 012 548 7152

20 – 22 APRILAmerican Academy of Aesthetic Medicine (AAAM):Level 1 – CERTIFICATE in Aesthetic Medicine Protea hotel, Midrand, JhBMareli J v Rensburg, [email protected] / 012 548 7152

9 MAYFilorga Product & Glykopeel training Pretoria Filorga [email protected] 548 3943 082 494 7670

10 MAYFiller & Mesotherapy workshopby Dr Riekie SmitPretoria Filorga Laboratoires [email protected] 548 3943 082 494 7670

11 – 13 MAY SASDSCape Town Denise [email protected]+27 41 3745654

31 MAYAMCSA Pre-Congress*Level 1 Botulinum Toxin course*Expert Botulinum Toxin courseCSIR [email protected] 548 7152

1 & 2 JUNE 20127th Aesthetic Medicine Congress of South Africa (AMCSA) / www.amcsa.org 11 – 12 JUNEI2PL Training CSIR, PretoriaTechnolase – [email protected] 349 1750083 379 3988

1 AUGUSTFilorga Product & Glykopeel training Pretoria Filorga Laboratoires [email protected] 548 3943 / 082 494 7670

2 AUGUSTFiller & Mesotherapy workshopby Dr Riekie SmitPretoria Filorga Laboratoires [email protected] 548 3943 / 082 494 7670

6 – 7 AUGUSTI2PL Training CSIR, PretoriaTechnolase – Louise, [email protected] 349 1750 / 083 379 3988

4 – 7 SEPT 2012International Society of Aesthetic Plastic Surgery ISAPS 21st Congress - [email protected], www.isapscongress2012.org

1 – 2 OCTOBERI2PL Training, CSIR, PretoriaTechnolase – Louise, [email protected] 349 1750 / 083 379 3988

19-22 OCTOBER APRSSA, DrakensburgElite Conferences-hendrika v d Merwe [email protected], (021) 910 3322, 083 270 6344

24-27 OCTOBER3rd Continental Congress of the International Society of Dermatology [email protected], 0437435353

31 OCTOBER Filorga Product & Glykopeel training Pretoria Filorga [email protected] 548 3943 / 082 494 7670

1 NOVEMBERFiller & Mesotherapy workshop by Dr Riekie SmitPretoria Filorga Laboratoires [email protected] 548 3943 / 082 494 7670

5 – 6 NOVEMBERI2PL Training CSIR, PretoriaTechnolase – Louise, [email protected] 349 1750 / 083 379 3988

23-25 NOVEMBERAmerican Academy of Aesthetic Medicine (AAAM):Level 1 – CERTIFICATE in Aesthetic Medicine Protea hotel, Midrand, JhBMareli J v Rensburg, [email protected] / 012 548 7152

25-26 NOVEMBERAmerican Academy of Aesthetic Medicine (AAAM):Level 3 – BOARD EXAM South Africa,Protea hotel, Midrand, JhBMareli J v Rensburg, [email protected] / 012 548 7152

CALENDAR OF EVENTS

cALenDAROF AESTHETIC / ANTI AGING MEDICAL EVENTS Supplied as a service by the Aesthetic and Anti-aging Medicine Society of South Africa (AAMSSA) [email protected]

2012

14 – 16 FEBRUARY 201319th World Congress of Aesthetic Medicine 2013Cape Town, CTICCAMCSA organizing [email protected] 012 548 7152

TRAINING PROVIDED ON REqUEST

Sclerotherapy, Nutrition & Weight loss, Mesotherapy, Chemical Peeling, Aesthetic practice management & staff training, etc. PretoriaSoy Secrets of youthWinette [email protected] 442 7000015 291 2404

Microdermabrasion – all manufacturers and also on Synergie AMS systemsAnywhereStern LaserValerie van Zylwww.sternlaser.co.za083 628 9946

Lasers, IPL’S, Slimming and Cellulite units trainingJohannesburgRadiant [email protected] 794 8253

2013

The scalpel is no longer the only weapon to fight the signs of periorbital aging.

By Linda W. Lewis

periorbitalREVOLUTION

Crow’s feet and glabellar furrows dig in for the siege. Dispigmentation, unsightly veins and dark undereye circles take up offensive positions. Then the truly frightening enemies start their advance. Brows and lashes thin and fade; lids get heavier and begin to sag; bags develop under the eyes; and the surrounding skin becomes thin and crepey. Most women begin to camouflage these flaws long before they’re ready for blepharoplasty. Even those who would never consider cosmetic surgery happily spend whatever they can afford to defend themselves against these distressing signs of aging.

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“Those in their 30s and 40s start with Botox,

then add fillers in their 40s and 50s.”

“We are seeing an increased demand for minimally and noninvasive therapies for orbital rejuvenation, and not just because of the economy,” says Michelle R. Yagoda, MD, associate adjunct attending clinical instructor at the New York Eye and Ear Infirmary; medical director of Rejuvenessence Space for Beauty in Manhattan; and co-creator of Beauty Scoop, a patent-pending beauty supplement. “Lots of patients just prefer effective nonsurgical options. And there are many useful tools. What’s new is our ability to combine these minimally invasive treatments to achieve noticeable and natural results.”

To address the needs of women from 30 years old to 70 years old, aesthetic physicians are combining neurotoxins, dermal fillers, energy devices and skincare topicals to rejuvenate the periorbital region.

“My approach to periorbital rejuvenation starts with Botox, progresses to fillers and then lasers and skin tightening devices, depending on the patient’s specific needs,” says George J. hruza, MD, clinical professor of dermatology and otolaryngology, St. Louis University, and medical director of the Laser and Dermatologic Surgery Center, St. Louis. “This progression often follows the ages of patients. Those in their 30s and 40s start with Botox, then add fillers in their 40s and 50s, and lasers and skin tightening treatments in their 50s and 60s. Many patients want something other than surgical intervention even into their 70s.”

Can every patient benefit from these minimally invasive approaches? “Only surgery can repair large fat pads that have begun to herniate,” says Michael Sinclair, MD, dermatologist, Epilution Medspa, West Palm Beach, Florida. “But for women with mild to moderate sun damage, whether they are in their 20s or 60s, a combination of dermal fillers, neurotoxins, laser treatments and a good homecare regimen can turn back the clock.”

Battle LinesAesthetic practitioners agree that Botox Cosmetic (onabotulinumtoxinA, Allergan, botoxcosmetic.com) led the minimally invasive revolution. Now we have Dysport (abobotulinumtoxinA, Medicis Aesthetics, dysport.com), and XEOMIN (incobotulinumtoxin A, Merz Aesthetic, xeomin.com) with others in development. Most of our panelists use both Botox Cosmetic and Dysport almost interchangeably (XEOMIN

had just gained cosmetic clearance as we went to print). Both have FDA clearance for use on glabellar lines, but are also widely used in other areas of the face.

“Botox and Dysport are comparable in most cases,” says Dr. Yagoda. “Some patients have preferences and I try to honor those, although they rarely make sense to me. Dysport does have a slightly shorter onset of action, which could be beneficial to a patient who is getting treatment for an upcoming event. If there are lots of blood vessels in the way of the muscle I want to inject, Dysport might have an

advantage because it diffuses more, allowing me to affect the muscle without injecting as precisely.”

In the first head-to-head trial conducted at the University of California, San Francisco, and published in the July issue of Archives of Facial Plastic Surgery, 90 patients were randomly assigned to receive Botox to treat crow’s feet on one side of the face and Dysport on the other. After 30 days, two-thirds of the patients said they preferred the results in the area treated with Dysport. When the patients and researchers judged photos of the treated patients using a five-point scale, rating differences were statistically significant only in photos where the eye muscles were contracted, not when they were at rest.

After many years of use, neurotoxins have proved to be not only effective but safe. “The main danger is the possibility of affecting nearby muscles, which can lead to eyelid drooping or a feeling of heaviness in the eyelids,” says Dr. hruza. “Although this goes away in a few weeks, it makes patients uncomfortable.”

ReinforcementsWhile Botox may have started the revolution, it was the introduction of hyaluronic acid-based dermal fillers that enabled aesthetic physicians to wage an all-out war on periorbital aging. While there are rare reports of nodules and allergic reactions, hA-based fillers are generally safe and have the added advantage of being immediately reversible with the injection of hyaluronidase.

“Most patients have shadowing under the eye as they [reach] their late 30s,” says Saul Lahijani, MD, a plastic surgeon with a private practice in Beverly hills, California. “This can be corrected with fillers. My favorite for the eye area is Restylane (Medicis Aesthetics, restylaneusa.com) because it isn’t as hydrophilic [as other fillers]. The others absorb a lot of fluids

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PERIORBITAL REVOLUTION


and can cause edema.” Dr. Sinclair also likes Restylane for tear troughs. “I use a

blunt cannula for placement so there’s less bruising and it’s more comfortable for the patient. The technique may be a little more difficult to learn and is more time-consuming, but the results are worth it. You can slide the cannula right up to the medial aspect and layer the product underneath with little trauma.”

Dr. Yagoda also prefers Restylane. “It comes out of the needle in a more linear fashion,” she explains. “Juvederm (Allergan, juvederm.com) tends to come out as a series of droplets.”

“I use them all and, though there are subtle differences, I think you can achieve similar results with any of them,” says Dr. Sinclair. “The one exception may be Radiesse (Merz Aesthetics, radiesse.com), which is thicker. It’s my preference for deeper placement. I don’t use it in first-time patients, though. Radiesse may not last as long after the first treatment as it does after the second and third treatments, but it can’t be reversed like the hyaluronic acid fillers.”

Dr. hruza will use Radiesse for patients who ask for longer-lasting treatments, but only after he has established the look the patient wants. “I am always careful not to place any filler too superficially. I go right on the bone,” he adds. “I also occasionally use fillers under the eyebrow to raise it and improve definition.”

Heavy ArtilleryWhile lines and wrinkles may be held in check with strategically placed needles, erasing sun damage-induced discoloration and skin texture changes requires targeted equipment. Even surgery cannot repair dyschromia and thin, crepey skin. Intense pulsed light (IPL), lasers, radiofrequency (RF) and ultrasound energies have all shown the ability to erase or improve one or more of these concerns.

Laser Options. To say there’s no consensus about the best lasers for periorbital rejuvenation is an understatement. Eric F. Bernstein, MD, director of Main Line Center for Laser Surgery in Ardmore, Pennsylvania, specializes in laser treatments and uses many different tools, depending on the specific target. “One of my favorite treatments around the eyes uses the

Candela Perfecta (candelalaser.com) to remove broken (extra) blood vessels,” he says. “I often reduce fluencies for sensitive periocular skin. Even so, you do get some swelling when using lasers around the eyes so you need to warn patients. The results are worth it though.

“When it comes to brown spots, I prefer a Q-switched laser. The one I choose depends on how dark the patient’s skin is and the darkness of the spots,” continues Dr. Bernstein, who uses either the Candela TriVantage, Sinon Q-Switched Ruby (Palomar Medical, palomarmedical.com, formerly Wavelight Aesthetics) or ConBio RevLite (ConBio, conbio.com).

“When you get down to improving skin texture, enlarged pores, and fine lines and wrinkles, the Fraxel Dual (Solta Medical, solta.com) or the Cynosure Affirm (cynosure.com) are my favorites,” says Dr. Bernstein. “Downtime is minimal and progressive treatments yield progressively better results. Patients report skin tightening, but that’s a controversial topic.”

Four of the doctors interviewed use fractional C02 lasers

to improve skin texture and tone in the eye area. Resurfacing lasers address problems that can’t even be corrected with blepharoplasty, says Dr. Sinclair. “I use my Lux 2940 (erbium micro fractional ablative laser, Palomar Medical, palomarmedical.com) to tighten eyelids and shrink redundant folds,” he says. “If there’s dyschromia, I might suggest IPL treatments as well.”

Researchers at the University of Florence, Florence, Italy, studied 45 patients who received two to three treatments with a fractional CO2 laser in the upper eyelids, lower eyelids and the periorbital region for one year and concluded that fractional laser treatments allow physicians to achieve “notable improvements in eyelid skin tightening and brow elevation safely and without significant side effects.” Their results were published in the June 2011 issue of the Journal of the European Academy of Dermatology and Venereology.

One of the newest approaches to improving undereye dark circles is using the 1064 Nd:YAG laser. The June 2011 issue of Dermatologic Surgery includes a study from China assessing low-fluence treatments with a Q-switched 1064nm laser for the treatment of infraorbital dark circles. Twenty-six of the 30 patients who underwent eight sessions showed global improvement that they rated as excellent or good. Results


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Patient pre-treatment and 90 days post-treatment with the Ulthera ultrasound system.

Before After

• Laser Consultation • Laser Sales

• Laser Training • Laser Education• Laser Repairs • Maintenance

• Laser Installations.

Laser Skin Resurfacing & Rejuvenation

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Pigment Restoration

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Superficial VascularLesions

Vascular & PigmentedLesions

Skin Rejuvenation

Various Skin Conditions

Super Hair Removal

Skin Tightening

Leg Veins

Wrinkles &Acne Scars

Tattoo Removal

Fractional AblativeSkin Resurfacing

Hair Removal & Pigmented Lesions

Fat destruction & Skin tightening

LEGATO

Hair Reduction

Scars, Acne Scars & Strea

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also showed a dramatic decrease in melanin deposition in the upper dermis for these patients.

Dr. Lahijani is enthusiastic about using 1440nm or 1444nm lasers—which have an affinity for fat—to get rid of herniated fat on the lateral aspect of the eye. “I’ve used the Smartlipo Triplex (Cynosure, cynosure.com) with good results,” he says. “This technique is very new and not [many] surgeons are doing it. You don’t really suction the fat; you simply melt the fat and tighten the skin. I recently began using the Lutronic AccuSculpt 1444nm (lutronic.com). It’s used a lot in Korea. I’m impressed but waiting to assess longer term outcomes.”

Despite the widespread use of lasers in the periorbital region, there is always reason to be cautious when working in the eye area. “To work around the eyes you need a ton of experience, especially if you are using ablative tools,” says Dr. Bernstein. “Even with experience you need to be careful. Too much tightening under the eye can lead to ectropion. Good eye shields are essential. My favorites are Durette Shields; in my opinion they fit the best. With a small and large pair of external shields I can protect all of my patients.”

“I’m very careful when working with patients who have a history of dry eyes or laxity of the lower lid and those who have had previous blepharoplasty,” adds Dr. Lahijani. “I assess them more closely and am cautious about which procedures I offer. I almost always use intraocular eye shields because I think they are more comfortable for patients. When I use external shields, it seems they are always trying to sneak a peek around them. With the internal shields they seem to relax better.”


Radiofrequency and Ultrasound Energies. “The two newest tools for periorbital rejuvenation are Thermage (Solta Medical, solta.com) and focused ultrasound, which are used for eyebrow lifts and tightening eyelid skin,” says Dr. hruza. “I prefer the Thermage for eyelids because it has a small tip.”

The first and only system to receive FDA clearance for noninvasive eyelid treatments, Thermage has a specially designed Eye Tip 0.25 (ST) to deliver precise, shallow heating to smooth and tighten the skin of the upper and lower eyelids. The Face Tip 3.0 (STC) can be used to soften periorbital wrinkles and reduce hooding. Because it is not light energy, RF is safer for use on patients with dark skin.

The newest weapon for noninvasive skin rejuvenation is Ulthera focused ultrasound (ulthera.com), but it has not yet been widely used in the periorbital region. The device produces vibrations, which generate heat and selective coagulation in the focal region of the beam. Deep penetration (4mm to 5mm) means it works to tighten skin from the subcutaneous layers, rather than more superficially.

“I’ve encountered no permanent complications with RF devices or the Ulthera,” says Dr. hruza. “There were reports in early days of skin waffling in the eye area with Thermage, but that was because the initially recommended settings were too high. The main issue I face with RF is discomfort. I treat to patient tolerance.”

Addressing Discoloration. “To correct brown spots or abnormal blood vessels in the lower lid, I use the Clareon IPL (Novalis Medical, novalismedical.com), which employs krypton technology,” says Dr. Yagoda. “It produces a more focused and targeted wavelength. There is less potential risk and I can attach it to my chiller, which makes the treatment entirely comfortable. To correct looseness, I use a TCA peel, which tightens the skin, lightens it and gets rid of fine lines. TCA peels may not be as new as lasers but they are proven to produce results equal to or even superior to lasers and at half the price. Eyelids that have more looseness than can be treated with TCA peels need surgery.

“Every laser has a specific thing that it’s really good for,” Dr. Yagoda continues. “My concern is that once a physician buys a laser, the search begins for other ways to use it. Often the

results don’t justify the cost to patients. In most cases the benefits from RF or fractional lasers are too small to satisfy patients. As a female as well as a plastic surgeon, I’m always assessing how well the treatment solves the problem in relation to its cost. I’ve seen patients who have spent $10,000 on laser treatments without discernible benefits.” holding Ground“Using topicals to continue the good effects of office treatments is a key to longer-term success,” says Dr. Bernstein. “The skin around the eyes is so thin it responds well to topical alphahydroxy acids, retinoids and antioxidants. And it is always important to stress the use of a good sunscreen every morning.”

All of our panelists agreed that recommending daily sunscreen protection with the addition of dark glasses and hats is essential in combating periorbital aging. “I also recommend Phyto Gel (Skinceuticals, skinceuticals.com) or Teamine (Revision Skin Care, revisionskincare.com) to address dark circles under the eye,” says Dr. Yagoda. “NeoStrata Eye Cream (neostrata.com) treats fine lines, wrinkles and discolorations, and

has the added benefits of being highly moisturizing and nonirritating. It provides great value for the money.”

“My favorite skincare ingredients, which I include in my Epilution line, are salicylic acid, glycolic acid and stabilized vitamin C. The latest development in vitamin C derivatives—tetrahexyldecyl ascorbate—is oil soluble and penetrates readily to allow the skin to make collagen,” says Dr. Sinclair.

What about those thinning, fading brows and lashes that can make such a difference in the appearance of eyes? “I offer Latisse (Allergan, latisse.com), and my patients have had great results with it,” says Dr. Lahijani. “Some even claim success with using it (off-label) on their eyebrows.”

Dr. Yagoda recommends Latisse or lash tinting. “For my male patients and some women, I recommend eyelash tinting. having darker brows and lashes is really important to a more youthful look,” she adds. “Most women will solve the problem of thin, light eyelashes with mascara, but men usually won’t, so I have an esthetician in my office who offers lash tinting.”

Linda W. Lewis is MedEsthetics contributing editor.

“To work around the eye area, you need a ton of experience, especially if you are using ablative tools.”

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A combination of Botox cosmetic and Restylane injections plus IPL and an

HQ/vitamin c topical were used to smooth wrinkles and diminish dark undereye

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D greatTurn your poorly performing device into a winning profit center.

EQUIPMENT

ThE

turnaroundby Inga Hansen

Energy-based devices have become an integral part of the medical aesthetic specialty. With new and improved models hitting the show floors every year and big-budget consumer campaigns telling your patients to try the latest technologies, physicians face the perilous task of staying competitive without getting buried under an avalanche of cutting-edge devices that turn out to be duds. The five and sometimes six-digit price tags of aesthetic lasers and platforms necessitate a certain level of due diligence on the part of the buyer. Still, there are times when even well thought-out purchases fail to deliver. We spoke with equipment manufacturers and experienced practice owners to find out what steps a physician can take to turn around a poorly performing device.


Get The Entire Staff on BoardThough the physician handles the patient consult and recommends treatment options, there is an enormous amount of marketing and selling that goes on before the patient ever enters the treat-ment room. Accordingly, your employees are your most valuable allies when it comes to promoting new or lagging procedures. “Treat staff members [with the device] and ensure that all of your staff members are comfortable talking about the device,” says Paul Fried-man, MD, director of the Derma-tology & Laser Center in houston (dermlasersurgery.com).

Brad Renton, PhD, vice presi-dent of aesthetics at IRIDEX (iri-dex.com) concurs, noting that your sales rep and device manu-facturer should be able to provide a wealth of support in bringing staff members up to speed. “We spend a substantial amount of time working with every member of the staff from the receptionist to the patient counselors so they all know what the equipment is, what it does and how to talk to the patients about it,” says Renton.

“One of the best places you can market any of these procedures is to the existing patients in your office, so it is important that any-one in your practice who has con-tact with patients is aware of the equipment you offer, understands what these devices do and is com-fortable talking about these pro-cedures with the patients.”

Patients may also feel more comfortable speaking with the receptionist or nursing staff about possible treatments, notes Rent-on. If the staff member is edu-cated about the procedure or—better yet—has undergone the treatment herself, she can share the benefits she received first-hand. “Everyone in the practice needs to be comfortable talking about what the doctor does and the what the available services are,” says Renton. “This has to be the culture of the office.”

Reach Out To Existing Patients In addition to showcasing new procedures through brochures and waiting room videos, Dr. Friedman promotes new devices t o his existing patient base

through his practice’s e-newsletter, website and social media pages.

Renton also encour-ages these efforts, “If you have a Twitter feed

or Facebook page, defi-nitely do weekly posts

and updates to let your followers know that this is some-thing you’re offering in your prac-tice,” he says. “It’s often an easier

way to update patients than email because a lot of people aren’t comfortable giving out their email addresses, but they are happy to ‘like’ or follow you on social me-dia.”

Lisa Zdinak, MD, of Precision Aesthetics in New York and Miami Beach (precisionaestheticsmd.com) recommends creating a

“It is important that anyone in

your practice who has contact

with patients is aware of the equipment you offer.

Cosmetic dermatologist Paul M. Friedman, MD, is the director of the Dermatology & Laser Center in Houston. He is a clinical assistant professor at the University of Texas Medical School,

Department of Dermatology, and a clinical assistant professor of Dermatology at Weill Cornell Medical College, The Methodist Hospital.

Brad Renton, PhD, is the vice president of aesthetics at IRIDEX corporation, a developer and manufacturer of light-based medical devices.

Plastic surgeon Lisa A. Zdinak, MD, is the chief surgeon and medical director of Precision Aesthetics in New York. She is a member of the American Academy of Ophthalmology, the

American Society for Laser Medicine and Surgery, the American Medical Association, and the New York State Medical Society. She has authored several scientific papers and textbook chapters on the use of minimally invasive techniques for facial rejuvenation.

Sarah Brice, RN, is the director of clinical services at HOYA ConBio, a developer and supplier of laser-based medical aesthetic devices. She offers clinical training as well as business development

consulting for the company. Brice is also the former director of nursing with Dr. TATTOFF in Beverly Hills, California.

Robert Ruck is the executive vice president of sales and marketing at Sciton, a developer and supplier of medical aesthetic laser- and light-based devices.

Panel of Experts

Equipment Turnaround


specific landing page on your website dedicated to the new technology. In-clude a link to this landing page on all related social media posts, blogs and newsletter articles. This page should include educational content about the treatment as well as before-and-after images, notes Renton.

Open house events are growing in popularity among cosmetic physi-cians, because they work. “A lot of our customers have successfully used open house events where they offer demon-strations as well as food and drinks,” says Robert Ruck, executive vice president of sales and marketing, Sciton (sciton.com). “It’s a fun way to get the message out in a non-threatening way. Following the demonstrations, [patients] are of-fered a percentage-off discount on the first treatment [if they] book a consult that night.”

If the procedure requires multiple sessions, book the next session before the patient leaves, recommends Sarah Brice, RN, director of clinical services,

hOYA ConBio (conbio.com). “I’m also a big believer in following up with all your patients,” says Brice. “You need to have a good way of tracking the last time [a] patient was in the office so that you can call her when it’s time for her next treatment. And follow-up with consults who don’t book the procedure in the consultation. This is someone who took the time to look at your website, make a phone call and come in for a consult, so there’s definitely interest there. Maybe she didn’t have the money, or maybe she went home to think about it and then got busy and never called to book the appointment. So following up with your patients and consults is very im-

portant.”

Take Advantage Of All Manufacturer-Provided Support. Manufacturers offer a plethora of marketing materials and training seminars. If you’re not already taking advantage of them, don’t be shy. “Go to any and all semi-nars offered by the company in your area,” advises Dr. Zdinak.

Brice recommends seeking out training programs with cli-nicians who are using the device in clini-cal practice. “This way, you get a lot of practice-building tips in addition to the clinical training,” she says.

At Sciton, each customer is provided a ‘work kit’ when he purchases a new system. “There are advertising and email blast templates; radio message scripts; posters; counter cards; brochures—a variety of materials that can be used to market the practice and the system,” says Ruck. “In addition to the kits and

our sales reps, we have third-party marketing experts available.” The company can help coordinate sessions with these experts—many of whom are practicing physicians—at the customer’s practice, by phone or at the trainer’s clinic.” The cost will vary based on your supplier and the number of sessions you are seeking, but often a base number of marketing sessions are included with the purchase of a new device, and additional support is available at an additional fee.

Other support to discuss with your supplier includes webinars, national or regional seminars, and preceptorships that allow you to train with one of the

c o m -pany’s clinical expert physicians in his practice. In addition to the clinical training, “the physician will share how he operates his practice, his menu of services and pricing, so you can get some practical tips by seeing the device in practice,” says Ruck.

Incentivize ReferralsWord-of-mouth advertising is your most powerful means of promoting new services, and you can encourage happy patients to sing the praises of a recent procedure and refer friends, colleagues and family members by re-warding referrals. “For example, if three people come in for a procedure and mention the patient’s name, she gets a free treatment,” says Ruck. “This is a valuable reward for an achievable task. Patients can typically find three people to refer.”

“Also, you can incentivize your staff to sell certain procedures by offering a monthly bonus based on an increase in bookings for specific procedures,” says Renton.

Use the Device to its Full Potential “Most lasers will treat a multitude of indications, but most clinicians buy a device with one specific treatment in mind,” says Brice. “If you bought the de-vice to offer tattoo removal, but it also does skin rejuvenation and laser toning, think about offering these treatments to your patients.” Not only does this al-

Manufacturers offer a plethora of marketing materials and training

seminars. If you’re not already taking advantage

of them, don’t be shy.

Equipment Turnaround

GREAT EQUIPTMENT TURNAROUND


low you to get the most out of your laser system, it broadens the word-of-mouth about your laser treatments, in general.

Reach Out To New PatientsJust as the Web is a great medium to communicate new treatments to existing patients, it’s also a vast and cost-effective means of reaching new patients. Dr. Zdinak regularly blogs about new technologies (dr212renew.com), posts YouTube (YouTube.com) videos of new procedures, and she is also a big believer in Google Ads. (For more information on online key word advertising, see “Target: Growth” on page 10.)

Other options for reaching out to new prospects include paid advertising through direct mail pieces or in regional news-papers, magazines, radio and even television (don’t forget to

take advantage of the images, templates and copy provided by your supplier). “Some of the best advice I’ve

heard is that if you want to make XXX

dollars a month in your aesthetic practice, you need to spend at least 10% of that amount on marketing,” says Ruck. “There’s got to be a conscious decision to spend money to generate that business.”

“There are a lot of mixed reviews out there on Groupon,” says Brice. “From what I’ve seen, it works. You do get bargain hunters who only come in once, but you also get people inter-ested in your treatments who needed a little push.”

A less expensive option is public relations or PR. “It can be as simple as sending out press releases to local media,” says Renton. “They’re often interested in medical stories for their broadcasts and pages, so—especially with newer proce-dures—let them know you offer them. They may want to run a spot with you.”

If there is a charitable tie-in that can promote your practice and specifically this new device, this can bring a lot of positive press coverage as well, says Brice. “For example, if you’re intro-ducing tattoo removal, you could offer to remove gang tattoos for free,” she says.

Whatever mix of marketing and PR you decide to launch, “make sure you have a metric in place to track the effectiveness of that campaign,” says Renton. “The first metric is the number

of contacts you get from that effort, the second is the number of procedures you book. This allows you to make sure that the external marketing expenditure makes sense.”

Finally, “if a technology is not bringing in the revenue you were expecting, consider lowering the price to the patient,” says Dr. Friedman.

Re-Evaluate Your ProcessIf you’ve found yourself struggling under the weight of an expensive device that’s not performing to your expectations, you don’t want to repeat the situation. The one upside of this predicament is that it allows you to re-evaluate your process and develop a better system for investigating new technologies. Dr. Zdinak takes the following steps to research new technologies prior to making a purchase:• Scrutinize before-and-after photos provided by the

company to make sure that they are not manipulated through the use of different lighting, positioning or makeup

• Attend seminars provided by the company and speak to several non-competing physicians who have the device

• Ask the company for physician references to find out how the technology is working in clinical practice

• Ask your patients if they would be interested in doing this type of procedure

• Make sure that you can afford any consumables • Determine if someone else in the practice can perform the

procedure (besides an MD) • Calculate how much the procedure will cost in hours ver-

sus revenue (i.e, is it more beneficial to do four Restylane patients versus one patient with the new device.)

“All of these things need to be decided before you buy,” says Dr. Zdinak, who also recommends asking the company if they will lend you a machine for a 30-day trial. “Then offer a few select patients free treatments in return for their feedback on the device,” she says. “You should be able to pre-sell the new technology to at least 10 existing patients before you bring it into your office. If you can’t pre-sell at least 10 existing patients, then there is something wrong with the device for your individual practice demographic.”

Inga hansen is the executive editor of MedEsthetics.

“If you can’t pre-sell at least 10 existing patients,

then there is something wrong with the device for your individual

practice demographic.”

GREAT EQUIPTMENT TURNAROUND


cYtoRI COMPANY OVERVIEW

Cytori Therapeutics is a world leader specializing in the development of medical technologies that enable physicians to use the body’s resources, such as adult stem and regenerative cells from a patient’s adipose tissue, for clinical benefit.

The Company was founded with a commitment to improve patients’ quality of life and provide physicians around the world with innovative, cell therapy-based medical technologies that address unmet medical needs.

In cooperation with its partners, Cytori develops, manufactures, and globally markets medical devices that are based on unique adult stem and regenerative cell extraction methods, ground-breaking research, and novel clinical approaches, enabling the practice of regenerative medicine in ways that would not otherwise be possible.

Cytori’s core technology, the Celution® System, provides fast, easy, point-of-care access to a clinical grade mixture of stem and regenerative cells from human adipose tissue. As a platform technology it automates and standardizes the extraction and concentration of a patient’s own adipose-derived regenerative cells (ADRCs) for use at both, the point of care or for future clinical or research use. Celution is broadly applicable for a wide range of diseases.

The publicly traded company (NASDAQ: CYTX) was set up in 1996, and was ranked as one of the World’s Most Innovative Companies by leading business magazine Fast Company in 2010.

FAST FACTS

YEAR FOUNDED 1996LOCATION headquartered San Diego, California, USA Offices in Zug, Switzerland / Tokyo, Japan / Mumbai, IndiaEMPLOYEES 128+PRODUCTS Celution® – Fat Tissue and Cell Processing System StemSource® – Fat Tissue and Cell Bank PureGraft™ – Fat Tissue Processing SystemPARTNERS / INVESTORS Olympus Corporation / The Olympus-Cytori Joint Venture Design & Manufacturing / Since 2005 / Approx. $55 millions Green hospital Supply / StemSource® Cell Bank Commercialization Asia Since 2007 / $18 million GE healthcare / Product Commercialization in North America & Europe Since 2009 / $25 million loan Astellas Pharma Inc. / Strategic Equity Agreement / Right to negotiation liver disease development & distribution Since 2010 / $10 millions

PRESS RELEASE

PRODUCT REVIEWS

PRODUCT REVIEWS

01 The Soprano XL 810mm diode laser is the solution to eliminate any unwanted body hair. The Soprano is a revolutionary diode laser laser system for permenent hair reduction and also skin tighening. It is the worlds first hair removal system that is virtually painless. The reason it is virtually pain free is because Alma has developed an in motion technology that means that one does not need to keep the hand piece in a stationary position, but move it around in a circular motion which will also minimize the chance of missing a hair and also speeds up the procedure. Conventional lasers use a “high peak power”, but the “in motion” technique uses a “high average power” and the cumulative energy is important. But if you like the traditional method you now have the choice between the two. The Soprano can treat all skin types even tanned skin. The size of the tip is a 12x10mm spot and up to 10hz. There are no disposable tips on the Soprano. In addition, the new skin-tightening module can further expand your aesthetic offering by tightening and re-contouring loose skin. Its another in demand application for today’s aesthetic minded consumer. Contact: Best Lasers: 012 998-9844, [email protected]

02 Fractionalise your present Co2 or Erbium laser Alma Lasers has released a Pixel Omnifit which is the perfect solution for any practice with an existing Co2 / Erbium system looking to offer fractional laser treatments. The Pixel Omnifit hand piece combines the proven effectiveness of an ablative approach with a level of patient comfort and convenience that approaches a non-ablative solution. Pixel Omnifit offers: Your choice of 7x7 or 9x9 pixel array, Pixel perfect skin revitazation, Significant reduced downtime, compared to traditional resurfacing. Contact: Best Lasers, 012 998-9844, [email protected]

03 eLase - painless hair removal – most cost effective laser technology launched by Syneron! Syneron’s new eLase system offers painless laser hair removal via its “motif” function. Delivering more than 4 million pulses from its applicator (at 5cents per pulse) makes it one of the markets most cost effective systems.

By using Syneron elōs (laser and RF) technology all hair colors and skin types can be treated safely!

01

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04 CYNOSURE ELITE - HAIR REMOVAL LASER - LASER HAIR REMOVAL DEVICE Cynosure’s Elite Aesthetic Workstation is the most comprehensive laser hair removal system available today. Since it’s designed for all skin types, you can treat the broadest range of clients. In addition, the system is optimized for effective treatment of facial and leg veins, as well as benign epidermal pigmented lesions.

The Best of Both Worlds

The Elite removes unwanted hair with unsurpassed efficacy and client comfort. That’s because its revolutionary technology combines two optimal wavelengths in one system: the 755-nm Alexandrite laser and the 1064-nm Nd:YAG laser.

Since you can switch between wavelengths during a single procedure, you can select the most appropriate laser for any given hair or skin type. You can also perform multiple procedures on the same client during the same visit. As such, you won’t have to compromise performance capabilities—and you won’t have to purchase two separate laser hair removal systems to ensure both optimal results and client safety. What’s more, you’ll be able to administer treatments in significantly less time than with a single-wavelength product. For more information please contact Intamed: 011 444 0404 | [email protected] | www.intamed.co.za

05 JAN MARINI ANTI-OXIDANT LINE Sun protection must be considered an essential element of every Skin Care Management System. For sunscreen to be truly efficacious, it must contain a critical balance of agents that can adequately protect the skin from damaging UVB and UVA rays through the entire UV spectrum. Protection can be greatly enhanced by the addition of topicals and antioxidants that can further protect the skin’s immune function, prevent damage to DNA and further enhance photo-protection. The Jan Marini Skin Research Antioxidant Line features state-of-the-art broad spectrum sun protection to cover both UVA and UVB rays. In addition, our unique sun protection formulas combine cutting-edge microscopic sponge encapsulation technology, powerful antioxidant components and a superb hydrating complex for extraordinary skin protection and rejuvenation. For more information please contact Intamed: 011 444 0404 | [email protected] | www.intamed.co.za

06 LET YOUR BEST SkIN SHINE THROUGH - POLISH AND REFINE wITH MICRO CLEANSE EXFOLIANT On average, most people produce approximately 35,000 dead skin cells every single minute! These tiny cells can block pores and cause unsightly problems such as acne, blackheads and dull, lifeless looking skin.

Alpha-h’s Micro Cleanse Exfoliant is a secret skincare weapon as when used regularly this key product improves the tone, texture, and clarity of the skin as well as improving its ability to absorb other skincare products. Magic! Exfoliation is a process of rejuvenating the skin by removing the dead cells from the upper surface of the skin. This not only helps to bring the glow and freshness back to your complexion, but also helps the skin to stay healthy and soft looking.

“The benefits of this granulated exfoliant are immense. Perfect for all skin types, it truly removes imbedded impurities from the skin’s pores and leaves you feeling like you’ve just had a treatment at the salon!” -Michelle Doherty, Owner and Director Alpha-h. This skin smoothing scrub contains properties such as 12% Glycolic Extract which eliminates dead skin cells and removes dulling surface debris, which dramatically improves the skin’s appearance. Unique ingredients of Cucumber and Rice Bran Extract cleanse pores and balance ph levels, directly targeting pigmentation and imperfections, which has a brightening effect on the skin.

Peppermint Oil works to invigorate the skin and helps improve the appearance of fine lines and wrinkles while leaving your face smelling oh-so-delicious.

Not only will this product refine the skin’s texture but it will enhance the penetration of age-fighting actives into the skin, making it an essential part of one’s skincare regime.

Don’t let your skin go another day looking dull and lifeless. Brighten your complexion and renew your skin with Alpha-h Micro Cleanse Exfoliant.

For media enquiries or information on the Alpha-h range please contact Christina Bowman on 079 527 1232 or e-mail [email protected]

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PRODUCT REVIEWS


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07 DMk EFA+ DMK efa+ - based on the knowledge of the cell functions and their

nutritional needs. Essential means they must be obtained directly from a dietary

source because the body cannot produce them. The question is with the frantic pace

of life, does your diet contain a reliable source of essential elements? Why DANNÉ DMk

efa+ Using the most expensive CO2 extraction method, we ensure the least structural

damage to the extracted oils without adding trace toxins. This means you get all the

bioactive properties at their highest potency • Evening Primrose Oil • Seabuckthorn

• Vit E. The use of fish sourced gelatin eliminates any fear of BSE contamination.

Available from Danné Montague-King, 011 262 6120 [email protected]

08 ELASE - PAINLESS HAIR REMOVAL – MOST COST EFFECTIVE LASER

TECHNOLOGY LAUNCHED BY SYNERON! Syneron’s new eLase system offers

painless laser hair removal via its “motif” function. Delivering more than 4 million

pulses from its applicator (at 5cents per pulse) makes it one of the markets most cost

effective systems. By using Syneron elōs (laser and RF) technology all hair colors and

skin types can be treated safely! For more information contact Radiant healthcare.

Office 011-794-8252, Mobile Jacques 082-829-9300, Melissa 082-306-5138 Email:

[email protected], Website: www.radianthealth.co.za

09 RADIANT HEALTHCARE TO LAUNCH NEw NON-INVASIVE

“LIPOTECHNOLOGY”!! Radiant healthcare was recently awarded the Coccon

distributorship from Spain. One of the products in the Coccon range – is Lipotechnology

system. It uses ultrasound (cavitation) technology to most effectively treat (stubborn)

body fat, thighs, buttocks, stomach, arms, hips etc. The Lipotechnology system

is a breakthrough for the body treatment market. This CE approved system comes

at an unbelievably low introductory offer! For more information contact Radiant

healthcare. Office 011-794-8252, Mobile Jacques 082-829-9300, Melissa 082-306-5138

Email: [email protected], Website: www.radianthealth.co.za

10 wITH ALL THE NON-INVASIVE BODY CONTOURING (LIPO) PRODUCTS

OFFERED ON THE MARkET TODAY VERY LITTLE IS OFFERED AND DONE TO

PROMOTE ADEqUATE LYMPH DRAINAGE FOLLOwING TREATMENTS! Without

lymph drainage most non-invasive contouring and lipo orientated products will not

give the desired result.Radiant healthcare will be launching the Presotechnology

system from Coccon! · The Presotechnology system promotes lymphatic drainage,

blood circulation and stimulates the metabolism · Automated system with 14

independent compression segments and application levels · Easy to use: no accessories

with tubes TREATMENTS · Lymphatic system opening and drainage · Fat dissolution ·

Post exercise · Post trauma · Blood circulation and metabolism improvement · Chronic

venous insufficiency · Venosclerosis · Limb convulsion. For more information contact

Radiant healthcare. Office 011-794-8252, Mobile Jacques 082-829-9300, Melissa

082-306-5138 Email: [email protected], Website: www.radianthealth.co.za

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PRODUCT REVIEWS


The use of a highly pigmented

MAkEUP FOUNDATION TO COVER COSMETIC DEFECTS

both in Stable & Evolving Skin Conditions

submitted by Dr. Lawrence Birnbaum, M.D., Beverly Hills, cA

DANNé MONTAGUE-KING ADVERTORIAL

GOALS/PURPOSE:To demonstrate the laudable properties of a newly formulated highly pigmented makeup foundation for its use in both stable and evolving skin conditions.

THESE INCLUDE:1. A requirement to employ minimal amounts of the makeup

(generally less than 1/5th of conventional commercially available formulated foundations) to cover all manner of skin conditions.

2. A markedly more lasting duration to the applied foundation which virtually resists alteration or removal by the body’s sweaty secretions or even the ordinary abrasive wear and tear of the clothing coming in contact with the covered areas.

3. A low incidence of intolerance by the wearer.4. A minimal visibility of the applied foundation due to the

paucity of product required for coverage of even very dark lesions and conditions.

5. A concomitant dramatic masking of fine lines due to the layering of the microscopic strands of nylon-12 that is integral to the formulation of this foundation.

METHODS/TECHNIqUE:The author will demonstrate a newly formulated makeup foundation which, unlike the commercially available products, does not contain any oils or petroleum based products but rather is largely silicone based. The resultant formulation allows for inclusion of as much as 47% to 53% of pigment (depending on the intended skin color for its use) which will cover such conditions as multicolored dark tattoos, post-surgical bruising and post laser and burn erythema. In

addition it will be demonstrated that the patients themselvescan learn to alter the applications of the pigmented foundation to keep up with the evolving changes they are experiencing during the healing process. Materials and equipment are also affordable, easy to learn to apply and to adapt to each individual’s unique needs. Photographic documentation of each of the subjects and their conditions will be demonstrated before, during and after applications of the foundation as well as a short video presentation illustrating the aesthetician’s steps on both static and evolving skin conditions.

RESULTS/COMPLICATIONS:This paper has demonstrated the use of a newly formulated highly pigmented makeup foundation which offers an exciting major advance in our abilities to cover all manner of skin lesions, color variations and evolving healing phases. Because each condition only requires a relatively small amount of the covering agent it has to an attendant minimal ability to detect the corrections obtained (no heavy makeup look.) To date none of the subjects treated with the foundation have had any adverse reactions or complications develop.

CONCLUSION:The author demonstrates that only a relatively small amount of a new ultra highly pigmented makeup base is needed to cover conspicuous skin discolorations including dark tattoos.

The product is much less perceptible to any potential viewer due to the small amounts required to conceal any defects. The techniques of application are easy to learn even when discolorations are changing and the product is not nearly as costly as competing and less effective formulations.


Over 60 different clinical and aesthetic applications

The harmony xl gives you ultimate flexbility to treat a wide variety of patient-requested procedures. The system’s modular handpieces are designed to deliver effective and reliable results with minimal to no patient discomfort and downtime.

No single device will do more than the harmony xl to expand your aesthetic treament offerings and help grow your practice revenue.

WoRLD’s Most

versatile & expandable platform for

aesthetic laser & light treatments

The Harmony xl is the wolrd’s most versatile and expandable platform for aesthetic laser and light treatments. Its modular design provides your practice multiple distinct cosmetic solutions all built into one compact unit. With Harmony xl, you can purchase only the handpieces you require today and add new technologies as your practice grows.

· Ten distinct technologies, with many integrated contact cooling· 60 + aesthetic/medical applications· high output energy for greater efficacy· Expandable and upgradeable· Easily transportable from room to room and between facilities· Offers Alma’s exclusive patient-preferred treatments of Laser360™, Pain-Free, hair-Free™ and Pixel Perfect™.· Customised to fit your practice· Affordable with a high return on investment· IN-Motion™ Technology

Contact: Best Lasers: 012 998-9844, [email protected]

Best Lasers Advertorial


BEST PRACTICES

01 LIPO FAT REAPPEARS, BUT IN NEw PLACES Fat that is removed from the hips during liposuction comes back within 12 months in the abdomen, according to a study published online on April 7, 2001 in the journal Obesity. For “Fat Redistribution Following Suction Lipectomy: Defense of Body Fat and Patterns of Restoration,” University of Colorado-Denver researcher Teri L. hernandez, et al, followed 32 non-obese women with disproportionate adipose tissue in the lower abdomen, hips or thighs. A control group of 18 women received no liposuction, 14 participants underwent small-volume liposuction. The researchers recorded baseline body composition measurements for all subjects using dual-energy X-ray absorptiometry, abdominal and limb circumferences, subcutaneous skinfold thickness and magnetic resonance imaging in the torso and thighs. The measurements were repeated six weeks, six months and one year out, and the participants agreed not to make lifestyle changes while enrolled. At six weeks, body fat decreased by 2.1% in the liposuction group and by 0.28% in the control group. The difference decreased at six months and by one year, the difference in the groups was no longer significant. But, the adipose tissue did reaccumulate differently among different sites. In the liposuction group, the thigh region remained reduced while the adipose tissue reaccumulated in the abdominal region. The researchers conclude, “Body fat was restored and redistributed from the thigh to the abdomen.”

02 A NEw STEP IN TELECONFERENCING Dermatologist Steven hacker, MD, can make a visual diagnosis of emergency skin conditions, even when he’s not in the office, thanks to a new telepresence robot now roaming the halls of his Palm Beach County, Florida-based practice. The VGO robot (pictured) allows Dr. hacker to remotely interact with patients in his practice. While he does not use the robot to evaluate moles, pigmented lesions or possible skin cancers, due to a lack of fine resolution and zoom functionality. “For pattern recognition in acute rashes such as shingles or poison ivy and post-operative complications, for example, it is more than adequate,” says Dr. hacker. For more information visit vgocom.com.

03 NEw HOPE FOR PERSISTENT wOUNDS Researchers at the University of Wisconsin-Madison have developed a new technology that may destroy bacteria in persistent wounds. Author Ankit Agarwal and his team created an ultra-thin antibacterial coating made of extremely fine silver nanoparticles. The coating—just a few molecules thick—was assembled on a flexible piece of rubber and then rubber-stamped onto a piece of cadaver skin that had been incubated with Staphylococcus epidermidis and Pseudomonas aeruginosa bacteria. Within 12 hours, the bacteria were undetectable in the skin that was stamped with the silver ions. The doses of silver used by the researchers were “below that which is cytotoxic to NIh 3T3 mouse fibroblast cells.”

04 FLAT FEE FINANCING Private practices have a new option for patient financing. healthcare Finance Direct is offering independent healthcare providers in-house financing services that include flat fee, interest-free payment schedules for providers and their patients. For more information visit healthcarefinancedirect.com.

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BEST PRACTICES


TECHNOLASE ADVERTORIAL

LIPo LAseRTraditional liposuction does have associated drawbacks like increased blood clots, ecchymosis, long recovery time, trau-ma, emboli, visceral perforation seromas.

Laser assisted lipolysis is a minimal invasive surgical proce-dure. A thin canula with a laser fibre is inserted through a tiny incision in the skin up to the fatty deposits in the hypodermis where the laser light e.g. Nd:Yag cause the swelling and rup-ture of the adipocytes.

This procedure provides patient tolerability, shorter recovery time and skin tightening. Nd:Yag laser lipolysis is particularly good in areas that tend to exhibit greater lasticity after the removal of adipose tissue e.g. neck, jowls, upper arms, abdo-men, inner thighs and knees. The laser liquefies the adipose tissue and larger volumes can be removed. There is less trau-ma, faster recovery, less ecchymosis, less blood loss and af-fords skin tightening which may last up to 8 months. In some cases 1/3 patients still exhibit edema and mild accymosis but less severe and for shorter time than standard liposuction.

The Fotona Nd:Yag 1064nm la-ser lipo was the pioneer for laser lipolysis for over 10 years during which it has been evaluated in many clinical studies (1-5).

In a paper by Matjaz Lukac et al. Journal of Laser and health Academy 2009:4:p1-12 they com-pared the Fotona Nd:Yag 1064nm with other laser devices (includ-ing diode lasers) with 920nm, 980nm, 1064nm and 1320nm and 1440nm, for safety and efficacy of laser lipolysis procedures.

Analysis of the fat/dermis on thermal effects showed to be the smallest with 1064nm laser. At other wavelengths the thermal

effects are more expressed and can exceed the maximum al-lowed temperatures.

The 1064nm laser showed the largest size of thermal volume where as 920nm or 980nm diodes were smaller probably ac-counting for the now commonly found hot spots, lumps and bumps. In many cases the doctor has to revert to endermol-ogy type procedures e.g. LPG, Vela, G5 to “iron” out bumps. ND:Yag 1064nm is one of the most efficient lasers with lowest temperature at the surface <65oC which is the end point but with largest depth of thermal volume.

The latest ND:YAG laser devices can be used not only for la-ser lipolysis but also for endo and exo vascular procedures, FRAC3 skin rejuvenation, acne treatments, hair removal, and other procedures. The high performance and versatility of the latest technology solid crystal ND:YAG 1064nm laser systems, combined with their optimal efficacy and safety, make these lasers the medical devices of choice when compared with other wavelength devices for laser lipolysis.

Downside

Apart from lumps and bumps forming doctors are finding that procedures with unqualified devices take a very long time to perform lasting several hours. A well known Dr K in Johannesburg now gets many referrals to repair the compli-cations of these procedures. Several Doctors in South Africa are now opting for the more efficient and safer 1064nm Fo-tona laser lipo.

Alternatives

One alternative to the time consuming laser assisted lipolysis which requires additional aspiration is the radio frequency assisted lipolysis (RFAL). In this case the conventional liposuc-tion is combined with radio frequency built into the canula tip which heats and liquefies fat in conjunction with the as-piration so that fat removal and skin tightening occurs at the same time and this is less time consuming and four times faster than laser lipo. The Body Title device is the only one of this nature.

See also handpiece in operation affording safe and uniform heating.


TECHNOLASE ADVERTORIAL

The pros and cons of this technique compared with laser lip can be seen in the following table

Only one treatment is required compared to with several in some laser lipo treatments. ReferencesKh Kim and RG Geronemus, Laser Lipol-ysis Using a Novel 1064nm ND:YAG La-ser “American Society for Dermatologic Surgery (2006). Published by Blackwell Publishing.KS Massoud, SM Aboul Fotouh and DM EL Sherbiny “Evaluation of Blood Loss in Laser-Assisted Liposuction”T Taine, WT hankins, and SM Sohn, “Laser-Assisted Lipolysis with a 1064nm Nd-YAG Systems with Select Plus”K Ichikawa, M Miyasaka, R Tanaka, R Tanino, K Misukami, and M Wakaki “his-tologic Evaluation of the Pulsed Nd:YAG Laser for Laser Lipolysis “Lasers in Sur-gery and Medicine 36 (2005): 43-46.A Goldman, DE Schavelzon and GS Blugerman, “Laserlipoysis: Liposuction Using Nd:YAG Laser” Rev. Soc. Bras. Plast., Sao Paulo, (17-26 January 2002)


For more information on JanMarini, please contact Intamed on 0800 110 679 or visit janmarini.co.za for detailed information.

INTAMED ADVERTORIAL


About SyneronSyneron™ Medical Ltd. is the recognized world leader in the aesthetic device market. The company develops, manufactures and distributes medical aesthetic devices that are powered by proprietary, patented elos™, a combined energy technology of bi-polar radio frequency and light.

The innovative elos technology is the foundation for efficacious, safe and cost-effective systems that enable physicians and aesthetic professionals to provide advanced solutions for a broad range of medical aesthetic applications treating both the face and body.

With its undisputed pioneering approach to aesthetic treatments, Syneron has now ventured out into one of the largest in-demand applications, skin lightening. elure™ products are based on a breakthrough lightening technology, with proven clinical results in a considerably shorter time when compared to other modalities available on the market.

Syneron has offices and distributors throughout the world, including a headquarters in Israel; a North American headquarters in Irvine, California; an Asia Pacific headquarters in Hong Kong and subsidiaries in Spain, France, Italy, Portugal, UK, Japan, Australia and China.

www.syneron.com, [email protected] Healthcare are distributors for Southern Africa

www.syneron.com · [email protected]

RADIANT HEALTHCARE ADVERTORIAL


Natural R

adiance. Pure B

eauty.Advanced Skin Lightening

Breakthrough patented natural enzymelignin peroxidase (trademarked Melanozyme™ by Syneron)

Revolutionary approach to topical skin lightening The first topical skin lightening product that works by temporarily reducing melanin in the skin to improve skin appearance

Excellent safety profile elure is very safe, with no safety concerns seen in 4 clinical studies

Non-irritating No side effects were found to be directly related to LIP exposure in comprehensive preclinical studies or in 4 clinical trials, which means no sloughing and shedding

Rapid results Majority of patients see benefits in the first month

Hydroquinone free Does not include any other existing skin lightening

active ingredients

Dermatologists tested & clinically demonstrated



INTAMED ADVERTORIAL

For treatment information or to purchase a Pelleve system contact: Intamed – Tel: 011 444 0404, E-mail:[email protected]


INTAMED ADVERTORIAL


Let YoUR Best sKIn

sHIne tHRoUGH - PoLIsH AnD ReFIne WItH MIcRo cLeAnse exFoLIAnt

“The benefits of this granulated exfoliant are immense. Perfect for all skin types, it truly removes imbedded impurities from the skin’s pores and leaves you feeling like you’ve just had a treatment at the salon!” -Michelle Doherty, owner and Director Alpha-H

On average, most people produce approximately 35,000 dead skin cells every single minute! These tiny cells can block pores and cause unsightly problems such as acne, blackheads and dull, lifeless looking skin.

Alpha-h’s Micro Cleanse Exfoliant is a secret skincare weapon as when used regularly this key product improves the tone, texture, and clarity of the skin as well as improving its ability to absorb other skincare products. Magic!

Exfoliation is a process of rejuvenating the skin by removing the dead cells from the upper surface of the skin. This not only helps to bring the glow and freshness back to your complexion, but also helps the skin to stay healthy and soft looking.

This skin smoothing scrub contains properties such as 12% Glycolic Extract which eliminates dead skin cells and removes dulling surface debris, which dramatically improves the skin’s appearance.

Unique ingredients of Cucumber and Rice Bran Extract cleanse pores and balance ph levels, directly targeting pigmentation and imperfections, which has a brightening effect on the skin.

Peppermint Oil works to invigorate the skin and helps improve the appearance of fine lines and wrinkles while leaving your face smelling oh-so-delicious.

Not only will this product refine the skin’s texture but it will enhance the penetration of age-fighting actives into the skin, making it an essential part of one’s skincare regime.

Don’t let your skin go another day looking dull and lifeless. Brighten your complexion and renew your skin with Alpha-h Micro Cleanse Exfoliant.

For media enquiries or information on the Alpha-h range please contact Christina Bowman on 079 527 1232 or e-mail [email protected]

Alpha-H Advertorial


ALPHA-H AntI-AGInG coLLectIon

With Alpha-h it’s never too early or too late to start looking after your skin. Our Anti-Aging Kit is suitable for all ages and has been designed to deliver fresher, firmer and more supple, skin in just days. This kit is ideal for all skin types, in particular dry and more mature skin.

The Anti-Aging Kit contains a 50ml Balancing Cleanser, 50ml Rejuvenating Cream, 100ml Liquid Gold, Daily Essential Moisturiser SPF 30+ and a 15ml Age Delay Facial Oil.

The Alpha-h Balancing Cleanser is a gentle creamy cleanser that softly hydrates and cleanses the skin without drying and stretching. This cleanser removes all traces of face and eye makeup whilst balancing the skin. The Rejuvenating Cream is a Luxurious skin refining formula – which encourages collagen production, smoothes away lines and imperfections and restores a luminous, radiant glow. A nourishing rescue cream for mature, dry, sun damaged and pigmented skin.

Alpha-H’s world renowned skin refining solution is the Liquid Gold, a powerful night time resurfacing and firming lotion for the skin. This exclusive complex jump-starts the skin’s metabolism, tightens enlarged pores, and delivers lighter, clearer and a more even skin tone.

The Alpha-h Ultra Protector is a daily moisturiser providing the ultimate daily defense system to shield your skin against the harsh environmental conditions that causes premature ageing. It will not clog pores and is suitable to wear under makeup. This sunscreen/ daily moisturiser is a broad spectrum UVA / UVB protector for all skin types. And our Age Delay Facial Oil helps repair cell damage while firming, toning and softening skin that’s become dry, mature or sun damaged. This serum deeply hydrates for noticeable results.

The Alpha-h Anti-Aging Kit is a great starter point for newbies to the range; it is also a great travel size companion.

New Skin Begins with the Alpha-h Anti-Aging Kit.

For more information on the Alpha-h range please contact Christina Bowman on 079 527 1232 or e-mail [email protected] | www.alpha-h.co.za

Alpha-H Advertorial



Contact 082 829 9300, 011 794 8253, email: [email protected] www.radianthealth.co.zarenew – reduce – refine – reshape

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new

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educ

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refin

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resh

ape

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new

Finance and Rental

options available

FACIAL ANALYSIS SYSTEMObservation and Measurement of• Pores• Wrinkles• Spots• Sebum• Porphyrin• Skin colour & tone

• Image processing via normal• light image, polarised light and UV light shapes• 3D display of each area• History and comparison analysis• Printed output of above

Visibly Better!

• Unique Bi-lamp technology• Large spot size – faster treatment• Treats Hair Removal, Skin Rejuvenation,

Pigmentation, Vascular Lesions and Acne• Easy to own• Easy to operate• Portable

sPTF+IPL

Powered by

• Virtually pain free with “Motif” function.

• Fastest hair removal

• Most economical (4 cents/ Pulse)

• All skin types.

• All hair colours

Too good to be true? – Phone us for a no obligation demonstration.

• Circumference and cellulite reduction, skin texture improvement and skin tightening through body contouring

• Proprietary technology delivers optimal results for treating both deeper tissue and the skin’s surface

• Leading non-invasive, effective & safe procedure with no down-time

• Treats large and small body areas including abdomen, thighs, arms and flanks

• Fast return on investment• Endorsed by the medical community

worldwide• Over 10 000 treatments done Daily!• Easily bundled with complementary

aesthetic therapies

Latest PainFree diode laser hair removal system from the world cosmetic and aesthetic leader.

Cavitation + Radiofrequencyincorporating Lipotechnology

• Body reshapingCircumference reduction

• Body FirmingCellulite, Skin tightening

• Facial FirmingWrinkle reduction, Skin tightening

NEW

Documents

Making WAVES - AAMSSA · The LightSheer DUET enables you to treat backs and legs comfortably in only 15 minutes without any anaesthetics or gels. LightSheer DUET is CE marked and