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au
tum
n e
dit
ion
2009
aestheticpractice
Endorsed by
recessiONproof your practice
NeUrOtOXiNs& alternatives
*setting up an
accreDite
D FOr
1 eth
ics c
pD pO
iNt
per is
sUe*
Fully Portable
The affordable professional option• Effective • Clinically proven • Non-invasive
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Unique ultrasound technologyDynamic Resonant Low Frequency CavitationDynamic Resonant Low Frequency CavitationNon-focus, no superstructureMechanical Cavitation, non-thermal
Selective fat cell lysis - Reduces fat depositsNo damage to nerves, blood vessels.No damage to nerves, blood vessels.No effect on hepatic system
Variable low frequencyUnlike focused fi xed frequency Unlike focused fi xed frequency Sweeps specifi c frequency to locate fat tissue
Scientifi cally provenScientifi c papers confi rm superiorityScientifi c papers confi rm superioritySuperior results compared to similar systemsAfter 3-5 treatments up to 4cm reduction on thighs and waist
The affordable professional option• Effective • Clinically proven • Non-invasive
Novashape A4 3.indd 1 28/10/08 9:05:12 PM
MedEsthetics | Southern Africa
Conversations between aesthetic doctors are lately focused on the question of whether everybody is feeling the pinch due to the economic turmoil.
A report in Modern Medicine (January 2009) regarding the economic impact in the USA mentioned a decline in the amount of cosmetic procedures, but especially surgical cosmetic procedures. They also noted that instead of getting facelifts, patients are gravitating to Botox (botulinum toxin A, Allergan) and especially fillers, because they’re a fraction of the price. Though, even with these procedures patients are stretching out visits and follow up treatments.
In South Africa the use of Botulinum Toxin and fillers has not declined in the past few months. The usage has remained stable and constant. A decline was surely expected, but it is explained by some experts as a ‘comforter’ during turmoil and that this could be the reason for the consistency in the usage of Botulinum Toxin and Fillers in South Africa. When stress levels increase people need wellness treatments all the more. Though, the use of fillers remains low in South Africa compared to rates versus Botulinum Toxin usage in other countries.
A number of aesthetic practices locally have not felt any change in the amount of bookings, but report that patients tend to ‘budget’ a bit more and carefully select the type and amount of procedures.
During this current economic climate being proactive and flexible is the best way to avoid or minimize the negative impact on an aesthetic practice. One can offer more flexibility with payment plans but with absolute caution to not negatively impact on the already bad debt situation of patients. This should actually be quite a personal selection and it is difficult to put specific guidelines down for this.
Personally, I think that the one technique that could help aesthetic practices to maintain a constant income throughout the year is to give your patients a treatment plan for the forthcoming 12 months. After an analysis of their facial features and skin, the doctor can recommend the type of treatments, their costs and the amount of sessions with their frequency for the rest of the year. This will ensure that your patients make this part of their budget for the year. This strategy can often serve as a motivation for patients to increase their targets at work ‘in order to afford their cosmetic treatments’. Treatment plans serve as an excellent tool to retain existing patients and assisting them to plan ahead for their aesthetic procedures. It also serves as an accurate guidance to the correct procedures for the specific individual.
This year might teach us some more creativity and planning skills, which is actually a necessity. Good Readings,
Dr Riekie SmitMedEsthetics Southern Africa Editor
note from the editoreconomic turmoil & aesthitic procedures
MedEsthetics | Southern Africa�
MedEstheticsSouthern Africa
PUBLISHER
Reni RouncilvellMedSpec Publishing
PO Box 12973 · Clubview · 0014South Africa
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DISCLAIMER This publication contains selected items originally published under license from
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This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights for translation, reprinting reuse of illustrations, broadcasting, reproduction of CD-Rom, microfilm, online publication, or in
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consulting the relevant literature.
contents...
COLUMnS
6 BUSINESS CONSULTANT recession: proof your practice
- 8 strategies
9 DETAILS injectable thread lift
13 LEGAL ISSUE setting up an aesthetic practice
22 NEWS & EVENTS
47 BEST PRACTICES
13 24
autumn edition �009FEAtURES
4 tracking patients
18 roundtable: neurotoxins
& alternatives
24 why choose just one?
26 calendar of aesthetic / anti
aging medical events
30 laser eye protection
34 maximum exposure
We Have Beauty Down to a Science. Find out more at Cutera.com
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ERgOn MEDICAL SUPPLIESTel 011 454 1876 · Cell 082 576 1380 · www.ergonmedical.co.za · [email protected]
KEY FEATURE
Time to pull out all the stops when it comes to customer service. Are the records you use helping your providers take the best care of your patients?
Many spas choose to use a travel card or daily ticket
that is computer-generated at each visit. This offers
your staff complete client information, allowing them
to take customer service to the next level.
Daily tickets aid staff members in their consults, retail
recommendations, rebooking and many other tasks.
In a spa setting, the esthetician is responsible for
helping the front desk gather pertinent information,
such as email addresses and phone numbers. Daily
tickets show frequency of services and visits, allowing
your staff to suggest more frequent services when
appropriate or to contact a patient who has not
been in for several months. They help track purchases
and allow the service provider to formulate proper
regimens based on past use and discussions.
One of the goals of a technician is to suggest other
appropriate services—the more services performed,
the better the retention rates. When you have a history
of services right at your fingertips, it allows you to look
at past services that may not have been rebooked and
identify appropriate services the patient may not have
experienced. Providing your patients the best service
means always being one step ahead of them. They will
appreciate you for it and they will return!
Lisa Marie Arnold, Salon and Spa Solutions,
patientstracking
By Lisa Marie Arnold
SAMPLE
MedEsthetics | Southern Africa�
Cipla Medpro (Pty) Ltd. Reg. No. 1995/004182/07, Rosen Heights, Pasita Street, Rosen Park, Bellville, 7530. Tel (021) 943 4200, Fax (021) 914 4699.E-mail: [email protected] Website: www.cipla.co.za
Specif ic skincare for hyperpigmentationand photo-ageing.
Contains Rucinol and Sophora-- unique ingredients to effectively managehyperpigmentation.
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LAMAR franceT H E T R U S T E D S K I N C A R E C O M P A N Y
proof your practice- 8 strategies
recessionBUSINESS CONSULTANT
MedEsthetics | Southern Africa�
When the economy is tight, patients
expect more for their money
By Cheryl Whitman
MedEsthetics | Southern Africa�
A tough economy doesn’t have to wreck your bottom line. With ingenuity, you can cut costs and expand your base without sacrificing quality or patient care.
How are you weathering the current economy? Being in an industry that is driven more by
want than need could put your practice in a precarious position. To keep damage to your
bottom line to a minimum and protect the long-term health of your practice, you’ll need to
take action now. Here are eight strategies to consider.
1. Be flexible. Despite economic concerns, your target market is still investigating new
products and services. The more you offer, the more patients you will be able to attract.
To address both tighter budgets and local competition, consider repositioning your
products and marketing them to a new clientele. For existing patients you can bundle
your current services (i.e., Botox Cosmetic, filler, a peel and a tightening procedure)
into a promotional package for a single cost. You may even market some treatments as
a “purchase three, get one free” package to entice budget-conscious prospects. Take
a close look at the demographic you are trying to reach and set your prices for their
budgets. Do what you can to further accommodate a range of incomes in your market
by offering financing options that allow patients to pay for high-ticket treatments over
time.
Autumn Edition | MedEsthetics ��
2. Be open to new opportunities. It may sound shocking but
difficult economic times can provide attractive opportunities to
expand your business. This may be a good time to evaluate the
acquisition of an existing medical spa/practice that is not able or
willing to withstand an economic downturn. Make sure that you
do your due diligence and review the profit and loss statements
with your accountant.
3. Cut costs. Take a close look at your expenses and assess which
variable costs and fixed expenses can be reduced or eliminated.
Focus on core markets and spend money in those areas, as you cut
back in areas that haven’t been as profitable. Lower debt levels,
especially debt incurred for nonproductive purposes. Consider
reducing expenses by:
• Eliminating unnecessary purchases.
• Reducing essential expenses, such as insurance, by shopping for a
better deal. Review marketing expenditures to determine whether
the processes you’re using are reaching your target market or
bringing in valid leads.
• Turning off lights in empty rooms, turning off computers, removing
chargers overnight or even eliminating an extra phone line.
• Hiring part-time rather than full-time employees. Develop more
creative compensation programs with incentives for full-time
employees to boost productivity so they can earn more. Your staff
may make less per hour, but they will have the opportunity to earn
more on a solid commission and bonus structure.
• Gathering money-saving suggestions from your staff members.
• Renegotiating contracts and leases as they come up for renewal.
• Increasing cash on hand by asking suppliers to extend your
payment period, while you work to collect any outstanding
receipts.
• Tightening inventory so you don’t have excess product on the
shelves.
4. Intensify your marketing. As P.T. Barnum said, “Without promotion,
something terrible happens—NOTHING!” You may be tempted
to cut back on marketing, but this is not the time. You still have
a considerable target market, and if you don’t reach out to them,
someone else will. During sluggish economic times, begin by
focusing on your internal database and existing patients. With
a relationship already established, they are worth much more to
you than new customers.
Aforementioned bundled promotions such as lunchtime or
Friday afternoon specials that combine several treatments like
Botox Cosmetic, fillers and skin rejuvenation into one package
at a special rate can bring patients back and increase bookings
among your regulars. Create a loyalty or VIP program to reward
and retain existing patients.
Examine low- or no-cost avenues of attracting new patients.
Free directories, online forums and local/community networking
groups can help you get the word out to new prospects, as can
seminars and speaking engagements at local women’s groups
and country clubs. “I’ve started doing patient education ‘soirees’
about once a month, which always result in increased bookings,”
says Roxanne Guy, MD, FACS, of Brevard Plastic Surgery & Skin
Treatment Center, Melbourne, Florida, and immediate past
president of ASPS. “The overriding theme I use is ‘Beauty for Life.’
I involve the whole staff and speak about the team approach.
We introduce the treatments offered by my estheticians, nurse
and nurse practitioner and explain the role of our patient care
coordinator and ancillary staff. We do drawings for facials and
skincare treatments, and we make sure attendees have the
opportunity to book appointments right then and there. For a
reasonably small investment of time and money, our soirees have
been extremely effective, especially for patients who have been
‘on the fence’ and for those who feel more comfortable booking
a procedure once they’ve met the doctor and the staff.”
To promote your events and new treatment packages, focus
on public relations versus paid advertising. Contact your local
newspapers, television stations and radio stations and provide
press releases for all upcoming seminars and new products and
services. It costs little to write a press release, which can be
emailed to your local news contacts. Concentrate on a 5- to 10-
mile radius for best results (rural practices may need to extend to
30 miles).
Finally, don’t forget to update your database of past clients,
existing clients and new leads. Invite them to upcoming seminars,
or to visit your website and blog for news about your practice.
recession, proof your practice BUSINESS CONSULTANT
recession
Create a loyalty or VIP program to reward and retain existing patients
MedEsthetics | Southern Africa�
5. Focus on service. When the economy is tight, patients expect more for
their money. Providing an experience that exceeds their expectations is the
best way to build and maintain trust, loyalty and patient satisfaction. This
is one of the best ways to add value without incurring cost. Ask current
clients to complete a satisfaction survey to make sure their needs are being
met and to find out what services or products are on their wish lists. Their
suggestions may lead to new and profitable product and/or service lines.
Continue to monitor for new market opportunities and understand that
as the economic climate shifts, your target market will move with it. Most
importantly, maintain your focus on customer service to retain the clients
you have worked so hard to attract. One way to do this is to step up
your involvement in patient consults, meet and greet as many patients as
possible and follow up with patients to check in on their recovery. “In good
or bad economic times the focus should always be on providing superlative
service to the patient,” says Julio F. Gallo, MD, FACS, medical director of The
Miami Institute for Age Management and Intervention, Miami. “This will
keep clients coming back throughout economic cycles. These are also the
times when you have to show more appreciation. Hosting special events or
gatherings can be one way of saying, ‘Thanks for staying with us through
the good and the bad.’ "
6. Invest in your staff. When the going gets tough, it is your team that will
make the difference for your practice. For that reason, it’s important to
avoid layoffs. Because most economic downturns are temporary, keeping
the staff you have worked so hard to train and encouraging productivity
can do more for your bottom line than you might at first expect. First, you
have the benefit of high morale that comes with job security in tough
times. Second, you can increase your bottom line by offering low-cost
incentives (i.e., days off, gift certificates, cash bonuses, etc.) for higher
productivity in product and service sales. Use any free staff members you
may have to execute promotions and improve patient services. If you are
innovative and adaptable, you can even take this opportunity to build your
staff by hiring some of the very talented, highly trained professionals who
have been laid off by other practices.
BUSINESS CONSULTANT recession, proof your practice
7. Look for ways to improve. Just as you regularly
assess your business and marketing plans, you
should also be evaluating practice policies, pricing
and employee performance. You may need to
adjust your hours of operation to better meet the
needs of those individuals who can only come
in on evenings or weekends. You may need to
train or retrain staff to improve efficiency or add
sought-after new treatments. Invite vendors,
pharmaceutical and equipment representatives to
provide additional training to your staff. This boosts
their excitement about the services and products
you’re offering. In addition, stay on top of cutting-
edge technologies and determine which to invest
in so you can stay ahead of the competition.
8. Stay focused. Success is closely tied to the
attention you pay to both short- and long-term
goals. Regardless of the present economy, you
must keep in mind that every decision you make
today will affect the future. Dropping prices, laying
off employees and cutting out improvements are
shortsighted ways of making it through tough
times. Do what you must to keep your credit
rating solid, but don’t discount your products and
services to make a quick buck. You do not want to
come out of a recession with a diluted brand and
reputation.
There is no doubt we will all face challenges as we
weather this economic shift. However, being proactive
and maintaining a strong focus on your goals
and objectives while using these challenges as an
opportunity to refine your services will put you ahead
of the competition and first in the minds of those in
your target market.
Cheryl Whitman is the founder and CEO of Beautiful
Forever Spa Business Consulting. Contact her at www.
medicalspaconsultant.com or www.medicalspasuccess.
com.
Autumn Edition | MedEsthetics 9
shows insertion
points
short needlelong needle
DIAgRAM 1
By Leslie Fletcher, Rn, MEP-C
Give nasolabial folds an extreme makeover with
this innovative dermal filler injection technique.
The Injectable Thread Lift literally lifts the skin and tacks it back, anchoring
it away from the dreaded weight of the folds.
DETAILS
injectablethread lift
If injected correctly, dermal fillers can push out nasolabial folds and alleviate the shadows
that draw the face down. If injected incorrectly, they can make your patient look as if she
forgot to swallow those two pieces of breakfast sausage and is storing them for a long
winter. I’ve developed a technique designed to offer a more aesthetically pleasing option
for your patients. Called the Injectable Thread Lift, it incorporates placing product medial
and lateral to the fold in a horizontal pattern. My inspiration came from the well-docu-
mented Fern Pattern technique (“A novel method to inject hyaluronic acid: the Fern Pattern
technique,” Tom van Eijk, MD, and Martin Braun, MD, J Drugs in Derm, August 2007), but
the Injectable Thread Lift offers many advantages over the Fern Pattern technique. When
placed in the fashion described below, the product fills the nasolabial fold; adds volume
and lifts the cheeks; turns out the lips, making them appear fuller; and supports the tear
troughs. It can do all of this while using the same amount of product as the traditional
method with fewer injections. It literally lifts the skin and tacks it back, anchoring it away
from the dreaded weight of the folds.
It may seem counterintuitive to inject filler on the full side of the fold, but the direction
of placement is critical. The effect is much like laying down structural support beams to
reinforce the sagging folds. Think of the columns of filler as working much like the threads
in a barbed suture face-lift.
PAtIEnt SELECtIOn AnD PREPThis technique is appropriate for any patient who has sagging skin that needs to be re-
directed, whether it is nasolabial folds, oral commissures, upper lip overhangs or jowling.
Contraindications would be the same as for any dermal filler procedure, including making
MedEsthetics | Southern Africa10
DETAILS injectable thread lift
sure the patient has not been using anticoagulants for at least one week before treat-
ment and has signed the consent form for the injectable filler you are using.
Proper anesthesia for this procedure depends on the area you are treating; follow the
same protocol with this technique as you would for any other filler procedure. If you are
filling only the nasolabial folds, topical numbing cream may be sufficient. If you are add-
ing oral commissures, you might want to consider a nerve block. In this case, you may
want to mark the patient before putting in the block, which can distort the tissue. Next
choose the appropriate needle length for the facial area of correction. A longer needle
works well on some faces, because you have more surface area to pull away from, giving
more of the appearance of a midface contour lift by involving the lateral malar eminence.
However, with the long needle you have to remember to use enough product to make it
supportive. No tiny threads here. These are structural cylinders.
A shorter needle (1/2 inch to 3/4 inch) works great too—maybe even better—because it
is easier to control, and you have a better perspective of the plane you are in. When you
use a small needle, you can gather the skin “accordion style” to make the short length
work longer for you. In other words, when you reach the hub of the needle, continue
pushing. You’ll be able to bunch up the skin to gain more distance with your short needle.
(See photo 1.)
Finally, disinfect the skin with alcohol, waiting for it to evaporate before injecting.
PROCEDUREDiagram 1 on page 12 should help you visualize the technique, but tailor it according to
your patient’s needs. Just keep following down the shadow of the fold until the correc-
tion is optimal. The dots represent approximate needle insertion points. Each should be
approximately 1cm lateral and superior to the fold. The main thing is to make sure your
needle extends at least 1/2 cm past the fold. The right side of the diagram shows what it
might look like if you used a short needle. The left side shows what it might look like if
you used a long needle.
The insertion point must be superior, not inferior, to the fold. When you are laying down
the “thread” of product, it should feel as if you are pulling the skin in the direction you
want it to go, mainly in an upward vector. (See photo 2.) You may actually have to get
behind and above your patient to access the area you need. It would seem ergonomically
easier to do this from below, but I honestly can’t see it working as well.
Insert the needle into the appropriate depth for the filler you are using. Radiesse would
be in the deep reticular/subcutaneous junction. Hyaluronic acid would be in the mid to
upper reticular dermis. This is because you will end up bearing down on the needle a bit
while injecting and placing the material a little deeper than your initial needle place-
ment.
You are going to “cross the line” or pass the fold by at least 1/2 cm and lay down a con-
tinuous line of filler as you withdraw the needle. You will end up placing a little more of
your filler on the other side of the fold and tapering off as you ascend, remembering to
stop short of the tip. Place the threads 1cm to 2cm apart, depending on what is needed
for optimal correction.
As you lay down each thread, push the needle down against the skin—the opposite
of tenting against the skin—and arc upward, tugging as you ascend to the end of the
needle, finishing with the end of your syringe at a 60- to 75-degree angle. (See photo 3.)
This helps to tether the skin as you redirect it upward. The words that come to mind to
describe this idea, while far from medical, are effective: Picture yourself “scooping” and
“gathering” as if to redirect the loose skin and “staple” it into place. While injecting in
this manner, you may actually feel some “crunching” as the dermal attachments release.
the lifting technique fills the nasolabial folds, adds volume to the cheeks and
turns out the lips.
AFtER
BEFORE
1
2
3
lidocaine 25mg & prilocaine 25mg
availablefrom pharmacies without a prescription
why should looking good
be a painful experience?
www.emla.co.za
At this time, you will see the product fill beautifully in the
pockets you have just formed with your needle, creating a
structure that lifts the skin upward. After you have com-
pleted your supportive columns, resist the urge to massage
them. Remember, they are supportive rods. If you smash
them, you end up with non-supportive blobs.
If you have failed to “stop short,” you might see small nod-
ules at some of the injection points. Press on the bumps
only with a cotton-tipped applicator to soften them. If you
were overzealous while filling, you may end up with a rip-
pling effect or a ledge superior to the insertion points. If this
happens, simply add injections to more or less “connect the
dots” (or all of the insertion points) in an arcing fashion.
FOLLOW-UP AnD RESULtSFollow up with your patient one to two weeks after the
procedure to ensure that your injections are symmetrical
and to check for any complications. Possible complications
with this technique are the same as with other types of filler
injections, but because of the multiple puncture sites, there
may be a greater tendency to bruise.
The best thing about this technique is that, when the patient
animates, such as by smiling, the nasolabial fold doesn’t
have the opportunity to “get into the groove” because the
support beams obstruct the way. With the traditional way
of filling these folds, the carefully placed product could shift
into the groove and would look rope-like upon animation.
This Injectable Thread Lift also works well for oral commis-
sures, marionette lines, separation of the malar fat pad,
lateral malar laxity, brow elevation, lower face jowling and
fine lines to the lower cheeks. I’ve even seen it work in
extremely dense mouth frowns, where the smile is in the
shape of an upside down “U.” This technique can be used
any time there is an overhang of skin to redirect upward.
No area is exempt when it comes to lifting up the skin and
going perpendicular to the wrinkle or fold. Any area that
needs to be lifted can benefit from an Injectable Thread Lift.
Be creative when it comes to this technique, remembering
that aesthetic injecting is as much an art as it is a science.
Leslie Fletcher, RN, an aesthetic nurse specialist for eight
years, works with several physicians in the Los Angeles
area, including plastic surgeon Michael Newman, MD, and
dermatologist Ava Shamban, MD. As a national educator
for Aesthetic Advancements Incorporated, she is recognized
for her expertise with sculpting and contouring using der-
mal fillers and Botox Cosmetic. Contact her at www.ede-
nestheticnursing.com.
MedEsthetics | Southern Africa
ADVERTORIAL
emla® has been shown to be an effective dermal anaesthetic when treating
port wine stains (naevus flammeus) with pulsed dye lasers (Lanigan, 1987).
In a cinical study emla® reduced mean pain scores by 66% and made the
treatment pain free in 40% of cases (Sherwood, 1993). emla® has been shown
not to influence the efficacy (effectiveness) of the treatment (Ashinoff, 1990).
Taking into consideration the vasocontrictive effect if applied for less than 60
minutes, emla® can offer another advantage when vasocontriction is preferred.
This effect will assist with laser hair removal where the laser or light spectrum
should be focused on the hair follicle and not the vein. If you are using emla® for
pain reduction when treating veins with lasers or lights, ensure that the emla®
is applied for longer than 60 minutes to ensure that no vasoconstriction occurs.
This will not affect the efficacy of the treatment. This should be considered with
all vascular treatments. The vasoconstrictive effect of emla® has shown to not
affect the ease of venous cannulation at all.
The vasoconstrictive effect can be used to one’s advantage when performing
dermal filler injections or mesotherapy as this could reduce the risk of bruising
and bleeding as an additive effect to the reduced pain effect.
emla® has been studied for the depth of analgesia during a study with 2
groups of patients undergoing various depths of skin biopsies after 60 and 120
minutes of emla® application (Wahlgren & Quiding, 2000). The mean insertion
depths with acceptable pain were 2.9 and 4.5 mm respectively. After 3 to 4
hours of application, 6-mm deep insertions were made with acceptable pain
in all 5 subjects.
A study on the use of emla® for laser resurfacing demonstrated the usefulness
for pain relief without anaesthesia (Murison & Tucker, 2007). The authors
concluded that a cooling device in combination with emla® cream provided
a level of anaesthesia sufficient to allow laser resurfacing without the use of
local anaesthetic injections or intravenous agents.
emla® has sufficient data to show its effectiveness and usefulness in aesthetic
practices. It is important that doctors should make use of this data to reduce
pain during aesthetic procedures to improve the patient’s comfort level and
improve the overall experience of the specific aesthetic procedure.
added benefitesof emla® in aesthetic procedures
A eutectic mixture of local anaesthetics (EMLA) is commonly used to provide topical anaesthesia for needle procedures. Now, emla® is proving to be very useful in aesthetic medical procedures to improve your patient’s comfort and enhance the overall experience of the patient coming to such a clinic.
emla® cream is a mixture of equal parts of 2.5%
lidocaine and 2.5% prilocaine and is applied to
the skin, then covered with an occlusive dressing
and left in place for at least 60 minutes. The
peak action for emla® occurs at 2 hours and
lasts for as long as 4 to 5 hours. emla® has a
vasoconstrictive effect on the area applied, but
this effect is reduced if the cream remains in
place for longer than the minimum 60 minutes
(Moureau & Zonderman, 2000; Häfner et al.
2003). The rare side effects of emla® include
local minor skin reactions, such as itching or
erythema, which quickly disappears when emla®
and the occlusive dressing are removed. Allergic
reactions to emla® are extremely rare, but mild
systemic reactions have appeared in a small
percentage of patients with known allergies to
lidocaine.
1�
LOCAL ARTICLE - LEGAL ISSUE
aesthetic practicesetting up an
The Health Professions Council of SA (HPCSA) has very specific rules in respect of practice structures, collaboration amongst health care practitioners and the sharing of facilities. Since an “aesthetic medical practice” is in essence a “medical practice”, all these provisions are applicable to such practices. The relevant provisions are briefly reviewed in this article.
1 PRACtICE MODELS
A medical practice may be conducted as a single owner business (solus practice), a partnership, an
incorporated company or in an association.
The main features of the different vehicles of practice are the following:
• SOLUS PRACtICES
A single owner business is operated with full personal risk for the owner whose estate is liable for all the
commitments of his business. In this instance the medical practitioners practise under their own names
as single practitioners. They are still entitled to employ other practitioners such as professional assistants
and locum tenentes (locums) in their practices.
Autumn Edition | MedEsthetics 13
Esmé Prins
Attorney, notary and
Conveyancer of the High
Court of SA, Healthcare
Consultant.
BLC (Cum laude) (1986),
LLB (Cum laude) (1988)
and LLM (Cum laude)
(1997) (University of
Pretoria) Attorney,
notary and Conveyancer
of the High Court of SA
Healthcare Consultant.
CPD ARTICLE
SUBSCRIBE & EARN
1 ETHICS CPD POINT
PER ISSUE
SUBSCRIPtIOn InStRUCtIOnS1. Go to www.medspecpublishing.co.za 2. Click on the MedEsthetics CPD programme button.
3. Complete the registration form and click the submit button. 4. You will be directed to your landing page,
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once completed click submit.
• PARtnERSHIPS
A partnership is a group of persons who unite with a profit motive.
A partnership is limited to a minimum of 2 and a maximum of 20
members. The Minister of Trade and Industry has exempted the
medical profession from this restriction. This means that medical
practitioners may form partnerships of up to 50 partners.
The partners in a partnership are jointly and severally liable for
the debts and liabilities of the partnership, but only to the extent
that such liabilities cannot be met out of the partnership assets.
• InCORPORAtED COMPAnIES
Since 1994 medical practitioners and other health care
practitioners registered with the HPCSA are permitted to practise
their professions as juristic persons in incorporated companies.
Incorporated companies must comply with the requirements of
the Companies Act 61 of 1973 as well as the following provisions
that were published in the Government Gazette:
• The Memorandum or Articles of Association must provide for the
joint and several liability of all past and present directors together
with the company for the debts and liabilities of the company
contracted during their period of office. Incorporated companies
must therefore be constituted with unlimited liability. This
implies that individual health care practitioners remain personally
accountable for their professional and clinical responsibilities and
cannot be afforded the protection of the legal entity in the case
of negligence or professional misconduct;
• Only natural persons registered in terms of the Health Professions
Act and who practise the profession of a medical practitioner,
dentist, psychologist or supplementary health service profession
(practitioners) may be shareholders of the company and have an
interest in its shares;
• Another incorporated company, all the directors and shareholders
of which are practitioners, may hold shares in the company up to
a maximum of 24% of the issued share capital;
• Only registered practitioners may be directors of the company;
• Each shareholder may only practise the profession in respect of
which he is registered;
• If a shareholder of the company or a person with an interest
in the shares dies or ceases to comply with the requirements,
the estate or person concerned may for a period of 6 months
or such a longer period as approved by the HPCSA continue
to hold the shares. These shares will have no voting rights and
the shareholders may not act as directors, receive any director’s
remuneration or share in the income or profit of the company;
• Only an authorised agent who is a shareholder of the company
may speak or vote on behalf of a shareholder at a meeting of a
company;
• Each shareholder remains personally subject to the provisions of
the Health Professions Act and the disciplinary authority of the
HPCSA;
• Neither a natural nor a juristic person may directly or indirectly
share in the profits or income of the company or have an interest
therein unless he/she is a shareholder of the company; and
• If the company neglects or fails to comply with these provisions,
such neglect or omission shall constitute conduct on the part of
the directors or shareholders in respect of which the HPCSA may
take disciplinary steps.
• ASSOCIAtIOnS
An association is a practice where certain expenses such as
facilities are shared but each health care practitioner practises in
his/her individual capacity for his/her own account. Agreements
can be verbal or in writing. A written agreement is recommended
for purposes of clarity and to minimise disputes during the
existence and dissolution of the association.
All the practitioners registered with the HPCSA are allowed to
conduct private medical practices together with the exclusion of
pathologists and radiologists1 in respect of whom restrictions
exist. ”Practising together” could mean to work together in an
employment relationship, as partners in a partnership or as directors
and shareholders of an incorporated company. Practitioners excluded
from practising together with medical practitioners are those that
are unregistered (e.g. beauty therapists) or practitioners who register
with other statutory councils (e.g. nurses, pharmacists, homoeopaths
and beauty therapists). Nurses may, however, be employed by medical
practitioners to assist them in their practices.
Ethical Rule 8 pertaining to partnerships and juristic persons was
recently amended and provide as follows:
LEGAL ISSUE - LOCAL ARTICLE
MedEsthetics | Southern Africa1�
Autumn Edition | MedEsthetics
LOCAL ARTICLE - LEGAL ISSUE
(1) A practitioner may practise in partnership or association with
or employ only a practitioner who is registered under the Act,
and who is not prohibited under any of the annexures to these
rules or any ethical rulings from entering into such partnership
or association or being so employed: Provided that, in the case
of employment, the practitioner so employed either provides a
supportive health care service to complete or supplement the
employing practitioner’s health care or treatment intervention
or is in the same professional category as the employing
practitioner.
(2) A practitioner shall practise in or as a juristic person who is
exempted from registration in terms of section 54A of the Act
only if such juristic person complies with the conditions of such
exemption.
(3) A practitioner shall practise in a partnership, association or as a
juristic person only within the scope of the profession in respect
of which he or she is registered under the Act.
(4) A practitioner shall not practise in any other form of practice
which has inherent requirements or conditions that violate or
potentially may violate one or more of these rules or an annexure
to these rules.
In terms of this amended rule an employed practitioner (e.g.
professional assistant) must provide a supportive health care service
to complete or supplement the employer’s health care treatment or
interventions (e.g. a radiographer supporting a radiologist) or be in
the same professional category2 as the employing practitioner.
Ethical Rule 9 should also be noted in respect of the employment of
professional assistants and locums and the collaboration between
the different health practitioners. It provides as follows:
(1) A practitioner shall employ as a professional assistant or locum
tenens or in any other contractual professional capacity and, in
the case of locum tenens for a period not exceeding six months,
only a person
(a) Who is registered under the Act to practise in independent
practice;
(b) Whose name currently appears on a register kept by the
registrar under section 18 of the Act; and
(c) Who is not suspended from practising his or her profession.
(2) A practitioner shall help or support only a person registered
under the Act, the Pharmacy Act, 1974 (Act No. 53 of 1974),
the Nursing Act, 1978 (Act No. 50 of 1978), the Social Service
Professions Act, 1978 (Act No. 110 of 1978), the Dental
Technicians Act, 1979 (Act No. 19 of 1979), or the Allied Health
Professions Act, 1982 (Act No. 63 of 1982), if the professional
practice or conduct of such person is legal and within the scope
of his or her profession.
In terms of the ethical rulings of the HPCSA locums can only support
a practice for a period of up to 6 months. A locum can therefore not
“conduct” a practice on behalf of another practitioner for any period
exceeding 6 months.
A person employed as a professional assistant or locum must also be
registered in the category “independent practice”, his/her name must
appear on the register and may not be suspended from practising
his/her profession. A practitioner employed by the government
could therefore for example not act as a locum unless he/she is
also registered in the category of “independent practice” and has
obtained the necessary permission from his/her fulltime employer,
e.g. the state, to do so.
Furthermore, a medical practitioner may only help or support another
registered practitioner provided that such person’s practice or conduct
is legal and within the scope of his/her profession.
2 MAnAgEMEnt EntItIES
Practitioners may form entities to manage and administer their
practices and/or to own assets used by the practice. These
entities would be engaged in the rendering of non-patient
related services such as the renting of rooms, leasing of vehicles
and office equipment, payment of staff salaries, maintenance of
buildings and billing services. Practitioners would then effectively
purchase the required support services from such an entity.
Billing must, however, still occur in the name of the professional
practice. There is no restriction on the legal form of such an entity.
It could for instance be structured as a close corporation or a
trust provided that it is separate from the professional practice.
3 nAMES OF PRACtICES
The name of one or more of the practitioners in the practice must
appear in the name of that practice. Partnerships and incorporated
companies are only allowed to include the surnames of the
shareholders or partners in the name of the practice. It is not
15
MedEsthetics | Southern Africa1�
required that all the relevant surnames must be used. Business
names are not allowed such as “Aesthetic Medical Practice Inc”.
Should the person whose name has been used in the name of a
partnership or incorporated company leave the practice, it is not
required to change the name of the practice provided that all the
parties agree that their names could be retained even whilst no
longer being associated with that practice.
A private practice may also not include in its name the expression “hospital”, “clinic” or “institute” or any other special term, which could create the impression that the practice forms part or is in association with a hospital, clinic or similar facility.
A building from where practitioners practise could be called a
“medical centre” provided that at least 2 independent medical
practices are situated in that building.
4 SHARIng OF ROOMSEthical Rule 8A provides that:
A practitioner shall not share his or her rooms with a person or entity not registered in terms of the Act.
According to the Ethical Rules “rooms” refer to a physical structure
where a practitioner conducts his/her practice
• With an exclusive entrance; and
• Walled all round for the
• Privacy of patients;
• Preservation of their confidentiality; and
• Safe-keeping of records.
This definition should be understood to include for example the
waiting room and not only the space (cubicle) where the patient
is examined. It should also be read with Ethical Rule 21 that
provides that a practitioner may only perform professional acts
under proper conditions and in appropriate surroundings (except
in emergencies).
Practitioners registered at the HPCSA may therefore not share
rooms with any practitioner registered at any other statutory
council (e.g. homeopath, chiropractor or traditional healer) or an
unregistered person (e.g. beauty therapist)3.
5 COnCLUSIOn The establishment of aesthetic medical practices is fairly recent.
Although specific needs exist in these practices to for example
employ beauty therapists to assist with non-invasive therapies, it
should be noted that such conduct is neither authorised by the
Health Professions Act nor the Ethical Rules at present.
The HPCSA may conduct an enquiry into the professional conduct
of any medical practitioner that transgresses any of the Rules
of Conduct (Ethical Rules) and upon a finding of guilt, impose
an appropriate penalty on such a practitioner. In addition, if a
patient suffers harm as a result of the treatment or care offered
by an unauthorised person in a practice, the medical practitioner
in charge of that medical practice may be held liable for such
harm.
References:
1. Exemption of Juristic Persons from the Operation
of Certain Provisions of the Medical, Dental and
Supplementary Health Service Professions Act 56
of 1974. Government Notice R706 Government
Gazette 15627 of 15 April 1994
2. GNR. 717 of 4 August 2006: Ethical Rules of
Conduct for Practitioners registered under the Health
Professions Act, 1974 as amended by No. R. 68 of 2
February 2009
3. Health Professions Act 56 of 1974
4. Medical and Dental Professions Board of the HPCSA.
Guidelines for Making Professional Services Known.
Booklet 5. July 2001
5. Policy Document on Undesirable Business Practices.
HPCSA. 22 September 2005
1 The establishment of incorporated practices
and partnerships are only permissible between
pathologists and medical technologists in the case of
pathology and between radiologists, radiographers
and specialists in nuclear medicine in the case of
radiology.
2 It is not clear what the “same professional category”
means and consequently results in interpretational
problems. It could either be interpreted to mean “the
same discipline” or “the category of independent
practice”.
3 An exception exists in respect of physiotherapists
who may with the permission of their Professional
Board for example have their rooms in a gym.
LEGAL ISSUE - LOCAL ARTICLE
neurotoxinsalternativesBy Wendy Lewis
KEY FEATURE
&With several novel neurotoxins currently undergoing investigational trials or awaiting FDA approval, including some that are topically applied, the market is poised to explode in the next few years.
One of these, Reloxin (Medicis), has been in use in Europe under the name Dysport
for years. Many expect it to be the first U.S. competitor of Botox Cosmetic (Allergan).
Some analysts predict FDA approval of Reloxin early in 2009. Another potential Botox
Cosmetic rival, PurTox (Mentor), is in clinical trials, and Merz Pharmaceuticals is planning
to introduce its own botulinum toxin type A product into the United States after its
success in Europe with Xeomin. At the same time, there is a wave of new technologies
entering the market that offer expression-line relief without the need for continuing
injections. The GFX System (BioForm Medical), a device that uses minimally invasive
bipolar radiofrequency energy to selectively weaken nerve signal transduction, is
currently FDA cleared via a 510(k) to create heat lesions in nerve tissue. BioForm, which
purchased the device from Advanced Cosmetic Intervention in April, intends to apply
for FDA clearance to market the product, also known as Relaxed Expressions, for the
treatment of frown lines. We asked five luminaries in dermatology and plastic surgery
to give us their thoughts on these developments.
Q: What do you believe are some of the advantages Reloxin may offer your pa-tients?
Dr. Sadick: One could be better diffusion which may be helpful around the eyes or for hyperhydrosis. Dr. Weiss: Rapid onset of action, possibly longer duration of action, and possibly fewer injections per treatment.
MedEsthetics | Southern Africa1�
ROUNDTABLE
neurotoxins & alternatives KEY FEATURE
Autumn Edition | MedEsthetics 19
LEFt tO RIgHt James newman MD, FACS, clinical assistant professor, Stanford University Medical Center, San Mateo, California Robert A. Weiss MD, president-elect, American Society for Dermatologic Surgery; director, Maryland Laser Skin & vein Insti-
tute, Hunt valley, MarylandJoel Schlessinger MD, FAAD, FAACS, board-certified dermatologist and general cosmetic surgeon, Omaha,
nebraska; immediate past president, American Society of Cosmetic Dermatology and Aesthetic Surgeryneil Sadick MD, FACP, FAACS, FACPh, dermatologic surgeon, new York CityAnthony Sclafani MD, FACS, director of facial plastic surgery, the new York Eye & Ear Infirmary, new York City
Dr. Sclafani: With high-quality products, choice is always an advan-tage. While the mechanism of action is the same as Botox Cosmetic, Reloxin may have a shorter onset of action and give a more immedi-ate result. Dr. newman: In particular areas of the face, such as in the crow’s feet area, greater diffusion or spreading of neurotoxin could produce a good result with fewer injection sites, thus reducing the risk of bruising in this area.Dr. Schlessinger: So far, the data on Reloxin is very compelling. While it has many of the same characteristics as Botox Cosmetic, it seems to be quicker in onset. If the treatment is a last-minute one, Reloxin may be a good option. It may also be an option for people who have become resistant to Botox Cosmetic, but that remains to be seen. Lastly, it seems to spread more smoothly, creating a more even appearance. I will continue to use Botox Cosmetic for many patients—and there are some who will insist upon it based on pref-erence. For those who are interested in something different, Reloxin may prove to be an eye-opening experience. We are also working on other products from Mentor and Merz. Without a doubt, the science is expanding in this arena, and that is exciting.
Q: For patients who maintain lingering doubts about the long-term safety of botulinum toxin type A injections, what are some of the alternative treatments you offer?
Dr. Sadick: We use fillers for forehead lines, radiofrequency and broadband light sources for skin tightening, and iontophoresis for hyperhydrosis.Dr. Weiss: We offer Thermage for brow elevation and smoothing the skin around the eyes.Dr. Sclafani: Injectable soft tissue fillers and neurotoxins address similar areas in unique ways. Often these treatments are comple-mentary. For the neurotoxin-phobic patient, treatment of the same area with appropriate soft tissue fillers can help relieve the patient’s anxiety and still demonstrate, at least partially, the effect cosmetic treatments can achieve. For example, treating glabellar furrows with a hyaluronic acid filler in a patient concerned about neurotoxins will demonstrate the positive effect. Most patients will agree to adding neurotoxin treatment when they realize that it may enhance and pro-long the beneficial effect of fillers. New technology, such as selective nerve ablation devices, may eliminate any concerns, especially in the glabella. Ancillary procedures such as light-based and chemical skin
resurfacing can help reduce signs of facial aging caused by muscle hypertonicity. It is important to point out to patients that neurotoxin type A has demonstrated an excellent safety profile for more than two decades when administered by appropriately trained injectors.Dr. newman: Our No. 1 alternative is the Relaxed Expressions treat-ment using clinically proven selective radiofrequency energy to create relaxation of the frowning muscles by creating specific nerve blocks. This procedure takes the “toxin” perception out of the equation and lets patients significantly reduce frown lines while maintaining a natural expression. Patients like the natural results they achieve with the procedure, including some aesthetically pleasing brow elevation. There are no diffusion effects as seen with neurotoxins and the physi-cian has complete control of the therapeutic energy delivery.Dr. Schlessinger: We’ve worked on many studies over the past several years and the conclusions all seem to point to this: Neuro-toxins such as Botox Cosmetic and its second and third generations are safe. While bad press still continues to emerge about botulinum toxin injections, much of it is misleading and based on huge amounts of commercial-grade product injected into odd areas in techniques more consistent with neurologic than dermatologic use. There are many new topicals that have been developed, but none touch the type of dramatic improvement that Botox Cosmetic offers.
Q: Among the technologies offering alternatives to neurotoxin injec-tions, which do you believe are backed by compelling scientific data and which are you excited about using in your practice?
Dr. newman: Having participated in a multicenter trial of the Re-laxed Expressions system with five physicians producing efficacy greater than 80%, I find the data for this system very compelling. Because the radiofrequency energy used in Relaxed Expressions has treated thousands of patients in cardiology and neurology, it is one of the most well-known and safest treatments used in medicine today.
Q: What pearls can you offer on introducing other neurotoxins and related products and technologies into a cosmetic practice?
Dr. Sadick: I would recommend that they be used in conjunction with fillers and light sources.Dr. Weiss: The best way is to have patients understand that neuro-toxins can actually prevent the progression of wrinkles and reverse most wrinkles on the forehead or around the eyes. The safety has
neurotoxins
MedEsthetics | Southern Africa�0
KEY FEATURE neurotoxins & alternatives
now been established for almost 20 years! Neurotoxins are by far the easi-est way to perform noninvasive reju-venation, and I believe they reduce the need for brow-lifts if maintained.Dr. Sclafani: Start simple, with “home run” procedures. Crow’s feet are an excellent place to begin; once patients are comfortable with the process and pleased with the results, suggest ad-ditional treatment areas as needed. I often add Botox Cosmetic to the lat-eral superior orbicularis oculi muscle to enhance the natural brow arch and let patients see how neurotoxins can be used to contour the brow. Dr. newman: Other neurotoxins will need to be differentiated and offered when a physician can determine a specific benefit to the patient against established risks. Many physicians will rely on clinical trials until their own experience builds up. Because Relaxed Expressions is a new concept in aesthetic treatments, many physicians will need to refresh their knowledge on more specific neuroanatomy. When considering the implementation of Relaxed Expressions in your prac-tice, identify groups of patients who have been searching for a good alternative to neurotoxins. The results will surprise many doctors and bring in a new group of patients who may otherwise not seek treat-ment. It is important to be able to offer patients choices ranging from neurotoxins to more permanent eyelid and brow-lift surgery. The Re-laxed Expressions treatment fits between those two options.Dr. Schlessinger: These products will be something to offer to the consumer who may, for some reason, have become disenchanted with Botox Cosmetic. Many times, this is simply a factor of wanting something new, so it will be great to have another option once new forms become available.
Q: In your practice, how will you price these treatments? Is it per unit, per region or per treatment? How will having other products available influence your pricing structure?
Dr. Sadick: Per unit, but it depends on the cost of the product. Dr. Weiss: We price per unit. When Reloxin becomes available, we will price at equivalent units; for example, if it is a 3:1 ratio for units, we can price at one-third the cost per unit. If the pricing structure is reduced to us, we will pass that along to patients.Dr. Sclafani: For neurotoxin procedures, I typically price by treat-ment area; I find this is more appropriate than pricing by unit, as there will always be an incentive to use less. The most expensive option is to undertreat and thus underwhelm your patient. Dr. newman: We price per unit but always put it in context of the area we are treating so that patients have an education as to what their dosing may be. Other neurotoxins will most likely be priced in a similar fashion as they try to compete with the market leader. The Relaxed Expressions treatment does more than a neurotoxin, producing relaxed frowns and adding an aesthetic lift. As such, it is priced similarly to an upper-lid blepharoplasty in most practices.
Dr. Schlessinger: We do a combi-nation of per treatment and per unit, and I hope that competition created by new products will offer us a cost savings.
Q: Do you think the arrival of effec-tive alternatives to Botox Cosmetic will bring new patients into the mar-ket? If so, why?
Dr. Sadick: Yes, topical Botox-like products and GFX will draw in new patients.Dr. Weiss: Typically, as more aware-ness is created by different brands, new patients enter the market. We saw this with fillers. It will be in-teresting to see what happens on Google and other search engines
when someone searches for “Botox” once competitive products are introduced.Dr. Sclafani: Botox Cosmetic has be-
come a routine part of life in American society, and there is little or no resistance to it among my patients. However, there are some patients who have not sought care because of prejudices against neurotoxins as “unnatural.” Nerve ablation may fill a role in addressing the con-cerns of these potential patients. Dr. newman: I feel strongly that the introduction of alternative treatments such as Relaxed Expressions will bring in patients who
Phot
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Dr. Joel Schlessinger noted these results 17 days after treatment with Botox Cosmetic and
Restylane.
AFtER BEFORE
The results will surprise
many doctors and bring in a new group of patients.
Dr. Joel Schlessinger used Botox Cosmetic in the forehead and periorbital area and Restylane for the
nasolabial folds.
Phot
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r. Sc
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sing
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AFtER BEFORE
Phot
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ewm
an
Dr. newman treated this patient with Relaxed Expres-sions. Photos show results pretreatment and at four
months after treatment.
BEFORE AFtER
have been reluctant to seek treatment because of percep-tions about toxins and their temporary effects. When patients learn there is an alternative with the potential to last longer that will allow them to avoid neurotoxins and give them a lift at the same time, this will provide them with a powerful reason to seek more information from aesthetic specialists.Dr. Schlessinger: There is no doubt that alternatives will bring in more patients. This happened very noticeably when Juvéderm (Allergan) came to market. We saw our filler num-bers go much higher. People feel more comfortable when a second product becomes available. It happens in other mar-kets as well. For example, when the first flat-screen televi-sions came to market, there were some early adopters, but most consumers waited until more options were available.
Q: In the near future, do you foresee having multiple neu-rotoxins in your practice for different indications, similar to what we are seeing now with dermal fillers?
Dr. Sadick: No, I do not.Dr. Sclafani: Unless the mechanism of action, onset of action, duration of action, shelf life, ease of use or safety profiles are significantly different, I don’t think neurotoxins will find particular niches. Instead, individual injectors will have their personal preferences for one over another.Dr. newman: Whereas the fillers have undergone years of differentiation with regard to placement, injection technique and biocompatibility, neurotoxins are all targeting the same area. I see most practices using two at most. Fillers are used for volume correction, and because we are dealing with dif-ferent layers, there is the need for more than one type of filler. The neurotoxins are singular in mode of action, and physicians will seek out the one or two with the best safety profiles and duration of effect.Dr. Weiss: We will definitely be carrying multiple neurotoxins as we learn and become more experienced with their par-ticular strengths and weaknesses. Onset of action and per-sistence will have subtle benefits for different regions and applications.Dr. Schlessinger: Absolutely! Research is planned for mul-tiple uses of these products, and as research delineates more opportunities to use these products, patient satisfaction rates and the patient base will only increase.
Wendy Lewis is president of Wendy Lewis & Co. (www.wl-beauty.com), an international consultancy specializing in aesthetic medicine and cosmeceuticals, and author of nine books.
Onset of action and persistence will have subtle
benefits for different regions and applications.
NEWS & EVENTS
MedEsthetics | Southern Africa��
PHOtOMEDEx ACQUIRES PHOtO tHERAPEUtICSPhotoMedex, a leader in the development of proprietary excimer
laser and fiber optic systems, announced in early August that it
has acquired Photo Therapeutics Limited for $13 million in cash
at closing, and up to an additional $7 million if certain profit
milestones are met. Photo Therapeutics, based in Carlsbad,
California, develops nonlaser light devices and skincare
products. Jeff O’Donnell, president and CEO of Montgomeryville,
Pennsylvania-based PhotoMedex said of, “This proposed
acquisition would be a transforming event for PhotoMedex
and underscore our strong strategic focus on dermatology. We
believe that the combined company will offer even greater value
to dermatologists by providing a proven platform for treating
a wide range of skin conditions, as well as effective pre- and
postprocedure treatment products that generate recurring
revenue and an opportunity to improve practice profitability.”
Contact: Ian Ziervogel, www.sternlaser.co.za, 082 551 5938
EUROPEAn ExPAnSIOnThe Hair Loss Control
Clinic has expanded
its reach overseas,
opening new clinics
in Sweden, Norway,
Cyprus, Israel, Ireland
and England. HLCC,
a world leader and
pioneer in laser hair
loss treatment, has
local offices in Latham and Saratoga in New York, and is affiliated
with 78 clinics in 18 countries. In September, the company launched
new lasers and hair loss products at the European Congress on
Anti-Aging in Dusseldorf, Germany. Bill Platter, president of HLCC,
and Nancy Belard, vice-president of sales, presented the new
product line. “There is much opportunity in Europe,” Platter said.
“We already have a distributor in Germany and we hope to open
several clinics there.” Contact: www.enhancehair.co.za,
[email protected], 011 319 7227
A DOnE DEALStiefel Laboratories, the world’s largest independent
pharmaceutical company specializing in dermatology, announced
in September that it has completed its acquisition of Barrier
Therapeutics, based in Princeton, New Jersey. Barrier’s acquisition
broadens Stiefel’s already extensive product offering with three
premium prescription products. Barrier currently markets Xolegel,
Vusion and Solage. “Barrier’s innovative products are a valuable
addition to Stiefel,” said Charles W. Stiefel, chairman and CEO of
Stiefel Laboratories. “The acquisition reinforces Stiefel’s promise
to provide novel, high-quality, safe and effective products for the
treatment of skin diseases and our continued commitment to
advancing the field of dermatology.” In addition, the acquisition
provides more opportunities for Stiefel to leverage its global
footprint for the newly acquired portfolio. Stiefel’s global
headquarters will remain in Coral Gables, Florida, while the
marketing and sales headquarters will remain in Duluth, Georgia.
For more details, visit www.stiefel.com.
RELIAnt JOInS FORCES WItH PHILIPSReliant Technologies has partnered with Philips to develop
skincare technologies for home use. The collaboration will
combine Reliant’s expertise in innovative skin rejuvenation laser
treatments with Philips’ design, marketing and global distribution
capabilities. “We are excited to team up with Philips - a company
with a globally recognized consumer brand and a commitment to
offer consumers advanced, easy-to-use products,” said Eric Stang,
president and CEO of Reliant. “This exclusive partnership will
allow us to leverage Reliant’s unique fractional laser technology
and enter the growing aesthetic market for home use with
innovative products that use the Philips and Fraxel brands.”
According to the American Society of Aesthetic Plastic Surgeons,
laser skin resurfacing is one of the fastest growing segments of
the cosmetics industry, having increased 230% from 1997 to
2007. In addition, more consumers have expressed interest in
aesthetic treatments for home use.” For more information, call
888.437.2937 or go to www.fraxel.com.
MADE In tHE USASound Surgical Technologies has brought back its disposable
product manufacturing to the United States. The Louisville,
Colorado-based company, which developed the VASER Lipo
System, has partnered with two local companies, IPAX and Front
Range Tooling, to produce the new VASER systems and canister
products. “We are thrilled to bring the disposables business and
associated manufacturing jobs back to Colorado and look forward
to a successful partnership with our new domestic vendors,” said
Dan Goldberger, CEO of Sound Surgical Technologies.
IPAX is an FDA-registered and ISO-certified manufacturing and
packaging firm that designs and assembles a variety of medical
components. It has designed and produced new infusion and
section tubing to complement the Vaser Lipo System. Front
Autumn Edition | MedEsthetics �3
Range Tooling is a mold-making company that has created the
new precision canister mold and now manufactures canisters for
Sound Surgical. For more information, go to www.vaser.com.
EnERgY COStSRecognizing economic challenges in the
market, Syneron has developed a pay-as-
you-go program for physicians interested in
offering their patients laser-assisted lipolysis
but reluctant to make the major investment
purchasing such equipment demands. The
LipoLite Energy Access Program lets U.S.
physicians purchase a one-year subscription
that includes enough fat-destruction power
to perform between 15 and 30 procedures. If
demand is higher than expected, physicians
can purchase additional energy packets as
needed. At the end of the year, they have
the option of extending the subscription,
purchasing the device or returning the
system. Contact: [email protected]
www.radianthealthcare.co.za, 011794 8253
SYnEROn ACQUIRES InLIgHt CORP.Syneron Medical, an innovator in the development, marketing and
sales of combined-energy medical aesthetic devices, has signed
an agreement to acquire San Diego-based Inlight Corporation, a
laser technology development and research firm. As part of the
agreement, Inlight president and cofounder Shlomo Assa will join
the Syneron management team. Assa has worked with several
laser companies including Laser Industries and holds multiple
United States patents for laser-based technologies. “With the
expertise offered by Inlight, we have assembled a powerful team
for enhancing the capabilities, applications and success of laser
technology for our customers and partners,” said Doron Gerstel,
CEO of Syneron. “This acquisition represents an important expan-
sion of our product development presence in the U.S. and serves
as a foundation for our commitment to improve and continue to
diversify our product offerings.” Contact: radiant@worldonline.
co.za www.radianthealthcare.co.za, 011794 8253
ISOLAgEn COMPLEtES PHASE III StUDIESIsolagen has presented an analysis of results from the completed
pivotal phase III double-blind, placebo-controlled studies IT-R-005
and IT-R-006 of Isolagen Therapy for the treatment of nasolabial
folds. Both studies, conducted under the United States Food and
Drug Administration (FDA) Special Protocol Assessment (SPA),
showed statistically significant results compared to placebo.
Under the SPA, a two-point improvement on both scales was
required to demonstrate the efficacy of Isolagen as compared
to placebo. The subject response rates for the modified intent to
treat (MITT) populations, those subjects who received at least
one of three treatments, were 68.7% (Isolagen Therapy) versus
33.7% (placebo) and 51% (Isolagen Therapy) versus 19.2%
(placebo) in IT-R-005 and IT-R-006 respectively. The occurrence of
local adverse reactions was low and events reported were mostly
mild in nature and of short duration. Adverse events reported
were similar to those seen in the placebo group. “The full analysis
of data from these pivotal studies is very exciting and further
supports the potential of Isolagen Therapy as an innovative and
well-tolerated treatment for wrinkles,” said Stacy R. Smith, MD,
study investigator and assistant clinical professor, division of
dermatology, University of California, San Diego.
Contact www.bolandcell.co.za
SAggIng BREAStS nOt FROM BREASt-FEEDIngA study published in the Aesthetic Surgery Journal (September/
October 2008) suggests that, contrary to popular belief, breast-
feeding is not a likely cause of post-pregnancy breast drooping
or ptosis. Using data from 93 patients who sought aesthetic
breast surgery between 1998 and 2006, plastic surgeon and
lead author Brian Rinker, MD, determined that older age, larger
pregnancy cup size, higher body mass index and a history of
smoking were significant risk factors for post-pregnancy ptosis,
while breast-feeding was not. All patients had a history of at
least one pregnancy, and 54 patients (58%) had a history of
breast-feeding. “Patients need to be armed with objective data
rather than broad assumptions when making important health
decisions,” said Alan H. Gold, MD, president of the American
Society for Aesthetic Plastic Surgery (ASAPS). “While further study
in a larger number of patients is necessary to assess the effects of
breast-feeding on the breasts versus other factors, this study is a
good start in providing information for those who are concerned
about the potential aesthetic effect of breast-feeding.”
NEWS & EVENTS
Since the first Ruby laser was introduced
in the 1960s, new wave-lengths and delivery systems
have proliferated in the medical market and beyond. In cosmetics, these technologies are now joined by radiofrequency and ultrasound, each offering additional benefits to pa-tient care. Keeping up to date with the latest equipment without blowing your budget has become the challenge of cosmetic practitioners. Enter the aesthetic platform. These multifunction devices incorporate a variety of wavelengths and, in some cases, a variety of technologies to help you provide patients with the best tools for their concerns - and stay ahead of the competition.
KEY FEATURE
By Inga Hansen
MedEsthetics | Southern Africa��
whychoose
just
one?
Autumn Edition | MedEsthetics �5
One of the key benefits of multifunction platforms is their ability to
harness the power of multiple technologies that allow you to provide
the best results to a wide cross-section of patients. “Lasers are so
specific in their targets that the majority of patients require treat-
ment with more than one wavelength to address their concerns,”
says Douglas J. Key, MD, The Key Laser Institute for Aesthetic Medi-
cine and a Center for Body Contouring, Portland, Oregon. “We need
to combine multiple modalities and wavelengths to get the best re-
sults, which is part of why aesthetic platforms are becoming more
popular.’”
MULtIPLE tREAtMEntS, OnE tREAtMEnt ROOMFacial rejuvenation can encompass everything from reducing red-
ness and wrinkles to tightening lax skin. Practices with standalone
devices may need to shift patients from one treatment room to an-
other to treat skin laxity, pigmentation problems and overall texture
concerns.
“A platform like the Revlite with multiple wavelengths—532nm,
585nm, 650nm and 1064nm—allows you to penetrate to a variety
of depths with one system so you can treat pigmented lesions, acne
scarring, wrinkles and more in one treatment room with one piece of
equipment,” says Tim Gehlmann, president/CEO, HOYA Conbio, mak-
ers of the RevLite and MedLite platforms, Fremont, California.
“I love platform systems for facial rejuvenation because I can look at
the whole face,” says John Shieh, MD, owner of RejuvaYou Medical
Spas with three locations in Southern California. “I can perform an
IPL and if I notice some problems around the lips and eyes, I can
switch over to the fractionated handpiece without rescheduling or
moving the patient.”
The ability to attack multiple targets with one device is what led Will
Kirby, MD, a board-certified dermatologist in Beverly Hills, California,
to bring the Revlite to his practice, Dr. Tattoff, which specializes in
tattoo removal. “Different colors respond to different wavelengths,”
he says. “The 1064nm wavelength targets black ink while a 532nm
laser targets red ink, for example, so the Revlite is great for tattoo
removal. I don’t have to switch from one laser to another. I just push
a button to move from one wavelength to the next.”
The majority of platform systems offer two to three base wavelengths
and pulsed light ranges that you can toggle between with the use of
the system software. In some systems, handpieces can be purchased
individually to filter specific wavelength ranges. Some practitioners,
like Shieh, use their systems with additional upgrades to cover most
or all of their light, laser-based and radiofrequency treatments. Oth-
eMax, Syneronwww.syneron.com Technologies: 810nm diode laser; bipolar radiofrequency; 400nm–980nm pulsed lightDimensions: 35kg(77lb); 18" x 17" x 40"FDA-approved Indications: Skin tightening, acne, leg veins, vascular lesions, pigmented lesions, telangiectasia, permanent hair reduction.The eMax system is a configurable platform that allows you to perform skin rejuvenation, ReFirme Skin Tightening, Matrix IR nonablative fractional skin treatments, MatrixRF ablative fractional skin resurfacing plus hair removal and acne treatments.
CoolLipo trio, Cooltouchwww.cooltouch.com Technologies: 1320nm laserDimensions: 160lb; 18" x 21" x 31"FDA-approved Indications: fat ablation, leg veins, fine lines, acne, acne scarring.The CoolLipo Trio allows you to perform CoolBreeze nonablative skin rejuvenation, CoolLipo laser-assisted lipolysis and CoolTouch CTEV ablation of varicose veins.
StarLux 500, Palomar Medical Technologieswww.palomarmedical.com Technologies: 1064nm laser; 525nm–1200nm pulsed light.Dimensions: 149lb; 23.5" x 17.8" x 42"FDA-approved Indications: permanent hair reduction, vascular lesions, acne, leg veins, soft tissue coagulation, pigmented and vascular lesions. The StarLux 500 can be configured for your practice to include the Lux2940 for fractional ablative skin resurfacing; Lux1540 for nonablative skin resurfacing; LuxDeepIR fractional infrared for skin tightening; LuxY, LuxR and LuxG pulsed light handpieces for hair removal, telangiectasia and pigmentation concerns; and the LuxV for acne.
why choose just one KEY FEATURE
MedEsthetics | Southern Africa��
25-27 FEBRUARY Endermologie training
Johannesburg
0216838505
2 MARCH Restylane Advanced Course
Johannesburg
0117062518
2 MARCH Lipomassage
Johannesburg
0216838505
3 MARCH Basic Botox
(Upper Face) Cape Town
0214389800
4 MARCH Advanced Botox / Fillers
(Lower Face) Cape town
0214389800
4 MARCH Mesotherapy training
Pretoria
0125486374
11-13 MARCH Endermologie training
Cape Town
0216838505
17 MARCH Basic Botox
(Upper Face) Johannesburg
0214389800
18 MARCH Advanced Botox / Fillers
(Lower Face) Johannesburg
0214389800
20 MARCH ALC Lasers training
Cape Town
0722267660
19-21 MARCH AMWC
Monte Carlo
www.euromedicom.com
25-27 MARCH Endermologie training
Johannesburg
0216838505
28 MARCH Solal technologies
Laboratories evaluation
Johannesburg
0117833939
7 APRIL Basic Botox
(Upper Face) Cape Town
0214389800
8 APRIL Advanced Botox / Fillers
(Lower Face) Cape town
0214389800
15-17 APRIL Endermologie training
Cape Town
0216838505
20 APRIL Restylane Full Facial Balance
Johannesburg
0117062518
21 APRIL Basic Botox
(Upper Face) Johannesburg
0214389800
22 APRIL Advanced Botox / Fillers
(Lower Face) Johannesburg
0214389800
20-22 APRIL AMWC
Monte Carlo · France
21 APRIL Chemical Peel training
Pretoria
0125486374
22-24 APRIL Endermologie training
Johannesburg
0216838505
23- 26 APRIL Dermatology Congress
5 MAY Filorga Product training
Pretoria
5 MAY Basic Botox
(Upper Face) Durban
0214389800
6 MAY Advanced Botox / Fillers
(Lower Face) Durban
0214389800
11 MAY Restylane Introductory Course
Johannesburg
0117062518
13-15 MAY Endermologie training
Cape Town
0216838505
19 MAY Mesotherapy training
Pretoria
0125486374
19 MAY Basic Botox
(Upper Face) Johannesburg
0214389800
20 MAY Advanced Botox / Fillers
(Lower Face) Johannesburg
0214389800
22 MAY ALC Lasers training
Pretoria
0722267660
27-29 MAY Endermologie training
Johannesburg
0216838505
2 JUnEBasic Botox
(Upper Face) Cape Town
0214389800
3 JUnEAdvanced Botox / Fillers
(Lower Face) Cape Town
0214389800
8 JUnERestylane Advanced Course
Johannesburg
0117062518
17-19 JUnE
Endermologie training
Cape Town
0216838505
CALENDAR OF EVENTS
Calendar of Aesthetic/ Anti-Aging Medical Events Supplied as a service by the Aesthetic and Anti-aging Medicine Society of South Africa
(AAMSSA) [email protected]
Autumn Edition | MedEsthetics ��
CALENDAR OF EVENTS
21 JUnEBasic Botox
(Upper Face) Johannesburg
0214389800
22 JUnEAdvanced Botox / Fillers
(Lower Face) Johannesburg
0214389800
23 JUnEChemical Peel training
Pretoria
0125486374
24-26 JUnE
Endermologie training
Johannesburg
0216838505
6 JULYRestylane Full Facial Balance
Johannesburg
0117062518
15-17 JULY Endermologie training
Cape Town
0216838505
24-26 JUnE
Endermologie training
Johannesburg
0216838505
17-19 JULYCanada World Congress
www.aestheticmedicine2009.com
Canada
3 AUgUStRestylane Introductory Course
Johannesburg
0117062518
4 AUgUStBasic Botox
(Upper Face) Cape Town
0214389800
5 AUgUStAdvanced Botox / Fillers
(Lower Face) Cape Town
0214389800
18 AUgUStBasic Botox
(Upper Face) Johannesburg
0214389800
19 AUgUSt Advanced Botox / Fillers
(Lower Face) Johannesburg
0214389800
19-20 AUgUSt
Endermologie training
Cape Town
0216838505
26-28 AUgUSt
Endermologie training
Johannesburg
0216838505
2-3 SEPtEMBERAMCSA
Pre-congress beginners & advanced
training workshops
4-5 SEPtEMBERAMCSA
Aesthetic Medicine Congress
of South Africa
www.aestheticcongress.co.za
CSIR ICC
Pretoria
0125486374
8 SEPtEMBER Basic Botox
(Upper Face) Johannesburg
0214389800
9 SEPtEMBERAdvanced Botox / Fillers
(Lower Face) Johannesburg
0214389800
14 SEPtEMBER
Restylane Advanced Course
Johannesburg
0117062518
16-18 SEPtEMBER Endermologie training
Cape Town
0216838505
25-26 SEPtEMBERSFME – Aesthetic Medicine
Congress of the French Society of
Aesthetic Medicine
Paris, France
30- 2 OCtOBER Endermologie training
Johannesburg
0216838505
7 OCtOBER Basic Botox
(Upper Face) Durban
0214389800
8 OCtOBER Advanced Botox / Fillers
(Lower Face) Durban
0214389800
12 OCtOBER Restylane Full Facial Balance
Johannesburg
0117062518
14-16 OCtOBER Endermologie training
Cape Town
0216838505
27 OCtOBERBasic Botox
(Upper Face) Johannesburg
0214389800
28 OCtOBERAdvanced Botox / Fillers
(Lower Face) Johannesburg
0214389800
18-30 OCtOBER Endermologie training
Johannesburg
0216838505
2 nOvEMBER Restylane Introductory Course
Johannesburg
0117062518
10 nOvEMBERBasic Botox
(Upper Face) Cape Town
0214389800
11 nOvEMBERAdvanced Botox / Fillers
(Lower Face) Cape Town
0214389800
17 nOvEMBERBasic Botox
(Upper Face) Johannesburg
0214389800
18 nOvEMBERAdvanced Botox / Fillers
(Lower Face) Johannesburg
0214389800
18-20 nOvEMBER Endermologie Training
Cape Town
0216838505
25-27 nOvEMBER Endermologie Training
Johannesburg
0216838505
MedEsthetics | Southern Africa��
KEY FEATURE why choose just one
ers find that certain combinations of technologies offer a better result
within certain indications.
The Kovak Laser Institute in Elmhurst, Illinois, features a wide variety
of both standalone and modular laser and light systems. “I’ve always
liked the 755nm and the 1064nm wavelengths for hair removal,
which made the Candela GentleMax system, which includes both of
these wavelengths, very attractive to me,” says owner and director
Stanley Kovak, MD. “We use both wavelengths, depending on the
patient’s hair color and skin tone. The 1064nm tends to be more
effective and safer for darker hair and skin tones while the 755nm
works well for lighter hair.”
WIDER OFFERIngS FOR A SMALLER InvESt-MEntIn addition to offering multiple modalities in one treatment, aesthetic
platforms are a popular choice for new practices that don’t have the
budget and/or the space to bring in multiple devices.
When Shieh made the decision to incorporate laser treatments
into his practice in 2002, he chose the Syneron eMax
platform, a configu- rable modular system that allows
you to custom- build your initial platform and add
new modules as needed. It was a good fit for his
f l e d g l i n g practice because he could offer
multiple technologies in a relatively small footprint, and the system
allowed him to grow his offerings along with his patient base as his
practice expanded. “I started with hair removal and skin resurfacing.
I soon realized that leg vein treatments would be a good addition to
my practice,” he says. “The system let me add what I needed at the
moment and then branch out as my practice grew and I pinpointed
my patient base. And it’s cost effective because I don’t have to invest
in a whole new laser or radiofrequency device as newer technologies
become available.”
Palo Alto, California-based Sciton was one of the first companies to
offer a custom, configurable aesthetics platform. Its Profile device
offers up to six modules for everything from hair removal to nonabla-
tive and fractional skin resurfacing. “The power supply and computer
software are shared, which is what helps reduce the cost of add-
ing new modules,” says Robert Ruck, vice president of worldwide
marketing. “Even with a wide range of price points on the market,
you save a lot by buying additional modules versus buying multiple
standalone devices.”
Like other devices, the system’s tend to include a warranty of one
to three years plus additional maintenance contracts that you pur-
chase with the system. In the case of the Profile, the cost of the
maintenance contract is dependent upon the number of modules in-
cluded. “The more modules one buys, the more the service contract
Profile Platform, Sciton
www.sciton.com Technologies: 2940nm Er:YAG, 1064nm Nd:YAG and 1319nm Nd:YAG lasers; 410nm–1400nm pulsed light.Dimensions: 200lb; 15" x 32" x 43"FDA-approved Indications: Port wine stains, acne/acne scars, scar revision, telangiectasia, pigmented lesions, wrinkles, hair removal, skin tightening and more.The Profile is an upgradable and configurable platform that includes up to five laser and light modules with no consumable components.
Quantum, Lumenis
www.lumenis.com Technologies: 1064nm Q-switched Nd: YAG laser, 560nm–1200nm pulsed lightDimensions: 16" x 16" x 39"FDA-approved Indications: Rosacea, telangiectasia, vascular lesions, hemangiomas, port wine stains, leg veins, solar lentigines, pigmented lesions, permanent hair reduction, tattoo removal.The Quantum platform can be configured to include the DL 1064nm Nd:YAG laser, QS 1064nm Q-switched Nd: YAG laser and HR pulsed light handpiece for hair removal.
Harmony xL, Alma Lasers
www.almalasers.com Technologies: 2940nm Er:YAG; 1064nm and 1320nm Nd:YAG lasers; 515nm–950nm pulsed lightDimensions: 133lb; 15.7" x 21.7" x 48.5"FDA-approved Indications: Acne, vascular lesions, pigmented lesions, permanent hair reduction, leg veins and more.The Harmony XL is an upgradable platform with more than 60 indications.
Autumn Edition | MedEsthetics �9
gentleMax Workstation, Candelawww.candelalaser.comTechnologies: 1064nm Nd: YAG laser, 755nm alexandrite laser Dimensions: 342lb; 45" x 26.5" x 38"FDA-approvedIndications: Permanent hair reduction, wrinkle reduction, reduction of diffuse redness and pigmentation, facial telangiectasia, leg veins, sun spots, age spots, melasma and more.The GentleMax 1064nm Nd:YAG and 755nm alexandrite laser system can be upgraded to include the SmoothPeel low-power erbium laser and additional light-based technologies.
RevLite, HOYA ConBiowww.conbio.com Technologies: 532nm, 585nm, 650nm and 1064nm Q-switched Nd:YAG laserDimensions: 154lb; 28.5" x 12" x 31.8" FDA-approved Indications: Wrinkle reduction, acne scars, tattoo removal, pigmented lesions, vascular lesions, hair removal and dermal lesions.The RevLite features PhotoAcoustic Technology Pulse, which allows for 60% more power output than the company’s previous MedLite platform.
Affirm Anti-Aging Workstation, Cynosurewww.cynosure.comTechnologies include: 1440nm and1320nm lasers; 560nm–950nm pulsed lightDimensions: 210lb; 45.2" x 18.7"x 29.3"FDA-approved Indications: Wrinkle reduction, pigmentation and redness reduction, coagulation of tissue and age spots.The Affirm Anti-Aging Workstation features Multiplex technology that allows for sequential emission of two laser wavelengths in one fiber delivery.
MultiFlex, Ellipsewww.ellipse.orgTechnologies: 1064nm Nd:YAG laser and 400nm–950nm pulsed lightDimensions: 154lb; 24.4" x 29.5" x 55.1"FDA-approved Indications: Hair reduction, pigmentation, port wine stains,telangiectasias, acne and more.The MultiFlex is an upgradable platform that features Dual Mode filtering to lower the risk of adverse outcomes.
will cost,” notes Ruck. You may also want to discuss repair options
as you investigate devices. In the case of modular systems or those
offering additional handpieces, ask your supplier if you can repair
components individually when problems occur.
The decision to invest in a multifunction system versus standalone
devices often hinges on volume. “Buying three separate devices can
be cost prohibitive if you’re offering only a few treatments per month
with each device,” says Key. “But if I’m performing 20 to 30 IPL treat-
ments each month, for example, or 20 Cool Breeze facial rejuvena-
tion treatments, then I want a dedicated laser to perform each of
these treatments.”
Kovak has found that even with the option of additional handpieces,
he prefers to use his GentleMax Workstation as a dedicated hair re-
moval device. “I only use it for hair removal because it offers the best
results,” he says. “My patients like it, and I like it. The system is also
good for veins, but it requires you to change handpieces, and I al-
ready have a dedicated laser for vein treatments. Dedicated lasers do
have some pluses. They’re a little faster and a little more aggressive,
but they don’t offer the versatility of the platform systems.”
They also don’t offer the compact footprint that can be attractive to
some practices. “If space is at a premium, you can’t beat the modular
systems,” says Shieh. “When I opened my second location, I could
actually pack the eMax in the back of my car and transport it to the
other facility for treatments until I was ready to invest in a second
system.”
Inga Hansen is the managing editor of MedEsthetics magazine.
why choose just one KEY FEATURE
KEY FEATURE
“The same laser that can remove a tattoo or kill a hair follicle can immediately cause permanent damage if it comes in contact with the retina,” says David Bothner, director of marketing at NoIR Laser in South Lyon, Michigan. The high-energy, focused rays emitted by these devices can cause serious eye damage. With the stakes so high, laser eyewear is no place to cut corners in your practice. The good news is that most laser manufacturers include three or four pairs of protective eyewear with each machine. But if that original eyewear gets damaged or isn’t comfortable to work in, you’ll need to purchase your own eye protection. Here’s what you need to know to be sure that you, your staff and your patients are all protected.
By Darcy Lewis
protectionlaser eye
MedEsthetics | Southern Africa30
The protective eyewear you will need depends on the wavelengths
you use in your practice. “The wavelength of your eyewear must
correspond to that of the laser you are using, or the laser could
destroy your eye without leaving even a mark on the lens,” says Mark
McLear, director of sales at Sperian Laser Products in Smithfield,
Rhode Island. “There’s a video on the Internet (www.youtube.com/
watch?v=iukFVUiN_rU) that shows a red balloon inside a clear one.
The laser beam pops the red one, leaving the clear one untouched.
Exactly the same thing can happen to an eye with the wrong
protection.”
You also need to know how much energy your laser produces to
calculate the level of optical density (OD) required to provide adequate
protection. “The answer is based on both the wavelength and power
of the laser since the eye is more sensitive to some wavelengths than
others,” says McLear. “You need to set the energy of your laser to
a safe level that won’t hurt your eye if it comes in contact with the
beam.”
“The eyewear you choose should be based on the worst-case
scenario, accidental exposure at the maximum output of the laser,”
says Bill Janssen, laser safety product manager at Laservision USA
in St. Paul, Minnesota. “Doctors often assume the majority of laser
light is absorbed by the patient’s tissue, but the exact percentage of
diffusely reflected light cannot be determined. Medical staff working
around Class IV lasers must be provided with eyewear that weakens
laser light to levels below maximum permissible exposure (MPE)
levels.”
gLASS OR POLYCARBOnAtE?Laser protective eyewear is made of either glass or polycarbonate
plastic. The choice is largely a matter of personal preference. Each
material offers its own set of positives and negatives, and each uses
different technology to protect the eye.
With polycarbonate, dyes within the plastic offer the protection. “We
make a polymer lens with absorptive dye molded into the plastic.
If a laser hits the lens, the dye absorbs the energy and transfers it
through the material,” says Bothner. “These dyed glasses do have
a tint to them, but they’re also lightweight and can be molded into
comfortable shapes and frame styles.”
McLear notes that improved dyes means that the tint of newer lenses
is not as dark as it was in past models. “The color is now a lime green
instead of a dark green, for example,” he says. Plastic lenses are also
less expensive, but they tend to scratch more easily than glass and,
therefore, may need to be replaced more often.
Glass goggles are heavier and more expensive, but they offer an
important plus: improved visible light transmission (VLT). “Weight is
definitely a factor, but given the detailed and exact nature of laser
work, most of our customers prefer glass because it offers a higher
VLT,” says Tom Barrows, owner of Innovative Optics in Maple Grove,
Minnesota. “Polycarbonate is a good choice for peripheral personnel,
who don’t need to see as clearly as the doctor.”
Hybrid lenses are also available. “These are lenses that use reflective
coatings on absorptive filters. The goal is to cover multiple wavelengths
so the user can be protected against multiple lasers with a single pair
of lenses,” says Bothner. “They are significantly more expensive, but
many think they’re worth the price. Polymer lenses would have to be
very dark to work under these circumstances, but coated glass offers
a higher VLT.” Other popular features include dielectric (so-called thin
film) coatings that give greater VLT in ambient light, antifog coatings,
prescription inserts and protective options for clinicians who use
loupes.
Another innovative option involves eye protection for IPLs. While they
are technically not lasers, IPLs also require eye protection due to the
device’s flash lamp. “In normal light, our IPL glasses are clear, but as
soon as the light pulses, the lenses darken and create the protection,”
says Daniel A. Buscaglia, DO, FAOCD, president and medical director
of the Cosmetic Vein & Laser Center in Amherst, New York. “The
glasses ‘see’ the light before our eyes do.”
Reusable metal eyeshields must be sterilized between patients, but for a high volume practice, they can be a more cost-effective choice
than disposables.
Autumn Edition | MedEsthetics
laser eye protection KEY FEATURE
protection
31
FRAME StYLESOnce you wade through the intricacies of wavelength, OD, VLT
and lens material, choosing a frame is rather straightforward: You
simply pick what you like. And, for most people, what they like is
synonymous with what feels comfortable. “You need a very specific
filter for protection but the frame is where personal preference comes
in,” says Janssen. “Frequently, the laser manufacturer provides all-
purpose, utilitarian goggles with its device, but many physicians
prefer a more contemporary frame style.”
Choosing comfortable eyewear offers important safety benefits:
“People are far more likely to wear glasses or goggles that fit well
and look good,” says Bothner. “Plus, if the frame doesn’t fit well or
doesn’t offer the correct angular coverage, you have a chance of
injury.”
PAtIEnt PROtECtIOnIn addition to protecting yourself and your staff, you need to provide
proper eye protection for your patients. Just like options for clinicians,
patients’ laser-protective eyewear has come a long way. “Twenty
years ago, doctors would cut the handles off regular spoons and
tape them over patients’ eyes with gauze pads,” says Barrows. “The
spoons worked, but the solution was cumbersome.”
Today, you have three main choices for patient eye protection: the
same laser glasses or goggles you use, reusable metal eye shields or
disposable eye shields, which consist of a thin piece of metal with
an adhesive bandage. Each type of protection offers advantages and
disadvantages.
Offering patients the same kind of eye protection you wear is the
most convenient. You can simply pull an additional pair of glasses
or goggles out of the drawer before beginning treatment. But given
the difference in angle between an upright clinician and a reclining
patient, laser glasses and goggles might not provide sufficient
protection for facial procedures, and they’re not an option when you
are working around the eyes.
Reusable metal eye shields, which offer maximum protection, cost
$100 or more and must be sterilized between patients. Still, in a
high-volume practice the overall cost may be less than for single-
use disposable eye shields. With the disposables, there are no fit,
hygiene or ease-of-use issues. “From the technician’s standpoint,
the disposables are much easier because they have the adhesive so
you don’t need to keep refitting them while you work,” says McLear.
There is also no need for sterilization (see “Note of Caution” on this
page).
Melanie Grossman, MD, offers both metal shields and goggles in
her New York-based dermatology practice. “Some patients will freak
out at the idea of having their eyes covered,” she says. “For these
patients I always have transparent, wavelength-protective goggles
or glasses available so they can see during the procedure unless I’m
treating the eye area and opaque shields are essential. I’ve noticed
that, when patients wear the protective glasses, however, they want
to treat them like sunglasses and lift them up when I’m not firing
the laser. The metal eye shields set the tone that this is a medical
procedure and the shields need to stay on for the entire session.”
REPLACEMEnt RULESOnce you ensure that everyone in the treatment room is wearing
proper laser-protective eyewear, you’re all set, right? Well, yes, until
that eyewear gets scratched or wears out. “If the glasses are properly
cared for and stored, they can last as long as your favorite sunglasses
or eyeglasses,” says Janssen, “provided their laser protection
properties remain clearly legible on the eyewear.” Loss of labels and
confusion among staff can be a good impetus to reexamine your eye
protection needs.
“I made the decision to upgrade all of my laser eyewear when I
KEY FEATURE laser eye protection
MedEsthetics | Southern Africa3�
Disposable eyeshields, like these offered by Sperian, feature adhesive bandages over a metal plate so the shields won’t slip out of place
during treatments.
If the glasses are properly cared for
and stored, they can last as long as
your favorite sunglasses or eyeglasses
Autumn Edition | MedEsthetics 33
realized my newer staff members couldn’t decipher which glasses
went with which machine,” says Dr. Buscaglia. “We had eight pairs
of glasses for the tattoo removal laser, and they all looked different,
which increased the likelihood that someone could get hurt.”
Dr. Buscaglia spent a Saturday morning going through all of the
glasses for his 14 lasers. “It became clear to me that we needed
all-new eyewear. Many were cracked or damaged or looked like old
ski goggles,” he says. “I gave a complete list of my lasers to my
eyewear manufacturer, then got together with my staff and we tried
on glasses. We agreed on a frame style and bought three pairs for
each device, plus one pair of goggles to accommodate corrective
lenses.”
For a laser center with multiple devices, buying new eyewear for
everyone carries a substantial pricetag, but Dr. Buscaglia has no
regrets. “At about $160 to $280 per pair, I spent $8,000 for all the
glasses,” he says. “I knew this was going to be a bit of an upfront
cost but you really can’t put a price on safety.”
Darcy Lewis is an award-winning freelance writer in Chicago who
specializes in healthcare topics.
RECOURCES
American Society for Laser Medicine and Surgery
715.845.9283, www.aslms.org
Laser Institute of America · 800.345.2737, www.laserinstitute.org
Innovative Optics · 800.990.1455, www.innovativeoptics.com
Kentek · 800.432.2323, www.kenteklaserstore.com
Laservision USA · 800.393.5565, www.lasersafety.com
NoIR Laser · 800.521.9746, www.noirlaser.com
Oculo-Plastik · 888.381.3292, www.oculoplastik.com
Sperian Laser Products · 800.343.3411, www.sperianprotection.com/us
NOTE OF CAUTION Placing plastic or metal eye shields in sterilizing
solution can result in serious corneal abrasions, reported Amy F. Taub,
MD, and Erin C. DaVita of Advanced Dermatology and SkinQRI, Lin-
colnshire, Illinois, at the April 2008 annual meeting of the American
Society for Laser Medicine and Surgery. They reported on two pa-
tients who suffered corneal abrasions attributable to eye shields used
in two different laser procedures. They determined that the problem
was the result of immersing the shields in sterilizing solution, even
though the shields were rinsed after the immersion and then auto-
claved. To avoid similar problems, they recommended against plac-
ing eye shields in any sterilizing solution. Simply wash and autoclave
them.
Autumn Edition | MedEsthetics 33
laser eye protection KEY FEATURE
“Twenty years ago, doctors would cut the handles off regular spoons and tape them over patients’ eyes with gauze pads,”says Barrows.
“The spoons worked, but the solution was cumbersome.”
KEY FEATURE
MedEsthetics | Southern Africa3�
One of the quickest ways to raise your company’s profile among the local and national media is to create a killer press center on your
website. Posting press releases, along with contact information and downloadable images of your practice and its key players is a great start. But
you can ratchet up your press pages with various forms of digital catnip that will make you and your practice virtually impossible for editors and reporters to ignore.
maximumexposure
By Joe Dysart
Autumn Edition | MedEsthetics 35
While a page of text including quotes and contact information is a
good start for a press release, you’ll get better play if you optimize it
for the Web. This means embedding relevant keywords that can be
found by search engines in the press release headline as well as in
the text. Offering formats with cut-and-paste portability will make
it easier for reporters on the go to pick up quotes and information.
Press releases posted on site in simple Web page format are easy to
cut and paste. Adobe .PDFs, while great for retaining an unchanged,
official record of your press release online, are often difficult to cut
and paste.
Editors and reporters are always hungry for story ideas, so you can
never offer too much content on your press center. The over-arching
guideline here is to clearly state that editors and reporters are wel-
come to directly quote information provided in your press releases.
This little permission can save the press five days of phone tag with
your practice and mean the difference between getting covered and
being passed over in favor of a more press-friendly practice.
Specific content ideal for launching press coverage includes quotes
from you and your staff on recent industry news, legislation or studies,
and short articles on new treatments you’re bringing into your prac-
tice. The press also loves transcripts of seminars or presentations they
can quote (always include a name and title), transcripts of recent we-
bcasts, case studies, survey results and patient testimonials. If you’ve
already enjoyed media coverage, offer links on your site to news stories
that have been written or aired about your practice, like
Dermatology Consultants (www.dallasderm.com/About/Press- Cen-
ter.html) and Forever Young (www.foreveryoung-inc.com/-practice-
media.html).
PROvIDE MEDIA SOURCESIf you establish yourself or your practice members as media authori-
ties, you’ll find yourself at the top of reporter’s lists when industry
news arises. Blogs are one of the quickest ways for a professional
to loom large before the press, but only if the blog is interesting and
insightful. Consider writing a major chore? Think about hiring a good
ghost blogger for your practice.
Meanwhile, you can gain additional authority with the media
by publicizing yourself in the various “expert stables” on the
Web—places where experts can present their experience, ex-
pertise and credentials to the press. Some of the more prominent
ones include Profnet (www.profnet.com), and Yearbook.com
(www.expertclick.com).
Your press releases should offer contact information including name,
title, phone and email for any media contacts. Providing the same
contact information in your press center for physicians who are avail-
able for interviews is even better. A promise, and a practice, to turn-
around all media requests within 24 hours will win you friends in the
press for life. And a stated openness to quickly respond to a media
“email interview” will inspire reporters to wonder if they’ve died and
gone to heaven.
Simply put, a reporter racing against deadline at three in the morning
will never forget the kindness of a quick, email interview. Moreover,
email interviews offer hidden advantages. They allow you to think
through your responses to the reporter and, given that your respons-
es are in writing, you’re less likely to be misquoted.
ADD RICH MEDIA UPgRADESOnce you’ve integrated the basics of an effective press center, you
can build out your content with a variety of multimedia tools. One
thing we’ve learned from the success of YouTube (www.youtube.
com) is that Web users, including the press, love sound and pictures.
Besides posting procedure videos on YouTube, you can also embed a
YouTube video player on your own website for free. Essentially, once
you post your completed video to the YouTube site, you can cut and
paste a snippet of YouTube-provided code that will create a YouTube
player on your own website in seconds. Such players can be dropped
beside your press releases in your press center, next to your blog or in
virtually any other sector of your website.
You have the option of posting the YouTube player “as is,” with its
familiar chrome border and YouTube logo or customizing it with your
company logo, as well as a look and feel that’s distinctive to your
brand. (With either option, a faint YouTube watermark appears in
the right-hand corner.) Sites that are currently using this technol-
ogy include The Reed Center for Plastic Surgery (www.thereedcenter.
com/rc-press.html) and Anil R. Shah, MD (www.shahfacialplastics.
com/media.html).
For video on how to add the YouTube player to your website, check
out www.youtube.com/youtubeonyoursite. There’s also a separate in-
structional video on how to customize your player at www.youtube.
com/watch?v=uTwWEtVtu58.
One caveat: You may want to have your attorney look at YouTube’s
fine print if you’re using the video strictly for advertising purposes. As
with many Web-related legal issues, this area is still very gray.
AttRACt AttEntIOnOne of the great equalizers of the Web is that a tiny, nimble compa-
ny can leap ahead of a lumbering goliath with the right promotion.
You can start promoting your press center with a sign-up box that
encourages visitors to join your email list for press releases and the
company e-newsletter. You can offer RSS (Really Simple Syndication)
While a page of text including quotes and contact information is a good start for a press release, you’ll get better play if you optimize it for the Web.
maximum exposure KEY FEATURE
maximum
Evolve Medical group’s site offers potential patients video, current news, newsletters and profile listings.
KEY FEATURE maximum exposure
feeds for reporters who like their news delivered this way through free
services like IceRocket (http://rss.icerocket.com) that make your pages
RSS-friendly.
During the past few years, Google has released a number of free tools
designed to help your press center get the best play on the Google search
engine. The idea is that if you use these tools, your site will appear higher
in Google search returns for the keywords highlighted on your site. Sign
up for a free Google Webmaster’s account (www.google.com/webmas-
ters) for tools, tips and tricks to optimize your press center domain for
the Google search engine. Once your press center is search-friendly for
Google, you’ll also be optimized for most other major search engines.
Other tactics that help direct media professionals to you and vice versa
include professional press release distribution services that, for a fee, dis-
tribute your press materials to media contacts worldwide. PRNewswire
(www.prnewswire.com) is one of the largest press release distribution
services. To find free services, you can search under the keywords “free
press release distribution.” “Press releases often lead to personal inter-
views, which can make you and your website very popular,” says Thomas
Wong, author of 101 Ways to Boost Your Web Traffic (Intesync).
With all of the new technologies available, it’s extremely important to
ensure that your press center downloads fast. The easiest way to lose an
editor or reporter is to serve up a press center site that takes forever to
download. For optimization tips, check out Andrew B. King’s book, Speed
Up Your Site (New Riders). King is the founder of Web Site Optimization,
LLC, which offers a free tool to analyze the download speed of your site
(www.websiteoptimization.com/services/analyze/).
MEASURE YOUR SUCCESSUpgrading your press center requires an investment of both time and
money, and you want to make sure your investment is paying off. Google
Analytics (www.google.com/analytics) allows you to measure not only
traffic to your press center, but the ways the press is interacting with
your site as well. This online service is a breeze to use—just cut and
paste a snippet of Google-provided code on every page of your press
center—and you’ll be able to analyze all sorts of press visits and activity
on your site with easy-to-understand reports. Google regularly enhances
this service. And the price is hard to beat: It’s free.
Once editors, reporters and bloggers start talking about your practice
on the Web, you’ll want to keep an eye on what they’re saying. The im-
portance of such reputation monitoring cannot be underestimated, says
Bruce Arnold, founder of Caslon Analytics (www.caslon.com.au), a Web
marketing firm that counsels clients on managing reputations online.
Specific reputation monitoring providers you’ll want to evaluate include
Factiva Insight (www.factiva.com/factivainsight/repu tation), Nielsen On-
line (www.nielsen-online.com/) and BlogSquirrel (www.cyberalert.com/-
blogmonitoring.html). z
Joe Dysart is an Internet speaker and business consultant based in
Thousand Oaks, California. Contact him at [email protected],
www.joedysart.com.
MedEsthetics | Southern Africa3�
Anil M. Shah, MD, and the Reed Center for Plastic Surgery employ Youtube players as part of their press centers.
Dermatology Consultants provides clips on its website of recent television and print media coverage.
the ASAPS offers news releases that can be cut and pasted by media professionals. Contact information is printed clearly at the top of each release.
SUNLIFE - SENSITIVE CAREA Sun life Series for Sensitive, Allergy Prone and Damaging Skin
All products have been Dermatologically tested, UV - tested, Photo Stable, andFree of Allergy Causing Perfumes
Sun Life Sensitive Allergy Care SPF 12Sun Life Sensitive Age Stop SPF 25Sun Life Sensitive Body Lotion SPF 30Sun Life Sensitive Stop SPF 50Sun Life Sensitive After Sun Gel for Face & BodySun Life Sensitive Pre Tan LotionSun Life Sensitive Self Tan Lotion
SUNLIFE & SUNLIFE SENSITIVE
BY KLAPP
CELL AND SUN PROTECTORA breakthrough in SUNLIFE Products containing ECTOIN® that envelopes the individual
cells like a mantle and thus acts as a UV and Cell protector
SUNLIFE – CELL PROTECTORSun Life Protection Lotion SPF 8 200 mlECTOIN® - cell protectorCOPPER – stimulates melanin synthesis and strengthens the immune systemCell revitalizer, against free radicals, anti-inflammatory, anti-aging effectSun Life High Protection Lotion SPF 18 200mlECTOIN® - cell protectorCOPPER – stimulates melanin synthesis and strengthens the immune systemCell revitalizer, against free radicals, anti-inflammatory, anti-aging effectSun Life Pre Tan Lotion 200mlTanning activator for face ad body which stimulates melanin synthesisSun Life Tanning Lotion 200mlSelf tanning lotion giving the face and body a natural tanSun Life Cool Repair Lotion 200mlCooling after sun lotion with repair function
Optimum Esthetic SystemsTel : 012 362 6571/2/3Fax : 012 362 [email protected]
Klapp beauty wellness.indd 1 1/11/08 10:26:50 AM
Liquid Ice CosMedicals AG • Zugerbergstrasse 86 • 6314 Unterägeri • SwitzerlandTel. +41 41 750 89 89 • E-Fax +41 44 355 34 49 • E-Mail [email protected] • www.icemask.com
Aesthetic Buyer’s GuideSept 2008
ADVERTORIAL
MedEsthetics | Southern Africa3�
ice maskcosMedical deliversperfect cooling after facial procedures
Celebrate A Year of Body Shaping In the year since VelaShape first entered the global spotlight, it has reshaped the way practitioners and patients think about non-invasive body contouring results!
Proven Clinical Results
What VelaShape Customers Are Saying
Practitioner Survey Highlights Include:
Clinical studies also report that patients can comfortably and safely achieve a toned, contoured and well shaped body in as few as 4 treatment sessions.
“VelaShape has also brought in new patients to the office – often friends and relatives of our existing patients come in just for VelaShape.”Mark Winter, M.D. – Orange Coast Women’s Medical Group, California
“We get consistent results with VelaShape. In fact, I guarantee my patients will see results whether it’s smoothing of the skin or circumferential reduction.”John Shieh, M.D. – RejuvaYou Medical Spas, California
97% of practitioners report an average of 3 - 10 centimeters reduction • in circumference of the treated areas for their patients. 87% of practitioners report that they treat at least 1 and up to 10 • VelaShape patients per week.78% of practitioners report seeing a significant reduction in the • appearance of cellulite on their patients.
“We see a lot of people who don’t want to go to the operating room but want to make a change in their body. VelaShape is certainly a way to achieve the results they are seeking with a non-invasive procedure.”Talmage Raine, M.D. – Hinsdale Center for Plastic Surgery, Illinois
1 Year Anniversary!
Perfectly Positioned for Today’s Economy
Aesthetics Buyers Guide July/August 2008Minimally Invasive Procedures Sustain Growth in Declining Economy
“As big ticket surgical items become financially out of reach for more consumers, several physicians and analysts pointed to a ‘trading down’ phenomenon whereby consumers are foregoing expensive surgical procedures for lower cost, often more minimally invasive alternatives.”
© 2009. All rights reserved. Syneron, the Syneron logo, VelaShape and elōs are trademarks of Syneron Medical Ltd. and may be registered in certain jurisdictions. elōs (electro-optical synergy) is a proprietary technology of Syneron Medical. LipoLite is a trademark of SpaMedica.* Temporary reduction of thigh circumference. PB71451
For an innovative approach to offering your patients effective, minimally invasive body contouring with great results and a fast recovery, use the VelaShape in combination with Syneron’s LipoLite Laser LipoSculpture system.
Body Contouring
Post 5 treatments.Photos courtesy of Longevity Medical Clinic
Before After
Cellulite Reduction
Post 4 treatments.Photos courtesy of Gerald Boey, M.D.
Before After
VelaShape™ treats both deeper tissue and the upper layers of the skin by offering a measurable reduction in fat layers, circumference and cellulite. Powered by the revolutionary elos™ technology, VelaShape is CE marked for body contouring and cellulite reduction and FDA cleared for circumferential* and cellulite reduction.
Better Together!
The Ultimate Body Contouring Treatment
&
For more information: www.velashape.com, www.syneron.com, [email protected]
Autumn Edition | MedEsthetics �1
ADVERTORIAL
The NovaShape is a-state-of-the-art system manufactured in Switzerland (Ultra Med Ltd) for fat reduction and body con-touring.
Years of research went into the manufacturing of the NovaShape. It uses low frequencies ultrasound (25Khz – 150Khz) which results in the
mechanical destruction of the adipose tissue - in contrast to similar ultrasound devices currently on the market which uses high frequencies
(1MHZ – 2.4Mhz) causing a thermal effect of adipose destruction. The NovaShape’s mechanical process results in a much safer and effective
treatment.
non-invasiveNovaShape
body contouringNEW FROM TECHNOLASE CC
tHE tECHnOLOgY On WHICH It IS BASED
The destruction of the adipose tissue or fat cells is caused is by a
process called Cavitation at Resonant Level.
The low frequency ultrasound causes a variation in pressure within
the tissue resulting in a large number of micro-bubbles to be formed
within the tissue. Due to the variation in pressure (the pressure
exceeds 50Kg per cm2) the bubbles explode and implode. This me-
chanical effect of exploding and imploding is strong enough to break
down the adipose membranes. It is a selective process – only the
adipocytes are ruptured –the surrounding tissue is not affected.
The rupturing of the adipose membranes (cell walls) destroys the fat
cells. The released fat and cellulite debris – triglycerides - are cleared
via the body’s natural physiological and metabolic pathways.
A SPECIALIzED HAnDPIECE
The NovaShape uses a piezoelectric emitter in the hand piece. It
houses a strong cooling mechanism. This unique refrigeration allows
the high power emitter to work continuously without over heating,
for optimal effectiveness and maximum comfort to the patient.
SPECIAL FEAtURES
• Permanent and Visible results from the first treatment
• Can be used over entire body
• No need for anesthesia or shaving
• Very comfortable due to cooling head.
• Extremely easy to use.
• Continuous research – therefore future upgrades.
• Low running cost
The NovaShape is Fully portable and weighs 65 Kg.
MedEsthetics | Southern Africa��
ADVERTORIAL
SUPER HIGH TECH COSMETIC POWERoptimum esthetic systems
Experience the Quality“Innovation Yesterday-Today and also Tomorrow”
Optimum Esthetic Systems is the
exclusive distributor of the KLAPP
COSMETICS range in southern Africa.
This includes the Klapp Professional,
Klapp Beauty Specialist, Klapp Wellness
and the GK Medical Cosmetics ranges.
KLAPP COSMETICS was founded in
1980 by Mr. Gerhard Klapp. KLAPP
develops and produces skin care
products and body lines that include a
variety of innovative professional and
home care ranges.
Gerhard Klapp, Anti-Aging-Specialist, alternative practitioner, Advocate of TCM, owner of the
KLAPP GROUP and Author has been dedicated to the research and development of effective
beauty-products for the preservation of beauty for over 25 years.
KLAPP has always been one of the trendsetters in the Beauty Market. To name only some of his
innovations, , Bio Cell therapies, Retinol (Vit A) series, Hyaluronic acid, Vit C, BX - Argireline®,
DMAE, DHEA, Collagen, Liposome’s, Peptides, Micro Silver, Gold, Ectoin®, Normasept®, Rona
care VTA® and DNA and Glycolic, Salicylic and Alfa Hydroxy Acids & Vit C series.
Klapp and GK products are NOT tested on animals and natural ingredients are used whenever
possible. All products are approved by the different National FDA’s. The company had its
international breakthrough with the massage technique CHI YANG and is currently exporting to
over 40 countries all over the world and is now available in South Africa.
GK COSMETICS GmbH, a division of Klapp Cosmetics, was founded in 2005 in order to develop
the market in the field of Medical Cosmetics. GK COSMETICS uses medical technology methods
and applies them for cosmetic use.
Technologies such as Impulse Light, Ultra Sound and High Voltage are used to penetrate the
upper layers of the skin and to enable active ingredients to be transported into the required areas,
connective tissue and the deeper skin layers.
The company has been awarded twice the sought-after German BEAUTY AWARD for Innovation, Products and Service
tREAtIng, PAMPERIng, RECOMMEnDIngKLAPP’S POSt LASER CARE SYStEMS
After being exposed to laser treatment
the skin needs extra care. Therefore it is
even more important now to support the
skin with the right choice of products.
KLAPP Cosmetics have developed specially
formulated products and treatments to
support the need of post-laser skin.
KLAPP Aloe Ferox gel – which
contains high concentration of naturally
ripened ingredients, harvested only
every three years .Alloe Ferox is used
immediately after the laser treatment
for its healing, moisturizing, astringent,
softening, regenerating and protective
properties. It also protects effectively
against UV rays and stress through
oxidation. It strengthens the collagen
and elastin fibres .Its disinfection action
prevents impurities and calms irritations.
Aloe Ferox Gel contains rich sources of
minerals and trace elements such as
magnesium, calcium, iron and zinc.
For the best results KLAPP recommends
keeping the Alloe Ferrox in the fridge to
enhance its cooling effect so important
after the laser procedure .The treatment
with Alloe Ferrox should continue for the
few first days after the laser .
Ideally immediately after the laser
treatment KLAPP Algen Aktiv Mask can
be used to improve moisture content
and elasticity and for additional cooling
effect.
OPTIMUM ESTHETIC SYSTEMS Tel: 012 362 6571/2/3 Fax : 012 362 6570 www.clubwellness.co.za [email protected]
ONLY
R6630.00Professional
use only
The GK 4 combines three technologies, which have been most successfully been used in medicine and cosmetic usage:• Ultrasound• Far Infrared• Ionization
Gk 4 offers Maximum Results• Moisture checking function• Skin regeneration• Deep activation of skin tissue and its metabolism• Increased permeability and open transport channels• Deep cleansing mode• Whitening mode• Wrinkle care mode • Massage mode• Nutrition mode• Lifting mode• Body care mode to improve body
shape by stimulating and exercising cellulites & fatty tissue
with MOISTURE CHECKING FUNCTION
ULTRASONIC & ION SKIN CARE MASSAGER
Beautiko GK.indd 1 26/2/08 12:04:06
MedEsthetics | Southern Africa��
Filorga® extends its range of anti-ageing chemical peelsFilorga Laboratories has been leader in the superficial chemical peel market with its advanced formulation GlyKopeel®, giving superior results
with no recovery period or social eviction. Last year, the new formulation of GlyKopeels was launched providing even lower pH with still no
skin flaking and need for social or sport eviction. This process of lower pH and less skin irritation were made possible after numerous years of
research and multiple experts from various countries.
tHE UnIQUE PH vARIAtIOn PROCESSThe sequential variation of pH during the GlyKopeel® procedure remains unique and is one of the major contributing factors reducing the risk
of side effects and improving visible results on skin appearance. Traditional peelings lower and increase the skin’s pH in a very sudden way.
GlyKopeel® is the first chemical superficial dermatological peeling in 4 steps, with sequential pH variations. By associating a first, preliminary
step (Prepeel with a pH of 4.5) with a final repairing phase (isotonic mist with a pH of 6.5) it allows a gentle treatment that provides an
immediate, visible result with no need for social eviction.
pH 4.5
pH 0.8 - 2
StEP 1 StEP 2 StEP 3 StEP 4pH
PREPEEL
PEELIng
POStPEELBRUME
pH 6.5
pH 8
Preparation Exfoliation neutralisaton Reparation
gLYKOPEEL * Is the first peeling with sequential variation of pH in 4 steps
4
6.5
4.5
1.6
UnIQUE IngREDIEntSThe new formula contains 18 ingredients improving the range of indications of skin imperfections. Results are visible immediately (brightness and softness) as well as progressive improvement (antiwrinkle and brown spots). Immediate results are ensured by the exfoliating action of glycolic acid combines with the antiradical, anti-inflammtory and hydrating action of the white mulberry, brown algae and glycerine. Progressively improving results on wrinkles and brown spots are due to the stimulating action of Vitamin A, C and E combined with the depigmenting action of Kojic acid and bearberry.
The peeling comes in 3 different glycolic acid concentrations and with 4 pH levels: 70 % with a pH of 0.8 and 1.6 / 50 % with a pH of 1.8 / 20 % with a pH of 2. Choice of peeling is made according to the skin type indication: Glykopeel® 20% is reserved to hyper-sensitive skins and can be performed by a medical assistant. Glykopeel® 50% is specifically indicated for sensitive skins or to be used in first sessions.
Glykopeel® 70% enables a higher efficiency level on more tolerant skin or skin used to peelings.
nEW!For an intensive treatment and a radical result, FILORGA® laboratories have developed the new Glykopeel® max, composed of 70% glycolic acid buffered at pH 0.8.
2009 marks the launch of numerous new innovations from the leading laboratory, the first in this year being the GlyKopeel 70% Max. This extends the indications of GlyKopeel® to also treat acne scars and deep dermal imperfections including pigmentary imperfections. The next breaktrough innovation to be launched in March at the Anti-ageing Medicine World Congress in Monte Carlo is the first of the X-peel range from Filorga. This range completes the chemical peel range in 3 formulations offering a ‘superficial – medium’ depth peel, a medium depth peel and deep peel formulation. An amazing composition of various acids makes this a new innovative peel offering more than any peel worldwide could ever offer. More information will be supplied after its launch in March.
For more information: www.filorgasouthafrica.co.za 012 548 3943 [email protected]
GlyKopeel® is recommended to treat wrinkles, loss of suppleness, dull complexion, hyperpigmentation, microcystic acne and skin imperfections.
ADVERTORIAL
Autumn Edition | MedEsthetics �5
ADVERTORIAL
Derma C, from the Filorga Professional range,
and Meso C, from the Cosmesotherapie range,
offers pure L-ascorbic acid delivered in its most active version thanks to its
ingenious packaging. Derma C is packaged in 3
vials needing activation instantly before use to
ensure optimal stability.
Each vial will be able to deliver the pure and active
form of Vitamin C for up to 7 days. This package
of 3 vials for 7 dya use of each vial, gives your
patients a 21 day cell renewal cycle with the most
active and pure benefits that one can ever expect
from Vitamin C combined with moisturizing
polysaccharides.
pure vitamin Coptimal benefits from
in its most active form
Vitamin C in its active form has numerous studies confirming its valid effects as an anti-oxidant, photoprotector, collagen stimulator and
depigmenting agent (by inhibiting melanin synthesis).
Derma C combines 100% of pure vitamin C with biosaccharides. These ingredients give it remarkable properties, having the effect of:
stimulating the cutaneous cellular metabolism, reinforcing the anti-oxidant power, hydrating and improving the skin’s tone.
BEnEFItS- Smooths lines and wrinkles with first use.
- Fades and lightens sun spots and age spots.
- Creates a new, more beautiful facial complexion.
- Enhances elasticity, firmness and skin texture.
- Restores radiance, smoothes, rebuilds collagen.
- Removes dull skin cells, reduces wrinkles and smoothes roughness due to excess dryness, acne and other problem skin conditions.
Derma C has received the PRICE OF INNOVATION in Europe already 8 years ago and has ever since become a vital part of prescription
following aesthetic consultations.
For more information and clinical trials contact gA Active Wholesalers 012 548 3943 or www.filorgasouthafrica.co.za or [email protected].
Autumn Edition | MedEsthetics ��
BEST PRACTICES
CAnFIELD MODELIng SOFtWARESurgeons offering breast augmentation can save time, deliver
more realistic consultations and improve patient satisfaction by
adding the new Breast Sculptor surgical modeling software to
the Canfield VECTRA 3D imaging platform. The software pro-
vides 3D comparisons of different implant scenarios to help
patients select the type of augmentation they want quickly
and precisely. Unlike two-dimensional simulation tools, Breast
Sculptor presents an augmentation outcome that can be ro-
tated to show an almost infinite number of views. The VECTRA
3D platform for Breast Sculptor produces fast, accurate three-
dimensional surface imaging and precise measurement tools
for volume, area, circumference and distance. The surgeon can
also automatically calculate volume to provide an objective in-
dication of the amount of asymmetry prior to surgery. “Breast
Sculptor is a tremendous tool for developing a common under-
standing between me and my patients prior to surgery,” states
Nolan Karp, MD, of New York City. “This results in more satis-
fied patients and additional referrals.” For more information,
www.genophealthcare.co.za, [email protected]
CAnFIELD MODELIng SOFtWARE MAtRIx RF RECEIvES CLEARAnCEIn late September, Syneron Medical announced that its Matrix RF
applicator received FDA clearance for use in dermatologic proce-
dures requiring ablation and resurfacing of the skin. The Matrix RF
applicator is the first bipolar RF nonlaser and nonlight-based aes-
thetic device capable of creating tunable ablation/resurfacing im-
pact, simulating the effects of common ablative/coagulative lasers
used for a range of aesthetic applications. It is the first bipolar RF
device able to treat skin in a method similar to fractional laser or
light-based devices, heating discrete columns of skin while leaving
the surrounding tissue intact.
“In my trials, I have found that the Matrix RF produces a unique
combination of skin rejuvenation, wrinkle reduction, skin tighten-
ing and even lifting with less downtime than found with traditional
skin rejuvenating treatments,” reports dermatologist Amy Taub, MD,
who participated in the clinical studies of the Matrix RF. Matrix RF
will be sold as an applicator add-on to all exisiting eLight, eLaser
and eMax platforms. For more information, radiant@worldonline.
co.za, 011 794 8253
FDA APPROVED
Cour
tesy
Pal
omar
AFtER BEFORE
FDA APPROvEDPalomar Medical Technologies, a leader in the development of light-
based systems for cosmetic treatments, announced FDA clearance
for the treatment of scars with the Palomar Lux 1540 Fractional
Non-Ablative Laser Handpiece. The Lux 1540 has been shown to be
effective in treating both atrophic and hypertrophic scars by creating
micro-columns of coagulated tissue in the skin. This process results
in significant improvement in the appearance of scars, offers short
recovery times and allows doctors to tailor the treatment for each
patient’s individual type of skin and scar. “Treatment with the Palo-
mar Lux 1540 fractional technology has the potential to become the
gold standard for scar treatment,” said David B. Vasily, MD, medical
director of the Aesthetica Cosmetic and Laser Center in Bethlehem,
Pennsylvania. For more information, www.genophealthcare.co.za,
MedEsthetics | Southern Africa��
FIvE-POIntED StARSFive is the winning number if you want to become a media relations star, says Richard Virgilio,
managing director of PayPerClip public relations (www.payperclip.com). Becoming a media-
recognized industry expert has never been more important and Virgilio has found that keep-
ing these “fives” in mind can keep reporters and broadcasters coming back to you:
Five seconds is the optimal length for a newsworthy sound bite.
Five words is the limit for a business title. Think dermatologist specializing in
medical aesthetics instead of medical director of Bronzky, North and
York Dermatology Group.
Five points is ample content. Keep messages concise. If you try to say more,
you will be rushed and scattered, giving the impression that you are
unsure of your message.
Five sentences is all it should take to answer a reporter’s question on a specific
topic. Be direct.
Five deep breaths before an interview is the most important preparation after content.
If you are not composed, alert and focused, the interviewer may
sense your tension as lack of confidence and lose interest.
SCEnt OF SKIn CAnCERHuman skin produces numerous airborne chemical molecules known as
volatile organic compounds, many of which are odorous. In findings pre-
sented at the 236th meeting of the American Chemical Society in August,
researchers suggest that these scents might be used to detect basal cell
carcinoma and other forms of skin cancer. Using gas chromatography-
mass spectrometry techniques, scientists at the Monell Chemical Senses
Center (www.monell.org), a nonprofit basic research institute based in
Philadelphia, sampled air above basal cell tumors in 11 patients and found
a different profile of chemical compounds compared to skin located at the
same sites in 11 healthy control subjects. “Our findings may someday al-
low doctors to screen for and diagnose skin cancers at very early stages,”
said Michelle Gallagher, PhD.
In-OFFICE ADS WItH IMPACtDo patients pay any attention to the brochures and videos in your waiting room? A recent
Health Media Network (www.hmnads.com) study by Arbitron says that 86% of those
exposed to advertising in healthcare facilities could recall at least one advertisement
they had seen during their visits. HMN advertisements were in the form of framed wall
posters or broadcast over widescreen digital television monitors in waiting rooms or
treatment areas of the facilities.
If your in-office advertising is relegated to a few brochures on a crowded counter or
tabletop, it might be worth considering adding a sign unit like the one shown here
from Walls + Forms (www.wallsforms.com). The Lights Alive backlit floor stand lets
you highlight a premier service in the lighted portion of the sign and provides pockets
underneath for brochures.
BEST PRACTICES
Autumn Edition | MedEsthetics �9
vASER LIMItS BLOOD LOSSVaser-assisted lipoplasty should be recommended over
traditional suction-assisted lipoplasty for patients undergoing
large-volume liposuction procedures or treatments in very
fibrous areas of the body where increased blood loss is
expected, according to the findings of a study published
in the July/August 2008 issue of Aesthetic Surgery Journal.
The 57-patient study comparing traditional liposuction
(27 patients) with Vaser Lipo treatments (30 patients) was
conducted by Onelio Garcia Jr., MD, and Nirmal Nathan. The
findings showed that traditional liposuction results in 7.5
times more blood loss than in Vaser Lipo procedures.
“Vaser Lipo already has several well-documented clinical
advantages, but this particular scientific study adds new
levels of credibility to the benefits of Vaser technology over
traditional methods,” says Dan Goldberger, CEO of Sound
Surgical Technologies, the manufacturer of the Vaser Lipo
System. For more about Vaser Lipo, [email protected],
011 444 0404, [email protected], 011 794 8253
ADvAnCED WHItEnIngThe BEYOND WhiteSpa Select system is the new generation
in teeth whitening, offering a high
quality, specially-formulated whitening
gel. The system is a comprehensive,
turnkey product that comes with
the original teeth whitening
accelerator, free materials for
your first 10 treatments and
other promotional products
for your practice. Contact:
866.695.6452,
www.beyondwhitespa.com
MedEsthetics | Southern Africa
BEST PRACTICES
50
tWO-In-OnE The eCO2 system from Lutronic is the first multifunctional fractional laser system that combines
both Static and Dynamic operation modes. Users can stamp an area up to 14mm by 14mm
and feather the treatment edges, thereby reducing the “checkerboard” appearance that is
common with currently available eCO2 devices. “The eCO2 has the ability to perform incisional
surgery, traditional ablative resurfacing and ablative microfractional photothermolysis,”
says J. David Holcomb, MD, immediate past president of the Florida Society of Facial Plastic
Surgeons. Contact: 609.275.1565, www.lutronic.com.
RESURFACIng BREAKtHROUgHAlma Lasers introduces the Pixel CO2, the company’s latest fractional, ablative CO2 solution.
The FDA-cleared system combines the effectiveness of an ablative approach with the comfort
level and convenience of a nonablative solution. Another plus is the shortened healing time-
the Pixel CO2 takes downtime from 30 days to approximately three. It also comes with a
lower risk of complications as compared to traditional laser skin resurfacing. Contact: www.
squabb.co.za, 012 667 5304, [email protected]
SKIn REnEWALSmooth deep wrinkles and firm skin
in as little as one session with the Af-
firm CO2 from Cynosure. Adjustable
power, pulse length and spot pacing
allow you to customize treatments
for skin resurfacing and collagen
rejuvenation. Contact: www.sternla-
ser.co.za, 082 551 5938
InCREASED vERSAtILItYPerform skin tightening, skin rejuvenation, hair
removal and more with one device. The Cutera
XEO is a customizable and upgradable platform
featuring 2790nm wavelength laser, 520nm to
1800nm pulsed light technologies and the Cool
Glide 1064 nm Nd:YAG laser. Contact:
www.ergonmedical.co.za, [email protected],
011 454 1876
Autumn Edition | MedEsthetics
FAStER FRACtIOnAL RESURFACIngReliant Technologies has received FDA 510(k) clearance for the new Fraxel re:pair 600micron
handpiece. The handpiece allows you to perform superficial fractionated procedures both on
and off the face, including the neck, hands and chest, with more uniform results and faster re-
covery times. Developed to treat fine lines, age spots and sun spots, the 600micron handpiece
works up to four times faster than other ablative technologies and offers additional collagen
remodeling capabilities. “The Fraxel re:pair’s 600micron handpiece is a significant advance-
ment for my practice,” says David H. McDaniel, MD. “Treatment is comparable to a series of IPL
treatments plus a series of microdermabrasion sessions, with the added benefit of increased,
long-term collagen production.” Contact: www.laserderm.co.za, 011 476 1228
tHREE DIMEnSIOnAL IMAgIngYou can help your patients visualize potential outcomes with Face Sculptor three dimensional
surgical modeling software from Canfield Imaging. The easy-to-learn software offers pictorial
icons and slide bars that allow you to sculpt facial images to the desired appearance. During
consultations, patients can see the results of rhinoplasty, chin augmentation and more, all
through three-dimensional, high resolution images that can be rotated and viewed from any
angle. The VECTRA 3D images are saved in the software’s Mirror database. The Face Sculptor
also allows you to capture two-dimensional before-and-after images, which can be printed into
photo quality reports for your medical files. www.genophealthcare.co.za, Dianne@genophc.
co.za
WAtER-ASSIStED LIPOSUCtIOnBody-Jet from Eclipsemed simultaneously irrigates and aspirates fat tissue during liposuction
to reduce bruising, swelling and collateral tissue damage. The Body-Jet uses only 25% of the
infiltration fluid normally required in traditional liposuction, which allows for less swollen mass
and improved patient comfort. The flushing action of the system helps protect surrounding
nerves and vessels. The Body-Jet also assists in fat transfer. When immediately filtered with
appropriate accessories, the fat does not require a lengthy centrifuge process to reduce water
volume prior to transfer. Contact: 800.759.6876, www.eclipsemed.com.
BEST PRACTICES
51
›› Image processing via normal light image, polarised light and UV light images.
›› 3D display of each area ›› History and comparisson analysis›› Printed output of above
FaciaL aNaLYsis sYsteM -Janus
Observation & Measurement of› Pores› Wrinkles› Spots› Sebum› Porphyrin› SkinColour&Tone