The Key to Mastering Cosmetic Dermatology Patient Selection


Choosing the best cosmetic dermatology candidates and appropriate interventions for each appears deceptively simple at first glance. Ideally, objective assessment of the individuals’ skin and relevant cosmetic units is performed. This objective data are compared to the culturally determined “norms for beauty” and areas of discrepancy are targeted for correction. Once adequate correction is achieved, patient satisfaction and “happiness” should be a certainty

 10 Myths About Cosmetic Dermatology

Myth #10: After taking my “after pictures” for a before-and-after series, I can forget about them.

Truth #10: I need to save pictures for 7 years.

Medical images that are part of the medical record need to be saved just as long as the medical record, which in most states is 7 years. Pictures are an essential part in the billing for MOHS, as images showing the defect are needed for the medical record.

Exceptions. Images taken for educational purposes or at medical conferences that are not parts of the medical record do not fall under the ambit for the strictures involved in retaining the integrity of the medical record. (Note that this issue has not been tested in court.) The taking of pictures for educational as opposed to clinical purposes must be made clear to the patient.

Skincare Regimens to Optimize Laser Success

Advanced Skin Care and skin rejuvenation starts with careful assessment of the client and tailoring the treatment plan to address the client's concerns.

Dr. Gold emphasizes that routines be customized to each patient’s needs. “You need to look at the patient as an individual. And you need to look at what’s bothering them and what they are there for, and then come up with a treatment regimen that is useful for them before, during and after your procedures,” Dr. Gold says.

Tailoring your treatment regimens to each patient before and after laser resurfacing can be as important as the technology you choose in striving to help patients recapture the more youthful appearance they seek.

After laser treatment, skincare routines promote rapid healing, and enhance and reduce the risk of complications such as infection, pigmentary changes and scarring.

Skin changes that progress with age

Advanced Skin Care starts with basic skin care on a daily basis. Daily skin care is necessary In order the achieve optimal results from chemical peels and Light Based Technology for skin rejuvenation.

It's not just your face that can show your age. Skin changes are also noticeable on your neck, shoulders and hands. These areas are frequently exposed to the sun, wind, changing temperatures and pollution, so they need to be moisturized and protected as well, especially from the sun's harmful UV rays.

Aging Skin

Varicose Veins and Spider Veins

Varicose leg veins and telangiectasia (spider veins) are the visible surface manifestations of an underlying venous insufficiency syndrome. Venous insufficiency syndromes allow venous blood to escape from a normal flow path and flow in a retrograde direction into an already congested leg.

Mild forms of venous insufficiency are merely uncomfortable, annoying, or cosmetically disfiguring, but severe venous disease can produce serious systemic consequences and can lead to loss of life or limb.

A successful Laser vein treatment is dependent on proper evaluation of the leg veins.

The visual appearance of the lower extreme ties is a useful, but not always reliable, guide to the peripheral venous condition. Multiple factors contribute to varicose veins. Intrinsic pathological conditions combine with extrinsic environmental factors to produce a wide spectrum of disease. Heredity seems to be particularly important in determining susceptibility to primary valvular failure. Occupations that require prolonged standing can lead to chronic venous distention and secondary valvular incompetence at any level. Women seem to be more susceptible to this problem, most likely because vein walls and valves periodically become more distensible under the influence of cyclic increases in progesterone. Pregnancy is an important risk factor that causes varicosities through several mechanisms. Most important are circulating hormonal factors that increase the distensibility of vein walls and soften valve leaflets. Another factor is the increase in venous capacity the develops to accommodate a greatly expanded circulation blood volume. Age is an independent risk factor for varicosities because with advancing age the elastic lamina of the vein becomes atrophic and the smooth muscle layer begins to degenerate, leaving a weakened vein that is more susceptible to dilatation. Most patients with venous insufficiency have subjective symptoms of pain, soreness, burning, aching, throbbing, cramping, muscle fatigue, and restless legs.

"Vein Diagnosis&Treatment: A Comprehensive Approach"
Robert A. Weiss; Feied, Craig F.; Margaret A. Weiss

Greater Saphenous Vein


Venous Anatomy


Varicose Veins

Laser based technology basic principles:


Lasers, General Principles and Physics

Laser radiation, like all light, consists of electromagnetic radiation.

Lasers and the Eye

Laser Safety Filter Guide

Advanced Skin Care with Laser based technology may require methods of pain managament and control.

 

Examples of Pain Control for Ablative Procedures

 

 

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.

 

A topical anesthetic is recommended for most ablative procedures. Prior to treatment, a topical anesthetic such as 7% lidocaine and 7% tetracaine is generally used. CAUTION: Toxicity may result with the overuse of topical anesthesia. Consult the manufacturer’s labeling.

 

Example: Some practices are using a BLT which is a compounded anesthetic.

It is usually 10-20% Benzocaine, 6% Lidocaine and 4% Tetracaine.

It is best to leave the anesthetic on for at least 45 min to an hour.

 

Additional forms of pain management are often used to assist in patient comfort, examples include but are not limited to the following:

 

A Zimmer skin cooling system or small fan blowing

 

Anxiolytics for relaxation and further pain control

 

Nerve blocks

 

Acetaminophen

 

Nonsteroidal anti-inflammatory drugs (NSAIDs)

 

Opioids

 

For more detailed information for assessment and management of acute pain:

 

Institute for Clinical Systems Improvement; Sixth Edition March 2008;

Health Care Guideline: Assessment and Management of Acute Pain

 

http://www.icsi.org/guidelines_and_more/gl_os_prot/musculo-skeletal/pain_acute/pain__acute__assessment_and_management_of__2.html

Distilled Water Only

Remember to always use distilled water in your Cutera Laser system. Using tap or bottled drinking water can contaminate your system and damage the device over time. Even a capful of inappropriate water can contaminate the cooling system..

Please remember to have your Cutera Laser system serviced annually to check calibration and change filters.

Cleaning the air intake

The air intake is located on the bottom of the Cutera Laser system console and should be kept free of dust and lint accumulation. Inspect the air intake monthly. Lightly vacuum the air intake to remove any accumulated dust and lint to ensure that the unit air flow is not obstructed. Please refer to Cutera Operator Manual for detailed instructions.

Keeping Your Cutera Handpieces and Laser System out of Sub-freezing Temperatures

As we begin another season of Winter throughout the North Americas, please be aware of the risk of exposing Cutera products to sub-freezing temperatures. All of our products require internal water cooling, and any short term exposure to sub-freezing temperatures, could result in severe damage to any item associated to any Cutera Product. This includes any IPL, Titan, Pearl, and Pearl Fractional hand pieces, and Xeo or Solera System.
The Cutera Service Contract/Warranty Policy does not protect, nor warrant, any system or hand piece, from exposure to sub-freezing temperatures or any other type of owner negligence.
 
Please contact Cutera Technical Support at 1-866-258-8763 for questions about service.

Laser Hair Removal&Permanent Hair Reduction

Each hair has 3 distinct components: the bulb, which lies near the insertion of the erector pili, the isthmus, and the infundibulum.

Pluripotential cells in the bulb and bulge areas cause growth of the hair follicle. Melanocytes are present in these areas. For most people, the bulb is approximately 4 mm beneath the surface of the skin (deeper in some individuals). Therefore, a considerable laser-penetration depth is required to remove the bulb.

Hair grows in cycles. Anagen is the active growth phase, catagen is the transition phase, and telogen is the resting phase. The duration of the anagen phase governs the length of hair at different body sites. Lasers are truly effective in only the anagen phase, when hair-matrix cells divide rapidly and migrate outward from the shaft and when the melanin load is at its highest. During the catagen phase, mitosis ceases, the hair matrix regresses, the papilla retracts to a place near the bulge, and capillary nourishment diminishes. In the telogen phase, the follicle detaches from the papillae and contracts to a third of its original depth, eventually falling out. The telogen phase varies in duration from one body area to the next. For example, the telogen phase may last as long as a year for hair on the leg.

The ratio of anagen follicles to telogen follicles varies with body location. Because not all of the hairs are in the anagen phase at any 1 time, laser treatment must be repeated to capture the new hairs coming into the anagen phase.

The timing of treatments is important because hair should be treated during the anagen phase. This phase is short (6-12 wk) for hair on the head, and treatments are spaced a month apart. On the trunk, the telogen phase lasts 12-24 wk, and 2-month spacing is best.

Author: Mounir Bashour, MD, CM, FRCS(C), PhD, FACS, Assistant Professor of Ophthalmology, McGill University; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD

 Three top dermatologists with extensive backgrounds in laser and light based procedures describe their unique experiences with the Cutera LimeLight programmable wavelength device.

Multi-Center Clinical and Technical Perspectives on LimeLight

3-in-1 Programmable Device

Christine Lee, M.D^a., Kei Negishi, M.D.^b, E. Victor Ross, M.D.^c

As presented by Antonio Campo Voegeli, MD at the American Society for Laser Medicine and Surgery

Twenty-Fifth Annual Meeting in Orlando, Florida, April 2005

 

Background and Objective:

The 1064 nm Nd:YAG laser has proved to be one of the most useful light sources for the treatment of deep vascular lesions. A deeper penetration and a lower absorption by haemoglobin makes this wavelength more useful for the treatment of deep or thick vascular lesions than the traditionally used shorter wavelengths (KTP, pulsed dye, IPL, diode) (Figure 1). However, problems with previously used Nd:YAG devices such as limited parameter combinations and pulse durations, non-optimal cooling systems, and uneven fluence distribution made them of limited value for the treatment of superficial or facial vascular lesions, as pain or risk of burning were common events. Since adequate absorption of this wavelength is achieved by haemoglobin, a system able to control depth of penetration through appropriate spot selection (Figure 2), with variable pulse duration to adjust to different vessel diameters, high fluences and optimal cooling systems to avoid pain or burning, should theoretically be able to treat any vascular lesion both superficial and deep or thick. An Nd:YAG laser with variable spot sizes (3, 5, 7 and 10 mm), highly-variable pulse duration (0.1-300 ms) and high fluences (up to 300J/cm2) (CoolGlide Vantage, Cutera) was evaluated for the treatment of a wide spectrum of vascular lesions.

A New Way To Treat Difficult Vascular Lesions

 Making the grade: New acne severity index helps doctors assess lesions

Bikowski Acne Severity Index or BASI

 Laser eye safety: How to keep you, your staff and your patients seeing clearly

 My physician extender performs nonivasive laser procedures


Did I commit battery?


Whose liability is it anyway?

 Treating Asian skin: Fast-growing population requires delicate treatment

With nearly a 25 percent increase in the Asian population of the United States between 2000 and 2005 (Source: U.S. Census Bureau, National Population Estimates, 2005), people of Asian origin have become the fastest-growing population group in the United States. The greatest proportion of that population is centered in five states: California, Hawaii, New York, New Jersey and Texas.

The many faces of South Asia

East Asian skinCultural, physiological idiosyncrasies dictate treatment approach

Melasma affects dermis, epidermisin most patients

 Hispanic skin conditions: Understanding diseases, cultural issues key

Hispanics more prone to hyperpigmentation. Like other individuals with skin of color, Hispanic Americans have a tendency to have long-lasting pigmentary changes. The Hispanic population is very heterogeneous in nature, and includes patients that span the spectrum of Fitzpatrick skin phototypes, according to Dr. Miguel Sanchez, M.D., associate professor at New York University and director of dermatology at Bellevue Hospital in New York.

Hispanic influences more than skin deep


Hispanic skin's three challenges

Melasma affects dermis, epidermisin most patients

Special considerations: Exacerbating factors mandate acne treatments for ethnic skin

Acne vulgaris ranks as the most common dermatologic disease, regardless of skin type, and its pathophysiology is the same in light and ethnic skin. "However, there are special considerations for acne management in ethnic skin that must be taken into account to optimize outcomes," says Dr. Callender, clinical assistant professor of dermatology, Howard University College of Medicine, and a private practitioner in Mitchellville, Md.

Boom Times Continue for Cosmetic Medicine Specialists

Consumer Demand for Aesthetic Procedures Remains Solid Despite Economic Downturn  (Click on "Featured Articles" ; scroll down page and look for title)

Here is a great way to promote your practice in today's tougher market...

There is a new popular patient / physician web site for cosmetic treatments titled "RealSelf.com". This web site allows patients to review products / procedures. The site then rates each procedure based on reviews. The site is gaining recognition with physicians and consumers. I heard a friend of mine mention it just the other day! It will be nice to encourage your customers and patients to use it to show the value of your Cutera Skin Rejuvenation products like Pearl, Pearl Fractional, Titan, Limelight, Genesis, CoolGlide Hair removal of dark skin types, and leg Vein therapy. This will help drive patients to your door too because there is a physician locator on this site!

If you could have your patients that have had a treatment, go to this site and fill out a real review. Site address is http://www.realself.com/. Please have them fill this in truthfully with their treatment experience. The site specifically states that it does not want "promotional" company pieces and will pull posts that are. If, however, you were treated, you represent a very valid and honest patient perspective.

There are already reviews for Pearl, Titan and Laser Genesis. Do a search for each application in the search bar and you should quickly be able to find reviews. To post a review, select "Write you review" from the bottom right of the home page, or below any procedure review section as "review it". Alternately, follow this link and fill in the form: http://www.realself.com/node/add/treatment-review

Also, please tell any people you work with that have had procedures and ask them to review the product as well. The more reviews and the more positive the reviews, the better for your Cutera technology and hopefully you can gain some new patients. If it was a demo patient that did not pay due to the nature of the treatment (training, demo, etc.) I recommend submitting the price the patient would have paid to be treated by the physician performing the procedure.

Here are the guidelines for posting at http://www.realself.com/community-guidelines

Make sure you sign up for the site for your office. Your practice and location become visible so this is a huge benefit to you if any potential customers in your area are looking at this site for cosmetic treatments. I suggest you have your customers post a review (hopefully they are predominately satisfied).

You can sign up by selecting the "Free Doctor Profile" at the bottom of the page and follow the form instructions from there

If you would like to list your practice on DermaNetwork

DermaNetwork is your premier online resource for skin rejuvenation. We offer you free access to a network of physicians who perform skin rejuvenation techniques.

Plastic Surgery Products has an interesting article on hiring the right person to help manage your practice.  See what they have to say here.