Topical Treatment of RosaceaThe management of Rosacea may include light and laser based technology in addition to topical medications. Laser Genesis and LimeLight facial are often used to treat diffuse redness and visible facial veins. It is important that clients understand that laser based technology is not a cure for Rosacea and treatments may need to be repeated to maintain results.
Skin-lightening Challenges
By: Zoe Diana Draelos, MD
Irregular pigmentation of the face is one of the most common signs of photoaging. Pigmentation occurs because of the uneven production of melanin—a brown pigment produced by melanocytes—in the skin. Many different patterns can be seen on the faces of people of different ages.
Clients often are seeking an advanced skin care consult for pigmentary issues. An aesthetic Laser system may be used as part of the treatment plan to address the pigmentary needs. Laser Genesis and LimeLight facial are often combined with light chemical peels, cosmeceuticals, sunblock and good client education about sun protection to decrease the appearance to pigmented lesions.
I'm happy to report that
Karen Lederman, of
Cutera Success Insights, will be hosting a session on Practice Marketing at Cutera's
Clinical Forum held in San Francisco, August 15-16, 2009.
Karen and her team offer ancillary marketing services to Cutera customers. She has a wealth of experience managing and marketing several successful and competitive aesthetic practices in Palm Beach county and has conducted meticulous marketing research. She will share her tips for success for marketing services using aesthetic laser systems, fillers, injectibles, retail products and body shaping. If you or your staff need a boost with your practice marketing - please attend Karen's session on Saturday, August 15.
Are you baffled by Twitter, Facebook or LinkedIn? We are also
considering a session on "Understanding & Leveraging Social Media Networks" at the San Francisco Intercontinental hotel on Friday afternoon. Karen has dived into social media and has great tips and ideas on how (and why!) to use these tools (LinkedIn, Facebook, Twitter).
Please post a comment or contact me if you would be interested in attending this informal session with Karen on Friday right before the Clinical Forum.
This kind of aesthetic laser system purchase involves asking thorough questions to ensure the decision is good for your practice.
Questions to Ask Before Buying an Aesthetic System from a Third Party
Does the seller have a clean title on the system?
Most aesthetic systems are leased. For any system that is less than 3 years old, there may be a sizable payment remaining on the lease. Until the lease is paid in full, the lien holder (usually the lease company) has rights to the system. At a minimum, you should call the manufacturer to check the serial number on the system to verify the title is clear.
How old is the system? What is the pulse count on the handpieces?
Are you buying the system sight-unseen? Is the system in good condition?Are the handpieces at the end of their life-cycle for pulse count?
How long will it take to service your system?
Each day your system is not operating can cost you thousands of dollars. Without access to parts and with a limited staff, how long will it take for your system to be repaired?
How will the system be calibrated after repair?
Many companies use proprietary tools and software for system repairs. Do your patients want to be treated with a system that may not be calibrated properly after repair?
How will you receive certified clinical training on the system?
Many insurance companies require training on the device for a malpractice insurance policy to be activated. Will your insurance company honor training not performed by a manufacturer’s representative?
Do you have access to the latest technology?
Technology evolves faster today than ever before, and patients have access to the latest information through the internet. Will you have access to the most recent innovations to offer your patients the procedures they are demanding?
You can print a copy of these questions/answers here.
Medical Insight, Inc. just released the following news that will positively affect the aesthetic laser equipment industry:
"New skin tightening devices, body shaping devices, dermal fillers and neuromodulators will drive 13.1% compound annual growth, according to the newly released Global Aesthetic Market (GAM) VI market study from Medical Insight, Inc."
Their study details how, "despite a softening economy, new advanced technologies will drive aesthetic industry growth, so that from 2008 to 2012:
- Skin tightening systems will expand by 21.3% per year
- Body shaping devices will rise by 20.1% annually
- Dermal fillers will increase by 15.6% per year
- Neuromodulators will grow by 14.8% annually
GAM VI separates sales of the ten top aesthetic markets into four regions (North America, Europe, Asia, South America) with comprehensive analysis of competitors, market and economic trends in each area. Included are manufacturer sales, number of practitioners, procedure volume and treatment fees for all segments."
For more details on Medical Insight, Inc.'s studies, visit their web site.
Acne Treatment GuideAny signs of acne should be treated as soon as possible. The longer acne is left to progress without treatment, the higher the possibility of scarring. Acne treatment primarily depends on the type of acne and its severity. Your dermatologist can best prescribe the appropriate treatment for your acne but it pays for you to be knowledgeable about this skin condition. Here are some of the common procedures in treating acne.
Acne Skin GuideInfrared technology of aesthetic laser systems can be used to treat textural issues from acne. However, it is very important to control the breakouts prior to starting any treatment. Laser Genesis is effective to help decrease the redness and improve textural issues of mild acne scars.
It is important for treatment providers to be familiar with legal issues of operating an Aesthetic medical practice. The regulations for the use of Laser based technology vary from state to state on who can perform the treatments. In some states Laser hair removal may be delegated to "an employee under the physician's supervision" while in other states the person performing the treatment must be a licensed healthcare professional.
New Report Outlines Key Legal Issues for Medical Spas and Aesthetic Medical Practices
Source: The International Association for Physicians in Aesthetic Medicine
www.IAPAM.com
Laser Safety
Source: Betty Minor, BS, RN is President of Laser Resource, Inc., Aurora, Colorado since 1986 actively consults and teaches laser safety programs, facility safety audits and overall laser safety development across the country. She was the Operating Room Director of Surgical Services; Director of Education east coast based Laser Company. She is a Sitting Member of the ANSI Z136.3 Safety Committee. She was instrumental in the development of the Medical Laser Safety seminar, which is recognized throughout the country as the most informative and practical for any health care laser facility. For more information, please contact her via e-mail at bettyminor@ds-int.com.
Contact dermatitis may occur with any aesthetic laser system or laser based technology that has the capacity to ablate the epidermis.
Contact dermatitis is usually irritant in nature. Because of the loss of the epidermal barrier and protection, the skin is more susceptible to irritation. An allergic or irritant raction to fragrances or allergens contained within a wide variety of topical ointments, soaps, moisturizers, or cosmetics may develop. It is important that clients refrain from the application of self prescribed remedies during the healing phase since these applications may exacerbate the irritation and contribute to post treatment complications. Signs and symptoms of irritant or allergic contact dermatitis include diffuse and intense facial redness (erythema) and itching. Frequent applications of cool compresses such as with vinegar soaks (acetic acid) may help decrease the intense itching and discomfort.
Lasers and Lights Volume 2
"Complications in Laser and Light Surgery"
Tina S. Alster, Elizabeth L. Tanzi
Contact Dermatitis, IrritantContact Dermatitis, Irritant: Differential Diagnoses & WorkupContact Dermatitis, Irritant: Treatment & MedicationContact Dermatitis, Irritant: Follow-up
Laser based technology may trigger a cold sore eruption. This may occur with any aesthetic laser system. A skin care treatment plan may include prophylactic treatment with an anti-viral medication. It is important to perform a complete medical history during the initial consultation to help identify clients that are risk of an outbreak. It is important to remember that Laser hair removal in the genital area may trigger an outbreak of genital herpes.
Cold Sores - How to Prevent and Treat ThemThe facts about cold soresThe fact about genital herpes
Clients must take steps to protect their skin from environmental factors that contribute to the visible signs of aging. Clients often seek skin rejuvenation treatments in the winter months in preparation for their summer activities.
Sunblock remains important to protect from the UV rays that form pigmented lesions and contribute to the formation of visible facial veins and redness. Infrared technology of an aesthetic laser system can be used to treat the results of the skin damage from the environment. In order to preserve the investment of time and money of skin rejuvenation treatments the client can follow some simple daily skin care practices listed in the articles below.
How To Stop Winter From Weathering Your SkinSkin Needs 'Winterizing' To Head Off DamageBattle Dry Skin During The Winter By Following Tips From National Jewish Medical And Research Center
Laser based technology used for skin rejuvenation may produce vaporized tissue resulting in Laser Generated Airborne Contaminates (LGAC). This is often referred to as "Laser Plume" or "Laser smoke".
LGAC may be generated during a Laser hair removal or any aesthetic laser system capable of ablating tissue. Ablative procedures are becoming more common in advanced skin care and require that the treatment providers be aware of the non-beam hazards. The standards for control of LGAC may be found in ANSI Z136.3
7.4.2 Control Measures. Airborne contaminants shall be controlled by the use of ventilation and respiratory protection. Ventilation techniques can include general room or local exhaust ventilation or a combination.
ANSI Z136.3 - 2005 Pg. 18
Use of Medical Lasers and LGAC
Dr. Drew Ordon presented the Pearl Laser on the popular syndicated TV show THE DOCTORS this week. Dr. Ordon talked about the wavelength (YSGG 2790 nm), the procedure, the indications Pearl treats (wrinkles, fine lines, skin texture, pore-size and removing pigemented lesions). He also showed animations on laser tissue interactions.
Dr. Ordon then introduced his patient and they discussed the photoaging and extensive sun damage she wanted treated on her face. The show then showed her being treated.
Dr. Ordon's patient was brought back to the show two weeks after her treatment and Dr. Ordon was able to not just visibly identify the improvements but was also able to quantifiably measure improvements to her fine lines, wrinkles, texture, pigment and pore size using a Canfield Visia photography system. Dr. Ordon's patient was VERY pleased with her Pearl treatment.
This is not unusual; RealSelf.com has a number of great testimonials on Pearl Laser patient satisfaction.
Physicians - have your patients visit RealSelf.com, post about all of their aesthetic treatments, their satisfaction with them and ask if they will recommend you as their physician. This is another means for potential patients to find you online and call you for a consultation or appointment.
And don't forget to keep your practice contact information updated on Cutera's VIP Physician Locator.
Laser based technology requires that the treatment provider accurately assess client skin type. Successful skin rejuvenation may require treatment of pigmented lesions, skin tightening and Laser vein treatment. In order to minimize and manage unexpected outcomes and possible complications the treatment provider must choose correct parameters on the aesthetic laser system based on a comprehensive skin type evaluation. The Roberts Skin Type Classification System is a 4-part serial system that comprehensively identifies a patient's skin type characteristics, and provides data to predict the skin's likely response to insult, injury, and inflammation (i/i/i) for individuals of global skin types. The clinician evaluates 4 elements (phototype, hyperpigmentation, photoaging, and scarring) and assigns a numeric "feature" to each, according to established and original scales. This classification system can uniquely help determine the course of treatment, clarify postprocedure expectations, and optimize outcomes. This individualized approach to identifying features and elements in various skin types will positively impact on physician communication, patient awareness and compliance, and preventive measures.
There are
possible complications that are associated with the use of any aesthetic laser system. A comprehensive health history including past medical history, allegies, medications, hobbies and lifestyle choices (smoking, alcohol, sun exposure) help the treatment provider identify and prevent possible complications that may occur. Accurate initial assessment, reassessment and evaluation of the intervention along with client education are key to reducing the incidence of complications associated with Laser based technology.
Laser Hair Removal can present an uncommon side effect of
paradoxical hair growth along with the more common side effects found with permenant hair reduction.
Skin Rejuvenation and
Laser resurfacing complications can be classified as mild, moderate or severe. It is important that the treatment provider be able to correctly identify and treat these possible complications. Do not ever perform a treatment that may produce a side effect that you are unable to recognize and treat. Accurate assessment and client education are key minimizing many of the potential complications.
Vascular lesions can be associated with other disease processes and require the correct diagnosis of the lesion before deciding on which laser based technology would be most appropriate for the vascular treatment.
Treating pigmented lesions or using an IPL device can prove to be challengeing to many treatment providers. Performing a test spot in the area of treatment and then evaluating epidermal response 48 hours later can be very valuable in preventing unwanted damage to the epidermis ("foot printing"). However, the test spot may take 1-2 months to demonstrate the signs of post inflammatory hyperpigmentation.
R. Lierly, RN
Most laser based technology used in Dermatology creates a laser induced thermal injury by the absorption of electromagnetic energy by chromophores in the skin (melanin, hemaglobin and water). Thermal damage to structures of the skin is a combination of time and temperature, the temperature to which the cell is heated as well at the time period for which the temperature is sustained. The goal of controlling a thermal injury requires careful selection of wavelength, fluence, pulse duration and spot size. Skin color in addition to Cooling the epidermis before, during and after a laser pulse must be taken into consideration to prevent unwanted thermal injury to adjacent tissues. The failure to properly assess the client, select appropriate parameters and ineffective or improper cooling may all contribute to an unwanted adverse effect of a burn injury.
Laser hair removal, Laser vein treatment and the treatment of pigmented lesions can all result in a unwanted burn injury. The first objective in burn wound care is to dissipate the heat. Clinical evidence indicates a beneficial effect from immediate active cooling of a burn injury to dissipate the heat.
Cool tap water or saline compresses is an effective method of cooling. Colder substances such as ice can be detrimental by extending the zone of injury by constricting the blood vessels. The period of time that is required for active cooling is brief. Cooling stabilizes skin mast cells, decreasing histamine release, thereby, decreasing edema of the wound. Cooling is an effective way of controlling the pain of a partial-thickness burn. Cooling for pain control may be achieved by using moist cool compresses, not ice packs.
Treatment providers should not perform any procedure that produces a side effect that they are unable to recognize and treat. Treatment of a side effect must comply with the standard of care ordinarily used by other healthcare professionals practicing their profession in the same or similar locality and under the same or similar circumstances. The failure of a healthcare professional to observe the standard of care is negligence.
It does not matter if the burn injury was caused by an Aesthetic Laser system of some other heat source, the standard of care remains the same.
I have included several links for burn injury first aid to reference as the standard of care.
Mayo Clinic
Health Sciences Center, University of Utah
Burn Injury Lawyers
Massachusetts General Hospital
Total Burn Care--- Renee Lierly, RN
Customer incentives when used correctly, can both generate loyal consumers as well as attract new ones. It's important to offer incentives based on consumers' spending habit, interests and still be profitable for the practice.
Patients love
frequent buyer programs. These provide a way in which to take care of patients who regularly come in for aesthetic procedures such as laser hair removal, skin rejuvenation, vein treatments or injectibles. Patients want, even expect, some incentive for being loyal to your practice. So, give them what they want.
How to get started? Talk with your injectible and filler vendors, since they may have a corporate VIP program you can tap into. Botox® Cosmetic and Restylane® both offer a frequent user VIP card that offers a discount on their next treatment.
Create your own with outside assistance -
vendors have software programs or
web-based programs to assist you in setting up, implementing and measuring your customer loyalty programs.
Be sure to create a system that is effective, fun, offers different levels of loyalty and most of all - is measurable.
Laser based technology is both safe and effective for permanent hair reduction, skin rejuvenation, skin tightening, laser vein treatment and treatment of pigmented lesions. The use of an aesthetic laser system for advanced skin care requires the operator to be familiar standards of care and laser safety in order to be in compliance with Laser regulatory agencies such as JCAHO, OSHA, ASNI standards and state regulations.
The Laser Training Institute offers Aesthetic Laser Training and National Laser Certification. The laser course offers a foundation in aesthetic office procedures and safety.
Renee Lierly, RN
Laser Based Technology is used by Biomedical Engineers, Laser Manufacturers, Physicians, Nurses, Aesthetic and Cosmetic Laser Users. It is important to be up to date on the latest FDA regulations, State Licensing Requirements & Laser Certification whether you perform Laser Hair Removal, Vascular Treatments, Skin Tightening or do Skin Rejuvenation. However, Laser Based Technology is found in many areas outside of Aesthetic Systems. Whatever your needs are for Laser Safety or CME/CEU credits Laser Training Institute is a great resource.
Laser Training Institute
Professional Medical Education Association, Inc.Provider Approved by the California Board of Registered Nursing
Category II CME’s for physicians
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