I just read a very interesting article by Brent Foster in Practical Dermatology. It's entitled "Nonverbal Communication in the Patient Consultation".
Brent recommends using the clues patients provide to help you during a consultation; i.e. are they uncomfortable, interested, undecided with what you are explaining or proposing?
Perhaps you are discussing laser hair removal but they just learned about vascular treatments or they are concerned about pigmented lesions and they want to change the subject? See if these visual clues can help you with more successful consultations - with better closure rates!
You can read Brent's article
here.
Cutera offers monthly webinars on a variety of clinical education and practice marketing tips.
Today's webinar is hosted by David A. Engleman, MD FACC who will discuss the latest advances and advanced techniques for treating leg veins with sclerotherapy and using lasers - specifically the Cutera CoolGlide 1064 nm long-pulsed, high powered laser.
Do you find treating leg veins or any kind of laser vascular treatment to be tricky? Please watch this webinar. For your convenience, it will be recorded and available to view on-demand in Cutera webinar archive.
I'll be your host today; hope to see you online!
The use and delegation of Laser based technology differs from state to state. Treatment providers are required to know the state laws that govern the use of Laser and Light based technology. Some states mandate that the physician be physically present and supervise procedures such as Laser Hair removal and vascular treatments. While other states mandate that the physician can delegate Laser based treatments to staff that have recieved adequate training. The physician is not required to be physically present when the Laser Hair removal or vein treatment is performed.
USE OF LASERS/DELEGATION OF MEDICAL FUNCTIONS REGULATION BY STATE
Last Updated: 7/1/2008
Survey: Women View Cosmetic Procedures As Measure of SuccessWomen appear to believe cosmetic procedures can give them the edge in an increasingly competitive workplace.
Source:
February 11, 2009 Healthy Aging.
Women consider laser based technology, chemical peels and advanced skin care very important part of the "dress of success". Laser Genesis can be used on all ages and skin types to improve tone, texture and poor size. Limelight can treat pigmented lesions anywhere on the body and provide a vascular treatment to the face, neck and chest.
Treatment of Minor Burns Cooling of the burn wound: the ideal temperature of the coolant.Laser based infrared technology in advanced skin care can result in complications. Complications with Laser based technology can result when someone does not understand light/heat - tissue interaction, poor technique and inadequate cooling. Burn injuries can happen with vascular treatments, Laser hair reduction and the treatment of pigmented lesions. A treatment provider should never perform a treatment that may result in an adverse event that they can not recognize and properly treat.
Proper and timely treatment of a burn injury is key to minimize such adverse events as scarring and pigmentary issues.
It is very important to NEVER ICE a burn.
**Renee Lierly, R.N. has worked Burn Intensive care for 7 yrs and continues to work in a verified burn unit in the San Francisco/Bay area.
Limelight may be used to treat pigmented lesions. Sunscreens are helpful to prevent the formation of pigmented lesions. It is preferable to avoid sun exposure when performing skin rejuvenation treatments, Laser hair removal or vascular treatments.
Sunscreens and PhotoprotectionEncouraging photoprotection is the leading preventative health strategy used by physicians involved in skin care. Although sun avoidance is most desirable, outdoor occupations and lifestyles make total avoidance impossible for many individuals.
Author: Stanley B Levy, MD, Clinical Professor, Department of Dermatology, University of North Carolina at Chapel Hill
I came across Dr. Fairfield's
article on writing copy in an Advance for Healthy Aging web site. He highlights many excellent points.
When creating any kind of advertisement, remember you must ask yourself this "what does my patient want to know" and "why should they care?".
Dr. Fairfield feels that mentioning brands of lasers is unimportant. I disagree -- if the branded laser has received great media coverage, then you should leverage that visibility in your ad (i.e. Pearl Laser as seen on TV show, The Doctors or Titan as seen on Access Hollywood or Extra!). Consumers want to look like stars and have treatments that celebrities may have experienced.
Advertise what you can offer patients and why they should come to you for those procedures (injectibles, permanent hair removal, skin rejuvenation, vascular treatments, fractional skin resurfacing or skin tightening) with copy that appeals to them.
Safe and effective Laser vein treatment requires assessment and correct diagnosis of the vascular lesion. Laser based technology may be part of the vascular treatment plan.
The most apparent indication of Sturge-Weber Syndrome is a facial birthmark or "Port Wine Stain" present at birth and typically involving at least one upper eyelid and the forehead. Much variation in the size of the stain has been reported and may be limited to one side of the face or may involve both sides. The stain, varying from light pink to deep purple, is due to an overabundance of capillaries just beneath the surface of the involved skin. In persons with dark pigmentation, the stain may be difficult to recognize. In rare instances, there is an absence of a Port Wine Stain.
Sturge-Weber Syndrome (encephelotrigeminal angiomatosis) is a congenital, non-familial disorder of unknown incidence and cause. It is characterized by a congenital facial birthmark and neurological abnormalities. Other symptoms associated with Sturge-Weber can include eye and internal organ irregularities. Each case of Sturge-Weber Syndrome is unique and exhibits the characterizing findings to varying degrees.
Source: Sturge-Weber Foundation; Seattle Children's Hospital
Laser vein treatment requires assessment and correct diagnosis before performing the vascular treatment.
Management Strategies for Infantile Hemangiomas
Hemangiomas are benign tumors in which growth of capillary blood vessels occurs through angiogenesis.2 They rarely occur in utero, but instead appear as bluish or red marks within the first 2 weeks of infancy. Following this initial stage, they show rapid growth lasting for up to 12 months, the proliferation phase. In the next phase, the involuting phase, they slowly regress until an average of 5 to 7 years, after which hemangiomas remain unchanged.3 Traditional management of hemangiomas therefore, has been to wait until involution occurs spontaneously. However, complications such as bleeding, infection, ulceration, obstruction of orifices or psychosocial distress may be cues for intervention.
Source: Skin and Aging
VOLUME: 17 PUBLICATION DATE: Jan 09 2009
Issue Number:
1 Jan 09
author: Maya Barsky, BS, and Robert Buka, MD, JD
Skin Rejuvenation, Laser Hair Removal, Pigmented Lesions and Vascular Treatment
Laser based technology and treatment has advanced steadily for treatment of many cutaneous conditions, including a host of vascular and pigmented lesions, wrinkles, tattoos, scars and unwanted hair during the past decade. Demand for aesthetic treatments by skin ablation (resurfacing), and more subtle non-ablative treatments, has increased. Safety and ease of using lasers and high-energy flashlamps, has improved to the point that treatment can in some settings be given by non-medical personnel. Unwanted, preventable complications and side-effects are not uncommon. This article briefly reviews theory, clinical applications and potential for further progress of laser surgery in dermatology.
Source: Skin and Aging
VOLUME: 12 PUBLICATION DATE: Jun 15 2004
author:
By Hirotaka Akita, M.D., Ph.D., and R. Rox Anderson, M.D.
Laser based infrared technology may be used to perform a Laser Vein treatment to hemangiomas. Treating hemangiomas is an advanced vascular treatment and should only be attempted if the treatment provider understands the anatomy and physiology of the lesion and has performed a complete assessment.
Management Strategies for Infantile Hemangiomas
Hemangiomas are benign tumors in which growth of capillary blood vessels occurs through angiogenesis.2 They rarely occur in utero, but instead appear as bluish or red marks within the first 2 weeks of infancy. Following this initial stage, they show rapid growth lasting for up to 12 months, the proliferation phase. In the next phase, the involuting phase, they slowly regress until an average of 5 to 7 years, after which hemangiomas remain unchanged.3 Traditional management of hemangiomas therefore, has been to wait until involution occurs spontaneously. However, complications such as bleeding, infection, ulceration, obstruction of orifices or psychosocial distress may be cues for intervention.
Maya Barsky, BS, and Robert Buka, MD, JD
Performing Test Spots serve several different purposes and are an important part of a skin care treatment plan. Infrared technology used in laser-tissue interactions produces thermal effects on the tissue.
The primary reason for performing a test spot is to observe epidermal response and to determine safe treatment parameters when treating tissue because of absorption by the chromophore. Immediate epidermal damage presents as a blanching or graying of the skin (common with the Nd:YAG). Epidermal damage may take up to 72 hours to be visibly evident especially when treating melanin. A burn from an IPL may take 48-72 hours to appear. It is very important to perform a test spot when treating pigmented lesions.
A test spot may be beneficial for skin types IV-VI to evaluate risk for developing post inflammatory hyperpigmentation. However, this test spot must be evaluated 4-8 weeks post procedure as it takes this amount of time for the PIH to develop. Laser based technology on skin types IV-VI may increase the risk of pigmentatary changes.
Port Wine Stains require test spots as the parameters will vary widely due to the different types and involvement of these vascular malformations. Starting parameters for vascular treatments are usually lower then an average vascular treatment. A cluster of veins is a better target then a single leg vein so there is a higher risk of a burn.
There are advertisements on the internet offering "Free Test Spots" prior to Laser hair removal in order to determine if the treatment "will work before the client pays for the treatments". This perhaps could be beneficial to help determine proper parameters; however, the time period for evaluating the test spot for efficacy may be 4 to 12 weeks or longer depending on the growth cycle.
Test spots are considered an "Industry Standard of Care" and therefore have Medical/Legal implications. The elements of a malpractice suit are the "Breach of a duty that causes harm".
Informed Consent should be obtained for Test Spots and should include any potential complications that can occur from performing a test spot. It is better for the practitioner see the patient back to observe the test spot rather then allowing to patient to report on the results. This allows the practitioner to learn what the end result is and eliminates uncertainty if there is a complication.
This myth might be the cause.
"8. MYTH: Let winter-ravaged skin hibernate — cut back on pro treatments.
TRUTH: Actually, winter is one of the best times to start in-office laser treatments like laser hair removal, as pre-laser skin shouldn't be at all tanned, and post-laser skin won't tolerate sun exposure."
To expand on this particular myth, many of Cutera's aesthetic laser and light treatments such as Titan, Laser Genesis, CoolGlide Laser Hair Removal and CoolGlide Excel Laser Vein Therapy are color-blind; they can be performed on all six skin types and can be performed year-round, irregardless of tanned or tanning skin.
Let your patients know they don't have to wait for Spring or Summer to start laser or light-based cosmetic treatments. In fact, they will appreciate that they can get a head-start now!
Laser based technology and IPL technology may be used for a vascular treatment and skin rejuvenation. Clients often present with both pigmented lesions and facial veins caused by actinic damage.
Telangiectasias are small dilated blood vessels near the surface of the skin or mucous membranes measuring between 0.5mm and 1mm millimeters in diameter
.
They can develop anywhere on the body but are commonly seen on the face around the nose, cheeks, and chin.
Causes of Telangiectasia Rosacea, acne rosacea, and actinic telangiectasiaCauses of Varicose Veins and Spider VeinsVaricose Veins and Spider Veins
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
Advanced skin care and Laser based technology has become increasingly popular and growing field of study for many health care professionals. Clients are requesting a number of diverse procedures when they seek our assistance. It is not uncommon to have a client who requests "Skin Rejuvenation". The skin care treatment plan may consist of skin tightening, Laser Genesis and a Limelight facial for a vascular treatment or pigmented lesions. It is quite possible that this same client may later request a chemical peel, Botox or fillers and even Laser hair removal. The diversity of the procedures requires the treatment provider to have a wide range of knowledge in order to adequately meet the client's needs. Some resources I have found to be easy to read and a very valuable resource are listed below. Of course, there are many specialized books that are available and can be found at the links listed below.
Cosmetic Laser Books
Laser and Lights Volume 2
Cosmetic Laser Surgery
R. Lierly, RN
Many factors contribute to the development of telangiectatic facial veins and leg veins. Age, heredity, pathological conditions, occupations that require long periods of standing and pregnancy can all contribute to development venous disease. A successfull vascular treatment is dependent upon comprehensive history including presenting complaint, active symptoms, history of vascular disease, and general health and occupation history. Varicose vein treatment may require a combination of Laser based technology and sclerotherapy to adequately address the client's needs. Any successful vascular treatment is dependent on the treatment provider being able to successfully locate facial veins, legs veins and any reticular feeder veins that are often associated with the superficial telangiectasias.
There are several tools that can aid the visualization of the superficial venous system:
Syris V600 headlamp uses cross polarization technology allows the user
to see approximately 1mm below the skin's surface.
The new Venoscope® II transilluminator utilizes an array of high intensity LED lights to transilluminate the patient’s subcutaneous tissue thereby highlighting the veins which absorb the light rather that reflecting it.
| The VeinViewer by Luminetx® uses a combination of near-infrared light and patented technologies to image vascular structures, thus allowing physicians, nurses and other healthcare professionals to clearly see accessible vasculature |
| directly on the surface of the skin. |
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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