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.

The use of lasers in ethnic skin can pose a therapeutic challenge due to significant risks of post-inflammatory pigment alteration in this patient population. The greatest risk occurs in lasers with wavelengths in the range of the absorption spectrum on melanin due to the epidermal melanin absorption and resultant thermal injury in richly pigmented skin. In this article we will review lasers that have been studied in ethnic skin and will offer a practical approach to the safe use of lasers in ethnic skin.

The long pulsed Nd:YAG is the safest for laser hair removal in darker skin types.

A short pulsed nonablative Nd:YAG (Laser Genesis, Cutera, Inc., Brisbane, CA) has been studied in skin types I-V for the treatment of acne scars

Skincare Regimens to Optimize Laser Success

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.

Here, experts share their pre- and post-op regimens to optimize treatment success.

Informed consent is more than simply getting a patient to sign a written consent form. It is a process of communication between a patient and physician that results in the patient's authorization or agreement to undergo a specific medical intervention.

Medical Battery is defined as the intentional violation of a patient’s rights to direct his or her medical treatment. No injury or negligence is necessary for a finding of medical battery. Battery involves an unauthorized touching of another person. Medical battery occurs when a patient is treated without informed consent.

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 telangiectasia

Causes of Varicose Veins and Spider Veins

Varicose Veins and Spider Veins

Cosmetic dermatology represents that aspect of diagnosing, treating, and preventing the changes to the skin that are aesthetically not pleasing to the patient. Whether it be aging lines, pitting from acne, or scarring from sun damage, each of these occurrences prevents the patient from lookin’ good.

In this part of the International Academy of Cosmetic Dermatology website, authorities from various parts of the world present their views on cosmetic dermatology in a succinct manner.

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.

Patient eye protection is imperative to prevent permanent eye damage from Laser based technology. It can difficult to perform a laser vein treatment, Laser Genesis or a Limelight facial if the patient safety goggles are not adjustable.

Download the PDF file for patient laser goggle

For further information, contact:

A very inportant part of a skin care treatment plan is client teaching about the importance of sun block to prevent further damage.

FDA CRITICIZED: A new study reports that 85% of sunscreen products don't live up to their SPF promises or contain potentially dangerous chemicals.

Bio2 Cosmeceuticals treatment products are designed to enhance healing time by reducing the patient's recovery time and redness (erythema) from chemical peels and ablative laser treatments.

The amount of melanin in the skin can influence the skin care treatment plan.
Accurate skin typing is very important to the success of the Laser treatment and helps to identify the client's risk of adverse events related to pigment (hyper or hypo pigmentation) .  Skin color is influenced by genetics and exposure to ultraviolet radiation.

Fitzpatrick Skin Type Chart


Certain melanin makes skin more vulnerable to sunburn

Causes of Hyperpigmentation

Topical agents used in the management of hyperpigmentation

Postinflammatory Hyperpigmentation

Perform a physical exam and ask questions

Treating Acne in Skin of Color

Aesthetic Procedures in Skin of Color

Laser based technology is regulated by the FDA based on ANSI standards.  Cutera is committed to safe use of  Lasers in Dermatology.  Links have been provided to help educate our clients on the Rules and Regulations associated with the use of aesthetic systems.  Some information may be directed toward Laser Surgery and may appear to not be related to advanced skin care, however, the principles of safety are the same.

USE OF LASERS/DELEGATION OF MEDICAL FUNCTIONS REGULATION BY STATE

Laws and Regulations

Current Legislation Pending by State

Directory of State Medical Boards


Laser Regulatory Agencies and Professional Organizations

Food and Drug Administration

American National Standards Institute (ANSI Z136.3)

Joint Commission on Accreditation of Health Organizations (JCAHO)

JCAHO

OSHA (Occupational Safety & Health Administration)

Association of Operating Room Nurses

American Society for Laser Medicine and Surgery (ASLMS)

Clients seek advice for advanced skin care for Acne, Melasma and skin rejuvenation. It is important to identify the root cause of the condition in order to recommend an appropriate and effective treatment.

Three main factors contribute to the formation of acne: androgenic hormones, plugging of the hair follicle, and bacteria.   7 Acne Myths

Melasma is hyperpigmentation in sun exposed areas. The skin care treatment plan for melasma may include topical medications, chemical peels and Laser based technology.

Laser Genesis has been found to be helpful as a part of skin care treatment plan for treating Melasma. However, it should be noted that anything you use to treat Melasma may make it worse. A treatment protocol that is very effective for one client will not work on a different client and may even make their symptoms worse.
R. Lierly, RN

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

It was wonderful to meet Cutera's customers at this past weekend's Clinical Forum.  I really enjoyed putting faces to names and voices. 

We had a number of breakout sessions on practice building.  I'll be posting tips about advertising, keeping existing customers, attracting new customers and other pearls of wisdom from our presenters shortly.

Dr. Carol Clinton had a fascinating talk about the components of skin care products and their role.  For those who did not attend the Clinical Forum, Renee Lierly, RN, should be posting about Dr. Clinton's presentation on her Clinical blog.