better with age - aesthetic and anti-aging medicine ... · private practice at the holistic...

GET INK OUT Improvement in laser tattoo removal

BETTER WITH AGERetinoid therapy and anti-aging in skincare

BUY NOW PAY LATERAesthetic procedures on account

Offi cial journal ofVOLUME 5 NUMBER 1

AUTUMN EDIT ION 20 1 2

1Autumn Edition 2012 Volume 5 Number 1

MEDESTHETICS

southern africa

note

SAILING CLOSE TO THE ROCKS

Just like the Greek cruise ship that hit the rocks early in January 2012,

many small businesses have been sailing close to the rocks believing it to

be the safer place in a turbulent economy. Globally however, the sea is

looking calmer and this is defi nitely true in South Africa.

For aesthetic businesses that survived the turbulent waters, now is the

time to set sail, defi ne new visions and grow again.

In this issue, there are a few interesting articles giving guidance on the

choices we have in the fi nancial world.

In the article Time to Find a New Bank it seems that banks are hungry

to expand small business operations to drum up new business. JT Brown

shares tips to help you fi nd a bank that your practice can count on during

this time of expansion. David Chen encourages practitioners to embrace

new adaptive patient fi nancing options. It has been found that patient

fi nancing has the potential to both increase a practice’s bottom line

and to improve patient satisfaction. He helps us to understand today’s

patient fi nancing options and how to investigate the companies that off er

fi nancing programmes. He highlights that “providers that off er fi nancing

will close more business.”

Growing a practice also implies appointing more staff . However, often

the problem is not fi nding a person but rather in fi nding a competent

person. The concept therefore of working interviews defi nitely has its

benefi ts, allowing a practitioner to work with a potential employee before

appointing them. Detailed information is given, understanding the rules

and taking the necessary precautions to avoid any unnecessary liability.

editor’s

MedEsthetics Southern Africa

Dr Nerina WilkinsonGuest Editor

Lasers still remain one of the most profi table treatments

in an aesthetic practice. However to achieve the best

results with minimal complications, practitioners need to

continuously improve their knowledge. Linda Lewis shares

her experience on improving tattoo removal outcomes by

combining diff erent lasers and new treatment regimes.

I am sure the business stress that we have experienced

over the past year has left a few tell tale lines which need

eradicating. For more than 40 years retinoids have been

the cornerstone in anti-aging skin care. This issue helps us

understand the formulations and effi cacy of retail retinoids

and how to maximise patient compliance.

Bon voyage for the rest of 2012 may the seas be calm

while taking your businesses to new, exciting places.

Dr Nerina WilkinsonGUEST EDITOR

Plastic and reconstructive surgeon, Dr Nerina Wilkinson has a full time private practice at the holistic anti-aging Renaissance Body Science Institute in Cape Town. She is a member of the Association of Plastic and Reconstructive Surgery. She has presented scientifi c papers at congresses and publishes in health-related magazines. She has a major interest in aesthetic surgery of the face, breast and body, closely integrating surgical with other non-invasive procedures.

2Volume 5 Number 1 Autumn Edition 2012

MEDESTHETICSsouthern africa

Autumn Edition 2012contents

PUBLISHERReni Rouncivell

MedSpec Publishing

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DISCLAIMER

This publication contains selected items originally published under license from Creative Age Publications in the USA. This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifi cally the rights for translation, reprinting reuse of illustrations, broadcasting, reproduction of CD-Rom, microfi lm, online publication, or in any other way, and storage in data banks. The use of registered names trademarks etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt for the relevant laws and regulations and therefore free for general use.

Product liability: the publishers cannot guarantee the accuracy of any information about the publication of medications contained in this publication. In every individual case, the user must check such information by consulting the relevant literature.

ARTICLES page

Getting better with age 4Get ink out 10Buy now, Pay later 14

DETAILS 8Chin-Tox

NEWSMAKERS 18Battling the Red Menace

BEST PRACTICES 20AESTHETICS CALENDAR 22BEST PRACTICES 24NEWS & EVENTS 26INTRODUCTIONS 42

ADVERTORIALSIncred 17Medilase 33Intamed 34Filorga 36Danne Montague-King 38Technolase 40Radiant Healtcare 44

get ink out

getting better with age4

10

Volume 5

Number 1

GET INK OUT Improvement in laser tattoo removal

BETTER WITH AGERetinoid therapy and anti-aging in skincare

BUY NOW PAY LATERAesthetic procedures on account

O cial journal ofVOLUME 5 NUMBER 1

AUTUMN EDIT ION 20 1 2



GETTING

WITH AGEBETTER

Efficacy & evolving formulations have made

retinoids a cornerstone of acne and anti-aging skin care

for more than 40 years.

By Adrienne Hymes

© M

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(Roy

alty

-Fre

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Retinoids burst onto the scene in 1969, literally infl aming patients as a powerful new tool to wipe out acne. Now in their 40s and buff ered by anti-infl ammatory ingredients, new delivery systems and a greater understanding of what it takes to achieve effi cacy, these ubiquitious, vitamin A-based active ingredients are more popular than ever for an expanding array of indications.

A SCIENCE IS BORNCo-developer of Retin-A, James E. Fulton, MD, PhD, board certifi ed dermatologist, researcher and founder of Vivant Skincare (Vivantskincare.com), recalls his earliest encounter with vitamin A acid. While running an acne clinic with his mentor, Dr. Albert Kligman at the University of Pennsylvania, in 1969, “We realized that after using the vitamin A acid three times per day, the acne suff erers were peeling, but their acne got better,” syas Dr. Fulton. “Shortly thereafter, Johnson & Johnson coined the name tretinoin, and made it commercially available as Retin-A gel—one of

the fi rst formulas—which was followed by a creme-based 0.1% vitamin A acid formula. The science of retinoids developed after that.”

Today, dermatologists have three types of topical retinoids—including tretinoin (retinoic acid), retinaldehyde and retinol—available to treat acne and photoaging. Tretinoin—available in 0.025% to 0.1% prescription-only concentrations—is the most aggressive form of retinoid. It is also most closely associated with some of the harsher side eff ects—such as redness, dryness and fl aking—that contribute to low patient compliance. “Now we have second generation retinoids tazarotene and adapalene,” says Jim Lee, vice president of clinical and medical dermatology, Stiefel (stiefel.com). “With early acne formulations, we tended to go very simple—they were a little greasy and not very elegant. We’ve really advanced the formulations.” New vehicles, including ointment, cream, gel and a tazarotene foam currently on the horizon from Steifel, are just one signifi cant evolution of retinoid formulations.

Other changes to retinoid-based skincare include the incorporation of retinol and retinaldehyde in non-

prescription strength skincare formulations.“Retinaldehyde is the immediate precursor to retinoic

acid in the pathway retinol>retinaldehyde>retinoic acid, and therefore it allows the skin to convert to retinoic acid as needed without over irritating or overdosing the skin,” explains Janice Lima-Maribona, DO, a Miami-based, board certifi ed dermatologist.

“The closer you can get to retinoic acid in the conversion progression, the better, since each step will not have a 100% conversion,” says Jim Krulisky, CEO and president of Axia Medical (dermesse.com). “Ideally a patient would use retinoic acid. However, this form of vitamin A tends to produce undesired eff ects. The alternative precursor forms do not exhibit these side eff ects and they tend to be less expensive than retinoic acid.”

Although retinol and retinaldehyde tend to be signifi cantly weaker than prescription-strength tretinoins, Dr. Lima-Maribona warns that companies are developing more stabilized high concentrations of retinol, for example, which can be irritating to the skin.

ACNE VERSUS ANTI-AGINGInitially, retinoic acid was used to treat skin diseases like psoriasis, ichthyosis and acne. In 1984, Dr. Kligman held a press conference to share vitamin A acid’s eff ectiveness in reducing fi ne lines over time. His announcement launched an overnight sales windfall for Johnson & Johnson, and created a new fan base for vitamin A acid—the baby boomers.

“Our acne clinic patients, at the time, continued to use the treatment, and their fi ne lines disappeared. We knew

”The closer you get to retinoic acid in theconversion progression, the better, since each

step will not have a 100% conversion.”

© H

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KEYFEATUREGETTING BETTER WITH AGE



that we had a valuable tool to combat photoaging,” says Dr. Fulton. “The fi ne-line market is much larger than the acne market. While acne is still my primary focus, half of my practice caters to acne patients—typically teens—and the other half to their moms.”

“Prescription treatments for acne typically contain retinoids, benzoyl peroxide and antibiotics, while antiaging products typically contain retinoids alone, but the retinoids are in a gentler base than you fi nd in acne formulations,” says Joel Schlessinger MD, FAAD, FAACS, an Omaha, Nebraska-based dermatologist and cosmetic surgeon. “The base of the formula may vary from a cream for antiaging to help combat dryness to a lighter, gel-cream better tolerated by acneic/oily skin.”

“Ointments are not preferred for acne formulations,” agrees Lee. “Creams and gels are preferred. Renova was the fi rst formulation approved for antiaging. It uses a lower concentration [of retinoids] and its approval is based on improvement in fi ne lines. Some retinoids can be very potent, and that’s what you want for acne. In a cosmetic or antiaging indication, the patient does not want to look red, so formulators use a lower concentration.”

Rahul Mehta, PhD, executive director of scientifi c aff airs, SkinMedica (skinmedica.com), emphasizes time as a factor in treating acne versus treating the signs of aging with retinoids. “Treatment of acne requires short-term use of higher levels of retinoid (0.05% tretinoin equivalent or higher) whereas preferred antiaging treatments require longer-term use of lower levels of retinoids (lower than 0.05% tretinoin equivalent),” he says.

MAXIMIZE PATIENT COMPLIANCEChoosing the appropriate retinoid-based topical starts by evaluating the type and age of the patient’s skin as well as the climate in which the patient lives (humid or

dry). “Patient selection for acne depends on severity and level of oiliness (gel vs. cream). A photoaging patient may start with a retinol or retinaldehyde product, and we may graduate her to a prescription form of retinoic acid,” says Jeannette Graf, MD, dermatologist and assistant clinical professor of dermatology at Mount Sinai Medical Center (askdrgraf.com).

One factor that affects the success of any retinoid-based skincare regimen is patient compliance. Side effects—such as redness, peeling, drying and flaking—may become an obstacle in the home treatment protocol. Fortunately, physicians have a growing number of options to address these concerns.

“The best course to handle patient side eff ects is to start at a low percentage—0.025%—and work the patient up to a higher strength, 0.1% as the patient gains

tolerance. Some patients even cut it more by mixing in a moisturizer with the tretinoin before application,” says Krulisky.

Proprietary delivery systems—such as liposomal encapsulation and time release—allow formulators to use a lower concentration of the retinoid while achieving increased effi cacy. Dr. Lima-Mirabona explains, “RETIN-A MICRO (tretinoin gel) has a unique microsponge delivery system that allows each microsponge to act as a reservoir that releases the tretinoin in small doses without causing irritation. Regular tretinoin creams and other formulations almost fl oat on the skin and release the active ingredient right away in bulk therefore irritating the skin more easily.”

“Multiple types of encapsulation technologies—such as microsponge and solid lipid nanospheres—are available to reduce the rate of release of retinoids from topical products which can lead to a reduction in irritation,” says Mehta.

Educating patients on proper product application techniques can signifi cantly reduce side eff ects. “This is particularly important with prescription-strength products. If the patient is not using the products correctly—such as applying them to damp skin or applying too much—irritation will be an issue which will aff ect outcome,” says Dr. Graf.

Michael H. Gold, MD explains, “In the old days, dermatologists would use Retin-A to dry the patient

“Some retinoids can be very potent, and that’s whatyou want for acne. In a cosmetic or antiaging

indication, the patient does not want to look red.”

© Ju

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KEYFEATURE GETTING BETTER WITH AGE

out. But if I dry out someone with photodamage, she is never going to be compliant, and she will discontinue her medicine. Education is the key, and we, as dermatologists, have to be cognizant of that.”

Patient expectations must also be managed. Acne patients may be motivated to adhere to their skincare regimens because shorter periods of required treatment result in visible improvement in a relatively short period of time. The same is not true for antiaging patients. The slower process of restoring photoaged skin back to health may lead a patient to discontinue her regimen before results become apparent.

In addition, retinoid use temporarily increases

sensitivity to the sun and may invite additional sun damage. Dr. Fulton encourages his antiaging retinoid users to follow some “common sense” rules to optimize skin rejuvenation. They include avoiding the sun, eating a low-glycemic diet and no smoking.

RETINOIDS ON THE OTC STAGE“There is a whole realm of over-the-counter products

that are strictly marketed as photoaging medicines, which require longer-term use to produce the expected results. Most of my colleagues and I will use retinol and retinaldehyde for photodamage, while sticking with the prescription retinoids for the treatment of acne, primarily because they have demonstrated safety and demonstrated effi cacy,” says Dr. Gold.

“Retinol is approved for over-the-counter formulations because it doesn’t have a lot of side eff ects,” says Lee. “It also doesn’t have a lot of eff ect. OTC retinol products are designed to be weaker products with higher safety profi les.”

Retinyl palmitate, and other esters of vitamin A, also can be found in many OTC products in retail stores. Drs. Graf and Fulton warn consumers that higher concentrations of retinyl palmitate are needed in order for it to be eff ective, as it must fi rst bioconvert into retinol. “Vitamin A and palmitic acid are two big molecules that don’t penetrate the skin very well. It takes 5% vitamin A palmitate to compete with these retinoids, and most of the products you see in the cosmetic aisle of the drug store off er a very small amount,” says Dr. Fulton. He notes that companies leverage the vitamin A “wow” eff ect for marketing and sales, but consumers may not be aware that there are diff erences in the types of vitamin A acid in their products. As a result, they may end up paying for a worthless active ingredient.

Though the popularity of retinoids has led to some unscrupulous claims, the consumer market—like the prescription-only formulations—continues to evolve, developing new products and formulations every season. “Retinoid formulations continue to be the benchmark with regards to proven skin age-fi ghting results,’ says Dr. Schelssinger. “Over-the-counter retinol

treatment options will continue to expand, and we will see future products that are even more eff ective and well-tolerated, including retinol products that combine other actives to provide eff ective, multi-tasking capabilities.”

Adrienne Hymes is an Alexandria, Virginia-based freelance writer.

“If I dry out someone with photodamage, she is never going to be compliant, and she will

discontinue her medicine.”

KEYFEATUREGETTING BETTER WITH AGE



Chin-ToxBotulinum toxin injections can provide relief for patients

bothered by their dimpled or creased chins.

By B

rian

S. G

latt

, MD

, FAC

S

“Chin-tox” refers to the application of Botox Cosmetic—or botulinum toxin—to the chin area of patients with dimpled or wrinkled chins to smooth the appearance. This treatment also can be used for a more severe mental crease along the chin area. The patient may present with puckering or dimpling of the chin that appears when she voluntarily or involuntarily activates the mentalis muscle. Treatment of this area with botulinum toxin is simple, eff ective and results in a high level of patient satisfaction.

The key to treating this area is having a strong working knowledge of the mentalis muscle; its anatomy and muscle action. The mentalis is a paired muscle that originates low in the incisive fossa on the midline interior surface of the mandible and it inserts on the integument on either side of the frenulum of the lower lip. Action of this muscle protrudes the lower lip, but it can also lead to a corrugated or dimpled appearance in the chin. In some people, a hyperkinetic mentalis muscle produces a deep mental crease, the appearance of which may be disturbing to the patient. Denervation of the mentalis muscle by means of the administration of Botox Cosmetic may help alleviate distress felt by these patients.

DOSAGE AND LONGEVITYIn general, Botox Cosmetic treatments take three to seven days following injection to begin to show results. The eff ect typically lasts three to fi ve months, but this can be variable depending on dosage used as well as variations between individual patients, such as age and

baseline muscle strength. There is also some evidence that with repeated injections a longer response time may be seen. Dosage should always be tailored to each individual patient as well as to the specifi c muscle group being treated. A thorough knowledge of anatomy in the area of injection is an absolute prerequisite for administering botulinum toxin injections to the facial region in order to optimize outcome as well as safety. Established ranges of Botox Cosmetic dosages for specifi c muscle groups and facial areas have been well described and should be used as a guideline for a relative starting point. Patients may still achieve maximal benefi t from dosages below the guidelines; others may require amounts above the typical recommended range for a particular muscle group. A followup appointment one to two weeks after injection is a useful strategy to

check if the administered amount of toxin was eff ective enough to produce the desired results for the injector as well as the patient.

THE PROCEDUREPrior to any injection, the skin should be thoroughly prepped with an alcohol or betadine- “Chin-tox” refers to the application of Botox Cosmetic—or botulinum toxin—to the chin area of patients with dimpled or wrinkled chins to smooth the appearance. This treatment also can be used for a more severe mental crease along the chin area. The patient may present with puckering or dimpling of the chin that appears when she voluntarily or involuntarily activates the mentalis muscle. Treatment of this area with botulinum toxin is simple, eff ective and results in a high level of patient satisfaction.

The key to treating this area is having a strong working knowledge of the mentalis muscle; its anatomy and muscle action. The mentalis is a paired muscle that originates low in the incisive fossa on the midline interior surface of the mandible and it inserts on the integument on either side of the frenulum of the lower lip. Action of this muscle protrudes the lower lip, but it can also lead to a corrugated or dimpled appearance in the chin. In some people, a hyperkinetic mentalis muscle produces a deep mental crease, the appearance of which may be disturbing to the patient. Denervation of the mentalis muscle by means of the administration of Botox Cosmetic may help alleviate distress felt by these patients.

DOSAGE AND LONGEVITYIn general, Botox Cosmetic treatments take three to seven days following injection to begin to show results. The eff ect typically lasts three to fi ve months, but this can be variable depending on dosage used as well as variations between individual patients, such as age and baseline muscle strength. There is also some evidence that with repeated injections a longer response time may be seen. Dosage should always be tailored to each individual patient as well as to the specifi c muscle group being treated. A thorough knowledge of anatomy in the area of injection is an absolute prerequisite for administering botulinum toxin injections to the facial region in order to optimize outcome as well as safety. Established ranges of Botox Cosmetic dosages for specifi c muscle groups and facial areas have been

REGULARFEATURE DETAILS - Chin-Tox

In some people, a hyperkinetic mentalis muscle produces a deep mental crease.

well described and should be used as a guideline for a relative starting point. Patients may still achieve maximal benefi t from dosages below the guidelines; others may require amounts above the typical recommended range for a particular muscle group. A followup appointment one to two weeks after injection is a useful strategy to check if the administered amount of toxin was eff ective enough to produce the desired results for the injector as well as the patient.

THE PROCEDURE

Prior to any injection, the skin should be thoroughly prepped with an alcohol or betadine-containing solution. Alcohol is typically preferred for botulinum toxin injections as it does not need to be washed off following treatments. Light application of ice immediately prior to treatment can help provide a more comfortable experience as the skin will be lightly anesthetized, making the tiny injections essentially painless. Numbing creams are greasy, time consuming (to take eff ect), and generally not necessary for these simple injections. In order to properly treat the mentalis muscle, bilateral, symmetric 5-unit to10-unit injections are made approximately 2mm above the inferior border of the body of the mandible, 5mm to 10mm lateral to the midline. Many injectors prefer a single point of injection aimed more centrally. If this option is chosen, then a slightly higher point—which would be close to the central area of the muscle belly—should be targeted. Carefully palpating the muscle action can help determine the best area of injection for a particular patient. Instructing the patient to raise her lower lip to her nose will accentuate the mentalis muscle and help determine the exact, appropriate area of injection. Interestingly, the depth of injection has not been found to be critical to success, although a deeper injection into the belly of the muscle is always preferred to one that may be too superfi cial under the skin or too deep on the bone. The fact that one does not need to achieve a specifi c depth of injection to produce success, however, provides a slightly higher margin of error than that which exists in other areas of the facial region where Botox Cosmetic may be applied. Treatment of the mentalis muscle with botulinum toxin should take three minutes to fi ve minutes or less. Gentle pressure to the site following injection will reduce post-injection bruising and also may help disperse the toxin within the muscle mass.

Botox Cosmetic treatment to the chin area, or “chin-tox,” is highly eff ective, simple to perform, safe and results in a high level of patient satisfaction. As with all botulinum toxin injections, a clear knowledge of the specifi c anatomy of the area as well as attention to technique is crucial to success.

Brian S. Glatt, MD, FACS is a board certifi ed plastic surgeon serving the New Jersey and New York metropolitan areas and a fellow of the American College of Surgeons (FACS).

The mentalis muscle can cause dimpling in the chin. This can be alleviated with the injection

of botulinum toxin.

Before After

Botox Cosmetic treatment to the chin area, or “chin-tox,” is highly effective, simple to perform, safe

and results in a high level of patient satisfaction.



get the

INK OUTLaser surgeons are improving tattoo removal outcomes by combining tools and developing new treatment regimens.By Linda W. Lewis

You can eff ectively remove tattoos with today’s lasers, but it’s a balancing act,” says Jafar Koupaie, MD, Boston Dermatology and Cosmetic Surgery Center in Canton, Massachussetts. “Until 1976, nobody knew why color disappeared when tattoos were treated. I was involved in a study at Boston University that discovered that the process of irritating the skin stimulated an immune response that brought macrophages to the wound site, which

swallowed the bits of pigment and carried them away little by little. That’s why it is more diffi cult to remove tattoos on parts of the body with less circulation or in individuals with impaired immune function. The challenge is fi nding the best way to irritate the skin and stimulate this response without causing scarring or pigment changes. We are still looking for the best solution.”

KEYFEATURE GET THE INK OUT


MEDESTHETICS

southern africa

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The introduction of Q-switched (QS) lasers in the early 1990s was a major breakthrough in tattoo removal. QS lasers emit nanosecond energy pulses that can be used for selective photothermolysis. Diff erent wavelengths are absorbed by diff erent pigments. The energy converts to heat, which breaks down the pigment into particles that can be cleared by the macrophages. “We work with an array of QS lasers. There is too much risk of scarring with any other type of tattoo removal,” says Elliot T. Weiss, MD, Laser & Skin Surgery Center of New York in Manhattan and Southampton, New York. “Our workhorses are the Sinon Q-Switched Ruby laser (Palomar Medical, palomarmedical.com) and an Nd:YAG. Some doctors get by with just an Nd:YAG laser, but in my opinion they do not work as well on light skin.” Another reason for owning multiple lasers is that diff erent ink colors respond better to diff erent laser wavelengths.

“For example, green inks respond best to the QS ruby or QS alexandrite lasers,” explains David B. Vasily, MD, Aesthetica Cosmetic & Laser Center, Bethlehem, Pennsylvania. “Blue and brown inks respond nicely to the ruby as well, while red and orange do well with the 532nm QS Nd:YAG. Black inks respond to the ruby, YAG or alexandrite wavelengths. Yellow inks do not respond well to any laser wavelength. In my opinion, there is no one box or laser that contains all these wavelengths with adequate peak power to address all colors.”

“Because most tattoos are black, I recommend an Nd:YAG as the fi rst line treatment for tattoos,” says Eric F. Bernstein, MD, Main Line Center

Image of results one year after receiving four treatments on the same day with a ruby laser. The ruby laser targets melanin more intensely

than the Nd:YAG and can cause hypopigmentation.

Before After

“We just completed a study using both

QS lasers & Fraxel re:pair & or Fraxel re:store to

remove tattoos.”

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for Laser Surgery, Ardmore, Pennsylvania. Because the 1064nm wavelength is the longest QS wavelength available, it has the least ability to “see” melanin pigment, yet it is still absorbed “very strongly by black tattoo ink,” says Dr. Bernstein. “Thus, this laser is safest to use on skin of color and works extremely well on any skin type. I just got the new RevLite SI (ConBio, conbio.com), and it is simply awesome. This laser allows one to select the maximum fl uence and continually vary spot sizes, so I can use the largest possible spot size with the desired fl uence. This means that more of the laser energy reaches the tattoo in the dermis. I also use the new Alex TriVantage (Candela, candelalaser.com). This laser is capable of removing multicolored tattoos: the 755nm wavelength works extremely well for blue and green tattoo inks and it has the 532nm wavelength to treat red ink.”

While there have been no major changes in tattoo removal lasers since the advent of the Q-switched laser, device manufacturers are making incremental changes. “Newer Q-switched lasers off er shorter pulses and a general trend toward refi ning the beam profi le and adding enough power to allow larger spot sizes,” says Dr. Weiss.

ADDING FRACTIONAL“Ideally, you want a QS Nd:YAG and either a QS alexandrite or QS ruby to at least cover the basics of tattoo removal,” says Richard Fitzpatrick, MD, with Goldman, Butterwick, Fitzpatrick & Groff Cosmetic Laser Dermatology, San Diego. “Some inks will still be diffi cult to remove. We have found that adding a fractional ablative CO2 or erbium laser treatment can be benefi cial. These lasers are attracted to the water in tissue and vaporize it along with the ink.”

Dr. Weiss and his colleagues at the Laser & Skin Surgery Center of New York have been studying the eff ects of adding fractional treatments to QS laser tattoo removal protocols for about three years. They routinely use nonablative fractional treatments but are cautious with ablative fractional treatments.

“We just completed a study using both QS lasers and Fraxel re:pair and/or Fraxel re:store (Solta Medical, fraxel.com) to remove tattoos (E.T. Weiss and R.G. Geronemus, Dermatologic Surgery, January 2011),” says Dr. Weiss. “Adding nonablative fractional laser treatments to the appropriate QS laser treatments helped [to] eliminate hypopigmentation, speed healing and improve clearance. Adding ablative fractional treatments also improved clearance of colors, like yellow, as well as titanium-based inks, including white and fl esh colors that often turn dark when treated with

QS lasers alone. There was a defi nite improvement in the end results.” Dr. Weiss continues, “If the patient already has hypopigmentation because of previous attempts to remove the tattoo or if he begins to develop hypopigmentation during treatment, adding fractional treatments can correct this. I routinely do nonablative treatments on all tattoo patients. If I’m working with tattoos that include titanium-based ink or the color yellow, I add a fractional ablative treatment about every third laser treatment. And if the patient has scar tissue from the tattoo itself, fractional treatments can speed the clearance.”

In the research paper cited above, Drs. Weiss and Geronemus identifi ed several possible mechanisms leading to improved outcomes with fractional treatments. In addition to removing any pigment superfi cial enough to be vaporized in the ablated tissue zones, ablative fractional resurfacing induces a robust infl ammatory response that could improve phagocytic removal of tattoo pigment. The wound columns typical with ablative fractional resurfacing allow fl uid to escape rather than building up and forming blisters. This allows the skin to heal more quickly. Nonablative fractional treatments may also stimulate melanocyte activity or migration leading to less risk of hypopigmentation.

FOUR A DAYA new tattoo treatment regimen, consisting of four QS laser treatments on the same day was fi rst introduced by Dora Kossida, MD, at the Advances and Controversies in Laser and Aesthetic Surgery 3rd International Conference held in Innsbruck, Austria in September 2010. Dr. Kossida developed the technique while working with R. Rox Anderson, MD, and Dieter Manstein, MD, at the Wellman Center for Photomedicine at Massachusetts General Hospital in Boston.

“They limited the initial study to simple black ink tattoos,” says Dr. Fitzpatrick, “and found that doing four treatments on the same day removed greater than 75% of the ink without scarring. I’ve had similar responses to the treatment regimen in my practice, even with multicolor tattoos. We do a treatment with the appropriate laser(s), wait until the tissue whitening clears—usually about 30 minutes—do a second treatment, then a third and a fourth. One patient with a multicolor tattoo that included red, black and yellow inks showed 90% clearance when treated with this regimen. That kind of result with no scarring prompted us to begin a study of the regimen with a large patient base. In one of the study groups we will do three QS laser treatments followed by a fractional

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KEYFEATURE GET THE INK OUT

CO2 treatment to see if adding the fractional treatment will improve clearance and/or minimize scarring. The study is just starting so we won’t have results for a year or so.”

Why would consecutive treatments make such a diff erence? “Studies have repeatedly shown that higher fl uencies are more eff ective,” explains Dr. Fitzpatrick. “But when we go too high, we run the risk of scarring. We think multiple treatments in the same day allow you to sequentially reach deeper layers with each treatment.”

PATIENT MANAGEMENTThe new treatment regimen may help with another problematic aspect of tattoo removal: getting patients to stick with time-consuming treatment regimens. It’s often impossible to give patients an accurate estimate of the number of treatments, the approximate cost and even what results they can expect. “There is a lot of judgment involved in assessing the tattoo and what it will take to remove it,” says Dr. Vasily. “We tend to charge by the inch and tell patients that results are unpredictable and the endpoint can’t be guaranteed.”

Most physicians charge per session and base the cost on tattoo size, ink density and the number of colors involved, as well as its location on the body. The cost per session can range from $50 to more than $500.

“We usually wait four weeks between treatments and, on average, we will do four to 12 treatments—more rather than less to ensure against scarring and pigment changes,” notes Dr. Koupaie. “We start with medium joules and fi nd out from the patient how many days of burning and scabbing he had. If healing took two days or less, we increase the joules; three days or more and we decrease the joules. We want to irritate but not too much.”

Dr. Bernstein reminds patients that the inks used in tattoos are not regulated by the FDA, which means there’s no way of knowing the composition of the ink and how many treatments it may take to achieve complete removal. “I do add that having all three types of Q-switched lasers should allow me to remove the ink in the fewest treatments possible,” he says. And as for turning patients away? Dr. Koupaie will do this as necessary. “You need to manage expectations with tattoo removal just as you do with any other cosmetic treatment. I turn away patients who think one treatment can do the trick.”

If the proposed sequential treatment regimen and the addition of fractional lasers improves safety and effi cacy, managing tattoo removal patients could become easier in the near future.

Linda W. Lewis is a MedEsthetics contributing editor.



KEYFEATURE BUY NOW PAY LATER

BUY NOW PAY LATER

Understanding today’s patient financing options.

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Understanding the OptionsCareCredit (carecredit.com) and ChaseHealthAdvance (chasehealthadvance.com) are the two largest players in the fi eld of fi nancing cosmetic procedures. They off er what is known as standard fi nancing options that are structured to pay the healthcare provider up front for services rendered. In most cases, the provider is charged a fee when the fi nance company purchases the transaction. There are also a handful of companies—including Healthcare Finance Direct (healthcarefi nancedirect.com)—that will manage in-house patient fi nancing programs. When Healthcare Finance Direct approves a transaction, the provider receives a down payment from the patient. The amount of the down payment—determined by

Healthcare Finance Direct—is based on credit risk and the cost of the procedure.

One hundred percent of the required down payment is retained by the provider. This diff ers

from standard fi nancing in that the provider is paid the remaining balance via monthly payments made through Healthcare Finance Direct, rather than receiving the entire balance up front. The provider is charged 7% on payments collected to cover administrative

costs. There are other distinctions between in-house and standard programs, says Nancy Coy, executive vice president and co-founder of Healthcare Finance Direct. When investigating a company that administers a standard program, be sure to examine the merchant fees and approval ratios before signing up. When working with an in-house fi nancing company, look at delinquency ratios in addition to approval ratios and fees. And make sure to ask if the company is in compliance with state and federal regulations and if it will indemnify the provider. In order to mitigate the provider’s risk, Healthcare Finance Direct looks at the cost associated with a procedure and obtains a down payment to cover the hard cost (i.e., the products needed to perform the procedure). “We manage and

In-house financing differs from standard financing in that the provider is paid the remaining

balance via monthly payments.

service the entire portfolio for the provider so they can do what they do best: treat patients,” says Coy. Risk management programs and credit matrix put in place by patient fi nancing companies help curb delinquencies. In the case of a delinquency—typically defi ned as 120 days past due—the patient’s information is sent to a collection agency. With a standard fi nancing option, the third-party fi nancing company handles collections as the practice has already been paid up front. In the case of an in-house fi nancing program managed by a third-party, the practice has two options: Send the patient to the practice’s own collection agency or have the fi nancing company handle the collection. In this case, Healthcare Finance Direct, for instance, receives a small fee while the practice receives the bulk of collected revenue.

The Evolution of Patient FinancingCareCredit was introduced in 1987 to help patients pay for new dental implant technologies. Now it is commonly used for cosmetic treatments and surgeries. The company provides a healthcare credit card that can be used to pay for certain expenses not covered by insurance or to bridge a payment when desired care exceeds insurance coverage. “There have been a lot of changes—most notable are the advances in technology and procedures that have created many new options for care—and a widening gap in insurance coverage,” says Mindy Karro, vice president of marketing for CareCredit. “Financing now takes a more prominent role, whether it is in the form of provider payment plans, bankcards or healthcare-specifi c fi nancing options.” CareCredit off ers patients two basic payment plans: deferred interest and extended payment plans. With a deferred interest plan, the accountholder pays no interest if she makes all of the required minimum monthly payments and pays the balance in full within a predetermined promotional period—typically 6, 12 or 18 months. Extended payment plans are available for 24, 36, 48 or 60 month time spans. These plans include an interest rate on purchases that is competitive with most bankcards. “Many providers tell us that the program has had a positive impact on their practices and patient satisfaction because it gives their patients a simple way to consolidate and manage certain healthcare expenses whether they are surgical procedures or minimally invasive treatments,” says Karro.

Why Off er Financing?Off ering patient fi nancing programs can alleviate procrastination while increasing patient satisfaction levels. Tara McLaughlin, surgical coordinator at JUVA Skin & Laser Center (juvaskin.com)—a New York City-based medspa and laser center—that has been off ering patient fi nancing programs since 2008, says that patients have expressed gratitude for having alternative payment options available. “Most patients really want to get procedures done, but with this economy they are afraid to spend



the money,” she says. “Since we have an interest-free option, it’s a much easier decision for them.”Coy points out that patient fi nance programs help practitioners capitalize on their marketing eff orts. “Many providers market their services, bring patients into their practices and the patients walk out the door

because they can’t aff ord the services off ered,” she says. Thus, off ering patient fi nancing programs can be a huge competitive advantage. JUVA off ers fi nancing to everyone who comes in for a consult, and it walks patients through the application process. “We have staff members available to help them apply online when they are in the offi ce so they can take advantage of the interest-free fi nancing while they’re here,” McLaughlin explains. “We also help them with credit line increases.”Since fi nancing is attractive to prospective patients, don’t hesitate to tout these services in your practice and in your marketing. Include information about patient fi nancing on your website, in new patient welcome kits, and in direct mail pieces and enewsletters. Update the practice’s fi nancial policy and patient payment agreement form to include fi nancing as an option along with cash and credit cards. Patient fi nancing information also can be displayed in practice areas used to discuss treatments and fees. Coy recommends off ering fi nance options to all patients, “at least make them aware that options exist,” she says. “Providers that off er fi nancing will close more business.”

Finding the Right FitKatie Ziemba, surgical patient coordinator for the offi ce of Steven H. Dayan, MD in Chicago (drdayan.com), says it’s important for practitioners to work with a company that doesn’t charge providers or patients large fees or high interest rates. And she cautions, “Ask about hidden fees.” McLaughlin concurs. “You really have to be selective with the fees associated with interest-free plans, the customer service level and also the approval process. The company we use (CareCredit) makes it

easy for us and especially the customer.” When looking for a patient fi nancing company to partner with, it’s important to ask if the company provides onsite training for your staff at no additional charge; how long the training period will last; and what information is off ered. Training components should include: how to

present plan details, terms and disclosures; patient privacy; and fraud prevention. Key personnel should be able to inform patients about how the fi nancing program works, including the credit terms to which they are agreeing, and their payment responsibilities. The ideal fi nancing

company will off er a variety of loans, including low interest rate loans and discounts for prompt payment. Every program is structured diff erently, so it’s important to learn about each company’s features before committing. Ask for specifi cs on the cost to patients and the cost to your practice. Determine if the credit arrangement is revolving or term—once a revolving line of credit has been partially or completely repaid, the patient can use the available line for additional transactions. Term programs are for specifi c procedures. Convenience and ease of use are part of any successful program. It’s important to fi nd out how much time it takes for the patient to apply and how long it takes to be approved or denied. Addiitonally, patients should be off ered a variety of payment options including pay-by-web, pay-by-phone, credit card, check and automatic payment plans. Don’t hesitate to ask for references. Obtain a list of clients who provide similar services and inquire about their experience with the fi nance company. Be sure to ask about acceptance rates. The vendor should be able to qualify patients with large or small balances, as well as patients with less than perfect credit scores.

Chelan David is a Kansas City-based freelance writer. Contact him at [email protected].

The ideal financing company will offer a variety of loans, including low-interest rate loans and

discounts for prompt payment.

KEYFEATURE BUY NOW PAY LATER


MEDESTHETICS

southern africa

Procedures available to be fi nanced include (but are not limited to) the following:• Plastic surgery • Cosmetic dentistry • Fertility treatment • Ophthalmology (laser eye surgery) • Audiology (hearing devices) • Non-surgical aesthetic procedures

(skin rejuvenation and body contouring)

Incred Medical Finance provides loans of between R5000 and R100 000 and off ers repayment terms to patients over six to 36 months at competitive interest rates. As the medical practitioner, you would receive payment for the procedure three days before it would take place.Incred Medical Finance is a registered, independent credit provider (NCR registration number: NCRCP5459) and subscribes to responsible lending. The mutually benefi cial properties of patient fi nancing mean that the potential to both increase a practice’s bottom line and improve patient satisfaction has never before been so accessible.

For further information, please visit www.incred.co.za, email [email protected] or call 011-262-2385 to speak to an Incred consultant.

MEDICAL PROCEDURES MORE POSSIBLE FOR PATIENTS THAN EVER BEFORE

life-changingMAKING

INCRED ADVERTORIAL

It is human instinct to want to improve our lives, including our intellectual, emotional and physical well-being. As a medical practitioner, your desire to help your patients access the most sound medical techniques for the most desired outcomes is, unfortunately, often thwarted by a patient’s inability to raise adequate funds. This is where Incred Medical Finance steps in to make this possible. Incred Medical Finance provides aff ordable fi nancial solutions that are tailored to assist patients with fi nance for elective surgical and non-surgical procedures. The process is simple and convenient: the patient can apply for fi nancing and fi nd out if he/she is approved within days. Over the years, elective medical procedures have increased in popularity, and the number performed each year continues to grow. The prevalence of reality TV programmes showcasing the latest cosmetic procedures has led to more awareness than ever before among the general public about the techniques and options available to them, while also removing any stigma attached to undergoing such interventions. As a result, it is likely that you are seeing more and more individuals who express that they want to feel more comfortable with their self-image, but do not necessarily have the funds available immediately to achieve this. At the same time, you need to ensure that you are able to reduce risk of non-payment as far as possible in order to grow your business. Incred Medical Finance ensures that your patients are able to access the specialist medical services they require. Never lose a patient because of his/her lack of available funds In what is undoubtedly a quantifi able benefi t to you, the medical practitioner, Incred Medical Finance ensures that you will not lose a patient owing to his/her fi nancial constraints. As your business partner of choice, the organisation enters into a loan agreement with your patient, ensuring that your fee will be paid to you prior to the procedure.

CEO of Incred Medical Finance, Warren Katz (CA) SA, notes that by referring a patient for a loan, the practitioner is able to provide services on a risk-free basis, because he/she is paid upfront in full. “If the practitioner extends credit him/herself, the risk exists of not being paid in full if the patient defaults. In this way, referring patients to third-party credit providers is a win-win situation, for both the practitioner and the patient.”

This is a workable solution for individuals who are hesitant to put additional charges on their high-interest credit cards or who may not have the funds available to make a lump-sum payment, says Katz.



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In late October 2011, Galderma Pharma S.A. (galderma.com) announced top-line results from its Phase 2b trial of CD07805/47 gel 0.5%, the company’s proprietary brimonidine tartrate formulation. The results confi rm the gel’s potential to become a viable topical treatment option for the persistent facial redness of rosacea. If approved, the formulation could provide an alternative to laser and IPL treatments currently considered the gold standard in addressing rosacea-related redness and telangectasia.

Galderma obtained the brimonidine tartrate solution—a vasoconstrictor most notably used in eye drops (Alphagan by Allergan, allergan.com) for the treatment of open-angle glaucoma—when it bought CollaGenex Pharmaceuticals in 2008.

“We currently have topical medications to treat pimples caused by rosacea but no medical therapies with FDA approval to treat the persistent redness,” says Joseph F. Fowler, MD, clinical professor of dermatology at the University of Louisville, Louisville, Kentucky and a principal study investigator. “Some patients with rosacea have no symptoms other than the fl ushing. While the Galderma compound may not get at the source of rosacea, it could possibly help enhance the quality of life for the millions of patients aff ected by persistent facial redness.”

Perhaps the most exciting news to come out of the eight-week, daily-use study was that there was no evidence of tachyphylaxis with CD07805/47. Results also showed the drug to be safe and well-tolerated. “We still need to establish the best regimen,” says Dr.

RED MENACEGalderma reports positive top-line results from its Phase 2b trial of a

novel medication to treat the redness of rosacea.

By Linda W. Lewis

REGULARFEATURE NEWSMAKERS - Battling the Red Menace

battling the

Fowler, “but it looks like the drug can be eff ectively used once a day to get an ongoing eff ect. This may vary with some individuals but trial data do indicate that continued use is safe.”

More complete results will be submitted for publication and further data analysis. “While we don’t have quantitative numbers to share as yet, qualitatively, the drug does seem to produce visibly obvious results,” reports Dr. Fowler. “It may not provide 100% clearance for all patients, but it certainly gives a noticeable eff ect. In our trials, we were looking for a 2-grade improvement on a scale of 0 to 5 and we did fi nd that consistently.” Phase 3 studies are underway.

When might the drug be available? Galderma’s Phase 3 trial will be complete in August 2012 at the earliest. The FDA approval process that follows has taken 15 months or so for similar drugs. “If the trial continues to prove the drug’s safety and effi cacy, it will be great to have something to off er patients. Right now we don’t have anything that does this,” says Dr. Fowler.

Linda W. Lewis is a MedEsthetics contributing editor.

Results confirm the gel’s potential to become a viable topical treatment option for the persistent facial redness of rosacea.



02

A study by Neil Sadick, MD, et al that appeared in the October 2011 edition of the Journal of Cosmetic and Laser Therapy, showed that the EndyMed PRO RF-based fractional skin resurfacing is eff ective for the treatment of facial wrinkles and acne scarring. The researchers treated 30 subjects - 26 with moderate to severe wrinkles and four with depressed acne scars - three times over the course of three months. Two uninvolved blinded evaluators graded photographs of the subjects. The study showed a signifi cant reduction in the depth of the wrinkles and acne scars at four weeks post-treatment with further improvements at the three-month followup.

02 Researchers Turn Off Aging Cell senescence has been causally implicated in the progression of age-related disorders and the “removal of senescent cells can prevent or delay tissue dysfunction and extend healthspan,” say researchers Darren J. Baker, et al, in a recent study published in the Nature journal (November 2011, vol. 479, Issue 7372). Based on the hypothesis that senescent cells accumulate in tissues with age and secrete a component that disrupts tissue function, the researchers used a senescence biomarker, p16Ink4a, to develop a novel transgene, INK-ATTAC, to destroy the marked senescent cells. They found that continued or “life-long removal” of p16Ink4a- expression cells in adipose tissue, skeletal muscle and the eye—areas in which p16Ink4a is believed to contribute to the acquisition of age-related pathologies—resulted in a “delayed onset of these phenotypes. Furthermore, late-life clearance attenuated progression of already established age-related disorders,” concluded Baker, et al.

03 A Simple Exercise To Track Conversions Cosmetic practices focused on bringing in new patients often spend 10% or more of their projected revenues on marketing initiatives. But budgeting the money is only the beginning, says Catherine Maley, founder of Cosmetic Image Marketing (cosmeticimagemarketing.com). In order to optimize marketing eff orts, she recommends that physicians undertake a simple exercise to track their prospect-to-patient conversions: Go through your schedule and look at the last 20 to 100 patients who had high-ticket procedures performed in your practice. Now look for important trends, such as:• Patient Demographics. Is the patient younger, older, married, single and so on?• Was this the patient’s fi rst visit to your practice or have you treated her before?• If she was new to your practice, how did she fi nd you? (i.e., through the Internet,

local news coverage, a referral from another patient, etc.)• Does the patient live locally or did she travel to your practice from a distant

place? The answers to these questions will tell where you should be focusing the majority of your marketing eff orts and rands.

BESTpractices01 SCIENCE LOG Kevin C. Smith, MD, FAAD, presented results from a long-term follow up of KYTHERA Biopharmaceutical’s ATX-101 injectable drug for submental fat reduction at the 2011 ASDS meeting in Washington, DC. Preliminary results show that at two year follow up visits, greater than 90% of the 45 responders from the company’s phase 2A studies who are taking part in the long-term follow up exhibited a sustained or improved response. Results were measured by physician evaluation using the Clinician-Reported Submental Fat Rating Scale. In addition, 80% of these subjects demonstrated sustained or improved satisfaction based on patient evaluation using the Subject Satisfaction Rating Scale.

03

REGULARFEATURE BEST PRACTICES

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APRIL 14 APRILTMJ/Bruxism & Gummy Smiles TrainingPretoriaSoy Secrets of Youth – Marissa [email protected] | 0123461552

18-22 APRILAmerican Academy of Aesthetic MedicineLevel 2 – DIPLOMA in Aesthetic MedicinE SA,Protea Hotel, Midrand, JHBAAAM SA organizer: Mareli J v [email protected], 012 548 7152

20 – 22 AprilAmerican Academy of Aesthetic Medicine Level 1 – CERTIFICATE in Aesthetic Medicine SA,Protea Hotel, Midrand, JHBAAAM SA organizer: Mareli J v [email protected], 012 548 7152

MAY5 May Weight loss Training - Pretoria Soy Secrets of Youth – Marissa [email protected] | 0123461552

7 & 8 MayI2PL Training - TechnolaseCSIR, PretoriaLouise - [email protected] 349 1750 | 083 379 3988

9 MayFilorga Product & Glykopeel training Pretoria Filorga Laboratoires Colette@fi lorgasouthafrica.co.za0125483943 | 0824947670

10 MayFiller & Mesotherapy workshopby Dr Riekie Smit Pretoria Filorga Laboratoires Colette@fi lorgasouthafrica.co.za0125483943 | 0824947670

12 MayLips Training - PretoriaSoy Secrets of Youth – Marissa [email protected] | 0123461552

11 – 13 MaySASDS - Cape Town Denise Kemp, [email protected]+27413745654

17 & 18 MayBotulinum Toxin & Dermal Filler training – Beginners Cape TownDr Alek Nicolic, [email protected]

31 May 2012AMCSA Pre-Congress* Level 1 Botulinum Toxin course* Mesotherapy course* Chemical Peel courseCSIR ICC, PretoriaAMCSA organizing [email protected], 0125487152

JUNE 1 & 2 June 20127th Aesthetic Medicine Congress of South Africa (AMCSA)

JULY 09 – 10 JulyI2PL Training - TechnolaseCSIR, PretoriaLouise - [email protected] 349 1750 | 083 379 3988

21 July 2012Deep Volumizing - Pretoria Soy Secrets of Youth – Marissa [email protected] | 0123461552

AUGUST 1 AugustFilorga Product & Glykopeel training Pretoria Filorga Laboratoires Colette@fi lorgasouthafrica.co.za0125483943 | 0824947670

2 AugustFiller & Mesotherapy workshop by Dr Riekie Smit Pretoria Filorga Laboratoires Colette@fi lorgasouthafrica.co.za0125483943 | 0824947670

4 AugustWeight loss Training - Pretoria Soy Secrets of Youth – Marissa [email protected] | 0123461552

16 & 17 AugustBotulinum Toxin & Dermal Filler training – Beginners Cape TownDr Alek Nicolic, [email protected]

SEPTEMBER 4 – 7 SeptemberInternational Society of Aesthetic Plastic SurgeryISAPS 21st CongressGENEVAisaps@conmx.netwww.isapscongress2012.org1-603-643-2325

10 - 11 SeptemberI2PL Training - TechnolaseCSIR, PretoriaLouise - [email protected] 349 1750 | 083 379 3988

15 SeptemberTMJ/Bruxism & Gummy Smiles Training PretoriaSoy Secrets of Youth – Marissa [email protected] | 0123461552

OCTOBER 4 & 5 OctoberBotulinum Toxin & Dermal Filler training – Beginners Cape TownDr Alek Nicolic, [email protected]

13– 14 OctoberBasic Aesthetic TrainingCape TownSoy Secrets of Youth – Marissa [email protected] | 0123461552

19-22 October APRSSA DrakensburgElite Conferences-Hendrika v d Merwe [email protected] 910 3322, 083 270 6344

20-22 OctoberBasic Aesthetic Training - Pretoria Soy Secrets of Youth – Marissa [email protected] | 0123461552

24-27 October3rd Continental Congress of the Intl Society of Dermatology [email protected], 0437435353

CALENDARSupplied as a service by the Aesthetic and Anti-aging Medicine Society of South Africa (AAMSSA) [email protected]

REGULARFEATURE CALENDAR

OF AESTHETIC ANTI-AGING MEDICAL EVENTS


MEDESTHETICS

southern africa

31 OctoberFilorga Product & Glykopeel trainingPretoria Filorga Laboratoires Colette@fi lorgasouthafrica.co.za0125483943 | 0824947670

NOVEMBER 1 NovemberFiller & Mesotherapy workshop by Dr Riekie Smit Pretoria Filorga Laboratoires Colette@fi lorgasouthafrica.co.za0125483943 | 0824947670

3 NovemberLips Training - PretoriaSoy Secrets of Youth – Marissa [email protected] | 0123461552

13-14 NovemberI2PL Training - Technolase - CSIR, PretoriaLouise - [email protected] 349 1750 | 083 379 3988

17 NovemberDeep Volumizing - Soy Secrets of Youth – Marissa [email protected] | 0123461552

23-25 NovemberAmerican Academy of Aesthetic Medicine (AAAM):Level 1 – CERTIFICATE in Aesthetic Medicine SA - JohannesburgAAAM SA organizer: Mareli J v [email protected], 012 548 7152

25-26 NovemberAmerican Academy of Aesthetic Medicine (AAAM):Level 3 – BOARD EXAM SA,JohannesburgAAAM SA organizer: Mareli J v [email protected], 012 548 7152

29-30 NovemberBotulinum Toxin & Dermal Filler training– Beginners - Cape TownDr Alek Nicolic, [email protected] Training provided on requestSclerotherapy, Nutrition & Weight loss, Mesotherapy, Chemical Peeling, Aesthetic practice management & staff training, etc. Soy Secrets of Youth Marissa [email protected] | 0123461552

Microdermabrasion – all manufacturers and also on Synergie AMS systemsStern LaserValerie van Zylwww.sternlaser.co.za, 083 628 9946

Lasers, IPL’S, Slimming and Cellulite units training - JohannesburgRadiant [email protected], 011 794 8253

Comparison of methods for

Permanent Hair Removal



05

04 REVLITE® Introducing RevLite® from ConBio, the next generation of Q-switched laser technology — a multi-purpose, multi-wavelength aesthetic laser that off ers maximum power and versatility for a broad range of indications on all skin types.RevLite® utilizes an extremely high-speed shutter to produce nanosecond pulse widths, enabling highly eff ective procedures with less heat and increased safety. Featuring PhotoAcoustic Technology Pulse®, the RevLite® delivers very narrow pulse widths at peak energy, even at larger spot sizes. The PhotoAcoustic technology is delivered through a superior fl at-top beam profi le - a hallmark of the RevLite laser - without spikes or hot spots that are prevalent in other Q-Switched Nd:YAG lasers. RevLite® FDA-Cleared Indications: • Wrinkle Reduction • Acne Scar Treatment • Tattoo Removal (Full-color Spectrum) • Pigmented Lesion Removal • Vascular Lesion Treatment • Dermal Lesion Treatment • Nevus of Ota Treatment. For more information please contact Intamed: 011 444 [email protected] | www.intamed.co.za

05 MARINI LASH JanMarini unique and patent-pending combination of peptides provides superior results and clinical studies demonstrate remarkable results with signifi cantly satisfi ed subjects. No other lash product on the market can use both of the enhancing peptides found in our Marini Lash Conditioner. - Dermatologist Tested - Opthalmologist Tested - Prostagladin Free - Synthetic Prostaglandin Free - Hypoallergic - Safe for sensitive eyes - Safe for Contact Lense Wearers. For more information please contact Intamed:011 444 0404 | [email protected] | www.intamed.co.za

06 SKIN CARE MANAGEMENT SYSTEM™ MD The award-winning Skin Care Management System MD utilizes synergistic layered technology to measurably improve the appearance of hyperpigmentation, fi ne lines, wrinkles, acne, rosacea and sun damage. Age Intervention® Enlighten MD Enlighten MD is specifi cally designed to combat sun damage, fi ne lines, wrinkles and hyperpigmentation. Its advanced non-hydroquinone formulation delivers rapid improvement with long-term control to achieve maximum results. Age Intervention® Duality MD™ Duality MD is a breakthrough solution providing serious acne control and anti-aging benefi ts. Its unique dual chamber dispensing solution combines previously incompatible technologies – the maximum allowed percentage of benzoyl peroxide, a concentrated retinol, peptides and antioxidants. For more information please contact Intamed: 011 444 0404 | [email protected] | www.janamarini.co.za | www.intamed.co.za

06

04

BESTpractices

REGULARFEATURE BEST PRACTICES



PostgraduatesFirst group of doctors completed the

two-year Postgraduate Course in

Aesthetic Medicine.

FIRST

On the 9th of March 2012, the fi rst group of 43 doctors completed the very fi rst two-year course in Aesthetic Medicine. This course is off ered by the FPD (Foundation for Professional Development).

Foundation for Professional Development (FPD) is a South African Private Institution of Higher Education established in October 1997 by the South African Medical Association.

The programme is designed to give participants advanced comprehension and skills so that they can manage and treat various pathological and non-pathological indications pertaining to aesthetics at a high level of competency and confi dence.The course modules in Aesthetic Medicine have been specifi cally developed for health care practitioners working in the Aesthetic and Anti-aging medical fi eld. The course is tailored to take into account the time and fi nancial constraint of practitioners working full-time in a practice. The range of course modules has been designed to develop and expand the participants’ comprehensive knowledge and advanced skills in this rapidly evolving and sophisticated fi eld of medicine.

This intensive course is made up of four modules, each running over a six month period. The 1st module includes a revision of basic medical sciences applied to Aesthetic Medicine. The second module integrates endocrinology, integrative medicine as well as obesity management and nutrition into the fi eld of Aesthetic Medicine. The 3rd and 4th modules is an in-depth focus on theoretical and practical apects of the various aesthetic medical procedures for face, body, skin, veins, hair etc.

The course is distance based learning with practical assignments combined with lecture days every six months. During these lecture days, experts teach, demonstrate and give hands-on guidance on performing aesthetic procedures.

The doctors are evaluated on theory, practical (skills) and assignments. This fi rst group of doctors put in a huge eff ort to ensure that they have the necessary knowledge and skills in the fi eld of aesthetic medicine.

The FPD and the entire industry is very proud of our fi rst group of qualifi ed doctors.

REGULARFEATURE NEWS & EVENTS


MEDESTHETICS

southern africa

It’s almost time for the annual aesthetic medical event of the year!

This gathering of all doctors and companies in the industry of aesthetic medicine has educational, business and social importance.

This year the Congress starts off with pre-congress trainings for doctors wanting to start with Botulinum Toxin and Dermal Fillers (Level 1 training) on 31 May 2012. This theoretical and practical training workshop is under the expert guidance of Dr Alessio Redaelli from Milan, Italy. He is the author of one of the most respected books on Botulinum Toxin and a number of other literature and publishings.

Another pre-congress course taking place on the same day is the Aesthetic Mesotherapy course by Dr Philippe Petit form Bordeaux, France. This course includes theoretical and practical skills on performing mesotherapy for skin rejuvenation, cellulite, adipocytolysis and hair rejuvenation. Dr Petit is one of the fi rst co-inventors of mesotherapy for general medical and aesthetic conditions in France more than 45 years ago. He is an international trainer, lecturer and course developer.

The Congress from 1 - 2 June has a number of interesting subjects that are being covered in three parallel running auditoriums in the form of presentations, demonstrations and live workshops. Local as well as international experts brinsg the latest trends, techniques and updates to our medical audience.

The Congress Program off ers presentations and workshops for both beginners in the industry as well as the advanced practitioners. The carefully selected topics are focused at bringing you up to

REGULARFEATURENEWS & EVENTS

CONGRESSdate with changes in techniques and products, new fi ndings and more expert guidance on procedures. Doctors leave the Congress with new knowledge, enthusiasm and new friends.

On Saturday the 2nd of June, the Congress has included an Allergan Master Class by the famous, Dr Mauricio de Maio from Brazil. Dr de Maio is world renowned for his excellent teaching skills and unique techniques of patient evaluation and treatment for Botulinum Toxin and Dermal Filler injections.

The Congress is complimented by a large exhibition where all the role players in the industry showcases there latest products, devices and techniques at their spectacular booths.

On the 1st of June the Aesthetic Medicine Gala Dinner is an ideal gathering with a relaxed atmosphere. This year taking place at Pebble Rock Golf Clubhouse that features a spectacular bush veld sunset not to be missed.

The Gala Dinner prices to delegates have been reduced this year making it more appealing to attend.

For more information on the Congress please visit the website: www.amcsa.org or contact us: 012 548 7152 or [email protected]



By Dr Alistair Clark, Sandton Aesthetics Institute

Probably the most important aspect of any aesthetic practice is that a top aesthetic practice leaves nothing to chance.

1. Top quality productsUsing the best products available keeps your patients

safe and allows you to have confi dence in repeatable treatments. Poor products are not well supported by companies and supply and service can let you down. Most importantly top quality products are backed up by safety data. The fastest way to destroy an aesthetic practice is by using sub-standard products that can harm or under-deliver to your patients.

2. Technique trainingUnderstanding how to use your products correctly

and with the right indication will always breed word-of-mouth business. If you are using gold standard products in the way they were designed to be used, your results will be consistent allowing you to over-deliver. Remember, poor training and good products won’t make for good aesthetic results. You can never have enough training.

3. BrandingA positive brand image is your key to success. Quality

products support your brand, technique training supports your brands – but your brand is your identity. It is your visibility. Your brand should be recognisable and relay the message of who you are and what your practice stands for.

4. MarketingMarketing is the representation of your brand into

the world. This means a successful aesthetic practice needs to be aware of how best to promote their brand in the media, online and to the public – of course in ethical ways. Marketing can take on many forms and should be considered both internally and externally.

5. Spectrum of needsIt is important for any successful aesthetic practice

to satisfy the full spectrum of a patient’s needs. This means that you should use the best available products and be trained to do so. Once you can satisfy a patient’s complete anti-ageing need they will never go anywhere else, as long as you keep delivering results.

6. Staff selection Remember that if it is hard to deal with your staff

then patients will go elsewhere. In the aesthetics world your patients are elective and they choose to visit your practice. Your staff need to carry your message and deliver your marketing fl awlessly to avoid patient dissatisfaction.

7. Staff trainingHiring constructive and harmonious staff members

is one thing but training them to achieve your results is another. Reception training will improve word-of-mouth referrals because of great service and rapport. Similarly training therapists to achieve better results using the latest technology will increase faith in your practice and the results. Uplift your staff and your practice will become more successful.

8. Location You don’t have to be in an affl uent suburb to succeed,

but you must take advantage of your location and surroundings. Many successful practices function in low income areas but use their location to attract customers. I.e. have a visible practice, make it easy to fi nd.

9. Interior designThis point cannot be stressed enough. Mediocre

practices have mediocre interiors and they are not unrelated. A clean, sophisticated design will give your clients faith in your ability. A professional interior design will promote your brand and form part of your internal marketing strategy. Remember, patients are looking for an experience. They have chosen to sample yours and


FOR A SUCCESSFUL AESTHETIC PRACTICE

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if your waiting rooms and treatment facilities are not up to scratch then they will simply go elsewhere next time.

10. Packages and specials We do need to be careful here because of canvassing and

touting restrictions but it is important to off er good packages to your patients. Off ering specials and packages benefi ts both the practice and the patient. They get a deal and you get consistent turnover and exposure of your technique, products, marketing and branding and your exceptional staff . This creates more opportunity to promote further word-of-mouth referrals.

ConclusionThe above set of steps to a successful practice will only prove

successful if you adhere to two common aesthetic business prerequisites, those are:

1. Know your limits and refer your patients when better options are available i.e. surgical intervention or specialists. Be honest in your own abilities and limitations.

2. Always manage your patients well, especially the complications. Do not shy away from complications, make those patients feel extra special and you will avoid losing clients and poor word-of-mouth marketing.

To be successful in Aesthetic Medicine takes planning, training and focus. These tips will help you establish your brand and live up to the ideals you create.

By Dr Chris Giezing, Secrets of Youth

When we discuss top tips, it is presumed that solid technique as well as all the relevant principles of good practice has already been addressed. To my mind, the top tips for an aesthetic practice are important mostly for the value that they add.

Tips can be divided into fi ve categories.

Experience of client In my aesthetic practice our mission statement is: Results with

an E. The E in this case refers to a (very) positive experience. Elsewhere it has also been coined the “client journey” and I believe this to be at the very the core of any such business. The “look and feel” will be the fi rst impression of your practice that a prospective client gets. It should be diff erent to a normal clinical medical practice. In my experience clients prefer a softer, warmer and more luxurious lay out where a lot of thought has been given to fl ow and privacy as well as their comfort. We should never forget that aesthetic clients see us because they want to! We are “grudge sales”! All staff should be very well trained, but in the aesthetic set up, it is more important that they should care! The old adage goes that clients are interested to know that you care more than they care what you know. This is doubly true for this industry. The last aspect of the client experience is what I call: “fi nishes”. This refers to the small elements of care that add to the comfort of our clients or lessen their discomfort. This might be something as small as an effi cient local anesthetic or an ice pack to lessen swelling or




FOR A SUCCESSFUL AESTHETIC PRACTICE

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prevent bruising. Often it can only be to have someone hold the hand of a frightened client.

Quality information In South Africa many of our clients still believe

that Botox® is the equivalent (or worse) than snake venom. As such a very important aspect is the quality of information that we provide our clients. From the verbal explanation of our reception staff (training), the informational pdf fi les that we send via email, to the information leafl et we give them after consultation, it is important that care be given to provide information in an understandable format.

Information should be readily available on products off ered, procedures done, outcomes to be expected, time spans for recovery as well as aftercare. Another very important aspect is the breakdown of costs of every procedure and all treatment plans. Few things are as embarrassing for a client as the possibility that they might not have the available funds to pay for their treatment.

Aff ordabilityMedical aesthetic treatments are expensive and the

demand mostly outstrips the ability of many clients to aff ord them. A major eff ort should thus be made to help our clients in this regard. It is furthermore of the utmost importance that we never compromise the quality or eff ectiveness of our off ering.

To this end I generally focus on two issues: The fi rst is what I call my cost versus return ratio.

Simply put this involves advising my clients on which areas might generate the highest impact when treated. This never means that you not address the issues that brought your client to you in the fi rst place; you just help them to prioritise all their concerns.

Natural resultsMost (all) of our clients are very concerned that they

will look “diff erent” (read odd) after a procedure and looking at some of the very big lips and totally immobile faces walking around certain neighborhoods, a client’s

fear is justifi ed! The single best way to prevent unnatural outcomes is to shift our focus towards combining treatments. Always remember the three golden rules of medical aesthetics: combination, combination and combination. Never overdo any single treatment!

The next focal point in this regard should be the so-called “key areas”. These areas are typically either the most visible or sometimes even the primary origin of bigger problems. We all know how the softening of frown lines can transform the upper face. Similarly the mid-face volumes are the key to the mid and lower face. Treating these well will often be the diff erence between acceptable and very good outcomes.

Follow upsFollow ups might make the diff erence between

good and great results. It might also be the diff erence between retaining a client (as well as her 10 best friends) and losing a client. In a worst case scenario it might even be the diff erence between building a long lasting relationship and getting sued – which is a very real possibility if regarded in the light of recent developments.

Follow up every client each and every time! Follow them up telephonically or in person and preferably both. It is the single most eff ective way to detect suboptimal outcomes and to make the most of great ones. It will build your practice and it will keep you out of the newspapers!

By Dr Jennifer Irvine, The Aesthetics Centre

1. Do no harm. If you can’t improve your patient’s situation don’t touch! Catering to whims can harm your reputation. Stay true to your own professional standards.

2. Run an ethical practice. Don’t over charge and don’t promise what you can’t deliver.

Know your limitations; don’t be afraid to acknowledge when you are out of your fi eld of expertise and ability. Patients appreciate this honesty and feel safe in your hands.

3. Follow up is essential and be accountable for the work you do. You won’t lose a client because her treatment didn’t meet her expectations, but you will lose her if you don’t fi x it up and manage the problem. Remember that a patient who complains is engaged and can be converted into future business; the ones who don’t complain go elsewhere.

4. Respect. Respect clients’ time. Try not to run late. Don’t cancel appointments needlessly.

5. Keep up to date. Aesthetics is a rapidly growing fi eld in medicine. The products and techniques we are using change and improve as companies invest in research and development. Keep ahead of the game. Know what your competitors are off ering in terms of products and technology.

6. Surround yourself with like-minded people. A clinic usually grows around a particular person and the reputation they have earned. Your clients are attracted to the clinic because they like the way the individual treats them and interacts with them. Employ other staff members who fi t the same mold and up-hold the practice’s ethos. You need the right support staff in the right jobs. Spread the risk by having more than one person being able to perform a specifi c procedure or treatment. Chose your receptionist carefully, she is the fi rst point of contact in your business and becomes the face of the practice.

7. Keep your fi ngers on the pulse of your business. It is essential that you are involved in or at least have an understanding of the day-to-day processes involved in running the practice. Understand where your income is generated and where it is being spent. It is even more important that you have good managerial staff that you trust overseeing the day-to-day running of the business and accounts. You need good administrative systems to support your business.

8. Look your best – you are your own advert. Develop a happy, professional and organised work environment. Make your clients’ experience in your clinic a good one. Smile and be friendly.

9. Communication. Good communication with clients is essential. Make every eff ort to understand your clients’ needs and expectations and try to achieve this or manage it appropriately.

Support your staff and understand their needs. Good communication with staff keeps them motivated and productive. Show you value their opinions.

10. Good Marketing. Know you client base. What are your clients looking for in a treatment? Where are they looking for this information? In the local paper, magazine or internet? Understand what it is about your clinic that attracts clients and market this. Sell yourself and advertise wisely – make sure the money you are spending is generating new clients and income. Not all marketing is good.



AWARDHITECH LASERS RECEIVES AN

international

Hitech Lasers was announced as the winner of the 2011 award for Best Aesthetic Performance for EMEA region (Europe, Middle East and Africa) during an award ceremony hosted by Lumenis, global developer, manufacturer and distributor of laser and light-based devices for surgical, ophthalmic and aesthetic applications. The ceremony was held on 12th January 2012 in Lisbon, Portugal.

Every year, Lumenis honours and celebrates the achievements of its distributors. What tipped the scales to Hitech Lasers as 2011 winner was their outstanding increase in sales of aesthetic equipment during the past 12 months.

Wicus Olivier (Jnr.) director of Hitech Lasers, on receiving this award said: “We are very pleased above receiving

this award. This is a seal of approval for the dedication, positivity and loyalty of the Hitech Lasers team to deliver good sales results in a challenging business environment. It is also testament to our clients who invest in equipment that fulfi l their high standards of excellence, quality and reliability.˝

About Hitech LasersHitech Lasers, SA’s leading distributor of lasers and light-based equipment for surgical, ophthalmic and aesthetic applications, has an installed base of almost 500 lasers in Africa and neighbouring islands.

Contact Information:Tel: +27 12 349 1250E-mail: [email protected]



MEDESTHETICS

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*CORE™ Bi-Polar RF for Skin Tightening Proven CORE™ (Channelling Optimized RF Energy) bi-polar RF contracts tissue fi bres for immediate smoothing and tightening results. CORE™ technology balances frequency, intensity and an integrated skin cooling system to ensure the safest and most eff ective skin tightening results. CORE™ off ers three individual frequency modes and a fourth Multi Channel Mode which simultaneously incorporates all three in a single pulse. Thinner, more sensitive areas are treated using a higher frequency, while thicker, deeper areas are treated with a lower frequency or the Multi-channel Mode.

V-touch – the next generation in fractional RF technology - integrates SVC™ and CORE™ technologies* (see description below) to off er Fractional RF and Bi-polar RF treatments, ensuring better and more effi cacious patient experiences. V-touch with the combined technology off ers the ideal solution for an aesthetic practice.

V-touch off ers a less painful, safer and more controlled

treatment experience with outstanding results. V-touch uses fractional energy for facial rejuvenation and resurfacing plus bi-polar skin tightening. Based on Switching, Vacuum and Cooling (SVC) technology, the new device can be used on ALL skin types. The cooling aspect signifi cantly reduces pain. The device also enhances access to areas considered more diffi cult to reach such as the neck, décolleté and hands.

V-TOUCH APPLICATIONS• Facial rejuvenation and resurfacing V-touch uses

its unique SVC™ technology to treat the dermal and epidermal layers as a whole, without targeting specifi c cells, including coagulation and necrosis in the deeper epidermal layers and papillary dermis. New cells are created to improve the skin’s overall appearance and tone. V-touch non-invasive skin resurfacing is based on fractional ablation of the epidermis and inducing a controlled wound in the dermis. Healing of these controlled wounds leads to the replacement of damaged skin cells with a fresh surface of papillary dermis and overlying epidermis.

• Skin tightening and lifting V-touch encourages the production of elastic fi bres to improve skin elasticity. RF generated dermal heating stimulates fi broblasts, which results in collagen remodelling and neocollagenesis.

• Epidermal irregularities - texture and tone improvement Fractional RF with V-touch moderately ablates the epidermis in conjunction with dermal heating. This augments elastin and collagen production, making the skin more taut and reducing the appearance of these irregularities. In addition, an increase in blood circulation leads to more effi cient oxygen delivery to the treated area.

• Scar reduction While superfi cial wounds typically heal without scarring, deeper damage at the dermal layer usually leads to the formation of scars. The controlled induction of thermal damage with V-touch to the dermis with a degree of epidermal ablation, results in collagen denaturation and new collagen synthesis, also known as dermal remodelling. This has been proven to be eff ective in reducing the appearance of scars.

V-TOUCH HIGHLIGHTS• Dual-function fractional and bi-polar system• *SVC™ technology for a more eff ective, safer and

more comfortable treatment: Switching – generates heat prior to RF pulsing and prepare treatment area. Vacuum - ensures proper skin and tip coupling reducing the healing time due to increased blood fl ow, eliminating the risk of epidermal burns, reducing level of pain. Cooling - ensures a safer, more pleasant treatment experience

• Two fractional tip sizes for fl exible treatment off erings

• Suitable for ALL skin types• Touch screen controls with pre-set programs• Multiple applications to increase ROI

Contact Medilase for more info on all Viora productsT: +27 12 349 1250 or E: [email protected]

MEDILASE ADVERTORIAL

Dual function Fractional RF System for non-invasive Facial Rejuvenation and Skin Tightening on ALL skin types.

Viora V-touch

Proprietary SVC™ technology allows diverse treatment options, a positive patient experience, and enables long lasting clinical results.



BREAKTHROUGH Technology for Adult Acne and Anti-Ageing

ADVERTORIAL Intamed

Age Intervention Duality is a breakthrough anti-aging acne solution providing serious acne control and dramatic anti-aging benefi ts. Its unique dual chamber dispensing solution combines some of the most medically validated, yet previously incompatible, technologies in one product. The maximum allowed percentage of benzoyl peroxide, concentrated retinol and powerful anti-aging technologies, including multiple peptides, anti-infl ammatory agents and antioxidants, are combined in a gentle formulation.

Clinical Data• 100% of patients experience a reduction in acne lesions • The average number of acne lesions reduced by 64% (ranging from 36% - 78%)• 100% of patients experience an improvement in overall skin satisfaction • Delivers unparalleled acne treatment with dramatic anti-aging benefi ts• Helps decrease erythema and infl ammation and reduces the appearance of acne scars and

discoloration• Advanced BPO increases penetration and decreases dryness and irritation• Concentrated retinol improves cellular turn-over and addresses the main signs of aging including

the appearance of lines and wrinkles, rough texture and hyperpigmentation• Anti-aging peptides rebuild and rejuvenate skin• Antioxidants deliver anti-aging benefi ts and increase free radical protection• Signifi cant moisturizers for improved hydration and barrier function• Easily incorporates into Step 3 of the Skin Care Management System for intensifi ed results• A perfect solution for adults and of every skin type

For more information please contact Intamed:011 444 0404 | [email protected] | www.janamarini.co.za | www.intamed.co.za

Before After


MEDESTHETICS

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Forc

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inje

ctio

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X-HAVOLUME®

Volumizing cross-linked hyaluronic acid fi llerREDEFINE FACIAL CONTOURS

The X-HA Volume® is indicated for injection into the deep dermis, subcutis or

supraperiosteally.

Affordable · SafeVolumizing · Mouldable

This fi ller is indicated to increase or restore volume of the face, remodel facial contours

and to correct deeper wrinkles and folds.

The X-HA Volume® benefi ts from a high purifi cation technology allowing to obtain

a pure cross-linked hyaluronic acid, with the lowest proteins and endotoxins rates, which is much lower than required by the

European Pharmacopeia’s. X-HA® range therefore limits risks of hypersensitivity,

infl ammation and secondary reactions, andoff ers perfect biocompatibility.

It perfectly compliments corrections made with X-HA³®, polyvalent fi ller

for the treatment of medium and deep wrinkles and lip enhancement.

INDICATIONS:Volumizing · Cheekbones · Hollow cheeks

· Lipoatrophy · Temple area · Very deep wrinkles · Face ovale

FOR MORE INFO: www.fi lorgasouthafrica.co.za

Contact: Colette Kotzecolette@fi lorgasouthafrica.co.za

012 548 3943

X-HA Volume® has a very high viscosity to resist to deformations and create volume

Easy Injection: Thanks to its high viscosity, X-HA Volume®

can be easily injected with a needle or cannula. Long-lasting remanence. Thanks to its high cross-linking, X-HA Volume®

resist to degradation factors of hyaluronic acid. Its remains in the tissues for longer than 12 months.

Vis

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Cross-linked hyaluronic acid volumizing implants: A: 22mg/ml – B: 25,5 mg/ml – C: 24mg/ml

ADVERTORIAL Filorga

Before After

Before After


MEDESTHETICS

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M-HA10 NEW FROM FILORGA

Hyaluronic acid is one of modern skincare’s greatest skin miracles, helping to hydrate and plump the skin from within, whilst acting as a powerful anti-oxidant. Filorga’s M-HA10 is a pure hyaluronic acid that, when injected into the skin as part of Filorga’s NCTF mesotherapy cocktail, has an immediate eff ect on hydration and skin radiance. Filorga’s enriching blend if key skincare ingredients contained within its NCTF compound, combined with the hydrating, plumping and antioxidant eff ects of the M-HA 10 Hyaluronic acid provides the skin with all the essential moisture and nourishment that becomes vital in the drying conditions that characterise the winter months. As a result, the skin overcomes the dryness and dullness that is so common during the winter months a soft, glowing and refreshed appearance is maintained.

THE TREATMENTFor best results, one treatment a month for three months is required followed by a maintenance treatment every six months.

THE RESULTSAfter the fi rst treatment the skin already appears brighter, has greater elasticity and seems plumper, whilst fi ne lines and wrinkles appear to be reduced. The skin is softer, smoother and more hydrated.

CONCENTRATION10 mg/ml of free HA | 30mg HA per/vial | The highest concentration one can reach with fi ltration sterilisation, for a preserved hyaluronic acid

MOLECULAR WEIGHT1,1x106 Daltons | A molecular weight close to the one of endogenous HA, for a high bioaffi nity with the dermis

PRICER1575 excl VAT for 3 x 3ml ampoules

For further information on Filorga products visit www.fi lorgasouthafrica.co.za

PURE HYALURONIC ACID

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Before After



ADVERTORIAL DMKC

NEUTRALIZE

THE PRINCIPLE OF COLOR - For many years, understanding how to use color to “neutralize” unwanted tones and skin discoloration was taught, learned and practiced by Hollywood makeup professionals. In recent years, this concept has been replaced by concealers and cosmetic products that camoufl age rather than neutralize. The majority of concealers are highly pigmented versions of their corresponding foundations; lighter tonal colors that highlight the under-eye area and attempt to cover dark circles, redness and other skin discolorations. It is the word “camoufl age” that we have to get away from and utilize the principle of color. Consumers and industry professionals have

been led to believe that if they use a lighter shade of concealer, it will eliminate unwanted color. In some paramedical and postsurgical instances this might be necessary, but in most cases, layering on color simply does not work. A thick coat of color certainly cannot be used in high-defi nition fi lm or photography, as the camera will instantly read the thickness. So how do we go about covering up blemishes and discoloration before applying foundation? Certain colors will do the work for us when it comes to removing discoloration within, underneath or on the skin.

LIGHT is the key factor and the main tool we work with. Without light, we cannot see our work. The selection of white light is important. White light comes in a variety of colors. Ranging from a reddish-orange white, such as the lamp beside your bed, to the blue-white lights on most new car headlights. Both examples have many white light colors between them, including normal daylight. All of these white colors are measured in temperature variations called Kelvin (K).The light beside your bed is about 2,800 K, while car headlights are about 7,000 K. The lower the Kelvin temperature, the warmer the shade of white light, and the higher the temperature, the bluer the shade of white light. If we go outside on a clear day at noon and the sun is directly overhead, that is the color closest to the pure white light that we need to work with when applying makeup. The color temperature is about 6,000 to 6,500 K. If you apply makeup in this color temperature and

it looks good, makeup in other color temperatures (e.g., house 2,800 K or studio 3,200 K) will look fantastic. The key here is to realize that white light comes in a spectrum of colors, just like a prism displays a spectrum of colors on a wall. This is the basic starting point for correction. You must be working in the correct light. Even the best surgeons use great lighting—most hospital surgical lighting is 6,500 K. As a fun exercise, go outside on a clear day around noontime and apply your makeup. Then go inside and see just how good you look. In the chart below, you will notice how using a yellow-green cosmetic as a fi lter eliminates the unwanted redness from the light.

* view chart below

COLOR NEUTRALIZATION - Red and green, blue and orange and pink and brown are all color duos that cancel each other out. For example, someone who has blue tones under the eyes would use a color with a little orange in the undertones to correct or neutralize the blue. Someone with a reddish-colored blemish on the face would use a color with yellow-green makeup u n d e r t o n e s .


MEDESTHETICS

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AND CORRECT

So what color would we lightly add to make the red go away? If you are thinking something like yellow-green, you are right. Take your brush and use a very small amount of the red neutralizer (yellow-green) color to stop the red light from refl ecting. This lets the normal skin color through and makes it appear as if there is hardly any makeup on. What about the blueness under the eyes? That blue color is the same as the red; small amounts of blue color are refl ecting (through the skin) and going to your eyes, where your brain is saying “Yikes! It is blue.” The solution is simple: grab the blue neutralizer and apply it as you would the red neutralizer. Your blue neutralizer is going to have an orange-coral undertone. Brown circles would need a brown neutralizer, which has a pink undertone. The smaller, the better I cannot stress enough how important it is to use a small amount of neutralizer or correction product.

If you use too much, you will not have a red or blue area on the face, you will have instead a yellow-green or orange-coral spot. That would look many times worse than the original problem. But what about purple? That requires a two-stage approach. First, cover the redness with a red neutralizer - This time, rather than apply it so that the natural color of the skin appears, add it so that the red disappears from the purple and the only shade you see is blue. This now requires an additional step. With a power puff —not a brush—press loose, clear, color free, non-translucent powder into the red neutralizer and remove the excess with a powder brush. Then use the blue neutralizer to remove the redness on the skin. After applying these two colors, add loose powder as before. This covers the purple - Ta da! Now you fi nally know how to disguise that heinous tattoo on your client’s daughter’s back. All jokes aside, the key concept of fl awless cover-up makeup is to ensure the correct lighting for proper application, and to use the right color neutralizing products in appropriate amounts.Tommy Parsons is the director of DMK Cosmetics, where he works with the company’s international team of distributors in marketing, education and training. Parsons has an extensive background in the makeup industry. He has been a makeup artist for various entertainment corporations, and has worked with a multitude of major celebrities including music stars, politicians and pageant contestants. Parsons has also designed colors for numerous professional cosmetic brands. (chart courtesy of DMK Cosmetics)

It is important to remember to never use pure red, green, blue or orange to neutralize. Use a color that has undertones of red, green, orange, blue or pink for the correction.

For years, ladies thought they had to purchase this lighter color in the form

of concealer for use under their eyes, where they would simply pile it on. But this type of concealer is actually called a highlight and is used to assist the shading color

(blush) in lifting and accenting the cheekbones. Usually you have just camoufl aged the unwanted colors by just pouring

the makeup onto the face to eliminate them. Neutralizing is completely diff erent. Remember the light part? The reason we see the redness is because the light refl ects off the area of redness on the face and bounces into our eyes, where

our brains tell us we see red. If we could stop or adjust the redness,

maybe we could eliminate the red

refl ection

DMKC ADVERTORIAL

011 2626120www.dannemking.com



LASERLIPO

ADVERTORIAL Technolase

Laser Lipolysis involves inserting a thin canula with a laser fi bre in a tiny incision in the skin up to the fatty deposits in the hypodermis where the Nd:YAG laser cause the swelling and rupture of the adipocytes.

In the previous edition of MedEsthetics (Vol. 4, No 4, 2011) it was shown that not all lasers have the same eff ects. Eff ective and safe results were found with the 1064 nm laser, one being found in the Fotona stable.

Others bear testimony of complications such as fi brotic bands, lumps and bumps in the sub-dermal tissue. Even indentations of the skin surface arise due to fi brotic bands which then have to be released with a second procedure.

More recently it has been advocated that the complications can be ‘ironed’ out with yet another device like endermology eventually fi nding an application for some of these devices which were purportedly meant to reduce fat and cellulite.

Alternative avenues include the conventional liposuction which is one of choice due to the speed and eff ective results in the hands of the experienced practitioner.

More recently this liposuction procedure has been combined with simultaneous radiofrequency (RF) at the tip of the canula aff ording skin tightening in a homogenous and safe way albeit taking slightly longer than liposuction, being nonetheless four times faster than laser lipo.

Devices in this category include the BodyTiteTM

(MedEsthetics, vol. 4, No.4, 2011), which has now been extended to include the NeckTiteTM, CelluTiteTM, FaceTiteTM, TiteFxTM, FractoraFIRMTM, FractoraTM, all on one platform.

Complications & Alternative Non-Invasive Options

Dr Diane Irvine Duncan (Aesthetic Surgery Journal, Vol. 32, No 1, 2012) had important outcomes in upper arm liposuction – adding Radiofrequency-assisted Liposuction to induce skin contraction.

Before After one year

Before After

Technolase ADVERTORIAL

To avoid the possible complications of invasive liposuction and often the combined attempt of a body lift to remove excess skin, led to the development of a non-invasive technology found in the CoaxMed. Two non-invasive techniques, i.e. cavitation using ultrasound (US) and radiofrequency (RF) are used singularly or in combination to break down fat and tighten skin in the body or face.

US and RF break the walls of the fat cells by the implosion and explosion of the interstitial gas particles between the fat cells. The liquefi ed fat and debris is removed by the lymphatic system especially when the vacuum suction drainage is applied.

The CoaxMed has yet a further unique modality, i.e. Cryo - 5ºC which is applied on the skin to further break down fat and smoothing skin imperfections. The CoaxMed combines fi ve diff erent technologies: Mono-polar and Bi-polar Radiofrequencies, Cavitational Low Frequency Ultrasound, Endo-massage and Cryo-action. Three diff erent long-life, stainless steel hand pieces deliver diff erent forms of energy at diff erent power levels.

COAXMed



REGULARFEATURE INTRODUCTIONS

INTRODUCTIONS

02

01 Cryolipolysis - Launched by Radiant Healthcare with great excitement!Coccon Cryotherapy™ has many advantages over competitors: · Aff ordable · Dual applicator – resulting in faster treatment times · Low consumable cost-resulting in more aff ordable treatments. How does it work? The CRYOTHERAPY treatment consists of applying cold vacuum applicator heads to the fat cells, freezing the localised tissue for a controlled period of time. The CRYOTHERAPY heads generate a vacuum eff ect when the skin is suctioned, thus decreasing the blood fl ow to the treatment zone, immobilizing the fat tissue, and partially isolating it from the other tissues to protect the tissues and to avoid damaging them. Once the freezing procedure is completed, the damaged fat cells are liberated into the lymphatic system. The damaged fat cells are gradually eliminated through the natural metabolic process. The results are visible between the 1st and 3rd month. For more information contact: RADIANT HEALTHCARE Jayde Wilson on telephone: 011 794 8252/3 or Mobile: 082 688 1305, www.radianthealth.co.za

02 eLase™ - A New Picture of Pain Free Hair Removal & Skin TreatmentseLase is the fastest diode laser platform to deliver safe and eff ective treatments on the widest variety of skin and hair types: • The NEW Motif LHR™ hair removal modes are both eff ective and comfortable with increased patient safety and reduced treatment times on all skin types. Specifi cally the high frequency, lower energy elōs combination of both diode laser and bi-polar radio frequency used in the Motif mode provides virtually pain free treatments with far shorter treatment times than competitive systems. • The NEW Motif IR™ applicator is a safer, more effi cient way of treating superfi cial skin texture and pore size for overall facial rejuvenation with zero downtime. Driven by science, we deliver exceptional results that have earned trust - your trust in us and your customer’s trust in you. For more information contact: RADIANT HEALTHCARE Jayde Wilson on telephone: 011 794 8252/3 or Mobile: 082 688 1305, www.radianthealth.co.za

03 eTwo™ - Complete Facial Rejuvenation eTwo combines the unique Sublime and Sublative applications for comprehensive facial rejuvenation: • Sublime™ uses the elōs combination of safe and eff ective levels of infrared light and bi-polar radio frequency energies to remodel the deep dermal layer of the skin by stimulating new collagen growth for immediate and long term improvement of wrinkles and facial contour. • Sublative™ fractionated bi-polar radio frequency technology places the heat energy eff ectively into the upper dermis where it can produce a signifi cant increase in both collagen and elastin with minimal epidermal disruption leading to a smoother, rejuvenated appearance of the skin. For more information contact:RADIANT HEALTHCARE Jayde Wilson on telephone: 011 794 8252/3 or Mobile: 082 688 1305, www.radianthealth.co.za

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01

Natural R

adiance. Pure B

eauty.Advanced Skin Lightening

Breakthrough patented natural enzymelignin peroxidase (trademarked Melanozyme™ by Syneron)

Revolutionary approach to topical skin lightening The first topical skin lightening product that works by temporarily reducing melanin in the skin to improve skin appearance

Excellent safety profile elure is very safe, with no safety concerns seen in 4 clinical studies

Non-irritating No side effects were found to be directly related to LIP exposure in comprehensive preclinical studies or in 4 clinical trials, which means no sloughing and shedding

Rapid results Majority of patients see benefits in the first month

Hydroquinone free Does not include any other existing skin lightening

active ingredients

Dermatologists tested & clinically demonstrated

© 2010. All rights reserved. Syneron, the Syneron logo, elure 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. PB72812EN

Lignin Peroxidase, A Safe & Unique Enzyme For Use As A Topical Cosmetic Treatment For Skin Lightening

Alain Khaiat PhD, Seers Consulting. Yoram Karmon, PhD and Paula Belinky, PhD, Rakuto Bio Technologies (a Syneron company)

To characterize the safety and tolerability of lignin peroxidase as

a cosmetic product, the following safety tests have been

performed:

Acute dermal toxicity

Mutagenesis

Eye irritation

Primary skin irritation

Primary sensitive skin irritation

Skin sensitization

The enzyme lignin peroxidase (LIP) is produced extracellularly

during submerged fermentation of the fungus Phanerochaete chrysosporium and then purified from the fermented liquid

medium by Lonza of Switzerland. This proprietary production

process of lignin peroxidase, trademarked Melanozyme™ by

Syneron, is formulated into both a lotion and a cream to improve

the skin appearance for those who desire skin lightening.

After final formulation and packaging, the product will be sold as

elure™. Each packaging unit (whether cream or lotion) will

contain an Active Melanozyme component and a proprietary

Bio-Activator. The combination of the two formulations creates a

temporary reaction that results in a targeted and time-limited

catalysis of eu-melanin in the epidermis. The appearance of the

skin for most patients will become noticeably lighter within 7

days.

Acute dermal toxicity tests of LIP show the absence of dermal

toxicity (NOAL) at concentrations up to 2,000 mg/Kg, which is a

Margin of Safety greater than 17,000.

LIP did not induce gene mutations in the mutagenesis study.

There were no abnormal findings of the cornea or iris observed

in the eye irritation study.

There was no visible skin reaction to the LIP cream in either the

primary skin irritation study, the sensitive skin study, or in the skin

sensitization study (hRIPT).

We conclude that the LIP enzyme formulated into a cosmetic

product has a low risk of primary skin irritation, cumulative

irritation, allergy or eye irritation.

Four clinical studies in 4 countries have shown marked

improvement in the break-down of melanin by LIP cosmetic

treatment as early as after one week of application. In these

clinical studies, only two subjects reported minor skin irritation,

for which a specific cause was not determined. However, in each

case the irritation resolved after application was discontinued.

LIP enzyme provides a unique, innovative approach to skin

lightening, eliminating the melanin in the upper layers of the

epidermis. The enzyme is safe and effective.

Clinically irrelevant amount (0.012%) of H²O² is instantly

consumed to potentiate LIP activity

Presence of Veratryl Alcohol (VA) maintains the specific

depolymerization process of eumelanin, the substrate (S)

LIP enzyme is inactivated and remains on the skin surface as

a simple glycoprotein

Introduction Results

Clinical Findings

Conclusions

Mechanism of Action

Objectives & Methods

Before

Example of clinical results after 28 days of treatment

After

Example of clinical results after 28 days of treatmentImages were photographed under UV light

Before After

www.elureskin.com, [email protected]

Visibly Better!

Too good to be true?

NEW

Cavitation + Radiofrequency

Fat Reductionusing latest cryolipolysis technology

sPTF+ IPL

better with age - aesthetic and anti-aging medicine ... · private practice at the holistic...

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