MEETING REPORT www.aestheticmed.co.uk

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The world-famous Bellagio Hotel on the Las Vegas strip was the setting for the 10th annual Vegas Cosmetic Surgery meeting.

The meeting was founded by S Randolph Waldman MD who wanted to foster a spirit of

cooperation and understanding between the four “core” specialties that are primarily involved in the science, practice and teaching of aesthetic surgery and medicine. The conference is a unique opportunity for open exchanges of information among cosmetic specialists about topics ranging from the nuts and bolts of running a practice to specific procedural techniques, and even the most experienced practitioners can leave with practical pearls that they can use immediately.

As usual the symposium hosted the leading educators and teachers in the fields of facial plastic surgery, plastic surgery, dermatology and oculoplastic surgery, including Drs Grant Stevens, Corey Maas, Heidi Waldorf, David Goldberg, Michael Gold, Doris Day, Neil Sadick and myself.

Dr Sadick addressed new applications to medical treatment for hair loss, such as low level lasers, inflammatory cases of hair loss, and transplantation techniques using new mediums. He said, “Hereditary hair loss affects millions of men and women, but with more research, treatments are improving”.

Dr Heidi Waldorf, also a dermatologist from New York, gave a presentation “KISSES – 6 Tips for Lips,” during the

Leading lights, big city Dr Patrick Treacy reports back on the 10th annual Vegas Cosmetic Surgery meeting

14 Aesthetic Medicine • July/August 2014

minimally invasive/non-invasive session. “I spend a lot of time trying to convince patients not to inject their lips,” she said. The reason, she emphasised, is that the lips are no different than the rest of the face when it comes to attributing visible signs of ageing – it’s all affected.

“If they really want to do their lips, I tell them we must do the face”, she continued. “When everything else is sagging on the face, the lips, too, change in appearance — not necessarily because the lips have changed, but because they are visibly altered by falling tissues. Replace that lost volume and watch the appearance of the lips improve without doing a thing.” Her six point KISSES plan was:

Evening falls on Las Vegas. With Dr Randy Waldman VCS2014 Conference organiser and founder

K - Know your anatomyI - Inject from outside the lipS - Side view is as important as the frontS - Shape is more important than sizeE - Expectations must be realisticS - Safety first

Cheryl Bisera, consultant and co-author of “The Patient-Centered Payoff” said that aesthetic practices must consider the importance of developing a strong brand image. “Your brand is the external expression of your practice and what your existing and potential patients think and feel when they hear your practice’s name,” she said.In addition, she emphasised that an aesthetic brand must communicate luxury, because patients are choosing to spend their money with you; so you need to give them more than what they expect. Dr Grant Stevens gave a lecture on “Marketing a new product or service” using his experience with CoolSculpting to illustrate his point. “I’m successful because of marketing,” he said.

Dr Michael Gold lectured on “Micro-focused Ultrasound and RF for Skin Tightening: New Clinical Concepts”. He said ultherapy could be used for acne scarring and said the company had submitted a clinical article for publication describing study results for chest skin tightening and knee tightening.

Dr Val Lambros said that, although he uses fat in every face-lift he performs, “it is unpredictable, overrated, has significant complications.” He continued, “A rookie mistake might be to overgraft fat into the face to smooth away wrinkles. But if that fat grows over time, it can make the face unnaturally big, thereby masking the natural contours. Thus, the wrinkles may be gone, but patients tend not to be happy when they no longer look like themselves.”

Laurie Mercier, a practice consultant with Allergan Practice Consulting, told attendees at the VCS 2014 meeting of 10 mistakes that front desk personnel can make. These included not answering the telephone within one to two rings; not giving their name or the practice’s name when answering; not asking for and using the patient’s name; putting callers on hold without asking

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15Aesthetic Medicine • July/August 2014

MEETING REPORT

N E W S A N D A N A LY S I S

permission and not asking how callers or prospective customers have heard

about the practice. The general feeling was that medicine

is a business and you’ve got to make money and if you’re not, you’re not going to be in

business. This is a highly competitive industry so it is very important that you keep that in mind the whole time you’re working.

One of the main round table discussions about dermal fillers included Drs Corey Maas, Vivan Bucay, Joel Cohen, Heidi Waldorf, Doris Day, Neil Sadick and myself. A special roundtable also addressed complications and management of dermal fillers. Dr Claudio de Lorenzo and I agreed that the units of hyaluronidase used to address embolic phenomenon caused by HLA fillers is much too low. The both agreed starting at 150 to 300 IU, of Hyalase and then treating repeatedly until the circulation returns.

Dr Claudio de Lorenzo said, “repeated treatment, massage, and the other recommendations to promote vasodilation are continued. It is probable as the material starts to break down, it flows further downstream, where it probably opens collateral vessels, or it can flow further past these and obstruct a slightly different area”. He also stated, “When it gets to the precapillary arterioles, it gets permanently stuck, unless it is bathed in more unless it is bathed in more HYAL and is hydrolyzed.”

There are so many variables in a typical case that it is impossible to be specific, since the manner of manipulation of the area, the quantity and nature of the filler within the vessel, and the actual location of the emboli all factor into the equation.

My thoughts? The doses required are probably closer to the 350 IU-1000 IU rather than the figures of 35 IU to 100 IU that are often mentioned. At the end of the day, the absolute quantity of hyaluronidase is probably irrelevant during an acute event; it’s the eventual results that count. AM

The general feeling was that medicine is a

business and you’ve got to make money and if you’re

not, you’re not going to be in business

The Vegas Selfie