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For Physicians In Cosmetic MedicineMedical Spa MD is the premier physician community for dermatologists, plastic surgeons and clinicians practicing in skin clinics, laser centers, and medspas with thousands of physician members around the world. Why should you join Medical Spa MD? Learn More > Join Now For Instant Access To Members Content & Downloads. It's free!

What's The Best Music For Face Lifts?

The next time you're performing a face lift, consider what music you're listening to.

A survey of surgeons in the UK revealed that a whooping 90% listen to music while they are operating on their patients; with half of respondents favoring up-tempo rock, 17% pop music and 11% classical.

In fact, an article written by Henley J, “Music for surgery,” published in The Guardian (2011) revealed that plastic surgeons play the most music. When asked, the surgeons revealed that music contributed to creating a "harmonious and calm atmosphere."

According to a 1994 publication of the Journal of the American Medical Association,

Surgeon-selected music was associated with reduced autonomic reactivity and improved performance of a stressful nonsurgical laboratory task in study participants.

Further, researchers from the psychology department at the State University of New York at Buffalo, found that listening to Pachelbel was better than not listening to any music at all. There was a decreased stress and increased performance after surgeons listened to music, especially when it was their own choice.

A recent study reveals that listening to music may reduce the time spent on surgical closures. The study was conducted with 15 residents performing layered closures on a simulated wound model on a pig's feet. These were done with and without their preferred music.

Twelve residents (five lower level and seven upper level residents) completed both sessions, performing 48 repairs. Blinded faculty completed 144 repair ratings.

These were the results of the pig's feet study:

  • There was an 8% overall reduction of operative time among all residents.
  •  There was a 10% decrease in the operative time of surgical closure for upper-level residents who were listening to their music of choice.
  •  A resident took an average of 11.5 minutes to complete the surgery without music. On the other hand, it only took 10.6 minutes to complete the repairs with music. 

The study further revealed that there was also an improved efficiency and repair quality for those who listened to music.

For patients, music reduces anxiety before surgery. A research done by Yale University anaesthetist Zeev Kain reveals that music decreases the amount of pain or the patient's needs for anxiety medication. A study by the department of anaesthesia at Glasgow's Western Infirmary surveyed 200 anaesthetists; it found 72% worked in theatres where music was played regularly, and around 63% generally enjoyed it.

Some 26%, though, said they thought music, especially music they didn't know and like, could at times "reduce vigilance and impair communication".

On the other side...

It's a distraction. Junior surgeons who are performing new tasks may be distracted by operating room music. This was reported in a November 2008 issue of Surgical Endoscopy.

For patients, it may also be a cause for discord and anxiety, especially when the music is not to their liking. The results are ultimately related to the surgeon's preferences as to the kind of music and its volume.

It is important that both create a harmony in the operating room between and among the surgeons and the patients. The reduction in the amount of time to perform a surgery finds a positive welcome in the healthcare environment.

The September 2015 issue of the Aesthetic Surgery Journal says that

In the current health care environment, where cost reduction is center stage and operative time is money, every second counts.

Read more on:


Viability of Autologous Fat Calf Grafting

Research shows that autologous calf fat grafting is a viable alternative to traditional implant-based calf augmentation for congenital calf discrepancies and aesthetic pseudo-varus deformity.

According to the study published in the official publication of the American Society for Aesthetic Plastic Surgery (ASAPS), Aesthetic Surgery Journal, fat grafting for slender calves provides results that are comparable to those obtainable via traditional methods. 

Some patients who want to undergo calf implants are concerned with the risks associated with the surgery and the possibility that strenuous exercise may cause the implant to move. Some plastic surgeons use silicone implants that is selected based on the patient's anatomy. These implants are placed under the fascia of the original calf muscle that is strong enough to withstand physical sporting activities.

Researchers Gerhard S. Mundinger and James E. Vogel pointed out in the research that there are few studies published regarding the advantages of fat grafting for calf augmentation and re-shaping compared with the traditional silicone calf implants.

According to Dr. James E. Vogel,

Autologous fat augmentation offers a number of advantages over calf implants, including liposuction in adjacent areas to improve calf contour, smaller incisions, additional augmentation through subsequent fat grafting, durable results, lack of foreign body reaction, and precise patient-specific adjustments not possible with off-the-shelf implants.

Medial and lateral calf augmentation was accomplished with injection of prepared autologous lipoaspirate intramuscularly and subcutaneously.

Thirteen patients underwent calf augmentation and reshaping with autologous fat grafting over a period of five years. Ten patients underwent bilateral calf augmentation, and three cases were performed for congenital leg discrepancies.

Prior to the fat transfer, local anesthesia was injected to utilize the smallest amount of effective anesthetic volume. This was also done to precisely place it into the muscle resulting in less sedation and more rapid postoperative recovery.

Fat was harvested from the abdomen, lateral thigh, medial thigh, waistline, flanks, axilla, upper back, and hips. Irrespective of the fat harvest site, liposuction was also performed at the knee to improve contour.

A mean of 157 cc of separated fat was transferred per leg, with roughly 60% and 40% transferred into the medial and lateral calf, respectively. Injections were first performed directly into the calf muscles and then into the subcutaneous calf tissue.

Four patients underwent a second round of autologous fat injection for further calf augmentation because they desired additional volume. Fat volume was judged to be sufficient when the calf was minimally firm but not tense. At a mean of 19.6 months of follow-up, durable augmentation in calf contour was documented by comparison of standardized preoperative and postoperative photographs.

The research concluded that the use of autologous fat transfer is a viable option compared to the use of traditional silicone implants.

Read more on:


Search for the Best Hyaluronic Acid Filler

The October issue of the official medical journal of the American Society of Plastic Surgeons (ASPS) reports a new and validated method for providing standard cohesivity ratings for hyaluronic acid dermal fillers.

The search for the best hyaluronic filler comes after the surge of interest in the use of dermal fillers to enhance shallow contours, soften facial creases and wrinkles and improve the appearance of recessed scars.

Dermal fillers can be very helpful in those with early signs of aging, or as a value-added part of facial rejuvenation surgery. These fillers are often injected in medspas or a surgeon's office and are predictable, with relatively minimal risks and side effects.

In 2014, ASPS data revealed that around 2.3 million dermal filler injections were done. Statistics from the Cosmetic Surgery National Data Bank and other market research show that dermal filler market in the United States is valued at a whooping $1 billion.

Hyaluronic acid dermal fillers are natural, gel-based products which are highly compatible with the body, making them the most commonly used dermal filler in the industry. Plastic surgeons are now looking for evidences that will aid them in selecting the product that will give the best result for their patients.

Though there is a wide range of available products, there still exists a lack of scientific data to support the rheologic or the flow-related properties of the available dermal fillers in the market.

Dr. Hema Sundaram, a dermatologist in Rockville, MD, Samuel Gavard Molliard, a scientist in Geneva, Switzerland, and colleagues used the ratings of cohesivity and other biophysical properties to identify the dermal filler that is suited to each procedure being done.

The biophysical characteristics of hyaluronic acid gel fillers reflect individual manufacturing processes. They confer rheologic properties that provide scientific rationale with Evidence Level II clinical correlation for selection of appropriate fillers for specific clinical applications.

Cohesivity measures the capacity of a material to "stick together" and not dissociate. It is a key property that maintains gel integrity, contributes to tissue support with natural contours, and diminishes surface irregularities.

Researchers point out that products with higher cohesivity scores are not always the best. The ranking system aims to ‘provide a scientific rationale for the intuitive selection of different products for specific clinical objectives.’

According to Dr. Sundaram and colleagues, fillers with higher cohesivity may be better used for more superficial placement, or placement in mobile areas such as around the mouth or eyes while products with lower cohesivity may be effective for use as ‘deep volumizers’.

The researchers developed a standard test for comparing the cohesivity of hyaluronic acid dermal fillers. Samples of each filler gel were dyed, then squeezed into water and stirred using automated technology.

A panel of plastic surgeon and dermatologist specialists experienced in using HA fillers then rated each sample’s cohesivity on an original five-point scale, known as the Gavard-Sundaram scale.

Cohesivity scores of the FDA-approved fillers varied across the full range of the scale: from ‘fully dispersed’ to ‘fully cohesive’. Cohesivity was rated high for one product, medium to high for three, low to medium for one, and low for one.

Aside from the data on cohesivity, researchers believe that comparative data on other rheologic properties (such as elasticity and viscosity) can make dermal filler procedures more sophisticated and successful.


Results of the study "Cohesivity of Hyaluronic Acid Fillers: Development and Clinical Implications of a Novel Assay, Pilot Validation with a Five-Point Grading Scale, and Evaluation of Six U.S. Food and Drug Administration–Approved Fillers" may be read on:


Finally – A Non-Invasive Machine That Delivers on the Promise

We are all used to the myriad of vendors who scurry up to us at every conference or torment our office staff for a 10 minute appointment to discuss the next GREAT non-invasive cosmetic surgical miracle machine.  Everybody promises everything….and seldom is the technological “punch” anywhere near the nirvana alluded to in the glitzy ad brochures. How many of you have $100,000 dollar machines in a back room with dust covers over them?  They are expensive doorstops!!  So typical of this industry.

As you can surmise, I have a jaundiced view of the whole “gadget” biz in cosmetic medicine. I like using cold steel, but appreciate the demand for non-surgical alternatives in this market. I have NEVER purchased a laser box (the economics just don’t make sense to me).  I dodged the Smart Lipo frenzy………..whew.  So, as a certified Negative Nellie, I have finally crossed over to the other side and am totally thrilled with the results a new minimally invasive technology is delivering.  In my mind, they deliver EXACTLY what was promised  in the hype.

ThermiAesthetics is a relatively new company employing temperature controlled radio frequency technology for multiple applications that really work.  Basically, ThermiRF delivers radiofrequency energy in a multitude of platforms – the common denominator being using thermal energy to safely shrink tissue.

In my mind the ‘home run’ for this technology can be found in two applications: ThermiTight is a minimally invasive procedure where a micro-probe in passed under the skin and withdrawn in a controlled fashion, heating the dermis underneath.  This results in significant skin shrinkage and is best used in the lower face and neck (great for jowls).  It also shrinks skin in the arms, abdomen and above the knees. ThermiVa is a topical application, designed to shrink labia, tighten vaginal mucosa, increase vaginal moisture and sensitivity and even cure mild to moderate stress incontinence. Really!

Ya sure, you may quip…………..but it delivers as promised.  My staff, my wife, my patients are all raving about it.  Easy, cheap and relatively painless.  Who can ask for anything more? Sure, the technology is relatively new and the longevity of the procedures is still being figured out.  But so far, I think this technology is a refreshing home run – delivering as promised – even for a cynic like me. Check them out.


Domino Effect of Weight Loss Aesthetic Surgeries

New data released by the American Society of Plastic Surgeons (ASPS) revealed that US weight loss surgeries have spurred the number other procedures such as tummy tucks, breast lifts and upper arm lifts over the last four years.

In 2013, 179,000 Americans underwent weight loss surgery, averaging nearly 500 procedures every day. Reports from the American Society of Metabolic and Bariatric Surgery reveal that it's the most since 2009 and the third highest number on record. From then on, there has also been an across the board increase of plastic surgeries related to weight loss.

ASPS President Scot Glasberg, MD thinks that there is a correlation between the two types of procedures and this trend is expected to continue. According to him, post-massive weight loss patients are the number one growth area that he has seen in his practice, and he is also sure that's the case in many doctor's offices across the country.

"You can't attribute that to anything other than the fact that there are more massive weight loss patients out there looking to take care of the problems that they now have after their weight loss surgery. On the one hand they are thrilled to have lost so much weight, but they are trading one dilemma for another."

"Going forward, we'd like to be a part of the process from the outset, when patients are first starting to consider weight loss surgery. A lot of times patients think weight loss surgery is the answer to their issues, when in reality it may only be one step in the process."

Those who experience massive weight loss are often left with excessive amounts of sagging skin, particularly in the thighs, under the arms, around the abdomen and in the breasts. The excess skin can not only be unsightly and uncomfortable, in many cases it can be painful. with these, previously obese patients opt to have a plastic surgery to remove inelastic excess skin and tissue after substantial weight loss and to reshape or recontour their bodies.

In 2014, nearly 45,000 patients who experienced massive weight loss also opted to undergo plastic surgery to reshape their bodies. While those numbers represent the biggest single-year increase in nearly a half decade, it's still only a fraction of patients who may benefit from it.

Henry Ford Hospital researchers report that aesthetic procedures following bariatric surgeries may contribute to improving their long-term results. The researchers recorded patients' Body Mass Index both before the bariatric surgery and 2.5 years after the procedure. Out of the patients who had a contouring surgery, the average decrease in BMI was 18.24 at 2.5 years. This is in comparison to statistically significant decrease in BMI of only 12.45 at 2.5 years for those who did not have further surgery.

Dr. Jason Lichten, MD, of Lancaster, Ohio says that "If plastic surgeons can get involved with patients earlier, we can not only give them a more realistic idea of what to expect from a physical standpoint, but we can help them devise a plan for any follow up procedures after their weight loss.

Read more:


Juvederm Ultra XC: Year-Long Lip Fillers

The US FDA has approved Allergan's JUVEDERM® ULTRA XC for the injection into the lips and perioral area for lip augmentation in adults over the age of 21.

Allergan's trials show that results last up to a year in the lips, but as always, there are two sides to the coin.

Juvederm Ultra Plus XC

Since 2006, Juvederm formulations were already FDA approved for correction of moderation to severe facial wrinkles and folds such as parentheses lines around the nose and mouth. Then in 2013, the Juvederm XC for age-related mid-face volume loss was introduced.

Clinical trials for Juvederm revealed that 79% of subjects showed an improvement in lip fullness three months following the treatment. More than 78% of the subjects reported an improvement in their overall satisfaction with the smooth and natural look and feel of their lips at one year after treatment.

Executive Vice President & President, Allergan Medical Philippe Schaison said that:

As the leader in medical aesthetics, Allergan is committed to continued research and development in this area. Providing physicians and patients with premium products that allow them to achieve the aesthetic results they want is always our goal. Understanding that the desire with lip augmentation is to achieve a natural-looking and lasting result, we continued our research of JUVEDERM® ULTRA XC for the lips. With this approval, JUVEDERM®ULTRA XC is now the only filler that is approved to last up to one year in the lips while providing natural-looking results.

Juvederm Ultra XC contains a smooth gel formulation of modified form of hyaluronic acid (HA) and a small amount of lidocaine. The hyaluronic acid helps the skin to maintain its moisture and softness and the lidocaine acts as a local anesthetic to improve the comfort of the injection.

While the increase in the time between injections is going to be welcomed by patients, there are some physicians and clinics that might lose income since patients are not coming in as frequently. Additionally, these longer fillers might not be appropriate as a "first-time" filler for patients who are unsure if thy're going to love the effect. There's a big psychological difference between living with a change for a few months and an entire year. Still, the general increase in lenght is a good thing for clincs and patients who are familiar with the effects.


Hysterectomy & Panniculectomy Combined In One Surgery?

The September issue of the official medical journal of the American Society of Plastic Surgeons (ASPS) has reported that hysterectomy and panniculectomy - the removal of hanging abdominal fat and skin - may be done at the same surgery.

Click to read more ...


Touch Your Way To Increased Clinical (And Sales) Success.

Touch is a language; it is a skill that is more versatile than voice, facial expression, or other modalities for expressing opinion.

Nonverbal communication to relay our emotions and desires via our postures and expressions have been the subject of several researches for several years. DePauw University psychologist Mattew Hertenstein conducted a study to show how we have the innate ability to decode emotions by touch.

Participants of Hertenstein's study revealed a 78% accuracy for identifying and communicating eight distinct emotions including anger. fear. disgust, love, gratitude, sympathy, happiness, and sadness. The power of touch is beyond physical.

It may be used as a way to effectively communicate what we feel. It does not need to be social to be effective.

This was shown in the research done in the Touch Research Institute at the University of Miami’s Miller School of Medicine.

It was shown that the brain is very good at distinguishing an emotional touch from a similar, but non-emotional, one. And the emotions that are communicated by touch can go on to shape our behavior. One recent review found that, even if we have no conscious memory of a touch—a hand on the shoulder, say—we may be more likely to agree to a request, respond more (or less) positively to a person or product, or form closer bonds with someone.

The language of touch is not to be underestimated as it may increase the speed of communication.

There have been a number of studies showing that servers in restaurants recive significantly higher tips (somewhere around 20%) when they appropriately touch a customer on the shoulder in a familiar way during service.

According to Laura Guerrero, coauthor of Close Encounters: Communication in Relationships:

If you're close enough to touch, it's often the easiest way to signal something. We feel more connected to someone if they touch us.

The right kind of touch may be used as an effective sales and communication tool. A touch may be done to placate a patient who is anxious about his condition, or it may be used to encourage a new customer to try out your product.

It is to be remembered that the power of touch is to be done with caution, bearing in mind that there are people who may not be comfortable with a stranger touching them. Nevertheless, the right gestures combined with a non-sexual touch can be one of your tickets to closing more sales deals.

Read more on:


Hyaluronic Acid for Facial Paralysis

Lip filler hyaluronic acid may be useful for people with facial paralysis.

In an interesting use case for the fillers in use at every cosmetic clinic,... A small research study conducted at the Johns Hopkins and Stanford universities reveal that aside from hyaluronic acid's use in cosmetic surgery, it may be useful for patients who struggle with drooling, eating, and drinking because of lack of lip control due to facial paralysis.

According to Kofi Boahene, M.D., a facial plastic and reconstructive surgeon in the Department of Otolaryngology-Head and Neck Surgery at the Johns Hopkins University School of Medicine, facial paralysis causes both both physical and psychological problems among patients making them self-conscious about how they look.

Boahane has used the analogy of a plant filling its leaves and stems with water to maintain structure. He says that

It’s a crude analogy, but injecting the lips with hyaluronic acid works in much the same way. It tones the tissue surrounding the muscle.

Boahene was working on a patient with then-undiagnosed case of muscular dystrophy when he had his own eureka moment. He stumbled across a possible role for hyaluronic acid injection to improve a patient's lip muscle tone. After trying the injection, the patient's face appeared stronger and her articulation improved.

Boahene and his collaborators tested 22 more patients with facial paralysis. His team got the participants' baseline measure of lip tone and the weakest points were identified by having them blow air with pursed lips. The researchers injected hyaluronic acid at the point where the air escaped.

After the procedure, he said that the patients showed marked improvement as confirmed by a speech therapist who conducted the assessment. Boahene further adds that the injection may last up to a year when done for cosmetic improvement.

Because lip augmentation and injection is a minimally invasive procedure, a plastic surgeon or dermatologist may perform such procedures. However, Boahene mentions that it is advised that the lip injectionsbe done by physicians who are experienced with treating muscle weaknesses and facial paralysis.

Read more on:


Finacea: US FDA Approved Topical Treatment for Rosacea

Rosacea is known to affect around 16 million Americans however, a survey by the National Rosacea Society found that 95 percent of rosacea patients had known little or nothing about its signs and symptoms prior to their diagnosis. Papulopustular rosacea is a skin disease causing inflammatory lesions (papules and pustules) on the nose, cheeks, chin and forehead.

Recently, Bayer HealthCare Pharmaceuticals Inc. announced the US Food and Drug Administration approval of its product Finecea Foam (azelaic acid) 15% for the topical treatment of the inflammatory papules and pustules of mild to moderate rosacea.

According to Bayer VP and General Manager, James Robins,

The FDA approval of Finacea® Foam is the result of several years of research and development. Not only does it add to our current product line, it also demonstrates Bayer's continued commitment to addressing the needs of patients with mild to moderate rosacea.

According to reports, the efficacy and safety of Finacea® Foam was evaluated in two multicenter, randomized, double-blind, vehicle-controlled, 12-week clinical trials (Trials 1 and 2) in subjects with papulopustular rosacea, with a mean lesion count of 21.3 (range 12 to 50) inflammatory papules and pustules. A total of 1362 (active: 681; vehicle: 681) subjects aged 19 to 92 years (mean age = 50.6 years), 95.7% Caucasian, and 73.4% female participated in the trials. T

he severity of a subject's rosacea was based on scoring from an IGA scale as well as a count of the inflammatory lesions. The clinical trials revealed that the use of Finacea resulted in a higher success rate in the reduction in the mean nominal change of inflammatory lesion count from baseline to the end of the 12-week treatment period.

Finacea gel is usually applied twice daily, in the morning and at bedtime. This treatment will soon be available by prescription only beginning in September 2015.

For more info:


miraDry: FDA Approved Treatment for Unwanted Underarm Hair and Sweat


Good news for armpits or another player competing in the same space?

The US Food and Drugs Administration has recently approved miraDry - the only FDA cleared technology for the treatment of unwanted underarm hair of all colors and permanent reduction of underarm sweat.

How does miraDry work?

According to its manufacturer Miramar Labs, the miraDry System delivers precisely controlled microwave energy non-invasively to the region where the sweat glands reside resulting in thermolysis of the sweat glands.

At the same time, a continuous hydro-ceramic cooling system protects the superficial dermis and keeps heat at the level of the sweat glands. Because sweat glands do not regenerate after treatment, the results are significant and lasting with most patients reporting an average of 82% sweat reduction.

CEO and President of Miramar Labs, Mr. Michael Kleine says that

We believe the potential for microwave energy in aesthetics is exceptional. Miramar was the first company to receive clearance for axillary sweat reduction and we are now the only company with FDA clearance for permanent reduction of axillary hair of all colors. These are both tremendous market making opportunities in aesthetics.

The miraDry System, which came out as a result of more than 6 years of study and clinical research provides a range of energy settings, hydro-ceramic cooling system to protect dermis and a vacuum to stabilize tissue. It also comes with a custom software that guides the procedure.

Is anyone using this system and willing to share thoughts?

Read more on:


ReShape: US FDA Approved Non-Surgical Weight Loss Procedure

ReShape's approval by the US Food and Drug Administration comes as a good news for people who want to lose weight but have not achieved such by diet and exercise alone.

The ReShape Integrated Dual Balloon System, according to the company's website, is the first-of-its kind non-surgical weight loss procedure for those who do not want to undergo surgery or those who do not qualify for bariatric surgery.

It is best for obese patients with a Body Mass Index (BMI) of 30 – 40 kg/m2 and one or more obesity-related comorbid conditions. In the study that paved the way for the US FDA approval of ReShape, it was found that patients lost twice as much weight compared to those who only received diet and exercise coaching.In Europe, it was shown that patients lost around 47% of their excess weight and maintained 98% of their weight loss at one year.

A patient of ReShape will undergo and three-process journey in a span of one year. First, the patient will be educated regarding ReShape and a personalized evaluation will be done. In the second phase, two balloons will be inserted in a patient's stomach through an endoscopic procedure with sedation. The medical-grade and saline-filled balloons will take up room in the patient's stomach so there will be less space for food.

According to its website, these balloons will help curb appetite and will allow patients to enjoy food in healthy proportions. The balloons will be removed after six months, otherwise adverse effects such as intestinal obstruction may occur. Personalized coaching will still be undertaken so that a patient can focus on healthy eating and lifestyle habits to increase success.

The third phase will be the continued support and coaching after the balloons are removed to make sure that patients achieve and maintain their optimal weight and lifestyle.

In an interview, Carmella, a ReShape patient said that:

Anyone who struggled with diet and exercise to lose weight knows it can be a very frustrating cycle. Still the idea of undergoing surgery or being on medication for life is also unattractive. The ability to make long-term changes in my lifestyle with ReShape has not only changed how I see myself in the mirror, but how I see my future.

There are still several risks associated with the use of ReShape Integrated Dual Balloon which include ulceration, perforation, abdominal pain, nausea, vomiting, bloating, belching, heartburn, dehydration, sore throat, device migration, and intestinal obstruction. These may cause the early removal of the balloons before the 6 month period.

Read more at:

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