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Sunday
Aug092015

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:

http://ictr.johnshopkins.edu/news_announce/cosmetic-surgery-drug-to-treat-facial-paralysis/

Monday
Aug032015

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:

https://www.finaceafoam.com/
http://labeling.bayerhealthcare.com/html/products/pi/Finacea_Foam_PI.pdf
http://www.rosacea.org/patients/causes/introduction

Wednesday
Jul222015

miraDry: FDA Approved Treatment for Unwanted Underarm Hair and Sweat

miraDry

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:

http://www.prnewswire.com/news-releases/miramar-labs-announces-fda-clearance-for-the-permanent-reduction-of-underarm-hair-of-all-colors-and-subsequent-launch-of-mirasmooth-300117634.html

http://physicians.miradry.com/physicians/miradry-system

Tuesday
Jul212015

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:

http://reshapeready.com/now-fda-approved-in-the-united-states/#sthash.eq4VUdYE.dpuf

Monday
Jul132015

What I love about Belotero Balance

I have been an avid user of Belotero Balance for a few years in my cosmetic injection practice. Last month (April 2015), I injected 4638 units of Botox and 75 syringes of fillers.  20% of the fillers I use is Belotero Balance.  Much of what I do with Belotero is considered off-label FDA use.  I am a frequent user of cannulas in my filler practice which includes the spectrum of Juvederm available in America and Radiesse.

Belotero Balance Injections

Briefly about my Practice

I spend half of my clinical time personally performing cosmetic injections.   I think I would be a bit busier if I spent more time on the Botox/filler side of the practice but I have plastic surgery assisting duties (my wife is a plastic surgeon, I am a general surgeon with trauma experience), a small cosmetic vein practice, and I also have an acupuncture practice which I love.  After clinical hours, I am an administrator for our plastic surgery practice.  I feel that I spend about 80 hours per week on our practice clinical+administrative.

Great for tear troughs and around the eyes

I use a cannula and lay down Belotero for tear troughs.  It works well for many tear troughs, and flows very well through a cannula.  I've learned over the years to tell the patients that the duration in that area seems to average about 6 months.  Of course this varies from patient to patient.   I was a Juvederm user for almost all tear troughs before and ran into some trouble with swelling  for a few patients.  I still run into some swelling issues with Belotero but it is much less.  It also works well for building up a little bit of the cheek above the zygoma laterally.

Great for forehead lines

Some fine forehead lines are amenable to Belotero filling.  It is especially useful for those patients who want a smoother forehead with less brow drooping which can happen with overzealous Botox use on the forehead.  It is also great for those wrinkles in the eyebrows.

Great for a touch up on the oral commissures

Belotero is wonderful just as a small touch to a slight downturn in the oral commissure.  I'm not talking about the entire marionette line, but just the corner of the mouth and injected superficially.

Great for crows feet

I need to be careful with the bruising in this area but it works well for some of the fine crows feet lines.  It works well with Botox to battle those static lines.

Great for neck lines

Those horizontal lines - belotero becomes very labor intensive but well worth it.  The patients get a bit of bumpy look for the first 2-3 weeks, but it settles and the Belotero works well to integrate into the skin.  I'm not talking about platysmal bands - in that case - look to Botox.

Great for chest wrinkles

Or some call it decollatage area.  These chest crinkles smoothes out well with Belotero well.  For many patients, I have to bend the needle to get the angle I need - especially for the ones where my wife had performed breast augmentation.  And it would be useful to have a chaperone in the room for these procedures.

Serial Puncture method

Yes, this is useful, and can at times reduce bruising because the needle doesn't go in very deep.  A wrinkle is injected several times about 2 mm apart and the needle just barely goes into the skin.  For most of what I like to do with Belotero, except for the tear troughs, I am injecting very superficially.  If I'm threading the needle through (ie, in neck lines), I can see the needle through the skin.  This superficial needling probably has an added collagen induction characteristic for the patients - similar to microneedling.

Superficial injections for longer lasting effect

Superficial injections lead to longer lasting effect.  I have found that deeper injections in areas with movement seem to eat up the Belotero in 3 months.  But 5-6 months can be derived from superficial injections.

I would recommend Belotero to other injectors

I like Belotero and would recommend it as part of our creative set of tools for beauty.  It's like a very thin paintbrush.  And Belotero works well with other fillers in a layered approach.  Belotero has lasting effect when injected very close to the skin and when injected into areas with minimal movement.  And it doesn't seem to have a bluish tint under the skin.

 

Calvin Lee, MD
Botox injector in Modesto, CA

Monday
Jun012015

Kerastem: FDA Approval for Clinical Trials for Androgenic Alopecia

US Food and Drug Administration Center for Biologics Evaluation and Research (CBER) office has recently granted conditional approval to Kerastem Technologies for its clinical trial investigation on the feasibility of the company's treatment for female and early male pattern baldness.

The clinical study will determine if the use of Kerastem's Celution and Puregraft Systems is safe and feasible in the processing and preparation of an autologous fat graft enriched with adipose-derived regenerative cells (ADRCs) in the treatment of early alopecia androgenetica.

Initial clinical works have been done in Europe and Japan which also served as basis for the FDA submission. The STYLE trial will compose the phase II of the study where 70 controlled patients, coming from 8 centers in the United States, are expected to be enrolled in late 2015.

According to the ClinicalTrials.gov,

The STYLE Trial is a prospective, randomized, multi-center device trial intended to evaluate the safety and efficacy of the Celution and Puregraft Systems in the processing and preparation of an autologous fat graft enriched with adipose-derived regenerative cells (ADRCs) in the treatment of early alopecia androgenetica.

The patients will undergo fat harvest using local anesthesia and then they will be randomly assigned to receive either of the following: fat graft cell enriched with ADRCs (available in two different doses),a fat graft without cell enrichment using a visually-matched blood saline solution (fat alone control), or a saline injection (no-fat control) in a 2:2:2:1 ratio.

While undergoing liposuction, lipoaspirate will be processed in the Puregraft System to remove the lipoaspirate of impurities and in the Celution System to isolate and concentrate ADRCs. After the liposuction is completed), patients will have, under a ring block local anesthesia (see further description below), a subcutaneous scalp injection of either Puregraft purified autologous fat or saline (no-fat control) followed by a separate second injection, of either ADRCs (available in two different doses),a visually-matched blood saline solution (fat alone control), or saline (no-fat control) in a 2:2:2:1 ratio.

Currently, there are studies to regarding the use of plasma rich plasma injection to address hair loss problem. Research has shown that application of minoxidil (a tablet used for treatment of high blood pressure)directly into the scalp may promote hair growth. 

Read more on:

https://www.clinicaltrials.gov/ct2/show/NCT02503852?term=kerastem&rank=1 http://www.prnewswire.com/news-releases/kerastem-receives-conditional-approval-from-fda-for-alopecia-trial-300119592.html http://www.puregraft.com/category/news/

Tuesday
May122015

Avoid Medspa Litigation Claims = Provide Comprehensive Information

Exceptional patient services will do more than just keep your patients happy, they'll also keep you out of court (or may your stay much shorter).

In a recently decided case of James v. Decorato, the defendant medical practitioner was absolved of liability after showing to the court the the patient has been adequately informed about the procedure that she will be undergoing.

Their case stemmed when the patient and plaintiff Rebecca B. James sued the defendants John W. Decorato, M.D. and Aesthetic Pavilion, LLC for alleged negligence and malpractice by the latter. In her complaint, Rebecca claimed there was negligence in the performance of various cosmetic surgeries which included liposuction, blepharoplasty, lipoplasty, autologous gluteal augmentation with fat grafting, submental and neck smartlipo, bilateral transconjunctival lower blepharoplasty with CO2 laser resurfacing, and autologous upper and lower lip augmentation with fat grafting.

She alleged that there the malpractice resulted in the formation of excessive and severe scarring, non-uniform appearance of her abdomen, concave left inner thigh with pain, hypo-pigmented skin under eyes leaving non-uniform skin color on the face, among others.

Further, she said that Dr. Decorato violated the Public Health Law when he allegedly failed to disclose alternatives, risks and benefits that may arise after the treatment. She said that had she known of them, she would not have undergone with the treatments altogether.

In an answer, Dr. Decorato said that the plaintiff was able to sign multiple consent forms which outlined the risks and effects that may happen after the treatment. The defendant doctor also argued that the plaintiff's argument must be summarily dismissed because they only stemmed out of her dissatisfaction with the results of the procedures.

In support, Dr. Decorato submitted to the court the examination done by Dr. Theodore Diktaban, a certified Plastic, Reconstructive as well as Head and Neck Surgeon. Dr. Diktaban indicated that he was able to review the consent forms signed by the plaintiff and found them all clear and complete.

According to Dr. Diktaban's affidavit,

The forms adequately provided for the proposed procedures, alternatives thereto, and the reasonably foreseeable risks and benefits associated therewith, including the need for revisionary surgery. The lack of an informed consent could not be a proximate cause of any of plaintiff's subjective dissatisfaction, which she classifies as injuries. Regarding the issue on malpractice and negligence, the pre-and post-operative care rendered to plaintiff comports with good and accepted medical practice.

He further opined that the results of plaintiff's surgery were devoid of any functional deficits, except for the purported and subjective paresthesias of the left medial thigh.

These claims were opposed by the plaintiff Rebecca and presented the statement of a cosmetic surgeon, Dr. Richard Marfuggi. He claimed that after examining Rebecca, he can say that "with a reasonable degree of medical probability, the complications experienced by plaintiff were the result of Dr. Decorato's failure to follow good and accepted practice".

According to the Supreme Court, the basis for establishing the liability of the physician is the departure of the physician from accepted community standards of practice and this was the proximate or direct cause of the plaintiff's injuries.

The Supreme Court sided with Dr. Decorato and summarily dismissed the case. Dr. Decorato, with the affirmation of the statement of Dr. Diktaban, was able to show that indeed he did not deviate from accepted medical procedures. The Supreme Court noted that the plaintiff's claim of "lack of informed consent" has not been proven. Instead, Dr. Decorato was able to produce in evidence the fact that Rebecca was able to sign the consent forms.

On the other hand, the plaintiff Rebecca and Dr. Marfuggi's affidavits did not show any medical evidence establishing that Dr. Decorato was indeed negligent. According to the Supreme Court, Dr. Marfuggi's recitation of facts failed to address the concern of whether or not this was a departure from accepted practices.

Note to self: make sure that all forms are clear and complete.

Monday
May112015

How Patients Deal with Discomfort after CoolSculpting

Popsicle panniculitis became the inspiration for the non-surgical CoolSculpting procedure. This phenomenon was observed when excessive exposure to cold popsicles result in the reduction of fats in cheeks.

CoolSculpting usually works on patients who have fats in certain areas of their body that can be "pinched" by doctors. This procedure will not work with obese patients. It specifically targets fat cells and doesn't harm any muscle tissue or skin.

Patients undergoing this procedure often complain of discomfort, most often in the abdomen area, after the non-surgical treatment. Itching is associated with the body digesting the dead fat cells. A patient who has experienced such itchiness after the CoolSculpting noted that the doctor prescribed Neurontin to ease the discomfort felt while the nerves in the affected area are still recovering. Others also use compression garments or lightly massage the area to lessen the itch. Redness, bruising, and swelling may also develop for some patients but these are only temporary.

One patient took Motrin every five hours to treat the pain and inflammation in the area. With CoolSculpting, patients' level of discomfort is lower compared to those performed after a tummy tuck or liposuction. There are even patients who immediately go back to work the day after the non-surgical treatment, claiming that the discomfort they feel is tolerable.

Most patients are actually looking forward to the results and wouldn't mind the little discomfort. It is very important for those who administer CoolSculpting procedures to assess whether a patient can have this treatment. Also, they must be briefed and informed about the after-effects of the procedure and the discomforts they might feel.

Popsicle Panniculitis?

"Popsicle Panniculitis" can be caused by a number of conditions, most often exposure to cold that affects some infants 6 to 72 hours after they suck on a popsicle or ice cube. Popsicle panniculitis causes swelling and redness in the cheeks near the corners of the mouth. It's a rare condition that usually only affects infants and young children, possibly because infants have a higher concentration of fatty acids in their subcutaneous tissue than adults do. The only treatment required for popsicle panniculitis is to remove the source of cold or limit the child's exposure to cold.

Thursday
May072015

Aesthetic Show 2015: We are Invited!

On July 9-12, 2015, the Aesthetic Show will bring together new procedures and breakthrough products related to running a Medical Spa.  This will be held at The Wynn Hotel, Las Vegas, Nevada.

This is a sales-oriented show that is an avenue for medical professionals, buyers and potentials partners to meet. Continuing education credits are provided for attendees.

This is great opportunity to learn about marketing strategies, discover new products and meet other Medical Spa practitioners.

According to its website, the show presents Advanced Techniques for Practice Success courses which are helpful in building, growing and marketing an aesthetic business. Some of the lecture topics include Internet and digital marketing, expanding practice and profitability, analysis of one's business model, mastering patient consultations, improving staff management skills, and real world success examples.

There will also be discussions about emerging procedures and techniques, use of energy-based treatments for skin resurfacing and tightening, and updates about injections techniques and tips from experts among others.

You may visit the Aesthetic Show website for more information: http://www.aestheticshow.com/ or call +1 (949) 830-5409. 

Tuesday
May052015

PicoWay: FDA Approved Laser for Removal of Tattos and Benign Pigmented Lesions

Here's some good news for patients who want to remove their tattoos and cosmetic surgeons alike: the Food and Drug Administration's has approved of Syneron Candela's PicoWay, a dual-wavelength picosecond laser.

It is estimated that about 25% of the population in the United States have tattoos and about 50% of them want to have their tattoos removed.

The newly FDA approved PicoWay enables the removal of recalcitrant and multi-colored tattoos, as well as benign pigmented lesions on any skin.

According to the Syneron Candela's site, the PicoWay works by delivering ultra-short picosecond pulses of energy to the tissues. The burst of energy create a photo-chemical impact which breaks up the tattoo ink or pigmentation into smaller and more easily eliminated particles. 

Some of the advantages of using PicoWay include its use of dual wavelengths and its ability to treat wide range of tattoos. It claims also to have the shortest picosecond pulses, that is 40% shorter, making it more effective while lowering risks or other side effects.

As early as 1965, Q-switched lasers were already used. These types of lasers produce a very short laser pulse in nanosecond range. This is the most commonly used laser in clinical practice. As Q-switched lasers come in three types, there is a tendency that there will be a need to use another type of laser, rather than owning just one of them to completely remove a patient's tattoo.

To remedy this, physicians shrink the spot size and increase energy deposits which significantly lead to the probability of producing a scar.

Compared to Q-switched lasers, Dr.Shimon Eckhouse of PicoWay says that:


Scientists acknowledge that shorter pulse duration lead to higher efficiency for converting laser energy needed to fracture particles into fragments. Smaller fragments mean that it is easier for the body to effectively remove it. Q-switch technology requires numerous treatment sessions, causes significant discomfort during treatment and incompletely removes tattoos and pigmented lesions.

Picosecond technology has ultra-short pulse durations that are 100 times shorter than Q-switch lasers, and in trillionths of a second. 

Read more on:

http://syneron-candela.com/na/product/picoway

Sunday
May032015

Kybella: FDA Approves Non-surgical Drug for Double Chin

In a 2014 survey, about 68% of those asked by the American Society for Dermatologic Surgery said they are bothered by submental fullness... welcome Kybella

Submental fullness (double chin: subcutaneous fat that makes a person look older and heavier) has a new FDA approved treatment that gives medical spas who are not performing tumescent liposuction another newly approved treatment. (Liposuction is the current standard to remove submental fullness.) Good news for cosmetic physicians in the US who need FDA approval.

Kybella, (ATX-101 accordig to the Kythera website) is a patented formulation of deoxycholic acid. It is a less-invasive, non-surgical option treatment for submental fullness. It's manufactured by Kythera Biopharmaceuticals in California.

Kybella contours the area under the chin by destroying fat cells when it is injected into the adipose tissue or subcutaneous fat. Injections into the fat are done through a series of treatments, no less than one month apart. A natural healing and elimination process should follow.

The drug has been developed for more than 9 years. More than 2,600 patients were involved and 20 clinical studies were conducted. Noted side effects may include nerve injuries that may lead to a lopsided smile or facial weakness, bruising, redness, swelling, and pain.

The approval by the FDA of Kybella does not carry with it the approval of its use for fats located in other parts of the body.

In a statement made by the deputy director of the Office of Drug Evaluation III in the FDA's Center for Drug Evaluation and Research, Dr. Amy Egan mentioned that the drug is only approved for treatment of fat below the chin and it is not known if Kybella is safe or effective for treatment outside this area.

Download: Product Info & Final Labeling PDF - Indications, Dosage, and Injection Technique Information.

Thursday
Apr302015

Cosmetic Medicine = Patient Complaints

In 2010, a Customer Experience Report showed that poor quality and rude customer service is the main reason why a customer leaves a businss. I'ts the same deal for your clinic. It is not about price, instead it all boils down to proper customer service.

Everyone's who's worked in any cosmetic practice has dealt with the overly-demanding, never happy patient, many of whom are particularly hard and abusive of your staff. The way you deal with these patients can have a pretty dramatic effect on how many headaches you have to deal with, and how productive your team is. (You'll also lighten the potential downside of any potential medical liabilities since patients who like their physicians are much less likely to sue.)

Here are some tips in dealing with irate patients and complaints in general:

Compose yourself. As Forbes puts it, Remember, the customer is not angry with you, they are displeased with the performance of your treatment or (most commonly) the quality of the service you provide. Your personal feelings are beside the point.Think about the situation positively.

Listen well. Give your complete focus to your customer, and make sure they know it. Allow your client to tell her side of the story. Do not interrupt her while he narrates his side of the story. Be an active listener.

Be emphatic. Your body language should communicate that you understand why your patient is upset. Empathize with her. Respect and understanding go a long way toward smoothing things over.

Apologize. The legitimacy of the customer's complaint does not matter. If you want to keep your patient and difuse the situation,  you will need to apologize for the problem that they have or perceive to be having. A simple and straightforward "I'm sorry" can do miracles in diffusing a customer's emotional rant.

Present a Solution. When you have the solution to the client's problem, tell her that you would correct the situation immediately. If you can't take care of it immediately, ask for your patients opinion on how she wants to address the situation. Allow her to identify what will make her happy. Work a solution together. Explain the steps that you are going to do to fix your patient's problem.

Take Action. It is important that you do what you have promised your client. This is crucial in fixing your relationship with unhappy patients. 

You can always go beyond expectations. You may also give out gift certificates or coupons to "compensate" for your client's inconvenience. You can make a follow-up call a few days later to your client to make sure that she is happy with the resolution.

Of course, experience is the best teacher. Every encounter with a client is a unique one but every experience is a great chance to improve your relationship.

Each complaint is an insight for you to improve your business better. Proper resolution of complaints will surely increase client loyalty.

Read more on:

http://www.forbes.com/sites/thesba/2013/08/02/7-steps-for-dealing-with-angry-customers/

http://www.restaurantdoctor.com/articles/complaint.html#ixzz3YqYaWMQZ

http://www.mindtools.com/pages/article/unhappy-customers.htm

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