I also attended the meeting and thought it was great.
I also believe,if you are only going to attend one meeting /yr.-this is the meeting to attend.
"KNOWLEDGE IS POWER" invest in yourself!

Jeff, It was a pleasure spending a few moments with you and our other members. A few of my thoughts. I am not sure whether ASLMS has a clear plan for the future regarding Aesthetic Medicine or Laser Medicine for pathology. It seems to be the former judging from the list of exhibitors. Your plans for MAPA complement the larger organization, but recognize that the interest of Laser and other manufacturers do not correlate with or complement the needs of the practitioner. For example, if there are head to head comparisons of the indications, results and complications of different machines, I am not aware of them. The manufacturers probably believe in the excellence of their machine, but their responsibility is to their stockholders or their VC backers, and not to us. We must be cautious inviting the “big money manufacturers” or their salespeople into our midst. As we grow it will be harder to recognize who is giving an opinion. Is there a way to have our office or spa automatically listed on the signature line? If we can do that we would know that a contribution to our blog/email without that identification is suspect. With proper marketing I think there is a very helpful role for MAPA, and the group should grow. I appreciate your energy and expertise.

From my ASLMS Notes:

The experts recommend treating moderate to severe acne scars with THREE fractional ablative treatments spaced 1-2 month apart. They were speaking specifically about the Fraxel Re;pair but I think this also applies to the other Fractional Ablative lasers as well.

From my ASLMS Notes: Zinc oxide provides better sun protection than Titanium Dioxide because it blocks all wavelengths up to 400 nm while Titanium Dioxide only blocks up to 360 nm. Use ZO after laser procedures rather than TO

I also attended the meeting, and to those of you who didn't attend, you missed out. There were some great "pearls" that we all took away. But, perhaps more importantly, we are building a community of providers who are all truely committed to providing the highest quality care possible for our patients. At this meeting we are able to draw on the experiences of providers from all around the world. As a result, the information is vast and varied, and the opportunities to expand our fund of knowledge are countless.

On a different note, I use the Fraxel Re:store on acne scars. Patients see considerable changes after the first treatment, but typically require 4-5 treatments in total. Once they start to see those scars smoothing out, they all continue for the whole series.

MAPA will be meeting at the "Controversies and Conversations in Laser and Cosmetic Surgery - An Advanced Symposium" -- Fairmont Southampton, Bermuda; August 14-16, 2009

https://www.nwregistration.com/SkinCare/

When you sign up ask for the MAPA Discount!

Jeff

Jeffrey E. Epstein, MD
Cherry Hill Laser & Skin Care Center
Jeff4459@aol.com
856-751-8181
ChLaserMD.com

It doesn't seem like many patients visit this site so I may be the first. I was a patient at Dr Epstein's center. I went there several times, was charged a lot of money for procedures that I now learn he doesn't believe in. It is amazing to hear what he told me versus what he says online about these treatments.
He was also rude and abusive to his staff. He rushed in and out of the treatments. I have since learned that it is standard practice to take before and after photos. He never did this. He also never washed his hands either before or after my treatments or consults. I have several other friends that had similar experiences. None of us will ever return. We will be looking for a Dr that is interested in more than just the money. As a single mom, I don't have a lot of money to spend on these procedures. I wanted to do a few things to simply feel better about myself, this experience made me feel worse.

When we first started we didn’t get very good results with our non-ablative treatments. Cutera’s Titan and Laser Genesis just did not work very well. We were mislead by Cutera and we probably oversold this to some patients (my Cutera Rep [Randy Freed] and I got into a big fight because he did not like it when I told people that Titan did not work).

When we decided that our Cutera treatments did not work very well, we bough new lasers (Fraxel Glass Erbium & UltraPulse Fractional CO2 Laser) and contacted all our patients who had had the Cutera treatments. We re-treated everyone at no charge. One of the reasons that I started MAPA was to help other new doctors so they would not be mislead by the Laser Companies.

If Sharon is truly a patient of ours, she is welcome to contact us and we will do our best to make things right. We take before and after pictures of EVERY patient (we have a room dedicated to photography) so I am wondering if she is a real patient. She could be Mitch Goldman or Randy Freed or Robert Mann or Dale Koop.

Many of you know me because of the training sessions we do in our center and many of you know me from MAPA (www.MapaSkin.com ). One of my main goals is to help other providers avoid the problems we had when we first opened our clinic. Information Exchange and Clinical Exchange are the best ways to find the truth and get optimal clinical outcomes. I speak openly and honestly about my experiences. This makes some people uncomfortable. Our clinic is not perfect but we try our hardest to please each and every patient.

DR. Epstein, Since you have used the Cutera Titan laser, I wonder if you have had any experiences similar to mine. I am a patient. I had my most recent Titan laser treatment about 7 weeks ago. I have had one a year for the past 3 years , with good, modest results on my face. this time however I was badly burned after just 2 minutes of the procedure . I have second and third degree burns on my face. The nurse stopped the treatment because I complained of unusual pain. Nothing in my health or face has changed since my first treatment 3 years ago. Cutera says there is nothing wrong with their machine. I have these treatments in a doctor's office, under the operation of a registered nurse who has been using this laser for 5 years with no problems. The doctor has been treating me for the past 7 weeks and I am also seeing a burn specialist. I have consulted with 5 other doctors, all of whom concur that this was causd by an overheated device. I think the least I can do is let other people who use this laser know that this can happen. You will not hear it from Cuters...Any thoughts?

Since the laser companies NEVER provide any feedback on the energy that their laser is putting out (other than the number on the display), we never know exactly how much energy we are delivering. Each time my lasers are serviced, they have to be adjusted and are off by about 10%. I am not a laser electrical engineer, but I can imaging something going wrong with "the computer" and the machine putting out a much greater amount of energy then it shows on the display. Experience laser surgeons always watch the "clinical endpoint" and you were fortunate that your laser provider stopped when they did (inexperienced providers might have "soldiered on" and caused much worse burns). Sounds like the laser was set improperly or the laser put out too much energy or the cooling failed. The fact that you were burned means that you got too much energy or too little cooling (simple as that). If I was Cutera, I would look into this very thoroughly (but they won't do this because they don't care about patients). Lumenis also does a terrible job investigating laser burns and scars. They don't even take calls from patients. They hide behind regulations and are afraid to say anything because they might get sued. The executives at these laser companies are a disgrace. They don't care about patients, they only care about their profit and being able to selll more lasers. They are arrogant and dismissive (even to physicians). J CA, you need to do whatever you need to do to get answers, but don't be suprised if you are stonewalled and ignored by the Cutera Executives. I would go to their website and contact the CEO directly (or contact the board of directors) or buy one piece of stock and go to their next stockholder meeting. You will get attention IF you are a squeeky enought wheel. Your efforts just might save another person's face from getting burned. Good luck. There are other patients forming groups and thinking about class action law suits. Some have posted on this site. Keep up the good fight. The companies NEED this type of pressure to get better.

At the ASLMS, Dr. Geronomous mentioned that fractional ablative treatments seem to effect fat under the eyes. Eyes look better after Fractional Ablative Treatment. He seemed to think it was the treatment actually effecting the fat. My question is: could it be that tightening and thickening the skin under the eye holds the fat "in" better or is the fat reduced or changed in some way? Opinions?

ASLMS Notes: For skin tightening you need to keep the surfact temperature at 40 degrees C for 10 minutes. The temperature is higher deeper down in the tissue. 40 d cent is 104 degrees F. Body temp is 98.6 d F. This would apply to Thermage and InfraRed Skin tighteners. Rember that if you are cooling the skin, the skin temp will be lower while you are heating deeper. You can check skin temperature with infrared thermometers.

Jeff

At which depth seem to effect a Fractional Ablative laser the fat under the eyes?If it's true maybe this is the answer of the Dark cycles under the eyes?But again at which depth?

Jeff: How is it possible to maintain an external skin tem,p of 40 degrees C for ten minutes when using a pulsed device like Thermage? Theoretically you would have to keep pulsing over and over again in a very small area to heat the tissue to the necessary temperature threshold for such a long time???

This is not a problem for many of the RF devices which operate more like "continuous wave" lasers. But with the pulsed delivery I don't know how you can maintain the heat for such a long time.

Charry, you can't go much deeper than 300-400 microns under the eyes because of increased scarring risk. The effect on the fat must be a thermal effect (if the treatment effects fat at all). Dr. Geronomus seemed to think the treatment effected the fat itself, but maybe he did not consider that the skin over the fat could cause the change seen on photos.

MedSpaGuy, I am not sure how to do this. This is what the experts said during their talk on skin tightening. Maybe someone from Thermage or Solta can help us.