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Connect with new and current patients

It can be challenging to find new patients considering the competition. Some aesthetic physicians could be offering a treatment at a lesser cost or list a popular treatment that allows patients to return to them more. It would be a bummer if one of your former patients would go to them or have a prospective one go to another. Thus you'll need to brush up on some simple marketing skills on how to retain patients or bring in new ones.

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Dr. Michele Green - A Manhattan Dermatologist

New York Dermatologist Dr. Michele Green shares about her background in the cosmetic field, the way she runs her office, and the devices she uses in her practice.

Dr. Michele Green - Manhattan, NYName: Dr. Michele S. Green MD
Location: Manhattan, New York City
Brief Bio: Dr. Michele S. Green is a board-certified dermatologist based in NYC. She is a graduate from Yale University, with an MD from Mount Sinai Medical School in NYC, and has since opened her own private practice on the Upper East Side of Manhattan, and treats both medical and cosmetic dermatology patients with an emphasis on anti-aging and skin cancer prevention.

I use a range of laser treatments for skin rejuvenation and skin tightening. Popular laser treatment requests include Thermage for facial skin tightening, V-Beam, Fraxel dual laser and its “mini-fraxel” counterpart, the Clear+Brilliant, or eMatrix which helps produce new collagen and rejuvenate the skin’s appearance. I utilize the BBL laser which is my favorite IPL laser because of the ST skin tightening handpiece. While all new technologies and developments are of interest, we are very specific with picking the ones that we use for each condition and do not have...

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Krachap Lips: Lip "reduction" in Thailand

For most patients it would be unthinkable to want to have smaller lips. Not so in Thailand.

Plastic surgery in Thailand is cheap (which makes it popular). It's also pretty dangerous, with little to no regulation or oversight of services.

A fashion trend in Thailand is for women to 

Lip reduction is an uncommon procedure in the US, but its counterpart, lip augmentation, is a common procedure, with two options in doing so. One is surgical lip augmentation, while thither is through dermal fillers. So far, the only available option in reducing lips is to treat it surgically.

A lip reduction would need to remove skin or excess tissue along the dry-wet line of the lip. The stitches remain to form a "new" lip line (where they either disolve or are removed manually).

In Thailand, they call it “krachap lips” wherein they reshape the lips as if they were buffalo horns with very pronounced curvers. (Removing distal portions of the lip along the vermilion border to achieve an exagerated 'bowed' look.) Lip reduction has been linked to Thai’s superstition of having smaller lips to good fortune explaining why many opt to undergo the procedureThe lips are modeled after actor Patcharapa “Aum” Chaichua. The procedure’s common and immediate side effects are redness, pain, bruising, and swelling. According to some websites, a lip reduction surgery costs anywhere from $800 to $2000 (US).

Despite botched consequences for other patients, it doesn’t stop some other potential patients undergoing the knife for the procedure. Presently, there are no significant studies about lip reduction.

Photos: Dr Apple Surgery/Facebook


Dr. Ron Shelton - Cosmetic Lasers & Surgery In Manhattan, NY

With more than 27 years of practice under his belt, Dermatologist Dr. Ron Shelton gives us an insight about his experiences and running his practice in New York City.

Dr. Ron Shelton - Manhattan, NYName: Ron Shelton MD
Location: Manhattan, New York City
Brief Bio: An industrious, forward thinker, Dr. Ron Shelton, in 2001, brought together an accomplished group of surgeons to holistically address the needs of both cosmetically-minded patients and those needing Mohs surgery and reconstruction for skin cancer.

New York Aesthetic Consultants included Cosmetic Dermatologic and Plastic Surgeons. It was one of the first medical spas in New York City. In July 2014, Dr. Shelton was invited to join the prestigious NYC laser practice, Laser and Skin Surgery Center of New York. Both Dr. Shelton’s and LSSC’s practices have benefited by this merger as the Midtown NYC cosmetic dermatology practice has more than 60 lasers and devices and a dedicated research division for the development of new laser technology.

Our practice has 8 full time dermatologists and several part time dermatologists and a plastic surgeon. We practice in Midtown Manhattan and Southamptom Long Island, but my full time practice is limited to our NYC practice, in which I see patients from 8 AM to 5 PM, Monday through Friday. We have many administrators including the executive practice administrator, COO, office manager, nursing manager, laser research manager, many RNs and a few medical assistants. I perform all laser and cosmetic device treatments for my patients. We do not have ancillary providers perform lasers in our practice. Half of my practice is cosmetic dermatology including laser resurfacing, laser treatment of discoloration (facial erythema, lentigines, tattoo removal), body sculpting / skin tightening with liposuction and minimally invasive (ThermiTight) and non invasive treatments (Thermage, Ultherapy, ThermiSmooth, CoolSculpting, UltraShape, SculpSure), volume augmentation with fat injections as well as many of the hyaluronic acid treatments (Voluma, Vollure, Volbella, Juvederm, Restylane, Belotero) and other fillers and Sculptra. Botox is very commonly performed. The other half of my practice deals with skin cancer treatment with excisions, and Mohs Micrographic Surgery and Reconstruction.

The list of devices we have is quite long, approximately sixty and they encompass many types of lasers and devices. We have only one IPL. We have gentle laser toning with Cutera XEO Laser Genesis and PicoSure focus lens array and Clear & Brilliant and Permea. Lasers for resurfacing include Fraxel Restore/Dual, and Fraxel Repair.

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Injection Techniques for the Hand and Neck

In our previous post, we discussed filler injections for hand and neck rejuvenation. These procedures are on the rise, and many physicians are considering this procedure in their practice.

Injection Techniques for the Hands

There is a significant amount of literature for hand rejuvenation. Most have focused on injections and laser for the hands, as a non-surgical alternative. For this article, we shall go in detail on the injection techniques included in two studies.

LeFebvre-Vilardebo, Trevidic, and et al. (2015) go in depth with injection techniques, as different authors included in the study present their own injection methods on hands. The researchers also introduced their own injection technique: Scrape Skin Threading Technique. Below is the table detailing more on the injection techniques.

Data from Lefebvre-Vilardebo (2015)

LeFebrve-Vilardebo and Trevidic (2015) suggest using a blunt-tip cannula when injecting. The researchers use four injection techniques to administer the CaHA.

The first method only injected without massaging, and it is most effective on a less fat hand. On the 2nd method, massaged aided in distributing the filler evenly. However, the third method showed the filler only stayed under the tendons. In using their own technique, the SSTT, it was the only technique that showed where the product was targeted.

For Dr. Moradi (2015), he used Radiesse with lidocaine HCl. In performing the procedure, he tented the skin and utilized a bolus injected in the dorsum of the hand. Specifically, Moradi injects “…proximally by the wrist-hand junction, distally the metacarpal-phalangeal joint” (p. 265s).

In addition, the doctor added smaller units for added improvement on the hands. Its intended result is to lessen the appearance of veins and tendons and improve volume.

Alternatively, in Dr. Busso’s (2015), he used HA that would minimize the appearance of tendons. The patient should be in supine position. In order to see the veins better, Dr. Busso suggests placing the hand below the level of the heart. In addition, mark all injection sites. Then, finally, raise the hand slightly above the level of the heart.

The injection on the dorsal superficial lamina would yield easier injection administration. Injected fillers can easily spread and lessen any abnormal skin formation. Skin tenting is recommended to separate the veins from the injection area. There is a risk of nerve injury, so refrain from doing any intracompartmental injections “below the deep dorsal fascia” (p. 270S).

As for Drs. Sutton and Bucay (2015), their choice of filler is Radiesse. Like the previous cases above, cannula was used to administer the filler. The insertion of the cannula is between the 2nd and 3rd metacarpal.

The common observed side effects were edema and erythema in all cases.

Dr. Rivkin (2016) also conducted a study on hand rejuvenation and injection techniques. The author makes use of needles, instead of a cannula as mentioned in previous studies mentioned above. The technique the author adopted was injecting between the phalanges. Rivkin carefully fills in the spaces. The author expects that the appearance of vein and tendon reduce. After administering the procedure, it is recommend that the hand is massaged.

After the procedure, the author advises the patient to have hands elevated for the next couple of days and any tedious activity.

Here are the tips that Rivkin provides.

Injection Techniques for the Neck

The literature for injection techniques on the neck is limited; most studies have only studied on the use of lasers on the neck. There have been research on the neck using botulinum toxin, and there are doctors who use botox on their patients to perform a non-surgical neck lift.

Physicians should take note of the danger zones in the neck. Calisti and Elattar (2017). The researchers introduced a new injection technique on the neck, which is the “Three-Dimensional Circumferential Injection Technique” (p. 1). They applied this approach on the Posterior and Lateral Subcutaneous Areas of the Neck and Anterior Subcutaneous Area of the Neck and Horizontal Neck Rings.

Below is the table that further details the study.

Data from: Calisti and Elattar (2017)

Hand and neck rejuvenation are two procedures that result in patient satisfaction. The procedures are not nascent, and it is expected to rise in the coming years.


The Coming Shift to Telemedicine (Everywhere)

There is a rise of telemedicine startups everywhere, especially in cosmetic medicine. What might this mean for you?

The Shift to TelemedicineSilicon Valley, New York, London and Berlin all are investing big in telemedicine, A.I. and big data services. There are massive changes in the US that are opening doors for new services. what does it all mean for a little one-doc clinic in Des Moines, Charolette or San Antonio?

Why is there a need to utilize telemedicine?

Telemedicine makes it easier to keep patient records, track patient progress, saves time (and money) and offers the promise of integrated deep learning for clinical decision support.

There has been a report that patient preference leans towards employing telemedicine. It provides follow-up care for those who underwent surgery and many patients favor that. The convenience allowed for better communication with the physician through email.

Why are some physicians skeptical about telemedicine?

While there are many benefits to telemedicine, it is still faced with criticism. Many physicians are hesitant to adopt telemedicine because of costs. One of the many concerns about adopting telemedicine is the HIPAA. Patient privacy can be breached, especially with aesthetic medicine where photographs and video can be saved or used as before and after media output. Tools and software can be costly, because of this doctors would prefer to stick with traditional practice instead.

When will aesthetic medicine adopt telemedicine practices?

Several dermatology and plastic surgery practices have made progress in using telemedicine. The most common telemedicine method for aesthetic practices are Skype consults. Virtual consults cost less and patient retention is slightly higher.

Another example of telemedicine applicable for aesthetic practices are Virtual (VR) and Augmented Reality (AR). Primarily known for its use in gaming, it has branched out to other science and technology fields. Several plastic surgery practices have installed some devices such as VR or AR for patients to visualize the expected outcome of their procedure. Back in 2015, plastic surgery performed through Google Glass resulted successfully. In other uses, scribes send data to physicians via Glass. Expectations to use Google Glass in the practice is huge.

Telemedicine is also not limited to patient care, as it focuses also on the devices you use for your practice. While Luan et al., (2015) study focuses on access to plastic surgery literature, a physician can utilize their devices to use to communicate with patients. In addition, since the rise of smartphones, it is easier to enforce telemedicine. Video messaging apps like FaceTime and Skype can be used for telemedicine.

How to prepare yourself in integrating telemedicine in your practice?

Telemedicine, while mostly beneficial, may be difficult to integrate to a practice especially if it is not telemedicine-ready. You may need to consider these factors.

According to Krupinski (2014), set-up a room dedicated for all telemedicine needs. You will need to examine factors such as lighting and audio and video so you can examine them better. Let your patients feel comfortable inside the room as well.

2015 Telemedicine Report from Freelance MD

Choose the telemedicine tools, methods, and technologies you will adopt. As we have mentioned there are various tools and devices for the physician’s use, but you do not need to employ everything. Some examples of the telemedicine methods you can use are Real Time (RT), which you can do on your own devices or through store-forward (SF). A physician can find a telemedicine tool or software online, which one can subscribe to.

Training is important, as studies have shown that those who are mishandling telemedicine tools or software can make patients feel uncomfortable. Train along with your staff so everyone in the practice has an idea how your telemedicine devices and software work.

Most physicians overlook the hindrances and barriers to using telemedicine for easier accessibility. Telemedicine is not just implementation just to keep up with trends, but its convenience and eventual cost-cutting advantages can help save practices.

Download the Medical Spa MD Telemedicine Report here.


Integrating Aesthetics in Your Practice

Non-surgical cosmetic procedures continue to rise steadily, and it is expected to so in the coming years. The market, however saturated, is still competitive with the increasing demand of patients seeking these procedures. Thus, many physicians venture to aesthetics either through ancillary services or as the focus of their practice.

Admittedly, adding aesthetic treatments and procedures is more profitable and bring in more patients in the practice. Based on the statistics published by the American Society for Aesthetic Plastic Surgery (ASAPS), non-surgical procedures have steadily every year with statistics only limited to plastic surgeons, what more for dermatologists and general practice physicians. Many expect the number of procedures to...

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New Advancements In Cosmetic Lasers (2017)

Cosmetic laser technology has continuously advanced over the years, and many physicians have noted the progress in the past few years.

The American Association of Dermatology (AAD) Annual Meeting was held in March. One common topic according to the AAD articles is the advancement and improvement of aesthetic laser devices. Aesthetic laser devices can target skin and facial conditions, even allowing multiple treatments on one device.

Dr. Michael Gold, a renowned dermatologist, spoke in a symposium, noting the significant changes of the current aesthetic devices.

Aesthetic companies like Syneron, is gearing up to release new devices and make improvements with their current devices. In addition, Cutera introduced PICO Genesis last December that treats skin pigmentation, which also enhances the patient’s skin complexion.

Two doctors from the AAD conference has noted that laser will improve further in the future. Dr. Chapas said that there are studies being conducted over the use of a picolaser for other cosmetic purposes other than laser hair removal. Additionally, Dr. Waibel mentioned that research is also done to examine other laser uses.

The dermatologist added she is aware that new technology are being developed such as the free electron laser, which has promising uses for the medical sector.

It is expected that lasers will continue to develop in aesthetic medicine. What are your expectations for aesthetic or cosmetic lasers in the future?


Thinking of a Picosecond Laser? Do I need one and which one to buy.

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