Drs. Jason Pozner and Jason Emer explain how and why they use energy treatments on patients to improve liposuction results. Video panel recording courtesy X-Medica.
Marketing without social media is like baking a cake and forgoing the icing. But keeping up with what’s hot and what’s not in social media can be challenging for busy cosmetic surgeons.
One plastic surgeon who has figured out how to make Snapchat and Instagram social media platforms work for his practice is New York City plastic surgeon Matthew Schulman. The International Business Times named Dr. Schulman’s Snapchat account, @nycplasticsurg, as one of 17 new usernames to follow in 2016.
Why Snapchat and Instagram?
With 115 million Snapchat users, and 10,000 joining the social media platform every month, it’s hard to ignore. About a third of 18 to 34 year olds in the U.S. have a Snapchat account, according to Static Brain’s Snapchat statistics. Instagram has more than 182 million users, with 18.7 billion photos shared, Static Brain reports.
Dr. Schulman says especially Snapchat has the power to reach patients in key demographics who are hungry for information about cosmetic procedures.
“Snapchat is an extremely powerful platform. I broadcast my entire day, including consultations, surgeries and behind-the-scene footage,” he says. “I have almost half a million people who watch me every day. Not only do they watch my surgeries, but they also watch me and my staff prepare for surgeries. They know details about me and my staff that only my loyal viewers can know. To have 500,000 people follow every step of every day is powerful.”
We asked Dr. Schulman (www.drschulmanplasticsurgery.com), who gives viewers an all-access pass inside the operating room, to share his best practices.
Dr. Schulman and his team pictured filming surgery for Snapchat.
In This Article
Tips for Making Snapchat Work for Your Practice
NEXT: How Do You Use Snapchat?
How do you use Snapchat? How do you use Instagram?
Dr. Schulman: My primary platform, right now, is Snapchat. I start broadcasting first thing in the morning, and stop when my day ends. We broadcast the entire surgical process, including the preparation and what the staff does in between cases. We also show consultations and allow our patients to participate as much as they feel comfortable. On Instagram, I generally show before and after photos as well as some small video clips taken from my Snapchat account. There is still a percentage of Instagram followers that have not embraced Snapchat, so it is important to maintain a strong Instagram account as well.
How are these different than old-school Facebook and Twitter?
Dr. Schulman: Instagram is photo- and video-dependent. It becomes a great tool to demonstrate before and after photos. The picture is the content. Snapchat allows the physician to tell a story using short video segments. I use Snapchat to show my day, my surgeries, and my patients' stories. Both Snapchat and Instagram can be interactive, allowing followers to ask questions and have you answer them directly. Instagram also allows followers to easily tag friends, alerting them that your account is worth following, and this can rapidly grow your follower base. Instagram and Snapchat are platforms used by a younger demographic, and include patients who are among the fastest growing patient base. Only Snapchat has the ability to show a "story," which can be your entire day made up of 10 second video clips. My viewers can see exactly what I did all day. They can watch my 13-hour day in only about 10 minutes!
NEXT: What Are Your Returns?
What kinds of returns are you getting from your social media activity on these platforms?
Dr. Schulman: The return is very strong. I use it as a part of my entire branding process, so it is impossible to quantify the actual ROI. I have always had a strong national reputation and a very busy practice. However, ever since my Snapchat account has taken off, I have gotten even busier, mostly because of an increased close rate (the percentage of people coming for a consultation who book a procedure). My close rate is extremely high now. When a patient comes for a consultation, and they indicate on the intake paperwork that they are following me on Snapchat, there is an 85% closure rate. This compares to a 50% closure rate among non-followers. The reason is that my Snapchat followers know me and my staff intimately, and have seem me operate. They like what they see, which is why they came for the consult. When these followers come for a consult, I don't even need to introduce myself or my staff. They often act ‘star-struck’ since my Snapchat account is like my own reality television show. These patients want to be part of the ‘show,’ so it makes them eager participants. Over 90% of my patients agree to appear on my Snapchat.
Why do you think it’s important [cosmetic surgeons] know about Snapchat and Instagram and how to use these social media platforms?
Dr. Schulman: Social media is the most important marketing tool of 2016. Potential patients are using social media platforms, such as Instagram and Snapchat, to educate themselves about cosmetic procedures and select physicians. Existing and past patients are using the same platforms to demonstrate their own results and endorse their surgeon. They act as brand ambassadors and are essentially doing the advertising for you. Public endorsements are far superior to any paid advertising out there. I strongly believe that the days of website search engine optimization (SEO), and pay per click advertising are done.
NEXT: Tips for Making Snapchat Work for Your Practice
What do you think doesn’t work and what should cosmetic surgeons avoid?
Dr. Schulman: Physicians need to be authentic and not try too hard. I follow many other physicians, so that I can put myself in my viewers' shoes and see what works. One of the most common mistakes that I see is a physician who thinks that they need to put on a show. Avoid creating characters. Your staff should be your staff. It is not necessary to have cute nicknames for each and having them dress in costumes and wigs. You are all medical professionals, not comedians, actors or dancers. You want to be entertaining, but the primary goal should be education. If you try to broadcast a sitcom, your viewers will lose interest very quickly. Even worse, you can be perceived as being disrespectful to your patients and unprofessional. Not only can this lose you followers and potential patients, but it may even lead to a formal complaint to your medical board. Unfortunately, I see other physicians engaging in behavior that can be perceived as an ethics violation by many medical boards.
What are some tips you can offer readers if they want to get in on this media craze?
Dr. Schulman:
1. Be Authentic
The key is to be authentic in your broadcast. People will respect you when you simply show your day. People who are not in the medical field will find what you are doing to be interesting, even if you think it is boring. There is no need to embellish things.
2. Create (and Commit to) a Pattern
You want to develop a pattern to your broadcast. Viewers want a pattern. Each day should have a beginning, a middle and an end to it.
3. Invest in Your Setup
Make sure that you have proper lighting and proper sound. This will take some experimentation. It took me several weeks to figure out how to adjust my operating room lighting, so that the videos would be clear enough for the viewer to see exactly what I am doing. We also had to figure out what camera angles work best. I installed boom microphones in my operating room, because I found that the sound quality was lacking in some earlier broadcasts.
4. Get Written Consent
Of ultra-importance is to make sure that you have written consent for every single patient that is shown on Snapchat, even if you do not disclose their face, name or any personal information on the broadcast. This is a new area and you want to make sure that you are not violating a patient's privacy.
5. Be Patient
Another key is to be patient. Unlike Twitter or Instagram, there is no way for people to find you on Snapchat unless they are actually looking for you. There is no search function. To follow you, they need to physically type in your account name. This means that it will take longer to gain followers and it is important to have compelling content so that your followers will tell their friends.
Dr. SundaramIn an editorial published April 2014 in the Journal of Drugs and Dermatology, Hema Sundaram, M.D., encourages U.S. cosmetic surgeons to travel abroad for scientific meetings. She writes about how current clinical practice in Europe is the “shape of things to come” in the U.S. The advent of hyaluronic acid fillers is one example. In Europe, physicians were using HA fillers in 1996, about seven years before HA fillers were approved in the U.S.
“International dialogue in cosmetic surgery is important for a number of reasons,” says the Washington, D.C., area dermatologist. “First, approvals of many cosmetic surgery devices come quicker in Europe and elsewhere in the world. This is especially true for injectable fillers.”
Understanding these advances allows U.S. physicians to become better injectors, by refining their facial analysis skills and increasing the sophistication of their treatment planning and implementation, she says.
“… the international dialogue is a two-way process. American cosmetic surgeons also make significant contributions when they participate in international meetings. This is through our focus on safety, since the U.S. FDA has rigorous safety standards. And … our expertise in problem solving with the aesthetic toolbox we have available to us,” Dr. Sundaram says.
The Face2Face Congress and International Master Course on Aging Science (IMCAS) are among the organizations that hold important international meetings and are good sources of scientific information for cosmetic surgeons worldwide, according to Dr. Sundaram.
Taking part in global topics and discussions at these meetings has far-reaching benefits for U.S. physicians who attend — even if the discussions revolve around fillers and more which are not yet approved in the states, according to Dr. Sundaram.
“Many eventually come to the U.S. A worldly view empowers us to develop the techniques to successfully combine new and existing fillers to achieve the best and safest results for our patients,” she says.
In This Article:
Upcoming International Meetings
NEXT: IMCAS Academy
IMCAS Academy
IMCAS recently launched the IMCAS Academy, which provides online learning and interaction among cosmetic surgery specialists, including dermatologists and plastic surgeons, according to Dr. Sundaram, who is on the scientific board for the IMCAS Academy and a theme editor for Injectables. The IMCAS Academy includes an international panel of experts and offers courses and discussions on broad range of topics from practice management issues (including social media best practices) to clinical best practices. One recent topic, for example, is vulvovaginal repair.
The Global Aesthetic Consensus Group is an advisory group of leading dermatologists and plastic surgeons from the U.S., Canada, Europe, Asia, Latin America and Australia, according to Dr. Sundaram. The group’s first three publications are consensus papers on botulinum toxin and hyaluronic acid fillers. Dr. Sundaram is the group’s North American chair.
“These consensus papers were independently developed by the physician faculty, with the support of an educational grant from Allergan…,” she says. “The first Global Aesthetics Consensus paper, on botulinum toxin, was recently published in Plastic & Reconstructive Surgery (PRS).”
The second is in press for PRS (Sundaram H, Liew S, Signorini M, et al. Global Aesthetics Consensus Group: Hyaluronic Acid Fillers and Botulinum Toxin Type A: Recommendations for Combined Treatment and Optimizing Outcomes in Diverse Patient Populations), and the third, she says, will appear in the June 2016 issue of PRS (Signorini M, Liew S, Sundaram H, et al. Global Aesthetics Consensus Group: Avoidance and Management of Complications from Hyaluronic Acid Fillers: Evidence and Opinion-Based Review and Consensus Recommendations).
NEXT: Can’t Travel? Read This
Can’t Travel? Read This
One of the next best things to traveling abroad is reading about international research efforts. Dr. Sundaram says that some of the highest impact peer-reviewed journals in core aesthetics are published in the U.S., but are distributed and read throughout the world.
“The journals Plastic & Reconstructive Surgery (PRS), Dermatologic Surgery and the Aesthetic Surgery Journal (ASJ) have excellent articles from both U.S. and international authors,” she says. “I would recommend them and other core aesthetic specialty journals to cosmetic surgeons who are striving to stay up to date with the latest advances.”
NEXT: Upcoming International Meetings
Upcoming International Meetings
These are the meetings Dr. Sundaram recommends:
June 2 through 5, 2016, the Philippines Academy of Dermatologic Surgery Foundation (PADSFI) presents Dermatologic Surgery: Basic and Evolving Trends, which includes three meetings in the Philippines.
“This is a comprehensive conference that covers all aspects of minimally invasive cosmetic surgery and also advanced dermatologic surgery,” Dr. Sundaram says.
For more, go to: http://www.padsfi.org/.
London, England is the host city for the June 16 through 19, 2016, Facial Aesthetic Conference and Exhibition (FACE) Conference.
Among the topics at this conference, according to Dr. Sundaram: fillers, body contouring with radiofrequency, new techniques for botulinum toxin, lasers and light energy devices for skin rejuvenation, hair restoration and practice management.
For more, go to: www.faceconference.com.
July 29 through 31, in Taipei, Taiwan, the International Master Course in Aging Science (IMCAS) will hold its Asia Congress.
“The international faculty, from throughout Asia and also Europe, Australia and North America, will present a full educational curriculum of cutting edge concepts to treat Asian patients,” says Dr. Sundaram, who is on the IMCAS I'm on the scientific committee.
For more, go to: www.imcas.com.
The FACE2FACE Congress will be held September 9 and 10, 2016, in Cannes, France.
“Like IMCAS, this conference has high level content on injectables. The faculty is again very international and will provide both European and global perspectives on injectables, regenerative medicine, lasers, body contouring and other current topics,” says Dr. Sundaram, who is scientific director of the Face2Face Congress and served as congress president in 2013.”
For more, go to: http://www.face2facecongress.com/en/.
In a study of 28 female patients with cellulite, the Profound (Syneron Candela) microneedle-based fractional radiofrequency device resulted in a 100% response rate at various degrees for rebuilding collagen, elastin and hyaluronic acid.
The study’s author Leyda Elizabeth Bowes, M.D., medical director, Bowes Aesthetics & Body Contouring, in Miami, Fla., presented the findings in April at ASLMS 2016, the 36th Annual Conference of the American Society for Laser Medicine & Surgery, Boston, Mass.
Dr. Bowes treated patients with the device bilaterally, and graded cellulite severity at one, three and six months.
“The treatments were done using a modified 6-mm length 5-pair micro-needle tip at a 75-degree angle,” Dr. Bowes tells Cosmetic Surgery Times. “At the six-month follow up, we found an improvement in the degree of cellulite, typically by one to two points on the grading scale, which translates to a 30% to 40% improvement. That’s only with one minimally invasive, 30-minute treatment. This is quite significant.”
Related: CoolSculpting for cellulite?
Most patients in the study, she says, are planning to do a second treatment, with the hopes to achieve further enhancement of results.
Dr. Bowes reports the treatment resulted in improvement of the skin’s overall appearance. She attributes the improvement to the device’s stimulation of new collagen. The increased collagen production also improves skin texture and the cellulite’s indentations and undulations, which she says improved moderately with one treatment in the study.
What’s different about the Profound system for cellulite is that the needles penetrate about 6-mm, reaching the subcutaneous fat, where the thermal effect of the radiofrequency affects the fatty tissue and stimulates, in turn, the production of collagen. It is precisely this collagen that will build up newer, stronger and more abundant fibrous bands in the superficial fat or subcutaneous fat. Women, she explains, have more cellulite than men because their fibrous bands in the superficial fat tend to be fewer and straighter than men’s, which are more abundant and tend to be in a crisscross pattern. With the results of the microneedle-based radiofrequency approach, women’s fibrous bands will mimic more those of men.
“We’re trying to stimulate more collagen, instead of breaking up the bands,” she says.
Related: Cellfina insights: Q&A
The dermatologist has used the Profound system for treatment of wrinkles and skin tightening on patient faces. In that case, the Profound system uses microneedles at a 25-degree angle, which penetrates between 2 mm and 3 mm.
“The effect on the face is more collagen, more elastic fibers and hyaluronic acid,” she says. “The same treatment device is used for cellulite, but the applicator device has the microneedles at a 75-degree angle.”
The more vertically oriented needles allow providers to deliver radiofrequency to the subcutaneous fat, causing low levels of thermal injury to the tissue, which leads to collagen production.
“That’s a big difference: The 25-degree angle versus the 75-degree angle,” she says.
Patients who are not candidates for Profound treatment are those with pacemakers.
“We cannot do radiofrequency treatments, in general, on those patients,” Dr. Bowes says.
Being on anticoagulant therapy, however, is not a contraindication.
“Patients might have a little bit of bruising, but you’re not really transecting planes,” she says.
Disclosure: Dr. Bowes is a researcher for Syneron Candela.
Three-dimensional (3D) analysis and planning is a powerful tool in plastic surgery — one that can improve diagnoses, patient communication and education and intraoperative transfer for optimal results, according to a recently published paper on 3D applications for plastic surgery planning.
Senior author Derek M. Steinbacher, M.D., D.M.D., director of craniofacial surgery at Yale Plastic and Reconstructive Surgery, New Haven, Conn., tells Cosmetic Surgery Times that he uses 3D analysis and planning with as many of his patients as possible.
“Certainly, with [almost] every cosmetic patient,” he says.
Dr. Steinbacher, who uses the Vectra 3D camera (Canfield) and a 3D CT technology (Materialise), says 3D analysis can increase efficiency and accuracy for many cosmetic surgical procedures. The application is especially useful for procedures involving bone reduction or repositioning, and when placing implants for cosmetic purposes (breast, mandibular or facial). The utility is less, at least for now, for soft-tissue only procedures like face and neck lift, skin resurfacing and abdominoplasty, he says.
“It’s not as suitable to use for abdominoplasty because you’re not repositioning hard-tissue or placing an implant, so there are no guides generated for intraoperative repositioning and no predictable response of placing an implant. However, 3D imaging can serve as an effective communication tool in patients presenting for a tummy-tuck or facelift, where image simulation can depict the goals for the desired post-operative abdominal or facial contour. However, it is not as predictive as when used for rhinoplasty, breast augmentation or aesthetic orthognathic jaw surgery,” Dr. Steinbacher says.
Patient shown before and after jaw surgery and rhinoplasty with 3D image from two vantage points. Photos courtesy Derek M. Steinbacher, M.D., D.M.D.
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Application in the Cosmetic Practice
NEXT: Application in the Cosmetic Practice
Application in the Cosmetic Practice
Joe Niamtu, III, D.M.D., an oral and maxillofacial surgeon with a practice limited to cosmetic facial surgery in Richmond, Va., says 3D planning has limited application in his current practice, which for 15 years has been focused on surgery of the aging face.
“There are not a lot of soft tissue applications for this type of technology,” Dr. Niamtu says.
Where he does use a similar technology is in genioplasty surgery and to make custom facial implants.
“I have a cone beam CT scanner in my office specifically for these applications,” Dr. Niamtu says.
Dr. Niamtu, who before limiting his practice to cosmetic surgery practiced as an oral and maxillofacial surgeon, performed a lot of trauma, reconstruction and orthognathic surgery. He says he agrees with 3D planning’s value.
“I have ample experience in the shortcomings of doing surgery prior to this technology,” Dr. Niamtu says. “Although this type of technology and surgical guidance is in its infancy, great strides are being made with diagnosis, treatment, surgical guidance, prosthetics, custom implants and 3D models. Again, most of these current applications are for hard tissue applications, but this will permeate all areas of surgery in the future.”
Still, the surgeon’s skill and expertise are paramount to repeatable outcomes, especially when it comes to orthognathic or reconstructive procedures.
“Much of the actual treatment is in reality an educated guess or approximation based on experience. This is something that is difficult to teach, learn, duplicate or quantify. It is a learned skill set that comes from hundreds or thousands of procedures,” Dr. Niamtu says.
Related: 3D Planning Start to Finish
Three-dimensional planning can eliminate some of the guesswork for plastic surgeons and others by simplifying and replicating some of the steps in these surgeries that have been more conceptual than physical, according to Dr. Niamtu.
“It was not that we did not apply metrics to previous surgical technique, it is more that we were using two-dimensional x-rays with plaster models and direct impression techniques. All of these are fraught with inaccuracies when it comes to moving the facial skeleton in terms of millimeters. We relied primarily on splints for repositioning and stabilizing, and these were fabricated with manual technologies that are not as accurate as computer guidance and fabrication,” he says.
NEXT: 3D Pointers and Pitfalls
3D Pointers and Pitfalls
In a recent Cosmetic Surgery Times survey question, 47% of readers responded that they use 3D imaging system to simulate treatment results for patients. The rest indicated they do not use the technology.
Dr. Steinbacher says today’s cosmetic surgeons use 3D planning at various levels.
“Certainly…, there are more 3-dimensional assessment and analysis tools available, so practitioners use these technologies to look at the existing preoperative state and as a patient communication tool, to better define and outline what their aesthetic goals are,” he says. “The next level is trying to incorporate simulation. That’s also an effective tool, where you can create something that you think is feasible and achievable, surgically, and then ensure that the patient understands and is in agreement with the surgical goals and desired realistic result.”
Breast augmentation patient shown before (left) vs. simulation (middle) vs. actual after (right). Photos courtesy Derek M. Steinbacher, M.D., D.M.D.
Altering the images can become tricky for less experienced cosmetic surgeons who change pictures digitally, but not in ways that are biologically possible, according to Dr. Steinbacher.
“The less experienced surgeon must take care to not give an unrealistic expectation of what can be achieved as a result during the simulation. One must know the limits of what is possible biologically and what may happen with time, with tissue settling, scar contracture and so forth. It is advisable to create a more conservative simulation, to avoid giving a false expectation or false representation of what can feasibly be achieved.” he says. “The naysayers or those skeptical of using [3D technology] voice this as a concern. They don’t want to promise a patient that they can achieve something that may not be possible or give the patient false hope or expectations.”
While Dr. Steinbacher doesn’t use a special consent form for the 3D planning in plastic or reconstructive surgery, he says it’s clearly noted on the images that these are simulated results only, they are not representative of actual results and in no way guarantee actual results.
3D planning is not yet the gold standard approach in cosmetic or reconstructive surgery, according to Dr. Niamtu.
“In many cases, the expense outweighs the benefit, these surgeries can take a lot longer, in some instances, and inaccuracies can still occur with this technology, so, it is not fool proof,” Dr. Niamtu says. “There is no doubt, [however,] that this type of technology will be a game changer and paradigm shift.”
Disclosures: None
Reference:
Pfaff MJ, Steinbacher DM. Plastic Surgery Applications Using Three-Dimensional Planning and Computer-Assisted Design and Manufacturing. Plast Reconstr Surg. 2016 Mar;137(3):603e-616e.
To achieve the best possible results, the study authors of a recently published paper on 3D applications for plastic surgery planning, suggest that aesthetic surgeons consider five core components for making the most of 3D technology: analysis, planning, virtual surgery, 3D printing and comparison of planned to actual results.
Senior author Derek M. Steinbacher, M.D., D.M.D., director of craniofacial surgery at Yale Plastic and Reconstructive Surgery, New Haven, Conn., says “Some of those five core components that I mention in the article have to do with bone, boney repositioning and reconstructive surgery, but they are also applicable to 3D simulation, implant placement, and soft tissue manipulation.”
1. Analysis
This basically informs the diagnosis, and complete 3D understanding of the anatomy. The analysis offers the opportunity to look at the nose, face, breast or other area from every vantage point.
“You can look from a frontal view, lateral view, bird’s-eye view, worm’s-eye view; you can rotate things; you can zoom in; you can measure distances and volumes; you can look at skin quality,” he says. “All of those things can be really well described and discussed.”
Analyses are performed for planning and thinking about what needs correction and what needs to be accomplished. They are also for patients, as a communication tool, to show patients not only things they may recognize and have presented for, but also to point out relationships or cosmetic issues the patient may not see.
2. Planning
Once you understand the patient’s preoperative situation and existing anatomy, you can plan what needs to be done and what can be achieved. The planning component involves asking such questions as:
“In some of these modules, there are different types, shapes and sizes of breast implants, so we can actually place those digitally, or virtually, and get a sense for how the soft tissue is going to respond and what the breast size will look like with a specific implant. The patients then can compare different options and sizes to come to an informed decision about the desired result…,” Dr. Steinbacher says. “For a nose, we’re doing simulation to look at removing tissue or changing tip projection or changing the appearance of the nose. And we’re actually, in real-time, doing some modification and manipulation to the 3D nasal image to inform the patient of options, and ensure that the patient and surgeon are on the same page, with the same goals.”
NEXT: 3. Virtual surgery
3. Virtual surgery
This means performing the surgical steps in the virtual space. As such, this component has more to do with procedures which involve bone repositioning, according to Dr. Steinbacher. For instance, for aesthetic jaw surgery, the facial bones can be repositioned in virtual space; the relationships with subjacent anatomical structures noted; and the soft-tissue response to these movements considered and modified.
“When we’re repositioning the bone for jaw and orthognathic surgery, we actually move or reposition the bone segments and then go through the operative maneuvers, digitally. Interferences and anatomical nuances can be appreciated, and operative moves optimized. Some virtual manipulation can occur for breast augmentation, as well. We can place the implant, and then you can move the implant footprint along the chest wall. The implant-to-breast tissue interface and response can be virtually simulated, helping decide the type of implant and where on the chest wall that implant should go,” he says.
4. 3D printing
Three-dimensional printing typically relates to custom implants, or splints and guides used to reposition bone or skeletal structures, Dr. Steinbacher says.
“We can use these guides or splints to help us reposition facial bones, so there’s some kind of reference point or plane that we can tack onto,” Dr. Steinbacher says.
Prints can be performed that represent the patient’s actual or desired anatomy as well, to be used as intraoperative reference. Examples, according to Dr. Steinbacher, include printing a 3D image of a nose or breasts, both the preoperative and planned, and bringing those to the operating room to serve as a reference during manipulations.
“We can also print the patient’s actual native structure that we can use to fashion implant size and fit, intraoperatively. For instance, for mandibular augmentation, we use the patient’s actual mandible print, and chose, size and carve the implants we want to use,” he says. “We can 3-dimensionally print custom implants that fit like a glove as onlays on the patient’s facial skeleton. It is also theoretically possible to make custom breast implants, though that’s typically not done, as the multitude of stock implants available suit most needs.”
In essence, he says, the 3D printing component may involve one or more of these three things:
NEXT: 5. Comparison of planned to actual results
5. Comparison of planned to actual results
By taking a postoperative 3D dataset (either photo or CT scan), cosmetic surgeons can look at and compare the actual result to simulations. The images can be overlaid or assessed side by side, to determine how closely they met their goals. In addition to using this information to improve or refine techniques, surgeons can use the comparisons, for example, to demonstrate to patients how their nasal shape or breast size has changed.
Galderma has announced its second collaboration with a noncompeting aesthetic brand in less than six months. In the latest move to garner consumer and surgeon loyalty, Galderma, which is focused on skin aesthetics, announced a nationwide collaboration with Mentor Worldwide, a breast aesthetics and reconstruction company.
Known for such popular brands as Restylane, Dysport (abobotulinumtoxinA) and Sculptra Aesthetic, Galderma announced last December that it would collaborate with CoolSculpting’s parent company ZELTIQ.
Related: Galderma, ZELTIQ collabroate on aesthetics in U.S.
While Galderma announced the news of the collaboration in April, it had not announced how exactly physicians and patients would benefit.
This newest collaboration will include Galderma's brands Restylane family of fillers, Dysport (abobotulinumtoxinA) 300 units for Injection and Sculptra Aesthetic, as well as Mentor’s MemoryShape and MemoryGel breast implants, for the U.S. aesthetics (non-reimbursed) market, according to a Galderma press release. Research suggests there is a significant overlap in patients who opt for fillers, as well as breast augmentation surgery. Data show up to 33% of women who had injectable treatments also had breast augmentation, according to global luxury goods industry advisor Bain and Company 2014 data.
The collaboration’s aim is to identify ways to leverage market growth strategies. The collaboration will tie in with Galderma’s ASPIRE rewards loyalty program, which encourages consumers to sign up for free to get rewards, bonuses and discounts on Galderma brands.
NEXT: Plastic Surgeons Weigh In
Plastic Surgeons Weigh In
Dr. DoftNew York plastic surgeon Melissa A. Doft, M.D., says while she does not know the program’s specifics, Allergan ran a similar special a few years ago, where for each set of implants, patients were given complimentary Botox.
“My patients were always excited to receive the free Botox. It was a little bonus after surgery. Many had never tried it before and always wanted to. This was a chance for them to try it with no financial risk,” Dr. Doft says.
Loyalty programs make sense in the cosmetic surgery space, according to Dr. Doft, clinical assistant professor of surgery, Weill Cornell Medical College, New York, N.Y.
“In this competitive marketplace and with implant and injectable prices continuing to increase, I think it is always worth looking into these partnerships,” she says. “But would it lead me to change brands? No. My patients are coming to my practice to receive the best medical care that I can offer. If I think that one product is better than another product, I never hesitate to use the best product, even if it is a more expensive product.”
Dr. Doft, who says she thinks Mentor and Galderma make excellent products, says such a program may affect plastic surgeons by helping them to convert a one-time surgical patient into a returning injectable patient.
“There are many patients who still do not realize that plastic surgeons also inject neurotoxins and fillers,” Dr. Doft says. “This collaboration is an easy way to explain to a patient the broader spectrum of your practice.”
Dr. PlantPlastic and reconstructive surgeon Mathew A. Plant, M.D., who practices in Toronto, Ontario, Canada, says there are several benefits of industry loyalty programs, for the companies, physicians and patients.
“While they have not announced the specifics yet, I would imagine there will be a program similar to the competitors’ that allows patients who have had Mentor implants to receive some sort of discounted or complimentary treatment with a Galderma product (most likely Dysport), which would then get people into the physician’s roster of injectable patients,” Dr. Plant says. “There would also, hopefully, be some special pricing for physicians who order product from both, which would help the bottom line and perhaps allow physicians to pass savings onto the patient, driving up overall demand for services.”
The Galderma-Mentor collaboration, he says, will likely create healthy competition in the marketplace.
“Up to this point, there was only one company [Allergan] offering both injectables and implants, so they didn’t need to offer more than a few percent off as incentive to use both of their product lines. Now that there is another implant-injectable partnership competing with them it is likely to cause all of the companies in the market to provide more aggressive discounts and better incentives to patients and physicians to maintain or gain market share,” Dr. Plant says. “Another benefit that we have already started to see (up in Toronto at least) are new educational events sponsored by this new partnership, and any opportunity to learn is a benefit to any physician and their patients.”
Dr. Plant says he thinks such programs can cause physicians to switch brands.
“Absolutely, in cases where there are very similar offerings from both companies pricing can at least drive a physician to look at what Galderma-Mentor have to offer. As long as the new product is as-good-as or better than what the surgeon is currently using they may very well switch brands,” he says.
Disclosures:
Dr. Doft reports no relevant disclosures.
Dr. Plant sat on the Toronto advisory board for Galderma’s release of Emervel Lips.
Rump, booty, bottom, tushie. There are a lot of terms for rear ends — almost as many as there are approaches used by plastic surgeons to augment them.
Most seem to use fat to expand volume and mold new contours, but some still turn to silicone implants and injectable fillers, according to a poll of audience members at April’s annual meeting of the American Society for Aesthetic Plastic Surgery and Aesthetic Surgery Education and Research Foundation in Las Vegas.
Still more poll results revealed varying opinions:
But among the speakers, there was general agreement on one thing: Fat is where it’s at — but implants haven’t vanished into the history books just yet.
When it comes to fat grafting and implants, says Brazil plastic surgeon Raul Gonzalez, M.D., “the surgeon who wants to work with buttocks has to master them both.”
Dan Del Vecchio, M.D., a plastic surgeon based in Boston, prefers to rely on fat. “I can get much better results with fat than implants. There’s no question,” he says. In contrast, he says butt implants are often problematic, especially when there’s inadequate soft tissue: “I tell patients that one-third will need to have them removed due to pain, infection, malposition.”
However, he says, implants can be appropriate “when you want to augment an existing good butt.”
For his part, Dr. Gonzalez recommends that his colleagues rely on fat grafting even when they turn to implants. When he uses implants, he says, he also performs fat grafting in about 70% to 75% of cases.
NEXT: Why Use Implants at All?
Why Use Implants at All?
Dr. Gonzalez says they’re appropriate in thin patients, patients with high expectations and those who had disappointing results with previous fat-grafting procedures.
M. Mark Mofid, M.D., FACS, associate clinical professor (voluntary) of plastic surgery at the University of California at San Diego, has similar views. “Fat grafting is always preferable to implants, assuming that donor fat graft material is available and the amount of volume restoration reasonably expected by the patient is attainable,” he says.
However, fat will not meet every need in this age of body standards set by the Kardashians. That’s where implants come in, he says, but large ones — those over 350 cc — “place patients at logarythmically higher risks of complications.” And most surgeons will agree: No badonkadonk is worth a trip to the hospital.
A multisite study on use of the LightSheer Infinity (Lumenis) dual (805 nm and 1060 nm) wavelength laser shows the hair reduction system provides long-term hair reduction, is tolerable without topical anesthetic; works on all skin types; and requires shorter treatment sessions because of its large spot size, according to research presented in April at ASLMS 2016, the 36th Annual Conference of the American Society for Laser Medicine & Surgery, Boston, Mass.
E. Victor Ross, M.D., who practices dermatology and conducts research at the Scripps Clinic in San Diego, Calif., says key points for physicians who offer hair removal are the laser’s lager spot size (~75% at 6M FU) and vacuum feature.
“These features allow for less painful hair removal and faster hair removal,” Dr. Ross tells Cosmetic Surgery Times. “[The] larger spot [size] allows for use of lower fluences, but still has good effects due to photon recycling, increased depth of penetration and the suction.”
In essence, the 805 nm is best for lighter skin and the 1060 nm is optimal for darker skin types, he says. He reports that long-wavelength lasers increase the ratio of hair bulb to epidermal heating, successfully addressing the challenges of selective photothermolysis posed by dark-skinned populations.
In this study of 26 patients, the primary objective was to assess hair reduction three months following a seven-series 1060 nm laser treatment regimen utilizing the device’s vacuum-assisted pain reduction mechanism.
The LightSheer, according to the company’s website, integrates the Chilltip contact cooling with the smaller conventional spot (ET) (9 or 12 mm), and the other handpiece (high speed) (22 x 35 mm spot), uses HIT-vacuum assisted high speed technology for patient comfort management and treatment speed.
NEXT: How It Works
How It Works
In this study only the HS 22x35 mm handpiece was used, and Dr. Ross describes the pain reduction mechanism as beginning with the vacuum gently pulling the skin into the handpiece. The hair is pulled to the energy source as the skin is stretched thin. This reduces the density of melanocytes in the skin and lessens the energy absorbed by the epidermis. The vacuum pressure temporarily compresses the tissue and surrounding vessels, blood is temporarily displaced and less energy is absorbed by the oxyhemoglobin. As a result, less energy is lost to competing chromophores and more photons reach the target melanin in hair. The heat builds and damages the hair follicles and their ability to regrow.
Average times for treatment areas ranged from 1.36 minutes on the bikini area to 11.20 minutes on the thigh. The average time of treatment, overall, was 5.3 minutes. Pain scores using the Visual Analog Scale (VAS) averaged about 4, and there were “marked effects” on hair removal in all skin types, according to Dr. Ross. Patient satisfaction was moderate to very good, for the most part. Patients were least satisfied with the treatment’s effects on their arms.
A new study looking at nine years of follow-up data on the use of Sientra’s HSC and HSC+ silicone gel breast implants helps to confirm implant safety profile and continued patient satisfaction.1
These round and shaped implants were FDA approved in March 2012. Researchers conducted the Core Study, which is an ongoing 10-year study, with 1,788 patients (3,506 Sientra implants) who had breast surgery for primary augmentation, revision-augmentation, primary reconstruction and revision-reconstruction. Researchers evaluated postoperative complications, including adverse effects from the implants. They also studied patient satisfaction scores on even years.
They found that the overall capsular contracture risk through nine years was 12.6%, with the smooth devices having higher capsular contracture rates than textured implants. There were 610 reoperations in 477 patients, with 51.6 % of those being for cosmetic reasons. According to the abstract, 90% of the primary augmentation patients reported they were satisfied with the implants’ natural and soft feel.
Commenting on the study Cosmetic Surgery Times advisor plastic surgeon Jason N. Pozner, M.D., of Boca Raton, Fla., says this newest study helps to confirm silicone gel implants’ safety. Sientra implants, he says, are as safe as the silicone gel implants from Mentor and Allergan.
“I think they’re all very similar,” Dr. Pozner says.
Related: Rethinking breast augmentation
A study published in 2015 on contoured cohesive gel breast implants assessed a single surgeon's outcomes in breast augmentation, secondary augmentation and breast reconstruction using implants from Allergan, Mentor and Sientra over a 10-year period. The author’s findings, which included 695 patients, suggest an overall low complication rate and high patient and surgeon satisfaction. While the total complication rate was lowest for primary augmentation of the Mentor group, versus the Allergan and Sientra groups, there were no notable differences in complication rates when the implants were used for secondary augmentation and reconstruction. There also were no statistically significant differences among the implant groups regarding reoperation, explantation or capsular contracture rates.2
While Dr. Pozner says he used to use Sientra’s implants, he now uses Allergan’s breast implants because Allergan allows physicians to tie in and save on their purchasing of the implants with Botox and fillers.
The only finding in this study that seems different than other silicone gel breast implant studies, according to Dr. Pozner, is the others did not show as significant a difference between smooth and textured implants in capsular contracture rates.
Disclosures:
Dr. Pozner reports no relevant disclosures.
Among the authors on the study is the vice president of clinical operations, Sientra, based in Santa Barbara, Calif.
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