Physicians now have evidence-based recommendations for when skin cancer leaves a patient in need of reconstructive surgery. UConn Health’s chief of plastic surgery, Dr. Andrew Chen, led a national brain trust to come up with them.

Some of the brightest minds in dermatology and surgery are in agreement on the first clinical practice guidelines for reconstructive procedures following skin cancer resection.

Dr. Andrew Chen, UConn Health’s chief of plastic surgery, is the lead author of the guidelines, published concurrently in Plastic and Reconstructive Surgery, a journal of the American Society of Plastic Surgeons, Dermatologic Surgery, and the Journal of the American Academy of Dermatology.

Chen was chosen to lead a group of stakeholders including dermatologists, plastic and reconstructive surgeons, dermatologic and Mohs surgeons, head and neck, and ear, nose and throat surgeons, and others, including patient representatives, to analyze the evidence and make recommendations to guide physicians as they care for patients who need reconstructive surgery after having cancerous skin removed.

“We studied the evidence to make determinations on antibiotics, what are the recommendations with respect to pain control, the use of anticoagulants, as well as the timing of reconstruction,” Chen says. “What are the best practices? What kind of things should we be doing or should we not be doing?”

 

Read more here.

 

Source:

UConn Today

Thousands of women who were victims of the PIP breast implant scandal should receive compensation, a French appeal court has decided.

Women involved in the case say they are elated and exhausted after 10 years of fighting for justice.

The court also upheld an earlier judgement finding German safety body TUV Rheinland negligent.

TUV said it had acted "diligently", and that women must prove they had a PIP implant to be entitled to compensation.

It awarded safety certificates for faulty breast implants made by French company Poly Implant Prothèse (PIP).

The court decision could have far-reaching implications for thousands of other victims around the world.

• PIP breast implant scandal: Victims visited by bailiffs
• PIP breast implants: 'serious lessons must be learned'

Jan Spivey, one of 540 British women involved in the case, was given PIP implants after she had a mastectomy due to breast cancer.

After hearing the decision, she said she was "elated and exhausted".

"It's been a very long journey," she said.

"We've been in and out of court, and that's been really difficult for women. We've got health issues and we've got lots of other responsibilities too - PIP has had an impact on the whole of our lives.

"It's been an inescapable issue."

Jan developed aching joints, pain and fatigue after having the implants, and once they were removed it was clear they had been leaking silicone into her body.

 

Read more here.

 

Source:

BBC News

Intralesional vitamin D injections are effective and safe for treating patients with keloid scars, according to the results of a study published in the Journal of Cosmetic Dermatology.

Researchers enrolled 40 Egyptian patients with keloid scars from March 2019 to October 2019. The participants received weekly injections of intralesional vitamin D ampoules (cholecalciferol), 0.2 mL (200,000 IU) per 1-cm lesion, for a maximum of 3 to 4 sessions. The Vancouver Scar Scale (VSS) and high-resolution B mode ultrasound were used to assess the keloid scars before and after treatment.

The patients (mean age, 30.8±1; 52.5% women) had keloid scars ranging from 1 to 5 cm. Among the cohort, 38 patients (95%) had a negative family history of keloids, and 5 patients (12.5%) had previous treatment for their keloid scars. The patients were followed up for 2 months after their last injection.

The researchers found a statistically highly significant reduction in VSS after treatment. The mean VSS value before treatment was 9.6±1.3, compared with 4.35±1.7 after treatment (P ≤ .001).

A statistically highly significant improvement was observed in ultrasonic keloid scar thickness after treatment with intralesional vitamin D injection. The mean value of ultrasonic measurements before treatment was 1.4±0.5, compared with 0.8±0.4 after treatment (P ≤.001). A positive correlation was observed between VSS and ultrasonic response (P ≤.05).

Most patients were satisfied according to the Visual Analog Scale, with scores ranging from 6 to 10 in 72.5% of cases (29 patients), and from 0 to 5 in 27.5% of patients (11 patients).

A total of 21 patients (52.5%) had side effects, including pain, redness, swelling, and tenderness for 2 days after the injections. No difference was observed in clinical response between those with side effects and those without, and no statistically significant association was observed between clinical response and differences in age, sex, family history, previous treatment, and site and cause of keloid scars.

 

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Source:

Dermatology Advisor

Counterfeit dermal fillers have popped up in the market not long after the genuine ones were generalised. From the unlawful beauticians using illegitimate fillers, to the consumers buying fakes online and injecting themselves, the harm that can be inflicted to consumers are tremendous.

In both 2015 and 2017, the FDA issued a warning about fake Botox and injectable dermal fillers on the market. The counterfeits are entirely unregulated and potentially fatal. Sadly, this trend keeps surging: doctors in Scotland recently warned against fake botox being sold on social media.

In this article, we will take a look at the scope of the problem and what beauty professionals can do about it.

Counterfeit Fillers, a Fatal Problem

While all counterfeit cosmetics have the potential to be harmful, some can actually be fatal. Fake botox and fillers have caused hospitalisation, paralysis and even death for hundreds in recent years.

This has led the FDA to issue official warnings indicating that they had not safety-approved liquid silicone or silicone gel for injection, and urging people to only accept treatment from trained professionals and carefully scrutinise institutions based on certifications. However, the problem doesn’t appear to have disappeared. Last year, the US Customs seized $35,000 worth of counterfeit Botox in Cincinnati.

Although fake botox seems like a counterfeit product people would never buy, fakes are becoming harder and harder to spot. Consumers are almost always duped into purchasing counterfeit cosmetic treatments, and many speak out following bad experiences and unprecedented side effects.

These types of cases are detrimental to both consumers and filler brands like Botox, but more damaging are cases that go unreported and undiscovered, serving to further support the harmful underground industry.

Cosmetics Industry is Booming, So Do Counterfeits

Counterfeit cosmetics copy genuine branded products, using the same packaging and trademarks in order to dupe consumers into purchases, usually with an incentive of a discounted price. However, because they are created unlawfully they are entirely unregulated; counterfeit cosmetics can and often do contain many harmful ingredients including lead, mercury and even cyanide.

 

Read more here.

 

Source:

Cosmetic Business

 

I remember being at a party with my sister and she was at a crossroads in her career. She was talking to one of my colleagues from work, who is a phenomenal coach. She was explaining her dilemma to him and his response was really interesting. He could have given her ideas, thoughts, suggestions, even a solution, but he didn’t. He just asked questions. He questioned her motivations, processes, ideas, goals, and over a very casual drink, she achieved clarity as to the solution that would work for her. She didn’t realize she had been coached, but she went and implemented her plan, as a result of this informal conversation.

One of six management styles, coaching lies at the opposite end of the spectrum to ‘command and control’ management styles. It is a set of tools and techniques to help someone achieve their goals, either personal or in business. It can help an individual, grow, develop and take ownership of the decisions that they are making.

If an individual comes to you for guidance and asks, “How do I do this?” It is very easy for you to simply tell them. Since you are giving them the answer, they are not taking ownership. This is where there is an opportunity to coach them. Because the reality is, they may have ideas, they may know what to do, they may just be lacking the confidence to do it. Coaching allows you to support them in that moment by asking questions.

Coaching Questions

Here are some questions to start off with. Try them out and see how the coachee responds.

• What are you trying to achieve?
• What is the outcome you are looking for?
• What have you tried so far?
• What was the result of that?
• How do you think you can achieve that? • What ideas have you had already?
• What would happen if you tried that?
• What is stopping you from trying it?
• What are you going to do next?
• When will you do that?

As you read these questions, you may realize that some of them are similar but are being asked in a different way. One of the techniques used in coaching is to frame questions differently to trigger alternative thought processes.

Coaching Benefits

The benefit of this style of coaching is the individual is empowered to own the solution and the implementation, they feel pride and excitement. They have been given the trust to put their ideas into place. As opposed to you just telling them what they need to do.

This leads to happier, more fulfilled staff members and a team that is more productive and takes ownership of what they are doing. The ripple effect it has on your patients is the environment shift – it is a far more dynamic, happier practice and therefore creates an enhanced patient experience, leading to higher conversion rates, better retention and more referrals.

 

About the Author

Chris Stock

Chris is a certified executive coach, a Neuro-linguistic programming coach and trainer who helps aesthetic practices convert leads into patients by delivering worldclass training and coaching. Prior to working with medical practices, Chris, a global leader in sales development, had an impressive portfolio of clients including Google, Adobe and GE Medical. He has translated world-class sales training to be specific to aesthetic practices. In doing so, he delivers transformational results.

Eyes have always been a primary facial feature, referred to as “the window to the soul”, but now more than ever, they are today’s aesthetic focal point. With masks covering the lower face, the eyes are left to do all the talking. Video conferencing platforms showcase the face, especially the eyes in motion.

Jeffrey Joseph, MD Ophthalmic Plastic and Reconstructive Surgeon Newport Beach, CA

Christopher Surek, DO Plastic Surgeon Overland Park, KS

Faisal Darwiche, NP CEO Panacea Aesthetics & Wellness Center Newport Beach, CA

Nuttapol Larpcharoenkij, MD Aesthetic Dermatologist Bangkok, Thailand

But eye rejuvenation is not easy. The eye is an unforgiving structure and feature. Using the wrong treatment for an aesthetic problem or failing to comprehensively treat aesthetic eye concerns can lead to unnatural and unsatisfactory results.

“The character of our facial identity comes first through our eyes. Our emotion comes first through our eyes. The eyes are the first thing that we notice when we look in the mirror and people notice when they look at us,” said Jeffrey Joseph, MD, an ophthalmic plastic and reconstructive surgeon in Newport Beach, Calif.

Dr. Joseph has been in practice for eight years and during that time he has seen big changes in the options available to aesthetic providers and patients. The options for eye rejuvenation went from basic surgical treatments and some injections to much more, including energy-based devices that address skin tone and texture.

Proven Nonsurgical Remedies

Dr. Joseph’s go-to nonsurgical option for eye area rejuvenation has been and still is neurotoxin.

“It is definitely powerful around the eyes, in the crow’s feet and for the glabellar lines,” Dr. Joseph emphasized. “All that muscle contraction really brings a harshness to the eyes that develops over time. Neurotoxin injections are still the most popular, most reliable nonsurgical treatment I do.”

Dr. Joseph is doing more with hyaluronic acid fillers around the eyes to build volume and create a smoother contour. And treating the skin texture has become more popular in his practice. He uses modalities from peels to energy- based devices, including radiofrequency (RF), to improve skin and tissue quality around the eyes.

Each nonsurgical modality plays a role in eye rejuvenation, and often a combina- tion of treatments is best. For example, according to Dr. Joseph, RF can help reduce periocular edema, as well as improve skin tone. Laser resurfacing and chemical peels improve superficial skin texture and build collagen.

Oftentimes, he uses neurotoxin, a filler and RF treatment in combination, as part of a nonsurgical eye rejuvenation plan.

According to Christopher Surek, DO, a plastic surgeon in Overland Park, Kan. being familiar with the anatomy is a must for treating patients’ aesthetic eye con- cerns, whether the provider addresses concerns surgically or nonsurgically.

Nonsurgical correction of the tear trough and cheek, for example, is primarily focused on volume, which means adding volume in the correct places to soften the harsh shadows related to fat compartment and ligamentous anatomy changes of the aging face.

One must separate lower eyelid anatomy from cheek anatomy. The division line is the lid-cheek junction, which is formed by a ligament that runs from the bone of the orbit to the skin.
“Really that is the division line between what is going on in the lower eyelid, versus what is happening in the cheek leading to mid face deflation and surface changes secondary to facial aging,” Dr. Surek explained.

Treatment can be done nonsurgically with filler products or in some cases autologous fat. Providers need to know the ligamentous anatomy as well as three-dimensional (3D) layering anatomy of the face before tackling facial injectables of any kind, Dr. Surek emphasized.

“In my opinion, the lower eyelid nasojugal groove is what separates surgical from nonsurgical candidates,” Dr. Surek noted. “[The provider has to decide] whether there is a lack of volume that can be replenished with a nonsurgical option or if there is excess volume of lower eyelid fat or tissue texture changes of the lower eyelid skin that require a surgical procedure potentially combined with resurfacing.”

Faisal Darwiche, NP, CEO of Panacea Aesthetics & Wellness Center in Newport Beach, Calif., believes the best nonsurgical way to rejuvenate eyes is with threads.
Many patients complain that their eyelids are hooded and foreheads are drooping. While providers using neurotoxin to treat those complaints can accurately paralyze the muscles, they cannot accurately lift areas to create a look for the eyes, Mr. Darwiche expressed.

“The beauty of threads for eyelifts and eyebrow lifts is that we can really customize treatment based on each patient’s face and look, and what they want to achieve,” he said. “Threads provide that control, but the provider must use the right approach. And that approach needs to be individualized for the patient.

“We have to individualize the vector, the angle of how we are lifting the brow. It can be anywhere from inside the middle of the brow, all the way to the outside, all the way to the extreme fox eyes, which is a trend that I think will fade away,” Mr. Darwiche continued.

There are two proven approaches for using threads to rejuvenate the eyes. Either providers enter through the scalp on the top of the head or from the eyebrow and move up. “Both yield really good results. Inserting the thread from the scalp and moving down toward the eyelid gives you a more subtle lift,” Mr. Darwiche began, “inserting the thread from under the eyebrow and moving up toward the scalp will give you a stronger lift.”

Mr. Darwiche uses a thread that has anchoring and lifting portions. The anchoring portion has more area than the lifting, which allows him to reverse insert it from the brow moving up. “Instead of cutting some of the anchoring portion, I can use the full 5 cm as lifting,” he shared. “The challenge with that comes with the size of the forehead. If the forehead is too small or skinny it is better not to insert from the eyebrow, going up toward the hairline.”

Mr. Darwiche says he never does a thread lift on the brows through the forehead unless the patient is first treated with neurotoxin to paralyze the forehead, which prevents forehead mus- cles from moving against the threads. Patients get more longevity from treat- ment when the forehead muscles do not move much. “I inject a heavy dose of neurotoxin, then a week or two later, when it kicks in, I insert the threads.”

He also recommends that patients main- tain neurotoxin treatment for as long as they can while the threads remain under their skin, to avoid breaking the threads. “These threads are very thin. Because the area is bony, you cannot use very thick threads. That makes them more vul- nerable to breaking and our muscles are stronger than we think.”

Natural, more youthful, more open eyes from threads last for six to eight months. And most patients are good candidates for the treatment, according to Mr. Darwiche.

“I think the people who see the best outcomes are people whose saggy skin is more to the sides – to the lateral outside portion where the crow’s feet are. There, I can do a lot more in terms of opening the entire eye, not just lifting the brow. We can pull the skin on the sides of the eye, moving back and up toward the hairline, then we would finish it up by lifting the brows from the top. Those patients see a much bigger wow! factor,” he stated.

Aesthetic providers are also using devices to treat the eyes. Nuttapol Larpcharoenkij, MD, an aesthetic dermatologist who practices in Bangkok, Thailand, uses Medixysteme’s 3D Trifocal SygmaLift, to treat the wrinkled, puffy and dyschromic under-eye skin.

The SygmaLift combines stabilized high-intensity focused ultrasound (HIFU) with a diode laser. Providers use the 3D Trifocal probe to treat skin around the eyes in direct contact and circular patterns at a proper energy level for about 20 minutes per eye, followed by the low-level laser. The laser provides oxygen and drains out aged cells, according to Dr. Larpcharoenkij.

Optimal interval for treatments should be one month, he advised. “With emis- sion of ultrasonic waves in a 3D Helix pattern, the specific eye handpiece of 3D Trifocal induces neocollagenesis at the right tissue depth contributing to smoother, tighter, less saggy and brighter under-eye skin. Many clinical experiences show significant improve- ment [one week] after the treatment,” Dr. Larpcharoenkij reported.

Recognizing the true pathology of each patient’s aging eyes is key for successful treatment. This allows providers to choose the optimal energy and correct depth of treatment. “I also encourage use of the device’s diode laser after that in order to facilitate the more brilliant outcome without downtime,” Dr. Larpcharoenkij added.

Dr. Larpcharoenkij often combines therapies for additional aesthetic improve- ment. To customize treatment around the eyes, for example, he might also use laser resurfacing and injectable hyal- uronic acid fillers.

“For those who have severe wrinkles and static lines, I do fractional laser and RF to achieve the best patient satisfaction,” he stated. “For sunken eyes, I use the hyaluronic acid filler to replace the bone or fat loss in conjunction with the 3D Trifocal treatment.”

Surgery Remains a Mainstay

Despite increasing demand for non- surgical options, upper and lower lid blepharoplasty remain the most popular treatments for addressing aesthetic eye concerns at Dr. Joseph’s practice. He said focused temporal brow lifting also helps reframe and balance the relation- ship between the brow and upper lid.
The reality is there are some things that only surgery can accomplish, such as long-term elevation of a structure like the brow or removal of excess skin, according to Dr. Joseph.

“I like to break up periocular treatments into above the eye and below the eye. Above the eye is the brow and upper lid. The biggest pearl I have for that area is do not forget the brow. There are a lot of surgeons who see the heaviness of the upper lid skin and do an upper lid blepharoplasty, but the patient is disap- pointed because they still have bunching at the lateral brow area. Elevating the lateral brow, whether it is surgically or even with a little bit of neurotoxin, can be really powerful to enhance the overall result with an upper lid blepharoplasty,” Dr. Joseph explained.

Upper eyelid surgery has changed in recent years, according to Dr. Surek.

“We’ve transitioned away from volume reduction surgery to volume retention,” Dr. Surek pointed out. “We do a very conservative skin excision of the upper eyelid and sometimes even fat graft the infa-brow to create volume. We have really come to find out that the youthful brow is often a full brow, as opposed to a skeletonized brow and upper lid.”

In Dr. Surek’s opinion, providers often underestimate the lower eyelid. “That is a surgery that should be taken very seriously and performed with the appropriate amount of caution and detail,” he stated.

There are two ways to surgically access lower eyelid fat, Dr. Surek advised. “One way is from the inside of the eye, through what is called a transconjunctival approach. With this approach you make an incision in the conjunctiva and then dissect down to the fat pads of the intraorbital fat pad,” Dr. Surek explained. “The other option is to make a subciliary incision, which is an incision on the front of the eyelid in the skin right below the eyelashes.”

With access to the intraorbital fat, surgeons can resect it and if needed release the tear trough ligament. “You can release that ligament and sometimes even transpose that lower eyelid fat down underneath the tear trough ligament to help prevent reinsertion of the ligament post-operatively,” Dr. Surek shared.

Assessing for Optimal Outcomes

Assessing individual patient’s needs is the key to achieving optimal outcomes from eye rejuvenation.

“From a nonsurgical perspective, you need to determine are they really a can- didate for volume correction or do they need surgery?” Dr. Surek stated.
For surgical patients, the assessment includes looking at the position of the globe relative to the cheekbone, and whether there is a negative or positive vector. The surgeon needs to assess for the position of the lateral canthus and determine if a patient has laxity of the lower eyelid that might affect a proce- dure. Surgeons must also assess for pre- existing conditions, like dry eyes.

Forming a complete treatment plan requires that the provider study the relationships among the periocular structures, including the brow, upper lid, lower lid, cheek, as well as tissue quality, according to Dr. Joseph.

“It is important to have a balanced approach to the patient’s problems,” Dr. Joseph began, “I very rarely do just one treatment for this area because the eyes are so complex and there are so many factors that contribute to the way our eyes age. When formulating a plan for eye rejuvenation, I always make sure my plan is comprehensive and incor- porates as many of those factors as possible.”

One-third of plastic surgeons saw their income decline over the past year, but the specialty overall gained more among the 29 specialties in this year’s compensation survey.

Plastic surgeons also earned the highest salary gain last year (almost 10%) among all specialties. Otolaryngology and allergy / immunology were at the other end of the scale with a 9% loss of compensation.

The average income of plastic surgeons increased from $ 479,000 to $ 526,000, according to the Medscape 2021 Plastic Surgeon Compensation Report, a sum more than double the six specialties with the lowest earnings on the list.

Plastic surgeons took first place among orthopedists, who earned $ 511,000 this year, unchanged from the previous year.

Various Reasons for the Ascent

The specialty benefited from several factors from academic plastic surgeon Chris Reid, MD, in pandemic, said the assistant professor of surgery at the University of California at San Diego Medscape Medical News.

Among them, people were much more likely to work from home, and even when they were not at home they wore masks so that they could hide the signs of cosmetic surgery without taking time off.

“People freed themselves to do things in the pandemic,” he said.

Many also had more income available as activities were restricted, he said.

Reid said his own rebuilding practice had “the most productive year of last year.”

As more operating rooms were freed from the lack of elective surgeries, he said, he was able to do more reconstructive surgeries such as breast reconstructions after mastectomy.

“If you let me, it would work all the time. But I don’t have unlimited access to the operating room,” he said.

Also, because plastic surgeons often own their own surgery centers, many did not operate under the same limitations that hospitals had to stop elective surgeries, Reid said.

“Many plastic surgeons continued to operate when no one was doing it,” he said.

People who see their own image on screens with the video call boom may also have played an important role, according to report by the American Society of Plastic Surgeons.

Medscape previously reported that with filters and apps to enhance selfies, people can try to change their appearance, which can lead to greater acceptance of plastic surgery.

All the plastic surgeons in the survey who stated that their income decreased decreased that COVID-19 was a factor either for job loss, for fewer patients or for fewer hours. Respondents could choose more than one answer; 12% listed other non-COVID engines.

Of those who dropped revenue, about half (51%) said they expected compensation to return to pre-pandemic levels in a year; 30% said it would take 2-3 years; and 8% said they would never return to pre-pandemic levels.

Other specialties had much less lucrative years.

Pediatrics this year had the lowest compensation at $ 221,000, followed by family medicine ($ 236,000) and public health and preventive medicine ($ 237,000).

Plastic Surgeons Have a Small Demand for Paperwork

Plastic surgeons were almost inferior in administrative demands. They spent 12.7 hours a week on administrative tasks, compared to 14.2 hours a week last year. This included time to enter information into electronic health records, clinical reading, participation in professional organizations, and managerial work.

In contrast, doctors of infectious diseases spent almost twice as much of this time (24.2 hours a week) on administrative tasks.

 

Read more here.

 

Source:

TheHealthGuide

Evolus, Inc. (NASDAQ: EOLS), a performance beauty company with a customer-centric approach focused on delivering breakthrough products, today announced two newly published peer review studies in Aesthetic Surgery Journal that provide supportive evidence of the safety and efficacy of repeat doses of prabotulinumtoxinA (Jeuveau^®) to decrease the appearance of glabellar lines, also known as frown lines between the eyes. The two Phase II studies, conducted to support the registration and regulatory approval of Jeuveau in the United States, Canada and Europe, demonstrate that prolonged use of Jeuveau is safe and effective with repeat treatments. The studies also reveal that the patented Hi-Pure™ manufacturing technology used to make Jeuveau is not associated with antibody formation or neutralizing antibody formation.

“These peer reviewed studies add to the evidence base that repeat doses of Jeuveau are safe for patients and complement the results of the Phase III studies conducted for Jeuveau. Importantly, it’s reassuring to see the adverse event rates decreasing with each subsequent treatment,” said Rui Avelar, Chief Medical Officer and Head of Research & Development and an author of the study publications. “This is significant because consumers typically receive repeat treatment over time and want assurances that the product is safe and will continue to work. These results validate the positioning of Jeuveau as an exciting option for providers and consumers looking for an alternative neurotoxin for aesthetic use.”

Both studies were long-term (one-year), open-label, phase II studies designed to investigate the safety of repeat doses of 20 U prabotulinumtoxinA for the treatment of glabellar lines. The complementary studies primarily differed in the number of patients and in the product formulation process employed (freeze-dried in EV-004; vacuum-dried technology in EV-006). In both studies, among study completers, there was no evidence of shortening retreatment periods that might suggest immunogenicity and/or the development of resistance; in fact, the opposite was observed, with a trend towards longer retreatment periods. This is important because, when treating patients with a biological agent, a shortening time interval between treatments may be suggestive of increasing resistance or antibody development. In addition, the percentage of patients who experienced an adverse event (AE) after treatment decreased with repeat exposure. The most reported AE was headache. There were no serious adverse reactions related to the drug.

 

Read more here.

 

Source:

Evolus