Offering quick and relatively easy solutions to newly named concerns like the “Zoom effect,” many aesthetic practitioners reported sustained consumer demand for injectables despite the pandemic. According to Robyn Siperstein, MD, of Siperstein Dermatology Group in Boca Raton and Boynton Beach, Fla., demand for injectables is up but with a post-pandemic shift in areas of concern.

“We are doing a lot more work off the front of the face, which used to be the main interest of those unhappy with their photos,” she shared. “Now treatments on the side of the face, such as the jawline, temples and lateral cheeks are more popular since patients are now unhappy with their 3D image and side profiles, which they see constantly on social media, Zoom and Facetime.”

Injectables were the most popular minimally invasive procedures performed in 2020, based on the latest American Society of Plastic Surgeons (ASPS) statistics. ASPS surgeons reported about 8.8 million botulinum toxin type A treatments (the number one minimally invasive procedure) and soft tissue filler procedures (second most popular) that year.

The most recent statistics released by the International Society of Aesthetic Plastic Surgery (ISAPS) suggest that while there was an overall decrease of nearly 11% in aesthetic surgery globally in 2020, nonsurgical hyaluronic acid (HA) filler procedures increased. The top five nonsurgical procedures globally mimicked the ASPS findings, with botulinum toxin leading in popularity, followed by HA fillers.

As positive as this sounds, it is only the beginning. “We are just beginning to understand the power of injectables,” stated Alexander Z. Rivkin, MD, assistant clinical professor at the David Geffen UCLA School of Medicine and owner of Rivkin Westside Aesthetics in Los Angeles, Calif. Furthermore, consumer acceptance of, and comfort with, cosmetic dermal filler and neuromodulation treatments are also in the early stages, he added.

Dr. Rivkin predicts exciting things to come, not only for clinicians as they learn more about injectables and have more products at their disposal but also for patients as they start to more fully embrace injectable treatments in the coming years. “Just over the last few years, the number of people admitting to using injectables, and millennials talking about injectables on social media, has increased,” Dr. Rivkin pointed out. “This is an entirely new phenomenon and I think injectable treatments will continue to grow in popularity, becoming more accepted and more of a routine in life.”

What’s New?

Trends, products and techniques are changing the injectable marketplace. Gideon Kwok, DO, co-owner and medical director of seven Skin Perfect medical clinics in Southern California, says he is seeing a few trends in the use of injectables. “One is a reversal of the old injectable ways, with more patients coming in to have their facial fillers dissolved because of migration issues, especially if their lips have been “overfilled” or the injector went into the deeper planes.”

The big lip look of the past is evolving into patients desiring a natural look to the lips, but still wanting to improve the height and definition of the borders. “They are not as interested in the huge juicy ‘overfilled’ lips,” Dr. Kwok reiterated.

A technique that helps achieve the desired outcome is the tenting technique, during which Dr. Kwok begins injecting fillers more from the top, at the vermillion border, and works down toward the mucosal, or wet-dry border. This technique, in which he threads the filler more vertically than horizontally, makes it less likely that the filler will migrate and creates a more open (less bulky) look to the lips.

Another evolution in the marketplace: natural fillers. Although there are many phenomenal HA fillers on the market, some patients and practitioners prefer to offer aesthetic solutions that are not synthetic, said facial plastic surgeon Kian Karimi, MD, founder and medical director of Rejuva Medical Aesthetics in Los Angeles, Calif.

“ezGEL from CosmoFrance (Miami, Fla.) allows practitioners to offer their patients a completely natural way to enhance their beauty,” Dr. Karimi stated. “ezGEL is created by a proprietary system of heating and cooling whole blood after centrifugation to create albuminrich, platelet-rich fibrin (PRF) and pure PRF – these two are mixed together to create the ultimate gel. ezGEL is useful for temporary volumization and improved appearance of areas such as under-eye circles and hollows. [It] can be injected into the skin, subcutaneous tissues, and used topically.”

It can also be mixed with commercial HA fillers to create a platelet buffer for some of these fillers. According to Dr. Karimi, “ezGEL is also an excellent solution for reconstructive issues with the face and body including hollows created by trauma, infection, prior surgery, or energy-based devices that caused an inadvertent loss of fat.”

Neurotoxin use also continues to evolve. For example, investigators are looking into delivering higher doses of concentrated neurotoxins to determine whether they can safely increase the duration of eff ect, Dr. Rivkin reported. While more research is needed to determine whether high-dose neurotoxins are safe and effective for a longer duration, not all dosing strategies pan out completely. On the other end of the spectrum, in Dr. Kwok’s experience, neurotoxin micro-dosing, which has been used in recent years at cosmetic practices, has its benefits and drawbacks.

“Micro-toxin is beautiful, you can minimize wrinkling, tighten the skin, and things like that, but when you are talking about microdosing, you are also talking about less longevity to your toxins,” Dr. Kwok added. “With toxins, dose equals duration. Micro-toxin is a great concept for those who have the extra money and time to do it. But I think the other thing you need to think about is antigenicity – are you going to end up with somebody with neutralized antibodies?”

One way to potentially avoid neutralizing antibodies is by using products like XEOMIN® from Merz Aesthetics or, if it is approved, DAXI from Allergan Aesthetics, an AbbVie Company. As Dr. Kwok explained, these products are naked proteins. They do not have as many of the accessory proteins that, theoretically, can cause neutralizing antibodies. However, “The industry is still studying whether that is true or not,” he asserted. “The washout period is at least five years before re-trying neurotoxins, and when you re-try, you have to use the naked protein.”

While training clinicians on neurotoxin use, Dr. Kwok often hears students say they will use a lower dose for a more natural look. But that is not how it works; he contends. “Toxins have an on and off switch. The more toxins you put in, the longer the duration. The way you place your toxins in the muscle groups affects how you will create a more natural look based on hitting the origin, rather than the insertion of the muscle,” Dr. Kwok explained.

Dr. Kwok also warns injectors to beware of using neurotoxins in the upper lip, “Yes, you are adding a tiny amount, but your patients have to come in every six weeks to get neurotoxin. Unless you inject XEOMIN in the area, you are priming the body for potentially producing neutralizing antibodies. And is that muscle really going to relax enough to give that patient a lip lift?” he queried.

What and Where?

Dr. Rivkin is seeing a sharp increase in demand for temporary and permanent nonsurgical rhinoplasty. “Patients are very well educated by the internet and social media. They know that nasal contours can be corrected safely and effectively, even with permanent fillers,” he shared.

For temporary fi llers in nonsurgical rhinoplasty, Dr. Rivkin tends to use Juvéderm® Voluma (Allergan Aesthetics) and Restylane® Lyft from Galderma. He uses Bellafi ll® from Suneva Medical as a permanent filler in the nose. “I’ve been using Bellafill over the last decade and am very comfortable using it. I think it is a great product and is very safe. Now, most of my liquid rhinoplasties are becoming permanent noses,” Dr. Rivkin expressed.

Training is key for optimal liquid rhinoplasty outcomes. “Nose treatments are becoming more and more popular with online videos advertising ten-minute nonsurgical nose jobs,” Dr. Siperstein began. “While this procedure can be safe [from] those knowledgeable of anatomy and safer injection techniques, it can also lead to permanent blindness, especially from those without this knowledge.”

Dr. Kwok, who is admittedly a big Galderma filler user, thinks the company has done a great job in recent years with its XpresHAn™ technology, including Restylane® Kysse for the lips and, more recently, Restylane® Contour, which is indicated for the cheeks, but he is using it to make fuller lips.

“Contour takes Kysse to the next level. Kysse is more of a mild lip plumper while Contour is going to give you more of a look like you ate a jalapeno pepper, but still with naturalness and nice definition,” Dr. Kwok revealed. “I let my patients dictate what they want because, at the end of the day, it is something they have to live with. Still, I think patients are loving the use of Contour in their lips.”

Dr. Kwok also called out two important approvals: Radiesse® (Merz) for a jawline indication, making the calcium hydroxylapatite (CaHA) filler the first approved to contour the jawline, and Juvéderm®’ Volbella (Allergan), which is already approved for injection into the lips and skin around the lips, receiving an expanded indication for the infraorbital hollow.

Dr. Siperstein says she is excited about the first FDA approval for undereye filler granted to Juvéderm Volbella, so this area is no longer “off-label;” however, she recommends that future injectors are educated on best practices before starting in this advanced area.

While treating the undereye area can be incredibly gratifying, it can also cause many long-term aesthetic complications, Dr. Siperstein stressed. “Delayed onset swelling can happen many years after treatment, so it is important that patients and injectors are properly educated on this topic. I have had patients who went for extensive medical workup because their physician falsely assumed swelling could not be related to filler done five years earlier,” Dr. Siperstein shared. “It is vital that both patients and physicians are properly educated so that this side effect can be easily reversed by using hyaluronidase instead of sending patients for costly CT scans that subject them to unnecessary radiation exposure.”

As a tip, Dr. Siperstein suggests that when treating with fillers around the eye region, it is essential to place the majority of the product deep to prevent blockage of the superficial lymphatics, and always inject the cheeks first. Dr. Siperstein authored a retrospective review of over 700 infraorbital injections published in April 2022 in the Journal of Clinical and Aesthetic Dermatology (JCAD). She found no difference between side effects when using either Restylane-L, Juvéderm Volbella or Belotero® (Merz) in this area but did note that if less was used (<0.55), there was significantly less post-procedure swelling. In this article, she also shared her technique to decrease swelling by adding 1 mg of triamcinolone.¹

Dr. Kwok no longer uses Volbella or other fillers with Vycross technology because of the potential for late onset nodules. In a study published in 2019 in Dermatologic Surgery, researchers concluded: “The introduction of [Vycross] HAs introduced a new variable that may be changing the immune tolerance of these substances, resulting in a higher incidence of delayed nodules than previously expected.”²

For the under eyes, Dr. Kwok uses Restylane products, especially Lyft and Kysse, “I think it is best for practitioners to figure out their tools in the toolbox and understand rheology, or the characteristics of these products,” Dr. Kwok emphasized. “I use Restylane Lyft when I am treating the undereye area because it is more of a filler to use in the upper mid-cheek to create foundational support, which is what I want. For a softer undereye, or to treat slight undereye hollowness, I might use something lighter, like Belotero or Restylane Kysse. You can also combine fillers, using one as a foundation and another superficially.”

For lips, the mid-face and temples, Dr. Rivkin speculated that a filler not yet approved for use in the U.S. might make a big splash; “Profil from Allergan is a more robust HA filler that is great for sculpting the jawline, chin and cheeks,” he began. “I think it will be an interesting tool because it is a firm, long-lasting filler. It will be helpful for temples as well because you will be able to put it in very deep.”

Thoughts About Fat

Fat grafting is more limited to dermatologists and plastic surgeons who have surgical experience and offer liposuction, which is how one harvests the fat, Dr. Kwok stated. There is; however, an off-the-shelf option: Renuva from MTF Biologics. “MTF Biologics has taken and killed off all the live fat cells but left the honeycomb, called the fat matrix. You slightly rehydrate it and inject it into the face, buttocks or wherever, and you can cause the body to stimulate fat to grow into those areas,” Dr. Kwok explained. Dr. Rivkin stated that he does not use much fat for cosmetic injection, “I don’t think fat is a reliable volumizer, so I do not use it. I use both temporary and permanent fillers and my results are really good, so I have not needed to go to fat.”

Know Your Anatomy and How to Use These Products

While FDA approvals are to evaluate a product’s longevity and safety, and are often based on perception and subjective values, Dr. Kwok believes that cosmetic injectors need practical training in each indication to achieve the best outcomes. “We highly recommend that injectors continually and constantly further their education and skills. They can go to conferences, hire people they know in the industry for private training or do a shadowing day with leaders in the industry,” Dr. Kwok advised. Even company training on a specific filler, while valuable, has its limitations. Trainers can only train on-label and cannot talk about off-label products.

Knowledge of facial anatomy is critical to safe and effective injection techniques. Understanding the location of the important vessels is key to avoiding complications like ischemia and necrosis, Dr. Rivkin added.

Overfilling the face with dermal fillers is also an issue, Dr. Kwok indicated. “We know from studies with CT scans and ultrasounds that fillers can be detected in the tissue for 12 years and longer,” he reported. “Patients need to understand that they should not get overfilled. They need to understand that the face ages in totality, so it is not appropriate to do the same thing you did six months ago. We potentially need to inject other areas to avoid overfilling.”

Some injectors have started using ultrasound as an injection tool to increase safety. And while ultrasound increases one’s visualization of an area, making it easier to avoid blood vessels, Dr. Kwok feels the technology also takes away from the clinician’s artistry. “When injecting with ultrasound, you do not see what you are changing,” Dr. Kwok elaborated. “I am not sure of the viability of ultrasound in the majority of practices. I think having ultrasound is nice from a teaching perspective, but I am still questioning how it will be used in the mainstream.”

In Dr. Siperstein’s opinion, visualization technology is a great tool. Along with the use of microcannulas for filler injection, she said the Accuvein vein visualization technology has transformed her practice by decreasing bruising substantially.

TENTECH’S ADVANCED CROSS-LINKING TECHNOLOGY

Tentech (South Korea), claims that the cross-linking agent used in its line of HA fillers is among the differentiators of its dermal fillers. These fillers, which are not yet FDA approved, include Fine Fill, for fine lines under the eyes, eye bags and lips; Rhino Fill, for elevating the nose; and Regevan Fill, for overall volume on the cheekbones, nasolabial folds, temples, forehead and chin.

According to the company, many cross-linking agents, which are essential for HA fillers, can be highly toxic. Tentech claims to have found a solution to the existing cross-linking agent problem with a completely new material, divinyl sulfone (DVS).

“The reaction [from DVS] is over in 20 minutes,” said Ro Young Woo, MD, a dermatologist at Cheongdam Oracle Dermatology in Seoul, South Korea. “The fact that the reaction in the body ends quickly means that there is no crosslinking agent remaining in the body, thus there is no instance of the human body being exposed to toxic cross-linking agents long-term. And these fillers last for 8-14 months…,” Dr. Woo stated.

References: 

1. Siperstein R, Montes JR, Speranza A. A Retrospective Review of
the Safety and Efficacy of Low-dose Triamcinolone Mixed with
Hyaluronic Acid Fillers to Reduce Post-injection Infraorbital
Swelling. J Clin Aesthet Dermatol. 2022 Apr;15(4):13-19. PMID:
35465031; PMCID: PMC9017664.
2. Sadeghpour M, Quatrano NA, Bonati LM, Arndt KA, Dover
JS, Kaminer MS. Delayed-Onset Nodules to Differentially
Crosslinked Hyaluronic Acids: Comparative Incidence and Risk
Assessment. Dermatol Surg. 2019 Aug;45(8):1085-1094. doi:
10.1097/DSS.0000000000001814. PMID: 30789508.

 

The Certified Aesthetic Practice Program (CAPP) was launched in Spring 2022 as a collaboration between Informa Medical Aesthetics – the leading global producer of events, educational resources, and networking platforms for medical aesthetic professionals– and Dr. Paul Nassif of NassifMD®, a renowned facial plastic and reconstructive surgeon, professor at USC (Los Angeles, Calif.) and UCLA (Los Angeles), and entrepreneur who operates successful businesses and brands worldwide.

Designed to bridge the gap between medical school education and the practical business knowledge necessary to build and maintain a successful medical practice, this 12-part, multi-tiered course will cover topics such as branding, marketing, fi nance, accounting, capital investments, customer experience, human resources and compliance. The modules are scheduled according to what happens chronologically when building a practice – but are also available singly or on-demand for those just needing a refresher course in a particular area.

CAPP is open to anyone in medical aesthetics: residents, newcomers transitioning into medical aesthetics, staff at a medical aesthetic practice, or experienced practice owners who want to grow or improve their business knowledge.

We recently interviewed Dr. Nassif to get his take on the CAPP program, the partnership, and what he, as a physician, hopes to accomplish through this new type of education program for the medical aesthetic community.

TAG: CAPP is pretty unique in that it takes you through just about every step of building or running a practice. But you have typically taught medical procedures and techniques. How did you and Informa arrive at this concept?

During The Aesthetic Show in 2021, I was speaking with Erin Velardo and Eileen Baird from Informa about where the gaps in education lie for practitioners and how I came to build my practice. I half-jokingly said, “medical school certainly did not prepare me for how to start and build a practice. Thank God I have a degree in finance too!” At this point, the conversation turned more serious about the comparable educational programs that tend to assume the basics are covered. So, we thought, why not start our own program where the basics, not offered elsewhere, really are covered, in depth? Since most doctors and healthcare professionals may not also have a business/finance background like me, it could be a more compelling and engaging way to share real-world knowledge and experience – and set our community up for success.

TAG: There are a lot of courses and education offerings around the country focused on practice management. How does CAPP differ?

Each CAPP module is led by real-world thought leaders who have had their own successes in their relevant category, which I believe makes for much more engaging and meaningful content. We are bringing in experts for each topic covered.

TAG: Dr. Nassif, you are a real-life story of going from waiting tables to becoming the world-renowned facial plastic and reconstructive surgeon and general businessperson you are today. Can you expand on this?

Many people do not know I waited tables starting in high school and continued while pursuing my finance degree at USC. At one point, I was the manager of a restaurant on the Sunset Strip that all the celebrities frequented. I opened my own restaurant in 1987 and immediately afterward was accepted to medical school in Chicago. I had to transfer to USC Medical School to keep running the restaurant!

Of course, I eventually built my practice, a surgery center, and my skincare business, but I also invest and provide guidance to businesses in the restaurant arena.

TAG: What are the top 3 subjects being covered in CAPP that you wish you knew when you were starting out? And why?

First would be Money Matters – Most doctors do not have a finance degree and are not prepared for the major financial investments, decisions and management required to build a practice. In some cases, doctors can be taken advantage of. This is a hugely important module.

Next would be Mastering Marketing – I was not prepared at all for this. Who knew this would become a major part of running a practice? There is so much more to digital marketing than anyone realizes. I am excited that these sessions will be held in person at The Aesthetic Show, also.

Lastly, I’d say Incorporating Retail into the Practice – every practice needs a means of passive income, and retail takes care of that. The office still makes money without you.

TAG: Is there anything you would have done differently in retrospect?

I don’t think so… I think my life has turned out well!

TAG: What are your hopes for how CAPP will impact the business of running a medical aesthetic practice?

I hope people come away with real-world knowledge from the team of experts who have “been there, done that – and know how to do it better”, and can share what they learned from their mistakes along the way.

This one-of-a-kind program features a faculty of astute subject matter experts.

The full CAPP program includes in-person and online modules, available both live and on-demand, that will catapult you, your team, and your practice to the next level.

The following modules will be held in person on July 7, 2022, during The Aesthetic Show’s preshow education program:

Module 4: Mastering Marketing – The Foundation
Module 5: Mastering Marketing – Assess, Adjust, Advance
Module 6: Creating the Patient Experience to Build Loyalty

 

Today’s consumer has an increasing focus on price above all else. This price sensitive consumer believes they can always get it cheaper elsewhere if they keep searching. It has practically become a sport for many consumers to price shop. Even if they have the money, they like to shop and negotiate to see how great a price they can get.

To combat this phenomenon, here are pricing strategies that can help you create a win-win solution – the patient gets what they want while you maintain your pricing.

“If…Then” Price Strategy

If you take something of value away when you lower price, this helps the patient determine how much they value it, and if they are willing to pay for it or lose it. For example, let’s say they want to do fractional rejuvenation on their face and chest:

“Sara, IF you do just your face, THEN you save $500.”

You empower the patient to determine if it is worth saving $500 to do just her face rather than face and chest.

Take-Away Pricing

In this strategy, you start with higher pricing knowing you have room to negotiate. So, you present this higher pricing and only lower the price if they agree to do something that is of value to you. For example:

• They agree to let you use their before/after photos in your marketing efforts
• They agree to shoot a testimonial video
• They agree to have physicians in the training room during their procedure

Specials for Special Groups

Come up with specials for special groups. If you are in an area with military service people, those people have to “make tape” as a requirement to join the military. So, offer special pricing for that particular group. It is your way of thanking them for protecting our country.

You can also have special group pricing in your community for teachers, realtors, mommy group members and so on.

“2-for-1” Specials

The younger demographic of consumers can be tough cosmetic patients. They are typically strapped for cash, naïve, easily influenced and distracted with lots of technology.

They “grew up” on deals, so offer them a two for- one special such as a consultation, peel or neurotoxin injections. Now, it is fun for them because they can bring a friend to their consultation or to a simple cosmetic treatment. They split the cost with their friend, and you gain two new patients.

Use Urgency

Cosmetic patients need a sense of urgency to act now rather than continue to procrastinate.

Nobody NEEDS aesthetic rejuvenation so oftentimes, consumers will keep putting it off unless you give them a good reason to act now. Because if it is urgent enough, the patient will manufacture time and money.

When they really want something, they find a way. So do your part – give them a reason to say yes now rather than continue to put it off.

Urgency strategies that work well are “offer expires in a week” or “for the first 10 to respond.”

Decide ahead of time how far you are willing to negotiate, then add urgency and you will see better conversion rates.

“Work on it, not just in it” has been a fundamental entrepreneurial principle ever since Michael E. Gerber coined the phrase in The E-Myth Revisited. So easy to say, so difficult to do. The good news? The Aesthetic Show (TAS) has you – and your team – covered. TAS provides you with a one-stop solution to hone your skills, perfect your art and solidify your practice in order to stay competitive in a rapidly expanding industry. In fact, there are at least eight reasons you should plan to attend TAS with your team July 7-10, 2022, at the Wynn Las Vegas.

1. Knock out Those CMEs

Let’s just get this one out of the way – TAS is a no-brainer for physicians and allied health professionals who need to tick off credits for continuing medical education accreditation. With 20 CME credits available over the course of four days, you will have plenty of opportunities to work toward your licensing requirement goals.

Further, TAS is one of the only industry events where physicians and their entire staff of medical and practice management professionals can attend together to gain specialized and focused knowledge for each of their individual
roles.

For more information, visit the Continuing Education tab on the TAS website.

2. Pre-Game with a Packed Pre-Show Program

Speaking of education, the robust preshow program, taking place on Thursday, July 7th, has something for everyone in aesthetics.

Here are a few highlights:

Brand New Foundations of Advanced Injections

Powered by Aesthetic Immersion, the all-new Foundations of Advanced Injections Certification Program will help you hone your injection skills and improve patient outcomes.

Comprised of a combination of virtual didactic and live injection training, this CME-accredited course is focused on teaching the fundamentals of advanced medical aesthetic injections.

This brand-new course, available in two levels, will provide you with unfiltered learning, including off-label treatments, practical knowledge and techniques you can start implementing immediately. Specifically, you will receive:

• Four hours of convenient, at-home virtual didactic training, 3.75 hours of in-person didactic review and hands-on experience station learning
• 3.5 hours of advanced, interactive injection training*
• In-depth, empirical review of anatomy, neurotoxins, and dermal fillers
• Six months of access to the recordings of the live training and virtual curriculum
• And much more!

Thread Lift Masterclass

The Thread Lift Masterclass features a lecture series followed by an observational and interactive learning experience. Trainers will demonstrate various threads and techniques on live patients on the face, neck and decolletage. 

You will learn how to choose appropriate patients and set realistic expectations. Plus, you will walk away with a better understanding of the full potential of threads, complications, risks and practical techniques to implement immediately. The Masterclass is presented in two parts: 

• Part 1: Threads for the Face – Lectures
• Part 2: Threads for the Face – Live Demonstrations/Observational Training

Brand New Certified Aesthetic Practice Program (CAPP)

Join Paul Nassif, MD, as he leads the Marketing and Patient Experience Modules of the new Certified Aesthetic Practice Program. CAPP is an immersive educational program designed to fill the gaps in business training not covered in traditional medical education. Comprising a total of 12 educational modules covering every aspect of building a successful practice – from your initial market research to HR, financial and legal considerations – this program delivers the most comprehensive medical aesthetic business training course in the industry.

Whether you are a resident, transitioning your practice into aesthetics, or want to expand and
improve your existing medical aesthetic practice, CAPP will guide you through the obstacles and pitfalls.

Visit CertifiedAestheticPP.com for additional details.

3. Further Augment Your Business Acumen

In addition to new, groundbreaking business programs, you and your team can brush up on your business fundamentals with the Practice Management Track that runs July 8 – 10, 2022. Back by popular demand, this track tackles
topics such as:

• Enhancing Your Presence in Person, On Camera and Online
• Financial Planning and Wealth Management
• Growing Pains in Practice: Choices and Challenges
• Process Improvement
• Marketing Strategies
• Company Culture and Leadership

4. Experience Cutting-Edge Treatments First-Hand

Be the practitioner and the patient with The Aesthetic Show’s first ever Treatment Center.

Get a full treatment experience at The Aesthetic Show’s Treatment Center. The Treatment Center puts you in the patient’s shoes while you test new products, devices and treatments. Appointments are available on a first-come first served basis for all registrants.

In addition, real-time demonstrations on live patients run throughout the program, showcasing:

• Injectables
• Threads
• Energy-based devices
• Microneedling
• Regenerative therapies
• And more...

5. Pump up Your Practice

You will have the opportunity to meet more than 150 leading product and service providers, attend Lunch and Learn Workshops and more than 24 industry education workshops.

Another new feature this year is the Personalized Nutrition Pavilion

Driven by ongoing breakthroughs in scientific research on the impact and importance of nutrition to the skin, medical aesthetic professionals are incorporating whole-person assessments, treatments and therapies into their practices.

If you are looking to add services to your practice, then this area of emerging therapies could be for you. Be sure to stop by the brand-new Personalized Nutrition Pavilion to see how “Aesthetics from the Inside Out” could be your next big thing in patient care.

Make sure to leave enough time to browse the entire show floor so you can leave Vegas with your list of new ways to enhance patient care, expand your practice and generate new revenue.

For more information about what you can expect on the show floor, visit the Exhibit tab at https://bit.ly/TAS-Exhibitor

6. Rub Shoulders with KOLs and SMEs

As the only fully multispecialty conference in the U.S., TAS welcomes attendees and features speakers from every specialty and provider-level specializing in aesthetics.This means you will have ample opportunity to brainstorm with a diverse professional pool from around the globe – including more than 90 key opinion leaders and subject matter experts.

TAS draws healthcare providers from disciplines such as:

• Plastic surgery
• Dermatology
• Cosmetic Surgery 
• OB/GYN
• Internal Medicine 
• Primary Care 
• Family Practice 
• Orthopedics
• Dental 
• EMT
• Radiology 

In short, you’ll be able to mingle with more than 2,000 healthcare professionals from 55 countries and pick the brains of some of the brightest minds in the industry.

To see the 2022 Faculty, go to the faculty tab at https://bit.ly/TAS22-Faculty

7. Glow Up at the Awards Gala

In addition to all the networking opportunities and exclusive social events throughout the show, the prestigious Aesthetics Awards Gala is the highlight.

For more than a decade, The Aesthetic Awards has honored the exceptional outcomes and accomplishments from some of the finest practitioners and product manufacturers in aesthetic medicine.

The 2022 Award Winners are chosen from hundreds of submissions and nominations representing surgical, nonsurgical, practice management and industry innovation. Winners of the top three awards (Lifetime Achievement, Best Overall Patient Enhancement and Best Aesthetic Practice) will be revealed during this elegant, sought-after event benefitting myFace, a nonprofit organization dedicated to changing the faces – and transforming the lives – of children and adults with craniofacial differences.

Be sure to pack something fancy to look your finest while the industry’s stars are unveiled during this night to remember.

8. Hear What Your Peers Have to Say

Perhaps the most compelling reason of all to bring your entire team to TAS is that your peers highly recommend it.

Here are just a handful of testimonials from past attendees:

“Great opportunity to get the latest techniques and connect with others in multiple specialties. It was perfect for establishing professional relationships and networking as it allowed for more
intimate conversations.”

“I come to The Aesthetic Show because I meet and learn from the broadest range of the savviest professionals in the country... from all disciplines!”

“It is the best aesthetic meeting available, offering sessions for myself and everyone on my staff. We come back rejuvenated and eager to apply everything we have learned.”

“What an incredible weekend of learning about new technologies and trying them out. There were excellent speakers on a wide variety of topics, and I just had a great time at The Aesthetic
Show.”

With so much to see and do, it is no wonder TAS attendees return year after year. Why not join them?

QUICK LINKS

Looking for more details? These quick links will help.

• Show Website: www.aestheticshow.com
• Program at a Glance: https://bit.ly/TAS-PAG
• Faculty: https://bit.ly/TAS22-Faculty
• Registration: https://bit.ly/TAS22-Reg
• Hotel and Travel: https://bit.ly/TAS-Hotel
• Exhibit Floor Plan: https://bit.ly/TAS-Exhibitor
• Continuing Education: https://bit.ly/TAS-CME
• Certified Aesthetic Practice Program: CertifiedAestheticPP.com
• Add-on Training Courses: https://bit.ly/TAS-Add-On-Training

Over the past two years, as COVID has ravaged our world’s health systems and economy, we’ve observed a surge in the prevalence of anxiety and depression across the population. COVID has impacted not only our collective experience of distress and anxiety, but interestingly enough has influenced our perceptions of body image, both through the long-term effect of the lock downs and through increased exposure to social media.

COVID has changed patients’ patterns of behavior relevant to your practice, manifesting as high-risk clinical situations. It is more important than ever that you know how to identify them and how to set your practice up for success.

Open your internet browser news feed, and you’ll certainly find articles about increased anxiety and depression in both adults and teens. From COVID, to racial tensions, to the war in the Ukraine, our news events are constantly bombarding us with negative messages, and the aftermath is a resultant escalation in the prevalence of anxiety and depression. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) describes generalized anxiety as severe worry about a number of topics, events or tasks – which exceeds the real impact of the expected event. This constant worry disrupts daily function, making it hard to focus on tasks. Those with anxiety experience trouble sleeping, muscle aches and tension, as well as headaches. As you read this list of symptoms, think of your own reaction to the changes in our world, as well as the reactions of your friends, colleagues and patients.

Trauma and stress disorders, including posttraumatic stress disorder (PTSD), are defined by the DSM-5 as symptom clusters which arise as a reaction to a traumatic situation. Common symptoms include fear, anxiety, forgetfulness, anger, trouble sleeping, nightmares, avoidance, withdrawal and feeling detached or distanced from others. It is hard to imagine not having at least some of these listed symptoms in reaction to our world’s events over the past two years.

COVID Impact Studies

The Centers for Disease Control and Prevention (CDC) examined the degree to which life domains (economic, health, change in routine and social isolation) were associated with anxiety in 2020. Subjects in the U.S., U.K. and Israel uniformly reported moderate levels of anxiety in all four domains, with the most severe symptoms being experienced in the economic and health categories.

Other international studies have tried to explore the impact of COVID on anxiety and depression. One study, conducted between January 2020 and March 2020 in China and Italy, surveyed over 2,000 healthcare workers, employing the psychometric instruments to assess anxiety, depression, PTSD and insomnia. Across all subjects, over 25% experienced clinically significant anxiety and depression, and over 40% experienced symptoms of PTSD. Studies such as these have revealed that the worldwide prevalence of anxiety and depression has exceeded our previously understood rate of 1 in 5.

For example, Sherman A. Lee, PhD et al., developed the Coronavirus Anxiety Scale (CAS) to quantify the psychological impact of COVID, specifically in frontline healthcare workers. The questionnaire is a five item screening instrument, and a score of greater than nine
predicts dysfunctional anxiety with 90% specificity, 85% sensitivity. Elevated scores are correlated with global impairment in function, maladaptive coping with drugs and alcohol, hopelessness, suicidal ideation, along with negative attitudes towards the former president,
as well as Chinese food and products. Symptoms specific to COVID anxiety include excessive fear, discrimination, anger, guilt, post-traumatic stress, stigmatization, insomnia and depressive symptoms. Not only can COVID anxiety lead to acute complications of underlying psychiatric symptoms, but it can aggravate pre-existing chronic diseases.

Caroline Stamu-O’Brien, MD et al., found risk factors for COVID anxiety to include female sex, lower socio-economic status, baseline interpersonal conflicts, low social supports, frequent social media use and misinformation.² Their data mirrors studies on health anxiety, defined as excessive vigilance to perceived bodily changes, which can lead to lower immunity, increased blood glucose, impaired sleep quality and exacerbation of mental health diagnoses. Although high health anxiety leads to catastrophic misinterpretations of body sensations and dysfunctional beliefs about health, with social distancing there has been more avoidance of the doctor’s office and hospital, which can lead to increased morbidity.³

• Examples of observed maladaptive behaviors unique to the COVID pandemic include:
• Excoriation disorder triggered by excessive hand washing
• Excessive hand washing triggering irritant contact dermatitis 
• Escalated symptoms of obsessive compulsive disorder marked by contamination fears 
• Removal of social supports as a result of physical isolation

COVID and Body Image

Body image can be defi ned as ‘the individual’s experience of embodiment, especially selfperceptions and self-attitudes towards one’s appearance.⁴ In 2015, a study conducted by Meghan M. Gillen, PhD et al., demonstrated a significant association between positive body image and less risk of depression, higher selfesteem, fewer unhealthy dieting behaviors, lower drive for muscularity and greater intention to protect the skin from UV damage.⁵ In 2020 Rachel F. Rodgers, PhD et al., examined the impact of the COVID lockdown on body image.⁶ A perfect storm arose – risk factors to positive body image increased (social media exposure, daily activity disruption, social isolation, changes in patterns of physical activity and sleep, fear of contagion), and protective factors were eliminated, such as social support and access to care.

Social media is fi lled with images promoting both the thin-ideal and panning the COVID-19 ‘19’ and ‘pandemic recipes.’ The use of video conferencing increased preoccupation with appearance since we are seeing an image of ourselves while attending a meeting. Furthermore, fears of contagion have led to increases in disordered and restrictive eating.

In 2020, Viren Swami, PhD et al., specifically studied the impact of COVID stress on body image.⁷ Their linear regression analysis of data from 506 adults in the U.K. sought to explore the extent to which COVID related stress and anxiety is associated with body image outcomes over and above trait anxiety and generalized stress. Their assumption was that changes to daily routine can impede adaptive body image coping mechanisms and lead to a heightened concern about shape and weight as well as increase negative ruminations about body image.

In the 255 women studied, COVID anxiety was associated with body dissatisfaction as well as with a drive for thinness. In the 251 men surveyed, COVID anxiety was associated with greater body fat and dissatisfaction with muscularity. Their study confirms that COVID specific stress and anxiety are associated with negative body image well over trait anxiety alone. Their group postulated that lifestyle factors, including diminished coping skills, increased exposure to thin ideals on social media, increased screen time and decreased physical activity are all to blame. These represent opportunities for awareness and intervention in our patients. 

What does this mean for your aesthetic practice? A 2021 study published in the Journal of Cosmetic Dermatology reported respondents (n=221) were more comfortable with the aesthetic procedure clinic than they were with going to the grocery store, gym, workplace or hairdresser. In addition, 82% of respondents felt trust was an extremely important factor driving their aesthetic medicine visits. When asked what factors influenced their decision to pursue cosmetic procedures in order to refresh their look, do something positive, gain confidence or address a concern, 23% of those surveyed reported that COVID specifically influenced their decision. Of those surveyed, during periods they were unable to access aesthetic care, they experienced frustration, anxiety, stress and disappointment.⁸

Are your patients more at risk for COVID anxiety and other mental health concerns? In 2020, Selami Akyut Temiz, MD et al., studied the difference in anxiety, depression and CAS scores amongst their cosmetic unit patients compared to controls (cosmetic unit procedures included botulinum toxin injections, laser therapy, gold needle radiofrequency, mesotherapy and platelet-rich plasma treatments). Compared to controls, the cosmetic unit patients had elevated levels of depressive and anxiety symptoms, however both groups had similar CAS scores. The authors postulate that “cosmetic patients are a special group within dermatology, and the psychosocial needs of this group may differ.”⁹

As previously described, risk factors for negative body image include increased exposure to social media’s thin ideal images. The relationship between social media and body image was explored by Jasmine Fardouly, PhD and Lenny R. Vartanian, PhD in 2016. Their work revealed unique features of social media: that the medium features images of the users themselves, rather than magazines and television, which feature others. In addition, social media users are compelled
to present idealized and altered images of themselves and interact with one another, specifically with appearance-related comments and content.¹⁰ They also reported on studies on pre-teen and high school age girls using Facebook who report higher drive for thinness, internalization of the thin ideal, body objectification and appearance related concerns compared to non-Facebook using peers. A separate
study of female undergraduate students demonstrated higher levels of body dissatisfaction, and the drive for thinness and dieting was associated with higher amounts of time on Facebook. Facebook was the selected medium in the 2016 studies because, at that time, an estimated 10 million photographs were uploaded each hour.

In 2019, Candice E. Walker, MSc et al. examined whether social media influences the desire to pursue cosmetic procedures. Their research created a task examining the impact of exposure to images of facial enhancement compared to the impact of control images (travel related images). Those exposed to the facial enhancement reported greater desire to pursue changes within themselves.¹¹

Earlier social media studies focused on Facebook; however, Instagram revolves around images, not text, and a 2017 report from the Royal Society of Public Health (U.K.) states ‘Instagram is the most detrimental social media platform for young people’s mental health and wellbeing.’

Multiple studies have demonstrated that exposure to attractive peers and celebrities on Instagram negatively impacts mood, self-image and self-esteem in women.¹² In addition, cosmetic procedure patients report getting their information and inspiration from social media.¹³

We know that body dissatisfaction – the negative feelings associated with the discrepancy between the ideal and the actual – can drive the desire to pursue aesthetic procedures. Based on the aforementioned studies, we now know that there is a strong association between social media exposure and self-image, as well as body dissatisfaction. When considering these concepts in relation to the COVID pandemic related lockdowns contributing to increased exposure to both social media and self-awareness via video conferencing, it easily explains the considerable rise in cosmetic procedures that is being reported everywhere. But what if the expectations for cosmetic procedures are unrealistic?

Body Dysmorphic Disorder

Body dysmorphic disorder (BDD) describes a preoccupation with an imagined or minimal defect in appearance, which leads to functionally impairing emotional and psychological distress. The flaws perceived by the patients with BDD are viewed as slight or non-existent by outsiders.¹⁴

Of those seeking cosmetic procedures, between 7% to 15% may have BDD. Patients with BDD often have been victims of childhood teasing, and experience low self-esteem. They may have family histories of anxiety and depression. Among the cohort of BDD patients, of the 46% who followed through with their cosmetic procedure, 76% were dissatisfied with the outcome.¹⁵ Of the plastic surgeons surveyed, 12% reported receiving physical threats from dissatisfied BDD patients post-operatively.

So, how do you identify the right candidate for a procedure? The Body Dysmorphic Disorder Questionnaire is a screening instrument examining the degree to which a patient is preoccupied with body image concerns.16 This screening tool, as well as an examination into your patient’s insight into realistic post-procedure expectations, can help screen out inappropriate candidates.

Can Cosmetic Procedures Improve Body Image

Now to the question constantly on all of our minds. Can cosmetic procedures improve body image in the non-BDD candidate cohort? According to a 2016 review of data collected between 1978-2012, Carlo M. Oranges, MD, PhD et al., demonstrated an association between body image improvement and receiving breast augmentation or reduction, abdominoplasty, cosmetic facial surgery, rhinoplasty and blepharoplasty.¹⁷ And a 2013 study by Sotonye Imadojemu, MD, MBE et al., reported a 20% improvement in body image in four out of five rhinoplasty recipient cohorts included in their review.¹⁸

Since the above-mentioned studies were retrospective analyses, Timothy P. Moss, MPH, PhD and David L. Harris strengthened the evidence through a prospective controlled outcome study of individuals seeking plastic surgery.¹⁹ They compared psychological metrics at three time points: pre-operative, three months and one year post operative in two groups: general surgery patients from an ENT clinic, and cosmetic surgery patients. Their data demonstrates
higher reported anxiety and depression pre-operatively in the cosmetic surgery patients compared to the general surgery patients; however, at both time points post-operatively, the cosmetic surgery cohort had a significant reduction in both anxiety and depression symptoms, whereas symptom levels remained the same for the general surgery cohort.

A German study conducted in 2013 by Jürgen Margraf, PhD et al. demonstrated similar findings comparing wait-listed cosmetic surgery patients to those receiving procedures. Compared to baseline, at both three months and one year, anxiety and dysmorphia were statistically significantly improved in the cosmetic surgery group compared to the control group at one year, as were quality of life measures. The authors concluded that cosmetic procedures can have a positive impact on multiple domains (psychological, feelings of well-being, feelings of attractiveness) and can decrease anxiety as well as dysmorphia.20 It should be noted that patients with BDD were excluded from this study.

In conclusion, the COVID pandemic is associated with increased prevalence of anxiety and depression. In addition, independent of this rise in anxiety and depression, body image discomfort has risen with COVID, and is signifi cantly impacted by social media exposure which also rose during COVID lockdowns. And, patients without access to their scheduled aesthetic procedures experienced worsened psychological symptoms.

Finally, while several studies conducted prepandemic clearly illustrate long lasting psychological improvement as a result of aesthetic procedures, the unique changes to our world as a result of COVID present a unique opportunity to support patients’ psychological wellness and screening out BDD will set your practice up for success.

References:

References:
1. Lee SA. Coronavirus Anxiety Scale: A brief mental health
screener for COVID-19 related anxiety. Death Stud.
2020;44(7):393-401. doi: 10.1080/07481187.2020.1748481.
Epub 2020 Apr 16. PMID: 32299304.
2. Stamu-O’Brien C, Carniciu S,Halvorsen E, Jaff erany M.
Psychological aspects of COVID-19. J Cosmet Dermatol.
2020;19:2169–2173.
3. Torales J, O’Higgins M, Castaldelli-Maia JM, Ventriglio A. The
outbreak of COVID-19 coronavirus and its impact on global
mental health. Int J Soc Psychiatry. 2020 Jun;66(4):317-320.
doi: 10.1177/0020764020915212. Epub 2020 Mar 31. PMID:
32233719.
4. Sarwer, D. B., Crerand, C. E., Magee, L. (2011). Cosmetic
surgery and changes in body image. In Thomas F. Cash &
Linda Smolak (Eds.) Body image: A handbook of science,
practice, and prevention (2nd ed.)., (pp. 394-403). New York,
NY:Guilford Press.
5. Gillen MM. Associations between positive body image
and indicators of men’s and women’s mental and physical
health. Body Image. 2015 Mar;13:67-74. doi: 10.1016/j.
bodyim.2015.01.002. Epub 2015 Feb 12. PMID: 25682474.
6. Rodgers R, Lombardo C, Cerolini S, Franko D, Omori M,
Fuller-Tyszkiewicz M, Linardon J, Quartet P, Guillaume S. The
impact of the COVID-19 pandemic on eating disorder risk
and symptoms. International J of Eating Disorders. 2020; 53:
1166-1170.
7. Swami V, Horne G, Furnham A. COVID-19 related stress
and anxiety are associated with negative body image in
adults from the United Kingdom. Personality and Individual
Differences. 2021; 170, 110246.

8. DOI: 10.1111/jocd.13509 Aesthetic dermatology procedures
in coronavirus days Ümit Türsen MD1 | Belma Türsen MD2 |
Torello Lotti MD3
9. Temiz S, Durmaz K, Dursun R, Ataseven A, Isik B, Karaagac
O, Ozer I, Date M. Eff ect of the COVID-19 pandemic on the
anxiety and depression levels in patients who applied to the
cosmetology unit. Dermatologic Therapy. 2021, 34: e14625.
10. Fardouly J, Vartanian L. Social media and body image
concerns: current research and future directions. Current
Opinion in Psychology. 2016; 9:1-5.
11. Walker C, Krumhuber E, Dayan S, Furnham A. Eff ects of social
media use on desire for cosmetic surgery among young
women. Current Psychology. 2019: 10: 1077.
12. Tiggemann M, Zaccardo M: Exercise to be fi t, not skinny’’: The
eff ect of fi tspiration imagery on women’s body image. Body
Image. 2015, 15:61-67http://dx.doi.org/10.1016/
13. Sorice, S. C., Li, A. Y., Gilstrap, J., Canales, F. L.,& Furnas, H. J.
(2017). Social media and the plastic surgery patient. Plastic
and Reconstructive Surgery, 140(5), 1047–1056.https://doi.
org/10. 1097/PRS.0000000000003769.
14. Castle, D. J., Honigman, R. J., & Phillips, K. A. (2002). Does
cosmetic surgery improve psychosocial wellbeing? Medical
Journal of Australia, 176(12), 601–604
15. Sarwer DB. Awareness and identifi cation of body dysmorphic
disorder by aesthetic surgeons: results of a survey of american
society for aesthetic plastic surgery members. Aesthet Surg
J. 2002 Nov;22(6):531-5. doi: 10.1067/maj.2002.129451. PMID:
19332010.
16. Grant, J. E., & Phillips, K. A. (2005). Recognizing and treating
body dysmorphic disorder. Annals of Clinical Psychiatry, 17(4),
205-210.
17. Oranges C, Schaefer K, Haug M, Schaefer D. The impact of
aesthetic surgery on body image and its implications for
mental and physical health. Aesthetic Surgery Jnl. 2016; 36(8),
256-258.
18. Imadojemu S, Sarwer DB, Percec I, Sonnad SS, Goldsack JE,
Berman M, Sobanko JF. Infl uence of surgical and minimally
invasive facial cosmetic procedures on psychosocial outcomes:
a systematic review. JAMA Dermatol. 2013 Nov;149(11):1325-
33. doi: 10.1001/jamadermatol.2013.6812. PMID: 24068036.
19. Timothy P. Moss & David L. Harris (2009) Psychological change
after aesthetic plastic surgery: A prospective controlled
outcome study, Psychology, Health & Medicine, 14:5, 567-572.
20. Margraf J, Meyer A, Lavallee K. Well-being from the
knife? Psychological eff ects of aesthetic surgery. Clinical
Psychological Science. 2013; 1(3) 239-252.

Additional References:

1. Türsen Ü, Türsen B, Lotti T. Aesthetic dermatology procedures
in coronavirus days. J Cosmet Dermatol. 2020;19:1822–1825.
2. Kaye K, Paprottka F, Escudero R, Casabona G, Montes J,
Fakin R, Moke L, Stasch T, Richter D, Benito-Ruiz J. Elective,
non-urgent procedures and aesthetic surgery in the wake of
SARS-COVID-19: Considerations regarding safety, feasibility
and impact on clinical management. Aesth Plast Surg. 2020;
44: 1014-1042.
3. Pietrobelli A, Pecoraro L, Ferruzzi A, Heo M, Faith M, Zoller T,
Antoniazzi F, Piacentini G, Fearnbach S, Heymsfi eld S. Effects
of COVID-19 lockdown on lifestyle behaviors in children with
obesity living in Verona, Italy: a longitudinal study. Obesity.
2020; 26(8) 1382-1385.
4. Cooper M, Reilly E, Siegel J, Coniglio K, Sadeh-Sharvit S,
Pisetsky E, Anderson L. Eating disorders during the COVID-19
pandemic and quarantine: an overview of risks and recommendations
for treatment and early intervention. Eating Disorders.
DOI 10.1080/10604266.2020.1790271

Crown Laboratories (“Crown”), a leading, fully integrated global skincare company, has finalized an agreement with Eclipse, a medical technology company, to acquire its global, aesthetics-focused assets. The acquisition expands Crown’s aesthetics’ product portfolio and enhances Crown’s overall value proposition as a global leader in science-based aesthetic skincare solutions.

“We pride ourselves on being at the forefront of today’s aesthetics market by developing and delivering best-in-class medical technologies and products that are exceptionally safe and effective,” said Jeff Bedard, President and CEO of Crown. “This strategic acquisition furthers Crown’s mission to drive innovation and provide superior products and customer service to aesthetics providers around the world. Eclipse’s excellent products will broaden our product line and customer base, domestically and internationally.”

“We are thrilled to have completed this transaction with Crown,” added Paul O’Brien, CEO of Eclipse. “The combination of Eclipse’s innovative product offerings with Crown’s leadership position in the aesthetics market will undoubtedly expand the reach and optimize the range of services health care professionals can provide to their patients.”

As an innovative company focused on skin science, Crown will integrate the Eclipse products into the Aesthetics business unit of Crown to complement its award-winning SkinPen® Precision and other brands. Eclipse customers can expect to continue receiving superior customer service, medical education, and access to Crown’s expanded range of highly effective aesthetic products.

About Crown Laboratories, Inc.

Crown, a privately held, fully integrated global skincare company, is committed to developing and providing a diverse portfolio of aesthetic, premium and therapeutic skincare products that improve the quality of life for its consumers throughout their skincare journey. An innovative company focused on skin science for life, Crown’s unyielding pursuit of delivering therapeutic excellence and enhanced patient outcomes is why it has become the leader in dermatology and aesthetics. Crown has been listed on the Inc. 5000 Fastest Growing Privately Held Companies List for eight years and has expanded its distribution to over 38 countries. For more information, visit www.crownlaboratories.com.

About Eclipse

Eclipse was established in January 1993 as a specialty surgical supply company. It quickly became a successful privately held medical device company and one of the pioneers in the aesthetic market, launching several energy-based devices globally. For more than 28 years, Eclipse has been an innovative leader in advancing medical technologies to bring medical supplies to practices in the U.S. and around the globe. Based in Dallas, Eclipse manufactures and distributes high-efficacy, affordable products to physicians that exceed patient expectations and put immediate profit into our partners' practices.

 

Source:

Crown Aesthetics