Dr. Emer

This year was the 10th Annual Summer Meeting for Cosmetic Bootcamp, held at the St. Regis, Aspen, Colo., June 12-15. Even if you wanted to attend this year, you had to register early to get a guaranteed seat — the meeting hit capacity this year and had a registration waitlist! Since I was fortunate enough to be in attendance, the editor of Cosmetic Surgery Times invited me to share my takeaways. 

1. Combine or be left behind

Combination treatments give more impressive results. Vic Narurkar, M.D., lectured about global facial rejuvenation and his combination of Fraxel or Clear and Brilliant for improvement in texture and tone; Thermage for skin tightening; fillers such as Voulma for volume and facial contour; and Botox (neuromodulation) for dynamic lines of the forehead, glabella and crow's feet. According to Dr. Narurkar, this combination of treatments provides optimum outcomes and high patient satisfaction.

2. The consultation is key

The cosmetic consultation is extremely important not only for suggesting treatments and offering long-term plans, but also for developing your patient relationships and demonstrating confidence and success. Here's the golden nugget: Listen to what your patients want, but give them what they need. Suggest the most appropriate treatments for the best results, not only what the patient believes he or she needs.

​3. Neglected areas of the past are no more

Don't forget the neck, chest, hands, temples, forehead and lashes. Patients may not seek out rejuvenation of these areas, but it is our responsibility as aesthetic physicians to start the conversation if treatments in these areas would give enhanced aesthetic results. The neck, chest and hands can be treated safely and effectively with lasers, light and peels for textural improvements, as well as fillers for "crepey," wrinkled skin. Treating the temples not only provides improvement in lost volume, but also rejuvenates the entire periorbital area by providing an indirect eyebrow lift.

Wrinkles of the forehead can be addressed with a combination of Botox (neuromodulation) and deep depot filler injection, which is specifically impressive in patients with deep midline horizontal lines, a "neanderthal" type forehead, or those with low eyebrows for which excessive toxin may improve wrinkling but cause eyebrow ptosis.

4. Beauty comes from within ... jars, tubes and bottles

Don't forget to offer skincare product options to your patients. Combining treatments with at-home skincare product use can improve patient satisfaction, enhance the results of treatments, and increase compliance and revenue. It was discussed that fractional laser delivery of skincare can enhance results. Research is focusing on the use of antioxidants, growth factors and skin-brightening products after fractional laser therapy to enhance the topical delivery of skincare. This may translate to alternate uses for lasers and topical medications to treat other dermatological conditions such as skin cancer or psoriasis.

5. Use blunt-tipped cannulas for a painless procedure

There is an increased trend to using blunt-tipped microacannulas for the placement of fillers, as they have less risk of bruising or swelling and and can be used in thin skin or high-risk areas. They also cause little to no pain during injection. The best locations for use include the midface, marionette lines, jawline, preauricular area and temples. From very few entry points, multiple locations of the face can be accessed and treated with less risk of bruising and swelling as compared to sharp needle.

• Mary Lupo, M.D., demonstrated the use of cannula for filler placement into the dorsal hands. The blunt-tipped instrument bounced off vessels and caused no pain, with significant improvement in the tendinous appearance of the hand.
• Jose Montes, M.D., showed his technique of using the cannula to fill lines of the upper and lower eyelids in patients with dark circles and fine wrinkling of the periorbital area.

6. Use the pico for pigment

Picosecond Q-switched laser technology goes beyond the tattoo. Roy Geronemus, M.D., discussed the most advanced laser technology for treating pigmented lesions and tattoos, the picosecond laser. The fast pulses of this laser give superior results with less epidermal injury compared with the older nanosecond Q-switched lasers. Focused (fractionated) handpieces may offer superior treatment for scars, striae and photodamage. Studies are already under way and many companies are said to be creating devices. Stay tuned...

7. Go green to get rid of red

The Cutera Excel V laser (KTP, long-pulsed Nd:YAG) is a modern platform for treating facial redness, acne, scars, veins and vascular malformations of all depths. Joely Kaufman, M.D., presented an excellent review of a vast array of clinical cases for which she chose to use this modern laser system that offers high energy in short pulses for exceptional clinical results. Contact cooling and versatility in parameters makes this a laser of choice in her practice.

8. Fat is the future

Grant Stevens, M.D., discussed his experience with all the noninvasive body contouring devices that are dominating the fat loss and skin tightening market. Although liposuction is still one of the highest sought out cosmetic surgical procedure, many more patients are seeking a quick and painless way to shed the pounds and tighten their bodies. This is a quickly growing market and aesthetic physicians are rushing to get involved.

9. Say hello to Halo

Halo, the first fractional hybrid laser combining both ablative (2,940 nm) and nonablative (1,470 nm) wavelengths for skin rejuvenation, was demonstrated at the conference. It offers the ability to fully tailor treatments for individual skin types with differing degrees of photodamage with very little pain and downtime.

10. ATX101 is on the horizon

Injectable medications for submental fat reduction are coming. Could ATX101 possibly replace liposuction as a gold standard treatment? Only time will tell!

Sports-related facial injuries that require surgical correction have a higher incidence in the summer months and according to a study in the June issue of Plastic and Reconstructive Surgery-Global Open, maxillofacial trauma is also a commonly reported injury in Brazilian soccer players.

“As with any sport, soccer provides both agony and ecstasy for its fans — as well as the occasional injury,” Dov Charles Goldenberg, M.D., Ph.D., and colleagues at the University of São Paulo, Brazil, noted in the study.

While the most frequent injuries are orthopedic in nature, serious injuries to the face are also an issue, as the face is unprotected.

“Maxillofacial trauma sustained during soccer games often entails serious facial injuries requiring hospital admissions and invasive procedures,” study authors wrote.

Researchers performed a retrospective review of patients from two university hospitals in São Paulo who sustained soccer injuries from 2000 to 2013 and underwent surgical treatment for facial fractures; 44 of 45 patients were male, with an average age of 28. Nasal bone and orbitozygomatic fractures each occurred in 16 patients, mandibular fractures in seven patients, orbital fractures in six patients and frontal and nasoorbitoethmoid fractures each in one patient. The majority of injuries resulted from physical contact among players (n = 39). Only six patients reported injury as a result of the ball itself.

Most facial fractures were repaired with open surgery and the internal use of plates and screws to reposition bones. Fractures of the nose required repositioning bones and splinting. The average hospital stay was five days, with six to eight weeks required for healing before retuning to the soccer field.

The authors suggested that the rate of soccer-related facial trauma is likely much higher than reported, citing socioeconomic factors, and the possibility that many nasal fractures may only be treated with anti-inflammatories and analgesics, as they frequently present without clinically evident deviations.

As a result, the researchers stressed the importance of generating awareness of the frequency of these kinds of injuries as well as knowledge of the anatomy among first responders, nurses and physicians.

“Furthermore, missed diagnosis or delayed treatment can lead to facial deformities and functional problems in the physiological actions of breathing,” they concluded.

CoolSculpting, an FDA approved non-surgical treatment for fat reduction of the flank and abdomen, has recently received an expanded approval to also treat and sculpt the thigh areas. Could this new indication be the next hot niche to be explored? Dr. Lawrence Broder, MD, a cosmetic surgeon in Austin, Texas, offers his opinion.

Creating Thigh Gap

“With this new FDA-approval the technique can now be used to help patients achieve that coveted thigh gap. Women who are thin and have wide hips—due to genetics—can often achieve a thigh gap naturally; however, those who do not have that particular genetic makeup can now achieve a gap through CoolSculpting procedures on their thighs.”

Curious patients will want to know: Does it work?

Dr. Broder: “With addition of the thigh areas, this treatment is now the only cold-based fat reduction technique that has passed clinical trials. Interestingly, during those FDA clinical trials, 86% of participants claimed to see a visible reduction in their thighs approximately 16 weeks after the procedure.”

While CoolSculpting is a non-invasive fat reduction/body sculpting option, it’s important to set expectations with patients. “This approval is great news for those who are looking for a non-invasive, safe procedure to achieve slimmer thighs, including the popular and coveted thigh gap look,” says Dr. Broder. “However, erythema and minor urticarial plaques may occur, as well as some bruising and residual numbness.”

The Making of ‘ManLand’

If you happened to attend any one of Dr. Grant Steven’s presentations at this year’s Vegas Cosmetic Surgery 2014 meeting, you know he’s been very successful in making CoolSculpting work for his. In “Marketing a New Product or Service,” Dr. Stevens, Marina del Rey, Calif., told the audience, “I never dreamed I’d have seven machines.”

But it didn’t happen all at once.

Using a strategic growth model, he generated an awareness and strong brand association for his practice with this non-surgical fat reduction device.  Importantly, he is nurturing a specific patient niche based on trends and real numbers. More than half of his CoolSculpting business comes from men. That’s right: 51 percent, to be precise. As a result, the next step for him is the soon-to-open ManLand at Marina Plastic Surgery, designed specifically for this patient segment where men can get “more hair on their heads and less on their back” in the company of attractive staff members and sports on the big screen. As for any concerns about the nearly 4-hour treatment time required to treat certain areas? "I have two deveices in each room." And that means half the treatment time.

Related article: “Marketing a New Product or Service? 4 Steps to Success"

CoolSculpting, an FDA approved non-surgical treatment for fat reduction of the flank and abdomen, has recently received an expanded approval to also treat and sculpt the thigh areas. Could this new indication be the next hot niche to be explored? Dr. Lawrence Broder, MD, a cosmetic surgeon in Austin, Texas, offers his opinion.

Creating Thigh Gap

“With this new FDA-approval the technique can now be used to help patients achieve that coveted thigh gap. Women who are thin and have wide hips—due to genetics—can often achieve a thigh gap naturally; however, those who do not have that particular genetic makeup can now achieve a gap through CoolSculpting procedures on their thighs.”

Curious patients will want to know: Does it work?

Dr. Broder: “With addition of the thigh areas, this treatment is now the only cold-based fat reduction technique that has passed clinical trials. Interestingly, during those FDA clinical trials, 86% of participants claimed to see a visible reduction in their thighs approximately 16 weeks after the procedure.”

While CoolSculpting is a non-invasive fat reduction/body sculpting option, it’s important to set expectations with patients. “This approval is great news for those who are looking for a non-invasive, safe procedure to achieve slimmer thighs, including the popular and coveted thigh gap look,” says Dr. Broder. “However, erythema and minor urticarial plaques may occur, as well as some bruising and residual numbness.”

The Making of ‘ManLand’

If you happened to attend any one of Dr. Grant Steven’s presentations at this year’s Vegas Cosmetic Surgery 2014 meeting, you know he’s been very successful in making CoolSculpting work for his. In “Marketing a New Product or Service,” Dr. Stevens, Marina del Rey, Calif., told the audience, “I never dreamed I’d have seven machines.”

But it didn’t happen all at once.

Using a strategic growth model, he generated an awareness and strong brand association for his practice with this non-surgical fat reduction device.  Importantly, he is nurturing a specific patient niche based on trends and real numbers. More than half of his CoolSculpting business comes from men. That’s right: 51 percent, to be precise. As a result, the next step for him is the soon-to-open ManLand at Marina Plastic Surgery, designed specifically for this patient segment where men can get “more hair on their heads and less on their back” in the company of attractive staff members and sports on the big screen. As for any concerns about the nearly 4-hour treatment time required to treat certain areas? "I have two deveices in each room." And that means half the treatment time.

Related article: “Marketing a New Product or Service? 4 Steps to Success"

There may not be a magic formula for making a new service or product successful in your aesthetic practice, but there is a four-step process Grant Stevens, M.D., shared during his presentation “Marketing a new product or service” at Vegas Cosmetic Surgery 2014.

Dr. Stevens illustrated his point on Saturday using a case study with CoolSculpting in his practice. “I never dreamed I’d have seven machines,” he said. “I’m averaging 80-plus cycles with CoolSculpting per week.” What’s more, 51 percent of his patients are male, he added.

How did he achieve such success with this nonsurgical fat treatment device?

“I’m successful because of marketing,” he said.

In 2010, Dr. Grant’s office performed 201 cycles of CoolSculpting. This year, he’s on track to hit 5,000 to 6,000 cycles. Because the majority (51 percent) of his CoolSculpting patients are men, Dr. Grant is soon opening ManLand at Marina Plastic Surgery, a treatment center designed exclusively for this patient segment, where men are surrounded by attractive staff members, can watch sports on TV and are perfectly comfortable getting the treatments they desire. According to Dr. Stevens, that means “more hair on their heads and less on their back. Men want to treat love handles, the tummy, and ‘moobs.’”

Four marketing stages

1. Introduce the product to your staff, friends and family

This is how to begin accumulating before and after treatment pictures for later marketing efforts.

2. Reach out to your top 100 patients

These are your patient ambassadors, explained Dr. Stevens. They will help you spread the word.

3. Reach out to your current patients

The next logical step in expanding your reach.

4. Reach out to new/prospective patients

The final step in ultimate market opportunity.

First things first. You need to be able to show that the treatment you’re selling works, Dr. Grant explained.

• Internal: Send out an eblast announcement promoting the treatment to those closest to you.
• External: Create a procedure-driven microsite. FreezetheFat.com was designed by Dr. Stevens to promote CoolSculpting.

Next, set the stage for patient awareness and growth.

• Internal: Brand the office with materials provided by the device manufacturer; create a video loop for the office with patient before and after pictures and other relevant promotional information and materials; prep your patient coordinator to talk about these treatment to patients.
• External: Consider local print ads; refine your website/microsite; include patient before and afters, news and upcoming events.

Finally, cast a wide net to patients and prospective patients.

• Internal: Beauty blasts – Treatment promotions  
• External: Dr. Stevens used several successful external marketing efforts, including billboards (which was picked up and used by Jerry Seinfeld), ESPN radio (to target men), coffee sleeves, lip balms and airplane banners.

One of the secrets to Dr. Grant’s marketing success? “We let the growth pay for the next step,” he said. “We didn’t start with the billboards.”

Follow our VCS 2014 coverage

When you consider bringing a new device into your practice, key questions usually include (a) can I turn a profit and (b) will it deliver promised results? (Not necessarily in that order.) When it comes to CoolSculping (Zeltiq), specifically, two cosmetic surgeons offer clinicians their perspective.

Creating thigh gap

CoolSculpting, nonsurgical treatment approved by the Food and Drug Administration for fat reduction of the flank and abdomen, has recently received an expanded approval to also treat and sculpt the thigh areas. Could this new indication be the next hot niche to be explored? Lawrence Broder, M.D., a cosmetic surgeon in Austin, Texas, offers his opinion.

“With this new FDA-approval the technique can now be used to help patients achieve that coveted thigh gap. Women who are thin and have wide hips — due to genetics — can often achieve a thigh gap naturally; however, those who do not have that particular genetic makeup can now achieve a gap through CoolSculpting procedures on their thighs.”

Curious patients will want to know: Does it work?

“With addition of the thigh areas, this treatment is now the only cold-based fat reduction technique that has passed clinical trials," Dr. Broder says. "Interestingly, during those FDA clinical trials, 86 percent of participants claimed to see a visible reduction in their thighs approximately 16 weeks after the procedure.”

While CoolSculpting is a noninvasive fat reduction/body sculpting option, it’s important to set expectations with patients.

“This approval is great news for those who are looking for a noninvasive, safe procedure to achieve slimmer thighs, including the popular and coveted thigh gap look,” he says. “However, erythema and minor urticarial plaques may occur, as well as some bruising and residual numbness.”

The making of ‘ManLand’

If you happened to attend any one of the presentations by Grant Stevens, M.D., at this year’s Vegas Cosmetic Surgery 2014 meeting, you know he’s been successful in making CoolSculpting work for his practice. In “Marketing a New Product or Service,” Dr. Stevens, of Marina del Rey, Calif., told the audience, “I never dreamed I’d have seven machines.”

But it didn’t happen all at once.

Using a strategic growth model, he generated an awareness and strong brand association for his practice with this non-surgical fat reduction device. Importantly, he is nurturing a specific patient niche based on trends and real numbers. More than half of his CoolSculpting business comes from men.

That’s right: 51 percent, to be precise.

As a result, the next step for him is the soon-to-open ManLand at Marina Plastic Surgery, designed specifically for this patient segment where men can get “more hair on their heads and less on their back” in the company of attractive staff members and sports on the big screen. As for any concerns about the nearly four-hour treatment time required to treat certain areas?

"I have two deveices in each room," he says. And that means half the treatment time.

Related article: “Marketing a new product or service? 4 steps to success"