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The MVP of my practice

Article-The MVP of my practice

MVP Practice
Advancements in medical technology have catapulted the practice of aesthetic medicine from surgery and dermabrasion to a world of cutting-edge, effective, non-invasive modalities. For an aesthetic practitioner, whose work is dedicated to making their patients look and feel better, success is especially reliant on consistently providing efficacious results, so the role of the ‘right’ tools cannot be overstated. We asked several experts to reveal the ‘most valuable products’ in their practices and explain the “It” factor that makes these devices stand out from the crowd.

Advancements in medical technology have catapulted the practice of aesthetic medicine from surgery and dermabrasion to a world of cutting-edge, effective, non-invasive modalities. For an aesthetic practitioner, whose work is dedicated to making their patients look and feel better, success is especially reliant on consistently providing efficacious results, so the role of the ‘right’ tools cannot be overstated. We asked several experts to reveal the ‘most valuable products’ in their practices and explain the “It” factor that makes these devices stand out from the crowd.

“First, you must be clear on what your practice is all about, because that will be a key determining factor,” said dermatologist Michael H. Gold, MD, director of the Tennessee Clinical Research Center and Gold Skin Care Center (Nashville, Tenn.). “If the scope includes medical, then devices that help treat acne, psoriasis and vitiligo, but also have safe and effective aesthetic applications are particularly useful. If you are focusing on purely aesthetic concerns, the focus of your armamentarium and versatility within may be different.” He added that it is also important to look at what other practices in your area are doing, as well as what is in demand.

As far as specific categories go, Dr. Gold is a big believer in IPL, and with good reason. “This is one of the best technologies for anybody to have, by far,” he explained. “You can treat vascularity, pigment, acne and much more, both medical and aesthetic. You can also achieve collagen remodeling. Current IPLs from reputable companies are sophisticated in that they provide very consistent, safe and reproducible treatments. After that the latest ablative and non-ablative lasers, various microneedle devices, radiofrequency (RF) body contouring, and others, can be looked at based on how they fit into your practice.”

Reliability is a key factor as well. “The reputability of the company is important because you want something that won’t go down often or stay down long. If you take body contouring devices as an example, you are doing the same thing over and over, and you don’t want that functionality taken away from you for any length of time,” Dr. Gold emphasized.

Versatility is prized, which is where platform-based devices come into play. “As a community we like to do combination treatments to get the best outcomes,” Dr. Gold said, “and platforms are great for that. The downside with platforms, if you can call it that, is that you are tying up all that functionality each time you use the device, but the alternative is more devices which cost X amount of money and take up space. Again, you want to look realistically at what you are doing and what you want to do in the future.”

One example is Elite iQTM, the next generation of Cynosure’s (Westford, Mass.) Elite+TM Aesthetic Workstation, which was the first ever Alexandrite / Nd:YAG system on the market. “We rely on Elite iQ because it is easy to operate and made for heavy use,” said dermatologist E. Victor Ross, MD (San Diego, Calif.). “The built-in Melanin Reader makes it easier to navigate through safe treatment on the fly, regardless of skin type.

Energy-Based Devices, Sexual-health, Feminine Rejuvination, Lasers

Michael H. Gold, MD Dermatologist

Tennessee Clinical Research Center
Gold Skin Care Center Nashville, TN

E. Victor Ross, MD

E. Victor Ross Dermatologist San Diego, CA

lasers, nonsurgical procedures, fat reduction, sculpting, microneedling

Erez Dayan, MD Plastic Surgeon
Medical Director
Avance Plastic Surgery Institute Reno, NV

microneedling, potenza, skin rejuvenation, acne, scars, wrinkles

Emil Tanghetti, MD Dermatologist Sacramento, CA

cosmetic surgery, plastic surgery, aesthetics, education, practice management

S. Randolph Waldman, MD Waldman Schantz Plastic Surgery Lexington, KY

David Shafer, MD

David Shafer, MD Plastic Surgeon
Shafer Clinic Fifth Avenue New York City, NY

Gaurav Bharti, MD

Gaurav Bharti, MD H/K/B Surgeons Charlotte, NC

Bill Kortesis, MD

Bill Kortesis, MD H/K/B Surgeons Charlotte, NC

Lois Wagstrom, MD
Lois Wagstrom, MD Plastic Surgeon Nashville, TN

Janine Hopkins, MD

Janine Hopkins, MD Medical Director
 Hopkins Dermatology Monroe, LA

PRP, Platelet-rich Plasma, thread lift, dermal filler, neurotoxins, laser

Gregory Laurence, MD Cosmetic Surgeon
Germantown Aesthetics Germantown, TN

“It features a larger range of spot sizes up to 24 mm, and you can use higher fluences and rep rates at those spot sizes,” Dr. Ross added. This advanced platform, which also features an enhanced, intuitive user interface with a new dashboard design, enables practitioners to perform the most requested aesthetic treatments to both revitalize and treat common skin concerns including facial and leg veins, sun damage, facial wrinkles and razor bumps.

Elite iQ also offers faster, personalized laser hair removal treatments at a higher maximum energy compared to previous generation devices to permanently reduce unwanted hair for all skin types, anywhere on the body including the face, back, chest, arms, underarms, bikini area and legs. Skintel® technology, a live Melanin ReaderTM, allows for customizable, real-time adjustment of treatment settings, hurdling challenges historically encountered when treating darker skin types.

According to Harvard-trained plastic surgeon Erez Dayan, MD, medical director of Avance Plastic Surgery Insitute in Nevada, when considering devices in the plastic surgery setting, we are targeting skin, fat and/or muscle. “For skin resurfacing, there are lasers such as CO2 and erbium, or options such as RF microneedling that can both resurface and tighten skin. We can do a lot for fat, but reliable skin tightening is essential to ensuring a satisfied aesthetic patient,” he explained.

“In our practice, minimally or non-invasive RF devices are workhorses in that capacity because they not only give us a skin tightening option, they fill the gap between less aggressive protocols involving injectables and skincare, and surgical intervention,” Dr. Dayan continued. “That gap is quite large and growing. Surgery is often too aggressive for middle aged patients, but lesser options have traditionally fallen short.”

For Emil Tanghetti, MD, a dermatologist in Sacramento, Calif., the SmartXide Tetra CO2 laser with CoolpeelTM from DEKA M.E.L.A. (Florence, Italy), which features the company’s proprietary PSD® Technology, stands out due to its ability to provide selectable pulse shapes for specific skin conditions to achieve superior results in minimal time. “We know the capabilities of the laser, so with SmartXide Tetra we are turning the technology on its head with short pulse, high peak power, low energy treatment that wounds superficially for a quick and low downtime procedure that is extremely comfortable,” he stated.

SmartXide Tetra allows users to manage downtime; the Coolpeel delivers a fully ablative treatment without damaging surrounding tissue for impressive superficial, no-downtime skin resurfacing results. SPRAY mode allows for complete erasure of post-laser demarcation lines, and other modes include a random delivery mode (SmartTrackTM) and STACK mode, which provides deep treatment functionality.

“Histology shows an ablated epidermis and wounded superficial dermis much like a thulium laser, but without the epidermal dehydration,” Dr. Tanghetti reported. “You can use it by itself or in conjunction with a deeper treatment like RF microneedling, which doesn’t have the superficial component, for a more comprehensive treatment.”

In terms of microneedling, Dr. Tanghetti is also a fan of the VivaceTM from Aesthetics Biomedical (Phoenix, Ariz.). As a next-generation RF microneedling device, the Vivace is designed for a comfortable patient experience with superior, natural-looking results. This minimally invasive FDA-cleared treatment stimulates the natural production of collagen and is shown to be effective in alleviating facial wrinkles and fine lines as well as tightening and toning the face, neck, hands and body.

“The Vivace provides a quick, safe, effective low-downtime treatment requiring only topical anesthetic so it can be delegated to staff,” Dr. Tanghetti pointed out. “We initially used it by itself, but we have learned to combine it with other low-impact procedures on the same day, such as more superficial lasers. And after treatment, patients can go back to work the next day.”

S. Randolph Waldman, MD of Waldman Schantz Plastic Surgery (Lexington, Ky.), has come to count on the PiXel8-RF microneedling device in his practice. “In my experience it is particularly effective for acne scarring, enlarged pores and facial dyschromia.” This system was developed to combat the signs of aging with bipolar RF energy alongside minimally invasive microneedles to facilitate effective, nonsurgical skin tightening. During treatment, heat is driven deep within the skin to stimulate and remodel collagen and cause elastin cells to regenerate for a firmer, smoother and more consistent skin surface.

PiXel8-RF may improve fine lines, wrinkles, acne scars and striae. It is suited for all skin types, and after a single treatment, most patients notice that the area treated is smoother and softer. The amount of energy delivered is adjust- able and the microneedles can also be adjusted from .5 mm up to 3.5 mm to address individual patient needs. “The limited variables in settings and the safety make it easy to delegate to well-trained ancillary staff,” Dr. Waldman added.

Bridging a gap in the armamentarium, DiamondGlowTM skin resurfacing treatment from Allergan (Irvine, Calif.) gently exfoliates while infusing essential nutrients and skin boosting serums to give the skin a youthful-looking glow. The device is used in conjunction with one of four SkinMedica® Pro-Infusion Serums: Ultra Hydrating, Vitamin C, Skin Brightening and Pore Clarifying.

“DiamondGlow can be perfect for a one-off special event or integrated into a patient’s skincare maintenance routine,” said David Shafer, MD of the Shafer Clinic Fifth Avenue (New York City, N.Y.). “What I enjoy most is that it truly is for all skin types and as a provider, we can tailor the treatment to the patient’s unique needs and concerns following professional assessment. In addition to the different serums, the diamond tips are customizable as well for a totally unique treatment. For someone with sensitive skin, your provider will select a finer diamond tip; for deep exfoliation, your provider may start out with the coarser tip and progress to the fine tip for the final touch. We recommend maintaining these transformative results with a specially curated regimen of SkinMedica products.”

In the realm of body sculpting as well, there are new devices being introduced to improve results and fill voids. Fat reduction devices have come a long way. “We have one device that provides electric muscle stimulation (EMS) and has a RF module that treats fat and tightens skin depending on which applicator you use,” Dr. Dayan noted. “Versatility is important because patients come in all shapes and sizes and have different aesthetic concerns. The more options we have, the more we can do overall, and the better the global outcome for a patient will be.”

As a high-volume plastic surgery practice with lots of body contouring and liposuction, Gaurav Bharti, MD and Bill Kortesis, MD, of H/K/B Surgeons in Charlotte, N.C., are very familiar with technology in the space. Combining helium plasma with a proprietary RF energy to deliver even, controlled deposition with exceptional precision, Renuvion® from Apyx Medical (Clearwater, Fla.) heats tissue in a way that was never before possible, resulting in rapid tissue contraction that is not reliant on bulk heating. “Skin contraction using Renuvion does wonders to help us avoid skin resection and scars,” said Dr. Bharti.

“Whether in an adjunctive role or as a stand-alone therapy, this technology delivers consistent, predictable, significant results unlike anything else we have ever seen.” Dr. Kortesis agreed. “It has been a game-changer for us,” he said. “We use it often, believe in it, and it definitely shows in the results we can now achieve.”

Devices that play an adjunctive role are becoming ubiquitous. “For so many procedures, adding a less invasive device-based treatment is what pushes the surgical result over the top,” Dr. Dayan expressed. “Contracting skin and touching up a result after liposuction is a difference maker.”

When it comes to treating capsular contracture, reducing swelling, ecchymosis and other side effects of liposuction, Lois Wagstrom, MD, a plastic surgeon in Nashville, Tenn. has had tremendous success using Z WaveQ from Zimmer MedizinSystems (Irvine, Calif.). Z WaveQ is Zimmer Aesthetic Division’s latest shock-wave technology, featuring an innovative water-cooled generator for high efficiency and durability with a softer sound, without losing efficacy.

“But what really excites me about it,” Dr. Wagstrom began, “is the success we have had tightening the upper arm in patients who don’t want or need liposuction in that area, where scars are very visible.”

Z WaveQ features a new ergonomic hand- piece with “shock absorber,” offering the industry’s quietest operation and the highest level of safety. Other technology advancements result in a softer pulse and maximum comfort to the patient. It can also be used as an adjunct to body con- touring treatments for enhanced results.*

Janine Hopkins, MD, medical director of Hopkins Dermatology in Monroe, La., says SP Dynamis is an essential part of her anti-aging restoration protocol: neuromodulators to relax expression lines, fillers to restore volume and Fotona laser for skin rejuvenation. “Fotona4D provides a nonsurgical treatment to tighten and treat skin laxity and photodamage on the face, including the eyelids and neck, to provide the youthful, healthy look patients want that you simply cannot achieve with injectables alone.”

By combining two complementary wavelengths, the Fotona SP Dynamis laser is a highly versatile, multi-purpose system that can perform an exceptionally wide range of treatments in a single platform. Key treatments include, but are not limited to, Fotona4D® non-invasive laser facelifting, TightSculpting body contouring, acne and acne scar revision, pigmented lesions, vascular lesions, onychomycosis, permanent hair removal and NightLase® non-invasive snoring treatment.

Cosmetic surgeon Gregory Laurence, MD of Germantown Aesthetics (Germantown, Tenn.) relies on the Slim EVO ll CO2 with V-Lase from Lasering USA (San Ramon, Calif.), as the only non-ablative CO2 laser for vaginal therapy sold in the U.S. “The defocused ‘flash’ pulsing of the laser for internal vaginal applications delivers thermal energy rapidly and comfortably for the patient,” he said. “The same technology is applied for external tightening of the vaginal introitus using a specifically-designed applicator, rather than the probe used in internal applications.”

Being non-ablative, Slim EVO ll has no risk of intra-operative tissue injury or post-op side effects. It is also non-fractional, utilizing a large 10 mm collimated laser spot which gently heats up the vulvovaginal tissue. No topical anesthetic or smoke evacuator is required, there is no post-op downtime of any kind, and there are no consumables as the V-Lase attachment is steam sterilizable and reusable. This 15-minute procedure induces neocollagenesis and neovascularization in treated tissue.

In Dr. Gold’s final tip, consider the company you keep. “Working with reputable companies, especially as we come out of the COVID-19 crisis, is essential because it is not just the company’s job to be accessible,” Dr. Gold stated, “you have to maintain those relationships and stay on top of new developments to get the most out of your devices. We took a big hit in the aesthetic medical business; everybody took a beating these last few months and is looking to regroup, so dealing with strong and experienced companies will help you right the ship.”

*Editor’s note: Z WaveQ is FDA cleared for the temporary reduction of the appearance of cellulite, the temporary increase in local blood circulation, and to relieve minor muscle aches and pains.


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