| CONTENTS ARTIClES
14 coVer Story How to enhance lips with hyaluronic acid Lakhdar Belhaouari illustrates how any aesthetic treatment requires a perfect understanding of anatomy, physiology and the ageing process
22 on tHe coVer Futuristic approaches to skin care: stem cells, genes and topical treatment Neil S. Sadick describes how a formulation enriched with biopeptides improves multiple signs of skin ageing
34 on tHe coVer cosmetic uses of botulinum toxin a in central brow frown lines Anthony V. Benedetto explains functional anatomy, problem assessment, dosing, outcomes, adverse events and treatment implications to be considered when treating glabellar frown lines
48 on tHe coVer the ageing face in a multiethnic world Paul J Carniol describes facial ageing, and provides insights, practical tips and management strategies for facial ageing in multiethnic patients
p58 Neurotransmitter
research has been at the heart of the development of products to treat seemingly myriad diseases, both in the mainstream medical and in the alternative sectors.
pRACTICE mANAgEmENT
66 incorporating skin care products into your practice Mary P Lupo explains how the inclusion of cosmeceuticals into the practice of dermatology is good for both patients and doctors
p34 OpINION
58 neurotransmitters in ageing and disease
Peter Charlish explains how neurotransmitters are related to age, disease and physiological function
62 deregulation “the wrong route” Ashley Yeo reports on how less regulation of lasers and IPL are changing the market
70 ergonomics for an aesthetic office
Steven K. Cordonnier on why investing in the ergonomics of your practice can lead to business success as well as a long and healthy career
pROdUCTS
76 the latest product news and technologies for the aesthetic and anti-ageing market
EVENTS
78 a round-up of the major industry events happening around the world over the next 12 months
prime-journal.com | March 2011 ❚ 7
PrActice mAnAgement | SKIN CARe PRoDUCTS | Into your practIce
IncorporatIng skIn care products
Mary P Lupo explains how the inclusion of cosmeceuticals into the practice of dermatology is good for both patients and doctors
A
MARY P LUPO, MD, FAAD Clinical Professor of
Dermatology, Tulane Medical School, New Orleans, LA
Founding Director, Lupo Center for Aesthetic and General
Dermatology , New Orleans, LA email
DrLupo@DrMaryLupo.com
w Orleans and KEYWORDS
Cosmeceutical; antioxidant; ethics; exfoliant; collagen- stimulating; dermatologist
al; antio ollagen- dermatologists 66 ❚
ll dermAtologists mAke skin cAre recommendAtions to their patients. medical dermatologists diagnose and treat a myriad of skin conditions that require adjunctive topical care to complement the prescription treatments. Atopic dermatitis, contact dermatitis, psoriasis, seborrheic dermatitis, and rosacea are just some of the most commonly diagnosed conditions that should have strict protocols to
help treat and then prevent flares of these skin diseases. Acne treatment with retinoids can lead to dry, inflamed skin if the dermatologist does not properly instruct the patients with skin care recommendations that help to hydrate and protect the epidermal barrier. retinoid irritation can result in non-compliance and treatment failure if skin care instructions are not outlined by the treating dermatologist. surgical dermatologists who diagnose and treat skin cancers always admonish these patients h
to protect their skin from the risk of future skin cancers by using skin creams that provide adequate ultraviolet (sPF) protection. Finally, cosmetic or “procedural” dermatologists utilize cosmeceutical protocols to prepare the skin for treatments such as chemical peels and laser, to complement the benefits and speed healing of these procedures, and use skin care to maintain the benefits of these treatments.
skin Using products such as retino post-laser and
hydroquinone is a gold standard in pre -based
treatments(1). For these reasons,
oiids and e--
light-based it is a
natural extension of the dermatologists’ care to include these topical cosmeceutical products in treatment recommendations and to incorporate practices.
Patients for
them into their look
to th direction on which
product to recommend, ethica and medical
practices
products to purchase for their individual needs and goals. The decision of which all business of
selling
cosmeceuticals, and the logistics of adding this service are important considerations that must be resolved.
March 2011 |
prime-journal.com their
How to choose products In
order to
recommendations important
make to
patients,ts
cosmeceutical it
is to understand the potential
benefit that a product can deliver and which medical or cosmetic condition may respond to that product. Some of the clinical
diagnoses that dermatologists
treat which can be improved with the addition of appropriate complementary cosmeceuticals
include skin cancer,
photoageing, acne, rosacea, melasma, and any skin condition that results in lipid barrier disruption (i.e., atopy). Some topical prescription 5-fluoruracil,
elasma, remedies such imiquimod, as and aminolevulenic acid for actinic damage
and adapalene, tretinoin, and tazarotene for acne or photoageing, all require complementary topical care to protect from ultraviolet light and epidermal barrier disruption. If a dermatologist wants to offer skin
care products for sale out of their office, there are common categories of products that would likely be included. Photoprotective products, antioxidants, collagen-stimulating products, pigment lightening, exfoliants, area-specific products, cleansers, and barrier- restorative would be good categories to offer. Many products do multi-tasking such as retinol, which is both pigment lightening and collagen stimulating, and alpha hydroxy acids which exfoliate, thereby improving acne as well as dyschromia. Photoprotection creams, or sunscreens, are the most important recommendation that dermatologists can make to patients. Rosacea,
skin
photoageing, dermatoses
like cancers, and melasma, polymorphic
light-sensitive light
eruption, are just some of the medical conditions needing regular
sunscreen
use. It is critical that pulsed light, peel, and laser
patients prevent use sun pigmentation
post-inflammatory immediately
protection
before procedures to begin the process of correction, and after the procedure to
hyper- post-
procedure and consistently over time to maintain the benefit of these paid-out-of- sm
pocket and costly cosmetic procedures. The benefits of hydroquinone
using both pre-
retinoids and and
post-
treatment have been proven to enhance results and these products can irritate the skin, so adequate sun protection enhances
their tolerability. Much
progress has been made recently in
improvement A of rays broad
spectrum sunscreens, especially with improved protection from ultraviolet
and
improvement in photo-stability of final product formulations.
Antioxidants purportedly complex free radicals that have various deleterious effects on the skin. Free radicals crosslink collagen and accelerate its breakdown. It would make sense to use this product class to protect from increases of matrix metallo- proteinase
I (MMP-1, collagenase) and
sunburn cell formation that result from ultraviolet light exposure. UVR also causes NK– ß activation and the production of
prime-journal.com | March 2011 ❚ practice management | ergonomics in the workplace |
ergonomics for an
aesthetic office
Steven K. Cordonnier on why investing in the ergonomics of your practice can
lead to business success as well as a long and healthy career
one that is barely surviving. this is why it should be an important component during the design and layout of any examination or procedure room and aesthetic office. it should also be a consideration during any equipment purchases and staff
e healthcare 70 ❚ training.
Unfortunately, ergonomics is often an overlooked area that many times is not given serious attention. When it comes to facilities,
rgonomics plays an extremely vital role in an aesthetic office. it can often mean the difference between a very successful and growing practice and
Benefits of ergonomic principles the benefits of implementing good ergonomic principles in the aesthetic office are many. and these benefits are felt by patients, physicians, and staff. as we mentioned earlier, the two most significant benefits of ergonomic principles are that the office and exam rooms will be more comfortable and safe for everyone. these two factors alone can directly influence the quality level of the physician/ patient relationship during a visit. Following are the benefits, including
ergonomic principles are just as important for patients as it is for physicians and staff. For patients, the issue is also one of accessibility, which can often be tied to ergonomic principles. When implemented correctly, ergonomic principles can help the healthcare facility owner achieve the highest levels of comfort and safety for patients, physicians, and staff. the foundation for any efficient and successful practice is the level of comfort and safety provided by the facility, especially its exam and procedure rooms.
For patients, the level of comfort can directly
influence their level of anxiety and help ease “white-coat syndrome”
comfort and safety, that can be realized when ergonomic principles are implemented in an aesthetic office.
Comfort comfort is one of those basic human needs, that when met, can help put someone at ease, foster efficient
performance, and help facilitate a pleasant experience. these results are especially important in a health-care environment. For patients, the level of comfort can
directly influence their level of anxiety and help ease “white-coat syndrome.” meanwhile, physicians need to be comfortable in their environment in order to provide efficient and effective patient care.
March 2011 |
prime-journal.com For instance, the inability to easily
maneuver in the examination or procedure room can often cause physicians to alter their work style over time, which can result in repetitive motion injuries. simple comfort considerations in design and equipment can play a significant role in helping physicians conduct a more thorough and accurate exam or procedure and increase the overall satisfaction level of the patient.
Safety it is important that patients and staff feel safe when they are in the office and exam/ procedure room. a safe environment is conducive to a pleasant experience for everyone. if a patient does not feel safe, they may become agitated and decide not to visit this office in the future. staff who do not feel safe may become dissatisfied and decide to look for different employment. and if an accident does occur, a safety concern can quickly lead to a liability issue. For example, with the average age of
patients on the rise, it is more likely that patients may need assistance in accessing an exam or procedure table. in many facilities, the burden falls on staff to lift or assist the patient. this sort of patient/staff interaction has a high potential for serious injury to one or both of the parties
involved. at the very least, it could result in back injuries for staff, which is a serious issue in the healthcare industry. the national institute for occupational safety and health (niosh) estimates that direct and indirect costs associated with back injuries in the healthcare industry are about $20 billion annually.
Accessibility as the healthcare industry evolves, equal access healthcare is an increasingly important issue affecting our healthcare system across the country. it basically pertains to a practice’s ability
and willingness to ensure that healthcare is accessible and inviting for elderly patients, as well as those with other mobility concerns, such as patients with disabilities or obesity issues.
Quality of care/efficiency of procedures implementing ergonomic and accessibility principles in a healthcare facility, and in particular the exam/procedure room, will raise the level of the quality of care being provided and increase the efficiency of the procedures being conducted. the basic fact is that the less physicians and staff are forced to strain to move patients or endure uncomfortable positions, the more they will be able to
focus on the patient and provide the best quality care possible.
Reputation and perception From a business standpoint, the perception of the patient and the reputation of the healthcare practice are very important. the more pleasant the patient experience, the more likely it is that they will not only return for other procedures; they may even recommend these services to a friend or family member. in any medical practice, especially a cosmetic one, the appearance of your exam tables, lighting, etc. immediately tells a patient whether you are using the best and staying current or whether you are a poseur.
Growing importance of accessibility too many facilities and clinics still lack total architectural and programmatic accessibility. By providing an accessible healthcare environment that works for everyone, providers improve the quality of patient care as well as the quality of their patients’ lives. Full accessibility is closely tied to many ergonomic principles. as a result, it can greatly improve patient safety and patient outcomes, as well as productivity and profitability for the practice.
Considerations for the aesthetic office to fully understand the significant role ergonomic and accessibility principles can play in an aesthetic office, it is important to look individually at specific areas and equipment found inside the facility.
Entrance and lobby For patients, ergonomic and accessibility principles can have an effect on them before they ever step foot inside the exam or procedure room. simple considerations such as accessible parking, wheelchair accessibility, and power door operators can make the office more inviting and create a more safe and comfortable environment. additionally, it is important to have adequate and comfortable seating for patients and any staff.
Ergonomics for an aesthetic office another ergonomic issue often found in entrance and lobby areas is the potential for trips and falls caused from environmental hazards such as slippery or wet floors, uneven surfaces, cluttered or obstructed passageways, inadequate lighting, or poorly maintained walkways.
prime-journal.com | March 2011 ❚ 71
STEVEN K. CORDONNIER Midmark Corporation, Versailles, Ohio, USA
email
scordonnier@midmark.com | ergonomics in the workplace | practice management
| SKIN CARe PRoDUCTS | PrActice mAnAgement
pro-inflammatory mediators (2). Anti- oxidants have anti- inf lammat o ry actions against these mediators and may protect against DNA damage. Table 1 lists some of the most popular antioxidant ingredients found in mainstream product lines. Since no sun protection cream can block all ultraviolet light, the use of antioxidants in the morning to complement the protective benefits of sunscreens, would be a reasonable recommendation to patients. Collagen-stimulating products are
many products do multi-tasking such as
retinol, which is both pigment lightening and collagen stimulating, and alpha hydroxy acids which exfoliate, thereby improving acne as well as dyschromia
typically recommended for older skin in which wrinkles and fine lines are the primary concern. Table 1 lists some of the ingredients with cosmeceutical studies documenting in vitro or in vivo increases of collagen. These increases in collagen are the result of fibroblast stimulation(3). Besides collagen, other components of the dermis, such as elastin and glycosaminoglycans are produced by fibroblasts. Improvement in skin texture is often the result of all of these fibroblast- stimulating effects. Ageing skin and fine
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