Day 4: Highlights

Sunday, February 12, 2017

Hand Rejuvenation

Bruce Katz, MD
Outside the face, the hands are the most visible and expressive part of the body. Similar to the face, the hands are constantly exposed to photodamage and show signs of aging through volume loss and increased prominence of veins and tendons. If you rejuvenate the face and not the hands, the dimorphism can be a sign that someone has obviously had cosmetic surgery. It is important to achieve harmony of these two areas.
Currently, single therapeutic modalities are utilized for hand rejuvenation. However, Dr. Katz discussed that we should employ combination therapy to address the causes of aging hands. Aging hands exhibit thinned epidermis, decreased fat, irregular distribution of melanin, volume loss, wrinkling, lentigines, and telangiectasia. Studies have shown that you can accurately estimate someone’s age by viewing only their hands.
The same topical therapies for the face should be encouraged for patient use on the hands, including topical retinoids and sunblock with a high SPF. These medications can be used in conjunction with in-office treatments such as peels, laser treatments, and microneedling. Fillers such as calcium hydroxyapatite can provide immediate volume improvement and over time stimulate further improvement in fibroblast function, collagen production, and network scaffolding, further enhancing results.
It is essential to educate patients about the importance of hand rejuvenation as part of the overall aesthetic program. When choosing treatment, adopt a multi-modality approach guided by consideration of the morphologic skin changes present on examination.

Treating the Male Aesthetic Patient

Neil Sadick, MD
Between 1997 and 2015, there was a 273% increase in cosmetic procedures requested by male patients. The increased demand is primarily for liposuction, fat reduction and body contouring, treatment for hair loss, and neuromodulators. The number of men seeking cosmetic treatment will continue to increase, and it is essential that we understand the unique approaches to treating the male aesthetic patient.
When developing a treatment plan, it is important to consider the different male anatomy. Additionally, men require much more education during a consultation visit. Men often want to look better but are unaware of the different treatment options available. They tend to also be less open about goals and expectations, so it is crucial to take time to address these behavioral and emotional differences during the consultation.
In addition, men appear to be less interested than women in correcting fine lines and wrinkles and typically want to address structural change and volume loss. Using fillers with a high G prime are essential for correcting volume loss and common goals include eliminating deep rhytides and augmenting masculine facial features. It is important to avoid overcorrection of the medial and lateral, which can lead to a feminine appearance. When utilizing neurotoxins, men will always require larger doses due to their thicker, larger muscle mass. It is also important to keep treatments more lateral to avoid unwanted arching or uplifting that results in a more feminine appearance.

The Use of Physician Extenders

David J. Goldberg, MD, JD
In today’s busy world, physicians will make a mistake at some point in their career. Usually the mistakes made are minor, but at times they can turn into large-scale issues. The main reasons patients sue are poor communication retribution, economic reasons, and negligence. With the growing number of mid-level providers such as physician assistants and nurse practitioners, multiple negligence cases have occurred.
In the field of dermatology, there have been several cases where physician extenders provided aesthetic services that created poor outcomes that could have been avoided. These occurrences led to the formulation of proper physician supervision guidelines. When performing any procedure, physicians should ensure that their informed consents disclose all common and uncommon adverse events. Negligence cases must involve duty, breach of duty, causation, and damages. Physicians need to ensure that their nurse practitioners, physician assistants, and nurses have all been appropriately trained and certification tests should be kept on file. Many negligence cases can be prevented when the physician extenders who are performing your procedures have appropriate supervision and training.

Creating a Clinical Studies Center

Michael H. Gold, MD

Creating a clinical trials center takes time, commitment, and personnel. When considering conducting research, there are many terms that you should know including Form 1572 (a signed commitment by the investigator between their research site and the sponsor), IRB (Institutional Review Board), IC (Informed Consent), GCP (Good Clinical Practice), SOP (Standard Operating Procedures), etc. When conducting clinical trials, you should have an ethical eye, protect your subjects, have a well-designed plan, select qualified study staff, and document appropriately. The biggest component of research is the FDA. They monitor offices and can perform audit visits if needed. At these visits, they are allowed to look at every aspect of the office.

Performing research requires multiple people including the sponsor, the CRA, a monitor, and the investigator which includes the principal investigator, sub-investigators, and coordinators. If you want to start doing research, it is essential to talk to many other people in the field and to speak with your medical reps. The reps have access to their district manager and/or the companies’ medical science liaison who can help you get started and provide more information. At the beginning, expect to get Phase III trials that are conducted among numerous clinical sites or long term safety studies. After showing that you can handle studies like these, then you may get Phase II studies or even botox/filler studies. If you decide to get involved in research, you need to be ready, get proper staff to help you, get organized in your office, and have extra room for storage for the clinical trial materials and collected data.