A study in the Journal of the American Academy of Dermatology says if you want to see a skin doctor about a changing mole, get ready to wait. The average wait time is 26 days. But if you want a Botox shot, it’s just eight days, two-and-half weeks shorter. Here in mid-Missouri, two dermatologists say that’s not true.

“There’s a shortage of dermatologists nationally,” dermatologist John Despain said. ”Also, patients have direct access to dermatologists for skin care.”

Dr. John Despain owns Despain Dermatology Center and Skintuition Medical Spa in Columbia, focusing on cosmetic dermatology like Botox. He says at his practice, clinical appointments always come before cosmetics.

“They are seen on a priority basis within a few days,” Despain said. ”If they’re a new patient, if there’s the ability to put them in a new patient slot, they priority over anyone calling for cosmetic concerns, of course.”

At Dr. Lindall Perry’s practice in Columbia, they treat all appointment requests the same.

“We don’t have, quote, ‘cosmetic appointments,’” he said.

Although Perry is booked through January, he says patients with skin problems can get appointments.

“We have open appointments in two weeks with our newer staff and they would take both a cosmetic patient, an acne patient, a wart patient,” Perry said.

Perry says it can be a challenge juggling business and patient care.

“I like to think I have sound business practices,” she said. ”I do schedule myself very fully. My staff would say too full. My patients would say too full. We pay attention though to the frustration of long waits.”

With a heavy focus on clinical treatments, Perry says he tries to see as many patients as possible. Often leaving the Botox appointments for after hours. He says money is a benefit of his practice, not the motivator.

“My desire everyday is to find every melanoma that’s in front of me and not to miss that,” he said. 

As for Despain, he likes biopsies just as much as Botox.

“I view them as a compliment to each other,” he said. ”If I had to choose how to spend my time out of enjoyment or profitability, they’re probably equal.”

Both doctors say there’s certainly a demand in mid-Missouri for cosmetic dermatology, but most of their patients and profits stem from clinical work. In the meantime, if you want to see a dermatologist, the best idea is to plan ahead.

Post from: Laser Clinic MD

Cosmetic Dermatology: No wait for Botox or Photofacials.

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Although this chapter from the Advanced Medical Aesthetics Training Manual wasn’t actually requested in the training manual I wrote for the academy students, I felt it was extremely important for the entire medical spa staff, especially for medical estheticians, to know the difference amongst the various treatments used to alleviate the appearance of wrinkles and folds, and the difference between dynamic and static lines.

Medical estheticians have the most “face time” with clients, examining it with magnifying lenses, treating it with exfolliants, moisturizers, galvanic current, high frequency, various acids, etc. They understand the realm of fine lines and wrinkles and know what can be alleviated with topical treatments such as facials, peels, microdermabrasion and laser resurfacing, and what cannot.

I cannot tell you how many patients call or come into our office with no knowledge of the difference between paralyzing agents such as Botox and Dysport, and dermal fillers. We take it for granted that we know the difference, but injectable products can be very confusing to the lay person. Because the aesthetician works with the client’s skin, they should be well versed in the differences in the two categories of injectables and the products that lie within. Estheticians become your most powerful education source for your clients which ultimately leads to an upsell for them (with possible commission).

Many people think all fillers products are the same, nor do they care to understand the difference between hyaluronic acid or calcium hydroxylapetite. All they truly care about is “how long will it last” and will the “results look fake”. Only with proper education can the medical esthetician effectively and intelligently discuss the differences in the filler products, educate the patient about the effects and lasting results, and help lead the patient to the right product, or combination of products, for their expected outcome.

This information in this chapter is very important for your medical spa front desk/phone people as well!

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Medical Esthetician Training from Medical Spa MD

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Medical Spa MD: I came across this article from Australia on Botox and Restylane being injected in womens feet.

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Bootox? Botox & Restylane injections for women’s high heels.

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Is your medical spa using a new vial of Botox for every patient?

If your medical spa is using a new vial of Botox for every patient, yours will be the first medical spa or cosmetic practice of any kind that I’ve ever know to do so.

Here’s a story from the Las Vegas Review Journal that specifically points out Botox as a ‘contributor’ to an outbreak of hepatitis C. Of course, if you read the story you’ll see that some nurses were observerd ‘reusing needles’ that contaminated vials of Botox. A very different cause indeed from just using the Botox on multiple patients.

And of course, there’s the cost, which almost every medical spa meantioned in the story. (You’d have to get all of your Botox from Canada to afford that.)

Skin Clinic MD: Here’s the story on Botox.

Single-use Botox vials used on more than one patient.

That practice at the Endoscopy Center of Southern Nevada, public health officials have repeatedly said, contributed to the hepatitis C outbreak in the Las Vegas Valley.

A phone call to inquire about the cost of a Botox party was greeted with this information: “It will be cheaper if all the partiers use the same vial.”

One business that seems to be going well in Las Vegas is known for throwing Botox parties. That’s an ongoing phenomenon across the country where friends get together and drink champagne while their wrinkles are needled away.

“We just couldn’t handle it financially,” said one medical assistant who asked to remain anonymous. “We would have gone out of business.”

Medical assistants at two different spas said their owners only stopped multipatient use of single-use vials of Botox “until things quieted down” after the hepatitis outbreak was announced.

The Review-Journal had little trouble finding medical providers who said they and their companies knowingly broke state and federal regulations.

“You can’t have doctors worrying about breaking the law or guidelines or whatever,” Niamtu said.

A new company called Dysport is manufacturing a similar product, and the competition could force Allergan to provide smaller dosage vials to physicians who want them, he said.

Now a federal lawsuit filed in California by Las Vegas physician Ivan Goldsmith argues that sales representatives for Allergan Inc., maker of the popular anti-wrinkle drug Botox, promote multipatient use of its 50-unit or 100-unit single-use vials.

Goldsmith’s lawsuit alleges that doctors can only make a profit using Botox if they reuse the single-use vials that the drug comes in.

But the complaint also raises issues that go beyond dollars and cents, ones that the community has been acutely aware of since the hepatitis C outbreak became public in February of last year.

The Botox business model “created an unacceptable and unreasonable risk of serious and debilitating injuries and illnesses, including HIV and Hepatitis B and C,” states the lawsuit, filed Sept. 29 in U.S. District Court for the Central District of California.

Allergan spokeswoman Kellie Reagan said the product’s (Botox) prescribing label has always been clear: single use only.

She wouldn’t comment, however, on how Allergan’s sales representatives promote the drug’s use.

Goldsmith said in the lawsuit that Allergan misrepresented to him “the true and permissible use of the product.”

Most patients need far less Botox than is provided by Allergan in either its 50-unit or 100-unit vials, the lawsuit said.

And, according to the suit, the medication can’t be saved for later use on the same patient because, once a vial is opened, it must be thrown away within four hours of first use.

Physicians and medical spa providers of Botox contacted by the Review-Journal said Allergan’s sales representatives have consistently said vials of Botox could be used for multiple patients.

“No matter what training seminar or continuing medical education course I went to, the Allergan people always said a vial was for multiuse,” said Sandra Bledsoe, who operates Focus Medical Weight Loss & Spa. “Many patients only need 15 or 20 units at a time.”

“Allergan seminars have demonstrated multiple patient use of the product for years,” said Las Vegas plastic surgeon Dr. Julio Garcia, who said he has attended the company’s seminars.

Garcia said doctors felt they could be safe if they used a new syringe and needle for each injection, which, even if against the rules, would result in sterile treatments.

The problem comes when mistakes happen, said Dr. Joseph Niamtu, a Richmond, Va.-based cosmetic facial surgeon long active with the American Academy of Cosmetic Surgeons and the Cosmetic Surgery Foundation.

“Someone inadvertently picks up a contaminated syringe and inoculates the entire vial,” he said.

That may sound familiar.

Last year, health officials revealed that authorities investigating a cluster of hepatitis C cases had observed nurses at the Endoscopy Center’s Shadow Lane clinic reusing syringes in a manner that contaminated single-use vials of medication.

Nine hepatitis cases were linked to the practice, and more than 50,000 people were urged to get tested for blood-borne diseases.

Medical officials say no cases of hepatitis C have been connected to Botox injections.

Still, Dr. Ihsan Azzam, state epidemiologist for the Nevada State Health Division, said concerns about blood-borne diseases in relation to the administration of Botox can’t be dismissed.

He said discussions with some of the state’s medical providers have made it clear to him that multipatient use of single-use Botox vials continues in Nevada.

The Review-Journal also contacted providers who say the practice is ongoing.

“I think we need to include use of Botox as a risk factor when we talk about hepatitis,” Azzam said.

He noted that after he sent a bulletin to physicians and other medical providers about injection safety in the wake of the hepatitis C crisis in Las Vegas, some providers who administered Botox in their practices were not supportive.

In his directive, which echoes the position of the Centers for Disease Control and Prevention, he wrote: “Do not administer medications from single-dose vials to multiple patients or combine leftover contents for later use.”

He said a number of providers called him to say that they wouldn’t follow the regulations because they knew how to safely administer Botox to multiple patients from a single-dose vial.

“I was very surprised,” Azzam said Thursday, adding he hopes state inspectors will catch those who refuse to abide by medical regulations. “Some seemed to be daring me to come after them.”

If caught, physicians’ licenses would be at risk.

Azzam said Botox providers told him it would not be possible to make a profit if the injection practices he supported were followed.

“I followed the rules,” Goldsmith said last week. “And it killed me financially.”

Goldsmith is asking the court that his lawsuit be certified as a class action, arguing that more than 100 doctors who invested in the product are affected nationwide, with their economic losses exceeding more than $5 million.

In his lawsuit, Goldsmith said a 100-unit vial of Botox could cost him $1,000, but a patient treatment might only be $500. Because it is a single-use drug, the rest would then have to be thrown away.

“You were losing money that way, not making it,” Goldsmith said. “The patient didn’t want to eat the cost.”

Goldsmith has had a run-in with the Nevada State Board of Medical Examiners, which last year subpoenaed some of his patient records.

The board said it had received information that Goldsmith illegally dispensed compounded medications, dispensed medications without having a pharmacist on site, allowed clerks to dispense medications, and used human growth hormone on patients without meeting Food and Drug Administration criteria.

Goldsmith has denied the allegations and, more than a year after the board’s subpoena, no action has been taken.

Garcia said he is following the rules regarding Botox injections, but knows that many in the medical community aren’t doing so.

Last year he wrote a letter to the state medical board saying patient safety could be compromised because spa personnel continue to inject Botox “with the doctor not present.”

That issue has been in the news lately, the result of recent attempts by the medical board to keep medical assistants from injecting Botox. That effort failed.

“The possibilities of infection, given what is going on when it comes to injecting Botox by whomever, are terrifying,” Garcia said.

“We’re not talking about 40,000 or 50,000 people. We’re talking about hundreds of thousands of injections” in Southern Nevada.

Tracy Jones, a Las Vegas saleswoman, said while she has been a frequent user of Botox, she generally doesn’t know if she is the only one receiving Botox from a vial.

“It’s not something people ask,” she said.

Most medical providers are well aware that Botox, like any injectable medication, can be contaminated when drawn up into a syringe.

To prevent contamination in his Botox injections, Niamtu, the Virginia facial surgeon, said he and his staff every day will draw up five sterile 20-unit syringes of Botox from a 100-unit vial.

Though he said that may not be in accordance with CDC guidelines that say single-use vials cannot be used for more than one patient, Niamtu said he must walk a tightrope between the “practical and the optimal.”

He said “something will have to be done,” if medical officials in other states become as aggressive in enforcing regulations as he believes they are in Nevada.

“Doctors can’t throw away that much medication, and patients aren’t going to pay for the extra,” Niamtu said. “Allergan will have to step up to the plate and make different quantities of the drug. It may cost them a little more.”

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Laser Clinic MD: Single use Botox?

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Laser Treatment Classifications in Cosmetic Medicine

The invention of the laser has led to many advancements in the electronic and medical device industries. In the aesthetic arena, new and improved lasers are entering the market every few months. This rapid development is leaving the classification criterion to continually be redefined. Therefore, the following information is deemed to be a guideline and is not considered to be a definite and thorough description.

Lasers in use by medical practitioners typically have low outputs of energy and power, and are thus placed in ANSI (American National Standards Institute) Class 2 category. Another important organization is the LIA (Laser Institute of America). The majority of medical lasers fall into the ANSI Class 3 or 4 categories with most surgical lasers being in ANSI Class 4. Most medical and/or surgical lasers are classified by the FDA (Food and Drug administration) as Class II or Class III medical devices.

Class 1: These types of low power lasers are not considered to pose any hazards when operated according to normal conditions and includes lasers which are completely enclosed such as CD players, fiber-optics devices, and printers. These devices cannot have emissions exceeding the maximum permitted exposure (MPE) under any conditions are considered to be class 1 systems.

Potential dangers can occur during the repair of such devices since the laser is outside of the enclosure. Warning labels are required for this class inside the unit or underneath the cover.

Class 2a Lasers: Few lasers qualify for this class of low-power, visible light lasers. Lasers in this class do not pose a threat if the beam of light is directly viewed for periods of time less than 16 minutes or so. Visible light lasers with a total output power less than 1 milliwatt, but greater than a few microwatts.

Class 2: This class of lasers includes visible light lasers that are intense enough that viewing the beam into a human eye can cause the normal “aversion response”. An aversion response is when the eyelids close, or the head moves in order to avoid the light. It can occur within 0.25 seconds and includes the blink reflex time.

Class 3a: This includes those lasers emitting ultraviolet or infrared light as well as visible light. All devices within the Class 1 AEL (Allowed Exposure Level) with laser output between .18μm and 1mm fall in this class. (Common Laser pointers are class 3a laser devices.)

Class 3b: These include the same spectrum as class 3a, but increase the output levels to that of Class 2 AEL.

Class 4 Lasers: This class of lasers includes any that exceeds the Class 2 AEL. Most every laser that produces an excess of 0.5 watts is in this class. Laser hair removal, photofacials, laser resurfacing… these are all class 4 lasers and are classified as medical devices that must be used or overseen by a physician.

Post from: Laser Clinic MD

Cosmetic Laser Clinic Classifications

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