MAY-JUN 2017

MedEsthetics—business education for medical practitioners—provides the latest noninvasive cosmetic procedures, treatment trends, product and equipment reviews, legal issues and medical aesthetics industry news.

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BEST PR ACTICES 8 MAY/JUNE 2017 | MedEsthetics © GETTY IMAGES A study published in Plastic and Reconstructive Surgery (March 2017) examined bacterial biofi lm as a possible cause of adverse nodular reactions following treatment with soft tissue fi llers. Researchers Mayuran Saththianathan, et al, per- formed an in vitro analysis of the propensity for three classes of fi ller materials—hyaluronic acid (HA), polyacrylamide gel and poly-L-lactic acid—to support biofi lm growth with and without nutrition, and analyzed biopsy samples from patients presenting with postprocedure chronic granulomatous infl ammation. All three materials supported the growth of S. epidermidis in the presence and absence of tryptic soy broth. In the absence of nutrition, bacterial growth was signifi cantly greater on the HA fi ller sample compared with the other fi ll- ers and control. Bacterial growth on poly-L-lactic acid fi ller samples was greater than that of polyacrylamide gel and control; bacterial growth on the polyacrylamide gel fi ller samples was not different from the control substrate. In the presence of nutrition, polyacrylamide gel supported signifi cantly more growth than either poly-L-lactic acid or HA, and the HA fi ller had signifi cantly more growth than poly-L-lactic acid. Biopsy results and microbiome analysis of granulomas revealed multispecies biofi lm, with an overall predominance of Pseudomonas and other intraoral and skin fl ora species. Common organisms forming 5% or more of the biofi lm included Streptococcus mitis, S. salivarius, Staphylococcus aureus, coagulase-negative Staphylococci, Acidovorax spe- cies, Herbaspirillum putae, Ralstonia pickettii and Acinetobacter. The authors concluded that biofi lm is the likely cause of chronic granulomatous infl ammation following fi ller injection, and they highlighted the need for ongoing research to identify risk factors and techniques to prevent contamination at the time of injection. Bio-Film and Soft Tissue Fillers A randomized, controlled, split-scar trial published in Lasers in Sur- gery and Medicine (February 2017) revealed that ablative fractional laser treatments can improve the appearance and pliability of mature caesarean section (c-section) scars. Katrine E. Karmisholt, MD, et al, treated 11 patients with mature c-section scars. Each patient underwent three ablative fractional laser treatment sessions. Effi cacy was measured at one, three and six months following treatment by blinded on-site clinical evaluations using the Patient and Observer Scar Assessment Scale (POSAS) and Vancouver Scar Scale (VSS), blinded photo-evaluations, refl ectance measurements, tissue histology and patient satisfaction. At one month, the treated side of the scars had signifi cantly more pliability and smoother surfaces compared to the control side. Transient erythema and hyperpigmentation, confi rmed by refl ectance measurements, peaked between one and three months following treatment. At six months, blinded photo-evaluation showed signifi cant improvement in the treated sides of the scars compared to control, and the majority of patients (64%) favored subsequent ablative fractional treatment of their untreated control scar tissue. CO 2 FOR C-SECTION SCARS Physicians who want to encourage their patients to purchase and use recommended homecare products have a new tool to improve compliance at their disposal. Electronic medical provider Modernizing Medicine has joined forces with Galderma, maker of the Cetaphil skincare line, to create a new eCommerce solution for users of Modernizing Medicine's EMA practice software. This new feature allows patients to order physician-recom- mended over-the-counter (OTC) products online and have them delivered directly to their homes. Physicians can create documents that detail recommended usage and application instructions, and include a link that leads patients to the eCommerce site to order the suggested products. The practice then gets a commission of online sales made by its patients. "This new functionality is being developed to help save time for both doctors and their patients, by providing a more powerful and easier to understand homecare treatment regimen with integrated eCommerce capability for OTC products," explains Daniel Cane, CEO and cofounder of Modernizing Medicine. MODERNIZING MEDICINE AND GALDERMA OFFER NEW ECOMMERCE TOOL

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