JUL-AUG 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 JULY/AUGUST 2017 | MedEsthetics TOP: © GETTY IMAGES; BOTTOM: IMAGE COURTESY OF THE NATIONAL ROSACEA SOCIETY Erbium YAG (Er:YAG) laser treatment leads to in- creased expression of collagen and may be more effective in treating acne scars than combination bi-polar radiofrequency with infrared diode laser (BRDL), according to a study published in Lasers in Surgery and Medicine (April 2017). Authors Seonguk Min, MD, PhD, et al, per- formed a split-face study that included 24 subjects. Each patient received two treatments spaced four weeks apart. The patients were assessed at baseline, 1, 3 and 7 days after each treatment, and four weeks after the fi nal treatment session. The researchers also took skin biopsy specimens at baseline, 1, 3, 7 and 28 days after one session to investigate the molecular profi le of acute skin changes. The Investigator's Global Assessment (IGA) showed a 2.1 (50%) improvement in scars treated with the fractional Er:YAG laser and 1.2 (25%) im- provement on the BRDL-treated side. The Er:YAG laser induced later and higher peak expression of TGFßs and collagenases, whereas BRDL induced earlier and lower expression of TGFß and collage- nases. Immunohistochemistry revealed higher ex- pression of TIMP after Er:YAG treatment compared with BRDL. The authors posited that the superior effi cacy of the fractional Er:YAG laser may be associated with higher expression of collagen, due to differential ex- pression of TGFßs, collagenases, PPARγ and TIMP. ERBIUM LASER MORE EFFECTIVE FOR SCARS THAN RF WITH INFRARED A recent study in the American Journal of Managed Care (March 2017) followed primary care practices that underwent a "Lean" redesign and found improved workfl ow, higher physician productivity and more satisfi ed patients. The Lean approach, taken from the manufacturing industry, brings together team mem- bers to review processes and identify value-added and non-value-added steps. The goal is to create an ongoing improvement of your processes to reduce waste and enhance the value of your products or services. To quantify its success, the study's authors assessed changes at 46 primary care departments in 17 different locations following a phased introduction of Lean-based strategies. They analyzed workfl ow effi ciency, physician productiv- ity, operating expenses, clinical quality, and satisfaction among patients, physi- cians and staff. The authors wrote that the practices experienced "system-wide improve- ments in workfl ow effi ciencies and physician productivity, with no adverse effects on clinical quality. Patient satisfaction increased with respect to access to care, handling of personal issues, and overall experience of care, but decreased with respect to interactions with care providers. Departmental operating costs decreased, and annual staff and physician satisfaction scores increased particular- ly among early adopters, with key improvements in employee engagement, con- nection to purpose, relationships with staff, and physician time spent working." LEAN STRATEGIES IMPROVE PRACTICE EFFICIENCY AND PATIENT SATISFACTION New research published online on April 20, 2017 in the Journal of the American Academy of Dermatology revealed that increased consump- tion of alcohol, particularly white wine and liquor, is associated with a higher risk of rosacea in women. To examine rosacea's connection to alcohol use in women, the authors—led by Wen-Qing Li, an assistant professor of dermatology at Brown University—reviewed data collected from 82,737 women over 14 years (1991-2005) via the Nurses' Health Study II. There were 4,945 cases on rosacea. They found that patients who drank alcohol had an elevated risk of developing rosacea, and that risk increased as their alcohol consump- tion increased. In examining the risk associated with specifi c types of alcohol, the researchers found that white wine and liquor were signifi cantly associated with a higher rosacea risk. WHITE WINE AND LIQUOR MAY INCREASE RISK OF ROSACEA

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