JAN-FEB 2016

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 © GETTY IMAGES An international group of dermatologists and plastic surgeons has developed and validated the Gavard-Sundaram Cohesivity Scale for dermal fi llers. The scale—published in Plastic and Recon- structive Surgery (October 2015)—is designed to help providers choose the fi ller product that will give the best results for their patients. Cohesivity (how well the gel maintains its integrity when placed in sterile water and stirred at a constant rate) provides guidance on which areas the fi ller is best suited to treat. For example, fi llers with higher cohesivity may be a better choice for more superfi cial placement, or placement in mobile areas such as around the mouth or eyes. Products with lower cohesivity may be more effective for use as "deep volumiz- ers," according to lead author Hema Sundaram, MD, and co-authors. The researchers tested six FDA-approved fi llers. Cohesivity scores varied across the full range of the scale from "fully dispersed" to "fully cohesive." Cohesivity was rated high for one product (Belotero Balance), medium-high for two (Juvéderm Ultra 2/Ultra XC and Juvéderm Ultra 3/UltraPlus XC), low-medium for one (Ju- véderm Voluma XC) and low for two (Restylane and Perlane). 10 JANUARY/FEBRUARY 2016 | Med Esthetics UNDERSTANDING FILLER COHESIVITY Early treatment of ischemia with hyaluronidase is key to preventing fi ller- related necrosis, according to a retrospective study published in Plastic and Reconstructive Surgery (October 2015). Researchers Zhong-Sheng Sun, MD, et al, reviewed the clinical outcomes and the risk factors for facial skin ischemia/necrosis caused by hyaluronic acid (HA) fi ller injections. Using case-control analysis, they reviewed 20 consecutive patients who developed impending nasal skin necrosis as a primary concern after nose and/or nasolabial fold augmentation with HA fi llers. Seven patients (35%) developed full skin necrosis and 13 patients (65%) recovered fully after combination treatment with hyaluronidase. Both groups had similar age, sex, fi ller injection sites and complication treatment, yet 85% of subjects in the full skin necrosis group were late presenters who did not receive the combination treatment with hyal- uronidase within two days after the vascular complication fi rst appeared. In contrast, 15% of the patients in the full recovery group were late presenters (p = 0.004). The researchers concluded that identifying and treating the ischemia as early as possible is key to keeping it from progressing to necrosis and that early (< two days) combination treatment with hyaluronidase is associated with full resolution of the complication. OUTCOMES IN FILLER- RELATED NECROSIS In order to generate a strong return on investment, practices that invest in new technologies must develop a marketing plan to introduce their new devices to the community and their existing patient base—and manufacturers can provide much-needed support. Thermi, in conjunction with aesthetic consultant Cheryl Whitman, has released the results of a survey designed to measure the effectiveness of its "Jump Start" marketing program. Created for doctors who purchase Thermi RF-based devices, the program involves setting up two special VIP events—one held during the day for stay-at-home moms and one held in the evening for working patients—where attendees learn about the new technology, are provided with educational handouts on how it works and potential outcomes, and have the opportunity to sign up for a treatment. In their survey of 14 practices that completed the program, they found that 100% of respondents booked at least 10 procedures, bringing in $10,000 or more in immediate profi table revenue with 40% netting more than $20,000 in new bookings, and one practice reporting more than $59,000 in profi table revenue. Jump Start Interest in New Technologies

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