APR 2018

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 14 APRIL 2018 | Med Esthetics © GETTY IMAGES Needle aspiration alone is an inadequate safety measure to prevent inadvertent intravascular injection with soft tissue fi llers (STFs), accord- ing to a study by Jani AJ Van Loghem, MD, et al, of The Netherlands. For their paper published in Cosmetic Dermatology (February 2018), the researchers performed aspiration with 11 different needle sizes and 24 different STFs using Ringer's lactate (RL) colored with blue skin marking ink and an empty saline bag containing anticoagulated blood, both pres- surized to 150 mmHg to mimic arterial blood pressure. Out of 340 individual aspiration tests, true-positive results were seen in only 33 percent of the tests within one second of aspiration; that number increased to 63 percent when a true-positive result was defi ned as being positive up to 10 seconds after start of aspiration. The authors noted that the test results were infl uenced by needle diameter, needle length and rheological properties of STFs and recommended additional safety measures including: • When injecting with a sharp point needle, use a retrograde tech- nique when product is released. • Avoid large-volume bolus injections with the needle in a static posi- tion to avoid occlusion of a large area of the arterial system. • Avoid high-pressure injections as these may lead to retrograde fl ow against the arterial blood fl ow into a proximal arterial system (like the ophthalmic artery). • Use cannulas over needles and with diameters of 25G and larger to reduce the possibility of penetrating arterial walls. • When choosing periosteal bolus injections with a needle, use mul- tiple small boluses (0.05 mL per bolus or less) with low pressure. • When injecting in the periorbital area (e.g., close to the supratroch- lear artery), use smaller boluses (<0.04 mL) as intravascular injec- tion in this region can cause blindness. Two courses at February's American Academy of Dermatology con- ference addressed the growing concern of physician burnout. Discus- sion at "Bureaucracy, Compliance, and Burnout: What it Means to Dermatologists," centered on the impact that online reviews can have on a physician's psyche. With Yelp and social media, consumers are quick to hit "post" on scathing reviews. Unfortunately, physicians are prohibited by HIPAA rules from responding. But there are ways to cope, said Suzanne Olbricht, MD, who encouraged physicians to consider that there may be a "nugget" of importance in what the review had to say. "Everybody is being rated about everything. This isn't a phenomenon that is targeting doctors," she said. "Maybe there's a nugget of something we can learn from the review. If so, learn from it. If not, dismiss it." In another session, "Battle the Burnout: Reignite the Flame," Rochelle R. Torgerson, MD, PhD, and Karen Wiss, MD, shared strategies for reducing personal burnout based on author Amit Sood, MD's 5-3-2 daily practice model. Sood recommends being grateful for fi ve people in your past or present every day (for a few minutes each while practicing deep breathing), three minutes of being present (focused on an object) and two minutes of silent "wish you well" thoughts for anyone you choose. Effective time and task management is important in reducing burnout as well, Dr. Wiss said. She advocates using just one calendar and listing both personal and professional commitments—even sleep—on the calendar. When deciding to take on a commitment or task, ask when it has to be completed and say "no" appropriately if you cannot commit. "Whenever you're saying yes to something, think about what you're saying no to. Something has to give," Dr. Wiss said. Finally, Dr. Torgerson encouraged attendees to make a list of their core values. It could include the obvious, such as family, faith and friendship, or things such as meaningful work, justice and humor. Combatting Burnout NEEDLE ASPIRATION INADEQUATE AS SAFETY MEASURE

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