Акценти от 4-ти ден
AESTHETIC DERMATOLOGY FOR MEDICAL INDICATIONS
LIGHT BASED TREATMENT OF ROSACEA
Report by Dr. Adrian ALEGRE SÁNCHEZ (Dermatologist, Spain)
According to the oral communication of Dr. Pablo BOIXEDA (Dermatologist, Spain)
Rosacea includes various etiopathogenic aspects, with a wide range of symptoms: transitory or persistent erythema, papules, pustules, phymas, telangiectasias, and eye problems, among other issues. Vascular laser treatments are presented in most clinical treatment guidelines as the only treatments for the vascular component of the disease (erythema or telangiectasias). However, Dr. BOIXEDA highlighted their usefulness in also treating the inflammatory component of the disease (mainly papules and pustules). The most important vascular lasers include pulsed dye laser, KTP laser, Nd:YAG laser, and intense pulsed light. The neodymium laser requires more experience because of its narrow therapeutic window and its use should be limited to the deep vascular portion or thick, well defined blood vessels. In his presentation, Dr BOIXEDA also highlighted the versatility of lasers, as they can be combined with other treatments, such as low-dose isotretinoin (0.1-0.2 mg/kg/day) in cases of inflammation or topical ivermectin in cases of demodicosis. Another major indication for vascular lasers is reactions causing papules and pustules in cancer patients undergoing treatment with EGFR inhibitors. In addition to vascular lasers, for phymatous rosacea, CO2 laser is also very useful for eliminating excess tissue.
ENERGY BASED DEVICES I, INCLUDING LASERS
LASERS FOR VASCULAR LESIONS INCLUDING IPL
Report by Dr. Adrian ALEGRE SÁNCHEZ (Dermatologist, Spain)
According to the oral communication of Prof. Agneta TROILIUS RUBIN (Dermatologist, Sweden)
Prof. RUBIN highlighted the importance of lasers for medical conditions such as radiodermatitis, rosacea, and rhinophyma. She underscored the importance of knowing the appropriate endpoints in order to safely achieve the desired results. For this purpose, she recommends doing test treatments.
In regards to capillary malformations, she recommends starting as soon as possible in order to obtain the best results. In such cases, the endpoint is a deeper purple. Some of the combinations that have been tested include rapamycin, imiquimod, or timolol with pulsed dye laser. The results are moderate. In regards to treatment intervals, Prof. RUBIN proposes not treating with intervals that are too short in order to avoid the effects of neovascularisation.
In regards to infantile haemangiomas, a recent in-vitro study demonstrated that laser treatment reduces the expression of endothelial growth factors and also reduces rates of apoptosis. In addition, laser can be combined with propanolol.
LASERS FOR PIGMENTED LESIONS, TATTOOS AND HAIR REMOVAL
According to the oral communication of Prof. Keyvan NOURI (Dermatologist, United States)
For treatment of solar lentigo with 532 nm (Nd:YAG) laser, Prof. NOURI highly recommends Q-switched lasers with ultra-short pulses. In regards to tattoos, he recommends choosing the wavelength according to the colour: black with 1064 nm or 755 nm, red/orange with 532 nm, green with 755 nm. There are devices that combine different wavelengths. Prof. NOURI recommends not promising patients total removal, nor telling them an exact number of sessions.
There are new developments like the “Freedom-2” tattoo, which uses bio-reabsorbable microbeads of dyes that can be removed with a single session of laser treatment. In regards to the mode of treatment, the R20 method published by Rox Anderson involves making four laser passes, waiting 20 minutes between each. This method is more effective, but it requires a very long treatment time. A similar effect can be achieved using perfluorodecalin patches, with a shorter treatment time. Another good alternative is the combination of Er:YAG or fractional CO2 laser to achieve greater transepidermic elimination.
FRACTIONAL ABLATIVE/NON-ABLATIVE RESURFACING INCLUDING DRUG DELIVERY
According to the oral communication of Prof. Merete HAEDERSDAL (Dermatologist, Denmark)
Prof. HAEDERSDAL noted the importance of knowing the histological consequences of each of the methods: non-ablative fractional laser, ablative fractional laser, and radio-frequency microneedling. Prof. HAEDERSDAL underscored the usefulness of these lasers for improving scars. Another interesting indication is residual scars from haemangiomas. In regards to acne scars, it is still undetermined if ablative fractional laser or radio-frequency microneedling is more effective. In regards to laser-assisted drug delivery, Prof. HAEDERSDAL recommends using low densities around 5%. There are many molecules that have been delivered using this technique. The indications with the most demonstrated efficacy are actinic keratosis (laser-assisted photodynamic therapy) and scars. However, it is also important to note that greater absorption of drugs can result in greater intensity of side effects.
PRACTICE MANAGEMENT, INCLUDING PSYCHOLOGY
FIVE STRATEGIES FOR GROWING A SUCCESSFUL AESTHETIC DERMATOLOGY PRACTICE
Report by Prof. Anna ZALEWSKA JANOWSKA (Dermatologist, Poland)
According to the oral communication of Dr. Wendy LEWIS (Dermatologist, United States)
Dr. Wendy LEWIS from USA presented 5 strategies for growing successful aesthetic dermatology practice, namely right staff, professional webside, active social media channels, staying visible & relevant to patients and building a brand, not just a practice. When brand is built then it can quite easily be sold when the doctor decide to retire and make decent revenue when successful brand has been built. Staff, including administrative at the registration desk should share the same approach to the business as the doctor. It is of extreme importance that staff is satisfied with the job and makes a huge difference in practice success. Webside of the practice should be really professional so proper investment has to be done by the owner and true professional should be hired for this service. Webside is a continuous investment because it should continuously be updated according to the changing professional standards. Being visible on at least 2 social media channels, preferably Facebook and Instagram is a must.
SETTING REALISTIC EXPECTATIONS FOR THE AESTHETIC PATIENT
According to the oral communication of Dr. Didac BARCO (Dermatologist, Spain)
Dr. D. BARCO from Spain pointed at the importance of setting realistic expectations for the aesthetic patient. First the speaker stressed that it is extremely important to carefully listen to the patients in order to work out what bothers them most and approach this very problem. Of importance literature data demonstrated that doctors prevented patients from completing an opening statement in 72% of visits. A relatively simple question “What bothers you most?” could be a breaking through as for patient-doctor relation building and trust. The speaker also pointed out that some words should be avoided like: “perfect”, “disappear”, “no complications”. Rather the following should be implemented “improve” “fade”, “low risk procedures”. Dr BARCO also strongly advised to take photographs of the patients before and after the procedure and even during downtime and during the consultation estimate in % how much the patient can improve after chosen aesthetic intervention. He also stressed that It is much more advisable not to overpromise and be both empathic and assertive when consulting a patient. Taken an informed consent for each and every procedure is a must.
MARKETING ASPECTS IN AESTHETIC DERMATOLOGY
According to the oral communication of Dr. Moshe LAPIDOTH (Dermatologist, Israel)
Dr. M. LAPIDOTH from Israel shared his experience in marketing aspects in aesthetic dermatology pointing at seven most important “Ps” of marketing namely: product i.e. aesthetic procedure, price, place, promotion, people, physical evidence and process. He discussed based on his professional life all seven aspects of “Ps” stating that satisfaction of the employees is of most importance. Of note physical evidence means image and image essentials are as follows building, design, layout, décor, furniture, facilities, uniforms, equipment. The clear message was do not economize on essentials, but on the other hand do not overinvest especially when you are a “beginner” in the filed. Communication between doctor and patient was also pointed as being the core of good dermato-surgical marketing service building trust and relationships with the patients.
A REVIEW OF RECENT SCIENTIFIC LITERATURE ON AESTHETIC PATIENT PSYCHOLOGY
According to the oral communication of Dr. Maurice A. ADATTO (Dermatologist, Switzerland)
Dr. M. ADATTO from Switzerland delivered a review on recent scientific literature data on psychologic/psychiatric problems accounted in aesthetic medicine. The speaker stressed the necessity of proper recognition of patients who are suffering from dysmorphophobia (body dysmorphic disease, BDD) which is a true psychiatric disease. Such patients account for up to 15% of patients of aesthetic consultations and they are virtually never satisfied from the outcome of any procedure and quite willing to sue the doctors afterwards. Increase in tattoo acquiring nowadays also leads to increase in their removal procedure, and all aesthetic doctors should be aware of that new trends and possibilities of medical professionals. The speaker stated that acne patients are still on the increase as for aesthetic consultations and professional approach including isotretinoin administration should be in place once required. Then, the speaker switched to scar treatment underlying that specially self-harm scars did not fully resolve but is worth trying to approach them because when the patient has realistic expectations even slight improvement in their appearance is appreciated.