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We are now pleased to announce that we have beeen shortlisted for the 2009 Aesthetic Medicine Awards,
05 Jan 2009
03 Dec 2008
In The Press
The learning curve for laser-assisted lipolysis is steep, and patients are unforgiving of ignorance caused by inadequate training. It is vital that laser liposculpture operators have a detailed understanding of the procedure, says Dr Paul Steventon
Laser-assisted lipolysis has the potential to be the biggest development in surgical fatreduction procedures ever seen in the UK. In an American Society for Dermatologic Surgery (ASDS) study of laser lipolysis in 15,336 patients, there were no reports of deaths, pulmonary emboli, viscus perforation, thrombophlebitis, hypovolaemic shock, seizures or toxic reactions. Overall, the prevalence of infection was 0.4%, skin irregularity around 1%, haematoma or seroma 0.7%, unacceptable scarring 0.02%, sensory nerve impairment 0.9%, and contact dermatitis 0.12%.
During liposculpture, the physician makes a 2–3mm incision through which Klein’s solution is injected to produce tumescent anaesthesia. A small diameter laser probe is then inserted and manipulated, causing rupture of adipocytes and releasing liquid fat.
In most cases, the liquefied fat is removed using light aspiration but a small amount can be left to be absorbed and metabolised naturally. A skin-tightening effect takes place as the laser heats the skin from below, stimulating the formation of new collagen. For most patients, normal activities (excluding deliberate physical exercise) are resumed within 48 hours.
When a clinician new to the procedure begins treating patients, the pitfalls become apparent. The aim is a safe, painless and precise improvement in body appearance, but the learning curve is steep and patients are unforgiving of ignorance and mistakes produced by inadequate training. A detailed understanding not only of the basics of laser lipolysis, but also of the fine details of the procedure, including all the “tricks of the trade” and how to vary the treatment for different cases are essential for early and sustained success.
I have carried out more than 300 liposculpture procedures. My results and side-effects profile approximate those of the ASDS study. As I gained experience, I became aware of the low standards that characterised my initial training in lipolysis.
The absence of pertinent information and misinformation about the effectiveness of the treatment meant I had a difficult introduction to the procedure— like many of my colleagues, I came close to abandoning it as flawed.
After careful reappraisal of my resources and goals, and research into outpatient liposuction carried out in the USA, I put together a series of protocols aimed at allowing a high success and low failure rate during the early stages of a clinician’s practice of liposculpture.
The first aim was to improve the anaesthetic. No careful and considered body reshaping is possible if the patient is intolerant of the procedure. Papers on tumescent analgesia published in the USA and Taiwan provided insights leading to the development of a formulation that allowed the necessary time and care to obtain good results, along with a wide margin of safety. The skills necessary for correct administration of the anaesthetic were also identified.
Subsequently, an integrated clinical team approach to liposculpture was developed, relying on good protocol-driven nursing care before, during and after the procedure.
When clinicians train, it is essential that the lipolysis nurse—whose ability to facilitate is vital—is trained alongside the physician. Efficient and proactive ordering of equipment garments and supplies is a sine qua non.
After an uncertain start, our inhouse team approach to laser-assisted liposculpture is a successful part of our clinical portfolio. We train, advise and assess medical and nursing colleagues. Students from the UK, Sweden, Israel and Poland have attended courses— and (most) have passed an assessment to gain a useful clinical skill.
Dr Paul Steventon is medical director
of the Epsom Skin Clinic in Surrey. W:
It wasn’t that long ago that the GDC made continuous professional development (CPD) mandatory for all dentists on the UK register believing that they had an ethical responsibility to continue to undertake appropriate continuous education. Since that time the number of course providers has grown enormously as too have the variety of topics covered. One area that has recently started to arouse interest is facial aesthetics, and there are courses to cover these treatments too.
In the UK there is still much mystery surrounding facial aesthetics, however, Lindsay Woolf, Training Manager for Med-fx Training sets out to dispel some of the myths. ‘Dentists are ideally placed to carry out facial aesthetic procedures’ she comments. ‘They’re experts in the facial region and more importantly already have a patient base to which they can market their new skills. Given a choice of going to an unknown treatment centre or the ‘family dentist’ most people would naturally chose the latter. For the dentist, the transition is an easy one since their practice is already the ideal environment to carry out clinical procedures meaning there are no additional start-up costs. The only investment is in training, which must be completed in order to gain the insurance necessary to practice’.
Heather Muir, a dentist from Scotland, was an early convert to facial aesthetics. ‘Dentistry has evolved enormously in the last few years and cosmetic procedures are driving those changes. Although I still keep my traditional dental skills up to date I’ve found facial aesthetics a natural adjunct to such treatments and have specialised in facial aesthetics over the last five years. I am even a certified trainer for Med-fx Training and am grateful that I can now pass on my experience and clinical skills in this treatment area to others wishing to expand their services’.
So what advice would Heather offer fellow practitioners? Well, like any new skill she advocates good training. ‘You need to be taught by people who understand the business of dentistry and how facial aesthetic procedures can be used to enhance a practice’s profile. As soon as you’ve completed your course and have gained all the necessary insurance, I would also urge dentists to start treating patients immediately whilst the knowledge is fresh in their mind and their confidence high. In my experience, the more education an individual takes, the better the result. I regularly go on CPD courses to enhance my dental clinical skills, so it stands to reason, that if you want to practice facial aesthetics you need to invest in your education in this area too’.
Lindsay Woolf, Training Manager for Medfx Training commented, ‘If you’re getting tired of revisiting the usual topics covered in CPD tutorials and seminars why not ‘step outside the box’ and consider a course on facial aesthetics? We offer both beginner and advanced courses’.
In order to register for a course, or simply to get more information, please log ontoor call a member of the team on 01376 532832.
Many areas of dentistry provide job satisfaction but the one I hear cited most frequently is the improvement that can be made to an individual’s appearance and the resultant increase in confidence. First impressions count for a lot, and more often than not, it is the smile, not the eyes, that make the biggest impact. Dentists are ideally placed to carry out facial aesthetic procedures. They’re experts in the facial region and more importantly already have a patient base to which they can market their new services. Given a choice of going to an unknown treatment centre or the “family dentist” most people would naturally choose the latter. For the dentist, the transition is an easy one since their practice is already the ideal environment to carry out clinical procedures, meaning there are no additional start-up costs. The only investment is in training, which must be completed in order to gain the insurance necessary to practice.
Training is a must for expertise in the newly found world of facial aesthetics where the right courses and the correct instruction can work wonders for personal confidence, increased skill sets and practice expansion.
Whenever we move into new activities and areas of practice, most of us do so with some trepidation and few of us would do so without the full and relevant training. As facial aesthetics become ever more popular in dental practice, increasing numbers of practitioners are taking steps to discover all there is to know about this in-demand, satisfying and profitable therapy.
Jenny Cook, who practices at the Summervale Cottage Dental Practice in Tunbridge Wells is one such dentist whose curiosity got the better of her and has led her into a whole new realm of professional satisfaction. “I basically went on a study day and found it so interesting and felt that it was such a fantastic and interesting addition to dentistry. I am very enthusiastic about these treatments and find the work exceptionally rewarding”, Jenny told us.
Like Jenny, Robin Warne of Huddersfield Dental Implants and Cosmetics has been keen to learn the detailed procedures of facial aesthetics. He too attended basic and advanced courses, as provided by Med-fx, and is clear about the benefits when we asked what advice he would give to colleagues contemplating taking the plunge. “Learn, learn, learn!” he replied with the certainty that comes with experience, “ensure that you are fully trained and confident in offering these new services.”
Is it dentistry?
A question often debated is whether facial aesthetics is really dentistry. Jenny has no doubts about its place in helping to “put a frame around a new smile” and providing a patient who has invested time and money in their appearance with not just a great new smile but also a life enhancing improved look. Dr Rafaella Gabassi, has found exactly the same positive outcomes in her practice in Godstone, Surrey with a 70% : 30% ratio of NHS to private patients.
“The uptake of these procedures has been great for those who want to improve their appearance” reports Rafaella, adding that her own satisfaction from helping such patients is immense. “There is nothing like seeing someone smile with confidence for the first time in their life. I am very privileged to be able to help.”
Robin concurs with this view adding that offering facial treatments has broadened the appeal of the practice to the public giving him a competitive edge, so important in today’s dental market place. Patients attend for their dentistry but are pleased to discover that they can also have dermal fillers and skin injectables. Similarly, people attending for facial treatments are delighted to have their dentistry completed at the same place and by someone they trust. “We are already trusted dentists, we are the right people to provide this service in a clinical environment,” explains Robin.
Rafaella has seen how uptake has grown from people in all walks of life. “People still think that it is a thing for the rich but it costs less than many of the expenses we incur on a daily basis.” She is finding that the message is gradually sinking in to her patients who are increasingly aware of the benefits and the affordability.
Type of treatments
For a beginner the range of terms can be bewildering; skin injectables (Botulinum Toxin Type A), dermal fillers and facial peels but none is so complex that it is outside the accepted clinical skills and knowledge of a dentist. When added to the established activities of tooth whitening, veeners, crowns and cosmetic dentistry in general the advantages of being able to provide facial harmony are a logical extension of patient care.
However, the range and application of techniques and materials underline the need for comprehensive training to ensure competence and familiarity. Prior to carrying out any of the procedures Jenny did three full days training which allowed her to gain her certificate to commence training and get insurance cover.
Profitability and costs
The costs involved for the dentist need to be considered but the profitability is clearly good. Additional insurance is required which can be of the order of £1,000 a year but there are specialist insurers such as Hamilton Fraser and as the realisation grows that the risks are minimal, premiums have actually been falling.
The materials themselves are often economic in use especially with some forward planning. “I use Dysport from Dental Directory and can provide treatment for one area at about £20, which I charge at £120” reports Robin. “If I complete three areas on one patient I charge £220 but I can treat between three and four patients from one vial, so there is a good profit margin.”
While there are regional differences in market rates and even in perception of appearance there are no differences among the practitioners to whom we spoke on one important issue. The first and most important step is to get good training but from then on you will find the world smiling back at you.
The Dental Directory have teamed up with Med-fx Training to offer a series of dedicated training seminars. All courses are recognised by Hamilton Fraser Insurance Solutions (HFIS plc). The sessions cover a variety of topics including Dermal Fillers, Botulinum Toxin, Chemical Peels, and Cosmeceuticals. In order to register for a course, or simply to get more information, please visitor call the Med-fx Training Team on 01376 532832.
Despite the credit crunch, the number of dentists looking to move into facial aesthetics is continuing to grow, according to Med-fx Training.
Lindsay Woolf, manager for Med-fx Training, specialist in facial aesthetic courses, said, “We saw a huge interest at the Dental Showcase, with people quite literally queuing in the aisles to watch hands-on demonstrations.” Woolf said that delegates at the show were booking onto courses well into 2009.
“It looks as if facial aesthetics will increasingly be used alongside traditional cosmetic dentiststy,” she added.
Joe Sullivan spends a A weekend with medfx.
The image of the High Street dental clinic is undergoing profound changes. The rapid increase in private practice has broadened areas of interest for practitioners who now deal with a clientele who are prepared to pay for quality work. Television makeover programmes and targeted glossy advertising have created a demand for aesthetic dentistry. The public are now becoming very aware of what is available. Having gained a youthful smile, many are now demanding other treatments which enhance appearance. Botulinum Toxin, Dermal Fillers and Chemical Peels are growing in demand. The dentist and the dental surgery are ideal for the delivery of these procedures but questions will rightly be asked as to whether providing such treatments is the correct use of a highly trained dentist’s time. Poor workforce management within the NHS – which has led to a large influx of dentists and competition for associate jobs - and financial uncertainties associated with the introduction of the new contract have caused a rush to private practice where the absence of any NHS work has created free time enabling practitioners to move towards facial aesthetics. There is little doubt that the demand for these treatments will grow.
Having little knowledge in this field I decided to explore the various treatments by attending training. The training was arranged through Med-FX which is an associated company with Dental Directory. I had seen them demonstrate at the BDTA exhibition at Birmingham. I arranged a series of three training days.
Facial aesthetics is a field which I did not feel could easily be incorporated into my practice. Working in a busy practice does not leave room to concentrate on new treatments such as these. However, like many dentists one likes to have the skills to match ones colleagues. Before I undertook training I spoke with my indemnity insurers to explore potential pitfalls. I was advised to proceed with great caution. There had been a significant number of claims against dentists by unhappy patients. Allergic reaction to fillers has been a serious risk.
Overall this was an excellent training session. Small numbers of trainees and one-to-one training on that session – it may be two-to-one on other days – made it interesting and gave a lot of hands-on experience. There is little doubt that the techniques are made much easier for the patients when small amounts of local anaesthetic, given in the labial sulcus as for dental infiltration, are used. Therapists other than doctors or dentists can only use topical anaesthetic. This seemed inadequate for some procedures, even for the most cooperative patient. There is a role for the dentist. The course materials provided by Q-Med are excellent. Further support and guidance following training are promised. A full range of patient paperwork, consent forms, medical history sheets, treatments cards and other clinical records are provided for use at the surgery. There is a full range of marketing material available free of charge also. It was a good day with a good product with a supportive company. I have yet to use Restylane in my surgery but am confident that with the promised support at my surgery, I could safely do so with very nice outcomes.
At 9am the following morning, I moved on to a lecture room in Harley St where the training on the use of botulinum toxin, BTX, was to take place. My perception of this drug was rapidly changed. Here is a substance which has many important uses in medicine. By relaxing muscle spasm it can be used to treat spasms post stroke, help in tics, cerebral palsy and other spasticity. It has also been used to treat reflux and bladder sphincter problems. Treating the muscles of the forehead has also helped in relieving migraine headaches. In facial aesthetics BTX is used to soften active lines – lines which appear when one frowns or smiles. It will not help in lines which are permanently present or where the skin is sagging. It can be regarded as a hibernating treatment for muscles. Smiling and frowning do not produce the lining of the forehead or the crows-feet once the muscles are treated. The effect takes a few days to appear and lasts for up to 3 months. When someone is deprived of the movement, seen in a frown, for some time, they learn new methods of expression and therefore do not need retreatment after perhaps the 3rd treatment. The drug is very safe with no reported anaphylactic reactions. The lethal dose is estimated to be about 25 times the normal treatment dose. BTX is different from Dermal fillers, in that it is a prescription drug and therefore can not be advertised.
This was once again a very full day. There were 5 trainees with at least one model per trainee. The morning session was packed with information on the toxin, anatomy, patient selection, indications for use and contraindications, treatment planning, consent and how to use the toxin. The course notes are comprehensive. A lengthy afternoon session followed, during which we experimented on each other with saline before demonstration and hands on practice with a variety of differing requirements of a large number of models. There was emphasis on meticulous note keeping. One could not have asked for more from the training.
Then it was Sunday. After a little lie-in I returned to Harley St for 9.30am for training on the really horrible sounding Chemical Peels. I wasn’t going to like this. Why was I here instead of my usual Sunday run in the countryside of Kent. But beauty knows no bounds. This was another well organised day. There were just 5 of us again. The instruction was detailed and interesting. This was more commonsense than the other two days in many ways. We did not peel anyone’s face off. Nature does the peeling after treatment. Many women spend hours having very expensive facials to little avail because the materials can not do what can be achieved by the substances used for Peels in 90 seconds. Over the weekend I learned a lot about the skin and how to keep it subtle and young looking. The use of chemical peels with proper follow-up treatment using the correct products can produce real rejuvenation of the skin quickly. Of the three days I came away with the feeling that this was something which could really help people with the very worrying problems of acne and pigmentation and damage post acne. It is not an inexpensive treatment but can give lasting good results as long as clients change their lifestyles and use correct skincare creams and lotions afterwards. The training gave information on all aspects of care. Is this a treatment that dentists should be carrying out? It is certainly a treatment which can help a lot of people. I have changed my mind. Peels can be appealing.
The hands-on session was participated in enthusiastically by all. We had numerous models on whom we treated the face, arms and the upper chest and then we treated each other. There seemed to be a reluctance to stop. But before we went we had to do the test. Each day ended with a self assessment test which forced one to reproduce the information learned through the day. I passed all three!
After three days I was somewhat exhausted. I had started out with a number of questions of whether dentists should be doing these treatments, are the treatments safe and whether it is the right image for a dentist to be involved in facial aesthetics. I wondered also whether one could learn enough in a one day course to be proficient. Over the following days I pondered what I had seen and learned. Dentists will decide for themselves what they like to do. Poor workforce management may mean an over supply of dentists in the private market. This will allow for a broadening of services offered.
Eighteen solid, information packed, hours of Med-fx training gave me certification which is a requirement for indemnity insurance; [advice is given on the best value insurance]. One can not fault the training. What was encouraging also was that almost all of those attending the various days had some previous knowledge in each of the fields and were there to extend their knowledge. The small groups with a lot of hands on experience gave the additional opportunity to learn from the informed questioning of these participants. The offer for backup support gave confidence to the novice also.
I can recommend this training from Med-fx.
The repeated warning over the weekend was of the dangers of exposing the skin to sunlight, even on a cloudy day. I always find this hard to accept. There were no roofs on the planet when we arrived, nor was there sun-block. People look healthier and therefore more attractive with suntan. Balance this with the advice that to keep skin healthy looking one should use botulinum toxin from the age of 26, when collagen production starts its decline; another unnatural approach. However, the expert use of all three of all three techniques which I explored over the weekend will protect the skin from aging and help to repair damage caused by poor diet, habits such as smoking and other unhealthy lifestyle choices.
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