The Chronicle of Cosmetic Medicine & Surgery Spring 2014. A new journal from the publishers of The Chronicle of Skin & Allergy. Chronicle Information Resources Ltd.
<ul><li><p>!" # </p><p>!</p><p>$</p><p> %</p><p>! </p><p> %</p><p>&'(%)</p><p>*+,)'</p><p>% $</p><p>%</p><p>!</p><p> #!</p><p> " </p><p>!% </p><p> !%</p><p>% )%('&</p><p>'),+*</p><p>CosMed_Spring2014_05-28-14_cosmetic_dermatology_summer-2013_07-19-13.qxd 5/28/2014 10:29 AM Page 1</p></li><li><p>DYSPORT D I S C O V E R </p><p>DYSPORT D I S C O V E R</p><p>Onset of effect was reported as soon as 24 hours, with a median time of 3 days to onset of treatment response1</p><p>t0OTFUPGSFTQPOTFXBTDBMDVMBUFEGSPNQBUJFOUEJBSZEBUB*PSXBTCBTFEPOJOWFTUJHBUPSTPSQBUJFOUTBTTFTTNFOUTBU%BZ</p><p>Signi cant treatment success as assessed by both investigators and patients, respectively was reported at Day 30 through Day 120 vs. placebo1</p><p>With demonstrated FAST-ACTING and LONG-LASTING results</p><p>NEW botulinum toxin Now available in Canada</p><p>Dysport (botulinum toxin type A) is indicated for the temporary improvement in the appearance of moderate to severe glabellar lines in adult patients </p></li><li><p>From the editors Dr. Michael J. Weinberg on whether cosmetic surgery is best undertakenafter learning reconstructive surgery ..............................................................................................4</p><p>Thinking like a businessman? Dr. Eric Swanson argues for a return to a tradi-tional model: Treat patients well and they will beat a path to your door ........................................6</p><p>Cosmetic Update: On the leading edge of research, discoveries and new clinical findings in aesthetic medicine. Complications for obese reduction-mammaplasty patients, &c. 10</p><p>Cosmetic Medicine 2014: Growing experience has taught Canadian clinicians whotreat patients with fillers that adhering to the principle of less is more is a good approach ..........12</p><p>Bimatoprost effective for growing eyelashes Dr. Jean Carruthersexplains the aesthetic effect of a medicine developed as glaucoma therapy ..................................19</p><p>Managing patient expectations and outcomes Tools such as FACE-Qcan be useful measuring instruments of patient satisfaction in facial surgery ................................20</p><p>Age perception An objective study finds cosmetic procedures reduce an average of 3.1years from patients appearance................................................................................................21</p><p>Pregnant or post-partum women: Dr. Mary Maloney says a checklist is essen-tial for dermatologic or cosmetic procedures on this cohort ........................................................23</p><p>Body contouring Increased demand follows explosive growth of bariatric surgery proce-dures, according to Dr. Jonathan Toy ....................................................................................25</p><p>Treating the Cosmetic Patient Taking herbal supplements? Thats the questionphysicians sometimes forget to ask ............................................................................................26</p><p>Published four times annually by the proprietor, Chronicle Infor mation Resources Ltd., from offices at 555 Burnhamthorpe Rd., Suite 306, Tor onto, Ont. M9C 2Y3Canada. Tele phone: 416.916.2476; Fax 416.352.6199.E-mail: health@chroni cle.orgContents Chronicle Information Resources Ltd, 2014,except where noted. All rights reserved worldwide. ThePublisher prohibits reproduction in any form, including print,broadcast, and electronic, without written permission. Printed in Canada.Subscriptions: $59.95 per year in Canada, $79.95 per yearin all other countries, in Canadian or US funds. Single copies:$7.95 per issue. Subscriptions and single copies are subjectto 13% HST.Canada Post Canadian Publications Mail Sales ProductAgreement Number 40016917. Please forward all correspon-dence on circulation matters to: Circulation Manager, DentalChronicle, 555 Burnhamthorpe Rd., Suite 306, Toronto, Ont.M9C 2Y3 Canada.E-mail: email@example.com ISSN 1927-4955 Cover image: Luba V Nel | Dreamstime Photos</p><p>Since 1995, Ideas in the Service of Medicine. Publishers of: The Chronicle of Skin & Allergy, The Chronicle of Neurology & Psychiatry,The Chronicle of Healthcare Marketing, Best Practices Chronicle, healthminute.tv, and Linacres Books </p><p>EditorsSheetal Sapra, Oakville, Ont.</p><p>Nowell Solish, Toronto</p><p>Guest EditorMichael J. Weinberg, Toronto</p><p>National Editorial Board</p><p>Sheldon V. Pollack, Toronto (Chairman)</p><p>Scott Barr, Sudbury, Ont.</p><p>Arie Benchetrit, Montreal</p><p>Vince Bertucci, Woodbridge, Ont.</p><p>Yves Hbert, Montreal</p><p>Frances Jang, Vancouver</p><p>Julie Khanna, Oakville, Ont.Mark Lupin, VancouverMathew Mosher, Vancouver</p><p>W. Stuart Maddin, Vancouver</p><p>William McGillivray, VancouverKent Remington, Calgary</p><p>Jason K. Rivers, Vancouver</p><p>Arthur Swift, Montreal</p><p>Jean-Franois Tremblay, Montreal</p><p>Fred Weksberg, Toronto</p><p>Industry AdvisorsAnn Kaplan, iFinance, Toronto</p><p>Roxane Chabot, RBC Consultants,Montreal/Miami</p><p>Publisher Mitchell Shannon</p><p>Editorial DirectorR. Allan RyanSenior Associate EditorLynn Bradshaw</p><p>Assistant EditorsJohn Evans</p><p>Emily Innes</p><p>Sales & Marketing Sandi Leckie, RNProduction & CirculationCathy Dusome</p><p>ComptrollerRose Arcierowww.firstname.lastname@example.org</p><p>DYSPORT D I S C O V E R </p><p>Onset of effect was reported as soon as 24 hours, with a median time of 3 days to onset of treatment response1</p><p>t0OTFUPGSFTQPOTFXBTDBMDVMBUFEGSPNQBUJFOUEJBSZEBUB*PSXBTCBTFEPOJOWFTUJHBUPSTPSQBUJFOUTBTTFTTNFOUTBU%BZ</p><p>Signi cant treatment success as assessed by both investigators and patients, respectively was reported at Day 30 through Day 120 vs. placebo1</p><p>With demonstrated FAST-ACTING and LONG-LASTING results</p><p>NEW botulinum toxin Now available in Canada</p><p>Dysport (botulinum toxin type A) is indicated for the temporary improvement in the appearance of moderate to severe glabellar lines in adult patients </p></li><li><p>4 The Chronicle of Cosmetic Medicine + Surgery</p><p>It is a privilege to write the guest editorial forthis issue. The ChronICle of CosmeTICmedICIne + surgery is a new initiative whichfills a niche in the cosmetic medicine and sur-gery market. showcasing all the excellentwork done by Canadian medical and surgicalspecialists in the field, The ChronICle servesto foster collaboration between the medicaland surgical members and among those of uswith varying areas of expertise within eachdiscipline.</p><p>highlights in this issue include the sur-vey by Dr. Jugpal Arneja on plastic sur-gery practices in Canada which revealed that amajority of plastic surgeons have significantreconstructive practices at the start of theircareers, and that this is maintained well intotheir more senior years (see page 27). further,the study found that the transition to a cosmet-ic practice may be happening earlier in theunited states than in Canada, leading theauthors to theorize that this may be due topoor reimbursement for reconstructive work inthe u.s. </p><p>Achieving a balance between reconstruc-tive surgery or medical dermatology and cos-metic practice is a significant issue for derma-tologists and plastic surgeons. universalhealth care is a pillar on which social andcommunity support rests in this great countrywe live in. Consequently, I was glad to seethat a significant percentage of plastic sur-geons in Canada continue to maintain some</p><p>aspect of reconstructive practice. In my view,the transition to cosmetic surgical practice islikely best undertaken after some experiencein reconstructive surgery, and some experi-ence in understanding patients and theirexpectations. </p><p>unfortunately, in the new medical envi-ronment, in which many new graduates willstruggle to find hospital jobs, we may find anincreasing number of residents going directlyinto cosmetic medicine. I am not convincedthat this is the best path, both for surgeons,and for patients. my hope is that physicianswill continue to maintain some balance, inthe interests of promoting excellence in ourfield, ensuring patients receive our full sup-port, and also in the hope that future surgeonswill have the benefit of the rich and variedcareer that those that came before them haveenjoyed.</p><p>I found the report on Dr. PeterAdamsons discussion of facial rejuvenationand attractiveness very interesting. I commenddr. Adamson on his diligent surgical studywhich showed a range of longevity in rejuve-nation results from three to seven years.Previously the general teaching has beenandthe public has come to expecta five to 10year span. I have never thought that 10 yearswas typically achievable, nor necessarilysomething desirable to strive for, as I agreewith dr. Adamson that people prefer a morenatural look. </p><p>Commentaryand opinion oncurrent topics of interest in aesthetic medicine</p><p>Cosmetic surgery: best undertaken after learning reconstructiven Dr. Michael J. Weinberg, TO R O N TOP L A S T I C S U R G E O N</p><p>Your feedback, please: The editors of The Chronicle of Cosmetic Medicine + Surgeryinvite your comments concerning the articles in this publication, on issues of current interestin the practice of aesthetic medicine, and on matters at large. Write us at:email@example.com</p><p>CosMed_Spring2014_05-28-14_cosmetic_dermatology_summer-2013_07-19-13.qxd 5/28/2014 10:30 AM Page 4</p></li><li><p>Volume 4 Number 1 5</p><p>Over-correction in the interests of offer-ing a more long-lasting result can push usinto the realm of the very unnatural or donelook that the public increasingly finds unat-tractive and fears. However, while modest,natural looking correction may be desirable,it behooves us to carefully manage the expec-tations of our patients. The attractivenessfinding was surprising. I am not sure that Iagree with his explanation and I think thatthis warrants further investigation as patientsreally do want to look more attractive afterour treatments. It would be great to see thisstudy repeated after non-surgical proceduresor injectible face lifts.</p><p>The article on commercialization in plas-tic surgery brings up some important points.The piece focuses mostly on the restrictionsplaced on surgeons by big corporations in theU.S., however, some of the principlesaddressed can be applied to our Canadianpractices. We are fortunate in Canada not tohave the challenges of dealing with HMOs,but tight hospital budgets and rising expensesfor private facilities exert their own uniquepressures.</p><p>Out of the grip of greedTemptations are significant to work from theproduct backwards, rather than starting withthe patient. Evidence of questionable respons-es to the pressures we face can be seen inincreasingly aggressive marketing practices,early adoption of unproven techniques inorder to be the first and most fashionable,and unproven claims of efficacy for newproducts, just to name a few. My dad oncetold me that I would stay out of the grip ofgreed if I went to work everyday and didn't</p><p>think about how much money I was makingor needed to make. These words from a sea-soned surgeon are indeed wise, especially inthese challenging and highly competitive fis-cal times.</p><p>Finally, I thoroughly enjoyed the pieceon looking forward to 2014. Kudos to Dr.Vince Bertucci, whose insights I havealways appreciated. Its always good tohave newer and better tools for our trade.Just as we have been fortunate in the surgi-cal sphere to see a huge range of breastimplants become available, expanding theoptions and improving the outcomes for ourbreast augmentation patients, so too we nowsee the same great expanse in the filler mar-ket.</p><p>I agree that Volbella and Voluma are twosafe, versatile new products that offer advan-tages to previous fillers. The ideal durationfor a product has not been established, andwe are still haunted by the complications ofprevious permanent fillers.</p><p>I think that the non-invasive body con-touring market is a huge potential market, butthe fat cell is proving to be a tough adversary.Hence, the current early generation machinesare not yielding results that are consistentenough for wide adoption, and will requiresignificant improvement if we are to attainthe levels of patient satisfaction all of us aimfor.</p><p>I hope that you too will enjoy the highlyinformative, current and diverse articles in thisedition of THE CHRONICLE, as I have. We wel-come comments.</p><p>Dr. Weinberg is Division Lead PlasticSurgery, Trillium Health Partners, and MedicalDirector, Toronto Plastic Surgery Clinic</p><p>Cosmetic surgery: best undertaken after learning reconstructiven Dr. Michael J. Weinberg, TO R O N TOP L A S T I C S U R G E O N</p><p>s 10% Glycolic Acid</p><p>s 100% Perfume-free</p><p>s Ideal for Keratosis Pilaris and Ichthyosis</p><p>s Hydrates and smoothes rough dry skin</p><p>skinsmoothing</p><p>bodylotion</p><p>ADDICTIVE</p><p>CosMed_Spring2014_05-28-14_cosmetic_dermatology_summer-2013_07-19-13.qxd 5/30/2014 1:00 PM Page 5</p></li><li><p>n Dr. Eric Swanson, a plastic surgeon practic-ing in leawood, Kan., was born in Toronto andcompleted medical school and a residency in plas-tic surgery at the university of Toronto followedby a fellowship in cosmetic surgery at scarboroughgeneral hospital. dr. swanson moved to Kansas in1989 to begin practice and opened the swansonCenter for Cosmetic & laser surgery and leawoodsurgery Centre 10 years later. his practices web-site states, dr. swanson believes that knowledgeis the remedy for patient apprehension about cos-metic surgery and that the marketplace is often toofocused on selling commercial products to be areliable source. </p><p>dr. swanson recently explored the topic ofcommercialization of plastic surgery and its ethicalimplications of a corporate model in medicine in anarticle published in the sept. 2013 issue of The</p><p>Aesthetic Surgery Journal (33(7):1065-1068). TheChronICles Emily Innes spoke with dr. swansonabout his observations on the changing practices inplastic surgery. How do you define corporate medicineandwhat does it have to do with plastic surgery? Corporate medicine applies corporate businessstrategies to what has traditionally been a doctor-patient service relationship. It views plastic surgeryas a commercial product as opposed to a medicalservice. It limits the surgeons options. It may insiston a specific treatment or procedureyou donthave the freedom to recommend another treatmentthat might be better suited for your patient. </p><p>lets say the corporate strategy is to performall surgery in the office under local anesthesia, butthe patient is scared of needles. That is not going towork very well for that individual. or, perhaps thecorporation promotes laser liposuction, but thepatient would be better treated with a tummy tuck.Applying the corporate model, the product comesfirst. The traditional pattern is inverted. rather thanstarting with the patients concernthe way itsbeen done in medicine for over a centuryyou arestarting with have I got a treatment for you.Why would some surgeons want to work withinthis corporate model, and what do they haveto gain? It is economic. They are thinking, especially whenthe economy is tight, I wouldnt mind [gaining]more patients and having more business and thecorporation can take care of my expenses and mymalpractice insurance. All I need to do is performthis procedure. This approach might appeal to ayoung surgeon who is just starting practice and thephone...</p></li></ul>