Eyeworld

EW NEWS & OPINION 21 Incorporating neuromodulators and fillers into the practice T hese days the adoption of aesthetic procedures such as using neuromodulators and fillers has an appeal for practitioners of many stripes. Use of such procedures is on the rise, said Joely Kaufman, MD, associate professor of dermatology, University of Miami. "According to the American Society of Plastic Sur- geons, aesthetic use of botulinum toxins is still increasing, with more than 6 million procedures per- formed in 2012," she said. "The market is expected to grow to $4 billion by the year 2018." 1 However, the fact is not all prac- titioners are incorporating these in the best way, she said. "With the downturn in healthcare reimburse- ments, it seems that many physi- cians are trying to find non-covered procedures to keep up practice rev- enue," Dr. Kaufman said. To do so, some are hiring physician extenders, such as nurses and physician assis- tants, to perform these. Many exten- ders are taking weekend courses and injecting with little experience, she pointed out. "Few are properly trained in aesthetics, and the com- plications are increasing," she said. However, Dr. Kaufman views core physicians, such as ophthal- mologists who have received train- ing in their residencies on skin and cosmetic procedures, as being at a huge advantage in mastering aes- thetic techniques. Likewise, Steve Yoelin, MD, in private practice, Newport Beach, Calif., sees facial aesthetics as well within the purview of the typical ophthalmologist. "I would compare it to [procedures] that we traditionally execute," Dr. Yoelin said. "Although aesthetics procedures are different in scope, ophthalmic maneuvers can be sim- pler to perform. It's a matter of the commitment and practice," he ex- plained. Gaining experience Dr. Kaufman agreed that for physi- cians injecting toxins and fillers it is not that complicated, but she also stressed the need for proper training. "It takes a long time to master the skills to get predictably successful results," she said. "All patients are different, and there is not one standard injection technique." To get the needed background, she urged practitioners to start with a hands-on course and then practice on staff or family members. "Start in the easier-to-inject, FDA-approved areas such as the glabella or crow's feet for toxins and the nasal labial folds for fillers," Dr. Kaufman said. "Getting trained by several different instructors from different fields will give you a more well-rounded fund of knowledge and techniques." Dr. Yoelin is a faculty member of a CME injectables program that can be found online at www.paletteresources.com. Palette Resources offers live, hands-on train- ing nationwide to those interested in learning and perfecting their injectable aesthetic technique. "The program begins with a 1-hour lec- ture followed by a 3-hour hands-on session. Enrollees are encouraged to bring in a model that will be treated by the attendee (student) under the close supervision of a faculty mem- ber," Dr. Yoelin said. He pointed out that various ophthalmic societies offer instructional courses as well. "These examples represent different ways to obtain the knowledge neces- sary to use injectables in a safe and effective manner. It is recommended that the practitioner return to his or her office and prac- tice what was learned. This process, learning and practicing, should be repeated until the practitioner feels comfortable with the procedures." Surveying the products As for the aesthetic products them- selves, they differ by category. For the neuromodulators, there are currently three available in the U.S.—Botox (onabotulinumtoxinA, Allergan, Irvine, Calif.), Dysport (abobotulinumtoxinA, Ipsen, Wrexham, Wales), and Xeomin (incobotulinumtoxinA, Merz Phar- maceuticals, Frankfort, Germany). Dr. Yoelin recommended starting with just one neuromodulator, so that you won't end up with a big inventory of unused products sitting in your refrigerator or storage cabi- net. "It makes sense to initially work with one company—the one that you feel most comfortable with or that makes products that you're most familiar with and then branch out from there," he advised. Dr. Kaufman agreed that begin- ning with just one of the three products and expanding from there makes the most sense. "If you are not sure that you will be injecting every day, it may be good to keep the newest approved toxin on hand, Xeomin," she said. "This does not require refrigeration, so it can be easily shipped and stored." Likewise, with fillers she recom- mends a focused approach. "You will be able to master the fillers better if you are concentrating on one type," she said. "Each filler is a little differ- ent, and injections and results can be dissimilar if you are constantly switching products in the begin- ning." Sticking with one company will also help with costs, she ex- plained, as each company has a loyalty program and the more you buy, the better your pricing. "The most common fillers on the U.S. market are the hyaluronic acid fillers," Dr. Kaufman said. "These have become the mainstay in aesthetic volumization because these May 2014 by Maxine Lipner Aesthetic appeal Pharmaceutical focus continued on page 22

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