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In Focus: Hacks

Get Better Brow Lifts

An effective neuromodulator brow lift depends on identifying two key points that will help determine the ideal injection location, says Joel L. Cohen, MD, a dermatologist in Greenwood Village, CO. The key is to inject the orbicularis oculi only and to avoid the frontalis entirely.

Watch as Dr. Cohen explains and demonstrates his injection technique at

Dr. Cohen is co-editor, along with David M. Ozog, MD, of Botulinum Toxins: Cosmetic and Clinical Applications (Wiley & Sons, 2017), which provides a comprehensive and in-depth review of the use of botulinum toxin for aesthetic procedures and medical applications as a stand-alone treatment and as part of combination therapy.

Amazon Business: Could it Save Your Medical Practice money?

Amazon Business is open for medical practices. Amazon Business offers, “the selection, convenience and value that [customers] know and love from Amazon, with features and benefits tailored to businesses,” the company says.

Amazon Business users can access a number of features, including saved suppliers lists, internal order approval processes, and real-time analytics.

In addition to standard business supplies, like janitorial products and stationery, the site also offers products specifically for medical practices through Amazon Business Professional Healthcare enrollment. Enrollment is currently available to customers in most states (See the list here: Available products include certain devices and items such as sutures. The service does not deliver drug products.

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Low Tech, High Impact

Suneel Chilukuri, MD shares a low-tech, high-impact office hack to improve communciaiton in the clinic: Use a two-way communication radio in your ear throughout the day so you don’t need to be interrupted during a patient office visit. If staff need you, they can let you know without needing to knock on the door so you can choose the best time to respond.

Watch the full video at

Trial Skincare Regimen Packs Now Available for Patients from Revision Skincare

Patients unwilling to commit to skincare without trying it first? Revision Skincare has introduced a collection of five comprehensive 45-day trial regimens they say are designed to address the needs of women who depend on professionals for anti-aging solutions ranging from powerful in-office treatments to customized at-home regimens. All regimens are designed to take the guesswork out of caring for skin when addressing the visible signs of aging, the company says. Plus, the trial regimens are travel-friendly, featuring TSA approved sizes and a complimentary travel bag.

As a bonus, each set includes an online redeemable code for a free full-size anti-aging moisturizer.

The kits are available exclusively at authorized skincare professionals’ offices. More information is available at

There’s an App for That

Apps have simplied life for many professionals. Modern Aesthetics® asked our editorial board members to name some of the apps that they have found useful in their personal and pofessional lives.

Ryan Greene, MD reports, “Our EMR system recently launched a HIPAA-compliant app so that I have access to my patient schedule and charts. This allows me to better control my schedule and be aware of any last minute scheduling changes that occur.”

“Apple iCAL with multiple calendars helps to organize my schedule,” says Adam Scheiner, MD.

According to Daniel Friedmann, MD, “Scanbot is a phenomenal paid app for uploading any important paper document (receipts!) on the fly. In about 10 seconds, I can photograph it, label it, and have it automatically uploaded to my encrypted Dropbox professional account.”

Read more about the practice hacks editorial board members share in the Board Forum.

This non-invasive makeover was accomplished with nothing more than a change in lighting and camera angles. Dr. Subbio explains online.

Quality Check: Before and After Photos

A simple lightening trick is all it takes to create the illusion of a dramatic surgical makeover. But for ethical aesthetic physicians, that’s not the kind of hack they want to employ. Rather, the goal is to get consistent before and after images that allow for legitimate comparisons and showcase the kind of results you can provide.

What Makes Before and After Photos Bogus?

With the advent of Instagram and the widespread sharing of before and after photos by doctors to an ever-increasing audience, the consumer needs to be wary. All is not what it seems. Sharing before and after photos isn’t new. For years doctors have shared their photo gallery on their own website. But that’s not the same as sharing photos on social media.

For one, there wasn’t a “crowdsourcing” of consumer “photo” knowledge prior to social media. What I mean is that consumers couldn’t leave comments under the photos on a doctor’s website. On Instagram, once consumers view an exhaustive number of before and after photos and educate themselves. They know a bogus photo when they see it. And they’re happy to share their knowledge in the comments on social media.

With this new-found knowledge, consumers, and even doctors themselves, are calling doctors out for disingenuous photos. The following will serve as a tutorial for the doctor on what not to do…and for the consumer: When you see something, say something!

How to spot bogus before and after photos: Lighting
A change in lighting from the before to the after photo is the oldest trick in the book. Or adding makeup and a new hairdo to the after photo can serve as confounding variables. In other words, do they look better because of the procedure or because of lighting and camera tricks.

A perfect example is demonstrated below by Dr. Christian Subbio of Newtown Square, Pennsylvania. In the rotating images below, he reveals the secret to his non-invasive makeover. Light! Even as a seasoned plastic surgeon taking before and after photos for years, I’m still amazed how much the lighting and position of the head can affect perceived results.

How to spot bogus before and after photos: Angle
I’ll admit I’m guilty of posting an immediate ‘after’ photo of a patient on the operating room table on Snapchat or Instagram Stories. My rationale is that while broadcasting the procedure in a quasi-live manner on social media, it would leave the consumer wanting if we didn’t show the patient immediately after surgery.

Of course it would be more accurate to show the patient in the same position as the preop photo. But all preop photos show the patient in a standing position, regardless of whether we’re talking about a facelift, breast aug or tummy tuck. At the end of the operation, with an anesthetized patient, we can’t very well stand the patient up. Remember Weekend at Bernie’s?!

So while I recognize this is comparing apples to oranges (standing before and laying down after vs standing before and standing after), the audience watching the procedure would be aggravated if we showed nothing. So we leave it to the viewer to judge for themselves, knowing full well that the preop is standing and the immediate postop is laying down. You can hear my opinion further articulated in the video below.

That said, this is different than an intentional trick used by some doctors. As illustrated below by our friend Dr. Subbio, the patient’s position on the bed is manipulated further than just comparing standing “befores” and laying “afters.”

What about tummy tuck scars?
Before plastic surgeons get too self-righteous about what is and is not appropriate, they should consider one technique we’re all guilty of. Ever notice how most before and after tummy tuck photos have the underwear covering the patient’s incision? Sure it would be more honest to show the patient’s incision, as I’ve done before. But after the thousandth viewer asks why the patient has a scar, it’s easier to get on the same playing field as other surgeons and just cover the incision. It’s disingenuous in my opinion to act as though the patient doesn’t have a scar after a tummy tuck. But it’s better than taking the high road, showing the scar, and never doing another tummy tuck because patients think you’re a hack!


Less is More in Record Note-Taking

Some tools intended to make note-taking more efficient may have the opposite effect, UCLA researchers have found. They say that the key to better notes is education and guidelines that emphasize best practices.

To avoid the potentially problematic practice of “copying-forwarding” notes and to eliminate note bloat, researchers invited residents to participate ,“in brief educational conferences and received an electronic progress note template that incorporated a set of best practice guidelines.”

Encouraging residents to document only information relevant to that day’s visit and avoiding use of auto-fill and copy-forward options, the notes were significantly improved for quality, completed more quickly, and shorter in length. The findings were reported by UCLA and appear in Journal of Hospital Medicine.