In Focus

Many issues affect core aesthetic physicians. No matter the core area of speciality, topics like safety with injections, proper training, malpractice premiums, fighting commoditization, marketing, advertising, and much more matter. And learning from one another is key to achieving success.

Two physicians who have been instrumental in pioneering multispeciality meetings include S. Randolph Waldman, MD and Joel Schlessinger, MD.

The Vegas Cosmetic Surgery & Aesthetic Dermatology Conference (www.vegascosmeticsurgery.com) celebrated its 11th anniversary in Las Vegas in June. The meeting, which was founded by and is led by Dr. Waldman, was initiated to foster a spirit of cooperation and understanding between the four “core” specialties of facial plastic surgery, plastic surgery, dermatology, and oculoplastic surgery.

Cosmetic Surgery Forum (cosmeticsurgeryforum.com), a multi-specialty educational symposium that covers the latest research, treatment, and techniques in dermatology and cosmetic surgery, is led by course director Dr. Schlessinger. The meeting will celebrate its 7th year in December in Las Vegas.

Ahead, Drs. Schlessinger and Waldman share their thoughts about the value of multi-specialty education.

Q. What are the most significant benefits physicians get from
working with interspeciality
colleagues? 

Dr. Schlessinger: We learn so much more when we are in a room with other specialties, as they have a completely different approach to various concerns. That reflects different methods of risk assessment and or mitigation, as well as the training differences that occur in these different specialties.

Dr. Waldman: I think we learn that there are many different perspectives in addressing a problem. We also learn that our colleagues from other specialties are very bright and talented, and we learn respect for one another.

This is especially important in dealing with controversies and complications. In the end, we learn that we really have much in common with one another.

Q. Why is it important to
cross-educate?

Dr. Schlessinger: Without collegial interactions we practice in a vacuum and that doesn't do anyone any good. Additionally, the interplay between specialties allows for us to see better what they do and be a more informed specialist ourselves. By improving the overall field of medicine we create a better environment for everyone.

Dr. Waldman: No single specialty has a lock on the knowledge base within the aesthetic field. We have so much to learn from one another. To not take advantage of the opportunity to do so results in a tremendous disservice to our patients.

FDA Issues Safety Communication About Fillers; Physician Training Important

The FDA issued an alert to healthcare providers and consumers about the possibility of rare, but serious, injuries that may occur due to unintentional injection of soft tissue filler into blood vessels in the face.

“Unintentional injection can block blood vessels and restrict blood supply to tissues. Sometimes this can result in embolization. This means the filler material has traveled to other parts of the body. This can cause vision impairment, blindness, stroke and damage and/or death of the skin (necrosis) and underlying facial structures,” according to the alert.

The FDA's review of literature and adverse event reports identified injections into the glabella, in and around the nose, forehead, and around the periorbital region as sites where blood vessel blockage have been reported more often.

The FDA made recommendations for healthcare providers, including a warning not to inject soft tissue fillers if you do not have appropriate training or experience and making sure that you are familiar with the anatomy at and around the site of injection. Other recommendations include informing patients of all the risks of the procedure and the specific product you intend to use, understanding that the approved indications for use of soft tissue fillers vary depending on the product, and taking extra care when injecting soft tissue fillers, for example inject the product slowly and apply the least amount of pressure necessary.

Other recommendations include:

• Know the signs and symptoms associated with injection into blood vessels, and have an updated plan detailing how you plan to treat the patient if this should this occur. Immediately stop the injection if a patient exhibits any signs or symptoms associated with injection into a blood vessel, such as changes in vision, signs of a stroke, white appearance (or blanching) of the skin, or unusual pain during or shortly after the procedure.
• Tell patients that they should seek immediate medical attention after the procedure if they experience signs and symptoms associated with injection into a blood vessel.
• Educate healthcare facility employees on how to quickly assist patients that report signs and symptoms of filler complications. They must understand how to instruct the patient to receive appropriate medical care.
• Report to the FDA and the manufacturer any adverse event associated with unintentional injection of soft tissue filler into a blood vessel.

Recommendation to consumers included being educated about fillers and asking their doctor about their training and experience.

The FDA is working with manufacturers to update their labeling to include additional warnings, precautions, and other statements about the risk of unintentional injection into blood vessels.

The American Society for Dermatologic Surgery Association (ASDSA) stands in agreement, with a formal Board-approved position statement asserting that “only properly trained physicians should be injecting dermal fillers and botulinum toxins. Training should include an extensive understanding of cutaneous medicine and the aging face, knowledge of the various FDA-approved injectable products and their indications, experience in injection techniques appropriate to the products, and the pre- and post-procedure care involved in treatment.”

For the FDA's full communication, visit http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm448255.htm.