This week in aesthetics, we discuss tips to hiring practice staff, Dustin Portela, DO, reviews the best skincare products he tried in 2021, and we highlight different muscle toning and sculpting devices to analyze their effectiveness.

An expert details the ways to gain and retain new practice staff.

Pointers with Dr Portela: The End of the Year Product Review

In this week’s Pointers with Dr Portela, the 208SkinDoc lists his favorite skincare products that he used this year.

Toning and strength technologies work, according to investigators, but many in cosmetic medicine question the procedures' efficacy in their field.

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This week in aesthetics, we highlight toning and strength technologies, our weekly “Pointers with Dr Portela”, and more. 

This Week in Aesthetics: December 27-31

A panel of dermatologists experienced in muscle toning and strength technologies shared their knowledge at the Controversies and Conversations in Laser and Cosmetic Surgery Virtual Meeting 2021, which featured a range of hot topics discussed by more than 50 experts.

Bioelectrical stimulation isn’t new. In ancient times, Egyptians and Romans managed pain using electrical charges from fish. Russians employed direct electrical stimulation to prevent muscle wasting under zero gravy in their 1960s space program. The technology was modified in 2018 for aesthetic use with high-intensity focused electromagnetic technology, or HIFEM (Emsculpt; BTL), according to panel member Anne M. Chapas, MD, dermatologist and medical director at Union Square Laser Dermatology in New York, New York.

Today, these technologies also include magnetic muscle stimulation (CoolTone; Allergan Aesthetics), multidirectional stimulation (truSculpt Flex; Cutera), and bioelectric muscle activation (Accufit; Lutronic).

Chapas combed the literature before incorporating muscle toning and strength into her practice. “Most studies suggest we should only be treating people with 25 BMI [body mass index] or lower,” she said. “But there are studies that suggest this works on visceral fat.”

Although investigators tend to recommend using 4 treatments over 2 weeks, Chapas said the ideal treatment and follow-up regimens remain to be determined. HIFEM study results show longevity for a duration of 6 to 12 months. However, patient satisfaction scores on abdominal use vary from 54.8% in a study by Fabi et al using CoolTone to 92% at 12 weeks in a study by Jacob et al.

Another consideration is that not everyone is a responder to muscle toning and strength treatment in the aesthetic practice, Chapas said. Anecdotally, she has reported positive outcomes in a wide range of patients, including those who are fit, have skin laxity, have BMIs over 25, and are 50 or older. “It gets harder to build muscle over the age of 50 and after menopause,” she said. “These are people that need more muscle mass to prevent injuries, to prevent falls, and to just maintain mobility.”

Technologies to tone and strengthen muscle can be used on the bi- ceps, abdomen, thighs, triceps, flanks, and buttocks, but not all devices are FDA approved to treat all areas, according to panelist Suzanne L. Kilmer, MD, clinical professor of dermatology at UC Davis Medical Center in Sacramento, California.

Study results suggest that treating patients with one of these technologies can reduce volumetric fat, improve aesthetics, and thicken muscle. She cited findings by Kinney et al, which show a simultaneous muscle and fat effect from HIFEM.

At 2 months, the 22 patients studied had an average circumferential reduction of 3.6 cm, a fat reduction of 18.6%, a muscle mass increase of 15.4%, and a diastasis recti reduction of 10.4%.

But there is more, according to Kilmer: After treatment, patients sit up straighter, feel better, and improve in sports. “There have been so many unsolicited comments from my patients, my friends, myself, that support this,” Kilmer said. “Backs don’t hurt as much. Posture is better. They can hold a plank longer. They are much better at yoga and Pilates. They have stronger tennis serves.”

Panelist Leah Spring, DO, US Navy commander, of Naval Medical Center Portsmouth in Virginia, described a study that found that treating athletes after anterior cruciate ligament (ACL) tear and reconstruction with exercise and neuromuscular electrical stimulation (NMES) strengthened quadriceps more than exercise alone.

Another sports medicine study looked at 25 patients with acute ACL rupture who received NMES or a sham treatment.

 Investigators measured muscle fiber size and contractility. “The authors found that ACL tear and subsequent reconstruction reduced muscle fiber size and contractility across all fiber types by 26%, the most marked of which was in fast-twitch type II fibers,” Spring said. “[NMES not only] reduced muscle fiber atrophy through effects on fast-twitch type II fibers but also preserved contractility in slow-twitch type I fibers.”

Spring was the lead author of a study that investigated functional outcomes using a commercially available NMES device marketed for aesthetic improvement. Although treated participants’ waist circumference decreased and thigh circumference increased, Spring said she was most impressed by the improvements she saw in strength and endurance performance.

For example, participants who received 4 NMES treatments using the strength protocol increased the time they could hold a single-leg wall sit 25% at 2 weeks and 119% at 4 weeks post treatment. Those given the endurance protocol increased performance by 50% at 2 weeks and 76% at 4 weeks post treatment. Treated participants also improved in static abdominal muscle endurance (a held abdominal crunch) and dynamic abdominal muscle endurance (standard crunches).

“We concluded that four 45-minute treatments with an NMES device led to significant improvement in abdominal and quadriceps strength and endurance. Results were sustained through 4 weeks post treatment. There was high patient satisfaction and no unanticipated adverse events,” Spring said.

Historically, it was not safe to combine HIFEM and radiofrequency (RF) in 1 device, according to panelist David J. Goldberg, MD, JD, director of Skin Laser and Surgery Specialists of New York and New Jersey; past director of Mohs and Laser Research, Icahn School of Medicine at Mount Sinai in New York, New York; adjunct professor of law at Fordham University School of Law in New York; and an editorial advisory board member for 

“RF electrodes are made of metal for good electrical conductivity,” he said. “Metal objects are contraindicated to HIFEM because they rapidly heat up when exposed to the electromagnetic field.” That changed with BTL’s Emsculpt Neo, a device that safely combines HIFEM and RF in a synchronized applicator, according to Goldberg, who studied the combined technology.

He reported on 5 patients who had three 30-minute abdominal treatments once a week for 3 weeks. Four participants were treated with HIFEM and RF and 1 received a sham treatment. He looked at histology, fatty tissue changes, in vivo temperature measurement, waist circumference, and patient comfort and satisfaction.

One week and 1-month post treatment, results showed ruptured membranes and alterations of adipocytes, as well as pyknotic nuclei, a sign of apoptosis. “We saw a statistically significant decrease in adipocyte area in the treated group. The sham subject showed no change. Digital photographs of a typical patient showed improved body contour, both in fat and muscle tone, after 1 month,” Goldberg said. “We expanded on that study last year, looking at ultrasound and MRI. If you look at ultrasound and MRI at 3 months, you can see a fat reduction as well as a muscle increase.”

In a 65-year-old female patient with a BMI of 20.1 kg/m

, there was an average fat reduction of 32% and an average muscle increase of almost 21%. Three months after treatment, MRI showed a decrease in the fatty layer and increase in muscle size, according to Goldberg.

He concluded that the histology showed apoptotic elimination of adipocytes, reduced fat cell size, and no necrosis; the therapy reaches effective temperatures for apoptosis; and the procedure is safe and comfortable, with high patient satisfaction.

Aesthetic practices might have viewed muscle toning and strength as treatment for a narrow patient population—people of or very near ideal body weight, according to Spring. “But I think so many different patient populations are good candidates for this,” Spring said.

These patients include many who could benefit from improvements in function, such as those who want to optimize strength and endurance, decrease pain, and return to sports after inactivity or injury, as well as older patients, according to Spring.

Kilmer serves on medical advisory boards for Dominion Aesthetic Technologies, Lumenis, and Solta/Valeant; serves on medical advisory boards of and does research support for Aesthetics Biomedical, Alastin Skincare, Allergan Aesthetics, Cytrellis, Lutronic, Merz Aesthetics, Miramar, Pulse Biosciences, Sciton, Sienna Labs, and Syneron Candela; and does research support for BTL Industries, Cutera, Cynosure, Galderma, and R2 Dermatology.

Goldberg does research for BTL and is a speaker for Allergan Aesthetics, Merz Aesthetics, and Revance. Chapas is a trainer for Allergan Aesthetics and a researcher and speaker for Lutronic.

Controversies and Conversations in Laser and Cosmetic Surgery Virtual Meeting 2021. Controversies Virtual Meeting. Accessed November 9, 2021. https://controversiesvirtualmeeting.com

Fabi S, Dover JS, Tanzi E, Bowes LE, Tsai Fu F, Odusan A. A 12-week, prospective, non-comparative, non-randomized study of magnetic muscle stimulation for improvement of body satisfaction with the abdomen and buttocks. LasersSurgMed. 2021;53(1):79-88. doi:10.1002/lsm.23348

Jacob CI, Paskova K. Safety and efficacy of a novel high-intensity focused electromagnetic technology device for noninvasive abdominal body shaping. JCosmetDermatol. 2018;17(5):783-787. doi:10.1111/jocd.12779

Kinney BM, Lozanova P. High intensity focused electromagnetic therapy evaluated by magnetic resonance imaging: safety and efficacy study of a dual tissue effect based non-invasive abdominal body shaping. LasersSurgMed. 2019;51(1):40-46. doi:10.1002/lsm.23024

Taradaj J, Halski T, Kucharzewski M, et al. The effect of neuromuscular electrical stimulation on quadriceps strength and knee function in professional soccer players: return to sport after ACL reconstruction. BioMedResInt. 2013;2013:802534. doi:10.1155/2013/802534

Toth MJ, Tourville TW, Voigt TB, et al. Utility of neuromuscular electrical stimulation to preserve quadriceps muscle fiber size and contractility after anterior cruciate ligament injuries and reconstruction: a randomized, sham-controlled, blinded trial. AmJSportsMed. 2020;48(10):2429-2437. doi:10.1177/0363546520933622

Goldberg DJ. Deletion of adipocytes induced by a novel device simultaneously delivering synchronized radiofrequency and hifem: human histological study. JCosmetDermatol. 2021;20(4):1104-1109. doi:10.1111/jocd.13970

 Muscle Toning and Strength

Dustin Portela, DO, a board-certified dermatologist and dermatologic surgeon at Treasure Valley Dermatology in Boise, Idaho, reviews different skincare products that he received over the year of 2021. “I'm sure there are many that I could have included on this list, but here are a few of my favorites,” he wrote his YouTube description.

Opinions expressed are that of Portela and do not express the views or opinions of Aesthetic Authority™.

In this week’s Pointers with Dr Portela, the 208SkinDoc lists his favorite skincare products that he used this year. 

Investing time and attention in the medical practice staff hiring process can reduce costs and boost staff retention.

In a busy medical office, an empty staff position can be a real problem. Days that were already full and often hectic are even more so. Patients are complaining. The instinctive response is to fill the slot ASAP. Resist the impulse! Any short-term relief will almost inevitably produce long-term aggravation and higher employment costs.

The data vary widely, but it is generally agreed that filling a staff position costs more than the associated annual salary. Most of these costs are “soft costs” that have a real impact on productivity and operating costs but do not require the practice to write a check to cover them. They include:

Lost productivity and increased overtime while the position is vacant

Time associated with interviewing candidates

Even more lost productivity and increased overtime while the new hire is learning the ropes

The biggest soft cost, however, is making a hiring mistake. Hiring carefully is worth the investment. Here are 6 steps to significantly reduce hiring costs:

Experience and credentials are important but they are the easy part of describing requirements. The more difficult requirements are the ones not apparent in a résumé or transcript. They include:

. For instance, should the individual be cheerful? Optimistic? High-energy? Empathetic? Independent?

. Do you want a self-starter? Team player? Leader? Someone who is detail-oriented?

. Should the individual speak up? Look people in the eye? Be poised? Youthful? Mature?

It will be useful to flesh out the attributes by actually describing how your ideal candidate would respond in 2 or 3 hypothetical situations. (You can use these hypotheticals in the eventual interviews.)

I also recommend describing the ideal candidate from the candidate’s point of view. To whom would the job be most appealing? To whom might the appeal be short-lived? Your best source of this information is your impression of staff, current and past. What type of person at what age and stage has performed well, been happy, and stayed a long time? What are the attributes of people who have not worked out well?

The object of the exercise is to have something definite against which to measure candidates. It is unlikely that you will find an ideal candidate, but you will get much closer if you know what you want and hold out for a reasonably good fit.

You may discover that the highly professional, well-turned out, mature person you would really like to hire has no interest in the duties of the job and finds the compensation inadequate. A long-term solution requires adjustments to your requirements, the job, or both.

Think about more than adjustments in monetary compensation. More flexible hours, the opportunity to learn, educational benefits, a pleasant workplace, and discounts on care and services are all examples of perks that have real value to candidates without necessarily increasing costs. Once you know the desired attributes, it becomes relatively easy to tailor the job to attract the ideal candidate.

STEP 4: ESTABLISH A PROCESS THAT WEEDS OUT CANDIDATES FOR YOU

Before anyone looks at candidate submissions, have someone respond to everyone with a request for some action on the part of the candidate. The action should be related to the position so that the request maintains your credibility, but the task itself is unimportant.

The objective is to let casual candidates self-select out of the process. If you still have too many candidates to seriously consider, assign another task. About 90% of the pool will drop out with each request.

STEP 5: VERIFY SELECTED RÉSUMÉ AND APPLICATION INFORMATION

If something on a résumé or application is important to you, independently verify the assertions. Otherwise, ignore the contents of those documents.

STEP 6: GIVE NEW HIRES AN EASY WAY TO QUIT AFTER A SHORT TRIAL PERIOD

It is not at all unusual for a new hire to discover that accepting the job was a mistake. The sooner the new hire can admit it and move on, the less you will have lost in integrating the new person into the practice. A bonus is that your second choice may still be available and willing.

Hiring is a necessary evil. Investing time and attention in the process so that your hires are smart ones reduces the costs substantially.

Carol Stryker is the founder of Symbiotic Solutions, a practice management consulting company. Send your practice management questions to medec@mjhlifesciences.com.

6 Steps to Hiring Great Practice Staff

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This week, consumer magazines highlight TikTok beauty trends in 2021, traction alopecia, and more. 

Predicting the Most Popular Minimally Invasive Treatments for 2022

This week in aesthetics, Zoe Diana Draelos, MD, explores scalp health, Dustin Portela, DO, reviews sleep devices and explores their connection to skin health and Will Kirby, DO, FAOCD, interviews with Emily Kaye Perbellini, MSN, FNP-Ca, about the aesthetics industry.

In this month's Cosmetic Conundrums column, Zoe Diana Draelos, MD, explores scalp flaking causes and treatments.

Pointers with Dr Portela: Can Sleep Devices Help Your Skin?

In this week’s Pointers with Dr Portela, the 208SkinDoc goes into the science behind sleep and skin while also review 3 different sleep improvement devices.

Meet the Aesthetic Expert with Dr. Will Kirby: Emily Kaye Perbellini, MSN, FNP-C

In this month’s “Meet the Aesthetic Expert” column, Will Kirby, DO, FAOCD, talks with Emily Kaye Perbellini, MSN, FNP-Ca, board-certified family nurse practitioner specializing in aesthetic dermatology. They discuss how to avoid burnout, challenging patient populations, and the role allied healthcare professionals in aesthetics.

This week in aesthetics, we highlight our monthly "Meet the Aesthetic Expert,"  our weekly “Pointers with Dr Portela”, and more. 