Coming into the summer, a new aesthetic landscape is starting to appear, and independent medical practices are at the forefront of the change. Can practices continue to thrive in with increased buying interest from private equity, staff shortages, the enduring effects of the pandemic, and threats of increased tax burden? And what can practices do for a leg up on the competition?

In this Summer issue, now nestled within the pages of our sister publication, 

®, Paul Nassif, MD, gives his advice on how to create a successful skin care brand, Joe Niamtu, III, DMD, shares how to safeguard the practice from scams when donating to charitable organizations, Gary Linkov, MD, shares his protocol for facial hair transplants, and Mark Mandell-Brown, MD, highlights how to address female to male breast reduction surgically and through minimally invasive procedures.

Click on the cover below to read the digital issue and let us know what you think on our social media.

Articles

In this Summer issue, Paul Nassif, MD, gives his advice on how to create a successful skin care brand, Joe Niamtu, III, DMD, shares how to safeguard the practice from scams when donating to charitable organizations, and Gary Linkov, MD, shares his protocol for facial hair transplants. 

Smart Skin Care: Aesthetic Authority Vol. 2: No. 2

Microwave and microablative CO2 laser treatment is effective for postpartum abdominal laxity, according to findings of a 2020 study published in the

Laxity can occur post pregnancy due to loss of muscle tone and abdominal elasticity, wrote study coauthors Paolo Bonan, MD, and Alice Verdelli, MD, of the Laser Cutaneous Cosmetic & Plastic Surgery Unit at Villa Donatello Clinic in Florence, Italy.

 The study’s goal was to assess the efficacy of combined microwave and fractional microablative CO

 laser treatment to improve these postpartum effects.

The investigators examined 15 women who were 18 years or older (median age, 38) and who were at least 12 months postdelivery. The patients received microwave treatments (ONDA Coolwaves; Deka)

 to the abdomen once a month for 3 months followed by fractional microablative CO

 1 month later, for a total of 4 months of treatment.

Coolwaves, a patented microwave technology, reduces localized adiposities in the abdomen and other areas, according to Deka. It dissolves fat, tightens and contours the skin, and firms tissue. The technology is to be used in place of radiofrequency for tightening and skin toning, according to the company.

 fractional microablative system to cause a rapid tightening of the skin; it reduces blemishes and softens irregularities and scarring. The laser stimulates collagen production, making the skin look younger and plumper. This collagen production in turn helps prolong the treatment effects and gives more even results.

Patients were instructed to maintain the same eating and exercise habits prior to the treatments throughout the study. The investigators also did a follow-up of patients’ eating habits and weight. They used a patient satisfaction index, abdominal laxity score and measurements, and digital and 3D photography to assess the treatment’s effectiveness.

The investigators reported the overall mean circumference as 3.6 cm plus/minus 1.2 cm. Both physicians and patients reported great improvement in tightening and skin laxity, and striae distensae were also reduced. The investigators noted umbilicus repositioning following the treatment and reported that the procedure was well tolerated, with no adverse effects.

“This initial study confirms that the combined ONDA Coolwaves and SmartXide2 (microablative CO

 laser) treatment are safe and effective for the treatment of postpartum skin laxity and striae distensae,” the study authors wrote. “Thus, combined treatment could be a promising option for those patients who refuse surgical procedures in the rapidly growing demand for noninvasive aesthetic treatment.”

Jessica A. Shepherd, MD, MBA, an aesthetic gynecologist and CEO and founder of Sanctum Med + Wellness, spoke with

 as an independent commentator on the study. She says postpartum abdominal skin laxity is caused by a combination of genetics, hormonal changes, and weight gain. She adds that an increase in relaxin decreases adhesiveness between collagen fibers, and that formation of ground substance creates striae in areas causing stretch marks and loose skin. Shepherd notes that even with weight loss through diet and exercise, factors such as genetics and number of pregnancies also affect abdominal skin laxity.

“Alternative therapies for skin tightening that do not require significant downtime or surgical intervention are important options to present to women,” Shepherd says.

Regarding the study, she notes that using this particular type of laser treatment not only tightened the skin but also improved the appearance of its texture. “The upgraded technology of the Coolwaves brings up the energy to 3 times the efficiency and selectively targets subdermal fat,” she explains.

Shepherd emphasizes that although the study had a small population, the findings highlight the sustainable changes in the reduction of circumference and appearance of skin, which is appealing for women seeking marked changes in this area.

“Convenient and time-saving options for women in the postpartum phase are important, and with the variety of complex physiological changes in the skin during pregnancy, [we need] to have solutions,” she says. “This combined technology…seems promising and may create another innovative option that is safe and decreases the need for surgical intervention.”

1. Bonan P, Verdelli A. Combined microwaves and fractional microablative CO2 laser treatment for postpartum abdominal laxity. J Cosmet Dermatol. 2021;20(1):124-131. doi:10.1111/jocd.13510 

2. SmartXide2 laser. Deka. Accessed June 9, 2021. https://www.dekalaser.com/en-GB/product.aspx?item=samrt1 

3. ONDA Coolwaves. Deka. Accessed June 9, 2021. https://www.thecoolwaves.com

4. Smartxide CO2 Laser. Ciao Bella Medical Spa & Vein Clinic. Accessed June 9, 2021. https://www.ciaobellaplasticsurgery.com/smartxide-co-2-laser/

Combining microwave and microablative CO2 laser treatment is both safe and effective for treating postpartum abdominal laxity.

Microwave and Fractional Microablative CO2 Laser for Postpartum Abdominal Laxity

Chest masculinization, or top surgery, is the most common operation performed for gender affirmation, according to the findings of a 2020 study published in 

Gender affirming surgery can help transgender patients with gender dysphoria feel more comfortable in their bodies. In addition, results from a 2021 survey show the surgery have been associated with decreased rates of mental health disorders and improved psychosocial function.

Patient demand for female to male breast reduction is increasing, says cosmetic surgeon Mark Mandell-Brown, MD, who recently talked with 

 about treatment options, surgical protocols, and his experience with the procedure.

“Realistically, we are reducing the breasts and there are different ways of doing that,” says Mandell-Brown, president of the American Academy of Cosmetic Surgery, and a triple board-certified cosmetic surgeon at Mandell-Brown Plastic Surgery Center in Cincinnati, Ohio. “As a surgeon, you have to approach it in a stepwise fashion.”

Mandell-Brown often recommends liposuction as a standalone treatment for patients with small breasts—an A or B cup, potentially a small C—and no ptosis, or breast sagging.

“If the patient has a larger areola, we remove some of the areola in a circular fashion. We make 2 incisions, an outer circle and an inner circle, and remove the excess areola or breast skin. Then we close the outer and inner circle,” he says.

There are 3 categories of breast ptosis. The first category is nipples that are on the breast fold level—when one puts a finger under the breast on the crease—with minimal sagging. The second category is nipples that fall below that line. Nipples that point downward toward the ground are considered to be category 3 ptosis.

To address sagging, Mandell-Brown often uses Renuvion (Apyx Medical), which delivers helium plasma and radiofrequency energy to provide controlled coagulation and contraction of soft tissue. The small entry points and reduced pain result in shorter recovery times and minimal scarring.

“We use Renuvion in combination with liposuction,” he says. “Often that will shrink the breast down, making it more compatible with a male breast.”

Whether using liposuction as monotherapy or combination therapy, Mandell-Brown says his goal is to use minimally invasive options when possible. These, for example, limit incisions to 2-mm openings on each breast. When reducing larger breasts, he often uses a 2-step approach. The first step involves the previously discussed procedures for smaller breasts. 

“We see how much the tissues contract,” Mandell-Brown says. “I would say 80% of patients are happy with [the initial] stage.”

If patients are not yet satisfied, he fine tunes results with either more liposuction or additional reduction around the areola in a circular fashion. Patients with very large breasts—a D cup or larger and class 3 ptosis—might be candidates for a “double incision” technique.

“A double incision technique is where we make an incision along that breast fold and then have the patient flex,” he explains. “The upper [flexed] portion shows you where the border of the pectoralis muscle is. You make a separate incision there and remove that tissue between the 2 horizontal lines.”

On men, the nipple/areola sits off to the outer third of the chest and is smaller when compared to that of a cisgender woman.

“For the male, if you divide the collar bone into thirds, it should be between the middle and the outer third and should be just at the border of the pectoralis muscle,” Mandell-Brown says. “The nipple and areola should be about 2 cm wide as opposed to [that of] most females, which is about 4 cm wide.”

Mandell-Brown advises his breast surgery patients to avoid aspirin and acetaminophen, fish oil, and vitamin E, all of which promote bleeding. Nipple and areola numbness can occur temporarily but is rarely permanent when using a keyhole or periareolar technique.

 However, performing a free areola or nipple graft causes permanent numbness to the area, which Mandell-Brown prefers to avoid.

“With the free areola or nipple graft you are actually taking off the areola, setting it aside, reducing the breast and then sewing it back on with what we call bolster dressing, which holds it in place,” he says. “With that technique, you do have 100% loss of sensation.”

Scarring is another major factor. Mandell-Brown notes that he makes every attempt to minimize scarring because breast reduction surgery scars can be aesthetically disabling.

In general, patients transitioning have a high satisfaction rate and tend to be grateful, he says. Most of those who come to Mandell-Brown’s Cincinnati practice for female-to-male top surgery are from 26 to 38 years old.

Performing chest masculinization has been a satisfying part of practice for Mandell-Brown, but he recommends that surgeons first check with patients’ endocrinologists and/or psychologists to make sure patients are ready both emotionally and physically for the change.

Gonzalez E, Frey JD, Bluebond-Langner R. Technical refinements in gender-affirming top surgery. 

. 2020;146(1):38-40. doi:10.1097/PRS.0000000000006913

Alcon A, Kennedy A, Wang E, et al. Quantifying the psychosocial benefits of masculinizing mastectomy in trans male patients with patient-reported outcomes: the University of California, San Francisco, Gender Quality of Life Survey.

. 2021;147(5):731e-740e. doi:10.1097/PRS.0000000000007883

Stocum L. Psychosocial benefits of gender affirming surgery. 

®. May 10, 2021. Accessed June 8, 2021. 

https://www.aestheticauthority.com/view/psychosocial-benefits-of-gender-affirming-surgery

Hobbins K. Female to male breast augmentation. 

®. March 9, 2021. Accessed May 14, 2021. 

https://www.aestheticauthority.com/view/female-to-male-breast-augmentation

Renuvion. Apyx Medical. Accessed June 8, 2021. 

Non-binary nipple and areola options. Gender Confirmation Center by Dr. Scott Mosser. Accessed June 8, 2021. 

https://www.genderconfirmation.com/non-binary-nipple-and-areola-options/

Mark Mandell-Brown, MD, details his treatment protocol for addressing female to male breast reduction surgically and through minimally invasive procedures.

Female to Male Top Surgery Protocols

While scalp hair transplants are common in aesthetics, using hair transplant technology to improve facial hair outcomes is gaining increased popularity for patients who wish to improve beard and eyebrow fullness. In an interview with 

, Gary Linkov, MD, board-certified facial plastic and hair surgeon and founder and medical director of 

 in New York, New York, gives an overview of beard and eyebrow grafting to improve patient facial hair appearance.


First, when patients are preparing for grafting, he says, they are directed to stop all oral supplements along with over-the-counter medications that can cause blood thinning.


“Vitamin C and Vitamin K a week before the facial hair transplant procedure can help improve healing and minimize bleeding,” he says.


Patients shower the night before or the morning of the procedure to prevent infection and are also prescribed an antibiotic, an anti-inflammatory pill, a sedative, and ananxiolytic the morning of the procedure, he explains. Following patient consent, the beard area or eyebrow area is marked carefully to incorporate the patient’s wishes.


Patients then undergo follicular unit extraction (FUE), which takes hair strands with the follicles attached from one body site and then transplants them to the desired area. Another method of transplanting hair is follicular unit transplantation (FUT), which excises a strip of skin with hair follicles to be used.


“Once the grafts are removed, recipient site creation and then placement of the grafts occurs,” Linkov says. “The overall process may take a few hours for smaller cases, up to a full day for larger cases, and occasionally may require an extra day. A lunch break is provided for longer cases.”


Explaining the procedure downtime, he says bleeding, swelling, and bruising are all possible after a facial hair transplant. “The most important precaution in the recovery phase of a beard transplant is to not get the transplanted hairs wet for the first 5 days. This allows them to set in the proper orientation and to eventually grow,” he emphasizes.


Post-procedure, patients are also given both an oral and topical antibiotic for the donor area, he says.


For beard transplants, patients are able to shave after 10 days, he says. Linkov explains that after about 3 weeks the shafts of the transplanted hairs will usually fall out. Hair regrowth then starts at 4-6 months, with patients having final results assessed at 1 year.


There are some associated risks with the procedure; one of which is poor angulation. 

“Despite every best effort to use an acute angle to the skin surface when making recipient sites and placing grafts, occasionally, grafts may still grow at a more perpendicular angle and may need to be removed,” he notes.


There is also the chance of bump formation. “The main area at risk of small bump formation is the goatee area under the lower lip,” Linkov says. “These can be difficult to correct.”


The risk of poor regrowth, while possible, is rare, according to Linkov. “The face has very good blood supply and typically results in excellent hair regrowth,” he says. “A touch-up procedure is sometimes needed after 10 months if certain areas show poor growth.”


Finally, inclusion cysts can occur but are very rare in the transplanted beard area and may need to be incised and drained or removed, he says.


Linkov explains that scar formation is another consideration. Small circular scars are left after using the FUE method, “but they are barely noticeable even with a shaved head,” he said. The FUT method, however, leaves a linear scar across the back of the head, which makes it more difficult to wear shorter hairstyles.


“The recipient area where the new beard hairs grow should not display any scars,” he explains.


Medical conditions not compatible with local anesthesia containing epinephrine would be contraindications to FUE and FUT facial hair transplantation.


“Contraindications to facial hair transplants is scarring alopecia’s or autoimmune alopecia areata, in which the body will continue to try and destroy the hair follicles,” he says, adding that having minimal hair supply for transplantation to the facial area is also a contraindication.


1.	NYC Beard Transplant/New York Beard Restoration/UES. City Facial Plastics. 2021. Accessed May 25, 2021. https://cityfacialplastics.com/beard-transplant/


2.	NYC Eyebrow Restoration/New York Eyebrow Hair Transplant/UES. City Facial Plastics. 2021. Accessed May 25, 2021. https://cityfacialplastics.com/eyebrow-transplant/

Facial hair grafting is becoming an increasingly popular procedure with methods such as follicular unit extraction (FUE) and follicular unit transplantation (FUT) to improve the hair appearance of beards and eyebrows. 


The Growing Rate of Facial Hair Transplants

Now that the days of safe in-person services are returning, and thanks to consumers with pent-up buying impetus and a year’s worth of savings, the dermatology and cosmetic surgery sectors are experiencing a notable trend: The popularity of minimal to noninvasive cosmetic procedures is surging. Chief among those procedures is the patented MyEllevate light-guided suture technology for facial rejuvenation. As clients experience these innovative techniques and their significant results with negligible recovery time, they are referring their friends and coming back for more. MyEllevate has become the poster child for minimally invasive procedures. Cynosure’s recent acquisition of MyEllevate confirms the method’s arrival as the leader of this new and improved generation of technology.

The question most people ask is what is MyEllevate, and how did this paradigm shift occur in a steadfast industry like cosmetic surgery?

Gregory Mueller, MD, FACS, a plastic surgeon in Beverly Hills, California, developed MyEllevate and the ICLED light-guided suture system. The highly effective neck rejuvenation technique has minimal downtime and long-lasting results. In addition to its speedy recovery time, MyEllevate effectively treats a broad range of aging-related concerns: from excess neck fat to bulging glands and prominent platysma bands.

MyEllevate was designed very simply as a percutaneous approach to placing a neck suspension suture. Vincent C. Giampapa, MD, FACS, and Barry DiBernardo, MD, published an article in 2000 on placing a neck suspension suture during an open facelift.

 Mueller took this concept and over a 15-year period developed the MyEllevate procedure. Initial variations had issues with the depth of suture placement, which led to the light-guided approach of the procedure. He experimented with many types of absorbable and permanent sutures, finally deciding on a 4-0 braided permanent suture.

The surgeon performs the procedure in an operating or procedure room under local anesthesia or intravenous sedation of general anesthesia, according to the patient’s wishes. The approach is simplified and broken down into easy-to-learn steps.

The patient is prepped and the platysma bands, if present, are marked and injected with local anesthetic. A puncture wound is made adjacent to the bands with a specialized puncture tool and then the attachments are cleared with a “clearing” tool that is part of the ICLED kit. The rod and Suturod suture, also included in the kit, are placed deep and superficial to the band. The band is then cut by sawing the suture back and forth until the suture pulls through.

The neck is tumesced with 300 to 400 cc of standard tumescent solution. If desired, the physician can use an energy-based device internally; however, this step may be omitted.Commonly used devices include Precision Tx SmartLipo (Cynosure),

 or the Vaser ultrasonic system (Solta Medical).

 Liposuction is then performed and damaged fat is removed, and the area is additionally undermined by the liposuction cannula.

). The light is activated and placed on the rod, then the light-guided suture is placed through standardized puncture sites. The suture is tied through the first puncture site and cut. The rod is then used to help bury the knot. Finally, a dressing is applied.

The procedure is routinely performed in under 1 hour and patient recovery is swift. Patients are asked to wear a soft collar for 10 days after surgery and many resume normal activities within 48 hours.

The MyEllevate team vets all physicians before they are trained in the procedure to help maintain quality control. Physicians are asked to go to the Myellevate.com website to register and then watch a recorded procedure. Live training is available at 4 US sites and a trainer is sent to observe the physician’s first 2 cases.

The procedure has been rapidly implemented by physicians and has generated much interest from patients in recent times. An article in 

magazine brought national exposure to MyEllevate in its December 2020/January 2021 print issue, dubbing the procedure the “Zoom Lift.”8

The procedure’s popularity started with the struggle shared by many people during the early days of Covid-19, which in turn abruptly introduced the work-from-home culture. Dermatologists and plastic surgeons were suddenly inundated with requests and complaints about previously unobserved “trouble areas,” and their appointment books began to fill quickly. On a global scale, working professionals went from looking at their faces for perhaps 30 minutes each day—from a glimpse in the mirror to a quick FaceTime call and the occasional selfie—to staring at them for 8-plus hours daily on Zoom as they worked remotely. This increased, targeted focus on facial features led to many plastic surgeons’ clients scrutinizing their imperfections on an intensified level that substantially raised the demand for cosmetic procedures, including MyEllevate.

Mueller is the creator of MyEllevate. Pozner and DiBernardo stockholders in ICLED Surgical and trainers for MyEllevate.

1. Cynosure to acquire MyEllevate, innovative minimally invasive facial rejuvenation treatment. Cynosure, Inc. Press release. April 30, 2021. Accessed June 8, 2021. 

https://www.prnewswire.com/news-releases/cynosure-to-acquire-myellevate-innovative-minimally-invasive-facial-rejuvenation-treatment-301281186.html

2. MyEllevate. MyEllevate. Accessed June 8, 2021. 

3. Giampapa VC. Suture suspension technique offers predictable, long-lasting neck rejuvenation. 

. 2000;20(3):253-255. doi:10.1016/S1090-820X(00)70026-4

4. Precision Tx. Cynosure. Accessed June 8, 2021. 

https://www.cynosure.com/product/precisiontx/

5. FaceTite: minimally invasive face contouring. InMode. Accessed June 8, 2021. 

https://inmodemd.com/technologies/technologies-facetite/

6. Renuvion. Apyx Medical. Accessed June 8, 2021. 

7. Vaser ultrasonic system. Solta Medical. Accessed June 8, 2021. 

Expert physicians highlight the rise in minimally invasive procedures using the MyEllevate light-guided suture technology for neck and facial rejuvenation.

MyEllevate Reinforces Trend of Minimally Invasive Procedures 

Beverly Hills facial plastic surgeon Paul Nassif, MD, FACS, of NassifMD Plastic Surgery in California, knows how to create a successful brand. His image alone creates awareness with anyone who has tuned into E! Entertainment’s 

Among his many claims to fame, Nassif developed and markets NassifMD Dermaceuticals. He shared strategies for building a successful skin care line with colleagues during the April 17 International Society of Aesthetic Plastic Surgery (ISAPS) Business School.

Launching a skin care line is not easy, according to Nassif.

“This is more of a long-term investment, and really if you are going to do this you need dedication and, of course, a lot of money,” he says.

Aesthetic physicians and surgeons have different reasons for creating proprietary skin care lines.

“You have to think about, ‘What is my endgame? Am I doing this because it is a passion project of mine? Am I doing this as a source of passive income?’” he says. “I did this for my patients because when you do surgery, what happens to [the quality of the] skin? Nothing. If you have surgery plus great skin care…it makes your surgery look better.”

Regardless of the reason, says Nassif, the goal of creating a skin care line should be to develop great products because repeat business is the key to long-term success.

“You can always get someone to buy the product, but the question is, are they going to keep using it? That is why the product has to be fantastic,” he says.

Science and testing should be the foundation of any physician-developed skin care brand. That includes developing thoughtful formulations, as well as formal and informal testing and feedback.

“I chose to individually formulate each product to ensure control of ingredients, potency, and efficacy, and to tailor each [product] to my patients’ needs and input,” he says.

Proper product testing is a time-consuming endeavor, but necessary. For his line, Nassif worked with chemists to achieve efficacy and potency for each product, whether it was designed for the face, neck, under eyes, nose, or other areas.

“There are probably 7 to 8 different tests that you have to do with your chemist,” Nassif explains.

Nassif’s skin care products went through laboratory testing, consumer perception studies, before and after studies, hydration studies, skin pathology testing, and Visia (Skin Analysis System; Canfield Scientific) studies. He also funded clinical trials that incorporated side-by-side visual comparisons. Additionally, he received qualitative and quantitative feedback from friends, colleagues, patients, and staff.

During the ISAPS Business School presentation, Nassif shared images from a Visia study that had 30 participants. In the study, patients wearing fluorescent makeup cleansed their face using soap and water on one side of the face and his NassifMD Detox Pads on the other to remove dirt, makeup, and residue.

“[My detox pads were] 108% more effective than soap and water,” he says.

Although companies do the actual testing for providers such as Nassif, it’s the providers who foot the bill, he says. He also commissioned a perception study in which 32 participants wrote down what they thought about products.

Providers should highlight before and after images for each product, he says, noting that consumers look to these transformations when deciding what to buy. In his presentation, Nassif showed before and after images of his Deco-Lift and Peri-Orbital Complex products.

“What I focus on here is the luminosity and glow. I look at the color and the crow’s feet and also…at the lifting ability,” he says. “This is from a key ingredient called Vin-upLift, that gives immediate temporary hydration and lifting.”

Formulating products with key ingredients that may not be widely available but are backed up by science to suggest they work is important for product differentiation. Nassif describes the Vin-upLift ingredient as “a unique tightening ingredient that is derived from Swiss ice wine,” on his website NassifMDskincare.com.

“Your ingredients have to be excellent,” he says. “You have to have the science behind the different products.”

Nassif uses many avenues to reach his target audience for skin care products, including TV shopping and e-commerce. His product line is featured on HSN in the United States and international shopping channels such asTVSN in Australia, QVC UK, and TSC in Canada.

As for e-commerce, Nassif markets the brand on the NassifMDskincare.com website and also sells the line on additional websites. The brand has its own Amazon.com consumer page.

The skin care line has a large social media presence, with advertisements on popular platforms and lifestyle websites, such as PopSugar. Social media marketing is a conduit to reach specific demographic groups, he says, adding that it is also important to use online influencers and their high-profile engagement.

Brick and mortar is a separate conversation, according to Nassif, who only briefly touched on having product conversations with Ulta Beauty Inc and Sephora, in his ISAPS presentation. On-air skin care sales, coupled with a robust online and social media presence, helps to educate buyers, develop brand awareness, fuel sales, and build an international viewership, he says.

Of course, Nassif’s practice also generates product sales. His practice integrates skin care into surgical treatments, and the skin care line also supplements his medical spa and aesthetic treatments.

Creating a skin care line involves dedication, product testing, clinical trials, marketing, sales, and yes, a lot of money. 

Paul Nassif, MD: Building a Successful Skin Care Brand

Most practitioners are indebted to their community for the success of their practices. I truly believe that most fulfilled and successful doctors are eager to give back to their communities. I, like many readers of this article, have provided pro bono services, participated in volunteer efforts, become involved with numerous charitable organizations, and simply tried to make my community a better place. I performed many charitable reconstructive surgeries on children in the earlier part of my career. I have 2 special needs children with severe disabilities but was active in helping children years before my sons were born. Having said that, much of my current charitable work centers around children and adults with disabilities.

Like many, my practice is called on frequently for charitable fundraising support for innumerable causes. This began as a trickle 20 years ago and has developed into a streaming pipeline. Despite this, I've tried to support any request. The most common request is the donation of a cosmetic item for a charitable auction. Providing a neuromodulator or filler treatment or a skin care basket has been an easy way to support these groups.

Many of the groups are well-known national charities. Additionally, I have supported public and private school fundraising auctions, gymnastic team auctions, golf tournaments, and pretty much every describable request within a community.

For the most part, this has been extremely bilaterally beneficial. My practice gets to assist organizations with raising funds for their good work and at the same time I get recognition as a provider of cosmetic services in my community. Some fundraising “winners” have become regular patients. Generally, this is a win-win situation.

Whether it be seen as good or bad, the more charities you support with donations of products or services, the more requests you get for further donations. As I mentioned earlier, what began as a trickle became a significant investment.

This did not bother me because in the end, I am helping people in need.

Even when they are soliciting with the best of intentions, some people find a way to take advantage of the person or practice donating. In the beginning, we simply accepted all requests and printed a certificate redeemable for a given service. We had no rules and assumed it would be an easy situation.

In years past, some people would come to the practice holding crumpled and tattered auction certificates issued 3 years prior. Others would show up with a certificate they personally did not bid on and once, someone showed up with a photocopy of a certificate demanding redemption.

We quickly learned there had to be some rules, so we refined our certificates. We began putting a chronological number on the certificate as well as issuing an expiration date and declaring that the certificates are nontransferable.

This immediately solved some of our problems, but unfortunately our diligence was not enough. After implementing the updated rules, I would ask certificate recipients what price they had paid in the auction. Frequently, and especially for nationally known charities, the bidder had paid far more than what the actual auction item was worth in the fun of a charitable bidding war.

This made me feel great because the charity really benefited. Other times, people would show up with a certificate for neuromodulator treatments or injectable filler that had a retail worth of $1000 and they had only spent $20 for the winning bid. After this, we started informing charities that if the item did not sell for a reasonable portion of its value, it should not be auctioned, and we would re-donate the next year.

Just when we thought we had everything under control, a member of my staff noticed that a person who had requested auction items for various “charity golf tournaments” had not only picked up the certificate from our office but also personally redeemed it. At first this did not set off red flags. I have seen auction chairs purchase an item they personally requested from a practice because they either wanted the service or product themselves or wanted to drive up the value for the organization.

However, the reality was that the person collecting these golf tournament certificates would pick them up and redeem them when different staff was in my office. Well, that is until someone noticed. At this point we investigated the charitable golf tournaments: we could find no record of 1, another responded that they had never asked for or received any auction item from the practice, 1 didn’t respond at all, and the last said they did not keep records of charitable donations.

It was at this moment we realized we had been scammed. Adding to the hurt was the fact that some of this malfeasance was done in the name of children’s charities.

This situation made us review our entire process and add additional safeguards. First and foremost, we issued a compliance list for receiving, auctioning, and redeeming a charitable certificate, with the following requirements:

The certificate cannot be redeemed by the person requesting it or collecting it from the office.

The person picking up the certificate in office must provide a photo ID which we then copy and keep in our records.

The receiving organization must provide us with detailed information about the certificate winner. This is documented in a form that we give to the organization and must also include the amount of the winning bid. The certificate cannot be honored without this information. This puts some of the responsibility on the organizations, which can be lazy with record keeping.

Needless to say—and shame on us for not doing more research—we now investigate any organization that requests a charitable gift. Due to the amount of requests we receive, we have also started rotating the smaller venues (sports teams, PTAs) instead of honoring every single request.

It has been my pleasure to support national and local charities and organizations within our community. Like anything else in life, there are situations where people may take advantage of one’s generosity. We learned much of this the hard way and I would like to pass along some caveats, which include the following:

Investigate all requesting organizations for legitimacy and obtain detailed information about the requesting individual.

Invest some time and thought into a professional redemption certificate that includes:

Expiration date of service or product redemption

An accompanying form that must be filled out and followed exactly for redemption. Clearly state the necessity of this form on the actual certificate: If the form is not completed and returned by the organization, the certificate is void.

When the charitable affiliate comes to collect the certificate, obtain a copy of their photo ID. We request personal pick-up and don’t mail out certificates.

Inform all people involved that any fraud will be reported to authorities.

I still believe that the more you give, the more you get. Just give wisely.

Donating to charitable organizations is a great way to give back to the community. However, physicians and practices need to create concrete safeguards to protect against being scammed, says Joe Niamtu III, DMD, who knows the hurt of this very real situation.

No Good Deed Goes Unpunished

Skin care companies are marketing regenerative topicals featuring stem cells, exosomes and platelet-rich plasma (PRP). 

But do they work? And is skin care using stem cells, exosomes and PRP safe?

 asked experts in the regenerative skin care space for answers.

“There are no products that contain stem cells in over-the-counter skin care,” said Amy Forman Taub, MD, medical director of Advanced Dermatology, in Lincolnshire, Illinois. “There are companies that have cultured media [growth factors extracted] from these cells, but these products have not been proven to be more effective than what we currently have from cultured media, i.e., growth factor products from prenatal or perinatal tissue.”

The use of stem cells in skin care has taken a decade to evolve with the early issues of stem cell sources, such as embryonic vs adult stem cells, and the requisite clinical studies to demonstrate consistent efficacy, according to Lawrence A. Rheins, PhD, chief scientific officer at Aesthetics Biomedical in Phoenix, Arizona, creator of SoME skin care.

“A few years ago, there was interest in using botanical stem cells for skin care products. Frankly, I do not understand how that would work,” Rheins said. “Those stem cells are not going to get into the skin. [Plus], how physiologically relevant are botanical stem cells with human skin? Adipose adult stem cells are finding a significant growing role in aesthetic medicine including facial rejuvenation….”

According to Taub, exosomes are non-cellular and may be able to lyophilize, but research is in the early phases. In other research, Mayo Clinic investigators reported on Science Daily that purified exosomal product, known as PEP, an off-the-shelf, room-temperature-stable exosome, can heal wounds that do not have adequate blood supply in single exosome application.

Safety concerns are a hurdle for using stem cells and exosomes in skin care. The FDA regulates stem cell- and exosome-containing products.

 While exosome-containing products are available in the marketplace, some companies that make them have received FDA warning letters, according to Rheins. These FDA safety concerns could limit the commercial potential of exosome-containing skin care topicals for the near term, he said. 

The use of a patient’s own PRP growth factors in personalized skin care is an area that has gained rapid momentum in recent years, with the clinical science to show its safety and efficacy, according to Rheins.

SoME, which features patients’ autologous PRP in a serum mixture for topical application, is proven to be stable and able to keep growth factors alive.

Autologous PRP is safe, according to Taub.

"[SoME] is stable for 3 months, if refrigerated,” Taub said. “PRP is great for healing, so this could afford some correction of damage, but this does require drawing your patient’s blood and spinning it down to extract the PRP.”

According to Rheins, SoME took a different approach in product development.

“We are not taking stem cells. We are not taking synthetic exosomes. We are using the body’s own autologous physiological growth factors,” he said. “Consumers want personalized and more individualized skin care products. There is nothing more individualized or personalized than your own growth factors.”

Aesthetics Biomedical has patented is a way of preserving platelet function over 90 days in SoME products, Rheins said. 

After centrifuging the blood, the physician drops 3 ml of the patient’s PRP into the prepared SoME serum bottles. The patient takes the 3 bottles home in a supplied mini refrigerator and uses the product twice daily for the next 90 days. 

“It’s the unique physiological electrolyte base formula of 23 ingredients that provides us with the opportunity to keep the platelets stable,” Rheins said. “The change in temperature, going from the small refrigerator to air temperature to skin temperature, causes platelet activation, and the granules inside the platelets begin to degranulate to release hundreds of the growth factors including exosomes… which are small enough to get into the skin. The patient puts the bottle back in the fridge and the platelets basically go back into a senescent state.”

Scientific journals published two studies on SoME in recent years. Investigators of the first study, published in 2019 in the Journal of Cosmetic Dermatology, studied 20 female and male subjects 30 to 60 years of age in a single-site, investigator blinded, vehicle controlled, split-face study to look at the effect of the PRP-containing serum vs the serum alone on facial photoaging. Study results showed the serum contained stable PRP for 90 days, and PRP-treated facial skin biopsies showed improvement in skin architecture and upregulation for collagen type I with concomitant upregulation of mRNA for collagen after 8 weeks of topical use.

In the second study published last year in the Journal of Drugs in Dermatology, investigators reported that platelets remained viable for up to 120 days in a refrigerated cosmetic base serum vehicle. The product demonstrated clinical, histological, light, and scanning electron microscopy endpoints to demonstrate a mechanism of action leading to PRP facial benefits. PRP kits of 20ml and 60ml volumes for topical PRP were shown to be equally efficacious.

Aesthetic providers typically use SoME alone for facial rejuvenation to improve the appearance of fine lines, sun damage, hyperpigmentation, and sallowness. However, professional aesthetic practices are increasingly using SoME for post-treatment care following radiofrequency microneedling or other invasive devices, including various lasers, to assist in the healing process, according to Rheins.

“SoME has been on the market for 2 years and no one has complained of any irritant or allergic reactions,” he said. “… the physiological electrolytes of SoME provide additional product safety.”

Experts evaluate the efficacy, safety of regenerative skin care products.

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