Could freezing away your wrinkles be the new Botox?

Article

By ALICE HART-DAVIS

As the three thin needles at the tip of what looks like a futuristic electric toothbrush start to fur up with ice, I begin to feel a bit queasy.

These needles will be jabbed into my face, to freeze and disable - albeit temporarily - the nerve that enables me to lift my eyebrows. 

Am I mad? Not entirely. 

Getting the needle: Alice has the Iovera treatment, the latest Botox-alternative to banish wrinkles (its makers claim)

This is the 'world's first toxin-free treatment for dynamic facial lines', aka the latest Botox-alternative to banish your wrinkles, which has just launched in the UK. 

Having followed the treatment's progress for the past year, I've been mad keen to be the first journalist to try it. 

Instead of injecting toxins into the face, this technique uses 'Focused Cold Therapy' to - literally - freeze wrinkles into submission. 

It works instantly so, unlike Botox, there's no waiting around for a week to see if your eyebrows will end up wonky. And the results should last for around three months, until the frozen section of the nerve regrows.

As with any new procedure that promises to be an alternative to Botox, there has been huge interest in Iovera. 

Despite the fact that Botox has an impressive safety record and has been used and studied extensively for almost 40 years, it is still not to everyone's liking - usually because people don't want to have a toxin injected into them, even in tiny amounts. 

Although there are several competing technologies that take the freezing approach, dubbed things like 'cold tox' or 'Frotox', Iovera appears to be the most reputable of them all. 

So, ignoring the advice I frequently dish out about not trying new procedures before they have been extensively tested, I elbowed my way to the front of the queue.

'Iovera is a good alternative for people who don't want actual Botox,' says Dr Yannis Alexandrides, a well-known Harley Street cosmetic surgeon - he's been on TV's Embarrassing Bodies - and Iovera's head practitioner for the UK.

Before and after: After eight cycles, there is little sign of the treatment

He has been conducting official trials on the technique for the past year. 'Overall I'm happy with it,' he says. Ninety per cent of his trial group saw good results, he tells me, but the treatment had little or no effect on the other 10 per cent.

Most women in this group were enthusiastic. 'It's amazing!' one has said. 'It's so fast, the results are instant, and my forehead looks really smooth yet natural.'   

He tells me the procedure, properly known as 'cryoneuromodulation', was created by American company Myoscience, and that its patented 'Focused Cold Therapy' procedure has already received Food And Drug Administration approval for pain relief in the U.S. FDA trials for the cosmetic, wrinkle-freezing aspect of the technique are into their final stages. 

He shows me the sleek Iovera device with those needles sticking out at the end. These needles are inserted into the skin near the path of the nerve that controls the frontalis, the muscle that raises the eyebrows. 

To chill the nerve, liquid nitrogen is passed into the needles (but not the skin). Dr Alexandrides presses the button to demonstrate and I watch aghast as the probes fur up with ice.

Am I being stupid to try this at such an early stage? I canvass opinions from experts in the beauty industry, who sounded notes of caution.   

'The three mainstream Botulinum toxins [Botox, Azzalure and Bo-Coture] work so well and so consistently that regular users have no compelling reason to switch,' says Wendy Lewis, an adviser on cosmetic surgery and skincare. Especially to something that will last no longer and is no less expensive. 

'I wiggle my eyebrows, and only one responds, Roger Moore-style.'

She adds: 'The real potential of this technology lies in treating pain and headaches.' 

Cosmetic dermatologist Dr Sam Bunting was even less enthusiastic. 'This is not a treatment you can easily fine-tune,' she says, 'because you're inhibiting the nerve, rather than targeting individual muscles. That's a bit like attacking the tree at its trunk to get an apple off a branch.  

'Botulinum toxin has become such a sophisticated treatment that we can reshape brows, widen the eyes and minimise facial asymmetries, while preserving natural movement. 

'Because Iovera currently only treats the frontalis muscle, the only muscle that lifts our eyebrows up, the risk of ending up with a heavy, angry-looking, dropped brow and upper eyelids seems high. Iovera seems like a retrograde step.'

I have had Botox on and off for the past decade and have a love/hate relationship with it. I love the way it can smooth lines and make my face look fresher, but hate not being able to move my forehead. 

So I end up having just a bit in between my eyebrows, and leave the horizontal lines on my forehead to their own devices. 

I have a gut feeling that I ought to stick with the devil I know, but curiosity gets the better of me. 

Before he can start my treatment, Dr Alexandrides has to pinpoint the correct nerve pathway, using a TENS machine, used for pain-relief, that stimulates nerves with electric currents. He hits the right nerve, and my eyebrow starts to twitch. 

Next come pinprick injections of lidocaine, a local anaesthetic to numb the area. And then the probe. I feel only a small amount of pressure as the needles are plugged into my skin. 

Deep freeze: Though Iovera may not use any toxins (unlike Botox), Alice recommends holding off on using the treatment until more is known about its efficacy

When the chill-down cycle starts, it feels painful, rather than cold. Not agonising, but the 60 seconds that the cycle lasts seem long. 

My eyebrow can still move as normal, so Dr Alexandrides delivers another dose of focused cold a fraction further along the nerve pathway - but I still can't see any difference - and moves to my left side. 

There, it simply doesn't work. After six cycles, Dr  Alexandrides goes back to the right side. One more cycle and my right eyebrow can't move at all. 

I wiggle my eyebrows, and only one responds, Roger Moore-style. 

Back on the left side, two more shots fail to subdue the eyebrow. Dr Alexandrides has to leave it as eight cycles is the maximum dose - though there is no bruising and little trace of the treatment, apart neat prong-marks vanishing into my hairline. 

Does this happen often? Apparently not - only one in ten of Dr Alexandrides' trial group complained of slight asymmetry. 

To my own eyes, I look bizarre, but over the next week, before I go back to have another two cycles of treatment which quell my left brow, no one notices  - not my family, or the beauty editors I work with, or even the cosmetic practitioners I see at the industry's big annual shindig.  

Even good old Botox has left me looking lop-sided in the past. But, now I've had both sides successfully treated, I will have a poker-face, or at least a poker-brow, until September.

Or longer, if some experts are to be believed. While the people behind Iovera insist the nerves grow back, critics have warned me that this nerve damage could be permanent.

So, should you try this treatment? My honest advice is not yet. 

The technology is fascinating and Iovera may yet become the best wrinkle-fixer since time began, but right now, it's still early days. 

Iovera treatments cost £500 from Dr Yannis Alexandrides, 111 Harley Street, London W1, 111harleystreet.com

Original Article posted from.
http://www.dailymail.co.uk/femail/article-2363794/Could-freezing-away-wrinkles-new-botox-FEMAIL-tries-new-procedure-dont-to.html

PRP on the Doctors

PRP Therapy featured on “The Doctors Show” on CBS:
http://www.youtube.com/watch?feature=player_embedded&v=m8wFv-KOPkI

Outlook for NP's

Outlook for NP’s

All across the country some 155,000 NP’s give physicals, stitch wounds, prescribe drugs and manage chronic illnesses.  They do almost everything that a primary care physician does.  These Nurse practitioners are playing an increasingly important role as the pool of primary care doctors shrinks.  Many practice in partnership with a physician, but several states allow NP’ to treat patients independently. 

Researh show that nurse-practitioners decrease the cost per patient visit by as much as third, because NPs- who are paid less than physicians-tend to order fewer tests and cut down on return visits by coordinating care better.  Patients also give them high marks for spending time with them, according to a 2011 report in Medscape Medical News.  The four-NP staff of nurse-managed FamilyCare of Kent, Washington, for example sees only 16-20 patients a day.  Our patients visits last from 15-45 minutes,” says Bob Smithing, NP, FamilyCare’s clinical director.  “people are choosing nurse-practitioners because they care about having a onsistent provider who gets to know them.  Printed in AARP The Magazine, June.

Esthetic Nursing Gets a Face Lift (Esthetic Skin Institute Feature)

This was a great article written about AAMEP in 2004, in the years since AAMEP has done some amazing things. 

Esthetic Nursing Gets a Face Lift

By Christina Orlovsky, senior staff writer

Sasha Parker, RN, was burnt out of nursing. After more than 15 years working with plastic surgeons in the specialty of plastic peri-operative nursing, she decided to leave the profession. It was only when she learned of sclerotherapy, a cosmetic procedure to remove spider veins, that Parker decided to combine her nursing skills with her interest in esthetics and become an esthetic nurse.

"Esthetic nursing is a relatively new specialty," Parker said. "Nurses really weren't performing these procedures unless they were working in a dermatologist's office."

Today, with society's ever-growing interest in maintaining a youthful appearance, estheticians are in hot demand. To Parker, it only seems natural for nurses to step into the role.

"Nurses are natural at these procedures because of our clinical skills," she said. "Most nurses just need training in specialized areas."

These areas include: chemical peels, microdermabrasion, dermal fillers (such as Botox), mesotherapy and sclerotherapy.

Recognizing nurses' need for training, Parker established the Esthetic Skin Institute, in Ft. Lauderdale, Florida, where she trains nursing professionals in these procedures.

However, it is once they are trained that Parker believes esthetic nurses face the most difficult challenges: legislative dysfunction, professional liability issues, insurance coverage, rapidly advancing technology and undefined standards of specialty esthetic nursing practice.

To help combat these issues, in April 2004 Parker formed the Association of Medical Esthetic Nurses, or A.M.E.N., a nonprofit professional organization dedicated towards promoting high standards in medical esthetic nursing, and educating and certifying future esthetic nurses in a rapidly emerging field.

"We want to come together as a united force to create some standardization," Parker said.

"State to state, there is so much discrepancy about regulations for esthetic practices," she added. "In Nevada, for example, estheticians are allowed to perform numerous procedures with just three to six months of training, while nurses, who have degrees in nursing, are not. A.M.E.N. aims to mend that dysfunction."

In the six months since its inception, A.M.E.N. has recorded a victory in at least one state. The Arizona Board of Nursing's scope of practice committee composed a draft to establish requirements and practice parameters for nurses performing esthetic skin procedures, Parker explained.

"Arizona has adopted my policies and I am helping them write standards," she said.

Among the future plans of A.M.E.N. is the creation of a national certification test for RNs, physicians and physician's assistants that have been working in the field of esthetics without certification. Parker anticipates that the program will be underway by the end of November. (completed in 2009)

In 2005, A.M.E.N. held its first meeting, in Ft. Lauderdale. Already several hundred members strong, Parker hoped the meeting would draw more interest in the association from professionals in the field.

"There are thousands of nurses practicing this specialty," she said. "They just need to know that they now have a voice."

For more information about the organization or the annual meeting, visit the AAMEP Website at www.AAMEP.org .

Get Credentialed in Medical Esthetics!

The American Academy of Medical Esthetic Professionals, having recognized the need for certification in esthetic practice, has developed such a program in accordance with commonly accepted esthetic guidelines.  Realizing that many medical practitioners practice medical esthetics and the knowledge required to administer these non-surgical medical esthetic procedures safely are the same for all medical practitioners, be it an MD, DO, PA, NP, RN, or LPN/LVN.  With this in mind, the Association of Medical Esthetic Nurses moved forward to bring together a cohesive group of medical esthetic professionals to form the American Academy of Medical Esthetic Practitioners (AAMEP) (herein known as the “Academy”).  The Academy has appointed AMEN as the current administrator for the exam.

The Center for Medical Esthetic Certification (herein known as the “Center”) a division of the American Academy of Medical Esthetic Practitioners (AAMEP) bases its credentialing program on the standards set by other subspecialty credentialing organizations with the goal of  promoting and enhancing esthetic practice excellence by certifying professionals. 

Certification is reserved for those practitioners who have met requirements for clinical or functional practice in the esthetic field, pursued training beyond basic preparation, and received the endorsement of their peers.  After meeting these criteria, professionals take the certification examination based on nationally recognized standards of esthetic practice to demonstrate their special knowledge and skills which surpass those required for licensure.

The credentialing board for the “Center” provides feedback in the following areas:  development of the examination, passing scores, eligibility requirements, and certifying practitioners who pass the written examination and meet the requirements for certification.

The certification examinations are objective tests that cover knowledge, understanding, and application of professional esthetic theory and practice.  The examinations are developed by a test development committee which is composed of expert representatives of the various areas of esthetic medicine.  Recognized as having familiarity with current practice, these individuals are prepared by education and experience to have a comprehensive knowledge of the field.  The committee defines content areas to be covered, relative emphasis, and the nature of professional abilities and skills to be measured by the tests. 

Examination items undergo a rigorous process of review and revision to ensure high quality.  The subject matter is reviewed and critiqued, and each item is rated for accuracy and relevancy. The “Center’s” staff provides psychometric and editorial review of test items.  The test development committee responsible for the examination then selects an appropriate sample of items representing the specified areas of competency and staff prepares the final printed examination.

Credentialing is an evaluative process that provides practitioners in the medical esthetic specialties the opportunity to publicly demonstrate what they know and to be recognized for the knowledge they possess.  On a voluntary basis the Center provides certification examinations designed to test entry level knowledge.

The Center’s credential carries no licensing authority.  The ability to practice is regulated by the state boards and the Center has no regulatory power to require states to recognize certification.  Practice and educational standards are reflected in the credentialing process, but the responsibility for development of such standards rests with the professional specialty organizations and the medical and nursing education community.

The Center encourages individual healthcare professionals to seek out information about how certification relates to state licensure requirements and employment opportunities in their community.

Upon successful completion of exam the professional may use Medical Esthetics Practitioner-Certified (MEP-C) to designate additional qualifications fulfilled. 

The Center plans to seek accreditation by the National Commission for Certifying Agencies, National Organization for Competency Assurance, American Board of Medical Specialties, and/or American Board of Nursing Specialties after the two years of mandatory testing has been satisfied.  All aspects of the certification exam are in compliance with the accreditation standards in preparation for this process.

CREDENTIALING EQUALS VALUE-RECOGNITION, VALUE, EXPERTISE

Ask your patients if they value credentialed health care professionals-You bet they do!

Ask a certified colleague what they believe about certification and you are most likely to hear that they think certification is one of the most important milestones in their career.

You owe it to yourself to take the next step in your professional development.  Earning your MEP-C will validate your expertise and will give you tangible recognition of your commitment to excellence in medical esthetics.

For more information visit www.aamep.org 

Med-Esthetics Magazine Feature Article for Esthetic Skin Institute

The Esthetic Skin Institute, a highly accredited resource for medical aesthetics training and certification for medical professionals, owes its success to its founder’s unique combination of skills and experience.

Working as a registered nurse in Florida in the 1990s, Sasha Parker discovered that she also had a keen interest in skin care and holistic health. “I had a friend who was working as an esthetician,” she ex- plains, “and she was so happy working with healthy, appreciative clients. She was also doing very well.” So Parker obtained licenses both as an esthetician and as an electrologist, and started to establish a skincare practice. Soon she was working in both fields with a goal of eventually phasing out of nursing and working full time as a skincare specialist. Her plans changed however after an encounter with a physician at the facility where she worked. Observing his high degree of stress and fatigue, she suggested that he consider incorporating skin care into his practice, explaining the advantages and benefits of doing so. At the time, the concept of aesthetic medicine was so new that the MD was uncertain and declined. Later, after attending one of her educational presentations, he invited her to meet with him and his partner. Convinced of the potential for enhancing his practice with aesthetics, he invited her to join them.

That was the beginning of the Esthetics Skin Institute. As time passed and the medical aesthetics field developed, more and more doctors and nurses contracted with Parker for training. Because she was a gifted and passionate educator, training soon eclipsed all of her other activities and in 1997 she established the institute.

Today, Parker provides courses for doctors, registered nurses, nurse practitioners, physician assistants, dentists and dental surgeons as well as select courses for licensed practical nurses and licensed vocational nurses. No matter what the subject, her primary goal is training practitioners to provide safe, high quality care. “It’s amazing how many of us feel that just because we have a license to provide medical care, we are knowledgeable enough to provide aesthetics care,” she says. But this isn’t always the case. “In my state,” Parker re- ports, “from 1997 to 2003, 244 cases of adverse events were reported from laser treatments.  Out of those 244 events, 202 treatments were administered by physicians.” She believes it’s imperative, therefore, for every individual in the medical aesthetics profession—from physicians to nurses to physician assistants—to obtain in-depth, hands-on training. “The key to good delivery of care,” says Parker, “is good education.”

Her high standards for Esthetic Skin Institute courses receive continuous praise from her students, and her return and referral rates are high. “My students return for training in all of the aesthetics services they plan to offer in their practices,”  she notes. “They also refer colleagues who wish to transition into aesthetics or add aesthetic services to their practices.”

Another indication of the quality of her service is the caliber of physicians who comprise her board of advisers. “Such highly respected  physicians do not become affiliated with an organization that is not high quality,” she observes. 

Parker has been referred to as “a visionary and a pioneer ahead of her time” for developing this training system. Her response? “I have always been a seeker and giver of knowledge,” she notes, “and I have had some great teachers along the way who helped me, so now I strive to help others.”

www.esiw.com 

Med-Esthetics Magazine Feature Article

by Janet McCormick