Recap CSF 2018: Tips, Tricks and Pearls Pt. 1

This was a special year for Cosmetic Surgery Forum. The 10 year anniversary meeting included up to 30+ CME sessions, 78 exhibiting partners and over 250 core-specialty physicians in attendance.

The content ranged from hot topics such as feminine rejuvenation, the science of living a long healthy life, cosmetic controversies, the latest tools and techniques around the world, and private equity involvements in our practices.

The mission of CSF is to share fresh and exciting content that cuts straight to the heart of challenging issues and topics to provide you with practical, honest and insightful information you can implement into your daily practice. Check out some of the great tips, tricks and pearls from the 2018 meeting.

The Science of Living your Longest, Healthiest Life with Dr. Matthew Zirwas

• If you want to live a long life, your lifestyle should consist of these things: do what you love, be married, have between 1-4 children, be physically active, sleep for 7-9 hours a night and take Metformin daily. Intermittent feeding, living at an altitude and consuming coffee will probably benefit the longevity of your life as well. Most importantly, be optimistic. This will reverse adverse effects of stress and improve overall health and personal relationships.
• You’ll want to avoid working more than 45 hours/week, growth and sex hormones, IGF (insulin-like growth factors) and you will want to restrict calories (about 1,200) and activity levels commensurately if you’re a male.
• Well, what doesn’t work? An intake of Omega-3/fish oil supplements and low cholesterol. Low cholesterol seems to increase the risk of cancer and infections. Regular vitamin and mineral supplements may not help you live longer. Antioxidants do not prolong life and may have a negative effect on longevity as your own cells will decrease their own antioxidant production. If you’re taking a few aspirins every day, drinking a few glasses of red wine or indulging in dark chocolate, chances are that’s not working either!
• You’ll find results taking Nicotinamide Ribose and Rapamycin (if you can find some). Nicotinaminde Ribose is marketed as Elysium and Niagen which as shown to help the mitochondria work better. However, no long term data has been provided and may accelerate mitochondrial damage. Rapamycin is beneficial to animals but hasn’t been around long enough to show benefits in humans.
• Burnout of Physicians: In 2011, Dermatology was 23/24 burned out of different specialties. Now, it is near the top for burnout. Burnout is a real problem in the dermatology physician population – female physicians are particularly at risk.
  • Website recommended for physician well-being: https://www.stepsforward.org 

Negotiating a Contract with Dr. George Hruza

• Dr. Hruza can’t stress enough: Negotiate, Negotiate and Negotiate!! There is always room for a better deal!
• The majority of the states in the U.S. recognizes and enforces non-compete agreements. Some states such as California, North Dakota, Oklahoma and Montana do not support and totally ban non-compete agreements. If you spend a large amount of time negotiating, make sure you’re being very specific. If your argument/contract is too broad, it’s unenforceable.

Jowl Treatment with Deoxycholic Acid with Dr. Melanie Palm

• Treating jowls with DCA (Kybella) is safe and effective. Use 0.5 to 0.8 ml with 2- 3 injections per side. Pinch skin away from mandible while injecting and avoid a deep injection. If necessary, you can add Lidocaine to bottles. Only small volumes of DCA are required for this treatment.You must know your anatomy in order to avoid marginal medial nerve. Contact with the medial nerve causes asymmetry and alopecia can occur if it’s placed too superficial.
• Repeat in 6-8 weeks.
• Dr. Cassuto added that it is important to treat the cause of jowls, which is actually volume loss in lateral face.

Tips and Tricks in Dermatology: Dealing with Psoriasis and the Bowel with Dr. Haines Ely

• If you’re dealing with a patient who has Psoriasis, a leaky gut may be the cause! Dr. Ely suggests a regimen of DuoZyme and Quercetin (500 mg tabs), 2 caps of each with each meal.
• The patient should have a low fat diet consisting of mostly vegetables. It’s imperative they avoid emulsifiers, alcohol, peppers. Patients should not consume anything spicy or hot on the tongue which includes all peppers and black pepper.
• Dr. Ely advises all antibiotic usage to be discouraged. The idea is to restore the patient’s microbiome, not destroy it. A great alternative is Azithromycin as it is cheap, effective, and supported by literature.
• Helpful tip: Itchy psoriasis – think Heliobacter or blastocystis hominis. Red Psoriasis – think alcohol as the cause.

Reference is Clinics in Dermatology (2018) 36, 376-389. Article is posted on CSF site under Dr. Haines Ely’s name.

PRP for Hair Loss in African American Women with Dr. Brooke Jackson

• PRP shows promise as an addition in treatment armamentarium.
• For Androgenetic Alopecia, one can take Minoxidil 0.25mg /day orally, which is difficult as you cannot cut the 2.5 mg tablet into tenths. An alternative, which supposedly has no effect on blood pressure, is ¼ tsp of 2% Rogaine solution added to a 16 oz bottle of water. The patient is prescribed to take 5ml/day by mouth. There is a 1% incidence of facial hypertrichosis, and if you discontinue, it resolves.
• Dr. Andrea Murina suggests for patients with Alopecia Areata, have the patient take JAK inhibitors orally Tofacitinib 5mg po bid. One study showed 64% responded to treatment, and 20 patients rebounded.
• CSF Tip for using a topical for treating eyebrows: 2% tofacitinib in liposomal cream. The cream can be purchased at Smith’s Pharmacy in Wisconsin for $68/35gms for the time being, but the price may go up soon.

Treating Senile Purpura with Dr. Matthew Zirwas

• Treatment Plan: Rutin 50 mg bid + 1 gram Vitamin C once a day
• Dr. Matthew Zirwas says, “I use it orally in patients with solar purpura and pigmented purpuric dermatosis, both of which it works GREAT for – doesn’t prevent purpura, just makes it go away a lot faster. Dose is at least 50 mg bid combined with 500 mg vitamin C. It may make bruising go away faster after injections although I’ve never seen any reports of using it this way. If you were to try it (it is a totally safe supplement, so no harm that I could see) as an oral to reduce duration of bruising, I’d have people start taking a week before the injections and keep taking it for a week afterwards.”
• Dr. Zirwas’ oral recommendations for dry skin is his favorite oral ceramide product. Take as directed on bottle. The ceramide should be combined with oral L histidine, which increases natural moisturizing factor in the stratum corneum. Patients need to take 1 teaspoon a day. It does not have a great taste, so he suggests putting it in apple juice or orange juice.

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