What I learned at Cosmetic Bootcamp 2018
As usual, I learned a lot this year at Cosmetic Bootcamp. The best parts for me are always the anatomy lab, the injection technique demonstration, and the comparisons of lasers and energy devices.
The dissections and narration this year were performed by Drs Rod Rohrich, Deb Sherman, and David Sieber, with technical demonstration and narration by a host of different physicians. Every time I sit through this session I think that it is amazing that we do not have more complications. Perhaps (and I would like to believe this is the case), we see fewer complications because of courses like this one, which stress the anatomic danger zones and then follow it up by allowing participants to see the nerves, arteries, and vessels up close.
We have a pretty candid dialogue regarding where the needle should and should not go. For me, this is worth the trip to Colorado. I see the angular artery up close, marvel at the vasculature of the periorbital region, and try to keep track of the branches that come off the external carotid as they course through the regions I am going to treat. I would love to have a means (ultrasound?) of seeing these in patients, but for now the landmarks have to suffice. What is particularly interesting is the different perspectives from each specialty. I think that the oculoplastics and plastic surgeons have a special perspective because they dissect the face on a daily basis.
With respect to the fillers injected, it was amazing to review the placement of the facial fat pads in youth and in the aging face. By presenting this information, a roadmap of where to restore volume is provided. This always helps to guide my injections. Unlike many of my colleagues, I do not draw on patients. Instead, I use their anatomy to guide my injections and by watching the dissection of the fat pads and ligaments, my injections become more targeted.
Toxins Are Getting More Complicated
The world of toxins is going to get more complicated as newer toxins enter the market to compete with Botox, Dysport, and Xeomin. I have used many of these products as well as some of the topical toxins and think that the market for toxins is going to expand. Based on duration, diffusion, and cost, my impression is that these products are going to compete and that some patients and some physicians will find unique niches for each product. There are also going to be great opportunities to market to consumers, and I believe that this is going to catapult the toxins into a more popular treatment than it already is. Topical toxins offer a range of offerings from acne treatment to hyperhidrosis and once these are effectively utilized will bring more people to the toxin world.
Treating the Fat
Fat continues to dominate the discussions with treatments ranging from traditional liposuction to freezing to heating to chemical treatments that lyse the fat. Each of these has its proponents and there is data to support these treatments. The data for some of these companies supports approval for the indications marketed for some of the products, while others obtain clearance for a narrow indication but end up being used for a range of other indications. Injections to treat fat are going to continue to expand as the areas that can be treated increase. Combinations of treatments (eg, freezing and heating) are likely to help treat recalcitrant regions.
Lasers to Resurface Skin
Technology is also improving resurfacing and we have seen the advent of different energy sources to help resurface the skin with less down time. Fractionated lasers are getting better at treating fine line and laxity with fewer down days and lower adverse events. Bootcamp is a nice forum for discussions about what is and is not helpful in resurfacing. Although opinions vary, the data presented at the meetings supports the use of lasers as part of an integrated skin rejuvenation regimen.
Highlights From C Suite Summit
In addition to the scientific sessions, each year Bootcamp has a C suite summit. Some previous topics included were the role of venture capital, the future of dermatology, and what technologies will change the specialty. This year’s meeting had discussions about marketing to millennials and how consolidation is affecting the specialties. The discussion was far ranging and brought together a range of leaders from the corporate and medical world. There was no consensus about whether consolidation was good or bad or how to market to millennials and it remains to be seen how these will evolve.
Additional Bootcamp Meetings
Bootcamp is always my favorite meeting because I learn so much and I get to see many of my colleagues in a relaxed, cordial environment. In addition to the summer meeting, we are offering a meeting for all core cosmetic providers to include physicians, residents, fellows, nurse practitioners, and physician assistants in Napa this fall. We also continue to provide regional cosmetic bootcamps across the country to help educate core providers, especially those in training who can attend for free, in an effort to improve patient outcomes. n
Dr Beer is in private practice in West Palm Beach, FL. He is also a volunteer clinical instructor in dermatology at the University of Miami, a consulting associate in the department of medicine at Duke University, and shareholder and director of the Cosmetic Bootcamp meeting. For information on upcoming Cosmetic Bootcamp Meetings, please visit www.cosmeticbootcamp.com.
Disclosure: Dr Beer is an equity partner in Cosmetic Bootcamp and a paid consultant and investigator for Allergan, Sienna, Galderma, Revance, Evolus, Theraplex.