HairMax LaserComb Technology (PhotoTherapy For Photogenic Hair)

In order to reverse or stop the progression of hair loss in males*, the entire hair-growing environment is stimulated by the unique characteristics of laser energy provided by the HairMax LaserComb. The HairMax LaserComb produces nine laser beams which generate columnated, coherent visible light in the red spectrum. Laser light in the red spectrum and with the appropriate power output has been clinically proven to be beneficial for cutaneous medicine. In addition, the HairMax LaserComb has a patented hair parting mechanism. This combined with the precise alignment of the hair parting teeth to the individual laser beams provides a true direct path for the laser light to effectively bathe the scalp.

View of the HairMax LaserComb Premium's Patented Hair Parting and Laser Delivery System for Maximum Efficacy

ATP – Nature’s Energy Store

All living things, plants and animals alike, require a continual supply of energy in order to function. This energy is used for all of the processes which keep the organism alive. Some of these processes occur continually, such as the metabolism of food, the synthesis of large biologically important molecules, e.g. proteins and DNA, and the transport of molecules and ions throughout the organism.

Scientific studies have been performed showing that increases in the amount of the biological molecule adenosine triphosphate, or ATP, causes the individual cells to increase their activity. ATP is integral to the function of the cell as an “energy transporter”. It is postulated that laser light energy can be collected in the mitochondria of the cell which then transfers this energy to produce ATP. This process is similar to photosynthesis which causes growth in plants.

ATP works by releasing the endmost phosphate group when instructed to do so by an enzyme. This reaction releases a large amount of energy, which the organism can then use to build proteins and other cell functions.

ATP and Laser Light Stimulation

Other studies using specific wavelengths of certain lasers show increased activity in cell and bacterial cultures, probably the result of ATP production.

Laser light bathing the hair and follicles

The HairMax LaserComb provides stimulating laser energy in what we believe is a two fold approach to energize the weakened follicle. The hypothesis behind the HairMax LaserComb’s success combines increased vascularization and an increase in cellular metabolism. Laser energy has been demonstrated to increase the blood flow and circulation in the scalp. This increase in blood flow is crucial to promoting a healthy hair follicle. The increase in blood flow brings the important nutrients into the follicle, while taking away harmful waste products such as DHT. The increase in ATP as described in earlier paragraphs, increases cellular metabolism and cellular activity. The hair follicle now has the building blocks and energy to transform from a weakened follicle to one that is healthy and capable of producing beautiful, thick healthy hair. The enhanced environment then in turn invigorates the hair follicle which produces healthier hair, prevents further hair loss and stimulates the re-growth of hair.

Customer Satisfaction is of Primary Importance Clinically Proven to Promote Hair Growth* Greater than 90% User Satisfaction Reported Patented and Manufactured in the USA ISO Quality Assured Proud Members of the Better Business Bureau

* The HairMax LaserComb is cleared for marketing by the FDA for The Promotion of Hair Growth in males with Androgenetic Alopecia who have Norwood Hamilton Classifications of IIa-V and Fitzpatrick Skin Types I to IV

Hairmax Laser Combo (What Can I Expect? A Typical User Experience)

What Can I Expect? A Typical User Experience

If you are losing your hair, we know you want a convenient, cost-effective solution that will deliver real results real fast. When used as directed, over 90% of HairMax users notice positive benefits starting in as little as 8 weeks. These results include: increased hair growth, cessation of hair loss, faster growing hair, more manageability and more vibrant color.

It is believed that the HairMax is an anagen inductor promoting healthy anagen (terminal) hair growth. Hair grows in cycles, Anagen - the active growth phase, Catagen - the resting phase and Telogen - the shedding phase. At any given time, 10-20% of your hair is in the Catagen or Telogen phase waiting to be shed and replaced by an active Anagen hair (similar to the way a baby tooth is pushed out by a permanent tooth).

The HairMax stimulates the scalp and energizes follicles in the Catagen or Telogen phase causing a new Anagen hair to be formed. These new Anagen hairs cause the old Catagen and Telogen hairs to shed now as opposed to being shed at a later time. This increase in Anagen hair activity results in a slight increase in shedding and should not be a cause for concern. The hairs being shed during this time are being replaced by new healthier stronger hairs. Supporting this hypothesis are user reports of increased hair shedding during the onset of treatment. This is a positive sign and, in-line with the Anagen induction hypothesis, indicates that hairs in the Catagen and Telogen phases are being stimulated to fall out of the scalp only to be replaced by healthier, thicker hair.

If you are noticing an increase in fallout during the early phases of your treatment, this is one of the most positive indicators that the HairMax is working for you.

Below is a breakdown of how a typical male user responds to treatments with the HairMax.

Weeks 1-8:	As early as the first treatment, users report that their hair feels more lively, is more manageable and that their scalp feels healthier. Having “better hair days,” noticing more vibrant shine, having less scalp itch and experiencing significantly decreased hair fallout are just a few of the immediate benefits of using the HairMax. Ultimately you should see some early indicators that your hair and follicles are responding to the laser.
As Early as Week 8-12:	Consistent with our clinical data, 45% of users start seeing noticeable hair growth in a few weeks. It may start with small “peach fuzz” like hairs sprouting from the scalp, and may also include a general thickening of the hair you have. Additionally, improved manageability, increased shine is a strong indicator that the HairMax is working for you.
Weeks 12 -20:	During this period another 45% of our users start to experience the full benefits of using the HairMax. A reduction of hair loss, marked new growth and all of the benefits as described in the previous section.
Post 20 Weeks:	Most users of the HairMax experience the benefits within the first 12 weeks. It is not uncommon for some users to require more than 12 weeks to experience the full benefits. Please remember, it is difficult to see hair growth on the top of your head. We recommend having a relative or hair dresser look into your scalp to recognize the new hair growth, It is important to note, though, that sometimes perceived benefits do not parallel actual benefits. While you may not experience dramatic improvements that are easily noticeable, little indicators, such as increased shine and manageability or an overall feeing of better scalp health, are signs that the HairMax is having a positive effect on your hair.

Our clinical studies and historical experience demonstrate that a HairMax user should see an average of 20% new hair growth. This is statistically significant but just as important to the 20% new hair growth, most users experience a reduction in shedding. This reduction in shedding is extremely significant. If left untreated, your hair loss would have continued and in six months to one year, your hair loss could look considerably worse. Using the HairMax to stabilize your loss will help to maintain your existing hair and retard the progression of pattern baldness.

If you don’t see results between 12 and 20 weeks, we encourage you to continue using the HairMax on a regular basis. Many of our users report that even in this time frame, with continued use, they slowly start to notice a thickening of their hair, and even show signs of re-growth.

Customer Satisfaction is of Primary Importance Clinically Proven to Promote Hair Growth* Greater than 90% User Satisfaction Reported Patented and Manufactured in the USA ISO Quality Assured Proud Members of the Better Business Bureau

* The HairMax LaserComb is cleared for marketing by the FDA for The Promotion of Hair Growth in males with Androgenetic Alopecia who have Norwood Hamilton Classifications of IIa-V and Fitzpatrick Skin Types I to IV

HairMax LaserComb Technology:

Introduction: A Breakthrough in Hair Growth, Hair Care and Hair Science

Some say it is the hair that makes the man; it’s been called our crowning glory and defines our style, framing our personal presentation. Sometimes we even joke about it, but for the many people whose hair is thinning, hair loss is no laughing matter. Thanks to new technology breakthroughs in hair loss treatments, proven solutions for men are quickly advancing and being made available worldwide.

Many men deal with hair loss by spending thousands of dollars and countless hours on drugs, messy topicals and so-called miracle supplements. Some of these treatments require prescriptions or can have unwanted adverse effects and require ongoing costs. Even worse yet, all of this effort is sometimes in vain: many of these products do little if anything to help the problem, leaving many users feeling hopeless in their fight against hair loss or thinning hair. Thanks to the HairMax laser hair treatment, though, it no longer has to be this way. HairMax now offers a cost effective safe and convenient option for hair loss: a proven solution that is shown to be effective in 90% of users.

Perhaps you feel diminishing attractiveness and dwindling confidence due to your hair loss. If so, there is a light at the end of the tunnel in your battle against Androgenetic Alopecia. The HairMax LaserComb® laser hair treatment has revolutionized the massive hair care industry, and has made baldness a choice rather than an unavoidable reality.

Introducing The HairMax LaserComb® Finally, there is a clinically proven solution, FDA Cleared for marketing to fight your hair loss. After rigorous clinical testing, the HairMax LaserComb® has been proven effective in over 90% of users. It is also safe, having been shown to cause no unwanted side effects and is free from on-going costs. The end result: our medically significant clinical data and our recent FDA clearance to market for our laser hair treatment solidifies the HairMax as a true revolution in the hair care industry. Treatment Objectives Similar to the process of photosynthesis, the Laser Light of the HairMax effectively stimulates the hair follicle causing increased density, increased rate of growth, and an overall normalization of the scalp. The HairMax LaserComb is the easiest, most effective way to reverse thinning hair. The objective of Laser Phototherapy, as delivered through the HairMax LaserComb, can be summarized through the following descriptions:

A. Live root growing a hair. HairMax provides energy for healthier hair follicle stimulating more rapid hair growth.	B. Live root in resting or shedding phase. HairMax stimulates root to produce a new healthier hair follicle.
C. Weakening root with a miniaturized Vellus hair. HairMax stimulates growth of thicker, healthy hair and helps to reverse the process of miniaturization.	D. Dead root. Beyond revitalization.

A. In the “Growth Phase” or “Anagen Phase”, each hair grows approximately one centimeter (1/2 inch) per month for a period of 2 to 8 years. The HairMax LaserComb helps by providing energy to the hair growth process thus producing healthier, fuller hair.

B. In the “Resting Phase” or “Telogen Phase”, the hair stops growing and ‘rests’ for 2 to 4 months and eventually falls out. The HairMax helps by stimulating re-growth of new hair.

C. Termed “Vellus Hair” (light colored, short, fine "peach fuzz” hairs), the HairMax helps these fine hairs by stimulating them to grow into thicker, more mature hair.

D. The root is dead and cannot be helped.

It is postulated by Lexington that the HairMax LaserComb® may stop or reverse the cycle of miniaturization by stimulating the follicle and encouraging the production of living cells in the hair root that eventually make up the hair shaft.

Studies on the effects of Laser Photo-Therapy have shown an increase in Adenosine Triphosphate (ATP), the fuel of the cell. An increase in ATP provides the necessary higher energy level in the hair follicle to overcome the adverse affects of DHT. In addition, Laser Photo-Therapy hair treatment has shown to increase blood flow to the capillaries of the hair root, delivering more nutrients to the living cells that create the hair shaft.

Real Users, Real Data and a Proven Hair Loss Solution

Since 2000, the HairMax LaserComb® has been delivering results to men worldwide suffering from hair loss. * During this time our users and our clinical data have confirmed that the HairMax LaserComb® is effective in not only stopping hair loss*, but also a proven solution in re-growing lost hair and improving overall scalp health.

For over two decades, Laser PhotoTherapy hair treatment or “Low Level Laser Therapy” (LLLT) has been used in hair salons and clinics around the world with great success. The problem, though, is that these treatments are costly and require ongoing clinical visits. With the HairMax, what was once an “exclusive” treatment is now an affordable, convenient, proven solution for re-growing your hair.*

Our landmark multi center, sham-controlled clinical study completed in 2006 showed that 93% of all users experienced hair re-growth and better hair condition. The results of the key clinical study performed with the HairMax LaserComb which led to FDA clearance to market was published in the May 2009 Issue of Clinical Drug Investigation. The article entitled, HairMax LaserComb Phototherapy Device in the Treatment of Male Androgenetic Alopecia, is indexed as Clin Drug Invest 2009: 29 (5): 283-292 in most of the biomedical databases such as MEDLINE, EMBASE/Excerpta Medica, etc. It also showed that users reported no unwanted adverse effects and users can start seeing results in as early as 8 weeks.

Our clinical data coupled with our user satisfaction rate of over 90% is among the best in the hair-care industry and is proof that you too can achieve exciting, visible results with the HairMax LaserComb's proven laser hair treatment solution.

Customer Satisfaction is of Primary Importance Clinically Proven to Promote Hair Growth* Greater than 90% User Satisfaction Reported Patented and Manufactured in the USA ISO Quality Assured Proud Members of the Better Business Bureau

* The HairMax LaserComb is cleared for marketing by the FDA for The Promotion of Hair Growth in males with Androgenetic Alopecia who have Norwood Hamilton Classifications of IIa-V and Fitzpatrick Skin Types I to IV

Tria laser Hair Treatment

How It Works

It’s all about selective photothermolysis. Big word – simple to understand.

Photothermolysis is the process by which the TRIA System’s laser energy targets the dark pigment in the hair, where it is transformed into heat that disables the hair follicle. This targeted process causes the hair to gradually fall out and stop growing back.

It is important to understand that visible results are not immediate because hair grows in cycles.

During any single treatment, some hair follicles will be dormant with no visible hair growth and some will be in a growth cycle, where the hair is visible on the surface of the skin. To benefit from laser treatment, the hair must be in the growth cycle (visible prior to shaving) during treatment.

For optimal results, we recommend one treatment every other week for the first three months then one treatment per month for 3-5 months. This is the average amount of time it takes for the majority of the hair follicles to move through the growth cycle and be treated.

How To Use

The TRIA Laser Hair Removal System can be used on the legs, underarms, bikini line, back, chest, abdomen, arms, hands, or feet, or anywhere that’s suitable, below the neck.

Ready to be hair-free? It’s easy! Let’s get started:

Step 1:
Cleanse, shave, and thoroughly towel-dry the skin.

Step 2:
Select the energy level that's comfortable for you. There are three levels to choose from: 1 (low), 2 (medium), 3 (high).

Step 3:
Apply the tip of the laser to the skin and listen for the beep indicating that and the device has delivered an automatic laser pulse*. If you hear a buzz, the laser has misfired and you will need to re-treat the area

Step 4:
Reposition the TRIA laser by overlapping slightly with the last treatment area and repeat until you have covered the desired area.

Step 5:
Repeat every other week for the first three months then one treatment per month for the next 3-5 months.

It’s that simple!

*When applied to the skin, the TRIA laser emits a single laser pulse, delivering a beam of light through the tip of the device. The tip is large enough to treat multiple hair follicles at a time in a concentrated area. Once the pulse is complete, the TRIA laser will emit a short beep, indicating you should move on to the next treatment area.

Before And After

From May 2003 through January 2004 TRIA Beauty co-founder Mark Weckwerth treated a 3”x 3” square patch on his leg once per month with the TRIA System.

Proven Results

So you can all see for yourself the fab results that TRIA System achieves in just a few, simple treatments, below are a few photos from our clinical trials.

Underarm

Leg (3" x 7" test patch)

Cost Comparison:
The TRIA System vs. Professional Laser Hair Removal

Based on US national averages, the cost of professional hair removal on the legs, underarms, and bikini line only is upwards of £7000–£8500* for a full course of treatments.

Treatments average upwards of £200–£700 per treatment, with most areas requiring five to eight treatments for permanent hair reduction, the size of the area, along with the amount of hair being treated, will determine the exact price.

Below is a rough breakdown of the cost of in-office laser hair removal by treatment area:
• Medium areas like the bikini line or underarms: £200–£300+ per treatment.
• Larger areas like the full legs or a man’s full back: £350–£650+ per treatment.**

The good news is that the TRIA System delivers the same, lasting results as the professionals, at a cost of just £675 for the entire body.

*Source: American Society of Plastic Surgeons
**Source: laserhairremoval.com

N.B. Please note we have converted the dollar equivalent to pounds

TRIA Beauty Clinics
Want to learn more? Visit our FAQ section.

TRIA Laser Hair Removal System

TRIA Laser Hair Removal System

Imagine a life free of unwanted hair – TRIA Beauty makes it possible.

TRIA Beauty didn’t just miniaturize the technology – we invented it.
Experience the same gold-standard technology that TRIA Beauty’s team of scientists invented for the professionals – in the privacy of your own home.

Get lasting results.
Not only is the TRIA System FDA-cleared and simple and safe to use, it delivers long-lasting, hair-free results that until now were available only at a doctor’s office.

Save time.
Skip the next trip to the salon and opt for treatments that now take mere minutes to complete — thanks to the TRIA System’s faster, improved technology.

Save money.
Based on national averages, the cost of professional hair removal on the legs, underarms, and bikini line only is upwards of £7000 for a complete course of treatments. The TRIA system delivers the same long-lasting results at just £675 for the entire body.

Stop shaving.
Stop waxing.
Go ahead, bare it all...
You’re just 6–8 months away from a hair-free existence.

TRIA Beauty Clinics
Want to learn more? Visit our FAQ section.

Your safety and satisfaction is a top priority here at TRIA Beauty

In order to ensure the safety and authenticity of your TRIA Beauty purchase, shop with us here at www.TRIABeauty.co.uk or visit an authorized TRIA Beauty Clinic.

TRIA Beauty realizes that laser hair removal is a personal choice, so we’ve partnered with leading cosmetic doctors and clinics across the country to answer your questions and let you experience the TRIA system first-hand to determine if at-home laser hair removal is for you.

Locate a TRIA Beauty Clinic near you.

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Permanent Laser Hair Removal

Laser Hair Removal,
when first introduced in the late 1990’s, was limited to light skinned individuals with dark hair. Efficient Laser Hair Removal was produced by Alexandrite and Diode lasers. Dark skinned individuals could not use these lasers for effective hair removal because early generation lasers were unable to distinguish between skin pigment and hair follicles, which led to the burning of those with darker skin. Today this has all changed. The advent of the new laser line, the YAG, and the re-invention of the IPL system has afforded excellent results for individuals with dark skin and dark hair.
Permanent Laser Hair Removal,
Permanent Laser Hair Removal can be achieved by precisely following each treatment protocol recommended by your Laser Hair Removal Clinic. Most Laser Hair Removal websites have not been updated with current information, therefore may not portray the care that needs to be taken in order to ensure effective results. We have found some website information to be as much as seven years old. This, quite frankly, is unacceptable. It is with this in mind that the Laser Hair Removal information you find on this website will be up to date, accurate and informative. It is here to help guide the consumer and help answer the most difficult Laser Hair Removal Questions either in Arizona Hair Laser Removal or Hair Laser New Removal York.

Am I a good candidate for
laser hair removal?
Take Our FAST and EASY Analysis and get your results back in just a few seconds!
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Removing Your Unwanted Hair Just Got Easier!

While hair removal by laser has been in existence for almost 10 years, it is still a relatively up and coming procedure. When researching laser hair removal, consumers come across many concerns including, typical cost of laser hair removal, seeing before and after shots of laser hair removal pictures and any laser hair removal risk that could be involved, including laser hair removal side effects and undergoing treatments for laser hair removal during pregnancy. LaserHairRemoval.Com continually strives to effectively address many of these concerns.

While LaserHairRemoval.Com can provide you with the most up to date, and accurate lazer hair removal information, there are a few aspects of the laser hair removal procedure that can vary throughout the country; which is why LaserHairRemoval.com works to put you in touch with local clinics in your area including Chicago Hair Laser Removal and Hair Laser NYC Removal. The average cost of laser hair removal and overall laser hair removal danger are concerns that vary from clinic to clinic based on the area in which the clinic resides and the experiences clinics have had with their patients. It is important as a consumer to ask about these factors as well as which type of laser hair removal system the clinic you are researching uses, because all of these factors can influence the overall outcome of your procedure. Only when you have all the information can you truly make an informed decision about undergoing laser hair removal treatments for Hair Laser NY Removal as an example.

Shaving…

Shaving is the simplest and least invasive form of hair removal, so many individuals choose to shave their unwanted hair on a daily basis. Whether you are shaving facial hair, Shaving Pubic Hair, shaving leg hair or shaving any other areas, if you need to get rid of hair quickly, then shaving is your best option. One of the most popular areas for men and women to shave is the pubic area. Many individuals do opt to use Pubic Shaving as their main form of hair removal in the pubic area because Pubic Hair Shaving can greatly vary from person to person. Whether you are shaving the pubic area or any other area, using clean razors and Shaving Cream will help you to reduce the risk of redness and razor bumps so that all you take away from your shaving experience is smooth, hair free skin.

Whatever your hair removal needs are...

We can help by educating you about hair removal.

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Let us know what you think of the site. Complete the feedback form and receive industry updates and special offers for permanent laser hair removal.

Learn more about the TOP FIVE (5) most popular laser hair removal treatment areas...

Laser Hair Removal Back treatments, Laser Hair Removal Bikini treatments, Laser Facial Hair Removal treatments, Laser Hair Removal Legs treatments and Laser Hair Removal Upper Lip Treatments.

Laser Hair Removal Training...

We offer Laser Hair Removal Training for Physicians, Nurses, Electrologists and Medical Assistants. Check with our training centers for current state regulations on Laser Hair Removal Training.

Laser Hair Removal Procedure - Video Footage... If you have never seen the procedure....it's worth it! The video shows a laser quickly clearing a female underarm area.

Full footage of laser hair removal with description
(Fast Download for Cable and DSL)!
Shorter Video
Download for 56K modem!

Note - The tubing that is visible in the video is a smoke evacuator. This helps to eliminate the lased hair odors from the treatment room.

DC Hair Laser Removal Washington

DC Hair Laser Removal Washington

Laser hair removal services are provided by various specialists in professional centers in the Washington DC area. dc hair laser removal washington is a safe and effective treatment to remove unwanted hair from your upper lip, chin, legs, underarms, bikini area, chest, neck,... in fact from most anywhere.

The laser beam that is used in the laser hair removal device is directed at the hair follicles. The dark pigments in the follicle absorb the laser light energy. As the follicle absorbs more and more energy the follicle dies and can no longer grow hair. This is the mechanism on which dc hair laser removal washington works. Whatever be your skin complexion you can expect to have a good result thanks to advanced technology and professional expertise. Although it may hurt a bit both men and women are trying it out and that too successfully.

Find out your skin type and choose the laser center that is most suited for you. Try to get suggestions from those who have been through dc hair laser removal washington. Then you can surely leave all your worries behind.

Laser hair removal can also treat your problem of ingrown hair. Often men have to deal with ingrown hair in their beard area and neck. Women face problem with it mainly in the bikini area. Since laser hair removal targets hair at the follicle it's the most remarkable ingrown hair treatment. It actually removes the root of the problem. After several sessions, you yourself will notice your hair shedding and the dark spots and bumps from folliculitis disappearing.

The cost of dc hair laser removal washington varies from one specialist to another. Each case is unique and the cost of treatment is dependent on this individuality factor also.

So if you have unwanted facial and body hair I can tell you for sure that dc hair laser removal washington is the perfect treatment for you. You can check out Sona MedSpa, a laser hair removal office in the Washington DC area. Whether you are a male or a female through expert and professional care you will get yourself a new look at quite reasonable prices.

Laser Hair Removal

Discover laser hair removal information Articles and resources for prices, cost, and treatments of laser hair removal in cities like New York, Washington DC, Toronto, and Dallas. Visit this site for the best in laser hair removal! http://www.informationonlaserhairremoval.com/

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Laser Hair Removal Basics

Unsightly hair can make both men and women uncomfortable about their appearance, and constant shaving and waxing can be a burden, not to mention the constant irritation. For this reason, Americans seek permanent laser assisted removal at a rate of more than half a million treatments per year.

How It's Done

Laser hair removal works when light energy penetrates the skin, converts into heat during penetration, and causes thermal injury to the hair follicle. The high temperature reaches and disables the follicle, effectively inhibiting re-growth. This process can be accomplished only during the growth stage of hair. Because hair grows in cycles and not all follicles are at the same stage at the same time, laser removal is done in sessions in order to achieve the best results.

In some instances a topical anesthesia or numbing cream can be used, but this often not necessary, as pain is minimal. Total surgery can be as short as ten minutes or as long as an hour depending on the size of the area to be treated.

Technology

There are many different lasers that have been approved for hair removal. When the FDA grants approval for such lasers, they are approved to permanently reduce hair growth, not permanently remove. This is because hair can re-grow in some cases when it is not treated during the appropriate stage. You can check the approval of a specific laser on the FDA Web site.

Recovery / Post Op

After the procedure the treated area may appear slightly red or swollen. This can be remedied with cream or ointment. Return to normal activities can take place immediately, however sun exposure should be avoided. Within the first few weeks, hair will appear in the treated area, this is dead hair that is falling out. The hair can be shaved, but bleaching or waxing should be avoided.

Complications

For the most part, laser hair removal is safe and effective. In some instances there can be changes in pigmentation, or blistering, scaring, or burning will occur, however these are almost always temporary.

Am I A Candidate

To be considered a candidate, the basic rule of thumb is that your hair must be darker than your skin. The best candidates are fair-skinned individuals with brown or black hair. Blonde, red, or gray hair does not respond as well to laser removal.

Cost

The cost of laser hair removal will vary depending on the size of the treated area. The national average surgeon fee for 2003 was $429 per session according to the American Society of Plastic Surgeons (ASPS). Doctors typically advise that their patients undergo a treatment schedule of four sessions.

10 Cosmetic Plastic Surgery Predictions for 2005 from ASAPS

10 Cosmetic Plastic Surgery Predictions for 2005 from ASAPS

New York, NY (December 21, 2004) - The American Society for Aesthetic Plastic Surgery (ASAPS), the leading national organization of board-certified plastic surgeons who specialize in cosmetic surgery, offers its predictions for cosmetic surgery in 2005. Predictions are based on interviews with leading plastic surgeons around the country.

• National attention to issues of patient safety will result, in some states, in more stringent requirements for physician credentials to perform cosmetic surgery. The American Society for Aesthetic Plastic Surgery (ASAPS) will be among the leaders of this patient safety movement in 2005.
• Endoscopic (arthroscopic) facial rejuvenation procedures may become more popular. Suture suspension techniques, promising facial rejuvenation with minimal downtime, may also increase in popularity; however, many patients will opt for traditional facelifts or endoscopic procedures with more predictable and long-lasting results.
• Experimental techniques for non-invasive fat removal, as a future alternative to liposuction (lipoplasty) surgery, will be tested in clinical trials.
• The number of patients seeking plastic surgery for body contouring after dramatic weight loss will rise by at least 20 percent in 2005, reflecting growing public awareness of significant long-term health benefits of weight loss for the morbidly obese.
• Cosmetic surgery for racial and ethnic minorities in the United States will continue increasing, most likely exceeding 20 percent of the total procedures performed.
• Hyaluronic acid (Restylane, Hylaform) will surpass collagen as the most popular soft tissue filler for lines and wrinkles. Additional hyaluronic acid products developed specifically for facial volume enhancement and for improvement of depressed scars will be introduced.
• Fashion and beauty in 2005 will emphasize nostalgia and elegance as embodied by Hollywood icons Lauren Bacall and Grace Kelly, and modern stars such as Nicole Kidman. In cosmetic surgery, more patients will express a preference for classical facial features, and a growing number of women will opt for smaller-size breast implants.
• More plastic surgeons will offer lifestyle assessment and counseling to their cosmetic surgery patients. The focus will be on "wellness" basics, with support from nutritionists and weight management specialists.
• In 2005, a new generation of breast implant fillers and coatings; advanced lasers that rejuvenate the skin from the inside out; new products for scar management and prevention of keloids; and permanent injectable treatments for facial lines and wrinkles may be the biggest "buzz" in cosmetic plastic surgery.
• The proliferation of "Reality" TV programs featuring plastic surgery may lose their public appeal. The long term psychological effect of undergoing a dramatic change in appearance from simultaneous multiple-procedures, as is common for participants of reality shows, may surface in 2005.

Screening test mandatory for foreign medical graduates

Screening test mandatory for foreign medical graduates

Medical graduates with foreign degrees will not be able to practise in India till they have cleared a screening test conducted by the Medical Council of India, the Supreme Court has ruled.

The screening test will also be mandatory for those students who have got MBBS degrees from a country with which India has a reciprocity agreement. At present, certain medical qualifications of UK, Australia, Canada, Italy, Japan, New Zealand, South Africa, Ireland, Nepal, Pakistan and Bangladesh are covered under the reciprocity clause. From now, if an Indian student gets a medical degree from a foreign country covered under the reciprocity clause and wants to practise in India, he can do so only after clearing the MCI’s screening test.

The worst affected would be Indian students who had made a beeline for medical degrees from colleges in Nepal after the MCI had refused to recognise medical degrees from institutes in erstwhile USSR countries, which had liberal admission criteria.

Students went in droves to get admission in medical colleges in Nepal, with which India has a reciprocity clause, and had approached the SC after MCI said they were required to appear in the screening test.

Dismissing their plea against the screening test, a Bench comprising Chief Justice K G Balakrishnan and Justices P Sathasivam and J M Panchal said:

Appellants have to appear in the screening test conducted by the National Board of Examination in terms of the Screening Test Regulations made by the MCI. It was noticed that such students also included those who did not fulfil the minimum eligibility requirements for admission to medical courses in India. Serious aberrations were noticed in the standards of medical education in some foreign countries, which were not on par with standards of medical education available in India,” the SC said justifying its ruling.

It was therefore felt necessary by Parliament to make a provision to enable MCI to conduct a screening test to satisfy the regulatory body about the adequacy of knowledge and skills acquired by citizens of India, who obtained medical qualifications from universities or medical institutions outside India.

MCI aims to bring back 5000 NRI doctors in 5 years

MCI aims to bring back 5000 NRI doctors in 5 years

Amendments in the Medical Council of India (MCI) regulations will open the floodgates for hundreds of non-resident Indian (NRI) doctors to come back to their roots. MCI has eased the cross-over rules and has set a target of bringing back 5,000 Indian doctors, including teachers, settled in US, UK, Canada, Australia and New Zealand.

MCI has removed the main bottleneck by recognising the postgraduation and other degrees of these specific countries where health facilities are supposedly best in the world and the education was done in English medium. They have the choice of coming back to teach in a private or government college as well as work in a private or government hospital. Also, they can set up their own medical colleges and hospitals. Indian doctors in these countries are the richest segment even among NRIs.

Apart from accepting foreign degrees, the MCI has made special provision so that foreign experience is also counted. For example, if there is a professor of medicine in a US university, with the required number of years of experience to become one in India, he can be hired as a professor by any medical college in India. This will bring about a huge change not only in the cities but also in the countryside, if the doctors returning home really go deeper into their roots. Besides, MCI also sees the possibility of groups of NRI doctors coming back and pooling in their resources to build hospitals and medical colleges.

Tomorrow's Doctors...

Tomorrow's Doctors...

...are going to be quite similar to yesterday's doctors, apparently. According to the GMC, Medical Schools should now be focussing on giving students meaningful clinical experience, making sure that medical students are ready to become junior doctors. Which is what we've always thought, right?

But it is encouraging to see the GMC trying to take the lead in guiding medical schools towards promoting useful clinical experience rather than increasing PBL, training sessions, communication skills and simulations (all of which are valuable educational tools as an adjunct to clinical teaching, but have perhaps been over-represented).

In my brief run-through the new Tomorrow's Doctors I can't say I found much to substantively address two related issues though:

1. It's all very well incorporating clinical experience into the first few years of medical school, but this experience is of limited value when basic knowledge is so poor (as you'd expect early in undergrad training). Students need a good grounding in relevant medical science (ie you don't need to know the Krebs cycle inside-out but a good knowledge of pharmacology is essential). For example, I spent 5 minutes teaching a medical student (not final year, but not 1st either) about a lumbar spine x-ray. It took longer than I thought because instead of concentrating on the osteoporotic crush fractures, we had to spend some time working out what the calcified tube-thing anterior to the spine was (hint, it sounds a bit like "Ray Liotta") I didn't use that clue, though.

2. Dumping groups of medical students on wards doesn't equal clinical experience. All the checkboxes, DOPS etc in the world will not ensure that the student isn't spending most of his/her time wandering round aimlessly behind a disinterested ward-round, chatting to the other students because no one has the time or interest to actively teach. My ward was short staffed earlier this week, leaving a house officer for one team and an SHO for the other. This situation is manageable, but not ideal. Enter 5 medical students. You can imagine what kind of educational experience they got that day. Perhaps the advent of Student Assistanships will make the students more responsible and useful on the ward, which would undoubtedly improve the educational yield from their 'ward time'.

Once I've had a chance to have a proper read I may need to eat those words. We'll see.

The 11th Reason Doctors order unnecessary tests

The 11th Reason Doctors order unnecessary tests

I liked this list of reasons why doctors order tests. It's based on medical practice in the US but most apply to doctors in the UK too. I'd go so far as to add another - temporizing. It's really an extension of reason 1, with a bit of 2,3 and to some extent 5 as well.

Time can be an excellent way of finding out what the natural history of a disease process is, of gaining new information, etc, so ordering a few tests while watchfully observing your patient is often reasonable or even very good practice. However there's definitely a trap that many doctors fall into where they have a patient in want of a diagnosis or definitive plan, who doesn't readily fit into a disease paradigm, and they'll keep on ordering tests until they get bored. The problem with this sequential over-testing is it allows the doctor to stop thinking. All you need to do is fire off a few tests, then you don't need to think until they all come back negative. What to do? Order another test that takes a few days! And again, and again…

Although this could result in the diagnosis coming to light, either by eventually finding the 'right' test, or by the disease revealing itself more clearly (or just resolving), the unfortunate side effect of the process is that instead of being watchful and considering possible diagnoses for a time, the doctor disengages brain for all but the 30 seconds it takes to think up another few tests - thus while thinking he's exemplifying the considerate, watchful doctor, he becomes the exact opposite of that, sometimes for weeks on end.

However, I'd add just a tiny critique of Dr Rangel's underlying rationale for critiquing over-testing. Not that I disagree with him, because the behaviours he describes are absolutely not good medicine and should all be avoided. But why are they not good? In criticizing the lazy physician who can't be bothered to formulate a diagnosis using clinical skills, he says:

"It takes time to listen to and sort through a patient’s symptoms and to do a proper and directed physical exam. But if you have 55 patients to see today and you want to make it home on time then you can just order a GIANT MRI SCAN of EVERYTHING that’s all but guaranteed to detect any and every abnormality. Wrong. That’s not practicing medicine. That’s the cookie cutter approach. My dog can do that."

Yes, that's not very impressive doctoring. But the problem with the 'cookie cutter' approach is not that it's intellectually lazy, although it is. It's that it doesn't work - it has a terrible signal to noise ratio, and it results in patients being exposed to risks from the original investigation and from subsequent investigations or procedures relating to incidentalomas. However, if we had some amazing new body scan that could accurately predict the natural history and effects of every 'abnormality', at £1 per scan, then ordering a GIANT WIZZBANG SCAN of EVERYTHING might be very good for patients, even though any lazy idiot could order the scan. I'd be out of a job, but people would probably be healthier.

Despite what a few mail-order scanning companies would like to tell you, that scan doesn't exist, and is very unlikely to any time soon, so us good doctors who use clinical skill and judgement can rest safe in our paycheques. But it's important to remember what the point of our jobs is - being a 'good doctor' (which includes using investigations judiciously) improves the health and lives of our patients. It's not an end in itself.

As a medical teacher, I can't teach my students / juniors about every situation where they should or shouldn't order a particular test. But if I can teach them an underlying throught process or behaviour pattern relating to how to approach diagnostic situations - with the outcome for the patient paramount - then I shouldn't need to tell them how to avoid each of the 10 bad reasons for ordering tests. They should be able to work that out for themselves.

A Nursing student writes...

A Nursing student writes...

I recently received an email from a charming nursing student who read my blog, and wanted to know a little more about a presentation I'd uploaded to slideshare - on NICE and healthcare rationing. Primarily she wanted to reference it in an essay for her nursing degree on a similar topic. Now, of course I was very flattered, and yes, I do think my opinions are sensible and backed up by evidence, but I'm clearly not an expert on the ethics, law or economics of healthcare rationing. So I advised her to go to my references and look at the primary sources.

Because I'm a doctor I'm contractually obliged to unthinkingly underestimate nurses, and in fact she'd already done that. But she still thought it was appropriate to reference my presentation since she felt it had influenced her thinking:

"In some ways it's a grey area as I could solely reference primary sources and the Tutor would be unlikely to question it. But I am definitely borrowing the odd point from your presentation, so best to do the right thing"

TBH I don't think I would have been quite so honourable. I read a lot in articles, blogs, twitter feeds, on the TV, and from friends and colleagues. Sometimes I hear ideas or opinions I like or that persuade me to change my thinking. Some of it is conscious, much unconscious. So, when it comes to writing scholarly work, I tend to reference the primary sources that are at least published if not peer-reviewed too. Even if a blog article or online presentation influenced my thinking, I think I wouldn't reference it unless I was quoting it.

Is this reasonable, or am I being a snob about referencing sources that I don't think of as traditionally 'authoritative'? Would I feel better about referencing an article or book chapter by someone rather than the same person's blog? I think I probably would. And what about sites like wikipedia, which has the advantage of being 'peer reviewed' in some sense?

The debate about referencing wikipedia in scholarly work still has some distance to run, I think. For now, the rule seems to be that you can use wikipedia to learn but shouldn't rely on it as authoritative - and therefore shouldn't reference it directly. I think there's a lot to be said for wikipedia generally, especially if you understand how it works and how to look at the evolution of the article and its related discussions. But no matter how good wikipedia / my slideshare presentations / my blog waffling is, if I'm still sceptical about sticking them in the reference section of my essays, I think it'll be some time before these kinds of resources are widely accepted as reasonable reference points for academic work.

Perhaps this is a shame, but perhaps a conservative attitude to this new medium is wise until theres a widespread and deeper appreciation of how it works, how it can be used and what it adds.

Finally, my web-savvy nursing-student reader signed off with another interesting point. Having reviewed many of the primary sources I'd mentioned in my talk, she did pause for thought at the end of the assignment, reflecting...

"Oh well, I still can't give a patient a urinary catheter, but I read Aristotle today..."

What hath I wrought?

Bait for the MedWeb2Skeptic

Bait for the MedWeb2Skeptic

Gah, @amcunningham beat me to a proper look at this paper on web2 use in medical education. To be fair, I was on night shift at the time, so wasn't really in the right frame of mind to write anything longer than 140chars. Still, feeling quite chuffed that I got in there early with the critique, even if it was a little... concise.

Anyway, there isn't a massive amount to add to Anne-Marie's skewering of this survey-based paper on use of Web2 tools in medical/nursing education - she rightly critiques the low response rate, confusion & conflation of web2 / social media tools, and the authors' rather bold conclusions (subsequently echoed around the twittersphere).

The authors do acknowledge one of the paper's weaknesses when they state:

"...given the small sample size, it is difficult to predict whether the use of Web 2.0 tools portends a growing trend in education or merely represents a passing fad"

But although they note the small sample size, they still accept their findings as significant, albeit perhaps transient. To be honest, in this paper, the future of web2 use in medical education is not 'difficult to predict', it's completely outwith any of the conclusions that could possibly be drawn from the data.

But just a few more points...

1. A survey of web2 usage by medical/nursing institutions by a fairly open-access survey, with a very poor response rate means that any conclusions must be interpreted with a degree of caution. But it's not just the low response rate that sounds a note of caution. One also has to question why those particular people bothered to respond (selection bias). It's easy to hypothesize that survey recipients who'd never heard of Moodle etc would just delete the email, while those who were evangelical about using wikis and youtube would reply in their droves. So the sample biases itself.

2. I think there's two other ways to do this kind of research - either spend some time identifying IT/education leads at medical schools and send them a better-designed survey asking questions about overall web2 tool use in medical school, or survey a large number of medical students from several medical schools with a very short survey to ask what tools they actually use on a regular basis.

3. As Anne-Marie mentioned, the qualitative data isn't mentioned. My guess is that there wasn't very much of it. The question is too broad and vague "please briefly describe how these tools are used in your institution". This makes it difficult to answer (therefore most respondents probably don't bother) and unlikely to identify any common themes, as the responses given are likely to be highly heterogenous. If you've ever tried to get useful qualitative responses from questionnaires, you learn this lesson pretty quickly. I did, and I was doing an MSF in my spare time.

So, having kicked the corpse a bit, what's the real issue here? I think it's this - apart from generating headlines, what use is this kind of research anyway? So 45% of medical/nursing schools use web2 tools. Big woop. Who uses them? What for? How? How often? And most importantly, why? If a web2 tool can deliver a better educational outcome (or an equivalent one more cheaply / easily / quickly) than a conventional teaching method, that's a good thing. But just using web2 education tools isn't important - it's what you do with them that counts.

Teaching Feedback - 'The Intimidator'

Teaching Feedback - 'The Intimidator'

In 7 years as a doctor I think I've filled in a bazillion (approx) work-based assessments for junior doctors (most with contemporaneous structured feedback, some rather pointlessly a week or so later via email). I've handed in a few multi-source-feedback questionairres, and I've probably completed 0.3 bazillion post-lecture feedback forms. Feedback is everywhere in medicine now, and if it's done well it's incredibly useful. If it's done poorly, it's a total waste of time.

In terms of feedback I've received, most of it relates to my skills as a doctor, and very little has been comment on my skills as an educator. And if you don't count the aggregated scores from near-useless lecture feedback forms, I've received almost no feedback about my teaching. In fact, I really don't count those forms - the quantitative questions are so vague they're only useful for comparing yourself to the other speakers in a putative best-speaker competition. There is no specific information from this that can inform self-improvement.

Recently for the MSc in Geriatric Medicine (Teaching/Communication Module) I'm working towards, I completed an assigment on devising a multi-source feedback survey on one aspect of my teaching skills. The process, results and reflection was delivered by means of PowerPoint slides. This is it...

Appraising my Teaching Skills using MSF

View more documents from Colin Mitchell.

Notes:
1. Now, for those of you who don't know me, I'm not the kind of person that thinks of himself as intimidating. I'm a 5'7" geriatrics reg, ex-computer game reviewer, briefly a stand-up comedian. Not that these things define me or negate the possibility that I'm a scary, dastardly figure. But it's not something that's really come up very often, and frankly quite the opposite of my self-image, which is why I decided to explore the issue with my MSF. It seems I can be intimidating, to a few juniors. In fact this shouldn't be such a surprise, really. I've got just over 2 years until I'm a consultant, for many of them I'm 2-3 grades up in the professional hierarchy, I'm the teacher, I've (usually) got more knowledge than them... What do I do about it, though?

2. I don't actually think I'm Pete 'Maverick' Mitchell in Top Gun. But we do share a surname. And a nickname. Not really. But doing an MSF on yourself, about an aspect of your professional identity you're quite proud of is quite a challenge to self-image. That's what I was discussing with these slides.

3. Yes, the PPT slides are a bit wordy. But words mean points mean prizes (for the MSc markers).

4. HT to @nlafferty, who worked on the original DREEM, and pointed me towards the PHEEM (more relevant to F1s generally but less about teaching style, so I ended up using the DREEM as inspiration). The people you meet on Twitter...

Why are Junior Doctors no cleverer than I was?

Why are Junior Doctors no cleverer than I was?

Amongst doctors in training there seems to be little appreciation for the benefits of on-line learning. As a source of information (primarily via google and wikipedia) all but the most luddite seem to appreciate some of the benefits, although the benefits that are most often praised seem to be immediacy and accessibility. Accuracy less so, and not because most doctors know how accurate the information sources they're accessing are, thus give them less weight or learn how to assess, compare and cross reference relevant data - but because unfortunately many don't seem to care. That's fine when you need a two-line summary of a condition in a patient's medical history, but not good enough when on-line information is the backbone of your learning & referencing. Confession - I can't remember the last time I opened a traditional medical textbook to look something up.

The old-fashioned method of trusting a few reputable names (Davidson's, Harrison's, The Lancet, NEJM, Cochrane, the AHA, or even specialized online efforts such as Medscape or Up-to-date etc) isn't going to fly when there is such a huge amount of information available, going far beyond the scope of any of these august institutions. Frankly, appealing to authority rather than assessing sources, data and methodology yourself has never really been good enough either, even before the intertubes. Not to devalue these organs (all worthy in their own right, and still regularly form the backbone of my referencing) but their depth and breadth are already dwarfed by the rest of what's out there on the tubes.

So, we need to teach young doctors how to obtain, interpret, and evaluate data sources from more sources than can ever be pre-emptively approved. They also need to know how to integrate this new learning into their pre-existing knowledge to form new understanding and improve practice. That is, in order to learn and improve practice, they need to self-apply a constructive hierarchy of learning, from finding new information and understanding it, through using and evaluating that knowledge academically, and then applying it to their patients (creativity).


(Simplified version of the Revised Bloom's taxonomy (Anderson & Krathwohl, 2001))

I've talked before about how medical students are exposed to a huge volume of experience but seem to lack the skills or opportunity to assimilate it usefully. The same can be said of junior doctors, only substituting 'teaching' for 'experience'. When I was a junior doctor I got one hour of organized teaching a week at lunchtime, and the occasional attendace at grand round. I was often too busy to make either. Currently, the juniors in my hospital get an afternoon of teaching (An hour of Grand Round and 2.5-3h of specific F1/F2/CMT tutorials). It's bleep free and their wards are covered by on-call staff. So, 2-4x the amount of teaching, and they usually get to it. But knowledge and practice don't seem to be any better (and I am aware of the 'when I was a house officer' fallacy - I don't think they're any worse than I was). But why no better?

Often the methods used in hospital teaching programs try to jump over the intervening stages of learning, firing knowledge at the bemused faces of junior doctors via PowerPoint and expecting that to magically enhance their practice. I've even heard consultants bemoaning the fact that "They were taught this last week!". Not well enough, it would seem. Further, doing this kind of thing for 3 hours is utterly pointless. Even if they remember a few points from the first PowerPoint, they've forgotten them by the end of the third one, and are also apocalyptically bored.

The Plan

So, junior doctors have access to a huge amount of information, but don't know how to use it. They're also given a large amount of teaching time, a lot of which is wasted. I think there's an opportunity here, and I'm currently planning to change some of the junior doctor training at my next Manchester hospital placement to demonstrate it. Details a bit sketchy at the minute, but if things work out, I'll be setting up a (probably Wetpaint-based) VLE / Wiki to assist with the delivery of either the CMT or Foundation curriculum.

Face-to-face teaching will remain the backbone of the program, but with a 30 min introductory lecture rather than 3 hours of PPT-punishment. Then, case discussions (PBL style), followed by wiki-based knowledge sharing, evaluation and synthesis. I'm aware that contributions outside of class time are substantially lower than during, so I'd plan for them to do the majority of the work straight away. Also, since I'm a believer in evaluation-driven learning (but sceptical of how accurately exam scores reflect real skills) I'd expect to use their contributions as a marker of the learning process. So instead of just checking at an appraisal that the doctor has signed in to 70% of teaching sessions, I'd be able to give an indication of exactly how much the doctor has participated - this could even be used as a official learning objective by the educational supervisor.

So, that's the idea. I expect it will change, due to practical constraints, and also because I'm learning about the process of delivering this kind of connectivist program. But for me to be learning alongside those that I'm teaching is really exciting.