Learn more about what treatments are on the rise for plaque psoriasis, the latest management advice and what trends are shaping the future of the disease. 

The changing treatment landscape of plaque psoriasis

 variant known as Omicron has global health officials concerned as scientists race to discover how mutations will impact the transmission and severity of the virus. Here’s what we know.

 officially known as B.1.1.529, was designated a variant of concern on November 26 by the World Health Organization.

The designation was made based on evidence presented to the WHO's Technical Advisory Group on Virus Evolution that Omicron has several mutations that may affect how the variant behaves, ie, the severity of disease it causes, its degree of transmissibility, and the variant's immune escape potential--that is, whether it can bypass protection offered by current COVID-19 vaccines.

Omicron was first identified in South Africa and reported to the WHO on November 24; it has now been detected in Australia, Belgium, Botswana, Britain, Denmark, Germany, Hong Kong, Israel, Italy, the Netherlands, France, Canada, and South Africa. At least 44 countries have imposed travel restrictions from several African countries, 

. Japan and Israel have banned all foreign nationals from entering their countries. Health officials in Canada confirmed the country's first 2 cases in Ottawa on Sunday, November 28.

There have been 50 mutations identified in the B.1.1.529 lineage, the most concerning being more than 30 in the spike protein region, the area that facilitates a virus' entry into the host cell, enhancing its transmissibility as well as the potential for immunoescape.

WHO notes, however, that it is not clear yet whether the variant is more transmissible compared to other recent variants, including Delta. While the number of persons testing positive for Omicron has increased in areas of South Africa where circulation has been identified, studies have been launched to understand if the variant is to blame or if other factors may be implicated.

There are as yet no data to clarify whether Omicron causes more severe disease compared to other variants, and WHO again points to Delta as the primary comparator. “Preliminary data suggest that there are increasing rates of hospitalization in South Africa, but this may be due to increasing overall numbers of people becoming infected, rather than a result of specific infection with Omicron,” states WHO. Nor is there any suggestion that symptoms associated with Omicron infection are different from those seen with currently circulating variants.

 a South African physician who was among the first clinicians to suspect a different strain of the coronavirus among patients he saw said that “the symptoms of the Omicron variant were so far mild and could be treated at home.” The chair of South African Medical Association, also speaking to Reuters, said that no patients so far have reported loss of smell or taste and there has been no major drop in oxygen levels observed.

According to WHO, initial reported infections were among university students who overall tend to have milder infection and symptoms.

Better understanding of both infectivity and transmissibility of Omicron will likely take several weeks, the WHO stressed, as will accruing information on whether the variant can potentially render current vaccinations less effective.

“Work is already under way to look at the immune escape potential of B.1.1.529 in the laboratory setting,” note scientists with South Africa’s National Institute for Communicable Diseases (NICD) in 

. “Based on our understanding of the mutations in this lineage, partial immune escape is likely, but it is likely that vaccines will still offer high levels of protection against hospitalization and death.”

Effectiveness of current tests is currently not in question, according to WHO, as the widely used PCR assays continue to detect infection, including with Omicron. Research is underway to assess any potential impact of the variant on other tests including rapid antigen detection tests. Treatments for COVID-19 also are being assessed for efficacy against Omicron infection but WHO stresses that both corticosteroids and IL-1 receptor antagonists will continue to be effective against severe COVID-19.

In statements to Reuters leaders from both Pfizer-BioNTech and Moderna said virus mutations have been anticipated since the beginning and that the companies are working closely with authorities to process information as soon as it is available.

This was originally posted by our sister publication Medical Economics.

Articles

The Omicron variant of COVID-19 is spreading quickly, jumping continents with infected travelers. Here’s the latest on what global health officials know about it.

Omicron COVID-19 variant: What we know and what we don’t

and joined the MJH Life Sciences team in April 2021. She graduated from Kent State University in 2018 with a bachelor's degree in journalism and a minor in sociology. Linda used to work as a creative writer for 

 and was a technical writer/regulatory specialist/purchasing agent at GM Industrial before coming on to the team. She enjoys reading, traveling, and learning new perspectives. You can reach her at 

Galderma, the world’s largest independent dermatology company, announced that it has signed a definitive agreement to acquire Alastin Skincare, Inc., a specialty aesthetics company dedicated to developing innovative and clinically-tested physician-dispensed skincare products, 

 The acquisition is subject to customary closing conditions and necessary regulatory approvals and the financial terms have not been disclosed.

Alastin was founded in 2015. It features both daily and per-procedural use skincare products that are backed by its TriHex Technology. TriHex Technology is a blend of peptides and active botanicals to support the appearance of rejuvenated skin, according to the release.

Alastin has achieved rapid and consistent sales growth, achieving a CAGR of 106% between 2016 and 2020. Its skincare was ranked the most preferred skincare brand in a blinded survey of physicians who carry Alastin and other skincare brands, conducted by Corsica Life Sciences in December 2020, the press release continued. 

The company was named as one of Forbes best start-up employers in America in 2020 and 2021 and was named as one of the fastest growing private companies in America on the INC 5000 2020 and 2021 lists.

"Galderma’s business consistently delivers strong results and remains at the forefront of this rapidly expanding market, driven by increasing consumer interest and acceptance of aesthetic procedures,” Flemming Ørnskov, MD, MPH, CEO of Galderma, said. “The addition of Alastin, with its synergistic portfolio and expertise in science-proven skincare, increases our ability to serve the needs of consumers and underscores our commitment to be the partner of choice for aesthetic professionals.”

He continued. “This transaction will further enhance our premium product offering and provides a tremendous platform for future growth. We look forward to welcoming the Alastin team into Galderma and partnering with them to advance the science of dermatology together.” 

Galderma plans to leverage its global reach and integrated dermatology platform to promote Alastin’s continued growth and reach more healthcare professionals and consumers more effectively, the release further explained. 

Also, Galderma will support further product innovation of Alastin’s portfolio, while simultaneously enabling cross-selling opportunities for Alastin’s products and technologies in the US. Effectively combining Galderma’s pipeline and track record of first-to-market innovation with Alastin’s proprietary and award-winning skin care technology represents an unparalleled opportunity for Galderma to better meet the needs of aesthetic professionals and patients. 

"We are thrilled to become part of Galderma for the next stage of Alastin’s growth story. We share the same vision of bringing the highest levels of science and innovation to the professional skin care market, and I look forward to working with the team to leverage Galderma’s expertise in this space to drive the Alastin Skincare brand to new heights,” said Diane S. Goostree, president and CEO of Alastin Skincare. 

Ropes & Gray LLP is acting as legal advisor to Galderma, and Latham & Watkins LLP is acting as legal advisor to Alastin. William Blair & Company, LLC is serving as the exclusive financial advisor to Alastin.

Galderma to acquire award-winning Alastin Skincare enhancing its integrated dermatology platform to continue delivering the best experience to patients. Press release. Published November 29, 2021. Accessed November 29, 2021. 

https://www.businesswire.com/news/home/20211129005282/en/Galderma-to-Acquire-Award-winning-ALASTIN-Skincare%C2%AE-Enhancing-Its-Integrated-Dermatology-Platform-to-Continue-Delivering-the-Best-Experience-to-Patients

Galderma announced it has signed a definitive agreement to acquire ALASTIN Skincare.


Galderma to Acquire ALASTIN Skincare

Dustin Portela, DO, a board-certified dermatologist and dermatologic surgeon at Treasure Valley Dermatology in Boise, Idaho.

Dustin Portela, DO, a board-certified dermatologist and dermatologic surgeon at Treasure Valley Dermatology in Boise, Idaho, explains sugaring for hair removal. It is a treatment where warm sugar instead of wax is applied to the skin and then stripped. He tells his audience whether or not he approves of this type of hair removal.

Opinions expressed are that of Portela and do not express the views or opinions of Dermatology Times®.

Videos

In this week’s Pointers with Dr Portela, the 208SkinDoc undergoes sugaring for hair removal. 

Pointers with Dr Portela: Sugaring for Hair Removal

James Del Rosso, DO, dermatologist at the Las Vegas Skin and Cancer Clinics and research director and principal investigator of JDR Dermatology Research in Nevada, sits down with 

to highlight the in practice concerns many have when dealing with JAK Inhibitors. 

In this video interview, James Del Rosso, DO, tackles the clinical impact of JAK Inhibitors and how to deal with patient concern. 

Clinical Implications of JAK Inhibitors

I’m glad, Bill, that you mentioned diagnosis because I think we’re delving right into that. If you don’t mind, I’d love to get your pearls on diagnostic steps. What do you do when you approach a patient with a different skin type, for example? Or testing, how do you talk to the patient? You’re in the examination room, give us some practical sound bites on what you like to do to work these people up.

: Thanks for the question. I think physical examination really remains the backbone of diagnosis in vitiligo. I think for the vast majority of patients, a careful physical examination by preferably a board-certified dermatologist, but certainly someone with experience in the area, is ideal. What we look for in vitiligo is complete pigment loss, what we call depigmentation. It’s an important distinction to make from hypopigmentation, which is the relative loss of skin color but not the complete loss of skin color. In vitiligo, in the vast majority of patients, we see depigmentation. If we see hypopigmentation, the differential diagnosis is a little different, so really making that distinction is important. A really handy tool that dermatologists commonly use to examine patients where vitiligo is a consideration is something called the Wood’s lamp examination. Wood’s lamp is basically a black light, and what it does is, it helps to accentuate areas of true depigmentation. If the skin has lost all of its melanin content, all of its normal pigment content, it becomes quite apparent under a Wood’s lamp examination. And that becomes particularly important to patients with lighter skin because oftentimes, vitiligo can be unapparent in patients with lighter skin. Oftentimes, under Wood’s lamp examination, we’ll identify vitiligo lesions the patient wasn’t even aware of. I think, really, especially early on, a Wood’s lamp is important, and you should expect your dermatologist to be taking that out to examine you.

: I love the Wood’s lamp. I use it all day long. It’s my workhorse. It also, I think, to your point, gives the patient a sense that you’re actually looking and you’re taking the time to delve in instead of just saying, “Oh, that’s a white spot, it’s vitiligo.” We don’t want a patient with vitiligo to ever leave our offices thinking they have no hope. It’s upsetting sometimes to see patients feel that hopelessness because there is hope. There are things we can do to make it better. Most importantly, there are things that are on the horizon. Speaking of hope, though, that brings me to a question that you segued to well. What do you think is theawareness factor among primary care physicians or the medical community or even among dermatologists who don’t treat a lot of pigment diseases about vitiligo? Why do you think we’re starting to talk about it more, which of course, I am so happy about, but what are your thoughts?

: I think it’s really an exciting time in vitiligo. Of course, it’s potentially a devastating disease, and it is really difficult to have, but there is some light. I think that light comes from new research that’s helping us to understand disease pathogenesis at a better level, that research bearing out into pathogenesis-directed therapies, and those pathogenesis-directed therapies actually being incorporated into large controlled clinical trials where we can really evaluate efficacy. Although we still don’t have an FDA-approved repigmenting agent in vitiligo, I think it may be on the horizon. So there’s really a lot of excitement. In terms of awareness, I think this is a critical question, and I appreciate you asking it because I think that there is the recognition of vitiligo. Certainly, dermatologists know vitiligo and most know it well. Among primary care, although they may recognize vitiligo, I think the message is that it needs to be taken seriously and that it’s not a cosmetic disorder. As you explained so eloquently, it’s a medical disorder and it shouldn’t be dismissed in patients who want to be treated, which is probably the vast majority, and they should be referred to someone who can treat them. I think, really, it’s that message: take it seriously, listen to what the patient wants, and if the patient is interested in pursuing treatment, they should have that opportunity.

I think, to tie into that, one of the things that I share when I speak about vitiligo at meetings and conferences and platforms like this, the earlier we can treat the patient, the better. There are data to support the fact that the longer the depigmentation has persisted in that area of the skin, the less likely those melanocytes that are hiding in the bulge part of the hair follicle, which is where we think they repopulate from, are going to be there. That continued oxidative stress and that CD8 T-cell–mediated damage for persistent depigmented patches is a challenge. I think one of the messages is we need to educate like we’re doing today and like we’ve done in other sessions, that we want to see the patients sooner, faster, and treat them more aggressively so that repigmentation can happen faster, you can stabilize these patients better, and then maintain their outcomes. I think if you treat them earlier, you start to notice that repigmentation faster, and that itself leads to better compliance and adherence to treatment. Certainly, that’s a goal of therapy when I see my patients.

: If patients are getting better and the disease is being taken seriously and being treated aggressively if it’s appropriate, I think patients are more willing to be compliant with therapy. I think it’s so important.

Expert perspectives on the diagnosis of vitiligo and considerations for improving provider awareness in dermatologist and community settings.

Diagnosing Vitiligo and Improving Care Provider Awareness

POLL: Are Pre- Pro- Post- biotics Effective for Skin Care?

What's Trending in Skin Care? November 2021

Each month, Dermatology Times® features a roundup of products trending in skin care. Click here to find out what products are trending for the month of November.

Vitiligo: Clinical Presentations and Classifications

A comprehensive breakdown of the different classifications of vitiligo and how these may present clinically.

In this video interview, James Del Rosso, DO, tackles the clinical impact of JAK Inhibitors and how to deal with patient concern.

In this week’s Pointers with Dr Portela, the 208SkinDoc undergoes sugaring for hair removal.

Galderma announced it has signed a definitive agreement acquire ALASTIN Skincare.

The Cutaneous Connection- Episode 35: QRPs and the Dermatology Practice

In this week's podcast, we sit down with from the OJM Group to discuss qualified retirement plans and how dermatology practices may be able to save money.

Meet the Aesthetic Expert with Dr. Will Kirby: José Raúl Montes, MD, FACS, FACCS

In this month’s “Meet the Aesthetic Expert” column, Will Kirby, DO, FAOCD, talks with José Raúl Montes, MD, FACS, FACCS, a board-certified Oculoplastic surgeon and established injector, researcher, speaker, and trainer. They speak about his aesthetics journey, the changing aesthetic patient, and the future of the field.

COVID-19 and malpractice lawsuits: What the future may hold

COVID-19 is prompting significant changes to malpractice laws and regulations at the state and federal levels.

Looking at the scalp and nails during a skin exam is key

A presentation from the 2021 virtual American Academy of Pediatrics Conference & Exhibition urges including examination of the scalp and nails during any skin exam.

ICYMI, some of this week’s featured content includes an exclusive interview about the clinical implications of JAK inhibitors, and articles on trending skincare, Galderma, and more.

Weekly Roundup: November 29- December 3

“Examination of the scalp and nails is an important part of any skin exam,” noted Sheilagh M. Maguiness, MD, associate professor of dermatology and pediatrics at the University of Minnesota in Minnesota at her session, “Common Hair and Nail Conditions in Children.”

Maguiness described a case of tinea capitis, a common fungal infection of the scalp in children. Swollen lymph nodes in the neck (cervical lymphadenopathy) often signal this condition. Confirm diagnosis with a fungal culture prior to treatment, she said, especially because of the “long duration of oral antifungal therapy…up to 4 to 8 weeks, depending on the agent.”

Maguiness also reviewed longitudinal melanonychia, which she described as “brown to black pigmented longitudinal bands in the nail plate [caused by] melanocyte hyperplasia or increased melanin production,” common in African American and Asian children but rare in Caucasians.

Maguiness also discussed congenital malalignment of the great toenails and psoriatic nails, which can cause pitting, onycholysis, and subungual hyperkeratosis. “When children have psoriasis, about 15% to 20% will also have nail findings,” she said.

When it comes to head lice, Maguiness advised practitioners to check the postauricular areas and nape of the neck. “That’s where the nits like to group,” Maguiness said. She outlined available treatments, OTC topicals such as permethrin and pyrethrins, prescription drugs such as topical and oral ivermectin, and topical spinosad.

Maguiness ended with this advice: review dose and duration of therapy for oral antifungal agents to treat tinea capitis; perform a fungal culture of the scalp to help diagnose tinea capitis; and know how to distinguish between several common nail disorders in children

This article was originally posted by our sister publication Contemporary Pediatrics. 

Since COVID-19 arrived in the United States, health care providers have been working tirelessly to address every aspect of the pandemic. The public saw how frontline workers were making sacrifices day in and day out to keep as many people healthy as possible. But even as the media focused on this heroic work, behind the scenes COVID-19 was prompting significant changes to malpractice laws and regulations at the state and federal levels.

Providers should be aware of what has happened and of the changes that may occur in coming months and years.

At medical malpractice insurer EmPRO, we have been keeping a close eye on the pandemic because global health events have the potential to expose both insured clients and insurers alike to staggering liabilities. Thankfully in New York state, where EmPRO is headquartered, the governor and the legislature moved swiftly to enact emergency measures that shielded health care professionals from the worst liabilities. Had they not done so, the pandemic had the potential to lead to the proposal of new, more stringent regulations and policies, which in turn could have resulted in increased premiums.

New York was hit incredibly hard with COVID-19 cases right from the start, with the first confirmed case on March 1, 2020. The legislature and the governor produced the Emergency Disaster Treatment Protection Act (EDTPA), which extended broad immunity to health care providers and facilities.

Around the state, hospitals filled with patients with COVID-19 had to bring in nurses from out of state, bring health care providers out of retirement, build temporary facilities to provide COVID-19 care and enlist doctors, nurses, physician assistants and others to provide services out of title — meaning outside their usual purview of care.

The EDTPA granted them immunity from liability in the diagnosis and treatment of patients with COVID-19, as well as other patients whose treatment was affected by a facility’s response to the pandemic. Before doctors knew precisely how to care for patients with COVID-19, many frontline health care providers had reasonable concerns that experimental treatments could not only expose them to the disease but also lawsuits. The EDTPA helped alleviate those fears.

Medical malpractice attorney Tom Benvenuto, J.D., of Benvenuto & Slattery says this was a critical decision that empowered health care providers to make every effort to save patients without fear of legal action. “The immunity the EDTPA provided to New York health care professionals was essential to the state’s response and handling of the pandemic because it enabled physicians to pursue necessary measures to care for patients that may have otherwise been construed as extraordinary under otherwise normal circumstances,” he said.

The federal government issued its own legislation on protections for frontline workers, facilities and even personal protective equipment (PPE). The Public Readiness and Emergency Preparedness (PREP) Act provides liability immunity related to the manufacture, testing, development and — importantly for medical providers — use of medical countermeasures against pandemics and other public health emergencies.

Essentially, the government extended liability protection to medical equipment and PPE manufacturers. With this protection in place, manufacturers such as General Motors, Ford, Fitbit and Procter & Gamble were able to quickly launch production lines or repurpose existing ones to make medical equipment such as respirators, ventilators, face shields and masks.

The PREP Act also covered health care facilities that were using these countermeasures. For example, in the event of a PPE shortage — as was seen across the country due to a global shortage — a facility may invoke the immunity from liability if a patient claimed that they contracted COVID-19 at that facility while the facility was reallocating what PPE they had available to them.

In the midst of the pandemic, medical malpractice insurers and the attorneys working with them began planning for a potential tidal wave of lawsuits related to COVID-19, given the potential for morbidity that the diagnosis carried for a significant portion of the population. This would have put a tremendous strain on insurers across the country.

However, the industry so far has seen relatively few cases. In fact, medical malpractice lawsuit filings were down during the pandemic. This was due, in part, to many states implementing a hiatus on filing lawsuits when lockdown restrictions began. Because there are statutes of limitations on filing cases, there may be more COVID-19-based lawsuit filings when those statutes approach their expiration dates. Plaintiffs may file cases in order to buy time hoping that there will be a change in how the courts interpret and apply the immunities. However, in many cases, this situation is still more than a year away.

In August 2020, when New York’s infection rate was less than 1%, the legislature reduced the scope of the EDTPA to cover only patients with COVID-19, eliminating those tangentially affected by a facility’s COVID-19 care for others. Furthermore, the statute was repealed, thereby ending the immunity for providers treating patients with COVID-19 after April 6, 2021. New York has returned to business as usual for malpractice regulations.

Although it has been amended a number of times, the federal PREP Act is still in place, and malpractice insurers, courts and health care professionals are paying close attention to any potential legal aftershocks.

According to Benvenuto, the industry must keep a close watch on how federal courts approach challenges to PREP Act immunities that may be filed. “Although the immunities appear to be ironclad, and cases would likely be dismissed by the court in light of same, any suit that survives an initial motion to dismiss could provide plaintiffs in each state a playbook to filing and maintaining a similar case,” he said.

In the end, the COVID-19 pandemic did not bring about a sea change in medical malpractice regulations or policies. States expanded immunities where and when they had to, and when conditions improved enough to remove those exemptions, it appears most states have gone back to what worked before. Fortunately, this means premiums have not seen a “COVID-19 spike,” but it remains to be seen if this will hold in the future, especially if the Delta variant or another variant proves lasting or if a new pandemic emerges.

Bruce C. Shulan is president and CEO of EmPRO. For more than 30 years, he has served as a senior executive, board member, consultant and attorney to the insurance industry.

This article was originally published by our sister publication Medical Economics.

Will Kirby, DO, FAOCD, is a contributing author for Dermatology Times and Aesthetic Authority, as well as chief medical officer at LaserAway.

Welcome to “Meet the Aesthetic Expert,” where, each month, dermatologist 

, of LaserAway, will connect with select industry leaders to get their expert opinion on the aesthetic specialty. With an emphasis on straightforward, candid questions, Kirby will focus on the best in aesthetics and get the experts’ frank thoughts on where the field is headed.

 is board-certified oculoplastic surgeon in both the United States and Puerto Rico. He is a Fellow of the American Academy of Cosmetic Surgery (AACS), American Academy of Ophthalmology (AAO), American College of Surgeons (ACS), and American Society of Ophthalmic Plastic & Reconstructive Surgery (ASOPRS). Also, Montes is a member of American College of Surgeons Association (ACSA), Colegio de Médicos Cirujanos de Puerto Rico, PanAmerican Association of Ophthalmology, and Puerto Rico Society of Ophthalmology, as well as an honorary affiliate of the American Society for Dermatologic Surgery (ASDS).

With more than 25 years of experience in the field and a member of various pharmaceutical advisory boards, Montes has overseen the process of introducing new products for FDA approval. He is an established top injector, author, researcher, speaker, and trainer with numerous publications in medical journals and contributions in medical books.

In addition to having a successful practice—which doubles as a research and training center—in San Juan, Puerto Rico, in his role as a professor at the University of Puerto Rico School of Medicine, Montes serves as a mentor to medical residents at the Río Piedras Medical Center.

 Dr Montes! Thanks for agreeing to this interview. Tell me, what led you down an aesthetic career path?

 As an ophthalmology resident, I had the opportunity to treat patients that had eye movement disorders with Botox as early as 1990. After my ophthalmology graduation, I went to the University of Cincinnati to pursue a fellowship in oculoplastic surgery. At my fellowship program, we were using Botox to treat not only blepharospasms patients, but also cosmetic patients in an off-label manner. When I returned to Puerto Rico around 1994 to start practicing, I was already an experienced Botox injector.

In the beginning, my idea was to have a functional practice in oculoplastics, eyelid surgical procedures, orbital tumors, lacrimal pathology, trauma, and reconstructive surgery for cancer patients. However, after having a small clinic of Botox injections for blepharospasms patients, I began to treat patients for cosmetic reasons. Then, I quickly experienced an unexpected growth in my practice of patients seeking Botox cosmetic injections and referring other patients. If there is one thing to which I have to give credit for changing my life and shifting my practice focus was the advent and approval of Botox.

 If you could do it all over again, what would you do differently?

 I believe that the best advice I have received is to always try to find procedures that you like performing. After all, people should have fun as much as possible at work. Instead of trying to establish a buffet practice which might have a little bit of everything, why not take the approach of having a boutique practice wherein you may offer fewer things and be the best in those?

 With so much confusion in the industry, where do you go for trusted aesthetic information?

 This is a tough question because, regrettably, in this industry for many people the focus is mostly about sales. In my case, I go directly to my peers, especially those who I trust and consider friends.

 What aesthetic patient demographic do you believe is the most coveted? Has this always been the case? Is this shifting?

 I think that nowadays, due to the boom on social media, especially Instagram, TikTok, etc., young providers in the cosmetic industry are looking more into the millennial and the younger patient population. I, on the other hand, have been in practice for over 25-years, so definitely my patient population is more baby boomers, whom I think are the core of my practice. 

Nevertheless, I foresee this shifting as we are now seeing a younger cohort of patients and more men coming into our practices.

 What aesthetic patient population is the most challenging and why?

 I think that the most challenging population is defined by the provider’s age group. For instance, providers like myself being a baby boomer, tend to believe that baby boomers are easier patients than young patients like millennials. I think that the younger patients nowadays are more challenging, not just because they are more demanding, but they have more information shaped by social media, which may not necessarily be accurate or true. Therefore, we have to demystify a preconceived idea of treatment aspirations for their cosmetic journey. For me, that is challenging.

 Is telehealth here to stay? What role will it have in aesthetics moving forward?

 I personally do not do telehealth. I do not think that it has a place in my practice, so moving forward I think that nothing will replace the in-person assessment, diagnosis, and interaction with patents.

 Very interesting. What will the aesthetic industry look like 10 years from now?

 Well, if I knew the answer to this, I would apply to a CEO position in the industry! I would love to think that 10 years from now, the fillers and neurotoxins market will grow. Also, I believe the typical patient will no longer be a middle-aged Caucasian female, instead it will expand into a more diverse population. I contemplate injectables—especially neurotoxins and fillers—will be a commodity and there will be competition for prices. With the rise in people offering these procedures, cost will definitely be an important consideration for providers as they try to attract patients as well.

 What can the industry do to increase diversity and inclusion?

 To increase diversity and inclusion, first, it is necessary to ensure that the systems responsible for the education of practitioners (ie, universities offering dermatology, ophthalmology, plastic surgery and facial plastic surgery programs), have a more diverse student population in their programs. Second, if an increase in the industry for a more diverse population is to be made, marketing efforts should be directed to that group of patients, in terms of ethinicity and gender. In addition, the industry should be more inclusive in clinical trials, bringing in principal investigators who represent other ethnicities. Likewise, clinical trials should be comprised of patients of all skin types, ethnicities, and genders.

 That’s a great call out. What changes would you like to see take place in the aesthetic industry?

 I would definitely like to see a big advancement or innovation. I think that, after Botox, there has not been anything that compares to it, in terms of the way it has transformed our lives, practices, and industry. We need another big invention in this industry. Also, I would like to see a change in the way the meetings are conducted. Educational meetings for providers should be more practical in terms of content. Usually, speakers are selected for what they are able to say on behalf of industries, but not necessarily freely and openly on their bona fide experience with patients. We need more honesty in the meetings and in the podium from our peers and colleagues. I would like to see an expansion in the aesthetic industry.

 What advice do you have for aesthetic providers to avoid ‘burnout’?

 There are many things you can do to avoid burnout. First, have your priorities very clear. For example, in life, for me my ranking is family first, friends and personal relationships are second. Work is important, but it does not have to be the single most important thing in your life.

There has to a balance in your life. Therefore, advice that I would give upcoming aesthetic providers is to avoid getting involved in the social media frenzy, which might put unnecessarily pressure on them. They should focus on their practice and not that of others. Otherwise, you will never be happy if you are paying attention to what is being showcased in social media and what others are claiming they are doing.

 Ready for the toughest question that one wants to answer? What can a top expert with your credentials reasonably expect to earn?

 I think that someone with my credentials should expect to earn enough to have freedom to travel the world, do creative things, and share those experiences with loved ones.

 What is your biggest operational hurdle and what could be done to fix it?

 At the moment, I think that my biggest operational hurdle is that I have yet to transition to a good perfectly fitted electronic record for my practice. I still have not found the most adequate one. In addition, social media demand is time-consuming, yet necessary for our practices in this new era of technology. However, I am considering hiring someone to handle my social media platforms, because I do not want to do it; it is not my preference or as they say, ‘not my cup of tea’.

 If you weren’t an aesthetic expert, what would you do for a living?

 I would have been a doctor in probably any other field in which I am interested. I love science, medicine, dealing with patients, and, above all, I love being my own boss. Thus, this is the profession for me.

 What is your personal favorite aesthetic treatment to implement?

 I love injecting Sculptra, because is like sculpting a face. Also, I like to do combination treatments of injectables. I think the power of injectables (fillers and neurotoxins) well-chosen in the right patient are great. I also like to do periocular surgeries. I do not think there is anything that has the power of transforming someone more than upper eyelid, lower eyelid, blepharoplasty, or eyelid surgical procedures.

 What is your favorite quote (mantra, etc.) that is applicable to the aesthetic industry?

 Definitely, my favorite quote is, “You are what you do every day.” That applies not only to providers, but also to patients. There are so many people looking to better themselves, their physique, and more, but they do not understand that this is a philosophy, a way of living. If you want to look good, you have to invest in yourself on a daily basis, not just with a visit to a provider. For peers and practices, it is the same way. if you want to become an expert, a trusted successful KOL, it is necessary to be consistent, focus on what you do daily, and always bring the best version of yourself, with an artistic eye and demeanor.

 What advice do you have for someone not in the industry who wants to enter the field of aesthetics?

 I can say that as a professor and mentor, I tell my students that this is a great industry, a great field, but to be successful, it is necessary to have a thorough well-rounded education and knowledge. Talent is also necessary to excel in a field such as this one. You need an artistic sense for beauty. Without that, you could be a successful provider, but probably not a top provider.

 As an expert in the aesthetic industry, people look to you to lead. If you could inspire a movement in our industry, what would it be?

 Honestly, the movement I would love to inspire and move forward would be to avoid making people look weird and avoid making people all look the same. I would actually put a break on this proliferation of inciting people to get so many injectables and discourage the very young patient population to embark into a journey of injectables. I think that some of our peers, and probably the industry itself, are pushing or trying to expand the market at the expense of bringing very young patients that do not need injectables at such a young age. I would be a deterrent to this proliferation of craziness of looking weird so young.

 How can readers get more aesthetic expert information from you?

 I would love to have reactions, comments, questions of the few things that I shared with you through this interview. I want to thank my friend and colleague, Dr Will Kirby, for this opportunity. I invite all of you to reach out to me, preferably via my Instagram account: @jrmontesmd or email: jrmontes@jrmontes.com. I am very good at responding to questions or emails I receive!

Podcasts

In this week's podcast, we sit down with from the OJM Group to discuss qualified retirement plans and how dermatology practices may be able to save money. 