There's a New Yorker article detailing the commencement address Atul Gawande Atul Gawande delivered this commencement address, titled “Money,” to the graduates of the University of Chicago Pritzker School of Medicine. It expands on the themes he touched on in his recent article about health-care costs in McAllen, Texas, which figured in President Obama’s speech on health care.
The text of this speech is available in this Medical Spa MD: best medical spas?
The political aspects of health care reform march on.
Not every doctor is qualified to perform every procedure. Do you really want to turn your body over to someone who doesn’t really know what they’re doing? Here are five questions you should ask before you get a cosmetic tweak from a doctor working outside of her specialty.
How many times have you done this procedure?
Ideally, you should hear “hundreds” or “thousands,” not “dozens” or something vague like “more than I can count.” Also ask the doc how long she’s been doing the procedure (less than a year means there’s still a learning curve) and how many times a week she does it (too few times a week means she’s less likely to have fresh product or offer you free touch-ups if you aren’t happy).
Do you own or rent your laser?
Renting may be a tip-off that the doctor isn’t doing the procedure often enough to make owning worth it. Rented lasers aren’t always calibrated correctly, which could mean an increased chance of a burn. Also, not every laser is suitable for every skin type, so be wary of the physician who has only one. Ask about the number of fillers being offered, too.
What muscle causes the lid to droop?
If a doctor can tell you it’s the levator muscle, then he probably knows enough facial anatomy to avoid or fix this problem that can result from a poorly placed Botox injection.
How did you learn how to do this procedure?
If the answer is, “I took courses,” ask: Who taught them? How long did they last? Look for the MD who has completed multiple courses and takes continuing-ed classes in the field. If she trained with a top plastic surgeon, ask, “How did you find time for that?” She may let it slip that the training only took one afternoon.
Will you be the one doing the procedure?
It doesn’t matter how many hours of training your gyno has in fillers if his assistant is the one shooting you up. If something goes wrong, you want to know that the med school grad is right there to manage the complications. Remember: You’re paying for the expertise of the best-trained person in that practice.
Of course you'll want to be somewhat circumspect when asking all of theses questions. You don't want an angry plastic surgeon performing your liposuction or boob job.
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Photos: Above, recent online photos of Rachel Uchitel. (Photos courtesy of Gala.de and TheImproper.com) Below, Rachel Uchitel yesterday in Los Angeles. (AP photo)
Plastic surgeons and celebrity watchers gave party hostess Rachel Uchitel a once-over as soon as the tabloids thrust her into the spotlight last week as the alleged mistress of golfing great Tiger Woods.
She flatly denies the allegation, but Uchitel’s photos on the Web have provided evidence for cosmetic doctors to analyze. For example, plastic surgeon and blogger Dr. John Di Saia of San Clemente and Huntington Beach wrote:
[Her photos] show her to be an attractive woman who has probably seen the inside of a plastic surgeon’s office before. She seems to have had breast implants at the least from the images we have seen.
The online Plastic Surgery Channel commented on the uncertainties surrounding Uchitel:
Her lips do suggest lip injections, and her chest suggests breast augmentation. Uchitel would likely deny rumors of plastic surgery, just as she has denied other rumors. But, in all cases, she may be telling the truth.
The Talk Surgery site went far beyond what the photographic evidence supports when it called her a “Surgery Diva.”
More of this tragedy playing out today.
Argentine model dies after plastic surgery:London, England (CNN) -- Following the death of a former Miss Argentina after complications arising from plastic surgery, questions are being raised about the risks of cosmetic surgery.
Solange Magnano, 37, died in hospital, after being transferred from a clinic where she underwent an elective surgery on her buttocks last Wednesday.
Nigel Mercer, president of the British Association of Aesthetic Plastic Surgeons, last month described the cosmetic surgery industry an "unregulated mess" in the journal Clinical Risk.
Following revelations of Magnano's death, he told CNN, "Unfortunately, the things we're saying about this type of surgery keep being proven right by people having major disasters."
Magnano is reported to have died from a pulmonary embolism, a blockage of the blood supply to lungs.
It is currently not known if Magnano's death was a result of her surgery and there is no suggestion that it came about through surgical error, but there are risks associated with buttock-enhancement surgery.
Mercer said Magnano may have had a solid implant in her buttocks, a relatively low-risk procedure, but he said it's possible that she had liquid silicone injected into her buttocks -- a "highly unpleasant" procedure that is banned in most countries. An alternative would have been to extract fat from another part of her body using liposuction, and then inject the fat into the buttocks.
"With a pulmonary embolism something blocks blood supply to the lungs and circulation literally stops dead," Mercer told CNN.
"The lump in the lungs can be stuff you've injected into the patient -- their own fat or a lump of silicone -- or it can be clots from leg veins as a result of deep vein thrombosis (DVT)."
While DVT is not common with cosmetic surgery, Mercer said that operations on the pelvis, buttocks and legs carry a much higher risk of causing the condition.
"No cosmetic surgery is totally risk free," Mercer told CNN. "Even having botox and fillers is not risk free. There's a chance of infection, bruising or bleeding with any procedure."
via cnn.com
The result is sometimes a tragedy, like the death of Solance Magnano, a former Miss Argentina.
From a news story.
38-year-old former Miss Argentina Solange Magnano died after complications arising from plastic surgery on her buttocks.
Solange Magnano, the 1994 winner and a mother of 8-year-old twins, died of pulmonary embolism Sunday three days after having a gluteoplasty, a procedure that involves placing implants to enhance firmness. News of her death shocked her fans. The cause of her death was under investigation, the authorities said. Officials said the injected liquid went into her lungs and brain.
In the past half decade, the number of people seeking plastic surgery in Argentina has soared by 60 percent, to around 50,000. Estimates say that 1 in 30 Argentines has gone under the knife, making plastic surgeons in Argentina some of the most experienced on the globe, attracting large number of medical tourists.
Medical tourism in Argentina has seen a huge jump over the past decade, and is projected to be a 100 billion dollar global industry by 2010, according to the Deloitte Center for Health Solutions, a U.S. research center focused on trends in the health care system.
What a tremendous waste. Perhaps the worst quote of the story is that the 'injected liquid went into her lungs and brain'.
Dr. Ricardo Rodriguez is a Yale trained, board certified plastic surgeon specializing in multiple procedure makeovers. He performs unique procedures such as the body lift, Brazilian butt lift, stem cell facelift, endoscopic brow lift, and lip lift. He is Medical Director of his own AAAASF accredited surgery center in Baltimore, Maryland.
The following is from a string of emails that were circulating among some of Medical Spa MDs Members. I've edited this somewhat to make it readable and get rid of all the extraneous copies. I'm also not displaying the identity or email addresses of the physicians in this thread.
Note: Some of the comments below might be out of order from the original thread. Emails' somewhat difficult to follow as a thread but you'll get the gist.
1. When I use the "push ahead" technique, I feel that I get better "plumping" per cc of filler. I learned this from Kevin (thanks Kevin).2. When I use the "push ahead" technique, the filler fills a few millimeters in front of the needle tip. You need to realize this to be able to put the material exactly where you want it. Sometimes you have to "feel" the injection because you can't "see" the plumping.3. I mix 0.1 cc of lidocaine with epinephrine with my Juvederm. This helps with bruising (epinephrine) and when the lidocaine goes away and the Juvederm attracts water, the two effects cancel each other and there is not as much enhancement after the injection due to the hydrophilic nature of the Juvederm.4. I use Juvederm Ultra under the eye and above the lip. I use Juvederm UltraPlus everywhere else.5. I constantly complain to my Juvederm Rep about the 0.8 cc syringes. I use lots of Radiesse because you get almost twice as much material for the same price. Volume, volume, volume. Please complain to your rep, maybe we can get them to change.6. I hear the Evolence is very good. We will be getting trained and start using it next month.
Thanks for the filler tips.Can you explain how you get the Lido with epi mixed into the Juvederm syringe? --PD
Fluid Dispensing Connector from Braun Medical Inc (you can get from PSS)BD 1 ml Luer-Lok SyringeThis syringe allows you to get very precise amount of lidocaine (swish back and forth 20 times).I use this syringe to put exaclty 1 cc of saline in my Botox Bottle. When I reconstitute the Botox (this gives it full strength per unit). The chances of intravascular injection might be lower with push ahead because the material will push the vessels out of the way as you advance -- Jeff
Hi Jeff,--I agree w/ #6. I seem to get good augmentation, less redness, swelling and bruising with Evolence. I use it for deeper fills in cheeks, NLF, etc. Don't use it for lips or under eyes. I do same with Lido w/ epi. I tend to use Juvederm in lips. Perlane / Restylane for other areas. I agree w/ why Allergan uses 0.8 cc syringes. I've moved away from Radiesse. I feel that the duration is not that much longer than a good correction with the HA's. Besides, I believe a fair amount of the volume of Radiesse is a gel carrier, thus needing touch-ups at 2-3 months. Perhaps that's why the went to the larger syringes? -- Don
The push ahead technique also moves small blood vessels out of the way, so you may notice less ecchymosis is overall pts. -- Greg
Jeff: --"Push ahead" has a higher risk of vessel cannulation & potential for vascular effects - skin necrosis in glabella, even potential for retro-grade flow to eye (causing visual loss). I wouldn't recommend that technique for the periorbital area.
Restylane is recommended for the tear troughs; it's less hydrophilic than juvederm - which means less post-treatment swelling.--Tom -- [note from Jeff: Tom is a plastic surgeon]
I would not use push ahead around the eye, I agree with Tom's comments. It works great for NLF. I was actually taught this by a PS -- Greg
Thanks Jeff for your kind comments. However I must make a few points in regards to fillers:1) There are some areas that one has to still do the retrograde injection either b/c the purpose was to make a straight line (eyebrow lift and vermillion border and the bow-tie (the vertical lines connecting the base of nose and the upper lip border) AND when injecting the most inner 1/3 of the tear-trough to avoid risk of filler getting into the orbital space due to its close proximity to the orbital rim.2) On the glabellar injection, it is best to first push and pull the needle thru the space underneath to break up the tissue before actually injecting the filler both in an anterograde and retrograde pattern3) I ONLY use the 1/2 inch needles in all my injections4) One can inject even Radiesse and/or Perlane via an 1/2 inch 30 gage needle. Why is this noteworthy to mention?? When I work on the lips and Marrionette's lines, I ususally first build the Vermillion border with Radiesse or Perlane (I get the best "lifting outcome" with heavier filler). I push the 1/2inch needle all the way forward then slowly and steadily inject while withdrawing (retrograde method). Then I re-evaluate how much of a correction I already get of the Marrionette' line and lifting up of the lip body. My next step is to inject into the most lateral lip section (about 1 cm distance) starting at the corner (using Perlane or Restylane or Juverderm). This time I inject slowly as I push forward (anterograde). Often I ended up correcting about 50% of the marrionette's line by going after the lip's border and most lateral body. Besides, the patient loveto see that they now could see their lip body all the way to the corner and more "smiley shape". The last step is the trickiest one, I use either Radiesse or Perlane on an 1/2 inch 27 gage needle. First placing my left thumb at the patient's lower half NLF's I retract the skin upward (about 2-3cm upward) then I approach my needle in an upward (vertical) position at about one centimeter lateral and one cm below the mouth corner of that same side. Then I aim diagonally toward the corner and start injecting anterograde just 1-2 mm below the imaginary horizontal line of the mouth corner (about 0.2 cc), then I withdraw the needle and reaim straight up and inject just below the horizonal line (0.2cc) then I do it one more time aiming diagonally outward (0.2cc). What was I attempting to do?? I was laying down a new flooring along the imaginary horizontal line. After the injection, release the left thumb. You will be surprised to see the retracted portion just rest right along this new floor, thus the Marrionette'line has been corrected. This is different from the common fanning technique of using the filler to "blow up" around the Marrionette's line. If you look carefully at those company's issued photos, the area around the Marrionette's line now appeared very swollen and puffed up. It is aesthetically unpleasant. It looked like the patient was beat up below the mouth. It reduced the profile of the chin.5) For those of you that use fillers on the highly vascularized and shallow areas such as the temporal, crow's feet, undereye area lateral to the submalar area and along the lateral border of the cheek prominence (especially in those older skinny Caucasian ladies with much excessive very thin skin) I now emulate the same technique used in the hand. I would pinch to levitate the skin itself above the bony structure, then I bolus Restylane into the empty space. Then I massage it down. This elimates the risks of injecting into the vessels and nodules.
Interesting discussion. So Kevin, how do you account for the difference in that anterograde injection you need less filler than in retrograde injections, assuming all else being equal?
Second, I am understanding one group claims anterograde injection carries a higher risk of vessel cannulation and possible intravascular injection, while another group claims that anterograde injection "pushes away" blood vessels, thus decreasing the risk. Not sure how anterograde increases risk of intravascular injection any more than retrograde. If you push the needle ahead, transfixing a vessel, then begin injection, you can still conceivably deposit some material intravascularly, can you not? Am I missing something here?I also found an interesting idea of sub q bolus technique in areas of thin skin, ie crowsfeet, etc. Anyone else try this method? ~ Don
Tom:I do agree with you about those risks with anterograde injection. The key is always the skills in doing it, be it retrograde or anterograde. One always has to be very carefully doing anything around the eyes. However, the anterograde techinique has been advocated some of the best known experts such as Arnold Klein, MD and Kent Remington, MD. I also believed that the filler amount used was critical. It takes much more amount to get the same result with the often taught retrograde technique compared with the anterograde one. For example, I almost never required more than one full syringe in correcting bilateral NLF's vs what was typically used ( 2 syringes) by most others. I attached the before and after of a case wherein I used Readiesse to correct her NLF's and Marrionette's lines with anterograde technique. The after photo was taken right after. You can still see some of needle marks. I used one full 1.3 cc syringe, 1/2inch 30g for the Vermillion border and 1/2inch for NLF's and Marrionette's line. Notice also there was no "puffy/swollen look" medial to the Marrionette's line often seen with retrograde and fanning technique used by most others. ~ Kevin
All interesting comments. The only place, I use “push ahead” is in the cheeks when doing them via the intra-oral route. (Apparently Radiesse is no longer teaching this method because may practitioners couldn’t get the hang of it but it works for me.) I might try it in the “safe” areas such as NL folds. We use only Radiesse and Juvederm and I find that neither filler lasts as long as advertised in “first-timers”. I’ve also had disappointing longevity in my older patients (>65) with both types fillers despite using numerous syringes. I’m sure this has to do with their inability to generate collagen around the filler once the carrier gel is gone. Does anyone know the age range of patients done in the filler studies? ~ SD
I came across this old thread way down in my inbox and read it again. I’m not sure who wrote #4 below. It sounds interesting but I’m having a hard time visualizing it. Do you steadily move the needle forward toward the lip edge as you are injecting or do you hold it in place while the area fills? I’d love to see a drawing on where you start. ~ SD
SD: I wrote those threads. The techniques that I described were similar to what you could see watching the video instruction on www.thederm.org by Kent Remington and his colleagues (lower face injection portion) THe only thing new from my thread was when fixing the Marrionette's line, his doctor (Nowell Solish) injection upward and anterograde from the lower part toward the lip corner only one time vs what I now do is I do the same thing but with a fanning pattern where (with the skin lifted about 1-2cm upward with the other thumb) I laid down "three such "anchoring points" along an imaginary horizontal floor starting from the lip corner going laterally for about 3-5cm long. Here I used something firmer such as Radiesse or Perlane. Having done this, you would release the thumb letting the skin go back down. Often you will see the Marrionetter's line is much improved because "part of that Marrionette's line" now is positioned along the horizontal flooring that you just created. ~ Kevin
PS: It is hard for me to send over some graphic illustration but I will attempt to do this in the future
Something worth knowing. How is your plastic surgeon or dermatologist communicating with other physicians to keep abreast of the latest information about treatments?
Less-acculturated Latinas with breast cancer are less likely to have reconstruction surgery after a mastectomy, say researchers at the University of Michigan Comprehensive Cancer Center.
Amy Alderman, MD, MPH, assistant professor of plastic surgery at the U-M Medical School and lead author conducted a study to examine trends in breast reconstruction among different races, including white women, African-American women, and Latina women. The group of Latina women was further divided into women who were either highly acculturated into American society or less acculturated.
After looking at 806 women who were treated for breast cancer, researchers found 41% of white women and 41% of highly acculturated Latinas underwent reconstruction, while only 34% of African-Americans and 14% of less acculturated Latina did.
The study authors found that the lagging reconstruction rates did not correlate to lack of interest. More than half of the less-acculturated Latinas said they would have like more information about breast reconstruction.
When patients' satisfaction with their surgery was measured, the highest satisfaction rates were among white women who were satisfied with their treatment (94%) compared with the lowest rate, 56%, among less-acculturated Latinas who did not receive reconstruction.
Furthermore, this group was also less likely to report that their surgeon explained breast reconstruction, and they were less likely to be referred to a plastic surgeon than the other racial groups. The study also showed similar trends for African-American women, although the most significant data was among the less acculturated Latinas.
“Reconstruction is important to these women, but significantly more of the less-acculturated Latinas did not know how to get it. It suggests significant unmet needs for this vulnerable group. They have a desire for reconstruction, but no one's telling them about it,” Dr Alderman suggested.
The study authors suggest that more efforts be made to present breast reconstruction options to all patients, including those who speak only Spanish. Further research is planned to understand how language and other cultural issues affect whether women receive breast reconstruction.
Unfazed by a recession and rampant inflation, image-conscious Venezuelans show no signs of cutting back on the facelifts, liposuction, and breast augmentation that have become de rigueur beauty treatments.
"There is never a question of not doing it, but of how you can do it. We all want to get everything done," said Helen Patino, a 37-year-old former model who had her first breast augmentation when she was 21 and her third about three months ago.
Venezuela's inflation is the highest in Latin America, up more than 20 percent in the first 10 months of this year and the South American nation is in recession after a five year boom.
Hard times may even encourage cosmetic procedures as people look for ways to lift their spirits, with many dipping into savings or taking on debt to get operations, surgeons say.
"The financial crisis has spurred people to spend more on themselves ... to console themselves in this crisis. I have not seen demand diminishing," said Peter Romer, a plastic surgeon in Caracas.
For Iris Delgado, a 57-year-old dental technician, a lack of funds was not an obstacle to getting a recent eyelid tuck.
"With the economy, one has to make sacrifices, because you don't have the money. So, you get it from credit cards, from family and you pay for it," said Delgado, who borrowed 7,000 bolivares -- about $3,250 -- for the procedure, a move she saw as a hedge against inflation in plastic surgery prices.
Like Delgado, many go into debt to finance plastic surgery, according to those in the industry.
"It's an investment that people make and they look for money everywhere," said Romer, adding that one of his patients moved into a smaller apartment to get a makeover and another traded her car for a facelift.
Leoncio Barrios, a social psychologist at the Central University of Venezuela, said such stories are the exception. "The majority of middle and lower-income women do not have property to sell or the capacity to save," he said.
An estimated 100,000 cosmetic surgical procedures are performed in Britain each year, many by doctors who have had no specialist training in cosmetic surgery. In addition, hundreds of thousands of non-surgical procedures are done, including Botox for wrinkles and laser treatments to rejuvenate skin, many by non-medical staff with little or no training.
The 200-member Baaps represents the top surgeons in the business who performed 34,187 surgical procedures in 2008, twice the number in 2004. More than 90 per cent of them were on women. The most popular procedure was breast augmentation, demand for which rose 30 per cent last year.
But Mr Mercer, who combines private practice as a cosmetic surgeon specialising in facelifts with his work as an NHS consultant in reconstructive surgery for cancer patients, said the market for cosmetic surgery, of which Baaps surgeons account for less than one third, was an "unregulated mess".
He added: "There has been a massive increase in marketing, including discount vouchers, two-for-one offers and holidays with surgery. In no other area of medicine is there such an unregulated mess. What is worse is that national governments would not allow it to happen in other areas of medicine. Imagine a two-for-one advert for general surgery. That way lies madness."
Mr Mercer, in the journal Clinical Risk, which publishes articles on cosmetic surgery today, he warns that "the doctor's first duty to protect the patient" has been forgotten in the headlong rush to cash in. "The motive for performing any procedure must never be financial gain ... if we cannot self-regulate then regulation will eventually be imposed."
Citing experience in France, where all advertising of cosmetic procedures is banned, he says: "Perhaps, like tobacco, there should be a Europe-wide ban on advertising all cosmetic surgical procedures, including on the internet search engines."
Among those who can testify to the dangers is Jill Saward, the former lead singer of 1980s group Shakatak, who last year agreed to a facelift in the hope of reviving her career after her divorce. But she suffered complications aggravated by her high blood pressure and bitterly regretted the decision. Three months after the operation she still did not have full feeling and was warned full recovery could take a year.
"Surgery is not a quick-fix solution," she said. "The simple truth is that I could have died. I was an idiot, I should have thought much more carefully about the operation and its dangers. It was pure vanity."
Foad Nahai, president of the International Society of Aesthetic Plastic Surgeons, backed Mr Mercer's warning, and called for tougher regulations to prevent doctors practising without specialist training. A code of practice backed by self-regulation of cosmetic clinics was announced by the Government in 2007. Clinics are also subject to inspection by the Care Quality Commission. But Baaps says the measures do not go far enough.
Medical Spa MD today announced that it has selected Sendside Networks as it's exclusive member communication platform. A secure replacement to email, Sendside offers a 1:1 secure sales communication platform that offers high touch interactive messaging and real-time reporting and control for mission-critical communications in a secure environment.
"Sendside is the only solution that addresses our need to communicate easily but still allows us to protect confidential information," said Jeff Barson, Editor of Medical Spa MD.
"Unlike any other technology, Sendside gives us the ability to send interactive tabbed messages that allow recipients to fill out forms and actually make purchases 'inside' the message, without being redirected to an external link from an email. This gives us the ability to actually send the entire Medical Spa MD site directly through a message while retaining control and accessing all of Sendside's analytics and real time reporting.
For the first time we can see exactly who has read a message, downloaded and attachment, or forwarded a message to a collegue, providing us with an inside look at what a recipient is doing and offering a perfect opportunity of knowing when to send follow-up information.
The cost to create and send this type of content would be cost prohibitive using any other solution.
Best of all, it's free for the recipient and as easy to use as web based email."
Medical Spa MD is currently using Sendside to communicate with thousands of plastic surgeons, dermatologist, and cosmetic physician members around the world.
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ABOUT SENDSIDE NETWORKS, INC.
Utah-based Sendside® Networks, Inc. has developed Sendside—the 1 to 1 Sales Communication Platform that provides organizations a secure, interactive communications channel directly to their customers, prospective customers, clients and investors. Sendside combines secure, interactive messaging with file delivery, interactive forms, e-signatures, payments, and secure storage into a comprehensive communication and interaction platform unlike anything on the market today. Sendside currently has fifteen U.S. Patents pending including Sendside Markup Language (SML), Behavior-based Messaging (BBM), Multi-dimensional Messaging (MDM), Sendside eSign, on demand messaging, embedded payments and acknowledgement. www.sendside.com
ABOUT MEDICAL SPA MD
Medical Spa MD is a community of Plastic Surgeons, Dermatologists, Aesthetic Physicians, and Medical Spa Professionals. Medspa MD has Blogs, Forums, and Classified advertising. Members include 2,000+ members worldwide and medicalspa.com recieves more than 100,000 page views each month from physicians and individulals looking for informaton about cosmetic medicine and the lates advances in non-surgical technology.
Medical Spa MD is the premier community destination for physicians and medical providers offering cosmetic medicine with 2,000+ Members & 1.3 Million full page views in the last 12 months.
Our Members are the physician-architects and individuals behind the development of some of the current medical spa businesses models and non-surgical medical technologies. Best of all, it's free, which is a terrific price. Join us.
Well, it truly doesn't have to be that way... and on Medical Spa MD it's not.
You know, Medical Spa MD started as nothing. No Members, no community, no partners... Nothing. Just a single voice of sanity in the cosmetic medical wilderness.
But that's no longer the case. Medical Spa MD now has more than 2,000 Medical Members and is visited by more than 50,000 people every month. In the last 12 months Medical Spa MD has more than 1.3 million page views, making it the single premier community for plastic surgeons, dermatologists, and aesthetic physicians practicing retail cosmetic medicine. And that's just the public facing side. As a Medical Spa MD Member, you'll have access to exclusive information, reports, forums and content that's not available to non-members.
Where there are a host of other sites built for patients, Medical Spa MD is built specifically for physicians and medical providers. There's no doubt that Medical Spa MD is absolutley the best library of information available for medical providers in the business of retail cosmetic medicine. We don't say that as a demonstration of ego but as a statement of fact. Medical Spa MD has been built over the last 5 years into a community that's almost unknown in medicine, a place where you can get real information without the marketing spin that comes from companies and the advertisers that have to bow to them.
Too good to be true? Maybe, but there's method to the madness. Yes, you'll receive some marketing, special offers, products and services put in front of you, but you'll now be part of a huge purchasing group that weilds some real clout with suppliers. Nice for once.
Join us now and start making your cosmetic practice more profitable, and your life a little easier.
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