The 10th Annual Vegas Cosmetic Surgery 2014 took place at the Bellagio on June 18th - 22nd, 2014. This event has become the most foremost cosmetic event in the world and celebrated its 10th anniversary in Las Vegas under the leadership of its founder, S. Randolph Waldman, MD who wanted to foster a spirit of cooperation and understanding between the four “core” specialties that are primarily involved in the science, practice and teaching of aesthetic surgery and medicine. The conference is a unique opportunity for open exchanges of information among core cosmetic specialists about topics ranging from the nuts and bolts of running a practice to specific procedural techniques and even the most experienced practitioners can leave with practical pearls that they can use immediately

1. MEETING REPORT www.aestheticmed.co.uk
N E W S A N D A N A LY S I S
T
he world-famous Bellagio Hotel on the Las Vegas
strip was the setting for the 10th annual Vegas
Cosmetic Surgery meeting.
The meeting was founded by S Randolph
Waldman MD who wanted to foster a spirit of
cooperation and understanding between the four “core”
specialties that are primarily involved in the science,
practice and teaching of aesthetic surgery and medicine.
The conference is a unique opportunity for open exchanges
of information among cosmetic specialists about topics
ranging from the nuts and bolts of running a practice
to specific procedural techniques, and even the most
experienced practitioners can leave with practical pearls
that they can use immediately.
As usual the symposium hosted the leading educators
and teachers in the fields of facial plastic surgery, plastic
surgery, dermatology and oculoplastic surgery, including
Drs Grant Stevens, Corey Maas, Heidi Waldorf, David
Goldberg, Michael Gold, Doris Day, Neil Sadick and myself.
DrSadickaddressednewapplicationstomedicaltreatment
for hair loss, such as low level lasers, inflammatory cases of
hair loss, and transplantation techniques using new mediums.
He said, “Hereditary hair loss affects millions of men and
women,butwithmoreresearch,treatmentsareimproving”.
Dr Heidi Waldorf, also a dermatologist from New York,
gave a presentation “KISSES – 6 Tips for Lips,” during the
Leading lights,
big city
Dr Patrick Treacy reports back on the 10th annual Vegas Cosmetic Surgery meeting
14 Aesthetic Medicine • July/August 2014
minimally invasive/non-invasive session. “I spend a lot of
time trying to convince patients not to inject their lips,”
she said. The reason, she emphasised, is that the lips are
no different than the rest of the face when it comes to
attributing visible signs of ageing – it’s all affected.
“If they really want to do their lips, I tell them we must do
the face”, she continued. “When everything else is sagging
on the face, the lips, too, change in appearance — not
necessarily because the lips have changed, but because
they are visibly altered by falling tissues. Replace that
lost volume and watch the appearance of the lips improve
without doing a thing.” Her six point KISSES plan was:
Evening falls on Las Vegas. With Dr Randy Waldman VCS2014
Conference organiser and founder

2. K - Know your anatomy
I - Inject from outside the lip
S - Side view is as important as the front
S - Shape is more important than size
E - Expectations must be realistic
S - Safety first
Cheryl Bisera, consultant and co-author of “The Patient-
Centered Payoff” said that aesthetic practices must
considertheimportanceofdevelopingastrongbrandimage.
“Your brand is the external expression of your practice and
what your existing and potential patients think and feel
when they hear your practice’s name,” she said.In addition,
sheemphasisedthatanaestheticbrandmustcommunicate
luxury, because patients are choosing to spend their money
with you; so you need to give them more than what they
expect. Dr Grant Stevens gave a lecture on “Marketing
a new product or service” using his experience
with CoolSculpting to illustrate his point. “I’m
successful because of marketing,” he said.
Dr Michael Gold lectured on “Micro-
focused Ultrasound and RF for Skin
Tightening: New Clinical Concepts”.
He said ultherapy could be used for
acne scarring and said the company
had submitted a clinical article for
publication describing study results
for chest skin tightening and knee
tightening.
Dr Val Lambros said that, although he
uses fat in every face-lift he performs, “it
is unpredictable, overrated, has significant
complications.” He continued, “A rookie
mistake might be to overgraft fat into the face to
smooth away wrinkles. But if that fat grows over time,
it can make the face unnaturally big, thereby masking
the natural contours. Thus, the wrinkles may be gone,
but patients tend not to be happy when they no longer look
like themselves.”
Laurie Mercier, a practice consultant with Allergan
Practice Consulting, told attendees at the VCS 2014
meeting of 10 mistakes that front desk personnel can
make. These included not answering the telephone within
one to two rings; not giving their name or the practice’s
name when answering; not asking for and using the
patient’s name; putting callers on hold without asking
www.aestheticmed.co.uk
15Aesthetic Medicine • July/August 2014
MEETING REPORT
N E W S A N D A N A LY S I S
permission and not asking how callers
or prospective customers have heard
about the practice.
The general feeling was that medicine
is a business and you’ve got to make money
and if you’re not, you’re not going to be in
business. This is a highly competitive industry so
it is very important that you keep that in mind the whole
time you’re working.
One of the main round table discussions about dermal
fillers included Drs Corey Maas, Vivan Bucay, Joel Cohen,
Heidi Waldorf, Doris Day, Neil Sadick and myself. A special
roundtable also addressed complications and management
of dermal fillers. Dr Claudio de Lorenzo and I agreed
that the units of hyaluronidase used to address embolic
phenomenon caused by HLA fillers is much too low. The
both agreed starting at 150 to 300 IU, of Hyalase and then
treating repeatedly until the circulation returns.
Dr Claudio de Lorenzo said, “repeated treatment,
massage, and the other recommendations to promote
vasodilation are continued. It is probable as the material
starts to break down, it flows further downstream, where
it probably opens collateral vessels, or it can flow further
past these and obstruct a slightly different area”. He also
stated, “When it gets to the precapillary arterioles, it gets
permanently stuck, unless it is bathed in more unless it is
bathed in more HYAL and is hydrolyzed.”
There are so many variables in a typical case that it is
impossible to be specific, since the manner of manipulation
of the area, the quantity and nature of the filler within the
vessel, and the actual location of the emboli all factor into
the equation.
My thoughts? The doses required are probably closer to
the 350 IU-1000 IU rather than the figures of 35 IU to 100 IU
thatareoftenmentioned.Attheendoftheday,theabsolute
quantity of hyaluronidase is probably irrelevant during an
acute event; it’s the eventual results that count. AM
The general feeling
was that medicine is a
business and you’ve got to
make money and if you’re
not, you’re not going to
be in business
The Vegas Selfie