One of the more exciting uses of Platelet Rich Plasma (PRP) injections is its extended use for alopecia treatments in patients. Though it is generally used in combination with other treatments for the hair it has been shown to work as well as a stand-a-lone treatment option. The evidence based science behind these results correlate to the various growth factors and concentration of stem cells within PRP. As part of Empire’s Platelet Rich Plasma Training you will be exposed to the various medical and aesthetic uses of PRP.

Within each dormant hair shaft there are stem cells responsible for the growth cycle of hair, it does not contain pigment or melanin but is responsible for the production of hair follicle cell within the hair matrix. Platelet Rich Plasma (PRP) when introduced to the scalp will trigger a number of biological activities through the release of glykoproteins thus activating specifically KGF/FGF7 – Keratinocyte growth factor. KGF/FGF7 is a paracrine mediator of epithelial cell growth including hair. CD34+Cells and other cytokines (Alpha SDF-1α) attract additional stem cells to the damaged follicle and regeneration site. There are other growth factors released within the PRP and they also help in differentiation, proliferation, and inducing other intracellular events. It is believed that these various biological activities and events will activate a dormant hair follicle and allow for new hair growth.

So why doesn’t PRP work for all patients suffering from thinning hair or patterned baldness? There are medical conditions and reasons for thinning and balding hair and there are certain hair follicles where the stem cells are permanently damaged. Differing delivery methods concerning PRP and the concentration of PRP can influence outcomes as well. Typically platelet rich plasma (PRP) for alopecia treatments are injected using micro needling devices, these devices are used to force the solution to the proper depth for tissue interaction. Since PRP can only be absorbed through the skin through the pores of the skin and hair shafts it is an inexact method of delivery. The second issue with PRP deals with the variability of platelet concentrations within PRP. Single spin methods in preparing PRP are inferior to the dual spin units in preserving CD34+Cells and in the concentration of platelets needed for differentiation, regeneration, angiogenesis, and new cell proliferation to begin. The FDA Approved dual spin method for harvesting blood platelets yields over 6 times more than other methods of harvesting platelets. Other factors affecting successful outcomes are the handling of the PRP and in proper diagnosis of the type of hair loss the patient is suffering from.

The practical side of using PRP in alopecia treatments is that there are a number of hair follicles that are dormant despite their condition. Platelet Rich Plasma has been shown to initiate hair growth for these dormant cells due to the biological nature of the treatment and interaction of stem cells within the hair follicle. Therefore, whether used in combination with hair transplantation, use of medications (i.e. Minoxidil), cold level lasers (LLT), or other type of alopecia treatments being used there is a benefit of using PRP in combination with other therapies or by itself. Find out more about PRP alopecia treatments and the many other aesthetic and medical uses through Empire’s Platelet Rich Plasma Training.

Nurses are afforded the opportunity to attend a number of Botox seminars and training programs in just about every major city and every weekend throughout the year. In addition, Empire has created special seminar tuition rates to make the process even more convenient and attractive. (Don’t forget to mention you are a nurse when registering).

Part of the reason and desire for nurses to learn about Botox procedures is the additional income that potentially may be earned as well as how well your credentials may be enhanced along with your Curriculum Vitae. Physicians and other practice owners (including nurses) understand that nurses may perform many of these aesthetic procedures, especially Botox, in an office setting and separate from the physician.

Botox Training for Nurses in Texas 

Each state is different and we strongly suggest that nurses contact their local state board for more information but nurses looking for Botox Training in Texas as an example will receive quite a bit of flexibility when it comes to performing a variety of procedures because of the training they have received during their nursing curriculum. Nurses in Texas are able to attend and learn a variety of aesthetic procedures including Botox. Empire offers programs in Texas just about every month due to the large percentage of our nurse attendees who come from the Texas area. In addition to Botox, nurses may learn a variety of other aesthetic procedures over the weekend to maximize the productivity of your time. When looking for a teaching program in Botox, make sure you confirm that you will receive hands on instruction and are afforded the opportunity to practice extensively on live patients. Empire has pioneered this type of training. If you are a nurse in Texas, feel free to contact Empire Medical Training for more information about learning to perform these injections as well as other aesthetic procedures.

Botox Training for Nurses in California 

Other states are equally flexible for nurses looking to learn about Botox procedures. If you are a nurse and are looking for a Botox Training program in California, we suggest you not only contact our support staff for more information but also your local state board.Common questions we receive from nurses in California involve the level of supervision required when performing a Botox procedure. Nurses often inquire about whether or not they may go on their own and perform these procedures in an office setting without the supervision or involvement of a physician. Sometimes this involves working with a medical director in California who will work directly with you as well as oversee and supervise your practice. California nurses often times want to practice on their own and hope they may be completely independent of the supervising physician. The nursing state board in California will help answer these concerns and guide you in the right direction. These and other questions are important for nurses in California who are serious about starting an Aesthetic practice or integrating Botox procedures into their current practice.

Botox Training for Nurses in New York and New Jersey 

Due to the internet and our direct mail campaigns, the majority of the nurses who attend our Botox Training seminars are from the North East, particularly New York. There is no real significance to this other than noticing how many nurses there are in New York looking to attend a Botox Training event. (Not surprisingly a large number).  Empire has offered this type of training for over 17 years and is truly the original and largest seminar company of this type. We have successfully graduated more Nurses in New York than any other seminar company in the nation. In fact, since 1998 Empire has successfully graduated well over 30,000 physicians and other medical professionals.

It is interesting to note the differences between New York and New Jersey as far as the regulations and restrictions that not only nurses must understand and comply with but also physicians and other practice owners. During all our training programs we spend quite a bit of time discussing the regulations that nurses from New York, as well as from other states, who are looking for comprehensive training in Botox must abide by. Some of the common questions we receive from nurses in New York involve the actual materials and how to order their Botox supplies and medicines. The answer to this will vary depending on how the ownership structure of the practice is set up and who is the actual practice owner. In the meantime, feel free to contact our staff for questions we can help you with regarding your career or more specifically any of these aesthetic procedures.

Call Empire today for more information at 954-525-4273. 

Empire Medical Training will as part of its teaching of the Comprehensive Botox® & Xeomin® Training include the treatment of Bruxism as part of the protocols given.  Bruxism (not to be confused with TMJ) refers to patients who excessively grind their teeth and clench their jaw either involuntarily (awake Bruxism) or during sleep (sleep Bruxism).  It is estimated that over 30% of the population have this type of parafunctional activity which presents itself as a hypertrophic masseter muscle in the face.

Though we do not fully understand why people develop Bruxism its symptoms may include headaches, teeth sensitivity, and jaw muscle pain.  Conventional treatments typically has been mouth guards to protect the teeth due to excessive tooth wear, breaks, or damaged restorations.

As stated before, we do not fully understand the immediate causes for Bruxism though it is hypothesized that it may involve a number of factors:

• Anxiety (stress, anger, tension)
• Teeth alignment issues (malocclusion)
• Sleeping disorders
• Neurological disorders (i.e. Huntington’s or Parkinson’s)
• Reactions to medications (i.e. antidepressants, psych drugs)

What is known is that “awake” Bruxism is more common in women while “sleep” Bruxism is proportionate to the male/female population.  Though there are many mechanical treatments for the effect of Bruxism there is little evidence that any of these treatments help in the management of Bruxism.  The use of Botox® allows for the correction of these symptoms of the effects as well as management of the condition.

Bruxism is presented as hypertrophic activity of the masseter muscle, Botox will relax the muscle and not allow for the involuntary grinding of teeth and help in the alleviation of pain associated with the muscle spasticity.  The treatment can be either cash basis or reimbursement by insurance may also be available.  The most common protocol is as follows:

• Mark from the Head (caput) of the condylar process (ear canal opening) of the ear to the corner commisure of the mouth using a marking pen.  This will represent the zone of adherence as the Botox® injections to the Masseter muscle will be distal to these markings as you do not wish to inject the Masseteric fascia.
• Patient will clench their teeth together and you will palpate the masseter muscle and make markings medial and lateral to the muscle.  The injections will be between these (2) markings as you wish to avoid the Buccinator muscle and Risorius muscle.  Injection will also be above the base of the mandible.
• The dosing per injection is (4) units each at (4-5) injection points within the muscle (intramuscular).  Isolation of the muscle is possible if you wish to pinch the muscle but can also be administered if resistance is felt at the injection point.

Typically these injections are bi-lateral and the only possible complication or symptom after the injection is that the patient may feel fatigued when chewing after a prolonged period of time.  For most patients it is very well tolerated and the effects can last up to (6) months per treatment.  Prolonged therapeutic use of Botox® for bruxism may also allow for effective treatments over (6) months since the muscle having been relaxed for long periods will not become quite as dominant and hypertrophic after extended periods of atrophy.

If you would like to find out more about the therapeutic and aesthetic uses for Botox® and Xeomin® please refer to our 1-Day Comprehensive Botox® and Xeomin® Training which goes over the most common medical and aesthetic treatments of Botox® for the face.  At Empire Medical Training we not only want you to be safe with these injections but also have the standard of care to refer back to as you successfully integrate these new procedures within your practice.

As part of all of our aesthetic and medical training programs (i.e. Comprehensive Botox & Xeomin Training), Empire Medical Training teaches physicians in the latest marketing techniques as it relates to the new procedures and being successful in these procedures.  Many professional practices have a website but over 90% of these practices are not utilizing the internet to its potential or not at all. Take the time to read over and implement these (28) simple strategies that will make a difference to your internet marketing and website.  Reach your potential as an organization, differentiate yourself from others offering the same service, and reap the rewards that are “real” when internet marketing.  These simple to implement strategies will make a difference and will ensure you have an advantage compared to other professional practices.

1. Your Web design should reflect your brand. You may have a strong brand but your website may be outdated thereby inspiring the trust of people visiting you’re your web design directly affects trust, is it time for a design refresh?
2. Can visitors to your website or present patients buy from you online. If you sell retail products (i.e. cosmeceuticals), make sure your website visitors or patients can actually buy your products from your website. If you don’t have e-commerce enabled, you may be leaving money on the table.
3. Integrate your website with social media. Does your website automatically update to all of the social networks you belong to when new content is posted? Can website visitors share and distribute your content easily? If not, consider making your website more socially aware.
4. Optimize your website with social media. Conversely, beyond the basic social media integration which is a “must have”, optimize your website and fine tune the content so that you get maximum impact from your social distribution websites. Check your title tags, images for Facebook sharing, and Twitter attributions to maximize exposure and correct any errors.
5. Offer a digital download. Every business has information visitors to your website would find valuable.  Give away these materials as a free download and harvest their e-mail and contact information in the process.  In addition, these educational materials help your prospective patients form a perception on your practice and we all know first impressions are invaluable.
6. Engage in a good Content Management System. In order to stay relevant with the various search engines, modern websites need to stay up-to-date. A Content Management System (CMS) will make this easy so you can streamline your online communications in real time.
7. Publish or purchase a new press release at least once a month. By posting press releases you will demonstrate activity and “buzz” within and outside your practice. This will also give your website credibility, exposure, needed content to distribute on your social networks and for SEO.
8. Invest in SEO that has knowledge of your business. Though you can do a lot yourself for your website, to really increase your search engine visibility, a true SEO campaign will boost rankings in a significant way by making use of external campaigns applicable to your business.
9. Create an educational newsletter bi-weekly or monthly. By creating an educational newsletter you will encourage patients to subscribe from your website. Make sure it is not all self promotion, but rather useful and informative.
10. Showcase/Display pictures and information about your staff. No longer can a business hide behind faceless logos, words, and information. Have on your website the names, photos, and contact information for the staff so your website visitors and potential patients can create a bond with them by knowing more about them. People do business with other people, not just logos and a pretty website.
11. Create a blog on your website. By creating a blog you will be demonstrating an expertise, create SEO benefits to your site, and will help potential patients learn more about your practice. Blogging also will give you needed content to share on social networks that in turn will bring more traffic to your website. As a reminder, your blog should be educational for patients as you may build a following of new potential patients through this social media integration.
12. Check your website load time. Customers are unwilling and impatient for slow websites to load.  In addition, websites that are slow to load can incur SEO penalties from the search engines. If this is your website, check your coding and invest in better hosting for your website.
13. Convert paper forms to digital online forms. Either your present patients or potential customers want to fill out a bunch of paperwork at your office. Move your paper forms to web-based online forms so that your constituents can fill them out from any computer or I-Pad without wasting time and paper.
14. Optimize your calls to action. Whether selling retail, harvesting e-mails through digital downloads or newsletters, fill out digital forms, or click “buy now”, make sure your calls to action are clear and easy.  In other words, ask for their business or desired action.
15. High-quality photography. There are many beautiful websites where the photo quality within the website is poor or low resolution.  Just as the design of your website is important, photos can make or break the design and affect the trust your patients feel toward your organization (unprofessional). If your website photos are not properly reflecting the image and brand you wish to portray, invest in professional photography.
16. Display your work. As an aesthetic practice you need to display your work online through photographs or testimonials. Even other types of businesses, whether you make products or provide a service, need to list past work or services so your customers trust you because they can see what you’ve done for others. Try and include more than just pictures if possible.
17. Review and analyze your website content for SEO. If you are not utilizing a SEO campaign, then along with social media, search engines such as “Google” still are the top research tools for consumers today. Utilize a service or software program to tune your website content for greater search visibility.
18. Look at your website analytics. Piwik, Urchin, and Google Analytics are a snap to run behind your website and will tell you what potential patients and patients are doing and going to on your website. By analyzing the data that is given from these sites, you can make better decisions about how to promote your content, what pages are being visited, and what may be working and what is not working.
19. Publish customer testimonials online. Surely your customers have great things to say about you. Collect their testimonials and (with their permission) publish them on your website to give prospects confidence in your company.
20. Utilize video when possible. If you have an aesthetic practice the selective use of video can demonstrate your competency even more than pictures.  Videos can be of procedures, customer testimonials, or anything you wish to portray to potential patients.  Added benefits of having video include “You Tube” and other similar sites where the SEO benefit is great.
21. Experiment with Facebook Ads. Facebook has an ad network that is very easy to use and laser-targeted. You can focus on people in your demographics by drawing on the massive amount of personal data that Facebook collects on its users. Surprisingly, not many businesses are using Facebook Ads yet so the service is lower cost than AdWords and less competitive (at least for now). We’ve posted a tutorial in our Learning Center that will get you up and running in minutes. Facebook Ads can bring lots of targeted traffic to your website.
22. Publish a FAQ. A Frequently-asked Questions (FAQ) page is a super-simple but incredibly useful tool for helping your customers get to know your producer or service before contacting you. It can shorten the sales cycle and save time by letting people self-filter.
23. Make your website mobile accessible. More and more people access websites via a mobile device, such as an iPhone, iPad, Droid, or Blackberry device. Though these devices may show your website normally, it can be harder to navigate on a small screen. Invest in creating a “mobile-only” version of your website that displays only the most high-priority content, fast, and strips away most of the graphics. This will give mobile users a much better experience on your website and maximize the chances of them calling and a phone conversion.
24. Link to your website from every other source. Have a Twitter account, facebook account and LinkedIn profiles that do not link to a website? External links to your website are probably the very most important website SEO tool available. Link every communication tool available (including press releases) to your website.
25. Forget the marketing-speak. Too many websites fall prey to the marketing-speak epidemic where they do not give their potential patients enough credit to understand the services they provide. Try educating these potential patients about the services you offer, this will reduce consultation time and patients will look to you as more of an expert because you are teaching them. Take some time in the near future to review the content of your website to make sure it is educational and can be easily read by others. Try writing in a conversational tone or style that makes sense to the average person.
26. Allow visitors to register or make appointments online. Most of your practices will want to host events, if so online registration is a must have. If you make people call or send in invitations to register, you will not only lose prospective attendees you will have created unnecessary overhead burden to your staff that will cost you time and money.
27. Create a Referral Campaign. Make it easy for patients to refer you to others via your website (e-mail a friend or send link). Offer them incentives or rewards for doing so and for consultations or appointments. 
28. “Contact Information” on website must be easy to find. How many times have you gone to a website and find it difficult to get a phone number or street address for the company you are contacting. Don’t make potential patients search for your contact information, they will stop looking and go to another website.

Empire Medical Training offers this training free of charge as part of its practice profile which can easily be filled out at any of our training (i.e. Comprehensive Botox & Xeomin Training), on-line, or can be requested by calling (954) 525-4273 and answering a few short questions about your practice.  Conventional Marketing and Internet Marketing are only briefly discussed and given out at the training programs but for a thorough review of your opportunities and your practice please take advantage of what else Empire Medical Training has to offer.

Ever wonder why other aesthetic practices offer Botox© procedures for as little as $8.00 – $10.00 per unit?  Have you ever received e-mails from internet pharmacies offering 100 unit vials of Botox© for hundreds less than the pricing from Allergan?  Well odds are the products they are promoting is not Botox© Cosmetic as labeled and packaged for the United States as a prescription item.  Though the practice by unethical pharmacies and unsuspecting physicians are now forefront of a new nationwide investigation by the FDA to crack down on the illegal distribution and uses of imported Botox© not marked or labeled to be used in America.

The practice by physicians of using Botox© not marked for distribution or use in the United States has become rampant in recent years as there was little regulatory control to discourage its use.  Many physicians considered a gray area since they purchased and received the prescription drug within the United States and many websites exploited this point to persuade doctors that it was OK to purchase and use the drug.  However, the FDA has now definitely defined this issue by stating that if the product does not contain the Rx label, labeled for use in the United States, labeled as Botox© Cosmetic, and has the “N” code next to the bar code then it is not approved for use in the United States.

Though it sounds unfair that Allegan and Botox© are able to charge hundreds of dollars more in this country than in others it is because it is a prescription drug (Schedule 2) and is regulated.  By cracking down on its illegal purchasing by physicians in the United States, the FDA has balanced the playing field for all physicians which are a good thing for physicians though maybe not the consumer.  Now all physicians will be paying the same for Botox© which will make it equal to all physicians to sell these procedures at a fair price.

Empire Medical Training has always condoned the safe practice of purchasing Botox© from Allergan or through approved distribution (i.e. McKesson) due to the many benefits in buying from the Allergan directly such as:

• Access to the Physician Network of Allergan
• Access to HA Dermal Fillers (i.e. Juvederm Ultra© & Juvederm Ultra Plus©)
• Access to collagen products; Cosmoderm© and Cosmoplast©
• Access to Latisse© and cosmeceutical line; MD Forte©
• Enrollment in Allergan Rewards rebate program
• Marketing support (referral program, brochures, promotions, training materials, etc.)

As part of our Comprehensive Cosmetic Botox© & Xeomin™ Training you will receive the proper information as to where to purchase the product as well as pricing and packaging information to be able to incorporate these procedures seamlessly within your practice.  In addition, Empire Medical Training offers specific marketing strategies and options for your continued success blending medicine and aesthetics as part of your physician practice.  So next time someone offers pricing to good to be true – they are probably right in that it is too good to be true – be safe!

Simple, The treatment of hypertrophic and keloid scarring typically was to diminish the look of these scars by softening of the tissue. Most treatments including light energies, medicines, and ablative devices did not work very well in releasing the hypertrophic tissue associated with these scars. Dermatologists used liquid nitrogen to diminish the scar with variable results but are limited by the size of the lesion, the need for several treatments, and a prolonged period of time to see results. Other therapeutic treatments including various laser light energies and corticosteroid injections have risk of skin atrophy and of recurring keloids.

CryoShape™ is a device that includes a patented freezing needle to ensure penetration of the inner scar tissue and can be used in association with commercial cryogen tanks or as part of the closed system. Invented in the 1990(s) in Europe, this device is now available in the United States. The specifically designed needle provides excellent thermal conductivity while easily penetrating the dense scar tissue. After anesthesia is administered the surgical session lasts only (5) to (30) minutes depending upon the presentation of the scar. The treatment is painless and very little post-procedure discomfort thus avoiding any types of suture or wound.

What CryoShape™ is able to accomplish is to induce necrosis of the inner scar tissue and leaves the surrounding skin and upper tissues undamaged. Initial destruction of dense disorganized collagen is followed by reorientation and restructuring of collagen as part of your normal dermal structure. The deep scar tissue is destroyed and the original skin pigmentation is preserved. Usually only (1) visit is necessary for a significant and immediate reduction in scar volume as evidenced in (9) out of (10) patients. There is minimal wound care needed post-procedure and the results are dramatic and long-term. Over 93% of patients have had significant improvement of keloid/hypertrophic scarring without recurrence.

Empire Medical Training now offers this information including protocols, white papers, videos, and other information associated with CryoShape™ as part of the 2-Day Cosmetic Laser Workshop Training and other pertinent programs. Now there is a simple therapeutic remedy and better way to treat hypertrophic and keloid scarring.

As technology develops so do new ways of delivering traditional treatments for patients. Case in point is the resurgence of DermaRoller® micro needling technology and a new way of delivering the precise dose and depth of injections – Dermapen®.  Advances concerning the variety of needle options and the materials used for the needles (i.e. titanium, stainless steel) allow for better treatments but can also be confusing. Some of the newer applications that are now utilizing these types of micro needling devices include acne, acne scars, cellulite, and for the administration of platelet rich plasma. The convenience of having a patient pay for his/her individual roller/pen allow the physician to avoid the high capital cost of ablative lasers, cellulite technologies, and other expensive equipment. The average cost to the patient for these types of micro needling devices range from $49.00 to about $150.00 depending upon features and types of materials used.

Medicines for the face and skin have been developed for many years but issues of how to effectively deliver these same medicines have been the challenge in effecting treatments. Mesotherapy agents used for cellulite reduction for example are shown to increase elasticity of subcutaneous chambers and have been used for decades, however the number of treatments (10-14) needed and the number of injections per treatment (300-500) made it unattractive to patients. Using micro needling devices the number of treatments, the number of injections, and the correct depth of the injections are reduced. Dermapen® allows for the correct dosage and depth for each injection given. For both types of delivery methods there is no guesswork to deliver medicines at the correct depth and treatment times are reduced.

In addition, new therapies and treatment options have evolved thanks to micro needling devices such as acne scar treatments, alopecia treatments (i.e. Platelet Rich Plasma), and other conditions such as stretch marks, anti-aging, and face/body. Though delivery of these medicines is accomplished with these micro needling devices, it should also be noted that there are many varieties and qualities of these devices. The following represents the size variations of the needle lengths for the most common types of conditions:

There are also different qualities of these micro needling devices which can be classified as medical grade and for aesthetic use. Many of these devices cannot be unused because of the materials used in the product while others are constructed of stainless steel needles and/or titanium which can be used more than once for the patient. Stainless steel and titanium cannot dull after repeated use like non-medical grade uses and are more aseptic than others though we never would use rollers between patients. For some patients they may elect to purchase multiple length rollers depending upon the condition treated. There are many manufacturers and the number of needles for each type of roller vary (192 – 540 needles) so it is necessary to do your homework before offering it to your patients.

Empire Medical Training has recently updated their programs to incorporate these new micro needling techniques, specifically the Acne Therapies for an Aesthetic Practice where micro needling is discussed as a possible alternative to more expensive laser solutions. All of the Empire courses have been updated for possible uses and the newer medicines that have been introduced that relate to these therapies (i.e. Facial Aesthetics Training, Medical Hair Loss, and Mesotherapy Training Courses). This relatively inexpensive addition to your practice will allow you to perform these specific therapies without the need for large capital expenditures and will allow you to serve the needs of a greater cross section of your patient population and outside your practice.

Modern integrated medicine has progressed to a point where it can be reasonably stated that normalization of serum testosterone in men who are testosterone-deficient is likely to improve symptoms of fatigue, sexual dysfunction, weakness, or reduced muscle mass, and anecdotal evidence supports testosterone improving mood, sense of well-being, motivation, and osteoporosis. Although testosterone replacement does not work for all individuals it works for the majority of patients and therefore needs to be seen as a viable treatment option or medication not with the disdain of clinicians who are ignorant to be familiar with the benefits associated with testosterone replacement therapies. Just as menopause affects all women, andropause is real and affects all men at different ages.

Testosterone therapy may have a wide range of benefits for men, not only in the improvement of sexual symptoms but for a wide variety of metabolic and medical symptoms that promote overall health. The loss of fat and the gain in muscle routinely seen with testosterone therapy represents a positive change in body composition that has implications for cardiovascular and metabolic health. There are substantial observational and interventional studies that strongly indicate important links between testosterone and diabetes as well as testosterone and cardiovascular health. The instance of low testosterone levels is associated with 40-55% in active men with diabetes and has been shown to have reduced insulin resistance.

In addition, there are changing attitudes regarding testosterone therapy and prostate cancer. Originally, it was feared that testosterone therapy might convert occult prostate cancer into clinical disease, new evidence supports that serum testosterone appears unrelated to prostate cancer risk.

The goal of any treatment is to restore serum testosterone levels to normal (600-800 ng/dL) though lower levels may be adequate for symptom improvement in many men. Treatment options include topical gels, patches, injections, implantable pellets, and a buccal tablet. Gels and patches require daily application, injections are given intramuscularly every 1-3 weeks, and pellets may provide adequate serum testosterone concentrations for a range of 3-5 months. Serum testosterone monitoring is mandatory for any of the transdermal modalities since absorption is not uniform and dosage may need to be adjusted to reach therapeutic levels.

It is time that the medical community re-evaluates the health benefits of testosterone therapy. Just the word “testosterone” denotes negative connotations (i.e. athletes, body builders, virility) with many physicians when testosterone can be a solution for a variety of health problems for which evidence is lacking. Although there is still much to be learned, it is no longer acceptable to suggest that the benefits are uncertain or that these relate only to sexual function. Testosterone deficiency is a meaningful risk factor for serious medical conditions such as diabetes, atherosclerosis, metabolic syndrome, osteoporosis, and cardiovascular mortality.

For more information on bio-identical hormone therapies and our Anti-Aging Module I & II course please inquire.

Besides pounds and inches that we tend to validate weight loss for our patients it may also be beneficial to measure weight loss success in relation to body fat. As part of Empire’s hCG Training for Physicians we review not only the latest diet trends and traditional bariatric diet options but also a practical way of incorporating various aspects into a successful weight loss program for patients. One aspect we review and discuss is the need to document your success of patients which will include the reduction of body fat in comparison to the total weight loss achieved.

Skin Fold Caliper (Fat Measurement)

There are three methods used by healthcare professionals to gauge and record body fat measurements.  Skin-fold Calipers, a traditional way of measuring body fat of patients, has been used for many years and though it is not difficult to learn it is the least accurate of the various methods. Calipers are relatively inexpensive but the typical error rate applied for measuring body fat using skin fold calipers can be more than 2%. One way of reducing the error rate is to take additional measurements (at least 6) and apply the formula given within the course study. Typical measurements to determine overall body fat percentage would include:

• Front of the Leg (Thigh)
• Side of the Chest  (except in women)
• Along the Shoulder Blade (Scapula)
• Top of the Hip Bone (Ileum)
• Back of the Arm (Triceps)
• Near the Belly Button (Abdomen)

Bio-Electrical Impedance

Bio-Electrical Impedance has replaced the skin fold caliper method in determining body fat due to the inexpensive solutions in determining a patient’s body fat composition. Bio-electrical impedance is the quickest method for measuring body fat percentage as there are scales that are portable and inexpensive to more advanced, expensive models that will chart segmental fat. Many models now have a software interface that will compare to national averages and graph out this information and subsequent tests throughout the weight loss program for the patient. The process is non-invasive and is better suited for people with suspected higher percentages of body fat or may include those who would feel uncomfortable with having Skin-fold measurements taken. Older models used attached electrodes to different areas of the body and a current is then sent to estimate total body water. As muscle contains a greater percentage of water then the more water your body contains, the lower your body fat measurement will be.  Newer models do not require the attachment of electrodes but work within these same principles at a fraction of the cost.

Hydrostatic Weighing

The Hydrostatic Weighing method is the most accurate measurement of all the methods of determining fat but it is also the most uncomfortable and impractical for physicians to incorporate within a weight loss program because of its expense. Typically, only universities offer this method of testing and may or may not offer it to the general public. The principle for the basis of this measurement is that fat is less dense than water and thus floats. When a body is submerged in water special equipment will determine how much of the body composition is lean and how much is fat.

The last concept to incorporate within your weight loss program is the calculation of the basal metabolic rate especially if you are utilizing ketosis type diet programs. There are a couple of methods to calculate this rate and can be a key tool in ensuring patient compliance with the diet.

Basal Metabolic Rate

Basal metabolic rate (BMR), also called the resting metabolic rate, is the amount of energy needed to support the body’s most basic functions when at rest in a neutral, non-stressful, environment. The BMR is calculated as the number of calories a person needs per day to stay alive and typically is responsible for 70% of the calories burned per day. The body’s most basic functions are those that are immediately necessary for a person to stay alive. These functions include pumping blood, breathing and producing heat. Nonessential functions, such as digestion and standing are not included in this calculation. The BMR was originally created as a tool for measuring the thyroid status of humans by comparing the metabolic rate of animals to that of humans. Today, the BMR is used as a measure of an individual’s metabolism, which changes with age, weight, height, and a variety of medical conditions as well as exercise habits that can affect their BMR.

There are (3) layers of fat in association with our skin; adipose layer, deep reserve fat layers, and subcutaneous layer (4-6mm deep). Cellulite and the origins of cellulite reside in the subcutaneous fat chambers and these chambers tend to be regulated by hormones, not diet and exercise. Contrary to belief, cellulite is not caused by, or is more prevalent in obese or overweight individuals. Hormone imbalances are the main cause for cellulitic changes in the subcutaneous fat layer over time and contribute to hormonal changes within the body.

The hormone factors associated with cellulite development refers to excess estrogen levels at varying intervals which inhibit catecholamine-mediated lipolysis at the cellular level. This is why the incidence of cellulite is much greater with women rather than men besides the fact that women have fewer beta receptors in problem areas as well as having fewer chambers within the subcutaneous layers to store fat. Though hormones are the main cause of cellulite in women (85-90% incidence), vascular perfusion challenges, impaired venous and lymphatic drainage contribute to cellulite formation. Other contributory factors include smoking, poor diet, and genetic disposition to smaller subcutaneous fat chambers.

Similar to acne, the cellulitic process is progressive and is not a condition that presents itself fully in a short period of time. Fat in the subcutaneous chambers become engorged (venous and hormone mediated), increased capillary permeability causes leakage of fluid and edema occurs within the chambers. The result is decreased lymphatic drainage of the area as the elastin fibers which make up these chambers become inelastic. Eventually proteinaceous deposits cause stiffening of the septae of the elastin vertical fibers with possible permanent scarring and painful nodule formation.

However, there are preventative measures for younger people to delay or defer the development of cellulite. Diet, including natural estrogen blockers, do not allow for the large swing of estrogen levels. Educating patients and clinically grading cellulite for patients bring to light the need for intervention. Intervention can take on many roles including hormone balancing after child bearing years, estrogen blockers, mechanical treatments (i.e. Injections, RF, LLT, Ultrasound), and combination therapies. If you are interested in fully understanding your patient needs and be able to treat cellulite effectively for this condition as well as small fat pocket formation, Empire’s Mesotherapy Training, Certification and Courses will train you in the latest protocols and treatment options.