Notes from the first Cosmetic Boot Camp

With the stunning backdrop of Wyoming’s majestic Gros Ventre mountain range in the heart of the wild, wild West, an eager group of dermatologists and senior dermatology residents hung up their saddles for 3 intensive days of training in cosmetic procedures. The sold-out lineup included the best and brightest in light therapies, advanced techniques with fillers and fat, a fresh look at peeling, botulinum toxin Type A tricks, dispensing skin care, building a cosmetics practice, effective staffing, and practice enhancement.

There was also time to mosey on down among the bison and moose for some rafting, riding, and rock climbing. As course director Ken Beer, MD, a clinical instructor in dermatology at the University of Miami, said, “Cosmetic Boot Camp is a rare opportunity to get up close and personal with the faculty in a relaxed atmosphere.”

Day 1 Roundup

Gary Monheit, MD, an assistant professor of dermatology at the University of Alabama, Birmingham, began by telling us what’s new and exciting in skin and volume filling. According to Monheit, “The 4 R’s of facial aesthetic treatment for line eradication and facial contouring are: refill, relax, resurface, and redrape.”

Beer followed with the next generation of hyaluronic acid fillers and tips on what to use where. “Hyaluronic acid is integral to any cosmetic practice,” he said. He told anyone who wishes to branch out into the cosmetics arena to get really good at injecting a few products and stick with those.

Roberta Sengelmann, MD, from the Center for Dermatologic and Cosmetic Surgery in St Louis, educated Boot Camp recruits about her experience with in-jectable calcium hydroxyapatite. “The nasolabial folds and marionette lines are the most forgiving areas to treat and a great place to start.” she said.

Next, Susan Weinkle, MD, from Bradenton, Fla, spurred us on with her talk on the art and science of poly-l-lactic acid. “You can’t go wrong going deep. You can only get into trouble with this product by going too superficially,” she said.

Diane Berson, MD, from Cornell University Medical College in New York City, tackled the vast category of cosmeceuticals, an industry that is growing by 6% per year. Regarding these products, she said, “We know they aren’t better than [botulinum toxin Type A], but they can improve your skin. Most products have some quasiscience and at least an emollient effect, and can increase barrier function, which is key to reducing photodamage.”  

Vic Narurkar, MD, an assistant clinical professor of dermatology at the University of California, Davis, Medical School in San Francisco, gave a straight-shootin’ workshop on lasers and light sources. “The tetrad for nonsurgical facial rejuvenation is skin care, devices, fillers, and botulinum toxin,” he said. He concluded that multiple wavelengths are needed for best results and that, “The new direction in devices lies in defining the role of bulk infrared heating for tissue tightening.”

As the sun set on Teton Village, the aroma of Bubba’s famous barbecue beckoned us under the big tent.

Day 2 Roundup

Course director Mary Lupo, MD, of the Lupo Center for Aesthetic and General Dermatology and an associate clinical professor of dermatology at Tulane Medical School in New Orleans, began with an astute presentation on an Old Faithful technique: sclerotherapy for leg veins. “Like your dad’s old car, it may not be sexy, but it got you where you wanted to go,” she said.

Joel Cohen, MD, director, AboutSkin Dermatology and DermSurgery, and clinical assistant professor at the University of Colorado (Englewood), had the daunting task of teaching us how to avoid “the [botulinum toxin Type A] look,” and talking about complications. The two things every smart injector needs to have on hand, he explains, are an epinephrine injector and 2% nitroglycerine ointment. “Hope you never need them,” he said, “but check the expiration date every month to be safe.”

Timothy Flynn, MD, clinical professor of dermatology at University of North Carolina, Chapel Hill, clued the group in on best practices for using botulinum toxin Type A in the upper face. “Unlike with cosmeceuticals that may or may not work, with [botulinum toxin Type A] you get a bull’s-eye effect.” He advised using caution with patients who have had previous brow or eyelid surgery.

Joel Schlessinger, MD, the Omaha, Neb-based president of, gave a lesson on building a medical spa and a skin-care practice. “Have your staff test every product before you decide to offer it to your patients,” he said. “If they like it, chances are your patients will too.”

The day ended with dueling syringes as Lupo, Beer, and Monheit showed ’em how it’s done with combination therapy.

Day 3 Roundup

The Boot Camp posse lassoed us for a final showdown on the perils of practice management. And seldom was heard a discouraging word from Monheit, who awed the folks with how to grow a cosmetics practice from the ground up. “A different facility from general dermatology is needed to provide the right atmosphere and focus for cosmetics clients,” he said. “Adding a patient advocate to listen to patient needs is critical for success.”

Naomi Lawrence, MD, an associate professor of medicine and head of procedural dermatology, at the University of Medicine and Dentistry of New Jersey (Marlton), wowed the crowd with precision techniques for liposuction and fat transfer. “The future of fat transfer,” she said, “may be in transfer of adipose stem cells, which are small and more resilient than mature fat cells. They may provide filler in patients with an inadequate donor area.”

As the dust settled at the end of the trail, campers had the chance to ask questions and receive some parting words from Lupo: “Dermatology is a constantly evolving specialty that presents new challenges and opportunities for us. At Cosmetic Boot Camp, there were many pointers exchanged that we hope will make a real difference for you. Even at an advanced stage of practice, there is always something new to learn.”

Now, y’all come back next year. PSP

Wendy Lewis is a contributing writer for Plastic Surgery Products.