From the January 2015 issue of HealthCare Business News magazine

Vascular
For blood vessels and vascular lesions such as port wine stains, the best choices would be the pulsed dye laser which targets hemoglobin or a KTP filtered ND Yag Laser,with shorter green and yellow wavelengths strongly absorbed by blood cells.

Skin tightening and noninvasive fat reduction methods

There are a number of non-laser approaches that work for both tightening areas of the skin such as the neck, and fat reduction. “This has become a hugely popular area. As people get into their 40s and beyond, there is a greater likelihood of accumulating excess fat. All forms of energy-based devices are being used and developed for non-invasive fat reduction,” says Weiss.

A significant development several years ago was cryolipolysis or freezing of the fat cells. More recently, focused ultrasound is being used to break up fat, by causing non-selective thermal injury underneath the skin, bypassing the surface. While the technology has been around for several years, it has become quite popular more recently. The FDA has cleared this for marketing for fat cell destruction in the U.S.

Radiofrequency emits heat energy and is being used for skin tightening, as well as heating up and destroying fat cells. A larger area, such as the abdomen or flank, can be treated in a shorter period of time.

These skin-bypassing technologies can be effective with a wide range of patients, including those with darker color skin that may experience discoloration with a laser.

More light-based technology for non-invasive fat reduction is on the horizon. Weiss says, “We will have all forms of energy to reduce fat. In another two or three more years, I would say that liposuction will be the treatment of last resort, if the patient does not respond to the non-invasive options. We have seen some really nice results. There is no downtime. A patient can come in, take a treatment, walk out and go back to work. There is no long recovery period. That is probably one of the most exciting developments in recent years.”

Reimbursement for cosmetic laser treatments
Cosmetic laser treatments are not generally covered by insurance. A general rule is that “If it is cosmetic, it is not reimbursable.”However, under certain circumstances, such as treatment of a port wine stain, laser procedures that commonly are considered cosmetic may be deemed medically necessary.

Scars due to a traumatic injury are treated with lasers, but at this point in time, there is no code for a laser treatment of a scar. Weiss pointed to the scenario of laser scar treatment as part of the Wounded Warrior Project. Military dermatologists provide treatment at no cost while the patient is in the military, but when the patient is no longer in the military, treatment by a civilian dermatologist may be considered cosmetic and not reimbursable by the insurance company.“We need to see that change, scars are medical problems and effective treatments by laser need to be viewed as medical, not cosmetic treatments,” Weiss said.

January 2015 Magazine

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