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DR. WILLIAM HEIMER: I've been practicing dermatology since 1990 when I started my residency, and there is nothing that I'm more excited about as far as preventing skin cancer and helping people manage their pre-cancers than photodynamic therapy. It has changed so many lives for so many of my patients. It's been one of the best treatments that we've been able to offer. It's been a true advance in our ability to manage pre-cancers and inevitably some of those pre-cancers becoming skin cancer. One of the exciting things about photodynamic therapy is that it is an FDA approved product that we can actually get covered by insurance, and so a lot of our patients can benefit from this significantly.

The alternatives to photodynamic therapy have been Efudex, Cryotherapy, chemical peeling, and a lot of these things, while effective, have a significantly greater amount of down time. This allows us to do a treatment for these pre-cancers over a large area and every single patient; they're generally healed in seven days. And that's pretty dramatic when you compare it to Efudex, many of those patients might be having discomfort for out to several weeks or even longer than that if it's off the face. This is a major advance for us as far as treating pre-cancers and potentially preventing cancers. Photodynamic therapy also has been a God-send for many of our acne patients who don't want to take Accutane or don't want to take oral medications. We're able to, in many of those patients, effect an Acutane-like improvement in their acne without putting any medicines in their body, by applying the medicine to the face, applying light for approximately 15 to 20 minutes after the procedure, and doing that for approximately three to four times, we can get fantastic long term clearance of acne in many of our patients. One of the exciting things for those patients as well is that we're seeing improvement in their skin and their scar tissue and other cosmetic issues including brown spots and things that might make the skin look a little older. So there's a huge cosmetic benefit while we're seeing a big improvement in acne, and a big improvement in pre-cancers and cancer potential.

Refirm is a nice advance in our armamentarium for trying to tighten the skin. The challenge with skin tightening has always been that we have to do some sort of procedure that would be ablative, we have to have a wound; we'd have to have recovery time and down time. Refirm puts energy into the skin with two different modalities that has shown clinically to be very effective in improving the youthfulness, the tone, the vitality to that skin, and you can walk in and you can walk out. Generally you need about five to seven treatments over an area. Common areas that are selected are the lateral face to make the jowls pull up, or the malleolar fold which is right around the mouth, that kind of area where you catch a shadow. Also the neck is a really nice area to tighten using the refirm. You can lift the brows laterally. It's very, very exciting. The other area that is commonly used interestingly enough is if you have lax skin on the belly. If you have a lot of extra lax skin, again ideal body weight patient but extra skin, this type of technology can tighten the skin without down time.