Laser Treatment MD

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From Health magazine

Watch for these red-flag phrases that suggest your “skin-care specialist” is subpar, says San Francisco ophthalmologist Krista Ramonas, MD, who has treated medical and aesthetic patients for six years.

“You’ll look 20 years younger.”
Beware the cosmetic doctor who overpromises, Ramonas says. Instead of flattering you, he should be discussing what you can reasonably expect from the procedure and addressing possible side effects.

“I’m an artist.”
The prima donna who tosses this phrase around may value her vision over standard operating procedures. “There is a little bit of art to it,” Ramonas points out, “but there’s a lot more science. We have certain parameters we all have to follow.”

“I’m so good, I’ve never seen complications.”
That may be code for “not very experienced,” Ramonas says. “Medicine is always about being prepared for complications.” You need a doctor who can handle the unexpected.

Of these, the greatest is the 'Artist'.

Medical spas in the US and elsewhere have increased in numbers and are popular as medical tourism destinations. Several countries have reported problems of medical spas undertaking medical procedures that neither the spa nor the staff are qualified to do.

Unfortunately, this reflects badly on the majority who are professional. They have tended to fall between the gaps in legislation, but one of the first countries seeking to remedy that is the USA. Nationally, the number of medical spas around the country has grown from 500 in 2004 to 2,500 today. If this growth rate continues, more states will follow the four who are preparing regulations, and almost every sate has discussed the idea.

According to the International Medical Spa Association, the official definition for medical spa is a facility that operates under the full-time on-site supervision of a licensed health care professional. The facility operates within the scope of practice of its staff, and offers traditional, complementary, and alternative health practices and treatments in a spa-like setting. Practitioners working within a medical spa will be governed by their appropriate licensing board, if licensure is required.

The death of a nurse, who had a liposuction procedure performed, has raised concerns over the safety of medical spas to the level that several states are progressing legislation. The proposed legislation is now travelling through several state medical boards in Massachusetts, New York, Florida, and Utah. Proposed legislation would require owners of medical spas to have certain credentials, dictate which procedures can be performed, and set a minimum level of training for those performing particular procedures. Legislation does not want to stop consumers having medical procedures in spas, but to ensure that the procedures are performed safely and by someone with the correct training.

The concern of cosmetic surgeons is the lack of training or experience of some employees at medical spas. An employee of a medical spa may start out performing one procedure and move to another more difficult procedure without much experience. Indeed, lack of experience with certain medical procedures has resulted in serious consequences for some customers, but more common is minor problems such as second-or third-degree burns from improperly conducted laser hair removal procedures.

Medical spas in the US offer treatments including laser hair removal and liposuction, as well as massages and other traditional spa treatments. The types of procedures performed in medical spas have expanded to include chemosurgery for skin cancer and reconstructive surgery.

Massachusetts health officials want to crack down on medical spas, following the lead of Florida, which has been preparing legislation for three years. In Massachusetts a medical spa task force has been set up to advise the state legislature on how best to regulate the facilities. It would prefer a system of federal regulation of medical spas as it would be more cohesive than a state-by-state model but believes that is unlikely to happen, as medical and other professional boards, like nursing, electrology and aestheticians boards, are regulated and licensed by individual states. But the government has just decided to take insurance regulation away from states into a national body, so national regulation is a possibility. The task force has proposed that spas be required to get licenses from the Massachusetts Department of Public Health, and recruit a physician or nurse with special training to remove age spots or tattoos with a laser. Non medical practitioners - cosmetologists, electrologists, and aestheticians - will be allowed to remove body hair using a laser, but only after special training and certification. The task force reported that doctors and other professionals not specifically trained in dermatology have begun offering laser skin procedures, presenting an unacceptable risk to patients.

Regulating medical spas is complicated because they combine many different professionals under one roof, including cosmetologists, electrologists, aestheticians, nurses, and physicians. In most US states each of these professions is licensed by its own board, and each has its own standards. There are no overall regulations governing who can do certain cosmetic procedures and what type of training is required, and there is no requirement that medical spas be licensed.

Bras are an often uncomfortable but necessary evil for the majority of women.

But if you've got serious bra issues and can't be bothered with a different strap arrangement for every occasion, plastic surgery now has the answer.

Israeli plastic surgeon Eyal Gur has invented the Cup & Up bra and there's no straps to be worried with... on the outside at least.

In fact, the invention is an alternative to breast implants and promises perky breasts for years without any of the drawbacks of implants.

The first guinea pig has already had her internal bra fitted and surgeons say it was a huge success.

Avi Cohen, managing director of Orbix Medical, the company helping to develop the bra, told the Daily Mail: "The operation went really well and the woman, who is in her 30s, has made a good recovery.

"The bra has given her the lift she wanted. Her breasts look natural and she is happy with the result. The surgeons have done a fantastic job."

The Cup & Up involves a kind of internal silicon bra. The 'straps' are attached to the ribs with titanium screws, stitched to silicon 'cups' and then it's all tightened into place.

As gruesome and unpleasant as that sounds, those of you in need of a lift can be in and out of hospital in a morning as the keyhole operation takes just 40 minutes.

Mr Cohen believes the internal bra will become widely available throughout Europe within the next 18 months.

"We have enough women volunteers in the trial and we will be doing our second patient just before Christmas.

"In a year's time we will have enough evidence that it works. Then we will be able to get the green light from the European medical licensing authorities."

Call us cautious, but we think we might wait a little longer.

If you’re involved with or own a medical spa, this question is no doubt on your mind.

In this article, I will give you several tips and tools to evaluate your laser centers culture and operations, so you can successfully navigate any economic downturn… And live to sell another day when the inevitable upturn comes around.

What is the Passion and Purpose of Your Medical Spa?

You reap what you sew. When you engage proactively and passionately in your business you will undoubtedly be successful and see your practice expand. It helps to articulate your passion for your medical spa.

At Assara Laser, our passion is to “help clients look and feel great, not fake.”

Why the Recession Drastically Affects Your Laser Clinics Bottom Line

You’ve probably noticed that generating revenue is not as easy as it once was. There are myriad reasons for this; from the decline in disposable income, to unemployment hitting record highs and tanking real estate valuations. As if these facts were not bleak enough, credit markets are virtually frozen so business owners are finding it nearly impossible to obtain small business loans and lines of credit. Refinancing current loans has become difficult for small businesses.

In short, we're operating in the perfect storm.

Accepting Reality and Responsibility Today

The easy way out is to close up shop and blame the recession. This will not help you going forward, it will not pay your devoted employees their wages, and most of all, it will not help your clients “look and feel great, not fake.” So, accept responsibility. 

The hardships of the recession create a fact-pattern, problem to be solved; not a reason for failure. To paraphrase Michael Jackson, start, first, with the man in the mirror. Think about the following questions. And pay attention - there will be homework at the end of this article!

Finding Your Medspas Winning Competitive Difference?

Let’s be honest. The quality of your laser clinc's treatments are probably not drastically better than that of your competitors. The proprietary equipment and IPL or laser systems (Thermage, Fraxel, Titan) that you use are, for the most part, available to the competitive skin clinic market at large.

You may believe (and tell clients) that your microdermabrasion treatments are better because you use a diamond-tipped wand or aluminum oxide crystals. You may think that your IPLs or laser hair removal treatments are better because you use cryo-cooling or because you use chilled air cooling, or because you use a diode laser or because you use alexandrite lasers . . .

BUT . . .

Step in to your clients' shoes. To them, the bells and whistles of your Thermage or Fraxel device don't matter. Your clients already expect expert advice and cutting edge cosmetic lasers, IPLs and skin tighening equipment, so merely meeting this fundamental requirement is not a winning competitive difference.

What does matter to your clients are presentation, client interaction, customer service, reliability and consistency. Consider this carefully.

What is each of your medspas clients worth? 

At Assara Laser, one of the most popular packages is our $449 per month Unlimited Laser Hair Removal Program. On average, a client that signs up for this program will remain a member of the Program for 7 months, depending on the results they wish to achieve. How much is a single unlimited client worth to us?  A client in the program for 7 months, making a monthly payment of $449 is worth $3,143. For many laser clinic owners, a single laser hair removal client is worth more than a home mortgage payment!

Do you treat every single potential laser treatment client that contacts your laser clinic as if they’re worth $3,000?

What is your time and effort worth?

Before my partners and I built Assara Laser, I was an attorney. I still practice corporate law as a labor of love, when a friend or business contact has an exciting deal. I normally discount my rate to about $400 per hour, as law isn’t my primary source of income. 

Assume an hour of your time is worth $400.  Assume further that, every time your customers complain, you are willing to give a discount, or a free treatment and that, collectively, free and discounted treatments account for a 20% loss in your revenue. To make up for this lost revenue, how much more work do you have to do? 

Well, let’s add 20% to your 10 hour day, which now makes it a 12 hour day. If your annual sales are say $1,000,000 per year, you’ve lost $200,000. This translates into 500 hours more of work you must do to bring your revenue back to status quo!

Is there a big difference between a day that starts at 9:00 a.m. and ends at 7:00 p.m. versus ending at 9:00 p.m.  You betcha there is!  Is there a big difference between a loss of $200,000 and a loss of zero. You betcha there is!  And these differences drastically affect your quality of life.

How Can You Avoid Mistakes?

Mistakes are costly. A happy client is worth more than $3,000, and will likely refer business, the best and cheapest form of marketing. A single angry client will result in you working 2 hours more per day for the following seven work days, and will possibly diminish your reputation by badmouthing your medspa. 

A lot of people think excellent customer service means free treatments. It doesn’t. Excellent customer service means delivering what you promise. You know the limitations and effectiveness of your treatments so promise only what you can deliver and do it consistently, with a smile on your face!

An estimated 100,000 cosmetic surgical procedures are performed in Britain each year, many by doctors who have had no specialist training in cosmetic surgery. In addition, hundreds of thousands of non-surgical procedures are done, including Botox for wrinkles and laser treatments to rejuvenate skin, many by non-medical staff with little or no training.

The 200-member Baaps represents the top surgeons in the business who performed 34,187 surgical procedures in 2008, twice the number in 2004. More than 90 per cent of them were on women. The most popular procedure was breast augmentation, demand for which rose 30 per cent last year.

But Mr Mercer, who combines private practice as a cosmetic surgeon specialising in facelifts with his work as an NHS consultant in reconstructive surgery for cancer patients, said the market for cosmetic surgery, of which Baaps surgeons account for less than one third, was an "unregulated mess".

He added: "There has been a massive increase in marketing, including discount vouchers, two-for-one offers and holidays with surgery. In no other area of medicine is there such an unregulated mess. What is worse is that national governments would not allow it to happen in other areas of medicine. Imagine a two-for-one advert for general surgery. That way lies madness."

Mr Mercer, in the journal Clinical Risk, which publishes articles on cosmetic surgery today, he warns that "the doctor's first duty to protect the patient" has been forgotten in the headlong rush to cash in. "The motive for performing any procedure must never be financial gain ... if we cannot self-regulate then regulation will eventually be imposed."

Citing experience in France, where all advertising of cosmetic procedures is banned, he says: "Perhaps, like tobacco, there should be a Europe-wide ban on advertising all cosmetic surgical procedures, including on the internet search engines."

Among those who can testify to the dangers is Jill Saward, the former lead singer of 1980s group Shakatak, who last year agreed to a facelift in the hope of reviving her career after her divorce. But she suffered complications aggravated by her high blood pressure and bitterly regretted the decision. Three months after the operation she still did not have full feeling and was warned full recovery could take a year.

"Surgery is not a quick-fix solution," she said. "The simple truth is that I could have died. I was an idiot, I should have thought much more carefully about the operation and its dangers. It was pure vanity."

Foad Nahai, president of the International Society of Aesthetic Plastic Surgeons, backed Mr Mercer's warning, and called for tougher regulations to prevent doctors practising without specialist training. A code of practice backed by self-regulation of cosmetic clinics was announced by the Government in 2007. Clinics are also subject to inspection by the Care Quality Commission. But Baaps says the measures do not go far enough.

A study in the Journal of the American Academy of Dermatology says if you want to see a skin doctor about a changing mole, get ready to wait. The average wait time is 26 days. But if you want a Botox shot, it's just eight days, two-and-half weeks shorter. Here in mid-Missouri, two dermatologists say that's not true.

"There's a shortage of dermatologists nationally," dermatologist John Despain said. "Also, patients have direct access to dermatologists for skin care."

Dr. John Despain owns Despain Dermatology Center and Skintuition Medical Spa in Columbia, focusing on cosmetic dermatology like Botox. He says at his practice, clinical appointments always come before cosmetics.

"They are seen on a priority basis within a few days," Despain said. "If they're a new patient, if there's the ability to put them in a new patient slot, they priority over anyone calling for cosmetic concerns, of course."

At Dr. Lindall Perry's practice in Columbia, they treat all appointment requests the same.

"We don't have, quote, 'cosmetic appointments,'" he said.

Although Perry is booked through January, he says patients with skin problems can get appointments.

"We have open appointments in two weeks with our newer staff and they would take both a cosmetic patient, an acne patient, a wart patient," Perry said.

Perry says it can be a challenge juggling business and patient care.

"I like to think I have sound business practices," she said. "I do schedule myself very fully. My staff would say too full. My patients would say too full. We pay attention though to the frustration of long waits."

With a heavy focus on clinical treatments, Perry says he tries to see as many patients as possible. Often leaving the Botox appointments for after hours. He says money is a benefit of his practice, not the motivator.

"My desire everyday is to find every melanoma that's in front of me and not to miss that," he said. 

As for Despain, he likes biopsies just as much as Botox.

"I view them as a compliment to each other," he said. "If I had to choose how to spend my time out of enjoyment or profitability, they're probably equal."

Both doctors say there's certainly a demand in mid-Missouri for cosmetic dermatology, but most of their patients and profits stem from clinical work. In the meantime, if you want to see a dermatologist, the best idea is to plan ahead.

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