Medical Laser Blog - Fotona Straight Talk for the Physician

Fotona Aesthetic Laser Before and After: No Squinting Necessary

We recently attended the AAD weekend with our booth for Fotona.  The really entertaining part of AAD is walking around and looking at the aesthetic laser before & after pictures.  It’s amazing what people will put up.  It’s very common that you have to squint and twist your head around to decide which photo is the before and which one is the after.  

So many companies are so hooked on trying to create a buzz about a non-invasive, minimally invasive, no-down-time yada-yada-yada kind of procedure that they forget results are important.  People are not interested in a result that requires a computer analysis of your skin in order to decide if your skin is better or not.  They want to look in a mirror from across the room and see if it’s better or not.

So we simply haven’t chased these kinds of treatments.  In our practice, we want “Wow” results.  Wow results don’t happen with no sign of treatment.  Now, maintenance can certainly happen with no sign of treatment.  So the aesthetic procedures that other companies position as a primary therapy for your skin we provide…we have them….and in fact, the ones that we do have been shown in some studies to be better than other things that are out there, but we use them as maintenance, because it’s going to be a rare patient who’ll excited about and stick to a treatment course of once every two weeks for a year before they see results.  Also, when you go through the economics of one big procedure with a few days of redness vs. coming in week after week with time lost for other activities, etc., people will invariably choose one big procedure and then maintenance at some interval like once every six or eight weeks.  They’re happy right away, they get great results, and they’re excited to tell their friends about the great procedure they had.

Don’t be fooled by the one-trick-pony, minimally invasive , no-downtime…can hardly see the difference kind of therapy.  Get a real laser that can do it all.  If the patient comes in and says “yes, this is definitely what I want.  I heard your consult and I don’t want to have any downtime.  I want to have that procedure that tightens my skin slowly over time.”  Fine!  We can provide it!  But don’t let that be the only thing you have in your office because a lot of people will be profoundly disappointed. 

AAD Peddles Snake Oil

Fotona was at the AAD Conference this year, as always, and I had the opportunity to walk around the exhibit floor.  While there are many, many high quality companies, many of the vendors are really peddling products of extremely dubious use.  

For example, supposedly, all you have to do is wave a reddish-colored diode over your abdomen and you will magically lose weight!  (That, according to one company.)  Another company will make bruises go away within 3 minutes to 3 hours with another laser diode device.  It’s an amazing world we live in when magical things can happen that nobody else can reproduce and yet, they can get FDA clearance to sell these devices.  

Here’s where the difference lies.  When you talk with Fotona Lasers, you find there are many things that lasers can do.  There are also things that lasers can do that have very little clinical efficacy, but Fotona sticks with the things that have the “wow” factor.  Even when we CAN do an excellent job of non-invasive, non-ablative skin rejuvenation, we don’t put that in the front.  We say, “you know what? That’s really positioned as an add-on service after you do the “wow” service” OR we explain very carefully to the patient that if they’re willing to show up every four weeks for a year, at the end of the year they can expect to see significant improvement in the texture, tone and the coloration of their skin.  We don’t hype it as the noontime fix-it-all…because that just doesn’t exist!

What a patient wants is a therapy that makes them look better – soon.  They want something that actually works and where you don’t have to have a photographic computer analysis to tell them how much better their skin is.  They want to see it, they want to feel it, and they want other people to comment on it.  And unless your therapy does that, it’s not a real therapy.  So, we sell real therapies, with the softer therapies either carefully consulted, long-term projects for the patient who really understands, and wants to have a completely non-invasive, non-ablative, no-sign-of-treatment therapy, or we position them only as maintenance for bigger aesthetic treatments that they’ve had.

Now, the non-invasive, non-ablative, no-sign-of-treatment therapies that Fotona has have been shown in various published studies to be as good as stuff that’s already out there that’s being sold as first line therapy.  So it’s not that we have a second rate no-sign-of-treatment therapy, we have a FIRST-RATE no-sign-of-treatment therapy, but that’s not how we position it, because it’s just not what patients get excited about or happy about, again, unless it’s a very careful consult.  So think about that.  Fotona…it’s the no B.S. Company.

Aesthetic Treatments. They’re Getting It Somewhere!

It’s interesting how physicians are fairly oblivious to what’s going on in their patients’ lives.  I include myself in that.  I was surprised to find out, years ago, when I decided to think about being more premeditated about the offerings in my office.

I found out that patients were going elsewhere to get a wide variety of things.  I decided to start doing my continuing medical education based on what my patients seemed to need.  And one of the things I found my patients were very interested in was aesthetic treatments and services.  Previously, I had only a peripheral understanding…I had been doing sclerotherapy for spider vein treatments for many, many years, but that was my only real involvement in aesthetic medicine.

As I queried my patients, I found out that they were going off to get injections of various kinds of fillers and botox, etc.  They were getting hair removal, they were getting microdermasion…they were getting all of these services that I was completely oblivious to.  In fact, most family doctors, or most general internists, or most obstetricians will find that they have enough patients within their own practice to make their laser a significant revenue stream…all the while, providing what your patients want or need.  

Things that we used to consider frivolous are now, on some level, not required (obviously),  but very desired.  We live in a youth culture and as one of the people who lives near me and is always giving me a lot of grief says, “you’re not touching me with that laser – I earned every one of these wrinkles.”  Well that’s good for him, but for most people who are working in a competitive environment, we live in a youth culture and people want to present themselves in the best way you can.  Your patients want to present themselves the best way they can, and that means looking as young, vital and vibrant as you feel.  That is what aesthetic medicine is really about.   In my opinion, aesthetic medicine is really about wellness….it is a part of preventative medicine.  When you look in the mirror, you can either think “hey – I look as good as I feel” OR you can gasp with “oh my…who is that old person in the mirror?”  I prefer the former – and so do most of my patients, and I’ll bet most of yours do too.

So think about that when you’re searching for reasons to add things to your practice.  Think about the needs and the wants of your patients.

Laser Technology For Tissue Absorbtion: High or Low, Good or Bad?

Many companies will tout their laser technology regarding the high absorption of their laser into their target tissues, and depending on the application, this can be a very good thing or a very bad thing.  In the case of ablative procedures, extremely high coefficient of absorption into water is clearly a very good thing.  This is fully explained in Fotona’s white paper on ablative procedures.

The short answer here is that a very high coefficient of absorption into water allows for more versatility in your ablative procedures.  You can use a very short pulse duration with this highly absorbed wavelength and get nearly cold or completely cold ablation.  You could also manipulate the pulse duration using a longer pulse duration to get more coagulation - leaving more heat in the tissue, if that is the desired outcome.  On the other hand, laser lipolysis is an area where you really don’t want a highly absorbed wavelength while doing that procedure.  Some companies tout that their wavelength is highly absorbed in the fat layer.  Well, if that’s the case, if they really have a high absorption coefficient, they’re going to have a small volume of tissue that is highly heated.  Now at first glance, this seems like a good idea, but what this really means is that your footprint with each pass is small, so you’re going to require more and more passes through the fat layer in order to get the desired temperature and “fat melting.”

With an optimal mixture of absorption and diffusion into the tissue, you can get a larger volume of tissue to your target temperature.  And it is the target temperature that you desire.  Not too cold, not too hot.  As Goldilocks would say…  “just right.”  It turns out that for laser lipolysis, a lower coefficient of absorption allows for a larger volume of tissue to be heated through diffusion of heat which results in more efficient melting of the fat for fewer passes and more efficient and a faster laser lipolysis procedure.  

So you need to be cautious when listening to sales pitches from sales guys.  It is not simply a matter of  “does this laser have high absorption or low absorption?” The  question is, “what is the application and what are we trying to accomplish?”  If we’re trying to accomplish the warming or heating of a bulk area, you don’t want high absorption.  On the other hand, if you want ablation, very specifically, and you want to have the latitude to manipulate the amount of heat you’re placing in tissue, then you do want very high absorption.  

The other thing you want is a laser that can be fully manipulated.  Having the opportunity to vary the wavelength is difficult.  There are lasers out there that call themselves “tunable lasers.”  The lasers in the aesthetic market that call themselves tunable are actually a fixed wavelength that are varying their pulse-width… something that Fotona has been doing, not by trying to trick you into thinking it’s a variable wavelength, but my simply telling you that we can vary the pulse duration.

So, rather than going for gimmicks, look for the laser that you have the most authority over and look for the company that has perfected the square pulsing, the flat top optics, the variance of it’s pulse durations and the power that will give you spot sizes and speed.  That’s what you’re looking for…not some magical marketing terms like “tunable!”

Fotona Laser Treatment VS. As Seen On TV

Many times in our laser spa we’ll get calls after some television program or talk show host will highlight a therapy of some sort.  And of course, it will be a specific company with a big media budget and they will have been able to position their product onto some television show.  The brand name will be spoken..the wonderful accolades will be given to this new “miracle” procedure.  And yet, the procedure is almost always, frankly, not unique.  

We get calls all the time as a result of shows highlighting a laser treatment.  One caller might ask “do you do fraxel?”  And we say, “we do fractional laser treatments, absolutely.  Come on in and let us explain it to you.”    We might be asked if we do some other specific, brand-name treatment.    Well, the truth is, Fotona has the most powerful lasers, the largest range of spot sizes, the largest range of pulse widths and the largest range of procedures of any company on our platforms.  Period.

So when people call us and ask, can you do “that?”, our answer is always, “Yes, we can do that.”  The scenario is often like this:  people call….and might be asking for ‘kleenex’ and we can tell them that we have high-end, top quality tissue – every bit as good as Kleenex and in many cases (I would go so far as to say MOST cases), better than Kleenex.

So, our competitors ads are always good for us. And the other interesting thing is, our competitors down the street are always good for us, because it’s extremely rare that we can’t get better results, with less discomfort and less downtime.  That’s our experience in our medical spa.  And I think it’ll be your experience as well.

Adding Lasers to a Medical Practice: The Business of Herd Mentality

I had an interesting experience the other day that set me on my heels because it was so antithetical to the way I would ever think.  We were talking to a guy from New York City and he was interested in buying and adding lasers to his medical practice.  His sales person had referred him to Robin and I to get information on our practice and how we utilize our lasers.  He called back later, very distressed, because  he had spoke to a few of the other spas in his area who had very different experiences from us and they, frankly, questioned our credibility.  They also all had the same laser brand “x.”  This physician wanted to buy that brand as well because he felt that  there was strength in numbers and there was somehow safety there.  

This gentleman also said he would never do the wide variety of treatments that we offer, because they really only do laser hair removal.  So what we did is to show him a couple of days of our spa bookings, where we indeed do all of the therapies that we were talking to him about and I asked him how he was planning on differentiating his clinic.  If he has exactly the same equipment as everybody else around him, he’s just another “McDonalds.”    Why should I go to one McDonalds over the other McDonalds?  Would it be because at one McDonalds there’s a more sparkling personality behind the cash register?  Is the big mac really more tasty at one versus the other?  

In business, you need an edge.  Something Warren Buffet calls a “durable market advantage.”  If you have the same old stuff that everybody else has, you don’t have a durable market advantage.   The customer has no idea what brand “x”, brand “y” or even brand “a” is.   What they do know, is their experience.  The experiences our patients have in our clinic are clearly different than the experiences they’ve had in other clinics.  To the person, they will tell you that the hair removal treatments they have with us are less painful.  

So, when you’re thinking about equipment, do you want to be a part of the herd, or do you want to be set apart?  Do you want to be bigger, better and faster?  Do you want to have patients who are raving about your medical and aesthetic laser treatments vs. the other treatments?  I guess it really depends.  In tough economic times like today, there is an interest in safe harbor…in looking for commonality/similarity.  But the truth is, in business, you win by being different, by being innovative and by setting yourself apart.  

Generally speaking, people are herd animals.  But being part of a herd, means that you will be average.  Setting yourself apart places you with an opportunity to be great.

Turn Bad News into Good News For Your Aesthetic Laser Practice

In my last blog post, I talked about the calls we get at our aesthetic laser practice from people who have seen reports of laser treatments gone bad.  This presents an opportunity for us to contrast that bad news with our good news with Fotona Lasers. 

In order for bad news to be good news for you, you need to have your elevator talk down pat!  Your elevator talk is your clear, concise and understandable discussion, in everyday language, using interesting and understandable analogies about each of the medical or aesthetic procedures you do.  You need to put some time, energy and effort into this and then you need to explain to and rehearse these “elevator talks” with your staff.  

The concept behind an elevator talk is this:  you enter an elevator, encounter a stranger, exchange pleasantries and the stranger says to you “so, what do you do?”  If you can’t explain it in the time it takes a high speed, express elevator to reach the next floor, you can’t explain it to anyone. So get your game on, get your elevator talk ready, and let’s learn how to turn bad news into good news!

When it Comes to Laser Technology, When is Bad News, Good News?

Every time there is a report on the television news about some bad outcome at a medical laser spa some place in the country, we get phone calls.  We get phone calls from our existing patients, and we get phone calls from new patients.  They’ve been contemplating having some kind of aesthetic procedure and when see this news report, they call to ask us if this is the kind of equipment we have, or if we have something else.

Bad news….is wonderful advertising for us! People call us and we’re able to have a brief conversation on the phone to explain the difference between what we do and what was shown on tv or to explain the difference in the laser technology we have vs. the technology used on the tv report or to explain the difference in our knowledge base and the knowledge base of the people that got into trouble on the news report.

What we generally try to do is have a brief conversation that will demonstrate our fund of knowledge, not by using big words and trying to baffle them with technical terminology, but instead by translating what we know into clear, concise, normal, everyday English.  When you make things clear, concise and understandable by using normal, everyday words and analogies that make sense to people, they then understand what’s going to be done, how it’s going to be done, and why it’s going to be safe and effective.  We then try to get them to come in to see our office, see our aesthetic laser equipment and maybe even have a brief demo of how the equipment works or watch a short procedure video.  

So bad news is almost always good news for us.  Don't take our word for it...contact us and we'll talk!

Fractional Laser Treatment is Just One Trick

So where does fractional resurfacing fit into your cosmetic laser treatment line-up?  Fractional resurfacing is just one trick in your bag.  Fractional treatments are used for decreasing downtime.  If you injure 10-20% of the skin with a tiny injury, it will tighten the skin and stimulate new collagen growth. Over time, with more and more fractional resurfacing, you’ll get more and more tightening and more and more improvements to the surface of the skin.  

So fractional resurfacing should really be positioned for that patient that does not have the luxury of significant downtime.  Maybe they’re interested in having their fractional treatment on Friday after work, with the intention that by Monday morning the redness is gone and they’re ready to go back to work.  On the other hand, if they’re looking for that wow treatment…that 10 years younger look in 10 days… then what they really need is full resurfacing. 

So rather than owning a one trick pony machine that only does one type of therapy, it’s better to have the treatment options at your disposal - to have a machine that is versatile enough to do fractional resurfacing when minimizing downtime is important to the patient, and to do full-on resurfacing when the wow factor in the shortest possible recovery time is required.  

When you think about it, if there are 3 days of downtime per fractional resurfacing treatment (which is probably conservative as there is likely a longer recovery in some cases), and you have to do 5 resurfacings, then 3x5 = 15 days of downtime.  If I do a papillary dermis peel with the erbium yag laser, using warm settings, or even fairly hot settings to achieve good collagen stimulation, the vast majority of the time patients can be in camouflage makeup and be back to work in 5 days.  In 7-10 days they are, in most cases, back to their baseline - of course with the exception of the improved tone, texture and tightness of their skin!

When is a Fractional Laser Treatment NOT Fractional?

As you probably know, fractional resurfacing is all the rage.  The idea behind a fractional laser treatment is that you make small, discreet and non-confluent injuries to the skin.  The uninjured skin around the sight of injury then accelerates the healing process, providing for a faster recovery time.  Typically, a fractional resurfacing will cover somewhere between 5 and 25% of the skin’s surface, per pass.  The original idea was that you would do one pass, allow things to heal, and then come back and do further treatments at a later time - generally at 4-6 wk intervals in order to give the initial treatment time to heal.

More and more we’re hearing about “multiple pass” fractional resurfacing.  As an easy example, if you’re covering 20% of the skin on a single pass, when you do three to five passes you are now covering 60-100% of the skin, making it no longer a fractional resurfacing.

So, many physicians are being fooled into believing that they’re giving a fractional resurfacing when they’re actually doing multiple, multiple passes.  Are they getting good results?  They are. But are they also getting the long down times?  They are indeed.

So be careful about the claims surrounding fractional and understand the concepts behind it.  One or two passes is probably still fractional, but three, four, five, six passes is no longer fractional – it’s just resurfacing.