Medical Laser Blog - Fotona Straight Talk for the Physician

The Ideal Practice For Adding An Aesthetic Laser

So here’s an interesting question I got the other day... “what is the ideal practice for adding an aesthetic laser?”  Well, the ideal practice is one with people coming to it that are interested in maintaining a youthful appearance.  Now, that pretty much means EVERY practice. 

Let me ask you – what would you think would be the furthest practice from an aesthetic market?  Maybe a Pediatric practice?  Well, we have several Fotona owners who are pediatricians.  They don’t market to their patients, but rather to the parents of their patients.  When the parents bring their child in for an office visit, the waiting room will have information available about aesthetic procedures offered in the clinic, and most importantly, they have before/after pictures tastefully framed and hung in the waiting room.  This grabs the attention of the parent and often this converts into an additional aesthetic conversation along with the well-child visit.  Many of our pediatric owners are quite successful in their aesthetic businesses.

What about Urology?  This practice type might seem a far distance from an aesthetic practice, yet we have several very successful Urologist laser owners who are able to easily able to convert patients from their urological issues (once properly treated of course) to the treatment offerings from the aesthetic laser.

These are just two examples of medical specialties – fairly distant from anything you might consider for a cosmetic practice – and yet they are quite successful.  What doctors fail to understand is the demand for aesthetics.  In our practices, whether it is primary care such as Family Practice, Internal Medicine  or Ob/Gyn, etc., we are so bombarded with people being upset about the cost of their co-pay that we can’t imagine that they’d actually put down cash for non-covered services such as aesthetic laser therapies.  The truth is…people pay for what they want and they begrudgingly come in for the things that they need!

J. Paul Getty once said, “Give people what they need and you can make a living.  Give people what they want and you can become rich.”  So while you are indeed providing what people need in your primary specialty, remember that you can augment your income and you can dramatically improve the satisfaction of your patient base by offering cosmetic therapies (including laser therapies).  

So the ideal practice for an aesthetic laser is YOUR practice!

Back To School Aesthetic Laser Treatments

Here we are…it’s back to school. Our patients are super busy. Probably your aesthetic procedures are down a little bit because everyone is trying to get their kids ready to go back to school. But remember this….as soon as the kids are settled in school, parents will have a little more free time. Now is the time to remind people that they hated their spider veins all summer and they wanted to get them treated. It’s time to remind them that hair removal is easy to accomplish over the winter so that next spring they can wear their shorts with confidence and it’s time to remind your patients that all of the procedures they’ve been putting off because of summer – well, it’s now time to get them!

Whether it is a medium depth peel of their face or hair removal and spider vein treatments, or simply non-invasive skin tightening, now is the time to start thinking about incentive programs to get your patients re-thinking about their winter time treatments…because unfortunately, out of sight out of mind. All summer, people are wishing they didn’t have those spider veins or the hair on that certain part of their body and now they’re not thinking about it as they go back to wearing long pants, etc. So YOU need to remind them that now is the time to get these treatments. Or maybe you need to look even further ahead into the future and encourage your patients to consider gift certificates, as Christmas gifts for loved ones.

The key to sustaining your aesthetic clinic through the quieter times? Stay focused on thinking ahead.  Human nature has people wanting things, but they only remember them when they need them….and sometimes when they need them they don’t want to get them because it causes an interruption in their routine for summer, etc.

Aesthetic Laser Medicine: Is it the shot in the arm your practice needs?

I was looking at this month's issue of Medical Economics and the entire issue was dedicated to bringing more joy to your practice. Well, I must tell you that aesthetic laser medicine has brought a lot of joy to MY practice. Not just for me – but for my patients. It has freed up my time, it’s freed up intellectual curiosity (I’m able to learn new things and apply them) and frankly, it’s nice to see a patient come in and do something because they want to do it and are excited to do it and not just there because they have to do it and they don’t want to do it!

The biggest challenge I have in sorting out my practice comes from my diabetic patients who are more interested in getting their aesthetic procedures done than they are in refilling their diabetic supplies. I have a few heart-to-hearts with my diabetics and tell them we’re not going to treat their aesthetic issues if their diabetes is not under good control.

That’s the difference between “want to do it” and “have to do it.” There might be a complaint about a co-pay to see me for diabetes, yet the same patient will gladly drop multiple $100 dollar bills on the table to have their aesthetic work done.

So as you’re thinking about our patients and realizing that they’re all complaining about their co-pays (because yes, that’s something they have to do – not want to do) – know that what your patients want is to feel good and look younger. In my case, I can do that by treating their diabetes so they have good control and help them to look younger by having an aesthetic practice.

They shot in the arm I asked about? This comes in the greater sense of pleasure within the practice of medicine.  It comes in a better bottom line which means you don’t have to fight quite as often or quite as hard with the insurance companies over trivial rules they have about whether or not you can use this drug or that drug, etc.

In other words – an aesthetic medicine practice gives you some freedom. Freedom = choices. Choices often lead to happiness.

The Laser Lipolysis Debate

The debate about laser lipo continues to rage.  In a recent article from AmericanHealthandBeauty.com there is a point/counter-point about laser lipo.  The pro-guy is saying it’s the greatest thing since sliced bread, while the con-guy is saying it hasn’t been shown to be as effective as standard lipo and that it may, in fact, be dangerous. 

 I think one piece of the puzzle surrounding laser lipo is that there is a lot of confusion around what our goals are.  The goal of laser lipo is to heat a volume of tissue (fat) to a relatively specific temperature.   Companies using the sort of over-simplified idea of selective photothermolysis have at some points chosen inappropriate wavelengths. 

In our paper on laser lipolysis, we show how there is an optimal place between affinity or absorption and scattering.  There are also other safety considerations because we’re looking at a volume of different kinds of tissues.  We certainly want to achieve a specific temperature within the target tissue, but we don’t want to super-heat surrounding tissues to an unwanted amount.  Certain wavelengths have a higher affinity or higher absorption in the skin than they do in the fat.  As an example: Nd:YAG actually has no significant change in absorption in the fat vs. the skin so you don’t see a spike in this undersurface of the skin temperature the way you do with other wavelengths such as 1440nm, 1320nm,  980nm or 920nm.

Laser Lipolysis, like any procedure, if done incorrectly certainly can be very dangerous so should only be done by:

1) people who understand what they’re trying to achieve and have been trained in the ways to achieve it. 

2) selecting the proper equipment. 

Everyone is trying to get an edge, and as I’ve said many times before in this blog, most companies, rather than trying to figure out what needs to be done and perfecting it, focus instead on marketing and aim for a patented, custom wavelength that’s a few nanometers here or there from a standard wavelength.  A good example of that is Nd:YAG, which has several harmonics (the primary of which is the 1064nm wavelength) but there are other harmonics as well.   Some companies have used these other wavelengths, and even patented them, telling us that there is some new, bigger, better, faster idea or way to manage aesthetic laser procedures.  The truth is….that’s hype.

If you look at an absorption curve, there aren’t tiny regions – there are broad regions – where wavelengths are efficacious.  The idea that 3 or 4 nm this way or that way or even 1, 20, 100 or 200nm are dramatically different is really just wishful thinking on the part of the marketing department. 

What’s really important is having precise control of the delivery of your energy so you can have precise control over the tissue interactions, and that of course, as I’ve said many, many times, is the strong suit of Fotona.   

Fotona has taken the time, effort, energy and engineering know-how to create the kinds of controls on their lasers that really matter.

When you’re contemplating laser lipolysis, take care not to be fooled by the hype and all these goofy machines that measure temperature, etc.  If you have to measure temperature so closely, you’re not doing it right!  When you’re doing laser lipolysis, you should have one hand right over where the tip is so that you can feel it moving through the tissue and guess what?  If you’re hand is getting hot, the skin is getting hot!   These goofy gizmos that turn the thing on and off automatically or presume to give you dosimetry – these are rough estimates on a good day.  What really needs to be done is to put your human hands on your patient just like you always have and you need to feel what’s going on.   When you feel it, you will a) get consistent results, because you will feel how the tissue is reacting to the laser and b) you won’t over-heat the tissue because you will be feeling it the heat!

So, laser lipolysis… friend or foe?  I think it’s a friend.  I think it has specific applications.  I think it’s a great addition to a liposuction practice.  We use it and we find it useful, especially for double-sided skin tightening.  Consider the "laser sandwich." We put the skin between laser on the underside of the skin and laser on the upper side of the skin and get really dramatic skin tightening along with the fat removal.

 

Is Laser Hair Removal Right For You?

 There seems to be a lot of interest on the internet about laser hair removal. I guess I think of it as a fairly mature and reasonably understood technology, however, that doesn’t appear to be the case. Constantly educating our patients is so important. There is so much mis-information out there. I recently saw a blog post that talked about laser hair removal being “absolutely” safe. Well nothing is absolutely safe. Everything has some element of risk and it’s imperative that you consult your patients carefully, thoroughly and honestly.

The risks of hair removal are mostly trivial, in terms of medicine, but they can be dramatically devastating to an individual patient. A patient coming to you for hair removal is sometimes looking for convenience – simply not wanting to shave their underarms. Sometimes the patient comes to you because of a deep stigma that they feel. We have women come in that have five o’clock shadows every bit as dense as mine. They come to our clinic to get laser hair removal because they are devastated by this hair growth. They have been teased throughout their life or maybe it’s just something in their own mind that makes them feel not feminine. If that person were to get maybe even a perfect hair removal result, but because of the way the therapy was delivered, they get a side effect of a hypo-pigmentation, the person could be left with a stigmata that is every bit as devastating to them psychologically as the hair growth was.

The consult needs to help the patients understand the things that could possibly happen. Now – I try to give them some sort of reference point for how likely it is for these things to happen. A few weeks back, I talked in a blog post about you get in your car every day and drive around, not really considering that this is likely the most dangerous thing you could be doing! And putting it over the course of your lifetime, the danger from driving your car is quite significant. Now – the problems that can crop up with hair removal are 1) it might not work to your satisfaction, 2) you might get burned, and the burns can result in hypo-pigmentation or hyper-pigmentation, 3) it’s possible that you don’t kill the hair follicle but instead only burn it below the surface of the skin, and if that happens, you could end up with a lot of ingrown hairs in that area which can become infected and quite unpleasant – even leading to disfigurement.

Some laser operators use lidocaine or similar numbing gel. Virtually all of the deaths associated with laser hair removal can be attributed to an inappropriate application of lidocaine to the skin. Fortunately, with Fotona Lasers we do not use any kinds of topical lidocaine preparations because we simply don’t need them. We have other ways to very adequately control any discomfort. All things need to be adequately explained to the patient and in the end the question that really needs to be asked is: “listen – which is worse in your mind, the hair you have growing or the potential side effects?” And if the answer is “the side effects,” then you should simply advise the patient not to have hair removal. Side effects are unlikely, but they could happen. On the other hand, if the patient says “well gosh, if I get a color change in my skin I could always camouflage it with make-up, but you can’t camouflage a five o’clock shadow." Well that’s someone who understands what we’re talking about and I would do the hair removal on her without hesitation.

You must think through these consults. You must be honest and thorough with your patients because what you don’t want is someone to have what is a known complication of hair removal, and for them to be surprised and profoundly unhappy, feeling like they weren’t properly consulted.

Enhance Your Income With An Aesthetic Laser Practice

My team and I have been very successful in all aspects of Aesthetic Medicine and we would like to show you how.  Allow me to "talk at you" with this short video and check out this web page that will also show you some conservative aesthetic laser practice financials.

If you're interested in doing laser hair removal, collagen and skin rejuvenation, laser vein treatments, treating cystic acne, warts and more - you have the patients already.

To get started, download our free papers and then contact us.  We're here to help you jump start this new and lucrative piece of your medical practice.

 

What's Fractional Laser Skin Resurfacing Got to Do With Driveway Cracks?

Father’s Day is right around the corner and while many of us may not think about it, men want aesthetic services just as women do.  We see a lot of men in our medical laser practice, particularly men in the sales professions, wanting to look young, healthy and vital.  They do this with Botox, by getting a Fotona full or fractional laser skin resurfacing, re-volumizing injections…basically all the same procedures that women are interested in (just applied slightly differently).  

With Father’s Day coming up you might think about coming up with a promotion that reminds men that they fix the cracks in their driveways, kill the weeds in their lawns, repair the paint chips on their car and why aren’t they fixing the imperfections in their face?

When you present an issue to your audience, you need to use their own language.  Men understand maintenance and men understand health.  To promote your medical laser spa services to men, you really need to present from the perspective of a man’s point of view.  While he’s thinking about the chips on his car and the cracks in his driveway, etc., he may not be thinking about beauty and aesthetics and could use a friendly reminder!   You should also promote wellness.  Men work hard and workout hard, but wanting to look good includes healthy looking skin.  In addition to toning muscles, you can help him look healthy by taking the furrows out of his face.  

Promote your services to men…especially now around Father’s Day.  Speak the right language using the concepts of “maintenance” and “wellness.”

How to Properly Consult the Aesthetic Laser Patient

People are funny.  The other day I was in the office, just having completed an aesthetic laser procedure consultation.  My consultations are fairly detailed.  I go into all the possible side effects and complications.  I want people to go into any kind of cosmetic procedure with their eyes wide open, so that they understand the risks.  I want them to accept the risk and I try to place the risk into some kind of context.  Statistics are sometimes very difficult to grasp, so I typically try to place it in terms of ordinary activities.  

There might be a risk the equivalent of driving your car in the city for a year.  I tell them, “look, you jump in your car and drive off, not really thinking about the fact that there are bridge abutments and semi-trucks out there that could run you over.  Now, that could result in nothing more than damage to your property but it could also result in serious bodily injury or even death. 

I went through this entire consultation and the patient’s response to me was “so…there’s nothing that could really go wrong here, right?”  What do you do with that patient?  I’ll tell you what I do with that patient:  I look them in the eye and say, “everything I just said to you is a potentially real complication."  If it’s true, I might say, “I haven’t experienced that complication with any of my patients,” or “out of the x number of treatments I’ve done I’ve seen that complication x number of times.”  But, in one instance, the patient said this same “yeah, but nothing bad is going to happen, right?”  three times in a row.  After the third time I said, “’y’know what?  I can’t guarantee that and we’re done.”  Then I cancelled the procedure.

Now interestingly enough, this patient came back to our Fotona Laser clinic about a month later, bringing her husband.  She wanted to do the consult again and I was a little beside myself.  I thought, “I’m a busy guy and I’m not terribly interested in re-telling this story.”  But I did – this time with the husband present.  The husband was an interesting guy.  He said maybe 4 or 5 times throughout the consult: “sweetheart, I love you and you don’t need to do this for me.  I love you just the way you are and I’m here to support you if you want to do this.”  At the end of the consult, the patient turned to her husband and said, “What do you think?”  He said, “I don’t think you need to do this, but if you want it, I think what he’s telling you is that it’s perfectly safe but he can’t predict the future.”  She then agreed to do the procedure.  

What happened in that instance is that I made it perfectly, abundantly and absolutely clear that I don’t have control over every single possible side effect and she was forced to take responsibility for her own body’s healing, etc. (at least in our presence).  Whether she would hold to that in a court of law is a different issue.  But I think these consults are very important.  I think you need to stand your ground and to protect yourself from people who are just plain goofy.  

A properly consulted patient understands the normal things that are going to happen in a procedure.  They understand that their face is going to be beet red (as I like to tell them, it looks like “they’ve washed their face in a french fryer,”) - when they understand that that’s what they’re going to look like the next morning when they look in the mirror, they’re not freaked out or mad at you. In fact, most of my patients when I call to check on them chuckle and say “yep – it’s exactly like you said…I look terrible!”  That’s really the way you want your post-op situation to be.  You want to have your patients so clear on what’s going to happen that when it does indeed happen, you get a chuckle that says, “That guy was right.”

Your consults are the way you make your life less stressful.  If your patient is calling you in a panic, there was something wrong with the consult.  

The Magic is in Real Medical Lasers With Real Results

Have you noticed how much magical thinking there is in the world today?  In the vendor area of both AAD and ASLMS this year, we saw gizmos and contraptions that are presumably painless, leave no sign of treatment, and just make you look fabulous!  Whether it’s the red laser gizmo that just melts away your fat while you just lay there, or some other similar technology – it seems we’re surrounded by magic.  

Well, I don’t believe in magic.  I looked very carefully at these devices and you know what?  If you shine these devices on somebody’s belly AND then you do laser lipolysis, they DO look great afterwards.  And these are exactly the pictures they’re showing you.  

You’ve got to be careful when you’re looking at the latest fad gizmo.  The truth is:  physics is real.  Physics is how the world works.  Physics is the study of nature and nature is where we live.  Now…are there new discoveries to be made?  Yes, there absolutely are.  

But remember this:  your patients don’t care about fancy computer-generated graphics.  Nor do they care about the fancy third-order statistics required to show there was improvement.  They want their friends to notice from across the room and exclaim “Oh my gosh, what did you do?  You look fabulous!”  THAT’S THE MAGIC!  The magic is in real aesthetic/medical lasers with real results.  

The real lasers that provide real results unfortunately have downtimes.  I’ve talked a lot in the past about non-ablative, non-invasive procedures and they’re great.  I typically position them as a procedure that is for maintenance.  Now, a lot of people will lead with them, and in fact many of our owners that have only a Fotona Nd:YAG and don’t have the opportunity to do ablative procedures, will lead with FRAC3® and they have great results, but those results come over time.  You do FRAC3® every 8 weeks for a year, you’re going to have a really nice result.  You’re going to improve dyschromia, texture and tone.  But for the “wow” result in 10 days,  you need to do an er:YAG ablative procedure – whether it’s fractional or standard.

In the bottom line is the old adage:  “If you see something that’s too good to be true, the overwhelming probability is, it is.”

Your Medical Laser Spa Clients ARE Your Best Advertising

We get calls all the time from people we’ve trained all over the country and in fact, all over the world, asking if our medical spa or laser practice is busy.  The answer is a resounding, “YES – we are busy!”  Would we like to be busier?  Sure.  But we are busy.  And if you’re not….why not?

The problem is that the day-to-day operation of the practice overwhelms most people and they forget to do the things that bring in traffic.   What I mean by that is promotion, and I’m not talking about a multi-million dollar ad campaign, although you can do ads on cable networks relatively inexpensively these days.  What I’m really talking about is recruiting your patients to be your best advertisers and you can incentivize them.  I’ve talked about this in the past but it deserves talking about again. 

When you see a new patient, or any patient for that matter, you should be giving them a card, or several cards, that they can give to their friends and to their family.  That card has some sort of discount associated with it.  As you give these cards to your patients, you write their name on it so when they give it to somebody and that somebody brings it in to your office, not only does the card holder get a discount, but you put that card in your patient's file and the next time they come in you say to them “gosh, you have been responsible for the referral of “x” number of people and for each person you’ve referred in, you get a discount of…”

Now remember that these are discounted services, so it doesn’t really cost you anything but the time to provide the service and most importantly, it brings in a new patient.  So when a new patient is brought in, don’t think of it as simply the upper lip and chin laser hair removal.  Think of it as a whole new revenue stream because that person is going to hopefully love your office and the person that took care of them. They’re going to love their upper lip and chin treatment so they’re going to want a micro-laser peel of their face and after that they’re going to want to do their axillary hair and after that they’re going to want liposuction or some other bigger procedure.  Don’t forget that these patients are not just there for their one treatment on that one particular day.  They are a continuous revenue stream.  Treat them with the dignity and respect that they deserve.

Each one of your patients should become a source for more patients and you do that by incentivizing them to tell their friends and family.  The best possible recommendation is from a satisfied client.