Medical Laser Blog - Fotona Straight Talk for the Physician

Setting up a Medical Spa? Bring them in with "YES, WE HAVE BOTOX!"

YES, WE HAVE BOTOX!

I have been saying for years that Botox is good for the Pharmaceutical company that makes it, but that the margins are too small to be a revenue center in your practice.  So why am I telling you to advertise Botox?  Ride the wave baby, ride the wave!  You can't turn on the TV or open a magazine without seeing something about Botox.  Some is good, some is bad, but in marketing, any publicity is good publicity. 

Every one knows that Botox is for wrinkles.  They just don't know that there are different kinds of wrinkles.  Since you have the best skin rejuvenation lasers on the planet (Fotona, of course), you are prepared to treat whatever comes in the door.  If they have pure dynamic wrinkles without skin creases or advanced skin aging they may well be best treated with Botox.  But most of your patients will be best served with a combination of therapies.  Often that will be an Er:YAG laser treatment along with Botox.  This will treat the solar damaged skin and prevent additional dynamic creases from forming, to give a more youthful appearance to the skin.  This can be followed with Nd:YAG T3 or Frac3 Treatments to keep the skin looking its youthful, natural best.

A good medical aesthetic consult, combined with savvy advertising, is how you guide your patient to the proper treatment for their specific need.  In my practice we consult our patients with a menu approach.  We will start with the least invasive and least expensive therapies and as the consult progresses, we show them the more aggressive therapies.  We conclude with what we believe will give them the best result for the issue they are concerned about.  In this way, they understand that there are a variety of options available at various prices and various outcomes.  From that they can choose.

Nd:YAG Laser Equipment for Sweet Dreams

"Nightmares of Cosmetic Surgery"... I love those TV shows.

No I don’t watch them, but the phone starts ringing at the office after Oprah, or whoever, shows all of those laser burns.  The patients always want to know if we have THAT kind of laser.  We don’t because almost all of those shows are about IPL or short wavelength lasers like KTP, or pulsed dye.  We have Nd:YAG laser equipment!  Most of the shows even tell the audience that the safe laser is the Nd:YAG…. my job is done for me.  People are out there looking for these procedures, they are looking for a safe place to have them.  

Your office is a safe place.  You have patients right now that are already getting these procedures and others who are thinking about getting them.  They have concerns about the laser center down the street, but they trust you.  You may have delivered their baby, or saved their mom from a heart attack.  They trust you.

My patients often want me to do their surgery.  One even wanted me to do his Craniotomy.  I only do procedures I am good at.  Laser aesthetics with Fotona is easy to learn, safe and effective.  We routinely train physicians to give expert level laser treatments in a single day.

Tattoo Removal Laser System: What Happens in Vegas

I saw a great ad for a laser tattoo removal clinic.  The ad showed an attractive woman with a large tattoo on her back, and the caption said: “Sometimes what happens in Vegas doesn’t stay in Vegas - XXX laser tattoo removal clinic”.  Some people get a tattoo on a whim and have regrets; some need room for a new one… others need to change the name.  Tattoos have long been a vibrant subculture, but recently it is more and more mainstream, resulting in the growth of the tattoo removal business. 

Tattoo removal laser systems are special Q-Switched lasers.  They have extremely short pulse durations and very high peak power.  This makes these systems unique.  They are quite technically challenging to build.  Most companies that try and build them have underpowered machines.  Our Fotona tattoo laser is the most powerful on the planet in terms of pure Q-Switched power.  This results in more efficient ink removal and faster treatments.  Our 4-wavelength laser gives excellent coverage for all ink colors.  Each color of ink absorbs a different wavelength of laser light.  The laser light is converted to heat and the ink is broken up.  This results in the smaller ink particles being eaten by WBC’s in the body.  Several treatments are needed to fully remove a tattoo.  Homemade or jailhouse tattoos are most often removed in just a few sessions while multicolor professional tattoos will require more sessions.

The Fotona QX Tattoo removal laser has been featured on the History Channel’s Ancient Ink segment.

Laser Hair Removal System: Your Look...Your Choice

We have an ad we run in the local “shopper” for male laser hair removal.  The ad is 2 pictures: the first is of a mountain gorilla looking down at his chest and the other is of a “GQ” looking guy with his shirt open to a hairless chest.  The caption is simply “YOUR CHOICE.”

The truth is, most any quality system will be able to produce permanent hair reduction, so why should you consider a Fotona laser?  Speed, comfort and safety are the first three reasons. The next is versatility. 

Speed.  Most companies use misleading parameters to look bigger, better and faster.  Fotona has the most powerful Nd:YAG laser on the market - period.  What that means is that you can go faster.  

Comfort.  The way to speed for most companies is through a larger spot size.  Unfortunately, the larger the spot, the more heat at the center. This impacts comfort (due to pain) and safety (due to the possibility of burns).  Other companies brag about the large spot and the maximal depth of penetration.  Fotona uses a spot with more than adequate depth of penetration and uses a computer-controlled scanner to optimize speed and comfort.  The scanner can precisely lay down spots in a "skip and fill-in" manner to optimize cooling for greater safety.

Safety.  As you can see, comfort and safety are intertwined.  Other issues that set Fotona apart are the energy feedback control system (EFC), variable square pulsing (VSP) and flat top optics. EFC is important because the max energy of a pulse and the average energy are nearly the same.  This means no over-treated areas…what you select on the control panel is what is delivered. VSP enables Fotona to precisely control the pulse duration, and no bell shaped onset and decay, just on and off. Flat top optics prevent hot spots – again for greater comfort and safety.

Versatility.  When getting equipment for your office you would like to have tools working toward a diverse income.  The problem is that most equipment is like a Swiss army knife - fair at a lot of stuff and good at none.  Most IPL’s would fall into this category.  Fotona has optimized their parameter selections to coincide with published peer-reviewed settings.

The Fotona XP MAX Nd:YAG laser system list of indications is vast. It is able to do:
•    laser hair removal treatment with excellent results
•    vascular laser treatments that work on any part of the body
•    collagen remodeling that has been shown to be as good or better than radiofrequency, and with far less pain
•    active acne treatments, generally in one or two sessions, with long term results
•    wart treatments achieved non-abrasively, with little or no after-treatment  discomfort
•    onychomycosis or tinia pedis are treated in as little as 2 weeks, without drugs

Collagen Stimulation Laser Treatment – Reverse Wrinkles & Sagging

Collagen is the framework that your skin is built around.  It is a decrease in the concentration of collagen that results in sagging and wrinkling of skin.  Collagen is injected as a filler to reduce the appearance of wrinkles.  The injected collagen however is not replacing the natural collagen in your skin.  To do that you need to stimulate the growth of new collagen fibers within the skin itself.  We offer several levels of collagen stimulation laser treatments.  Some are no down time, like Frac3, or T3, while others are more aggressive and associated with some redness for a few hours or a few days, like various papillary dermis peels or Smooth Mode treatments.

The growth of collagen is stimulated by injury.  Heat injury is particularly good at stimulating collagen growth.  Frac3 is a 3 dimensional, subsurface, auto-selective process that targets skin imperfections within the collagen-producing layer of skin and heats them, resulting in collagen growth.  T3, is a bulk heating technique that stimulates collagen.  Both of these treatments are available on the Fotona Nd:YAG laser system.  Nd:YAG has been shown to be as or more effective than “radio frequency” treatments and with less pain.  The Fotona Er:YAG laser system with VSP technology is able to independently control depth of ablation and coagulation (heating).  So with this laser you can elect to heat not at all, a little or a LOT.  The Fotona Er:YAG, placed in smooth mode, will produce nearly pure heat for an aggressive stimulation of collagen.  To see what is possible with an advanced Fotona Collagen stimulation laser treatment, take a look at this link of before and after photos: (http://fotonamedicallasers.web5.hubspot.com/photo-b-a/)

Laser Hair Removal - why offer in your practice?

It has been said that if you give people what they need, you can make a living.  That is being in the commodity business. Commodities are where the competition is, the price pressure is and the hard work lives.  Give people what they want and now you are in a different business.  You are now in the business of helping people achieve their dreams. Dreams are different than needs. Dreams are what motivate us, drive us.  They are what make us happy.  We, as physicians, strive to give people what they need, every day.  It's our calling, our duty.  We provide it willingly, and with a sense of honor.  For that effort we get complaints about the co-pay, complaints about the next appointment, complaints about the cost of medicine and complaints about the problems of compliance to the treatment plan.  We also get continuous pressure from the insurance companies - complaints on both sides.  Our malpractice carriers want us to order more tests, write longer notes and createmore work.  Our health insurance contracts are getting harder to live with.  At times the reimbursement is less than the cost of doing business.
 
What can one do?

Diversify your practice.  Your patients need what they need - so continue to provide it.  But they want what they want!  You can provide that as well.  This is true diversification as these types of cosmetic procedures are cash.  No insurance companies, no contracts - just a pure and true relationship with your patient. Laser Hair Removal is the single most popular laser procedure. With the right equipment it is fast, safe and fun.  Generally you as the physician are not required to perform the hair removal, so it becomes a parallel income stream. While you are treating hypertension and reducing the risk of CVA, one of your staff can be treating a woman's upper lip and chin hair growth.  On the surface of it, that seems trivial.  I assure you it is not trivial to the women with a mustache.  Below is a woman we will call Janet.  Janet has had problem hair growth since her teens.  She is your typical patient. She is only one of a hundred women in your practice right now with problem hair growth.

Janet is so self-conscious about her hair growth that she shaves twice a day.  She has turned down opportunities to go on "shopping weekends" with her girl friends. She covers her mouth when speaking to people because she feels as if they are looking at her hair growth.

We saw her about a week after going to Chicago with a group of her friends for the first time. This was after six laser treatments for her hair growth.  She is a new woman.  She smiles more, talks without a hand over her face and simply looks more happy.  This is not trivial.

So it is a cash business, for patients you already serve.  Right now you give them the things they need and they have to go elsewhere to get what they want.
 
Learn more about hair removal... click here.

"No one can possibly achieve any real and lasting successor 'get rich' in business by being a conformist."
J. Paul Getty

Setting up a medi-spa for college and retirement

As a dedicated health care professional you work hard and meet the needs of your patients every day.  But how are you rewarded?  Often it is by lower reimbursements for what you do.  Don’t get me wrong, I love being a doctor.  I love treating patients with diabetes, HTN, and the like.  It is very rewarding, just not necessarily lucrative.  With two people to process paper work, fight with insurance companies and resubmit claims for every one person that is in direct patient care, it gets harder and harder to make ends meet.

A Medi-Spa (in my practice we call it a Medical Laser Center) is a cash practice providing what people really want.  In our center, we do everything that people are seeing on Oprah and other TV shows.  Laser hair removal, spider vein treatments, skin tightening, acne, warts and skin resurfacing.  Look, if you can do a biopsy, you can do this stuff.  Right now your patients are getting this stuff done… just not by you.  While they are complaining to your front desk about the co-pay, they are coming into my office and laying down $100 dollar bills to get these services.  Yes they are.

The trick is picking the right technology.  There is a lot of smoke and mirrors out there. Find out more about understanding the technology that matters...click to receive article.  When I go to conferences like ASLMS (American Society for Laser Medicine & Surgery) I am amazed at what some companies are willing to put up as before and after pictures.  They are often terrible.  One needs to squint and turn your head sideways to determine which is before and which is after.  Take a look at our before and after photo gallery - it is clear, you don’t need to read the caption or any explanation… before is before and after is after - period.

So how will this help put your kids through college or improve your retirement?  Simple… parallel income streams. You will only make the money you can make until you start to delegate.  Right now you delegate your patients care to the nurse in the ICU, you delegate giving shots, but that makes you little money.  Delegating hair removal or spider vein treatments can make you a lot of money.  Having your staff “mining” your spa patients for the bigger procedures like skin resurfacing can make a lot of money.  It’s all about parallel income streams.

Skin Resurfacing Laser. And The Winner Is..….

There are three main lasers used in laser skin resurfacing.  They are CO2, YAGG and Er:YAG.  Each has advantages and disadvantages, but I believe the Fotona Er:YAG is the clear winner.  Why? The reason has to do with the basic issues of resurfacing to control ablation depth, coagulation thickness and heat deposition.  

Depth of ablation is controlled by energy delivery so all lasers are essentially equivalent.  The depth of ablation is chosen based on the lesion being treated and the degree of surface irregularity.

Coagulation is controlled by the native absorption coefficient (AC) of the wavelength into water and the pulse duration.  Because Er:YAG laser equipment has the highest AC, it is capable of the least coagulation.  Because the Fotona Er:YAG has a wide pulse duration, it is able to increase its coagulation thickness.   More or less, coagulation is chosen based on the need for homeostasis and for skin tightening purposes. Coagulation is related to heat deposition and is associated with a greater degree of pigmentation changes.  In individuals at risk for pigmentation changes, cold ablation is desirable.  On a practical level, cold ablation is only achievable with an Er:YAG.

Heat deposition is accomplished with coagulation or with stacked, sub-ablative long pulses.  The Fotona Er:YAG has the ability to separate the coagulation from the heat with its proprietary “Smooth Mode”.  Smooth mode is often used with a fractional handpiece (any of the modes can be) to achieve a minimal down-time skin, tightening effect.

Fotona is about versatility without compromise.  The Fotona Er:YAG can be used to give treatments like a micro-dermabration or a chemical peel, or to perform papillary dermis peels or a plasma treatments.  This can be done with or without fractionation, with independent control of depth, coagulation and heat.

Adding lasers to a Medical Practice. Easy? True.

Why would you want to go adding lasers to a medical practice?  The answer is parallel income streams.  In these days of increasing overhead and lowering reimbursements, finding ways to make ends meet is important.  Not only that, but it is so great to see a patient that is in your office because they want to be, not because they have to be.  Aesthetic patients are the same people who complain about their co-pay and yet lay down $100.00 bills with a smile!  It is strange, but it is true. 

Adding cosmetic laser equipment to a medical practice is really quite easy.  With the right equipment and excellent training you can be giving expert level treatments in a single day.  That may sound like a ridiculous claim, but it isn’t.  I am not saying you will be a laser expert in a single day… I am saying that you can use the knowledge of other laser experts to give expert level treatments in only one day.  Over time and with experience you will become a laser expert.  But in those first few days after training you will have settings to fall back on that will give great results with minimal or no side effects, building your confidence and your practice.

Oh, and did I mention that Aesthetic laser medicine is not covered by insurance so it is a cash business…a business that is in great demand and will help you improve your cash flow.  In my case it paid for private college for both my sons and help each of them get into a home. Not bad considering that before we started our laser practice we were basically making ends meet, but little more.