Are Some Doctors Selling Fake Botox To Their Patients?

The Houston physician, Dr. Gayle Rothenberg was sentenced to 5 ½ months in Federal prison last month for treating men and women with some counterfeited injectable never recognized by the Food and Drug Administration for use.

Apparently Rothenberg treated around one hundred seventy patients utilizing fake Botox. As per testimony, Rothenberg ceased using Botox Cosmetic following a new cost increase in January 04 and started off buying that bogus stuff that was fifty percent of the cost even though being aware it was not designed for human utilization .

In 2004, as a number of people became paralyzed at the hands of that phony junk, the FDA’s input has contributed to 31 arrests as well as 29 convictions of people marketing and advertising the false Botox. In addition to her prison sentence, former doctor Rothenberg will need to pay off more than $98,000 in restitution to clientele and may not reinstate her revoked Texas medical license.

The circumstance of Gayle Rothenberg is not any different than the example of Laurie D’Alleva, the other fine resident of Tx charged with selling fake Botox. Thus far this instance has yet to be prosecuted .

The prevalent similarities between the two are that both of these people appeared to be inspired by greed to risk individuals for economic gain. Laurie’s scenario is particularly intriguing to me based on opinions posted on Medical Spa MD. Here is an individual that appears to be deemed by her clientele as a “business person” who was performing “good service” for consumers which believed that Botox Cosmetic had been too expensive due to the fact greedy MDs were charging too much for their Botox. Even while Laurie seems to be viewed by many as some nurturing individual helping to make Botox reasonable to the public, public discourse about Dr. Rothenberg is somewhat the reverse. Responses such as “5-1/2 months? Justice is not only blind, it's stupid. (and maybe corrupt) “ and “That sentence is not even one day of confinement for every defrauded patient!.” I think the same option as the above several remarks, but precisely why is public sentiment different with these two con-artists? Could it be due to the fact one may be a MD and one is not?

On my own, I find it relatively unacceptable that the buying price of Botox has doubled since its introduction. I was really excited as soon as Dysport became available due to the fact I imagined that Dysport should be 50 percent the price and might drive the price of Botox downward so extra patients can afford it. Sadly, that hasn't been the situation. While MDs and medical spas must pay much more for Botox, and so do the clients. These kinds of raising prices allow persons like D’alleva and Dr. Rothenberg to find shady Botox they can buy at a more cost-effective price in order to create a larger profit while sacrificing patient safety. d’Alleva’s “botox” price was probably pennies on the dollar, while a doctor's cost for Botox can be now at $600 for each container.

Eventually a different business selling Botox may come along, secure Food and Drug Administration endorsement and push the price of Botox to a affordable price for physicians to be able to order for their patients. Till then, brace for more Laurie d’Allevas and Rothenberg’s to come along.

First posted on Medical Spa MD: The Price Of Fake Botox

Posted via web from Medical Spa RX: Wholesale Botox

I recently purchased Dysport from Discount Medspa.

I recently purchased Dysport from Discount Medspa. Did it myself, and the results were just fine. I did experience ptosis in the left eyelid, but that was my own fault for injecting too close to the brow. The ptosis only lasted about 10 days.This occurance is very common even for all those professionals out there...about 3 to 5% of patients get the temporary droopy eye. I do recommend doing a great deal of research before you decide to inject yourself, but overall I have been pleased. Maybe the price of getting it done at a spa will go down someday, who knows. I know in my case, the expense is what brought me to purchase on line. No regrets. Just be very careful.

via medicalspamd.com

This woman is a damn idiot! Injecting herself with some 'Botox' substitute she bought online.

Not only is she an idiot, she's completely wrong. In seven years I've never seen tosis (droopy eyelid from Botox) from any physician.

Posted via web from Medical Spa RX: Wholesale Botox

Medical Spa MD - Plastic Surgeon, Dermatologist, Cosmetic Surgeon, Laser Clinic & Laser Treatment Forums

Restylane, Juverderm and filler injections tips for physicians running medical spas and laser clinics.

The following is from a string of emails that were circulating among some of Medical Spa MDs Members. I've edited this somewhat to make it readable and get rid of all the extraneous copies. I'm also not displaying the identity or email addresses of the physicians in this thread.

Note: Some of the comments below might be out of order from the original thread. Emails' somewhat difficult to follow as a thread but you'll get the gist.

Filler Injection Discussion & Tips: Restylane | Juevederm | Evolence

1.  When I use the "push ahead" technique, I feel that I get better "plumping" per cc of filler.  I learned this from Kevin (thanks Kevin).

2.  When I use the "push ahead" technique, the filler fills a few millimeters in front of the needle tip.  You need to realize this to be able to put the material exactly where you want it.  Sometimes you have to "feel" the injection because you can't "see" the plumping.

3.  I mix 0.1 cc of lidocaine with epinephrine with my Juvederm.  This helps with bruising (epinephrine) and when the lidocaine goes away and the Juvederm attracts water, the two effects cancel each other and there is not as much enhancement after the injection due to the hydrophilic nature of the Juvederm.

4.  I use Juvederm Ultra under the eye and above the lip.  I use Juvederm UltraPlus everywhere else.

5.  I constantly complain to my Juvederm Rep about the 0.8 cc syringes.  I use lots of Radiesse because you get almost twice as much material for the same price.  Volume, volume, volume.  Please complain to your rep, maybe we can get them to change. 

6.  I hear the Evolence is very good.  We will be getting trained and start using it next month.

Thanks for the filler tips.Can you explain how you get the Lido with epi mixed into the Juvederm syringe? --PD

Fluid Dispensing Connector from Braun Medical Inc (you can get from PSS)

BD 1 ml Luer-Lok Syringe

This syringe allows you to get very precise amount of lidocaine (swish back and forth 20 times).

I use this syringe to put exaclty 1 cc of saline in my Botox Bottle. When I reconstitute the Botox (this gives it full strength per unit). The chances of intravascular injection might be lower with push ahead because the material will push the vessels out of the way as you advance --  Jeff

Hi Jeff,--I agree w/ #6.  I seem to get good augmentation, less redness, swelling and bruising with Evolence.  I use it for deeper fills in cheeks, NLF, etc.  Don't use it for lips or under eyes.  I do same with Lido w/ epi.  I tend to use Juvederm in lips.  Perlane / Restylane for other areas.  I agree w/ why Allergan uses 0.8 cc syringes. I've moved away from Radiesse.  I feel that the duration is not that much longer than a good correction with the HA's.  Besides, I believe a fair amount of the volume of Radiesse is a gel carrier, thus needing touch-ups at 2-3 months.  Perhaps that's why the went to the larger syringes? -- Don

The push ahead technique also moves small blood vessels out of the way, so you may notice less ecchymosis is overall pts. -- Greg

Jeff: --"Push ahead" has a higher risk of vessel cannulation & potential for vascular effects - skin necrosis in glabella, even potential for retro-grade flow to eye (causing visual loss).  I wouldn't recommend that technique for the periorbital area.

Restylane is recommended for the tear troughs;  it's less hydrophilic than juvederm - which means less post-treatment swelling.--Tom  --  [note from Jeff:  Tom is a plastic surgeon]

I would not use push ahead around the eye, I agree with Tom's comments. It works great for NLF. I was actually taught this by a PS -- Greg

Thanks Jeff for your kind comments. However I must make a few points in regards to fillers:

1) There are some areas that one has to still do the retrograde injection either b/c the purpose was to make a straight line (eyebrow lift and vermillion border and the bow-tie (the vertical lines connecting the base of nose and the upper lip border) AND when injecting the most inner 1/3 of the tear-trough to avoid risk of filler getting into the orbital space due to its close proximity to the orbital rim.

2) On the glabellar injection, it is best to first push and pull the needle thru the space underneath to break up the tissue before actually injecting the filler both in an anterograde and retrograde pattern

3) I ONLY use the 1/2 inch needles in all my injections

4) One can inject even Radiesse and/or Perlane via an 1/2 inch 30 gage needle. Why is this noteworthy to mention?? When I work on the lips and Marrionette's lines, I ususally first build the Vermillion border with Radiesse or Perlane (I get the best "lifting outcome" with heavier filler). I push the 1/2inch needle all the way forward then slowly and steadily inject while withdrawing (retrograde method). Then I re-evaluate how much of a correction I already get of the Marrionette' line and lifting up of the lip body. My next step is to inject into the most lateral lip section (about 1 cm distance) starting at the corner (using Perlane or Restylane or Juverderm). This time I inject slowly as I push forward (anterograde). Often I ended up correcting about 50% of the marrionette's line by going after the lip's border and most lateral body. Besides, the patient loveto see that they now could see their lip body all the way to the corner and more "smiley shape". The last step is the trickiest one, I use either Radiesse or Perlane on an 1/2 inch 27 gage needle. First placing my left thumb at the patient's lower half NLF's I retract the skin upward (about 2-3cm upward) then I approach my needle in an upward (vertical) position at about one centimeter lateral and one cm below the mouth corner of that same side. Then I aim diagonally toward the corner and start injecting anterograde just 1-2 mm below the imaginary horizontal line of the mouth corner (about 0.2 cc), then I withdraw the needle and reaim straight up and inject just below the horizonal line (0.2cc) then I do it one more time aiming diagonally outward (0.2cc). What was I attempting to do?? I was laying down a new flooring along the imaginary horizontal line. After the injection, release the left thumb. You will be surprised to see the retracted portion just rest right along this new floor, thus the Marrionette'line has been corrected. This is different from the common fanning technique of using the filler to "blow up" around the Marrionette's line. If you look carefully at those company's issued photos, the area around the Marrionette's line now appeared very swollen and puffed up. It is aesthetically unpleasant. It looked like the patient was beat up below the mouth. It reduced the profile of the chin.

5) For those of you that use fillers on the highly vascularized and shallow areas such as the temporal, crow's feet, undereye area lateral to the submalar area and along the lateral border of the cheek prominence (especially in those older skinny Caucasian ladies with much excessive very thin skin) I now emulate the same technique used in the hand. I would pinch to levitate the skin itself above the bony structure, then I bolus Restylane into the empty space. Then I massage it down. This elimates the risks of injecting into the vessels and nodules.

Interesting discussion.  So Kevin, how do you account for the difference in that anterograde injection you need less filler than in retrograde injections, assuming all else being equal?

Second, I am understanding one group claims anterograde injection carries a higher risk of vessel cannulation and possible intravascular injection, while another group claims that anterograde injection "pushes away" blood vessels, thus decreasing the risk. Not sure how anterograde increases risk of intravascular injection any more than retrograde.  If you push the needle ahead, transfixing a vessel, then begin injection, you can still conceivably deposit some material intravascularly, can you not?  Am I missing something here?

I also found an interesting idea of sub q bolus technique in areas of thin skin, ie crowsfeet, etc.  Anyone else try this method? ~ Don

Tom:

I do agree with you about those risks with anterograde injection. The key is always the skills in doing it, be it retrograde or anterograde. One always has to be very carefully doing anything around the eyes. However, the anterograde techinique has been advocated some of the best known experts such as Arnold Klein, MD and Kent Remington, MD. I also believed that the filler amount used was critical. It takes much more amount to get the same result with the often taught retrograde technique compared with the anterograde one. For example, I almost never required more than one full syringe in correcting bilateral NLF's vs what was typically used ( 2 syringes) by most others. I attached the before and after of a case wherein I used Readiesse to correct her NLF's and Marrionette's lines with anterograde technique. The after photo was taken right after. You can still see some of needle marks. I used one full 1.3 cc syringe, 1/2inch 30g for the Vermillion border and 1/2inch for NLF's and Marrionette's line. Notice also there was no "puffy/swollen look" medial to the Marrionette's line often seen with retrograde and fanning technique used by most others. ~ Kevin

All interesting comments.  The only place, I use “push ahead” is in the cheeks when doing them via the intra-oral route. (Apparently Radiesse is no longer teaching this method because may practitioners couldn’t get the hang of it but it works for me.)  I might try it in the “safe” areas such as NL folds.  We use only Radiesse and Juvederm and  I find that neither filler lasts as long as advertised in “first-timers”.  I’ve also had disappointing longevity in my older patients (>65) with both types fillers despite using numerous syringes.  I’m sure this has to do with their inability to generate collagen around the filler once the carrier gel is gone.  Does anyone know the age range of patients done in the filler studies? ~ SD

I came across this old thread way down in my inbox and read it again.  I’m not sure who wrote #4 below.  It sounds interesting but I’m having a hard time visualizing it.  Do you steadily move the needle forward  toward the lip edge as you are injecting or do you hold it in place while the area fills?  I’d love to see a drawing on where you start.  ~ SD

SD: I wrote those threads. The techniques that I described were similar to what you could see watching the video instruction on www.thederm.org by Kent Remington and his colleagues (lower face injection portion) THe only thing new from my thread was when fixing the Marrionette's line, his doctor (Nowell Solish) injection upward and anterograde from the lower part toward the lip corner only one time vs what I now do is I do the same thing but with a fanning pattern where (with the skin lifted about 1-2cm upward with the other thumb) I laid down "three such "anchoring points" along an imaginary horizontal floor starting from the lip corner going laterally for about 3-5cm long. Here I used something firmer such as Radiesse or Perlane. Having done this, you would release the thumb letting the skin go back down. Often you will see the Marrionetter's line is much improved because "part of that Marrionette's line" now is positioned along the horizontal flooring that you just created. ~ Kevin

PS: It is hard for me to send over some graphic illustration but I will attempt to do this in the future

via Medical Spa MD: Juvederma, Restylane, & Filler Injection Tips for Physicians.

Something worth knowing. How is your plastic surgeon or dermatologist communicating with other physicians to keep abreast of the latest information about treatments?

Posted via web from Medical Spa RX: Wholesale Botox

Botox Tax? Health care fight swells lobbying.

Companies and groups hiring lobbying firms on health issues nearly doubled this year as special interests rushed to shape the massive revamp of the nation's health care system now in its final stretch before Congress.

About 1,000 organizations have hired lobbyists since January, compared with 505 during the same period in 2008, according to a USA TODAY analysis of congressional records compiled by the nonpartisan CQ MoneyLine.

Overall, health care lobbying has increased, exceeding $422 million during the first ninth months of the year, according to the Center for Responsive Politics, which tracks money in politics. That's more than any other industry and a nearly 10% jump over the same period in 2008. The center's Dave Levinthal said the frenzy of new lobbying activity makes financial sense.

"If lobbying didn't work, people wouldn't do it," he said.

via usatoday.com

Botax coming to a medical spa near you.

Posted via web from Medical Spa RX: Wholesale Botox

Plastic surgery advertising regulation push in Britan.

Cosmetic surgery can carry risks as well as benefits

Several newspapers have reported the dangers associated with cosmetic surgery, including a lack of regulation in some areas of the industry. The reports also feature warnings from Nigel Mercer, the president of the British Association of Aesthetic Plastic Surgeons, who voiced his views as part of a series of medical articles on cosmetic surgery.  Mr Mercer called for tighter regulation and testing of drugs, procedures and implants to offer more protection to patients.

The Times reported that the number of cosmetic surgical operations conducted by “audited members of the profession” has more than tripled to 34,000 since 2003, but that many additional procedures are being carried out on the black market. The newspaper says that these are “fuelled by internet promotions, magazine advertising and aggressive discounting”.

 

What is the basis for these news reports?

The reports were based on a special edition of the journal Clinical Risk, which featured several articles on the issues surrounding cosmetic surgery. These issues include the potential for physical and psychological harm, and the need for tighter regulation of the industry, better training programms for surgeons and measures to improve patient experience.

Nigel Mercer, president of the British Association of Aesthetic Plastic Surgery, wrote an accompanying editorial arguing that the availability of consumer credit and a change in public attitudes has led to an explosion in cosmetic surgery in recent years. According to Mercer, this growth, combined with increasing public expectation and media hype, has resulted in “the perfect storm in the cosmetic surgical market”.

 

What is cosmetic surgery?

Cosmetic surgery, sometimes called aesthetic surgery, was described by a doctor in the journal Clinical Risk as being “purely elective, a lifestyle choice undertaken to enhance physical appearance, improve self-esteem and boost confidence”. Another doctor says that it differs from all other forms of surgery in that it is a treatment for “want” rather than for “need”.

In the 2005 Regulation of Cosmetic Surgery report, published by the Department of Health, cosmetic surgeries are defined as “operations and other procedures that revise or change the appearance, color, texture, structure or position of bodily features, which most would consider otherwise to be within the broad range of ‘normal’ for that person”.

Cosmetic surgery differs from plastic surgery, which is generally surgery to repair or reconstruct tissue or skin damaged by congenital (inherited) disease, injuries or burns. The primary role of plastic surgery is to restore function, and aesthetic improvement is secondary.

 

How is cosmetic surgery currently regulated in the UK?

At present, there are measures and standards to help regulate the industry but some cosmetic surgeons operate outside these regulations. Some treatments and procedures are unlicensed for cosmetic use, but can be given the discretion of doctors, or “off license”, by some clinics.

Surgical practice in the UK is regulated by the General Medical Council (GMC) and practicing surgeons should be enrolled on its specialist register. However, some concessions are made for private cosmetic surgeons who have been practicing since before April 2002. By satisfying certain criteria, these doctors can practice without the need to be on the specialist register.

Invasive cosmetic surgery and laser treatments are also regulated under the Care Standards Act 2000. The Healthcare Commission inspects all registered establishments that carry out invasive procedures and laser surgery in the UK, and has the power to revoke practice licenses and to take enforcement action.

Some cosmetic surgical procedures are not covered by current regulations, such as Botox injections and injections of aesthetic fillers. Botox is not licensed for cosmetic use, but it can be prescribed “off license”, in which circumstances the doctor assumes liability for its use. Most fillers are tested in the UK as “devices” rather than as drugs. This means that they are regulated based on the standard of their production and not on whether the treatment works.

The Department of Health report concluded that the regulatory situation for cosmetic surgery was not satisfactory because of the group of doctors who can practise without being on the GMC specialist register and the lack of clarity around the definition of “fillers”. Although practitioners of cosmetic surgery must demonstrate certain competencies, these may not be the equivalent standard of NHS consultants.

 

What do these journal articles say about cosmetic surgery?

The authors of these articles have argued several opinions, including that:

• Patient psychology should be considered by clinical staff as issues of mental health and body image may be behind the desire for cosmetic changes. These could also arise in people who feel disappointed or upset by the results of their surgery.
• Surgeons should keep records detailing their patients’ expectations and provide them with guidance on whether these are realistic.
• There are risks associated with any type of surgery and patients should be informed of these and their surgeon’s success rates when considering procedures.
• It is important that patients are given time to consider their options. Doctors should also inform patients about alternative treatments that may be available.
• Before procedures are carried out, it should be clear who will be financially liable for the correction of any complications.
• There may be some merits to adopting a regulation system similar to that in France. Under this system, patients must be given information on costs, risks and the surgeon’s qualifications to perform their selected procedures.
• The way that cosmetic surgery is marketed should also be regulated.

What is the problem with plastic surgery marketing?

Mercer says that cosmetic procedures are often marketed using special offers, including vouchers, two-for-one deals and surgery holidays, and that these practices contribute to an “unregulated mess”. 

The articles also feature a call to ban advertising of cosmetic procedures, stating that, like tobacco, there should perhaps be a Europe-wide ban on advertising all cosmetic surgical procedures, including on internet search engines. While advertising can be powerful, says Mercer, it is often misused by the cosmetic surgery industry and misinterpreted by those it is aimed at.

 

Where can I find more information on reputable plastic surgeons?

The British Association of Aesthetic Plastic Surgery is a not-for-profit organization based at the Royal College of Surgeons. It was established to advance the education and practice of cosmetic surgery for public benefit. While it is not a regulatory body, it has long been involved in giving the public information on the safety of cosmetic surgery.

Its research into cosmetic surgery tourism was discussed at a recent conference and its press releases highlight a number of dangers associated with unregulated procedures, including DIY injectable treatments available over the internet.

via nhs.uk

Posted via web from Laser Treatment MD

Cosmetic Dermatology: No wait for Botox or Photofacials.

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.

via komu.com

Posted via web from Laser Treatment MD

Paula D. Young RN joins Medical Spa MD

Paula D. Young RN joins Medical Spa MD

Medica lSpa MD is proud to announce the addition of Paula D. Young RN to it's editorial board.

"It's a fantastic addition to Medical Spa MDs ability to provide expert viewpoints from a diverse group of expert medical providers and business people", says Jeff Barson, Medical Spa MDs founder and publisher. "Paulas experience will give Medical Spa MD voice for mid-level medical providers an an invaluable resource for the growing number of medical estheticians and laser techinics who are visiting Medical Spa MD to learn."

"To really know what's going on in the aesthetic business you must join Medical Spa MD!", says Young. "Nowhere else can you find the information crucial to your success in this ever changing arena. From the classified ads section, to the professional community forum discussion threads, to real equipment reviews by aesthetic professionals. I especially value the articles on marketing and the community forum discussions on therapy management like melasma, fillers, laser lipolysis, and skin resurfacing. Medical Spa MD keeps me on my toes as a medical spa owner, marketer, and nurse!"

* * *

ABOUT Paula D. Young RN

Paula is the staff nurse and co-owner of Young Medical Spa in the Lehigh Valley area of Pennsylvania along with her husband Thomas E. Young, MD. Prior to establishing Young Medical Spa, Paula previously owned a Merle Norman Cosmetics national franchise, a full-service beauty salon and spa, and a chain of tanning salons. Most recently, Paula worked for Johnson & Johnson for over 10 years and held senior management positions in the medical and sales education, and customer relationship management departments. Her associations include:

• Dermatology Nurses Association
• American Academy of Medical Esthetic Professionals
• Association of periOperative Registered Nurses
• American Nurses Association
• The Aesthetic Practice Association

Paula also holds a current license with the Cosmetology Board in the State of Pennsylvania. She has written for Medical Spa Report Magazine and authored a textbook on Advanced Aesthetic Practices.

ABOUT MEDICAL SPA MD
Medical Spa MD is a community of Plastic Surgeons, Dermatologists, Aesthetic Physicians, and Medical Spa Professionals. Medspa MD has Blogs, Forums, and Classified advertising. Members include 2,000+ members worldwide and medicalspa.com recieves more than 100,000 page views each month from physicians and individulals looking for informaton about cosmetic medicine and the lates advances in non-surgical technology.

via medicalspamd.com

Posted via web from Laser Treatment MD

9 Top Tips For Medical Spa Success

If you're a plastic surgeon or dermatologist starting a medical spa, skin clinic, or laser center, you'll need to have all of your ducks in a row.

Here are 9 tips to keep your medspa in the black, and your laser treatments and Botox appointments full.

1. Have sufficient funds to kee your Medical Spa open for months.
Don’t even think about opening a Medical Spa unless you have the capital needed to bring it through the startup and first year of operation. Invariably, your planning will not deal with all of the unforeseen issues that can occur in the MedSpa industry. From regulatory compliance changes and training costs, to increased marketing costs. Under-capitalization is a leading indicator of business failure. You should considering a combination of various financing strategies from leasing to working capital.

2. Talk with other doctors who have successful, operating Medical Spas
Ask them what they would do the same, and what they would do differently. We are starting to see some established Medical Spas out there, try and learn from their experiences and best practices.

3. Join associations that help new Medical Spas succeed
They are a great source of experienced MedSpa owners, who have already gone through what you will. In addition, they often have members who have specialized in the MedSpa industry, including: business planning, marketing, design, dealing with regulatory issues, insurance and finance. The International Medical Spa Association even has a mentorship program that is available for new MedSpa owners. It is invaluable to chat with someone across the country who has had the same problems you may have, especially if you know they are not a local competitor!

4. Know your strengths and weaknesses
No one is strong in all areas, you may be an expert in age management medicine, but you may be weak on the business and marketing side. That’s fine, but you are going to need to identify the areas where you are weak and compensate. Not all areas require a permanent, full-time employee, you may consider hiring a consultant who has the necessary experience.

5. Watch your medical spa's monthly expenses
Especially during the startup phase of a MedSpa, it can be easy to see the glamour of having marble flooring, but is it really necessary? You may be better off adding another hair removal treatment room, which will generate income. Remember the old adage: “it will take twice as long and cost twice as much as you anticipated.”

6. Determine what need your Medical Spa meets.
As with any successful business, you need to meet a consumer demand. With 11,500 people joining the over 50 crowd every day, you have a great potential market. But you need to make sure you are where they can be found (i.e. medical centers, shopping centers, established communities).

7. Know your laser clinic's monthly cash flow.
You may think financial statements are only for accountants to understand, but you need to be able to read some key financial statements. Including the cash flow statement, this lets you know where the money is coming from and where it is going. You must always know your current cash flow situation, if you cannot pay your bills, you are effectively out of business. Botox, Restylane, Juvederm, IPL, cosmetic lasers... they're all expensive.

8. Open your medical spa because you want to.
Starting a MedSpa is going to consume two things: time and money. The profit potential of a MedSpa is huge, but if you are not doing what you really enjoy, it will show on your bottom-line! As you will probably be spending more time and money than you originally planned, you need to make sure operating a Medical Spa is what you really want to do.

9. Don’t hire family and friends
They may be able to provide you with valuable assistance during the startup phase, but they most likely will not be able to get you to that next level. This is where having an experienced MedSpa director is very important. Not only are they going to hire and train your employees, but they also will be responsible for the day-to-day operations of the MedSpa. Hiring a competent MedSpa Director can allow you to run your MedSpa as a stand alone profit center; one that makes money whether you are there or not.

Posted via web from Laser Treatment MD

Dysport + Botox

Is Dysport the new Botox?

Dysport is often called the “New Botox.” However, Dypsort has actually been available in Europe for therapeutic indications since 1991 and for cosmetic applications since 2001. In April 2009, Dysport (officially known as BoNT-A/D) was approved in the United States for the “temporary improvement in the appearance of moderate to severe glabellar lines.” These are the lines between your eyebrows. However, just like Botox Cosmetic, Dysport can be used “off-lable” for treatment of crow’s feet (squinting lines around your eyes), forehead wrinkles, chemical brow lifts, platysmal bands (neck bands) and sweaty palms and armpits.

The molecule in Dysport is exactly like Botox Cosmetic but is covered by a different coating, which dissociates (dissolves) at a different rate. That is why the onset of action of Dysport is thought to be faster than Botox Cosmetic since the coating comes off faster. In Botox Cosmetic Treatment the usual onset of action is 3 to 7 days where the Dysport onset of action seems to be a few days faster. The dosing is different with Dysport, so there may be some confusion when translating Botox “units” with Dysport “units.” This is why you need to see an injector who has experience specifically in Dysport injections. Also, there is a learning curve with Dysport injections, so you may not initially achieve the same results as you are used to receiving with Botox Cosmetic.

There is also some confusion about the pricing of Dysport with many reports on the Internet and advertising claiming that it is cheaper than Botox Cosmetic. There is a discrepancy in the potency of units. A “unit” of Botox is not equivalent to a “unit” of Dysport, so unit pricing is not comparable. There is a slight savings with Dysport, but it is about 5% - nothing substantial. So, do not expect to go to your plastic surgeon, medical spa, laser center or skin clinic to achieve the same results as Botox Cosmetic for half the price. However, with competition, hopefully prices will come down. Allergan (Botox Cosmetic) is currently offering a $50 mail-in rebate for Botox Cosmetic customers and Medicis Aesthetics (Dysport) is offering a $75 mail-in rebate. With these rebates and introductory pricing, you may be able to get a better deal than your last injection.

In the end, it is great to have another minimally invasive product approved on the market which can give consistent and noticeable results with virtually no downtime and minimal risks.

via Medical Spa RX: Dysport

Posted via web from Medical Spa RX: Wholesale Botox

Medical Spa MD - Medical Assistant's can not inject Botox!

I've seen and head about medical estheticians, medical assistants and even front desk staff administering Botox injections at a laser clinic.

It's not legal, as this story on the prosicution of a medical assistant clearly shows.

Betty Guerra’s months-long nightmare is over.

The 45-year-old former medical assistant learned today from her attorney that the 10 felony counts against her on allegations of “unlawful practice of medicine” will be dismissed, she said.

“I always believed things would work out the right way,” she said tearfully. “I cannot be punished for something I didn’t do.”

Guerra’s July arrest sparked controversy over what medical assistants can and cannot do. Specifically, there was confusion over whether they are able to give shots.

Guerra was accused of unlawfully administering cosmetic injections, an act commonly performed by medical assistants throughout Nevada.

The state attorney general’s office did not specifically say charges against Guerra would be dropped but indicated it won’t be pursuing the case.

“The complaint against Betty Guerra submitted to the Attorney General’s Office by the Board of Medical Examiners has been contradicted by the subsequent actions by the Board,” Attorney General Catherine Cortez Masto said in a statement. “Therefore, it is fair for us to conclude that it would be difficult to prosecute this case beyond a reasonable doubt.”

Guerra’s attorney, Jason Weiner, said this evening that the attorney general’s office had sent him a copy of an unfiled motion dismissing the case earlier in the day. He would not be able to provide the Review-Journal with a copy of that motion until Wednesday, he said.

After Guerra’s arrest, physicians became concerned about what duties their medical assistants could perform.

Former medical board director Louis Ling said that upon reading a 30-year-old law, he concluded that the assistants could not give shots. With flu season coming on, he then attempted to draft emergency regulations that would allow them to give flu shots, but not Botox or other cosmetic injections.

However, that effort was shot down when a judge recently ruled that the board, in considering the regulations, had violated the open meeting law.

The board later reversed its position, determining that state law allows medical assistants to administer everything from flu shots to Botox. Medical assistants could give shots as long as they are under the “direct supervision” of a physician. Most health officials and doctors take that to mean the physician is on premises.

via medicalspamd.com

If you're a plastic surgeon or dermatologist running a skin clinic, laser clinic or medical spa (medspa) you might want make sure that your medical estheticans and medical assistants are well within the guidelines for their individual scope of practice.

Posted via web from Laser Treatment MD