There's a New Yorker article detailing the commencement address Atul Gawande Atul Gawande delivered this commencement address, titled “Money,” to the graduates of the University of Chicago Pritzker School of Medicine. It expands on the themes he touched on in his recent article about health-care costs in McAllen, Texas, which figured in President Obama’s speech on health care.
The text of this speech is available in this Medical Spa MD: best medical spas?
The political aspects of health care reform march on.
Watch for these red-flag phrases that suggest your “skin-care specialist” is subpar, says San Francisco ophthalmologist Krista Ramonas, MD, who has treated medical and aesthetic patients for six years.
“You’ll look 20 years younger.”
Beware the cosmetic doctor who overpromises, Ramonas says. Instead of flattering you, he should be discussing what you can reasonably expect from the procedure and addressing possible side effects.
“I’m an artist.”
The prima donna who tosses this phrase around may value her vision over standard operating procedures. “There is a little bit of art to it,” Ramonas points out, “but there’s a lot more science. We have certain parameters we all have to follow.”
“I’m so good, I’ve never seen complications.”
That may be code for “not very experienced,” Ramonas says. “Medicine is always about being prepared for complications.” You need a doctor who can handle the unexpected.
Of these, the greatest is the 'Artist'.
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.
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.
Medical spas in the US and elsewhere have increased in numbers and are popular as medical tourism destinations. Several countries have reported problems of medical spas undertaking medical procedures that neither the spa nor the staff are qualified to do. Unfortunately, this reflects badly on the majority who are professional. They have tended to fall between the gaps in legislation, but one of the first countries seeking to remedy that is the USA. Nationally, the number of medical spas around the country has grown from 500 in 2004 to 2,500 today. If this growth rate continues, more states will follow the four who are preparing regulations, and almost every sate has discussed the idea.
According to the International Medical Spa Association, the official definition for medical spa is a facility that operates under the full-time on-site supervision of a licensed health care professional. The facility operates within the scope of practice of its staff, and offers traditional, complementary, and alternative health practices and treatments in a spa-like setting. Practitioners working within a medical spa will be governed by their appropriate licensing board, if licensure is required.
The death of a nurse, who had a liposuction procedure performed, has raised concerns over the safety of medical spas to the level that several states are progressing legislation. The proposed legislation is now travelling through several state medical boards in Massachusetts, New York, Florida, and Utah. Proposed legislation would require owners of medical spas to have certain credentials, dictate which procedures can be performed, and set a minimum level of training for those performing particular procedures. Legislation does not want to stop consumers having medical procedures in spas, but to ensure that the procedures are performed safely and by someone with the correct training.
The concern of cosmetic surgeons is the lack of training or experience of some employees at medical spas. An employee of a medical spa may start out performing one procedure and move to another more difficult procedure without much experience. Indeed, lack of experience with certain medical procedures has resulted in serious consequences for some customers, but more common is minor problems such as second-or third-degree burns from improperly conducted laser hair removal procedures.
Medical spas in the US offer treatments including laser hair removal and liposuction, as well as massages and other traditional spa treatments. The types of procedures performed in medical spas have expanded to include chemosurgery for skin cancer and reconstructive surgery.
Massachusetts health officials want to crack down on medical spas, following the lead of Florida, which has been preparing legislation for three years. In Massachusetts a medical spa task force has been set up to advise the state legislature on how best to regulate the facilities. It would prefer a system of federal regulation of medical spas as it would be more cohesive than a state-by-state model but believes that is unlikely to happen, as medical and other professional boards, like nursing, electrology and aestheticians boards, are regulated and licensed by individual states. But the government has just decided to take insurance regulation away from states into a national body, so national regulation is a possibility. The task force has proposed that spas be required to get licenses from the Massachusetts Department of Public Health, and recruit a physician or nurse with special training to remove age spots or tattoos with a laser. Non medical practitioners - cosmetologists, electrologists, and aestheticians - will be allowed to remove body hair using a laser, but only after special training and certification. The task force reported that doctors and other professionals not specifically trained in dermatology have begun offering laser skin procedures, presenting an unacceptable risk to patients.
Regulating medical spas is complicated because they combine many different professionals under one roof, including cosmetologists, electrologists, aestheticians, nurses, and physicians. In most US states each of these professions is licensed by its own board, and each has its own standards. There are no overall regulations governing who can do certain cosmetic procedures and what type of training is required, and there is no requirement that medical spas be licensed.
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.
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 SyringeThis 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 pattern3) I ONLY use the 1/2 inch needles in all my injections4) 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
Something worth knowing. How is your plastic surgeon or dermatologist communicating with other physicians to keep abreast of the latest information about treatments?
Here’s an overview of Active FX and some links to more information.
The goal of laser skin resurfacing is simple: replace damaged skin with new, fresh skin. Techniques for skin resurfacing have made enormous advances, allowing nearly everyone to achieve close to flawless complexions. Many systems allow for light, moderate or deep laser resurfacing. The primary targets of laser skin resurfacing include:
How it Works
The gold standard of laser resurfacing systems, the UltraPulse® CO2 laser delivers thousands of tiny laser pulses in a pattern over the skin. Each pulse heats a column of tissue eliminating pigment discolorations at the surface and creating a zone of heating deep in the tissue. Unique to the UltraPulse Encore, these zones of heating shrink collagen and tighten the skin immediately*. The CO2 laser also offers the benefits of heating deeper layers of skin tissue, thereby stimulating collagen remodeling, tightening* the skin further. Patients can select from a range of treatments depending on the needs of your skin and lifestyle.
What is ActiveFX “fractional” laser resurfacing?
ActiveFX is a fractional laser procedure performed in a single treatment with minimal patient downtime. During the procedure, a high-energy beam of laser light is used to smooth out lines, wrinkles and scars, remove brown spots and other irregularities, and tighten the skin. It also stimulates formation of new underlying collagen to continue improvement over time. With fractional laser treatment, only a fraction of the skin’s surface is treated by the laser, leaving small “bridges” of untouched skin. This technique makes the healing process much faster and enables you to get back to normal activities sooner.
Is ActiveFX right for you?
Treated areas should be washed twice a day with cool water and a mild soap. Use our lotion twice daily to treated areas for 3 to 5 days or until healing is complete. Treated areas should be protected from direct exposure to sunlight. Sunscreen with SPF greater than 15 should be used at all times on the treated areas.
ActiveFX is ideal for you if you:
What you can expect from ActiveFX
Most physicians perform the procedure in the office with a topical anesthetic cream that is applied 30-40 minutes before the ActiveFX procedure begins. There is little to no pain associated with the procedure – most patients say they feel warmth similar to sunburn. You can drive yourself home after the procedure. With a gentle washing and moisturizing regimen, your photodamaged skin will begin to flake off within 2 days. After about 3-5 days, your doctor will probably let you wear make-up. Pinkness should be gone in about a week.
ActiveFX treatment produces a dramatic effect on the skin:
The results of ActiveFX laser treatment are long-term and, with proper sun protection, can persist for many years. Most effects of treatment become visible right away, whereas others – such as new collagen formation, which leads to continued inner tightening – build up gradually and become more evident over time. Therefore, most people look even better 3-5 months after the procedure.
Additional Information on ActiveFX
http://www.aesthetic.lumenis.com/wt/page/activefx
http://www.lumenis.com/wt/page/pr_1170434066
http://www.skinandhealth.com/details/wrinkles_treatment#wrinkles_co2
Redness after IPL & Laser Treatments: DeepFX & ActiveFX
Reliant UltraPulse Fractional CO2 Laser
Active FX: Physician User Group ~ Medical Spa MD
Some fantastic info on Active FX laser resurfacing from Botox Patient. Love it.
In this article, I will give you several tips and tools to evaluate your laser centers culture and operations, so you can successfully navigate any economic downturn… And live to sell another day when the inevitable upturn comes around.
What is the Passion and Purpose of Your Medical Spa?
You reap what you sew. When you engage proactively and passionately in your business you will undoubtedly be successful and see your practice expand. It helps to articulate your passion for your medical spa.
At Assara Laser, our passion is to “help clients look and feel great, not fake.”
Why the Recession Drastically Affects Your Laser Clinics Bottom Line
You’ve probably noticed that generating revenue is not as easy as it once was. There are myriad reasons for this; from the decline in disposable income, to unemployment hitting record highs and tanking real estate valuations. As if these facts were not bleak enough, credit markets are virtually frozen so business owners are finding it nearly impossible to obtain small business loans and lines of credit. Refinancing current loans has become difficult for small businesses.
In short, we're operating in the perfect storm.
Accepting Reality and Responsibility Today
The easy way out is to close up shop and blame the recession. This will not help you going forward, it will not pay your devoted employees their wages, and most of all, it will not help your clients “look and feel great, not fake.” So, accept responsibility.
The hardships of the recession create a fact-pattern, problem to be solved; not a reason for failure. To paraphrase Michael Jackson, start, first, with the man in the mirror. Think about the following questions. And pay attention - there will be homework at the end of this article!
Finding Your Medspas Winning Competitive Difference?
Let’s be honest. The quality of your laser clinc's treatments are probably not drastically better than that of your competitors. The proprietary equipment and IPL or laser systems (Thermage, Fraxel, Titan) that you use are, for the most part, available to the competitive skin clinic market at large.
You may believe (and tell clients) that your microdermabrasion treatments are better because you use a diamond-tipped wand or aluminum oxide crystals. You may think that your IPLs or laser hair removal treatments are better because you use cryo-cooling or because you use chilled air cooling, or because you use a diode laser or because you use alexandrite lasers . . .
BUT . . .
Step in to your clients' shoes. To them, the bells and whistles of your Thermage or Fraxel device don't matter. Your clients already expect expert advice and cutting edge cosmetic lasers, IPLs and skin tighening equipment, so merely meeting this fundamental requirement is not a winning competitive difference.
What does matter to your clients are presentation, client interaction, customer service, reliability and consistency. Consider this carefully.
What is each of your medspas clients worth?
At Assara Laser, one of the most popular packages is our $449 per month Unlimited Laser Hair Removal Program. On average, a client that signs up for this program will remain a member of the Program for 7 months, depending on the results they wish to achieve. How much is a single unlimited client worth to us? A client in the program for 7 months, making a monthly payment of $449 is worth $3,143. For many laser clinic owners, a single laser hair removal client is worth more than a home mortgage payment!
Do you treat every single potential laser treatment client that contacts your laser clinic as if they’re worth $3,000?
What is your time and effort worth?
Before my partners and I built Assara Laser, I was an attorney. I still practice corporate law as a labor of love, when a friend or business contact has an exciting deal. I normally discount my rate to about $400 per hour, as law isn’t my primary source of income.
Assume an hour of your time is worth $400. Assume further that, every time your customers complain, you are willing to give a discount, or a free treatment and that, collectively, free and discounted treatments account for a 20% loss in your revenue. To make up for this lost revenue, how much more work do you have to do?
Well, let’s add 20% to your 10 hour day, which now makes it a 12 hour day. If your annual sales are say $1,000,000 per year, you’ve lost $200,000. This translates into 500 hours more of work you must do to bring your revenue back to status quo!
Is there a big difference between a day that starts at 9:00 a.m. and ends at 7:00 p.m. versus ending at 9:00 p.m. You betcha there is! Is there a big difference between a loss of $200,000 and a loss of zero. You betcha there is! And these differences drastically affect your quality of life.
How Do You Avoid Mistakes?
Mistakes are costly. A happy client is worth more than $3,000, and will likely refer business, the best and cheapest form of marketing. A single angry client will result in you working 2 hours more per day for the following seven work days, and will possibly diminish your reputation by badmouthing your medspa.
A lot of people think excellent customer service means free treatments. It doesn’t. Excellent customer service means delivering what you promise. You know the limitations and effectiveness of your treatments so promise only what you can deliver and do it consistently, with a smile on your face!
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.
Botax coming to a medical spa near you.
For those of you that have had problems with Cynosure there is help, for those that do not or have not had problems you are lucky. Not all of Cynosure service department is bad, there are a few good technicians and some that are just there for a job.
Cynosure hair removal lasers are very good if maintained properly. There are few things that you must be aware of:
If you are thinking of having your Cynosure laser service by a third party company, just remember not everyone can work on them, even some of the manufacture’s technician have problems working on them. There are many after market parts available as well but you get what you pay for. Would you take your Mercedes to Bob’s Auto for service? I know of only a couple technician outside of Cynosure who can repair them. We make sure that you get what you would expect from the manufacture.
If you are thinking of purchasing a used Cynosure laser or other cosmetic laser, please have a technician that knows the laser look at it for you before you put any money down. Would you buy a used car from a fly by night dealer without having your mechanic look at it? I have seen and heard every nightmare you could think of, I have also seen some very good deals. I had a lady call me that purchased a laser that had blown the power supply on it 2 weeks after purchasing the laser. That same laser was about to be sold to a customer of mine that wanted me to help him find a laser. I told him that this laser in poor shape and that it would need very costly repairs. I was not surprised when the lady called me and gave me the serial number of the laser. It does not cost to get a second opinion on something that could save you in the long run.
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.
An estimated 100,000 cosmetic surgical procedures are performed in Britain each year, many by doctors who have had no specialist training in cosmetic surgery. In addition, hundreds of thousands of non-surgical procedures are done, including Botox for wrinkles and laser treatments to rejuvenate skin, many by non-medical staff with little or no training.
The 200-member Baaps represents the top surgeons in the business who performed 34,187 surgical procedures in 2008, twice the number in 2004. More than 90 per cent of them were on women. The most popular procedure was breast augmentation, demand for which rose 30 per cent last year.
But Mr Mercer, who combines private practice as a cosmetic surgeon specialising in facelifts with his work as an NHS consultant in reconstructive surgery for cancer patients, said the market for cosmetic surgery, of which Baaps surgeons account for less than one third, was an "unregulated mess".
He added: "There has been a massive increase in marketing, including discount vouchers, two-for-one offers and holidays with surgery. In no other area of medicine is there such an unregulated mess. What is worse is that national governments would not allow it to happen in other areas of medicine. Imagine a two-for-one advert for general surgery. That way lies madness."
Mr Mercer, in the journal Clinical Risk, which publishes articles on cosmetic surgery today, he warns that "the doctor's first duty to protect the patient" has been forgotten in the headlong rush to cash in. "The motive for performing any procedure must never be financial gain ... if we cannot self-regulate then regulation will eventually be imposed."
Citing experience in France, where all advertising of cosmetic procedures is banned, he says: "Perhaps, like tobacco, there should be a Europe-wide ban on advertising all cosmetic surgical procedures, including on the internet search engines."
Among those who can testify to the dangers is Jill Saward, the former lead singer of 1980s group Shakatak, who last year agreed to a facelift in the hope of reviving her career after her divorce. But she suffered complications aggravated by her high blood pressure and bitterly regretted the decision. Three months after the operation she still did not have full feeling and was warned full recovery could take a year.
"Surgery is not a quick-fix solution," she said. "The simple truth is that I could have died. I was an idiot, I should have thought much more carefully about the operation and its dangers. It was pure vanity."
Foad Nahai, president of the International Society of Aesthetic Plastic Surgeons, backed Mr Mercer's warning, and called for tougher regulations to prevent doctors practising without specialist training. A code of practice backed by self-regulation of cosmetic clinics was announced by the Government in 2007. Clinics are also subject to inspection by the Care Quality Commission. But Baaps says the measures do not go far enough.
Medical Spa MD today announced that it has selected Sendside Networks as it's exclusive member communication platform. A secure replacement to email, Sendside offers a 1:1 secure sales communication platform that offers high touch interactive messaging and real-time reporting and control for mission-critical communications in a secure environment.
"Sendside is the only solution that addresses our need to communicate easily but still allows us to protect confidential information," said Jeff Barson, Editor of Medical Spa MD.
"Unlike any other technology, Sendside gives us the ability to send interactive tabbed messages that allow recipients to fill out forms and actually make purchases 'inside' the message, without being redirected to an external link from an email. This gives us the ability to actually send the entire Medical Spa MD site directly through a message while retaining control and accessing all of Sendside's analytics and real time reporting.
For the first time we can see exactly who has read a message, downloaded and attachment, or forwarded a message to a collegue, providing us with an inside look at what a recipient is doing and offering a perfect opportunity of knowing when to send follow-up information.
The cost to create and send this type of content would be cost prohibitive using any other solution.
Best of all, it's free for the recipient and as easy to use as web based email."
Medical Spa MD is currently using Sendside to communicate with thousands of plastic surgeons, dermatologist, and cosmetic physician members around the world.
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ABOUT SENDSIDE NETWORKS, INC.
Utah-based Sendside® Networks, Inc. has developed Sendside—the 1 to 1 Sales Communication Platform that provides organizations a secure, interactive communications channel directly to their customers, prospective customers, clients and investors. Sendside combines secure, interactive messaging with file delivery, interactive forms, e-signatures, payments, and secure storage into a comprehensive communication and interaction platform unlike anything on the market today. Sendside currently has fifteen U.S. Patents pending including Sendside Markup Language (SML), Behavior-based Messaging (BBM), Multi-dimensional Messaging (MDM), Sendside eSign, on demand messaging, embedded payments and acknowledgement. www.sendside.com
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.
Medical Spa MD has been chosen by MAPA - The Medical Aesthetic Practice Association as the exclusive technology platform for MAPA Members.
“This is a great day for MAPA”, explained Dr. Epstein. “Medical Spa MD has been a pioneer in information exchange within the cosmetic medical field for years now. His MedicalSpaMD.com Internet Website & Blog has already advance our knowledge by quantum leaps. Combining our manpower, our experience and our content with his robust internet platform will take us even further.”
The Medical Aesthetic Practice Association was formed in response to a need for information sharing in the Medical Aesthetic Practice area. The Medical Aesthetic Practice Association (MAPA) is THE Clinical and Business Information Exchange Forum for Aesthetic Medical Practices and their business and clinical staff.
Jeffrey E. Epstein, MD, MAPA’s founder and Executive Director explained the need and the purpose of MAPA, “the Medical Aesthetic Practice Association’s purpose is to promote and facilitate information exchange among Medical Aesthetic Practices. By sharing our ideas, experiences, opinions and insights, we can learn faster and benefit from each other’s successes and failures. In order to facilitate the convenient and high volume exchange of advanced business and clinical information, MAPA provides Internet Based Platforms for Medical Aesthetic Practice Owners and their Clinical Staff. MAPA also hosts live discussions in their Chat Rooms on a regular basis to promote real-time discussion about important, topical issues.”
MAPA & MSMD will soon have in excess of 2000 (two thousand) members. MAPA currently has Fifty Diamond Club Members who produce content and manage daily activities.
MAPA is planning on hosting their third clinical exchange meeting this Spring at the Cherry Hill Physician Training and Research Center. The meeting held in November 2008 was a huge success. There is no cost to attend these meetings. MAPA will also be meeting at this years ASLMS Conference in Baltimore, MD the first week in April.
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ABOUT MAPA
The Medical Aesthetic Practice Association’s purpose is to promote and facilitate information exchange among Medical Aesthetic Practices. By sharing our ideas, experiences, opinions and insights, we can learn faster and benefit from each other’s successes and failures. In order to facilitate the convenient and high volume exchange of advanced business and clinical information, MAPA provides Internet Based Platforms for Medical Aesthetic Practice Owners and their Clinical Staff. MAPA hosts live discussions in their Chat Rooms on a regular basis to promote real-time discussion about important, topical issues.
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.
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!"
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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:
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.
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.
Is click fraud costing your laser center or medical spa and driving up your prices? If you’re one of the tens of thousands of cosmetic medical practices, laser clinics and med spas advertising online with Google Adwords or Yahoo, don’t be surprised to find that at least some of the money you’re paying every month is sucked out of your marketing fund by click fraud.
The practice of “click fraud” began in the early days of the Internet’s popularity with software programs that automatically surfed Web sites to increase traffic figures. This led companies to develop policing technologies touted as antidotes to the problem. (Some marketing executives estimate that up to 20 percent of fees in certain advertising categories continue to be based on nonexistent consumers in today’s search industry.)
Don’t think it’s already happening to your skin clinic, med spa or laser clinic? Here’s a recent quote from Michael Caruso, CEO of click fraud services vendor ClickFacts in an interview:
“In particularly fraud prone verticals such as finance, class action lawsuits and medical, we see click fraud rates in the 30-45 percent range. These are all categories that see high keyword pricing in the auction model. That makes them particularly tasty for click fraud artists. “If you can make more money from the dark side than the light side of search, there are plenty of people who will take advantage. Plus, it’s not even technically illegal yet.”
There are two main ways that your skin clinics and medical spas marketing budget is being drained by click fraud:
First, your medical spas and laser clinics competitors who see your ad are simply clicking on it, draining your marketing budget and costing you advertising dollars. Second, fraudsters set up ‘affiliate sites’ that run skin clinics ads where they are clicked on by bots or employees. (These sites are the most damaging since you’re paying for every click without any return at all. Click fraud around skin clinics, med spas or laser clinics can be very lucrative since dermatology or plastic surgery clinics are becoming such a competitive market and the payment per click can be as high as $4-6.)
Unfortunately, to keep your laser centers budget safe you have very few tools. (Google just gave advertisers $90 million to compensate for click fraud as the result of a class action suit but you can bet they’re not that Google’s not interested in your individual account. Especially since they’re making money from click fraud when your ads are clicked on.)
Start by limiting your laser centers exposure. If your dermatology or plastic surgery clinic is still running an Adwords or Yahoo campaign, they allow you to limit the maximum amount you spend in a day. Take advantage of this feature by limiting your maximum cost to what you can afford to spend. You can also look for the tracks of click fraud by examining the reports you might have available to you. Multiple clicks coming from the same IP address are a sure sign of fraud. (Malaysia has become such a haven for click fraud around medspas and IPL laser treatments.)
If you’re going to run ppc ads, protect your laser center, med spa or laser clinic. You can be sure that you’re the only one trying to.
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.
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.
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.
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.
There's a new pharmacy from Canada offering wholesale Botox, Restylane and Juvederm to the worldwide market. It's associates with Medical Spa MD.
Medical Spa MD will also be publishing a training manual for medspa staff members: IPL & Laser Training for Non-Physicians
