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Saturday
Jun242017

Cutera Reviews: Buying Used Lasers & IPLs

Cutera is a major player in the cosmetic space with a number of platforms and systems:Cutera Coolglide, Cutera XEO, Solera Opus, the LimeLight IPL, ProWave Nd:YAG and Solera Titan. So what's Cutera's reputation with physians?

If you read the discussion threads on Cutera there are some positive opinions about the technology but there's a a lot of negative reactions to the company policies around sales and support practices. Much of it mimics these opinions in the comments on this Cutera discussion thread from way back in 2007: Is any Cutera technology work buying?

Many of the comments or reviews fall in to a couple of buckets that are recognizable and are often repeated; problems with the effacacy, pricing and costs too high, buyer felt lied to or misled by the sales rep (oversold and under-delivered), and the companies desire to lock in the buyer and extract every possible dollar. (We're working on series of posts and a guide to address all of these areas.)

Cutera's not the only laser manufacturer facing some negativity of course. All of the cosmetic laser companies have some issues that they deal with all of the time. In some cases it's unrealistic expectations from buyers but there's a lot of sales reps that aren't doing these companies any favors in overselling and promising revenue outcomes that are much more dependent on the buyers business sense and marketing that the IPL or laser they're buying.

Don't Buy New comments:

I'm new to this site and so happy to see that I'm not alone. Recently wooed into purchasing the Cutera Excel V (at a conference) BIG mistake. Free drinks, good salespeople, and me-new to industry, naive and inexperienced with lasers and zero business savvy. I was told by the speaker at the event, who was also a friend of a friend who I thought had my best interest in mind, that I was getting "the best deal the salespeople are allowed to give" for the demo unit at that conference. Paid $125,000, it broke on day of training and then 2 more times over next few months, and I did not see the results I expected. Long story short...after 6 months of minimal use, I am trying to get rid of the laser, have been offered $30,000 by 2 different laser re-sale companies! Called financing company Cutera had me sign with-Heartland (no options given and no discussion of terms) who informed me that my payoff is actually $170,000 with no ability to pay less early! Can't resell on my own because warranty doesn't transfer unless I pay Cutera another $30,000 to transfer ownership.

and from LH

... The only Cutera piece I still use is the 1064. I will never buy new from Cutera again. I may buy a used 1064 for 20 cents on the dollar or less. The secondary market is very crowded with Cutera products which continues to devalue them.

but one anonymous poster (sarah) said this:

As a Cutera owner I am shocked to stumble across this site. I have been working with this system 2 years. I have very satisfied patients, many of them are thrilled with the how much better the 1064 works for hairs than other treatments they have had elsewhere.  There the no equal to the 1064 for safely treating facial veins.
Also, anyone who is not getting great results with the Titan is just not doing right. I have people coming over from Thermage all the time. Just prepare your patients, doing this treatment to get great results comes with a lot of discomfort. 
Anyone complaining about a warranty... should have bought it at the beginning. My sales rep is amazing, we can always count on him to support our events and set up extra training whenever we feel under prepared.

In short, We love our Cutera system! It just took learning how to use it correctly.

My impression in reading Sarah's comment is that she is not the owner of the clinic or buyer of the system. (Just a hunch.) Most buyers are always talking about the business costs vs return rather than the personality of the sales rep.  : |

Notes: We allow anonymous comments on this site for obvious reasons but you might want to judge the voracity of those comments vs commenters who are identifying themselves (which you do when you login and comment.) All comments are individual opinions and don't necessarily reflect the views or opinions of others on the site. Make your own decisions.

Anyone have thoughts on the current state of Cutera's technology or sales practices?

Friday
Jun232017

Medical Spa MD Classified Ads 

We're re-launching the classified ads for cosmetic clinic owners to let you buy and sell your used devices. IPL's, cosmetic lasers, RF devices, services and even entire clinics have a place to find a new home.

The 'classified ad' section of the site was a great start when it was first launched years ago and we're happy to say that hundreds of lasers and IPL's and even cliincs transited the site, but truth be told, it's suffered from some neglect. Since it was free to post it attracted a fair amount of spam and junk. We decided that it was worth fixing, so we started fresh and revamped the site.

The new site (http://ad.medicalspamd.com) will now charge $10 for a 30 day listing and $97 for a full year. That should be enough to keep the spammers at bay but be negligable for members who are really looking to sell a device or service. After all, if you're selling a $90k IPL, a $10 classified ad listing is probably the best deal you're ever going to see. 

You can always access this through the "Classifieds" link in the main menu above. Additionally, we reserve the right to delete listings that we don't like for any reason or for no reason, especially if we think it's spam.

To create a classified ad and sell your laser or IPL.

To create a classified ad you'll have to create a new account since it's on a separate platform and manages a different system. (Sorry about that.) You'll be able to sort and filter depending upon what you're looking for since there are a number of categories; Cosmetic Lasers, Fractional Lasers, IPL, RF devices, equipment, business services, miscellaneous and even medspas and clinics for sale

Don't worry if there's not a massive selection right now. It will grow.

 

  1. Create a new account on the classifieds site: http://ad.medicalspamd.com
  2. Post your ad. (Make sure it's good if you want it to sell.)
  3. Go through the pament process.

That's pretty much it. You can log in to that account to change/edit your ad any time you want, and all payment and communications will take place outside of the system. (You'll be responsible for that after the initial contact.) Simple, simple, simple.

Notes:

  • Once we have a few ads up we'll be sending a selection from the classifieds out during our weekly emails to all members so we'll take care of that too.
  • We have members worldwide. Take that into account when you're browsing or selling.
Tuesday
Jun202017

Survey: The Cosmetic Clinic Consultation Blueprint

The money is a cosmetic clinic is made in the consultation room. We want you to make more of it.

Take this quick survey and help us build a blueprint of best practices for cosmetic patient consultations.

What do you say? What do you do? What tools, software, or photos do you use to educate your patients during a consultation? What's your teams process and training? What results or metrics do you track?

Patient consutations are where your clinic makes money. That's the truth. The services you then deliver are just a fulfillment of the promises and commitments you made in the consult room. So improving your patient conslultatons is something that you should be focused on as a clinician, and working to get everyone on your team behind. 

Help us build the roadmap to the perfect cosmetic patient consultation by taking this quick survey and telling us how you perform consults, what works, and what you've tried that doesn't. We'll compile all of the answers along with input from consult guru's and top performers to build a "cosmetic clinc consultation blueprint" that will be available to members to learn from and help train their team to up-level one of the most critical parts of your cosmetic business. 

Take this survey and share your thoughts. 

This survey has 10 questions and should take you just a few minutes. (We might even contact you for more info for the guide.)

Friday
Jun162017

Sex Sells: Vaginal Rejuvenation For Your Clinic Or Medspa

Vaginal rejuvenation is one area of cosmetic medicine where OBGYN's are actually leading the way. Surgery, lasers, filler injections, and RF tightneing are all being used. Should you take a look at adding labiaplasty, vaginoplasty, vaginal tightening or rejuvenation to your services?

OBGYN's have been making inroads into cosmetic medicine for more than a decade with some of the nonsurgical treatments (Botox, fillers, lasers) but the actually have a big head start on vaginal rejuvenation front and the laser and RF companies are increasingly marketing to them as a 'first choice'.

It's clear that female genital rejuvenation is in demand across the board and many clinics are adding it in some form to their services.

One study showed that women are being influenced by increased media attention to the appearance of their genitals. In the study, most participants (95%) frequently examined their own labia minora (LM). Almost half of the participants (43%) found the appearance of their LM important, and 7% had considered LM reduction.

If you extend those number just to your own patient base, you can see that there's plenty of demand if you're positioning and marketing these services correctly.

So what treatment options are available for most cosmetic clinics? Generally they fall into three areas; lasers (ablative and non-ablative), Radio Frequency (RF), and some different modalities around filler injections. Below is some information to get you started, but we'll be following up by providing in depth looks at individual devices, service histories, patient satisfaction and efficacy.

Lasers

Lasers are probably the the most common current treatment modality and we've included a list of some of the players here.

Laser-based devices

FemiLift
Alma Lasers
Fractional CO2 Laser 3 Tx at 4–6 wk intervals
MonaLisa Touch
Cynosure
Fractional CO2 Laser
3 Tx at 6 wk intervals
IntimaLase 
Fotona
2,940-nm non-ablative Er.YAG
2 Tx at 8 wk intervals
Petit Lady
Lutronic
2,940-nm Er:YAG
3 Tx at 2 wk intervals


Studies show a pretty good satisfaction by patients with these laser treatments. Ablative lasers (e.g. CO2 and Er:YAG) have lesser side effects based on different research (Vanaman et al., 2016; Karcher and Sadick, 2016). Many patients reveal their sexual activity has improved after the treatment and they are satisfied by the procedure. In one study that explored CO2 to treat-vulvo-vaginal atrophy, there was a 91.7% satisfaction rate among the participants in the study. In the studies we reviewed there are no significant reported complications with ablative lasers but lasers are highly dependent upon the skill level of the clinician so it's hard to say what those rates are in real-world environments.

Non-ablative lasers have shown efficacy as well, but there was one adverse effect: mucosal burn in one study, which eventually healed. We did look at another study that reported that lasers were effective, but a few of the study’s patients that opted out of treatment after a 24-week follow-up due to complications (Gambacciani et al., 2015).

Radiofrequency (RF)

RF is an alternative for lasers and show similar efficacy and patient satisfaction. There are a number of players who are offering this RF tech. (There are others that may not be included here for a variety of reasons.)

None of these treatments require anesthesia, and on average, the treatment duration spans 15 to 30 minutes. Patients report tolerable warmth but usually not pain. There's no down-time and patients can resume their normal activities the same day

Radiofrequency-based devices

ThermiVa
ThermiAesthetics
Temperature-controlled radiofrequency 3 Tx at 4–6 wk intervals
ReVive 
Viora 
Bipolar radiofrequency 4-6 Tx at 2–3 wk intervals
Venus Fiore 
VenusConcept 
Multipolar-radiofrequency with pulsed electromagnetic field 3 Tx at 1 wk intervals
Viveve System
Viveve Medical
Patented radiofrequency 1 Tx
Ultra Femme 360
BTL Aesthetics
Monopolar radiofrequency 3-4 Tx at 1 wk intervals
Pelleve 
Ellman International
Monopolar radiofrequency 3 Tx at 2–3 wk intervals


Studies here that show that it's a viable treatment modality. Patients responded well to the treatments - there were also some reported complications in these studies - but overall the results are similar that of with lasers.

Study: Radiofrequency treatment of vaginal laxity after baginal delivery: nonsurgical vaginal tightening.  Vanaman et al. 2016

Results: No adverse events were reported; no topical anesthetics were required. Self-reported vaginal tightness improved in 67% of subjects at one month post-treatment; in 87% at 6 months (P<0.001). Mean sexual function scores improved: mv-FSFI total score before treatment was 27.6 ± 3.6, increasing to 32.0 ± 3.0 at 6 months (P < 0.001); FSDS-R score before treatment was 13.6 ± 8.7, declining to 4.3 ± 5.0 at month 6 post-treatment (P < 0.001). Twelve of 24 women who expressed diminished sexual satisfaction following their delivery; all reported sustained improvements on SSQ at 6 months after treatment (P = 0.002).

Conclusion: The RF treatment was well tolerated and showed an excellent 6-month safety profile in this pilot study. Responses to the questionnaires suggest subjective improvement in self-reported vaginal tightness, sexual function and decreased sexual distress. These findings warrant further study.

Study: Vaginal rejuvenation using energy-based devices - Karcher and Sadick (2016)

Results: ...Results from the study showed that after 1 month, post-treatment self-reported vaginal tightness significantly improved in 67% of subjects and in 87% at 6 months. Mean sexual function scores also improved, and no adverse events were reported.

Lastly, in Fistonić et al.’s (2016) work, RF is effective also in non-invasive labial laxity. Similar to vaginal rejuvenation, it improved their participants’ sexual function and satisfaction.

Study: Monopolar Radiofrequency Device for Labial Laxity Improvement - Noninvasive Labia Tissue Tightening - Fistonić et al.’s (2016)

Results: An average 2.9 (of maximum 4) points improvement rate in vulvar appearance was observed (P < 0.01). Mean of the total FSFI score enhanced from initial 75–87% (P < 0.001). Resultant 4.7 (18%) points increase was achieved. Ninety four percent of subjects reported mild to none discomfort during the treatment. No adverse events during the study course were reported.

Conclusion The present study demonstrates the positive effect of focused monopolar RF device for non-invasive labia tissue tightening. The treatment is effective and safe with high patient satisfaction.

In a study conducted by Hamori (2014), the author suggests that three to four sessions per month shall be done to achieve best results and satisfaction.

Possible complications with RF? The reported complications of using RF however include leukorrhea and abdominal discomfort. According to studies, the efficacy of the RF treatment lasts up to 12 months.

Injectables: Filler injections, autologous fat injections

While less commonly used than RF and lasers, injectables treatments (hyalurnonic acid, autologous fat) are being used for genital rejuvenation. These are generally used to increase size of a specific area to decrease laxity rather than 'shrinking' tissue as with lasers and RF. There have been a number of studies on this and these treatments do offer some benefits; reversible, cheaper for patient, no technology costs for clinician.

Study exploring the use of HA for the labia majora: Labia Majora Augmentation with Hyaluronic Acid Filler - Fasola and Gazzola (2016)

Results: A total of 31 patients affected by mild to moderate labia majora hypotrophy were treated with 19 mg/mL HA filler; 23 patients affected by severe labia majora hypotrophy were treated with 21 mg/mL HA filler. Among the first group of patients, one underwent a second infiltration 6 months later with 19 mg/mL HA filler (maximum 1 mL).  A significant improvement (P < .0001) in GAIS score was observed, both in the scores provided by the patients and by the doctor. A greater relative improvement was observed in patients affected by severe hypotrophy. No complications were recorded.

Hexsel et al. (2016) also conducted a similar study using Macrolane VRF 20 (originally used to augment the breasts, which is discontinued by Q-Med due to the side effects). In their study, the researchers injected around 14 to 120mL of soft-tissue fillers on the labia. No adverse complications arose from the treatment.

There are some other treatments that also deserve mentioning here.

G-Spot Amplification: Supposedly a way of increasing sexual gratification, G-spot shots involve injecting HA fillers into that area to increase friction during intercourse. Other fillers (collagen, autologous fat, silicone) have been used but it seems that HA is the most common.

O-Shot: Something different here. O-shots use injections of platelet-rich plasma (PRP) injected into the clitoris and upper vaginal wall, intended to stimulate stem cells to grow new tissue. While there are some patients who express satisfaction, there's not been much study of this.

Most results lead to women feeling more satisfied about how their sexual activity became better, and sexual function has significantly improved. There is still a lack of reported outcomes regarding vaginal rejuvenation using fillers, but if you're in a situation where you're just investigating where these types of treatments might fit in your services offering, fillers may be a place to start.

Thoughts, ideas or comments welcome.

Wednesday
Jun142017

Survey Results: What Are Cosmetic Clinics Interested In?

What are cosmetic clinics looking for? Here's what they said.

A little while ago we emailed a survey to a few hundred physicians to try and understand what topics they were most interested in. (If you were one of the clinicians who responded; thank you.)  While some of the findings seem pretty straightforward. There were a few things that were suprising.

Below are the questions, response percentages, and some thoughts. Note: Not all responeses were from the same physician base.

What information are you most interested in?

No big suprise here. Most clinics think that they do a great job on clinical care and services, a passable job on business operations, but want to know how to get more patients. 

 

Would you pay for access to new staff (nonclinical) training programs?

Example: An online beginning training course for new staff members; sales, consultations, marketing, customer service, etc.

New staff onboarding is always problematic. Most clinics are small and just throw new staff into the mix to learn on the job, but that inroduces lots of slop in the system. We're going to look at how we might provide some services that help small (and big) clinics implement real operational systems.

 

Would you consider paying for an operations manual that you could customize to your clinic?

An editable operations manual that allows you to have written procedures for every appointment, job, and task in your clinic.

This question goes hand in hand with the question above. Clinic operations is often a week point and many physicians want an 'office manager' to just handle everything. (Read the free embezzlement and employee theft scams report to see how this can work out.)

 

Would you consider paying a flat fee of $399/month to have access to ongoing (and unlimited) marketing and advertising resources for your clinic?

For anyone answering yes to this question, check out Tea & Muffins or Frontdesk Marketing who provide advertising, marketing and design services for cosmetic clinics and advertise on this site.

Thoughts

The survey we sent out was in direct response to a number of inboud inquiries requesting some of these services. Knowing if there's real demand allows us to focus on providing information that's actually of use to our members (you). 

So, it looks like there's a fair amount of interest in all of the info/services above, and it's probably worth the effort to souce or find reputable businesses that can provide them. 

Note: If you're business that feels that you can address these areas, please contact us on our parnters page and let us know what you're offering.

Wednesday
Jun142017

Reversing Hyaluronic Acid Filler Injections With Hyaluronidase

It's possible that at some point in your cosmetic clinical career - for whatever reason - you might need to try and minimize or reverse the results of a HA filler injection.

Patient's have been know to 'freak out' when the big lips that they thought they wanted are actually the ones they see in the mirror. It can be something of a challenging conversation.

Fortunately, there's Hyaluronidase, and some researchers have found that even small amounts were effective in dissolving hyaluronic acid fillers.

In a study by Juhász et al. (2017), the researchers found that small amounts of hyaluronidase were effective in treating complications from hyaluronic acid (HA). The study focused on the degradation of HA, and different periods to see its efficacy. Randomized study participants were injected with a HA injectable; Juvederm Ultra XC, Juvederm Ultra Plus, Juvederm Voluma XC, Restylane Silk, Belotero Balance, Restalyne Lyft (Perlane), and Restylane-L. Then patients were injected with saline or 20 or 40 unites of hyaluronidase and monitored over 14 days. 

The results showed that haluronidase was effecive in degrading the filler and that there was no decernable difference between the 20 and 40 unit injections. (So you don't have to use much.)

Here are the findings:

  • Day 1 Post-Injection: JUVEDERM ULTRA PLUS, JUVEDERM VOLUMA XC, RESTYLANE SILK, BELOTERO BALANCE, RESTALYNE LYFT (PERLANE)
  • Day 2 Post-Injection: JUVEDERM ULTRA PLUS, JUVEDERM VOLUMA XC, RESTYLANE SILK, BELOTERO BALANCE, RESTALYNE LYFT (PERLANE), RESTYLANE-L
  • Day 3: JUVEDERM ULTRA PLUS, JUVEDERM VOLUMA XC, RESTYLANE SILK, BELOTERO BALANCE, RESTYLANE-L
  • Day 4: JUVEDERM ULTRA PLUS, JUVEDERM VOLUMA XC, RESTYLANE SILK, BELOTERO BALANCE, RESTALYNE LYFT (PERLANE)
  • Week 1 Post-Injection: JUVEDERM ULTRA PLUS, JUVEDERM VOLUMA XC, RESTYLANE SILK, BELOTERO BALANCE
  • Week 2 Post-Injection: Everything except JUVEDERM ULTRA XC

The researchers also found that dermal fillers like Juvederm Ultra Plus and Restylane-L had a higher concentration, which took longer to dissolve with hyaluronidase, while Belotero Balance was the quickest to degrade.

Previous studies have only given their recommendations on the number units of hyaluronidase, based on experience or training. However the 2017 study presented their recommended dosage in degrading the HA. The authors suggest that a 20 unit injection of hyaluronidase is an effective way to degrade the HA.

One possible complication from using hyaluronidase is an allergic reaction. For patients who incur any allergies from hyaluronidase, there are other treatments for HA complications.

It's highly advisable to conduct allergy testing for patients before administering the dermal filler, which could reduce the incidence of complications. Ablon (2016) reminds medical providers in cosmetic medicine to observe the tissue as the dermal filler is injected.

Monday
Jun122017

Physician Depression, Suicide, & Burnout

Last year more than 62,000 medical professionals and their families signed a petition asking medical associations to track physician suicides and address factors common in healthcare environments that cause psychological distress.

There's an epidemic of depression and suicide among physicians. It's no joke.

The grim tally of suicides among physicians and medical students - 300 to 400 - in the US is probably low (since many suicides aren't listed as such on death certificates). It's about the size of the average medical school class. Male doctors are 1.4 times more likely to kill themselves than men in the general population; female physicians, 2.3 times more likely.

In one study, nearly 1/4 of med students reported significant symptoms of depression, and 7% had suicidal thoughts in the last two weeks.

Pam Wible MD on Why Physicians Kill Themselves TED talk.

Know this: You're not alone.

Friday
Jun092017

Teens Are Getting Cosmetic Surgeries To Avoid Bullies

We're seeing a rise in the number of teens getting cosmetic surgery as a reaction to external stressors like bullying and social media.

Cosmetic surgery centers have seen a rise in teens seeking cosmetic surgical solutions. For some, it's somewhat aspirational, looking to try and improve what they see as a shortcoming or achieve a specific aesthetic. For others there are darker reasions like bullying.

In a study by Lee et al. (2017), bullying is one of the main factors in teenagers getting cosmetic surgeries. The researchers found that bullied teens can have long-lasting trauma that lead to a desire to change their appearance.

One example: Ear surgery is consistently...

Click to read more ...

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