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Lumenis: LightSheer, AcuPulse & UltraPulse > Lumenis: The SKoop

Lumenis recently fired Dale Koop, Senior Vice President in charge of their World Wide Aesthetic Division, because he was terrible at what he did. I asked him a simple question about his laser and he never answered the question. He ignored me, he sent me on wild goose chases and he lied to me. I began to blog about this situation. It was very embarrassing to Lumenis and their top executives. Now he has been fired. There ARE consequences. Even for top Laser Executives! There is a NEW paradigm in the Cosmetic Laser World.

Recently I asked Robert Mann (Former President of Lumenis North America and now General Manager of World Wide Aesthetics) and Dov Ofer (CEO of Lumenis World Wide) to answer another question about my Lumenis UltraPulse Fractional CO2 Laser. I promised them that if they did not answer the question, that I would resume my blogging.

They have not answered the question and it seems they are not planning to answer the question. Therefore … I blog … again …

I will outline the issues in my next post.

I would love to discuss this in this public forum with Robert and Dov. I hope they will join me and explain why they won’t answer my question. I am sure they will accuse me of threatening them. They will accuse me of being an extortionist. They will do all they can to muddy the waters and deflect attention away from the main issue at hand. They will send their surrogates to blog about me in negative and untrue ways. I don’t mind. I know what I am doing. I am passionate about high quality medical care and I am passionate about patient safety. My issues are important. What I say is true.

Robert and Dov are business and marketing guys, they are not doctors. I don’t think Lumenis has a medical doctor on their staff (I never spoke to one and I was never told about one). It seems incredible to me that a Medical Laser Company would not have a medical doctor on their staff to help guide the business guys! Robert and Dov don’t understand patient safety and they don’t understand quality medical care, yet they decided that my question was not important and they decided that my question did not matter.

I am putting this on the blog because I want you can be the judge as I outline my most recent problems with these Top Laser Executives at Lumenis.

I kind of like these guys – Robert & Dov. They seem nice and they are very charming. I am NOT SURE if they “just don’t get it”, they “just don’t care” or they think I am an annoying, stupid idiot who has to be taught a lesson (the way the teacher ignores the kid who asks too many questions). In my opinion, their lack of action and lack of support impacts significantly on patient safety and quality of care (especially in users who are much less experienced than me). This is unacceptable and cannot be tolerated.

My next blog entry will outline the issues and the question. The whole situation brings up important questions about the judgment and leadership ability of the top executives at Lumenis AND it brings up important questions about the “corporate culture” at Lumenis (maybe the problem was NOT Koop, maybe all their executives are arrogant, smug and clueless).

I am sending a copy of this post directly to Robert Mann and Dov Ofer. I hope they will respond to me on this blog and I hope they will stay focused on the question that I asked and explain why they have not answered it.


I asked Robert Mann and Dov Ofer to collect the techniques and settings that their top ten experts were using so that we could examine these techniques and settings. They would not do this. They had other projects which they thought were more important. These other projects ARE NOT MORE IMPORTANT. I will explain in my next post.

Clinical variation in surgical or laser techniques is NEVER a good thing unless that variation is necessary and it is understood. You can check the cardiac bypass literature for an in-depth discussion of this issue. You can also check “Total Quality Management Theory” for an in-depth discussion about VARIATION.

There is a tremendous amount of variation in the laser settings and techniques used when using the Lumenis UltraPulse Fractional CO2 Laser. We are taught that we can use different settings and different techniques but we are not told which is better or which to use in different clinical situations. We are told (by Lumenis) that no one knows the best technique, so you just have to pick and choose blindly. I guess we are supposed to experiment on our patient’s faces - trail and error! This is really a good idea (sarcastic tone). My questions is, “why isn’t Lumenis right on top of this, helping us get the best outcomes with the lowest risk of complication”?

The Top Experts (Fellowship Trained Cosmetic Dermatologist at the Top Medical Schools) use different settings and techniques. These top experts have not discussed their clinical variation and they have not made informed decisions (based on discussions with their colleagues) about which technique is best or which settings and techniques are better.

I asked Robert Mann and Dov Ofer to collect the techniques and settings that their top ten experts were using so that we could examine these techniques and setting (it would be even better if they collected more techniques and settings). My thought was that we could learn a lot from this exercise, we could improve our personal techniques and we could begin discussing the pros and cons of the various techniques and settings. I thought that a discussion among these top experts would lead to innovation and improved techniques and that input from busy community clinicians like myself would add to the discussion.

I am convinced that this needs to be done ASAP. I am not happy being given a number of techniques to use without any attempt to determine which techniques might be better than the others. The current state of VARIATION in UltraPule Techniques is unacceptable and can lead to poor clinical outcomes and it is not SAFE for patients.

So … Robert and Dov … why won’t you do this?

Robert and Dov did get THREE opinions and from these three opinions we now know that this “variation problem” is worse than I originally thought.

Robert and Dov, now that we know that one of your experts thinks that DeepFx Density 4 is 20% Coverage and another thinks that it is 100% (fully ablative) Coverage, doesn’t that concern you? Is DeepFx Density 4 - 20% Coverage or is it 100% Coverage?

Robert and Dov, why do some of your experts use Density 2 and others use Density 4? Why does one expert switch “CoolScan” to the OFF position when he does under the eyes? Why does one of your experts “DOUBLE PULSE”? Why does one of your experts do “DOUBLE PASSES”?

Robert and Dov, you wouldn’t answer my questions before. I hope you will now answer my questions now that you have a wider audience.

Please explain to everyone why a prospect should buy YOUR laser when you don’t know how to use it and you don’t care to learn?

This was my questions and this is my issue currently with Lumenis.

I look forward to the day (very soon) when we all know what settings and techniques the top experts us and we have heard them discuss the pro and cons of these various techniques AND we have their recommendations about settings and techniques we should use in our busy community practices!

And, by the way … for all of you “art of medicine” idiots … the art is 5% and the science & technique is 95%. You need to know the science before you can take it to the next level which is “the art”.

And, by the way … for all you “medicine is not cookbook” idiots …all great chefs start by studying and learning from cookbooks. Then they take it to the next level which is the art of cooking. All great doctors learn from mentors and textbooks and they some take it to the next level which is “the art”.

So don’t give me the “art of medicine” argument or the “medicine is not cookbook” argument. I don’t buy into those intellectually lazy, disingenuous & self-serving arguments.


I would guess that Lumenis, Palomar, Cutera and the rest don't actually know what protocols are actually used by their top docs.

I would guess that these physicians want to be paid to reveal this information and keep it from the tech providers. This is a commercial endeavor and this type of information has commercial value. While Lumenis and Palomar have responsibilities to their buyers, they also have responsibilities to their shareholders. They are not and should not be responsible to every physician demand for information. That's a customer service issue.

They may not like the your public griping, but they have a business to run. Perhaps you should switch to another provider. The physicians that you're demanding information from won't be in any hurry to share it.

Perhaps you should contact these physicians directly and ask them for their trade secrets. Good luck with that.

02.15 | Unregistered CommenterLMD

I strongly believe that it is the company's duty to provide the information to the physicians. Afterall we (physicians and laser companies) all want to deliver good results to our patients.As they invest money for R & D, to bring out new and improved technologies, they should invest in this as well. They are already making huge amounts of money on machines that cost them a fraction from the actual selling price. Dr Epstein, keep up the pressure; there is only one way to go forward.

Stav

02.15 | Unregistered CommenterStav

Go get 'em Jeff!

02.15 | Unregistered CommenterTF

Hi LMD,

Good points but I don't accept any of those EXCUSES. If a Laser company sells me a $175,000 Laser, they have an obligtaion and a duty to teach me how to use that laser and use it well. They have a duty and an obligation to learn how best to use their laser and then teach it to their customers. They have a duty and an obligation to make sure their treatments are SAFE and EFFECTIVE. Quality of Care and Patient Safety (ever learn about these concepts in executive school - Robert and Dov?).

The experts give their settings, techniques and insights freely when they are being paid to do a Webinar or Meeting. If they have to pay for this information, then let them pay. I don't care how they do it, I just want it done. NOW.

Robert Mann and Dov Ofer JUST DON'T WANT TO DO IT. I am not sure why. My prediction is that it WILL be done very soon. Robert and Dov just want to be beat up a little bit before they give in and admit that I am right (again). I am happy to provide the spanking. See you all tomorrow!

"...they have an obligation and a duty to teach me how to use that laser and use it well. They have a duty and an obligation to learn how best to use their laser and then teach it to their customers. They have a duty and an obligation to make sure their treatments are SAFE and EFFECTIVE..."

I find myself in agreement mostly with LMD. I would agree with your assertion that they have an obligation to teach you how to be safe, the market will determine if they're effective... but that's not what you're asking for. Safe and effective is measured by a disinterested third party, the FDA in this case. When you're asserting that they teach you 'how to use it well', you're asking that they be held to whatever standards YOU set as a consumer of their product and let YOU decide what constitutes training you how to use their product 'well'. If there's a business that would ever accept this standard I've yet to hear of it.

Your comment amounts to a consumer complaint by someone unhappy with the service they're receiving and wanting access to other physicians protocols, not a safety complaint. (That would have gone to the FDA or someone else.) Lumenis is not obligated to provide you with whatever information you want on demand. Especially when they're not the holders of that information. If you're position is that this is medicine and that that somehow makes it different from regular business, make these same demands of the physicians who's treatment protocols you want and see what happens.

I'm guessing that Lumenis has given you the 'standard' information that they provide to all of their customers. You want more. Well and good. That may be in your self interest but pushing those standards and providing you from a corporate level with treatment parameters and protocols that have not been approved for use by anyone, puts the entire corporation at risk and I can't believe that Lumenis or Paomar or Sciton or Cutera or anyone will be willing to do that.

If any patient is harmed you better believe that the physician and the malpractice lawyers will immediately be wagging a finger at Lumenis and saying that whatever happened was promoted by Lumenis. Corporations don't like that exposure and won't accept that risk no matter how loud the complaints are. You're Lumenis comments may cost them a few sales. Giving in to your complaints could cost the entire company.

"The experts give their settings, techniques and insights freely when they are being paid to do a Webinar or Meeting. "

If the info is out there, go get it. Take the webinar. Go to the meetings. I get the emails from these guys all the time promoting this stuff. Perhaps you can get them to archive them on this site and we can all benefit.

"If they have to pay for this information, then let them pay. I don't care how they do it, I just want it done. NOW."

Oh, I see. You don't care if Lumenis has to pay to get this information from it's luminary physicians , but you're not willing to pay yourself. Clever.

Palomar Medilux MD (not Lumenis),

I appreciate your comments and I will explain why I think you are wrong.

This is a great topic to discuss.
I still believe very strongly that the Laser Companies should know the best protocos and techniques and then share them with their customers. I will explain my thoughts in detail in my next post.

Again, thanks for your opinion. This is a topic that needs to be thoroughly and completely discussed.

This company is in shambles and has some of the poorest most upscrupulious managers and ethics in the business. The company had one of the best sales forces ever put together and was ruined by Ty Guthaus and the "gallo" guys. Very poor management pressure tactics and micro management lead to the demise of many top notch ethical reps. Managers such as playboy Kevin Collins-many inappropriate violations but with substance and sexual to female reps. Horrible management by one of the worst ever John Santos. Great likeable guy and salesman-horrible follow up and no clue (best friends w Guthaus)
Isreal is a joke and all the company is concerned with is putting lip stick on the pig to sell off each business unit.

Some of the best laser technology in the industry however lack or innovation and poor management including robert mann has done them in.

02.16 | Unregistered Commenterex insider

'Oh, I see. You don't care if Lumenis has to pay to get this information from it's luminary physicians , but you're not willing to pay yourself. Clever"

-- I can't afford it. They can. They make over $100,000 profit on each laser they sell.
-- It is their (Robert Mann & Dov Ofer's) responsibility. If you are going to manufacture and sell a medical laser, you have the responsibility to find out (and know) the best way and safest way to use it. Period.
-- They claim to have the best lasers and the best company. They may have the best lasers, but judging by the actions and decisions of their top executives, they have a terrible corporate culture ("they just don't care", "they just don't get it"). Typical Executive arrogance. They live in a fantasy world where they think they can do anything they want without any consequences. The world is changing. I am holding them personally responsible and I will make sure they "feel" the consequences.
-- My standards are higher than the FDA. The FDA has rules that have very bad "unintended consequences". The Technocrates at the FDA don't treat patiients. They are not in the trenches the way we are. We (community cliniciians)know better. I am not willing to trust my health or the health of my patients to the FDA. The Laser Companies and the Product companies use the FDA Rules to make excuses for not doing the right thing and for not doing what is best for doctors and patients. They ignore the FDA rules when it is convenient to do so and then they evoke these rules when they don't want to do something. Very convenient. I don't accept that game.
-- Palomar Guy, there are big changes coming to the Laser Industry. "Business as usual" is no longer ok.
-- I advocate for what I feel is right and for what feels right in my gut.
-- I am a doctor and I put my patient's health first. Peroid. If I need help figuring out the best and safest way to use my laser, I expect the company to help me any way they can. Robert Mann and Dov Ofer have some other agenda (I don't know what it is), but I plan to be very disruptive until I get what I know is the help I need and other Laser Physicians need. The funny thing is that if they would just help me, I would be their best friend and strongest advocate. It would be a tremendous WIN WIN. I don't understand them and they don't explain. They think they are too smart and too important to communicate fully with a little pion doctor like me. Afterall, I didn't go to CEO School.
-- All I have to do is shine a bright spotlight on the situation and tell the truth. That is what I am doing. You can make up your own mind about whether it is fair or not. I think it is fair and I think it is necessary. "The cockroaches will soon be scrambling".
-- What is right is right. I really don't care about the FDA Rules or what other laser companies do or what has been done in the past. Things need to change and I plan to be that agent of change. I hope others willl join me, but if they don't, I will do it myself. Robert Mann and Dov Ofer know how committed I am. They will change or be changed.
-- there is more to come. Much more ...
-- See you all tomorrow ! ...

I have the UltraPulse Fractional CO2 Laser and I want to know the answers to these questions!
Dr. Epstein brings up some troubling information.
I would like to know what percent coverage I get when I set my DeepFx Laser to Density 4!!!
I want to know NOW.

"Robert and Dov did get THREE opinions and from these three opinions we now know that this “variation problem” is worse than I originally thought. Robert and Dov, now that we know that one of your experts thinks that DeepFx Density 4 is 20% Coverage and another thinks that it is 100% (fully ablative) coverage, doesn’t that concern you? Is DeepFx Density 4 - 20% coverage or is it 100% coverage? Robert and Dov, why do some of your experts use Density 2 and others use Density 4? Why does one expert switch “CoolScan” to the OFF position when he does under the eyes? Why does one of your experts “DOUBLE PULSE”? Why does one of your experts do “DOUBLE PASSES”? Robert and Dov, you wouldn’t answer my questions before. I hope you will now answer my questions now that you have a wider audience."

I am Dr. Doug and I want answer now!
Every day that goes by without the answer is a day that I might injur a patient or not get optimal results.
I have read of may injured patients on this site. Injured by all types of lasers because the laser companies don't provide the support and continuing edcuation they should provide.
The whole Laser Industry better take note of this blog. We are as mad as hell and we are not going to take it anymore!

02.16 | Unregistered CommenterDr. Doug

These settings are taken directly from Lumenis Internal Documents.

Deep FX

1 = 5% Face and neck
2 = 10% Experienced operators only (Increased pinpoint bleeding)
3 = 15%
4 = 20%
5 = 25%

Active FX

a. Density 1: 55% of tissue is ablated
b. Density 2: 68% of tissue is ablated
c. Density 3: 82% of tissue is ablated

02.16 | Unregistered Commenterwhatifound

Thanks, whatifound,
Palmoar guy, I tried to get information from the experts but they are too busy or too arrogant or too self-important to spend time with someone like me. See below. Plus some of them seem confused!

Please read the exchange below. I am talking about Density Setting with DeepFx and percent of area covered. I was taught that density 3 was 15% and density 4 is 20%. I routinely treat with Density 3. This expert says that density 3 is really 70% and density 4 is really 100% and then he goes on to talk about Gausian Distribution and "Top Hat" Pulses. Can anyone help me with this. Does anyone understand what he is talking about? He won't tell me. He just tells me to read his text books on Laser Physics.

My comments are in regular text, his are in CAPITALS. Thanks:

I usually use density 3 which I thought was 15% coverage. NO, IT IS MORE LIKE 70% Dr. Ross uses Density 4 which I think is 20% IT IS REALLY ALMOST 100% REMEMBER, IT IS A GUASIAN DISTRIBUTION coverage. You say that anything over density 2, is doing a full resurfacing.CORRECT I thought a full resurfacing was 100%. AGAIN, REMEMBER THAT THESE ARE NOT "TOP HAT" PULSES OF ENERGY BUY ENERGY DELIVERED IN A GAUSIAN DISTRIBUTION. PLEASE REFER TO MY LASER TEXTBOOK OR ANY LASER TEXTBOOK FOR FURTHER EXPLAINATION I am confused here. Could you clarify?

This expert then told me to stop emailing him until I read his text book. I don't have his textbook. So I stopping emailing him. Nice guy, real helpful! His webinar was even more confusing! I thought he was confusing DeepFx with ActiveFx, but he said he was not. I was told that the UltraPulse was "Flat Topped or Top Hat" by my Lumenis Rep, but this expert says that it is NOT.

Robert Mann and Dov Ofer have known of this confusion for two weeks now. They have not clarified anything. They just leave it out there. They don't care. They are a disgrace to all Laser Executives!!!

This expert also told us in his webinar that he did treatments in 15 to 20 minutes with no blood at energy level 17.5! Later I found out that he has two UltraPulse Lasers and he does not have to change handpieces. He probably has two people doing the treamtents as well. The point is that this expert told everyone in a Marketing Webinar (the only type of webinars that Lumenis does) that he could do treatments in 15 minutes suggesting that they could do this as well- very misleading and bordering on telling a lie! He also said he gets no blood and no hyperpigmentation suggesting that you don't have to worry about blood or hyperpigmentation - again - misleading if not downright untrue! *I get blood, Dr. Ross gets blood. I also believe that Hyperpigmentation is a risk if you do darker skin types with the ActiveFx and don't use the CoolScan (do you know that the lasers default to "coolscan off" - increasing the risk of PIH tremendously).

So .... who is right? Where do I turn? I turn to this blog because the Executives at Lumenis (Robert Mann and Dov Ofer) don't think this type of confuion is important! They just don't care.

"the info is out there, go get it. Take the webinar. Go to the meetings"-Palomar Guy
The Webinars are not a reliable source of information - see above. I do go to the meetings. They are very good but not sufficient. I have been to the ASLMS, Rox Anderson's Harvard Conference and I am going to ASLMS again in April and Contraversies this Summer.

Jeff, you are crazy! Go back to internal medicine...what your trained for! I am a Dermatologist and use the Ultrapulse, I know the answers to your questions...it isn't that hard.

Anybody that has the time to blog this much does not have many patients to treat. Let us Derms take the lasers from here, we know the answers to your C02 questions.


Lee

All,

I agree with Lee here, Dr. J, you seem kind of obsessed. If a large company makes a scalpel, you can't demand that the company should tell you EXACTLY how to use it. The reason we are physicians has to do with our mental capacity to learn, understand and use devices to assist with practicing medicine. Lumenis provides good information but there is no one right way to do resurfacing, if you ask the top ten users, you would get 10 VERY different answers.

Learn from your experience, speak to your peers, take some some personal responsibility for how you practice medicine.

That is why we became Physicians, we don't need A B C settings.

C02 MD

02.17 | Unregistered CommenterCo2 Expert

Please Informed Doc and Co2 Expert, instead of trying to derail this discusssion, share your vast knowledge with us.

02.17 | Unregistered CommenterVC

CO2 Expert, this is for you,

"And, by the way … for all you “medicine is not cookbook” idiots …all great chefs start by studying and learning from cookbooks. Then they take it to the next level which is the art of cooking. All great doctors learn from mentors and textbooks and they some take it to the next level which is “the art”. "

So don’t give me the “art of medicine” argument or the “medicine is not cookbook” argument. I don’t buy into those intellectually lazy, disengenuous & self-serving arguments.

Also "if you ask the top ten users, you would get 10 VERY different answers." CO2 Expert, you just made my point. Do you know anything about THE PROBLEMS with "clinical variation"? Do you know anything about "Total Quality Management in Medicine"?

Hey, Informed Doc, if you are not a Fellowship Trained Cosmetic Dermatolgist, then you don't know more than me, you probably don't do as many treatments as I do.

I am not going back to Internal Medicine because I choose to practice Cosmetic Dermatology. You guys clearly need someone like me to shake things up. Major dispuption is sometimes a good thing. Laser Medicine is not nearly the science or art or medical practice it should be and with small minds running things like CO2 Expert and Informed Doc, I can see why. You need someone smart, like an Internist, to get involved and tune you guys up :)

Hi Evertyone,

I am a bus driver who has taken weekend courses on flying a 747 jet, please come fly with me I am an expert! I wish these Boeing guys would call me back, I don't know how to use all the fancy lights in the cockpit! Why isn't the Boeing CEO calling me? Boeing isn't supporting me properly! I have the weekend certificates to show that I am more than a bus driver, I am now a pilot!

Keep blogging until you see a paying patient...it may be awhile...

Lee

"Anybody that has the time to blog this much does not have many patients to treat. Let us Derms take the lasers from here, we know the answers to your C02 questions." -- Uninformed, Arrogant Doc


7. Why do we need Experienced, Expert, Full-Time Non-Core Cosmetic Physicians Practicing and Teaching Cosmetic Dermatology?

Full-Time, Expert Non-Core Cosmetic Physicians are needed because there is an inadequate number of Fellowship Trained Cosmetic Dermatologists and an inadequate number of Cosmetic Dermatology Fellowship Training Programs. A physician’s clinical results are directly related to their clinical skills.These skills come from their ability, their training, their dedication to learning and their clinical experience. Gifted mentors along with a high volume clinical practice are also important ingredients.Plastic Surgeons, Dermatologists and Non-Core Cosmetic Physicians all start from the same point.Dermatologists are expert in skin physiology and pathology. The Plastic Surgeons and the Non-Core Cosmetic Physicians must become experts in skin physiology. The Fellowship Trained Dermatologists are the future of Cosmetic Dermatology, but until there are more training programs and more Fellowship Trained Dermatologists, they will not be the primary providers of Cosmetic Services to the general population. Many of the best non-invasive cosmetic physicians are non-core physicians who have dedicated 100% of their professional activity to cosmetic dermatology.

Signed, A Full-Time, Non-Core Cosmetic Physician

02.17 | Unregistered CommenterCut&Paste

"I asked Robert Mann and Dov Ofer to collect the techniques and settings that their top ten experts were using so that we could examine these techniques and settings. They would not do this."

Hey, Informed Doc. You have any problem with this????

[This comment has been removed for violating our terms of use. Violations could result in an IP ban or other action.]
The Management

02.17 | Unregistered CommenterCut&Paste

Informed Doc,

I can guarantee that you do not have the answers to the CO2 questions because nobody does. I have been researching the topic for 3 to 6 months and most of the answers are answers given by the laser companies themselves not from independent physicians.

At this time, no one can tell you what the best depth of penetration, spot size, dwell time or percent coverage are. There are very few good quality, independent studies looking at fractional CO2 lasers. That is what JEE is trying to get from Lumenis. They are one of the oldest CO2 producing companies in the world and they should be experts at the technology. JEE is looking for the best parameters to safely treat his patients.

The problem we have is that to many dermatologists have become whores for the laser companies. They do not do research unless they are paid for the research. And as we were all trained in med school do not trust research that is paid for by the company trying to sell you something. many of those derms are no better than a used car saslesman. So when you have done independent research to back up your claims, then you can come on this site with that attitude. So unless you want to be of help and answer questions shut up and go away.

02.17 | Unregistered CommenterLH

Hey guys, let's play nice. Anyone is welcome to comment and entitled to their opinion. We won't be censoring anyone or pushing them out the door unless they misbehave. If you're going to make every declaration as a statement of fact you'll need to develop a thicker skin to deal with those pointing out counter-arguments.

My name is Jeffrey E. Epstein, MD. My email is Jeff4459@aol.com. My website is www.ChLaserMD.com.

I have always put my name to my posts. I am not afraid of the small minded Dermatologists, the arrogant Plastic Surgeons or the “out of touch”, inbred Laser Executives. I am hoping that the bright and curious Dermatologists, Plastic Surgeons and Laser Executives, who want a better Cosmetic Laser Field, will understand what I am trying to do, and help me.

This is a discussion that needs to occur and I am happy to defend and advocate my position.

I went to Swarthmore College, Rutgers Medical School and did my Internal Medicine Training in San Diego California. I was a full-time, busy General Internist for 20 years before I began doing Cosmetic Dermatology. I know medicine.

We have 14 Cosmetic Lasers in my clinic. I do all the treatments and we are very busy. We get great results and have very happy patients. I am expert with the UltraPulse but I want to be better. I know cosmetic dermatology. I know it much better than the Dermatologist who do it “part-time” and I know it better than the Plastic Surgeons who have nurses doing all their treatments.

I am frustrated and angry that Lumenis will not help me become a better UltraPulse user. They have the means and the reason to take their Laser to a new (better) level, but they won’t. This confuses me. You may not agree with my methods of getting what I know is needed for us all (I have exhausted all other methods), but the end result will justify the means. Sometimes you have to tear down before you can build up. Dov Ofer and Robert Mann are making this tearing down step a necessary step. That is too bad, because we can accomplish so much together.

I am hoping that Dov and Robert will come onto this blog to defend their position. I am hoping that the Luminary Dermatologist who told me that DeepFx Density 4 is 100% (no bleeding, no pain, no PIH, 15 minute procedure, pulse not “top hat”, pulse has gausian distribution of energy) will come on this blog to defend his position. I am hoping that the bloggers “who say” that they are dermatologists, will come on this blog and identify themselves by name, email and website, so we can be sure that they are really doctors (and not sales reps) and we can make sure that they are willing to stand behind their opinions the way I am willing to stand behind mine.

I am also hoping that other experts and luminaries will come to this blog and tell us their opinion about this issue and tell us how they use the UltaPulse (settings and techniques) so we can all learn and become better UltraPulse Users and provide better care of our patients (fewer complications and better clinical outcomes). It is all about the patient! All about better results and fewer complications. The small mindedness of people does not surprise me. I have seen it before and I have battled it before. I usually win. In the end, these people always fail because their positions are intellectually dishonest, short-sighted and self-serving. So, I say … bring it on … let’s have a go of it!


Open Email to Dov Ofer and Robert Mann from Jeffrey E. Epstein, MD

Dov and Robert,

It is 9:00 am on the East Coast.

I know two doctors, through MAPA, who are considering the UltraPulse. They asked my opinion and I have advised them not to buy from Lumenis until Lumenis works out the best ways to use their Lasers. I told them that the top executives at Lumenis are idiots who don't care about their doctors or their doctor's patients.

I told them that Lumenis does not know the percent area covered by their DeepFx Density 4 and they don't know whether their laser's energy pattern is "flat topped" or "pointed". I also told them that Lumenis does Marketing Webinars that are misleading and potentially dangerous to patients.

I believe this all to be true based on my experiences with the two of you and based on watching the webinars and seeing comments from your Luminary Experts.

More lost sales are coming.
Good work, Geniuses (Dov and Robert)!
I think your demoralized sales force should rise up and have you two fired.
My prediction is that both of you will be fired by the third quarter of this year (2009).
My Dale Koop prediction came true three quarters ahead of time (this means I won the over/under).
Maybe the problem was NOT Dale. Maybe it was the two of you all along!
The question is whether your Board of Directors will let you two sink "the ship" before they get rid of you.

Jeff

The collective intellectual capacity among us, as cosmetic laser providers, is tremendous. If we all worked together, we would discover and share treatment protocols that are more effective and less painful, and produce fewer complications. We would discover better ways to reduce and treat complications when they do arise. Our field would become stronger, and we'd become better practitioners.

--The Power of Clinical Connection

From the Lumenis Website:

Dov Ofer
Dov Ofer joined Lumenis as Chief Executive Officer in April 2007. Prior to his appointment at Lumenis, Mr. Ofer served as Corporate VP and General Manager of HP-Scitex. Until the acquisition by HP, Mr. Ofer served as the President & CEO of Scitex Vision Ltd., and previously managed Matan Digital Printing, one of the pioneering companies in the super-wide format printing industry. Dov Ofer holds an MBA degree from University of California at Berkeley and a BA degree in Economics from the Hebrew University in Jerusalem.

02.19 | Unregistered CommenterDove Ofer

I am not very impressed with this resume. This man is making decisions that effect me and my patients and he is making terrible decisions. He comes from the Printing Industry!!!! Wide Format Printing - WOW. Mr. Ofer, do you know ANYTHING about Medicine? Anything about treating patients? Anything about Patient Safety and Clinical Care? Do you have any Medical Doctors advising you? So, Dov, you have been CEO for 2 years. Wow ... that is a really long time. You must be an expert by now. Dov, have you read my article on Clinical Exchange? Do you know about Total Quality Management in Medicine? Do you know anything about anything?

My next post will be examining the Board of Directors of Lumenis. Let's see who they are and see how they can sit still and do nothing like idiots while their CEO ruins their company. I will start with the Chairman of the Board - Mr. Harel Beit-On.

Jeffrey E. Epstein, MD

02.19 | Unregistered CommenterDove Ofer

Lumenis recently fired Dale Koop, Senior Vice President in charge of their World Wide Aesthetic Division, because he was terrible at what he did. I asked him a simple question about his laser and he never answered the question. He ignored me, he sent me on wild goose chases and he lied to me. I began to blog about this situation. It was very embarrassing to Lumenis and their top executives. Now he has been fired. There ARE consequences. Even for top Laser Executives! There is a NEW paradigm in the Cosmetic Laser World.

Dov Ofer is now making similar terrible decisions. In fact, it may have been HIM all along and I just thought it was Dale Koop. We are going to clean house. Throw out all the dead weight and all the incompetant laser executives.

Jeffrey E. Epstein, MD

Open Letter to Dov Ofer, CEO of Lumenis

You probably think there is something wrong with me. You don’t understand me so let me explain who I am. I have already told you, but I guess you are not a quick study or you don’t believe me. I want to repeat it here for everyone else reading this blog.

I am not crazy, obscessed or reckless. I know exactly what I am doing. I am patient and I am persistent. I am committed and now truculent (fierce and disposed to fight). There is an important principle that I am fighting for – it is serious Clinical Exchange Support from Laser Companies. This is SO important that I am making this PERSONAL between you and me. Man to Man - not business as usual. Not the usual two faced backstabbing you are familiar with in the corporate world. This is “in your face” brutal honesty, passion and committment.

I will achieve my goals even if it means that I have to break you. As long as you continue to be obstinate & obdurate (hardened and stubbornly adhering to the wrong attitude, opinion and course of action), you risk losing your job and you risk the financial well-being of your company (Lumenis) as well as its reputation. Remember, in the end ... I am right and you are wrong. I am a doctor who knows what providers need and you are a “wide-format printer” who has no clue what is going on in the medical treatment rooms. I have decided that The Ends (better patient care and safety) justify the Means (broadcasting what I think and what I feel and making this personal). In the end, I will be vindicated and you will look like a fool.

I will hammer away until I get what I want. I don’t need your help anymore (I know how to use the UltraPulse), but I WILL GET what I have been asking for and I will get it from Lumenis (with or without you).

My prediction is that you will give me what I want by the third quarter of 2009 (same prediction I made about our friend Koop) or you will be gone (fired, resigned, downsized or retired).

Remember, what I want is the right thing to do, it is easy for you to do and it is needed and necessary. So the only conclusion that I can draw is that you are either stupid, lazy, out of touch or incredibly arrogant. The position you hold (CEO of a major Laser Company) makes this an unacceptable situation. Change or be changed. There is no other option.

Signed,

Jeffrey E. Epstein, MD

The Dilbert Principle and how it applies to Cosmetic Laser Companies

When I entered the workforce, the Peter Principle described management pretty well. Now I think we’d all like to return to those Golden Years when you had a boss who was ONCE good at something … Back then we had hopes of being promoted beyond our level of competence … It was a time when we freely admitted that the customer didn’t matter. It was a time of joy … Nit pickers found lots of problems with the Peter Principle, but on the whole it worked … Lately, however, the Peter Principle has given way to the “Dilbert Principle” … The basic concept of the Dilbert Principle is that the most ineffective workers are systematically moved to the place where they can do the least damage: MANAGEMENT … This has NOT proved to be the winning strategy that you might think …
Scott Adams, The Dilbert Principle p. 12-14.

Several Solutions

Working with laser companies is one way to combat this problem. Laser companies can be particularly valuable in the clinical exchange arena. These companies have the resources to start, support and nurture this activity. They know who their users are, they can enlist the knowledge of luminaries, and they have company doctors and scientists who understand the clinical applications of their laser devices. It's important to mix all of these elements in the proper environment to spur the best advances and innovations from these groups.

--The Power of Clinical Connection

This is from The DeepFx Forum Thread:

Why we need written summaries of Webinars. Why we need discussion after Webinars. Why “the expert” has to be available for on-line Q& A after Webinars (Bulletin Board, not real-time). Why we need training Webinars in addition to Marketing Webinars. Why it would be nice to be able to download Webinars to our iPods for review in our cars.

We all need to become better providers of services and get better results which generate happy patients who refer friends and family to our practices. By having easier, more convenient access to the information in the Webinars and sharing our thoughts and experiences, we all learn more quickly and we avoid making the same mistakes made by others. In this manner, we gain access to “best practices” more quickly and the whole field evolves more rapidly. We want to use these Webinars as “Seminal Events” to stimulate meaningful “Clinical Exchange” of important information.

We hope to get the industry “Luminaries” to participate in these discussions. We also hope the Laser Companies will start to host these type of “On-Line” discussions after their Webinars and we hope the Laser Companies will start to host more “Continuing Education” Webinars rather than just “Marketing Webinars”.

Lumenis (Dov Ofer, Robert Mann & Gail Dunlop) have known for weeks now that there is MAJOR CONFUSION about the DeepFx Denstity 3 Setting (the setting most commonly used in TotalFx Treatments).

Is it 15% or is it 70% surface area covered?

There has been no clarification to me or other users. This is SHAMEFUL and INEPT.

Do these laser executives and lumenis employees care? I don't think so!

Is is 15% or is it 70%?

See also the "Mitchel P. Goldman, MD" Thread and the "Lumenis Malcontent thread" for more background on this issue. Goldman seems to be hiding in a cave (the little wimp).

The AAD has just been completed.
I will be waiting for word from Lumenis (Ofer & Mann) about the DeepFx Issue with Mitch P. Goldman, MD.
Is it 20% or 100%? (I know the anwer, but I want to hear it from them)
I will be reporting each day about the status of this issue.
I will let you know whether they just told ME or whether they bothered to tell all their users!

Monday March 9, 2009 Report: No word from Lumenis.

Monday May 11, 2009.
Krappy "Physician Recommend Treatment Parameters" Released.
Incomplete, inconsistent and inadequate.
Now they can say they did it, but it really sucks.
D+ work does not count in my book.
Typical salesman type shoddy work.
Typical huckster and charlitan type stuff.
So typical for the insincere and dishonest laser executives.

05.11 | Unregistered CommenterJEE

"Forum rules
All posts are subject to moderator approval."

This is the Lumenis Physician Portal. All posts must be approved!
Uncensored, Unbiased (yea, right)

Control the information and you control the truth (this was true in "Animal Farm", but is not true now. Keep trying you corporate idiots!

Long live freedom of speech. The Recommended treatment parameters suck and the portal sucks as well.

An Open Letter to Robert Mann (GM), Dov Ofer (CEO), Gail Dunlop (Clinical) and Robert Lightfoot (webmaster)

I woke up this morning and realized that the glass is now half full! You have put up a Physician Portal, you have put out Guidelines for the TotalFx and you have come up with the 4X Software Update for 2009.

The glass is now half full. I am hopeful.

Everything you have done is “ok”, it is not good or great, but it is ok. We can make it great. The glass is half full.
Even though you cut me out of the process (and you did this to piss me off or you did this because of your underlying arrogance and superiority [or maybe I am too in love with myself and think I am too important]) with these tools I can now work my magic and show you why you did this and demonstrate the good it will do for your company and possibly all of laser medicine (“Vote for Pedro and all of your Wildest Dreams will come True”).

I know you hate me and you think I am a jerk, but that is ok. Many teenagers hate their parents and think their parents are stupid jerks. Good parents wear these labels proudly knowing that their kids will be better adults in the future once they learn a few important life lessons.

You probably have mixed feelings about me telling you “the engagement is on again” and you may not want “the engagement to be on again”, but it is. When you took my $200,000 for the UltraPulse and the LightSheer, you accepted me as your adopted parent -- forever! Sorry ...

I am going to work with your physician portal and work with your Guidelines. All I ask is that you allow me promote your site and facilitate the clinical exchange. With these tools, I can do lots of good for your company, your customers (providers) and your patients (the people your providers treat). I only act like a total jerk when I have no outlet for my positive ideas and energy. These tool will give me a positive outlet.

For the physician portal, my first request is that you allow things to be posted right away and then remove them later if they violate your policy (and I ask that you publish your policy and make it very clear and fair). The best clinical exchange will be uncensored, transparent and honest. Immediate posts will allow real time exchange which is important. As long as you can review and remove, you should be able to satisfy any oversight concerns you have (MedicalSpaMD allows immediate posting, but Jeff Barson and his team review all posts and remove those that violate their policy).

I posted something very simple and innocuous yesterday on your portal. I am going to see how long it takes you guys to review it and post it.

I look forward to working with you and I thank you for putting up the portal and publishing the guidelines. Your “stress test” is not over. We are just beginning. Let’s see what you do with these tools and let’s see what you allow me to do with these tools.

Respectfully (for now) -- Jeffrey E. Epstein, MD

ps. for all of you Lumenis owners and users, go to www.lumenis.com, find the physician portal and register. Let's start some discussions. We can start by discussing the TotalFx Guildelines which are posted. They are ok, but they needs lots of work and input from users. Let's get this "clinical exchange" thing going!

http://aestheticportal.lumenis.com/

This is the link for the Physician Portal. Check it out.

05.12 | Unregistered CommenterJEE

I submitted a post to Lumenis' Physician Portal
I was just notified that it was accepted.
It took them SEVEN days to review and approve.
I forget what I wrote ... it was so long ago.

The portal is great. The executiion is pretty poor so far.
This type of delay will render the portal almost useless.
I say put the posts up right away and then review.

Nonetheless, check it out and participate.
Let the Lumenis people know what you think and suggest improvements

http://aestheticportal.lumenis.com/

05.19 | Unregistered CommenterJEE

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