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« Intense Pulse Light & Sciton BBL | Main | Medical Spa Marketing: 01.14.09 »
Friday
Jan302009

Thermage, Fraxel, Fractional C02 Laser

Chat transcript: Tuesday, January 27 - Thermage, Fraxel & C02 Laser


Jeff E.: Hello, i will be right back.
Jeff E.: Fraxel, Thermage, Fractional co2 Chat
Jeff E.: Hi cls
CLS: Hi Jeff..Its Norma
Jeff E.: hey ron
Jeff E.: hi normal
med spa guy: Hi Jeff. i finally downloaded the Java applet!
Jeff E.: Norma, could you introduce yourself to Ron?
CLS: Hi Ron..I'm in the Boston/RI area. Have Juvia and do some Fraxel restore amongst other things
Jeff E.: Tom and Kevin can't make it tonight but i think Greg will be with us.
Jeff E.: Norma, Greg is a Fraxel Restore expert
Jeff E.: Tom Fiala has the Juvia. He can't make it tonight, but i know he would love to talk to you
med spa guy: Hello Norma. Nice to meet you. i am not a physician but i have been a med spa owner/operator for 3 of the past 5 years and currently work as a product manager of light based devices for a small company located in Minnesota.
Jeff E.: Ron is one of our MedicalSpaMD lumenaries!
Jeff E.: Hi Peter d
CLS: Greg: have you been treating asians or type iv-VI with restore
PETERD: hi!
Jeff E.: Peterd, where are you from? Are you a doctor? What laser do you have?
Jeff E.: Norma, are you a doctor?
PETERD: cherry hill
CLS: No...owner/laser tech for 5 years
med spa guy: i have been asked by many people about the advisability of treating above Fitz iv with Er:YAG and only been able to find articles discussing everyones' concerns about pih with Fitz iv patients.
Jeff E.: Hi Peter.
PETERD: hi jeff!
Jeff E.: i treat skin type 6 with my Fraxel Glass Erbium 1550. i don't treat above skin type 4 with my DeepFx
CLS: Question for all..I'm having an issue with blt cream melting and getting in people's eyes. Since Pliaglis is out any other recommendations?
Jeff E.: i don't know too much about regular erbium
Jeff E.: We use 7% Lidocaine and 7% Tetracaine. It works better than blt (just as good or better).
Jeff E.: You have to get it from the right compounding pharmacy. If you don't get it from the right place, it might not work as well
CLS: Is it a thick substance?? I've tried a couple of different companies but so far still melts
Jeff E.: is this with the juvia?
Jeff E.: Ron, i can't wait to see your Fractional co2 summary of the msmd Thread. It should be very instructive.
CLS: Yes...and restore. i try to tighten the skin below the eyebrow so i put numbing cream there..pull up the skin before pulsing and go so the cream is close to the eye area
med spa guy: i agree. Once we separate the "wheat from the chaff" there should be a nice "string of pearls" for everyone.
Jeff E.: Norma, when i do a DeepActiveTotalFx, i wipe off the numbing cream before i start the treatment.
CLS: Also, i tried a cream from One stop Pharmacy for post fractional: aquafor base, lidocaine, hydrocortisone and a few other things..seems to reduce redness and itching by one day for down time
Jeff E.: When i do a Fraxel Re:store, i wipe of 90% of the cream before i do the treatment.
Jeff E.: we are looking into a post op cream from Young Pharm. i prefer to keep my active ingredients seperate.
med spa guy: i thought it was sop to always remove topical products from skin before treating. Who knows if a product contains molecules- such as water- which might absorb a lot of photons.
CLS: i wipe all the cream off, the problem is during hour numbing time. I'll have to try another compounding company
Jeff E.: The Young cream has Vit c esterase. We also use RetinA to stimulate collagen. We add steroid if too much redness.
med spa guy: Got ya.
Jeff E.: Norma, how do you like the Juvia?
CLS: i like the Juvia, settings are fairly easy, no consumables. Just started to do 25% coverage in certain areas. With the Juvia though i may have to do 2-3 sessions for deep wrinkles. Is that the case with ActiveFX/Deep?
Jeff E.: How much did you pay for it and why did you choose it over the other Fractional co2 Lasers?
CLS: It was either 55k or 65k can't remember...I'll have to check. Needed portability to seperate locations. Has fiber no articulated arm. large 500 micron spot size and can adjust pulse width
med spa guy: The depth of penetration as relates to both ablation and coagulation is such a mysterious phenomenon-- the basic textbooks all say it correlates to the energy fluence used, as well as pulse duration. But with all these different fractional devices it is really so hard to compare and know what is truth vs. fiction regarding the actual depth of the treatment. And Norma, how much does the Juvia device weigh??
CLS: 55lbs..come in nice cart which for me is easy as it goes into a van with a hydrolic lift
Jeff E.: i think i could just lift it up! Sounds light.
med spa guy: Norma: Jeff can tell you the diameter of the micro beams with Active Fx vs. Deep and will possibly tell you that with a 500 micron diameter you will always be pretty superficial. Multiple treatments does not equal greater depth (I believe).
CLS: You could...rep just puts it in his car..I'm too lazy for that
Jeff E.: Lumenis is doing histology to find out how deep and how wide their treatments go. i think we have that information right now
Jeff E.: i don't think the fda should approve a laser unless the company knows certain things about the laser. For example, how deep does it go, how much ablation, how much coagulation.
med spa guy: Jeff: That would be great to see. And possibly to compare to the depths typically achieved with traditional (whole beam) co2, etc.
Jeff E.: who beam co2 is shallow.
Jeff E.: whole beam
med spa guy: Jeff: You have a point there. They also do not evaluiate beam profiles or spectral analyses of ipl systems. It's amazing what they do not look at. They are not really laser experts (in my opinion).
med spa guy: Jeff: You need to take into account the tremendous coagulation the traditional co2 treatments were using. The huge thermal component was what i am always reading gave such great tightening and wrinkle reduction-- if the patient was willing to endure all that!
Jeff E.: buy peter!
Jeff E.: by peter
Jeff E.: We all need to insist that the Laser Companies supply certain information. If we don't do this ... shame on us!
med spa guy: Most docs just getting started simply don't know what questins to ask. That is one of many areas where this forum could help a great deal. But it is a long learning curve to understand all these principles - laser physics + tissue interaction, etc. etc.
Jeff E.: i don't think the stuff is that complex. It just needs to be explained well.
Jeff E.: That is where we come in.
Jeff E.: We shine the light into the dark corners
Jeff E.: And then we watch the cockroaches scatter!
med spa guy: Jeff: Is your telephone ringing adequately these days? Does business for these discretionary procedures seem to be picking up???
Jeff E.: gregggggggggggggggggggggggg
Greg: Hi Guys
Jeff E.: You are Late!
Greg: work. computer issues!!
Jeff E.: We are very busy. Mainly because of word of mouth referrals becaues we are getting great results
Greg: i had 2 fraxel consult. heard my rep. thats a cool feeling.
Jeff E.: We have the right lasers because we did our homework. We know how to use them because we have used MedicalSpaMD to learn from the msmd Luminaries like Florida pa, MedSpaGuy, lh, pmdoc, Charry, etc
med spa guy: Jeff: i am very happy to hear that. Everything i see you do -- from your web site to your marketing events to your extreme focus on good outcomes, etc. etc. etc. -- it always seems like you are doing all the right things (as well as working very hard)! Good for you!
Greg: true. it would take me years to get where i am
Greg: jeff, u know anyone using smartxide i could chat with
CLS: has anyone tried the under eye bags/dark circle paraments from i think it was Florida PA..Had someone today Type iv skin i was thinking of trying it out on.
Jeff E.: Greg, meet Norma (cls). She has the Fraxel Re:store and the Juvia
Greg: i treat all st with that protocol. no issues
Jeff E.: Norma, we have Florida pa with us tonight (Greg)
med spa guy: Norma: Greg is Florida pa! And i am the shore patrol also.
Greg: hi norma
Jeff E.: i don't know anyone with the SmartXide, but we need to find someone who can help us with our mapa Fractional Summary Report.
Jeff E.: Is the SmartXide the "Dot" Treatment?
CLS: Ok..great...I'll give it a shot. Greg..I have alot of Iv-VI's with acne scarring...how much do you do in those skin types
med spa guy: i have read several articles that say the primary cause of the "dark circles" is vascular. Hard to see why a fractional resurfacing would treat the underlying cause???
Greg: yes the dot. i will start next week
Greg: it is not vascular it is atrophy
Jeff E.: Dark circles can be caused by pigment, vascular or shadowing from deep tear trough. You must determine the cause before you treat. Each cause is treated seperately.
Greg: i would be glad to start a email discussion its good stuff
Jeff E.: differently
Jeff E.: email discussion about "dot"
med spa guy: Jeff: Now you sound like the attorney!!!
Greg: shadow, u are right jeff
Greg: no jeff, lower lids
Jeff E.: Greg we need to put your fraxel tips in our mapa Archive on MedicalSpaMD.
Greg: i get consistant results unless fat pad needs surgical removal
Jeff E.: Greg, i have been doing lots of your undereye protocol with my Fraxel. Hoping to see great results!
Greg: pts today got my name off medspamd and traced it back. they were right in orlando
Greg: they were looking up for fraxel tx
Jeff E.: Greg, Ron is doing a summary of the Fractional co2 thread on msmd. Could you do one on the Fraxel Re:pair thread?
CLS: Is everybody charging 1,000 per session for full face??
Greg: i will be using the dot. so any info will be anecdotal. but i will if you want
med spa guy: i believe Jeff was considering building a separate web site for consumers. It is amazing how many patients and consumers are checking out the blog and writing in as well. But it doesn't work well these days for selling used equipment. Last year i got lots of "hits" but this year -- zero.
Jeff E.: i think i can hook you up with a guy in Texas. i will send link later. He was on tv and he is in their press releases. He would be a great guy for our mapa group.
Greg: i charge 1000. some are doing 600 because they are really taking a beating. i tell pt , do u want to coupon shop cosmetic tx?
Greg: med spa guy, we started ocm med marketing. did we talk net seo before?
Jeff E.: We probably need to charge more. We want the business and if you treat and they do well, they refer.
med spa guy: Greg: What is your typical recovery period for patients who purchase the $1000 treatment? And what is the comfort level?
Greg: i have best results down to 3 tx
Greg: 3-5 days 80%. wow that burned 20% need narcs
med spa guy: Greg: Are you seeing quick results from the seo project??? Was it an expensive endeavor for you?
Jeff E.: what is ocm med marketing?
Greg: i do some or tx now. 50-70mj tl 10-12 8 passes. u can see mtz for 2 wks.
Greg: i have a kickass software programmer. has written software for partial automated seo, sem, lead generation and it works .he can do work of 5 guys. so i made a deal i get rights to medical market. landed one gig already
Greg: not expensive but it took forever to write code
med spa guy: Greg: Is your programmer available for outside consultations and projects?
Greg: we outsource design
med spa guy: Jeff: Have you had seo done? Are you getting an adequate number of hits from the Internet???
Greg: we are in bed together but yes. it is just me and him
CLS: My web site is not seo friendly so i have to have it re-done so i can optimize seo..any suggestions
Greg: i can send u services. computers not my thing but this guy is tops now that i have learned some things. i really think a big player will want to buy in some time
Jeff E.: we get lots of leads. mostly organic. we are starting to experiment with paying for keywords. If you google anything in cherry hill, nj, we will probably show up on first page organically
med spa guy: Greg: If you guys have written some excellent code that works for an aesthetics practice wouldn't it be worth exploring making the code available to other MDs (in other states??) for a modest fee???
Jeff E.: You can learn how we do this if you come to our next Networking Meeting the Spring in Cherry Hill. Our internet seo guru will be giving a one hour presentation.
Greg: best part is the code is generic. plug in any search words any industry.
Jeff E.: Greg, i need to find out more abou this.
Greg: medspaguy, thats where we are going. we just started selling. took along time to test different searches
Jeff E.: i have to go guys. Thanks for showing up. Very good chat. Hopefully more people will show up next time. This will be posted on msmd in the mapa Area.
med spa guy: Greg: i would like to speak with you on the phone about this some time. My cell number is 952.220.3014. Jeff-- i hope i can make the next meeting in Cherry Hill.
CLS: see ya...N
Greg: do you have time now?
med spa guy: See you soon, everyone. Take care.
med spa guy: Greg: If you can call me any time later in the week-- i am buried right at the moment. Thanks.
Greg: ok sounds good. day? time?
med spa guy: Maybe Thursday afternoon? In msp i am one hour behind you. If you are busy Thurs, try Friday. Thanks again. ron
Greg: ok talk to you then. nite ron
Guest_1: i guess the meeting is over. hello ???
End Time: 08:58 PM

 

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Reader Comments (5)

I have an opportunity to go into a partnership with a plastic surgeon in purchasing the Fraxel Re:Pair. My cost would be $32,000 and the device would be at my office - we would have a percentage worked out along with other details. My question is - is it worth $32K??? If you could get one for this price and be the only one using it, would you do it??

06.26 | Registered CommenterBeth Haney

Researching lasers to add to our practice. Currently utilizing the IPL Quantum and Lightsheer with great results. Looking for resurfacing - Have looked at Fraxel, Pearl, Mosaic, Quadralase - probably more confused today then ever -

We Like the non-ablative deep penetration with fraxel. Question..... How much does the depth of treatment matter? Is there a big difference between 1mm and 1.2; Does the client get a good and long term result with Pearl, which is more of a surface laser vs. fractional even though Pearl is mid-ablative. and Fraxel is sub-ablative.

Is there an UNBIASED source that we can research to help make this decision. We attended the asthetics show in Las Vegas, and came away with lots of knowledge - but each Dr. says their laser it the Gold standard. Really would like an unbiased opinion.

Julie,

The first things I would like to know is:
1) What are you planning on treating?
2) Who will be doing the treatments?
3) What are the primary skintypes you will be treating (i.e. Fitzpatrick skintype)?

These answers will help us to eliminate some of your choices.

LH

07.1 | Unregistered CommenterLH

Don’t buy a one trick pony!
I agree with LH
"The first things I would like to know is:
1) What are you planning on treating? 
2) Who will be doing the treatments?
3) What are the primary skintypes you will be treating (i.e. Fitzpatrick skintype)?
These answers will help us to eliminate some of your choices."
Because the minimum amount of coagulation is a function of the base absorption of a wavelength in the target tissue, Erbium has the potential for the least coagulation, YSGG next and CO2 most. But remember that coagulation is a function of pulse duration (see below). With an Erbium laser with VSP one can choose the degree of coagulation. Coagulation with VSP can range from none (cold ablation) to pure coagulation in smooth mode.
We have shown that the degree of coagulation is related to the pulse duration and the depth of ablation is related to the energy selected (ie Fluence). With VSP technology the physician is able to independently control both depth and coagulation. Choosing a Short pulse duration and high energy will give “cold ablation”. In cold ablation the tissue remains cool because the heat is ejected into space along with the ablated tissue. At the other extreme one can choose a very long pulse duration and stack them in a special mode called “Smooth Mode”. This gives a pure heat effect, similar to plasma. Configurations between can also be selected, these can be chosen to emulated YSGG or CO2
Our practice (www.aestheticsofwillmar.com) is in a small town 90 west of the Twin Cities (that’s Minneapolis and St Paul, MN). You need to understand, for 80 of those miles you will see nothing but farmland.
Despite that we routinely get people from the Twin Cities at our clinic. You can find lots of fractional systems in the cities, why are they coming to our clinic? We don’t have a one trick pony. We have a Fotona Er:YAG laser. With our laser we can do everything from laser microdermabration to papillary dermis peels with or without fractionation. We can also do Smooth mode, a more precise plasma like treatment, also with our without fractionation… and everything in between. So rather than fitting the patient to the treatment you have, we fit the treatment to the needs of the patient.
When a new patient comes to our office they get a complete consult. They will understand the option and the various levels of outcome. If they need a no down time treatment, we can arrange it. If they want the “10 years younger in 10 day” we can do that also. Most importantly we fit the treatment to the patient not the other way around
“If the only tool you have is a hammer, you tend to see every problem as a nail.”
Abraham Maslow
Tom Sult, MD

www.Fotona.us

hi, i just had the quadralase c02 laser procedure done 10/3 and not know what strength the dr used would it resurface my skin and shrink my pores if by chance the did the procedure on the lowest setting? the down time is 3 days. i would like someone's opinion, please

10.3 | Unregistered CommenterKathy

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