This episode of the Medical Spa MD Podcast, Dr. Thomas Young of Young Medical Spa discusses new Smartlipo techniques and training, choosing cosmetic lasers, and cosmetic stem cell treatments.
We discuss the latest trends and nonsurgical cosmetic technologies including Smartlipo, stem cell treatments, laser liposuction, technology choices and integrating new surgical techniques into your cosmetic practice.
Dr. Young began performing SmartLipo Laser Body Sculpting soon after it's FDA approval and was the first physician to introduce awake tumescent laser liposuction to the Lehigh Valley. He trains other physicians across the country in awake tumescent liposuction and liposculpture procedures and was the first physician to perform Vaser® Lipo, SlimLipo, Body-Jet®, Stem Cell Enriched Fat Transfer Natural Breast Augmentation, Brazilian Butt Lift, ZERONA, VelaShape, and the Soprano XL Pain-free Laser Hair Reduction procedures in the region.
Dr. Young performs approximately 25-40 procedures per month identifying him as the most experienced awake tumescent liposuction physician in the region. As of February 2011, Dr. Young had performed over 1200 laser liposuction procedures and is a Speaker for the SlimLipo body sculpting laser. He continues to further expand his experience by continuing his training with industry pioneers in the art of body sculpting.
Dr. Young is double board-certified by the American Board of Internal Medicine, is a native of the Lehigh Valley, and has been practicing medicine in the Valley for 20 years. He is a Platinum Provider for Botox, and has extensive experience with Juvéderm, Restylane, Perlane and ArteFill dermal filler procedures. He is also a Premier Provider for Radiesse.
Some of what we talked about in this episode.
Dr. Thomas Young Interview Transcript
This is Medical Spa MD
Jeff: So Dr. Young, you own Young Medical Spa and you operate on Pennsylvania. Can you give me a little sense of how you have switched your practice over from Internal Medicine over to Cosmetic Medicine and how that kind of came about?
Dr. Young: Oh, about 5 to 6 years ago I decided that I needed a career change. As I looked at my options, as most of it, I started to dabble on the Cosmetic field doing some mild fillers and laser treatments and as the SmartLipo phenomenon started to sweep across the country, it helped to propel me into full time Cosmetics. I was able to shut down my Internal Medicine practice completely about 2 years ago and I've been full time Cosmetics since.
Jeff: Now you say that..2 things struck me about what you just said. One was that you were able to shut down your Internal Medicine practice so does that mean that you were kind of no longer, you know.It was, this wasn't just something that you approached as a sideline but you saw this as a career change and you..That kind of intimated to me that you were looking to get out of Internal Medicine.
Dr. Young: Absolutely. There were several factors for that which everybody have a ____. One was the managed care intrusiveness into practice wherein you have to get the prioritizations for this and that. And then the other was just you know, 25 years of doing Internal Medicine. I didn't see myself doing it for another 20 years. I loved it but it was just not for me to do for another 20 years.
Jeff: And so you started doing probably, you know, dabbling in Cosmetic Medicine fillers and probably Botox and some other kinds of things. You had enough success with that that you start putting more of your internal resources towards that. What was the kind of the precursor that made you decide "Okay, I'm actually going to start buying technology and moving towards this full time."?
Dr. Young: The SmartLipo phenomenon 3 years ago was our turning point. That procedure, we were early in on that and that allowed me to make enough revenue to then continue to get new technology, new procedures and we've just been rolling with that, you know, rolling with that trend, the new trends for the last 3 years. I think that with any new technology when on you're on the forefront, nobody really knows exactly. Because they're so new ,they've not been vetted out. So with any new technology when you get in early, there's the risk-reward and sometimes you get burned type phenomenon. You know, there's luck and then there's doing your homework and then there's always a little bit of both. And so you know, I would tribute half the luck and half the looking for the new technologies that are coming out. And certainly SmartLipo has all of this snow swept across the cosmetic plane probably second only to Botox.
Jeff: Now that SmartLipo has got a number of competitors now, have you seen a decrease in the either the name recognition? Or is there kind of been a watering down of the SmartLipo name recently?
Dr. Young: No, I think SmartLipo continues to get recognition. For you and I, it's an old news but for not everybody in the general public. And a lot of people equate SmartLipo has a brand name that really means "I'm going to get some kind of laser liposuction or some kind of liposuction done in a doctor's office while I'm awake." So when they come in for SmartLipo, lots of doctors will use their Vaser, their BodyJet, their SlimLipo. Even though people might have came in or linked up with SmartLipo, a lot of times they don't know the difference and the technology and they trust you. They just know that it's the awake tumescent technique in the office and they like that no anesthesia part. Early on the lasers were very underpowered. There was only one laser from SmartLipo which was a 1064 wavelength. And nobody really knew how much fat it melted, nobody really knew exactly how to use it. Early on doctors were just using it to tighten the skin and they were still using their PowerLipo's. So at time of all cause you know, initially, you know they say it's going to melt all the fat and you can just melt it and walk away which it took us all about, all of us doctors for 15 minutes to figure out that that was all not true. So the lasers have evolved a lot in these 3 years. They've gotten higher powers, they've used different wavelengths. So sometimes the laser is powerful enough to do all the fat melting. Other doctors still use their primarily superficially for skin tightening. As all Lipo procedures are, every doctor is a little bit unique in his approach.
Jeff: So have you kind of stuck with the tumescent liposuction techniques to build your practice? Have you added any other you know skin tightening. Are you using Thermage or any of those or other kinds of treatments?
Dr. Young: The new direction that our practice has taken. Again trying to say with all the technology is the fat transplantation market. We've been trying to now. We've been taking fats out for years. We're now trying to look into the market of taking..putting the fat back in. Also possibly adding in the stem cells to the fat going back in.
Jeff: First of all, how did you receive training for that and then what kind of results? Are you still kind of in a trial or test phase or are you actually performing this treatments regularly?
Dr. Young: We are performing the fat transfer. We're not using stem cells at the present time. We're doing the fat transfer. We do breast enhancement called the natural breast augmentation. We do the buttocks augmentation. We do face fat injection for fullness of wrinkles as well as hands. And you can do a lot of other parts of the body expressing you know. Some people use it to repair liposuction defects. Training as all of these things is that you don't learn it in your residency so you have to seek out the appropriate mentors, the appropriate training courses. And then you have to come back home and slowly implement them into your practice. Which is kind of standard for all of our cosmetic practices. That's kind of the standard now whenever there's anything new that's..You have to slowly implement it. And being doctors we're always trying to be safe as we slowly increase those things-not over progressing early on.
Jeff: So typically do you take patients that you have a good relationship with and then when you're introducing a new technology do you give them discounted treatments or you kind of have a ___ to do your early treatments on?
Dr. Young: We implement you know depending on the technology, the patient, the learning curve, how steep it is. Oftentimes, you'll do several patients at no charge. You know, and when your patients trust you that you're not going to do them any harm. That's kind of the big thing when you're early on if I can say to you and look you in the eye and say: "We're not going to cause you any harm. We might not have the treatment perfectly trained or learned at this point but we're not going to cause you any harm. Well, probably we're going to do you some good." Lots of people are very satisfied with that.
Jeff: How is your practice divided? I know that you're doing, you have a medical spa as well as I think you characterize it on your website as a surgical center something. How are you kind of divided operationally of around the treatments and organization here?
Dr. Young: By procedures, we would be divided into the Liposuction-fat transfer area which is the highest percentage. Number 2 would be the filler and Botox percentage. Number 3 would be the laser treatment percentage. This includes laser hair. And then we drop down a little bit into the skin care line in the facials, the peels, the VelaShape and the Zerona. That would be our lower percentage treatments.
Jeff: Now when you say percentage, are you referring to the amount of physician involvement?
Dr. Young: Percentage..
Jeff: Do you see that fat transfer techniques are potentially stem cell fat transfer techniques have the ability to move to the top of the revenue scale or is that something that you see more as kind of a ___ of the treatments that you're doing?
Dr. Young: I personally am still in the beginnings of my learning curve for some of the fat transfer. Like the fat transfer to the face. I'm a little bit at more at my beginning curve. For the breast and the buttocks, I actually have been doing that for some time. And the stem cell applications will be the ____, the breast, a lot of that will be for the face. But fat transfer market I think is going to continue to grow because people come in for fillers. They get filler fatigue overtime. Now I can offer them a semi-permanent filler that's their own fat so the risk is low.
Jeff: Is the selling point there that they're not actually having fillers? Or is the permanency of having potentially their own cells to transfer in the fat transfer? Is that the thing resonates with potential clients of this one?
Dr. Young: Several things including the things you just said. You know it's your own filler. It's your own fat, number 1. Number 2, it lasts you know say 5 plus years cause you continue to age. Number 3, you can do much more cause once you're harvesting fat, I can harvest 50 cc'sYou know if I translate that to the 6 or 7 syringes of a filler, you know they do the whole face and all the lips and all the lines. The price has come to be incomparable for permanent versus temporary. And then there's also the rejuvenating effect of that fat has all over the lying skin. So a lot of selling points. Everybody would do it but it's a little more invasive and a little more downtime so that's the reason a lot of people don't do it. You know, it's a little new, it's a little more invasive, it's a little more downtime to getting the fat transfer.
Jeff: So you're saying that the pricing of that is roughly the same over the period of 5 years as opposed to having filler injections?
Dr. Young: I think it's less expensive.. Less expensive.
Jeff: By half? Or what you know..What is the price reduction that somebody is realizing now?
Dr. Young: Well, it's a little hard to compare because when you know.. When most of the time you do fat transfer, you're doing multiple areas. So you almost always come out ahead just on the first treatment. If you would compare just nasolabial folds--you know after 3 or 4 treatments of getting your nasolabial folds done, that equals about the fat.
Jeff: Brings up an interesting point. So how do you decide how much you're going to charge for different treatments? What is it that--is it your local market that you kind of look at? I mean is it kind of you know crowd sourcing that here's what the average physician price is and therefore I'm going to price it incomparably or 10 % above or 10 % below? How is it that you arrive at the price you're going to charge for these treatments?
Dr. Young: You touched on a couple of good, good points that we would consider to come up with a price. I start by getting the average prices that physicians charge. There's big city prices, there's the expert in the field prices that in my market I would never command. So I tend to be on the lower end of the scale. And then you're also calculating your time and the cost of that technology. One thing about fat transfer is that it's cost of the technology is not that high. Most of it is just learning the skill. So then it's mostly your time and then would anybody else offer that service? Using early on, you can charge a little more until there's lots of competition.
Jeff: Sure and that becomes commoditized. Do you see that that is going to happen if there's something that doesn't cost a lot of money to get into for a lot of physicians? And it really is their time? I would guess that fat transfer--that makes fat transfer appealing in a number of ways. Do you see that that's going to kind of help push the fat transfer technologies kind of into the forefront around what physicians are actually talking to patients about in the consultation room?
Dr. Young: I think that it will be not as widely utilized as some of the other technologies cause I think the learning curve is a little bit higher. I'll give you an example. If I had teach you how to put fat or Restylane into nasolabial folds, that learning curve is not that long. But with fat, you're putting it all over the face. So, for example, how many physicians are doing the whole liquid facelift compared to who's just doing the nasolabial fold? You know, cuts down a lot of you know the percentage of doctors doing the liquid facelift onto the whole face versus just the nasolabial folds is a lot less. Because of skill set and the invasiveness and the cost is a lot higher. So I see that it's going to be a popular treatment. I don't think it's going to be adopted as widely by a high number of physicians. I don't see dermatologists picking it up like every dermatologist picks up filler and Botox. I don't see them picking up fat transfer because harvesting fat is not something that they do. You know the whole aspect of harvesting the fat.
Jeff: Have you seen any complications with fat transfer?
Dr. Young: Most of the complications of fat transfer tend to be that either A. the fat doesn't tame and goes away or B. On the other side that they're a little bit too puffy or lumpy in an area. Most of that is technique dependent, but you know, sometimes we all get results that are not quite as good as we would like.
Jeff: Where would you put this on a scale of patient satisfaction? The fat transfer kind of techniques?
Dr. Young: I'd put it at about to 8 out of 10. Cause it takes a little while for them to _______ for them to get used to things and then they tend to be very happy.
Jeff: Is there something that drives more patient satisfaction than you're doing? You know is that SmartLipo? Is that 9 out of 10? Or is there something that you're doing that drives even more patient satisfaction?
Dr. Young: You know, patients are our tough audience. You know, getting 8 or 9 out of 10 is always a tough thing to do at my day. You know, I would say we have a lot of our laser lipo patients, SmartLipo patients that are very happy.
Jeff: What skill sets did you have to learn when you moved from Internal Medicine over to Cosmetic Medicine that surprised you?
Dr. Young: I don't know if I have a good answer to that question. As far as dealing with my patients, I've always had the demeanor of trying to make my patients happy and doing what I need to make them happy. So I guess I didn't really have to learn that something that we have to do everyday which is do what we can reason to make our patient happy. Even if sometimes we don't necessarily agree that it needs a little more or can be a little better or what's good as what they've thought. We going to have to work to that.
Jeff: You probably now have a marketing budget. You're probably compensating your staff differently than you were before. Are there any of those things that either surprised you or you know that you had to think of these differently?
Dr. Young: Surprising for me, you know, certainly the financial area was incompletely different. Your revenue can be not.. is not as predictable. In medical practice, your revenue is very predictable. You know, you see X number of patients in a week or in a month and the reimbursement is wide. You know there's a little bit of cycles up and down. Certainly I am surprised at the trying to keep up with the technology now. How fast the aesthetic companies will find new machines for me to..that I must have. And for me to figure out whether I must have them or not.
Jeff: So when the reps are calling you up and saying "Okay we've got you know..now we've gone from the G to the H or the zed model of this and we'd like to upgrade you and.." How do you balance that? Or what is the process you go through to decide if you're going to actually take them up on? And then how do you negotiate with that?
Dr. Young: Very, very difficult on how to fare out that information. But you know, cause I think that the companies are not always as honest as they could be or should be. There are not always good studies that are common sense. Like the noninvasive fat reducing market now which is or we know that the trend will head but we all know that the results so far are minor and not as good as we would like versus the cost of the treatments you know. Trying to get that information is difficult at times and then you going to you know, go to the doctor and the doctor that's usually talking to you is very close to that particular company early on so it is very difficult. You often have to talk to the first doctor that took the leap that's not connected with the company and hear from him on how that machine really performs.
Jeff: How have you tracked down those physicians and what have they kind of..Have they steered you clear from things that you were actually considering purchasing?
Dr. Young: Oh absolutely. Especially if that tends to be someone you know personally that is also trying to stand to the forefront. That can be very..then they can be very honest with you because you know..they're going to be honest with you and hopefully you're being honest back at them for something that you're doing that's different. So then it could be very difficult to make those decisions especially if you're trying to be an early adopter. If you're the person that's not an early adopter, it's easier. You can just sit back for that 6 to 12 months, you're not worried about the first wave of TV press and saying, you know "There's Zeltiq that's fat freezing machine" that's in the press all over you know,and somebody calls if you have it. You're not worried that you're..you know, cause you'd rather be letting the market sort out or this is.. You know, because the market ends up sorting things out. You know, that's what's nice about America-the free market. They're going to sort out whether what the patient has to pay for the treatment or the other towards it.
Jeff: What are you saying in the consultation room around those patients who are looking for something that you don't provide? Are you managing their expectations by saying, like you know, "I haven't yet made a decision"? Have you seen that as a potential problem? Have you lost patients that way or is generally a trust issue where a patient that comes to you--you can build up that level of trust that they will either wait to see what you decide or they'll go to a treatment that you will offer?
Dr. Young: In my particular market, I tend to be the leader of the technology. So I don't tend to lose in my market patients to somebody that has a new machine cause I'm a little bit more a smaller market as compared to a big city who's somebody's going to buy the new technology no matter what it is. So I'm a little bit more fortunate that way. And most of the new technology you least know about it to give an intelligent answer about doesn't work how well we think it's working you know, especially with the noninvasive body contouring. People don't know that the results are modest with Zerona, Zeltiq, Vaser shape you know. Right now the results are modest and I'll say "Well, if you want an inner tube, go on, those are okay. If you want it all gone, this is how we do it."
Jeff: So Zerona and Velashape, those kind of treatments, are they basically just paying for themselves or are they not big producers just because the results aren't there?
Dr. Young: You know, Zerona.. Some people do well with the Zerona depending on the market. My market, the cost for the 1 or 2 inches seems to keep some people away from that. But the Zerona's are good you know, those noninvasive things. Even the results are not as good but they are a good opportunity for people that will not consider anything invasive. So that and the other person expect that you won't let you ever inject anything into them, that can be a good option for them cause that's what they want and they understand it. And we..you know, you always have to set the expectations correctly.
Jeff: Are there treatments that you used to offer that you no longer offer for whatever reason?
Dr. Young: It's interesting you asked. We're talking about Lipodissolve today. That's certainly one that we had for a little while and abandoned as the laser body contouring market took over and also the risk of that. The risk benefit of that wasn't as good and we just abandoned that, you know, technique.
Jeff: So where do you see the next kind of wave of technology? I know that you're training for.. I think that you're training for Palomar, correct me if I'm wrong and that you're also kind of training physicians and how to do these treatments inside of your own practice. Where do you see. you know, do you have any insight to where the next treatments are going to go either technology wise? Or where the technology companies are working to push this?
Dr. Young: I would give you several areas to keep their eye open for. Number 1 is the fat transfer market that we touched on, injecting the fat on the breast, the buttocks, the face, the hands and the other areas. Number 2 would be the noninvasive body contouring market. There's a number of ultrasound devices out there. There's the Zerona, the low level laser, there's the Zeltiq, there's the cold therapy. I think we're at the beginning of that and because that market has huge potential so I think everybody who has a cosmetic or aesthetic practice is watching that. We're all a little wary now because the results are so-so. So depending in your market if you can get..if you have enough patients to do those results, some people get those machines. If you got a market where they got to wait for results a lot of people are still on the sidelines for that. The third market is stem cells. Stem cells are very cutting-edge. Everybody has heard of stem cells and the controversy that surrounds them. They know their controversies so they must do something good. So to the public, stem cells are a lot of buzz. I think there's going to be a lot of applications for them in the aesthetic arena that we just haven't touched on. Most of the research so far is just in the stem cells in hands and fat survival after transfer and that's been shown pretty well in the literature so far.
Jeff: Do you see that stem cells would be basically an issue of training physicians? Or do you think there's going to be technology that takes over you know? Is that going to be training dependent? Or is that kind of technology?
Dr. Young: Well certainly, it's always..I think it's both because the application of stem cells, there's going to be training. The harvesting of the stem cells is where the technology comes in. You kind of break it down into 2 parts: How do I get the stem cells? That's where the technology component is cause you kind of get it out your fat. Number 2, using stem cells is going to be the learning part, the technique part. What are you going to do with the stem cells once you have them? Are you going to have them make the fat look better? Are you going to inject them into wrinkles? I think there's a lot and..Those are just of the 2 I know there's going to be a lot more applications that if we can get the stem cells up then doctors are going to find out, doctors and patients are going to find out where to put them. And because they're fairly safe so you can.. it will be easy to try them. For example, we can inject them in your scalp and see if hair rose.
Jeff: If you were to tell a physician that they needed one..well, if they're going to buy one piece of technology, what technology would you be telling a physician who is just entering the market to buy?
Dr. Young: You mean other than a computer?
Jeff: Other than a computer.
Dr. Young: Other than a computer? That's a difficult question because I think it would be market-dependent you know and skill set dependent..so it has to hedge on that answer saying that the, you know, the laser hair removal photofacial market which is saturated is still often your beginning step cause you kind of get to have a..sometimes you need to learn to walk before you can run. The next, the other piece of equipment is that I would say some sort of laser liposuction device would be the one that I would pick just for me..and knowing what it's helped me. That would be the one if I'd to pick one.
Jeff: Okay so an IPL and something with laser liposuction?
Dr. Young: Yeah.
Jeff: Okay. Now you're training physicians, could you tell me a little bit about how your physician training works and what a physician for your training could expect?
Dr. Young: I'm training doctors how to use a laser and awake tumescent laser liposuction, you know the classic tumescent technique utilizing laser as part of the fat melting process. What I've tried to do in my training sessions goes back to an earlier point that you mentioned which is how do you get trained?
So I don't focus my training on all the book work and all the kinds of ___ and all that. I think you can just give them a book and all that in. That's all I literally give them a book on liposuction that has much better stuff than I can teach them. What I teach them is hands on so that they could get an experience from a live patients, with them doing it. Cause that could be harder in some of these aggressive procedures. You can watch them. Doctors will let you watch but how will you actually get hands on while you're supervised by a doctor? So that's the emphasis at my course. You know I take my patients that and I give them a discounted fee.
In return, they'll let know that another doctor will be working with me and alternately they know I'm responsible finishing the case but then the doctor's going to be you know learning how to do, you know injecting tumescent technique, injecting the laser and I'm going to keep them safe while we all do that.
Jeff: Is that..do you have a waiting list for those clients? Or is that something like you kind of wait for potential patients that want to do that?
Dr. Young: We usually have a waiting list.
Jeff: Is that a multiple day training? Or..
Dr. Young: 2 days..
Jeff: And they come visit you, your clinic?
Dr. Young: Yeah.
Jeff: Tom, I want to thank you very, very much for your time.
Andy: Thank you very much for listening. Hope you enjoyed it. We'd love to hear from you so if you got any questions or comments, send them along to the email address at firstname.lastname@example.org or leave comments in the physician's forum on the MedicalSpaMD.com website. If you're a subscriber, that's great. If you haven't subscribed yet and you'd like this show to be automatically downloaded when a new episode that comes along, then search for Medical Spa MD in iTunes or visit the Medical Spa MD website then click on podcast or also search for Medical Spa MD on Twitter, in Facebook and in LinkedIn cause you'll find us there as well. As always, please consider everything we say to be a complete conjecture and random speculation, not medical or legal advice. There are also regulations made everywhere so consult a medical or legal professional in your country before taking in any action. So that's it. So it's goodbye from Andy White
Jeff: And goodbye from Jeff Barson.
Andy: Wishing you all the best and we'll see you next time on Medical Spa MD.