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Friday
Feb082008

Cutera Lasers: The old bull & the young bull

twobulls.jpgSome of Cutera's customers seem less than thrilled with the level of service and hospitality they're receiveing:

 
From the thread on Is any Cutera technology worth buying? 

"What a nightmare! The folks at Cutera have seemingly gone mad. I imagine that business is slow for them lately, and it shows. I agree with the person who said service contracts must be how they're cashing in these days. I am stunned at how virtually impossible it seems to avoid the exorbitant fees Cutera is asking for what I have experienced as substandard service. I have had too many "surprises" when it comes to their seemingly ever-changing service arrangements and hidden costs (I never know I'd be paying another $6800 for a "replacement" Prowave a little over 1 yr after I spent $25K to "buy" it!). Service contract information was never properly explained to me and I feel like I am being extorted for cash. My only options are to spend $16,000 (yes, $16,000!) for a 1-year service warranty (of course this does not cover Titan when it runs out of shots), or spend $6800 for a new Prowave (still paying off the $25K lease!)! I have spoken to more docs lately who deal with Cutera and it seems we are all told different things or left with different impressions about the longevity of the handpeices, service warranties, handpeice replacement and contracts. I get the feeling that whatever needs to be conveyed to make the sale is what is conveyed! Then once you buy, you are stuck! And of course they know they have a captive audience of customers who rely on the technology and have no other means of servicing the equipment. And of course all of this is as clear as mud when you are first being wheeled and dealed. It seems very short-sighted of Cutera to anger and frustrate their current client base and think they'll continue to get new business.

I admit, I enjoy the safety and efficacy of the 1064, Titan and Prowave, especially in the darker population we serve, but I am no longer convinced it's worth it. I would not purchase another item from Cutera, not because of the technology but because of the inferior service and what I consider to be unfair business practices. I feel misled and misinformed, which is very unsettling given that the business relies upon this technology!
Any attorneys out there??" - SkinHealthMD

And Dermadoc's not far behind:

"SkinHealth MD sounds like one of the Dermacare franchisees that got roped into a 'required' equipment package with Cutera. We were told they had the premier technology for all the applications necessary for a successful clinic. I'm glad you are pleased with the Titan, but I think you are in the minority there. I don't have any issues with the ProWave, LP560 or 1064Yag, but then again, we didn't have nearly as much information available for comparisons as there is now. If we did, I probably would have made other equipment choices also. I am definitely with you in that we won't be buying any more Cutera equipment." - Dermadoc

It looks from the comments that Cutera's lasers aren't the problem (although the Titan and Pearl don't fare well) it's the strong-arm tactics around support and after purchase services that are so irritating.

Cutera's rapidly developed a customer service problem for themselves. In the old days that wasn't something to be feared since the plastic surgeons and dermatologists weren't sharing much information about what they used. Certainly that legacy of keep everything hush-hush is alive and well locally, but these days a single bad experience can poison the entire well. Cutera's management (and Palomars) would do well to understand this.

It's like the story from the move Colors that Robert Duval says to Shawn Penn:

There's two bulls up on the hill looking down at a bunch of cows. The young bull says to the old bull, "Hey Dad, lets run down this hill and &%*# that cow!" The old bull turns to the young bull and says, "Son, lets walk down the hill, and (&%)# them all."

Now perhaps this is harsh, but Cutera seems to be that young bull.

It shouldn't be the goal to sell you a laser, it should be the goal to sell you a dozen lasers. 

Reader Comments (90)

I actually remember that line from the movie. An excellent, it somewhat obtuse, reference.

I have to agree, Cutera's not doing themselves any favors in the long run.

02.8 | Unregistered CommenterGrumpyMD

I am not a Cutera user but must admit in general they do a very good job at "scamming" new practices into going for their products despite their overall inferior product lines except for the Xeo. For example, they were able to push thru with Healthcare Partners' poorly informed and new-to-cosmetic MD's in installing the entire line in its 2 new medspas in CA and the Titan in the new California Longevity Institute. Even as of today, I cannot fathom how my physician colleagues can STILL be so easily induced into buying the Titan which is not only not FDA-approved for skin tightening but with not even remotely convincing photos on their own website as proofs. Now comes their "new" Pearl YSSG which is Erbium with fractional technology but 2 years LATER. They are worse than car salesmen!!!!

02.10 | Unregistered Commenterpmdoc

I hate Cutera. Their lasers don't work.
The Titan does not work and they get upset when you tell them this.
The Emporer has no clothes.
And Laser Genesis does not work either.
They don't teach you how to use their other lasers to the best of your ability. They just want to sell more lasers.
Their webinars are good for selling lasers, not for learning to use them. They are very short sighted.
Their sales people are also unethical cutting other sales people out of their commissions.
The lie, they cheat, they steal.
They suck.
I hate Cutera.

They are headed for a big fall.

Marketing is KING!!
I am amazed at the number of good docs that have bought Cutera or other lasers that don't work. Just look at the locate a doc for Cutera in your area. Marketing and a slick sales pitch can make a well educated medical professional forget science.

Example: Cutera Pearl (from the website)

Ablation means nothing more then removal of material from a surface.
Cutera knows most docs associate this with skin tightening.
Pearl ablates 20-30 microns. Epidermis is about 100 micron, dermis is about four times thicker. At 20-30 microns, old and dead keratinocytes
are looking for a new home in the atmosphere. We did this in the past
with erbium, couple of passes at 1-2 joules ( not much of an aesthetic effect).
Cutera claims coagulation. Sufficient heat is NOT produced with YSSG 2790nm at 20-30 microns.
Cutera claims collagen remodeling. What?? There is no thermal effect to the reticular layer.
Cutera says yes, science says no.

A piece of advice. Be well educated on skin anatomy, active laser mediums, intensity, thermal effect, etc... before you buy any laser.
This will give you an advantage over a slick sales pitch.

I hope no one is offended, I'm trying to be helpful. I am not an expert by any means, but if I did my homework first I would have had happier patients and not bought useless equipment. besides I don't think all the people on this site are within 20 miles of my office. If you are, disregard all above and buy a Cutera

02.19 | Unregistered CommenterFlorida PA

My name is Dave Gollnick. I am the Vice President of Research and Development and one of seven co-founders of Cutera. There are a number of anonymous posts in this dialog. I would encourage any owner who would like to discuss service issues, pricing or product performance to contact me directly. My direct phone number is (415) 657-5514 or if you'd prefer email, my email address is dgollnick@cutera.com. We are proud of the company we've created but, like any other company, we are not perfect. We believe that the true cost of ownership of Cutera's devices is competitive with any in the marketplace. Perhaps changes or flexibility are necessary. I'm happy to discuss this with any owner. We are always looking for ways to create more satisfaction with our customers. As an example, Cutera sponsors annual user group meetings. In this forum we invite all owners to a two or three day symposium that is an open dialog between owners, clinical experts and company executives. We believe that Cutera's greatest asset doesn't appear on a balance sheet or in company financials, rather in the satisfaction of its employees and owners.

Sincerely,
Dave Gollnick
EVP, R&D
Cutera, Inc.

Dear Mr. Gollnick:

Thank you for participating in this thread.
As a Cutera laser owner, there are several areas that I can personally comment on - areas where Cutera could significantly improve.

1. Cutera local reps only come and talk to me when Cutera has a new product to sell. They never come around to check on how I'm doing with my current platform, or if I need anything (training, refills, brochures, what's new, etc.). Turnover of the reps has also been very high - I think we've been through at least 4 area reps in 5 years, here in Orlando.

2. The yearly service contract is exorbitantly priced. I feel like I'm buying the laser twice - once upfront, and once more over 5 years with the service agreement...and this was never made clear at the time of the original purchase. Big ouch! If you don't have the service contract, and you need service - you are treated like a second class citizen.

3. Cutera doesn't permit any non-Cutera laser technicians to do service. It smacks of monopolistic price fixing.

4. The Cutera IPL 560 head is underpowered. Rather than allowing an reasonable upgrade pathway to the newer "limelight" unit, Cutera charges me full price. Ouch again...no reward for loyalty.

5. Refills for the titan hand piece, particularly the XL unit, are expensive.

6. Optimal parameters and technique for the Titan treatment have still, several years after its introduction, not been established. Where is the research? And where is the "imminent" FDA approval for skin tightening for the Titan?


That being said, there are some positives for Cutera:
a) the 1064 laser is good for vascular treatments, once you find the right parameters. (e.g. Cutera's suggested vein treatment parameters are too low).
b) the webinar and clinical conferences are more than what the competition does, and are moderately helpful.

I hope, Mr. Gollnick, that you will participate in this discussion, and will consider these comments in the spirit of improvement in which they are offered.

Sincerely,
Thomas Fiala, MD, FACS, FRCSC

Dear Dr. Fiala,

Would you have some time early next week to discuss this via phone? I have time on Tuesday or Wednesday afternoons or evenings.

Sincerely,
Dave Gollnick

Dave:

Some of the legitimate dissatisfied users are also disatisfied Franchisees and I believe you are going to have to give them some sort of written non-disclosure agreement before they will talk to you.

03.8 | Unregistered CommenterWPS

Dear Mr. Gollnick,

I agree that it is great to have you on this site. There are not many of the administrative people from the technology companies willing to stick their neck out like you have. I was amazed to check the site this morning and to see you post.

I also am a Cutera owner and if you read some of my posts I have not been very happy with Cutera as a company. I agree with many of the comments from Dr. Fiala.

1. The only time I hear from my sales rep is when they want to sell me something.

2. The webinars are almost useless for advanced users. They are either focused on marketing a product or for new users. (I also do not like receiving the same invitation 4 times in the same day). I have yet to watch a webinar and have it be beneficial.

3. Your service contracts are WAY over priced. This alone is a reason to not buy Cutera.

4. Your IPL 600 head is also underpowered.

5. I recently looked at new IPL systems. I looked at Syneron, Sciton, Palomar, Cutera Limelight and ProWave. I did not choose Cutera even though the Cutera would have been less expensive for me.

6. Titan not worth $40,000. Over promised and under delivered. Head replacements are too expensive. Mine has become a very expensive coat rack. It cost me too much to use based on the results I feel it gives.

7. Agree that after 3 years Cutera should have a better understanding of the Titan and its best parameters.

8. Cutera will not sell parts to not Cutera service people.

9. Not enough service reps. I am in the midwest and my service person comes in from oregon which of course drives up my costs.

10. The 1064 is a work horse. I have over 2.5 million pulses on it. I have only had a small leak in a hose that was not properly strapped down and was rubbing on the frame.

11. We have also had 4 reps in 4 years.

12. The problem with the users group is that they are never close enough. I can not afford the time to attend. I would recommend to tape and put out as a webinar.

I appreciate that you have joined us here. I hope we can have an honest discusion about the Cutera product. I have the opportunity to buy a used xeo at a very good price but at this time likely will not purchase it because Cutera has made it so difficult to get parts. This same situation alse makes it so that at this time I will never purchase another Cutera product. That could change if Cutera were to change their corporate policies.

03.8 | Unregistered CommenterLH

Mr. Gollnick does not really care. It is all a PR move to get us to shut up. I complained loudly a few years ago and I was told to shut up and I was told that I was "disloyal".

If Cutera really cared they would go out into the field and see that their lasers are not working and that doctors and patients were not happy. They don't do this, they have not done this and I doubt they will do this because all they will find is discontent and misery.

Cutera will fail in the end because they don't care about the doctors who have bought their equipment and they don't care about our patients who get "clinically insignificant" results.

The 1064 laser for hair removal is also underpowered. Everyone knows that you need 3 ms pulse duration at high energies to get thin brown hairs, but the Cutera 1064 can only go down to 10 ms for hair removal. The ProWave is not much better. Works some of the time, but what do we do with the patients (a significant %), who do not get results?????

Mr. Gollnick. You lie in the bed you make. You have screwed your doctor customers. The word is getting out. I don't see anything positive for Cutera in the years to come. Sell your stock options now. It is going to get ugly.

Good luck surviving.

I agree that the Titan sucks, the Laser Genesis does not work and I don't know much about the Perl, but I would not be suprised if it did not work either. When Cutera began SELLING the Perl, they had done only ONE STUDY with 40 patients.

Cutera does not care about us or our patients. How much does it cost to go to your user conferences? I went to one and all I got was your bought and paid for luminaries telling us that "The Emperor Had New Clothes" and that we were stupid for now seeing the beautiful clothers. Well, I know when I see a fat, old naked man and I don't need your luminaries telling me I am stupid.

Oh and by the way, your sales people screw the other sales people they work with. Your leads are going to dry up really fast.

Mr. Gollnick, you have a lot of work to do. Your company is rotting from the inside out. It is about to catch up to you. And I don't believe you did not know.

I would like to hear from someone who likes Cutera and thinks the machines actually work. And I don't want to hear from your luminaries, I already know they are bought and paid for and don't tell the truth.

I have made numerous suggestions over the years and I have been ignored. I am sure you will ignore me now. I don't want to talk to you because I am too busy doing retreatments on patient who did not get clinically significant results from my Cutera "clunkers".

I hate Cutera,

I always try to give people the benfit of the doubt but I understand your frustration. My frustration is similar to yours but I do have to say the Cutera 1064 is a workhorse. I do not use any other portions of my xeo. I could have saved about $80,000.

Mr. Gollnick,

I hope that you are reading and listening to what is being said. I do not think that all people at Cutera are bad. I just think the business model needs to be reworked. I have been contacted multiple times by physicians comparing Cutera to other high quality systems. Not one of them has chosen Cutera. Just my discusssions of the Cutera business model have been enough for these individuals to not choose Cutera. I am guessing that this has cost you at least $1.5 million in revenue.

I do not want to just blast away at you. I hope that the lines of communication and trust can be developed so that Cutera will improve its backend support of providers as well as its lasers. I am going to give you the benefit of the doubt and hope to see some of your answers on this post.

03.9 | Unregistered CommenterLH

LH:
I agreed with you. I used to use Cutera products, actually when it was Altus Medical. What got under my skin was when the company went out of its way to "feed off" on other companies' early misfortunes (like with Thermage in 2002) or put a "new spin" on something already existing (like fractional technology). Their spin on the Titan 3-D is nothing but to "soup up" on something that is very inferior on its own right, thus incapable of getting a formal FDA-approval. But when Cutera sells it to the doctors they don't honestly disclose that and then do this "song and dance smoke screen" on the 3-D crap charging doctors at a premium just to attend to find out its "new secret combo" therapy. Then I have to hear from this "new fish" from New Zealand named Maureen wishing to enlighten us about her great success with it and lots of pics to share. I checked her website and SURPRISE!!!!! she carries the entire Cutera lines. I was falling down laughing b/c it clearly showed her practice's lack of "in-depth knowledges". Her site has NO before and after photos. I see this often when someone like her invested SOOOOOO MUCH $ into something, now she exhibits this "justification self-defense" wherein one unconsciously tries in vain in denial of admitting that MAYBE one might have made a very big mistake. I wish her all the luck with her Cutera song and dance. As I have said before their 1064 Xeo is the only one platform that I find to be quite good. Other than that, it is time to check other manufacturers

03.9 | Unregistered Commenterpmdoc

Money talks and bullshit walks.
I will change my opinion when I "see" change.
I am sick and tired of promises and giving people the "benefit of the doubt".
They know exactly what they are doing. They know they are selling "crap".

Mr. Gollnick,
I am pleased that you are willing to listen to some genuine complaints and concerns about your company. I would like to make you aware of the problems we have encountered with Cutera;
1. We purchased the XEO platform in 2005 and NEVER used the machine (this was our fault not yours). However, 1 year ago we began our aesthetic practice. We spoke with your service department and they wanted an unreasonable fee to "check out" our machine before we used it on our patients.
2. About 6 months ago a random error code appeared. I spoke with Michael in CA., he told us that this would require a 6500$ replacement to our 560. WRONG, the error code was actually air in the h2o cooling line. We were able to correct this problem without replacing the handpiece. Thanks Micheal for your help. NOT.
3. BS that you charge for patient brochures.
4.Difficult to understand the receptionist that answers the phone in CA.
5. New Prowave 770 purchased 7 days ago caused a fault in the power supply board. We "get" to wait 5 days to have this repaired. Every second that the machine is not running I am losing money. Many laser co. will have another machine at your door the next day. (However, our rep drove a machine in from Kansas City and we appreciate his effort)
6. Warranty cost is absurd. Only a fool would purchase this.
7. We would like to have a copy of the error code or troubleshooting tables. Not the kindergarten BS in the owners manual.
8. I would like a service department that repairs their equipment. I am certain that the majority of your equipment can be repaired (and not replaced at big $$$). We have used Med1online with great results.

We are pleased with Brett Houston our rep, the majority of these concerns have also been discussed with him.

Our group will be purchasing another laser and without major reform it will not be Cutera.

Again, I am glad that you had the spine to hear us out.

03.9 | Unregistered Commentermidcity

P.S. You may want to entertain the idea of hiring LH as a consultant. He has more knowledge than a lot of us combined.

03.9 | Unregistered Commentermidcity

Aren't those before and after pics of Cutera's Pearl really Benay Todzo the marketing gal from Cutera ? Come on you guys........ Cutera stock at its all time low 11 bucks...

03.9 | Unregistered Commenterphoto

midcity,

Thanks for the vote of confidence. I appreciate your comment but there is one problem with it. I am not for sale. These companies have way too many physicians in their pocket. That is the problem many of these speakers get money or even equipment from these companies. Cutera definitely needs input from outsiders though.


Mr. Gollnick,

I was really looking forward to hearing from you today. If you are truely interested in what users have to say, then it needs to be two way communication. I really hope that you are willing to take some of the heat as you said no company is perfect. So listening to customers that own your equipment is important. I hope to hear constructive input from you.

03.10 | Unregistered CommenterLH

Dear LH,

Please contact me at your earliest convenience to discuss or kindly post your contact information and I will get in touch with you. Since my post last week, I've heard from one owner. We have a call later today.

Sincerely,
Dave Gollnick
(415) 657-5514
dgollnick@cutera.com

Hi Mr. Gollnick,

This is a test for you and your company.

You can get this started within 30 days. If you do this, I will be more predisposed to give you the "benefit of the doubt". If you don't do this, I will become another "I hate Cutera". This is my proposal. I hope all of the others on this site will hold you to this.

Start a series of Advanced Webinars. Give real parameters with very experienced users as the presenters. Keep it focused on what we need to do to get great results (for example, I want parameters for all types of veins in all areas-I don't need to hear about vein anatomy again and I don't need to hear about endovascular treatments and surgical options again). Provide TRANSCRIPTS of these webinars to any customer who wants them (for free or $5.00 max). Provide the transcripts within a week of the webinar (those that watch the webinar need them to learn more, those who cannot or do not watch the webinar should be able to benefit without sitting through an hour and a half of webinar).

This type of advanced webinar should be done for:

Laser Vein
Laser Hair with 1064
Laser Hair with ProWave
Rosacia
Laser Genesis
Titan
Opus 560
Perl
and any other device you sell.

I will expect one per month starting in April.

I will have other suggestions, but lets start with an easy one.

Remember, this is a test. I hope you pass. I am skeptical.
If you really care about us and really care about our patients, you will do this and do it happily.

Disappointed with Cutera,
I agree that "advanced settings" may be helpful but how can you account for patient skin type, past medical history, etc... thats why laser surgical medicine is an art not cook book. I can do a vein for nose and the settings depending on the patient may range from 3mm at 115 to 190 J and 8 ms -- 20 ms ???? How can I teach you that. Veins take time and experience not just putting in numbers and shooting away. IPL is the same thing. You have to do test spots to see and adjust settings. I use Cutera and Sciton but what you may be asking is maybe the art of medicine ?????

03.11 | Unregistered Commentercutera?

Another idea.

Stop charging us for Titan Head replacements.

I have stopped using the Titan because the results are minimal and they are not even worth the $600 I spend on Titan pulses ($200 per treatment).

If I could do Titan treatments for less money with the appropriate "dumbing down of expectations", I might do more. Maybe my patients would be happy with the minimal results if they only paid $1000 instead of our current $3000-$4000.

This would be an easy change for you to make. It will cost you money, but I think you better plan on re-investing in your company and your doctors if you want to survive.

03.11 | Unregistered CommenterJKD

Cutera?,

I have heard your argument so many times and it is alway offered by people who are not very bright or are too lazy to teach or who don't want to share secrets.

I am a doctor. You can and have to teach medicine. You can and have to teach us how to use the lasers. Just throwing up you hands and saying it is "the art of medicine", go figure it out yourself is a cop-out.

If Cutera can't teach us how to use their lasers, they should not sell them. Period.

All great artists have mentors and teachers.

Cutera better get their Luminaries to start teaching and mentoring just like we were taught and mentored in Medical School.

Cutera?, are you a doctor? Do you understand me? If you truly know what you are doing, you can probably teach it if you took the time and effort to reflect on what you did and how you did it.

I am not saying you can learn laser medicine in one hour. I am saying that Cutera better start teaching and mentoring on the use of their lasers and light devices. So far they have done very little. Very Little.

Dear Mr. Gollnick,

I was hoping that some of the discussion would be held here on the forum. I feel having the conversation out in the public is important. There are a fair number of Cutera users on here that would like to hear what you have to say. This would go a long way in improving your companies image.

We had one post from a thermage exec but he never followed through. This is not just about me and my concerns with Cutera. This is about multiple users on this site. I hope that we can have constructive communication. As you have seen some individuals are very upset with Cutera.

03.11 | Unregistered CommenterLH

As a doctor trying to evaluate the various laser platforms I am very interested to see whether Mr Gollnick will enter into a public discussion on the issues raised. I have also asked for transcripts of the Cutera webinars. It is mindless to have to sit through an hour and a half of a webinar when one could get the same info by browsing a document for 10 minutes.

03.12 | Unregistered CommenterDrDave

DrDave,

Many of the webinars are mostly advertisement and marketing.

03.12 | Unregistered CommenterLH

DrDave,

Thank you!

There is lots of great information in the webinars (you have to sit through 50 minutes of marketing to get 10 minutes of good info), so I have stopped watching.

What I want is 90 minutes of solid training and then transscrpts to read, review and learn from. Maybe I will watch the webinar and maybe I won't, but I want the transcripts so I can learn.

Lets see if Cutera is going to do this.

29 days and counting.

They should announce within a week or I will become "Pissed off at Cutera" and then "I hate Cutera" and I love to blog.

I'd like to report the readers of this blog that I had a one-hour conversation with Mr. Gollnick of Cutera last night, and he attentively listened to my litany of complaints. I got the impression that he is honestly concerned, and wants to help.

Some fixes - particularly in the areas of local reps and tech support - are underway corporate-wide.

Research into optimal Titan parameters is ongoing, as are plans for a resubmission to the FDA for an official indication for "wrinkles".

They are also considering some alternatives to the current service agreement arrangment.

Apparently, the Cutera Users meeting now features an "advanced user" stream - for the first time.

So - let's keep an open mind here, and see what develops.

03.13 | Unregistered CommenterDr. Fiala

DrFiala:
One thing that I found objectionable about Cutera was its sales people conducts even as of today. I incidentally received a forwarded email from one of the company's SoCal reps about its Cutera product. He stated that: FDA-approved deep dermal heating is IDENTICAL to FDA-approved skin tightening. He attached 3 articles showing that depth of penetration is identical for the titan and thermage (FALSE), showing studies conducted in 2004 comparing titan to thermage's old old tips at that point in time. I did not even bother responding since I found the tactics WAYYYYYY below the line. I felt this tactic is deep rooted in Cutera's culture and I am afraid that they will continue "inducing" OTHER new MD's into this trap that you all have gone thru. Until Cutera STARTS retraining its sales people to be more ETHICAL in their conducts, I am afraid more and more of us will be taken alive FINANCIALLY and PROFESSIONALLY.

03.13 | Unregistered Commenterpmdoc

Dr. Fiala,
We don't know who you are. Money talks and bullshit walks. Lets see some action. 5 days and counting until an announcement of advanced webinars that are practical and helpful along with transcripts. 5 days and counting.

Talk is cheap. I want to see verifiable actions NOW.

Disappointed by ready to "hate".

Well, "Disappointed", I obviously don't know who you are either. I've been a frequent poster on this site for quite some time as 'TF', but de-cloaked for this discussion, since I feel using my real name adds significant credibility.

If you should care to learn about me, please look at my practice website, at www.drfiala.com or www.plasticsurgeryinflorida.com

03.14 | Unregistered CommenterDr. Fiala

Dr. Fiala,

Thanks for your discussion. I think you add to this site so I am with you on this one. I want to give them the benefit of waiting to see what they do. My assumption though is that not much will change but we can at least say they have heard our complaints.

03.14 | Unregistered CommenterLH

I think we need to keep all discussions completely transparent and on the blog. I have been disappointed in the past after being mislead by "Luminaries" who were "bought and paid for" by Cutera. Dr. Fiala, I am not suggesting that you have anything but the highest intentions, but I just don't trust ANY laser company or ANY doctors at this point. Fool me once, shame on you, fool me again, shame on me.

4 days to go before the announcement of advanced webinars. If this does not happen OR if Cutera does not engage in a frank and open discusson on this blog, I will go from "disappointed" to "hate". Anyone is welcome to have private discussions, but I WILL NOT be reassured by those discussion or by empty promises of change. I want to see change NOW. 4 days to go.

I had another idea: Since the Titan does not work, perhaps Cutera should recharge our heads for free. This way we could sell the treatments for less money and perhaps our patients would be satisfied with minimal results if they paid less money for the treatments.

What do you think?

Dr. Fiala,

I just reread you email about your discussion with Cutera.

There was nothing concrete that they were going to do now.
A bunch of promises and illusions to what is going on behind the scenes. Typical corporate "bullshit".

What do they say about a series of advanced webinars which would start in April?

I want specifics that can be done now. I want specific plans with specific dates and I want to know how it will benefit me.

How are they going to make me happy.
They sold me machines that don't work too well.
They did not provide adequate training.
They did not manage MY expectations before I bought.
Now, what are they going to do for me?

When are they going to start the advanced webinars with transcripts?
When are they going to start replacing our Titan Heads for Free?
When are they going to upgrade our Opus 560 IPLs to LimeLights for a reasonable fee (like $1000)?
When are they going to give us enough power in our 1064 laser to get the thin dark hairs (we need to be able to treat with 3 ms)?

Cutera better realize that their practices and their light devices have created a situation here where we (the users) are very unhappy. We are like a saturated solution. This blog is the "string" that will get us all to crystalize into action. The action will either be "good" or "bad" depending on how Cutera ACTS (not what they say).

"I am the straw that stirs the drink" - Reggie Jackson.

Cutera is looking at the string which could change the course of their history. They better be ready to work very hard and spend lots of money to make us happy (unless I am the only idiot who has poor clinical results and unhappy patients).

The Emporor has new clothes. I am not afraid to say the he is naked. Are you secure enough or smart enough to stop lying to yourself and everyone else?

hows bout calling in during webinar and bringing up some of these issues?

03.15 | Unregistered Commenterthought?

did anyone go to this weekends conference? every cutera owner seems to be a making millions with their xeo? why not we? pearl anyone?

03.15 | Unregistered Commenterthought?

Still no word about the Advanced Webinars. I don't think Cutera or Mr. Gollnick are genuine in their desire to help us.

I just can't wait to be set loose.

Let's see if Cutera puts their money (and some action) where their mouth is.

My bet is that they don't do a thing.

Cutera . . . you will feel my furry!!!!!!!!!!!!!!!!!!

We have an advanced Webinar. Yahoo! (maybe it was related to this site, maybe not). Let's see if we are offered transcripts. Transcripts are a key component of the support.

Let's see if we get one per month.

Does anyone have any suggestions for future advanced webinars?

I am looking at the Cutera Pearl versus the Alma Harmony. Both companies are killing each others product but it seems like Alma is better to deal with then Cutera.

03.27 | Unregistered CommenterDrBuyer

If anyone has an opinion on Alma Harmony versus Cutera Pearl I would appreciate your feedback.

03.27 | Unregistered CommenterDrBuyer

buy whatever is the cheapest. look for great chinese products and botox from mexico !

03.27 | Unregistered Commenter.

DrBuyer,

If you are looking at resurfacing, which it appears you are since you are looking at Pearl, you should consider Sciton as well. Both the Alma and Pearl are both limited. Are you looking at Alma Pixel? Pearl is resurfacing and pixel is fractional.

03.27 | Unregistered Commenterdexter

Cutera Pearl is an Erbium based fractional skin resurfacing
Alma Harmony is a diode (810nm) based laser platform that Alma touted to be able to do multiple functions. In general diode is not the best at anything, not for effective hair removal nor vascular treatment nor skin rejuvenation. It is technically not safe for anything Fitz skin types of IV-VI

03.28 | Unregistered Commenterpmdoc

Don't buy anything until you look at Lumenis ActiveFx/DeepFx (Fractional CO2) and Reliant: Fraxel (re:store & re:pair).

These are the gold standard lasers and companies.

If you are looking to treat melasma, resurfacing, acne scars, fine lines, wrinkles with a fractional technology (ablative or non-ablative)

You MUST interview at least 4 companies and tell each sales person what the other sales people are saying (they are all either stupid, liars or misinformed or all three. They are all "sales people". If you do this, the truth will eventually be "distilled" out of them in the end. You are a physician, you understand science. Don't let them treat you like an idiot!

Push them, don't let them tell you things which are half-truths or downright lies.

Just my opinion

Dr. Buyer and PmDoc: Just to clarify a point-- the Alma Harmony also has an optional laser module available for its Harmony platform which can be added to the basic Harmony platform for an additional $19,900. I believe the Harmony console costs $39,700 and then you start adding the various laser and IPL "heads" you want to purchase. The Pearl is - I believe- Cutera's stand alone device to give them something in the "laser resurfacing" category. According to their recent ads, Pearl utilizes a "revolutionary" new (and exclusive!) 2790 nm YSGG wavelength and provides the following--

1. Ablates (vaporizes) from 10-30 microns of the stratum corneum, and coagulates an additional 20-60 microns of tissue beneath the vaporized portion (resulting in the formation of a "natural protective dressing" on the skin.

2. On day 3 or 4 this "natural dressing" peels or sloughs off, leaving "new", fresh skin beneath.

3. Cutera also claims that "residual heat in the upper dermis stimulates new collagen production", etc.

All this with only 3 - 4 days downtime. It will be interesting to see what practitioners who are trying the Pearl say about it. I am curious what price it is being sold at. Does anyone know? Does anyone have the actual specs in terms of energy fluence, spot size(s), pulse durations, rep rate, etc.??

pmdoc,

The Pearl is not fractional. It is resurfacing.

The Alma Harmony is not a diode. It does not have 810.

03.29 | Unregistered Commenterdexter

Dexter:
You are right, I meant the Soprano to be the 810 diode.
As I said above, Pearl is a skin resurfacing as a fractional device not a full ablative one.

Medspaguy:
As an Erbium platform, it vaporizes the water so quickly that thermal coagulation is very unlikely thus it is hard to say it can achieve reasonable skin tightening effects as in in CO2 or plasma platforms

03.30 | Unregistered Commenterpmdoc

A few opinions:

Don't get me wrong. I don't really care about the Pearl so I'm not trying to pick a fight. But Pearl is a fully ablative device. Yes the water absorption of the wavelength is in between CO2 and erbium but regardless it is delivered so that 100% of the skin is removed. Histologically they claim that about 30-50 microns is ablated and something like that is left as thermal necrosis but that would make it ablative by definition. Fractional is taking only a "fraction" or percentage of the epidermis away. It seems that most fractional devices are removing somewhere between 1% to 50%. However if a single pass damages 80 microns then about 60-70%% percent is ablated and 30%-40% coagulated necrosis. Regardless, Pearl removed 100% of the skin. However, it wouldn't surprise me if they came out with a fractional scanner soon. In it's current configuration it is extremely limited when comparing to other technologies out there. They are one step behind.

The Pearl is not 2940 erbium yag. It is 2790 ysgg. It has a different peak of water absorption than erbium yag. It does create coagulation because the peak is between CO2 and traditional erbium 2940. It's simply a different wavelength.

Regarding CO2, the reality is that fractional CO2 is just CO2 resurfacing but instead of removing 100% they just take a scanner, reduce the spot size and instead of overlapping the spots they space them apart. It's really not that revolutionary. If you bought an Ultrapulse Encore or for that matter an Ultrapulse 5000C, the only difference now is the scanner and some software. In fact, Alma is selling a fractional scanner that is compatible with the old Coherent 5000C. Why in the world would anyone buy reliant re:pair since they choose to have a consumable and it's only a fractional device?

You will see a lot of competition in the fractional CO2 market. It's just a scanner. These companies (from Japan and China especially) can just recreate their old CO2 lasers, but put a different scanner on them and voila, they are fractional.

We fought this argument in the late 90's. What is better, CO2 or erbium? If you want less downtime and 80% of the results you go with erbium (assuming similar depths). If you want immediate contraction and can put up with more downtime then you go with CO2. It doesn't matter if it's fully ablative or fractional the argument will stay the same. We choose less downtime and a little less result with Sciton. However, with the Sciton we can add coagulation which makes it different than other erbiums. It has the ability to work as a erbium/CO2 hybrid. This is our patient base. It works for us. However, I can see that if you have patients who are willing to put up with more downtime then CO2 would be a good choice. I just don't think CO2 gives the same amount of flexibility as the Sciton. I'm sure this is on account of consumer bias. We bought Sciton and we think it's the best and I want to justify why I made the right decision. Until someone can convince me otherwise though I will continue to believe my own hype.

Hopefully this will create some conversation. Things have been getting a little boring the past few days.

04.1 | Unregistered Commenterdexter

Dexter:
I appreciate your response. Definitely, I want to engage in cordial discussions here on this wonderful thread. I did go to the Cutera Pearl site. Under their mechanism of action, I copied and pasted this section "..Ablation: The safe removal of a portion of the epidermis is achieved with a controlled amount of vaporization. 10-30 microns of epidermis are vaporized in this process.." Based on this, it would clearly appear to me that Pearl is a fractional based device or at least a pseudo-fractional one.
In regards to the concept of "thermal coagulation" I believe a platform (even a CO2 platform) cannot achieve such unless it is a true full ablative one since a metaphor for thermal coagulation is like placing a complete blanket on the surface to MAINTAIN the heat underneath long enough (e.g. for an ablative CO2 laser, it only needs to ablate down to 20-30micrometers to leave behind a thermal damage measuring 0.2-1mm in thickness). As per this clinical white paper from the Palomar 2940, http://www.palomarmedical.com/FileUploads/WhitePaper2940RossKhatri.pdf , you will see that when tissue is fractionally treated, the amount of so-called "marginal coagulation" is quite minimal relative to the "total ablated column" I doubt if this "technique" could ever truly achieve true skin tightening globally speaking. For example if you said 60-70% of skin surface is "ablated", then maybe, this is a big maybe, 30% of this 60-70% area gets "coagulation" on the margins of the ablated columns. This would hardly do much tightening even in a best case scenario, I would presume.
By the way, the Pearl 2790 would be on the LEFT side of 2940, not between 2940 and 10,000nm.

04.1 | Unregistered Commenterpmdoc

Hey,

Let's get back to the business at hand.

Is Cutera doing anything to help us.

Have any of "I hate Cutera" issues been addressed? Was the Advanced Webinar any good. Did they offer transcripts?

Are they doing another Advanced Webinar next month???? in April???

What is going on????

Let's start another blog about the Pearl somewhere else.

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