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Entries by Medical Spa MD (1210)

Thursday
Apr202017

What Your Medical Spa Staff Should Understand About Body Dysmorphic Disorder

Are you at risk of treating patients with Body Dysmorphic Disorder (BDD)? What should your staff be doing to screen and communicate with risky patients.

Understanding Body Dysmorphic DisorderEveryone who's in the industry has delt with peatients who have unrealistic expecations and who make you think that there's not something quite right with their perception of themselves.

Most physicians avoid these patients after dealing with one or two of them that go from big cheerleaders before the treatment, to keying cars in the parking lot after the results don't live up to their unrealistic expectations.

It's something that everyone experiences and the more ethical providers aim to steer clear of these patients, but the result is that they'll go elsewhere.

Whill BDD seems to be underdiagnosed, there are some things we've learned that you might want to pass along to your clinic staff.

What have studies found out so far?

Many patients are faced with this concern that going under the knife would appease them, however symptoms of BDD can still linger. Many studies have shown that patients who have undergone cosmetic surgery still exhibit symptoms of BDD.

In a study conducted by Bouman, Mulkens, van der Lei (2017), a sizeable number of physicians are still unaware about body dysmorphic diagnostic disorder and what it entails both for the patient and the provider. In their study, they found when plastic surgeons refused patients to cosmetic treatment and had them referred to a psychologist, some of these patients attempted to sue the physicians. Additionally, their plastic surgeon sample considered surgery as a contraindication of BDD. Their sample also mentioned that they will not pursue with a procedure, provided the patient exhibited symptoms of BDD.

In the end, the researchers stressed the importance for cosmetic physicians to educate themselves further about recognizing the disorder, diagnosing the patient, and treating it.

Despite such events, there was research about the positive effects of cosmetic procedures with BDD also (Bowyer, Krebs, Mataix-Cols, Veale, and Monzani, 2016). One study was conducted that some patients manifested some BDD symptoms pre-surgery and the patient group reported satisfaction one year after the surgery (Felix et al., 2014).

What should you tell your staff to look for? (Note: This is not medical or legal advice, just an opinion.)

Patients may exhibit a number of symptoms and attitudes that staff can identify as potential problems including:

  • If a patient thinks that a treatment is going to change their life in some kind of unrealistic way.
  • Odd confidence that a physician is going to 'fix' them. These patients often are your most ardent supporters before the treatment.
  • Wanting to 'stack' treatments together and build a pipeline of problems that they want fixed.

What can your clinic staff do?

  • Understand that this is not really a vanity issue, even though it appears to be. BDD patients feel bad about this and their perceived as vain and shallow, but they're not able to stop obsessing. This is as real as depression, anxiety or other mental disorders.
  • Understand that they have poor insight regarding their treatment and their body perception. You won't be able to 'talk them out of it'.
  • Don't encourage BDD if you see symptoms. (I've seen a number of unethical clinics do just this.)

This isn't something that you want your staff to be in the dark about since there can be serious consequences if you don't take it seriously.

Thursday
Apr132017

Dr. Gregory Buford - Beauty by Buford, Englewood, CO

Dr. Gregory Buford of Beauty by Buford gave us insight of how he started practicing medicine and how he runs his clinic in our interview with the author and plastic surgeon.

Name: Dr. Gregory Buford
Clinic:Beauty by Buford
Location: Englewood, CO
Website: http://www.beautybybuford.com/

Brief Bio:

Dr. Gregory A. Buford is Board Certified in Plastic Surgery with additional Fellowship training in Anti-Aging/Restorative Medicine. He is a nationally recognized expert on minimally invasive facial rejuvenation and author of “Beauty and the Business” and has performed over 6000 procedures with liquid facelift products including BOTOX® and advanced dermal fillers, such as Juvederm®, Voluma®, Sculptra®, Radiesse®, Vollure®, and Volbella®. Dr. Buford is recognized by Allergan as a Diamond BOTOX® /Juvederm® Provider, signifying that he is ranked among the TOP 1% of BOTOX® injectors in the nation. In addition, he is a nationally recognized trainer for the Allergan Facial Portfolio and trains other medical practitioners in advanced injection techniques. Dr. Buford has been consistently recognized in the media for his Plastic Surgery expertise and has participated with resources including Vogue, E Online, ABC News, FOX News, EMedicine, and many others. In addition, he was selected twice as a finalist...

Click to read more ...

Saturday
Apr012017

Simple Video Marketing Can Make You An Extra $10K A Month

Step up your practice’s marketing strategy by adopting a or improving your video marketing strategy. According to SEO Experts, Video Marketing will dominate in 2017. What would that mean for your practice?

How Video Marketing Will Save Your PracticeWell, it means two things.

One is if you have been using video marketing, good for you. You're already doing things that others aren't which is where you want to be on the marketing side.

Two is if you have no intention or have yet to implement video marketing. The challenge: Starting up and competing against fellow physicians who have adopted the strategy.

Video marketing in this age is not limited to the traditional YouTube upload where you introduce your practice or enumerate all the procedures you offer. This marketing strategy has expanded to temporary or expiring content. Snapchat and Instagram Live or Stories are two prime examples, aiding several businesses reach new customers.

It is also an effective marketing strategy because according to Boast video is available across different devices and that could be a better replacement for text.

Many social media experts claim that video also gets reaches and engagement aside from traditional SEO Techniques. According to Hubspot, over 90% deemed video marketing effective for customers to understand a business.

What kind of videos can you put out there? The videos you play in your practice is considered a marketing tool.

1. Procedural-related videos

Your menu of services could be in video form that can be presented in your practice, social media accounts, or on websites. Decide your most popular procedures and select which ones you would recommend. In addition, you can show this bit by doing it on livestream or uploading the procedure on YouTube. This shows your credibility as a physician and your ability in performing procedures.

2. FAQ or Informational videos

Give them an idea about your background, your clinic or practice’s background. Answer all frequently asked questions that all your patients ask about any procedure or your staff or clinic.

3. Review or Testimonial videos

Capture prospective patients’ attention by posting testimonials of your current patients. Reviews are helpful to ensure your reputation and credibility as a physician.

Do not limit your video marketing to only your clinic’s waiting room. Post all your available videos on social media or on your website. You can even utilize Snapchat, Instagram Stories, or Twitter Live.

Thursday
Mar232017

Regenerative Aesthetics: A New Dimension to Anti-Aging

Guest post by Dr. Kavita Beri

Discussing regenerative technologies and procedures with your patients.

Aesthetics and Anti-aging is an exciting field in modern medicine. New technologies, procedural devices and cosmeceuticals make it an ever changing and expanding specialty.  As physicians, we are challenged to stay on top of what is new and what your patients hear and see on the media. As important as it maybe to stay in touch with the latest trends that surface the cosmetic and aesthetic world, having a strong foundation in Anti-aging physiology will help us make better choices in terms of what we would like to offer to our patients.

Regenerative aesthetics adds a new dimension to anti-aging skin care.  Our body has an innate ability to heal and regenerate.  Aging slows down cellular processes, but can we make treatments focused on maintaining the machinery that the skin is already equipped, with instead of just bandaging the surface.  Making aesthetics and anti-aging a holistic entity with services that help mind body and spirit stay in- tune with healthy skin will offer a wide array of options and services to your clients.  This will not only help clients be satisfied with the treatment they are getting for the skin but also have a “feel good” component that is longer lasting. The most interesting component of regenerative aesthetics is looking at aging skin as an ongoing chronic inflammatory process that is occurring over the years. Targeting this chronic inflammation by the various factors that influence it, will include a nutritional approach, lifestyle approach and anti-stress approach to helping the skin regenerate to its best.  To heal from any ailment, eating a healthy balanced diet, avoiding stress, having mechanisms coping with stress and of course having the mind be in tune with healing, helps the process tremendously.  Having information on lifestyle, healthy nutrition will give you clients more confidence in the care they will get from you. My experience has been, an honest approach to patients seem to get them to understand their own expectations and then can channel them to what they are looking to change about themselves. I make sure to tell my patients that it is so important to visualize themselves with healthy skin, having a mind focused in a positive image will help the anti-aging aesthetics be more effective. Personally, with my clients, they have LOVED this idea, and have made beautiful progress not only in having healthy skin as they are aging but also to understand their expectations and be more content with themselves.

I never forget to mention to my patient in the initial consultation: that there is nothing out there that will make the clock-” stop” from ticking…..and so starting  with the Truth….we will be able set our goals more realistically and bring light to a beautiful and dynamic field of regenerative aesthetics.

Friday
Mar172017

Cosmetic Procedures Statistics in 2016

The American Society of Plastic Surgeons (ASPS) has released an initial report of their annual statistics. According to the ASPS, the most performed procedures are on the face and most procedures involve fat reduction.

Cosmetic Procedures Statistics in 2016Breast augmentation remains popular among patients being the highest number of procedure performed in 2016. Labiaplasty, on the other hand, is gaining traction in the plastic surgery scene.

In the side of the non-surgical treatments, Botox remains number one (7,056,255 procedures for 2016; a 4% increase from 2015) and numbers will probably continue to rise in the future. The other mostly performed non-surgical procedures are dermal fillers, chemical peel, laser hair removal, and microdermabrasion. The total for the top 5 non-surgical is 12,902,372, accounting for 84% of total non-surgical cosmetic procedures.

It also reports the new trends in non-surgical procedures focusing on fat reduction techniques like injecting and freezing fat. It is expected that fat reduction trends will continue to boost in the coming years.

The cosmetic non-surgical side still has a higher number compared to plastic and cosmetic surgery procedures, considering these are easily administered treatments. A possible contributing factor to the rise of Botox related procedures is that men are also undergoing the treatment, and have raised the statistics. Many predict that fillers will become a steady popular procedure and there could be a growth in Platelet Rich Plasma procedures.

Monday
Mar062017

Pricing Dermal Fillers: Radiesse, Sculptra, Belotero, Juvederm, Kybella... 

filler injection pricing MD

Should I switch to a new filler? Can I increase my profits or decrease my cost? Fillers are a must-have in any cosmetic practice, so how do you make sense of the options?

You've got to have them since they're one of the primary reasons you're generating new patients AND they keep those patients coming back every month or two. Many generalized (includes surgical treatments) generate 40% of their income from injectables and others (nonsurgical) can turn these needles into wildly profitable practices. But you can also spin your wheels just bumping along the barely-breaking-even line by either under-pricing or over-paying. So what's the current state of cost/price in the market?

In a market report released in 2015, according to Research and Markets, dermal fillers average price (in the US at least) are estimated around $400-$1500 per treatment (patient cost). That's quite a range. So what's going on here? It's a busy and (increasingly) confusing market but here are some stats/thoughts on some of the market leaders.

RADIESSE

Radiesse is primarily around the patient's mouth (specifically correcting nasolabial folds but also lips) but is also commonly used to increase volume in hands (where you can end up using a lot of it, increasing the cost/price). Typical usage is between a half to 2 or more syringes. Like with other facial fillers, the effects on Radiesse on the body will take for as long as 10-12 months. An average cost for a Radiesse treatment is around $900, with a range of $400-$1200. Most procedures are on the chin and cheeks.

Patient satisfaction seems to be around 83%. Adverse reactions include ashes, loss of volume swelling, and lumping. These, as with others, are generally attributable to poor technique or over-treatment.

BELOTERO

Similar to Radiesse, Belotero targets the nasolabial folds and the lines around the mouth. Although, there are some physicians that have used it to target dark circles and lines under the eyes.

It is possible to get multiple treatments for Belotero as well. The filler lasts around to 6 months, maybe up to a year. Although some patients may have shorter filler effects. The treatment costs around $625.00, with a range of $200-$1350.

Patient reviews (from a well known patient site) tended to be slightly higher than Radiesse which is interesting but not terribly informative. It worked well for patients who had their under eye lines treated, on their lip lines, crows' feet, tear troughs, and glabellar area. Complaints include bruising, swelling, and bumpiness.

SCULPTRA

Sculptra is a liquid based injectable that also targets the above mentioned treatments for lines. The use for the filler has been used for those who have lost weight and want to treat lines.

Primary treatment areas for Sculptra are temples and jowls and there's some increase in the after-care instructions including daily 'face massage' of the treatment areas. Repeat treatments may need to be administered after four to six or four to eight weeks, depending on the patient's results from the first treatment. (Always better to under-treat and have them come back than over-treat and have them unhappy.)

Price of treatment is around $1900, with a range of $150-$3800. Selling price of Sculptra to physicians is estimated around $750-$800. According to some physicians Sculptra retains on the face for around 6 to 24 months.

Sculptra seems to hover around a 90% patient satisfaction rate. Among the reviews on one website, 21% reported lumping and adverse reactions (which seems high).

JUVEDERM

Juvederm is one of the most popular volume enhancing fillers in the market. The target areas are lips, cheeks, and lines and wrinkles. A technique to administering the filler on the cheek is creating circles around the target area (similar to a Venn Diagram). Aside from the cheeks, lips are also a popular treatment region.

Juvederm products have a selling price of around $350-$1000. Cost of treatment is around $550, ranging from $250-$990. Treatment lasts from 6 to 12 months.

In looking into patient feedback, only Juvederm received more than 90% positive rate from patients across different review websites. Many are also doing returning treatments after their results. Common complaints for the filler are sagging and swelling under eyes and lips.

KYBELLA

We thought we'd take a look at something outside of fillers with Kybella since it's main usage is to remove the fat under the chin. Multiple treatments are done to achieve the expected result. Like with all the treatments here, Kybella can be done quickly. In administering Kybella, the box comes with a temporary tattoo guide which should be stuck under the chin. (We don't have personal experience with this so would appreciate ayone's thoughts from the community.)

Physicians buy a vial of Kybella at around $600. As for prices, Kybella has a range of $600-$2500 for a treatment, with an average of $1375.

The treatment is well received with an 87% positive rating on one website. Swelling is normal with the treatment after a few days. The treatment had boosted patient self-esteem. Negative reviews are few so far, some had mentioned they saw no change prior to treatment and should have opted Liposuction over injections.

Read the sister post on pricing of Botox, Xeomin & Dysport.

Pricing & Costs

There are a lot of physicians who enter the market at the low end of pricing in order to attract new patients (very successfully since this is essentially a commodity now) but if your prices don't include enough just to break-even, you’re heading for trouble. Medical businesses are expensive to run and it's more true than ever that a dollar saved is a dollar earned. All vendors are not all pricing fillers the same and it can cost you literally thousands of dollars a month right off the top-line profit if you're not getting the best deal from your local pharmacy or the manufacturer. Depending upon where you are in the world you might want to do a little research and find out if you can get a better deal.

Warning: Everyone is getting bombarded with solicitations from companies in China promising the lowest cost. Do NOT buy any drugs or pharmacy products from China (or South East Asia, or Africa). These countries do not have the same regulations as the US, Canada, and the EU where regulatory safeguards are in place.

Monday
Mar062017

Pricing Dysport, Xeomin, & Botox in the Aesthetics Market

Can you make money on Botox? Should you switch to Xeomin? The newest information shows that facial fillers and injectables will continue to be the primary physician-based cosmetic treatment (and a primary source of revenue and patient flow).

With Botox, Dysport and now Xeomin targeting wrinkles, and Juvederm, Radiesse, Kybella, Scupltra, and Belotero for volume/fullness, injection based treatments are the initial treatment point of contact for most cosmetic clinics, even those run by surgeons.

With the prevalence of these treatments we thought we'd take a look at the current state of care in the US (the largest single market) since there are a number of new players that are making inroads and taking some market share from the biggest players.

First up; Botox, Dysport and Xeomin.

Botox, Dysport, and Xeomin primarily treat glabellar Lines and lateral orbital rhytids (crow's feet) but they've seen increasing usage around the mouth in some practices. (We do not recommend this unless you're extremely skilled since this can cause some serious problems if you paralyze someone's mouth.)

These treatments are restricted by licence although there have been a number of unlicensed individuals (like this horror story) where individuals were treating patients.

Let's take a look at each.

BOTOX

The big boy in the market, Botox or onabotiliniumtoxinA was approved for cosmetic use in 2002. Approved treatment areas are as follows: hyperhidrosis, migraines, and the neck and chin. It is not limited to those areas as there are other FDA Approved uses in the body (Blepharophasm, Strabismus, and Overactive Bladder). It is used off-label by some physicians to treat other areas.

In 5 major US Cities, the average price of a Botox treatment for a patient is around $400. Botox (10mu) is selling around $400-$525 according to some US physicians and based on pharmacy price but it's much cheaper outside the US. Units used differ depending on the treated area, with a recommended 20 Units for the Glabellar Area, 6 to 20 Units for the Forehead, 4 to 12 for the Crow's Feet.

Many patients find Botox as the most effective in making wrinkles disappear, most are satisfied with their treatments over time, with a 95% Satisfaction Rate among patients. Not all however are mostly satisfied with their procedure, because some have complained making their appearance worse, probably do to the fact that every patient with a new treatment becomes hyper-focused on the mirror. Still, don't be to quick to discount patient reported effects of unevenness, ptosis, and sagging.

According to Mukherjee (2015), Botox is expected to grow to $2.9 Billion by 2018 with the facial aesthetic market to balloon to more than $4 Billion, with the US contributing half of it. (Nice!)

DYSPORT

The teenager Dysport (abobotiliniumtoxinA) entered the market in 2009 and has actually been giving Botox (Allergan) a respectable competitor. In its early release, many were skeptical about its efficacy, strengthening Botox' popularity among patients (possibly do to it's lower cost). However, many studies have shown that Dysport is a fast acting injectable as compared to Botox.

Why choose Dysport over Botox?

In a double-blind study conducted in 2011, Botox and Dysport were used to test ninety patients. Dysport was the better choice to treat crow's feet in the study. The dosage used in the study had 30 Units for Dysport, while 10 only for Botox.

On average, Dysport treatment costs $360 for some major US cities we looked at for Botox. As for the selling price of Dysport to physicians, it is at around $475-$800. According to some physicians, for treatment of crow's feet at least 30 units is used to treat one side, 20-80 for the forehead, and 40-80 units for the glabellar.

Dysport can be an alternative to those who do not find Botox effective. Some prefer Dysport as their neuromodulator of choice due to its longer efficacy. It has been said that due to lesser proteins, Dysport can easily be accepted by the body.

It has proven itself to be a worthy competitor against Botox with a 93% satisfaction rate by Dysport users. On the other hand, it is not all met with praise since it can cause the same side effects to patients that Botox can.

XEOMIN

The new kind on the block. Among the three neuromodulators, Xeomin contains only incobotulinumtoxin A, resulting in some calling Xeomin the 'Naked Botox'. It has no proteins which both the two prior injectables contain, and it requires no refrigeration. Many observe that Xeomin has the slowest onset among the toxins, with results appearing 3-4 days after treatment.

In administering Xeomin, the needle is smaller and the injections are a few centimeters away from each other (less pain?). It also uses only around 10-25 units for one side for crow's feet treatment, 10-15 for the forehead, and 20 for the glabellar. Merz retails a bottle of Xeomin at $466, with some pharmacies selling it at a lower cost around $260 - $300. On average, the treatment of Xeomin to patients is around $355.

Xeomin showed great results for frown lines for most patients, but it's often rated slightly lower by patients in terms of satisfaction. This may be due to actual results, but it's also likely that differing injection techniques by new clinicians who have previous experience with Botox and Dysport, as well as less patient name recognition could be the cause.

As part of this series we're going to do some internal surveys and research into pricing and satisfaction across physicians. If you'd like to be involved and/or have access when we release these results, please make sure that you sign up as a member.

Read the sister post to this on filler injections pricing and satisfaction for clinicians.

Sunday
Mar052017

New Concierge Startups Could Devastate The Cosmetic Medicine Market

Futuristic new startups in concierge medicine could really put the screws to competitors as they expand their offering.

Silicon Valley is rife with startups looking to disrupt all aspects of healthcare, moving from traditional approaches to entirely new delivery systems and business models. The result is a number of new, well financed competitors that don't have the baggage of traditional methodologies and can easily adopt new methodologies and could bury existing competitors. Here are a couple of examples.

Forward is a new tech concierge medical start-up San Francisco that is focusing on reinventing the primary care clinic. With something of a clean look that founder Adrian Aoun describes as something aking to an Apple store crossed with Star Treks next generation sick bay. Physicians have access to some really cool gizmos, from a wall-sized screen to visualize and show patient data to automated speach recognition that transcribes converstaions in real time and adds them to patient records. Patients can get their prescritions filled in the on-site pharmacy and can text staff around the clock (with 30 second response times).

But the biggest value is not the glass and white walls, it's the removal of trivial tasks that prevent clinicians from operating at the top of their license. According to a 2016 study in the Annals of Internal Medicine, physicians spend more than half of their time on paperwork, compared to a measly 27% interacting with patients. (Read the study here)

Forward is using technology to ruthlessly elimiate waste and improve physician productivity while also delivering what patients are asking for with whiz-bang tools. They currently don't taken insurance - although they have plans to change that - and charge patients $149/month all in.

Of course Forward is joining a number of other primary care and concierge competitors.

One Medical is another that already has a number of locations. It's not quite as technically cool but it's also getting traction by delivering what patients want  - same day appointments, online access, and 24/7 virtual care - at the even more affordable price of $149 per year.

And that brings us to telemedicine and what's happening there.

Read the 2015 Telemedicine Report from Medical Spa MD

In a poll asking dermatologists if they were to use telemedicine in their practice, 41.84% were opposed to the idea of adopting it. Only 38.1% were in favor in using telemedicine, but that may be changing.

In a study by Wilson and Maeder (2015), teledermatology has produced positive outcomes with user satisfaction and uptake, and hopeful in the idea of improvements with healthcare. Another study mentions the benefits of using teledermatology, which could serve as an educational tool.

Despite study findings about telemedicine’s ability to diagnose illnesses, it is still met with resistance. In another study referenced by the authors, it seems that while it can screen and diagnose illnesses, it faced a challenge with an accuracy. Bashur et al., (2015) also suggest the same finding that inaccuracy could be a common challenge when using teledermatology.

According to the Wall Street Journal, the American Telemedicine Association expected the number of physicians using telemedicine to rise approximately 30% more. Healthmine has conducted a poll saying that out of 1500 physicians, only 15% employed telemedicine.

What does this mean for cosmetic / aestheitic practices?

These new startups are going to be under increasing pressure to find ways to generate revenue Forward, for example, has already raised $30m from venture capitalists and needs to get to a value of more than $100m to raise additional funding.

The likely result is that they, like others before them, will see that cosmetic medicine is primarily a cash fee-for-service business that will need little additional investment to add. Since these new competitors are built to deliver such extrodinalry patient satisfaction it will be more than just a little challenging for stand-alone clinics to compete.

Of course their success is not yet assured and they could implode if they can't meet their revenue needs.

If they can, there will be a period of adoption but they will be riding the wave of transformative care that is coming.

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