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Entries in Fraxel (11)

Wednesday
May022012

Brian Howard MD FACS, North Fulton Plastic Surgery

Dr. Brian Howard FACS

Dr. Brian Howard runs his solo-practice in Roswell, just outside of Atlanta, Georgia.

Dr. Brian Howard is boarded in both plastic surgery and otolaryngology. In this interview we got together to find out what he thinks of his practice, cosmetic technologies and staff compensation.

Name: Brian Howard, MD, FACS
Location: Roswell, GA
Website: drbrianhoward.com


That's interesting: Dr. Howard is a recipient of the Outstanding Research Award given by the American Academy of Facial Plastic and Reconstructive Surgery and was recognized by the Consumer Research Council of America as a Top Physician.

Click to read more ...

Wednesday
Apr182012

An Interview With Dr. Mary Lupo Of Lupo Center For Aesthetic Dermatology

Mary Lupo MD, FAAD Board Certified Dermatologist New OrleansSince 1983, Dr. Mary Lupo has been at the forefront of non-surgical skin rejuvenation.

As the founder of Tulane University's resident's cosmetic clinic, a Platinum plus Botox and Juvederm provider, and a clinical instructor for Allergan, Dr. Mary Lupo knows her way around injectables. In fact, she launched Botox to physicians in Austrailia in 2007. We wanted to hear what Dr. Lupo has to say about how she manages her dermatology clinic and her lifestyle as a physician.

Name: Mary P. Lupo MD FAAD
Location: New Orleans, LA
Website: drmarylupo.com/index.html

That's interesting: Dr. Lupo received the Peterkin Award for original research in skin lipids and inflammation in patients with atopic dermatitis. Author of over 50 publications and presentor of over 230 presentations. Researcher, author, lecturer, teacher. Founding co-director of the Cosmetic Boot Camp in 2005. Past-president of the Women’s Dermatological Society and former member of the board of directors of the American Society for Dermatologic Surgery.

Click to read more ...

Monday
Apr092012

Warren Seiler MD, A Laser Center & Medical Spa In Alabama

Warren B. Seiler III, MD, A Board Certified Cosmetic Laser Surgeon in Alabama

Dr. Seiler is a speaker, preceptor and physician trainer for Lumenis Laser Company and injection trainer for Allergan (manufacturer of Botox & Juvederm).

Birmingham Alabama is home to Seiler Skin, Cosmetic Laser Center & Medical Spa, a single-physician clinic run by Dr. Warren Seiler and his wife. We sat down with Dr. Seiler to find out what he thinks of the current crop of cosmetic lasers, how he runs his clinic, and hear what advice he has for other physcians.

Name: Dr. Warren B. Seiler III
Location: Homewood, AL
Website: seilerskin.com

That's interesting: Dr. Seiler is a Board Examiner and the Executive Director of the American Board of Laser Surgery and co-author of the ABLS examination text book and board certification exam.

As a single physician owner, how does your clinic operate?

My practice, Seiler Skin Cosmetic Laser Center, is a single physician driven cosmetic practice. I personally perform the laser and injectable procedures. I have a very good medical aesthetician working directly under me who helps patients with skincare programs, Hydrafacial, chemical peels, and laser hair removal. My wife is our marketing and website director and she is co-owner with me in the practice. We run the practice together, but we have an office manager that helps.  I perform fractional CO2, Fraxel, Thermage, Laser Hair Removal, Laser Spider Vein treatments, IPL, and others. Botox and Juvederm are the only injectables, although I have tried many others, I feel they are the best. Our practice is really the only one in Birmingham in which the physician specializes entirely in cosmetic laser procedures and nothing else, which really helps to offer the experience that I provide.  

Click to read more ...

Wednesday
Mar072012

Interview: Lila Bratani MD, Plastic Surgeon In Germany

AA look at plastic surgery in Germany with Dr. Lila Bratani.

Physician:  Dr. Lila Bratani
Location: Karlsruhe, Germany
Website: www.drbratani.com, http://www.estheticon.de/chirurgen/dr-lila-bratani

That's interesting: Dr. Lila Bratani is recognized as a member of Stanford's Who's Who for having demonstrated outstanding leadership and achievement in her field.

How did your cosmetic medicine training kick off?

Back when I was a teenager, I was attracted to aesthetic medicine and of course beauty and anti-aging. My first step in Plastic Surgery was when I got a good training by my teacher, Prof. Muehlbauer, one of the leading aesthetic surgeons in Germany and recognized worldwide. I also completed a fellowship in advanced aesthetic medicine and got trained in cadaver courses in Brazil (Sao Paulo and in Brasilia). I was working with great colleagues and I am still learning a lot of new techniques in the aesthetic medicine field. The art of this profession gives the ultimate satisfaction.

Can you tell us more about your surgical clinic and how it's organized?

I’m the chief of the Plastic and Aesthetic Department in a private clinic. The owners are dermatologists and it works perfectly. We offer plastic surgery, hand surgery as well as non invasive treatments such as laser. We also have 3 cosmeticians in our skin cosmetic center. The clinic consists of: 1 plastic surgeon (me), 6 dermatologists, 3 cosmeticians, 1 practice manager, 1 PR and clinic manager, 1 OR nurse, 3 frontdesk assistants and 8 physician assistants. We serve to a mix of private and state health care patients.

The requirements for hiring staff in our plastic and aesthetic surgery clinic are very high. PA’s and nurses have to understand that they need to have this extra “service” for extraordinary plastic surgery patients. We like them to have a corporate identity that represents our clinic well and of course a fabulous attitude and behavior.

We use commission on the cosmetic sales.

What laser technologies are you using? What are your thoughts about the technologies you’re using now?

We don’t use IPL, but we are using Alexandrite, Ruby, NdYag laser and Fraxel, CO2-Laser. I like most of the Fraxel  and new devices of Radiofrequency (Thermage and BodyTite). I have a lot of experience on the smooth liposuction with radiofrequency using the BodyTite device and so far, I'm seeing great results with skin tightening.

Where do you spend money on advertising? What works best for your practice?

We have websites, social media as Facebook, publications on newspapers and  journals such as Vogue. We also distribute e-newsletters for existing patients via email. In the waiting rooms, we showcase programs with different techniques of aesthetic procedures. This kind of advertising works much better than handing out external flyers or ads. 

(Sponsored: See Frontdesk waiting room videos for plastic surgeons and dermatologists.)

What are the in demand treatments in your clinic? Are you planning to add something new?

All kind of aesthetic surgery procedures like breast augmentation, facelifts, liposuction and face skin rejuvenation with radiofrequency as well the small procedures as fillers such as Botulinum toxin therapy.  I will be adding more fat grafting and liposculpturing techniques soon.

What have you learned about practicing cosmetic medicine? What stories can you tell?

I have learned to offer what I think is good for the patients and not to please the unrealistic demands of someone. Sometimes patients bring their own drawings of unrealistic body parts. I’m aware of dysmorphophobic patients and refuse to do anything on those. 

What advice would you give to other physicians based upon your experiences?

Working hand in hand with other colleagues is a benefit for starting into aesthetic medicine. You may share the cosmetic lasers and IPLs (which are very expensive) when starting your own clinic. Never underestimate the non-invasive procedures, even we plastic surgeons love it than being in the operating room with the scalpel in the hand.  Set your own “branding” so that patients will be pleased with your work and aura and will bring you more patients via word of mouth, which is also a great marketing tool.

About: Dr. Lila Bratani completed her Craniofacial and Plastic Surgery fellowship in Nova Southeastern University. With over 10 years of experience in Plastic, Aesthetic, Reconstructive, Laser and Hand Surgery, she is a university lecturer, medical manager and an esteemed health care consultant in New York,USA. She specializes in burn surgery and tissue engineering. Other than that, she is an active member of the Society of Plastic Surgeons of Germany DGPRAEC, WOSAAM (World Society of Anti Aging Medicine), IPRAS (International Society of Plastic Reconstructive and Aesthetic Surgeons) and DGBT (German Society for Aesthetic Botulinum Toxin Therapy.

This interview is part of a series of interviews of physicians running medical spas, laser clinics and cosmetic surgery centers. If you'd like to be interviewed, just contact us.

Monday
Mar052012

Interview: Dr. Samir Ibrahim Abu Ghoush, Plastic Surgery In Poland

Mandala Plastic Surgery Clinic

Dr. Samir Ibrahim Abu Ghoush, Plastic Surgeon

 

Plastic surgeon and hair transplant physician Samir Ibrahim Abu Goush who practices in both Poland and the Middle East.

Physician: Dr. Samir Ibrahim Abu Ghoush
Plastic Surgery Clinic: Mandala Beauty Clinic
Location: Poznań, Poland
Website: www.mandalaclinic.pl

That’s interesting: Dr. Ghoush is a trainer for Cool Lipo in the Middle East and Central Europe and a pioneer of LVR (Laser Vaginal Rejuvenation) in the Middle East and Poland.

Profile: Dr. Ibrahim was awarded twice by the International Society of Hair Restoration Surgery for presenting the best clinical case and poster. Aside from that he is recognized worldwide for planting facial hair, moustaches and beards. He is a distinguished Faculty member and Chairperson of many live workshops in HAIRCON and OLSW (Orlando Live Surgery Workshop). Dr. Samir has performed thousands of Aesthetic, Plastic Surgery, Reconstructive and Hair Restoration Procedures in a career spanning for more than 15 years. His patients are women and men from different countries, from all facets of society, many celebrities. Dr. Samir trained and worked with world renowned specialists in their fields.

We hadn't really thought of Poland as a hotbed for cosmetic medicine, until we met plastic surgeon and hair transplant specialist Dr. Samir Ibrahim Abu Goush.

Can you tell us more about your clinic? What are the services available?

Mandala Beauty Clinic is located in the heart of Poznan, Poland. It is very modern, with an integrated operating room with inpatient services. We offer a wide spectrum of innovative methods of treatment, and lasers that include: Vaser Hi def. Liposculpture, Laser Assisted Liposuction, Laser Vaginal Rejuvenation and Aesthetic Gynecology, CTEV Endovenous Laser, Aesthetic Plastic Surgery, Facial Surgery, Breast Surgery, Body Procedures, Hair Transplants, and Dermatology & Aesthetic Medicine 

How is your clinic organized? How do you manage your staff’s salary?

Physicians are working with us as partners on the (win/win) basis. We have at least 25 medical spa staff. The permanent staff is paid a monthly salary while the rest are paid on a per case/per hour basis.

What IPL or laser technologies are you using? What are your thoughts about the technologies you’re using now?

I use a German made IPL (smart plus). I have the Vaser machine from Sound Surgical Technologies, the Cool Lipo Laser and the CTEV Endovenous Laser from Cool Touch, a Laser for LVR (laser vaginal rejuvenation) from Innogyn.

I am very happy and much satisfied with these technologies. I use the Vaser all the time.

How do you market your clinic?

First of all, we have our website that has great medical spa SEO and generates a lot of traffic. We also get featured in both print magazine and TV shows and we always look for ways to make our practice more visible through interviews or PR. However, I still believe that the most important way of spreading word about our clinic is word of mouth. Patients are the most valuable asset you will ever have. If they are happy with your services, there’s a higher probability that they will recommend you to their friends and family and we take every effort to provide both the best medical services, and the best patient care..

What treatments attract the majority of your patients?

The Vaser body sculpturing remains to be the most profitable treatment in my clinic, which delivers amazing results and achieves a high patient satisfaction. Hair transplants are in demand as well. I am always looking into adding new services and innovations to my practice. I am planning to purchase a Fraxel Laser soon.

Can you share your thoughts on what you have learned in the cosmetic industry?

I believe that practicing this profession requires continuous learning. I never stop learning new things, new technologies and how others do the same procedures. If you are in doubt, ask your physician colleagues in the industry and share what you know! Attend workshops, seminars and webinars to keep your self updated.

This interview is part of a series of interviews of physicians running medical spas, laser clinics and cosmetic surgery centers. If you'd like to be considered for an interview, just contact us.

Sunday
Mar042012

Interview: Stephen Weber MD, PhD of Lone Tree Plastic Surgery

Sitting down with Dr. Stephen Weber of Lone Tree Facial Plastic & Cosmetic Surgery Center outside of Denver, Colorado.

Physician: Stephen Weber MD, PhD
Location: Lone Tree, CO
Website: http://www.lonetreefacial.com

That's interesting: Dr. Weber has participated in the "Face to Face" program where local plastic surgeons donate their services to the victims of domestic violence and has participated in the annual humanitarian mission surgical trips providing free care to medically isolated, indigent patients.

Profile: I am a double board-certified Facial Plastic and Reconstructive Surgeon practicing at Lone Tree Facial Plastic & Cosmetic Surgery Center in the Denver metro area. My practice involves all aspects of facial cosmetic surgery including facelift, browlift, blepharoplasty, rhinoplasty, otoplasty, facial implants, facial resurfacing and scar revision. Our office also provides comprehensive treatments for facial aging including Botox and Dysport to reduce facial wrinkles, dermal fillers to minimize facial lines and folds as well as fractional laser (Fraxel and MiXto) resurfacing.

Can you tell us a little bit about you and how you got started in cosmetic medicine?

I became a Facial Plastic & Reconstructive Surgeon by a very circuitous route. In medical school, I planned to become an Infectious Disease specialist and even obtained a Ph.D. in Immunology and Microbiology in pursuit of that goal. However, my first rotation after successfully defending my thesis was in head and neck surgery. I knew that first day that I wanted to become an Otolaryngologist (Head & Neck Surgeon, ENT). During my residency training in Otolaryngology and Head & Neck Surgery I realized that my goals of performing a diversity of procedures in a technically demanding sub-specialty made Facial Plastic Surgery a very well suited specialty. I trained as Dr. Shan Baker’s fellow in Facial Plastic Surgery at the University of Michigan and then entered practice.

Can you tell us more about your clinic and the services available? 

My practice is a single specialty clinic. We have two plastic surgeons here at the practice, myself and Dr. Rick Schaler who is my partner and practice owner. We have eight other staff including one nurse, five estheticians, one front desk staff member and a billing manager. We offer the full range of facial reconstructive and cosmetic surgery. Our office has a fully functional operating room in which we perform all of our cosmetic procedures under IV sedation. On the medical spa side, we offer all of the available injectable treatments including Botox, Dysport, Xeomin, Restylane, Perlane, Juvederm, Radiesse and Sculptra. We perform laser services including Fraxel and MiXto (fractional CO2) resurfacing, vascular laser and laser hair removal treatments. We also perform a full complement of facial peels and facial treatments. Our patient population comes from the surrounding suburbs of Lone Tree, Highlands Ranch, Littleton, Parker as well as Denver proper.

How are you dealing with staff in your clinic?

Fortunately, we have not had the need to fire staff. The reason for this is that we’re very careful with the hiring process. The communication between members of our office is very clear. When we set out to hire a new member of the office we have a clear, articulated goal regarding our needs and the type of person we want to hire. Everybody in the office has a chance to veto a potential new member of the office staff. Each member of the office also has the opportunity to veto that potential candidate. We tend to hire from a pool of people already familiar to the office or from strong referrals from friends of the practice. We have avoided print advertising of open positions of late as this always leads to a huge response with relatively low yield of the type of candidate that we need.

For the front desk staff, compensation is hourly. For procedure or treatment oriented members of the office, including physicians, compensation is heavily weighted toward production. This is the most fair compensation method and encourages productivity. The formula is simple, clearly articulated and fair. Employees are paid a percentage of net collections. An employee can review their production at the end of each month, if requested. I review my own production at the end of every pay period and encourage the rest of our staff to do the same.

What laser technologies are you using now? How do you decide on new purchases?

We perform laser treatments including Fraxel and MiXto (fractional CO2) resurfacing, vascular laser and laser hair removal treatment. In terms of new purchases, laser companies really need to show us a substantial improvement in results before we will purchase new technology. We are marketed to by phone, mail, email and at conferences. I am interested in new radiofrequency technologies but I think the jury is still out and we’re holding out on making that purchase.

How do you market your clinic?

In terms of social media, we market on Facebook , Twitter, as well as LinkedIn. We’re trying to determine whether Pinterest can be leveraged with pre- and post-op photos and other images. We use social media to communicate with current and prospective patients with informational posts and product samples/ give-aways. Our email list of current patients is our most valuable marketing tool. Providing current patients with updates that they can forward to friends is invaluable. We also put on open houses and seminars that allow us to provide education, meet new patients and learn more about our current clients.

In the pay-per-click arena, we use Google AdWords with a relatively conservative budget. That has drawn a lot of traffic to our website and helped generate surgical cases. We have been testing the waters of direct mail and print advertising. Direct mail has had moderate result. Print advertising has been disappointing. We do not currently take part in Groupon, Living Social or any other daily deal sites. The main reason for this is cost and questionable ability to develop lasting relationships with users of these services.

What are the most coveted treatments/services in your practice? Have you tried removing some of your services?

The sun and dry air in Denver are the reason why people flock to this area. However, they wreak havoc on facial skin. As a result the demand for lasers and peels here is tremendous. On a volume basis, Fraxel skin resurfacing and Botox are the most common services in our office. However, the fixed cost associated with these services is significant. From a revenue perspective, surgery provides the greatest revenue and greatest profit for the practice. About 75% of our cases are elective in nature. We have not dropped any procedures recently. When I joined the practice, I introduced Sculptra facial injections and Radiesse hand rejuvenation and we’ve seen high demand for these treatments. 

What have you learned about practicing cosmetic medicine?

I’ve developed a thicker skin and learned not to take things personally. In the past, when a patient booked surgery with a competitor I assumed that I had erred in some way or not provided excellent photos of patient results or …. I’m noticing today more and more patients that will meet multiple surgeons and come back to book surgery with me. When I’ve asked why, the answers that patients provide are incredibly vague. It really is a gut feeling that people have that you are or are not the surgeon that will provide what they’re looking for. All we can do is provide as much information and education, quality photos of surgery results, a top notch facility and a warm, caring environment to convince patients that we’re the right team for them.

Any last thoughts on advice for your physician colleagues in the cosmetic industry?

I would urge physicians, especially in the plastic surgery realm, to compete by providing exceptional service. With Groupon and other daily deal sites, there is increasing pressure to compete on cost. Some of these deals will temporarily drive patients into the practice. However, few are likely to be loyal patients when the practice down the road runs an even cheaper deal. The daily deal trend has provided consumers with cheap (not necessarily quality) services. However, this has come at the expense of sustainability for practices that jumped in without doing enough research. The bottom line is that daily deals will lead to a spike in volume composed of largely price-oriented patients. Further, the deal seeking crowd is unlikely to see the value in your services. Continuing to drive down prices when our costs are fixed is not only unsustainable but diverts your attention from providing services, such as surgery, that are the profit engine for the practice. When you offer services at cost, you CANNOT "make it up on volume."

This interview is part of a series of interviews of physicians running medical spas, laser clinics and cosmetic surgery centers. If you'd like to be interviewed, just contact us.

Friday
Oct022009

Solta illumiNATION Tour: Thermage & Fraxel

Solta is taking it's show on the road with the illumiNATION tour. (Perhaps the Illuminati for Fraxel & Thermage?)

You can see if it's passed you by yet or you still have a shot at getting some finger food and a demo.

You can see the site detailing the tour here.

Sunday
Jan182009

Thermage changes its name to Solta Medical

Thermage Inc., has changed its name to Solta Medical Inc. and unveiled a new logo, along with a new logo and website for the Thermage product.

Theremage the company bought Reliant Technologies, maker of the laser resurfacing device Fraxel, for $87.5 million in a cash and stock deal last year. The new ticker symbol will be "SLTM" and is listed on the Nasdaq.

The design of the new Thermage site a fine change from the stagnant templates that most of the IPL and laser companies use. We'll have to see how it works for them.

From the Solta press release:

Thermage, Inc. (NASDAQ: THRM) announced that effective today it has changed its corporate name to Solta Medical, Inc. At the open of the NASDAQ exchange this morning, Solta Medical, Inc. will begin trading under the symbol “SLTM.”

"The name and ticker symbol changes are a great start to the New Year and a key milestone in the integration of the acquisition of Reliant Technologies, Inc. The new company combines the industry’s two leading brands, Thermage® and Fraxel®, under a new corporate name that will now form a global leader in aesthetic energy devices,” said Stephen J. Fanning, chairman of the board, president and CEO. “Solta Medical will focus on providing superior anti-aging solutions for patients and physicians by offering the gold standard of care for tightening, contouring and resurfacing of the skin with Thermage and Fraxel treatments.”

Solta Medical also announced the expansion of its industry-exclusive customer loyalty program which allows physicians to lock-in preferred pricing for Thermage and Fraxel treatment tips along with other preferred customer benefits to help physicians grow their practices and increase practice profitability.

“Thermage and Fraxel are the strongest aesthetic device brands available to physicians today,” said Suzanne Bruce, MD, dermatologist and president of Suzanne Bruce and Associates in Houston, Texas. “By combining these two brands into one company and expanding the customer loyalty program, Solta Medical is opening a number of new opportunities for doctors to conveniently and cost-effectively access a full suite of safe and effective anti-aging solutions.”

Monday
Jun162008

DeepFx Forum (Exclusively for Encore UltraPulse Users)

Reliant UltraPulse Fractional CO2 Laser

 

DeepFx Webinar:  Notes and Analysis - Tuesday May 19, 2008
Reliant UltraPulse Fractional CO2 Laser

Introduction

Many Laser Companies offer regular Webinars for marketing and education (mostly marketing). These companies include, but are not limited to: Cutera, Lumenis, Reliant and Cynosure. These Webinars are available live or on the companies’ websites in their Webinar Archive Area. 

                                                                                     

We have produced these notes for several reasons. We want to generate a clinical discussion of these Webinars so we can all learn more from the Webinars and learn even more from the discussion. We want to clarify certain points that were not clear during the Webinar. We want to ask and answer questions that were not asked and answered during the live Webinar (there is never enough time to ask and answer all questions). It takes 2 hours to sit through a Webinar, most are for marketing purposes and not worth our time, these notes will help us decide which Webinars we want to watch. Hopefully many times we will not have to watch the Marketing Webinar once we have read the summary and participated in the resulting discussion. This will enable us to get the information without sitting at our computer watching a Webinar for 2 hours. 

 

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

 

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

 

The first set of notes is from a Lumenis Webinar about the DeepFx treatment with The UltraPulse Fractionated CO2 Laser. This was a Round Table Discussion with some of the top Cosmetic Physicians in the field. It was very good, but had its flaws and requires further discussion and clarification on points made. The participants (Luminaries) were James Heinrich, MD, Robert Weiss, MD, E. Victor Ross, MD and Jeffrey Dover, MD.

 

If you are considering using the information in this summary, please view the Webinar to make sure you are comfortable with the parameters! If you view the Webinar and find any inaccuracies in my notes, please correct them in our discussion on MedicalSpaMD. I am hoping Lumenis and “The Luminaries” will review these notes and comment.

small-diagram.png

 

TotalFX Notes

 

Basic Facts & Theory:

  1. ActiveFx plus DeepFx gives you a TotalFx Treatment
  2. ActiveFx ablates 1.3 mm columns and can go 300 microns or 0.3 mm deep
  3. DeepFx ablates 0.12 mm columns and can go 2000 microns or 2.0 mm deep
    1. 1000 microns = 1.0 mm
  4. 125 mj of energy with ActiveFx penetrates 300 microns deep
  5. 30 mj of energy with DeepFx penetrates 1.9 mm deep (1900 microns)
  6. Most photoaging occurs in the papillary dermis (the worse “solar elastosis” in elderly farmers is at a depth of 800 microns), so there is no need to go deeper.  Therefore our panel recommended a max DeepFx strength of 20 mj (1 mm deep?).  Going deeper gets you more tightening because of more tissue ablation and volume loss.   
  7. Using 30 mj of energy and going to 2.0 mm deep has caused scarring around the eyes in one provider’s experience.  They do not recommend going this deep.
  8. How long does the tightening last?  No one knows for sure.
  9. ActiveFx:  Density 1:  75%; Density 2:  80%;  Density 3:  85%;  Density 4:  95%;  Density 5:  100%
  10. MaxFx is ActiveFx at Density 5:  100%.
  11. The MaxFx now is somewhat different than CO2 treatments done in the 1990s because only one pass is done.  In the 1990’s 3 passes were done wiping off the epidermis in between passes.
  12. DeepFx:  Density 1:  5%;  Density 2:  10%;  Density 3:  15%;  Density 4: 20%;  Density 5: 25%.
  13. Stronger treatments are done with the TotalFx on the West Coast.  Why?  In California the people have greater solar damage so you need higher settings OR the people in California are more demanding and want more dramatic results.  Interesting question!  What do you think?
  14. Healing is slower off the face.  Dr. Weiss says 2-3 times longer, did he mean 2-3 days longer?
  15. Doing Upper Lip Treatments with TotalFx can cause more vermillion lip border to “show”.  This is good

 

Clinical Tips:

  1. Do the DeepFx first and then do the ActiveFx
  2. If the DeepFx causes bleeding, wait until the bleeding stops before doing the ActiveFx (blood will absorb the energy from the ActiveFx pulses)
  3. The experts said that they did a second treatment one month after first treatment.  I was told to wait 3 months.  This one month interval is new information to me. My big question to Lumenis is “when were you going to tell me and your other users about this change?  How do you keep us up to date about changes like this?”  I am pissed off, I am angry.  I want an answer and I want it NOW!
  4. Dr. Ross sometimes uses thrombin spray (from Baxter) to stop the bleeding.
  5. With DeepFx, you treat lower face first and move upwards so blood won’t drip down into your treatment field.  “South to North”
  6. Do DeepFx before you do fillers.  The DeepFx may go deep enough to disrupt the fillers.
  7. You can do fillers and then ActiveFx because ActiveFx only goes 100 - 300 microns deep.  Fillers are placed deeper than this.
  8. Anesthesia:  Atavan or Valium (5 mg), IM Torodol 60 mg, Zimmer Cooler, Pliaglis Topical or Topical Lidocaine.  Is po Torodol ok? What about Percocet or Vicodan?
  9. You may need to use a nerve block for upper lip treatment.  Dr. Weiss, “Do you do the Infraorbital Nerve Block or 5 short injections near the upper lip gingiva?”
  10. Use intraocular eyeshields for upper eyelids.  You might be able to use tongue blade wrapped in moist gauze for lower lids
  11. Segmental Resurfacing:  Do IPL on cheeks for pigment and do ActiveFx in peri-occular areas for fine lines and tightening.  Get the most out of your hour with the patient.  This sounds like a great idea-Segmental Resurfacing!
  12. Dr. Heinrich does DeepFx only and then Deep plus Active one month later.  He says the patient’s skin gets used to treatment the first time, so downtime is less the second time.  This is my question:  what is the downtime with the first treatment and what is the downtime with the second treatment?  Do patients have to have two 4 day periods of downtime within 30 days?  I am not sure this makes much sense.
  13. Some older patients (your mother-in-law) really need traditional CO2 or a facelift.  Give them that option.
  14. Class 4 Wrinkles:  The best option is traditional CO2 with two weeks or downtime OR do TotalFx  2-3 times at one month intervals (Dr. Heinrich)

 

Treating Specific Conditions:

  1. DeepFx is best for vertical lip lines, deep wrinkles, acne scars.  It goes deep and stimulates more collagen and ablates more tissue for more tightening.
  2. ActiveFx is better for pigment and more superficial textural problems
  3. Stretch Marks (Stria):  Use ActiveFx:  80-100 mj, density 1-2 (use Density 2 for thicker Stria).  Do NOT use DeepFx for Stria.
  4. Melasma:  Experts are not sure it will work.  They do not recommend at this time.  They are doing test spots and experimenting with it.  Melasma is a whole topic unto itself.  Look for a specific blog about this in the future.
  5. Tattoos:  DeepFx might be good for resistant Tattoos

 

ActiveFx, DeepFx & Total Fx Settings:

  1. The experts usually treat with DeepFx in the range of 15 mj – 20 mj
  2. Most experts would not go higher than density 3 with DeepFx (15%).
  3. Recommended Settings: 
    1. DeepFx:  15 mj, density 3, one pass. 
    2. ActiveFx:  100 mj, density 3, one pass. 
    3. You can go to 20 mj with DeepFx
    4. You can to to 125 mj with ActiveFx. 
    5. Density 3 seems to be highest density used with DeepFx (Dr. Ross goes higher, but he is very experience, an expert and he has experience with the full CO2).  Don’t go higher than Density 3 with DeepFx. 
    6. For ActiveFx:  Higher density with one pass is better than lower density with two passes (Dr. Weiss).
  4. To stay out of trouble with ActiveFx off the face, use Density 1 and 70-80 mj

 

Treating Specific Areas:

  1. Eyes:  Use ActiveFx. Don’t do DeepFx around eyes (skin too thin?)
  2. Eyes:  ActiveFx:  90-100 mj, density 2-3.  Downtime:  7-8 days of downtime (what TYPE of downtime?)
  3. Eyes:  Upper Lid:  ActiveFx:  60-70 mj, density 1
  4. Eyes:  Might consider using DeepFx for low lids:  5-10 mj with density 2?  This was the experts thinking outloud.  They are not recommending this!
  5. Eyes:  Treat to the lid margins with ActiveFx:  Density 4-5, one pass (for greater tightening and because this is where much of the problem lines reside?)  This seems strong.  Listen to Webinar for yourself before doing this!
  6. Neck:  Necklass lines are done with DeepFx, the rest of the neck is done with ActiveFx. 
    1. DeepFx on the Neck:  15 mg, density 2 or 3. 
    2. ActiveFx on Neck:  90 mj, Density 1 or 2. 
    3. Neck with the above settings:  10-14 Days of downtime (what TYPE of downtime?)
  7. Neck:  ActiveFx:  100 mj and density 3 was too strong.  Produced prolonged erythema.
  8. Chest: 
    1. ActiveFx:  100 mj, Density 1. 
    2. DeepFx for sagging and wrinkling on Chest?  I think the experts recommending doing DeepFx.  Perhaps 15 mg, density 2?  Check the Webinar.
  9. DeepFx can be done on neck, chest and hands

 

Pigment Changes, Post Inflammatory Hyperpigmentation, Melasma

  1. Don’t treat Melasma (Dr. Ross)
  2. Dr. Weiss has never seen PIH with ActiveFx.  The company has told a friend of mine that they don’t get PIH with ActiveFx.  This is complete and utter bull!  I have gotten PIH with skin types 4 (Italian, Greek). We need an open and honest discussion of this.  Dr. Weiss may only be treating skin types 1-3.  If this is the case, he and the company need to be much more transparent, open and honest when they talk about PIH.  What they say (you don’t get PIH with ActiveFx) is misleading, false and dangerous.  To just dismiss the PIH problem with ActiveFx is irresponsible and dishonest!  This type of cavalier attitude pisses me off!  This view (no PIH with ActiveFx is parroted by others (company reps and clinical advisors) and this type of dishonesty will get YOU & ME into trouble!  If PIH is not a problem, why isn’t ActiveFx used in darker skin types?  A friend of mine has posted his PIH pictures at www.geocities.com/pih_pih/.  Go to this site to see PIH after ActiveFx.  Dr. Weiss, I am looking forward to your comments about these pictures.  Please don’t talk about PIH if you only treat skin types 1-3!  I would also like to hear from the other Luminaries and Lumenis who claim that PIH is not a problem.  Let’s move on . . . I am calming down now.
  3. None of the presenters use Hydroquinone to prevent or treat PIH.  This is because they say they don’t get PIH with ActiveFx, DeepFx or TotalFx.  Either I am an idiot or they are not being honest or they are not treating the patients that I am treating.  I am not treating any skin types 5 or 6 and I am being very careful with skin type 4.  I use Hydroquinone, RetinA and Hydrocortisone pre and post treatment on my skin type 4 patients.  Maybe I should not treat skin type 4?  Not treating skin type 4-6 eliminates about 40% of my patient population (so why should anyone buy the machine unless they live in Sweden or Finland?).  Let’s discuss this PIH issue!  Is “bronzing” PIH?  You can go to www.geocities.com/pih_pih/ to see my photos of PIH after ActiveFx.  I am interested in your comments (and I hope Drs. Weiss, Ross, Dover and Henrich will comment as well).  I think this is another case of “The Emperor Has No Clothes” (Everyone thinks that they will be called “stupid” if they don’t see what everyone says they are supposed to see. This is the question, “Do you get PIH with ActiveFx?”  If so, how do you prevent it, how do you treat it, who do you have to be careful with?  This is THE “cop out” answer that I do not want to hear, “I only have skin type 1-3 in my practice”.  This is bull (almost 50% of our population is now “patients of color” and if this is true, then YOU are not an expert using this technology!  (Just my opinion) (Sorry about the emotion, but I am fed up with the dishonest bull that comes from the companies and their luminaries.  I am on the front lines and it is me and my patients who get screwed by this type of pandering and dishonesty - hopefully one of the benefits of this type of blog will be to get the “experts” to be more thorough and honest in their presentations, you can’t be dishonest when everyone is watching and talking about your presentation!).
  4. Dr. Ross uses Hydroquinone once he sees PIH.  You generally start to see PIH 15-28 days after procedure.  Wouldn’t it be better to prevent the PIH, Dr. Ross?  Can you prevent it?  Do you know who is at greatest risk for PIH?
  5. Patients are generally not allergic to Hydroquinone (HQ), they can be sensitive to it.  15% of patients get irritated with HQ – contact irritation.  This is not a true allergy.  You can change the HQ to 2% OTC Hydroquinone.  Other options are to use it less frequently (every other day), use if for less time (3 hours per day rather than overnight), or use it with Hydrocortisone 1%.   (These other options are from me, not the experts).  There are also other bleaching agents like Azelaic Acid and Kojic Acid (see The Supplement to the September 2005 Skin & Aging Magazine on www.geocities.com/foxydog1064 for a Hyperpigmentation Round Table Discussion). 
  6. In skin types 4 and higher (Persians and Hispanics) go a little lighter (less density, less energy).  Density is % coverage; Energy is depth of treatment.  I think both matter.  Perhaps % coverage matters more (it matters more when you do a Fraxel Treatment).
  7. No one is treating skin types 5 and 6 with ActiveFx or DeepFx.  This includes Aftrican-Americans, East Asians (Japan, China) and Southern Asians (India, Middle East).  You can use Fraxel Re:store 1550 for these patients.  Be very careful to avoid PIH when you treat these darker skin types with the Fraxel. 
  8. Experts:  “PIH clears very quickly”.  Me:  I have read that it can last 6 months to 2 years.  In my opinion, you should not minimize PIH by saying it clears so quickly.  Just read www.realself.com to see patients with long standing PIH.
  9. Experts:  “Koreans are skin type 4”. Me:  I would treat them as skin type 5!  I wonder what Dr. Eliot Battle would say?

 

Downtime:

  1. The experts discussed “Downtime” and “Quality of Downtime”.  Absolute Downtime, Relative Downtime & Social Downtime.  Absolute Downtime would be when you can’t go out (the day after an ActiveFx).  Social downtime would be when you don’t want to go out but can go to work (after the peeling, ActiveFx:  days 5-7). Days 2-4 are Relative Downtime, when you feel fine but don’t look to good.  You don’t want to go to work, but you can work at home and pick the kids up from school (stay in the car).     
  2. We should come up with some words and definitions for the different types of downtimes so we can communicate this to our patients.  What are your thoughts on how to categorize downtime?
  3. There is a big difference between 3-4 days of downtime and 5-7 days of downtime.  With 3-4 days, you can have procedure on Thursday and be back to work by Monday.  With 5-7 days of downtime, you have to take the week off.
  4. The experts prefer to do TotalFx over Fraxel Re:store (1550).  They do the Fraxel when the patient prefers to give one day of downtime x 5 rather than 4 days of downtime once.

 

ActiveFx, DeepFx, TotalFx vs other Lasers:

  1.  DeepFx and Fraxel Re:pair CO2 are the only lasers that go deep and ablate.  The others ablate shallow and then coagulate deep.  They also have spot sizes which are macro (1.3mm)  rather than micro (0.12mm)
  2. The best results for deep wrinkles, vertical lip lines and acne scars can only be obtained with deep ablation
  3. Experts:  It is nice to have a CO2 Laser because it has an ablative handpiece that can treat syringomas, sebaceous hyperplasia, warts and moles.  We need to start a blog which discusses how to treat these conditions and avoid scarring.  Feel free to blog on sryingomas, sebaceous hyperplasia, warts and moles!  How do you treat them with the ablative handpiece of the Encore?
  4. Why Deepfx?  People were disappointed in Perioral wrinkles and lines.  DeepFx does a better job.  You may have to do 2-3 treatments, one month apart!  How much downtime would this be?  What type of downtime (absolute, relative, social)?  How do we explain this to our patients? 

 

Pre and Post Treatment Tips:

  1. Mild moisturizers avoid acne flare-ups
  2. You don’t have to use aquaphor or vasoline.  Mild moisturizers are good enough (personal communication from company reps).
  3. Be careful of the lanolin in the aquaphor.
  4. Using Aveeno Water Gel gets you one less day of Downtime!  (From Dr. Weiss).  What is Aveeno Water Gel?  How do we get it?
  5. Post TotalFx Care:  Use “Soaks” every 3-4 hours.  (What type of soaks?  Saline Soaks (saline and gauze)?  How long do you soak every 3-4 hours?) 
  6. Post Care:  Cold packs or Zimmer Cooler for 30-45 min after treatment
  7. Valtrex for everyone.  One case of disseminated herpes on the face is not good.  Can we use Acyclovir?  It costs less, much less (Four Dollars at Walmart!).
  8. Check all patients the next day, this makes you and them feel better.
  9. Don’t give pain meds after treatment.  If they have pain, you want to know about it and see them.  They should not have pain for more than a few hours after treatment.  Prolonged pain suggests infection:  bacterial, viral, fungal.  Can we discuss post procedure infections and how to treat them? 
  10. Pliaglis can be mixed with cetaphil cleanser or cetaphil moisturizer.  90% Pliaglis and 10% cleanser or moisturizer.
  11. Experts worry about Lidocaine toxicity.  Compounded Lidocaine works as well or better than Pliaglis.  Pliaglis costs $60 per treatment.  Compounded Lidocaine costs about $6 per treatment.  Do the experts have a financial interest in Pliaglas?  Are the experts afraid that they will be sued if they talk about compounded lidocaine?  The discussion on this topic did not seem to be open, honest and complete!
  12. Experts do not routinely use oral antibiotics unless indicated for acne outbreak prevention:   Keflex 500 mg TID, Doxycycline 100 mg BID, Erythromycin can be used to prevent acne outbreak.
  13. Sunscreens:  Use everyday after skin is healed up.  Wear hat and stay out of sun until healed.
  14. Use a good UVA blockers:  Neutrogena, Helioplex or Loreal Products.

 

The Opinions of the Transcriber (CHMD) & Other Misc Issues:

  1. These experts have only been using the DeepFx and TotalFx for 6 months, so their use is evolving.  It will be very important for Lumenis to keep us informed about changes in these expert’s opinions as they get more experience.  We must all advocate very loudly and strongly for a Newsletter from the company which keeps us up to date (not just Webinars which take 2 hours to watch and are mostly for marketing and selling lasers).  Go to www.geocities.com/FoxyDog1064  for more information about Advocacy for Better Clinical Education and Clinical Exchange Programs. 
  2. We must also make sure the company picks experts that have significant experience using their laser in skin type 4!!!  To say, “I don’t have the problem because I don’t have patients with skin type 4” is bull.  It is a big cop out and is counterproductive.  Plus, I don’t believe it or accept it.  Skin type 4 is Italians, Greeks and others who don’t burn but tan easily and get dark easily when exposed to the sun.  If you are not treating skin type 4, patients I am not sure you are practicing in the USA!
  3. If you want to contact Lumenis directly, address all questions and comments to Amy Easterly, Product Manager.  Her email is: amy.easterly@lumenis.com.  Perhaps she can ask the Drs. Heinrich, Weiss, Ross and Dover to participate in this discussion, read this blog and comment and clarify.  I believe that they get paid a lot of money to do the Webinar.  I believe their job has been done incompletely when they leave us with unanswered questions and incomplete thoughts.  Remember, we are treating patients.  Real patients with real faces that can be scarred and hyperpigmented!!!  We want excellent outcomes with very few complications.  Lumenis owes it to us!
  4. This Webinar will be available soon in Aesthetics Buyers Guide.  When?  Let’s see how good the Aesthetics Buyer Guide Version is.  I bet it will be edited to sell lasers!  Lumenis, it’s ok to do a version to sell your laser, but you should also do a version for your Encore UltraPulse Users as Continuing Education.  Let’s see if you step up to the plate for your Users!

Now let’s blog.  Let’s get it on!!!  Let’s get what we need (more self support and more company support).

Friday
Jun292007

Review: Squarespace.com

You can find a list of other reviews I have completed and links to the products and resources I use to run my businesses in the Resources Section of this website.

Review: Squarespace.com - Dynamic web sites

Blogging Evolved

Name: SquareSpace
URL: www.squarespace.com
Purpose: Dynamic web sites, blogs, content management for laymen.
 

Let me start by saying that my personal experience to date with Squarespace has been 100% satisfactory. I have never had a complaint the system has always done what I wanted it to do. I’ve been blogging for the last four years and have switched all of my blogs from hosting systems like Wordpress or Blogger, and my static sites (I still have one) to squarespace.com.

Your web site is the most important part of your online presence. How it looks. How it acts. And more importantly, how easy it is to change, are of prime importance in making a decision on what kind of system to use.

What are your options?

 

Static Sites:

By far the most common choice are static sites. Of course it's not really by choice, they were simply the only available choice until recently. If you have a site, it's probably static, meaning that it's not easily updatable and you can't to it yourself unless your pretty technically inclined.

Pros: You already have one.
Cons: Hard to build. Expensive. Search engines hate them. No traffic.
Cost: Expensive to build and host.

Blogging Software:

Extremely uncommon for medical businesses in the current market. Wordpress , Blogger, Typepad... these were the first attempts at making dynamic sites that are easily updatable and they work as far as they go. Their somewhat technical and again you'll have to hire someone if you'd like to customize your site and offer more than a standard template. 

Pros: Relatively easy to set up. Inexpensive or free. Search engines love them if regularly updated.
Cons: Hard to customize. Limited function. Still need some tech savvy to implement.
Cost: Cheap. From little to free depending on configuration.

Dynamic Sites:

Squarespace.com is the next generation of content management systems that go far beyond what's previously been available. Squarespace has built a system that takes absolutely no knowledge of html, css, or other geek speak and it's built from the ground up for ease of use. If you can use Word, you can use squarespace.

Pros: Easiest to use and setup. Completely functional with advanced features like built in RSS feeds. You can try it for free.
Cons: None, if you don't mind the price tag.
Cost: About what a static site costs: From $7 to $25 a month.

The Bad.
I always like to get the bad news out of the way so here it is... I used to have here that I couldn't think of anything but I've since stumbled across some shortcomings. Here it is:
Squarespace is not open source so they don't have nearly as many members or or growth as Wordpress has. While it means that squarespace provides detailed support (which is excellent I might ad) it also means that they don't have nearly the footprint or developer time that Wordpress does. So, squarespace does not support at least one of the options that I would like to use on my blog. Text Link Ads uses server side scripts. Since squarespace is hosted, they don't allow you to install server side scripts and so I can't use one of methods I'd like to monetize my traffic. Text Link Ads doesn't offer a scripted solution yet so I'm SOL on this one.
I emailed Anthony about this and he responded that if they felt any platform gained enough of a foothold they would start supporting it. I would expect this negative to resolve itself and I certainly can't consider it as anything but a note but I thought I'd include it since I it is something I would like.

How I found Squarespace.
Blogging Evolved

Back in 1999 I started to need web sites. So I learned how to write and code so I could build them the way I wanted.

As usual I conducted extensive due diligence before deciding to use squarespace. (As a guy the definition of horror is finding out later that there was a better choice I could have made.). I read forums and surfed around the web. I talked to my geek coder friends. I quickly came to realize that squarespace different from everything else available. It was clean, it was customizable, and most of all, it just worked perfectly and had everything I could want and nothing I didn't. The fact that they were charging actually made it an easier decision for me since it convinced me that they were going to make money and actually stay in business, making it easier to get help and service rather than have to research and do everything on my own with a 'free' service.

Now I'm inherently nervous about putting all of my eggs in one basket, so I started a new site in order to test squarespace and find out if it was as good as I hoped. 

To be honest I have very little confidence that squarespace would live up to my expectations. I've been more than pleasantly surprised. In fact, every site but one (Surface Medical Spas) has been built or switched to squarespace. Here's the list:

There are some others that I've helped my friends set up as well but I don't own them.

Why choose Squarespace over a free blog site?

You can get a blog up and running for free as on Wordpress or Blogger. It's a valid solution and I've done just that in the past. (Squarespace also has a 30 day trial period that's free.) There are a number of things to take into account:

  1.  I've found the 'free services' to be something of a misnomer since there is either:
    • Significant time involved that could better be spent elsewhere so you're, in effect, paying yourself 50cents an hour.
    • You end up having to pay someone to do it for you anyway.
  2. Starting at $7 a month squarespace is a steal. In most cases if you're really running a site you're going to be responsible for hosting it anyway. (My virtual server for Surface Medical Spas runs about $49 a month.)

  3. Since Squarespace is a paid service, they offer a host of support features and technical support. Since switching all of the blogs I run to Squarespace I've opened up around 35 support tickets. In every case the problem has been resolved and the tech support has been phenomenal with same day turnaround.

  4. Squarespace comes with some really great features standard:
    • Search: Where Google's site search works great, Squarespace blows the doors off.
    • FAQ builder: If you've ever tried to build a FAQ (as I first did here: Medspa FAQ) The new FAQ feature stomps any other solution I've seen.
    • Drag & Drop: Moving stuff around on a whim.
    • RSS: No longer any need to configure your RSS feeds. It's already done.
    • SEO: Snap. Everything is valild and optimized so people can find you.
    • Build forms and capture information from your visitors. You've truly got to see this in action to believe it.
    • I could go on ad nauseum but here's the Squarespace feature set.
Building a dynamic business site that actually works the way it's supposed to.

If you're building a business site these day's it's easier than every. You no longer need to know HTML or CSS or any geek speak. However, and this is important, building a site that no one goes to is a waste of time. There are literally billions of web pages and your tiny spot on the web had better be easy to find.

Perhaps the biggest benefit of using Squarespace is the ease of use. While I'm writing this on the site, I've got spellcheck and the rest of the editing tools that everyone takes for granted. If my front desk needs to offer a special at a certain location, they just log in and do it... The don't have to call me, get the IT guys involved, or shed a tear. It's so easy that my daughters site at Pony Tail Club is run completely by my wife and daughter who have zero, zilch, nada, snake-eyes, by way of geek training. 

If that isn't the tipping point I don't know what is. 

Thursday
Aug032006

Thermage is comission. Titan & Fraxel are hourly.

As business models: Thermage is commission, Titan & Fraxel are hourly.

(Thermage + Fraxel discussion threads)

pages2and15_machine.jpgI had lunch with Clint Carnell, Vice President of Domestic Sales for Thermage today. While we were talking about the current state of the medical spa market he referred to the Thermage business model as 'razors and blades' and it triggered the thought that there was an analogy with commission vs. hourly employees.

Physicians seeking to minimize risk will often try to hire staff on commission with the hopes that they'll achieve two things; a motivated employee, and lower cost per treatment since they'll only be paying a percentage of treatments that are being performed. Nice in theory.

Here's the flip side. Commission robs you of success. This is a business that has very high fixed costs, but once those costs are met, there is a large potential profit to be made. As a business, its usually preferable to absorb those fixed costs if possible and keep the profit rather than have it diluted by paying commissions.

(That's why Surface has decided to grow as an entirely company owned business rather than persuing franchising with it's associated problems. If you have the capital, wholy owned businesses offer the most success while franchises offer the ability to grow the business using other peoples money.) 

petit_fraxel_02.jpgThermage made a radical decision to offer the 'box' (razors) for near cost, and focus on selling the disposables (blades). Smart enough. But Thermage is not charging 100% markup. Thermage tips probably cost around $12-$16 dollars to produce (that's a wild guess) but Thermage sells them for $450 or more. That's a helluva markup and it's led to a built in profit potential for anyone who can figure out a way around it as well as being a source of friction with those who have to buy them. (I have yet to hear any physician anywhere think that Thermage tips are a 'great deal'.) Refurbished Thermage tips came on the scene soon after Thermage launched and have even been studied for safety and performance.

Thermage faces a challenge in keeping providers happy with paying a commission on every treatment they perform. If they can, Thermage promises to be the gold standard for the foreseeable future.

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