The Medical Fusion Conference. A New Select Partner.

A new Select Partner has joined Medical Spa MD, the Medical Fusion Conference.

The Medical Fusion Conference is something of an anomaly in the medical conference circut. It's a conference built around providing physicians additional or tangential sources of income in addition to their regular clinical practice, and it's a damn good idea.

The Medical Fusion Conference offers something that's sorely lacking among the conglomeration of clinical shows and expos, a 'horizontal' approch to how physicians can direct their careers along a path of their own choosing. Truth be told, a great number (perhaps the greatest number) of physicians who enter cosmetic medicine or open a laser clinic or medical spa are doing so in order to have more control over their practice, their income, and their life. The Medical Fusion Conference is designed with exactly that goal in mind.

At this coming conference on November 5th to the 7th there will be physicians who have successfully made career choices that have allowed them to escape the grind an hours of traditional clinical practice and have forged their paths that 'leveraged their medical training'. They're film makers, authors, consultants, marketers, and entrepreneurs that have freed up their time and lifestyle to be able to make choices that most physicians can only dream of. The conference brings them all to together in a way that allows other physicians to learn how to replicate their success.

You might not want to be a physician author, consultant, or film maker, or run a concierce practice while consulting for pharmaceutical companies... but the same thinking and skill sets that these physicians have that allowed them to chart their own career path are perfectly applicable to you if you're a physician who wants more control of your practice and your life. Why? Because while the big conferences and expos are really marketing and advertising floor shows that are paid for by vendors, this conference is designed to give you information and skills that you can put to practical use.

Best of all, the conference is still small and intimate enough that you'll have access to every speaker. That's something that you'll never get at the monster expos and conferences. Faculty who are true experts in their fields are being brought in to discuss their careers and developing trends in medicine.  Each day is designed to maximize learning and face time with faculty members including the scheduling of two "meet the faculty" sessions that allow sit down time between participants and the Medical Fusion speakers.

I just got off of the phone with the founder of the conference, Gregory H. Bledsoe, MD, MPH who is also the CEO of ExpedMed and Chief Editor of Expedition & Wilderness Medicine and I was more than just a little impressed. This conference is quite obviously something special and deserves your support.

If you're looking to give yourself some new tools in your career, this is the place to be.

Confirmed faculty for the Medical Fusion Conference include:

• Gregory Bledsoe, MD, MPH, CEO of ExpedMed and Chief Editor of the textbook Expedition & Wilderness Medicine. ExpedMed.org
  
• Natalie Hodge, MD, Co-Founder & Chief Health Officer of Personal Medicine PersonalMedicine.com
• Elliot Justin, MD, Founder of telemedicine group SwiftMD and CEO of Pegasus Emergency Group. SwiftMD.com   Pegasus.md
• John LaPuma, MD, New York Times best-selling author and founder of ChefMD. ChefMD.com
• Steven Knope, MD, New York Times best-selling author of Concierge Medicine: A New System to Get the Best Healthcare. ConciergeMedicineMD.com
• Setu Mazumdar, MD, Founder and President, Lotus Wealth Solutions.  lotuswealthsolutions.com
• Arlen Meyers, MD, MBA, Professor of Otolarynogology, Dentistry, & Engineering, University of Colorado and Founder of the Society of Physician Entrepreneurs. sopenet.org
• Steven Peskin, MD, MBA, Executive VP and CMO of MediMedia. medimedia.com
• Jeffrey Segal, MD, JD,  Founder and CEO of Medical Justice. medicaljustice.com
• Gary Taff, MD, entrepreneur and real estate investor
• Mike Woo-Ming, MD, MPH, entrepreneur and internet marketing consultant. themarketingmd.com

Medical Tourism: $100B and growing

Smartlipo in Mexico, a nose job in the Philippines or a kidney transplant in India.....

Medical tourism is generally defined as leaving home for care. It can be inbound, (someone from Mexico coming to the US), outbound (leaving the home country to go to another country) or domestic. There are local, regional, national and international medical tourism clusters developing throughout the United States and around the world.

It is estimated that global medical tourism is a $100B global industry expected to grow significantly over the next few years. While no one can know for certain the effects of the recent US healthcare reform bill, rising costs, lack of supply of physicians and the demand for technologies and treatments continue to expand and fuel the growth of the industry.

There are several ways for physicians to get involved in medical tourism. The first is as a provider, either in their home location or in a remote site doing surgery. Second, physician entrepreneurs are creating service companies like medical tourism facilitators or aggregators. Other potential business opportunities exist in supporting the medical tourism supply chain by providing insurance products, healthIT infrastructure, real estate projects, quality ratings agencies, accreditation and marketing arms and other consultation services. In addition, more and more payors and employers are offering voluntary medical tourism benefits to their employees and insureds, driving the demand for talent who can do medical tourism quality improvement and utilization review.

The most common procedures sought by patients considering medical tourism are cosmetic surgery and dentistry, bariatric surgery, IVF and short stay procedures in urology, orthopedics, ENT and ophthalmology. That said, because of the onerous costs of some procedures in the US, patients are seeking life saving cardiac surgery in India, proton beam irradiation in South Korea and living donor liver transplants in Asia.

A recent report from the Center for Medical Tourism Research in San Antonio, Texas called medical tourism "arguably one of the fastest growing industries in the US"  Maybe it's time for you to take a look.

Arlen Meyers, MD, MBA is Cofounder, President and Chief Medical Officer for www.medvoy.com.  He will be a speaker at the Medical Fusion Conference in November.

Medical Fusion Conference: Guest Speaker Medical Justice

Dr. Jeffrey Segal, founder of Medical Justice, will be speaking at the Medical Fusion conference in November.  He also happens to be a Medical Spa MD Select Partner to boot.

Turning A Negative Into A Positive, The Medical Justice Story

I am a board-certified neurosurgeon who was sued one time for what I perceived to be a frivolous reason. The single expert who testified against me had been expelled from our professional society for delivering frivolous testimony. This expert had never performed or even observed the specific technique in question.

At the time I was practicing in Indiana, a state that embraced substantive tort reform years earlier. Nonetheless, I was in the crosshairs.  After two years, the case was dismissed a few weeks before trial. But, I never felt as if I won anything. I just felt as if I lost less.  I learned I was in good company. Many have been sued. Few talk about it.

Beyond the age of 40, I quit my day job and started Medical Justice, a physician-based organization focused on keeping doctors from being sued for frivolous reasons. The organization now addresses an array of medico-legal threats and serves thousands of physicians nationwide.  The single goal is to make it easier for doctors to practice medicine.

Migrating from a comfortable living as a neurosurgeon to the calculated risk inherent in the entrepreneurial world was not easy.  Many lessons were learned.  My session at the Medical Fusion Conference, "Physicians and the Legal System, the Story of Medical Justice", will focus on the story and these lessons --the good, the bad, and the ugly.

Take in some more information from Dr. Segal at the Medical Fusion Conference, November 5th throught the 7th at the Wynn confernce center in Las Vegas.

ArTek ~ ThermoTek: How to Stand Out in the Crowd

I just returned from attending the ASLMS conference in Washington, DC. The cherry blossoms were in full bloom and the laser and IPL manufacturers were in full force!

As expected, all of the companies displayed their equipment there for us to see and play with. With the current technology present, came the vision of new technologies balancing on the horizon. One can almost envision the progression of technological development when you're at ASLMS as all of the companies seem to be racing to release that next perfect modality that will change the face of aesthetic medicine as we know it.

What presence these companies displayed with their engineers and physicists standing along side of their sales force. Once, where you would discuss the steps of treating various conditions, you now find yourself discussing, and more curiously, understanding the importance of discussing pertinent wavelengths and wattage.

I can seriously envision one day stepping into a sort-of tanning booth, being hit with a flash of laser light, and stepping out of the booth with 3 inches of fat shed from my waist. Almost reminiscent of the Jetsons, this technology is truly within our grasps! Parents sending your children to college for the first time, relish in the thought of them becoming engineers or physicists for they surely will have a booming career in aesthetic medicine!

One cannot peruse through Medical Spa MD without coming across the gripes and concerns of disgruntled laser owners completely dissatisfied with how they were handled and treated after the sale. I, for one, would like to give you a story of hope by posting some positive words for a change about a little company with a big conception of customer service. So much so that it should be a considered a text book gold standard for anyone struggling in today's aesthetic market

I'd like to tell you about ArTek, the manufacturer of ThermoTek, an air chiller we use for laser skin resurfacing. In shipping back to the company for firmware flashing, the carrier dropped the box and smashed our unit. Busy as we are in our practice, no one thought to add the extra insurance and the carrier only was responsible for $100 of damage. We were now out $5000 just like THAT!

ArTek had such compassion for our situation that they completely took care of us and rushed repairs to the unit, as well as expedited shipping, so we could have it back in time in our office for our patient's resurfacing procedure.

I saw them at ASLMS. I walked up to them and extended my hand and introduced myself. They knew who I was and recounted my plight. I sincerely thanked each one of them personally for caring enough about my situation, about my patients who needed this device for comfort, and for forgoing the cost of the repair bill due to the shipping company's error.

To all of you laser companies, (and you know who you are as you've already been singled out!) take notice of this excellent display of customer service. THIS is how you take care of your customers and THIS is how you stay a leader in the aesthetic marketplace. 

Great technology is good for about 3 years...

Outstanding customer service lasts a lifetime!

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course, Study Guide, and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

Submit a guest post and be heard.

Medica Spa Expo in LA: Program

Also, here's the program for the Medical Spa Expo.

(I'd love it if those of you who are going would fire me off an email wrapup.) There are actually a couple of speakers that I don't know... or who weren't memorable I guess.

It's $50 for the convention floor and $600 to attend both days. They used to have a medical spa tour which was something of the highlight, but I didn't see it on the site.

Medical Spa Trade Shows in LA

The Spa & Resort Expo is opening February 21-22, 2009 Los Angeles Convention Center. Here's a link >

I've personlly been to this show at least six times in LA, NYC, and Miami.

The New York show is my personal favorite since I lived in Manhattan for ten years. It also has the best showing medspas if you're looking for drama. LA and Miami just don't have the skyline.

Here's some of the lasers and IPL's that'll be hawked:

Matrix Fractional CO2 Laser
Sandstone Medical Technologies
sandstonemedicaltechnologies.com
The Matrix Fractional CO2 Laser uses “Gold Standard” Resurfacing technology. The laser delivers Micro-Thermal Zones of energy leaving small areas untreated. The Matrix is fast and affordable.
Booth(s) #: 624

Pixel® CO2 OMNIFIT handpiece
Alma Lasers
www.almalasers.com
Alma Lasers’ fractional ablative solution, the Pixel® CO2 OMNIFIT handpiece, represents the best of both worlds for skin resurfacing. It combines the proven effectiveness of an ablative approach with the patient comfort level and convenience that approaches a non-ablative solution.
Booth(s) #:619

The Reveal Imager
Canfield Imaging Systems
www.canfieldsci.com
The Reveal Imager takes high quality images of surface and sub-surface skin features. Designed for the skin care counter, it is ideal for spas, medical spas and traditional medical practices.
Booth(s) #: 610

Synergie ELITE
Synergie By Dynatronics
www.dynatronics.com
Introducing the NEW Synergie ELITE effective proven treatments with a sleeker sexier look. System includes FDA cleared cellulite reduction, inch loss, and body contouring, microdermabrasion and light therapy.
Booth(s) #:211

VASER LipoSelection®
Sound Surgical Technologies
www.vaser.com
VASER LipoSelection®, by Sound Surgical Technologies, is a minimally invasive body contouring procedure that can be performed in-office and provides practices additional income while expanding their continuum of care.
Booth(s) #: 710

Affirm CO2
Cynosure, Inc.
www.cynosure.com
The new Affirm CO2 LaserSkin Renewal Workstation, with a proprietary scanning delivery system, combines ablative CO2 skin resurfacing and collagen rejuvenation in a single laser.
Booth(s) #: 618

SlimLipo^TM body sculpting laser
Palomar Medical Technologies, Inc.
www.palomarmedical.com
The SlimLipo^TM body sculpting laser offers a blend of 924 nm and 975 nm wavelengths for preferential absorption by fat and dermal tissue, respectively. Together, these unique SlimLipo wavelengths result in efficient fat "melting" and overlying skin retraction.
Booth(s) #: 736

Medical Spa MD... Looking for some volunteer conference reporters.

Volunteer Conference Reporters

From Jeffrey E. Epstein, MD

We would like to organize a group of “Volunteer Conference Reporters” who are going to various conferences and can report on what they have seen, heard and learned.

For example, I am going to the Harvard Conference in October (Laser & Aesthetic Skin Therapy:  What’s the Truth? 2008).  I will write about one or more of the topics covered at that conference.   After my summary is published, others can read it and learn from it.  We can also discuss it via the blog (the same way we are discussing the DeepFx Webinar Summary).   I am hoping that other readers who are going to this conference will become Volunteers and write about other topics covered at this conference.  This conference is organized by R. Rox Anderson and promises to be excellent (What is the Truth?).

We have a few other notable conferences coming up in the next few months.  In addition to the Harvard Conference in October, we have the Controversies and Conversations in Laser and Cosmetic Surgery:  An Advanced Symposium August 8-10, 2008 in British Columbia , Canada and the Cutera Clinical Forum in Chicago August 15-17, 2008.  There is also an Obagi Conference, November 13-14, 2008 (Ultimate Skin Symposium) in Los Angeles .  Finally, every April the ASLMS has its annual conference which is excellent.  I am hoping we can cover these conferences at a minimum and add others that we feel are top notch!

I have volunteered to be the Conference Reporter Coordinator and Organizer.

If you will be going to any of these conferences and would be willing to write a summary of one or more of the topics covered, please contact me so that we can coordinate our efforts.

Thanks,

Jeffrey E. Epstein, MD

email: Jeff4459@aol.com

Clinical Exchange for Medspa Doctors: A Call to Action

We are looking for Clinical Providers and MedSpa Owners to help us with our Continuing Education Efforts. 

We want to provide quality content on Medical Spa MD to act as a stimulus for meaningful clinical exchange activities.

One type of Clinical Exchange is the discussions and the conversations that occur on blogs and websites.  Medical Spa MD is currently one of the only internet based clinical exchange platforms for Cosmetic Medicine.  We want to take advantage of Medical Spa MD’s leading position and large readership base to enhance its already strong presence in the Clinical Exchange field.

Our plan is to have people do summary notes of Webinars, Articles and Clinical Meetings.  These notes will be posted on Medical Spa MD and then a discussion can take place.  The conversations and debates will instruct us all!  Hopefully by sharing experiences and opinions, we will move the whole field forward in a positive and more rapid manner.

The first such Clinical Exchange Post was the summary of The IPL Dog and Lemon Guide.  This post has stimulated a lively discussion of the various IPL Systems.  Sciton and Palomar seem to be the favorite systems.  The clinical settings for treating Hair, Pigment and Vascular are being discussed.  We are all learning a great deal and a few knowledgeable and experienced thought leaders are emerging – Charry, Med Spa Guy, pmdoc, LH and SpaDocinCR.

Our second post will be a Summary of the DeepFx Round Table Webinar (May 2008) produced by Lumenis.  The Webinar was a Round Table Discussion between four of the most experienced and well known cosmetic physicians in the country – Jeffrey Dover, MD, Robert Weiss, MD, E. Victor Ross, MD and James Heinrich, MD.  Our post will summarize the Webinar.  The original Webinar is available to everyone on Lumenis’ Website.  We are hoping that our summary will prompt people to view the actual Webinar and then participate in the resulting discussion.  In the future, we hope that Lumenis will make their Webinars available in a form that can be downloaded onto iPods so we can listen in our cars.

Finally, it is our goal to get summaries done of the various meetings that are happening in the near future.  A few upcoming clinical meetings are The Cutera Clinical Forum in Chicago (August 2008), Controversies & Conversations in Laser and Cosmetic Surgery:  An Advanced Symposium in Whistler, BC Canada (August 2008) and the Harvard Conference in Boston hosted by R. Rox Anderson, MD entitled  “Laser & Aesthetic Skin Therapy:  What’s the Truth?” (October 2008).  We are hoping that conference attendees will write notes about the lectures and the sessions and then will submit those notes to Medical Spa MD to be posted.  We will be able to read these notes, learn from them and then discuss the content.  This will bring the information to countless more clinical providers.  In the future, we hope that the organizers of these conferences will record their sessions and sell the audio so we can benefit without having to travel and take time off from work.  At this years ASLMS Meeting, the lectures were recorded and you can purchase them for a nominal fee ($11 per Tape).

This Clinical Exchange Project is a grass roots activity that is meant to take the place of formal activities that Allergan and the big Laser Companies are not doing.  We are not sure why they have left this “information gap” and do not support meaningful continuing clinical education and meaningful clinical exchange, but we hope they will join our efforts once they see the value in these types of activities.  Better clinical outcomes and fewer adverse events will benefit the whole field.  By sharing information and communicating and making more information available to more providers, we can advance the field much more rapidly then our current method of each provider trying to figure things out by trial and error.

We hope you will join our effort as a summarizer of Webinars and Conferences or as an active participant in the resulting discussions and debates.

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.

 

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:

16. Do the DeepFx first and then do the ActiveFx
17. If the DeepFx causes bleeding, wait until the bleeding stops before doing the ActiveFx (blood will absorb the energy from the ActiveFx pulses)
18. 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!
19. Dr. Ross sometimes uses thrombin spray (from Baxter) to stop the bleeding.
20. With DeepFx, you treat lower face first and move upwards so blood won’t drip down into your treatment field.  “South to North”
21. Do DeepFx before you do fillers.  The DeepFx may go deep enough to disrupt the fillers.
22. You can do fillers and then ActiveFx because ActiveFx only goes 100 - 300 microns deep.  Fillers are placed deeper than this.
23. 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?
24. 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?”
25. Use intraocular eyeshields for upper eyelids.  You might be able to use tongue blade wrapped in moist gauze for lower lids
26. 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!
27. 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.
28. Some older patients (your mother-in-law) really need traditional CO2 or a facelift.  Give them that option.
29. 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:

30. 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.
31. ActiveFx is better for pigment and more superficial textural problems
32. Stretch Marks (Stria):  Use ActiveFx:  80-100 mj, density 1-2 (use Density 2 for thicker Stria).  Do NOT use DeepFx for Stria.
33. 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.
34. Tattoos:  DeepFx might be good for resistant Tattoos

ActiveFx, DeepFx & Total Fx Settings:

35. The experts usually treat with DeepFx in the range of 15 mj – 20 mj
36. Most experts would not go higher than density 3 with DeepFx (15%).
37. 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).
38. To stay out of trouble with ActiveFx off the face, use Density 1 and 70-80 mj

Treating Specific Areas:

39. Eyes:  Use ActiveFx. Don’t do DeepFx around eyes (skin too thin?)
40. Eyes:  ActiveFx:  90-100 mj, density 2-3.  Downtime:  7-8 days of downtime (what TYPE of downtime?)
41. Eyes:  Upper Lid:  ActiveFx:  60-70 mj, density 1
42. 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!
43. 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!
44. 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?)
45. Neck:  ActiveFx:  100 mj and density 3 was too strong.  Produced prolonged erythema.
46. 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.
47. DeepFx can be done on neck, chest and hands

Pigment Changes, Post Inflammatory Hyperpigmentation, Melasma

48. Don’t treat Melasma (Dr. Ross)
49. 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.
50. 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!).
51. 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?
52. 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). 
53. 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).
54. 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. 
55. 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.
56. Experts:  “Koreans are skin type 4”. Me:  I would treat them as skin type 5!  I wonder what Dr. Eliot Battle would say?

Downtime:

57. 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).     
58. 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?
59. 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.
60. 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:

61.  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)
62. The best results for deep wrinkles, vertical lip lines and acne scars can only be obtained with deep ablation
63. 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?
64. 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:

65. Mild moisturizers avoid acne flare-ups
66. You don’t have to use aquaphor or vasoline.  Mild moisturizers are good enough (personal communication from company reps).
67. Be careful of the lanolin in the aquaphor.
68. Using Aveeno Water Gel gets you one less day of Downtime!  (From Dr. Weiss).  What is Aveeno Water Gel?  How do we get it?
69. 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?) 
70. Post Care:  Cold packs or Zimmer Cooler for 30-45 min after treatment
71. 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!).
72. Check all patients the next day, this makes you and them feel better.
73. 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? 
74. Pliaglis can be mixed with cetaphil cleanser or cetaphil moisturizer.  90% Pliaglis and 10% cleanser or moisturizer.
75. 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!
76. 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.
77. Sunscreens:  Use everyday after skin is healed up.  Wear hat and stay out of sun until healed.
78. Use a good UVA blockers:  Neutrogena, Helioplex or Loreal Products.

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

79. 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. 
80. 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!
81. 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!
82. 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).

Medical Spa Videos: From the LA Medspa Expo.

If you haven't been to one of the Medical Spa Expos, here's your chance to see what you're missing.

I went to the first six or eight. The format is conventional (pun). There is a vendor floor with sales booths including products, technologies and services. It ranges from incense burners to liposuction cannulas. There's also a classroom component where speakers also talk about their businesses. They try to keep the level of self aggrandizement and pitches to a minimum but what are you going to do when you have a franchise talking to physicians about how to run a medical spa. Duh?

The event is one giant sales pitch. Expect it and if you go take it for granted. They're not putting on this event for charity. 

I was sent a link to this eight part series of videos on YouTube: Rey visits the Spa Resort/ Medical Spa Expo at the LA Convention Center. Here's the first in the series of interviews with vendors so you can feel just like you're walking the floor.

 

If you've never been to one of these events and don't know the first thing about what you're doing it's probably not a bad idea. Don't think you're going to come out ready to launch.

 The favorite class I attended was at the Miami Medspa Expo where I was lured into a talk titled "How to make $1,000,000 per treatment room, right now!" The premise? You never let a client leave the treatment room until they've purchased $100 or more in product and scheduled another treatment. That was quite literally the point. Tackle the patient if you have to and rummage through her purse. Of course! Why didn't I think of that.

]It was ridiculous and the only thing that struck me as being more ludicrous than the speaker is that there were docs in the room hanging on every word.

If you're a doc that could get suckered into believing someone who so obviously doesn't know what they're talking about, don't go. This is like crack for you since the real benefits are derived by reading between the lines and not taking everything at face value.

There are actually some people there who know what they're talking about. Angela Caponi from Juva in NY and  Alexis from Lexi Designs are two I'd put in this category.

Just be careful and don't check your brain at the door. If what you're hearing doesn't make sense... it just doesn't make sense. Bullshit is not unheard of in sales. 

What's wrong with 90% of medspa convention presentations?

Everyone's attended useless presentations. My guess is that 90% of all the speakers I've heard have fallen into one or more of the gaffs below.

Which is sad. Hundreds of attendees have paid and given up time to learn something only to be confronted with information that's just not useful. What's up with the speakers? It's really the show organizers fault. The Medical Spa Expo for example is put on by Reed Exhibitions, a business that organizes conventions and expos as a venture. They find a group in the market they're interested in and, voila, instant show. The politics that go into picking speakers are profound. The first presentors are a resouce to the company putting on the expo. They tend to bring in their friends and keep out the competiton.

Now events are often worth going to for the 10% of speakers that are worth listening to. There's often a useful tidbit here and there among the rest as well. But speakers would be better off resisting the most common traps. Here are some tips drawn from my own experience as a speaker and, more importantly, sitting in the audience.

#1. Speakers: No, you can't pitch your lovely company

If you're presentation is really a sales pitch (i.e., your company markets goods or services to the types of people who attend this show), your chances of making it worth sitting on a folding chair for an hour are extremely slim unless you:

• Have your clients speak with you and eliminate all the tricky little references to your company.
• Present new research thats usefull ot the audience and give it away.
  
• Present tactics, jobs, mistakes, etc., anything with numbers. The more, the better.
• Run a workshop at the conference.
• Pitch your physicians or other professionals who are completely and thoroughly unrelated to marketing and sales.

I've seen some absolute horror shows with this one. Please don't regale me with your franchise pitches and tell me how easy it is to make money if only I'd place myself in your caring hands.

#2. Consultants: No tired speeches about your glory days.

Show attendees sit in multiple presentations on the same topic. At medical spa expos it's the marketing baby. Show organizers know this (which is way they often swap postal lists with each other for promotions). They'll pad the schedule with medspa consultants who did lots of stuff in the past but don't own or run a clinic now. If the resume doesn't currently include something other than consulting, it should. This is a lucritive field. Consultants don't make the money or have the info, owners do.

#3. Experts: Avoid overviews

Great -- you've noticed there's a presentation about a topic that promises to pull back the curtin and let you into the good stuff. What you get is not an expert with hands-on experience but a novice with strong opinions about the topic. In either case, the expert and the psuedo-expert, the overview speaches are useless in the daily operations and growth of a business. That's what blogs are for.

#4. Don't ignore format

Most shows tend to focus primarily on one particular type of presentation such as group panels, intensive workshops, case studies, roundtables, etc. Stick with what you're supposed to be there for. Here's a link to Guy Kawasaki's 10/20/30 powerpoint rule. Required reading for anyone presenting anything anywhere.

#5. Copywrite or sell your presentation

The last time I saw this I was at a Thermage presentation by Virginia Stevens M.D.. Doctor Stevens was presenting information for performing Thermage treatments on the body for a packed room of docs. Everyone sat speachless while Dr. Stevens literally flew through her presentation without pause, questions or clairity. The reason became apparent at the end when Dr. Stevens last slide showed the ordering information available for the presentation on her website for a mere $295. The Thermage sales people were horrified and apologized to everyone (out of hearing of Dr. Stevens).

If you're going to accept the invitation to present, then present, don't sell. You just piss people off.

#6. Let go of your ego

Yeah, you're the expert. But the audience is smart too. Prancing around as the man with the plan will get you used and discarded. I sat on a panel with one doctor (remaining nameless here) who bluntly told the audience that he had the ego of any three men. (He was completely believable too.) But that was the end. The audience totally tuned him out an he was forced to elbow his way in to answers. Everybody has an ego. We just don't want to hear about yours.

technorati tags: medspa, expo, medicalspa, consultants, training

Connotea - Reference For Clinicians & Researchers

Connotea is a free website to help researchers and clinicians manage and share information. A memetracker for life science blogs. Find the most talked about news and the latest reviews of scientific papers. Postgenomic also supports structured blogging and microformats. An extremely good effort and a well-designed site. An excellent resource for its target audience.

From their site: a place to keep links to the articles you read and the websites you use, and a place to find them again. It is also a place where you can discover new articles and websites through sharing your links with other users. By saving your links and references to Connotea they are instantly on the web, which means that they are available to you from any computer and that you can point your friends and colleagues to them. In Connotea, every user's links are visible both to visitors and to every other user, and different users' libraries are linked together through the use of common tags or common bookmarks.

Thanks to Dermgal for referencing this site.